HALCYON

The science

The Library

The practices at Halcyon are old. The research on them is newer, and growing. These are the studies we read and return to, each with a short note in plain language and a link to the original paper. We share them to inform, not to promise, and none of it is medical advice.

46 studies

Healing Through Dance · Somatic and Movement Healing

Effects of Dance Movement Therapy and Dance on Health-Related Psychological Outcomes. A Meta-Analysis Update

Koch SC, Riege RFF, Tisborn K, et al.

Frontiers in Psychology · 2019

This meta-analysis updated earlier reviews by gathering 41 controlled studies published between 2012 and 2018, with 2,374 participants in total. Twenty-one studies tested dance movement therapy, a therapeutic approach led by trained therapists, and 20 tested dance classes or programs. Overall there was a medium effect on psychological health outcomes such as quality of life, depression, anxiety, social skills, thinking skills and motor skills. Dance movement therapy showed a smaller but consistent effect on depression, anxiety, quality of life and social and cognitive skills, while dance programs showed larger but less consistent effects, especially on movement skills. Follow-up data suggested most effects held about 22 weeks later. Limitations: results varied a lot between studies, larger effects came from observer-rated measures that may be biased, and many studies had methodological weaknesses.

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Sleep · Meditation

The effect of mindfulness meditation on sleep quality: a systematic review and meta‐analysis of randomized controlled trials

Rusch HL, Rosario M, Levison LM, et al.

Annals of the New York Academy of Sciences · 2019

This meta-analysis gathered randomized controlled trials of mindfulness meditation for people with sleep problems. It included 18 trials with 1,654 participants and analysed two kinds of comparison separately. Against established sleep treatments, mindfulness showed no difference in sleep quality, with low strength of evidence, meaning it performed about the same rather than better. Against control activities that matched time and attention, mindfulness significantly improved sleep quality, with moderate strength of evidence, both straight after the program and at follow-up. The authors suggest mindfulness meditation may help with some aspects of sleep disturbance and call for more research. A limitation is that the evidence that mindfulness is as good as established sleep treatments was rated low, so it should not be seen as a substitute for them.

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Nature immersion

Effects of forest bathing (shinrin-yoku) on levels of cortisol as a stress biomarker: a systematic review and meta-analysis

Antonelli M, Barbieri G, Donelli D

International Journal of Biometeorology · 2019

This systematic review and meta-analysis looked at whether forest bathing (shinrin-yoku) lowers cortisol, a commonly used stress hormone marker. From 971 screened articles, 22 studies were included in the review and 8 in the statistical meta-analysis. In all but two of the included studies, cortisol was lower after time in the forest compared with control or urban groups, or dropped from before to after the forest session. The pooled analysis found salivary cortisol was lower in forest groups than urban groups. The authors conclude that forest bathing can influence cortisol in the short term in a way that suggests lower stress, while noting that people's expectations, a placebo effect, may play an important role. They also point to the limited amount of available data as a reason for more research.

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Nature immersion · Guided Hike

Nature experience reduces rumination and subgenual prefrontal cortex activation

Bratman GN, Hamilton JP, Hahn KS, et al.

Proceedings of the National Academy of Sciences · 2015

Rumination, the habit of repetitive negative thinking about oneself, is linked to higher risk of depression. In this study published in PNAS, healthy participants took a 90-minute walk either in a natural setting or in an urban setting. Those who walked in nature showed reduced self-reported rumination and reduced activity in the subgenual prefrontal cortex, a brain area associated with rumination, as measured by brain imaging. Those who walked along a busy urban route showed no such changes. The authors suggest this may be one pathway by which nature experience supports mental well-being, and that accessible natural areas could be an important mental health resource. One limitation is that the abstract does not report a large sample, and the participants were healthy adults, so the effect in people with depression is not tested here.

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Nature immersion · Guided Hike

Shinrin-Yoku (Forest Bathing) and Nature Therapy: A State-of-the-Art Review

Hansen MM, Jones R, Tocchini K

International Journal of Environmental Research and Public Health · 2017

Shinrin-yoku, or forest bathing, is the Japanese practice of spending mindful time among trees. This state-of-the-art review set out to gather empirical research on its physical and psychological effects, much of it from Japan and China, and to encourage longitudinal research in Western countries. Searching five databases, the authors started with 127 papers and included 64 studies published between 2007 and 2017, grouping them into physiological, psychological, sensory and framework studies. They conclude that the human health benefits of immersion in nature continue to be actively researched and suggest nature therapy as a possible health promotion approach for modern stress, including technology-related stress. The limitation is that this is a narrative review: it summarizes research but does not pool results or rate how strong each study was.

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Nature immersion

Outdoor blue spaces, human health and well-being: A systematic review of quantitative studies

Gascon M, Zijlema W, Vert C, et al.

International Journal of Hygiene and Environmental Health · 2017

Blue spaces are outdoor water environments such as lakes, rivers and the sea. This systematic review gathered 35 quantitative studies on how exposure to blue space, whether near home or while visiting, relates to human health and well-being; most studies were rated as good quality. The balance of evidence suggested a positive link between more blue space exposure and better mental health and well-being (12 studies) and higher levels of physical activity (13 studies). Evidence for links with general health, obesity and heart health was less consistent. The authors call the findings encouraging but point to clear limitations: relatively few studies, wide variation in how exposure and outcomes were measured, and mostly observational designs that cannot establish cause and effect.

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Nature immersion · Guided Hike

Spending at least 120 minutes a week in nature is associated with good health and wellbeing

White MP, Alcock I, Grellier J, et al.

Scientific Reports · 2019

Using a nationally representative survey of 19,806 people in England, researchers examined whether the amount of recreational time spent in nature during the previous week was linked to self-reported health and well-being. Compared with people who had no nature contact that week, those who spent at least 120 minutes in nature were significantly more likely to report good health and high well-being. Benefits peaked at around 200 to 300 minutes a week, with no further gain beyond that. The pattern held across groups, including older adults and people with long-term health conditions, and it did not matter whether the time came from one long visit or several shorter ones. The key limitation is that this was a cross-sectional survey, so it shows an association, not that nature time caused better health.

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Massage

A Preliminary Study of the Effects of a Single Session of Swedish Massage on Hypothalamic-Pituitary-Adrenal and Immune Function in Normal Individuals

Rapaport MH, Schettler P, Bresee C

The Journal of Alternative and Complementary Medicine · 2010

This study asked what a single Swedish massage does inside the body of a healthy person. Healthy adults aged 18 to 45 received either 45 minutes of Swedish massage or a carefully matched light touch session at an academic medical center. Researchers took repeated blood samples to measure hormones and immune markers. Compared with light touch, massage produced a large decrease in arginine vasopressin, a hormone linked to stress and blood pressure, and a small decrease in cortisol. Massage also increased the number of several types of circulating immune cells and lowered levels of a range of inflammatory signalling molecules. The researchers had expected oxytocin to explain these effects, but it did not. The authors describe the results as preliminary and needing replication, and the abstract does not report a large sample.

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Massage

A Meta-Analysis of Massage Therapy Research.

Moyer CA, Rounds J, Hannum JW

Psychological Bulletin · 2004

This landmark meta-analysis in Psychological Bulletin gathered 37 randomized studies of massage therapy and calculated average effects across nine outcomes. A single massage session reduced state anxiety, blood pressure and heart rate, but did not measurably change negative mood, immediate pain ratings or cortisol. A course of multiple sessions reduced pain measured later on. The largest effects were reductions in trait anxiety and depression after a course of treatment, which the authors note were similar in size to those seen with psychotherapy. No factors were found that reliably changed how well massage worked. The authors argue that massage may be better understood through a psychotherapy lens than a purely medical one. A limitation is age: the analysis is from 2004, and the number of studies for some outcomes was modest.

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Yoga

Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials

Cramer H, Lauche R, Anheyer D, et al.

Depression and Anxiety · 2018

This review pooled randomized controlled trials of yoga for people with anxiety disorders or elevated anxiety levels. Eight trials with 319 participants, mostly in their 30s, were included. Compared with no treatment, yoga showed small short-term reductions in anxiety, and compared with active comparison groups the effects were larger. There were also small effects on depression compared with no treatment. Importantly, no effects were found for people whose anxiety disorder was formally diagnosed under DSM criteria; the benefits appeared in those diagnosed by other methods and in people with elevated anxiety but no formal diagnosis. Only three trials reported side effect data, and these did not show more injuries with yoga. The authors call the evidence preliminary and ask for more high-quality trials, and the small number of studies is the main limitation.

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Yoga · Somatic and Movement Healing

Yoga for chronic non-specific low back pain

Wieland LS, Skoetz N, Pilkington K, et al.

Cochrane Database of Systematic Reviews · 2022

This Cochrane review assessed yoga for adults with chronic low back pain that has no specific identified cause. It included 21 randomized trials with 2,223 participants, mostly women in their 40s and 50s practicing Iyengar, hatha or viniyoga styles. Compared with no exercise, yoga produced small improvements in back function and pain at three months, smaller than what is usually considered clinically important, along with a small improvement in physical and mental quality of life and possibly a higher chance that people rated their back as improved. Compared with other back-focused exercise, yoga made little or no difference. Yoga was also associated with more adverse events, mainly temporary increases in back pain. A key limitation is that participants could not be blinded, and most outcomes were self-reported.

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Yoga · Meditation

Yoga, mindfulness-based stress reduction and stress-related physiological measures: A meta-analysis

Pascoe MC, Thompson DR, Ski CF

Psychoneuroendocrinology · 2017

Rather than relying on how people say they feel, this meta-analysis looked at physical markers of stress. It included 42 randomised controlled trials comparing practices that involve yoga postures (asanas), with or without mindfulness-based stress reduction, against active control groups. Compared with active controls, yoga-based practices were associated with lower evening and waking cortisol, lower ambulatory systolic blood pressure, lower resting heart rate, changes in heart rate variability, and lower fasting blood glucose, total cholesterol and LDL cholesterol. The authors conclude that yoga-based practices appear to be associated with better regulation of the body's main stress systems, the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. The main limitation is that the yoga programs studied were very different from each other, which makes it hard to say which style, dose or format matters most.

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Yoga

Yoga for depression: A systematic review and meta-analysis

Cramer H, Lauche R, Langhorst J, et al.

Depression and Anxiety · 2013

This systematic review and meta-analysis examined randomized controlled trials of yoga for people with depressive disorders or elevated depression levels. Twelve trials with 619 participants were included, three of which had low risk of bias. Compared with usual care, yoga showed moderate evidence of short-term reductions in depression severity, and there was more limited evidence that yoga reduced depression compared with relaxation and with aerobic exercise. There was also limited evidence of short-term effects on anxiety compared with relaxation. Effects appeared both in people with diagnosed depression and in those with elevated symptoms. The authors suggest yoga could be considered an additional option alongside other treatment. Limitations: the trials were few and varied, long-term effects could not be analysed, and none of the trials reported data on side effects.

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Sound Bath · Nature immersion

The Effect of Music on the Human Stress Response

Thoma MV, La Marca R, Brönnimann R, et al.

PLoS ONE · 2013

Sixty healthy women with an average age of 25 were randomly assigned to one of three conditions before a standardized stress test: listening to relaxing choral music (Allegri's Miserere), listening to the sound of rippling water, or resting in silence. Researchers measured cortisol, salivary alpha-amylase, heart rate, heart rate variability, perceived stress and anxiety. Surprisingly, cortisol response to the stressor was highest in the music group and lowest in the rippling water group. However, after the stressor, the music group's alpha-amylase, a marker of the autonomic nervous system, returned to baseline faster than the silent rest group. Heart rate and self-reported stress did not differ between groups. Limitations: the sample was small and included only young women, and the results were mixed rather than pointing in one direction.

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Sound Bath

Music therapy for stress reduction: a systematic review and meta-analysis

de Witte M, Pinho ADS, Stams GJ, et al.

Health Psychology Review · 2022

Music therapy means personally tailored music interventions led by a trained music therapist, which is different from simply listening to music. This multilevel meta-analysis combined 47 studies, 76 effect sizes and 2,747 participants to measure how music therapy affects stress, looking at both physiological signs such as heart rate and psychological measures such as self-reported stress. Overall, music therapy showed a medium-to-large effect on stress-related outcomes. Effects were larger in studies without full randomization, in studies comparing music therapy with a waiting list rather than usual care, and in studies from non-Western countries. Those moderator findings are also the main limitation: the strongest effects came from the weaker study designs, so the true effect in rigorous trials is likely smaller than the headline number.

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Sound Bath · Meditation

Effects of Singing Bowl Sound Meditation on Mood, Tension, and Well-being: An Observational Study

Goldsby TL, Goldsby ME, McWalters M, et al.

Journal of Evidence-Based Complementary & Alternative Medicine · 2017

This observational study looked at how people felt before and after a Tibetan singing bowl sound meditation, a format close to what many people call a sound bath. Sixty-two women and men with an average age of about 50 took part. Compared with how they felt beforehand, participants afterward reported significantly less tension, anger, fatigue and depressed mood, and their sense of spiritual well-being increased. People who had never tried this kind of meditation before showed a larger drop in tension than those who were already familiar with it. The authors suggest singing bowl meditation may be a low-cost, low-technology way to ease tension and low mood. The key limitation is the design: there was no control group, so the changes cannot be separated from the effect of simply lying down and resting in a calm setting.

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Sleep · Meditation

Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances

Black DS, O’Reilly GA, Olmstead R, et al.

JAMA Internal Medicine · 2015

Sleep problems are common in older adults and often go untreated. In this randomized clinical trial, 49 adults with an average age of 66 and moderate sleep disturbance were assigned to six weeks of a mindful awareness practices program (two hours a week plus homework) or to a structured sleep hygiene education course of the same length. Sleep quality was measured with the Pittsburgh Sleep Quality Index. The mindfulness group improved more than the sleep hygiene group, with a large effect size, and also showed greater improvements in insomnia symptoms, depression symptoms and fatigue. There were no differences between groups for anxiety, stress or an inflammation marker. The main limitation is that the trial was small and measured outcomes immediately after the program, so it cannot say how long the improvement lasts.

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Meditation · Consciousness

Mindfulness practice leads to increases in regional brain gray matter density

Hölzel BK, Carmody J, Vangel M, et al.

Psychiatry Research: Neuroimaging · 2011

This study from the Lazar lab at Massachusetts General Hospital used MRI brain scans to look for structural changes after an eight-week mindfulness-based stress reduction (MBSR) program. Sixteen healthy adults who had never meditated were scanned before and after the course and compared with 17 people on a waiting list. The MBSR group showed increases in gray matter concentration in the left hippocampus, an area involved in learning and memory, and in the posterior cingulate cortex, the temporo-parietal junction and the cerebellum. These regions are associated with emotion regulation, self-referential thinking and perspective taking. The authors suggest that taking part in MBSR is associated with measurable changes in brain structure. The obvious limitation is size: with about 33 people in total and no randomization described in the abstract, the findings are best seen as early and in need of replication.

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Meditation

Mindfulness-based stress reduction for healthy individuals: A meta-analysis

Khoury B, Sharma M, Rush SE, et al.

Journal of Psychosomatic Research · 2015

Most research on mindfulness-based stress reduction (MBSR), the eight-week program developed by Jon Kabat-Zinn, has focused on people with health conditions. This meta-analysis looked instead at healthy adults, combining 29 studies with 2,668 participants. MBSR showed moderate effects both when comparing people before and after the program and when comparing MBSR groups with control groups, and the gains held at an average follow-up of 19 weeks. Effects were large for stress, moderate for anxiety, depression, distress and quality of life, and small for burnout. Increases in mindfulness and self-compassion tracked with these improvements. The main limitation is that results varied a lot across studies, likely because of differences in design, how the program was delivered and what was measured.

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Breathwork

Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review

Banushi B, Brendle M, Ragnhildstveit A, et al.

Brain Sciences · 2023

This scoping review looked for clinical studies that used breathwork on its own, without other treatments, for adults formally diagnosed with an anxiety disorder under DSM-5 criteria. From 1,081 articles found in three databases, 16 studies were included. Across a range of breathing techniques, the studies reported meaningful improvements in anxiety symptoms. The authors note that dysfunctional breathing is a hallmark of anxiety, yet standard treatments rarely address it, and they discuss protocols that are feasible and accessible for patients. Results on the role of hyperventilation were contradictory in a few studies. As a scoping review, it maps the available research rather than pooling results statistically or rating study quality in depth, so it shows where evidence exists more than how strong it is.

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Breathwork

The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults

Ma X, Yue ZQ, Gong ZQ, et al.

Frontiers in Psychology · 2017

Forty healthy adults were randomly assigned either to a diaphragmatic breathing program or to a control group that did not receive the training. The breathing group completed 20 sessions over eight weeks, using a real-time feedback device and breathing at about four breaths per minute. Everyone completed attention and mood tests before and after, and gave saliva samples to measure cortisol, a stress hormone. After training, the breathing group showed less negative affect, better sustained attention, and lower cortisol levels, while the control group showed no change in cortisol. The authors see diaphragmatic breathing as a mind-body practice with value for health promotion in healthy people. Limitations: the sample was small, and the control group received no alternative activity, so some of the benefit could come from attention or expectation rather than the breathing itself.

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Breathwork · Consciousness

How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing

Zaccaro A, Piarulli A, Laurino M, et al.

Frontiers in Human Neuroscience · 2018

This systematic review asked what actually happens in the body and brain when healthy people slow their breathing to fewer than ten breaths per minute. From 2,461 abstracts, 15 studies met the criteria. Across them, slow breathing was linked with higher heart rate variability, a marker of parasympathetic (rest and digest) activity, along with shifts in brain activity such as more alpha and less theta power on EEG. People also reported feeling more comfortable, relaxed, pleasant, vigorous and alert, with less anxiety, anger and confusion. The authors propose two possible mechanisms, one involving awareness of internal body states and one involving nasal breathing and the olfactory system. A clear limitation is the small evidence base: only 15 studies qualified, and the brain imaging findings rest on a single fMRI study.

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Breathwork

Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials

Fincham GW, Strauss C, Montero-Marin J, et al.

Scientific Reports · 2023

This meta-analysis pooled randomised controlled trials that compared breathwork, meaning deliberate control of the breath, with non-breathwork control conditions. For the main outcome, self-reported stress, the authors combined 12 trials with 785 adults. Breathwork was associated with lower stress than control conditions, a small-to-medium effect. Secondary analyses of anxiety (20 trials) and depressive symptoms (18 trials) showed effects of a similar size. The authors conclude that breathwork may help with stress and mental health, but they explicitly urge caution so that public enthusiasm does not run ahead of the evidence. The honest limitation is in the studies themselves: most were judged to be at moderate risk of bias, and results varied between trials, so better-designed research is still needed.

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Breathwork · Meditation

Brief structured respiration practices enhance mood and reduce physiological arousal

Balban MY, Neri E, Kogon MM, et al.

Cell Reports Medicine · 2023

Researchers at Stanford ran a remote randomized controlled trial comparing three daily five-minute breathing exercises with five minutes of mindfulness meditation, practiced every day for one month. The breathing styles were cyclic sighing, which stretches out the exhale; box breathing, with equal inhale, hold and exhale; and cyclic hyperventilation with breath retention. The team tracked mood, anxiety and physiological arousal, including breathing rate, heart rate and heart rate variability. Breathwork overall, and especially exhale-focused cyclic sighing, produced a greater improvement in mood and a larger drop in resting breathing rate than mindfulness meditation. The authors describe daily cyclic sighing as a promising stress management exercise. One honest limitation: the abstract reports the comparison against meditation rather than against a no-practice group, and the study ran for a single month, so longer-term effects remain open.

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Meditation

Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders

Hoge EA, Bui E, Mete M, et al.

JAMA Psychiatry · 2023

This randomized clinical trial compared an eight-week mindfulness-based stress reduction (MBSR) course with escitalopram, a commonly prescribed medication for anxiety disorders. Adults with a diagnosed anxiety disorder were recruited at three US academic medical centers, and 208 completed the trial. It used a noninferiority design, meaning it tested whether MBSR was not meaningfully worse than the medication. In this study, anxiety severity dropped by a similar amount in both groups, and MBSR met the prespecified test for noninferiority. Fewer people in the MBSR group reported study-related side effects, and none left the MBSR group because of them. A limitation is that participants knew which treatment they received, and results apply to people willing to try either option.

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Meditation

Meditation Programs for Psychological Stress and Well-being

Goyal M, Singh S, Sibinga EMS, et al.

JAMA Internal Medicine · 2014

This systematic review and meta-analysis looked at whether meditation programs improve stress-related outcomes in adults with various health conditions. The authors screened over 18,000 citations and included 47 randomized trials with 3,515 participants, focusing on studies with active control groups to account for placebo effects. In this review, mindfulness meditation programs showed moderate evidence of small improvements in anxiety, depression and pain, and low evidence for improved stress and mental health-related quality of life. There was little or no evidence of effects on positive mood, attention, sleep, eating or weight, and meditation was not found to be better than other active treatments such as medication or exercise. The authors call for stronger study designs.

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Meditation

Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse

Kuyken W, Warren FC, Taylor RS, et al.

JAMA Psychiatry · 2016

This meta-analysis combined individual patient data from 9 randomized trials, covering 1,258 people with recurrent depression, to see whether mindfulness-based cognitive therapy (MBCT) helps prevent relapse. MBCT was compared with usual care and with other active treatments, including antidepressants. In this analysis, people who received MBCT had a lower risk of depressive relapse over 60 weeks than those who did not, and a somewhat lower risk compared with other active treatments. Age, sex, education and relationship status did not change the effect, and there was some evidence that people with more severe symptoms before treatment benefited more. A limitation is that it relied on a fairly small number of trials, and one eligible study's data were unavailable.

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Meditation

Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy.

Teasdale JD, Segal ZV, Williams JMG, et al.

Journal of Consulting and Clinical Psychology · 2000

This randomized trial was one of the first tests of mindfulness-based cognitive therapy (MBCT), a group program that teaches people who have recovered from depression to notice and step back from the thinking patterns that can pull them back into it. In this study, 145 people who had recovered from recurrent depression were randomized to their usual treatment alone or usual treatment plus MBCT, and were followed for 60 weeks. For participants with three or more past episodes of depression, about three quarters of the sample, MBCT significantly lowered the risk of relapse. For those with only two past episodes, it did not. A limitation is that benefits appeared only in a subgroup, so MBCT may suit some people better than others.

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Meditation · Yoga

Meditation and yoga for posttraumatic stress disorder: A meta-analytic review of randomized controlled trials

Gallegos AM, Crean HF, Pigeon WR, et al.

Clinical Psychology Review · 2017

This meta-analysis pooled 19 randomized controlled trials, covering 1,173 adults, that tested meditation or yoga for posttraumatic stress disorder. The researchers also checked whether results differed by type of practice, population, outcome measure, or control group. In this analysis, meditation and yoga were associated with a small to medium reduction in PTSD symptoms overall. No clear differences appeared between meditation and yoga or across populations, though smaller studies tended to show larger effects. The authors conclude these complementary approaches are promising and warrant further study. An honest limitation: the pattern of larger effects in small studies suggests that some estimates may be inflated, and these practices were studied as complements rather than replacements for established treatment.

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Somatic and Movement Healing · Yoga

Yoga as an Adjunctive Treatment for Posttraumatic Stress Disorder

van der Kolk BA, Stone L, West J, et al.

The Journal of Clinical Psychiatry · 2014

This randomized controlled trial examined trauma-informed yoga for 64 women with chronic PTSD that had not responded to earlier treatment. Participants attended either a weekly one-hour trauma-informed yoga class or a supportive women's health education class for 10 weeks. In this study, 52% of the yoga group no longer met criteria for PTSD at the end, compared with 21% of the control group. Both groups improved in the first half of treatment, but the yoga group kept its gains while the control group tended to slip back. The authors suggest yoga may help people tolerate body sensations tied to fear and build emotional awareness. A limitation is the modest sample of women only, so results may not generalize to everyone.

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Somatic and Movement Healing

Somatic experiencing - effectiveness and key factors of a body-oriented trauma therapy: a scoping literature review

Kuhfuß M, Maldei T, Hetmanek A, et al.

European Journal of Psychotraumatology · 2021

This scoping review set out to summarize what is known about Somatic Experiencing, a therapy that addresses trauma by working with body sensations connected to the traumatic experience. The authors searched the literature through August 2020, found 83 articles, and analyzed the 16 that met their criteria. In this review, there was preliminary evidence of positive effects on PTSD-related symptoms, and early signs of benefit for mood, physical symptoms and wellbeing in both traumatized and non-traumatized groups. Practitioners and clients pointed to a focus on resources and the use of touch as key ingredients. An honest limitation: overall study quality was mixed, and the authors call for more unbiased randomized trials.

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Somatic and Movement Healing

Somatic Experiencing for Posttraumatic Stress Disorder: A Randomized Controlled Outcome Study

Brom D, Stokar Y, Lawi C, et al.

Journal of Traumatic Stress · 2017

This was described as the first randomized controlled study of Somatic Experiencing, a body-focused therapy for trauma. Sixty-three adults meeting full criteria for PTSD were randomly assigned to 15 weekly Somatic Experiencing sessions or to a waitlist, and the waitlist group later received the therapy too. In this study, the treatment group showed significant reductions in posttraumatic symptom severity and depression compared with the waitlist, and these changes were still present at follow-up. The authors conclude Somatic Experiencing may be an effective approach for PTSD. An honest limitation: the comparison was a waitlist rather than another active therapy, and the authors say more research is needed to understand who benefits most.

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Psychedelic Assisted Psychotherapy · Consciousness

Human hallucinogen research: guidelines for safety

Johnson MW, Richards WA, Griffiths RR

Journal of Psychopharmacology · 2008

This paper from Johns Hopkins reviews the history of human research with classic psychedelics, the risks involved, and how researchers can reduce them. It is a review and set of guidelines rather than a trial. The authors note that while these substances carry relatively low physical risk and are not considered drugs of dependence, they carry unique psychological risks. The most likely is overwhelming distress during the session, and rarer risks include prolonged psychotic reactions. Recommended protections include screening out people with a personal or family history of psychotic or other severe psychiatric disorders, building trust before the session, careful preparation, a supportive physical setting, and at least two monitors present. A limitation is that these guidelines were written for research settings rather than everyday clinical practice.

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Psychedelic Assisted Psychotherapy

Attenuation of psilocybin mushroom effects during and after SSRI/SNRI antidepressant use

Gukasyan N, Griffiths RR, Yaden DB, et al.

Journal of Psychopharmacology · 2023

Researchers at Johns Hopkins wanted to know whether common antidepressants change how strongly psilocybin mushrooms are felt. They ran an online retrospective survey of people who had used psilocybin mushrooms while taking an antidepressant, or within two years of stopping one. In this study, across 611 reports of use while on an antidepressant, weaker-than-expected effects were reported about 47% of the time with SSRIs, 55% with SNRIs, and 29% with bupropion. Among 1,542 reports after stopping an SSRI or SNRI, reduced effects were still reported up to three to six months later. An honest limitation: this is self-reported, retrospective survey data, so recall and expectation may have shaped the answers. Psilocybin remains a Schedule I substance under US federal law, and regulated access currently exists only through state programs in Oregon and Colorado; it is not available in New Jersey.

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Psychedelic Assisted Psychotherapy

MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study

Mitchell JM, Bogenschutz M, Lilienstein A, et al.

Nature Medicine · 2021

This phase 3 randomized, double-blind, placebo-controlled trial tested MDMA-assisted therapy for severe PTSD in 90 adults, including people with dissociation, depression, substance use histories and childhood trauma. Everyone received the same manualized therapy, with three preparation and nine integration sessions; the difference was whether the medicine sessions used MDMA or placebo. In this study, PTSD symptom scores fell more in the MDMA group than the placebo group two months after the last session, and functional impairment also improved more. The researchers did not observe signs of abuse potential, increased suicidality, or heart rhythm problems. A limitation is that the placebo group also improved considerably, and blinding is difficult with MDMA. MDMA remains a Schedule I substance and is not an approved treatment in the United States.

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Psychedelic Assisted Psychotherapy

Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression

Goodwin GM, Aaronson ST, Alvarez O, et al.

New England Journal of Medicine · 2022

This phase 2 double-blind trial studied a single dose of a synthetic psilocybin formulation in 233 adults with treatment-resistant depression across many sites. Participants were randomized to 25 mg, 10 mg, or 1 mg (the control), each with psychological support. In this study, the 25 mg dose reduced depression scores more than the 1 mg dose at three weeks, while the 10 mg dose did not differ significantly from control. The difference was not clearly maintained as sustained response at 12 weeks. Adverse events were reported by 77% of participants, including headache, nausea and dizziness, and suicidal ideation, behavior or self-injury occurred in all dose groups. The authors call for larger and longer trials. Psilocybin remains a Schedule I substance under US federal law, and regulated access currently exists only through state programs in Oregon and Colorado; it is not available in New Jersey.

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Psychedelic Assisted Psychotherapy

Trial of Psilocybin versus Escitalopram for Depression

Carhart-Harris R, Giribaldi B, Watts R, et al.

New England Journal of Medicine · 2021

This phase 2 double-blind trial at Imperial College London compared psilocybin with escitalopram, a common SSRI antidepressant, in 59 adults with long-standing moderate to severe depression. One group received two 25 mg psilocybin doses three weeks apart plus daily placebo pills; the other received two 1 mg doses plus six weeks of escitalopram. Everyone received psychological support. In this study, the main depression measure at six weeks did not differ significantly between groups. Some secondary measures, such as remission rates, leaned toward psilocybin, but these were not corrected for multiple comparisons. The authors state that larger and longer trials are needed, which is the key limitation. Psilocybin remains a Schedule I substance under US federal law, and regulated access currently exists only through state programs in Oregon and Colorado; it is not available in New Jersey.

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Psychedelic Assisted Psychotherapy

Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder

Davis AK, Barrett FS, May DG, et al.

JAMA Psychiatry · 2021

This Johns Hopkins randomized clinical trial asked whether psilocybin-assisted therapy could help adults with major depressive disorder who were not taking antidepressants. Twenty-seven participants were randomized to start treatment right away or after an eight-week wait, and 24 completed it. Treatment was two psilocybin sessions, a few weeks apart, within about 11 hours of supportive psychotherapy. In this study, depression scores in the immediate group dropped substantially compared with the waiting group at both one and four weeks after treatment, and effect sizes were large. An honest limitation: the comparison group was a waiting list rather than a placebo, the sample was small, and follow-up in the main comparison was short. Psilocybin remains a Schedule I substance under US federal law, and regulated access currently exists only through state programs in Oregon and Colorado; it is not available in New Jersey.

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Psychedelic Assisted Psychotherapy · Consciousness

Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial

Ross S, Bossis A, Guss J, et al.

Journal of Psychopharmacology · 2016

This NYU trial, published alongside a similar Johns Hopkins study, examined a single moderate dose of psilocybin given with psychotherapy for anxiety and depression linked to cancer. Twenty-nine patients were randomly assigned in a double-blind crossover design to psilocybin or niacin, an active placebo, with therapy in both conditions. In this study, psilocybin was followed by rapid and lasting reductions in anxiety and depression, less demoralization and hopelessness, and better spiritual wellbeing and quality of life. At about six and a half months, roughly 60 to 80% of participants still had clinically significant reductions. As in the companion study, the intensity of the mystical experience was linked to the benefit. The small sample is an important limitation. Psilocybin remains a Schedule I substance under US federal law, and regulated access currently exists only through state programs in Oregon and Colorado; it is not available in New Jersey.

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Psychedelic Assisted Psychotherapy · Consciousness

Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial

Griffiths RR, Johnson MW, Carducci MA, et al.

Journal of Psychopharmacology · 2016

This Johns Hopkins trial studied psilocybin in 51 people with life-threatening cancer who also had symptoms of depression and anxiety. Using a randomized, double-blind crossover design, each person received a very low, placebo-like dose and a high dose about five weeks apart, with preparation and support from staff. In this study, the high dose was followed by large decreases in depressed mood and anxiety, along with gains in quality of life, sense of meaning and optimism, and less fear of death. About 80% still showed clinically significant improvement at six months, and the strength of a mystical-type experience during the session was linked to the benefits. A limitation is that blinding is hard with psilocybin, since participants can often tell which dose they received. Psilocybin remains a Schedule I substance under US federal law, and regulated access currently exists only through state programs in Oregon and Colorado; it is not available in New Jersey.

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Ketamine-Assisted Psychotherapy · Meditation

Adjunctive Ketamine With Relapse Prevention-Based Psychological Therapy in the Treatment of Alcohol Use Disorder

Grabski M, McAndrew A, Lawn W, et al.

American Journal of Psychiatry · 2022

This phase 2 trial tested whether ketamine, combined with talk therapy, could help people with severe alcohol use disorder stay abstinent. Ninety-six adults were randomly assigned, double-blind, to three weekly ketamine or saline infusions, paired with either mindfulness-based relapse prevention therapy or alcohol education. In this study, the ketamine groups had more days without alcohol at six months than the placebo groups, an average difference of about 10%, and the largest difference was between ketamine plus therapy and saline plus education. There was no significant difference in relapse rates, and the treatment was well tolerated. The authors describe it as a proof-of-concept study with wide confidence intervals, so the results need confirming in larger trials.

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Ketamine-Assisted Psychotherapy

Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy

Dore J, Turnipseed B, Dwyer S, et al.

Journal of Psychoactive Drugs · 2019

This paper describes Ketamine Assisted Psychotherapy (KAP), an approach in which ketamine is given alongside psychotherapy and its psychedelic qualities are treated as part of the therapeutic process rather than as unwanted side effects. The authors gathered demographic and outcome data from 235 patients across three private practices using similar methods, mostly without intravenous access. In this study, patients showed decreases in depression and anxiety, and the authors report the changes were especially notable for older patients and those with more severe symptoms. An honest limitation: this was an observational report from the treating practices themselves, with no control group or randomization, so it cannot show that KAP caused the improvements.

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Ketamine-Assisted Psychotherapy

Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression

Daly EJ, Trivedi MH, Janik A, et al.

JAMA Psychiatry · 2019

This phase 3 trial looked at whether continuing esketamine nasal spray helps people with treatment-resistant depression stay well after they improve. Of 705 adults enrolled, 297 who reached stable remission or stable response after 16 weeks of esketamine plus an oral antidepressant were randomly assigned, double-blind, to keep using esketamine or switch to a placebo spray while staying on their antidepressant. In this study, among those in stable remission, 26.7% relapsed on esketamine versus 45.3% on placebo, and among those in stable response, 25.8% versus 57.6%. Temporary altered taste, vertigo, dissociation, sleepiness and dizziness were the most common side effects. A limitation is that only people who had already done well on esketamine were randomized, so results may not apply to everyone.

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Ketamine-Assisted Psychotherapy

Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study

Popova V, Daly EJ, Trivedi M, et al.

American Journal of Psychiatry · 2019

This phase 3 trial, run at 39 outpatient centers, studied esketamine, a nasal-spray form related to ketamine, in adults with moderate to severe depression who had not responded to at least two antidepressants. Of 227 randomized participants, one group started esketamine twice weekly plus a new oral antidepressant, and the other started the new antidepressant plus a placebo spray, in a double-blind design. In this study, depression scores at day 28 improved more in the esketamine group, with a difference of about 4 points on the rating scale. Dissociation, nausea, vertigo, altered taste and dizziness were more common with esketamine and usually settled within 1.5 hours. A limitation is the short four-week window of the main comparison.

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Ketamine-Assisted Psychotherapy

Antidepressant Efficacy of Ketamine in Treatment-Resistant Major Depression: A Two-Site Randomized Controlled Trial

Murrough JW, Iosifescu DV, Chang LC, et al.

American Journal of Psychiatry · 2013

This two-site randomized controlled trial tested a single intravenous ketamine infusion in 73 adults with treatment-resistant major depression. To make the comparison fairer, the control group received midazolam, an anesthetic that produces noticeable effects of its own, so participants were less able to guess which drug they had. In this study, depression scores 24 hours after the infusion were about 8 points lower on average in the ketamine group, and 64% of the ketamine group responded compared with 28% of the midazolam group. The authors themselves note an important limitation: more information on how long the response lasts, and on longer-term tolerability, was needed before routine clinical use.

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Ketamine-Assisted Psychotherapy

A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression

Zarate CA, Singh JB, Carlson PJ, et al.

Archives of General Psychiatry · 2006

This small study from the National Institute of Mental Health asked whether a single dose of ketamine could lift depression quickly. Eighteen adults with depression that had not responded to earlier treatments took part in a randomized, double-blind, placebo-controlled crossover design, receiving one intravenous ketamine infusion and one placebo infusion a week apart. In this study, people improved within about two hours of ketamine compared with placebo, and the difference held through the following week. The day after the infusion, 71% met criteria for response and 29% for remission, and 35% kept their response for at least a week. An honest limitation: the sample was very small, there was no psychotherapy component, and the effect faded for most participants within days.

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