Practicing positive activities may serve as an effective, low-cost treatment for people suffering from depression

Practicing positive activities may serve as an effective, low-cost treatment for people suffering from depression, according to researchers at the University of California, Riverside and Duke University Medical Center.

In “Delivering Happiness: Translating Positive Psychology Intervention Research for Treating Major and Minor Depressive Disorders,” a paper that appears in the August 2011 issue of the Journal of Alternative and Complementary Medicine, the team of UCR and Duke psychology, neuroscience and psychopharmacology researchers proposed a new approach for treating depression – Positive Activity Interventions (PAI).

PAIs are intentional activities such as performing acts of kindness, practicing optimism, and counting one’s blessing gleaned from decades of research into how happy and unhappy people are different. This new approach has the potential to benefit depressed individuals who don’t respond to pharmacotherapy or are not able or willing to obtain treatment, is less expensive to administer, is relatively less time-consuming and promises to yield rapid improvement of mood symptoms, holds little to no stigma, and carries no side effects.

More than 16 million U.S. adults – about 8 percent of the population – suffer from either major or chronic depression. About 70 percent of reported cases either do not receive the recommended level of treatment or do not get treated at all, according to the National Institute of Mental Health. Globally, the World Health Organization estimates that depression affects more than 100 million people.

Although antidepressants can be lifesaving for some individuals, initial drug therapy produces full benefits in only 30 percent to 40 percent of patients. Even after trying two to four different drugs, one-third of people will remain depressed.

The research team – Kristin Layous and Joseph Chancellor, graduate students at UC Riverside; Sonja Lyubomirsky, professor of psychology and director of the Positive Psychology Laboratory at UC Riverside; and Lihong Wang, M.D., and P. Murali Doraiswamy, M.B.B.S., FRCP, of Duke University – conducted a rigorous review of previous studies of PAIs, including randomized, controlled interventions with thousands of normal men and women as well as functional MRI scans in people with depressive symptoms.

“Over the last several decades, social psychology studies of flourishing individuals who are happy, optimistic and grateful have produced a lot of new information about the benefits of positive activity interventions on mood and well-being,” Lyubomirsky said.

However, such findings have not yet entered mainstream psychiatric practice.

“Very few psychiatrists collaborate with social scientists and no one in my field ever reads the journals where most happiness studies have been published. It was eye-opening for me as a psychopharmacologist to read this literature,” Doraiswamy said.

Lyubomirsky said that after she and Doraiswamy exchanged notes, “the obvious question that popped up was whether we can tap into the PAI research base to design interventions to galvanize clinically depressed people to move past the point of simply not feeling depressed to the point of flourishing.”

Although the paper found that positive activity interventions are effective in teaching individuals ways to increase their positive thinking, positive affect and positive behaviors, only two studies specifically tested these activities in individuals with mild depression.

In one of these studies, lasting improvements were found for six months. Effective PAIs used in the study included writing letters of gratitude, counting one’s blessings, practicing optimism, performing acts of kindness, meditating on positive feelings toward others, and using one’s signature strengths, all of which can be easily implemented into a daily routine at low cost.

People often underestimate the long-term impact of practicing brief, positive activities, Lyubomirsky said. For example, if a person gets 15 minutes of positive emotions from counting her blessings, she may muster the energy to attend the art class she’d long considered attending, and, while in class, might meet a friend who becomes a companion and confidant for years to come. In this way, even momentary positive feelings can build long-term social, psychological, intellectual, and physical skills and reserves.

The researchers’ review of brain imaging studies also led them to theorize that PAIs may act to boost the dampened reward/pleasure circuit mechanisms and reverse apathy – a key benefit that does not usually arise from treatment with medication alone.

“The positive activities themselves aren’t really new,” said Layous, the paper’s lead author. “After all, humans have been counting their blessings, dreaming optimistically, writing thank you notes, and doing acts of kindness for thousands of years. What’s new is the scientific rigor that researchers have applied to measuring benefits and understanding why they work.”

A major benefit of positive activities is that they are simple to practice and inexpensive to deliver.

“If we’re serious about tackling a problem as large as depression, we should be as concerned about the scalability of our solutions as much as their potency,” Chancellor said,

While PAIs appear to be a potentially promising therapy for mild forms of depression,” Doraiswamy cautioned, “they have not yet been fully studied in people with moderate to severe forms of depression. We need further studies before they can be applied to help such patients."

Kim Jobst, a physician and editor-in-chief of the Journal of Alternative and Complimentary Medicine, said the review provides one location in which to reference all relevant PAI findings to date, and includes recommendations that should prove useful to researchers, clinicians and the public. The journal is devoted to publishing research about novel and unconventional treatment approaches.

Transcendental Meditation improves brain functioning in ADHD students

A non-drug approach to enhance students' ability to learn

A random-assignment controlled study published today in Mind & Brain, The Journal of Psychiatry (Vol 2, No 1) found improved brain functioning and decreased symptoms of attention-deficit/hyperactivity disorder, ADHD, in students practicing the Transcendental Meditation® (TM) technique. The paper, ADHD, Brain Functioning, and Transcendental Meditation Practice, is the second published study demonstrating TM's ability to help students with attention-related difficulties.

The first exploratory study, published in Current Issues in Education, followed a group of middle school students diagnosed with ADHD who meditated twice a day in school. After 3 months, researchers found over 50% reductions in stress, anxiety, and ADHD symptoms. During the study, a video was made of some students discussing what it felt like to have ADHD, and how those experiences changed after 3 months of regular TM practice.

In this second study, lead author, neuroscientist Fred Travis, PhD, director of the Center for Brain, Consciousness and Cognition, joined principal investigator Sarina J. Grosswald, EdD, a George Washington University-trained cognitive learning specialist, and co-researcher William Stixrud, PhD, a prominent Silver Spring, Maryland, clinical neuropsychologist, to investigate the effects of Transcendental Meditation practice on task performance and brain functioning in 18 ADHD students, ages 11-14 years.

The study was conducted over a period of 6 months in an independent school for children with language-based learning disabilities in Washington, DC. The study showed improved brain functioning, increased brain processing, and improved language-based skills among ADHD students practicing the Transcendental Meditation technique..

What was Measured

Students were pretested, randomly assigned to TM or delayed-start comparison groups, and post-tested at 3- and 6-months. Delayed-start students learned TM after the 3-month post-test.

EEG measurements of brain functioning were taken while students were performing a demanding computer-based visual-motor task. Successful performance on the task requires attention, focus, memory, and impulse control.

In addition, students were administered a verbal fluency test. This test measured higher-order executive functions, including initiation, simultaneous processing, and systematic retrieval of knowledge. Performance on this task depends on several fundamental cognitive components, including vocabulary knowledge, spelling, and attention.

Theta/Beta Power Ratios and ADHD

Using EEG measurements, the relationship of theta brain waves to beta brain waves can be diagnostic of ADHD. Dr. Joel Lubar of the University of Tennessee has demonstrated that the theta/beta ratio can very accurately identify students with ADHD from those without it.

While theta EEG around 4-5 Hz is commonly associated with daydreaming, drowsiness, and unfocused mental states, theta EEG around 6-8 Hz is seen when one focuses on inner mental tasks, such as memory processing, identifying, and associating.

"In normal individuals, theta activity in the brain during tasks suggests that the brain is blocking out irrelevant information so the person can focus on the task," said Dr. Travis. "But, in individuals with ADHD, the theta activity is even higher, suggesting that the brain is also blocking out relevant information."

And when beta activity, which is associated with focus, is lower than normal," Travis added, "it affects the ability to concentrate on task for extended periods of time.


"Prior research shows ADHD children have slower brain development and a reduced ability to cope with stress," said Dr. Stixrud. "Virtually everyone finds it difficult to pay attention, organize themselves and get things done when they're under stress," he explained. "Stress interferes with the ability to learn—it shuts down the brain. Functions such as attention, memory, organization, and integration are compromised."

Why the TM Technique

"We chose the TM technique for this study because studies show that it increases brain function. We wanted to know if it would have a similar effect in the case of ADHD, and if it did, would that also improve the symptoms of ADHD," said Dr. Grosswald.

Dr. Stixrud added, "Because stress significantly compromises attention and all of the key executive functions such as inhibition, working memory, organization, and mental flexibility, it made sense that a technique that can reduce a child's level of stress should also improve his or her cognitive functioning."

The Transcendental Meditation technique is an effortless, easy-to-learn practice, unique among categories of meditation. "TM does not require concentration, controlling the mind or disciplined focus—challenges for anyone with ADHD," Grosswald added.

There is substantial research showing the effectiveness of the TM technique for reducing stress and anxiety, and improving cognitive functioning among the general population. "What's significant about these new findings," Grosswald said, "is that among children who have difficulty with focus and attention, we see the same results. The fact that these children are able to do TM, and do it easily, shows us that this technique may be particularly well-suited for children with ADHD."

Transcendental Meditation produces an experience of restful alertness, which is associated with higher metabolic activity in the frontal and parietal parts of the brain, indicating alertness, along with decreased metabolic activity in the thalamus, which is involved in regulating arousal, and hyperactivity.

With regular practice, this restfully alert brain state, characteristic of the TM technique, becomes more present outside of meditation, allowing ADHD students to attend to tasks. "In a sense," Dr. Travis said, "the repeated experience of the Transcendental Meditation technique trains the brain to function in a style opposite to that of ADHD."

Improved Brain Functioning

During the practice of the Transcendental Meditation technique, coherence is found across different EEG frequencies. After meditation, the brain utilizes this increased functioning ability to support the performance of a task in an integrated manner.

Three months of TM practice resulted in significant decreases in theta/beta ratios and increased verbal fluency. This translates into improved executive function and more efficient cognitive processing.

During the first 3 months of the study, the theta/beta ratios of the control group (delayed start) actually increased. After learning, and practicing TM for 3 months, this group experienced dramatic decreases in theta/beta ratios and increased verbal fluency as well.

Student and Parent Surveys

Students reported that the TM technique was enjoyable and easy to do. They felt calmer, less stressed, and better able to concentrate on their schoolwork. They also said they were happier since they started TM. This correlated with reports from the parents.

At the end of the research, the parents completed a questionnaire to assess their perceptions of changes in five ADHD-related symptoms in their children from the beginning to the end of the study. There were positive and statistically significant improvements in the five areas measured: a) Ability to focus on schoolwork, b) Organizational abilities, c) Ability to work independently, d) Happiness, and e) Quality of sleep.

Promising Results

The combined results were significant. There was a 48% reduction in the theta/beta power ratios and a 30% increase in brain coherence after the 6-month period. Studies have shown that pharmaceuticals decrease theta/beta power ratios by 3%, and neurofeedback by 25%.

"These are very encouraging findings," said Dr. Stixrud. "Significant improvement in the theta/beta ratio without medication and without having to use any expensive equipment is a big deal, as is significant improvement in student happiness and student academic functioning reported by the parents."

"While stimulant medication is very beneficial for some of my clients with ADHD," Stixrud added, "the number of children who receive great benefit from medicine with minimal side-effects is relatively small. The fact that TM appears to improve attention and executive functions, and significantly reduces stress with no negative side-effects, is clearly very promising." Stixrud said he hoped these findings would lead to more research on the use of TM with children and adolescents.

In conclusion, these findings warrant additional research to assess the impact of Transcendental Meditation practice as a non-drug treatment for ADHD, and to track meditating students' improved academic achievements.


FACT SHEET

Attention-Deficit/Hyperactivity Disorder (ADHD)

• Attention-deficit/hyperactivity disorder (ADHD)—characterized by inattentiveness, impulsivity, and hyperactivity—is diagnosed in almost 10% of children ages 4-17 years, representing 5.4 million children.
• The Center for Disease Control and Prevention reported among children with current ADHD, 66.3% were taking medication for the disorder. In total, 4.8% of all children ages 4-17 years (2.7 million) were taking medication for ADHD. The majority of them stay on it into adulthood.
• The rate of prescriptions for Attention-Deficit/Hyperactivity Disorder in the U.S. has increased by a factor of five since 1991—with production of ADHD medicines up 2,000 percent in 9 years.
• The commonly used drugs for ADHD are stimulants (amphetamines). These drugs can cause persistent and negative side-effects, including sleep disturbances, reduced appetite, weight loss, suppressed growth, and mood disorders. The side-effects are frequently treated with additional medications to manage insomnia or mood swings. Almost none of the medications prescribed for insomnia or mood disturbances are approved by the Food and Drug Administration (FDA) for use with children.
• The long-term health effects of ADHD medications are not fully known, but evidence suggests risks of cardiac disorders and sudden death, liver damage and psychiatric events. It has also been found that children on long-term medication have significantly higher rates of delinquency, substance use, and stunted physical growth.
• A new study, Study raises questions about long-term effects of ADHD medication, the first of its kind, released February 17, 2010 by the Government of Western Australia's Department of Health, found that "long-term use of drugs such as Ritalin and dexamphetamine may not improve a child's social and emotional well-being or academic performance." The chair of the Ministerial Implementation Committee for Attention Deficit Hyperactivity Disorder in Western Australia said in the Department's press release, "We found that stimulant medication did not significantly improve a child's level of depression, self perception or social functioning and they were more likely to be performing below their age level at school by a factor of 10.5 times."

Tai chi could be key to overcoming cognitive effects of chemotherapy

According to the American Cancer Society, more than 11.4 million Americans are currently living with cancer. While cancer treatments are plentiful, many have negative side effects. Previous studies have indicated that a significant number of patients who receive chemotherapy also experience cognitive declines, including decreases in verbal fluency and memory. Now, one University of Missouri health psychologist has found evidence that indicates Tai Chi, a Chinese martial art, might help overcome some of those problems.

"Scientists have known for years that Tai Chi positively impacts physical and emotional health, but this small study also uncovered evidence that it might help cognitive functioning as well," said Stephanie Reid-Arndt, assistant professor and chair of the Department of Health Psychology in the School of Health Professions. "We know this activity can help people with their quality of life in general, and with this new study, we are encouraged about how Tai Chi could also help those who have received chemotherapy. I also hope this encourages more people to think about Tai Chi positively on a broader scale in their lives."

Tai Chi involves practicing slow motion routines and is based on several principles, including mindfulness, breathing awareness, active relaxation and slow movements. The emphasis on slow movement makes Tai Chi particularly suited to a wide range of fitness levels, which makes it very relevant for those who have had chemotherapy and might be experiencing physical limitations as a result, Reid-Arndt said.

The MU pilot study followed a group of women with a history of chemotherapy. The women participated in a 60-minute Tai Chi class two times a week for 10 weeks. The women were tested on memory, language, attention, stress, mood and fatigue before and after the 10-week sessions. According to Reid-Arndt, the results of the tests indicated that the women had made significant improvements in their psychological health and cognitive abilities.

"Tai Chi really helps individuals focus their attention, and this study also demonstrates how good Tai Chi could be for anyone, whether or not they have undergone treatment for cancer," Reid-Arndt said. "Due to the small size of this study, we really need to test a larger group of individuals to gain a better understanding of the specific benefits of this activity for patients who have been treated with chemotherapy and how significant these improvements might be."

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The study was published recently in Complementary Therapies in Clinical Practice.

Yoga Helps Older Stroke Victims Improve Balance, Endurance

An Indiana University study that exposed older veterans with stroke to yoga produced promising results as researchers explore whether this popular mind-body practice can help stroke victims cope with their increased risk for painful and even deadly falls.

The pilot study involved 19 men and one woman, average age of 66. For eight weeks, they participated in a twice weekly hour-long group yoga class taught by a yoga therapist who dramatically modified the poses to meet the veterans' needs.

A range of balance items measured by the Berg Balance Scale and Fullerton Advance Balance Scale improved by 17 percent and 34 percent respectively by the end of the program. But equally exciting to lead researcher Arlene A. Schmid, rehabilitation research scientist at the Richard L. Roudebush VA Medical Center in Indianapolis, was the measurable gain in confidence the study participants had in their balance.

"It also was interesting to see how much the men liked it," said Schmid, assistant professor of occupational therapy in the School of Health and Rehabilitation Sciences at Indiana University-Purdue University Indianapolis. Many of the veterans wanted the study to continue or asked for a take-home exercise plan so they could continue the practice. "They enjoyed it so much partly because they weren't getting any other treatment. They had already completed their rehabilitation but felt there still was room for improvement."

Schmid discussed her findings at the American College of Sports Medicine meeting in Denver during her poster presentation, "Preliminary Evidence of Yoga on Balance and Endurance Outcomes for Veterans with Stroke" in the session for Fitness and Performance Testing for Posture, Stability and Balance.

Statistics concerning strokes and falls are grim, with studies showing that strokes can quadruple the risk of falling and greatly increase the risk of breaking a hip after a fall. An estimated 80 percent of people who have strokes will also have some degree of impaired balance.

The study participants performed poses initially while seated in chairs and then progressed to seated and standing poses. Eventually, they all performed poses on the floor, something Schmid considers significant because of a reluctance many older adults have to working on the floor.

"Everything was modified because we wanted them to be successful on day one," Schmid said. "Everyone could be successful at some level."

A score of less than 46 on the Berg Balance Scale indicates a fall risk. Schmid said the study participants on average began the study with a score of 40 and then improved to 47, moving them past the fall risk threshold. The study participants also showed significant improvements in endurance based on a seated two-minute step test and a six-minute walk test.

Schmid said research into therapeutic uses for yoga is "really taking off," particularly in mental health fields. Clinically, she has been watching a small trend of occupational therapists and physical therapists also becoming yoga therapists. The yoga performed in the study was modified to the extent that Schmid said it would be very difficult to find a comparable class offered publicly. Such a class should be taught by a yoga therapist who has had additional training in anatomy and physiology and how to work with people with disabilities. Schmid hopes to expand the study so she and her colleagues can explore whether such classes are effective on a larger scale.

Veterans show a 50 percent reduction in PTSD symptoms after 8 weeks of Transcendental Meditation

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Veterans of the Iraq/Afghanistan wars showed a 50 percent reduction in their symptoms of post-traumatic stress disorder (PTSD) after just eight weeks of practicing the stress-reducing Transcendental Meditation technique, according to a pilot study published in the June 2011 issue of Military Medicine (Volume 176, Number 6).

The study evaluated five veterans, ages 25- to 40-years-old, who had served in Iraq, Afghanistan or both from 10 months to two years involving moderate or heavy moderate combat.

The study found that Transcendental Meditation produced significant reductions in stress and depression, and marked improvements in relationships and overall quality of life. Furthermore, the authors reported that the technique was easy to perform and was well accepted by the veterans.

The Clinician Administered PTSD Scale (CAPS) was the primary measure for assessing the effectiveness of TM practice on PTSD symptoms. CAPS is considered by the Department of Veterans Affairs as the "gold standard" for PTSD assessment and diagnosis for both military Veteran and civilian trauma survivors.

The paper's senior researcher, Norman Rosenthal, M.D., is clinical professor of psychiatry at George


"Even though the number of veterans in this study was small, the results were very impressive," Rosenthal said. "These young men were in extreme distress as a direct result of trauma suffered during combat, and the simple and effortless Transcendental Meditation technique literally transformed their lives."

The findings were similar to those from a randomized controlled study of Vietnam veterans conducted by researchers at the University of Colorado School of Medicine. In that study, published in the Journal of Counseling and Development in 1985, after three months of twice-daily TM practice, the veterans had fewer symptoms than those receiving conventional psychotherapy of the day. In fact, most of the TM-treated subjects required no further treatment.

"Even though the combat experiences of OEF/OIF veterans and Vietnam veterans are quite different, the fact that our study corroborates the results of the previous study tells us that this technique has the potential to be an effective tool against PTSD and combat stress, regardless of combat situation," explained Sarina Grosswald, EdD, co-researcher on the study.

Rosenthal hypothesizes that Transcendental Meditation helps people with PTSD because regular practice produces long-term changes in sympathetic nervous system activity, as evidenced by decreased blood pressure, and lower reactivity to stress. "Transcendental Meditation quiets down the nervous system, and slows down the 'fight-or-flight' response," he said. People with PTSD show overactive fight-or-flight responses, making them excellent candidates for Transcendental Meditation.

Rosenthal points out that there is an urgent need to find effective and cost-effective treatments for veterans with combat-related PTSD. "The condition is common, affecting an estimated one in seven deployed soldiers and Marines, most of whom do not get adequate treatment. So far, only one treatment—simulation exposure to battleground scenes—has been deemed effective, but it requires specialized software and hardware, trained personnel and is labor intensive.

"Based on our study and previous findings, I believe Transcendental Meditation certainly warrants further study for combat-related PTSD," says Rosenthal.

FACT SHEET

Post-Traumatic Stress Disorder (PTSD)

A new report paints a stark picture of the toll on the U.S. military of almost a decade of war: higher stress and lower morale. The report, released Thursday, May 19, 2011, at the Pentagon, relied on questions to soldiers and Marines in Afghanistan in July and August of last year and compared responses with similar surveys in 2005 and 2009. The report noted "significant decline in reports of individual morale" as well as "acute stress rates significantly higher" than in earlier years. Source: CNN: New Pentagon study finds psychological toll from years of fighting.

"Research suggests that 18% to 30% of Vietnam veterans, 10% to 20% of Iraq War veterans, and 5% to 15% of Gulf War veterans have experienced PTSD," says U.S. Army Colonel Charles C Engel, Director of Deployment Health Clinical Center. Source: Britannica Blog: PTSD in War Veterans: 5 Questions for Psychiatrist and U.S. Army Col. Charles C. Engel.

A May 8, 2008 report said the number of suicides among veterans of wars in Iraq and Afghanistan may exceed the combat death toll because of inadequate mental health care, the U.S. government's top psychiatric researcher said. Source: Bloomberg: Post-War Suicides May Exceed Combat Deaths, U.S. Says (Update1).

VA's suicide hotline receives 10,000 calls per month from active and retired servicemen. There are 950 suicide attempts per month by veterans receiving care from the VA. 18 veterans commit suicide each day, 5 of them are under the care of the VA. Source: Army Times: 18 veterans commit suicide each day.

Every night, an estimated 63,000 veterans lay down to sleep in a county jail. Source: Syracuse.com: The Post-Standard: Syracuse VA Medical Center visits county jails, searches for military veterans who need assistance.

Each night, 107,000 veterans find their home on the street. Source: National Coalition for Homeless Veterans.

27% of returning OEF/OIF veterans meet criteria for alcohol abuse. Of returning soldiers, 20% of active duty and 42% of reservists are in need of mental health treatment. Source: NIDA: A Research Update from the National Institute on Drug Abuse.
The Rand Corporation's study "Invisible Wounds of War" revealed a disturbing truth about the health of our military as recently as 2008: Over 300,000 returning veterans from Iraq and Afghanistan suffer from PTSD or major depression. According to the Rand report, these "invisible wounds" take a high toll—impacting veterans' quality of life, hindering their performance at work, straining their families, and placing them at greater risk for violent and self-destructive behaviors. The economic cost of these disorders is equally great—reaching as high as $6 billion over 2 years. Yet, despite the heavy toll of PTSD and depression, only half of affected veterans seek care, and only a third of those who do, receive adequate treatment. Thus, over 80% of affected veterans remain without needed help.

Since October 31, 2007, over 1.6 million troops have been deployed in Iraq and Afghanistan. According to the Rand Corporation's study, 225,000 of the returning troops suffer from PTSD, 226,000 are diagnosed with major depression, and 303,000 develop either illness. Source: Rand Corporation: Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, 2008.

The Transcendental Meditation Technique

The Transcendental Meditation technique is an effortless technique practiced 10-20 minutes twice a day sitting comfortably with the eyes closed.

TM is not a religion or philosophy and involves no new beliefs or change in lifestyle.
Over 350 peer-reviewed research studies on the TM technique confirm a range of benefits for mind, body and behavior.

Several studies have compared the effects of different meditation practices and found that Transcendental Meditation provides deeper relaxation and is more effective at reducing anxiety, depression and hypertension than other forms of meditation and relaxation. In addition, no other meditation practice shows the widespread coherence throughout all areas of the brain that is seen with Transcendental Meditation.
The Transcendental Meditation technique is taught in the United States by a non-profit, educational organization.

Acupuncture of benefit to those with unexplained symptoms

Attending frequently with medically unexplained symptoms is distressing for both patient and doctor and effective treatment or management options are limited: one in five patients have symptoms that remain unexplained by conventional medicine. Studies have shown that the cost to the NHS of managing the treatment of a patient with medically unexplained symptoms can be twice that of a patient with a diagnosis.

A research team from the Institute of Health Services Research, Peninsula Medical School, University of Exeter, has carried out a randomised control trial and a linked interview study regarding 80 such patients from GP practices across London, to investigate their experiences of having five-element acupuncture added to their usual care. This is the first trial of traditional acupuncture for people with unexplained symptoms.

The results of the research are published in the British Journal of General Practice. They reveal that acupuncture had a significant and sustained benefit for these patients and consequently acupuncture could be safely added to the therapies used by practitioners when treating frequently attending patients with medically unexplained symptoms.

The patient group was made up of 80 adults, 80 per cent female with an average age of 50 years and from a variety of ethnic backgrounds who had consulted their GP at least eight times in the past year. Nearly 60 per cent reported musculoskeletal health problems, of which almost two-thirds had been present for a year.

In the three months before taking part in the study, the 80 patients had accounted for the following NHS experiences: 21 patient in-days; 106 outpatient clinic visits; 52 hospital clinic visits (for treatments such as physiotherapy, chiropody and counselling); 44 hospital visits for investigations (including 10 magnetic resonance imaging – MRI – scans); and 75 visits to non-NHS practitioners such as opticians, dentists and complementary therapists.

The patients were randomly divided into an acupuncture group and a control group. Eight acupuncturists administered individual five-element acupuncture to the acupuncture group immediately, up to 12 sessions over 26 weeks. The same numbers of treatments were made available to the control group after 26 weeks.

At 26 weeks the patients were asked to complete a number of questionnaires including the individualised health status questionnaire "Measure Yourself Medical Outcome Profile."

The acupuncture group registered a significantly improved overall score when compared with the control group. They also recorded improved wellbeing but did not show any change in GP and other clinical visits and the number of medications they were taking. Between 26 and 52 weeks the acupuncture group maintained their improvement and the control group, now receiving their acupuncture treatments, showed a 'catch up' improvement.

The associated qualitative study, which focused on the patients' experiences, supported the quantitative work.

This element identified that the participating patients had a variety of longstanding symptoms and disability including chronic pain, fatigue and emotional problems which affected their ability to work, socialise and carry out everyday tasks. A lack of a convincing diagnosis to explain their symptoms led to frustration, worry and low mood.

Participating patients reported that their acupuncture consultations became increasingly valuable. They appreciated the amount of time they had with each acupuncturist and the interactive and holistic nature of the sessions – there was a sense that the practitioners were listening to their concerns and, via therapy, doing something positive about them.

As a result, many patients were encouraged to take an active role in their treatment, resulting in cognitive and behavioural lifestyle changes, such as: a new self-awareness about what caused stress in their lives, and a subsequent ability to deal with stress more effectively; and taking their own initiatives based on advice from the acupuncturists about diet, exercise, relaxation and social activities.

Comments from participating patients included: "the energy is the main thing I have noticed. You know, yeah, it's marvellous! Where I was going out and cutting my grass, now I'm going out and cutting my neighbour's after because he's elderly"; "I had to reduce my medication. That's the big help actually, because medication was giving me more trouble…side effects"; and "It kind of boosts you, somehow or another."

Dr. Charlotte Paterson, who managed the randomised control trial and the longitudinal study of patients' experiences, commented: "Our research indicates that the addition of up to 12 five-element acupuncture consultations to the usual care experienced by the patients in the trial was feasible and acceptable and resulted in improved overall well-being that was sustained for up to a year.

"This is the first trial to investigate the effectiveness of acupuncture treatment to those with unexplained symptoms, and the next development will be to carry out a cost-effectiveness study with a longer follow-up period. While further studies are required, this particular study suggests that GPs may recommend a series of five-element acupuncture consultations to patients with unexplained symptoms as a safe and potentially effective intervention."

She added: "Such intervention could not only result in potential resource savings for the NHS, but would also improve the quality of life for a group of patients for whom traditional biomedicine has little in the way of effective diagnosis and treatment."

Acupuncture relieves hot flashes from prostate cancer treatment

Acupuncture provides long-lasting relief to hot flashes, heart palpitations and anxiety due to side effects of the hormone given to counteract testosterone, the hormone that induces prostate cancer, according to a study published in the April issue of the International Journal of Radiation Oncology•Biology•Physics, an official journal of the American Society for Radiation Oncology (ASTRO).

The main treatments for men with metastatic prostate cancer are either surgery or hormone therapy to significantly reduce the level of testosterone in the body. Eliminating testosterone has been proven to keep the cancer in check by starving the cancer of hormones it needs to grow and spread. However, about half of the time, this therapy also causes very uncomfortable hot flashes similar to those women experience during menopause. The main way to combat hot flashes is to take antidepressants, but these drugs can cause side effects of their own, including nausea, dry mouth, sleeplessness, altered appetite and sexual changes.

In a prospective study conducted in the department of radiation oncology and the acupuncture section of New York Methodist Hospital and Weill Cornell Medical College of Cornell University, both in New York, researchers evaluated 14 men who were experiencing hot flashes due to hormone therapy for prostate cancer. Upon enrolling in the study, the men were given a hot flash score (HFS) to evaluate their discomfort from daily hot flashes. The mean initial HFS was 28.3.

Participants then received acupuncture twice a week for 30 minutes at a time for four weeks. Two weeks after receiving acupuncture, their HFS was measured again and had dropped more than half to 10.3. At six weeks post-treatment, their HFS was 7.5. After eight months, the men were evaluated again and their mean HFS was 7. "Our study shows that physicians and patients have an additional treatment for something that affects many men undergoing prostate cancer treatment and actually has long-term benefits, as opposed to more side effects," Hani Ashamalla, M.D., lead author of the study and a radiation oncologist at New York Methodist Hospital, said. "We are now designing a randomized clinical trial to further evaluate acupuncture after prostate cancer treatment. I encourage men suffering this symptom to talk to their doctors about enrolling."