Progressive muscle relaxation may help reduce anxiety in schizophrenia


People with schizophrenia often experience psychological distress and anxiety. This can have a knock on impact on the positive (delusions and hallucinations) and negative (apathy, social withdrawal, cognitive impairments) symptoms of schizophrenia.

As a result, there’s lots of interest in psychosocial approaches that may help patients relax. These include talking treatments like CBT, as well as social skills training and psychoeducation.

Another technique that is generating some interest is progressive muscle relaxation, which involves tensing and relaxing major muscle groups. It is unclear exactly how this helps people relax, but it has been suggested that muscle relaxation can bring about physiological changes that help to reduce metabolic rate, decrease blood pressure and decreased middle cerebral artery blood flow.

A new systematic review conducted by researchers in Belgium looks at the effectiveness of progressive muscle relaxation on psychological distress and anxiety symptoms and on response/remission for people with schizophrenia.

The reviewers carried out a systematic search and found 3 randomised controlled trials (RCT) involving a total of 146 inpatients with schizophrenia in acute inpatient settings. None of the trials were conducted in a single- or double-blind fashion.

Outcome measures were the mean change in psychological distress and anxiety scores compared with baseline measures, and the mean change in total, positive, and negative symptoms compared with baseline and measured with validated scales.

All 3 RCTs compared progressive muscle relaxation with quiet resting in a room for the same amount of time, but one of the three trials last for significantly longer (11 sessions on consecutive days) than the other two (3 sessions).

Here’s what they found:

  • All 3 RCTs found significant reductions in anxiety in patients who received progressive muscle relaxation, compared with the control group
  • None of the trials looked at progressive muscle relaxation as an add-on treatment to help with the positive or negative symptoms
  • The studies also did not look at progressive muscle relaxation in longer-term treatment and for relapse prevention
  • No side effects were reported for progressive muscle relaxation

The authors concluded:

Progressive muscle relaxation might be a useful add-on treatment to reduce state anxiety and psychological distress and improve subjective well-being in persons with schizophrenia.

Limitations of this study:

These are clearly only preliminary findings as this is the first systematic review in this field and there are relatively few studies on which to base our conclusions.

The reviewers highlighted a number of issues with the quality of the evidence in this field and encouraged future researchers to focus on the following:

  • Conducting RCTs in line with the CONSORT statement and with a focus on the blinding of outcome assessors
  • The effect of progressive muscle relaxation on positive or negative symptoms and on long-term outcomes, including relapse rates
  • The ways in which progressive muscle relaxation can help reduce the need for antipsychotics and antidepressants
  • The ways in which progressive muscle relaxation can help increase rates of abstinence from nicotine or illegal drugs


Vancampfort D, Correll CU, Scheewe TW, Probst M, De Herdt A, Knapen J, De Hert M. Progressive muscle relaxation in persons with schizophrenia: a systematic review of randomized controlled trials. Clinical Rehabilitation – published online 27 July 2012 DOI: 10.1177/0269215512455531 [PubMed abstract]

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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