Cognitive, behavioral, and affective mechanisms underlying the efficacy of Applied Relaxation in reducing psychopathological symptoms: A randomized controlled trial

Background: This study examined the cognitive, behavioral, and affective mechanisms underlying the efficacy of Applied Relaxation (AR) in reducing psychopathological symptoms. AR is a cognitive-behavioral technique that allows for rapid relaxation at the first sign of stress or tension in daily life. Methods: A randomized controlled trial was conducted in 277 adults (18–55 years) with elevated symptoms of depression, anxiety, or stress but without a 12-month DSM-5 mental disorder at study entry. Participants were randomized to an intervention group receiving AR training (10 weeks, N = 139) and an assessment-only control group (N = 138). Mental health outcomes (depressive, anxiety, and stress symptoms) and potential cognitive (self-efficacy, perceived control), behavioral (coping behaviors) and affective (positive and negative affect) mediators of the intervention efficacy were assessed at baseline and post-assessment in both groups. Results: Structural equation models indicated that baseline to post reductions in psychopathological symptoms due to AR partially passed through less avoidance-oriented and less other dysfunctional coping (proportion of total effect mediated; ratio of indirect to total effect: resignation: 55.0%, rumination: 27.9%, escape: 27.4%, aggression: 21.3%), less negative affect (46.3%), more positive affect (41.8%), lower external control beliefs (14.5%), and higher self-efficacy (13.3%). Conclusions: Our results suggest that improvements in cognitive, behavioral, and affective mediator variables partially explain the intervention efficacy of AR in improving mental health. Trial registration and data statement: The study protocol has been pre-registered on ClinicalTrials.gov (NCT03311529). The study protocol, minimum dataset, and analysis codes are available at OpARA - Open Access Repository and Archive. Supplementary materials (e.g., the course manual and additional training materials) are available on request from the last author (katja.beesdo-baum@tu-dresden.de).