Effect of Progressive Muscle Relaxation on depression, anxiety, and stress of primigravid women

Document Type : Original Quantitative and Qualitative Research Paper


1 MS in Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

2 Assistant Professor of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

3 Assistant Professor of Clinical Psychology, Research Center of Psychiatry and Behavioral Sciences, Ebne-sina Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Professor of Biostatistics, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran


Background: Hormonal changes in pregnancy can alter a person's emotions and feelings. The most common mental disorders during pregnancy are anxiety and depression. Relaxation is one of the interventions that increases comfort through affecting the sympathetic system, and can probably reduce psychological tension in pregnant women.
Aim: To investigate the effect of progressive muscle relaxation on depression, anxiety and stress of primigravid women.
Methods: This randomized clinical trial was conducted on 66 primigravid women from April to September 1393(2014) in two health care centers covered by health center No-1 in the city of Mashhad. Subjects were randomly divided into two groups of progressive muscle relaxation and control. After two sessions of relaxation within two weeks, the intervention group was doing exercises at home for 4 weeks. The instrument used in this study, was Depression Anxiety Stress Scale (DASS 21). Data were analyzed with SPSS statistical software version 11.5, using descriptive statistics and Mann-Whitney U and independent t-tests.
Results: The mean age of subjects in this study was 25.5±4.3 years. Before the study, the two groups showed no significant differences in depression (p=0.24), anxiety (p=0.36) and stress (p=0.58); but after the intervention, depression (p=0.001), anxiety (p<0.001) and stress (p<0.001) of the pregnant women was significantly lower in the progressive muscle relaxation group than those of the control group.
Conclusion: Due to the relaxation effect on reducing depression, anxiety and stress, and also lack of side effects and its easy applicability, this method can be recommended to use as an approach to reduce depression, anxiety and stress in women during pregnancy.


  1. Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Wiliams Obstetrics. Ghazijahani B, Ghotbi R. 23rd ed. Tehran: Golban; 2010. 49-54.
  2. Bondad R, Abedian Z. Sleep Patterns and Factors Affecting It in the Third Trimester Pregnant Women Referred to Health Centers In Mashhad 1380. IJN 2003;16(36):22-6 (Persian).
  3. Alipour Z, Lmyyan M, Hajizadeh E. Sleep Quality in Late Pregnancy and Postpartum Depression. IJOGI. 2011 (40):39-47 (Persian).
  4. Sadock B, Kaplan H, Sadock V. Kaplan & Sadock's Synopsis of Psychiatry Behavioral Sciences. Rezaee F.10th ed. Tehran: Arjmand; 2007. 149-54.
  5. Forouzandeh N, Delaram M, Deris F.The Quality of Mental Health Status in Pregnancy and It's Contributing Factors in Women Visiting the Health Care Centers of Shahrkord .J Reprod Infertil 2003;4(2):146-55 (Persian).
  6. Babanazari L, Kafi SM. Relationship of Pregnancy Anxiety to Its Different Periods, Sexual Satisfaction and Demographic Factors. Iran J Psychiatry Clin Psychol 2008;4(2):206-13 (Persian).
  7. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. Risk Factors for Depressive Symptoms During Pregnancy: A Systematic Review. Am J Obstet Gynecol 2010;202(1):5-14.
  8. Omidvar SH, Kheirkhah F, Azimi H. Depression in Pregnancy and Its Associated Factors. J Med Hormozgan.2007; 11(3): 213-19 (Persian).
  9. Bunevicius A, Cesnaite E. Antenatal Maternal Mental State and Anthropometric Characteristics of the Neonates: Impact of Symptoms of Depression and Anxiety. Biologinė Psichiatrija. 2007; 91(1): 3-6.
  10. Nasiri Amiri F, Salmalian H, Hajiahmadi M, Ahmadi AM. Association between Prenatal Anxiety and Spontaneous Preterm Birth. J Babol Univ Med Sci. 2009; 11(4): 42-8 (Persian).
  11. Bazrafshan MR, Mahmoudi Rad AR. The Effect of Pregnant Women's Anxiety on APGAR Score and Birth Weight of Newborns. Sci J Hamadan Nursing & Midwifery Faculty. 2009; 17(1-2):58-62 (Persian).
  12. Shahhosseini Z, Abedian K, Azimi H. Role of Anxiety During Pregnancy in Preterm Delivery. J Mazand Univ Med Sci. 2008; 16 (63):85-92 (Persian).
  13. Alipour Z, Lamyian M, Hajizadeh E. Anxiety during Pregnancy: A Risk Factor for Neonatal Physical Outcome?. Journal of Nursing and Midwifery Urmia University of Medical Sciences. 2010; 9(1):30-8 (Persian).
  14. Woods SM, Melville JL, Guo Y, Fan M-Y, Gavin A. Psychosocial Stress During Pregnancy. Am J Obstet Gynecol. 2010;202(1):61. e1-. e7.
  15. Martini J, Knappe S, Beesdo-Baum K, Lieb R, Wittchen H-U. Anxiety Disorders before Birth and Self-Perceived Distress during Pregnancy: Associations with Maternal Depression and Obstetric, Neonatal and Early Childhood Outcomes. Early Hum Dev. 2010;86(5):305-10.
  16. Everly JG, Lating JM. A Clinical Guide to the Treatment of the Human Stress Response [book online].3rd ed. New York: Springer; 2012. 186-89.
  17. Apóstolo J, Kolcaba K. The Effects of Guided Imagery on Comfort, Depression, Anxiety, and Stress of Psychiatric Inpatients with Depressive Disorders. Arch Psychiatr Nurs. 2009;6(3):403-11.
  18. Bastani F, Heidarnia A, Kazemnejad A, Vafaei M, Kashanian M. A Randomized Controlled Trial of the Effects of Applied Relaxation Training on Reducing Anxiety and Perceived Stress in Pregnant Women. J Midwifery Womens Health. 2005;50(4):e36-e40.
  19. Lau MA, Mcmain SF. Integrating Mindfulness Meditation with Cognitive and Behavioural Therapies: The Challenge of Combining Acceptance and Change-Based Strategies. Can J Psychiatry. 2005;50(13):863-74.
  20. Hamid N. The Effect of Relaxation and Mental Imagery and Relaxation Therapy on Anxiety and Hopefulness in Women with Breast Cancer in Ahvaz. Asian J Med Pharm Res. 2012;2(1):10-5.
  21. Alwan M, Zakaria A, AbdulRahim M, AbdulHamid N, Fuad M. Comparison between Two Relaxation Methods on Competitive State Anxiety Among College Soccer Teams During Pre-Competition Stage. International Journal of Advanced Sport Sciences Research. 2013;1(1):90-104.
  22. Jorm AF, Morgan AJ, Hetrick SE. Relaxation for Depression. Cochrane Database Syst Rev 2008: CD007142.
  23. Davis M. Tutorial Relaxation and Stress Reduction. Khajehmougahi N. Tehran: Tabib; 2005. 78-81.
  24. Davis M, Eshelman ER, Mckay M. The Relaxation and Stress Reduction Workbook. London: New Harbinger Publication; 2000. 85-115.
  25. Rafiee B, Akbarzadeh M, Asadi N, Zare N. Comparing the Effects of Educating of Attachment and Relaxation on Anxiety in Third Trimester of Pregnancy and Postpartum Depression in the Primipara Women. Hayat. 2013; 19(1): 76-88. (Persian)
  26. Tragea C, Chrousos GP, Alexopoulos EC, Darviri C. A Randomized Controlled Trial of the Effects of a Stress Management Programme During Pregnancy. Complement Ther Med. 2014; 22(2): 203-11.
  27. ParsaieRad E, AmirAliAkbari S, Sadeghnia K, AlaviMajd H. Relationship between Sleep Disorder and Pregnancy Depression in Primigravidae Women Referring to Health Centers of Ahvaz Jundishapur University of Medical Sciences in 2010. J Shahid Sadoughi Univ Med Sci. 2011;19(4):454-62.(Persian)
  28. Henry JD, Crawford JR. The Short Form Version of the Depression Anxiety Stress Scales (DASS 21): Construct Validity and Normative Data in a Large Non-Clinical Sample. Br J Clin Psychol. 2005;44(2):227-39.
  29. SharifiRad Gh, Rabiei L, Hamidizadeh S, Bahrami N, Rashidi Nooshabadi MR, Masoudi R. The Effect of Progressive Muscle Relaxation Program on the Depression Anxiety, and Stress of Premenstrual Syndrome in Female Students. J Health Syst Res 2014; Health Education supplement: 1786-96.(Persian)
  30. Apóstolo JLA, Mendes AC, Azeredo ZA. Adaptation to Portuguese of the Depression, Anxiety and Stress Scale (DASS). Rev Latino-am Enfermagem .2006; 14(6):863-71.
  31. Elali ES, Mahdavi Ali, Jannati Y, Yazdani J, Setareh J. Effect of Benson Relaxation Response on Stress Among in Hemodialysis Patients. J Mazand Univ Med Sci. 2012; 22(91): 61-8 (Persian).
  32. Malekzadegan A, Moradkhani M, Ashayeri H, Haghani H. Effect of Relaxation on Insomnia During Third Trimester among Pregnant Women. IJN. 2010;23(64):52-8 (Persian).
  33. Payne RM. Relaxation Techniques. 3rd ed. NewYork: Edinburgh; 2005. 78-92.