The relative effectiveness of three techniques to induce the trophotropic response

Non-Pharmacological Treatment of Primary Headaches-A Focused Review

Headache disorders are a significant global health burden, leading to reduced quality of life. While vast pharmacological treatments are available, they may be associated with adverse effects or inadequate efficacy for some patients, therefore there is a need for exploring alternate treatment strategies. This review gives a brief explanation and evaluation of some established and emerging non-pharmacological approaches for headache management, focusing on nutraceuticals and diet, acupuncture, cognitive behavioral therapy (CBT), biofeedback, relaxation techniques, autogenic training, and neuromodulation. Special consideration is given to psychological interventions as they increase patient self-efficacy and provide strategies for managing chronic pain. Future research should focus on optimizing these therapies, identifying patient-specific factors influencing their effectiveness, and integrating them into holistic headache management strategies.

WITHDRAWN: Transcendental meditation for the primary prevention of cardiovascular disease

BACKGROUND

A major determinant in cardiovascular disease (CVD) is stress. As transcendental meditation (TM) is thought to help in lowering negative stress indicators, it may be a beneficial strategy for the primary prevention of CVD.

OBJECTIVES

To determine the effectiveness of TM for the primary prevention of CVD.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 10); MEDLINE (Ovid) (1946 to week three November 2013); EMBASE Classic and EMBASE (Ovid) (1947 to week 48 2013); ISI Web of Science (1970 to 28 November 2013); and Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment Database and Health Economics Evaluations Database (November 2013). We also searched the Allied and complementary Medicine Database (AMED) (inception to January 2014) and IndMed (inception to January 2014). We handsearched trial registers and reference lists of reviews and articles and contacted experts in the field. We applied no language restrictions.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of at least three months' duration involving healthy adults or adults at high risk of CVD. Trials examined TM only and the comparison group was no intervention or minimal intervention. We excluded trials that involved multi-factorial interventions. Outcomes of interest were clinical CVD events (cardiovascular mortality, all-cause mortality and non-fatal events) and major CVD risk factors (e.g. blood pressure and blood lipids, occurrence of type 2 diabetes, quality of life, adverse events and costs).

DATA COLLECTION AND ANALYSIS

Two authors independently selected trials for inclusion, extracted data and assessed the risk of bias.

MAIN RESULTS

We identified four trials (four papers) (430 participants) for inclusion in this review. We identified no ongoing studies. The included trials were small, short term (three months) and at risk of bias. In all studies, TM was practised for 15 to 20 minutes twice a day.None of the included studies reported all-cause mortality, cardiovascular mortality or non-fatal endpoints as trials were short term, but one study reported survival rate three years after the trial was completed. In view of the considerable statistical heterogeneity between the results of the studies for the only outcomes reported, systolic blood pressure (I2 = 72%) and diastolic blood pressure (I2 = 66%), we decided not to undertake a meta-analysis. None of the four trials reported blood lipids, occurrence of type 2 diabetes, adverse events, costs or quality of life.

AUTHORS' CONCLUSIONS

Currently, there are few trials with limited outcomes examining the effectiveness of TM for the primary prevention of CVD. Due to the limited evidence to date, we could draw no conclusions as to the effectiveness of TM for the primary prevention of CVD. There was considerable heterogeneity between trials and the included studies were small, short term and at overall serious risk of bias. More and larger long-term, high-quality trials are needed.

Transcendental meditation for the primary prevention of cardiovascular disease

BACKGROUND

A major determinant in cardiovascular disease (CVD) is stress. As transcendental meditation (TM) is thought to help in lowering negative stress indicators, it may be a beneficial strategy for the primary prevention of CVD.

OBJECTIVES

To determine the effectiveness of TM for the primary prevention of CVD.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 10); MEDLINE (Ovid) (1946 to week three November 2013); EMBASE Classic and EMBASE (Ovid) (1947 to week 48 2013); ISI Web of Science (1970 to 28 November 2013); and Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment Database and Health Economics Evaluations Database (November 2013). We also searched the Allied and complementary Medicine Database (AMED) (inception to January 2014) and IndMed (inception to January 2014). We handsearched trial registers and reference lists of reviews and articles and contacted experts in the field. We applied no language restrictions.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of at least three months' duration involving healthy adults or adults at high risk of CVD. Trials examined TM only and the comparison group was no intervention or minimal intervention. We excluded trials that involved multi-factorial interventions. Outcomes of interest were clinical CVD events (cardiovascular mortality, all-cause mortality and non-fatal events) and major CVD risk factors (e.g. blood pressure and blood lipids, occurrence of type 2 diabetes, quality of life, adverse events and costs).

DATA COLLECTION AND ANALYSIS

Two authors independently selected trials for inclusion, extracted data and assessed the risk of bias.

MAIN RESULTS

We identified four trials (four papers) (430 participants) for inclusion in this review. We identified no ongoing studies. The included trials were small, short term (three months) and at risk of bias. In all studies, TM was practised for 15 to 20 minutes twice a day.None of the included studies reported all-cause mortality, cardiovascular mortality or non-fatal endpoints as trials were short term, but one study reported survival rate three years after the trial was completed. In view of the considerable statistical heterogeneity between the results of the studies for the only outcomes reported, systolic blood pressure (I(2) = 72%) and diastolic blood pressure (I(2) = 66%), we decided not to undertake a meta-analysis. None of the four trials reported blood lipids, occurrence of type 2 diabetes, adverse events, costs or quality of life.

AUTHORS' CONCLUSIONS

Currently, there are few trials with limited outcomes examining the effectiveness of TM for the primary prevention of CVD. Due to the limited evidence to date, we could draw no conclusions as to the effectiveness of TM for the primary prevention of CVD. There was considerable heterogeneity between trials and the included studies were small, short term and at overall serious risk of bias. More and larger long-term, high-quality trials are needed.

Stress management techniques: are they all equivalent, or do they have specific effects?

This article evaluates the hypothesis that various stress management techniques have specific effects. Studies comparing various techniques are reviewed, as well as previous literature reviews evaluating the effects of individual techniques. There is evidence that cognitively oriented methods have specific cognitive effects, that specific autonomic effects result from autonomically oriented methods, and that specific muscular effects are produced by muscularly oriented methods. Muscle relaxation and/or EMG biofeedback have greater muscular effects and smaller autonomic effects than finger temperature biofeedback and/or autogenic training. EMG biofeedback produces greater effects on particular muscular groups than progressive relaxation, and thermal biofeedback has greater finger temperature effects than autogenic training. Disorders with a predominant muscular component (e.g., tension headaches) are treated more effectively by muscularly oriented methods, while disorders in which autonomic dysfunction predominates (e.g., hypertension, migraine headaches) are more effectively treated by techniques with a strong autonomic component. Anxiety and phobias tend to be most effectively treated by methods with both strong cognitive and behavioral components.

A meta-analysis of frontalis EMG levels with biofeedback and alternative procedures

The lack of comparative reviews of the efficacy of EMG frontalis biofeedback versus alternative procedures for reduction of muscle tension prompted the present meta-analytic treatment of literature previously concluded to be "equivocal." Twenty studies comparing EMG frontalis biofeedback with other tension-reduction procedures produced a total of 68 separate effect sizes suitable for meta-analysis. Differences between "clinical" and "normal" samples were nonsignificant, and data analyses revealed that EMG frontalis biofeedback was significantly superior to control (p less than .05) but that alternative forms of muscle relaxation, while effective, did not reach statistical significance.

Physiological responses during meditation and rest

Forty nonmeditators and 12 experienced transcendental meditators were randomly assigned to four experimental cells devised to control for order and expectation effects. All 52 (female) subjects were continuously monitored on seven physiological measures during both meditation and rest. Each subject was her own control in an abab experimental paradigm comparing meditation to rest. Analyses of variance on change scores calculated from both initial and running (intertrial) baselines revealed small but significant conditions effects for all variables except diastolic BP. The same subjects (both experienced meditators and those meditating for the first time) showed lower psychophysiological arousal during the meditation than during the rest condition for systolic BP, HR, SCL, digital BV, digital ST, and frontalis EMG. The experienced meditators showed only marginally more conditions effects than the novices practicing "noncultic" meditation. For the nonmeditators, deliberately fostering positive expectations of meditations was associated with lower physiological arousal in terms of diastolic BP, HR, and SCL. These findings suggest that both cultic and noncultic meditation are associated with lower physiological activation than eyes-closed rest. The meditators, however, tended to become more relaxed over meditation trials, whereas the nonmeditators showed the opposite trend.

Single- and successive-site EMG training in responding to anticipated pain

In a comparison among relaxation procedures, 32 college students were assigned to four group of equal size. Electromyographic response training was given with biofeedback (EMG training) on the forehead (frontal area) alone, on the frontal area, neck (sternomastoid), and forearm areas in succession, or on these three sites in conjunction with recorded relaxation instructions used at home. Relative to a control group, which received no training, the three biofeedback-trained groups maintained lower EMG levels on the frontal and sternomastoid sites, and the group provided with the relaxation instructions plus EMG training showed lower skin conductance levels. These patterns were generally maintained during the presentation of a stimulus (stressor) that ostensibly signaled an impending electric shock. Other measures, including peripheral temperatures and self-reported anxiety, also showed effects consistent with the stressor presentations but did not differentiate the groups. The results are discussed in terms of common clinical relaxation procedures, an alternative procedure for training several sites simultaneously, and implications for models of EMG training and arousal.

Treatment of substance abuse by relaxation training: a review of its rationale, efficacy and mechanisms

The efficacy of relaxation training as a treatment for alcohol and drug abuse is reviewed, and directions for future research derived. Such use of relaxation procedures, notably progressive muscular relaxation and meditation, has been widespread and is premised on the assumptions that substance abuse is causally linked to anxiety and that anxiety can be reduced by relaxation training. However, the evidence suggests that such precipitating anxiety is limited to interpersonal-stress situations involving diminished perceived personal control over the stressor, and that alcohol and other drugs are often consumed for their euphoric rather than tranquilizing effects. Consequently, the empirical support for the effectiveness of relaxation training as a treatment for substance abuse in general is equivocal. As well, the existing outcome studies suffer from numerous methodological and conceptual inadequacies. In cases of demonstrated effectiveness, increased perceived control is a more plausible explanation than is decreased anxiety.