Evidence Explorer · MS-N056

Progressive muscle relaxation plus guided imagery for anxiety during chemotherapy

Family: Relaxation and imagery supportive care
Clinical question: Can progressive muscle relaxation combined with guided imagery reduce anxiety and depression during chemotherapy?
Evidence label: Positive short-term randomized evidence; package effect and reporting limitations.

Evidence at a glance

• Benefit: A three-week randomized trial reported substantially larger reductions in anxiety and depression with the combined program.
• Certainty: Short-term, single-trial evidence; the two components cannot be separated and reporting raises denominator questions.
• Risk: Usually low physical risk, but imagery can be distressing and relaxation is not a substitute for symptom medication or urgent mental-health care.
• Cancer control: Not studied.

What was studied

The registered trial enrolled people with breast or prostate cancer receiving chemotherapy. Of 256 registered, 236 were randomized; the report describes 104 assigned to each analyzed group. Participants received progressive muscle relaxation plus guided imagery or control care over three weeks. Anxiety (SAS), depression (BDI-II), salivary cortisol, and salivary amylase were assessed.

What the evidence shows

Changes in both anxiety and depression differed between groups (reported regression coefficient −29.4 for each, P<.001). Cortisol fell from 0.30±0.25 to 0.16±0.18 in the intervention group and rose from 0.21±0.22 to 0.44±0.35 in controls; the biomarker interaction was significant. These findings support a short-term symptom-care signal, not a physiologic or anticancer claim. The combined package means progressive relaxation and imagery cannot be evaluated separately.

What this does not show: Cortisol and amylase changes do not demonstrate better chemotherapy response, less recurrence, or longer survival.

Limits and uncertainty

• The report states 236 randomized but gives 104 per analyzed group; the disposition of the remaining randomized participants requires cautious interpretation.
• Three-week follow-up does not establish durability.
• Participants and intervention staff could not be blinded.
• The package combines two techniques, and therapist attention may contribute.
• A clinically meaningful threshold for the reported anxiety and depression changes was not independently verified.

Safety and practical context

People with painful muscle spasm, recent surgery, severe neuropathy, trauma-related symptoms, psychosis, or panic may need adaptation or a clinician-guided alternative. Do not use relaxation to defer prescribed antiemetics, pain treatment, evaluation of delirium, or urgent mental-health care.

Questions for the care team

• Who will teach and monitor the technique?
• Could imagery trigger trauma, panic, or distress?
• What standard symptom medicines and psychological care should continue?
• How will anxiety or depression be measured, and what triggers escalation?

Sources

• Primary randomized trial full text (PMCID PMC4545275)
• Primary trial abstract (PMID 26347018)
• ClinicalTrials.gov NCT01275872
• Systematic review of the combined intervention (PMID 29506956)

Identifiers: PMID 26347018; PMCID PMC4545275; NCT01275872; DOI 10.1155/2015/270876
Last literature search: October 17, 2026
Record appraised: October 17, 2026

Educational information, not personal medical advice. Decisions about symptoms, supplements, movement, or psychological care during cancer treatment should be made with the oncology team.