Publication: Adolescents and Stress - Relaxation training and a school based stress management program for stress related complaints in adolescents, a randomized controlled trial

Adolescents and Stress - Relaxation training and a school based stress management program for stress related complaints in adolescents, a randomized controlled trial.
Cairns, Australien:; 2013.


Abstract Objectives: Stress related complaints are an increasing problem among adolescents. Adolescent girls and adolescents with recurrent idiopathic pain are at high risk of developing psychosomatic symptoms. Relaxation training has in studies been proved effective on stress related complaints and recurring idiopathic pain, and a variety of stress management programs for adolescents have been evaluated. This RCT evaluates a physiotherapist led group intervention with five sessions of relaxation training and a stress management program at school, compared with one individual stress-and-coping counseling session in primary care physiotherapy and relaxation training at home. Methods: Measurements were obtained with a self-assessment questionnaire at three time points; at base line, post intervention after five weeks and after four months. Primary outcome was self-assessed perceived stress, reported by four items; 1) somatization, 2) sleep disorder, 3) anxiety and 4) depression. The stress management protocol in the intervention treatment was based on education to strengthen internal resources and self-efficacy with stepwise increased knowledge of stress, stress reactions and coping with a problem-solving focus. The counseling session in the control treatment was based on the theoretical framework of Motivational Interviewing with a client centered approach and with an interaction designed to increase the likelihood that an individual will make adaptive behavior changes in relation to stress. Adherence was measured in percentage of completed treatment in both groups and exclusion criterion was less compliance to treatment than 60 %. Analyses were run per protocol with participants with complete data. However, for the reader's interest, findings were also reported based on intention to treat analyses, using the "last value carried forward" approach, including dropouts with baseline values. All participants were analyzed in the group to which they were randomized. An analysis of the dropouts was conducted to evaluate causes and consequences of the withdrawals and exclusions in the study. Results: Of 146 randomized participants, a total of 98 adolescents between 13-19 years of age completed the study. Dropout rate was 33 %. Per protocol analyses with participants with complete data showed improved levels of somatization and anxiety, compared to the control group. The reduction was significant both in short term (baseline to post intervention) and sustained four months after the intervention (baseline to four months follow up). There were no statistical significant differences regarding sleep disorder or depression in short term, but in long term, significant differences were found between groups favoring the intervention group. Attrition analyses showed that drop outs in the control group scored significantly higher on the item anxiety at baseline. This might indicate that in reference to adherence to treatment, adolescents with high levels of anxiety might not be able to practice relaxation training by themselves at home. Analyses also showed that 56% of the boys in the intervention group in this study drop out, which could indicate that adolescent boys in general, might rather practice relaxation training by themselves at home, than participate in a stress management program at school. Conclusions: Findings suggest that a five-week group intervention with physiotherapist led relaxation training and a stress management program may lessen stress related somatic complaints and anxiety, both in short term and after four months. The effect of the intervention on sleep disorder and depression may be considered having effect in the long term. Future studies are needed to find ways to improve compliance and to further explore the efficacy of early group interventions for stress, specially adapted for adolescents’ heterogeneous needs. Keywords: Adolescence; Coping skills; Relaxation therapy; Self efficacy; Somatization disorders; Stress, psychological

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