Effectiveness of Relaxation Techniques in Reducing Academic-Related Stress Among Female University Students: A Quasi-Experimental Study

Effectiveness of Relaxation Techniques in Reducing Academic-Related Stress Among Female University Students: A Quasi-Experimental Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of Relaxation Techniques in Reducing Academic-Related Stress Among Female University Students: A Quasi-Experimental Study M Lekhna, Chitra Venkateswaran, Binukumar Bhaskarapillai, Denny John This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7869525/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Objectives To assess the effectiveness of structured relaxation techniques in reducing academic-related stress and improving health-related quality of life among female university students residing in hostel settings. Design and setting: A quasi-experimental, non-randomized controlled trial with a comparator group was conducted among female university students at M.S. Ramaiah University of Applied Sciences, Bengaluru. Out of 1,043 students screened using the Perceived Stress Scale (PSS) and the EQ-5D-5L tool, 60 eligible participants were selected—30 each for the intervention and comparator groups. Results Baseline characteristics, including age and year of study, were comparable between the groups (p > 0.01). The intervention group showed a significant reduction in stress (PSS median: 21 to 20; p < 0.001; r = 0.22) and improved quality of life (EQ-5D-5L: 0.73 to 0.83; p < 0.001; r = 0.87). Conversely, the comparator group exhibited increased stress (PSS: 20 to 22; p < 0.001; r = 0.78) and no significant QoL change. Difference-in-Differences analysis indicated a net improvement in the intervention group (PSS: − 3; EQ-5D-5L: +0.10). Conclusion Relaxation techniques effectively reduced academic-related stress and enhanced quality of life. Academic stress Relaxation techniques Female university students Quality of life Perceived Stress Scale Quasi-experimental study Figures Figure 1 What is already known? Female university students face higher academic stress from psychological, physiological, and socio-cultural factors, impacting performance, mental health, and well-being. Progressive Muscle Relaxation is one of the most studied and effective relaxation methods in the literature. There is value of gender-matched interventions fostering trust, relatability, and engagement, promoting female-focused engagement for comfort, empathy, and stress management. What this paper adds? This study provides initial evidence on how structured relaxation techniques—Box Breathing, Guided Imagery, and Progressive Muscle Relaxation—can reduce academic stress and improve quality of life among female university students, marking one of the first studies in India to do so. One of the primary strengths is the use of a quasi-experimental design and validated tools—the Perceived Stress Scale and EQ-5D-5L—which enhance the validity and reliability of the study. The study's findings highlight the vital role of school- and college-based nurses in promoting the mental well-being of adolescents and young adults, with implications for healthcare services. Introduction Stress is an internal response to overwhelming physical or environmental demands (Manansingh et al., 2019a ). Stress refers to pressure exceeding coping ability; defined physiologically and psychologically.(Manansingh et al., 2019a ). Stress is psychological distress or stimuli disrupting behaviour and equilibrium.(Manansingh et al., 2019a ). Stress involves complex psychological and physiological responses interacting with environmental factors.(Muhammad Khir et al., 2024 ).Academic stress is a systematic, adaptive psychological process that happens in learning contexts when students encounter difficulties and find them stressful. It is an issue that is harmful in many different places (Iqra, 2024 ). Academic stress stems from heavy workload, competitive exams, disinterest in learning, and challenges, shaped by students’ perceptions and coping abilities(Jun & Choi, 2015 ; Li et al., 2023 ; Wunsch et al., 2017 ). Box breathing, also known as tactical breathing, to reduce stress and enhance performance. It is characterised by equal inhale, hold, and exhale ratios (Balban et al., 2023 ; Del Negro et al., 2018 ; Röttger et al., 2021 ). Guided imagery and progressive muscle relaxation (PMR) are effective techniques for reducing stress. Guided imagery uses vivid mental images to replace distressing thoughts, enhancing sensory engagement. PMR involves consciously tensing and relaxing muscle groups, helping individuals identify physical tension. It is affordable, self-guided, and beneficial for reducing anxiety, stress, and depression.(Lanier, 1930 ; Muhammad Khir et al., 2024 ) Female university students face higher academic stress due to psychological, physiological, and socio-cultural factors, affecting performance, mental health, and well-being.(Graves et al., 2021 ). Academic workload, societal expectations, and emotion-focused coping strategies contribute to this disparity, making female students more vulnerable to stress-related health issues (Gefen & Fish, 2012 ). Academic stress in females is associated with emotional eating, elevated cortisol levels, and psychological distress (Barbayannis et al., 2022 ). Cultural norms and dual responsibilities increase stress in female students, with 57% reporting anxiety compared to 40% of male students, which affects academic performance. (Graves et al., 2021 ). This heightened stress can negatively impact academic performance and overall well-being (Graves et al., 2021 ). Female-led interventions have been shown to improve outcomes among women in Nepal and India (Neupane et al., 2016 ). Similarly, the Intervention for health enhancement and living (iHEAL) trial in Canada, a woman-led intervention, significantly improved mental health outcomes among female survivors of violence (Ford-Gilboe et al., 2024 ; Varcoe et al., 2021 ). These findings support the value of gender-matched interventions that foster trust, relatability, and engagement, promoting female-focused engagement for comfort, empathy, and effective stress management. Among the relaxation methods reviewed from published literature, Progressive Muscle Relaxation emerged as one of the most widely studied and consistently effective. Progressive Muscle Relaxation works by inducing a state of deep relaxation through sequential tensing and relaxing of muscle groups, which in turn reduces autonomic arousal associated with stress (Anuar, 2019). In a quasi-experimental study, the application of Progressive Muscle Relaxation among medical students over 4 weeks resulted in significant reductions in Perceived Stress Scale (PSS) scores post-intervention. Decreased anxiety levels among Indonesian medical students following Progressive Muscle Relaxation. The consistency across these studies supports Progressive Muscle Relaxation’s potential as a foundational stress management tool in university contexts (Anuar, 2019; Yüksel & Bahadır Yılmaz, 2020a; Carisa & Wahyuni, 2022a; Raj & Tripathi, 2023; Hasan, 2024; Roozbahani, Nourian, & Saatchi, 2017). Guided imagery and box breathing, although less studied than PMR and mindfulness, are promising techniques worth further exploration (Antony and Prasad, 2023). Guided imagery is a cognitive-behavioural strategy that involves envisioning calming scenarios to elicit a relaxation response, whereas box breathing uses a four-step breathing pattern to regulate physiological arousal. Included box breathing within a composite relaxation program and observed moderate reductions in stress levels among health science students(Hasan, 2024). However, the lack of isolated interventions leaves a gap in identifying the specific effects of each technique (Hasan, 2024). Validated instruments such as the Perceived Stress Scale and EuroQol 5-Dimension 5-Level (EQ-5D-5L) are widely used in stress research. The PSS measures perceived stress based on self-reported responses, while EQ-5D-5L captures health-related quality of life across five domains—the reliability and sensitivity of PSS in measuring changes in stress following guided relaxation sessions among undergraduate students. However, the application of these tools remains limited in Indian studies, highlighting the need for context-specific validation (Hasan, 2024; Milner, 2025). Given this evidence, this study focuses on female students to provide targeted interventions that address their unique stress-related challenges and contribute to improving their mental health and academic performance. By incorporating structured relaxation techniques, including Progressive Muscle Relaxation, Box Breathing, and Guided Imagery, this study aims to evaluate the effectiveness of these interventions in mitigating academic-related stress among female university students. This study, employing a quasi-experimental design, aimed to evaluate the effectiveness of structured relaxation techniques, led by a female researcher, in reducing academic-related stress and enhancing health-related quality of life (HRQoL) among female university students residing in hostel settings. Methods Study design and participants A quasi-experimental controlled trial was conducted at MS Ramaiah University of Applied Sciences, Bengaluru, to assess the effectiveness of relaxation techniques in reducing academic-related stress among female university students. The study setting was selected through purposive sampling, with two of the university’s three girls' hostels—Sapthagiri (intervention group) and Gomati (comparator group)—chosen based on administrative approval and feasibility. An initial pool of 1,043 students residing in the selected hostels was considered. Eligible participants were identified through baseline screening using the Perceived Stress Scale and EQ-5D-5L tools. Students scoring between 14 and 40 on the Perceived Stress Scale (moderate to high stress) and with an EQ-5D-5L score below 0.8 were included. Those who regularly practised relaxation techniques or were unwilling to participate were excluded. If more than 30 eligible students were identified in a group, final selection was done using alphabetical ordering to limit the sample size to 30 per group (total n = 60). The intervention group received structured relaxation sessions that included box breathing, guided imagery, and progressive muscle relaxation over a four-week period, conducted by a female researcher trained in these techniques as part of her Master of Public Health (MPH) dissertation research project. The comparator group received no intervention. Both groups were assessed pre- and post-intervention using the same tools to evaluate changes in perceived stress and quality of life within a controlled hostel-based environment. Sample size was calculated based on an expected medium effect size (Cohen's d) of 0.5 on reduction in academic-related stress among female university students and a standard deviation of 10 (Hasan et al., 2024 ). Furthermore, for a statistical power of 80% to detect significant differences in the study and a level of significance of 5%, the minimum sample size required is approximately 22 participants per group in the paired design As the researchers anticipated a dropout rate of around 20–25%, the final target sample size was 30 participants per group. G*Power version 3.1.9.7 software was used to calculate the sample size. Instruments The Perceived Stress Scale and EQ-5D-5L tools, validated in India, demonstrate strong reliability and validity for assessing stress and quality of life. The PSS demonstrates high internal consistency (α = 0.80–0.89), while the EQ-5D-5L shows acceptable reliability (α = 0.70–0.79), making both suitable for evaluating intervention outcomes in this study. Data collection procedures The data collection was conducted in April 2025 among female university students at MS Ramaiah University of Applied Sciences, Bengaluru. At baseline and immediately post-intervention, participants used validated questionnaires in a quiet, supervised setting to ensure confidentiality and reduce distractions. Participants were assured of anonymity and informed that there would be no academic consequences or financial benefits. Brief instructions were given to clarify the study's purpose. Although video and audio recordings were initially planned for process documentation, this was not feasible due to lack of permission from hostel authorities and participants’ discomfort. Instead, still photographs were taken with consent to document the sessions. Endline data for the intervention group were collected on Day 1 after the final session, and for the comparator group on Day 2, ensuring timely evaluation while minimising external influences. Implementation Intervention group Eligible female university students aged 18 and above were screened using the Perceived Stress Scale and EQ-5D-5L. Those scoring above 14 on the PSS and below 0.8 on the EQ-5D-5L were enrolled with informed consent. A structured four-week intervention comprising 20 sessions (5 sessions/week) was conducted. Each session (30–45 minutes) included Box Breathing (5–7 minutes), Guided Imagery (10–15 minutes), and Progressive Muscle Relaxation (15–20 minutes), delivered in a consistent format by the principal investigator. Sessions took place in a quiet room, with a minimum attendance of 75% required. Following the intervention, both groups were reassessed using the same tools, and feedback was collected. Comparator Group The comparator group continued with their regular academic routines and did not receive any structured intervention during the study period, and underwent pre- and post-test assessments using the Perceived Stress Scale and EQ-5D-5L tools. Data analysis This quasi-experimental study analysed individual-level data using R software (version 4.5.0). Pre- and post-intervention scores for the Perceived Stress Scale and EQ-5D-5L were assessed. Baseline characteristics were compared using Chi-square and Fisher’s exact test, as appropriate. For within-group comparisons, due to non-normal distribution confirmed by the Shapiro–Wilk test, the Wilcoxon signed-rank test was used. For between-group comparisons, the Mann–Whitney U test was applied. Analysis of Covariance (ANCOVA) was used to adjust for baseline covariates and control for confounding factors. Effect sizes (r) were calculated for the PSS and EQ-5D-5L to evaluate the magnitude of change. Additionally, median change and Percentage Change Were computed for within-group comparisons to quantify the practical significance of the improvements. For analyzing the difference in outcomes between the intervention and comparator groups over time, a Difference-in-Differences (DiD) approach was employed to assess the net intervention effect by accounting for baseline differences. Ethical aspects The study received ethical approval from the University Ethics Committee for Human Trials at MS Ramaiah University of Applied Sciences, Bangalore (EC-25/38-PG-FLAHS) (Appendix A) and was registered with the Clinical Trials Registry of India (CTRI) (CTRI/2025/04/085705). Written informed consent was obtained from all participants, and ethical guidelines by the Indian Council of Medical Research (ICMR) were strictly followed to ensure confidentiality and participant welfare.(Mathur & Swaminathan, 2018 ) Results A total of 1,043 female university students were considered for the study, with 590 residing in Hostel 1 (intervention group) and 453 in Hostel 2 (comparator group). From these, informed consent was obtained from 100 students (50 from each hostel). Based on inclusion and exclusion criteria, 60 participants were enrolled—30 in each group. Baseline assessment was conducted using the Perceived Stress Scale for academic-related stress and EQ-5D-5L for quality of life. The intervention group received structured relaxation techniques including Box Breathing (5–7 minutes), Guided Imagery (10–15 minutes), and Progressive Muscle Relaxation (PMR) (15–20 minutes), delivered over 20 sessions across 4 weeks (5 days per week, 30–45 minutes per session). The comparator group did not receive any intervention and continued with their usual routine. Post-intervention (endline) data collection included reassessment using Perceived Stress Scale and EQ-5D-5L for both groups, and feedback was collected from the intervention group (Figure 1). Participants in both groups were primarily within the 18–23 years age range (Table 1) . In the intervention group, 11 participants (36.6%) were aged 18–20 years, and 16 (53.3%) were aged 21–23 years. In the comparator group, 13 (43.3%) and 16 (53.3%) fell into these age categories, respectively. A small number of participants in both groups were aged 24–26 years. No statistically significant difference was found in age distribution between the groups (p = 0.55). There was a significant difference in the distribution of participants’ academic fields between the two groups (Fisher’s Exact Test, p < 0.001). The intervention group consisted of students from B.Pharm (6.6%), BSc Anesthesia and Operation Theatre Technology (AOTT) (3.3%), BSc Nursing (46.6%), and GNM (43.3%), while the comparator group primarily comprised MBBS students (93.3%) and a small proportion from Bachelor of Physiotherapy (BPT) (6.6%). Given the unequal distribution of academic fields, ANCOVA was performed to adjust for its potential confounding effect. The adjusted post-test scores showed no significant difference for PSS (p = 0.8) and EQ-5D-5L (p = 0.10) after controlling for academic field. Majority of participants in both groups were in their 1st and 2nd years. In the intervention group, 6 (20%) were in their 1st year, 13 (43.3%) in 2nd year, 8 (26.6%) in 3rd year, and 3 (10%) in the 4th year. In the comparator group, 10 (33.3%) were in 1st year, 11 (36.6%) in 2nd year, 6 (20%) in 3rd year, and 3 (10%) in the 4th year. The difference was not statistically significant (p = 0.69). Table 1: Baseline Demographic Characteristics Characteristics Intervention group (n=30) Frequency (n), % Comparator group (n=30) Frequency (n), % P value Age 18-20 11(36.6%) 13(43.3%) 0.55 21-23 16(53.3%) 16(53.3%) 24-26 3(10%) 1(3.3%) Field of study B Pharm 2(6.6%) - < 0.001 BPT - 2(6.6%) BSc AOTT 1(3.3%) - BSc Nursing 14(46.6%) - GNM 13(43.3%) - MBBS - 28(93.3) Year of studying 1 6(20%) 10(33.3) 0.69 2 13(43.3%) 11(36.6%) 3 8(26.6%) 6(20%) 4 3(10%) 3(10%) Abbreviations: B Pharm – Bachelor of Pharmacy; BPT – Bachelor of Physiotherapy; BSc AOTT – Bachelor of Science in Anaesthesia and Operation Theatre Technology; BSc Nursing – Bachelor of Science in Nursing; GNM – General Nursing and Midwifery; MBBS – Bachelor of Medicine and Bachelor of Surgery, %- Percentage At baseline, the median Perceived Stress Scale score for the intervention group was 21 (IQR = 4.75), which decreased to 20 (IQR = 3.75) post-intervention, indicating a median reduction of 1 point and a 4.8% decrease in perceived stress levels. The within-group comparison using the Wilcoxon signed-rank test showed this reduction to be statistically significant (Z = 1.24, p < 0.001), with a small effect size (r = 0.22) (Table 2). In contrast, the comparator group exhibited an increase in stress levels, with the median PSS score rising from 20 (IQR = 4) at baseline to 22 (IQR = 4.5) post-intervention, reflecting a median increase of 2 points and a 10% rise in perceived stress. This change was also statistically significant (Z = -4.29, p < 0.001), with a large effect size (r = 0.78), indicating a worsening of stress levels in the absence of intervention. In the intervention group, the EQ-5D-5L index score increased from a median of 0.734 (IQR = 0.06) at baseline to 0.83 (IQR = 0.12) post-intervention, representing a 0.10-point increase and a 13.7% improvement in perceived quality of life. This improvement was statistically significant (Z = 4.79, p < 0.001), with a large effect size (r = 0.87). The comparator group, however, showed negligible change, with the median EQ-5D-5L score shifting only slightly from 0.761 (IQR = 0.03) to 0.763 (IQR = 0.11), resulting in 0% change. This difference was not statistically significant (Z = -1.56, p = 0.85), and the effect size was small (r = 0.28). Table 2: Within-Group Comparison Outcome Variable Groups (N=30) Pre Median (IQR) Post Median (IQR) Median Change % Change Statistical analysis PSS Intervention 21 (4.75) 20 (3.75) ↓1 ↓4.8% Z = 1.24 p < .001 r = 0.22 EQ-5D-5L 0.734 (0.06) 0.8355 (0.12) ↑0.10 ↑13.7% Z = 4.79 p < .001 r =0.87 PSS Comparator 20 (4) 22 (4.5) ↑2 ↑10% Z = -4.29 p < .001 r = 0.78 EQ-5D-5L 0.761 (0.03) 0.7635 (0.11) 0.00 0% Z = -1.56 p = 0.85 r = 0.28 Abbreviations: EQ-5D-5L-EuroQol 5 Dimensions, 5 Levels; IQR – Interquartile Range; n- Sample Size; p- Probability Value; PSS – Perceived Stress Scale; r – Effect Size; Z- Standardized Test Statistic At the baseline, the intervention group reported a median Perceived Stress Scale score of 21 (IQR = 4.75), while the comparator group had a median of 20 (IQR = 4) (Table 3). The difference between the groups was statistically significant (Z = 2.90, p = 0.004), with a moderate effect size (r = 0.37), indicating slightly higher perceived stress in the intervention group at baseline. At the post-test, the intervention group showed a decrease in stress, with a median score of 20 (IQR = 3.75), whereas the comparator group exhibited an increase, with a median score of 22 (IQR = 4.5). The between-group difference at post-test was also statistically significant (Z = -2.49, p = 0.01), with a moderate effect size (r = 0.32). The Difference-in-Differences (DiD) for PSS was −3, indicating a meaningful reduction in stress levels in the intervention group compared to the comparator group. At baseline, the intervention group had a median EQ-5D-5L score of 0.734 (interquartile range [IQR] = 0.06), while the comparator group had a slightly higher median of 0.76 (IQR = 0.03). This baseline difference was statistically significant (Z = -2.57, p = 0.01), with a moderate effect size (r = 0.33). At post-test, the intervention group showed a significant improvement in quality of life, with a median score of 0.83 (IQR = 0.12), compared to 0.76 (IQR = 0.11) in the comparator group. This difference was statistically significant (Z = 2.90, p = 0.004), with a moderate effect size (r = 0.37). The DiD for EQ-5D-5L was +0.10, indicating a substantial improvement in the intervention group’s perceived quality of life relative to the comparator group. Table 3: Between-Group Comparison Outcome Variable (N=30) Intervention Median (IQR) Comparator Median (IQR) DiD Statistical analysis Pre-test- PSS (IBP vs CBP) 21(4.75) 20(4) −3 Z = 2.90 p = 0.004 r = 0.37 Post-test- PSS (IEP vs CEP) 20 (3.75) 22(4.5) Z = -2.49 p = 0.01 r = 0.32 Pre-test- EQ-5D-5L (IBQ vs CBQ) 0.73(0.06) 0.76(0.03) +0.10 Z = -2.57 p = 0.01 r = 0.33 Post-test- EQ-5D-5L (IEQ vs CEQ) 0.83(0.12) 0.76(0.11) Z = 2.90 p = 0.004 r = 0.37 Abbreviations: CBP – Comparator Baseline Perceived Stress Scale; CBQ – Comparator Baseline Quality of Life; CEP – Comparator Endline Perceived Stress Scale; CEQ – Comparator Endline Quality of Life; DiD- Difference-in-Differences; EQ-5D-5L-EuroQol 5 Dimensions, 5 Levels; IBP – Intervention Baseline Perceived Stress Scale; IBQ – Intervention Baseline Quality of Life; IEP – Intervention Endline Perceived Stress Scale; IEQ – Intervention Endline Quality of Life; IQR – Interquartile Range; n- Sample Size; p- Probability Value ; PSS – Perceived Stress Scale; QoL- Quality of Life; r – Effect Size; Z- Standardized Test Statistic Discussion This quasi-experimental study evaluated the effectiveness of relaxation techniques in reducing academic-related stress and improving the quality of life among female university students. The findings revealed that the intervention group experienced a significant reduction in perceived stress and a substantial improvement in quality of life. In contrast, the comparator group exhibited a significant increase in stress, with no meaningful improvement in quality of life. These outcomes are consistent with previous literature supporting the utility of relaxation-based interventions in academic settings. The observed reduction in perceived stress levels in the intervention group aligns with findings from a meta-analysis and reported that stress management interventions, particularly those incorporating relaxation techniques, were effective in reducing stress among university students(Regehr et al., 2013). In the current study adds to this by demonstrating that even short-term, guided relaxation techniques can yield measurable improvements in stress levels, as evidenced by a statistically significant reduction in PSS scores and a moderate effect size ( r = 0.323) post-intervention. Similarly, structured relaxation practices significantly reduced both academic stress and test anxiety in nursing students(Manansingh et al., 2019b). In the current study, nursing and allied health students who received the intervention also demonstrated improved stress profiles and enhanced quality of life scores, highlighting the generalizability of such interventions across health science disciplines. Moreover, the results are supported by a previous study among nursing students in Bengaluru who noted the benefits of relaxation techniques in reducing stress among nursing students (Wosser et al., 2020). Although their study lacked a control group, our findings strengthen their conclusions by incorporating a comparator group and using both within- and between-group statistical comparison. The improvement in quality of life among participants in the intervention group is particularly notable. Our findings mirror those of , who reported that various relaxation strategies, including guided imagery and breathing techniques, significantly enhanced the well-being of health sciences students by reducing academic-related stress (Toussaint et al., 2021). In our study, the EQ-5D-5L scores in the intervention group improved significantly (from 0.734 to 0.8355), with a large effect size ( r = 0.875), suggesting a meaningful impact on participants' overall quality of life. This is in contrast with the findings in the comparator group, which saw no significant changes, thereby reinforcing the effectiveness of the intervention. An important consideration in interpreting the results is the unequal distribution of the field of study between the two groups. While the intervention group comprised students from diverse health disciplines, the comparator group primarily included MBBS students. Given that stress levels and coping mechanisms may vary by academic program, this was accounted for using ANCOVA to adjust for baseline differences in the outcome variables. The adjustment further validates the reliability of the intervention's effect. Additionally, although the year of study distribution did not differ significantly between groups, the academic year may still influence stress due to varying academic demands. Nonetheless, the consistent direction and significance of our results across both stress and quality of life measures strengthen the internal validity of the findings. This study followed Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) guidelines to ensure transparent reporting of quasi-experimental public health interventions.(Haynes et al., 2021). Despite the positive outcomes, certain limitations warrant discussion. The sample size, although adequate for statistical analysis, was drawn from a single university setting, which potentially limits the generalizability of the findings to broader student populations. Additionally, the use of self-reported measures—though standardized and validated—introduces the possibility of response, social desirability and recall biases. Another important consideration is that while the intervention showed a significant impact, the effect size for stress reduction was moderate. This suggests that while relaxation techniques were effective, they may benefit from being combined with other supportive strategies, such as cognitive-behavioural training, peer support, or academic counselling, for a greater impact. The intervention period was short, and assessments were conducted only immediately post-intervention, with no follow-up at later time points such as 3 or 6 months. This limits understanding of long-term effects. Future research should consider conducting larger, multi-centre trials with diverse academic disciplines and extended follow-up periods to assess the long-term sustainability of relaxation technique benefits. Furthermore, tailored interventions that target students with moderate stress—rather than waiting for high stress levels to manifest—may serve as a proactive approach to mental health promotion in university settings. The unequal distribution of academic disciplines across the groups may have introduced confounding variables. Lastly, the study focused only on female hostel residents, which may reduce applicability to male or non-residential students. This study provides preliminary evidence on the effectiveness of structured relaxation techniques—Box Breathing, Guided Imagery, and Progressive Muscle Relaxation—in reducing academic-related stress and enhancing quality of life among female university students. One of the primary strengths is the use of a quasi-experimental design and validated measurement tools—the Perceived Stress Scale and the EQ-5D-5L—which strengthen internal validity and reliability. The study achieved full participant retention (100%), with no attrition reported during the intervention period. This consistency supports the robustness of the findings. Statistically significant improvements in stress and quality of life were observed both within and between groups, with effect size calculations indicating a small to moderate effect for the Perceived Stress Scale and a larger effect for the EQ-5D-5L. These results suggest the potential for broader application of the intervention in similar academic settings. Moreover, the study adds culturally relevant insights to the limited evidence base on mental health interventions for university students in low- and middle-income countries. Implications to Practice The findings from this study have valuable implications for school and college health services, particularly emphasizing the vital role of school- and college-based nurses in promoting the mental well-being of adolescents and young adults. Structured relaxation techniques, including Box Breathing, Guided Imagery, and Progressive Muscle Relaxation, have demonstrated effectiveness in reducing academic-related stress and improving the quality of life among female university students. These techniques are low-cost, easy to implement, and can be integrated into daily routines within educational environments. School and college nurses are uniquely positioned to lead such interventions, offering individual or group-based relaxation sessions within hostel settings, wellness centres, or health units. Their trusted role within the educational system allows them to identify students at risk of academic stress, deliver timely interventions, and monitor ongoing outcomes. Nurses can also collaborate with educators and mental health counsellors to incorporate relaxation strategies into broader student wellness programs and orientation activities. From a policy standpoint, the inclusion of nurse-led mental health interventions in institutional health guidelines can ensure sustainability and accessibility. Educational institutions should recognize and support the capacity of nurses to contribute to mental health promotion, especially in low-resource and high-stress academic environments. Additionally, school and college nurses can lead further research, advocate for integrated stress management policies, and facilitate cross-sector collaboration to promote a holistic and preventive approach to student mental health. Conclusion This study demonstrated that structured relaxation techniques are effective in reducing academic-related stress and improving quality of life among female university students. The intervention group showed a statistically significant reduction in perceived stress levels and a marked improvement in quality of life scores post-intervention, while the comparator group experienced increased stress and no significant improvement in quality of life. These findings support the integration of relaxation practices into student wellness programs, particularly in high-stress academic environments, to promote better mental health and overall well-being. Declarations Clinical Trial Number: Clinical Trials Registry of India (CTRI) Registration: CTRI/2025/04/085705) Funding : This research was conducted without any specific grant support from public, commercial, or not-for-profit funding agencies. Ethical approval : This study was approved by University Ethics Committee for Human Trials at M. S. Ramaiah University of Applied Sciences, Bangalore (20.03.2025), in accordance with Indian Council of Medical Research and Declaratin of Helsinki guidelines. Data Availability : The datasets generated and analysed during the current study are available from the corresponding author upon reasonable request. Declaration of Competing Interest : The authors declare that they have no known competing financial or non-financial interests that could have appeared to influence the work reported in this paper. Consent to publication : Obtained from patients as part of informed consent. Contributions ML & DJ conceived the study. ML is the lead researcher responsible for conducting the intervention, data collection, data analysis and manuscript writing. DJ provided methodological expertise and reviewed the draft manuscript prepared by ML. BB provided statistical validation. CV provided clinical validation. All authors reviewed and agreed on the final manuscript. Acknowledgements: The authors acknowledge the patients who provided consent to participate in this study. References Balban MY, Neri E, Kogon MM, Weed L, Nouriani B, Jo B, Holl G, Zeitzer JM, Spiegel D, Huberman AD. Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Rep Med. 2023;4(1):100895. https://doi.org/10.1016/j.xcrm.2022.100895 . Barbayannis G, Bandari M, Zheng X, Baquerizo H, Pecor KW, Ming X. Academic Stress and Mental Well-Being in College Students: Correlations, Affected Groups, and COVID-19. Front Psychol. 2022;13:886344. https://doi.org/10.3389/fpsyg.2022.886344 . Del Negro CA, Funk GD, Feldman JL. Breathing matters. Nat Rev Neurosci. 2018;19(6):351–67. https://doi.org/10.1038/s41583-018-0003-6 . Ford-Gilboe M, Varcoe C, Scott-Storey K, Browne AJ, Jack SM, Jackson K, Mantler T, O’Donnell S, Patten-Lu N, Smye V, Wathen CN, Perrin N. Longitudinal effectiveness of a woman-led, nurse delivered health promotion intervention for women who have experienced intimate partner violence: iHEAL randomized controlled trial. BMC Public Health. 2024;24(1):398. https://doi.org/10.1186/s12889-023-17578-4 . Gefen DR, Fish MC. Gender Differences in Stress and Coping in First-Year College Students. J Coll Orientat Transition Retent. 2012;19(2). Article 2. https://doi.org/10.24926/jcotr.v19i2.2797 . Graves BS, Hall ME, Dias-Karch C, Haischer MH, Apter C. Gender differences in perceived stress and coping among college students. PLoS ONE. 2021;16(8):e0255634. https://doi.org/10.1371/journal.pone.0255634 . Hasan S, Anis T, Saeed H, Haidery AB, Shahid G, Intikhab R. Evaluating the impact of relaxation methods on reducing academic-related stress in health sciences students. J Popul Ther Clin Pharmacol. 2024;31(7):615–24. Haynes AB, Haukoos JS, Dimick JB. TREND Reporting Guidelines for Nonrandomized/Quasi-Experimental Study Designs. JAMA Surg. 2021;156(9):879. https://doi.org/10.1001/jamasurg.2021.0552 . Iqra. A systematic – Review of academic stress intended to improve the educational journey of learners. Methods Psychol. 2024;11:100163. https://doi.org/10.1016/j.metip.2024.100163 . Jun S, Choi E. Academic stress and Internet addiction from general strain theory framework. Comput Hum Behav. 2015;49:282–7. https://doi.org/10.1016/j.chb.2015.03.001 . Jyani G, Prinja S, Garg B, Kaur M, Grover S, Sharma A, Goyal A. Health-related quality of life among Indian population: The EQ-5D population norms for India. J Global Health. 2023;13:04018. https://doi.org/10.7189/jogh.13.04018 . Jyani G, Sharma A, Prinja S, Kar SS, Trivedi M, Patro BK, Goyal A, Purba FD, Finch AP, Rajsekar K, Raman S, Stolk E, Kaur M. Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study: The Indian 5-Level Version EQ-5D Value Set. Value Health: J Int Soc Pharmacoeconomics Outcomes Res. 2022;25(7):1218–26. https://doi.org/10.1016/j.jval.2021.11.1370 . Kapasia N, Paul P, Roy A, Das P, Ghosh T, Chouhan P. Perceived academic satisfaction level, psychological stress and academic risk among Indian students amidst COVID-19 pandemic. Heliyon. 2022;8(5):e09440. https://doi.org/10.1016/j.heliyon.2022.e09440 . Lanier LH. (1930). [Review of Review of Progressive Relaxation , by E. Jacobson]. The American Journal of Psychology , 42 (3), 473–475. https://doi.org/10.2307/1415459 Lee E-H. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res. 2012;6(4):121–7. https://doi.org/10.1016/j.anr.2012.08.004 . Li R, Che Hassan N, Saharuddin N. Psychological Capital Related to Academic Outcomes Among University Students: A Systematic Literature Review. Psychol Res Behav Manage. 2023;16:3739–63. https://doi.org/10.2147/PRBM.S421549 . Manansingh S, Tatum SL, Morote E-S. Effects of Relaxation Techniques on Nursing Students’ Academic Stress and Test Anxiety. J Nurs Educ. 2019a;58(9):534–7. https://doi.org/10.3928/01484834-20190819-07 . Manansingh S, Tatum SL, Morote E-S. Effects of Relaxation Techniques on Nursing Students’ Academic Stress and Test Anxiety. J Nurs Educ. 2019b;58(9):534–7. https://doi.org/10.3928/01484834-20190819-07 . Mathur R, Swaminathan S. National ethical guidelines for biomedical & health research involving human participants, 2017: A commentary. Indian J Med Res. 2018;148(3):279–83. https://doi.org/10.4103/0971-5916.245303 . Morgan ES, Umberson K, Hertzog C. Construct validation of self-reported stress scales. Psychol Assess. 2014;26(1):90–9. https://doi.org/10.1037/a0034714 . Muhammad Khir S, Wan Mohd Yunus WMA, Mahmud N, Wang R, Panatik SA, Sukor M, M. S., Nordin NA. Efficacy of Progressive Muscle Relaxation in Adults for Stress, Anxiety, and Depression: A Systematic Review. Psychol Res Behav Manage. 2024;17:345–65. https://doi.org/10.2147/PRBM.S437277 . Neupane D, McLachlan CS, Christensen B, Karki A, Perry HB, Kallestrup P. Community-based intervention for blood pressure reduction in Nepal (COBIN trial): Study protocol for a cluster-randomized controlled trial. Trials. 2016;17:292. https://doi.org/10.1186/s13063-016-1412-3 . Pangtey R, Basu S, Meena GS, Banerjee B. Perceived Stress and its Epidemiological and Behavioral Correlates in an Urban Area of Delhi, India: A Community-Based Cross-Sectional Study. Indian J Psychol Med. 2020;42(1):80–6. https://doi.org/10.4103/IJPSYM.IJPSYM_528_18 . Regehr C, Glancy D, Pitts A. Interventions to reduce stress in university students: A review and meta-analysis. J Affect Disord. 2013;148(1):1–11. https://doi.org/10.1016/j.jad.2012.11.026 . Röttger S, Theobald DA, Abendroth J, Jacobsen T. The Effectiveness of Combat Tactical Breathing as Compared with Prolonged Exhalation. Appl Psychophysiol Biofeedback. 2021;46(1):19–28. https://doi.org/10.1007/s10484-020-09485-w . Toussaint L, Nguyen QA, Roettger C, Dixon K, Offenbächer M, Kohls N, Hirsch J, Sirois F. (2021). Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation. Evidence-Based Complementary and Alternative Medicine: eCAM , 2021 , 5924040. https://doi.org/10.1155/2021/5924040 Varcoe C, Ford-Gilboe M, Browne AJ, Perrin N, Bungay V, McKenzie H, Smye V, Price (Elder R, Inyallie J, Khan K, Dion Stout M. The Efficacy of a Health Promotion Intervention for Indigenous Women: Reclaiming Our Spirits. J interpers Violence. 2021;36(13–14):NP7086–116. https://doi.org/10.1177/0886260518820818 . Wosser T, Mathew B, Idiculla J. A Study to assess the Perceived stress and its contributing factors among nursing students during the initial period of their clinical posting in selected college of nursing, Bengaluru with a view to develop a Preclinical sensitization programme. Int J Adv Nurs Manage. 2020;8(4):331–4. https://doi.org/10.5958/2454-2652.2020.00073.6 . Wunsch K, Kasten N, Fuchs R. The effect of physical activity on sleep quality, well-being, and affect in academic stress periods. Nat Sci Sleep. 2017;9:117–26. https://doi.org/10.2147/NSS.S132078 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 17 Feb, 2026 Reviews received at journal 19 Jan, 2026 Reviewers agreed at journal 22 Dec, 2025 Reviewers agreed at journal 23 Nov, 2025 Reviews received at journal 22 Nov, 2025 Reviewers agreed at journal 18 Nov, 2025 Reviewers invited by journal 18 Nov, 2025 Editor assigned by journal 06 Nov, 2025 Editor invited by journal 27 Oct, 2025 Submission checks completed at journal 16 Oct, 2025 First submitted to journal 16 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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07:05:03","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":123305,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7869525/v1/5f7a6c3b74e895e86b1ae5c5.html"},{"id":97136716,"identity":"78d51b81-b096-42e9-b252-762187c3bc29","added_by":"auto","created_at":"2025-12-01 09:56:55","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":122324,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Figure1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7869525/v1/5f5b20601af05e1a3187d18c.jpeg"},{"id":97144626,"identity":"1a2447fe-ae42-4a03-b17c-92ad514c50a1","added_by":"auto","created_at":"2025-12-01 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interventions fostering trust, relatability, and engagement, promoting female-focused engagement for comfort, empathy, and stress management.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eWhat this paper adds?\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThis study provides initial evidence on how structured relaxation techniques\u0026mdash;Box Breathing, Guided Imagery, and Progressive Muscle Relaxation\u0026mdash;can reduce academic stress and improve quality of life among female university students, marking one of the first studies in India to do so.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOne of the primary strengths is the use of a quasi-experimental design and validated tools\u0026mdash;the Perceived Stress Scale and EQ-5D-5L\u0026mdash;which enhance the validity and reliability of the study.\u003c/li\u003e\n \u003cli\u003eThe study\u0026apos;s findings highlight the vital role of school- and college-based nurses in promoting the mental well-being of adolescents and young adults, with implications for healthcare services.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eStress is an internal response to overwhelming physical or environmental demands (Manansingh et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019a\u003c/span\u003e). Stress refers to pressure exceeding coping ability; defined physiologically and psychologically.(Manansingh et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019a\u003c/span\u003e). Stress is psychological distress or stimuli disrupting behaviour and equilibrium.(Manansingh et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019a\u003c/span\u003e). Stress involves complex psychological and physiological responses interacting with environmental factors.(Muhammad Khir et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).Academic stress is a systematic, adaptive psychological process that happens in learning contexts when students encounter difficulties and find them stressful. It is an issue that is harmful in many different places (Iqra, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Academic stress stems from heavy workload, competitive exams, disinterest in learning, and challenges, shaped by students\u0026rsquo; perceptions and coping abilities(Jun \u0026amp; Choi, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Li et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Wunsch et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBox breathing, also known as tactical breathing, to reduce stress and enhance performance. It is characterised by equal inhale, hold, and exhale ratios (Balban et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Del Negro et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; R\u0026ouml;ttger et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Guided imagery and progressive muscle relaxation (PMR) are effective techniques for reducing stress. Guided imagery uses vivid mental images to replace distressing thoughts, enhancing sensory engagement. PMR involves consciously tensing and relaxing muscle groups, helping individuals identify physical tension. It is affordable, self-guided, and beneficial for reducing anxiety, stress, and depression.(Lanier, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e1930\u003c/span\u003e; Muhammad Khir et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eFemale university students face higher academic stress due to psychological, physiological, and socio-cultural factors, affecting performance, mental health, and well-being.(Graves et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Academic workload, societal expectations, and emotion-focused coping strategies contribute to this disparity, making female students more vulnerable to stress-related health issues (Gefen \u0026amp; Fish, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Academic stress in females is associated with emotional eating, elevated cortisol levels, and psychological distress (Barbayannis et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Cultural norms and dual responsibilities increase stress in female students, with 57% reporting anxiety compared to 40% of male students, which affects academic performance. (Graves et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This heightened stress can negatively impact academic performance and overall well-being (Graves et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFemale-led interventions have been shown to improve outcomes among women in Nepal and India (Neupane et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Similarly, the Intervention for health enhancement and living (iHEAL) trial in Canada, a woman-led intervention, significantly improved mental health outcomes among female survivors of violence (Ford-Gilboe et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Varcoe et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). These findings support the value of gender-matched interventions that foster trust, relatability, and engagement, promoting female-focused engagement for comfort, empathy, and effective stress management.\u003c/p\u003e\u003cp\u003eAmong the relaxation methods reviewed from published literature, Progressive Muscle Relaxation emerged as one of the most widely studied and consistently effective. Progressive Muscle Relaxation works by inducing a state of deep relaxation through sequential tensing and relaxing of muscle groups, which in turn reduces autonomic arousal associated with stress (Anuar, 2019). In a quasi-experimental study, the application of Progressive Muscle Relaxation among medical students over 4 weeks resulted in significant reductions in Perceived Stress Scale (PSS) scores post-intervention. Decreased anxiety levels among Indonesian medical students following Progressive Muscle Relaxation. The consistency across these studies supports Progressive Muscle Relaxation\u0026rsquo;s potential as a foundational stress management tool in university contexts (Anuar, 2019; Y\u0026uuml;ksel \u0026amp; Bahadır Yılmaz, 2020a; Carisa \u0026amp; Wahyuni, 2022a; Raj \u0026amp; Tripathi, 2023; Hasan, 2024; Roozbahani, Nourian, \u0026amp; Saatchi, 2017). Guided imagery and box breathing, although less studied than PMR and mindfulness, are promising techniques worth further exploration (Antony and Prasad, 2023). Guided imagery is a cognitive-behavioural strategy that involves envisioning calming scenarios to elicit a relaxation response, whereas box breathing uses a four-step breathing pattern to regulate physiological arousal. Included box breathing within a composite relaxation program and observed moderate reductions in stress levels among health science students(Hasan, 2024). However, the lack of isolated interventions leaves a gap in identifying the specific effects of each technique (Hasan, 2024).\u003c/p\u003e\u003cp\u003eValidated instruments such as the Perceived Stress Scale and EuroQol 5-Dimension 5-Level (EQ-5D-5L) are widely used in stress research. The PSS measures perceived stress based on self-reported responses, while EQ-5D-5L captures health-related quality of life across five domains\u0026mdash;the reliability and sensitivity of PSS in measuring changes in stress following guided relaxation sessions among undergraduate students. However, the application of these tools remains limited in Indian studies, highlighting the need for context-specific validation (Hasan, 2024; Milner, 2025).\u003c/p\u003e\u003cp\u003eGiven this evidence, this study focuses on female students to provide targeted interventions that address their unique stress-related challenges and contribute to improving their mental health and academic performance. By incorporating structured relaxation techniques, including Progressive Muscle Relaxation, Box Breathing, and Guided Imagery, this study aims to evaluate the effectiveness of these interventions in mitigating academic-related stress among female university students. This study, employing a quasi-experimental design, aimed to evaluate the effectiveness of structured relaxation techniques, led by a female researcher, in reducing academic-related stress and enhancing health-related quality of life (HRQoL) among female university students residing in hostel settings.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and participants\u003c/h2\u003e\u003cp\u003eA quasi-experimental controlled trial was conducted at MS Ramaiah University of Applied Sciences, Bengaluru, to assess the effectiveness of relaxation techniques in reducing academic-related stress among female university students. The study setting was selected through purposive sampling, with two of the university\u0026rsquo;s three girls' hostels\u0026mdash;Sapthagiri (intervention group) and Gomati (comparator group)\u0026mdash;chosen based on administrative approval and feasibility. An initial pool of 1,043 students residing in the selected hostels was considered. Eligible participants were identified through baseline screening using the Perceived Stress Scale and EQ-5D-5L tools. Students scoring between 14 and 40 on the Perceived Stress Scale (moderate to high stress) and with an EQ-5D-5L score below 0.8 were included. Those who regularly practised relaxation techniques or were unwilling to participate were excluded. If more than 30 eligible students were identified in a group, final selection was done using alphabetical ordering to limit the sample size to 30 per group (total n\u0026thinsp;=\u0026thinsp;60). The intervention group received structured relaxation sessions that included box breathing, guided imagery, and progressive muscle relaxation over a four-week period, conducted by a female researcher trained in these techniques as part of her Master of Public Health (MPH) dissertation research project. The comparator group received no intervention. Both groups were assessed pre- and post-intervention using the same tools to evaluate changes in perceived stress and quality of life within a controlled hostel-based environment.\u003c/p\u003e\u003cp\u003eSample size was calculated based on an expected medium effect size (Cohen's d) of 0.5 on reduction in academic-related stress among female university students and a standard deviation of 10 (Hasan et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Furthermore, for a statistical power of 80% to detect significant differences in the study and a level of significance of 5%, the minimum sample size required is approximately 22 participants per group in the paired design As the researchers anticipated a dropout rate of around 20\u0026ndash;25%, the final target sample size was 30 participants per group. G*Power version 3.1.9.7 software was used to calculate the sample size.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cp\u003eThe Perceived Stress Scale and EQ-5D-5L tools, validated in India, demonstrate strong reliability and validity for assessing stress and quality of life. The PSS demonstrates high internal consistency (α\u0026thinsp;=\u0026thinsp;0.80\u0026ndash;0.89), while the EQ-5D-5L shows acceptable reliability (α\u0026thinsp;=\u0026thinsp;0.70\u0026ndash;0.79), making both suitable for evaluating intervention outcomes in this study.\u003c/p\u003e\n\u003ch3\u003eData collection procedures\u003c/h3\u003e\n\u003cp\u003eThe data collection was conducted in April 2025 among female university students at MS Ramaiah University of Applied Sciences, Bengaluru. At baseline and immediately post-intervention, participants used validated questionnaires in a quiet, supervised setting to ensure confidentiality and reduce distractions. Participants were assured of anonymity and informed that there would be no academic consequences or financial benefits. Brief instructions were given to clarify the study's purpose.\u003c/p\u003e\u003cp\u003eAlthough video and audio recordings were initially planned for process documentation, this was not feasible due to lack of permission from hostel authorities and participants\u0026rsquo; discomfort. Instead, still photographs were taken with consent to document the sessions.\u003c/p\u003e\u003cp\u003eEndline data for the intervention group were collected on Day 1 after the final session, and for the comparator group on Day 2, ensuring timely evaluation while minimising external influences.\u003c/p\u003e\n\u003ch3\u003eImplementation\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eIntervention group\u003c/h2\u003e\u003cp\u003eEligible female university students aged 18 and above were screened using the Perceived Stress Scale and EQ-5D-5L. Those scoring above 14 on the PSS and below 0.8 on the EQ-5D-5L were enrolled with informed consent. A structured four-week intervention comprising 20 sessions (5 sessions/week) was conducted. Each session (30\u0026ndash;45 minutes) included Box Breathing (5\u0026ndash;7 minutes), Guided Imagery (10\u0026ndash;15 minutes), and Progressive Muscle Relaxation (15\u0026ndash;20 minutes), delivered in a consistent format by the principal investigator. Sessions took place in a quiet room, with a minimum attendance of 75% required. Following the intervention, both groups were reassessed using the same tools, and feedback was collected.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eComparator Group\u003c/h2\u003e\u003cp\u003eThe comparator group continued with their regular academic routines and did not receive any structured intervention during the study period, and underwent pre- and post-test assessments using the Perceived Stress Scale and EQ-5D-5L tools.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThis quasi-experimental study analysed individual-level data using R software (version 4.5.0). Pre- and post-intervention scores for the Perceived Stress Scale and EQ-5D-5L were assessed. Baseline characteristics were compared using Chi-square and Fisher\u0026rsquo;s exact test, as appropriate. For within-group comparisons, due to non-normal distribution confirmed by the Shapiro\u0026ndash;Wilk test, the Wilcoxon signed-rank test was used. For between-group comparisons, the Mann\u0026ndash;Whitney U test was applied. Analysis of Covariance (ANCOVA) was used to adjust for baseline covariates and control for confounding factors. Effect sizes (r) were calculated for the PSS and EQ-5D-5L to evaluate the magnitude of change. Additionally, median change and Percentage Change Were computed for within-group comparisons to quantify the practical significance of the improvements. For analyzing the difference in outcomes between the intervention and comparator groups over time, a Difference-in-Differences (DiD) approach was employed to assess the net intervention effect by accounting for baseline differences.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical aspects\u003c/h3\u003e\n\u003cp\u003e The study received ethical approval from the University Ethics Committee for Human Trials at MS Ramaiah University of Applied Sciences, Bangalore (EC-25/38-PG-FLAHS) (Appendix A) and was registered with the Clinical Trials Registry of India (CTRI) (CTRI/2025/04/085705). Written informed consent was obtained from all participants, and ethical guidelines by the Indian Council of Medical Research (ICMR) were strictly followed to ensure confidentiality and participant welfare.(Mathur \u0026amp; Swaminathan, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 1,043 female university students were considered for the study, with 590 residing in Hostel 1 (intervention group) and 453 in Hostel 2 (comparator group). From these, informed consent was obtained from 100 students (50 from each hostel). Based on inclusion and exclusion criteria, 60 participants were enrolled\u0026mdash;30 in each group. Baseline assessment was conducted using the Perceived Stress Scale for academic-related stress and EQ-5D-5L for quality of life. The intervention group received structured relaxation techniques including Box Breathing (5\u0026ndash;7 minutes), Guided Imagery (10\u0026ndash;15 minutes), and Progressive Muscle Relaxation (PMR) (15\u0026ndash;20 minutes), delivered over 20 sessions across 4 weeks (5 days per week, 30\u0026ndash;45 minutes per session). The comparator group did not receive any intervention and continued with their usual routine. Post-intervention (endline) data collection included reassessment using Perceived Stress Scale and EQ-5D-5L for both groups, and feedback was collected from the intervention group (Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants in both groups were primarily within the 18\u0026ndash;23 years age range (Table 1) . In the intervention group, 11 participants (36.6%) were aged 18\u0026ndash;20 years, and 16 (53.3%) were aged 21\u0026ndash;23 years. In the comparator group, 13 (43.3%) and 16 (53.3%) fell into these age categories, respectively. A small number of participants in both groups were aged 24\u0026ndash;26 years. No statistically significant difference was found in age distribution between the groups (p = 0.55). There was a significant difference in the distribution of participants\u0026rsquo; academic fields between the two groups (Fisher\u0026rsquo;s Exact Test, p \u0026lt; 0.001). The intervention group consisted of students from B.Pharm (6.6%), BSc Anesthesia and Operation Theatre Technology (AOTT) (3.3%), BSc Nursing (46.6%), and GNM (43.3%), while the comparator group primarily comprised MBBS students (93.3%) and a small proportion from Bachelor of Physiotherapy (BPT) (6.6%). Given the unequal distribution of academic fields, ANCOVA was performed to adjust for its potential confounding effect. The adjusted post-test scores showed no significant difference for PSS (p = 0.8) and EQ-5D-5L (p = 0.10) after controlling for academic field. Majority of participants in both groups were in their 1st and 2nd years. In the intervention group, 6 (20%) were in their 1st year, 13 (43.3%) in 2nd year, 8 (26.6%) in 3rd year, and 3 (10%) in the 4th year. In the comparator group, 10 (33.3%) were in 1st year, 11 (36.6%) in 2nd year, 6 (20%) in 3rd year, and 3 (10%) in the 4th year. The difference was not statistically significant (p = 0.69).\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1: Baseline\u0026nbsp;Demographic\u0026nbsp;Characteristics\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"566\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention group (n=30)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(n), %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComparator group \u0026nbsp;(n=30)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n), %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e11(36.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e13(43.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e21-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e16(53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e16(53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e24-26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3(10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1(3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eField of study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eB Pharm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2(6.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eBPT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2(6.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eBSc AOTT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1(3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eBSc Nursing\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e14(46.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eGNM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e13(43.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMBBS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e28(93.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eYear of studying\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e6(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e10(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e13(43.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e11(36.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e8(26.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e6(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3(10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3(10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: B Pharm \u0026ndash; Bachelor of Pharmacy; BPT \u0026ndash; Bachelor of Physiotherapy; BSc AOTT \u0026ndash; Bachelor of Science in Anaesthesia and Operation Theatre Technology; BSc Nursing \u0026ndash; Bachelor of Science in Nursing; GNM \u0026ndash; General Nursing and Midwifery; MBBS \u0026ndash; Bachelor of Medicine and Bachelor of Surgery, %- Percentage\u003c/p\u003e\n\u003cp\u003eAt baseline, the median Perceived Stress Scale score for the intervention group was 21 (IQR = 4.75), which decreased to 20 (IQR = 3.75) post-intervention, indicating a median reduction of 1 point and a 4.8% decrease in perceived stress levels. The within-group comparison using the Wilcoxon signed-rank test showed this reduction to be statistically significant (Z = 1.24, p \u0026lt; 0.001), with a small effect size (r = 0.22) (Table 2). In contrast, the comparator group exhibited an increase in stress levels, with the median PSS score rising from 20 (IQR = 4) at baseline to 22 (IQR = 4.5) post-intervention, reflecting a median increase of 2 points and a 10% rise in perceived stress. This change was also statistically significant (Z = -4.29, p \u0026lt; 0.001), with a large effect size (r = 0.78), indicating a worsening of stress levels in the absence of intervention.\u003c/p\u003e\n\u003cp\u003eIn the intervention group, the EQ-5D-5L index score increased from a median of 0.734 (IQR = 0.06) at baseline to 0.83 (IQR = 0.12) post-intervention, representing a 0.10-point increase and a 13.7% improvement in perceived quality of life. This improvement was statistically significant (Z = 4.79, p \u0026lt; 0.001), with a large effect size (r = 0.87). The comparator group, however, showed negligible change, with the median EQ-5D-5L score shifting only slightly from 0.761 (IQR = 0.03) to 0.763 (IQR = 0.11), resulting in 0% change. This difference was not statistically significant (Z = -1.56, p = 0.85), and the effect size was small (r = 0.28).\u003c/p\u003e\n\u003cp\u003eTable 2: Within-Group Comparison\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome Variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroups\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre Median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian Change\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% Change\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003ePSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e21 (4.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e20 (3.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026darr;1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026darr;4.8%\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eZ = 1.24\u003c/p\u003e\n \u003cp\u003ep \u0026lt; .001\u003c/p\u003e\n \u003cp\u003er = 0.22\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eEQ-5D-5L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e0.734 (0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.8355 (0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026uarr;0.10\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026uarr;13.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;Z = 4.79\u003c/p\u003e\n \u003cp\u003ep \u0026lt; .001\u003c/p\u003e\n \u003cp\u003er \u0026nbsp; \u0026nbsp; =0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003ePSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eComparator\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e20 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e22 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026uarr;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026uarr;10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eZ = -4.29\u003c/p\u003e\n \u003cp\u003ep \u0026lt; .001\u003c/p\u003e\n \u003cp\u003er = 0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eEQ-5D-5L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e0.761 (0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.7635 (0.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0%\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eZ = -1.56\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ep = 0.85\u003c/p\u003e\n \u003cp\u003er = 0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: EQ-5D-5L-EuroQol 5 Dimensions, 5 Levels; IQR \u0026ndash; Interquartile Range; n- Sample Size; p- Probability Value; PSS \u0026ndash; Perceived Stress Scale; r \u0026ndash; Effect Size; Z- Standardized Test Statistic\u003c/p\u003e\n\u003cp\u003eAt the baseline, the intervention group reported a median Perceived Stress Scale score of 21 (IQR = 4.75), while the comparator group had a median of 20 (IQR = 4) (Table 3). The difference between the groups was statistically significant (Z = 2.90, p = 0.004), with a moderate effect size (r = 0.37), indicating slightly higher perceived stress in the intervention group at baseline. At the post-test, the intervention group showed a decrease in stress, with a median score of 20 (IQR = 3.75), whereas the comparator group exhibited an increase, with a median score of 22 (IQR = 4.5). The between-group difference at post-test was also statistically significant (Z = -2.49, p = 0.01), with a moderate effect size (r = 0.32). The Difference-in-Differences (DiD) for PSS was \u0026minus;3, indicating a meaningful reduction in stress levels in the intervention group compared to the comparator group. At baseline, the intervention group had a median EQ-5D-5L score of 0.734 (interquartile range [IQR] = 0.06), while the comparator group had a slightly higher median of 0.76 (IQR = 0.03). This baseline difference was statistically significant (Z = -2.57, p = 0.01), with a moderate effect size (r = 0.33). At post-test, the intervention group showed a significant improvement in quality of life, with a median score of 0.83 (IQR = 0.12), compared to 0.76 (IQR = 0.11) in the comparator group. This difference was statistically significant (Z = 2.90, p = 0.004), with a moderate effect size (r = 0.37). The DiD for EQ-5D-5L was +0.10, indicating a substantial improvement in the intervention group\u0026rsquo;s perceived quality of life relative to the comparator group.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;3: Between-Group Comparison\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome Variable (N=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention Median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComparator Median (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003ePre-test- PSS (IBP vs CBP)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e21(4.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e20(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026minus;3\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eZ = 2.90\u003c/p\u003e\n \u003cp\u003ep = 0.004\u003c/p\u003e\n \u003cp\u003er = 0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003ePost-test- PSS (IEP vs CEP)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e20 (3.75)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e22(4.5)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;Z = -2.49\u003c/p\u003e\n \u003cp\u003ep = 0.01\u003c/p\u003e\n \u003cp\u003er = 0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003ePre-test- EQ-5D-5L (IBQ vs CBQ)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.73(0.06)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.76(0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e+0.10\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eZ = -2.57\u003c/p\u003e\n \u003cp\u003ep = 0.01\u003c/p\u003e\n \u003cp\u003er = 0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003ePost-test- \u0026nbsp;EQ-5D-5L \u0026nbsp; \u0026nbsp; (IEQ vs CEQ)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.83(0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.76(0.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eZ = 2.90\u003c/p\u003e\n \u003cp\u003ep = 0.004\u003c/p\u003e\n \u003cp\u003er = 0.37\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: CBP \u0026ndash; Comparator Baseline Perceived Stress Scale; CBQ \u0026ndash; Comparator Baseline Quality of Life; CEP \u0026ndash; Comparator Endline Perceived Stress Scale; CEQ \u0026ndash; Comparator Endline Quality of Life; DiD- Difference-in-Differences; EQ-5D-5L-EuroQol 5 Dimensions, 5 Levels; IBP \u0026ndash; Intervention Baseline Perceived Stress Scale; IBQ \u0026ndash; Intervention Baseline Quality of Life; IEP \u0026ndash; Intervention Endline Perceived Stress Scale; IEQ \u0026ndash; Intervention Endline Quality of Life; IQR \u0026ndash; Interquartile Range; n- Sample Size; p- Probability Value ; PSS \u0026ndash; Perceived Stress Scale; QoL- Quality of Life; r \u0026ndash; Effect Size; Z- Standardized Test Statistic\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis quasi-experimental study evaluated the effectiveness of relaxation techniques in reducing academic-related stress and improving the quality of life among female university students. The findings revealed that the intervention group experienced a significant reduction in perceived stress and a substantial improvement in quality of life. In contrast, the comparator group exhibited a significant increase in stress, with no meaningful improvement in quality of life. These outcomes are consistent with previous literature supporting the utility of relaxation-based interventions in academic settings.\u003c/p\u003e\n\u003cp\u003eThe observed reduction in perceived stress levels in the intervention group aligns with findings from a meta-analysis and reported that stress management interventions, particularly those incorporating relaxation techniques, were effective in reducing stress among university students(Regehr et al., 2013). In the current study adds to this by demonstrating that even short-term, guided relaxation techniques can yield measurable improvements in stress levels, as evidenced by a statistically significant reduction in PSS scores and a moderate effect size (\u003cem\u003er\u003c/em\u003e = 0.323) post-intervention.\u003c/p\u003e\n\u003cp\u003eSimilarly, structured relaxation practices significantly reduced both academic stress and test anxiety in nursing students(Manansingh et al., 2019b). In the current study, nursing and allied health students who received the intervention also demonstrated improved stress profiles and enhanced quality of life scores, highlighting the generalizability of such interventions across health science disciplines.\u003c/p\u003e\n\u003cp\u003eMoreover, the results are supported by a previous study among nursing students in Bengaluru who noted the benefits of relaxation techniques in reducing stress among nursing students (Wosser et al., 2020). Although their study lacked a control group, our findings strengthen their conclusions by incorporating a comparator group and using both within- and between-group statistical comparison.\u003c/p\u003e\n\u003cp\u003eThe improvement in quality of life among participants in the intervention group is particularly notable. Our findings mirror those of , who reported that various relaxation strategies, including guided imagery and breathing techniques, significantly enhanced the well-being of health sciences students by reducing academic-related stress (Toussaint et al., 2021). In our study, the EQ-5D-5L scores in the intervention group improved significantly (from 0.734 to 0.8355), with a large effect size (\u003cem\u003er\u003c/em\u003e = 0.875), suggesting a meaningful impact on participants\u0026apos; overall quality of life. This is in contrast with the findings in the comparator group, which saw no significant changes, thereby reinforcing the effectiveness of the intervention.\u003c/p\u003e\n\u003cp\u003eAn important consideration in interpreting the results is the unequal distribution of the field of study between the two groups. While the intervention group comprised students from diverse health disciplines, the comparator group primarily included MBBS students. Given that stress levels and coping mechanisms may vary by academic program, this was accounted for using ANCOVA to adjust for baseline differences in the outcome variables. The adjustment further validates the reliability of the intervention\u0026apos;s effect. Additionally, although the year of study distribution did not differ significantly between groups, the academic year may still influence stress due to varying academic demands. Nonetheless, the consistent direction and significance of our results across both stress and quality of life measures strengthen the internal validity of the findings. This study followed Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) guidelines to ensure transparent reporting of quasi-experimental public health interventions.(Haynes et al., 2021).\u003c/p\u003e\n\u003cp\u003eDespite the positive outcomes, certain limitations warrant discussion. The sample size, although adequate for statistical analysis, was drawn from a single university setting, which potentially limits the generalizability of the findings to broader student populations. Additionally, the use of self-reported measures\u0026mdash;though standardized and validated\u0026mdash;introduces the possibility of response, social desirability and recall biases. Another important consideration is that while the intervention showed a significant impact, the effect size for stress reduction was moderate. This suggests that while relaxation techniques were effective, they may benefit from being combined with other supportive strategies, such as cognitive-behavioural training, peer support, or academic counselling, for a greater impact. The intervention period was short, and assessments were conducted only immediately post-intervention, with no follow-up at later time points such as 3 or 6 months. This limits understanding of long-term effects. Future research should consider conducting larger, multi-centre trials with diverse academic disciplines and extended follow-up periods to assess the long-term sustainability of relaxation technique benefits. \u0026nbsp;Furthermore, tailored interventions that target students with moderate stress\u0026mdash;rather than waiting for high stress levels to manifest\u0026mdash;may serve as a proactive approach to mental health promotion in university settings. The unequal distribution of academic disciplines across the groups may have introduced confounding variables. Lastly, the study focused only on female hostel residents, which may reduce applicability to male or non-residential students.\u003c/p\u003e\n\u003cp\u003eThis study provides preliminary evidence on the effectiveness of structured relaxation techniques\u0026mdash;Box Breathing, Guided Imagery, and Progressive Muscle Relaxation\u0026mdash;in reducing academic-related stress and enhancing quality of life among female university students. One of the primary strengths is the use of a quasi-experimental design and validated measurement tools\u0026mdash;the Perceived Stress Scale and the EQ-5D-5L\u0026mdash;which strengthen internal validity and reliability. The study achieved full participant retention (100%), with no attrition reported during the intervention period. This consistency supports the robustness of the findings. Statistically significant improvements in stress and quality of life were observed both within and between groups, with effect size calculations indicating a small to moderate effect for the Perceived Stress Scale and a larger effect for the EQ-5D-5L. These results suggest the potential for broader application of the intervention in similar academic settings. Moreover, the study adds culturally relevant insights to the limited evidence base on mental health interventions for university students in low- and middle-income countries.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eImplications to Practice\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe findings from this study have valuable implications for school and college health services, particularly emphasizing the vital role of school- and college-based nurses in promoting the mental well-being of adolescents and young adults. Structured relaxation techniques, including Box Breathing, Guided Imagery, and Progressive Muscle Relaxation, have demonstrated effectiveness in reducing academic-related stress and improving the quality \u0026nbsp;of life among female university students. These techniques are low-cost, easy to implement, and can be integrated into daily routines within educational environments. School and college nurses are uniquely positioned to lead such interventions, offering individual or group-based relaxation sessions within hostel settings, wellness centres, or health units. Their trusted role within the educational system allows them to identify students at risk of academic stress, deliver timely interventions, and monitor ongoing outcomes. Nurses can also collaborate with educators and mental health counsellors to incorporate relaxation strategies into broader student wellness programs and orientation activities. From a policy standpoint, the inclusion of nurse-led mental health interventions in institutional health guidelines can ensure sustainability and accessibility. Educational institutions should recognize and support the capacity of nurses to contribute to mental health promotion, especially in low-resource and high-stress academic environments. Additionally, school and college nurses can lead further research, advocate for integrated stress management policies, and facilitate cross-sector collaboration to promote a holistic and preventive approach to student mental health.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrated that structured relaxation techniques are effective in reducing academic-related stress and improving quality of life among female university students. The intervention group showed a statistically significant reduction in perceived stress levels and a marked improvement in quality of life scores post-intervention, while the comparator group experienced increased stress and no significant improvement in quality of life. These findings support the integration of relaxation practices into student wellness programs, particularly in high-stress academic environments, to promote better mental health and overall well-being.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u0026nbsp;\u003c/strong\u003eClinical Trials Registry of India (CTRI) Registration: CTRI/2025/04/085705)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This research was conducted without any specific grant support from public, commercial, or not-for-profit funding agencies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e: This study was approved by University Ethics Committee for Human Trials at M. S. Ramaiah University of Applied Sciences, Bangalore (20.03.2025), in accordance with Indian Council of Medical Research and Declaratin of Helsinki guidelines.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e: The datasets generated and analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interest\u003c/strong\u003e: The authors declare that they have no known competing financial or non-financial interests that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publication\u003c/strong\u003e: Obtained from patients as part of informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eML \u0026amp; DJ conceived the study. ML is the lead researcher responsible for conducting the intervention, data collection, data analysis and manuscript writing. DJ provided methodological expertise and reviewed the draft manuscript prepared by ML. BB provided statistical validation. CV provided clinical validation. All authors reviewed and agreed on the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eThe authors acknowledge the patients who provided consent to participate in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBalban MY, Neri E, Kogon MM, Weed L, Nouriani B, Jo B, Holl G, Zeitzer JM, Spiegel D, Huberman AD. Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Rep Med. 2023;4(1):100895. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.xcrm.2022.100895\u003c/span\u003e\u003cspan address=\"10.1016/j.xcrm.2022.100895\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBarbayannis G, Bandari M, Zheng X, Baquerizo H, Pecor KW, Ming X. Academic Stress and Mental Well-Being in College Students: Correlations, Affected Groups, and COVID-19. Front Psychol. 2022;13:886344. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2022.886344\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2022.886344\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDel Negro CA, Funk GD, Feldman JL. Breathing matters. Nat Rev Neurosci. 2018;19(6):351\u0026ndash;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41583-018-0003-6\u003c/span\u003e\u003cspan address=\"10.1038/s41583-018-0003-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFord-Gilboe M, Varcoe C, Scott-Storey K, Browne AJ, Jack SM, Jackson K, Mantler T, O\u0026rsquo;Donnell S, Patten-Lu N, Smye V, Wathen CN, Perrin N. Longitudinal effectiveness of a woman-led, nurse delivered health promotion intervention for women who have experienced intimate partner violence: iHEAL randomized controlled trial. BMC Public Health. 2024;24(1):398. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-023-17578-4\u003c/span\u003e\u003cspan address=\"10.1186/s12889-023-17578-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGefen DR, Fish MC. Gender Differences in Stress and Coping in First-Year College Students. J Coll Orientat Transition Retent. 2012;19(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003eArticle 2. https://doi.org/10.24926/jcotr.v19i2.2797\u003c/span\u003e\u003cspan address=\"Article 2. 10.24926/jcotr.v19i2.2797\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGraves BS, Hall ME, Dias-Karch C, Haischer MH, Apter C. Gender differences in perceived stress and coping among college students. PLoS ONE. 2021;16(8):e0255634. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0255634\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0255634\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHasan S, Anis T, Saeed H, Haidery AB, Shahid G, Intikhab R. Evaluating the impact of relaxation methods on reducing academic-related stress in health sciences students. J Popul Ther Clin Pharmacol. 2024;31(7):615\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaynes AB, Haukoos JS, Dimick JB. TREND Reporting Guidelines for Nonrandomized/Quasi-Experimental Study Designs. JAMA Surg. 2021;156(9):879. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jamasurg.2021.0552\u003c/span\u003e\u003cspan address=\"10.1001/jamasurg.2021.0552\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIqra. A systematic \u0026ndash; Review of academic stress intended to improve the educational journey of learners. Methods Psychol. 2024;11:100163. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.metip.2024.100163\u003c/span\u003e\u003cspan address=\"10.1016/j.metip.2024.100163\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJun S, Choi E. Academic stress and Internet addiction from general strain theory framework. Comput Hum Behav. 2015;49:282\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.chb.2015.03.001\u003c/span\u003e\u003cspan address=\"10.1016/j.chb.2015.03.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJyani G, Prinja S, Garg B, Kaur M, Grover S, Sharma A, Goyal A. Health-related quality of life among Indian population: The EQ-5D population norms for India. J Global Health. 2023;13:04018. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7189/jogh.13.04018\u003c/span\u003e\u003cspan address=\"10.7189/jogh.13.04018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJyani G, Sharma A, Prinja S, Kar SS, Trivedi M, Patro BK, Goyal A, Purba FD, Finch AP, Rajsekar K, Raman S, Stolk E, Kaur M. Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study: The Indian 5-Level Version EQ-5D Value Set. Value Health: J Int Soc Pharmacoeconomics Outcomes Res. 2022;25(7):1218\u0026ndash;26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jval.2021.11.1370\u003c/span\u003e\u003cspan address=\"10.1016/j.jval.2021.11.1370\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKapasia N, Paul P, Roy A, Das P, Ghosh T, Chouhan P. Perceived academic satisfaction level, psychological stress and academic risk among Indian students amidst COVID-19 pandemic. Heliyon. 2022;8(5):e09440. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.heliyon.2022.e09440\u003c/span\u003e\u003cspan address=\"10.1016/j.heliyon.2022.e09440\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLanier LH. (1930). [Review of \u003cem\u003eReview of Progressive Relaxation\u003c/em\u003e, by E. Jacobson]. \u003cem\u003eThe American Journal of Psychology\u003c/em\u003e, \u003cem\u003e42\u003c/em\u003e(3), 473\u0026ndash;475. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2307/1415459\u003c/span\u003e\u003cspan address=\"10.2307/1415459\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee E-H. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res. 2012;6(4):121\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.anr.2012.08.004\u003c/span\u003e\u003cspan address=\"10.1016/j.anr.2012.08.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi R, Che Hassan N, Saharuddin N. Psychological Capital Related to Academic Outcomes Among University Students: A Systematic Literature Review. Psychol Res Behav Manage. 2023;16:3739\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/PRBM.S421549\u003c/span\u003e\u003cspan address=\"10.2147/PRBM.S421549\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eManansingh S, Tatum SL, Morote E-S. Effects of Relaxation Techniques on Nursing Students\u0026rsquo; Academic Stress and Test Anxiety. J Nurs Educ. 2019a;58(9):534\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3928/01484834-20190819-07\u003c/span\u003e\u003cspan address=\"10.3928/01484834-20190819-07\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eManansingh S, Tatum SL, Morote E-S. Effects of Relaxation Techniques on Nursing Students\u0026rsquo; Academic Stress and Test Anxiety. J Nurs Educ. 2019b;58(9):534\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3928/01484834-20190819-07\u003c/span\u003e\u003cspan address=\"10.3928/01484834-20190819-07\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMathur R, Swaminathan S. National ethical guidelines for biomedical \u0026amp; health research involving human participants, 2017: A commentary. Indian J Med Res. 2018;148(3):279\u0026ndash;83. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/0971-5916.245303\u003c/span\u003e\u003cspan address=\"10.4103/0971-5916.245303\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorgan ES, Umberson K, Hertzog C. Construct validation of self-reported stress scales. Psychol Assess. 2014;26(1):90\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/a0034714\u003c/span\u003e\u003cspan address=\"10.1037/a0034714\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMuhammad Khir S, Wan Mohd Yunus WMA, Mahmud N, Wang R, Panatik SA, Sukor M, M. S., Nordin NA. Efficacy of Progressive Muscle Relaxation in Adults for Stress, Anxiety, and Depression: A Systematic Review. Psychol Res Behav Manage. 2024;17:345\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/PRBM.S437277\u003c/span\u003e\u003cspan address=\"10.2147/PRBM.S437277\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNeupane D, McLachlan CS, Christensen B, Karki A, Perry HB, Kallestrup P. Community-based intervention for blood pressure reduction in Nepal (COBIN trial): Study protocol for a cluster-randomized controlled trial. Trials. 2016;17:292. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13063-016-1412-3\u003c/span\u003e\u003cspan address=\"10.1186/s13063-016-1412-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePangtey R, Basu S, Meena GS, Banerjee B. Perceived Stress and its Epidemiological and Behavioral Correlates in an Urban Area of Delhi, India: A Community-Based Cross-Sectional Study. Indian J Psychol Med. 2020;42(1):80\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/IJPSYM.IJPSYM_528_18\u003c/span\u003e\u003cspan address=\"10.4103/IJPSYM.IJPSYM_528_18\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRegehr C, Glancy D, Pitts A. Interventions to reduce stress in university students: A review and meta-analysis. J Affect Disord. 2013;148(1):1\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jad.2012.11.026\u003c/span\u003e\u003cspan address=\"10.1016/j.jad.2012.11.026\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eR\u0026ouml;ttger S, Theobald DA, Abendroth J, Jacobsen T. The Effectiveness of Combat Tactical Breathing as Compared with Prolonged Exhalation. Appl Psychophysiol Biofeedback. 2021;46(1):19\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10484-020-09485-w\u003c/span\u003e\u003cspan address=\"10.1007/s10484-020-09485-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eToussaint L, Nguyen QA, Roettger C, Dixon K, Offenb\u0026auml;cher M, Kohls N, Hirsch J, Sirois F. (2021). Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation. \u003cem\u003eEvidence-Based Complementary and Alternative Medicine: eCAM\u003c/em\u003e, \u003cem\u003e2021\u003c/em\u003e, 5924040. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1155/2021/5924040\u003c/span\u003e\u003cspan address=\"10.1155/2021/5924040\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVarcoe C, Ford-Gilboe M, Browne AJ, Perrin N, Bungay V, McKenzie H, Smye V, Price (Elder R, Inyallie J, Khan K, Dion Stout M. The Efficacy of a Health Promotion Intervention for Indigenous Women: Reclaiming Our Spirits. J interpers Violence. 2021;36(13\u0026ndash;14):NP7086\u0026ndash;116. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0886260518820818\u003c/span\u003e\u003cspan address=\"10.1177/0886260518820818\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWosser T, Mathew B, Idiculla J. A Study to assess the Perceived stress and its contributing factors among nursing students during the initial period of their clinical posting in selected college of nursing, Bengaluru with a view to develop a Preclinical sensitization programme. Int J Adv Nurs Manage. 2020;8(4):331\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5958/2454-2652.2020.00073.6\u003c/span\u003e\u003cspan address=\"10.5958/2454-2652.2020.00073.6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWunsch K, Kasten N, Fuchs R. The effect of physical activity on sleep quality, well-being, and affect in academic stress periods. Nat Sci Sleep. 2017;9:117\u0026ndash;26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/NSS.S132078\u003c/span\u003e\u003cspan address=\"10.2147/NSS.S132078\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Academic stress, Relaxation techniques, Female university students, Quality of life, Perceived Stress Scale, Quasi-experimental study","lastPublishedDoi":"10.21203/rs.3.rs-7869525/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7869525/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eTo assess the effectiveness of structured relaxation techniques in reducing academic-related stress and improving health-related quality of life among female university students residing in hostel settings.\u003c/p\u003e\u003ch2\u003eDesign and setting:\u003c/h2\u003e\u003cp\u003eA quasi-experimental, non-randomized controlled trial with a comparator group was conducted among female university students at M.S. Ramaiah University of Applied Sciences, Bengaluru. Out of 1,043 students screened using the Perceived Stress Scale (PSS) and the EQ-5D-5L tool, 60 eligible participants were selected\u0026mdash;30 each for the intervention and comparator groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eBaseline characteristics, including age and year of study, were comparable between the groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.01). The intervention group showed a significant reduction in stress (PSS median: 21 to 20; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.22) and improved quality of life (EQ-5D-5L: 0.73 to 0.83; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.87). Conversely, the comparator group exhibited increased stress (PSS: 20 to 22; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.78) and no significant QoL change. Difference-in-Differences analysis indicated a net improvement in the intervention group (PSS: \u0026minus;\u0026thinsp;3; EQ-5D-5L: +0.10).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eRelaxation techniques effectively reduced academic-related stress and enhanced quality of life.\u003c/p\u003e","manuscriptTitle":"Effectiveness of Relaxation Techniques in Reducing Academic-Related Stress Among Female University Students: A Quasi-Experimental Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-28 07:04:58","doi":"10.21203/rs.3.rs-7869525/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-17T16:16:20+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-19T19:11:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"287888023182037573842291550995221431049","date":"2025-12-22T11:38:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"309774522243217293712506890227837605244","date":"2025-11-23T15:49:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-22T06:31:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"302269860449834999036598479126684908641","date":"2025-11-18T06:22:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-18T06:18:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-06T07:20:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-27T12:50:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-16T12:40:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-10-16T12:35:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5802487c-ba2c-4311-84dc-e999c53df8ab","owner":[],"postedDate":"November 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-22T04:23:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-28 07:04:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7869525","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7869525","identity":"rs-7869525","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}