INTRODUCTION:

We are experiencing anxiety in our daily life. The concept of anxiety may differ according to the individual’s state of contexts and interpretations. Anxiety as a symptom is very frequent in alcoholic patient and the co-morbidity between alcoholism and anxiety disorder is very high, habitually it is better to treat both disorders at the same time. In India, WHO (1980) reported that there are millions alcoholics or one in twenty five persons who consumed alcohol were found severely addicted Gnanadasan (1989) stated that in India 1.8/. of the adult population is addicted to alcohol, in recent years studies conducted on different groups of population such as college students (Deba at al; 1977) have shown a significant inclination towards alcohol abuse.

A large number of studies were conducted to identify the factors contributing to alcohol dependent syndrome.

Despite adequate medical supervision for alcohol withdrawal, hyper anxiety, which is an intensely uncomfortable state below threshold of panic, may occur early in sobriety. Many clinicians working in alcohol treatment centers have observed hyperactivity in early sobriety and noted its contribution to relapse.

REVIEW OF LITERATURE:

Literature Related to Progressive Muscle Relaxation Technique on Anxiety:

STONE (1983) indentified relaxation techniques in general practice, study reveals that many common disorders which are present in general practice may be treated successfully when patients learn techniques of relaxation. Tension, headache, migraine, pre examination tension and some phobia have a high curable success rate. The technique is a lifelong asset for both patient and the doctor.

Collins and Nitz !1990) conducted a study to explore the use of muscle stretching exercises in relaxing training with a clinical population. Relaxation training were administered for clinical population. The study revealed that the utility of relaxation was based primarily on muscle stretching exercise for lowering the subjective and objective anxiety status of arousal. Results showed that the utility of relaxation of muscle stretching was effective in reducing the subjective anxiety.

A study done by Maria (1994) in Bombay to find out the effect of relaxation exercise on patient of bronchial asthma showed the relaxation exercise made a significant difference in reduction of fear (P<0). On breathlessness it was observed that before the relaxation exercise 80% of patients had breathlessness which was reduced from 40% to 50% for patients who had breathlessness at night on the first day it was reduced 2% which means the number of patients who had good sleep at night increased.

Tello Bernabe (1997) conducted group relaxation techniques in the treatment of several types of anxiety on non-randomized controlled trail study. This study concludes that the relaxation technique intervention is effective in reducing temporary anxiety and improves to a small extent the inbuilt tendency to react with anxiety. These groups provide a qualitative improvement in the self –esteem women’s network of relationships.

Rapp and Thomas (1998) reported that muscle relaxation techniques are an important therapeutic tool in treatment of anxiety related conditions, they are found to be beneficial in insomnia and tension, headache, chronic anxiety and hypertension.

Literature related to progressive muscle relaxation on anxiety among alcoholic De- addiction clients:

Johnson (1980) examined the natural course of anxiety before and after de-addiction therapy using the state-trait anxiety inventory in four studies involving 136 de-addiction patients. the results suggested that high levels of anxiety were experienced before admission to hospital. The study showed that after progressive muscle relaxation technique the anxiety level was reduced.

Shapiro (1980) did a study on psychological effect of progressive muscle relaxation technique as autogenic training; twenty two elderly subjects received live seasons of instructions in progressive relaxation technique autogenic training over a 5 week period. The result showed that the progressive muscle relaxation technique decreased the intensity and number of symptoms of anxiety and depression.

Green and Webster (1981) conducted a comparative study on effectiveness of progressive muscle relaxation technique and self induced relaxation training and their relative effects on subjective anxiety and autonomic arousal. Two groups of forty eighty alcoholic patients with anxiety were compared in their response to relaxation therapy. Evaluating progressive muscle relaxation technique on alcoholic was superior to self induced relaxation for most of the elderly subjects.

Klajner F, Hartman LM and sobell MB (1984) conducted a study to find out the efficiency of relaxation training as a treatment for alcohol and drug abuse. This has been reviewed and directions for future research derived from it. Such use of relaxation procedures, notably progressive muscular relaxation and meditation have been widespread and are premised on the assumptions that alcohol abuse is causally linked to anxiety can be reduced by relaxation training.

Weber (1996) did a study to investigate the effects of relaxation exercise on anxiety level in an in-patient general psychiatric unit. Convenience samples of 39 subjects were studied. Levels of anxiety were measured prior to and post intervention with the state portion of the state trait anxiety intervention. progressive muscle relaxation meditative, breathing guided imagery and soft music were employed to promote relaxation.

Manicavasagar (2003) conducted a study to examine socio demographic, psychological and physical health correlation with separation anxiety in the alcoholic subjects. They were determined by structural clinical interview measured by Hamilton anxiety scale. After the relaxation technique the anxiety was reduced.

Sinoff and Werner (2003) reported that to empirically investigate the hypothesis that anxiety was prevalent in the alcoholic patients, interview assisted depression rating scale were used for assessment .in cognitive aspect respective risk of 3.96% risk of impairment were found. A more parsimonious model showed anxiety to have both a direct and indirect effect on predicting future cognitive decline and the indirect effect on memory in cognitive decline due to the result of anxiety. The post treatment mean anxiety scores for the treatment group were significantly lower (P<13.05) than that of the control group.

METHODOLOGY:

STATEMENT OF THE PROBLEM:

A quasi experimental study to determine the effectiveness of progressive muscle relaxation technique among clients with anxiety undergoing alcohol de-addiction.

OBJECTIVES:

1. To assess the level of anxiety among client undergoing alcohol de-addiction

2. Find out the association of selected demographic variables with the level of anxiety.

3. Evaluate the effectiveness of progressive muscle relaxation technique on level of anxiety of study subjects.

HYPOTHESIS:

1. H – there will be a significant association between the level of anxiety and selected demographic variables (age, usage of alcohol per week and usage of alcohol per year)

2. H- there will be a significant difference between the level of anxiety (physiological, psychological, sociological aspects) and before and after progressive muscle relaxation techniques among clients undergoing alcohol de addiction.

RESEARCH APPROACH:

The research approach used for the study is quasi-experimental

Design of the study

The research design, selected for this study is ‘one group pre test-post test (1x02)

01 - pre test to assess the level of anxiety among alcoholic patients

X - Demonstration of practice of progressive muscle relaxation technique

02 - post-test to determine the level of anxiety among alcoholic de-s-addiction clients

A single test group was selected and the dependent variables (anxiety level) was measured before the introduction of the treatment. The treatment or nursing intervention in the form of JPMR (independent variable) was then introduced and again the dependent variables (anxiety level) was measured. the effect of the treatment (independent variable) would be equal to the level of the phenomena mean value after the nursing intervention (K2) minus the level of the phenomena before the nursing intervention (K1). here K is denoted for the dependent variable,

Population:

KAHN (1993) state that population is a group of individual that have one or more characteristics in common that is of interest to the researcher, the study population comprises of all alcoholics who undergo de-addiction treatment in selected rehabilitation centers.

Sample:

Clients who undergo alcoholic de-addiction in selected rehabilitation centers at Madurai

Sample Size:

The sample size consists of 60 clients who have undergone alcoholic de- addiction therapy.

Sampling Creteria:

Inclusion Criteria:

1. Clients who are undergoing alcoholic de-addiction therapy.

2. Male clients only.

Exclusion Criteria:

1. Those who are not willing to participate

2. Those who will not be able to perform the progressive muscle relaxation

3. Those who will not be able to follow Tamil language /English language

Sampaling Technique:

Samples for this study were selected through purposive sampling technique. Purposive sampling is a non probability sampling method in which the researcher selects participants based on personal judgment about which ones will be the most representative or informative, it is also called judgmental sampling.

Development of The Tool:

The tool consists of two sections

SECTION A: Demographic data

SECTION B: Semi structured Questionnaire

SECTION A: Demographic variables of the alcoholic de-addiction patients including age, religion, education, locality, occupation, usage of alcohol and percentage of alcohol consumed are included.

SECTION B: This section consists of 30 items divided in 3 parts viz

Part A: Consisting of 10 questions regarding physical aspects

Part B: Consists of 10 questions regarding psychological aspects

Part C: Consists of 10 questions regarding social aspects/

SCORING PROCEDURE:

The 30 items in section B are built on a 4 point ordinal type scale which has options such as not- present, Rare, Often, Always. with a score of 1,2,3,4, Respectively, a maximum score of 120 can be obtained against a minimum score of 1.

1-30 –normal anxiety level.

31-60 mild anxiety level

61-90 moderate level

91-120 severe anxiety level

RELIABILITY:

Test and retest method applied to verify the reliability of the tool. The reliability of the tool was computed by Spearman coefficient –correlation method r= 0.08 was high positive, The semi structured questionnaire was found to be reliable.

Plan for Data Analysis:

Systematically collected raw would be analyzed and processed using percentage mean and standard deviation to find out comparison of pre and post assessment of anxiety level.

Technique of Data Collection:

The data collection procedure has been completed in two stages, first before (prior to) the nursing intervention (JPMR) and after the nursing intervention from the study subjects. Each subjects had six week sessions. First session included introduction of self, establishment of rapport, explanation regarding the purpose and nature of the study and the benefit of participating during the whole study programmer.

After the initial session on progressive muscle relaxation technique, the patients practiced regularly for 30 minutes every day for week. On the eight day post test was conducted by using the semi structured questionnaire. Anxiety level was measured after post test.

Data on anxiety level among alcoholic de-addiction clients in selected rehabilitation centers.

Table 1: Frequency and Percentage Distribution of Level of Anxiety Among Alcoholic DE-Addiction clients In Selected Rehabilitation Centers. N= 60

Level of anxiety	Pre test		Post test
	No	%	No	%
Mild	1	1.7	33	55
Moderate	58	96.6	27	45
Severe	1	1.7	0	0
Total	60	100	60	100

This table shows that among 60 subjects, 58(96.6%) were having moderate anxiety during pretest. After progressive muscle relaxation technique about 27 (45%) were in the moderate level and 33(55%) were in mild anxiety

Table No 2: Association between level of anxiety and age N=60

Age in Years		Level of anxiety					Chi square
	Mild		Moderate		Severe
	No %		No %		No %
20-30	10	16.66	9	15.00	0	0
30-40	15	25.00	9	15.00	0	0	0.289
40-50	4	6.66	7	11.66	0	0	N. S.
50 and above	4	6.66	2	3.33	0	0	P<.05

Table 3 shows the association between the level of anxiety and age of alcoholic de-addiction clients in selected rehabilitation centers. Chi square 0.289 (P<0.05) shows that there is no association between level of anxiety and age of alcoholic de-addiction clients in selected rehabilitation centers.

It is inferred that there is no significant association between level of anxiety and age of alcoholic de-addiction clients in selected rehabilitation centers. Therefore the null hypothesis was accepted and the research hypothesis was rejected.

Table No 3: Association between level of anxiety and usage of alcohol per week N=60

Usage of alcohol per week	Level of anxiety						Chi square
	Mild		Moderate		Severe
	No %		No %		No %
1-2 times	9	15.00	9	15.00	0	0
3-4 times	10	1.66	3	5.00	0	0	436
More than 5 times	14	23.33	15	25.00	0	0	N. S.

Table 2 shows the association between level of anxiety and age of alcoholic de-addiction clients in selected rehabilitation centers.

Chi square 0.289 (P<0.05) shows that there is no association between level of anxiety and age of alcoholic de-addiction clients in selected rehabilitation centers.

Section IV:

Data to evaluate the overall effectiveness of progressive muscle relaxation technique on the level of anxiety

Table 4: Effectiveness of progressive muscle relaxation on physical aspect

Physiological aspect	Mean	Std deviation	“ t” value
Pre test	21.7	3.88	10.5
Post test	11.90	3.511	P>2.000

Paired t” test was compared to find out if there is any significant difference between before and after intervention on physiological aspect of anxiety among alcohol de-addiction clients. The “t” value of 10.5 (P>2.000) shows that there is high significance on physiological aspect.

It is inferred that the progressive muscle relaxation technique has highly influenced the physiological aspects of alcoholic de-addiction clients in selected rehabilitation centers.

Therefore the null hypothesis was rejected the research hypothesis was accepted.

Table5: Effectiveness of progressive muscle relaxation on psychological aspect

Psychological aspect	Mean	Std deviation	t”value
Pre test	25.72	4.38	11.2
Post test	17.27	3.12	P>2000

Paired t” test was compared to find out if there is any significant difference between before and after intervention on psychological aspect of anxiety among alcohol de-addiction clients. The “t” value of 11.2 (P>2.000) shows that there is high significance on physiological aspect.

It is inferred that the progressive muscle relaxation technique has highly influenced the physiological aspects of alcoholic de-addiction clients in selected rehabilitation centers.

Therefore the null hypothesis was rejected the research hypothesis was accepted

Table 6: Effectiveness of progressive muscle relaxation on social aspect

Sociological aspect	Mean	Std deviation	“ t” value
Pre test	28.56	4.84	7.2
Post test	27.88	6.91	P>2.000

Paired t” test was compared to find out if there is any significant difference between before and after intervention on psychological aspect of anxiety among alcohol de-addiction clients. The “t” value of 7.2 (P>2.000) shows that there is high significance on social aspect.

It is inferred that the progressive muscle relaxation technique has highly influenced the physiological aspects of alcoholic de-addiction clients in selected rehabilitation centers.

Therefore the null hypothesis was rejected the research hypothesis was accepted

DISCUSSION:

The first objective of the study was to assess the level of anxiety among alcoholic de-addiction clients.

Semi structured questionnaire was used to assess the level of anxiety among de-addiction patients. Table -1 shows that among 60 subjects 58 (96.6%) were having moderate anxiety during pre-test. After progressive muscle relaxation about 27 subjects (45%) were having moderate anxiety and 33 subjects (55%) had mild anxiety the same study was conducted by Yunpingli, ranran Wang Chen Chen among alcoholic clients in de-addiction centre for 12 week duration. the results depicts that the PMR group showed significant improvement in mental health domain (P<0.05). In contrast, the control group showed no significant improvement in any QOL domain. In conclusion, this study suggests that PMR practice is effective in improving anxiety, depression, and the mental health components of QOL in patients with PAH.

The second objective of the study was to assess the demographic variables with the effectiveness of progressive muscle relaxation technique among de-addiction clients with anxiety

Table 2-shows that Chi square value of .289 shows that in post test there was no significant associating between effectiveness of progressive muscle relaxation technique on anxiety level and age.

Table 3 reveals that Chi-square value of 0.436 showed that there was no significant association between effectiveness of progressive muscle relaxation technique on anxiety level and usage of alcohol per week

The third objective of the study was to evaluate the over all effectiveness of progressive muscle relaxation technique on the level of anxiety in physiological, psychological, sociological aspects among de-addiction clients with anxiety.

As per table no 4 reveals that ‘t’ value 10.5(P>2.000) was statistical significant difference between progressive muscle relaxation technique on the level of onn physiological aspect (Pretest-Post test)

As per table no 5 depicts that ‘t’ value 11.2.(P>2.000) was statistical significant difference between progressive muscle relaxation technique on the level of on psychological effect aspect (Pretest-Post test)

As per table no 6- depicts that ‘t’ value 7.2.(P>2.000) was statistical significant difference between progressive muscle relaxation technique on the level of on psychological effect aspect (Pretest-Post test)

MAJOR FINDINGS OF THE STUDY:

There is a statistical significance in the effectiveness of progressive muscle relaxation technique on the level of anxiety among alcoholic de-addiction clients.

There is no statistically significant association between the effectiveness of progressive muscle relaxation technique on the level of anxiety and the demographic variables of the alcoholic de-addiction clients.

CONCLUSION:

The mental health team nurse play a vital role in the provision of psycho socio therapy. The nurse in the psychiatric are knows that anxiety is the baseline cause for depression and other mental disorder, in alcoholic clients, the progressive muscle relaxation technique is a simple exercise and an easy way of handling the anxiety.

REFERENCES:

1. Carlson C.R: and ventrella M.A Relaxation Training through Muscle stretching procedure: Journal of behaviour therapeutic psychiatry, June 1987;18, (2): 120-126.

2. Deborah Antai–otong: generalized anxiety disorder: Journal if psychosocial Nursing, December 2003;4(12):20-22

3. Green K.D Webster J:and Beiman I: progressive and self induced Relaxatation training: journal of clinical psychology, April 1997; 37 (2):309-315

4. Teena M: Hyper anointing in early sobriety: Journal of Psychological Nursing. Dec.2003;41(912), 23-24

5. Halsband S. A. anxiety and alcoholism; Journal of vertex, January, 2004;15(1):16-21.

Received on 04.12.2020 Modified on 13.01.2021

Int. J. Nur. Edu. and Research. 2021; 9(2):207-212.

DOI: 10.5958/2454-2660.2021.00050.8