Research Database -
International Updates

Stress

Issue 91

SHI and colleagues, Department of Molecular Genetics, Microbiology and Immunology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, 661 Hoes Lane, Piscataway 08854, USA, shiyu@umdnj.edu, have reviewed (100 references) the implications of lymphocyte apoptosis for psychoneuroimmunology.
Abstract: Psychological and physical stress serves as a good example of how the immune and nervous systems intercommunicate. Stress has been shown to alter susceptibility to various diseases. While acute stress often enhances immune response, chronic stress can lead to immunosuppression. Among many parameters commonly examined upon exposure to chronic stress are the reduction in lymphocyte proliferation and lymphocyte cellularity. Chronic restraint stress could induce lymphocyte reduction, and this effect depends on endogenous opioids. The effect of the endogenous opioids is exerted through increasing the available amount of a cell death receptor, Fas, and thus an increased sensitivity of lymphocytes to programmed cell death (apoptosis). Stress-induced lymphocyte reduction is not affected by adrenalectomy. The review focuses on the role of the hypothalamic-pituitary-adrenal axis and endogenous opioids and examines the mechanisms by which chronic stress influences lymphocyte apoptosis.
Shi Y, Devadas S, Greeneltch KM, Yin D, Allan MR, Zhou JN. Stressed to death: implication of lymphocyte apoptosis for psychoneuroimmunology. Brain, Behavior and Immunity 17 Suppl 1: S18-26, Feb 200

Issue 90

COE and LUBACH, Department of Psychology, University of Wisconsin, 22 North Charter Street, Madison, WI 53175, USA, ccoe@facstaff.wisc.edu, write about critical periods of special health relevance for psychoneuroimmunology.
Abstract: Psychological factors have an influence on immune function at any time in the lifespan of an animal or human. However there are
critical periods when the implications for health may be greater. Based on research on nonhuman primates, the authors propose that there are two such periods: the foetal and neonatal stages of young infants with their immature immune systems, and also the age-related period of immune senescence in old people. It is concluded that special attention should be paid in psychoneuroimmunology to the age of the subjects studied.
Coe CL, Lubach GR. Critical periods of special health relevance for psychoneuroimmunology. Brain, Behavior, and Immunity 17 (1): 3-12, Feb 2003.

ESCH and colleagues, The Mid-Body Medical Institute, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA, tesch@aregroup.harvard.edu, have reviewed (154 references) the therapeutic use of the relaxation response in stress-related diseases.
Background: The work aimed at investigating a possible connection between the relaxation response (RR) and stress-related diseases, as well as possible common underlying molecular mechanisms and autoregulatory pathways.
Methods: Peer-reviewed articles only were analyzed.
Results: The RR has been shown to be an appropriate therapeutic tool to counteract stress-related disease processes and certain health restrictions, particularly in immunological, cardiovascular, and neurodegenerative disorders. Common underlying molecular mechanisms may exist. Particularly, constitutive or low-output nitric oxide (NO) production may be involved in a protective or ameliorating context, whereas inducible, high-output NO release may facilitate detrimental disease processes. In mild or early disease processes, there is still a high degree of dynamic balance, and the use of RR may be particularly relevant here by activating constitutive NO pathways.
Conclusions: RR techniques represent an important tool to be added to the therapeutic strategies for dealing with stress-related disease. They may also serve primary or secondary prevention. Further studies are necessary to elucidate the complex physiology underlying the RR and its effects on stress-related disease processes.
Esch T, Fricchione GL, Stefano GB. The therapeutic use of the relaxation response in stress-related diseases. Medical Sciences Monitor 9 (2): RA23-34, Feb 2003.

MAJUMDAR and co-workers, Albert-Ludwigs-University of Freiburg, Department of Industrial and Organizational Psychology, Freiburg, Germany, have evaluated the question of whether mindfulness meditation contributes to health.
Background: This exploratory study was designed to examine the effects of an 8 week meditation based programme in mindfulness in a German sample.
Methods: 21 participants with chronic physical, psychological, or psychosomatic illness were examined in a longitudinal pre-test and post treatment design with a 3 months follow-up. Emotional and physical wellbeing, sense of coherence, overall psychological distress, and satisfaction with life were measured with standardized instruments.
Results: Overall the intervention led to high levels of adherence to the meditation practice, and satisfaction with the benefits of the course, as well as lasting and effective reduction of symptoms. Changes were of moderate to large size, especially in psychological distress, wellbeing, and quality of life. Positive complementary effects with psychotherapy were also found.
Conclusions: These findings warrant controlled studies to evaluate the efficacy and cost effectiveness of mindfulness-based stress reduction as an intervention for chronic physical and psychosomatic disorders.
Majumdar M, Grossman P, Dietz-Waschkowski B, Kersig S, Walacvh H. Does midnfulness meditation contribut to health? Outcome evaluation of a German sample. The Journal of Alternative and Complementary Medicine 8 (6): 719-730, Dec 2002.

Issue 85

SCHOFIELD, Nursing, University of Sheffield, evaluated Snoezelen [a multiplicity of different activities on the sensory level – light, noises, feelings, smells and taste] for relaxation in chronic pain management.

Background: Snoezelen is a sensory environment purporting to produce relaxation. The study was designed to test Snoezelen against conventional relaxation in the pain clinic setting.

Methods: Pain, anxiety, depression, coping. self-efficacy, and disability were measured. Assessments were carried out at three time intervals.

Results: The experimental group experienced significant reductions in pain (p = 0.002), and an improvement in self-efficacy (p = 0.02), as well as for sickness impact on the following scales: physical (p = 0.009), psychosocial (p = 0.009), recreation (p = 0.001), sleep (p = 0.001) and total sickness impact (p = 0.001). The control group experienced significant improvements in the psychosocial scale (p = 0.05), sleep scale (p = 0.01) and total sickness impact (p = 0.004).

Conclusions: The study suggests that Snoezelen environments are as effective as, if not slightly better than, teaching relaxation in the traditional pain clinic environment for chronic pain patients.

Background: Autogenic training is a self-relaxation procedure eliciting a psychophysiological relaxation response.

Methods: 73 controlled outcome studies were found published between 1952 and 1999. 60 studies, of which 36 were randomized controlled trials (RCTs), qualified for inclusion in this meta-analysis.

Results: Medium to large effect sizes were found in pre treatment/post treatment comparisons, with the RCTs showing larger effects. When autogenic training was compared to real control conditions, medium effects were found. Comparison of autogenic training to other psychological treatments mostly resulted in no effects or small negative effects. Unspecific autogenic training effects such effects on mood, cognitive performance, quality of life, and physiological variables, tended to be larger than main effects. A separate meta-analysis for different disorders revealed a significant reduction of the heterogeneity of effect sizes.

Conclusions: Positive effects of autogenic training in the meta-analysis of at least 3 studies were found for tension headache/migraine, essential hypertension, coronary heart disease, bronchial asthma, somatoform pain disorder, Raynaud’s disease, anxiety disorders, depression, and functional sleep disorders.

Comments: These are impressive results for a treatment which is probably unknown outside of the cognoscenti in the psychological world. Positive effects of autogenic training for such serious conditions such as hypertension, heart disease, asthma, Raynaud’s disease and depression need to become more widely known in the clinical world, to provide patients with real choice in their treatment.

Issue 83

PAWLOW and JONES, Department of Clinical Psychology, University of Southern Mississippi, Southern Station Box 5309, Hattiesburg, MS 39406-5309, USA, E: pawlow@musc.edu, measured the impact of progressive muscle relaxation on salivary cortisol.

Background: The purpose of the study was to examine whether acute relaxation training, conducted on two separate occasions, would be associated with reliable reductions in subjective and physiological indices of stress.

Methods: 46 subjects were led through an abbreviated progressive relaxation training (APRT) during two sessions spaced one week apart. 15 control subjects were asked to sit quietly in the laboratory for an equal length of time. Heart rate, state anxiety, perceived stress, and salivary cortisol were measured pre and post treatment.

Results: Subjects in the experimental group had significantly lower heart rate, state anxiety, perceived stress and salivary cortisol than control subjects. They reported higher levels of relaxation.

Issue 82

CURTIS, Marie Curie Centre, Newcastle-upon-Tyne, UK, reported on an audit of a pilot hypnotherapy service – provided for patients, carers and staff – at a specialist palliative care unit in Newcastle-on-Tyne.

Background: Existing data suggest that hypnotherapy may be useful for patients, their carers and healthcare professionals in palliative care settings. All parties may benefit from stress reduction, and patients may also be able to find ways to cope better with their illness and the prospect of dying.

Methods: The investigator assessed the demand for the hypnotherapy service, practical issues presented by providing the service, and benefits as perceived by the clients and the hypnotherapist. Qualitative and quantitative data, covering a period of 5 months and involving 11 clients (4 patients and 7 staff members), were obtained using questionnaires and other evaluation methods.

Results: All the clients appeared to benefit from the service in terms of improved coping and relaxation. 82% of the clients reported that hypnotherapy had helped to improve the particular problem for which they had sought the service and 91% reported a general overall benefit from the therapy.

Discussion: The author discusses additional issues, including the therapeutic relationship, non-attendance and the therapy environment.

Conclusion: This audit of a pilot hypnotherapy service indicated that hypnotherapy in the palliative care setting can benefit both patients and healthcare providers.

JACOBS, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA, gjacobs@caregroup.harvard.edu, reviewed (30 references) evidence for the benefits and cost-effectiveness of mind-body therapies (incorporating the ‘relaxation response’ and/or cognitive therapy), particularly in relation to stress-related conditions.

Background: Over the last 20 years, several valid scientific studies have been conducted demonstrating that the relaxation response and mind-body therapies are beneficial in alleviating many stress-related conditions and conditions that are exacerbated by stress. Furthermore, in recent years it has emerged that mind-body therapies can improve the outlook for patients with coronary heart disease and can bolster the immune system. The mechanism of action is thought to include reduction of sympathetic nervous system activity and enhancement of the parasympathetic division of the autonomic nervous system. The overall effect of this is to restore the natural homeostatic balance of the body. Studies have also shown that cognitive therapy may be as effective if not more so than pharmacological interventions for treating clinical depression.

Discussion: The author reviews a range of studies that have demonstrated beneficial effects of mind-body therapies (involving the relaxation response and/or cognitive therapy) on headaches, sleep problems and cardiovascular conditions. The evidence indicates that mind-body therapies are effective and can reduce the costs of patient treatment. However, mind-body therapies should not be seen as a ‘cure-all’ and it is recommended that they be used in an integrated manner alongside conventional medical treatment.

KJELLGREN and colleagues, Department of Psychology, Karlstad University, Karlstad, Sweden, investigated the possible benefits of rest/relaxation in a flotation tank to patients suffering chronic muscle tension/pain.

Background: Floating and relaxing in a high-salt content flotation tank is a form of restricted environmental stimulation technique (REST) termed ‘flotation-REST’.

Methods: This randomized, controlled study involved 14 men and 23 women suffering from chronic muscular pain/tension in the neck and/or back. 17 of the subjects served as controls, while 20 were given the opportunity to use the flotation-REST technique in a flotation tank (filled with water containing a very high salt concentration) up to nine times over a 3-week period.

Results: The flotation-REST technique significantly reduced perceived pain that was of the most severe intensity, but did not affect perceived pain that was of low intensity. In patients who undertook flotation-REST, blood levels of 3-methoxy-4-hydroxyethyleneglycol (a metabolite of noradrenaline) were significantly reduced following treatment, whereas such levels in controls were unchanged. Flotation-REST did not significantly affect endorphin levels. However, patients in the flotation-REST group did report experiencing elevated optimism and reduced anxiety and depression and were better able to fall asleep at night compared with controls.

Conclusion: The results indicate that the flotation-REST technique may offer benefits for patients suffering from chronic pain.

Comments: The above research studies show how powerful mind/body therapies are for a broad spectrum of conditions, from muscular pain, coping with the distress of dying, headaches, cardiovascular and sleep problems. These techniques and approaches need to be integrated into medical education, as well as made available as add-on services to conventional health services.

Issue 81

Issue 80

Issue 79

KIECOLT-GLASER and colleagues, Department of Psychiatry, The Ohio State University College of Medicine, 1670 Upham Drive, Columbus, Ohio 43210, USA, Kiecolt-Glaser.1@osu.edu, reviewed (176 references) literature providing evidence that links negative emotions with the onset and course of a range of illnesses/conditions that can be influenced by the immune system.
Background: Inflammation has been associated with a wide range of age-related conditions such as cardiovascular disease, osteoporosis, arthritis, type 2 diabetes, certain cancers, Alzheimer’s disease, frailty and functional decline and periodontal disease. Negative emotions and stress can directly stimulate production of proinflammatory cytokines, which influence these and other conditions. Negative emotions can also help prolong infection and delay wound healing, resulting in sustained production of proinflammatory mediators.
Discussion: The authors of this review argue that negative emotions and distress may contribute to dysregulation of normal immune function, and that this may be one core mechanism precipitating the appearance of and/or fuelling the progression of a range of common diseases and conditions of diminished health. Factors that reduce negative emotions, such as close personal relationships, may therefore enhance health partly through their beneficial effects on immune and hormonal functions.
Kiecolt-Glaser JK et al. Emotions, morbidity, and mortality: new perspectives from psychoneuroimmunology. Annual Review of Psychology 53: 83-107. 2002.

Comment: Readers are also referred to Kiecolt-Glaser’s review of the literature regarding psychoneuroimmunology in Issue 78 of Positive Health (see below).

Issue 78

KIECOLT-GLASER and colleagues, Department of Psychiatry, Ohio State University, Columbus, Ohio 43210, USA, kiecolt-glaser.1@osu.edu, reviewed (155 references) early and recent research relevant to the field of psychoneuroimmunology (PNI).
Background: Brain-immune modulation is now a well-established phenomenon, with an explosion of research and literature on the subject appearing over the last decade. The history of the field goes back much farther, however, largely under the auspices of studies in psychosomatic medicine. This article reviews that history and speculates on where PNI may take us in the future.
Methods:Human PNI studies published since 1939, particularly in the journal Psychosomatic Medicine, are reviewed here. Studies were grouped according to key themes, such as: stressor duration and characteristics (e.g. laboratory stressors, short-term stressors, chronic stress); influences of psychopathology, personality or interpersonal relationships; and immune responses to behavioural interventions. The authors also examined population trends, changes and developments in immunological assessment methods, health outcomes and likely future directions in the field of PNI.
Results:The body of evidence is now sufficient to conclude that psychosocial stressors or interventions can cause alterations in immune function that can result in actual changes in health. The strongest evidence of this is in the areas of infectious diseases and wound healing. In addition, it is now apparent that the onset and course of a range of common diseases are significantly influenced by proinflammatory cytokines; such conditions range from cardiovascular disease to loss of function and frailty such as those commonly associated with ageing. Numerous studies have demonstrated that negative emotions (e.g. anger, depression, despair) and stressful experiences can directly stimulate production of proinflammatory cytokines; chronic or recurrent infections are also indirect stimulators of these agents. Thus, the wide range of health risks associated with negative emotions may be mediated, in large part, by distress-related disturbances of normal immune function.
Conclusion:The facts of PNI have far-reaching implications for basic biological sciences, academic and clinical medicine and the effectiveness of healthcare.
Kiecolt-Glaser JK et al. Psychoneuroimmunology and psychosomatic medicine: back to the future. Psychosomatic Medicine 64 (1): 15-28. Jan-Feb 2002.
Comment:Kiecolt-Glaser are amongst the giants in the field of psychoneuroimmunology. This review summarizes the vast research which substantiates how the mind has a powerful influence upon health, as also discussed in the featured cover stories. The importance of psychosocial and emotional factors to disease and general health must now finally be given the emphasis they merit, starting with the medical school curriculum and finishing up in medical consultations placing the overall wellbeing of the patient as the supreme consideration.

REID and colleagues, School of Psychology, Murdoch University, Perth, Western Australia 6150, Australia, investigated whether stress management techniques could reduce the incidence or severity of symptoms of colds and ‘flu in students undergoing college exams.
Methods: Subjects were 27 university students. They were assessed in the periods before and after their exams on the incidence of upper respiratory tract symptoms, levels of negative affect (low mood) and the secretion rate of secretory immunoglobulin A (sIgA), an antibody found in mucosal linings (such as in the respiratory tract) of the body that often reflects the general immune status of the person. Assessments were made during 5 weeks prior to the start of treatment, during 4 weeks of treatment (participation in a stress management programme; SMP) and for 8 weeks after treatment. A further 25 students who did not participate in the stress management programme served as controls.
Results: Symptoms decreased in the SMP group, but not in control students, during and after the exam period. sIgA secretion increased significantly after individual sessions of relaxation, but resting levels of secretion did not increase over the period of the study as a whole. In both groups, mood improved after the examination period and was not affected by SMP treatment.
Conclusion:The number of days of illness due to colds and ‘flu were reduced by stress management. The effects were independent of low mood or sIgA secretion rate. The precise aspect of the treatment responsible for reducing symptoms remains unclear. However, the results indicate that psychological treatments can be useful for reducing symptoms of upper respiratory tract infections.
Reid MR et al. The effect of stress management on symptoms of upper respiratory tract infection, secretory immunoglobulin A, and mood in young adults. Journal of Psychosomatic Research 51 (6): 721-8. Dec 2001.

TAKAHASHI and colleagues, Department of Clinical Neuroscience, Psychiatry, Osaka University Graduate School of Medicine, D3, Suita City, Osaka 565-0871, Japan, kiyotake@psy.med.osaka-u.ac.jp, investigated the effects of laughter, including the experiential aspects of laughter, on a measure of immune function, natural killer cell activity (NKCA).
Background: Positive emotions are thought to be beneficial to health and immune status. In previous studies, the effects of laughter on NKCA were examined, but results were inconclusive due to methodological limitations of the studies. The researchers therefore designed and carried out a more rigorous study to investigate the relationship between laughter and NKCA.
Methods:In a cross-over design study, NKCA was measured in 21 healthy male subjects before and after they watched a 75-minute comedy film and a non-emotive film (control) on different days. Magnitude of laughter was measured (as an indicator of emotional expression) by electromyographic recordings (recordings of muscle electrical activity) from the left major zygomatic muscle of the face during film-watching. The subjects rated themselves on the pleasantness of the comedy film using a visual analogue scale (VAS). The researchers also rated the subjects’ mood state before and after watching the film using the Profile of Mood States (POMS) scale.
Results: Watching the comedy film resulted in significant increases in NKCA (26.5-29.4%). Watching the non-emotive film had no effect on NKCA (27.1-24.8%). Elevated NKCA was associated with lowered scores on the negative mood scales of POMS (suggesting an association with improvement of mood). No associations were found between NKCA elevation and self-rated pleasantness or magnitude of laughter. Further analysis of the subjects and data suggested that subjects with high scores of depression and anger/hostility had a suppressed NKCA response to laughter (i.e. negative mood suppressed the NKCA elevation caused by laughter). Subjects’ NKCA levels before and after watching the comic film seemed to be somewhat related to the self-rated pleasantness score they assigned the comedy film. NKCA levels per se were not correlated with magnitude of laughter measures.
Conclusion:The results indicated that elevations of NKCA and NKCA levels before and after watching a comedy film are associated with the experiential aspects of laughter rather than its expressive aspects.
Takahashi K et al. The elevation of natural killer cell activity induced by laughter in a crossover designed study. International Journal of Molecular Medicine 8 (6): 645-50. Dec 2001.

JOHNSEN and LUTGENDORF, Department of Psychology, University of Iowa, Iowa City 52242, USA, erica-johnsen@uiowa.edu, examined whether the ability to visualise mental imagery affected the psychological and physiological responses to stress and relaxation.
Methods: 176 subjects completed two study sessions. In session 1, subjects completed the Creative Imagination Scale and were assigned to either a stress or a relaxation condition based on their imaging scores. In session 2, subjects either watched a stressful film (‘stress condition’) or listened to a relaxation tape (‘relaxation condition’). Stress and mood were assessed before and after the stress/relaxation conditions and finger temperature was measured during the conditions.
Results:The stress/relaxation conditions resulted in changes in finger temperature and self-reported scores of stress and mood, indicating that the experimental conditions were effective. ‘High imagers’ reported greater stress after the stressful film and less stress and negative mood after the relaxation tape compared with ‘low imagers’. Imagery ability did not predict levels of negative mood following the stress condition or changes in positive mood or finger temperature during either of the conditions. In the stress condition, the observed association between imagery ability and psychological stress was partly due to expectations of stress. Conversely, in the relaxation condition, observed responses were unrelated to expectations of relaxation.
Conclusion:Subjects with higher imagery ability may show greater subjective responses to both stress and relaxation. In stressful situations, expectation of stress may contribute to the effects of imagery ability on psychological stress.
Johnsen EL, Lutgendorf SK. Contributions of imagery ability to stress and relaxation. Annals of Behavioral Medicine 23 (4): 273-81. Autumn 2001.

Issue 76

ROTH and STANLEY, Haight-Ashbury Free Medical Clinic and the Department of Public Health in San Francisco, CA, USA, bethroth@snet.net, investigated whether a programme of mindfulness-based stress reduction (MBSR) could reduce the usage of primary healthcare services by people living in an inner city area.
Background: Previous studies of MBSR have examined its ability to reduce symptoms in relation to general health problems in ‘middle class’ and ‘working class’ populations.
Methods: The researchers reviewed medical charts from the Community Health Center, Meriden, Connecticut, USA. They compared the number of and diagnoses resulting from health centre visits during the year before and the year after patients entered an 8-week MBSR programme. The review covered healthcare utilization by 73 patients who completed the MBSR programme (54 in Spanish, 19 in English). Analysis focused on 47 of these patients, for whom data were available for a complete year before and after the programme.
Results: The number of chronic care visits decreased significantly in the subgroup of 47 patients. 36 of these 47 completed the MBSR programme in Spanish – in these, total medical visits and number of chronic care visits both decreased significantly.
Conclusion: MBSR may reduce healthcare costs of inner city patients by decreasing the number of visits to their GPs.
Roth B, Stanley TW. Mindfulness-based stress reduction and healthcare utilization in the inner city: preliminary findings. Alternative Therapies in Health and Medicine 8 (1): 60-2, 64-6. Jan-Feb 2002.

Issue 64

RAMARATNAM and SRIDHARAN, Department of Neurology, Apollo Hospitals, 21 Greams Lane, off Greams Road, Madras, Tamil Nadu, India, 600006, rsridharan@vsnl.com assessed the efficacy of yoga in the treatment of patients with epilepsy.
Background: Stress is thought to be an important factor in precipitating seizures. Yoga can induce relaxation and reduce stress; effects on the electroencephalogram (EEG) and autonomic nervous system have been reported. If effective in epilepsy, it would be an attractive therapeutic option.
Methods: Reports of controlled trials (search criteria: randomized control trials and controlled clinical trials) of the treatment of epilepsy with yoga were obtained by searching the following: the Cochrane Epilepsy Group trial register; the Cochrane Controlled Trials Register (The Cochrane Library Issue 4, 1998); MEDLINE for articles published up to the middle of 1998; and registries of the research council for complementary medicine. References of all the identified studies were also searched. Members of the Neurological Society of India, several neurophysiology institutions and yoga institutes were also contacted to find information about any ongoing studies or studies published in nonindexed journals or unpublished studies. The two reviewers extracted the data independently. Any discrepancies were resolved by discussion. The main outcomes assessed were: percentage of patients rendered seizure free; number of patients with more than 50% reduction in seizure frequency or duration; and overall reduction in seizure frequency. Analyses were on an intention-to-treat basis.
Results: Only one study met the selection criteria. 32 patients were recruited: 10 to sahaja yoga, 22 to control treatments. All patients continued with anti-epileptic medication. Randomisation was by roll of a dice. 4 patients treated with yoga were seizure free for 6 months compared with none in the control groups. The odds ratio (OR) for yoga treatment versus sham yoga was 14.5 and for yoga versus no treatment was 17.3. 9 patients treated with yoga had more than 50% reduction in seizure frequency compared with only one among the controls. The OR for yoga versus sham yoga was 81 and for yoga versus no treatment was 158.3. Yoga-treated patients had a decrease in the average number of attacks per month compared to baseline. The weighted mean difference between yoga versus sham yoga was –2.1 and between yoga versus no treatment was –1.1. 7 of the 10 patients treated with yoga had a more than 50% reduction in seizure duration, compared with none among the 22 controls. The OR for yoga versus sham yoga was 45 and for yoga versus no treatment was 53.57.
Conclusion: No reliable conclusions could be drawn regarding the efficacy of yoga as a treatment for epilepsy. Further studies are needed.
Ramaratnam S, Sridharan K. Yoga for epilepsy. The Cochrane Database of Systematic Reviews (2): CD001524. 2000.

TAKEICHI and SATO, Department of Psychiatry, Saga Medical School, Japan examined the possibilities that ill-health, lifestyle illness and stress-related disease are a clinical expression of the ‘anxiety-affinitive constitution’.
Background: Previously, the researchers used visual observation of the sublingual vein (which, according to Oriental psychosomatic research, can give early indication of vital energy stagnation and blood stasis) for diagnostic purposes. They developed the concept of the ‘anxiety-affinitive constitution’, based on unbalanced Qi, blood and body fluid in ill health, as a causative factor for stress-related diseases and life-style illnesses. The present study develops this concept through the diagnosis and treatment of functional subclinical psychosomatic disorders.
Methods: The study involved 197 medical school students with a diagnosis of functional subclinical psychosomatic disorders (ill health).
Results: The researchers found that the trait ‘anxiety’, forming the core of the ‘anxiety-affinitive constitution’, was linked to Dr. Lester Breslow’s 7 good health habits and the manner of respiration. Treatment of functional subclinical psychosomatic disorders in 8 medical students with kampo medication and, in particular, relaxation training (RT) produced lower scores for STAI-trait anxiety and transformed respiration from a thoracic pattern to a balanced thoracic and abdominal pattern. A high score for anxiety trait correlated with the formation of inappropriate health habits and habituation of inadequate (thoracic pattern) respiration.
Conclusion: The researchers concluded that individuals with an anxiety-affinitive constitution will develop lifestyle illness or stress-related diseases unless their constitution is improved with kampo medication and/or RT.
Takeichi M, Sato T. Studies on the psychosomatic functioning of ill-health according to Eastern and Western medicine. 4. The verification of possible links between ill-health, lifestyle illness and stress-related disease. The American Journal of Chinese Medicine 28 (1): 9-24. 2000.

Issue 63

SCHEUFELE, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA examined whether effects of individual elements of relaxation could be measured and whether there were specific effects, or whether relaxation resulted from a generalized ‘relaxation response’.
Methods: 67 healthy male volunteers were exposed to a stress manipulation condition and then to a) progressive relaxation, b) music, c) attention control or d) silence. Measures of attention, relaxation and stress responses were obtained during each phase of the study.
Results: All four groups showed a reduction in physiological arousal following their relaxation or control condition (as shown by their performances on behavioural measures of attention), as well as a decreased heart rate. However, progressive relaxation resulted in the greatest effects on behavioural and self-report measures of relaxation.
Conclusion: The findings suggest that cognitive cues provided by stress management techniques contribute to relaxation.
Scheufele PM. Effects of progressive relaxation and classical music on measurements of attention, relaxation, and stress response. Journal of Behavioral Medicine 23 (2): 207-28. Apr 2000.

CRUESS and colleagues, Department of Psychology, University of Miami, Coral Gables, Florida 33124-2070, USA examined salivary cortisol and mood during relaxation training in symptomatic, HIV-positive gay men.
Methods: In 30 symptomatic, HIV-positive gay men participating in a 10-week, group-based, cognitive-behavioural stress management intervention, cortisol levels in saliva samples and mood were assessed within the therapy sessions immediately before and after 45-minute relaxation exercises. Subjects also recorded their stress levels and compliance with daily home relaxation practice.
Results: Pre-session salivary cortisol levels decreased over the course of the 10-week period and were associated with decreases in global measures of total mood disturbance and anxious mood and with decreases in self-reported stress level during home practice. Greater reductions in cortisol levels occurred during the first three therapy sessions and were associated with more frequent home relaxation practice.
Conclusion: Salivary cortisol appears to represent an objective neuroendocrine marker for changes in anxiety and distress observed during relaxation training in symptomatic, HIV-positive men.
Cruess DG et al. Reductions in salivary cortisol are associated with mood improvement during relaxation training among HIV-seropositive men. Journal of Behavioral Medicine 23 (2): 107-22. Apr 2000.

Issue 53

RIABUS and KOLOSOVA, Eastern Europe, analysed the efficiency of electromyographic (EMG) biofeedback (BFB) in the treatment of tension type headache (TTH).
Methods: 50 patients with episodic and chronic TTH were treated by a standard course of BFB therapy (10 sessions). Results were compared with data in a comparison group (12 patients receiving lerivon therapy) and in controls (15 healthy individuals). Outcome measures include severity index, psychological data, amplitude of EMG of frontal, temporal, trapezius, and orbicularis oris muscles.
Results: The best results were obtained in the episodic TTH group – 87%. In the chronic TTH group the efficiency was lower: full effect: 26%; partial: 35%; no effect: 39%. The 6-month period following treatment showed that BFB effect was more protracted than that of the pharmacological therapy.
Riabus MV and Kolosova OA. Treatment of various forms of tense headaches by biofeedback. Zhurnal Nevrologii I Psikhiatrii Imeni SS Korsakova 99(12): 35-8. 1999.
Comments: The results of the above study indicated that EMB biofeedback treatment of tension headaches had a more long-lasting effect than drugs. I look forward to the day when we are all able to use this technique for our headaches.

SAWAZAKI and colleagues, First Department of Internal Medicine, School of Medicine, Toyama Medical and Pharmaceutical University, Japan previously reported that docosahexaenoic acid (DHA) prevented aggression from increasing during time of mental stress. The authors further studied whether DHA intake modified stress response in medical students.
Methods: 14 medical students, randomly assigned, double-blind, to either control or DHA group, participated in the current study. Students in the control group (4 males and 3 females) took 10 control capsules/d, each capsule with 280 mg of mixed plant oil; the DHA group (4 males and 3 females) took 10 DHA capsules/d containing 1.5 g DHA for a period of 9 weeks, during which time subjects underwent more than 20 stressful final exams. At the outset and end of the study, plasma catecholamines (epinephrine, norepinephrine (NE) and dopamine) and cortisol were measured; a 75 g oGTT was also performed.
Results: There were intra- or intergroup differences in plasma glucose concentrations. NE concentrations were significantly diminished following DHA administration. The other catecholamines and cortisol did not change significantly. Plasma ratios of epinephrine to NE increased in each DHA subject and intergroup differences were significant.
Conclusions: The effects of DHA may be applied to people under long-lasting psychological stress to prevent stress-related diseases.
Sawazaki S et al. The effect of docosahexaenoic acid on plasma catecholamine concentrations and glucose tolerance during long-lasting psychological stress: a double-blind placebo-controlled study. Journal of Nutritional Science and Vitaminology 45(5): 655-65. Oct 1999.

Issue 52

SADIGH, Department of Psychology, good Shepherd Hospital, Allentown, PA 18103 USA writes that recurrent and frightening dreams are commonly experienced by patients who suffer from post-traumatic stress disorder after an automobile accident. These, if left untreated, may result in severe distress along with physical, emotional and psychophysiological effects. The author presents a single case study investigating the effects of the standard autogenic exercises in reducing frequency and severity of post-traumatic nightmares in a survivor of a car crash.
Methods: The patient was instructed in standard autogenic exercises and autogenic abreaction, as well as two additional organ-specific formulas in order to improve her sleep.
Results: The interventions were successful in effectively treating the patient's distressing nightmares. Follow-up data suggested that the treatment effects persisted following termination of therapy. The author discusses suggestions for future investigations.
Sadigh Mr. The treatment of recalcitrant post-traumatic nightmares with autogenic training and autogenic abreaction: a case study. Applied Psychophysiology and Biofeedback 24(3): 203-10. Sep 1999.

BURNS and colleagues, Department of Psychology, University of South Alabama, Mobile 36688, USA evaluated the effects of listening to different types of music upon physiological indicators of relaxation.
Methods: Fifty-six undergraduate students, 24 male and 32 female, mean age 21, were randomly assigned to listen either to classical, hard rock, self-selected relaxing music or no music. Participants' relaxation level, skin temperature, muscle tension and heart rate were evaluated prior to and following exposure to a music condition.
Results: Skin temperature decreased for all conditions; classical, self-selected relaxing music and no music groups reported significant increases in feelings of relaxation.
Conclusions: These results partially support the hypothesis that classical and self-selected relaxing music may increase perceptions of relaxation to a greater degree than listening to hard rock music. No differences were found between different types of music upon physiological indicators of arousal. The authors discuss implications for using music to reduce stress.
Burns J et al. Perceived and physiological indicators of relaxation: as different as Mozart and Alice in chains. Applied Psychophysiology and Biofeedback 24(3): 197-202. Sep 1999.

MACHT and ELLGRING, Institute for Psychology, University of Wurzburg, Wuerzburg, Germany macht@psychologie.uni-wuerzburg.de studied the effects of using relaxation and loud rhythmic counting upon the 'freezing' phenomenon in Parkinson's disease (PD).
Background: The 'freezing' phenomenon was studied in a 77-year old male patient with Parkinson's disease (PD). Motor blocks occurred several times per day, lasting between 2 and 5 minutes, which affected mainly walking. Freezing was elicited and intensified by external factors (limited space and room to move), as well as by negative cognitions, negative emotions and tension.
Results: The most effective behaviour to overcome freezing was a combination of relaxation and loud rhythmic counting. Effectiveness in overcoming freezing correlated positively with self-rated mobility prior to trials. Relaxation training improved self-rated mobility.
Conclusions: Relaxation training and cognitive techniques should be used to reduce tension, negative thoughts and negative emotions contributing to freezing, and to improve the ability to cope with freezing.
Macht M and Ellgring H. Behavioral analysis of the freezing phenomenon in Parkinson's disease: a case study. Journal of Behavior Therapy and Experimental Psychiatry 30(3): 241-7. Sep 1999.

McGLYNN and colleagues, Department of Psychology, Auburn University, AL 36849-5214 USA mcglyfd@mail.auburn.edu studied the effects of relaxation training upon fear of snake phobics.
Methods: 20 carefully selected snake phobics were exposed to a caged snake for 8 trials on a conveyor apparatus. During the first and eighth trials the subjects brought the snake toward themselves as closely as tolerable; records were kept of the end-of-trial distances remaining between the subject and the snake. For the 6 intervening trials the experimenter placed the snake a standard distance away; records were kept of the subjects' heart rates and skin-conductance levels prior to and during the exposures and of their self-reported fear intensities following the exposures. Half of the subjects had received six sessions of progressive relaxation training prior to the exposures.
Results: Compared to those subjects who had received relaxation training, those who had not received relaxation training had heightened arousal and fear levels in the context of in vivo exposure. Relaxation worked by lowering arousal throughout the course of exposure, not by hastening or facilitating arousal decrement during exposure.
McGlynn FD et al. Relaxation training inhibits fear and arousal during in vivo exposure to phobia-cue stimuli. Journal of Behavior Therapy and Experimental Psychiatry 30(3): 155-68. Sep 1999.

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