The relaxation response

Efficacy of Imagery and Meditation Techniques in Treating Psoriasis

Using a dismantled time-series design, eighteen subjects were randomly assigned to three groups: meditation ( N = 5); meditation and imagery ( N = 4); waiting list ( N = 5). Treatment lasted twelve weeks, while pre- and post-baseline periods were of four weeks. An assessment control group control was also used during baseline periods ( N = 4). The severity of psoriasis symptoms was reliably rated by dermatologists. While controlling for extraneous factors influencing psoriasis symptoms, a time-series multivariate regression analysis revealed a significant difference between the mean psoriasis ratings of treatment and control groups after treatment (partial r = .30, p < .01). No additional impact was associated with the use of the imagery technique (partial r = − .06, p > .05). Four subjects in the treatment groups, two in each condition, succeeded in clinically improving their psoriasis symptoms, and none deteriorated. The practice of mediation may be clinically effective for some patients in reducing their psoriasis symptoms.

Effectiveness of a relaxation intervention (progressive muscle relaxation and guided imagery techniques) to reduce anxiety and improve mood of parents of hospitalized children with malignancies: A randomized controlled trial in Republic of Cyprus and Greece

PURPOSE

To explore the effect of Progressive Muscle Relaxation (PMR) and Guided Imagery (GI),in reducing anxiety levels among parents of children diagnosed with any type of malignancy receiving active treatment at a Paediatric Oncology Unit in Republic of Cyprus and in Greece.

METHOD

A randomized non-blinded control trial was conducted between April 2012 to October 2013, at two public paediatric hospitals. Fifty four eligible parents of children hospitalized with a malignancy were randomly assigned to the intervention (PMR and GI) (n = 29) and a control group (n = 25). The study evaluated the changes in anxiety levels(HAM-A) and mood changes(POMSb).

RESULTS

There was a statistically significant difference in the mean scores of the subjects in the intervention group in HAM-A scale between the T0 (14.67 ± 9.93) and T1 (11.70 ± 8.15) measurements (p = 0.008) compared to the control group in which a borderline difference (16.00 ± 11.52 vs 13.33 ± 8.38) was found (p = 0.066). The effect size for the intervention group was low to moderate (0.37). Regarding mood changes, there was a statistically significant difference in tension for parents in the intervention group between T0 and T1 (11.15 ± 5.39 vs 9.78 ± 4.26), (p = 0.027). Furthermore, the parents in the intervention group were significantly less sad following the intervention (T1) (2.81 ± 1.07 vs 2.19 ± 1.21), (p = 0.001), and felt significantly less tense (2.93 ± 0.91 vs 2.26 ± 0.90), (p = 0.001) and anxiety (2.63 ± 1.21 vs 2.19 ± 1.07), (p = 0.031) compared to those in the control group.

CONCLUSIONS

These findings provided evidence on the positive effect of the combination of PMR and GI in reducing anxiety and improving mood states in parents of children with malignancy.

Group-Based Relaxation Response Skills Training for Pharmacologically-Resistant Depressed and Anxious Patients

BACKGROUND

Drug-resistance for depression and anxiety is a major limitation in the treatment of these common disorders, and adjunct support interventions may be beneficial in the treatment of these patients.

AIMS

The purpose of this study was to evaluate the effects of a short-term (8 session) Relaxation Response Skills Training (RRST) programme for a population of psychiatric outpatients with anxiety and mood disorders who were unresponsive to drug treatment, and to test the feasibility of this intervention as complementary treatment for a psychiatric setting.

METHOD

Forty patients were measured for overall psychopathological symptoms, depression, and anxiety, and were then given an 8-week course of RRST, while continuing their pharmacological treatment. Following the RRST intervention, participants were again assessed.

RESULTS

The results demonstrated reductions in overall symptoms (large effect size and reasonable clinically significant change), and also in depression and anxiety (medium effect sizes and clinically significant change).

CONCLUSIONS

These results suggest that this short-term RRT offers a simple and cost-effective way to augment drug management for participants with common psychiatric disorders who are less responsive to the drug treatment.

Mantras and Meditation: A Literature Review

It is often claimed by teachers of meditation that the “mantra-person fit” is of central importance to the effects of practice. A review of the literature exposed no compelling evidence to support such a claim. On the contrary, it appears that any “mental device,” onto which the attention can be focussed, is equally effective in terms of measurable outcome.

Expectation and Meditation

94 prospective meditators were administered 2 14-item questionnaires to ascertain their present perceived-selves and their expectations of Transcendental Meditation on 3 occasions: (1) just before 2 introductory talks on meditation, (2) just after these talks, and (3)7 mo. later on follow-up. 36 subjects decided against taking up meditation. Analysis of variance and correlations showed that those who took up meditation were older, initially had more negative perceived-selves, and had higher expectations. In general, a more positive perceived-self at retest and high expectations at the 3 testing periods were related to a high frequency of meditation practice. Frequent practice, in turn, was related to improved perceived-self and increased expectation scores on follow-up. Younger subjects appeared to be more suggestible (responded more positively to the talks); on follow-up they meditated more frequently, had more positive perceived-selves, and were more likely to report an improved perceived-self compared with their initial pre-talk scores, than older subjects.

Personality Characteristics and Regularity of Meditation

A prospective study was conducted in which personality scores taken prior to meditation initiation were used to predict responses to meditation. Eysenck's (1963) Personality Inventory, Byrne's (1963) Repression-Sensitization Scale, Rotter's (1966) Locus of Control, and Barber's (1965) Suggestibility Scale were completed by 55 prospective meditators. Subjects were recontacted after 18 mo. and grouped according to how frequently they meditated into ‘regulars,’ ‘irregulars,’ and ‘drop-outs.’ Eight subjects remained ‘uninitiated.’ Statistical analysis of preinitiation scores and frequency of meditation practice showed: (1) Frequency of meditation was negatively correlated with both neuroticism and sensitization. (2) Neuroticism and sensitization were positively correlated independently of meditation practice. (3) Prospective ‘dropouts' scored significantly higher on both neuroticism and sensitization than prospective regular meditators and than the uninitiated subjects and were significantly more neurotic than Eysenck's norms. (4) Scores of regular meditators and uninitiated subjects were not significantly different from Eysenck's norms for neuroticism. (5) Regular meditators and uninitiated subjects did not differ significantly with regard to neuroticism and sensitization. (6) Meditators-to-be were significantly more neurotic than uninitiated subjects and than Eysenck's norms. No significant differencs were found a propos extraversion, locus of control, and suggestibility. The maintenance of the practice of meditation was not related to one's gender, but drop-outs tended to be younger.

Brief Online Focused Attention Meditation Training: Immediate Impact

BACKGROUND

There is increasing interest in brief, online training in mind-body skills to improve resilience in health professionals.

METHODS

We analyzed data from an online training program in focused attention meditation. Resilience, relaxation, stress, positive and negative affect, and flourishing were measured before and after training using standardized scales.

RESULTS

The 379 participants included nurses (31%), physicians (21%), social workers and psychologists (10%), and others (38%). At baseline, participants reported high levels of stress (mean 16.7 compared with population norms of 12-14). Completing modules was associated with small but significant improvements in relaxation, resilience, stress, positive and negative affect, and flourishing ( P <. 01 for all) Conclusion. Online focused attention meditation training reaches diverse health professionals and is associated with improvements in relaxation, resilience, stress, affect, and flourishing. Additional research is warranted to compare the long-term cost-effectiveness of different amounts and types of mind-body training on clinician burnout and quality of care.

A Theoretical Model of Psychosomatic Illness in Blacks and an Innovative Treatment Strategy

In regard to Black people in America, the internal colonialism model makes the researcher cognizant of the phenomenon "controlled oppressed environment." In this context, Blackness, which has an obvious biological base, is a highly stress-induced stimulus because of the negative attitudes toward it. For some Blacks, this circumstance is catalytic to or evokes psychosomatic illness. It is proposed that a holistic paradigm serve as the theoretical under pinning of interventions into psychosomatic illness. A particular holistic paradigm is proposed that is built on the supposition that there is an interplay between physiologic and psychologic processes. Furthermore, it relies upon general system theory and a hierarchical conceptuali zation of the nervous system and consciousness. Based on the conceptual model, T'ai Chi Ch'uan is proposed as an appropriate holistic intervention to actively assault upon the Black individual's psychosomatic disorder.

The Effect of Therapeutic Back Massage in Hypertensive Persons: A Preliminary Study

Hypertension, one of the most pervasive disease processes in the United States, can lead to target organ damage. Although there is no one cause of primary hypertension, the theory of an unchecked long-term stress response continues to be a valid argument. Conversely, eliciting the relaxation response may alter the course of the unchecked stress response. Massage therapists have suggested that their therapy elicits the relaxation response and therefore can decrease blood pressure (BP) and hypertension. This preliminary study tested the effects of a regularly applied back massage on the BP of patients with clinically diagnosed hypertension. In this experimental, pretest-posttest study, a 10-min back massage was given to the experimental group (n = 8), three times a week for 10 sessions. The control group (n = 6) relaxed in the same environment for 10 min, three times a week for 10 sessions. Analysis of variance determined systolic BP changed significantly, F (1, 12) = 17.90, p = .001, between groups over time as did the diastolic BP, F (1, 12) = 8.34, p = .014. Effect size was 2.25 for systolic pressure and 1.56 for diastolic pressure (alpha of .05 and power at .80). This preliminary study suggests that regular massage may lower BP in hypertensive persons.

Differential Effects of 7 and 16 Groups of Muscle Relaxation Training Following Repeated Submaximal Intensity Exercise in Young Football Players

This study compares two versions of progressive muscle relaxation (PMR) training (7 and 16 muscle groups) on oxygen consumption (VO2), heart rates, rating of perceived exertion and choice reaction time. Football (soccer) players (N = 26; M age = 13.4 yr., SD = 0.5) were randomly assigned to either 7 muscle groups PMR, 16 muscle groups PMR, or a control group. PMR training requires the participants to tense a muscle, hold the muscle contraction, and then relax it. Measurement was conducted prior to and after the completion of 12 sessions of PMR. The dependent variables were measured following four bouts of intermittent exercise consisting of 12 min. of running at 60% VO2max for 10 min. followed by running at 90% VO2max for 2 min. with a 3-min. rest for each bout. Lower VO2, heart rate, perceived exertion, and quicker reaction time were expected in both relaxation groups compared to the control group. The results revealed a significant reduction in heart rates and choice reaction time for both relaxation groups, but the longer version produced significantly quicker choice reaction time.

Mind-body group treatment for women coping with infertility: a pilot study

OBJECTIVES

To evaluate the feasibility of a 10-week mind-body intervention (MBI) for women coping with fertility challenges, examine the impact of an MBI on psychological distress and cortisol levels, and assess adherence to MBI skills 12-months after completion of the intervention.

DESIGN

Prospective open pilot study of 51 women with infertility enrolled in a group MBI. Psychological variables and salivary cortisol levels were obtained pre- and post-intervention; a 12-month follow-up survey assessed MBI skill adherence. Participants completed practice logs throughout the intervention.

RESULTS

Participants attended an average of eight sessions (SD = 2.0), and practiced mind-body techniques which elicited the relaxation response (RR) an average of 5.9 (SD = 0.8) days/week and 20.1 (SD = 9.9) min/day; 80% completed the post-treatment assessment. The intervention resulted in a significant increase in perceived social support and a decrease in depressive symptoms and perceived stress; however, there were no significant changes in cortisol levels. Sixty-eight percent of the participants completed the 12-month follow-up, with 51% reporting continuation of RR-eliciting practice.

CONCLUSION

This group of women with infertility provided with an MBI showed decreased symptoms of depression and stress and increased perceived social support. The protocol was feasible and participants reported a high degree of adherence and maintenance to the skills taught during the intervention. The findings indicate the value of appropriate evaluation against a control group.

Mechanistic Pathways of Mindfulness Meditation in Combat Veterans With Posttraumatic Stress Disorder

OBJECTIVE

This study's objective was to evaluate the effect of two common components of meditation (mindfulness and slow breathing) on potential mechanistic pathways.

METHODS

A total of 102 combat veterans with posttraumatic stress disorder (PTSD) were randomized to (a) the body scan mindfulness meditation (MM), (b) slow breathing (SB) with a biofeedback device, (c) mindful awareness of the breath with an intention to slow the breath (MM+SB), or (d) sitting quietly (SQ). Participants had 6 weekly one-on-one sessions with 20 minutes of daily home practice. The mechanistic pathways and measures were as follows: (a) autonomic nervous system (hyperarousal symptoms, heart rate [HR], and heart rate variability [HRV]); (b) frontal cortex activity (attentional network task [ANT] conflict effect and event-related negativity and intrusive thoughts); and (c) hypothalamic-pituitary-adrenal axis (awakening cortisol). PTSD measures were also evaluated.

RESULTS

Meditation participants had significant but modest within-group improvement in PTSD and related symptoms, although there were no effects between groups. Perceived impression of PTSD symptom improvement was greater in the meditation arms compared with controls. Resting respiration decreased in the meditation arms compared with SQ. For the mechanistic pathways, (a) subjective hyperarousal symptoms improved within-group (but not between groups) for MM, MM+SB, and SQ, while HR and HRV did not; (b) intrusive thoughts decreased in MM compared with MM+SB and SB, while the ANT measures did not change; and (c) MM had lower awakening cortisol within-group (but not between groups).

CONCLUSION

Treatment effects were mostly specific to self-report rather than physiological measures. Continued research is needed to further evaluate mindfulness meditation's mechanism in people with PTSD.

The Applied Mindfulness Process Scale (AMPS): A process measure for evaluating mindfulness-based interventions

OBJECTIVE

Mindfulness-based interventions (MBIs) include the application of meditation and mind-body practices used to promote mindful awareness in daily life. Operationalizing the construct of mindfulness is important in order to determine mechanisms of therapeutic change elicited by mindfulness practice. In addition to existing state and trait measures of mindfulness, process measures are needed to assess the ways in which individuals apply mindfulness in the context of their practice.

METHOD

This report details three independent studies (qualitative interview, N = 8; scale validation, N = 134; and replication study, N = 180) and the mixed qualitative-quantitative methodology used to develop and validate the Applied Mindfulness Process Scale (AMPS), a 15-item process measure designed to quantify how mindfulness practitioners actively use mindfulness to remediate psychological suffering in their daily lives.

RESULTS

In Study 1, cognitive interviewing yielded a readily comprehensible and accessible scale of 15 items. In Study 2, exploratory factor analysis derived a potential three-factor solution: decentering, positive emotion regulation, and negative emotion regulation. In Study 3, confirmatory factor analysis verified better model fit with the three-factor structure over the one-factor structure.

CONCLUSIONS

AMPS functions as a measure to quantify the application of mindfulness and processes of change in the context of MBIs and general mindfulness practice.

Strategies to manage patients with dental anxiety and dental phobia: literature review

Dental anxiety and phobia result in avoidance of dental care. It is a frequently encountered problem in dental offices. Formulating acceptable evidence-based therapies for such patients is essential, or else they can be a considerable source of stress for the dentist. These patients need to be identified at the earliest opportunity and their concerns addressed. The initial interaction between the dentist and the patient can reveal the presence of anxiety, fear, and phobia. In such situations, subjective evaluation by interviews and self-reporting on fear and anxiety scales and objective assessment of blood pressure, pulse rate, pulse oximetry, finger temperature, and galvanic skin response can greatly enhance the diagnosis and enable categorization of these individuals as mildly, moderately, or highly anxious or dental phobics. Broadly, dental anxiety can be managed by psychotherapeutic interventions, pharmacological interventions, or a combination of both, depending on the level of dental anxiety, patient characteristics, and clinical situations. Psychotherapeutic interventions are either behaviorally or cognitively oriented. Pharmacologically, these patients can be managed using either sedation or general anesthesia. Behavior-modification therapies aim to change unacceptable behaviors through learning, and involve muscle relaxation and relaxation breathing, along with guided imagery and physiological monitoring using biofeedback, hypnosis, acupuncture, distraction, positive reinforcement, stop-signaling, and exposure-based treatments, such as systematic desensitization, “tell-show-do”, and modeling. Cognitive strategies aim to alter and restructure the content of negative cognitions and enhance control over the negative thoughts. Cognitive behavior therapy is a combination of behavior therapy and cognitive therapy, and is currently the most accepted and successful psychological treatment for anxiety and phobia. In certain situations, where the patient is not able to respond to and cooperate well with psychotherapeutic interventions, is not willing to undergo these types of treatment, or is considered dental-phobic, pharmacological therapies such as sedation or general anesthesia should be sought.

Positive Emotional Experience: Induced by Vibroacoustic Stimulation Using a Body Monochord in Patients with Psychosomatic Disorders: Is Associated with an Increase in EEG-Theta and a Decrease in EEG-Alpha Power

Relaxation and meditation techniques are generally characterized by focusing attention, which is associated with an increase of frontal EEG Theta. Some studies on music perception suggest an activation of Frontal Midline Theta during emotionally positive attribution, others display a lateralization of electrocortical processes in the attribution of music induced emotion of different valence. The present study examined the effects of vibroacoustic stimulation using a Body Monochord and the conventional relaxation music from an audio CD on the spontaneous EEG of patients suffering from psychosomatic disorders (N = 60). Each treatment took about 20 min and was presented to the patients in random order. Subjective experience was recorded via self-rating scale. EEG power spectra of the Theta, Alpha-1 and Alpha-2 bands were analysed and compard between the two treatment conditions. There was no lateralization of electrocortical activity in terms of the emotional experience of the musical pieces. A reduction in Alpha-2 power occurred during both treatments. An emotionally positive attribution of the experience of the vibroacoustically induced relaxation state is characterized by a more pronounced release of control. In the context of focused attention this is interpreted as flow experience. The spontaneous EEG showed an increase in Theta power, particularly in the frontal medial and central medial area, and a greater reduction in Alpha-2 power. The intensity of positive emotional feelings during the CD music showed no significant effect on the increase in Theta power.

Strategies to improve anxiety and depression in patients with COPD: a mental health perspective

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by progressive and only partially reversible symptoms. Worldwide, the incidence of COPD presents a disturbing continuous increase. Anxiety and depression are remarkably common in COPD patients, but the evidence about optimal approaches for managing psychological comorbidities in COPD remains unclear and largely speculative. Pharmacological treatment based on selective serotonin reuptake inhibitors has almost replaced tricyclic antidepressants. The main psychological intervention is cognitive behavioral therapy. Of particular interest are pulmonary rehabilitation programs, which can reduce anxiety and depressive symptoms in these patients. Although the literature on treating anxiety and depression in patients with COPD is limited, we believe that it points to the implementation of personalized strategies to address their psychopathological comorbidities.

Complementary and alternative medicine (CAM) following traumatic brain injury (TBI): Opportunities and challenges

Traumatic brain injury (TBI) is highly prevalent and occurs in a variety of populations. Because of the complexity of its sequelae, treatment strategies pose a challenge. Given this complexity, TBI provides a unique target of opportunity for complementary and alternative medicine (CAM) treatments. The present review describes and discusses current opportunitites and challenges associated with CAM research and clinical applications in civilian, veteran and military service populations. In addition to a brief overview of CAM, the translational capacity from basic to clinical research to clinical practice will be described. Finally, a systematic approach to developing an adoptable evidence base, with proof of effectiveness based on the literature will be discussed. Inherent in this discussion will be the methodological and ethical challenges associated with CAM research in those with TBI and associated comorbidities, specifically in terms of how these challenges relate to practice and policy issues, implementation and dissemination. This article is part of a Special Issue entitled SI:Brain injury and recovery.

A small randomized pilot study of a workplace mindfulness-based intervention for surgical intensive care unit personnel: effects on salivary α-amylase levels

OBJECTIVE

To determine whether a workplace stress-reduction intervention decreases reactivity to stress among personnel exposed to a highly stressful occupational environment.

METHODS

Personnel from a surgical intensive care unit were randomized to a stress-reduction intervention or a waitlist control group. The 8-week group mindfulness-based intervention included mindfulness, gentle yoga, and music. Psychological and biological markers of stress were measured 1 week before and 1 week after the intervention.

RESULTS

Levels of salivary α-amylase, an index of sympathetic activation, were significantly decreased between the first and second assessments in the intervention group with no changes in the control group. There was a positive correlation between salivary α-amylase levels and burnout scores.

CONCLUSIONS

These data suggest that this type of intervention could decrease not only reactivity to stress but also the risk of burnout.

Somnomat: a novel actuated bed to investigate the effect of vestibular stimulation

Rocking movements are known to affect human sleep. Previous studies have demonstrated that the transition from wake to sleep can be facilitated by rocking movements, which might be related to relaxation. However, it is not yet known which movements would have the greatest effect. Thus, a 6-degree-of-freedom tendon-based robotic bed was developed, for systematic evaluation of vestibular stimuli. The applicability of the device was evaluated with 25 subjects. Six movement axes were tested and analyzed for differences in promoting relaxation. Relaxation was assessed by electroencephalogram, electrocardiogram, respiration and a questionnaire. The developed device fulfilled all needed requirements proving the applicability of this technology. Movements had no significant effects on the electroencephalogram and electrocardiogram. Respiration frequency was significantly lower for baseline measurements without movement (median 0.183-0.233 Hz) compared to movement conditions (median 0.283-0.300 Hz). Questionnaire ratings showed a trend (p = 0.057) toward higher relaxation for movements along the vertical axis (z-axis) (median 4.67; confidence interval 4.33-5.67) compared to the roll-axis (median 4.33; confidence interval 3.67-5.00). Movements along the vertical axis (z-axis), therefore, appear most promising in promoting relaxation, though no effects were found in electroencephalogram and electrocardiogram variables. This lack of effect might be attributed to the short exposure to the movements and the large inter-individual variability and individual preferences among subjects.

Addressing "Nature-Deficit Disorder": A Mixed Methods Pilot Study of Young Adults Attending a Wilderness Camp

Background and Objectives. Rapid urbanization raises concern about chronic human health issues along with less frequent interaction with the natural world. "Nature-deficit disorder," a nonclinical term, describes this potential impact on the well-being of youth. We conducted a mixed methods pilot study of young adults attending a four-week wilderness camp to investigate whether nature-based camp experiences would increase connection to nature and promote multiple dimensions of well-being. Methods. Participants completed precamp (n = 46) and postcamp (n = 36) online questionnaires including nature-related and holistic well-being measures. Differences were investigated using paired t-tests. Interviews (n = 16) explored camp experiences and social relations. Results. All nature-related measures-exposure, knowledge, skills, willingness to lead, perceived safety, sense of place, and nature connection-significantly increased. Well-being outcomes also significantly improved, including perceived stress, relaxation, positive and negative emotions, sense of wholeness, and transcendence. Physical activity and psychological measures showed no change. Interviews described how the wilderness environment facilitated social connections. Conclusion. Findings illustrate the change in nature relations and well-being that wilderness camp experiences can provide. Results can guide future research agendas and suggest that nature immersion experiences could address the risk of "nature-deficit disorder," improve health, and prepare future environmental leaders.

Stopping the tsunami of stress in primary care

This article provides an overview of the psychoneuroimmunologic impact of stress on illness along with a review of mind/body therapies to counteract the effects of stress. Primary care providers are encouraged to promote stress reduction and translate evidence into practice by recommending mind/body therapies.

Web-Based Mindfulness Intervention in Heart Disease: A Randomized Controlled Trial

BACKGROUND

Evidence is accumulating that mindfulness training has favorable effects on psychological outcomes, but studies on physiological outcomes are limited. Patients with heart disease have a high incidence of physiological and psychological problems and may benefit from mindfulness training. Our aim was to determine the beneficial physiological and psychological effects of online mindfulness training in patients with heart disease.

METHODS

The study was a pragmatic randomized controlled single-blind trial. Between June 2012 and April 2014 we randomized 324 patients (mean age 43.2 years, 53.7% male) with heart disease in a 2:1 ratio (n = 215 versus n = 109) to a 12-week online mindfulness training in addition to usual care (UC) compared to UC alone. The primary outcome was exercise capacity measured with the 6 minute walk test (6MWT). Secondary outcomes were other physiological parameters (heart rate, blood pressure, respiratory rate, and NT-proBNP), subjective health status (SF-36), perceived stress (PSS), psychological well-being (HADS), social support (PSSS12) and a composite endpoint (all-cause mortality, heart failure, symptomatic arrhythmia, cardiac surgery, and percutaneous cardiac intervention). Linear mixed models were used to evaluate differences between groups on the repeated outcome measures.

RESULTS

Compared to UC, mindfulness showed a borderline significant improved 6MWT (effect size, meters: 13.2, 95%CI: -0.02; 26.4, p = 0.050). There was also a significant lower heart rate in favor of the mindfulness group (effect size, beats per minute: -2.8, 95%CI: -5.4;-0.2, p = 0.033). No significant differences were seen on other outcomes.

CONCLUSIONS

Mindfulness training showed positive effects on the physiological parameters exercise capacity and heart rate and it might therefore be a useful adjunct to current clinical therapy in patients with heart disease.

TRIAL REGISTRATION

Dutch Trial Register 3453.

Association Between Mind-Body Practice and Cardiometabolic Risk Factors: The Rotterdam Study

OBJECTIVES

The increased popularity of mind-body practices highlights the need to explore their potential effects. We determined the cross-sectional association between mind-body practices and cardiometabolic risk factors.

METHODS

We used data from 2579 participants free of cardiovascular disease from the Rotterdam Study (2009-2013). A structured home-based interview was used to evaluate engagement in mind-body practices including meditation, yoga, self-prayer, breathing exercises, or other forms of mind-body practice. We regressed engagement in mind-body practices on cardiometabolic risk factors (body mass index, blood pressure, and fasting blood levels of cholesterol, triglycerides, and glucose) and presence of metabolic syndrome. All analyses were adjusted for age, sex, educational level, smoking, alcohol consumption, (in)activities in daily living, grief, and depressive symptoms.

RESULTS

Fifteen percent of the participants engaged in a form of mind-body practice. Those who did mind-body practices had significantly lower body mass index (β = -0.84 kg/m, 95% confidence interval [CI] = -1.30 to -0.38, p < .001), log-transformed triglyceride levels (β = -0.02, 95% CI = -0.04 to -0.001, p = .037), and log-transformed fasting glucose levels (β = -0.01, 95% CI = -0.02 to -0.004, p = .004). Metabolic syndrome was less common among individuals who engaged in mind-body practices (odds ratio = 0.71, 95% CI = 0.54-0.95, p = .019).

CONCLUSIONS

Individuals who do mind-body practices have a favorable cardiometabolic risk profile compared with those who do not. However, the cross-sectional design of this study does not allow for causal inference and prospective, and intervention studies are needed to elucidate the association between mind-body practices and cardiometabolic processes.

The effect of meditation on regulation of internal body states

Meditation is commonly thought to induce physiologically quiescent states, as evidenced by decreased autonomic parameters during the meditation practice including reduced heart rate, respiratory rate, blood pressure, skin conductance, and increased alpha activity in the electroencephalogram. Preliminary empirical support for this idea was provided in a case report by Dimsdale and Mills (2002), where it was found that meditation seemed to regulate increased levels of cardiovascular arousal induced by bolus isoproterenol infusions. In that study, while meditating, a self-taught meditator exhibited unexpected decreases in heart rate while receiving moderate intravenous doses of the beta adrenergic agonist isoproterenol. This effect was no longer observed when the individual received isoproterenol infusions while not meditating. The current study was designed to explore this phenomenon empirically in a group of formally trained meditators. A total of 15 meditators and 15 non-meditators individually matched on age, sex, and body mass index were recruited. Participants received four series of infusions in a pseudorandomized order: isoproterenol while meditating (or during a relaxation condition for the non-meditators), isoproterenol while resting, saline while meditating (or during a relaxation condition for the non-meditators), and saline while resting. Heart rate was continuously measured throughout all infusions, and several measures of heart rate were derived from the instantaneous cardiac waveform. There was no evidence at the group or individual level suggesting that meditation reduced the cardiovascular response to isoproterenol, across all measures. These results suggest that meditation is not associated with increased regulation of elevated cardiac adrenergic tone.

Mind-Body Practices and the Adolescent Brain: Clinical Neuroimaging Studies

BACKGROUND

Mind-Body practices constitute a large and diverse group of practices that can substantially affect neurophysiology in both healthy individuals and those with various psychiatric disorders. In spite of the growing literature on the clinical and physiological effects of mind-body practices, very little is known about their impact on central nervous system (CNS) structure and function in adolescents with psychiatric disorders.

METHOD

This overview highlights findings in a select group of mind-body practices including yoga postures, yoga breathing techniques and meditation practices.

RESULTS

Mind-body practices offer novel therapeutic approaches for adolescents with psychiatric disorders. Findings from these studies provide insights into the design and implementation of neuroimaging studies for adolescents with psychiatric disorders.

CONCLUSIONS

Clinical neuroimaging studies will be critical in understanding how different practices affect disease pathogenesis and symptomatology in adolescents. Neuroimaging of mind-body practices on adolescents with psychiatric disorders will certainly be an open and exciting area of investigation.

Stress, Meditation, and Alzheimer's Disease Prevention: Where The Evidence Stands

Although meditation is believed to be over five thousand years old, scientific research on it is in its infancy. Mitigating the extensive negative biochemical effects of stress is a superficially discussed target of Alzheimer's disease (AD) prevention, yet may be critically important. This paper reviews lifestyle and stress as possible factors contributing to AD and meditation's effects on cognition and well-being for reduction of neurodegeneration and prevention of AD. This review highlights Kirtan Kriya (KK), an easy, cost effective meditation technique requiring only 12 minutes a day, which has been successfully employed to improve memory in studies of people with subjective cognitive decline, mild cognitive impairment, and highly stressed caregivers, all of whom are at increased risk for subsequent development of AD. KK has also been shown to improve sleep, decrease depression, reduce anxiety, down regulate inflammatory genes, upregulate immune system genes, improve insulin and glucose regulatory genes, and increase telomerase by 43%; the largest ever recorded. KK also improves psycho-spiritual well-being or spiritual fitness, important for maintenance of cognitive function and prevention of AD. KK is easy to learn and practice by aging individuals. It is the premise of this review that meditation in general, and KK specifically, along with other modalities such as dietary modification, physical exercise, mental stimulation, and socialization, may be beneficial as part of an AD prevention program.

Effectiveness of app-based relaxation for patients with chronic low back pain (Relaxback) and chronic neck pain (Relaxneck): study protocol for two randomized pragmatic trials

BACKGROUND

Chronic low back pain (LBP) and neck pain (NP) are highly prevalent conditions resulting in high economic costs. Treatment guidelines recommend relaxation techniques, such as progressive muscle relaxation, as adjuvant therapies. Self-care interventions could have the potential to reduce costs in the health care system, but their effectiveness, especially in a usual care setting, is unclear. The aim of these two pragmatic randomized studies is to evaluate whether an additional app-delivered relaxation is more effective in the reduction of chronic LBP or NP than usual care alone.

METHODS/DESIGN

Each pragmatic randomized two-armed study aims to include a total of 220 patients aged 18 to 65 years with chronic (>12 weeks) LBP or NP and an average pain intensity of ≥ 4 on a numeric rating scale (NRS) in the 7 days before recruitment. The participants will be randomized into an intervention and a usual care group. The intervention group will be instructed to practice one of these 3 relaxation techniques on at least 5 days/week for 15 minutes/day over a period of 6 months starting on the day of randomization: autogenic training, mindfulness meditation, or guided imagery. Instructions and exercises will be provided using a smartphone app, baseline information will be collected using paper and pencil. Follow-up information (daily, weekly, and after 3 and 6 months) will be collected using electronic diaries and questionnaires included in the app. The primary outcome measure will be the mean LBP or NP intensity during the first 3 months of intervention based on daily pain intensity measurements on a NRS (0 = no pain, 10 = worst possible pain). The secondary outcome parameters will include the mean pain intensity during the first 6 months after randomization based on daily measurements, the mean pain intensity measured weekly as the average pain intensity of the previous 7 days over 3 and 6 months, pain acceptance, 'LBP- and NP-related' stress, sick leave days, pain medication intake, adherence, suspected adverse reaction, and serious adverse events.

DISCUSSION

The designed studies reflect a usual self-care setting and will provide evidence on a pragmatic self-care intervention that is easy to combine with care provided by medical professionals.

TRIAL REGISTRATION

ClinicalTrials.gov identifier Relaxback NCT02019498, Relaxneck NCT02019134 registered on 18 December 2013.

Toxic Stress: Effects, Prevention and Treatment

Children who experience early life toxic stress are at risk of long-term adverse health effects that may not manifest until adulthood. This article briefly summarizes the findings in recent studies on toxic stress and childhood adversity following the publication of the American Academy of Pediatrics (AAP) Policy Report on the effects of toxic stress. A review of toxic stress and its effects is described, including factors of vulnerability, resilience, and the relaxation response. An integrative approach to the prevention and treatment of toxic stress necessitates individual, community and national focus.

Effect of restorative yoga vs. stretching on diurnal cortisol dynamics and psychosocial outcomes in individuals with the metabolic syndrome: the PRYSMS randomized controlled trial

PURPOSE

Chronic stimulation and dysregulation of the neuroendocrine system by stress may cause metabolic abnormalities. We estimated how much cortisol and psychosocial outcomes improved with a restorative yoga (relaxation) versus a low impact stretching intervention for individuals with the metabolic syndrome.

METHODS

We conducted a 1-year multi-center randomized controlled trial (6-month intervention and 6-month maintenance phase) of restorative yoga vs. stretching. Participants completed surveys to assess depression, social support, positive affect, and stress at baseline, 6 months and 12 months. For each assessment, we collected saliva at four points daily for three days and collected response to dexamethasone on the fourth day for analysis of diurnal cortisol dynamics. We analyzed our data using multivariate regression models, controlling for study site, medications (antidepressants, hormone therapy), body mass index, and baseline cortisol values.

RESULTS

Psychosocial outcome measures were available for 171 study participants at baseline, 140 at 6 months, and 132 at 1 year. Complete cortisol data were available for 136 of 171 study participants (72 in restorative yoga and 64 in stretching) and were only available at baseline and 6 months. At 6 months, the stretching group had decreased cortisol at waking and bedtime compared to the restorative yoga group. The pattern of changes in stress mirrored this improvement, with the stretching group showing reductions in chronic stress severity and perseverative thoughts about their stress. Perceived stress decreased by 1.5 points (-0.4; 3.3, p=0.11) at 6 months, and by 2.0 points (0.1; 3.9, p=0.04) at 1 year in the stretching compared to restorative yoga groups. Post hoc analyses suggest that in the stretching group only, perceived increases in social support (particularly feelings of belonging), but not changes in stress were related to improved cortisol dynamics.

CONCLUSIONS

We found significant decreases in salivary cortisol, chronic stress severity, and stress perception in the stretching group compared to the restorative yoga group. Group support during the interactive stretch classes may have contributed to these changes.

The beneficial role of spiritual counseling in heart failure patients

To ascertain the beneficial role of spiritual counseling in patients with chronic heart failure. This is a pilot study evaluating the effects of adjunct spiritual counseling on quality of life (QoL) outcomes in patients with heart failure. Patients were assigned to "religious" or "non-religious" counseling services based strictly on their personal preferences and subsequently administered standardized QoL questionnaires. A member of the chaplaincy or in-house volunteer organization visited the patient either daily or once every 2 days throughout the duration of their hospitalization. All patients completed questionnaires at baseline, at 2 weeks, and at 3 months. Each of the questionnaires was totaled, with higher scores representing positive response, except for one survey measure where lower scores represent improvement (QIDS-SR16). Twenty-three patients (n = 23, age 57 ± 11, 11 (48 %) male, 12 (52 %) female, mean duration of hospital stay 20 ± 15 days) completed the study. Total mean scores were assessed on admission, at 2 weeks and at 3 months. For all patients in the study, the mean QIDS-SR16 scores were 8.5 (n = 23, SD = 3.3) versus 6.3 (n = 18, SD = 3.5) versus 7.3 (n = 7, SD = 2.6). Mean FACIT-Sp-Ex (version 4) scores were 71.1 (n = 23, SD = 15.1) versus 74.7 (n = 18, SD = 20.9) versus 81.4 (n = 7, SD = 8.8). The mean MSAS scores were 2.0 (n = 21, SD = 0.6) versus 1.8 (n = 15, SD = 0.7) versus 2.5 (n = 4, SD = 0.7). Mean QoL Enjoyment and Satisfaction scores were 47.2 % (n = 23, SD = 15.0 %) versus 53.6 % (n = 18, SD = 16.4 %) versus 72.42 % (n = 7, SD = 22 %). The addition of spiritual counseling to standard medical management for patients with chronic heart failure patients appears to have a positive impact on QoL.

Mind-body skills groups for medical students: reducing stress, enhancing commitment, and promoting patient-centered care

BACKGROUND

For several decades, psychological stress has been observed to be a significant challenge for medical students. The techniques and approach of mind-body medicine and group support have repeatedly demonstrated their effectiveness at reducing stress and improving the quality of the education experience.

DISCUSSION

Mind-Body Skills Groups provide medical students with practical instruction in and scientific evidence for a variety of techniques that reduce stress, promote self-awareness and self-expression, facilitate imaginative solutions to personal and professional problems, foster mutual understanding among students, and enhance confidence in and optimism about future medical practice. The Center for Mind-Body Medicine, which developed this model 20 years ago, has trained medical school faculty who offer these supportive small groups to students at more than 15 US medical schools. This paper describes the model, surveys its use in medical schools, summarizes published research on it, and discusses obstacles to successful implementation as well as its benefits.

SUMMARY

Mind-Body Skills groups have demonstrated their effectiveness on reducing stress in medical students; in enhancing the students' experience of medical education; and in helping them look forward more confidently and hopefully to becoming physicians. The experience of these 15 institutions may encourage other medical schools to include mind-body skills groups in their curricula.

Effectiveness of the relaxation response-based group intervention for treating depressed chinese american immigrants: a pilot study

Background: This study examined the feasibility, safety and efficacy of an 8-week Relaxation Response (RR)-based group. Methods: Twenty-two depressed Chinese American immigrants were recruited. Outcomes measures were response and remission rates, the Hamilton Rating Scale for Depression, Clinical Global Impressions Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, and the Multidimensional Scale of Perceived Social Support Scale. Results: Participants (N = 22) were 82% female, mean age was 53 (±12). After intervention, completers (N = 15) showed a 40% response rate and a 27% remission rate, and statistically significant improvement in most outcome measures. Discussion: The RR-based group is feasible and safe in treating Chinese American immigrants with depression.

Smile--It's in your blood!

Emotions and feelings are the bricks of our social life and yet we often forget that they have a significant impact on our physical wellbeing. Indeed, a growing number of studies have shown that both an imbalanced or improved emotional state can significantly influence the way our immune system responds. In this commentary, we have summarized the most recent studies on the effects of different types of emotional states on the immune system and we have also explored the effects of mood modulator approaches on the immune response. We hope this commentary will prompt scientists and clinicians to think about the therapeutic value and potential of emotions and feelings in immune-related diseases. At the same time, we think that this commentary will shed some light on the scientific truth behind the very famous expression "It's in my blood" when we talk about feelings and personality.

[Development of a short-form self-report measure to assess relaxation effects]

The present study aimed to develop a short-form self-report measure to assess relaxation effects (S-MARE). Participants (N = 190) responded to a questionnaire comprised of 45 items assessing relaxation and non-relaxation based on the Relaxation Inventory (Crist et al., 1989). Exploratory factor analysis identified three factors: physiological tension, psychological relaxation, and anxiety. Each factor was related to 5 items and each had an acceptable Cronbach's coefficient (alpha = .93, .94, and .85). S-MARE scores pre- and post- relaxation instruction were significantly correlated with the Emotional Relaxation Scale (Tokuda, 2011) (r = .446) and with State Anxiety (r = -.531) (N = 172). There was a significant correlation between the amplitude of the high frequency component of heart rate variability during relaxation instruction and physiological tension scores on the S-MARE (r = .456-.474, N = 24). These results confirmed the reliability and validity of the S-MARE in terms of physiological correlation with cardiac parasympathetic tone, suggesting that the S-MARE is a valid measure of relaxation effects.

The science of mind body medicine and the public health challenges of today

An expanding research base of mind body medicine is adding to our understanding of stress, allostasis, and resiliency. This article will summarize a rationale in support of efficiently and effectively using mind body approaches as agents of self-care enhancement in an effort to meet major public health challenges around the world.

Positive patient experiences in an Australian integrative oncology centre

Background

The purpose of this study was to explore the experiences of cancer patients’ utilising complementary and integrative therapies (CIT) within integrative oncology centres across Western Australia.

Methods

Across four locations 135 patients accessed CIT services whilst undergoing outpatient medical treatment for cancer. Of the 135 patients, 66 (61 ± 12 y; female n = 45; male n = 21) agreed to complete a personal accounts questionnaire consisting of open-ended questions designed to explore patients’ perceptions of CIT. All results were transcribed into nVivo (v9) and using thematic analysis, key themes were identified.

Results

Of the 66 participants, 100% indicated they would “recommend complementary therapies to other patients” and 92% stated “CIT would play a significant role in their future lifestyle”. A mean score of 8 ± 1 indicated an improvement in participants’ perception of wellbeing following a CIT session. Three central themes were identified: empowerment, support and relaxation. Fourteen sub-themes were identified, with all themes clustered into a framework of multifaceted views held by cancer patients in relation to wellbeing, role of significant others and control.

Conclusions

Exploration of patients’ experiences reveals uniformly positive results. One of the key merits of the environment created within the centres is patients are able to work through their cancer journey with an increased sense of empowerment, without placing them in opposition to conventional medical treatment. In order to effectively target integrative support services it is crucial to explore the experiences of patients in their own words and use those forms of expression to drive service delivery.

Effectiveness of autogenic training in improving motor performances in Parkinson's disease

BACKGROUND

Relaxation training can be an important adjunct in reducing symptoms associated with Parkinson's disease (PD). Autogenic Training (AT) is a simple, easily administered and inexpensive technique for retraining the mind and the body to be able to relax. AT uses visual imagery and body awareness to promote a state of deep relaxation.

OBJECTIVE

To investigate whether AT when used as an adjunct to Physiotherapy (PT) improves motor performances in PD in comparison with a control group receiving PT alone.

DESIGN

Randomized, controlled, single blinded trial.

SETTING

Movement Disorder Clinic and Department of Physiotherapy, Sree Chithira Thirunal Institute of Medical Sciences and Technology in Trivandrum, Kerala, India.

PARTICIPANTS

Patients with PD of grade 2 or 3 of Hoehn & Yahr (H&Y) scale (N = 66).

INTERVENTIONS

AT group or control group. The techniques were administered by Physiotherapists trained in AT and consisted of 40 sessions per patient over 8 weeks.

MAIN OUTCOME MEASURE

Motor score subscale of Unified Parkinson's Disease Rating Scale (UPDRS) was used to measure the motor performances. The primary outcome measure was the difference in Motor score subscale of UPDRS scores between Week 1 (pretest score), Week 8 (posttest score), and follow-up at Week 12 after randomization.

RESULTS

The simple main effects analysis showed that the AT group performed better than the control group in weeks 8 and 12 (P < .005). Patients in the AT and control groups reported a 51.78% and 35.24% improvement, respectively, in their motor performances in Week 8 compared with that in Week 1, which persisted, in the follow-up (Week 12) as 30.82% in the AT group and 21.42% in the control group.

CONCLUSIONS

This study provides evidence that AT when used as an adjunct to PT is more effective than PT alone in improving motor performances in PD patients.

How mindfulness changed my sleep: focus groups with chronic insomnia patients

BACKGROUND

Chronic insomnia is a major public health problem affecting approximately 10% of adults. Use of meditation and yoga to develop mindful awareness ('mindfulness training') may be an effective approach to treat chronic insomnia, with sleep outcomes comparable to nightly use of prescription sedatives, but more durable and with minimal or no side effects. The purpose of this study was to understand mindfulness training as experienced by patients with chronic insomnia, and suggest procedures that may be useful in optimizing sleep benefits.

METHODS

Adults (N = 18) who completed an 8-week mindfulness-based stress reduction (MBSR) program as part of a randomized, controlled clinical trial to evaluate MBSR as a treatment for chronic insomnia were invited to participate in post-trial focus groups. Two groups were held. Participants (n = 9) described how their sleep routine, thoughts and emotions were affected by MBSR and about utility (or not) of various mindfulness techniques. Groups were audio-recorded, transcribed and analyzed using content analysis.

RESULTS

Four themes were identified: the impact of mindfulness on sleep and motivation to adopt a healthy sleep lifestyle; benefits of mindfulness on aspects of life beyond sleep; challenges and successes in adopting mindfulness-based practices; and the importance of group sharing and support. Participants said they were not sleeping more, but sleeping better, waking more refreshed, feeling less distressed about insomnia, and better able to cope when it occurred. Some participants experienced the course as a call to action, and for them, practicing meditation and following sleep hygiene guidelines became priorities. Motivation to sustain behavioral changes was reinforced by feeling physically better and more emotionally stable, and seeing others in the MBSR class improve. The body scan was identified as an effective tool to enable falling asleep faster. Participants described needing to continue practicing mindfulness to maintain benefits.

CONCLUSIONS

First-person accounts are consistent with published trial results of positive impacts of MBSR on sleep measured by sleep diary, actigraphy, and self-report sleep scales. Findings indicate that mindfulness training in a group format, combined with sleep hygiene education, is important for effective application of MBSR as a treatment for chronic insomnia.

Exploring the effectiveness of a modified comprehensive mind-body intervention for medical and psychologic symptom relief

BACKGROUND

Chronic illnesses are a major current health concern associated with elevated stress and increased health care costs.

OBJECTIVE

The objective of this study was to describe the preliminary effectiveness of a modified, multimodal 8 week mind-body intervention on reducing physical and psychological symptoms in patients with chronic physical, mental and comorbid health issues.

METHODS

Two hundred and twenty six adults enrolled in a mind-body group program and completed pre and post program assessments (63% completer rate), including the Medical Symptoms Checklist (MSCL), Health Promoting Lifestyle Profile (HPLP-II), and Symptom Checklist 90R (SCL-90R).

RESULTS

Significant improvement was found on 9 of 23 medical symptoms (p < .002), all health promoting lifestyle behaviors (p < .001), and all mental health symptoms (p < .001).

CONCLUSIONS

These results indicate that a multimodal mind-body intervention might be useful as a complementary or adjunct therapy for treatment of chronic medical symptoms. Future research is needed to test the intervention using a randomized controlled trial.

Mindfulness training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface

Prominent neuroscience models suggest that addictive behavior occurs when environmental stressors and drug-relevant cues activate a cycle of cognitive, affective, and psychophysiological mechanisms, including dysregulated interactions between bottom-up and top-down neural processes, that compel the user to seek out and use drugs. Mindfulness-based interventions (MBIs) target pathogenic mechanisms of the risk chain linking stress and addiction. This review describes how MBIs may target neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface. Empirical evidence is presented suggesting that MBIs ameliorate addiction by enhancing cognitive regulation of a number of key processes, including: clarifying cognitive appraisal and modulating negative emotions to reduce perseverative cognition and emotional arousal; enhancing metacognitive awareness to regulate drug-use action schema and decrease addiction attentional bias; promoting extinction learning to uncouple drug-use triggers from conditioned appetitive responses; reducing cue-reactivity and increasing cognitive control over craving; attenuating physiological stress reactivity through parasympathetic activation; and increasing savoring to restore natural reward processing. Treatment and research implications of our neurocognitive framework are presented. We conclude by offering a temporally sequenced description of neurocognitive processes targeted by MBIs through a hypothetical case study. Our neurocognitive framework has implications for the optimization of addiction treatment with MBIs.