-
1.
Comparing Mindful and Non-Mindful Exercises on Alleviating Anxiety Symptoms: A Systematic Review and Meta-Analysis.
So, WWY, Lu, EY, Cheung, WM, Tsang, HWH
International journal of environmental research and public health. 2020;17(22)
-
-
-
Free full text
Plain language summary
Physical exercise is well known to be beneficial for physical and mental health, and has been proposed as effective treatment for anxiety symptoms. Recent studies have suggested mindful exercises, such as yoga, tai chi, and qigong, may further alleviate anxiety symptoms, compared with traditional exercise. The aim of this review is to compare the effects of mindful and non-mindful exercise on anxiety. A total of 14 studies were included in this analysis. Overall these studies found a significant decrease in anxiety in both mindful and non-mindful exercise. Eight studies found significantly lower anxiety levels in the mindful exercise group compared with the non-mindful exercise group. Based on these results, the authors conclude in general, exercise helps reduce anxiety and mindful exercise seems to be more effective in alleviating symptoms compared with non-mindful exercise. The authors recommend further studies explore the underlying mechanisms of mindful exercise and encourage yoga to be a primary intervention to help reduce overall anxiety.
Abstract
BACKGROUND In recent years, studies and reviews have reported the therapeutic benefits of both mindful and non-mindful exercises in reducing anxiety. However, there have not been any systematic reviews to compare their relative effectiveness for therapeutic application, especially among the non-clinical population. Thus, the aim of this review is to compare the effectiveness between mindful and non-mindful exercise on treating anxiety among non-clinical samples. METHODS Potential articles were retrieved from PubMed, Embase, Academic Search Premier, and PsycInfo. Randomized controlled trials, which involved both mindful and non-mindful exercises as intervention, and the use of anxiety outcome measures were included. RESULTS Twenty-four studies fulfilled the inclusion criteria and were included in our systematic review. In addition, 14 studies provided sufficient data to be included in the meta-analysis. For studies that reported significant group differences at post-assessment, results showed that mindful exercise was more beneficial in reducing anxiety than non-mindful exercise. The meta-analysis reported that yoga was more effective in reducing anxiety than non-mindful exercise. CONCLUSIONS Compared to non-mindful exercise, yoga is shown to be more effective in alleviating anxiety symptoms. It is recommended that yoga could be used as a primary healthcare intervention to help the public reduce anxiety.
-
2.
Use of Meditation and Cognitive Behavioral Therapies for the Treatment of Stress, Depression and Anxiety in Students. A Systematic Review and Meta-Analysis.
González-Valero, G, Zurita-Ortega, F, Ubago-Jiménez, JL, Puertas-Molero, P
International journal of environmental research and public health. 2019;16(22)
-
-
-
Free full text
Plain language summary
Research in the field of the mind is increasing, with students becoming key objects of study in the field of social sciences and health. The main aim of this study was to review the scientific literature in order to analyze the effect produced by cognitive-behavioural programs and meditation strategies on stress, anxiety, and depression in students. A secondary aim was to identify the determinants of treatment success. This study is a systemic review and meta-analysis of 34 articles which included 3296 participating students. A total of 22 effect sizes were calculated for stress treatment, 28 for anxiety and 28 for depression. Results show that interventions based on cognitive-behavioural programs, self-reflection, and mindfulness-based approaches produce satisfactory and significant results in relation to the reduction of stress, anxiety, and depression in students. Furthermore, taking into consideration the theoretical foundations of the studies analysed, meditation (mindfulness, yoga and tai chi), muscle relaxation and breathing, coaching, and cognitive-behavioural therapy are strategies that have shown effectiveness in improving mental health. Authors conclude that it is essential to focus attention on how to improve the mental health of students, including an increase in the number of interventions in the classroom.
Abstract
The prevalence of mental health problems within students due to high academic demands and learning difficulties is a current challenge the field of education. The aim of this study is to review the scientific literature in order to analyze the effect produced by cognitive-behavioral programs and meditation strategies on stress, anxiety, and depression in students. A further aim is to identify the determinants of treatment success. The bibliographic search was carried out using Web of Science, specifically in the categories of "Education and Educational Research" and "Psychology", obtaining a sample of 122 articles published between 2007 and 2018. Studies were included which had a pre-experimental or quasi-experimental design and included pre-test and post-test phases. Following application of inclusion criteria, 34 articles were selected for inclusion in a meta-analysis of the random effects of each variable. This obtained an average effect size of -0.41 for stress, -0.37 for anxiety, and -0.30 for depression. Three moderating variables were analyzed, with significant correlations being found for the type of treatment relating to stress (Q = 11.01, df = 2, p = 0.004, R2 = 0.294) and depression (Q = 6.14, df = 2, p = 0.048; R2 = 0.436). The stage of education of the individuals was also found to impact upon anxiety intervention success (Q = 13.093 df = 2, p = 0.0009, R2 = 0.196). Interventions mainly addressed the importance of meditation strategies, mindfulness programs, and cognitive-behavioral therapy to reduce stress, anxiety, and depression in students. This supports the need to increase research at an early age, considering the treatment of mental health as a key factor influencing academic performance and quality of life.
-
3.
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
-
-
-
Free full text
-
Plain language summary
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.
-
4.
Impact of implementation intentions on physical activity practice in adults: A systematic review and meta-analysis of randomized clinical trials.
Silva, MAVD, São-João, TM, Brizon, VC, Franco, DH, Mialhe, FL
PloS one. 2018;13(11):e0206294
-
-
-
Free full text
Plain language summary
Many behavioural interventions have been implemented in order to increase physical activity levels among adults. Despite these efforts, there is often a large gap between setting goals and attaining goals. The aim of this systematic review and meta-analysis was to evaluate the effectiveness of using theory-based strategies on goal attainment in promoting physical activity among adults (specifically implementation intentions or if-then planning). Particular interest was given to the impact of reinforcements during the intervention and follow-up period for coping with obstacles. A total of 13 randomised controlled trials were included. Implementation intentions consisted of two strategies. Firstly, action planning which was designed to increase awareness of possible future situations where behaviours could be achieved. Secondly, coping planning which focused on barriers that might impede the goal behaviour, and ways to overcome these possible barriers. According to the current literature, application of the theory-based goal setting promoted physical activity behaviours, and this was heightened among those who received reinforcement of plans to increase physical activity during the follow-up period.
Abstract
OBJECTIVE The aim of this study was to verify the efficacy of using theory-based strategies on implementation intentions in promoting physical activity (PA) among adults. METHODS This review was conducted in accordance with the PRISMA recommendations. The search was carried out in seven electronic databases (LILACS, PubMed, SciELO, Cochrane, Web of Science) and two searches of the "grey literature" were performed (Openthesis and OpenGrey). Randomized clinical trials (RCT), published up to September 2016, were considered eligible for this study. Two reviewers independently and systematically evaluated the eligibility criteria, and performed data extraction. A meta-analysis was performed for the purpose of comparing the effect between the intervention and control groups. The effect sizes were grouped in two subgroups with the purpose of more accurately verifying the effect caused by reinforcing the implementation intentions strategy, and using the inverse variance statistical method with random effects models to estimate the main effect of the implementation intention strategy on the PA behavior. Heterogeneity among the studies was evaluated by using I-square statistics, and the Jadad scale to evaluate the quality of included papers. RESULTS The search resulted in 12,147 records, of which 13 RCTs were considered eligible for this review. Sample age ranged from 18 to 76 years, and participants had conditions such as medullary lesion, coronary disease, obesity, diabetes mellitus, sedentarism or occupational stress. When the summary of the effect was analyzed in the meta-analysis, the result found in the subgroup with reinforcement of the implementation intentions strategy was 0.25 (IC 95% = 0.05-0.45) in favor of the intervention group. This demonstrated that application of the implementation intentions strategy was capable of increasing PA practice in the participants of these studies, in comparison with others that did not use this reinforcement. CONCLUSION The findings of this review indicated that application of the theory of implementation intentions promoted PA behavior among the adults who received reinforcement of this strategy. The systematic review protocol was registered in the PROSPERO database under the number CRD42018090482.
-
5.
Cognitive Behaviour Therapy for Health Anxiety: A Systematic Review and Meta-Analysis.
Cooper, K, Gregory, JD, Walker, I, Lambe, S, Salkovskis, PM
Behavioural and cognitive psychotherapy. 2017;45(2):110-123
-
-
-
Free full text
-
Plain language summary
Hypochondriasis is characterised by preoccupation with the belief that one has, or could acquire, a serious illness, emanating from “anxiety about the meaning, significance or cause” of their symptoms. The main aim of this study was to investigate the efficacy of cognitive behaviour therapy (CBT) for clinical and subclinical health anxiety (HA) relative to control conditions, focusing on measures of HA, depression and anxiety pre and post intervention, and assessing the quality of the randomized control trials. This study is a systemic review and meta-analysis which included 14 studies in the final analysis with a total of 1544 participants. Results provide evidence supporting CBT treatment of HA, in people with and without medical problems, and in people with subclinical as well as clinical levels of HA. Authors conclude that further investigation is required in order to delineate the active treatment elements.
Abstract
BACKGROUND Health anxiety (HA), or hypochondriasis, is a psychological problem characterized by a preoccupation with the belief that one is physically unwell. A 2007 Cochrane review (Thomson and Page, 2007) found cognitive behavioural therapy (CBT) to be an effective intervention for individuals with HA. Similar findings were reported in a recent meta-analysis (Olatunji et al., 2014), which did not employ a systematic search strategy. The current review aimed to investigate the efficacy of CBT for HA, and to update the existing reviews. METHOD A systematic search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance, including randomized controlled trials that compared CBT with a control condition for people with HA. Five hundred and sixty-seven studies were found in the original search, of which 14 were included in the meta-analysis. RESULTS Meta-analysis was conducted on 21 comparisons and a large effect size for CBT compared with a control condition was found at post therapy d = 1.01 (95% confidence interval 0.77-1.25), as well as at 6- and 12-month follow-up. CONCLUSIONS This systematic review and meta-analysis provides support for the hypothesis that CBT is an effective intervention for HA when compared with a variety of control conditions, e.g. treatment-as-usual, waiting list, medication, and other psychological therapies.
-
6.
Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components.
Probyn, K, Bowers, H, Mistry, D, Caldwell, F, Underwood, M, Patel, S, Sandhu, HK, Matharu, M, Pincus, T
BMJ open. 2017;7(8):e016670
-
-
-
Free full text
Plain language summary
Non-pharmacological self-management interventions have been promoted as a promising approach for helping people with intractable chronic conditions. For migraine and tension type headaches self-management can be used either alongside pharmacological interventions or as a stand-alone therapy. The aims of this study were to provide an overall effect size of non-pharmacological self-management interventions against usual care, and to explore different components and delivery methods within those interventions. This study is a systematic review of 16 peer reviewed RCTs with one or more relevant self-management interventions compared with usual care. Findings indicate that non-pharmacological self-management appears to be slightly more effective in improving pain intensity, headache-related disability, quality of life and medication consumption. Furthermore, it is moderately more effective than usual care in improving mood. Assessed self-management interventions did not improve measures on headache frequency. Authors conclude that their findings provide some preliminarily evidence to guide research-based decisions about intervention content and delivery details of self-management interventions that aim to improve patients’ capacity to manage their headaches.
Abstract
OBJECTIVES To assess the effect of non-pharmacological self-management interventions against usual care, and to explore different components and delivery methods within those interventions PARTICIPANTS People living with migraine and/or tension-type headache INTERVENTIONS Non-pharmacological educational or psychological self-management interventions; excluding biofeedback and physical therapy.We assessed the overall effectiveness against usual care on headache frequency, pain intensity, mood, headache-related disability, quality of life and medication consumption in meta-analysis.We also provide preliminary evidence on the effectiveness of intervention components and delivery methods. RESULTS We found a small overall effect for the superiority of self-management interventions over usual care, with a standardised mean difference (SMD) of -0.36 (-0.45 to -0.26) for pain intensity; -0.32 (-0.42 to -0.22) for headache-related disability, 0.32 (0.20 to 0.45) for quality of life and a moderate effect on mood (SMD=0.53 (-0.66 to -0.40)). We did not find an effect on headache frequency (SMD=-0.07 (-0.22 to 0.08)).Assessment of components and characteristics suggests a larger effect on pain intensity in interventions that included explicit educational components (-0.51 (-0.68 to -0.34) vs -0.28 (-0.40 to -0.16)); mindfulness components (-0.50 (-0.82 to -0.18) vs 0.34 (-0.44 to -0.24)) and in interventions delivered in groups vs one-to-one delivery (0.56 (-0.72 to -0.40) vs -0.39 (-0.52 to -0.27)) and larger effects on mood in interventions including a cognitive-behavioural therapy (CBT) component with an SMD of -0.72 (-0.93 to -0.51) compared with those without CBT -0.41 (-0.58 to -0.24). CONCLUSION Overall we found that self-management interventions for migraine and tension-type headache are more effective than usual care in reducing pain intensity, mood and headache-related disability, but have no effect on headache frequency. Preliminary findings also suggest that including CBT, mindfulness and educational components in interventions, and delivery in groups may increase effectiveness. TRIAL REGISTRATION NUMBER PROSPERO 2016:CRD42016041291.
-
7.
Does forming implementation intentions help people with mental health problems to achieve goals? A meta-analysis of experimental studies with clinical and analogue samples.
Toli, A, Webb, TL, Hardy, GE
The British journal of clinical psychology. 2016;55(1):69-90
-
-
-
Free full text
-
Plain language summary
There is often a gap between goal setting and goal attainment, and this is likely worsened by mental health problems. While forming implementation intentions (if-then planning) has been shown to be a useful technique for bridging this gap, the extent to which planning can help people with mental health problems has not yet been systematically examined. Implementation intentions (if-then planning) are designed to present good opportunities to act ('if') together with the cognitive or behavioural responses to these ('then'). For example, a person with anxiety may form an implementation intention that 'if' they begin to feel anxious or under-pressure, they will 'then' use deep breathing for 5 minutes to relax. The aim of this meta-analysis was to investigate the effect of implementation intentions (if-then planning) on goal attainment among people with clinically diagnosed mental health disorders. A total of 29 experimental studies were included in the analysis. Based on the current literature, this study found forming implementation intentions had a beneficial impact on goal attainment across a range of various mental health disorders. Based on these results, the authors conclude that forming implementation intentions can be an effective strategy to integrate into treatment approaches for patients with mental health diagnoses.
Abstract
OBJECTIVE People struggle to act on the goals that they set themselves, and this gap between intention and action is likely to be exacerbated by mental health problems. Evidence suggests that forming specific if-then plans (or 'implementation intentions') can promote goal attainment and a number of studies have applied such techniques in clinical contexts. However, to date, the extent to which planning can help people with mental health problems has not been systematically examined. METHOD The present review used meta-analysis to investigate the effect of if-then planning on goal attainment among people with a DSM-IV/ICD-10 diagnosis (i.e., clinical samples) or scores above a relevant cut-off on clinical measures (i.e., analogue samples). In total, 29 experimental studies, from 18 records, met the inclusion criteria. RESULTS Excluding one outlying (very large) effect, forming implementation intentions had a large-sized effect on goal attainment (d+ = 0.99, k = 28, N = 1,636). Implementation intentions proved effective across different mental health problems and goals, and in studies with different methodological approaches. CONCLUSIONS Taken together, the findings suggest that forming implementation intentions can be a useful strategy for helping people with mental health problems to achieve various goals and might be usefully integrated into existing treatment approaches. However, further studies are needed addressing a wider range of mental health problems.
-
8.
Hunger and binge eating: a meta-analysis of studies using ecological momentary assessment.
Haedt-Matt, AA, Keel, PK
The International journal of eating disorders. 2011;44(7):573-8
-
-
-
Free full text
-
Plain language summary
Binge eating is a key feature of both bulimia nervosa (BN) and binge-eating disorder (BED). Impaired appetite regulation (i.e. excessive hunger) has been implicated in binge eating. This study is a meta-analysis of ten studies (180 participants) that explored hunger as an antecedent for binge eating. It focused on studies using Ecological Momentary Assessment (EMA), where a participant reports symptoms, affect, behaviours and cognitions close to binge-eating and in their natural environment. It found that hunger was rated significantly lower before a binge compared to before a regular meal. This suggests that excessive hunger may not be an antecedent to binge eating and support the anecdotal reports that BED eaters binge when they are not physically hungry. The authors suggest that binge eating may be a result of cognitive factors (e.g. eating in response to dietary rules) and/or negative feelings rather than physical hunger. The authors also suggest that the effectiveness of establishing a regular eating pattern and using selective serotonin reuptake inhibitors (SSRI) medications may therefore be effective in BN and BED for another reason other than reducing hunger.
Abstract
OBJECTIVE Binge eating has been associated with increased hunger, suggesting a role for impaired appetite regulation. Ecological momentary assessment (EMA) is ideally suited to examine whether hunger is a precipitant of binge eating but results from such studies have not been systematically reviewed. This study provides a meta-analysis of EMA studies that have examined hunger as an antecedent of binge eating. METHOD Electronic database and manual searches produced seven EMA studies with N = 180 participants. Meta-analyses were conducted to compare: (1) pre-binge eating hunger to average ratings of hunger, and (2) pre-binge eating hunger to hunger before regular eating. RESULTS Across studies, hunger was significantly greater before binge eating compared with average hunger ratings, but was significantly lower before binge eating compared with before other eating episodes. DISCUSSION Excessive hunger does not appear to be a precipitant of binge eating because higher levels of hunger are observed before regular eating episodes. However, lower hunger before food consumption may contribute to the experience of a particular eating episode as a binge.
-
9.
Do implementation intentions help to eat a healthy diet? A systematic review and meta-analysis of the empirical evidence.
Adriaanse, MA, Vinkers, CD, De Ridder, DT, Hox, JJ, De Wit, JB
Appetite. 2011;56(1):183-93
-
-
-
Free full text
Plain language summary
Eating a healthy diet reduces the likelihood of becoming overweight or chronically ill. Many people are aware of the health benefits of eating a healthy diet, and are hence motivated to eat healthily. This study is a review and meta-analysis with the aim to evaluate the effectiveness of setting implementation intentions (the where, when and how planning in goal setting) in promoting healthy eating behaviour. Results indicate that implementation intentions can be effective in increasing healthy eating behaviours with 12 studies showing an overall medium size effect on increasing fruit and vegetable consumption. Authors conclude that implementation intentions to promote healthy eating have more promising effects that those aiming to diminish unhealthy eating patterns.
Abstract
OBJECTIVE This systematic review and meta-analysis examined whether implementation intentions are an effective tool to help people put their intentions to eat a healthy diet into practice. Additionally, it was investigated whether the quality of the outcome measures and the quality of the control conditions that are used in these studies influence implementation intentions' effectiveness. METHODS Twenty three empirical studies investigating the effect of implementation intentions on eating behavior were included. In assessing the empirical evidence, a distinction was made between studies that aim to increase healthy eating (i.e., eating more fruits) and studies that aim to diminish unhealthy eating (i.e., eating fewer unhealthy snacks). RESULTS Implementation intentions are an effective tool for promoting the inclusion of healthy food items in one's diet (Cohen's d=.51), but results for diminishing unhealthy eating patterns are less strong (Cohen's d=.29). For studies aiming to increase healthy eating, it was found that higher quality outcome measures and lower quality control conditions tended to yield stronger effects. CONCLUSION Implementation intentions are somewhat more effective in promoting healthy eating than in diminishing unhealthy eating, although for some studies promoting healthy eating effect sizes may have been inflated due to less than optimal control conditions.