Combined Progressive Muscle Relaxation and Mindfulness in Patients with Schizophrenia Experiencing Auditory Hallucinations: A Two-Case Study

Abstract

Auditory hallucinations in schizophrenia remain a challenge in psychiatric nursing, highlighting the need for complementary interventions that support symptom management and patients’ ability to cope with distressing experiences. However, evidence describing the implementation and patient-level responses to combined progressive muscle relaxation (PMR) and mindfulness remains limited. This study aimed to describe the implementation of a combined PMR and mindfulness intervention and the changes in reported hallucinations, observable behaviors, emotional responses, participation, and intervention performance among patients with schizophrenia. A descriptive case study was conducted with two purposively selected male inpatients experiencing active auditory hallucinations in the Sawit Ward of Rumah Sakit Khusus Daerah (RSKD) Dadi, South Sulawesi, Indonesia. Each patient received one 15–20-minute session daily for five consecutive days, with PMR followed by mindfulness. Data were collected through interviews, structured observations, medical record reviews, and information from ward nurses, then analyzed descriptively. Both patients reported feeling calmer and experiencing fewer auditory hallucinations. Patient H reported that the voices were less frequent and easier to ignore and performed the intervention independently by Day 5. Patient R also reported improvement but continued to require guidance and intermittently displayed behaviors associated with responding to internal stimuli. The study’s contribution is a detailed, patient-level account integrating subjective experiences, observable behaviors, and self-management performance. These preliminary findings support considering the combined intervention as a complement to individualized nursing care, while larger comparative studies with validated measures and longer follow-up are needed to establish its effects.