Impact of Applied Progressive Deep Muscle Relaxation Training on the Level of Depression, Anxiety and Stress among Prostate Cancer Patients: A Quasi-Experimental Study

  • Isa, Mohamad Rodi (Population Health and Preventive Medicine Unit, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus) ;
  • Moy, Foong Ming (Julius Centre University of Malaya, Department of Social & Preventive Medicine) ;
  • Razack, Azad Hassan Abdul (Department of Surgery, Faculty of Medicine, University of Malaya) ;
  • Zainuddin, Zulkifli Md. (Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre (UKMMC)) ;
  • Zainal, Nor Zuraida (Department of Psychological Medicine, Faculty of Medicine, University of Malaya)
  • Published : 2013.04.30


Background: The aim of this study was to determine the impact of applied progressive muscle relaxation training on the levels of depression, anxiety and stress among prostate cancer patients. Materials and Methods: A quasi-experimental study was conducted at the University Malaya Medical Centre (UMMC) and Universiti Kebangsaan Malaysia Medical Centre (UKMMC) over six months. Prostate cancer patients from UMMC received the intervention and patients from UKMMC were taken as controls. The level of depression, anxiety and stress were measured using Depression, Anxiety Stress Scales - 21 (DASS-21). Results: A total of 77 patients from the UMMC and 78 patients from the UKMMC participated. At the end of the study, 90.9% and 87.2% of patients from the UMMC and UKMMC groups completed the study respectively. There were significant improvements in anxiety (p<0.001, partial ${\eta}^2$=0.198) and stress (p<0.001, partial ${\eta}^2$=0.103) at the end of the study in those receiving muscle training. However, there was no improvement in depression (p=0.956). Conclusions: The improvement in anxiety and stress showed the potential of APMRT in the management of prostate cancer patients. Future studies should be carried out over a longer duration to provide stronger evidence for the introduction of relaxation therapy among prostate cancer patients as a coping strategy to improve their anxiety and stress.


  1. Mehnert A, Lehmann C, Graefen M, Huland H, Koch U (2010). Depression, anxiety, post-traumatic stress disorder and health-related quality of life and its association with social support in ambulatory prostate cancer patients. Eur J Cancer Care, 19, 736-45.
  2. Musa R, Fadzil MA, Zain Z (2007). Translation, validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales (DASS). Asean J Psychiatry, 8, 82-9.
  3. Musa R, Salmiah MA, Nurul Ain M (2009). Validation and Psychometric properties of Bahasa Malaysia version of the depression anxiety and stress scales (DASS) among diabetic patients. Malaysian J Psychiatry, 18, 1-7
  4. Nelen V (2007). Epidemiology of prostate cancer. Recent Results Cancer Res, 175, 1-8
  5. Nickel C, Kettler C, Muehlbacher M, et al (2005). Effect of progressive muscle relaxation in adolescent female bronchial asthma patients: a randomized, double-blind, controlled study. J Psychosomatic Res, 59, 393-8.
  6. Pawlow LA, Jones GE (2002). The impact of abbreviated progressive muscle relaxation on salivary cortisol. Biol Psychol, 60, 1-16.
  7. Pawlow LA, O'Neil PM, Malcolm RJ (2003). Night eating syndrome: effects of brief relaxation training on stress, mood, hunger, and eating patterns. Int J Obesity, 27, 970-78.
  8. Payne RA (2000). Relaxation Techniques: A Practical Handbook for the Health Care Professional (2nd ed.). London: Harcourt Publishers Limited.
  9. Sadock BJ, Sadock VA (2003). Psychotherapies. In Benjamin James Sadock and Virginia A. Sadock (Eds.), Synopsis of Psychiatry Behavioral Sciences Clinical Psychiatry. Philadelphia: Lippincott Williams and Wilkins.
  10. Sharpley CF, Bitsika V, Christie DHR (2008). Psychological distress among prostate cancer patients: fact or fiction? Clinical Medicine Oncology, 1, 563-72.
  11. Sharpley CF, Bitsika V, Christie DRH (2007). Causal 'mapping' of depression and anxiety among prostate cancer patients: a preliminary interview study. J Mens Health Gender, 4, 402-8
  12. Sloman R (2002). Relaxation and imagery for anxiety and depression control in community patients with advanced cancer. Cancer Nursing, 25, 432-5.
  13. Yu DSF, Lee DTF, Woo J (2007). Effects of relaxation therapy on psychologic distress and symptom status in older Chinese patients with heart failure. J Psychosomatic Res, 62, 427-37
  14. Zenger M, Lehmann-Laue A, Stolzenburg JU, et al (2010). The relationship of quality of life and distress in prostate cancer patients compared to the general population. Psychosoc, 30, 7.
  15. Emery CF, France CR, Harris J, Norman G, Arsdalen CV (2008). Effects of progressive muscle relaxation training on nociceptive fleaxion threshold in healthy young adults: a randomized trial. Pain, 138, 375-9.
  16. Epstein JI (2006). Histopathology of prostate cancer and pathologic staging. In Kirby RS, Partin AW, Feneley M, Parsons JK (Eds.), Prostate Cancer. Principles and Practice. London & New York: Taylor & Francis Group.
  17. Gill S, Kolt GS, Keating J (2004). Examining the multi-process theory an investigation of the effects of two relaxation techniques on state anxiety. J Bodywork Movement Therapies, 8, 288-96.
  18. Gloster AT, Rhoades HM, Novy D, et al (2008). Psychometric properties of the Depression Anxiety and Stress Scale-21 in older primary care patients. J Affective Disorders, 110, 248-59
  19. Henry JD, Crawford JR (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Bri J Clinical Psychology, 44, 227-39
  20. Jacobson E (1938). Progressive Relaxation (2nd ed.). Chicago, IL University of Chicago Press.
  21. Katz A, Katz A (2008). The top 13-What family physicians should know about prostate cancer. Can Fam Physician, 54, 198-203
  22. Kunkel EJS, Bakker JR, Myers RE, Oyasanmi O, Gomelia LG (2000). Biopsychosocial aspects of prostate cancer. Psychosomatics, 41, 85-94.
  23. Lahmann C, Leow TH, Tritt K, Nickel M (2008a). Efficacy of functional relaxation and patient education in the treatment of somatoform heart disorders: a randomized, controlled clinical investigation. Psychosomatics, 49, 378-85.
  24. Lahmann C, Schoen R, Henningsen P, et al (2008b). Brief relaxation versus music distraction in the treatment of dental anxiety: a randomized controlled clinical trial. J Am Dent Assoc, 139, 317-24.
  25. Latiffah AL, Nor-Afiah M, Shashikala S (2005). Psychological well-being of the elderly people in Peninsular Malaysia. Int Med J, 4, 38-43
  26. Leo'n-Pizarro C, Gich I, Barthe E, et al (2007). A randomized trial of the effect of training in relaxation and guided imagery techniques in improving psychological and quality-of-life indices for gynecologic. Psycho-Oncology, 16, 971-9
  27. Lovibond PF, Lovibond SH (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney: Psychology Foundation of Australia.
  28. Mackereth PA, Booth K, Hillier VF, Caress AL (2009). Reflexology and progressive muscle relaxation training for people with multiple sclerosis: a crossover trial. Complementary Therapies in Clinical Practice 15, 14-21
  29. Mackie S, Rai B (2008). Prostate cancer reviewed: part 1-epidemiology, aetiology and pathology. Oncology, 3, 22-4.
  30. Manne S, Badr H, Zaider T, Nelson C, Kissane D (2010). Cancer-related communication, relationship intimacy and psychological distress among couples coping with localized prostate cancer. J Cancer Surviv, 4, 74-85
  31. American Cancer Society (2011). Cancer Facts & Figures: 2011. Retrieved 1st December 2011, from acs/groups/content/@epidemiologysurveilance/documents/ document/acspc-029771.pdf
  32. Apostolo JLA, Mendes AC, Azeredo ZA (2006). Adaptation to portuguese of The Depression, Anxiety and Stress Scales (DASS). Rev Latino-am Enfermagem, 14, 863-71.
  33. Bados A, Solanas A, Andres R (2005). Psychometric properties of the Spanish version of Depression, Anxiety and Stress Scales (DASS). Psicothema, 17, 679-83.
  34. Akin A, Cetin B (2007). The Depression Anxiety and Stress Scale (DASS): The study of validity and reliability. Educational Sciences: Theory and Practice, 7, 260-8.
  35. Altekruse SF, Kosary CL, Krapcho M, et al (2001). SEER Stat Fact Sheets: Prostate Cancr 2010. Retrieved 15th January 2010, from
  36. Bastani F, Hidarnia A, Kazemnejad A, Vafaei M, Kashanian M (2006). A randomized controlled trial of the effects of applied relaxation training on reducing anxiety and perceived stress in pregnant women. J Midwifery Women Health, 50, 36-40.
  37. Berggren U, Hakeberg M, Carlsson SG (2000). Relaxation vs. cognitively oriented therapies for dental fear. J Dent Res, 79, 1645-51.
  38. Bloch S, Love A, Macvean M, et al (2007). Psychological adjustment of men with prostate cancer: a review of the literature. Bio Psycho Social Med, 1, 2.
  39. Bracarda S, de Cobelli O, Greco C, et al (2005). Cancer of the prostate. Critical Reviews in Oncology/Hematology, 56, 379-96.
  40. Cancer Research UK (2010). CancerStats Key Facts: Prostate Cancer. Retrieved 10th October 2009. From http://info.
  41. Charles CR, Rick HH (1993). Efficacy of abbreviated progressive muscle relaxation training: a quantitative review of behavioral medicine research. J Consult Clin Psychol, 61, 1059-67.
  42. Chen WC, Chu H, Lu RB, et al (2009). Efficacy of progressive muscle relaxation training in reducing anxiety in patients with acute schizophrenia. J Clinical Nursing, 18, 2187-96
  43. Cheung YL, Molassiotis A, Chang AM (2003). The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. Psycho-Oncology, 12, 254-66
  44. Cohen J (1992). A power primer. Psychol Bull, 112, 155-9.
  45. Dehdari T, Heidarnia A, Ramezankhani A, Sadeghian S, Ghofranipour F (2009). Effects of progressive muscular relaxation training on quality of life in anxious patients after coronary artery bypass graft surgery. Indian J Med Res, 129, 603-8
  46. Dupont WD, Plummer WD (1990). Power and sample size calculations: a review and computer program. Controlled Clinical Trials, 11, 116-28.

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