Directional brain networks underlying OM chanting

The Pregnancy Tele-yoga Module to Combat Stress, Anxiety, and Depression Associated with Pregnancy: An Exploratory Open-label Multicentric Study

Purpose

Untreated stress, anxiety, and depression during the perinatal period can lead to adverse maternal and infant outcomes. Yoga, the practice of body-mind-spirit techniques has been shown to reduce stress, anxiety, and depression.

Aims

The aim of the study was to examine the feasibility and limited efficacy of the 4-week practice of pregnancy tele-yoga module (PTYM) delivered and monitored through an online platform.

Methodology

A multicentric, open-label, exploratory study was conducted in the antenatal clinics (ANCs) of three tertiary care hospitals in India. Pregnant women between 13 and 32 weeks of gestation were invited to participate. PTYM was taught by the trained research staff. A YouTube link demonstrating the PTYM developed by the researchers was shared with consenting participants. Using the Yoga Performance Assessment (YPA), research staff monitored the online performance of the PTYM. Pre- and postintervention, women were assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21).

Results

Preintervention, among 162 consented pregnant women, anxiety (62.34%) was the most common mental health condition, followed by stress (55.55%) and depression (45.67%). YPA at the end of week 1, week 2, week 3, and week 4 was 19.45, 21.35, 24.15, and 28.45, respectively. Postintervention anxiety, stress, and depression persisted in 19.78%, 11.44%, and 10.41% of women. Pregnant women with stress (DASS-21 ≥15; n = 90), anxiety (DASS-21 ≥8; n = 101), and depressive (DASS-21 ≥10; n = 74) symptoms after undergoing 4 weeks of PTYM reported significant reduction in the scores.

Conclusion

The current study demonstrated the feasibility and limited efficacy of PTYM in ANCs of a tertiary care hospital in India.

The thalamus is the causal hub of intervention in patients with major depressive disorder: Evidence from the Granger causality analysis

Major depressive disorder (MDD) is the leading mental disorder and afflicts more than 350 million people worldwide. The underlying neural mechanisms of MDD remain unclear, hindering the accurate treatment. Recent brain imaging studies have observed functional abnormalities in multiple brain regions in patients with MDD, identifying core brain regions is the key to locating potential therapeutic targets for MDD. The Granger causality analysis (GCA) measures directional effects between brain regions and, therefore, can track causal hubs as potential intervention targets for MDD. We reviewed literature employing GCA to investigate abnormal brain connections in patients with MDD. The total degree of effective connections in the thalamus (THA) is more than twice that in traditional targets such as the superior frontal gyrus and anterior cingulate cortex. Altered causal connections in patients with MDD mainly included enhanced bottom-up connections from the thalamus to various cortical and subcortical regions and reduced top-down connections from these regions to the THA, indicating excessive uplink sensory information and insufficient downlink suppression information for negative emotions. We suggest that the thalamus is the most crucial causal hub for MDD, which may serve as the downstream target for non-invasive brain stimulation and medication approaches in MDD treatment.

Meditation and yoga for irritable bowel syndrome: study protocol for a randomised clinical trial (MY-IBS study)

INTRODUCTION

When delivered in person, yoga has been shown to be effective in managing irritable bowel syndrome (IBS) symptoms. Research is needed to test the feasibility and effectiveness of yoga as a therapeutic option when delivered virtually. The primary aim of the mind and yoga for IBS randomised controlled trial is to determine the effects of an 8-week virtual meditation and yoga intervention on IBS symptom severity compared with an advice-only active control group.

METHODS AND ANALYSIS

Adults diagnosed with IBS will be randomised to receive either a Upa Yoga intervention or an advice-only control group. The intervention will consist of weekly online classes for 8 weeks delivered by a facilitator using Microsoft Office Teams and daily home practice. Feasibility will be evaluated by examining recruitment and attrition rates, adherence, participant satisfaction with the programme and safety. The primary outcome is IBS symptom severity, and key secondary outcomes include (but not limited to) quality of life, anxiety and depression symptoms, COVID-19-related stress and anxiety, and fatigue. Outcomes will be assessed at baseline, 4 weeks and 8 weeks. An embedded design experimental model substudy will be conducted post intervention using qualitative research methods to identify participants' experiences in the yoga programme.

ETHICS AND DISSEMINATION

This study has been approved by the Conjoint Health Research Ethics Board (REB ID 20-0084). Findings will be disseminated through peer-reviewed publication, conference presentation and social media.

TRIAL REGISTRATION NUMBER

NCT04302623.

Unexpected Cardiovascular Oscillations at 0.1 Hz During Slow Speech Guided Breathing (OM Chanting) at 0.05 Hz

Slow breathing at 0.1 Hz (i.e., 6 cycles per minute, cpm) leads to strong cardiovascular oscillations. However, the impact of breathing below 6 cpm is rarely addressed. We investigated the influence of OM chanting, an ancient Indian mantra, with approx. 3 respiratory cpm (0.05 Hz) on the synchronisation of heart period (RR), respiration (RESP) and systolic blood pressure (SBP). Nine healthy, trained speech practitioners chanted three sequences of five subsequent OM with 2 min pauses in between. Each single OM chanting consisted of taking a deep breath and a long “OM” during expiration and lasted approx. 20 s. ECG, respiration and blood pressure were recorded continuously, of which the RR tachogram, RESP and SBP were derived. Synchronisation between the signals was computed using the phase difference between two signals. During OM chanting synchronisation among the oscillations of RR, SBP and RESP was significantly increased compared to rest. Furthermore, OM chanting at breathing frequencies between 0.046 and 0.057 Hz resulted in 0.1 Hz oscillations in RR and SBP. In conclusion, OM chanting strongly synchronized cardiorespiratory and blood pressure oscillations. Unexpected oscillations at 0.1 Hz in SBP and RR appear at breathing frequencies of approx. 0.05 Hz. Such frequency doubling may originate from an interaction of breathing frequency with endogenous Mayer waves.

Evaluation of an integrated yoga program in patients with inflammatory bowel disease: A pilot study

BACKGROUND

The effects of integrated yoga programs on mental health outcomes in inflammatory bowel disease (IBD) have not been well explored. To explore the acceptability, implementation and effectiveness of an integrated eight-week yoga program plus aromatherapy massage in patients with IBD.

METHODS

Nine participants with documented IBD were recruited from a gastroenterology clinic in Calgary, Alberta, Canada to participate in an integrated yoga program weekly for eight weeks with outcomes assessed at baseline and week 8. Primary outcomes were assessed using Theory of Planned Behaviour as a guiding theory to identify salient beliefs from qualitative analysis of a semi-structured interview, survey items measuring the strength of beliefs and a daily log was used to capture adherence and adverse events. Secondary outcomes were collected using validated survey tools examining anxiety, depression, stress, sleep quality, and physical and mental quality of life.

RESULTS

Attitude, subjective norm and perceived behavioral control beliefs pertinent to the yoga intervention and daily practice were identified. Participants reported feeling the intervention was very helpful; however, felt guilt about not completing daily practices which decreased confidence and intention to continue with the practice. An average of 55.6% of in-person sessions were attended and decreased over time. Participants practiced on average of 5.4 days per week. Depression and mental health scores improved at week 8 from baseline.

CONCLUSIONS

We were able to identify key salient beliefs of IBD patients in regard to an integrated yoga plus aromatherapy massage intervention. This intervention appears to be acceptable and further research should explore its potential to improve mental and physical health outcomes including IBD symptoms.

Add on yoga treatment for negative symptoms of schizophrenia: A multi-centric, randomized controlled trial

The efficacy of antipsychotic medications in the treatment of negative symptoms of schizophrenia is modest at best. Preliminary studies suggest the beneficial effects of add on Yoga, a traditional Indian practice, in the treatment of schizophrenia. Hence, in this study, we examined the efficacy of yoga as an add-on treatment for negative symptoms of schizophrenia in a randomized, wait-list controlled design from two clinical institutes in south India. 89 patients (age - 34.20 ± 8.06 years; education - 14.22 ± 2.69 years; 28 females) were randomized into the add-on yoga or treatment as usual (TAU - wait-list control) group. Patients had a mean illness duration of 10.97 ± 7.24 years with an age at onset of 23.34 ± 5.81 years. Central block randomization was followed to ensure concealed allocation. Participants randomized to the yoga treatment group attended 12 supervised yoga training sessions over two weeks and practiced yoga sessions at home for the subsequent 10 weeks. 64 patients completed the trial. An intent to treat analysis was conducted with 89 participants using a linear mixed model. Improvement in negative symptoms was our primary outcome measure. The two groups were matched on demographic variables and baseline psychopathology severity. Participants in the add-on yoga group had significantly greater improvement in negative symptoms (SANS baseline: 49.13 ± 2.30; 12-weeks follow up: 31.55 ± 2.53) compared to the TAU group (SANS baseline: 51.22 ± 2.40; 12-weeks follow up: 45.30 ± 2.93; t = 3.36; p = 0.006; Cohen's d-0.65). The current study findings suggest the efficacy of yoga as an add-on treatment for negative symptoms of schizophrenia. The effectiveness of yoga practice as a regular clinical intervention for patients needs to be explored in future studies by integrating yoga services along with other clinical services.

Repetitive Religious Chanting Invokes Positive Emotional Schema to Counterbalance Fear: A Multi-Modal Functional and Structural MRI Study

Introduction

During hard times, religious chanting/praying is widely practiced to cope with negative or stressful emotions. While the underlying neural mechanism has not been investigated to a sufficient extent. A previous event-related potential study showed that religious chanting could significantly diminish the late-positive potential induced by negative stimuli. However, the regulatory role of subcortical brain regions, especially the amygdala, in this process remains unclear. This multi-modal MRI study aimed to further clarify the neural mechanism underlying the effectiveness of religious chanting for emotion regulation.

Methodology

Twenty-one participants were recruited for a multi-modal MRI study. Their age range was 40–52 years, 11 were female and all participants had at least 1 year of experience in religious chanting. The participants were asked to view neutral/fearful pictures while practicing religious chanting (i.e., chanting the name of Buddha Amitābha), non-religious chanting (i.e., chanting the name of Santa Claus), or no chanting. A 3.0 T Philips MRI scanner was used to collect the data and SPM12 was used to analyze the imaging data. Voxel-based morphometry (VBM) was used to explore the potential hemispheric asymmetries in practitioners.

Results

Compared to non-religious chanting and no chanting, higher brain activity was observed in several brain regions when participants performed religious chanting while viewing fearful images. These brain regions included the fusiform gyrus, left parietal lobule, and prefrontal cortex, as well as subcortical regions such as the amygdala, thalamus, and midbrain. Importantly, significantly more activity was observed in the left than in the right amygdala during religious chanting. VBM showed hemispheric asymmetries, mainly in the thalamus, putamen, hippocampus, amygdala, and cerebellum; areas related to skill learning and biased memory formation.

Conclusion

This preliminary study showed that repetitive religious chanting may induce strong brain activity, especially in response to stimuli with negative valence. Practicing religious chanting may structurally lateralize a network of brain areas involved in biased memory formation. These functional and structural results suggest that religious chanting helps to form a positive schema to counterbalance negative emotions. Future randomized control studies are necessary to confirm the neural mechanism related to religious chanting in coping with stress and negative emotions.

Does Yoga Have a Role in Schizophrenia Management?

PURPOSE OF REVIEW

To review the efficacy of add-on yoga therapy in improving symptoms of schizophrenia and quality of life and examine the possible underlying biological mechanisms of yoga in schizophrenia.

RECENT FINDINGS

Quality of life, cognitive symptoms, and negative symptoms have been found to improve with add-on yoga therapy in schizophrenia (pooled mean effect size 0.8, 0.6, and 0.4, respectively). Yoga also seems to have a small effect on improving positive symptoms. Less explored areas include adverse effects of yoga itself as well as its effects on antipsychotic-induced complications. Preliminary findings suggest that the effects of yoga may be mediated by neurohormonal mechanisms and functional changes in brain activity. Add-on yoga therapy is a potential treatment option for improving quality of life, cognitive symptoms, and negative symptoms in schizophrenia. Future studies should explore efficacy in multicentric trials as well as possible neurobiological changes underlying the effects.

Multi-Level Clustering of Dynamic Directional Brain Network Patterns and Their Behavioral Relevance

Dynamic functional connectivity (DFC) obtained from resting state functional magnetic resonance imaging (fMRI) data has been shown to provide novel insights into brain function which may be obscured by static functional connectivity (SFC). Further, DFC, and by implication how different brain regions may engage or disengage with each other over time, has been shown to be behaviorally relevant and more predictive than SFC of behavioral performance and/or diagnostic status. DFC is not a directional entity and may capture neural synchronization. However, directional interactions between different brain regions is another putative mechanism by which neural populations communicate. Accordingly, static effective connectivity (SEC) has been explored as a means of characterizing such directional interactions. But investigation of its dynamic counterpart, i.e., dynamic effective connectivity (DEC), is still in its infancy. Of particular note are methodological insufficiencies in identifying DEC configurations that are reproducible across time and subjects as well as a lack of understanding of the behavioral relevance of DEC obtained from resting state fMRI. In order to address these issues, we employed a dynamic multivariate autoregressive (MVAR) model to estimate DEC. The method was first validated using simulations and then applied to resting state fMRI data obtained in-house (N = 21), wherein we performed dynamic clustering of DEC matrices across multiple levels [using adaptive evolutionary clustering (AEC)] – spatial location, time, and subjects. We observed a small number of directional brain network configurations alternating between each other over time in a quasi-stable manner akin to brain microstates. The dominant and consistent DEC network patterns involved several regions including inferior and mid temporal cortex, motor and parietal cortex, occipital cortex, as well as part of frontal cortex. The functional relevance of these DEC states were determined using meta-analyses and pertained mainly to memory and emotion, but also involved execution and language. Finally, a larger cohort of resting-state fMRI and behavioral data from the Human Connectome Project (HCP) (N = 232, Q1–Q3 release) was used to demonstrate that metrics derived from DEC can explain larger variance in 70 behaviors across different domains (alertness, cognition, emotion, and personality traits) compared to SEC in healthy individuals.