Abstract
This randomized controlled trial investigated whether adding the psychodynamically based body-oriented psychotherapy “Functional Relaxation” (FR) to psychoeducation (PE) is more effective than PE alone to reduce stress and stress-associated complaints. Eighty-one participants with elevated stress-levels, ≥50 points on the global scale of the Perceived Stress Questionnaire (PSQ), received either 10 sessions of manualized FR + PE (n = 42) or two sessions of manualized PE alone (n = 39) in a group setting. Six FR trainers took part in this study. Stress-level (PSQ) was the primary outcome and secondary outcomes were depression (PHQ-9) and somatization (PHQ-15). Multilevel models for discontinuous change revealed that FR + PE was more helpful to reduce stress-levels than PE from pre-treatment to post-treatment (t0 → t1) as well as from pre-treatment to 6-month follow-up (t0 → t2) (both p < 0.05) with effect sizes (d) being medium for PE (dt0 → t1 = 0.57; dt0 → t2 = 0.67) and large for FR + PE (dt0 → t1 = 1.57; dt0 → t2 = 1.39). Moreover, FR + PE affected depression and somatization more positively than did PE from t0 to t1 as well as from t0 to t2 (all p < 0.05). Effect sizes for depression were small to medium for PE (dt0 → t1 = 0.52; dt0 → t2 = 0.37) and large for FR + PE (dt0 → t1 = 1.04; dt0 → t2 = 0.95). Effect sizes for somatization were small for PE (dt0 → t1 = 0.18; dt0 → t2 = 0.19) and medium to large for FR + PE (dt0 → t1 = 0.73; dt0 → t2 = 0.93). In summary, the combination of FR and PE was more effective than PE alone. The results of the present trial provide first evidence of FR as a potent component of stress interventions. Adding FR to such interventions might better help prevent clinically relevant disorders such as depression or somatization.
Highlights
The Stress in AmericaTM survey 2015 (American Psychological Association, 2016) revealed that 24% of the adult population experienced high stress-levels and that 34% perceived increased stress during the last year
The negative and significant “time1” term (p < 0.05) shows that stress-levels were significantly reduced by PE from t0 to t1
Functional Relaxation” (FR) + PE was superior to PE in reducing stress-levels at the end of the intervention as well as at 6-month followup
Summary
The Stress in AmericaTM survey 2015 (American Psychological Association, 2016) revealed that 24% of the adult population experienced high stress-levels and that 34% perceived increased stress during the last year (vs. 16% who reported decreased stress). Studies on FR solely rely on clinical samples and the results support the efficacy of FR for the following disorders: Somatoform heart disorder (Lahmann et al, 2008a), asthma (Loew et al, 1996, 2001; Lahmann et al, 2009, 2010a), irritable bowel syndrome (Lahmann et al, 2010b), chronic headache (Loew et al, 2000), and dental anxiety (Lahmann et al, 2008b) These studies have shown that FR can reduce clinically relevant problems, it remains unclear whether FR is an effective intervention for stress in non-clinical samples. The hypotheses were that the condition offering FR + PE is superior to a condition with PE alone at the end of the intervention as well as at 6-month followup to reduce stress-levels (primary outcome) as well as depression and somatization (secondary outcomes)
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