Discuss about the Inquiry in Health Care for Translational Psychiatry.
The report is based on the scenario of Mariana, a single mother studying as a science student in the Australian University. She has a 18 months old daughter who suffers from asthma and hence she is worried that she might not able to interact with other students as her she has additional responsibilities in life. Mariana also suffers from health issues like diabetes and rare blood disorder which had made her very depressed in life. Based on this scenario, the report will critically analyze two research articles to determine which paper provides strongest evidence to reduce stress in Mariana.
Critical Appraisal Paper 1
The first paper by von Haaren, et al., (2015) is a randomized controlled trials study to determine the impact of 20-week aerobic exercise on reducing emotional stress reactivity in real life. On the S5 level of evidence heirarchy, this research article comes under unfiltered piece of information and according to S6 evidence hierarchy, it come under the lowest level of studies as it is an article published in psychology of sport and exercise journal (Dicenso et al., 2016). Randomized controlled trial comes under level II of NHMRC level of evidence (NHMRC, 2009). and the research study is an experimental study according to JBI level of evidence (The JBI Approach | JBI, 2016).
The introduction part of the research article clearly highlights the purpose of the study by stating that daily life stressors have impact on physical and emotional functioning of the people. The researcher stated that impact of physical exercise on reducing stress has so far been explained by stress-buffer hypothesis which means physical exercise acts as a moderator in reducing stress (von Haaren, et al., 2015). The purpose of study became important when the researcher highlighted the scope of problem by stating that so far studies have only focused on laboratory based task however real time assessment has not been done to determine the benefits of aerobic exercise on reducing stress (Grove et al., 2012). The research was carried out with 61 engineering students who were randomly assigned to a control group and aerobic exercise group. Their physical activity level was assessed by questionnaires and the cardiopulmonary exercise was done before the intervention. Experimental groups received 20 week aerobic training and the outcome was evaluated by parameters like maximum oxygen consumption, maximum running speed, lactate threshold and anaerobic threshold. The success of aerobic exercise intervention was determined using the analysis of covariance after intervention. The findings of the result showed that lower emotional stress reactivity was found in intervention group compared to control groups after 20 week aerobic training programme (von Haaren, et al., 2015).
The strength of the study is that the results are consistent throughout the article and it is also found consistent with other studies. Silveira et al., (2013) also studied about the impact of exercise on stress and it favoured the effect of exercise intervention on reducing the symptoms of depression. Hence, the research provided solution to the problem of dealing with daily life stress and recommending people with mild and moderate depression to feel motivated in life after incorporation of physical activity in daily life. The weakness of the study is that the research has not considered other factors that can have impact on stress response. Secondly, the study has been done only on same age group students and to determine the application of intervention, it is necessary to consider the effects on other age group of population too. As Mariana also suffers from depression and incorporating physical exercise intervention may help her enhance her motivations in life and reduce stress (von Haaren, et al., 2015).
Critical Appraisal Paper 2
The second paper by Kim et al., (2013) investigates the effect of Kouk Sun, mind body exercise to improve respose to stress and reduce symptoms. The research design consisted of a a pilot study where university students with anxiety symptoms were randomly assigned to treatment group and control group. This form of pilot study comes under under unfiltered informantive evidence according to S5 evidence of heirarchy and original article published in journal according to 6S heirarchy of preappraised evidence (Dicenso et al., 2016). The NHMRC level of evidence classifies such study under the level III-2 evidence and and in top level of experimental studies according to JBI level of evidence (The JBI Approach | JBI, 2016).
Kouk Sun Do (KSD) is a traditional mind-body based exercise practiced in Korea and the researcher’s main objective was to determine the effect of this meditative exercise, as the efficacy of this method has not been evaluated scientifically by researchers (Llapa Rodrigue et al., 2015). The purpose of the research became evident after the report that meditation and mindfulness has significant therapeutic effects on medical and psychiatric condition (van der Zwan et al., 2015). Within this context, yoga and Qigong exercise technique has been considered to foster stress tolerance after synchronizing breathing patterns. However, the researcher proposal of Kouk Sun Do, as an exercise programme to reduce stress is commendable because it consists of combination of all types of meditative exercise. Firstly, it consists of warm-up exercise and then meditative exercise with short postures and then followed by cool down exercise. Hence the research became significant in the absence of little empirical evidence on psychotherapeutic impact of KSD intervention.
The research was carried out with university student with anxiety symptoms, out of which 18 students were provided KSD intervention and the rest were in the control group. Both groups completed pre-test and post-test. The intervention group was given 70 minute KSD sessions three times per week for a period of four weeks and the outcome were assessed by parameters like depressive symptoms, self-efficacy and coping skills. The benefits of the session were analyzed using open-ended questionnaires and the data was analyzed using the repeated measure analysis of variance. The results findings showed that depressive symptoms in treatment group improved compared to control group with time (Kim et al., 2013). The findings of the research are also supported by (Alderman et al., 2016) who highlighted that mental and physical training is a significant intervention that increases the neurogenesis on the adult brain. After 8 weeks of intervention, neural responses enhanced in participants and hence it proved that combining the effects of meditation and exercise can help in eliminating ruminating thoughts and coping with depression.
The strength of study is that it helped in identification of the benefits of KSD combining physical exercise and meditation to enhance relaxation and reduce anxiety symptoms. It also helped in analyzing the effects of time and characteristic of people to determine the effect of KSD intervention. One weakness of the study was that since the effects of the study was studied with a very small size of sample, it is necessary that research is done with greater sample to make the intervention more reliable and useful for future intervention. However, the research was effective in providing an alternative approach to self-healing without the need for medical intervention. The intervention can also have great implication to reduce stress in Mariana’s life without the need of expenditure on medical expense.
Justification for Best Evidence According to Scenario
Since Mariana is a single mother and has little social support from family, it is necessary to provide an intervention that she can easily follow without compromising her priorities in life. Keeping this view in mind, it can be said that the second article on KSD intervention is the best treatment procedure to reduce stress in Marian compared to the intervention on aerobic exercise provided the first article. Kouk Sun Do is a combination of meditative and physical exercise and there is also many literature that supports the fact that mind-body exercise increases coping skills in people with depression. Lin et al., (2014) supports the effect of aerobic exercise and mind-body exercise in improvement in cognitive function and psychotic symptoms in people. The researcher suggested that mental stress is associated with impairment in attention and memory and it can also lead to other severe functional impairments. It also investigated the neuro-mechanism associated with stress. Similar to the research by Kim et al., (2013), Lin et al., (2014).) also assessed the paramenters of congitive function, fitness level and quality of life before and after intervention. The results showed that combination of mediation and physical exercise lead to significan improvement in memory and enhanced attention in particpants and reduced stress in participants. Hence, with support from this finding, it can be said that KSD intervention can also be recommended to Mariana to enhance her quality of life and reduce depressive symptoms.
The reported was based on identifying the best evidence to improve stress symptoms and mood improvement in Mariana, a single mother with depressive symptoms. The critical appraisal of article explained the influence of AET and KDS intervention on reducing stress in patient with depressive symptoms. Comparison with other existing literature revealed that second article is most effective in improving neural response and reducing stress in patients. Hence, KSD intervention was regarded as a better intervention to reduce stress in Mariana’s life.
Alderman, B. L., Olson, R. L., Brush, C. J., & Shors, T. J. (2016). MAP training: combining meditation and aerobic exercise reduces depression and rumination while enhancing synchronized brain activity. Translational psychiatry, 6(2), e726.
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von Haaren, B., Haertel, S., Stumpp, J., Hey, S., & Ebner-Priemer, U. (2015). Reduced emotional stress reactivity to a real-life academic examination stressor in students participating in a 20-week aerobic exercise training: A randomised controlled trial using ambulatory assessment. Psychology of Sport and Exercise, 20, 67-75. doi:10.1016/j.psychsport.2015.04.004