Emotional Awareness and Expression Training Reduces Symptom Severity in Irritable Bowel Syndrome

IBS is a functional gut disorder that disturbs the normal functions of the bowel but with no obvious, single cause. The main signs and symptoms of IBS are abdominal pain or discomfort, that is associated with either diarrhoea or constipation or a combination of both. IBS is suspected to be a disorder that involves the dysfunction of the brain-gut-microbiome axis; for some reason the signalling and feedback to and from the brain and the gut is impaired leading to changes in motility, increased nerve sensitivity and comorbid symptoms of depression and anxiety. For a fuller overview of the disorder tune in to the podcast episode all about understanding the illness. Listen here.

It is well documented that people with a diagnosis of IBS tend to experience high levels of psychological stress and/or have experienced traumatic experiences in the past. They are also more likely to have difficulty in intimate relationships and in expressing their feelings. Building on previous research that psychological therapies are an effective treatment for IBS, a new randomised controlled trial investigated the utility of a type of therapy specifically designed to address emotional awareness and expression in people with IBS.

In this study IBS patients were recruited and were then randomly assigned to one of three groups:

1.      Emotional Awareness and Expression Training (EAET)

2.      Relaxation training, which has been shown to be helpful for IBS patients

3.      Waiting list – this was the control group, to compare whether any changes seen in the other two groups would have happened anyway without any intervention.

Both the EAET and relaxation groups received three 50-minute training session delivered over three consecutive weeks i.e. one session a week. They were then assessed two weeks after the end of the last session and then again 10 weeks after that. Participants in groups one and two received a similar explanation about the link between stress and IBS but the EAET group were provided with specific skills to improve emotional expressions such thinking of someone they have a difficult relationship with and being encouraged to describe those feelings out loud as if the person was present. They were later encouraged to express their emotions directly with that person. The relaxation group were coached in muscle relaxation, deep breathing and mindfulness meditation.

Most of the 106 participants in this study were women (IBS is more common in women than men) and had had IBS for more than 20 years. At the end of the 10-week follow-up period 63% of the people in the EAET group reported significant improvements in their IBS symptoms. People in the relaxation and waiting list groups did not report any significant change in the severity of their IBS. Both relaxation and EAET improved the participants’ quality of life. What is striking about this result is that the intervention was very brief, less than three hours in total, and the participants had been ill for many years. The therapists administering the treatment were clinical psychology graduate students. This could mean that, in practical terms, provision of this kind of treatment might be highly cost-effective.

This was a small study with a short follow-up period. It will be important to replicate and extend the research by looking at larger groups and whether the results are sustained over many months. Nonetheless, this paper supports the theory that psychological stress and emotional suppression lead to overstimulation of the stress response and that this dysregulates the nervous communication between the brain and the gut. On an everyday level we recognise this as, for example, feeling so nervous about something that we feel nauseous or have butterflies in our stomachs. In IBS there is  understood to be a continuous over-activation of this system, and the body struggles to return to equilibrium.

Separately, this study also reinforces the importance of acknowledging and expressing emotions rather than ignoring, avoiding or denying them. Unexpressed emotional states don’t just go away, they exert a physiological effect that can lead to somatic symptoms.

As a side note, the researchers’ description of EAET sounds akin to the Distress Tolerance protocols inherent in a type of therapy called Dialectical Behaviour Therapy (DBT), originally designed to help people with a diagnosis of Borderline Personality Disorder to improve how they manage their emotions and their interpersonal effectiveness. There are many Clinical and Counselling Psychologists trained in DBT so this may prove a more accessible route for clients than trying to find an EAET trained therapist.

 

Reference

Thakur, E. R, Holmes, H. J, Lockhart, N. A., Carty, J. N., Ziadni, M. S., Doherty, H. K., Lackner, J. M., Schubiner, H. & Lumley MA. (2017). Emotional awareness and expression training improves irritable bowel syndrome: A randomized controlled trial. Neurogastroenterology, Epub ahead of print. doi: 10.1111/nmo.13143

 

Psychotherapy Improves Mental Health and Daily Functioning in Irritable Bowel Syndrome: Meta-Analysis.

Last year I reported on a study that showed that psychotherapy was effective at reducing the physical pain of Irritable Bowel Syndrome (IBS) and that, at the same time, it was superior to medication at reducing healthcare costs associated with the illness. A new meta-analysis extends the work on psychological treatments for IBS and shows that talking therapies are also effective for improving the mental health and quality of life sufferers. Quality of Life is a psychological measure that looks at the wellbeing of an individual or group and can assess how much satisfaction they derive from their lives or from an aspect of it, such as work or relationships. IBS can reduce quality of life by getting in the way of normal daily activities like work or socialising and can create mental distress but, for example, increasing anxiety around eating and meal times, depression and, in severe cases, suicidal thoughts.

This new meta-analysis looked not only at the efficacy of psychotherapy on improving mental health in IBS sufferers but also at which type of therapy was most effective. The researchers collated 31 randomised controlled trials that provided data on overall mental health and daily functioning of nearly 2000 individuals from different countries. The researchers found that all kinds of psychotherapy were effective at improving psychological wellbeing, people felt better. When it came to daily function cognitive behaviour therapy (CBT) appeared to be the most effective, compared to psychodynamic, hypnosis or relaxation therapy.

Whilst this research is encouraging in relation to the value of therapy in treatment of IBS it does present with a number of problems. First, the researchers have been unable to distinguish between what types of CBT were being provided. For example, some ‘brands’ of CBT focus more on mindfulness, whilst others focus on acceptance and behaviour change. It may be that there is further variability within these groups. In addition, CBT was by far the most studied therapy. Looking at mental health, for example, there were 19 CBT trails compared to 3 psychodynamic. More research on other types of psychotherapy will be useful to add strength to the conclusions. Also, another paper published this year suggested that though CBT did lead to improvements in quality of life for IBS sufferers the results did not last long after the therapy ended.

What we can be surer of is that psychological therapy does improve the mental wellbeing of IBS patients and can be an important tool in helping improve their quality of life. Though there is further research required this meta-analysis adds to the body of research highlighting the powerful role that psychological therapies play in IBS treatment.

 

References

Laird, K. T., Tanner-Smith, E. E., Russell, A. C., Hollon, S. D. & Walker, L. S. (2017). Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: A systematic review and meta-analysis. Clinical Psychology Review, 51, 142-152. https://doi.org/10.1016/j.cpr.2016.11.001

Dehkordi AH, Solati K. The effects of cognitive behavioral therapy and drug therapy on quality of life and symptoms of patients with irritable bowel syndrome. Journal of Advanced Pharmaceutical Technology & Research. 2017;8(2):67-72. doi:10.4103/japtr.JAPTR_170_16.

Exercise (Walking) Increases Effectiveness of CBT in Reducing Depression and Suicidal Thoughts

Depression is now the leading cause of global disease burden. This means that depression is a greater cause of loss of quality of life and days without illness than other illnesses such as heart disease and type 2 diabetes. This week the Mental Health Foundation published a report indicating that only 13% of people in the UK report living with good mental health. More than ever we need to find ways to support mental wellness and increase the efficacy of standard treatment.

I have reported elsewhere research indicating the beneficial effects of physical exercise on mental health. Exercise improves brain function in a number of ways including increasing blood flow to the brain, promoting the growth of new brain cells and increasing levels of serotonin and dopamine, neurotransmitters associated with good mood and satisfaction. A new study compared the effectiveness of Cognitive Behavioural Therapy (CBT), a recognised effective treatment for depression, against a combined treatment package of exercise and CBT for treating depression. In this Iranian study 54 (70 started, 16 dropped out) sedentary people with mild to moderate depression were assigned to either a combined CBT and exercise group or a CBT only group. The CBT was delivered in groups of 4-6 people, one 90-minutes session per week for 12 weeks. Interestingly, and importantly, the exercise was not strenuous or high-impact. It involved:

  • 5 minutes of warm up flexibility exercises
  • 5 minutes of clapping and light movements
  • 20 minutes walking at moderate intensity
  • 5 minutes cool down and deep breathing.

This was repeated three times per week for 12 weeks in the evening.

The authors conclude that both groups saw improvements in their depression and reduced suicidal thoughts. However, the combined CBT and exercise group also improved their daily functioning and the combined treatment was superior than CBT alone at reducing depression and suicidal thoughts.

Using exercise as an adjunct to traditional therapy provides a low-cost, safe, easily accessible way to improve the effectiveness of standard treatment that has the added benefit of improving physical health too. This work adds further support to the importance approaching mental health from a whole-body perspective.

 

Reference

Abdollahi, A., LeBouthillier, D. M., Najafi, M., Asmundson, G. J. G., Hosseinian, S., Shahidi, S., Carlbring, P., Kalhori, A., Sadeghi, H. & Jalili, M. (2017). Effect of exercise augmentation of cognitive behavioural therapy for the treatment of suicidal ideation and depression. Journal of Affective Disorders, https://doi.org/10.1016/j.jad.2017.05.012

Dietary Intervention for Depression – The SMILES Trial

I have reported on epidemiological studies that show a relationship between a consistently healthy diet and depression in the general population and in women. This research has been correlational; it shows that there is a relationship but cannot say that what causes what. It could be that depressed people are more likely to eat a poor diet. All that changed recently with the publication of a randomised controlled trial of the use of diet as a treatment of depression; The ‘SMILES’ Trial.

The 67 participants in this 12-week Australian study were depressed adults who had a clinically defined poor diet. A poor diet was one that was low in fibre, fruit and vegetables and lean protein, and high in sweets, salty snack foods and processed meats. Some participants were receiving treatment in the form of medication, talking therapy or both.

Participants were randomly assigned to either a nutritional intervention group or a befriending control group. In the intervention group the participants had seven one-hour sessions with a registered nutritionist who provided them with personalised nutritional advice, meal plans, and coached them around goal setting and motivation to help them to stick to the nutritional recommendations. They were encouraged to eat (servings in brackets):

  • Whole grains (5–8 servings per day)
  • Vegetables (6 per day);
  •  Fruit (3 per day),
  • Legumes/beans (3–4 per week);
  • Low-fat and unsweetened dairy foods (2–3 per day);
  • Raw and unsalted nuts (1 per day);
  • Fish (at least 2 per week);
  • Lean red meats (3–4 per week);
  • Chicken (2–3 per week);
  • Eggs (up to 6 per week); and
  • Olive oil (3 tablespoons per day).

In addition, participants were encouraged to reduce their intake of “‘extras’ foods, such as sweets, refined cereals, fried food, fast-food, processed meats and sugary drinks (no more than 3 per week). Red or white wine consumption beyond 2 standard drinks per day and all other alcohol (e.g. spirits, beer) were included within the ‘extras’ food group. Individuals were advised to select red wine preferably and only drink with meals.” Those in the social support/befriending group had seven one-hour meetings with a trained professional who talked to them about neutral. Anxiety, depression and general mood were assessed at the beginning and end of the study, along with biometric and anthropometric data such as weight, waist circumference, fasting blood glucose and cholesterol.

People in the dietary intervention group were four times more likely to be in remission at the end of 12 weeks than those in the befriending group. They also had reduced severity of anxiety symptoms. There was no change in BMI, blood glucose, cholesterol or physical activity within or between the groups.

The NNT in the SMILES Trial was four. This compares favourably to common antidepressant medication which can vary from 5-16, which is still considered effective particularly in relation to the high global rates of depression. The authors also make the point that that this nutritional intervention would also have positive outcomes for other problems that are commonly associated with depression such as heart disease, type 2 diabetes and obesity. Crucially, the researchers also looked at the affordability of the diet and found that, on average, people adhering to the diet spent $26 less per week on food and drink than they were at the start of the study.

Of course, this was a small study and it will both interesting and exciting to see the trial replicated with more participants from different ethnic backgrounds. However, it is also, I think, hugely important. It is the first study that demonstrates a direct influence of diet on depression. Depressed people who improved their diet felt better. The upshot is that improving diet in line with general guidelines had a significantly positive effect on depression. The benefit of this kind of intervention is that there are no waiting lists or side-effects, and it doesn’t have to be expensive. We eat several times a day and this research shows us that each meal provides us with a valuable opportunity to make a difference to how we feel.

 

Jacka, F. N., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., Chatterton, M. L., Brazionis, M., Dean, O.M. Hodge, A. M. & Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the “SMILES” trial). BMC Medicine15, 23. http://doi.org/10.1186/s12916-017-0791-y

 

Tea Protects Cognitive Function in the Elderly

A new paper has  highlighted the role of tea drinking on protecting brain function. Researchers tracked 957 people aged over 55 who all had normal cognitive function at the start and then assessed them a few years later as part of the Singapore Longitudinal Aging Study. They found that non-tea drinkers had almost twice the risk of developing neurocognitive disorder as consistent tea drinkers (11.1% vs 5.9%), and protection could start with just a few cups per week.

Interestingly, this study also looked at people who were carriers of the APOE ε4 gene, which is a gene variation that is linked with an increased risk of developing Alzheimer’s Disease. The researchers found that women and APOE ε4 carriers benefitted most from the protective effects of tea consumption.

As an important side note, in this paper cognitive decline was associated with higher rates of heart disease, depression and lower levels of social and productive activities, which previous research indicates might all share stress as an influencing factor.

Though the participants in this research were older Chinese adults the results are consistent with results with people from different backgrounds. As yet there is no cure for Alzheimer’s Disease and much of the focus of research in this area is on understanding its causes and finding preventative strategies. Encouraging people to drink a daily cup or two of green, black or oolong tea could be an effective and affordable way to help protect brain function in aging.

 

Reference

L. Feng, M-S. Chong, W-S. Lim, Q. Gao, M. S. Z. Nyunt, T-S. Lee, S. L. Collinson, T. Tsoi, E-H. Kua, & T. -P. Ng. Tea consumption reduces the incidence of neurocognitive disorders: Findings from the Singapore longitudinal aging study. The Journal of Nutrition, Health & Aging, 2016; 20 (10): 1002 DOI: 10.1007/s12603-016-0687-0

 

Effect of Probiotics on Central Nervous System Functions in Animals and Humans: A Systematic Review

Many by now will be familiar with the term ‘friendly bacteria’, referring to the vast population of bacteria in the digestive tract. This population of microbes (the microbiome) play an important role in maintaining our digestive health and many people consume yogurt and other fermented milk drinks to promote gut health. Increasingly research is showing us that the gut microbiome has a significant effect on our mental as well as physical health.

To gain a better overview of the current status of research in this area a systemic review of random controlled trials was conducted and published in the Journal of Neurogastroenterology & Motility. The researchers reviewed 25 animal and 15 human trials. Of the studies involving human participants just over half described significant effects of probiotics on central nervous system function and an intake of probiotics for four weeks appeared to be the threshold for noticeable effects. In the human trials the most common bacterial strains tested were Bifidobacterium longum, B. breve, B. infantis, Lactobacillus helveticus, L. rhamnosus, L. plantarum, and L. casei, all of which are present in fermented foods such as yogurt, kefir and traditional (unpasteurised) sauerkraut.

Looking at both the animal models and human trials the results of this review indicated that probiotics were an effective intervention for a range of mental health disorders including anxiety, depression, Obsessive Compulsive Disorder (OCD) and memory function. A number of potential mechanisms were identified:

  • Reduced cortisol (stress hormone) levels

  • Reduced inflammation.

  • Improved immune function

It is also feasible that some of the known metabolites of the microbiome such as GABA, an inhibitory neurotransmitter, might play a role either via the vagus nerve or more directly by crossing the blood-brain barrier. Whilst the review is generally positive the researchers called for further studies to be conducted with human participants in order to be able to draw firmer conclusions on the promising role of probiotics on mental diseases.

 

Reference:

Wang, H., Lee, I., Braun, C. & Enck, P. (2016). Effect of Probiotics on Central Nervous System Functions in Animals and Humans: A Systematic Review. Journal of Neurogastroenterology & Motility, 22, 589-605.

Poor Diet Associated with Increased Risk of Depression in Women

The Whitehall II Study is a large, longitudinal study following the health and wellness of over 10,000 British civil servants between the ages of 35 and 80. Recruitment started in 1985 and follow-up is ongoing. Whilst the study primarily releases data on the relationship between physical health and socioeconomic status the enormous amount of data collected is often shared with and analysed by international researchers interested in other aspects of health and lifestyle. A paper published in Clinical Psychological Science reviewed the Whitehall data looking at the relationship between diet and depression. They were curious as to whether the inflammatory potential of a person’s diet had any bearing on their risk of developing the illness.

Inflammation is they way that the body responds to physical illness and injury and is also associated with lifestyle factors such as chronic stress and poor diet. The Dietary Inflammatory Index (DII) is a reliable assessment of how likely certain foods are to promote inflammation in the body. Broadly, processed foods increase inflammation while whole foods, fruits, vegetables, nuts and oily fish reduce it. A higher score on the DII is linked to higher markers of inflammation in the body.

In this analysis the researchers looked at the available dietary information and depression status of 4246 people over a period of five years. They were interested in what they have called ‘recurrent depression’ - people who had depression at the start and again at the end of this five-year period. (They did not look at whether the depression was ongoing during this period or whether it had gone in to remission at any point.) Alongside diet they looked at other health-related factors such as level of exercise, smoking status, alcohol consumption, obesity, heart disease, diabetes and stroke. 

The researchers found that women with high scores on the Dietary Inflammatory Index were significantly much more likely to develop recurrent depression, and this effect was independent of other health factors. This is similar to the results of the large Spanish 'SUN Project' that showed that healthy (anti-inflammatory) diets were linked to a reduced risk of depression in men and women. The authors comment that these results support the growing body of research in to the relationship between diet, inflammation and depression. 

 

Reference

Akbaraly, T. N., Kerlau, C., Wyart, M., Chevallier, N., Ndiaye, L., Schivappa, N., Hébert, J. R., Kivimäki, M. (2016). Dietary Inflammatory Index and Recurrence of Depressive Symptoms: Results From the Whitehall II Study. Clinical Psychological Science, first published on August 8, 2016 doi:10.1177/2167702616645777

 

The Role of Emotion Suppression in Chronic Fatigue Syndrome

Last month a report on the possible biological mechanisms underlying Chronic Fatigue Syndrome (CFS) generated a lot of interest on social media so I thought I would follow that up with a new study that discusses the psychological and emotional processes of the disorder.

This study from researchers at King’s College London looked at the relationship between emotional suppression and fatigue in CFS. Patients recruited from two specialist CFS services (and healthy controls) were required to watch a distressing film clip. Half of the group were told that they could deal with the emotions from watching the film in any way that they liked and the other half were told that they had to suppress their emotional responses. All were monitored for signs of distress by video-tape and skin conductivity.

Before watching the video participants completed a questionnaire about their beliefs about emotions. This scale is designed to uncover whether people hold unhelpful beliefs, for example that showing emotions is a sign of weakness, that it is important to keep up a brave face or that others will think less of you for expressing your true feelings. Participants also completed a measure of depression and anxiety. After watching the clip participants were asked how fatigued the felt.

The results showed that participants with CFS experienced higher rates of distress but were less likely to express them, even when they were allowed to. This study indicates that this is partly due to self-held beliefs by the CFS group that expression of emotion is unacceptable. Interestingly, all participants in the suppression condition experienced higher levels of anxiety at the end of watching the film.

The researchers also showed an important relationship between emotional suppression and fatigue. When emotions were suppressed the distress didn’t go away but showed up in the body, and this increased physiological distress was associated with higher rates of fatigue. In short: the more suppression the more fatigue.

In addition, people in the CFS group were so efficient at hiding their feelings that observers found it difficult to tell if they were suffering. In the real world this makes it harder for individuals to access support and increases the likelihood of being overwhelmed and isolated.

This paper is important for individuals and professionals dealing with CFS. It highlights the importance of addressing the beliefs about emotions as a way of relieving the symptoms of the syndrome. Psychotherapy and mindfulness-based treatments are an effective way of helping people to stop supressing their emotions and learn how to accept, process and manage them providing hope for the 250,000 people with CFS in the UK.

 

Rimes, K. A., Ashcroft, J., Bryan, L., & Chalder, T. (2016). Emotional Suppression in Chronic Fatigue Syndrome: Experimental Study. Health Psychology. Advance online publication. http://dx.doi.org/10.1037/hea000034

Chronic Fatigue in Your Gut Not Your Head

In April I reported a study demonstrating that probiotic supplementation had a beneficial effect on one of the psychological symptoms of Chronic Fatigue Syndrome (CFS). In that 2009 paper patients on the treatment for eight weeks were significantly less anxious than those taking the placebo product. Published in June this year a new study builds on that observation. The researchers at Cornell University first noted the frequent comorbidity of gastro-intestinal disorders with CFS, as well as evidence of abnormal immune response in individuals with CFS as indicated by markers of inflammation in the blood. They hypothesised that, taken together, gut microbiome diversity and levels of inflammation could predict who had a diagnosis of CFS.

This study compared the samples of 39 healthy people and 49 individuals with CFS. By looking at differences in the samples the researchers were able to identify disease cases with 83% accuracy. They found that those with CFS were significantly more likely to show signs of microbial translocation, where bacteria that reside in the gut break through the gut wall and enter the blood stream. Since they should not be present in this part of the body the immune system recognises these roving bacteria as intruders and launches an immune (inflammatory) response. This inflammation is associated with many of the symptoms of illness in CFS and other infections.

Compared to the samples of healthy individuals ME patients had reduced numbers and diversity of a type of bacteria called Firmicutes¸ typically the most abundant phyla in the human gut microbiome, as well as significantly lower amounts of types associated with an anti-inflammatory affect.

In the long-running debate about what causes Chronic Fatigue Syndrome the arguments tend to fall dichotomously: it’s either psychological OR biological in nature. Some research has shown a positive effect of psychotherapy in alleviating symptoms whilst others have found improvement with microbiome modification. The likelihood is, therefore, that a combined treatment approach will yield the best results for patients, helping them to manage both the physical and psychological symptoms of this debilitating disease. 

Giloteaux, L., Goodrich, J. K., Walters, W. A., Levine, S. M., Ley, R. E. & Hanson, M. R. (2016). Reduces diversity and altered composition of the gut microbiome in individuals with myalgic encephalomeylitis/chronic fatigue syndrome. Microbiome, 4:30.

Jason, L. A., Torres-Harding, S. Friedberg, F., Corradi, K., Njoku, M. G., Donalek., J., Reynolds, N., Brown, M., Weitner, B. B., Rademaker, A. & Papernik, M. (2007). Non-pharmalogical interventions for CFS: A randomized trial. Journal of Clinical Psychology in Medical Settings, 14, 275-296.

Borody, T. J., Nowak, A & Finlayson, S. (2012). The GI mircobiome and its role in Chronic Fatigue Syndrome: A summary of bacteriotherapy. Journal of the Australasian College of Nutritional and Environmental Medicine, 31, 3-8.

Mental Health Awareness Week – Special Focus on Depression (Probiotics)

Just last week the NHS reported a study stating that there was insufficient evidence that probiotics were beneficial for healthy people. The trials analysed so far had not been well enough designed to be sure.

“Given the limitations of the studies – including the variety of probiotics examined – it is not possible to conclude with certainty that all probiotics are ineffective.

Absence of good-quality evidence is not evidence of there being no effect. Better-designed studies may yet find some benefit from taking probiotics.”

However, there is certainly some good evidence that particular probiotics do have a beneficial effect on depression, particularly where that depression is associated with cellular inflammation. Inflammation is the body’s immune response to illness or injury; the swelling around a cut or a bruise is part of this process. But inflammation also happens within and around the cell in response to other non-injury factors such as poor diet, prolonged stress or an imbalance of bacteria in the gut. Inflammatory diseases such as rheumatoid arthritis and inflammatory bowel disease are commonly associated with psychological and behavioural changes such as lack of energy or interest, loss of appetite, loss of appetite; and depression. This consistent relationship between inflammation and depression has led to the inflammation theory of depression; that is to say that for some sufferers inflammation may be contributing to the severity of their depressive symptoms.

A well-designed study of petrochemical workers published in 2015 showed that probiotic yogurt and supplements significantly improved scores of depression and anxiety. I have reported elsewhere that probiotics have been shown to alleviate the negative thoughts associated with low mood. A more recent controlled study showed that eight weeks of probiotic supplementation was associated with a significant reduction on depression scores in patients with a diagnosis of Major Depressive Disorder. It is thought that part of the mechanism underlying this effect are the by-products of the bacteria’s metabolism. When breaking down food in the gut (particularly fibre) gut bacteria produce a number of metabolites, many of them beneficial to the human body such as vitamin K and some B vitamins. They also produce short-chain fatty acids. One of these, butyric acid, in a potent anti-inflammatory. It also forms part of a neurotransmitter called GABA, which has a calming, tranquilizing effect on the brain.

There are a lot of probiotic products on the market and it can be difficult to know which is likely to be the most effective. There is very good research data supporting the anti-inflammatory properties of a highly concentrated probiotic supplement called VSL#3 in a number of different diseases. Whilst not necessarily a recommendation, this is the product that I use as well as ensuring regular consumption of fermented and high fibre foods.

 

http://www.nhs.uk/news/2016/05May/Pages/No-evidence-probiotics-are-beneficial-for-healthy-adults.aspx

Mohammadi, A. A., Jazayeri, S., Khosravi-Darani, K., Mohammadpour, N., Asemi, Z., Adab, Z., Djalali, M., Tehrai-Doost, M., Hosseini, M. & Eghtesadi, S. (2015). The effects of probiotics on mental health and hypothalamic–pituitary–adrenal axis: A randomized, double-blind, placebo-controlled trial in petrochemical workers. Nutritional Neuroscience. Published online April 16th.

Laura Steenbergen, Roberta Sellaro, Saskia van Hemert, Jos A. Bosch, and Lorenza S. Colzato. 2015. A randomized controlled trial to test the effect of multispecies probiotics on cognitive reactivity to sad mood. Brain, Behavior, and Immunity, 48, 258-264.

Akkasheh, G., Kashani-Poor, Z., Tajabadi-Ebrahimi, M., Jafari, P., Akbari, H., Taghizadeh, M., Memarzadeh, M. R., Asemi, Z., & Esmaillzadeh, A. (2016). Clinical and metabolic response to probiotic administration in patients with major depressive disorder: A randomized, double-blind, placebo-controlled trial. Nutrition, 32, 315-20.

D'Mello, C.Ronaghan, N.Zaheer, R.Dicay, M.Le, T.MacNaughton, W. K.Surrette, M. G.Swain, M. G. (2015) Probiotics Improve Inflammation-Associated Sickness Behavior by Altering Communication between the Peripheral Immune System and the Brain. Journal of Neuroscience, 35, 10821-18030.

Mariman, R.Tielen, F.Koning, F. & Nagelkerken, L. (2014). The probiotic mixture VSL#3 dampens LPS-induced chemokine expression in human dendritic cells by inhibition of STAT-1 phosphorylation. PLoS One, 9: e11567.

 

Disclaimer

This information is provided for information purposes only and should not be taken as advice or instruction. This information does not replace the advice of your doctor. Please consult an appropriate health professional if you believe you are experiencing a mental or physical health concern. Speak to your GP or a trainer before making any significant changes to your exercise routine.

Mental Health Awareness Week – Special Focus on Depression (Mindfulness)

Yoga, Meditation & Mindfulness

Mindfulness meditation - the skill of paying attention without judgement – has been a feature of some religious and cultural traditions for centuries. Over the last 30 years psychology has been interested in how this ancient practice might have beneficial effects on our modern lives. Mindfulness mediation really came to public attention in 2011 when a study at Harvard University showed that eight weeks of mindfulness practice was able to reshape the brain’s structure, improving function in the areas associated with memory, empathy and stress. More recently, a study published in the journal Neural Plasticity used functional MRI to demonstrate the nature of meditation-induced brain changes and showed that meditation was able to significantly reduce the participants’ depression scores; participants who at the start of the study were identified as depressed had scores below the cut-off for diagnosis by the end of the intervention, a near 50% reduction in symptoms in eight weeks. Earlier, researchers at the University of Bologna compared the efficacy of mindfulness-based therapy to a matched psychoeducation programme. The mindfulness-based intervention yielded significantly greater improvement in depression scores.

The practice of yoga has a strong mindfulness component, requiring practitioners to focus on the position of their bodies, their breathing as well as any thoughts or emotions they become aware of during the practice. The case for yoga and meditation as a useful tool in tackling depression is strong and growing. A randomised control trial comparing yoga to walking found that yoga was more effective at improving mood (and decreasing anxiety). A recent study published in Depression and Anxiety found that yoga had a significantly beneficial effect on depression scores compared to standard treatment alone, and that it also improved overall wellbeing. In another recent trial a consistent yoga practice was associated with better outcomes and recovery from Post-Traumatic Stress Disorder and depression.

Both yoga and mindfulness/meditation have health benefits beyond a sense of calm. As well as reducing the severity of depressive symptoms they can increase levels of brain chemicals that promote the growth of new brain cells, reduce levels of stress hormones, increase concentration and reduce anxiety. Yoga also comes with the added physical advantages of increased strength, balance and flexibility, all of which are important in slowing the process of aging. Both yoga and mindfulness are practices whose benefits are accumulative, requiring regular application for the best results. As with physical exercise, it is best to start with shorter, manageable efforts and build up to a longer regular practice. When introducing my own clients to mindfulness I recommend starting with just one minute a day first thing in the morning, before they can get distracted. Mindfulness practice is also helpful before bed as it can help to ease you into a restful sleep. There are free apps, such as Headspace, and online tutorials and guided meditations that can be useful to get you started as well a number of taught courses and books. Those interested in giving it a try might find this video from Martin Boroson an easy introduction.

 

Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research191(1), 36–43. http://doi.org/10.1016/j.pscychresns.2010.08.006

Yang, C.-C., Barrós-Loscertales, A., Pinazo, D., Ventura-Campos, N., Borchardt, V., Bustamante, J.-C., … Walter, M. (2016). State and Training Effects of Mindfulness Meditation on Brain Networks Reflect Neuronal Mechanisms of Its Antidepressant Effect. Neural Plasticity2016, 9504642. http://doi.org/10.1155/2016/9504642    

Streeter, C. C., Whitfield, T. H., Owen, L., Rein, T., Karri, S. K., Yakhkind, A., … Jensen, J. E. (2010). Effects of Yoga Versus Walking on Mood, Anxiety, and Brain GABA Levels: A Randomized Controlled MRS Study. Journal of Alternative and Complementary Medicine16(11), 1145–1152. http://doi.org/10.1089/acm.2010.0007

de Manincor, M., Bensoussan, A., Smith, C. A., Barr, K., Schweickle, M., Donoghoe, L.-L., Bourchier, S. and Fahey, P. (2016). Individualized yoga for reducing depression and anxiey, and improving well-being: A randomized controlled trial. Depression and Anxiety. doi: 10.1002/da.22502

Rhodes, A., Spinazzola, J. & van der Kolk, B. (2016). Yoga for adult women with chronic PTSD: A long-term follow—up study. The Journal of Alternative and Complementary Medicine, 22, 189-196. doi:10.1089/acm.2014.0407.

Chiesa, A., Castagner, V., Andrisano, C., Serretti, A., Mandelli, L., Porcelli, S. & Giommi, F. (2015). Mindfulness-based cognitive therapy vs. psycho-education for patients with major depression who did not achieve remission following antidepressant treatment. Psychiatry Research, 226, 474 – 483.

 

Disclaimer

This information is provided for information purposes only and should not be taken as advice or instruction. This information does not replace the advice of your doctor. Please consult an appropriate health professional if you believe you are experiencing a mental or physical health concern. Speak to your GP or a trainer before making any significant changes to your exercise routine

Mental Health Awareness Week – Special Focus on Depression (Heat)

Hot off the press is some brand new research in to the role of heat on alleviating the symptoms of depression. Turkish baths, saunas and sweat lodges have been a feature of cultures all over the world for hundreds of years. Full body heat has been used for therapeutic and sacred purposes by indigenous peoples across North America, Scandinavia, Central and South America, Central Europe where they are known to create a sense of relaxation. More recently research into the hormetic effects of heat on the body have uncovered many more health benefits. Hormesis is the term used to describe the beneficial effects of stress on the body. The most commonly understood example of this is exercise; the process of applying manageable stress to the body, by lifting weights for example, compels the body to respond by becoming stronger. Similarly, heat stress can activate biological pathways linked to improved health, longevity and neurogenesis (the formation of new brain cells).

In this paper the authors sought to clarify an earlier observation that a single session of infrared heat exposure reduced depression for five days post-treatment. Conducted over two years the participants in this current study all had a very high depression scores on a standard symptoms scale but were not taking any antidepressant medication. Participants were randomly allocated to one of two conditions: either one session of full body infrared heat treatment or one session of a placebo treatment; an identical set up just without sufficient heat to significantly raise core body temperature. The sham condition was so convincing that the majority of the people who received it believed they were receiving the real treatment. At the end of the intervention participants were reassessed at 1, 2 and 3 days, and 1, 2, 4 and 6 weeks after by assessors who did not know whether the participant had had the real or the sham treatment. Remarkably the participants who had received just one session of heat treatment showed significantly reduced depression scores up to six weeks after treatment and experienced only mild and short-lived side effects (such as dry mouth, headache or sweating). Though small, this study builds on previous research that showed a significant reduction in depression following heat treatment as well, of course, as the established therapeutic use of heat in many cultures.

Whole body heat treatment has the potential to be a powerful, safe, fast-acting and long-lasting treatment for depression. It means that a visit to the gym (see yesterday’s post) followed by a few minutes in the sauna could have tremendous positive effects on mood and depressive symptoms.

 

Janssen CW, Lowry CA, Mehl MR, et al. Whole-Body Hyperthermia for the Treatment of Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. Published online May 12, 2016. doi:10.1001/jamapsychiatry.2016.1031.

Hanusch, K. U., Janssen, C. H., Billheimer, D., Jenkins, I., Spurgeon, E., Lowry, C. A.  & Raison, C. L. (2013). Whole-body hyperthermia for the treatment of major depression: associations with thermoregulatory cooling. American Journal of Psychiatry, 170, 802-804.

Koltyn, K. F., Robins, H. I., Schmitt, C. L., Cohen, J. D. & Morgan, W. P. Changes in mood state following whole-body hyperthermia. International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group 8, 305-307 (1992).

Disclaimer

This information is provided for information purposes only and should not be taken as advice or instruction. This information does not replace the advice of your doctor. Please consult an appropriate health professional if you believe you are experiencing a mental or physical health concern. 

Mental Health Awareness Week – Special Focus on Depression (Exercise)

Many people will have heard that there are mood benefits of exercise. This is often linked to the ‘runners high’; the body’s release of endorphins and other ‘feel good’ chemicals during and just after exercise. There are also other neurological benefits of exercise that are linked to improved mood and wellbeing. For example, aerobic exercise increases the production of a protein called Brain Derived Neurotrophic Factor (BDNF). BDNF promotes the growth of new brain cells and is associated with improved memory, executive function and mood. Several studies and meta-analyses have demonstrated a positive effect of exercise on the symptoms of depression that are comparable to psychotherapy and antidepressant medication, and a new meta-analysis published last month, looking specifically at Quality of Life (QoL) adds to this body of research. QoL differs from illness symptoms in that it relates to a more global sense of wellbeing or satisfaction with life including where one perceives oneself to be in relation to peers or cultural expectations.

In this review the researchers collated exercise trials that assessed QoL in people with a diagnosis of Major Depressive Disorder (MDD). All trials included in this review had to include a non-exercise control group so that the effect of exercise could be established (as opposed to some other factor). The results indicated that moderate aerobic exercise, performed three times per week (the average across the studies) was associated with improved overall QoL for people with MDD. In addition, there were specific improvements in the psychological domain. The psychological domain (compared to the physical and social domains) has been shown have the greatest effect on overall QoL in long-term illness. There was no change in QoL in the non-exercising (control) groups. The authors state that exercise can be used as an effective treatment strategy for depression especially since antidepressant medication alone tends not to improve QoL even when depressive symptoms improve.

The evidence for the benefits of exercise in treating depression is robust and established. Regular exercisers have up to 30% reduced risk of developing the illness.  Of course, the experience of depression can make it difficult to find the motivation to exercise in the first place. For some people it may be important to start with smaller exercise goals such as a five minute walk three times a week to help build a sense of achievement and consistency. Walking with a friend or a group could potentially enhance the social domain of QoL as well as helping you to stay committed. Exercise can be a very effective, accessible, low-cost, low-risk (of side effects) weapon in the arsenal against depression.

 

Schuch, F. B., Vancampfort, D., Rosenbaum, S., Richards, J., Ward, P. B. & Stubbs, B. (2016). Exercise improves physical and psychological quality of life in people with depression: A meta-analysis including the evaluation of control group response. Psychiatry Research, 241, 47-54.

Arnold, R., Ranchor, A. V., Sanderman, R., Kempen, G. I., Ormel, J. & Suurmeijer, T. P. (2004). The relative contributions of domains of quality of life to overall quality of life for different chronic diseases. Quality of Life Research, 13, 883-896.

http://www.nhs.uk/Livewell/fitness/Pages/Whybeactive.aspx

Disclaimer

This information is provided for information purposes only and should not be taken as advice or instruction. This information does not replace the advice of your doctor. Please consult an appropriate health professional if you believe you are experiencing a mental or physical health concern. Speak to your GP or a trainer before making any significant changes to your exercise routine.

Mental Health Awareness Week – Special Focus on Depression (Omega-3)

Depression, or more technically Major Depressive Disorder (MDD), is a common and growing mental health concern, currently affecting 350 million people worldwide, making it one of the leading causes of global disability. Many people will be familiar with the symptoms of depression; low mood, loss of interest and enjoyment, disturbed sleep, change in appetite, low self-worth and fatigue, among others. This constellation of symptoms can rob sufferers of meaning from life, impair relationships and in severe cases lead to suicidal and self-harming thoughts and behaviours. Anybody who feels they might be experiencing these symptoms is strongly encouraged to talk to their GP about their symptoms and available treatments. Depression can be a very isolating experience but help is available and you are entitled to it.

A number of treatments have been shown to effectively treat depression including Cognitive Behavioural Therapy and Psychodynamic Psychotherapy. Anti-depressant medication can also be helpful if well tolerated, though side effects can be problematic for a number of patients. Recent research has started to identify other factors that can influence mood disorders or enhance the effectiveness of treatments. This week I will be presenting the latest research on lifestyle interventions that have been shown to alleviate the symptoms of depression.

The first in the series is the promising research on the efficacy of omega-3 fats in the reduction of severity of depressive symptoms. I have mentioned elsewhere the results of a meta-analysis showing that these fats have positive effects on depression. A new meta-analysis published in March this year builds on these results and addresses some of the limitations of previous papers.

In this latest analysis published in the journal Translational Psychiatry researchers reviewed the pooled results of over 1200 patients with a diagnosis of MDD. They found a significant beneficial effect of omega-3 supplementation on the depressive symptoms of MDD, comparable to the effects of anti-depressant medication. In particular, studies that included higher doses of the specific omega-3 eicosapentaenoic acid (EPA) showed the most benefit. Omega-3 supplementation also appeared to improve the effectiveness of antidepressant medication. The authors speculate that this effect might be mediated by EPA’s known anti-inflammatory action, though more research is needed to confirm this hypothesis. They also note that the long-term effects of high-dose omega-3 supplementation have not been fully analysed and should be before any clinical recommendations can be made.

The safest way to ensure you are getting enough omega-3 is through your diet. EPA is found primarily in oily fish such as mackerel, herring, trout, salmon and sardines. The body is able to convert it from the essential fat alpha-linolenic acid (ALA) but not very efficiently and only in small amounts; it is much more easily absorbed from marine sources. The NHS recommends that a healthy diet should include at least one serving of oily fish per week but the most recent National Diet and Nutrition Survey published by Public Health England showed that Britons are not consuming anywhere close to the recommended amounts. The research is encouraging but there is still work to be done. Until then trying to eat the recommended amounts of oily fish could be a useful adjunct to prescribed treatment.

 

Mocking, R. J. T., Harmsen, I., Assies, J., Koeter, M. W. J, Ruhé, H. G. & Schene, A. H. (2016). Meta-analysis and meta-regression of omega-3 polyunsaturated fatty acid supplementation for major depressive disorder. Translational Psychiatry, 6, e756; doi:10.1038/tp.2016.29

http://www.nhs.uk/Livewell/Goodfood/Pages/fish-shellfish.aspx

https://www.bda.uk.com/foodfacts/omega3.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/310997/NDNS_Y1_to_4_UK_report_Executive_summary.pdf

https://www.sciencedaily.com/releases/2016/04/160426091725.htm

 

Disclaimer

This information is provided for information purposes only and should not be taken as advice or instruction. This information does not replace the advice of your doctor. Please consult an appropriate health professional if you believe you are experiencing a mental or physical health concern.

Dietary Fibre Linked with Improved Cognitive Control in Children

A correlation study conducted with small group of 7 and 9 year olds demonstrated a positive relationship between diet quality, in particular dietary fibre content, and performance on a task designed to assess attention and the ability to disregard distracting stimuli.

65 children undertook a modified version of the Erikson Flanker Test in which they were asked to pay attention to the direction of a fish in the centre of a computer screen and to try to ignore other fish that appeared on the screen at the same time that were facing either the same direction or the opposite direction of the target fish. Their results were correlated against food diaries that tracked a range of nutrients and subsets of nutrients. For example fats were broken down in to saturated fatty acids, cholesterol, omega-3s and DHA .

They found that children who had higher fibre diets had significantly improved accuracy scores on the Flanker test. The results showed that soluble fibre was associated with overall accuracy and pectin was particularly linked to accuracy in the version of the test that required greater effort. The researchers postulate that the effects might be linked to better control of blood sugar and/or the interaction of the gut microbiota. Fibre cannot be assimilated into the body but is highly fermentable by the bacteria in the gut. Some of the important end products of this fermentation are short-chain fatty acids, which have been linked to reduced inflammation in the brain and increased BDNF, compound associated with the creation of new brain cells.

Whilst this study was conducted on children it is highly likely that the outcomes will be similar in adults.

  • High soluble fibre foods: Oats and oat bran, beans, lentils, apples, pears.
  • High insoluble fibre foods: Wheat bran and wholegrains, brown rice, seeds, fruit and vegetable skins.
  • High pectin foods: Apples, pears, quince, peaches, plums, oranges, lemons, grapefruit, gooseberries, apricots, guava, carrots, tomatoes.

 

Reference

Khan, N. A., Raine, L. B., Drollette, E. S., Scudder, M. R., Kramer, A. F., & Hillman, C. H. (2015). Dietary Fiber Is Positively Associated with Cognitive Control among Prepubertal Children. The Journal of Nutrition145(1), 143–149. http://doi.org/10.3945/jn.114.198457

Gut Microbes Regulate Nerve Cell Myelination (Animal Model)

The prefrontal cortex (PFC), the foremost part of the brain, is the seat of what is called ‘executive function’. Executive functions are the higher order tasks of the brain (beyond regulating the systems and processes of the body) such as attention, planning, decision-making, memory, managing social interactions, making moral judgements and anticipating the consequences of a particular behaviour. The PFC also plays an important role in emotional functioning; regulating fear, anxiety, normal guilt, and PFC dysfunction is implicated in the development of mental disorders such as schizophrenia and autism spectrum disorders.

New research from University College Cork has uncovered an important role of the gut microbiome on the structure and functions of neurones in the PFC. In this study the researchers compared the brains of mice raised in ‘germ free’ conditions (i.e. no gut microbiome) with mice raised conventionally and those who spent the first part of their lives germ-free then were later introduced to the conventionally-raised animals, which would lead to some colonisation of the gut microbiome.

They found that over 221 genes behaved differently in the brains of the germ-free and ex-germ-free mice compared to those raised conventionally. The germ-free vs the conventional mice made up the biggest difference accounting for 190 of the 221 differently expressed genes. Many of these genes were involved in the task of myelination and these changes were confined to the PFC region of the brain. Myelin is the fatty sheath that surrounds a nerve cell, like the protective plastic coating around an electrical wire. Myelin aids the conductivity of the nerve cell, helping it to send messages faster and more efficiently. Failure in myelination is the cause for the loss of muscle function and control in Multiple Sclerosis, for example. This study was looking at the underlying biological mechanism so the researchers did not make any comment on the potential implications of these changes other than to note previous research showing increased anxiety in germ-free mice and stating ‘Our results further highlight the microbiota as a viable therapeutic target in psychiatric disorders’. They also note that the unusual changes in the myelin of the germ-free mice was corrected in the ex-germ-free mice, indicating that later colonisation of the gut microbiome normalised myelin gene expression in this important region of the brain.

 

Reference

Hoban, A. E., Stilling, R. M., Ryan, F. J., Shanahan, F., Dinan, T. G., Claesson, M. J., Clarke, G. & Cryan, J. F. (2016). Regulation of prefrontal cortex myelination by the microbiota. Translational Psychiatry, 6, e774. doi:10.1038/tp.2016.4

http://www.nature.com/tp/journal/v6/n4/full/tp201642a.html

Short-Term Psychodynamic Psychotherapy Effective at Reducing Depressive Symptoms and Inflammatory Markers

Depression is rapidly becoming the leading cause of disease burden (negative effects on quality of life) in the world. Psychologists and biologists have been trying to understand the underlying mechanisms of depression for a long time, wondering whether it is mainly biological or psychological in nature; a disease of the body or of the mind? My clinical experience is that it can be either or both, which is why a thorough assessment is essential. For some people the roots of their depression lie in difficult early circumstances, abusive relationships or a traumatic event. For others there may be a genetic predisposition to the illness, it ‘runs in the family’, or some other physiological factor.

Several studies have demonstrated a relationship between inflammation in the body and depression. Inflammation is your body’s response to illness or infection and can be activated by a number of factors such as poor diet, underlying illness and chronic stress. Many studies have illustrated that the higher the degree of inflammation in the body the more severe the depressive symptoms and vice versa. The consistency of this finding has led to the ‘Inflammatory Hypothesis of Depression’, proposing that inflammation is the driving force in depression in many people, and that it can increase symptom severity in those already dealing with low mood.

In a trial thought to be the first of its kind researchers from Brazil and the USA looked at the levels of inflammation in patients' blood as well as the severity of their depression before and after 16 standard (50 minutes) sessions of psychotherapy (plus an extra two for data collection). The result demonstrated a relationship between the levels of markers for inflammation and the severity of symptoms such that after psychotherapy treatment patients were less depressed and their inflammation had reduced. Previous research had looked at the ways that medication and CBT could reduce inflammation but this was the first study to look at the role of psychodynamic psychotherapy and the results are interesting enough to warrant further research.

The implications are powerful because, as the upward trend of depression continues, it will become increasingly important to find effective and low-cost treatments for the illness. This study suggests that patients could potentially gain relief from their mild or moderate depression in as little as four months and without the side-effects associated with medication.

 

Silva, G. D. G. d., Wiener, C. D., Barbosa, L. B., Araujo, J. M. G., Molina, M. L., Martin, P. S., Oses, J. P., Jansen, K., Souza, L. D. d. M. & Silva, R. A. d. (2016). Pro-inflammatory cytokines and psychotherapy in depression: Results from a randomised clinical trial. Journal of Psychiatric Research, 75, 57-64. 

Probiotic Relieves Anxiety in Chronic Fatigue Syndrome (Pilot Study)

Chronic Fatigue Syndrome (CFS) or Myalgic Encephalopathy (ME) is a complex illness of unknown cause that has both physical and psychological symptoms. The major physical symptom is intense bodily fatigue, which is made worse by bouts of physical or mental exertion and is not relieved by sleep. Muscle and joint pain and bowel conditions such IBS are often also seen. Psychologically, people with a diagnosis of CFS often report feeling depressed and/or anxious and find it hard to concentrate. Although it is not clear what causes CFS there is a strong link to increased markers of inflammation (the body’s immune response to illness or infection) and disturbances in the gut microbiome. This observation is interesting because the gut is the crucible of the immune system and plays an important role in ‘teaching’ the immune system to respond appropriately to pathogens and in distinguishing the body’s own cells from invaders.

In a small but well-designed pilot study, participants with a diagnosis of CFS and comorbid depression and/or anxiety were randomly assigned to two experimental groups. The test group took three sachets a day of a probiotic (Lactobacillus casei Shirota) totalling 24 billion bacteria per day. The control group ingested three sachets of an identical looking placebo product. After eight weeks the patients were reassessed on the depression and anxiety scales.

At the end of the test period not only had there been an increase in the number of Lactobacillus in the patients’ guts but also increased numbers of Bifidobacteria, a different strain of bacteria that is associated with a healthy digestive system. This is noteworthy a) because it indicates that the introduction of one helpful strain can encourage the proliferation of another, b) because CFS patients tend to have low levels of Bifidobateria and c) because some strains of Bifidobacteria are known to improve blood levels of tryptophan, an essential amino acid that is the precursor of serotonin, a neurotransmitter linked to happiness and good mood.

The researchers also found that patients who had been taking the probiotic were significantly less anxious than at the start of the study, a valuable finding considering the significant burden of anxiety in this patient group. Importantly, the probiotic was well tolerated, which means that it did not cause any unwanted or unpleasant side-effects.

 

Rao, A. V., Bested, A. C., Bealune, T. M., Katzman, M. A., Iorio, C., Berardi, J. M. & Logan, A. C. (2009). A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathogens, 1:6.

Healthy Diet Linked to Reduced Risk of Depression

In 2015 a large Spanish study reported results showing that improvements in diet reduced a person's likelihood of developing depression. Similarly, a new correlation study of Iranian adults (average age 36 years) has demonstrated a statistically significant relationship between healthy diet and reduced rates of depression. The researchers assessed the diet and lifestyle of over 3000 people - looking at their eating habits, weight, BMI, smoking status and levels of psychological distress - and compared them against measures for anxiety and depression. They found that non-smokers were less likely to be anxious than smokers and those with healthier diets were 29% less inclined to be depressed than those with poor diets. Further research is required to understand the predictive features of these results.

 

Saneei, P., Esmaillzadeh, A., Keshteli, A. H., Reza Roohafza, H., Afshar, H., Feizi, A. & Adibi, P. (2016). Combined healthy lifestyle is inversely associated with psychological disorders in adults. PLoS One. DOI: 10.1371/journal.pone.0146888

Psychotherapy Reduces Physical Symptoms in Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is the name given to a collection of abdominal and digestive symptoms. Typically suffers present abdominal pain and bloating, diarrhoea or constipation. Doctors are unclear as to what causes the symptoms but have linked the syndrome to altered immune function, stress and inflammation and, in some instances, abnormalities in the gut microbiome. Additionally, there is no known cure for IBS leaving sufferers in ongoing pain and discomfort that significantly impairs their quality of life.

A meta-analysis published this year has shown that psychotherapy is an effective long term treatment for reducing symptom severity in IBS. The researchers included only high-quality (random controlled trial) studies and the final analysis included data from a pool of 2290 individuals. Trials included standard psychological therapy as well as relaxation technique training, individual and group treatments and therapy provided in-person or by a therapist online.

Psychological treatments were shown to be effective both at short term (1-6 months) and long-term follow (6 month-one year); the treatment worked and the effects lasted. This study follows an earlier(2) meta-analysis that showed psychotherapy to be as effective as antidepressant medication at improving quality of life for IBS sufferers, but that psychotherapy was more effective than medication at reducing subsequent healthcare costs.

 

1. Laird KT, Tanner-Smith EE, Russell AC, Hollon SD, Walker LS, Short- and Long- Term Efficacy of Psychological Therapies for Irritable Bowel Syndrome: A Systematic Review and Meta-analysis, Clinical Gastroenterology and Hepatology (2016), doi: 10.1016/j.cgh.2015.11.020.

2. Creed, F., Fernandes, L., Guthrie, E., Palmer, S., Ratcliffe, J., Read, N., Rigby, C., Thompson, D., Tomenson, B. on behalf of the North of England IBS Research Group. The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome.  Gastroenterology, 124, 303-317.