Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation

Does it need an app? - Differences between app-guided breathing and natural relaxation in adolescents after acute stress

A key component of stress management and biofeedback training is the use of relaxation exercises, such as slow/deep breathing (6 breaths/minute) in heart coherence exercises (HCEs). Breathing exercises are also increasingly being integrated into smartphones as part of health apps, though their effectiveness in adolescents after acute stress has rarely been validated scientifically. The aim of the current study was to investigate the effectiveness of an app-guided HCE (n = 36) after an acute stress situation (Trier Social Stress Test) compared with natural relaxation (n = 37), among healthy adolescents (aged 11-17 years). Endocrine, autonomic, and psychological stress parameters (cortisol, alpha-amylase, heart rate, heart rate variability, mood) were examined in 73 adolescents (46 female, 27 male; Mage = 13.86, SDage = 1.87). Significant group differences were found in heart rate variability, with higher values in the low frequency band and low-to-high frequency ratio for the HCE condition, possibly indicating improved physiological functions through the stimulation of vagal tone and baroreflex. The use of a general breathing technique (natural and app-guided) also resulted in stronger relaxation reactions in cortisol when controlling for the previous stronger stress reactivity. On the other hand, app-guided slow breathing without a long training may be experienced as more uncomfortable during relaxation. The integration of breathing exercises in health apps for adolescents appears to be useful, offering a helpful and low-threshold coping/relaxation strategy during acute stress situations. Further studies should examine the benefits of app-guided breathing exercises in both psychiatric samples and the general population across a wide age range.

Exercise and endometriosis-is there a promising future? A narrative review

BACKGROUND

Endometriosis is the leading cause of chronic pelvic pain in women of reproductive age with debilitating effects on quality of life, yet no cure exists. Exercise yields the potential in providing women with a non-invasive, non-pharmacological method of symptom control.

AIM(S)

Present up-to-date knowledge regarding how exercise may contribute to the management of endometriosis-related symptoms.

OBJECTIVE(S)

Discuss: 1. The pathophysiology surrounding exercise and endometriosis. 2. The role of exercise in endometriosis symptom control.

RATIONALE

Scientific literature has alluded to exercise being a favourable factor in the management of endometriosis-related symptoms. Moreover, current clinical guidelines for endometriosis fail to reflect the aforementioned benefits of exercise.

SEARCH STRATEGY

A search strategy using the terms 'endometriosis', 'endometriomas', 'exercise', and 'physical activity' was devised. Pubmed, Medline, Cochrane reviews, and Embase were reviewed.

INCLUSION CRITERIA

Interventional studies, within-subjects studies, randomised-control trials, systematic reviews, meta-analysis, cohort studies, publication since 2000.

EXCLUSION CRITERIA

Non-English publications, non-human studies.

RESULTS

Numerous studies have suggested positive effects for endometriosis patients who performed exercise exclusively or in conjunction with other therapies. Improvements in pain levels, quality of life, anxiety, and depression were noted.

DISCUSSION

Current research outlines promise regarding the potential benefit of exercise prescribing in patients with endometriosis as well as a synergy between exercise and hormonal therapies for the management of endometriosis-related symptoms. However, the current paucity of high-quality robust studies investigating these aspects of endometriosis management is an apparent obstacle to progression in this area.

CONCLUSION

For clinicians to incorporate exercise in managing endometriosis, clear recommendations regarding advice and benefits are needed.

Effect of a Single-Session Mindfulness-Based Swinging Technique (MBST) Intervention on Emotional Distress in Cancer Patients Undergoing PET-CT Scan: A Randomized Controlled Trial

Introduction: Undergoing complex diagnostic investigation of positron emission tomography-computed tomography (PET-CT) scans is associated with high levels of distress, fear, and anxiety in oncological patients. This study evaluated the effects of a single 20-min session of an innovative mindfulness-based swinging technique (MBST) intervention on emotional distress in cancer patients scheduled for PET-CT scans. Material and Methods: Adult cancer patients undergoing PET-CT scans (n = 57) were assigned to the intervention group (n = 27) or the control group (n = 30). The emotion thermometer (ET) was used to measure distress, anxiety, depression, anger, and need for help at baseline and after the PET-CT scan. Participants in the intervention group received a 5-min psycho-education followed by listening to an audio recording of the MBST intervention just before their PET-CT scan. The session included mindfulness-based visualization, imaginary swinging activity, and synchronized breathing. The control group participants received brief 5-min counseling. Results: There was a statistically significant reduction in distress (p < 0.001), anxiety (p < 0.001), depression (p < 0.001), anger (p = 0.002), and need for help (p < 0.001) in the intervention group compared with the control group. Safety: None of the participants reported adverse events caused by the MBST intervention. The intervention was well accepted by the participants. However, n = 3 participants could not complete the intervention due to mind wandering, inability to focus, difficulty complying with the guided instructions, falling asleep, and physical discomfort unrelated to the intervention. Conclusion: The findings suggest the potential role of MBST intervention in mitigating emotional distress in patients undergoing complex diagnostic imaging procedures. Integrating this with conventional care in nuclear medicine settings can provide patient-centered care that addresses their unmet requirements. There is a need for further validation with a larger sample size. Clinical Trial Registration Number: CTRI/2023/04/051243 (Registered prospectively on 03/04/2023).

Brain and heart activity during interactions with pet dogs: A portable electroencephalogram and heart rate variability study

Dog ownership has been linked to numerous benefits to human health and wellbeing. However, due to the lack of previous research on changes to brain activity during interactions with pet dogs, the underlying psychophysiological mechanisms are still unclear. The aim of the present study was to examine changes in heart rate (HR), heart rate variability (HRV), and electroencephalogram (EEG) power during interactions between dog owners and their pet dog. Fifty healthy adult dog owners completed baseline psychological measures and pet attachment scales. Subjective units of relaxation (SUR) as well as continuous EEG, HR, and HRV via portable devices were measured during five experimental conditions (baseline resting, relaxation-induction exercise, patting a toy dog, real dog present, and patting a real dog) in participants' homes. SUR was higher in all experimental conditions than at baseline. SUR was also higher during dog interaction than when the dog was present with no interaction. However, SUR during dog interaction was not significantly different from the toy dog and relaxation induction condition. Higher delta, theta, alpha, beta power and HR were found during dog interaction than all other conditions. Higher HRV was found during dog interaction compared to baseline, patting a toy dog, and relaxation-induction exercise, but not significantly different from the real dog present only condition. Lastly, overall HR correlated with psychological measures. Overall, the results show that there are significant changes in brain and heart activity when humans interact with pet dogs, consistent with increases in relaxation and focussed attention. These findings are relevant to understanding the potential mechanisms for health benefits associated with pets.

Neurobiological Implications of Chronic Stress and Metabolic Dysregulation in Inflammatory Bowel Diseases

Chronic stress is a significant factor affecting modern society, with profound implications for both physical and mental health. Central to the stress response is cortisol, a glucocorticoid hormone produced by the adrenal glands. While cortisol release is adaptive in acute stress, prolonged exposure to elevated levels can result in adverse effects. This manuscript explores the neurobiological implications of chronic stress and its impact on metabolic dysregulation, particularly in the context of inflammatory bowel diseases (IBDs). The hypothalamic-pituitary-adrenal (HPA) axis regulates cortisol production, which influences metabolism, immune response, and neurobiology. Elevated cortisol levels are associated with the development and exacerbation of metabolic disorders like IBD and contribute to neurodegenerative processes, including cognitive impairments and increased susceptibility to psychiatric conditions. The interaction between cortisol and its receptors, particularly glucocorticoid receptors, underscores the complexity of these effects. This review aims to elucidate the mechanisms through which chronic stress and cortisol dysregulation impact metabolic health and neurobiological function, providing insights into potential therapeutic strategies for mitigating these effects.

Exploring Heart Rate Variability Biofeedback as a Nonpharmacological Intervention for Enhancing Perioperative Care: A Narrative Review

Heart rate variability biofeedback (HRVBF) is a non-invasive therapeutic technique that aims to regulate variability in heart rate. This intervention has promise in mitigating perioperative stress, a critical factor for surgical patient outcomes. This comprehensive review aimed to explore the current evidence on the perioperative role of HRV biofeedback in improving patient outcomes, reducing perioperative stress, enhancing recovery, and optimizing anaesthesia management. A review of the PubMed and Google Scholar databases was conducted to identify articles focused on HRVBF in relation to the perioperative period. Studies were selected using appropriate keywords in English (MeSH). Ample potential applications of HRVBF in clinical anaesthesia have been identified and proven feasible. It is a non-invasive and an easy method an anaesthesiologists has at its disposal with potential utility in reducing perioperative stress, as a tool of optimization of comorbidities, analgesia supplementation and in predicting catastrophic complications. Although HRVBF has the potential to enhance anaesthesia management and improve patient outcomes, several limitations and challenges must be addressed to maximize its clinical utility. Overcoming these obstacles through research and technological advancements will be crucial for realizing the full benefits of HRVBF in perioperative care.

Posting Holistic Health and Fitness Reels on Social Media Platforms to Improve Soldier Health in the Brigade

INTRODUCTION

As of 2020 Holistic health and fitness (H2F) teams have been embedded into brigades to engage Soldiers in Preventative Mental, Physical, Nutritional, Spiritual, and Sleep Readiness services. This represents a change in Army culture from a focus on testing to one of wellness because of increasing sleep concerns, mental health concerns, and injury rates. Soldier awareness of H2F services, where to find them, how to use them, and command endorsement of H2F professional's services has been limited and not well studied. Most soldiers fall into the Generations Y and Z categories, and this population tends to access information primarily from social media sources. Social media platforms therefore represent potentially effective ways to reach these individuals to increase their awareness of H2F services.

MATERIALS AND METHODS

This quality improvement project used therapist produced brief interactive videos covering the topics of sleep hygiene and consequences of sleep supplement use and sleep deprivation, mental readiness, and journaling as a form of mindfulness. Video reels were posted to one brigade H2F's social media (Facebook and Instagram) platforms to improve Soldier awareness and engagement in wellness activities in these areas. Data were tracked before and after the initiation of the reel series via Facebook and Instagram MetaBusiness Suite, and via utilization tracking for H2F occupational therapy group and 1:1 visits.

RESULTS

Data tracked before and after the initiation of the video series revealed an 898.2% increase in Facebook access, including reel reach, and increases in 1:1 and group sleep and mental readiness visits to the H2F occupational therapist.

CONCLUSIONS

The use of social media to facilitate soldier awareness and use of H2F mental and sleep readiness services is a viable option for H2F units seeking to enhance their reach in these areas. The project created very little demand on the local therapist's time or to brigade resources and may help increase Soldier accessing of H2F resources online and directly.

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.

Effects of app-based relaxation techniques on perceived momentary relaxation: Observational data analysis in people with cancer

OBJECTIVE

To examine the effects of six relaxation techniques on perceived momentary relaxation and a possible association of relaxation effects with time and practice experience in people with cancer.

METHODS

We used data from participants with cancer in a larger study practicing app-based relaxation techniques over 10 weeks, assessed momentary relaxation before and after every third relaxation practice, and analyzed momentary relaxation changes with a linear mixed-effects model.

RESULTS

The sample included 611 before-after observations from 91 participants (70 females (76.9%)) with a mean age of 55.43 years (SD 10.88). We found moderate evidence for variations in momentary relaxation changes across different techniques (P = .026), with short meditation, mindfulness meditation, guided imagery, and progressive muscle relaxation more frequently observed and leading to more relaxation than body scan and walking meditation. Furthermore, we found moderate evidence for increasing momentary relaxation changes over time (P = .046), but no evidence for an association between momentary relaxation and the number of previous observations (proxy for practice experience; P = .47).

CONCLUSION

We compared six app-based relaxation techniques in a real-life setting of people with cancer. The observed variations in perceived momentary relaxation appear to correspond with the popularity of the techniques used: The most popular relaxation techniques were the most effective and the least popular were the least effective. The effects increased over time, likely caused by dropout of individuals who gained no immediate benefit. Our findings open an interesting avenue for future research to better understand which relaxation techniques work best for whom in which situations.

TRIAL REGISTRATION

DRKS00027546; https://drks.de/search/en/trial/DRKS00027546.

The effect of neurolinguistic programming and progressive muscle relaxation exercises on breastfeeding success and breastfeeding self-efficacy: A randomized controlled trial

INTRODUCTION

This research was to determine the effect of neurolinguistic programming (NLP) and progressive muscle relaxation exercises (PMRE) on breastfeeding success and breastfeeding self-efficacy in primiparous women after cesarean section.

MATERIAL AND METHODS

This is a single-blind, three-arm, parallel-group, randomized controlled trial. Data were collected between 01 October 2023, and 18 December 2023. The sample of the study consisted of 99 primiparous women who gave birth by cesarean section (NLP=33, PMRE=33, and control=33). Women were randomly assigned to the groups. Starting from the first mobilization time after cesarean section, NLP was applied to the NLP group and PMRE was applied to the PMRE group every eight hours for 48 h. In the control group, NLP or PMRE was not applied and the women were allowed to rest on their backs. The primary outcomes of the study were breastfeeding success and breastfeeding self-efficacy.

RESULTS

The mean scores of breastfeeding success and breastfeeding self-efficacy measured over time were highest in the NLP group and lowest in the control group (p<.05). The mean scores of breastfeeding success and breastfeeding self-efficacy measured over time increased by 78.4 %, and 97.7 %, respectively, in the NLP group compared to the control group, 74.7 %, and 88.1 %, in the PMRE group compared to the control group, and 13.5 %, and 90.2 %, respectively, in the NLP group compared to the PMRE group (p<.05).

CONCLUSION

NLP intervention may have a more positive effect on breastfeeding success and breastfeeding self-efficacy than PMRE intervention.

TRIAL AND PROTOCOL REGISTRATION

ClinicalTrials.gov, NCT06070792.

The effects of progressive muscle relaxation exercise on dementia caregivers

While progressive muscle relaxation has demonstrated effectiveness in reducing anxiety, stress, and depression in general populations, its impact on caregivers of dementia patients remains understudied. This study investigated the effectiveness of Progressive Muscle Relaxation (PMR) in improving the well-being of dementia caregivers. Caregivers of individuals with dementia (n = 57) participated in a 3-month intervention, engaging in PMR thrice weekly. Participants completed assessments of depression, anxiety, stress, and caregiver burden at pre-test and post-intervention period. The intervention led to significant reductions in anxiety, stress, depression, and caregiver burden among participants. Female caregivers reported to have higher levels of anxiety and stress compared to males. Caregivers under financial stress showed high levels of distress and increased caregiver burden. These promising findings suggest the need for further research with larger, multicenter samples. Notably, PMR is a readily implementable intervention by nurses, requiring minimal equipment and offering a cost-effective approach to supporting caregiver well-being.

Effect of different physical activity interventions on perinatal depression: a systematic review and network meta-analysis

BACKGROUND

Perinatal depression can have profound impacts on both families and society. Exercise therapy is gradually becoming a widely used adjunct treatment for perinatal depression. Some studies have already focused on the relationship between physical activity and perinatal depression (PND). However, there is currently a lack of systematic and comprehensive evidence to address the crucial question of making optimal choices among different forms of physical activity. This study aims to compare and rank different physical activity intervention strategies and identify the most effective one for perinatal depression.

METHODS

Four databases, namely PubMed, Cochrane Library, Embase, and Web of Science, were searched for randomized controlled trials assessing the impact of physical activity interventions on perinatal depression. The search covered the period from the inception of the databases until May 2024. Two researchers independently conducted literature screening, data extraction, and quality assessment. Network meta-analysis was performed using Stata 15.1.

RESULTS

A total of 48 studies were included in the analysis. The results indicate that relaxation therapy has the most effective outcome in reducing perinatal depression (SUCRA = 99.4%). Following that is mind-body exercise (SUCRA = 80.6%). Traditional aerobics and aquatic sports were also effective interventions (SUCRA = 70.9% and 67.1%, respectively).

CONCLUSION

Our study suggests that integrated mental and physical (MAP) training such as relaxation therapy and mind-body exercise show better performance in reducing perinatal depression. Additionally, while exercise has proven to be effective, the challenge lies in finding ways to encourage people to maintain a consistent exercise routine.

TRIAL REGISTRATION

This study has been registered on PROSPERO (CRD 42,023,469,537).

Progressive Muscular Relaxation Versus Breathing Excercise Techniques to Control Blood Pressure among Mild Preeclamptic Pregnant Women

Background

Hypertensive disturbances during pregnancy are the leading cause of maternal and fetal death; unfortunately, no effective treatment exists. Therefore, interventions that reduce the likelihood of developing preeclampsia during pregnancy are required. This study aimed to see how Progressive Muscle Relaxation (PMR) compared to breathing exercise techniques affected Blood Pressure (BP) levels among mildly preeclamptic pregnant women.

Materials and Methods

A convenience sample was used in a quasi-experimental study of 75 mild preeclamptic pregnant women in the Obstetrical Outpatient Clinics at the Suez Canal University Hospital in Ismailia, Egypt. They were divided into three groups: study group [I]: the deep breathing exercise group; study group [II]: the PMR group; and study group [III]: the control group. Data were collected using two methods: an interviewing information collection tool and a physiological measurement tool.

Results

There was a statistical significant difference in systolic and diastolic blood pressure after six weeks of training among intervention groups (PMR and breathing excercise technique with p value 0.001 for both groups) compered to contol group. However, there was no statistical difference in BP (systolic or diastolic) after two weeks of intervention among the three groups.

Conclusions

PMR and breathing techniques could effectively control BP in pregnancy complicated by mild preeclampsia. Both techniques could be introduced in routine antenatal care for women diagnosed with mild preeclampsia. Health and fitness professionals should focus more on preparing and delivering various sports programs incorporating various muscle relaxations and breathing techniques.

Effect of mHealth-based relaxation program on stress coping and anxiety levels in mothers of children with cancer: A randomized controlled study

OBJECTIVE

This study aimed to explore the effects of a mHealth-based relaxation program on anxiety and stress coping levels in mothers of children with cancer.

METHODS

This randomized controlled, single-blind, parallel-group trial was conducted in the pediatric hematology-oncology unit of a university hospital. The study was completed by 50 mothers (intervention group: n = 25; control group: n = 25). The mothers in the intervention group participated in a mHealth-based relaxation program for eight weeks (including progressive muscle relaxation, guided imagery, and the four-leaf clover of mindfulness). Videos of the relaxation program were sent to mothers' WhatsApp accounts. The mothers in the control group received routine care. The State-Trait Anxiety and Stress Coping Scales were administered during the first and eighth weeks. The registration number of this study on ClinicalTrials.gov is NCT05807295.

RESULTS

Mothers who participated in the relaxation program had lower anxiety levels and higher stress-coping scores than those in the control group (p < 0.05).

CONCLUSION

Progressive muscle relaxation exercises, guided imagery, and cognitive-based therapeutic approaches were effective in reducing mothers' anxiety and stress coping.

PRACTICE IMPLICATIONS

Pediatric oncology nurses can apply mHealth-based relaxation programs to support caregivers, particularly mothers. In this way, ensuring the continuity and integrity of care is easy.

Development of audio-guided deep breathing and auditory Go/No-Go task on evaluating its impact on the wellness of young adults: a pilot study

OBJECTIVES

Numerous studies indicate that deep breathing (DB) enhances wellbeing. Multiple deep breathing methods exist, but few employ audio to reach similar results. This study developed audio-guided DB and evaluated its immediate impacts on healthy population via self-created auditory Go/No-Go task, tidal volume changes, and psychological measures.

METHODS

Audio-guided DB with natural sounds to guide the DB was developed. Meanwhile, audio-based Go/No-Go paradigm with Arduino was built to measure the attention level. Thirty-two healthy young adults (n=32) were recruited. Psychological questionnaires (Rosenberg's Self-Esteem Scale (RSES), Cognitive and Affective Mindfulness Scale-Revised (CAMS-R), Perceived Stress Scale (PSS)), objective measurements with tidal volume and attention level with auditory Go/No-Go task were conducted before and after 5 min of DB.

RESULTS

Results showed a significant increment in tidal volume and task reaction time from baseline (p=0.003 and p=0.033, respectively). Significant correlations were acquired between (1) task accuracy with commission error (r=-0.905), (2) CAMS-R with task accuracy (r=-0.425), commission error (r=0.53), omission error (r=0.395) and PSS (r=-0.477), and (3) RSES with task reaction time (r=-0.47), task accuracy (r=-0.362), PSS (r=-0.552) and CAMS-R (r=0.591).

CONCLUSIONS

This pilot study suggests a link between it and young adults' wellbeing and proposes auditory Go/No-Go task for assessing attention across various groups while maintaining physical and mental wellness.

Perceived Stress, Salivary Cortisol, and Temperament Traits among Students of Dental Medicine: A Prospective and Interventional Study

Academic stress affects students' psychological and physiological well-being. Dental undergraduate programs are known for their demanding curriculum, leading to significant stress symptoms. The objective was to determine if salivary cortisol levels were higher in students exposed to academic stress, assess the relationship between stress severity/temperament and cortisol values, and explore relaxation technique effects. Salivary cortisol was measured at two time points for all participants: Before exams and during a relaxation period after summer break. A third measurement was conducted for students with high pre-test cortisol levels who received instructions on progressive muscle relaxation (PMR) before subsequent exams. Additionally, participants completed two questionnaires: Perceived Stress Scale (PSS) and Fisher's Temperament Questionnaire. The group analysis based on the PSS indicated that 39 participants reported high stress. Women demonstrated significantly higher stress than men (p = 0.042054). A significant difference in stress levels was observed between director and builder temperament types (p = 0.029276). Cortisol levels showed a significant decrease from the first measurement to the second measurement, and the third measurement after implementing PMR. The grade in the "Dermatovenereology" course correlated with stress level according to the PSS (k = 0.578467). Pre-test cortisol levels correlated with the frequency of using PMR guidelines during winter test periods (k = 0.416138). Stress negatively affects the immune system and poses health risks. Implementing stress reduction techniques in dental/medical education could benefit students and the healthcare system.

Efficacy of online psychoeducation and relaxation training program (OnPR) on mental health problems in COVID-19 patients: A randomized controlled trial

Purpose

Prior studies found that the prevalence of anxiety, depression, stress and insomnia were relatively high in COVID-19 patients. This study aimed to explore the efficacy of OnPR on mental health outcomes in patients with asymptomatic or mildly symptomatic COVID-19.

Patients and methods

We employed a randomized controlled trial following the CONSORT guidelines. The Thai Clinical Trials Registry identification number of this study is TCTR20220729003. We used a block of 4 randomizations generated by a computer program. The intervention group (n = 38) received the OnPR program, and the control group (n = 36) received care as usual. OnPR was an online psychological intervention comprising psychoeducation, sleep hygiene education and relaxation techniques. OnPR was provided by qualified therapists trained with a standard protocol. The primary outcomes were depression, anxiety, and stress, which were determined by the Depression Anxiety and Stress Scale-21 (DASS-21). Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Outcomes were compared between groups at pre-intervention and post-intervention at 1, 4, and 12 weeks using paired t-test or Wilcoxon signed-rank test. In addition, a linear mixed model was employed to demonstrate the effect changes of OnPR over time. All analyses were two-tailed, with a significance level of 0.05.

Results

Of 74 Thai participants, 89.2 % were female, and 11.8 % were male. The average age was 31 years. Participants' baseline characteristics were not statistically significant between the intervention and control groups except for depression and stress scores from DASS-21. OnPR resulted in significantly better improvement in depression, anxiety, stress, and sleep quality. The mean differences between groups of DASS-21 scores in depression, anxiety and stress at 7-day follow-up were -4.69, -3.29, and -5.50 respectively. The differences continue to be significant at 4-week and 12-week follow-ups. The mean difference between groups of PSQI at 7-day follow-up is -0.91.

Conclusion

OnPR improved mental health outcomes, and the effect on depression, anxiety and stress lasted for at least a 12-week follow-up period. In addition, it could enhance sleep quality after the intervention.

Deep breathing exercises in easing educational stress among Indian high school students

In this educational landscape, the pervasive issue of stress among higher secondary students has emerged as a serious matter. Acknowledging the challenges posed by educational stress, this research explores holistic and accessible interventions, with a focus on the promising avenue of deep breathing exercises known for their effectiveness in promoting relaxation and reducing stress. The study employs a quasi-experimental design, comparing an experimental group engaged in daily deep breathing exercises with a control group following a regular routine. Sixty higher secondary students in Visnagar participate through purposive sampling, adhering to specific inclusion criteria. The intervention includes a pre-tested questionnaire to assess stress levels, the implementation of daily deep breathing exercises in the experimental group, and a post-intervention stress level reassessment in both groups. The findings reveal a notable reduction in stress levels post-intervention, particularly in the experimental group practicing deep breathing exercises. Statistically significant reductions in mean stress scores underscore the effectiveness of this intervention, with the experimental group demonstrating a significantly lower mean stress score compared to the control group. This study contributes vital insights into stress management strategies for higher secondary students, highlighting the efficacy of incorporating deep breathing exercises into their routine. The observed reductions in stress levels emphasize the potential benefits of practical stress reduction techniques within the educational milieu.

Effects of relaxation interventions during pregnancy on maternal mental health, and pregnancy and newborn outcomes: A systematic review and meta-analysis

BACKGROUND

Stress during pregnancy is detrimental to maternal health, pregnancy and birth outcomes and various preventive relaxation interventions have been developed. This systematic review and meta-analysis aimed to evaluate their effectiveness in terms of maternal mental health, pregnancy and birth outcomes.

METHOD

The protocol for this review is published on PROSPERO with registration number CRD42020187443. A systematic search of major databases was conducted. Primary outcomes were maternal mental health problems (stress, anxiety, depression), and pregnancy (gestational age, labour duration, delivery mode) and birth outcomes (birth weight, Apgar score, preterm birth). Randomized controlled trials or quasi-experimental studies were eligible. Meta-analyses using a random-effects model was conducted for outcomes with sufficient data. For other outcomes a narrative review was undertaken.

RESULT

We reviewed 32 studies comprising 3,979 pregnant women aged 18 to 40 years. Relaxation interventions included yoga, music, Benson relaxation, progressive muscle relaxation (PMR), deep breathing relaxation (BR), guided imagery, mindfulness and hypnosis. Intervention duration ranged from brief experiment (~10 minutes) to 6 months of daily relaxation. Meta-analyses showed relaxation therapy reduced maternal stress (-4.1 points; 95% Confidence Interval (CI): -7.4, -0.9; 9 trials; 1113 participants), anxiety (-5.04 points; 95% CI: -8.2, -1.9; 10 trials; 1965 participants) and depressive symptoms (-2.3 points; 95% CI: -3.4, -1.3; 7 trials; 733 participants). Relaxation has also increased offspring birth weight (80 g, 95% CI: 1, 157; 8 trials; 1239 participants), explained by PMR (165g, 95% CI: 100, 231; 4 trials; 587 participants) in sub-group analysis. In five trials evaluating maternal physiological responses, relaxation therapy optimized blood pressure, heart rate and respiratory rate. Four trials showed relaxation therapy reduced duration of labour. Apgar score only improved significantly in two of six trials. One of three trials showed a significant increase in birth length, and one of three trials showed a significant increase in gestational age. Two of six trials examining delivery mode showed significantly increased spontaneous vaginal delivery and decreased instrumental delivery or cesarean section following a relaxation intervention.

DISCUSSION

We found consistent evidence for beneficial effects of relaxation interventions in reducing maternal stress, improving mental health, and some evidence for improved maternal physiological outcomes. In addition, we found a positive effect of relaxation interventions on birth weight and inconsistent effects on other pregnancy or birth outcomes. High quality adequately powered trials are needed to examine impacts of relaxation interventions on newborns and offspring health outcomes.

CONCLUSION

In addition to benefits for mothers, relaxation interventions provided during pregnancy improved birth weight and hold some promise for improving newborn outcomes; therefore, this approach strongly merits further research.

Endometriosis and physical activity: A narrative review

Endometriosis is a painful gynecological disorder that affects many women. Constant treatments and contraception changes affect women looking for solutions to treat and limit the problems caused by endometriosis. The current narrative review discusses the effects of physical activity on the management, pain, and quality of life in patients with endometriosis. Findings suggest that body awareness practices such as Hatha yoga, the Jacobson method, and progressive muscle relaxation reduce pain and stress and improve the quality of life associated with endometriosis. It also highlights the current knowledge gap on available evidence and future research. Moreover, care must be taken when considering patients' physical abilities and goals and avoiding intense physical activities. The forms of endometriosis and its symptoms vary from one woman to another, so it is important to perform studies with various nonmedicinal or surgical techniques. It is important to continue randomized controlled trials to obtain more data on the benefits of physical activity in women with endometriosis and also to identify what types of activities could be beneficial to combat pain symptoms and improve the daily lives of women with endometriosis.

Effectiveness and mediators of change of an online CBT intervention for students with adjustment disorder-study protocol for a randomized controlled trial

BACKGROUND

Adjustment problems and disorders are highly prevalent among university students worldwide. These problems can cause significant interference in academic and social functioning and increase vulnerability to other mental health disorders. Unfortunately, only half of students in need receive psychological help. Furthermore, few studies have evaluated psychological interventions for adjustment disorders in students. New, more scalable forms of treatment for students with an adjustment disorder need to be developed, evaluated, and implemented. The study aims to determine the effectiveness of an online transdiagnostic cognitive behavioural intervention for students experiencing adjustment disorder and to assess mediators of change.

METHOD/DESIGN

In this three-arm randomized controlled trial, we plan to recruit 214 Polish students diagnosed with an adjustment disorder. Participants who meet initial eligibility criteria will be randomly assigned to one of three 6-week conditions: (1) online cognitive behavioural therapy intervention based on an existing, empirically supported transdiagnostic protocol, the unified protocol; (2) online progressive muscle relaxation training as an active control group; or (3) waiting-list control group. Both interventions are asynchronous, interactive, and include minimal amount of therapist support. Assessments will consist of self-report questionnaires, daily diary measures, and neurocognitive tasks for evaluating cognitive functioning. These will be conducted at baseline, post-treatment, and 1-month follow-up. Daily diary measures will be taken during the first and last week of treatment (or waitlist period). Primary outcome measures will include adjustment disorder severity; secondary outcome measures will consist of other negative (psychopathology: depression, anxiety, and stress) and positive (life satisfaction) indexes of mental health as well as process measures (e.g. mindfulness, experiential avoidance, cognitive fusion).

DISCUSSION

To our knowledge, the current study is the first to evaluate the effectiveness of a psychological intervention for students with adjustment disorder. Therefore, it may have important practical implications for students with this disorder. It can potentially guide the development of a scalable, validated treatment option.

TRIAL REGISTRATION

Clinical Trials, NCT05768308, registered 14 March 2023, https://www.

CLINICALTRIALS

gov/ct2/show/NCT05768308.

Effect of slow breathing exercise and progressive muscle relaxation technique in the individual with essential hypertension: A randomized controlled trial

PURPOSE

The present study aims to investigate the combined effect of slow breathing exercise (SBE) and progressive muscle relaxation (PMR) technique on blood pressure (BP), heart rate (HR), respiratory rate (RR), and anxiety in patients diagnosed with essential hypertension.

TRIAL DESIGN

This study was based on a 4-arm parallel-group, randomized control design.

METHODS

Sixty-four participants diagnosed with essential hypertension were randomly allocated into SBE, PMR, SBE-PMR, and Control groups, with 16 subjects each. All 3 groups received different treatments according to their name; however, the Control group received no treatment. Systolic and diastolic BP (SBP and DBP), HR, RR, and anxiety were all evaluated as the study outcomes using a digital sphygmomanometer and perceived stress scale (PSS) at baseline (pretest), 2nd week and 4th weeks post-intervention. A repeated measure analysis of variance test assessed intra-group comparison (overall) analyses across multiple time points. Bonferroni multiple comparison tests were used to analyze the mean differences between the groups. The confidence interval was kept at 95% for all the statistical analyses, that is, P < .05 is considered significant.

RESULTS

There was a significant change in the HR (F = 239.04, P = .0001), RR (F = 167.74, P = .0001), SBP (F = 266.64, P = .0001), DSP (F = 279.80, P = .0001), and PSS (F = 473.42, P = .0001) as an outcome of baseline measurements versus (vs) the following weeks. There were significant (F = 48.57, P = .001) differences among different training on HR. The SBE vs SBE-PMR showed an insignificant difference (F = 48.54, P = 1.000). The RR showed significant differences (F = 32.05, 0.0001) between the SBE vs PMR, SBE vs Control, PMR vs Control, and SBE-PMR vs Control groups and insignificant differences for the SBE vs SBE-PMR and PMR vs SBE-PMR groups. The SBE vs SBE-PMR groups showed insignificant differences for DPP and SBP. However, PSS showed significant differences (F = 67.12, P = .0001) among the intervention groups except for the PMR and SBE-PMR groups.

CONCLUSIONS

The combined interventions of SBEs and progressive muscle relaxation techniques can effectively reduce the heart rate, respiratory rate, BP, and anxiety in essential hypertensive patients compared to both techniques when given alone.

Returning to employment following allogeneic hematopoietic stem cell transplant: A major problem among survivors

Quality of life (QoL) is an important aspect of cancer survivorship. One of the most acute problems that impact survivors in many aspects of activities of daily living and compromise their QoL is the inability to return to employment following successful cancer therapy. This is most prominent among survivors after allogeneic hematopoietic stem cell transplant (allo-HSCT). More than 50% of the survivors following allo-HSCT remain unemployed one year after the procedure. This problem extends beyond the initial few years; unemployment rates among those who underwent allo-HSCT during their childhoods or adolescence have remained high. The inability to return to employment imposes a financial burden. Survivors following allo-HSCT also experience a multitude of chronic psychosocial complications that may be both contributing and consequential to the inability to return to employment. However, many transplant programs and cancer centers do not have return-to-employment programs. In this review paper, we discuss the prevalence of unemployment following allo-HSCT. We examine the psychosocial symptoms experienced by survivors and how they may affect survivors' ability to return to employment. Finally, we propose a multi-disciplinary multi-pronged occupation-focused approach to address the complex and inter-related psychosocial symptoms to help alleviate the problem.

The Effects of Brief Guided Imagery on Patients Suffering From Chronic Back Pain: An A-B Design Study

BACKGROUND

Guided imagery (GI) is a non-pharmacological method used to reduce pain, stress, and anxiety.

AIMS

This study aimed to evaluate the impact of brief GI on symptoms of chronic back pain in adults treated in the Rheumatology clinic.

DESIGN

A-B design study.

SETTINGS & PARTICIPANTS

A sample of 35 women with chronic back pain were recruited at the Rheumatology Outpatient Clinic of Barzilai Medical Center in Ashkelon, Israel.

METHODS

All subjects completed questionnaires at recruitment (T1), and after 8-10 weeks, they completed questionnaires again before the first intervention (T2). The intervention included five brief GI group meetings every 2-3 weeks, one hour each (3-5 subjects per group). Participants learned 6 GI exercises and were asked to practice brief guided imagery exercises at least once daily. Then, questionnaires were completed the third time (T3).

OUTCOME MEASURES

MOQ - Modified Oswestry Low Back Pain Disability Questionnaire, STAI - State-Trait Anxiety Inventory, FABQ - Fear-Avoidance Beliefs Questionnaire, NPRS - Numerical Pain Rating Scale (average pain over the last week).

RESULTS

Compared with the period without intervention, NPRS (Δ = 2.53, standard error [SE] = 0.43, p < .001), STAI (Δ = 8.41, SE = 1.95, p < .001), and MOQ (Δ = 0.06, SE = 0.02, p = .019) reported significantly lower levels after brief guided imagery training. However, no statistically significant change was found in FABQ.

CONCLUSIONS

The brief guided imagery intervention may help alleviate chronic back pain, help decrease anxiety, and improve daily activity in women who suffer from chronic low back pain.

Effects of short mindful breathing meditations on executive functioning in two randomized controlled double-blinded experiments

While current models of mindfulness propose benefits to the executive functions of inhibition, updating and shifting through mindful breathing meditations, empirical findings on the effects of short mindful breathing meditations are inconclusive regarding their specificity and dose-response relations. Therefore, we compared short mindful breathing meditations (Experiment 1, 45 min over three sessions; Experiment 2, 80 min over four sessions) with relaxation trainings (progressive muscle relaxation; active control) and listening to podcasts (passive control) in two randomized controlled double-blinded trials. Reaction time tasks were used to assess the executive functions of updating (N-Back), inhibition (CPT-II), and shifting (Number-Letter Task). Results of both experiments suggest no mindfulness-specific improvements in executive functions. We conclude that effects following the first stages of mindfulness training may not be specific to the practice or too transient to be reliably measured in pre-post intervention designs. Implications for research in the field are discussed.

A student-driven mindfulness curriculum for first-year osteopathic medical students: a pilot study

CONTEXT

Medical education is stressful and can adversely affect the health and well-being of students. Although mindfulness-based interventions (MBIs) have been successfully utilized in other settings, little is known about the use of student-led interventions in undergraduate medical education.

OBJECTIVES

The objectives of this study are to assess student satisfaction with four student-selected and student-led mindfulness activities incorporated into mandatory small-group sessions, the immediate impact of these activities on student stress levels, and student use of these activities outside the mindfulness sessions.

METHODS

First-year osteopathic medical students voluntarily participated in weekly student-selected and student-led mindfulness activities once a week for 8 consecutive weeks during regularly scheduled class time. Activities included yoga postures, the 4-7-8 breathing technique, progressive muscle relaxation (PMR), and values affirmation. Each activity was completed twice during the 8 weeks. After each session, students could anonymously complete an electronic survey assessing participation, change in stress level, satisfaction with the activity, and mindfulness activities practiced outside the session. Survey questions included dichotomous, Likert-like, and multiple-choice responses. A chi-square test was utilized to analyze student responses from each week about the decrease in stress level, and satisfaction with the mindfulness activity, and student use of the activities outside the classroom. Wilcoxon rank sum tests were utilized to determine associations between outcomes, and a logistic regression model was utilized to determine relationships between the change in stress levels and other outcomes.

RESULTS

Of the 154 first-year medical students initially enrolled in the 2021-2022 academic year, 14 (9.1 %) to 94 (61.0 %) actively participated in the weekly mindfulness activities. Students indicated that the 4-7-8 breathing technique was the activity most practiced outside the mindfulness sessions (32.3 %, 43/133 total responses) across all weeks. The mindfulness activity with the highest percentage of reported decrease in stress level was the yoga postures in week 5 (94.8 %, 36/38), and both weeks of the yoga activities had the highest reported student satisfaction (95.7 %, 90/94 for week 1; 92.1 %, 35/38 for week 5). For students who answered the change in stress level question, the stress level decrease was related to participation in the weekly activity for weeks 1 through 7 (all p<0.03). For students who participated in mindfulness sessions, the odds of reporting a reduction in the stress level were 16.6 times (95 % CI, 6.8-47.2; p<0.001) that of students who did not participate. For those satisfied with the activities, the odds of reporting a reduction in stress level were 6.7 (95 % CI, 3.3-13.9; p<0.001).

CONCLUSIONS

Results suggested that the student-selected and student-led mindfulness activities may successfully reduce medical student stress in students who actively participate. However, additional research is needed to determine how to optimize mindfulness curricula implementation.

Effectiveness of an app-based intervention to improve well-being through cultivating positive thinking and positive emotions in an adult sample: study protocol for a randomized controlled trial

Introduction

Interventions to promote health and well-being based on the construction of psychological resources can positively impact the daily life of users and foster human flourishing. Nowadays, mobile health represents a safe way to support health research and implement evidence-based psychological interventions. The present study aims to evaluate the effectiveness of a mobile app-based intervention program (OneUS) designed to cultivate positive emotions and positive thinking to improve overall well-being.

Methods

The study is designed as a randomized controlled trial. Two hundred participants will be randomly assigned to either a mobile health intervention condition (OneUS App) or an active control condition. The intervention consists of a program to cultivate positive emotions and positive thoughts. The active control intervention will comprise a set of mental imagery exercises and daily routine recording. The primary outcome comprises optimal well-being assessed using the multidimensional PERMA-Profiler scale. The sample will include adult people from the general population, who will be assessed at 8 time points: baseline (t1), intervention (t2, t3, t4, t5, t6) post-intervention (t7) and 3-month follow-up (t8).

Discussion

Mobile apps seem to be promising tools to promote health and well-being. This study will evaluate the effectiveness of a mobile app (OneUS) aiming to cultivate positive emotions and positive thinking to improve well-being. The main strength of this study is the development of an evidence-based mobile health app, based on intentional mental training, to promote well-being. The limitations of this study relate to potential participant drop-out and the non-generalizability of the results to clinical populations.

Clinical trial registration

https://ensaiosclinicos.gov.br/rg/RBR-43hpwqk, Identifier RBR-43hpwqk.

Psychophysiological stress response after a 6-week Mindful Self-Compassion training in psychiatric rehabilitation inpatients: a randomized post-test only study

Objectives

Mindfulness-based interventions (including self-compassion interventions) are effective in improving stress management at psychological and physical levels. Mindful Self-Compassion (MSC) is a newly developed program particularly aimed at increasing self-compassion. The main objective of this study was to determine whether the psychophysiological stress response during a social-evaluative speaking task differs in inpatients participating in the MSC or the Progressive Muscle Relaxation (PMR) program at the end of their 6-week psychiatric rehabilitation stay (i.e., post-test only design).

Method

Data from 50 inpatients (25 MSC, 25 PMR, 35 female) aged 19 to 76 years (M = 47.22, SD = 12.44) were analyzed in terms of psychophysiological stress response. For this purpose, heart rate variability, heart rate, and blood pressure were assessed together with several psychometric variables: positive and negative affect (PANAS), subjective stress perception (Visual Analog Scale), self-compassion (Self-Compassion Scale), cognitive reappraisal and suppression (Emotion Regulation Questionnaire), psychological distress (Brief Symptom Inventory-18), and appraisal and rumination (selected items).

Results

After correction for alpha inflation no differences in the psychophysiological stress response and psychometric parameters between the MSC and PMR group were found.

Discussion

In general, our results indicate that MSC is not superior to PMR training. However, more research with clinical randomized controlled trials investigating larger samples are needed to further affirm these initial findings.

A Validation Study for the German Versions of the Feeling Scale and the Felt Arousal Scale for a Progressive Muscle Relaxation Exercise

The aim of the present study is to prove the construct validity of the German versions of the Feeling Scale (FS) and the Felt Arousal Scale (FAS) for a progressive muscle relaxation (PMR) exercise. A total of 228 sport science students conducted the PMR exercise for 45 min and completed the FS, the FAS, and the Self-Assessment Manikin (SAM) in a pre-test-post-test design. A significant decrease in arousal (t(227) = 8.296, p < 0.001) and a significant increase in pleasure (t(227) = 4.748, p < 0.001) were observed. For convergent validity, the correlations between the FS and the subscale SAM-P for the valence dimension (r = 0.67, p < 0.001) and between the FAS and the subscale SAM-A for the arousal dimension (r = 0.31, p < 0.001) were significant. For discriminant validity, the correlations between different constructs (FS and SAM-A, FAS and SAM-P) were not significant, whereas the discriminant analysis between the FS and the FAS revealed a negative significant correlation (r = -0.15, p < 0.001). Together, the pattern of results confirms the use of the German versions of the FS and the FAS to measure the affective response for a PMR exercise.

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.

Acute Relaxation Response Induced by Tibetan Singing Bowl Sounds: A Randomized Controlled Trial

The prevalence of anxiety has increased dramatically due to COVID-19, so effective preventive interventions are welcome. The main objective of our study was to compare the acute relaxation response (RR) induced by Tibetan singing bowl (TSB) sound-based treatment against progressive muscle relaxation (PMR) and a control waiting list group (CWL) in a single treatment session in an adult nonclinical anxious population. In this cross-sectional randomized control trial, 50 participants selected based on high state anxiety were randomly assigned to one of the experimental groups. Pre/post self-reported anxiety, electroencephalographic activity (EEG), and heart rate variability (HRV) were recorded at baseline (T1), minute 15 (T2), minute 30 (T3), and minute 45 (T4). The TSB group showed significant reductions in alpha power (from T2 to T4) and increased HRV (from T3 to T4) compared with the PMR and CWL groups. Moreover, TSB and PMR both showed significant reductions in self-reported anxiety compared with CWL, with this effect being more evident in the TSB group. We concluded that a single session of TSB treatment was able to induce a more evident psychological/physiological relaxation response compared with PMR and CWL. TSB could be a relevant acute intervention in stressful situations or crisis intervention and while waiting for conventional interventions.

The Effects of Laughter Yoga on Perceived Stress, Positive Psychological Capital, and Exercise Capacity in Lung Cancer Chemotherapy Patients: A Pilot Randomized Trial

BACKGROUND

Lung cancer is the malignant tumor with the highest morbidity and mortality rate in China. Although chemotherapy is effective in improving clinical symptoms, it causes a variety of acute and chronic side effects, seriously aggravating the psychological stress of patients. Laughter Yoga as a new type of aerobic exercise can effectively reduce stress levels and increase positive mood in patients. This study aimed to examine the effects of laughter yoga on perceived stress, positive psychological capital, and exercise capacity in lung cancer patients.

METHODS

This study was a randomized, single-blind, parallel-group trial. The study enrolled 84 lung cancer chemotherapy patients from a general hospital in central China. These patients were randomly allocated to control and intervention groups (n = 42 per group) after baseline assessments. Patients in the control group received routine care and those in the intervention group received laughter yoga intervention. Perceived stress, positive psychological capital, and exercise capacity were assessed at baseline, immediately post-intervention.

RESULTS

During the implementation of the study, there were 2 dropouts in each of the intervention and control groups. Ultimately, 80 patients in the control and intervention groups completed the trial. Patients who received laughter yoga intervention had significantly higher scores in positive psychological capital (P < .01, Cohen's d = 0.692) and exercise capacity (P < .01, Cohen's d = 0.659). Discernible differences were also observed in perceived stress (P < .01, Cohen's d = 1.087) between the 2 groups.

CONCLUSIONS

The results of this study suggest that laughter yoga is an effective way and may produce beneficial effects on perceived stress, positive psychological capital and exercise capacity.

Cost-effectiveness of transdiagnostic group cognitive behavioural therapy versus group relaxation therapy for emotional disorders in primary care (PsicAP-Costs2): Protocol for a multicentre randomised controlled trial

Several randomised controlled trials (RCT) have demonstrated the superiority of transdiagnostic group cognitive-behavioural therapy (TD-CBT) to treatment as usual (TAU) for emotional disorders in primary care. To date, however, no RCTs have been conducted to compare TD-CBT to another active intervention in this setting. Our aim is to conduct a single-blind RCT to compare group TD-CBT plus TAU to progressive muscle relaxation (PMR) plus TAU in adults (age 18 to 65 years) with a suspected emotional disorder. We expect that TD-CBT + TAU will be more cost-effective than TAU + PMR, and that these gains will be maintained at the 12-month follow-up. Seven therapy sessions (1.5 hours each) will be offered over a 24-week period. The study will be carried out at four primary care centres in Cantabria, Spain. The study will take a societal perspective. Psychological assessments will be made at three time points: baseline, post-treatment, and at 12-months. The following variables will be evaluated: clinical symptoms (anxiety, depression, and/or somatic); functioning; quality of life (QoL); cognitive-emotional factors (rumination, worry, attentional and interpretative biases, emotion regulation and meta-cognitive beliefs); and satisfaction with treatment. Data on health service use, medications, and sick days will be obtained from electronic medical records. Primary outcome measures will include: incremental cost-effectiveness ratios (ICER) and incremental cost-utility ratios (ICURs). Secondary outcome measures will include: clinical symptoms, QoL, functioning, and treatment satisfaction. Bootstrap sampling will be used to assess uncertainty of the results. Secondary moderation and mediation analyses will be conducted. Two questionnaires will be administered at sessions 1, 4, and 7 to assess therapeutic alliance and group satisfaction. If this trial is successful, widespread application of this cost-effective treatment could greatly improve access to psychological treatment for emotional disorders in the context of increasing demand for mental healthcare in primary care. Trial registration: ClinicalTrials.gov: Cost-effectiveness of a Transdiagnostic Psychological Treatment for Emotional Disorders in Primary Care (PsicAP). NCT05314920.

Current study on the influence of psychological factors on returning to sports after ACLR

It is considered that psychological factors are important in determining exercise regression outcomes of patients with anterior cruciate ligament reconstruction (ACLR). This review summarizes the definition and research progress of current undefined psychological factors related to returning to sports (RTS) after ACLR, as well as the application of corresponding measuring scales, and common psychological interventions in the field. The aim is to understand and clarify the impact of psychological factors in the ACL injury and rehabilitation, and to provide a theoretical basis for the application of psychological evaluation and intervention in the later stage. It is believed that there are still many prospects for the research in this field.

Differential effects of guided imagery and progressive muscle relaxation on physical and emotional symptoms in nursing students taking initial clinical training: A randomized clinical trial

Background

The initial clinical training has been reported by nursing students as the most challenging component of the nursing programs. Although progressive muscle relaxation and guided imagery have been reported to improve emotional and physical health, the use of such approaches among nursing students rarely exist.

Purpose

The purpose of this study was to examine the deferential effects of progressive muscle relaxation [PMR] and guided imagery [GI] on physical and emotional symptoms in nursing students taking their initial clinical training.

Methods

Using a three-group, randomized, single blinded study conducted in a large Jordanian university, 156 nursing students were randomly allocated into one of three study groups (PMR group, GI group, and control group). The physical symptoms and emotional symptoms of depression, anxiety, and stress were assessed at baseline and end of the intervention. The study protocol was registered in ClinicalTrail.gov, identifier: xxxxxx.

Results

Using one-way MANOVA and post-hoc comparisons, the results showed that PMR and GI significantly reduced more physical symptoms than control condition although PMR was more effective than GI in this regard. GI significantly decreased more emotional symptoms such as anxiety, depression, and stress than PMR and control condition. PMR decreased anxiety, depression, and stress but the results were not statistically significant.

Conclusion

The findings of this study support the ABC relaxation theory claiming that PMR im-proves better physical symptoms while GI improves better emotional symptoms. However, further studies using students from multiple settings are needed.

The Effect of Olfactory Inhalation on KPGA Golfers' Putting Performance, Postural Stability and Heart Rate

Some athletes utilize olfactory inhalation treatments using ammonia salt and aromatic oils to attain their peak performance or for physical and psychological relaxation. However, there is still a lack of clear evidence on olfactory inhalation treatment and scent types via precise experiments, and there is no research regarding fine motor control performance in activities such as golf putting. Thus, the purpose of this study was to examine the effects of various olfactory inhalations (lavender, citrus, and ammonia) on professional golfers' 3-meter putting performance (percentage of success), postural stability (CoP area), and heart rate (HR). In order to examine the effects of olfactory treatment on actual automated task performance, ten professional golfers were recruited for the putting task experiment. During the putting task, a biometric shirt was utilized to record the HR changes, and a force plate was used to measure changes in the CoP area. The results were as follows. First, the olfactory inhalation treatment inhibited the putting performance (no inhalation: 68.75%; lavender: 51.25%; citrus: 40.00%; ammonia: 52.50%); however, no statistically significant difference was found (p = 0.115). Second, the olfactory inhalation treatment inhibited postural stability while putting; it had a partially statistically significant lower value (address: p = 0.000; downswing: p = 0.035; total putting section: p = 0.047). Third, the olfactory inhalation treatment decreased the HR during putting; however, there was no statistically significant difference between groups (address: p = 0.838; putting: p = 0.878; total: p = 0.666). This study implies that olfactory inhalation affects putting performance, postural stability, and HR. The effect size results for the olfactory treatment in the CoP area during the putting task (address: η² = 0.524; downswing: η² = 0.349; total putting section: η² = 0.298) suggest that arousal regulation through olfactory inhalation may have negative effects on dynamic postural stability in static tasks such as golf putting, showing the direction of its useful application for athletes in sports.

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.

Development and validation of audio-based guided imagery and progressive muscle relaxation tools for functional bloating

Mind-body techniques, including Guided Imagery (GI) or Progressive Muscle Relaxation (PMR), may effectively manage bloating. The current study aimed to develop and validate (psychometric and psychological responses) audio-based GI and PMR techniques for bloating. Audio scripts were first developed from literature reviews and in-depth interviews of participants with bloating diagnosed based on the Rome IV criteria. Scripts were validated using psychometric (content & face validity index) and physiological approaches (brain event-related potentials & heart rate variability). 45/63 participants completed the in-depth interview, and ‘balloon’ emerged as the synonymous imagery description for bloating, of which inflation correlated with a painful sensation. The final tools consisted of narrated audio scripts in the background of a validated choice of music. Overall, the content and face validity index for PMR and GI ranged from 0.92 to 1.00. For ERP and HRV, 17/20 participants were analyzed. For ERP, there was a significant difference between GI and PMR for alpha waves (p = 0.029), delta waves (p = 0.029), and between PMR and control for delta waves (p = 0.014). For HRV, GI and PMR exhibited similar autonomic responses over controls (overall p<0.05). The newly developed GI and PMR audio-based tools have been validated using psychometric and physiological approaches.

Social Connectedness in Schizotypy: The Role of Cognitive and Affective Empathy

Social connectedness is increasingly understood to be a resilience factor that moderates vulnerability to poor physical and mental health. This study examines cognitive and affective processes that support normal socialization and social connectedness, and the impact of schizotypy, in well-functioning college students. In this study, a total of 824 college students completed a series of self-report questionnaires, and structural equation modeling was then employed to identify relationships between cognitive and affective empathy, alexithymia, distress tolerance, social connectedness, and schizotypy. Schizotypy is a trait-like condition, presumed to be genetic in origin, associated with the risk for schizophrenia. Like schizophrenia, schizotypy is thought to have three distinct dimensions or categories, termed positive, negative, and disorganized. Results indicate that the respective dimensions of schizotypy have different pathways to social connectedness, through both direct and indirect effects. Positive schizotypy exerts a counterintuitive positive influence on social connectedness, mediated by positive effects on cognitive empathy, but this is obscured by the high correlations between the schizotypal dimensions and the strong negative influences on empathy and social connectedness of the negative and disorganized dimensions, unless all those intercorrelations are taken into account. Overall, the pathways identified by structural equation modeling strongly support the role of empathy in mediating the impact of schizotypy on social connectedness. Implications for the etiology of social impairments in schizotypy, and for interventions to enhance social connectedness to improve quality of life and reduce health disparities in people at risk for severe mental illness, are discussed.

The Role of Personalization in the User Experience, Preferences and Engagement with Virtual Reality Environments for Relaxation

Virtual Reality Environments (VREs) are widely deployed in mental health treatments, often associated with relaxation techniques. The personalization of natural VR-based scenarios is a key element that can further facilitate users’ sense of presence and relaxation. This study explored the role of VREs’ personalization in the user experience with an environment supporting relaxation, by deploying mixed methods. Methods: A non-clinical sample of 20 individuals participated in exposure to a supportive body-scan-guided relaxation VRE. In the personalized conditions, the participants had the option of choosing the context (e.g., sea, mountain, or countryside) and including in the scenario different types of sounds, visual elements, and changing the time of day and weather. In the standard conditions, individuals were exposed to a relaxing VRE, but they could choose neither the context nor the auditory and visual elements. The order of presentation of the personalized vs non-personalized environments was randomized. Measures regarding relaxation, state-anxiety perceived levels, VRE-related symptoms, the usability of the Virtual Reality (VR) setting, sense of presence, pleasure, activation, engagement, and level of immersion experienced were collected before and after exposure to the VR environments. Results: Findings showed that personalized VREs were preferred by users. Participants generally preferred to experience a greater immersivity, pleasure, engagement, and relaxation in the personalized virtual settings. Conclusion: The study further confirms the role of personalization as a component positively contributing to relaxation and engagement. Future research may further assess this effect in the context of large-scale controlled studies involving clinical and non-clinical populations.

A Qualitative Analysis of the Mental Health Training and Educational Needs of Firefighters, Paramedics, and Public Safety Communicators in Canada

Background-Public safety personnel (PSP) are at heightened risk of developing mental health challenges due to exposures to diverse stressors including potentially psychologically traumatic experiences. An increased focus on protecting PSP mental health has prompted demand for interventions designed to enhance resilience. While hundreds of available interventions are aimed to improve resilience and protect PSPs' mental health, research evidence regarding intervention effectiveness remains sparse. Methods-Focus groups with PSP elicited a discussion of psychoeducational program content, preferred modes of program delivery, when such training should occur, and to whom it ought to be targeted. Results-The results of thematic analyses suggest that PSP participants feel that contemporary approaches to improving mental health and resilience are lacking. While welcomed, the provision of sporadic one-off mental health and resilience programs by organizations was seen as insufficient, and the available organizational mental health supports were perceived as being questionable. The available programs also left participants feeling insufficiently prepared to deal with personal mental health problems and in discussing mental health concerns with co-workers. Conclusions-Participants reported needing more engaging methods for delivering information, career-long mental health knowledge acquisition, and a systems approach to improve the workplace culture, particularly regarding mental health.

Neurobiological and epigenetic perspectives on hedonism, altruism and conscience

This article examines notions of hedonism, altruism and conscience in relation to the activity of four neurotransmitter pathways: the dopamine reward, noradrenaline fight or flight, serotonin calming and glutamine learning pathways. Associated brain areas that modulate behaviour are highlighted: the prefrontal cortex (activity planning, risk mitigation), the hippocampus (memory retrieval) and the insular cortex (integration of information to decide on action). Putative epigenetic changes influencing adult behaviours after childhood privation are discussed. Pharmacological and psychological means of mitigating harmful behaviours are summarised, alongside the ethics of epigenetic screening to predict future addictive and violent tendencies.

Symptom provocation for treatment of obsessive-compulsive disorder using transcranial magnetic stimulation: A step-by-step guide for professional training

Transcranial Magnetic Stimulation (TMS) is a non-invasive brain stimulation technique that was cleared by the Food and Drug Administration (FDA) for the treatment of Obsessive-Compulsive Disorder (OCD) in 2018. The approved protocol includes individualized symptom provocation before each stimulation session, to elicit a moderate level of obsessional distress. Although symptom provocation can be a delicate, demanding, and uncomfortable procedure, structured training methods for those who are going to apply it are not available. Here, we describe a model for training in symptom provocation for TMS technicians, developed at the Champalimaud Clinical Centre in Lisbon, Portugal. Our programme includes two-sessions dedicated to clinical communication and symptom provocation techniques from a theoretical and practical perspective. Additionally, supervision meetings are conducted during treatment of patients, allowing regular case discussion and redefinition of symptom provocation hierarchy, as needed. In addition to having a strong practical component, our training program is short and pragmatic, allowing for easy implementation and fluid transition to clinical practice. By sharing our experience, we hope to contribute to systematize training procedures required for symptom provocation in the context of TMS, and to qualitatively describe a methodology that can be used for implementation of TMS programmes for the treatment of OCD.

Three Mediating Pathways of Anxiety and Security in the Relationship between Coping Style and Disordered Eating Behaviors among Chinese Female College Students

Background

According to previous studies, eating disorders and disordered eating behaviors are associated with coping style, anxiety, and sense of security. However, the specific mechanism between them has not been elucidated. The purpose of this study was to explore whether anxiety and sense of security play mediating roles in coping style and disordered eating behaviors among Chinese female college students.

Method

Six hundred and ninety-one female college students (mean age = 19.36; SD = 1.06) completed the Simple Coping Style Questionnaire, the Eating Disorder Inventory, the Security Questionnaire, the Hospital Anxiety and Depression Scale, and a brief demographic survey. The percentage bootstrap method of deviation correction was conducted to determine the mediating effect of anxiety and sense of security on coping style and disordered eating behaviors.

Results

Coping style had direct and indirect effects on disordered eating behaviors. Anxiety and sense of security were not only independent mediators in the relationship between coping style and disordered eating behaviors but also chain mediators.

Conclusions

The results of the current study provide preliminary evidence that preventive interventions targeting anxiety and sense of security may be feasible for young women who develop disordered eating behaviors due to stress in their lives.