Relaxation Training for Anxiety: A Ten-Years Systematic Review With Meta-Analysis

Gian Mauro Manzoni; Francesco Pagnini; Gianluca Castelnuovo; Enrico Molinari


BMC Psychiatry 

In This Article


Findings from this meta-analysis must be interpreted with caution given limitations of meta-analysis in general and of data collected for this analysis in particular.

A critical issue for this meta-analysis, as is true of any systematic review, was deciding which trials or studies to include and which to exclude. While some researchers (e.g. Cochrane Collaboration) view the randomized trial (RCT) as the only acceptable evidence on treatment outcome, many systematic reviews are indeterminate because they include insufficient RCTs whilst they reject large numbers of non-randomized controlled studies.

We decided to include all studies published and relevant to our aim, independently from their research design, in order to increase the number of studies and participants. However, within group meta-analysis we conducted is very limited because it is impossible to state if anxiety enhancements were directly related to or caused by relaxation training.

As in any review of studies in a given area, it is possible that studies with non significant results are underreported. The practice of publishing only studies with significant outcomes may create a distortion of the subject under investigation, especially if a meta-analysis is done.[49]

It is important to note that, for some variables, meta-analyses were based on relatively few subjects.

We searched studies in the most important databases for psychology (PsychInfo) and medicine (Medline). Other databases (e.g. CINAHL) were not screened and this may be a limitation to the generalizability of our results.


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