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

The Prevalence and Factors of Dyspnea Among Advanced Cancer Survivors: A Systematic Review and Meta-analysis

BACKGROUND

Dyspnea is a significant symptom in advanced cancer patients, yet comprehensive evidence on its prevalence and related factors is lacking.

OBJECTIVE

This review aims to summarize the prevalence of dyspnea among advanced cancer survivors and identify associated factors.

METHODS

MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL Plus, and Web of Science were searched from inception to May 2024. Observational studies focusing on advanced cancer patients reporting dyspnea were included. Two reviewers performed data extraction and quality assessment independently using the Newcastle-Ottawa Scale. Prevalence estimates were pooled using a random-effects model. Subgroup analyses and metaregression were performed to explore heterogeneity.

RESULTS

A total of 67 studies involving 78 409 advanced cancer survivors were included, revealing a pooled prevalence of dyspnea of 43% (95% prediction interval, 0.07, 0.84). Significant variations were observed based on cancer types, with lung cancer showing a prevalence of 55%. Factors associated with dyspnea were categorized using the Breathing, Thinking, Functioning clinical model: (1) breathing: physical (eg, fatigue), medical (eg, lung disease), and treatment-related (eg, palliative sedation) factors; (2) thinking: psychological (eg, anxiety) factors; and (3) functioning: performance (eg, Karnofsky Performance Status) and demographic characteristics (eg, age).

CONCLUSIONS

The findings highlight a high prevalence of dyspnea among advanced cancer survivors and identify several associated factors, stressing the need for early detection and comprehensive management strategies.

IMPLICATIONS FOR PRACTICE

Health providers can improve the quality of life for patients by effectively managing dyspnea, thereby reducing symptom burden, and alleviating psychological distress, leading to better overall well-being for patients and caregivers.

The use of immersive virtual reality for managing physical and psychological distress in children and adolescents with cancer undergoing chemotherapy via implanted vascular access device needle insertion: A systematic review

PURPOSE

Children and adolescents undergoing cancer treatment often endure distressing procedures, leading to pain and anxiety. Immersive virtual reality (VR) is a novel distraction technique for distress management, but research in pediatric oncology remains limited. This systematic review aims to assess the effectiveness of IVR intervention utilizing advanced head-mounted displays, in alleviating physical and psychological distress among Children and Adolescents diagnosed with malignancies undergoing chemotherapy treatment via Implantable Venous Access Device/Port (IVAD/P) (P) needle insertion. Additionally, the study evaluates the usability and acceptability of the IVR intervention among healthcare professionals, patients, and their parents.

METHOD

A thorough database search (PubMed, Medline, Embase, CINHAL, and APA Psycinfo) identified seven relevant quantitative studies published until April 2024.

RESULTS

In five studies, VR significantly reduced physical distress, especially pain, though the other two showed positive trends without statistical significance. For psychological distress, two studies reported significantly lower levels in the VR group, while three showed promising but statistically insignificant results. Children and adolescents, as well as healthcare professionals, found VR user-friendly and expressed willingness to use it again.

CONCLUSIONS

The review suggests that immersive VR has significant potential as a distraction method for children and adolescents undergoing CMT via IVAD/P. It shows promise in reducing physical and psychological distress and is well-received by patients and healthcare professionals.

Cross-Lagged Panel Networks of Sleep Inertia Across Its Distinct Change Patterns Among Intern Nurses with Shift Work in China

Purpose

Although experimental psychopathology using PET, EEG, and fMRI is at the forefront of understanding the underlying mechanisms of sleep inertia, many questions concerning causality remain unanswerable due to ethical constraints and the use of small and heterogeneous samples in experimental methods. There is a pressing need for a novel perspective in a large and relatively homogeneous population to fully capture and elucidate longitudinal processes and dynamic causality that culminate in episodes of sleep inertia over time. Therefore, this study aimed to reveal the causal relationships between symptoms of sleep inertia across its distinct patterns.

Patients and Methods

A total of 1636 intern nurses participated in the first survey (94.1% validity rate), then 1277 intern nurses were followed up (82.9% tracing rate). Symptoms of sleep inertia were self-reported using the Sleep Inertia Questionnaire. The cross-lagged panel network models were used to examine unique longitudinal relationships between symptoms of sleep inertia across distinct trajectories.

Results

Four distinct trajectories of sleep inertia were established. Additionally, we found differences in those symptoms with the highest influence on other symptoms at the subsequent point across the networks of four trajectories, particularly, "Difficulty in concentrating" in the persistent-high group and "Feeling tense" in the deteriorating groups.

Conclusion

The current study highlights changes in sleep inertia based on the long-term course over time. Notably, symptoms of "Difficulty in concentrating" and "Feeling tense" are imperative to address these specific symptoms within subpopulations.

Effect of mHealth-based relaxation program on stress coping and anxiety levels in mothers of children with cancer: A randomized controlled study

OBJECTIVE

This study aimed to explore the effects of a mHealth-based relaxation program on anxiety and stress coping levels in mothers of children with cancer.

METHODS

This randomized controlled, single-blind, parallel-group trial was conducted in the pediatric hematology-oncology unit of a university hospital. The study was completed by 50 mothers (intervention group: n = 25; control group: n = 25). The mothers in the intervention group participated in a mHealth-based relaxation program for eight weeks (including progressive muscle relaxation, guided imagery, and the four-leaf clover of mindfulness). Videos of the relaxation program were sent to mothers' WhatsApp accounts. The mothers in the control group received routine care. The State-Trait Anxiety and Stress Coping Scales were administered during the first and eighth weeks. The registration number of this study on ClinicalTrials.gov is NCT05807295.

RESULTS

Mothers who participated in the relaxation program had lower anxiety levels and higher stress-coping scores than those in the control group (p < 0.05).

CONCLUSION

Progressive muscle relaxation exercises, guided imagery, and cognitive-based therapeutic approaches were effective in reducing mothers' anxiety and stress coping.

PRACTICE IMPLICATIONS

Pediatric oncology nurses can apply mHealth-based relaxation programs to support caregivers, particularly mothers. In this way, ensuring the continuity and integrity of care is easy.

Unravelling the role of mind-body therapies in paediatric palliative care: A narrative review

AIM

Given the multifaceted nature of paediatric palliative care (PPC), integrative medicine and mind-body therapies, in particular, are increasingly used in this setting. However, to our knowledge, their use in PPC has never been specifically reviewed. Therefore, this work aims to provide a comprehensive overview of the application and possible beneficial effects of mind-body therapies in the PPC setting.

METHODS

Papers about the use of meditation and mindfulness, biofeedback, hypnosis, yoga, tai chi and qi gong, imagery, creative outlets, and art therapy in PPC were identified by browsing PubMed and CINHAL.

RESULTS

We found that the harmless nature of mind-body therapies has been extensively described, and available studies consistently show some benefits on the anxiety, stress, and quality of life of parents/caregivers and healthcare providers. However, well-grounded and robust evidence does not fully support the efficacy of mind-body therapies, especially in patients.

CONCLUSION

Considering the peculiarity of the PPC setting, we suggest that mind-body therapies should be further considered and properly investigated through larger controlled studies and according to the different populations of PPC children, as well as for parents, caregivers, and healthcare professionals.

Combined mind-body intervention for premenstrual dysphoric disorder: A randomized controlled trial

In this study, we aimed to examine the effectiveness of relaxation training in women with PMDD through a randomized controlled design. Sixty-three women were recruited and randomized to relaxation training or control groups. The outcome measurements, administered at baseline and post-training, included the Premenstrual Symptoms Screening Tool (PSST), Hospital Anxiety and Depression Scale (HADS), Nottingham Health Profile (NHP), and Sheehan Disability Scale (SDS). The intervention group received 12 sessions of relaxation training, including progressive muscle relaxation and guided imagination. While there were significant differences within the group in the relaxation training group, no significant differences were found in the control group. Relaxation training had a positive effect on reducing premenstrual symptoms, anxiety, depression and disability and improving quality of life in women with PMDD. More research is necessary to recommend relaxation training as a primary and long-term treatment and to understand how it should be included in a comprehensive treatment plan.

Efficacy of Progressive Muscle Relaxation in Adults for Stress, Anxiety, and Depression: A Systematic Review

Background

The rise in the prevalence of mental health problems among adults worldwide has raised concerns, highlighting the critical need for evidence-based mental health interventions that are accessible, comprehensive, and effective. Previous research suggests that Progressive Muscle Relaxation (PMR) is a promising intervention widely used to reduce mental health problems. Nevertheless, the current literature on the efficacy of PMR among adults globally is fragmented, indicating a potential gap in this research area. Hence, this paper aims to systematically compile the research evidence on the efficacy of PMR in adults for stress, anxiety, and depression.

Methods

The Scopus, Web of Sciences, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials were searched from the earliest available evidence to 28th March 2023. The PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analyses) guidelines were followed, and the protocol was registered on the Open Science Framework. Joanna Briggs Institute (JBI) Critical Appraisal Tools were used to assess the quality of the included studies.

Results

A total of forty-six (46) publications from sixteen (16) countries covering more than 3402 adults were included in the review. The results show that PMR are effective in reducing stress, anxiety, and depression in adults. When PMR is combined with other interventions, the combined techniques have also consistently exhibited enhanced efficacy. Moreover, findings also indicate that the efficacy of PMR is heightened when implemented in conjunction with other interventions, surpassing its standalone efficacy.

Funding and Registration

This research was supported/funded by the Ministry of Higher Education (MoHE) under the Fundamental Research Grant Scheme (FRGS) (FRGS/1/2020/SS0/UTM/02/23). The review was registered on Open Science Framework (OSF) on the 7th of March 2023; DOI: https://doi.org/10.17605/OSF.IO/U2HZP.

The Effect of Online-Delivered Guided Imagery Relaxation on Stress and Well-Being of Primary School Children

Background

In the context of the coronavirus (COVID-19) pandemic, effectively coping with daily stressors is crucial for children who experience restrictions on physical movement and social activities. We examined the effects of the online-delivered guided imagery relaxation (GIR) technique on the stress and well-being of primary school children.

Methods

Thirty-four (N = 34) 11-year-old students were randomly assigned to either intervention (n = 17) or waitlist-control (n = 17) groups. The participants from the intervention group were required to attend a 4-week online GIR session and practice the techniques daily for 5 min-10 min. The Stress in Children (SiC) questionnaire, the Strengths and Difficulties Questionnaire-Parent Reported (SDQ-PR) and tracking form were administered pre- and post-intervention.

Results

Eleven (64.7%) participants attended all sessions and eight (47.0%) completed daily practices. Mixed-model ANOVA indicated no significant difference between participants from intervention and waitlist-control groups across pre- and post-intervention time points, with P-values greater than 0.05 for stress and well-being.

Conclusion

Issues regarding online intervention, including managing children's activities from a distance, Internet connectivity, and time limitations might have affected their adherence and the research outcome. Nonetheless, the online-delivered GIR technique is a promising intervention modality. However, its implementation should be improvised to be more impactful.

Comparative Efficacy of Mitchell's and Benson's Relaxation Techniques in Alleviating Pain and Improving Quality of Life Among Patients With Premenstrual Syndrome: A Randomized Controlled Trial

Background Most women of reproductive age suffer physical discomfort or distress in the weeks before menstruation. Even though symptoms are typically not severe enough to impede daily activities seriously, they occasionally can. Physical problems like breast discomfort and bloating can also be a problem. The most irritating symptoms are those that affect mood and behaviour. Women of reproductive age experience premenstrual syndrome frequently, necessitating study into non-pharmacological methods for symptom reduction. Methodology The objective of the study was to evaluate and compare the clinical efficacy of Benson's relaxation technique to Laura Mitchell's physiological approach in patients with premenstrual syndrome. Study design was comparative parallel experimental study with patient-reported questionnaire data (online) collected before and post-intervention in tertiary hospital setting. Participants were 70 adult females aged 18 to 35 with premenstrual syndrome. Patients were administered Benson's relaxation technique once a day for a month versus Mitchell's relaxation technique once a day for a month. Both techniques were first taught for one session followed by home program to be performed by patients. The premenstrual syndrome questionnaire and a numerical pain rating scale were used to quantify premenstrual symptoms pre and post-intervention. Results The result revealed significant (p<0.01) improvement in premenstrual symptoms in both groups following the intervention. However, Bensons' relaxation technique was found to be more significant while alleviating the premenstrual symptoms. Conclusions When it comes to lowering the intensity of premenstrual syndrome in young people, Benson's relaxation method is superior to Mitchell's. Both approaches should be entrenched as a regular practice and can be employed on patients to improve their menstrual well-being.

Adding Structured Components to Home Visitation to Reduce Mothers' Risk for Child Maltreatment: a Randomized Controlled Trial

Purpose

Home visitation program effects are generally small, which may be caused by flexible intervention content leading to inconsistent outcomes. In this study we therefore examined whether the effectiveness of a Dutch home visitation program (i.e., Supportive Parenting) can be improved by adding structured intervention components targeting key risk factors for child maltreatment: parental sense of competence, perceived stress, parental anger, and PTSD symptoms.

Method

Participants were randomly assigned to an experimental group (n = 74) that received four additional intervention components in two home visits, or a control group (n = 60) that received regular Supportive Parenting. Outcomes were assessed before (T1) and after (T2) the first, and before (T3) and after (T4) the second home visit. Effects were examined using ANCOVA for primary outcomes: parental sense of competence, perceived stress, parental anger, and PTSD symptoms, and secondary outcomes: risk of child maltreatment, parental warmth, and negative parenting. Moderation effects were examined for T1 scores, child temperament and life events.

Results

Mothers who received the intervention components showed less stress compared to the control group at T3 and T4. There were no differences between groups on other outcomes and no moderation effects, although parental sense of competence reduced and anger increased within the experimental group specifically.

Conclusion

The structured components may enhance the effectiveness of Supportive Parenting to reduce parenting stress. Future research into how other outcomes can be improved is needed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10896-023-00509-7.

Effects of guided imagery relaxation in hematopoietic stem-cell transplantation patients: a quasi-experimental study

OBJECTIVE

To analyze the effects of the technique of virtual reality guided imagery in the vital signs of hematopoietic stem-cell transplantation patients.

METHOD

Quasi-experimental study with 35 participants who received an intervention using virtual reality guided imagery with progressive muscle relaxation, applied three times a week for four weeks in a referral hospital for transplants in the south of Brazil. Data collected included: temperature, arterial pressure, respiratory rate, heart rate, pain, and oxygen saturation, before and after each intervention. The comparisons were analyzed using Wilcoxon's test.

RESULTS

There was a clinical significance between the mean measurements before and after for respiratory rate (p=0.00) in all stages, and for the variables Heart rate, Temperature, and Oxygen saturation from the 1st to the 12th measurements (p=0.05).

CONCLUSION

The intervention was low cost, easy to apply, and showed positive effects, presenting itself as an option for patient-focused care.

Fatigue, stigma, and mood in patients with multiple sclerosis: effectiveness of guided imagery

BACKGROUND AND OBJECTIVES

The present study aimed to assess the effectiveness of guided imagery on fatigue, stigma, and mood in patients with multiple sclerosis.

METHODS

This clinical trial is a double-blind study that was conducted on 60 patients with multiple sclerosis referred to the largest center for special diseases in the southeast of Iran in 2020. The convenience sampling method was used to select the participants who were later divided into two groups of intervention (n = 30) and control (n = 30) using block randomization method. The intervention group listened to the guided imagery audio file at home for 25 min. The control group did not receive any intervention. Data were collected by demographic information questionnaires, Fatigue Severity Scale (FSS), Reece Stigma Scale for Multiple Sclerosis (RSS-MS), and the Profile of Mood States (POMS) before and one month after the intervention.

RESULTS

According to the results, there was no significant difference between the two groups before the intervention in terms of the score of fatigue (P < 0.0 = 67), stigma (P < 0.64), and mood (P < 0.17). However, after the intervention, a significant differences was observed in this regard (P < 0.0001). In the intervention group, the mean score of fatigue decreased from 59.72 ± 18.32 to 35.8 ± 16.15, and the mean score of stigma decreased from 17.31 ± 15.62 to 5.09 ± 8.06, showing a significant reduction in the levels of fatigue (P < 0.0001) and stigma (P < 0.0001) compared to before intervention. Also, the mean score of mood decreased from 36.90 ± 12.21 to 28.55 ± 11.87, indicating an improvement in the mood of samples in the intervention group (P < 0.0001).

CONCLUSIONS

The results indicated that guided imagery, as a cost-effective method, can decrease the fatigue and stigma, and enhance the mood of patients with MS. Therefore, nursing staff can use this method to improve MS patients' mood and decrease their fatigue and stigma.

Efeito do relaxamento com imagem guiada em transplantados de células-tronco hematopoéticas: estudo quase experimental

RESUMO Objetivo: Analisar os efeitos da técnica de imagem guiada por realidade virtual nos sinais vitais de transplantados de células-tronco hematopoéticas. Método: Estudo quase experimental com 35 participantes que receberam intervenção de imagem guiada por realidade virtual com relaxamento muscular progressivo, aplicada três vezes por semana durante quatro semanas, em um hospital de referência em transplante no Sul do Brasil. Os dados coletados foram: temperatura, pressão arterial, respiração, frequência cardíaca, dor e saturação de oxigênio, antes e depois de cada intervenção. As comparações foram analisadas pelo teste de Wilcoxon. Resultados: Houve significância clínica entre as médias das aferições de antes e depois para Frequência respiratória (p=0,00) em todas as etapas; e nas variáveis Frequência cardíaca, Temperatura e Saturação de oxigênio, entre a 1ª até 12ª avaliação (p=0,05). Conclusão: Os efeitos da intervenção se mostraram favoráveis, de baixo custo e fácil realização, sendo uma opção de ação de cuidado centrado no paciente.

Effect of Relaxation Therapy on Pre-Induction Blood Pressure and Anxiety in Hypertensive Patients

Background:

Anxiety associated with surgical stress can lead to high blood pressure (BP), which may end up with undue last minute cancellation of surgery. Relaxation therapy is now being widely used as a complementary therapy for stress and high BP. We conducted a randomized controlled study to compare the effect of relaxation therapy on pre-induction anxiety and BP in hypertensive patients.

Materials and Methods:

A randomized controlled study was conducted on hypertensive patients undergoing elective surgery. They were allocated into two groups (relaxation therapy and control) using simple randomization with allocation concealment. The relaxation therapy group received intervention by an audio clip an evening prior and 30 min before the scheduled surgery. Their anxiety score on numerical rating scale (0–10) and BP was recorded before and after each intervention. The control group received standard care only. Pre-induction BP and anxiety score were recorded in both groups. The outcome measures were difference in pre-induction anxiety and BP between relaxation and control groups and difference in pre- and post-relaxation anxiety and BP.

Results:

Out of 70 patients, 30 received relaxation therapy and 34 received standard pre-operative care. There was a significant reduction in BP and anxiety after relaxation therapy in the intervention group (P < 0.0001). The relaxation therapy group showed significantly lower pre-induction systolic BP (138.93 vs. 156.59, P < 0.0001) and anxiety score (2.5 vs. 5.5, P < 0.0001) than the control group. Requirement of anxiolytic drug was less in the relaxation therapy group.

Conclusion:

Relaxation therapy significantly reduces pre-induction BP and anxiety.

A systematic review and meta-analytic evaluation of psychosocial interventions in parents of children with cancer with an exploratory focus on minority outcomes

Parents of children with cancer are prone to psychosocial distress, yet little is known about intervention response among diverse parents. Our systematic review and meta-analysis evaluated the efficacy of psychosocial interventions on anxiety and depression among parents of children with cancer and explored race and/or ethnicity differences in the efficacy of these interventions. Twenty articles met inclusion. The aggregate effect size on anxiety (-0.01, 95% CI: -0.95, 0.93, p = .97) and depression (-0.56, 95% CI: -1.65, 0.54, p = .32) showed micro to medium effects, with larger negative effect sizes indicating that anxiety and depression scores after treatment were lower for parents in intervention group as compared to control group. Neither aggregate effect size was statistically significantly different from zero. Due to underrepresentation of minorities, we could not perform subgroup or moderator analyses. Several efficacious psychosocial interventions were found to reduce parental anxiety. Future studies to examine psychosocial interventions in minority parents are warranted.

Effectiveness of autogenic relaxation training in addition to usual physiotherapy on emotional state and functional independence of stroke survivors

INTRODUCTION

The occurrence of post-stroke emotional problems is significant during the early post-stroke stage and affects the recovery of functionality among the survivors. Because stroke survivors require active engagement in rehabilitation to optimize the process of neuroplasticity in the initial stage of stroke, there is a need to integrate an intervention, preferably therapists-mediated during rehabilitation, which reduce emotional problems thus improve motivation level among the survivors. One such technique is autogenic relaxation training (ART). ART has been found to reduce anxiety and depression among patients with several medical conditions. However, its usage in stroke survivors during rehabilitation has been limited to date. Therefore, this study is intended to evaluate the effectiveness of ART in addition to usual physiotherapy in improving emotional state and functional level of stroke survivors during rehabilitation.

METHODS

This is an assessor blinded randomized controlled trial comparing 2 intervention approaches namely ART-added physiotherapy (experimental group) and usual physiotherapy (control group). A total of 70 post-stroke patients will be recruited and allocated into either the ART-added physiotherapy or the usual physiotherapy group. The ART-added physiotherapy group will undergo a 20-minute ART session followed by 40 minutes of usual physiotherapy. While the usual physiotherapy group will receive usual physiotherapy alone for 60 minutes. All participants will be treated once a week and are required to carry out a set of home exercises for 2 times per week during the 12-week intervention. Assessment of emotional status and functional independence will be carried out at pre-intervention and week 13 of the intervention with the use of Hospital anxiety and depression scale, Barthel index, and EuroQol-5 dimensions-5 levels. All data will be analyzed using descriptive and inferential statistics.

DISCUSSION

The expected main study outcome is an enhanced evidence-based physiotherapy program that may be used by physiotherapists in the rehabilitation of stroke patients with emotional disturbances.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ACTRN12619001664134 (last updated on 28/11/2019).

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.

The Feasibility and Efficacy of Self-help Relaxation Exercise in Symptom Distress in Patients With Adult Acute Leukemia: A Pilot Randomized Controlled Trial

AIMS

To examine the feasibility and efficacy of self-help relaxation exercises in alleviating symptom distress in adult patients with acute leukemia (AL).

METHODS

A pilot randomized controlled trial was used. Thirty adult patients with AL who were hospitalized in a teaching hospital were enrolled and randomly divided into a wait-list control group or an intervention group. The intervention group received self-help relaxation exercise twice per day for 4 weeks. The feasibility indicators, patients' symptom distress were assessed by a blinded data collector.

RESULTS

Twenty-nine patients completed the study. The recruitment rate, retention rate, and adherence rate was 65.2%, 93.3%, and 98.2%, respectively. The intervention group had a significantly decreased distress score for pain symptoms (F_{1, 27} = 6.594, P = .016, the partial η² = 0.20, 90% confidence interval = 0.02-0.39).

CONCLUSIONS

Self-help relaxation exercises were feasible for the AL patients and significantly reduced their pain symptoms. Minor revision of the protocol for future definitive trials is needed.

Stress Reduction Techniques for Health Care Providers Dealing With Severe Coronavirus Infections (SARS, MERS, and COVID-19): A Rapid Review

OBJECTIVE

A rapid review was conducted to identify the most effective stress reduction techniques for health care providers dealing with patients infected with severe coronavirus (SARS, MERS, and COVID-19).

METHODS

PubMed, PsychInfo, Embase, and CINAHL databases were searched to identify relevant studies. Searches were restricted by date (2000 until present). All empirical quantitative and qualitative studies in which relaxation techniques of various types implemented on health care providers caring for patients during severe coronavirus pandemics and articles that consider the implementation of mental health care services considered to be pertinent, such as commentaries, were included.

RESULTS

Fourteen studies met the selection criteria, most of which were recommendations. Only one study described a digital intervention, and user satisfaction was measured. In the recommendations, both organizational and individual self-care interventions were suggested.

CONCLUSIONS

Further research is necessary to establish tailor-made effective stress reduction interventions for this population, during these challenging and particular times.

A review of psychosocial interventions targeting families of children with cancer

Objective

Psychosocial interventions in families of children with cancer are considered an effective way of empowering family members to tackle the complex hurdles they face. The ability of parents to develop adaptive coping strategies during the child's treatment is not only important to their own mental and physical health, but also to their child's well-being and long-term adjustment with the disease.

Methods

The aim of this review was to evaluate the existing literature for the period from 2009 to 2017 on psychosocial interventions targeting families of children with cancer. We searched the PubMed database using the following combination of keywords: “cancer AND children AND (intervention OR training) AND (mothers OR primary caregivers OR parents OR fathers OR siblings).”

Results

After careful evaluation of 995 papers, 17 full-text papers were found to match our criteria (12 randomized controlled trials and 5 quasi-experimental studies). The quality of the studies was assessed using the Delphi score questionnaire, and the score of the reviewed studies ranged from 3 to 5. The findings suggest that most interventions reduced distress and improved coping strategies among participants. Interventions, mainly cognitive behavioral therapy and problem-solving skills training targeting maternal distress, were associated with improved adjustment outcomes in mothers of children with cancer.

Significance of results

Psychosocial interventions are helpful, and efforts should be made to promote them in a larger scale. Protocols should be implemented to ensure that all parents benefit. Computer-assisted methods may provide additional benefit by improving cancer-related knowledge and cancer-related communication.

Family Support System as an Effort to Optimize Coping Mechanism of Preschool Children During Hospitalization

Introduction: The condition of the child during hospitalisation can experience stress due to environmental changes. Child coping mechanism is very supportive of the adaptation process. The purpose of this study was to analyze the effect of family support system on coping mechanisms during hospitalisation. Methods: It was quasi-experimental with pre-test post-test with control group design. The study population was preschool children who were treated in the Hospital of Bangkalan, East Java Province, Indonesia. Total sample was 60 respondents in treatment and control group and obtained consecutive sampling. The variables were family support system and coping mechanism. Data collection used Children’s Coping Behavior questionnaire and tested by paired t-test. Results: The treatment group showed the coping mechanism was mostly maladaptive (mean=34.07) and after the intervention most of them had adaptive coping (mean=46.87). Whereas in the control group before the intervention, the coping mechanism was mostly maladaptive (mean=36.22) and after the intervention most of the coping groups had maladaptive coping (mean=36.74). Conclusion: Family support systems play an important role in improving the adaptive coping of preschool children during hospitalisation. Nurses should maximise family support as a strategy in interacting with children to enhance coping mechanisms to reduce the stress of hospitalisation.

Progressive Muscle Relaxation and guided imagery as techniques to enhance the way of coping of parents of children with malignancies: Findings from a randomized controlled trial

PURPOSE

The aim of this study was to test the effectiveness of relaxation techniques in altering the coping strategies that were employed by the parents of children with malignancy on active treatment.

METHODS

It was a randomized non-blinded controlled trial, including pre - and post assessments, comparing a 3-week relaxation intervention with the standard psychological care. Participants were recruited consecutively from two Public Pediatric Oncology - Hematology Departments in Cyprus and Greece. Fifty four parents of children hospitalized with a malignancy, were randomly assigned either to the intervention group (n = 29), receiving the Progressive Muscle Relaxation (PMR) and Guided Imagery (GI) Relaxation Techniques or to the control group (n = 25) receiving only the Standard Psychological Care by nurses and psychologists. Data were collected with the Questionnaire of 'Ways of Coping Checklist' (WofCC).

RESULTS

The results showed that the intervention did not have an impact on the coping strategies that parents employed as these are reflected on the WofCC' factors. The results showed that parents in both intervention and control group prefer using positive ways of coping in stressful situations: positive approach, positive re-evaluation and prayer/daydreaming.

CONCLUSIONS

The findings did not support the utilization of PMR and GI as coping strategies altering interventions in this clinical context. However, these findings should be interpreted in light of the short duration of the intervention that under these specific circumstances might have required a more lengthy approach for coping strategies to be altered. Furthermore, the stress relieving properties of these interventions could fortify (although not altering) existing coping strategies.

The effect of progressive muscle relaxation on anxiety and sleep quality in burn patients: A randomized clinical trial

BACKGROUND AND OBJECTIVES

Burn patients experience a high level of anxiety and poor sleep quality due to their special physical and psychological conditions. The present study aimed to investigate the effect of progressive muscle relaxation on anxiety and sleep quality in burn patients.

METHODOLOGY AND PARTICIPANTS

In this randomized controlled clinical trial, a total of 80 patients admitted to burn ward were enrolled using convenient sampling and randomly assigned to one of the experimental or control groups. In the experimental group, patients were intervened using Jacobson's relaxation technique 20-30min daily for three consecutive days. During this period, the control group received only routine care and treatment. Patients' anxiety and their sleep quality were measured and recorded before and after the intervention using the Spielberger State-Trait Anxiety Inventory (STAI) and St Mary's Hospital Sleep Quality Questionnaire (SMHSQ) respectively. Eventually, data analysis was conducted using SPSS version 20.0 software (IBM Corp., Armonk, N.Y., USA).

RESULTS

The findings of the present study showed a statistically significant decrease in anxiety and improvement in sleep quality in the experimental group compared to the control group (P<0.05).

CONCLUSION

Relaxation as a complementary method can be used along with modern medicine to reduce anxiety and improve sleep quality in burn patients.

Psychological interventions for parents of children and adolescents with chronic illness

BACKGROUND

Psychological therapies for parents of children and adolescents with chronic illness aim to improve parenting behavior and mental health, child functioning (behavior/disability, mental health, and medical symptoms), and family functioning.This is an updated version of the original Cochrane Review (2012) which was first updated in 2015.

OBJECTIVES

To evaluate the efficacy and adverse events of psychological therapies for parents of children and adolescents with a chronic illness.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsycINFO, and trials registries for studies published up to July 2018.

SELECTION CRITERIA

Included studies were randomized controlled trials (RCTs) of psychological interventions for parents of children and adolescents with a chronic illness. In this update we included studies with more than 20 participants per arm. In this update, we included interventions that combined psychological and pharmacological treatments. We included comparison groups that received either non-psychological treatment (e.g. psychoeducation), treatment as usual (e.g. standard medical care without added psychological therapy), or wait-list.

DATA COLLECTION AND ANALYSIS

We extracted study characteristics and outcomes post-treatment and at first available follow-up. Primary outcomes were parenting behavior and parent mental health. Secondary outcomes were child behavior/disability, child mental health, child medical symptoms, and family functioning. We pooled data using the standardized mean difference (SMD) and a random-effects model, and evaluated outcomes by medical condition and by therapy type. We assessed risk of bias per Cochrane guidance and quality of evidence using GRADE.

MAIN RESULTS

We added 21 new studies. We removed 23 studies from the previous update that no longer met our inclusion criteria. There are now 44 RCTs, including 4697 participants post-treatment. Studies included children with asthma (4), cancer (7), chronic pain (13), diabetes (15), inflammatory bowel disease (2), skin diseases (1), and traumatic brain injury (3). Therapy types included cognitive-behavioural therapy (CBT; 21), family therapy (4), motivational interviewing (3), multisystemic therapy (4), and problem-solving therapy (PST; 12). We rated risk of bias as low or unclear for most domains, except selective reporting bias, which we rated high for 19 studies due to incomplete outcome reporting. Evidence quality ranged from very low to moderate. We downgraded evidence due to high heterogeneity, imprecision, and publication bias.Evaluation of parent outcomes by medical conditionPsychological therapies may improve parenting behavior (e.g. maladaptive or solicitous behaviors; lower scores are better) in children with cancer post-treatment and follow-up (SMD -0.28, 95% confidence interval (CI) -0.43 to -0.13; participants = 664; studies = 3; SMD -0.21, 95% CI -0.37 to -0.05; participants = 625; studies = 3; I2 = 0%, respectively, low-quality evidence), chronic pain post-treatment and follow-up (SMD -0.29, 95% CI -0.47 to -0.10; participants = 755; studies = 6; SMD -0.35, 95% CI -0.50 to -0.20; participants = 678; studies = 5, respectively, moderate-quality evidence), diabetes post-treatment (SMD -1.39, 95% CI -2.41 to -0.38; participants = 338; studies = 5, very low-quality evidence), and traumatic brain injury post-treatment (SMD -0.74, 95% CI -1.25 to -0.22; participants = 254; studies = 3, very low-quality evidence). For the remaining analyses data were insufficient to evaluate the effect of treatment.Psychological therapies may improve parent mental health (e.g. depression, anxiety, lower scores are better) in children with cancer post-treatment and follow-up (SMD -0.21, 95% CI -0.35 to -0.08; participants = 836, studies = 6, high-quality evidence; SMD -0.23, 95% CI -0.39 to -0.08; participants = 667; studies = 4, moderate-quality evidence, respectively), and chronic pain post-treatment and follow-up (SMD -0.24, 95% CI -0.42 to -0.06; participants = 490; studies = 3; SMD -0.20, 95% CI -0.38 to -0.02; participants = 482; studies = 3, respectively, low-quality evidence). Parent mental health did not improve in studies of children with diabetes post-treatment (SMD -0.24, 95% CI -0.90 to 0.42; participants = 211; studies = 3, very low-quality evidence). For the remaining analyses, data were insufficient to evaluate the effect of treatment on parent mental health.Evaluation of parent outcomes by psychological therapy typeCBT may improve parenting behavior post-treatment (SMD -0.45, 95% CI -0.68 to -0.21; participants = 1040; studies = 9, low-quality evidence), and follow-up (SMD -0.26, 95% CI -0.42 to -0.11; participants = 743; studies = 6, moderate-quality evidence). We did not find evidence for a beneficial effect for CBT on parent mental health at post-treatment or follow-up (SMD -0.19, 95% CI -0.41 to 0.03; participants = 811; studies = 8; SMD -0.07, 95% CI -0.34 to 0.20; participants = 592; studies = 5; respectively, very low-quality evidence). PST may improve parenting behavior post-treatment and follow-up (SMD -0.39, 95% CI -0.64 to -0.13; participants = 947; studies = 7, low-quality evidence; SMD -0.54, 95% CI -0.94 to -0.14; participants = 852; studies = 6, very low-quality evidence, respectively), and parent mental health post-treatment and follow-up (SMD -0.30, 95% CI -0.45 to -0.15; participants = 891; studies = 6; SMD -0.21, 95% CI -0.35 to -0.07; participants = 800; studies = 5, respectively, moderate-quality evidence). For the remaining analyses, data were insufficient to evaluate the effect of treatment on parent outcomes.Adverse eventsWe could not evaluate treatment safety because most studies (32) did not report on whether adverse events occurred during the study period. In six studies, the authors reported that no adverse events occurred. The remaining six studies reported adverse events and none were attributed to psychological therapy. We rated the quality of evidence for adverse events as moderate.

AUTHORS' CONCLUSIONS

Psychological therapy may improve parenting behavior among parents of children with cancer, chronic pain, diabetes, and traumatic brain injury. We also found beneficial effects of psychological therapy may also improve parent mental health among parents of children with cancer and chronic pain. CBT and PST may improve parenting behavior. PST may also improve parent mental health. However, the quality of evidence is generally low and there are insufficient data to evaluate most outcomes. Our findings could change as new studies are conducted.

The Effect of Two Methods of Relaxation and Prayer Therapy on Anxiety and Hope in Patients with Coronary Artery Disease: A Quasi-Experimental Study

Background

Mental health problems such as anxiety and disappointment are common in patients with heart disease, resulting in poor outcomes. The purpose of this study was to compare the effectiveness of two methods of relaxation and prayer therapy on anxiety and hope in patients with coronary artery disease (CAD).

Materials and Methods

A quasi-experimental study was conducted in three groups of 25 subjects (i.e., two groups of relaxation and prayer therapy and one control group) and two stages (i.e., pretest and posttest) in hospitals affiliated to Isfahan University of Medical Sciences, Iran. Data collection instrument consisted of three parts: (a) demographic and individual characteristics of the subjects, (b) Beck Anxiety Inventory, and (c) Snyder's Hope Scale. The interventions consisted of Benson's relaxation and prayer therapy. Data were analyzed using descriptive and inferential statistics.

Results

The results showed that there was a significant difference between the mean score of anxiety after intervention in the three groups which was related to each of the relaxation and prayer therapy group with the control group. Also, the result of analysis of covariance with controlling the effect of pretest revealed significant between-subject effects of interventions on posttest scores of hope (F(2, 71) = 8.55, p = 0.012, ηp ² = 0.12) and anxiety (F(2, 71) = 4.71, p < 0.001, ηp ² = 0.19).

Conclusions

Both relaxation and prayer therapy interventions are effective in promoting hope and reducing anxiety in patients with CAD and provide optimal, short-term, and easy-to-follow options for the health team.

Reliability and first validity of the inner correspondence questionnaire for painting therapy (ICPTh) in a sample of breast cancer patients

Objectives Art therapy (ArT) such as mindfulness-oriented painting therapy is increasingly used in psychosomatic, oncological integrative and rehabilitative medicine. Though it remains unknown how ArT works, we hypothesize that an engaged participation with painting ('Inner-Correspondence') contributes to improved symptom scores. In the context of a comprehensive cohort study for breast cancer survivors with cancer-related fatigue, we developed a patient-reported outcome measure to assess 'Inner Correspondence' with painting therapy and conducted a first validation study. Design A 24-item questionnaire on 'Inner Correspondence' (ICPTh) was administered after ten weeks of intervention and at six month followup together with concurrent scales (Inner Correspondence and Peaceful Harmony, Cancer Fatigue Scale, Hospital Anxiety and Depression Scale, Internal Coherence Scale). Statistical assessment included reliability- and factor analyses. Results A total of n = 68 BC (mean age, 58.2 years, SD = 8.7) participated in the preliminary validation study. Exploratory factor analysis revealed a robust 22-item scale with an unambiguous four-factor solution explaining 78% of total variance and the following subsales: 1) therapy congruence and relaxation (11 items), 2) inner development and mood (6 items), 3) artistic skill (3 items) and 4) task congruence (2 items). The 22-item ICPTh yielded high reliability (Cronbach's alpha = .966, item-total correlation = .497 - .883, test-retest reliability = .888). Conclusions We present a reliable instrument to measure 'Inner Correspondence' with painting therapy. Due to the small sample size and sample selection further validation studies are indicated.

Effects of a Brief Hypnosis Relaxation Induction on Subjective Psychological States, Cardiac Vagal Activity, and Breathing Frequency

This study investigated the effects of a brief hypnosis including relaxation suggestions on physiological markers of relaxation, cardiac vagal activity, and breathing frequency. Forty participants were tested in a within-subjects design. Participants listened to a recorded hypnosis session and to a nonhypnotic recording. No differences were found regarding cardiac vagal activity. Participants breathed significantly faster during the audio conditions (hypnosis and nonhypnotic recording) in comparison to resting measures. After hypnosis, subjective arousal was significantly lower and emotional valence was significantly more positive than after the nonhypnotic recording condition. The relaxing effects of hypnosis that includes relaxation suggestions appear to be located at the subjective level but not at the peripheral physiological level.

Mind-Body Therapies in Childhood Cancer

PURPOSE OF REVIEW

Advances in the field of Pediatric Oncology have led to increased survival rates in children with cancer, and addressing the emotional well-being and quality of life of this specific population is a critical component of care. Mind-body therapies (MBTs) are an adjuvant modality of treatment that appears to have a positive impact on patient quality of life, patient mental health, and family perceptions toward illness. In this review, we describe several evidence-based MBTs, such as art therapy, meditation, prayer, music therapy, hypnosis and relaxation techniques, their use, and our personal experience with MBT in our institution.

RECENT FINDINGS

Current data suggests that MBTs have been effective in decreasing symptoms related to oncologic pathology in children. Based on experience in our institution, the administration of these therapies can be expanded with the use of technology and also foster family inclusion in care, which can lead to improved quality of life for the patient and family. Further studies are warranted to ascertain the effects of MBTs in childhood cancer. MBTs are increasingly important in the care of youth with oncologic disease. It is necessary to increase the quantity and quality of research for the selection and inclusion of MBT in this population.

Supporting Parent Caregivers of Children with Life-Limiting Illness

The well-being of parents is essential to the well-being of children with life-limiting illness. Parents are vulnerable to a range of negative financial, physical, and psychosocial issues due to caregiving tasks and other stressors related to the illness of their child. Pediatric palliative care practitioners provide good care to children by supporting their parents in decision-making and difficult conversations, by managing pain and other symptoms in the ill child, and by addressing parent and family needs for care coordination, respite, bereavement, and social and emotional support. No matter the design or setting of a pediatric palliative care team, practitioners can seek to provide for parent needs by referral or intervention by the care team.