Document Type

DNP Project

Publication Date


Degree Name

Doctor of Nursing Practice

Faculty Advisor

Chrystyne Olivieri, DNP, APRN, FNP-BC, CDEC,

Practice Mentor

Danielle Mallory, MSN, APRN, FNP-BC



Depression affects 1 in 5 individuals during their lifetime (Hidalgo et al., 2021), with 23 million Americans seeking mental health treatment annually (Parish et al., 2023). While guidelines from the AAFP and APA advocate comprehensive care approaches, medication prescriptions for anxiety and depression remain prevalent, particularly among children aged 6-18 (Lester et al., 2022). Direct observation identified a need to bridge gaps in adjunctive therapies between the primary care setting and counseling services for patients who presented with mild or mild to moderate anxiety or depression. Feedback analysis by staff in the setting identified a gap in knowledge and perceived comfort in instructing on adjunctive therapies. Additionally, 88% of clinical staff agreed that there is a barrier to patients accessing counseling services.


This quality improvement project aims to educate clinicians and empower them to promote the application of progressive muscle relaxation (PMR) as an adjunctive therapy for anxiety, depression, and acute stress. The goals are to establish a simplified educational modality for clinicians, implement education into practice, and increase utilization of adjunctive therapies in initial visits.

Intervention and Setting

Clinical staff received individual education sessions and handouts on PMR techniques. Retrospective chart reviews assessed patient GAD7 and PHQ9 scores. Scores from patients prior to clinician education implementation, and reviews at the 6- and 12-week post implementation evaluate use of PMR. Additional EHR documentation notating PMR implementation and additional therapeutics prescribed.

The setting is a 12-person primary care practice in a Connecticut community of over 40,000. The practice services adult and geriatric patients who are both insured and uninsured, working, retired, and disabled.


Staff participation reached 73%, with a notable 75% improvement in reported comfort levels teaching PMR. Of eligible patients, 80% received PMR education. Post-implementation, GAD7 and PHQ9 scores showed overall reduction from initial evaluation. Project goals were met with these results.


The implementation of PMR education for clinical staff demonstrated promising utility as adjunctive therapy for anxiety and depression, evidenced by improved staff confidence and patient-reported reductions in symptom severity.


A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.

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Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

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