title: Breathing exercise combined with cognitive behavioural intervention improves sleep quality and heart rate variability in major depression.
abstract: OBJECTIVE
  The aim of this study was to investigate the effects of a cognitive behavioural intervention combined with a breathing relaxation exercise on sleep quality and heart rate variability in patients with major depression.
  
  
  BACKGROUND
  Depression is a long-lasting illness with significant effects not only in individuals themselves, but on their family, work and social relationships as well. Cognitive behavioural therapy is considered to be an effective treatment for major depression. Breathing relaxation may improve heart rate variability, but few studies have comprehensively examined the effect of a cognitive behavioural intervention combined with relaxing breathing on patients with major depression.
  
  
  METHODS
  An experimental research design with a repeated measure was used.
  
  
  METHODS
  Eighty-nine participants completed this study and entered data analysed. The experimental group (n = 43) received the cognitive behavioural intervention combined with a breathing relaxation exercise for four weeks, whereas the control group (n = 46) did not. Sleep quality and heart rate variability were measured at baseline, posttest1, posttest2 and follow-up. Data were examined by chi-square tests, t-tests and generalised estimating equations.
  
  
  RESULTS
  After adjusting for age, socioeconomic status, severity of disease and psychiatric history, the quality of sleep of the experimental group improved, with the results at posttest achieving significance. Heart rate variability parameters were also significantly improved.
  
  
  CONCLUSIONS
  This study supported the hypothesis that the cognitive behavioural intervention combined with a breathing relaxation exercise could improve sleep quality and heart rate variability in patients with major depression, and the effectiveness was lasting.
  
  
  CONCLUSIONS
  The cognitive behavioural intervention combined with a breathing relaxation exercise that included muscle relaxation, deep breathing and sleep hygiene could be provided with major depression during hospitalisation. Through group practice and experience sharing, participants could modulate their heart rate variability and share feeling about good sleep as well relaxation.
authors.affiliation: Medical Affairs, Mackay Memorial Hospital, Hsinchu, Taiwan.|National Defense Medical Center, Taipei, Taiwan.
authors.forename: Hui-Ching
authors.initials: HC
authors.lastname: Chien
authors.affiliation: School of Nursing, Yuanpei University, Hsinchu, Taiwan.
authors.forename: Yu-Chu
authors.initials: YC
authors.lastname: Chung
authors.affiliation: School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
authors.forename: Mei-Ling
authors.initials: ML
authors.lastname: Yeh
authors.affiliation: Buddhist Tzu Chi General Hospital, Taiwan.
authors.forename: Jia-Fu
authors.initials: JF
authors.lastname: Lee
mesh_terms: D000328:Adult; D001945:Breathing Exercises; D015928:Cognitive Behavioral Therapy; D003865:Major Depressive Disorder / Q000150:complications / Q000451:nursing / Q000523:psychology / Q000628:therapy*; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D012893:Sleep Wake Disorders / Q000150:complications / Q000451:nursing / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
keywords: adult nursing; behaviour; cognitive therapy; depression; relaxation breathing exercise; sleep quality