Relaxation and Guided Imagery for Adults Living With and Beyond Breast Cancer (2018–2022)

Abstract

Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings related to relaxation and guided imagery interventions for adults living with and beyond cancer.

Full Systematic Review Question

This systematic review addressed the question “What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve performance and participation for adults living with cancer?”

Current Theme Reported

The main theme of the studies presented in this systematic review brief includes relaxation and guided imagery for adults living with and beyond breast cancer.

Clinical Scenario

Adults with cancer undergoing chemotherapy treatment experience a myriad of physical and psychological distressing symptoms including but not limiting to anxiety and depression. Research has found that complementary therapies, such as progressive muscle relaxation (PMR) and guided imagery (GI), can be used to alleviate physical and psychological effects of chemotherapy (Chen et al., 2015). PMR involves tensing and relaxing successive muscle groups while focusing on the changes in sensation as a result of this practice (Charalambous et al., 2016). PMR is an intervention that facilitates mental calmness and, when practiced effectively, has been found effective in reducing anxiety (Charalambous et al., 2016). GI is a technique that involves an individual focusing on positive visual images in their mind, in an effort to facilitate relaxation, lower stress, and promote well-being (National Cancer Institute, n.d.). As breast cancer is the most common cancer experienced worldwide, the combined PMR + GI in this population can support improved outcomes.

Summary of Key Findings

One systematic review was included related to interventions focusing on the combination of PMR and GI for breast cancer survivors receiving chemotherapy at various stages of disease management (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009). The strength-of-evidence designations are based on the guidelines of the U.S. Preventive Services Task Force (2018).

Table 1.

Evidence Table for Relaxation and Guided Imagery for Adults Living With and Beyond Breast Cancer

Author, YearLevel of Evidence (types of study designs)Risk of Bias (RoB)Setting	Systematic Review Details	Findings From Reviews
Theme: PMR With GI in Adults With Breast Cancer Receiving Chemotherapy One Level 1a review provided moderate strength of evidence to support the use of PMR and GI to reduce stress and anxiety and improve quality of life for adults with breast cancer receiving chemotherapy at various stages of disease management.
Sinha et al. (2021) Level 1a—Systematic review with meta-analysis RoB Moderate Setting Hospital and home based (mixed)	Participants N = 344; various stages of disease management; 100% breast cancer; receiving radiotherapy (n = 2) or chemotherapy (n = 3); mean age: not reported; race/ethnicity: not reported Number of Articles (and Level) Five RCTs Databases Searched PubMed/Medline, CINAHL, CENTRAL (EBSCO), and Clinical Trials.gov Outcome(s) Stress, anxiety, depression, mood, QOL, nausea, pain, and fatigue Intervention(s) PMR + GI Delivery Methods Varied: n = 2 single session at hospital, then practice at home; n = 3 either multiple sessions of training in beginning or evenly spread over a long duration; all studies had practice at home. Dose Ranges (If Available) Varied: n = 2 single session; n = 3 multiple sessions either at beginning or spread over long duration; in all studies, instructional CDs were given to patients for practice at home.	PMR + GI significantly reduced stress and anxiety in chemotherapy group. In addition, there was a significant positive improvement in QOL in the chemotherapy group. There were no clinically significant improvements in depression, mood, nausea, pain, and fatigue.

Note. GI = guided imagery; PMR = progressive muscle relaxation; QOL = quality of life; RCT = randomized controlled trial; RoB = risk of bias.

Bottom Line for Occupational Therapy Practice

Managing stress and anxiety while receiving chemotherapy for breast cancer, regardless of stage, is an important area in which occupational therapy practitioners should be involved. PMR and GI are effective in reducing stress and anxiety in adults with cancer receiving chemotherapy. In addition, these interventions can be used to improve quality of life.

These techniques are easy to learn and can be delivered in various settings. PMR sessions are generally no longer than 20 min and involve brief periods of tightening and relaxing muscles. GI is straightforward in requiring only verbal instruction and the ability of the participant to attend to visual or auditory sensations. Occupational therapy practitioners should consider providing education and resources (i.e., instructional CDs) for practice of these techniques at home for integration into daily routine.