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Effect of Jacobson’s Progressive Muscle Relaxation on Anxiety and Happiness of Older Adults in the Nursing Home

Tapeh, Zahra Asgari 1 ; Darvishpour, Azar 1,2 ; Besharati, Fereshteh 1 ; Gholami- Chaboki, Bahare 3

1 Department of Nursing, Zeyinab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran

2 Social Determinants of Health (SDH) Research Center, Guilan University of Medical Sciences, Rasht, Iran

3 Cardiovascular Research Center, Guilan University of Medical Sciences, Rasht, Iran

Address for correspondence: Dr. Azar Darvishpour, Department of Nursing, Zeyinab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. E-mail: [email protected]

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 4.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: 

Older adults encounter serious psychological challenges in addition to physical problems. Reducing stress and anxiety, along with promoting happiness, is critical to maintaining the mental health of the elderly. Jacobson’s Progressive Muscle Relaxation (JPMR) will lead to peace of mind by relieving physical stress. The present study aimed to investigate the effect of JPMR on the anxiety and happiness of older adults.

Materials and Methods: 

A single-group pretest-posttest design as a type of quasi-experimental study was conducted on 34 older adults living in a nursing home in Rasht, the north of Iran, in 2021. The intervention was performed one session per week, for 8 weeks. The research instruments included the Geriatric Anxiety Inventory (GAI) and the Oxford Happiness Inventory (OHI). Descriptive statistics and the Wilcoxon test were used for data analysis.

Results: 

After the intervention, the Mean (Standard Deviation [SD](of anxiety was 4.91 (1.96), and the Mean (SD) (of happiness was 37.18 (7.92). The mean score of anxiety among older adults after the intervention was significantly lower compared to the before intervention ( Z = −4.73, p < 0.001). In addition, the mean score of happiness of the samples after the intervention was significantly higher compared to the before intervention ( Z = −5.09, p < 0.001).

Conclusions: 

JPMR has a positive effect on reducing anxiety and promoting happiness in the elderly. Developing training programs and allocating time to non-pharmacological treatments such as JPMR for the elderly living in nursing homes will help make them happier and healthier.

Introduction

Anxiety is one of the most prevalent mental disorders among older adults. [ 1 ] The prevalence of anxiety disorders in older adults living in nursing homes is higher than others and varies from 3.2 to 20%. [ 2 ] Typical amounts of anxiety increase attention, but if not controlled, in addition to negative impacts on physical health, it could have adverse consequences such as reduced quality of life, emotional suffering, loss of interest, [ 3 ] and also disruption of performance. [ 4 ] As most countries around the world have entered the status of aging society, anxiety as a prevalent and important challenge in late-life raises the numbers accessing health care, and individual and social costs. [ 5 ] In contrast, happiness could be a barricade against the impact of negative feelings among the elderly, especially residents living in nursing homes. [ 6 ] This is while physical deprivation and anxiety in old age could induce unhappiness and trigger depression in the elderly. [ 7 ] Happiness as a positive emotion increases the ability to cope with mental burdens, [ 8 ] plays a vital role in raising physical and mental health, [ 9 ] and can predict longevity and survival among older adults by correlating with life satisfaction and quality of life. [ 10 ] Despite the significant advances in human comfort facilities, his happiness could be negatively affected by age and functional limitations. [ 11 ]

Avoiding stress and anxiety concurrent with increasing happiness, especially in old age, is on the public health agenda around the world. [ 12 ] Therefore, it is important to investigate interventions that reduce anxiety and increase happiness in older adults as, the most vulnerable group. A previous study indicated that physical activity could diminish negative feelings and improve positive ones, such as happiness. [ 13 ] One of the most common relaxation techniques is progressive muscle relaxation, developed by Edmund Jacobson in the 1920s. [ 14 ] Jacobson’s progressive muscle relaxation (JPMR) involves exercises in which selected muscle groups respectively first contract and then expand to achieve a state of deep relaxation. In fact, JPMR is based on the rule that muscle relaxation brings peace of mind. [ 15 ] With low muscle strength, no need for special equipment, easy learning, and low cost, [ 16 ] JPMR as a non-pharmacological intervention can be utilized in elderly care, treatment, and education programs. [ 15 , 17 ] Previous studies conducted on JPMR have shown its effectiveness in reducing depression [ 18 ] and insomnia in older adults, [ 19 ] increasing the quality of life, and adaptation to old age. [ 20 ] Despite JPMR studies, the knowledge about the effect of this technique on psychological indicators such as anxiety and happiness of older adults living in nursing homes is limited. Therefore, considering the different structures of nursing homes in different countries and the accelerating trend of the aging population, the present study aimed to investigate the effect of JPMR on the anxiety and happiness of older adults living in a nursing home. It was hypothesized that JPMR would decrease anxiety and increase the happiness of the elderly living in the nursing home.

Materials and Methods

This is a clinical trial study of quasi-experimental type (IRCT20190315043062N3) with a single-group pretest-posttest design, which was conducted in a nursing home in Rasht, the north of Iran, in 2021. This type of study is commonly used to study design. First, a single pretest measurement is taken, followed by an intervention, and then a posttest measurement is taken. [ 21 ]

The subjects in this study were older adults living in a nursing home. Due to the limited number of elderly people who met the entry criteria, the sample size was not calculated, and as shown in the Consolidated Standards of Reporting Trials (CONSORT) flowchart in Figure 1 , finally, the information of 34 older adults was analyzed. Inclusion criteria included age of 60 years and older, having normal cognition status (a score of eight or more on the Abbreviated Mental Test (AMT), [ 22 ] informed consent to participate in the study, physical ability to perform JPMR, no use of anti-anxiety drugs, absence of cardiopulmonary, and no previous experience with the technique. The exclusion criterion was the absence from training sessions. Figure 1 shows the number of participants who reached the final stage of data analysis.

As shown in Figure 1 , out of 182 elderly people living in a nursing home, 174 who were older than 60 years with normal cognition status and physically able to perform JPMR were recruited. The study protocol was announced to the older adults by one of the researchers of our research team. One hundred thirty-eight of the older adults were excluded from the research because of using anti-anxiety drugs and having a cardiopulmonary disease that would affect undertaking JPMR training during the program or any cognitive problems that could impede the elderly from understanding and answering the content of the informed consent and questionnaires. Therefore, 36 of the samples entered the JPMR training. During the 8 weeks of the training, two of the samples were not willing to continue the exercise and quit the research, so 34 samples completed the JPMR exercise.

The tools included three questionnaires. The Geriatric Anxiety Inventory (GAI) was designed by Pachana et al . [ 23 ] was used to measure anxiety. This scale has 20 items based on a 2-point scale (agree = score 1, disagree = score zero). The total score varied between zero and 20, and a score of 0–7 was considered as mild to moderate anxiety, and a score of 8 or 9 and above was considered severe anxiety. The validity and reliability of this scale were confirmed in a study on Iranian older adults. The exploratory factor analysis showed the questionnaire that jointly explained 59.48% of the overall variance observed. The findings indicated a positive and significant correlation between the two measures, lending support to its concurrent validity ( r = 0.67, P < .001). Ultimately, the GAI was found to have a favorable internal consistency. [ 24 ] The Oxford Happiness Inventory (OHI) is used to measure happiness. This tool has 29 items based on a 4-point Likert scale (not at all = score zero, low = score 1, high = score 2, and very high = score 3). The total score range varied from 0 to 87. A score of 0–25 was considered poor happiness, a score of 26–50 was considered moderate happiness, a score of 51–75 was considered good happiness, and a score of 76 and above was considered high happiness. In previous studies, the validity and reliability of this scale in Iran have been confirmed. [ 25 ] In the present study, the reliability of the tools was calculated by internal consistency in 20 older adults living in nursing homes. Cronbach’s alpha coefficient was 0.89 for GAI and 0.86 for OHI.

The cognitive status of the samples was investigated using the AMT, and a score of 7 or higher was considered as having no cognitive problem. The findings of a study conducted among Iranian older adults confirmed that the Persian version of the AMT is a valid tool for assessing cognitive function. The Cronbach’s alpha coefficient of this scale was 0.90. Scores 6 and 7 showed the optimum balance between sensitivity (99% and 94%, respectively) and specificity (85% and 86%, respectively). [ 22 ]

Before the intervention and in the 8 weeks of the intervention, the researcher, through face-to-face interviews using the tools, measured the anxiety and happiness of the samples. Each question was read to the samples, and the options were selected based on their responses. To avoid participant fatigue, data were collected at intervals and over time.

In this study, first, a training session was held for each of the subjects to introduce the JPMR technique, its effects, and how to do it. Then, for 8 consecutive weeks, a session of the JPMR technique was performed per week for 20 min individually in a room in the nursing home under the supervision of the researcher. When the individual was put in where his/her head and back were in a comfortable position (sitting), he/she was asked to close the eyes and take a few deep breaths. Then, the muscle groups (wrist, arm, forehead, eyes, jaw, shoulders, back, chest, abdomen, legs, and toes, respectively) contract symmetrically for approximately 10–15 s (inhalation) and then expand for 15–20 s (exhalation). The exercise was repeated two to three times for each muscle group. In the end, with a few deep breaths and the researcher countdown, five to one, the exercise was completed. [ 15 ]

The intervention (JPMR) was designed by the research team based on valid references. [ 14 , 26 , 27 ] One researcher (Master of Elderly Nursing) devoted a month to learning and studying the JPMR technique, about how it works, its effects, and possible side effects, and took steps to gain acceptable mastery of the technique. Therefore, she provided the intervention. After choosing a specific day of the week, she was at the nursing home at certain times during that day to perform the JPMR technique for the samples under the supervision of an ergo therapist at the nursing home. She taught the JPMR technique to the participants, and the progressive muscle relaxation (PMR) was done under her supervision. She had full control over how the intervention (JPMR technique) was performed by the samples in the training session and then through the whole eight intervention sessions.

After selecting the eligible samples to enter, the study informed consent to participate in the research was obtained from them. To obtain informed consent, the researcher first explained the purpose and method of the study to the participants. The researcher then gave the consent form, which was written in plain language, to the samples that agreed to participate in the study, and asked the samples to read it. For the illiterate, the researcher read this form. After confirming that the samples understood the content of the consent form, they were asked to participate in the study and sign the consent form. To implement the intervention, at first, an individual training session was held for each sample in their room. During the training session, sufficient explanations were given to the samples about the JMPR technique, its effects, and implementation steps. In addition to practicing the JPMR technique, the contents were repeated several times, and the researcher answered the samples’ questions. By ensuring that the samples had learned the JPMR technique correctly, a fixed day per week (Saturdays) was set aside to perform the intervention, which ensured equal and comparable conditions for all samples.

The JPMR technique was performed for 8 weeks, one session per week, with a fixed duration (20 min), individually, by the elderly on their bed in a nursing home in Rasht, with the supervision of the responsible researcher for the intervention. The educational content, intervention method, frequency, and duration of the intervention sessions were the same for all samples. The frequency and duration of intervention were monitored using a stopwatch and finger counting.

Data analysis was conducted using SPSS (Statistical Package for the Social Sciences) software version 22 (IBM, Chicago, USA), descriptive statistics (mean, standard deviation), and inferential statistics. The Wilcoxon test was used to compare the level of anxiety and happiness before and after the intervention.

To compare the mean scores of anxiety and happiness before and after the intervention, due to the abnormal distribution of anxiety, the Wilcoxon test was used, and, according to the normal distribution of happiness, a paired t -test was used. The significance level in all tests was considered 0.05.

Ethical consideration

This study is the result of a master’s thesis approved by the Ethics Committee of Guilan University of Medical Sciences in Rasht, Iran (Ethics code No: IR.GUMS.REC. 1399.399). According to the principles of research ethics, all ethical principles are observed in this article. Participants were reminded that at each stage of the study, they could refuse to continue their cooperation if they did not want to. They were also reminded that, if they wished, the results of the research would be made available to them and that their information would be kept confidential.

Most of the subjects were 60 to 74 years old (70.60%), male (58.80%), and illiterate (55.90%). Half of them had lost their spouse (50%), and more than half of them had been living in a nursing home for 1 to 5 years (52.90%). The majority of the subjects had at least one underlying disease (70.60%) and reported their economic situation as moderate-income (61.80%) [ Table 1 ].

Before performing the JPMR technique, all subjects had anxiety; 58.80% had severe levels of anxiety, and 41.20% had mild to moderate levels of anxiety. Before performing the JPMR technique, the total Mean (Standard Deviation (SD)) of anxiety in subjects was 10.41 (5.24). After performing the JPMR technique, this value reached 4.91 (1.96). JPMR caused a statistically significant difference in the anxiety mean score of subjects after the intervention. The mean scores of anxiety in older adults were reduced significantly after the intervention ( Z = −4.73, p < 0.001 ) [ Table 2 ].

Before performing the JPMR technique, 52.9% of the subjects had poor levels of happiness, 47.10% of them had moderate levels of happiness, and none of them had a good or excellent level of happiness. Before performing the JPMR technique, the total Mean (SD) of happiness in subjects was 26.59 (8.86). After performing the JPMR technique, this value reached 37.18 (7.92). JPMR caused a statistically significant difference in the mean score of happiness in subjects after the intervention. The mean scores of happiness in older adults increased significantly after the intervention ( p < 0.001 ) [ Table 3 ].

The present study investigated the effect of the JPMR technique on the anxiety and happiness of older adults living in a nursing home. Regarding the level of anxiety of older adults living in nursing homes, the results of the present study showed that before performing the JPMR technique, all the older adults were anxious, so more than half of them had severe anxiety, and the rest had mild to moderate anxiety. In general, the level of anxiety in older adults was high, according to their scores. These results are consistent with the findings of previous studies. In the study by Levina et al. , [ 28 ] an evaluation of self-mental conditions of older adults living in a nursing home, it indicated a high level of anxiety among 51% of the subjects, and average anxiety rates among 27% of them. In a study by Elias et al . [ 29 ] on the prevalence of loneliness, anxiety, and depression in older adults living in care centers in various populations, including the United States, Norway, and Malaysia, the prevalence of anxiety was generally high among them.

In the present study, the implementation of the JPMR technique decreased the level of anxiety of older adults living in the nursing home. These results are consistent with the study results of Ghodela et al . [ 30 ] and Tak et al . [ 31 ] The results of the present study also support the findings of previous studies related to the effectiveness of JPMR in reducing the anxiety of COVID-19, [ 15 ] and leprosy patients. [ 14 ]

Regarding the happiness of older adults living in nursing homes, the results of the present study showed that before the implementation of the JPMR technique, the level of happiness of the study samples was weak and moderate, and none of them had a good or excellent level of happiness. In general, the overall happiness status of the older adults was evaluated as moderate according to the mean scores. These results are consistent with the findings of previous studies. [ 32 , 33 ] Although Hong et al . [ 34 ] found that happiness in older adults depended on a variety of individual and social factors, including income, health level, and literacy. However, it is agreed that educational and welfare programs play an important role in increasing happiness in old age.

In the present study, after performing the JPMR technique, the level of happiness of the older adults increased from weak to moderate. In addition, after the intervention, a group of the samples enjoyed a good level of happiness. In other words, the JPMR technique was useful for increasing the happiness of older adults living in the nursing home. These results are largely consistent with the findings of Alphonsa et al . [ 35 ] and Bostani et al . [ 36 ] Gaiswinkler et al . [ 37 ] also compared the effectiveness of the 6-week Mindful Self-Compassion (MSC) and PMR programs for psychiatric patients and found the MSC program more successful for increasing happiness. The results of the present study also support the results of studies related to the effectiveness of JPMR in improving the quality of life of older adults with cancer [ 38 ] and reducing depressive symptoms of aging living in nursing homes. [ 39 ] Nevertheless, Meister et al . [ 40 ] found no impact of anaerobic training on mental indices. Furthermore, Kianian et al . [ 41 ] did not find any significant differences in depression symptoms or happiness levels between aerobic and nonaerobic physical activity in nonathletic men. Differences in samples, duration of the course, and measurement tools could explain the inconsistencies with the current research.

Since the high prevalence of anxiety disorders among adults in nursing homes [ 42 ] could increase disability and diminish well-being, [ 43 ] it is necessary to pay more attention to the implementation of operational strategies that could affect psychological indicators of them. Using JPMR, which is based on the principle of muscle relaxation preceding mind relaxation, could decrease anxiety gradually in older adults, which contributes to their happiness. In particular, those living in nursing homes or hospitals could benefit from JPMR’s mental health output.

The main limitation of this study was the absence of a control group. There is only one non-profit, a public nursing home in Rasht, the capital of the Guilan province, that operates free for the elderly and disabled, and the rest are small and private. Therefore, because of this and the quarantine due to the COVID-19 pandemic, which made access to the samples difficult, the present research has been conducted in a single research environment with one group. Sampling was conducted by coordinating with nursing home officials, following health protocols, using protective equipment, and performing polymerase chain reaction (PCR) tests. Other limitations were fatigue and the unwillingness of some study samples to cooperate. By explaining the purpose and significance of the study and observing rest intervals, the researcher encouraged subjects to cooperate until the end.

The present study provides non-invasive interventions that have been demonstrated to be effective in reducing anxiety and enhancing happiness in older adults. It was found that JPMR reduced anxiety and increased happiness among the elderly living in nursing homes. The use of JPMR by trained nurses in the daily care of the elderly in nursing homes could promote healthy and active aging. Therefore, older adults will be healthier and happier, reducing overhead costs for families and society as a whole.

Financial support and sponsorship

Research and Technology Deputy of Guilan University of Medical Sciences

Conflicts of interest

Nothing to declare.

Acknowledgements

This study is the result of a master’s thesis approved by the Ethics Committee of Guilan University of Medical Sciences (code: 1399.399). Hereby, the researchers would like to express their gratitude to the Vice Chancellor for Technology and Research for approving this research project. The authors would like to thank the older adults who participated in the present study as well.

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Impact of Jacobson Progressive Muscle Relaxation (JPMR) and Deep Breathing Exercises on Anxiety, Psychological Distress and Quality of Sleep of Hospitalized Older Adults

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This study attempted to investigate the impact of JPMR and deep breathing exercises in reducing anxiety, psychological distress and improving quality of sleep among hospitalized older adults. Sixty inpatients, 30 each in experimental and control group were recruited adopting a quasi-experimental study design. To check contamination, the experimental group was recruited in the first three and the control group in the last three months. Geriatric Anxiety Inventory, K-10, and Pittsburgh Sleep Quality Index were administered. An audio taped Hindi JPMR and 4 steps breathing were used. Significant improvements were found in the experimental group in reducing anxiety, and psychological distress, and improving quality of sleep. The significant improvement in anxiety, psychological distress and quality of sleep showed the efficacy of JPMR and deep breathing exercises in management of older adults. The feasibility of integrating relaxation exercises as a part comprehensive quality care services for hospitalized older adults was highlighted.

Key words: JPMR, Deep breathing, Anxiety, Psychological distress, Quality of sleep.

INTRODUCTION

Old age is a crucial period of life during which mental health related problems may become a cause or an effect of various physical health related problems, amongst which anxiety (Wolitzky-Taylor, et al., 2010), psychological distress (Joshi, Kumar & Avasthi, 2003; Rabinowitz, et al., 2005) and sleep difficulties (Lindstrom, et al., 2012) are commonly reported. The association of anxiety disorders are moderately associated with reduced sleep quality resulting in poor the quality of life (Ramsawh, et al., 2009). Recently, studies revealed significant association between higher anxiety, depression and poor sleep quality in elderly chronically ill (Suh, et al., 2013). However, remaining active was associated with lesser psychological distress (Yorston, et al., 2012). A review of 106 articles on sleep problems among older adults reported the common problems as waking up too early, trouble falling asleep, daytime napping, and multiple nocturnal awakenings (Cochen, et al., 2009).

Among the non-pharmacological interventions, deep breathing and other relaxation exercises (such as Jacobson Progressive Muscle Relaxation - JPMR) have been found to be effective in for various categories of hospitalized population such as cancer patients on chemotherapy (Lee, et al., 2012; Hayama & Inoue, 2012), patients with gynecological diseases (Pan, et al., 2012; Zhao, et al., 2012), patients with COPD (Singh, et al., 2009) and coronary...

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• DOI: 10.37506/MLU.V21I2.2811
• Corpus ID: 234862124

Effectiveness of Jacobson’s Progressive Muscle Relaxation (JPMR) on Hypertension among School going Adolescents

• Rajagopal Manjushambika , B. Prasanna , +1 author B. Sushama
• Published in Medico-Legal Update 12 March 2021

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Exploring Jacobson’s Progressive Muscle Relaxation (JPMR)

Introduction: what is jpmr.

In our modern world, stress has become an unwelcome companion, affecting our well-being. To combat this, numerous relaxation techniques have emerged, and one such method is Jacobson’s Progressive Muscle Relaxation (JPMR). In this brief blog, we delve into the origins of JPMR, its benefits, and how you can integrate it into your daily routine for a more serene and harmonious life.

How does JPMR work?

JPMR works by systematically tensing and relaxing muscle groups, reducing muscle tension and promoting deep physical and mental relaxation, which can help alleviate anxiety and stress. This relaxation technique enhances self-awareness and helps individuals recognize and release unnecessary muscle tension. By engaging in the deliberate sequence of muscle contraction and release, JPMR taps into the mind-body connection, promoting a state of calmness and providing individuals with a sense of control over their physiological responses. Regular practice of JPMR can lead to improved stress management, reduced anxiety levels, and an overall sense of well-being.

Benefits of JPMR:

JPMR offers an array of benefits for both physical and mental health. By sequentially tensing and relaxing specific muscle groups, JPMR helps individuals develop an enhanced awareness of their body’s response to stress and tension. This heightened awareness serves as a valuable tool for managing anxiety, reducing muscle tension, and promoting overall relaxation.

Research has shown that regular practice of JPMR can yield numerous positive outcomes. It has been found effective in reducing symptoms of anxiety disorders, insomnia, and chronic pain. Furthermore, JPMR has been observed to improve overall psychological well-being, leading to increased self-control, improved concentration, and better coping mechanisms during stressful situations.

Implementing JPMR into your daily routine is a simple and accessible process. Follow these steps to get started:

1. Find a quiet and comfortable space where you can relax without interruptions.

2. Close your eyes and take a few deep breaths to center yourself.

3. Begin by focusing on a specific muscle group, such as your hands or feet.

4. Slowly tense the muscles in that group for 5-10 seconds, feeling the tension build up.

5. Release the tension suddenly and completely, allowing the muscles to relax and unwind.

6. Take a moment to experience the sensations of relaxation before moving on to the next muscle group.

7. Gradually work your way through your entire body, moving from one muscle group to another, repeating the tension-release cycle.

Remember to start with the muscles in your face, jaw, neck, shoulders, and then progress downwards, including your arms, chest, abdomen, back, and legs. The key is to focus on each muscle group individually, allowing yourself to fully experience the contrast between tension and relaxation.

Jacobson’s Progressive Muscle Relaxation is a valuable technique for managing stress, anxiety, and promoting overall relaxation. With its origins rooted in the research of Dr. Edmund Jacobson, JPMR has garnered recognition for its ability to alleviate muscle tension, enhance self-awareness, and improve mental well-being. By integrating JPMR into your daily routine, you can unlock a path towards tranquility and a more balanced life.

Written by Neha Gurung and Varshini

References:

1.Jacobson,E.(1938).Progressive Relaxation: A Physiological and Clinical Investigation of Muscular States and Their Significance in Psychology and Medical Practice. University of Chicago Press.

2.Harvard Health Publishing. (2020). Relaxation techniques: Breath control helps quellerrant stress response. Harvard Medical School. https://www.health.harvard.edu/mind-and-mood/relaxation-techniques-breath-control-helps-quell-errant-stress-response

3.Jain, S., Shapiro, S. L., Swanick, S., Roesch, S.

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Comparative Study of the Efficacy of Biofeedback-Assisted Jacobsons Progressive Muscle Relaxation (Jpmr) for Managingmild/Moderate Depression

Swayamprava prava baral, Gyanendra Raghuvanshi, Abhay paliwal

This is a preprint; it has not been peer reviewed by a journal.

https://doi.org/ 10.21203/rs.3.rs-744964/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Biofeedback is the way of gaining greater awareness of physiological functions with a goal of self-regulation. JPMR (Jacobsons progressive muscle relaxation) causes release of tension in the skeletal muscles, neuro-muscular system is thus seen as a mediator in the relief of depressive symptoms. This study aimed to see the Comparative efficacy of Biofeedback assisted JPMR, Escitalopram and Bimodal use of both in management in mild/moderate depression. The study was conducted at Mental hospital, Indore, with a Sample Size of 30 [ Group A 10 ; biofeedback , Group B 10 ; Escitalopram , Group C 10;both]. 8 sessions of biofeedback assisted JPMR was given to group A and C .Escitalopram was given group B and C. HAM-D and BDI was applied at baseline , 4 weeks and 8 weeks. As per BDI scale scores, Biofeedback assisted JPMR combined with escitalopram has significantly better response than only biofeedback or only Escitalopram in patients of mild to moderate depression. As per HAM-D scale scores, Biofeedback assisted JPMR combined with escitalopram has significantly better response than only biofeedback or only Escitalopram in patients of mild to moderate depression.  Thus Biofeedback appears to be a useful adjunctive treatment for mild to moderate depressive episode. 

Biofeedback

Summary Points

• Biofeedback is the way of gaining greater awareness of  physiological functions with a goal of self-regulation.
• JPMR   (Jacobsons progressive muscle relaxation) causes release of tension in the skeletal muscles, neuro-muscular system is thus seen as a mediator in the relief of depressive symptoms
• As per HAM-D scale scores, Biofeedback assisted JPMR combined with escitalopram has significantly better response than only biofeedback or only Escitalopram in patients of mild to moderate depression
• Thus Biofeedback appears to be a useful adjunctive treatment for mild to moderate depressive episode. 

1. Introduction

Biofeedback is the process of gaining greater awareness of many physiological functions by using instruments that provide information on the activity of those same systems( ( EEG, EMG, GSR, PR, TEMP, RESP) , with a goal of being able to change them at will (Barlow et al.,2016) .  A growing body of research indicates that autonomic nervous systemdysfunction in depression ( Veith et al., 1994; Carney et al., 2005).The Bio-feedback method aims to counteract the effects of SympatheticNervous System by promoting the action of the Parasympathetic Nervous System(Benson et al.,1974).

Before Biofeedback:  Sympathetic arousal,Beta activity in EEG, Muscular constriction in EMG, Shallow and rapid respiratory curves in Pneumograph, Increased resistance in GSR, Vasoconstriction in thermal feedback, Increased Noradrenalin secretion After Biofeedback:  Parasympathetic dominance, Alpha activity in EEG, Muscular relaxation in EMG,Deep and regular respiratory curves in Pneumograph, Decreased skin resistance in GSR ,Vasodilatation in Thermal feedback,Acetylcholine secretion.

Most patients are trained to relax and modify their behaviour in biofeedback. Stressful events produce strong emotions, which arouse certain physiological responses. Many experts believe that these individual responses to stress can become habitual.When the body is repeatedly aroused, one or more functions may become permanently overactive. Actual damage to bodily tissues may eventually result (Lazarus and Folkman,1984). Biofeedback is often aimed at changing the habitual reactions to stress that can cause pain or disease. Many clinicians believe that some of their patients have forgotten how to relax. Feedback of physical responses such as skin temperature and muscle tension provides information to help patients recognize a relaxed state. The feedback signal may also act as a kind of reward for reducing tension.

In a health care environment that where cost containment and evidence-based practice are important, biofeedback provides an effective way of non-pharmacological management in neurotic disorders like mild-moderate depression that comprises of maximum percentage of depressive disorders. Moreover it is not associated with any side effects or pain and has long term effect.   Yucha and Montgomery’s (2008) ratings are listed for the five levels of efficacy recommended by a joint task force and adopted by the Boards of Directors of the Association for Applied Psychophysiology (AAPB) and the International Society for Neuronal Regulation (ISNR) (Vaque et al., 2002). For depression it was Level 2 (Possibly Efficacious).   This study aims to demonstrate that biofeedback achieves comparable efficacy as that of pharmacological methods.

2.1: Study Objectives

Efficacy of Biofeedback assisted JPMR in management of patients with mild/moderate depression.

Comparative efficacy of Biofeedback assisted JPMR, Escitalopram and bimodal use of both in management in mild/moderate depression

2.2  Subjects And Design

It was a comparative longitudinal study conducted at   mental hospital,dept of psychiatry, mgmmc , indore, biofeedback unit. Randomized sampling technique was used to recruit 30 subjects divided into Group A10Depression patients on biofeedback, Group B   10 Depression patients on antidepressant (Escitalopram) ,Group C   10 Depression patients on biofeedback + antidepressant(Escitalopram)

2.3 Inclusion criteria:  Diagnosis of Depression (F32 Depressive Episode or F33 Recurrent Depressive Episode, mild and moderate, except severe depression, depression with psychotic symptoms, depression with suicidality) according to ICD 10 (DCR). Patient aged between 18-60 yrs, either sex, who were drug naïve or drug free for 3 months.Patients giving written, informed consent.

2.4 Exclusion criteria:  Any co-morbid psychiatric illness, h/o substance dependence, Head injury, epilepsy, SOL, any medical co-morbidity like .hypertension, endocrinological disorder (hypothyroidism, hyperthyroidism, cushing syndrome, diabetes mellitus,), Pregnancy and lactation, Current use of anti-hypertensive drugs, steroid hormones, growth hormone, anabolic steroids, retinoids, antipsychotics, Sedatives, immunosuppresants and immunomodulatory agents.

2.5 Tools: Informed Consent Form, Socio Demographic and Clinical Data Sheet, General Health Questionnaire 12, Hamilton depression rating scale, Beck Depression Inventory BIOFEEDBACK MACHINE –RELAX 701, Biofeedback workbook

2.6 PROCEDURE: 

Subjects were recruited from mental hospital indore, fulfilling the inclusion and exclusion criteria. Written informed consent was taken after explaining the objectives and procedure of study in detail. Detailed physical examination was done to rule out any medical or neurological abnormality. The diagnosis of depression was made using the ICD -10. 1 st session wasintroductory session which involved explaining the patients details of the study procedure. Group B and C patients were given escitalopram in optimum dosage. For group A and C, Next Sessions involved 20-25 minutes of abdominal breathing and   biofeedback guided JPMR and parameters (alpha-EEG, EMG, GSR, PR ,RR, TEMPERATURE) were recorded using the biofeedback machine. Recorded audio was used for guided JPMR. Sessions were repeated once a week and continued upto two months. Rest 6 days of the week patients had to practice the techniques at home without biofeedback. Records of changes of all the parameters of all patients (all the 3 groups) through subsequent weeks was maintained in biofeedback computer. HAM-D was applied to all patients at baseline, 4weeks and 8weeks.

3. Results And Discussion

The mean age, in years, of patients in group A was 31.34±11.21 years. The mean age, in years, of patients in group B was 33.1±11.33 years. The mean age, in years, of patients in group C was 31.52±11.11 years.(table 2) Patients were more likely to have low socioeconomic status (table 2) , an urban background, and be educated up to primary school and mostly Hindu, married, and from joint family. There was no statistically significant difference among the groups in gender, habitat, education or marital status (table 1).

The mean age of onset of depression in patient group A was 28.64±8.76 years. The mean age of onset of depression in patient group B was 27.66±9.20 years. The mean age of onset of depression in patient group C was 29.66±9.44 years. The mean duration of illness in patient group A was45.48± 46.08 months. The mean duration of illness in patient group B was 53.64±45.49 months. The mean duration of illness in patient group C was 48.44± 40.55 months (table 3). Most patients had precipitating factors, had no past history, had no family history and had acute onset of illness (table 4).

For group A, the HAM-D score was 11 at baseline, 7 at 1 month, and 4 at 2 months. For group B, the mean HAM-D score was 11 at baseline, 8 at 1 month, and 4 at 2 months. For group C, the mean HAM-D score was 11 at baseline, 7 at 1 month, and 3at 2 months. (table 5) For group A, the mean BDI score was 15 at baseline, 12at 1 month, and 10 at 2 months. For group B, the mean BDI score was 15 at baseline, 12 at 1 month, and 10 at 2 months. For group C, the mean BDI score was 15 at baseline, 12at 1 month, and 8 at 2 months 8 (table 6).

Significant improvements were noted in the Hamilton Depression Scale (HAM-D) and the Beck Depression Inventory (BDI) by Session 4, and further significant improvement was noted between session 4 and session 8 in patients in all groups.

The difference in BDI score (baseline vs 8 th session) was significantly greater  in group C (biofeedback +escitalopram) than in groups A (only biofeedback)and B (only escitalopram).The difference in BDI score (baseline vs 8 th session) was equal for group A (only biofeedback) and group B (only escitalopram).The difference in BDI score (baseline vs 4th session) was significantly  greater in group C (biofeedback +escitalopram) than in groups A (only biofeedback)and B (only escitalopram).The difference in BDI score (baseline vs 4th session) was significantly greater for group B (only escitalopram) than for group A(only biofeedback).The difference in BDI score (4th session vs 8 th session) was significantly  greater in group C (biofeedback +escitalopram) than in groups A (only biofeedback) and B (only escitalopram). The difference in BDI score (4th session vs 8 th session) was equal for group A (only biofeedback) and group B (only escitalopram).

Therefore , according to BDI scale scores,  biofeedback- assisted JPMR combined with escitalopram as a treatment modality produces a  better response than  biofeedback alone or SSRIs alone (escitalopram ) in patients  with  mild to moderate depression.

Biofeedback - assisted JPMR produces  an  equal response compared  to  escitalopram in patients  with  mild to moderate depression.

The difference in HAM-D score (baseline vs 8 th session) was greater in group C (biofeedback +escitalopram) than in groups A (only biofeedback) and B (only escitalopram).The difference in HAM-D score (baseline vs 8 th session) was greater for group B (only escitalopram) than for group A (only biofeedback). The difference in HAM-D score (baseline vs 4th session) was greater in group C (biofeedback +escitalopram) than in groups A (only biofeedback) and B (only escitalopram). The difference in HAM-D score (baseline vs 4th session) was greater in group A (only biofeedback) than in group B (only escitalopram). The difference in HAM-D score (4th session vs 8 th session) was significantly  greater in group C (biofeedback +escitalopram) than in groups A (only biofeedback) and B (only escitalopram). The difference in HAM-D score (4th session vs 8 th session) was significantly  greater for group B (only escitalopram) than for group A (only biofeedback).

Therefore , according to HAM-D scale scores,  biofeedback- assisted JPMR combined with escitalopram as a treatment modality produces  a  better response than  biofeedback alone or SSRIs alone (escitalopram ) in patients  with  mild to moderate depression.

According to HAM-D scale scores,biofeedback-assisted JPMR produces more response than escitalopram in patients with mild to moderate depression after 1 month(4 th session), but produces less of a response than escitalopram between 1 to 2 months (between 4 th and 8 th session).

This finding can be explained by the fact  that antidepressant  action needs 2 to 3 weeks ,  but biofeedback - assisted JPMR acts immediately by inducing relaxation and reducing sympathetic tone.

Therefore, considering  the overall improvement in symptoms for patients assessed using both HAM-D and BDI,  biofeedback- assisted JPMR combined with  SSRIs (escitalopram ) as a treatment modality produces  a  better response than  biofeedback alone or SSRIs alone (escitalopram ) in patients  with  mild to moderate depression.

 Only biofeedback is also a successful treatment for mild-moderate depression.

Moreover, it is not associated with any side effects or pain and has long-term effects. It improves overall relaxation for all parameters (i.e., EEG, EMG, GSR, PR, TEMP, RESP) over subsequent sessions.

The findings of this study are substantiated by the findings of previous studies. ‘ Preliminary case studies (Kumano et al., 1996; Rosenfeld, 2000) and pilot studies (Waldkoetter & Sanders, 1997) show neurofeedback  decreases depressive symptoms. One study compared biofeedback-assisted relaxation to a wait-list control on depression in chronic pain patients and  improved scores on the Beck Depression Index was found (Corrado & Gottlieb, 1999).

Physiological arousal is governed by the ANS. When the organism is under threat the SNS (Sympathetic Nervous System) increases arousal on the other hand the PNS (Parasympathetic Nervous System) restores the body to a resting state. These actions are involuntary and enable the organism to survive. When the activity of SNS is prolonged and the organism is exposed to constant threat the organs concerned can become fatigued. The Bio-feedback method aims to counteract the effects of SNS by promoting the action of the PNS ( Basmajian, 1979).

Neuro-therapists have used EEG biofeedback when treating addiction, attention deficit hyperactivity disorder (ADHD),learning disabilities, anxiety disorders (including worry, obsessive-compulsive disorder and posttraumatic stress disorder), depression, migraines, and generalized seizures ( Yucha & Montgomery, 2008).

HRV biofeedback may be useful for reducing loss of energy, lack of motivation, sleep disturbances or any of the other neuro-vegetative features of MDD. As an inexpensive, safe, and noninvasive technique, it may prove to be a useful alternative to some medical or surgical interventions (Karavidas et al., 2007)

Conclusions

On the basis of the index study, which substantiate the earlier findings of previous studies, it can be concluded that:

Biofeedback is a useful adjunctive treatment for mild to moderate depressive episode.

Biofeedback assisted JPMR is a successful non-pharmacological modality for treatment of mild-moderate depression.

So, non-pharmocological methods like biofeedback should be added to pharmacological management of mild-moderate depression.

This the only study of its kind that compared the response three groups (only biofeedback ,only escitalopram and both).

Previous studies had conducted fewer sessions of biofeedback.

LIMITATIONS

Sample size could have been larger.

FUTURE DIRECTIONS

Further studies with larger sample size and more sessions of biofeedback assisted JPMR should be conducted in patients of depression as well as other psychosomatic illness.

Biofeedback is applicable not only for people suffering from any psychological or physiological disorders, but also applied on normal healthy individuals as Peak Achievement Training for improving attention and concentration. So further studies should be done in this regard.

Declarations

Acknowledgment: Authors wish to thank department of psychiatry MGM Medical College Indore.

Competing interests:  None

Funding: There was no funding for this article

There is no conflict of interests.         

Ethical Approval :  THE STUDY WAS APROVED BY INSTITUTIONAL ETHICAL COMMITEE MGMMC INDORE.

Funding: There was no funding for this article. There is no conflict of interest.

Authors contribution : dr S. P . baral and dr G. Raghuvanshi collected the data and analysed the date and compiled it. Dr A paliwal guided the project.

Consent for publication  was obtained from each author and the institution.

• Basmajian, J. V. (1979). Biofeedback: Principles and practice for clinicians . Williams & Wilkins.
• Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory-II. San Antonio, 78(2), 490-498.
• Benson, H., Beary, J. F., & Carol, M. P. (1974). The relaxation response. Psychiatry, 37(1), 37-46.
• Carney, R. M., Freedland, K. E., &Veith, R. C. (2005). Depression, the autonomic nervous system, and coronary heart disease. Psychosomatic medicine , 67 , S29-S33.
• Corrado, P., & Gottlieb, H. (1999). The effect of biofeedback and relaxation training on depression in chronic pain patients. American Journal of Pain Management, 9, 18-21.
• Damasio, A. (2012). Emotions create our preference: the somatic marker hypothesis. Neurorelay. Recuperado de: http://neurorelay. com/2012/05/15/emotions-create-our-preferences-the-somatic-marker-hypothesis.
• Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2016). Abnormal psychology: An integrative approach . Cengage learning.
• Hamilton, M. Journal of Neurology, Neurosurgery, and Psychiatry. 23:56-62, 1960.
• Jacobson, E. (1938). Progressive muscle relaxation. Interview Behaviour". Journal of Abnormal Psy-University of Chicago Piess, Chicago. chology, 75(1), 18.
• Karavidas M. K., Lehrer P. M., Vaschillo E. G., Vaschillo B., Marin H., Buyske S. et al. (2007). "Preliminary results of an open-label study of heart rate variability biofeedback for the treatment of major depression". Applied Psychophysiology and Biofeedback 32 (1): 19–30.doi:10.1007/s10484-006-9029-z. PMID 17333315.
• Kumano, H., Horie, H., Shidara, T., Kuboki, T., Suematsu, H., & Yasushi, M. (1996). Treatment of a depressive disorder patient with EEG-driven photic stimulation. Biofeedback and self-regulation, 21(4), 323-334.
• Lazarus, R. S., &Folkman, S. (1984). Stress, appraisal, and coping . Springer publishing company.
• Rosenfeld, J. P. (2000). An EEG biofeedback protocol for affective disorders. Clinical Electroencephalography, 31(1), 7-12.
• Vaque, T. J. L., Hammond, D. C., Trudeau, D., Monastra, V., Perry, J., Lehrer, P., ...& Sherman, R. (2002). Template for developing guidelines for the evaluation of the clinical efficacy of psychophysiological interventions. Journal of Neurotherapy, 6(4), 11-23.
• Veith, R. C., Lewis, N., Linares, O. A., Barnes, R. F., Raskind, M. A., Villacres, E. C., ...&Pascualy, M. (1994). Sympathetic nervous system activity in major depression: basal and desipramine-induced alterations in plasma norepinephrine kinetics. Archives of general psychiatry , 51 (5), 411-422.
• Waldkoetter, R. O., & Sanders, G. O. (1997). Auditory brainwave stimulation in treating alcoholic depression. Perceptual and Motor Skills, 84(1), 226-226.
• What is biofeedback? Association for Applied Psychophysiology and Biofeedback. 2008-05-18. Retrieved 2010-02-22.
• Yucha, C., & Montgomery, D. (2008). Evidence-based practice in biofeedback and neurofeedback. Wheat Ridge, CO: AAPB.

TABLE  1:  COMPARISON OF SOCIODEMOGRAPHIC VARIABLES BETWEEN   THE GROUPS

TABLE  2:  COMPARISON OF SOCIO-DEMOGRAPHIC PROFILE BETWEEN  THE GROUPS  (CONTINUOUS VARIABLES)

TABLE 3: CLINICAL CHARACTERISTICS OF THE DEPRESSION PATIENTS (CONTINUOUS VARIABLES )

TABLE 4: CLINICAL CHARACTERISTICS OF THE DEPRESSION      PATIENTS(CATEGORICAL VARIABLES)

TABLE5: COMPARISON OF HAM-D SCORES 

TABLE6: COMPARISON OF BDI  SCORES

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• Iran J Nurs Midwifery Res
• v.29(1); Jan-Feb 2024
• PMC10849282

Effect of Jacobson’s Progressive Muscle Relaxation on Anxiety and Happiness of Older Adults in the Nursing Home

Zahra asgari tapeh.

1 Department of Nursing, Zeyinab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran

Azar Darvishpour

2 Social Determinants of Health (SDH) Research Center, Guilan University of Medical Sciences, Rasht, Iran

Fereshteh Besharati

Bahare gholami-chaboki.

3 Cardiovascular Research Center, Guilan University of Medical Sciences, Rasht, Iran

Background:

Older adults encounter serious psychological challenges in addition to physical problems. Reducing stress and anxiety, along with promoting happiness, is critical to maintaining the mental health of the elderly. Jacobson’s Progressive Muscle Relaxation (JPMR) will lead to peace of mind by relieving physical stress. The present study aimed to investigate the effect of JPMR on the anxiety and happiness of older adults.

Materials and Methods:

A single-group pretest-posttest design as a type of quasi-experimental study was conducted on 34 older adults living in a nursing home in Rasht, the north of Iran, in 2021. The intervention was performed one session per week, for 8 weeks. The research instruments included the Geriatric Anxiety Inventory (GAI) and the Oxford Happiness Inventory (OHI). Descriptive statistics and the Wilcoxon test were used for data analysis.

After the intervention, the Mean (Standard Deviation [SD](of anxiety was 4.91 (1.96), and the Mean (SD) (of happiness was 37.18 (7.92). The mean score of anxiety among older adults after the intervention was significantly lower compared to the before intervention ( Z = −4.73, p < 0.001). In addition, the mean score of happiness of the samples after the intervention was significantly higher compared to the before intervention ( Z = −5.09, p < 0.001).

Conclusions:

JPMR has a positive effect on reducing anxiety and promoting happiness in the elderly. Developing training programs and allocating time to non-pharmacological treatments such as JPMR for the elderly living in nursing homes will help make them happier and healthier.

Introduction

Anxiety is one of the most prevalent mental disorders among older adults.[ 1 ] The prevalence of anxiety disorders in older adults living in nursing homes is higher than others and varies from 3.2 to 20%.[ 2 ] Typical amounts of anxiety increase attention, but if not controlled, in addition to negative impacts on physical health, it could have adverse consequences such as reduced quality of life, emotional suffering, loss of interest,[ 3 ] and also disruption of performance.[ 4 ] As most countries around the world have entered the status of aging society, anxiety as a prevalent and important challenge in late-life raises the numbers accessing health care, and individual and social costs.[ 5 ] In contrast, happiness could be a barricade against the impact of negative feelings among the elderly, especially residents living in nursing homes.[ 6 ] This is while physical deprivation and anxiety in old age could induce unhappiness and trigger depression in the elderly.[ 7 ] Happiness as a positive emotion increases the ability to cope with mental burdens,[ 8 ] plays a vital role in raising physical and mental health,[ 9 ] and can predict longevity and survival among older adults by correlating with life satisfaction and quality of life.[ 10 ] Despite the significant advances in human comfort facilities, his happiness could be negatively affected by age and functional limitations.[ 11 ]

Avoiding stress and anxiety concurrent with increasing happiness, especially in old age, is on the public health agenda around the world.[ 12 ] Therefore, it is important to investigate interventions that reduce anxiety and increase happiness in older adults as, the most vulnerable group. A previous study indicated that physical activity could diminish negative feelings and improve positive ones, such as happiness.[ 13 ] One of the most common relaxation techniques is progressive muscle relaxation, developed by Edmund Jacobson in the 1920s.[ 14 ] Jacobson’s progressive muscle relaxation (JPMR) involves exercises in which selected muscle groups respectively first contract and then expand to achieve a state of deep relaxation. In fact, JPMR is based on the rule that muscle relaxation brings peace of mind.[ 15 ] With low muscle strength, no need for special equipment, easy learning, and low cost,[ 16 ] JPMR as a non-pharmacological intervention can be utilized in elderly care, treatment, and education programs.[ 15 , 17 ] Previous studies conducted on JPMR have shown its effectiveness in reducing depression[ 18 ] and insomnia in older adults,[ 19 ] increasing the quality of life, and adaptation to old age.[ 20 ] Despite JPMR studies, the knowledge about the effect of this technique on psychological indicators such as anxiety and happiness of older adults living in nursing homes is limited. Therefore, considering the different structures of nursing homes in different countries and the accelerating trend of the aging population, the present study aimed to investigate the effect of JPMR on the anxiety and happiness of older adults living in a nursing home. It was hypothesized that JPMR would decrease anxiety and increase the happiness of the elderly living in the nursing home.

Materials and Methods

This is a clinical trial study of quasi-experimental type (IRCT20190315043062N3) with a single-group pretest-posttest design, which was conducted in a nursing home in Rasht, the north of Iran, in 2021. This type of study is commonly used to study design. First, a single pretest measurement is taken, followed by an intervention, and then a posttest measurement is taken.[ 21 ]

The subjects in this study were older adults living in a nursing home. Due to the limited number of elderly people who met the entry criteria, the sample size was not calculated, and as shown in the Consolidated Standards of Reporting Trials (CONSORT) flowchart in Figure 1 , finally, the information of 34 older adults was analyzed. Inclusion criteria included age of 60 years and older, having normal cognition status (a score of eight or more on the Abbreviated Mental Test (AMT),[ 22 ] informed consent to participate in the study, physical ability to perform JPMR, no use of anti-anxiety drugs, absence of cardiopulmonary, and no previous experience with the technique. The exclusion criterion was the absence from training sessions. Figure 1 shows the number of participants who reached the final stage of data analysis.

Consolidated Standards of Reporting Trials (CONSORT) flow diagram of participants. * Abbreviated Mental Test. **Jacobson Progressive Muscle

As shown in Figure 1 , out of 182 elderly people living in a nursing home, 174 who were older than 60 years with normal cognition status and physically able to perform JPMR were recruited. The study protocol was announced to the older adults by one of the researchers of our research team. One hundred thirty-eight of the older adults were excluded from the research because of using anti-anxiety drugs and having a cardiopulmonary disease that would affect undertaking JPMR training during the program or any cognitive problems that could impede the elderly from understanding and answering the content of the informed consent and questionnaires. Therefore, 36 of the samples entered the JPMR training. During the 8 weeks of the training, two of the samples were not willing to continue the exercise and quit the research, so 34 samples completed the JPMR exercise.

The tools included three questionnaires. The Geriatric Anxiety Inventory (GAI) was designed by Pachana et al .[ 23 ] was used to measure anxiety. This scale has 20 items based on a 2-point scale (agree = score 1, disagree = score zero). The total score varied between zero and 20, and a score of 0–7 was considered as mild to moderate anxiety, and a score of 8 or 9 and above was considered severe anxiety. The validity and reliability of this scale were confirmed in a study on Iranian older adults. The exploratory factor analysis showed the questionnaire that jointly explained 59.48% of the overall variance observed. The findings indicated a positive and significant correlation between the two measures, lending support to its concurrent validity ( r = 0.67, P < .001). Ultimately, the GAI was found to have a favorable internal consistency.[ 24 ] The Oxford Happiness Inventory (OHI) is used to measure happiness. This tool has 29 items based on a 4-point Likert scale (not at all = score zero, low = score 1, high = score 2, and very high = score 3). The total score range varied from 0 to 87. A score of 0–25 was considered poor happiness, a score of 26–50 was considered moderate happiness, a score of 51–75 was considered good happiness, and a score of 76 and above was considered high happiness. In previous studies, the validity and reliability of this scale in Iran have been confirmed.[ 25 ] In the present study, the reliability of the tools was calculated by internal consistency in 20 older adults living in nursing homes. Cronbach’s alpha coefficient was 0.89 for GAI and 0.86 for OHI.

The cognitive status of the samples was investigated using the AMT, and a score of 7 or higher was considered as having no cognitive problem. The findings of a study conducted among Iranian older adults confirmed that the Persian version of the AMT is a valid tool for assessing cognitive function. The Cronbach’s alpha coefficient of this scale was 0.90. Scores 6 and 7 showed the optimum balance between sensitivity (99% and 94%, respectively) and specificity (85% and 86%, respectively).[ 22 ]

Before the intervention and in the 8 weeks of the intervention, the researcher, through face-to-face interviews using the tools, measured the anxiety and happiness of the samples. Each question was read to the samples, and the options were selected based on their responses. To avoid participant fatigue, data were collected at intervals and over time.

In this study, first, a training session was held for each of the subjects to introduce the JPMR technique, its effects, and how to do it. Then, for 8 consecutive weeks, a session of the JPMR technique was performed per week for 20 min individually in a room in the nursing home under the supervision of the researcher. When the individual was put in where his/her head and back were in a comfortable position (sitting), he/she was asked to close the eyes and take a few deep breaths. Then, the muscle groups (wrist, arm, forehead, eyes, jaw, shoulders, back, chest, abdomen, legs, and toes, respectively) contract symmetrically for approximately 10–15 s (inhalation) and then expand for 15–20 s (exhalation). The exercise was repeated two to three times for each muscle group. In the end, with a few deep breaths and the researcher countdown, five to one, the exercise was completed.[ 15 ]

The intervention (JPMR) was designed by the research team based on valid references.[ 14 , 26 , 27 ] One researcher (Master of Elderly Nursing) devoted a month to learning and studying the JPMR technique, about how it works, its effects, and possible side effects, and took steps to gain acceptable mastery of the technique. Therefore, she provided the intervention. After choosing a specific day of the week, she was at the nursing home at certain times during that day to perform the JPMR technique for the samples under the supervision of an ergo therapist at the nursing home. She taught the JPMR technique to the participants, and the progressive muscle relaxation (PMR) was done under her supervision. She had full control over how the intervention (JPMR technique) was performed by the samples in the training session and then through the whole eight intervention sessions.

After selecting the eligible samples to enter, the study informed consent to participate in the research was obtained from them. To obtain informed consent, the researcher first explained the purpose and method of the study to the participants. The researcher then gave the consent form, which was written in plain language, to the samples that agreed to participate in the study, and asked the samples to read it. For the illiterate, the researcher read this form. After confirming that the samples understood the content of the consent form, they were asked to participate in the study and sign the consent form. To implement the intervention, at first, an individual training session was held for each sample in their room. During the training session, sufficient explanations were given to the samples about the JMPR technique, its effects, and implementation steps. In addition to practicing the JPMR technique, the contents were repeated several times, and the researcher answered the samples’ questions. By ensuring that the samples had learned the JPMR technique correctly, a fixed day per week (Saturdays) was set aside to perform the intervention, which ensured equal and comparable conditions for all samples.

The JPMR technique was performed for 8 weeks, one session per week, with a fixed duration (20 min), individually, by the elderly on their bed in a nursing home in Rasht, with the supervision of the responsible researcher for the intervention. The educational content, intervention method, frequency, and duration of the intervention sessions were the same for all samples. The frequency and duration of intervention were monitored using a stopwatch and finger counting.

Data analysis was conducted using SPSS (Statistical Package for the Social Sciences) software version 22 (IBM, Chicago, USA), descriptive statistics (mean, standard deviation), and inferential statistics. The Wilcoxon test was used to compare the level of anxiety and happiness before and after the intervention.

To compare the mean scores of anxiety and happiness before and after the intervention, due to the abnormal distribution of anxiety, the Wilcoxon test was used, and, according to the normal distribution of happiness, a paired t -test was used. The significance level in all tests was considered 0.05.

Ethical consideration

This study is the result of a master’s thesis approved by the Ethics Committee of Guilan University of Medical Sciences in Rasht, Iran (Ethics code No: IR.GUMS.REC. 1399.399). According to the principles of research ethics, all ethical principles are observed in this article. Participants were reminded that at each stage of the study, they could refuse to continue their cooperation if they did not want to. They were also reminded that, if they wished, the results of the research would be made available to them and that their information would be kept confidential.

Most of the subjects were 60 to 74 years old (70.60%), male (58.80%), and illiterate (55.90%). Half of them had lost their spouse (50%), and more than half of them had been living in a nursing home for 1 to 5 years (52.90%). The majority of the subjects had at least one underlying disease (70.60%) and reported their economic situation as moderate-income (61.80%) [ Table 1 ].

Demographic characteristics of the older adults living in the nursing home ( n =34)

Before performing the JPMR technique, all subjects had anxiety; 58.80% had severe levels of anxiety, and 41.20% had mild to moderate levels of anxiety. Before performing the JPMR technique, the total Mean (Standard Deviation (SD)) of anxiety in subjects was 10.41 (5.24). After performing the JPMR technique, this value reached 4.91 (1.96). JPMR caused a statistically significant difference in the anxiety mean score of subjects after the intervention. The mean scores of anxiety in older adults were reduced significantly after the intervention ( Z = −4.73, p < 0.001 ) [ Table 2 ].

Levels and mean scores of anxiety in older adults before and after the intervention Jacobson Progressive Muscle (JPMR)

Note: *Relative percentage changes in mean scores before and after the intervention ((After-Before)/Before) ×100, **Wilcoxon JPMR=Jacobson’s progressive muscle relaxation JPMR, SD=Standard deviation

Before performing the JPMR technique, 52.9% of the subjects had poor levels of happiness, 47.10% of them had moderate levels of happiness, and none of them had a good or excellent level of happiness. Before performing the JPMR technique, the total Mean (SD) of happiness in subjects was 26.59 (8.86). After performing the JPMR technique, this value reached 37.18 (7.92). JPMR caused a statistically significant difference in the mean score of happiness in subjects after the intervention. The mean scores of happiness in older adults increased significantly after the intervention ( p < 0.001 ) [ Table 3 ].

Levels and mean scores of happiness in older adults before and after the intervention (JPMR)

Note: *Relative percentage changes in mean scores before and after the intervention ((After-Before)/Before) ×100, ** Wilcoxon JPMR=Jacobson’s progressive muscle relaxation JPMR, SD=Standard deviation

The present study investigated the effect of the JPMR technique on the anxiety and happiness of older adults living in a nursing home. Regarding the level of anxiety of older adults living in nursing homes, the results of the present study showed that before performing the JPMR technique, all the older adults were anxious, so more than half of them had severe anxiety, and the rest had mild to moderate anxiety. In general, the level of anxiety in older adults was high, according to their scores. These results are consistent with the findings of previous studies. In the study by Levina et al. ,[ 28 ] an evaluation of self-mental conditions of older adults living in a nursing home, it indicated a high level of anxiety among 51% of the subjects, and average anxiety rates among 27% of them. In a study by Elias et al .[ 29 ] on the prevalence of loneliness, anxiety, and depression in older adults living in care centers in various populations, including the United States, Norway, and Malaysia, the prevalence of anxiety was generally high among them.

In the present study, the implementation of the JPMR technique decreased the level of anxiety of older adults living in the nursing home. These results are consistent with the study results of Ghodela et al .[ 30 ] and Tak et al .[ 31 ] The results of the present study also support the findings of previous studies related to the effectiveness of JPMR in reducing the anxiety of COVID-19,[ 15 ] and leprosy patients.[ 14 ]

Regarding the happiness of older adults living in nursing homes, the results of the present study showed that before the implementation of the JPMR technique, the level of happiness of the study samples was weak and moderate, and none of them had a good or excellent level of happiness. In general, the overall happiness status of the older adults was evaluated as moderate according to the mean scores. These results are consistent with the findings of previous studies.[ 32 , 33 ] Although Hong et al .[ 34 ] found that happiness in older adults depended on a variety of individual and social factors, including income, health level, and literacy. However, it is agreed that educational and welfare programs play an important role in increasing happiness in old age.

In the present study, after performing the JPMR technique, the level of happiness of the older adults increased from weak to moderate. In addition, after the intervention, a group of the samples enjoyed a good level of happiness. In other words, the JPMR technique was useful for increasing the happiness of older adults living in the nursing home. These results are largely consistent with the findings of Alphonsa et al .[ 35 ] and Bostani et al .[ 36 ] Gaiswinkler et al .[ 37 ] also compared the effectiveness of the 6-week Mindful Self-Compassion (MSC) and PMR programs for psychiatric patients and found the MSC program more successful for increasing happiness. The results of the present study also support the results of studies related to the effectiveness of JPMR in improving the quality of life of older adults with cancer[ 38 ] and reducing depressive symptoms of aging living in nursing homes.[ 39 ] Nevertheless, Meister et al .[ 40 ] found no impact of anaerobic training on mental indices. Furthermore, Kianian et al .[ 41 ] did not find any significant differences in depression symptoms or happiness levels between aerobic and nonaerobic physical activity in nonathletic men. Differences in samples, duration of the course, and measurement tools could explain the inconsistencies with the current research.

Since the high prevalence of anxiety disorders among adults in nursing homes[ 42 ] could increase disability and diminish well-being,[ 43 ] it is necessary to pay more attention to the implementation of operational strategies that could affect psychological indicators of them. Using JPMR, which is based on the principle of muscle relaxation preceding mind relaxation, could decrease anxiety gradually in older adults, which contributes to their happiness. In particular, those living in nursing homes or hospitals could benefit from JPMR’s mental health output.

The main limitation of this study was the absence of a control group. There is only one non-profit, a public nursing home in Rasht, the capital of the Guilan province, that operates free for the elderly and disabled, and the rest are small and private. Therefore, because of this and the quarantine due to the COVID-19 pandemic, which made access to the samples difficult, the present research has been conducted in a single research environment with one group. Sampling was conducted by coordinating with nursing home officials, following health protocols, using protective equipment, and performing polymerase chain reaction (PCR) tests. Other limitations were fatigue and the unwillingness of some study samples to cooperate. By explaining the purpose and significance of the study and observing rest intervals, the researcher encouraged subjects to cooperate until the end.

The present study provides non-invasive interventions that have been demonstrated to be effective in reducing anxiety and enhancing happiness in older adults. It was found that JPMR reduced anxiety and increased happiness among the elderly living in nursing homes. The use of JPMR by trained nurses in the daily care of the elderly in nursing homes could promote healthy and active aging. Therefore, older adults will be healthier and happier, reducing overhead costs for families and society as a whole.

Financial support and sponsorship

Research and Technology Deputy of Guilan University of Medical Sciences

Conflicts of interest

Nothing to declare.

Acknowledgements

This study is the result of a master’s thesis approved by the Ethics Committee of Guilan University of Medical Sciences (code: 1399.399). Hereby, the researchers would like to express their gratitude to the Vice Chancellor for Technology and Research for approving this research project. The authors would like to thank the older adults who participated in the present study as well.

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How the 'JASPER' writing course improved the work of my team

Home Office senior investigating officer Richard Murray explains why he recommends Foundations of writing in government (JASPER) course.

Richard Murray, Home Office

Richard Murray’s job is to investigate complaints against Home Office staff.

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Foundations of writing in government (JASPER) is one of Government Campus’ most highly rated courses. It is free on Civil Service Learning and comprises four hours of bite-size learning that can be done at the learner’s own pace.

“I was looking for a course that would help investigators in my team to write with real impact,” he said.

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