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The Efficacy of Progressive Muscle Relaxation for Stress Reduction in Survivors of Hurricane Katrina
Paul Kadetz, MSN, MPH Department of International Health & Development
Introduction
The objective of this pilot study is to determine the
efficacy of Progressive Muscle Relaxation for stress
reduction in survivors of Hurricane Katrina. The goal
is to supplement the literature on potentially safe, costeffective, non-pharmacological stress reduction
interventions that can be easily taught and require no
special knowledge, physical ability, or cultural beliefs
in order to practice.
Stress experienced by survivors of a disaster can result
in chronic physical and psychological morbidity.
According to the Louisiana Office of Mental Health,
it is anticipated that 54% of survivors of Hurricane
Katrina will become depressed, 5-9% will progress to
Post Traumatic Stress Disorder and 100% will experience
some degree of post trauma symptoms. The literature
reviewed primarily documents the effect of such
modalities as yoga and meditation on reduction of pain,
pain perception and physiological manifestations of
stress. However, there remains a dearth of research
pertaining to non-pharmacological stress reduction
modalities with disaster survivors.
Progressive Muscle Relaxation is a technique developed
by an American physician, Edmund Jacobsen, in 1938.
The technique is taught by a facilitator who suggests
that the participant direct their awareness to given areas
of the body and slowly tense & relax muscle groups in
a sequential manner. This activity is coordinated with
inhalation and exhalation. Usually this procedure begins
at the head or face, then progresses to the upper
extremities, the back and is completed with relaxation
of the lower-extremities.
Materials & Methods
The Perceived Stress Scale is a validated assessment
tool designed to measure the degree to which life
situations are perceived as stressful and serves as an
outcome measure of experienced stress levels. This
14-item self-report instrument measures perceived
stress along a five-point Likert scale.
Data was analyzed quantitatively for statistical
significance both within and between experimental
and control groups utilizing Analysis of Variance.
The variables of age, gender , and race were reported
by some subjects, providing for analysis along these
variables.
All subjects provided a signed informed consent. All
precautions to protect subject confidentiality, including
the use of numerical identifiers, of which only the subject
had knowledge, were implemented. This pilot study was
granted IRB approval from the Tulane Office of Human
Research Protection Institutional Review Boards.
Results
Tulane University School of Public Health & Tropical Medicine
Results
Conclusions
Subjects were invited to include demographic
information on the Perceived Stress Scale of age, gender
and race. However, not all subjects included this data
rendering statistical analysis along these variables
difficult. Although, preliminary analysis of the data does
not demonstrate a correlation between Perceived Stress
Scale values and these variables.
In conclusion, although statistical significance was not
demonstrated for the utilization of Progressive Muscle
Relaxation in reducing stress amongst survivors of a
disaster such as Hurricane Katrina in this pilot study, we
maintain that future studies of greater sample size over
longer duration and with more frequent interventions are
necessary.
Subjects were invited to continue after the final meeting
with Progressive Muscle Relaxation a minimum of once
weekly. A recording was made for subjects of a
Progressive Muscle Relaxation session and Perceived
Stress Scale surveys were provided. Both experimental
and control groups were invited to participate on their
own. Two subjects from the experimental group and
Three subjects from the control group participated on
their own for an extra week. Unfortunately, the sample is
too small to conduct significant statistical analysis.
However, preliminary analysis of the data demonstrates
marked decreases on values of the Perceived Stress Scale
for both the experimental and control subjects
participating.
Discussion
Data was analyzed using ANOVA. Statistical significance
was determined by comparing the change in Perceived
Stress Survey scores between the first and second and
second and third weeks both within the experimental
and control groups and between both groups.
Hence, a total of four groups were compared.
Clearly, the sample size and the number of longitudinal
values were insufficient to demonstrate significance
in utilizing Progressive Muscle Relaxation for reducing
stress. Due to the fact that stress was reduced
significantly in the control sample, size and number of
trials is brought into question, as well as the utilization of
the Perceived Stress Scale as an appropriate assessment
instrument for this study.
Materials & Methods
The between group sum of squares = 80.49
Subjects who live or work in Orleans Parish, Louisiana
were selected. The sample size is N=20. Participants
were invited via word of mouth and snowball sampling.
Inclusion criteria consisted of all adults (regardless of
gender, race or ethnicity) 18 years of age and older,
who are able and willing to participate in three half-hour
sessions a minimum of once weekly. Exclusion criteria
are subjects who are not competent to provide informed
consent and anyone defined as vulnerable according to
the Tulane University Institutional Review Board criteria.
The within group sum of squares = 859.01
The Perceived Stress Scale contains positive and negative
statements under the same Likert scale, which could have
caused confusion amongst participants. Furthermore, it
is questionable whether perceived stress is a more
accurate method for measuring stress than direct
measurement of physiological indicators of stress, such
as heart rate and blood pressure. This is especially
noteworthy when experimental subjects stated a marked
reduction in stress from the intervention, even though
their Perceived Stress Scale values demonstrated an
increase in perceived stress.
Subjects were randomly assigned to an experimental
group or a control group. The experimental group
participated in two to three 20-minute sessions of
Progressive Muscle Relaxation facilitated by the
principle investigator. The control group participated
in two to three 20-minute open discussion sessions
regarding what subjects have done to reduce stress.
Both groups were asked to fill out an assessment tool
at the beginning of each session and after completion
of the final session.
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df between groups = 3
df within groups = 34
Hence, the F-ratio = 1.06
According to the F Table for the .05 level of significance,
an F-ratio of a minimum greater than 2.84 is necessary
for this data to be considered statistically significant.
Therefore, it cannot be concluded that the difference
between the results of the experimental group receiving
Progressive Muscle Relaxation and the control group are
statistically significant.
Furthermore, it should be noted that evaluations were
completed up to a week after the intervention, rather
than directly after Progressive Muscle Relaxation.
Hence, the intervention may, in fact, be significantly
efficacious for a given period with decreased efficacy
over time. Evaluations should be conducted within a
reasonable time frame that will more accurately assess
the efficacy of Progressive Muscle Relaxation.
Similarly, the intervention may need to be performed
more frequently than once or twice a week, in order to
demonstrate significant reduction of stress and for the
subject to have an awareness of stress reduction.
The importance of utilizing a simple technique to reduce
stress in populations surviving disasters and coping with
recovery cannot be underestimated.
Mental health and well-being are as imperative in disaster
recovery as physical health. Although the benefits of
performing Progressive Muscle Relaxation were
demonstrated more significantly by subjects’ report, than
by statistical analysis of Perceived Stress Scale values, this
intervention is considered worthy of future assessment.
Clearly, assessments of interventions for these vulnerable
populations is as imperative as assessments of their
vulnerability.
Sources
Astin, j, Shapiro, S, Eisenberg, D, Forys, K. (2003) Mind-Body Medicine:
State of the Science, Implications for practice. The Journal of The
American Board of Family Practice. 16:131-147.
Bernstein, B, Borkovec, T, Hazlet-Stephens, H. (2000) New Directions in
Progressive Relaxation Training. Westport, CT. Praeger.
Cohen, S, Kamarack, T, Mermelstein, R. (1983) A Global Measure of
Perceived Stress. Journal of Health & Social Behavior. 24;(4):385-396.
Louisiana Office of Mental Health. Retrieved from:
http://www.dhh.louisiana.gov/offices/?ID=62
Vitetta, L, Anton, B, Cortizo, F, Sali, A. (2005) Mind-Body Medicine: stress
& impact on overall health. Ann. NY Acad. of Science.1057(1):492-505
Acknowledgements
Sincere gratitude to Penny Jessop, Meredith McLanahan, Roseanna
Rabelais, and the staff of Tulane University School of Public
Health & Tropical Medicine for their contribution.
Paul Kadetz
5 St. Margaret’s Road
Oxford, OX2 6RU
[email protected]