Meditative therapies for reducing anxiety: a systematic review and meta-analysis of randomized controlled trials

Yoga and its effect on sperm genomic integrity, gene expression, telomere length and perceived quality of life in early pregnancy loss

Achieving successful pregnancy outcomes is a delicate interplay between the maternal and the fetal counterparts. Paternal factors play a critical role in health and disease of offspring. Early pregnancy loss (EPL) is a psychologically devastating condition affecting the quality of life (QOL). Thus, it needs to be managed by a mind body integrated approach like yoga.The prospective single arm exploratory studyincluded male partners of couples experiencing recurrent pregnancy loss (RPL, n = 30), and recurrent implantation failure (RIF, n = 30) and semen samples wereassessed at the beginning and completion of yoga (6 weeks) (WHO 2010).A significant increase in the sperm concentration, motility, decrease in seminal ROS, DFI and increase in relative sperm telomere length was found at the end of yoga. The relative expression of genes critical for early embryonic developmentnormalized towards the levels of controls. WHOQOL-BREF questionnaire scores to assess QOL also showed improvement.Integration of regular practice yoga into our lifestyle may help in improving seminal redox status, genomic integrity, telomere length, normalizing gene expression and QOL, highlighting the need to use an integrated, holistic approach in management of such cases. This is pertinent for decreasing the transmission of mutation and epimutation load to the developing embryo, improving pregnancy outcomes and decreasing genetic and epigenetic disease burden in the next generation.

Designing and developing a nature-based virtual reality with heart rate variability biofeedback for surgical anxiety and pain management: evidence from total knee arthroplasty patients

OBJECTIVES

Total knee arthroplasty (TKA) is one of the most common joint surgeries, with over a million procedures performed annually in the US. Over 70% of patients report moderate to high pain and anxiety surrounding TKA surgery, and 96% are discharged with an opioid prescription. This population requires special attention as approximately 90% of TKA patients are older adults and one of the riskiest groups prone to misusing opioids. This study aimed to develop and compare the efficacy of nature-based virtual reality (VR) with heart rate variability biofeedback (HRVBF) to mitigate surgical pain and anxiety.

METHODS

This randomized control trial recruited 30 patients (mean age = 66.3 ± 8.2 years, 23 F, 7 M) undergoing TKA surgery and randomly assigned to a control, 2D video with HRVBF, or VR with HRVBF group. A visual analog scale (VAS) was used to measure pain levels before and after the intervention. In addition, a second VAS and the State-Trait Anxiety Inventory (STAI) were used to measure anxiety before and after the intervention. Electrocardiogram (ECG) was used to continuously measure HRV and respiration rate in preoperative and postoperative settings.

RESULTS

VR and 2D-video with HRVBF decreased pain and anxiety post-intervention compared with the control group, p's <.01. On analyzing physiological signals, both treatment groups showed greater parasympathetic activity levels, and VR with HRVBF reduced pain more than the 2D video, p < .01.

CONCLUSIONS

Nature-based VR and 2D video with HRVBF can mitigate surgical pain and anxiety. However, VR may be more efficacious than 2D video in reducing pain.

Impact of mindfulness-based and health self-management interventions on mindfulness, self-compassion, and physical activity in older adults with subjective cognitive decline: A secondary analysis of the SCD-Well randomized controlled trial

INTRODUCTION

Older adults experiencing subjective cognitive decline (SCD) have a higher risk of dementia. Reducing this risk through behavioral interventions, which can increase emotional well-being (mindfulness and compassion) and physical activity, is crucial in SCD.

METHODS

SCD-Well is a multicenter, observer-blind, randomized, controlled, superiority trial. Three hundred forty-seven participants (mean [standard deviation] age: 72.7 [6.9] years; 64.6% women) were recruited from memory clinics in four European sites to assess the impact of an 8-week caring mindfulness-based approach for seniors (CMBAS) and a health self-management program (HSMP) on mindfulness, self-compassion, and physical activity.

RESULTS

CMBAS showed a significant within-group increase in self-compassion from baseline to post-intervention and both a within- and between-group increase to follow-up visit (24 weeks). HSMP showed a significant within- and between-group increase in physical activity from baseline to post-intervention and to follow-up visit.

DISCUSSION

Non-pharmacological interventions can differentially promote modifiable factors linked to healthy aging in older adults with SCD.

Experiences of Irritable Bowel Syndrome Patients in a Virtual Yoga Program: Qualitative Findings from a Clinical Trial

BACKGROUND AND AIMS

In-person yoga interventions have shown feasibility and effectiveness in improving the outcomes of patients with irritable bowel syndrome (IBS), but experiences in virtual yoga interventions have not been examined. This study aimed to explore patients' experiences of a virtually delivered yoga intervention for IBS.

METHODS

An embedded qualitative substudy was included in a randomized controlled trial examining the feasibility and effectiveness of a virtual yoga program among adult patients with IBS. Semi-structured interviews captured participants' past and current experiences, program satisfaction, perceived impact on IBS symptoms and overall physical and mental health, facilitators and barriers to participation, perceptions of social support and supervised learning, and input on improving future programming. Data were coded and analyzed in duplicate using NVivo 12. An analytic template based on the interview guide was developed and thematic analysis identified themes, as well as the relationship between themes and subthemes.

RESULTS

Among the 14 participants (all female, mean age 47.7 years), three major themes were identified: (1) positive experience in the yoga program, (2) incorporating yoga into IBS management post-study, and (3) recommendations for program improvement.

CONCLUSION

Patients with IBS experience in a virtual yoga program was positive with improvements in physical and mental health outcomes. Considering the barriers and facilitators to participating in an online yoga program along with participant recommendations may improve future intervention design and delivery to increase self-efficacy and confidence among patients with IBS.

Meditation for Anxiety: A Holistic Approach to Treatment

This comprehensive integrated literature review provides evidence-based information on mindfulness meditation as a primary care treatment for anxiety. A variety of databases were utilized for article collection including MEDLINE Complete, CINAHL Plus with full text, Cochrane library, APA PsycInfo, APA PsycTests, Health Source: Nursing/Academic Edition, and PsycARTICLES. Research suggests anxiety can be treated effectively with a minimum of 8 weeks of meditation practice. Meditation is a cost effective and safe treatment modality that can be incorporated into the care of patients struggling with anxiety.

Effects of a mindfulness-based intervention and a health self-management programme on psychological well-being in older adults with subjective cognitive decline: Secondary analyses from the SCD-Well randomised clinical trial

OBJECTIVES

Older adults with subjective cognitive decline (SCD) recruited from memory clinics have an increased risk of developing dementia and regularly experience reduced psychological well-being related to memory concerns and fear of dementia. Research on improving well-being in SCD is limited and lacks non-pharmacological approaches. We investigated whether mindfulness-based and health education interventions can enhance well-being in SCD.

METHODS

The SCD-Well trial (ClinicalTrials.gov: NCT03005652) randomised 147 older adults with SCD to an 8-week caring mindfulness-based approach for seniors (CMBAS) or an active comparator (health self-management programme [HSMP]). Well-being was assessed at baseline, post-intervention, and 6-month post-randomisation using the Psychological Well-being Scale (PWBS), the World Health Organisation's Quality of Life (QoL) Assessment psychological subscale, and composites capturing meditation-based well-being dimensions of awareness, connection, and insight. Mixed effects models were used to assess between- and within-group differences in change.

RESULTS

CMBAS was superior to HSMP on changes in connection at post-intervention. Within both groups, PWBS total scores, psychological QoL, and composite scores did not increase. Exploratory analyses indicated increases in PWBS autonomy at post-intervention in both groups.

CONCLUSION

Two non-pharmacological interventions were associated with only limited effects on psychological well-being in SCD. Longer intervention studies with waitlist/retest control groups are needed to assess if our findings reflect intervention brevity and/or minimal base rate changes in well-being.

Effects of aromatherapy on sore throat, nasal symptoms and sleep quality in adults infected with COVID-19: A randomized controlled trial

Background

Patients with coronavirus disease 2019 (COVID-19) usually complain of fever, cough, and sore throat. This study examined the effects of aromatherapy on sore throat, nasal symptoms, stress, fatigue, and sleep quality by administering it to adults with post-COVID-19 condition.

Methods

This study was conducted in a randomised controlled design. Its target population were adults who were released from COVID-19 quarantine treatment within 45 days from infection onset and capable of performing daily activities after isolation treatment. The participants were randomised into aromatherapy group (AG) and control group (CG). To test experimental treatment effects, the levels of sore throat, nasal symptoms, stress, fatigue and sleep quality were measured at the baseline (pre-test) and after the trial (post-test), using the numerical rating scale for sore throat, stress and fatigue, the Total Nasal Symptoms Score for nasal symptoms, and the Korean Version of Modified Leeds Sleep Evaluation Questionnaire for quality of sleep.

Results

After experimental treatment, there was a significant difference in sore throat in AG compared to CG on the 3rd day (t=-2.022 p=0.048) and 4th day (t=-2.450, p=0.017) of treatment. There was also a significant difference in fatigue between AG and CG on the 2nd day(t=-2.748, p=0.008), 3rd day (t=-2.948, p=0.005) and 4th day (t=-3.084, p=0.003) of treatment. There was no significant difference in TNSS, stress, and sleep quality between the two groups after the experimental treatment.

Conclusion

Inhaling aroma essential oils reduced sore throat and fatigue in adults with post-COVID-19 condition, demonstrating the feasibility of aromatherapy as an effective treatment.

Trial registration

The study was registered with Clinical Research Information Service (KCT0008029).

Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature

Anxiety and stress plague populations worldwide. Voluntary regulated breathing practices offer a tool to address this epidemic. We examined peer-reviewed published literature to understand effective approaches to and implementation of these practices. PubMed and ScienceDirect were searched to identify clinical trials evaluating isolated breathing-based interventions with psychometric stress/anxiety outcomes. Two independent reviewers conducted all screening and data extraction. Of 2904 unique articles, 731 abstracts, and 181 full texts screened, 58 met the inclusion criteria. Fifty-four of the studies' 72 interventions were effective. Components of effective and ineffective interventions were evaluated to develop a conceptual framework of factors associated with stress/anxiety reduction effectiveness. Effective breath practices avoided fast-only breath paces and sessions <5 min, while including human-guided training, multiple sessions, and long-term practice. Population, other breath paces, session duration ≥5 min, and group versus individual or at-home practices were not associated with effectiveness. Analysis of interventions that did not fit this framework revealed that extensive standing, interruptions, involuntary diaphragmatic obstruction, and inadequate training for highly technical practices may render otherwise promising interventions ineffective. Following this evidence-based framework can help maximize the stress/anxiety reduction benefits of breathing practices. Future research is warranted to further refine this easily accessible intervention for stress/anxiety relief.

Effect of Heartfulness meditation program on perceived stress and satisfaction with life of female students

Though literacy levels are slowly improving in India due to the steps taken by the Government of India, it has been a challenge for female students with gender disparities in literacy levels. Stress levels are high in students, more so during their exam times. While prior literature has demonstrated the prevalence of stress during student life, there is limited evidence of any interventions to decrease stress and improve satisfaction with life, specifically for female students. Heartfulness meditation is a heart-based meditation practice that may reduce stress and improve satisfaction with life among female students. We conducted a prospective cohort analysis comparing perceived stress and satisfaction with life outcomes among female students who self-selected to participate in the Heartfulness meditation program. The first group, G20, underwent intervention from week 0 until week 12 and continued their practice independently until week 20. The second group, G14, joined the intervention from week 7 until week 12 with only a 6-week exposure to guided meditation sessions through Heartfulness Trainers. They continued their practice independently until week 20. Data on Perceived Stress (PSS) and Satisfaction with Life (SWLS) were collected at week 0 and week 20 for both groups. G20 had 127 participants, and G14 had 113 participants. Ninety-four participants from the G20 group and 93 from G14 completed the study. The G20 group showed a statistically significant reduction of PSS scores from 20.79 to 18.96, and an increase in the SWLS scores from 22.03 to 23.51 from baseline to the end of the study period. The study of the Pearson correlation coefficient indicated that there is a weak positive correlation between pre- and post-scores for both the groups for both PSS and SWLS. Our findings suggest that Heartfulness meditation practice offers significant benefits with perceived stress and satisfaction with life among female students independent of their age. Still, a prolonged guided intervention of over 6 weeks is needed. A larger, randomized study with an additional control group with no meditation intervention is recommended.

Clinical trial registration

ISRCTN11302156, https://doi.org/10.1186/ISRCTN11302156.

Mindfulness-Based App to Reduce Stress in Caregivers of Persons With Alzheimer Disease and Related Dementias: Protocol for a Single-Blind Feasibility Proof-of-Concept Randomized Controlled Trial

BACKGROUND

Informal caregivers (ie, individuals who provide assistance to a known person with health or functional needs, often unpaid) experience high levels of stress. Caregiver stress is associated with negative outcomes for both caregivers and care recipients. Mindfulness-based interventions (MBIs) show promise for improving stress, emotional distress, and sleep disturbance in caregivers of persons with Alzheimer disease and related dementias (ADRD). Commercially available mobile mindfulness apps can deliver MBIs to caregivers of persons with ADRD in a feasible and cost-effective manner.

OBJECTIVE

We are conducting a single-blind feasibility proof-of-concept randomized controlled trial (RCT; National Institutes of Health [NIH] stage 1B) comparing 2 free mobile apps: the active intervention Healthy Minds Program (HMP) with within-app text tailored for addressing stress among caregivers of persons with ADRD, versus Wellness App (WA), a time- and dose-matched educational control also tailored for caregivers of persons with ADRD.

METHODS

We aim to recruit 80 geographically diverse and stressed caregivers of persons with ADRD. Interested caregivers use a link or QR code on a recruitment flyer to complete a web-based eligibility screener. Research assistants conduct enrollment phone calls, during which participants provide informed consent digitally. After participants complete baseline surveys, we randomize them to the mindfulness-based intervention (HMP) or educational control podcast app (WA) and instruct them to listen to prescribed content for 10 minutes per day (70 minutes per week) for 12 weeks. Caregivers are blinded to intervention versus control. The study team checks adherence weekly and contacts participants to promote adherence as needed. Participants complete web-based self-report measures at baseline, posttest, and follow-up; weekly process measures are also completed. Primary outcomes are a priori set feasibility benchmarks. Secondary outcomes are stress, emotional distress, sleep disturbance, caregiver burden, mindfulness, awareness, connection, insight, and purpose. We will calculate 1-sided 95% CI to assess feasibility benchmarks. Effect sizes of change in outcomes will be used to examine the proof of concept.

RESULTS

Recruitment started on February 20, 2023. We have enrolled 27 caregivers (HMP: n=14; WA: n=13) as of June 2023. Funding began in August 2022, and we plan to finish enrollment by December 2023. Data analysis is expected to begin in May 2024 when all follow-ups are complete; publication of findings will follow.

CONCLUSIONS

Through this trial, we aim to establish feasibility benchmarks for HMP and WA, as well as establish a proof of concept that HMP improves stress (primary quantitative outcome), emotional distress, sleep, and mindfulness more than WA. Results will inform a future efficacy trial (NIH stage II). HMP has the potential to be a cost-effective solution to reduce stress in caregivers of persons with ADRD, benefiting caregiver health and quality of care as well as patient care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05732038; https://clinicaltrials.gov/study/NCT05732038.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50108.

Heart Rate Variability Biofeedback as Adjunctive Treatment of Generalized Anxiety Disorder: A Case Report

Introduction

Generalized anxiety disorder (GAD) is a common psychiatric disorder that can cause significant functional impairment to a patient's life. Mind body therapies (MBT) have increasingly been used as an intervention to manage symptoms of anxiety. Heart rate variability (HRV) biofeedback is a specific MBT that utilizes real-time feedback on autonomic functioning to train the physiological stress response through diaphragmatic breathing.

Case Presentation

A 39-year-old female was referred for a seven-week HRV biofeedback training protocol at Bastyr University Clinic for adjunctive treatment of GAD and depression. She had been taking citalopram for approximately four months prior to the first visit.

Discussion/Conclusion

After completing the seven-week protocol, the patient's anxiety improved from severe to mild, and her depression improved from mild to minimal. This improvement was maintained at a four-week follow-up, and eight weeks after the final visit she reported that her anxiety was no longer a concern to her. HRV biofeedback demonstrated to be an effective adjunctive treatment for GAD in this patient's case; however further research is needed to elucidate the effects of HRV biofeedback in patients with GAD.

Does learning a skill with the expectation of teaching it impair the skill's execution under psychological pressure if the skill is learned with analogy instructions?

OBJECTIVE

Having learners practice a motor skill with the expectation of teaching it (versus an expectation of being tested on it) has been revealed to enhance skill learning. However, this improvement in skill performance is lost when the skill must be performed under psychological pressure due to 'choking under pressure.' The present study investigated whether this choking effect is caused by an accrual of declarative knowledge during skill practice and could be prevented if a technique (analogy instructions) to minimize the accrual of declarative knowledge during practice is employed.

DESIGN

We used a 2 (Expectation: teach/test) x 2 (Instructions: analogy/explicit) x 2 (Posttest: low-pressure/high-pressure) mixed-factor design, with repeated measures on the last factor.

METHODS

One-hundred fifty-six participants were quasi-randomly assigned (based on sex) to one of four groups. Participants in the teach/analogy and teach/explicit groups practiced golf putting with the expectation of teaching putting to another participant, and analogy instructions or explicit instructions, respectively. Participants in the test/analogy and test/explicit groups practiced golf putting with the expectation of being tested on their putting, and analogy instructions or explicit instructions, respectively. The next day all participants completed low- and high-pressure putting posttests, with their putting accuracy serving as the dependent variable.

RESULTS

We observed an Expectation x Instructions × Posttest interaction, such that a main effect of expectation was found in the low-pressure posttest, with the teach group exhibiting superior accuracy, and an Expectation × Instructions interaction was revealed for the high-pressure posttest. This interaction resulted from the teach group showing greater accuracy than the test group exclusively when receiving analogy instructions.

CONCLUSION

Results show that participants who practiced with the expectation of teaching exhibited superior learning and indicate that they choked under pressure likely due to their accrual of declarative knowledge during practice, since the choking effect was prevented by having them practice with analogy instructions. Accordingly, having learners practice with the expectation of teaching and techniques that minimize the accrual of declarative knowledge is recommended.

Adjuvant yoga therapy for symptom management of functional dyspepsia: A case series

Functional Dyspepsia (FD), commonly called chronic indigestion, comes under the umbrella of 'Disorders of Gut-Brain Axis'. It manifests as a cluster of upper gastrointestinal symptoms including epigastric pain or burning, postprandial fullness and early satiety. Since the pathophysiology is complex, it is often difficult to effectively manage and significantly impacts the patient's quality of life. This case series aims to elucidate the role of Yoga as an adjuvant therapy to modern medicine in providing relief of dyspeptic symptoms in such patients. Yoga is an ancient Indian mind-body practise that has the potential to be used for various brain-gut disorders. Apart from treating the gut disorders from top down (mind-gut) pathway, it may have more direct physiological effects as well. Researches on IBS and one research on abdominal pain related FGID have shown Yoga therapy to be effective in ameliorating the symptoms. In this study, we present three such cases (1 male and 2 female) having a clinical diagnosis of FD in detail. These patients were initially non-responsive to medications but later showed remarkable improvement in symptoms within one month of added Yoga therapy intervention. This study was conducted as a part of a larger study conducted at a tertiary hospital in Pondicherry in collaboration between its Yoga department and Medical Gastroenterology Department. Yoga therapy protocol was given along with their regular medical management for a month. Gastrointestinal Symptom Rating Scale (GSRS) and Dyspepsia Symptom Score questionnaires were used to assess symptoms before and after the intervention period. All three patients showed marked reductions in symptom scores both in the GSRS and Dyspepsia Questionnaire. The present case series suggests effect of adjuvant Yoga therapy in reducing symptoms of functional dyspepsia. Future studies may clarify the psycho-physiological basis of the same.

Feasibility, appropriateness, and acceptability of a mobile mindfulness meditation intervention to improve sleep quality among a racially/ethnically diverse population

OBJECTIVES

To evaluate the acceptability, appropriateness, and feasibility of using a mindfulness meditation mobile application to improve sleep quality among a diverse group of adults.

METHODS

This explanatory qualitative study used online focus group discussions (N = 4 groups with 17 individuals) to collect information about user experiences with a mindfulness meditation mobile application (Headspace) among participants enrolled in the MINDS study. A rapid analyses approach was used to descriptively compare motivators of app use, barriers and facilitators to app use, and perceived tailoring needs across participants.

RESULTS

Participants on average were 30 years old, 88% female, and identified as Black/African American (52.9%), White (29.4%), Asian (11.8%), and Hispanic (17.6%). All participants felt the app was acceptable and appreciated the ability to personalize their app experience. Individuals with ≥50% intervention adherence (daily use for 30 days) reported being motivated to use the app because it helped them to fall asleep faster, while the remainder of participants used the app to relax throughout the day and faced external barriers to app use (eg, lack of time) and difficulty with app navigation. Only those participants who used the app exclusively in the evenings reported falling asleep faster and staying asleep. Suggestions for tailoring the app differed by race and age. Only Black/African American participants preferred using an instructor based on their race and gender.

CONCLUSION

Using a mobile meditation app to enhance sleep quality is acceptable and feasible, but additional tailoring for Black/African American individuals may improve uptake in this population.

Integrative Surgery: Embedding Complementary and Nonpharmacologic Therapies into Surgical Pain Management Strategies

There has been a growing interest in the use of complementary and alternative medicine in modern pain management strategies on behalf of both patients and clinicians. Nonpharmacologic modalities such as cryotherapy, acupuncture, music, and mind-body therapies have been shown to aid in symptom control and improve quality of life in patients suffering from acute and chronic pain, and there is a growing body of literature demonstrating their feasibility, acceptability, and efficacy in the perioperative period. Here, we provide a brief review of the current evidence supporting the use of complementary therapies within existing perioperative pain management strategies and highlight evidence-based protocols to facilitate implementation into modern surgical practice.

Anxiety in children and youth: Part 2-The management of anxiety disorders

Anxiety disorders are the most common mental health concerns affecting Canadian children and adolescents. The Canadian Paediatric Society has developed two position statements that summarize current evidence regarding the diagnosis and management of anxiety disorders. Both statements offer evidence-informed guidance to support paediatric health care providers (HCPs) making decisions around the care of children and adolescents with these conditions. The objectives of Part 2, which focuses on management, are to: (1) review the evidence and context for a range of clinical approaches that combine behavioural and pharmacological interventions to effectively address impairment, (2) describe the roles of education and psychotherapy in the prevention and treatment of anxiety disorders, and (3) outline the use of pharmacotherapy, with side effects and risks. Recommendations for managing anxiety are based on current guidelines, review of the literature, and expert consensus. Note that when the word 'parent' (singular or plural) is used, it includes any primary caregiver and every configuration of family.

Effects of a Neuroscience-Based Mindfulness Meditation Program on Psychological Health: Pilot Randomized Controlled Trial

BACKGROUND

Mindfulness and meditation have a rich historical tradition, and a growing scientific base of evidence supports their use in creating positive psychological and neuroplastic changes for practitioners. Although meditation can be taught in various ways, the scientific community has yet to systematically study the impact of different types of meditation on neuropsychological outcomes, especially as it pertains to digital implementation. Therefore, it is critical that the instruction of mindfulness be evidence based because meditation is being used in both scientific and clinical settings.

OBJECTIVE

This study investigated the use of teacher cueing and the integration of neuroscience education into a meditation program. Compassion cueing was chosen as the element of experimental manipulation because traditional lineages of Buddhist meditation teach compassion for self and others as one of the primary outcomes of meditation. We hypothesized that participants receiving compassion cueing would have enhanced neuropsychological outcomes compared with those receiving functional cueing and that gains in neuroscience knowledge would relate to positive neuropsychological outcomes.

METHODS

Participants (n=89) were randomized to receive either functional cueing (control group) or compassion cueing (experimental group) and engaged with five 10-minute meditation sessions a week for 4 weeks. All intervention sessions were administered through digital presentation. All participants completed ecological momentary assessments before and after the daily intervention, as well as pre- and postintervention questionnaires.

RESULTS

Participants demonstrated significant benefits over time, including increased mindfulness and self-compassion, decreased depression, and gains in neuroscience content (all P<.001); however, no significant between-group differences were found. Daily scores from each day of the intervention showed a statistically significant shift from active toward settled. Importantly, long-term increases in mindfulness were positively correlated to changes in compassion (r=0.326; P=.009) and self-compassion (r=0.424; P<.001) and negatively correlated to changes in anxiety (r=-0.266; P=.03) and depression (r=-0.271; P=.03). Finally, the acute effects of meditation were significantly correlated to the longitudinal outcomes (with a small-to-medium effect size), especially those relevant to mindfulness.

CONCLUSIONS

We developed a novel neuroscience-based education-meditation program that enhanced self-regulation as evidenced by improved mindfulness, self-compassion, and mood state. Our findings demonstrate the behavioral importance of engaging with mindfulness meditation and reinforce the idea that the benefits of meditation are independent of teacher cueing behavior. Future studies will need to investigate the brain-based changes underlying these meditation-induced outcomes.

The effects of mindfulness-based interventions on anxiety, depression, stress, and mindfulness in menopausal women: A systematic review and meta-analysis

Background

Mindfulness-based interventions (MBIs) are psychological interventions widely used in menopausal women. Currently, there is no evidence summary on the effectiveness of MBIs on anxiety, depression, stress, and mindfulness in menopausal women. This meta-analysis examines the effectiveness of MBIs in improving anxiety, depression, stress, and mindfulness scores in menopausal women.

Methods

A systematic search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, CNKI (China National Knowledge Infrastructure), and Wanfang, using relevant terms such as MBIs as keywords and covering all studies published before March 13, 2022. The outcomes were anxiety, depression, stress, and mindfulness. The screening and extraction of data were conducted by two independent reviewers.

Results

A total of 1,138 menopausal women participated in 13 studies. Meta-analysis results showed that MBIs significantly reduced stress in menopausal women (SMD = -0.84, 95% CI: -1.64 to -0.05, p = 0.04), but no statistical differences were found in reducing anxiety (SMD = -0.40, 95% CI: -0.81 to 0.01, p = 0.06) and depression (SMD = -0.19, 95% CI: -0.45 to 0.07, p = 0.16) and in raising the scores of mindfulness (SMD = 0.37, 95% CI: -0.06 to 0.81, p = 0.09) in menopausal women.

Conclusion

MBIs may reduce stress in menopausal women, but their effect on improving anxiety, depression, and mindfulness needs further validation.

Systematic review registration

https://www.crd.york.ac.uk/prospero/#recordDetails.

The relationship between mindfulness, anxiety and depression during the COVID-19 pandemic: A meta-analysis of correlational studies

Background

The emergence of the COVID-19 pandemic has created an environment in which numerous determinants of poor mental health are intensified. Lockdown, re-lockdown, and media coverage of the spread of the virus, have the potential to contribute to increased levels of anxiety and depression. Mindfulness may act as a buffer against COVID-19-related depressive and anxiety disorders.

Methods

We conducted a systematic review and meta-analysis by searching PubMed, PsycINFO, Web of Science, and Google Scholar for any study published between January 2020 and March 2022. In this study, Comprehensive Meta-Analysis Version 3.3 software was applied to evaluate the effect size by random effect model. In addition, the heterogeneity analysis was evaluated using indicators Q and I² indicators. Three methods were used to test for publication bias: funnel plot, Classic Fail-safe N, and Egger's linear regression. According to the features of the included articles, subgroup analysis was utilized for the moderator analysis of this study.

Results

The analysis finally included 12 articles (16 samples, N = 10,940) and obtained 26 independent effect sizes. In accordance with the meta-analysis, in the random effect model, the correlation between mindfulness and anxiety was -0.330 (p < 0.001), and the correlation between mindfulness and depression was -0.353 (p < 0.001), which supported the effect of mindfulness on anxiety and depression. In the meta-analysis of the correlation between mindfulness and anxiety, study region had an essential moderating effect (p < 0.001). The Sample type did not produce a significant moderating effect (p = 0.190). The mode of action of mindfulness was a significant moderator (p = 0.038). In the meta-analysis of the linkage between mindfulness and depression, regional differences had a significant moderating effect (p < 0.001). The sample type had no discernible moderating impact (p = 0.213). The mode of action of mindfulness was a significant moderator (p = 0.003).

Conclusion

Our meta-analysis indicated that there was an essential correlation between public mindfulness and mental health. Our systematic review added evidence supporting the beneficial nature of mindfulness. A cascading development of beneficial traits that improve mental health may start with mindfulness.

Effects of Mindful Awareness Practice (MAP) on Subclinical Depressive and Anxiety Symptoms and General Cognitive Function in Older Adults with Mild Cognitive Impairment: A 5-Year Follow-Up of the MAP-Randomized Controlled Trial

BACKGROUND

Few randomized controlled trials (RCTs) investigated the effects of mindfulness intervention on affective and cognitive symptoms in older adults with mild cognitive impairment (MCI). Furthermore, no RCTs on mindfulness followed participants beyond two years.

OBJECTIVE

To examine the longitudinal effects of a mindful awareness practice (MAP) intervention on depressive, anxiety, and cognitive symptoms in MCI.

METHODS

In this parallel-arm and assessor-blinded RCT, 55 community-dwelling older adults with MCI were randomized into the MAP or active control, i.e., health education program (HEP). Intervention sessions were conducted weekly for three months and monthly for the subsequent six months. Assessments and follow-up were conducted at baseline, 3-month, 9-month, and 5-year time points. Depressive, anxiety, and cognitive symptoms were measured using the Geriatric Depression Scale-15 (GDS-15), Geriatric Anxiety Inventory-20 (GAI-20), and Mini-Mental State Examination (MMSE), respectively. Linear-mixed models, following the intention-to-treat principle, were used for data analyses.

RESULTS

A total of 55 participants aged 60 to 86 (Mean age: 71.3±6 years old) was recruited, with n = 28 allocated to the MAP arm and n = 27 allocated to the HEP arm. Compared to HEP, GDS-15, GAI-20, and MMSE scores did not differ significantly in MAP during follow-ups.

CONCLUSION

Compared to HEP, MAP did not improve affective symptoms nor delay deteriorations in general cognition in community-dwelling older adults with MCI. Compared to our previous findings showing domain-specific improvements in MAP over HEP in attention and memory up to 9 months, this study highlights the importance of examining domain-specificity using detailed cognitive measures in non-pharmacological intervention with MCI.

The biological dimensions of transcendent states: A randomized controlled trial

This study evaluated the biological dimension of meditation and self-transcendent states. A convenience sample of 513 participants was drawn from attendees at a 4-day guided meditation workshop. Half were randomly assigned to an active placebo control intervention. All were assessed on a variety of measures, both psychological [anxiety, pain, posttraumatic stress disorder (PTSD), positive emotions, and transcendent states], and physiological (physical functioning). Additional biological assessments including salivary immunoglobulin-A (SIgA), cortisol, and Quantitative Electroencephalography (qEEG) were obtained from subset of the Experimental group (N = 117). No significant difference in psychological symptoms or positive emotions was observed between Experimental and placebo groups at baseline. At post-test, significant improvements were noted in the Experimental group, including a 49.5% median increase in SIgA (p = 0.01), though cortisol remained unchanged. qEEG z-score analysis identified sustained stress reduction, including delta frequency band amplitude increases, high beta decreases, and faster acquisition of sustained alpha states (all p < 0.001). Psychological symptoms also improved on all measures. At 6-month follow-up (N = 140), PTSD and somatic symptoms significantly improved from baseline, and post-test versus 6-month follow-up results indicated significant increases in happiness and spiritual and physical oneness, along with decreases in depressive symptoms. These findings suggest that autonomic self-regulation and transcendent states may be measured in both biological and psychological dimensions and are associated with pervasive health benefits.

Effect of Aromatherapy with Essential oil of Lavandula Angustifolia Mill- Citrus Bergamia and Mindfulness-Based Intervention on Sexual Function, Anxiety, and Depression in Postmenopausal Women: A Randomized Controlled Trial with Factorial Design

BACKGROUND

Due to the importance of psychological support for women during menopause as a period with a high prevalence of mental health problems, this study aimed to evaluate the effect of the essential oil of lavender-Bergamot (La-Ber) and Mindfulness-Based Intervention (MBI) on sexual function, anxiety (primary outcome), and depression score (secondary outcome) in postmenopausal women with sexual dysfunction.

MATERIALS AND METHODS

This controlled randomized trial with a factorial design was performed on 132 postmenopausal women. Participants were randomly allocated into four equal groups: Aromatherapy-Routine Care (Aroma-RC), MBI-Placebo (MBI-P), Aromatherapy-MBI (Aroma-MBI), or Routine Care-Placebo (RC-P). Two to three drops of La-Ber or a similar placebo were inhaled three times a day for 8 weeks. Eight sessions of MBI intervention were conducted. At the end of the intervention and eight weeks afterward, the outcomes were assessed.

RESULTS

The sexual function score improved significantly in Aroma-MBI (adjusted Mean Difference [aMD]: 2.4, 95% CI: 0.01 to 4.80) and MBI-P (aMD: 2.6, 95% CI: 0.2 to 5.1) groups compared to the RC-P group. The anxiety score was reduced in the Aroma-RC group at the end of the intervention (aMD: -4.12, 95% CI: -7.41 to -0.72; p = 0.020) and eight weeks later as well as in the Aroma-MBI group. In terms of depression, the mean score of depression was significantly lower than the RC-P group in the Aroma-RC group at the end of the intervention (p = 0.011).

CONCLUSIONS

MBI and aromatherapy seem effective on sexual function and menopausal anxiety. MBI improves sexual function, while aromatherapy ameliorated anxiety and depression.

Perceived Stress, Resilience, and Wellbeing in Seasoned Isha Yoga Practitioners Compared to Matched Controls During the COVID-19 Pandemic

Background

Yoga practices, including breathing, meditation, and posture protocols (asanas), have been shown to facilitate physical and mental wellbeing.

Methods

Seasoned yoga practitioners were recruited from the Isha Foundation. Recruitment of the comparison group was achieved using snowball sampling and were not yoga practitioners. Participants in the non-yoga group were randomized to a 3-min Isha practice or a comparator group asked to perform 15-min of daily reading. Participants completed a series of web-based surveys (REDCap) at baseline, 6, and 12 weeks. These surveys include validated scales and objective questions on COVID-19 infection and medical history. The validated questionnaires assess for: perceived stress (PSS), mood states [anxiety and depression (PHQ-4), joy (DPES-Joy subscale)], mindfulness attention and awareness (MAAS), resilience (BRS), mental wellbeing (WEMWBS) and recovery from traumatic event (PTGI). Weekly activity diaries were employed as a tool for collecting compliance information from study participants. Perceived stress scale scores were identified as primary outcome for this study.

Findings

The median Perceived Stress Scale (PSS) score for the yoga practitioners compared to the active and placebo comparators was significantly lower at all time-points: baseline: 11 [IQR 7–15] vs. 16 [IQR 12–21] in both the active and placebo comparators (p &lt; 0.0001); 6 weeks: 9 [IQR 6–13] vs. 12 [IQR 8–17] in the active comparator and 14 [IQR 9–18] in the placebo comparator (p &lt; 0.0001); and 12 weeks: 9 [IQR 5–13] vs. 11.5 [IQR 8–16] in the active comparators and 13 [IQR 8–17] in the placebo comparator (p &lt; 0.0001). Among the randomized participants that were compliant for the full 12 weeks, the active comparators had significantly lower median PSS scores than the placebo comparators 12 weeks [10 (IQR 5–14) vs. 13 (IQR 8–17), p = 0.017]. Further, yoga practitioners had significantly lower anxiety at all three-time points (p &lt; 0.0001), lower depression at baseline and 6 weeks (p &lt; 0.0003), and significantly higher wellbeing (p &lt; 0.0001) and joy (p &lt; 0.0001) at all three-time points, compared to the active and placebo comparator groups.

Interpretation

The lower levels of stress, anxiety, depression, and higher level of wellbeing and joy seen in the yoga practitioners compared to the active and placebo comparators illustrate the impact of regular yoga practices on mental health even during the pandemic.

Trial Registration

ClinicalTrials.gov, identifier: NCT 04498442.

Meta-Analysis of Psychological Interventions for Reducing Stress, Anxiety, and Depression among University Students during the COVID-19 Pandemic

(1) Background: The aim of this study is to investigate the effects of internet-based intervention programs for reducing stress, anxiety, and depression among university students during the COVID-19 pandemic by conducting a meta-analysis. (2) Methods: Searches were conducted in the following databases: MEDLINE, EbscoHost Academic Search Ultimate, and PsycArticles, using a combination of “Covid-19 AND ‘Randomized Controlled Trial’ AND students”, as well as a combination of the following search terms: “internet”, “online”, “treat_”, “psycholog_”, “intervention”, “program_”, “stress_”, “depress_”, “anxiety”, “university”, “college”, ”freshm_”, “sophomore_”, and “undergraduat_”. The population, intervention, control, outcomes, and study design (PICOS) framework was used (P (population): university students during the COVID-19 pandemic; I (intervention): internet-based intervention programs for reducing stress, anxiety, and depression; C (control): no intervention, usual care, or on a waiting list; O (outcomes): stress, anxiety, and depression indicators; S (study design): meta-analysis including only randomized controlled trials (RCTs)). A meta-analysis was performed on the 10 retrieved studies published between 2021 and 2022. Only RCTs were analyzed. (3) Results: All 10 analyzed papers revealed a trend in the effectiveness of internet-based intervention for reducing stress, anxiety, and depression in university students during COVID-19. Significant effects from the included RCTs with interventions for reducing stress and depression were established. (4) Conclusions: Psychological internet-based interventions may help to reduce depression and stress among university students; however, more research is needed to determine their effectiveness in reducing anxiety.

Mindfulness-Based Stress Reduction Live Online During the COVID-19 Pandemic: A Mixed Methods Feasibility Study

Objectives: To assess the feasibility, acceptability, and effects of Mindfulness Based Stress Reduction (MBSR) live online during the COVID-19 shutdown. Design: Mixed-methods study using a sequential explanatory design. Settings/location: Cohorts 1-4 took place in-person and Cohorts 5-6 took place over Zoom following the onset of the COVID-19 pandemic. Subjects: Participants were paying members of the general public enrolled in one of six live MBSR courses. Interventions: All MBSR courses followed the standard 8-week MBSR curriculum, led by experienced instructors. Outcome measures: Feasibility measured via class attendance, acceptability measured via the adapted Treatment Satisfaction Survey, and MBSR course effects measured by a focus group with Cohort 5, and the following assessments completed by all cohorts: Perceived Stress Scale-10, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9 and the 36-item Short Form Survey. Results: 73 adults participated in six live MBSR courses (48 in the four in-person courses; 25 in the two online courses). Most of the participants identified as white, non-Hispanic, middle-aged females, with annual household income >$100,000. Course completion, defined as at least 6/8 classes attended, did not differ between in-person and online cohorts (84.1% versus 67.6%, respectively, p = 0.327). Participants in Cohort 5 who completed the course (n = 10) rated it as very important and useful for stress coping, and reported high likelihood of continuing their mindfulness practice (all ratings: between 8 and 10 on a 1-10 Likert scale), with open-ended responses corroborating their numerical ratings. Focus group (n = 6) responses indicated that online MBSR was positively received, reduced perceived loss of control, and improved quality of life and morale during the pandemic. Conclusions: Delivering MBSR live online can be feasible and acceptable for the general public, and is potentially beneficial, including during the social upheaval of the COVID-19 pandemic. Online delivery could help expand access to MBSR and address health inequities.

Health-Related Quality of Life Outcomes with Regular Yoga and Heartfulness Meditation Practice: Results from a Multi-national, Cross-sectional Study (Preprint)

Background

Although the benefits of yoga are well established across the world, there are limited studies exploring the long-term interrelation between yoga, meditation, and health. Specifically, there is limited research exploring the differences in health-related quality of life (HRQOL) among regular meditators and nonmeditators.

Objective

This study explored the differences in 7 domains of HRQOL (including quality of life, ability to adopt a healthy lifestyle, ability to relax, frequency of nervousness and stress, coping with day-to-day stress, workplace productivity, and staying healthy during the COVID-19 pandemic) among practitioners of yoga and meditation.

Methods

A cross-sectional, online survey was distributed to all members who participated in a 100-day yoga and meditation program, culminating in the International Day of Yoga event, organized by the Heartfulness Institute in partnership with the Central Council for Research in Yoga and Naturopathy, Ministry of Ayush, SVYASA Yoga University, and Patanjali Yoga Institute, India. The program consisted of daily virtual yoga, meditation, and speaker sessions. The data were analyzed by nonparametric Mann-Whitney U test and Kruskal-Wallis tests for continuous variables and chi-square test for categorical variables.

Results

A total of 3164 participants from 39 countries completed the survey. Mean age was 33.8 (SD 13.6) years. The majority of the participants were female (n=1643, 52%) and students (n=1312, 41.5%). Regular yoga and meditation practice was associated with a positive impact on all 7 domains of HRQOL (Mann-Whitney P<.05 and χ²P<.05). Notably, experienced Heartfulness (≥2 years) meditators reported better outcomes in all the domains of HRQOL as compared to those not currently practicing this form of meditation and participants with ≤1 year of Heartfulness meditation experience (P<.05).

Conclusions

This is one of the first cross-sectional studies to explore HRQOL outcomes among participants of a 100-day virtual yoga and meditation program. Overall, a yoga and meditation practice was found to be an effective tool for promoting HRQOL. Regular yoga and meditation practice was associated with factors promoting health and well-being, with long-term meditation practice associated with increased benefits.

The Impact of Qigong and Tai Chi Exercise on Drug Addiction: A Systematic Review and Meta-Analysis

BACKGROUND

Previous preliminary studies have found that qigong exercises produced significant effects in healthy people and in various clinical populations. The purpose of this study was to systematically review the effects of qigong and tai chi exercise on individuals with drug addiction.

METHODS

A systematic search of seven English databases and three Chinese databases was conducted to identify randomized controlled trials (RCTs) and non-randomized comparative studies (NRS) assessing the effects of qigong and tai chi on drug addiction. Study quality was assessed using the Checklist for the Evaluation of Non-Pharmaceutical Trial Reports (CLEAR-NPT).

RESULTS

Two RCTs and nine NRS studies were included in this study, including a total of 1072 patients with drug addiction (age range, 27-43 years). The results showed that qigong and tai chi exercise had a significant overall effect on depression (SMD = -0.353, 95%CI [-0.548, -0.159]), anxiety (SMD = -0.541, 95%CI [-0.818, -0.264]), quality of life (SMD = 0.673, 95%CI [0.438, 0.907]), and sleep quality (SMD = -0.373, 95%CI [-0.631, -0.116]). The subgroup analysis found that qigong outperformed tai chi on the improving depression, anxiety, and sleep quality.

CONCLUSION

Existing studies suggest that qigong and tai chi are effective at improving depression, anxiety, and quality of life in drug users; however, the evidence from rigorous randomized controlled group trials is lacking.

The Effects of Tai Chi and Qigong Exercise on Psychological Status in Adolescents: A Systematic Review and Meta-Analysis

Background: The purpose of this study was to systematically review the effectiveness of Tai Chi and Qigong exercise on adolescents' symptoms of depression and anxiety, and psychological status based on clinical evidences, and to calculate the pooled results using meta-analysis. Methods: A systematic search using seven English and three Chinese databases was initiated to identify randomized controlled trials (RCT) and non-randomized comparison studies (NRS) assessing the effect of Tai Chi and Qigong exercise on psychological status among adolescents. Standardized mean differences (SMD) and their 95% confidence intervals (CI) were used to determine the pooled effect of the intervention. Study quality was evaluated using a Checklist to Evaluate a Report of a Non-pharmacological Trial (CLEAR-NPT) designed for non-pharmacological trials. Results: Four RCTs and six NRS were identified, including 1,244 adolescents. The results suggested a potential beneficial effect of Tai chi and Qigong exercise on reducing anxiety (SMD = 0.386, 95 CI% [0.233, 0.538]) and depression (SMD = 1.937 [95 CI%, 1.392-2.546]) symptoms, and reducing cortisol level (SMD = 0.621 [95 CI%, 0.18-1.062]) in adolescents. Conversely, non-significant effects were found for stress, mood, and self-esteem. Conclusions: The findings of this review suggest Qigong appears to be an effective therapeutic modality to improve psychological well-being in adolescents. Hope future studies will have rigorously designed, well-controlled randomized trials with large sample sizes in order to confirm these findings.

Assessment of yogic relaxation techniques for its anxiolytic effects in patients requiring endodontic treatment: A prospective, randomized controlled study

Background:

The aim of the study is to assess the anxiolytic effects of yogic relaxation technique (YRT) in patients requiring root canal treatment (RCT).

Materials and Methods:

In this prospective, randomized, placebo-controlled study, 30 patients undergoing RCT with baseline visual analog scale for anxiety (VAS-A) of score >4 were divided into Group 1: YRTs; Group 2: alprazolam (0.25 mg/0.5 mg), and Group 3: placebo. After 30 min of completion of YRT, endodontic treatment was performed. Reduction in anxiety was analyzed using state anxiety score (domain) of the state-trait anxiety inventory scale.

Results:

There was no significant difference in anxiety score 1 h before RCT between groups (P = 0.401). Ten minutes before (P < 0.0001) and after RCT (P < 0.0001), there was significant difference between groups (yogic relaxation vs. alprazolam [P < 0.0001]; yogic relaxation vs. placebo [P < 0.0001]). Ten minutes before RCT, yoga relaxation showed significant difference in anxiety score for pain versus alprazolam and placebo (P < 0.0001 for both). Ten minutes after RCT, the change from baseline in mean anxiety score for pain was significantly different with yogic relaxation (versus alprazolam [P = 0.043]; versus placebo [P = 0.002]). As per the global assessment of efficacy, the response was excellent in 9 (90%), 2 (20%), and 1 (10%) patients in yoga relaxation group, alprazolam group, and placebo group, respectively. Difference in response between three groups was significant (P < 0.0001). There was no significant difference in the global assessment of tolerability between three groups (P = 0.535). No adverse events were reported.

Conclusion:

Before RCT, YRT is an effective alternative to anxiolytic agents, alprazolam.

Integrative surgical oncology: A model of acute integrative oncology

Integrative oncology has emerged as a recognized medical subspecialty because of growing interest in the use of integrative medicine in modern cancer care on behalf of both patients and providers. Acutherapy and mind-body techniques, such as meditation and yoga, have been shown to aid in symptom control and improve quality of life in oncologic patient populations, and the Society of Integrative Oncology and American Society of Clinical Oncology have recently endorsed a set of guidelines for the implementation of these techniques specifically in patients with breast cancer. Although the current guidelines focus largely on the management of chronic symptoms, there exists evidence to support the use of these techniques in acute symptom management as well. With surgical resection representing the backbone of many cancer treatment regimens, symptoms that arise during the perioperative period are prime examples of the acute symptomatology common among patients with cancer. Here, the authors provide a detailed literature review of the current evidence supporting the use of integrative techniques during the perioperative period and demonstrate their applicability for acute symptom management within oncologic and surgical populations. In doing so, the authors introduce a new paradigm of surgical practice they call integrative surgical oncology and integrative surgery.

Effects of a Mindfulness-Based Intervention versus Health Self-Management on Subclinical Anxiety in Older Adults with Subjective Cognitive Decline: The SCD-Well Randomized Superiority Trial

INTRODUCTION

Older adults experiencing subjective cognitive decline (SCD) have a heightened risk of developing dementia and frequently experience subclinical anxiety, which is itself associated with dementia risk.

OBJECTIVE

To understand whether subclinical anxiety symptoms in SCD can be reduced through behavioral interventions.

METHODS

SCD-Well is a randomized controlled trial designed to determine whether an 8-week mindfulness-based intervention (caring mindfulness-based approach for seniors; CMBAS) is superior to a structurally matched health self-management program (HSMP) in reducing subclinical anxiety. Participants were recruited from memory clinics at 4 European sites. The primary outcome was change in anxiety symptoms (trait subscale of the State-Trait Anxiety Inventory; trait-STAI) from pre- to postintervention. Secondary outcomes included a change in state anxiety and depression symptoms postintervention and 6 months postrandomization (follow-up).

RESULTS

One hundred forty-seven participants (mean [SD] age: 72.7 [6.9] years; 64.6% women; CMBAS, n = 73; HSMP, n = 74) were included in the intention-to-treat analysis. There was no difference in trait-STAI between groups postintervention (adjusted change difference: -1.25 points; 95% CI -4.76 to 2.25) or at follow-up (adjusted change difference: -0.43 points; 95% CI -2.92 to 2.07). Trait-STAI decreased postintervention in both groups (CMBAS: -3.43 points; 95% CI -5.27 to -1.59; HSMP: -2.29 points; 95% CI -4.14 to -0.44) and reductions were maintained at follow-up. No between-group differences were observed for change in state anxiety or depression symptoms.

CONCLUSIONS

A time-limited mindfulness intervention is not superior to health self-management in reducing subclinical anxiety symptoms in SCD. The sustained reduction observed across both groups suggests that subclinical anxiety symptoms in SCD are modifiable. ClinicalTrials.gov identifier: NCT03005652.

Gender Gap in Mindfulness Assessment Among Italian Nurses: A Pilot Descriptive Study

"Purpose: The present study aimed to explore gender differences in the mindfulness tendency, specifically in the awareness and attention dimensions and also in the observing, describing, acting with awareness and accepting without judgement in Italian nurses. Methods: In June 2020 an on-line questionnaire was administered to nurses in order to analyze any differences both in the Mindfulness Attention Awareness Scale (MAAS) and the Kentucky Inventory of Mindfulness Skills (KIMS) according to gender variable. Findings: 200 questionnaires were collected. Findings showed significant higher MAAS total score in males than females (p=.004). Additionally, by considering the four sub dimensions in the Mindfulness tendency, females reported significant higher levels in some items of “Observe” (p=.004) and “Act with awareness” (p=.001) than males, while males reported significant higher scores in the “Accept without judgement” than females (p<.001). Conclusions: The present study was a pilot research on exploring gender differences in mindfulness in Italian nurses in order to hope that it will be only the beginning of empirical research on this topic and to better address future mindfulness training courses addressed to nurses by emphasizing certain aspects of mindfulness for females compared to males and vice versa."

Mind-Body Interventions for Anxiety Disorders: A Review of the Evidence Base for Mental Health Practitioners

Mind-body interventions have gained increasing popularity for use with anxiety symptoms; however, it is unclear what role they play in the treatment of anxiety disorders, such as generalized anxiety disorder, panic disorder, and social anxiety disorder. Although psychopharmacology and psychotherapy treatment interventions are available, mind-body interventions may be low-stigma options that can serve as effective alternatives. The goal of this review is to provide clinicians with an overview of high-quality studies for the most well researched mind-body interventions. This review involved a search of the primary literature, including meta-analyses, systematic reviews, and randomized controlled trials (RCTs), that evaluated mind-body interventions for the treatment of anxiety disorders. When published evidence was limited, lower-quality studies were reviewed. Overall, data were limited on the efficacy of most mind-body modalities for anxiety disorders. The highest-quality data existed for yoga, mindfulness-based interventions, and applied relaxation for anxiety disorders. However, findings were sometimes inconsistent across studies, and some studies were limited by small sample sizes, poorly defined randomization and blinding procedures, and inadequate control groups. Although not enough data exist to recommend mind-body interventions as primary treatment options, they may be considered as part of a larger treatment plan given their relatively low levels of risk. Future steps for researchers include conducting additional RCTs with adequate control groups, comparing mind-body treatments with existing treatments, and examining long-term effects of mind-body interventions.

Perceived stress, resilience, well-being, and COVID 19 response in Isha yoga practitioners compared to matched controls: A research protocol

Objectives

The COVID-19 pandemic has been a significant stressor worldwide and reports of psychological distress, depression, sedentary lifestyles, and overall decreased wellbeing are increasing. Yoga practices have been found to improve mental and physical health. The purpose of this randomized controlled trial is to compare Isha yoga practitioners to controls on perceived stress, resilience, wellbeing, and protection and recovery from COVID-19. Trial Design. In this prospective randomized control trial, the effects of yoga practices are being compared between seasoned yoga practitioners with two controls who are age (±3 years), gender matched, and living in the same neighborhood.

Methods

Participants will be asked to complete a series of web-based surveys at baseline, six weeks, and 12 weeks. These surveys include validated scales and objective questions on COVID-19 infection and medical history. The validated questionnaires assess stress, mood states, resilience, and overall wellbeing. Questionnaires, weekly activity diaries, and medical history, will be collected using REDCap.

Results

We hypothesize that routine yoga practice during the COVID-19 pandemic will reduce stress, enhance well-being, and provide protective effects against COVID-19.

Conclusion

With the growing concern about the physical and mental impacts of COVID-19 and increased interest in alternative practices such as yogic practices, this study will contribute to the growing body of evidence about the safety and efficacy of yoga for emotional, mental, and physical health conditions.

Isha Yoga Practices and Participation in Samyama Program are Associated with Reduced HbA1C and Systemic Inflammation, Improved Lipid Profile, and Short-Term and Sustained Improvement in Mental Health: A Prospective Observational Study of Meditators

Background: Meditation is gaining recognition as a tool to impact health and well-being. Samyama is an 8-day intensive residential meditation experience conducted by Isha Foundation requiring several months of extensive preparation and vegan diet. The health effects of Samyama have not been previously studied. The objective was to assess physical and emotional well-being before and after Samyama participation by evaluating psychological surveys and objective health biomarkers. Methods: This was an observational study of 632 adults before and after the Isha Samyama retreat. All participants were invited to complete surveys. Controls included household significant others. Surveys were completed at baseline (T1), just before Samyama (T2), immediately after Samyama (T3), and 3 months later (T4) to assess anxiety, depression, mindfulness, joy, vitality, and resilience through validated psychometric scales. Voluntary blood sampling for biomarker analysis was done to assess hemoglobin (Hb), HbA1c, lipid profile, and C-reactive protein (CRP). Primary outcomes were changes in psychometric scores, body weight, and blood biomarkers. Results: Depression and anxiety scores decreased from T1 to T3, with the effect most pronounced in participants with baseline depression or anxiety. Scores at T4 remained below baseline for those with pre-existing depression or anxiety. Vitality, resilience, joy, and mindfulness increased from T1 to T3 (sustained at T4). Body weight decreased by 3% from T1 to T3. Triglycerides (TG) were lower from T2 to T3. Participants had lower HbA1c and HDL at T2, and lower CRP at all timepoints compared with controls. Conclusions: Participation in the Isha Samyama program led to multiple benefits. The 2-month preparation reduced anxiety, and participants maintained lower anxiety levels at 3 months post-retreat. Physical health improved over the course of the program as evidenced by weight loss and improved HbA1C and lipid profile. Practices associated with the Samyama preparation phase and the retreat may serve as an effective way to improve physical and mental health. Future studies may examine their use as an alternative therapy in patients with depression and/or anxiety. Clinical Trial Registration: www.ClinicalTrials.gov, Identifier: 1801728792. Registered retrospectively on 4/17/2020.

A cross--sectional study of mental wellbeing with practice of yoga and meditation during COVID-19 pandemic

Background:

COVID-19 pandemic has resulted in increased mental health issues. Yoga and meditation can help in alleviating mental stress and improving psychological wellbeing.

Methods:

It was a community-based online cross-sectional study involving adult general population. Data collection was done by using a Google form link that was circulated via online platforms. The data were analyzed using Microsoft Excel and SPSS version 22. Qualitative data were expressed in proportions or percentages and quantitative data were expressed in mean and standard deviation. Chi-square test was used to check the association of various factors and mental wellbeing.

Results:

A total of 649 (58.4%) subjects had normal mental wellbeing score, whereas 279 (25.1%) were found to be at risk of developing psychological distress and 184 (16.5%) were at risk of depression. A significantly larger proportion of subjects with normal mental wellbeing was found with the practice of both yoga and meditation (66.2%), followed by practice of only meditation (62.1%), only yoga (59.9%), and none of them (50.6%). A similar association of yoga and meditation practices was found with the change in eating, sleeping patterns, and family relations. The frequency of practice was positively associated with a higher level of mental wellbeing in the case of both yoga as well as meditation, with daily practice having the highest wellbeing scores.

Conclusion:

The practice of yoga and meditation, preferably both of them, is associated with higher level of mental wellbeing during the COVID-19 pandemic.

The effects of mindfulness-based interventions on nursing students: A meta-analysis

BACKGROUND

Recently, mindfulness interventions have been extensively applied in the field of nursing education. However, no consensus has been reached on whether these interventions can reduce anxiety and depression in nursing students.

OBJECTIVE

This meta-analysis was designed to determine the effect of mindfulness interventions on levels of depression, anxiety, stress and mindfulness for nursing students.

DESIGN

Meta-analysis of randomized controlled trials.

METHODS

The following Chinese and English databases were searched for relevant articles: Pubmed, Embase, Cochrane library, Web of Science, CNKI (China National Knowledge Infrastructure) and Wanfang. The search encompassed the establishment of these databases up until January 2020. Two reviewers separately entered the data into Review Manager Software 5.3.

RESULTS

A total of 10 randomized controlled trials (RCTs) were reviewed. It was found that mindfulness interventions significantly lowered levels of depression (SMD = -0.42, 95% CI:-0.56 to -0.28, P < 0.001), anxiety (SMD = -0.32, 95% CI:-0.47 to -0.17, P < 0.001) and stress (SMD = -0.50, 95% CI:-0.65 to -0.35, P < 0.001) in nursing students. Furthermore, the interventions raised levels of mindfulness in this group (SMD = 0.54, 95% CI:0.33-0.75, P < 0.001).

CONCLUSIONS

Mindfulness interventions can significantly reduce nursing students' negative emotions, helping them to manage their stress and anxiety. College nursing educators should consider adopting mindfulness interventions in nursing education to promote the mental health of students.

The Effect of Baseline Patient and Caregiver Mindfulness on Dementia Outcomes

BACKGROUND

Mindfulness is the practice of awareness and living in the present moment without judgment. Mindfulness-based interventions may improve dementia-related outcomes. Before initiating interventions, it would be beneficial to measure baseline mindfulness to understand targets for therapy and its influence on dementia outcomes.

OBJECTIVE

This cross-sectional study examined patient and caregiver mindfulness with patient and caregiver rating scales and patient cognitive performance and determined whether dyadic pairing of mindfulness influences patient outcomes.

METHODS

Individuals (N = 291) underwent comprehensive evaluations, with baseline mindfulness assessed using the 15-item Applied Mindfulness Process Scale (AMPS). Correlation, regression, and mediation models tested relationships between patient and caregiver mindfulness and outcomes.

RESULTS

Patients had a mean AMPS score of 38.0±11.9 and caregivers had a mean AMPS score of 38.9±11.5. Patient mindfulness correlated with activities of daily living, behavior and mood, health-related quality of life, subjective cognitive complaints, and performance on episodic memory and attention tasks. Caregiver mindfulness correlated with preparedness, care confidence, depression, and better patient cognitive performance. Patients in dyads with higher mindfulness had better cognitive performance, less subjective complaints, and higher health-related quality of life (all p-values<0.001). Mindfulness effects on cognition were mediated by physical activity, social engagement, frailty, and vascular risk factors.

CONCLUSION

Higher baseline mindfulness was associated with better patient and caregiver outcomes, particularly when both patients and caregivers had high baseline mindfulness. Understanding the baseline influence of mindfulness on the completion of rating scales and neuropsychological test performance can help develop targeted interventions to improve well-being in patients and their caregivers.

The effects of acceptance and commitment therapy on the psychological and physical outcomes among cancer patients: A meta-analysis with trial sequential analysis

OBJECTIVE

The current study used meta-analysis and trial sequential analysis to estimate the effects of Acceptance and Commitment Therapy (ACT) on the psychological and physical distress of cancer patients, and to identify potential moderators in this body of research.

METHODS

A search of multiple databases in February 2020 identified 25 independent trials (17 randomized controlled trials, 8 non-randomized controlled trials; 2256 participants) on the effects of ACT among cancer patients. Trial sequential analysis (TSA) was used to determine whether the available evidence is sufficient to draw strong conclusions.

RESULTS

ACT significantly reduced cancer patients' psychological distress (g = 0.88), and improved psychological flexibility (g = 0.58), quality of life (g = 1.19), and sense of hope (g = 2.17). TSA showed that there was sufficient evidence to obtain stable estimates of the effect of ACT on psychological distress and quality of life. Effect sizes for psychological distress were larger in studies conducted in eastern countries, in younger samples, and when therapy was of longer duration.

CONCLUSION

Acceptance and Commitment Therapy can effectively improve the mental health of cancer patients, and can be applied to clinical practice as an effective psychological intervention. Researchers are encouraged to take into account stage and trajectory of cancer in future studies.

A randomized controlled trial on the comparative effectiveness of mindfulness-based cognitive therapy and health qigong-based cognitive therapy among Chinese people with depression and anxiety disorders

BACKGROUND

The goal of this study was to investigate treatment outcome and related intervention processes of mindfulness-based cognitive therapy versus health qigong-based cognitive therapy versus waitlist control among individuals with mood disorders.

METHODS

A total of 187 individuals with mood disorders were randomized and allocated into mindfulness-based cognitive therapy, health qigong-based cognitive therapy, or waitlist control groups. All participants were assessed at three time points with regard to depressive and anxiety symptoms, physical and mental health status, perceived stress, sleep quality, and self-efficacy. Linear mixed models analysis was used to test the individual growth model by studying the longitudinal data.

RESULTS

Mindfulness-based cognitive therapy and health qigong-based cognitive therapy both produced greater improvements on all outcome measures as compared with waitlist control. Relatively, more reductions of mood symptoms were observed in the health qigong-based cognitive therapy group as compared with the mindfulness-based cognitive therapy group. Health qigong-based cognitive therapy is more conducive to physical health status whereas mindfulness-based cognitive therapy has more favorable mental health outcomes. Individual growth curve models indicated that alterations in perceived stress was the common predictor of mood changes in both intervention groups.

CONCLUSIONS

The predominant emphasis on physical health in health qigong-based cognitive therapy makes it more acceptable and effective than mindfulness-based cognitive therapy as applied in Chinese individuals with mood disorders. The influence of Chinese culture is discussed.

TRIAL REGISTRATION

HKU Clinical Trials Registry. Identifier: HKUCTR-2558 . Registered 21st Nov 2018.

Meditation and Cardiovascular Health in the US

The 2017 American Heart Association Scientific Statement on meditation and cardiovascular risk suggested that meditation may be considered as an adjunct to guideline-directed cardiovascular risk-reduction interventions. Meditation could potentially increase physical and mental relaxation, leading to improved outcomes after a major cardiovascular event. We hypothesized that meditation is associated with lower cardiovascular risk in the US general population. Using data from the 2012 and 2017 National Health Interview Survey, we identified all patients with hypercholesterolemia, systemic hypertension (SH), diabetes mellitus (DM), stroke, and coronary artery disease (CAD), as well as those who reported that they meditate. Multivariable logistic regression analyses were performed to evaluate the association between meditation and risk of hypercholesterolemia, SH, DM, stroke, and CAD, adjusting for potential confounders. Of 61,267 the National Health Interview Survey participants, 5,851 (9.6%) participated in some form of meditation. After adjusting for age, gender, body mass index, race, marital status, cigarette smoking, sleeping duration, and depression, meditation was independently associated with a lower prevalence of hypercholesterolemia (odds ratio [OR] 0.65; 95% confidence interval [CI] 0.54 to 0.79; p = 0.001), SH (OR 0.86; 95% CI 0.75 to 0.99; p = 0.04), diabetes (OR 0.70; 95% CI 0.59 to 0.84; p = 0.0001), stroke (OR 0.76; 95% CI 0.58 to 0.99; p = 0.04), or CAD (OR 0.51; 95% CI 0.39 to 0.66; p <0.001), compared with those who did not meditate. In conclusion, using a large national database, we found that meditation is associated with a lower prevalence of cardiovascular risks factors and disease.

An analysis on self-management and treatment-related functionality and characteristics of highly rated anxiety apps

BACKGROUND AND OBJECTIVE

Anxiety is a common emotion that people often feel in certain situations. But when the feeling of anxiety is persistent and interferes with a person's day to day life then this may likely be an anxiety disorder. Anxiety disorders are a common issue worldwide and can fall under general anxiety, panic attacks, and social anxiety among others. They can be disabling and can impact all aspects of an individual's life, including work, education, and personal relationships. It is important that people with anxiety receive appropriate care, which in some cases may prove difficult due to mental health care delivery barriers such as cost, stigma, or distance from mental health services. A potential solution to this could be mobile mental health applications. These can serve as effective and promising tools to assist in the management of anxiety and to overcome some of the aforementioned barriers. The objective of this study is to provide an analysis of treatment and management-related functionality and characteristics of high-rated mobile applications (apps) for anxiety, which are available for Android and iOS systems.

METHOD

A broad search was performed in the Google Play Store and App Store following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) protocol to identify existing apps for anxiety. A set of free and highly rated apps for anxiety were identified and the selected apps were then installed and analyzed according to a predefined data extraction strategy.

RESULTS

A total of 167 anxiety apps were selected (123 Android apps and 44 iOS apps). Besides anxiety, the selected apps addressed several health issues including stress, depression, sleep issues, and eating disorders. The apps adopted various treatment and management approaches such as meditation, breathing exercises, mindfulness and cognitive behavioral therapy. Results also showed that 51% of the selected apps used various gamification features to motivate users to keep using them, 32% provided social features including chat, communication with others and links to sources of help; 46% offered offline availability; and only 19% reported involvement of mental health professionals in their design.

CONCLUSIONS

Anxiety apps incorporate various mental health care management methods and approaches. Apps can serve as promising tools to assist large numbers of people suffering from general anxiety or from anxiety disorders, anytime, anywhere, and particularly in the current COVID-19 pandemic.

Yoga as a Therapy for Irritable Bowel Syndrome

The aim of this state-of-the-art narrative review is to evaluate the current evidence about the effectiveness of yoga as therapy for IBS and explore its potential mechanisms of action. The current literature suggests yoga is effective and safe and may target multiple mechanisms involved in treatment of IBS. Evidence from randomized controlled trials identified yoga as more effective compared to pharmacological treatment and equally effective as dietary interventions or moderate-intensity walking. Improvements were seen in both physical health (IBS symptom severity, gastric motility, autonomic and somatic symptom scores, and physical functioning) and mental health outcomes (depression, anxiety, gastrointestinal-specific anxiety, and quality of life). Given favorable changes in IBS-related physical and mental health outcomes, preliminary data supports yoga as beneficial in this population. However, the relatively low-quality evidence resulting from heterogeneity of study designs, interventions, and outcome measures limit our ability to make specific recommendations about the use of yoga as therapy for patients with IBS.

A Cross-Sectional Evaluation of Complementary and Alternative Medicine Use in a Non-urban Malaysian Population

Complementary and alternative medicine (CAM) therapies have been an integral part of Malaysia culture for many centuries. In recent years influences from other parts of the world have gained a foot-hold in Malaysian popular culture. We investigated the engagement with CAM in a non-urban, Malaysian population. We investigated the association of CAM use with cultural influence, perceived health status, gender and age. We recruited 700 adult participants to this study across three sites in central Malaysia. We found massage, Vitamin supplements, Herbal medicine and traditional Chinese medicine to be the most popular CAM modalities with participation at 67.7%, 55.7%, 55.5% and 26.3% respectively. CAM use was equally high at 67% among those people who claimed a predominantly Malay or Chinese cultural influence. The use of vitamins and participation in yoga were at higher prevalence among female participants compared to males. There was no gender difference for other CAM modalities. There were differences between age groups for most CAM modalities, and those over 50 years tended to be the highest frequency users for most modalities. There is a high rate of CAM use in non-urban Malaysia with younger people being more engaged with less traditional modalities such as aromatherapy, yoga and music therapy.

The Effectiveness of Mindfulness-Based Interventions on Anxiety Disorders. A Systematic Meta-Review

OBJECTIVE

There has been a growing interest in the study of the effectiveness of mindfulness-based interventions (MBIs). Many clinical trials and experimental designs have been implemented, with different samples and diverse MBI procedures. Reviews have shown unclear results, apart from a tendency to identify low-to-moderate effectiveness. The purpose of this review is to examine the effectiveness of MBIs on anxiety complaints, analyzing available systematic reviews and meta-analyses.

METHOD

The literature search was done in MEDLINE (PubMed) and PsycINFO, from the first available review in 2003 until March 2020. From 82 initial references, 12 reviews were selected.

RESULTS

Reviews confirmed a moderate effect size of MBIs in improving anxiety symptoms. This efficacy was similar to that of well-established therapies for reducing anxiety symptoms, such as cognitive behavioral therapies. A large effect size was found when well-developed MBI protocols were applied.

DISCUSSION

More refined clinical trials are needed to establish clear conditions of MBI effectiveness (protocols, samples, psychological mechanisms, etc.). In addition, considering mindfulness processes, new outcome measures are needed (such as acceptance, self-awareness, or well-being) to test the incremental value of MBIs.

Retracted: Exploring the microbiome and mindfulness connection

Mental health and its impact on overall well-being is a topic that is at the forefront of consideration in most industrialized countries. Ironically in the expansive world of the microbiome, gut microbes are most affected by modern, fast paced, westernized lifestyles, indicating a significant correlation based on geography, and physical and mental habits. The gut–brain axis is an established axis demonstrating the effect of the gut microbiota on the biochemical processes in the brain. With the existence of mindfulness initiatives such as adoption of a ‘yogic lifestyle’ aimed at creating a sense of harmony and balance within the individual, this special report considers the available evidence base, asking whether the harmony created by adopting this lifestyle can be related to establishing harmony in the gut–brain axis.

In current times, mental health has been given much significance for the overall health of the individual. The microbiome provides a new gateway to approach mental health through the gut via the established gut–brain axis. This opinion article explores the current evidence establishing the strong gut–brain connection. We discuss the impact of lifestyle, yoga and mindfulness in balancing and creating mental health based on this data.