The effect of progressive muscle relaxation, thought-stopping therapy, and acupressure on adolescent mental health

Desak Made Ari Dwi Jayanti (Department of Nursing, College of Health Sciences Wira Medika Bali, Indonesia)
I Gusti Ayu Putu Satya Laksmi (Department of Nursing, College of Health Sciences Wira Medika Bali, Indonesia)
Sang Ayu Ketut Candrawati (Department of Nursing, College of Health Sciences Wira Medika Bali, Indonesia)
Ni Putu Dita Wulandari (Departement of Nursing, STIKES Bina Usada Bali, Indonesia)
Windu Astutik (Department of Nursing, Stikes Kesdam IX/Udayana Denpasar, Bali, Indonesia)

JNKI (Jurnal Ners dan Kebidanan Indonesia) (Indonesian Journal of Nursing and Midwifery)
2026: Just Accepted Manuscript and Article In Press 2026

Background: Adolescence is a critical developmental period marked by biological, psychological, and social changes that increase susceptibility to mental health problems. Although various psychological interventions have been developed, practical, non-pharmacological, and school-based complementary approaches remain limited. Objectives: This study aimed to examine the effect of a combination of Progressive Muscle Relaxation (PMR), Thought Stopping Therapy (TST), and acupressure on improving adolescents' mental health. Methods: A pre-experimental study with a one-group pre-test and post-test design was conducted among tenth-grade students at a senior high school in Denpasar, Bali, Indonesia. From a population of 401 students, 34 respondents were selected using purposive sampling. Mental health status was assessed using the Strengths and Difficulties Questionnaire (SDQ). The intervention consisted of four sessions, each including 15 minutes of PMR, 15 minutes of TST, and acupressure stimulation at ST36 (Zusanli), CV17 (Shanzhong), and HT7 (Shenmen). At each acupoint, stimulation was performed by applying moderate pressure accompanied by circular rotational movements, with 30 repetitions of pressure and rotation at each point. Data were analyzed using the Wilcoxon Signed-Rank Test with a significance level of p<0.05. Results: The mean SDQ score decreased from 16.97 (SD=1.114) before the intervention to 14.09 (SD=0.933) after the intervention, representing a mean reduction of 2.61 points. Statistical analysis demonstrated a significant improvement in adolescents' mental health following the intervention (p=0.001). Participants also showed a transition from the borderline category to the normal category based on SDQ classification. Conclusions: The combination of PMR, TST, and acupressure effectively improves adolescents' mental health through complementary physiological, cognitive, and somatic mechanisms. This integrated intervention represents a feasible, low-cost, and school-based complementary strategy that can support adolescent mental health promotion and prevention programs.