正念瑜珈减少有风险孕妇的忧郁


  【24drs.com】新研究显示,正念瑜珈可让有心智健康风险孕妇的忧郁症状减少,并且强化母婴连结。
  
  美国密西根大学妇婴心智健康亲子健康计画主任Maria Muzik医师表示,许多孕妇从事产前哈达瑜伽,藉由物理姿势与冥想聚焦,而有助于生产、减少产程疼痛。
  
  Muzik医师表示,我们的正念瑜珈课程藉由强调正念禅修、有针对性的指导、提醒和阅读,而与一般的产前哈达瑜珈不同。
  
  这篇研究在线刊载于7月14日临床辅助疗法期刊。
  
  她表示,在怀孕期间,许多孕妇都不愿意以药物治疗忧郁和焦虑,因为担心会伤及胎儿,也不愿意开始心理治疗,因为在这脆弱时刻难以藉由治疗克服过去或现在的冲突。
  
  不过,未治疗忧郁对母亲和胎儿有许多健康风险,例如体重增长不佳、先兆子痫、早产、与胎儿的连结不佳。
  
  在这篇研究中,研究者招募了18名有忧郁高风险的孕妇,参与10周的正念瑜珈计画;这些妇女怀孕12- 26周,参与研究时的爱丁堡产前忧郁量表分数大于9分。除了开始时的诊断评估,妇女们在进行正念瑜珈前后各完成了对忧郁、正念、母婴附属的自我评估。
  
  Muzik医师解释,指导员在课程中不断提醒妇女将注意力集中到自己的身体感觉、在瑜珈动作中倾听身体的回馈、理解她们的身体如何改变以支持生长中的胎儿。教导参与者正念技术,包括呼吸、引导可视化和放松。
  
  她指出,这个介入方式的重要观念是专注于胎儿,以感觉其独特人格而有助于亲子的附属过程。
  
  每次课程持续90分钟且专注于各种姿势,专注于受孕的母体与对胎儿之意识。这些课程会因参与经验或妊娠年龄而调整。
  
  研究者发现,10周后,参与正念瑜珈课程者显著较少忧郁,且母婴连结和正念技能皆显著改善。
  
  瑜珈计画之前,母亲的平均贝氏忧郁量表(BDI)分数为13.95;介入之后为9.63分(P = .025)。平均母胎依附分数(MFAS)值在介入前为83.56,介入后为95.50 (P = .01)。
  
  整体而言,这些妇女认为正念瑜珈是有帮助的处理策略,且有益于她们的胎儿。一位母亲表示,瑜珈帮助她面对高风险孕程—她的孩子有最平静且温和的灵魂,压力降低对胎儿也有帮助。
  
  Muzik医师表示,她们也受益于来自其它母亲的社会支持。研究首度提出有利证据认为,正念瑜珈可改善忧郁症状、促进对怀孕的注意立场、促进母亲和胎儿之间的连结,而获得对孩童健康的长期效益。
  
  有些妇产科也会建议病患进行正念瑜珈,我们希望有朝一日传统治疗机构也可提供正念瑜珈课程,让妇女们在她们的妇产科诊间就可进行。
  
  纽约大学Langone医学中心精神科临床助理教授Sudeepta Varma医师评论此篇研究时表示,研究结果为有忧郁的妇女提供另一个治疗选项。
  
  Varma医师表示,当孕妇寻求忧郁治疗时通常会发现选项有限,约有半数会选择在怀孕期间停用抗忧郁药物,让她们自己面临复发的高风险。我们知道,未治疗忧郁对母婴都有严重后遗症,包括产前照护不佳、低出生体重、先兆子痫、胎儿宫内发育迟缓(IUGR [intrauterine growth restriction])等等。
  
  虽然这项研究有一些限制,例如没有对照组、样本数相对少、样本同质性高(白人、社经状态较高的高等教育妇女),这篇研究仍在心理治疗和药物治疗之外,提供了另一种有效的辅助治疗选项。
  
  Varma医师指出,研究设计也提供孕妇接受社会支持的机会,并在每次课程开始时讨论她们的病症、且学习正念技能。这些都显示可有助于忧郁治疗。
  
  她表示,身为精神科医师与母亲,也是正念减压疗法和瑜伽的实践者,我将和我的病患分享这些研究结果,并且希望此一领域有后续研究。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6917&x_classno=0&x_chkdelpoint=Y
  

Mindfulness Yoga Reduces Depression in At-Risk Pregnant Women

By Fran Lowry
Medscape Medical News

August 17, 2012 — Mindfulness yoga reduces symptoms of depression and strengthens the mother-baby bond in pregnant women with mental health risks, new research shows.

"Many pregnant women take prenatal hatha yoga, which can help prepare for delivery and make labor less painful by combining physical poses with meditative focus," lead author Maria Muzik, MD, director of the Parent-Infant Wellness Program in Women's and Infants Mental Health at the University of Michigan in Ann Arbor, told Medscape Medical News.

"Our mindfulness yoga classes differ from typical prenatal hatha yoga classes by highlighting mindfulness practice, with targeted instructions, reminders, and readings," Dr. Muzik said.

The study was published online July 14 in Complementary Therapies in Clinical Practice.

Visualization, Relaxation

Many pregnant women are reluctant to initiate drug therapy for depression and anxiety during pregnancy because of concerns about harm to the unborn baby or to initiate psychotherapy because of a reluctance to work through past or present conflicts in therapy during a vulnerable time, she said.

However, untreated depression bears many health risks for both mother and unborn child, such as poor weight gain, preeclampsia, premature labor, and trouble bonding with the unborn baby.

In this study, the researchers recruited 18 pregnant women at high risk for depression to take part in a 10-week mindfulness yoga program. The women were 12 to 26 weeks' pregnant and had elevated scores of greater than 9 on the Edinburgh Postnatal Depression Screen at study entry.

In addition to the baseline diagnostic assessment, the women completed self-ratings on depression, mindfulness, and maternal-fetal attachment before and after mindfulness yoga.

"The instructors consciously made it a part of class to continually remind women to focus inward toward the sensations of their body, listen to the feedback of their body during asana, and be aware of how their bodies are changing to support their growing baby," Dr. Muzik explained. "Participants were taught mindfulness techniques, including breathing, guided visualization, and relaxation."

A significant aspect of the intervention was being "mindful" of the baby to sense its unique persona, which facilitates the attachment process, she added.

Each session lasted 90 minutes and focused on a variety of poses, all taught specifically for the pregnant body, with awareness of the baby. The sessions were modified for level of experience or gestational age.

Promotion of Child Well-Being

The researchers found that after 10 weeks, participants in the mindfulness yoga intervention became significantly less depressed and showed significant improvement in mother-baby attachment and mindfulness skills.

Before the yoga program, the mean maternal Beck Depression Inventory (BDI) score was 13.95; after the intervention, it was 9.63 (P = .025). The mean Maternal-Fetal Attachment Scale (MFAS) score before the intervention was 83.56, and after the intervention it was 95.50 (P = .01).

Overall, the women felt that mindfulness yoga was a helpful coping strategy and benefited their child as well. One mother commented: "Yoga helped me to cope with a high-risk pregnancy — and my son is the most calm and gentlest of souls. The stress reduction really helps the baby, too."

They also benefited from the social support of the other mothers, Dr. Muzik said.

"Our work provides promising first evidence that mindfulness yoga may improve depression symptoms, promote a mindful stance towards pregnancy, and enhance a mother's attachment towards her child, which in turn is a long-term gain promoting child well-being," she said.

Mindfulness yoga would also be something that ob/gyns could recommend to their patients, she added.

"We hope that mindfulness yoga will one day be offered in traditional treatment facilities so that women can attend classes at their obstetrician's or psychiatrist's office."

A Step in the Right Direction

Commenting on the study for Medscape Medical News, Sudeepta Varma, MD, clinical assistant professor of psychiatry at New York University Langone Medical Center in New York City, said the findings offer pregnant women with depression another treatment option.

Pregnant women dealing with depression often find themselves with limited options, with about one half choosing to go off of antidepressant medication during pregnancy, which puts them at high risk for relapse, Dr. Varma said.

"We know that untreated depression has severe consequences in both mom and baby that include poor prenatal care, low birth weight, preeclampsia, IUGR [intrauterine growth restriction], etc.

"Although there were limitations to this study, for example no control group, a relatively small sample size, with a homogeneous group of white, highly educated women from a higher socioeconomic status, this study gives further direction in complementary effective treatments in addition to psychotherapy and medication management," she said.

The study design also offered pregnant women an opportunity to receive social support and to discuss their ailments at the beginning of each session and learn mindfulness skills. All of these are shown to be effective aspects of depression treatment, Dr. Varma noted.

"As a psychiatrist, mom, and practitioner of mindfulness-based stress reduction therapy and yoga, I will definitely be sharing these results with my patients and hope for further research in the area," she said.

Dr. Muzik and Dr. Varma have disclosed no relevant financial relationships.

Complement Ther Clin Pract. Published online July 14, 2012.

    
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