Unexpected Effect of Muscle Relaxation on Grief Severity

DENVER — A first-of-its-kind study evaluating a mindfulness intervention to ease grief unexpectedly showed that the control treatment, progressive muscle relaxation, was more effective.

Dr Lindsey Knowles

“Both progressive muscle relaxation and mindfulness training were shown to improve grief severity, yearning, depression symptoms, and stress; [but] the results from this study suggest that progressive muscle relaxation is most effective compared to a wait-list control condition for improving grief,” study investigator Lindsey Knowles, PhD, senior fellow, MS Center of Excellence, VA Puget Sound Health Care System, and University of Washington School of Medicine, Seattle, Washington, told Medscape Medical News.

“With replication, progressive muscle relaxation could be a standalone intervention for non-disordered grief or a component of treatment for disordered grief,” Knowles said.

The findings were presented here at the Anxiety and Depression Association of America (ADAA) 2022.

Disordered Grief

Approximately 10% of individuals grappling with loss “get stuck” in their grief and develop disordered grief, which is distinguished by repetitive thought processes of yearning and grief rumination, the investigators note.

The researchers hypothesized that mindfulness training, which has been shown to reduce maladaptive repetitive thought, could be an effective intervention to prevent disordered grief.

To investigate, they enrolled 94 widows and widowers (mean age, 67.5 years) who were experiencing bereavement-related grief and were between 6 months and 4 years postloss.

The researchers compared a 6-week mindfulness intervention (n = 37) with a 6-week progressive muscle relaxation intervention (n = 35), Knowles said, because there has been speculation that benefits from mindfulness training may be related more to the relaxation response than to the actual mindfulness component.

Both study groups received the intervention in similar settings with matched instructors.

The mindfulness intervention sessions included 10 to 25 minutes of meditation and mindfulness practices. It also included instructions for home practice.

Participants in the progressive muscle relaxation group were trained to tense and relax the body’s various muscle groups with an end goal of learning to relax four key muscle groups without initial tensing.

A third group of patients were placed on a waitlist with no intervention (n = 22).

Measures taken throughout the study interventions and at 1 month postintervention showed reductions in the study’s two primary outcomes of grief severity and yearning for both interventions vs baseline (P = < .003).

However, only the progressive muscle relaxation group had a significantly greater reduction in grief severity vs the waitlist control group (P = .020).

The muscle relaxation group also showed lower grief severity at 1‑month follow‑up vs the waitlist group (P = .049) — with a value at that time falling below an established cut‑off for complicated grief, based on the Revised Inventory of Complicated Grief.

All three treatment groups showed a drop in the third primary outcome of grief rumination (P < .001).

Secondary outcomes of depression and stress were reduced in both active study groups vs the waitlist group (P = .028). Sleep quality also improved in both active intervention groups.

Simple Technique

Knowles said the study’s findings were unexpected.

“We had hypothesized that mindfulness training would outperform progressive muscle relaxation and wait-list for improving grief outcomes,” she said.

Mindfulness experts underscore that a state of global relaxation is considered integral to the benefits of mindfulness, which could explain the benefits of progressive muscle relaxation, Knowles noted.

Importantly, progressive muscle relaxation has a key advantage: It is quickly and easily learned, which may partially explain the study’s findings, she added.

“Progressive muscle relaxation is a relatively simple technique, so it is also likely that participants were able to master [the technique] over the 6-week intervention,” Knowles said. “On the other hand, the mindfulness intervention was an introduction to mindfulness, and mastery was not expected or likely over the 6-week intervention.”

Either way, the results shed important light on a potentially beneficial grief intervention.

“Although mindfulness training and progressive muscle relaxation practices may both be perceived as relaxing, mastering progressive muscle relaxation may in fact enable people to maintain better focus in the present moment and generalize nonreactive awareness to both positively and negatively balanced phenomena,” Knowles said.

However, “more research is necessary to clarify how progressive muscle relaxation improves grief outcomes in widows and widowers.” 

CNS Benefits?

Commenting for Medscape Medical News, Zoe Donaldson, PhD, assistant professor in Behavioral Neuroscience, Department of Psychology and Neuroscience, University of Colorado Boulder, said the study is important for ongoing efforts in finding effective therapies for grief.

“We often struggle to try to help those experiencing the pain of loss and this study suggests a discrete set of exercises that may help,” said Donaldson, who was not involved with the research.

She also described the study results as surprising, and speculated that a combination of factors could explain the findings.  

“First, mindfulness is hard to achieve, so the moderate beneficial effects might increase with more substantial mindfulness training. Secondly, it is not clear why progressive muscle relaxation had an effect, but the focus and attention to detail may engage the central nervous system in a beneficial way that we don’t fully understand,” Donaldson said.

Importantly, it’s key to remember that grief is an individual condition when investigating therapies, Donaldson noted.

“We likely need to develop multiple interventions to help those who are grieving. Incorporating loss can take many forms,” she said.

Anxiety and Depression Association of America (ADAA) 2022. Abstract #305R. Presented March 18, 2022.

The investigators and Donaldson report no relevant financial relationships.

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