Effects of Benson Relaxation Technique and Music Therapy on the Anxiety of Primiparous Women Prior to Cesarean Section: A Randomized Controlled Trial

Sedigheh Nosrati Abarghoee, Abbas Mardani, Robabe Baha, Nasrin Fadaee Aghdam, Mahboobeh Khajeh, Fatemeh Eskandari, Mojtaba Vaismoradi, Sedigheh Nosrati Abarghoee, Abbas Mardani, Robabe Baha, Nasrin Fadaee Aghdam, Mahboobeh Khajeh, Fatemeh Eskandari, Mojtaba Vaismoradi

Abstract

Background and aims: Primiparous women experience high levels of anxiety before cesarean section. Therefore, this research aimed to investigate the effects of the Benson Relaxation Technique (BRT) and Music Therapy (MT) on the anxiety of primiparous women prior to cesarean section.

Methods: A randomized controlled trial was carried out on 105 women scheduled for cesarean section. They were randomly assigned into three groups: BRT, MT, and control (n = 35 per group). The women in the BRT and MT groups performed exercises and listened to music, respectively, for 20 minutes prior to cesarean section. The State Anxiety Inventory was used to measure the women's anxiety in the groups before and after the intervention.

Results: Within-group comparisons showed that the women in the BRT (t = 5.61, p < 0.001, effect size (Cohen's d) = 0.94) and MT (t = 3.83, p = 0.001, d = 0.64) groups had significantly lower anxiety after the interventions compared to before the interventions. Also, between-group comparisons revealed that anxiety after the intervention was significantly lower in the BRT and MT groups compared to the control group (p = 0.007).

Conclusions: Although both of the BRT and MT helped with the reduction of anxiety among primiparous women before cesarean section, the BRT was shown more effective. These nonpharmacologic methods are safe and cost-effective and can improve well-being among women undergoing this invasive procedure. They can be used along with pharmacologic methods for reducing overreliance on medications.

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Copyright © 2022 Sedigheh Nosrati Abarghoee et al.

Figures

Figure 1
Figure 1
The process of the study is according to the CONSORT flow diagram (2010).
Figure 2
Figure 2
Comparison of anxiety between the study groups.

References

    1. Abdelrahman A. H. N., Samy M. M., Shawky M. E. A., Azmy G. A. Subcutaneous tissue irrigation with povidone iodine in decreasing the rate of surgical site infection following cesarean section: (randomized control trial) QJM: International Journal of Medicine . 2020;113(1):hcaa056–20. doi: 10.1093/qjmed/hcaa056.020.
    1. Long Q., Kingdon C., Yang F., et al. Prevalence of and reasons for women’s, family members’, and health professionals’ preferences for cesarean section in China: a mixed-methods systematic review. PLoS Medicine . 2018;15(10) doi: 10.1371/journal.pmed.1002672.e1002672
    1. Betrán A. P., Ye J., Moller A.-B., Zhang J., Gülmezoglu A. M., Torloni M. R. The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PLoS One . 2016;11(2) doi: 10.1371/journal.pone.0148343.e0148343
    1. Sun Y., Huang K., Hu Y., et al. Pregnancy-specific anxiety and elective cesarean section in primiparas: a cohort study in China. PLoS One . 2019;14(5) doi: 10.1371/journal.pone.0216870.e0216870
    1. Olieman R. M., Siemonsma F., Bartens M. A., Garthus-Niegel S., Scheele F., Honig A. The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review. BMC Pregnancy and Childbirth . 2017;17(1):195–198. doi: 10.1186/s12884-017-1371-z.
    1. Maleki M., Mardani A., Harding C., Basirinezhad M. H., Vaismoradi M. Nurses’ strategies to provide emotional and practical support to the mothers of preterm infants in the neonatal intensive care unit: a systematic review and meta-analysis. Women’s Health . 2022;18 doi: 10.1177/17455057221104674.174550572211046
    1. Beilin Y., Rosenblatt M. A., Bodian C. A., Lagmay-Aroesty M. M., Bernstein H. H. Information and concerns about obstetric anesthesia: a survey of 320 obstetric patients. International Journal of Obstetric Anesthesia . 1996;5(3):145–151. doi: 10.1016/s0959-289x(96)80021-5.
    1. Maheshwari D., Ismail S. Preoperative anxiety in patients selecting either general or regional anesthesia for elective cesarean section. Journal of Anaesthesiology Clinical Pharmacology . 2015;31(2):p. 196. doi: 10.4103/0970-9185.155148.
    1. Ferede Y. A., Bizuneh Y. B., Workie M. M., Admass B. A. “Prevalence and associated factors of preoperative anxiety among obstetric patients who underwent cesarean section”: a cross-sectional study. Annals of Medicine and Surgery . 2022;74 doi: 10.1016/j.amsu.2022.103272.103272
    1. Nekoee T., Zarei M. Evaluation the anxiety status of pregnant women in the third trimester of pregnancy and fear of childbirth and related factors. British Journal of Medicine and Medical Research . 2015;9(12):1–8. doi: 10.9734/bjmmr/2015/19784.
    1. Ali N. S., Azam I. S., Ali B. S., Tabbusum G., Moin S. S. Frequency and associated factors for anxiety and depression in pregnant women: a hospital-basedcross-sectional study. The Scientific World Journal . 2012;2012:9. doi: 10.1100/2012/653098.653098
    1. Çiçek Ö, Mete S. A common problem: fear of birth. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi . 2015;8(4):263–268.
    1. Zafarghandi N., Hadavand S., Torkestani F., Zaeri F., Variji M. Evaluation of anxiety and fear of labor in postpartum period. Journal of medical council of Islamic Republic of Iran . 2005;2(23):155–160.
    1. Mousavi F. S., Golmakani N., Saki A. The relationship between postoperative pain after cesarean section with pre and postoperative anxiety. The Iranian Journal of Obstetrics, Gynecology and Infertility . 2016;19(24):1–10.
    1. Schaal N. K., Hepp P., Heil M., et al. Perioperative anxiety and length of hospital stay after caesarean section - a cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology . 2020;248:252–256. doi: 10.1016/j.ejogrb.2020.03.045.
    1. Hepp P., The Magic Group, Hagenbeck C., et al. Measuring the course of anxiety in women giving birth by caesarean section:a prospective study. BMC Pregnancy and Childbirth . 2016;16(1):113–117. doi: 10.1186/s12884-016-0906-z.
    1. Sadeghian A., Moghadam K. B., Baradaran R., Esmaeilzadeh M. H. Evaluation of the relationship between prenatal anxiety and intra-cesarean hemorrhage. International Journal of Medical Investigation . 2019;8(3):40–46.
    1. Koca C., Yıldırım B., Şenyuva İ. Association between self-reported bruxism, peripartum depression and myogenous temporomandibular disorders among postpartum women in Turkey. Balkan Journal of Dental Medicine . 2021;25(3):139–146. doi: 10.2478/bjdm-2021-0022.
    1. Mayoral V. A., Espinosa I. A., Montiel ÁJ. Association between signs and symptoms of temporomandibular disorders and pregnancy (case control study) Acta Odontológica Latinoamericana: AOL . 2013;26(1):3–7.
    1. Minervini G., Russo D., Herford A. S., et al. Teledentistry in the management of patients with dental and temporomandibular disorders. BioMed Research International . 2022;2022:7. doi: 10.1155/2022/7091153.7091153
    1. Minervini G., Fiorillo L., Russo D., et al. Prosthodontic treatment in patients with temporomandibular disorders and orofacial pain and/or bruxism: a review of the literature. Prosthesis . 2022;4(2):253–262. doi: 10.3390/prosthesis4020025.
    1. Minervini G., Del Mondo D., Russo D., Cervino G., D’Amico C., Fiorillo L. Stem cells in temporomandibular joint engineering: state of art and future persectives. Journal of Craniofacial Surgery . 2022;33(7):2181–2187. doi: 10.1097/scs.0000000000008771.
    1. Salmanzadeh A., Rahgoi A., Fallahi-Khoshknab M., Mohammadi-Shahbelaghi F., Rahgozar M. The Effect of Benson’s relaxation on pre-operative anxiety in Cesarean section in Nulliparus Women. Journal of Advanced Pharmacy Education & Research . 2018;8(S2):194–200.
    1. Amiri A., Eslami J., Hatami N., Akbarzadeh M. The potential beneficial effects of education and familiarity with cesarean section procedure and the operating room environment on promotion of anxiety and pain intensity: a randomized controlled clinical trial. Journal of Education and Health Promotion . 2020;9(1):p. 240. doi: 10.4103/jehp.jehp_31_20.
    1. Kushnir J., Friedman A., Ehrenfeld M., Kushnir T. Coping with preoperative anxiety in cesarean section: physiological, cognitive, and emotional effects of listening to favorite music. Birth . 2012;39(2):121–127. doi: 10.1111/j.1523-536x.2012.00532.x.
    1. AjorPaz N., Ranjbar N. Effects of recitation of holy quran on anxiety of women before cesarean section: a randomize clinical trial. Qom University of Medical Sciences Journal . 2010;4(1):15–19.
    1. Abadi F., Abadi F., Fereidouni Z., Amirkhani M., Karimi S., Najafi Kalyani M. Effect of acupressure on preoperative cesarean section anxiety. Journal of acupuncture and meridian studies . 2018;11(6):361–366. doi: 10.1016/j.jams.2018.07.001.
    1. Poorolajal J., Ashtarani F., Alimohammadi N. Effect of Benson relaxation technique on the preoperative anxiety and hemodynamic status: a single blind randomized clinical trial. Artery Research . 2017;17(C):33–38. doi: 10.1016/j.artres.2017.01.002.
    1. Vagnoli L., Bettini A., Amore E., De Masi S., Messeri A. Relaxation-guided imagery reduces perioperative anxiety and pain in children: a randomized study. European Journal of Pediatrics . 2019;178(6):913–921. doi: 10.1007/s00431-019-03376-x.
    1. Ertuğ N., Ulusoylu Ö, Bal A., Özgür H. Comparison of the effectiveness of two different interventions to reduce preoperative anxiety: a randomized controlled study. Nursing and Health Sciences . 2017;19(2):250–256. doi: 10.1111/nhs.12339.
    1. Benson H., Klipper M. Z. The Relaxation Response . NY, USA: Harpercollins; 1975.
    1. Bagheri H., Moradi-Mohammadi F., Khosravi A., et al. Effect of Benson and progressive muscle relaxation techniques on sleep quality after coronary artery bypass graft: a randomized controlled trial. Complementary Therapies in Medicine . 2021;63 doi: 10.1016/j.ctim.2021.102784.102784
    1. Rambod M., Pourali-Mohammadi N., Pasyar N., Rafii F., Sharif F. The effect of Benson’s relaxation technique on the quality of sleep of Iranian hemodialysis patients: a randomized trial. Complementary Therapies in Medicine . 2013;21(6):577–584. doi: 10.1016/j.ctim.2013.08.009.
    1. Elali E., Mahdavi A., Jannati Y., Cherati J., Setareh J. Effect of benson relaxation response on stress among in hemodialysis patients. Journal of Mazandaran University of Medical Sciences . 2012;22(91):61–68.
    1. Keihani Z., Jalali R., Shamsi M. B., Salari N. Effect of benson relaxation on the intensity of spinal anesthesia-induced pain after elective general and urologic surgery. Journal of PeriAnesthesia Nursing . 2019;34(6):1232–1240. doi: 10.1016/j.jopan.2019.05.005.
    1. Zakerimoghadam M., Shaban M., Mehran A., Hashemi S. Effect of muscle relaxation on anxiety of patients undergo cardiac catheterization. Hayat . 2010;16(2):64–71.
    1. Solehati T., Rustina Y. Benson relaxation technique in reducing pain intensity in women after cesarean section. Anesthesiology and Pain Medicine . 2015;5(3) doi: 10.5812/aapm.22236v2.e22236
    1. Gorji M. A., Ardebil M., Mahdavi A., Gorji A. M., Yazdani J. Implementing benson’s relaxation training in hemodialysis patients: changes in perceived stress, anxiety, and depression. North American Journal of Medical Sciences . 2013;5(9):536–540. doi: 10.4103/1947-2714.118917.
    1. Ibrahim A., Koyuncu G., Koyuncu N., Suzer N. E., Cakir O. D., Karcioglu O. The effect of Benson relaxation method on anxiety in the emergency care. Medicine . 2019;98(21) doi: 10.1097/md.0000000000015452.e15452
    1. Sadeghimoghaddam S., Alavi M., Mehrabi T., Bankpoor-Fard A. The effect of two methods of relaxation and prayer therapy on anxiety and hope in patients with coronary artery disease: a quasi-experimental study. Iranian Journal of Nursing and Midwifery Research . 2019;24(2):102–107. doi: 10.4103/ijnmr.ijnmr_60_18.
    1. Parsa Yekta Z., Sadeghian F., Taghavi Larijani T., PhD, Mehran A. The comparison of two types of relaxation techniques on postoperative state anxiety in candidates for the mastectomy surgery: a randomized controlled clinical trial. International journal of community based nursing and midwifery . 2017;5(1):61–69.
    1. Najafi S., Zareipour H., Yekta T., Moaref A. The effect of music therapy on the level of anxiety and vital signs in patients undergoing trans-esophageal echocardiography. Journal of anesthesiology and pain . 2018;8(3):1–11.
    1. Rolvsjord R., Stige B. Concepts of context in music therapy. Nordic Journal of Music Therapy . 2015;24(1):44–66. doi: 10.1080/08098131.2013.861502.
    1. Plapus-George D., Weiss C. Successful introduction of music therapy for post-operative pain, anxiety and nausea in the adult oncology patient. Journal of PeriAnesthesia Nursing . 2019;34(4):p. e42. doi: 10.1016/j.jopan.2019.05.100.
    1. Horuz D., Kurcer M. A., Erdoğan Z. The effect of music therapy on anxiety and various physical findings in patients with COPD in a pulmonology service. Holistic Nursing Practice . 2017;31(6):378–383. doi: 10.1097/hnp.0000000000000235.
    1. Xu X., Sun B. L., Huang F., et al. The impact of music on patient satisfaction, anxiety, and depression in patients undergoing gynecologic surgery. Journal of PeriAnesthesia Nursing . 2021;36(2):122–127. doi: 10.1016/j.jopan.2020.08.014.
    1. Spielberger C. D. State-Trait Anxiety Inventory. The Corsini Encyclopedia of Psychology . Hoboken, NJ, US: John Wiley & Sons; 2010.
    1. Kim J., Shin W. How to do random allocation (randomization) Clinics in orthopedic surgery . 2014;6(1):103–109. doi: 10.4055/cios.2014.6.1.103.
    1. Spielberger C. D., Gorsuch R. L., Lushene R., Vagg P. R., Jacobs G. Manual for the State-Trait Anxiety Inventory . Palo Alto, CA: Consulting Psychologists Press; 1983.
    1. Mahram B. Validation of Eshpil berger Anxiety Test in Mashhad . Tehran: University of Education; 1994.
    1. Mirhosseini S., Mohammadi A., Rezaei M., Mirbagher Ajorpaz N. The effect of benson relaxation technique on the fatigue severity of patients with MS. Journal of Client-Centered Nursing Care . 2019;5(3):175–182. doi: 10.32598/jccnc.5.3.175. ‏.
    1. Groarke J. M., Groarke A., Hogan M. J., Costello L., Lynch D. Does listening to music regulate negative affect in a stressful situation? Examining the effects of self-selected and researcher-selected music using both silent and active controls. Applied Psychology: Health and Well-Being . 2020;12(2):288–311. doi: 10.1111/aphw.12185.
    1. Pardede J. A., Tarigan I. The anxiety level of mother presectio caesar with Benson’s relaxation therapy. Jendela Nursing Journal . 2020;4(1):20–28. doi: 10.31983/jnj.v4i1.5801.
    1. Barabady A., Baghdassarians A., Memary E., Yazdani A., Barabady A., Sayadi S. Effect of Benson’s relaxation technique on propofol consumption and preoperative anxiety of patients undergoing cataract surgery. Anesthesiology and Pain Medicine . 2020;10(3) doi: 10.5812/aapm.100703.e100703
    1. Hasanpour-Dehkordi A., Solati K., Tali S. S., Dayani M. A. Effect of progressive muscle relaxation with analgesic on anxiety status and pain in surgical patients. British Journal of Nursing . 2019;28(3):174–178. doi: 10.12968/bjon.2019.28.3.174.
    1. Malmir M., Teimouri F., Pishgooie A., Dabaghi P. The Role of Benson´ s relaxation on reducing state anxiety on candidate of open heart surgery patient’s. Military Caring Sciences . 2015;2(3):182–190. doi: 10.18869/acadpub.mcs.2.3.182.
    1. Torabi M., Salavati M., Ghahri Sarabi A. R. Effect of foot reflexology massage and benson relaxation techniques on anxiety and physiological indexes of patients undergoing coronary heart angiography. Avicenna J Nurs Midwifery Care . 2012;20(1):63–73.
    1. Woldegerima Y. B., Fitwi G., Yimer H., Hailekiros A. Prevalence and factors associated with preoperative anxiety among elective surgical patients at University of Gondar Hospital. Gondar, Northwest Ethiopia, 2017. A cross-sectional study. International Journal of Surgery Open . 2018;10:21–29. doi: 10.1016/j.ijso.2017.11.001.
    1. Nahayati M. A., Vaghar Seyyedin S. A., Bahrami-Taghanki H. R., Rezaee Z., Mehrpooya N., Rahimi H. Effect of acupressure on stress and anxiety of patients with multiple sclerosis: a sham-controlled randomized clinical trial. Complementary Medicine Journal . 2020;10(3):270–283. doi: 10.32598/cmja.10.3.1020.1.
    1. Lali M., Jouzi M., Moghimian M. The effect of back massage on anxiety components of mothers with preterm infants. Complementary Medicine journal . 2020;9(4):3902–3913. doi: 10.32598/cmja.9.4.933.1.
    1. Rahimi Bashar F., Vahedian-Azimi A., Salesi M., Hosseini S. M. The effect of progressive muscle relaxation on the outcomes of myocardial infarction: review study. Journal of military medicine . 2017;19(4):326–335.
    1. Daube W. C., Jakobsche C. E. Biochemical effects of meditation: a literature review. Scholarly Undergraduate Research Journal at Clark . 2015;1(1):80–85.
    1. Li Y., Dong Y. Preoperative music intervention for patients undergoing cesarean delivery. International Journal of Gynecology & Obstetrics . 2012;119(1):81–83. doi: 10.1016/j.ijgo.2012.05.017.
    1. Hekmat-Afshar M., Hojjati H., Sharif nia S. H., Hojjati H., Salmasi E., Arazi S. The effect of music therapy on anxiety and pain in mothers after caesarean section surgery. Journal of Health and Care . 2012;14(3):16–22.
    1. Mou Q., Wang X., Xu H., Liu X., Li J. Effects of passive music therapy on anxiety and vital signs in lung cancer patients undergoing peripherally inserted central catheter placement procedure. The Journal of Vascular Access . 2020;21(6):875–882. doi: 10.1177/1129729820908088.
    1. Lopez-Yufera E., López-Jornet P., Toralla O., Pons-Fuster López E. Non-pharmacological interventions for reducing anxiety in patients with potentially malignant oral disorders. Journal of Clinical Medicine . 2020;9(3):p. 622. doi: 10.3390/jcm9030622.
    1. Marwang S., Passe R., Aswan R., Triananinsi N., Iskandar N., Ohorella F. Effects of classical music therapy on anxiety level of caesarean section mother. Medico-Legal Update . 2020;20(3):806–810.
    1. Hashemy S., Zakerimoghadam M. Comparative study of the effect of muscle relaxation and music therapy on anxiety level in patients waiting for cardiac catheterization. Iranian Journal of Cardiovascular Nursing . 2013;1(4):22–30.
    1. Buckley S. J. Executive summary of hormonal physiology of childbearing: evidence and implications for women, babies, and maternity care. The Journal of Perinatal Education . 2015;24(3):145–153. doi: 10.1891/1058-1243.24.3.145.
    1. Santiváñez-Acosta R., Tapia-López E.N., Santero M. Music therapy in pain and anxiety management during labor: a systematic review and meta-analysis. Medicina . 2020;56(10):p. 526. doi: 10.3390/medicina56100526.
    1. Radha C., Bommi K., Sumithra S. Effectiveness of benson’s relaxation therapy on pain and stress among post caesarean mothers. International Journal of Advances in Nursing Management . 2019;7(4):316–320. doi: 10.5958/2454-2652.2019.00074.x.
    1. Price B. Managing patients’ anxiety about planned medical interventions. Nursing Standard . 2017;31(47):53–63. doi: 10.7748/ns.2017.e10544.
    1. Eskandari S., Mirhaghjou S. N., Maleki M., Mardani A., Gholami M., Harding C. Identification of the range of nursing skills used to provide social support for mothers of preterm infants in neonatal intensive care. Critical care research and practice . 2021;2021(4):7. doi: 10.1155/2021/6697659.6697659

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