The caregiving experience for mothers of children with special needs is complex and multifaceted. It involves not only managing the child's health and educational needs but also navigating social and emotional challenges that can impact family dynamics and personal relationships [1]. The psychological burden can be so significant that it affects not only the mother's mental health but also her ability to provide effective care and support to her child.   Elevated blood pressure, heart rate, and respiratory rate are common physiological responses to stress, which, if prolonged, can increase the risk of cardiovascular disease and other health complications [2]. Chronic stress leads to prolonged cortisol release, which, while essential for short-term stress responses, can negatively impact health over time, contributing to weight gain, sleep disturbances, and weakened immune function [3]. Therefore, interventions that can effectively reduce stress and cortisol levels are crucial for maintaining the health and well-being of caregivers.   Autogenic Relaxation Therapy (ART) offers a promising approach to managing stress and promoting relaxation. By teaching individuals to focus on specific body parts and induce feelings of warmth and heaviness, ART helps reduce muscle tension and promote a state of deep relaxation [4]. This technique has been shown to be improving the sleep quality and reducing heart rate and blood pressure [5]. Additionally, ART's emphasis on self-regulation and mindfulness can enhance emotional resilience, allowing individuals to better cope with stressful situations [6].   The application of Autogenic Relaxation Therapy (ART) presents a promising intervention for reducing psychological and physiological distress among mothers of children with special needs. These mothers often face unique challenges that lead to heightened stress and anxiety, and ART has shown effectiveness in alleviating these symptoms. The theoretical underpinnings of ART, which incorporates self-hypnosis and relaxation techniques, provide a platform for mothers to engage constructively with their emotional and physiological states [7-8].   Despite the documented benefits of ART in various populations, there remains a need for research specifically targeting mothers of special children. These caregivers face unique stressors that may require tailored interventions to address their specific needs. By exploring the effectiveness of ART in this demographic, this study aims to evaluate the effect of autogenic relaxation therapy on psychological (stress, anxiety and depression) and bio-physiological parameters (pulse, respiration, systolic and diastolic blood pressure, salivary cortisol) among mothers of special children.

A quasi-experimental design was adopted to assess the impact of Autogenic Relaxation Therapy (ART) on mothers of special children in Puducherry. A total of 40 mothers were selected using non-probability convenience sampling from Anbagam Special Schools. Inclusion criteria included mothers aged 18–55 years with children aged 3–18 years diagnosed with disabilities who exhibited borderline to moderate depression (BDI score 17–30). Mothers with severe depression, psychiatric illness, suicidal ideation, or those undergoing steroid or complementary therapies were excluded.   Tools Data collection tools included three parts: Part I covered demographic variables; Part II included standardized self-rating scales—Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Berry and Jones Parental Stress Scale; and Part III involved biophysiological measures including pulse, respiratory rate, blood pressure, and salivary cortisol (measured via ECLIA at Rainbow Clinical Laboratory, Puducherry).   Data Collection Procedure The data collection was conducted in three phases. Phase I (Week 1) involved baseline assessments, including administration of the Berry and Jones Parental Stress Scale, Beck Anxiety Inventory (BAI), measurement of physiological parameters (pulse, respiratory rate, and blood pressure), and collection of 5 ml saliva samples for cortisol analysis. Phase II (Weeks 4, 8, and 12) consisted of the intervention period, during which the experimental group received Autogenic Relaxation Therapy (ART) twice weekly for eight weeks, with each session lasting 20-25 minutes. The control group received no intervention. Follow-up assessments were conducted at Weeks 4, 8, and 12 to evaluate changes over time. Telephonic reminders were provided to ensure adherence. Phase III addressed ethical considerations, offering ART to the control group after the 12-week study period, following the same intervention schedule as the experimental group.   Intervention: Autogenic Relaxation Therapy (ART) In the experimental group, mothers were provided with a mat and guided to perform Autogenic Relaxation Therapy (ART) in a quiet room. They received demonstrations on the day of data collection and then lay down to follow a structured relaxation protocol, starting with 3 minutes of guided imagery and ART verbal cues such as "feeling heavy, warm, relaxed, and calm." These sessions lasted 20-25 minutes and were conducted twice weekly for 8 weeks, with telephonic reminders sent twice a week to ensure adherence. No intervention given to control gorup. Data was collected at four intervals: baseline, midline (4 weeks), endline (8 weeks), and follow-up (12 weeks), allowing for a comprehensive assessment of ART's impact over time.   Statistics The effectiveness of autogenic relaxation was analysed using two-way RM ANOVA for psychological and biophysiological parameters, followed by Bonferroni t-test. Demographic data were analysed using chi-square tests for homogeneity, with p≤0.05 as significant. Analysis was conducted using SigmaPlot 14.5.

Stress, Anxiety, and Depression The experimental group showed a 27.1% reduction in stress, while the control group remained stable. Anxiety increased by 7.2% in the control group but decreased significantly in the experimental group. Depression rose slightly (3.7%) in the control group but declined by 36% in the experimental group. The result revealed significant group, time, and interaction effects (p<0.001 for all outcomes), confirming the intervention's effectiveness (Table 1).   Respiratory Rate and Pulse Rate The control group showed a 7.2% increase in respiratory rate, while the experimental group had a 7.7% decrease. Pulse rate increased by 2% in the control group but decreased by 7.6% in the experimental group. Significant group × time interactions were found (p<0.001), with between-group differences at 8 and 12 weeks, supporting ART's physiological benefits (Table 2).   Systolic and Diastolic Blood Pressure Systolic BP increased by 3% in the control group and decreased by 2.3% in the experimental group. Diastolic BP increased by 1.9% in the control group and decreased by 3% in the experimental group. Significant differences were observed between groups and over time (p<0.05), with notable group × time interaction (p<0.001), indicating reduced BP in the experimental group (Table 3).   Salivary Cortisol Cortisol levels increased by 3.3% in the control group and decreased by 37.1% in the experimental group.   Though between-group cortisol difference at 12 weeks was not statistically significant (p = 0.152), significant time and interaction effects were found (p<0.001), confirming the intervention's influence on cortisol reduction (Table 4).   Demographic Characteristics Demographic and clinical homogeneity between control and experimental groups, with no significant differences across all variables (p>0.05) (Table 5).   Table 1: Comparison of Stress, Anxiety, Depression in Control and Experimental Groups. S.No Groups comparisons Test comparisons Stress Mean+SE Anxiety­ Mean+SE Depression Mean+SE 1 Control 1-week 58.65+1.424 30.35+1.276 21.35+0.987 Control 4-week 59.2+1.241 30.9+1.117 21.5+0.803 Control 8-week 59.05+1.175 32.2+0.972 22.15+0.604 Control 12-week 59.35+1.118 32.85+0.921 22.15+ 0.504 Experimental 1-week 56.1+1.849 32.05+1.693 21.8+0.97 Experimental 4-week 51.7+1.67 29.05+1.538 21.1+0.778 Experimental 8-week 45.15+0.755 23.05+1.035 15+0.894 Experimental 12-week 40.9+0.946 20.15+0.741 13.95+0.863 2 Among control and experimental groups. F = 40.779 P<0.001 F = 12.304 P = 0.001 F = 12.760 P<0.001 Among tests in 1-week/4-week/8-week/12-week. F = 44.741 P<0.001 F = 32.775 P<0.001 F = 53.617 P<0.001 Interaction with groups X week F = 51.528 P<0.001 F = 77.332 P<0.001 F = 81.174 P<0.001   Table 2: Comparison of on Pulse and Respiratory Rate (Rr) Control and Experimental Groups. S.No Groups comparisons Test comparisons Pulse (beats/min) Mean+SE RR (breaths/min) Mean+SE 1 Control 1-week 99.25+2.184 20.8+0.9 Control 4-week 98.6+2.328 21.3+0.8 Control 8-week 100.25+2.319 22.1+0.8 Control 12-week 101.2+2.335 22.3+0.7 Experimental 1-week 99.15+2.232 20.7+0.8 Experimental 4-week 99.3+2.295 20.4+0.8 Experimental 8-week 95.35+1.873 19.1+0.5 Experimental 12-week 91.6+1.965 19.1+0.5 2 Among control and experimental groups F = 1.362 P = 0.251 F = 3.521 P = 0.068 Among tests in 1-week/4-week/8-week/12-week F = 6.230 P<0.001 F = 0.232 P = 0.874 Interaction with groups X week F = 21.680 P<0.001 F = 12.655 P<0.001 RR: Respiratory rate, SE: Standard error   Table 3: Comparison of Systolic BP and Diastolic BP S.No Groups Test Systolic BP (Mean+SE) Diastolic BP (Mean+SE) 1 Control 1-week 123.75+2.678 83.5+1.533 Control 4-week 126.05+2.642 83.95+1.45 Control 8-week 126.5+2.289 84.35+1.42 Control 12-week 127.5+2.559 85.1+1.556 Experimental 1-week 118.9+2.488 80.8+1.068 Experimental 4-week 118.35+2.362 80.4+1.21 Experimental 8-week 117.4 +2.063 78.55+1.186 Experimental 12-week 116.15+1.986 78.4+0.816 2 Among control and experimental groups. F = 6.213 P = 0.017 F = 7.162 P = 0.011 Among tests in 1-week/4-week/8-week/12-week. F = 0.778 P = 0.509 F = 1.116 P = 0.345 Interaction with groups X week F = 10.625 P<0.001 F = 8.127 P<0.001 BP: Blood pressure, SE: Standard error   Table 4: Comparison of Salivary Cortisol S.No Groups and comparisons Tests Cortisol (ng/L) mean+SE 1 Control 1-week 5.606+1.584 Control 12-week 5.798+1.634 Experimental 1-week 4.556+1.309 Experimental 12-week 2.865+1.076 2 Among Control and Experimental group F = 0.993 P = 0.325 Among tests in 1-week/4-week/8-week/12-week. F = 18.744 P <0.001 Interaction (groups X week) F = 29.569 P <0.001 3 Baseline assessment (Control and Experimental) t = 0.523 P = 0.604 Significance between 12-week among Control and Experimental t = 1.462 P = 0.152 4 Within Control (baseline and 12-week) t = 0.784 P = 0.438 Within Experimental (baseline and 12-week) t = 6.906 P =<0.001 SE: Standard error   Table 5: Demographic Details S.No. Variable Category Control group Experimental group Chi-square 1 Age of mother < 30 years 13 16 c2 = 0.502 P = 0.479 > 31 years 7 4 2 Residential area Urban 15 15 c2 = 0.133 P = 0.715 Rural 5 5 3 Education of head of family Graduate 13 10 c2 = 0.409 P = 0.522 Schooling 7 10 4 Occupation of head of family Professional 6 4 c2 = 0.622 P = 0.733 Office employed 6 6 General worker 8 10 5 Type of family Nuclear 7 8 c2 = 0 P = 1.0 Joint 13 12 6 Age at marriage of mother < 20 years 5 8 c2 = 0.456 P = 0.500 > 21 years 15 12 7 Type of marriage Consanguineous 10 10 c2 = 1.0 P = 0.752 Nonconsanguineous 10 10 8 Age of child < 10 years 10 12 c2 = 0.101 P = 0.751 > 11 years 10 8 9 Gender of child Male 15 14 c2 = 0 P = 1.0 Female 5 6 10 Birth order First 14 15 c2 = 0 P = 1.0 Second and above 6 5 11 Type of disability Intellectual disability 11 10 c2 = 0.190 P = 0.979 Learning disability 4 4 Autistic spectrum 3 4 Cerebral palsy 2 2 12 Duration of treatment < 3 years 11 11 c2 = 0.101 P = 0.751 > 3 years 9 9 13 No of disabled children 1 19 20 c2 = 0 P = 1.0 > 1 1 0

The findings of the study significantly underscore the therapeutic potential of Autogenic Relaxation Therapy (ART) in enhancing both psychological and physiological health outcomes among participants. The experimental group exhibited a marked reduction in psychological distress, with stress levels decreasing by 27.1% and depression levels declining by 36%. In contrast, the control group demonstrated no such improvements, which aligns with existing literature that supports the efficacy of ART in mental health improvement [7].   The emphasis on stress reduction is crucial since stress is a prevalent psychological condition that affects many individuals today. This reduction is consistent with research highlighting how effective autogenic techniques are at promoting relaxation and emotional regulation, thereby decreasing overall stress reactivity [8]. Furthermore, the significant decrease in anxiety and depression as a result of ART correlates with findings indicating autogenic training as an intervention that successfully lowers depressive symptoms among diverse populations [9].   Physiologically, ART also contributed to significant improvements, as observed in the experimental group. Participants experienced a 7.7% decrease in respiratory rate and a 7.6% reduction in pulse rate, alongside a 2.3% decrease in systolic blood pressure (BP). These findings can be contextualized within the framework of mind-body therapies that engage both physiological and psychological mechanisms to promote health [10-11]. The reductions in respiratory and pulse rates suggest a shift towards a more relaxed state, indicative of decreased activation of the sympathetic nervous system commonly associated with stress responses [12].   Although the difference in cortisol levels did not reach statistical significance at the 12-week mark, the overall physiological trends observed in the experimental group bolster the argument for ART as a valuable intervention for managing physiological markers of stress. Previous studies have indicated that ART can lead to enhanced physiological states conducive to health. Moreover, the integration of physiological markers such as blood pressure and heart rate provides a comprehensive understanding of ART's multifaceted efficacy [13-15].   In sum, the results from this study affirm the efficacy of Autogenic Relaxation Therapy, encompassing both psychological and physiological dimensions of health. The significant improvements in stress, anxiety, and depression levels, combined with the physiological changes, provide a strong case for incorporating ART into therapeutic regimens aimed at promoting holistic well-being [16]. These findings resonate with previous research efforts that advocate for ART's use in various clinical settings to aid stress management and improve health outcomes [17,18].

This study highlight that ART improves psychological and physiological well-being. ART showed potential to reduce stress, anxiety, and depression, while enhancing key health indicators. Future directions should also briefly suggest the value of broader, more diverse samples and the inclusion of qualitative assessments, without requiring immediate implementation.   Limitations This study offers valuable insights but is limited by a small, demographically narrow sample, affecting generalizability. Further research, using larger and more diverse populations, and longitudinal designs should be performed. Acknowledgments We sincerely thank the mothers of special children for their informed consent and participation. We also extend our gratitude to the authorities and teachers of Anbagam Special School for their support and permission to conduct this study.