Benson-Henry Institute

ObjectivesThe mind–body research field has explored a broad range of outcome measures, however, there has not been systematic investigation on these outcome measures and there is little knowledge on what outcome measures can capture the differences between different mind–body practices. Therefore, this three-arm randomized controlled trial examined the effects of meditation vs. yoga vs. an active control condition of stress education, with a large battery of outcome measures including psychosocial self-report variables, allostatic load biomarkers, and gene expression measures.MethodsA total of 211 chronically stressed but otherwise healthy adults were randomized to 8-week one-on-one in-person interventions of meditation (N = 73), yoga (N = 68) or stress education (N = 70) interventions. Between-group differences in psychological outcome measurements, allostatic load biomarkers and genomic measures were compared at baseline (week 0), post-intervention (week 9), and at 26-week follow-up. Data were analyzed using a shared-baseline, two-way, repeated-measures ANOVA with unstructured within-person covariance over measurement timepoints. Treatment and time-specific effects were estimated using linear contrasts of adjusted means. False discovery rate correction was applied for multiple comparisons.ResultsNone of the outcome measures had significant differences among the three treatment arms. Within each treatment arm, most psychological questionnaire measures showed significant improvements (corrected p < 0.05). IL-6 showed slight elevation (but still within normal range for healthy adults) at the post-intervention timepoint within the stress education arm (corrected p < 0.05) and at the follow-up timepoint within the meditation arm (corrected p < 0.05). High density lipoprotein (HDL) levels were increased within the yoga arm at the follow-up timepoint (corrected p < 0.05). Post-intervention score changes of the Perceived Stress Scale (PSS) correlated with blood pressure changes in the meditation arm, insulin level changes in the yoga arm, and changes of allostatic load index in the control arm, none of which survived correction for multiple comparisons.ConclusionThis study did not find any significant between-group effects with any outcome measures. The null findings in this study might have been due to floor effects from the study sample of healthy adults.Clinical trial registrationhttps://clinicalTrials.gov, identifier: NCT01308970.

Non-communicable diseases (NCDs) are the leading cause of mortality and morbidity worldwide. Underlying NCDs are modifiable risk factors, which may be targeted through Lifestyle Medicine (LM). LM is an evidence-based and clinical discipline that supports healthy lifestyle habits. Much of LM integration in practice is rooted in the education afforded within health professional's curricula. The study aimed to determine the effectiveness of LM educational interventions within health professional's curricula on knowledge, competence, self-efficacy/confidence and skills. A systematic review and meta-analysis were conducted with data analyzed using descriptive statistics and a Random Effect Meta-analysis. A total of 14 studies were included. Interventions centered around substance use, nutrition and physical activity with no studies obtained on the sleep health, stress management and social connectedness pillars. Interventions showed a positive impact on improving knowledge standardized mean difference (SMD): 0.71 (95% CI: 0.25-1.18), self-esteem/self-confidence SMD: 1.34 (95% CI: 0.61-2.07), and outcome practice SMD: 0.78 (95% CI 0.29-1.26). There was insufficient power to provide reliable estimates for the attitude outcome. Integrating LM educational interventions within health professional's curricula is promising and recommended to better equip trainees and future health care providers to support patients with the adoption of a healthy lifestyle.

Healthcare workers face an elevated risk of chronic stress and burnout, for which resiliency interventions are needed. The Stress Management and Resiliency Training Program (SMART-3RP; 8 weekly 90-minute sessions) was offered to 254 hospital employees between 2/2021 and 1/2024. Participants were surveyed pre- and post-intervention for measures of resiliency, stress coping, positive affect, perceived stress, anxiety, and depression. The baseline sample was 84% female, 89.5% non-Hispanic, 71.3% White, and averaged 45 years of age (SD = 14.25). Baseline and follow-up survey completion rates were 71.3% (N = 181) and 35.8% (N = 91), respectively. Significant improvements were seen pre-post intervention for all measures (all ps <.001): resiliency (d = 0.57), stress coping (d = 1.1), positive affect (d = 0.83), perceived stress (d = -0.88), anxiety (d = -0.74), and depression (d = -0.43). Alleviating employee stress is crucial for improving individual, clinical, and systems-level outcomes in hospitals. The SMART-3RP is a promising program that provides healthcare workers with resiliency and stress coping skills.

Catatonia is a neuropsychiatric disorder characterized by motor, affective and cognitive-behavioural signs, which lasts from hours to days. Intensive research over the past two decades has led to catatonia being recognized as an independent diagnosis in the International Classification of Diseases, 11th Revision (ICD-11) since 2022. Catatonia is found in 5-18% of inpatients on psychiatric units and 3.3% of inpatients on medical units. However, in an unknown number of patients, catatonia remains unrecognized and these patients are at risk of life-threatening complications. Hence, recognizing the symptoms of catatonia early is crucial to initiate appropriate treatment to achieve a favourable outcome. Benzodiazepines such as lorazepam and diazepam, electroconvulsive therapy, and N-methyl-D-aspartate antagonists such as amantadine and memantine, are the cornerstones of catatonia therapy. In addition, dopamine-modulating second-generation antipsychotics (for example, clozapine and aripiprazole) are effective in some patient populations. Early and appropriate treatment combined with new screening assessments has the potential to reduce the high morbidity and mortality associated with catatonia in psychiatric and non-psychiatric settings.

Introduction: The study aimed to pilot test a well-being curriculum for KL2 scholars to be used across the Clinical and Translational Science Award consortium. Methods: Between November 2022, and May 2023, 36 KL2 scholars from 25 hubs participated in the program. The General Well-Being Index for U.S. Workers and the Patient Reported Outcomes Measurement Information System (PROMIS-29) were completed by scholars before and after the program. Results: Postparticipation, there was a trend of improvement in the domains of well-being, sleep, anxiety, and fatigue. Conclusion: Implementing a virtual synchronous well-being curriculum allowed the scholars to connect across the consortium and improve their well-being.

BackgroundPeripheral vascular interventions (PVIs) performed under procedural sedation and analgesia (PSA) can be associated with anxiety and poor compliance with patient instructions during surgery. Mind-body interventions (MBIs) such as meditation have demonstrated the potential to decrease perioperative anxiety, though this area is understudied, and no tailored interventions have been developed for the vascular surgical patient population.ObjectivesWe aimed to design a perioperative MBI that specifically targeted vascular surgical patients undergoing PVIs under PSA. We sought to perform this in a scientifically rigorous, multi-disciplinary collaborative manner.MethodsFollowing the Obesity-Related Behavioral Intervention Trials (ORBIT) model, we designed (Phase 1a) and then refined (Phase 1b) a MBI for patients undergoing PVIs under PSA to decrease perioperative anxiety and sedation and facilitate patient intraoperative compliance. Phase 1a involved a literature review, informal information gathering and synthesis, and drafting a preliminary protocol for a perioperative MBI. Phase 1b involved assembling a multi-disciplinary expert panel of perioperative and mind-body clinicians and researchers to improve the MBI using an iterative, modified Delphi approach.ResultsThe modified Delphi process was completed, and a consensus was reached after three iterations. The resulting MBI consisted of two seven-minute preoperative guided meditations on the day of surgery, including diaphragmatic breathing, body scans, and guided imagery emphasizing awareness of the ipsilateral leg where the vascular surgery was performed. A document delineating the integration of the MBI into the operating room workflow was produced, including details regarding the intervention’s timing, duration, and modality.ConclusionUsing a multi-specialty expert panel, we designed a novel MBI in the form of a guided meditation with elements of mindfulness and guided imagery to decrease anxiety and increase intraoperative compliance for patients undergoing PVIs under PSA. A prospective pilot study is being planned to test the program’s feasibility.

Intracerebral hemorrhage (ICH) survivors are at high risk for recurrent stroke and cardiovascular events. Blood pressure (BP) control represents the most potent intervention to lower these risks, but optimal treatment targets in this patient population remain unknown. We sought to determine whether survivors of ICH achieving more intensive BP control than current guideline recommendations (systolic BP <130 mmHg and diastolic BP <80 mmHg) were at lower risk of major adverse cardiovascular and cerebrovascular events and mortality. We analyzed data for 1828 survivors of spontaneous ICH from 2 cohort studies. Follow-up BP measurements were recorded 3 and 6 months after ICH, and every 6 months thereafter. Outcomes of interest were major adverse cardiovascular and cerebrovascular events (recurrent ICH, incident ischemic stroke, myocardial infarction), vascular mortality (defined as mortality attributed to recurrent ICH, ischemic stroke, or myocardial infarction), and all-cause mortality. During a median follow-up of 46.2 months, we observed 166 recurrent ICH, 68 ischemic strokes, 69 myocardial infarction, and 429 deaths. Compared with survivors of ICH with systolic BP 120 to 129 mmHg, participants who achieved systolic BP <120 mmHg displayed reduced risk of recurrent ICH (adjusted hazard ratio [AHR], 0.74 [95% CI, 0.59-0.94]) and major adverse cardiovascular and cerebrovascular events (AHR, 0.69 [95% CI, 0.53-0.92]). All-cause mortality (AHR, 0.76 [95% CI, 0.57-1.03]) and vascular mortality (AHR, 0.68 [95% CI, 0.45-1.01]) did not differ significantly. Among participants aged >75 years or with modified Rankin Scale score 4 to 5, systolic BP <120 mmHg was associated with increased all-cause mortality (AHR, 1.38 [95% CI, 1.02-1.85] and AHR, 1.36 [95% CI, 1.03-1.78], respectively), but not vascular mortality. We found no differences in outcome rates between survivors of ICH with diastolic BP <70 versus 70 to 79 mmHg. Targeting systolic BP <120 mmHg in select groups of survivors of ICH could result in decreased major adverse cardiovascular and cerebrovascular events risk without increasing mortality. Our findings warrant investigation in dedicated randomized controlled trials.

Background: In April 2017, the American College of Physicians (ACP) published a clinical practice guideline for low back pain (LBP) recommending nonpharmacologic treatments as first-line therapy for acute, subacute, and chronic LBP. Objective: To assess primary care provider (PCP)-reported initial treatment recommendations for LBP following guideline release. Design: Cross-sectional structured interviews. Participants: Convenience sample of 72 PCPs from 3 community-based outpatient clinics in high- or low-income neighborhoods. Approach: PCPs were interviewed about their familiarity with the ACP guideline, and how they initially manage patients with acute/subacute and chronic LBP. Treatment responses were coded as patient education, nonpharmacologic, pharmacologic, or medical specialty referral. PCPs were also asked about their comfort referring patients to nonpharmacologic treatment providers, and about barriers to referring. Responses were assessed using content analysis. Differences in responses were assessed using descriptive statistics. Key results: Interviews were completed between December 2017 and March 2018. Of 72 participating PCPs (50% male; mean years of practice = 13.8), over three-fourths indicated being familiar with the ACP guideline (76%-87% at 3 clinics). For acute LBP, PCPs typically provided advice to stay active (81%) and pharmacologic management (97%; primarily nonsteroidal anti-inflammatory drugs). For chronic LBP, PCPs were more likely to recommend nonpharmacologic treatments than for acute LBP (85% vs. 0%, p < 0.001). The most common nonpharmacologic treatments recommended for chronic LBP were physical therapy (78%), chiropractic care (21%), massage therapy (18%), and acupuncture (17%) (each compared with 0% for acute LBP, all p < 0.001). The cost of nonpharmacologic treatments was perceived as a barrier. However, PCPs working in low-income neighborhood clinics were as likely to recommend nonpharmacologic approaches as those from a high-income neighborhood clinic. Conclusions: While most PCPs indicated they were familiar with the ACP guideline for LBP, nonpharmacologic treatments were not recommended for patients with acute symptoms. Further dissemination and implementation of the ACP guideline are needed.