The effects of Chinese calligraphy handwriting and relaxation training in Chinese Nasopharyngeal Carcinoma patients: A randomized controlled trial

Effectiveness of Early Multimodal Non-pharmacological Interventions in Cognitive Preservation in the Elderly

INTRODUCTION

Multimodal non-pharmacological interventions (MNPI) have been determined as effective in delaying cognitive deterioration. The effectiveness of timing of such interventions in elderly is less discussed. We compared the different effectiveness of MNPI in cognitive preservation in elderly subjects with and without dementia.

METHODS

We enrolled volunteer the elderly subjects. Subjects were classified as dementia group and non-dementia group by instrument of ascertainment of dementia 8. All were assigned to attend 3 hours of MNPI (physical fitness training, Chinese capillary, and Chinese drawings and paintings) twice a week over a 16-week period. Neuropsychiatric tests, including Mini-Mental State Examination (MMSE), Cognitive Assessment Screening Instrument (CASI), clinical dementia rating (CDR), and neuropsychiatric inventory (NPI), were administered before and 1 year after MNPI. We demonstrated the changes of cognition and behavioral and psychological symptoms of dementia (BPSD) before and after MNPI. We compared the different effectiveness of cognition preservation between two groups.

RESULTS

In total, there were 43 participants in our study, including 18 with non-dementia and 25 with dementia. The non-dementia group had a significantly higher proportion of cognitive preservation in remote memory (100.0% vs 68.0%, P = .007), orientation (94.4% vs 48.0%, P = .001), drawing (94.4% vs 64.0%, P = .021) and language (77.8% vs 48.0%, P = .049) than the dementia group. The highest proportion of preserved cognition after MNPI was remote memory (100%), followed by orientation (94.4%) and drawing (94.4%) in the non-dementia group. The highest proportion of preserved cognition after MNPI was attention (72%) followed by remote memory (68%), recent memory (64%) and drawing (64%) in the dementia group. Overall, their improved rate in behavioral and psychological symptoms was 55.6%.

CONCLUSION

Our study concluded the benefits of early MNPI in cognition preservation in the elderly, especially in the field of remote memory, orientation, drawing and language.

Mind-Body Therapies for Sleep Disturbance among Patients with Cancer: A Systematic Review and Meta-analysis

OBJECTIVE

s: To assess whether mind-body therapies (MBTs) are effective for relieving sleep disturbance among patients with cancer.

DESIGN

Systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS

Seven English electronic databases were searched from the date of inception to September 2022. All RCTs that included adults (≥18 years) who were treated with mindfulness, yoga, qigong, relaxation, and hypnosis were screened. The outcome was subjective and/or objective sleep disturbance.The revised Cochrane tool (RoB 2.0) was applied to evaluate the risk of bias. The RevMan software was applied to assessed each outcome according different control groups and assessment time points. Subgroup analyses were performed according to different categories of MBTs.

RESULTS

Sixty-eight RCTs (6339 participants) were identified. After requesting for missing data from corresponding authors of included RCTs, 56 studies (5051 participants) were included in the meta-analysis. The meta-analysis showed a significant immediate effect of mindfulness, yoga, relaxation, and hypnosis on subjective sleep disturbance, compared with usual care or wait list control, and the effect of mindfulness lasted at least 6 months. For objective sleep outcomes, we observed significant immediate effects of yoga on wake after sleep onset and of mindfulness on sleep onset latency and total sleep time. Compared with active control interventions, MBTs had no significant effect on sleep disturbance.

CONCLUSIONS

Mindfulness, yoga, relaxation, and hypnosis were effective in sleep disturbance severity reduction among patients with cancer at post-intervention, and the effect of mindfulness lasted at least 6 months. Future MBTs studies should apply both objective and subjective sleep measurement tools.

Calligraphy-based rehabilitation exercise for improving the upper limb function of stroke patients: protocol for an evaluator-blinded randomised controlled trial

INTRODUCTION

A common complication of stroke is upper limb dysfunction. Chinese calligraphy handwriting (CCH) is an aesthetical exercise developed from the traditional way of writing in China and holds potential to become a rehabilitation method to improve upper limb functions in patients with stroke. This study aims to design a randomised controlled trial to assess the effect of a customised CCH-based exercise for poststroke rehabilitation of upper limb dysfunction.

METHODS AND ANALYSIS

A single-blinded randomised controlled trial will be conducted on 60 stroke patients. The patients will be randomly allocated into three groups: (1) conventional occupational therapy (COT) group, (2) COT+CCH group, (3) COT+Graded Repetitive Arm Supplementary Program (GRASP) group. For the COT group, patients will receive COT treatment of 1 hour/day. For the COT+CCH group, patients will receive 30 mins COT treatment and 30 mins CCH training. For the COT+GRASP group, patients will receive 30 mins COT treatment and 30 mins GRASP training. All the interventions will be performed 5 days per week for a total of 3 weeks. The upper limb functions will be assessed before and after the interventions using a series of rating scales.

ETHICS AND DISSEMINATION

This study has been approved by the Research Ethics Committees of the Second Rehabilitation Hospital of Shanghai (study ID: 2020-32-01) and the Shanghai University of Sport (study ID: 102772021RT043). Results will be directly disseminated to the patients at the end of the study and to the public via publications in peer-reviewed journals and presentations in conferences.

TRIAL REGISTRATION NUMBER

ChiCTR 2100043036; Chinese Clinical Trials Registry.

Effectiveness of using calligraphic activity to treat people with schizophrenia: a randomized controlled trial in Southern Taiwan

Background:

Prior research has shown preliminary evidence that calligraphy activity improves various body functions and decreases severity of psychotic symptoms in individuals with schizophrenia. However, major limitations of earlier studies include small and heterogeneous samples. The current large-scale randomized controlled trial examined effects of calligraphy activity on cognition (including attention), emotions, psychotic symptoms, quality of life, and mood in people with schizophrenia.

Methods:

One-hundred-and-fifty patients with schizophrenia were randomly allocated to the treatment group (receiving calligraphy activity) or the control group (receiving general activity), both of which lasted for 24 weeks (70 minutes per session; one session per week). Assessments were conducted at pretest, posttest, and three-month follow-up. The Montreal Cognitive Assessment, Chu’s Attention Test, Depression, Anxiety, and Stress Scale, Positive and Negative Syndrome Scale, World Health Questionnaire on the Quality of Life-Brief Form, and Visual Analogue Scale were used.

Results:

Improved cognition and attention were found in both groups, although no group effects were shown. The treatment group appeared to show lower severity of positive symptoms at follow-up than posttest, whereas the control group appeared to show the opposite pattern. Improved mood was found in the treatment group.

Conclusion:

This study provides evidence regarding effects of calligraphy activity on increasing cognition and potentially decreasing severity of positive symptoms in patients with schizophrenia. Calligraphy activity can be incorporated in clinical occupational therapy and may be provided to supplement medication treatment.

Trial Registration:

ClinicalTrials.gov NCT03882619; https://clinicaltrials.gov/ct2/show/NCT03882619

The Effect of Progressive Relaxation Exercise on Physiological Parameters, Pain and Anxiety Levels of Patients Undergoing Colorectal Cancer Surgery: A Randomized Controlled Study

PURPOSE

This study aimed to determine the effect of progressive relaxation exercises on physiological parameters, pain, anxiety, and serum cortisol levels in patients undergoing colorectal cancer surgery.

DESIGN

This study is a randomized controlled study and has been registered at the Clinical Trial Registry Center (ID: NCT04731428).

METHODS

The study was conducted on 63 patients (experimental group = 31, control group = 32), who were scheduled for elective laparoscopic-colorectal surgery in the general surgery clinic of a university hospital in Istanbul between March 2018 and May 2019 and met the inclusion criteria. The patients in the experimental group were given progressive relaxation exercises for 15 minutes preoperatively and on postoperative days 1, 2, and 3 after breathing exercise training. The routine treatments and care process of the patients in the control group were maintained. The preoperative and postoperative pain and anxiety levels of both groups were evaluated. Blood pressure, heart rate and respiratory rate, oxygen saturation, and serum cortisol levels were measured at certain time intervals before and after the relaxation exercise.

FINDINGS

The patients in the experimental group had lower postoperative pain and anxiety levels and a lower rate of using opioid analgesic on postoperative day 0 compared to the control group. Progressive relaxation exercise had no statistically significant effect on serum cortisol or physiological parameters (P > .05).

CONCLUSIONS

Progressive relaxation exercise did not affect cortisol levels and vital signs but decreased pain and anxiety, and relatively increased tissue oxygenation, appearing an effective, safe, and practicable nursing intervention.

The Use of Islamic Patterned Art Therapy: Healing of Psychological Problems Among University Students

This study was designed to adopt art therapy from an Islamic perspective by adding/including shapes and designs of Islamic origin. This was basically color therapy and was designed to find its effectiveness in reducing depression, anxiety. Stress and enhancing psychological well-being of university students with high and low-religious levels from Islamabad and Rawalpindi. This study was carried out in two phases. The first phase was to develop Islamic adult coloring book with Islamic patterns and calligraphy. The second phase was the main study, and it was an experimental study which included screening out a sample, consisting of mild to moderate levels of depression, anxiety and stress and high and low-religiosity levels. A sample of 60 university students received Islamic patterned art therapy. On the basis of religiosity, two groups were formed as either a high-religious group or a low-religious group with individuals in both groups completing fourteen sessions. Pre- and post-test assessments were undertaken via the psychometric tools DASS-21, psychological well-being scale and religiosity scale. Statistics from the independent sample t-test and paired sample t-test and repeated measures ANOVA for within group and between group comparisons, revealed that there was a significant difference from pre-test to post-test assessments of depression anxiety and stress and psychological well-being, whereas there were nonsignificant gender differences on the bases of high and low-religiosity levels. Therefore, it could be concluded that Islamic patterned art therapy was found effective in reducing depression anxiety stress and increasing psychological well-being of university students.

Effects of Different Finger Grips and Arm Positions on the Performance of Manipulating the Chinese Brush in Chinese Adolescents

This study aimed to investigate the effects of finger grip and wrist position on Chinese calligraphy handwriting (CCH). Thirty participants were recruited in the study and asked to manipulate the Chinese brush using two finger grip methods (three-finger grip and five-finger grip) and two wrist positions (suspended wrist and raised wrist). Three experimental writing tasks were applied to investigate writing stability, agility, and hand–eye coordination, and to evaluate the completion time (s), area of error (cm²), and error times. Subjective responses (arm aching level, ease of grip, exertion level, and comfort) regarding the four combinations of Chinese brush manipulation were measured. The results indicated significantly better performance with the three-finger grip for the stability and agility tests, and with the five-finger grip for the hand–eye coordination task. Using the suspended wrist position for CCH allowed better agility and hand–eye coordination than the raised wrist position. In consideration of the results of the four operational combinations, the three-finger grip with a suspended wrist position demonstrated the best performance in both objective and subjective measurements. It is recommended for application in the early learning stage. These findings can be considered when teaching Chinese brushes for beginners of CCH in schools.

Calligraphy, Psychology and the Confucian Literati Personality

Our research in the past 40 years has identified beneficial effects of Chinese calligraphy handwriting (CCH) practice on visual attention, cognitive activation, physiological slowdown, emotional relaxation and behavioural change. We hypothesised that these outcomes may constitute a compressive set of foundations which could impact several traits of Chinese personality within the context of Confucian culture and values. Here, we give a brief overview of the background of CCH and its effect in the cognitive, physiological and bio-emotional domains. We then provide empirical evidence showing strong association of CCH and personality traits and discuss the results in the contexts of calligraphy practice and Confucian literati personality, Confucianism and Chinese personalities as well as calligraphy writing and tool-using psychological theory.

Framework of treating Alzheimer’s dementia

Current treatment paradigm in Alzheimer’s disease (AD) involves multiple approaches combining pharmacological and nonpharmacological intervention to mitigate the clinical symptoms, slow the progressive loss of cognitive and functional abilities, or modify the disease course. So far, beyond anti-cholinesterase inhibitors (AChEIs), donepezil, rivastigmine, galantamine, and antagonist of N-methyl-D-aspartic acid (NMDA) receptor, there are no newly approved medicines to treat AD. Under pharmacological treatment, the personal characteristic and the intra-individual therapeutic evaluations to examine various cognitive domains, behavioral and psychological problems, and global function should be considered when choosing any of AChEIs. The use of optimal dosage referring to the expected clinical outcomes and currently reported deficits from patient with AD has become an important issue in clinical treatment. Establishing and maintaining a strong therapeutic alliance to physician, patient, and caregiver is crucial and central to the comprehensive care in AD.

Effects of multiple training modalities in the elderly with subjective memory complaints: A pilot study

BACKGROUND

This study investigated the effects of multiple training modalities (MTM) on senior fitness and neuropsychiatric function in the elderly with subjective memory complaints (SMC).

METHODS

This study was conducted in 24 elderly subjects with Clinical Dementia Rating (CDR) score of 0 and instrument of ascertainment of dementia 8 (AD8) score of <2. The participants were classified into SMC (n = 7) and non-SMC (n = 17).All were assigned to receive multiple training modalities (1 hour for each training: physical fitness activities, calligraphy or drawing, and meditation) twice a week over a 16-week period.A series of senior fitness test, and neuropsychiatric tests, namely the Traditional Chinese version Mini-Mental Status Examination (MMSE), Cognitive Assessment Screening Instrument (CASI), and the Center for Epidemiologic Studies Depression Scale (CESD), were conducted before and after the intervention. We compared the differences of pre/posttest-MTM and SMC/non-SMC in senior fitness and the neuropsychological tests.

RESULTS

There was no significant difference between SMC and non-SMC groups in demographic characteristics. MTM showed significant improvement in senior fitness and CESD, but not in CASI and MMSE. Significant change in recent memory subscale of CASI was only observed in SMC group, whereas improvement of partial senior fitness and CESD were observed in both groups.

CONCLUSION

MTM had effects in enhancing senior fitness and improving depressive syndromes in the elderly. MTM contributed to greater improvement in recent memory function in the SMC group than in the non-SMC group.

Sleepless in the hospital: A systematic review of non-pharmacological sleep interventions

OBJECTIVE

Poor sleep is highly prevalent in inpatient medical settings and has been associated with attenuated healing and worsened outcomes following hospitalization. Although nonpharmacological interventions are preferred, little is known about the best way to intervene in hospital settings.

METHOD

A systematic review of published literature examining nonpharmacological sleep interventions among inpatients in Embase, PsycINFO and PubMed in accordance with PRISMA guidelines.

RESULTS

Forty-three of the 1529 originally identified manuscripts met inclusion criteria, encompassing 2713 hospitalized participants from 18 countries comprised of psychiatric and older adult patients living in hospital settings. Main outcomes were subjective and objective measures of sleep duration, quality, and insomnia.

CONCLUSIONS

Overall, the review was unable to recommend any specific intervention due to the current state of the literature. The majority of included research was limited in quality due to lack of controls, lack of blinding, and reliance on self-reported outcomes. However, the literature suggests melatonin and CBT-I likely have the most promise to improve sleep in inpatient medical settings. Additionally, environmental modifications, including designated quiet time and ear plugs/eye masks, could be easily adopted in the care environment and may support sleep improvement. More rigorous research in nonpharmacological sleep interventions for hospitalized individuals is required to inform clinical recommendations.

Long-term Chinese calligraphic handwriting reshapes the posterior cingulate cortex: A VBM study

As a special kind of handwriting with a brush, Chinese calligraphic handwriting (CCH) requires a large amount of practice with high levels of concentration and emotion regulation. Previous studies have showed that long-term CCH training has positive effects physically (induced by handwriting activities) and psychologically (induced by the state of relaxation and concentration), the latter of which is similar to the effects of meditation. The aim of this study was to investigate the long-term CCH training effect on anxiety and attention, as well as brain structure. Participants were 32 individuals who had at least five years of CCH experience and 44 controls. Results showed that CCH training benefited individuals' selective and divided attention but did not decrease their anxiety level. Moreover, the VBM analysis showed that long-term CCH training was mainly associated with smaller grey matter volumes (GMV) in the right precuneus/posterior cingulate cortex (PCC). No brain areas showed larger GMV in the CCH group than the control group. Using two sets of regions of interest (ROIs), one related to meditation and the other to handwriting, ROI analysis showed significant differences between the CCH and the control group only at the meditation-related ROIs, not at the handwriting-related ROIs. Finally, for the whole sample, the GMV of both the whole brain and the PCC were negatively correlated with selective attention and divided attention. The present study was cross-sectional and had a relatively small sample size, but its results suggested that CCH training might benefit attention and influence particular brain structure through mental processes such as meditation.

Does Chinese calligraphy therapy reduce neuropsychiatric symptoms: a systematic review and meta-analysis

BACKGROUND

There are currently no systematic reviews or meta-analyses of Chinese calligraphy therapy (CCT) to reduce neuropsychiatric symptoms. The aim of this systematic review and meta-analysis was to explore the efficacy of CCT for people with neuropsychiatric symptoms.

METHODS

We searched Chinese and English databases, including the Cochrane Central Register of Controlled Trials and Wanfang Data for relevant articles published between the earliest year available and December 2016. The search was limited to randomized controlled trials and controlled clinical studies and the associated keywords were "handwriting," "Chinese calligraphy," "Chinese calligraphy therapy," "Calligraphy exercise," and "Calligraphy training." The 21 articles that met these criteria were used in the analysis. The Joanna Briggs Institute critical appraisal checklist was used to assess methodological quality.

RESULTS

CCT significantly reduced psychosis (10 studies, 965 subjects, standardized mean difference [SMD] = - 0.17, 95% confidence intervals [CI] [- 0.30, - 0.40], Z = 2.60, p < 0.01), anxiety symptoms (9 studies, 579 subjects, SMD = - 0.78, 95% CI [- 0.95, - 0.61], Z = 8.98, p < 0.001), and depressive symptoms (7 studies, 456 subjects, SMD = - 0.69, 95% CI [- 0.88, - 0.50], Z = 7.11, p < 0.001). CCT also significantly improved cognitive function (2 studies, 55 subjects, MD = 2.17, 95% CI [- 0.03, 4.38], Z = 1.93, p = 0.05) and neurofeedback (3 studies, 148 subjects, SMD = - 1.09, 95% CI [- 1.44, - 0.73], Z = 6.01, p < 0.001). The therapy also significantly reduced the positive psychopathological expression of schizophrenia symptoms (4 studies, 287 subjects, SMD = - 0.35, 95% CI [- 0.59, - 0.12], Z = 2.96, p = 0.003) and reduced the negative symptoms of schizophrenia (4 studies, 276 subjects, SMD = - 1.39, 95% CI [- 1.65, - 1.12], Z = 10.23, p < 0.001).

CONCLUSIONS

CCT exerts a curative effect on neuropsychiatric symptoms, but the evidence remains insufficient. A large number of RCTs are needed to facilitate additional systematic reviews of evidence for CCT.

Chinese calligraphy handwriting (CCH): a case of rehabilitative awakening of a coma patient after stroke

INTRODUCTION

This study investigated the efficacy of Chinese calligraphy handwriting (CCH) for the awakening of patients under a vegetative state after stroke. The theories, the instrument, and the treatment protocols were reported. A single case of a severe stroke patient who was in a coma state for 2 years is presented in this study. The objectives were to apply finger writing as a new method to awaken a stroke patient in a coma state and to test the effect of this method in improving the patient's vegetative states over time.

CASE PRESENTATION

A 55-year-old man suffered a severe stroke in 2004 which left him in a coma for 2 years without any systematic rehabilitation. A culture-based finger-writing method of visual-spatial intervention was then applied to improve his condition. The writing tasks involved aided viewing and finger tracing of sets of innovative characters with enriched visual-spatial and movement characteristics. Following regular treatment protocols involving diverse movement and sensory feedback, the patient was awakened after 12 months. As a consequence, the patient showed significant behavioral changes favoring enhanced focusing, alertness, visual scan, visual span, and quickened visual and motor responses. The treatment continued for another 12 months. As the treatment progressed, we gradually observed improvements in his attention span and mental concentration. His eye ball movements - the left eye in particular - were quickened and showed wider visual angularity in his focal vision. Currently, the patient can now watch television, engage in improved visual sighting, and focus on visual-spatial and cognitive-linguistic materials.

CONCLUSION

This CCH method of training by finger tracking has shown its effectiveness in awakening the patient from his coma state and in producing long-term, clinical outcomes that were similar from those that took place 10 years ago. This finding supports the efficacy of the system for clinical improvement of the patient's conditions.

Long-Term Experience of Chinese Calligraphic Handwriting Is Associated with Better Executive Functions and Stronger Resting-State Functional Connectivity in Related Brain Regions

Chinese calligraphic handwriting (CCH) is a traditional art form that requires high levels of concentration and motor control. Previous research has linked short-term training in CCH to improvements in attention and memory. Little is known about the potential impacts of long-term CCH practice on a broader array of executive functions and their potential neural substrates. In this cross-sectional study, we recruited 36 practitioners with at least 5 years of CCH experience and 50 control subjects with no more than one month of CCH practice and investigated their differences in the three components of executive functions (i.e., shifting, updating, and inhibition). Valid resting-state fMRI data were collected from 31 CCH and 40 control participants. Compared with the controls, CCH individuals showed better updating (as measured by the Corsi Block Test) and inhibition (as measured by the Stroop Word-Color Test), but the two groups did not differ in shifting (as measured by a cue-target task). The CCH group showed stronger resting-state functional connectivity (RSFC) than the control group in brain areas involved in updating and inhibition. These results suggested that long-term CCH training may be associated with improvements in specific aspects of executive functions and strengthened neural networks in related brain regions.

Effects of multiple training modalities in patients with Alzheimer's disease: a pilot study

OBJECTIVE

This pilot study investigated the effects of multiple training modalities on cognition, neuropsychiatric symptoms, caregivers' burden, and quality of life in patients with Alzheimer's disease (AD).

PATIENTS AND METHODS

This intervention study was conducted in 24 patients with AD aged ≥65 years with a Clinical Dementia Rating (CDR) score of 0.5-1. The patients were assigned to receive multiple training modalities (1 hour for each training: Tai Chi, calligraphy, and drawing) over a 6-week period in either the experimental group (n=14) or the comparison group (n=10). A series of neuropsychological tests - namely the Traditional Chinese version Mini-Mental Status Examination, Cognitive Assessment Screening Instrument (CASI), Neuropsychiatric Inventory and the Neuropsychiatric Inventory Caregiver Distress Scale, and the Clinical Dementia Rating Sum of Boxes scale - were conducted at the baseline and after the intervention. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) and Zarit Caregiver Burden Scale were used to assess the quality of life and caregivers' burden, respectively. Independent sample t-test and paired sample t-test were used to analyze the data.

RESULTS

After the intervention, the experimental group reported higher scores in the orientation domain of CASI (P=0.007) and in the psychiatry domain of WHOQOL-BREF (P=0.042) compared with the comparison group. Caregivers' distress was significantly decreased in the experimental group (P=0.035) but not in the comparison group (P=0.430).

CONCLUSION

The multiple training modalities improved scores in the orientation domain of CASI and psychiatry domain of WHOQOL-BREF in patients with AD. Moreover, the intervention reduced caregivers' distress.

Effect of Relaxation With Guided Imagery on The Physical and Psychological Symptoms of Breast Cancer Patients Undergoing Chemotherapy

Background:

Breast cancer patients frequently experience psychological distress during the chemotherapy period.

Objectives:

This study aimed to evaluate the effect of relaxation with guided imagery on patients with breast cancer.

Patients and Methods:

A two-group, pretest-posttest, quasi-experimental design with a randomized controlled trial was conducted. Sixty-five breast cancer patients from one medical center in Taiwan were enrolled in the study. These patients were randomly assigned to the experimental group (n = 32) or to the control group (n = 33). Both groups received chemotherapy self-care education, but the experimental group also received relaxation with guided imagery training. The training on relaxation with guided imagery was conducted before chemotherapy, and the patients were supplied with a compact disc detailing the performance of relaxation with guided imagery for 20 minutes daily at home for 7 days after chemotherapy.

Results:

The experimental group showed significant decreases in insomnia (-0.34 ± 0.83, P < 0.05), pain (-0.28 ± 0.58, P < 0.05), anxiety (-3.56 ± 2.94, P < 0.00), and depression (-2.38 ± 2.70, P < 0.00) between the pretest and the posttest. Comparing the two groups, statistically significant differences were found in the overall symptom distress (B = 0.11, P < 0.05), insomnia (B = 0.50, P <0.05), depression (B = 0.38, P < 0.05), and numbness in physical symptoms (B = 0.38, P < 0.05), as well as in anxiety (B = 3.08, P < 0.00) and depression (B = 1.86, P < 0.00) in psychological distress. One week of relaxation with guided imagery can significantly improve the overall symptoms of distress, insomnia, depression, physical symptoms, and anxiety, and can decrease psychological distress.

Conclusions:

Relaxation with guided imagery had a positive effect on mediating anxiety and depression in breast cancer patients.

The Effects of Mind-Body Interventions on Sleep Quality: A Systematic Review

Study Objectives. To evaluate the effect of mind-body interventions (MBI) on sleep. Methods. We reviewed randomized controlled MBI trials on adults (through 2013) with at least one sleep outcome measure. We searched eleven electronic databases and excluded studies on interventions not considering mind-body medicine. Studies were categorized by type of MBI, whether sleep was primary or secondary outcome measure and outcome type. Results. 1323 abstracts were screened, and 112 papers were included. Overall, 67 (60%) of studies reported a beneficial effect on at least one sleep outcome measure. Of the most common interventions, 13/23 studies using meditation, 21/30 using movement MBI, and 14/25 using relaxation reported at least some improvements in sleep. There were clear risks of bias for many studies reviewed, especially when sleep was not the main focus. Conclusions. MBI should be considered as a treatment option for patients with sleep disturbance. The benefit of MBI needs to be better documented with objective outcomes as well as the mechanism of benefit elucidated. There is some evidence that MBI have a positive benefit on sleep quality. Since sleep has a direct impact on many other health outcomes, future MBI trials should consider including sleep outcome measurements.

Quantifying psychological distress among cancer patients in interventions and scales: a systematic review

The management of cancer-related psychological distress has been addressed in numerous studies, which have examined both the development of interventions to alleviate psychological distress as well as scales for evaluating their efficacy. In this systematic review, we examine results from randomized controlled trials (RCTs) on the relative effectiveness of interventions in reducing cancer-related psychological distress and the scales employed to measure this distress. An electronic database search for RCTs of psychological interventions in cancer patients from October 2008 to July 2013 was conducted using PubMed, MEDLINE, and CINAHL. Data was independently extracted and assessed by two researchers. Nineteen RCTs on interventions for psychological distress were identified and analyzed, among which eight studies reported that the interventions had a positive effect and improved the symptoms of psychological distress, and in which seven main instruments were used to measure psychological distress. The most frequently employed interventions were exercise training, cognitive behavioral therapy, and complementary therapy, followed by meeting with a psychologist and a combination of keeping a written journal and peer counseling. The three most frequently employed scales were the Profile of Mood States-Short Form (POMS-SF), Distress Thermometer (DT), and Hospital Anxiety and Depression (HADS). The majority of cancer patients experience considerable psychological and emotional distress at some time during the course of the disease. Reports have shown that interventions such as exercise training, cognitive behavioral therapy, and complementary therapy can assist oncology personnel in alleviating this distress. Future studies should consider optimizing such interventions. The POMS-SF scale, which has frequently been employed to measure the effects of psychological distress, could be incorporated into elements of screening programs for measuring unfulfilled needs, desire for assistance, clinical response, and longitudinal outcomes.

Calligraphy and meditation for stress reduction: an experimental comparison

BACKGROUND

Chinese calligraphic handwriting (CCH) has demonstrated a new role in health and therapy. Meanwhile, meditation is an traditional and effective method for coping with stress and staying healthy. This study compared the effectiveness of CCH and meditation as distinctive and parallel stress reduction interventions.

METHODS

Thirty graduate students and academic staff members in Taiwan who suffered from stress were selected by the General Health Questionnaire and randomly assigned to one of three treatment groups, ie, a CCH group, a meditation group, or a control group, for 8 consecutive weeks. Changes in physiological parameters were measured before, during, and after treatment.

RESULTS

CCH and meditation showed their strength in the respective indices of stress. There was a significant difference in respiratory rate, heart rate, and electromyographic scores between the groups. Comparing pre- and post-effects, a decrease in heart rate and an increase in skin temperature was seen in subjects who practiced CCH. Increased skin temperature and decreased respiratory rate were also seen in subjects who practiced meditation, along with reduced muscle tension and heart rate.

CONCLUSION

CCH and meditation have good effects in stress reduction. CCH is a particularly promising new approach to reducing stress.

Effect of calligraphy training on hyperarousal symptoms for childhood survivors of the 2008 China earthquakes

BACKGROUND

This study investigated the treatment effects of calligraphy therapy on childhood survivors of the 2008 Sichuan earthquakes in the People's Republic of China.

METHODS

In experiment 1, 129 children participated in a 30-day calligraphic training, and 81 children were controls. The Children's Revised Impact of Event Scale was adopted to assess behavioral effects. Experiment 2 involved 41 treatment subjects and 39 controls, with the same procedure as in experiment 1 except that salivary cortisol level was also measured as a physiological indicator.

RESULTS

After 30 days of calligraphy treatment, the arousal symptoms and salivary cortisol levels in the experimental group decreased from 5.72±0.31 and 13.34±2.88 to 4.98±0.31 and 9.99±2.81, respectively. In the control group, there was not a significant decrease from pretest to post-test. In addition, the arousal scores in posttest (4.98±4.39) were significantly lower than midtest (5.71±4.14) for girls; in contrast, for boys, posttest (4.90±4.24) showed little change compared with midtest (5.04±4.36), but both were significantly lower than pretest (6.42±4.59).

CONCLUSIONS

Calligraphy therapy was effective in reducing hyperarousal symptoms among child survivors.

A randomized controlled trial of the effects of brief mindfulness meditation on anxiety symptoms and systolic blood pressure in Chinese nursing students

BACKGROUND

Previous studies suggested that mindfulness meditation effectively reduced stress-related anxiety and depression symptoms, but no research has evaluated the efficacy of mindfulness meditation in nurses and nursing students in China.

OBJECTIVES

To evaluate the effects of brief mindfulness meditation on the anxiety and depression symptoms and autonomic nervous system activity in Chinese nursing students.

DESIGN

A randomized controlled trial.

SETTING

A medical university in Guangzhou, China.

PARTICIPANTS

One hundred and five nursing students were randomly approached by email and seventy-two responded. Sixty recruited students were randomized into meditation and control group (n=30 each) after screening and exclusion due to factors known to influence mood ratings and autonomic nervous system measures.

METHODS

The meditation group performed mindfulness meditation 30 min daily for 7 consecutive days. The control group received no intervention except pre-post treatment measurements. The Self-Rating Anxiety Scale and Self-Rating Depression Scale were administered to participants, and heart rate and blood pressure were measured. Pre- and post-treatment data were analyzed using repeated-measures analysis of variance.

RESULTS

Differences between pre- and post-treatment Self-Rating Anxiety Scale scores were significantly larger in the meditation group than in the control group, but no similar effect was observed for Self-Rating Depression Scale scores. Systolic blood pressure was reduced more after the intervention in the meditation group than in the control group, with an average reduction of 2.2 mmHg. A moderate level of anxiety was associated with the maximum meditation effect.

CONCLUSIONS

Brief mindfulness meditation was beneficial for Chinese nursing students in reducing anxiety symptoms and lowering systolic blood pressure. Individuals with moderate anxiety are most likely to benefit from a short-term mindfulness meditation program.

Sleep disturbance interventions in oncology patients and family caregivers: a comprehensive review and meta-analysis

Sleep disturbance is a significant problem for both oncology patients and family caregivers (FCs), and is associated with poorer functional status, quality of life, and potentially disease progression. This review describes a comprehensive literature search and meta-analysis of the efficacy of interventions for sleep disturbance in oncology patients and their FCs. This search revealed 47 studies that evaluated the effects of a number of interventions on sleep disturbance/sleep quality, as a primary or secondary outcome in oncology patients. The primary purposes of the review were to synthesize findings from intervention studies for sleep disturbance in oncology patients and their FCs; to evaluate the efficacy of these interventions; to identify gaps in the literature; and to provide directions for future research. In addition, all 47 intervention studies were evaluated in terms of key intervention and study characteristics. Both strong patterns and inconsistencies were identified among the studies, which complicate an evaluation of the efficacy of interventions, and may collectively guide future research. Finally, the importance of including the FC in sleep disturbance interventions is discussed. In light of the detrimental effects that sleep disturbance has on both the patient and the FC, this systematic review may better inform essential future intervention efforts.

Cognitive effects of calligraphy therapy for older people: a randomized controlled trial in Hong Kong

Background:

This pilot study investigated the effects of calligraphy therapy on cognitive function in older Hong Kong Chinese people with mild cognitive impairment.

Methods:

A single-blind, randomized controlled trial was carried out in a sample of 31 adults aged 65 years or older with mild cognitive impairment. They were randomly assigned to receive either intensive calligraphy training led by a trained research assistant for eight weeks (calligraphy group, n = 14) or no calligraphy treatment (control group, n = 17). Participants’ cognitive function was assessed by the Chinese version of the Mini-Mental State Examination (CMMSE) before and after calligraphy treatment. Repeated measures analysis of variance and paired samples t-tests were used to analyze the data.

Results:

A significant interaction effect of time and intervention was detected [F (1, 29) = 9.11, P = 0.005, η² = 0.24]. The calligraphy group was found to have a prominent increase in CMMSE global score, and scores in the cognitive areas of orientation, attention, and calculation after two months (ΔM = 2.36, P < 0.01), whereas their counterparts in the control group experienced a decline in CMMSE score (ΔM = −0.41, P < 0.05).

Conclusion:

Calligraphy therapy was effective for enhancing cognitive function in older people with mild cognitive impairment and should be incorporated as part of routine programs in both community and residential care settings.