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).