Relaxation Techniques

Our assessments of evidence for each medical benefit fall into one of these categories:

• Strong evidence: consistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analysesa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results
• Good evidence: significant effects in one large or several mid-sized and well-designed clinical studies ( randomized controlled trialsa study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects with an appropriate placebo or other strong comparison control or observational studies that control for confounds)
• Modest evidence: significant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies), or several small studies aggregated into a meta-analysis
• Preliminary evidence: significant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect
• Weak evidence: one or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects
• Insufficient evidence: preclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example)

• No changes in proliferation during radiotherapy among people with breast cancer treated with relaxation and visualization therapy compared to radiotherapy alone in a small RCT¹Nunes DF, Rodriguez AL et al. Relaxation and guided imagery program in patients with breast cancer undergoing radiotherapy is not associated with neuroimmunomodulatory effects. Journal of Psychosomatic Research. 2007 Dec;63(6):647-55.
• No evidence of an effect on clinical or pathological response to 6 cycles of chemotherapy 3 weeks after completion among women with newly diagnosed large or locally advanced breast cancer treated with standard care plus relaxation training and imagery compared to standard care alone in a small RCT²Walker LG, Walker MB et al. Psychological, clinical and pathological effects of relaxation training and guided imagery during primary chemotherapy. British Journal of Cancer. 1999 Apr;80(1-2):262-8.

Without regard to treatment stage: modest evidence of lower anxiety among people with cancer participating in relaxation training, often with other mind-body therapies

• Lower ratings of anxiety among women newly treated for stage 0–3 breast cancer participating in a 10-week group cognitive behavior stress management intervention that included anxiety reduction (relaxation training), cognitive restructuring, and coping skills training compared to controls in a mid-sized RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁶Antoni MH, Wimberly SR et al. Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer. American Journal of Psychiatry. 2006 Oct;163(10):1791-7.
• Lower anxiety among people with cancer who have anxiety and depressive symptoms treated with progressive muscle relaxation at an initial session with a behavioral psychologist and then asked to listen at home to an audiotape of the session 3 times a day compared to baseline, but a slightly slower reduction in symptoms compared to alprazolam in a mid-sized randomized trial⁷Holland JC, Morrow GR et al. A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. Journal of Clinical Oncology. 1991 Jun;9(6):1004-11.
• Lower anxiety scores among people with cancer participating in 8 weeks of progressive muscle relaxation training combined with five elements music therapy of Chinese medicine compared to controls in a small RCT⁸Liao J, Wu Y et al. Progressive muscle relaxation combined with Chinese medicine five-element music on depression for cancer patients: a randomized controlled trial. Chinese Journal of Integrative Medicine. 2018 May;24(5):343-347.
• A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently toward less anxiety among women with stage 1 breast cancer participating in relaxation, guided imagery, and biofeedback training compared to no intervention in a small RCT⁹Gruber BL, Hersh SP et al. Immunological responses of breast cancer patients to behavioral interventions. Biofeedback and Self-Regulation. 1993 Mar;18(1):1-22.

During chemotherapy: preliminary evidence of less anxiety during chemotherapy among people treated with relaxation, sometimes also with guided imagery

• Less anxiety during first-time chemotherapy among people with breast cancer treated with progressive muscle relaxation training and guided imagery compared to controls in a small RCT¹⁰Yoo HJ, Ahn SH, Kim SB, Kim WK, Han OS. Efficacy of progressive muscle relaxation training and guided imagery in reducing chemotherapy side effects in patients with breast cancer and in improving their quality of life. Supportive Care in Cancer. 2005 Oct;13(10):826-33.
• Less anxiety during chemotherapy among people treated with progressive muscle relaxation compared to baseline in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design¹¹Lee EJ, Bhattacharya J, Sohn C, Verres R. Monochord sounds and progressive muscle relaxation reduce anxiety and improve relaxation during chemotherapy: a pilot EEG study. Complementary Therapies in Medicine. 2012 Dec;20(6):409-16.

During radiotherapy: modest evidence of less anxiety during or soon after radiotherapy among people treated with relaxation, sometimes also with guided imagery

• Somewhat less anxiety during palliativerelieving pain or suffering without dealing with the cause of the condition; palliative care is specialized medical care that focuses on providing patients relief from pain and other symptoms of a serious illness radiotherapy among people with stage 3 or 4 lung cancer receiving education on symptom management and coaching in the use of progressive muscle relaxation 1 week before and 3 weeks after starting radiotherapy compared to usual care in a mid-sized RCT¹²Chan CW, Richardson A, Richardson J. Managing symptoms in patients with advanced lung cancer during radiotherapy: results of a psychoeducational randomized controlled trial. Journal of Pain and Symptom Management. 2011 Feb;41(2):347-57.
• Lower anxiety scores after lumpectomy among women with early stage breast cancer having received adjuvanttreatment applied after initial treatment for cancer, especially to suppress secondary tumor formation radiotherapy treated with a home visit and 2 months of weekly autogenic (relaxation) training compared to a home visit alone in a small RCT¹³Hidderley M, Holt M. A pilot randomized trial assessing the effects of autogenic training in early stage cancer patients in relation to psychological status and immune system responses. European Journal of Oncology Nursing. 2004 Mar;8(1):61-5.
• Less anxiety during radiotherapy among people with breast cancer treated with relaxation and visualization therapy compared to radiotherapy alone in a small RCT¹⁴Nunes DF, Rodriguez AL et al. Relaxation and guided imagery program in patients with breast cancer undergoing radiotherapy is not associated with neuroimmunomodulatory effects. Journal of Psychosomatic Research. 2007 Dec;63(6):647-55.
• Less anxiety during brachytherapy within hospitalization among people with gynecologic or breast cancer treated with relaxation and guided imagery compared to controls in a small RCT¹⁵León-Pizarro C, Gich I et al. A randomized trial of the effect of training in relaxation and guided imagery techniques in improving psychological and quality-of-life indices for gynecologic and breast brachytherapy patients. Psycho-oncology. 2007 Nov;16(11):971-9.

With surgery: modest evidence of less anxiety soon after surgery among people with cancer treated with relaxation, sometimes with other complementary therapies

• Less anxiety at the time of initial surgery among women with breast cancer using a self-care toolkit of audio-files of guided mind-body techniques (breathing, progressive muscle relaxation, meditation, guided imagery, and self-hypnosis) and acupressure antinausea wristbands compared to usual care in a mid-sized RCT¹⁶Stoerkel E, Bellanti D et al. Effectiveness of a self-care toolkit for surgical breast cancer patients in a military treatment facility. Journal of Alternative and Complementary Medicine. 2018 Sep/Oct;24(9-10):916-925.
• Less anxiety after radical mastectomy among female breast cancer patients treated with routine nursing care plus music therapy and progressive muscle relaxation training compared to nursing care alone in a mid-sized RCT¹⁷Zhou K, Li X et al. A clinical randomized controlled trial of music therapy and progressive muscle relaxation training in female breast cancer patients after radical mastectomy: results on depression, anxiety and length of hospital stay. European Journal of Oncology Nursing. 2015 Feb;19(1):54-9.
• Less anxiety after stoma surgery among people with colorectal cancer treated with progressive muscle relaxation training through 2 teaching sessions and practice at home for 10 weeks compared to routine care in a small RCT¹⁸Cheung YL, Molassiotis A, Chang AM. The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. Psycho-oncology. 2003 Apr-May;12(3):254-66.
• Less anxiety immediately and 5 and 10 weeks after stoma surgery among people treated with audiotaped instructions on progressive muscle relaxation training compared to controls in a small RCT¹⁹Cheung YL, Molassiotis A, Chang AM. A pilot study on the effect of progressive muscle relaxation training of patients after stoma surgery. European Journal of Cancer Care (Engl). 2001 Jun;10(2):107-14.

Among children with cancer and their parents:

Weak evidence of less anxiety among hospitalized children with cancer treated with relaxation and guided imagery

Preliminary evidence of less anxiety among parents of hospitalized children with cancer treated with relaxation and guided imagery

• A weak trend toward less anxiety (low to moderate effect size) among children hospitalized with a malignancy with progressive muscle relaxation and guided imagery compared to no intervention in a small RCT²⁰Tsitsi T, Charalambous A, Papastavrou E, Raftopoulos V. Effectiveness of a relaxation intervention (progressive muscle relaxation and guided imagery techniques) to reduce anxiety and improve mood of parents of hospitalized children with malignancies: a randomized controlled trial in Republic of Cyprus and Greece. European Journal of Oncology Nursing. 2017 Feb;26:9-18.
• Less anxiety among parents of children hospitalized with a malignancy with progressive muscle relaxation and guided imagery compared to no intervention in a small RCT²¹Tsitsi T, Charalambous A, Papastavrou E, Raftopoulos V. Effectiveness of a relaxation intervention (progressive muscle relaxation and guided imagery techniques) to reduce anxiety and improve mood of parents of hospitalized children with malignancies: a randomized controlled trial in Republic of Cyprus and Greece. European Journal of Oncology Nursing. 2017 Feb;26:9-18.

During hospice care: preliminary evidence of less anxiety among people with cancer in hospice with interactive guided imagery and progressive muscle relaxation

• Less anxiety among people with terminal cancer in hospice treated with interactive guided imagery and progressive muscle relaxation compared to baseline, and an apparently larger benefit than with usual care in a mid-sized randomized trial²²De Paolis G, Naccarato A et al. The effectiveness of progressive muscle relaxation and interactive guided imagery as a pain-reducing intervention in advanced cancer patients: a multicentre randomised controlled non-pharmacological trial. Complementary Therapies in Clinical Practice. 2019 Feb;34:280-287.

• Less breathlessness during palliativerelieving pain or suffering without dealing with the cause of the condition; palliative care is specialized medical care that focuses on providing patients relief from pain and other symptoms of a serious illness radiotherapy among people with stage 3 or 4 lung cancer receiving education on symptom management and coaching in the use of progressive muscle relaxation 1 week before and 3 weeks after starting radiotherapy compared to usual care in a mid-sized RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects²³Chan CW, Richardson A, Richardson J. Managing symptoms in patients with advanced lung cancer during radiotherapy: results of a psychoeducational randomized controlled trial. Journal of Pain and Symptom Management. 2011 Feb;41(2):347-57.

Without regard to treatment phase: modest evidence of less depression among people with cancer treated with relaxation training, sometimes with other mind-body therapies

• Less depressive mood (affect) among women with stage 0-3 breast cancer participating in a 5-week relaxation training intervention compared to health education in a mid-sized RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects²⁴Gudenkauf LM, Antoni MH et al. Brief cognitive-behavioral and relaxation training interventions for breast cancer: a randomized controlled trial. Journal of Consulting and Clinical Psychology. 2015 Aug;83(4):677-688.
• Lower depression among people with cancer treated with progressive muscle relaxation at an initial session with a behavioral psychologist and then asked to listen at home to an audiotape of the session 3 times a day compared to baseline, but not as much reduction in symptoms compared to alprazolam in a mid-sized randomized trial²⁵Holland JC, Morrow GR et al. A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. Journal of Clinical Oncology. 1991 Jun;9(6):1004-11.
• Less mood disturbance among people treated with cancer with cancer-related education, progressive muscle relaxation and emotional support compared to controls in a small RCT²⁶Zhang H, Zhou Y, Cui Y, Yang J. The effectiveness of a rehabilitation programme for Chinese cancer survivors: a pilot study. International Journal of Nursing Practice. 2016 Feb;22(1):79-88.
• Less mood disturbance among people with nasopharyngeal carcinoma treated with progressive muscle relaxation and guided imagery training compared to baseline in a mid-sized uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design²⁷Yang XL, Li HH, Hong MH, Kao HS. The effects of Chinese calligraphy handwriting and relaxation training in Chinese nasopharyngeal carcinoma patients: a randomized controlled trial. International Journal of Nursing Studies. 2010 May;47(5):550-9.

During chemotherapy: modest evidence of less depression during chemotherapy among people treated with relaxation, sometimes also with guided imagery

• Less depression during chemotherapy among people treated with guided imagery and progressive muscle relaxation compared to no intervention in a mid-sized RCT²⁸Charalambous A, Giannakopoulou M et al. Guided imagery and progressive muscle relaxation as a cluster of symptoms management intervention in patients receiving chemotherapy: a randomized control trial. PLoS One. 2016 Jun 24;11(6):e0156911.
• Less depression during initial chemotherapy among people with breast cancer treated with progressive muscle relaxation training and guided imagery compared to controls in a small RCT²⁹Yoo HJ, Ahn SH, Kim SB, Kim WK, Han OS. Efficacy of progressive muscle relaxation training and guided imagery in reducing chemotherapy side effects in patients with breast cancer and in improving their quality of life. Supportive Care in Cancer. 2005 Oct;13(10):826-33.
• Better mood scores during 6 cycles of chemotherapy among women with newly diagnosed large or locally advanced breast cancer treated with standard care plus relaxation training and imagery compared to standard care in a small RCT³⁰Walker LG, Walker MB et al. Psychological, clinical and pathological effects of relaxation training and guided imagery during primary chemotherapy. British Journal of Cancer. 1999 Apr;80(1-2):262-8.
• A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently toward less negative emotions (affect) during chemotherapy among people with cancer treated with relaxation training with guided relaxation imagery compared to standard care in a small RCT³¹Burish TG, Snyder SL, Jenkins RA. Preparing patients for cancer chemotherapy: effect of coping preparation and relaxation interventions. Journal of Consulting and Clinical Psychology. 1991 Aug;59(4):518-25.

During radiotherapy: preliminary evidence of less depression during radiotherapy among people with cancer treated with relaxation, sometimes also with another mind-body therapy

• Lower depression scores after lumpectomy among women with early stage breast cancer having received adjuvanttreatment applied after initial treatment for cancer, especially to suppress secondary tumor formation radiotherapy treated with a home visit and 2 months of weekly autogenic (relaxation) training compared to a home visit alone in a small RCT³²Hidderley M, Holt M. A pilot randomized trial assessing the effects of autogenic training in early stage cancer patients in relation to psychological status and immune system responses. European Journal of Oncology Nursing. 2004 Mar;8(1):61-5.
• Lower depression during radiotherapy among people with breast cancer treated with relaxation and visualization therapy compared to radiotherapy alone in a small RCT³³Nunes DF, Rodriguez AL et al. Relaxation and guided imagery program in patients with breast cancer undergoing radiotherapy is not associated with neuroimmunomodulatory effects. Journal of Psychosomatic Research. 2007 Dec;63(6):647-55.
• Less depression during brachytherapy within hospitalization among people with gynecologic or breast cancer treated with relaxation and guided imagery compared to controls in a small RCT³⁴León-Pizarro C,  Gich I et al. A randomized trial of the effect of training in relaxation and guided imagery techniques in improving psychological and quality-of-life indices for gynecologic and breast brachytherapy patients. Psycho-oncology. 2007 Nov;16(11):971-9.

With surgery: preliminary evidence of less depression after radical mastectomy among women with breast cancer treated with relaxation and music therapy

• Less depression after radical mastectomy among women with breast cancer treated with routine nursing care plus music therapy and progressive muscle relaxation training compared to nursing care alone in a mid-sized RCT³⁵Zhou K, Li X et al. A clinical randomized controlled trial of music therapy and progressive muscle relaxation training in female breast cancer patients after radical mastectomy: results on depression, anxiety and length of hospital stay. European Journal of Oncology Nursing. 2015 Feb;19(1):54-9.

Among parents of hospitalized children with cancer: preliminary evidence of less sadness among parents of hospitalized children treated with progressive muscle relaxation and guided imagery

• Less sadness among parents of children hospitalized with a malignancy treated with progressive muscle relaxation and guided imagery compared to no intervention in a small RCT³⁶Tsitsi T, Charalambous A, Papastavrou E, Raftopoulos V. Effectiveness of a relaxation intervention (progressive muscle relaxation and guided imagery techniques) to reduce anxiety and improve mood of parents of hospitalized children with malignancies: a randomized controlled trial in Republic of Cyprus and Greece. European Journal of Oncology Nursing. 2017 Feb;26:9-18.

During hospice care: preliminary evidence of less depression among people with terminal cancer in hospice treated with interactive guided imagery and progressive muscle relaxation

• Less depression among people with terminal cancer in hospice treated with interactive guided imagery and progressive muscle relaxation compared to baseline, and an apparently larger benefit than with usual care in a mid-sized randomized trial³⁷De Paolis G, Naccarato A et al. The effectiveness of progressive muscle relaxation and interactive guided imagery as a pain-reducing intervention in advanced cancer patients: a multicentre randomised controlled non-pharmacological trial. Complementary Therapies in Clinical Practice. 2019 Feb;34:280-287.

During chemotherapy: modest evidence of less fatigue during chemotherapy among people treated with relaxation, sometimes also with guided imagery

• Less fatigue during adjuvanttreatment applied after initial treatment for cancer, especially to suppress secondary tumor formation paclitaxel among people with early breast cancer treated with progressive muscle relaxation compared to no intervention in a mid-sized RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects³⁸Gok Metin Z, Karadas C, Izgu N, Ozdemir L, Demirci U. Effects of progressive muscle relaxation and mindfulness meditation on fatigue, coping styles, and quality of life in early breast cancer patients: an assessor blinded, three-arm, randomized controlled trial. European Journal of Oncology Nursing. 2019 Oct;42:116-125.
• Substantially less fatigue (fatigue decreased with the intervention and increased without it) during chemotherapy among people treated with guided imagery and progressive muscle relaxation compared to no intervention in a mid-sized RCT³⁹Charalambous A, Giannakopoulou M et al. Guided imagery and progressive muscle relaxation as a cluster of symptoms management intervention in patients receiving chemotherapy: a randomized control trial. PLoS One. 2016 Jun 24;11(6):e0156911.
• Less fatigue during chemotherapy among people with gynecologic cancer treated with progressive muscle relaxation compared to controls in a small RCT⁴⁰Dikmen HA, Terzioglu F. Effects of reflexology and progressive muscle relaxation on pain, fatigue, and quality of life during chemotherapy in gynecologic cancer patients. Pain Management Nursing. 2019 Feb;20(1):47-53.

During radiotherapy: preliminary evidence of somewhat less fatigue during palliative radiotherapy among people with lung cancer treated with progressive muscle relaxation

• Somewhat less fatigue during palliative radiotherapy among people with stage 3 or 4 lung cancer treated with education on symptom management and coaching in the use of progressive muscle relaxation 1 week before and 3 weeks after starting radiotherapy compared to usual care in a mid-sized RCT⁴¹Chan CW, Richardson A, Richardson J. Managing symptoms in patients with advanced lung cancer during radiotherapy: results of a psychoeducational randomized controlled trial. Journal of Pain and Symptom Management. 2011 Feb;41(2):347-57.

With surgery or procedures: modest evidence of less fatigue after surgery or stem cell transplant among people with cancer treated with relaxation, sometimes with other complementary therapies

• Less fatigue severity during hematopoietic stem cell transplant among people with cancer treated with relaxation techniques in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 10 randomized trials⁴²Duong N, Davis H et al. Mind and body practices for fatigue reduction in patients with cancer and hematopoietic stem cell transplant recipients: a systematic review and meta-analysis. Critical Reviews in Oncology/Hematology. 2017 Dec;120:210-216.
• Less fatigue during initial surgery among women with breast cancer using a self-care toolkit of audio-files of guided mind-body techniques (breathing, progressive muscle relaxation, meditation, guided imagery, and self-hypnosis) and acupressure antinausea wristbands compared to usual care in a mid-sized RCT⁴³Stoerkel E, Bellanti D et al. Effectiveness of a self-care toolkit for surgical breast cancer patients in a military treatment facility. Journal of Alternative and Complementary Medicine. 2018 Sep/Oct;24(9-10):916-925.
• No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on reported fatigue after conventional resection of colorectal carcinoma among elderly people treated with relaxation compared to guided imagery or controls (no intervention) in a small RCT⁴⁴Haase O, Schwenk W, Hermann C, Müller JM. Guided imagery and relaxation in conventional colorectal resections: a randomized, controlled, partially blinded trial. Diseases of the Colon and Rectum. 2005 Oct;48(10):1955-63.

• Less nausea during cancer treatment among people treated with relaxation training compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁴⁵Luebbert K, Dahme B, Hasenbring M. The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: a meta-analytical review. Psycho-oncology. 2001 Nov-Dec;10(6):490-502.
• Less nausea, vomiting, and retching during chemotherapy among people treated with guided imagery and progressive muscle relaxation compared to no intervention in a mid-sized RCT⁴⁶Charalambous A, Giannakopoulou M et al. Guided imagery and progressive muscle relaxation as a cluster of symptoms management intervention in patients receiving chemotherapy: a randomized control trial. PLoS One. 2016 Jun 24;11(6):e0156911.
• Less anticipatory and chemotherapy-induced nausea and vomiting in the 3 days following chemotherapy among people with breast cancer new to chemotherapy treated with progressive muscle relaxation training and guided imagery compared to controls in a small RCT⁴⁷Yoo HJ, Ahn SH, Kim SB, Kim WK, Han OS. Efficacy of progressive muscle relaxation training and guided imagery in reducing chemotherapy side effects in patients with breast cancer and in improving their quality of life. Supportive Care in Cancer. 2005 Oct;13(10):826-33.
• Shorter duration of nausea and vomiting, with weak trendsan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently toward lower frequency of nausea and vomiting, but no evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on intensity, during chemotherapy among people with breast cancer new to chemotherapy treated with progressive muscle relaxation training and imaging techniques 1 hour before and for 5 days following chemotherapy sessions compared to controls in a small RCT⁴⁸Molassiotis A, Yung HP, Yam BM, Chan FY, Mok TS. The effectiveness of progressive muscle relaxation training in managing chemotherapy-induced nausea and vomiting in Chinese breast cancer patients: a randomised controlled trial. Supportive Care in Cancer. 2002 Apr;10(3):237-46.
• Lower intensity a weak trend toward shorter duration of nausea during treatment with doxorubicin and cyclophosphamide among people with breast cancer treated with intravenous antiemetics half an hour before the chemotherapy session plus progressive muscle relaxation training once a day for 5 days compared to oral antiemetics (maxolon) per hospital protocol in a small RCT⁴⁹Molassiotis A. A pilot study of the use of progressive muscle relaxation training in the management of post-chemotherapy nausea and vomiting. European Journal of Cancer Care (England). 2000 Dec;9(4):230-4.
• Lower scores of nausea, vomiting, and retching during chemotherapy among hospitalized people treated with routine nursing and progressive muscle relaxation training compared to routine nursing and contact with the investigator in a small RCT⁵⁰Arakawa S. Relaxation to reduce nausea, vomiting, and anxiety induced by chemotherapy in Japanese patients. Cancer Nursing. 1997 Oct;20(5):342-9.
• Less nausea after chemotherapy treatment among people with cancer treated with progressive muscle relaxation training before chemotherapy compared to standard care in a small RCT⁵¹Lerman C, Rimer B et al. Effects of coping style and relaxation on cancer chemotherapy side effects and emotional responses. Cancer Nursing. 1990 Oct;13(5):308-15.
• A weak trend toward less vomiting during chemotherapy among people with cancer treated with relaxation training with guided relaxation imagery compared to standard care in a small RCT⁵²Burish TG, Snyder SL, Jenkins RA. Preparing patients for cancer chemotherapy: effect of coping preparation and relaxation interventions. Journal of Consulting and Clinical Psychology. 1991 Aug;59(4):518-25.
• Less nausea, but no evidence of an effect on frequency of vomiting, among people who had developed negative conditioned responses to their chemotherapy and treated with progressive muscle relaxation training and guided relaxation imagery instructions immediately before and during their chemotherapy treatments compared to controls in an RCT⁵³Burish TG, Lyles JN. Effectiveness of relaxation training in reducing adverse reactions to cancer chemotherapy. Journal of Behavioral Medicine. 1981 Mar;4(1):65-78.
• Less nausea and nausea combined with fatigue 7 days after autologous bone marrow/peripheral blood stem cell transplantation among people with breast cancer receiving preparatory information, cognitive restructuring, and relaxation with guided imagery compared to controls in a mid-sized RCT⁵⁴Gaston-Johansson F, Fall-Dickson JM et al. The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation. Cancer Nursing. 2000 Aug;23(4):277-85.

• Lower oral mucositis pain levels during bone marrow transplants among people with cancer treated with relaxation and imagery, whether with or without cognitive-behavioral coping skills, compared to usual care in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁵⁵Syrjala KL, Donaldson GW, Davis MW, Kippes ME, Carr JE. Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: a controlled clinical trial. Pain. 1995 Nov;63(2):189-198.

Without regard to treatment phase: good evidence of less pain among people with breast cancer treated with relaxation-based intervention

• Less pain among people with breast cancer treated with relaxation-based interventions compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 26 clinical studies⁵⁶Johannsen M, Farver I, Beck N, Zachariae R. The efficacy of psychosocial intervention for pain in breast cancer patients and survivors: a systematic review and meta-analysis. Breast Cancer Research and Treatment. 2013 Apr;138(3):675-90.

During cancer treatment as a whole: modest evidence of less pain during cancer treatment among people treated with relaxation training

• Less pain during cancer treatment among people treated with relaxation training compared to controls in a meta-analysis of RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁵⁷Luebbert K, Dahme B, Hasenbring M. The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: a meta-analytical review. Psycho-oncology. 2001 Nov-Dec;10(6):490-502.

During chemotherapy: modest evidence of less pain during chemotherapy among people treated with progressive muscle relaxation, sometimes also with guided imagery

• Substantially less pain (pain decreased with the intervention and increased without it) during chemotherapy among people treated with guided imagery and progressive muscle relaxation compared to no intervention in a mid-sized RCT⁵⁸Charalambous A, Giannakopoulou M et al. Guided imagery and progressive muscle relaxation as a cluster of symptoms management intervention in patients receiving chemotherapy: a randomized control trial. PLoS One. 2016 Jun 24;11(6):e0156911.
• Less pain during chemotherapy among people with gynecologic cancer treated with progressive muscle relaxation compared to controls in a small RCT⁵⁹Dikmen HA, Terzioglu F. Effects of reflexology and progressive muscle relaxation on pain, fatigue, and quality of life during chemotherapy in gynecologic cancer patients. Pain Management Nursing. 2019 Feb;20(1):47-53.

During radiotherapy: preliminary evidence of less body discomfort during brachytherapy among people with gynecologic or breast cancer treated with relaxation and guided imagery

• Less body discomfort during brachytherapy within hospitalization among people with gynecologic or breast cancer treated with relaxation and guided imagery compared to controls in a small RCT⁶⁰León-Pizarro C, Gich I et al. A randomized trial of the effect of training in relaxation and guided imagery techniques in improving psychological and quality-of-life indices for gynecologic and breast brachytherapy patients. Psycho-oncology. 2007 Nov;16(11):971-9.

With surgery

Preliminary evidence of less pain during initial surgery among people with breast cancer using a self-care toolkit of complementary therapies including relaxation

No evidence of an effect on pain after conventional resection of colorectal carcinoma among elderly people treated with relaxation in a preliminary study

• Less pain during initial surgery among women with breast cancer using a self-care toolkit of audio-files of guided mind-body techniques (breathing, progressive muscle relaxation, meditation, guided imagery, and self-hypnosis) and acupressure antinausea wristbands compared to usual care in a mid-sized RCT⁶¹Stoerkel E, Bellanti D et al. Effectiveness of a self-care toolkit for surgical breast cancer patients in a military treatment facility. Journal of Alternative and Complementary Medicine. 2018 Sep/Oct;24(9-10):916-925.
• No evidence of an effect on analgesic consumption or subjective pain intensity at rest or while coughing after conventional resection of colorectal carcinoma among elderly people treated with relaxation compared to guided imagery or controls (no intervention) in a small RCT⁶²Haase O, Schwenk W, Hermann C, Müller JM. Guided imagery and relaxation in conventional colorectal resections: a randomized, controlled, partially blinded trial. Diseases of the Colon and Rectum. 2005 Oct;48(10):1955-63.

During hormone therapy: modest evidence of less aromatase inhibitor-associated joint pain among postmenopausal women with non-metastatic breast cancer treated with relaxation techniques

• Less aromatase inhibitor-associated joint pain (arthralgia) among postmenopausal women with non-metastatic breast cancer treated with relaxation techniques in a meta-analysis of 19 intervention studies⁶³Yang GS, Kim HJ et al. Interventions for the treatment of aromatase inhibitor-associated arthralgia in breast cancer survivors: a systematic review and meta-analysis. Cancer Nursing. 2017 Jul/Aug;40(4):E26-E41.

During hospitalization: preliminary evidence of less pain among hospitalized people with cancer treated with relaxation

• Lower subjective pain ratings and lower use of non-opiate analgesic among people with advanced cancer newly admitted to an oncology ward treated with relaxation training by audio tapes or live relaxation training by nurses compared to no relaxation training in a small RCT⁶⁴Sloman R, Brown P, Aldana E, Chee E. The use of relaxation for the promotion of comfort and pain relief in persons with advanced cancer. Contemporary Nurse. 1994 Mar;3(1):6-12.
• Lower pain intensity and more perceived control over pain among hospitalized patients with cancer pain treated with progressive muscle relaxation compared to controls, mostly among people with greater imaging ability, more positive outcome expectancy, and fewer concurrent symptoms, in a small controlled triala study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial⁶⁵Kwekkeboom KL, Wanta B, Bumpus M. Individual difference variables and the effects of progressive muscle relaxation and analgesic imagery interventions on cancer pain. Journal of Pain and Symptom Management. 2008 Dec;36(6):604-15.

During hospice care: preliminary evidence of less pain among people with terminal cancer in hospice treated with interactive guided imagery and progressive muscle relaxation

• Less pain intensity among people with terminal cancer in hospice treated with interactive guided imagery and progressive muscle relaxation compared to baseline, and an apparently larger benefit than with usual care in a mid-sized randomized trial⁶⁶De Paolis G, Naccarato A et al. The effectiveness of progressive muscle relaxation and interactive guided imagery as a pain-reducing intervention in advanced cancer patients: a multicentre randomised controlled non-pharmacological trial. Complementary Therapies in Clinical Practice. 2019 Feb;34:280-287.

Without regard to treatment phase

Preliminary evidence of better self-efficacy and quality of life among people with cancer treated with relaxation, sometimes with other mind-body therapies

Preliminary evidence of less illness-related social disruption among women with breast cancer treated with relaxation

• Better scores of self-efficacy among people with cancer participating in daily relaxation techniques for 2 months compared to routine care in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁶⁷Noruzi Zamenjani M, Masmouei B et al. The effect of progressive muscle relaxation on cancer patients’ self-efficacy. Complementary Therapies in Clinical Practice. 2019 Feb;34:70-75.
• Better self-efficacy and quality of life among Chinese cancer survivors treated with cancer-related education, progressive muscle relaxation and emotional support compared to controls in a small RCT⁶⁸Zhang H, Zhou Y, Cui Y, Yang J. The effectiveness of a rehabilitation programme for Chinese cancer survivors: a pilot study. International Journal of Nursing Practice. 2016 Feb;22(1):79-88.
• Less illness-related social disruption among women with stage 0-3 breast cancer treated with a 5-week relaxation training intervention compared to health education in a mid-sized RCT⁶⁹Gudenkauf LM, Antoni MH et al. Brief cognitive-behavioral and relaxation training interventions for breast cancer: a randomized controlled trial. Journal of Consulting and Clinical Psychology. 2015 Aug;83(4):677-688.

During chemotherapy: preliminary (conflicting) evidence of better quality of life and function during chemotherapy among people treated with relaxation, often with other complementary therapies

• Substantially better health-related quality of life (quality increased with the intervention and decreased without it) during chemotherapy among people treated with guided imagery and progressive muscle relaxation compared to no intervention in a mid-sized RCT⁷⁰Charalambous A, Giannakopoulou M et al. Guided imagery and progressive muscle relaxation as a cluster of symptoms management intervention in patients receiving chemotherapy: a randomized control trial. PLoS One. 2016 Jun 24;11(6):e0156911.
• Better quality of life, health, functioning, and psychological/spiritual well-being among people with stage 2–4 breast cancer scheduled to receive high dose chemotherapy and autologous hematopoietic stem cell transplantation with a comprehensive coping strategy program of educational information, cognitive restructuring, coping skills enhancement, and relaxation with guided imagery compared to no program in a mid-sized RCT⁷¹Gaston-Johansson F, Fall-Dickson JM et al. Long-term effect of the self-management comprehensive coping strategy program on quality of life in patients with breast cancer treated with high-dose chemotherapy. Psycho-oncology. 2013 Mar;22(3):530-9.
• Better scores for use of emotional support, positive reframing, and planning, but no evidence of an effect on quality of life during adjuvanttreatment applied after initial treatment for cancer, especially to suppress secondary tumor formation paclitaxel treatment among people with early breast cancer treated with progressive muscle relaxation compared to no intervention in a mid-sized RCT⁷²Gok Metin Z, Karadas C, Izgu N, Ozdemir L, Demirci U. Effects of progressive muscle relaxation and mindfulness meditation on fatigue, coping styles, and quality of life in early breast cancer patients: an assessor blinded, three-arm, randomized controlled trial. European Journal of Oncology Nursing. 2019 Oct;42:116-125.
• No evidence of an effect on emotional well-being, functional well-being, physical well-being, or total symptom severity during chemotherapy among Spanish-speaking Hispanic and Latina women receiving Spanish-Language Self-Administered Stress Management Training comprising deep breathing, progressive muscle relaxation and guided imagery, and use of coping self-statements compared to baseline in a mid-sized randomized trial⁷³Hoogland AI, Lechner SC et al. Efficacy of a Spanish-Language Self-Administered Stress Management Training intervention for Latinas undergoing chemotherapy. Psycho-oncology. 2018 Apr;27(4):1305-1311.
• No evidence of an effect on quality of life during chemotherapy among people with gynecologic cancer treated with progressive muscle relaxation compared to controls in a small RCT⁷⁴Dikmen HA, Terzioglu F. Effects of reflexology and progressive muscle relaxation on pain, fatigue, and quality of life during chemotherapy in gynecologic cancer patients. Pain Management Nursing. 2019 Feb;20(1):47-53.

With surgery: modest evidence of better quality of life after surgery among people with cancer treated with relaxation, sometimes with other mind-body therapies

• Better health-related quality of life and upper limb function after breast cancer surgery among women treated with routine nursing care and progressive upper limb exercises and muscle relaxation training compared to routine nursing care alone in a mid-sized RCT⁷⁵Zhou K, Wang W et al. Effects of progressive upper limb exercises and muscle relaxation training on upper limb function and health-related quality of life following surgery in women with breast cancer: a clinical randomized controlled trial. Annals of Surgical Oncology. 2019 Jul;26(7):2156-2165.
• Better quality of life after stoma surgery among people with colorectal cancer treated with progressive muscle relaxation training through 2 teaching sessions and practice at home for 10 weeks compared to routine care in a small RCT⁷⁶Cheung YL, Molassiotis A, Chang AM. The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. Psycho-oncology. 2003 Apr-May;12(3):254-66.
• Better quality of life immediately and 5 and 10 weeks after stoma surgery among people treated with audiotaped instructions on progressive muscle relaxation training compared to controls in a small RCT⁷⁷Cheung YL, Molassiotis A, Chang AM. A pilot study on the effect of progressive muscle relaxation training of patients after stoma surgery. European Journal of Cancer Care (Engl). 2001 Jun;10(2):107-14.
• Better perceived quality of life during treatment after mastectomy among women treated with brief psychotherapy (average of 6 sessions) and relaxation, mental images, and spirituality compared to brief psychotherapy alone in a small RCT⁷⁸Elias AC, Ricci MD et al. The biopsychosocial spiritual model applied to the treatment of women with breast cancer, through RIME intervention (relaxation, mental images, spirituality). Complementary Therapies in Clinical Practice. 2015 Feb;21(1):1-6.

• Better body image among women with breast or gynecologic cancer treated with 6 weeks of progressive muscle relaxation sessions compared to baseline in a small randomized trial⁷⁹Barton DL, Brooks TM et al. Phase II randomized controlled trial of hypnosis versus progressive muscle relaxation for body image after breast or gynecologic cancer. Breast Cancer Research and Treatment. 2019 Nov;178(2):357-365.

• A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently toward less wake time after sleep onset but no evidence of an effect on nighttime sleep duration during outpatient chemotherapy treatment among children with acute lymphoblastic leukemia receiving maintenance treated with a 60-minute educational session to discuss sleep and fatigue in children with cancer and strategies to improve sleep, including use of storybooks to teach deep breathing and progressive muscle relaxation in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁸⁰Zupanec S, Jones H et al. A sleep hygiene and relaxation intervention for children with acute lymphoblastic leukemia: a pilot randomized controlled trial. Cancer Nursing. 2017 Nov/Dec;40(6):488-496.
• Less insomnia among people with nasopharyngeal carcinoma treated with progressive muscle relaxation and guided imagery training compared to baseline in a mid-sized RCT with unstated comparisons to controls⁸¹Yang XL, Li HH, Hong MH, Kao HS. The effects of Chinese calligraphy handwriting and relaxation training in Chinese nasopharyngeal carcinoma patients: a randomized controlled trial. International Journal of Nursing Studies. 2010 May;47(5):550-9.

Without regard to treatment phase: preliminary evidence of less stress or distress among people with cancer treated with relaxation and other mind-body therapie

• Moderately less psychological distress among people recently diagnosed with localized cancer treated with progressive muscle relaxation with guided imagery compared to controls in a mid-sized RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁸²Baider L, Peretz T, Hadani PE, Koch U. Psychological intervention in cancer patients: a randomized study. General Hospital Psychiatry. 2001 Sep-Oct;23(5):272-7.
• Less emotional distress among women newly treated for stage 0–3 breast cancer participating in a 10-week group cognitive behavior stress management intervention including anxiety reduction (relaxation training), cognitive restructuring, and coping skills training compared to controls in a mid-sized RCT⁸³Antoni MH, Wimberly SR et al. Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer. American Journal of Psychiatry. 2006 Oct;163(10):1791-7.
• Less stress and better problem-oriented coping strategies, but worse emotion-oriented coping strategies among women with breast cancer receiving education regarding breast cancer, progressive muscle relaxation, stress management, emotional coping, and problem-solving strategies compared to no intervention in a small RCT⁸⁴Samami E, Elyasi F et al. The effect of a supportive program on coping strategies and stress in women diagnosed with breast cancer: a randomized controlled clinical trial. Nursing Open. 2021 May;8(3):1157-1167.

During cancer treatment or intervention: preliminary evidence of less stress or better coping skills during cancer treatment or intervention among people with breast cancer treated with relaxation, sometimes also with visualization

• Better active coping scores during adjuvanttreatment applied after initial treatment for cancer, especially to suppress secondary tumor formation paclitaxel treatment among people with early breast cancer treated with progressive muscle relaxation compared to no intervention in a mid-sized RCT⁸⁵Gok Metin Z, Karadas C, Izgu N, Ozdemir L, Demirci U. Effects of progressive muscle relaxation and mindfulness meditation on fatigue, coping styles, and quality of life in early breast cancer patients: an assessor blinded, three-arm, randomized controlled trial. European Journal of Oncology Nursing. 2019 Oct;42:116-125.
• Lower stress, but no changes in stress hormones during radiotherapy among people with breast cancer treated with relaxation and visualization therapy compared to radiotherapy alone in a small RCT⁸⁶Nunes DF, Rodriguez AL et al. Relaxation and guided imagery program in patients with breast cancer undergoing radiotherapy is not associated with neuroimmunomodulatory effects. Journal of Psychosomatic Research. 2007 Dec;63(6):647-55.
• Less mental stress and associated mental processes (brain activity) among people with cancer under a stressing state generated by a diagnostic medical intervention with progressive relaxation compared to controls, and comparable to sublingual diazepam in a small RCT⁸⁷Pifarré P, Simó M et al. Diazepam and Jacobson’s progressive relaxation show similar attenuating short-term effects on stress-related brain glucose consumption. European Psychiatry. 2015 Feb;30(2):187-92.

During hospitalization: preliminary evidence of less tension or distress among hospitalized people with cancer or parents of hospitalized children with cancer treated with relaxation, sometimes also with guided imagery

• Less tension among parents of children hospitalized with a malignancy treated with progressive muscle relaxation and guided imagery compared to no intervention in a small RCT⁸⁸Tsitsi T, Charalambous A, Papastavrou E, Raftopoulos V. Effectiveness of a relaxation intervention (progressive muscle relaxation and guided imagery techniques) to reduce anxiety and improve mood of parents of hospitalized children with malignancies: a randomized controlled trial in Republic of Cyprus and Greece. European Journal of Oncology Nursing. 2017 Feb;26:9-18.
• Less pain-related distress among hospitalized people with cancer pain treated with either progressive muscle relaxation or analgesic imagery compared to controls, mostly among people with greater imaging ability, more positive outcome expectancy, and fewer concurrent symptoms, in a small controlled triala study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial⁸⁹Kwekkeboom KL, Wanta B, Bumpus M. Individual difference variables and the effects of progressive muscle relaxation and analgesic imagery interventions on cancer pain. Journal of Pain and Symptom Management. 2008 Dec;36(6):604-15.

During hospice care: preliminary evidence of less distress among people with cancer in hospice treated with interactive guided imagery and progressive muscle relaxation

• Less distress among people with terminal cancer in hospice treated with interactive guided imagery and progressive muscle relaxation compared to baseline, and an apparently larger benefit than with usual care in a mid-sized randomized trial⁹⁰De Paolis G, Naccarato A et al. The effectiveness of progressive muscle relaxation and interactive guided imagery as a pain-reducing intervention in advanced cancer patients: a multicentre randomised controlled non-pharmacological trial. Complementary Therapies in Clinical Practice. 2019 Feb;34:280-287.

• Shorter hospital stays after radical mastectomy among women with breast cancer treated with routine nursing care and music therapy and progressive muscle relaxation training compared to nursing care alone in a mid-sized RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁹¹Zhou K, Li X et al. A clinical randomized controlled trial of music therapy and progressive muscle relaxation training in female breast cancer patients after radical mastectomy: results on depression, anxiety and length of hospital stay. European Journal of Oncology Nursing. 2015 Feb;19(1):54-9.
• No evidence of an effect on pulmonary function or duration of postoperative ileus after conventional resection of colorectal carcinoma among elderly people treated with relaxation compared to guided imagery or controls (no intervention) in a small RCT⁹²Haase O, Schwenk W, Hermann C, Müller JM. Guided imagery and relaxation in conventional colorectal resections: a randomized, controlled, partially blinded trial. Diseases of the Colon and Rectum. 2005 Oct;48(10):1955-63.

• Better sleep quality, but no significant effect on sleep latencythe length of time to transition from full wakefulness to sleep or waking after sleep onset among people with insomnia treated with relaxation in a review of 8 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies of generally poor quality⁹³Edinger JD, Arnedt JT et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. Journal of Clinical Sleep Medicine. 2021 Feb 1;17(2):263-298.
• Better quality of sleep around the time of surgery for anorectal diseases among people treated with a guided imagery tape with a relaxation technique of music and relaxing text before, during and after surgery compared to standard care in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁹⁴Renzi C, Peticca L, Pescatori M. The use of relaxation techniques in the perioperative management of proctological patients: preliminary results. International Journal of Colorectal Disease. 2000 Nov;15(5-6):313-6.
• Less surgical wound redness (erythema) after gallbladder surgery (cholecystectomy) among people treated with relaxation with guided imagery compared to controls given a quiet period in a small RCT⁹⁵Holden-Lund C. Effects of relaxation with guided imagery on surgical stress and wound healing. Research in Nursing & Health. 1988 Aug;11(4):235-44.
• Lower heart rate values, subjective ratings of anxiety, reflux symptom ratings, and total esophageal acid exposure after a stressful task among people with reflux disease receiving a relaxation intervention compared to an attention-placebo control intervention in a small controlled trial⁹⁶McDonald-Haile J, Bradley LA, Bailey MA, Schan CA, Richter JE. Relaxation training reduces symptom reports and acid exposure in patients with gastroesophageal reflux disease. Gastroenterology. 1994 Jul;107(1):61-9.