We are delighted that you are interested in our study. In terms of diet, we mainly recorded the usual diet and the diet from the past 24 hours. We found that the diet structure was consistent, but we did not further quantify the relative amount of food you mentioned. Regarding BMI, although we collected the same sample as the previous study, the selecting sample number is a different and we ended up selecting only a fraction of the original samples according to the strict sample collecting rule's limitation, therefore, some BMI values were missing and thus not complete analyzed in the article. Partly Data ANCOVA analysis Result showed no difference. The high altitude and small population of Tibet, combined with communication barriers, made it challenging to collect the sample. Therefore, we could not follow the strict inclusion and perfect criteria to collect the sample. However, as a preliminary study on the relationship between meditation and intestinal bacteria, our findings shed some light on the subject. It still is also good to bring some enlightenment to the field.
Reference: Xue T, Chiao B, Xu T, et al. The heart-brain axis: a proteomics study of meditation on the cardiovascular system of Tibetan monks. EBioMedicine 2022;80:104026.
Thank you for your interesting study on the effect of meditation on the faecal microbiota. The paper itself states that "...both [control and meditation] groups had the same dietary structure. The staple food mainly included highland barley, rice, steamed bread and noodles, and the supplementary food primarily comprised vegetables, meat and butter tea.'", but no other information or data is provided.
In your reply to Dr Ong’s Rapid Response, you helpfully point readers interested in this question to the supplementary tables of your previously published paper using the same participants (1), with Supplementary Table 7 being the most relevant here. However, after examining the table and the other information provided in both papers, it is still unclear to me how diet was controlled for. The implication from the table is that participants in the Monk and Control groups were simply asked, in a qualitative way, whether or not various food groups were included in their daily diet. This information does not seem sufficient to use to control for diet, since the food groups participants about which participants were asked are very broad (e.g. highland barley, rice, noodles) - meaning that participants are likely to include/not include similar groups in their diet, even as the relative quantities of each food group that they consume may differ substantially. Could you please clarify how information about participants’ diet was recorded, and...
Thank you for your interesting study on the effect of meditation on the faecal microbiota. The paper itself states that "...both [control and meditation] groups had the same dietary structure. The staple food mainly included highland barley, rice, steamed bread and noodles, and the supplementary food primarily comprised vegetables, meat and butter tea.'", but no other information or data is provided.
In your reply to Dr Ong’s Rapid Response, you helpfully point readers interested in this question to the supplementary tables of your previously published paper using the same participants (1), with Supplementary Table 7 being the most relevant here. However, after examining the table and the other information provided in both papers, it is still unclear to me how diet was controlled for. The implication from the table is that participants in the Monk and Control groups were simply asked, in a qualitative way, whether or not various food groups were included in their daily diet. This information does not seem sufficient to use to control for diet, since the food groups participants about which participants were asked are very broad (e.g. highland barley, rice, noodles) - meaning that participants are likely to include/not include similar groups in their diet, even as the relative quantities of each food group that they consume may differ substantially. Could you please clarify how information about participants’ diet was recorded, and whether or not a more quantitative measure was used, providing additional (anonymised) data to support this?
In a potentially related issue, when comparing differences between Monk and Control groups, the previous paper actually finds that BMI is significantly higher in Monks (i.e. they are clinically obese on average). Although this was statistically controlled for in the previous analysis/paper, BMI differences are not even mentioned in the current paper. Could you please clarify how BMI differences were accounted for in the current paper?
Thank you for taking the time to consider my request.
Yours sincerely,
Dr Matt Lloyd Jones
1. Xue T, Chiao B, Xu T, et al. The heart-brain axis: a proteomics study of meditation on the cardiovascular system of Tibetan monks. EBioMedicine 2022;80:104026.
Sun and colleagues compared the faecal microbiota of 37 Tibetian monks with 19 ordinary residents nearby to conclude that meditation favorably affected gut microbiota to have a positive effect on health. However, monks in a temple may differ from ordinary lay residents in other ways besides the practice of meditation. While monks are strict vegetarians, lay people are under no such obligation. Life in a temple is also more sheltered and less stressful when compared to that of ordinary people living in a harsh, high altitude environment. To show that it is meditation which causes the favorable faecal microbiota, the researchers would have to test the monks after a meditation free period, or else subject their lay controls to a period of intense mediation to see if there is any change in fecal microbiota afterwards. In selecting non monks who may be different as their controls, the researchers can be justified in concluding that monastic life favorably influences gut microbiota, but are not justified in attributing the change solely to meditation.
Reference:
Sun Y, Ju P, Xue T, et al. Alteration of faecal microbiota balance related to long-term deep meditation. General Psychiatry 2023;36:e100893. doi: 10.1136/gpsych-2022-100893
Hean T Ong, FRCP, FACC, FESC
Consultant Cardiologist, HT Ong Heart Clinic, Penang, Malaysia
Reply：
Thank you for your letter and interest in our study. We would like to make some clarification in reply to the...
Sun and colleagues compared the faecal microbiota of 37 Tibetian monks with 19 ordinary residents nearby to conclude that meditation favorably affected gut microbiota to have a positive effect on health. However, monks in a temple may differ from ordinary lay residents in other ways besides the practice of meditation. While monks are strict vegetarians, lay people are under no such obligation. Life in a temple is also more sheltered and less stressful when compared to that of ordinary people living in a harsh, high altitude environment. To show that it is meditation which causes the favorable faecal microbiota, the researchers would have to test the monks after a meditation free period, or else subject their lay controls to a period of intense mediation to see if there is any change in fecal microbiota afterwards. In selecting non monks who may be different as their controls, the researchers can be justified in concluding that monastic life favorably influences gut microbiota, but are not justified in attributing the change solely to meditation.
Reference:
Sun Y, Ju P, Xue T, et al. Alteration of faecal microbiota balance related to long-term deep meditation. General Psychiatry 2023;36:e100893. doi: 10.1136/gpsych-2022-100893
Hean T Ong, FRCP, FACC, FESC
Consultant Cardiologist, HT Ong Heart Clinic, Penang, Malaysia
Reply：
Thank you for your letter and interest in our study. We would like to make some clarification in reply to the points you raised.
Since lifestyle may contain confounding factors when investigating the effects of meditation, our study aimed to minimize the impact of lifestyle factors in this investigation of the effects of meditation. To achieve this, we strictly matched age, sex, smoking, alcohol, and dietary habits between the monk and Tibetan control groups. Tibetian monks are not strict vegetarians so that all our participants, monks and controls, consumed a similar diet mainly of highland barley, rice, steamed bread, noodles, and other staple foods, supplemented with vegetables, meat, and butter tea. This information can be found in section 3.1 of our article, as well as in the supplementary tables of our previously published paper (1,2).
Tibetan Buddhism and Tibetan lifestyle deeply influence each other and are closely connected so that the daily life of the monks and the lay people in our study are similar. Both groups come from the same community and maintain social connections with their nearby families. While the lay controls often work in physically demanding jobs, the monks have to undertake equally hard physical work to maintain their temple premises in a similarly high altitude harsh environment. Additionally, both the monks and Tibetan controls of this area generally are subjected to low levels of mental stress.
While we acknowledge that there may be some other differences in the lifestyles of monks and lay Tibetans, the biggest difference is in the time spent in meditation. Therefore, the changes we observed in gut microbiota are very likely to be specifically associated with the practice of meditation.
There are practical limitations to consider in trying to implement the suggestions proposed . For the monks, meditation is a daily and mandatory practice, making it impossible to discontinue. Furthermore, for lay people it would be impossible to achieve the level of sophistication and depth of meditation that the monks have developed over many years of practice.
However, this is only a preliminary study and further research is necessary to gain a deeper understanding of the effects of medication and its underlying mechanisms. We welcome further discussion and interest in this topic and hope that future studies will provide additional insights.
References:
1. Xue T, Chiao B, Xu T, et al. The heart-brain axis: a proteomics study of meditation on the cardiovascular system of Tibetan monks. EBioMedicine 2022;80:104026.
2.Sun Y, Ju P, Xue T, et al. Alteration of faecal microbiota balance related to long-term deep meditation. General Psychiatry 2023;36:e100893. doi: 10.1136/gpsych-2022-100893
We consider that the intestinal microbiota is not only related to anxiety disorders. The microbiota-gut-brain axis is related to multiple mental disorders. If we start from the phrase "we are what we eat" we should pay better attention to a healthy diet and support Hippocrates when he said "let food be your best medicine and your best medicine be your food". We know the microbiota as the set of microorganisms that live symbiotically in a given ecological niche, in this case it refers to the intestinal microbiota where there are native species that colonize the gastrointestinal tract and a variable series of living microorganisms that are transiting through the tube digestive. Anaerobic germs predominate, bacteroides, bifidobacterium, eubacterium, clostridium, lactobacillus. The evolution of the microbiota varies from the fetal stage to adulthood and factors that modify it intervene in this evolution: diet, pH, oxygen concentration, nutrient availability, stress, genetic factors, the use of antibiotics, lactation maternal, prematurity, caesarean section among others. There is a bidirectional and dynamic communication between the intestine and the brain through nervous, endocrine and immune signaling pathways, so the role of neurotransmitters, hormones, metabolites, cytokines is fundamental in the appearance of mental illnesses that are reference.
The article by Vadivel et al addressed the issue of impending mental health crisis in the Post COVID era [1]. The article comprehensively highlights the risk factors, vulnerable groups with either existing or potential of developing mental health issues during these unforeseen circumstances. There are certain pertinent points we would like to highlight in the study.
The authors have correctly pointed out the lack of specific diagnostic or screening tools for Post COVID assessment of mental health. Additionally, both DSM-5 and ICD-10 are interview-based, which may under-report or over-report the underlying conditions.[1] Further to explore the mental health concerns, traditionally psychometric questionnaires have been used as an instruments for assessment, with the advantage of ease of use and highlighting the perception of the subject. However, since they are subjective and may be influenced by subject’s unwillingness, thereby can lead to delay in treatment.[2]
Here, we would like to emphasize the role of objective physiological markers for the assessment of stress. Stress is one of the plausible factor increasing the existing mental health illness or contributing to new ones. Though the impact of stress has been explored using subjective questionnaires in COVID-19, but it is mostly done during the course of the illness rather than addressing the Post COVID sequalae. Surprisingly, there is an inconspicuous absence of quantitative measures, which may help to del...
The article by Vadivel et al addressed the issue of impending mental health crisis in the Post COVID era [1]. The article comprehensively highlights the risk factors, vulnerable groups with either existing or potential of developing mental health issues during these unforeseen circumstances. There are certain pertinent points we would like to highlight in the study.
The authors have correctly pointed out the lack of specific diagnostic or screening tools for Post COVID assessment of mental health. Additionally, both DSM-5 and ICD-10 are interview-based, which may under-report or over-report the underlying conditions.[1] Further to explore the mental health concerns, traditionally psychometric questionnaires have been used as an instruments for assessment, with the advantage of ease of use and highlighting the perception of the subject. However, since they are subjective and may be influenced by subject’s unwillingness, thereby can lead to delay in treatment.[2]
Here, we would like to emphasize the role of objective physiological markers for the assessment of stress. Stress is one of the plausible factor increasing the existing mental health illness or contributing to new ones. Though the impact of stress has been explored using subjective questionnaires in COVID-19, but it is mostly done during the course of the illness rather than addressing the Post COVID sequalae. Surprisingly, there is an inconspicuous absence of quantitative measures, which may help to delineate the aetiology and effectively monitor stress in these patients. These physiological signals are based on the heart-brain interactions, controlling visceromotor, neuroendocrine, and behavioral responses, critical for goal-directed behavior and/or stress adaptability. [3] The adaptability to stress can further be envisaged through stress reactivity paradigms using physical and mental stressors which may be helpful to monitor physiological changes in real time. [4]
Amongst, the quantitative measures, autonomic function as assessed by heart rate variability is a physiological metric that provides insight into the interplay between the parasympathetic and sympathetic nervous systems that modulate cardiac contractility and cause variability in the beat-to-beat intervals.[5] It is reported to be an emergent property of interdependent regulatory systems that operates on different time scales to adapt to environmental and psychological challenges. [6] Infact, longitudinally collected HRV metrics from a commercial wearable device (Apple Watch) was able to predict the diagnosis and identify COVID-19–related symptoms, even prior to the nasal swab testing. [7]
Skin conductance responses (SCR) represent a reliable, inexpensive and robust biochemical marker, especially in context to emotional stress. [8] A new avenue in research with respect to wearable cortisol sensors could be used in future for the real time and continuous monitoring of stress levels.[9]Additionally, Electromyographic (EMG) stress reactivity is also a candidate, which can work as a stress physiological marker, especially picking up changes in the facial and trapezius muscle. [10]
Furthermore, direct measurements of the cortical response to stress can be obtained through modern neuroimaging tools like Electroencephalography (EEG). EEG offers an excellent temporal resolution, which can pick up the neuronal changes due to stress in milliseconds resolution.[11] It can offer cost effective, non-invasive and personalized method to quantifying stress in terms of the power changes and cortical sources involved, thereby assisting in therapeutic interventions as well.
In COVD era or during similar unforeseen circumstances, to curb the mental health issues and the associated stress, it is imperative to identify and objectify the potential features of stress, which may be considered as biomarkers and may be implemented in future for stress monitoring method, thus targeting even before the subjective manifestation of stress.
1 Vadivel R, Shoib S, Halabi SE, et al. Mental health in the post-COVID-19 era: challenges and the way forward. Gen Psychiatry 2021;34:e100424. doi:10.1136/gpsych-2020-100424
2 Durán-Acevedo CM, Carrillo-Gómez JK, Albarracín-Rojas CA. Electronic Devices for Stress Detection in Academic Contexts during Confinement Because of the COVID-19 Pandemic. Electronics 2021;10:301. doi:10.3390/electronics10030301
3 Jung W, Jang K-I, Lee S-H. Heart and Brain Interaction of Psychiatric Illness: A Review Focused on Heart Rate Variability, Cognitive Function, and Quantitative Electroencephalography. Clin Psychopharmacol Neurosci Off Sci J Korean Coll Neuropsychopharmacol 2019;17:459–74. doi:10.9758/cpn.2019.17.4.459
4 Huang C-J, Webb HE, Zourdos MC, et al. Cardiovascular reactivity, stress, and physical activity. Front Physiol 2013;4. doi:10.3389/fphys.2013.00314
5 Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health 2017;5:258. doi:10.3389/fpubh.2017.00258
6 McCraty R, Shaffer F. Heart Rate Variability: New Perspectives on Physiological Mechanisms, Assessment of Self-regulatory Capacity, and Health risk. Glob Adv Health Med 2015;4:46–61. doi:10.7453/gahmj.2014.073
7 Hirten RP, Danieletto M, Tomalin L, et al. Use of Physiological Data From a Wearable Device to Identify SARS-CoV-2 Infection and Symptoms and Predict COVID-19 Diagnosis: Observational Study. J Med Internet Res 2021;23. doi:10.2196/26107
8 The Body and the Brain: Measuring Skin Conductance Responses to Understand the Emotional Experience - George I. Christopoulos, Marilyn A. Uy, Wei Jie Yap, 2019. https://journals.sagepub.com/doi/full/10.1177/1094428116681073 (accessed 19 Jun 2021).
9 Parlak O. Portable and wearable real-time stress monitoring: A critical review. Sens Actuators Rep 2021;3:100036. doi:10.1016/j.snr.2021.100036
10 Luijcks R, Vossen CJ, Roggeveen S, et al. Impact of early life adversity on EMG stress reactivity of the trapezius muscle. Medicine (Baltimore) 2016;95. doi:10.1097/MD.0000000000004745
11 Saeed SMU, Anwar SM, Khalid H, et al. EEG Based Classification of Long-Term Stress Using Psychological Labeling. Sensors 2020;20. doi:10.3390/s20071886
Psychological distress is common and expected in people who have not only contracted COVID but also their families and not the least the treating health professionals too. There is not just Peritraumatic Stress but also Pretraumatic Stress (before infection), Posttraumatic Stress (after coming out) and Paratraumatic Stress (for those around). We are indeed in extraordinary times. Extraordinary problems call for extraordinary solutions. After reading this article and feeling despondent I was particularly impressed by an article by Lizzie Burns titled Transforming the everyday into something beautiful: How origami can help encourage self-care (BMJ Opinion December 21, 2020). It nicely highlights one way in which how our creative instincts could be cultivated to uplift our consciousness to become more self-conscious, self-compassionate and self-confident in sustaining and thriving during these challenging times. This article is encouraging and reassuring that healthcare is indeed as much an art as a science. It is time that more of us recognize this and create the much-needed mainstreaming of aesthetics into essential healthcare.
The COVID-19 crisis has had its impact on mental well-being and has stretched our physical psychological resources to their capacity. The challenges have been extraordinary. Agencies of all disciplines from molecular genetics to psychology are trying their best to come up with varying approaches to sustainable solutions to the pandemic proble...
Psychological distress is common and expected in people who have not only contracted COVID but also their families and not the least the treating health professionals too. There is not just Peritraumatic Stress but also Pretraumatic Stress (before infection), Posttraumatic Stress (after coming out) and Paratraumatic Stress (for those around). We are indeed in extraordinary times. Extraordinary problems call for extraordinary solutions. After reading this article and feeling despondent I was particularly impressed by an article by Lizzie Burns titled Transforming the everyday into something beautiful: How origami can help encourage self-care (BMJ Opinion December 21, 2020). It nicely highlights one way in which how our creative instincts could be cultivated to uplift our consciousness to become more self-conscious, self-compassionate and self-confident in sustaining and thriving during these challenging times. This article is encouraging and reassuring that healthcare is indeed as much an art as a science. It is time that more of us recognize this and create the much-needed mainstreaming of aesthetics into essential healthcare.
The COVID-19 crisis has had its impact on mental well-being and has stretched our physical psychological resources to their capacity. The challenges have been extraordinary. Agencies of all disciplines from molecular genetics to psychology are trying their best to come up with varying approaches to sustainable solutions to the pandemic problem. Health care workers are more than ever facing new challenges every day. In this climate of confusion and caution creative contemplation like self-care through creative art should come as a welcome grace.
A challenge of this nature and during these tumultuous times places novel burdens on our cognitive, sensory-motor, emotional abilities. This could easily lead to maladaptive states fueling compromised immunity, inflammation and psychopathology.
Fortunately advances in modern neuroscience research provides us with a growing body of health outcome tools that allow improved self-awareness, self-regulation, prosocial behaviour and well-being through systematic mental training and physical culture along with lifestyle and nutritional care. This body of research come under the category of consciousness studies and contemplative neuroscience. This provides the scientific basis for interventions in the form of Mindfulness and Mindfulness-Based Therapies and other psychophysical cultural training like Yoga, Tai Chi, Qi Gong, Zen and other forms of meditation practices that are derived from Eastern contemplative practices. These practices are as much an art as they are therapeutic that allow flourishing through a culture of compassion and expand the consciousness towards an experience of self-actualization and beatitude.
When the author in her blog says that for Origami all you need is a piece of paper, it struck me that the most helpful tools are the simplest. It reminded me of Leonardo Da Vinci who was as much a scientist as he was an artist. His astonishing diagrams on paper where he uses every little space and turns the paper into a laboratory of thinking and feeling is quite remarkable. Neuroaesthetics is this emerging field of research combining neuropsychology with art or aesthetics through the study of neural and psychological correlates of aesthetic judgement and creativity which are highly evolved acquired human abilities that can be capitalized as a therapeutic tool for health and wellbeing.
Be it Origami the art of paper folding, Ikebana the art of flower arranging, the art of graceful movements like dance, yoga, tai chi, etc. music or meditation all seem to have contemplation and creativity at their core bringing harmony and balance in the mind and the body that is bound to have harmonizing and balancing effects on the psycho-neuro-endocrino-immunological systems creating the right climate for healing not only our individual but also our collective consciousness. It is indeed the coming of age of contemplative neuroaesthetics in healthcare.
References:
Bingaman, Kirk A. "The art of contemplative and mindfulness practice: Incorporating the findings of neuroscience into pastoral care and counseling." Pastoral Psychology 60.3 (2011): 477-489.
Ramachandran V S, Hirstein W: The Science of Art: A Neurological Theory of Aesthetic Experience. Journal of Consciousness Studies, 6, No. 6-7, 1999, pp. 15–51
Wolfe, Uta, and Amy Moran. "Integrating brain science into health studies: An interdisciplinary course in contemplative neuroscience and yoga." Journal of Undergraduate Neuroscience Education 16.1 (2017): A77.
I found the editorial by Qiu J et al[1] on the “first nationwide large-scale survey of psychological distress in the general population of China during the COVID-19 epidemic” very insightful. There are similar reports from several other countries on a similar mental health crisis initiated by COVID-19 pandemic and the economic downturn. Qiu J et al[1] have presented the content effectively, and I was gratified with the viewpoint on the recommendation on “nationwide strategic planning and coordination for psychological first aid during major disasters, potentially delivered through telemedicine” along with “screening, referral and targeted intervention should be built to reduce psychological distress and prevent further mental health problem”.
While this recommendation is expected to be very effective, there are of course practical, logistical, and economic challenges in the implementation of any large scale nationwide yet much needed psychological first aid. "Biopsychosociospiritual" model of primary healthcare could be however one of the strategies for effective promotion of mental health and prevention of mental disorders, substance abuse and self-harm behaviours.
In psychology, the “philosophy of mind" explores the relationship and association between the “mind” referred to as the “mental or emotional domain” and the “brain or body” referred to as the “physical domain”.[2] In the context of the relationship between mind and brain, mind most of...
I found the editorial by Qiu J et al[1] on the “first nationwide large-scale survey of psychological distress in the general population of China during the COVID-19 epidemic” very insightful. There are similar reports from several other countries on a similar mental health crisis initiated by COVID-19 pandemic and the economic downturn. Qiu J et al[1] have presented the content effectively, and I was gratified with the viewpoint on the recommendation on “nationwide strategic planning and coordination for psychological first aid during major disasters, potentially delivered through telemedicine” along with “screening, referral and targeted intervention should be built to reduce psychological distress and prevent further mental health problem”.
While this recommendation is expected to be very effective, there are of course practical, logistical, and economic challenges in the implementation of any large scale nationwide yet much needed psychological first aid. "Biopsychosociospiritual" model of primary healthcare could be however one of the strategies for effective promotion of mental health and prevention of mental disorders, substance abuse and self-harm behaviours.
In psychology, the “philosophy of mind" explores the relationship and association between the “mind” referred to as the “mental or emotional domain” and the “brain or body” referred to as the “physical domain”.[2] In the context of the relationship between mind and brain, mind most often stands for “human consciousness”.[3] According to the dualist theory of metaphysics, “mind” and “brain or body” are different because both thoughts and consciousness are not “physical”; however, no unified consensus explains the relationship between the mind and the brain or body yet.[4]
The mind-body problem (MBP) is the key underlying scientific question faced by mental health specialists and is represented as a solved issue with physicalism or materialism, and dualism being considered as a superstitious and old-fashioned ideology.[5] Yet there is plenty of evidence that our "thoughts" eventually affect our health and the prevention of negative automated thoughts (NATs) boosts both mental and physical health.[6]
The biopsychosocial model covers a holistic and modern humanistic view of human well-being and recommends that "all three levels, biological, psychological, and social, must be taken into account in every health care task" .[7] Many experts have recommended that the biopsychosocial model should include a 'spiritual' dimension for "Integrative Mental Health" .[7-9] However, spiritual care is often not considered in the field of Western medicine, likely because its definition may be ambiguous, or its association is generally perceived to be highly personal.[10] Strong neuropsychological and clinical evidence, however, suggests several positive self-regulatory effects of mindfulness and learned optimism and resilience practice in the population, enhance mental health including, self-regulation, stability, attention control and coping skills, which are enhanced by changes in prefrontal brain function.[6-12]
Spirituality and mindfulness are useful adjuncts to behavioural as well as medical interventions to manage stress, low mood, anxiety, and physical conditions, and can be taught to even children to improve self-regulation and self-leadership, particularly in reaction to stressors of day to day life.[11-12 ]
However, spirituality in psychiatry, as well as the general medical practice, remains much underappreciated and underpromoted. Yet its implementation for integrated mental health in primary care could be one of the powerful strategies to cope with the escalated mental health crisis due to COVID-19 pandemic.
I declare no competing interests.
REFERENCES
1. Qiu J, Shen B, Zhao M, et al. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. General Psychiatry 2020;33:e100213. doi: 10.1136/gpsych-2020-100213.
2. Van Oudenhove L, Cuypers SE. The philosophical" mind-body problem" and its relevance for the relationship between psychiatry and the neurosciences. Perspectives in biology and medicine. 2010;53(4):545-557. DOI: 10.1353/pbm.2010.0012.
3. Ascoli GA. The mind-brain relationship as a mathematical problem. ISRN neuroscience. 2013. DOI: 10.1155/2013/261364.
4. Howard R. Dualism. Metaphysics Research Lab, Stanford University. The Stanford Encyclopedia of Philosophy Web site. Published 2017. Accessed 16th Feb 2020. https://plato.stanford.edu/archives/fall2017/entries/dualism/.
5. Moreira-Almeida A, Araujo SdF, Cloninger CR. The presentation of the mind-brain problem in leading psychiatry journals. Braz J Psychiatry. 2018;40(3):335-342. DOI: 10.1590/1516-4446-2017-2342.
6. Seligman ME. Learned optimism: How to change your mind and your life. Vintage; 2006.
7. Saad M, de Medeiros R, Mosini AC. Are We Ready for a True Biopsychosocial-Spiritual Model? The Many Meanings of "Spiritual". Medicines (Basel). 2017;4(4):79. DOI: 10.3390/medicines4040079.
8. Lake J, Helgason C, Sarris J. Integrative Mental Health (IMH): Paradigm, Research, and Clinical Practice. EXPLORE. 2012;8(1):50-57. DOI: 10.3390/medicines4040079
9. Sarris J, Glick R, Helgason C, Veizer C, Lake J. The International Network of Integrative Mental Health (INIMH). Advances in Integrative Medicine. 2014;1(1):59-60. DOI: 10.1016/j.aimed.2012.12.001.
10. Tu M-S. Illness: An opportunity for spiritual growth. Journal of Alternative and Complementary Medicine. 2006;12(10):1029-1033. DOI: 10.1089/acm.2006.12.1029.
11. Creswell JD. Mindfulness Interventions. Annual Review of Psychology. 2017;68(1):491-516. DOI: 10.1089/acm.2006.12.1029.
12. Hofmann SG, Gómez AF. Mindfulness-Based Interventions for Anxiety and Depression. Psychiatr Clin North Am. 2017;40(4):739-749. DOI: 10.1016/j.psc.2017.08.008.
The indicator of addiction severity in clinical studies, for a long time, relies on experienced craving report for drug-related cues. This condition ranges from both addictive assessments and diagnosis, to the estimation of clinical intervention. However, self-report of craving is susceptible to the influences of social desirability and self-masking in many situations. This necessitates the development of an objective measurement that can detect one’s real craving, which is independent of these obscuring factors. The article by Yuan Liang and colleagues entitled “Assessing the Severity of Methamphetamine Use Disorder Beyond the Subjective Craving Report: the Role of an Attention Bias Test” shows that attention bias test represents a more reliable indicator for the addictive severity in methamphetamine dependents. The authors observed that MA dependents, irrespective of high or low craving report, showed similar attention bias to drug-related photographs by using correlation analyses. Moreove...
The indicator of addiction severity in clinical studies, for a long time, relies on experienced craving report for drug-related cues. This condition ranges from both addictive assessments and diagnosis, to the estimation of clinical intervention. However, self-report of craving is susceptible to the influences of social desirability and self-masking in many situations. This necessitates the development of an objective measurement that can detect one’s real craving, which is independent of these obscuring factors. The article by Yuan Liang and colleagues entitled “Assessing the Severity of Methamphetamine Use Disorder Beyond the Subjective Craving Report: the Role of an Attention Bias Test” shows that attention bias test represents a more reliable indicator for the addictive severity in methamphetamine dependents. The authors observed that MA dependents, irrespective of high or low craving report, showed similar attention bias to drug-related photographs by using correlation analyses. Moreover, attention bias instead of craving rating is significantly correlated with each of the three clinical indexes of addictive severity. This study provides evidence that attention bias may serve as a more objective measure for addictive severity compared to the traditional craving report in addiction research. Reference: Liang Q, Yuan T, Cao X, et al. Assessing the severity of methamphetamine use disorder beyond the subjective craving report: the role of an attention bias test. General Psychiatry 2019; 32 : 68–74. doi:10.1136/gpsych-2018-100019
Dear Sir / Madam - many thanks to Mudgal et al for their interesting and comprehensive case report. I wonder, however, how useful the term 'Van Gogh' syndrome is compared with simply 'self - mutilation'? The term is commonly used to refer to self-mutilation in the context of psychosis, but my contribution to a similar case caused me to research Van Gogh's medical history (1). Although it is commonly assumed Van Gogh suffered psychosis, evidence for this is scant: his behaviour was always variably aggressive and unpredictable but there were no clear 'episodes' with a 'well' Van Gogh in between, and overt delusions and hallucinations were conspicuous by their absence. Sometimes his style of painting is suggested as 'proof' of psychosis but this belies his creative genius. In fact, it seems the traits of aggression and unpredictable behaviour, coupled with a desire to punish himself or others in the context of unstable relations, were longstanding and suggest an emotionally unstable personality disorder. A bull's ear was traditionally given as a prize to victorious bull fighters in Arles, where Van Gogh was trying to set up an artistic community with Gaugain. Van Gogh's 'gift' of his ear to a maid in a brothel , Rachel, (she was not a sex worker) could be seen as a symbolic rather than psychotic act: he and Gaugain were vying for her affections and it is in this context that he gave his ear as a...
Dear Sir / Madam - many thanks to Mudgal et al for their interesting and comprehensive case report. I wonder, however, how useful the term 'Van Gogh' syndrome is compared with simply 'self - mutilation'? The term is commonly used to refer to self-mutilation in the context of psychosis, but my contribution to a similar case caused me to research Van Gogh's medical history (1). Although it is commonly assumed Van Gogh suffered psychosis, evidence for this is scant: his behaviour was always variably aggressive and unpredictable but there were no clear 'episodes' with a 'well' Van Gogh in between, and overt delusions and hallucinations were conspicuous by their absence. Sometimes his style of painting is suggested as 'proof' of psychosis but this belies his creative genius. In fact, it seems the traits of aggression and unpredictable behaviour, coupled with a desire to punish himself or others in the context of unstable relations, were longstanding and suggest an emotionally unstable personality disorder. A bull's ear was traditionally given as a prize to victorious bull fighters in Arles, where Van Gogh was trying to set up an artistic community with Gaugain. Van Gogh's 'gift' of his ear to a maid in a brothel , Rachel, (she was not a sex worker) could be seen as a symbolic rather than psychotic act: he and Gaugain were vying for her affections and it is in this context that he gave his ear as a pointed 'prize' to the woman who he saw as having won Guagain - whom he idolised - over him. (An alternative explanation is that he saw Guagain as the 'winner' of Rachel's affection but this is a less satisfactory explanation). Without proof of a psychotic motive for Van Gogh's act, the use of the eponym is at best unnecessary and at worst potentially misleading.
Yours Dr Brian Murray
(1) Parrot, H & Murray, B. Self-mutilation: review and case study International Journal of Clinical Practice 2001; 55(5)
While there are multiple causes, vaccine-induced schizophrenia cannot be ignored.
Arumugham V, Trushin M V. Role of NMDA receptor autoimmunity induced by food protein containing vaccines, in the etiology of autism, type 1 diabetes, neuropsychiatric and neurodegenerative disorders. Int J Pharm Res. 2019;11(1):428–37.
We are delighted that you are interested in our study. In terms of diet, we mainly recorded the usual diet and the diet from the past 24 hours. We found that the diet structure was consistent, but we did not further quantify the relative amount of food you mentioned. Regarding BMI, although we collected the same sample as the previous study, the selecting sample number is a different and we ended up selecting only a fraction of the original samples according to the strict sample collecting rule's limitation, therefore, some BMI values were missing and thus not complete analyzed in the article. Partly Data ANCOVA analysis Result showed no difference. The high altitude and small population of Tibet, combined with communication barriers, made it challenging to collect the sample. Therefore, we could not follow the strict inclusion and perfect criteria to collect the sample. However, as a preliminary study on the relationship between meditation and intestinal bacteria, our findings shed some light on the subject. It still is also good to bring some enlightenment to the field.
Reference: Xue T, Chiao B, Xu T, et al. The heart-brain axis: a proteomics study of meditation on the cardiovascular system of Tibetan monks. EBioMedicine 2022;80:104026.
Dear authors,
Thank you for your interesting study on the effect of meditation on the faecal microbiota. The paper itself states that "...both [control and meditation] groups had the same dietary structure. The staple food mainly included highland barley, rice, steamed bread and noodles, and the supplementary food primarily comprised vegetables, meat and butter tea.'", but no other information or data is provided.
In your reply to Dr Ong’s Rapid Response, you helpfully point readers interested in this question to the supplementary tables of your previously published paper using the same participants (1), with Supplementary Table 7 being the most relevant here. However, after examining the table and the other information provided in both papers, it is still unclear to me how diet was controlled for. The implication from the table is that participants in the Monk and Control groups were simply asked, in a qualitative way, whether or not various food groups were included in their daily diet. This information does not seem sufficient to use to control for diet, since the food groups participants about which participants were asked are very broad (e.g. highland barley, rice, noodles) - meaning that participants are likely to include/not include similar groups in their diet, even as the relative quantities of each food group that they consume may differ substantially. Could you please clarify how information about participants’ diet was recorded, and...
Show MoreSun and colleagues compared the faecal microbiota of 37 Tibetian monks with 19 ordinary residents nearby to conclude that meditation favorably affected gut microbiota to have a positive effect on health. However, monks in a temple may differ from ordinary lay residents in other ways besides the practice of meditation. While monks are strict vegetarians, lay people are under no such obligation. Life in a temple is also more sheltered and less stressful when compared to that of ordinary people living in a harsh, high altitude environment. To show that it is meditation which causes the favorable faecal microbiota, the researchers would have to test the monks after a meditation free period, or else subject their lay controls to a period of intense mediation to see if there is any change in fecal microbiota afterwards. In selecting non monks who may be different as their controls, the researchers can be justified in concluding that monastic life favorably influences gut microbiota, but are not justified in attributing the change solely to meditation.
Reference:
Sun Y, Ju P, Xue T, et al. Alteration of faecal microbiota balance related to long-term deep meditation. General Psychiatry 2023;36:e100893. doi: 10.1136/gpsych-2022-100893
Hean T Ong, FRCP, FACC, FESC
Consultant Cardiologist, HT Ong Heart Clinic, Penang, Malaysia
Reply：
Thank you for your letter and interest in our study. We would like to make some clarification in reply to the...
Show MoreWe consider that the intestinal microbiota is not only related to anxiety disorders. The microbiota-gut-brain axis is related to multiple mental disorders. If we start from the phrase "we are what we eat" we should pay better attention to a healthy diet and support Hippocrates when he said "let food be your best medicine and your best medicine be your food". We know the microbiota as the set of microorganisms that live symbiotically in a given ecological niche, in this case it refers to the intestinal microbiota where there are native species that colonize the gastrointestinal tract and a variable series of living microorganisms that are transiting through the tube digestive. Anaerobic germs predominate, bacteroides, bifidobacterium, eubacterium, clostridium, lactobacillus. The evolution of the microbiota varies from the fetal stage to adulthood and factors that modify it intervene in this evolution: diet, pH, oxygen concentration, nutrient availability, stress, genetic factors, the use of antibiotics, lactation maternal, prematurity, caesarean section among others. There is a bidirectional and dynamic communication between the intestine and the brain through nervous, endocrine and immune signaling pathways, so the role of neurotransmitters, hormones, metabolites, cytokines is fundamental in the appearance of mental illnesses that are reference.
The article by Vadivel et al addressed the issue of impending mental health crisis in the Post COVID era [1]. The article comprehensively highlights the risk factors, vulnerable groups with either existing or potential of developing mental health issues during these unforeseen circumstances. There are certain pertinent points we would like to highlight in the study.
Show MoreThe authors have correctly pointed out the lack of specific diagnostic or screening tools for Post COVID assessment of mental health. Additionally, both DSM-5 and ICD-10 are interview-based, which may under-report or over-report the underlying conditions.[1] Further to explore the mental health concerns, traditionally psychometric questionnaires have been used as an instruments for assessment, with the advantage of ease of use and highlighting the perception of the subject. However, since they are subjective and may be influenced by subject’s unwillingness, thereby can lead to delay in treatment.[2]
Here, we would like to emphasize the role of objective physiological markers for the assessment of stress. Stress is one of the plausible factor increasing the existing mental health illness or contributing to new ones. Though the impact of stress has been explored using subjective questionnaires in COVID-19, but it is mostly done during the course of the illness rather than addressing the Post COVID sequalae. Surprisingly, there is an inconspicuous absence of quantitative measures, which may help to del...
Psychological distress is common and expected in people who have not only contracted COVID but also their families and not the least the treating health professionals too. There is not just Peritraumatic Stress but also Pretraumatic Stress (before infection), Posttraumatic Stress (after coming out) and Paratraumatic Stress (for those around). We are indeed in extraordinary times. Extraordinary problems call for extraordinary solutions. After reading this article and feeling despondent I was particularly impressed by an article by Lizzie Burns titled Transforming the everyday into something beautiful: How origami can help encourage self-care (BMJ Opinion December 21, 2020). It nicely highlights one way in which how our creative instincts could be cultivated to uplift our consciousness to become more self-conscious, self-compassionate and self-confident in sustaining and thriving during these challenging times. This article is encouraging and reassuring that healthcare is indeed as much an art as a science. It is time that more of us recognize this and create the much-needed mainstreaming of aesthetics into essential healthcare.
The COVID-19 crisis has had its impact on mental well-being and has stretched our physical psychological resources to their capacity. The challenges have been extraordinary. Agencies of all disciplines from molecular genetics to psychology are trying their best to come up with varying approaches to sustainable solutions to the pandemic proble...
Show MoreI found the editorial by Qiu J et al[1] on the “first nationwide large-scale survey of psychological distress in the general population of China during the COVID-19 epidemic” very insightful. There are similar reports from several other countries on a similar mental health crisis initiated by COVID-19 pandemic and the economic downturn. Qiu J et al[1] have presented the content effectively, and I was gratified with the viewpoint on the recommendation on “nationwide strategic planning and coordination for psychological first aid during major disasters, potentially delivered through telemedicine” along with “screening, referral and targeted intervention should be built to reduce psychological distress and prevent further mental health problem”.
Show MoreWhile this recommendation is expected to be very effective, there are of course practical, logistical, and economic challenges in the implementation of any large scale nationwide yet much needed psychological first aid. "Biopsychosociospiritual" model of primary healthcare could be however one of the strategies for effective promotion of mental health and prevention of mental disorders, substance abuse and self-harm behaviours.
In psychology, the “philosophy of mind" explores the relationship and association between the “mind” referred to as the “mental or emotional domain” and the “brain or body” referred to as the “physical domain”.[2] In the context of the relationship between mind and brain, mind most of...
The indicator of addiction severity in clinical studies, for a long time, relies on experienced craving report for drug-related cues. This condition ranges from both addictive assessments and diagnosis, to the estimation of clinical intervention. However, self-report of craving is susceptible to the influences of social desirability and self-masking in many situations. This necessitates the development of an objective measurement that can detect one’s real craving, which is independent of these obscuring factors.
Show MoreThe article by Yuan Liang and colleagues entitled “Assessing the Severity of Methamphetamine Use Disorder Beyond the Subjective Craving Report: the Role of an Attention Bias Test” shows that attention bias test represents a more reliable indicator for the addictive severity in methamphetamine dependents. The authors observed that MA dependents, irrespective of high or low craving report, showed similar attention bias to drug-related photographs by using correlation analyses. Moreove...
Dear Sir / Madam - many thanks to Mudgal et al for their interesting and comprehensive case report. I wonder, however, how useful the term 'Van Gogh' syndrome is compared with simply 'self - mutilation'? The term is commonly used to refer to self-mutilation in the context of psychosis, but my contribution to a similar case caused me to research Van Gogh's medical history (1). Although it is commonly assumed Van Gogh suffered psychosis, evidence for this is scant: his behaviour was always variably aggressive and unpredictable but there were no clear 'episodes' with a 'well' Van Gogh in between, and overt delusions and hallucinations were conspicuous by their absence. Sometimes his style of painting is suggested as 'proof' of psychosis but this belies his creative genius. In fact, it seems the traits of aggression and unpredictable behaviour, coupled with a desire to punish himself or others in the context of unstable relations, were longstanding and suggest an emotionally unstable personality disorder. A bull's ear was traditionally given as a prize to victorious bull fighters in Arles, where Van Gogh was trying to set up an artistic community with Gaugain. Van Gogh's 'gift' of his ear to a maid in a brothel , Rachel, (she was not a sex worker) could be seen as a symbolic rather than psychotic act: he and Gaugain were vying for her affections and it is in this context that he gave his ear as a...
Show MoreWhile there are multiple causes, vaccine-induced schizophrenia cannot be ignored.
Arumugham V, Trushin M V. Role of NMDA receptor autoimmunity induced by food protein containing vaccines, in the etiology of autism, type 1 diabetes, neuropsychiatric and neurodegenerative disorders. Int J Pharm Res. 2019;11(1):428–37.
https://doi.org/10.5281/zenodo.1463600
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