正念瑜珈減少有風險孕婦的憂鬱


  【24drs.com】新研究顯示,正念瑜珈可讓有心智健康風險孕婦的憂鬱症狀減少,並且強化母嬰連結。
  
  美國密西根大學婦嬰心智健康親子健康計畫主任Maria Muzik醫師表示,許多孕婦從事產前哈達瑜伽,藉由物理姿勢與冥想聚焦,而有助於生產、減少產程疼痛。
  
  Muzik醫師表示,我們的正念瑜珈課程藉由強調正念禪修、有針對性的指導、提醒和閱讀,而與一般的產前哈達瑜珈不同。
  
  這篇研究線上刊載於7月14日臨床輔助療法期刊。
  
  她表示,在懷孕期間,許多孕婦都不願意以藥物治療憂鬱和焦慮,因為擔心會傷及胎兒,也不願意開始心理治療,因為在這脆弱時刻難以藉由治療克服過去或現在的衝突。
  
  不過,未治療憂鬱對母親和胎兒有許多健康風險,例如體重增長不佳、先兆子癇、早產、與胎兒的連結不佳。
  
  在這篇研究中,研究者招募了18名有憂鬱高風險的孕婦,參與10週的正念瑜珈計畫;這些婦女懷孕12- 26週,參與研究時的愛丁堡產前憂鬱量表分數大於9分。除了開始時的診斷評估,婦女們在進行正念瑜珈前後各完成了對憂鬱、正念、母嬰附屬的自我評估。
  
  Muzik醫師解釋,指導員在課程中不斷提醒婦女將注意力集中到自己的身體感覺、在瑜珈動作中傾聽身體的回饋、理解她們的身體如何改變以支持生長中的胎兒。教導參與者正念技術,包括呼吸、引導可視化和放鬆。
  
  她指出,這個介入方式的重要觀念是專注於胎兒,以感覺其獨特人格而有助於親子的附屬過程。
  
  每次課程持續90分鐘且專注於各種姿勢,專注於受孕的母體與對胎兒之意識。這些課程會因參與經驗或妊娠年齡而調整。
  
  研究者發現,10週後,參與正念瑜珈課程者顯著較少憂鬱,且母嬰連結和正念技能皆顯著改善。
  
  瑜珈計畫之前,母親的平均貝氏憂鬱量表(BDI)分數為13.95;介入之後為9.63分(P = .025)。平均母胎依附分數(MFAS)值在介入前為83.56,介入後為95.50 (P = .01)。
  
  整體而言,這些婦女認為正念瑜珈是有幫助的處理策略,且有益於她們的胎兒。一位母親表示,瑜珈幫助她面對高風險孕程—她的孩子有最平靜且溫和的靈魂,壓力降低對胎兒也有幫助。
  
  Muzik醫師表示,她們也受益於來自其他母親的社會支持。研究首度提出有利證據認為,正念瑜珈可改善憂鬱症狀、促進對懷孕的注意立場、促進母親和胎兒之間的連結,而獲得對孩童健康的長期效益。
  
  有些婦產科也會建議病患進行正念瑜珈,我們希望有朝一日傳統治療機構也可提供正念瑜珈課程,讓婦女們在她們的婦產科診間就可進行。
  
  紐約大學Langone醫學中心精神科臨床助理教授Sudeepta Varma醫師評論此篇研究時表示,研究結果為有憂鬱的婦女提供另一個治療選項。
  
  Varma醫師表示,當孕婦尋求憂鬱治療時通常會發現選項有限,約有半數會選擇在懷孕期間停用抗憂鬱藥物,讓她們自己面臨復發的高風險。我們知道,未治療憂鬱對母嬰都有嚴重後遺症,包括產前照護不佳、低出生體重、先兆子癇、胎兒宮內發育遲緩(IUGR [intrauterine growth restriction])等等。
  
  雖然這項研究有一些限制,例如沒有對照組、樣本數相對少、樣本同質性高(白人、社經狀態較高的高等教育婦女),這篇研究仍在心理治療和藥物治療之外,提供了另一種有效的輔助治療選項。
  
  Varma醫師指出,研究設計也提供孕婦接受社會支持的機會,並在每次課程開始時討論她們的病症、且學習正念技能。這些都顯示可有助於憂鬱治療。
  
  她表示,身為精神科醫師與母親,也是正念減壓療法和瑜伽的實踐者,我將和我的病患分享這些研究結果,並且希望此一領域有後續研究。
  
  資料來源: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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