Effects of relaxation therapy with and without cognitive therapy on anxiety in cardiac patients: systematic review and meta-analysis

Relaxation therapy (RT) is a form of stress management that has been used for treatment of stress and anxiety in many situations. A literature search revealed that its use in cardiac patients has been investigated in 11controlled studies. Four of them used an abbreviated form of relaxation therapy, consisting of only one modality, taught in less than 3 hours. Another four used full relaxation training, consisting of several modalities, more hours of training and including discussion of experiences in daily life. In three studies, full relaxation training was supplemented with cognitive therapy. The overall effect on state anxiety in 1097 patients was rather small, but statistically highly significant: standardised mean difference (SMD)=0.27 (95% CI 0.39, 0.15). The effect of abbreviated RT was smallest (SMD=0.08, 95% CI 0.27,-0.09), full RT had largest effect (SMD= 0.51, 95% CI 0.71,0.31), whereas the addition of cognitive treatment did not increase effect (SMD=0.24, 95% CI 0.51, -0.04). There were no indications of negative side-effects of relaxation, like relaxation induced anxiety.

It is concluded that state anxiety in cardiac patients decreases substantially with full RT, but not with abbreviated RT. Moreover, there was no additional effect of cognitive therapy.


Dr J van Dixhoorn

Centre for Breathing Therapy

F van Blankenheymstraat 10

3817 AG Amersfoort, The Netherlands