Progressive Muscle Relaxation to Reduce Anxiety Before Electroconvulsive Therapy (ECT)

Abstract

Background: ECT is a well-established treatment modality for severe psychiatric disorders, particularly major depressive disorder and bipolar disorder. It is well-documented that patients experience significant anxiety before treatment, which can adversely affect nursing care and the treatment process. This study aims to determine the effect of progressive muscle relaxation exercises on anxiety levels among patients with bipolar and depressive disorders prior to their first ECT session. Method: Data for this quasi-experimental study were collected from 30 in-patients with bipolar disorder and depression who received ECT for the first time in the hospital between May 29 and October 29, 2020. Data collection involved an information form, the STAXI State Anxiety Scale, and the Visual Analogue Scale for Anxiety. The data were analyzed using descriptive statistics, the Friedman test, and the Wilcoxon test. Results: The mean VAS-A score decreased from 4.93 ± 1.88 before PMR to 2.83 ± 1.76 after PMR, and further to 1.43 ± 1.21 after ECT (p <.001). However, STAI-S scores did not show a statistically significant difference before and after PMR (p >.05). Heart rate and respiratory rate also significantly decreased after PMR exercises (p <.05), while oxygen saturation remained unchanged. Prior to the next ECT session, the mean VAS-A score increased to 5.10 ± 1.77, and no significant changes were observed in either physiological parameters or anxiety measures. Conclusion: While a short-term effect on VAS Anxiety levels was observed following PMR exercises before ECT, patients still exhibited high levels of anxiety before subsequent ECT sessions. Therefore, it is recommended that PMR exercises be performed before each ECT session, and the effects of long-term application should be further investigated. Future studies should employ a randomized controlled design to compare results with a control group. Clinical trial number: Not applicable. © 2025 Elsevier B.V., All rights reserved.