thesis stress relaxation

Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation

Affiliations.

• 1 Luther College, Decorah, IA, USA.
• 2 Neurofeedback Clinic of Northern Colorado, Fort Collins, CO, USA.
• 3 Gasteiner Heilstollen Hospital, Bad Gastein, Böckstein, Austria.
• 4 University of Munich, Munich, Germany.
• 5 Coburg University, Coburg, Germany.
• 6 East Tennessee State University, Johnson City, TN, USA.
• 7 University of Sheffield, Sheffield, UK.
• PMID: 34306146
• PMCID: PMC8272667
• DOI: 10.1155/2021/5924040

Research suggests that multiple forms of relaxation training (e.g., progressive muscle relaxation, meditation, breathing exercises, visualization, and autogenics) can help individuals reduce stress, enhance relaxation states, and improve overall well-being. We examined three different, commonly used approaches to stress relaxation-progressive muscle relaxation, deep breathing, and guided imagery-and evaluated them in a head-to-head comparison against each other and a control condition. Sixty healthy undergraduate participants were randomized to one of the four conditions and completed 20 minutes of progressive muscle relaxation, deep breathing, or guided imagery training that was delivered by recorded audio instruction. Baseline and follow-up assessment of psychological relaxation states were completed. Physiological relaxation was also assessed continuously using measures of electrodermal activity and heart rate. Results showed that progressive muscle relaxation, deep breathing, and guided imagery all increased the state of relaxation for participants in those groups, compared to participants in the control group. In each case, the increase was statistically significant and although the groups did not differ on relaxation before training, all groups were significantly higher on relaxation after training, as compared to the control group. Progressive muscle relaxation and guided imagery showed an immediate linear trend toward physiological relaxation, compared to the control group, and the deep breathing group showed an immediate increase in physiological arousal followed quickly by a return to initial levels. Our results lend support to the body of research showing that stress relaxation training can be effective in improving relaxation states at both the psychological and physiological level. Future research could examine stress relaxation techniques in a similar manner using designs where multiple techniques can be compared in the same samples.

Copyright © 2021 Loren Toussaint et al.

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Strategies easy steps to manage thesis related stress.

Managing stress during thesis writing is crucial for both academic success and personal well-being. By understanding the sources of stress and implementing strategic steps, students can navigate this challenging period more effectively. This article outlines practical strategies to help manage thesis-related stress, ensuring a smoother and more productive thesis writing experience.

Key Takeaways

• Understand the psychological impacts and long-term consequences of thesis stress to better manage its effects.
• Develop a structured thesis plan with clear objectives and a realistic timeline to minimize uncertainty.
• Implement effective time management strategies to enhance productivity and reduce procrastination.
• Incorporate relaxation techniques like mindfulness and physical activities to maintain mental and physical health.
• Build a support network including peers, academic resources, and professional counseling to bolster resilience and motivation.

Understanding Thesis Stress and Its Implications

Defining thesis stress.

Thesis stress is the overwhelming feeling you might experience while managing the demands of your thesis project. It often stems from the pressure to meet high academic standards and the fear of not completing the thesis on time. Recognizing the signs of thesis stress early can help you take proactive steps to manage it effectively.

Psychological Impact of Thesis Writing

The process of thesis writing can significantly impact your mental health. It's not uncommon to experience feelings of anxiety, frustration, or doubt during this period. Engaging in regular self-care practices and mindfulness can mitigate these effects and enhance your overall well-being.

Long-term Consequences of Academic Stress

Prolonged exposure to academic stress can lead to serious health issues, such as chronic anxiety and depression. It's crucial to establish a balanced routine that includes physical activity, proper nutrition, and sufficient rest to protect your health in the long term. Implementing effective time management strategies can also reduce the risk of enduring stress.

Developing a Structured Thesis Plan

Setting clear objectives.

Begin your thesis journey by pinpointing a compelling and feasible research topic. This foundational step is crucial as it sets the direction for your entire project. Utilize resources like Literature Navigators to explore existing research and identify gaps that your study could fill. Setting clear objectives early on will guide your research and ensure that your efforts are focused and effective.

Creating a Timeline

Break down your thesis into manageable parts by setting clear, achievable milestones. This approach not only keeps you organized but also provides a sense of accomplishment as you progress. Consider using tools like the Academic Project Planner to outline each phase of your research. Creating a detailed timeline helps you visualize the entire process, making it easier to manage your time and resources efficiently.

Regular Progress Reviews

Keep track of your thesis progress with regular reviews. This not only helps in maintaining a clear direction but also in identifying any areas that need more attention. Use tools like academic project planners to organize and visualize your milestones, ensuring that you stay on top of your work and manage your time effectively. Regular progress reviews are essential for adapting your plan to meet any unforeseen challenges.

Effective Time Management Strategies

Prioritizing tasks.

To manage your time effectively while writing your thesis, start by prioritizing tasks . Identify the most critical aspects of your research and allocate more time to these areas. This approach ensures you focus on what matters most, leading to increased productivity and decreased stress.

Scheduling Techniques

Effective scheduling is crucial for maintaining a steady pace in your thesis work. Utilize tools like the Academic Project Planner to visually organize your tasks. Regularly updating your schedule allows you to adapt to any changes and ensures continuous progress.

Avoiding Procrastination

One key to successful time management is actively avoiding procrastination. Set realistic goals and break your work into manageable segments. Remember, the art of time management includes learning how to best eliminate distractions . Establish a dedicated workspace and limit interruptions to maintain focus.

Incorporating Relaxation Techniques

Mindfulness and meditation.

Embrace mindfulness and meditation as your allies in the thesis journey. These practices not only reduce stress but also enhance your focus and cognitive functions, making it easier to tackle complex research topics. Incorporate daily sessions of meditation into your routine to maintain a calm and composed mindset throughout your thesis writing process.

Physical Activities

Physical activities can be effective stress-relief tools. You don't need to set aside large chunks of time for relaxation. Start with short, focused sessions. Even 5-10 minutes can make a difference and provide a sense of calm and rejuvenation to counter the impact of stress.

Engaging in Hobbies

Find activities that you enjoy and that provide a counterbalance to the intellectual demands of thesis writing. Whether it's painting, reading, or playing a musical instrument, engaging in hobbies can significantly reduce stress levels and enhance your overall productivity.

Establishing a Support Network

Leveraging academic resources.

To effectively manage thesis stress, it's essential to leverage academic resources available to you. Universities often provide access to libraries, writing centers, and research groups that can offer guidance and support. Engaging with these resources early in your thesis process can provide a solid foundation and alleviate feelings of being overwhelmed.

Seeking Peer Support

Building a robust support network with peers who understand the pressures of thesis writing can be invaluable. Joining study groups or online forums can foster a sense of community and shared understanding, which is crucial for maintaining mental well-being during this challenging period.

Professional Counseling Services

If you find the stress of thesis writing to be unmanageable, consider seeking professional counseling services. Many educational institutions offer counseling services to help you navigate academic and personal challenges. These services can provide you with strategies to manage stress effectively and maintain your mental health.

Utilizing Technological Tools and Resources

Academic software.

Embrace the power of academic software to enhance your thesis writing process. Tools like Grammarly or Scrivener can automate mundane tasks such as grammar checking and formatting, allowing you to focus more on the content of your work. This technology not only saves time but also improves the overall quality of your thesis.

Online Research Databases

Leverage online research databases to access a vast array of scholarly articles and resources that are crucial for backing up your thesis arguments. Platforms like JSTOR or Google Scholar provide you with the necessary academic articles, books, and papers, streamlining your research process.

Project Management Tools

Utilizing project management tools helps you maintain a clear overview of your tasks and deadlines, ensuring that you stay on track throughout your research journey. Tools like Trello or Asana are particularly useful for scheduling regular reviews and updates on your progress, optimizing productivity with study routines, and setting realistic goals.

Adopting Healthy Lifestyle Choices

Balanced diet.

Maintaining a balanced diet is crucial for sustaining the energy levels needed for thesis writing. Start by prioritizing basic nutrition and focus on eating whole, unprocessed foods. Invest a little time in meal planning and preparation by cooking in batches and storing leftovers for later use.

Adequate Sleep

Adequate sleep is essential for cognitive function and overall well-being. Aim for 7-9 hours of quality sleep per night to ensure that you are well-rested and ready to tackle your thesis challenges.

Regular Exercise

Engaging in regular exercise can boost your mood and increase your energy levels. Whether it's a morning jog, a cycling session, or a dance class, physical activity helps in managing stress and improves cognitive functions, making it easier to handle complex research tasks.

Evaluating and Adjusting Strategies

Continuous feedback loop.

To ensure your thesis remains on track, establish a continuous feedback loop with your advisors and peers. Regularly soliciting feedback and acting on it allows you to make necessary adjustments, keeping your research relevant and your arguments strong.

Adapting to Challenges

Challenges are inevitable in thesis writing. When faced with obstacles, it's crucial to adapt your strategies. Whether it's revising your research questions or altering your methodology, flexibility is key to overcoming these hurdles.

Seeking Expert Advice

Don't hesitate to seek expert advice when needed. Professionals and academic advisors can provide invaluable insights that might not be apparent from your perspective. This guidance can be crucial in refining your thesis and ensuring its success.

In our 'Evaluating and Adjusting Strategies' section, we delve into the importance of continuously refining your approach to thesis writing. At Research Rebels, we understand the challenges students face and provide innovative solutions to overcome them. Don't let thesis anxiety hold you back any longer! Visit our website to explore our Thesis Action Plan and claim your special offer today. Let us help you transform your academic journey with ease and confidence.

In conclusion, managing stress during the thesis writing process is crucial for both your mental well-being and academic success. By implementing the strategies discussed, such as maintaining a balanced lifestyle, setting realistic goals, and utilizing available resources, you can navigate this challenging period with greater ease and effectiveness. Remember, the journey of thesis writing is not just about the end result but also about developing resilience and learning to manage pressures effectively.

Frequently Asked Questions

What are the key strategies to manage stress during thesis writing.

Key strategies include developing a structured thesis plan, practicing effective time management, incorporating relaxation techniques, establishing a support network, utilizing technological tools, adopting healthy lifestyle choices, and continuously evaluating and adjusting strategies.

How can I create an effective thesis plan?

Start by setting clear objectives, creating a detailed timeline, and scheduling regular progress reviews to stay on track and make necessary adjustments.

What are some effective time management strategies for thesis writing?

Prioritize tasks based on importance and deadlines, use scheduling techniques to organize your work, and avoid procrastination by setting short-term goals and deadlines.

How can relaxation techniques help in managing thesis stress?

Relaxation techniques like mindfulness, meditation, and engaging in physical activities can reduce stress, enhance focus, and improve overall mental and physical health.

What role does a support network play in thesis writing?

A support network can provide emotional encouragement, share resources and advice, and offer constructive feedback. Leveraging academic resources, seeking peer support, and considering professional counseling are beneficial.

How can technological tools aid in thesis writing?

Technological tools such as academic software, online research databases, and project management tools can help organize research, manage time efficiently, and streamline the writing process.

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Home > Student Research, Creative Works, and Publications > Masters Theses and Doctoral Dissertations > 512

Masters Theses and Doctoral Dissertations

The role of resilience, emotion regulation, and perceived stress on college academic performance.

Katherine A. Pendergast , University of Tennessee at Chattanooga Follow

Committee Chair

Ozbek, Irene Nichols, 1947-

Committee Member

Clark, Amanda J.; Rogers, Katherine H.

Dept. of Psychology

College of Arts and Sciences

University of Tennessee at Chattanooga

Place of Publication

Chattanooga (Tenn.)

Stress is a common problem for college students. The goal of this thesis was to examine the relationships between protective and risk factors to experiencing stress and how these factors may predict academic performance in college students. 125 college students were surveyed twice over the course of a semester on emotion regulation strategies, trait resilience, and perceived stress. The relationships between these variables and semester GPA were analyzed using correlational, multiple regression, and hierarchical regression analyses. It was determined that trait resilience scores do predict use of emotion regulation strategies but change in stress and trait resilience do not significantly predict variation in academic performance during the semester. Limitations and future directions are further discussed.

Acknowledgments

Thanks to my advisor, Dr. Ozbek, and committee members, Dr. Clark and Dr. Rogers, for invaluable feedback and support. Additional thanks to Dr. Jonathan Davidson, M.D., for his permission to use the CD-RISC to better understand resilience in the college population. Also, I would like to extend thanks to Linda Orth, Sandy Zitkus, and the entire records office staff of the University of Tennessee at Chattanooga for their willingness to collaborate and assist with this project. Lastly, I would like to thank the faculty and students of the Psychology Department for their overall support.

M. S.; A thesis submitted to the faculty of the University of Tennessee at Chattanooga in partial fulfillment of the requirements of the degree of Master of Science.

Stress (Psychology); Academic achievement -- Education (Higher)

Stress; Resilience; Emotion regulation; Academic performance

Document Type

Masters theses

xi, 72 leaves

https://rightsstatements.org/page/InC/1.0/?language=en

http://creativecommons.org/licenses/by-nc/3.0/

Recommended Citation

Pendergast, Katherine A., "The role of resilience, emotion regulation, and perceived stress on college academic performance" (2017). Masters Theses and Doctoral Dissertations. https://scholar.utc.edu/theses/512

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What is stress?

Stress is your body’s reaction to events that make you feel threatened or upset your balance in some way. When you sense danger – whether it’s real or imagined – the body’s defences kick into high gear in a rapid, automatic process known as the “fight-or-flight” reaction, or the stress response. Facing the prospect of completing a thesis, with only little structured support, can be extremely stressful, even to the most confident student.

Not all stress is bad . You need some stress to get everyday things done. Stress can be positive and motivating in the short term, helping to achieve success. Too little stress can lead to boredom – but too much stress can produce a “burn out”.

What causes stress?

Different things cause stress in different people. The thought of deadlines to beat and piled up paperwork can give you an excessive amount of stress. Some of the other things students commonly cite as causes of stress include examinations, the pressure of combining paid work and study, difficulty in organising work, poor housing, adjusting to life in a new environment or country, balancing the demands of a family with studying, parents or problems at home. These are all examples of external causes. Important internal causes are perfectionism, lack of assertiveness and unrealistic expectations.

Very often, stress results from an accumulation of many different pressures, which build up gradually without us noticing. Because of the widespread damage stress can cause, it is important to know your own limit. However, just how much stress is “too much” differs from person to person.

How to manage stress?

The key to success is to think positively; take control of your stress and anxiety by learning effective techniques to combat it. Navigate the toggles below to find some more information.

Understand how you stress

Everyone experiences stress differently . How do you know when you are stressed? How are your thoughts or behaviours different from times when you do not feel stressed?

Try to identify your sources of stress . What events or situations trigger stressful feelings? Are they related to family, health, financial decisions, work, relationships or something else?

Learn to recognise your own stress signals . People experience stress in different ways. You may have a hard time concentrating or making decisions, feel angry, irritable or out of control, or experience headaches, muscle tension or a lack of energy.

Recognise how you deal with stress

Determine if you are using unhealthy behaviours (such as smoking, drinking alcohol and over/under eating) to cope. Is this a routine behaviour, or is it specific to certain events or situations? Do you make unhealthy choices as a result of feeling rushed and overwhelmed?

Find healthy ways to manage stress . Consider healthy, stress-reducing activities, such as meditation, exercising or talking things out with friends or family. Keep in mind that unhealthy behaviours develop over time and can be difficult to change.

Don’t take on too much at once . Focus on changing only one behaviour at a time

Relax your body

Relaxing bodily tension in order to reduce the physical sensations of stress is a good place to start. If your body is free of tension, your mind tends to be relaxed. This helps you concentrate and study, take decisions and solve problems. When you are relaxed, you can view each task as a positive challenge. Learning how to quickly relieve stress won’t happen overnight. Like any skill, it takes time, self-exploration and above all, practice. However, it will pay off!

Take care of yourself

Ensure you have a healthy mind and body through activities like yoga, taking a short walk, going to the gym or playing sports that will enhance both your physical and mental health.

No matter how hectic life gets, make time for yourself — even if it’s just simple things like reading a good book or listening to your favourite music.

Reach out for support

Accepting help from supportive friends and family can improve your ability to manage stress. If you continue to feel overwhelmed by stress, you may want to talk to a student psychologist, who can help you better manage stress and change unhealthy behaviours.

General tips & tools for students

• Learn the art of time management. Find more information here.
• Work with sub-tasks.
• Write the things down you have to remember, so you can clear your head.
• Work step by step instead of doing things all at once.
• Use relaxation techniques; Engage in deep breathing for 2-5 minutes. Close your eyes and concentrate on the air going in and out of your lungs. Take long, deep breaths, fill your lungs and abdomen, hold your breath, and then exhale slowly. The belly goes up and down, it goes up when inhaling and goes down when exhaling.
• Tense and relax different muscle groups ( progressive muscle relaxation ). For example, if your shoulders are tense pull them back and hold them for a few seconds, then relax. This will help you to be aware of the relaxation of muscles and help you to relax more.
• Engage in guided imagery for a few minutes. Pick a scene that you find peaceful, beautiful, and natural. Think about what you see, what you hear, what you feel and what you smell while in this scene.

Get support

Long-term stress and associated anxiety is difficult to resolve by yourself and it is often best for you to seek help. Do not struggle alone. Anxiety can seriously impair your academic performance and that is not only distressing for you, but means a lot of wasted effort. Student advisors and student psychologists are specialised in stress management linked to student issues.

Available workshops at Maastricht University

The Student Services Centre has a wide range of training, workshops and lectures available that can help you with your studies.  Take a look at their website for more information , for example for these topics: workshop mindfulnes; workshop stress management.

• http://www.helpguide.org/mental/stress_signs.htm
• http://www.brookes.ac.uk/student/services/health/stress.html
• http://www.apa.org/news/press/releases/2007/10/stress-tips.aspx

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The effect of the demonstration-based progressive muscle relaxation technique on stress and anxiety in nurses caring for COVID-19 patients: a randomized clinical trial

Samaneh ganjeali.

1 Student Research Committee Department, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran

Zahra Farsi

2 Research and Community Health Departments, Faculty of Nursing, Aja University of Medical Sciences, Kaj St., Shariati St, Tehran, Iran

Seyedeh Azam Sajadi

3 Nursing Management Department, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran

Kourosh Zarea

4 Nursing Care Research Center in Chronic Diseases. School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Associated Data

The datasets analyzed in this study are available from the corresponding or first author upon reasonable request.

Caring for patients with coronavirus disease 2019 (COVID-19) challenges nurses and causes them to experience stress and anxiety. From this perspective, it is of utmost importance to develop quick and effective intervention strategies to prevent numerous complications. This study aimed to investigate the effect of the progressive muscle relaxation technique, using the demonstration method on the stress and anxiety of nurses who care for COVID-19 patients.

This randomized clinical trial was conducted in 2021. Forty-six nurses working in two referral hospitals with wards for COVID-19 patients in Tehran, Iran recruited by convenience sampling method and then randomly assigned to experimental or control groups. The nurses in the experimental group educated the progressive muscle relaxation by the demonstration method, and they were encouraged to practice it. The Depression Anxiety Stress Scale-21 was utilized to measure the stress and anxiety levels in the nurses.

Before the intervention, the levels of stress in the experimental and control groups were 13.91 ± 2.41 vs. 14.34 ± 2.74 ( p  = 0.571), and their anxiety was 13.34 ± 3.41 vs. 12.78 ± 2.21 ( p  = 0.510), respectively. After the intervention, the levels of stress in the experimental and control groups were 10.95 ± 2.01 vs. 14.17 ± 2.34 ( p  < 0.001), and their anxiety was 9.47 ± 2.37 vs. 12.91 ± 1.85 ( p  < 0.001), respectively. Moreover, the levels of stress and anxiety in the experimental group significantly diminished after intervention ( p  < 0.001), but no significant changes were observed in the control group ( p  > 0.05).

Concerning the effectiveness of the progressive muscle relaxation technique in relieving the stress and anxiety of the nurses caring for COVID-19 patients, it is suggested to include this relaxation technique in nursing courses.

Since March 11, 2020, when the World Health Organization declared the novel coronavirus disease 2019 (COVID-19) a pandemic has been focused more on global health [ 1 ]. The COVID-19 outbreak has created a shock in the healthcare systems in most countries, including Iran [ 2 ]. Caring for patients with COVID-19 has further given rise to countless psychological complications, including stress and anxiety in nurses [ 3 – 6 ]. For instance, a study reported that the prevalence rates of stress and anxiety among nurses who provided care to patients with COVID-19 were 54.9% and 89.7%, respectively [ 5 ]. Also, evidence showed that the stress and anxiety of Iranian nurses increased significantly first wave of the COVID-19 pandemic [ 6 ]. A recent study showed that caregiving stress, impression on all aspects of life, COVID as a strange disease, stress caused by patient characteristics, and stress reduction over time were issues in the formation of stress in nurses caring for patients with COVID-19 [ 7 ].

The primary source of stress is known and an external factor often induce it. While multiple unpleasant emotions and hypothetical experiences cause anxiety [ 8 ]. Anxiety has been further introduced as one of the negative impacts of stress. Thus, stress can develop into anxiety as individuals find themselves in stressful situations and are even unable to control them. As well, stress can be decreased after coping with stressful events, but anxiety becomes a life routine and persists for a long time [ 8 ].

Since the COVID-19 pandemic started, nurses have been on the frontline of fighting against this disease, caring for infected patients, and have primarily suffered from work pressure. Their performance has been further disturbed by some issues, such as the inadequate supply of personal protective equipment in many healthcare facilities, media pressure, and no support from relevant authorities [ 9 – 11 ]. In critical situations, such as the COVID-19 pandemic, nurses always play against a mixture of circumstances with limited resources to care for patients, so they are often suffered high levels of stress [ 12 , 13 ]. For example, Mohamadzadeh Tabrizi et al. reported that half of the nurses working in the wards for COVID-19 cases had experienced moderate-to-severe anxiety [ 14 ]. Ariapooran et al. also found that more than 51% of nurses working in the covid-19 ward suffered from secondary stress disorder caused by covid-19 [ 15 ]. As well, de Pinho et al. revealed that 64% of frontline nurses fighting against COVID-19 in Portugal were experiencing abnormal stress [ 16 ].

Exposure to COVID-19 can also have double effects on mental health, so one of the complications of contracting this virus is its mental consequences, on the one hand, patients with mental illnesses are susceptible to this pandemic, on the other hand [ 17 ]. Evidence has further demonstrated that the unknown nature of COVID-19, insufficient knowledge about the novel disease, mainly at its onset, patients' conditions, no definitive medications, rapid viral mutations, fear of being infected or losing one's life, transmitting the disease to family and friends, no support from relevant authorities and organizations, high treatment costs in case of infection, elevated workload, and worsened nursing shortage cause to increase stress and anxiety in nurses [ 18 , 19 ]. According to Doo et al., the incidence rates of anxiety among the nurses working in the COVID-19 wards were significantly higher versus those involved in other wards [ 20 ].

Since nurses' anxiety cause decreased efficiency, and increase mental and physical injuries as well as dissatisfaction with healthcare services [ 21 ], selecting the best solution can reduce the negative impacts on their mental health and quality of care. So far, various intervention strategies have been implemented in this field, including the progressive muscle relaxation (PMR) technique [ 22 ]. Relaxation here refers to the establishment of a specific state of moderation, which is the opposite of tensions, such as anxiety [ 23 ]. First proposed by Jacobson, PMR is a technique that affects physiology by slowing the body's metabolism and increasing the number and strength of heart contractions, respiration rates, epinephrine secretion levels, and blood pressure, and aiding people in promoting their physical and mental health [ 24 ]. In this line, Özlü et al. reported that the relaxation technique could relieve anxiety in COVID-19 patients [ 25 ]. Also, Liu et al. found that PMR can reduce anxiety in patients with COVID-19 [ 26 ]. Toqan et al. indicated the positive influence of PMR on nursing students’ anxiety levels in pediatric clinical settings [ 27 ]. On the other hand, Matourypour et al. found that implementing this technique as an emotion-oriented adaptation strategy could not diminish the psychological problems facing nurses [ 28 ]. We found that most of the studies have examined the effectiveness of PMR on patients and we did not find any study that assessed its effects on stress and anxiety nurses during the COVID pandemic. Given the contradictory results in the previous studies, this study aimed to investigate the effectiveness of PMR using the demonstration method on stress and anxiety in nurses caring for COVID-19 patients.

This randomized clinical trial was conducted from March to September 2021 and it was registered on the Iranian Registry of Clinical Trials (ID: IRCT20210808052111N1, Registration date: 04/09/2021). The entire trial protocol can be accessed at Aja University of Medical Sciences.

Participants and setting

The statistical population consisted of all nurses working in two referral hospitals with wards for COVID-19 patients in Tehran, Iran. Of note, both hospitals were comparable in terms of workload, organizational culture, and nursing staff. The sample size was also estimated to be about 19 nurses in each group, according to the sample size formula, the mean and standard deviation (SD) reported in the previous study [ 29 ], with a 99% confidence interval, and a 95% test power. Considering the possibility of 20% attrition, 23 nurses in each group and 46 individuals in total were recruited by convenience sampling. The hospitals were further divided into two experimental and control groups through simple random sampling by coin flipping. A researcher assistant generated the random allocation sequence.

The inclusion criteria were at least a Bachelor's degree in nursing, at least six months of clinical work experience, taking no anxiolytic and psychoactive medications, not receiving any training via the Jacobson's PMR, and experiencing no critical situations (such as the death of the beloved ones and/or incurable diseases) over the last six months. The exclusion criteria were withdrawal from the study, absenteeism even for one training session, being infected with COVID-19, having first-degree relatives with COVID-19 confirmed, and undergoing stressful events at the time of the study. One of the researchers enrolled participants and assigned them to intervention and control groups.

Data collection

The data collection tool consisted of the demographic characteristics questionnaire (gender, age, marital status, education, number of children, clinical work experience, hospital, ward, and work shift) and the 21-item Depression Anxiety Stress Scale-21 (DASS-21), designed by Lovibond and Lovibond in 1995. This questionnaire comprised three 7-item subscales, and the final score for each one was obtained through the sum of the values of the related items. Each item was further scored from 0 ( does not apply to me at all ) to 3 ( totally applies to me ). As DASS-21 was the short form of the main scale (with 42 items), the final score needed to be doubled for each subscale. The researchers used the stress and anxiety subscales in this article. In 1995, Lovibond and Lovibond confirmed the validity of this questionnaire as 0.77. Also, they confirmed the reliability of the entire questionnaire and its subscales with Cronbach's alpha coefficient [ 30 ]. In addition, Taheri Gharagzlu et al. found the Cronbach's alpha coefficients for the depression, anxiety, and stress subscales to be 97%, 92%, and 95%, respectively, and the test–retest coefficients for these dimensions were 79%, 67%, and 81%, respectively [ 31 ]. Both experimental and control groups completed the DASS-21 questionnaire in the pre-and post-intervention stages.

Intervention

First, one of the researchers (viz. a Master's student of Military Nursing with ten years of clinical work experience in general, critical care unit, and COVID-19 wards) referred to certified psychiatrists and clinical psychologists, and learned about PMR, acquired the necessary skills, received an approval certificate in this field. Then she implemented the PMR, with much focus on four components (a quiet environment, a mental tool like a word for concentration, a passive attitude, and a comfortable position) to reduce stress and anxiety in the nurses [ 29 ]. Then, the researcher taught PMR to the nurses in the experimental group, divided into groups of six nurses, in a quiet environment (here, the hospital venue) for two 60-min sessions every other day. During the first session, the nurses were trained in PMR by demonstration. In the second session, the nurses practiced the PMR to consolidate the training. All the sessions were videotaped and provided to the experimental group through a compact disc. Then, the nurses were encouraged to practice the PMR.

For this purpose, the nurses could sit or lie in a comfortable chair. Then, they put on loose clothing if possible and took off their watch, bracelets, and other accessories. A piece of light music was subsequently played during the intervention. Afterward, the nurses tensed and relaxed their muscles with effective and deep breathing while listening to the audio file. Such exercises were more tangible for the nurses at the start. Once they tensed and relaxed their muscles, they could chill out and release their whole body easily and spontaneously with PMR, and divested themselves of anxiety, stress, and any other unpleasant mental and physical feelings [ 32 ]. The muscles that are mostly used in PMR exercise include “hand and forearm, forehead, upper arm, mouth and jaw, eyes and cheeks, shoulder blades, shoulders, neck, chest and stomach, hips and buttocks, upper leg, lower leg, and foot”. These muscles should be contracted and expanded in the order of Table ​ Table1 1 [ 27 ]. Next, the nurses were requested to practice this technique once a day for two weeks, each time lasting 20 min, in a quiet environment and a comfortable position. Of note, they were encouraged to do so via a phone call every day. After two weeks, the researchers assessed the stress and anxiety of nurses in the experimental group. However, the control group received no training or intervention. They completed the stress and anxiety subscales of DASS-21 after two weeks. No sample loss occurred in this study (Fig.  1 ).

Progressive muscle relaxation (PMR) exercise

This table is taken from a recent study [ 27 ]

The process of study

Data analysis

The data analysis was performed using the SPSS software package (ver. 21), particularly descriptive (i.e., mean, SD, frequency, and percentage) and analytic tests, including Fisher's exact test, Chi-square test, independent-samples t -test, and paired-samples t -test. Kolmogorov–Smirnov test was utilized to check the normality of the data, considering the significance level of p  > 0.05. The statistical analyst was blinded to the control and intervention groups.

Individual characteristics

The nurses' mean age was 31.52 ± 6.36 (20–50 years), and the majority (60.9%) were between 20 and 30 years. 60.9% of the nurses were male, and 54.3% were single. The nurses' mean clinical work experience was 7.93 ± 4.95 (1–20 years), and most (39.1%) had clinical work experience of 1–5 years. Moreover, 82.6% of the nurses had a Bachelor's degree, and the majority (78.3%) were permanently employed. Furthermore, 41.3% of the nurses had rotating shifts. In the baseline, the mean score of stress and anxiety were 14.13 ± 2.56 and 13.06 ± 2.86, respectively. Of note, there were no significant differences between the experimental and control groups regarding individual characteristics (Table ​ (Table2 2 ).

Nurses' individual characteristics

a Independent-samples t -test

Stress and anxiety

The findings showed that there was no significant difference in the level of stress ( p  = 0.908) and anxiety ( p  = 0.233) of nurses in the two groups before the intervention, while there was a significant difference after the intervention ( p  < 0.001). So, nurses who experienced severe or extremely severe stress and anxiety were less in the experimental group than in the control group (Tables  3  and  4 ).

Comparing nurses' stress levels in experimental and control groups before and after intervention

Comparing nurses' anxiety levels in experimental and control groups before and after intervention

The independent-samples t -test revealed that the mean score of stress ( p  = 0.571) and anxiety ( p  = 0.509) of the nurses in both experimental and control groups did not significantly differ at the pre-intervention stage, while the nurses in the experimental group experienced less stress ( p  < 0.001) and anxiety ( p  < 0.001) at the post-intervention. Based on Cohen’s method, the overall effect size of demonstration-based PMR on the nurses’ stress and anxiety was 1.47 and 1.61, respectively (Table ​ (Table5 5 ).

Comparing nurses' stress and anxiety scores in experimental and control groups before and after intervention

SD standard deviation

As well, the paired-sample t -test showed that the levels of stress in the nurses in the experimental group reduced after the intervention ( p  < 0.001), while there was no significant difference in the control group ( p  = 0.257). Besides, the nurses' anxiety significantly declined at the post-intervention stage ( p  < 0.001), whereas no significant change was observed in the control group ( p  = 0.479) (Table ​ (Table5 5 ).

This study did not have any harm or unintended effects on each group.

This study aimed to investigate the effectiveness of the demonstration-based PMR technique on the stress and anxiety of nurses caring for COVID-19 patients. The findings showed that in the baseline, prevalence rates of moderate to severe stress and anxiety nurses were 78.3% and 10.8%, respectively. Also, the prevalence rates of extremely severe stress and anxiety were 15.2% and 89.1%, respectively. A study showed that the prevalence rates of moderate to severe stress and anxiety in Iranian nurses in COVID‑19 care wards were 23.7% and 61.3%, respectively [ 5 ]. Also, Sheikhbardsiri et al. reported that the mean scores of stress and anxiety in nurses at educational hospitals during the COVID-19 pandemic were at a moderate level [ 4 ]. These findings emphasized that COVID-19 affected nurses’ mental health.

The mean score of stress and anxiety of all nurses were 14.13 ± 2.56 and 13.06 ± 2.86, respectively. Several previous studies reported that the mean score of stress was 9.62 ± 4.94 [ 4 ], 15.13 ± 4.76 [ 5 ], and 16.23 ± 9.25 [ 6 ] among nurses in Iran during the COVID-19 pandemic. Also, they reported that the mean score of anxiety was 10.32 ± 4.85 [ 4 ], 13.21 ± 4.90 [ 5 ], and 12.65 ± 9.52 [ 6 ]. The mean score of stress in Zakeri et al. [ 6 ] was higher than in other studies. They studied nurses during the first wave of the COVID-19 pandemic. It seems that at the beginning of the pandemic, nurses experienced higher stress and anxiety. Also, the nurses’ stress and anxiety in Sheikhbardsiri et al.’ study [ 4 ] that was conducted in Kerman were lower than in other cities in Iran. The study setting was one of the referral hospitals where patients with or suspected of COVID-19 were hospitalized during the entire pandemic. Therefore, there is a possibility that the nurses who worked in this hospital experienced higher stress and anxiety.

Findings showed that the given relaxation technique could significantly reduce the stress and anxiety scores in the experimental group. In this study, the overall effect size of demonstration-based PMR on the nurses’ stress and anxiety was 1.47 and 1.61, respectively. These effect sizes imply that this method had high effects on nurses’ stress and anxiety. In this regard, evidence showed that relaxation techniques effectively decreased stress and anxiety. According to Liu et al., PMR has a positive effect on reducing anxiety in patients with COVID-19 [ 26 ]. Özlü et al. mentioned that PMR can be considered a nonpharmacological method of reducing the anxiety of COVID‐19 patients [ 25 ]. Also, Toqan et al. confirmed that PMR has an effect in decreasing clinical experience anxiety among nursing students [ 27 ]. As well as, some researchers found that Benson's Relaxation Technique was an effective intervention strategy to relieve anxiety in intensive care unit nurses [ 30 ]. According to de Avila Silveira et al., relaxation techniques could effectively and significantly moderate stress in nurses [ 33 ]. Ozgundondu and Metin also reported that PMR and music could reduce the stress of nurses working in the critical care units, anesthesia, and internal wards of hospitals [ 32 ]. As stated by Jourabchi et al., Benson's Relaxation Technique was an effective strategy for decreasing work-related stress in midwives [ 34 ]. The evidence further showed that PMR alleviated stress and anxiety in nursing students [ 35 ] and some patients [ 32 , 34 ]. The reason for the consistency between previous researches and the present study and the effectiveness of the intervention programs can be attributed to the nature of the relaxation technique as a complementary medicine founded on stress relief as a key element for moderation.

Limitations

One of the limitations of the present study was the possibility of contamination bias. Thus, there were attempts to select two different hospitals for sampling to minimize it. Also, the nurses of the experimental group were requested not to share their information about PMR with the nurses of other hospitals until the end of the study. As well as the nursing population in Iran is mainly made up of women while most of the participants were men. However, the two groups were homogeneous in terms of gender. Also, as mentioned in the methodology section, the validity and reliability of the original version and the Persian version of the DASS-21 questionnaire were confirmed in the previous studies. However, it would have been better if it was re-examined in this study as well.

In general, nurses working in intensive care units and the wards for COVID-19 patients undergo fatigue, work pressure, livelihood problems, and burnout caused by their profession, and observe pain, suffering, and death of patients, get infected with the virus, live with confirmed cases in their families, and experience high levels of stress and anxiety. Sometimes nurses are also ignored and burdened with much stress. High stress and anxiety of nurses can affect the quality of patient care.

The findings revealed that PMR was effective in reducing the stress and anxiety of the nurses caring for COVID-19 patients. In this view, it is recommended to implement this simple, affordable, and valid non-pharmacological intervention to help nurses cope with stress and anxiety and improve the quality of nursing services. Furthermore, it is suggested to assess the effects of this relaxation technique on other psychological complications caused by the care for COVID-19 patients in future research.

Acknowledgements

This study was a part of the Master's thesis in nursing, approved by Aja University of Medical Sciences, Tehran, Iran. The authors would like to extend their gratitude to the respected officials of the Vice Chancellor's Office for Research and Technology and the Postgraduate Education Department of the Faculty of Nursing at Aja University of Medical Sciences, Tehran, Iran. They also appreciate the cooperation of the honorable administrators and nurses who contributed to this study.

Abbreviations

Authors’ contributions.

SG contributed to the conceptualization, planning, data collection, and writing the initial draft of the manuscript. ZF was involved in the planning, data analysis, supervision of the study, and critical revision of the manuscript. SAS and KZ contributed to the supervision of the study. All authors collaborated in the study and they read and approved the final manuscript.

This study was funded by a grant from the Aja University of Medical Sciences (No. 599689 on 19/12/2019).

Availability of data and materials

Declarations.

This study was approved by the Ethics Committee of Aja University of Medical Sciences, Tehran, Iran (ID: IR.AJAUMS.REC.1400.041). The researchers observed the Declaration of Helsinki provisions. The nurses were allowed to voluntarily participate in the study, and withdraw whenever they liked. Furthermore, the study objectives were explained, and an informed consent form that was approved by the ethics committee of Aja University of Medical Sciences was signed by all the nurses. The confidentiality of data was respected. In addition, the Committee on Publication Ethics principles were met.

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Rapid stress relaxation and degradable aromatic disulfide vitrimer for recyclable carbon fiber reinforced composite

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• Published: 04 March 2024
• Volume 31 , article number  87 , ( 2024 )

Cite this article

• Qinghua Zhang 1 , 2 ,
• Mingzhuan Li 1 , 2 ,
• Peifeng Feng 1 , 2 ,
• Luoli Meng 1 ,
• Xigao Jian 1 &
• Jian Xu   ORCID: orcid.org/0000-0003-2542-1971 1 , 2  

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Carbon fiber thermoset composites pose significant challenges due to their inability to be reprocessed and the difficulties in recycling carbon fibers. Vitrimer materials with reversible dynamic covalent bonding offer a promising solution for the degradation of thermosetting resins and the recycling of carbon fibers. However, their practical application is limited by inability to quickly release stresses from deformation and long degradation times. To address these limitations, this study presents a novel vitrimer material based on free amine-catalyzed aromatic dynamic disulfide exchange. The dynamic disulfide exchange network, catalyzed by free amines, exhibits rapid stress relaxation, with a relaxation time of only 14 s at 180 °C. This exceptional dynamic exchange capability grants the vitrimer material outstanding self-healing properties, shape memory functionality, and recycling performance. Moreover, the higher concentration of disulfide bonds and the generation of small molecules increase the susceptibility of the crosslinked network to thiol degradation, resulting in resin degradation within 5 h. Additionally, this research successfully applies the vitrimer material as a matrix to prepare carbon fiber composites with exceptional mechanical properties. Furthermore, by degrading the resin matrix, effective recycling of carbon fibers is achieved, contributing to sustainable practices in the automotive and aerospace industries.

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Acknowledgements

This work was supported by the National Natural Science Foundation of China [grant number 52075526], the “Ningbo 3315 Plan Innovation Team” [grant number 2017A-28-C], the National Natural Science Foundation of China [grant number 91860204], the Fundamental Research Funds for the Central Universities [grant number DUT22-LAB605], the National Key Research and Development Program [grant number 2018YFB1107500], and the financial support from National Young Talents Program of China.

National Natural Science Foundation of China, 52075526, Jian Xu, 91860204, Xigao Jian, Ningbo 3315 Plan Innovation Team, 2017A-28-C, Jian Xu, Fundamental Research Funds for the Central Universities, DUT22-LAB605, Xigao Jian, National Key Research and Development Program, 2018YFB1107500, Jian Xu.

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Qinghua Zhang: Conceptualization, Methodology, Investigation, Formal analysis, Data curation, Visualization, Writing—Original draft preparation, Writing – Review & Editing. Mingzhuan Li: Visualization, Investigation. Peifeng Feng: Investigation, Methodology. Luoli Meng: Investigation, Methodology. Xigao Jian: Funding Acquisition, Supervision. Jian Xu (Corresponding Author): Conceptualization, Methodology, Funding Acquisition, Resources, Supervision, Writing—Review & Editing.

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Zhang, Q., Li, M., Feng, P. et al. Rapid stress relaxation and degradable aromatic disulfide vitrimer for recyclable carbon fiber reinforced composite. J Polym Res 31 , 87 (2024). https://doi.org/10.1007/s10965-024-03939-z

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DOI : https://doi.org/10.1007/s10965-024-03939-z

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