Qigong and Tai Chi for Treatment of Depression
Albert Yeung, M.D., Sc.D.
Director of Primary Care StudiesMGH Depression Clinical and Research Program
Associate ProfessorHarvard Medical School
Co-Medical DirectorSouth Cove Community Health Center
Albert Yeung, M.D. - Disclosures
No Conflict of Interest to Disclose
What is Major Depressive Disorder (MDD)?Diagnostic Criteria :1. Depressed mood and/or2. ↓Interest or pleasure3. Sleep disturbance4. Guilt or feelings of worthlessness5. ↓ Energy 6. ↓Concentration7. Appetite change with significant weight loss or weight gain 8. Psychomotor agitation or retardation 9. Suicidal ideation, recurrent; suicide attempt
5 out of these 9 s/s, ≥ 2 wks, + subjective distress and/or functional impairment
American Psychiatric Association, Diagnostic & Statistical Manual 5th ed. 2013
Treatment Types
Pharmacological therapies Psychotherapy Somatic therapies Complimentary & holistic treatment
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Qigong: A Movement Meditation
Qi
gong
6
Bajuanjin Qigong
7
Qigong
Tai Chi
What is Qigong?A form of meditative movement that involves: Relaxed, quiet postures sitting, standing, lying, Low impact movements, Stretching, Muscle resistance Slow breathing, Mental focusing exercises, and Visualization
Qigong: What does it do?Hypothesis 1
It might affect the practitioner’s subjective state or they might reflect an underlying physiological
process; or a somatic feeling may trigger… a feedback loop … that in turn produce an
alteration in physiological processes.
Kerr C: Culture, Medicine and Psychiatry 26: 419–447, 2002.
Qigong: What does it do?Hypothesis 2
It may be that qigong practitioners re-map the experiences of their own bodies, using embodied
visualization in a focused, concentrated and positive way. This sensory re-mapping can bring about a kind
of immediate healing of small strains…through stretching and dissolving, and these small healings
may encourage the practitioner’s sense that a deeper healing is also taking place.
Kerr C: Culture, Medicine and Psychiatry 26: 419–447, 2002
Self-Efficacy: The Social Cognition Theory
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Proprioception, Kinesthesis, Interoception and Emotions
Avery JA et al. (2013). Biological Psychiatry
Qigong and Bodily Sensations Meditative movements are exercises that use movement in
conjunction with meditative attention to body sensations, including proprioception, kinesthesis and interoception. Proprioception:
sensation pertaining to stimuli originating from within the body relatedto spatial position and muscular activity or to the sensory receptors that they activate
Kinesthesis: the perception of one's own body parts, weight, and movement
Interoception: pertaining to stimuli originating from within the body that are related to the functioning of the internal organs or the receptors they activate
Payne and Crane-Godreau; Frontiers in Psychiatry 2013
Somatosensory Cortex:Homunculus
The cerebellum is largely responsible for coordinating the unconscious aspects of proprioception.
Propioception and Balancing
Increase awareness re-balancing homeostasis
Interoception and affective stability (I)
Damasio A. The Feeling of What Happens: Body and Emotion in the Making of Consciousness (2000).
Visceral information Insular, Affective and Autonomic State Accessible by Consciousness
Damasio A,Carvalho GB. The natureoffeelings: evolutionary and neurobiologicalorigins. Nat Rev Neurosci (2013) 14(2):143–52.
Interoceptive and Homeostasis
Major Depressive Disorder is associated with Abnormal Interoceptive Activity and
Functional Connectivity in the Insular
Avery JA et al. (2013). Biological Psychiatry
Tai Chi and Brain Functional Plasticity
Wei GX et al. Frontiers in Aging Neuroscience April 2014 | Volume6 | Article 74
blue colors indicate decreases in 2dReHo, while red colors indicate increases in 2dReHo
Qigong and Psychological Well-Being
Methods: Hospital Staff were randomized to either 6-wkQigong class (N=16) or waitlist (N=21)
Results: Subjects in Qigong class had significant reduction in perceived stress (Perceived Stress Scale), improved in social functioning (SF-36), and reduction in pain (100mm Analog)
Results: Short term Qigong training resulted in reduced stress in hospital staff
Griffith J et al., 2008 J Altern Comple Med 14:939-945
Qigong for Patients with DepressionMethods: 82 elderly adults with depression were randomized to 1) 16 wk qigong, 2) control (newspaper reading group)
Results: Qigong group improved more in mood, self-efficacy, and personal well-being in 8 weeks. After 16 weeks of practice, the improvement generalized to daily task domain of the self-concept
Conclusion: Qigong practice could relieve depression, improve self-efficacy and personal well-being among elderly persons with chronic physical illness and depression
Tsang et al., 2006, Int J Geriatric Psychiatry
Qigong Treatment for Depressed Chinese Americans: A Pilot Study
A clinical trial to use Qigong for treating Chinese American patients with MDD is feasible and safe.
A twelve-week Qigong intervention may be effective in improving symptoms and inducing remission in Chinese Americans with MDD.
Qigong exercises, a Chinese folk well-being practice, has a potential to augment conventional treatment of depression.
Yeung et al. Evid Based Compl & Altern Med 2013
Meta-analysis: Effects of Tai Chi on Depression
Wang C (2010) BMC Compl & Altern Med
Systematic Review of Effects of Qigong on Anxiety, Depression, & Psychological Well-Being
Methods: Relevant studies on Qigong published between 2001 and 2011 in Chinese and English data-bases were searched. Fifty studies with randomized clinical trial or quasi-experimental design were reviewed and meta-analyses were performed on 3 studies.
Results: In the reviewed studies, Qigong was found to reduce depression, anxiety, somatic complaints, and improve quality of life. Meta-analyses were performed on 3 studies of patients with type-II diabetes, based on homogeniety assessment; Qigong was found to reduce depression (ES=-0.29; 95% CI, -0.58--0.00) and anxiety (ES=-0.37, 95% CI, -0.66 --0.08), and improve psychological well-being (ES=-0.58, 95% CI, -0.91--0.25).
Conclusion: Preliminary evidence suggests that qigong may have positive effects on psychological well-being among patients with chronic illnesses.
Wang et al, Evidence-Based Compl & Altern Medicine. 2012.
Meta-analysis: Effects of Qigong on Depression
Oh et al. (2013) Evid Based Compl & Altern Med
The evidence suggests potential effects of Qigong in the treatment of depression,
the review of the literature shows inconclusive results. Further research using
rigorous study designs is needed
Tai Chi Treatment for Depressed Chinese Americans: A Randomized Trial
Objective: To examined the feasibility, safety, and efficacy of using Tai Chi for treating depressed Chinese Americans
Subjects: Sixty-seven Chinese Americans with MDD with no treatment for depression were randomized (1:1:1) into a tai chi invention, an education program, or a waitlist group for 12 weeks
Intervention
Intervention Group: Two instructors followed a standard protocol, which included 12 weeks of training, and taught the first section (24 basic movements) of the traditional 108 movements of Yang-style tai chi.
Education Group: Participants in the education group received didactic training and discussed stress, mental health, depression and its treatment for one hour, twice per week, for 12 weeks.
Waitlisted Group: Participants in the waitlisted group were assessed at weeks 6 and 12, but received no other interventions during their waiting and follow-up periods.
Figure 1. Flow Chart of Subject Recruitment, intervention, and follow-up
Tai Chi Treatment for Depressed Chinese Americans
93 potential participants were interviewed
Tai Chi Intervention group Baseline
N=23
Education Control Group Baseline
N=22
Waitlisted Control group Baseline
N=22
8 Withdrew
Week 6 N=18
5 Withdrew
Week 6 N=14
Week 6 N=20
2 Withdrew
Week 12 N=17
Week 12 N=14
Week 12 N=19*
1 Discontinued#
Week 18 N=17
1 Discontinued#
Week 24 N=17*
Week 18 N=14
Week 24 N=14
Week 18 N=18
Week 24 N=17*
1 Discontinued#
1 Discontinued#
67 Eligible were Randomized
26 Not eligible/Withdrew
Waitlist Education Tai Chi Tai Chi vs. Education
Tai Chi vs. Waitlist
Education vs. WaitlistN=20 N=14 N=18
n % n % n % OR (95% CI) OR (95% CI) OR (95% CI)
Wk 12 (post-intervention)HAMD Response (yes)
5 25 3 21 10 56
8.90 (1.17, 67.70) 2.11 (1.01, 4.46) 1.1 0(.18, 6.75)
Wk 12 (post-intervention)HAMD Remission (yes)
2 10 3 21 9 50
4.40 (.78, 24.17) 3.01 (1.25, 7.10) 4.10 (.40, 43.78)
Wk24 (follow-up)HAMD Response (yes)
8 40 8 57.1 13 72.2
2.26 (.47, 10.84) 2.51 (1.11, 5.70) 1.96 (.48, 7.93)
Wk 24 (follow-up)HAMD Remission (yes)
6 35.3 6 42.9 11 64.7
2.40 (.53, 10.85) 2.20 (1.04, 4.64) 2.09 (.42, 10.34)
Tai Chi for Treatment of Depression: Primary Outcomes
Yeung et al., J Clin Psych 2017
Conclusions1. Existing evidence suggest that qigong/Tai Chi is
beneficial for promoting well-being and for treating a range of physical conditions including diabetes and fibromyalgia, and depression symptoms in medically ill patients.
2. A small number of studies suggested possible effectiveness of qigong for treating patients with major depressive disorder (MDD).
3. Future studies are needed to establish whether qigong is effective for well-being, and for treating patients with various medical illnesses; whether it is effective as monotherapy or as adjunctive treatment with conventional interventions, and whether it can be used to prevent the onset, relapse, or recurrence of illnesses.
Clinical Trials on Qigong/Tai Chi Treatment for Depression:
Methodological Considerations for Future Studies:■ How to define the study population?■ Is the intervention standardized? ■ How to assess the reliability among Qigong/Tai Chi instructors?■ What is the choice of the control group?
■ Waitlist? Attention controls? ■ Blinding of the subjects?■ Blinding of the raters?■ What are the outcome variables?■ Are there confounding variables?■ Are results statistically and clinically significant? ■ Are results generalizable?■ Can results be disseminated in the real world?
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