SelfRelax: mobile phone application for relaxation Evaluation study Juho Merilahti
SelfRelax Mobile phone based guided relaxation application which includes different relaxation methods (Progressive muscle relaxation, Deep breathing, Autogenic Training, Body scan (contacts), Body scan (tensions), Meditation, and Visualization) User can select relaxation reason and duration from the application (Stress was used in the study) Session content (methods) can be modified from the settings
Hypotheses 1. Does SelfRelax induce relaxation that can be detected with psychological and physiological measurements? 2. Compare whether subjects can relax better with SelfRelax than without? 3. Can the subjects relax better on their own after a short use of SelfRelax?
Subjects Subjects which perform mentally demanding work (stress) Inclusion criterion: under 55 mentally stressful job no known cardiovascular diseases no regular relaxation training experience no regular smoking no medication affecting the cardiovascular system or mood feel comfortable of using mobile phones able to perform the study protocol tasks during their daily routines
Subjects City of Tampere, PirAmk, VTT 16 participants (12 females/ 4 males) + 3 dropouts Other issues two had schedule problems after agreeing to participate for one subject the method was not feasible (reminds meditation) one subject had problems when starting SelfRelax -> after selecting "Start" the application asks to press "Start" once more (failure of a guidance of the study) one subject was a professional in teaching of different relaxation methods (interesting for the study - excluded from analysis) 14 usable cases
Relaxation effect estimation: psychological Finnish version of State Anxiety Inventory (STAI) 2 short statements: before and after each session STAI is the most widely used inventory according to the literature for this type of purposes. For example in metaanalysis it was found that STAI was the most used inventory to evaluate the relaxation effect. STAI seems to be a consistent and sensitive indicator to evaluate the relaxation effect output: 2-8 points; working adults average ~35
Relaxation effect estimate: physiological Blood pressure: before and after each session Especially for hypertensive subjects relaxation training is documented to lower the blood pressure. Normotensive subjects reactions are not systematic R-R interval recording during the whole day HRV changes during the relaxation session compared to a control event such as quiet rest Findings are not always consistent, but in most of the studies HF component s power seems to increase during the relaxation compared to control period.
Protocol of the study Start session: info&education 1st day baseline (no relaxation) 2nd/3rd day with or without SelfRelax End session: feedback from the users + user gift Feedback to the users: own data, Firstbeat reports, analysis result of the material
Results (6/29): data quality 73/84 planned relaxation sessions (+ 4; the professional) 71 STAI filled before and after each session 71 Blood pressure measurements before and after each session HRV data was of poor quality in general -> HRV results are studied as single cases (subjects) during the pre-study cases we did not encounter problems
Results (6/29): relaxation effect of SelfRelax STAI Average change toward less anxiety direction according to STAI with SelfRelax was 6.6 points Starting level of STAI and change in STAI had a strong correlation (R=.57, P <.1) SelfRelax induces relaxation according to STAI and the level of change is related to the starting level (also mentioned in the STAI manual)
Results (6/29): relaxation effect of SelfRelax Blood pressure Systolic BP change depends on the beginning level (R=.35, P <.5) Drop was significant if SysBp>14 (hypertensive) compared to persons having SysBp<13 (normotensive) No significant changes in diastolic Bp Systolic blood pressure drops significantly after using SelfRelax among hypertensive subjects -> consistent with other relaxation studies
Results (6/29): differences between self guided and SelfRelax relaxation - STAI The effect of the starting level of STAI on the STAI change remained similar in the whole dataset (.48**) When comparing STAI scores between SelfRelax and self guided for subjects having STAI over 35 (StaiGroup1) SelfRelax visually induced more relaxation (however, the difference is not significant, P=.89)
Results (6/29): differences between self guided and SelfRelax -> Blood pressure Beginning level of systolic Bp and change in systolic Bp have strong correlation in whole dataset as well no significant difference between using SelfRelax or not according to systolic BP change
Results (6/29): better self guided relaxation effect after usage of SelfRelax No differences in features of self guided relaxation for persons who first relaxed with SelfRelax compared to persons who first performed the self guided relaxation longer intervention period could be better to evaluate this e.g. self guided relaxation effect (basic level) -> longer time with SelfRelax -> self guided relaxation effect (possible intervention effect)
Feedback from the users 9/14 reported SelfRelax helped them relax better than on their own 3/14 reported that they preferred their own methods 2/14 could not say which one they preferred
Individual effects All parameters were merged for subjects who had good quality beat to beat heart rate recordings over the whole study Three minutes of beat to beat data was selected during the relaxation focusing more on the session ends.
Test person 2 STAI change slightly higher = SelfRelax Systolic BP change not consistent no differences in heart rate (HR) no consistent differences in HRV relaxation effect of merged data is unclear Subject reported that SelfRelax was not better compared to self guided = self guided 2 1 4 2 1 5 1-1 1 5 deltastai deltabpsys HR HFintraind RMSSD 2 LF/HFintraind -2
Test person 3 = SelfRelax 2 = self guided1 2 deltastai deltabpsys SelfRelax introduces larger positive (less anxiety) change Systolic BP drops more due to SelfRelax HR is slightly slower during SelfRelax usage (self guided are high) HF and RMSSD are higher during SelfRelax according to merged data SelfRelax worked better Subject reported that SelfRelax was better compared to self guided -2 2 1 2-2 1 5 2-2 HR HFintraind RMSSD LF/HFintraind
Test person 6 = SelfRelax = self guided -1 1 1 deltastai 1 2 3 4 5 deltabpsys STAI changes are small Systolic blood pressure changes are not consistent between the two methods HR do not differ between methods HF and RMSSD are slightly higher during SelfRelax SelfRelax gave somewhat better relaxation effect Subject reported that SelfRelax was better than self guided -1 1 5 2-2 5 1 1 2 3 4 5 HR 1 2 3 4 5 HFintraind 1 2 3 4 5 RMSSD 1 2 3 4 5 LF/HFintraind -1 1 2 3 4 5
Test person 12 no differences in STAI change Systolic blood pressure dropped more due to self guided relaxation = SelfRelax HF was slightly higher during SelfRelax no visible difference between two methods = self guided Subject reported that SelfRelax was better than self guided 1 5 2-2 1 5 2-2 5 2 deltastai 1 2 3 4 deltabpsys 1 2 3 4 HR 1 2 3 4 HFintraind 1 2 3 4 RMSSD 1 2 3 4 LF/HFintraind -2 1 2 3 4
Conclusions According to STAI SelfRelax induces relaxation According to systolic BP for hypertensive participants SelfRelax lowers systolic BP (-> relaxation) Visually SelfRelax introduces more relaxation than self guided among subjects having STAI over average (difference was not statistically significant) For some cases all variables indicated that SelfRelax induced deeper relaxation than self guided A significant part (9/14) of the participants indicated that they relaxed better with SelfRelax than without Beat to beat interval recording device is not suitable for these types of studies