Center for Integrative Psychiatry

Groningen, Netherlands

Center for Integrative Psychiatry

Groningen, Netherlands
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News Article | August 3, 2017

WASHINGTON -- People who suffer from depression may want to look to yoga as a complement to traditional therapies as the practice appears to lessen symptoms of the disorder, according to studies presented at the 125th Annual Convention of the American Psychological Association. "Yoga has become increasingly popular in the West, and many new yoga practitioners cite stress-reduction and other mental health concerns as their primary reason for practicing," said Lindsey Hopkins, PhD, of the San Francisco Veterans Affairs Medical Center, who chaired a session highlighting research on yoga and depression. "But the empirical research on yoga lags behind its popularity as a first-line approach to mental health." Hopkins' research focused on the acceptability and antidepressant effects of hatha yoga, the branch of yoga that emphasizes physical exercises, along with meditative and breathing exercises, to enhance well-being. In the study, 23 male veterans participated in twice-weekly yoga classes for eight weeks. On a 1-10 scale, the average enjoyment rating for the yoga classes for these veterans was 9.4. All participants said they would recommend the program to other veterans. More importantly, participants with elevated depression scores before the yoga program had a significant reduction in depression symptoms after the eight weeks. Another, more specific, version of hatha yoga commonly practiced in the West is Bikram yoga, also known as heated yoga. Sarah Shallit, MA, of Alliant University in San Francisco investigated Bikram yoga in 52 women, age 25-45. Just more than half were assigned to participate in twice-weekly classes for eight weeks. The rest were told they were wait-listed and used as a control condition. All participants were tested for depression levels at the beginning of the study, as well as at weeks three, six and nine. Shallit and her co-author Hopkins found that eight weeks of Bikram yoga significantly reduced symptoms of depression compared with the control group. In the same session, Maren Nyer, PhD, and Maya Nauphal, BA, of Massachusetts General Hospital, presented data from a pilot study of 29 adults that also showed eight weeks of at least twice-weekly Bikram yoga significantly reduced symptoms of depression and improved other secondary measures including quality of life, optimism, and cognitive and physical functioning. "The more the participants attended yoga classes, the lower their depressive symptoms at the end of the study," said Nyer, who currently has funding from the National Center for Complementary and Integrative Health to conduct a randomized controlled trial of Bikram yoga for individuals with depression. Elsewhere at the meeting, Nina Vollbehr, MS, of the Center for Integrative Psychiatry in the Netherlands presented data from two studies on the potential for yoga to address chronic and/or treatment-resistant depression. In the first study, 12 patients who had experienced depression for an average of 11 years participated in nine weekly yoga sessions of approximately 2.5 hours each. The researchers measured participants' levels of depression, anxiety, stress, rumination and worry before the yoga sessions, directly after the nine weeks and four months later. Scores for depression, anxiety and stress decreased throughout the program, a benefit that persisted four months after the training. Rumination and worry did not change immediately after the treatment, but at follow up rumination and worry were decreased for the participants. In another study, involving 74 mildly depressed university students, Vollbehr and her colleagues compared yoga to a relaxation technique. Individuals received 30 minutes of live instruction on either yoga or relaxation and were asked to perform the same exercise at home for eight days using a 15-minute instructional video. While results taken immediately after the treatment showed yoga and relaxation were equally effective at reducing symptoms, two months later, the participants in the yoga group had significantly lower scores for depression, anxiety and stress than the relaxation group. "These studies suggest that yoga-based interventions have promise for depressed mood and that they are feasible for patients with chronic, treatment-resistant depression," said Vollbehr. The concept of yoga as complementary or alternative mental health treatment is so promising that the U.S. military is investigating the creation of its own treatment programs. Jacob Hyde, PsyD, of the University of Denver, gave a presentation outlining a standardized, six-week yoga treatment for U.S. military veterans enrolled in behavioral health services at the university-run clinic and could be expanded for use by the Department of Defense and the Department of Veterans Affairs. Hopkins noted that the research on yoga as a treatment for depression is still preliminary. "At this time, we can only recommend yoga as a complementary approach, likely most effective in conjunction with standard approaches delivered by a licensed therapist," she said. "Clearly, yoga is not a cure-all. However, based on empirical evidence, there seems to be a lot of potential." Session 1301: "Effects of a Hatha Yoga Intervention on Depressive Symptoms in Male Military Veterans," "Effects of a Hatha Yoga Intervention on Depressive Symptoms: Mediating Roles of Mindfulness and Self," "Hyperthermic Yoga for the Treatment of Depressive Symptoms" and "Heated Yoga for the Treatment of Anxious Depression," Symposium, Thursday, Aug. 3, 2-2:50 p.m. EDT, Room 152A, Street Level, Walter E. Washington Convention Center, 801 Mount Vernon Pl., N.W., Washington, D.C. Session 2090: "The Influence of Yoga on Chronic Depression and Potential Cognitive Mediators," Paper Session, Friday, Aug. 4, 9-10:50 a.m. EDT, West Overlook Room, Level 2, Walter E. Washington Convention Center, 801 Mount Vernon Pl., N.W., Washington, D.C. Session 2258: "Multidisciplinary Collaboration in Creating a Yoga Protocol to Complement Evidence-Based Care," Poster Session, Friday, Aug. 4, 3-3:50 p.m. EDT, Exhibit Halls D and E, Level 2, Walter E. Washington Convention Center, 801 Mount Vernon Pl., N.W., Washington, D.C. Presentations are available from the APA Public Affairs Office. Lindsey Hopkins at or by phone at (415) 533-1749. Maren Nyer at or by phone at (617) 643-4897. Nina Vollbehr at or by phone at (+31) 6 17012443. Jacob Hyde at or by phone at (303) 871-6245. The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA's membership includes nearly 115,700 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives.

Bouwmans M.E.J.,University of Groningen | Bos E.H.,University of Groningen | Hoenders H.J.R.,Center for Integrative Psychiatry | Oldehinkel A.J.,University of Groningen | de Jonge P.,University of Groningen
Journal of Affective Disorders | Year: 2017

Background The exact nature of the complex relationship between sleep and affect has remained unclear. This study investigated the temporal order of change in sleep and affect in participants with and without depression. Methods 27 depressed patients and 27 pair-matched healthy controls assessed their sleep in the morning and their affect 3 times a day for 30 consecutive days in their natural environment. Daily sleep quality and average positive affect (PA) and negative affect (NA) were used to examine whether changes in sleep quality preceded or followed changes in PA and NA, and whether this was different for patients and healthy controls. Second, presumptive mediating factors were investigated. We hypothesized that fatigue mediated the effect of changes in sleep quality on subsequent PA/NA, and that rumination mediated the effect of changes in PA/NA on subsequent sleep quality. Results Multilevel models showed that changes in sleep quality predicted changes in PA (B=0.08, p<0.001) and NA (B=−0.06, p<0.001), but not the other way around (PA: B=0.03, p=0.70, NA: B=−0.05, p=0.60). Fatigue was found to be a significant mediator of the relationship between sleep quality and PA (Indirect Effect=0.03, p<0.001), and between sleep quality and NA (Indirect Effect=−0.02, p=0.01). Rumination was not investigated because of non-significant associations between PA/NA and sleep quality. The associations were not different for patients and controls. Limitations The analyses were restricted to self-reported sleep quality, and conclusions about causality could not be drawn. Conclusions Improvements in sleep quality predicted improvements in affect the following day, partly mediated by fatigue. Treatment of sleep symptoms would benefit affect in clinical care and beyond. © 2016 Elsevier B.V.

Wilhelm I.,University of Lübeck | Diekelmann S.,University of Lübeck | Molzow I.,Center for Integrative Psychiatry | Ayoub A.,University of Lübeck | And 2 more authors.
Journal of Neuroscience | Year: 2011

The brain encodes huge amounts of information, but only a small fraction is stored for a longer time. There is now compelling evidence that the long-term storage of memories preferentially occurs during sleep. However, the factors mediating the selectivity of sleep-associated memory consolidation are poorly understood. Here, we show that the mere expectancy that a memory will be used in a future test determines whether or not sleep significantly benefits consolidation of this memory. Human subjects learned declarative memories (word paired associates) before retention periods of sleep or wakefulness. Postlearning sleep compared with wakefulness produced a strong improvement at delayed retrieval only if the subjects had been informed about the retrieval test after the learning period. If they had not been informed, retrieval after retention sleep did not differ from that after the wake retention interval. Retention during the wake intervals was not affected by retrieval expectancy. Retrieval expectancy also enhanced sleep-associated consolidation of visuospatial (two-dimensional object location task) and procedural motor memories (finger sequence tapping). Subjects expecting the retrieval displayed a robust increase in slow oscillation activity and sleep spindle count during postlearning slow-wave sleep (SWS). Sleep-associated consolidation of declarative memory was strongly correlated to slow oscillation activity and spindle count, but only if the subjects expected the retrieval test. In conclusion, our work shows that sleep preferentially benefits consolidation of memories that are relevant for future behavior, presumably through a SWS-dependent reprocessing of these memories. Copyright © 2011 the authors.

Bos E.H.,Center for Integrative Psychiatry | Hoenders R.,Center for Integrative Psychiatry | De Jonge P.,University of Groningen
BMJ Case Reports | Year: 2012

Time-series analysis was used to study the associations between daily weather variables and symptomatology in a man suffering from recurrent anxiety. Outcome measures were the patient 's main symptoms: anxiety and energy. Wind direction appeared to be related to the patient's energy levels; these were significantly lower when the wind blew from the southeast. This effect could not be explained by other weather parameters. Decreases in energy in turn predicted increases in anxiety. The reverse effect was observed as well, with increases in anxiety predicting decreases in energy, indicating a positive feedback loop. Copyright 2012 BMJ Publishing Group. All rights reserved.

Meijer A.,University of Groningen | Conradi H.J.,University of Groningen | Conradi H.J.,University of Amsterdam | Bos E.H.,University of Groningen | And 4 more authors.
General Hospital Psychiatry | Year: 2011

Objective: A meta-analysis of over 25 years of research into the relationship between post-myocardial infarction (MI) depression and cardiac prognosis was conducted to investigate changes in this association over time and to investigate subgroup effects. Method: A systematic literature search was performed (Medline, Embase and PsycINFO; 1975-2011) without language restrictions. Studies investigating the impact of post-MI depression on cardiovascular outcome, defined as all-cause mortality, cardiac mortality and cardiac events within 24 months after the index MI, were identified. Depression had to be assessed within 3 months after MI using established instruments. Pooled odds ratios (ORs) were calculated using a random effects model. Results: A total of 29 studies were identified, resulting in 41 comparisons. Follow-up (on average 16 months) was described for 16,889 MI patients. Post-MI depression was associated with an increased risk of all-cause mortality [(OR), 2.25; 95% confidence interval [CI], 1.73-2.93; P<.001], cardiac mortality (OR, 2.71; 95% CI, 1.68-4.36; P<.001) and cardiac events (OR, 1.59; 95% CI, 1.37-1.85; P<.001). ORs proved robust in subgroup analyses but declined over the years for cardiac events. Conclusions: Post-MI depression is associated with a 1.6- to 2.7-fold increased risk of impaired outcomes within 24 months. This association has been relatively stable over the past 25 years. © 2011 Elsevier Inc.

Sarris J.,University of Melbourne | Sarris J.,Swinburne University of Technology | Lake J.,Arizona Center for Integrative Medicine | Hoenders R.,Center for Integrative Psychiatry
Journal of Alternative and Complementary Medicine | Year: 2011

Background: Bipolar disorder (BD) is a debilitating syndrome that is often undiagnosed and undertreated. Population surveys show that persons with BD often self-medicate with complementary and alternative medicine (CAM) or integrative therapies in spite of limited research evidence supporting their use. To date, no review has focused specifically on nonconventional treatments of BD. Objectives: The study objectives were to present a review of nonconventional (complementary and integrative) interventions examined in clinical trials on BD, and to offer provisional guidelines for the judicious integrative use of CAM in the management of BD. Methods: PubMed, CINAHL, ® Web of Science, and Cochrane Library databases were searched for human clinical trials in English during mid-2010 using Bipolar Disorder and CAM therapy and CAM medicine search terms. Effect sizes (Cohen's d) were also calculated where data were available. Results: Several positive high-quality studies on nutrients in combination with conventional mood stabilizers and antipsychotic medications in BD depression were identified, while branched-chain amino acids and magnesium were effective (small studies) in attenuating mania in BD. In the treatment of bipolar depression, evidence was mixed regarding omega-3, while isolated studies provide provisional support for a multinutrient formula, n-acetylcysteine, and l-tryptophan. In one study, acupuncture was found to have favorable but nonsignificant effects on mania and depression outcomes. Conclusions: Current evidence supports the integrative treatment of BD using combinations of mood stabilizers and select nutrients. Other CAM or integrative modalities used to treat BD have not been adequately explored to date; however, some early findings are promising. Select CAM and integrative interventions add to established conventional treatment of BD and may be considered when formulating a treatment plan. It is hoped that the safety issues and clinical considerations addressed in this article may encourage the practice of safety-conscious and evidence-based integrative management of BD. © 2011 Mary Ann Liebert, Inc.

de Vries R.M.,University of Groningen | Hartogs B.M.A.,Center for Integrative Psychiatry | Morey R.D.,University of Groningen
Behavior Therapy | Year: 2015

When researchers are interested in the effect of certain interventions on certain individuals, single-subject studies are often performed. In their most simple form, such single-subject studies require that a subject is measured on relevant criterion variables several times before an intervention and several times during or after the intervention. Scores from the two phases are then compared in order to investigate the intervention effect. Since observed scores typically consist of a mixture of true scores and random measurement error, simply looking at the difference in scores can be misleading. Hence, de Vries & Morey (2013) developed models and hypothesis tests for single-subject data, quantifying the evidence in data for the size and presence of an intervention effect. In this paper we give a non-technical overview of the models and hypothesis tests and show how they can be applied on real data using the BayesSingleSub R package, with the aid of an empirical data set. © 2014.

Hoenders H.J.R.,Center for Integrative Psychiatry | Appelo M.T.,Psycho oncology Therapy Center Het Behouden Huys | Van Den Brink E.H.,Center for Integrative Psychiatry | Hartogs B.M.A.,Center for Integrative Psychiatry | De Jong J.T.V.M.,University of Amsterdam
Journal of Alternative and Complementary Medicine | Year: 2011

Background: Complementary and alternative medicine (CAM) is subject to heated debates and prejudices. Studies show that CAM is widely used by psychiatric patients, usually without the guidance of a therapist and without the use of a solid working method, leading to potential health risks. Aim: The purpose of this study is to facilitate the judicious use of CAM alongside conventional psychiatry in an outpatient psychiatric clinic. Methods: A search was made through scientific and legal articles and discussion in focus groups. Results: In the Centre for Integrative Psychiatry (CIP) of Lentis in the Netherlands, some carefully selected CAM are offered under strict conditions, alongside conventional treatments. Because of the controversy and the potential health risks, Lentis designed a protocol that is presented. Conclusions: The CIP hopes, by using this protocol, to better serve and respect the individual needs and preferences of the diversity of psychiatric patients in our Dutch multicultural society, and better protect them from harm. © 2011, Mary Ann Liebert, Inc.

Time-series analysis was used to study the associations between daily weather variables and symptomatology in a man suffering from recurrent anxiety. Outcome measures were the patient's main symptoms: anxiety and energy. Wind direction appeared to be related to the patient's energy levels; these were significantly lower when the wind blew from the southeast. This effect could not be explained by other weather parameters. Decreases in energy in turn predicted increases in anxiety. The reverse effect was observed as well, with increases in anxiety predicting decreases in energy, indicating a positive feedback loop.

Hartogs B.M.,Center for Integrative Psychiatry
BMJ case reports | Year: 2013

A 23-year-old woman with anorexia nervosa (AN) and a strong need for control was offered an integrative treatment, empowering the patient to be an active participant and advocating shared decision-making. To emphasise this, both the therapist and patient describe their views on the therapy. The integrative treatment resulted in more psychological flexibility and behavioural improvements, as is evident from an increased weight, a decreased dietary restriction and an increased valued action. The strength of this integrative treatment is based on accepting and encouraging patient's self-chosen treatment method, within healthy limits, and thereby creating a flexible, supportive and empowering therapeutic alliance. More research is needed to test the efficacy of combining complementary therapies within conventional treatments of AN.

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