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Nakao M. My memories of the Benson-Henry institute for mind-body medicine. Biopsychosoc Med 2023; 17:13. [PMID: 36998016 PMCID: PMC10061842 DOI: 10.1186/s13030-023-00270-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 04/01/2023] Open
Affiliation(s)
- Mutsuhiro Nakao
- Department of Psychosomatic Medicine, School of Medicine, International University of Health and Welfare, Narita, Japan.
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Hennemann S, Witthöft M, Kleinstäuber M, Böhme K, Baumeister H, Ebert DD, Probst T. Somatosensory amplification moderates the efficacy of internet-delivered CBT for somatic symptom distress in emerging adults: Exploratory analysis of a randomized controlled trial. J Psychosom Res 2022; 155:110761. [PMID: 35182889 DOI: 10.1016/j.jpsychores.2022.110761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE While studies mainly provide positive evidence for the efficacy of internet-delivered cognitive-behavioral therapy (ICBT) for various persistent somatic symptoms, it remains largely unclear for whom these interventions work or not. This exploratory analysis aimed to identify moderators for the outcome between ICBT for somatic symptom distres and a waitlist control group (WL) in a vulnerable target group of emerging adults. METHODS Based on data from a randomized controlled trial on 156 university students with varying degrees of somatic symptom distress who were allocated to either an eight-week, therapist guided ICBT (iSOMA) or to the WL, we examined pretreatment demographic characteristics, health-related variables (e.g., somatic symptom duration), mental distress (e.g., depression, anxiety) and cognitive-emotional factors (emotional reactivity, somatosensory amplification) as candidate moderators of the outcome, somatic symptom distress (assessed by the Patient Health Questionnaire, PHQ-15) from pre- to posttreatment. RESULTS Somatosensory amplification (assessed by the Somatosensory Amplification Scale, SSAS) moderated the outcome in favor of iSOMA (B = -0.17, SE = 0.08, p = 0.031), i.e., higher pretreatment somatosensory amplification was associated with better outcome in the active compared to the control intervention. No significant moderation effects were found among demographic characteristics, health-related variables, or mental distress. CONCLUSION Our findings suggest that an internet-delivered CBT for somatic symptom distress should be preferred over no active treatment particularly in individuals with moderate to high levels of somatosensory amplification, which as a next step should be tested against further treatments and in clinical populations. TRIAL REGISTRATION German Clinical Trials Register (DRKS00014375).
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Affiliation(s)
- Severin Hennemann
- Johannes Gutenberg University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany.
| | - Michael Witthöft
- Johannes Gutenberg University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany
| | - Maria Kleinstäuber
- Utah State University, Emma Eccles Jones College of Education and Human Services, Department of Psychology, Logan (Utah), USA
| | - Katja Böhme
- Johannes Gutenberg University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany
| | - Harald Baumeister
- Ulm University, Department of Clinical Psychology and Psychotherapy, Ulm, Germany
| | - David Daniel Ebert
- Technical University of Munich, Department of Sport and Health Sciences, München, Germany
| | - Thomas Probst
- Danube University Krems, Department for Psychotherapy and Biopsychosocial Health, Krems, Austria
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Güneş S, Bulut BP. Health anxiety During COVID-19: Predictive Roles of Health Promoting Behaviors and Sensory Processing Sensitivity. THE JOURNAL OF PSYCHOLOGY 2022; 156:167-184. [PMID: 35201953 DOI: 10.1080/00223980.2021.2012110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE The emergence of the COVID-19 pandemic resulted in major changes in daily life and economic conditions while heightening physical and mental health problems, including health anxiety. Health authorities and elected officials have encouraged individuals to engage in health behaviors. Perceptions of and reactions to these changes could be subject to individual differences. In this line, the current study investigated the predictive roles of health promoting behaviors, sensory processing sensitivity, and their interactions with health anxiety.Design and measures: In this cross-sectional study, 355 participants (73% female, 25.9% male) whose ages range from 19 to 72 (M = 25.91, SD = 9.80) filled out self-reported measures on health promoting behaviors, sensory processing sensitivity, and health anxiety via an online platform between April and May 2020. RESULTS It was revealed that caring for a healthy diet, taking responsibility for health and sensory processing sensitivity, but not physical activity and stress management, were associated with health anxiety. Diagnoses and perceptions of physical and mental health problems also contributed to health anxiety during the COVID-19 pandemic. CONCLUSION Individuals with higher levels of sensory processing sensitivity and health responsibility were more likely to experience higher levels of health anxiety, while typical physical activities and stress management behaviors were less likely to have an impact during the COVID-19 pandemic. These results highlight the importance of having a healthy diet and the need for pandemic-specific interventions for stress management and sport activities.
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Affiliation(s)
- Seren Güneş
- University of Wuppertal, Wuppertal, Germany.,Middle East Technical University, Ankara, Germany
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Zhou J, Gao S, Sun T, Gao W, Fu W, Ying Z, Mao W. Sleep quality, anxiety, somatic symptoms, and features of brain structure in parents of children with disabilities. SOCIAL BEHAVIOR AND PERSONALITY 2022. [DOI: 10.2224/sbp.11557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated sleep quality, anxiety, and somatic symptoms of 330 parents of children aged 0–6 years with disabilities, and explored the features of their brain structure using the Pittsburgh Sleep Quality Index Scale, the Patient Health Questionnaire-15, and the Generalized Anxiety Disorder-7. We compared these results with those of a control group of parents (n = 330) of children with typical development. The parents of children with disabilities were divided into a poor-sleep-quality subgroup and a good-sleep-quality subgroup, and then 20 parents from each subgroup were randomly selected for analysis of variance of magnetic resonance imaging scanning. There were significant positive correlations between scores on the three scales for the parents of children with disabilities, and their mean scores for all scales were also significantly higher than those of the control group. Moreover, among the parents of children with disabilities, those with poorer sleep quality had lower density of gray matter in brain regions related to emotional cognition. These results suggest that parents raising children with disabilities may have poorer sleep and be more likely to have somatic symptoms and generalized anxiety than are parents of children with typical development; furthermore, these effects may correspond to changes in brain structure.
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Affiliation(s)
- Jing Zhou
- Ningbo College of Health Science
- Dhurakij Pundit University
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Nakao M, Takeuchi T. Alexithymia and Somatosensory Amplification Link Perceived Psychosocial Stress and Somatic Symptoms in Outpatients with Psychosomatic Illness. J Clin Med 2018; 7:E112. [PMID: 29748483 PMCID: PMC5977151 DOI: 10.3390/jcm7050112] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/06/2018] [Accepted: 05/08/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Psychosomatic patients often complain of a variety of somatic symptoms. We sought to clarify the role of clinical predictors of complaints of somatic symptoms. METHODS We enrolled 604 patients visiting a psychosomatic outpatient clinic. The outcome was the total number of somatic symptoms, and the candidate clinical predictors were perceived psychosocial stress, alexithymia, somatosensory amplification, adaptation, anxiety, and depression. All participants completed questionnaires assessing the outcome and the predictors. RESULTS The average number of reported somatic symptoms was 4.8; the most frequent was fatigue (75.3%), followed by insomnia (56.1%), low-back pain (49.5%), headache (44.7%), and palpitations (43.1%). Multiple regression analysis showed that the total number of somatic symptoms was significantly associated with the degree of perceived psychosocial stress, alexithymia, somatosensory amplification, and depression. Also, structural equation models indicated links between excessive adaptation (via perceived psychosocial stress, alexithymia, and somatosensory amplification) and the total number of somatic symptoms. CONCLUSION The results suggested that the association between psychosocial stress and reported somatic symptoms is mediated by alexithymia and somatosensory amplification in psychosomatic patients.
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Affiliation(s)
- Mutsuhiro Nakao
- Department of Psychosomatic Medicine, School of Medicine, International University of Health and Welfare, Narita, Chiba 286-8686, Japan.
- Department of Psychosomatic Medicine, Teikyo University Hospital, Tokyo 173-8605, Japan.
| | - Takeaki Takeuchi
- Department of Psychosomatic Medicine, Teikyo University Hospital, Tokyo 173-8605, Japan.
- Department of Psychosomatic Medicine, School of Medicine, Toho University Hospital, Tokyo 143-8541, Japan.
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Tse PS, González DA, Jenkins SR. Validating the Structure of the Depression and Somatic Symptoms Scale. PSYCHOSOMATICS 2018; 59:277-282. [DOI: 10.1016/j.psym.2017.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022]
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Luberto CM, Chad-Friedman E, Dossett ML, Perez GK, Park ER. Characteristics of adult smokers presenting to a mind-body medicine clinic. J Health Psychol 2018; 23:860-870. [PMID: 27688301 PMCID: PMC5519444 DOI: 10.1177/1359105316671023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Mind-body interventions can improve vulnerabilities that underlie smoking behavior. The characteristics of smokers who use mind-body medicine have not been explored, preventing the development of targeted interventions. Patients ( N = 593) presenting to a mind-body medicine clinic completed self-report measures. Patients were 67 percent never smokers, 27 percent former smokers, and 6 percent current smokers. Current smokers were younger; more likely to be single, unemployed, or on disability; and report greater depression symptoms, greater pain, and lower social support ( ps < .05).Current smokers who use mind-body medicine have unique psychosocial needs that should be targeted in mind-body smoking cessation interventions.
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Affiliation(s)
- Christina M Luberto
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | - Emma Chad-Friedman
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, USA
| | - Michelle L Dossett
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, USA
| | - Giselle K Perez
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | - Elyse R Park
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, USA
- Harvard Medical School, USA
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Yoshioka N, Nomura K, Asayama K, Takenoshita S, Nagasawa T, Nakata Y, Hiraike H, Sasamori Y, Tsuchiya A, Ohkubo T, Okinaga H. [Association between Job Stress and Number of Physical Symptoms among Female Nurses of Medical-university-affiliated Hospitals]. Nihon Eiseigaku Zasshi 2018; 73:388-394. [PMID: 30270307 DOI: 10.1265/jjh.73.388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To clarify the association between job stress and the number of physical symptoms among newly certified female nurses. METHODS In this cross-sectional self-administered survey, we investigated 313 female nurses working at three medical-university-affiliated hospitals in February 2016. We investigated working conditions including numbers of working and on-call hours, work-life balance, Job Content Questionnaire (JCQ) scores, and 16 physical symptoms perceived more often than once a week. RESULTS Among the 313 participants (mean age, 31.9), 57% were aged 21-29 years and 70% were single. Of the 16 physical symptoms investigated, fatigability was the most frequent complaint (66.1%), followed by lower back pain (44.7%). Univariate analysis showed that significant factors related to physical symptoms are job demands (p<0.001) and social support (p<0.001) in JCQ, binary index of supports (p<0.001), and total working hours per day (p =0.025). Multivariable-adjusted logistic regression analyses demonstrated that the likelihood of reporting a greater number (n≥3) of physical symptoms increased by 7% [95% confidence interval (CI), 2-13%] with a one-unit increase in job demand degree, and decreased by 16% (95% CI, 10-22%) in social support degree. When binary JCQ indexes were assessed, the high-support group [odds ratio (OR) 0.36; 95% CI, 0.23-0.59] was protectively associated with a greater number of physical symptoms while long working hours was significantly associated with a higher risk (OR 18%, 95% CI, 1-38%). CONCLUSIONS Reporting a greater number of physical symptoms may be a good indicator of job stress perceived by a nurse in a university hospital setting.
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Affiliation(s)
| | - Kyoko Nomura
- Department of Public Health, Akita University Graduate School of Medicine
- Support Center for Women Physicians and Researchers, Teikyo University
- Department of Hygiene and Public Health, Teikyo University School of Medicine
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine
| | | | | | | | - Haruko Hiraike
- Department of Obstetrics and Gynaecology, Teikyo University School of Medicine
| | - Yukifumi Sasamori
- Department of Obstetrics and Gynaecology, Teikyo University School of Medicine
| | | | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine
| | - Hiroko Okinaga
- Support Center for Women Physicians and Researchers, Teikyo University
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Relationships between catastrophic thought, bodily sensations and physical symptoms. Biopsychosoc Med 2017; 11:28. [PMID: 29151850 PMCID: PMC5678578 DOI: 10.1186/s13030-017-0110-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Researchers have recently begun to seek cognitive explanations for physical symptoms with no obvious biological cause. Concepts such as somatization, somatosensory amplification, and somatosensory catastrophizing have been invoked to explain these phenomena. Somatosensory amplification occurs when these bodily sensations become stronger and more painful. Somatosensory catastrophizing is the tendency to attribute these bodily sensations to unbearable functional modulation or as signs of serious illness. This causes the sufferer to pay excessive attention to these physical sensations. However, there is no scale for evaluating somatosensory catastrophizing, and there are no standard diagnostic criteria. There were two objectives for this study: to develop a scale for evaluating somatosensory catastrophizing and to investigate relationships between somatosensory amplification, somatosensory catastrophizing, and physical symptoms. Methods In the first part of this study, in which we developed the scale, there were 231 student participants with an average age of 20.1 years. Of these, 57% of the participants were female. In the second part of the study, there were two groups of participants. The first group consisted of 158 non-patient subjects, 56% of whom were female, with an average age of 20.2 years. There were 33 outpatients receiving treatment for somatoform disorders in the second group. The average age of these participants, of whom 67% were female, was 48.8 years. The second part of the study was conducted using standardized self-rating questionnaires to assess somatosensory amplification and catastrophizing. Results We developed a 27-item scale, which we have called the Somatosensory catastrophizing scale (SSCS). The SSCS assesses five key areas, and our analysis confirmed it to be valid and highly reliable. The scale identified that the patient group from the second part of the study scored more highly than the control group for both somatosensory amplification and catastrophizing. Additionally, the results of covariance structure analyses revealed a significant causal relationship of the form "somatosensory amplifcation" via "somatosensory catastrophizing" to "physical symptoms". This relationship held in both groups of participants. The key difference between the patient and non-patient groups was that somatosensory catastrophizing had a greater impact on the physical symptoms of the participants in the patient group. Conclusions In this study, we developed the SSCS, which enables us to measure somatosensory catastrophizing empirically. We then clarified the relationship between somatosensory amplification, somatosensory catastrophizing, and physical symptoms. In the future, we expect to be able to apply our new understanding to developing intervention techniques to mitigate the physical symptoms caused by somatosensory catastrophizing.
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Shirotsuki K, Nonaka Y, Abe K, Adachi SI, Adachi S, Kuboki T, Nakao M. The effect for Japanese workers of a self-help computerized cognitive behaviour therapy program with a supplement soft drink. Biopsychosoc Med 2017; 11:23. [PMID: 28932258 PMCID: PMC5604512 DOI: 10.1186/s13030-017-0109-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 07/28/2017] [Indexed: 11/16/2022] Open
Abstract
Background Computerized cognitive behaviour therapy (CCBT) programs can provide a useful self-help approach to the treatment of psychological problems. Previous studies have shown that CCBT has moderate effects on depression, insomnia, and anxiety. The present study investigated whether a supplement drink that includes L-carnosine enhances the effect of CCBT on psychological well-being. Methods Eighty-seven participants were randomly allocated to a control group, CCBT, or CCBT with supplement drink. The CCBT and CCBT with supplement drink groups received six weekly self-help CCBT program instalments, which consisted of psycho-education about stress management and coping, behaviour activation, and cognitive restructuring. The CCBT group consumed a bottle of the supplement soft drink every morning through the 6 weeks. This program was delivered by an e-learning system on demand and also included a self-help guidebook. Seventy-two participants completed the program or were assess at the end of the study. Results ANOVA revealed that there were significant interactions (times × groups) for POMS tension-anxiety and fatigue. The CCBT group showed significantly improved tension-anxiety scores, whereas the CCBT with drink group showed significant improvements on fatigue. Conclusion The self-help CCBT program reduced the subjective experience of tension-anxiety in this group of workers. The addition of a supplement drink enhanced the effect of CCBT on fatigue, providing one possible approach to enhancement of such programs. Trial registration This study was registered on September 2, 2016 at UMIN. The registration number is UMIN000023903.
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Affiliation(s)
- Kentaro Shirotsuki
- Faculty of Human Sciences, Musashino University, 3-3-3, Ariake, Koto-ku, Tokyo, 135-8181 Japan
| | - Yuji Nonaka
- Innovation Development Department, Suntory Global Innovation Center Limited, Osaka, Japan
| | - Keiichi Abe
- Innovation Development Department, Suntory Global Innovation Center Limited, Osaka, Japan
| | | | - Shohei Adachi
- Medical corporation So-bun-kai, Clinic Adachi, Gifu, Japan
| | | | - Mutsuhiro Nakao
- Department of Psychosomatic Medicine, Teikyo University Hospital, Tokyo, Japan
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Aquin JP, El-Gabalawy R, Sala T, Sareen J. Anxiety Disorders and General Medical Conditions: Current Research and Future Directions. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:173-181. [PMID: 31975849 DOI: 10.1176/appi.focus.20160044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Evidence that anxiety disorders are associated with general medical conditions is growing. While it is known that medical and mental conditions are often comorbid, research demonstrates that there may be underlying causal mechanisms. Furthermore, comorbid anxiety and general medical conditions are associated with poorer patient outcomes than either condition alone. Comorbid general medical and mental disorders not only affect individual patient health but also strain existing medical systems. Growing health care expenditures and increasing time pressures on clinicians create a challenging environment for intensive therapy in traditional settings. Effective screening, diagnosis, and treatment of individuals with comorbid conditions require health systems that are based on interprofessional collaboration, including integrative and collaborative care services. These models encourage the provision of patient care within a network of health care professionals, working together and sharing expertise for more efficient and holistic care. Research on the design and implementation of these systems within the context of anxiety disorders and comorbid general medical conditions is in its infancy. Given the staggeringly high rates of anxiety disorders within the general population and the continued rise of many chronic medical conditions coinciding with the increasing lifespan, mental health and primary care providers should consider how they might implement integrative care methods within their own practice.
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Affiliation(s)
- Joshua P Aquin
- Mr. Aquin is a medical student at the Max Rady College of Medicine; Dr. El-Gabalawy is an assistant professor, Department of Anesthesia, Perioperative Medicine, Clinical Health Psychology, Psychiatry and Psychology; Dr. Sala is the medical program director, Mood and Anxiety Disorders Program of the Health Sciences Centre, and assistant professor, Department of Psychiatry; and Dr. Sareen is a professor of Psychiatry in the Departments of Psychiatry, Psychology, and Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Mr. Aquin is a medical student at the Max Rady College of Medicine; Dr. El-Gabalawy is an assistant professor, Department of Anesthesia, Perioperative Medicine, Clinical Health Psychology, Psychiatry and Psychology; Dr. Sala is the medical program director, Mood and Anxiety Disorders Program of the Health Sciences Centre, and assistant professor, Department of Psychiatry; and Dr. Sareen is a professor of Psychiatry in the Departments of Psychiatry, Psychology, and Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tanya Sala
- Mr. Aquin is a medical student at the Max Rady College of Medicine; Dr. El-Gabalawy is an assistant professor, Department of Anesthesia, Perioperative Medicine, Clinical Health Psychology, Psychiatry and Psychology; Dr. Sala is the medical program director, Mood and Anxiety Disorders Program of the Health Sciences Centre, and assistant professor, Department of Psychiatry; and Dr. Sareen is a professor of Psychiatry in the Departments of Psychiatry, Psychology, and Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Mr. Aquin is a medical student at the Max Rady College of Medicine; Dr. El-Gabalawy is an assistant professor, Department of Anesthesia, Perioperative Medicine, Clinical Health Psychology, Psychiatry and Psychology; Dr. Sala is the medical program director, Mood and Anxiety Disorders Program of the Health Sciences Centre, and assistant professor, Department of Psychiatry; and Dr. Sareen is a professor of Psychiatry in the Departments of Psychiatry, Psychology, and Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada
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Group-Based Relaxation Response Skills Training for Pharmacologically-Resistant Depressed and Anxious Patients. Behav Cogn Psychother 2016; 45:193-197. [PMID: 27669887 DOI: 10.1017/s1352465816000400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Drug-resistance for depression and anxiety is a major limitation in the treatment of these common disorders, and adjunct support interventions may be beneficial in the treatment of these patients. AIMS The purpose of this study was to evaluate the effects of a short-term (8 session) Relaxation Response Skills Training (RRST) programme for a population of psychiatric outpatients with anxiety and mood disorders who were unresponsive to drug treatment, and to test the feasibility of this intervention as complementary treatment for a psychiatric setting. METHOD Forty patients were measured for overall psychopathological symptoms, depression, and anxiety, and were then given an 8-week course of RRST, while continuing their pharmacological treatment. Following the RRST intervention, participants were again assessed. RESULTS The results demonstrated reductions in overall symptoms (large effect size and reasonable clinically significant change), and also in depression and anxiety (medium effect sizes and clinically significant change). CONCLUSIONS These results suggest that this short-term RRT offers a simple and cost-effective way to augment drug management for participants with common psychiatric disorders who are less responsive to the drug treatment.
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Nakao M, Takeuchi T. Clinical Characteristics and Referral Patterns of Outpatients Visiting a Japanese Psychosomatic Medicine Clinic. Int J Behav Med 2015; 23:580-8. [DOI: 10.1007/s12529-015-9520-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Stahl JE, Dossett ML, LaJoie AS, Denninger JW, Mehta DH, Goldman R, Fricchione GL, Benson H. Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization. PLoS One 2015; 10:e0140212. [PMID: 26461184 PMCID: PMC4603901 DOI: 10.1371/journal.pone.0140212] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/23/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Poor psychological and physical resilience in response to stress drives a great deal of health care utilization. Mind-body interventions can reduce stress and build resiliency. The rationale for this study is therefore to estimate the effect of mind-body interventions on healthcare utilization. OBJECTIVE Estimate the effect of mind body training, specifically, the Relaxation Response Resiliency Program (3RP) on healthcare utilization. DESIGN Retrospective controlled cohort observational study. SETTING Major US Academic Health Network. SAMPLE All patients receiving 3RP at the MGH Benson-Henry Institute from 1/12/2006 to 7/1/2014 (n = 4452), controls (n = 13149) followed for a median of 4.2 years (.85-8.4 yrs). MEASUREMENTS Utilization as measured by billable encounters/year (be/yr) stratified by encounter type: clinical, imaging, laboratory and procedural, by class of chief complaint: e.g., Cardiovascular, and by site of care delivery, e.g., Emergency Department. Subgroup analysis by propensity score matched pre-intervention utilization rate. RESULTS At one year, total utilization for the intervention group decreased by 43% [53.5 to 30.5 be/yr] (p <0.0001). Clinical encounters decreased by 41.9% [40 to 23.2 be/yr], imaging by 50.3% [11.5 to 5.7 be/yr], lab encounters by 43.5% [9.8 to 5.6], and procedures by 21.4% [2.2 to 1.7 be/yr], all p < 0.01. The intervention group's Emergency department (ED) visits decreased from 3.6 to 1.7/year (p<0.0001) and Hospital and Urgent care visits converged with the controls. Subgroup analysis (identically matched initial utilization rates-Intervention group: high utilizing controls) showed the intervention group significantly reduced utilization relative to the control group by: 18.3% across all functional categories, 24.7% across all site categories and 25.3% across all clinical categories. CONCLUSION Mind body interventions such as 3RP have the potential to substantially reduce healthcare utilization at relatively low cost and thus can serve as key components in any population health and health care delivery system.
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Affiliation(s)
- James E. Stahl
- MGH Benson-Henry Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Dartmouth-Hitchcock Medical Center, Section of General Internal Medicine, Lebanon, New Hampshire, United States of America
- MGH Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Michelle L. Dossett
- MGH Benson-Henry Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- MGH Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - A. Scott LaJoie
- MGH Department of Psychiatry, University of Louisville, Health Promotion and Behavioral Sciences, Louisville, Kentucky, United States of America
| | - John W. Denninger
- MGH Benson-Henry Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- MGH Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Darshan H. Mehta
- MGH Benson-Henry Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- MGH Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Roberta Goldman
- MGH Benson-Henry Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Gregory L. Fricchione
- MGH Benson-Henry Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- MGH Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Herbert Benson
- MGH Benson-Henry Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Abstract
CONCLUSION The frequency of headaches in patients complaining of chronic dizziness is closely related to the severity of the dizziness impairments and mood states, such as anxiety. It is, therefore, important to treat co-morbid headache in patients with chronic dizziness. The severity of the dizziness impairments and other mood states, including anxiety, did not differ between patients with migraine or non-migraine headaches. OBJECTIVES Patients with chronic dizziness often complain of headaches or general fatigue. This study investigated the influence of the frequency of headaches on dizziness impairments, anxiety, quality-of-life, and other mood states in patients with chronic dizziness. METHOD The subjects consisted of 100 consecutive patients with intractable dizziness. Several types of questionnaires were used in the investigations. RESULTS Of the 85 patients, 51 had either type of headache (tension headache, 38; migraine, 13). The total score on the Dizziness Handicap Inventory correlated linearly with general fatigue (R = 0.39, p < 0.001) and headache (R = 0.25, p < 0.05). The patients with any type of headache had a significantly more positive family history of headache (p < 0.05).
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Affiliation(s)
- Fumiyuki Goto
- a 1 Department of Otolaryngology, National Hospital Organization Tokyo Medical Center , Meguro, Tokyo, Japan
| | - Miki Arai
- a 1 Department of Otolaryngology, National Hospital Organization Tokyo Medical Center , Meguro, Tokyo, Japan
| | - Motohiro Arai
- b 2 Department of Otolaryngology, Yokohama City Minato Red Cross Hospital , Kanagawa, Japan
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Sekizuka-Kagami N, Shimada K, Tabuchi N, Nakamura H. Association between the sense of coherence 13-item version scale score of pregnant women in the second trimester of pregnancy and threatened premature birth. Environ Health Prev Med 2015; 20:90-6. [PMID: 25586895 PMCID: PMC4597347 DOI: 10.1007/s12199-014-0436-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 11/19/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The purpose of this study is to determine whether the score of the sense of coherence 13-item version (SOC-13) scale in the second trimester of pregnancy is associated with threatened premature birth. METHODS All the subjects gave their informed written consent before their participation in the study. A self-reported questionnaire survey was conducted on the pregnant women at approximately 18 weeks of pregnancy. The questionnaire consisted of items on demographic characteristics, perinatal abnormalities, stress perception scale (SPS), and SOC-13 scale. Approximately 30 weeks of pregnancy after the first survey, we surveyed whether any treatment had been provided for threatened premature birth during the course of the current pregnancy. The study period was from December 2007 to February 2010. One hundred and seventy-seven pregnant women participated in the study, but only the data from 151 pregnant women were analyzed. RESULTS Forty-three (28.5%) pregnant women had threatened premature birth and received some treatment. Logistic regression analysis was carried out with threatened premature birth as the dependent variable and age, childbirth history, smoking habit, history of miscarriage or premature birth in previous pregnancies, SPS score, and SOC-13 scale score as the independent variables. It was shown that SOC-13 scale score affected threatened premature birth (p < 0.001) and that a low SOC-13 scale score was associated with threatened premature birth. CONCLUSIONS This study suggests that the SOC-13 scale score in the second trimester of pregnancy could be of great value in clinical health care of pregnant women with a risk of threatened premature birth in the subsequent course of pregnancy.
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Affiliation(s)
- Naomi Sekizuka-Kagami
- Department of Nursing, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan,
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Nakao M, Ohara C. The perspective of psychosomatic medicine on the effect of religion on the mind-body relationship in Japan. JOURNAL OF RELIGION AND HEALTH 2014; 53:46-55. [PMID: 22434576 PMCID: PMC3929030 DOI: 10.1007/s10943-012-9586-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Shintoism, Buddhism, and Qi, which advocate the unity of mind and body, have contributed to the Japanese philosophy of life. The practice of psychosomatic medicine emphasizes the connection between mind and body and combines the psychotherapies (directed at the mind) and relaxation techniques (directed at the body), to achieve stress management. Participation in religious activities such as preaching, praying, meditating, and practicing Zen can also elicit relaxation responses. Thus, it is time for traditional religions to play an active role in helping those seeking psychological stability after the Great East Japan Earthquake and the ongoing crisis related to the nuclear accident in Fukushima, Japan, to maintain a healthy mind-body relationship.
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Affiliation(s)
- Mutsuhiro Nakao
- Division of Psychosomatic Medicine, Teikyo University Hospital, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan,
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Bhasin MK, Dusek JA, Chang BH, Joseph MG, Denninger JW, Fricchione GL, Benson H, Libermann TA. Relaxation response induces temporal transcriptome changes in energy metabolism, insulin secretion and inflammatory pathways. PLoS One 2013; 8:e62817. [PMID: 23650531 PMCID: PMC3641112 DOI: 10.1371/journal.pone.0062817] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 03/26/2013] [Indexed: 01/08/2023] Open
Abstract
The relaxation response (RR) is the counterpart of the stress response. Millennia-old practices evoking the RR include meditation, yoga and repetitive prayer. Although RR elicitation is an effective therapeutic intervention that counteracts the adverse clinical effects of stress in disorders including hypertension, anxiety, insomnia and aging, the underlying molecular mechanisms that explain these clinical benefits remain undetermined. To assess rapid time-dependent (temporal) genomic changes during one session of RR practice among healthy practitioners with years of RR practice and also in novices before and after 8 weeks of RR training, we measured the transcriptome in peripheral blood prior to, immediately after, and 15 minutes after listening to an RR-eliciting or a health education CD. Both short-term and long-term practitioners evoked significant temporal gene expression changes with greater significance in the latter as compared to novices. RR practice enhanced expression of genes associated with energy metabolism, mitochondrial function, insulin secretion and telomere maintenance, and reduced expression of genes linked to inflammatory response and stress-related pathways. Interactive network analyses of RR-affected pathways identified mitochondrial ATP synthase and insulin (INS) as top upregulated critical molecules (focus hubs) and NF-κB pathway genes as top downregulated focus hubs. Our results for the first time indicate that RR elicitation, particularly after long-term practice, may evoke its downstream health benefits by improving mitochondrial energy production and utilization and thus promoting mitochondrial resiliency through upregulation of ATPase and insulin function. Mitochondrial resiliency might also be promoted by RR-induced downregulation of NF-κB-associated upstream and downstream targets that mitigates stress.
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Affiliation(s)
- Manoj K. Bhasin
- Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- BIDMC Genomics and Proteomics Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Jeffery A. Dusek
- Institute for Health and Healing, Abbott Northwestern Hospital, Minneapolis, Minnesota, United States of America
| | - Bei-Hung Chang
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Marie G. Joseph
- BIDMC Genomics and Proteomics Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - John W. Denninger
- Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Gregory L. Fricchione
- Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Herbert Benson
- Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Towia A. Libermann
- Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- BIDMC Genomics and Proteomics Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
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Sharma MP, Manjula M. Behavioural and psychological management of somatic symptom disorders: an overview. Int Rev Psychiatry 2013; 25:116-24. [PMID: 23383673 DOI: 10.3109/09540261.2012.746649] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The number of patients who seek help at primary and secondary care for somatic symptoms which cannot be explained by any known medical condition is enormous. It has been proposed to rename 'somatoform disorders' in DSM-IV as 'somatic symptom disorders' in DSM-5. This is supposed to include disorders such as somatization disorder, hypochondriasis, undifferentiated somatoform disorder, pain disorder and factitious disorder. The reason for the renaming and grouping is that all these disorders involve presentation of physical symptoms and/or concern about medical illness. In the literature, there is considerable variation adopted with respect to diagnosis and in the approaches adopted for intervention. However, the common feature of these disorders is the chronicity, social dysfunction, occupational difficulties and the increased healthcare use and high level of dissatisfaction for both the clinician and the patient. A number of behavioural and psychological interventions for somatic symptoms have been carried out at primary, secondary and tertiary care settings and recently there have been more attempts to involve the primary care physicians in the psychological interventions. This review aims at giving an overview of the components of the behavioural and other psychological interventions available for addressing medically unexplained somatic symptoms and to present their efficacy.
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Affiliation(s)
- Mahendra P Sharma
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Park ER, Traeger L, Vranceanu AM, Scult M, Lerner JA, Benson H, Denninger J, Fricchione GL. The development of a patient-centered program based on the relaxation response: the Relaxation Response Resiliency Program (3RP). PSYCHOSOMATICS 2013; 54:165-74. [PMID: 23352048 DOI: 10.1016/j.psym.2012.09.001] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 09/06/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Chronic daily stress has significant physical, emotional, and financial implications; levels of stress are increasing in the US. Dr. Benson highlighted how the mind and body function together in one's experience of the stress response and proposed the existence of the relaxation response (RR). OBJECTIVE The current paper describes the foundation and development of an 8-session multimodal treatment program for coping with chronic stress: the Relaxation Response Resiliency Program (3RP). METHODS We review the past decades of RR research, outline the development of the 3RP treatment, and provide an overview of the program's theory and content. RESULTS Extensive research and clinical work have examined how eliciting the RR may combat stress through down-regulation of the sympathetic nervous system. Related to this work are the multidimensional constructs of resiliency and allostatic load. The 3RP is based on principles from the fields of stress management, cognitive-behavioral therapy, and positive psychology, and has three core target areas: (1) elicitation of the RR; (2) stress appraisal and coping; and (3) growth enhancement. An 8-week patient-centered treatment program has been developed, with the purpose of assisting patients with a variety of psychological and medical issues to better cope with chronic stress. CONCLUSIONS Mastery of the RR is theorized to maximize one's ability to benefit from multimodal mind body strategies. The goal of the 3RP is to enhance individuals' adaptive responses to chronic stress through increasing awareness and decreasing the physiological, emotional, cognitive, and behavioral effects of the stress response, while simultaneously promoting the effects of being in the RR.
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Affiliation(s)
- Elyse R Park
- Massachusetts General Hospital Benson-Henry Institute for Mind Body Medicine, Boston, MA 02114, USA.
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Understanding urban green space as a health resource: a qualitative comparison of visit motivation and derived effects among park users in Sheffield, UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:417-42. [PMID: 23340602 PMCID: PMC3564151 DOI: 10.3390/ijerph10010417] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 01/11/2013] [Accepted: 01/15/2013] [Indexed: 12/03/2022]
Abstract
With increasing interest in the use of urban green space to promote human health, there is a need to understand the extent to which park users conceptualize these places as a resource for health and well-being. This study sought to examine park users’ own reasons for and benefits from green space usage and compare these with concepts and constructs in existing person-environment-health theories and models of health. Conducted in 13 public green spaces in Sheffield, UK, we undertook a qualitative content analysis of 312 park users’ responses to open-ended interview questions and identified a breadth, depth and salience of visit motivators and derived effects. Findings highlight a discrepancy between reasons for visiting and derived effects from the use of urban green space. Motivations emphasized walking, green space qualities, and children. Derived effects highlighted relaxation, positive emotions within the self and towards the place, and spiritual well-being. We generate a taxonomy of motivations and derived effects that could facilitate operationalization within empirical research and articulate a conceptual framework linking motivators to outcomes for investigating green space as a resource for human health and well-being.
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Chan AS, Wong QY, Sze SL, Kwong PPK, Han YMY, Cheung MC. A Chinese Chan-based mind-body intervention for patients with depression. J Affect Disord 2012; 142:283-9. [PMID: 22840618 DOI: 10.1016/j.jad.2012.05.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 05/07/2012] [Accepted: 05/07/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Given the recent growing interest and encouraging findings in studies of alternative treatments for depression, the present randomized controlled trial study aimed to compare the effect of a newly developed Chinese Chan-based Dejian Mind-Body Intervention (DMBI) with the Cognitive Behavioral Therapy (CBT) on improving depressive symptoms in patients with depression. METHODS Seventy-five participants diagnosed with major depressive disorder were randomly assigned to receive either 10-session CBT or DMBI, or placed on a waitlist. Pre-post measurements included record of anti-depressants treatment, ratings by psychiatrists who were blinded to the experimental design and self-report on mood measures, and performance in a cognitive test tapping concentration ability. RESULTS Both the CBT and DMBI groups demonstrated significantly reduced overall depressive syndrome after intervention at large effect size (0.93-1.10). Furthermore, the DMBI group (p<0.05), but not the CBT or waitlist groups, demonstrated significant reduction in intake of anti-depressants, and significant improvement in specific depression-related symptoms including difficulty in concentration (p=0.002), and problems in gastrointestinal health (p=0.02) and overall sleep quality (p<0.001). LIMITATIONS This study has provided some evidence for the short-term effect of the DMBI on Chinese population. Its long-term effect on a larger sample and on Caucasian population warrants further investigation. CONCLUSIONS The present findings suggest that a Chinese Chan-based Mind-Body intervention has positive effects on improving mood and health conditions of individuals with depression.
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Affiliation(s)
- Agnes S Chan
- Department of Psychology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
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Zonneveld LNL, van Rood YR, Kooiman CG, Timman R, van 't Spijker A, Busschbach JJV. Predicting the outcome of a cognitive-behavioral group training for patients with unexplained physical symptoms: a one-year follow-up study. BMC Public Health 2012; 12:848. [PMID: 23039913 PMCID: PMC3549894 DOI: 10.1186/1471-2458-12-848] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 10/02/2012] [Indexed: 11/30/2022] Open
Abstract
Background Although Cognitive-Behavioral Therapy (CBT) is effective for Unexplained Physical Symptoms (UPS), some therapists in clinical practice seem to believe that CBT outcome will diminish if psychiatric comorbidity is present. The result is that patients with a psychiatric comorbidity are redirected from treatment for UPS into treatment for mental health problems. To explore whether this selection and allocation are appropriate, we explored whether CBT outcomes in UPS could be predicted by variables assessed at baseline and used in routine-practice assessments. Methods Patients (n=162) with UPS classified as undifferentiated somatoform disorder or chronic pain disorder were followed up until one year after they had attended a CBT group training. The time-points of the follow-up were at the end of CBT (immediate outcome), three months after CBT (short-term outcome), and one year after CBT (long-term outcome). CBT outcome was measured using the Physical Component Summary of the SF-36, which was the primary outcome measure in the randomized controlled trial that studied effectiveness of the CBT group training. Predictors were: 1.) psychological symptoms (global severity score of SCL-90), 2.) personality-disorder characteristics (sum of DSM-IV axis II criteria confirmed), 3.) psychiatric history (past presence of DSM-IV axis I disorders), and 4.) health-related quality of life in the mental domain (mental component summary of SF-36). The effect of this predictor set was explored using hierarchical multiple regression analyses into which these predictors had been entered simultaneously, after control for: a.) pretreatment primary outcome scores, b.) age, c.) gender, d.) marital status, and e.) employment. Results The predictor set was significant only for short-term CBT outcome, where it explained 15% of the variance. A better outcome was predicted by more psychological symptoms, fewer personality-disorder characteristics, the presence of a psychiatric history, and a better quality of life in the mental domain. Conclusions As the predictors do not seem to predict CBT outcome consistently over time, the need for selection and allocation of patients for CBT is doubtful. It seems that this would unnecessarily deprive patients of effective treatment. Trial registration Nederlands Trial Register, NTR1609
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Affiliation(s)
- Lyonne N L Zonneveld
- Department of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, 3000 CA, the Netherlands.
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Improvement in physiological and psychological parameters after 6months of yoga practice. Conscious Cogn 2012; 21:843-50. [DOI: 10.1016/j.concog.2012.01.014] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 01/18/2012] [Accepted: 01/24/2012] [Indexed: 11/21/2022]
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Rogers KR, Hertlein K, Rogers D, Cross CL. Guided visualization interventions on perceived stress, dyadic satisfaction and psychological symptoms in highly stressed couples. Complement Ther Clin Pract 2012; 18:106-13. [DOI: 10.1016/j.ctcp.2011.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/20/2011] [Accepted: 10/26/2011] [Indexed: 11/25/2022]
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Ricanati EH, Golubić M, Yang D, Saager L, Mascha EJ, Roizen MF. Mitigating preventable chronic disease: Progress report of the Cleveland Clinic's Lifestyle 180 program. Nutr Metab (Lond) 2011; 8:83. [PMID: 22112436 PMCID: PMC3264524 DOI: 10.1186/1743-7075-8-83] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 11/23/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Poor lifestyle choices are key in development and progression of preventable chronic diseases. The purpose of the study was to design and test a program to mitigate the physical and fiscal consequences of chronic diseases. METHODS Here we report the outcomes for 429 participants with one or more chronic conditions, including obesity, hypertension, hyperlipidemia and diabetes mellitus, many of whom had failed traditional disease management programs, who enrolled into a comprehensive lifestyle intervention. The Lifestyle 180 program integrates nutrition, physical activity and stress management interventions and was conducted at the Wellness Institute of the Cleveland Clinic, United States. An intensive 6 week immersion course, with 8 hours of group instruction per week, was followed by 3 follow-up, 4 hour-long sessions over the course of 6 months. RESULTS Changes in biometric (weight, height, waist circumference, resting heart rate and blood pressure) and laboratory variables (fasting lipid panel, blood glucose, insulin, hemoglobin A1c, ultra sensitive C-reactive protein) at 6 months were compared with baseline (pre-post analysis). At week 30, biometric and laboratory data were available for 244 (57%) and 299 (70%) participants, respectively. These had a mean ± SD reduction in weight (6.8 ± 6.9 kg, P < 0.001), waist circumference (6.1 ± 7.3 cm, P < 0.001), glucose (4.5 ± 29.6 mg/dL or 0.25 ± 1.64 mmol/L, P = 0.009), triglycerides (26.4 ± 58.5 mg/dL or 0.30 ± 0.66 mmol/L, P < 0.001), low-density lipoprotein cholesterol (LDL) (7.9 ± 25.1 mg/dL or 0.2 ± 0.65 mmol/L, P < 0.001), hemoglobin A1c (HgbA1c) (0.20 ± 0.64%, P = 0.001), insulin (3.8 ± 11 microU/ml or 26.6 ± 76.4 ρmol, P < 0.001) and ultra sensitive C-reactive protein (US - CRP) (0.9 ± 4.8 mg/dL or 7.3 ± 40.2 nmol/L, P = 0.012), an increase in mean high-density lipoprotein cholesterol (HDL) (3.7 ± 8.4 mg/dL or 0.1 ± 0.22, P < 0.001), and decreased use of medications. CONCLUSION Implementation of a comprehensive lifestyle modification program among adults with common chronic conditions results in significant and clinically meaningful improvements in biometric and laboratory outcomes after 6 months.
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Affiliation(s)
- Elizabeth Hw Ricanati
- Wellness Institute, Cleveland Clinic, 1950 Richmond Road, TR2-341, Lyndhurst, OH 44124, USA.
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La Roche MJ, Batista C, D'Angelo E. A culturally competent relaxation intervention for Latino/as: assessing a culturally specific match model. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2011; 81:535-42. [PMID: 21977939 DOI: 10.1111/j.1939-0025.2011.01124.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In this study, we explored 2 questions: (a) Consistent with the cultural match theory (CMT), did treatment adherence and outcome improve as discrepancies between the cultural features of an anxiety treatment and patient characteristics decreased, and (b) In agreement with the specific therapy ingredient model (STIM), did the psychotherapeutic outcomes of a Culturally Competent Relaxation Intervention (CCRI) designed to reduce anxiety more effectively reduce anxiety rather than depression symptoms? The CCRI includes allocentric (the tendency to define oneself in relationship to others) relaxation interventions, while traditional relaxation strategies employ idiocentric (the tendency to define oneself in isolation from others) relaxation interventions. The CCRI was assessed with 44 Latino/a adults of low socioeconomic backgrounds. The results supported 2 hypotheses: (a) Based on the CMT, a relationship was found between participants' levels of allocentrism and their consequent levels of treatment adherence, and (b) Consistent with the STIM, treatment adherence on the CCRI was correlated with reductions in anxiety, but not with depressive symptoms. These findings are discussed with a focus on future efforts to create culturally competent interventions.
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Affiliation(s)
- Martin J La Roche
- Martha Eliot Health Center, 75 Bickford St., Jamaica Plain, MA 02130, USA.
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Maclaughlin BW, Wang D, Noone AM, Liu N, Harazduk N, Lumpkin M, Haramati A, Saunders P, Dutton M, Amri H. Stress biomarkers in medical students participating in a mind body medicine skills program. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2011:950461. [PMID: 21799696 PMCID: PMC3137844 DOI: 10.1093/ecam/neq039] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 04/09/2010] [Indexed: 11/12/2022]
Abstract
Georgetown University School of Medicine offers an elective Mind-Body Medicine Skills (MBMS) course to medical students to promote self-care and self-awareness. Participating medical students reported better management of academic stress and well-being than non-participants. In this study, we sought to assess the stress-reducing effects of MBMS by measuring physiological changes in first-year medical students. Saliva samples were collected before (January, time 1 (T1)-pre-intervention) and upon completion of the course (May, time 2 (T2p)-post-intervention), as well as from non-participating medical students (May, time 2 (T2c)-control). The T2p and T2c collections coincided with the period of final examinations. Cortisol, dehydroepiandrosterone-sulfate (DHEA-S), testosterone and secretory immunoglobulin A (sIgA) were measured. The mean morning salivary cortisol at T2p was 97% of the mean at baseline T1 which was significantly lower than for T2c (2.4) (95% confidence interval (CI) 0.57-1.60, P = .001); DHEA-S showed similar pattern as cortisol where the T2p levels were significantly lower than T2c (P < .001) in both morning and evening collections. Testosterone ratio at T2p (0.85) was also lower than T2c (1.6) (95% CI 0.53-1.3, P = .01). sIgA levels were not statistically different. On direct comparison, the T2c and T2p means were significantly different for all cortisol, DHEA-S and testosterone values. Participants maintained their hormonal balance within the normal range throughout the academic semester while the control group showed significantly increased levels, probably exacerbated by the end of the semester exam stress. To our knowledge, this is the first study to assess the physiologic benefits of a MBMS program in medical students.
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Affiliation(s)
- Brian W Maclaughlin
- Department of Physiology and Biophysics, Georgetown University Medical Center, 3900 Reservoir Road, Washington, DC 20007, USA
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Heider J, Zaby A. Einfluss von Angststörungen und Depression auf den Therapieerfolg bei Patienten mit somatoformen Störungen. VERHALTENSTHERAPIE 2011. [DOI: 10.1159/000323957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nakao M. [Series: Mind/body medicine in occupational health. Session 3. Treatment and management in mind/body medicine]. SANGYO EISEIGAKU ZASSHI = JOURNAL OF OCCUPATIONAL HEALTH 2010; 52:153-156. [PMID: 20234117 DOI: 10.1539/sangyoeisei.rensai9003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Mutsuhiro Nakao
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
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Non-dieting group interventions for overweight and obese women: what predicts non-completion and does completion improve outcomes? Public Health Nutr 2009; 13:1622-8. [DOI: 10.1017/s1368980009992977] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo determine factors which predict non-completion of group non-dieting interventions for overweight women, and to investigate whether completion improves outcomes.DesignFirst, baseline predictors of non-completion were identified; then changes at 10 weeks and 12 months were compared between completers and non-completers of 10-week non-dieting interventions.SettingGeneral community.SubjectsParticipants were 119 women (aged 25–65 years, BMI ≥ 28 kg/m2) with at least one cardiovascular risk factor. Participants who attended at least eight of the ten sessions were classified as completers, and non-completers were those who attended fewer than eight sessions. Measures included BMI, blood pressure, psychological distress, lifestyle behaviours and eating self-efficacy.ResultsLogistic regression analyses indicated that women were less likely to be non-completers at non-dieting group programmes if, at baseline, they were more highly educated or had healthier nutrition behaviours (controlling for education). Only healthier nutrition behaviour was negatively associated with non-completion in the final model. Twelve months after the intervention, completers showed significantly greater improvements in body weight (mean change −0·53 kg), systolic and diastolic blood pressure (−6·3 and −4·1 mmHg, respectively), stress management behaviour score (+0·5) and psychotic symptoms score (−0·1) than non-completers (all P < 0·05).ConclusionsHighly educated women already engaging in some healthier lifestyle choices were less likely to be non-completers in non-dieting group programmes. Since important treatment outcomes vary according to attendance, future trials of non-dieting interventions should report the effects of completion on outcomes.
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Sekizuka N, Sakai A, Shimada K, Tabuchi N, Kameda Y, Nakamura H. Low serum secretory immunoglobulin A level and sense of coherence score at an early gestational stage as indicators for subsequent threatened premature birth. Environ Health Prev Med 2009; 14:276-83. [PMID: 19582543 PMCID: PMC2728253 DOI: 10.1007/s12199-009-0096-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Accepted: 06/10/2009] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess the validity of the candidate indicators secretory immunoglobulin A (s-IgA) and sense of coherence (SOC) as predictors of threatened premature birth. METHODS This was a panel study conducted on women in their first and latter half of pregnancy during survey period. The survey period was from December 2005 to June 2006 and from December 2007 to June 2008. The women enrolled in the study were asked to complete the survey questionnaire and provide blood samples for the determinations of physiological indicators. The questionnaire consisted of questions related to the stress perception scale (SPS), SOC score as an indicator of modifiers of stress, demographic data, complications in a previous pregnancy, and the course of the current pregnancy. We used s-IgA and high-sensitivity C-reactive protein as a physiological stress indicator and a marker of infection, respectively. Seventy-two eligible subjects were included in the analysis. RESULTS Twenty-eight (38.9%) subjects had undergone treatment for threatened premature birth, and 44 (61.1%) subjects had not. In the logistic analysis, we set the course of pregnancy as a dependent variable, and age, birth history, smoking habits, a history of miscarriage, premature birth or threatened premature birth, SPS, SOC, and s-IgA in the first half of pregnancy as independent variables. We found that low serum s-IgA levels and low SOC scores in the first half of pregnancy were associated with threatened premature birth. CONCLUSIONS Our results suggest that low serum s-IgA level and SOC score at an early gestational stage are significant indicators for a threatened premature birth.
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Affiliation(s)
- Naomi Sekizuka
- Department of Health Sciences, Graduate School of Medical Science, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan,
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Hawley G, Horwath C, Gray A, Bradshaw A, Katzer L, Joyce J, O'Brien S. Sustainability of health and lifestyle improvements following a non-dieting randomised trial in overweight women. Prev Med 2008; 47:593-9. [PMID: 18817809 DOI: 10.1016/j.ypmed.2008.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 08/26/2008] [Accepted: 08/28/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare three non-dieting interventions that focused on lifestyle change rather than weight loss, in terms of the sustainability of improvements in lifestyle behaviors, psychological well-being and medical symptoms at 2 years. METHOD In Dunedin, New Zealand in 2002/2003, 225 obese/overweight women (BMI > or = 28; 25-68 years) participated in a randomised, intention-to-treat trial comparing two group programs (P1, P2) and a self-guided mail-delivered program (P3). Only P1 included intensive relaxation response training. All three non-dieting interventions involved a 10-week program, followed by an eight-month support phase. Participants completed baseline, 1-year and 2-year assessments. Outcomes included behavioral, psychological and medical symptom measures and a composite success score. RESULTS 118 participants completed the 2-year follow-up. Only among P1 participants were the reductions in psychological distress and medical symptoms achieved at 1 year, also maintained at 2 years. At 2 years, P1 participants had significantly greater increases in stress management behaviors than those in P2 (p<0.05), and significantly greater success scores than those in P3 (p<0.05). In all three programs, mean weight was unchanged at 2 years. CONCLUSION Inclusion of relaxation response training in a healthy lifestyle program facilitates long-term maintenance of psychological and medical symptom improvements even in the absence of weight loss.
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Affiliation(s)
- Greer Hawley
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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Nakao M, Takeuchi T, Yoshimasu K. A proposed approach to suicide prevention in Japan: the use of self-perceived symptoms as indicators of depression and suicidal ideation. Environ Health Prev Med 2008; 13:313-21. [PMID: 19568891 PMCID: PMC2698228 DOI: 10.1007/s12199-008-0048-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 08/14/2008] [Indexed: 11/24/2022] Open
Abstract
The incidence of suicide in Japan has increased markedly in recent years, making suicide a major social problem. Between 1997 and 2006, the annual number of suicides increased from 24,000 to 32,000; the most dramatic increase occurred in middle-aged men, the group showing the greatest increase in depression. Recent studies have shown that prevention campaigns are effective in reducing the total number of suicides in various areas of Japan, such as Akita Prefecture. Such interventions have been targeted at relatively urban populations, and national data from public health and clinical studies are still needed. The Japanese government has established the goal of reducing the annual number of suicides to 22,000 by 2010; toward this end, several programs have been proposed, including the Mental Barrier-Free Declaration, and the Guidelines for the Management of Depression by Health Care Professionals and Public Servants. However, the number of suicides has not declined over the past 10 years. Achieving the national goal during the remaining years will require extensive and consistent campaigns dealing with the issues and problems underlying suicide, as well as simple screening methods for detecting depression. These campaigns must reach those individuals whose high-risk status goes unrecognized. In this review paper, we propose a strategy for the early detection of suicide risk by screening for depression according to self-perceived symptoms. This approach was based on the symposium Approach to the Prevention of Suicide in Clinical and Occupational Medicine held at the 78th Conference of the Japanese Society of Hygiene, 2008.
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Affiliation(s)
- Mutsuhiro Nakao
- Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1, Itabashi, Tokyo, 173-8605, Japan,
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Katzer L, Bradshaw AJ, Horwath CC, Gray AR, O'Brien S, Joyce J. Evaluation of a “Nondieting” Stress Reduction Program for Overweight Women: A Randomized Trial. Am J Health Promot 2008; 22:264-74. [DOI: 10.4278/060728113r1.1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Determine if a “nondieting” intervention focused on intensive training in eliciting the relaxation response enhances health outcomes compared with nondieting interventions without such training. Design. Randomized trial with follow-up at 10 weeks, 4 months, and 12 months. Setting. General community. Subjects. Total of 225 overweight and obese women with at least one other cardiovascular risk factor. Interventions. Three 10-week nondieting interventions: a group program (P1) focused on intensive training in techniques for eliciting the relaxation response (n = 60), a group program (P2) focused on healthy eating and physical activity (n = 61), and a self-guided, mail-delivered version of P2 (P3; n = 101). Measures. The Revised Symptom Checklist measured psychological distress, the Medical Symptoms Checklist measured the experience of medical symptoms, and the Health-Promoting Lifestyle Profile measured a range of lifestyle behaviors. Self-efficacy for low-fat eating, intuitive eating, and body mass index were also assessed. Analysis. An intention-to-treat analysis was used. Results. At 12 months, P1 produced statistically greater improvements in stress management behaviors and medical symptom discomfort and was the only program to significantly improve self-efficacy for low-fat eating. In P1, the effect sizes for reductions in depression (0.75) and interpersonal sensitivity (0.85) were large. At 12 months, mean weight was unchanged. Conclusion. Inclusion of intensive relaxation response training in a nondieting program for overweight women enhanced stress management and medical symptoms outcomes but not weight outcomes.
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Affiliation(s)
- Lisa Katzer
- Lisa Katzer, BSc, PG Dip Diet, MSc; Alison J. Bradshaw, BPhEd (Hons), BSc, MSc; and Caroline C. Horwath, PG Dipl Nutr & Dietetics, PhD, are with the Department of Human Nutrition, University of Otago, Dunedin, New Zealand. Andrew R. Gray, BCom (Hons), BA, is with the Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Alison J. Bradshaw
- Lisa Katzer, BSc, PG Dip Diet, MSc; Alison J. Bradshaw, BPhEd (Hons), BSc, MSc; and Caroline C. Horwath, PG Dipl Nutr & Dietetics, PhD, are with the Department of Human Nutrition, University of Otago, Dunedin, New Zealand. Andrew R. Gray, BCom (Hons), BA, is with the Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Caroline C. Horwath
- Lisa Katzer, BSc, PG Dip Diet, MSc; Alison J. Bradshaw, BPhEd (Hons), BSc, MSc; and Caroline C. Horwath, PG Dipl Nutr & Dietetics, PhD, are with the Department of Human Nutrition, University of Otago, Dunedin, New Zealand. Andrew R. Gray, BCom (Hons), BA, is with the Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew R. Gray
- Lisa Katzer, BSc, PG Dip Diet, MSc; Alison J. Bradshaw, BPhEd (Hons), BSc, MSc; and Caroline C. Horwath, PG Dipl Nutr & Dietetics, PhD, are with the Department of Human Nutrition, University of Otago, Dunedin, New Zealand. Andrew R. Gray, BCom (Hons), BA, is with the Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Sue O'Brien
- Lisa Katzer, BSc, PG Dip Diet, MSc; Alison J. Bradshaw, BPhEd (Hons), BSc, MSc; and Caroline C. Horwath, PG Dipl Nutr & Dietetics, PhD, are with the Department of Human Nutrition, University of Otago, Dunedin, New Zealand. Andrew R. Gray, BCom (Hons), BA, is with the Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Janine Joyce
- Lisa Katzer, BSc, PG Dip Diet, MSc; Alison J. Bradshaw, BPhEd (Hons), BSc, MSc; and Caroline C. Horwath, PG Dipl Nutr & Dietetics, PhD, are with the Department of Human Nutrition, University of Otago, Dunedin, New Zealand. Andrew R. Gray, BCom (Hons), BA, is with the Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
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Zaby A, Heider J, Schröder A. Warten, Entspannung oder Verhaltenstherapie. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2008. [DOI: 10.1026/1616-3443.37.1.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Auf Grund hoher Prävalenzen und deutlicher einhergehender sozio-ökonomischer Folgen stellen multiple somatoforme Beschwerden ein ernst zu nehmendes Problem dar. Fragestellung: Wie effektiv ist eine ambulante kognitiv-behaviorale Gruppenbehandlung im Vergleich zu einem Entspannungsverfahren und einer Wartegruppe in Bezug auf körperliche Beschwerden, Angst, Depressivität und subjektive Gesundheit. Methode: Es wurde eine randomisierte Kontrollgruppenstudie (N = 77) durchgeführt. Die manualisierten Interventionen umfassten acht 90-minütige Termine, die wöchentlich stattfanden. Die manualisierte kognitiv-behaviorale Intervention baut auf dem Behandlungsansatz von Rief und Hiller (1998) auf. Ergebnisse: Sowohl die kognitiv-behaviorale Behandlung als auch die Entspannungsgruppe führten zu einer Verbesserung der somatoformen Beschwerden (SOMS-7). Die kognitiv-behaviorale Behandlung hatte darüber hinaus einen positiven Einfluss auf die Angst (HADS-D) und die subjektive psychische Gesundheit (SF-12). Schlussfolgerungen: Diese kurze, kognitiv-behaviorale Gruppenbehandlung hat positive Effekte auf ambulante Patientinnen und Patienten mit somatoformen Symptomen, die über die Effekte einer Entspannungsgruppe hinausgehen.
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Price C. Dissociation reduction in body therapy during sexual abuse recovery. Complement Ther Clin Pract 2006; 13:116-28. [PMID: 17400147 PMCID: PMC1965500 DOI: 10.1016/j.ctcp.2006.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 08/20/2006] [Indexed: 11/20/2022]
Abstract
The study purpose was to examine dissociation in body therapy for women receiving psychotherapy for childhood sexual abuse. An initial intervention study provided an opportunity to examine dissociation; the sample of 24 women received eight, 1-h body therapy sessions. The Dissociative Experiences Scale served as the predictor variable, and the outcome measures reflected psychological and physical health, and body connection. Repeated measures analysis of variance was used to examine dissociation reduction across time. Pearson correlations were used to describe associations between the relative change in dissociation and outcomes. The results demonstrated that the greatest change was the reduction of dissociation; there was an incremental effect across time and a strong association between change in dissociation and health outcomes. High dissociation at baseline (moderate levels) predicted positive outcomes. The results demonstrated the importance of moderate dissociation as an indicator of distress, and the central role of dissociation reduction in health and healing.
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Affiliation(s)
- Cynthia Price
- University of Washington, Box 357263, Seattle, WA 98105, USA.
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Nakao M, Yano E. Somatic symptoms for predicting depression: one-year follow-up study in annual health examinations. Psychiatry Clin Neurosci 2006; 60:219-25. [PMID: 16594947 DOI: 10.1111/j.1440-1819.2006.01489.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
It has recently been noted that screening for depression can improve clinical outcomes. The purpose of the present study was to examine whether somatic symptoms reported at health examinations predicted depression in the following year. Subjects were 1066 Japanese workers (732 men, mean age 35 years) attending annual health examinations at an institute in two successive years. A self-administered questionnaire including items of 12 major somatic symptoms was given to all the subjects. Then clinical interviews of the DSM-IV were used to diagnose major depression and minor depression in both years. In addition, the 17-item Hamilton Depression Scale (HDS-17) was measured as one of the outcomes of depression in the following year. The prevalence of major (minor) depression was 3.7 (7.8)% at baseline and 3.4 (5.9)% for the following year, respectively. The following year's HDS-17 scores were higher (all P < 0.05) in those who had complained of each somatic symptom at baseline than in those who had not. Three somatic symptoms (low back pain, dizziness, and abdominal pain) at baseline were significant risk factors of major depression for the following year. Dizziness at baseline significantly predicted major and minor depression for the following year as well. Somatic symptoms may be good predictors to screen for depression at health examination.
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Affiliation(s)
- Mutsuhiro Nakao
- Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan.
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Nakao M, Yano E. Prediction of major depression in Japanese adults: somatic manifestation of depression in annual health examinations. J Affect Disord 2006; 90:29-35. [PMID: 16337277 DOI: 10.1016/j.jad.2005.09.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2003] [Accepted: 09/29/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The present study examined whether somatic symptoms found in annual health examinations, could be predictive of major depression in the ensuing year. METHOD Subjects analyzed were 1027 non-major-depressive workers (706 men, mean age 35) attending annual health examinations at a research institute. All were Japanese and found not to be suffering from major depression when interviewed, according to the semi-structured interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). A self-administered questionnaire containing items relating to twelve major somatic symptoms was completed by all the subjects. The same DSM-IV interviews for the diagnosis of major depression were conducted to calculate the odds ratio of baseline variables for depressive and somatic symptoms, physical examination items, and health-related life-styles for the prediction of major depression in the ensuing year. RESULTS The prevalence of major depression in the ensuing year was 2.5%. For four somatic symptoms (fatigue, lower back pain, dizziness, and nausea), the prevalence was higher (all p < 0.05) in those who complained of each somatic symptom at baseline than in those who did not. Furthermore, the multiple logistic regression analysis indicated that lower back pain and dizziness at baseline were independent risk factors of major depression in the ensuing year [odds ratio (95% confidence intervals), 3.2 (1.1, 8.9) and 6.0 (1.8, 20.1), respectively]. LIMITATIONS It is possible that somatic manifestations of depression are culturally bound phenomena and results might be generalizable only to Japanese workers. CONCLUSION Somatic symptoms reported at annual health examinations may be useful indicators for predicting major depression.
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Affiliation(s)
- Mutsuhiro Nakao
- Department of Hygiene and Public Health, School of Medicine, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo 173-8605, Japan.
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Karita K, Nakao M, Nishikitani M, Nomura K, Yano E. Autonomic nervous activity changes in relation to the reporting of subjective symptoms among male workers in an information service company. Int Arch Occup Environ Health 2005; 79:441-4. [PMID: 16333680 DOI: 10.1007/s00420-005-0062-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Accepted: 11/23/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of the study was to clarify the relationship between major subjective symptoms and autonomic nervous system function by power spectral analysis of heart rate variability (HRV). METHODS Short-term HRV was examined for 413 male workers in a Japanese information service company aged 19-45 years, and questionnaire survey on subjective symptoms and biochemical measurements were conducted at annual health checkup. RESULTS The most prevalent subjective symptom (> or =10%) was dullness, followed by fatigue, backache, diarrhea, sleep disorder, and irritation. HRV in high frequency (HF 0.15-0.40 Hz) bands and the coefficient of variance in the electrocardiographic R-R interval (CVrr) were lower in the subjects with any of these six symptoms than in those without the symptoms. Both parameters were negatively associated with the reporting of any of the six symptoms by multiple regression analyses, controlling for the significant effects of age (HF and CVrr) and plasma cortisol levels (HF). CONCLUSION It was suggested that the reporting of the subjective symptoms is one of good predictors for reduced parasympathetic tones.
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Affiliation(s)
- Kanae Karita
- Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga, 173-8605, Tokyo, Japan.
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Nakao M, Tamiya N, Yano E. Gender and Somatosensory Amplification in Relation to Perceived Work Stress and Social Support in Japanese Workers. Women Health 2005; 42:41-54. [PMID: 16418121 DOI: 10.1300/j013v42n01_03] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To examine gender-related differences in somatization among workers, 490 Japanese municipal office employees (248 women) completed the Medical Symptom Checklist, Somatosensory Amplification Scale (SSAS), and Profile of Mood States (POMS), along with questionnaires on their working environment. In women, SSAS scores were positively associated with perceived work stress, and negatively with social support levels (both p < 0.01). Female sex was significantly associated with SSAS scores (p < 0.01), controlling for the effects of total somatic symptom count, POMS tension-anxiety and depression scores, perceived working stress, and social support. The phenomenon of somatosensory amplification might be essential in estimating gender-specific symptoms in a working population.
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Affiliation(s)
- Mutsuhiro Nakao
- Dept. of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo 173-8605, Japan.
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Nishikitani M, Nakao M, Karita K, Nomura K, Yano E. Influence of overtime work, sleep duration, and perceived job characteristics on the physical and mental status of software engineers. INDUSTRIAL HEALTH 2005; 43:623-9. [PMID: 16294916 DOI: 10.2486/indhealth.43.623] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
To investigate the impact of overtime work, sleep duration, and perceived job characteristics on physical and mental status, a cross-sectional study was conducted on 377 workers (average age; 28 years old) in an information-technology (IT) company, engaged in consultation, system integration solution, and data management relevant to IT system. The psychophysical outcomes of overtime work were assessed using the Hamilton Depression Scale (HDS), Profile of Mood Status (POMS), major physical symptoms, and overtime work data for the preceding three-months. Sleep duration was directly asked by a physician. A job strain index was defined as the ratio of job-demands to job-control scores evaluated using the Job Content Questionnaire (JCQ). In a univariate analysis, overtime work was significantly related with HDS scores, POMS anger-hostility scores, and the total physical symptom count in both sexes (all p < 0.05), but not in multiple regression models, after controlling for sleep duration and the job strain index. Sleep duration was negatively related to the symptom count in men and to POMS tension-anxiety scores in women (both p < 0.05); the job strain index was positively related to POMS anger-hostility scores in both sexes and to HDS scores and POMS tension-anxiety scores in men (all p < 0.05). Although overtime work was associated with physical and mental complaints, sleep duration and the job strain index seemed to be better indicators for physical and mental distress in overloaded workers.
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Affiliation(s)
- Mariko Nishikitani
- Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
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Vaerøy H, Tanum L, Bruaset H, Mørkrid L, Førre O. Symptoms of depression and anxiety in functionally disabled rheumatic pain patients. Nord J Psychiatry 2005; 59:109-13. [PMID: 16195107 DOI: 10.1080/08039480510022945] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of the present work was to study correlations between self-assessment of symptoms of depression, anxiety, rheumatic pain and functional disability. One hundred patients admitted to a university rheumatology clinic were tested in a consecutive manner, applying the Hospital Anxiety and Depression Scale (HADS). In addition, the patients were asked to express a quantitative measure of their subjective pain and functional disability on visual analogue scales (VAS). Regression analysis (analysis of variance) showed significant correlation between rheumatic pain and depression (P=0.04), between rheumatic pain and anxiety (P=0.03) and between rheumatic pain and functional disability (P<0.000). Significant correlations were also seen between depressive symptoms and functional disability (P=0.01) and between anxiety and functional disability (P=0.002). The correlation between symptoms of anxiety and depression was at a P=0.000 level. Applying the experience from this study and introducing, as part of a clinical examination, a minimum of psychiatric investigation based on self-assessment of anxiety and depression will provide relevant and reliable information sufficient for following up with specific psychiatric investigations and therapy. This in turn will be positive for those of the rheumatic patients having a comorbid mental health problem.
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Kolk AMM, Schagen S, Hanewald GJFP. Multiple medically unexplained physical symptoms and health care utilization: outcome of psychological intervention and patient-related predictors of change. J Psychosom Res 2004; 57:379-89. [PMID: 15518674 DOI: 10.1016/j.jpsychores.2004.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2003] [Accepted: 02/03/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To test the effect of psychological intervention on multiple medically unexplained physical symptoms, psychological symptoms, and health care utilization in addition to medical care as usual. To identify patient-related predictors of change in symptoms and care utilization. METHODS In a randomized controlled trial, subjects were assigned to one of two conditions: psychological intervention by a qualified therapist plus care as usual by a general practitioner (GP) or care as usual only. Participants (N=98) were administered a standardized interview and several outcome measures at intake and after 6 months and 12 months after intake. GPs rated medically unexplained and explained symptoms and consultations over a period of 1 1/2 years. RESULTS ANOVAs for repeated measures showed that self-reported and GP-registered unexplained physical symptoms decreased from pretest to posttest to follow-up. Psychological symptoms and consultations decreased from pretest to posttest. GP-registered explained symptoms did not decrease. However, intervention and control groups did not differ in symptom reduction. Path analysis revealed two paths to a decrease in self-reported unexplained physical symptoms: from more negative affectivity via more psychological attribution and more pretreatment anxiety, and from more somatic attribution via more psychological attribution and more pretreatment anxiety. CONCLUSION Intervention and control groups did not differ in symptom reduction. Reduction of self-reported medically unexplained symptoms was well predicted by patient-related symptom perception variables, whereas the prediction of change in registered symptoms and consultations requires a different model.
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Affiliation(s)
- A M M Kolk
- Department of Clinical Psychology, University of Amsterdam, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands.
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Hashimoto H, Nomura K, Yano E. Psychosomatic status affects the relationship between subjective hearing difficulties and the results of audiometry. J Clin Epidemiol 2004; 57:381-5. [PMID: 15135839 DOI: 10.1016/j.jclinepi.2003.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2003] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Subjective hearing difficulties are often used as a surrogate to audiometry in health check-up, although its effectiveness has not been tested in healthy workers. We conducted a study to test the usefulness of self-reported hearing difficulties for screening hearing impairment among healthy workers by comparing the results with those of audiometry. STUDY DESIGN AND SETTING This was a cross-sectional observational study. A sample of 12,495 healthy workers in Japan without excess noise exposure was recruited at regular health check-up. Audiometry was conducted after self-administered questionnaire asking symptoms including hearing difficulties. The results were compared to those of audiometry as the gold standard. RESULTS Overall prevalence of hearing impairment was 4.6% among the population. Subjective hearing difficulties showed 0.21 of sensitivity, 0.95 of specificity, and 0.93 of accordance against audiometry. When limited to those with more than two psychosomatic symptoms, however, the corresponding numbers were 0.43, 0.85, and 0.83. CONCLUSION The assessment of subjective hearing difficulty may not be able to replace audiometry, but may be useful to detect psychosocial problems of hearing in the workplace.
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Affiliation(s)
- Hideki Hashimoto
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi, Tokyo 173-8605, Japan.
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Takeuchi T, Nakao M, Nishikitani M, Yano E. Stress Perception and Social Indicators for Low Back, Shoulder and Joint Pains in Japan: National Surveys in 1995 and 2001. TOHOKU J EXP MED 2004; 203:195-204. [PMID: 15240929 DOI: 10.1620/tjem.203.195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aims to clarify the effects of stress perception and related social indicators on three major musculoskeletal symptoms: low back, shoulder, and joint pains in a Japanese population. Twenty health-related variables (stress perception and 19 social indicators) and the three symptoms were obtained from the following Japanese national surveys: the Comprehensive Survey of Living Condition of the People on Health and Welfare, the System of Social and Demographic Statistics of Japan, and the Statistical Report on Health Administration Services. The results were compared among 46 Japanese prefectures in 1995 and 2001. By factor analysis, the 19 indicators were classified into three factors of urbanization, aging and life-regularity, and individualization. The prevalence of stress perception was significantly correlated to the 8 indicators of urbanization factor. Although simple correlation analysis revealed a significant relationship of stress perception only to shoulder pain (in both years) and low back pain (in 2001), the results of multiple regression analysis showed that stress perception and some urbanization factors were significantly associated with all the three symptoms in both years exclusive of joint pain in 1995. Taking the effects of urbanization into consideration, stress perception seems to be closely related to the complaints of musculoskeletal symptoms in Japan.
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Affiliation(s)
- Takeaki Takeuchi
- Department of Psychosomatic Medicine, Teikyo University Hospital, Tokyo
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MacGregor MW, Davidson KW, Rowan P, Barksdale C, MacLean D. The use of defenses and physician health care costs: are physician health care costs lower in persons with more adaptive defense profiles? PSYCHOTHERAPY AND PSYCHOSOMATICS 2003; 72:315-23. [PMID: 14526134 DOI: 10.1159/000073028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objective of the present study was to determine if persons who use more adaptive defenses have lower physician health care costs compared to those who use less adaptive defenses. METHODS We randomly selected 667 persons from the 1995 population-based Nova Scotia Health Survey who completed a videotaped structured interview. Each interview was rated for typical defense use by the Defense-Q. We obtained physician health care costs for 3 months before and after the interview, as well as medical diagnoses and measures of psychological functioning. RESULTS A more adaptive defense profile significantly predicted lower future physician health care costs. These results were found when controlling for other psychosocial variables, before and after controlling for previous physician health care costs, and when testing only within a physically healthy subsample. Results of secondary analyses showed that a more adaptive defense profile was positively related to a number of psychosocial variables, such as nurse's rating of competence, lack of depressive symptoms, and days at work. CONCLUSIONS The adaptiveness of a person's defense use in managing affect is important in predicting physician health care costs as well as psychosocial functioning.
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Bitton A, Sewitch MJ, Peppercorn MA, deB Edwardes MD, Shah S, Ransil B, Locke SE. Psychosocial determinants of relapse in ulcerative colitis: a longitudinal study. Am J Gastroenterol 2003; 98:2203-8. [PMID: 14572569 DOI: 10.1111/j.1572-0241.2003.07717.x] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine the association between psychosocial characteristics and time to relapse in patients with inactive ulcerative colitis. METHODS Sixty patients with clinically and endoscopically inactive ulcerative colitis were followed for 1 yr, or less if they relapsed. Demographic, psychosocial, and clinical data were obtained. Stressful life events (Psychiatric Epidemiology Research Interview Life Events Scale), psychological distress (Symptom Checklist-90R), and perceived stress (Perceived Stress Scale) were recorded monthly by self-report. Multivariate time-dependent Cox regression was used to identify the independent determinants of earlier time to clinical relapse. RESULTS The patients' mean age was 39 yr (SD = 9.4), 37 (62%) were female, and 22 (37%) relapsed during the 1-yr follow-up. Univariate Cox regression indicated a weak association between number of stressful events in the preceding month and time to relapse (p = 0.09). This association strengthened in multivariate analysis (p = 0.02, hazard ratio = 1.26 per event, 95% CI = 1.04-1.53) after adjustment for significant covariates. CONCLUSIONS After controlling for demographic and clinical variables, more recent stressful events were associated with earlier time to relapse. These findings, which support a biopsychosocial model of disease, might help clinicians identify patients who might benefit from more intensive maintenance medical therapy and behavioral medicine interventions to reduce stress and improve coping.
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Affiliation(s)
- Alain Bitton
- Department of Medicine, McGill University, Montréal, Québec, Canada
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Nakao M, Yano E. Reporting of somatic symptoms as a screening marker for detecting major depression in a population of Japanese white-collar workers. J Clin Epidemiol 2003; 56:1021-6. [PMID: 14568635 DOI: 10.1016/s0895-4356(03)00154-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of this study was to assess screening practices for detecting major depression in workers complaining of somatic symptoms. METHODS A total of 1443 Japanese white-collar workers (991 men and 452 women, mean age 34 years) completed a medical symptom checklist (major 12 somatic symptoms) and were diagnosed using the structured clinical interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). RESULTS There were 42 cases (2.9%) with major depression in the total sample. Of the 902 subjects without somatic symptoms, only one (0.1%) was identified as having major depression. The prevalence of the disorder was positively associated (P<.001) with the total number of somatic symptoms, and the area under the receiver operator characteristic curve was 0.92 for men and 0.81 for women, which showed the sensitivity and specificity of the total number of somatic symptoms for detecting major depression. CONCLUSION The number of reported somatic symptoms is a simple and useful predictor of major depression.
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Affiliation(s)
- Mutsuhiro Nakao
- Department of Hygiene and Public Health, School of Medicine, Teikyo University, 2-11-1, Kaga, Itabashi, Tokyo 173-8605, Japan.
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Trikas P, Vlachonikolis I, Samonis G, Askoxilakis I, Tsiftsis D, Koutsoubi K, Paritsis N. Low psychopathology scores in the prognosis of breast cancer. A preliminary report. PSYCHOTHERAPY AND PSYCHOSOMATICS 2002; 71:162-7. [PMID: 12021559 DOI: 10.1159/000056284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Research findings regarding the influence of psychopathology on cancer progression are not yet clear. This preliminary report investigates the severity of psychopathology assessed before biopsy in patients with invasive breast carcinoma (IBC) and its association with two follow-up outcomes: disease-free (to first recurrence) and survival periods. METHOD The psychiatric assessment of 80 patients under 70 years old was established by means of an interview before biopsy. The DSM-IV criteria were used to establish the past and current psychiatric diagnoses. The Present State Examination (PSE)-Index of Definition (ID)-computer program (CATEGO) was used to define total PSE score, clusters of psychiatric symptoms (psychiatric syndromes) and current clinical severity (ID). The independent influence of biological prognostic factors and psychiatric variables on first recurrence or survival period was tested using Cox's proportional hazards regression model. RESULTS After biopsy, 38 IBC patients were followed up for 3 to 8-1/3 years. During this period, 8 patients died from IBC and 7 were alive with metastatic disease. Cox's proportional hazards regression analyses showed that tumor diameter and low ID were independent significant predictors of early recurrence, whereas tumor diameter, negative estrogen receptors and low ID were independent significant predictors of survival. CONCLUSIONS A low prebiopsy psychopathology score in IBC is a predictor of early recurrence and short survival.
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Affiliation(s)
- Panayotis Trikas
- Department of Psychiatry and Behavioral Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece.
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