Efficacy of Progressive Muscle Relaxation in Adults for Stress, Anxiety, and Depression: A Systematic Review

Figures & data

Table 1 The Search Terms

Databases	Concept	Search Terms
Scopus, Web of Science, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials	PMR	“Progressive muscle relaxation*” OR PMR
	Intervention/ Prevention	Intervention* OR therap* OR prevention* OR training* OR strateg* OR program* OR technique* OR exercise*
	Stress, Anxiety, Depression	Mental* OR psychiatr* OR psycholog* OR depress* OR anxi* OR stress* OR wellbeing OR well-being OR distress*

Table 2 Progressive Muscle Relaxation (PMR)

No	Author (Year)/ Country	Duration (Minutes/ Length)	Frequency Per Week	Participants	Study Design				Research Instrument	Components/ Content of PMR	Outcome Measures (with Effect Size Where Available)	Key Finding	Quality of the Article
					EXP	Pre-test	Post- test	F-Up
1	Avants et al^Citation34 (1990) United States	20m at laboratory/ 1 session	1 session only	40 university students (PMR: 20, CG: 20) S: Laboratory DO: 0%	QED	/	/		STAI	Use Jacobson’s PMR exercise by Bernstein, Borkovec.^Citation35	Anxiety	PMR did not significantly reduce (=) anxiety among the participants.	High
2	Battaglini et al^Citation36 (2022) Brazil	30–40m at classroom / 12 sessions	Once or twice/ week	59 athletes (PMR: 29, CG: 30) S: Classroom DO: 0%	QED	/	/		CSAI-2, RESTQ-Sport	Use the adapted Jacobson’s PMR exercise by Sándor.^Citation37	Stress (d=0.29), Anxiety (d=1.30)	There is a significant decrease (↓) in cognitive anxiety score and specific stress score in IG compared to CG.	High
3	Chaudhuri et al^Citation38 (2014) India	20m at home/ 12 weeks	7 days/ week	64 female healthcare workers (PMR: 64→57) S: At home DO: 10.9%	QED	/	/		PSS	Use Jacobson’s PMR exercise protocol by Varvogli, Darviri.^Citation39	Stress (d=4.12)	There is a significant decrease (↓) in stress scores at the post-test compared to the pretest.	High
4	Chellew et al^Citation40 (2015) Spain	5 45m session/ 1 week.	5 days/ week	101 university students (APMR: 101) S: N/A DO: 0%	QED	/	/		SRLE	Use the abbreviated Jacobson’s PMR exercise by Bernstein, Borkovec.^Citation35	Stress (d=0.38)	There is a decrease (↓) in stress score and cortisol secretion level at post-test compared to pretest in IG.	High
5	Silveira et al^Citation41 (2020) Brazil	10–15min at classroom/ 8 weeks	Once/ week	16 nurses (PMR: 16) S: Classroom DO: 0%	QED	/	/		WSS	Use the Jacobson’s PMR exercise.	Stress (d=0.36)	There is a decrease (↓) in stress score at post-test compared to pretest.	High
6	Dolbier & Rush^Citation42 (2012) United States	20m at laboratory/ 1 session	1 session only	128 university students (APMR: 66, CG: 62) S: Laboratory DO: 0%	QED	/	/		EMAS-S	Use the abbreviated Jacobson’s PMR exercise.	Anxiety (d=0.25)	There is a significant decrease (↓) in anxiety score in post-test compared to pretest in both IG & CG.	High
7	Ganjeali et al^Citation43 (2022) Iran	20m at home / 2 weeks + 2–60m classroom	7 days/ week	46 nurses (PMR: 23, CG: 23) S: Classroom & at home DO: 0%	RCT	/	/		DASS-21	Use the Jacobson’s PMR exercise by Toqan, Malak, Ayed, Fashafsheh, Salameh, Sarhan, Azizeh, Batran.^Citation44	Stress (d=1.47), Anxiety (d=1.61)	There is a decrease (↓) in stress and anxiety score at post-test compared to pretest in the IG.	High
8	Gao et al^Citation45 (2018) China	5m at home/ 12 weeks	7 days/ week	78 university participants (students and employees) (PMR: 47→25→14F-Up, CG: 31→25) S: At home DO: 35.9%	QED	/	/	/ (1 month)	PSS	Use the Jacobson’s PMR exercise.	Stress (d=0.42)	There is a significant decrease (↓) in stress score at post-test compared to pretest in the IG.	High
9	Gustainiene et al^Citation46 (2015) Lithuania	6 sessions at laboratory/ 4 weeks	Once or twice/ week	95 university students (PMR: 47, CG: 48) S: Laboratory DO: N/A	QED	/	/		PSS	Use the Jacobson’s PMR exercise.	Stress (d=0.31)	There is a decrease (↓) in stress score at post-test compared to pretest in IG.	High
10	Hayati et al^Citation47 (2020) Iran	15m /4 weeks + 2 sessions	Twice a day for 7 days /week	76 elders (PMR: 38, CG: 38) S: N/A DO: 0%	QED	/	/		GDS	Use the PMR audio file validated by Yousefi, Taraghi, Mousavinasab^Citation48	Depression (d=1.49)	There is a significant decrease (↓) in depression score in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG).	High
11	Jermaina et al^Citation49 (2022) Indonesia	30–60m/ 10 weeks	N/A	20 beginner athletes (PMR: 20) S: Classroom DO: 0%	QED	/	/		SAS	N/A	Anxiety	PMR did not significantly reduce (=) anxiety for beginner athletes.	High
12	Murphy^Citation50 (1983) United States	20m at small room and at home/ 2 weeks	5 days/ week	26 nurses (PMR: 17→9→8 F-Up, CG: 9→8 F-Up) S: Small room and at home DO: 30.8%	QED	/	/	/ (3 months)	Trait-anxiety scale of STAI	Use the Jacobson’s PMR exercise by Bernstein, Borkovec.^Citation35	Anxiety	There is a significant decrease (↓) in trait anxiety score in post-test compared to pretest in both IG and CG.	High
13	Mustafa et al^Citation51 (2021) Pakistan	4 sessions/ 4 weeks	N/A	10 female nurses (PMR: 10) S: N/A DO: 0%	QED	/	/		DASS-21	N/A	Stress (d=2.45), anxiety (d=0.53), depression (d=1.95)	There is a significant decrease (↓) in stress and depression score but not in anxiety at post-test compared to pretest in IG.	High
14	Palkar et al^Citation52 (2021) India	45m at home/ 4 weeks + 3 sessions at seminar hall	7 days/ week	114 medical students (PMR: 43, CG: 71) S: Seminar Hall & at home DO: 0%	QED	/	/		PSS, TAS	N/A	Stress (d=0.45), Anxiety (d=0.35)	There is a significant decrease (↓) in stress and anxiety score at post-test compared to pretest in IG.	High
15	Prakash Jha et al^Citation53 (2020) India	30m/ 2 weeks	7 days/ week	30 elderlies (PMR: 30) S: N/A DO: 0%	QED	/	/ (twice)		GDS	N/A	Depression	There is a significant decrease (↓) in depression score at post-test compared to pretest.	High
16	Yilmaz et al^Citation54 (2018) Turkey	28m at home/ 8 weeks	3 days/ week	65 caregivers of elders (PMR: 33→23, CG: 32→21) S: At home DO: 32.3%	RCT	/	/		BDS	Use the “Relaxation Exercises” (prepared by the Turkish Psychologists Association)^Citation55	Depression (d=0.86)	There is a significant decrease (↓) in depression score at post-test compared to pretest in IG.	High
17	Zargarzadeh & Shirazi^Citation56 (2014) Iran	At home/ 6 weeks + 4 30m sessions at classroom	Twice a day for 7 days/ week	50 nursing students (PMR: 25→24, CG: 25) S: At home and classroom DO: 2.0%	QED	/	/		STAS	N/A	Anxiety (d=2.54)	There is a significant decrease (↓) in anxiety score in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG).	High
18	Zhang et al^Citation57 (2022) China	30m classroom/ 6 weeks	Once/ week	90 medical students (PMR: 45→42, CG: 45) S: Classroom DO: 6.7%	RCT	/	/	/ (2 months)	TAS	Use standardized version of PMR by Bernstein, Borkovec.^Citation35	Anxiety (d=2.07)	There is a significant decrease (↓) in test anxiety score at post-test and at follow up compared to pretest in the IG.	High
19	Allison et al^Citation58 (2020) United States	10m at classroom /1 session	1 session only	124 veterinary students (PMR: 124→101) S: Classroom DO: 18.5%	QED	/	/		SRSI3	N/A	Stress (d=0.93)	There is a decrease (↓) in stress scores at the post-test compared to the pretest.	Moderate
20	Barling & Raine^Citation59 (2005) Australia	At home /3 weeks + 1 60m session	7 days/ week	30 volunteers (PMR: 15, CG: 15) S: At home DO: 0%	RCT	/	/		DASS	N/A	Stress, anxiety, depression	There is a significant decrease (↓) in 1. IG compared to CG at post-test (anxiety). 2. stress, anxiety and depression scores in the post-test compared to the pretest in IG.	Moderate
21	Çapacı et al^Citation60 (2022) Turkey	30m at home/ 8 weeks	4 days/ week (2 days with researchers, 2 days on their own)	36 caregivers of elders (PMR: 18→10), CG: 18→10) S: At home DO: 44.4%	RCT	/	/		BDI	Use the “Relaxation Exercises CD Sound Records” and “PMR Information Guide” (prepared by the Turkish Psychologists Association).	Depression (d=0.58)	There is a decrease (↓) in depression score in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG).	Moderate
22	Gökşin & Aşiret^Citation61 (2021) Turkey	28m at home/ 8 weeks	3 days/ week	58 elderly women (PMR: 24→21, CG: 34→28) S: At home DO: 15.5%	RCT	/	/		GDS-15	N/A	Depression (d=0.91)	There is a significant decrease (↓) in depression score in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG).	Moderate
23	İnangil et al^Citation62 (2020) Turkey	15m at practice room/ 2weeks	3 days/ week	60 nursing students (PMR: 30→28, CG: 30→28) S: Practice room DO: 6.7%	RCT	/	/		STAI	Use the “Relaxation Exercises” (prepared by the Turkish Psychologists Association)^Citation63	Anxiety (d=0.62)	There is a significant decrease (↓) in state anxiety score in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG).	Moderate
24	Khasky & Smith^Citation64 (1999) United States	25m / 1 session	1 session only	76 university students (PMR: 20, CG: 56) S: N/A DO: 0%	RCT	/	/		SQST	Use the Jacobson’s PMR exercise script by Smith.^Citation65	Stress (d=1.07)	There is a significant decrease (↓) in stress score in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG).	Moderate
25	Korkut et al^Citation66 (2021) Turkey	15m + 15m at laboratory/ one session	Twice in one session only.	88 nursing students (PMR: 44→41, CG: 44) S: laboratory DO: 3.4%	RCT	/	/		STAI	Use the Jacobson’s PMR exercise.	Anxiety (d=0.49)	There is a decrease (↓) in anxiety score at post-test compared to pretest in IG.	Moderate
26	Kurian et al^Citation67 (2021) India	N/A	N/A	30 non-teaching staff (PMR: 30) S: N/A DO: 0%	QED	/	/		JSS	N/A	Stress (d=4.31)	There is a significant decrease (↓) in stress score at post-test compared to pretest.	Moderate
27	Robb^Citation68 (2000) United States	15m at laboratory/ 1 session	1 session only	15 university students (PMR: 15) S: Laboratory DO: 0%	RCT	/	/		State-anxiety scale of STAI Form Y-1	Use the Jacobson’s PMR exercise.	Anxiety (d=1.65)	There is a significant decrease (↓) in anxiety score in post-test compared to pretest in IG.	Moderate
28	Toqan et al^Citation69 (2022) Palestine	45m Lab room+ 10–15m at home/ 2 weeks	5 days/ week	60 nursing students (PMR: 60) S: Lab room and at home DO: 0%	QED	/	/		State-anxiety scale of STAI Form Y-1	Use the Jacobson’s PMR exercise by Ramasamy, Panneerselvam, Govindharaj, Kumar, Nayak.^Citation70	Anxiety (d=4.20)	There is a decrease (↓) in anxiety score at post-test compared to pretest.	Moderate
29	Toqan et al^Citation71 (2022) Palestine	45m Lab room+ 10–15m at home/ 2 weeks	5 days/ week	90 nursing students (PMR: 90) S: Lab room and at home DO: 0%	QED	/	/		State-anxiety scale of STAI Form Y-1	Use the Jacobson’s PMR exercise by Ramasamy, Panneerselvam, Govindharaj, Kumar, Nayak.^Citation70	Anxiety (d=4.57)	There is a decrease (↓) in anxiety score at post-test compared to pretest.	Moderate
30	Toqan et al^Citation44 (2022) Palestine	45m Lab room+ 10–15m at home/ 2 weeks	5 days/ week	48 male nursing students (PMR: 48) S: Lab room and at home DO: 0%	QED	/	/		State-anxiety scale of STAI Form Y-1	Use the Jacobson’s PMR exercise by Ramasamy, Panneerselvam, Govindharaj, Kumar, Nayak.^Citation70	Anxiety (d=0.90)	There is a decrease (↓) in anxiety score at post-test compared to pretest.	Moderate
31	Vaughn et al^Citation72 (1989) United States	15m at home/ 4 weeks + 1 session at lunch room	3 days/ week	20 female clerical workers (PMR: 10→8, CG: 10) S: At home and Lunch Room DO: 10.0%	QED	/	/		SRI	Use the Jacobson’s PMR exercise by Jacobson.^Citation18	Stress	There is a significant decrease (↓) in stress score in IG compared to CG at post-test.	Moderate

Abbreviations: PMR, Progressive Muscle Relaxation; EXP, Experiment; F-Up, Follow up; S, Setting; DO, Dropouts; RCT, Randomized control trial; QED, Quasi-experimental design; IG, Intervention group; CG, Control group; d, Cohen’s d; TAS, Test anxiety scale; STAI, State-trait anxiety inventory; SAS, Zung Self-Rating Anxiety Scale; DASS, Depression; anxiety; stress scale; BDI, Beck Depression Inventory; CSAI-2, Competitive State Anxiety Inventory-2; RESTQ-Sport, Recovery-Stress Questionnaire for Athletes; PSS, Perceived Stress Scale; JSS, Job Stress Scale; GDS, Geriatric Depression Scale; WSS, Work Stress Scale; SRSI3, Smith Relaxation States Inventory 3; BDS, Beck Depression Scale; SRLE, Survey of Recent Life Experiences; STAS, Sarason test anxiety scale; EMAS-S, Endler Multidimensional Anxiety Scale—State; SQST, Smith Quick Stress Test; SRI, Stress Response Index.

Table 3 Progressive Muscle Relaxation with Other Interventions

No	Author (Year)/ Country	Other Intervention	Duration (Minutes/ Length)	Frequency Per Week	Participants	Study Design				Research Instrument	Components/ Content of Intervention	Outcome Measures (with Effect Size where Available)	Key Finding	Quality of the Article
						EXP	Pre-test	Post- test	F-Up
1	Alphonsa et al^Citation73 (2018) India	Relaxation Therapy (RT) - Music, physical exercise and laughter therapy	60m/ 4 weeks	Twice a day for 7 days/ week	20 elderlies (PMR + RT: 10, CG: 10) S: N/A DO: 0%	QED	/	/	/ (4 months)	DASS-21	Use Jacobson’s PMR exercise + RT (background music, followed by physical exercise and laughter therapy).	Stress, Anxiety, Depression	There is a decrease (↓) in stress, anxiety and depression scores at post-test and F-up compared to the pretest (in IG).	High
2	Corbett et al^Citation74 (2019) Ireland	Stress Control (SC)	15m PMR & SC at home/ 6 weeks + 1 session at the hall	N/A	35 adults (PMR + SC: 35→22→20) S: At home and a hall DO: 37.1%	QED	/	/	/ (3 months)	DASS-21	Use Jacobson’s PMR exercise + SC program by White.^Citation75	Stress (d=0.72), Anxiety (d=0.41), Depression (d=0.27)	There is a decrease (↓) in stress, and anxiety but not (=) depression score at post-test and F-Up compared to pretest (in IG).	High
3	Merakou et al^Citation76 (2019) Greece	Counselling Services (CS)	12m PMR at home+ 4 45m PMR session + 8 CS/ 8 weeks	PMR twice a day for 7 days + CS once/ week	50 unemployed individuals (PMR + CS: 30, CG: 20) S: At home DO: 0%	QED	/	/		DASS-21	Use the Jacobson’s PMR exercise + CS (provided by the mental health professionals of the PEPSAEE).	Stress (d=1.13), Anxiety (d=1.03), Depression (d=0.74)	There is a decrease (↓) in stress, anxiety and depression score 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG).	High
4	Ortega et al^Citation77 (2021) Spain	Cognitive Behavioural Therapy (CBT)	120m session/ 5 weeks	Once / week	44 nursing students (PMR + CBT: 15, CG: 29) S: N/A DO: 0%	QED	/	/	/ (3 months)	KEZKAK questionnaire, STAI	Use the Jacobson’s PMR exercise + CBT (emotional control, empathy, assertiveness, self-esteem, problem solving and time management)	Stress, Anxiety	There is a significant decrease (↓) in stress and state anxiety score in IG compared to CG at post-test and at F-Up.	High
5	Singer et al^Citation78 (1988) United States	Stress management skills (SMS)	At home + 120m session at meeting room/ 10 weeks	Once a day for 7 days + once at meeting room/ week	36 caregivers (PMR + SMS: N/A, CG: N/A) S: meeting room DO: N/A	QED	/	/		STAI, BDI	Use the Jacobson’s PMR exercise by Bernstein, Borkovec^Citation35 + SMS (self-monitoring of stressful events and physiological reactions to them + modification of cognitions associated with distress)	Anxiety (d=0.59), Depression (d=0.53)	There is a significant decrease (↓) in anxiety and depression score in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG). 3. CG depression increase (↑) slightly at post-test	High
6	Sundram et al^Citation79 (2016) Malaysia	Deep Breathing (DB)	15m at quiet room/ session (5x every 2 months)	N/A	761 male automotive workers (PMR + DB: 468→148, CG: 293→221) S: Quiet room DO: 51.5%	QED	/	/	/ (5x every 2 months)	DASS-21	Use the Jacobson’s PMR exercise by Jacobson^Citation18 + DB.	Stress, anxiety, depression (Total: d=0.60)	There is a significant decrease (↓) in stress score but not (=) anxiety and depression in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG).	High
7	Gallego et al^Citation80 (2020) Spain	Music Therapy (MT)	60m at classroom/1 session	1 session only	112 nursing students (PMR + MT: 56, CG: 56) S: Classroom DO: 0%	RCT	/	/		Heart rate	Use Jacobson’s PMR exercise + MT (use a CD player with volume established at 50–60 decibels).	Stress	There is a significant decrease (↓) in heart rate (indicating a reduction of stress) in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG).	Moderate
8	Korkut et al^Citation66 (2021) Turkey	Nature sound (NS)	15m + 15m at laboratory/ one session	Twice in one session only.	89 nursing students (PMR + NS: 45→42, CG: 44) S: laboratory DO: 3.4%	RCT	/	/		STAI	Use the Jacobson’s PMR exercise + the NS (rain, birds, wind, forest, ocean, waterfall, and stream)	Anxiety (d=1.14)	There is a decrease (↓) in anxiety score at post-test compared to pretest in IG.	Moderate
9	Masih et al^Citation81 (2019) United States	Mindfulness Meditation (MM)	20m PMR & MM at home + 30m session at laboratory/ 8 weeks	7 days practice + 1 session/ week	36 adults (PMR + MM: 19→17, CG: 17) S: At home and Laboratory DO: 5.6%	RCT	/	/		PSS, Trait-anxiety scale of STAI	Use the Jacobson’s PMR exercise by Bernstein, Borkovec^Citation35 + MM by Kabat‐Zinn.^Citation82	Stress (d=0.40), Anxiety (d= 0.15)	There is a decrease (↓) in stress but not (=) trait anxiety score at post-test compared to pretest (in IG).	Moderate
10	Ozgundondu & Metin^Citation83 (2019) Turkey	Music Therapy (MT)	20m at classroom/ 8 weeks	Once/ week	63 nurses (PMR + MT: 32→28, CG: 31→28) S: Classroom DO: 0%	RCT	/	/	/ (1 month)	PSS	Use the Jacobson’s PMR exercise + MT (relaxing music developed by Daniel Kobialka)	Stress (d=2.06)	There is a significant decrease (↓) in stress score in IG compared to CG at post-test and at F-Up.	Moderate
11	Robb^Citation68 (2000) United States	Music Therapy (MT)	15m at laboratory/ 1 session	1 session only	15 university students (PMR + MT: 15) S: Laboratory DO: 0%	RCT	/	/		State-anxiety scale of STAI Form Y-1	Use the Jacobson’s PMR exercise + MT (use Daniel Kobialka’s Going Home Medley).^Citation84	Anxiety (d=2.10)	There is a significant decrease (↓) in anxiety score in post-test compared to pretest.	Moderate
12	Tsiouli et al^Citation85 (2014) Greece	Deep Breathing (DB)	37m at home/ 8 weeks	Twice a day for 7 days/ week	80 caregivers (PMR + DB: 40→19, CG: 40→25) S: at home DO: 45.0%	RCT	/	/		PSS	Use the Jacobson’s PMR exercise + DB.	Stress (d=1.87)	There is a significant decrease (↓) in stress score at post-test compared to pretest in IG.	Moderate
13	Tsitsi et al^Citation86 (2017) Cyprus & Greece	Guided Imagery (GI)	25m at home and 25m at private room/ 3 weeks	Once a day for 7 days at home + once at private room/ week	54 caregivers (PMR + GI: 29, CG: 25) S: at home and private room DO: 0%	RCT	/	/		HAM-A	Use the Jacobson’s PMR exercise + GI (envisioning of a comfortable and restful place on the beach) by da Silva.^Citation87	Anxiety (d=0.37)	There is a decrease (↓) in anxiety score at post-test compared to pretest (in IG).	Moderate
14	Valarmathi & Vijayalakshmi^Citation88 (2016) India	Deep Breathing (DB)	30m at home/ 4 weeks	Twice a day for 7 days/ weeks	54 caregivers (PMR + DB: 60) S: at home DO: 0%	QED	/	/		N/A	Use the Jacobson’s PMR exercise (20m) + DB (10m).	Stress (d=2.24)	There is a significant decrease (↓) in stress score at post-test compared to pretest.	Moderate
15	Wang et al^Citation89 (2021) China	Health education (HE)	90m of HE, PMR demonstration and PMR practice in 24 sessions + 30m at home/ 48 weeks	Twice a day for 7/ week	110 caregivers of patients (EMR: 55, CG: 55) S: rehabilitation centre and at home DO: N/A	RCT	/	/	/ (3,6,12months)	HADS	Use the Jacobson’s PMR exercise by Kieffer^Citation90 + health education on the acute stroke patients.	Anxiety, depression	There is a significant decrease (↓) in anxiety and depression score in IG compared to CG at 6 and 12 months.	Moderate

Abbreviations: PMR, Progressive Muscle Relaxation; EXP, Experiment; F-Up, Follow up; S, Setting; DO, Dropouts; RCT, Randomized control trial; QED, Quasi-experimental design; IG, Intervention group; CG, Control group; d, Cohen’s d; EMR, Education & Muscle Relaxation; HE, Health Education; HADS, Hospital Anxiety and Depression Scale; NS, Nature sound; DASS-21, Depression; anxiety; stress scale-21; CBT, Cognitive Behavioral Therapy; MT, Music Therapy; CS, Counseling services; PEPSAEE, Pan-Hellenic Association for Psychosocial Rehabilitation and Professional Reintegration; MM, Mindfulness Meditation; PSS, Perceived Stress Scale; STAI, State-trait anxiety inventory; SC, Stress Control; RT, Relaxation Therapy; GI, Guided Imagery; HAM-A, Hamilton’s Anxiety Scale; DB, Deep Breathing; BDI, Beck Depression Inventory; SMS Stress management skills.

Figure 1 List of Countries Involved (16 Countries).

Figure 2 PRISMA flow diagram for the included and excluded studies.

Notes: PRISMA figure adapted fromPage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International journal of surgery. 2021 Apr 1;88:105906. Creative Commons.²³

Figure 3 The Efficacy of PMR on Stress, Anxiety and Depression.

Figure 4 The Efficacy of PMR combined with other interventions on Stress, Anxiety and Depression.

Avants SK, Margolin A, Salovey P. Stress management techniques: anxiety reduction, appeal, and individual differences. Imagin Cognit Person. 1990;10(1):3–23. doi:10.2190/WDH5-GEV3-YT3C-95NY

 Google Scholar

Bernstein DA, Borkovec TD. Progressive Relaxation Training: A Manual for the Helping Professions. ERIC; 1973.

 Google Scholar

Battaglini MP, Pessôa Filho DM, Calais SL, et al. Analysis of progressive muscle relaxation on psychophysiological variables in basketball athletes. Int J Environ Res Public Health. 2022;19(24):17065. doi:10.3390/ijerph192417065

 PubMed Web of Science ®Google Scholar

Sándor P. Técnicas de relaxamento. São Paulo: Vetor; 1982.

 Google Scholar

Chaudhuri A, Ray M, Saldanha D, Bandopadhyay A. Effect of progressive muscle relaxation in female health care professionals. Ann Med Health Sci Res. 2014;4(5):791–795. doi:10.4103/2141-9248.141573

 PubMedGoogle Scholar

Varvogli L, Darviri C. Stress management techniques: evidence-based procedures that reduce stress and promote health. Health SciJ. 2011;5(2):74.

 Google Scholar

Chellew K, Evans P, Fornes-Vives J, Perez G, Garcia-Banda G. The effect of progressive muscle relaxation on daily cortisol secretion. Stress. 2015;18(5):538–544. doi:10.3109/10253890.2015.1053454

 PubMed Web of Science ®Google Scholar

de Avila Silveira E, de Melo Batista K, da Silva Grazziano E, de Oliveira Bringuete ME, Lima Ed FA. Effect of progressive muscle relaxation on stress and workplace well‐being of hospital nurses. Enfermeria Global. 2020;58:485–493.

 Google Scholar

Dolbier CL, Rush TE. Efficacy of abbreviated progressive muscle relaxation in a high-stress college sample. Int J Stress Manage. 2012;19(1):48.

 Web of Science ®Google Scholar

Ganjeali S, Farsi Z, Sajadi SA, Zarea K. The effect of the demonstration-based progressive muscle relaxation technique on stress and anxiety in nurses caring for COVID-19 patients: a randomized clinical trial. BMC Psychiatry. 2022;22(1):1–9. doi:10.1186/s12888-022-04456-3

 PubMed Web of Science ®Google Scholar

Toqan D, Malak MZ, Ayed A, et al. Effect of progressive muscle relaxation exercise on anxiety among male nursing students undergoing maternity clinical training. Sage Open Nurs. 2022;8:23779608221136644. doi:10.1177/23779608221136644

 Web of Science ®Google Scholar

Gao L, Curtiss J, Liu X, Hofmann SG. Differential treatment mechanisms in mindfulness meditation and progressive muscle relaxation. Mindfulness. 2018;9:1268–1279. doi:10.1007/s12671-017-0869-9

 Web of Science ®Google Scholar

Gustainienė L, Perminas A, Pečiulienė I, Jarašiūnaitė G. Effectiveness of progressive muscle relaxation and biofeedback–assisted relaxation in reducing perceived stress among students with regard to personality features. Internat J Psychol. 2015;16:67–91.

 Google Scholar

Hayati A, Fanisaberi L, Yaghobi T, Pourasghar M, Mousavinasab N, Taraghi Z. The effect of progressive muscle relaxation on depressive symptoms in elderly people. J Nurs & Midwifery Sci. 2020;7(4):248. doi:10.4103/JNMS.JNMS_35_20

 Google Scholar

Yousefi S, Taraghi Z, Mousavinasab N. He effect of progressive muscle relaxation on sleep quality in patients with chronic heart failure. Pharmacophore. 2017;2017:1.

 Google Scholar

Jermaina N, Kusmaedi N, Ma’mun A, Gaffar V, Purnomo E, Marheni E. Effects of relaxation exercises to reduce anxiety in beginner athletes. Sciences. 2022;10(6):1275–1283.

 Google Scholar

Murphy LR. A comparison of relaxation methods for reducing stress in nursing personnel. Human Factors. 1983;25(4):431–440. doi:10.1177/001872088302500409

 PubMed Web of Science ®Google Scholar

Mustafa N, Farzeen M, Kiani S, Khan S, Ain NU, Mumtaz J. Comparison of progressive muscular relaxation (Pmr) and music therapy (Mt) in reducing the anxiety, depression and stress symptoms among nurses. Pakistan Armed Forces Med J. 2021;71(6):1930–1932.

 Google Scholar

Palkar D, Panigrahi S, Shatadal P, Mehta R. Impact of jacobson’s progressive muscle relaxation on stress levels of exam going MBBS students of a medical college in South Gujarat, India. J Clin Diagn Res. 2021;15:8.

 Web of Science ®Google Scholar

Prakash Jha SP, Deaver UJ, Sarin J. Effects of Dance and Movement Therapy (DMT) Versus Progressive Muscle Relaxation (PMR) on quality of life among elderly residing in selected old age homes of Haryana: a quasi experimental study. Indian J Public Health Res Dev. 2020;11(3):893–898.

 Google Scholar

Yilmaz CK, Aşiret GD, Çetinkaya F, Oludağ G, Kapucu S. Effect of progressive muscle relaxation on the caregiver burden and level of depression among caregivers of older patients with a stroke: a randomized controlled trial. Japan J Nurs Sci. 2019;16(2):202–211. doi:10.1111/jjns.12234

 PubMed Web of Science ®Google Scholar

Boyacıoglu G, Kabakçı E. Relaxation exercises tape. Ankara: Turkish Psychological Association Publications; 2015. Available from: www.psikolog.org.tr. Accessed January 18, 2024.

 Google Scholar

Zargarzadeh M, Shirazi M. The effect of progressive muscle relaxation method on test anxiety in nursing students. Iranian J Nurs Midwifery Res. 2014;19(6):607.

 PubMedGoogle Scholar

Zhang Y, Yang -X-X, Luo J-Y, et al. Randomized trial estimating effects of hypnosis versus progressive muscle relaxation on medical students’ test anxiety and attentional bias. World J Psych. 2022;12(6):801–813. doi:10.5498/wjp.v12.i6.801

 PubMed Web of Science ®Google Scholar

Allison S, Irwin Hamilton K, Yuan Y, Wallis Hague G. Assessment of progressive muscle relaxation (PMR) as a stress-reducing technique for first-year veterinary students. J Veterin Med Educ. 2020;47(6):737–744. doi:10.3138/jvme.2018-0013

 PubMed Web of Science ®Google Scholar

Barling NR, Raine SJ. Some effects of hypnosis on negative affect and immune system response. Austral J Clin Experi Hypnos. 2005;33(2):160.

 Google Scholar

Çapacı S, Aşiret GD, Kapucu S. Effect of progressive muscle relaxation on caregiver satisfaction, caregiver burden and depression levels of the caregivers of older patients: a randomized control trial. Eur J Int Med. 2022;50:102114. doi:10.1016/j.eujim.2022.102114

 Google Scholar

Gökşin İ, Aşiret GD. The effect of progressive muscle relaxation on the adaptation of elderly women to depression and old age: a randomised clinical trial. Psychogeriatrics. 2021;21(3):333–341. doi:10.1111/psyg.12673

 PubMed Web of Science ®Google Scholar

İnangil D, Şendir M, Kabuk A, Türkoğlu İ. The effect of music therapy and progressive muscle relaxation exercise on anxiety before the first clinical practice in nursing students: a randomized controlled study. Florence Nightingale J Nurs. 2020;28(3):341. doi:10.5152/FNJN.2020.19075

 PubMedGoogle Scholar

Derneği TP. Stresle etkili başa çıkma yöntemi: gevşeme egzersizleri. Türk Psikologl Dern Yayinl Ankara. 2010;2010:1.

 Google Scholar

Khasky AD, Smith JC. Stress, relaxation states, and creativity. Percept Motor Skills. 1999;88(2):409–416. doi:10.2466/pms.1999.88.2.409

 PubMed Web of Science ®Google Scholar

Smith JC. Relaxation Dynamics: A Cognitive-Behavioral Approach to Relaxation. Champaign: Research Press; 1985.

 Google Scholar

Korkut S, Ülker T, Çidem A, Şahin S. The effect of progressive muscle relaxation and nature sounds on blood pressure measurement skills, anxiety levels, and vital signs in nursing students. Perspect Psych Care. 2021;57(4):1782–1790. doi:10.1111/ppc.12749

 PubMed Web of Science ®Google Scholar

Kurian B, Hadke D, Kakade R, Kamble D, Kamble R, Kamble S. Assessment of the effectiveness of progressive muscle relaxation therapy on stress among non teaching staff. Biosci Biotechnol Res Communicat. 2021;14(9):55–57. doi:10.21786/bbrc/14.9.12

 Web of Science ®Google Scholar

Robb SL. Music assisted progressive muscle relaxation, progressive muscle relaxation, music listening, and silence: a comparison of relaxation techniques. J Music Therap. 2000;37(1):2–21.

 PubMed Web of Science ®Google Scholar

Toqan D, Ayed A, Amoudi M, Alhalaiqa F, Alfuqaha OA, ALBashtawy M. Effect of progressive muscle relaxation exercise on anxiety among nursing students in pediatric clinical training. Sage Open Nurs. 2022;8:23779608221090002. doi:10.1177/23779608221090002

 Web of Science ®Google Scholar

Ramasamy S, Panneerselvam S, Govindharaj P, Kumar A, Nayak R. Progressive muscle relaxation technique on anxiety and depression among persons affected by leprosy. J Exerc Rehabilit. 2018;14(3):375. doi:10.12965/jer.1836158.079

 PubMedGoogle Scholar

Toqan D, Ayed A, Joudallah H, et al. Effect of progressive muscle relaxation exercise on anxiety reduction among nursing students during their initial clinical training: a quasi-experimental study. Inquiry. 2022;59:00469580221097425.

 PubMed Web of Science ®Google Scholar

Vaughn M, Cheatwood S, Sirles AT, Brown KC. The effect of progressive muscle relaxation on stress among clerical workers. AAOHN J. 1989;37(8):302–306.

 PubMedGoogle Scholar

Jacobson E. Progressive Relaxation. Chicago: University of chicago press; 1938.

 Google Scholar

Alphonsa K, Abdul JA, Vijayaraghavan R, Sailesh KS. Effectiveness of relaxation therapy on psychological variables among the elderly in old-age homes-A pilot study. Nation J Physiol Pharm Pharmacol. 2018;8(6):907–911.

 Google Scholar

Corbett C, Egan J, Pilch M. A randomised comparison of two ‘stress control’programmes: progressive muscle relaxation versus mindfulness body scan. Mental Health Prev. 2019;15:200163.

 Google Scholar

White J. Treating Anxiety and Stress: A Psycho-Educational Approach in Groups Using Brief Cognitive Behavioural Therapy. Chichester: Wiley; 2000.

 Google Scholar

Merakou K, Tsoukas K, Stavrinos G, et al. The effect of progressive muscle relaxation on emotional competence: depression–anxiety–stress, sense of coherence, health-related quality of life, and well-being of unemployed people in Greece: an intervention study. Explore. 2019;15(1):38–46. doi:10.1016/j.explore.2018.08.001

 Google Scholar

Ortega RH, Pascual JLG, Araque AMF. Impact of an intervention program with reinforcement on nursing students’ stress and anxiety levels in their clinical practices. Nurse Educat Pract. 2021;55:103179.

 PubMed Web of Science ®Google Scholar

Singer GH, Irvin LK, Hawkins N. Stress management training for parents of children with severe handicaps. Mental Retardation. 1988;26(5):269.

 PubMedGoogle Scholar

Sundram BM, Dahlui M, Chinna K. Effectiveness of progressive muscle relaxation therapy as a worksite health promotion program in the automobile assembly line. Industrial Health. 2015;2015:2014–2091.

 Google Scholar

Gallego-Gómez JI, Balanza S, Leal-Llopis J, et al. Effectiveness of music therapy and progressive muscle relaxation in reducing stress before exams and improving academic performance in Nursing students: a randomized trial. Nurse Education Today. 2020;84:104217.

 PubMed Web of Science ®Google Scholar

Masih T, Dimmock JA, Epel E, Guelfi KJ. An 8‐week relaxation program consisting of progressive muscle relaxation and mindfulness meditation to reduce stress and attenuate stress‐driven eating. Appl Psychol. 2020;12(1):188–211. doi:10.1111/aphw.12179

 Google Scholar

Kabat‐Zinn J. 20‐minute Seated Meditation: On Guided Mindfulness Meditation: Series Two. Shrewsbury, MA: University of Massachusetts Centre for Mindfulness; 2002.

 Google Scholar

Ozgundondu B, Metin ZG. Effects of progressive muscle relaxation combined with music on stress, fatigue, and coping styles among intensive care nurses. Intens Crit Care Nurs. 2019;54:54–63. doi:10.1016/j.iccn.2019.07.007

 PubMed Web of Science ®Google Scholar

Robb SL, Nichols RJ, Rutan RL, Bishop BL, Parker JC. The effects of music assisted relaxation on preoperative anxiety. J Mus Yher. 1995;32(1):2–21. doi:10.1093/jmt/32.1.2

 Web of Science ®Google Scholar

Tsiouli E, Pavlopoulos V, Alexopoulos EC, Chrousos G, Darviri C. Short-term impact of a stress management and health promotion program on perceived stress, parental stress, health locus of control, and cortisol levels in parents of children and adolescents with diabetes type 1: a pilot randomized controlled trial. Explore. 2014;10(2):88–98. doi:10.1016/j.explore.2013.12.004

 Google Scholar

Tsitsi 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. Eur J Oncol Nurs. 2017;26:9–18.

 PubMed Web of Science ®Google Scholar

da Silva FL. Neural mechanisms underlying brain waves: from neural membranes to networks. Electroencephalogr Clin Neurophysiol. 1991;79(2):81–93. doi:10.1016/0013-4694(91)90044-5

 PubMedGoogle Scholar

Valarmathi, Vijayalakshmi. Assessment of effectiveness of selected relaxation strategies on stress and coping among the mothers of differently abled children. Int J Pharm Clin Res. 2016;8(2):130–132.

 Google Scholar

Wang J, Liu J, Li L, Man J, Yue S, Liu Z. Effect of education and muscle relaxation program on anxiety, depression and care burden in caregivers of acute stroke survivors: a randomized, controlled study. Medicine. 2021;100:4.

 Web of Science ®Google Scholar

Kieffer M; Progressive relaxation.Dr.E. Jacobson’s method. Bulletin de la Societe Des Sciences Medicales du Grand-Duche de Luxembourg. 1978;115(2):83–87.

 PubMedGoogle Scholar

Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10(1):89. doi:10.1186/s13643-021-01626-4

 PubMed Web of Science ®Google Scholar