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Muhammad Khir S, Wan Mohd Yunus WMA, Mahmud N, Wang R, Panatik SA, Mohd Sukor MS, Nordin NA. Efficacy of Progressive Muscle Relaxation in Adults for Stress, Anxiety, and Depression: A Systematic Review. Psychol Res Behav Manag 2024; 17:345-365. [PMID: 38322293 PMCID: PMC10844009 DOI: 10.2147/prbm.s437277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024] Open
Abstract
Background The rise in the prevalence of mental health problems among adults worldwide has raised concerns, highlighting the critical need for evidence-based mental health interventions that are accessible, comprehensive, and effective. Previous research suggests that Progressive Muscle Relaxation (PMR) is a promising intervention widely used to reduce mental health problems. Nevertheless, the current literature on the efficacy of PMR among adults globally is fragmented, indicating a potential gap in this research area. Hence, this paper aims to systematically compile the research evidence on the efficacy of PMR in adults for stress, anxiety, and depression. Methods The Scopus, Web of Sciences, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials were searched from the earliest available evidence to 28th March 2023. The PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analyses) guidelines were followed, and the protocol was registered on the Open Science Framework. Joanna Briggs Institute (JBI) Critical Appraisal Tools were used to assess the quality of the included studies. Results A total of forty-six (46) publications from sixteen (16) countries covering more than 3402 adults were included in the review. The results show that PMR are effective in reducing stress, anxiety, and depression in adults. When PMR is combined with other interventions, the combined techniques have also consistently exhibited enhanced efficacy. Moreover, findings also indicate that the efficacy of PMR is heightened when implemented in conjunction with other interventions, surpassing its standalone efficacy. Funding and Registration This research was supported/funded by the Ministry of Higher Education (MoHE) under the Fundamental Research Grant Scheme (FRGS) (FRGS/1/2020/SS0/UTM/02/23). The review was registered on Open Science Framework (OSF) on the 7th of March 2023; DOI: https://doi.org/10.17605/OSF.IO/U2HZP.
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Affiliation(s)
- Syazwina Muhammad Khir
- Department of Psychology, School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Wan Mohd Azam Wan Mohd Yunus
- Department of Psychology, School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
- INVEST Research Flagship, University of Turku, Turku, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Norashikin Mahmud
- Department of Psychology, School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Rui Wang
- Department of Psychology, School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Siti Aisyah Panatik
- Department of Psychology, School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Mohammad Saipol Mohd Sukor
- Department of Psychology, School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Nor Akmar Nordin
- Department of Psychology, School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Johor, Malaysia
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Rodriguez M, Kross E. Sensory emotion regulation. Trends Cogn Sci 2023; 27:379-390. [PMID: 36805103 DOI: 10.1016/j.tics.2023.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/17/2023]
Abstract
Decades of evidence reveal intimate links between sensation and emotion. Yet, discussion of sensory experiences as tools that promote emotion regulation is largely absent from current theorizing on this topic. Here, we address this gap by integrating evidence from social-personality, clinical, cognitive-neuroscience, and animal research to highlight the role of sensation as a tool that can be harnessed to up- or downregulate emotion. Further, we review evidence implicating sensation as a rapid and relatively effortless emotion regulation modality and highlight future research directions. Notably, we emphasize the need to examine the duration of sensory emotion regulation effects, the moderating role of individual and cultural differences, and how sensory strategies interact with other strategies.
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Affiliation(s)
- Micaela Rodriguez
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA.
| | - Ethan Kross
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA; Ross School of Business, University of Michigan, Ann Arbor, MI, USA.
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3
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Rio-Alamos C, Montefusco-Siegmund R, Cañete T, Sotomayor J, Fernandez-Teruel A. Acute Relaxation Response Induced by Tibetan Singing Bowl Sounds: A Randomized Controlled Trial. Eur J Investig Health Psychol Educ 2023; 13:317-330. [PMID: 36826208 PMCID: PMC9955072 DOI: 10.3390/ejihpe13020024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The prevalence of anxiety has increased dramatically due to COVID-19, so effective preventive interventions are welcome. The main objective of our study was to compare the acute relaxation response (RR) induced by Tibetan singing bowl (TSB) sound-based treatment against progressive muscle relaxation (PMR) and a control waiting list group (CWL) in a single treatment session in an adult nonclinical anxious population. In this cross-sectional randomized control trial, 50 participants selected based on high state anxiety were randomly assigned to one of the experimental groups. Pre/post self-reported anxiety, electroencephalographic activity (EEG), and heart rate variability (HRV) were recorded at baseline (T1), minute 15 (T2), minute 30 (T3), and minute 45 (T4). The TSB group showed significant reductions in alpha power (from T2 to T4) and increased HRV (from T3 to T4) compared with the PMR and CWL groups. Moreover, TSB and PMR both showed significant reductions in self-reported anxiety compared with CWL, with this effect being more evident in the TSB group. We concluded that a single session of TSB treatment was able to induce a more evident psychological/physiological relaxation response compared with PMR and CWL. TSB could be a relevant acute intervention in stressful situations or crisis intervention and while waiting for conventional interventions.
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Affiliation(s)
- Cristobal Rio-Alamos
- Faculty of Medicine, Department of Psychology, Austral University of Chile, Valdivia 5090000, Chile
- Correspondence:
| | - Rodrigo Montefusco-Siegmund
- Human Cognitive Neurophysiology and Behavior Lab, Locomotor Apparatus and Rehabilitation Institute, Faculty of Medicine, Department of Kinesiology, Austral University of Chile, Valdivia 5090000, Chile
- Centro Interdisciplinario de Estudios del Sistema Nervioso, Austral University of Chile, Valdivia 5090000, Chile
| | - Toni Cañete
- Medical Psychology Unit, Department of Psychiatry and Forensic Medicine, Institute of Neurosciences, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Joaquín Sotomayor
- Faculty of Medicine, Department of Psychology, Austral University of Chile, Valdivia 5090000, Chile
| | - Alberto Fernandez-Teruel
- Medical Psychology Unit, Department of Psychiatry and Forensic Medicine, Institute of Neurosciences, Autonomous University of Barcelona, 08193 Barcelona, Spain
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Salzmann S, Wilhelm M, Schindler S, Rief W, Euteneuer F. Optimising the efficacy of a stress-reducing psychological intervention using placebo mechanisms: A randomized controlled trial. Stress Health 2022; 38:722-735. [PMID: 35043534 DOI: 10.1002/smi.3128] [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: 08/27/2021] [Revised: 12/17/2021] [Accepted: 01/12/2022] [Indexed: 11/11/2022]
Abstract
This study examined whether i) brief videos aiming to optimise outcome expectations would augment the efficacy of progressive muscle relaxation (PMR) and ii) whether participants' characteristics would moderate these effects. Sixty-eight healthy subjects randomized to one of three experimental manipulations before undergoing a single PMR session either watched i) a video displaying a neutral expert, ii) a video with a warm expert, or iii) were part of an active control condition. Constrained linear mixed models indicated increased relaxation and decreased stress levels for all participants after the PMR session. The primary outcome was the change of perceived relaxation/stress from pre to post. Participants with high neuroticism and trait anxiety indicated an augmented PMR's efficacy and increased outcome expectations when watching the warm expert video compared to the control group or the less warm expert. Brief videos displaying an expert aiming to optimise outcome expectations regarding a brief stress-reducing psychological intervention may boost or decrease an intervention's efficacy. Effects may depend on the viewer's personality and the (video) expert's communication style. Trial Registration: The study protocol was approved by the local Ethics Committee of the University of Marburg, Germany. This study was registered at www.clinicaltrials.gov (NCT03330431).
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Affiliation(s)
- Stefan Salzmann
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Marcel Wilhelm
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Sebastian Schindler
- Institute of Medical Psychology and Systems Neuroscience and Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Muenster, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Frank Euteneuer
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.,Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
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Bastien L, Boke BN, Mettler J, Zito S, Di Genova L, Romano V, Lewis SP, Whitley R, Iyer SN, Heath NL. Peer-Presented Versus Mental Health Service Provider-Presented Mental Health Outreach Programs for University Students: Randomized Controlled Trial. JMIR Ment Health 2022; 9:e34168. [PMID: 35762935 PMCID: PMC9356327 DOI: 10.2196/34168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND University students are reporting concerning levels of mental health distress and challenges. University mental health service provider initiatives have been shown to be effective in supporting students' mental health, but these services are often resource-intensive. Consequently, new approaches to service delivery, such as web-based and peer support initiatives, have emerged as cost-effective and efficient approaches to support university students. However, these approaches have not been sufficiently evaluated for effectiveness or acceptability in university student populations. OBJECTIVE Thus, the overarching goal of this study was to evaluate a mental health service provider-presented versus peer-presented web-based mental health resilience-building video outreach program against a wait-list comparison group. METHODS Participants were 217 undergraduate students (mean age 20.44, SD 1.98 years; 171/217, 78.8% women) who were randomly assigned to one of the intervention groups (mental health service provider-presented: 69/217, 31.8%; peer-presented: 73/217, 33.6%) or the wait-list comparison group (75/217, 34.6%). Participants in the intervention groups were asked to watch 3 brief skill-building videos addressing strategies for building mental health resilience, whereas the comparison group was wait-listed. The mental health service provider-presented and peer-presented video series were identical in content, with presenters using a script to ensure consistency across delivery methods, but the videos differed in that they were either presented by mental health service providers or university students (peers). All participants were asked to complete web-based self-report measures of stress, coping self-efficacy, social support, social connectedness, mindfulness, and quality of life at baseline (time 1), 6 weeks later (time 2, after the intervention), and 1-month follow-up (time 3). RESULTS Results from a series of 2-way ANOVAs found no significant differences in outcomes among any of the 3 groups. Surprisingly, a main effect of time revealed that all students improved on several well-being outcomes. In addition, results for program satisfaction revealed that both the mental health service provider-presented and peer-presented programs were rated very highly and at comparable levels. CONCLUSIONS Thus, findings suggest that a web-based mental health resilience-building video outreach program may be acceptable for university students regardless of it being mental health service provider-presented or peer-presented. Furthermore, the overall increases in well-being across groups, which coincided with the onset and early weeks of the COVID-19 pandemic, suggest an unexpected pattern of response among university students to the early period of the pandemic. Limitations and barriers as well as research implications are discussed. TRIAL REGISTRATION ClinicalTrials.gov NCT05454592; https://clinicaltrials.gov/ct2/show/NCT05454592.
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Affiliation(s)
- Laurianne Bastien
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Bilun Naz Boke
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Jessica Mettler
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Stephanie Zito
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Lina Di Genova
- Student Services, McGill University, Montreal, QC, Canada
| | - Vera Romano
- Student Services, McGill University, Montreal, QC, Canada
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Rob Whitley
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Nancy L Heath
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
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Loh EW, Shih HF, Lin CK, Huang TW. Effect of progressive muscle relaxation on postoperative pain, fatigue, and vital signs in patients with head and neck cancers: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2022; 105:2151-2157. [PMID: 34785078 DOI: 10.1016/j.pec.2021.10.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Surgery for head and neck cancers are associated with significant preoperative stress. We investigated the effects of progressive muscle relaxation (PMR) on postoperative pain, fatigue, and vital signs in patients with head and neck cancers. METHODS All patients were hospitalized and randomly assigned to intervention or usual care groups. A generalized estimating equation was used to evaluate the PMR effects on pain and symptoms across the preoperative day to postoperative day 10. RESULTS The PMR group displayed significantly lower overall pain and muscle tightness than control group along with the timeline of multiple measurements (p < 0.01). PMR significantly reduces sleep disturbances and levels of fatigue, anxiety, and depression compared with the control group with time trend (p < 0.01). PMR also lowered the respiratory rates and diastolic blood pressure (p < 0.01). CONCLUSIONS PMR can reduce sleep disturbances and levels of pain, fatigue, muscle tightness, anxiety, and depression in patients with head and neck cancer undergoing major surgeries. Future study should focus on improving the effectiveness of the exercise and standardization of the application. PRACTICAL IMPLICATIONS progressive muscle relaxation help relieve discomforts in patients with head and neck cancers with minimal costs and efforts.
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Affiliation(s)
- El-Wui Loh
- Center for Evidence-Based Health Care, Shared Decision Making Resource Center, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, Zhonghe District, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Huei-Fen Shih
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan; Cell therapy Center, China Medical University Hospital, Taichung, Taiwan
| | - Chung-Kwei Lin
- School of Dental Technology, Taipei Medical University, Taipei, Taiwan
| | - Tsai-Wei Huang
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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Lee HJ, Hong JK, Choi H, Chung S, Yoon IY. Age-Limited Effects of Low-Frequency Transcutaneous Electric Nerve Stimulation on Insomnia: A 4-Week Multi-Center, Randomized Controlled Study. Psychiatry Investig 2022; 19:451-461. [PMID: 35753684 PMCID: PMC9233949 DOI: 10.30773/pi.2021.0374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/17/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Insomnia disorder is a common condition with considerable harmful effects on health. We investigated the therapeutic efficacy and safety of low-frequency transcutaneous electric nerve stimulation (LF-TENS) as an alternative treatment option for insomnia disorder. METHODS A 4-week, multi-center, randomized controlled study was conducted. A total of 160 individuals aged 40 to 80 years with insomnia disorder were included and randomized to the experimental group receiving active device (n=81) or control group receiving sham device (n=79). Both groups used the device for four weeks, more than five days a week. The participants also completed pre- and post-intervention assessment with questionnaires, sleep diaries, wrist actigraphy, and blood tests. RESULTS There was no significant between-group difference in the changes of mood and sleep parameters and blood test results among the two study groups. Meanwhile, in the exploratory sub-group analysis of patients aged over 60 years, the experimental group showed better improvement after intervention in the change of Pittsburgh Sleep Quality Index (PSQI) score (-2.63±3.25 vs. -1.20±2.28, p=0.039; Cohen's d=0.99 vs. 0.45) and blood cortisol level (-1.65±3.37 μg/dL vs. -0.16±3.49 μg/dL, p=0.007; Cohen's d=0.56 vs. 0.05). In addition, no serious adverse reaction occurred during the study period in both groups. CONCLUSION The effect of LF-TENS was limited to older patients aged over 60 years, which might be related to the modulation of hypothalamic-pituitary-adrenal axis activity.
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Affiliation(s)
- Hyuk Joo Lee
- Department of Public Medical Service, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung Kyung Hong
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hayun Choi
- Department of Psychiatry, Veteran Health Service Medical Center, Seoul, Republic of Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Young Yoon
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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Kische H, Zenker M, Pieper L, Beesdo-Baum K, Asselmann E. Applied relaxation and cortisol secretion: findings from a randomized controlled indicated prevention trial in adults with stress, anxiety, or depressive symptoms. Stress 2022; 25:122-133. [PMID: 35285766 DOI: 10.1080/10253890.2022.2045939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Previous research has shown that relaxation interventions can reduce distress, anxiety, and depression. The exact mechanisms that underlie the efficacy of relaxation interventions remain unresolved. This study aimed to investigate whether applied relaxation (AR) leads to changes in cortisol secretion and whether these effects mediate fewer symptoms due to AR. Data come from a randomized controlled preventive interventional trial (N = 277) with elevated tension/distress, anxiety, or depressive symptomatology. Participants were randomized to an intervention group (IG; n = 139, received AR training), or a non-interventional control group (CG, n = 138). Psychopathological symptoms were assessed with DASS-21 and diagnoses of mental disorders via DIA-X-5. Cortisol was measured as short-term index in saliva (six times/d for 2 d at pre-, post-, and follow-up [FU] assessment) and long-term index in hair samples (once at pre-assessment and FU, respectively). Data were analyzed as pre-specified secondary analyses of the randomized controlled trial (RCT) on completer basis (n = 134 CG, n = 102 IG), using multivariable-adjusted linear regression models and mediation analyses (the DASS-21 change in the IG vs. CG with cortisol (area under the curve [AUC]) as mediator). From pre- to post-assessment, total daily salivary cortisol (AUC) decreased more strongly in the IG vs. CG (β-coefficient: -13.83, 95% confidence interval [CI]: -26.85 to -0.81), but was rendered non-significant when adjusting for pre-assessment AUC. This effect was not found for the cortisol awakening response (CAR) or hair cortisol. There was no evidence for a mediation of cortisol (AUC). These findings provide little support for the idea that cortisol reductions explain the beneficial effects of AR on mental health.
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Affiliation(s)
- Hanna Kische
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Monique Zenker
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Lars Pieper
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Katja Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Eva Asselmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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Ozhanli Y, Akyuz N. The Effect of Progressive Relaxation Exercise on Physiological Parameters, Pain and Anxiety Levels of Patients Undergoing Colorectal Cancer Surgery: A Randomized Controlled Study. J Perianesth Nurs 2021; 37:238-246. [PMID: 34903440 DOI: 10.1016/j.jopan.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/06/2021] [Accepted: 08/15/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE This study aimed to determine the effect of progressive relaxation exercises on physiological parameters, pain, anxiety, and serum cortisol levels in patients undergoing colorectal cancer surgery. DESIGN This study is a randomized controlled study and has been registered at the Clinical Trial Registry Center (ID: NCT04731428). METHODS The study was conducted on 63 patients (experimental group = 31, control group = 32), who were scheduled for elective laparoscopic-colorectal surgery in the general surgery clinic of a university hospital in Istanbul between March 2018 and May 2019 and met the inclusion criteria. The patients in the experimental group were given progressive relaxation exercises for 15 minutes preoperatively and on postoperative days 1, 2, and 3 after breathing exercise training. The routine treatments and care process of the patients in the control group were maintained. The preoperative and postoperative pain and anxiety levels of both groups were evaluated. Blood pressure, heart rate and respiratory rate, oxygen saturation, and serum cortisol levels were measured at certain time intervals before and after the relaxation exercise. FINDINGS The patients in the experimental group had lower postoperative pain and anxiety levels and a lower rate of using opioid analgesic on postoperative day 0 compared to the control group. Progressive relaxation exercise had no statistically significant effect on serum cortisol or physiological parameters (P > .05). CONCLUSIONS Progressive relaxation exercise did not affect cortisol levels and vital signs but decreased pain and anxiety, and relatively increased tissue oxygenation, appearing an effective, safe, and practicable nursing intervention.
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Affiliation(s)
- Yasemin Ozhanli
- Kocaeli University Faculty of Health Sciences / Umuttepe Campus, İzmit, Kocaeli, Turkey.
| | - Nuray Akyuz
- Istanbul University-Cerrahpasa Florence Nightingale Faculty of Nursing, Istanbul, Turkey
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Boulet C, Lopez-Castroman J, Mouchabac S, Olié E, Courtet P, Thouvenot E, Abbar M, Conejero I. Stress response in dissociation and conversion disorders: A systematic review. Neurosci Biobehav Rev 2021; 132:957-967. [PMID: 34740754 DOI: 10.1016/j.neubiorev.2021.10.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/14/2021] [Accepted: 10/28/2021] [Indexed: 12/28/2022]
Abstract
Dissociative disorders (DD) and conversion disorders (CD) are frequent in general and psychiatric populations. Some evidence suggest that the hypothalamic-pituitary axis (HPA) and autonomic nervous system (ANS) are dysregulated in both disorders. We carried out a systematic review of the literature to summarize the existing knowledge on the stress response, via HPA and/or ANS, in patients with DD, CD, or dissociative symptoms. We systematically searched Medline and Web of Science using the Medical Subject Headings related to stress axis, CD, DD, and dissociative symptoms following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results suggest that in participants without psychiatric history, high cortisol secretion is related to high dissociation scores. Conversely the stress system might be blunted in patients with post-traumatic stress disorder who develop dissociative symptoms. Stress response changes seem to be associated with the emergence and persistence of dissociative and conversion disorders. Hence, monitoring the stress response and examining closely the history of stress exposure in DD and CD should be encouraged in future larger studies.
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Affiliation(s)
- Charlotte Boulet
- Department of Psychiatry, Nîmes University Hospital, Nîmes, France
| | - Jorge Lopez-Castroman
- Department of Psychiatry, Nîmes University Hospital, Nîmes, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Stéphane Mouchabac
- Saint-Antoine Hospital Center APHP, Department of Psychiatry, iCRIN Psychiatry (Infrastructure of Clinical Research in Neurosciences-Psychiatry), Brain and Spine Institute (ICM), Sorbonne University, INSERM, CNRS, 75013, Paris, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Eric Thouvenot
- Department of Neurology, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Mocrane Abbar
- Department of Psychiatry, Nîmes University Hospital, Nîmes, France
| | - Ismael Conejero
- Department of Psychiatry, Nîmes University Hospital, Nîmes, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France; Centre de Biochimie Structurale, University of Montpellier, Montpellier, France.
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Tan XYJ, Choong SYX, Cheng LJ, Lau Y. Relaxation interventions for improving sleep outcomes in perinatal women: A systematic review and meta-analysis of randomized controlled trials. Midwifery 2021; 103:103151. [PMID: 34607056 DOI: 10.1016/j.midw.2021.103151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/24/2021] [Accepted: 09/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sleep problem is common amongst perinatal women, and stress may trigger and intensify sleep problems in a vicious cycle. Relaxation interventions are gradually being adopted to improve sleep quality in various populations, but little is known about their effectiveness in perinatal women. OBJECTIVE To evaluate the effects of relaxation interventions on sleep outcomes amongst all perinatal women aged 18 and above, and identify the essential type, regime and approach in designing relaxation intervention. DESIGN Systematic review and meta-analysis of 11 studies among 1046 perinatal women. DATA SOURCES We searched Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, PsycINFO, ProQuest Dissertations and Theses, PubMed and Web of Science from their inception until December 15, 2019. REVIEW METHODS Studies were assessed for clinical and statistical heterogeneity and considered for meta-analysis. Comprehensive Meta-analysis and The Cochrane Risk of Bias tool were used for meta-analyses and assessing of risk of bias, respectively. RESULTS A total of 6346 records were identified, and 11 randomised control trials were selected. Significantly large effects were found in relaxation interventions in improving sleep quality (Cohen's d = 2.55), disturbance (Cohen's d = 1.52), latency (Cohen's d = 1.82) and duration (Cohen's d = 1.14) when compared with those in the control groups. Subgroup analyses showed that antenatal women who performed progressive muscle relaxation (PMR) by themselves for preventive function and long-term practice showed improved sleep quality compared with their counterparts. CONCLUSION PMR is preferable as a supplementary intervention to current existing antenatal care. The grade of the overall evidence of the outcomes ranged from very low to low. IMPLICATIONS FOR PRACTICE The meta-analysis addressed the effect of relaxation interventions on sleep outcomes amongst perinatal women. Relaxation interventions may effectively improve sleep quality, disturbance, latency and duration amongst perinatal women early in antenatal period. However, further well-designed trials in large samples are required.
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Affiliation(s)
- Xing Yee Jolyn Tan
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore.
| | - Shanise Yi Xin Choong
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore.
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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A School-Based Progressive Muscle Relaxation Program for Female Adolescents: Development and the Effectiveness on Physiological and Psychological Evidence. Healthcare (Basel) 2021; 9:healthcare9101319. [PMID: 34682999 PMCID: PMC8544355 DOI: 10.3390/healthcare9101319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: A variety of stressors may be potentially harmful to adolescents' health and well-being. Relaxation techniques have been recognized as a valid method for stress release, but the challenge is to apply them practically in schools to produce the desired effects. (2) Methods: This feasibility study used the Perceived Stress Scale (PSS) and hair cortisol concentration (HCC) to test the effects of an abbreviated progressive muscle relaxation (APMR) program on female adolescents. The participants were recruited from a high school and assigned by class cluster to either the experimental group (EG, n = 40) or the control group (CG, n = 35). Both received 4 weeks of stress-related lessons. The EG received 60 additional sessions of APMR over 12 weeks. (3) Results: The program dropout rate of the participants was 1.3%. The EG's program adhesion rate was 99.1%, and nearly half felt satisfied with the program. After adjusting for the BMI and the pretest in the ANCOVA, it was found that the CG had a greater change in HCC between the pre- and post-tests than the EG, while the PSS did not change significantly in either group. (4) Conclusion: APMR is a valid practice for physiological homeostasis of HCC for female adolescents, but it has no significant effect on perceived stress.
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Penedo FJ, Fox RS, Walsh EA, Yanez B, Miller GE, Oswald LB, Estabrook R, Chatterton RT, Mohr DC, Begale MJ, Flury SC, Perry K, Kundu SD, Moreno PI. Effects of web-based cognitive behavioral stress management and health promotion interventions on neuroendocrine and inflammatory markers in men with advanced prostate cancer: A randomized controlled trial. Brain Behav Immun 2021; 95:168-177. [PMID: 33737170 PMCID: PMC8888023 DOI: 10.1016/j.bbi.2021.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 01/08/2023] Open
Abstract
Cognitive behavioral stress management (CBSM) improves quality of life and mitigates stress biology in patients with early-stage cancer, including men with localized prostate cancer. However, treatments for advanced prostate cancer like androgen deprivation therapy (ADT) can lead to significant symptom burden that may be further exacerbated by stress-induced inflammation and cortisol dysregulation. The aim of this study was to examine the effects of CBSM (versus an active health promotion control) on circulating inflammatory markers and cortisol in men with advanced prostate cancer. METHODS Men with stage III or IV prostate cancer (N = 192) who had undergone ADT within the last year were randomized to CBSM or health promotion. Both interventions were 10 weeks, group-based, and delivered online. Venous blood was drawn at baseline, 6 months, and 12 months to measure circulating levels of CRP, IL-6, IL-8, IL-10, and TNF-α. Saliva samples were collected at awakening, 30 min after awakening, evening, and night for two consecutive days at baseline, 6-months, and 12-months to measure diurnal cortisol slopes. RESULTS Mixed modeling analyses demonstrated that changes in inflammatory markers and cortisol did not differ by intervention. Men in both CBSM and health promotion showed decreases in IL-10, IL-8, and TNF-α from baseline to 6 months (β = -3.85--5.04, p's = 0.004-<0.001). However, these markers generally demonstrated a rebound increase from 6 to 12 months (β = 1.91-4.06, p's = 0.06-<0.001). Men in health promotion also demonstrated a flatter diurnal cortisol slope versus men in CBSM at 6 months (β = -2.27, p = .023), but not at 12 months. There were no intervention effects on CRP, IL-6, or overall cortisol output. CONCLUSIONS Contrary to hypotheses, CBSM did not lead to changes in the circulating inflammatory markers and cortisol relative to health promotion. CBSM may be associated with healthy diurnal cortisol rhythm because of its focus on cognitive behavioral approaches to stress management. More research is needed to understand the impact of CBSM and health promotion on biomarkers among men with advanced prostate cancer.
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Affiliation(s)
- Frank J Penedo
- Department of Psychology, University of Miami, United States; Department of Medicine, University of Miami Miller School of Medicine, United States.
| | - Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, United States
| | - Emily A Walsh
- Department of Psychology, University of Miami, United States
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, United States
| | - Gregory E Miller
- Institute for Policy Research and Department of Psychology, Northwestern University, United States
| | - Laura B Oswald
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center & Research Institute, United States
| | - Ryne Estabrook
- Department of Psychology, University of Illinois at Chicago, United States
| | - Robert T Chatterton
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, United States
| | - David C Mohr
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States
| | | | - Sarah C Flury
- Department of Urology, Northwestern University Feinberg School of Medicine, United States
| | - Kent Perry
- Department of Urology, Northwestern University Feinberg School of Medicine, United States
| | - Shilajit D Kundu
- Department of Urology, Northwestern University Feinberg School of Medicine, United States
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, United States
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Raad G, Tanios J, Azoury J, Daher A, Fakih C, Bakos HW. Neurophysiology of cognitive behavioural therapy, deep breathing and progressive muscle relaxation used in conjunction with ART treatments: a narrative review. Hum Reprod Update 2020; 27:324-338. [PMID: 33238001 DOI: 10.1093/humupd/dmaa048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/13/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Infertility is defined as the failure to achieve clinical pregnancy after 12 months of regular unprotected intercourse. It could be due to male or female factors, each requiring different treatment options. ART treatment exposes couples to numerous psychological stressors. Therefore, it has been recommended by the ESHRE Psychology and Counselling Guideline Development Group recently that psychosocial support should be offered as a complementary therapy during infertility treatments. In this context, the efficiency of different psychological interventions, such as cognitive behaviour therapy (CBT), deep breathing (DB), and progressive muscle relaxation (PMR), was evaluated in several clinical trials in terms of couples' mental health and pregnancy outcomes. OBJECTIVE AND RATIONALE The neurophysiology of CBT, DB and PMR, which are used in interventional studies, in both men and women undergoing ART, has not yet been fully elucidated. This review represents a comprehensive report, aiming to collate novel insights into the neurobiological processes and physiological mechanisms that occur during the practice of CBT, DB and PMR. SEARCH METHODS PubMed, Google Scholar and Cochrane Library were interrogated to conduct this comprehensive literature review. The search was carried out using combinations of MeSH terms and keywords: infertility, assisted reproductive techniques, IVF, ICSI, emotions, psychological stress, cognitive behavioural therapy, mind-body therapies and relaxation. Relevant information related to the mechanism of action of stress management techniques were obtained from original articles and reviews published in English without taking into consideration the time of publication. Moreover, as it was not the major focus of the review, only recent systematic reviews (2015-2019) pinpointing the effects of psychological interventions on infertility treatment outcomes were also retrieved from the above-mentioned databases. OUTCOMES CBT, DB and PMR may modify the activity of stress-related brain regions such as the prefrontal cortex, amygdala, hypothalamus and hippocampus, as demonstrated by functional MRI and electroencephalogram studies. Furthermore, applying these techniques was associated with mood improvements and a decline in stress biomarkers, and, hypothetically, reducing stress biomarkers attenuates the stress-induced effects on ART outcomes. WIDER IMPLICATIONS Increasing the knowledge of fertility staff, researchers and physicians regarding the mechanisms of action of these stress management techniques has several advantages. For instance, understanding the underlying neurophysiological pathways would assist practitioners to engage ART couples in the practice of these techniques. Also, it may enhance the quality of the support programmes and psychological research. Accordingly, this will ensure that these interventions reach their full potential and therefore improve clinical outcomes.
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Affiliation(s)
- Georges Raad
- IVF Department, Al-Hadi Laboratory and Medical Center, Beirut, Lebanon
| | - Judy Tanios
- Embryology Department, IVF Lebanon, Hazmieh, Lebanon
| | - Joseph Azoury
- Azoury IVF clinic, Mount-Lebanon Hospital, Hazmieh, Lebanon
| | - Alain Daher
- Ob-Gyn department, St Joseph University, Beirut, Lebanon
| | - Chadi Fakih
- IVF Department, Al-Hadi Laboratory and Medical Center, Beirut, Lebanon
| | - Hassan W Bakos
- Monash IVF Group, Sydney, NSW, Australia.,School of Environmental and Life Sciences Faculty of Science, University of Newcastle, NSW, Australia
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Dib S, Wells JCK, Fewtrell M. A within-subject comparison of different relaxation therapies in eliciting physiological and psychological changes in young women. PeerJ 2020; 8:e9217. [PMID: 32509467 PMCID: PMC7247525 DOI: 10.7717/peerj.9217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/28/2020] [Indexed: 12/04/2022] Open
Abstract
Background Stress reactivity can be different in women compared to men, which might consequently influence disease risk.Stress in women may also generate adverse physiological effects on their offspring during pregnancy or lactation. The objective of this study was to compare the effects of different relaxation interventions on physiological outcomes and perceived relaxation in healthy young women, to assist in identifying the most appropriate intervention(s) for use in a subsequent trial for mothers who deliver prematurely. Methods A within-subject study was conducted in 17 women of reproductive age comparing five different relaxation interventions (guided-imagery meditation audio (GIM), music listening (ML), relaxation lighting (RL), GIM+RL, ML+RL), with control (silence/sitting), assigned in random order over a 3–6 week period. Subjective feelings of relaxation (10-point scale), heart rate (HR), systolic and diastolic blood pressure (SBP, DBP), and fingertip temperature (FT) were measured before and after each technique Results All interventions significantly increased perceived relaxation and FT, while music also significantly reduced SBP (p < 0.05). Compared to control, HR significantly decreased following GIM (mean difference = 3.2 bpm, p < 0.05), and FT increased (mean difference = 2.2 °C, p < 0.05) and SBP decreased (mean difference = 3.3 mmHg, p < 0.01) following ML. GIM + RL followed by GIM were the most preferred interventions. Conclusions Based on preference, simplicity, and the physiological and psychological effects, GIM and ML were identified as the most effective tools for reducing stress and improving relaxation. These techniques warrant further research in larger samples and other populations.
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Affiliation(s)
- Sarah Dib
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Jonathan C K Wells
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Mary Fewtrell
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Kazak A, Ozkaraman A. The Effect of Progressive Muscle Relaxation Exercises on Pain on Patients with Sickle Cell Disease: Randomized Controlled Study. Pain Manag Nurs 2020; 22:177-183. [PMID: 32224022 DOI: 10.1016/j.pmn.2020.02.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 02/04/2020] [Accepted: 02/23/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The study aimed to evaluate the effect of progressive muscle relaxation exercises on pain in patients with sickle cell disease. MATERIALS-METHOD This randomized controlled interventional study was conducted in a hospital in Mersin, Turkey between October 2017 and July 2018. The study sample comprised 58 patients who were aged >18 years, conscious, had sickle cell disease, reported pain, and were treated with non-opioid or weak opioid analgesic based on the physician's recommendation (treatment group = 29, control group = 29). Data were collected by the individual presentation form and visual analog scale. During the study, both groups were treated with analgesics prescribed by the physician for three days. In addition to the analgesics, the treatment group was performed progressive muscle relaxation exercises for 30 minutes whereas the control group was rested. Pain level of both groups was evaluated at three time points every day for three days. In the study, frequency distributions and descriptive statistics were presented for categorical and numerical variables, respectively. Chi-square analysis, independent samples t-test, Mann-Whitney U test, three-way ANOVA, and Sidak test were used to analyze the difference between the variables. RESULTS The mean age of the patients was 29.59 ± 6.94 years, and 53.4% of the patients were female and 69% were single. The mean pain score of the treatment group at the third time point on days 1, 2, and 3 was significantly lower than the control group (p < .05). There was no statistically significant difference between the two groups in terms of coping methods for pain, pain location, and complaints accompanying pain (p > .05). CONCLUSION Progressive muscle relaxation exercises were found to be effective in the pain management of patients with sickle cell anemia.
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Affiliation(s)
- Aysun Kazak
- Vocational School of Health Services, Gumushane University, Gumushane, Turkey
| | - Ayse Ozkaraman
- Department of Nursing, Eskisehir Osmangazi University, Eskisehir, Turkey.
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Luberto CM, Hall DL, Park ER, Haramati A, Cotton S. A Perspective on the Similarities and Differences Between Mindfulness and Relaxation. Glob Adv Health Med 2020; 9:2164956120905597. [PMID: 32076580 PMCID: PMC7003166 DOI: 10.1177/2164956120905597] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/31/2019] [Accepted: 01/13/2020] [Indexed: 11/17/2022] Open
Abstract
Mind-body medicine is an evidence-based approach to health and healing that focuses on interactions between the mind, body, and behavior. It encompasses a wide range of interventions that are similar yet different in meaningful ways. Mindfulness and relaxation practices are 2 mind-body techniques that have similarities and differences; however, these techniques are often used or discussed interchangeably, such that the differences between them become obscured. A greater understanding of the unique facets of mindfulness and relaxation is needed for researchers and clinicians to make informed decisions when selecting an approach. The purpose of the current article is to offer an evidence-informed perspective on similarities and differences between mindfulness and relaxation. Specifically, mindfulness and relaxation practices are compared and contrasted in terms of theoretical foundation, intention, and psychological and physiological effects and mechanisms. Implications for clinical practice and suggestions for future research are discussed.
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Affiliation(s)
- Christina M Luberto
- Benson-Henry Institute for Mind-Body Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Daniel L Hall
- Benson-Henry Institute for Mind-Body Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Elyse R Park
- Benson-Henry Institute for Mind-Body Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Aviad Haramati
- Department of Biochemistry, Molecular and Cellular Biology, Georgetown University School of Medicine, Washington, District of Columbia
| | - Sian Cotton
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Karrasch S, Hitzler M, Gumpp A, Karabatsiakis A, Kolassa IT. Molekulartoxische Folgen von chronischem und traumatischem Stress und deren Reversibilität durch entspannungs- und achtsamkeitsbasierte Interventionen. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000505380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Masih T, Dimmock JA, Guelfi KJ. The effect of a single, brief practice of progressive muscle relaxation after exposure to an acute stressor on subsequent energy intake. Stress Health 2019; 35:595-606. [PMID: 31430020 DOI: 10.1002/smi.2891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/04/2019] [Accepted: 08/08/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Given previous research suggests an association between stress and the intake of energy-dense foods, this study investigated whether poststressor relaxation practice can attenuate stress-induced eating. METHODS Twenty-five men and women were exposed to four conditions on separate days: an acute laboratory stressor (S), acute stressor followed by 20 min of relaxation (SR) in the form of Abbreviated Progressive Muscle Relaxation (APMR), relaxation alone (R), and a control condition (C). Physiological and psychological responses to stress and relaxation were assessed, in addition to the subsequent energy intake of high-energy snacks. RESULTS Salivary cortisol, blood pressure, heart rate, and perceived stress were transiently elevated postlaboratory stressor (S and SR compared with R and C; p < .05). Meanwhile, perceived relaxation was acutely enhanced after APMR alone (R) compared with S, SR, and C (p < .05) and in SR (immediately after the APMR) compared with S (p < .05). No difference in mean energy intake was observed between conditions (p > .05). Likewise, no differences in perceived appetite or the levels of ghrelin, leptin, and insulin were found between conditions (p > .05). CONCLUSIONS Much variation exists in stress-induced dietary responses, and APMR either postacute stressor or in isolation does not appear to consistently alter the intake of commonly eaten snacks.
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Affiliation(s)
- Tasmiah Masih
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
| | - James A Dimmock
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
| | - Kym J Guelfi
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
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Masih T, Dimmock JA, Epel E, Guelfi KJ. An 8-Week Relaxation Program Consisting of Progressive Muscle Relaxation and Mindfulness Meditation to Reduce Stress and Attenuate Stress-Driven Eating. Appl Psychol Health Well Being 2019; 12:188-211. [PMID: 31574585 DOI: 10.1111/aphw.12179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stress is often associated with the intake of energy-dense palatable foods. This trial examined the feasibility and preliminary efficacy of an 8-week worksite-based relaxation intervention to address psychological stress and unhealthy food intake. METHODS Thirty-six men and women were exposed to an acute stressor, while physiological and psychological responses were assessed, prior to being offered a test meal. Participants were then randomised to a relaxation intervention (RELAX; face-to-face classes and daily home practice of progressive muscle relaxation and mindfulness meditation), or a wait-list control (CON). All measures were repeated after the intervention. RESULTS Intervention compliance was high (80% ± 19% face-to-face; 79% ± 18% home practice), and each session acutely reduced perceived stress (p < .001) and increased relaxation (p < .001). After 8 weeks, trait mindfulness was increased (p = .025), along with reduced tension (p = .013) and increased relaxation (p < .05) post-acute stressor in the intervention group. There was no effect of the intervention on palatable eating, cravings, or energy intake at a laboratory test meal, with small associated effect sizes (d = 0.01-0.3). CONCLUSIONS The program studied here is feasible and sessions transiently reduce perceived stress and improve mindfulness; however, the program may not influence the physiological response to an acute stressor or appetite and eating variables.
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Affiliation(s)
- Tasmiah Masih
- The University of Western Australia, Perth, Western Australia, Australia
| | - James A Dimmock
- The University of Western Australia, Perth, Western Australia, Australia
| | - Elissa Epel
- University of California, San Francisco, CA, USA
| | - Kym J Guelfi
- The University of Western Australia, Perth, Western Australia, Australia
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Jackson JG. The Cortisol Awakening Response: A Feasibility Study Investigating the Use of the Area Under the Curve With Respect to Increase as an Effective Objective Measure of Tinnitus Distress. Am J Audiol 2019; 28:583-596. [PMID: 31318575 DOI: 10.1044/2019_aja-18-0174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Tinnitus is a chronic medical condition that can result in distress, concentration difficulties, and clinical depression. An effective, objective measure of tinnitus distress does not currently exist. Endocrinal studies into the condition have been few, with those investigating the cortisol awakening response limited in scope. It was hypothesized that distressed individuals with tinnitus would awaken and be unable to effectively prepare for the day ahead due to a blunted cortisol response. Method Twenty individuals with varying tinnitus distress were compared with a control group (n = 10) in a pilot study, which measured salivary cortisol concentrations on awakening. Multiple exclusion variables were applied. Results In line with previous studies, total cortisol volume (as measured by area under the curve) was not found to be significantly different in the most distressed individuals with tinnitus, F(2, 26) = 0.254, p = .777ns. However, a separate measure of changing cortisol levels-the area under the curve with respect to increase (or AUCi)-was found to be significantly less robust in those individuals reporting the most severe tinnitus distress, F(2, 26) = 7.671, p = .002. This indicates that fewer resources would be available to cope with the demands of the day ahead. Additionally, the AUCi correlated negatively with tinnitus distress later the same day. Conclusions Relationships between proposed objective and self-reported components of self-reported tinnitus distress are considered, with some aspects of tinnitus distress more closely related to physiological mechanisms than others. It is suggested that, with further research, the cortisol awakening response (AUCi) may be put forward as a credible objective biomarker of tinnitus distress.
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Affiliation(s)
- James George Jackson
- Psychology, Sociology and Criminology Group, School of Social and Health Sciences, Leeds Trinity University, Horsforth, United Kingdom
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Tang AL, Thomas SJ, Larkin T. Cortisol, oxytocin, and quality of life in major depressive disorder. Qual Life Res 2019; 28:2919-2928. [PMID: 31227958 DOI: 10.1007/s11136-019-02236-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Quality of life (QoL) is greatly impaired in major depressive disorder (MDD). These impairments are not fully accounted for by symptom severity, may persist beyond depressive episodes, and are a risk factor for poor outcomes. MDD is often associated with prominent neuroendocrine changes and increased risk of chronic disease. However, there is a lack of research examining whether biological factors are related to QoL in MDD. This research examined relationships between cortisol, oxytocin, symptom severity, and QoL in MDD. METHODS Sixty adults meeting DSM-5 criteria for MDD and 60 healthy controls provided morning plasma samples which were analysed for cortisol and oxytocin levels, and completed measures of QoL and psychopathology. RESULTS Participants with MDD had lower QoL than controls. Cortisol correlated negatively with overall QoL and all QoL domains. Oxytocin correlated positively with overall QoL, and Psychological and Social-Relationships domains. Additionally, cortisol levels were inversely related to psychological QoL, and oxytocin was positively related to social QoL, after controlling for symptom severity and demographic variables. CONCLUSIONS This study provides novel evidence linking neuroendocrine pathways to particular domains of QoL in MDD. The results indicate that activity of the hypothalamic-pituitary-adrenal axis is linked to poor psychological QoL, and that oxytocin is important to social QoL, independently of severity of psychopathology. Biopsychosocial approaches to QoL associated with mental health conditions may lead to greater understanding of the underlying mechanisms and to improved, tailored interventions.
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Affiliation(s)
- Ai Ling Tang
- Faculty of Social Sciences, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Susan J Thomas
- Graduate Medicine, Faculty of Science, Medicine and Health & Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Theresa Larkin
- Graduate Medicine, Faculty of Science, Medicine and Health & Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
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The effect of stress management incorporating progressive muscle relaxation and biofeedback-assisted relaxation breathing on patients with asthma: a randomised controlled trial. ADVANCES IN INTEGRATIVE MEDICINE 2019. [DOI: 10.1016/j.aimed.2018.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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A novel approach to modeling tissue-level activity of cortisol levels according to the theory of Endobiogeny, applied to chronic heart failure. JOURNAL OF COMPLEXITY IN HEALTH SCIENCES 2018. [DOI: 10.21595/chs.2018.19954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Page GG, Corwin EJ, Dorsey SG, Redeker NS, McCloskey DJ, Austin JK, Guthrie BJ, Moore SM, Barton D, Kim MT, Docherty SL, Waldrop-Valverde D, Bailey DE, Schiffman RF, Starkweather A, Ward TM, Bakken S, Hickey KT, Renn CL, Grady P. Biomarkers as Common Data Elements for Symptom and Self-Management Science. J Nurs Scholarsh 2018; 50:276-286. [PMID: 29575635 DOI: 10.1111/jnu.12378] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Biomarkers as common data elements (CDEs) are important for the characterization of biobehavioral symptoms given that once a biologic moderator or mediator is identified, biologically based strategies can be investigated for treatment efforts. Just as a symptom inventory reflects a symptom experience, a biomarker is an indicator of the symptom, though not the symptom per se. The purposes of this position paper are to (a) identify a "minimum set" of biomarkers for consideration as CDEs in symptom and self-management science, specifically biochemical biomarkers; (b) evaluate the benefits and limitations of such a limited array of biomarkers with implications for symptom science; (c) propose a strategy for the collection of the endorsed minimum set of biologic samples to be employed as CDEs for symptom science; and (d) conceptualize this minimum set of biomarkers consistent with National Institute of Nursing Research (NINR) symptoms of fatigue, depression, cognition, pain, and sleep disturbance. DESIGN AND METHODS From May 2016 through January 2017, a working group consisting of a subset of the Directors of the NINR Centers of Excellence funded by P20 or P30 mechanisms and NINR staff met bimonthly via telephone to develop this position paper suggesting the addition of biomarkers as CDEs. The full group of Directors reviewed drafts, provided critiques and suggestions, recommended the minimum set of biomarkers, and approved the completed document. Best practices for selecting, identifying, and using biological CDEs as well as challenges to the use of biological CDEs for symptom and self-management science are described. Current platforms for sample outcome sharing are presented. Finally, biological CDEs for symptom and self-management science are proposed along with implications for future research and use of CDEs in these areas. FINDINGS The recommended minimum set of biomarker CDEs include pro- and anti-inflammatory cytokines, a hypothalamic-pituitary-adrenal axis marker, cortisol, the neuropeptide brain-derived neurotrophic factor, and DNA polymorphisms. CONCLUSIONS It is anticipated that this minimum set of biomarker CDEs will be refined as knowledge regarding biologic mechanisms underlying symptom and self-management science further develop. The incorporation of biological CDEs may provide insights into mechanisms of symptoms, effectiveness of proposed interventions, and applicability of chosen theoretical frameworks. Similarly, as for the previously suggested NINR CDEs for behavioral symptoms and self-management of chronic conditions, biological CDEs offer the potential for collaborative efforts that will strengthen symptom and self-management science. CLINICAL RELEVANCE The use of biomarker CDEs in biobehavioral symptoms research will facilitate the reproducibility and generalizability of research findings and benefit symptom and self-management science.
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Affiliation(s)
- Gayle G Page
- Nu Beta, Professor and Independence Foundation Chair in Nursing Education, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Elizabeth J Corwin
- Alpha Epsilon, Professor and Associate Dean for Research, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Susan G Dorsey
- Pi, Professor and Chair, Department of Pain and Translational Symptom Science, University of Maryland Baltimore, Baltimore, MD, USA
| | - Nancy S Redeker
- Delta Mu, Beatrice Renfield Term Professor of Nursing, Professor, Section of Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT
| | - Donna Jo McCloskey
- Clinical Advisor, Contractor, National Institute of Nursing Research, NIH, Bethesda, MD, USA
| | - Joan K Austin
- Alpha, Distinguished Professor Emerita, Indiana University School of Nursing, Indianapolis, IN and National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Barbara J Guthrie
- Professor, Director of the PhD Program, Northeastern University, Boston, MA, USA
| | - Shirley M Moore
- Delta Xi, Edward J. and Louise Mellen Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Debra Barton
- Mary Lou Willard French Professor of Oncology Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Miyong T Kim
- Epsilon Theta, Professor, Associate Vice President for Community Health Engagement, University of Texas at Austin, Austin, TX, USA
| | - Sharron L Docherty
- Iota Omicron, Associate Professor, School of Nursing; Associate Professor, Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Drenna Waldrop-Valverde
- Associate Professor and Assistant Dean for Research, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Donald E Bailey
- Beta Epsilon and Theta Iota, Associate Professor, Duke University, Durham, NC, USA
| | - Rachel F Schiffman
- Alpha Chi and Eta Nu, Professor and Associate Dean for Research, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Teresa M Ward
- Psi-at-Large, Associate Professor, University of Washington School of Nursing, Seattle, WA, USA
| | - Suzanne Bakken
- Alpha Eta, The Alumni Professor of Nursing and Professor of Biomedical Informatics Director, Columbia University, New York, NY, USA
| | - Kathleen T Hickey
- Alpha Eta, Professor of Nursing at Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Cynthia L Renn
- Pi, Associate Professor Department of Pain and Translational Symptom Science, University of Maryland Baltimore, Baltimore, MD, USA
| | - Patricia Grady
- Tau, Director, National Institute of Nursing Research, National Institutes or Health, Bethesda, MD, USA
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26
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Stress-induced eating and the relaxation response as a potential antidote: A review and hypothesis. Appetite 2017; 118:136-143. [DOI: 10.1016/j.appet.2017.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 07/27/2017] [Accepted: 08/04/2017] [Indexed: 11/15/2022]
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27
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López-Rodríguez MM, Baldrich-Rodríguez I, Ruiz-Muelle A, Cortés-Rodríguez AE, Lopezosa-Estepa T, Roman P. Effects of Biodanza on Stress, Depression, and Sleep Quality in University Students. J Altern Complement Med 2017; 23:558-565. [DOI: 10.1089/acm.2016.0365] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
| | | | | | | | | | - Pablo Roman
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain
- Department of Nursing, Universitat Jaume I, Castellón, Spain
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