scholarly journals Yoga effectively reduces fatigue and symptoms of depression in patients with different types of cancer

2020 ◽  
Author(s):  
Teresa Zetzl ◽  
Agnes Renner ◽  
Andre Pittig ◽  
Elisabeth Jentschke ◽  
Carmen Roch ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Control Group ◽  
Attendance Rate ◽  
Yoga Therapy ◽  
Symptoms Of Depression ◽  
Cancer Related Fatigue ◽  
Yoga Group ◽  
Severe Fatigue ◽  
Different Types ◽  
Waitlist Control Group

Abstract Purpose Examine the effects of an 8-week yoga therapy on fatigue in patients with different types of cancer. Methods A total of 173 cancer patients suffering from mild to severe fatigue were randomly allocated to yoga intervention (n = 84) (IG) versus waitlist control group (CG) (n = 88). Yoga therapy consisted of eight weekly sessions with 60 min each. The primary outcome was self-reported fatigue symptoms. Secondary outcomes were symptoms of depression and quality of life (QoL). Data were assessed using questionnaires before (T0) and after yoga therapy for IG versus waiting period for CG (T1). Results A stronger reduction of general fatigue (P = .033), physical fatigue (P = .048), and depression (P < .001) as well as a stronger increase in QoL (P = .002) was found for patients who attended 7 or 8 sessions compared with controls. Within the yoga group, both higher attendance rate and lower T0-fatigue were significant predictors of lower T1-fatigue (P ≤ .001). Exploratory results revealed that women with breast cancer report a higher reduction of fatigue than women with other types of cancer (P = .016) after yoga therapy. Conclusion The findings support the assumption that yoga therapy is useful to reduce cancer-related fatigue, especially for the physical aspects of fatigue. Women with breast cancer seem to benefit most, and higher attendance rate results in greater reduction of fatigue. Trial registration German Clinical Trials Register DRKS00016034

Cancer-related fatigue and depression in breast cancer patients postchemotherapy: Different associations with optimism and stress appraisals

2014 ◽  
Vol 13 (5) ◽  
pp. 1141-1151 ◽  
Author(s):  
Inbar Levkovich ◽  
Miri Cohen ◽  
Shimon Pollack ◽  
Karen Drumea ◽  
Georgeta Fried
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Physical Symptom ◽  
Multivariate Regression Analysis ◽  
Physical Symptoms ◽  
Breast Cancer Patients ◽  
Life Orientation Test ◽  
Symptoms Of Depression ◽  
Cancer Related Fatigue ◽  
Stress Appraisals

AbstractObjective:Symptoms of depression and cancer-related fatigue (CRF) are common among breast cancer patients postchemotherapy and may seriously impair quality of life (QoL). This study aimed to assess the relationship between depression and CRF in breast cancer patients postchemotherapy and to examine their relationships to optimism and to threat and challenge appraisals.Method:Participants included 95 breast cancer patients (stages 1–3) 1 to 6 months after completion of chemotherapy. Patients submitted personal and medical details and completed the following: physical symptom questionnaires (EORTC QLQ–C30, and QLQ–BR23), a symptoms of depression questionnaire (CES–D), the Fatigue Symptom Inventory (FSI), the Life Orientation Test (LOT–R), and a stress appraisals questionnaire.Results:We found levels of depression, CRF, and appraisals of cancer as a threat to be moderate and levels of optimism and appraisals of cancer as a challenge to be high. Depression and CRF were positively associated. A multivariate regression analysis revealed that 51% of the CRF variance was explained and, together with physical symptoms and threat appraisal, were significantly associated with CRF. A total 67% of depression was explained and, and together with challenge and threat appraisals, were significantly associated with depression.Significance of Results:Although CRF and depression were often experienced simultaneously and both were found to be higher among individuals who gave higher appraisals of cancer as a threat, only depression was related to optimism and challenge appraisals, while CRF was related mainly to intensity of physical symptoms. The different pattern of associations between optimism and appraisals warrants further clinical attention as well as future study.

Effect of a combined diet plus exercise intervention on weight loss, physical fitness, and cancer-related fatigue among Japanese women with breast cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21658-e21658 ◽  
Author(s):  
Koki Okumatsu ◽  
Takehiko Tsujimoto ◽  
Akina Seki ◽  
Teruo Yamauchi ◽  
Hideko Yamauchi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Weight Loss ◽  
Physical Fitness ◽  
Cancer Patients ◽  
Endocrine Therapy ◽  
Intervention Group ◽  
Exercise Program ◽  
Control Group ◽  
Breast Cancer Patients ◽  
Cancer Related Fatigue

e21658 Background: Weight gain, deterioration of physical fitness, and cancer-related fatigue often occur in the breast cancer patients mainly due to endocrine therapy. A number of previous studies have reported that obesity increases the risk of breast cancer recurrence and death, while exercise habituation improves physical fitness and fatigue among breast cancer patients. However, almost all studies have been conducted in the Western community and there are few studies focused on Asian women who may have lower BMI compared with the Western ones. Therefore, we investigated whether a combined diet plus exercise program affects weight loss, physical fitness and fatigue indices among Japanese breast cancer patients undergoing endocrine therapies. Methods: Thirty-two Japanese women with breast cancer undergoing endocrine therapy (age; 50±6 years, body weight; 57±10 kg) were voluntarily assigned to either intervention group (n = 21) or control group (n = 11). The intervention group completed a 12-week combined diet plus exercise program, consisting of weekly diet instruction classes aimed at maintaining a nutritionally well-balanced 1,200 kcal/d diet and a weekly 90-min exercise session. Anthropometric indices, physical fitness, blood sample and cancer-related fatigue were measured at baseline and after the 12-week program. Results: All of the 21 women completed the 12-week program. Mean weight loss was 8.7% of the initial weight in the intervention group and 0.1% in the control group ( P < . 001). Significant improvements were observed in cardiorespiratory fitness ( P < .01), flexibility ( P < .01) and agility ( P < .01) in the intervention group. Cancer related-fatigue scores decreased by 7.9 points (39%) among the intervention group ( P < .001), while it remained essentially unchanged among the control group. No adverse events were reported in the intervention group. Conclusions: A combined diet plus exercise program may contribute to a decrease in body weight and improvement in physical fitness and cancer-related fatigue. Further study is needed to help reduce side effects due to endocrine therapy and enhance quality of life among Asian breast cancer patients. Clinical trial information: UMIN000025890.

Effects of exercise on cancer-related fatigue and muscular strength in patients with breast cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11507-11507
Author(s):  
Po-Ju Lin ◽  
Kah Poh Loh ◽  
Julia Ellen Inglis ◽  
Richard Francis Dunne ◽  
Ian Kleckner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Muscular Strength ◽  
Daily Activities ◽  
Control Group ◽  
Lower Body ◽  
Post Intervention ◽  
Cancer Related Fatigue ◽  
Body Strength ◽  
The Mean ◽  
Lower Body Strength

11507 Background: Cancer-related fatigue (CRF) is a persistent daily lack of energy commonly experienced by breast cancer (BC) patients. Due to CRF, BC patients have difficulties carrying out daily activities, become less active and consequently reduce muscular strength. Exercise can improve muscular strength and increase energy level; therefore it may alleviate CRF. This phase II RCT assessed the effects of exercise on CRF and muscular strength in BC patients. Methods: Ninety BC patients (55.5±9.6 years, 79% white, 48% and 46% under radiation or hormone therapy) were randomized into two arms: a 6-week Exercise for Cancer Patients (EXCAP) program or standard care (Control). EXCAP is a home-based, personalized, progressive exercise program combining aerobic walking and resistance band training. The Brief Fatigue Inventory was used to assess CRF and CRF interference with daily activities and a 7-10 repetition maximum chest press and leg extension strength test was used to assess upper- and lower-body strength at pre- and post-intervention. T-tests and ANCOVA with pre-intervention as the covariate were used to analyze within- and between-group changes, respectively. Results: Participants in the EXCAP group decreased CRF (-0.9±0.3, p = 0.01) and CRF interference with daily activities (-1.1±0.3, p < 0.01) from pre- to post-intervention while participants in the Control group did not. The mean improvement (from pre- to post-intervention) in CRF and CRF interference of daily activities for the EXCAP group were significantly higher than the change in the Control group (both p < 0.01). Participants in the EXCAP group increased upper- (3.9±1.4, p < 0.01) and lower-body strength (6.4±1.3, p < 0.01) from pre- to post-intervention, while participants in the Control group did not. The mean increase (from pre- to post-intervention) in lower-body strength for the EXCAP group was significantly higher than the change in the Control group (p = 0.01). Conclusions: Exercise combining aerobic walking and resistance band training reduces CRF and CRF interference with daily activities and improves muscular strength in BC patients. Results from this study provide further evidence of the benefits of exercise for supportive cancer care. Clinical trial information: NCT00851812.

scholarly journals Polyunsaturated Fatty Acids, Exercise, and Cancer-Related Fatigue in Breast Cancer Survivors

2021 ◽  
Vol 12 ◽  
Author(s):  
Yutaka Matsuoka ◽  
Katsunori Tsuji ◽  
Eisuke Ochi
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Exercise Group ◽  
Control Group ◽  
Omega 3 ◽  
Pufa Supplementation ◽  
Exercise Interventions ◽  
Cancer Related Fatigue ◽  
Omega 6

Cancer-related fatigue (CRF) is one of the most frequently reported and disabling symptoms in cancer survivors. With its negative impact on the activities of daily living, work, social activities, and mood, CRF causes severe impairment of quality of life. A previous study showed that omega-6 polyunsaturated fatty acid (PUFA) supplementation unexpectedly reduced CRF compared with omega-3 PUFA supplementation and that omega-6 PUFA supplementation reduced pro-inflammatory serum markers in fatigued American breast cancer survivors. Meanwhile, a recent meta-analysis of individual patient data revealed significant benefits of exercise interventions on CRF. Recently, we completed our randomized controlled trial among early-stage Japanese breast cancer survivors, in which we examined the effect of baseline blood PUFA characteristics on change in CRF during the 12-week trial by exercise group and confirmed that increased Cancer Fatigue Scale (CFS) was associated with both docosahexaenoic acid (DHA) (p = 0.06) and omega-3 index (p = 0.08) at baseline in all participants (n = 46, omega-6/omega-3 ratio = 6.79, SD = 1.90). On the contrary, DHA at baseline was positively correlated with change in CRF (r = 0.40, p = 0.06) in the control group (n = 24, omega-6/omega-3 ratio = 7.0). Moreover, eicosapentaenoic acid (EPA) at baseline was positively correlated with leg strength (r = 0.39, p = 0.10) in the exercise group. In conclusion, blood PUFA balance might be associated with the effect of exercise on CRF. In addition, higher EPA in individuals who conducted exercise likely has a beneficial effect on muscle strength. Further investigation is needed to clarify the interaction between PUFAs and exercise for alleviating CRF.

scholarly journals OR-052 Effects of Exercise Intervention on Cancer-Related Fatigue in Breast Cancer Survivors

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Zhiling Xie ◽  
Weibing Ye
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Aerobic Exercise ◽  
Breast Cancer Survivors ◽  
Exercise Intervention ◽  
Moderate Intensity ◽  
Control Group ◽  
Short Term ◽  
Cancer Related Fatigue ◽  
Significant Difference

Objective cancer-related fatigue(CRF) is the most commonly reported and most distressing symptom in cancer patient.The purpose of this study was to review the effect of exercise intervention on cancer-related fatigue in breast cancer survivors. Methods From 1998 to 2018 in Chinese and English literature of Wanfang Database, Pubmed, SportDiscus and Springer databases, picked out the randomized controlled trials which up to standard. Keywords cancer, exercise, fatigue, etc. were used for systematic search and tracking. 12 experiments were reviewed to analyze the effect differences between exercise intervention and exercise-related fatigue. Results Most interventions use aerobic exercise as the primary form of exercise. Generally, exercise interventions are effective for cancer-related fatigue, but some findings are not. Many studies have shown that moderate intensity aerobic exercise has a significant effect on cancer-related fatigue, with 50-70% heart rate reserve and 3-5 times of exercise per week for at least 30 minutes each time. Exercise methods mainly include walking, yoga, cycling and tai chi. Firstly, Supervised aerobic exercise was statistically more effective than conventional care in improving CRF among breast cancer survivors. It has been shown that group-based, supervised exercise produces positive psychosocial‘side-effects’ due to social interactions, improved self-efficacy, and attention from a trainer. Secondly, Cancer fatigue is divided into acute and chronic fatigue, 18 weeks of exercise intervention can reduce the short-term fatigue, at 36 weeks, baseline levels of fatigue index responses and contrast on the issue of the multivariate statistics. Thirdly, usual-care group were reported that they had been actively engaged in regular exercise before study enrollment. During the exercise intervention, most studies on the control ways are according to the daily life or to take care of, but studies have reported, before intervention, to a high level of 40% in the control group often exercise, exercise also as usual during the intervention, which causes the control to the baseline level is higher, but the intervention group and control group will be difference, no significant difference, lead to the result is invalid. Conclusions First, the exercise intervention of cancer-related fatigue needs to be supervised; second, the exercise intervention is effective for short-term cancer-related fatigue; third, the daily exercise level of the control group will affect the intervention effect.

scholarly journals Effect of yoga therapy on cardiovascular parameters in patients with psoriasis: A randomized control trial — pilot study

2021 ◽  
Vol 4 (2) ◽  
pp. 61-63
Author(s):  
Ganesan Dayanidy ◽  
Ananda Balayogi Bhavanani ◽  
Meena Ramanathan ◽  
S Srikanth
Keyword(s):  
Diastolic Pressure ◽  
Medical Condition ◽  
Rate Pressure Product ◽  
Control Group ◽  
Double Product ◽  
Yoga Therapy ◽  
Yoga Group ◽  
Before And After ◽  
Mean Pressure ◽  
Therapy Education

This study was done at the Centre for Yoga Therapy, Education and Research (CYTER) of Sri Balaji Vidyapeeth (SBV) to determine cardiovascular (CV) parameters in patients with psoriasis.Data of 20 patients (12 female, 8 male) with a mean age of 44.40 ± 15.2ywho were referred by Dept. of Dermatology and attended yoga therapy sessions at CYTER was used for analysis. Supervised yoga training was given to the participants who were randomized into the yoga group. Heart rate (HR), systolic and diastolic pressure (SP and DP) was recorded using non-invasive blood pressure (NIBP) apparatus before and after the study period of 12 weeks. CV indices such as Pulse pressure (PP), mean pressure (MP), rate-pressure product (RPP), and double product (DoP) were derived using appropriate formulae.The inter-group comparison showed significant change (p&#60;0.05) in SP. The derived CV indices such as PP, RPP & DoP also showed significant changes. (p&#60;0.05) after 12 weeks of Yoga training. The intragroup comparison in the control group showed a significant increase in SP and DP (p&#60;0.05). There is a healthy reduction in SP and derived CV indices following 12 weeks of yoga training. The magnitude of this reduction depends on the pre-existing medical condition and intensity of the disease in each individual. These changes may be attributed to enhanced harmony of cardiac autonomic function as a result of coordinated breath-body work and mind-body relaxation due to yoga resulting in a significant reduction in the perceived stress.

scholarly journals Yoga's Impact on Inflammation, Mood, and Fatigue in Breast Cancer Survivors: A Randomized Controlled Trial

2014 ◽  
Vol 32 (10) ◽  
pp. 1040-1049 ◽  
Author(s):  
Janice K. Kiecolt-Glaser ◽  
Jeanette M. Bennett ◽  
Rebecca Andridge ◽  
Juan Peng ◽  
Charles L. Shapiro ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Short Form ◽  
Post Treatment ◽  
Control Group ◽  
Yoga Practice ◽  
Randomized Controlled ◽  
Yoga Group ◽  
Tnf Α

Purpose To evaluate yoga's impact on inflammation, mood, and fatigue. Patients and Methods A randomized controlled 3-month trial was conducted with two post-treatment assessments of 200 breast cancer survivors assigned to either 12 weeks of 90-minute twice per week hatha yoga classes or a wait-list control. The main outcome measures were lipopolysaccharide-stimulated production of proinflammatory cytokines interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin-1β (IL-1β), and scores on the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), the vitality scale from the Medical Outcomes Study 36-item Short Form (SF-36), and the Center for Epidemiological Studies-Depression (CES-D) scale. Results Immediately post-treatment, fatigue was not lower (P > .05) but vitality was higher (P = .01) in the yoga group compared with the control group. At 3 months post-treatment, fatigue was lower in the yoga group (P = .002), vitality was higher (P = .01), and IL-6 (P = .027), TNF-α (P = .027), and IL-1β (P = .037) were lower for yoga participants compared with the control group. Groups did not differ on depression at either time (P > .2). Planned secondary analyses showed that the frequency of yoga practice had stronger associations with fatigue at both post-treatment visits (P = .019; P < .001), as well as vitality (P = .016; P = .0045), but not depression (P > .05) than simple group assignment; more frequent practice produced larger changes. At 3 months post-treatment, increasing yoga practice also led to a decrease in IL-6 (P = .01) and IL-1β (P = .03) production but not in TNF-α production (P > .05). Conclusion Chronic inflammation may fuel declines in physical function leading to frailty and disability. If yoga dampens or limits both fatigue and inflammation, then regular practice could have substantial health benefits.

scholarly journals Nephroprotective Impact of Adjuvant Yoga Therapy on Diabetes- A Randomised Controlled Trial

2020 ◽  
Author(s):  
Rajasekar Balaji ◽  
Meena Ramanathan ◽  
Ananda Balayogi Bhavanani
Keyword(s):  
Randomised Controlled Trial ◽  
Blood Sugar ◽  
Medical Management ◽  
Metabolic Diseases ◽  
Controlled Trial ◽  
Control Group ◽  
Diabetic Patients ◽  
Yoga Therapy ◽  
Yoga Group ◽  
Randomised Controlled

Introduction: Recent studies have provided abundant evidence about benefits of yoga in various chronic disorders. Diabetes Mellitus (DM) is a group of metabolic diseases characterised by chronic hyperglycaemia and renal complications of the disease are especially notable. It is estimated that 10% to 40% cases of Type 2 DM (T2DM) eventually end up having kidney failure. Yoga therapy may help to prevent progression of kidney damage in diabetic patients. Aim: To evaluate the effect of adjuvant yoga therapy on renal profile in diabetic patients. Materials and Methods: This single blind Randomised Controlled Trial (RCT) was designed as an interdisciplinary collaborative work between Centre for Yoga Therapy, Education and Research (CYTER) and Department of Endocrinology of Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India. A total of 72 diabetic patients with HbA1c, more than 7% were recruited and pre study evaluation of Fasting Blood Sugar (FBS), Postprandial Blood Sugar (PPBS), HbA1c, blood urea and serum creatinine were done. They were then randomised into control group (n=36) who received only standard medical management and yoga group (n=36) who received yoga therapy thrice weekly for 4 months along with standard medical management. Poststudy evaluation of all parameters was done at end of study period and data were analysed by Student’s paired and unpaired t-test for intra and intergroup comparisons. Results: Postinterventional comparisons revealed statistically significant reductions (p<0.001) in all glycaemic and renal parameters in the group receiving yoga therapy when compared with control group who didn’t receive the yoga intervention. Intragroup comparisons revealed significant reduction of all parameters in yoga group. Conclusion: It is concluded from the present RCT that yoga has a definite role as an adjuvant therapy as it enhances standard medical care and hence, can be recommended in routine clinical management of diabetes to prevent progression into complications that are part of the natural history of the disease.

scholarly journals A Meta-Analysis: Intervention Effect of Mind-Body Exercise on Relieving Cancer-Related Fatigue in Breast Cancer Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Cong Liu ◽  
Man Qin ◽  
Xinhu Zheng ◽  
Rao Chen ◽  
Jianghua Zhu
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Combined Effect ◽  
Assessment Tools ◽  
Cochrane Library ◽  
Control Group ◽  
Breast Cancer Patients ◽  
Intervention Effect ◽  
Cancer Related Fatigue

Objective. This paper aims to systematically evaluate the intervention effect of mind-body exercise on cancer-related fatigue in breast cancer patients. Methods. Databases including PubMed, the Cochrane Library, Embase, Web of Science, CNKI, Wanfang Data, and SINOMED were retrieved to collect randomized controlled trials on the effects of mind-body exercise on relieving cancer-related fatigue in breast cancer patients. The retrieval period started from the founding date of each database to January 6, 2021. Cochrane bias risk assessment tools were used to evaluate the methodological quality assessment of the included literature, and RevMan 5.3 software was used for meta-analyses. Results. 17 pieces of researches in 16 papers were included with a total of 1133 patients. Compared with the control group, mind-body exercise can improve cancer-related fatigue in breast cancer patients. The combined effect size SMD = 0.59, 95% CI was [0.27, 0.92], p < 0.00001 . Doing Tai Chi for over 40 minutes each time with an exercise cycle of ≤6 weeks can improve cancer-related fatigue in breast cancer patients more significantly. Sensitivity analysis shows that the combined effect results of the meta-analysis were relatively stable. Conclusion. Mind-body exercise can effectively improve cancer-related fatigue in breast cancer patients.

scholarly journals Effectiveness of an Internet- and App-Based Intervention for College Students With Elevated Stress: Randomized Controlled Trial (Preprint)

2017 ◽  
Author(s):  
Mathias Harrer ◽  
Sophia Helen Adam ◽  
Rebecca Jessica Fleischmann ◽  
Harald Baumeister ◽  
Randy Auerbach ◽  
...  
Keyword(s):  
Mental Health ◽  
College Students ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Waitlist Control ◽  
Symptoms Of Depression ◽  
Randomized Controlled ◽  
Waitlist Control Group

BACKGROUND Mental health problems are highly prevalent among college students. Most students with poor mental health, however, do not receive professional help. Internet-based self-help formats may increase the utilization of treatment. OBJECTIVE The aim of this randomized controlled trial was to evaluate the efficacy of an internet-based, app-supported stress management intervention for college students. METHODS College students (n=150) with elevated levels of stress (Perceived Stress Scale 4-item version, PSS-4 ≥8) were randomly assigned to either an internet- and mobile-based stress intervention group with feedback on demand or a waitlist control group. Self-report data were assessed at baseline, posttreatment (7 weeks), and 3-month follow-up. The primary outcome was perceived stress posttreatment (PSS-4). Secondary outcomes included mental health outcomes, modifiable risk and protective factors, and college-related outcomes. Subgroup analyses were conducted in students with clinically relevant symptoms of depression (Center for Epidemiological Studies’ Depression Scale >17). RESULTS A total of 106 participants (76.8%) indicated that they were first-time help-seekers, and 77.3% (intervention group: 58/75; waitlist control group: 58/75) showed clinically relevant depressive symptoms at baseline. Findings indicated significant effects of the intervention compared with the waitlist control group for stress (d=0.69; 95% CI 0.36-1.02), anxiety (d=0.76; 95% CI 0.43-1.09), depression (d=0.63; 95% CI 0.30-0.96), college-related productivity (d=0.33; 95% CI 0.01-0.65), academic work impairment (d=0.34; 95% CI 0.01-0.66), and other outcomes after 7 weeks (posttreatment). Response rates for stress symptoms were significantly higher for the intervention group (69%, 52/75) compared with the waitlist control group (35%, 26/75, P<.001; number needed to treat=2.89, 95% CI 2.01-5.08) at posttest (7 weeks). Effects were sustained at 3-month follow-up, and similar findings emerged in students with symptoms of depression. CONCLUSIONS Internet- and mobile-based interventions could be an effective and cost-effective approach to reduce consequences of college-related stress and might potentially attract students with clinically relevant depression who would not otherwise seek help. CLINICALTRIAL German Clinical Trial Register DRKS00010212; http://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00010212 (Archived by WebCite at http://www.webcitation.org/6w55Ewhjd)

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