Mind-Body Medicine Research Update

[Research Update]

Compiled By Kevin Chen

Advantage of meditation over exercise in reducing cold and flu illness is related to improved function and quality of life.  Influenza Other Respi Viruses. 2012 Nov 21. By Obasi CN, Brown R, Ewers T, et al. from Dept of Family Medicine, University of Wisconsin-Madison. Madison, WI, USA.

MD-meditate-3Purpose:  To examine whether apparent advantages following training in meditation over exercise can be attributed to specific symptoms, functional impairments, or quality-of-life indicators assessed by the Wisconsin Upper Respiratory Symptom Survey (WURSS-24).

Methods: Results from the randomized controlled trial “Meditation or Exercise for Preventing Acute Respiratory Illness” showed mean global severity and total days of illness were worse in control (358, 8·9) compared with  exercise (248, 5·1) or meditation (144, 5·0). Global severity of illness was estimated using area under the curve from daily self-reported severity scores on the WURSS-24. For this project, we estimated within-group WURSS item-level severity and between-group effect sizes (Cohen’s “d” statistic) relative to control. The item-level effect sizes were grouped into (i) symptom and (ii) function and quality of life domains.

Results:  Among the three groups, mediators showed the lowest severity estimates for 21 of 22 WURSS items. Item-level Cohen’s “d” indicated most benefit was evident in WURSS items representing function and quality of life. Compared with exercise, meditation fostered larger reductions in illness severity, although due mostly to improved function and the quality of life domain (d=-0·33, P <0·001) compared with symptom domain (d=-0·22,  P<  0·001).

Conclusions:  The apparent advantage of training in meditation over exercise for reducing cold and flu illness is explained more by improved function and quality of life than by a reduction in symptom severity.

 

Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity J Clin Psychiatry. 2013 Mar 13. By Hoge EA, Bui E, Marques L, et al. from Center for Anxiety and Traumatic Stress Disorders,  Massachusetts General Hospital, Boston, MA 02114 ehoge@partners.org

Purpose: Mindfulness meditation has met increasing interest as a therapeutic strategy for anxiety disorders, but prior studies have been limited by methodological concerns, including a lack of an active comparison group. This is the first randomized, controlled trial comparing the manualized Mindfulness-Based Stress Reduction (MBSR) program with an active control for generalized anxiety disorder (GAD), a disorder characterized by chronic worry and physiologic hyperarousal symptoms. shutterstock_10499413_epsavail

Method: Ninety-three individuals with DSM-IV-diagnosed GAD were randomly assigned to an 8-week group intervention with MBSR or to an attention control, Stress Management Education (SME), between 2009 and 2011. Anxiety symptoms were measured with the Hamilton Anxiety Rating Scale (HAMA; primary outcome measure), the Clinical Global Impressions-Severity of Illness and -Improvement scales (CGI-S and CGI-I), and the Beck Anxiety Inventory (BAI). Stress reactivity was assessed by comparing anxiety and distress during pretreatment and post treatment administration of the Trier Social Stress Test (TSST). 

Results: A modified intent-to-treat analysis including participants who completed at least 1 session of MBSR (n = 48) or SME (n = 41) showed that both interventions led to significant (P < .0001) reductions in HAMA scores at endpoint, but did not significantly differ. MBSR, however, was associated with a significantly greater reduction in anxiety as measured by the CGI-S, the CGI-I, and the BAI (all P values < .05). MBSR was also associated with greater reductions than SME in anxiety and distress ratings in response to the TSST stress challenge (P < .05) and a greater increase in positive self-statements (P = .004). 

Conclusions: These results suggest that MBSR may have a beneficial effect on anxiety symptoms in GAD and may also improve stress reactivity and coping as measured in a laboratory stress challenge.

 

An update on mindfulness meditation as a self-help treatment for anxiety and depression.  Psychol Res Behav Manag. 2012;5:131-41. By Edenfield TM, Saeed SA. From Dept of Psychiatric Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA.

In recent years, complementary and alternative medicine (CAM) treatments have increased in popularity. This is especially true for treatments that are related to exercise and mindfulness-based interventions (MBIs) in the treatment of both mental and physical illness. MBIs, such as Mindfulness-based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR), which are derived from ancient Buddhist and Yoga philosophies, have become popular treatments in contemporary psychotherapy. While there is growing evidence that supports the role of these interventions in relapse prevention, little is known about the role that MBIs play in the treatment of acute symptoms of depression and anxiety. Even less is known about the importance of specific components of MBIs (eg, mindfulness meditation [MM]) and the overall impact that these interventions have on the experience or expression of psychological distress. Moreover, few studies have rigorously evaluated the dose-response relationship that is required to effect positive symptom change and the mechanisms of change that are responsible for observed improvements. This review will define meditation and mindfulness, discuss the relationship between stress and health and how MM relates to therapeutically engaging the relaxation response, and review the empirical findings that are related to the efficacy of MM in the treatment of depression and anxiety symptoms. Given the paucity of research that examines the applications of these treatments in clinical populations, the limitations of applying these findings to clinical samples will be mentioned. A brief review of the issues related to the possible mechanisms of change and the dose-response relationship regarding MBIs, particularly MM, will be provided. Finally, limitations of the extant literature and future directions for further exploration of this topic will be offered.

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Physical exercise intervention in depressive disorders: Meta-analysis and systematic review.  Scand J Med Sci Sports. 2013 Jan 30. By Josefsson T, Lindwall M, Archer T. from School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.

Previous meta-analyses investigating the effect of exercise on depression have included trials where the control condition has been categorized as placebo despite the fact that this particular placebo intervention (e.g., meditation, relaxation) has been recognized as having an antidepressant effect. Because meditation and mindfulness-based interventions are associated with depression reduction, it is impossible to separate the effect of the physical exercise from the meditation-related parts. The present study determined the efficacy of exercise in reducing symptoms of depression compared with no treatment, placebo conditions or usual care among clinically defined depressed adults. Of 89 retrieved studies, 15 passed the inclusion criteria of which 13 studies presented sufficient information for calculating effect sizes. The main result showed a significant large overall effect favoring exercise intervention.  The effect size was even larger when only trials that had used no treatment or placebo conditions were analyzed. Nevertheless, effect size was reduced to a moderate level when only studies with high methodological quality were included in the analysis. Exercise may be recommended for people with mild and moderate depression who are willing, motivated, and physically healthy enough to engage in such a program.

 

Complementary medcine, exercise,  meditation,  diet, and lifestyle modification for anxiety disorders: a review of current evidence. Evid Based Complement Alternat Med. 2012; 2012:809653. By Sarris J, Moylan S, Camfield DA, et al.  from Dept of Psychiatry, The University of Melbourne, Melbourne, VIC 3000, Australia.

Use of complementary medicines and therapies (CAM) and modification of lifestyle factors such as physical activity, exercise, and diet are being increasingly considered as potential therapeutic options for anxiety disorders. The objective of this meta review was to examine evidence across a broad range of CAM and lifestyle interventions in the treatment of anxiety disorders. In early 2012 we conducted a literature search of PubMed, Scopus, CINAHL, Web of Science, PsycInfo, and the Cochrane Library, for key studies, systematic reviews, and meta analyses in the area. Our paper found that in respect to treatment of generalized anxiety or specific disorders, CAM evidence revealed current support for the herbal medicine Kava. One isolated study shows benefit for naturopathic medicine, whereas acupuncture, yoga, and Tai chi have tentative supportive evidence, which is hampered by overall poor methodology. The breadth of evidence does not support homeopathy for treating anxiety. Strong support exists for lifestyle modifications including adoption of moderate exercise and mindfulness  meditation, whereas dietary improvement, avoidance of caffeine, alcohol, and nicotine offer encouraging preliminary data. In conclusion, certain lifestyle modifications and some CAMs may provide a beneficial role in the treatment of anxiety disorders.  http://www.hindawi.com/journals/ecam/2012/809653/

 

The effects of qigong on anxiety, depression, and psychological well-being: a systematic review and meta-analysis.  Evid Based Complement Alternat Med. 2013;2013:152738. By Wang F, Man JK, Lee EK, et al.  From Psychological Department, Guang’an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China.

Introduction: The effect of Qigong on psychological well-being is relatively unknown. This study systematically reviewed the effects of Qigong on anxiety, depression, and psychological well-being.

Methods: Using fifteen studies published between 2001 and 2011, a systematic review was carried out and meta-analyses were performed on studies with appropriate homogeneity. The quality of the outcome measures was also assessed. 

Results: We categorized these studies into three groups based on the type of subjects involved as follows: (1) healthy subjects, (2) subjects with chronic illnesses, and (3) subjects with depression. Based on the heterogeneity assessment of available studies, meta-analyses were conducted in three studies of patients with type II diabetes in the second group, which suggested that Qigong was effective in reducing depression (ES = -0.29; 95% CI, -0.58-0.00) and anxiety (ES = -0.37; 95% CI, -0.66-0.08), as measured by Symptom Checklist 90, and in improving psychological well-being (ES = -0.58; 95% CI, -0.91-0.25) as measured by Diabetes Specific Quality of Life Scale. Overall, the quality of research methodology of existing studies was poor.  Conclusions: Preliminary evidence suggests that Gigong may have positive effects on psychological well-being among patients with chronic illnesses. However the published studies generally had significant methodological limitations. More high-quality studies are needed. http://www.hindawi.com/journals/ecam/2013/152738/

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Tai Chi practitioners have better postural control and selective attention in stepping down with and without a concurrent auditory response task. Eur J Appl Physiol. 2013 Mar 14. By Lu X, Siu KC, Fu SN, et al. from Dept of Rehabilitation Sciences, The Hong Kong Polytechnic University,  Hong Kong, China.

To compare the performance of older experienced Tai Chi practitioners and healthy controls in dual-task versus single-task paradigms, namely stepping down with and without performing an auditory response task, a cross-sectional study was conducted in the Center for East-meets-West in Rehabilitation Sciences at The Hong Kong Polytechnic University, Hong Kong. Twenty-eight Tai Chi practitioners (73.6 ± 4.2 years) and 30 healthy control subjects (72.4 ± 6.1 years) were recruited. Participants were asked to step down from a 19-cm-high platform and maintain a single-leg stance for 10 s with and without a concurrent cognitive task. The cognitive task was an auditory Stroop test in which the participants were required to respond to different tones of voices regardless of their word meanings. Postural stability after stepping down under single- and dual-task paradigms, in terms of excursion of the subject’s center of pressure (COP) and cognitive performance, was measured for comparison between the two groups. Our findings demonstrated significant between-group differences in more outcome measures during dual-task than single-task performance. Thus, the auditory Stroop test showed that Tai Chi practitioners achieved not only significantly less error rate in single-task, but also significantly faster reaction time in dual-task, when compared with healthy controls similar in age and other relevant demographics. Similarly, the stepping-down task showed that Tai Chi practitioners not only displayed significantly less COP sway area in single-task, but also significantly less COP sway path than healthy controls in dual-task. These results showed that Tai Chi practitioners achieved better postural stability after stepping down as well as better performance in auditory response task than healthy controls. The improved performance that was magnified by dual motor-cognitive task performance may point to the benefits of Tai Chi being a mind-and-body exercise.

 

Associations Between Tai Chi Chung Program, Anxiety, and Cardiovascular Risk Factors. Am J Health Promot. 2013 Mar 7. By Chang MY, Yeh SC, Chu MC, et al. from  the Graduate Institute of Integration of Traditional Chinese Medicine With Western Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.

Purpose: To examine the effects of a Tai Chi Chung (TCC) program, an efficiency approach, on anxiety and cardiovascular risk factors. Design: A quasi-experimental study. Setting. A community in Taipei City, Taiwan. Subjects. One hundred thirty-three adults aged 55 years and older. Intervention. Sixty-four participants (experimental group) attended a 60-minute Tai Chi exercise three times per week for 12 weeks, whereas 69 participants (control group) maintained their usual daily activities.

Measures: Anxiety states, systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), and waist circumference (WC) were assessed at baseline, 6 weeks into the experiment, and 12 weeks into the experiment.   Generalized estimating equations were used to evaluate the changes.

Results:  Participants showed a greater drop in anxiety levels (β = -2.57, p = .001) and DBP (β = -7.02, p < .001) at the 12-week follow-up than did the controls. SBP significantly decreased in the 6-week follow-up and 12-week follow-up tests. The participants in the intervention achieved a greater drop in BMI at the 6-week and 12-week follow-up visits than the controls. The interventions demonstrated decreased average WC at the 6-week and 12-week follow-up visits as compared to the controls.

Conclusion. The results highlight the long-term benefits of a TCC program in facilitating health promotion by reducing anxiety and risk factors for cardiovascular diseases.

 

Effect of an office worksite-based yoga program on heart rate variability: outcomes of a randomized controlled trial.  BMC Complement Altern Med. 2013 Apr 10;13(1):82. By Cheema BS, Houridis A, Busch L, et al.

Background:  Chronic work-related stress is an independent risk factor for cardiometabolic diseases and associated mortality, particularly when compounded by a sedentary work environment. The purpose of this study was to determine if an office work-site-based hatha yoga program could improve physiological stress, evaluated via heart rate variability (HRV), and associated health-related outcomes in a cohort of office workers. 

 Methods:  Thirty-seven adults employed in university-based office positions were randomized upon the completion of baseline testing to an experimental or control group. The experimental group completed a 10-week yoga program prescribed three sessions per week during lunch hour (50 min per session). An experienced instructor led the sessions, which emphasized asanas (postures) and vinyasa (exercises). The primary outcome was the high frequency (HF) power component of HRV. Secondary outcomes included additional HRV parameters, musculoskeletal fitness (i.e. push-up, side-bridge, and sit & reach tests) and psychological indices (i.e. state and trait anxiety, quality of life and job satisfaction).

 Results:  All measures of HRV failed to change in the experimental group versus the control group, except that the experimental group significantly increased LF:HF (p = 0.04) and reduced pNN50 (p = 0.04) versus control, contrary to our hypotheses. Flexibility, evaluated via sit & reach test increased in the experimental group versus the control group (p < 0.001). No other adaptations were noted. Post hoc analysis comparing participants who completed >=70% of yoga sessions (n = 11) to control (n = 19) yielded the same findings, except that the high adherers also reduced state anxiety (p = 0.02) and RMSSD (p = 0.05), and tended to improve the push-up test (p = 0.07) versus control.

Conclusions: A 10-week hatha   yoga  intervention delivered at the office work-site during lunch hour did not improve HF power or other HRV parameters. However, improvements in flexibility, state anxiety and musculoskeletal fitness were noted with high adherence. Future investigations should incorporate strategies to promote adherence, involve more frequent and longer durations of yoga training, and enroll cohorts who suffer from higher levels of work-related stress.  http://www.biomedcentral.com/1472-6882/13/82/abstract

 

Dr. Kevin Chen

Dr. Kevin Chen

Kevin W Chen, Ph.D. – is an associate professor at the Center for Integrative Medicine, University of Maryland.  Dr. Chen was educated in the universities of both China and the United States, and has years of experience and training in blending eastern and western perspectives, and in the practice of life-nurturing methods. As a long-time practitioner of Qigong Yang Sheng, he is one of the few scientists in the U.S. to have both hands-on knowledge of mind-body practice, and an active research career in mind-body medicine, which is funded through grants by the National Institutes of Health (NIH) and various foundations.  Dr. Chen devotes his career and life to the practice of Yang Sheng, and promotion of self-healing and mind-body-spirit integration through the non-profit organization, World Institute for Self Healing (WISH) (http://www.wishus.org).

 

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