Efficacy of different relaxation training

on emotional stress reduction for diabetic outpatients

Hau Yam MA

BHS(N) PgDNE  MSc(N) RN RM

Nursing Officer , Programme Management and Professional Development Branch,

Centre for Health Protection, Department of Health, Hong Kong SAR

ABSTRACT

Background

Diabetes mellitus is a physical illness which can create worries and anxiety in patients that last for a lifetime.  Literature on diabetic management has revealed that emotional stress would have tremendous impact on the physical and emotional well-being of diabetic patients.  Although emotional stress has been a long-standing concern of diabetic patients, it has not been specially addressed in most of the diabetic education programmes.   On the other hand, literature on health and behavioural sciences has shown that there was adequate evidence to support that relaxation therapy would be most effective when employed in reducing emotional stress. Moreover, there were different relaxation methods which would help in this aspect and enhance the psychological well-being of the individual.  Such findings have encouraged health care professionals to investigate the effectiveness of relaxation therapy as an intervention to reduce emotional stress of diabetic patients.

Aim

This study was designed to evaluate the effectiveness of different relaxation training on the reduction of emotional stress for diabetic patients in an outpatient setting. 

Methods

A Quasi-experimental pre-treatment and post-treatment design was adopted.  Seventy-six volunteer diabetic outpatients were recruited and randomly assigned to one of the following three groups: Stretch Release Relaxation Group (n=28), Cognitive Relaxation Group (n=24) and Test Control Group (n=24).  Emotional stress was measured physiologically in terms of blood pressure and heart rate, while psychologically in terms of anxiety, depression, general psychological well-being, and subjective tension level by using the Chinese versions of the State-Trait Anxiety Inventory, Centre for Epidemiological Studies Depression Scale, General Health Questionnaire-12 and Subjective Unit of Tension Scale.  Pre and post assessments were conducted among the three groups.  For the experimental groups, the relaxation therapy sessions were conducted once per week for four weeks.  The Test Control Group received no relaxation therapy.

Findings

The diabetic patients in both the Stretch Release and the Cognitive Relaxation Group obtained significant reductions (p < 0.05) in most dependent variables in their pre- and post-treatment comparisons as well as in their post-treatment comparison with the corresponding data in the Test Control Group. In contrast, subjects in the Test Control Group showed no significant difference in all dependent variables in their pre- and post-test comparisons.

Limitation

        As convenient sampling was drawn from an outpatient clinic in this study, therefore, generalization to the whole population of diabetic patients should be handled with caution. 

Recommendations    

The findings of this study supported those of previous studies that both stretch release and cognitive relaxation were effective methods in reducing physiological and psychological stress level of the subjects.  They also revealed that stretch release was a more powerful relaxation technique when compared with the cognitive relaxation method. 

This new information is worth further examination in order to identify the most effective relaxation technique.  Moreover, a longer period of study is recommended to examine the subjects’ ability in sustaining the practice and to evaluate the long term efficacy of the relaxation exercises.  In addition, blood sugar level can be included as a dependent variable for observing whether relaxation training has any positive effect on it. 

Conclusion

This study demonstrated the effectiveness of two practical relaxation training programmes targeted specifically for the reduction of emotional stress for diabetic outpatients.  Frontline nurses may learn to use these relaxation methods and incorporate them into their diabetic health education programmes so as to enhance the effectiveness of care for their patients.