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Are relaxation techniques effective in relieving depression?
Date of publication of systematic review: October 2008
Design
Systematic review of 5 randomized or quasi-randomized controlled trials.
Participants
243 patients who had a primary diagnosis of depression (age range: 10 to 55 years, 36.7% male)
Intervention
Intervention 1: Relaxation interventions including the following elements:
1) Progressive muscle relaxation;
2) Progressive muscle relaxation plus psycho-education including mental imagery and breathing;
3) Autogenic training;
4) Jacobson training or its derivative.
Each session last for 15 to 60 minutes per session, with a frequency of 7 to 40 sessions in a period of 5 to 8 weeks.
1) Progressive muscle relaxation;
2) Progressive muscle relaxation plus psycho-education including mental imagery and breathing;
3) Autogenic training;
4) Jacobson training or its derivative.
Each session last for 15 to 60 minutes per session, with a frequency of 7 to 40 sessions in a period of 5 to 8 weeks.
Comparator
Comparison: Relaxation intervention versus waiting list or no treatment.
Major Outcomes
Outcome 1: Post intervention self-rated depression scores;
Outcome 2: Post intervention clinician rated depression scores;
Outcome 3: Number of participants who perceived themselves as non-responsive, or experiencing a remission of depressive symptoms.
Outcome 2: Post intervention clinician rated depression scores;
Outcome 3: Number of participants who perceived themselves as non-responsive, or experiencing a remission of depressive symptoms.
Settings
The trials were conducted in outpatient and community settings.
Comparison Relaxation intervention versus waiting-list or no treatment
Main Results
Compared to waiting-list or no treatment, relaxation intervention showed significant reduction in post intervention depression score, both self-rated (Pooled standardized mean difference (Pooled SMD): -0.59, 95% CI: -0.94 to -0.24) and clinician rated (Pooled SMD: -0.74, 95% CI: -1.34 to -0.15). It also reduced the number of participants who perceived themselves as non-responsive to intervention or experiencing a remission of depressive symptoms.
| Outcomes | No. of studies (Total no. of participants) | Standardized mean / No. of participants | Heterogeneity test (I2) | Pooled SMD (95% CI) | Overall quality of evidence* | |
| Intervention | Comparator | |||||
| 1 | 5(136) | 1.51/69 | 2.12/67 | 49% | -0.59 (-0.94 to -0.24) | High |
| 2 | 2(52) | 0.82/25 | 1.59/27 | 83% | -0.74 (-1.34 to -0.15) | High |
| Outcomes | No. of studies ( Total no. of participants) | No. of events/ No. of participants | Heterogeneity test (I2) | Pooled RRR (95% CI) | Overall quality of evidence* | |
| Intervention | Comparator | |||||
| 3 | 2(52) | 6/25 | 25/27 | 0.0% | 0.72 (0.46 to 0.86) | High |
Comparison Relaxation intervention versus waiting-list or no treatment
Main Results
Compared to waiting-list or no treatment, relaxation intervention showed significant reduction in post intervention depression score, both self-rated (Pooled standardized mean difference (Pooled SMD): -0.59, 95% CI: -0.94 to -0.24) and clinician rated (Pooled SMD: -0.74, 95% CI: -1.34 to -0.15). It also reduced the number of participants who perceived themselves as non-responsive to intervention or experiencing a remission of depressive symptoms.
Comparison: Relaxation techniques versus waiting-list or no treatment for depression
| Outcomes | 1 | 2 | |
|---|---|---|---|
| No. of studies (Total no. of participants) | 5(136) | 2(52) | |
| Standardized mean / No. of participants | Intervention | 1.51/69 | 0.82/25 |
| Comparator | 2.12/67 | 1.59/27 | |
| Pooled SMD (95% CI) | -0.59 (-0.94 to -0.24) | -0.74 (-1.34 to -0.15) | |
| Overall quality of evidence* | High | High | |
| Outcomes | 3 | |
|---|---|---|
| No. of studies ( Total no. of participants) | 2(52) | |
| No. of events/ No. of participants | Intervention | 6/25 |
| Comparator | 25/27 | |
| Pooled RRR (95% CI) | 0.72 (0.46 to 0.86) | |
| Overall quality of evidence* | High | |
Key: SMD = standardized mean difference; RRR: relative risk reduction; CI = confidence interval.
Conclusion
Benefits
Compared to no treatment or waiting list control, relaxation intervention was effective in relieving post intervention depression symptoms, both self-rated and clinician rated. However, significant heterogeneity existed amongst results from these trials. It also reduced the number of participants who perceived themselves as non-responsive or experiencing a remission of depressive symptoms.
For all outcomes, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported in the included trial.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/18843744The synopsis is based on the following article:
Jorm AF, Morgan AJ, Hetrick SE. Relaxation for depression. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD007142.
Jorm AF, Morgan AJ, Hetrick SE. Relaxation for depression. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD007142.
* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.
Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.
Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.
