Sangee Research PDF

A STUDY TO ASSESS THE EFFECTIVENESS OF RELAXATION THERAPY
ON STRESS ANDANXIETY AMONG

CAREGIVERS OFMENTALLY ILL PATIENTS
INSNEKAMIND CARE CENTRE
AT THIRUNELVELI
A DISSERTATION SUBMITTED TO THE TAMILNADU

DR. M.G.R. MEDICAL UNIVERSITY, CHENNAI,
IN PARTIAL FULFILLMENT FOR THE
DEGREE OFMASTER OF SCIENCE
IN NURSING
APRIL 2015
AT THIRUNELVELI
_________________ _________________
Internal Examiner External Examiner
APRIL 2015
AT THIRUNELVELI
Approved by Dissertation Committee on……………..
RESEARCH GUIDE:
Prof. Mrs. Violin Sheeba, M. Sc.(N),Ph.D,
Principal ,
Thasiah College of Nursing,

Marthandam, K.K District, Tamil Nadu :…………….......................................
SUBJECTGUIDE:
Mr.Gurudhas. M.Sc(N),
Head of the departmentin Mental health Nursing,

Thasiah College of Nursing,
Marthandam, K.K District, Tamil Nadu :.…………….....................................
MEDICAL GUIDE:
. Dr.C. PaneerSelvan M.D. (PSYCH); NIMHANS,

Consultant Psychiatrist,
Sneka Mind Care Centre, Thirunelveli : ……………......................................
A DISSERTATION SUBMITTED TO THE TAMILNADU
DR. M.G.R. MEDICAL UNIVERSITY, CHENNAI,
IN PARTIAL FULFILLMENT FOR THE
DEGREE OFMASTER OF SCIENCE
IN NURSING
APRIL 2015
CERTIFICATE
This is to certify that this is thebonafide work of ------------ IIYear M.Sc. Nursing, Thasiah
College of Nursing, Marthandam, in partial fulfillment of the requirements for the degree of Master
of Science in Nursing from the Tamil Nadu Dr. M.G.R. Medical University, Chennai.
Place: Principal,
Date: Thasiah College of Nursing,
Marthandam.
ACKNOWLEDGEMENT
I wish to acknowledge my heartfelt gratitude to the Lord Almighty for all the
wisdom, knowledge, guidance, strength, protection, shield and support he has offered
me throughout this endeavor and given me courage to overcome the difficulties and
thus complete this study successfully.
It is my honor to thank our beloved chairmanMr. Thasian(Germany); for
providing entire facility and encouragement for conducting this study.
I consider myself to be privileged to express my honest and sincere gratitude
to Prof. (Mrs).T.Violin Sheeba, M.Sc.(N),Ph.D; Principal, Thasiah College of
Nursing, for her invaluable guidance, continuous support, promising criticisms,
suggestion and concern during the entire course of this dissertation.
At this moment I convey my profound gratitude toMr.Gurudhas, M.Sc.

(N);Head of the Department in Mental Health Nursing for his constant source of
inspiration and time in checking, rechecking the manuscripts, for sharing his
suggestions and constructive criticism, which was a key for the successful completion
of this study.
My heartfelt thanks toMrs.Feby, M.Sc.(N),Vice Principal for her
encouragement and support given during this work.
I express my deepest thanks toMrs.Shinola, M.Sc.(N),Lecturer Department
of Mental health Nursing for her guidance and suggestions for the completion of the
study.
I express my deepest thanks toMrs.JeyaMegala, M.Sc.(N),Lecturer
Department of Mental health Nursing for her guidance and suggestions for the
completion of the study
I express my thanks to entire faculty of ThasiahCollege of Nursing,

Marthandam, for their co-operation and encouragement.
My sincere thanks and honour toMr.AntoPaulinBrinto,
MSc,M.Ed,M.phil,PG,DBM, Professor of Bio statistics for extending his helping
hands in the course of analysis and interpretation of the data collected.
I thank all the Office Staff for their help in taking photocopies of study
reviews.
I express my deep sense of gratitude and heartfelt thanks to Experts who have
validated and edited my study and who devoted their valuable hours in solving my
doubts and in providing meticulous attention.
I would like to express my thanks to the Study Participants for their co-
operation and participation, without whom this study would have been impossible.
I am pleased to convey my profound thanks to The Management ofSneka
Mind Care Centre, Thirunelvelifor giving valuable suggestion and guidance for data
collection and also for giving permission to conduct the study in their respective
hospital.
I express my heartfelt gratitude to my loving husband Mr.R.Bright, my
brothers R.Sakthivelrajan and V.S.Ajith, my parents Mr.C.Varathan and
Mrs.C.Sreekumari and all my Family Members for their love, support,
encouragement and prayer throughout my study.
A word of thanks to My Colleagues for their help and support throughout the
course of this study.
Investigator
1
LIST OF CONTENTS
Chapter No Contents Page No
1 INTRODUCTION 1-10
Background of the Study 1-3
Need for the Study 3-5

Statement of the Problem 5
Objectives 5
Hypotheses 5-6
Operational Definitions 6-7
Assumptions 7
Delimitations 7
Ethical Consideration 7
Conceptual Framework 8-10
2 REVIEW OF LITERATURE 11-17
3 METHODOLOGY 18-25
Research Approach 18
Research Design 18
Variables 19
Setting of the Study 19
Population 19
Sample size 20
Sampling Technique 20
Sample Selection Criteria 20
Description of the Tool 22-23
Validity and Reliability 23
Pilot Study 24
Data Collection Procedure 24
Plan for Data Analysis 24-25
4 DATA ANALYSIS 26-48
5 DISCUSSION 49-51
6 SUMMARY AND RECOMMENDATIONS 52-57
2
7 BIBLIOGRAPHY 58-62
8 APPENDICES
LIST OF TABLES
Table No Title Page No

1 27-28
Frequency and Percentage Distribution of Study Samples
According to the Selected Demographic Variables
2 Frequency and Percentage Distribution of Pretest and Post 41
test Level of Stress Among Caregivers of Mentally ill
Patients
3 Frequency and Percentage Distribution Pretest and Post test 43

Level of Anxiety Among Caregivers of Mentally ill Patients
4 Effectiveness of Relaxation Therapy on Stress and Anxiety 45

Among Caregivers of Mentally ill Patients
5 Association of the Post test Scores of Stress and Anxiety 46
Among Caregivers of Mentally ill Patients with their
Selected Demographic Variables
3
LIST OF FIGURES
Figure No Title Page No
1 The Conceptual Framework Based on Ludwing Von 10

Bertanloffy's General System Theory
2 Schematic Representation of Research Methodology 21
3 Percentage Distribution of Caregivers of Mentally ill 31

Patients According to their age
PatientsAccording to their sex
PatientsAccording to their Educational Status
Patients According to their Religion
Patients According to their Occupation
Patients According to their Family Income per Annum
Patients According to their Marital Status
Patients According to their Relationship with the Patient
Patients According to their Type of Family
Patients According to the Patients Duration of Illness
13 Distribution of Percentage in Pretest and Post testLevel of 42
Stress
14 Distribution of Percentage in Pretest and Post testLevel of 44
Anxiety
4
APPENDICES
Appendices Title
1 Permission Letters
2 List of Experts for tool validation
3 Evaluation Criteria Check list for Tool Validation
4 Tool Used for the Study (English and Tamil)
Relaxation Therapy Procedure
5
5
ABSTRACT
A study to assess the effectiveness of relaxation therapy on Stress and

Anxiety among caregivers of mentally ill patients in Sneka Mind Care Centre at
Thirunelveli.
The objectives of the study is to assess the Stress and Anxiety level of
caregivers of mentally ill patients and to find out the effectiveness of relaxation
therapy.
Quantitative research approach with pre experimental - one group pre test
and post test design was adopted to this study. The study was conducted among
the caregivers of mentally ill patients at Sneka Mind Care Centre at
Thirunelveli. Convenience sampling technique was adopted to select 60
caregivers of mentally ill patients.
Data collection was done by using caregivers Stress assessment scale and
Beck Anxiety Inventory. Relaxation therapy was administered for the samples.
The data gathered were analyzed by descriptive and inferential statistical
method and interpretation was done on the basis of the objectives of the study.
The findings revealed that there was highly significant difference in

level of Stress and Anxiety among caregivers of mentally ill patients after
rendering the relaxation therapy.
During pre test, in caregivers Stress assessment the analysis of pre test
out of 60 samples 47 (78.3%) had moderate level of Stress and 13 (21.6%)
had severe level of Stress. In Modified Beck Anxiety Inventory Scale the
analysis of pre test out of 60 samples 38(63.3%) had moderate Anxiety and
22(36.6%) had severe anxiety. So it indicates that moderate and severe level of
6
Stress and Anxiety was common among caregivers of mentally ill Patients and
they require some relaxation measure.
In post test care givers Stress assessment, the mean post test score was 23.4
and standard deviation was 7.29. The mean difference was 28.5. The obtained paired
‘t ‘ test value 20.26 which is more than the table value at 0.05 level of significance.
In Modified Beck Anxiety Inventory Scale, the mean post test score was 26.3 and
standard deviation was 5.62.The mean difference is 25. The obtained paired ‘t’ test
value 21.36 which is more than the table value at 0.05 level of significance.
Hence the research hypothesis (H1) was accepted and it was inferred that
relaxation therapy is effective in reducing the level of Stress and Anxiety among
From the results of the study it is concluded that rendering relaxation therapy
to the caregivers of mentally ill patients was effective in reducing Stress and anxiety.
The caregivers of mentally ill patients with Stress and Anxiety can include this
therapy in their routine activities. The caregivers leisure time may be enough and
utilized for doing this relaxation therapy.
7
CHAPTER- I
INTRODUCTION
'Mental calmness is a natural result of physical relaxation'

- Dr Edmund Jacobson.
Background of the Study
Caregivers play a vital role in supporting family members who are sick, infirm
or disabled. Families not only provide practical help and personal care but also give
emotional support to their relatives with a mental disorder. Therefore the affected
person is dependent on the caregiver and their well-being is directly related to the
nature and quality of the care provided by the caregiver. These demands can bring
significant levels of Stress and Anxiety for the caregiver and can affect their overall
quality of life.
Research into the impact of care-giving shows that one-third to one-half of

caregivers suffer significant psychological distress and experience higher rates of
mental ill health than the general population. Being a caregiver can raise difficult
personal issues about duty, responsibility, adequacy and develop guilt. Caring for a
relative with a mental health problem is not a static process since the needs of the care
recipient alter as their condition changes. The role of the caregiver can be more
demanding and difficult if the care recipient’s mental disorder is associated with
behavioral problems or physical disability.
Over the past few decades, research into the impact of care-giving has led to
an improved understanding of this subject including the interventions that help. It has
now been realized that developing constructive working relationships with caregivers
and considering their needs is an essential part of service provision for people with
1
mental disorders who require and receive care from their relatives.(Aadil Jan Shah,
OvaisWadoo and JavedLatoo; 2010)
The family has always been recognized as an important factor both in the
genesis and prognosis of mental illness. Initial studies generally focused on the
possible etiologic role of the family, but the perspective has now changed to
incorporating the family as a “reactor” to mental illness of a member. This has led to
interest in various problems that arise from the patient’s presence at home such as
financial difficulties or marital disharmony. The sum total of these problems or
difficulties which affect the significant others of a psychiatric patient is referred to as
social or family burden.
Care for severely mentally ill individuals may carry a heavy burden than care
for other disabled individuals. It is particularly true for close family members such as
parents, many of whom take care of their mentally ill children for long. Such burden
manifests in reduced caregiver wellbeing which admittedly depends in part on
caregiver factors such as care-giving style. Moreover, such burden may manifest in
reduced wellbeing of the mentally ill individuals themselves, for example, impaired
caregiver support. (Guru Raj. et. al, 2008).
Stress is a term that is commonly used today but has become increasingly
difficult to define. It shares, to some extent, common meanings in both the biological
and psychological sciences. Stress typically describes a negative concept that can
have an impact on one’s mental and physical well-being, but it is unclear what exactly
defines Stress and whether or not Stress is a cause, an effect, or the process
connecting the two. With organisms as complex as humans, Stress can take on
entirely concrete or abstract meanings with highly subjective qualities, satisfying
definitions of both cause and effect in ways that can be both tangible and intangible.
2
Anxiety is a diffuse presentation which is vague in nature and associated with
feelings of uncertainty, helplessness, feelings of isolation, alienation, and insecurity.
Experiences provoking Anxiety begin in Infancy and continue throughout life. They
end with the fear of greatest unknown outcome.
At one time or another, most people experience Stress. The term Stress has
been used to describe a variety of negative feelings and reactions that accompany
threatening or challenging situations. However, not all Stress reactions are negative. A
certain amount of Stress is actually necessary for survival. The Stress reaction
maximizes the expenditure of energy which helps prepare the body to meet a
threatening or challenging situation and the individual tends to mobilize a great deal
of effort in order to deal with the event. Both the sympathetic/adrenal and
pituitary/adrenal systems become activated in response to Stress. The sympathetic
system is a fast-acting system that allows us to respond to the immediate demands of
the situation by activating and increasing arousal. The pituitary/adrenal system is
slower-acting and prolongs the aroused state. However, while a certain amount of
Stress is necessary for survival; prolonged Stress can affect health adversely.
Constant Stress is one of the defining features of modern life, and the source
of many health problems. Stress plays an obvious role in nervousness, anxiety,
insomnia and vast number of illnesses.
When we are mentally Stressed and anxious, we unconsciously tense our

muscles. Tension held in our muscles adds physical discomfort or pain. It will
commonly showed as headache, backache, stomachache, and ache in neck and
shoulders - making the mental Stress even worse. Therefore relaxation is the best and
cheapest method which helps an individual to combat Stress. The challenge is to
identify relaxation techniques that provide both safety and stimulation to help reboot
the system.
3
Relaxation techniques are those strategies used to reduce feelings of Stress and
Anxiety. They can be very useful during times of high Stress or nervousness and can
even help a person with getting through a panic attack. The most popular relaxation
technique was Progressive muscle relaxation (PMR) that has been found to help and
relieve feelings of Stress and Anxiety.
Need for the Study
Family caregivers are integral to the care of patients with physical or mental
impairments. Unfortunately, providing care is often detrimental to the caregivers'
health. As a result, in the last decade, there has been a proliferation of interventions
designed to improve caregivers' well-being. Interventions for caregivers of persons at
the end-of-life, however, are relatively few in number and are often underdeveloped.
They also are typically designed to help and reduce the work of care giving or to help
caregivers cope with the physical and emotional demands of providing care. While
useful, these interventions generally ignore a primary Stressor for family caregivers a
loved one's suffering. Patient suffering whether physical, psychosocial, or spiritual,
has a major impact on family caregivers.
Living with and caring for an individual with a psychiatric disorder seems
inherently stressful. Relatives of psychiatric patients report a wide range of reactions
to their situation. On the whole, these family members endorse significantly higher
level of psychological distress than the general population.
Deinstitutionalization, restricted hospital admission and reduction of length of

inpatient treatment also change the situation of relatives. Nowadays they are much
more involved in the care of patients. Many caregivers of a person with schizophrenia
suffer from ongoing distress whereas professionals tend to underestimate family
burden. Thus caregivers feel ignored by mental health professionals. This divergent
perception underlines the importance of quantitative studies on family burden
4
In a study on patient-caregiver dyads conducted in Trivandrum, it was found
that all eleven patients were obliged to give up work as a result of illness. In many
families, the caregiver also had to change work habits. All respondents stated illness
had forced them to sell assets.
According to a report from the Study to Understand Prognoses and

Preferences for Outcomes and Risks of Treatment, or support study, one-fifth of all
family members of mentally ill patients had to quit work or make another major life
change in order to care for their family member. Almost one-third reported the loss of
all of their family savings, and 29% reported the loss of the major source of family
income.
A study was conducted to explore the influences of selected social and

psychological factors that are associated with perceived caregiver burden in a sample
of 263 primary caregivers of the elderly in Allahabad City in northern India. The
results indicated that although male caregivers' perceived burden depends only on the
size of the role overload, female caregivers' perceived burden depends on the
interrelationship between the size of the role overload and adherence to Asian cultural
norms.
In the above discussion it has been seen that Stress faced by caregivers can
lead to many complications such as depression, stroke and other diseases which
eventually leads to death. As health professionals we should also pay attention to the
caregivers for such a study to be conducted. Therefore the researcher felt that there is
a need for such study to be conducted. which has been effective in relieving Stress
and Anxiety. The researcher is interested in taking up progressive muscles relaxation
Technique as it is found to be effective, easy to follow the steps, convenient for most
of the people and also takes 20 minutes only.
5
Statement of the Problem
A study to assess the effectiveness of Relaxation Therapy on Stress and Anxiety

among Caregivers of mentally ill patients in Sneka Mind Care Centre at
Thirunelveli.
Objectives of the Study
• To assess the level of Stress and Anxiety among the Caregivers of mentally ill
patients before giving Relaxation Therapy.
• To assess the effectiveness of Relaxation Therapy among Caregivers of
mentally ill patients after giving Relaxation Therapy .
• To find out the association between Stress and Anxiety among caregivers of
mentally ill patients with their selected demographic variables.
Hypotheses of the Study
This study attempts to examine the following hypotheses.

¾ H1:There will be a significant difference between the level of Stress and
Anxiety among Caregivers of mentally ill patients after Relaxation Therapy.
¾ H2: There will be a significant association between the level of Stress and
Anxiety among Caregivers of mentally ill patients with their selected
demographic variables.
Operational Definitions
Effectiveness
It refers to the outcome of Relaxation Therapy given to the Caregivers of

mentally ill patient, and it can be measured by caregiver Stress-assessment scale and
modified beck Anxiety inventory scale.
6
Relaxation Therapy
It is used to relieve Stress and Anxiety by affecting the synapses and

producing a relaxation response. It should be performed by tensing of each muscle
groups and then relaxing them in an orderly fashion as forehead, eyes, nose , lips,
cheeks, jaws, hand, shoulder, back, stomach, hip, feet, and toes practiced for 20
minutes daily about seven days.
Stress
It refers to the outcome of burden experienced by caregivers from the demand of

caring and seeing the suffering of their loved ones, which is manifested as
psychological response such as hopelessness , helplessness and physiological
response such as body ache, indigestion,due to Stressors among the Caregivers of
mentally ill patient.
Anxiety
It refers to the varying degrees of emotion experienced by caregivers stated as unable

to relax, difficulty in remembering, worry a lot, less intrest in activies, and it can be
measured by Beck Anxiety inventory scale.
Caregivers
It refers to the blood related family members or related to marriage and adoption,
who provide care to the mentally ill patient.
7
Assumptions
1. The Caregivers may experience significant level of Stress and Anxiety due to
caring of mentally ill patients.
2. Relaxation Therapy will have a significant effect in relieving Stress and
Anxiety among the Caregivers of mentally ill patients .
3. The Stress and Anxiety can lead to Stress related diseases if unattended which
can be prevented by effective utilization of Relaxation Therapy.
Delimitations
The study is delimited to
• The Caregivers of mentally ill patients in sneka mind care centre at

Thirunelveli.
• The Caregivers of mentally ill patients above 18years.
• Blood related family members and family members related to marriage and
adoption who is caring the mentally ill patients.
Ethical Consideration
This study required intervention in the form of Relaxation Therapy for which
the investigator had undergone training in Relaxation Therapy before data collection
to prevent harm to the participants.Confidentiality was assured by the investigator.
The ethical clearance was obtained from the ethical committee. Prior permission was
obtained from the Sneka Mind Care Centre and informed consent was obtained from
the caregivers.
8
Conceptual Framework
A conceptual framework can be defined as a set of concepts and assumptions

that integrate into a meaningful configuration (Fawcett, 1994). The conceptual
framework facilitates communication and provides a systematic approach to nursing
research, education, administration and practice. Conceptual models attempt to
represent reality with a minimal use of words.
The conceptual framework selected for this study isLudwing Von

Bertanloffy's General system theory. In 1968 Bertanloffy's introduce this theory as a
universal theory that could be applied to many fields of study.
Bertanloffy's model includes the following components.
System
In this study, caregivers of mentally ill patients are considered as a system.
Input
In this study, input includes selected socio demographic variable among

caregivers of mentally ill patients in Sneka Mind Care Centre at Thirunelveli and the
pre-test questionnaire which is assessing the level of Stress and Anxiety .
9
Through put
The system uses, organizes and transforms the information in between input
and output is throughput or process. This study try to evaluate the effectiveness of
progressive muscle Relaxation Therapy on Stress and Anxiety among caregivers of
mentally ill patients in Sneaka Mind Care Centre at Thirunelveli by administering the
progressive muscle Relaxation Therapy. The investigator conduct the post –test and
compare the results of pre and post test.
Output
The outcome of Progressive Muscle Relaxation Therapy is evaluated

bycaregivers Stress assessment scale and beck Anxietyinventary. After post test, there
will be significanant reduction in level of Stress and Anxiety that indicates the
effectiveness of Progressive Muscle Relaxation Therapy on Stress and Anxiety
Among caregivers of mentally ill patients .
Feedback
The feedback refers to the output that may be positive, negative or neutral. In
this study, feedback measured in the output reveals the significant effectiveness or
non effectiveness of the progressive muscle Relaxation Therapy on Stress and
Anxiety.
10
11
Caregivers of mentally ill patients in sneka mind care
centre
cio demographic variables among caregivers of mentally ill patients
Input Through Put Output
Significant
reduction
p
p in Stress
r
Providing progressive muscle Relaxationo Therapy andAnxiet
e
s y
t
e t
s t
Assessing comparison of pre and posttest result
t e
Stress and
s
Anxiety
t
No Significant
reduction in
Stress
andAnxiety
Figure:1 Conceptual Framework Based on Ludwing

12 Von Bertanloffy's General system
theory(1968)
13
CHAPTER-II
REVIEW OF LITERATURE
Review of literature is an essential component of the research process. This

chapter deals with studies related to research literature that will review to understand
and to gain insight into the selected chapter under study.
Review of literature is a written summary of the state of existing knowledge on a

research problem. The task of reviewing research literature involves the identification,
selection of a critical analysis and written description of existing information on a
topic(Polit D.F. and Hungler; 2003).
Review of literature is an essential step in the research project. It provides

basis for future investigations, justifies the need for study and throws light on the
feasibility of the study.
Review of literature for the present study is classified under two headings.
Studies related to Stress and Anxiety among caregivers of mentally ill patients.
Studies related to Relaxation Therapy (progressive muscle Relaxation
Therapy)
Studies Related to Stressand Anxiety among Caregivers of Mentally ill Patients.
Jose Anne;(2013)Study was conducted to investigate burden experienced by

caregivers of schizophrenia. Qualitative assessments were done by focus group
discussions (FGDs) with 20 family caregivers of patients diagnosed as Schizophrenia.
2 focus groups were held involving 10 caregivers.Data was analysed using thematic
and content analysis.The areas of burden identified are family functioning, financial
problems, social isolation,emotional burden, caregivers health, and refusal of
medicines.
14
Ratnakar.et al., (2008) Conducted a study on evaluation of Anxiety and
depression among the family caregivers of advanced cancer patients. The results show
that the family caregivers of advanced cancer patients undergo Anxiety and
depression associated with Stress leading to increased Stress.
Guru raj; (2008)Two Indian comparative studies were conducted in different

states of India on the caregivers’ burden of schizophrenia and OCD patients. Ninety
two First degree relatives/ spouses were compared. One study showed higher burden
in OCD group that was high among spouses than relatives of schizophrenia group .
The same author done another study showed higher burden in schizophrenia than
OCD.
Irene J HigginsonandWei Gao; (2006)Conducted a study to assess caregiver

reports of patient concerns and the roles of caregiver’s burden. 64 samples were
interviewed, and the level of burden assessed by Palliative Outcome Scale (POS) and
Zarit Burden Interview Scale (ZBI). The results showed the Caregivers had
significantly higher burden
Sunil Srivastava;(2005)The study was conducted to measure the perception

of burden by caregivers of patients with schizophrenia at Institute of Mental Health
and Hospital, Agra. TheBurden Assessment Schedule (BAS) was correlated to
spouse, physical and mental health, external support, caregiver's routines, support to
patient, responsibility-taking, other relatives, patient's behavior and caregiver's
strategy. A number of sample is thirty four caregivers of patient with schizophrenia. A
low positive correlation was found between urban domiciles and support of the patient
and the caregiver's routine. There was a low positive correlation between age less than
30 years and the physical and mental health of the caregiver, and with taking
responsibility
Rammohan, A; (2002) This comparative cross-sectional study assessed

family burden among caregivers of patients with OCD and schizophrenia in an Indian
15
setting. Findings shows Indian families experience significant degrees of burden in
the care of their relatives with OCD and schizophrenia. Relatives' demographic
characteristics did not influence burden severity. Illness severity and patients'
disability had a direct positive relationship with perceived family burden. This study
suggests to develop local needs based support programme for families of patients with
psychiatric disorders in India.
Studies Related to Relaxation Therapy (Progressive Muscle Relaxation Therapy)
Ms.Palak Patel; (2014)Conducted a Study to Assess the Effectiveness Of

Progressive Muscle Relaxation Therapy on Stress among Staff Nurses Working In
Selected Hospitals at Vadodara City.Pre experimental one group pre - test and post
-test research design was adopted to achieve the goal of the study by using instrument
i.e demographic data and Stress assessment scale among 30 staff nurses. The findings
of the study revealed that in pre test most of the nurses 53.3% had moderate Stress,
40.0% had mild Stress and 6.7% had severe Stress. In post test most of the nurses had
mild Stress 73.3 % and no Stress 26.7 % . It is concluded that Progressive Muscle
Relaxation Therapy is effective in reducing the Stress level of the staff nurses.
Febu Elizabeth Joy; (2014)An exploratory study was conducted to identify

the adolescents with social Anxiety and teach theJacobson's Progressive Muscle
Relaxation( JPMR) technique to those who would score high on social Anxiety scale.
The data were collected from 193 high school adolescents using Demographic
Proforma, Social Anxiety Scale for Adolescent and Tool to Assess the Associated
Factors of Social Anxiety. The JPMR technique was administered to the adolescents
with moderate to severe social Anxiety. The study found that 52(27%) adolescents
were having moderate social Anxiety and there was significant association (÷
=15.297, p<0.05) between age of the adolescents and social Anxiety. The Jacobson's
Progressive Muscle Relaxation Technique was found to be effective (t =10.646, df=
39, p=0.001) in reducing the social Anxiety. Social Anxiety is common among
adolescents and many modifiable factors related to parents and teachers are associated
with it. Appropriate interventions in an early time may help them to reduce it.
16
Rojan Jose; (2013) Conducted a study to assess the effectiveness of
Jacobson's Progressive Muscle Relaxation (JPMR) on Blood Pressure and Health
Related Stress Level among Patients with Hypertension in a Selected Hospital of
Mangalore. An evaluatory approach with one group pretest- post test design was
doneon a sample of 40 patients diagnosed with hypertension. JPMR was administered
for 20 minutes to the patients for 4 days both in the morning and evening as 8
sessions. Pre and post intervention BP and health related Stress was assessed.The
mean systolic BP had reduced from 155.8 ± 10.14 to 121.7 ± 4.47 and mean diastolic
BP had reduced from 92.7 ± 4.52 to 79.9 ± 62.63 after the administration of JPMR.
The average reduction of systolic BP was 6.42 mm of Hg and that of diastolic BP was
0.8 mm of Hg over the 4 days. The mean health related Stress level had reduced from
94.03 ± 7.64 to 62.8 ± 7.15, with a mean percentage reduction of 19.5%. JPMR is a
cost-effective, non-invasive, non-pharmacological alternative therapy in
themanagement of Stress and hypertension
Beulah Mavis; (2013) Conducted a comparative study to assess the

effectiveness of Reflexology and Two Minute Relaxation Technique on Fatigue
Reduction and Relaxation in Clients UndergoingHaemodialysis in Selected
Setting.The research design selected for this study was pre-experimental, that is, two
group pre-test post-test design.In this study the data collection instruments used are
Baseline Performa of ESRD patients undergoing haemodialysis, Self-expressed
Relaxation rating scale, Modified Piper Fatigue scale. The findings showed that there
was a significant difference in the pre-test and post-test score of fatigue and relaxation
in the reflexology and two minute relaxation technique group. This proved the
effectiveness of reflexology and two minute relaxation technique in reduction of
fatigue andenhancement of relaxation in both the groups.
Dolbier, christyln, rush, taylor e.; ( Feb 2012) Carried out a study to
examine the efficacy of abbreviated progressive muscle relaxation (APMR) to
enhance physiological and psychological functioning among high-Stress college
students.‖ Participants (N = 128) with high Perceived Stress Scale scores. After
random assignment, for 20 min, 66 experimental group participants underwent APMR
17
lying down and 62 control group participants lied down quietly. Pre- and post
intervention measures included the Endler Multidimensional Anxiety Scale,
relaxation items, electrocardiograph heart rate and heart rate variability (HRV), and
salivary cortisol. Compared with the control group, the experimental group
demonstrated significantly greater increases in mental (Cohen's d = 0.32) and physical
(Cohen's d = 0.32) relaxation, and normalized high-frequency HRV (Cohen's d =
0.29), and decreases in low- to high-frequency HRV ratio (Cohen's d = 0.31). Small
effect sizes were observed for Anxiety, normalized low-frequency HRV, and cortisol.
Analyses of the reliability and clinical significance of these changes indicate trends in
the expected direction. These findings indicate an APMR intervention can have
significant short-term effects, both reducing detrimental and enhancing beneficial
functioning in high-Stress college students.
Sandra M; (2011) Conducted a study to test the outcomes of an Art Infusion

(AI) intervention with family caregivers of cancer patients while patients were
undergoing treatment. The design used was pre-posttest quasi-experimental design.
The convenient sample of 49 family caregivers participated in the study. The findings
shows that highly significant findings indicate that family caregivers achieved relief
from Stress (p=.000), had lower Anxiety (p=.000), and increased positive emotions
(p=.000) following participation in the AI. They concluded that the research
participants demonstrated significant changes in Stress, Anxiety, and emotions.
Nayak H K, Hemant Tiwari et al., (2011)Conducted a study about

community-based cross-sectional study to assess the prevalence and pattern of Stress
relaxation practices in Ahmedabad city, Gujarat, India. The prevalence of different
types of Stress Relaxation practices in relation with their socio demographic profile
studied. Results reveals that out of 904 persons above 20 years of age were surveyed
among them 310 doing Stress Relaxation practices were able to maintain balance
between work and other activities than non - Stress relaxation practices group. Also
concluded that research study of the Stress among the workers of sedentary
occupation should be carried out.
18
Mohsen yazdani; (2010) Conducted a study on the effectiveness of Stress
management training programme (which included progressive muscle relaxation
technique) on depression, Anxiety and Stress of the nurses in Isfahan university of
medical science with 68 samples by using randomazied quasi experimental trial, result
saws that there was no significant difference before the intervention in depression,
Anxiety and Stress mean score of two groups, after the intervention, the mean score of
Anxiety and Stress in the intervention group was 5.09 (4.87) & 8.93 (6.01) and in the
control group was 10 (6.45) & 13.17 (7.20). This reduction also had been remained
after a month
Max G Feirstein; (2009)An experimental study wasconducted to determine

whether the characteristics of absorption or worry would moderate by the effects of
progressive muscle relaxation technique or guided imagery delivered to groups.
Twenty male and 49 female students were administered either progressive muscle
relaxation technique or imagery by a certified hypnotherapist. Although both
treatments produced significant increases in relaxation and reductions in Stress and
Anxiety, relaxation scores increasing from pre-test to post-test and Stress and Anxiety
decreasing, It is suggested that progressive muscle relaxation technique may hold
certain inherent benefits over imagery, as it may be less likely to were cause adverse
effects.
Manzoni et al;(2008) Conducted a study to enhances understanding of the

variability and clinical significance of Anxiety reduction outcomes after relaxation
treatment. observational and without control group, evaluating the efficacy of
relaxation training (Jacobson's progressive relaxation, autogenic training, applied
relaxation and meditation) for Anxiety problems and disorders were identified .27
studies qualified for the inclusion in the meta-analysis. As hypothesized, relaxation
training showed a medium-large effect size in the treatment of Anxiety. Cohen's d
was .57 (95% CI: .52 to .68) in the within analysis and .51 (95% CI: .46 to .634) in
the between group analysis. Efficacy was higher for meditation, among volunteers
and for longer treatments. Implications and limitations are discussed.. The results
show consistent and significant efficacy of relaxation training in reducing Anxiety.
19
Giju Thomas; (2006)Conducted a quasi experimental study to determine the
effectiveness of progressive muscle relaxation technique on Anxiety among elderly
people in selected old age home at Bangalore.‖ Study was carried out in Sarvodaya
old age home, Bangalore. Data was obtained from the 40 elderly persons staying in
Sarvodaya old age home through the standard state trait Anxiety inventory scale the
level of Anxiety was assessed. Purposive sampling technique was used .the finding of
the study reveals that the mean level of Anxiety during pretest was 89.82 and post test
it was reduced to 69.55. there was an effectiveness found after STP of progressive
muscle relaxation technique through statistical analysis by using paired ‗t‘ test. (t =
5.524 P< 0.05) .
Kwekkeboom.K.L; (2006)Conducted a study to review randomized trials of

relaxation interventions used for the treatment of pain in adults and to synthesize
evidence regarding the efficacy of specific techniques. Studies were reviewed and
categorized based on the type of relaxation intervention (progressive muscle
relaxation [PMR], autogenic training, jaw relaxation, rhythmic breathing, and other
relaxation exercises), and summarized with respect to various study characteristics
and results.Most of the studies reviewed had weaknesses in methodology, which
limited the ability to draw conclusions about interventions. Further research is needed
to confirm positive findings related to PMR, jaw relaxation, and systematic relaxation,
to address questions related to the dose-response relationship and the individual
differences that might influence response to relaxation interventions. These and other
relaxation techniques require testing in carefully designed and conducted trials
20
CHAPTER-III
METHODOLOGY
Research methodology refers to the techniques used to structure the study and
to gather and analyze information in a systematic fashion.
This chapter deals with the methodology adopted for this study and includes
the research approach, design, setting, variables, population, samples, sampling
method, inclusive criteria and exclusive criteria.
Research Approach
The study utilized quantitative study approach. The study was conducted in
two phases. Pre assessment was done for both Stress and Anxiety, and progressive
muscle relaxation was given to the participants in first phase. Post test was done for
both Stress and Anxiety in the second phase.
Research Design
Research design refers to the overall plan for obtaining answers to research
questions and it spells out the strategies that the researcher adopts to develop
information that is adequate, accurate, objective and interpretable. (Polit D.F. and
Hungler;1999).
In view of nature of the problem and to accomplish the objectives of the study
pre experimental - one group pre testpost test design was used to evaluate the
effectiveness of Relaxation Therapy on level of Stress and Anxiety.
Pre Experimental - one group pre testpost test design

O1 X O2
21
Pre test Intervention Post test
O1 X O2
O1 = Pretest (Level of Stress and Anxiety before Intervention)

X = Intervention (progressive muscle Relaxation Therapy)
O2 = Posttest (Level of Stress and Anxiety after Intervention)
Variables
Independent variable:
Relaxation Therapy (progressive muscle relaxation )
Dependent variable:
Stress and Anxiety among Caregivers of mentally ill patients.
Setting of the Study
In this study the research setting is ‘SnekaMind Care Centre’ at Thirunelveli,

which is located 75 kilometers away from ThasiahCollege of Nursing and it is an 80
bedded psychiatric hospital where the daily outpatients are above 250 and the
inpatients are 60-80.Among this majority of them are with acute mental illness with
psychosis. The hospital have a separate wing for alcohol deaddiction and psychiatric
rehabilitation. The hospital is equipped with facilities for activity therapy and other
psychological therapies. Counseling services also available within the hospital.
Population
Target population : Caregivers of mentally ill patients above 18 years.
Accessible population : Caregivers attending SnekaMind Care Centre at

Thirunelveli.
22
.Sample Size
The sample size consist of 60Caregivers of mentally ill patients in Sneka

Mind Care Centre.
Sampling Technique
The sampling technique adopted for this study is convenience sampling

method.
Sample Selection Criteria
Inclusive criteria
• Caregivers who were willing to participate in the study

• Caregivers who were present from first day of admission about 8 days.
• Caregivers those who have moderate and severe level of Anxiety and
Stress will be taken as a sample.
Exclusive criteria
• Caregivers who are not attended intervention regularly.

• The discharge of the patient before 8 days.
• Caregivers who are not familiar with Tamil and English language.
23
Research approach & design
Quantitative approach & pre-experimental design.
Population
Caregivers of mentally ill patients
Setting
Senka mind care centre.
Sampling
Sample size : 60
Sampling technique : Convenience
sampling technique
Data collection procedure

Structured interview schedule
Pre test
Intervention
(Progressive Muscle Relaxation
Technique)
Post test
Data analysis and interpretation

Descriptive and inferential statistics
24
Communication of findings
Figure : 2 Schematic Representation of the Research Methodology.
Description of the Tool
The tool consist of 3 sections,
Section: A
Demographic profile comprised of 10 variables such as age, sex, educational status,

religion, occupation, family income per annum, marital status, relationship with the
patient, type of family and duration of illness.
Section: B
This section dealswith caregivers Stress assessment to assess the level of

Stress. This section comprised of 20 items. Each item carries a score between 0-4
depending on the level of Stress. The minimum and maximum scores were 0 and 80
respectively. The score interpretation was done as follows,
Scoring andinterprretation
No Stress 0-20 (0-25%)

Mild Stress 21-40 (26% - 50%)
Moderate Stress 41-60 (51% - 75%)
Severe Stress 61-80 (76% - 100%)
Section: C
This section dealt with Beck’s Anxiety Inventory scale to assess the level of
Anxiety. This section comprised of 25 items. Each item had a score between 0-3
25
depending on the level of Anxiety. The minimum and maximum scores were 0 and
75 respectively. The score interpretation was done as follows,
Scoring and interprretation
Mild Anxiety 0-25 (0 - 33%)

Moderate Anxiety 26-50(34% - 66%)
Severe Anxiety 51-75 (67% - 100%)
Content Validity
Validity of the tool was established with the consultation of the guide and five
experts includes three M.Sc nursing faculties with five years experience, a expert of
psychiatric practitioner and an expert of clinical psychologist.The experts were
requested to give their opinion and suggestion for further modification of items to
improve the clarity and content of the items. The Final tool was prepared as per the
suggestions and advice given by the experts.
Reliability of the Tool
The reliability for application of tool was tested using the test retest method.
Instrument reliability is the consistency with which it measures the target
attribute. Reliability of the tool was established using test retest reliability method.
The reliability score is r =0.82, which showed a positive correlation, hence the tool
was considered reliable for proceeding with the study. An independent recording of
the data was done according to the tool instructions. There was no tool ambiguity
experienced by the investigator.
26
Pilot Study
Pilot study is defined as, "a small-scale version or trial run, done in preparation
of a major study". (Denise F. Polit; 2011)
Pilot study was conducted in Sneka Mind Care Centre at Thirunelveli. Initial
permission was sought from the institution and formal permission was sought from
the director for conducting pilot study. Pilot study was conducted in the month of
April for a period of one week. The investigator selected 6 samples using purposive
sampling method that fulfilled the inclusion criteria. Pretest was done using the
caregivers Stressassessment scale and becks Anxiety inventry scale followed by
progressive muscle Relaxation Therapy for 6 days; post test was conducted using the
same scales at the 7th day. The results of the pilot study, when analyzed, gave the
evidence that the tools were reliable then the findings of the pilot study revealed that
it was feasible and practicable to conduct the study.
Data Collection Procedure
The researcher obtained permission from the hospital authority for conducting
the study. Hence the caregivers of mentally ill patients were properly informed about
the Relaxation Therapy. The data collection was conducted from 01.05.2014 to
30.05.2015. Structured interview schedule was used to assess the level of Stress and
Anxiety of the samples. The time taken by the investigator to complete the tool for
each sample was 30 to 45 minutes. The samples were asked to choose the correct
response from the given options. After the pre-test the samples were trained with the
Progressive Muscle Relaxation Technique in a calm and quite environment. The
duration of the procedure was 20 minutes for each sample. During the procedure the
samples were requested to tighten and loosen their muscles one by one from head to
foot. The samples were instructed to do the technique daily. Next day, the
participants were asked to perform the demonstrated Relaxation Therapy infront of
the researcher to make sure they are doing it in right manner. Further visit to the
27
participants were made by the researcher to assess whether they are doing or not. The
post-test was done after seven days of intervention. The data were edited for
completion.
Data Analysis
Data collected was analyzed using both descriptive and inferential statistics
such as mean, standard deviation, chi square and paired‘t’ test.
Descriptive Statistics
Frequency and percentage distribution of sample according to demographic

variables of caregivers of mentally ill patients.
Frequency and percentage distribution were used to asses the level of Stress
and anxeity.
Mean and standard deviation were used to asses the effectiveness of

Relaxation Therapy in reducing Stress and anxeity.
Inferential Statistics
Paired‘t’ test was used to compare pretest and post test level of stres and
anxeity among caregivers of mentally ill patient.
Chi square test was used to find out the association of post test level of Stress
and Anxiety among caregivers of mentally ill patients with their selected demographic
variable.
28
CHAPTER - IV
DATA ANALYSIS AND INTERPRETATION
Research data must be proceed and analyzed in an orderly fashion so that

patterns and relationship can be discerned and validated and hypotheses can be tested.
Quantitative data analyzed through statistical analysis include simple procedures as
well as complex and sophisticated methods.(Polit; 2004)
This chapter deals with the analysis and interpretation of data.
Descriptive and inferential statistics were used for analyzing the data on the
basis of objectives of the study. The data has been tabulated and organized as follows.
Section A : Description of demographic variables of the Caregivers of mentally ill

patients.
Section B : Assessment of the pretest and posttest level of Stress among

Caregivers ofmentally ill patients.
Section C : Assessment of the posttest level of Stress and Anxiety among

Caregivers of mentally ill patients.
Section D : Effectiveness of Relaxation Therapy on Stress and Anxiety among

Caregivers of mentally ill patients.
Section E : Association of post level of Stress and Anxiety among caregivers of

mentally ill patients with their selected demographic variables.
29
Section A: Description of Demographic Variables of the Caregivers of
Mentally ill Patients.
Table: 1 Frequency & Percentage Distribution of Study Samples According to

the Selected Demographic Variables.
N=60
SI Demographic Variables Frequency Percentage

1 Age in years
18 – 30 16 26.6%
31 – 45 17 28.3%
46 – 60 22 36.6%
Above 60 5 8.3%
2 Sex
Male 33 55%
Female
27 45%
3 Educational status
illiterate 11 18.3%
up to 12th standard
21 35%
under graduate
post graduate 25 41.6%
3 5%
4 Religion
Hindu 19 31.6%
Christian
22 36.6%
Muslim
Others 19 31.6%
-
-
30
Table 1 Cont.
SI Demographic Variables Frequency Percentage

5 Occupation
12 20%
private employee
Government employee 15 25%
Unemployed 26 43.3%
Others
7 11.6%
6 Family income per annum

Below 25, 000 6 10%
26000 to 50,000
10 16.6%
51000 to 100,000
Above 1,00,000 18 30%
26 43.3%
7 Marital status
Married 48 80%
Single
10 16.6%
Separated
Widowed - -
2 3.3%
8 Relationship with Patients
Daughter 8 13.3%
Son
10 16.6%
Spouse
Parent 23 38.3%
Others
10 16.6%
9 15%
9 Type of the Family
Joint Family 17 28.3%

Nuclear Family
43 71.6%
10 Duration of illness
Below one illness 8 13.3%

One to six month
22 36.6%
Six to twelve month
Above one year 19 31.6%
11 18.3%
31
Table: 1Explains the study sample according to their selected demographic
variables.Distribution of sample according to age 26.6% sample falls under the age
group of 18.30 years, 28.8% of sample falls under the age group of 31-45 years,
36.6% of sample falls under the age group of 46- 60 years, 8.3% of sample falls
under the age group of above 60 years.
Distribution of sample according to sex 55% of sample were male and 45% of
sample were female.
Distribution of sample according to the educational status 18.3% of sample

were illiterate 35% of sample were studied up to 12th standard,41.6% of sample were
under graduate, 5% of sample were post graduate.
Distribution of sample according to religion 31.6% of sample were Hindu,

36.6% of sample were Christian, 31.6% of sample were Muslim.
Distribution of sample according to occupation 20% of sample were private

employee, 25% of sample were Government employee, 43.3% of sample were
unemployed, 11.6% of sample were other employees.
Distribution of sample according to Family income per annum, 10% of sample

have family income below 25,000, 16.6% of sample have 26000 to 50,000 , 30% of
sample have 51,000 to 100,000, 43.3% of sample haveabove 1,00,000
Distribution of sample according to marital status 80% of sample were

married, 16.6% of sample were single, 3.3 % of sample were widowed.
Distribution of sample according to relationship with the patients, 13.3% of

sample were Daughter 16.6% of sample were son, 38.8% of sample were spouse,
16.6% of sample were parents, 15% of sample were others.
32
Distribution of sample according to type of family 28.3% of sample were
living in joint family. 71.6% of sample were living in Nuclear family.
Distribution of sample according to the duration of illness, 13.3% of samples

were Below one month, 36.6% of sample were one to six month, 31.6% of sample
were six to twelve month, 18.3% of sample were above one year.
33
120.00%
100.00%
0.08
0.37
80.00%
Above 60
60.00% 46‐60
31‐45
28.30% 18‐30
40.00%
20.00%
0.27
0.00%
18-30 31-45 46-60 Above 60
Figure 3 :Distribution of Demographic Variables According to Age
34
120%
100%
45%
80%
60% Female
Male
40%
0.55
20%
0%
Male Female
Figure 4 :Distribution of Demographic Variables According to Sex
35
120%
100%
0.05
0.42
80%
60%
Post Graduate
35% Under graduate
upto12th standard
40% Illtrate
20%
0.18
0%
Figure 5:Distribution of Demographic Variables According to Educational Status
36
120%
100% 0
0.32
80%
Other
60% Muslim
Christian
36.60% Hindu
40%
20%
0.32
0%
Hindu Christian Muslim Other
Figure 6 :Distribution of Demographic Variables According to Religion
37
12%
20%
25%
43%
Private employee
Government employee
umemployed
others
Figure 7 :Distribution of Demographic Variables According to Occupation
38
120%
100%
0.43
80%
60%
above 100000
0.3
51000 to 100,000
26000 to 50,000
40% Below 25,000
16.60%
20%
0.1
0%
Figure 8:Distribution of Demographic Variables According to Family Income per

Annum
39
120%
100%
0.03
16.60%
0
80%
widowed
60% Separated
Single
Married
40% 0.8
20%
0%
Married Single Separated widowed
Figure 9 :Distribution of Demographic Variables According to Marital Status
40
120%
100%
0.15
0.17
80%
Others
0.38
Parent
60% Spouse
Son
Daughter
40%
16.60%
20%
0.13
0%
Daughter Son Spouse Parent Others
Figure 10:Distribution of Demographic Variables According to Relationship with

the Patient
41
80%
70%
60%
50%
40% Series 1
71.60%
30%
20%
28.30%
10%
0%
Nuclear family Joint Family
Figure 11 :Distribution of Demographic Variables According to Type of the

Family
42
40
36.6
35
30
25
20
above one year
six to twelve month
15
one to six month
below one month
10
13.3
5
Figure 12 :Distribution of Demographic Variables According to Duration of

Illness
43
Section B:Assessment of the Pretest and Posttest Level of Stress Among
Caregivers of Mentally Ill Patients.
Table: 2 Frequency and Percentage Distribution of Pretest and Posttest Level of

Stress.
N=60
SI. Level of Pretest Posttest
Frequency Percentage Frequency Percentage
No Stress
1 No Stress - - 41 68.3%
2 Mild - - 15 25%
3 Moderate 47 78.3% 4 6.6%
4 Severe 13 21.6% - -
The table : 2 reveals the frequency and percentage distribution of pretest and posttest
level of Stress among Caregivers of mentally ill patients, the pretest level of Stress,
78.3% of them had moderate Stress, 21.6% of them had severe Stress. The posttest
level of Stress 68.3% of them had no Stress, 25% of them had Mild Stress, 6.6% of
them had Moderate Stress and none of them had Severe Stress.
44
Section C:Assessment of the Pretest and Posttest Level of Anxiety Among
Caregivers of Mentally ill Patients.
Table: 3 Frequency and Percentage Distribution Pretest and Posttest Level of

Anxiety
N=60
SI. Level of Pretest Posttest
No Anxiety Frequency Percentage Frequency Percentage
1 Mild - - 44 73.3%
2 Moderate 38 63.3% 16 26.6%
3 Severe 22 36.6% - -
The table: 3 reveals the frequency and percentage distribution of pretest and posttest
level of Anxiety among Caregivers of mentally ill patients, the pretest level of
Anxiety, 63.3% of them had moderate Anxiety, 36.6% of them had severe Anxiety.
The posttest level of Anxiety 73.3% of them had mild Anxiety, 26.6% of them had
Moderate Anxiety and none of them had Severe Anxiety.
46
Section D: Effectiveness of Relaxation Therapy on Stress and Anxiety Among
Caregivers ofMentally Ill Patient.
Table 4 : Effectiveness of Relaxation Therapy on Stress and Anxiety Among

Caregivers of Mentally ill Patient.
N=60
S variables Pretest Posttest T value Mean difference
I
Mean Standar Mean Standard
d deviation
deviation
1 Stress 51.9 7.6 23.4 7.29 20.26 28.5
2 Anxiety 51.3 6.16 26.3 5.62 21.36 25

df = 59 p < 0.05
Table-4 reveals that pretest mean Stress score was 51.9 and Anxiety score 51.3. The
posttest mean Stress score was 23.4 and Anxiety score was 26.3. the difference in
mean for Stress and Anxiety were28.5 and 25 respectively. The calculated t value of
Stressand Anxiety were 20.26 and 21.36 which is significant to the table value,
revealing that the Relaxation Therapy was effective in reducing the level of Stress and
Anxiety.
48
Section:E
Table 5 Association of Posttest Level of Stress and Anxiety Among Caregivers of

Mentally ill Patients with their Selected Demographic Variable.
N=60
SI Demographic Anxiety Stress

variables
df x2 Significanc df x2 Significance
e
1 Age in years 3 1.97 P>0.05 6 4.94 P>0.05
2 Sex 1 0.49 P>0.05 2 1.07 P>0.05
3 Educational 3 3.84 P>0.05 6 3.66 P>0.05
status
4 Religion 2 0.53 P>0.05 6 3.15 P>0.05
5 Occupation 3 3.01 P>0.05 6 12.31 P>0.05
6 Family income 3 0.74 P>0.05 6 13.74 P<0.05
per annum
7 Marital status 2 4.02 P>0.05 4 6.58 P>0.05
8 Relationship 4 3.38 P>0.05 8 4.42 P>0.05
with the family 4
members
9 Type of the 1 0.09 P>0.05 2 5.69 P>0.05
family 4
10 Duration of 3 0.80 P>0.05 6 10.84 P>0.05
illness 3
The above table explains that, for the demographic variables age the Stress df
is 3 chi-square value is 1.97 and the table value is non significant at P = 0.05. The
Anxiety df is 6 chi-square value is 4.94 and the table value is non significant at
P = 0.05. Hence this demographic variable isnot associated with the post test score.
With regarded to sex the Stress df is 2 chi-square value is 1.07 and the table
value is non significant at P = 0.05. The Anxiety df is 1 chi-square value is 0.49 and
the table value is non significant at P = 0.05. Hence this demographic variable isnot
associated with the post test score.
49
In educational status the Stress df is 6 chi-square value is 3.36 and the table
In Religion the Stress df is 6 chi-square value is 3.15 and the table value is non
significant at P = 0.05. The Anxiety df is 2 chi-square value is 0.53 and the table
value is non significant at P = 0.05. Hence this demographic variable isnot associated
with the post test score.
In occupation the Stress df is 6 chi-square value is 12.31 and the table value is
non significant at P = 0.05. The Anxiety df is 3 chi-square value is 3.01 and the table
value is non significant at P = 0.05. Hence this demographic variable isnot associated
with the post test score.
In Family income per annum the Stress df is 6 chi-square value is 13.74 and
the table value is significant at P = 0.05. The Anxiety df is 3 chi-square value is 7.81
and the table value is non significant at P = 0.05. Hence this demographic variable
isassociated with the post test score of Stress.
In Marital status the Stress df is 4 chi-square value is 6.58 and the table value
is non significant at P = 0.05. The Anxiety df is 2 chi-square value is 4.02 and the
table value is non significant at P = 0.05. Hence this demographic variable isnot
In Relationship with the family members the Stress df is 8 chi-square value is

4.42 and the table value is non significant at P = 0.05. The Anxiety df is 4 chi-square
value is 3.38 and the table value is non significant at P = 0.05. Hence this
demographic variable isnot associated with the post test score.
50
The type of Family the Stress df is 2 chi-square value is 5.69 and the table
In Duration of Illness the Stress df is 6 chi-square value is 10.84 and the table
Summary
This chapter dealt with data interpretation in the form of statistical values
based on the objectives. Frequency and percentage distribution was found out on level
of Stress and Anxiety in caregivers of mentally ill patients with the selected
demographic variables. The paired t test was used to determine the effectiveness of
Relaxation Therapy among caregivers of mentally ill patients. Thechisquare analysis
was used to find out the association of posttest level of Stress and Anxiety among
caregivers of mentally ill patients with their selected demographic variable.
51
CHAPTER –V
DISCUSSION
This pre-experimental study was done to determine the effectiveness of

Relaxation Therapy on Stress and Anxiety in caregivers of mentally ill patients in
Sneka Mind Care Centre, Thirunelveli. Pre experimental - one group pre testpost test
design was adopted for the study. The result and discussion of the study are based on
the findings obtained from the statistical analysis.
The first objective of the study was to assess the level of Stress and
Anxiety among the caregivers of mentally ill patients before giving Relaxation
Therapy.
In pretest among 60 samples, 47(78.37%) of them had Moderate level of

Stress and 13 (21.6%) of them had severe Stress, None of them had No Stress or Mild
Stress.
In pretest among 60 samples 38 (63.3%) of them had moderate Anxiety and 22

(36.6%) of them had severe Anxiety. None of them had Mild Anxiety or no Anxiety.
The study findings is also congruent with a study conducted by

Rammohan,A;(2002). This comparative cross-sectional study assessed family burden
among caregivers of patients with OCD and schizophrenia in an Indian setting.
Findings shows Indian families experience significant degrees of burden in the care of
their relatives with OCD and schizophrenia. Relatives' demographic characteristics
did not influence burden severity. Illness severity and patients' disability had a direct
positive relationship with perceived family burden. This study suggests to develop
local needs based support programme for families of patients with psychiatric
disorders in India.
52
From the statistical values of both studies, it is concluded that caring for
mentally ill patients can add a significant degree of family burden to caregivers and
leads to high level of stress and anxiety to caregivers.
The second objective of the study was to assess the effectiveness of

Relaxation Therapy among caregivers of mentally ill patients after giving
Relaxation Therapy.
In post test among 60 samples, 41(68.3%) of them had No Stress, 15(25%) of

them had Mild Stress, and 4(6.6%) of had moderate Stress, None of them had severe
Stress. On assessing anxiety, among 60 samples 44(73.3%) of them had mild anxiety,
16 (26.6%) of them had moderate anxiety and none of them had severe anxiety.
In pretest Mean Stress score was 51.9 and the Anxiety score was 51.3. The
post test Mean Stress score was 23.4 and the Anxiety score was 26.3. The period ‘t’
value at p<.ool level for Stress and Anxiety were 2.265 and 21.36 respectively, which
shows that the Relaxation Therapy was effective in reducing the Stress and Anxiety in
The study findings is also congruent with the following studies,
Ms.PalakPatel(2014). A Study to Assess the Effectiveness Of Progressive

Muscle Relaxation Therapy on Stress among Staff Nurses Working In Selected
Hospitals at Vadodara City. Pre experimental one group pre - test and post -test
research design was adopted to achieve the goal of the study by using instrument i.e
demographic data and Stress assessment scale among 30 staff nurses. The findings of
the study revealed that in pre test most of the nurses 53.3% had moderate Stress,
40.0% had mild Stress and 6.7% had severe Stress. In post test most of the nurses had
mild Stress 73.3 % and no Stress 26.7 % . It is concluded that Progressive Muscle
Relaxation Therapy is effective in reducing the Stress level of the staff nurses.
53
Febu Elizabeth Joy(2014). An exploratory study to identify the adolescents
with social Anxiety and teach the JPMR technique to those who would score high on
social Anxiety scale. The data were collected from 193 high school adolescents using
Demographic Proforma, Social Anxiety Scale for Adolescent and Tool to Assess the
Associated Factors of Social Anxiety. The JPMR technique was administered to the
adolescents with moderate to severe social Anxiety. The study found that 52(27%)
adolescents were having moderate social Anxiety and there was significant
association (÷ =15.297, p<0.05) between age of the adolescents and social Anxiety.
The Jacobson's Progressive Muscle Relaxation Technique was found to be effective (t
=10.646, df= 39, p=0.001) in reducing the social Anxiety. Social Anxiety is common
among adolescents and many modifiable factors related to parents and teachers are
associated with it. Appropriate interventions in an early time may help them to reduce
it.
The results of above studies indicates that progressive muscle relaxation

technique is effective in reducing Stress and Anxiety
The third objectives of the study was to find out the association between
Stress and Anxiety among caregivers of mentally ill patients with their selected
demographic variables.
The result shows that, In caregivers Stress assessment scale there was
significant association between the level of Stress with demographic variables family
income per annum and all other variables are non significant. In beck Anxiety
inventory scale There is no significant association in the level of Anxiety with their
selected demographic variables. Hence the research hypothesis (H2) rejected.
54
CHAPTER-VI
SUMMARY AND RECOMMENDATION
This chapter consist of four section. In the first two section, the summary and
conclusion are presented and in the next two sections, implication for nursing practice
and recommendations for further research are presented.
Summary
The study was conducted to find out the effectiveness of Relaxation Therapy
on Stress and Anxiety among Caregivers of mentally ill patients in Sneka Mind Care
Centre at Thirunelveli.
Objectives of the Study
• To assess the level of Stress and Anxiety among the Caregivers of mentally ill
patients before giving Relaxation Therapy.
• To assess the effectiveness of Relaxation Therapy among Caregivers of
mentally ill patient after giving Relaxation Therapy .
• To find out association between Stress and Anxiety among caregivers of
mentally ill patient with their selected demographic variables.
Hypotheses of the Study
This study attempts to examine the following hypotheses.

¾ H1:There is a significant difference between the level of Stress and Anxiety
among Caregivers of mentally ill patients after Relaxation Therapy.
¾ H2: There is no association between the level of Stress and Anxiety among
Caregivers of mentally ill patients with their selected demographic variables.
55
Pre – experimental (one group pretest and posttest ) research design was used
to determine the effectiveness of Relaxation Therapy to reduce Stress and Anxiety
among caregivers of mentally ill patients . The tool used in this study consisted of two
sections. Section one was demographic variables, section two was caregivers Stress
arrestment scale and modified Beck Anxiety inventory to assess the level of Stress
and Anxiety among Caregivers of mentally ill patients. Convience sampling technique
was used to select the samples and data was collected from 60 caregivers of mentally
ill patients, in Sneka Mind Care Centre at Thirunelveli.
The data were collected and analysed using descriptive and inferential
statistics. To test the hypothesis, independent t test and chi square test were used. The
level of significance was assessed by p o.o5 to test the hypothesis.
Study Findings
Demographic profile of the sample, the Majority 22(36.6%)of samples

belonged to the age group of 46-60years, 33 (55%) of them were Male,
25(41.6%) were under graduate, 22 (36.6%) of them were Christian religion,
26 (43.3%) were unemployed, 26(43.3%) samples had a per annum family
income of above 1,00,000, Majority of the sample 48 (80%) were Married, 23
(38.3%) of the samples were spouse, Most of them belongs to 43 (71.6)
Nuclear family, 22(36.6%) of the samples are the Caregivers of mentally ill
patients with the duration of illness of one to 6 months.
In pretest, among 60 samples,47 (78.3%) of them had moderate level of Stress
and 13(21.6%) of them had severe Stress, none of them had mild or no Stress.
In pretest among 60 samples 38 (68.3%) of them had moderate Anxiety and 22
(36.6%) of them had severe Anxiety None of them had Mild Anxiety or no
Anxiety.
The pretest Mean Stress score was 51.9 and the Anxiety score was 51.3. The
post test Mean Stress was 23.4 and the Anxiety score was 26.3. The paired ‘t’
value at p<0.00l level for Stress and Anxiety were 2.265 and 21.36,
respectively which shows, that the Relaxation Therapy was effective in
reducing the Stress and Anxiety in Caregivers of mentally ill patients.
In caregivers Stress assessment scale there was significant association between
56
the level of Stress with demographic variables family income per annum and
all other variables are non significant. In beck Anxiety inventory scale There
is no significant association in the level of Stress and Anxiety with their
selected demographic variables. Hence the research hypothesis (H2) rejected.
Nursing Implications
The researcher has derived the following implications from the study results
which adds greater value to the field of nursing service, nursing administration,
nursing education, and nursing research. By Assessing the effectiveness of Relaxation
Therapy to reduce the level of Stress and Anxiety among caregivers of mentally ill
patients, we get a clear picture regarding different steps to be taken in all fields, to
improve the standard of nursing profession and implement evidence based practice in
health set up.
Nursing Practice
In the field of nursing, Ideally professionally accountable nurses should base

many of the nursing intervention as possible on research findings Relaxation Therapy
can be used as a nursing intervention in reducing the level of Stress and Anxiety
among caregivers of mentally ill patients among.
Relaxation Therapy is an effective Measure to reduce the Stress and Anxiety.

Nurses can make this Relaxation Therapy as an effective Measure to enhance
the coping strategies of caregivers of mentally ill patients.
Nurses can plan the goal of nursing management of psychiatric patients and
enhance their self concept, coping strategies and sense of well being through
the development of mutually agreed goals.
Relaxing by progressive muscle relaxation, decrease the Stress and Anxiety
among patients as well as the caregivers.
Student nurses can use this intervention to boost the withdrawn patients.
57
Nursing Education
A Nurse educator is not primarily to teach, but to promote learning and

provide the environment conducive to learning and create the teacheable moment
rather than first waiting for it to happen
Nurse educator can train and encourage the student nurses to utilize
Relaxation Therapy as an alternative complimentary therapy to reduce Stress
and Anxiety among caregivers of mentally ill patients
This study can motivate student nurses to explore new strategies for effective
reduction of Stress and Anxiety among caregivers of mentally ill patients
Student nurses can be trained to assess the level of Stress and Anxiety of the
patient and their relatives.
Student nurses can be educated in order to enhance their self esteem by using
various The nurse educators need to be equipped with adequate knowledge
regardingRelaxation Therapy.
Nursing educators can conduct conferences to strengthen the curriculum in
such a way, in-service education and work shop to encourage nurses to learn
about various alternative therapies to reduceStress and Anxiety among
caregivers of mentally ill patients
Nursing Administration
A Nurse administrator manages the client care and the delivery of specific
nursing services within a health care agency.
The nurse administrator co-ordinate her activity along with the curative
aspects of care among caregivers of mentally ill patient by participating,
practicing and supervising the Relaxation Therapy.
Nursing administrator can organize in service education programmers
regarding the effectiveness of Relaxation Therapy on Stress and Anxiety for
staff nurses.
58
Nursing Research
The research implication of the study lies in the scope for expanding the
quality of nursing service. In the era of evidence based practice, publication of these
studies will take nursing to new horizon.
Nursing research to be done to find out the various innovative Methods to

improve the coping skills and to decrease the level of Stress and Anxiety.
The findings of the study would help to expand the scientific body of
professional knowledge upon which further research can be conducted.
Large scale study can be conducted on Relaxation Therapy.
Teachers can direct and motivate the nursing researchers. So that they can
conduct research in the same and different specialties and thereby
professional independence can be achieved
Limitations
Since there were very few studies done on the effectiveness in national level,
the investigator had a difficulties in collecting the study materials for the
review.
The sampling size was only 60
The data collection period was only one month
Since the study was conducted among the old age people, the investigator had
difficulties in assembling caregivers of mentally ill patients
Recommendations
Similar study can be conducted as comparative between caregivers male

client and female client in different settings.
Study can be conducted as comparative study between Nurses and caregivers
of patients in family.
A study can be conducted with large sample size to generalize the results of
the study.
59
The study can be carried out for a longer period of time.
The study can be carried to assistive quality of life among caregivers of
Mentally ill patients.
Conclusion
Level of Stress and Anxiety is high among the Caregiversof mentally ill
patients. They require some interventions to reduce the level of Stress and Anxiety.
The finding of the study reveals that, there is no significant association between
demographic variables and level of Stress and Anxiety among caregivers of Stress and
Anxiety .The post test ‘t’ value of Stress were 20.26 and the Anxiety were 21.36
which is higher than the table value at (p<0.05) level which shows that there is
significant reduction in Stress and Anxiety level after Relaxation Therapy among
caregivers of mentally ill patients.It is an effective intervention to reduce the level of
Stress and Anxiety among caregivers of mentally ill patients.
60
BIBLIOGRAPHY
TEXT BOOKS
1. Ahuja.(1999).A short Text Book of Psychiatry.New Delhi: Jaypee Brothers

Publishers.
2. Basvanthappa, B.T. (2000). Nursing Research. New Delhi: Jaypee brothers

Publishers.
3. Basvanthappa, B.T. (2007). Psychiatric Mental Health Nursing. New Delhi:
Jaypee brothers Publishers.
4. Bhatia, M.S. (2007). Text Book of Psychiatry. New Delhi: C.B.S Publishers
and Distributors.
5. BimlaKapoor. (1994).Psychiatric Nursing. Hydrabad: Kumar publishing
house.
6. Burns, Nancy and Susan, K. Grove,(2004).The Practice of Nursing Research.
Conduct. Crialle and Utilization, W. B Sunders Company. Philadelphia.
7. Daniel. J, Buysse. (2005). Review of sleep and psychiatry. Washington.
American Psychiatry Publications.
8. Donald. W.N. (2000). Complementary and alternative medicine. Missouri.
Mosby Company.
9. Dr. Mary Verghese. (1994). Essentials of psychiatrics and Mental health
nursing. Elsevier Publications. India.
10. Johnson G. Alpimer. (1986). Psychiatric Mental Health Nursing Adaptation
and Growth. J.B.Lippincott Company. Philadelphia.
11. Kaplan H.P. and Sadok. B.J. (1982).Modern Synopsis of Comprehensive Text
Book of Psychiatry. Baltimore. Williams and Williams.
12. Lalitha, K. (2007). Mental Health and Psychiatric Nursing-an Indian

perspective. Bangalore: V.M.G. Book Publishers.
13. Mahajan, B.K. (1989). Methods in Biostatistics. New Delhi: Jaypee Brothers
Publishers.
14. Mary Ann Boyd. (2008). Psychiatric Nursing Contemporary Practice.
Lippincott Publications. New Delhi.
15. Polit, D.F. and Hungler, B. (2000). Nursing Research Principles and Methods.
New York: J.B. Lippincott.
16. Rawlins, etal. (1988). Mental Health – Psychiatric Nursing. A Holistic life-
61
cycle approach. Mosby –year book.
17. Sreevani, R. (2009). A Guide to Psychiatric and Mental Health Nursing.
(3rded.) New Delhi: Jaypee Brothers Publishers.
18. Stephan. D. et al. (2004). Mental Health Nursing Competencies for Practice.
Palgrave Macmillan Publication.
19. Stuart and Sudeen. (1979). Principles and Practice of Psychiatric Nursing.
London: C.V Mosby Publishers.
20. Townsend, M.C. (2005). Mental Health and Psychiatric Nursing-Concepts

Based on Evidence Based Practice. New Delhi: Jaypee Brothers Publishers.
21. Wetzel, M. (2003). Complementary and alternative medical therapies,
implications for medical education. Hongkong, BMC. Med. Education.
JOURNALS
1. Ando. M. Morita t et al. (2009). Efficacy of mindfulness based meditation

therapy on Anxiety and depression in Japanese patients. Journal of
Palliative medicine.12 (12).
2. Chiesa.A.Serretti.A. (2009). Mindfulness based Stress reduction for Stress
management in healthy people. Journal of Alternative and Complimentary
Medicine.15 (5).
3. Dolbier, Christyln, Rush, Taylor e. (Feb 2012). carried out a study to examine
the efficacy of abbreviated progressive muscle relaxation (APMR) to enhance.
iosrjournals.org/iosr-jnhs/papers/vol3-issue3/Version.../F03323459.
4. Edmund Jacobson. (2012). Treatment efficacy of Progressive Muscle
Relaxation Technique; - A relaxation technique of Stress management, Journal
of American Physician.34 .44-50.
5. Foley. E. Baillie. etal. (2008).mindfulness based cognitive therapy for
individual whose lives have been affected by cancer: A randomized controlled
trial. Journal of consulting and clinical psychology. 78(1).
6. Franco. Justo .C. (2009). Reducing Stress level and Anxiety in primary
Caregivers through training and practice of a mindfulness meditation
technique. Journal of palliative medicine.20.
7. Fugate, Jessica. (2005). Art Therapy with Family Caregivers of Patients with
Cancer. Journal of Palliative Medicine. 10(5).
8. Goldin, P. R. & Gross, J. J. (2010). Effects of mindfulness-based Stress
62
reduction (MBSR) on emotion regulation in social Anxiety disorder,
Emotions. 10(1).
9. GregorisIconomou .et al. (2001).Impact of Cancer on Primary Caregivers of
Patients Receiving Radiation Therapy. Act a Oncological Nursing. Vol.
40.No. 6.
10. Gross, C., Kreitzer. (2009).Mindfulness meditation to reduce symptoms after
organ transplant: A pilot study. Advances in Mind and Body Medicine.
20(2).
11. Grov. E, S et al. (2005). Primary caregivers of cancer patients in the palliative
phase: A path analysis of variables influencing their burden. Journal of Social
Science & Medicine. Vol- 63.Issue: 9.
12. Grov. E. K. et al.(2005).Anxiety, depression, and quality of life in Caregivers
of patients with cancer in late palliative phase, Journal of Palliative Medicine.
11(5).
13. Hanratty Barbara, et al.(2007). Financial Stress and strain associated with
terminal cancer. A systematic review of the evidence Palliative Medicine. 595-
607.
14. Irene J Higginson andWei Gao. (2006). Caregiver assessment of patients
with advanced cancer: concordance with patients, effect of burden and
positivity. . Journal of Social Science & Medicine. Vol- 63.Issue: 9.
15. Kurtz et.al. (2008). Anxiety and Autonomy in Adolescence among Orphaned
Kibbutz Children, Journal of Adolescence Psychiatry. Vol- 16.
16. Kvillemo .P. Branstrom .R. (2010).Experiences of a mindfulness based Stress
reduction intervention among patients with cancer. Cancer Nursing.19.
17. Lengachr.CA. (2009). Randomized controlled trial of MSBR for survivor of
breast cancer. Psycho oncology .18(12).
18. Ms.Palak Patel. (2014). Progressive Muscle Relaxation Therapy on Stress

IOSR Journal of Nursing and Health Science. 34-59.
19. Nayak H K, Hemant Tiwari et al. (2011). had carried out a community based
cross-sectional study to assess the prevalence and pattern of Stress
relaxation .iosrjournals.org/iosr-jnhs/papers/vol3.issue3/Version.../F03323459.
20. Ong, Shapiro SL. (2009).MSBR effects by trait mindfulness: results from a
randomized control trail. Journal of clinical psychology.22.
63
ELECTRONIC ARTICLES
1. Bailey Eileen.(2012). Coping With Stress When Caring for a Terminally Ill
Relative. Health Guide. .http://www.healthcentral.com/Anxiety/c/22705/10
5354 /aring-terminally.
2. Beulah Mavis. (2013). Effectiveness of
Reflexology.www.geni.com/people/Beulah-Illman/6000000007476181395.
3. Ghafari S. et al. (2009). Effectiveness of applying Progressive Muscle
Relaxation Technique on quality of life. Retrieved from www.university
ofmedicalscience,fasa,iran.org.
4. Giju Thomas. (2006). Effectiveness of progressive muscle relaxation.
Retrieved fromhttp://panicdisorder.about.com/od/livingwithpd/a/Progressive-
Muscle-Relaxation-Pmr.htm .
5. Helen Cooke. (2013).CAM-Cancer Consortium. Progressive Muscle
Relaxation. Retrieved fr.om. http://cam-cancer.org/CAM-Summaries/Mind-
body-interventions/Progressive-Muscle-Relaxation. .
6. Herbert Randy S, Arnold RM, Schluz M. (2012). Improving well-being in
caregivers of terminally ill
patients.http://www.ncbi.nlm.nih.gov/pmc/articles /PMC2195548/.
7. Kwekkeboom.K.L. (2006). Relaxation interventions.Retirved from.
http://www.ncbi.nlm.nih.gov/pubmed/17044345.
8. Max G Feirstein. (2009). the effects of progressive muscle relaxation
technique. Retrieved fromhttp://www.hsj.gr.
9. Mohsen yazdani.(2010). the effectiveness of Stress management training
programme. Retrieved fromhttp://nccam.nih.gov/health/Stress/relaxation. htm
10. Purvi J. Parikh et al. (2010). Occupational Stress and Coping among Nurses‖ -
Department of Humanities and Social Sciences, Indian Institute of
Technology, Bombay, Powai, Mumbai.
11. Star Katharina. (2012).rogressive Muscle Relaxation (PMR) Reduce Anxiety
12. Therese. J. Borchard. (2003). Tips to help Manage Anxiety. Retirved from
http://www.Crufact.Com/.
64
12
LETTER SEEKING EXPERTS OPINION FOR THE VALIDITY
OF THE TOOL
From,
Mrs. Sreeja. V,
M.Sc. Nursing II year,
Thasiah college of Nursing,
Marthandam.
To,
Respected Sir/ Madam,

Sub: Requisition to seek expert opinion and suggestion for the content
validity.
I Sreeja. V, M.Sc. Nursing II year student of Thasiah College of Nursing,
marthandam, have selected the following topic,“A study to assess the effectiveness
of relaxation therapy to reduce stress and anxiety among care givers of mentally
ill patients in sneka mind care centre at Thirunelveli”, for my dissertation to be
submitted to Tamilnadu Dr. M.G.R. Medical University in the partial fulfillment of
the requirement for award of Master of Science in Nursing.
I request you to go through the items and give your valuable suggestions and
opinion to develop the content validity of the tool. Kindly suggest modifications,
addition and deletions if any in the remarks column.
Thanking you,
Place: Marthandam.
Date: Yours sincerely,
Sreeja. V
13
LIST OF EXPERTS WHO VALIDATED THE TOOL
1. Dr.C. PaneerSelvanM.D(PSYCH)”NIMHANS
Consultant Psychiatrist
Sneka Mind Care Centre
12, South bypass road
Thirunelveli
2. Dr. satheesakumaran Nair
MM AND SP .PhD . Dip Edu. Couns.
Cerp.nutrition and mental health
Clinical psycology
GOVT . MHC HOSPTAL TVM
3. Mrs. Picthai.AMsc(N)
Lecturer
C.S.I. College of Nursing
Karakonam
4. Mrs.P, JegajuliatMsc(N)
Lecturer
ChristainCollege of Nursing
Neyoor
5. Mrs. Femaila.AMsc(N)
Lecturer
Christain college of Nursing
Neyoor
14
CRITERIA CHECK LIST FOR VALIDATION OF THE TOOL
Instruction:
Kindly give your suggestions regarding the accuracy, relevance and
appropriateness of the content. Kindly (9) against specific columns.
SECTION: A
Validation of demographic variables.
Item Very relevant Relevant Need for Not remarks
modification relevant
1
2
3
4
5
6
7
8
9
10
SECTION: B
Validation of care giver stress- Assessment scale.
1
2
3
4
5
6
7
8
9
10
11
12
13
15
14
15
16
17
18
19
20
SECTION: C
Validation of Modified Beck Anxiety Inventory.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
16
EVALUTION CRITERIA CHECKLIST FOR VALIDATION
Instructions;
The expert is requested to go through the following criteria for evaluation. Three
columns are given for responses and a columns for remarks.
Interpretation column:
Column I – Meets the criteria
Column II – Partially meets the criteria
Column III – Does not meet the criteria
S. NO CRITERIA 1 2 3 REMARKS
1 Scoring
Adequacy .
Clarity.
Simplicity.
2 Content
Logical sequence.
Adequacy.
Relevance.
3 Language
Appropriate.
Clarity.
Simplicity.
4 Practicability
Easy to score
Precise
Utility
Any other suggestion:
SIGNATURE:
NAME:
DESIGNATION:
ADDRESS:
17
TOOL FOR DATA COLLECTION
SECTION: A
Dear participants you are requested to answer all items. This information will be
treated as confidential. Kindly put a (9 ) mark next to answer to which you respond.
1. Age in years
a) 18 – 30
b) 31 – 45
c) 46 – 60
d) Above 60
2. Sex
a) Male
b) Female
3. Educational status
a)illtrate
b) up to 12th standard
c) Under graduate
d) Post graduate
4. Religion
a) Hindu
b) Christian
c) Muslim
d) Others
5. Occupation
a) Private employees
b) Government employees
c) Unemployed
d) Others
6. Family income per annum

a) Below 25,000
b) 26,000 to 50,000
c) 51,000 to 100,000
d) Above 100,000
18
7. Marital status
a) Married
b) Single
c) Separated
d) Widowed
8 . Relationship with the patient
a) Daughter
b) Son
c) Spouse
d) parents
e) Others
9. Type of the family
a) Joint family
b) Nuclear family
10. Duration of illness
a) Below one month
b) One to six month
c) Six to twelve month
d) Above one year.
19
SECTION: B
CAREGIVER STRESS -ASSESSMENT
(Dr. Steven Zarit, modified version)
Instructions:
. Dear participant, this section is to evaluate the level of stress and you are
requested to respond correctly. Your answers will be kept confidential.
Frequently
Nearly
Sometimes
Rarely
Never
Quite
QUESTIONS:
ways
0
1
1. Do you feel that your loved
oneasks for more help than
he/she needs?
2. Do you feel that you don’t get

enough time for yourself due to
spending more time with your
loved one?
3. Do you feel stressed by

caring for your loved one and
meeting other family needs or
work responsibilities?
4. Do you feel embarrassed over

your loved one’s illness?
5. Do you feel angry when you

are around your loved one?
6. Do you feel that caring for

your loved one currently affects
your relationship with other
family members or friends in a
negative way?
7. Do you feel afraid of what the

future holds for your loved one?
20
8. Do you feel your loved one is
dependent on you?
9. Do you feel your health has

suffered because of your
involvement in caring for your
loved one?
10. Do you feel that you don’t

have as much privacy as you
would like because of your loved
ones illness?
11. Do you feel that your social

life has suffered because of you
are caring for your loved one?
12. Do you feel uncomfortable

about having friends over
because you are caring for your
loved one?
13. Do you feel that your loved

one seems to expect you to take
care of him/her as if you were
the only one he/she could
depend on?
14. Do you feel that you don’t

have enough money to care for
your loved one in addition to the
rest of your expenses?
15. Do you feel that you will be

unable to take care of your loved
one much longer?
16. Do you feel you have lost

control of your life due to caring
21
for your loved one?
17. Do you feel you want to

leave the care of your loved one
to someone else?
18. Do you feel you should be

doing more for your loved one?
19. Do you feel you could do a

better job in caring for your
loved one?
20. Do you feel burdened by

caring for your loved one?
SCORING AND INTERPRETATION
0-20 = Little/No Stress (0-25%)

21-40 = Mild Stress ( 26.2 % - 50%)
41-60 = Moderate Stress( 51.2 % - 75%)
61-80 = Severe Stress( 76.2% - 100%)
22
SECTION: C
MODIFIED BECK ANXIETY INVENTORY (MBAI)
Instructions:
Dear participant, this section is to evaluate the level of anxiety and you are
requested to respond correctly. Your answers will be kept confidential.
SI CONTENT • NO not at YES, but YES, and it YES and

NO it did not was very I could
all
(0) bother me unpleasant, barely
much but I could stand it
(1) stand it. (3)
(2)
1 I am unable to relax
2 I am easily
frightened
3 I have difficulty in
remembering
4 I feel afraid of being left
alone
5 I feel I am losing control
6 I am easily irritated
7 I am afraid of my future
8 I have difficulty in
concentration
9 I worry a lot
10 I have less interest in

activities
11 I have numbness in my
extremities
12 I have hot and cold
flashes
13 I have dry mouth
14 I have palpitation
15 My muscles are aching
16 I experience shortness
of breath
17 I experience twitching,
23
trembling
18 I feel like fainting
19 I am unable to sleep
20 I feel tired
21 I have to empty my
bladder frequently
22 I feel tensed
23 I feel indigestion
24 I have neck pain

25 M y hands are
trembling
SCORING AND INTERPRETATION
Mild anxiety : 0 - 25 (0 - 33.3%)

Moderate anxiety : 26 – 50 ( 34.6% - 66.6%)
Severe anxiety : 51 – 75 ( 68% - 100%)
24
PROCEDURE OF PROGRESSIVE MUSCLE RELAXATION
Progressive muscle relaxation is a technique that involves tensing specific muscle

groups and then relaxing them to create awareness of tension and relaxation. It is
termed progressive because it proceeds through all major muscle groups, relaxing
them one at a time, and eventually leads to total muscle relaxation.
25
Step 1. Assume a comfortable position. You may lie down; loosen any tight clothing,
close your eyes and be quiet.
Step 2. Assume a passive attitude. Focus on yourself and on achieving relaxation in

specific body muscles. Tune out all other thoughts.
Step 3. Tense and relax each muscle group as follows:
• Forehead - Wrinkle your forehead, try to make your eyebrows touch

your hairline for five seconds. Relax.
• Eyes and nose - Close your eyes as tightly as you can for five seconds.
Relax.
• Lips, cheeks and jaw - Draw the centers of your mouth back and
grimace for five seconds. Relax. Feel the warmth and calmness in your
face.
• Hands - Extend your arms in front of you. Clench your fists tightly for
five seconds. Relax. Feel the warmth and calmness in your hands.
• Forearms - Extend your arms out against an invisible wall and push
forward with your hands for five seconds. Relax.
• Upper arms - Bend your elbows. Tense your biceps for five seconds.
Relax. Feel the tension leave your arms.
• Shoulders - Shrug your shoulders up to your ears for five seconds.

Relax.
26
• Back - Arch your back off the floor for five seconds. Relax. Feel the
anxiety and tension disappearing.
• Stomach - Tighten your stomach muscles for five seconds. Relax.
• Hips and buttocks - Tighten your hip and buttock muscles for five
seconds. Relax.
• Thighs - Tighten your thigh muscles by pressing your legs together as

tightly as you can for five seconds. Relax.
• Feet - Bend your ankles toward your body as far as you can for five
seconds. Relax.
• Toes - Curl your toes as tightly as you can for five seconds. Relax.
Step 4. Focus on any muscles which may still be tense. If any muscle remains tense,
tighten and relax that specific muscle three or four times.
Step 5. Fix the feeling of relaxation in your mind. Resolve to repeat the process again.
Remember, people respond differently to various activities. Some feel pleasant or

refreshed, and others feel calm and relaxed after an activity like this one. Some people
notice little change the first time, but with practice, their control increases - as well as
the benefits. If you practice this activity, your relaxation should increase.
27

Sangee Research PDF

Uploaded by

Copyright:

Available Formats

Sangee Research PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Sangee Research PDF

Uploaded by

Copyright:

Available Formats

A STUDY TO ASSESS THE EFFECTIVENESS OF RELAXATION THERAPY

ON STRESS ANDANXIETY AMONG

A DISSERTATION SUBMITTED TO THE TAMILNADU

Approved by Dissertation Committee on……………..

Prof. Mrs. Violin Sheeba, M. Sc.(N),Ph.D,

Thasiah College of Nursing,

Head of the departmentin Mental health Nursing,

. Dr.C. PaneerSelvan M.D. (PSYCH); NIMHANS,

Date: Thasiah College of Nursing,

At this moment I convey my profound gratitude toMr.Gurudhas, M.Sc.

I express my thanks to entire faculty of ThasiahCollege of Nursing,

Chapter No Contents Page No

Background of the Study 1-3

Need for the Study 3-5

Table No Title Page No

3 Frequency and Percentage Distribution Pretest and Post test 43

4 Effectiveness of Relaxation Therapy on Stress and Anxiety 45

Figure No Title Page No

1 The Conceptual Framework Based on Ludwing Von 10

3 Percentage Distribution of Caregivers of Mentally ill 31

A study to assess the effectiveness of relaxation therapy on Stress and

The findings revealed that there was highly significant difference in

'Mental calmness is a natural result of physical relaxation'

Background of the Study

Research into the impact of care-giving shows that one-third to one-half of

When we are mentally Stressed and anxious, we unconsciously tense our

Need for the Study

Deinstitutionalization, restricted hospital admission and reduction of length of

According to a report from the Study to Understand Prognoses and

A study was conducted to explore the influences of selected social and

A study to assess the effectiveness of Relaxation Therapy on Stress and Anxiety

Objectives of the Study

Hypotheses of the Study

This study attempts to examine the following hypotheses.

It refers to the outcome of Relaxation Therapy given to the Caregivers of

It is used to relieve Stress and Anxiety by affecting the synapses and

It refers to the outcome of burden experienced by caregivers from the demand of

It refers to the varying degrees of emotion experienced by caregivers stated as unable

The study is delimited to

• The Caregivers of mentally ill patients in sneka mind care centre at

• The Caregivers of mentally ill patients above 18years.

A conceptual framework can be defined as a set of concepts and assumptions

The conceptual framework selected for this study isLudwing Von

Bertanloffy's model includes the following components.

In this study, caregivers of mentally ill patients are considered as a system.

In this study, input includes selected socio demographic variable among

The outcome of Progressive Muscle Relaxation Therapy is evaluated

Input Through Put Output

Figure:1 Conceptual Framework Based on Ludwing

Review of literature is an essential component of the research process. This

Review of literature is a written summary of the state of existing knowledge on a

Review of literature is an essential step in the research project. It provides

Studies Related to Stressand Anxiety among Caregivers of Mentally ill Patients.

Jose Anne;(2013)Study was conducted to investigate burden experienced by

Guru raj; (2008)Two Indian comparative studies were conducted in different

Irene J HigginsonandWei Gao; (2006)Conducted a study to assess caregiver

Sunil Srivastava;(2005)The study was conducted to measure the perception

Rammohan, A; (2002) This comparative cross-sectional study assessed

Studies Related to Relaxation Therapy (Progressive Muscle Relaxation Therapy)