Depression

Improve the Physical and Psychological Health of Patients with Cardiac Arrhythmias with Yoga

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Improve the Physical and Psychological Health of Patients with Cardiac Arrhythmias with Yoga

 

By John M. de Castro, Ph.D.

 

“Exercise that revs up your heart rate isn’t the only kind of physical activity that can help prevent or manage heart disease. The calming exercise of yoga is good for the heart, too.” – Johns Hopkins Medicine

 

Cardiovascular disease is the number one killer, claiming more lives than all forms of cancer combined. Lifestyle changes have proved to be quite effective in reducing the risk of cardiovascular disease. These include quitting smoking, weight reduction, improved diet, physical activity, and reducing stresses. Contemplative practices, such as meditation, tai chi, and yoga, have also been shown to be helpful for heart health. These practices have also been shown to be helpful for producing the kinds of other lifestyle changes needed such as smoking cessation, weight reduction and stress reduction. Yoga is a mindfulness practice that has been shown to improve physical well-being and cardiovascular health.

 

“An arrhythmia is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slowly, or with an irregular rhythm. When a heart beats too fast, the condition is called tachycardia. When a heart beats too slowly, the condition is called bradycardia.” (NIH). Arrythmias if untreated could lead to heart failure, stroke, cardiac arrest and sudden infant death. So, it is very important to identify treatments for arrhythmias. Research on the ability of yoga practice to treat arrhythmias has been accumulating, So, it makes sense to step back and review what has been learned on the ability of yoga to treat heart arrhythmia.

 

In today’s Research News article “A Review on Role of Yoga in the Management of Patients with Cardiac Arrhythmias.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023436/ )  Sharma and colleagues review and summarize the published research on the effects of yoga practice on heart arrhythmia and its symptoms. They found 6 published research studies.

 

They report that the published research studies found that yoga practice significantly reduced the number of both symptomatic and non-symptomatic atrial fibrillation events and ventricular repolarization dispersion indices. There were also significant decreases in resting heart rate and blood pressure. The patients’ psychological well-being was also improved by yoga practice with significant decreases in depression and anxiety and significant increases in quality of life,

 

The results of this review indicates that yoga practice is a safe and effective treatment for patients with cardiac arrhythmias, improving both the physical and psychological manifestations of arrhythmias (paroxysmal atrial fibrillation, ventricular tachyarrhythmia, and palpitation). Although long-term follow-up was not included, the observed improvements produced by yoga practice would predict that there would be a lessened occurrence of cardiovascular disease and an increase in longevity.

 

So, improve the physical and psychological health of patients with cardiac arrhythmias with yoga.

 

“In the patients with cardiac arrhythmias, pranayama yoga therapy has been shown to reduce the ventricular repolarization dispersion thereby lowering the risk of developing malignant ventricular arrhythmias and sudden cardiac death. In heart failure patients, yoga therapy resulted in reduction in heart rate and blood pressure due to improved HRV, increased vagal tone and decreased sympathetic tone.” – Krishna Akella

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Sharma, G., Mooventhan, A., Naik, G., & Nivethitha, L. (2021). A Review on Role of Yoga in the Management of Patients with Cardiac Arrhythmias. International journal of yoga, 14(1), 26–35. https://doi.org/10.4103/ijoy.IJOY_7_20

 

Abstract

Evidence suggests that yoga is safe and effective in improving various risk factors, quality of life (QoL), and psychological burden that is related to arrhythmia. However, this is the first-ever systematic review performed to report the role of yoga in arrhythmia. We have performed a literature search using Cochrane Library, Medline/PubMed, Web of Science Core Collection, and IndMED electronic databases up to 3, January 2018. Of 240 articles, 6 potentially eligible articles were identified and included in the review. Results showed that yoga could be considered an efficient adjuvant in reducing arrhythmia (paroxysmal atrial fibrillation, ventricular tachyarrhythmia, and palpitation) related health problems; blood pressure, heart rate, depression and anxiety scores; and in improving health-related QoL of arrhythmia patients. However, there is a lack of randomized controlled trials and a clear mechanism behind the effect of yoga; studies had relatively a small sample size and different yoga protocols.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023436/

 

Improve Anxiety and Depression with an Abbreviated Mindfulness-Based Cognitive Therapy

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Improve Anxiety and Depression with an Abbreviated Mindfulness-Based Cognitive Therapy

 

By John M. de Castro, Ph.D.

 

“People at risk for depression are dealing with a lot of negative thoughts, feelings and beliefs about themselves and this can easily slide into a depressive relapse. MBCT helps them to recognize that’s happening, engage with it in a different way and respond to it with equanimity and compassion.” – Willem Kuyken

 

Anxiety disorders are the most common mental illness, affecting 40 million adults in the U.S., or 18% of the population. Depression affects over 6% of the population. And anxiety and depression often co-occur. Anxiety and depression are generally treated with drugs. But there are considerable side effects and these drugs are often abused. There are a number of psychological therapies for anxiety and depression. But, about 45% of the patients treated do not respond to the therapy. So, there is a need to develop alternative treatments.

 

Recently, it has been found that mindfulness training can be effective for anxiety disorders. Mindfulness has also been shown to be effective for depression. Mindfulness-Based Cognitive Therapy (MBCT) was specifically developed to treat depression and has been shown to be very effective. MBCT, however, is an 8-week program delivered in relatively small groups. It is not clear if a briefer program to larger groups might also be effective.

 

In today’s Research News article “A Brief Mindfulness-Based Cognitive Therapy (MBCT) Intervention as a Population-Level Strategy for Anxiety and Depression.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057287/ )  Burgess and colleagues recruited adult patients with an anxiety or mood disorders and provided them with 5 weekly 2-hour group based session of Mindfulness-Based Cognitive Therapy (MBCT) with daily home practice. The group size was larger than the typical MBCT program (i.e., 16–20 participants rather than 12 participants) and meditation practice was reduced to 10-15 minutes compared to the traditional 40 minutes. They were measured before and after training for anxiety, depression, self-compassion, perceived stress, mental well-being, and disability.

 

They found that after Mindfulness-Based Cognitive Therapy (MBCT) there was significant reductions in anxiety, depression, worry, and acute distress, and significant increases in self-compassion and mental well-being. There were large clinically significant changes such that 50% of the patients had remissions of depression and 20% had remissions of anxiety.

 

It should be noted that there was no control condition in the present study. But previous controlled studies have routinely demonstrated that Mindfulness-Based Cognitive Therapy (MBCT) produces significant improvements in anxiety, depression, worry, distress, self-compassion, and mental well-being. So, the present results are unlikely to be due to confounding factors. The present study demonstrates that the significant benefits of MBCT can be produced with an abbreviated program delivered to a large group. This reduces the amount of time clinicians have to devote to the program, thereby reducing cost. It would also be likely that the abbreviated program would improve adherence to the program requirements and reduce drop-outs. This allows more patients at lower cost to have their suffering reduced.

 

So, improve anxiety and depression with an abbreviated Mindfulness-Based Cognitive Therapy.

 

“Mindfulness-Based Cognitive Therapy (MBCT) is designed to help people who suffer repeated bouts of depression and chronic unhappiness. It combines the ideas of cognitive therapy with meditative practices and attitudes based on the cultivation of mindfulness. The heart of this work lies in becoming acquainted with the modes of mind that often characterize mood disorders while simultaneously learning to develop a new relationship to them.” – MBCT.com

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Emilee E. Burgess, Steven Selchen, Benjamin D. Diplock, Neil A. Rector. A Brief Mindfulness-Based Cognitive Therapy (MBCT) Intervention as a Population-Level Strategy for Anxiety and Depression. Int J Cogn Ther. 2021 Apr 20 : 1–19. doi: 10.1007/s41811-021-00105-x

 

Abstract

Mindfulness-based interventions (MBIs) have emerged as clinically effective interventions for anxiety and depression although there are significant barriers to their access in the general population. The present study examined the effectiveness of a 5-week abbreviated mindfulness-based cognitive therapy (MBCT) intervention for a physician-referred, treatment-seeking, community sample (N = 54) with mood and/or anxiety symptom burden. Treatment effects demonstrated significant reductions in mood and anxiety symptom severity and significant increases in general well-being. Observed effect sizes were generally large, with high response and remission rates. The present study offers preliminary support that an abbreviated MBCT protocol can offer large treatment effects for decreasing mood and anxiety symptoms and could potentially offer an effective population-level strategy to improve cost-effectiveness and access to care.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057287/

 

Reduce Insomnia and Rumination in Pregnant Women with Mindfulness

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Reduce Insomnia and Rumination in Pregnant Women with Mindfulness

 

By John M. de Castro, Ph.D.

 

“practicing mindfulness during the day, ideally for 20 minutes, . . The idea is to create a reflex to more easily bring forth a sense of relaxation. That way, it’s easier to evoke the relaxation response at night when you can’t sleep.” – Herbert Benson

 

Pregnancy is a time of intense physiological and psychological change. Anxiety, depression, and insomnia are quite common during pregnancy. More than 20 percent of pregnant women have an anxiety disorder, depressive symptoms, or both during pregnancy. Sleep disturbance including insomnia is also common affecting around 75% of pregnant women. The psychological health of pregnant women has consequences for fetal development, birthing, and consequently, child outcomes. Depression during pregnancy is associated with premature delivery and low birth weight. Insomnia has been linked to an increased risk of giving birth to a baby that’s too large or too small for its age, longer labor, and higher likelihood of a cesarean section.

 

Hence, it is clear that there is a need for methods to treat depression, anxiety, and insomnia during pregnancy. Since the fetus can be negatively impacted by drugs, it would be preferable to find a treatment that did not require drugs. Mindfulness training has been shown to improve anxiety, depression, and sleep normally and to relieve maternal anxiety and depression during pregnancy. In addition, mindfulness is known to reduce worry and rumination which can also lead to restlessness and sleep disturbance. So, it would make sense to study the relationship of mindfulness during the pregnancy to depression, rumination, and insomnia.

 

In today’s Research News article “Mindfulness and nocturnal rumination are independently associated with symptoms of insomnia and depression during pregnancy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190270/ )  Kalmbach and colleagues recruited pregnant women in their third trimester and had them complete measures of mindfulness, rumination, insomnia, and depression. These data were subjected to multivariate linear regression analysis.

 

They found that women who were high in mindfulness had significantly lower levels of rumination, insomnia, and depression. Women who were high in rumination had significantly lower levels of mindfulness and higher levels of insomnia, and depression. Employing multivariate modelling they found that mindfulness and rumination separately and independently were related to insomnia and that mindfulness and rumination separately and independently were related to depression.

 

These results were correlational and as such causation cannot be determined. But previous research has demonstrated that mindfulness training reduces rumination, insomnia, and depression. So, the relationships observed here are likely due to causal relationships among the variables. It appears that mindfulness and rumination work in opposite directions. Mindfulness helps pregnant women sleep better and helps relieve depression while rumination does the opposite of interfering with sleep and increasing depression.

 

Interestingly, mindfulness and rumination affect sleep and depression independently but are negatively related such that mindfulness decreases rumination while rumination lowers mindfulness. Mindfulness is an asset to pregnant women while worry produces problems. This suggests that pregnant women should be trained in mindfulness and also trained to reduce worry. Both of these goals can be accomplished with Mindfulness-Based Cognitive Therapy (MBCT). Future research should investigate this possibility.

 

So, reduce insomnia and rumination in pregnant women with mindfulness.

 

“It seems important to develop mindfulness to improve sleep in pregnancy or reduce the impact of insomnia symptoms (common at pregnancy).” – M. Marques

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Kalmbach, D. A., Roth, T., Cheng, P., Ong, J. C., Rosenbaum, E., & Drake, C. L. (2020). Mindfulness and nocturnal rumination are independently associated with symptoms of insomnia and depression during pregnancy. Sleep health, 6(2), 185–191. https://doi.org/10.1016/j.sleh.2019.11.011

 

Abstract

Background:

Insomnia and depression are highly prevalent perinatal complications. Ruminating on stress is etiologically implicated in both disorders, and ruminating while trying to fall asleep has been linked to insomnia and depression during pregnancy. Incompatible with rumination is everyday mindfulness, i.e., living with intentional and nonjudgmental awareness of internal and external experiences in the present moment. Responding to stress mindfully may protect against stress-related perinatal complications such as insomnia and depression. The present study described the association between everyday mindfulness and nocturnal rumination, and examined whether these trait characteristics were independently related to perinatal insomnia and depression.

Methods:

Cross-sectional and secondary analysis of existing data from 65 pregnant women recruited from a multisite hospital in Metro Detroit, MI, USA. Subjects completed online surveys including the Insomnia Severity Index, Edinburgh Postnatal Depression Scale, Presleep Arousal Scale, and the revised Cognitive and Affective Mindfulness Scale.

Results:

Over half (53.8%) of women screened positive for clinical insomnia and 12.3% screened positive for major depression. Women high in mindfulness, relative to those low in mindfulness, reported less nocturnal rumination (Cohen’s d=1.16), insomnia symptoms (Cohen’s d=1.24), and depressive symptoms (Cohen’s d=1.35). Multivariate linear regression revealed that both mindfulness (β=−.24, p=.03) and rumination (β=.38, p<.01) were independently associated with insomnia. Similarly, a multivariate model showed that mindfulness (β=−.41, p<.001) and rumination (β=.35, p<.01) were independently associated with depression.

Conclusions:

Ruminating in bed at night is strongly associated with insomnia and depression during pregnancy, whereas mindfulness may potentially protect against these stress-related perinatal complications.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190270/

 

Reduce Negative Moods and Depression in Healthy Individuals and Patients with Mood Disorders with Psychedelic Drugs

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Reduce Negative Moods and Depression in Healthy Individuals and Patients with Mood Disorders with Psychedelic Drugs

 

By John M. de Castro, Ph.D.

 

“the therapeutic use of psychedelic drugs in psychotherapeutic settings represents a promising and integrative treatment with enduring effects for mental health patients.” – Genis Oña

 

Psychedelic substances such as peyote, mescaline, LSD, Bufotoxin, ayahuasca and psilocybin have been used almost since the beginning of recorded history to alter consciousness and produce spiritually meaningful experiences. People find these experiences extremely pleasant. eye opening, and even transformative. They often report that the experiences changed them forever. Psychedelics have also been found to be clinically useful as they markedly improve mood, increase energy and enthusiasm and greatly improve clinical depression.

 

The research on the effectiveness of psychedelic drugs on mood and clinical depression is accumulating. So, it makes sense to step back and summarize what has been learned. In today’s Research News article “Classic serotonergic psychedelics for mood and depressive symptoms: a meta-analysis of mood disorder patients and healthy participants.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826317/ )  Galvão-Coelho and colleagues review, summarize, and perform a meta-analysis of the published research studies of the effectiveness of psychedelic drugs in improving mood and reducing depression with healthy individuals and patients with mood disorders.

 

They identified 12 published randomized controlled trials; 8 used psilocybin, 3 LSD, and 1 ayahuasca. They report that the research found that psychedelic treatment produced significant reductions in negative moods and depression in both healthy participants and in patients with mood disorders. In mood disorder patients the improvements were still significant 2 months after treatment. It should be recognized that the application of the psychedelics in these studies occur in highly structured controlled environments. This produces few if any troubling side effects with the exception of occasional slight anxiety. The safety of these drugs in uncontrolled non-clinical settings are not known.

 

The published research is clear that psychedelic drugs are effective in improving mood and reducing depression in both healthy individuals and those with mood disorders. Mood disorders including depression are by far the most common psychological problems in humans. The research is suggesting that controlled administration of psychedelic drugs is a safe and effective treatment relieving the suffering.

 

So, reduce negative moods and depression in healthy individuals and patients with mood disorders with psychedelic drugs.

 

“People who had recently used psychedelics such as psilocybin report a sustained improvement in mood and feeling closer to others after the high has worn off.” – Bill Hathaway

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Galvão-Coelho, N. L., Marx, W., Gonzalez, M., Sinclair, J., de Manincor, M., Perkins, D., & Sarris, J. (2021). Classic serotonergic psychedelics for mood and depressive symptoms: a meta-analysis of mood disorder patients and healthy participants. Psychopharmacology, 238(2), 341–354. https://doi.org/10.1007/s00213-020-05719-1

 

Abstract

Rationale

Major depressive disorder is one of the leading global causes of disability, for which the classic serotonergic psychedelics have recently reemerged as a potential therapeutic treatment option.

Objective

We present the first meta-analytic review evaluating the clinical effects of classic serotonergic psychedelics vs placebo for mood state and symptoms of depression in both healthy and clinical populations (separately).

Results

Our search revealed 12 eligible studies (n = 257; 124 healthy participants, and 133 patients with mood disorders), with data from randomized controlled trials involving psilocybin (n = 8), lysergic acid diethylamide ([LSD]; n = 3), and ayahuasca (n = 1). The meta-analyses of acute mood outcomes (3 h to 1 day after treatment) for healthy volunteers and patients revealed improvements with moderate significant effect sizes in favor of psychedelics, as well as for the longer-term (16 to 60 days after treatments) mood state of patients. For patients with mood disorder, significant effect sizes were detected on the acute, medium (2–7 days after treatment), and longer-term outcomes favoring psychedelics on the reduction of depressive symptoms.

Conclusion

Despite the concerns over unblinding and expectancy, the strength of the effect sizes, fast onset, and enduring therapeutic effects of these psychotherapeutic agents encourage further double-blind, placebo-controlled clinical trials assessing them for management of negative mood and depressive symptoms.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826317/

 

Increase Psychological Flexibility and Thereby Relieve Anxiety and Depression with Psychedelic Drugs

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Increase Psychological Flexibility and Thereby Relieve Anxiety and Depression with Psychedelic Drugs

 

By John M. de Castro, Ph.D.

 

“psilocybin may be effective in the much wider population of patients who suffer from major depression than previously appreciated. The magnitude of the effect we saw was about four times larger than what clinical trials have shown for traditional antidepressants on the market,” – Alan Davis

 

Psychedelic substances have been used almost since the beginning of recorded history to alter consciousness and produce spiritually meaningful experiences. People find these experiences very pleasant and eye opening. They often report that the experiences changed them forever. But only very recently have these effects of psychedelic substances come under rigorous scientific scrutiny.

 

When studied in the laboratory under double blind conditions psychedelic substances have been shown to “reliably occasion deeply personally meaningful and often spiritually significant experiences (e.g. mystical-type experiences).” Psychedelic substances have also been shown to improve clinical depression. The case seems clear, but it’s important to look at the mechanism by which psychedelic substances improve depression.

 

In today’s Research News article “Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451132/ )  Davis and colleagues recruited adults who have had an experience with a single psychedelic drug. LSD was used by 42% of the respondents and psilocybin was used by 38%. The respondents completed a questionnaire measuring the drug used, when and how much; mystical experiences, acute insight, anxiety, depression, stress, and psychological flexibility.

 

They found that the greater the level of mystical experiences the greater the levels of acute insights and psychological flexibility. They also found that the greater the level of levels of acute insights and psychological flexibility the greater the decrease in anxiety and depression. A path analysis revealed that the effects of mystical experiences and acute insights on anxiety and depression were indirect by way of psychological flexibility. They increased psychological flexibility which reduced anxiety and depression.

 

These are interesting results but caution must be exercised in reaching conclusions as there was no control condition and the results are completely correlational and based upon subjective recall by the individuals. In addition, the participants volunteered by responding to recruitment materials and those who respond are likely those that benefited from the psychedelic experiences.

 

Regardless, the results replicate previous findings that psychedelic drugs increase mystical experiences and acute insights and these are associated with improved mental health. But the results suggest that these effects are completely mediated by increased psychological flexibility. In other words, mystical experiences and acute insights increase flexibility which improves anxiety and depression. “Psychological flexibility is described as an essential set of processes that help people manage stressors and engage in adaptive behaviors that promote values-driven action.”  Hence, this flexibility allows the individual to adaptively respond to events in the environment rather than internalizing them producing anxiety and depression. Psychedelic drugs appear to enhance this flexibility and thereby improve mental health.

 

So, increase psychological flexibility and thereby relieve anxiety and depression with psychedelic drugs.

 

“The idea behind psychedelic therapy is that the receptive state that the drug confers opens the door to fresh ideas about how to think about the past and future, which the therapist can reinforce.” – Paul Tullis

 

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Davis, A. K., Barrett, F. S., & Griffiths, R. R. (2020). Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. Journal of contextual behavioral science, 15, 39–45. https://doi.org/10.1016/j.jcbs.2019.11.004

 

Abstract

Prior research has shown that acute subjective psychedelic effects are associated with both spontaneous and intended changes in depression and anxiety. Psychedelics are also theorized to produce increases in psychological flexibility, which could explain decreases in depression and anxiety following a psychedelic experience. Therefore, the present cross-sectional survey study sought to examine whether psychological flexibility mediated the relationship between acute psychedelic experiences and spontaneous or intended changes in depression and anxiety among a large international sample of people who reported having used a psychedelic (n=985; male=71.6%; Caucasian/white=84.1%; Mage=32.2, SD=12.6). A regression analysis showed that acute effects (i.e., mystical and insightful effects) were significantly associated with decreases in depression/anxiety following a psychedelic experience. A path analysis revealed that, while controlling for age and sex, increases in psychological flexibility fully mediated the effect of mystical and insightful experiences on decreases in depression and anxiety following a psychedelic experience. This suggests that psychological flexibility may be an important mediator of the therapeutic effects of psychedelic drugs. Future prospective experimental studies should examine the effect of psychedelic drug administration on psychological flexibility in order to gain a better understanding of the psychological processes that predict therapeutic effects of psychedelics.

Highlights

  • Acute psychedelic effects are related to changes in depression/anxiety
  • Changes in psychological flexibility fully mediate this relationship
  • Psychological flexibility should be examined in clinical trials with psychedelics

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451132/

 

Tai Chi Practice Improves the Symptoms of Multiple Diseases

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Tai Chi Practice Improves the Symptoms of Multiple Diseases

 

By John M. de Castro, Ph.D.

 

“In addition to easing balance problems, and possibly other symptoms, tai chi can help ease stress and anxiety and strengthen all parts of the body, with few if any harmful side effects.” Peter Wayne

 

Tai Chi is an ancient mindfulness practice involving slow prescribed movements. It is gentle and completely safe, can be used with the elderly and sickly, is inexpensive to administer, can be performed in groups or alone, at home or in a facility or even public park, and can be quickly learned. In addition, it can also be practiced in social groups without professional supervision. This can make it fun, improving the likelihood of long-term engagement in the practice. Indeed, studies have shown that Tai Chi practice is effective in improving the symptoms of many different diseases. The evidence is accumulating. So, it makes sense to step back and summarize what has been learned about the effectiveness of different Tai Chi practices for different disease conditions.

 

In today’s Research News article “.Clinical Evidence of Tai Chi Exercise Prescriptions: A Systematic Review” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7972853/ ) Huang and colleagues review and summarize the published randomized controlled trials on the effectiveness of different Tai Chi practices for different disease conditions. They identified 139 published randomized controlled trials utilizing a number of different Tai Chi styles and numbers of forms. Yang style was by far the most frequent style and 24 forms was the most frequent number of forms employed.

 

They report that the published research found that Tai Chi practice produced significant improvement in the symptoms of musculoskeletal system or connective tissue diseases such as osteoarthritis, fibromyalgia, and chronic low back pain.; on circulatory system diseases such as hypertension, stroke, coronary heart disease, and chronic heart failure; on mental and behavioral disorders such as depression, cognitive impairment, and intellectual disabilities; on nervous system diseases such as Parkinson’s disease, dementia, and sleep disorders; on chronic obstructive pulmonary disease (COPD); on endocrine, nutritional, or metabolic diseases such as type 2 diabetes and metabolic syndrome; on the physical and mental state of cancer patients, and on traumatic brain injury and urinary tract disorders; on balance control and flexibility and falls in older adults.

 

These are remarkable findings. Tai Chi practice appears to be a safe and effective treatment for the symptoms of a wide variety of diseases. It doesn’t cure the disease. Rather if alleviates the symptoms. It is not known the mechanisms by which Tai Chi has these benefits. Future research needs to further explore what facets or effects of Tai Chi practice are responsible for the disease symptom improvements.

 

So, Tai Chi practice improves the symptoms of multiple diseases.

 

“Tai Chi and Qigong are evidence-based approaches to improve health-related quality of life, and they may be effective for a range of physical health conditions.” – Ryan Abbott

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Huang, J., Wang, D., & Wang, J. (2021). Clinical Evidence of Tai Chi Exercise Prescriptions: A Systematic Review. Evidence-based Complementary and Alternative Medicine : eCAM, 2021, 5558805. https://doi.org/10.1155/2021/5558805

 

Abstract

Objectives

This systematic review aims to summarize the existing literature on Tai Chi randomized controlled trials (RCTs) and recommend Tai Chi exercise prescriptions for different diseases and populations.

Methods

A systematic search for Tai Chi RCTs was conducted in five electronic databases (PubMed, Cochrane Library, EMBASE, EBSCO, and Web of Science) from their inception to December 2019. SPSS 20.0 software and Microsoft Excel 2019 were used to analyze the data, and the risk of bias tool in the RevMan 5.3.5 software was used to evaluate the methodological quality of RCTs.

Results

A total of 139 articles were identified, including diseased populations (95, 68.3%) and healthy populations (44, 31.7%). The diseased populations included the following 10 disease types: musculoskeletal system or connective tissue diseases (34.7%), circulatory system diseases (23.2%), mental and behavioral disorders (12.6%), nervous system diseases (11.6%), respiratory system diseases (6.3%), endocrine, nutritional or metabolic diseases (5.3%), neoplasms (3.2%), injury, poisoning and certain other consequences of external causes (1.1%), genitourinary system diseases (1.1%), and diseases of the eye and adnexa (1.1%). Tai Chi exercise prescription was generally classified as moderate intensity. The most commonly applied Tai Chi style was Yang style (92, 66.2%), and the most frequently specified Tai Chi form was simplified 24-form Tai Chi (43, 30.9%). 12 weeks and 24 weeks, 2-3 times a week, and 60 min each time was the most commonly used cycle, frequency, and time of exercise in Tai Chi exercise prescriptions.

Conclusions

We recommend the more commonly used Tai Chi exercise prescriptions for different diseases and populations based on clinical evidence of Tai Chi. Further clinical research on Tai Chi should be combined with principles of exercise prescription to conduct large-sample epidemiological studies and long-term prospective follow-up studies to provide more substantive clinical evidence for Tai Chi exercise prescriptions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7972853/

 

Improve Pain, Sleep, and the Mental Health of Chronic Pain Patients with Internet Mindfulness Training

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Improve Pain, Sleep, and the Mental Health of Chronic Pain Patients with Internet Mindfulness Training

 

By John M. de Castro, Ph.D.

 

“In the context of chronic pain . . . meditation can help you to stop your mind wandering back to your pain when you are trying to focus on something else, therefore improving your ability to give your entire attention to the task at hand and in turn, improve your level of functioning. It gives you the power to take your mind off your pain and refocus it, therefore aiding you in replacing unhelpful, behaviours with healthy ones which can reduce your pain and allow you to take better care of your health.” – Ann-Marie D’arcy-Sharpe

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.

 

There is an accumulating volume of research findings that demonstrate that mindfulness practices, in general, are effective in treating pain. A therapeutic technique that contains mindfulness training and Cognitive Behavioral Therapy (CBT) is Acceptance and Commitment Therapy (ACT). It focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

Acceptance and Commitment Therapy (ACT) requires a scheduled program of sessions with a trained therapist. This results in costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules and at locations that may not be convenient. As an alternative, mindfulness training over the internet have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. In addition, research has indicated that mindfulness training online can be effective for improving the health and well-being of the participants.

 

In today’s Research News article “Internet‐delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1‐year follow‐up.” (See summary below or view the full text of the study at: https://onlinelibrary.wiley.com/doi/10.1002/ejp.1723 ) Rickardsson and colleagues recruited adult chronic pain patients and randomly assigned them to either a wait-list control condition or to receive an 8-week program of Acceptance and Commitment Therapy (ACT) delivered over the internet. ACT was delivered in daily microlearning short learning interactions. There was a 74% completion rate of the modules. The participants were measured before and after training and at 3-, 6-, and 12-month follow-ups for psychiatric problems, pain interference, pain intensity, anxiety, depression, psychological inflexibility, values, and health-related quality of life.

 

They found that compared to baseline and the wait-list control group, the group that received internet-delivered Acceptance and Commitment Therapy (ACT) had significant decreases in pain interference, pain intensity, anxiety, depression, psychological inflexibility, value obstruction, and insomnia. These improvements were long-lasting as they were maintained at the 12-month follow-up.

 

These are impressive improvements in the pain and psychological health of these diverse chronic pain patients. These results correspond with the frequent prior observations that mindfulness training produces reductions in pain, anxiety, depression, psychological inflexibility, and insomnia in a wide range of patient types and normal individuals. These results are particularly impressive as Acceptance and Commitment Therapy (ACT) was delivered over the internet. in daily microlearning short learning interactions. This was very convenient for the patients and required only 12.4 minutes per week of therapist time per week and was thus very inexpensive to deliver. Yet ACT was highly effective and lasting in relieving the suffering of these chronic pain patients.

 

So, improve pain, sleep, and the mental health of chronic pain patients with internet mindfulness training.

 

“What we want to do as best as we can is to engage with the pain just as it is. It’s not about achieving a certain goal – like minimizing pain – but learning to relate to your pain differently.” – Elisha Goldstein

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Jenny Rickardsson, Charlotte Gentili, Linda Holmström, Vendela Zetterqvist, Erik Andersson, Jan Persson, Mats Lekander, Brjánn Ljótsson, Rikard K. Wicksell. Internet‐delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1‐year follow‐up, European Journal of Pain, 2021;00:1–19, https://doi.org/10.1002/ejp.1723

 

Abstract

Background

Studies of Internet‐delivered acceptance and commitment therapy (ACT) for chronic pain have shown small to moderate positive effects for pain interference and pain acceptance. Effects on pain intensity, depression, anxiety and quality of life (QoL) have been less favourable, and improvements for values and sleep are lacking. In this randomized controlled trial iACT – a novel format of Internet‐ACT using daily microlearning exercises – was examined for efficacy compared to a waitlist condition.

Methods

Adult participants (mean age 49.5 years, pain duration 18.1 years) with diverse chronic pain conditions were recruited via self‐referral, and randomized to iACT (n = 57) or waitlist (n = 56). The primary outcome was pain interference. The secondary outcomes were QoL, depression, anxiety, insomnia and pain intensity. The process variables included psychological inflexibility and values. Post‐assessments were completed by 88% (n = 100) of participants. Twelve‐month follow‐up assessments were completed by 65% (iACT only, n = 37). Treatment efficacy was analysed using linear mixed models and an intention‐to‐treat‐approach.

Results

Significant improvements in favour of iACT were seen for pain interference, depression, anxiety, pain intensity and insomnia, as well as process variables psychological inflexibility and values. Between‐group effect sizes were large for pain interference (d = 0.99) and pain intensity (d = 1.2), moderate for anxiety and depressive symptoms and small for QoL and insomnia. For the process variables, the between‐group effect size was large for psychological inflexibility (d = 1.0) and moderate for values. All improvements were maintained at 1‐year follow‐up.

Conclusions

Internet‐ACT as microlearning may improve a broad range of outcomes in chronic pain.

Significance

The study evaluates a novel behavioral treatment with positive results on pain interference, mood as well as pain intensity for longtime chronic pain sufferers. The innovative format of a digital ACT intervention delivered in short and experiential daily learnings may be a promising way forward.

https://onlinelibrary.wiley.com/doi/10.1002/ejp.1723

 

jenny.rickardsson@ki.se

 

Improve Psychological Well-Being in Covid-19 Lockdown with Online Mindfulness Training

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Improve Psychological Well-Being in Covid-19 Lockdown with Online Mindfulness Training

 

By John M. de Castro, Ph.D.

 

“mindfulness is one tool that can help promote mental wellness throughout the COVID-19 pandemic and beyond.” – Julie Dunn

 

Mindfulness training has been shown to improve health and well-being in healthy individuals. It has also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. The COVID-19 pandemic has challenged the mental and physical health of the population. It has created intense stress both for frontline workers but also for people simply isolating at home. Mindfulness is known to decrease the psychological and physical responses to stress. So, mindfulness training may be helpful in coping with the mental and physical challenges resulting from the COVID-19 pandemic.

 

In today’s Research News article “A Brief Online Mindfulness-Based Group Intervention for Psychological Distress Among Chinese Residents During COVID-19: a Pilot Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7972025/ ) Zhang and colleagues recruited online Chinese adults who were staying at home during the Covid-19 lockdown. They were randomly assigned to a wait-list control condition or to receive online mindfulness training with an abbreviated group version of Mindfulness-Based Stress Reduction (MBSR). The training consisted of a 2-hour training followed by 13 days of 1.5 hours per day of practice separated into 3 30-minute sessions. Once training was complete for the mindfulness group, the wait-list group received the same 2-week mindfulness training. They were measured before and after the training for mindfulness and psychological distress, including somatization, depression, and anxiety.

 

They found that in comparison to baseline and the wait-list control group, the mindfulness training produced significantly higher mindfulness levels and significantly lower levels of psychological distress, including somatization, depression, and anxiety levels. The wait-list group after they received the mindfulness training had similar significant improvements in their psychological well-being.

 

These results are consistent with previous findings that mindfulness training produces decreases in distress, including somatization, depression, and anxiety. But the present study demonstrates that online mindfulness training can produce similar benefits for individuals locked down during a pandemic. Since the training is online, it could be made available to widespread individuals at low cost and thus would be ideal for maintaining the psychological health of people in lock down.

 

So, improve psychological well-being in covid-19 lockdown with online mindfulness training.

 

“In many ways, COVID-19 has shown us just how connected and how much the same we really are. All of us—and some of us more than others—are vulnerable to getting sick and none of us wants to become ill. Viewed through the lens of interconnectedness, practicing mindfulness as the coronavirus spreads is not only a way to care for ourselves but a way to care for everyone around us.” – Kelly Barron

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Hui Zhang, Anao Zhang, Chengbin Liu, Jian Xiao, Kaipeng Wang. A Brief Online Mindfulness-Based Group Intervention for Psychological Distress Among Chinese Residents During COVID-19: a Pilot Randomized Controlled Trial, Mindfulness (N Y) 2021 Mar 18 : 1–11. doi: 10.1007/s12671-021-01618-4

 

Abstract

Objectives

The coronavirus (COVID-19) global pandemic has increased psychological distress among the general population. The objective of this study is to evaluate a mindfulness-based intervention for psychological distress among Chinese residents during COVID-19.

Methods

This study used a switching replications design to test the feasibility and efficacy of a brief online mindfulness-based intervention for Chinese residents’ psychological distress. Fifty-one residents in the Hubei province were randomly allocated to two groups (experimental group and waitlist control group) with three waves of measurement at time 1, time 2, and time 3 for changes in mindfulness and psychological distress.

Results

In addition to significant within-group improvements over time for both groups, OLS linear regression with full information likelihood estimation revealed statistically significant between-group treatment effects across outcome domains, including mindfulness awareness, b = 2.84, p < 0.001, g = 6.92, psychological distress, b = −21.33, p < 0.001, g = 6.62, somatic symptoms, b = −6.22, p < 0.001, g = 4.42, depressive symptoms, b = −7.16, p < 0.001, g = 5.07, and anxiety symptoms, b = −8.09, p < 0.001, g = 6.84.

Conclusions

Results suggest that a brief online mindfulness-based intervention can be a feasible and promising intervention for improving mindfulness and decreasing psychological distress among Chinese residents staying at home during the COVID-19 outbreak. The study used a small convenience sample which led to a concern of external generalizability and with limited evaluation of long-term change.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7972025/

 

Reduce Stress and Improve Healthcare Worker Well-Being with Mindfulness

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Reduce Stress and Improve Healthcare Worker Well-Being with Mindfulness

 

By John M. de Castro, Ph.D.

 

“The therapeutic applications of mindfulness are considerable and its impact on clinical practice itself appears to be profound. Indeed, several commentators characterize mindfulness as inciting nothing short of a revolution in the way we conduct our mental lives both within the clinic and without.” – Matias P. Raski

 

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations, like healthcare, burnout is all too prevalent. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. It is estimated that over 45% of healthcare workers experience burnout. It not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion. Burnout, in fact, it is a threat to the entire healthcare system. Currently, over a third of healthcare workers report that they are looking for a new job. Hence, burnout contributes to the shortage of doctors and nurses.

 

Preventing burnout has to be a priority. Unfortunately, it is beyond the ability of the individual to change the environment to reduce stress and prevent burnout. So, it is important that methods be found to reduce the individual’s responses to stress; to make the individual more resilient when high levels of stress occur. Contemplative practices have been shown to reduce the psychological and physiological responses to stress and improve well-being. Indeed, mindfulness has been shown to be helpful in treating and preventing burnout, increasing resilience, improving sleep and reduce stress.

 

In today’s Research News article “Reducing stress and promoting well-being in healthcare workers using mindfulness-based cognitive therapy for life.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903308/ ) Strauss and colleagues recruited healthy adult healthcare workers and randomly assigned them to either a wait-list control condition or to receive 8 weekly 2-hour group sessions of Mindfulness-Based Cognitive Therapy (MBCT) along with 40 minutes of daily practice.  MBCT involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy that attempts to teach patients to distinguish between thoughts, emotions, physical sensations, and behaviors, and to recognize irrational thinking styles and how they affect behavior. MBCT was developed specifically to treat depression. For this study it was modified to be more appropriate for the general population. The participants were measured before and after training for attendance and practice amounts, stress, anxiety, depression, mental well-being, burnout, presenteeism, compassion, and mindfulness.

 

They found that in comparison to baseline and the wait-list control group after Mindfulness-Based Cognitive Therapy (MBCT) there were significant increases in mindfulness, mental well-being, and self-compassion, and significant decreases in anxiety, depression, and stress. They also found that the greater the increases in mindfulness and self-compassion produced by MBCT the greater the increase in mental well-being and the decrease in stress.

 

These findings are similar to those found in previous research with different groups that Mindfulness training increases well-being and self-compassion, and decreases anxiety, depression, and stress. Hence, mindfulness training improves the psychological well-being of healthcare workers. This should help protect them against burnout and increase their resilience in the face of high workplace stress.

 

So, reduce stress and improve healthcare worker well-being with mindfulness.

 

“As we become more adept at dwelling in the living presence of our own experience, we begin to connect more deeply with patients, as well as co-workers and family members. Mindfulness practice provides a simple and practical way to recapture the calling of healing.” – Penn Medicine

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Strauss, C., Gu, J., Montero-Marin, J., Whittington, A., Chapman, C., & Kuyken, W. (2021). Reducing stress and promoting well-being in healthcare workers using mindfulness-based cognitive therapy for life. International journal of clinical and health psychology : IJCHP, 21(2), 100227. https://doi.org/10.1016/j.ijchp.2021.100227

 

Background/Objective

Healthcare workers play a critical role in the health of a nation, yet rates of healthcare worker stress are disproportionately high. We evaluated whether mindfulness-based cognitive therapy for life (MBCT-L), could reduce stress in healthcare workers and target a range of secondary outcomes. Method: This is the first parallel randomised controlled trial of MBCT-L. Participants were NHS workers, who were randomly assigned (1:1) to receive either MBCT-L or wait-list. The primary outcome was self-reported stress at post-intervention. Secondary variables were well-being, depression, anxiety, and work-related outcomes. Mixed regressions were used. Mindfulness and self/other-compassion were explored as potential mechanisms of effects on stress and wellbeing. Results: We assigned 234 participants to MBCT-L (n = 115) or to wait-list (n = 119). 168 (72%) participants completed the primary outcome and of those who started the MBCT-L 73.40% (n = 69) attended the majority of the sessions. MBCT-L ameliorated stress compared with controls (B = 2.60, 95% CI = 1.63‒3.56; d = -0.72; p < .0001). Effects were also found for well-being, depression and anxiety, but not for work-related outcomes. Mindfulness and self-compassion mediated effects on stress and wellbeing. Conclusions: MBCT-L could be an effective and acceptable part of a wider healthcare workers well-being and mental health strategy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903308/

 

The Well-Being and Quality of Life in Cancer Patients are Related to Spirituality

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The Well-Being and Quality of Life in Cancer Patients are Related to Spirituality

 

By John M. de Castro, Ph.D.

 

“Many patients with cancer rely on spiritual or religious beliefs and practices to help them cope with their disease. This is called spiritual coping.” – National Cancer Institute

 

A cancer diagnosis has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing experience. These feeling can result from changes in body image, changes to family and work roles, feelings of grief at these losses, and physical symptoms such as pain, nausea, or fatigue. People might also fear death, suffering, pain, or all the unknown things that lie ahead. So, coping with the emotions and stress of a surviving cancer is a challenge and there are no simple treatments for these psychological sequelae of cancer.

 

Religion and spirituality become much more important to people when they survive cancer. It is thought that people take comfort in the spiritual when facing mortality. Hence, spirituality may be useful for cancer patients to cope with their illness and the psychological difficulties resulting from the disease. Thus, there is a need to study the relationships of spirituality on the well-being and quality of life of cancer patients.

 

In today’s Research News article “Association between spiritual well-being, quality of life, anxiety and depression in patients with gynecological cancer in China.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793354/) Chen and colleagues recruited women with primary gynecological cancer and had them complete measures of quality of life with cancer, global health, spiritual well-being, anxiety, and depression.

 

They found that the higher the levels of spiritual well-being the higher the levels of global health and quality of life and the lower the levels of depression and anxiety. Multiple regression analysis revealed that religion, depression, anxiety and quality of life were the strongest predictors of spiritual well-being.

 

These findings are correlational and as a result causation cannot be determined. Regardless, the results clearly show that spiritual well-being is significantly related to better health and quality of life and lower psychological problems in women with primary gynecological cancer. These findings are similar to those seen with other forms of cancer that spirituality is associated with the patient’s quality of life and well-being. This raises the possibility that promoting spirituality in cancer patients may improve their physical and psychological well-being. It remains for future research to explore this possibility.

 

So, the well-being and quality of life in cancer patients are related to spirituality.

 

“Consistent associations between spirituality, spiritual well-being, and health outcomes found in published studies highlight the importance of providing spiritual care to enhance cancer patients’ spiritual well-being and address their spiritual needs.” – Yi-Hui Lee

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Chen, J., You, H., Liu, Y., Kong, Q., Lei, A., & Guo, X. (2021). Association between spiritual well-being, quality of life, anxiety and depression in patients with gynaecological cancer in China. Medicine, 100(1), e24264. https://doi.org/10.1097/MD.0000000000024264

 

Abstract

The physical and psychological condition of patients with gynaecological cancer has received much attention, but there is little research on spirituality in palliative care. This study aimed to investigate spiritual well-being and its association with quality of life, anxiety and depression in patients with gynaecological cancer. A cross-sectional study was conducted in China in 2019 with 705 patients diagnosed with primary gynaecological cancer. European Organisation for Research and Treatment of Cancer quality of life instruments (EORTC QLQ-SWB32 and EORTC QLQ-C30) and the Hospital Anxiety and Depression Scale were used to measure spiritual well-being, quality of life, anxiety and depression. Univariate and multiple linear regression analyses were performed to examine associations between spiritual well-being, quality of life, anxiety and depression. Functioning scales and global health status were positively correlated with spiritual well-being (P < .05). Anxiety and depression were negatively correlated with spiritual well-being (P < .05). Depression (−0.362, P < .001) was the strongest predictor of Existential score. Anxiety (−0.522, P < .001) was the only predictor of Relationship with self. Depression (−0.350, P < .001) and Global health (0.099, P = .011) were the strongest predictors of Relationship with others. Religion (−0.204, P < .001) and Depression (−0.196, P < .001) were the strongest predictors of Relationship with someone or something greater. Global health (0.337, P < .001) and Depression (−0.144, P < .001) were the strongest predictors of Global-SWB. Well spiritual well-being is associated with lower anxiety and depression, and better quality of life. Health providers should provide more spiritual care for non-religious patients and combine spiritual care with psychological counselling to help patients with gynaecological cancer, especially those who have low quality of life or severe symptoms, or experience anxiety or depression.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793354/