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Qigong and Tai Chi for
Treatment of Depression
Albert Yeung, M.D., Sc.D.
Director of Primary Care Studies
MGH Depression Clinical and Research Program
Associate Professor
Harvard Medical School
Co-Medical Director
South 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/or
2. ↓Interest or pleasure
3. Sleep disturbance
4. Guilt or feelings of worthlessness
5. ↓ Energy
6. ↓Concentration
7. 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;
including Mind Body Treatment
5
Qigong (氣功)
Qi (氣): Fundamental life energy responsible for health & vitality
Qong (功): To Cultivate
Qigong (氣功) : Energy Cultivation
6
Qigong Practices
Ancient Chinese exercises that cultivate Qi for health maintenance, spirituality, and for healing and increasing vitality. Various forms of exercises practiced 1) during stillness: lying, sitting, or standing; and 2) with movements.
They integrate mental focusing, physical movement, and breathing techniques.
7
Bajuanjin Qigong
8
Qigong
Tai Chi
Synchronizing the
Mind, Movement, and Breathe
Possible Mechanisms for Healing:
Traditional Chinese Medicine Theories
A free-flowing, well-balanced Qi system reflects good health.
Illnesses are the result of Qi blockage in certain areas of the
body.
Qigong and Tai Chi are believed to promote the flow of Qi
and alleviate Qi blockages, and may potentially prevent or
delay the progression of illnesses.
11
12 Meridians in Traditional Chinese Medicine Theory
How Qigong Heals?
It is a Subjective Experience
The practitioner focuses on somatic feelings in
a positive way, which may trigger…
a feedback loop … that in turn produce an
alteration in physiological processes.
Kerr C: Culture, Medicine and Psychiatry 26: 419–447, 2002.
Proprioception, Kinesthesis, Interoception and Emotions
Avery JA et al. (2013). Biological Psychiatry
Homonculus of Sensory – Motor Cortex
Propioception and Balancing
Increase awareness re-balancing homeostasis
Possible Mechanisms of Healing:
Self-Efficacy: The Social Cognition Theory
1 1
17
Post
Potential Mechanisms of Healing: Relaxation Response to Counteract Stress Responses
Pre
Benson H et. al. Psychosomatic Medicine (1974) Vol. 36, No. 2, 115-120
180
200
220
240
260
280
300
320
12 min. 12 min. 12 min.
OX
YG
EN
CO
NS
UM
PT
ION
(cc
/min
)
The practice of Tai Chi decreased salivary cortisol
concentrations.1
Among older adults with high IL-6 levels at entry, Tai Chi
produced a drop in IL-6 levels, decrease in depressive
symptoms was correlated with decreases in IL-62
1Jin P. J Psychosom Res, 1989.
2Irwin & Olmstead R. Am J Geriatr Psychiatry, 2012.
Possible Mechanisms of Healing: The Psychological Effects of Mindfulness
Develop psychological skills such as observing,
describing, acting with awareness, nonjudging of
inner experience, and nonreactivity to inner
experience.1
The decrease in attachment to one’s thoughts and
emotions leads to clarification, exposure,
self-regulation, and cognitive flexibility
(reperceiving or decentering).2
1Baer RA: Assessment. 2008 Sep;15(3):329–42.
2Shapiro SL. J Clin Psychol. 2006 Mar;62(3):373–86.
Possible Mechanisms of Healing:
Qigong and Bodily Sensations
Qigong exercises involve movements and meditative
attention to body sensations, including proprioception,
kinesthesis and interoception.
Proprioception:
sensation pertaining to stimuli originating from within the body related
to 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
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
Possible Mechanisms of Healing:
Neuropsychological Effects on the Brain
Meditation modulates the structure and function of anterior
insula and ACC, key regions involved in interoception1.2
Tai Chi and Baduanjin significantly modulate the
cognitive control network, and the default mode network,
a network associated with self-inferencing in older adults.3,4
1Tang YY et al. Nat Rev Neurosci. 2015; 2Kong et al., Neurisci 2015.
3Kong J., et al. Brain Imaging Behav, 2018; 4Liu J. Soc Cogn Affect Neurosci, 2019
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-wk
Qigong 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 Depression
Methods: 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 Grpoup
8 Withdrew
Week 6 N=1 8
5 Withdrew
Week 6 N=1 4
Week 6 N=20
2 Withdrew
Week 1 2 N=1 7
Week 1 2 N=1 4
Week 1 2 N=1 9*
1 Discontinued#
Week 1 8 N=1 7
1 Discontinued#
Week 24 N=1 7*
Week 1 8 N=1 4
Week 24 N=1 4
Week 1 8 N=1 8
Week 24 N=1 7*
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.
Waitlist N=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
Conclusions 1. 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?