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 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 effects¹Nunes 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: preliminary evidence of lower anxiety among people with cancer participating in relaxation training

• 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 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 effects⁸Holland 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.

During chemotherapy: weak evidence of less anxiety during chemotherapy among people treated with relaxation techniques

• 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 design⁹Lee 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: preliminary evidence of less anxiety during or soon after radiotherapy among people coached in progressive muscle relaxation

• Somewhat less anxiety during palliative 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 RCT¹⁰Chan 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: preliminary evidence of less anxiety soon after surgery among people with cancer participating in progressive muscle relaxation training

• 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 RCT¹¹Cheung 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 RCT¹²Cheung 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.

• No evidence of an effect on pulmonary function after conventional resection of colorectal carcinoma among elderly people treated with relaxation techniques compared to guided imagery or controls (no intervention) 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 effects¹³Haase 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.

Without regard to cancer treatment phase: modest evidence of less depression among people with cancer treated with relaxation training

• 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 effects¹⁴Gudenkauf 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 RCT¹⁵Holland 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.

During chemotherapy: preliminary evidence of less depression during chemotherapy among people treated with relaxation techniques

• Less depression during chemotherapy among people treated with guided imagery and progressive muscle relaxation compared to no intervention in a mid-sized RCT¹⁶Charalambous 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.

During radiotherapy: preliminary evidence of less depression during radiotherapy among people with cancer treated with relaxation techniques

• Lower depression and tension scores after a first session of a 6-week course of radiotherapy among women with stage 1 or 2 breast cancer treated with relaxation training, whether with or without imagery, with tapes and instructions to practice 15 minutes a day, compared to encouragement to talk about themselves, and especially among women aged 55 and over in a mid-sized RCT¹⁷Bridge LR, Benson P, Pietroni PC, Priest RG. Relaxation and imagery in the treatment of breast cancer. BMJ. 1988 Nov 5;297(6657):1169-72.

During chemotherapy: modest evidence of less fatigue during chemotherapy among people treated with progressive muscle relaxation

• Less fatigue during adjuvant 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 effects¹⁸Gok 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.
• Less fatigue during chemotherapy among people with gynecologic cancer treated with progressive muscle relaxation compared to controls in a small RCT¹⁹Dikmen 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.

Modest evidence of less fatigue after surgery or stem cell transplant among people with cancer treated with relaxation techniques

No evidence of an effect on reported fatigue after conventional resection of colorectal carcinoma among elderly people treated with relaxation techniques in a small trial

• Less fatigue severity during hematopoietic stem cell transplant among people with cancer treated with relaxation techniques in a meta-analysis of 10 RCTs²⁰Duong 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.
• No evidence of an effect on reported fatigue after conventional resection of colorectal carcinoma among elderly people treated with relaxation techniques compared to guided imagery or controls (no intervention) in a small RCT²¹Haase 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 effects²²Luebbert 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.
• 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 RCT²³Arakawa S. Relaxation to reduce nausea, vomiting, and anxiety induced by chemotherapy in Japanese patients. Cancer Nursing. 1997 Oct;20(5):342-9.
• Lower intensity and a weak trend toward shorter duration of nausea during treatment with doxorubicin and cyclophosphamide including intravenous antiemetics half an hour before the chemotherapy session among people with breast cancer treated with progressive muscle relaxation training once a day for 5 days compared to oral antiemetics (maxolon) per hospital protocol in a small RCT²⁴Molassiotis 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.

• Fewer and less severe hot flashes, plus less distress caused by hot flashes, among women with primary breast cancer experiencing hot flashes treated with a single relaxation training session and instruction to use practice tapes on a daily basis at home for 1 month compared to no treatment 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 effects; the treatment benefit did not persist at a 3-month follow up²⁵Fenlon DR, Corner JL, Haviland JS. A randomized controlled trial of relaxation training to reduce hot flashes in women with primary breast cancer. Journal of Pain and Symptom Management. 2008 Apr;35(4):397-405.
• Lower number and duration of hot flashes and night sweats among people with primary breast cancer treated with progressive muscle relaxation therapy compared to placebo in a small RCT²⁶Shirzadi M, Farshchian N et al. Escitalopram and progressive muscle relaxation training are both effective for the treatment of hot flashes in patients with breast cancer: a randomized controlled trial. Journal of Psychosomatic Obstetrics and Gynaecology. 2022 Dec;43(4):393-399.

Without regard to treatment phase: modest 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 studies²⁷Johannsen 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 effects²⁸Luebbert 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: preliminary evidence of less pain during chemotherapy among people treated with progressive muscle relaxation

• Less pain during chemotherapy among people with gynecologic cancer treated with progressive muscle relaxation compared to controls in a small RCT²⁹Dikmen 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: no evidence of an effect on pain after conventional resection of colorectal carcinoma among elderly people treated with relaxation techniques in a preliminary study

• 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 techniques compared to guided imagery or controls (no intervention) in a small RCT³⁰Haase 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 studies³¹Yang 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 RCT³²Sloman 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 trial³³Kwekkeboom 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.

Without regard to treatment phase

Preliminary evidence of better self-efficacy and quality of life among people with cancer treated with relaxation techniques

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

• 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 effects³⁴Noruzi 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.
• 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 RCT³⁵Gudenkauf 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 evidence of better scores for use of emotional support, positive reframing, and planning during chemotherapy, but no evidence of better quality of life during chemotherapy among people treated with relaxation techniques

• 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 RCT³⁶Gok 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 quality of life during chemotherapy among people with gynecologic cancer treated with progressive muscle relaxation compared to controls in a small RCT³⁷Dikmen 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: preliminary evidence of better quality of life after surgery among people with cancer treated with relaxation techniques

• 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 RCT³⁸Cheung 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 RCT³⁹Cheung 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.

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 techniques

• 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 RCT⁴⁰Gok 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.
• Less mental stress and associated mental processes (brain activity) among people with cancer under a stressing state generated by a diagnostic medical intervention treated with progressive relaxation compared to controls, and comparable to sublingual diazepam in a small RCT⁴¹Pifarré 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 techniques

• Less pain-related distress among hospitalized people 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 trial⁴²Kwekkeboom 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 trial⁴³De 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.

No evidence of an effect on duration of postoperative ileus after conventional resection of colorectal carcinoma among elderly people treated with relaxation techniques

• No evidence of an effect on duration of postoperative ileus after conventional resection of colorectal carcinoma among elderly people treated with relaxation techniques compared to guided imagery or controls (no intervention) 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 effects⁴⁴Haase 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.

Preliminary evidence of better body image among women with breast or gynecologic cancer treated with progressive muscle relaxation

• 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 RCT⁴⁵Barton 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.

Cardiovascular symptoms: preliminary evidence of 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

• 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 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 trial⁴⁶McDonald-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.

Hot flashes: modest evidence of fewer and/or less severe hot flashes among perimenopausal or postmenopausal women treated with relaxation techniques

• Lower frequency and severity of hot flashes and night sweats among perimenopausal women treated with progressive muscle relaxation, and even stronger effects when health education was added, 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 effects⁴⁷Pelit Aksu S, Şentürk Erenel A. Effects of health education and progressive muscle relaxation on vasomotor symptoms and insomnia in perimenopausal women: a randomized controlled trial. Patient Education and Counseling. 2022 Nov;105(11):3279-3286.
• Substantially fewer hot flashes and better health-related quality of life for vasomotor symptoms, sleep, and memory among postmenopausal women with at least 7 moderate to severe hot flashes per 24 hours participating in group therapy with applied relaxation for 12 weeks compared to controls (no treatment) in a small RCT⁴⁸Lindh-Åstrand L, Nedstrand E. Effects of applied relaxation on vasomotor symptoms in postmenopausal women: a randomized controlled trial. Menopause. 2013 Apr;20(4):401-8.
• Fewer hot flashes among postmenopausal women treated with applied relaxation for 12 weeks compared to placebo in a small RCT⁴⁹Zaborowska E, Brynhildsen J et al. Effects of acupuncture, applied relaxation, estrogens and placebo on hot flushes in postmenopausal women: an analysis of two prospective, parallel, randomized studies. Climacteric. 2007 Feb;10(1):38-45.

Sleep disruption: modest evidence of better sleep quality among people with insomnia or undergoing surgery treated with relaxation

• Lower insomnia scores among perimenopausal women treated with progressive muscle relaxation, and even stronger effects when health education was added, compared to controls in a mid-sized RCT⁵⁰Pelit Aksu S, Şentürk Erenel A. Effects of health education and progressive muscle relaxation on vasomotor symptoms and insomnia in perimenopausal women: a randomized controlled trial. Patient Education and Counseling. 2022 Nov;105(11):3279-3286.
• Better sleep quality, but no significant effect on sleep latency 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 quality⁵¹Edinger 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.

Relaxation combined with other therapies, not specific to cancer

Relaxation combined with guided imagery: preliminary evidence of less surgical wound redness after gallbladder surgery among people treated with relaxation techniques with guided imagery

• Less surgical wound redness (erythema) after gallbladder surgery (cholecystectomy) among people treated with relaxation techniques with guided imagery compared to controls given a quiet period in a small RCT⁵²Holden-Lund C. Effects of relaxation with guided imagery on surgical stress and wound healing. Research in Nursing & Health. 1988 Aug;11(4):235-44.

Relaxation from music and text combined with guided imagery: preliminary evidence of better quality of sleep around the time of surgery for anorectal diseases (not specific to cancer) among people treated with a guided imagery tape with a relaxation technique of music and relaxing text

• 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 RCT⁵³Renzi 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.

Relaxation combined with group therapy: preliminary evidence of fewer hot flashes and better health-related quality of life for vasomotor symptoms, sleep, and memory among postmenopausal women with moderate to severe hot flashes participating in group therapy with applied relaxation

• Substantially fewer hot flashes and better health-related quality of life for vasomotor symptoms, sleep, and memory among postmenopausal women with at least 7 moderate to severe hot flashes per 24 hours participating in group therapy with applied relaxation for 12 weeks compared to controls (no treatment) in a small RCT⁵⁴Lindh-Åstrand L, Nedstrand E. Effects of applied relaxation on vasomotor symptoms in postmenopausal women: a randomized controlled trial. Menopause. 2013 Apr;20(4):401-8.

Relaxation and guided imagery or visualization

Anxiety

Modest evidence of less anxiety among people with cancer treated with relaxation techniques and guided imagery

Preliminary evidence of less anxiety among parents of children hospitalized with a malignancy treated with progressive muscle relaxation and guided imagery

• 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 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 effects⁵⁵De 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.
• A weak trend toward less anxiety (low to moderate effect size) among children hospitalized with a malignancy treated with progressive muscle relaxation and guided imagery compared to no intervention in a small RCT⁵⁶Tsitsi 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 during radiotherapy among people with breast cancer treated with relaxation and visualization therapy compared to radiotherapy alone in a small RCT⁵⁷Nunes 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 RCT⁵⁸León-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.
• 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 RCT⁵⁹Yoo 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 among parents of children hospitalized with a malignancy treated with progressive muscle relaxation and guided imagery compared to no intervention in a small RCT⁶⁰Tsitsi 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.

Depression or sadness

Modest evidence of less depression among people with cancer treated with relaxation and visualization or guided imagery, including during cancer treatment

• Lower depression during radiotherapy among people with breast cancer treated with relaxation and visualization therapy compared to radiotherapy alone in a small RCT⁶¹Nunes 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 RCT⁶²León-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.
• 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 RCT⁶³Yoo 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 RCT⁶⁴Walker 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 trend 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 RCT⁶⁵Burish 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 mood disturbance among people with nasopharyngeal carcinoma treated with progressive muscle relaxation and guided imagery training compared to baseline in a mid-sized uncontrolled trial⁶⁶Yang 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.
• No evidence of an effect on mood among people with metastatic breast cancer experiencing physical pain treated with relaxation and visualization training, whether with or without cognitive coping skills training, compared to no intervention in a small RCT⁶⁷Arathuzik D. Effects of cognitive-behavioral strategies on pain in cancer patients. Cancer Nursing. 1994 Jun;17(3):207-14.

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 RCT⁶⁸De 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.

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 RCT⁶⁹Tsitsi 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.

Fatigue: preliminary evidence of less fatigue during chemotherapy among people treated with guided imagery and progressive muscle relaxation

• 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 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.

Gastrointestinal symptoms: modest evidence of less nausea and/or vomiting during chemotherapy treatment among people with cancer treated with guided imagery and progressive muscle relaxation or another relaxation technique

• 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 RCT⁷¹Charalambous 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 RCT⁷²Yoo 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 trends toward lower frequency of nausea and vomiting, but no evidence of an effect 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 RCT⁷³Molassiotis 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.
• 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 RCT⁷⁴Burish 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 RCT⁷⁵Burish TG, Lyles JN. Effectiveness of relaxation training in reducing adverse reactions to cancer chemotherapy. Journal of Behavioral Medicine. 1981 Mar;4(1):65-78.

Pain or discomfort

Modest evidence of less pain during cancer treatment among people treated with relaxation techniques and 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 RCT⁷⁶Charalambous 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.
• 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 RCT⁷⁷Syrjala 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.

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 RCT⁷⁸De 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.

Preliminary evidence of less body discomfort during brachytherapy among people with gynecologic or breast cancer treated with relaxation techniques 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 RCT⁷⁹León-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.

Quality of life: modest evidence of better health-related quality of life during chemotherapy among people with cancer treated with guided imagery and progressive muscle relaxation

• 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 RCT⁸⁰Charalambous 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 6 months after chemotherapy among people with breast cancer new to chemotherapy participating in progressive muscle relaxation training and guided imagery compared to controls in a small RCT⁸¹Yoo 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.

Sleep disruption: weak evidence of less insomnia among people with nasopharyngeal carcinoma treated with progressive muscle relaxation and guided imagery

• 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 controls⁸²Yang 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.

Stress

Modest evidence of less psychological distress among people with cancer treated with progressive muscle relaxation with guided imagery

Preliminary evidence of less tension among parents of children hospitalized with a malignancy treated with progressive muscle relaxation and guided imagery

• 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 RCT⁸³Baider 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.
• Lower reported stress during radiotherapy among people with breast cancer treated with relaxation and visualization therapy compared to radiotherapy alone in a small RCT⁸⁴Nunes 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 distress among people with cancer and with pain participating in relaxation and visualization training in a preliminary study

• No evidence of an effect on distress among people with metastatic breast cancer who were experiencing physical pain treated with relaxation and visualization training, whether with or without cognitive coping skills training compared to no intervention in a small RCT⁸⁵Arathuzik D. Effects of cognitive-behavioral strategies on pain in cancer patients. Cancer Nursing. 1994 Jun;17(3):207-14.

Preliminary evidence of less tension among parents of children hospitalized with a malignancy treated with progressive muscle relaxation and 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 RCT⁸⁶Tsitsi 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.

Weak evidence of less distress among people with terminal 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 RCT⁸⁷De 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.

Relaxation with guided imagery and biofeedback training

Weak evidence of less anxiety among women with breast cancer participating in relaxation, guided imagery, and biofeedback training

• A weak trend 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 RCT⁸⁸Gruber BL, Hersh SP et al. Immunological responses of breast cancer patients to behavioral interventions. Biofeedback and Self-Regulation. 1993 Mar;18(1):1-22.

Relaxation with deep breathing, guided imagery, and use of coping statements

No evidence of an effect on emotional well-being, functional well-being, physical well-being, or total symptom severity during chemotherapy among women with cancer receiving Spanish-Language Self-Administered Stress Management Training comprising deep breathing, progressive muscle relaxation and guided imagery, and use of coping self-statements in one trial

• 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 with cancer 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 RCT⁸⁹Hoogland 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.

Relaxation and music therapy

Preliminary evidence of less anxiety or depression and shorter hospital stays after radical mastectomy among women with breast cancer treated with relaxation and music therapy

• Less anxiety or depression and shorter hospital stays 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 RCT⁹⁰Zhou 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.

Preliminary evidence of 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

• 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 RCT⁹¹Liao 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.

Relaxation with a home visit

Preliminary evidence of lower anxiety scores after lumpectomy among women with early stage breast cancer treated with a home visit and 2 months of weekly autogenic (relaxation) training

• Lower anxiety scores after lumpectomy among women with early stage breast cancer having received adjuvant radiotherapy treated with a home visit and 2 months of weekly autogenic (relaxation) training compared to a home visit alone in a small RCT⁹²Hidderley 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.

Relaxation techniques with psychotherapy

Preliminary evidence of less anxiety and emotional distress among women newly treated for breast cancer participating in a 10-week group cognitive behavior stress management intervention of anxiety reduction (relaxation training), cognitive restructuring, and coping skills training

• Lower ratings of anxiety and less emotional distress among women newly treated for stage 0–3 breast cancer participating in a 10-week group cognitive behavior stress management intervention of anxiety reduction (relaxation training), cognitive restructuring, and coping skills training compared to controls in a mid-sized RCT⁹³Antoni 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.

Relaxation techniques with education and psychotherapy

Preliminary evidence of 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

• 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 RCT⁹⁴Samami 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.

Relaxation techniques with psychotherapy, imagery, and spirituality

Preliminary evidence of better perceived quality of life during treatment after mastectomy among women treated with brief psychotherapy and relaxation, mental images, and spirituality

• Better perceived quality of life during treatment after mastectomy among women treated with brief psychotherapy (average of 6 sessions) and relaxation techniques, mental images, and spirituality compared to brief psychotherapy alone in a small RCT⁹⁵Elias 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.

Relaxation techniques with psychotherapy and guided imagery

Preliminary evidence of better quality of life, health, functioning, and psychological/spiritual well-being among people with breast cancer scheduled to receive high-dose chemotherapy and autologous hematopoietic stem cell transplantation treated with a comprehensive coping strategy program of educational information, cognitive restructuring, coping skills enhancement, and relaxation with guided imagery

• 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 treated 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 RCT⁹⁶Gaston-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.

Preliminary evidence of less nausea or nausea combined with fatigue after autologous bone marrow/peripheral blood stem cell transplantation among people with breast cancer receiving preparatory information, cognitive restructuring, and relaxation with guided imagery

• Less nausea or 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 RCT⁹⁷Gaston-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.

Relaxation techniques with exercises

Preliminary evidence of better health-related quality of life and upper limb function after breast cancer surgery among women treated with progressive upper limb exercises and muscle relaxation training

• 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 RCT⁹⁸Zhou 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.

Weak evidence of less stress urinary incontinence, less pelvic pain, and better pelvic floor strength after prostatectomy among people with stress urinary incontinence treated with an individualized program of exercise for underactive pelvic floor dysfunction (PFD), relaxation for overactive PFD, or a combination treatment for mixed-type PFD

• Less stress urinary incontinence, less pelvic pain, and better pelvic floor strength after prostatectomy among people with stress urinary incontinence treated with an individualized program of exercise for underactive pelvic floor dysfunction (PFD), relaxation for overactive PFD, or a combination treatment for mixed-type PFD compared to baseline in a mid-sized uncontrolled trial⁹⁹Scott KM, Gosai E et al. Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain. International Urology and Nephrology. 2020 Apr;52(4):655-659.

Relaxation techniques combined with education

Preliminary evidence of somewhat less fatigue during palliative radiotherapy among people with lung cancer treated with progressive muscle relaxation and education on symptom management

• 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 RCT¹⁰⁰Chan 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.

Preliminary evidence of less breathlessness among people with lung cancer receiving education on symptom management and coached in progressive muscle relaxation

• Less breathlessness during palliative 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 RCT¹⁰¹Chan 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.

Relaxation techniques, education, and deep breathing

Weak evidence of less awake time after sleep onset but no evidence of an effect on nighttime sleep duration during outpatient maintenance chemotherapy among children with acute lymphoblastic leukemia treated with an educational session and strategies to improve sleep, including use of storybooks to teach deep breathing and progressive muscle relaxation

• A weak trend toward less awake time after sleep onset but no evidence of an effect on nighttime sleep duration during outpatient maintenance chemotherapy among children with acute lymphoblastic leukemia 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 RCT¹⁰²Zupanec 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.

Relaxation techniques with education and emotional support

Preliminary evidence of less mood disturbance and better self-efficacy and quality of life among people with cancer treated with cancer-related education, progressive muscle relaxation and emotional support

• Less mood disturbance and better self-efficacy and quality of life among people with cancer treated with cancer-related education, progressive muscle relaxation and emotional support compared to controls in a small RCT¹⁰³Zhang 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.

Progressive muscle relaxation with breathing, meditation, guided imagery, and self-hypnosis, plus acupressure antinausea wristbands

Preliminary evidence of less pain, fatigue, and anxiety 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

• Less pain, fatigue, and anxiety 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 RCT¹⁰⁴Stoerkel 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.