, Volume 9, Issue 4, pp 1268–1279 | Cite as

Differential Treatment Mechanisms in Mindfulness Meditation and Progressive Muscle Relaxation

  • Liya Gao
  • Joshua Curtiss
  • Xinghua Liu
  • Stefan G. Hofmann


Mindfulness meditation and progressive muscle relaxation (PMR) practices are both effective in reducing stress, anxiety, and depression. To examine the mechanisms of change in mood in these two treatments, 95 participants were randomly assigned to present awareness mindfulness (PAM; N = 47) or PMR (N = 48). They were each given a 5-min audiotape of PAM or PMR and were asked to practice at least 5 min a day for 3 months. After attrition, 55 participants completed the post-intervention assessment. An additional 47 participants were assigned to a waitlist control group. Mindfulness, perceived stress, well-being, and mood symptoms were measured at pre-treatment, post-treatment, and 1-month follow-up assessment periods. PAM and PMR both led to a significant improvement in mindfulness and reduction in stress. Results of the latent growth curve analyses revealed that mindfulness and non-reactivity mediated changes in mood for PAM more than for PMR. These results suggest that differential treatment mechanisms underlie PAM and PMR.


Present awareness mindfulness Progressive muscle relaxation Mechanisms Mediation Audio Self-help 



The authors thank Leigh Andrews for the proofreading work.

Author Contributions

The first two authors contributed equally to this paper. LYG and JC contributed to the study idea, drafting of the manuscript, and data analyses. XHL and SH contributed to the study idea and drafting of the manuscript.

Funding Information

This research was supported by the National Science Foundation of China (Project 31271114). Dr. Hofmann receives support from NIH/NCCIH (R01AT007257), NIH/NIMH (R01MH099021, R34MH099311, R34MH086668, R21MH102646, R21MH101567, K23MH100259), the James S. McDonnell Foundation 21st Century Science Initiative in Understanding Human Cognition–Special Initiative, and the Department of the Army for work unrelated to the studies reported in this article. He receives compensation for his work as an advisor from the Palo Alto Health Sciences and Otsuka Digital Health, Inc., and for his work as a Subject Matter Expert from John Wiley & Sons, Inc. and Silver Cloud Health, Inc. He also receives royalties and payments for his editorial work from various publishers.

Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study received ethical approval from the Academic Committee of College of Psychology, Capital Normal University. No adverse events were reported in this study. These participants were contacted by telephone to obtain verbal informed consent.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. Agee, J. D., Danoff-Burg, S., & Grant, C. A. (2009). Comparing brief stress management courses in a community sample: mindfulness skills and progressive muscle relaxation. Explore the Journal of Science and Healing, 5, 104–109.Google Scholar
  2. Ainsworth, B., Marshall, J. E., Meron, D., Baldwin, D. S., Chadwick, P., & Munafò, M. R. (2015). Evaluating psychological interventions in a novel experimental human model of anxiety. Journal of Psychiatric Research, 63, 117–122.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Alliger, G. M., & Williams, K. J. (1993). Using signal-contingent experience sampling methodology to study work in the field: a discussion and illustration examining task perceptions and mood. Personnel Psychology, 46, 525–549.CrossRefGoogle Scholar
  4. Avianti, N., Desmaniarti, Z., & Rumahorbo, H. (2016). Progressive muscle relaxation effectiveness of the blood sugar patients with type 2 diabetes. Open Journal of Nursing, 6, 248–254.CrossRefGoogle Scholar
  5. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45.CrossRefPubMedGoogle Scholar
  6. Baer, R. A., Carmody, J., & Hunsinger, M. (2012). Weekly change in mindfulness and perceived stress in a mindfulness-based stress reduction program. Journal of Clinical Psychology, 68, 755–765.CrossRefPubMedGoogle Scholar
  7. Banks, J. B., Welhaf, M. S., & Srour, A. (2015). The protective effects of brief mindfulness meditation training. Consciousness and Cognition, 33, 277–285.CrossRefPubMedGoogle Scholar
  8. Bernstein, D. A., & Borkovec, T. D. (1973). Progressive relaxation training: a manual for the helping professions. Champaign, Illinois: Research Press.Google Scholar
  9. Boronkrupinska, K., & Kulmatycki, L. (2014). Effectiveness of progressive muscle relaxation (pmr) in alleviating psychophysical disorders-a systematic review (1982–2012). Global Journal for Research Analysis, 3, 113–115.Google Scholar
  10. Bränström, R., Kvillemo, P., Brandberg, Y., & Moskowitz, J. T. (2010). Self-report mindfulness as a mediator of psychological well-being in a stress reduction intervention for cancer patients—a randomized study. Annals of Behavioral Medicine, 39, 151–161.CrossRefPubMedGoogle Scholar
  11. Brown, T. A. (2007). Temporal course and structural relationships among dimensions of temperament and DSM–IV anxiety and mood disorder constructs. Journal of Abnormal Psychology, 116, 313–328.CrossRefPubMedGoogle Scholar
  12. Campbell, A., Converse, P. E., & Rodgers, W. L. (1976). The quality of American life: perceptions, evaluations, and satisfactions. New York: Russell Sage.Google Scholar
  13. Carmody, J., & Baer, R. A. (2008). Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine, 31, 23–33.CrossRefPubMedGoogle Scholar
  14. Carrington, P., Collings Jr., G. H., Benson, H., Robinson, H., Wood, L. W., Lehrer, P. M., et al. (1980). The use of meditation-relaxation techniques for the management of stress in a working population. Journal of Occupational and Environmental Medicine, 22, 221–231.Google Scholar
  15. Cavanagh, K., Strauss, C., Cicconi, F., Griffiths, N., Wyper, A., & Jones, F. (2013). A randomised controlled trial of a brief online mindfulness-based intervention. Behaviour Research & Therapy, 51(9), 573–578.CrossRefGoogle Scholar
  16. Chen, Y., Xueling, Y., Liyuan, W., & Xiaoyuan, Z. (2013). A randomized controlled trial of the effects of brief mindfulness meditation on anxiety symptoms and systolic blood pressure in Chinese nursing students. Nurse Education Today, 33, 1166–1172.CrossRefPubMedGoogle Scholar
  17. Cheong, J. (2011). Accuracy of estimates and statistical power for testing meditation in latent growth curve modeling. Structural Equation Modeling, 18, 195–211.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Cheong, J., MacKinnon, D. P., & Khoo, S. T. (2003). Investigation of mediational processes using parallel process latent growth curve modeling. Structural Equation Modeling, 10, 238–262.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Chi, S., & Lin, W. (2003). The preliminary revision of brief profile of mood states (BPOMS)—Chinese edition. Chinese Mental Health Journal, 17, 768–770.Google Scholar
  20. Chu, L., & Gao, S. (2005). The influence perceive stress towards mental health: the effect of meditation experience and emotion intelligence regulation. Chinese Journal of Psychology, 47, 157–179.Google Scholar
  21. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.CrossRefPubMedGoogle Scholar
  22. Colzato, L. S., Sellaro, R., Samara, I., & Hommel, B. (2015). Meditation-induced cognitive-control states regulate response-conflict adaptation: evidence from trial-to-trial adjustments in the Simon task. Consciousness and Cognition, 35, 110–114.CrossRefPubMedGoogle Scholar
  23. Curtiss, J., & Klemanski, D. H. (2014a). Factor analysis of the five facet mindfulness questionnaire in a heterogeneous clinical sample. Journal of Psychopathology and Behavioral Assessment, 36, 683–694.CrossRefGoogle Scholar
  24. Curtiss, J., & Klemanski, D. H. (2014b). Teasing apart low mindfulness: differentiating deficits in mindfulness and in psychological flexibility in predicting symptoms of generalized anxiety disorder and depression. Journal of Affective Disorders, 166, 41–47.CrossRefPubMedGoogle Scholar
  25. Curtiss, J., Klemanski, D. H., Andrews, L., Ito, M., & Hofmann, S. G. (2017). The conditional process model of mindfulness and emotion regulation: an empirical test. Journal of Affective Disorders, 212, 93–100.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Deng, Y., Liu, X., Rodriguez, M. A., & Xia, C. Y. (2011). The five facet mindfulness questionnaire: psychometric properties of the Chinese version. Mindfulness, 2, 123–128.CrossRefGoogle Scholar
  27. Desrosiers, A., Vine, V., Curtiss, J., & Klemanski, D. H. (2014). Observing nonreactively: a conditional process model linking mindfulness facets, cognitive emotion regulation strategies, and depression and anxiety symptoms. Journal of Affective Disorders, 165, 31–37.CrossRefPubMedGoogle Scholar
  28. Enders, C. K. (2010). Applied missing data analysis. Guilford Press.Google Scholar
  29. Feldman, G., Greeson, J., & Senville, J. (2010). Differential effects of mindful breathing, progressive muscle relaxation, and loving-kindness meditation on decentering and negative reactions to repetitive thoughts. Behaviour Research & Therapy, 48, 1002–1011.CrossRefGoogle Scholar
  30. Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1–12.CrossRefPubMedGoogle Scholar
  31. Harris, G. E. (2003). Progressive muscle relaxation: highly effective but often neglected. Guidance and Counseling, 18, 142–148.Google Scholar
  32. Hofmann, S. G., Sawyer, A. T., Witt, A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 169–183.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Hu, L. T., & Bentler, P. M. (1998). Fit indices in covariance structure modeling: sensitivity to underparameterized model misspecification. Psychological Methods, 3, 424–453.CrossRefGoogle Scholar
  34. Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction. Annals of Behavioral Medicine, 33, 11–21.CrossRefPubMedGoogle Scholar
  35. Jamshidian, M., & Jalal, S. (2010). Tests of homoscedasticity, normality, and missing completely at random for incomplete multivariate data. Psychometrika, 75, 649–674.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice, 10, 144–156.Google Scholar
  37. Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., Chapleau, M. A., Paquin, K., & Hofmann, S. G. (2013). Mindfulness-based therapy: a comprehensive meta-analysis. Clinical Psychology Review, 33, 763–771.CrossRefPubMedGoogle Scholar
  38. Liu, X., Xu, J., Zhang, Q., & Wu, Y. (2016). Definition, treatment procedure and feasibility report of “present awareness” mindfulness training. China Journal of Health Psychology, 24, 1224–1229.Google Scholar
  39. Luebbert, K., Dahme, B., & Hasenbring, M. (2001). The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute nonsurgical cancer treatment: a meta-analytical review. Psycho-Oncology, 10, 490–502.CrossRefPubMedGoogle Scholar
  40. McCallie, M. S., Blum, C. M., & Hood, C. J. (2006). Progressive muscle relaxation. Journal of Human Behavior in the Social Environment, 13, 51–66.CrossRefGoogle Scholar
  41. Mcnair, D., Lorr, M., & Droppleman, C. (1971). Profile of mood states. San Diego: Educational & Industrial Testing Service.Google Scholar
  42. Meyer, B., Berger, T., Caspar, F., Beevers, C. G., Andersson, G., & Weiss, M. (2009). Effectiveness of a novel integrative online treatment for depression (deprexis): randomized controlled trial. Journal of Medical Internet Research, 11(2), e15.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Moritz, S., Cludius, B., Hottenrott, B., Schneider, B. C., Saathoff, K., Kuelz, A. K., & Gallinat, J. (2015). Mindfulness and relaxation treatment reduce depressive symptoms in individuals with psychosis. European Psychiatry, 30, 709–714.CrossRefPubMedGoogle Scholar
  44. Morledge, T. J., Allexandre, D., Fox, E., Fu, A. Z., Higashi, M. K., Kruzikas, D. T., et al. (2013). Feasibility of an online mindfulness program for stress management—a randomized, controlled trial. Annals of Behavioral Medicine, 46, 137–148.CrossRefPubMedPubMedCentralGoogle Scholar
  45. Nyklíček, I., & Kuijpers, K. F. (2008). Effects of mindfulness-based stress reduction intervention on psychological well-being and quality of life: is increased mindfulness indeed the mechanism? Annals of Behavioral Medicine, 35, 331–340.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Nyklíček, I., Dijksman, S. C., Lenders, P. J., Fonteijn, W. A., & Koolen, J. J. (2014). A brief mindfulness based intervention for increase in emotional well-being and quality of life in percutaneous coronary intervention (PCI) patients: the MindfulHeart randomized controlled trial. Journal of Behavioral Medicine, 37, 135–144.CrossRefPubMedGoogle Scholar
  47. Preacher, K. J. (2015). Advances in mediation analysis: a survey and synthesis of new developments. Annual Review of Psychology, 66, 825–852.CrossRefPubMedGoogle Scholar
  48. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.CrossRefPubMedGoogle Scholar
  49. Robb, S. L. (2000). Music assisted progressive muscle relaxation, progressive muscle relaxation, music listening, and silence: a comparison of relaxation techniques. Journal of Music Therapy, 37, 2–21.CrossRefPubMedGoogle Scholar
  50. Rosseel, Y. (2012). Lavaan: an R package for structural equation modeling. Journal of Statistical Software, 48, 1–36.CrossRefGoogle Scholar
  51. Semple, R. J. (2010). Does mindfulness meditation enhance attention? A randomized controlled trial. Mindfulness, 1, 121–130.CrossRefGoogle Scholar
  52. Shapiro, S. L., Oman, D., Thoresen, C. E., Plante, T. G., & Flinders, T. (2008). Cultivating mindfulness: effects on well-being. Journal of Clinical Psychology, 64, 840–862.CrossRefPubMedGoogle Scholar
  53. Singh, V. P., Rao, V., Prem, V., Sahoo, R. C., & Pai, K. (2009). Comparison of the effectiveness of music and progressive muscle relaxation for anxiety in COPD—a randomized controlled pilot study. Chronic Respiratory Disease, 6, 209–216.CrossRefPubMedGoogle Scholar
  54. Vancampfort, D., De Hert, M., Knapen, J., Maurissen, K., Raepsaet, J., Deckx, S., et al. (2011). Effects of progressive muscle relaxation on state anxiety and subjective well-being in people with schizophrenia: a randomized controlled trial. Clinical Rehabilitation, 25, 567–575.CrossRefPubMedGoogle Scholar
  55. Wang, X., Wang, X., & Ma, H. (1999). Manual of psychological health evaluation and measurement (revised edition). Beijing: Chinese Mental Health Journal Publisher.Google Scholar
  56. Warnecke, E., Quinn, S., Ogden, K., Towle, N., & Nelson, M. R. (2011). A randomised controlled trial of the effects of mindfulness practice on medical student stress levels. Medical Education, 45, 381–388.CrossRefPubMedGoogle Scholar
  57. Weidt, S., Klaghofer, R., Kuenburg, A., Bruehl, A. B., Delsignore, A., Moritz, S., & Rufer, M. (2015). Internet-based self-help for trichotillomania: a randomized controlled study comparing decoupling and progressive muscle relaxation. Psychotherapy and Psychosomatics, 84, 359–367.CrossRefPubMedGoogle Scholar
  58. Wolever, R. Q., Bobinet, K. J., McCabe, K., Mackenzie, E. R., Fekete, E., Kusnick, C. A., & Baime, M. (2012). Effective and viable mind-body stress reduction in the workplace: a randomized controlled trial. Journal of Occupational Health Psychology, 17, 246–258.CrossRefPubMedGoogle Scholar
  59. Younge, J. O., Gotink, R. A., Baena, C. P., Roos-Hesselink, J. W., & Hunink, M. M. (2014). Mind-body practices for patients with cardiac disease: a systematic review and meta-analysis. European Journal of Preventive Cardiology, 22, 1385–1399.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017
Corrected publication January/2018

Authors and Affiliations

  1. 1.Beijing Key Laboratory of Learning and Cognition, College of PsychologyCapital Normal UniversityBeijingPeople’s Republic of China
  2. 2.School of General Practice and Continuing EducationCapital Medical UniversityBeijingChina
  3. 3.Department of Psychological and Brain SciencesBoston UniversityBostonUSA

Personalised recommendations