Comparative Efficacy of Progressive Muscle Relaxation Versus Sleep Hygiene in Psychiatric Outpatients with Insomnia suffering from Anxiety and Depression: A Quasi-Experimental Study
DOI:
https://doi.org/10.63682/jns.v13i1.8431Keywords:
Progressive Muscle Relaxation, Sleep Hygiene, Insomnia, Anxiety, Depression, Pediatrics, Quasi-Experimental, PakistanAbstract
Background: Insomnia is a prevalent concern among individuals with anxiety and depression, often exacerbating their psychological distress and impairing daily functioning. While non-pharmacological approaches have shown promise, limited data exists from Pakistan comparing these strategies in psychiatric populations.
Objective: This study aimed to compare the effectiveness of Progressive Muscle Relaxation (PMR) and Sleep Hygiene (SH) education in improving sleep quality among psychiatric outpatients with anxiety and/or depression, including adolescents.
Methods: A quasi-experimental study was conducted in the psychiatric outpatient department of CMH Kohat, Pakistan from March 2024 to August 2024. One hundred participants aged 13 to 60 years were purposively assigned into two groups: Group A received PMR training and Group B received SH education over a four-week period. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) at baseline and post-intervention. Subgroup analysis was performed for pediatric participants.
Results: Both interventions led to significant improvements in PSQI scores. However, the PMR group demonstrated a significantly greater reduction in PSQI scores compared to the SH group (p < 0.01). Pediatric participants in the PMR group also showed marked improvements in sleep quality and anxiety levels, along with high adherence and satisfaction.
Conclusion: Progressive Muscle Relaxation was more effective than Sleep Hygiene education in improving sleep quality among psychiatric patients, including adolescents. This study supports the integration of PMR as a practical, non-pharmacological intervention in outpatient psychiatric care in Pakistan
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References
Sadock BJ, Kaplan H, Sadock V. Kaplan & Sadock's synopsis of psychiatry behavioral sciences. Rezaee F.10th ed. Tehran: Arjmand; 2007. 149- 154.
Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine. 2008;4(5):487-504
Okun ML, Luther JF, Wisniewski SR, Wisner KL. Disturbed sleep andinflammatory cytokines in depressed and nondepressed pregnant women: an exploratory analysis of pregnancy outcomes. Psychosomatic Medicine. 2013; 75(7): 670-681
Williams MA, Miller RS, Qiu C, Cripe SM, Gelaye B, Enquobahrie D. Associations of early pregnancy sleep duration with trimester-specific blood pressures and hypertensive disorders in pregnancy. Sleep. 2010; 33(10): 1363-1371
Parsaie Rad E, AmirAliAkbari S, Sadeghnia K, AlaviMajd H. Relationship between sleep disorder and pregnancy depression in primigravidae referring to health– treatment centers of Ahvaz Jundishapur University of Medical Sciences in 2010. Journal of Shahid Sadoughi University of Medical Sciences. 2011;19(4):454-462. (Persian)
. Alipour Z, Lamyian M, Haji Zadeh E. Sleep quality in late pregnancy and postpartum depression. Iranian Journal of Obstetrics, Gyneocology And Infertility. 2012; 14(8):39-47. (Persian)
Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Wiliams Obstetrics. 23rd ed. Tehran: Golban; 2010. 409-414.
Everly GS, Lating JM. A clinical guide to the treatment of the human stress response. 3rded. New York: Springer; 2012. 186-189.
Bergdahl J, Bergdahl M. Perceived stress in adults: prevalence and association of depression, anxiety and medication in a Swedish population. Stress Health. 2002;18(5):235–241. doi: 10.1002/smi.946
Wahed WYA, Hassan SK. Prevalence and associated factors of stress, anxiety and depression among medical Fayoum University students. Alexandria Journal of Medicine. 2017;53(1):77–84. doi: 10.1016/j.ajme.2016.01.005
.Khir, SM, Yunus, WMAWM, Mahmud, N, Arif, LSM. Relationship Between Sleep Deprivation And Mental Health Problems Among Management University Students. Jurnal Kemanusiaan. 2020;18(2):46–57.
Dutta G, Chutia U, Singh B, et al. Psychological-clinical intercession and behaviour therapy techniques for active mindfulness to decrease stress and negative affect on mental health: lensing socio-legal angles and SDG 3-good health and well-being. J Reatt Therap Develop Divers. 2023;6(10s):1001–1012
Rainforth MV, Schneider RH, Nidich SI, Gaylord-King C, Salerno JW, Anderson JW. Stress reduction programs in patients with elevated blood pressure: a systematic review and meta-analysis. Curr Hypertens Rep. 2007;9(6):520–528. doi: 10.1007/s11906-007-0094-3
Tian X, Tang R-Y, L-L X, et al. Progressive muscle relaxation is effective in preventing and alleviating of chemotherapy-induced nausea and vomiting among cancer patients: a systematic review of six randomized controlled trials. Support Care Cancer. 2020;28:4051–4058. doi: 10.1007/s00520-020-05481-2
Torales J, O’Higgins M, Barrios I, González I, Almirón M. An overview of Jacobson’s progressive muscle relaxation in managing anxiety. Revista Argentina de Clínica Psicológica. 2020;29(3):17.
Duman M, Taşhan ST. 2018. The effect of sleep hygiene education and relaxation exercises on insomnia among postmenopausal women: a randomized clinical trial. Int J Nurs Pract. 24. doi: 10.1111/ijn.12650.
Dvořáková T, Bušková J, Bartoš A. 2022. Neurological symptoms associated with COVID-19 based on a nation-wide online survey [Article in Czech Neurologické příznaky asociované s onemocněním COVID-19 podle celostátního online průzkumu]. Cesk Slov Neurol N. 85:220–227. doi: 10.48095/cccsnn2022220.
Edinoff AN, Wu N, Ghaffar YT, Prejean R, Gremillion R, Cogburn M, Chami AA, Kaye AM, Kaye AD, Shreveport H. 2021. Zolpidem: efficacy and side effects for insomnia purpose of review. Health Psychol Res. 9. doi: 10.52965/001c.24927
Elmoneem HA, Fouad AI. 2017. The effect of a sleep hygiene program on older adults. IOSR J Nurs Health Sci. 6:40–51. doi: 10.9790/1959-0601054051.
Fabbri M, Beracci A, Martoni M, Meneo D, Tonetti L, Natale V. 2021. Measuring subjective sleep quality: a review. Int J Environ Res Public Health. 18:1–57. MDPI AG. doi: 10.3390/ijerph18031082
White, R.L.; Babic, M.J.; Parker, P.D.; Lubans, D.R.; Astell-Burt, T.; Lonsdale, C. Domain-Specific Physical Activity and Mental Health: A Meta-analysis. Am. J. Prev. Med. 2017, 52, 653–666
Scott, A.J.; Webb, T.L.; James, M.M.-S.; Rowse, G.; Weich, S. Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep. Med. Rev. 2021, 60, 101556.
Doorley, J.D.; Greenberg, J.; Stauder, M.; Vranceanu, A.-M. The Role of Mindfulness and Relaxation in Improved Sleep Quality Following a Mind–Body and Activity Program for Chronic Pain. Mindfulness 2021, 12, 2672–2680
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