Relaxation techniques are more effective at reducing depressive symptoms than no treatment
Photo credit: John Isaac
Why are relaxation techniques in depression patients important?
Treatment for depressive disorders is often inconsistent with best practice. While the standard treatments include antidepressants, cognitive-behavioural therapy (CBT) or interpersonal psychotherapy (IPT) studies have suggested that many people with depressive disorders either get no professional help or wait a long time before seeking help and up to half of people receive no treatment. One reason may be that patients have negative attitudes towards medication, including antidepressants. for this is that patients do not like antidepressants. Another reason is the limited availability of more acceptable therapies, such as CBT and IPT, which require trained therapists. Relaxation offers a more simple treatment which requires less training and has been shown to be viewed more positively by most people. In addition, relaxation is a low intervention and therefore may have wider accessibility than other treatments for depressive disorder.
Do relaxation techniques work in the treatment of depression patients?
Relaxation therapy works better than no treatment for reducing depressive symptoms but was less effective than psychological treatment, such as (CBT). The evidence comparing relaxation to medication was inconsistent but can be added to medication to increase the benefits. The authors concluded that relaxation techniques are an option for first-line treatment for depressive symptoms, especially when other treatments are not available.
Do relaxation techniques work in the disadvantaged depression patients?
There is no reason to indicate that relaxation therapy would be less effective among disadvantaged patients. Relaxation therapy is a low cost intervention that doesn’t require access to a therapist with specialized training in psychological treatment. The use of relaxation therapy could help increase access to treatment for depressive disorders, especially for patients who may be unable to afford other treatments or for those living in areas with limited access to therapists.
Intervention delivery
- Relaxation techniques included: progressive muscle relaxation, autogenic training, relaxation imagery, or combinations of muscle relaxation plus pain-reduction procedure, yoga, or psychoeducation including mental imagery and breathing
Relaxation was compared to medication (e.g. antidepressants), psychological therapy (e.g. CBT, IPT), or lifestyle or complementary therapies (e.g. massage, exercise)
The number of sessions of relaxation ranged from 5-40.
Relaxation was self-administered or delivered by a trained person
Participants were followed for 1 month to 6 months
Population and setting
- Included studies involved mostly adults but some studies included children and adolescents (aged 12-19)
Depression diagnoses varied. Three trials used a diagnostic system, such as Feighner Criteria, Research Diagnostic Criteria, DSM-III or ICD 10, and some used a diagnosis and a depression scale cut off
All patients had depression as the primary diagnosis rather than as a secondary diagnosis to another medical condition
Patients were treated in various settings including within the hospital, in educational settings (e.g. college), or community and home settings.
Studies were conducted mostly in the US (9 studies) but other countries included: Germany (1 study), Canada (1 study), Australia (3 studies), and the UK (1 study)
Summary of Findings (SOF) Table
Patient or population: Adults of any age and gender
Settings: Australia, Canada, Germany, UK, US
Intervention: All types of relaxation techniques
Comparison | Anticipated absolute effects | № of participants | Quality of the evidence |
Risk with comparison | |||
Outcome: Depression scores, self-rated , post intervention | |||
Relaxation compared to no treatment, wait list, or minimal treatment (contact with a treating person without a therapeutic element) | 0.59 lower (from 0.24 lower to 0.94 lower) | 136 | moderate |
Relaxation compared to medication (antidepressants) | 0.59 lower (0.89 lower to 2.07 higher) | 115 | low |
Relaxation + medication versus medication alone | 0.90 lower (from 0.24 to 1.56 lower) | 40 (2 RCTs) | low |
Relaxation versus psychological treatment (e.g. CBT, IPT) | 0.38 higher (from 0.14 to 0.62 higher) | 286 | moderate |
Relevance of the review for disadvantaged communities
Relaxation therapy is a low cost intervention that doesn’t require access to a therapist with specialized training in psychological treatment
Findings | Interpretation |
Equity – Which of the PROGRESS groups examined | |
All included studies were conducted in high income countries | Relaxation is likely to have similar effects in other settings |
Some of the studies included children and adolescents but the studies were too different to combine and the results were mixed so the effectiveness of relaxation for depressed adolescents and children is unclear. | Relaxation may help reduce depressive symptoms among children and adolescents and could be used as a first-line treatment since they may be more likely to respond since they are at an earlier stage of illness. |
The review did not report whether there were differences in the effectiveness of relaxation therapy for men or women, those living in urban versus rural areas, or other personal characteristics. | Future studies should assess whether there are differences in the effectiveness of relaxation among population subgroups. |
Equity Applicability | |
The included studies did not include diverse patients, such as those for whom depressive symptoms are secondary to another medical illness. | We don’t know if relaxation works for those with another health condition or in children or the elderly but as a simple and low cost intervention it could be beneficial as an initial treatment. |
The studies used different methods for selecting eligible patients which makes it hard to compare the benefits of relaxation based on severity of depression symptoms. | Some included studies used a depression score cutoff as part of the eligibility criteria and these found that relaxation reduced depression symptoms among those considered to have a typical case of depression. |
Cost-equity | |
Relaxation is a simple intervention which can be implemented at minimal cost compared to psychological therapies requiring highly skilled therapists. | Since the methods and steps for relaxation can be outlined in a treatment manual for health care providers, only brief training is required. This increases accessibility over psychological treatment which requires access to a therapist. Relaxation can be used as an initial treatment and medication and psychological therapy could be considered second-line treatments for those patients who do not find a benefit from relaxation. |
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