Explaining the Impact of the COVID-19 Pandemic on Massage Therapists in Australia and Canada: A Mixed Methods Study.

Background: The COVID-19 pandemic was a time of rapid change and uncertainty, with individual jurisdictions within countries implementing a variety of preventative measures. At the onset of the pandemic, as little was known about how COVID-19 was transmitted, restrictions, such as lockdowns, were implemented to prevent further spread of this virus. In many jurisdictions, massage therapists were deemed as nonessential for a period. This disruption to their livelihood, as a professional group and without autonomy to decide, was unprecedented. This prompted the question as to whether this experience had impacted massage therapists' professional identity. Methods: A sequential explanatory mixed methods design was used and massage therapists in Australia and Canada were recruited to participate. Results from a quantitative questionnaire completed by 649 respondents and from 31 semistructured interviews from a subset of the questionnaire participants were used in the mixed analysis. Results: Massage therapists, impacted by the pandemic, experienced a discord between what it means to be a massage therapist, providing patient-centered care and the public health initiatives implemented during the pandemic. This discord occurred in multiple situations and the type of discord was influenced by a number of factors, including how therapists identified themselves within the workforce (i.e., as a health care provider or a service provider). Conclusion: This study sought to understand how the COVID-19 pandemic impacted massage therapists' professional identity. Massage therapists reported that the pandemic impacted their professional identity through a lack of congruence and discord between their identity-constituting beliefs and what it means to be a massage therapist. The sequela to this discord was therapists experiencing different types of moral distress and or moral injury. Future research is needed to determine the longer-term impacts of COVID-19 on massage therapists.

Perceptions on Healthy Eating Impact the Home Food Environment: A Qualitative Exploration of Perceptions of Indigenous Food Gatekeepers in Urban Fiji.

The home food environment (HFE) can have important direct and indirect impacts on dietary practices. Nutrient transitions in the HFE of Pacific Island countries (PICs) are key contributors of the high rates of adult and childhood overweight and obesity in the region. Pacifica mothers are important sociocultural agents who play critical roles in their HFE through setting eating-appropriateness standards and mitigating the impacts of food availability and accessibility on the HFE. This study used an interpretative phenomenological approach to explore how urban indigenous Fijian mothers perceive healthy eating and how these perceptions impacted the food decisions they made for their families. Mothers in this study held complex, multifaceted perceptions on healthy eating and these perceptions had both positive and negative impacts on the family food choices they made, the strategies they adopted for healthy eating and their perceived motivators for healthy eating. The findings of this study underscore the need for a deeper understanding and analysis of uptake of public health messaging related to healthy and unhealthy eating and the importance of targeted promotion of healthful nutrition in this community. Promoting consumption of traditional and locally grown foods can enhance nutrition and food security and combat nutrition transition in the region.

Current approaches in the recognition and management of eating disorders.

Eating disorders are now well acknowledged mental health problems that are common and present in people from diverse sociodemographic backgrounds. The past decade has seen a rapid expansion in research into eating disorder interventions. In response to the increasing burden of eating disorders, the Australian Government Department of Health and Aged Care has implemented significant policy changes to improve patient access to Medicare and inpatient treatment facilities. There are several international clinical practice guidelines and a robust evidence base particularly for first line care with specific psychological therapies, including guidelines for the management of eating disorders in individuals with a high weight. Medications play an important adjunct role in care, and novel neuromodulating treatments, such as psychostimulants, are under study. There is emerging evidence for increased person-centred care, with more choice in the form of alternatives to hospital inpatient programs and more respectful consideration of care for all who experience an eating disorder, including people with high weight.

The paradox of the impact of the COVID-19 pandemic on massage therapists in Australia and Canada: The reporting of a qualitative strand of a mixed methods study.

INTRODUCTION: In both Australia and Canada, healthcare providers considered essential were allowed to operate during the COVID-19 pandemic. The impact of the global pandemic on professional identity included opportunities for role expansion, a focus on ethical principles and social accountability, and professional pride. These results were found only for those considered to be essential and do not likely resonate with those classified as non-essential, such as massage therapists, leaving a gap in understanding. MATERIALS AND METHODS: This qualitative strand of a sequential explanatory mixed methods study used qualitative description. Individuals who expressed interest were purposefully selected, based on age, gender, type of practice, and experience with the four key phenomena of interest. Data collected through semi-structured interviews was analyzed using qualitative content analysis. Member checking enhanced the trustworthiness of the results. RESULTS: Thirty-one (16 Australian and 15 Canadian) participants were interviewed. The main theme described was the pandemic paradox. At some point during the pandemic, most participants were labelled by government agencies as a non-essential service. However, participants reported feeling both essential and non-essential. Two subthemes were also described: factors contributing to creating the paradox and consequences of the paradox. CONCLUSION: A number of pre-existing factors around professional identity, such as patient relationships combined with the conditions instituted to manage the COVID-19 pandemic included designating health care services as essential or non-essential, created the paradox experienced by respondents and the subsequent experience of moral distress. Further research into moral distress experienced by massage therapists is needed.

Impact of the COVID-19 Pandemic on the Professional Identity of Massage Therapists: The Reporting of a Quantitative Strand of a Mixed-Methods Study.

Introduction: In late 2019, a pathogen outbreak occurred that rapidly spread, resulting in the coronavirus disease 2019 (COVID-19) global pandemic. Governments responded to the pandemic with a range of strategies, including forced quarantines and nationwide lockdowns. Research on professional identity during the pandemic has predominately focused on health care providers declared as "essential" rather than "nonessential." In this study, the authors examine the impacts on the professional identity of massage therapists (MTs) who were predominately deemed as nonessential health care providers during the COVID-19 pandemic. Materials and methods: An online, questionnaire-based study sought to answer "In what ways has the professional identity of MTs in Canada and Australia been impacted by the COVID-19 global pandemic?" MTs in Canada and Australia were recruited using convenience sampling through e-mail and social media. A questionnaire was developed and pilot tested before implementation. Results: Six hundred and forty-nine MTs participated (329 from Canada and 316 from Australia). Known constructs of professional identity that were affected during the pandemic included not feeling respected as a health care practitioner, feeling less professional than other health care providers, and experiencing burnout. New constructs that may have developed out of the pandemic and the measures established to manage them included being classified as nonessential and feeling a sense of camaraderie and belonging. Conclusions: This study is the first of its kind to report the impact of the COVID-19 pandemic on the professional identity of MTs. The emerging constructs reported will be used to create interview questions for the subsequent qualitative strand of this explanatory mixed-methods study. In the qualitative study, respondents will be invited to share their experiences with their own voice to further the understanding of the impact of the COVID-19 pandemic on MTs' professional identity.

Beyond Refeeding: The Effect of Including a Dietitian in Eating Disorder Treatment. A Systematic Review.

Eating disorders are potentially life-threatening mental health disorders that require management by a multidisciplinary team including medical, psychological and dietetic specialties. This review systematically evaluated the available literature to determine the effect of including a dietitian in outpatient eating disorder (ED) treatment, and to contribute to the understanding of a dietitian's role in ED treatment. Six databases and Google Scholar were searched for articles that compared treatment outcomes for individuals receiving specialist dietetic treatment with outcomes for those receiving any comparative treatment. Studies needed to be controlled trials where outcomes were measured by a validated instrument (PROSPERO CRD42021224126). The searches returned 16,327 articles, of which 11 articles reporting on 10 studies were included. Two studies found that dietetic intervention significantly improved ED psychopathology, and three found that it did not. Three studies reported that dietetic input improved other psychopathological markers, and three reported that it did not. One consistent finding was that dietetic input improved body mass index/weight and nutritional intake, although only two and three studies reported on each outcome, respectively. A variety of instruments were used to measure each outcome type, making direct comparisons between studies difficult. Furthermore, there was no consistent definition of the dietetic components included, with many containing psychological components. Most studies included were also published over 20 years ago and are now out of date. Further research is needed to develop consistent dietetic guidelines and outcome measures; this would help to clearly define the role of each member of the multidisciplinary team, and particularly the role of dietitians, in ED treatment.

Yoga as adjunctive therapy in the treatment of people with anorexia nervosa: a Delphi study.

BACKGROUND: There is preliminary evidence to suggest that yoga can be beneficial in reducing anxiety, depression and general eating disorder symptoms in people with Anorexia Nervosa (AN). It is unclear whether the therapeutic benefits of yoga are supported or utilised in the treatment of AN amongst clinical experts. The present study aimed to explore and synthesise expert opinion on the use of yoga as an adjunctive therapy in the management of anxiety, depression and over-exercise in individuals with AN. METHODS: A Delphi methodology was employed, with clinicians considered experts in the treatment of AN recruited internationally to form the panel (n = 18). The first iteration of questionnaires comprised of four open-ended questions concerning the experts' understanding of the term yoga and opinions on its' use in therapy generally and more specifically in the treatment of AN. Using content analysis, statements were derived from this data and included as Likert-based items in two subsequent rounds where panellists rated their level of agreement on each item. Seventeen out of 18 respondents completed all three iterations. RESULTS: Consensus (level of agreement defined at ≥ 85%) was achieved for 36.47% of the items included in the second and third rounds. The panel reached consensus on items defining yoga and pertaining to its' general benefits. The panel agreed that yoga is a adjunct therapy for various problems, consensus was not achieved on the specific use of yoga as an adjunct therapy in the treatment of comorbid anxiety, depression or trauma in patients with AN. Although the expert panel acknowledged a number of benefits for use of yoga in AN, they strongly endorsed that future research should evaluate the potential risks of using yoga as an embodied practice. CONCLUSIONS: It is possible that yoga could be considered for inclusion in future guidelines if supported by empirical research. We conclude that there seems to be enough consensus that such further scientific investigation is warranted. This study aimed to explore expert opinion on the use of yoga as an adjunctive therapy in the management of anxiety, depression and over-exercise in individuals with Anorexia Nervosa (AN). Clinicians considered experts in the treatment of AN recruited internationally to form the panel (n = 18). Experts were asked about their understanding of the term yoga and their opinions on its' use in therapy. The panel reached consensus on items defining yoga and pertaining to its' general benefits. Although the panel agreed that yoga is a nice additional therapy for various problems, consensus was not achieved on the use of yoga as an additional therapy in the treatment of specific problems like anxiety, depression or trauma in people with AN. The expert panel acknowledged a number of benefits for use of yoga in AN. However the panel strongly considered that future research should evaluate the potential risks of using yoga as an embodied practice. The areas of collective agreement gained in the study can serve as preliminary guidelines for the use of yoga in AN whilst guiding future research directions.

Australian massage therapists' views and practices related to preconception, pregnancy and the early postpartum period.

BACKGROUND AND PURPOSE: Massage is commonly used by the Australian public and is often sought by expectant mothers. Despite its popularity there is no regulatory body to enforce minimum educational standards, guidelines or evidence-based best practice for massage therapists. The aim of this paper is to critically examine the views and practices of massage therapists who offer preconception, antenatal or postnatal massage. MATERIALS AND METHODS: An online survey was administered to Australian massage therapists who provide massage in the preconception, antenatal or postnatal periods. RESULTS: Ninety-nine therapists completed the survey. The majority of respondents had received training in pregnancy massage (n = 72; 72.7%) only. The most confident respondents were those that had both training and experience. CONCLUSION: There are potential gaps in training for massage therapists including up-to-date curriculum and a fragmentation around industry training requirements for pregnancy massage, which may impact on the safety and benefits of pregnancy massage.

The feasibility of acupuncture as an adjunct intervention for antenatal depression: a pragmatic randomised controlled trial.

BACKGROUND: Antenatal depression is common and associated with adverse consequences for mothers, babies, and future generations. Limitations with conventional approaches has resulted in additional therapies being considered. This study examined the feasibility and effectiveness of acupuncture for improving mental health. METHODS: Fifty-seven pregnant women with depressive symptomologies were randomised to acupuncture (n=19) plus treatment as usual (TAU), progressive muscle relaxation (PMR, n=19) plus TAU or TAU (n=19). Treatments were conducted from 24 to 31 weeks gestation. Clinical assessments were performed throughout the intervention, as well as at a six-week postnatal follow-up. The primary outcome measure was depression. Secondary outcome measurements were stress, anxiety, psychological distress, quality of life and adjustment to mothering. Intention to treat (ITT), Linear Mixed Model (LMM) repeated measures and per protocol (PP) analyses were conducted. RESULTS: At end-of-intervention there were significantly lower depression scores in the acupuncture group versus TAU and PMR respectively [ITT p<0.001, mean difference (MD) -5.84 (95% CI -9.10 to -2.58); MD -3.42 (95% CI -6.64 to -0.20)]. LMM repeated measures analysis (including postnatal follow-up) also demonstrated significantly lowered acupuncture group scores for stress (p=0.006) and psychological distress (p<0.001) when compared to PMR and TAU. Between group differences were not significant at six-weeks postnatal. No adverse events were reported. LIMITATIONS: Main limitations are small sample size and the use of self-reported outcome measures. CONCLUSION: Prenatal acupuncture reduced depression, stress and distress, whilst also being well-tolerated and free from adverse events. Further research is warranted.

Elucidating knowledge and beliefs about obesity and eating disorders among key stakeholders: paving the way for an integrated approach to health promotion.

BACKGROUND: Understanding the knowledge and beliefs of key stakeholders is crucial in developing effective public health interventions. Knowledge and beliefs about obesity and eating disorders (EDs) have rarely been considered, despite increasing awareness of the need for integrated health promotion programs. We investigated key aspects of knowledge and beliefs about obesity and EDs among key stakeholders in Australia. METHODS: Using a semi-structured question guide, eight focus groups and seven individual interviews were conducted with 62 participants including health professionals, personal trainers, teachers and consumer group representatives. An inductive thematic approach was used for data analysis. RESULTS: The findings suggest that, relative to obesity, EDs are poorly understood among teachers, personal trainers, and certain health professionals. Areas of commonality and distinction between the two conditions were identified. Integrated health promotion efforts that focus on shared risk (e.g., low self-esteem, body dissatisfaction) and protective (e.g., healthy eating, regular exercise) factors were supported. Suggested target groups for such efforts included young children, adolescents and parents. CONCLUSIONS: The findings indicate areas where the EDs and obesity fields have common ground and can work together in developing integrated health promotion programs.

Acupuncture for Depression: A Systematic Review and Meta-Analysis.

BACKGROUND: Depression is commonly treated with anti-depressant medication and/or psychological interventions. Patients with depression are common users of complementary therapies, such as acupuncture, either as a replacement for, or adjunct to, their conventional treatments. This systematic review and meta-analysis examined the effectiveness of acupuncture in major depressive disorder. METHODS: A search of English (Medline, PsychINFO, Google Scholar, and CINAL), Chinese (China National Knowledge Infrastructure Database (CNKI) and Wanfang Database), and Korean databases was undertaken from 1980 to November 2018 for clinical trials using manual, electro, or laser acupuncture. RESULTS: Twenty-nine studies including 2268 participants were eligible and included in the meta-analysis. Twenty-two trials were undertaken in China and seven outside of China. Acupuncture showed clinically significant reductions in the severity of depression compared to usual care (Hedges (g) = 0.41, 95% confidence interval (CI) 0.18 to 0.63), sham acupuncture (g = 0.55, 95% CI 0.31 to 0.79), and as an adjunct to anti-depressant medication (g = 0.84, 95% CI 0.61 to 1.07). A significant correlation between an increase in the number of acupuncture treatments delivered and reduction in the severity of depression (p = 0.015) was found. LIMITATIONS: The majority of the included trials were at a high risk of bias for performance blinding. The applicability of findings in Chinese populations to other populations is unclear, due to the use of a higher treatment frequency and number of treatments in China. The majority of trials did not report any post-trial follow-up and safety reporting was poor. CONCLUSIONS: Acupuncture may be a suitable adjunct to usual care and standard anti-depressant medication.

The perceived therapeutic benefits of complementary medicine in eating disorders.

OBJECTIVES: The purpose of this study was to investigate the perception of Complementary Medicines (CMs) in community women; to identify which CM approaches people perceived as the most beneficial; and the impact of Eating Disorder (ED) symptoms on one's perception of treatment. DESIGN & SETTING: Electronic and paper-based surveys were distributed to a pre-existing cohort of community women (n = 100) aged 18 years and over. The survey included questions about the perception of CMs' benefits in EDs regarding a vignette of a women with Anorexia Nervosa (AN), and whether CMs helped the participant's own personal health. MAIN OUTCOME MEASURE: The mental health literacy of women with regards to the recognition, evidence-based and CM treatment, and outcomes of a fictional person with AN. RESULTS: Exercise, yoga, meditation, relaxation, vitamins and minerals, massage and creative therapy were perceived as very helpful for someone with AN and for general health. Excluding meditation, there was no significant relationship between the levels of ED symptoms and perceived helpfulness of the therapies. Positive benefits were perceived for the use of CMs for AN. CONCLUSION: Considering the positive regard for these approaches, empirical studies are required to test their efficacy in the treatment of EDs.

The side effects and mother or child related physical harm from massage during pregnancy and the postpartum period: An observational study.

INTRODUCTION: Women commonly use massage therapy during pregnancy for pregnancy-related health conditions such as lower back and neck pain; however, there is little to no research related evidence on the side effects or mother or child physical harm of massage during pregnancy and the postnatal period. OBJECTIVES: This study aims to report on the side effects and mother or child physical harm of massage during pregnancy and the postnatal period. DESIGN: An observational study methodology. SETTING AND TIME FRAME: Two massage clinics, one in Sydney and one in Melbourne recruited participants from December 2016 to December 2017. INTERVENTION: Massage. MAIN OUTCOME MEASURE: Side effects and mother or child physical harm from massage. RESULTS: One hundred and one participants were recruited to the study. Two fifths of the participants (n = 32, 40%) experienced one of more post-massage side effects. There were no mother or child physical harm events. Low back pain was the most common condition women sought massage treatment for 34 (33.7.%). A significant benefit (p < 0.001) was seen pre-massage to post-massage and pre-massage to 1-week post massage in decreasing stress, decreasing pain, increasing range of motion and improving sleep DISCUSSION: Similar to previous research, low back pain was the most common condition that women sought massage treatment for followed by hip pain, shoulder pain, neck pain and to improve mental health. Ninety-seven percent of the cohort received a full body massage including the feet leading credence that 'massage on the feet during pregnancy is harmful' is mythic in nature. CONCLUSION: While our findings lead credence that massage on the feet during pregnancy is a myth the study was not powered to determine the safety of pregnancy massage and further research is needed. Massage was commonly sought for low back pain with promising benefits in decreased pain and improved range of movement and further research on the effectiveness of massage for low back pain in pregnancy.

Acupuncture for depression.

BACKGROUND: Depression is recognised as a major public health problem that has a substantial impact on individuals and on society. People with depression may consider using complementary therapies such as acupuncture, and an increasing body of research has been undertaken to assess the effectiveness of acupuncture for treatment of individuals with depression. This is the second update of this review. OBJECTIVES: To examine the effectiveness and adverse effects of acupuncture for treatment of individuals with depression.To determine:• Whether acupuncture is more effective than treatment as usual/no treatment/wait list control for treating and improving quality of life for individuals with depression.• Whether acupuncture is more effective than control acupuncture for treating and improving quality of life for individuals with depression.• Whether acupuncture is more effective than pharmacological therapies for treating and improving quality of life for individuals with depression.• Whether acupuncture plus pharmacological therapy is more effective than pharmacological therapy alone for treating and improving quality of life for individuals with depression.• Whether acupuncture is more effective than psychological therapies for treating and improving quality of life for individuals with depression.• Adverse effects of acupuncture compared with treatment as usual/no treatment/wait list control, control acupuncture, pharmacological therapies, and psychological therapies for treatment of individuals with depression. SEARCH METHODS: We searched the following databases to June 2016: Cochrane Common Mental Disorders Group Controlled Trials Register (CCMD-CTR), Korean Studies Information Service System (KISS), DBPIA (Korean article database website), Korea Institute of Science and Technology Information, Research Information Service System (RISS), Korea Med, Korean Medical Database (KM base), and Oriental Medicine Advanced Searching Integrated System (OASIS), as well as several Korean medical journals. SELECTION CRITERIA: Review criteria called for inclusion of all published and unpublished randomised controlled trials comparing acupuncture versus control acupuncture, no treatment, medication, other structured psychotherapies (cognitive-behavioural therapy, psychotherapy, or counselling), or standard care. Modes of treatment included acupuncture, electro-acupuncture, and laser acupuncture. Participants included adult men and women with depression diagnosed by Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV), Research Diagnostic Criteria (RDC), International Statistical Classification of Diseases and Related Health Problems (ICD), or Chinese Classification of Mental Disorders Third Edition Revised (CCMD-3-R). If necessary, we used trial authors' definitions of depressive disorder. DATA COLLECTION AND ANALYSIS: We performed meta-analyses using risk ratios (RRs) for dichotomous outcomes and standardised mean differences (SMDs) for continuous outcomes, with 95% confidence intervals (CIs). Primary outcomes were reduction in the severity of depression, measured by self-rating scales or by clinician-rated scales, and improvement in depression, defined as remission versus no remission. We assessed evidence quality using the GRADE method. MAIN RESULTS: This review is an update of previous versions and includes 64 studies (7104 participants). Most studies were at high risk of performance bias, at high or unclear risk of detection bias, and at low or unclear risk of selection bias, attrition bias, reporting bias, and other bias.Acupuncture versus no treatment/wait list/treatment as usualWe found low-quality evidence suggesting that acupuncture (manual and electro-) may moderately reduce the severity of depression by end of treatment (SMD -0.66, 95% CI -1.06 to -0.25, five trials, 488 participants). It is unclear whether data show differences between groups in the risk of adverse events (RR 0.89, 95% CI 0.35 to 2.24, one trial, 302 participants; low-quality evidence).Acupuncture versus control acupuncture (invasive, non-invasive sham controls)Acupuncture may be associated with a small reduction in the severity of depression of 1.69 points on the Hamilton Depression Rating Scale (HAMD) by end of treatment (95% CI -3.33 to -0.05, 14 trials, 841 participants; low-quality evidence). It is unclear whether data show differences between groups in the risk of adverse events (RR 1.63, 95% CI 0.93 to 2.86, five trials, 300 participants; moderate-quality evidence).Acupuncture versus medicationWe found very low-quality evidence suggesting that acupuncture may confer small benefit in reducing the severity of depression by end of treatment (SMD -0.23, 95% CI -0.40 to -0.05, 31 trials, 3127 participants). Studies show substantial variation resulting from use of different classes of medications and different modes of acupuncture stimulation. Very low-quality evidence suggests lower ratings of adverse events following acupuncture compared with medication alone, as measured by the Montgomery-Asberg Depression Rating Scale (MADRS) (mean difference (MD) -4.32, 95% CI -7.41 to -1.23, three trials, 481 participants).Acupuncture plus medication versus medication aloneWe found very low-quality evidence suggesting that acupuncture is highly beneficial in reducing the severity of depression by end of treatment (SMD -1.15, 95% CI -1.63 to -0.66, 11 trials, 775 participants). Studies show substantial variation resulting from use of different modes of acupuncture stimulation. It is unclear whether differences in adverse events are associated with different modes of acupuncture (SMD -1.32, 95% CI -2.86 to 0.23, three trials, 200 participants; very low-quality evidence).Acupuncture versus psychological therapyIt is unclear whether data show differences between acupuncture and psychological therapy in the severity of depression by end of treatment (SMD -0.5, 95% CI -1.33 to 0.33, two trials, 497 participants; low-quality evidence). Low-quality evidence suggests no differences between groups in rates of adverse events (RR 0.62, 95% CI 0.29 to 1.33, one trial, 452 participants). AUTHORS' CONCLUSIONS: The reduction in severity of depression was less when acupuncture was compared with control acupuncture than when acupuncture was compared with no treatment control, although in both cases, results were rated as providing low-quality evidence. The reduction in severity of depression with acupuncture given alone or in conjunction with medication versus medication alone is uncertain owing to the very low quality of evidence. The effect of acupuncture compared with psychological therapy is unclear. The risk of adverse events with acupuncture is also unclear, as most trials did not report adverse events adequately. Few studies included follow-up periods or assessed important outcomes such as quality of life. High-quality randomised controlled trials are urgently needed to examine the clinical efficacy and acceptability of acupuncture, as well as its effectiveness, compared with acupuncture controls, medication, or psychological therapies.

The role of complementary and alternative medicine in the treatment of eating disorders: A systematic review.

This systematic review critically appraises the role of complementary and alternative medicine in the treatment of those with an eating disorder. Sixteen studies were included in the review. The results of this review show that the role of complementary and alternative medicine in the treatment of those with an eating disorder is unclear and further studies should be conducted. A potential role was found for massage and bright light therapy for depression in those with Bulimia Nervosa and a potential role for acupuncture and relaxation therapy, in the treatment of State Anxiety, for those with an eating disorder. The role of these complementary therapies in treating eating disorders should only be provided as an adjunctive treatment only.

Evaluation of an antenatal acupuncture intervention as an adjunct therapy for antenatal depression (AcuAnteDep): study protocol for a pragmatic randomised controlled trial.

BACKGROUND: Depressed pregnant women face difficulty navigating a course between the potentially serious consequences of leaving depression untreated and significant limitations associated with conventional therapies, such as foetal toxicity and teratogenicity. Preliminary evidence is suggestive that acupuncture may provide a safe and effective alternative treatment option for antenatal depression; however, additional research is required. The purpose of this study is to further investigate this treatment possibility, with an additional examination of a potential biomechanistic acupuncture effect. METHODS/DESIGN: In this pragmatic randomised controlled trial, we will compare individually tailored, flexible antenatal depression-oriented acupuncture with equivalent attention progressive muscle relaxation and routine antenatal depression hospital care. Eligible women at 24 weeks of gestation with Edinburgh Postnatal Depression Scale scores of 13 or more will be recruited from 2 antenatal clinics in South Western Sydney, Australia. The recruitment goal of 96 is powered to demonstrate a significant difference in Edinburgh Postnatal Depression Scale score severity between acupuncture and usual care, with intervention groups receiving weekly 1-h treatments for 8 weeks from 24 to 31 weeks of gestation. Mental health and quality-of-life assessments will occur at study commencement, intervention weeks 4 and 8 and 6 weeks post-natally via the collection of completed Edinburgh Postnatal Depression Scale scores, Depression, Stress and Anxiety Scale scores and World Health Organisation Quality of Life Scale scores. Adjustment to mothering will also be evaluated at 6 weeks post-natally using the Being a Mother Scale. A putative biomechanistic effect of acupuncture on the oxytocinergic system will additionally be examined by comparing baseline salivary hormone levels with those measured at intervention weeks 4 and 8, as well as leucocyte oxytocin receptor expression at baseline and intervention week 8. DISCUSSION: Ethical approval was received in February 2015, and recruitment is underway and expected to be completed in July 2016. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12615000250538, Registered on 19 March 2015.

Comparing cognitive behavioural therapy for eating disorders integrated with behavioural weight loss therapy to cognitive behavioural therapy-enhanced alone in overweight or obese people with bulimia nervosa or binge eating disorder: study protocol for a randomised controlled trial.

BACKGROUND: Around 40 % of individuals with eating disorders of recurrent binge eating, namely bulimia nervosa and binge eating disorder, are obese. In contrast to binge eating disorder, currently there is no evidence base for weight management or weight loss psychological therapies in the treatment of bulimia nervosa despite their efficacy in binge eating disorder. Thus, a manualised therapy called HAPIFED (Healthy APproach to weIght management and Food in Eating Disorders) has been developed. HAPIFED integrates the leading evidence-based psychological therapies, cognitive behavioural therapy-enhanced (CBT-E) and behavioural weight loss treatment (BWLT) for binge eating disorder and obesity respectively. The aim of the present study is to detail the protocol for a randomised controlled trial (RCT) of HAPIFED versus CBT-E for people with bulimia nervosa and binge eating disorder who are overweight/obese. METHOD/DESIGN: A single-blind superiority RCT is proposed. One hundred Brazilian participants aged ≥ 18 years, with a diagnosis of bulimia nervosa or binge eating disorder, BMI > 27 to < 40 kg/m(2), will be recruited from both community and clinics and individually randomised to a therapy arm. Five groups of ten participants will receive the experimental intervention (HAPIFED) and the other five groups of ten the control intervention (CBT-E). Both therapies are manualised, and in this RCT will comprise 1 individual session and 29 office-based group sessions over 6 months. Assessment points will be at baseline, end of therapy, and 6 and 12 months after end of therapy. The primary outcome of this intervention will be reduced weight. Secondary outcomes will be improved metabolic indicators of weight management, reduction in eating disorder symptoms including improved control over eating, improved adaptive function, physical and mental health-related quality of life, and reduced levels of depression and anxiety. DISCUSSION: This study will be the first to investigate a psychological therapy that aims to assist weight management in people with co-morbid overweight or obesity bulimia nervosa as well as with binge eating disorder. It will have the potential to improve health outcomes for the rapidly increasing number of adults with co-morbid obesity and binge eating disorder or bulimia nervosa. TRIAL REGISTRATION: US National Institutes of Health clinical trial registration number NCT02464345 , date of registration 1 June 2015.

Acupuncture and acupressure and massage health outcomes for patients with anorexia nervosa: findings from a pilot randomized controlled trial and patient interviews.

OBJECTIVES: This study examined the feasibility of conducting a randomized controlled trial of acupuncture compared with an active control in an inpatient setting, to examine individuals' experience of the interventions, clinical outcomes from the trial, and to integrate data to explain the trial findings. DESIGN: This was a pilot randomized controlled trial with in-depth interviews with trial participants. SETTING: The study was conducted at a private medical facility in Sydney, Australia. SUBJECTS: Twenty-six (26) patients with anorexia nervosa who were medically stable were the subjects. INTERVENTIONS: Treatment as usual was administered, and the intervention was delivered twice a week for the first 3 weeks, followed by weekly treatment for three weeks. The acupuncture group received acupuncture at the points Hegu (LI4), Zusanli (ST36), Neiguan (PC6), Taichong (LR3), Yanglingquan (GB34), and additional points based on the Traditional Chinese Medicine diagnosis. The control group received acupressure and massage. Acupressure involved consciously and gradually directing pressure to the center of the point being worked on. OUTCOME MEASURES: Clinical outcomes were measured at baseline and at 6 weeks following completion of the intervention. The primary outcome measure was body-mass index (BMI), and secondary outcomes included eating disorder psychopathology, anxiety, and depression. A semistructured interview was conducted asking questions about their interaction with the practitioner, what happened, how they felt, whether it made them feel differently, and what they attributed any change to. RESULTS: We found timely recruitment with the population recruited within a 5-month period. Study dropouts were 23% and treatment compliance was moderate, but acceptable for this challenging population. Participants in the control group demonstrated reduced eating concerns. Participants described both interventions positively, and experienced a sense of calmness and relaxation. CONCLUSIONS: Acupuncture and acupressure and massage may improve the patient's subjective sense of wellbeing, and further research is needed.

Patients with anorexia nervosa receiving acupuncture or acupressure; their view of the therapeutic encounter.

BACKGROUND: Anorexia nervosa is a serious illness with significant morbidity. The evidence base for existing psychological and pharmacological interventions to manage anorexia nervosa is not strong, and use of new adjunctive therapies that improve the effectiveness of existing treatments, and lead to improved mental health outcomes for this patient group is highly desirable. This study investigates the views of patients with anorexia nervosa receiving an acupuncture or acupressure intervention. METHOD: A randomised controlled trial was conducted in Sydney, Australia. Twenty-six inpatients with a diagnosis of anorexia nervosa were randomised to a six week intervention of acupuncture or acupressure with light massage. Treatment was administered twice weekly for three weeks, then weekly for three weeks. A post treatment questionnaire was administered to explore participant views, of the study consultation. Questions examined important aspects of the clinical encounter including the, patient's perception of the practitioners' relational empathy (CARE), treatment perceptions and the, therapeutic relationship. RESULTS: Participants in both groups scored highly on the CARE scale assessing empathy and the, therapeutic relationship. There was no difference in the mean CARE scores for the acupuncture group (50 (SD 0.0)) and the acupressure group (49.5 (SD 0.8)). Participants highly valued the therapeutic, encounter and in particular the characteristics of empathy, positive regard, acceptance, non, judgmental responses and trust. Having someone to talk to, being less stressed/relaxed and contact, with the study staff were also perceived to be important. CONCLUSION: Study participants perceive the therapeutic relationship and empathy as important qualities of the acupuncture or acupressure intervention as an adjunct therapy for the treatment of anorexia nervosa.

Use of serotonergic antidepressants and St John's wort in older Australians: a population-based cohort study.

OBJECTIVE: The study investigated the use of serotonergic antidepressants (SSRIs: selective serotonin reuptake inhibitors; SNRIs: serotonin-norepinephrine reuptake inhibitors) and St John's wort in a large NSW-based community sample, and sought to identify a potentially dangerous concomitant use of these medications. METHODS: Cross-sectional data from 266,848 participants from the '45 and Up' study were used. The questionnaire captures self-reported treatment for depression or anxiety and antidepressant medications in the last four weeks. RESULTS: 5.8% of participants received treatment for depression or anxiety, with 4.7% taking an SSRI and 1.3% an SNRI. St John's wort was taken by 0.3% of the participants. Use of SSRIs and SNRIs was reported more frequently by females than males (respectively, 64.1% vs 35.9%, 66.9% vs 33.1%). The gender difference was even more pronounced for St John's wort (75.6% vs. 24.4%). Use of antidepressants decreased after the age of 65 years. One hundred and forty people reported concurrent use of an SSRI and an SNRI, and 11 people of an SSRI with St John's wort. CONCLUSIONS: Around 7% of the study population aged 45-65 years reported the use of SSRIs or SNRIs, decreasing to 5% above 70 years of age. It is of concern that some individuals used an SSRI concurrently with St John's wort.