20 women with heart disease Mean age: T 57.3, C 63.6
MBSR/WLC
T 10/C 10; dropouts: 10% in each group (b)
2 h × 8 w (16 h + homework + retreat)
STAI (state anxiety): F (1, 16) D 6.79, (d)
Significant differences between the treatment and control groups on scores of anxiety, emotional control, and reactive coping in women diagnosed with heart disease
78 male/female medical students experiencing stress Mean age: ND
MBSR/WLC
T 37 (3%)/C 41 (9.8%) (b)
2.5 h × 7 w (17.5 + homework)
SCL-90 (revised): psychological distress and GSI () and STAI anxiety () (d)
Significantly reduced self-reported state and trait anxiety and reduced reports of overall psychological distress including depression, at termination of intervention
Significant larger decreases in perceived stress in the treatment group compared to control, implying that meditation-based stress management practices reduce stress among undergraduates
109 male/female cancer outpatients with various stages of disease Mean age: T 54.9, C 48.9
MBSR condensed/WLC
T 61 (13%)/C 48 (23%) (b)
1.5 h × 7 w (10.5 + homework)
POMS (anxiety): in treatment group from time 1 to time 2 and between the two groups; total stress score (t (88) 5–22.80, ) (d)
Significant decreases in mood disturbance and stress symptoms in both male and female patients with a wide variety of cancer diagnoses, stages of illness, and ages
104 male/female medical students, graduate nursing students, and undergraduate students Mean age: 25
MBSR condensed (MM)/stress reduction (SR)/control group
ND; dropouts: 23%, 23 participants (6 MM, 11 SR, and 6 controls) (a)
1.5 h × 4 (6 h + homework + retreat)
BSI: distress for MM and SR versus control group ( in all cases). Effect sizes for distress were large for both meditation and relaxation (Cohen’s d = 1.36 and .91, resp.)
Both MM and SR are effective in reducing negative psychological states and enhancing positive states of mind for students experiencing significant distress. There were no significant differences between meditation and relaxation on distress over time
103 male/female community volunteers with high perceived stress Mean age: 49.2
MBSR modified/group given educational materials on stress management and referral to community resources
T 59 (45%)/C 44 (41%) (a)
2.5 h × 8 w (20 h + one-day retreat)
DSI, SCL90-R (GSI). GSI (between group analysis): postintervention was borderline significant () and became significant at 3-month followup () (d)
Significant reductions in perceived stress and psychological distress found both between groups and within treatment group from pre- to postintervention
Cognitive behavioral relaxation training (RLXN)/focused Tai chi training (TCHI)/spiritual growth group (SPRT)/WLC
Unclear (overall dropout rate 35% (a)
1.5 h × 10 w (15 h + homework)
Coping subscale of the DIS: for emotion-focused coping; the RLXN and TCHI treatment groups showed significant total treatment effects over the control (d)
In comparison to WLC, both RLXN and TCHI groups less frequently used emotion-focused coping strategies. Generally, decreased emotion-focused coping can be considered an enhancement in coping strategies; however, there was no concurrent increase in problem-focused or appraisal-focused coping, making interpretation of this change more tenuous
HADS (anxiety): changes from baseline to 12 weeks between groups (−2.4 (−4.0–−0.9)) Effect size: for CBSM baseline to 12 months on HADS anxiety
CBSM training of HIV-infected persons taking cART does not improve clinical outcome but has lasting effects on quality of life and psychological well-being
37 healthy 3rd semester economics students Mean age: ND
CBSM/control not specified
4 groups of 8–10 subjects. (CBSM groups 1 and 2: , control groups 3 and 4: ); dropouts: T 28%/C 22% (b)
6 h × 2 d (12 h + homework)
MESA: between groups F (6, 19) = 1.30, , STAI (trait) CBSM = STAI (state) F ((2.06/53.59) Z3.84, . Effect size: state anxiety
CBSM prevents increases in anxiety and somatic symptoms prior to an upcoming stressor and influences the ability to exert a cortisol response corresponding to the subjective stress appraisal
PSS: group by time interaction effect from baseline to posttreatment (t35 = 2.57, ): F (1/46) = 5.27, , effect size )
Short, group-based, Cognitive Behavioral Stress Management training reduces the salivary free cortisol stress response to an acute stressor in healthy male subjects with treatment group showing a reduction in the level of perceived stress posttreatment
199 female breast cancer patients (stage III or less) Mean age: 50
CBSM and relaxation/condensed educational intervention or social support
T 92 (22%)/C 107 (19%) (b)
2 h × 10 w (20 h + homework)
MCOS: between groups changes from baseline to 10 weeks for relaxation () and coping (). Effect size Cohen's d MCOS relaxation = 0.86, coping
The intervention increased confidence in being able to relax at will. There was also evidence that effects of the intervention on the various outcomes examined were mediated by change in confidence about being able to relax
199 female nonmetastatic breast cancer patients at stage III or below and surgery within the past 8 weeks Mean age: 50
CBSM and relaxation/condensed educational intervention
T 92 (19.5%)/C 107 (22.4%) (b)
2 h × 10 w (20 h + 1-year followup)
HADS (anxiety): Group effect on slope: , ; Cohen’s d = 0.74. Affect balance scale (distress): group effect on slope: , ; Cohen’s d = 0.33. Groups differ at time 3 (, ; Cohen’s )
Structured, group-based cognitive behavior stress management may ameliorate cancer-related anxiety during active medical treatment for breast cancer and for 1 year following treatment
CBSM and relaxation/WLC with one-day didactic and experiential stress management program
T 26 (19%)/C 26 (30%) (b)
135 m × 10 w (22.5 h + homework)
COPE (60-item scale) for coping: () (d)
Significantly greater improvement in active coping than controls. Group-based CBT+ stress management significantly attenuated anxiety in HIV-positive men
87 men and 13 women admitted to hospitals for acute myocardial infarction (WHO criteria) or coronary artery bypass surgery Mean age: <70
Autogenic Training/WLC
T 50 (ND)/C 50 (ND) (c)
10 sessions (ND)
HAD (anxiety): group by time interactions , and at followup . (d)
Significant reductions in anxiety in treatment group. Stress management training may lead to improvements in the quality of life of myocardial infarction and coronary artery bypass patients
Autogenic Training/attention control using laughter therapy/time control with no treatment
T 32 (34%)/attention control 30 (20%)/time control 31 (16%) (a)
1 h × 8 w (8 h + homework)
STAI: state anxiety between treatment and time control () between treatment group and attention control (), and between the two control groups (). Trait anxiety between the treatment and time control groups () and between the treatment group and the attention control group () (d)
Autogenic Training is significantly more effective in reduction of state and trait anxieties than in both other groups immediately after treatment
56 male/female patients with tension headache Mean age: 36
Autogenic Training and self-hypnosis (SH)/WLC
ND (b)
45 m × 4 (3 h + homework + 3 boosters)
SCL 90: psychological distress at posttreatment and level of psychological distress in contrast to the waiting-list period (). Follow-up measurements indicated that therapeutic improvement was maintained (). CSQ: at posttreatment (d)
Patients treated with AT or SH training achieved moderate reductions in psychological distress and showed statistically significant reductions in distress compared to WLC
GSI (SCL-90-R) (psychological distress); between group analysis from baseline to postintervention: (). PSS: within group analysis: pre-post scores for intervention versus control group (); STAI state anxiety () (d)
A 6-week RR and CBT training program significantly reduce self-reported psychological distress, anxiety, and the perception of stress
80 male/female patients with psychosomatic complaints Mean age: 37
Relaxation Response Training/stress management information group
Ways to wellness 28/mind/body program 27/stress management info. group 25; 11% total dropouts (b)
WTW and MBP: 1.5 h × 6 w (9 h + homework), SMG: 1.5 h × 2 (3 h)
B-POMS: between groups analysis-psychological distress for both WTW and MB groups (, ), a decline that was significantly greater than that for the information group () (d)
At the 6-month followup, patients in the behavioral medicine groups showed significantly greater reductions in visits to the HMO and in discomfort from physical and psychological symptoms than did the patients in the information group
259 male/female participants who had experienced a hurtful interpersonal experience from which they still felt negative emotional consequences Mean age: 41.8
Meditation and imagery/no treatment control
Combination of cognitive restructuring positive and negative visualizations and heart-focused meditation techniques. Time was devoted to education about the negative health consequences of grudge-holding and unforgiveness, cognitive restructuring, and meditations/relaxation exercises. Exercises used in the training were principally tailored to instill and cultivate a more relaxed state, to reduce arousal during the recollection of interpersonal grievances, and to improve participants’ ability to regulate emotions by consciously shifting attention between negative and more neutral or positive thinking and feeling states
T 134 (14%)/C 125 (18%) (b)
1.5 h × 6 w (9 h)
PSS perceived stress (). Effect size: Cohen's D for PSS 0.66 at posttest and 0.54 at followup
Significant treatment effects were found for forgiveness self-efficacy, forgiveness generalized to new situations, and perceived stress
34 female breast cancer patients Mean age: T 54.2, C 50.07
Meditation, relaxation, breathing, and imagery: relaxation and visual therapy (RVT)/no intervention
Relaxation and visualization therapy (RVT) intervention includes a relaxation period (20 min), in which the subject is induced to mentally create an image of the desired objective or result, including progressive muscle relaxation, guided imagery, meditation, and deep breathing. Subjects were guided to create a mental image in which their tumor is attacked by their immune system and then to visualize the breast completely healed
T 20/C 14 (0%) (b)
0.5 h × 24 (12 h + homework)
ISSL, STAI: within groups (pre- versus postexperimental group): ISSL Q1 , Q2 , Q3 . STAI (state) , trait . The psychological scores did not change over time in the control group (all ). Effect sizes: SSL Q1 .72 ISSL Q2 .64 ISSL Q3 .70 STAI (State) .52 STAI (Trait).79
RVT is effective for reducing stress, anxiety, and depression scores and may improve the quality of life of cancer patients undergoing radiotherapy
Yoga, breathing/psychodynamic supportive-expressive therapy with coping preparation
Yoga intervention consisted of a set of asanas (postures done with awareness), breathing exercises, pranayama (voluntarily regulated nostril breathing), meditation, and yogic relaxation techniques with imagery. These practices were based on principles of attention diversion, mindful awareness, and relaxation to cope with day-to-day stressful experiences. The first session consisted of yogic relaxation, meditation using breath awareness, and impulses of touch emanating from palms and fingers or chanting a mantra from a Vedic text for 30 min. Subjects in the yoga group were provided with audio and video cassettes of the yoga modules for home practice; these home sessions started with a few easy yoga postures, breathing exercises and pranayama (voluntarily regulated nostril breathing), and yogic relaxation
T 28/C 34l (37%) (b)
YR 30 m (.5 h + homework) Counseling 1 h; control .5 h
STAI state anxiety score: between groups analysis . Subjective questionnaires: number of distressful symptoms ; symptom distress: (d)
There was a significant decrease in reactive anxiety states, depression, number of treatment-related distressful symptoms, severity of symptoms and distress experienced, and improvement in quality of life during chemotherapy in the yoga group as compared with control
108 severe mental illness male/female patients Mean age: 44.21
CBT and breathing/TAU with supportive counseling as needed
CBT program for PTSD included 8 modules: introduction, crisis plan review, psychoeducation (symptoms of PTSD), breathing retraining, psycho-education (associated symptoms of PTSD), cognitive restructuring (common styles of thinking), cognitive restructuring II (5 steps of cognitive restructuring), generalization training, and termination
CBT program 54 (20%)/treatment as usual (TAU) program 54 (0%) (a)
ND
PTCI, BAI, CAPS: between groups analysis CBT versus TAU (baseline versus postintervention): PTCI ; BAI , CAPS Dx , CAPS Dx (>65) , CAPS Dx (<65) .18. Post hoc analysis: subset with severe PTSD (CAPS > 65). Effect sizes for both CAPS-total increased, from .45 to .59 and in CAPS-diagnosis from .27 to .40. Subset with mild-moderate PTSD (CAPS < 65) The effect sizes decreased to .12 and .10, respectively
Findings suggest that clients with severe mental illness and PTSD can benefit from CBT and breathing, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations
75 male/female patients on sick leave for at least 50% of the time for stress-related diagnoses Mean age: 44
CBT and relaxation techniques/physical activity/usual care
Cognitive intervention focused on education, qigong and relaxation techniques, coping skills, and stress management exercises. Participants in the physical activity group were offered exercise sessions. Participants chose an exercise (e.g., strength training, swimming, aerobics, or walking) in consultation with the group leader. During the intervention, each participant kept a diary of their physical exercise
31 male/female patients with chronic schizophrenia who engaged in level 4 or 5 of the center's part time paid job program Mean age: 34.9
CBT and breathing/WLC
The work-related stress management program included short lectures on the influences of stress on cognition, emotion, and behavior; instruction in the techniques of handling negative emotions and stress (e.g., deep breathing, strut (walking proudly), and exercise) and emotional intelligence. Several sessions were devoted to communication, skills training, assertiveness training, and problem-solving skills training. Finally, methods dealing with work-related crises were presented and practiced
31 total Only 2 dropout total (b)
1 h × 12 w (12 h + homework)
WSQP: between groups analysis from first to second testing period (12 weeks): total WSQP stress score . Pooling data from both 12-week treatment periods, treatment effect for the change in total WSQP scores (). Effect size:
Work-related stress management program had large short-term positive effects on patients’ perceived work-related stress. These findings support providing this type of program to employed patients with schizophrenia
85 out of 175 who met the inclusion criteria, male/female pediatric headache patients Mean age: 12.1
CBT and relaxation (TG)/self-help (SH) control group following the same program except that treatment done through the use of a manual/WLC
Main topics TG: session 1 is an introduction to the training as well as education about headache. Session 2 dedicated to the acquisition of progressive relaxation techniques. Session 3 introduced the perception of stress symptoms, the role of stress regarding headache and how to cope with stress. Session 4 introduced the children to the significance of dysfunctional and functional cognitions regarding stress and headache. Session 5 explained the role of attention on pain experience and introduced positive imagery as means to distract attention from pain and attain a relaxed state. In Session 6, self assertive behavior was the main topic. Session 7 offered a model for general problem solving. Session 8 gave a summary of all skills.
TG 30/SH 35/WLC 20 Dropout: 12% (unclear as to which groups) (b)
1.5 h × 8 w (12 h)
The “coping with stress” subscale of the stress questionnaire: TG and SH compared to WLC overall () (d)
The efficiencies of the two training formats are nearly identical. Both groups significantly reduced stress as compared to the WLC. The group format, because of its better acceptance, is recommended for practical use
SMTP with relaxation/control group with delayed class attendance at the end of testing period
The stress management course in the “Fit to Win” program consisted of strategies involving stress awareness and principles of home management, environmental modification, and assertiveness, as well as multiple methods of relaxation. An audio cassette of relaxation strategies was available for home practice
T 31/C 33; dropouts: ND (b)
ND
STAI: pretest to posttest between groups F (1, 61) = 1.32 SCL-90: pretest to posttest between groups F (1, 62) = 5.21 . (d)
There was no statistically significant difference between groups for state anxiety. The lack of significance is primarily due to improvements in the control group members also participating in the overall wellness program. There was a significant overall improvement for the combined groups in relation to all four variables (stress-related physical symptoms, perception of anxiety, and systolic and diastolic blood pressure). There is benefit to this program with overall low cost
36 male/female parents of children with severe handicaps Mean age: ND
SMTP with relaxation/control
Lectures, demonstrations, and discussion focused on self-monitoring of stress and physiological reactions to stress, muscle relaxation, and restructuring/modifying cognitive distortions related to stress
T 18/C 18; dropouts: ND (b)
2 h ×8 w (16 h)
STAI: analysis of covariance (controlling preintervention scores) state and trait anxiety F (1, 34) = 5.98, . (d)
The treatment group improved significantly on measures of depression and anxiety
155 males/females recruited through employers Mean age: 38
SMTP with relaxation (different groups of workers)/assessment of only control group
The SMT program taught participants a variety of active coping strategies covering the following elements: (a) progressive muscle relaxation, (b) problem-solving training, (c) assertiveness skills training, and (d) raising awareness of individual stressors, stress reactions, coping style or styles, and (un)healthy lifestyle. At the outset of each session, an outlined agenda was provided. Agendas included theoretical lectures, exercises (i.e., relaxation and problem-solving exercises and behavioral role play with other group members), and homework assignments
SMTpsy 53 (11%)/SMT para 51 (14%)/controls 51 (20%) (b)
2.5 h × 8 w (20 h + homework)
GHQ for general distress and STAI (trait): difference between the intervention and control for both measures . (d)
Results show favorable effects of the SMT program both in the short term and at 6-month followup. Results showed no serious differences in effectiveness between trainers. It is argued that, to be effective, the SMT program does not necessarily have to be given by clinical psychologists only but may instead be given by individuals from other professional orientations
134 ischemic heart disease (IHD) patients Mean age: 63
Relaxation and imagery(SM)/ exercise only/usual care
3 key components to stress management (SM) training: education in which participants were provided information about IHD and myocardial ischemia, structure and function of the heart, traditional risk factors, and emotional stress. Second, patients underwent skills training, involving instruction in specific skills to reduce the affective, behavioral, cognitive, and physiological components of stress. Therapeutic techniques included graded task assignments, monitoring irrational automatic thoughts, and generating alternative interpretations of situations or unrealistic thought patterns. Patients instructed in progressive muscle relaxation and imagery techniques, along with training in assertiveness, problem solving, and time management. Role-playing also was used. Third, group interaction and social support were encouraged
SM 44 (5%)/exercise 48 (8%)/usual care 42 (9.5%) (a)
1.5 h × 16 w (24 h)
STAI general anxiety: for exercise and SM versus usual care after treatment and the 24-item GHQ to assess psychiatric symptoms and general distress for exercise and stress management versus usual care (d)
For patients with stable IHD, exercise and stress management training reduced emotional distress and improved markers of cardiovascular risk more than usual medical care alone
161 females with breast cancer stage I or II after first session of six-week course of radiotherapy Mean ages: R&I 53, R 51, control 54
Relaxation, breathing, and imagery/relaxation/ control group
Both treatment groups (relaxation and relaxation plus imagery) were taught a relaxation technique which by a process of direct concentration focuses sensory awareness on a series of individual muscle groups. These patients were also given instructions for diaphragmatic breathing, which slows respiration, induces a calmer state, and reduces tension. In addition to the breathing and relaxation, each patient in the relaxation plus imagery group was taught to imagine a peaceful scene of her own choice as a means of enhancing the relaxation.
Unclear; 13% total dropout b
.5 h × 6 w (3 h + homework)
The item “relaxed” is part of the subscale for tension in the POMS: The Leeds general scales for anxiety and depression showed no significant changes over the six weeks of treatment (d)
At the end of the study period the women trained in relaxation plus imagery were more relaxed than those trained in relaxation only, who in turn were more relaxed than the controls. Patients with early breast cancer benefit from relaxation training
50 female breast cancer patients Mean age: T 52.6, C 54.3
Relaxation and imagery/WLC
The model consisted of these components: (1) health education; (2) Coping Skills Training; (3) stress management; and (4) psychosocial support. In the health education component, medical and psychologic information specific to breast carcinoma was presented. In the coping skills component, the patients were taught to utilize the active-cognitive and active-behavioral coping methods when they encountered specific problems related to having cancer. In the stress management component, they were taught relaxation exercises, including progressive muscle relaxation (PMR) followed by guided imagery (GI). Psychologic support was offered by the staff throughout the intervention, and within-group support was provided by the patients themselves
T 25 (8%)/C 25 (8%) (b)
1.5 h × 6 w (9 h +homework)
POMS (tension/anxiety): (between groups), (group × time baseline, 6 weeks, 6 mos followup) HADS (anxiety) between groups, (group × time baseline, 6 weeks, 6 mos followup) (d)
Assessment of the effect on psychological distress indicated a significant decrease in total mood disturbance on the POMS over the study period
69 male/female students who scored in the upper 15% ile on the debilitating scale of the achievement anxiety scale Mean age: ND
Relaxation and breathing interventions/WLC/no treatment expectancy control
Relaxation as self-control involving discrimination training, relaxation training, application training, and guided practice in relaxation procedures. Modified desensitization involved learning relaxation as a coping skill, relaxation as self-control, and homework from relaxation skills learned, a scene presentation meant to relax the patient
AAT D (debilitating anxiety) and AAT F (facilitating anxiety): posttest and followup between groups and two control groups ; TAI: between groups at posttest and at followup (d)
Groups given relaxation as self-control and modified desensitization both reported significantly less debilitating test anxiety and significantly more facilitating test anxiety than controls. Relaxation as self-control group showed reduction and maintenance on both measures of nontargeted anxiety relative to the controls
+
Tables 3(a) and 3(b) have been split according to those programs that consist of “named” programs and those that consist of “un-named programs.” Because the un-named programs consist of sometimes multiple activities and are heterogeneous across, the authors have included the program description to complement those categories of studies. AAT D: achievement anxiety test (debilitating anxiety); AAT F: achievement anxiety test (facilitating anxiety); BAI: Beck anxiety inventory; B-POMS: bipolar profile of mood states; BSI: brief symptom inventory; CAPS: clinician administered PTSD scale; BQ: Shirom-Melamed burnout questionnaire; CSQ: coping strategy questionnaire; DIS: dealing with illness scale; DSI: differential stress inventory; ELSS: everyday life stress scale; GHQ: general health questionnaire; HADS: hospital anxiety and Depression Scale; ISSL: inventory of stress symptoms lipp for adults; MCOS: measurement of current status; MESA: Measure for Assessment of General Stress Susceptibility; POMS: Profile of Mood States; PSS: Perceived Stress Scale; PTCI: Post-Traumatic Cognition Inventory; SCL-90: Symptom Checklist 90; SCL90-R (GSI); symptom checklist 90 global severity index; STAI: state-trait anxiety inventory; TAI: trait anxiety inventory; WSQP: work-related questionnaire for chronic psychiatric patients.
(a) Power calculation done and achieved, (b): power calculation not done or reported, (c) unclear if power calculation done or achieved, and (d) effect size not reported, ND: not described, WLC: wait list control, T: treatment, C: control.
