Systematic Review of Progressive Muscle Relaxation for Stress, Anxiety, & Depression (2024)

Progressive Muscle Relaxation (PMR) is a technique that involves systematically tensing and relaxing muscle groups to reduce tension and promote relaxation.

By learning to recognize and release physical tension, PMR can help alleviate stress, anxiety, and depressive symptoms.

This mind-body approach is a safe, accessible, and effective tool for enhancing mental well-being in adults.

Muhammad Khir, S., Wan Mohd Yunus, W. M. A., Mahmud, N., Wang, R., Panatik, S. A., Mohd Sukor, M. S., & Nordin, N. A. (2024). Efficacy of Progressive Muscle Relaxation in Adults for Stress, Anxiety, and Depression: A Systematic Review.Psychology Research and Behavior Management,17, 345–365. https://doi.org/10.2147/PRBM.S437277

Rationale

Mental health issues like stress, anxiety and depression are prevalent worldwide, highlighting the urgent need for effective, accessible interventions (World Health Organization, 2022).

Previous research suggests PMR is a promising technique for reducing these problems (Melo-Dias et al., 2019; Tian et al., 2020; Torales et al., 2020).

However, the current evidence on PMR’s efficacy in the general adult population is fragmented.

This systematic review aimed to comprehensively compile research on PMR’s effectiveness for stress, anxiety and depression in adults to address this gap.

The findings can guide clinical practice and future studies on relaxation interventions.

Method

This systematic review followed PRISMA guidelines. Five electronic databases (Scopus, Web of Science, PubMed, PsycINFO, Cochrane Central Register of Controlled Trials) were searched for relevant studies from the earliest available evidence to March 28, 2023.

The reviewers used various keywords related to PMR, intervention/prevention, and mental health outcomes.

Inclusion criteria were: 1) Examined effects of PMR on stress, anxiety and/or depression in adults, either standalone or combined with other treatments, 2) Used rigorous experimental designs (RCT or quasi-experimental), 3) Published in English.

Exclusion criteria were: meta-analyses, systematic reviews, theses, non-experimental studies, clinical samples, non-English articles.

Two reviewers independently screened and selected studies, assessed methodological quality using Joanna Briggs Institute critical appraisal tools, and extracted data.

Disagreements were resolved through discussion or consulting a senior researcher.

Effect sizes (Cohen’s d) were reported where available.

Results

The initial search yielded 3,205 records, of which 46 met inclusion criteria after duplicate removal and screening. These studies represented 16 countries and over 3,402 total participants.

PMR-only studies (n=31) found:

• Significant reductions in stress (14 studies), anxiety (14 studies) and depression (7 studies) post-intervention
• Effect sizes ranged from small to large for stress (d=0.29-4.57), anxiety (d=0.25-2.54) and depression (d=0.58-1.95)
• A few studies found no significant changes in anxiety (3 studies) or reductions in control groups (2 studies)

PMR combined with other treatments (n=15) found:

• Significant decreases in stress (10 studies), anxiety (9 studies) and depression (4 studies) post-intervention
• Effect sizes spanned from small to large for stress (d=0.40-2.24), anxiety (d=0.15-2.10) and depression (d=0.27-0.74)
• Two studies indicated combining PMR with nature sounds or music was more effective than PMR alone

Insights

This comprehensive review provides strong evidence that PMR is beneficial for reducing stress, anxiety, and depressive symptoms in adult populations, whether used alone or paired with other relaxation techniques, psychoeducation, or psychotherapy.

The positive effects were demonstrated across diverse samples, countries, and research designs, underscoring PMR’s potential as a widely applicable tool for mental wellbeing.

Interestingly, treatment duration, frequency and the exact PMR protocol used did not substantially impact outcomes, suggesting even brief or adapted PMR interventions can yield mental health benefits.

This has practical implications, as shorter, flexible PMR practices may be easier to implement and maintain.

The finding that PMR combined with music therapy or nature sounds outperformed PMR alone in two studies points to the promise of multimodal relaxation interventions.

Engaging multiple senses and relaxation pathways simultaneously may have additive effects. Future research should further explore the relative efficacy and optimal “dosage” of PMR in combination with other established stress-reduction methods.

While results were generally positive, a handful of studies found no significant improvements or changes in control groups.

Delving into the participant characteristics, methodologies and contexts of these outlying studies could yield insights about boundary conditions or individual differences that influence PMR’s effectiveness.

Overall, as a low-cost, accessible, non-pharmacological technique, PMR appears to have considerable potential to mitigate the global burden of common mental health difficulties in adults.

Larger-scale studies directly comparing PMR to other front-line treatments, probing effects on clinical populations, and examining long-term outcomes can further strengthen the evidence base for this well-tolerated mind-body intervention.

Strengths

The study had many methodological strengths including:

• Adherence to PRISMA guidelines for transparent, standardized reporting
• Comprehensive search of five major databases using well-defined keywords
• Inclusion of the two most rigorous experimental designs (RCTs and quasi-experimental studies)
• Detailed screening procedures with multiple independent reviewers
• Evaluation of study quality using validated JBI critical appraisal tools
• Examination of both standalone PMR and PMR combined with other approaches
• Inclusion of studies from 16 diverse countries for broad global representation
• Reporting of effect sizes for more precise evaluation of PMR’s impact

Limitations

Despite its many strengths, this review had some limitations:

• Only English-language publications from English databases were included, potentially excluding relevant studies and limiting generalizability to non-English speaking populations.
• The included studies had highly variable sample sizes and participant demographics, which could affect comparability and generalizability of findings.
• There was considerable heterogeneity in the specific PMR protocols, treatment durations, outcome measures and control group types used across studies.
• Relatively few studies directly compared PMR alone vs. PMR plus other treatments, limiting conclusions about the comparative effectiveness of these approaches.
• Long-term follow-up assessments were rare, so the durability of PMR’s positive effects is unclear.

Clinical Implications

The robust evidence for PMR’s efficacy in reducing stress, anxiety and depression has several important implications:

• Healthcare providers should consider incorporating PMR as a firstline non-pharmacological treatment option for adults experiencing these common mental health concerns. PMR is cost-effective, low-risk and appears beneficial for diverse populations.
• PMR may be particularly helpful for individuals who prefer non-drug treatments, have limited access to mental health specialists, or are seeking portable coping techniques they can practice independently. The flexibility of PMR delivery (brief vs. extended, daily vs. less frequent, audio-guided vs. live, etc.) allows it to be adapted for different settings and needs.
• Combining PMR with psychoeducation, music, sounds of nature, or other relaxation practices may enhance its stress-reduction impact and should be explored further. Integrating PMR with gold-standard therapies like CBT is another promising direction.
• Policymakers and public health experts can promote PMR as an evidence-based mental wellbeing strategy to help counteract the societal costs and disability burden of untreated stress, anxiety and mood disorders. Funding high-quality research on PMR may yield even more insights to optimize its application.

Future studies should prioritize randomized designs, larger samples, standardized PMR protocols, long-term follow-up, and head-to-head comparisons of PMR vs. other treatments.

Overall, this comprehensive review positions PMR as a compelling, evidence-based tool to help combat the global prevalence of debilitating stress and distress.

References

Primary reference

Muhammad Khir, S., Wan Mohd Yunus, W. M. A., Mahmud, N., Wang, R., Panatik, S. A., Mohd Sukor, M. S., & Nordin, N. A. (2024). Efficacy of Progressive Muscle Relaxation in Adults for Stress, Anxiety, and Depression: A Systematic Review.Psychology Research and Behavior Management,17, 345–365. https://doi.org/10.2147/PRBM.S437277

Other references

Melo-Dias, C., Lopes, R. C., Cardoso, D. F. B., Bobrowicz-Campos, E., & Apóstolo, J. L. A. (2019). Schizophrenia and progressive muscle relaxation – A systematic review of effectiveness. Heliyon, 5(4), e01484. https://doi.org/10.1016/j.heliyon.2019.e01484

Tian, X., Tang, R.-Y., L-L X., Liu, X.-L., Qin, J.-M., Zhang, S.-H., & Yu, H.-Y. (2020). Progressive muscle relaxation is effective in preventing and alleviating of chemotherapy-induced nausea and vomiting among cancer patients: a systematic review of six randomized controlled trials. Supportive Care in Cancer, 28, 4051–4058. https://doi.org/10.1007/s00520-020-05481-2

Torales, J., O’Higgins, M., Barrios, I., González, I., & Almirón, M. (2020). An overview of Jacobson’s progressive muscle relaxation in managing anxiety. Revista Argentina de Clínica Psicológica, 29(3), 17.

World Health Organization. (2022, June 8). Mental health: Strengthening our response. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

Keep Learning

Here are some thought-provoking questions to stimulate class discussion on this paper:

1. Based on this review, what do you see as the most compelling reasons to recommend PMR to adults struggling with stress, anxiety or depression? What additional information would you want to guide your clinical decision-making?
2. The positive effects of PMR were demonstrated across many countries and cultures. Why do you think this mind-body technique “translates” so well globally? Are there any cultural factors that might influence its acceptability or efficacy?
3. This review found combining PMR with music therapy or nature sounds to be particularly beneficial. What are some other sensory experiences or treatment modalities you think could synergize well with PMR? What is the proposed mechanism behind these combinations’ effectiveness?
4. Despite PMR’s established efficacy, it is not commonly “prescribed” as a frontline mental health treatment in most healthcare systems. What are some possible barriers to wider adoption of PMR in clinical practice and public health promotion? How could these obstacles be overcome?
5. If you were designing a study to build on this review’s findings, what would be your priority research question(s)? What type of study design, population, and outcomes would you focus on to best advance our understanding of PMR’s therapeutic potential?