The Roles of Exercise and Yoga in Ameliorating Depression as a Risk Factor for Cognitive Decline

Mathersul, Danielle C.; Rosenbaum, Simon

doi:https://doi.org/10.1155/2016/4612953

Evidence-Based Complementary and Alternative Medicine

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Complementary Medicine for the Modification of Risk Factors for Cognitive Impairment

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Review Article | Open Access

Volume 2016 | Article ID 4612953 | https://doi.org/10.1155/2016/4612953

The Roles of Exercise and Yoga in Ameliorating Depression as a Risk Factor for Cognitive Decline

Danielle C. Mathersul^1,2,3and Simon Rosenbaum^4,5

Academic Editor: David Camfield

Received04 Aug 2016

Accepted25 Oct 2016

Published01 Dec 2016

Abstract

Currently, there are no effective pharmaceutical treatments to reduce cognitive decline or prevent dementia. At the same time, the global population is aging, and rates of dementia and mild cognitive impairment (MCI) are on the rise. As such, there is an increasing interest in complementary and alternative interventions to treat or reduce the risk of cognitive decline. Depression is one potentially modifiable risk factor for cognitive decline and dementia. Notably, exercise and yoga are two interventions known to both reduce symptoms of depression and improve cognitive function. The current review discusses the efficacy of exercise and yoga to ameliorate depression and thereby reduce the risk of cognitive decline and potentially prevent dementia. Potential mechanisms of change, treatment implications, and future directions are discussed.

1. Introduction

Globally, the population is aging, and disorders associated with cognitive decline, including dementia and mild cognitive impairment (MCI), are on the rise. Research is increasingly aiming to identify modifiable risk factors for cognitive impairment. Psychological disorders such as mood and anxiety disorders are highly prevalent in older populations [1]. These disorders are associated with cognitive deficits, including poor concentration, attention, and memory [2–4]. At the same time, there is growing evidence to suggest that mood and anxiety disorders may be risk factors for cognitive decline in later life [5]. Indeed, in older adults, dementia is associated with similar, overlapping symptoms to depression and delirium, and careful differential diagnosis is required to accurately confirm that [6, 7]. In this way, amelioration of low mood and depression may assist in improving symptoms of poor cognition in individuals either with or without a diagnosis of dementia or MCI. Beyond this though, these findings suggest that treatment and prevention of mood disorders prior to the onset of older age and/or cognitive decline may prevent or at least slow the development of clinically significant deficits in cognitive function.

Recent systematic reviews and meta-analyses have confirmed that both mid- and late-life depression are associated with an increased risk of dementia [8–10]. Indeed, the risk of Alzheimer’s disease (AD) is almost doubled, and the risk of vascular dementia (VaD) is almost tripled, if an individual presents with clinical symptoms of depression in mid- to late-life [8–10]. Due to the high rates of cooccurrence between depression and dementia there is also the suggestion that depression may be part of the dementia prodrome. Interestingly, emerging evidence suggests that first presentation of depression later in life may reflect prodromal AD, whereas chronic or recurrent life-time depression may be associated with long-term cerebrovascular changes that predispose an individual towards the development of dementia, including VaD [8, 11] and AD [10, 12]. Furthermore, the presence of depression in individuals showing signs of cognitive decline (i.e., MCI) increases the risk of developing AD [13].

Depression is therefore a potentially modifiable risk factor for cognitive decline and dementia [14, 15]. Current first-line treatments (pharmaceutical and psychological interventions) demonstrate moderate success; however, nonresponse occurs in up to 50% of cases and many individuals fail to maintain long-term improvements [16–19]. Similarly, there is no cure for dementia and no treatment to reverse cognitive decline [20]. At best, some treatments help to alleviate certain cognitive or behavioral symptoms [21]. This highlights the need to investigate complementary and alternative treatments. Alternative therapies are often appealing to individuals who have found little or no improvement through standard interventions. Advantages of these interventions include reduced cost [22] (allowing greater access to at-risk populations and potentially producing a more sustainable long-term intervention), fewer side-effects, high levels of acceptability, and high congruence with popular culture (potentially increasing compliance). Beyond this, complementary and alternative interventions may have the potential to prevent future symptoms, in a way that is not evident with pharmaceutical interventions. In this review, we discuss the potential for two complementary and alternative interventions, exercise and yoga, to target depression and therefore reduce a significant risk factor for cognitive decline and dementia.

2. Exercise to Treat Depression

Both physical activity and exercise (i.e., a subset of physical activity that is planned, structured, and repetitive and has physical fitness as a final or an intermediate objective [23]) have been identified as having prevention and treatment effects on depression [24–26]. Moderate intensity, supervised exercise programs of at least nine-week duration (trials typically range from 8 to 16 weeks), utilising a combination of aerobic and resistance based exercise sessions, and a group format appear to have the greatest impact on reducing depressive symptoms [27, 28]. The largest community-based trial of exercise for major depressive disorder (MDD) involved 946 outpatients randomized to either 12 weeks of prescribed exercise, Internet-based cognitive behavioral therapy (CBT), or usual care consisting of brief CBT-focused therapy and antidepressant treatment and found that supervised exercise three times per week resulted in significantly lower depression severity compared to usual care and was equivalent to the Internet-CBT group [29]. These results are promising from an implementation perspective, especially for those groups for whom significant barriers to accessing standard clinician-delivered CBT exist, including stigma and financial costs associated with seeking treatment.

Nonetheless, there is ongoing debate within the scientific literature regarding the magnitude of effect of exercise on depression. Methodological differences between recent systematic reviews and meta-analyses [30], specifically around (i) the argument for and against the inclusion of pragmatic interventions such as physical activity counseling and yoga, which many argue better reflect real world clinical practice [31], and (ii) a large control group response (SMD −0.9) across exercise and depression RCTs [32], have resulted in an underreporting of the overall effect size. A 2016 meta-analysis of 25 RCTs including people with a diagnosis of depression and those with depressive symptoms found a large and significant overall effect on depression after adjustment for publication bias with an SMD of −1.11, corresponding to an approximate 5-point reduction in the Hamilton Rating Scale for Depression (HAM-D) and a greater than 6-point reduction in the Beck Depression Inventory (BDI), both of which are considered clinically significant based on the National Institute for Health and Care Excellence (NICE) guidelines [24, 33]. Additionally, it was found that a total of 1,057 negative studies would be required to nullify the significance of the main analysis, further justifying the robustness of the analysis [24]. These data are consistent with a 2015 meta-analysis of 23 RCTs investigating the effect of exercise on depressive symptoms of adults with neurologic disorders including AD which found a small but significant overall effect size of 0.28, with stronger effects of interventions meeting recommended physical activity guidelines [34]. In a subsequent 2016 meta-analysis, Schuch et al. reviewed the literature relating to exercise for depression in older adults (60 years) and found a large, significant effect of exercise on depression across the eight included RCTs (SMD = −0.90) [27].

In addition to large treatment effects, the preventative role of physical activity is becoming increasingly clear. A 2013 review of 25 studies found that baseline physical activity was negatively associated with a risk of future depression, with evidence for an effect with even low levels of physical activity (i.e., less than the recommended weekly total of 150 minutes [35]) [25]. Evidence for the bidirectional relationship between physical activity and depression continues to increase, with a recent longitudinal study of more than 1,000 participants showing that positive lifestyle behaviors (e.g., physical activity) at baseline were associated with a 22% (RR 0.76) reduced risk of episodes of a mood disorder at five-year follow-up [36]. These data are in line with a 2014 meta-analysis of observational studies finding that sedentary behavior, independent of physical activity, is associated with a significantly increased risk of depression [37]. This then becomes a vicious cycle, as people experiencing depression engage in significantly less physical activity compared to the general population [38, 39].

3. Exercise to Improve Cognitive Function

Exercise is increasingly acknowledged as having a positive effect on cognition in both the general and clinical populations, including those with depression. Evidence suggests exercise has modest effects on aspects of cognitive performance, including attention, processing speed, memory, and executive functioning [40]. While there is emerging evidence of a dose-response relationship between exercise and cognition [41], even low doses of exercise appear to provide attention and visuospatial benefits for both healthy and depressed older adults [42, 43]. For example, improvements in attention and inhibitory control but not working memory have been found following a single, moderate intensity (65–75% of estimated maximal heart rate) exercise session [43]. Subsequent analysis of data from a large study of exercise for depression found that individuals with MDD who received a public health guideline concordant dosage of exercise (equivalent to 30 min of moderate intensity aerobic exercise, five or more days per week) had improved psychomotor speed, attention, visual memory, and spatial planning at 12-week follow-up [41].

In addition to aerobic exercise there is promising and increasing evidence for the role of strength (resistance) training in promoting cognition among older adults. In arguably one of the most comprehensive studies to date, Suo et al. found that, among 100 older individuals (mean age 70.1 years) with MCI, six months of progressive resistance training but not computerised cognitive training significantly improved global cognition [44]. Interestingly, the computerised cognitive training program but not the exercise intervention attenuated decline in overall memory performance. The available evidence suggests that targeted exercise programs are feasible, acceptable, and effective in improving aspects of cognition among vulnerable populations including older adults.

4. Yoga to Treat Depression

Yoga is an integrative mind-body practice that combines physical activity (postures or asanas) with mindfulness practices (breath control (pranayama) and meditation (dhyana)), typically performed concurrently. Several recent systematic reviews and meta-analyses have demonstrated that yoga is effective in ameliorating symptoms of depression across a range of different clinical disorders, including MDD [45–48], posttraumatic stress disorder (PTSD) [49], stress and anxiety [50], and schizophrenia [51], as well as at-risk samples, such as pregnant women [52, 53], and individuals with chronic illnesses (multiple sclerosis [54], cancer [55], and fibromyalgia [56, 57]). Yoga also improves sleep [58], a known transdiagnostic and risk factor for psychopathology [59, 60]. Importantly, one study demonstrated significant improvements in depressed mood, well-being, and self-efficacy for a group of older adults (65–92 years), compared to either a control or exercise group [61]. Similarly, yoga improved mental/emotional wellness in a small group of older adults (66 years) [62]. These studies suggest that yoga may have beneficial effects at any age, though longitudinal studies are needed to determine whether there is a crucial period for prevention of cognitive decline.

A major confound within the literature is the heterogeneity in methodology, including type of yoga intervention (particularly in the ratio of asana versus pranayama), control group, and duration and intensity of the intervention. In particular, yoga treatment studies do not always offer dosage equivalency to other standard treatments for depression [45]. While yoga appears to demonstrate a significant advantage in comparison to a no treatment or passive control group, findings are less conclusive when compared to active controls. For example, one study found yoga to be less effective than electroconvulsive therapy (ECT) but at least equivalent to antidepressants [63]. In contrast, a recent systematic review and meta-analysis found in favour of yoga when compared to aerobic exercise or usual care (including group therapy, support group, or pharmaceutical intervention, but also wait-list control) [47]. While some studies suggest a cumulative psychological advantage in long-term meditators [64, 65] and lower rate of depression remission at 9-month follow-up for group yoga [66], overall, there is a paucity of longitudinal follow-up studies investigating the long-term effects of yoga.

5. Yoga to Improve Cognitive Function

A recent meta-analysis concluded that yoga is associated with overall moderate improvements in cognitive function, particularly attention, processing speed, executive function, and memory [67]. Acute intervention studies demonstrated more consistent cognitive improvements and stronger effects sizes than RCTs ( = .56 versus = .33, resp.). Similarly, a recent systematic review confirmed that yoga improves executive function in both healthy individuals and those with chronic illnesses such as multiple sclerosis or type 2 diabetes mellitus [68]. A cross-sectional study of older adults (>55 years) classified as long-term yoga practitioners (>10 years) demonstrated significantly superior performance on multiple tests of attention than an age- and education-matched comparison group [69]. Importantly, yoga significantly improved cognitive impairments and depressed mood in a group of individuals with MDD [70], demonstrating scope for treatment across multiple domains. However, as with the literature regarding yoga interventions for mood difficulties, major limitations exist in the literature for yoga as a cognitive enhancing intervention. Very few studies provide sufficient information regarding the yoga intervention and the proportion of time spent practicing each of the major elements (i.e., asanas, pranayama, and dhyana) [67]. At the same time, yoga is inherently a mind-body exercise, and arguably, it is difficult to completely disentangle the various components (i.e., part of performing an asana correctly is to also simultaneously and concurrently employ pranayama and dhyana). Nonetheless, there is a need to compare yoga to interventions that are not inherently mind-body, that is, physical activity/exercise interventions alone, and to mindfulness-based interventions alone. A 2010 review of 10 studies comparing yoga to physical exercise found that yoga and exercise were equally beneficial for physical health, but yoga was superior to exercise for improving cognitive function and mental health [71]. However, further research is needed, particularly on populations with clinical disorders (either mental or cognitive) and in older samples. Currently, there is little regulation or standardisation in terms of recommended dose (e.g., session duration, frequency/regularity, and long-term duration) or type (especially in terms of variations in emphasis on the major components) of yoga intervention.

6. Mechanisms of Action

Many theorists suggest that the association between depression and dementia is due to a common underlying vulnerability factor (stress), which triggers neuroinflammation and disruption of the hypothalamic-pituitary adrenal (HPA) axis [72–75]. Resulting hypercortisolism may lead to neural damage, including reduced hippocampal neurogenesis [76, 77], possibly via reductions in hippocampal brain-derived neurotrophic factor (BDNF) [78, 79]. Hypercortisolism is associated with depression [80], long-term impairments in cognitive function [81], and dementia [82]. Abnormal expression of BDNF and associated reductions in hippocampal neurogenesis are linked to depression [78, 83]. Similarly, dysfunction of hippocampal neurogenesis [84] and reduced BDNF [85] are both associated with increased risk for dementia. More recently, a 38-year follow-up study found that mid-life neuroticism is associated with an increased risk of AD [86]. This is particularly interesting given that current theories propose a common, nonspecific factor of negative affect (neuroticism) as a vulnerability factor for emotional disorders, including depression and anxiety [87, 88]. That is, either stress or neuroticism may be vulnerability factor for depression and/or dementia. However, there is also evidence for a direct link between the two; depression may trigger neuroinflammation that then sensitises the brain to other precipitants of dementia [73]. Indeed, chronic neuroinflammation creates a vicious cycle that may maintain depression and increase the chances of permanent long-term damage [74], including cognitive decline and dementia. While further research is necessary to clarify cause and effect relationships, particularly the extent to which a genetic predisposition is necessary, breaking the inflammatory cycle and/or hippocampal neurogenesis is likely to be beneficial for preventing both depression and dementia.

Both acute and chronic responses to exercise have been identified, including increases in atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), copeptin, and growth hormone, as well as chronic adaptations of copeptin and thiobarbituric acid reactive species (TBARS) [89]. In a recent review of the neurobiological effects of exercise on depression, Schuch et al. [89] reported that the mechanisms by which exercise affects depression are yet to be clearly understood. Despite limited evidence that exercise promotes neurogenesis and changes in inflammation biomarkers and overall brain structure, two studies included within the review reported evidence of an association between improvements in depressive symptoms and increases in hippocampus volume and IL-1B following exercise [89].

At the same time, a recent systematic review and meta-analysis confirmed that yoga has a downregulating effect on the sympathetic nervous system and the HPA axis in response to stress, including reductions in morning cortisol, blood pressure, and heart rate [48]. There is also preliminary evidence suggesting yoga may increase BDNF [90]. Mindfulness-based psychological therapies which have some overlap with yoga (e.g., mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (mbCT/mCBT/MBCT)) are known to downregulate the sympathetic nervous system and the HPA axis in response to stress [64, 91–94] and are associated with long-term increases in hippocampal grey matter [95]. Beyond these anti-inflammatory effects, yoga and related activities such as mindfulness meditation may improve mood and cognition via increased focus, attentional awareness, and emotion regulation and/or reduced neuroticism or negative perseverative thinking (i.e., rumination, worry) [96–100]. In this way, yoga combines both top-down (from mind to body, through mindfulness) and bottom-up (from body to mind, through reduced neuroinflammation and stress response) effects that may distinguish it from exercise, where top-down effects are a potential side-effect versus core component. Further research is needed to disentangle the unique versus shared mechanisms of action between exercise and yoga.

7. Implications for Treatment

Henceforth, the challenge ahead lies in the adaptation and translation of findings from clinical trials to person-centred initiatives, capable of delivering appropriate exercise and yoga interventions at a scalable level for people at risk of or experiencing depression and/or cognitive decline. Despite the numerous protective and treatment benefits that physical activity and yoga may offer, effectiveness of these interventions is overwhelmingly limited by the barriers to being physically active that are prevalent across society (i.e., poor motivation) and compounded among those experiencing symptoms of depression or cognitive decline [101]. While continued research into the mechanisms behind the antidepressive effects of exercise or yoga is certainly required, a focus on implementation and addressing cultural, educational, and logistical issues within treatment services is equally as important. While behavioral activation, a key component of CBT that involves scheduling activities that are pleasurable and allow opportunities for mastery [102–104], may include some form of physical activity, this review suggests that it is necessary. From a pragmatic perspective, clinical psychologists may combine this scheduling with positive data logs [105] and gratitude or savoring techniques [106–110] to increase compliance. Furthermore, programs delivered by professionals such as physiotherapists and exercise physiologists with tertiary training in exercise prescription are associated with reduced dropout and increased motivation to exercise among people with an affective disorder [111], highlighting the importance of multidisciplinary mental health teams to ensure the translation of findings into real world, scalable programs [112–114].

8. Future Directions

Important questions remain. In particular, it is currently unclear whether or not there are unique or combined effects of physical activity versus mindfulness/meditation. That is, is there something extra special about yoga (which combines the two, within the same activity), or can either individually exert similar positive benefits? Alternatively, is there an external third factor (e.g., regular routine, organised social activity) contributing to the improvements? Currently, there is a paucity among the literature. Very few studies have compared yoga to either exercise or mindfulness/meditation as short-term interventions, for either mood or cognitive deficits. Beyond that, no studies have compared the long-term effects of any of these interventions in the prevention of either mood disorders or clinical cognitive deficits.

The heterogeneity of depression also needs to be addressed. Indeed, individuals require 5 of a possible 9 diagnostic symptoms to meet criteria for MDD, creating high internal variability amongst individuals, independent of symptom severity (see [115] for further discussion). Furthermore, do factors such as clinical symptom severity (including comorbidity) or clinical course (recurrent versus chronic, age of onset, etc.) moderate the potential benefits of exercise and/or yoga? For example, depression and anxiety are highly comorbid [116–120], which negatively affects treatment and recovery, quality of life, and global functioning, over and above the effects of either disorder independently [121–123], suggesting comorbid depression/anxiety may be quantitatively or qualitatively different than either disorder alone. Studies have also demonstrated that anxiety negatively affects cognition [2, 3, 124, 125] and that exercise [26, 46] and yoga [46, 126] may help to ameliorate these associated cognitive deficits. However, no study to date has teased apart the unique effects of exercise and/or yoga on anxiety versus depression, in relation to risk for cognitive decline. Furthermore, while it is known that age of onset of depression plays a role in the development of dementia [8, 10–13], it is unknown how this interacts with treatments. For example, is there crucial or optimal time window for intervention? Future studies should investigate the potential benefits of exercise and yoga in the context of clinical severity and course.

9. Conclusion

Depression is a potentially modifiable risk factor for dementia. Both exercise and yoga are effective treatments for depression and cognitive decline that are also relatively easy and cost-effective to implement. However, it is currently unclear which components of these interventions (e.g., physical activity, mindfulness) are necessary or sufficient to produce change. Further research is also needed to determine whether these interventions are capable of preventing or at least slowing the development of clinically significant deficits in cognitive function and, if so, the optimal timing of these interventions.

Competing Interests

The authors declare that they have no competing interests.

Acknowledgments

Danielle C. Mathersul is supported by a Veterans Affairs Postdoctoral Fellowship. Simon Rosenbaum is funded by a Society for Mental Health Research Early Career Fellowship.

References

A. L. Byers, K. Yaffe, K. E. Covinsky, M. B. Friedman, and M. L. Bruce, “High occurrence of mood and anxiety disorders among older adults: The National Comorbidity Survey Replication,” Archives of General Psychiatry, vol. 67, no. 5, pp. 489–496, 2010.
View at: Publisher Site | Google Scholar
F. Ferreri, L. K. Lapp, and C.-S. Peretti, “Current research on cognitive aspects of anxiety disorders,” Current Opinion in Psychiatry, vol. 24, no. 1, pp. 49–54, 2011.
View at: Publisher Site | Google Scholar
Y. Yang, X. Zhang, Y. Zhu, Y. Dai, T. Liu, and Y. Wang, “Cognitive impairment in generalized anxiety disorder revealed by event-related potential N270,” Neuropsychiatric Disease and Treatment, vol. 11, pp. 1405–1411, 2015.
View at: Publisher Site | Google Scholar
K. Yaffe, T. Blackwell, R. Gore, L. Sands, V. Reus, and W. S. Browner, “Depressive symptoms and cognitive decline in nondemented elderly women: A Prospective Study,” Archives of General Psychiatry, vol. 56, no. 5, pp. 425–430, 1999.
View at: Publisher Site | Google Scholar
C. Burton, P. Campbell, K. Jordan, V. Strauss, and C. Mallen, “The association of anxiety and depression with future dementia diagnosis: a case-control study in primary care,” Family Practice, vol. 30, no. 1, pp. 25–30, 2013.
View at: Publisher Site | Google Scholar
M. Benoit, G. Berrut, J. Doussaint et al., “Apathy and depression in mild Alzheimer's disease: a cross-sectional study using diagnostic criteria,” Journal of Alzheimer's Disease, vol. 31, no. 2, pp. 325–334, 2012.
View at: Publisher Site | Google Scholar
J. T. Olin, L. S. Schneider, I. R. Katz et al., “Provisional diagnostic criteria for depression of Alzheimer's disease: description and review,” Expert Review of Neurotherapeutics, vol. 3, no. 1, pp. 99–106, 2003.
View at: Publisher Site | Google Scholar
D. E. Barnes, K. Yaffe, A. L. Byers, M. McCormick, C. Schaefer, and R. A. Whitmer, “Midlife vs late-life depressive symptoms and risk of dementia,” Archives of General Psychiatry, vol. 69, no. 5, pp. 493–498, 2012.
View at: Publisher Site | Google Scholar
B. S. Diniz, M. A. Butters, S. M. Albert, M. A. Dew, and C. F. Reynolds III, “Late-life depression and risk of vascular dementia and Alzheimer's disease: systematic review and meta-analysis of community-based cohort studies,” British Journal of Psychiatry, vol. 202, no. 5, pp. 329–335, 2013.
View at: Publisher Site | Google Scholar
R. L. Ownby, E. Crocco, A. Acevedo, V. John, and D. Loewenstein, “Depression and risk for Alzheimer disease: systematic review, meta-analysis, and metaregression analysis,” Archives of General Psychiatry, vol. 63, no. 5, pp. 530–538, 2006.
View at: Publisher Site | Google Scholar
G. S. Alexopoulos, “Vascular disease, depression, and dementia,” Journal of the American Geriatrics Society, vol. 51, no. 8, pp. 1178–1180, 2003.
View at: Publisher Site | Google Scholar
L. V. Kessing and P. K. Andersen, “Does the risk of developing dementia increase with the number of episodes in patients with depressive disorder and in patients with bipolar disorder?” Journal of Neurology, Neurosurgery and Psychiatry, vol. 75, no. 12, pp. 1662–1666, 2004.
View at: Publisher Site | Google Scholar
P. J. Modrego and J. Ferrández, “Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study,” Archives of Neurology, vol. 61, no. 8, pp. 1290–1293, 2004.
View at: Publisher Site | Google Scholar
D. E. Barnes and K. Yaffe, “The projected effect of risk factor reduction on Alzheimer's disease prevalence,” The Lancet Neurology, vol. 10, no. 9, pp. 819–828, 2011.
View at: Publisher Site | Google Scholar
C. F. Reynolds III, P. Cuijpers, V. Patel et al., “Early intervention to reduce the global health and economic burden of major depression in older adults,” Annual Review of Public Health, vol. 33, pp. 123–135, 2012.
View at: Publisher Site | Google Scholar
J. C. Nelson, L. Portera, and A. C. Leon, “Residual symptoms in depressed patients after treatment with fluoxetine or reboxetine,” Journal of Clinical Psychiatry, vol. 66, no. 11, pp. 1409–1414, 2005.
View at: Publisher Site | Google Scholar
H. L. Van, J. Dekker, J. Peen, G. Van Aalst, and R. A. Schoevers, “Identifying patients at risk of complete nonresponse in the outpatient treatment of depression,” Psychotherapy and Psychosomatics, vol. 77, no. 6, pp. 358–364, 2008.
View at: Publisher Site | Google Scholar
R. J. DeRubeis, L. A. Gelfand, T. Z. Tang, and A. D. Simons, “Medications versus cognitive behavior therapy for severely depressed outpatients: mega-analysis of four randomized comparisons,” American Journal of Psychiatry, vol. 156, no. 7, pp. 1007–1013, 1999.
View at: Google Scholar
R. J. DeRubeis, S. D. Hollon, J. D. Amsterdam et al., “Cognitive therapy vs medications in the treatment of moderate to severe depression,” Archives of General Psychiatry, vol. 62, no. 4, pp. 409–416, 2005.
View at: Publisher Site | Google Scholar
M. Baumgart, H. M. Snyder, M. C. Carrillo, S. Fazio, H. Kim, and H. Johns, “Summary of the evidence on modifiable risk factors for cognitive decline and dementia: a population-based perspective,” Alzheimer's and Dementia, vol. 11, no. 6, pp. 718–726, 2015.
View at: Publisher Site | Google Scholar
H. B. Nygaard, “Current and emerging therapies for Alzheimer's disease,” Clinical Therapeutics, vol. 35, no. 10, pp. 1480–1489, 2013.
View at: Publisher Site | Google Scholar
Deloitte Access Economics, Value of Accredited Exercise Physiologists in Australia, Barton, ACT, 2015.
C. J. Caspersen, K. E. Powell, and G. Christenson, “Physical activity, exercise and physical fitness: definitions and distinctions for health-related research,” Public Health Reports, vol. 100, no. 2, pp. 126–131, 1985.
View at: Google Scholar
F. B. Schuch, D. Vancampfort, J. Richards, S. Rosenbaum, P. B. Ward, and B. Stubbs, “Exercise as a treatment for depression: A meta-analysis adjusting for publication bias,” Journal of Psychiatric Research, vol. 77, pp. 42–51, 2016.
View at: Publisher Site | Google Scholar
G. Mammen and G. Faulkner, “Physical activity and the prevention of depression: a systematic review of prospective studies,” American Journal of Preventive Medicine, vol. 45, no. 5, pp. 649–657, 2013.
View at: Publisher Site | Google Scholar
A. L. Rebar, R. Stanton, D. Geard, C. Short, M. J. Duncan, and C. Vandelanotte, “A meta-meta-analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations,” Health Psychology Review, vol. 9, no. 3, pp. 366–378, 2015.
View at: Publisher Site | Google Scholar
F. B. Schuch, D. Vancampfort, S. Rosenbaum et al., “Exercise for depression in older adults: a meta-analysis of randomized controlled trials adjusting for publication bias,” Revista Brasileira de Psiquiatria, vol. 38, no. 3, pp. 1–8, 2016.
View at: Publisher Site | Google Scholar
R. Stanton and P. Reaburn, “Exercise and the treatment of depression: a review of the exercise program variables,” Journal of Science and Medicine in Sport, vol. 17, no. 2, pp. 177–182, 2014.
View at: Publisher Site | Google Scholar
M. Hallgren, M. Kraepelien, A. Öjehagen et al., “Physical exercise and internet-based cognitive-behavioural therapy in the treatment of depression: randomised controlled trial,” The British Journal of Psychiatry, vol. 207, no. 3, pp. 227–234, 2015.
View at: Publisher Site | Google Scholar
P. Ekkekakis, “Honey, I shrunk the pooled SMD! Guide to critical appraisal of systematic reviews and meta-analyses using the Cochrane review on exercise for depression as example,” Mental Health and Physical Activity, vol. 8, pp. 21–36, 2015.
View at: Publisher Site | Google Scholar
S. Rosenbaum, A. Tiedemann, C. Sherrington, J. Curtis, and P. B. Ward, “Physical activity interventions for people with mental illness: a systematic review and meta-analysis,” Journal of Clinical Psychiatry, vol. 75, no. 9, pp. 964–974, 2014.
View at: Publisher Site | Google Scholar
B. Stubbs, D. Vancampfort, S. Rosenbaum et al., “Challenges establishing the efficacy of exercise as an antidepressant treatment: a systematic review and meta-analysis of control group responses in exercise randomised controlled trials,” Sports Medicine, vol. 46, no. 5, pp. 699–713, 2015.
View at: Publisher Site | Google Scholar
NICE, Depression: The Treatment and Management of Depression in Adults (Updated Edition) NICE Clinical Guideline 90, National Collaborating Centre for Mental Health, Leicester, UK, 2009.
B. C. Adamson, I. Ensari, and R. W. Motl, “Effect of exercise on depressive symptoms in adults with neurologic disorders: a systematic review and meta-analysis,” Archives of Physical Medicine and Rehabilitation, vol. 96, no. 7, pp. 1329–1338, 2015.
View at: Publisher Site | Google Scholar
WHO, Global Recommendations on Physical Activity for Health, World Health Organization, Geneva, Switzerland, 2010.
S. L. Gall, K. Sanderson, K. J. Smith, G. Patton, T. Dwyer, and A. Venn, “Bi-directional associations between healthy lifestyles and mood disorders in young adults: The Childhood Determinants of Adult Health Study,” Psychological Medicine, vol. 46, no. 12, pp. 2535–2548, 2016.
View at: Publisher Site | Google Scholar
L. Zhai, Y. Zhang, and D. Zhang, “Sedentary behaviour and the risk of depression: a meta-analysis,” British Journal of Sports Medicine, vol. 49, no. 11, pp. 705–709, 2015.
View at: Publisher Site | Google Scholar
J. J. Chapman, S. J. Fraser, W. J. Brown, and N. W. Burton, “Physical activity and sedentary behaviour of adults with mental illness,” Journal of Science and Medicine in Sport, vol. 19, no. 7, pp. 579–584, 2016.
View at: Publisher Site | Google Scholar
M. Hallgren, M. P. Herring, N. Owen et al., “Exercise, physical activity, and sedentary behavior in the treatment of depression: broadening the scientific perspectives and clinical opportunities,” Frontiers in Psychiatry, vol. 7, article 36, 2016.
View at: Publisher Site | Google Scholar
P. J. Smith, J. A. Blumenthal, B. M. Hoffman et al., “Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials,” Psychosomatic Medicine, vol. 72, no. 3, pp. 239–252, 2010.
View at: Publisher Site | Google Scholar
T. L. Greer, B. D. Grannemann, M. Chansard, A. I. Karim, and M. H. Trivedi, “Dose-dependent changes in cognitive function with exercise augmentation for major depression: results from the TREAD study,” European Neuropsychopharmacology, vol. 25, no. 2, pp. 248–256, 2015.
View at: Publisher Site | Google Scholar
E. D. Vidoni, D. K. Johnson, J. K. Morris et al., “Dose-response of aerobic exercise on cognition: a community-based, pilot randomized controlled trial,” PLoS ONE, vol. 10, no. 7, Article ID e0131647, 2015.
View at: Publisher Site | Google Scholar
P. E. Vasques, H. Moraes, H. Silveira, A. C. Deslandes, and J. Laks, “Acute exercise improves cognition in the depressed elderly: the effect of dual-tasks,” Clinics, vol. 66, no. 9, pp. 1553–1557, 2011.
View at: Publisher Site | Google Scholar
C. Suo, M. F. Singh, N. Gates et al., “Therapeutically relevant structural and functional mechanisms triggered by physical and cognitive exercise,” Molecular Psychiatry, vol. 21, no. 11, pp. 1633–1642, 2016.
View at: Publisher Site | Google Scholar
L. A. Uebelacker, G. Epstein-Lubow, B. A. Gaudiano, G. Tremont, C. L. Battle, and I. W. Miller, “Hatha yoga for depression: critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research,” Journal of Psychiatric Practice, vol. 16, no. 1, pp. 22–33, 2010.
View at: Publisher Site | Google Scholar
S. A. Saeed, D. J. Antonacci, and R. M. Bloch, “Exercise, yoga, and meditation for depressive and anxiety disorders,” American Family Physician, vol. 81, no. 8, pp. 981–987, 2010.
View at: Google Scholar
H. Cramer, R. Lauche, J. Langhorst, and G. Dobos, “Yoga for depression: a systematic review and meta-analysis,” Depression and Anxiety, vol. 30, no. 11, pp. 1068–1083, 2013.
View at: Publisher Site | Google Scholar
M. C. Pascoe and I. E. Bauer, “A systematic review of randomised control trials on the effects of yoga on stress measures and mood,” Journal of Psychiatric Research, vol. 68, pp. 270–282, 2015.
View at: Publisher Site | Google Scholar
S. Rosenbaum, D. Vancampfort, Z. Steel, J. Newby, P. B. Ward, and B. Stubbs, “Physical activity in the treatment of post-traumatic stress disorder: a systematic review and meta-analysis,” Psychiatry Research, vol. 230, no. 2, pp. 130–136, 2015.
View at: Publisher Site | Google Scholar
A. Büssing, A. Michalsen, S. B. S. Khalsa, S. Telles, and K. J. Sherman, “Effects of yoga on mental and physical health: a short summary of reviews,” Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 165410, 7 pages, 2012.
View at: Publisher Site | Google Scholar
M. Dauwan, M. J. Begemann, S. M. Heringa, and I. E. Sommer, “Exercise improves clinical symptoms, quality of life, global functioning, and depression in schizophrenia: a systematic review and meta-analysis,” Schizophrenia Bulletin, vol. 42, no. 3, pp. 588–599, 2016.
View at: Publisher Site | Google Scholar
H. Gong, C. Ni, X. Shen, T. Wu, and C. Jiang, “Yoga for prenatal depression: a systematic review and meta-analysis,” BMC Psychiatry, vol. 15, article 14, 2015.
View at: Publisher Site | Google Scholar
K. M. Sheffield and C. L. Woods-Giscombé, “Efficacy, Feasibility, and Acceptability of Perinatal Yoga on Women’s Mental Health and Well-Being: a systematic literature review,” Journal of Holistic Nursing, vol. 34, no. 1, pp. 64–79, 2016.
View at: Publisher Site | Google Scholar
A. Ahmadi, A. A. Arastoo, M. Nikbakht, S. Zahednejad, and M. Rajabpour, “Comparison of the effect of 8 weeks aerobic and yoga training on ambulatory function, fatigue and mood status in MS patients,” Iranian Red Crescent Medical Journal, vol. 15, no. 6, pp. 449–454, 2013.
View at: Publisher Site | Google Scholar
K.-Y. Lin, Y.-T. Hu, K.-J. Chang, H.-F. Lin, and J.-Y. Tsauo, “Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: a meta-analysis,” Evidence-Based Complementary and Alternative Medicine, vol. 2011, Article ID 659876, 12 pages, 2011.
View at: Publisher Site | Google Scholar
J. Langhorst, P. Klose, G. J. Dobos, K. Bernardy, and W. Häuser, “Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials,” Rheumatology International, vol. 33, no. 1, pp. 193–207, 2013.
View at: Publisher Site | Google Scholar
M. C. McCall, A. Ward, N. W. Roberts, and C. Heneghan, “Overview of systematic reviews: yoga as a therapeutic intervention for adults with acute and chronic health conditions,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 945895, 18 pages, 2013.
View at: Publisher Site | Google Scholar
F. Wang, O. E.-K. Lee, F. Feng et al., “The effect of meditative movement on sleep quality: a systematic review,” Sleep Medicine Reviews, vol. 30, pp. 43–52, 2016.
View at: Publisher Site | Google Scholar
A. G. Harvey, G. Murray, R. A. Chandler, and A. Soehner, “Sleep disturbance as transdiagnostic: consideration of neurobiological mechanisms,” Clinical Psychology Review, vol. 31, no. 2, pp. 225–235, 2011.
View at: Publisher Site | Google Scholar
P. K. Alvaro, R. M. Roberts, and J. K. Harris, “A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression,” Sleep, vol. 36, no. 7, pp. 1059–1068, 2013.
View at: Publisher Site | Google Scholar
K. B. Bonura and G. Tenenbaum, “Effects of yoga on psychological health in older adults,” Journal of Physical Activity and Health, vol. 11, no. 7, pp. 1334–1341, 2014.
View at: Publisher Site | Google Scholar
E. Lindahl, K. Tilton, N. Eickholt, and L. Ferguson-Stegall, “Yoga reduces perceived stress and exhaustion levels in healthy elderly individuals,” Complementary Therapies in Clinical Practice, vol. 24, pp. 50–56, 2016.
View at: Publisher Site | Google Scholar
N. Janakiramaiah, B. N. Gangadhar, P. J. Naga Venkatesha Murthy, M. G. Harish, D. K. Subbakrishna, and A. Vedamurthachar, “Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine,” Journal of Affective Disorders, vol. 57, no. 1–3, pp. 255–259, 2000.
View at: Publisher Site | Google Scholar
S. Brand, E. Holsboer-Trachsler, J. R. Naranjo, and S. Schmidt, “Influence of mindfulness practice on cortisol and sleep in long-term and short-term meditators,” Neuropsychobiology, vol. 65, no. 3, pp. 109–118, 2012.
View at: Publisher Site | Google Scholar
G. Verma and R. Araya, “The effect of meditation on psychological distress among buddhist monks and nuns,” International Journal of Psychiatry in Medicine, vol. 40, no. 4, pp. 461–468, 2010.
View at: Publisher Site | Google Scholar
L. D. Butler, L. C. Waelde, T. A. Hastings et al., “Meditation with yoga, group therapy with hypnosis, and psychoeducation for long-term depressed mood: a randomized pilot trial,” Journal of Clinical Psychology, vol. 64, no. 7, pp. 806–820, 2008.
View at: Publisher Site | Google Scholar
N. P. Gothe and E. McAuley, “Yoga and cognition: a meta-analysis of chronic and acute effects,” Psychosomatic Medicine, vol. 77, no. 7, pp. 784–797, 2015.
View at: Publisher Site | Google Scholar
K. Luu and P. A. Hall, “Hatha yoga and executive function: a systematic review,” Journal of Alternative and Complementary Medicine, vol. 22, no. 2, pp. 125–133, 2016.
View at: Publisher Site | Google Scholar
R. Prakash, P. Rastogi, I. Dubey, P. Abhishek, S. Chaudhury, and B. J. Small, “Long-term concentrative meditation and cognitive performance among older adults,” Aging, Neuropsychology, and Cognition, vol. 19, no. 4, pp. 479–494, 2012.
View at: Publisher Site | Google Scholar
V. K. Sharma, S. Das, S. Mondal, U. Goswami, and A. Gandhi, “Effect of Sahaj Yoga on neuro-cognitive functions in patients suffering from major depression,” Indian Journal of Physiology and Pharmacology, vol. 50, no. 4, pp. 375–383, 2006.
View at: Google Scholar
A. Ross and S. Thomas, “The health benefits of yoga and exercise: a review of comparison studies,” Journal of Alternative and Complementary Medicine, vol. 16, no. 1, pp. 3–12, 2010.
View at: Publisher Site | Google Scholar
M. Furtado and M. A. Katzman, “Examining the role of neuroinflammation in major depression,” Psychiatry Research, vol. 229, no. 1-2, pp. 27–36, 2015.
View at: Publisher Site | Google Scholar
J. Herbert and P. J. Lucassen, “Depression as a risk factor for Alzheimer's disease: genes, steroids, cytokines and neurogenesis—what do we need to know?” Frontiers in Neuroendocrinology, vol. 41, pp. 153–171, 2016.
View at: Publisher Site | Google Scholar
Y.-K. Kim, K.-S. Na, A.-M. Myint, and B. E. Leonard, “The role of pro-inflammatory cytokines in neuroinflammation, neurogenesis and the neuroendocrine system in major depression,” Progress in Neuro-Psychopharmacology and Biological Psychiatry, vol. 64, pp. 277–284, 2016.
View at: Publisher Site | Google Scholar
T. Esch, G. B. Stefano, G. L. Fricchione, and H. Benson, “The role of stress in neurodegenerative diseases and mental disorders,” Neuroendocrinology Letters, vol. 23, no. 3, pp. 199–208, 2002.
View at: Google Scholar
R. M. Sapolsky, H. Uno, C. S. Rebert, and C. E. Finch, “Hippocampal damage associated with prolonged glucocorticoid exposure in primates,” Journal of Neuroscience, vol. 10, no. 9, pp. 2897–2902, 1990.
View at: Google Scholar
H. Uno, S. Eisele, A. Sakai et al., “Neurotoxicity of glucocorticoids in the primate brain,” Hormones and Behavior, vol. 28, no. 4, pp. 336–348, 1994.
View at: Publisher Site | Google Scholar
S. B. Pinnock and J. Herbert, “Brain-derived neurotropic factor and neurogenesis in the adult rat dentate gyrus: interactions with corticosterone,” European Journal of Neuroscience, vol. 27, no. 10, pp. 2493–2500, 2008.
View at: Publisher Site | Google Scholar
M. J. M. Schaaf, J. De Jong, E. R. De Kloet, and E. Vreugdenhil, “Downregulation of BDNF mRNA and protein in the rat hippocampus by corticosterone,” Brain Research, vol. 813, no. 1, pp. 112–120, 1998.
View at: Publisher Site | Google Scholar
C. Stetler and G. E. Miller, “Depression and hypothalamic-pituitary-adrenal activation: a quantitative summary of four decades of research,” Psychosomatic Medicine, vol. 73, no. 2, pp. 114–126, 2011.
View at: Publisher Site | Google Scholar
O. Ragnarsson, P. Berglund, D. N. Eder, and G. Johannsson, “Long-term cognitive impairments and attentional deficits in patients with Cushing's disease and cortisol-producing adrenal adenoma in remission,” Journal of Clinical Endocrinology and Metabolism, vol. 97, no. 9, pp. E1640–E1648, 2012.
View at: Publisher Site | Google Scholar
I. Sotiropoulos, C. Catania, T. Riedemann et al., “Glucocorticoids trigger Alzheimer disease-like pathobiochemistry in rat neuronal cells expressing human tau,” Journal of Neurochemistry, vol. 107, no. 2, pp. 385–397, 2008.
View at: Publisher Site | Google Scholar
E. Castrén and T. Rantamäki, “The role of BDNF and its receptors in depression and antidepressant drug action: reactivation of developmental plasticity,” Developmental Neurobiology, vol. 70, no. 5, pp. 289–297, 2010.
View at: Publisher Site | Google Scholar
Y. Mu and F. H. Gage, “Adult hippocampal neurogenesis and its role in Alzheimer's disease,” Molecular Neurodegeneration, vol. 6, no. 1, article 85, 2011.
View at: Publisher Site | Google Scholar
G. Weinstein, A. S. Beiser, S. H. Choi et al., “Serum brain-derived neurotrophic factor and the risk for dementia: the Framingham Heart Study,” The JAMA Neurology, vol. 71, no. 1, pp. 55–61, 2014.
View at: Publisher Site | Google Scholar
L. Johansson, X. Guo, P. R. Duberstein et al., “Midlife personality and risk of Alzheimer disease and distress: a 38-year follow-up,” Neurology, vol. 83, no. 17, pp. 1538–1544, 2014.
View at: Publisher Site | Google Scholar
D. H. Barlow, S. Sauer-Zavala, J. R. Carl, J. R. Bullis, and K. K. Ellard, “The nature, diagnosis, and treatment of neuroticism: back to the future,” Clinical Psychological Science, vol. 2, no. 3, pp. 344–365, 2014.
View at: Publisher Site | Google Scholar
D. H. Barlow, K. K. Ellard, S. Sauer-Zavala, J. R. Bullis, and J. R. Carl, “The origins of neuroticism,” Perspectives on Psychological Science, vol. 9, no. 5, pp. 481–496, 2014.
View at: Publisher Site | Google Scholar
F. B. Schuch, A. C. Deslandes, B. Stubbs, N. P. Gosmann, C. T. B. D. Silva, and M. P. D. A. Fleck, “Neurobiological effects of exercise on major depressive disorder: a systematic review,” Neuroscience and Biobehavioral Reviews, vol. 61, pp. 1–11, 2016.
View at: Publisher Site | Google Scholar
G. H. Naveen, J. Thirthalli, M. G. Rao, S. Varambally, R. Christopher, and B. N. Gangadhar, “Positive therapeutic and neurotropic effects of yoga in depression: a comparative study,” Indian Journal of Psychiatry, vol. 55, no. 7, pp. S400–S404, 2013.
View at: Publisher Site | Google Scholar
D. Bergen-Cico, K. Possemato, and W. Pigeon, “Reductions in cortisol associated with primary care brief mindfulness program for veterans with PTSD,” Medical Care, vol. 52, pp. S25–S31, 2014.
View at: Google Scholar
M. T. Marcus, P. M. Fine, F. G. Moeller et al., “Change in stress levels following mindfulness-based stress reduction in a therapeutic community,” Addictive Disorders and their Treatment, vol. 2, no. 3, pp. 63–68, 2003.
View at: Publisher Site | Google Scholar
I. Nyklíček, P. M. C. Mommersteeg, S. Van Beugen, C. Ramakers, and G. J. Van Boxtel, “Mindfulness-based stress reduction and physiological activity during acute stress: a randomized controlled trial,” Health Psychology, vol. 32, no. 10, pp. 1110–1113, 2013.
View at: Publisher Site | Google Scholar
E. M. S. Sibinga, C. Perry-Parrish, S.-E. Chung, S. B. Johnson, M. Smith, and J. M. Ellen, “School-based mindfulness instruction for urban male youth: a small randomized controlled trial,” Preventive Medicine, vol. 57, no. 6, pp. 799–801, 2013.
View at: Publisher Site | Google Scholar
B. K. Hölzel, J. Carmody, M. Vangel et al., “Mindfulness practice leads to increases in regional brain gray matter density,” Psychiatry Research—Neuroimaging, vol. 191, no. 1, pp. 36–43, 2011.
View at: Publisher Site | Google Scholar
J. Gu, C. Strauss, R. Bond, and K. Cavanagh, “How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies,” Clinical Psychology Review, vol. 37, pp. 1–12, 2015.
View at: Publisher Site | Google Scholar
A. M. van der Velden, W. Kuyken, U. Wattar et al., “A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder,” Clinical Psychology Review, vol. 37, pp. 26–39, 2015.
View at: Publisher Site | Google Scholar
H. Ojha, K. Purushottam, and N. P. Yadav, “Transformation of personality by integral yogic training and practices,” Journal of the Indian Academy of Applied Psychology, vol. 39, no. 1, pp. 90–94, 2013.
View at: Google Scholar
B. W. Smith, B. M. Shelley, J. Dalen, K. Wiggins, E. Tooley, and J. Bernard, “A pilot study comparing the effects of mindfulness-based and cognitive-behavioral stress reduction,” Journal of Alternative and Complementary Medicine, vol. 14, no. 3, pp. 251–258, 2008.
View at: Publisher Site | Google Scholar
S. Telles, K. V. Naveen, N. Kumar, A. Balkrishna, and Acharya, “The effect of yoga on neuroticism in an Indian population varies with socio-demographic factors,” Journal of Cultural Diversity, vol. 19, no. 4, pp. 118–123, 2012.
View at: Google Scholar
D. Vancampfort, H. Moens, T. Madou et al., “Autonomous motivation is associated with the maintenance stage of behaviour change in people with affective disorders,” Psychiatry Research, vol. 240, pp. 267–271, 2016.
View at: Publisher Site | Google Scholar
C. R. Martell, M. E. Addis, and N. S. Jacobsoen, Depression in Context: Strategies for Guided Action, Norton, New York, NY, USA, 2001.
S. Dimidjian, S. D. Hollon, K. S. Dobson et al., “Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression,” Journal of Consulting and Clinical Psychology, vol. 74, no. 4, pp. 658–670, 2006.
View at: Publisher Site | Google Scholar
D. Veale, “Behavioural activation for depression,” Advances in Psychiatric Treatment, vol. 14, no. 1, pp. 29–36, 2008.
View at: Publisher Site | Google Scholar
M. J. Fennell, “Cognitive therapy in the treatment of low self-esteem,” Advances in Psychiatric Treatment, vol. 4, no. 5, pp. 296–304, 1998.
View at: Publisher Site | Google Scholar
F. B. Bryant and J. L. Smith, “Appreciating life in the midst of adversity: savoring in relation to mindfulness, reappraisal, and meaning,” Psychological Inquiry, vol. 26, no. 4, pp. 315–321, 2015.
View at: Publisher Site | Google Scholar
D. E. Davis, E. Choe, J. Meyers et al., “Thankful for the little things: a meta-analysis of gratitude interventions,” Journal of Counseling Psychology, vol. 63, no. 1, pp. 20–31, 2016.
View at: Publisher Site | Google Scholar
J. Quoidbach, E. V. Berry, M. Hansenne, and M. Mikolajczak, “Positive emotion regulation and well-being: comparing the impact of eight savoring and dampening strategies,” Personality and Individual Differences, vol. 49, no. 5, pp. 368–373, 2010.
View at: Publisher Site | Google Scholar
J. C. Huffman, C. M. DuBois, B. C. Healy et al., “Feasibility and utility of positive psychology exercises for suicidal inpatients,” General Hospital Psychiatry, vol. 36, no. 1, pp. 88–94, 2014.
View at: Publisher Site | Google Scholar
D. L. McMakin, G. J. Siegle, and S. R. Shirk, “Positive Affect Stimulation and Sustainment (PASS) module for depressed mood: a preliminary investigation of treatment-related effects,” Cognitive Therapy and Research, vol. 35, no. 3, pp. 217–226, 2011.
View at: Publisher Site | Google Scholar
B. Stubbs, D. Vancampfort, S. Rosenbaum et al., “Dropout from exercise randomized controlled trials among people with depression: a meta-analysis and meta regression,” Journal of Affective Disorders, vol. 190, pp. 457–466, 2016.
View at: Publisher Site | Google Scholar
B. Stubbs, M. Probst, A. Soundy et al., “Physiotherapists can help implement physical activity programmes in clinical practice,” The British Journal of Psychiatry, vol. 204, no. 2, p. 164, 2014.
View at: Publisher Site | Google Scholar
R. Stanton and B. Happell, “Exercise for mental illness: a systematic review of inpatient studies,” International Journal of Mental Health Nursing, vol. 23, no. 3, pp. 232–242, 2014.
View at: Publisher Site | Google Scholar
O. Lederman, K. Grainger, R. Stanton et al., “Consensus statement on the role of accredited exercise physiologists within the treatment of mental disorders: a guide for mental health professionals,” Australasian Psychiatry, vol. 24, no. 4, pp. 347–351, 2016.
View at: Publisher Site | Google Scholar
J. J. Gross and H. Jazaieri, “Emotion, emotion regulation, and psychopathology: an affective science perspective,” Clinical Psychological Science, vol. 2, no. 4, pp. 387–401, 2014.
View at: Publisher Site | Google Scholar
R. C. Kessler, M. Gruber, J. M. Hettema, I. Hwang, N. Sampson, and K. A. Yonkers, “Co-morbid major depression and generalized anxiety disorders in the National Comorbidity Survey follow-up,” Psychological Medicine, vol. 38, no. 3, pp. 365–374, 2008.
View at: Publisher Site | Google Scholar
R. C. Kessler, P. Berglund, O. Demler et al., “The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R),” Journal of the American Medical Association, vol. 289, no. 23, pp. 3095–3105, 2003.
View at: Publisher Site | Google Scholar
R. C. Kessler, “The epidemiology of pure and comorbid generalized anxiety disorder: a review and evaluation of recent research,” Acta Psychiatrica Scandinavica, vol. 102, no. 406, pp. 7–13, 2000.
View at: Publisher Site | Google Scholar
P. Gorwood, “Generalized anxiety disorder and major depressive disorder comorbidity: an example of genetic pleiotropy?” European Psychiatry, vol. 19, no. 1, pp. 27–33, 2004.
View at: Publisher Site | Google Scholar
K. Belzer and F. R. Schneier, “Comorbidity of anxiety and depressive disorders: issues in conceptualization, assessment, and treatment,” Journal of Psychiatric Practice, vol. 10, no. 5, pp. 296–306, 2004.
View at: Publisher Site | Google Scholar
J. Emmanuel, S. Simmonds, and P. Tyrer, “Systematic review of the outcome of anxiety and depressive disorders,” The British Journal of Psychiatry. Supplement, no. 34, pp. 35–41, 1998.
View at: Google Scholar
M. Fava, L. A. Uebelacker, J. E. Alpert, A. A. Nierenberg, J. A. Pava, and J. F. Rosenbaum, “Major depressive subtypes and treatment response,” Biological Psychiatry, vol. 42, no. 7, pp. 568–576, 1997.
View at: Publisher Site | Google Scholar
C. Brown, H. C. Schulberg, M. J. Madonia, M. K. Shear, and P. R. Houck, “Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders,” American Journal of Psychiatry, vol. 153, no. 10, pp. 1293–1300, 1996.
View at: Publisher Site | Google Scholar
K. O'Sullivan and E. F. Newman, “Neuropsychological impairments in panic disorder: a systematic review,” Journal of Affective Disorders, vol. 167, pp. 268–284, 2014.
View at: Publisher Site | Google Scholar
M. S. O'Toole and A. D. Pedersen, “A systematic review of neuropsychological performance in social anxiety disorder,” Nordic Journal of Psychiatry, vol. 65, no. 3, pp. 147–161, 2011.
View at: Publisher Site | Google Scholar
G. Kirkwood, H. Rampes, V. Tuffrey, J. Richardson, and K. Pilkington, “Yoga for anxiety: a systematic review of the research evidence,” British Journal of Sports Medicine, vol. 39, no. 12, pp. 884–891, 2005.
View at: Publisher Site | Google Scholar

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Copyright © 2016 Danielle C. Mathersul and Simon Rosenbaum. 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.

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