OBJECTIVE: To systematically investigate the treatment effects of massage therapy in depressed people by incorporating data from recent studies. DATA SOURCES: A meta-analysis of randomized controlled trials (RCTs) of massage therapy in depressed people was conducted using published studies from PubMed, EMBASE, PsycINFO, and CINAHL electronic database from inception until July 2008. The terms used for the search were derived from medical subheading term (MeSH) massage combined with MeSH depression. Hand searching was also checked for bibliographies of relevant articles. Retrieval articles were constrained to RCTs/clinical trials and human subjects. No language restrictions were imposed. STUDY SELECTION: We included 17 studies containing 786 persons from 246 retrieved references. Trials with other intervention, combined therapy, and massage on infants or pregnant women were excluded. DATA EXTRACTION: Two reviewers independently performed initial screen and assessed quality indicators by Jadad scale. Data were extracted on publication year, participant characteristics, and outcomes by another single reviewer. DATA SYNTHESIS: All trials showed positive effect of massage therapy on depressed people. Seventeen RCTs were of moderate quality, with a mean quality score of 6.4 (SD = 0.85). The pooled standardized mean difference in fixed- and random-effects models were 0.76 (95% CI, 0.61-0.91) and 0.73 (95% CI, 0.52-0.93), respectively. Both indicated significant effectiveness in the treatment group compared with the control group. The variance between these studies revealed possible heterogeneity (tau(2) = 0.06, Cochran chi(2)(16) = 25.77, P = .06). CONCLUSIONS: Massage therapy is significantly associated with alleviated depressive symptoms. However, standardized protocols of massage therapy, various depression rating scales, and target populations in further studies are suggested. © Copyright 2010 Physicians Postgraduate Press, Inc.

J Clin Psychiatry. 2010 Mar 23. Hou WH, Chiang PT, Hsu TY, Chiu SY, Yen YC. Department of Physical Medicine and Rehabilitation, Kaohsiung, Taiwan.

Tim Brunson, PhD, and Annie Brunson have created a new twenty module transformation program designed to install mastery-building techniques within the participant. The course is self-paced with one module released each Tuesday for the duration of the program. It includes exercises and demonstrations designed to progressively improve skills. While the intention is to teach how to quickly master anything, as the program progresses the student will steadily develop more and more abilities, which can then be applied to various aspects of their lives.

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Full Title: The effects of music therapy on postpartum blues and maternal attachment of puerperal women

PURPOSE: The purpose of this study was to determine the effects of music therapy on postpartum blues and maternal attachment of puerperal women. METHODS: The research design was a nonequivalent control group non-synchronized design. The participants were puerperal women who agreed to participate in this study and through a convenience sampling, 60 puerperal women were recruited (30 in the experimental group, 30 in the control group). After measuring postpartum blues and maternal attachment, music therapy was provided to the experimental group over 40 min, once a day, and for 8 days. Then, postpartum blues and maternal attachment for the experimental and control group were measured again on the 8th day. The data were analyzed using the SPSS WIN 12.0 Program. RESULTS: The first hypothesis that "the degree of postpartum blues for the experimental group who participated in music therapy would be lower than that of the control group" was accepted (t=4.350, p<.001). The second hypothesis that "the degree of maternal attachment of the experimental group who participated in music therapy would be higher than that of the control group" was accepted (t=4.828, p<.001). CONCLUSION: These findings indicate that music therapy has positive influences on decreasing postpartum blues and increasing maternal attachment of puerperal women.

J Korean Acad Nurs. 2010 Feb;40(1):60-8. Lee SM. Department of Nursing, Catholic University of Daegu, Daegu, Korea. selva88@hanmail.net.

The Kinesiology Institute presents Dawson Church, author of "Genie in Your Genes" demonstrating the Emotional Freedom Technique or EFT. The Kinesiology Institute offers training in Holistic Health to both lay people and health professionals (i.e. massage therapists, holistic nurses, chiropractors, psychologists) in Touch for Health Kinesiology to eliminate physical and emotional pain and stress and optimize health and performance.

Full Title: Successful treatment of OCD with a micronutrient formula following partial response to Cognitive Behavioral Therapy (CBT): a case study

Obsessive Compulsive Disorder (OCD) affects 0.5-2% of young people many of whom are resistant to conventional treatments. This case study describes an 18-year-old male with OCD who first underwent cognitive behavioral therapy (CBT) for a 1-year period with a modest response (his OCD had shifted from severe to moderate). Within a year, his anxiety had deteriorated back to the severe range and he now had major depression. He then entered an ABAB design trial using a nutritional formula consisting mainly of minerals and vitamins (together, known as micronutrients). After 8 weeks on the formula, his mood was stabilized, his anxiety reduced, and his obsessions were in remission. The treatment was then discontinued for 8 weeks, during which time his obsessions and anxiety worsened and his mood dropped. Reintroduction of the formula again improved the symptoms. This case illustrates the importance of considering the effect micronutrients have on mental illness.

J Anxiety Disord. 2009 Aug;23(6):836-40. Epub 2009 Mar 9. Rucklidge JJ. Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch, New Zealand. julia.rucklidge@canterbury.ac.nz

Randal Churchill is founder of HTI, which became one of the first licensed hypnotherapy schools in 1978. He is President of the American Council of Hypnotist Examiners, the original and primary Hypnotherapy Certification organization. He received his degree in Psychology with Honors from Sonoma State University and has completed over 35,000 hours of exceptional hypnotherapy in a practice that began upon completion of his initial training with legendary Gil Boyne in 1968.

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PURPOSE: This study investigated the influence of manual acupuncture on heart rate variability and the role which anxiety can play in modifying physiological outcomes. METHOD: Analysis of heart rate variability (HRV) was used as a sensitive and a reliable indicator of the balance between sympathetic and parasympathetic regulation of the heartbeat. Two groups of healthy female subjects were recruited into the study. The control group (n=30) attended one experimental session where no acupuncture treatment was used. The experimental group (n=30) attended three sessions in which unilateral manual stimulation of acupuncture points LU7 and KD6 was performed. RESULTS: The stimulation of the acupuncture points LU7 and KD6 was not associated with significant changes in HRV. Previous familiarity with acupuncture did not influence the outcomes but level of anxiety had a strong impact on physiological outcomes. Stimulation of LU7 acupuncture point counterbalanced naturally occurring sympathetic increase over time and had relaxing and harmonizing effect on the heart rhythm without influencing subjective perception of increased anxiety. Stimulation of KD6 acupuncture point had sympathetic influence on HRV in subjects with low "trait" anxiety and this influence was nullified by simultaneous stimulation of LU7 acupuncture point. CONCLUSIONS: It seems likely that the level of anxiety can modify HRV during acupuncture treatment and up to 40 min after the treatment. Psychological factors such as anxiety level should be considered as having important influence on physiological response to acupuncture.

Complement Ther Clin Pract. 2009 Aug;15(3):124-8. Epub 2009 Mar 10. Vickland V, Rogers C, Craig A, Tran Y. Department of Medical and Molecular Biosciences, University of Technology, Sydney, NSW 2007, Australia. victor.vickland@unsw.edu.au

Full Title: The Nordic maintenance care program: case management of chiropractic patients with low back pain - defining the patients suitable for various management strategies.

ABSTRACT: BACKGROUND: Maintenance care is a well known concept among chiropractors, although there is little knowledge about its exact definition, its indications and usefulness. As an initial step in a research program on this phenomenon, it was necessary to identify chiropractors' rationale for their use of maintenance care. Previous studies have identified chiropractors' choices of case management strategies in response to different case scenarios. However, the rationale for these management strategies is not known. In other words, when presented with both the case, and different management strategies, there was consensus on how to match these, but if only the management strategies were provided, would chiropractors be able to define the cases to fit these strategies? The objective with this study was to investigate if there is a common pattern in Finnish chiropractors' case management of patients with low back pain (LBP), with special emphasis on long-term treatment. METHODS: Information was obtained in a structured workshop. Fifteen chiropractors, members of the Finnish Chiropractors' Union, and present at the general assembly, participated throughout the entire workshop session. These were divided into five teams each consisting of 3 people. A basic case of a patient with low back pain was presented together with six different management strategies undertaken after one month of treatment. Each team was then asked to describe one (or several) suitable case(s) for each of the six strategies, based on the aspects of 1) symptoms/findings, 2) the low back pain history in the past year, and 3) other observations. After each session the people in the groups were changed. Responses were collected as key words on flip-over boards. These responses were grouped and counted. RESULTS: There appeared to be consensus among the participants in relation to the rationale for at least four of the management strategies and partial consensus on the rationale for the remaining two. In relation to maintenance care, the patient's past history was important but also the doctor-patient relationship. CONCLUSION: These results confirm that there is a pattern among Nordic chiropractors in how they manage patients with LBP. More information is needed to define the "cut-point" for the indication of prolonged care.

Chiropr Osteopat. 2009 Jul 12;17:7. Malmqvist S, Leboeuf-Yde C. Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. stefan.malmqvist@uis.no.

Cognitive hypnotherapy (CH) is a comprehensive evidence-based hypnotherapy for clinical depression. This article describes the major components of CH, which integrate hypnosis with cognitive-behavior therapy as the latter provides an effective host theory for the assimilation of empirically supported treatment techniques derived from various theoretical models of psychotherapy and psychopathology. CH meets criteria for an assimilative model of psychotherapy, which is considered to be an efficacious model of psychotherapy integration. The major components of CH for depression are described in sufficient detail to allow replication, verification, and validation of the techniques delineated. CH for depression provides a template that clinicians and investigators can utilize to study the additive effects of hypnosis in the management of other psychological or medical disorders. Evidence-based hypnotherapy and research are encouraged; such a movement is necessary if clinical hypnosis is to integrate into mainstream psychotherapy.

Int J Clin Exp Hypn. 2010 Apr;58(2):165-85. Alladin A. University of Calgary Medical School, Alberta, Canada. assen.alladin@albertahealthservices.ca

by Alfred A Barrios, PhD

My commentary will cover the following key areas:

I. Contrasting my theory with other major perspectives in the field including the Socio-cognitive, the Dissociation/Neo-Dissociation, and the Response-Expectancy perspectives, pointing out some of the key similarities and differences between these approaches and my theory.

II. Presenting some of the research and work subsequent to the first publication of my theory (Barrios, 1969) that I feel presents further support for it; and

III. Pointing out some of the subsequent benefits of the theory which will include:

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Full Title: Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial

OBJECTIVES: Although biofeedback therapy is effective in the short-term management of dyssynergic defecation, its long-term efficacy is unknown. Our aim was to compare the 1-year outcome of biofeedback (manometric-assisted pelvic relaxation and simulated defecation training) with standard therapy (diet, exercise, laxatives) in patients who completed 3 months of either therapy. METHODS: Stool diaries, visual analog scales (VASs), colonic transit, anorectal manometry, and balloon expulsion time were assessed at baseline, and at 1 year after each treatment. All subjects were seen at 3-month intervals and received reinforcement. Primary outcome measure (intention-to-treat analysis) was a change in the number of complete spontaneous bowel movements (CSBMs) per week. Secondary outcome measures included bowel symptoms, changes in dyssynergia, and anorectal function. RESULTS: Of 44 eligible patients with dyssynergic defecation, 26 agreed to participate in the long-term study. All 13 subjects who received biofeedback, and 7 of 13 who received standard therapy, completed 1 year; 6 failed standard therapy. The number of CSBMs per week increased significantly (P<0.001) in the biofeedback group but not in the standard group. Dyssynergia pattern normalized (P<0.001), balloon expulsion time improved (P=0.0009), defecation index increased (P<0.001), and colonic transit time normalized (P=0.01) only in the biofeedback group. CONCLUSIONS: Biofeedback therapy provided sustained improvement of bowel symptoms and anorectal function in constipated subjects with dyssynergic defecation, whereas standard therapy was largely ineffective.

Am J Gastroenterol. 2010 Apr;105(4):890-6. Epub 2010 Feb 23. Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K. Department of Gastroenterology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242-1009, USA. satish-rao@uiowa.edu

Linda Ferguson believes that human beings learn and function most effectively in connection with other people. Her enthusiasm, widespread learning, and deep commitment have been inspiring clients for more than 20 years. She is a coach with a finely tuned ear for opportunity and a delight in leading people safely through change. Linda is also an extraordinary storyteller with a gift for building metaphors that support individual and group transformations.

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Full Title: Itching, Pain, and Anxiety Levels Are Reduced With Massage Therapy in Adolescent Having Burn

Burn, a person may face, is one of the statuses, which can be a most severe physical and psychologic trauma. Patients with burns commonly have severe itching and pain. Severe itching has also been associated with the anxiety, sleep disturbance, and disruption of daily living activities. The addition of complementary treatments to standard care may lead to a greater pain management and may offer a safer approach for reducing pain and procedural anxiety for patients with burns. The authors conducted an experimental study to examine whether the effects of massage therapy reduced burned adolescents' pain, itching, and anxiety levels. Sixty-three adolescents were enrolled in this study shortly after admission (mean days = 3 +/- 0.48) at a burn unit in a large university hospital from February 2008 to June 2009. The measures including the pain, itching, and state anxiety were collected on the first and last days of the 5-week study period. The participants had an average age of 14.07 +/- 1.78 years and came usually from the lower socioeconomic strata. The authors observed that massage therapy reduced all these measures from the first to the last day of this study (P < .001). In most cultures, massage treatment are used to alleviate a wide range of symptoms. Although health professionals agree on the use of nonpharmacologic method for patients with burns, these applications are not yet common.

J Burn Care Res. 2010 Mar 31. Parlak A, Polat S, Nuran Akçay M. From the *Department of Pediatric Nursing, Faculty of Health Sciences, Atatürk University, Erzurum; daggerDepartment of Pediatric Nursing, Bozok University, School of Health, Yozgat; and double daggerDepartment of General Surgery, Medical Faculty, Atatürk University, Erzurum, Turkey.

Full Title: Pain-reduction strategies in hypnotic context and hypnosis: ERPs and SCRs during a secondary auditory task

Pain-rating scores were obtained from 10 high, 10 medium, and 10 low hypnotizable subjects who were holding a painful cold bottle in their left hands and were exposed to pain reduction treatments while they were performing a secondary oddball task. All subjects received suggestions of dissociative imagery and focused analgesia as cognitive strategies for pain reduction. The following measures were obtained for tone targets of the auditory oddball task: (a) reaction time; (b) P300 peak amplitude of the event-related potentials; (c) skin conductance levels and skin conductance responses. Focused analgesia produced the most pain reduction in high, but not medium or low, hypnotizable subjects who showed shorter reaction times, higher central and parietal P300 peaks, and higher skin conductance responses. These findings were discussed vis-a-vis the dissociated-control model assuming that capacity demands of hypnotic suggestion are low.

Int J Clin Exp Hypn. 2004 Oct;52(4):343-63. De Pascalis V, Bellusci A, Gallo C, Magurano MR, Chen AC. Department of Psychology, University of Rome, La Sapienza, Rome, Italy. v.depascalis@caspur.it

by Joyce-Anne Locking

This is the time of year we usually concentrate on getting in shape. We start a walking program or take up golf or tennis, canoeing, boating or other outdoor activities. We want to get fit and fit into our summer wardrobe once again. We strive to get ourselves ready to enjoy the summer by toning our muscles and shaping our plans. One thing we ought to include in this preparing for summer fitness program is our mind. Is the mind a muscle too? I just watched a television interview that suggested the mind is indeed a muscle, a muscle that can be programmed much in the same way as a computer! A mind can be set, somewhat like a clock, to begin routine tasks daily or to begin to change old habits into new ones. New habits, experts suggest, take twenty one days to form. Once we continue to practice a new activity each day for twenty one days, we have started a new habit.

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BACKGROUND: There are few published examples of research examining the effect of massage, aromatherapy, and reflexology in clinic settings. In addition to measuring treatment outcomes, it may also be important to measure the quality of the relationship between the client and therapist and assess its contribution to outcomes. AIMS: To evaluate perceived changes in client quality of life following treatment; to determine whether the relationship between the client and therapist predicts the outcome of treatment; to assess the usefulness of the measures used. METHOD: The Measure Yourself Medical Outcome Profile (MYMOP2) and the Working Alliance Inventory (WAI) were used to collect data from 66 clients and 13 therapists in a complementary therapies clinic in South Wales. RESULTS: The MYMOP2 data showed significant improvements for client symptoms and activity but not for well-being. A low correlation was found between MYMOP2 profile scores and WAI scores suggesting that symptoms, activity and well-being were associated with a positive working alliance but this narrowly failed to achieve statistical significance. CONCLUSION: Further research is necessary to confirm improvements in client quality of life and to establish causes. More research is needed to examine the client-therapist relationship and treatment outcome. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

Complement Ther Clin Pract. 2010 Feb;16(1):31-5. Epub 2009 Jul 4. Harris P, Atkins RC, Alwyn T. Centre for Complementary Therapies, Cardiff School of Health Sciences, University of Wales Institute Cardiff, Western Avenue, Cardiff, Wales, UK. peharris@uwic.ac.uk

by Bernie Siegel, MD

The key to life in all its forms is its ability to communicate. This includes the ability of complex organisms like ourselves to communicate with each other but more importantly within ourselves, our individual organs and cells. How do animals communicate without words? Studies show they can count and make intelligent choices when given options yet we do not know how they are able to reason and communicate without using words.

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This article reviews the evidence for using music therapy with young people who are supported by mechanical ventilation. The author argues that music therapy is essential for developing a holistic approach focusing on the developmental level of a child or young person, as well as being an inexpensive, non-pharmacological, non-invasive therapy, with significant physiological and psychological benefits. She argues that more research is needed in this area to develop a sound evidence base on which guidelines to inform practice could be based.

Paediatr Nurs. 2010 Apr;22(3):14-20. Austin D. Basingstoke and North Hampshire Foundation Trust, Hampshire.

Early intervention for psychosis has become an established clinical practice. Research is now focusing on identifying individuals in the pre-psychotic period when they appear to be putatively prodromal for psychosis. Criteria have been established for identifying these young people who are at clinical high risk, and there have been some early studies testing both pharmacological and psychological treatments. Cognitive behavioral therapy (CBT) has been tested as a potentially effective intervention in this group. Here, we describe two cases that were treated with CBT.

J Clin Psychol. 2009 Aug;65(8):879-90. Addington J, Mancuso E. Department of Psychiatry, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N4N1, Canada. jmadding@ucalgary.ca

Allen S. Chips, DCH, NATH PresidentAllen has earned a doctorate in clinical hypnotherapy and a doctorate in the philosophy of natural health. Managing editor for the Bridge Newsletter, official publication for the National Association of Transpersonal Hypnotherapists, and a popular presenter for the Association for Research and Enlightenment on the work of Edgar Cayce. A renowned international instructor of suggestive and regressive hypnotherapy, and author of two textbooks: Clinical Hypnotherapy: A Transpersonal Approach, Second Edition, and Script Magic: A Hypnotherapist's Desk Reference, Second Edition. Dr. Chips recently released the popular book, Killing Your Cancer Without Killing Yourself: Using Natural Cures That Work! He serves as the President of the American Holistic University, a distance education degree granting institution in Transpersonal Psychology and Naturopathy.

Full Title: The effects of acupuncture stimulation at PC6 (Neiguan) on chronic mild stress-induced biochemical and behavioral responses

In the present study, the effects of acupuncture on the behavioral and physiological responses induced by chronic mild stress (CMS) were evaluated. Sprague-Dawley rats were exposed to a variety of chronic unpredictable, mild stressors for 8 weeks. The effects of acupuncture on stress-induced anxiety and anhedonia were investigated using the elevated plus maze (EPM) and sucrose intake test. In addition, c-fos expression, as an early neuronal marker in the brain was also examined utilizing Fos-like immunohistochemistry (FLI). CMS rats significantly reduced the consumption of sucrose intake and latency in the open arms of the EPM, and gained body weight more slowly, compared to non-stressed normal rats. Exposure to CMS also significantly increased FLI in the paraventricular nucleus (PVN) of the hypothalamus. Acupuncture stimulation at point PC6 on the pericardium channels (3 min), but not at other point (TE5), restored stress-induced decrease in the latency in the open arms and significantly attenuated FLI in the PVN produced by CMS. Acupuncture stimulation also tended to restore stress-induced decrease in the sucrose intake. The present results demonstrated that acupuncture was effective in restoring CMS-related biochemical and behavioral impairments such as anxiety and anhedonia and that acupuncture point was more effective than non-acupuncture point. These results suggest that acupuncture has a therapeutic effect on chronic stress-related diseases such as depression and anxiety.

Neurosci Lett. 2009 Aug 21;460(1):56-60. Epub 2009 May 7. Kim H, Park HJ, Han SM, Hahm DH, Lee HJ, Kim KS, Shim I. Division of Brain Disease, Center for Biomedical Science, National Institute of Health, Seoul, 122-701 Republic of Korea.

Full Title: Hypnosis in the treatment of depression: considerations in research design and methods

Depressive disorders constitute a serious problem in the United States and around the world. The appearance of practice guidelines and lists of evidenced-based therapies suggests that adequate treatments for depression exist. However, a careful consideration of what is known and not known about the treatment of depression leaves plenty of room for improved approaches to addressing this condition. Although there has been a dearth of research on the treatment of depression using hypnosis, there are several compelling arguments for the inclusion of hypnotic approaches in the array of current strategies for dealing with depression. However, traditional "gold-standard" research methods, namely randomized controlled trials, have many shortcomings for identifying the potential impact of hypnosis on depression. Other strategies, notably single-case design and benchmarking approaches, may offer a more practical solution to the problem of determining "what works for depression."

Int J Clin Exp Hypn. 2010 Apr;58(2):147-64. McCann BS, Landes SJ. Department of Psychiatry, University of Washington School of Medicine, Seattle 98195, USA. mccann@u.washington.edu

Full Title: A retrospective analysis of self-reported symptoms from 761 consecutive new patients presenting to a Neuro Emotional Technique chiropractic clinic.

PURPOSE: To describe the profile of patients presenting to a private chiropractic clinic specialising in Neuro Emotional Technique (NET) and to identify trends in the presentation of symptoms from these patients. METHODS: 761 consecutive new patients presented to a large, multi-doctor chiropractic clinic in which practitioners all adopt a similar philosophical paradigm and practice NET From January 2005 to December 2005, self-referred patients completed a new patient questionnaire, in which they self-reported one primary complaint for why they were visiting the practitioner. Predetermined patient information was entered manually into a database and basic descriptive statistics extracted. RESULTS: 67.3% of participants were female and 32.6% of the participants were between the ages of 31 and 40. 54.8% of patients presented with a primary musculoskeletal complaint and 36.0% a non-musculoskeletal complaint. Of the musculoskeletal complaints, 40.8% of patients presented with back pain, 20.9% with neck pain and 11.5% with shoulder pain. The most common form of non-musculoskeletal complaint was immune and recurrent infections (13.9%), stress and anxiety (12.8%) and depression (10.9%). 41.4% of participants reported a first time complaint, however, of the patients who had had the presenting complaint before 60.7% reported as having the complaint for greater than 1 year. Musculoskeletal and non-musculoskeletal participants had similar pain profiles. CONCLUSION: This retrospective analysis is the first comprehensive description of the scope of NET patients and their presenting complaints. The patient profile of this NET clinic has a higher degree of non-musculoskeletal patients than that usually reported in non-NET chiropractic offices, and other forms of chiropractic previously described in the literature. Further cross sectional research is required to determine if this particular clinic is indicative of all NET practices and whether the presenting symptoms, especially the non-musculoskeletal, are resolved with NET.

Complement Ther Clin Pract. 2009 Aug;15(3):166-71. Epub 2009 Mar 4. Bablis P, Pollard H, Bonello R. Macquarie Injury Management Group, Department of Health and Chiropractic, Macquarie University, Sydney, NSW 2109, Australia.

By Coach Cary Bayer

My cat is a 10-pound Buddha named Ananda (Sanskrit for bliss) because she's the fastest purrer in the West. This calico has taught me volumes about how to succeed in the healing arts business. They can teach you, too.

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Full Title: Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome

BACKGROUND & AIMS: Levator ani syndrome (LAS) might be treated using biofeedback to teach pelvic floor relaxation, electrogalvanic stimulation (EGS), or massage of levator muscles. We performed a prospective, randomized controlled trial to compare the effectiveness of these techniques and assess physiologic mechanisms for treatment. METHODS: Inclusion criteria were Rome II symptoms plus weekly pain. Patients were categorized as "highly likely" to have LAS if they reported tenderness with traction on the levator muscles or as "possible" LAS if they did not. All 157 patients received 9 sessions including psychologic counseling plus biofeedback, EGS, or massage. Outcomes were reassessed at 1, 3, 6, and 12 months. RESULTS: Among patients with "highly likely" LAS, adequate relief was reported by 87% for biofeedback, 45% for EGS, and 22% for massage. Pain days per month decreased from 14.7 at baseline to 3.3 after biofeedback, 8.9 after EGS, and 13.3 after massage. Pain intensity decreased from 6.8 (0-10 scale) at baseline to 1.8 after biofeedback, 4.7 after EGS, and 6.0 after massage. Improvements were maintained for 12 months. Patients with only a "possible" diagnosis of LAS did not benefit from any treatment. Biofeedback and EGS improved LAS by increasing the ability to relax pelvic floor muscles and evacuate a water-filled balloon and by reducing the urge and pain thresholds. CONCLUSIONS: Biofeedback is the most effective of these treatments, and EGS is somewhat effective. Only patients with tenderness on rectal examination benefit. The pathophysiology of LAS is similar to that of dyssynergic defecation. 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

Gastroenterology. 2010 Apr;138(4):1321-9. Epub 2010 Jan 4 Chiarioni G, Nardo A, Vantini I, Romito A, Whitehead WE. Division of Gastroenterology, University of Verona at Verona, Italy. chiarioni@tin.it

Michael Licenblat is a Resilience Expert who teaches people how to become 'pressure proof' and bounce back fast from pressure, conflict and change in their work and life. Michael believes that motivation and life balance is more about becoming resilient to pressure and expanding your capacity, instead of trying to reduce your stress.

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Full Title: Hypnotically catalyzing experiential learning across treatments for depression: actions can speak louder than moods

A number of psychotherapeutic approaches for the treatment of major depression have received empirical support in the literature, most notably cognitive-behavioral and interpersonal therapies. Recent studies have shown the therapeutic value of the behavioral activation component of such interventions. Depressed individuals actively learning and applying new skills on their own behalf is widely considered a critical component of recovery. This article describes the use of hypnosis to catalyze experiential learning and to encourage behavioral activation in the depressed client by directly addressing and transforming cognitive and perceptual patterns that can impede such behavioral activation, especially global thinking and ruminative coping styles.

Int J Clin Exp Hypn. 2010 Apr;58(2):186-201. Yapko MD. michaelyapko@roadrunner.com

The efficacy of classical massage on stress perception and cortisol following primary treatment of breast cancer

To investigate the efficacy of classical massage on stress perception and mood disturbances, 34 women diagnosed with primary breast cancer were randomized into an intervention or control group. For a period of 5 weeks, the intervention group (n = 17) received biweekly 30-min classical massages. The control group (n = 17) received no additional treatment to their routine health care. The Perceived Stress Questionnaire (PSQ) and the Berlin Mood Questionnaire (BSF) were used and the patients' blood was collected at baseline (T1), at the end of the intervention period (T2), and 6 weeks after T2 (T3). Compared with control group, women in the intervention group reported significantly lower mood disturbances, especially for anger (p = 0.048), anxious depression (p = 0.03) at T2, and tiredness at T3 (p = 0.01). No group differences were found in PSQ scales, cortisol and serotonin concentrations at T2 and T3. However, perceived stress and cortisol serum levels (p = 0.03) were significantly reduced after massage therapy (T2) compared with baseline in the intervention group. Further research is needed to validate our findings.

Arch Womens Ment Health. 2010 Apr;13(2):165-73. Epub 2010 Feb 19. Listing M, Krohn M, Liezmann C, Kim I, Reisshauer A, Peters E, Klapp BF, Rauchfuss M. Center for Internal Medicine and Dermatology, Department of Psychosomatics and Psychotherapy Berlin, Charité-Universitätsmedizin Berlin, Luisenstr. 13a, Berlin, Germany. miriam.listing@charite.de

WHO SHOULD ATTEND: The 5th Annual Smoky Mountain Nurses Conference is a continuing education experience suitable for nurse anesthetists, operating room nurses, post-anesthesia nurses, nursing instructors, nursing managers, critical care nurses, O.R. technicians, physicians, psychologists, dentists, or any other interested health care worker. Healthy Visions is an approved provider of continuing nursing education by the Alabama State Nurses Association.

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PURPOSE: This study was done to examine the effects of aromatherapy on stress and stress responses in adolescents. METHODS: A two-group cross-over design was used for this study. The experimental treatment was aroma essential oil inhalation and the placebo treatment was carrier oil inhalation using a necklace. The sample included 36 female high school students. Fisher's exact test, t-test, and paired t-test using SPSS/WIN program were used to analyze the data. RESULTS: Stress levels were significantly lower when the students received the aroma treatment compared to when they received the placebo treatment. The stress responses except salivary IgA levels were significantly lower when the students received the aroma treatment. CONCLUSION: Aroma inhalation could be a very effective stress management method for high school students. Therefore, it is recommended that this program be used in clinical practice as an effective nursing intervention for high school students.

J Korean Acad Nurs. 2009 Jun;39(3):357-65. Seo JY. Department of Nursing, Youngnam Foreign Language College, Gyeongsan, Korea. marseo@hanmail.net

by Lorraine Pirihi

Many business owners try something once and if it doesn't work, they don't usually bother again. A great example of this is sending out a newsletter to your database.

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Pain is a normal finding in the postoperative patient, and noise can accentuate one's perception of discomfort. In this study, physiological measurements, intravenous (IV) opioid administration, length of stay, and satisfaction for postoperative patients who listened to music were compared with patients not provided music during their PACU stay. Of the 213 subjects enrolled, 163 experienced postoperative pain. The mean change in experimental subjects' respiratory rate was significantly lower than the controls. Decreases in heart rate and blood pressure from admission to discharge were similar between the two groups. On average, peripheral oxygen saturation and opioid pain control were not significantly different between control and experimental subjects. Subjects provided with music reported acceptable noise levels and increased satisfaction with their PACU experience. Music intervention is therefore a viable, minimal cost, and alternative therapy that PACU nurses can use to assist patients coping with postoperative pain. Copyright 2010 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

J Perianesth Nurs. 2010 Apr;25(2):79-87. Easter B, DeBoer L, Settlemyre G, Starnes C, Marlowe V, Tart RC. Catawba Valley Medical Center PACU, Hickory, NC 28602, USA. beaster@catawbavalleymc.org

Full Title: Cognitive Behavioral Therapy Plus Motivational Interviewing Improves Outcome for Pediatric Obsessive-Compulsive Disorder: A Preliminary Study

Lack of motivation may negatively impact cognitive behavioral therapy (CBT) response for pediatric patients with obsessive-compulsive disorder (OCD). Motivational interviewing is a method for interacting with patients in order to decrease their ambivalence and support their self-efficacy in their efforts at behavior change. The authors present a preliminary randomized trial (N = 16) to evaluate the effectiveness of adding motivational interviewing (MI) as an adjunct to CBT. Patients aged 6 to 17 years who were participating in intensive family-based CBT for OCD were randomized to receive either CBT plus MI or CBT plus extra psychoeducation (PE) sessions. After four sessions, the mean Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) score for the CBT plus MI group was significantly lower than for the CBT plus psychoeducation group, t(14) = 2.51, p < .03, Cohen's d = 1.34. In addition, the degree of reduction in CY-BOCS scores was significantly greater, t(14) = 2.14, p = .05, Cohen's d = 1.02, for the CBT plus MI group (mean Delta = 16.75, SD = 9.66) than for the CBT plus psychoeducation group (mean Delta = 8.13, SD = 6.01). This effect decreased over time, and scores at posttreatment were not significantly different. However, participants in the MI group completed treatment on average three sessions earlier than those in the psychoeducation group, providing support for the utility of MI in facilitating rapid improvement and minimizing the burden of treatment for families.

Cogn Behav Ther. 2009 Aug 12:1. Merlo LJ, Storch EA, Lehmkuhl HD, Jacob ML, Murphy TK, Goodman WK, Geffken GR. Department of Psychiatry, University of Florida, Gainesville, Florida, USA.

A key figure in the development of the profession of hypnotherapy, since the early 1980s Dr. Butler has been highly influential in establishing educational and training standards for hypnotherapists and in achieving public and political recognition of hypnotherapy as a major healing art.

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Full Title: Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs)

Controversy remains regarding the mechanisms of acupuncture analgesia. A prevailing theory, largely unproven in humans, is that it involves the activation of endogenous opioid antinociceptive systems and mu-opioid receptors (MORs). This is also a neurotransmitter system that mediates the effects of placebo-induced analgesia. This overlap in potential mechanisms may explain the lack of differentiation between traditional acupuncture and either non-traditional or sham acupuncture in multiple controlled clinical trials. We compared both short- and long-term effects of traditional Chinese acupuncture (TA) versus sham acupuncture (SA) treatment on in vivo MOR binding availability in chronic pain patients diagnosed with fibromyalgia (FM). Patients were randomized to receive either TA or SA treatment over the course of 4 weeks. Positron emission tomography (PET) with (11)C-carfentanil was performed once during the first treatment session and then repeated a month later following the eighth treatment. Acupuncture therapy evoked short-term increases in MOR binding potential, in multiple pain and sensory processing regions including the cingulate (dorsal and subgenual), insula, caudate, thalamus, and amygdala. Acupuncture therapy also evoked long-term increases in MOR binding potential in some of the same structures including the cingulate (dorsal and perigenual), caudate, and amygdala. These short- and long-term effects were absent in the sham group where small reductions were observed, an effect more consistent with previous placebo PET studies. Long-term increases in MOR BP following TA were also associated with greater reductions in clinical pain. These findings suggest that divergent MOR processes may mediate clinically relevant analgesic effects for acupuncture and sham acupuncture.

Neuroimage. 2009 Sep;47(3):1077-85. Epub 2009 Jun 6. Harris RE, Zubieta JK, Scott DJ, Napadow V, Gracely RH, Clauw DJ. Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, USA. reharris@med.umich.edu

by Tim Brunson, PhD

Ever since Stephen Covey mandated in his book The Seven Habits of Highly Effective People that people should learn to "think outside the box" and Bill O'Hanlon, LMFT, explained to Oprah Winfrey the central theme of his book Do One Thing Different, mental flexibility has been the popular buzz phrase for business consultants and therapists alike. Even during my coursework with the highly doctrine-oriented US Army War College, they too espoused the value of what is often called "critical thinking" among academics. Indeed, mental flexibility is both taught and explored. Yet, somehow I still feel that, despite the ubiquity of the concept, mental flexibility still needs further examination if its clinical applications are to be fully appreciated.

In the Neurology of Suggestion and Advanced Neuro-Noetic Hypnosis certification courses, I frequently mention that everything around us and within us is made up of patterns – which in turn have structure, encoding, and may be recalled. Neurologically this can be easily seen in the organization of neural networks. They are structured largely as a reflection of their environment – which can also be considered as learning. The late Canadian psychologist Donald Hebb, PhD, gave us the "Use it or Lose it" concept, which states that networks that are repetitively used are reinforced (as evidenced by additional connections between neurons in that network) and those that are neglected tend to wither or otherwise become subordinate.

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Full Title: Hypnosis, rumination, and depression: catalyzing attention and mindfulness-based treatments

Over the past 30 years, mental health practitioners, encouraged by rigorous empirical studies and literature and meta-analytic reviews, have increasingly appreciated the ability of hypnosis to modulate attention, imagination, and motivation in the service of therapeutic goals. This article describes how hypnosis can be used as an adjunctive procedure in the treatment of depression and rumination symptoms, in particular. The focus is on attention-based treatments that include rumination-focused cognitive behavioral therapy, cognitive control training, and mindfulness-based cognitive therapy. The authors provide numerous examples of techniques and approaches that can potentially enhance treatment gains, including a hypnotic induction to facilitate mindfulness and to motivate mindfulness practice. Although hypnosis appears to be a promising catalyst of attention and mindfulness, research is required to document the incremental value of adding hypnosis to the treatments reviewed.

Int J Clin Exp Hypn. 2010 Apr;58(2):202-21. Lynn SJ, Barnes S, Deming A, Accardi M. Psychology Department, Binghamton University, Binghamton, New York 13905, USA. slynn@binghamton.edu

Full Title: Chiropractic management of mechanical low back pain secondary to multiple-level lumbar spondylolysis with spondylolisthesis in a United States Marine Corps veteran: a case report.

OBJECTIVE: This case report describes the evaluation and conservative management of mechanical low back pain secondary to multiple-level lumbar spondylolysis with spondylolisthesis in a United States Marine Corps veteran within a Veterans Affairs Medical Center chiropractic clinic. CLINICAL FEATURES: The 43-year-old patient had a 20-year history of mechanical back pain secondary to an injury sustained during active military duty. He had intermittent radiation of numbness and tingling involving the right lower extremity distal to the knee. Radiographs of the lumbosacral region demonstrated a grade I spondylolisthesis of L3 in relation to L4 and a grade II spondylolisthesis of L4 in relation to L5 secondary to bilateral pars interarticularis defects. There was marked narrowing of the L4-5 disk space with associated subchondral sclerosis. INTERVENTION AND OUTCOME: A course of conservative management consisting of 10 treatments including lumbar flexion/distraction and activity modification was provided over an 8-week period. Despite the long-standing nature of the complaint and underlying multiple-level lumbar spondylolysis with spondylolisthesis, there was a 25% reduction in low back pain severity on the numeric rating scale and a 22% reduction in perceived disability related to low back pain on the Revised Oswestry Disability Questionnaire. CONCLUSIONS: Conservative management is considered to be the standard of care for spondylolysis and should be explored in its various forms for symptomatic low back pain patients who present without neurologic deficits and with spondylolisthesis below grade III. The response to treatment for the veteran patient in this case suggests that lumbar flexion/distraction may serve as a safe and effective component of conservative management of mechanical low back pain for some patients with spondylolysis and spondylolisthesis.

J Chiropr Med. 2009 Sep;8(3):125-30. Dunn AS, Baylis S, Ryan D. Staff Chiropractor, VA of Western New York, Buffalo, NY 14215; Adjunct Assistant Professor, New York Chiropractic College, Buffalo, NY 14215.

by Katherine Zimmerman, PhD, CHT

Renee's session starts in a huge, white sanctuary. She's feeling relaxed. I mention the anger, frustration and depression that we discussed prior to trance. I invite the part with these feelings to step forward so that we can let her know that she's done an extremely effective job– especially this last eighteen months– of keeping Renee angry and frustrated, without even knowing why... and depressed.

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Full Title: Traditional Chinese medicine in the treatment of rheumatoid arthritis: a general review

Rheumatoid arthritis (RA) is difficult to cure. Many methods have been used for its treatment, among which traditional Chinese medicine (TCM) has been considered as an important strategy. All of the three parts of TCM: Chinese herbs, acupuncture, and massage have been reported with varying degrees of therapeutic effects on RA. Also the mechanism exploration is under process. Many effective ingredients of anti-rheumatic Chinese herbs have been found to inhibit RA development and some of the effective ingredients have been verified. Furthermore, greatly enhanced life quality of RA patients was obtained using acupuncture and massage to relieve pain, expand joint motion and modulate emotion which mainly correlated with the possible modulation of immune system, nerve system, endocrine system, etc. Thus, a systemic review on the therapeutic effect of TCM on RA is necessary. In our paper, the current status of TCM application in the clinic for the therapy of RA was summarized accompanied with the related mechanism exploration using modern test facilities.

Rheumatol Int. 2010 Apr;30(6):713-8. Epub 2010 Mar 5. Zhang P, Li J, Han Y, Yu XW, Qin L. The Translational Medicine R&D Center, Shen Zhen Institute of Advanced Technology, Chinese Academy of Science, Shen Zhen, GuangDong Province, China. superzhangpeng@sina.com