A novel cognitive behavioral treatment for patients with chronic insomnia: A pilot experimental study

Stress and Well-Being of Greek Primary School Educators: A Cross-Sectional Study

The teaching profession has always been challenging, while for various reasons the magnitude of observed stress in teachers has been continually growing over time. This study was conducted to demonstrate the relevance of stress in this professional group and to generate evidence for the benefit of primary school teachers and, indirectly, their pupils. To this end, we examined a large number of school teachers in a descriptive cross-sectional study. The survey comprised 786 primary school instructors aged 21 to 65 years, 646 women (82.2%) and 140 males (17.8%), and was performed from March to October 2022. Participants were asked about their gender, age, marital status, place of domicile, satisfaction with their income, whether their income met their needs, number of children, whether they cared for a person with a disability, work experience, alcohol use, eating patterns, and their height and weight for computation of their Body Mass Index (BMI). The survey included the Teacher Subjective Well-being Questionnaire (TSWQ), the Perceived Stress Scale (PSS), the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ), and the Pittsburgh Sleep Quality Index (PSQI). The results showed that there were significant differences between the two sexes in age, marital status, work experience, smoking, alcohol use, and eating breakfast. Furthermore, there were significant differences between the two sexes in BMI, PSS Total, Dietary Health Choice, Harm Avoidance and Total HLPCQ. The variance of PSS Total was predicted by Sex, Teacher Efficacy, Total PSQI, Dietary Health Choice, organized physical exercise, social support and mental control, and Total HLPCQ. Between teacher efficacy, school connectedness, teacher well-being, organized physical exercise, social support and mental control, Total HLPCQ and PSS Total, the correlation coefficients were negative and significant at the <0.05 level. Between Total PSQI and PSS Total, the correlation coefficient was positive and significant at the <0.05 level. Between teacher efficacy, school connectedness and teacher well-being, organized physical exercise, social support and mental control, Total HLPCQ and Total PSQI, the correlation coefficients were negative and significant at the <0.05 level. In summary, we demonstrated that Greek primary school teachers experience significant stress, which is intertwined with their way of life, and reflected in significant decreases in their sense of well-being, quality of sleep, and overall life satisfaction, as well as in their standards of teaching.

The Effect of Pythagorean Self-Awareness Intervention on Stress and Mental Health Characteristics of Civil Servants in Crete, Greece

Evidence is limited regarding the effects of holistic programs on work-related stress, anxiety, and depressive symptomatology. This study aimed to evaluate the effects of the Pythagorean Self-Awareness Intervention (PSAI) on stress and mental health characteristics of civil servants in Crete, Greece. This was a single arm interventional study with PSAI outcome evaluation. Validated, self-reported scales were used to assess stress and mental health characteristics (PSS, DASS, UCLA, RSE, and STAXI). Hair samples were obtained to measure cortisol concentrations as a biological stress marker. Paired-samples t-test or Wilcoxon tests were used to evaluate pre- and post-intervention measures. Overall, 48 civil servants (56.3% women, mean age 51 years) participated in the study. Statistically significant reductions were observed in all self-reported stress scales (p < 0.05). Although hair cortisol decreased, this difference was not statistically significant (p = 0.109). Statistically significant improvements were also observed on depressive symptomatology (p < 0.001), self-esteem (p < 0.001), loneliness (p < 0.001), self-efficacy (p = 0.002), and anger (p = 0.017). The PSAI appeared beneficial with respect to all self-reported outcomes. Larger studies including control groups and further follow-up evaluations are needed to ascertain these findings.

The Effect of Pythagorean Self-Awareness on Heart Rate Variability, Perceived Stress and Behavior of Preschool Children

Stress is associated with unhealthy habits and non-communicable diseases. It is also linked to communicable diseases due to its impact on immune function. These can be prevented through intervention programs in schools. The aim of this study was to examine the effect of the simplified Pythagorean Self-Awareness Intervention on heart rate variability (HRV) parameters, perceived stress and behaviors of preschool children. The sample of the study consisted of 45 preschool students. A “one group (double) pretest—posttest design” was used, to allow for comparisons of the measurements before and after the intervention. Students were assessed via two questionnaires (“Perceived Stress Scale for Children” (PSS-C) and “Checklist for Screening Behavioral Problems in Preschool Children”) and a photoplethysmographic (PPG) device. The intervention lasted 9 weeks and included practicing of the Pythagorean Self-awareness techniques and the adoption of healthy behaviors. The results showed no statistically significant differences between the two pretests (p > 0.05 for all comparisons) and statistically significant differences between the second pretest and posttest (“Perceived Stress Scale for Children”, (PSS-C) p < 0.0001, “Checklist for Screening Behavioral Problems in Preschool Children” p < 0.0001 and two indices of PPG device: heart rate mean, p < 0.0001, low frequency/very low frequency, p = 0.034). In conclusion, the Pythagorean Self-Awareness Intervention had a beneficial effect on the sample of preschool students examined, as the results showed an improvement in the perceived stress and the HRV parameters tested, and in engaging healthier behaviors, findings that indicate a relaxed psychologic state and a healthier lifestyle.

Clinical Study of Ligustrazine Magnetic Nanoparticles Combined with Moxibustion in the Treatment of Migraine

The purpose of this article is to explore the clinical application of ligustrazine magnetic nanoparticles combined with moxibustion in the treatment of migraine. In this study 60 patients diagnosed with migraine were enrolled and divided into three groups of ligustrazine magnetic nanoparticles group, moxibustion treatment group and ligustrazine magnetic nanoparticles combined moxibustion group. Patients in ligustrazine magnetic nanoparticles treatment group were injected with quantitative ligustrazine magnetic nanoparticles, moxibustion treatment group used self-adhesive small. Acupuncture moxibustion in patients with moxibustion patients, ligustrazine magnetic nanoparticles combined with moxibustion treatment group using the combination of the above two treatments, after the treatment period, the treatment of patients in each group is effective, prognosis recurrence rate and adverse reaction rate perform statistics and analysis. The research results show that the treatment efficiency of the ligustrazine magnetic nanoparticles combined with moxibustion treatment group is as high as 97.2%, which is higher than that of the other two groups. The prognosis recurrence rate is only 4.76%, which is lower than that of the other two groups, and the adverse reaction rate is 3.85%, which is lower than the other two groups. It can be seen that the treatment of ligustrazine magnetic nanoparticles combined with moxibustion is an effective way to treat migraine.

The Role and Clinical Observation of Traditional Chinese Medicine in Relieving Senile Insomnia: A Systematic Review and Meta-Analysis

Objective

To assess the role and clinical observation of traditional Chinese medicine (TCM) in relieving senile insomnia and conduct a systematic evaluation and meta-analysis.

Methods

We searched Chinese literatures from some database, including the China Knowledge Network database, Chongqing CQVIP Chinese database, Wanfang database, and Chinese Biomedical Literature database. In addition, English literature retrieval database PubMed and the Cochrane Library were included in this meta-analysis. The randomized controlled trial (RCT) of cognitive behavioral therapy was found in the treatment of chronic insomnia. All articles were current up to December 1, 2021, and references in the literature were hand searched.

Results

About 16 studies were included, involving 1260 elderly patients with insomnia. Meta-analysis results showed that compared with the control group, the sleep latency of the experimental group MD = -8.02, 95% CI (10.95, 5.01), the number of awakenings of the experimental group MD = -0.41, 95% CI (0.68, 0.14), the total sleep time of the experimental group MD = 39.41, 95% CI (27.05, 51.71), the sleep efficiency of the experimental group MD = 7.82, 95% CI (1.87, 13.75) the Pittsburgh sleep quality index of the experimental group MD = 2.41, 95% CI (3.12, 1.46), the effective rate of the experimental group: OR = 3.12, 95% CI (1.76, 5.48), and the insomnia severity index of the experimental group MD = 1.05, 95% CI (2.04, 0.52).

Conclusion

Our current study has indicated that TCM may play a central role in relieving senile insomnia and may be effective when treating insomnia. However, due to the low quality of trial methodology and publication bias, it cannot be fully confirmed. Further high-quality trials are needed to be investigated in the future.

Pythagorean Self-Awareness Intervention for Multiple Sclerosis Patients: A Quasi-Experimental Pragmatic Trial

OBJECTIVE

Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system affecting patients' well-being and quality of life. Pythagorean Self-Awareness Intervention (PSAI) is a novel non-pharmaceutical intervention with significant benefits both in MS and other chronic diseases. In this study, the longstanding effectiveness of PSAI was investigated.

METHOD

This was a two-arm quasi-experimental pragmatic trial in relapsing-remitting MS patients (23 in the PSAI and 21 in the control group). PSAI patients received an 8-week training period and then they performed PSAI at home for another 16 weeks. Assessments took place at baseline, 8 weeks, and 24 weeks. These included cognition, fatigue, perceived stress, and hair cortisol.

RESULTS

Significant group × time interactions favoring PSAI were found during the first 8-week period for information processing speed, fatigue, and perceived stress. However, only verbal memory was found to be significantly improved in the PSAI group during the 24-week follow-up period. There were no significant group × time differences with respect to hair cortisol. No side effects were noted and compliance was excellent.

CONCLUSIONS

PSAI was mostly effective during the first 8-week training period. Its benefits worn out during the non-training period, albeit we observed a delayed significant improvement of verbal memory. Our findings will help to further refine the technique, either by extending the training period and/or by including booster sessions, throughout the PSAI treatment. This study provided Class III evidence for PSAI.

The effects of Pythagorean Self-Awareness Intervention on patients with major depressive disorder: A pilot randomized controlled trial

Stress plays an important role in major depressive disorder (MDD). Thus, a variety of stress management programs have been developed for people with this diagnosis. This is a pilot randomized clinical trial which implemented a holistic stress management program, Pythagorean Self-Awareness Intervention (PSAI) in adults with MDD, aiming to evaluate the effectiveness of PSAI compared to standard care for reduction of depressive symptoms (primary aim), improving mental health and quality of life (secondary aims). A total of 69 participants were randomized to an intervention group (N = 34), who received the usual care provided for patients with major depression and attended the PSAI program, and a control group (N = 35), who received the usual care only. Measurements were taken in both groups before and after the intervention and included: 1. Self-report questionnaires for measuring depressive symptoms, healthy lifestyle, perceived stress, anxiety, positive and negative affect and sleep quality, 2 Cognitive function assessment tools, 3. Hair and salivary cortisol. The intervention group demonstrated significantly greater reductions in depressive symptoms, negative affect, perceived stress, sleep quality and significantly greater increase in visual memory and healthy lifestyle compared to the control group. In addition, the intervention group demonstrated a significant reduction in first morning salivary cortisol, indicating a reduction in diurnal stress levels, while no significant change of salivary cortisol was observed in the control group. Finally, none of the study's groups demonstrated a significant change in hair cortisol concentration. In conclusion, PSAI can be applied to adults suffering from MDD with significant benefits for their mental health and quality of life. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04536714.

Effects of cognitive-behavioural therapy for stress management on stress and hair cortisol levels in pregnant women: A randomised controlled trial

OBJECTIVE

To demonstrate the effectiveness of a cognitive behavioural therapy for stress management in pregnant women in the reduction of psychological stress and hair cortisol levels.

METHODS

The trial was controlled and randomised, with a total of 78 pregnant women: control group (n-39) and Cognitive Behavioural Therapy group (n-39). To test the therapy's efficacy, an evaluation of the primary outcome (hair cortisol levels) and secondary outcomes (psychological stress, psychopathological symptomatology and resilience) was conducted before and after the treatment. The therapy was conducted during 8 sessions (one per week) in a group setting. The study was registered as a Randomised Controlled Trial with the code NCT03404141.

RESULTS

The results showed a group time interaction between hair cortisol levels, psychological stress (perceived and pregnancy-specific), and in the exacerbation and severity of psychopathological symptoms. These variables presented reductions after treatment only in the Cognitive Behavioural Therapy group.

CONCLUSIONS

Using a novel way of assessing chronic stress (psychological and objective measures as hair cortisol levels), this is the first study that has shown a decrease in both the levels of cortisol in hair and in psychological stress. This decline could have implications for maternal and fetal health.

The effects of Pythagorean Self-Awareness Intervention on breast cancer patients undergoing adjuvant therapy: A pilot randomized controlled trial

Introduction

Breast cancer patients undergo extended treatments that affect their psychological state and quality of life. There is a lack of studies examining the effects of holistic stress management interventions (that combine stress perception, cognitive and lifestyle interventions) on mental health and biological indices (e.g. cortisol concentrations) of breast cancer patients.

Materials and methods

This pilot randomized controlled trial provided the first assessment of the effects of a novel, cognitive-based intervention, the Pythagorean Self-Awareness Intervention (PSAI), on psychological symptoms, quality of life, sleep quality and lifestyle as well as on stress-related biological measures of breast cancer patients undergoing adjuvant therapy. Standardized questionnaires were administered at baseline and 8-weeksafter the intervention to evaluate quality of life, stress, depression, and anxiety (primary outcomes). Sleep quality, lifestyle and hair cortisol concentrations were also assessed (secondary outcomes).

Results

Forty-five breast cancer patients undergoing adjuvant therapy were randomly assigned to the PSAI group (n = 25) or the control group (n = 20).Women in the PSAI group reported significant improvements post-intervention in total Quality of Life, specific aspects of Quality of Life [Physical well-being, Social well-being, Emotional well-being, Functional well-being, Breast cancer concerns] as well as Perceived stress, depression, anxiety and stress. Improvements in secondary outcomes included increase in sleep quality, empowerment for healthy lifestyle and reduction of hair cortisol concentrations.

Conclusions

The PSAI was beneficial as complementary therapy in the women studied. Larger randomized controlled trials with longer follow-up are needed to ascertain these findings.

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Breast cancer patients face physical and psychological cancer-related stressors.

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Pythagorean self-awareness is a novel stress-management intervention (PSAI).

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Breast cancer patients were allocated to PSAI group and control group.

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Mental health, quality of life and sleep were ameliorated in PSAI group.

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Hair cortisol concentrations were reduced significantly in the PSAI group.

Pythagorean self-awareness intervention: A novel cognitive stress management technique for body weight control

BACKGROUND

Over the past decades, the prevalence of obesity has markedly increased worldwide. Stress is recognized as a substantial contributor to increased body weight; therefore, stress management interventions, especially cognitive behavioural, are becoming increasingly popular. The impact of stress management on stress- and obesity-related biomarkers (eg blood lipid profile, HBA1c, inflammatory biomarkers, such as CRP) has been scarcely studied. The aim of this study was to assess the effect of a novel cognitive behavioural stress management intervention, called 'Pythagorean Self-Awareness Intervention' (PSAI), in overweight/obese adults.

MATERIALS AND METHODS

This was a two-armed 1:1 randomized, nonblind controlled study including overweight/obese individuals. The control group followed a personalized Mediterranean low-calorie diet, and the intervention group followed the same diet in addition to the PSAI intervention for 8 weeks. Measurements included demographic, anthropometric (ie BMI, waist-to-hip ratio), stress (ie perceived stress, salivary cortisol), dietary behaviour (ie emotional eating) and metabolic parameters (ie blood lipid profile, HBA1c, CRP, body composition in fat and water). Outcome per-protocol analysis was performed using mixed linear models adjusted for age and gender.

RESULTS

A total of 49 of 62 eligible adults were analysed in the study (there were three dropouts in the intervention group and 10 dropouts in the control group); 28 were assigned to the intervention group (mean age 54.7 ± 11.9 years) and 21 to the control group (mean age 51.8 ± 11.9 years). The intervention group showed a statistically significant decrease in perceived stress, cortisol concentrations 30 minutes after awakening, cortisol's area under the curve, BMI, waist-to-hip ratio, restrained, emotional and external eating behaviour, fasting glucose, LDL, triglycerides, HbA1c and body and trunk fat, compared with the control group. Based on the observed effect sizes, clinically meaningful changes may be more evident in stress perception, restrained and external eating behaviour, Hb1ac and trunk fat. The compliance to the PSAI intervention reached 100%, and there were no adverse effects.

CONCLUSIONS

The PSAI technique may be an effective stress management method for overweight/obese adults. Future and larger randomized controlled studies are needed to allow generalization of these findings.

A novel cognitive-behavioral stress management method for multiple sclerosis. A brief report of an observational study

OBJECTIVES

Psychological stress is an important risk factor for multiple sclerosis (MS) onset, relapse, neurological symptoms and psychosocial adjustment to the disease. Mounting evidence suggests that stress management could halt the disease progression and improve patients' wellbeing. The aim of this study was to investigate the effectiveness of a novel cognitive-behavioral stress management technique (called Pythagorean Self-Awareness Intervention - PSAI) routinely used in our clinics in patients with MS.

METHODS

In this observational study, 148 MS patients receiving PSAI for 8-weeks were compared patients who followed only usual care. Measurements included cognitive function, psychological distress and physical fatigue. Propensity score (PS) methods (given the observational design) and linear mixed models were employed to address study's endpoints.

RESULTS

A total of 128 (86.5%) of MS patients fulfilled the PS criteria for analyses (72 in the PSAI group and 56 in the control group). Patients of tertiary education, longer disease duration, higher cognitive score and psychological distress were more likely to choose to participate in the PSAI group. PSAI patients were found with statistical significant beneficial changes in cognitive speed processing, verbal memory, stress, anxiety, depression and fatigue. Based on the numbers-needed-to-treat of the weighted data, PSAI was particularly effective in improving cognitive speed processing (NNT = 10) and stress (NNT = 12).

DISCUSSION

PSAI can benefit cognitive function and psychological distress in MS patients. Future studies should expand these results in randomized trials and by using longer follow-up and MS activity-related endpoints.

ABBREVIATIONS

BICAMS: Brief International Cognitive Assessment for Multiple Sclerosis BVMT-R: Brief Visuospatial Memory Test Revised CVLT: California Verbal Learning Test DASS: Depression Anxiety Stress Scale EDSS: Expanded Disability Status Scale MS: Multiple Sclerosis NNT: Numbers Needed to Treat PS: Propensity Score PSAI: Pythagorean Self-Awareness Intervention RR: Relapsing Remitting SDMT: Symbol Digits Modalities Test VAS-PF: Visual Analogue Scale Physical Fatigue.