Yoga is the Preferred Exercise for the Treatment of Type 2 Diabetes

December 1, 2020December 1, 2020 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“By increasing muscle mass through strengthening poses, yoga can improve your metabolism, helping you maintain a healthy body weight. Studies suggest that regular practice helps normalize blood pressure and cholesterol levels. By inducing a feeling of calm, yoga can lower the release of cortisol, a stress hormone that causes your body to release more glucose. Less unnecessary cortisol means fewer unnecessary elevations in blood sugar.” – Annie Kay

Diabetes is a major health issue. It is estimated that 30 million people in the United States and nearly 600 million people worldwide have diabetes and the numbers are growing. Type II Diabetes results from a resistance of tissues, especially fat tissues, to the ability of insulin to promote the uptake of glucose from the blood. As a result, blood sugar levels rise producing hyperglycemia. Diabetes is heavily associated with other diseases such as cardiovascular disease, heart attacks, stroke, blindness, kidney disease, and circulatory problems leading to amputations. As a result, diabetes doubles the risk of death of any cause compared to individuals of the same age without diabetes.

Type 2 diabetes is a common and increasingly prevalent illness that is largely preventable. One of the reasons for the increasing incidence of Type 2 Diabetes is its association with overweight and obesity which is becoming epidemic in the industrialized world. A leading cause of this is a sedentary life style. Unlike Type I Diabetes, Type II does not require insulin injections. Instead, the treatment and prevention of Type 2 Diabetes focuses on diet, exercise, and weight control. Recently, mindfulness practices have been shown to be helpful in managing diabetes. A mindfulness practice that combines mindfulness with exercise is yoga and it has been shown to be helpful in the treatment of Type II Diabetes.

In today’s Research News article “Effect of Yoga and Exercise on Glycemic Control and Psychosocial Parameters in Type 2 Diabetes Mellitus: A Randomized Controlled Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336951/ ) Singh and Khandelwal recruited adult patients with Type 2 Diabetes and randomly assigned them to either an exercise or yoga practice group. Exercise was practiced for 30 minutes 5 days per week for 3 months and consisted of walking and moderate aerobic exercise combined with diet. The yoga group were trained in postures and breathing exercises for 2 weeks and then practiced at home for 3 months. They were measured before and after training for anxiety, depression, diabetes quality of life and self-efficacy. They also had blood drawn for assessment of glycemic control (HbA1c).

They found that following training both groups had significant decreases in anxiety, depression, and HbA1c and significant increases in diabetes quality of life and self-efficacy. But the yoga group had significantly better outcomes on all measures compared to the diet and exercise group.

These results suggest that practicing yoga is better for the psychological and physical health of patients with Type 2 Diabetes than non-yoga exercises. Yoga practice not only improved psychological health but also glycemic control suggesting better control of the disease. The fact that yoga was superior in effectiveness to non-yoga exercise is important as yoga is both a mindfulness practice and an exercise. So, the results suggest that adding mindfulness to exercise potentiates the programs effectiveness in treating patients with Type 2 Diabetes.

Hence, yoga is the preferred exercise for the treatment of Type 2 Diabetes.

“I recommend yoga primarily for stress management. Stress elevates blood sugar, which can lead to more diabetes complications. Yoga helps us center ourselves, and centering calms us and can help keep blood sugar levels balanced.” – Janet Zappe

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

Vijay Pratap Singh, Bidita Khandelwal. Effect of Yoga and Exercise on Glycemic Control and Psychosocial Parameters in Type 2 Diabetes Mellitus: A Randomized Controlled Study. Int J Yoga. 2020 May-Aug; 13(2): 144–151. Published online 2020 May 1. doi: 10.4103/ijoy.IJOY_45_19

Abstract

Context (Background):

Type 2 diabetes has been strongly associated with psychosocial factors such as stress, anxiety, depression, and quality of life (QOL). There is not much evidence whether yoga can improve these factors and motivate individuals to engage in active lifestyle.

Aims:

This study aims to evaluate the effect of yoga and exercise over glycemic control, anxiety, depression, exercise self-efficacy (ESE), and QOL after 3-month program.

Methods:

Two hundred and twenty-seven individuals were randomly allocated to yoga group (YG) and exercise group. YG practiced yoga for 2 weeks under supervision and then carried out practice at home for 3 months. The exercise group practiced 30 min of brisk walking for 5 days a week.

Results:

On comparison among the groups, in YG, there was a mean change of 0.47 in glycated hemoglobin which was greater than mean reduction of 0.28 in the exercise group with P < 0.05. State anxiety reduced by 7.8 and trait anxiety reduced by 4.4 in YG (P < 0.05) in 3 months as compared to nonsignificant reductions of 3 and 1 in mean of state and trait anxiety scores in the exercise group (P > 0.05). There was a statistically significant reduction in depression score in both the groups, 8.6 in yoga and 4.0 in exercise, which was greater in YG. ESE improved by 19.2 in YG (P < 0.05), whereas it improved only 2.2 in the exercise group (P > 0.05). QOL improved by 23.7 in YG and 3.0 in the exercise group which was nonsignificant in the exercise group as compared to YG.

Conclusions:

Yoga is superior to exercise alone as a lifestyle modification program in improving glycemic control, anxiety, depression, and QOL as well as ESE.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336951/

Reduce Blood Pressure in Patients with Noncommunicable Diseases with Mindfulness

August 21, 2020 psyjdc Leave a comment

Reduce Blood Pressure in Patients with Noncommunicable Diseases with Mindfulness

By John M. de Castro, Ph.D.

“mindfulness practice can be an effective way to reduce blood pressure (and along with it, the risk of stroke or heart attack).” – NICABM

High Blood Pressure (Hypertension) is an insidious disease because there are no overt symptoms. The individual feels fine. But it can be deadly as more than 360,000 American deaths, roughly 1,000 deaths each day, had high blood pressure as a primary or contributing cause. In addition, hypertension markedly increases the risk heart attack, stroke, heart failure, and kidney disease. It is also a very common disorder with about 70 million American adults (29%) having high blood pressure and only about half (52%) of people with high blood pressure have their condition under control. Treatment frequently includes antihypertensive drugs. But these medications often have adverse side effects. So, patients feel lousy when taking the drugs, but fine when they’re not. So, compliance is a major issue with many patients not taking the drugs regularly or stopping entirely.

Obviously, there is a need for alternative to drug treatments for hypertension. Mindfulness practices have been shown to aid in controlling hypertension. Indeed, meditation, tai chi, and yoga, have also been shown to be helpful for heart health. Hypertension is frequently cooccurring with in patients with non-communicable diseases. In today’s Research News article “Mindfulness interventions reduce blood pressure in patients with non-communicable diseases: A systematic review and meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc), Intarakamhang and colleagues review, summarize and perform a meta-analysis of the effectiveness of mindfulness training in reducing blood pressure in patients with non-communicable diseases.

They defined non-communicable diseases (NCDs) to include cancers, cardiovascular diseases, respiratory diseases and diabetes and identified 14 published controlled studies including a total of 1117 patients. They report that the studies found that mindfulness training significantly reduced both systolic and diastolic blood pressure in the patients with NCDs.

The results are compatible with previous findings that mindfulness training reduces blood pressure in a wide variety of healthy and ill individuals. The present study demonstrates that mindfulness training is effective in reducing blood pressure in patients with non-communicable diseases (NCDs). This is reasonable given that mindfulness training has been shown to improve the symptoms of patients with the included NCDs, cancers, cardiovascular diseases, respiratory diseases and diabetes.

There are a number of possible mechanisms for this blood pressure reduction. Mindfulness training is known to reduce the physiological and psychological responses to stress and this may in turn lower blood pressure. Also mindfulness training has been shown to affect the autonomic nervous system increasing parasympathetic activity that tends to reduce blood pressure.

So, reduce blood pressure in patients with noncommunicable diseases with mindfulness.

“The hope is that if we can start mindfulness training early in life, we can promote a trajectory of healthy aging across the rest of people’s lives. That will reduce their chances of getting high blood pressure in the first place.” – Eric Loucks

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

Intarakamhang, U., Macaskill, A., & Prasittichok, P. (2020). Mindfulness interventions reduce blood pressure in patients with non-communicable diseases: A systematic review and meta-analysis. Heliyon, 6(4), e03834. https://doi.org/10.1016/j.heliyon.2020.e03834

Abstract

Purpose

Mindfulness based interventions (MBIs) are an emerging area of empirical study, not only in positive psychology, but also in clinical health care. This research aims to synthesize the evidence about whether MBIs reduce blood pressure (BP) in patients with non-communicable diseases (NCDs).

Methods

Relevant studies were identified via PubMed, the Cochrane Library, Embase and the CINAHL database between 2009 and 2019. The papers selected focused on mindfulness and the effect of these on the BP of patients with NCDs. The change in SBP and DBP were meta-analyzed, stratified by type of intervention (Breathing awareness meditation (BAM), Mindfulness Meditation (MM), and Mindfulness-based Stress Reduction (MBSR).

Results

Fourteen articles met eligibility criteria and were included in the final review. Among the studies using the type and duration of intervention, systolic BP was reduced after the mindfulness-based stress reduction for 8 weeks (-6.90 mmHg [95% CI: -10.82, -2.97], p < .050), followed by the breathing awareness meditation for 12 weeks (-4.10 mmHg [95% CI: -7.54, -0.66], p < .050) and the mindfulness-based intervention for 8 weeks (-2.69 mmHg [95% CI: -3.90, -1.49], p < .050) whereas diastolic BP was reduced after the mindfulness-based stress reduction for 8 weeks (-2.45 mmHg [95% CI: -3.74, -1.17], p < .050) and the mindfulness-based intervention for 8 weeks (-2.24 mmHg [95% CI: -3.22, -1.26], p < .050).

Conclusion

MBIs can provide effective alternative therapies to assist in blood pressure reduction for patients with NCDs.

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

Improve Cardiovascular and Metabolic Symptoms of Type 2 Diabetes with Yoga

July 11, 2020 psyjdc Leave a comment

Improve Cardiovascular and Metabolic Symptoms of Type 2 Diabetes with Yoga

By John M. de Castro, Ph.D.

“Yoga practices such as cleansing processes, asanas, pranayama, mudras, bandha, meditation, mindfulness, and relaxation are known to reduce blood glucose levels and to help in the management of comorbid disease conditions associated with type 2 diabetes mellitus, resulting in significant positive clinical outcomes.” – Arkiath Veettil Raveendran

In today’s Research News article “Yoga-based lifestyle treatment and composite treatment goals in Type 2 Diabetes in a rural South Indian setup- a retrospective study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156497/), Arumugam and colleagues recruited adults with Type 2 Diabetes in rural India and randomly assigned them to either standard care or to 6 months of 1 hour daily supervised yoga practice “comprised of loosening practices, asanas, pranayama, relaxation techniques, and meditation.” They were measured before and after treatment for blood levels of A1c, LDL and HDL-cholesterol, fasting blood glucose, postprandial blood glucose, systolic and diastolic blood pressure, weight, total cholesterol, triglyceride, and body mass index (BMI).

They found that for the most part the control group had deterioration of most measures of their cardiovascular and metabolic health while the yoga group had significant improvements in all measures, including blood fats and glucose, blood pressure, and body weight, except total triglycerides. Hence, the patients with Type 2 Diabetes markedly reduced their risk factors for cardiovascular disease while the control group increased their risk.

These are very encouraging results that yoga practice can improve the health of patients with Type 2 Diabetes in rural India and lower their risk of developing serious cardiovascular disease. It would be important in future research to include another condition of perhaps aerobic exercise to evaluate if yoga practice confers extra benefits beyond its exercise effects. Regardless, the results suggest that yoga practice improves the physical well-being of patients with Type 2 Diabetes in rural settings.

So, improve cardiovascular and metabolic symptoms of Type 2 Diabetes with yoga.

“Yoga is considered to be a promising, cost-effective option in the treatment and prevention of diabetes, with data from several studies suggesting that yoga and other mind-body therapies can reduce stress-related hyperglycemia and have a positive effect on blood glucose control.” – Diabetes UK

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

Arumugam, G., Nagarathna, R., Majumdar, V., Singh, M., Srinivasalu, R., Sanjival, R., Ram, V. S., & Nagendra, H. R. (2020). Yoga-based lifestyle treatment and composite treatment goals in Type 2 Diabetes in a rural South Indian setup- a retrospective study. Scientific reports, 10(1), 6402. https://doi.org/10.1038/s41598-020-63133-1

Abstract

This multicentre retrospective study examined the effects of adjunct yoga-treatment in achieving composite cardiovascular goals for type 2 diabetes (T2D), set forth by the American Diabetes Association (ADA) in rural Indian settings. Records were extracted for 146 T2D patients, aged ≥20–70 years, and treated under the “Apollo Total Health Programme” for rural diabetes management, for the period April 2016 to November 2016. The study cohort comprised of two treatment groups (n = 73 each); non-yoga group (standard of care) and yoga group (adjunct yoga-treatment). Propensity score matching was applied between the study groups to define the cohort. Composite cardiovascular scores were based on the combination of individual ADA goals; A1c < 7%, blood pressure (BP) < 140/90 mmHg, stringent BP (<130/80 mmHg) and lipid, LDL-C < 100 mg/dl [risk factor for atherosclerotic cardiovascular disease]. Logistic regression was used to compare between the two treatment groups. Compared to standard of care, adjunct yoga-treatment was found to significantly facilitate the attainment of ADA composite score by 8-fold; A1c, ~2-fold; LDL-C, ~2-fold; BP < 140/90 mmHg and <130/80 mmHg by ~8-and ~6-fold respectively. This study provides the first evidence for significant efficacy of adjunct yoga-treatment for the attainment of favourable treatment goals for T2D in rural Indian settings.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156497/

Improve Type 2 Diabetes with Mindful Movement

May 9, 2020 psyjdc Leave a comment

Improve Type 2 Diabetes with Mindful Movement

By John M. de Castro, Ph.D.

“Living with diabetes is a major life stressor, from the physical and psychological aspects of managing blood sugar and medications to the eating challenges. A great deal of what we go through in life is beyond our control. The diabetes is always going to be there, but until you connect with what you’re feeling and experiencing, you’re not going to be able to make conscious choices about living with its many challenges.” – Ivy Marcus

Diabetes is a major health issue. It is estimated that 30 million people in the United States have diabetes and the numbers are growing. Type 2 Diabetes results from a resistance of tissues, especially fat tissues, to the ability of insulin to promote the uptake of glucose from the blood. As a result, blood sugar levels rise producing hyperglycemia. Diabetes is the 7th leading cause of death in the United States. In addition, diabetes is heavily associated with other diseases such as cardiovascular disease, heart attacks, stroke, blindness, kidney disease, and circulatory problems leading to amputations. As a result, diabetes doubles the risk of death of any cause compared to individuals of the same age without diabetes.

Type 2 diabetes is largely preventable. One of the reasons for the increasing incidence of Type 2 Diabetes is its association with overweight and obesity which is becoming epidemic in the industrialized world. A leading cause of this is a sedentary life style. Current treatments for Type 2 Diabetes focus on diet, exercise, and weight control. Recently, mindfulness practices have been shown to be helpful in managing diabetes. Mindful movement practices such as Tai Chi and Qigong and yoga are mindfulness practices that are also gentle exercises. There is accumulating research on the effectiveness of these mindful movement practices for the treatment of Type 2 Diabetes. So, it makes sense to examine what has been learned.

In today’s Research News article “Meditative Movements for Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7016481/), Xia and colleagues review, summarize, and perform a meta-analysis of the published research literature on the effectiveness of mindful movement practices for the treatment of Type 2 Diabetes. They found 21 controlled studies; 6 employing Tai Chi practice, 3 Qigong practice, and 12 yoga.

They report that the published research found that mindful movement practices produced significant reductions in fasting blood glucose, glycated hemoglobin (HbA1c), and postprandial blood glucose levels. These results suggest that mindful movement practices improve glycemic control in type 2 diabetes. There were no significant differences found between different mindful movement practices.

They also report that the published research found that mindful movement practices produced significant reductions in total cholesterol and low-density lipoprotein cholesterol and significant increases in high-density lipoprotein cholesterol. These results suggest that mindful movement practices improve blood lipid levels in type 2 diabetes. There were no significant differences found between different mindful movement practices.

The improvements observed produced by Tai Chi, Qigong and yoga practices are very important for the treatment and control of type 2 diabetes. Glycemic control is a key to successful treatment and lipid control is important for reducing cardiovascular problems that can occur. So, these exercises significantly improve the metabolic state of patients with type 2 diabetes. The fact that the different practices were equivalent in effectiveness suggests that the patient can select the practice type that they enjoy most and best suits their lifestyle.

So, improve Type 2 Diabetes with mindful movement.

“Practicing mindfulness exercises and daily physical activity has been shown repeatedly to help manage stress and depression, and promote mental balance and happiness. Mindfulness exercises are therefore a crucial component in both preventing and managing type 2 diabetes, and reducing the risk of complications for type 1 and type 2 diabetics.” – Defeat Diabetes Foundation

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

Xia, T., Yang, Y., Li, W., Tang, Z., Huang, Q., Li, Z., & Guo, Y. (2020). Meditative Movements for Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine : eCAM, 2020, 5745013. https://doi.org/10.1155/2020/5745013

Abstract

Objective

Physical activity plays a specific role in the fundamental aspect of diabetes care. It is necessary to develop exercise programs for these patients. The aim of this systematic review is to summarize current evidence regarding the effectiveness of meditative movement in patients with type 2 diabetes.

Methods

The following databases were searched: PubMed, CENTRAL, Web of Science, Ovid LWW, and EMBASE. Two independent investigators searched and screened the studies by finding duplications, excluding irrelevant titles and abstracts, and then selecting eligible studies by reviewing full texts. 21 studies fulfilled the inclusion criteria. Meta-analyses were performed on glycated hemoglobin (HbA1c), fasting blood glucose (FBG) and postprandial blood glucose (PPBG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI).

Results

Meta-analyses showed that meditative movements significantly improved FBG, HbA1c, PPBG, TC, LDL-C, and HDL-C. No improvement was found in BMI.

Conclusions

The results demonstrated a favorable effect or tendency of meditative movements to improve blood glucose and blood lipid levels in patients with type 2 diabetes mellitus. The special effects of meditative movements in type 2 diabetes mellitus patients need further research.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7016481/

Improve Emotional Distress in The Elderly with Type 2 Diabetes with Mindfulness

March 25, 2020 psyjdc Leave a comment

Improve Emotional Distress in The Elderly with Type 2 Diabetes with Mindfulness

By John M. de Castro, Ph.D.

“Mindfulness based approaches has been found to be particularly effective in supporting diabetes management and the mental turmoil that is accompanied with a diagnosis of such as chronic physical illness. It can address the feelings of guilt, anger and aid self-acceptance to encourage the fulfilment of an unobstructed life. Mindfulness has also been found to have an enhanced clinical effect of glycemic control so not only aids psychological health but could potentially have a positive impact on the management of the physical condition.” – Diabetes UK

Acceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT). ACT 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. The problems resulting from diabetes get magnified in the elderly. So, it is important to study the efficacy of ACT for Type 2 Diabetes in the elderly.

In today’s Research News article “Efficacy of Acceptance And Commitment Therapy For Emotional Distress In The Elderly With Type 2 Diabetes: A Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802537/), Maghsoudi and colleagues recruited patients with Type 2 Diabetes over 60 years of age. They all continued on routine care while half were randomly selected to receive Acceptance and Commitment Therapy (ACT) in groups once a week for 90 minutes for 8 weeks. They were measured before and after training and 2 months later for diabetes-related emotional distress including the dimensions of emotional burden, physician-related distress, regimen-related distress and diabetes-related interpersonal distress.

They found that in comparison to baseline and the usual care group the patients who received Acceptance and Commitment Therapy (ACT) had significantly lower diabetes-related emotional distress. This lower diabetes-related emotional distress was maintained 2 months later. The study contained only a passive control condition, so caution must be exercised in interpreting the results. Nevertheless, ACT\ was a safe, effective, and lasting treatment to improve the emotions of elderly patients with Type 2 Diabetes.

So, improve emotional distress in the elderly with Type 2 Diabetes with mindfulness.

“Mindfulness training, including focused breathing and awareness training, helped U.S. veterans with diabetes significantly lower their diabetes-related distress and blood sugar levels and improve their self-management of the disease, researchers report.” – Science Daily

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

Maghsoudi, Z., Razavi, Z., Razavi, M., & Javadi, M. (2019). Efficacy Of Acceptance And Commitment Therapy For Emotional Distress In The Elderly With Type 2 Diabetes: A Randomized Controlled Trial. Diabetes, metabolic syndrome and obesity : targets and therapy, 12, 2137–2143. doi:10.2147/DMSO.S221245

Abstract

Introduction

Diabetes is among the common diseases in the elderly which results in depression, anxiety, and emotional distress in the elderly and impacts the disease control by the individual. This study was conducted with the aim of exploring the effectiveness of acceptance and commitment therapy (ACT) in the improvement of emotional distress in the elderly with type 2 diabetes.

Materials and methods

In this randomized control trial, 80 elderly with type 2 diabetes aged ≥60 years were randomly selected among the individuals visiting Yazd Diabetes Research Center. Then, the patients were randomly divided into two 40 individual groups, ie, the intervention group and the control group. The intervention group underwent group ACT during eight 90-min sessions. The diabetes-related emotional distress questionnaire was completed before the intervention, after the end of the group sessions and 2 months after that. The statistical software SPSS version 21 was used for data analysis.

Results

The emotional mean scores in the intervention and control groups were not significantly different before the intervention. However, the mean score of the intervention group was lower than of the control group immediately after the intervention (p=0.02) and 2 months after the intervention (p=0.02).

Conclusion

ACT results in the improvement of diabetes-related emotional distress in the intervention group. Considering the effectiveness of ACT, this therapeutic method is recommended to be used for the amelioration of emotional distress in the elderly with type 2 diabetes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802537/

Improve Blood Fat Levels in Type 2 Diabetes with Yoga

March 19, 2020 psyjdc Leave a comment

Improve Blood Fat Levels in Type 2 Diabetes with Yoga

By John M. de Castro, Ph.D.

“Yoga can do more than just relax your body in mind — especially if you’re living with diabetes. Certain poses may help lower blood pressure and blood sugar levels while also improving circulation, leading many experts to recommend yoga for diabetes management.” – Healthline

In today’s Research News article “Efficacy of a Validated Yoga Protocol on Dyslipidemia in Diabetes Patients: NMB-2017 India Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6963794/), Nagarathna and colleagues recruited a stratified sample of adult patients with Type 2 Diabetes and assigned them to receive yoga training that was specifically designed for the treatment of diabetes and consisted of 9 days of 2-hour training sessions followed by daily 1-hour practice at home guided by DVD. They were measured before training and 3 months later for body size and blood was drawn and assayed for fasting blood glucose, glycated hemoglobin (HbA1c), total cholesterol, triglycerides, LDL, VLDL, and HDL.

They found that in both male and female patients with Dyslipidemia (high blood fat levels) there was a significant decrease in the total blood fat levels produced by participation in the yoga program. This included significant decreases in triglycerides, LDL, and VLDL. These improvements were significantly greater in patients from rural areas than those from urban areas. Around two thirds of the patients with Dyslipidemia had their blood fat levels returned to normal levels after yoga practice.

These results are interesting but the lack of a comparison (control) conditions limits their significance. But prior controlled studies have shown the yoga practice produces significant improvements in the symptoms of Type 2 Diabetes. So, the present results likely also reflect the effects of yoga practice and not a confounding variable.

The results suggest that yoga practice can reduce Dyslipidemia in Type 2 Diabetes patients. It would be useful to follow up these patients to see if the treatment improves the patients’ overall health and reduces heart disease. The reduction in Dyslipidemia would predict such benefits.

So, improve blood fat levels in Type 2 Diabetes with yoga.

“findings suggest that yogic practices may promote significant improvements in several indices of importance in [Type 2 Diabetes] management, including glycemic control, lipid levels, and body composition.” – Kim Innes

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

Nagarathna, R., Tyagi, R., Kaur, G., Vendan, V., Acharya, I. N., Anand, A., … Nagendra, H. R. (2019). Efficacy of a Validated Yoga Protocol on Dyslipidemia in Diabetes Patients: NMB-2017 India Trial. Medicines (Basel, Switzerland), 6(4), 100. doi:10.3390/medicines6040100

Abstract

Background: Dyslipidemia is considered a risk factor in Type 2 diabetes mellitus (T2DM) resulting in cardio-vascular complications. Yoga practices have shown promising results in alleviating Type 2 Diabetes pathology. Method: In this stratified trial on a Yoga based lifestyle program in cases with Type 2 diabetes, in the rural and urban population from all zones of India, a total of 17,012 adults (>20 years) of both genders were screened for lipid profile and sugar levels. Those who satisfied the selection criteria were taught the Diabetes Yoga Protocol (DYP) for three months and the data were analyzed. Results: Among those with Diabetes, 29.1% had elevated total cholesterol (TC > 200 mg/dL) levels that were higher in urban (69%) than rural (31%) Diabetes patients. There was a positive correlation (p = 0.048) between HbA1c and total cholesterol levels. DYP intervention helped in reducing TC from 232.34 ± 31.48 mg/dL to 189.38 ± 40.23 mg/dL with significant pre post difference (p < 0.001). Conversion rate from high TC (>200 mg/dL) to normal TC (<200 mg/dL) was observed in 60.3% of cases with Type 2 Diabetes Mellitus (T2DM); from high LDL (>130 mg/dL) to normal LDL (<130 mg/dL) in 73.7%; from high triglyceride (>200 mg/dL) to normal triglyceride level (<200 mg/dL) in 63%; from low HDL (<45 mg/dL) to normal HDL (>45 mg/dL) in 43.7% of T2DM patients after three months of DYP. Conclusions: A Yoga lifestyle program designed specifically to manage Diabetes helps in reducing the co-morbidity of dyslipidemia in cases of patients with T2DM.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6963794/

Improve the Symptoms of Diabetic Neuropathy with Mindfulness

March 5, 2020 psyjdc Leave a comment

Improve the Symptoms of Diabetic Neuropathy with Mindfulness

By John M. de Castro, Ph.D.

“Daily mindfulness practice can be helpful for people living with chronic pain because sometimes there are negative or worrisome thoughts about the pain. These thoughts are normal, and can affect mood and increase pain. Being able to focus on relaxing the body, noticing the breath and body sensations as being there just as they are, can help manage pain, as well as reduce depression and anxiety symptoms.” – Mayo Clinic

Diabetes can lead to a very painful condition known as diabetic neuropathy. The high blood glucose levels associated with diabetes can damage nerves and result in a burning pain and numbness, particularly from the legs and feet. It affects the majority of long-term diabetes patients. This is not only painful but is also disruptive to the normal life functions of these patients. There are no cures, but diabetic neuropathy can be prevented by blood glucose control in the diabetic patient with a rigorous program of measured diet and exercise. Treatment for diabetic neuropathy usually involves pain management with drugs.

Mindfulness practices have been shown to help with pain management and with quality of life in diabetes patients. and has been shown to improve the symptoms of diabetic neuropathy. It is important, then, to continue studying the effectiveness of mindfulness practices for reducing pain and improving quality of life in patients with diabetic neuropathy.

In today’s Research News article “Mindfulness-Based Meditation Versus Progressive Relaxation Meditation: Impact on Chronic Pain in Older Female Patients With Diabetic Neuropathy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6757487/), Hussain and Said recruited elderly females with diabetes. They were randomly assigned to one of three condition, Mindfulness-Based Cognitive Therapy (MBCT), progressive muscle relaxation training, or a control condition consisting of 15 minutes of discussion and 20 minutes of quiet sitting. Treatment occurred twice a week for 8 weeks. MBCT consists of mindfulness training and Cognitive Behavioral Therapy (CBT). During therapy the patient is trained to investigate and alter aberrant thought patterns underlying their reactions to their neuropathy. The participants were measured before and after training for pain, analgesia, impression of change in their condition, and patient satisfaction.

They found that in comparison to baseline and the control group both the Mindfulness-Based Cognitive Therapy (MBCT) and progressive muscle relaxation groups had significant reductions in daily pain intensity and significant enhanced impression of change in their condition. In addition, the MBCT group had significant improvement in their satisfaction with treatment.

These results suggest that both Mindfulness-Based Cognitive Therapy (MBCT) and progressive muscle relaxation improve the daily pain of elderly female diabetic neuropathy patients and their perception of improvement in their condition. MBCT would appear to be somewhat superior to progressive relaxation in improving the condition. This is important as these patients suffer greatly and the pain interferes with their ability to conduct their lives. The pain relief is most welcome.

So, improve the symptoms of diabetic neuropathy with mindfulness.

“in addition to improving pain, mindfulness also addresses the psychological consequences of chronic pain, including depression symptoms.” -0 Shanna Patterson

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

Hussain, N., & Said, A. (2019). Mindfulness-Based Meditation Versus Progressive Relaxation Meditation: Impact on Chronic Pain in Older Female Patients With Diabetic Neuropathy. Journal of evidence-based integrative medicine, 24, 2515690X19876599. doi:10.1177/2515690X19876599

Abstract

Chronic pain, the most common complication of diabetes, is treated with medication often to no avail. Our study aimed to compare the use of mindfulness meditation and progressive relaxation to reduce chronic pain in older females with diabetes. Methods The 105 study participants were divided randomly into 3 groups: Group MM (mindfulness meditation), Group CM (control meditation), and Group PM (progressive relaxation meditation). Assessment of analgesic effectiveness required changes in average daily pain Brief Pain Inventory (BPI) modified for painful diabetic peripheral neuropathy and Patient Global Impression of Change using descriptive statistics, Student’s t test, and analysis of variance where applicable. Results Both Groups MM and PM experienced significant (P < .05) reduction in average daily pain in last 24 hours at study end compared to baseline (28.7% and 39.7%, respectively). Group MM had more significant (P < .01) reduction of pain compared to control, a score of 5.2 ± 1.2 dropped to 3.0 ± 1.1 by week 12 of treatment. Groups MM and PM showed significant improvement in patients’ impression at study end, 75 ± 5.1% (n = 36) and 61 ± 6.5% (n = 32), respectively. In Group MM, patient satisfaction scores increased significantly (P < .05) to 3.8 ± 1.9 by week 12. Conclusion Integrative therapies such as mindfulness meditation can be part of a comprehensive pain management plan. Benefits include reduction of pain-related medication consumption, better treatment outcomes, improvement in comorbid conditions such as anxiety and depression as well as no risk of addiction or abuse.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6757487/

Improve Type 2 Diabetes with Tai Chi Practice

January 18, 2020 psyjdc Leave a comment

Improve Type 2 Diabetes with Tai Chi Practice

By John M. de Castro, Ph.D.

“Tai Chi exercises can improve blood glucose levels and improve the control of type 2 diabetes and immune system response.” – Medical News Today

Type 2 diabetes is largely preventable. One of the reasons for the increasing incidence of Type 2 Diabetes is its association with overweight and obesity which is becoming epidemic in the industrialized world. A leading cause of this is a sedentary life style. Current treatments for Type 2 Diabetes focus on diet, exercise, and weight control. Recently, mindfulness practices have been shown to be helpful in managing diabetes. Tai Chi is mindfulness practice and a gentle exercise. As such, it is reasonable to investigate its usefulness in preventing and treating Type 2 Diabetes.

In today’s Research News article “Tai Chi for type 2 diabetes mellitus.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513484/), Zhou and colleagues review and summarize the published research randomized controlled trials of the effectiveness of Tai Chi practice for the treatment of Type 2 Diabetes. They report on 8 published randomized controlled trials.

The published studies found that in general Tai Chi practice produces significant improvements in the metabolic profile of Type 2 Diabetes patients including a significant reduction in fasting blood glucose levels, plasma HbA1c, total cholesterol, triglycerides, and body mass index (BMI). For fasting blood glucose levels, plasma HbA1c these reductions were greatest when Tai Chi had been practiced for at least 3 months.

These results suggest that Tai Chi practiced for at least 3 months is effective in treating Type 2 diabetes. It is important to recognize that Tai Chi is a gentle and safe exercise that is appropriate for all ages including the elderly and for individuals with illnesses. Also, Tai Chi is inexpensive to administer, can be performed in groups or alone, at home or in a facility, and can be quickly learned. In addition, it can be practiced in social groups. This can make it fun, improving the likelihood of long-term engagement in the practice. So, Tai Chi practice would appear to be an almost ideal gentle exercise to treat Type 2 Diabetes.

So, improve type 2 diabetes with Tai Chi practice.

“Diet and exercise are the cornerstone of diabetes management. People with diabetes who exercise regularly have better control over their blood glucose levels and fewer complications such as heart disease and stroke. Many people, however, are unable to keep up with their regular exercise because they either don’t enjoy it, or have a problem finding time to exercise. Tai chi offers a major advantage: It’s enjoyable, and to many, it’s almost addictive.” – Paul Lam

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

Zhou, J., Zhang, H., Shi, G., Zhang, L., Liu, H., Qin, Y., & Yang, J. (2018). Tai Chi for type 2 diabetes mellitus. The Cochrane Database of Systematic Reviews, 2018(7), CD009717. doi:10.1002/14651858.CD009717.pub2

Abstract

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

To assess the effects of Tai Chi for type 2 diabetes mellitus.

Background

Description of the condition

Diabetes mellitus is a metabolic disorder resulting from a defect in insulin secretion, insulin action, or both. A consequence of this is chronic hyperglycaemia (that is elevated levels of plasma glucose) with disturbances of carbohydrate, fat and protein metabolism. Long‐term complications of diabetes mellitus include retinopathy, nephropathy and neuropathy. The risk of cardiovascular disease is also increased. For a detailed overview of diabetes mellitus, please see under ‘Additional information’ in the information on the Cochrane Metabolic and Endocrine Disorders Group in the Cochrane Library (see ‘About’, ‘Cochrane Review Groups (CRGs)’).

Description of the intervention

Exercise or physical activity is one of the principal therapies for type 2 diabetes (Kirk 2007). A systematic review found that exercise can significantly reduce glycosylated haemoglobin A1c (HbA1c) levels by 0.6% (Thomas 2006). The rate of aerobic and resistance exercise necessary to achieve metabolic benefits in clinical trials has sometimes resulted in poor compliance (Brandon 2003), because a large proportion of adults with type 2 diabetes mellitus do not follow recommended physical activity guidelines (Mokdad 2003). A low‐impact, low‐intensity exercise such as Tai Chi may reduce poor compliance in this population and provide a beneficial alternative.

Tai Chi is a traditional Chinese martial art that has been practised for many centuries. The three major components of Tai Chi are movement, meditation and deep breathing (Li 2001a). There are various perspectives on how Tai Chi works. Eastern philosophy holds that Tai Chi unblocks the flow of ‘Qi’. When Qi flows properly, the body, mind and spirit are in balance and health is maintained (Cohen 1997). Others believe that Tai Chi works in the same way as other mind‐body therapies, i.e. the connection between the mind and the body can relieve stress, combat disease and enhance physical well‐being (Li 2001a; Qiang 2010). Tai Chi combines deep diaphragmatic breathing and relaxation with movement, including many fundamental postural stances, and Qi is said to flow imperceptibly and smoothly from one to the other through slow and soft activity (Chinese Sport 1983). Physical responses to Tai Chi do not exceed 55% of maximum oxygen intake or 60% of the individual maximum heart rate (Li 2001b).

Adverse effects of the intervention

Exercise may lead to hypoglycaemia, falls, injuries, pain or fatigue.

How the intervention might work

A meta‐analysis showed that exercise significantly improves glycaemic control and reduces visceral adipose tissue and plasma triglycerides, but not plasma cholesterol, in people with type 2 diabetes, independently of weight loss (Thomas 2006). Tai Chi is a low‐impact, low‐intensity exercise, and people with diabetes who exercise regularly have better glycaemia control and cardiovascular outcomes than those who do not exercise (Kuramoto 2006; Li 2001b). Tai Chi also has an impact on muscle mass through slow and gentle movements (Orr 2006; Qin 2005).

An insulin receptor defect is an important risk factor in the pathology of type 2 diabetes (Youngren 2007). Tai Chi exercise may increase insulin sensitivity (Wang 2008). Furthermore, Tai Chi enhances type 1 T helper function along with an increase in blood interleukin (IL)‐12 levels in people with type 2 diabetes mellitus (Yeh 2009).

Why it is important to do this review

Exercise is one of the principal therapies for type 2 diabetes mellitus and has definite effects and few side effects. Exercise interventions significantly improve glycaemic control, as indicated by a decrease in HbA1c. Tai Chi may be especially useful for elderly type 2 diabetes patients. Although Tai Chi may improve insulin sensitivity and lead to better glucose control, the evidence of the effects of Tai Chi on type 2 diabetes are still limited and conflicting. A systematic review of the effects of Tai Chi on type 2 diabetes is warranted.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513484/

Yoga Practice May Help Prevent the Development of Type II Diabetes

December 13, 2019 psyjdc Leave a comment

Yoga Practice May Help Prevent the Development of Type II Diabetes

By John M. de Castro, Ph.D.

In today’s Research News article “.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795440/), Ramamoorthi and colleagues reviewed, summarized, and performed a meta-analysis of the published controlled research studies of the effectiveness of yoga practice in improving prediabetic symptoms. The found 14 published studies with a total of 834 participants.

They report that the published research found that yoga practice significantly improved prediabetic symptoms. They included a significant reduction in fasting blood glucose levels and systolic blood pressure, and improved blood lipid profiles including low density lipoproteins, cholesterol, and triglycerides.

This meta-analysis suggests that yoga practice is a safe and effective practice that improves the metabolic signs predictive of future Type II diabetes. It appears to improve glycemic control, blood lipid profiles, and blood pressure. These are very encouraging results. It will be important to follow-up over the long-term to see if these improvements are lasting and if they reduce the transition from then prediabetic state to Type II diabetes.

So, yoga practice may help prevent the development of Type II Diabetes.

“yoga for diabetes provides unique benefits that can effectively restore the body to a state of natural health and proper function.” – Yoga U

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

Ramamoorthi, R., Gahreman, D., Skinner, T., & Moss, S. (2019). The effect of yoga practice on glycemic control and other health parameters in the prediabetic state: A systematic review and meta-analysis. PloS one, 14(10), e0221067. doi:10.1371/journal.pone.0221067

Abstract

A systematic review and meta-analysis was conducted to investigate the effects of yoga on glycemic control, lipid profiles, body composition and blood pressure in people in the pre-diabetic state. Studies on the effectiveness of yoga on population groups under high risk for diabetes, called prediabetic or suffering from metabolic syndromes were extracted from a thorough search of PubMed, Scopus, Cochrane Library, EBSCO and IndMED databases. Both Randomised Controlled Trial (RCT) and non-RCT studies were included in the systematic review and meta-analysis. Studies published between Jan 2002 and Dec 2018 were included. Studies were considered for evaluation if they investigated a yoga intervention to prevent T2DM, against a control group, while also reporting glycemic control and other health parameters of T2DM management. Summary effect sizes and 95% confidence intervals (CI) were calculated using the Comprehensive Meta-Analysis software in addition to publication bias. Of the 46,500 identified studies, 14 studies with 834 participants of whom were 50% women, were found to be eligible for inclusion in our systematic review. Our quantitative synthesis included 12 randomized control trials and 2 non-randomized control trials, with the follow-up period ranging from 4 to 52 weeks. Compared to controls, yoga intervention improved fasting blood glucose (FBG) [Standard Mean Difference (SMD -0.064 mg/dL (95% CI -0.201 to 0.074)]; low density lipoprotein (LDL) [SMD-0.090 mg/dL (95% CI -0.270 to 0.090)]; triglycerides [SMD -0.148 mg/dL (95% CI -0.285 to -0.012)]; total cholesterol [SMD -0.058 mg/dL (95% CI -0.220 to 0.104)] and systolic blood pressure [SMD -0.058 mm Hg (95% CI -0.168 to 0.053)]. This meta-analysis uncovered clinically improved effects of yoga intervention on glycemic control, lipid profiles and other parameters of T2DM management in prediabetic population. These results suggest that yoga intervention may be considered as a comprehensive and alternative approach to preventing T2DM. Further adequately powered, well designed RCTs are needed to support our findings and investigate the long-term effects of yoga in T2DM patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795440/

Mindfulness’ Reduction of Depression is not Related to Patient Engagement, Therapist Adherence or Interpersonal Skills

August 30, 2019 psyjdc Leave a comment

Mindfulness’ Reduction of Depression is not Related to Patient Engagement, Therapist Adherence or Interpersonal Skills

By John M. de Castro, Ph.D.

“Mindfulness training helps improve a patient’s engagement with their health, particularly in patients with chronic pain. It fosters a sense of bodily engagement and improves an individual’s ability to promote their health and well-being outside of the clinical setting.” – Caroline Meade

Psychotherapy is an interpersonal transaction. Its effectiveness in treating the ills of the client is to some extent dependent upon the chemistry between the therapist and the client, termed the therapeutic alliance. Research has demonstrated that there is a positive relationship with moderate effect sizes between treatment outcomes and the depth of the therapeutic alliance. The personality and characteristics of the therapist are essential ingredients in forming a therapeutic alliance. Research has shown that effective therapists are able to express themselves well. They are astute at sensing what other people are thinking and feeling. In relating to their clients, they show warmth and acceptance, empathy, and a focus on others, not themselves.

There are also other factors that may be important for successful therapy. The client’s engagement in the process may be as important as the therapists. In addition, the therapist’s adherence to the therapeutic program or interpersonal skills may also be important ingredients in producing successful therapeutic outcomes. There is little known, however, of the role of these characteristics in the effectiveness of treatment for mental health issues such as depression.

In today’s Research News article “Explaining variability in therapist adherence and patient depressive symptom improvement: The role of therapist interpersonal skills and patient engagement. Clinical psychology & psychotherapy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585745/), Snippe and colleagues recruited adults with diabetes and comorbid depression and randomly assigned them to receive either Mindfulness-Based Cognitive Therapy (MBCT), Cognitive Behavioral Therapy, or to a wait-list. Treatments occurred in 8 weekly 45-60-minute sessions. MBCT was specifically developed to treat depression and involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy that is designed to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms, particularly depression.

The patients were measured before and after treatment for depression. “Therapists received a structured treatment manual including specific instructions on exercises, inquiry, and homework assignments per session.” All treatment sessions were video recorded. The recordings were viewed and coded by 2 blinded evaluators who rated the sessions according to the therapists’ adherence to the manual, therapists’ interpersonal skills, and client engagement in the sessions.

They found that although depression levels were significantly reduced by both treatments, the degree of improvement was not related to either the therapists’ adherence to the manual, therapists’ interpersonal skills, or to the clients’ engagement in the sessions. They found that the clients’ engagement in the sessions was positively associated with the therapists’ adherence to the manual. They also found that non-adherence to the manual occurred with verbose clients, when no symptoms were present, and with the clients’ life events during the week.

The results are interesting and reveal, as has previously been reported, that Mindfulness-Based Cognitive Therapy (MBCT) and Cognitive Behavioral Therapy (CBT) are both effective in reducing depression. It is interesting that the degree of effectiveness was not related to therapists’ adherence to the manual, therapists’ interpersonal skills, or to the clients’ engagement in the sessions. It remains for future research to identify the factors responsible for differing therapeutic outcomes.

So, mindfulness’ reduction of depression is not related to patient engagement, therapist adherence or interpersonal skills.

“When you are looking at primary care, this is the single most important thing. Can your intervention help enhance people’s capacity for self-management and health behavior change, especially among those who struggle most with self-regulation? Because at the heart of accountable care and patient-centered care is people being able to self-manage their own illness.” – Zev Schuman-Olivier

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

Snippe, E., Schroevers, M. J., Tovote, K. A., Sanderman, R., Emmelkamp, P., & Fleer, J. (2019). Explaining variability in therapist adherence and patient depressive symptom improvement: The role of therapist interpersonal skills and patient engagement. Clinical psychology & psychotherapy, 26(1), 84–93. doi:10.1002/cpp.2332

Abstract

Understanding why therapists deviate from a treatment manual is crucial to interpret the mixed findings on the adherence–outcome association. The current study aims to examine whether therapists’ interpersonal behaviours and patients’ active engagement predict treatment outcome and therapist adherence in cognitive behaviour therapy (CBT) and mindfulness‐based cognitive therapy (MBCT) for depressive symptoms. In addition, the study explores rater’s explanations for therapist nonadherence at sessions in which therapist adherence was low. Study participants were 61 patients with diabetes and depressive symptoms who were randomized to either CBT or MBCT. Depressive symptoms were assessed by the Beck Depression Inventory‐II. Therapist adherence, therapist interpersonal skills (i.e., empathy, warmth, and involvement), patients’ active engagement, and reasons for nonadherence were assessed by two independent raters (based on digital video recordings). Therapist adherence, therapists’ interpersonal skills, and patients’ active engagement did not predict posttreatment depressive symptom reduction. Patients’ active engagement was positively associated with therapist adherence in CBT and in MBCT. This indicates that adherence may be hampered when patients are not actively engaged in treatment. Observed reasons for nonadherence mostly covered responses to patient’s in‐session behaviour. The variety of reasons for therapist nonadherence might explain why therapist adherence was not associated with outcomes of CBT and MBCT.

Key Practitioner Message

Therapist adherence was not associated with posttreatment depressive symptom improvement after CBT and MBCT
Patient engagement was positively associated with therapist adherence to CBT and MBCT
A broad variety of patient‐related reasons for therapist nonadherence were observed, of which some may not result in poorer treatment outcomes and may rather reflect therapist flexibility.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585745/