Jacobson'S Progressive Muscle Relaxation (Jpmr) Training To Reduce Anxiety And Depression Among People Living With Hiv

Introduction :

Acquired is obtained or received by a person that does not ordinarily exist within one's body. Immune deficiency is not an isolated disease but one which has a variety of symptoms leading to various disorders and a set of diseases¹. The acquired immune deficiency syndrome (AIDS) is a fatal illness caused by retro virus known as human immunodeficiency virus (HIV) which breaks down the body's immune system, leaving the victim vulnerable to a host of life threatening opportunistic infections, neurological disorders or unusual malignancies². One of the special features of HIV infection is that once infected there is a high probability that a person will be infected for life. The term AIDS refers only to the last stage of the HIV infection. AIDS can be called as our modern pandemic affecting both industrialized and developing countries. Every day, over 6800 persons become infected with HIV and over 5700 people die from AIDS. The HIV pandemic remains the most serious of infectious disease and a challenge to public health. In 2009, 2.6 million people were estimated to became newly infected with HIV³.

Stress is common in people with HIV. Because of this stress they develop anxiety and they will go to depression. Relaxation training is taught as a self control technique that the individual can use to reduce various forms of physiological over arousals that produce somatic symptoms. Relaxation training has been used to treat tension, headaches, migraine headaches, asthma, insomnia and hypertension (Lavige and Burns, 1981).

Physical activity is an important means of reducing stress levels and preventing some of its damaging effects on the body. Exercise uses up the adrenaline and other hormones which the body produces under stress and relaxes the muscles. It will help to strengthen the heart and improve blood circulation too.

Vardhana M and Laxminarayana K (2007) conducted a review of article in Manipal, on depression in Patients with HIV/AIDS in India, by comparing ten studies of HIV positive and at risk HIV negative patients. The study stated that safe and effective treatment of major depression, which is one of the most common comorbid conditions in individuals infected with HIV, significantly lowers morbidity and mortality of HIV disease⁴.

Progressive muscle relaxation was developed by Chicago physician Jacobson in the 1920's. Jacobson theorized that anxiety and stress lead to muscle tension which in turn increases feelings of anxiety. When the body is in a relaxed state however, there is little muscle tension leading to decreased anxious feelings. Jacobson believed that one's body is relaxed; one's mind cannot be in a state of angst ⁵.

Jacobson's muscle relaxation issimple non invasive and cost effective, method that can be used for promotion of quality of life without any adverse effects. It is known people living with HIV undergo a lot of anxiety and depression. Hence the researcher decided to check the usefulness of Jacobson's progressive muscle relaxation among these subjects.

Materials and Methods

Results :

Background information of the sample characteristics collected using demographic proforma is shown in table 1. Out of 30 subjects, majority 66.7% (20) subjects belonged to age group of 36-50 years. Equal number of males and females participated i.e. 50% (15).Most of the samples 33.3% (10) had only up to primary education, Hindus 46.7% (14). Maximum 63.3% (19) samples are married. Maximum 43.3% (13) samples belonged to nuclear family. All samples were financially supported by self / family members. Family income per month (in rupees) was less than 5,000 for majority i.e. 83.3% (25). Maximum 76.6% (23) samples were unskilled workers. Half of the samples changed their job after diagnosis.

Background information of the sample characteristics collected using disease specific proforma is shown in table 2. Out of 30 subjects, the diagnosis made for majority 80% (24) of people living with HIV within 2 years of duration. Maximum 46.7% (14) samples were having CD4 count less than 200. Half of them 50% (15) belonged to stage II of HIV. Majority 70% (21) samples were having opportunistic infections. Previous history of psychiatric illness i.e. 43.3% (13). Many of the subjects 46.7% (14) were suffering from ART side effects.

Description of anxiety, depression among people living with HIV: Out of 30 subjects 13.30% (4) experienced abnormal anxiety and 16.7% (5) abnormal depression and source of maximum information is shown in Figure 1.

Effectiveness of JPMR on anxiety: Since the anxiety scores were following normal distribution, parametric pairedt test was used. It is clear from table 3, that the p value was 0.001. The post test scores is reduced compared to the pre test scores of anxiety. JPMR is effective in reducing the anxiety.

Effectiveness of JPMR on depression: Since the depression scores were following normal distribution, parametric paired t test was used. It is clear from table 4, that the p value was 0.001. The post test scores is reduced compared to the pre test scores of depression. JPMR is effective in reducing the depression.

Association between anxiety with selected demographic variables and disease specific variables: It is clear from table 5, thatthere was no significant association between anxiety and selected demographic variables and disease specific variables. Concluded that anxiety is independent of the selected variables such as age, gender, educational status, religion, marital status, type of family, source of income, family income per month (in rupees), current occupation, job change after diagnosis, duration after diagnosis, CD4 count, HIV stages, opportunistic infections, ART side effects and previous history of psychiatric illness.

Association between depression with selected demographic variables and disease specific variables: It is clear from table 6,that there was no significant association between depression and selected demographic variables and disease specific variables except for pervious history of psychiatry illness. This study concluded that depression is independent of the selected variables such as age, gender, educational status, religion, marital status, type of family, source of income, family income per month (in rupees), current occupation and job change after diagnosis, duration after diagnosis, CD4 count, HIV stages, opportunistic infections and ART side effects. This study concluded that depression is dependent on previous history of psychiatric illness (X2= 6.584, df=2, p=0.037).

Discussion :

The findings of the present study showed that, out of 30 subjects a few of them 13.30% (4) experienced abnormal anxiety and 16.7% (5) abnormal depression. Similar findings supports the results of another study conducted by Chandra, Geetha and Sanjeev (2005), HIV and psychiatric disorder in India conducted in a group of 51 seropositive persons in south India by using the Hospital anxiety and depression scale. Out of 51 samples 57% of the samples scored anxiety disorder. The number of individuals diagnosed as having anxiety disorders in this study was higher⁷. Similar findings support the results of another meta-analysis study conducted by Vardhana et al (2007) in

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Fig 1.

Bar diagram showing the percentage of anxiety and depression of people living with HIV.

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Manipal by comparing the ten studies in South India. It reported that 40% of seropositive individuals suffering from depression. Anxiety severe enough to fulfill the ICD 10 criteria for generalized anxiety disorder has been found in 90% of the HIV infected individuals with depressive symptoms were identified.2 On the contrary an increase in the rates were reported by Chandra and Vardhana⁴.

In the present study it was observed that the mean post test anxiety and depression scores were significantly lower than the mean post test score which was significant at 0.05 level. The present study finding supports the results of the study conducted by Fukunishi et.al. (2005) conducted a study in Tokyo Metropolitan Komagome Hospital, examined the efficacy of relaxation techniques in a sample of HIV patients without AIDS in the early stages after infection, by comparing the three groups: relaxation group (progressive muscle relaxation and modified autogenic training); ordinary supportive psychotherapy group, and finally no psychiatric treatment group. The sample selected were 19 people living with HIV. Scores for anxiety, fatigue, depression and contusion, as measured by the profile of mood states (POMS), were significantly lower after relaxation than before. There were no significant differences in the POMS scores (except for anger) among the three groups. The results of patients using relaxation showed that difference between pre test and post test (mean =38.7, SD=7.8, P=<0.05). Results suggest that a combination of progressive muscle relaxation and modified autogenic training is a useful method, which can be easily employed in HIV patients without AIDS.⁸

Conclusion

People living with HIV were likely to experience abnormal anxiety and depression. JPMR training is effective in reducing the anxiety and depression among people living with HIV.JPMR is a simple non-invasive cost effective, method that can be used for promotion of quality of life without any adverse effects on the people living with HIV.