Effects of therapeutic relationship, expectancy, and credibility in breathing therapies for anxiety

The effect of breathing relaxation to improve poor sleep quality in adults using a huggable human-shaped device: a randomized controlled trial

PURPOSE

To examine whether or not breathing relaxation, using a huggable human-shaped device, improves poor sleep quality in adults.

METHODS

We conducted a randomized controlled trial using outpatients with sleep problems from two clinics in Japan. The intervention group conducted three minutes of breathing relaxation using a huggable human-shaped device before going to bed every night for four weeks. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), at pre-intervention, mid-intervention (2 weeks after pre-intervention), and post-intervention (4 weeks after pre-intervention). We employed intention-to-treat analysis.

RESULTS

A total of 68 participants (mean [SD] age, 41.7 [11.4] years; 64 female [95%]) were randomly assigned to the intervention group (n = 29, mean [SD] age, 43.6 [9.5] years; 28 female [97%]) and the control group (n = 36, mean [SD] age, 40.3 [12.7] years; 36 female [95%]). The intervention group showed a significant decrease in the PSQI score compared to the control group (F = 3.81, p = 0.025, effect size (η2) = 0.057). Furthermore, we found the intervention to be more effective in participants without suicide risk and with a lower number of adverse childhood experiences (effect size (η2) = 0.080 and 0.160, respectively).

CONCLUSIONS

A novel psychological intervention, breathing relaxation using a huggable human-shaped device, may be effective to improve sleep quality among people with sleep problems, especially those without severe psychological symptoms.

TRIAL REGISTRATION

UMIN000045262. (Registration Date: September 28th, 2021).

Therapist and treatment credibility in treatment outcomes: A systematic review and meta-analysis of clients' perceptions in individual and face-to-face psychotherapies

OBJECTIVE

No systematic review was identified investigating the influence of perceived therapist credibility on treatment outcomes. Extant treatment credibility reviews have focused on early perceptions without considering influence of various therapy phases. This study aimed to examine the relationship between perceived treatment and therapist credibility and treatment outcomes, while considering the timing of the credibility assessment as a potential moderator.

METHOD

Articles published in English peer-reviewed journals containing at least one quantitative measure of credibility and treatment outcome regarding face-to-face therapist-delivered interventions were eligible. PsycINFO, MEDLINE and Embase online databases were last searched on April 5th, 2023, and the Effective Public Health Practice Project tool was used to assess the study quality. Correlations between treatment credibility and outcomes, and therapist credibility were calculated separately.

RESULTS

Analysis of 27 studies revealed a positive association between perceived treatment credibility and treatment outcome (r = 0.15,95%CI = 0.09,0.21,p < 0.001,n = 2061). Nine studies showed a strong association between perceived therapist credibility and outcome (r = 0.35,95%CI = 0.18,0.51;p < .001,n = 1161). No significant moderator found in both meta-analyses.

CONCLUSION

Findings suggest that clients' perceptions of higher credibility - whether concerning the treatment or the therapist - are associated with better therapeutic outcomes. Constraints in inclusion criteria and the small sample size in eligible studies were notable limitations.

The effects of breathing exercises in mothers of children with special health care needs:A randomized controlled trial

BACKGROUND AND OBJECTIVE

Caring for a child with a disability affects musculoskeletal system pain, fatigue, sleep quality, and anxiety of the mothers. The purpose of the study was to determine the effectiveness of breathing exercises in mothers with chronic non-specific low back pain (NLBP).

METHODS

Forty-three mothers with chronic NLBP were randomly assigned to the experimental group (n= 23) and the control group (n= 20). The experimental group received breathing exercises with core stabilization exercises (BSET) for three sessions a week for 8 weeks, and the control group performed stabilization exercises (SET) only, for the same period. Pain severity, fatigue, anxiety, and sleep quality were evaluated before and after the treatment programs.

RESULTS

After the treatment programs, significant differences were observed in pain, fatigue, and sleep quality in both groups (p< 0.05). However, the BSET group showed a significantly better improvement in anxiety levels and sleep quality than the SET group (p< 0.05).

CONCLUSIONS

The improvements in pain, fatigue and sleep quality were seen in both groups after treatment programs. It is recommended breathing exercises are added to core stabilization programs to provide greater improvements in anxiety level and sleep quality for mothers of children with disabilities, who have NLBP.

How do people who use drugs experience treatment? A qualitative analysis of views about opioid substitution treatment in primary care (iCARE study)

OBJECTIVE

To understand the most significant aspects of care experienced by people in opioid substitution treatment (OST) in primary care settings.

DESIGN

Semistructured individual interviews were conducted, following the critical incidents technique. Interview transcripts were analysed following a thematic analysis approach.

PARTICIPANTS

Adults aged 18 years or older, receiving OST in UK-based primary care services.

RESULTS

Twenty-four people in OST were interviewed between January and March 2019. Participants reported several aspects which were significant for their treatment, when engaging with the primary care service. These were grouped into 10 major themes: (1) humanised care; (2) individual bond/connection with the professional; (3) professionals' experience and knowledge; (4) having holistic care; (5) familiarity; (6) professionals' commitment and availability to help; (7) anonymity; (8) location; (9) collaborative teamwork; and (10) flexibility and changes around the treatment plan.

CONCLUSIONS

This study included first-hand accounts of people who use drugs about what supports them in their recovery journey. The key lessons learnt from our findings indicate that people who use drugs value receiving treatment in humanised and destigmatised environments. We also learnt that a good relationship with primary care professionals supports their recovery journey, and that treatment plans should be flexible, tailor-made and collaboratively designed with patients.

Common Factors in Biofeedback Administered by Psychotherapists

Common factors are nonspecific therapeutic elements common across different varieties of psychotherapy. In a recent study, 68 expert psychotherapy researchers with a variety of allegiances collectively rated biofeedback as being negatively associated with many common factors (Tschacher et al. in Clin Psychol Psychother 21(1):82-96, 2014), including the therapeutic alliance. However, it seems implausible that biofeedback could benefit so many people while being incompatible with the therapeutic alliance and other common factors. The present study investigated the experiences of biofeedback clients who participated in a brief heart rate variability biofeedback protocol in order to explore the potential roles of common factors in biofeedback. The results of this study offer preliminary evidence that many common factors-including therapeutic alliance, self-efficacy expectation, mastery experiences, provision of explanatory scheme, mindfulness, and even cognitive restructuring-may play a role in biofeedback outcomes. Future research on this topic should include mediation and moderation models investigating the role of specific common factors on outcome and process studies to help determine what clinician behaviors are most helpful. Deeper investigation of common factors in biofeedback may benefit future biofeedback research and practice and address the concerns of colleagues outside of the biofeedback community who believe that biofeedback is at odds with common factors.

The effectiveness of diaphragmatic breathing relaxation training for improving sleep quality among nursing staff during the COVID-19 outbreak: a before and after study

OBJECTIVES

Recent studies have demonstrated that first-line nurses involved in the coronavirus disease-2019 (COVID-19) crisis may experience sleep disturbances. As breathing relaxation techniques can improve sleep quality, anxiety, and depression, the current study aimed to evaluate the effectiveness of diaphragmatic breathing relaxation training (DBRT) for improving sleep quality among nurses in Wuhan, China during the COVID-19 outbreak.

METHODS

This study used a quasi-experimental (before and after) intervention strategy, with 151 first-line nurses from four wards in Leishenshan hospital. The Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) to evaluate the effectiveness of DBRT before and after the intervention. Data were examined using the Shapiro-Wilk test, Levene's test, and paired t-test.

RESULTS

A total of 140 nurses completed the DBRT sessions. First-line nurses achieved significant reductions in global sleep quality (p < 0.01), subjective sleep quality (p < 0.001), sleep latency (p < 0.01), sleep duration (p < 0.001), sleep disturbances (p < 0.001), habitual sleep efficiency (p = 0.015), daytime dysfunction (p = 0.001), and anxiety (p = 0.001). There were no significant reductions in the use of sleeping medication (p = 0.134) and depression (p = 0.359).

CONCLUSION

DBRT is a useful non-pharmacological treatment for improving sleep quality and reducing anxiety among first-line nurses involved in the COVID-19 outbreak. The study protocol was clinically registered by the Chinese Clinical Trial Registry.

CLINICAL TRIAL REGISTRATION NUMBER

ChiCTR2000032743.

Improving neuropsychiatric symptoms following stroke using virtual reality: A case report

RATIONALE

Post-stroke cognitive impairment occurs frequently in patients with stroke, with a 20% to 80% prevalence. Anxiety is common after stroke, and is associated with a poorer quality of life. The use of standard relaxation techniques in treating anxiety in patients undergoing post-stroke rehabilitation have shown some positive effects, whereas virtual reality seems to have a role in the treatment of anxiety disorders, especially when associated to neurological damage.

PATIENTS CONCERNS

A 50-year-old woman, smokers, affected by hypertension and right ischemic stroke in the chronic phase (i.e., after 12 months by cerebrovascular event), came to our observation for a severe anxiety state and a mild cognitive deficit, mainly involving attention and visuo-executive processes, besides a mild left hemiparesis.

DIAGNOSIS

Anxiety in a patient with ischemic stroke.

INTERVENTIONS

Standard relaxation techniques alone in a common clinical setting or the same psychological approach in an immersive virtual environment (i.e., Computer Assisted Rehabilitation Environment - CAREN).

OUTCOMES

The patient's cognitive and psychological profile, with regard to attention processes, mood, anxiety, and coping strategies, were evaluated before and after the 2 different trainings. A significant improvement in the functional and behavioral outcomes were observed only at the end of the combined approach.

LESSONS

The immersive virtual reality environment CAREN might be useful to improve cognitive and psychological status, with regard to anxiety symptoms, in post-stroke individuals.

Light Therapy With Scheduled Rise Times in Young Adults With Delayed Sleep Phase Disorder: Therapeutic Outcomes and Possible Predictors

Clinical trials with light therapy (LT) for delayed sleep phase disorder (DSPD) are sparse and little is known about factors that are favorable for improvements. In this study, LT with scheduled rise times was conducted at home for 14 days by 44 participants with DSPD aged 16-26 years. Primary outcomes were sleep onset and sleep offset. Potential predictors were demographic characteristics, chronotype, dim light melatonin onset, the number of days the LT lamp was used, the daily duration of LT, daytime sleepiness, anxiety, depression, worry, and rumination. Significant advances were observed in sleep onset and sleep offset from baseline to the end of treatment. The number of days of LT predicted earlier sleep onset and sleep offset.

Effect of breathing type on electromyographic activity of respiratory muscles during tooth clenching at different decubitus positions

OBJECTIVE

To compare the effect of breathing type on electromyographic (EMG) activity of respiratory muscles during tooth clenching at different decubitus positions.

METHODS

Forty young men participants were included, 11 with upper costal, 9 with mixed, and 20 with costo-diaphragmatic breathing type. EMG recordings of diaphragm (DIA), external intercostal (EIC), sternocleidomastoid (SCM), and latissimus dorsi (LAT) muscles during tooth clenching in the intercuspal position were performed in dorsal, left lateral, and ventral decubitus positions.

RESULTS

DIA EMG activity was higher in subjects with upper costal or mixed than with costodiaphragmatic breathing type (p = 0.006; 0.021, respectively), whereas it was similar between upper costal and mixed breathing types. EIC, SCM, and LAT activity was similar among breathing types.

CONCLUSION

Higher DIA activity would be a risk factor to exceed the adaptive capability of healthy subjects with upper costal or mixed breathing type.

Placebo and Psychotherapy: Differences, Similarities, and Implications

The placebo and psychotherapy are both effective psychological interventions. Next to being characterized by their own and specific controversies and debates, there is a persistent-and least for psychotherapy-looming notion that these two interventions share more than just the first letter. Based on Grünbaum's influential conceptualization of placebo, this chapter critically reviews both the time-honored claim that psychotherapy is a placebo as well as the argument that the placebo concept does not translate to psychotherapy. We conclude that there is an unwanted proximity between these two interventions and that empirical attempts to separate the "wheat from the chaff" in psychotherapy research face several distinctive challenges and thus are often methodologically comprised by the integrity of the placebo. However, drawing on recent, innovative research, we conclude that psychotherapy can be saved, i.e., shown to be distinct from the placebo, by employing study designs derived from the placebo research. We conclude that the placebo concept has profound implications for psychotherapy, psychotherapy research, and last but not least its ethical practice.

The Effectiveness of Diaphragmatic Breathing Relaxation Training for Reducing Anxiety

PURPOSE

To evaluate the effectiveness on reducing anxiety of a diaphragmatic breathing relaxation (DBR) training program.

DESIGN AND METHODS

This experimental, pre-test-post-test randomized controlled trial with repeated measures collected data using the Beck Anxiety Inventory and biofeedback tests for skin conductivity, peripheral blood flow, heart rate, and breathing rate.

FINDINGS

The experimental group achieved significant reductions in Beck Anxiety Inventory scores (p < .05), peripheral temperature (p = .026), heart rate (p = .005), and breathing rate (p = .004) over the 8-week training period. The experimental group further achieved a significant reduction in breathing rate (p < .001).

PRACTICE IMPLICATIONS

The findings provide guidance for providing quality care that effectively reduces the anxiety level of care recipients in clinical and community settings.

Commentary on Kim et al., Effects of therapeutic relationship, expectancy, and credibility in breathing therapies for anxiety

Kim and colleagues (2015) explored influences on clinical outcomes related to nonspecific therapeutic factors, addressing the importance of client expectancy and development of the therapeutic alliance. In the process, however, the authors carry forward conclusions from their prior research on treatment of panic that two opposing breathing retraining protocols are equally effective. Neither the experimental design nor the sample size of the current or previous study warrants reaching those conclusions. This commentary examines the findings of the current and previous studies and points to consistent trends that suggest that breathing retraining of panic patients may be enhanced by protocols aimed at raising exhaled CO2.