A new randomized trial shows that on average, three months after receiving a series of 10 massage sessions, patients had half the symptoms of anxiety. This improvement resembles that previously reported with psychotherapy, medications, or both. But the trial, published in the journal Depression and Anxiety, also found massage to be no more effective than simple relaxation in a room alone with soft, soothing music.

“We were surprised to find that the benefits of massage were no greater than those of the same number of sessions of ‘thermotherapy’ or listening to relaxing music,” said Karen J. Sherman, PhD, MPH, a senior investigator at Group Health Research Institute. “This suggests that the benefits of massage may be due to a generalized relaxation response.”

Massage therapy is among the most popular complementary and alternative medical (CAM) treatments for anxiety, she added. But this is the first rigorous trial to assess how effective massage is for patients with generalized anxiety disorder.

The trial randomly assigned 68 Group Health patients with generalized anxiety disorder to 10 one-hour sessions in pleasant, relaxing environments, each presided over by a licensed massage therapists who delivered either massage or one of two control treatments:

* Relaxation therapy: breathing deeply while lying down

* Thermotherapy: having arms and legs wrapped intermittently with heating pads and warm towels

All three treatments were provided while lying down on a massage table in a softly lighted room with quiet music. All participants received a handout on practicing deep breathing daily at home. Unlike the two control treatments, massage was specifically designed to enhance the function of the parasympathetic nervous system and relieve symptoms of anxiety including muscle tension.

Using a standard rating scale in interviews, the researchers asked the patients about the psychological and physical effects of their anxiety right after the 12-week treatment period ended and three months later, Dr. Sherman said.

All three of the groups reported that their symptoms of anxiety had decreased by about 40 percent by the end of treatment – and by about 50 percent three months later. In addition to the decline in anxiety, the patients also reported fewer symptoms of depression and less worry and disability. The research team detected no differences among the three groups; but the trial did not include a control group that got no treatment at all.

“Treatment in a relaxing room is much less expensive than the other treatments (massage or thermotherapy), so it might be the most cost-effective option for people with generalized anxiety disorder who want to try a relaxation-oriented complementary medicine therapy,” Dr. Sherman said.

Researchers at UC Irvine and the Charles Drew University of Medicine & Science (CDU) will monitor the day-to-day health of low-birth-weight babies and their parents as part of a comprehensive initiative designed to combat chronic illnesses associated with low-weight births.

Gillian Hayes, UCI informatics professor, and Karen Cheng, CDU psychiatry & human behavior professor, were awarded a $480,000 grant from the Robert Wood Johnson Foundation (RWJF) to explore how recorded observations of daily living (ODLs) can be used to improve clinical care for low-weight babies.

Hayes and Cheng were among five research teams in the nation selected by RWJF through its Project HealthDesign: Rethinking the Power and Potential of Personal Health Records national program to receive two-year grants that will test how health information technology can help people become more informed patients and better healthcare consumers. The grantees will work with patients to explore how day-to-day information – such as stress levels of caregivers of premature infants and medication-taking routines of seniors at risk of cognitive decline – can be collected, interpreted and acted upon by patients as well as clinicians in real-world clinical settings.

For their project, Hayes and Cheng will use mobile technology to collect and report ODLs that can enable changes in clinical practices and alert healthcare providers earlier to potential problems. The team will develop a mobile application for parents of preterm infants, called FitBaby, which builds on Hayes’ past work with Dr. Dan Cooper, a UCI professor of pediatrics. The system enables parents to easily record ODLs on smartphones, including feeding times, weight measurements, baby’s activity and how parents deal with the stress of caring for an at-risk infant. The system also automatically tracks some observations through sensors in the environment.

“This work is particularly innovative in that we make it convenient for parents to record daily information about their babies by automatically sensing a number of important indicators,” Hayes said. “Pediatricians will have access to the information to make earlier diagnoses, which can improve the health outcomes of babies and caregivers.”

“Parent well-being is often ignored in infant care,” Cheng said. “By helping parents monitor and understand the patterns of their own emotional and physical well-being, we believe that parents will be encouraged to take better care for themselves, leading to better quality of care for the babies.”

Earlier Project HealthDesign work revealed that the data needed to inform day-to-day health decisions came less often from information contained in official medical records and more from information gained by monitoring health in everyday life. The new projects will build on that work.

“We know patients want better relationships with their clinicians and to make the most of their time during a doctor’s visit. Through Project HealthDesign, the patients and the clinicians will be working together to collect and interpret insights from the patient’s everyday life. This process will help empower people to be more informed patients and allow clinicians to determine if their care plan is working,” said Stephen Downs, S.M., assistant vice president for RWJF’s Health Group.

Since its launch in 2006, RWJF has committed $9.5 million in grants and technical assistance to the program, led by a team of experts working in health information technology and patient-centered care at the University of Wisconsin-Madison. Project HealthDesign is supported by RWJF’s Pioneer Portfolio, which funds innovative ideas and projects that can lead to significant breakthroughs in the future of health and health care.

In addition, the program provides legal and regulatory compliance support to grantees and contributes to the public discourse on the legal and regulatory aspects of capturing ODLs and integrating them into care processes. The program will develop resources around the cross-cutting issues regarding use and safe integrations of ODLs as well as specifically advise grantee teams on applicable law and regulations that may alter the consequences of data-sharing between patients and clinicians.

Hayes’ research interests are in human-computer interaction and ubiquitous computing. She studies record-keeping technologies, particularly in natural settings, such as the home. She also focuses on the application and uses of ubiquitous computing and collaborative technologies in the areas of education and healthcare.

Cheng is a social psychologist whose research focuses on the issues affecting use of computer technology in healthcare settings. Her work evaluates the efficacy of electronic versus paper-based data collection, and the acceptance of mobile health technologies among underserved populations, locally and in developing countries.

People who are stressed by daily problems or trouble at work seem to be more likely to grind their teeth at night. Researchers writing in BioMed Central’s open access journal Head & Face Medicine studied the causes of ’sleep bruxism’, gnashing teeth during the night, finding that it was especially common in those who try to cope with stress by escaping from difficult situations.

Maria Giraki, from Heinrich-Heine-University, Düsseldorf, Germany, worked with a team of researchers to study the condition in 69 people, of whom 48 were ‘bruxers’. She said, “Bruxing can lead to abrasive tooth wear, looseness and sensitivity of teeth, and growth and pain in the muscles responsible for chewing. Its causes are still relatively unknown, but stress has been implicated. We aimed to investigate whether different stress-factors, and different coping strategies, were more or less associated with these bruxism symptoms”.

Tooth grinding was measured by thin plates that were placed in trial participants mouths’ overnight, while stress and coping techniques were assessed by three questionnaires. Bruxing was not associated with age, sex or education level, but was more common in people who claimed to experience daily stress and trouble at work. Giraki adds, “Our data support the assumption that people with the most problematic grinding do not seem to be able to deal with stress in an adequate way. They seem to prefer negative coping strategies like ‘escape’. This, in general, increases the feeling of stress, instead of looking at the stressor in a positive way”.

Many people feel insecure when they drive in tunnels. However, their anxiety can be reduced.

“Driving in tunnels is actually twice as safe as driving in the open air, when all factors are taken into account,” says SINTEF scientist Gunnar Jensen.

However, a rough estimate suggests that as many as 10 – 20 percent of the population feel uncomfortable or very uncomfortable driving in tunnels. Older people in particular tend to feel insecure.

In a previous study carried out by SINTEF, as many as 40 percent of the older age-group said that they felt extremely insecure driving in tunnels. They spoke of walls and road lanes that seemed to shrink, and of a feeling of being completely exhausted when they eventually reached the end of the tunnel.

Gunnar Jenssen believes that this may be due to the fact that elderly people tend to have poorer vision than younger people. This means that lighting conditions in tunnels play a decisive role in determining how people experience tunnels, he believes.

Design can reduce discomfort

On this background, SINTEF transport researchers have been studying the use of various ranges of colour, lighting and patterns, as well as the use of cavern spaces in tunnels. The group’s driving simulator has been and still is a very aid in testing out lighting designs.

“The cavern in the tunnel is one measure that is high on our list. The trumpet-like widenings of the caverns’ entrances and exits are a way of breaking up the impact of long tunnels. The 24.5 km-long Lærdal Tunnel has three well-lit caverns designed according to proposals submitted by the Kadabra Produktdesign company, researchers and the artists Arild Juul and Brit Dyrnes.

Norwegian breathing spaces in Chinese tunnel

In 2007, the lighting design from Trondheim was exported to China, and Gunnar Jenssen was project manager for “Safety and Lighting Design” when that country inaugurated the world’s longest twin-tube tunnel, the Qinling Zhongnan Mountain Tunnel, in which the monotony is broken by huge caverns excavated at intervals of three to seven kilometres.

“The tunnel is 18×2 kilometres long, and to begin with it was a dry, monotonous tunnel, which was then developed in collaboration with Norwegian artists and designers into an oasis with palm-trees and clouds on the roof ,” says Jenssen.

Lighting for safety

The main point is to obtain a good distribution of light, in conjunction with the use of artistic lighting, which turns out to give drivers a feeling of space and of greater security. Modern lighting systems, with two rows of lamps, light sources that illuminate the opposite direction and driving lane, are beginning to be quite common in new Chinese tunnels, and they have also been installed in the tunnel that forms part of the Øresund Link between Denmark and Sweden.

This study shows that cognitive behavioural therapy (CBT) is effective in dealing with patients suffering from lupus and high levels of daily stress as it significantly reduces the incidence of psychological disorders associated with lupus and improves and maintains patients’ QOL, despite there being no significant reduction in the disease activity index.

A study that is published in the current issue of Psychotherapy and Psychosomatics by a group of Spanish investigators addresses the role of cognitive behavioral treatment in systemic lupus erythematosus.

Chronic stress worsens the quality of life (QOL) of lupus patients by affecting their physical and psychological status. The effectiveness of a cognitive-behavioural intervention in a group of patients with lupus and high levels of daily stress was investigated. Forty-five patients with lupus and high levels of daily stress were randomly assigned to a control group (CG) or a therapy group (TG); they received cognitive behavioural therapy (CBT) which consisted of ten consecutive weekly sessions. The following variables were evaluated at baseline and at 3, 9 and 15 months: (1) stress, anxiety, depression, (2) Systemic Lupus Erythematosus Disease Activity Index, somatic symptoms, number of flares, (3) anti-nDNA antibodies, complement fractions C3 and C4 and (4) QOL. A multivariate analysis of repeated measures and various analyses of variance were carried out.

The investigators found a significant reduction in the level of depression, anxiety and daily stress in the TG compared to the CG and a significant improvement in QOL and somatic symptoms in the TG throughout the entire follow-up period. They did not find any significant changes in the immunological parameters. CBT is effective in dealing with patients suffering from lupus and high levels of daily stress as it significantly reduces the incidence of psychological disorders associated with lupus and improves and maintains patients’ QOL, despite there being no significant reduction in the disease activity index.

A systematic review that is published in the current issue of Psychotherapy and Psychosomatics by Schulte and associates (University of Bremen, Germany) analyzes what is the psychosomatic component of abdominal pain with no apparent cause in children.

The objective of this study was to review the extant literature on functional abdominal pain in childhood through the lens of the developmental psychopathology perspective and to systematize research results by means of a two-stage pathway model in which the emergence of functional abdominal pain and its potential transition into a somatoform adjustment disorder is outlined. The investigators used electronic searches for published studies and previous reviews about functional abdominal pain. An association of functional abdominal pain with internalizing symptoms, poor well-being of family members, major life events and daily stressors was found. The impact of stress on pain seems to be moderated by the children’s coping style and their perceived competence and self-efficacy to manage the pain experience. There is evidence for the influence of modeling and operant mechanisms on pain experiences. A new term, ’somatoform adjustment disorder’, and its relation to functional abdominal pain is discussed. It seems that those children with functional abdominal pain who cannot adapt to the pain indeed run the risk of developing a somatoform adjustment disorder.

President Barack Obama’s recent physical examination revealed that he is in generally good health and that he is still trying to quit smoking. His doctor’s advice: keep up his “smoking cessation efforts”; in other words, he should keep trying to kick the habit.

Susan Rausch, health educator at the Pat Walker Health Center and co-chair of the University of Arkansas’ FRESH campaign to promote the Tobacco Free Campus policy, says that stress is one of the reasons people give for not being able to quit smoking.

“Obviously, President Obama has a very stressful job,” she says. “But University of Arkansas students facing mid-term exams know something about stress, too. There are ways to deal with stress and quit smoking, too.”

Her advice for the president, and anyone with the same problem, and same goal, is a five-step plan.

1. Deal with your stress first! Stress by itself is bad for your health. Examine your day and identify the sources of your stress. Research stress reduction strategies and find ones that will work for you. Make physical activity that you enjoy a part of each day.

2. Ask yourself why you want to quit smoking. The key to success is personal choice: It has to be for you. Envision yourself as a non-smoker. Think of quitting as a gift you give yourself, not something that you are taking away.

3. Set a date for quitting.

4. Prepare for that quit date by cutting down and each time you smoke ask yourself how much you “needed” that cigarette. Freshen your surroundings: clean your home, car, clothes even your teeth. The spring season is a prime time for this.

5. On your quit date, plan to be somewhere smoking is not allowed, and reward yourself each day you don’t smoke.

Rausch says it’s also important to remember that relapse is not failure.

“Most smokers try several times before they achieve freedom. Each attempt teaches you something about the type of smoker that you are and the role of tobacco in your life. The better you understand yourself, the more likely you will succeed. The important thing is to keep trying. That’s true for a student, a professor, a staff worker or even the president of the United States.”

Conducted at the Department of Developmental and Educational Psychology from the University of Granada, the research reveals that the negative effects on the caregiver’s physical, psychological and social development are highly associated with previous life history between caregiver and care receiver. To carry out this work, researchers applied a questionnaire to a population of 203 subjects whose only requirement was to be the informal caregiver of a dependent elderly person.

8 out of 10 people in charge of caring for a relative suffer from anxiety and stress, regardless of their socio-demographic variables. Families, and particularly daughters, assume the “informal care” of dependent elderly people in most of the cases. This follows an investigation carried out by Ruth M ª Calero Pérez and directed by professor José Mª Roa Venegas at the Department of Developmental and Educational Psychology at the University of Granada.

The work in the UGR shows that in some cases this care in the family creates inappropriate behaviour in the relationship, and that the negative effects on the physical, psychological and social caregiver are highly related to the previous life history between caregiver and care recipient, social isolation felt by the caregiver, and the feeling of loneliness in the relationship with the care recipient.

To carry out this work, the researchers applied a questionnaire to a population of 203 subjects whose only requirement was to be the informal caregiver of a dependent elderly person.

Family and institutional support

Results reveal that both positive and negative cognitive variables (thoughts and assessments) used by the caregiver have a decisive influence on how caregiver and care receiver relate to each other. These variables include family support and institutional support, and modulate the relationship between caregiver and care receiver.

In addition, cultural variables such as parenting patterns and styles of education received, have clear implications in the way of being and acting of informal carers, which will impact on the work of caring.

Researchers from the UGR intend to monitor all these variables as a first step towards government intervention in order to improve the quality of life of this group, and consider that this action “should use a psychoeducational approach and, somehow, ensure a better quality of life for dependent elderly people’s carers.

The fact is that the relationship between informal caregiver and care recipient, the authors note, “it is not an innocuous relationship, but it is full of effects, sometimes harmful, for the caregiver’s physical and psychological health. Effects of stress, anxiety, stress, etc., are known to affect the informal caregiver. But we believe these variables are insufficient to explain the variability that occurs in the conduct of the caretaker in his relationship with the care receiver. Therefore, it seemed interesting to us to introduce variables of a cognitive and (rather less studied) socio-cultural nature, in order to clarify that variability as far as possible.”

Stress is one of the most frequently used ‘buzz words’ across Western societies with an array of meanings ranging from scientifically defined experimental conditions for laboratory animals to a casual word for a nuisance. In humans, stress is mostly used as a term for psychological hardship and it causes a variety of conditions with, psychological, medical and sociological implications.

There have been many studies on the behaviour and physiological effects of stress, but now,for the first time, Professors Hermona Soreq, Alon Friedman and Daniela Kaufer provide in their new title ‘Stress – From Molecules to Behavior’ a comprehensive overview of the molecular basis of stress from a neurolobiological and immunological perspective.

Stress – From Molecules to Behavior explores the responses and changes of the nervous system upon stress exposure, providing a unique and fundamental insight into the molecular, physiological and behavioural basis of the stress response of a whole organism.

“It is well known that stress response may induce profound behavioural changes as well as physiological changes in the nervous and the immune system,” said Editor Professor Hermona Soreq from the Hebrew University of Jerusalem. “Unfavourable consequences of stress response are a common health problem in many societies, but studying the underlying molecular mechanisms driving stress induced changes opens the possibility of more targeted therapeutic approaches.”

Stress – From Molecules to Behavior takes a strong interdisciplinary approach, dealing with stress from a neurological, medical, behavioural, immunological and cellular angle. This approach provides an insight into the molecular alterations of the nervous system in response to stress, the molecular basis of stress related cognition and behavioural changes, and explores the interplay between the nervous and the immune system upon stress exposure.

Key sections of the title deal with neurotransmitter release, hormone metabolism and neurogenesis in response to stress stimuli, as well as the consequences of these factors on the immune system and the consequential behaviour of individuals.

First it was exercise on prescription, then it was arts on prescription, soon it could be singing on prescription, as the clinical evidence builds up, and as more and more projects promote the benefits of singing to health and wellbeing, both for those in generally good health and those with physical and mental health problems, or who find themselves socially excluded or isolated.

Consider this scenario: you go to your doctor and instead of coming away clutching a prescription for a bottle of pills or a referral to a counsellor, you have a leaflet about a local singing group. This is the vision of Grenville Hancox MBE, Director of the Sidney De Haan Research Centre for Arts and Health based at Canterbury Christ Church University in the UK.

Imagine the day, says Hancox, when your GP says: “Go and have a sing with that lot down the road” instead of “take these pills three times a day!”

Exercise on prescription schemes have been gaining ground all across the UK over the last decade, to the point where there are now national standards for GP exercise referral schemes. And more recently, Arts on prescription appeas to be growing too, as exemplified with projects by Healing Arts on the Isle of Wight (Time Being) and East Kent Health Promotion Department.

But the idea that involvement in group singing can benefit health and wellbeing is also growing; the Sidney De Haan Research Centre lists several established projects:

* Singing for the Brain, East Berkshire Alzheimer’s Society.
* Sing Your Heart Out, Hellesdon Hospital, Norwich
* Serendipity Singing for Health Choir, Midlothian
* Singing is Good for You, Voices Foundation
* Singing Medicine, Birmingham Children’s Hospital
* Sounds Lively Choir, Isle of Wight

And at Sidney De Haan they are also working on “providing a convincing rationale” for a practical scheme for Singing on Prescription that “can be tested for its effectiveness through controlled evaluation”, according to a statement on their website.

Chreanne Montgomery-Smith, a support and development officer with the West Berkshire branch of the Alzheimer’s Society founded Singing for the Brain in 2002.

She wrote in 2006 in the Journal of Dementia Care she believed there were seven therapeutic outcomes from singing in a group that were of particular benefit to people with Alzheimer’s, although one can see how these might apply to people in many other situations too:

* Communication: the singing warm up (exercises involving whole body, neck, shoulders, jaw, face, lips, tongue, diaphragm) strengthen neural connections to the voice and breath, and doing them in a group is fun and non-threatening compared to doing it one-to-one.

* Cognition: singing challenges concentration and attention, especially when techniques such as singing from memory, combining rhythm with action, and mental substitution are used.

* Engagement: for example making eye contact across the group and expressing to the audience the emtional message of a song.

* Confidence: joining a singing group can build confidence from the gradual gaining of skills, vocal strength and the thrill of being able to remember so much. Fear of failure is lessened when everyone is in the same situation and group members laugh together when they make mistakes.

* Relationships: in a group with a shared purpose and a leader that treats everyone equally, there is a chance to get away from those situations where you are a person with a condition, and relate to people in a different way. You make friends, find and give support, and express frustrations and emotions about relationship problems in many songs that cover those areas of life (Montgomery-Smith gives the example of “A Fine Romance” as a “safe” way to express one’s frustration with a life partner).

* Empowerment: by leading singing rounds, taking responsibility for setting out chairs, getting scores ready, writing lyrics, greeting new members, there is a wide range of roles that help people feel more in charge of themselves and their lives and what they contribute to a group. Former carers also benefit: giving them a new role when they have lost a major one.

* Exercise and stress reduction: an excellent way to reduce stress is learning to exhale; it increases circulation as the diaphragm massages internal organs. It releases endorphins and improves the immune response, according to research that showed immune system changes in salivary Immunoglobulin A and Cortisol.
Dr Nicholas Hopkinson, who is leading the study at the Royal Brompton, said the study was trialling a novel approach with teaching breathing techniques. Often, when you try to teach a patient directly, they become even more conscious of the need to breath correctly, and this can make things worse, he said.

By learning to sing, the patients are being approached more “from the side”, said Hopkinson, they are learning to “use their voice and their breathing for a different purpose, for singing, hoping that the skills that they gain through that in terms of controlling their breathing will actually be helpful in day-to-day life,” he told the BBC.

Voice trainer Phoene Cave said she saw improvements in breathing control after just one session.

“I’m helping them to become aware of their bodies in a way that they’re not used to,” she told the BBC.

The class always starts with vocal exercises, including collective sighing, buzzing noises, and making “ha-ha” sounds up and down the scales.

Research suggests that regular singing practice also helps people with dyspnea, improves mood and reduces depression.

John Townsend, a patient in the Royal Brompton and member of the singing group, said that the evidence was plain to see. He explained how when they start their lessons, people from the wards just come along and join in:

“You can hear it all the way along the wards. And people are cheerful.”

“They become cheerful and they’re not even singing. So of course it’s a great thing,” said Townsend.