Wellness Check: Mental Health

2 Minute Medicine is pleased to announce that we are launching Wellness Check, a new series dedicated to exploring new research evidence focused on wellness. Each week, we will report on articles examining different aspects of wellness, including (but not limited to) nutrition, sleep, reproductive health, substance use and mental health. This week, we explore the latest evidence-based updates in mental health.

Fruit intake may improve mood after Pavlovian progressive muscle relaxation conditioning

1. In this randomized control trial, following Pavlovian conditioning fruit consumption was associated with decreased distress.

2. Participants in the intervention group had similar improvements in negative mood when consuming traditional comfort foods.

Evidence Rating Level: 2 (Good)

Over one third of adults report experiencing high levels of stress on a daily basis. Traditional comfort foods which are high in fat and sugar are commonly used as a coping mechanism for stress by adults in the United States. Alternatively, increased fruit intake has been correlated with improved cardiovascular health and may represent a healthy alternative to traditional comfort foods for managing stress. In order to associate fruit with feelings of comfort, Pavlovian conditioning may be leveraged.

In the present randomized control trial, participants were randomized to either undergo progressive muscle relaxation while consuming fruit or progressive muscle relaxation unpaired with fruit consumption. Inclusion criteria were age over 18, English fluency, access to a smartphone with internet and camera access, moderate-to-high baseline stress, and neutral feeling about fruit consumption. Participants were excluded who were dieting, had a history of a substance use or eating disorder, current psychiatric diagnosis, or current significant illness. The primary outcome was perceived stress using the Positive and Negative Affect Schedule.

A total of 100 participants were included, of which half were randomized into the intervention (n=50) and control (n=50) groups. Following the intervention, fruit consumption significantly improved mood in the conditioning group as compared to the control group. Additionally, when compared to traditional comfort foods high in fat and sugar, fruit had a comparable positive impact on mood. However, the major limitations of the trial were that participants self-recorded fruit intake and that exclusion of those with psychiatric disorders limited generalizability of the results. In summary, Pavlovian pairing of fruit intake with progressive muscle relaxation may cause comparable improvements in distress as consumption of traditional comfort foods.

Online Eye Movement Desensitization and Reprocessing Therapy may improve mental health

1. In this intervention study, online Eye Movement Desensitization and Reprocessing (EMDR) Therapy resulted in significant improvements in mental health.

2. Online EMDR may represent an alternative for in-person therapy during the COVID-19 pandemic.

Evidence Rating Level: 2 (Good)

The increasing availability of online psychological interventions improves accessibility of mental health services for those with barriers to on-site care. Additionally, during the COVID-19 pandemic, online services have become crucial to providing emotional support during lockdown periods. Eye Movement Desensitization and Reprocessing (EMDR) has been previously validated as a tool for treating psychiatric disorders, and may confer mental health benefits delivered in an online format.

The present study evaluated the efficacy of online EMDR at improving mental health in individuals enrolled in online psychotherapy. Mental health status was measured via the Impact of Events Scale-Revised (IES–R), the General Anxiety Disorder 7 scale (GAD-7), the Public Health Questionnaire 9 (PHQ-9) scale, and the PTSD Checklist (PCL-5). All participants who were enrolled in online therapy with the EMDR therapists contacted were included. Accordingly, no exclusion criteria were applied.

Thirty-three therapists enrolled in the study with a total of 93 individual clients. The majority of clients were receiving treatment for PTSD, anxiety, and depression. Significant decreases in mean IES-R, GAD-7, PHQ-9, and PCL-5 (p<0.001) were recorded. Level of therapist accreditation, length of training, client gender, client age, and clinical outcomes were not associated with any significant difference in measured mental health outcomes. However, the major limitation of the study was that there was no control group to assess if clients generally improved over time or if EMDR significantly modified improvement of mental health parameters. Overall, EMDR may significantly improve mental health outcomes for those receiving online psychotherapy.

Dog training therapy may improve symptoms of post-traumatic stress disorder

1. This randomized control trial demonstrated that a dog training program significantly improved symptoms of post-traumatic stress disorder (PTSD) as compared to controls.

2. Emotional and attentional regulation was also improved in the intervention group.

Evidence Rating Level: 2 (Good)

Post-traumatic stress disorder (PTSD) may have a profound impact on the quality of life of those affected. Treatment often entails a combination of medications and psychotherapy. Complementary treatments, such as exercise interventions, have been demonstrated to improve PTSD recovery. Animal-assisted therapies have shown efficacy in other psychiatric disorders, and may represent another complementary therapy for improving symptoms of PTSD.

The aim of this randomized control trial was to evaluate the impact of a one-year dog-training program on PTSD symptoms. The primary outcome of the trial was Clinician-Administered PTSD Scale DSM V revision (CAPS-CA-5) score. Additionally, Beck Depression Inventory (BDI-II) and Auditory Sustained Attention Test (ASAT) scores were measured. Adolescents were included who had previous exposure to trauma. The main exclusion criterion was the inability to access mental health professionals.

A total of 54 participants enrolled in the trial and were randomized into either a dog training program (n=30) or treatment as usual (n=23). After completion of the dog training program, those in the treatment group had significantly greater improvements in their PTSD symptoms and ASAT scores as compared to controls. Conversely, both groups demonstrated similar improvements in BDI-II scores. However, the major limitation of the study was that follow-up was not conducted after the program was complete. Thus, the long-term impact of dog-training therapy for PTSD could not be elucidated. Nonetheless, this study was significant in suggesting participation in dog training programs may improve PTSD symptoms in conjunction with usual care.

Image: PD

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