Conference Coverage

Progressive muscle relaxation outperforms mindfulness in reducing grief severity


 

AT ADAA 2022

A first-of-its-kind study evaluating a mindfulness intervention to ease grief unexpectedly showed that the control treatment, progressive muscle relaxation, was more effective.

“Both progressive muscle relaxation and mindfulness training were shown to improve grief severity, yearning, depression symptoms, and stress, [but] the results from this study suggest that progressive muscle relaxation is most effective, compared to a wait-list control condition for improving grief,” study investigator Lindsey Knowles, PhD, senior fellow, MS Center of Excellence, Veterans Affairs Puget Sound Health Care System, and University of Washington, Seattle, told this news organization.

VA Puget Sound Health Care System, and University of Washington School of Medicine, Seattle, Washington University of Washington School of Medicine

Dr. Lindsey Knowles

“With replication, progressive muscle relaxation could be a standalone intervention for nondisordered grief or a component of treatment for disordered grief,” Dr. Knowles said.

The findings were presented as part of the Anxiety and Depression Association of America Anxiety & Depression conference.

Disordered grief

Approximately 10% of individuals grappling with loss “get stuck” in their grief and develop disordered grief, which is distinguished by repetitive thought processes of yearning and grief rumination, the investigators noted.

The researchers hypothesized that mindfulness training, which has been shown to reduce maladaptive repetitive thought, could be an effective intervention to prevent disordered grief.

To investigate, they enrolled 94 widows and widowers (mean age, 67.5 years) who were experiencing bereavement-related grief and were between 6 months and 4 years post loss.

The researchers compared a 6-week mindfulness intervention (n = 37) with a 6-week progressive muscle relaxation intervention (n = 35), Dr. Knowles said, because there has been speculation that benefits from mindfulness training may be related more to the relaxation response than to the actual mindfulness component.

Both study groups received the intervention in similar settings with matched instructors.

The mindfulness intervention sessions included 10-25 minutes of meditation and mindfulness practices. It also included instructions for home practice.

Participants in the progressive muscle relaxation group were trained to tense and relax the body’s various muscle groups with an end goal of learning to relax four key muscle groups without initial tensing.

A third group of patients were placed on a wait list with no intervention (n = 22).

Measures taken throughout the study interventions and at 1 month postintervention showed reductions in the study’s two primary outcomes of grief severity and yearning for both interventions versus baseline (P = < .003).

However, only the progressive muscle relaxation group had a significantly greater reduction in grief severity vs the wait-list control group (P = .020).

The muscle relaxation group also showed lower grief severity at 1month follow-up versus the wait-list group (P = .049) – with a value at that time falling below an established cutoff for complicated grief, based on the Revised Inventory of Complicated Grief.

All three treatment groups showed a drop in the third primary outcome of grief rumination (P < .001).

Secondary outcomes of depression and stress were reduced in both active study groups versus the wait-list group (P = .028). Sleep quality also improved in both active intervention groups.

Simple technique

Dr. Knowles said the study’s findings were unexpected.

“We had hypothesized that mindfulness training would outperform progressive muscle relaxation and wait-list for improving grief outcomes,” she said.

Mindfulness experts underscore that a state of global relaxation is considered integral to the benefits of mindfulness, which could explain the benefits of progressive muscle relaxation, Dr. Knowles noted.

Importantly, progressive muscle relaxation has a key advantage: It is quickly and easily learned, which may partially explain the study’s findings, she added.

“Progressive muscle relaxation is a relatively simple technique, so it is also likely that participants were able to master [the technique] over the 6-week intervention,” Dr. Knowles said. “On the other hand, the mindfulness intervention was an introduction to mindfulness, and mastery was not expected or likely over the 6-week intervention.”

Either way, the results shed important light on a potentially beneficial grief intervention.

“Although mindfulness training and progressive muscle relaxation practices may both be perceived as relaxing, mastering progressive muscle relaxation may in fact enable people to maintain better focus in the present moment and generalize nonreactive awareness to both positively and negatively balanced phenomena,” Dr. Knowles said.

However, “more research is necessary to clarify how progressive muscle relaxation improves grief outcomes in widows and widowers.”

CNS benefits?

Zoe Donaldson, PhD, assistant professor in behavioral neuroscience, department of psychology and neuroscience, University of Colorado, Boulder, said the study is important for ongoing efforts in finding effective therapies for grief.

“We often struggle to try to help those experiencing the pain of loss and this study suggests a discrete set of exercises that may help,” said Dr. Donaldson, who was not involved with the research.

She also described the study results as surprising, and speculated that a combination of factors could explain the findings.

“First, mindfulness is hard to achieve, so the moderate beneficial effects might increase with more substantial mindfulness training. Secondly, it is not clear why progressive muscle relaxation had an effect, but the focus and attention to detail may engage the central nervous system in a beneficial way that we don’t fully understand,” Dr. Donaldson said.

Importantly, it’s key to remember that grief is an individual condition when investigating therapies, Dr. Donaldson noted.

“We likely need to develop multiple interventions to help those who are grieving. Incorporating loss can take many forms,” she said.

The investigators and Dr. Donaldson reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Recommended Reading

Psychedelic therapy and suicide: A myth busted?
MDedge Family Medicine
Case report: Male with acute new-onset suicidal ideation tied to SARS-CoV-2
MDedge Family Medicine
Ketamine fast, effective for suicidal crises
MDedge Family Medicine
Combination antidepressant treatment outperforms monotherapy in meta-analysis
MDedge Family Medicine
Pandemic-stressed youths call runaway hotline
MDedge Family Medicine
Routine pharmacogenetic testing in psychiatry not indicated
MDedge Family Medicine
Depression, suicidal ideation continue to plague physicians: Survey
MDedge Family Medicine
Why is there an increased risk of cancer in depressed patients?
MDedge Family Medicine
‘Alarming’ worldwide decline in mental health
MDedge Family Medicine
Suicide attempts in kids ages 10-12 quadrupled over 20 years
MDedge Family Medicine