The effect of relaxation therapy on autonomic functioning, symptoms and daily functioning, in patients with chronic fatigue syndrome or fibromyalgia: a systematic review. — CFSMEATLAS
The effect of relaxation therapy on autonomic functioning, symptoms and daily functioning, in patients with chronic fatigue syndrome or fibromyalgia: a systematic review.
Meeus, Mira, Nijs, Jo, Vanderheiden, Tanja et al. · Clinical rehabilitation · 2015 · DOI
Quick Summary
This review looked at whether relaxation techniques like guided imagery and muscle relaxation help people with ME/CFS and fibromyalgia. Researchers examined 13 high-quality studies involving 650 fibromyalgia patients and 88 ME/CFS patients. They found that guided imagery may help with pain relief in the short term, but there wasn't enough evidence to say relaxation techniques work better than other treatment approaches, especially for ME/CFS-related fatigue.
Why It Matters
This systematic review addresses an important gap by synthesizing evidence on relaxation therapies for ME/CFS and fibromyalgia—conditions where patients often seek non-pharmacological symptom management. The findings help clarify which relaxation approaches have actual evidence support, preventing patients from investing time in unproven techniques and guiding researchers toward more effective intervention combinations.
Observed Findings
Guided imagery showed moderate evidence for acute pain relief in fibromyalgia based on single-session studies.
No studies measured effects of relaxation therapy on autonomic nervous system function despite this being a stated review objective.
Multimodal treatment approaches produced better fatigue outcomes than relaxation therapy alone in the three ME/CFS studies examined.
Most other relaxation techniques (progressive muscle relaxation, autogenic training) lacked conclusive evidence for fibromyalgia pain or functioning outcomes.
Considerable heterogeneity existed in visualization content and methodology across guided imagery studies.
Inferred Conclusions
Guided imagery may provide short-term pain relief in fibromyalgia, though mechanisms remain unclear.
Relaxation monotherapy is likely insufficient for ME/CFS fatigue management and should not replace multimodal approaches.
Current evidence does not support relaxation techniques as primary treatments for autonomic dysfunction in these conditions.
More rigorous, standardized research on relaxation interventions in ME/CFS populations is needed before clinical recommendations can be made.
Remaining Questions
Why do relaxation techniques fail to produce measurable autonomic nervous system improvements despite theoretical rationale?
What This Study Does Not Prove
This review does not prove that relaxation therapy is ineffective overall—only that evidence is insufficient for most techniques beyond guided imagery's acute pain effects. It does not establish whether relaxation might benefit as part of multimodal treatment rather than standalone therapy. The very small ME/CFS sample (88 patients across 3 studies) means conclusions about ME/CFS specifically have limited reliability.
Tags
Symptom:PainFatigue
Method Flag:Weak Case DefinitionSmall SampleMixed Cohort