We investigated the effects of exercise in multiple sessions on anxiety- and depression-like behavior during aging, and the role of serotonin and serotonin 1A receptors in this process. Both 24-month-old (aged) and 6-month-old (adult) female rats were divided into five groups; aged control, adult control, aged + serotonin re-uptake inhibitors (SSRIs), aged + exercise, and aged + SSRIs + exercise. After exercise, all groups were evaluated using the open field arena, elevated plus maze and forced swim tests. We assessed serum corticosterone levels; number of amygdala, hippocampus and prefrontal cortex cells; tissue serotonin and serotonin 1A (5-HT1A) levels. In the open field test, aged rats exhibited a significant increase in locomotor activity compared to the SSRIs and SSRIs + exercise groups. During the elevated plus maze test, aged rats were observed less frequently in the open arms of assembly compared to adults. The duration increased in the exercise group and remained unchanged in the SSRIs group. In the forced swim test, the aged rats were more immobile compared to adults; no change was observed in the immobility time between these groups. The tissue serotonin levels in amygdala and hippocampus were higher in SSRIs + exercise group compared to the aged, exercised and SSRIs groups. The number of cells in the hippocampus, prefrontal cortex and amygdala decreased in the aged group compared to adult rats; increased numbers of cell were observed in exercise, SSRIs and SSRIs + exercise groups compared to aged rats. Exercise in multiple sessions may increase the number of cells in the hippocampus, prefrontal cortex and amygdala, which may reduce senile anxiety and depression. Also, serotonin and serotonin 1A receptors may play role in depression-like behavior.

INTRODUCTION:Pain and anxiety are a major problem of burn patients. Despite the use of different medications, patients still suffer from these two problems. Aromatherapy along with medication may help in alleviating these symptoms. This study aimed to investigate the effect of inhalation aromatherapy with damask rose essence on pain and anxiety in burn patients.

METHODS:This three group clinical trial was conducted on 120 patients with burns less than 30% TBSA. The patients were randomly allocated into three groups, aromatherapy damask rose essence, placebo, and control. The pain intensity was assessed using visual analogue scale prior to intervention, immediately before, and 15 min after dressing. Anxiety was measured using Spielberger Inventory at before intervention and 15 min after dressing, also the prolonged effect of intervention on pain was assessed by number of the analgesics drugs received for four hours after dressing change. The intervention included inhalation of 6 drops of 40% damask rose essential oil in the damask group, and six drops of distilled water in placebo group one hour before dressing change. The control group received no intervention.

RESULTS:Baseline state-trait anxiety and pain intensity were similar in these three groups (p>0.05). We found a significant reduction in pain intensity immediately before and after dressing and state anxiety after dressing in the damask group compared to the placebo and control groups (p<0.001). However, we found no significant difference between the placebo and control groups in terms of these variables at these times (p>0.05). Also, we found no significant difference among three groups in frequency of analgesics drugs and trait anxiety after intervention (p>0.05).

CONCLUSION:Inhaled aromatherapy with Damask rose essence reduces subjective pain intensity and state anxiety in burned patients. Therefore, it is recommended considering use of damask rose essence, as an easy and affordable method along with other treatments.

PurposeTo investigate the anxiolytic effects of binaural beat embedded audio in patients undergoing cataract surgery under local anesthesia.MethodsThis prospective RCT included 141 patients undergoing cataract surgery under local anesthesia. The patients were randomized into three groups; the Binaural beat music group (BB), the plain music intervention group (MI), and a control group (ear phones with no music). Blood pressure (BP) and heart rate were measured on admission, at the beginning of and 20 min after the start of the operation. Peri-operative anxiety level was assessed using the State-Trait Anxiety Inventory questionnaire (STAI).ResultsThe BB and MI groups comprised 44 patients each and the control group 47. Patients in the MI group and BB group showed significant reduction of STAIstate scores after music intervention compared with the control group (P<0.001) but the difference was not significant between the MI and BB group (STAI-S score MI group -7.0, BB group -9.0, P=0.085). Systolic BP was significantly lower in both MI (P=0.043) and BB (0.040) groups although there was no difference between the two groups (P=1.000). A significant reduction in heart rate was seen only in the BB group (BB vs control P=0.004, BB vs MI P=0.050, MI vs control P=0.303).ConclusionMusic, both with and without binaural beat, was proven to decrease anxiety level and lower systolic BP. Patients who received binaural beat audio showed additional decrease in heart rate. Binaural beat embedded musical intervention may have benefit over musical intervention alone in decreasing operative anxiety.

PURPOSE:The purpose of the study was to investigate changes in the anxiety levels of patients receiving preoperative Reiki.

MATERIAL AND METHODS:This study used a quasi-experimental model with a pretest-posttest control group.

METHODS:Subjects (n = 210) were recruited from a hospital in Turkey, from June 2013 to July 2014. Subjects were then assigned to experimental (n = 105) and control (n = 105) groups.

RESULTS:The level of anxiety of experimental group patients did not change according to their state anxiety scores (p>0.10); however, the anxiety level of control group patients increased (p<0.001).

CONCLUSION:The results of this study imply that the administration of Reiki is effective in controlling preoperative anxiety levels and in preventing them from increasing.

INTRODUCTION:Experimental studies have reported associations between short-term exposure to natural outdoor environments (NOE) and health benefits. However, they lack insight into mechanisms, often have low external and ecological validity, and have rarely focused on people with some psycho-physiological affection. The aim of this study was to use a randomized, case-crossover design to investigate: (i) the effects of unconstrained exposure to real natural and urban environments on psycho-physiological indicators of people with indications of psychological distress, (ii) the possible differential effects of 30 and 30+180 minutes exposures, and (iii) the possible mechanisms explaining these effects.

MATERIAL AND METHODS:People (n = 26) with indications of psychological distress were exposed to green (Collserola Natural Park), blue (Castelldefels beach) and urban (Eixample neighbourhood) environments in Catalonia. They were exposed to all environments in groups for a period of 30+180 minutes between October 2013 and January 2014. During the exposure period, participants were instructed to do what they would usually do in that environment. Before, during (at 30 and 30+180 minutes) and after each exposure, several psycho-physiological measures were taken: mood (measured as Total Mood Disturbance, TMD), attention capacity (measured as backwards digit-span task), stress levels (measures as salivary cortisol), systolic and diastolic blood pressure, heart rate, autonomous nervous system (assessed as heart rate variability and the indicators: low frequency power (LF), high frequency power (HF), ratio between LF and HF (LF:HF), and coefficients of component variance of LF, HF, and LF:HF). We also measured several potential mediators: air pollution, noise, physical activity, social interactions, and self-perceived restoration experience.

RESULTS:When compared with responses to urban environment, we found statistically significantly lower TMD [-4.78 (-7.77, -1.79) points difference], and salivary cortisol [-0.21 (-0.34, -0.08) log nmol/L] in the green exposure environment, and statistically significantly lower TMD [-4.53 (-7.57, -1.49) points difference], and statistically significant favourable changes in heart rate variability indicators (specifically LF:HF and CCV-LF:HF with around -0.20 points of difference of the indicators) in the blue exposure environment. Physical activity and self-perceived restoration experience partially mediated the associations between NOE and TMD. Physical activity and air pollution partially mediated the associations between NOE and heart rate variability.

DISCUSSION AND CONCLUSIONS:This study extends the existing evidence on the benefits of NOE for people's health. It also suggests NOE potential as a preventive medicine, specifically focusing on people with indications of psychological distress.

TRIAL REGISTRATION:Clinicaltrials.gov NCT02624921.

BACKGROUND:Previous studies have acknowledged Tai Chi and Qigong exercise could be potential effective treatments for reducing depression and anxiety in both healthy and clinical populations. However, there is a scarcity of systematic reviews summarizing the clinical evidence conducted among individuals with substance use disorders. This study tries to fill up this gap.

METHODS:A systematic search using Medline, EMbase, PsychINFO, Eric, SPORTDiscus, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese National Knowledge Infrastructure (CNKI), Wanfang, and the Chinese Scientific Journal (VIP) databases was initiated to identify randomized controlled trials (RCTs) and non-randomized comparison studies (NRS) assessing the effect of Tai Chi and Qigong versus various comparison groups on depression and anxiety related outcomes. Study quality was evaluated using a Checklist to Evaluate a Report of a Nonpharmacological Trial (CLEAR-NPT) designed for nonpharmacological trial.

RESULTS:One RCT and six NRS with a total of 772 participants were identified. Some of them were meta-analyzed to examine the pooled effects based on different types of intervention and controls. The results of meta-analyses suggested the effect of Tai Chi was comparable to treatment as usual (TAU) on depression (standardized mean difference (SMD) = - 0.17[- 0.52, 0.17]). Qigong exercise appears to result in improvement on anxiety compared to that of medication (SMD = -1.12[- 1.47, - 0.78]), and no treatment control (SMD = -0.52[- 0.77, - 0.27]).

CONCLUSION:The findings suggest potentially beneficial effect of Qigong exercise on symptoms of anxiety among individuals with drug abuse. Considering the small number and overall methodological weakness of included studies and lack of RCTs, results should be interpreted with caution and future rigorously designed RCTs are warranted to provide more reliable evidence.

Background:In recent decades, several medical and scientific studies on yoga proved it to be very useful in the treatment of some diseases. This study was conducted to investigate the effects of yoga on stress, anxiety, and depression in women living in Ilam, Iran.

Methods:This study is a quasi-experimental study with pre-post test. To collect data, the questionnaire of DASS-21 (Depression Anxiety Stress Scale-21) was used. For eligible samples, hatha yoga exercises and training sessions were held for 4 weeks (3 time/weeks; 60-70 min each) by a specialist. Data were analyzed using SPSS version 20.

Results:52 women with a mean age of 33.5± 6.5 were included for analysis. Depression, anxiety, and stress decreased significantly in women after 12 sessions of regular hatha yoga practice (<0.001).

Conclusions:Yoga has an effective role in reducing stress, anxiety, and depression. Thus, it can be used as complementary medicine.

CONTEXT:The World Health Organization (WHO) places major depressive disorder (MDD), or depression, as the fourth leading cause of disability worldwide. Some studies have found that cognitive behavioral therapy (CBT) represents the most superior approach in treating mild to severe symptoms. Recent literature has indicated a number of limitations to this therapeutic approach. An approach that has received increasing attention within the literature is the emotional freedom technique (EFT).

OBJECTIVE:The current pilot study aimed to evaluate the effectiveness of CBT and EFT in the treatment of depression and comorbid anxiety.

DESIGN:The research team designed a pilot study structured as a randomized, controlled trial with 2 intervention arms.

SETTING:The study took place at Bond University in Gold Coast, Queensland, Australia.

PARTICIPANTS:Participants (n = 10) were local community members who had screened positive for a primary diagnosis of MDD.

INTERVENTION:Participants were randomly assigned to an 8-wk CBT or EFT treatment program, the intervention groups. A sample of individuals from the community was assessed for comparative purposes (control group) (n = 57).

OUTCOME MEASURES:Pre- and postintervention, all participants were interviewed using the Mini-International Neuropsychiatric Interview (MINI) 6.0, and they completed the following validated questionnaires: (1) the Beck Depression Inventory, second edition (BDI-2) and (2) the Depression, Anxiety, and Stress Scales (DASS-21).

RESULTS:Findings revealed that both treatment approaches produced significant reductions in depressive symptoms, with the CBT group reporting a significant reduction postintervention, which was not maintained with time. The EFT group reported a delayed effect involving a significant reduction in symptoms at the 3- and 6-mo follow-ups only. Examination of the individual cases revealed clinically significant improvements in anxiety across both interventions.

CONCLUSIONS:Overall, the findings provide evidence to suggest that EFT might be an effective treatment strategy worthy of further investigation.

AIM:The aim of this study was to evaluate the effects of massage and music on pain intensity, anxiety intensity and relaxation level in burn patients.

INTRODUCTION:Pain and anxiety are common among burn patients, but there are many physical and psychological consequences.

METHODS:This randomized controlled clinical trial with factorial design 2×2 included 240 burn patients admitted at Shahid Motahari Burns Hospital, Tehran, Iran, between September 2013 and May 2015. The patients were allocated into the following groups: (i) control (n=60) receiving the conventional primary care, (ii) music group (n=60) receiving their favorite songs, (iii) massage group (n=60) receiving Swedish massage, and (iv) music-plus-massage group (n=60) receiving a combination of their favorite songs and Swedish massage, for 20min once a day for 3 consecutive days, using random permuted blocks of sizes 4 with a 1:1 ratio. To collect the data before and afterthe intervention, a specific Visual Analogue Scale (VAS) was applied for pain intensity, anxiety intensity, and relaxation level. The data were analyzed using SPSS, version 21.

RESULTS:Our findings showed a decrease in pain and anxiety intensity and an increase in relaxation level in all three intervention groups as compared to the control group, indicating there was no significant difference among the interventions applied. Furthermore, following application of each intervention, pain and anxiety intensity decreased and relaxation level increased in the intervention groups as compared to before intervention.

CONCLUSION:Our results revealed that music, massage and a combination of both interventions were effective on reducing pain and anxiety intensity and increasing relaxation level. Due to easy, low-cost and availability of the interventions applied, these complementary therapies are suggested for the burn patients. Although application of a single complementary therapy is cost-effective, further studies are required to determine the most effective and cost-effective method to improve the burn care.

AIM:The aim of this study was to evaluate the effects of massage and music on pain intensity, anxiety intensity and relaxation level in burn patients.

INTRODUCTION:Pain and anxiety are common among burn patients, but there are many physical and psychological consequences.

METHODS:This randomized controlled clinical trial with factorial design 2×2 included 240 burn patients admitted at Shahid Motahari Burns Hospital, Tehran, Iran, between September 2013 and May 2015. The patients were allocated into the following groups: (i) control (n=60) receiving the conventional primary care, (ii) music group (n=60) receiving their favorite songs, (iii) massage group (n=60) receiving Swedish massage, and (iv) music-plus-massage group (n=60) receiving a combination of their favorite songs and Swedish massage, for 20min once a day for 3 consecutive days, using random permuted blocks of sizes 4 with a 1:1 ratio. To collect the data before and afterthe intervention, a specific Visual Analogue Scale (VAS) was applied for pain intensity, anxiety intensity, and relaxation level. The data were analyzed using SPSS, version 21.

RESULTS:Our findings showed a decrease in pain and anxiety intensity and an increase in relaxation level in all three intervention groups as compared to the control group, indicating there was no significant difference among the interventions applied. Furthermore, following application of each intervention, pain and anxiety intensity decreased and relaxation level increased in the intervention groups as compared to before intervention.

CONCLUSION:Our results revealed that music, massage and a combination of both interventions were effective on reducing pain and anxiety intensity and increasing relaxation level. Due to easy, low-cost and availability of the interventions applied, these complementary therapies are suggested for the burn patients. Although application of a single complementary therapy is cost-effective, further studies are required to determine the most effective and cost-effective method to improve the burn care.

AIMS AND OBJECTIVES:To (1) perform a meta-analysis of randomised controlled trials pertaining to the efficacy of music therapy on disruptive behaviours, anxiety levels, depressive moods and cognitive functioning in people with dementia; and (2) clarify which interventions, therapists and participant characteristics exerted higher and more prominent effects.

BACKGROUND:Present study was the first to perform a meta-analysis that included all the randomised controlled trials found in literature relating to music therapy for people with dementia over the past 15 years.

DESIGN:A meta-analysis study design.

METHODS:Quantitative studies were retrieved from PubMed, Medline, Cochrane Library Database, CINAHL, SCOPUS and PsycINFO. A meta-analysis was used to calculate the overall effect sizes of music therapy on outcome indicators.

RESULTS:Music therapy significantly improved disruptive behaviours [Hedges' g = -0·66; 95% confidence interval (CI) = -0·44 to -0·88] and anxiety levels (Hedges' g = -0·51; 95% CI = -0·02 to -1·00) in people with dementia. Music therapy might affect depressive moods (Hedges' g = -0·39; 95% CI = 0·01 to -0·78), and cognitive functioning (Hedges' g = 0·19; 95% CI = 0·45 to -0·08).

CONCLUSION:Music therapy exerted a moderately large effect on disruptive behaviours of people with dementia, a moderate effect on anxiety levels and depressive moods, and a small effect on cognitive functioning.

RELEVANCE TO CLINICAL PRACTICE:Individual music therapy provided once a week to patients with cognitive functioning and manual guided in music intervention construction is suggested. Group music therapy is provided several times a week to reduce their disruptive behaviours, anxiety levels and depressive moods. Music therapy is a cost-effective, enjoyable, noninvasive therapy and could be useful for clinical nurses in creating an environment that is conducive to the well-being of patients with dementia.

The Emotional Freedom Technique (EFT) is defined and described as a clinical procedure for the relief of psychological and physical distress that patients often bring to the attention of nurses. Frequently referred to as"tapping,"this technique combines the cognitive reprocessing benefits of exposure and acceptance therapy with the energetic disturbance releases associated with acupuncture and other energy therapies. More than 60 research articles in peer-reviewed journals report a staggering 98% efficacy rate with the use of this procedure from psychological distress (posttraumatic stress disorder, phobias, anxiety, depression, etc.) to physical conditions (asthma, fibromyalgia, pain, seizure disorders, etc.) to performance issues (athletic, academic). Perhaps because of this, this technique has encountered a fair degree of skepticism within the health care community. Easily taught as a self-help aid that patients can administer to themselves, EFT becomes an efficacious tool in the hands of nurses who are seeking whole person approaches for the healing of a wide variety of psychological and physical conditions. A conceptual framework, mechanisms of action, evidence of safety, literature review, and case studies are also included.

Application of auditory beat stimulation has been speculated to provide a promising new tool with which to alleviate symptoms of anxiety and to enhance cognition. In spite of reportedly similar EEG effects of binaural and monaural beats, data on behavioral effects of monaural beats are still lacking. Therefore, we examined the impact of monaural beat stimulation on anxiety, mood and memory performance. We aimed to target states related to anxiety levels and general well-being, in addition to long-term and working memory processes, using monaural beats within the range of main cortical rhythms. Theta (6 Hz), alpha (10 Hz) and gamma (40 Hz) beat frequencies, as well as a control stimulus were applied to healthy participants for 5 min. After each stimulation period, participants were asked to evaluate their current mood state and to perform cognitive tasks examining long-term and working memory processes, in addition to a vigilance task. Monaural beat stimulation was found to reduce state anxiety. When evaluating responses for the individual beat frequencies, positive effects on state anxiety were observed for all monaural beat conditions compared to control stimulation. Our results indicate a role for monaural beat stimulation in modulating state anxiety and are in line with previous studies reporting anxiety-reducing effects of auditory beat stimulation.

INTRODUCTION:Rajyoga meditation is a form of mind body intervention that is promoted by the Brahma Kumaris World Spiritual University. This form of meditation can be easily performed without rituals or mantras and can be practiced anywhere at any time. The practice of Rajyoga meditation can have beneficial effects on modulating anxiety and cortisol level in patients undergoing major cardiac surgery.

MATERIALS AND METHODS:A prospective randomized control study was carried out in a single tertiary care center. One hundred and fifty patients undergoing elective coronary artery bypass surgery were enrolled in the study. The patients were randomized in two groups namely, Group 1 (Rajyoga group) and Group 2 (Control Group). Anxiety was measured on a visual analog scale 1-10 before the start of Rajyoga training or patient counseling (T1), on the morning of the day of surgery (T2), on the 2nd postoperative day (T3), and on the 5th postoperative day (T4). The serum cortisol level was measured in the morning of the day of surgery (T1), on the 2nd postoperative day (T2) and on the 5th postoperative day (T3), respectively.

RESULTS:In the study, it was seen that the anxiety level of the patients before the surgery (T1) and on the day of surgery (T2) were comparable between the two groups. However on the 2nd postoperative day (T3), the patients who underwent Rajyoga training had lower anxiety level in comparison to the control group (3.12± 1.45 vs. 6.12 ± 0.14, P<0.05) and on the 5th postoperative day (T4) it was seen that Rajyoga practice had resulted in significant decline in anxiety level (0.69± 1.1 vs. 5.6 ± 1.38, P<0.05). The serum cortisol level was also favorably modulated by the practice of Rajyoga meditation.

CONCLUSION:Mindbody intervention is found to effective in reducing the anxiety of the patients and modulating the cortisol level in patients undergoing wellknown stressful surgery like coronary artery bypass surgery.

BACKGROUND:Some of the most debilitating symptoms of fibromyalgia (FM) include widespread chronic pain, sleep disturbances, chronic fatigue, anxiety, and depression. Yet, there is a lack of effective self-management exercise interventions capable of alleviating FM symptoms. The objective of this study is to examine the efficacy of a 10-week daily Qigong, a mind-body intervention program, on FM symptoms.

METHODS:20 participants with FM were randomly assigned to Qigong (experimental) or sham-Qigong (control) groups, with participants blinded to the intervention allocation. The Qigong group practiced mild body movements synchronized with deep diaphragmatic breathing and meditation. The sham-Qigong group practiced only mild body movements. Both groups practiced the interventions two times per day at home, plus one weekly group practice session with a Qigong instructor. Primary outcomes were: pain changes measured by the Short-Form McGill Pain Questionnaire, a visual analog scale for pain, pressure pain threshold measured by a dolorimeter. Secondary outcomes were: the Revised Fibromyalgia Impact Questionnaire the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale and the Quality of Life Scale.

RESULTS:The experimental group experienced greater clinical improvements when compared to the control group on the mean score differences of pain, sleep quality, chronic fatigue, anxiety, depression, and fibromyalgia impact, all being statistically significant at < 0.05.

CONCLUSION:Daily practice of Qigong appears to have a positive impact on the main fibromyalgia symptoms that is beyond group interaction.

TRIAL REGISTRATION:ClinicalTrials.gov NCT03441997.

BACKGROUND:Diabetic neuropathy (DN) is a common and serious complication of diabetes. DN patients are suffering from anxiety, depression, and impairment of functional capacity. Rare studies have assessed the effect of proprioceptive exercise training on anxiety, depression, and functional capacity in DN patients.

AIMS:This 2-month prospective study aims to investigate the effect of proprioceptive exercise training on anxiety, depression, and functional capacity in DN patients.

METHODS:Twenty-eight DN patients with a mean age of 53.2 ± 5.5 years were included in this prospective study between September and December 2019. They were randomly assigned into two groups, 14 in each group using a random number generator. The proprioceptive exercise group (PEG) received a program of proprioceptive exercise, while the control group (CG) received a conventional treatment without exercise intervention. Berg Balance Scale (BBS), Six-Minute Walk Test (6MWT), Beck Anxiety Inventory (BAI), and Hamilton Depression Rating Scale (HDRS) were investigated before and after 2 months of the study period.

RESULTS:The findings showed a significant improvement of the BBS, 6MWT, BAI, and HDRS in the PEG (p = 0.003, p < 0.001, p = 0.001, and p = 0.001, respectively) while non-significant changes in the CG (p > 0.05). Comparison between the two groups showed significant differences between the two groups in the all outcome measures in favor of the PEG at the end of the 2 months (BBS, p = 0.032; 6MWT, p = 0.001; BAI, p = 0.031; and HDRS, p = 0.013).

CONCLUSIONS:Two months of proprioceptive exercise may improve functional capacity, anxiety, and depression in DN patients. Serious recommendations should be devoted to encouraging the proprioceptive exercise training among different population, especially DN patients.Key Points• Proprioceptive exercise may improve postural stability in patients with diabetic neuropathy.• Proprioceptive exercise may improve psychological status and functional capacity in patients with diabetic neuropathy.• Serious recommendations should be devoted to encouraging the proprioceptive exercise training among diabetic patients.

CONTEXT:Compared with the general population, trauma experiences are higher among incarcerated women.

OBJECTIVE:To evaluate the effects of Transcendental Meditation (TM) on trauma symptoms in female offenders.

DESIGN:Twenty-two inmates at the Coffee Creek Correctional Facility in Wilsonville, OR, with at least 4 months left of incarceration were enrolled in this randomized controlled pilot study. Subjects were randomly assigned to either the TM group (n = 11) or a wait-list control group (n = 11).

MAIN OUTCOME MEASURES:Subjects were measured at baseline and 4-month posttest using the Posttraumatic Stress Disorder Checklist-Civilian version (PCL-C; primary outcome) with intrusive thoughts, avoidance, and hyperarousal subscales (secondary outcomes). Twenty of the subjects (10 in each group) took part in their treatment assignment and completed posttesting.

RESULTS:Significant reductions were found on total trauma (p<0.036), intrusive thoughts (p<0.026), and hyperarousal (p<0.043) on the PCL-C. Effect sizes ranged from 0.65 to 0.99 for all variables. Eighty-one percent of the TM subjects were compliant with their program.

CONCLUSION:The results of this study indicate feasibility of the TM program in a female prison population and suggest that TM may be an effective tool for decreasing trauma symptoms. Future large-scale research is warranted.

AIMS AND OBJECTIVES:To examine the effects of the two-month breathing-based walking intervention and its follow-up on anxiety, depression, dyspnoea and quality of life in patients with chronic obstructive pulmonary disease.

BACKGROUND:Mind-body-related exercises improve bio-psychological symptoms and quality of life in chronic diseases, but these improvements are not proven for chronic obstructive pulmonary disease.

DESIGN:This was a randomised controlled study and applied the Consolidated Standards of Reporting Trials (CONSORT) statement.

METHODS:Outpatients diagnosed with chronic obstructive pulmonary disease were recruited from a medical centre in Taiwan and randomly assigned to two groups. The walking group (n = 42) received breathing, meditation and walking for two months, and the control group (n = 42) did not. Data from the outcomes of anxiety, depression, dyspnoea and quality of life were collected at baseline and in Month 1, Month 2 and Month 3. Clinical trial registration was done (ClinicalTrials.gov.: NCT03388489).

FINDINGS:The results showed significant changes in anxiety, depression, dyspnoea and quality of life in the walking group across three months, compared to those in the control group and at baseline.

CONCLUSION:This breathing-based walking intervention is promising to achieve bio-psychological well-being for patients with chronic obstructive pulmonary disease.

RELEVANCE TO CLINICAL PRACTICE:This breathing-based walking, as a mind-body exercise, could serve as an evidence-based nursing care that contributes to improving anxiety, depression, dyspnoea and quality of life in stable chronic obstructive pulmonary disease outpatients. The feasibility and acceptability of the breathing-based walking were met the requirement of the chronic obstructive pulmonary disease outpatients, which could be considered as home-based exercise.

CONTEXT:Recent studies and anecdotal reports suggest that binaural auditory beats can affect mood, performance on vigilance tasks, and anxiety.

OBJECTIVE:To determine whether mildly anxious people would report decreased anxiety after listening daily for 1 month to tapes imbedded with tones that create binaural beats, and whether they would show a definite tape preference among 3 tapes.

DESIGN:A 1-group pre-posttest pilot study.

SETTING:Patients' homes.

PARTICIPANTS:A volunteer sample of 15 mildly anxious patients seen in the Clinique Psyché, Montreal, Quebec.

INTERVENTION:Participants were asked to listen at least 5 times weekly for 4 weeks to 1 or more of 3 music tapes containing tones that produce binaural beats in the electroencephalogram delta/theta frequency range. Participants also were asked to record tape usage, tape preference, and anxiety ratings in a journal before and after listening to the tape or tapes.

MAIN OUTCOME MEASURES:Anxiety ratings before and after tape listening, pre- and post-study State-Trait Anxiety Inventory scores, and tape preferences documented in daily journals.

RESULTS:Listening to the binaural beat tapes resulted in a significant reduction in the anxiety score reported daily in patients' diaries. The number of times participants listened to the tapes in 4 weeks ranged from 10 to 17 (an average of 1.4 to 2.4 times per week) for approximately 30 minutes per session. End-of-study tape preferences indicated that slightly more participants preferred tape B, with its pronounced and extended patterns of binaural beats, over tapes A and C. Changes in pre- and posttest listening State-Trait Anxiety Inventory scores trended toward a reduction of anxiety, but these differences were not statistically significant.

CONCLUSIONS:Listening to binaural beat tapes in the delta/theta electroencephalogram range may be beneficial in reducing mild anxiety. Future studies should account for music preference among participants and include age as a factor in outcomes, incentives to foster tape listening, and a physiologic measure of anxiety reduction. A controlled trial that includes binaural beat tapes as an adjunctive treatment to conventional therapy for mild anxiety may be warranted.

OBJECTIVE:Cannabidiol (CBD) has a proposed novel role in the management of anxiety owing to its actions on the endocannabinoid system. The purpose of this systematic review was to evaluate the current evidence on the safety and efficacy of CBD in anxiety and anxiety-related disorders.

DATA SOURCES:A literature search was conducted on PubMed, Google Scholar, and International Pharmaceutical Abstracts from database inception through June 2019. A bibliographic search of relevant articles was also conducted.

STUDY SELECTION:Articles published from case reports, case series, or randomized controlled trials on human subjects were included in the review if they examined the safety and efficacy of CBD therapy in anxiety and anxiety-related disorders.

DATA EXTRACTION:Two reviewers independently extracted the following data from the articles: year of publication; study design; patient characteristics (sex; type of anxiety disorder; use of concomitant anxiolytic therapy); dosing strategy and route of CBD administration; and safety and efficacy outcomes.

RESULTS:Eight articles were included in the review: 6 small, randomized controlled trials; 1 case series; and 1 case report. These studies examined the role of CBD in the anxiety response of healthy volunteers; in generalized anxiety disorder; in social anxiety disorder; and in the anxiety component of posttraumatic stress syndrome. No articles that evaluated CBD in panic disorder, specific phobia, separation anxiety, and obsessive-compulsive disorder were identified. In the studies, CBD was administered orally as a capsule or as a sublingual spray and as either monotherapy or adjunctive therapy. Doses varied widely, with studies employing fixed CBD doses ranging from 6 mg to 400 mg per dose. Various anxiety assessment scales were used in the studies to assess efficacy, with CBD demonstrating improved clinical outcomes among the instruments. In general, CBD was well-tolerated and associated with minimal adverse effects, with the most commonly noted adverse effects being fatigue and sedation.

CONCLUSION:CBD has a promising role as alternative therapy in the management of anxiety disorders. However, more studies with standardized approaches to dosing and clinical outcome measurements are needed to determine the appropriate dosing strategy for CBD and its place in therapy.