The relaxation response

The relaxation response: history, physiological basis and clinical usefulness

Considerable emphasis has been placed upon the relation of behavioural factors to the development of coronary artery disease. There is, however, the opposite potential: behavioural processes may lead to the alleviation and reversal of some of the predisposing features of this illness. This paper presents evidence that specific behaviours and thought patterns are associated with the elicitation of an innate physiological capacity termed the relaxation response. It will discuss the history of this response, its physiological basis, clinical usefulness (particularly in prevention) and some recent findings concerning the underlying mechanism of its actions.

The role of mindfulness in positive reappraisal

Mindfulness meditation is increasingly well known for therapeutic efficacy in a variety of illnesses and conditions, but its mechanism of action is still under debate in scientific circles. In this paper, we propose a hypothetical causal model that argues for the role of mindfulness in positive reappraisal coping. Positive reappraisal is a critical component of meaning-based coping that enables individuals to adapt successfully to stressful life events. Mindfulness, as a metacognitive form of awareness, involves the process of decentering, a shifting of cognitive sets that enables alternate appraisals of life events. We review the concept of positive reappraisal in transactional stress and coping theory, then describe research and traditional literature related to mindfulness and positive reappraisal, and detail the central role of mindfulness in the reappraisal process. With this understanding, we present a causal model explicating the proposed mechanism. The discussion has implications for clinical practice, suggesting how mindfulness-based integrative medicine interventions can be designed to support adaptive coping processes.

A review on the effects of aromatherapy for patients with depressive symptoms

PURPOSE

We reviewed studies from 2000 to 2008 on using essential oils for patients with depression or depressive symptoms and examined their clinical effects.

METHODS

The review was conducted among five electronic databases to identify all peer-reviewed journal papers that tested the effects of aromatherapy in the form of therapeutic massage for patients with depressive symptoms.

RESULTS

The results were based on six studies examining the effects of aromatherapy on depressive symptoms in patients with depression and cancer. Some studies showed positive effects of this intervention among these three groups of patients.

CONCLUSIONS

We recommend that aromatherapy could continue to be used as a complementary and alternative therapy for patients with depression and secondary depressive symptoms arising from various types of chronic medical conditions. More controlled studies with sound methodology should be conducted in the future to ascertain its clinical effects and the underlying psychobiologic mechanisms.

Increases in positive reappraisal coping during a group-based mantram intervention mediate sustained reductions in anger in HIV-positive persons

BACKGROUND

There is evidence that various meditation practices reduce distress, but little is known about the mechanisms of frequently repeating a mantram-a spiritual word or phrase-on distress reduction. Mantram repetition is the portable practice of focusing attention frequently on a mantram throughout the day without a specific time, place, or posture.

PURPOSE

We examined the hypothesis of whether increases in positive reappraisal coping or distancing coping mediated the sustained decreases in anger found following a group-based mantram intervention that was designed to train attention and promote awareness of internal experiences.

METHOD

A secondary analysis was performed on data collected from a randomized controlled trial that compared a group-based mantram intervention (n = 46) to an attention-matched control (n = 47) in a community sample of human immunodeficiency virus-positive adults. Positive reappraisal and distancing coping were explored as potential mediators of anger reduction.

RESULTS

Participants in the mantram intervention reported significant increases in positive reappraisal coping over the 5-week intervention period, whereas the control group reported decreases. Increases in positive reappraisal coping during the 5-week intervention period appear to mediate the effect of mantram on decreased anger at 22-week follow-up.

CONCLUSIONS

Findings suggest that a group-based mantram intervention may reduce anger by enhancing positive reappraisal coping.

Breath Psychology

As the study and use of the breath, breath psychology is an ancient applied science. While it is more obvious and flourishes in an holistic way in economically less developed countries of the world, it remains a foundation for modern forms of psychology, however academic and professional these have become, in the so-called first world countries. The aim of this article is to reintroduce this original psychology from a pragmatic, fundamental and applied perspective. Breath psychology fundamentals, which have been extolled for millennia in the form of various wisdom and spiritual traditions, are explicated in relation to the themes of consciousness, embodiment, ecology, spirituality and healing. Breath psychology applications are discussed with reference to health, sport and skills training. It is concluded that general breathing exercises constitute an immediate form of energy management, illness prevention and the basis for cost-effective public health promotion in both economically developed and developing countries. In an ecological and cosmic context, with threats such as pollution, overpopulation and global warming, optimal use of the breath becomes a planetary imperative.

Genomic counter-stress changes induced by the relaxation response

Background

Mind-body practices that elicit the relaxation response (RR) have been used worldwide for millennia to prevent and treat disease. The RR is characterized by decreased oxygen consumption, increased exhaled nitric oxide, and reduced psychological distress. It is believed to be the counterpart of the stress response that exhibits a distinct pattern of physiology and transcriptional profile. We hypothesized that RR elicitation results in characteristic gene expression changes that can be used to measure physiological responses elicited by the RR in an unbiased fashion.

Methods/Principal Findings

We assessed whole blood transcriptional profiles in 19 healthy, long-term practitioners of daily RR practice (group M), 19 healthy controls (group N₁), and 20 N₁ individuals who completed 8 weeks of RR training (group N₂). 2209 genes were differentially expressed in group M relative to group N₁ (p<0.05) and 1561 genes in group N₂ compared to group N₁ (p<0.05). Importantly, 433 (p<10₋₁₀) of 2209 and 1561 differentially expressed genes were shared among long-term (M) and short-term practitioners (N₂). Gene ontology and gene set enrichment analyses revealed significant alterations in cellular metabolism, oxidative phosphorylation, generation of reactive oxygen species and response to oxidative stress in long-term and short-term practitioners of daily RR practice that may counteract cellular damage related to chronic psychological stress. A significant number of genes and pathways were confirmed in an independent validation set containing 5 N₁ controls, 5 N₂ short-term and 6 M long-term practitioners.

Conclusions/Significance

This study provides the first compelling evidence that the RR elicits specific gene expression changes in short-term and long-term practitioners. Our results suggest consistent and constitutive changes in gene expression resulting from RR may relate to long term physiological effects. Our study may stimulate new investigations into applying transcriptional profiling for accurately measuring RR and stress related responses in multiple disease settings.

"I felt like a new person." the effects of mindfulness meditation on older adults with chronic pain: qualitative narrative analysis of diary entries

To identify the effects of mindfulness meditation on older adults with chronic low back pain (CLBP), we conducted a qualitative study based on grounded theory and used content analysis of diary entries from older adults who had participated in a clinical trial of an 8-week mindfulness meditation program. Participants were 27 adults > or = 65 years of age with CLBP of at least moderate severity and of at least 3 months duration. We found several themes reflecting the beneficial effects of mindfulness meditation on pain, attention, sleep, and achieving well-being. Various methods of pain reduction were used, including distraction, increased body awareness leading to behavior change, better pain coping, and direct pain reduction through meditation. Participants described improved attention skills. A number of participants reported improved sleep latency as well as quality of sleep. Participants described achieving well-being during and after a meditation session that had immediate effects on mood elevation but also long-term global effects on improved quality of life. Several themes were identified related to pain reduction, improved attention, improved sleep, and achieving well-being resulting from mindfulness meditation that suggest it has promising potential as a nonpharmacologic treatment of chronic pain for older adults.

PERSPECTIVE

Community-dwelling older adults with chronic low back pain experience numerous benefits from mindfulness meditation including less pain, improved attention, better sleep, enhanced well-being, and improved quality of life. Additional research is needed to determine how mindfulness meditation works and how it might help with other chronic illnesses.

Self-expansion as a mediator of relationship improvements in a mindfulness intervention

In a recent randomized controlled trial, couples participating in a mindfulness-based relationship enhancement program demonstrated significant improvements in relationship satisfaction and relationship distress (Carson, Carson, Gil, & Baucom, 2004). Here we report on a multiple mediation analysis of these couples' improvements. Potential mediators included measures of couples' engagement in exciting self-expanding activities, couples' ability to accept one another's difficult characteristics, and individual partners' ability to relax. Results indicate that to a large extent, the mindfulness-related relationship improvements can be attributed to partners' sense that they were participating in exciting self-expanding activities together during the course of the intervention. The implications of these findings for future mindfulness research are discussed.

The neurological basis of occupation

The purpose of the present paper was to survey the literature about the neurological basis of human activity and its relationship to occupation and health. Activities related to neurological function were organized into three categories: those that activate the brain's reward system; those that promote the relaxation response; and those that preserve cognitive function into old age. The results from the literature review correlating neurological evidence and activities showed that purposeful and meaningful activities could counter the effects of stress-related diseases and reduce the risk for dementia. Specifically, it was found that music, drawing, meditation, reading, arts and crafts, and home repairs, for example, can stimulate the neurogical system and enhance health and well-being, Prospective research studies are needed to examine the effects of purposeful activities on reducing stress and slowing the rate of cognitive decline.

Massage Relieves Nausea in Women with Breast Cancer Who Are Undergoing Chemotherapy

OBJECTIVES

The aim of the present study was to examine the effect of massage on nausea, anxiety, and depression in patients with breast cancer undergoing chemotherapy.

DESIGN

This work was a single-center, prospective, randomized, controlled trial.

SETTINGS/LOCATION

This study was conducted in an oncology clinic, in a hospital in southwestern Sweden.

SUBJECTS

Thirty-nine (39) women (mean age = 51.8) with breast cancer undergoing chemotherapy were enrolled.

INTERVENTIONS

The patients were randomly assigned to a massage therapy group (20 minutes of massage on five occasions) or a control group (five 20-minute visits).

OUTCOME MEASURES

All patients recorded nausea and anxiety on the Visual Analogue Scale before and after each intervention. They also completed the Hospital Anxiety and Depression Scale.

RESULTS

Massage treatment significantly reduced nausea compared with control treatment (p = 0.025) when improvement was measured as a percentage of the five treatment periods. Differences in anxiety and depression between the two treatment regimes could not be statistically demonstrated.

CONCLUSIONS

This study complements previous studies on the effect of massage and supports the conclusion that massage reduces nausea in these patients.

Relaxation strategies and enhancement of hypnotic susceptibility: EEG neurofeedback, progressive muscle relaxation and self-hypnosis

Hypnosis has been shown to be efficacious in a range of clinical conditions, including the management of chronic pain. However, not all individuals are able to enter a hypnotic state, thereby limiting the clinical utility of this technique. We sought to determine whether hypnotic susceptibility could be increased using three methods thought to facilitate relaxation, with particular interest in an EEG neurofeedback protocol which elevated the theta to alpha ratio. This was compared with progressive muscle relaxation and self-hypnosis. Ten subjects with moderate levels of susceptibility (2-7/12) were randomly assigned to each condition and assessed for hypnotic susceptibility prior to and upon completion of 10 sessions of training. Hypnotic susceptibility increased post-training in all groups, providing further evidence that operant control over the theta/alpha ratio is possible, but contrary to our predictions, elevation of the theta/alpha ratio proved no more successful than the other interventions. Nonetheless, all three techniques successfully enhanced hypnotic susceptibility in over half of the participants (17/30), a similar incidence to that reported using other methods. As previously reported, the majority who were not susceptible to modification were at the lower levels of susceptibility, and the greater increases tended to occur in the more susceptible subjects. However, here enhancement was disclosed in some at low levels, and capability was found of reaching high levels, both features not typically reported. Further research is warranted.

The relaxation response: Reducing stress and improving cognition in healthy aging adults

Aging adults are vulnerable to the effects of a negative emotional state. The relaxation response (RR) is a mind-body intervention that counteracts the harmful effects of stress. Previous studies with relaxation techniques have shown the non-pharmacological benefit of reducing stress and improving the memory of healthy older adults. Our pilot study evaluated whether a RR training program would decrease anxiety levels, improve attention, declarative memory performance and/or decrease salivary cortisol levels in healthy older adults. Fifteen adults participated and were randomly assigned to a RR training or control groups. Mean age was 71.3 years and mean education level was 17.9 years. Reaction time on a simple attention/psychomotor task was significantly improved (p<0.0025) with RR training, whereas there was no significant improvement on complex tasks of attention, verbal, or visual declarative memory tests. Self-reported state anxiety levels showed a marginally significant reduction (p<0.066). All subjects' salivary cortisol levels were within low-normal range and did not significantly change. Our 5-week program in highly educated, mobile, healthy, aging adults significantly improved performance on a simple attention task.

Mantram repetition for stress management in veterans and employees: a critical incident study

AIM

This paper reports a study assessing the usefulness of a mantram repetition programme.

BACKGROUND

Complementary/alternative therapies are becoming commonplace, but more research is needed to assess their benefits. A 5-week programme teaching a 'mind-body-spiritual' technique of silently repeating a mantram - a word or phrase with spiritual meaning - to manage stress was developed. A mantram was chosen by individuals, who were taught to repeat it silently throughout the day or night to interrupt unwanted thoughts and elicit the relaxation response.

METHODS

Participants who attended a 5-week course were invited to participate in the study. Of those who consented, a randomly selected subset (n = 66) was contacted approximately 3 months after the course for a telephone interview using the critical incident interviewing technique. Participants were asked whether the intervention was helpful or not, and if helpful, to identify situations where it was applied. Interviews were transcribed and incidents were identified and categorized to create a taxonomy of uses. The data were collected in 2001-2002.

RESULTS

Participants included 30 veterans, mostly males (97%), and 36 hospital employees, mostly females (86%). Mean age was 56 years (sd = 12.94). Fifty-five participants (83.3%) practiced the technique and reported 147 incidents where the programme was helpful. Outcomes were organized into a taxonomy of incidents using four major categories that included managing: (a) emotions other than stress (51%); (b) stress (23.8%); (c) insomnia (12.9%); and (d) unwanted thoughts (12.3%). A group of raters reviewed the categories for inter-rater reliability.

CONCLUSIONS

The majority of participants from two distinct samples reported that the mantram programme was helpful in a variety of situations. The critical incident interviewing method was found to be practical, efficient, and thorough in collecting and analyzing data. Such qualitative methods contribute to understanding the benefits of mind-body complementary therapies.

Effects of spiritual mantram repetition on HIV outcomes: a randomized controlled trial

We examined the efficacy of a psycho-spiritual intervention of mantram repetition--a word or phrase with spiritual associations repeated silently throughout the day--on psychological distress (intrusive thoughts, stress, anxiety, anger, depression), quality of life enjoyment and satisfaction, and existential spiritual well-being in HIV-infected adults. Using a 2-group by 4-time repeated measures design, 93 participants were randomly assigned to mantram (n = 46) or attention control group (n = 47). Over time, the mantram group improved significantly more than the control group in reducing trait-anger and increasing spiritual faith and spiritual connectedness. Actual mantram practice measured by wrist counters was inversely associated with non-HIV related intrusive thoughts and positively associated with quality of life, total existential spiritual well-being, meaning/peace, and spiritual faith. Intent-to-treat findings suggest that a mantram group intervention and actual mantram practice each make unique contributions for managing psychological distress and enhancing existential spiritual well-being in adults living with HIV/AIDS.

Use of reflexology foot massage to reduce anxiety in hospitalized cancer patients in chemotherapy treatment: methodology and outcomes

AIM

To examine the effectiveness of reflexology foot massage in hospitalized cancer patients undergoing second or third chemotherapy cycles.

BACKGROUND

Since the late-1970s, studies have been conducted to assess the efficacy of behavioural and relaxation approaches in controlling nausea/vomiting, anxiety and other side-effects associated with chemotherapy.

METHODS

The study consisted of 30 patients being admitted to the oncology unit at a Scientific Research Hospital in Italy. Only 15 of the 30 participants received therapeutic massage. The subjects' self-reports of anxiety (measured by the Spielberger State-Trait Anxiety Inventory) were recorded before, after and 24 hours after the intervention.

RESULTS

There was an average decrease of 7.9 points on the state-anxiety scale in the treatment group and of 0.8 points in the control group (P < 0.0001).

CONCLUSIONS

Reflexology foot massage can be considered a support treatment used in combination with traditional medical treatments and executed by an expert, qualified person to help cancer patients receiving chemotherapy feel better and also cope better with their disease.

Psychological and physiological effects of 24-style taijiquan

This study was conducted to determine whether 24-style Taijiquan (24TJQ) exhibits measurable psychological and physiological effects. Twenty-two middle-aged female subjects performed 24TJQ and cycle ergometry exercises at the same intensity determined by the same heart rate during 2 exercises. Electroencephalography and Profile of Mood State (POMS) were monitored before and after 2 exercises. The responses to 24TJQ exercise were different from those to cycle ergometry exercise when the heart rate returned to the resting level: (1) alpha increased and theta decreased significantly in the frontal region, while theta decreased significantly in the central and occipital regions; (2) in the POMS test, an improved positive mood was found following 2 exercises, while negative mood was suppressed following 24TJQ exercise; (3) significant correlations were found between the increased alpha in the frontal region, the decreased theta in the central or occipital region and the vigor of the POMS test. These results suggest that 24TJQ exercise induced a resting awakening state and exhibited a relaxing effect on both mind and body.

Effect of guided imagery with relaxation on health-related quality of life in older women with osteoarthritis

Osteoarthritis (OA) is the most common cause of disability in older adults, which, in turn, leads to poor quality of life (QOL). Disability is caused primarily by the joint degeneration and pain associated with OA. A randomized pilot study was conducted to test the effectiveness of guided imagery with relaxation (GIR) to improve health-related QOL (HRQOL) in women with OA. A two-group (intervention versus control) longitudinal design was used to determine whether GIR leads to better HRQOL in these individuals and whether improvement in HRQOL could be attributed to intervention-associated improvements in pain and mobility. Twenty-eight women were randomized to either the GIR intervention or the control intervention group. Using GIR for 12 weeks significantly increased women's HRQOL in comparison to the women who used the control intervention, even after statistically adjusting for changes in pain and mobility. These findings suggest that the effects of GIR on HRQOL are not limited to improvements in pain and mobility. GIR may be an easy-to-use self-management intervention to improve the QOL of older adults with OA.

Physiology of long pranayamic breathing: Neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system

Pranayamic breathing, defined as a manipulation of breath movement, has been shown to contribute to a physiologic response characterized by the presence of decreased oxygen consumption, decreased heart rate, and decreased blood pressure, as well as increased theta wave amplitude in EEG recordings, increased parasympathetic activity accompanied by the experience of alertness and reinvigoration. The mechanism of how pranayamic breathing interacts with the nervous system affecting metabolism and autonomic functions remains to be clearly understood. It is our hypothesis that voluntary slow deep breathing functionally resets the autonomic nervous system through stretch-induced inhibitory signals and hyperpolarization currents propagated through both neural and non-neural tissue which synchronizes neural elements in the heart, lungs, limbic system and cortex. During inspiration, stretching of lung tissue produces inhibitory signals by action of slowly adapting stretch receptors (SARs) and hyperpolarization current by action of fibroblasts. Both inhibitory impulses and hyperpolarization current are known to synchronize neural elements leading to the modulation of the nervous system and decreased metabolic activity indicative of the parasympathetic state. In this paper we propose pranayama's physiologic mechanism through a cellular and systems level perspective, involving both neural and non-neural elements. This theoretical description describes a common physiological mechanism underlying pranayama and elucidate the role of the respiratory and cardiovascular system on modulating the autonomic nervous system. Along with facilitating the design of clinical breathing techniques for the treatment of autonomic nervous system and other disorders, this model will also validate pranayama as a topic requiring more research.

Relaxation therapy for rehabilitation and prevention in ischaemic heart disease: a systematic review and meta-analysis

AIMS

To establish the effects of relaxation therapy on the recovery from a cardiac ischaemic event and secondary prevention.

METHODS AND RESULTS

A search was conducted for controlled trials in which patients with myocardial ischaemia were taught relaxation therapy, and outcomes were measured with respect to physiological, psychological, cardiac effects, return to work and cardiac events. A total of 27 studies were located. Six studies used abbreviated relaxation therapy (3 h or less of instruction), 13 studies used full relaxation therapy (9 h of supervised instruction and discussion), and in eight studies full relaxation therapy was expanded with cognitive therapy (11 h on average). Physiological outcomes: reduction in resting heart rate, increased heart rate variability, improved exercise tolerance and increased high-density lipoprotein cholesterol were found. No effect was found on blood pressure or cholesterol. Psychological outcome: state anxiety was reduced, trait anxiety was not, depression was reduced. Cardiac effects: the frequency of occurrence of angina pectoris was reduced, the occurrence of arrhythmia and exercise induced ischaemia were reduced. Return to work was improved. Cardiac events occurred less frequently, as well as cardiac deaths. With the exception of resting heart rate, the effects were small, absent or not measured in studies in which abbreviated relaxation therapy was given. No difference was found between the effects of full or expanded relaxation therapy.

CONCLUSION

Intensive supervised relaxation practice enhances recovery from an ischaemic cardiac event and contributes to secondary prevention. It is an important ingredient of cardiac rehabilitation, in addition to exercise and psycho-education.

A Relaxation Response Randomized Trial on Patients With Chronic Heart Failure

PURPOSE

Patients with various medical conditions benefit from eliciting the relaxation response (RR), using a variety of techniques, but few studies have focused on chronic heart failure (CHF). We evaluated the efficacy of an RR intervention program on the quality of life (QOL) and exercise capacity of CHF patients by conducting a single-blind, 3-arm, randomized, controlled trial.

METHODS

Between April 2000 and June 2002, we enrolled 95 patients with moderate severity CHF from the Veterans Affairs Boston Healthcare System. Patients in the study intervention group attended a weekly RR group for 15 weeks and were requested to practice the techniques at home twice a day. A 15-week cardiac education (EDU) program was used as an alternative intervention, and usual care (UC) was the control group. The QOL questionnaires and a bicycle test were administered at baseline and after intervention or 15 to 19 weeks.

RESULTS

Eighty-three (87%) of the 95 enrolled patients completed both baseline and post-intervention QOL measures (31 RR, 24 EDU, and 28 UC). No dropout bias was observed. The RR group had significantly better QOL change scores in peace-spiritual scales than did the UC group (P = .02), adjusting for baseline scores, time between assessments, age, education, diet, and medication, whereas no significant difference was observed between the EDU and UC groups. A similar trend was observed in emotional QOL (RR and UC group comparison, P = .07). No statistically significant intervention effect on physical QOL or exercise capacity was observed.

CONCLUSIONS

A short RR intervention can improve some aspects of QOL in CHF patients.

The mental self

In meditation both the quality and the contents of consciousness may be voluntarily changed, making it an obvious target in the quest for the neural correlate of consciousness. Here we present the results of a positron emission tomography study of yoga nidra relaxation meditation when compared with the normal resting conscious state. Meditation is accompanied by a relatively increased perfusion in the sensory imagery system: hippocampus and sensory and higher order association regions, with decreased perfusion in the executive system: dorsolateral prefrontal cortex, anterior cingulate gyrus, striatum, thalamus, pons, and cerebellum. To identify regions active in both systems we performed a principal component analysis of the results. This separated the blood flow data into two groups of regions, explaining 25 and 18% of their variance: One group corresponded to the executive system, and the other to the systems supporting sensory imagery. A small group of regions contributed considerably to both networks: medial parietal and medial prefrontal cortices, together with the striatum. The inclusion of the striatum and our subsequent finding of increased striatal dopamine binding to D2 receptors during meditation suggested dopaminergic regulation of this circuit. We then investigated the neural networks supporting episodic retrieval of judgments of individuals with different degrees of self-relevance, in the decreasing order: self, best friend, and the Danish queen. We found that all conditions activated a medial prefrontal - precuneus/posterior cingulate cortex, thalamus, and cerebellum. This activation occurred together with the activation of the left lateral prefrontal/temporal cortex. The latter was dependent on the requirement of retrieval of semantic information, being most pronounced in the "queen" condition. Transcranial magnetic stimulation, targeting precuneus, was then applied to the medial parietal region to transiently disrupt the normal function of the circuitry. We found a decreased efficiency of retrieval of self-judgment compared to the judgment of best friend. This shows that the integrity of the function of precuneus is essential for self-reference, but not for reference to others.

A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis

Osteoarthritis (OA) is a common, chronic condition that affects most older adults. Adults with OA must deal with pain that leads to limited mobility and may lead to disability and difficulty maintaining independence. A longitudinal, randomized clinical trial pilot study was conducted to determine whether Guided Imagery (GI) with Progressive Muscle Relaxation (PMR) would reduce pain and mobility difficulties of women with OA. Twenty-eight older women with OA were randomly assigned to either the treatment or the control group. The treatment consisted of listening twice a day to a 10-to-15-minute audiotaped script that guided the women in GI with PMR. Repeated-measures ANOVA revealed a significant difference between the two groups in the amount of change in pain and mobility difficulties they experienced over 12 weeks. The treatment group reported a significant reduction in pain and mobility difficulties at week 12 compared to the control group. Members of the control group reported no differences in pain and non-significant increases in mobility difficulties. The results of this pilot study justify further investigation of the effectiveness of GI with PMR as a self-management intervention to reduce pain and mobility difficulties associated with OA.

Meditation in health: an operational definition

Despite its evergrowing use in health-related areas, procedures characterized as meditation have been little or not at all defined operationally, which hinders its use in a standardized manner. In the present study, the authors present a possible operational definition of meditation, which has been used in social and academic projects, developed in Universidade Federal de São Paulo. In this proposal, it is emphasized that, in order to be characterized as meditation, the procedure should encompass the following requirements: (1) the use of a specific technique (clearly defined), (2) muscle relaxation in some moment of the process and (3) "logic relaxation"; (4) it must necessarily be a self-induced state, and (5) use of "self-focus" skill (coined "anchor").

Meditation's impact on chronic illness

Meditation is becoming widely popular as an adjunct to conventional medical therapies. This article reviews the literature regarding the experience of chronic illness, theories about meditation, and clinical effects of this self-care practice. Eastern theories of meditation include Buddhist psychology. The word Buddha means the awakened one, and Buddhist meditators have been called the first scientists, alluding to more than 2500 years of precise, detailed observation of inner experience. The knowledge that comprises Buddhist psychology was derived inductively from the historical figure's (Prince Siddhartha Gautama) diligent self-inquiry. Western theories of meditation include Jungian, Benson's relaxation response, and transpersonal psychology. Clinical effects of meditation impact a broad spectrum of physical and psychological symptoms and syndromes, including reduced anxiety, pain, and depression, enhanced mood and self-esteem, and decreased stress. Meditation has been studied in populations with fibromyalgia, cancer, hypertension, and psoriasis. While earlier studies were small and lacked experimental controls, the quality and quantity of valid research is growing. Meditation practice can positively influence the experience of chronic illness and can serve as a primary, secondary, and/or tertiary prevention strategy. Health professionals demonstrate commitment to holistic practice by asking patients about use of meditation, and can encourage this self-care activity. Simple techniques for mindfulness can be taught in the clinical setting. Living mindfully with chronic illness is a fruitful area for research, and it can be predicted that evidence will grow to support the role of consciousness in the human experience of disease.

Stress management training as related to glycemic control and mood in adults with Type 1 diabetes mellitus

Relationships between attending a stress management and relaxation-training program, glycemic control (HbA(1c)) and mood were examined in two randomised groups of 31 persons with Type 1 diabetes. The program involved group-education 2 h a week for 14 weeks. Whereas one group received the program, the other acted as a control group and received the program later. HbA(1c) was measured and subjects filled out a mood adjective checklist before the start of intervention and both 1 month and 1 year after completing it. In both groups, significant positive mood changes were obtained, but no significant changes in HbA(1c) values occurred. No significant relationship was found between measures of change in HbA(1c) and of changes in mood. For those attending the group-sessions less frequently, the HbA(1c) values were significantly worse on each of the three measurement occasions than the values of those attending more frequently. The effectiveness of the program, with its failure to improve glycemic control but enhancing the mood of participants, is discussed in terms of characteristics of the sample and various methodological issues as well as in comparison with results of similar studies involving Type 1 and Type 2 diabetes.

The physiology of mind-body interactions: the stress response and the relaxation response

There are key differences between mind-body medicine and alternative medicine. A central tenet of mind-body medicine is the recognition that the mind plays a key role in health and that any presumed separation of mind and body is false. Alternative medicine, however, does not focus on the role of thoughts and emotions in health and, therefore, is separate from mind-body medicine. Also, while there has been little scientific research on alternative medicine, the literature on mind-body medicine comprises more than 2000 peer-reviewed studies published in the past 25 years. The groundwork for understanding the physiology of mind-body interactions was established by pioneering studies in the 1930s by Walter Cannon, and in the 1950s by Walter Hess and by Hans Selye that led to an understanding of the fight-or-flight response. Later work by Holmes and Rahe documented measurable relationships between stressful life events and illness. Other research has shown clinical improvement in patients treated with a placebo for a variety of medical problems. The effectiveness of placebo treatment can be interpreted as compelling evidence that expectation and belief can affect physiological response. Recent studies using spectral analysis and topographic electroencephalographic (EEG) mapping of the relaxation response demonstrate that by changing mental activity we can demonstrate measurable changes in central nervous system activity. These, and other, studies demonstrate that mind-body interactions are real and can be measured.

The evaluation of a mind/body intervention to reduce psychological distress and perceived stress in college students

The authors examined the effect of a 6-week mind/body intervention on college students' psychological distress, anxiety, and perception of stress. One hundred twenty-eight students were randomly assigned to an experimental group (n = 63) or a waitlist control group (n = 65). The experimental group received 6 90-minute group-training sessions in the relaxation response and cognitive behavioral skills. The Symptom Checklist-90-Revised, Spielberger State-Trait Anxiety Inventory, and the Perceived Stress Scale were used to assess the students' psychological state before and after the intervention. Ninety students (70% of the initial sample) completed the postassessment measure. Significantly greater reductions in psychological distress, state anxiety, and perceived stress were found in the experimental group. This brief mind/body training may be useful as a preventive intervention for college students, according to the authors, who called for further research to determine whether the observed treatment effect can be sustained over a longer period of time.

The role of complementary and alternative therapies in women's mental health

The advent of the newly evolving field of Integrative Medicine has provided women with an opportunity to expand the health care resources available to prevent and treat mental health conditions. Aided by evidence-based science, practitioners can now broaden the scope of their therapeutic armamentarium and allow women to use the best of what western and complementary medicine has to offer in the field of mental health care. Acupuncture, medication, herbalism, and guided imagery are included in a list of therapeutic modalities designed to augment traditional care. It is clear that by providing such comprehensive care, a woman's physical and mental wellness and her longevity are optimized.

The short-term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects

AIM OF THE STUDY

To investigate the effects of myofascial trigger-point massage therapy to the head, neck and shoulder areas on cardiac autonomic tone.Background. No studies have reported on the effect of back massage on autonomic tone as measured by heart rate variability. This is especially relevant to the nursing profession, as massage is increasingly available as a therapy complementary to conventional nursing practice.

DESIGN/METHODS

An experimental study in which subjects were initially placed in age- and sex-matched groups and then randomized to treatment or control by alternate allocation. The study involved 30 healthy subjects (16 female and 14 male, aged 32.47 +/- 1.55 years, mean +/- standard error). A 5-minute cardiac interbeat interval recording, systolic and diastolic blood pressure and subjective self-evaluations of muscle tension and emotional state were taken before and after intervention. Autonomic function was measured using time and frequency domain analysis of heart rate variability.

RESULTS

Following myofascial trigger-point massage therapy there was a significant decrease in heart rate (P < 0.01), systolic blood pressure (P=0.02) and diastolic blood pressure (P < 0.01). Analysis of heart rate variability revealed a significant increase in parasympathetic activity (P < 0.01) following myofascial trigger-point massage therapy. Additionally both muscle tension and emotional state, showed significant improvement (P < 0.01).

CONCLUSIONS

In normal healthy subjects myofascial trigger-point massage therapy to the head, neck and shoulder areas is effective in increasing cardiac parasympathetic activity and improving measures of relaxation.

Mind-body interventions: applications for social work practice

In the past decade, we have seen an increase in the popularity of mind-body medicine as an alternative or complement to traditional health care interventions. This paper explores the history of mind-body medicine and how particular mind-body interventions focusing on stress reduction and relaxation can be useful complements to social work practice. Four types of mind-body interventions are described, research on their effectiveness is reviewed, conclusions are drawn, and the applicability to social work practice is discussed. Given existing empirical support for the effectiveness of these interventions, the authors suggest that efforts at both the systems and individual levels, including changes in social work education, can be made to enhance their use in traditional health settings, as well in other types of settings.

Mind-body medicine. An introduction and review of the literature

MBM is a well-established phenomenon in modern medicine. If one accepts a model of mind/body that is truly nondualistic, it could be said that the MBM phenomenon is inherent to medicine. Because of its popularity and efficacy for common chronic conditions, MBM may have its greatest presence in primary care medicine. The flourishing of MBM techniques resulting from the public's enthusiastic embrace of these therapies has created a great need for rigorous scientific examination. The MBM literature may be said to be in its adolescence, having grown out of its early years of enthusiastic case reports and small studies, but not yet fully grown into a broad catalogue of large controlled experimental trials. Nevertheless, clinical trials suggest that certain MBM therapies are effective in improving quality of life, anxiety, and pain intensity for a variety of conditions. There is moderate evidence to suggest these techniques improve chronic pain, headache, insomnia, and other common conditions. There is preliminary evidence to suggest these techniques may affect coronary artery disease and cancer. MBM techniques ultimately may prove to be most effective in combinations or in conjunction with traditional treatment.

Investigating Religious and Spiritually Oriented Coping Strategies in the Swedish Context: A Review of the Literature and Directions for Future Research

There has not been much systematic research in Sweden examining the existential and spiritual aspects of coping with serious illnesses. Taking one step toward redirecting attention on this research area, this article discusses some findings and barriers that are important when investigating the religious and spiritually oriented coping strategies among ill persons in the context of Swedish culture. The article concludes that a new alternative scale measuring spirituality among ill persons and new models of meaning and importance of religious and spiritual coping with serious illness should be developed from perspectives that consider the cultural context of societies such as Sweden, where people practice “religion” in a spiritual, subjective, and/or nonorganizational way rather than an organizational way and that, therefore, practicing organizational religiousness is not an important health-related measure. The Religious Orientation Scale and Spiritual Assessment Inventory seem to be appropriate methods on which new models can be based.

Effects of a 10-minute back rub on cardiovascular responses in healthy subjects

This study determined the cardiovascular responses to a 10-minute back rub. Twelve healthy, college-age males and females (mean age = 22 years) volunteered to participate as subjects. Using an ABA design, the subjects tested for 10 minutes (Control #1) on a padded plinth lying on one side. During the Treatment period, the back rub was administered, which was followed by Control #2. Oxygen consumption (VO2) was determined via the Medical Graphics CPX/D metabolic analyzer, which also estimated cardiac output (Q) using the CO2 rebreathing (equilibrium) method. A repeated measures ANOVA was performed to statistically compare the cardiovascular responses across the three periods. The back rub, when compared to Control #1, had no significant effect on VO2, but the central and peripheral components of VO2 were changed. Cardiac output was decreased as a result of the decreased stroke volume (SV), as a function of the increased peripheral vascular resistance (PVR). We also found an increase in the extraction of oxygen (a-vO2 diff) in the peripheral tissues. These results indicate that the VO2 response during the back rub was achieved by reciprocal central (SV,Q) and peripheral (a-vO2 diff) adjustments. Following the back rub, (i.e., Control #2 vs. Treatment), the decrease in VO2, VCO2, Ve, and a-vO2 diff appears to indicate that it was effective in inducing relaxation. Since HR, SV, and Q were unchanged, the VO2 response was a result of the decreased a-vO2 diff. Hence, the findings suggest certain positive implications for the health care industry.

The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumours

Research suggests that aromatherapy massage (AM) is increasingly being used by cancer patients, especially in the palliative care setting, although few studies have assessed its effectiveness. I wanted to find out whether AM reduces anxiety in patients with a primary malignant brain tumour attending their first follow-up appointment after radiotherapy. Eight patients were recruited to the study, which comprised three methods of data collection: the measurement of physical parameters; the completion of Hospital Anxiety and Depression Scales (HADS); and semi-structured interviews. The results from HADS did not show any psychological benefit from AM. However, there was a statistically significant reduction in all four physical parameters, which suggests that AM affects the autonomic nervous system, inducing relaxation. This finding was supported by the patients themselves, all of whom stated during interview that they felt 'relaxed' after AM. Since these patients are faced with limited treatment options and a poor prognosis, this intervention appears to be a good way of offering support and improving quality of life.

A pilot study on the effect of progressive muscle relaxation training of patients after stoma surgery

Eighteen patients who had undergone stoma surgery were assessed with respect to their anxiety level and self-reported quality of life (QoL) on three occasions; namely, immediately after surgery, 5 weeks after surgery, and 10 weeks after surgery. The patients were randomised into a control group (n = 10) and an experimental group (n = 8). A 20-min set of audiotaped instructions on progressive muscle relaxation training (PMRT) was given to the patients in the experimental group for home practice. Assessment instructions included the Chinese State-Trait Anxiety Inventory (C-STAI), the Quality of Life Index for Colostomy (QoL-Colostomy) and the Hong Kong Chinese version of the World Health Organisation Quality of Life Scale (WHOQoL). Results indicated that there was a significant decrease in both the C-STAI score (F = 4.66, P < 0.05) and the WHOQoL score (F = 4.74, P < 0.05) in the experimental group. Among the domains of WHOQoL, a significant difference was shown in physical health/independence and general perception of QoL, with the experimental group demonstrating better functioning. For the QoL-Colostomy, however, there was no significant difference between the control and experimental groups. The results suggest that the use of PMRT could enhance quality of life and decrease state anxiety in patients after stoma surgery.

A critical review of the psychophysiology of driver fatigue

Driver fatigue is a major cause of road accidents and has implications for road safety. This review discusses the concepts of fatigue and provides a summary on psychophysiological associations with driver fatigue. A variety of psychophysiological parameters have been used in previous research as indicators of fatigue, with electroencephalography perhaps being the most promising. Most research found changes in theta and delta activity to be strongly linked to transition to fatigue. Therefore, monitoring electroencephalography during driver fatigue may be a promising variable for use in fatigue countermeasure devices. The review also identified anxiety and mood states as factors that may possibly affect driver fatigue. Furthermore, personality and temperament may also influence fatigue. Given the above, understanding the psychology of fatigue may lead to better fatigue management. The findings from this review are discussed in the light of directions for future studies and for the development of fatigue countermeasures.

Yoga for control of epilepsy

Yoga is an age-old traditional Indian psycho-philosophical-cultural method of leading one's life, that alleviates stress, induces relaxation and provides multiple health benefits to the person following its system. It is a method of controlling the mind through the union of an individual's dormant energy with the universal energy. Commonly practiced yoga methods are 'Pranayama' (controlled deep breathing), 'Asanas' (physical postures) and 'Dhyana' (meditation) admixed in varying proportions with differing philosophic ideas. A review of yoga in relation to epilepsy encompasses not only seizure control but also many factors dealing with overall quality-of-life issues (QOL). This paper reviews articles related to yoga and epilepsy, seizures, EEG, autonomic changes, neuro-psychology, limbic system, arousal, sleep, brain plasticity, motor performance, brain imaging studies, and rehabilitation. There is a dearth of randomized, blinded, controlled studies related to yoga and seizure control. A multi-centre, cross-cultural, preferably blinded (difficult for yoga), well-randomized controlled trial, especially using a single yogic technique in a homogeneous population such as Juvenile myoclonic epilepsy is justified to find out how yoga affects seizure control and QOL of the person with epilepsy.