Research Article| Volume 32, ISSUE 2, P278-284, April 2018

Download started.


Effects of Relaxation Therapy on Anxiety Disorders: A Systematic Review and Meta-analysis

Published:November 20, 2017DOI:



      To explore the effect of relaxation therapy applied to people with anxiety disorders.


      Systematic review with meta-analysis.


      Sixteen Randomized Control Trials (RCTs) were included for meta-analysis to determine the effect of relaxation therapy. The overall effect of relaxation therapy on symptom of anxiety was significant with Hedges' g = 0.62 (95% CI: 0.42–0.81), which indicates a medium-high effect; heterogeneity was statistically significant with I2 = 48.84. Subgroup analysis exploring the possible causes of heterogeneity found that types of comparison of TAU and CBT was significant (Q = 4.20, p = 0.04). The effect of relaxation therapy on symptoms of depression, phobia, and worry was significant; Hedges' g = 0.44 (95% CI: 0.30–0.59), 0.40 (95% CI: 0.06–0.75), 0.54 (95% CI: 0.28–0.79), respectively.


      The results of this study provide evidence for the effectiveness of relaxation therapy for people with anxiety disorders. Therefore, relaxation therapy can be selected as a useful intervention for reducing negative emotions in people with anxiety disorders.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Psychiatric Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Arch J.J.
        • Ayers C.R.
        • Baker A.
        • Almklov E.
        • Dean D.J.
        • Craske M.G.
        Randomized clinical trial of adapted mindfulness-based stress reduction versus group cognitive behavioral therapy for heterogeneous anxiety disorders.
        Behav. Res. Ther. 2013; 51: 185-196
        • Baldwin D.S.
        • Anderson I.M.
        • Nutt D.J.
        • Allgulander C.
        • Bandelow B.
        • den Boer J.A.
        • Malizia A.
        Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology.
        J. Psychopharmacol. 2014; 28: 403-439
        • Bandelow B.
        • Reitt M.
        • Röver C.
        • Michaelis S.
        • Görlich Y.
        • Wedekind D.
        Efficacy of treatments for anxiety disorders: A meta-analysis.
        Int. Clin. Psychopharmacol. 2015; 30: 183-192
        • Baxter A.J.
        • Scott K.M.
        • Vos T.
        • Whiteford H.A.
        Global prevalence of anxiety disorders: A systematic review and meta-regression.
        Psychol. Med. 2013; 43: 897-910
        • Begg C.B.
        • Mazumdar M.
        Operating characteristics of a rank correlation test for publication bias.
        Biometrics. 1994; : 1088-1101
        • Boettcher J.
        • Åström V.
        • Påhlsson D.
        • Schenström O.
        • Andersson G.
        • Carlbring P.
        Internet-based mindfulness treatment for anxiety disorders: A randomized controlled trial.
        Behav. Ther. 2014; 45: 241-253
        • Borenstein M.
        • Hedges L.V.
        • Higgins J.
        • Rothstein H.R.
        Introduction to Meta-analysis.
        2009. John Wiley & Sons, Ltd, Chichester, UK2009: 1-452
        • Borkovec T.D.
        • Costello E.
        Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder.
        Journal of Consulting and Clinical Psychology. 1993; 61: 611
        • Clark D.M.
        • Salkovskis P.M.
        • Hackmann A.
        • Middleton H.
        • Anastasiades P.
        • Gelder M.I.C.H.A.E.L.
        A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder.
        The British Journal of Psychiatry. 1994; 164: 759-769
        • Conrad A.
        • Isaac L.
        • Roth W.T.
        The psychophysiology of generalized anxiety disorder: 2. Effects of applied relaxation.
        Psychophysiology. 2008; 45: 377-388
        • Dugas M.J.
        • Brillon P.
        • Savard P.
        • Turcotte J.
        • Gaudet A.
        • Ladouceur R.
        • Gervais N.J.
        A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder.
        Behavior Therapy. 2010; 41: 46-58
        • Egger M.
        • Smith G.D.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        Br. Med. J. 1997; 315: 629-634
        • Higgins J.
        • Thompson S.G.
        Quantifying heterogeneity in a meta‐analysis.
        Statistics in Medicine. 2002; 21: 1539-1558
      1. Higgins J.P. Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011
        • Hofmeijer-Sevink M.K.
        • Batelaan N.M.
        • van Megen H.J.
        • Penninx B.W.
        • Cath D.C.
        • van den Hout M.A.
        • van Balkom A.J.
        Clinical relevance of comorbidity in anxiety disorders: A report from the Netherlands Study of Depression and Anxiety (NESDA).
        J. Affect. Disord. 2012; 137: 106-112
        • Hoge E.A.
        • Bui E.
        • Marques L.
        • Metcalf C.A.
        • Morris L.K.
        • Robinaugh D.J.
        • Simon N.M.
        Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: Effects on anxiety and stress reactivity.
        The Journal of Clinical Psychiatry. 2013; 74: 786
        • Hoyer J.
        • Beesdo K.
        • Gloster A.T.
        • Runge J.
        • Höfler M.
        • Becker E.S.
        Worry exposure versus applied relaxation in the treatment of generalized anxiety disorder.
        Psychotherapy and Psychosomatics. 2009; 78: 106-115
        • Jazaieri H.
        • Goldin P.R.
        • Werner K.
        • Ziv M.
        • Gross J.J.
        A randomized trial of MBSR versus aerobic exercise for social anxiety disorder.
        J. Clin. Psychol. 2012; 68: 715-731
        • Kessler R.C.
        • Petukhova M.
        • Sampson N.A.
        • Zaslavsky A.M.
        • Wittchen H.U.
        Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States.
        Int. J. Methods Psychiatr. Res. 2012; 21: 169-184
        • Koszycki D.
        • Benger M.
        • Shlik J.
        • Bradwejn J.
        Randomized trial of a meditation-based stress reduction program and cognitive behavior therapy in generalized social anxiety disorder.
        Behaviour Research and Therapy. 2007; 45: 2518-2526
        • Lee S.H.
        • Ahn S.C.
        • Lee Y.J.
        • Choi T.K.
        • Yook K.H.
        • Suh S.Y.
        Effectiveness of a meditation-based stress management program as an adjunct to pharmacotherapy in patients with anxiety disorder.
        Journal of Psychosomatic Research. 2007; 62: 189-195
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.
        Ann. Intern. Med. 2009; 151: 264-269
        • NICE
        Anxiety disorders.
        in: Quality standard. National Institute for Health and Care Excellence, London2014 (Retrieved from)
        • Öst L.G.
        Applied relaxation vs progressive relaxation in the treatment of panic disorder.
        Behaviour Research and Therapy. 1988; 26: 13-22
        • Öst L.G.
        • Breitholtz E.
        Applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder.
        Behaviour Research and Therapy. 2000; 38: 777-790
        • Öst L.G.
        • Westling B.E.
        Applied relaxation vs cognitive behavior therapy in the treatment of panic disorder.
        Behaviour Research and Therapy. 1995; 33: 145-158
        • Öst L.G.
        • Westling B.E.
        • Hellström K.
        Applied relaxation, exposure in vivo and cognitive methods in the treatment of panic disorder with agoraphobia.
        Behaviour Research and Therapy. 1993; 31: 383-394
        • Pagnini F.
        • Manzoni G.M.
        • Castelnuovo G.
        • Molinari E.
        A brief literature review about relaxation therapy and anxiety.
        Body, Movement and Dance in Psychotherapy. 2013; 8: 71-81
        • SIGN
        SIGN 50 (2011): A guideline developers' handbook (Revised ed.).
        Scottish Intercollegiate Guidelines Network, 2011 (Available at:)
        • Starr L.R.
        • Hammen C.
        • Connolly N.P.
        • Brennan P.A.
        Does relational dysfunction mediate the association between anxiety disorders and later depression? Testing an interpersonal model of comorbidity.
        Depression and Anxiety. 2014; 31: 77-86
        • Strauss C.
        • Cavanagh K.
        • Oliver A.
        • Pettman D.
        Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: A meta-analysis of randomised controlled trials.
        PLoS One. 2014; 9e96110
        • Vøllestad J.
        • Sivertsen B.
        • Nielsen G.H.
        Mindfulness-based stress reduction for patients with anxiety disorders: Evaluation in a randomized controlled trial.
        Behaviour Research and Therapy. 2011; 49: 281-288
        • Zullino D.
        • Chatton A.
        • Fresard E.
        • Stankovic M.
        • Bondolfi G.
        • Borgeat F.
        • Khazaal Y.
        Venlafaxine versus applied relaxation for generalized anxiety disorder: A randomized controlled study on clinical and electrophysiological outcomes.
        Psychiatry Q. 2015; 86: 69-82