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      Control Group Design: Enhancing Rigor in Research of Mind-Body Therapies for Depression

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          Abstract

          Although a growing body of research suggests that mind-body therapies may be appropriate to integrate into the treatment of depression, studies consistently lack methodological sophistication particularly in the area of control groups. In order to better understand the relationship between control group selection and methodological rigor, we provide a brief review of the literature on control group design in yoga and tai chi studies for depression, and we discuss challenges we have faced in the design of control groups for our recent clinical trials of these mind-body complementary therapies for women with depression. To address the multiple challenges of research about mind-body therapies, we suggest that researchers should consider 4 key questions: whether the study design matches the research question; whether the control group addresses performance, expectation, and detection bias; whether the control group is ethical, feasible, and attractive; and whether the control group is designed to adequately control for nonspecific intervention effects. Based on these questions, we provide specific recommendations about control group design with the goal of minimizing bias and maximizing validity in future research.

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          Most cited references26

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          Usual and unusual care: existing practice control groups in randomized controlled trials of behavioral interventions.

          To evaluate the use of existing practice control groups in randomized controlled trials of behavioral interventions and the role of extrinsic health care services in the design and conduct of behavioral trials. Selective qualitative review. Extrinsic health care services, also known as nonstudy care, have important but under-recognized effects on the design and conduct of behavioral trials. Usual care, treatment-as-usual, standard of care, and other existing practice control groups pose a variety of methodological and ethical challenges, but they play a vital role in behavioral intervention research. This review highlights the need for a scientific consensus statement on control groups in behavioral trials.
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            Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study.

            Yoga and exercise have beneficial effects on mood and anxiety. γ-Aminobutyric acid (GABA)-ergic activity is reduced in mood and anxiety disorders. The practice of yoga postures is associated with increased brain GABA levels. This study addresses the question of whether changes in mood, anxiety, and GABA levels are specific to yoga or related to physical activity. Healthy subjects with no significant medical/psychiatric disorders were randomized to yoga or a metabolically matched walking intervention for 60 minutes 3 times a week for 12 weeks. Mood and anxiety scales were taken at weeks 0, 4, 8, 12, and before each magnetic resonance spectroscopy scan. Scan 1 was at baseline. Scan 2, obtained after the 12-week intervention, was followed by a 60-minute yoga or walking intervention, which was immediately followed by Scan 3. The yoga subjects (n = 19) reported greater improvement in mood and greater decreases in anxiety than the walking group (n = 15). There were positive correlations between improved mood and decreased anxiety and thalamic GABA levels. The yoga group had positive correlations between changes in mood scales and changes in GABA levels. The 12-week yoga intervention was associated with greater improvements in mood and anxiety than a metabolically matched walking exercise. This is the first study to demonstrate that increased thalamic GABA levels are associated with improved mood and decreased anxiety. It is also the first time that a behavioral intervention (i.e., yoga postures) has been associated with a positive correlation between acute increases in thalamic GABA levels and improvements in mood and anxiety scales. Given that pharmacologic agents that increase the activity of the GABA system are prescribed to improve mood and decrease anxiety, the reported correlations are in the expected direction. The possible role of GABA in mediating the beneficial effects of yoga on mood and anxiety warrants further study.
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              Meditative movement as a category of exercise: implications for research.

              Meditative Movement (MM) is proposed as a new category of exercise defined by (a) some form of movement or body positioning, (b) a focus on breathing, and (c) a cleared or calm state of mind with a goal of (d) deep states of relaxation. Two forms of exercise meeting this definition, Qigong and Tai Chi, are reviewed to examine health benefits found in the research literature, recap elements that should be assessed in MM research, and suggest where aspects of MM intersect with, and are distinguished from, conventional forms of exercise. Relevant dimensions of the key elements of MM, such as frequency, duration, type of movement, degree of exertion, description of breathing, and achievement of relaxed state are recommended to be clearly described and measured to consistently define the category across studies and clarify how MM may affect health outcomes in similar, and perhaps different, ways than conventional exercise. If these suggested standards are used, we will gain a better understanding of which elements are necessary for achieving targeted outcomes. Over time, as MM is studied as a category of exercise, research may progress more efficiently to define the domains of physiological and psychological benefit.
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                Author and article information

                Journal
                Evid Based Complement Alternat Med
                Evid Based Complement Alternat Med
                ECAM
                Evidence-based Complementary and Alternative Medicine : eCAM
                Hindawi Publishing Corporation
                1741-427X
                1741-4288
                2013
                7 April 2013
                7 April 2013
                : 2013
                : 140467
                Affiliations
                Virginia Commonwealth University, School of Nursing, 1100 East Leigh Street, Richmond, VA 23298, USA
                Author notes
                *Patricia Anne Kinser: kinserpa@ 123456vcu.edu

                Academic Editor: Vernon A. Barnes

                Article
                10.1155/2013/140467
                3638639
                23662111
                fe1854ea-d793-4d9c-a4de-9e11a82978e4
                Copyright © 2013 P. A. Kinser and J. L. Robins.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 November 2012
                : 21 February 2013
                : 13 March 2013
                Categories
                Review Article

                Complementary & Alternative medicine
                Complementary & Alternative medicine

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