The relaxation response

A School Nurse's Guide to Migraine

Migraine is a common neurologic disorder associated with considerable pain and disruption of daily function among school children. Given the impact of migraine on academics and social engagement, ensuring robust support in the school setting is vital to the well-being and development of students affected by migraine. School nurses have an active role in providing and coordinating care, acting as the critical link between care providers, families, and educators to promote health among students with migraine. We aim to equip school nurses and educational staff with practical tools for helping students manage migraine pain in the school setting. We suggest a comprehensive approach, including the use of medications, psychological and complementary interventions, and school accommodation plans, with a focus on both prevention and management.

Mindfulness Meditation and Network Neuroscience: Review, Synthesis, and Future Directions

Network neuroscience is an interdisciplinary field, which can be used to understand the brain by examining the connections between its constituent elements. In recent years, the application of network neuroscience approaches to study the intricate nature of the structural and functional relationships within the human brain has yielded unique insights into its organization. In this review, we begin by defining network neuroscience and providing an overview of the common metrics that describe the topology of human structural and functional brain networks. Then, we present a detailed overview of a limited but growing body of literature that has leveraged network neuroscience metrics to demonstrate the impact of mindfulness meditation on modulating the fundamental structural and functional network properties of segregation, integration, and influence. Although preliminary, results across studies suggest that mindfulness meditation results in a shift in connector hubs, such as the anterior cingulate cortex, the thalamus, and the mid-insula. Although there is mixed evidence regarding the impact of mindfulness training on global metrics of connectivity, the default mode network exhibits reduced intraconnectivity following mindfulness training. Our review also underscores essential directions for future research, including a more comprehensive examination of mindfulness training and its potential to influence structural and functional connections at the nodal, network, and whole-brain levels. Furthermore, we emphasize the importance of open science, adoption of rigorous study designs to improve the internal validity of studies, and the inclusion of diverse samples in neuroimaging studies to comprehensively characterize the impact of mindfulness on brain organization.

Effects of Reiki therapy on quality of life: a meta-analysis of randomized controlled trials

PURPOSE

This review aimed to evaluate the therapeutic effects of Reiki therapy on quality of life.

METHODS

The review followed standard scientific journal practices and a systematic search of PubMed, Web of Science, Embase, Scopus, and the Cochrane Library, with a literature cutoff of September 2024, was conducted to identify relevant studies. Inclusion criteria comprised articles published in English, randomized controlled trials (RCT), Reiki therapy as the independent variable, diverse patient populations, and outcome measures focusing on quality of life improvement.

RESULTS

The review involved 661 participants aged 14 years and above, showing a significant enhancement in quality of life post-Reiki therapy (SMD = 0.28, 95% CI 0.01 ~ 0.56, P = 0.043). The subgroup analysis showed that Reiki therapy interventions with a frequency of ≥ 8 sessions and a duration of ≥ 60 min and acute interventions of ≤ 20 min were most effective in improving quality of life.

CONCLUSIONS

The existing meta-analysis and systematic review suggested that Reiki therapy positively impacted quality of life. Therefore, it was recommended that patients with cancer, surgical patients, chronic illnesses, and the general population receive acute Reiki therapy sessions (≤ 20 min) or Reiki therapy with sufficient frequency (≥ 8 sessions) and duration (≥ 60 min) to enhance their quality of life.

SYSTEMATIC REVIEW REGISTRATION

Systematic review registration: PROSPERO CRD 42023483961.

Hindu Spiritual Music for Perioperative Anxiolysis and Stress Modulation: An Open-Label, Randomized Comparative Trial in Lower Limb Surgery Patients

Background Perioperative anxiety is a common concern in patients undergoing regional anesthesia, as they remain conscious during surgery. Various non-pharmacological interventions, including music therapy, have been explored to reduce anxiety and stress response. Spiritual interventions, particularly religious music, have been shown to provide emotional stability and enhance coping mechanisms during stressful situations. Objective This study aimed to evaluate the impact of Hindu religious music compared to patient-selected instrumental music on intraoperative anxiety, stress response, and patient satisfaction in individuals undergoing lower limb surgery under regional anesthesia. Methods This prospective, open-label, randomized controlled trial was conducted at Maharani Laxmi Bai Medical College, a tertiary care teaching hospital in Jhansi, India, after obtaining approval from the Institutional Ethics Committee (Certificate No. 5208/IEC/I/2022-2023) and registration with the Clinical Trials Registry of India (CTRI/2024/01/062006, registered on January 30, 2024). The trial included 150 ASA class 1 or 2 patients undergoing elective lower limb surgery under regional anesthesia. Participants were randomly assigned to two groups: Group A (Hindu spiritual music) and Group B (patient-preferred instrumental music). Music was played intraoperatively via noise-canceling headphones. The primary outcomes were intraoperative anxiety (measured using the Visual Analog Scale for Anxiety (VAS-A)) and serum cortisol levels as a biochemical marker of stress. Secondary outcomes included hemodynamic parameters, additional analgesic requirements, incidence of nausea and vomiting, and patient satisfaction. Results Group A had significantly lower intraoperative VAS-A scores compared to Group B (2.13 ± 0.91 vs. 3.41 ± 1.12; p = 0.01). Serum cortisol levels were also significantly lower in Group A at the end of surgery (28.54 ± 6.11 vs. 32.50 ± 8.82 µg/dL; p = 0.001) and remained lower on the first postoperative day (p = 0.001). The incidence of postoperative nausea and vomiting was significantly lower in Group A (6.8% vs. 17.5%; p = 0.028). Patient satisfaction was also higher in the Hindu spiritual music group (p = 0.03). Conclusion Hindu spiritual music reduced perioperative anxiety, attenuated the stress response, and decreased postoperative nausea and vomiting compared to non-spiritual instrumental music. It should be considered a non-pharmacological intervention in the perioperative period to alleviate anxiety and improve patient comfort. However, the study's findings may have limited generalizability to non-Hindu patients. Future research should explore whether similar benefits are observed in religious individuals listening to music of their own faith and cultural background.

A resiliency intervention adapted for older women with HIV: Results from a pilot randomized controlled trial in the northeastern US

Aging with HIV often results in psychosocial and health-related challenges for women; however, no resiliency interventions exist for older women with HIV (WWH). WWH aged ≥50 were randomized to 10 group sessions of an adapted resiliency intervention or time-matched supportive psychotherapy. Assessments were conducted at three timepoints. Feasibility and acceptability metrics were defined a priori; differences in resilience, stress coping, anxiety, and depression across timepoints were assessed. Overall, 44 WWH enrolled; participants were 58 years old on average, and 56.4% identified as Black/African American. Among those who attended any sessions, all feasibility metrics were met, and the intervention was acceptable. The interaction of study arm and time was associated with significant decreases in depression and a trend toward significant decreases in anxiety. The intervention was not associated with changes in resilience or stress coping. Adjusting delivery modality may further reduce barriers to attendance, improving feasibility and clinical outcomes.

Meditation, Mindfulness, and Prayer: Three Spiritual Modalities Utilized for Healing

This paper describes three spiritual practices utilized for healing. These modalities-meditation, mindfulness, and prayer-share a spiritual foundation and appear to operate, in part, through mind-body connections that can be accessed to ameliorate physical and psychological symptoms and to promote health. For each modality, this paper discusses pertinent conceptual issues, summarizes empirical evidence suggestive of a role in healing, and outlines theoretical support for such a relationship. Also discussed is a fourth modality, energy healing, and how it might be studied, as well as why further investigation of spiritual healing is merited and a worthwhile topic for medical research.

Exploring the Physiological and Psychological Effects of Group Chanting in Australia: Reduced Stress, Cortisol and Enhanced Social Connection

Chanting, an ancient ritual practiced in diverse cultures and traditions worldwide, has typically been employed for meditation, healing, self-awareness, and psychological growth. However, there is little understanding of the physiological and psychological benefits of chanting, and how vocalization might contribute to such effects. This study aimed to determine whether 12-minutes of group chanting, through vocal or silent repetition of the sound "om," would reduce stress and anxiety, while increasing feelings of social connection, and whether vocal chanting would yield stronger effects. Thirty-four participants were randomly assigned to vocal or silent group chanting conditions. Saliva samples were collected before and after chanting to assess cortisol levels, while self-report measures included the State Trait Anxiety Inventory and the Adapted Self-Report Altruism Scale (including additional items on cross-cultural altruism). Following chanting, participants also provided a written description of their experiences. Both vocal and silent chanting resulted in significant decreases in cortisol levels and self-reported anxiety. The reduction in cortisol was similar for vocal and silent chanting, but self-reported anxiety decreased more following vocal chanting. Altruism scores increased following both vocal and silent chanting. However, there was no evidence of altruistic tendencies extending toward people from a culture other than one's own. Results are discussed in relation to the phenomenology of chanting, and to current theory and evidence on the physiological and psychological effects of chanting and singing.

Changes in Brain Waves During Silent Repetition of OM: A Crossover Study from India

Previously, the electroencephalogram (EEG) recorded while listening to repetition of a Sanskrit monosyllable (i.e., OM) was not significantly different from the EEG recorded during control periods. In the present study, fifteen adult volunteers from northern India (all male, average age 25.0 ± 4.9 years) were assessed using monopolar scalp EEG recordings before, during and after (i) silent repetition of a monosyllable (OM), (ii) silent repetition of 'one' and (iii) quiet rest. In (i), (ii) and (iii) breathing was not consciously modified. The participants had an average of five years' experience of focused meditation (dharana), involving awareness directed to the breath. Participants had no prior experience of silent repetition of either 'OM' or 'one'. They were Indian Hindus for whom OM has special spiritual significance, whereas 'one' does not. The sessions were on separate days in random order. The absolute and relative energy of theta waves in the EEG recorded at Pz-A2 increased significantly during repetition of OM compared to the preceding state. There were no changes during silent repetition of 'one' or during quiet rest. Increased energy in the theta band while awake reflects a state of relaxation devoid of effort. Hence, during silent repetition of OM alone there were changes suggestive of effortless relaxation.

[Complementary and integrative medicine in cancer-related fatigue]

The majority of cancer patients experience fatigue during the course of their illness. Fatigue should not be seen as an inevitable consequence of cancer and its treatment. Cancer-related fatigue (CRF) is a multidimensional symptom complex that is influenced by a variety of factors. Complementary medicine approaches offer potentially promising strategies to address this fatigue and can therefore be a valuable addition to conventional therapies.In this narrative review, complementary medicine treatment approaches for tumor-associated fatigue are presented according to the historical development and current scientific evidence. The focus is on methods with the highest current evidence based on the recommendations of national and international guidelines. Therapeutic approaches from mind-body medicine, such as mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), yoga, tai chi, and qigong, as well as acupuncture, acupressure, moxibustion, and phytotherapeutic treatment approaches are presented.In Germany, the complementary therapies listed here are not generally covered by health insurances. However, a few clinics have developed comprehensive programs in mind-body medicine, for which cost coverage has already been obtained. As a result, complementary medical treatments for cancer-related fatigue that adhere to national and international guidelines are typically available only as private services or within the framework of study participation.

Feeling tired versus feeling relaxed: Two faces of low physiological arousal

Human well-being and functioning depend on two fundamental mental states: Relaxation and sleepiness. Relaxation and sleepiness are both assumed to be states of low physiological arousal and negatively correlated. However, it is still unclear how consistent this negative relationship is across different settings and whether it changes before and after an intervention. Here we investigated this intricate relationship between subjective momentary sleepiness and relaxation states by meta-analytically analyzing several data sets from studies using the Relaxation State Questionnaire. We discovered that subjective sleepiness and relaxation were in fact anti-correlated pre-intervention. This anti-correlation provides a quantitative dissociation between sleepiness and relaxation. Thus, even though sleepiness and relaxation both implicate a low arousal level, the two mental states are subjectively experienced in a qualitatively different fashion, and thus reflect distinct underlying constructs. For the post-intervention relationship, this negative correlation could not be consistently found. This indicates that there are aspects of the experimental setting or intervention that introduce changes in the dynamics of the relationship of the two constructs.

Neural consequences of 5-Hz transcranial alternating current stimulation over right hemisphere: An eLORETA EEG study

INTRODUCTION

Transcranial alternating current stimulation (tACS) at 5-Hz to the right hemisphere can effectively alleviate anxiety symptoms. This study aimed to explore the neural mechanisms that drive the therapeutic benefits.

METHODS

We collected electroencephalography (EEG) data from 24 participants with anxiety disorders before and after a tACS treatment session. tACS was applied over the right hemisphere, with 1.0 mA at F4, 1.0 mA at P4, and 2.0 mA at T8 (10-10 EEG convention). With eLORETA, we transformed the scalp signals into the current source density in the cortex. We then assessed the differences between post- and pre-treatment brain maps across multiple spectra (delta to low gamma) with non-parametric statistics.

RESULTS

We observed a trend of heightened power in alpha and reduced power in mid-to-high beta and low gamma, in accord with the EEG markers of anxiolytic effects reported in previous studies. Additionally, we observed a consistent trend of de-synchronization at the stimulating sites across spectra.

CONCLUSION

tACS 5-Hz over the right hemisphere demonstrated EEG markers of anxiety reduction. The after-effects of tACS on the brain are intricate and cannot be explained solely by the widely circulated entrainment theory. Rather, our results support the involvement of plasticity mechanisms in the offline effects of tACS.

Benson relaxation technique to address sleep quality and aggression among patients with bipolar type I disorder: A randomized clinical trial study

Purpose

The present research was conducted to assess the effect of the Benson relaxation technique on sleep quality and aggression among patients with bipolar type I disorder.

Methods

This study was conducted using a randomized clinical trial design with the participation of 60 patients with bipolar type I disorder (30 participants in each group) in Mashhad, Iran (IRCT20220108053659N1). The intervention group received the Benson relaxation technique for 21 days in a row, twice a day (in the morning and evening), under the supervision of an expert psychiatric nurse (On the first day, instruction was given on implementing BRT. In the subsequent days of the intervention, the nurse stayed by the patient's bedside for the entire relaxation process). Aggression and sleep quality were assessed using the Buss-Perry Aggression Questionnaire and Pittsburgh Sleep Quality Index, respectively, before and one week after the completion of the intervention. Data were analyzed using descriptive and inferential statistics (Chi-squared, Fisher's exact test, independent sample t-test, and analysis of covariance).

Results

The participants in the present study were individuals of both genders aged 18 and above. Based on the results, both groups were homogeneous regarding demographic characteristics. Prior to the intervention, the two groups of control and intervention were not significantly different from each other in terms of sleep quality (p = 0.870) and aggression (p = 0.961). After the intervention, in an intergroup comparison, a significant difference was observed between the two groups in terms of the mean difference of aggression (p < 0.001) and sleep quality scores (p < 0.001).

Conclusion

Despite the favorable effect of this intervention, it is necessary to conduct more studies considering the broader aspects of interventions and related variables before including these interventions in the care plan of patients with bipolar type I disorder.

Combined Effects of the Mobile Health (mHealth) Psychoeducation and Benson Relaxation Technique in Reducing the Caregiving Burden of Cancer Patients in Bangladesh: A Protocol for a Randomized Controlled Trial

BACKGROUND

Chronic and noncommunicable diseases, including cancer, are a significant global public health concern. Family members or friends who serve as caregivers significantly contribute to supporting cancer patients without formal medical training. In most cases in Bangladesh, women perform caregiving activities with household responsibilities and lack adequate support from the family and healthcare systems; consequently, they face a significant burden as caregivers. This study aims to assess the effectiveness of combined mobile health (mHealth) psychoeducation and the Benson relaxation technique (BRT) on the caregiving burden among female informal caregivers of cancer patients in Bangladesh.

METHODS

We shall conduct a prospective, open-label, two-arm (1:1), randomized controlled trial in a hospital, focusing on the burden of informal female caregivers of cancer patients in Bangladesh. The combined intervention will be delivered to the intervention group through mHealth starting April 2024 and will span six months. Participants' data will be collected through face-to-face interviews using the Zarit Burden Interview (ZBI), the Hospital Anxiety Depression Scale, and the World Health Organization Quality of Life Bangla Short Instrument. Outcomes will be assessed at the baseline, midline, and endline. We shall employ descriptive statistics such as frequencies, percentages, means, and standard deviations. The t-test or Mann-Whitney U test will be used to compare continuous variables. Additionally, a two-way repeated-measures analysis of variance will be employed to evaluate the outcomes.

RESULTS

Participant enrollment began in January 2024, and recruitment is ongoing. The results of this study will be disseminated through publications and conferences. No external professional writers were involved in writing this manuscript.

CONCLUSION

This study addresses the gap in the assessment of combined interventions for caregiver burden in Bangladesh. These outcomes may provide valuable insights into caregivers' well-being, caregiving responsibilities, and the potential for integrated interventions to reduce the burden, especially among women. If effective, we recommend the national integration of psychoeducation and BRT using mHealth.

The Effect of Benson's Relaxation Technique on Fatigue and Quality of Life of Patients Diagnosed With Heart Failure

Patients with heart failure (HF) reported poor quality of life (QOL) due to different reasons among which fatigue is the most important. Improving QOL is a crucial objective for patients with HF and their primary health care providers. Managing fatigue with medication is not enough. Benson's relaxation technique (BRT) is a complementary therapy used to manage fatigue among different populations with limited studies checking its effect among patients diagnosed with HF. The purpose of this quasi-experimental study was to check the effect of BRT on fatigue and QOL among 140 (68 intervention and 72 control) patients diagnosed with HF. Intervention group performed BRT for 20 minutes twice a day for 2 months. Control group received regular care from their health care providers. At baseline, there were no differences between intervention and control groups regarding fatigue, physical component summary, and mental component summary. At follow-up, intervention group had higher scores in physical and mental component summaries than control group (45.48 ± 10.52 vs 37.97 ± 14.78) and (46.22 ± 8.39 vs 41.01 ± 10.36), respectively. Also, intervention group had lower levels of fatigue than control group (2.54 ± 0.87 vs 6.33 ± 0.61). In conclusion, the use of BRT as a complementary therapy for patients with HF might decrease fatigue level and improve QOL.

Personalized Virtual Reality Compared With Guided Imagery for Enhancing the Impact of Progressive Muscle Relaxation Training: Pilot Randomized Controlled Trial

BACKGROUND

Empirical evidence has shown that virtual reality (VR) scenarios can increase the effects of relaxation techniques, reducing anxiety by enabling people to experience emotional conditions in more vivid settings.

OBJECTIVE

This pilot randomized controlled study aims to investigate whether the progressive muscle relaxation technique (PMRT) associated with a personalized scenario in VR promotes psychological well-being and facilitates the recall of relaxing images more than the standard complementary intervention that involves the integration of PMRT and guided imagery (GI).

METHODS

On the basis of a longitudinal, between-subject design, 72 university students were randomly exposed to one of two experimental conditions: (1) standard complementary procedure (PMRT and GI exposure) and (2) experimental procedure (PMRT and personalized VR exposure). Individuals were assessed by a therapist before and after 7 training sessions based on measures investigating anxiety, depression, quality of life, coping strategies, sense of presence, engagement, and side effects related to VR exposure. Heart rate data were also collected.

RESULTS

Differences in changes between the 2 groups after the in vivo PMRT session conducted by the psychotherapist (T1) were statistically significant for state anxiety (F1,67=30.56; P<.001) and heart rate (F1,67=4.87; P=.01). Individuals in the VR group obtained lower scores both before (t67=-2.63; P=.01; Cohen d=0.91) and after (t67=-7.23; P<.001; Cohen d=2.45) the relaxation session when it was self-administered by participants (T2). A significant reduction in perceived state anxiety at T1 and T2 was observed for both groups (P<.001). After the VR experience, individuals reported feeling higher engagement in the experience than what was mentioned by participants in the GI group (F1,67=2.85; P=.03; ηp2=0.15), and they experienced the environment as more realistic (F1,67=4.38; P=.003; ηp2=0.21). No differences between groups regarding sense of presence were found (F1,67=1.99; P=.11; ηp2=0.11). Individuals exposed before to the VR scenario (T1) referred to perceiving the scenario recalled in-imagination at T2 as more realistic than what those in the GI group experienced (F1,67=3.21; P=.02; ηp2=0.12). The VR group had lower trait anxiety levels than the GI group after the relaxation session during session 7 (T2; t67=-2.43; P=.02).

CONCLUSIONS

Personalized relaxing VR scenarios can contribute to improving relaxation and decreasing anxiety when integrated with PMRT as a complementary relaxation method.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05478941; https://classic.clinicaltrials.gov/ct2/show/NCT05478941.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/44183.

Respiratory function in healthy long-term meditators: a systematic review

BACKGROUND

There is a paucity of data on effects of long-term meditation on respiration. This systematic review summarized selected respiratory function parameters in healthy long-term meditators (LTMs) at rest, during meditation and their associations with meditation practice variables.

METHODS

A systematic search of PubMed, EMBASE (Ovid), Scopus, Proquest Dissertation and Thesis Global databases, CENTRAL, and Google Scholar was performed from year 1950 to August 15th, 2023. Keywords "meditation," "long-term meditation," and respiratory/pulmonary/lung function and spirometry were used. Controlled-trials and observational studies exploring respiratory parameters in healthy LTMs published in English were included. Two independent reviewers selected studies, extracted data, and assessed the quality of the evidence. The Joanna-Briggs Institute Critical Appraisal Tools and the Single-Case Reporting Guideline In BEhavioural Interventions Statement were used to assess the methodological quality of the included studies. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Effect estimates of some outcomes were synthesized using alternative methods and data for other outcomes synthesized narratively as a meta-analysis was not possible.

RESULTS

Nine studies comprising 3 case-control, 3 cross-sectional, and 3 single-subject study designs, involving 433 participants that met the eligibility criteria, were included. Two studies reported slower resting RR among LTMs compared to controls [SMD = - 2.98, 95% CI (- 4.48 to - 1.47), overall-effect (z-score) = 3.88 (p < 0.001), I2 = 69%] with similar trend reported in the third study (MD = - 1.6, p = 0.053). Three studies reported slower RR in LTMs during meditation compared to baseline. Slower resting RR and mean RR change during meditation compared to baseline significantly negatively associated with meditation experience. PEFR was significantly higher in LTMs than controls [MD = 1.67, 95% CI (0.19-3.15), z-score = 2.21 (p = 0.03)]. No significant difference was observed in tidal volume [SDM = 0.93, 95% CI (- 1.13 to 2.99), z-score = 0.89 (p = 0.37), I2 = 96%] and vital capacity [SDM = 1.25, 95% CI (- 0.45 to 2.95), z-score = 1.44 (p = 0.15), I2 = 94%] of LTMs compared to controls.

CONCLUSIONS

Long-term meditation appears to be associated with slower baseline RR, and immediate reduction in RR during meditation, where greater practice amplifies the effects. Evidence on spirometry parameters in LTMs with ≥ 3 years of practice was limited.

A randomized controlled trial to assess the impact of psychoeducation on the quality of life of parents with children with congenital heart defects-Quantitative component

PURPOSE

To develop, implement and assess the results of psychoeducation to improve the QoL of parents with CHD newborns.

METHODS

Participants were parents of inpatient newborns with the diagnosis of non-syndromic CHD. We conducted a parallel RCT with an allocation ratio of 1:1 (intervention vs. control), considering the newborns, using mixed methods research. The intervention group received psychoeducation (Parental Psychoeducation in CHD [PPeCHD]) and the usual routines, and the control group received just the regular practices. The allocation concealment was assured. PI was involved in enrolling participants, developing and implementing the intervention, data collection and data analysis. We followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines.

RESULTS

Parents of eight newborns were allocated to the intervention group (n = 15 parents) and eight to the control group (n = 13 parents). It was performed as an intention-to-treat (ITT) analysis. In M2 (4 weeks), the intervention group presented better QoL levels in the physical, psychological, and environmental domains of World Health Organization Quality of Life instrument (WHOQOL-Bref). In M3 (16 weeks), scores in physical and psychological domains maintained a statistically significant difference between the groups.

CONCLUSIONS

The PPeCHD, the psychoeducational intervention we developed, positively impacted parental QoL. These results support the initial hypothesis. This study is a fundamental milestone in this research field, adding new essential information to the literature.

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.

Effects of immersive virtual reality on sensory overload in a random sample of critically ill patients

Background

Sensory overload and sensory deprivation have both been associated with negative health outcomes in critically ill patients. While there is a lack of any clear treatment or prevention strategies, immersive virtual reality is a promising tool for addressing such problems, but which has not been repetitively tested in random samples. Therefore, this study aimed to determine how critically ill patients react to repeated sessions of immersive virtual reality.

Methods

This exploratory study was conducted in the mixed medical-surgical intermediate care unit of the University Hospital of Bern (Inselspital). Participants (N = 45; 20 women, 25 men; age = 57.73 ± 15.92 years) received two immersive virtual reality sessions via a head-mounted display and noise-canceling headphones within 24 h during their stay in the unit. Each session lasted 30-min and showed a 360-degree nature landscape. Physiological data were collected as part of the participants' standard care, while environmental awareness, cybersickness, and general acceptance were assessed using a questionnaire designed by our team (1 = not at all, 10 = extremely).

Results

During both virtual reality sessions, there was a significant negative linear relationship found between the heart rate and stimulation duration [first session: r(43) = -0.78, p < 0.001; second session: r(38) = -0.81, p < 0.001] and between the blood pressure and stimulation duration [first session: r(39) = -0.78, p < 0.001; second session: r(30) = -0.78, p < 0.001]. The participants had a high comfort score [median (interquartile range {IQR}) = 8 (7, 10); mean = 8.06 ± 2.31], did not report being unwell [median (IQR) = 1 (1, 1); mean = 1.11 ± 0.62], and were not aware of their real-world surroundings [median (IQR) = 1 (1, 5); mean = 2.99 ± 3.22].

Conclusion

The subjectively reported decrease in environmental awareness as well as the decrease in the heart rate and blood pressure over time highlights the ability of immersive virtual reality to help critically ill patients overcome sensory overload and sensory deprivation. Immersive virtual reality can successfully and repetitively be provided to a randomly selected sample of critically ill patients over a prolonged duration.

Respiratory function in healthy long-term meditators: A cross-sectional comparative study

PURPOSE

Respiratory function is thought to improve with long-term meditation. This study aimed to assess respiratory function in a cohort of healthy long-term meditators and non-meditators in Sri Lanka.

METHODS

Respiratory function of healthy, skilled long-term meditators (n = 20) practicing Buddhist meditation consistently >3 years, and age-sex matched non-meditators (n = 20) were assessed by assessing resting respiratory rate, spirometry, breath-holding time and six-minute-walk distance. Data were analyzed with SPSS-23 statistical software.

RESULTS

The long-term meditators; 45% male, mean (SD) total lifetime meditation experience 12.8 (6.5) years, aged 45.8 (8.74) years, BMI 23.68 (2.23) kgm-2, and non-meditators; 45% male, mean (SD) age 45.3 (8.05) years, BMI 23.68 (3.28) kgm-2, were comparable. Long-term meditators had slower resting respiratory rates [mean (SD); 13.35 (1.9) vs. 18.37 (2.31) breaths/minute; p < 0.001], higher peak expiratory flow rates [mean (SD); 9.89 (2.5) vs. 8.22 (2.3) L/s; p = 0.03], and higher inspiratory breath-holding times [mean (SD); 74 (29.84) vs. 53.61 (26.83) seconds, p = 0.038] compared to non-meditators. There was no significant difference in the six-minute-walk distance and estimated maximal oxygen consumption between the two groups.Resting respiratory rate of long-term meditators, showed a significant negative correlation with total lifetime meditation practice in years (r = -0.444, p = 0.049), and the average length of a meditation session per day (r = -0.65, p = 0.002). The long-term meditators with longer duration of retreat participation demonstrated lower resting respiratory rate (r = -0.522, p = 0.018) and higher tidal volumes (r = 0.474, p = 0.04).

CONCLUSIONS

Long-term meditators had significantly slower resting respiratory rates and longer breath-holding times, with better spirometry parameters than non-meditators. Greater practice duration and retreat experience appear to be associated with improved resting respiratory function in long-term meditators.

Adapting, testing, and refining a resilience intervention for older women with HIV: An open pilot study

Half of persons with HIV in the United States (US), many of whom are women, are over age 50. Aging women with HIV (WWH) face unique biopsychosocial challenges, including stigma, the physiological effects of aging, and illness-associated stressors. Resilience interventions can build awareness of such stressors and aid in facilitating the relaxation response; however, no existing interventions specifically cater to the needs of older WWH. The content of the Relaxation Response Resiliency Program, which teaches positive psychology strategies, relaxation techniques, and cognitive behavioral skills, was adapted for older WWH. Thirteen WWH over 50 participated in an open pilot of the adapted intervention to iteratively refine the program and its procedures. Participants attended either 8 or 10 weekly group sessions; three groups were conducted in total. Pre- and post-intervention assessments and qualitative exit interviews were conducted. Among completers, an increase in resilience was observed. Though significance testing was not conducted, social support also increased, and depression, anxiety, and HIV stigma decreased from pre- to post-intervention. Over half of eligible women enrolled; completers reported high satisfaction with the program. However, retention was difficult; six participants withdrew or were lost to follow-up. Mean number of sessions attended was 3.5 in the 8-session group and 5 in the 10-session groups. In this small sample, the adapted intervention led to a clinically meaningful increase in resilience, though recruitment and retention were challenging. Further refinements to the intervention are needed to minimize attrition and increase acceptability before additional testing is initiated.

Psychological Approaches for Migraine Management

Migraine headaches are among the most prevalent and disabling pain conditions worldwide. Best-practice migraine management is multidisciplinary and includes the psychological approaches to address cognitive, behavioral, and affective factors that worsen pain, distress, and disability. The psychological interventions with the strongest research support are relaxation strategies, cognitive-behavioral therapy, and biofeedback, though the quality of clinical trials for all psychological interventions needs continued improvement. The efficacy of psychological interventions may be improved by validating technology-based delivery systems, developing interventions for trauma and life stress, and precision medicine approaches matching treatments to patients based on specific clinical characteristics.

Social Determinants of Health: Implications for Voice Disorders and Their Treatment

PURPOSE

Adverse childhood experiences (ACEs) and related conditions, such as discrimination, are social determinants of health (SDOHs). Critical race theory (CRT) is a lens through which to understand SDOHs in a way that may impact our clinical care. When prolonged or chronic, SDOHs might cause toxic stress and trauma, which, in turn, adversely affect health and are shown to be relevant for some voice disorders. The goals of this tutorial are to (a) review the literature on SDOHs that potentially contribute to disparities; (b) discuss explanatory models and theories that describe how psychosocial factors influence health; (c) relate the foregoing information to voice disorders, highlighting functional voice disorders (FVDs) as a particular case in point; and (d) describe how trauma-informed care can improve patient outcomes and advance health equity for vulnerable populations.

CONCLUSIONS

This tutorial concludes with a call for heightened awareness of the role that SDOHs such as structural and individual discrimination may play in voice disorders, and a call for research into SDOHs, traumatic stress, and health disparities in this patient population. A call is also made for more universal practice of trauma-informed care in the clinical voice domain.

Personalized, Naturalistic Virtual Reality Scenarios Coupled With Web-Based Progressive Muscle Relaxation Training for the General Population: Protocol for a Proof-of-Principle Randomized Controlled Trial

BACKGROUND

Virtual reality (VR) is an innovative tool that can facilitate exposure to either stressful or relaxing stimuli and enables individuals who have difficulties visualizing scenes to be involved in a more realistic sensorimotor experience. It also facilitates multisensory stimulation, a sense of presence, and achievement of relaxation. VR scenarios representing visual and auditory elements of natural relaxing environments can facilitate the learning of relaxation techniques such as the progressive muscle relaxation technique (PMRT). A complementary standardized technique deployed to reduce anxiety symptoms is the integration of PMRT and guided imagery (GI). Exposure to a pleasant imaginary environment helps the establishment of an association between a relaxing scenario and the relaxation technique, consequently promoting relaxation. Empirical evidence has shown that VR scenarios can increase the effects of relaxation techniques by enabling people to experience emotional conditions in more vivid settings.

OBJECTIVE

The main aim of this pilot study protocol is to investigate the impact on state anxiety of PMRT, associated with a personalized relaxing scenario in VR, and the role of VR scenarios in facilitating the recall of relaxing images and a sense of presence. A secondary aim is to understand if relaxing sessions administered via Zoom are more effective for managing anxiety and stress than a procedural setting based on audio-track guidance.

METHODS

Based on a longitudinal, between-subject design, 108 university students will be randomly exposed to one of three experimental conditions: (1) PMRT via Zoom and GI exposure, (2) PMRT via Zoom and personalized VR exposure, and (3) PMRT based on audio-track guidance and personalized VR exposure. Individuals are assessed before and after 7 training sessions based on self-report questionnaires investigating anxiety, depression, quality of life, coping strategies, sense of presence, engagement, and side effects related to VR exposure. Heart rate data are also detected by an Mi Band 2 sensor.

RESULTS

The experimental procedure is ongoing. In this paper, preliminary data from a sample of 40 participants will be illustrated. The experimental phase is expected to conclude in May 2023, and the final results of the research will be presented in June 2023.

CONCLUSIONS

The results of this study will help shape the experimental design to apply it on a subsequent randomized controlled trial, also considering clinical samples. This work is expected to measure whether VR is a more engaging and helpful technique in promoting relaxation and decreasing anxiety levels than GI, by making the visualization process easier and by helping people to face more realistic sensory experiences. Assessing the efficacy of the PMRT in alternative delivery modes may extend its applications, especially in situations where the standard procedure is more challenging to be administered. To our knowledge, no equivalent study has been published so far on this matter.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05478941; https://clinicaltrials.gov/ct2/show/NCT05478941.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/44183.

A comparative study of well-being, resilience, mindfulness, negative emotions, stress, and burnout among nurses after an online mind–body based intervention during the first COVID-19 pandemic crisis

Background

To mitigate against the possible adverse effects of stress among nurses due to the COVID-19 outbreak, we designed a 12-week mind–body based online intervention program to promote well-being and prevent stress-related disorders such as burnout. Our study aimed to compare the impact of the intervention on perception of stress, negative emotions, burnout, mindfulness, resilience, and well-being at pretest and 6 months post-intervention and to compare the effect among nurses working at two different hospitals.

Methods

We conducted an uncontrolled trial using a convenience sample of nurses working at two hospitals in Mexico: one designated to treat confirmed COVID-19 patients (COVID-hospital) and the other whose patients had a negative COVID-19 test on admission (Non COVID-hospital). The 12 week online intervention consisted of 36 mind–body based micropractices, with subjective well-being as the primary outcome. Secondary outcomes were health perception, resilience, mindfulness, negative emotions, stress, and burnout.

Results

A pretest survey was completed by 643 nurses. Of the remaining valid responses, 82% were women, with a mean age of 34.8 (SD = 8.95) years old. For the analysis two groups of nurses were sampled by cluster: a COVID-hospital group of 429 (67%) nurses, and a non-COVID Hospital group of 214 (33%) nurses. The proportion lost to follow-up was 71% at postest (n = 188) and 42% at 6 months follow-up (n = 371). At pretest, non-COVID hospital nurses had lower subjective well-being and higher burnout than their COVID hospital counterparts. At postest, non-COVID hospital nurses displayed more negative emotions than their COVID hospital peers. At 6 months post-intervention, nurses experienced improved mindfulness, reduced negative emotions and stress, but a decrease in subjective well-being and resilience. Nurses working at the non-COVID hospital had significantly higher mean scores for burnout than those working at the COVID hospital.

Conclusion

The results of our study suggest that our online mind–body interventions can help to reduce stress and negative emotions, yet the effects on subjective well-being and resilience are uncertain. Further research is needed to gain a better understanding of their potential mechanisms and the associated efforts of such online interventions.

Clinical Trial Registration

ClinicalTrials.gov, NCT05515172.

A systematic review and meta-analysis of mindfulness-based stress reduction for arterial hypertension

Arterial hypertension is a major public health issue. Non-pharmacological approaches like Mindfulness-Based Stress Reduction (MBSR) might be a promising addition to conventional therapy. This systematic review and meta-analysis aim to evaluate the effects of MBSR on systolic (SBP) and diastolic blood pressure (DBP) among individuals with prehypertension or hypertension. We searched Medline/PubMed, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) from their inception until August 1st 2021. RCTs were included that compared MBSR to any control intervention in participants with diagnosed prehypertension (120-139/80-89 mmHg) or hypertension (≥140/≥90 mmHg). Mean differences (MD) and 95% confidence intervals (CI) were calculated. Risk of Bias was assessed using the Cochrane tool. Seven RCTs with 429 participants were included. Very low quality of evidence was found for positive effects of MBSR on SBP (MD = -11.26 mmHg, 95%CI = -20.24 to -2.29, p = 0.01) but no evidence for effects on DBP levels (MD = -3.62 mmHg, 95%CI = -8.52 to 1.29, p = 0.15) compared to waitlist control. Compared to active control, very low quality of evidence was found for positive effects on DBP (MD = -5.51 mmHg, 95%CI = -10.93 to -0.09, p = 0.05) but no effects on SBP levels (MD = -4.33 mmHg, 95%CI = -12.04 to 3.38, p = 0.27). Overall, the studies showed a high degree of heterogeneity. The effects found were robust against selection, detection, and attrition bias. Only one RCT reported safety data. MBSR may be an option for lowering blood pressure in people with prehypertension to hypertension. More and larger high-quality studies are needed to substantiate our findings.

An exploratory study of hypnosis-induced blood count changes in chronically stressed individuals

Hypnosis is a clinically accepted relaxation technique known for stress reduction. Results from hematological research provide evidence of changes in blood components through hypnosis. However, these hematological effects have been rarely examined. Hence, we exploratively investigated the effect of a single relaxation hypnosis on the hemogram in stressed individuals, assuming a reduction of leukocytes, thrombocytes, and erythrocytes (primary outcomes). Additionally, a reduction in the erythrocyte-related parameters (hemoglobin, hematocrit), and an increase in plasma volume was hypothesized (secondary outcomes). Forty-four either individuals (89 % women) with chronic stress and moderate to high hypnotic suggestibility were randomized to a hypnosis condition (20 min relaxation hypnosis; n = 20) or a control condition (20 min documentary; n = 24). Venous blood was drawn before and after the intervention and used to generate a differential hemogram and determine the plasma volume. The relaxation hypnosis led to a significant reduction in erythrocytes (Cohen's d=0.23) and consequently to a decrease in erythrocyte-related parameters (hemoglobin, d=0.27; hematocrit, d=0.37) as well as to a reduction in thrombocytes (d=0.15) in the hypnosis compared to the control condition. Putatively, this could be the consequence of an increased plasma volume (d=0.10), estimated by the hematocrit concentration and body weight. A hypnosis-induced change in leukocyte count could not be confirmed. Thus, a single session of relaxation hypnosis already alters specific blood count parameters. While relaxation-induced vasodilatation might explain these changes, it is still not completely clear how these changes affect our stress response system.

Finding and doing what matters most: Five productivity strategies for physicians in academic medicine

While structural change is needed to address the burnout epidemic among healthcare workers, it is important for physicians to avail themselves of the many productivity strategies that can help them succeed in navigating the multiple responsibilities of academic medicine. We present here 5 key strategies within our control that can help increase productivity in the pursuit of work in academic medicine that is meaningful and sustainable: (1) Clarify Priorities, (2) Track Tasks Systematically, (3) Focus and Monotask, (4) Invest in Timesavers, and (5) Celebrate Successes. The specific tools listed under each strategy may help academic physicians feel grounded and maintain our focus on doing meaningful work. While system-wide culture change around expectations, and institutional support for physician wellbeing, is more critical than ever, individual physicians can still benefit from learning strategies to prioritize, track, focus on, delegate and celebrate the work that matters to us in our lives.

Physical Exercise Effects on Cardiovascular Autonomic Modulation in Postmenopausal Women-A Systematic Review and Meta-Analysis

BACKGROUND

The cardioprotective effect of physical exercise has been demonstrated in several studies. However, no systematic or updated analysis has described the effects of physical exercise on cardiovascular autonomic modulation in postmenopausal women.

AIM

to describe the effects of physical exercise on cardiovascular autonomic modulation in postmenopausal women.

METHODS

The Scopus, PubMed, and Embase databases were searched for randomized clinical trials published between January 2011 and December 2021, and regarding the effects of physical exercise on cardiovascular autonomic modulation in postmenopausal women. Two independent authors processed the citations. The methodological quality was evaluated using the PEDRo scale.

RESULTS

Of the 91 studies identified, only 8 met the inclusion criteria, of which 7 had fair or poor methodological quality. The analyzed studies investigated the effects of functional training, whole-body vibration, muscular resistance, stretching, and aerobic exercises performed at home or at the gym. The majority of these exercise modalities showed improvements in heart-rate variability (HRV) indices and in the low-frequency band of blood pressure variability. The meta-analysis shows that exercise increased the standard deviation of instantaneous beat-to-beat variability (SD1) (mean difference (MD) = 3.99; 95% confidence interval (CI) = 1.22 to 6.77, n = 46; I²: 0%) and the standard deviation of long-term variability (SD2) (MD = 11.37; 95% CI = 2.99 to 19.75; n = 46; I²: 0%).

CONCLUSIONS

Aerobic exercise and some nonconventional training modalities may have beneficial effects on cardiovascular autonomic modulation in postmenopausal women. More high-quality studies are still needed to further confirm their efficacy and safety.

Evaluation of a Distance Reiki Program for Frontline Healthcare Workers' Health-Related Quality of Life During the COVID-19 Pandemic

Background

Reiki is a biofield therapy which is based on the explanatory model that the fields of energy and information of living systems can be influenced to promote relaxation and stimulate a healing response.

Objective

To conduct a pragmatic within-subject pilot trial of a remote Reiki program for frontline healthcare workers' health-related symptoms during the COVID-19 pandemic.

Methods

Healthcare professionals in the UK (eg, physicians, nurses, and paramedics) were eligible to sign up for a distance Reiki program and were also invited to participate in the research study. Eight Reiki practitioners simultaneously gave each participant Reiki remotely for 20 minutes on 4 consecutive days. Feasibility of the research was assessed, including recruitment, data completeness, acceptability and intervention fidelity, and preliminary evaluation of changes in outcome measures. Participants' stress, anxiety, pain, wellbeing, and sleep quality were evaluated with 7-point numerical rating scales. Measures were completed when signing up to receive Reiki (pre) and following the final Reiki session (post). Pre and post data were analyzed using Wilcoxon signed ranks tests.

Results

Seventy-nine healthcare professionals signed up to receive Reiki and took the baseline measures. Of those, 40 completed post-measures after the 4-day intervention and were therefore included in the pre-post analysis. Most participants were female (97.5%), and the mean age was 43.9 years old (standard deviations = 11.2). The study was feasible to conduct, with satisfactory recruitment, data completeness, acceptability, and fidelity. Wilcoxon signed ranks tests revealed statistically significant decreases in stress (M = -2.33; P < .001), anxiety (M = -2.79; P < .001) and pain (M = -.79; P < .001), and significant increases in wellbeing (M = -1.79; P < .001) and sleep quality (M = -1.33; P = .019).

Conclusions

The Reiki program was feasible and was associated with decreased stress, anxiety and pain, and increased wellbeing and sleep quality in frontline healthcare workers impacted by the COVID-19 pandemic.

Health professionals' perspectives of integrating meditation into cardiovascular care: A descriptive qualitative study

Preliminary research suggests that meditation may provide benefits in psychological health and well-being in people with cardiovascular disease (CVD). However, little is known about health professionals' perceptions of the barriers and facilitators to integrating meditation into CVD. A descriptive qualitative study design with semi-structured interviews was used to explore the acceptability of integrating meditation into outpatient CVD programs and the organisational factors that may affect its integration. Clinicians were recruited through purposive and snowball sampling. E-mail addresses were obtained from publicly listed profiles of cardiovascular and relevant health organisations. Interview questions included perspectives of organising or delivering meditation within a health setting, format of meditation delivery, organisational or other factors that facilitate or present barriers to integrating meditation into clinical practice, and perceived risks associated with integrating meditation in clinical settings. Verbatim transcripts were thematically analysed using an inductive approach and the Braun and Clarke (2006) method to identify themes within barriers and facilitators to implementation. Eighteen predominately female (61%) senior nursing and medical professionals (61%), as well as health managers (17%), psychologists (11%) and allied health professionals (11%), aged 40-60 years were interviewed between 18 May 2017 and 29 March 2018 in Australia via telephone, or face-to-face at a university or the participants' workplace. Three key themes were identified including: enhancing awareness of meditation within a biomedical model of care, building the evidence for meditation in CVD and finding an organisational fit for meditation in cardiovascular care. Meditation was perceived to sit outside the existing health service structure, which prioritised the delivery of medical care. Health professionals perceived that some physicians did not recognise the potential for meditation to improve cardiovascular outcomes while others acknowledged meditation's positive benefits as a safe, low-cost strategy. The benefits of meditation were perceived as subjective, based on preliminary evidence. Health professionals perceived that aligning meditation with health organisational objectives and integrating meditation into outpatient cardiac rehabilitation and community-based secondary prevention pathways is needed. A fully powered clinical trial is required to strengthen the evidence regarding the role of meditation for psychological health in CVD. Generating clinician engagement and support is necessary to enhance awareness of meditation's use in cardiovascular secondary prevention.

How Chanting Relates to Cognitive Function, Altered States and Quality of Life

Chanting is practiced in many religious and secular traditions and involves rhythmic vocalization or mental repetition of a sound or phrase. This study examined how chanting relates to cognitive function, altered states, and quality of life across a wide range of traditions. A global survey was used to assess experiences during chanting including flow states, mystical experiences, mindfulness, and mind wandering. Further, attributes of chanting were assessed to determine their association with altered states and cognitive benefits, and whether psychological correlates of chanting are associated with quality of life. Responses were analyzed from 456 English speaking participants who regularly chant across 32 countries and various chanting traditions. Results revealed that different aspects of chanting were associated with distinctive experiential outcomes. Stronger intentionality (devotion, intention, sound) and higher chanting engagement (experience, practice duration, regularity) were associated with altered states and cognitive benefits. Participants whose main practice was call and response chanting reported higher scores of mystical experiences. Participants whose main practice was repetitive prayer reported lower mind wandering. Lastly, intentionality and engagement were associated with quality of life indirectly through altered states and cognitive benefits. This research sheds new light on the phenomenology and psychological consequences of chanting across a range of practices and traditions.

Investigating the role of auditory and visual sensory inputs for inducing relaxation during virtual reality stimulation

Stress is a part of everyday life which can be counteracted by evoking the relaxation response via nature scenes presented using immersive virtual reality (VR). The aim of this study was to determine which sensory aspect of immersive VR intervention is responsible for the greatest relaxation response. We compared four conditions: auditory and visual combined (audiovisual), auditory only, visual only, and no artificial sensory input. Physiological changes in heart rate, respiration rate, and blood pressure were recorded, while participants reported their preferred condition and awareness of people, noise, and light in the real-world. Over the duration of the stimulation, participants had the lowest heart rate during the audiovisual and visual only conditions. They had the steadiest decrease in respiration rate and the lowest blood pressure during the audiovisual condition, compared to the other conditions, indicating the greatest relaxation. Moreover, ratings of awareness indicated that participants reported being less aware of their surroundings (i.e., people, noise, light, real environment) during the audiovisual condition versus the other conditions (p < 0.001), with a preference for audiovisual inputs. Overall, the use of audiovisual VR stimulation is more effective at inducing a relaxation response compared to no artificial sensory inputs, or the independent inputs.

Assessing momentary relaxation using the Relaxation State Questionnaire (RSQ)

Stress is ubiquitous in everyday life and hazardous for mental and physical health. To prevent or ameliorate stress-related disease, relaxation exercises aim to counteract stress by inducing short-lasting states of relaxation on a regular basis. Critically, current assessments capture the mid- and long-term consequences of relaxation, however, cannot measure its short-term effects on an individual’s momentary psychological state. To address this problem, we developed the Relaxation State Questionnaire (RSQ). We assessed the psychometric quality of the questionnaire by investigating its item properties, reliability, and validity in an online study with 92 participants. Construct validity was examined through correlations with the Perceived Stress Questionnaire (PSQ; Fliege in 10.23668/PSYCHARCHIVES.2889, 2009). An exploratory factor analysis revealed four factors capturing the momentary state of muscle tension, sleepiness, cardiovascular activity, and general relaxation. In a second online study with 99 participants, we conducted a confirmatory factor analysis. Results revealed high item loadings (0.70–0.91), excellent reliability (α = 0.86) and excellent fit indices, and a good construct validity of the RSQ. These findings establish the RSQ as a tool to measure momentary states of relaxation. As such, the RSQ opens up research of the immediate subjective effects and the effectiveness of relaxation exercises.

Do Placebos Primarily Affect Subjective as Opposed to Objective Measures? A Meta-Analysis of Placebo Responses in Insomnia RCTs

INTRODUCTION

Little is known about the relative magnitude of placebo responses on objective and subjective measures of sleep continuity. To address this issue, the pre-post effects of placebos on objective and subjective measures (i.e., polysomnography [PSG] and sleep diaries) were evaluated meta-analytically. The guiding hypothesis was that large responses would be observed on sleep diary measures and small responses would be observed on PSG measures.

METHODS

PubMed searches, 1967-2016, yielded 329 possible articles, 17 of which met the inclusion and exclusion criteria for the present analysis (including 879 subjects with PSG data, 1,209 subjects with diary data, and six studies with both PSG and sleep diary data). Average change and weighted effect sizes (ESs) were computed via modeling for sleep latency (SL), wake after sleep onset (WASO) and total sleep time (TST).

RESULTS

Pre-to-post change on PSG measures were: SL -13.7 min., ES = -0.37; WASO -14.3 min., ES = -0.36; and TST 29.8 min., ES = 0.50. Pre-to-post change on sleep diary measures were: SL -13.5 min., ES = -0.36; WASO -13.3 min., ES = -0.20; and TST 25.5 min., ES = 0.36. The modeled average objective subjective difference per sleep continuity measure was less than 5 minutes. The modeled average objective subjective difference per sleep continuity measure (in effect sizes) was less than 0.17.

DISCUSSION

The observed outcomes of this analysis suggest that placebos produce comparable effects on objective and subjective measures of sleep continuity. Thus, objective measures do not appear to protect against placebo responses. This being the case and given the importance of the subjective experience of illness severity and recovery, such data suggests that prospectively sampled sleep continuity data (sleep diaries) may be the optimal data for clinical trials, particularly when only one measure is possible.

Effect of 4-Week Heartfulness Meditation on Stress Scores, Sleep Quality, and Oxidative and Inflammatory Biochemical Parameters in COVID-19 Patients after Completion of Standard Treatment - A Randomized Controlled Trial

Context

COVID-19-affected patients showed increased stress, impaired sleep quality, altered complete blood count, and increased inflammatory and oxidative parameters. Yoga is an add-on nonpharmacological treatment that is established to normalize the abovementioned parameters. Heartfulness meditation is a form of Raja yoga.

Aims

The present study aimed to study the effects of 4 weeks of heartfulness meditation on the abovementioned parameters in COVID-19 patients following treatment completion.

Settings and Design

The present study was a randomized controlled trial carried out in the Department of Physiology, AIIMS, Mangalagiri, Andhra Pradesh.

Subjects and Methods

Out of 50 COVID-19 treatment-completed patients recruited for the study, 25 were randomly assigned to the study group who received 4-week app-based heartfulness meditation. Other 25 patients were assigned to the control group who received app-based relaxation for 4 weeks. Perceived stress score, Pittsburgh Sleep Quality Index questionnaire, baseline cardiovascular parameters, complete blood count, serum cortisol, inflammatory parameters, oxidative stress parameters, and antioxidant parameters were assessed before and after 4 weeks of intervention in both the groups. The outcome assessor was blinded in the present study.

Statistical Analysis Used

The mean difference between the two groups was tested using the Student's t-test or Mann-Whitney U-test based on data distribution. Effect of intervention was analyzed using paired Student's t-test for dependent samples test or Wilcoxon signed-rank test based on data distribution.

Results

The groups were comparable before intervention for all the variables. After 4 weeks of intervention, we observed a significant decrease in stress, circulating cortisol, inflammatory markers, and oxidative stress biomarker in both the groups. Further, we observed improved sleep quality and antioxidant biomarkers in both the groups. These beneficial alterations following intervention were high in the study group compared to the control group.

Conclusions

Our results suggest that app-based heartfulness meditation/relaxation can be used as a nonpharmacological adjuvant to hasten the recovery process in patients who have completed the COVID-19 treatment protocol. Beneficial effects in subjects practicing heartfulness meditation were more than that observed in subjects practicing relaxation.

Impact of hypnosis on psychophysiological measures: A scoping literature review

Exploring psychophysiological changes during hypnosis can help to better understand the nature and extent of the hypnotic phenomenon by characterizing its influence on the autonomic nervous system (ANS), in addition to its central brain effects. Hypnosis is thought to induce a relaxation response, yet studies using objective psychophysiological measures alongside hypnosis protocols show various results. We review this literature and clarify the effects of hypnosis on psychophysiological indices of ANS activity and more specifically of the stress/relaxation response, such as heart rate variability and electrodermal activity. Studies reporting psychophysical measures during hypnosis were identified by a series of Pubmed searches. Data was extracted with an interest for the influence of hypnotizability and effects of specific suggestions or tasks on the findings. We found 49 studies comprising 1315 participants, 45 concerning healthy volunteers and only 4 on patients. Sixteen compared high vs. low hypnotizable people; 30 measured heart rate, 18 measured heart rate variability, 25 electrodermal activity, and 23 respiratory signals as well as other physiological parameters. Globally, results converge to show reductions in sympathetic responses and/or increases in parasympathetic tone under hypnosis. Several methodological limitations are underscored, such as older studies (N = 16) using manual analyses, small sample sizes (<30, N = 31), as well as uncontrolled multiple comparisons. Nevertheless, we confirm that hypnosis leads to a physiological relaxation response and highlight promising avenues for this research. Suggestions are made for guiding future work in this field.

Effect of progressive muscle relaxation on postoperative pain, fatigue, and vital signs in patients with head and neck cancers: A randomized controlled trial

OBJECTIVE

Surgery for head and neck cancers are associated with significant preoperative stress. We investigated the effects of progressive muscle relaxation (PMR) on postoperative pain, fatigue, and vital signs in patients with head and neck cancers.

METHODS

All patients were hospitalized and randomly assigned to intervention or usual care groups. A generalized estimating equation was used to evaluate the PMR effects on pain and symptoms across the preoperative day to postoperative day 10.

RESULTS

The PMR group displayed significantly lower overall pain and muscle tightness than control group along with the timeline of multiple measurements (p < 0.01). PMR significantly reduces sleep disturbances and levels of fatigue, anxiety, and depression compared with the control group with time trend (p < 0.01). PMR also lowered the respiratory rates and diastolic blood pressure (p < 0.01).

CONCLUSIONS

PMR can reduce sleep disturbances and levels of pain, fatigue, muscle tightness, anxiety, and depression in patients with head and neck cancer undergoing major surgeries. Future study should focus on improving the effectiveness of the exercise and standardization of the application.

PRACTICAL IMPLICATIONS

progressive muscle relaxation help relieve discomforts in patients with head and neck cancers with minimal costs and efforts.

Characteristics of Kundalini-Related Sensory, Motor, and Affective Experiences During Tantric Yoga Meditation

Traditional spiritual literature contains rich anecdotal reports of spontaneously arising experiences occurring during meditation practice, but formal investigation of such experiences is limited. Previous work has sometimes related spontaneous experiences to the Indian traditional contemplative concept of kundalini. Historically, descriptions of kundalini come out of Tantric schools of Yoga, where it has been described as a “rising energy” moving within the spinal column up to the brain. Spontaneous meditation experiences have previously been studied within Buddhist and Christian practices and within eclectic groups of contemplative practitioners. Prior explorations of kundalini have emphasized extreme experiences, sometimes having clinical consequences. We conducted a first such investigation of kundalini-related experiences within a sample of meditators from a single Tantric Yoga tradition (known as Ananda Marga) that emphasizes the role of kundalini. We developed a semi-structured questionnaire to conduct an exploratory pilot investigation of spontaneous sensory, motor and affective experiences during meditation practice. In addition to identifying the characteristics of subjective experiences, we measured quantity of meditation, supplemental practices, trait affect and trait mindfulness. We administered it to 80 volunteers at two Ananda Marga retreats. Among reported experiences, we found the highest prevalence for positive mood shifts, followed by motor and then sensory experiences. The frequency of spontaneous experiences was not related to the quantity of practiced meditation or trait measures of mindfulness and affect. Self-reports included multiple descriptions of rising sensations, sometimes being directly called kundalini. Experiences with rising sensations were complex and many included references to positive affect, including ecstatic qualities. There were also reports of spontaneous anomalous experiences. These experiences of rising sensations resemble prior clinical descriptions that were considered kundalini-related. The individuals who reported rising sensations could not be distinguished from other participants based on the incidence of experiences, quantity of meditation practice, or trait measures of mindfulness and affect. In contrast, greater amount of Tantric Yoga meditation practice was associated with greater positive affect, less negative affect and greater mindfulness. Further study of these exploratory findings and how they may be related to spiritual and well-being goals of meditation is warranted along with scientific investigation of purported kundalini phenomena.

Effects of whole-body vibration on driver drowsiness: A review

INTRODUCTION

Whole-body vibration has direct impacts on driver vigilance by increasing physical and cognitive stress on the driver, which leads to drowsiness, fatigue and road traffic accidents. Although sleep deprivation, sleep apnoea and alcohol consumption can also lead to driver drowsiness, exposure to steady vibration is the factor most readily controlled by changes to vehicle design, yet it has received comparatively less attention.

METHODS

This review investigated interrelationships between the various components of whole-body vibration and the physiological and cognitive parameters that lead to driver drowsiness, as well as the effects of vibration parameters (frequency, amplitude, waveform and duration). Vibrations transmitted to the driver body from the vehicle floor and/or seat have been considered for this review, whereas hand-arm vibration, shocks, acute or transient vibration were excluded from consideration.

RESULTS

Drowsiness is affected by interactions between the frequency, amplitude, waveform and duration of the vibration. Under optimal conditions, whole-body vibration can induce significant drowsiness within 30 min. Low frequency whole-body vibrations, particularly vibrations of 4-10 Hz, are most effective at inducing drowsiness. This review notes some limitations of current studies and suggests directions for future research.

CONCLUSIONS

This review demonstrated a strong causal link exists between whole-body vibration and driver drowsiness. Since driver drowsiness has been established to be a significant contributor to motor vehicle accidents, research is needed to identify ways to minimise the components of whole-body vibration that contribute to drowsiness, as well as devising more effective ways to counteract drowsiness.

PRACTICAL APPLICATIONS

By raising awareness of the vibrational factors that contribute to drowsiness, manufacturers will be prompted to design vehicles that reduce the influence of these factors.

Benson Relaxation Technique Combined With Music Therapy for Fatigue, Anxiety, and Depression in Hemodialysis Patients: A Randomized Controlled Trial

This study aimed to investigate the effects of the Benson relaxation technique combined with music therapy on fatigue, anxiety, and depression levels of patients undergoing hemodialysis. This randomized controlled study was conducted with 61 patients (30 patients in the intervention group, 31 patients in the control group) in a province located in Turkey. This 8-week, randomized, clinical trial was carried out in 2 hemodialysis units. After the patients in both groups were informed about the study, the Piper Fatigue Scale and the Hospital Anxiety and Depression Scale were administered to the patients. All subdomain scores of the Piper Fatigue Scale in the intervention group were significantly lower at weeks 4, 8, and 10 than those of the control group (P < .05). The intervention group had significantly lower Anxiety subscale scores than those of the control group at week 10 (P < .05). Similarly, Depression subscale scores were significantly lower in the intervention group at weeks 8 and 10 than those in the control group (P < .05). The findings suggest that Benson relaxation technique combined with music therapy is an effective approach to manage fatigue, anxiety, and depression symptoms related to hemodialysis.

Classical Massage and Relaxation Exercise on Symptom Status and Quality of Life in Advanced Stage Patients With Heart Failure: A Randomized Controlled Trial

This randomized controlled study aimed to investigate the effects of classical massage (CM) and Benson relaxation exercise (BRE) on symptom status and quality of life (QoL) in patients with heart failure (HF). Seventy-two patients with HF were recruited from 4 hospitals in Ankara, Turkey. The study sample was allocated to a CM (n = 24), BRE (n = 26), or control group (n = 22) based on the New York Heart Association classification of HF (stages III and IV) through stratified randomization. The intervention groups received either CM or BRE twice daily for 7 days (total of 14 sessions). The control group received only routine care. The scores of symptom status decreased in the CM and BRE groups at the end of the intervention (first week) as compared with the control group (P < .05). Nevertheless, at the end of the monitoring period, no significant differences were detected between the 3 study groups at baseline (P = .474), week 1 (P = .936), and week 3 (P = .668) in terms of QoL scores. The CM and BRE showed beneficial effects in the management of HF symptoms in advanced stage HF patients who were hospitalized and received intensive treatment.

Mind and body interventions in cardiology : The importance of the brain-heart connection

Mind and body interventions aim to harness the "relaxation response", reduce stress, and improve quality of life, which is important in the search for more holistic treatment approaches in cardiovascular medicine. This article describes the pertinent pathophysiological correlates building the mechanistic backbone for these interventions. They can be found in the complex connections of brain and heart (central and autonomic nervous system, hypothalamic-pituitary-adrenal axis), which play an important role in the development of various cardiovascular disease conditions and hold potential as therapeutic targets. The evidence regarding the effect of mind and body interventions in cardiology with a focus on arrhythmia and psychocardiology is reviewed systematically. To date, mostly small pilot studies prone to substantial bias and without adequate power have dominated the field and longer-term outcome data are lacking. Ultimately, integration of mind and body interventions could empower patients by strengthening their individual responsibility and mental power in addition to the benefits of stress reduction and improvement of quality of life. Whether this will translate into relevant longer-term clinical outcomes remains uncertain. Therefore, this field offers multifaceted opportunities for further research and practical applications.

Effect of online counselling on emotional outcomes during the COVID‐19 pandemic: An innovative group intervention for university students using the Brain Wave Modulation Technique

Young people's mental health problems are a matter of concern during the COVID‐19 pandemic. Counselling services for university students by means of telemental support can help them to deal with psychological issues that they may be facing due to the pandemic. The present study investigated the effects of four once‐weekly online counselling sessions based on a mind‐body technique (the Brain Wave Modulation Technique; BWM‐T) on enhancing positive affect and on reducing negative affect and anxiety in a sample of 54 university students (96.3% females; M_age = 21.31 years, SD = 2.09). An experimental design was conducted: the participants were randomly assigned to the intervention group, which received 15 min of a guided online BWM‐T session, or to the control group, which watched a 15‐min video on how to sustain their psychological well‐being. The results of a two‐factor mixed‐design analysis of variance (ANOVA) showed that the participants in the intervention group reported a significant increase in positive affect and a decrease in negative affect over time compared to those in the control group. They also reported a slight decrease in state anxiety compared to the control group, although this was just short of statistical significance. The information provided by this study, regarding emotional outcomes among university students after four brief online counselling sessions, suggests that such interventions could be an effective and sustainable way to reinforce young people's mental health during the COVID‐19 pandemic, as well as later in their university careers and adult lives.

Crisis Containment: Tools for Harm Mitigation in Surgery

BACKGROUND

Surgical crises represent unrecognized opportunities for improving patient safety and adding value in healthcare. The first step in a crisis response is to contain and mitigate harm. While the principles of damage control are well established in surgery, methods of containing harm on broader clinical and organizational levels are not clearly defined.

STUDY DESIGN

A multimethods qualitative study identified crisis containment strategies and tools in commercial aviation. These were translated and clinically adapted in 3 stages: semi-structured observational fieldwork with commercial airlines, interviews with senior pilots, and focus groups with both healthcare and aviation safety experts. Thematic analysis and expert consensus methods were used to derive a framework for crisis containment.

RESULTS

Fieldwork with 2 commercial airlines identified 2 crisis containment concepts: the detrimental impact of surprising or startling events on operator performance; and the use of prioritization tools to take basic but critical actions (Aviate, Navigate and Communicate model). Twenty-two experts in aviation and healthcare practice informed the topic of crisis containment in 17 interviews and 3 focus groups. Three strategies were identified and used to form a crisis containment algorithm: 1. Manage the operators' startle response to facilitate meaningful mitigating actions (STOP tool); 2. Take priority actions to secure core functions. These included managing patients' physiologic shock, optimizing environmental risks, and mobilizing resources (Perfuse, Move and Communicate tool); 3. Deploy well-rehearsed drills targeting case-specific harms or errors (Memory Actions). This model requires validation in clinical practice.

CONCLUSIONS

Crisis containment can be achieved by controlling operators' startle response, applying prioritization tools, and deploying drills against specific failures. The application of this model may extend to healthcare areas outside surgery.

Effectiveness of mental simulations on the early mobilization of patients after cesarean section: a randomized controlled trial

We aimed to investigate whether psychological intervention (single mental simulation) among women after cesarean surgery (CC) can affect their willingness to verticalize, actual verticalization, and the duration of the first mobilization. In this prospective randomised, controlled study, 150 women after CC were divided into 3 groups: experimental group with process-simulation with elements of relaxation, experimental group with outcome-simulation with elements of relaxation and control group with elements of relaxation only. After a 5-h stay in the post-operative room, women listened to a recording with a stimulation. Pain and anxiety of verticalization were measured before and after listening to the recording and after verticalization. Almost 12% more patients verticalized in the process-simulation group than in the control group. Percentages of mobilized patients were: 39.4% the process-simulation group; 32.8% in the outcome-simulation group; 27.7% controls (p = 0.073). Mobilization was 5 min longer in the process-simulation group then in control (p < 0.01). Anxiety after the simulation was a significant covariate of the willingness to verticalize, actual verticalization and time spent in mobilization. We conclude that a single mental simulation can effectively motivate patients for their first verticalization after CC. Perceived anxiety before verticalization may affect the effectiveness of interventions, so we recommend to check it at the postoperative care.

ClinicalTrials.gov Identifier: NCT04829266.

Mindfulness and Behavior Change

Initiating and maintaining behavior change is key to the prevention and treatment of most preventable chronic medical and psychiatric illnesses. The cultivation of mindfulness, involving acceptance and nonjudgment of present-moment experience, often results in transformative health behavior change. Neural systems involved in motivation and learning have an important role to play. A theoretical model of mindfulness that integrates these mechanisms with the cognitive, emotional, and self-related processes commonly described, while applying an integrated model to health behavior change, is needed. This integrative review (1) defines mindfulness and describes the mindfulness-based intervention movement, (2) synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change, and (3) synthesizes current clinical research evaluating the effects of mindfulness-based interventions targeting health behaviors relevant to psychiatric care. The review provides insight into the limitations of current research and proposes potential mechanisms to be tested in future research and targeted in clinical practice to enhance the impact of mindfulness on behavior change.