anxiety

Posted on Autism

Study explores how changing autism traits are linked to mental health conditions.

Findings suggest that some restrictive and repetitive behaviors may help reduce anxiety for autistic individuals
Findings suggest that some restrictive and repetitive behaviors may help reduce anxiety for autistic individuals

A long-term study by UC Davis Health researchers sheds new light on the relationship between autism traits and mental health in middle childhood. The paper, published in the journal Autism, finds that changes in core autism characteristics are related to whether children develop additional mental health challenges during their elementary school years.

“Our findings suggest that different aspects of a child’s development may affect each other over time,” explained Einat Waizbard-Bartov, a doctoral researcher in developmental psychology at the UC Davis MIND Institute and the lead author on the paper. “Core autism traits and mental health challenges likely interact throughout development.”

A key finding was that a reduction in restrictive and repetitive behaviors during elementary school was linked to the emergence of mental health challenges, lending support to the idea that these behaviors may benefit autistic individuals. An increase in social-communication difficulties during this time was also linked to anxiety and other mental health challenges.

Study design

Waizbard-Bartov has published previous research showing autism characteristics can change significantly from ages 3 to 11.

The current study included 75 autistic children ages 6 to 11, including 15 girls. All were part of the MIND Institute’s Autism Phenome Project, a large, long-term study aimed at identifying different subtypes of autism.

Through parental interviews and questionnaires, the research team evaluated the children for mental health symptoms and restricted and repetitive behaviors, which can include seeking sensory stimulation, hand-flapping or sticking to set routines.  

They tracked changes in autism characteristics using the Autism Diagnostic Observation Schedule Calibrated Severity Score.

About a fifth (21%) of the youth had more severe social-communication difficulties, as well as an increase in anxiety, ADHD and behavioral challenges. In contrast, nearly 23% had decreased restricted and repetitive behaviors but higher anxiety levels by age 11. Nearly all — 94% —met the criteria for an anxiety disorder.

About a third of the participants had both decreasing restricted and repetitive behaviors and increased social-communication difficulties.

“We were pleased to see that our results confirmed what has been suspected by other autism researchers and clinicians as well as autistic individuals, that some forms of restricted and repetitive behaviors can potentially help to self-soothe,” said David Amaral, distinguished professor in the Department of Psychiatry and Behavioral Sciences, MIND Institute faculty member and senior author on the paper.

Waizbard-Bartov notes that the findings question the wisdom of therapies that try to eliminate these behaviors.

“In light of this, when thinking about interventions, it might be that trying to eliminate repetitive behaviors without providing alternative self-soothing tools is not the ideal way to go,” she said.

The study is the first, to the authors’ knowledge, to demonstrate an association between mental health challenges and increases in the severity of social-communication difficulties for autistic children. 

“This occurred in children who showed decreases in core autism traits during early childhood and whose cognitive functioning was in the typical range. We don’t currently understand why this happened. One possibility is that due to their relatively high cognitive ability, they became aware of their social challenges, and this may have contributed to increasing anxiety,” Amaral explained. “It’s definitely an area where we need more research.”

Posted on Pain Management

Music therapy significantly reduces pain, stress, and anxiety in community hospitals

UH Cleveland Medical Center
IMAGE: UH CLEVELAND MEDICAL CENTER view more CREDIT: UNIVERSITY HOSPITALS

CLEVELAND – A new study from University Hospitals (UH) Connor Whole Health found patients with moderate-to-severe pain, stress, or anxiety treated at UH community hospitals reported clinically significant reductions in pain, stress, and anxiety in response to a single session of music therapy. Furthermore, the clinically significant effect on pain was not influenced by patients’ demographic or clinical characteristics, suggesting that music therapy can be effective for acute pain management across various inpatient adult populations. The findings from this study were recently published in the journal, Pain Reports, a leading journal focusing on advancing pain research.

In this retrospective study conducted between January 2017 and July 2020, researchers from UH Connor Whole Health examined the first music therapy interventions provided to 1,056 adults receiving inpatient medical care who reported pre-session pain, anxiety, and/or stress scores greater than or equal to 4 on the 0 to 10 numeric rating scale. Unlike prior studies of music therapy, which have primarily been conducted at academic medical centers, this is the first and largest investigation of the real-world effectiveness of music therapy within community medical centers. This study builds upon a history of seminal music therapy studies funded by the Kulas Foundation, the country’s leading foundation for funding scientific research in music therapy, that have investigated the efficacy of music therapy in palliative care, surgery, and sickle cell disease as well as the clinical effectiveness of music therapy within an academic cancer center.

“The music therapists at UH Connor Whole Health offer non-pharmacological frontline treatment throughout our medical system while addressing issues of stress, pain, and anxiety. Greater Cleveland residents may receive these services during hospitalizations at UH as a clinical service line offering direct evidence-based community benefit,” said Seneca Block, The Lauren Rich Fine Endowed Director of Expressive Therapies at UH Connor Whole Health. UH Connor Whole Health manages the largest health system-based music therapy program in the US with 11 board-certified music therapists who collaborate with providers across the system to help patients and their families manage the physical and emotional toll of an illness or hospitalization. Additionally, UH Connor Whole Health provides a diverse offering of integrative health and medicine modalities, including acupuncture, chiropractic, and integrative medicine consults, that are centered on patients’ entire well-being.

In “Effectiveness of Music Therapy within Community Hospitals: An EMMPIRE Retrospective Study,” researchers examined the real-world effectiveness of music therapy at eight UH community medical centers and explored variables associated with pain reduction of greater than or equal to 2 units on a 0 to 10 unit numeric rating scale.

Music therapists provided interventions including live music listening, music-assisted relaxation and imagery, and active music making to address patients’ needs including pain management, coping, stress reduction, and anxiety reduction. As part of clinical care, the music therapists assessed patients’ self-reported pain, stress, and anxiety on a 0 to 10 scale at the beginning and end of each session and documented their sessions in the electronic health record.

“What makes this research novel is our ability to streamline data collection from music therapy clinical practice to the electronic health record. We can then use these data to understand the real-world impact of music therapy throughout multiple medical centers and how best to tailor music therapy interventions to meet patients’ needs,” said Sam Rodgers-Melnick, a music therapist, first author of the study, and a co-investigator on the EMMPIRE project (Effectiveness of Medical Music Therapy Practice: Integrative Research using the Electronic Health Record). The present EMMPIRE study was funded by a 3-year grant from the Kulas Foundation to UH Hospitals.org/ConnorWholeHealth with Jeffery A. Dusek PhD, Director of Research, UH Connor Whole Health, Block and Rodgers-Melnick as prime investigators. Said Dusek, “Routine collection of patient-reported outcomes from clinical practice (also called practice-based research) is becoming increasingly common as a patient-centered quality of care measure.”

Prior research has demonstrated that reductions of at least 1.3 units on the numeric rating scale for pain are clinically significant for patients with non-cancer pain, meaning that the symptom reduction represents a meaningful difference for patients with moderate-to-severe symptoms. Reductions of at least 2 units in stress and anxiety are also considered clinically significant. In this study, patients reported clinically significant mean reductions in pain (2.04 units), anxiety (2.80 units), and stress (3.48 units) in response to music therapy, with all changes exceeding clinically significant thresholds. Additionally, of the patients reporting a pain score greater than or equal to 4, 14% fell asleep during music therapy sessions, an important observation given the sleep challenges patients with moderate-to-severe pain face during hospitalization.

Additionally, after adjusting for demographic, clinical, and operational characteristics, patients receiving a music therapy session in which pain management was a goal were 4.32 times more likely to report pain reduction greater than or equal to 2 units than patients receiving a music therapy session in which pain management was not a session goal. Said Rodgers-Melnick, “this finding raises important questions regarding how music therapists tailor their interventions to address pain when that is the goal of the session, and we will be examining these specific features of music therapy interventions in future research.

Posted on Exercise, Mental health

Exercise is more effective than medicines in managing mental health

Exercise more effective than medicines to manage mental health
Exercise more effective than medicines to manage mental health


University of South Australia researchers are calling for exercise to be a mainstay approach for managing depression as a new study shows that physical activity is 1.5 times more effective than counselling or the leading medications.

Published in the British Journal of Sports Medicine, the review is the most comprehensive to date, encompassing 97 reviews, 1039 trials and 128,119 participants. It shows that physical activity is extremely beneficial for improving symptoms of depression, anxiety, and distress.

Specifically, the review showed that exercise interventions that were 12 weeks or shorter were most the effective at reducing mental health symptoms, highlighting the speed at which physical activity can make a change.

The largest benefits were seen among people with depression, pregnant and postpartum women, healthy individuals, and people diagnosed with HIV or kidney disease.

According to the World Health Organization, one in every eight people worldwide (970 million people) live with a mental disorder. Poor mental health costs the world economy approximately $2.5 trillion each year, a cost projected to rise to $6 trillion by 2030. In Australia, an estimated one in five people (aged 16–85) have experienced a mental disorder in the past 12 months. 

Lead UniSA researcher, Dr Ben Singh, says physical activity must be prioritised to better manage the growing cases of mental health conditions.

“Physical activity is known to help improve mental health. Yet despite the evidence, it has not been widely adopted as a first-choice treatment,” Dr Singh says.

“Our review shows that physical activity interventions can significantly reduce symptoms of depression and anxiety in all clinical populations, with some groups showing even greater signs of improvement.

“Higher intensity exercise had greater improvements for depression and anxiety, while longer durations had smaller effects when compared to short and mid-duration bursts.

“We also found that all types of physical activity and exercise were beneficial, including aerobic exercise such as walking, resistance training, Pilates, and yoga.

“Importantly, the research shows that it doesn’t take much for exercise to make a positive change to your mental health.”

Senior researcher, UniSA’s Prof Carol Maher, says the study is the first to evaluate the effects of all types of physical activity on depression, anxiety, and psychological distress in all adult populations.

“Examining these studies as a whole is an effective way to for clinicians to easily understand the body of evidence that supports physical activity in managing mental health disorders.

“We hope this review will underscore the need for physical activity, including structured exercise interventions, as a mainstay approach for managing depression and anxiety.”

Posted on Cardiovascular disease, Insomnia, Mental health

Frequent visits to green spaces linked to lower use of certain prescription meds

Lower use of drugs for depression, anxiety, insomnia, high blood pressure, and asthma in city dwellers. Findings independent of income and educational attainment


Frequent visits to urban green spaces, such as parks and community gardens in Finland, rather than the amount, or views of them from home, may be linked to lower use of certain prescription meds, suggests research published online in Occupational & Environmental Medicine.

The observed associations between frequent green space visits and lower use of drugs for depression, anxiety, insomnia, high blood pressure, and asthma were not dependent on socio-economic position.

Exposure to natural environments is thought to be good for health, but the evidence is inconsistent, say the researchers.

They wanted to determine if the amount of residential green and blue space (bodies of water), frequency of green space visits, and views of green and blue spaces from home might be separately associated with certain prescription meds.

They chose prescription meds as a proxy for ill health and those for anxiety and insomnia, depression, high blood pressure, and asthma, mainly because they are used to treat common and potentially severe health issues.

They drew on the responses of 16,000 randomly selected residents of Helsinki, Espoo, and Vantaa, to the Helsinki Capital Region Environmental Health Survey in 2015-16. These three cities make up the largest urban area in Finland. 

The survey gathered information on how city dwellers, aged at least 25, experience residential green and blue spaces within a 1 km radius of their homes.

Respondents were also asked to report their use of prescribed meds—drugs for anxiety, insomnia, and depression, collectively known as psychotropic drugs; high blood pressure and asthma drugs—if applicable, for periods ranging from within the past week up to more than a year ago or never.

They were also asked how often they spent time, or exercised outdoors, in green spaces, during May and September, with options ranging from never to 5 or more times a week. 

And they were asked whether they could see green or blue spaces from any of their windows at home, and, if so, how often they took in these views, with options ranging from seldom to often.

Green areas were forests, gardens, parks, castle parks, cemeteries, zoos, herbaceous vegetation associations such as natural grassland and moors, and wetlands. Blue areas were defined as seas, lakes, and rivers.

Potentially influential factors were also considered, including health behaviours, outdoor air pollution and noise, household income and educational attainment.

The final analysis included approximately 6000 participants who provided complete information.

This showed that the amount of residential green and blue spaces, or views of them from home, weren’t associated with prescription meds for mental health, insomnia, high blood pressure or asthma.

But the frequency of green space visits was. Compared with less than one weekly visit, visiting 3-4 times weekly was associated with 33% lower odds of using mental health meds, 36% lower odds of using blood pressure meds, and 26% lower odds of using asthma meds. 

The equivalent figures for visiting at least five times a week were 22%, 41%, and 24% lower.

These observed associations were weakened when weight (BMI) was factored in, particularly for asthma meds, as obesity is a known risk factor for asthma, point out the researchers. 

The effects of visiting green spaces were also stronger among those reporting the lowest annual household income ( below €30, 000). But overall, the associations found didn’t depend on household income and educational attainment.

This is an observational study, so we can’t establish cause and effect. No information was available on illness severity, and better health may enable a person to spend more time outdoors.

Finland has high forest cover, while Finnish cities are relatively green, making it easy for those willing to use green spaces to access them with minimal effort, they add. 

But they conclude: “Mounting scientific evidence supporting the health benefits of nature exposure is likely to increase the supply of high-quality green spaces in urban environments and promote their active use. This might be one way to improve health and welfare in cities.”

Posted on Cardiovascular disease, Mental health

Deep meditation may alter gut microbes for better health


Regular deep meditation, practised for several years, may help to regulate the gut microbiome and potentially lower the risks of physical and mental ill health, finds a small comparative study published in the open-access journal General Psychiatry.

The gut microbes found in a group of Tibetan Buddhist monks differed substantially from those of their secular neighbours. They have been linked to a lower risk of anxiety, depression, and cardiovascular disease.

Research shows the gut microbiome can affect mood and behaviour through the gut–brain axis. This includes the body’s immune response, hormonal signalling, stress response and the vagus nerve—the main component of the parasympathetic nervous system, which oversees an array of crucial bodily functions.

The significance of the group and specimen design is that these deep-thinking Tibetan monks can represent some more profound meditations. Although the number of samples is small, they are rare because of their location.

Meditation is increasingly being used to help treat mental health disorders, such as depression, anxiety, substance abuse, traumatic stress, and eating disorders as well as chronic pain. But it’s not clear if it might also be able to alter the composition of the gut microbiome, say the researchers.

The researchers analysed the stool and blood samples of 37 Tibetan Buddhist monks from three temples and 19 secular residents in the neighbouring areas to find out.

Tibetan Buddhist meditation originates from the ancient Indian medical system known as Ayurveda, and is a form of psychological training, say the researchers. The monks in this study had been practising it for at least 2 hours a day for 3 and 30 years.

None of the participants had used agents that can alter the volume and diversity of gut microbes: antibiotics; probiotics; prebiotics; or antifungal drugs in the preceding 3 months.

Both groups were matched for age, blood pressure, heart rate, and diet.

Stool sample analysis revealed significant differences in the diversity and volume of microbes between the monks and their neighbours. 

Bacteroidetes and Firmicutes species were dominant in both groups, as would be expected. But Bacteroidetes were significantly enriched in the monks’ stool samples (29% vs 4%), which also contained abundant Prevotella (42% vs 6%) and a high volume of Megamonas and Faecalibacterium.

“Collectively, several bacteria enriched in the meditation group [have been] associated with the alleviation of mental illness, suggesting that meditation can influence certain bacteria that may have a role in mental health,” write the researchers.

The previously published research suggests these include Prevotella, Bacteroidetes, Megamonas and Faecalibacterium species.

The researchers then applied an advanced analytical technique to predict which chemical processes the microbes might influence. This indicated that several protective anti-inflammatory pathways, in addition to metabolism—the conversion of food into energy—were enhanced in the meditation people.

Finally, blood sample analysis showed that levels of agents associated with a heightened risk of cardiovascular disease, including total cholesterol and apolipoprotein B, were significantly lower in the monks than in their secular neighbours by their functional analysis with the gut microbes.

Although a comparative study, it is observational. The numbers of participants were small, all male, and lived at high altitudes, making it difficult to draw any firm or generalisable conclusions. And the potential health implications could only be inferred from previously published research.

But based on their findings, the researchers suggest that the role of meditation in helping to prevent or treat psychosomatic illness merits further research.

And they conclude: “These results suggest that long-term deep meditation may have a beneficial effect on gut microbiota, enabling the body to maintain an optimal state of health.”