Introduction
The coronavirus disease 2019 (COVID-19), in addition to physical health problems, caused psychological health problems such as anxiety, depression, insomnia, emotional changes, fear, stigma, and post-traumatic stress syndrome. The use of drugs such as benzodiazepines in infected patients can lead to the suppression of the respiratory system and exacerbation of the disease; hence, it is better to use non-pharmaceutical methods to control the anxiety of patients. In a study, it was shown that Benson’s relaxation technique significantly reduced the anxiety of patients with breast cancer. Another study showed that this method reduced nurses’ anxiety. Stress and anxiety can weaken the body’s immune system and make them vulnerable to diseases. Considering the high prevalence of anxiety in patients with COVID-19 and its negative effects on the body organs as well as the side effects of anti-anxiety drugs, the present study aims to evaluate the effect of Benson’s relaxation technique on the anxiety of patients with COVID-19.
Methods
This is a quasi-experimental study. The study population consists of all patients with COVID-19 admitted to Amir al-Momenin Hospital affiliated to Arak University of Medical Sciences in 2021. The sample size was calculated 22 per group based on previous studies and considering 95% confidence interval and the test power of 80%. Considering the possibility of dropout, the number of samples in each group increased to 32 per group. A convenience sampling method was used to select the samples. Then, they were randomly divided into two groups of control and intervention. First, a pre-test was conducted using a demographic form and the Spielberger State-Trait Anxiety Inventory (STAI). Then, Benson’s relaxation method was taught to the experimental group. Then, the recorded relaxation audio file was provided to the experimental group through a headphone. They were instructed to perform the technique for two days twice a day, each for 15 minutes in the morning and evening (4 sessions in total). The control group did not receive any intervention. After the fourth relaxation session, the STAI was completed again by both groups. The collected data were analyzed in SPSS v. 21 software using descriptive statistics (mean and standard deviation) and inferential statistics (paired t-test, independent t-test, and chi-square test).
Results
The two groups were homogeneous in terms of demographic variables and there was no statistically significant differences between them (P>0.05) (
Table 1).
The mean anxiety score in the intervention group was 55.21±8.85 before relaxation and decreased to 40.43±9.97 after relaxation, and the difference was significant (P<0.001). The mean anxiety score in the control group was 54.75±6.62 before relaxation and 52.03±6.35 after relaxation, and the difference was significant (P<0.001). The independent t-test results showed a statistically significant difference in the post-test score of anxiety between the two groups (P<0.001) (
Table 2).
Discussion
Benson’s relaxation technique can reduce the anxiety of patients with COVID-19. This method as a complementary treatment, can be used along with common treatments, due to its low cost and simplicity, to reduce the anxiety of patients with COVID-19.
Ethical Considerations
Compliance with ethical guidelines
All ethical principles were considered in this study and an ethical approval was obtained from Arak University of Medical Sciences (Code: IR.ARAKMU.REC.1400.103).
Funding
This study was funded by Arak University of Medical Sciences.
Authors' contributions
The authors equally contributed to preparing this article.
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgements
The authors would like to thank the Deputy for Research and Technology of Arak University of Medical Sciences, the personnel of Amir al-Momenin Hospital, and all patients for their support and cooperation in this research.
References
- Ahmed MZ, Ahmed O, Aibao Z, Hanbin S, Siyu L, Ahmad A. Epidemic of COVID-19 in China and associated psychological problems. Asian Journal of Psychiatry. 2020; 51:102092. [PMID] [PMCID]
- Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, et al. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Research. 2020; 287:112921. [PMID] [PMCID]
- Talevi D, Socci V, Carai M, Carnaghi G, Faleri S, Trebbi E, et al. Mental health outcomes of the CoViD-19 pandemic. Rivista di Psichiatria. 2020; 55(3):137-44. [PMID]
- Kasavandi A, Amirani M, Pirzadeh Nori N. [A review of the correlation between anxiety and the prevalence of Covid 19 (Persian)]. New Cellular & Molecular Biotechnology Journal. 2021; 11(43):9-23. [Link]
- Azizi Mahkooyeh S, Rasti A, Asadpur Asl A, Rahimi S, Kordbagheri M. [Effect of face-to-face awareness training on the anxiety of patients with COVID-19: A quasi-experimental study (Persian)]. Journal of Hayat. 2022; 27(4):446-58. [Link]
- Yang L, Wu D, Hou Y, Wang X, Dai N, Wang G, et al. Analysis of psychological state and clinical psychological intervention model of patients with COVID-19. MedRxiv. 2020; 1-8. [DOI:10.1101/2020.03.22.20040899]
- Liu S, Yang L, Zhang C, Xiang YT, Liu Z, Hu S, et al. Online mental health services in China during the COVID-19 outbreak. The Lancet Psychiatry. 2020; 7(4):e17-8. [DOI:10.1016/S2215-0366(20)30077-8] [PMID]
- O’rourke DJ, Smith RE, Smoll FL, Cumming SP. Relations of parent-and coach-initiated motivational climates to young athletes’ self-esteem, performance anxiety, and autonomous motivation: Who is more influential? Journal of Applied Sport Psychology. 2014; 26(4):395-408. [DOI:10.1080/10413200.2014.907838]
- Kaydu A, Gokcek E. Frequency of anxiety and depression in patients of urtolithiasis undergoing Extracorporeal Shock Wave Lithotripsy in Diyarbakir, Turkey. The Journal of the Pakistan Medical Association. 2019; 69(3):426-31. [PMID]
- Pathak P, Mahal R, Kohli A, Nimbran V. Progressive muscle relaxation: An adjuvant therapy for reducing pain and fatigue among hospitalized cancer patients receiving radiotherapy. International Journal of Advanced Nursing Studies. 2013; 2(2):58-65. [DOI:10.14419/ijans.v2i2.715]
- Bajema KL, Oster AM, McGovern OL, Lindstrom S, Stenger MR, Anderson TC, et al. Persons evaluated for 2019 novel coronavirus-United States, January 2020. Morbidity and Mortality Weekly Report. 2020; 69(6):166-70. [DOI:10.15585/mmwr.mm6906e1] [PMID] [PMCID]
- Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis. Globalization and Health. 2020; 16(1):57. [PMID]
- Hu Y, Chen Y, Zheng Y, You C, Tan J, Hu L, et al. Factors related to mental health of inpatients with COVID-19 in Wuhan, China. Brain, Behavior, and Immunity. 2020; 89:587-93. [PMID] [PMCID]
- Ayyadhah Alanazi A. Reducing anxiety in preoperative patients: A systematic review. British Journal of Nursing. 2014; 23(7):387-93. [DOI:10.12968/bjon.2014.23.7.387] [PMID]
- Liu K, Chen Y, Wu D, Lin R, Wang Z, Pan L. Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complementary Therapies in Clinical Practice. 2020; 39:101132. [PMID] [PMCID]
- Najafi Ghezeljeh T, sedghian H, Mohades Ardabili F. [Effect of Benson relaxation technique on anxiety in critical care nurses (Persian)]. Iranian Journal of Cardiovascular Nursing. 2016; 5(3):26-33. [Link]
- Moradipour S, Soleimani MA, Mafi M, Sheikhi MR. [Effect of Benson’s relaxation technique on death anxiety among patients with breast cancer (Persian)]. Journal of Hayat. 2019; 24(4):355-67. [Link]
- Sajadi M, Goudarzi K, Khosravi S, Farmahini-Farahani M, Mohammadbeig A. Benson’s relaxation effect in comparing to systematic desensitization on anxiety of female nurses: A randomized clinical trial. Indian Journal of Medical and Paediatric Oncology. 2017; 38(2):111-5. [PMID]
- Elali E, Mahdavi A, Jannati Y, Yazdani J, Setareh J. [Effect of benson relaxation response on stress among in hemodialysis patients (Persian)]. Journal of Mazandaran University of Medical Sciences. 2012; 22(91):61-8. [Link]
- Seyed Ahmadi Nejad FS, Golmakani N, Asghary Pour N, Shakeri MT. [Effect of progressive muscle relaxation on depression, anxiety, and stress of primigravid women (Persian)]. Evidence Based Care. 2015; 5(1):67-76. [Link]
- Alipour A, Ghadami A, Alipour Z, Abdollahzadeh H. [Preliminary validation of the Corona Disease Anxiety Scale (CDAS) in the Iranian sample (Persian)]. Quarterly Journal of Health Psychology. 2020; 8(32):163-75. [Link]
- Roohy GR, Rahmany A, Abdollahy AA, Mahmoody Gh. [The effect of music on anxiety level of patients and some of physiological responses before abdominal surgery (Persian)]. Journal of Gorgan University of Medical Sciences. 2005; 7(1):75-8. [Link]
- Jafari H, Baghaei Lake M, Sedghisabet M, Kazemnejadleili E. [Benson muscle relaxation effect on patients anxiety undertake diagnostic and treatment within electrophysiological interventions (Persian)]. Journal of Holistic Nursing And Midwifery. 2015; 25(4):37-44. [Link]
- Aghakhani N, Seyyedakbari V, Khademvatani K, Alinejad V. [Study of the effect of benson relaxation method on the anxiety level of patients with myocardial infarction admitted to Ccu Wards of Educational and Treatment Center of Seyyed Shahada, Urmia, IRAN, 2017 (Prsian)]. Nursing and Midwifery Journal . 2019; 17(3):239-50. [Link]
- Fayazi S, Shariati A, Momeni M. [The efficacy of benson’s relaxation technique on postoperative pain in coronary artery bypasses graft (Persian)]. Jundishapur Scientific Medical Journal. 2010; 8(63):479-89. [Link]
- Bavazin F, Vieskarami H. [The effect of relaxation techniques on the reduction of stress, sexual anxiety, communication concerns, and social concerns in females with infertility (Persian)]. Iranian Journal of Nursing Research. 2018; 13(2):10-6. [Link]
- Jalaei T, Astanegi S, Rahmati M, Salari N. [The survey of perceived social support status and its relation to fear and anxiety of CABG candidate patient’s in Imam Ali’s Hospital of Kermanshah (Persian)]. Nursing and Midwifery Journal . 2018; 16(5):354-63. [Link]
- Bodaghi E, Alipour F, Bodaghi M, Nori R, Peiman N, Saeidpour S. [The role of spirituality and social support in pregnant women’s anxiety, depression and stress symptoms (Persian)]. Community Health Journal. 2016; 10(2):72-82. [Link]
- Teimouri F, Pishgooie SA, Malmir M, Rajai N. [The effect of Benson relaxation on physiological criteria in patients undergoing coronary artery bypass graft surgery (Persian)]. Complementary Medicine Journal. 2019; 9(3):3812-23. [DOI:10.32598/cmja.9.3.3812]
- Malmir M, Teimouri F, Pishgooie SAH, Dabaghi P. [The role of Benson› s relaxation on reducing state anxiety on candidate of open heart surgery patient›s (Persian)]. Military Caring Sciences Journal. 2015; 2(3):182-90. [DOI:10.18869/acadpub.mcs.2.3.182]
- Seifi L, Najafi Ghezeljeh T, Haghani H. [The effects of benson relaxation technique and nature sound›s on anxiety in patients with heart failure (Persian)]. Nursing and Midwifery Journal. 2017; 15(2):147-58. [Link]