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Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials.
Cramer, H, Lauche, R, Anheyer, D, Pilkington, K, de Manincor, M, Dobos, G, Ward, L
Depression and anxiety. 2018;35(9):830-843
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While temporary anxiety is a natural response, excessive and prolonged anxiety can lead to a wide range of physical symptoms and behavior changes. Current treatment options include psychological approaches and medication, however many individuals experiencing anxiety choose to self-manage their condition. Yoga has become a popular approach to improve emotional well-being, and based on a recent study, yoga practitioners have reported managing stress and anxiety as one of the main reasons for practicing. The aim of this meta-analysis was to review the effectiveness and safety of yoga for anxiety. Eight studies with 319 participants were included in this systematic review. Among these studies, no effects were found for patients with anxiety disorders diagnosed by the Diagnostic and Statistical Manual (DSM) criteria, only for patients without a formal diagnosis. Based on these results, the authors conclude yoga may be beneficial in the short-term for individuals with elevated levels of anxiety, however there was no conclusive evidence for individuals when only DSM-diagnosed anxiety disorders were considered. These findings warrant further studies to better understand the connection between mindfulness practices and anxiety.
Abstract
Yoga has become a popular approach to improve emotional health. The aim of this review was to systematically assess and meta-analyze the effectiveness and safety of yoga for anxiety. Medline/PubMed, Scopus, the Cochrane Library, PsycINFO, and IndMED were searched through October 2016 for randomized controlled trials (RCTs) of yoga for individuals with anxiety disorders or elevated levels of anxiety. The primary outcomes were anxiety and remission rates, and secondary outcomes were depression, quality of life, and safety. Risk of bias was assessed using the Cochrane tool. Eight RCTs with 319 participants (mean age: 30.0-38.5 years) were included. Risk of selection bias was unclear for most RCTs. Meta-analyses revealed evidence for small short-term effects of yoga on anxiety compared to no treatment (standardized mean difference [SMD] = -0.43; 95% confidence interval [CI] = -0.74, -0.11; P = .008), and large effects compared to active comparators (SMD = -0.86; 95% CI = -1.56, -0.15; P = .02). Small effects on depression were found compared to no treatment (SMD = -0.35; 95% CI = -0.66, -0.04; P = .03). Effects were robust against potential methodological bias. No effects were found for patients with anxiety disorders diagnosed by Diagnostic and Statistical Manual criteria, only for patients diagnosed by other methods, and for individuals with elevated levels of anxiety without a formal diagnosis. Only three RCTs reported safety-related data but these indicated that yoga was not associated with increased injuries. In conclusion, yoga might be an effective and safe intervention for individuals with elevated levels of anxiety. There was inconclusive evidence for effects of yoga in anxiety disorders. More high-quality studies are needed and are warranted given these preliminary findings and plausible mechanisms of action.
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The cognitive treatment components and therapies of cognitive behavioral therapy for insomnia: A systematic review.
Jansson-Fröjmark, M, Norell-Clarke, A
Sleep medicine reviews. 2018;42:19-36
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Insomnia disorder is characterised by problems getting to sleep at bedtime, periods of being awake, or waking early and not being able to go back to sleep. This leads to problems with daytime functioning (e.g. low energy levels, mood disruptions). Diagnosis requires difficulties for 3 or more nights each week for longer than 3 months. Cognitive behavioural therapy (CBT) is considered a viable treatment for patients with insomnia and usually is made up of elements such as sleep hygiene and relaxation, addressing problematic sleep behaviours, and dealing with unhelpful beliefs. However, the effectiveness of various CBT elements is still in question. This systematic review aims to address this, and is based on 1455 subjects in 32 studies. The review concluded there was support for paradoxical intention: instructing the subject to try to remain awake as long as possible rather than aiming to sleep, and cognitive therapy: to reverse unhelpful beliefs about sleep, sleep-worry, misperceptions of sleep and using safety behaviours. It also found that some cognitive elements appear promising including behavioural experiments: planned activities that help the subject test unhelpful beliefs and cognitive refocusing: getting subjects to focus on non-arousing thoughts such as film plots or by focusing on external things like audiobooks to shift attention. However, more methodologically robust studies are needed.
Abstract
Since the beginning of the twenty-first century, there has been an increased focus on developing and testing cognitive components and therapies for insomnia disorder. The aim of the current review was thus to describe and review the efficacy of cognitive components and therapies for insomnia. A systematic review was conducted on 32 studies (N = 1455 subjects) identified through database searches. Criteria for inclusion required that each study constituted a report of outcome from a cognitive component or therapy, that the study had a group protocol, adult participants with diagnosed insomnia or undiagnosed insomnia symptoms or reported poor sleep, and that the study was published until and including 2016 in English. Each study was systematically reviewed with a standard coding sheet. Several cognitive components, a multi-component cognitive program, and cognitive therapy were identified. It is concluded that there is support for paradoxical intention and cognitive therapy. There are also other cognitive interventions that appears promising, such as cognitive refocusing and behavioral experiments. For most interventions, the study quality was rated as low to moderate. We conclude that several cognitive treatment components and therapies can be viewed as efficacious or promising interventions for patients with insomnia disorder. Methodologically stronger studies are, however, warranted.
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Investigating effective treatment factors in brief cognitive behavioral therapy for panic disorder.
Lim, JA, Lee, YI, Jang, JH, Choi, SH
Medicine. 2018;97(38):e12422
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Both standard and short-term cognitive behaviour therapy (CBT) have been shown to be effective in the treatment of panic disorder (PD). The aim of this study was to investigate the effectiveness of a mindfulness-based brief CBT, in particular, with respect to physiological symptoms, like palpitations and accelerated heart rate, and factors that may help predict treatment outcome. Treatment consisted of psychoeducation about the condition and teaching meditation/relaxation techniques. CBT was delivered once a week over a four week period (a total of four sessions). Several self-assessed scales were used to determine outcome and efficacy. The four week intervention showed statistically significant improvements on almost all scores. The results suggest that fear of cardiovascular (CV) symptoms may be an important predictor of the clinical course of PD. The authors concluded that managing fear of CV symptoms can help improve effectiveness of brief CBT and that short-term CBT may be particularly effective for patients who suffered from CV symptoms. The study was limited by the fact that there was no control group and that participants had relatively mild PD symptoms and may therefore not have been representative of the PD patient population as a whole.
Abstract
Numerous studies have provided evidence for the effectiveness of cognitive behavioral therapy (CBT) on panic disorders (PDs). There has also been growing attention on brief CBT with regard to delivering intensive treatment efficiently. This study investigated the essential parts of mindfulness-based brief CBT to optimize treatment benefits.A total of 37 patients were retrospectively enrolled in this study. They were recruited from the anxiety/panic/fear clinic of Seoul National University Hospital. The patients participated in group CBT once a week for a total of 4 sessions over a 4-week period, when they were assessed using the Panic Disorder Severity Scale (PDSS), Anxiety Sensitivity Index-Revised (ASI-R), Albany Panic and Phobia Questionnaire (APPQ), State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) before and after brief CBT. Twenty-nine patients completed the 1-month follow-up.There were significant reductions in PDSS (P < .001), ASI-R-fear of respiratory symptoms (P = .006), ASI-R-fear of publicly observable anxiety reaction (P = .002), ASI-R-fear of cardiovascular symptoms (P < .001), ASI-R-fear of cognitive dyscontrol (P = .001), ASI-R-Total (P < .001), APPQ-Agoraphobia (P = .003), APPQ-Total (P = .028), STAI-State anxiety (P < .001), STAI-Trait anxiety (P = .002), BAI (P = .003), and BDI (P < .001) scores. We also found significant associations between ASI-R-fear of cardiovascular symptoms, ASI-R-Total, and changes in PDSS scores. A stepwise multiple linear regression analysis indicated that anxiety sensitivity for fear of cardiovascular symptoms predicted an improvement in panic severity (β = 0.513, P = .004).Our findings suggested that behavioral aspects, especially physiological symptom control, needed to be considered in brief, intensive CBT for PD. The results also suggested that a mindfulness-based brief CBT approach might be particularly helpful for patients with PD who have severe cardiovascular symptoms.
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Association between sleep duration and musculoskeletal pain: The Korea National Health and Nutrition Examination Survey 2010-2015.
Chun, MY, Cho, BJ, Yoo, SH, Oh, B, Kang, JS, Yeon, C
Medicine. 2018;97(50):e13656
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Musculoskeletal pain is highly prevalent in old age and can be disabling to sufferers, resulting in significant economic burden and a detrimental impact on quality of life. The aim of the study was to investigate the association between self-reported sleep duration and musculoskeletal pain in Korean adult population. The study showed that extreme sleep duration is prevalent in musculoskeletal pain subjects and it is more prevalent in subjects with multi-site joint pain. Thus, both longer and shorter sleep durations were linked with a higher prevalence of musculoskeletal pain. Authors conclude that specific assessment and treatment of sleep disturbance should be included as an important part of pain management in patients with musculoskeletal pain.
Abstract
Both extremely long and short sleep durations have been associated with increased risk of numerous health problems. This study examined the association between self-reported sleep duration and reporting of musculoskeletal pain in the adult Korean population.This study included data from 17,108 adults aged ≥50 years, obtained from the Korea National Health and Nutrition Examination Survey 2010-2012 and 2013-2015. Self-reported daily hours slept and the presence of musculoskeletal pain in knee joint, hip joint, or low back were examined. Patients were stratified into 5 groups by their sleep duration: ≤5, 6, 7, 8, or ≥9 h. Multivariate logistic regression analysis was performed, adjusting for covariates including age, sex, marital status, smoking, alcohol use, family income level, education, physical exercise, body mass index (BMI), and stress level.A U-shaped relationship was observed between the length of sleep duration and the presence of musculoskeletal pain. After adjusting for covariates, sleep duration of ≤5 h or ≥9 h was significantly associated with musculoskeletal pain experienced for more than 30 days over a 3-month period. We also found that the presence of multi-site musculoskeletal pain was significantly higher among those who slept for ≤5 h or ≥9 h than in those who slept for 7 h.These findings suggest that either short or long sleep duration is associated with musculoskeletal pain among Korean adults.
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A systematic review and meta-analysis of cognitive and behavioral interventions to improve sleep health in adults without sleep disorders.
Murawski, B, Wade, L, Plotnikoff, RC, Lubans, DR, Duncan, MJ
Sleep medicine reviews. 2018;40:160-169
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Sleep is important for good health but more than a quarter of the adult population reports poor quality sleep. This review and meta-analysis looked at cognitive and behavioural interventions in adults who report poor sleep but are not diagnosed with a clinical sleep disorder. The most commonly used interventions were stress management/relaxation, meditation, controlled breathing and stimulus control. A meta-analysis showed a medium improvement of overall sleep quality and a small but significant improvement of subjective sleep quality and duration with cognitive and behavioural interventions. The effects were bigger when sleep at baseline was worse. Effects of mode of delivery, study duration and the inclusion of a relaxation component were not assessed, due to insufficient numbers. The authors conclude that there is room for improvements of cognitive and behavioural interventions and call for more investigations into this.
Abstract
Many adults without a diagnosed sleep disorder report poor sleep health, which is defined by dissatisfactory levels of sleep duration, sleep quality, or the timing of sleep. No previous review has summarized and described interventions targeting poor sleep health in this population. This meta-analysis aimed to quantify the efficacy of behavioral and cognitive sleep interventions in adults with poor sleep health, who do not have a sleep disorder. Electronic databases (Medline, Embase, PsycInfo, Cinahl) were searched with restrictions for age (18-64 y) and English language full-text, resulting in 18,009 records being screened and 592 full-texts being assessed. Eleven studies met inclusion criteria, seven of which reported a measure of overall sleep health (Pittsburgh sleep quality index [PSQI]). Following appraisal for risk of bias, extracted data were meta-analyzed using random-effects models. Meta-analyses showed interventions had a medium effect on sleep quality (Hedge's g = -0.54, [95% confidence interval (CI)] -0.90 to -0.19, p < 0.01). Baseline sleep health was the only significant effect moderator (p = 0.01). The most frequently used intervention components were stress management and relaxation practice, stimulus control, sleep hygiene, and exercise. Interventions targeting cognitive and behavioral self-regulation improve sleep quality in adults without clinical sleep disorder.
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Shared Dysregulation of Homeostatic Brain-Body Pathways in Depression and Type 2 Diabetes.
Hoogendoorn, CJ, Roy, JF, Gonzalez, JS
Current diabetes reports. 2017;17(10):90
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Depression and type 2 diabetes (T2D) appear to have a bidirectional relationship, with the two diseases possibly being linked through emotional and biological changes. This review paper aimed to discuss this bidirectional relationship and in particular the biological changes that may be involved. The authors started by stating that two biological systems may be influenced in depression and T2D, the hypothalamic-pituitary-adrenal axis (HPA), which is responsible for many systems in the body involved in the stress response and emotional and physical health. The second is the brain-gut-microbiome axis (BGM), which is related to the microorganisms in the gut and how they communicate with the brain. The immune system, sleep and blood sugar balance may be influenced by the HPA and BGM and are all dysregulated in both depression and T2D indicating a link between the two diseases. However causal relationships need further research. Dietary and lifestyle changes may be of benefit in these individuals. It was concluded that the disruption of shared biological systems in T2D and depression may be an important target for treatments, however further research is warranted. This study could be used by healthcare practitioners to understand the relationship between T2D and depression and the potential therapeutic areas to target. However, although research is optimistic, it is still in its infancy.
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of shared dysregulation of the hypothalamic-pituitary-adrenal (HPA) and brain-gut-microbiome (BGM) axes associated with depression and type 2 diabetes (T2D). Clinical implications and future research are also discussed. RECENT FINDINGS Both depression and T2D are associated with dysregulation of the HPA and BGM axes. These pathways regulate immune function, glucose metabolism, and sleep, which are altered in both illnesses. Dysregulation of homeostatic brain-body pathways may be positively influenced through different therapeutic actions, including psychotherapy, healthy eating, physical activity, sleep promotion, and certain anti-inflammatory or antidepressant medications. While the causal nature of the relationship between depression and T2D remains unclear, these conditions share dysregulation of homeostatic brain-body pathways that are central to mental and physical health. Better understanding of this dysregulation may provide opportunities for interventions that could benefit both conditions. Future research should examine the additive burden of depression and T2D on HPA and BGM dysregulation and better differentiate depression from emotional distress.
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Melatonin Supplementation Lowers Oxidative Stress and Regulates Adipokines in Obese Patients on a Calorie-Restricted Diet.
Szewczyk-Golec, K, Rajewski, P, Gackowski, M, Mila-Kierzenkowska, C, Wesołowski, R, Sutkowy, P, Pawłowska, M, Woźniak, A
Oxidative medicine and cellular longevity. 2017;2017:8494107
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Obesity is one of the major global health problems. Melatonin is a hormone which regulates wakefulness, functions as an antioxidant and plays a role in the immune system. Previous research suggests that melatonin deficiency is associated with obesity. The aim of this study was to estimate the effect of melatonin on oxidative stress and levels of cell signalling proteins released by fat cells (adipokines) in obese patients on a calorie-restricted diet. Thirty obese patients were supplemented with a daily dose of 10 mg of melatonin or placebo for 30 days with a calorie-restricted diet. Blood levels of melatonin, adipokines and markers of oxidative stress were measured at baseline and after supplementation. Significant body weight reduction (7%) was observed only in the melatonin group. After melatonin supplementation, the adiponectin and omentin-1 levels and glutathione peroxidase activities statistically increased, whereas the malondialdehyde concentrations were reduced. In the placebo group, a significant rise in 4-hydroxynonenal and a drop in the melatonin concentrations were found. The results show evidence of increased oxidative stress accompanying calorie restriction. The authors concluded that melatonin supplementation facilitated body weight reduction, improved the antioxidant defence, and regulated adipokine secretion. The findings suggest that melatonin should be considered in the management of obesity.
Abstract
Obesity is one of the major global health problems. Melatonin deficiency has been demonstrated to correlate with obesity. The aim of the study was to estimate the effect of melatonin on oxidative stress and adipokine levels in obese patients on a calorie-restricted diet. Thirty obese patients were supplemented with a daily dose of 10 mg of melatonin (n = 15) or placebo (n = 15) for 30 days with a calorie-restricted diet. Serum levels of melatonin, 4-hydroxynonenal (HNE), adiponectin, omentin-1, leptin, and resistin, as well as erythrocytic malondialdehyde (MDA) concentration and Zn/Cu-superoxide dismutase, catalase, and glutathione peroxidase (GPx) activities, were measured at baseline and after supplementation. Significant body weight reduction was observed only in the melatonin group. After melatonin supplementation, the adiponectin and omentin-1 levels and GPx activities statistically increased, whereas the MDA concentrations were reduced. In the placebo group, a significant rise in the HNE and a drop in the melatonin concentrations were found. The results show evidence of increased oxidative stress accompanying calorie restriction. Melatonin supplementation facilitated body weight reduction, improved the antioxidant defense, and regulated adipokine secretion. The findings strongly suggest that melatonin should be considered in obesity management. This trial is registered with CTRI/2017/07/009093.
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The microbiome: A key regulator of stress and neuroinflammation.
Rea, K, Dinan, TG, Cryan, JF
Neurobiology of stress. 2016;4:23-33
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This study discusses the concept of intestinal microbiota as the key regulator involved in energy regulation, gut barrier function, protection from pathogens, and immune system function amongst others. The gut microbiota is the complex community of microorganisms that lives in the digestive tracts of humans. The main aim of this study is to summarise the role of gastrointestinal microbiota in fundamental physiological and pathophysiological processes and thereafter to understand and treat a range of stress and immune-related disorders. This review outlines the numerous complex relationships between gastrointestinal microbiota, stress and immune responses at the three critical stages of life The authors concluded that the evidence from this study suggests that resilience to stress and immune-related disorders and dysfunction of stress and immune systems may be dependent on the diversity and complexity of gastrointestinal microbiota. However, gut microbiota mediated relationship to stress and neuro-inflammation is still unconfirmed as previous studies mostly, have largely been, preclinical and further studies are warranted.
Abstract
There is a growing emphasis on the relationship between the complexity and diversity of the microorganisms that inhabit our gut (human gastrointestinal microbiota) and health/disease, including brain health and disorders of the central nervous system. The microbiota-gut-brain axis is a dynamic matrix of tissues and organs including the brain, glands, gut, immune cells and gastrointestinal microbiota that communicate in a complex multidirectional manner to maintain homeostasis. Changes in this environment can lead to a broad spectrum of physiological and behavioural effects including hypothalamic-pituitary-adrenal (HPA) axis activation, and altered activity of neurotransmitter systems and immune function. While an appropriate, co-ordinated physiological response, such as an immune or stress response are necessary for survival, a dysfunctional response can be detrimental to the host contributing to the development of a number of CNS disorders. In this review, the involvement of the gastrointestinal microbiota in stress-mediated and immune-mediated modulation of neuroendocrine, immune and neurotransmitter systems and the consequential behaviour is considered. We also focus on the mechanisms by which commensal gut microbiota can regulate neuroinflammation and further aim to exploit our understanding of their role in stress-related disorders as a consequence of neuroinflammatory processes.
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The impact of sleeping with reduced glycogen stores on immunity and sleep in triathletes.
Louis, J, Marquet, LA, Tiollier, E, Bermon, S, Hausswirth, C, Brisswalter, J
European journal of applied physiology. 2016;116(10):1941-54
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Endurance athletes are increasingly using training strategies focused on low glycogen availability in attempt to improve performance. It is well known, however, that increasing training stress could influence immune function and increase the risk of illness or injury. In endurance sports, training load, nutrient intake and sleep are key factors in modulating immune function. The aim of this study was to investigate the effects of a 3-week training strategy involving lowered glycogen availability overnight on immune function, upper respiratory tract infections and sleep patterns in 21 trained endurance athletes. This study found that reduced glycogen availability resulted in significantly faster 10km running times, and found no significant changes in the recorded immunity markers. Based on this study, the authors conclude that reduced glycogen availability has no deleterious impact on immune function.
Abstract
PURPOSE We investigated the effects of a 3-week dietary periodization on immunity and sleep in triathletes. METHODS 21 triathletes were divided into two groups with different nutritional guidelines during a 3-week endurance training program including nine twice a day sessions with lowered (SL group) or maintained (CON group) glycogen availability during the overnight recovery period. In addition to performance tests, sleep was monitored every night. Systemic and mucosal immune parameters as well as the incidence of URTI were monitored every week of the training/nutrition protocol. Two-ways ANOVA and effect sizes were used to examine differences in dependent variables between groups at each time point. RESULTS The SL group significantly improved 10 km running performance (-1 min 13 s, P < 0.01, d = 0.38), whereas no improvement was recorded in the CON group (-2 s, NS). No significant changes in white blood cells counts, plasma cortisol and IL-6 were recorded over the protocol in both groups. The vitamin D status decreased in similar proportions between groups, whereas salivary IgA decreased in the SL group only (P < 0.05, d = 0.23). The incidence of URTI was not altered in both groups. All participants in both groups went to bed earlier during the training program (SL -20 min, CON -27 min, P < 0.05, d = 0.28). In the SL group, only sleep efficiency slightly decreased by 1.1 % (P < 0.05, d = 0.25) and the fragmentation index tended to increase at the end of the protocol (P = 0.06). CONCLUSION Sleeping and training the next morning regularly with reduced glycogen availability has minimal effects on selected markers of immunity, the incidence of URTI and sleeping patterns in trained athletes.
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Circadian Rhythms, Metabolism, and Chrononutrition in Rodents and Humans.
Johnston, JD, Ordovás, JM, Scheer, FA, Turek, FW
Advances in nutrition (Bethesda, Md.). 2016;7(2):399-406
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Chrononutrition is an emerging field that links the body’s metabolism to its endogenous circadian rhythm. It is now recognised that numerous circadian clocks are found within all major tissues and most cells of the body. This complex network of clocks influences a wide range of biological processes including neuronal, endocrine, metabolic and behavioural function. When there is a disruption in a single circadian clock, whole-organism homeostasis can be impacted, potentially resulting in the development of disease. This review explains the potential mechanisms by which circadian clocks influence biological processes through transgenic animal studies, and how they are being translated to human genetics and metabolomics. The principles of chrononutrition are clinically significant factors that should be considered when managing and treating metabolic disease, as well as maintaining health in the general population.
Abstract
Chrononutrition is an emerging discipline that builds on the intimate relation between endogenous circadian (24-h) rhythms and metabolism. Circadian regulation of metabolic function can be observed from the level of intracellular biochemistry to whole-organism physiology and even postprandial responses. Recent work has elucidated the metabolic roles of circadian clocks in key metabolic tissues, including liver, pancreas, white adipose, and skeletal muscle. For example, tissue-specific clock disruption in a single peripheral organ can cause obesity or disruption of whole-organism glucose homeostasis. This review explains mechanistic insights gained from transgenic animal studies and how these data are being translated into the study of human genetics and physiology. The principles of chrononutrition have already been demonstrated to improve human weight loss and are likely to benefit the health of individuals with metabolic disease, as well as of the general population.