Comparing meditative scuba diving versus multisport activities to improve post-traumatic stress disorder symptoms: a pilot, randomized controlled clinical trial.

Background: Post-Traumatic Stress Disorder (PTSD) is a chronic and disabling disease that currently has no fully effective therapeutic solution. Complementary approaches, such as relaxation, sport, or meditation, could be therapeutic aids for symptom reduction. Scuba diving combines sport and mindfulness training and has been found to have a positive effect on chronic stress and PTSD. Objectives: The first objective of this pilot study is to compare the effectiveness of diving associated with mindfulness exercises (the Bathysmed® protocol) with multisport activity in reducing PTSD symptoms. The secondary objective is to compare the impact of the Bathysmed® protocol on mindfulness functioning in the two groups of subjects suffering from PTSD. Method: This proof-of-concept took the form of a controlled randomized clinical trial. The primary endpoint was the severity of PTSD symptoms, measured by the PCL-5 (PTSD Check List) scale. Half of the group were exposed to the Bathysmed® protocol (the experimental condition), and the other half to a non-specific multisport program. Results: Bathysmed® protocol improved PCL-5 scores more than the multisport program but the result was not significant. The protocol was significantly better than the multisport activity in reducing intrusion symptoms of PTSD after one month. Globally, trait mindfulness scores improved up to one month after the course, but the result was not significant. Three months after the course, there was no difference between the two groups with regard to PCL-5 and Freiburg Mindfulness Inventory scores.. Conclusion: Our study demonstrates the value of the Bathysmed® protocol even though it suffers from a lack of power and could only obtain partial but encouraging results. Mindfulness must be practiced over the long term to achieve stable benefits. This probably explains why no differences persisted three months after the course. Further work is needed to confirm the initial results obtained with this pilot study.

Antecedentes:El trastorno de estrés postraumático (TEPT) es una enfermedad crónica e incapacitante que actualmente no tiene solución terapéutica totalmente eficaz. Enfoques complementarios, como relajación, deporte o meditación podrían ser ayudas terapéuticas para la reducción de síntomas. El buceo combina deporte y entrenamiento mindfulness y se ha encontrado que tiene un efecto positivo sobre el estrés crónico y el trastorno de estrés postraumático.Objetivos:El primer objetivo de este estudio piloto es comparar la efectividad del buceo asociado a ejercicios de mindfulness (el protocolo Bathysmed®) con la actividad multideportiva para reducir los síntomas del TEPT. El objetivo secundario es comparar el impacto del protocolo Bathysmed® sobre el funcionamiento de mindfulness en los dos grupos de sujetos que padecen TEPT.Método:Esta prueba de concepto tomó la forma de un ensayo clínico aleatorizado controlado. El criterio de valoración principall fue la gravedad de los síntomas de TEPT, medida por la escala PCL-5 (Lista de chequeo para TEPT). La mitad del grupo estuvo expuesto al protocolo Bathysmed® (la condición experimental), y la otra mitad a un programa multideportivo no específico.Resultados:El protocolo Bathysmed® mejoró las puntuaciones de PCL-5 más que el programa multideportivo, pero el resultado no fue significativo. El protocolo fue significativamente mejor que la actividad multideportiva para reducir los síntomas de intrusión del TEPT luego de un mes. Globalmente, los puntajes de mindfulness de rasgo mejoraron hasta un mes luego del curso, pero el resultado no fue significativo. Tres meses después del curso, no hubo diferencias entre los dos grupos con respecto a las puntuaciones de PCL-5 y FMI (Freiburg Mindfulness Inventory).Conclusión:Nuestro estudio demuestra el valour del protocolo Bathysmed® a pesar de que sufre una falta de poder y solo pudo obtener resultados parciales pero alentadores. Mindfulness debe practicarse durante un largo plazo para alcanzar beneficios estables. Esto probablemente explica por qué no persistieron diferencias tres meses después del curso. Es necesario seguir trabajando para confirmar los resultados iniciales obtenidos con este estudio piloto.

Recreational Diving Practice for Stress Management: An Exploratory Trial.

Background: Within the components of Scuba diving there are similarities with meditation and mindfulness techniques by training divers to be in a state of open monitoring associated with slow and ample breathing. Perceived stress is known to be diminished during meditation practice. This study evaluates the benefits of scuba diving on perceived stress and mindful functioning. Method: A recreational diving group (RDG; n = 37) was compared with a multisport control group (MCG; n = 30) on perceived stress, mood, well-being and mindfulness by answering auto-questionnaires before and after a 1-week long UCPA course. For the diving group, stability of the effects was evaluated 1 month later using similar auto-questionnaires. Results: Perceived stress did not decrease after the course for the MCG [ The divers showed a significant reduction on the perceived stress score (p < 0.05) with a sustainable effect (p = 0.01)]. An improvement in mood scale was observed in both groups. This was associated to an increase in mindfulness abilities. Conclusions: The practice of a recreational sport improves the mood of subjects reporting the thymic benefits of a physical activity performed during a vacation period. The health benefits of recreational diving appear to be greater than the practice of other sports in reducing stress and improving well-being.

Pathophysiological and diagnostic implications of cardiac biomarkers and antidiuretic hormone release in distinguishing immersion pulmonary edema from decompression sickness.

Immersion pulmonary edema (IPE) is a misdiagnosed environmental illness caused by water immersion, cold, and exertion. IPE occurs typically during SCUBA diving, snorkeling, and swimming. IPE is sometimes associated with myocardial injury and/or loss of consciousness in water, which may be fatal. IPE is thought to involve hemodynamic and cardiovascular disturbances, but its pathophysiology remains largely unclear, which makes IPE prevention difficult. This observational study aimed to document IPE pathogenesis and improve diagnostic reliability, including distinguishing in some conditions IPE from decompression sickness (DCS), another diving-related disorder.Thirty-one patients (19 IPE, 12 DCS) treated at the Hyperbaric Medicine Department (Ste-Anne hospital, Toulon, France; July 2013-June 2014) were recruited into the study. Ten healthy divers were recruited as controls. We tested: (i) copeptin, a surrogate marker for antidiuretic hormone and a stress marker; (ii) ischemia-modified albumin, an ischemia/hypoxia marker; (iii) brain-natriuretic peptide (BNP), a marker of heart failure, and (iv) ultrasensitive-cardiac troponin-I (cTnI), a marker of myocardial ischemia.We found that copeptin and cardiac biomarkers were higher in IPE versus DCS and controls: (i) copeptin: 68% of IPE patients had a high level versus 25% of DCS patients (P < 0.05) (mean ±â€Šstandard-deviation: IPE: 53 ±â€Š61 pmol/L; DCS: 15 ±â€Š17; controls: 6 ±â€Š3; IPE versus DCS or controls: P < 0.05); (ii) ischemia-modified albumin: 68% of IPE patients had a high level versus 16% of DCS patients (P < 0.05) (IPE: 123 ±â€Š25 arbitrary-units; DCS: 84 ±â€Š25; controls: 94 ±â€Š7; IPE versus DCS or controls: P < 0.05); (iii) BNP: 53% of IPE patients had a high level, DCS patients having normal values (P < 0.05) (IPE: 383 ±â€Š394 ng/L; DCS: 37 ±â€Š28; controls: 19 ±â€Š15; IPE versus DCS or controls: P < 0.01); (iv) cTnI: 63% of IPE patients had a high level, DCS patients having normal values (P < 0.05) (IPE: 0.66 ±â€Š1.50 µg/L; DCS: 0.0061 ±â€Š0.0040; controls: 0.0090 ±â€Š0.01; IPE versus DCS or controls: P < 0.01). The combined "BNP-cTnI" levels provided most discrimination: all IPE patients, but none of the DCS patients, had elevated levels of either/both of these markers.We propose that antidiuretic hormone acts together with a myocardial ischemic process to promote IPE. Thus, monitoring of antidiuretic hormone and cardiac biomarkers can help to make a quick and reliable diagnosis of IPE.