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Whole body cryotherapy as a novel adjuvant therapy for depression and anxiety



Aim. The whole body cryotherapy (WBCT) is becoming a more popular adjuvant method in rehabilitation and renewal. The objective was to evaluate influence of WBCT on depressive and anxiety symptoms. Materials and methods. The study group (n=26) was treated using a series of 15 daily visits to a cryogenic chamber (-110° to 160°C) which lasted 2-3 minutes each. A control (n=34) group was similar to the study group as concerning diagnoses (anxiety and depressive disorders), age and gender. Both groups received standard out-patient psychopharmacotherapy. The Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale were used to evaluate the severity of symptoms before and after WBCT (3 weeks observation). The self-rating life satisfaction scale was used as well. Two efficacy measures were established: a significantly greater reduction of the scales' scores and mean scores lower at the endpoint in the study group in comparison to the control group. Results. Both efficacy criteria were fulfilled for the depression scale in 12 of the 16 HDRS items except gastrointestinal and genitourinary symptoms, hypochondria, body mass and criticism. Concerning the HARS scale, in 11 of 14 anxiety items (except gastrointestinal and genitourinary symptoms and behavior) the mean reduction was significantly bigger and the mean final status was better in the experimental group in comparison to the control one. As for the life satisfaction scale, efficacy was shown in 6 of the11 items: physical and mental health, everyday activity, vocational activity, hobbies and general life satisfaction - in the experimental group. Conclusion. These findings suggest a possible role for WBCT as a short-term adjuvant therapy for depressive and anxious patients.
Archives of Psychiatry and Psychotherapy, 2008; 2 : 49–57
Joanna Rymaszewska1 David Ramsey2:1DepartmentofPsychi-
Whole body cryotherapy as a novel adjuvant therapy
for depression and anxiety
Materials and methods.Thestudygroup(n=26)wastreatedusingaseriesof15dailyvisitstoacryo-
whole body cryotherapy / depression / anxiety / novel therapy
At the end of the 1970’s, Prof. Toshiro Yamauchi
constructed the first cryogenic chamber and suc-
cessfully used cryotherapy to treat rheumatism
]. Nowadays, whole body cryotherapy (WBCT)
is used to alleviate inflammation and pain in os-
teoarthritis [
] or for pain relief in fibromyal-
gia [
], in reduction of spasticity in neurologi-
cal diseases [
] and as the method of physiother-
apy in rheumatic diseases and sclerosis multi-
plex or giving a sedative effect in psoriasis and
neurodermatitis [2].
The whole body cryotherapy results in analge-
tic, antiswelling, hormone, immune, circulato-
ry system reactions[5,
]. The WBCT does not
affect the heart rate, arterial blood pressure nor
the value of the left ventricle fractional shorten-
ing index and its ejection, neither does it cause
50 Joanna Rymaszewska, David Ramsey
Archives of Psychiatry and Psychotherapy, 2008; 2: 49–57
arrhythmias and ischaemic changes of the heart
and is a safe treatment if the time of exposure is
strictly controlled [5,
]. However, WBCT should
be applied with caution in susceptible individu-
als, such as asthmatics [
WBCT activates the body’s system of temper-
ature regulation [
] and a hormonal response
(increase of body metabolism and the concen-
tration of adrenaline, noradrenaline, adrenocor-
ticotropic hormone (ACTH), cortisone, pro-opi-
omelanocortin (POMC) and beta-endorphins in
blood plasma, as well as male testosterone lev-
els) [8,
POMC is the source of several important bio-
logically active substances such as ACTH in the
anterior pituitary gland and melanocyte-stimu-
regulation of appetite and sexual behavior. One
of the neurobiological hypotheses of depres-
sion based largely on dysregulation of the hy-
pothalamic-pituitary-adrenal axis. Brain opio-
id peptide systems are known to play an impor-
tant role in motivation, emotion, attachment be-
haviour, the response to stress and pain, and the
control of food intake [
]. The positive effects of
WBCT in treating both external and internal pain
are due to the activation of the endogenic opio-
id system and “pain control system” [13]. It is
possible that such a multi-system reaction could
play a role in the treatment of mental disorders
]. The WBCT is successfully used in clinical
work in several countries, however a very limit-
ed number of data is available.
The aim of the study was to assess the effect of
whole-body cryotherapy (WBCT) on the symp-
toms observed in a group of patients suffering
from affective and anxiety disorders and their
own subjective assessment of life satisfaction.
The study protocol was accepted by the Bioeth-
ics Commission. It is based on the evaluation of
depressive and anxiety symptoms in a group of
subjects exposed to WBCT with a control group
and was carried out in the Department of Psy-
chiatry of Wroclaw Medical University.
Exclusion criteria were as follows: circulatory
and breathing insufficiency, clotting, embolism,
inflammation in blood vessels, open wounds, ul-
cers, serious cognitive disturbances, fever, ad-
dictions, claustrophobia, and oversensitivity to
After written informed consent, subjects (18-65
years old) from the control (n=34) and study
group (n=26) received standard psychopharma-
cotherapy as prescribed in an outpatient psychi-
atric clinic. This treatment was not modified dur-
ing the evaluation period.
Patients were diagnosed as having depres-
sive and anxiety disorders (ICD-10 criteria) (Ta-
ble 1).
Subjects in the study group were additionally
exposed by a cycle of 15 visits (2-3 minutes) in a
cryogenic chamber carried out 5 times per week
according to Zagrobelny et al. guidance of the
appropriate duration of exposure and tempera-
ture for adult patients, as well as a list of medi-
cal conditions [13]. The cryogenic chamber has
the temperature between –1100C and –1600C.
This temperature was systematically lowered
over successive visits to permit the organism to
adapt to low temperatures. Patients walked in-
side the chamber in swimming suits with their
noses and mouths secured by a surgical mask
lined from the inside with two layers of gauze,
their ears covered by a woollen headband and
feet in woollen socks and wooden clogs.
Observations were made before and after the
WBCT (three weeks). Apart from standard med-
ical documentation, the study used Hamilton’s
scales of depression and anxiety and the life sat-
isfaction scale.
The 17-item Hamilton Depression Rating
Scale (HDRS-17) is used to assess the severity
of depressive symptoms and provides a valua-
ble guide of a patient’s progress over time [
Items are scored from 0 to 4 and, in general, the
higher the total score the more severe the de-
pression. The original 17-item HDRS reported
to be the most sensitive scale for measuring re-
sponse to treatment often used in clinical trials.
The Hamilton Anxiety Rating Scale (HARS)
included 13 items, each item is rated on
a five-point scale. The five scores are: none (0),
mild (1), moderate (2), severe (3) and very severe
(4). This is a widely used scale and an accepted
outcome measure in clinical trials.
The life satisfaction scale[
] is the self rat-
ing scale composed of 11 items, which allows to
Whole body cryotherapy as a novel adjuvant therapy for depression and anxiety 51
Archives of Psychiatry and Psychotherapy, 2002; 2 : 49–57
asses current satisfaction from different life do-
mains. It’s structure is based on a 7-point ana-
logue scale.
The authors established two outcome measures
for assessing the short term WBCT efficacy:
1. the reduction of the scales’ scores have to be
significantly greater in the study group than
in the control one,
2. The mean of the scores in the study group
have to be lower at the endpoint.
The authors used several statistical methods:
the Fishers exact test, the Wilcoxon rank test
(changes within groups between both measure
points) and the Mann-Whitney rank test (com-
parisons of these changes between groups).
There was no significant difference between
two groups concerning sociodemographic fea-
tures or clinical ones except the level of educa-
tion (Tab. 1)
The results of items 16B and 17 from HDRS-17
scale were the same for all patients (“0”) except
one, so those items were not included to the
Before the experiment, the severity of anxiety
symptoms were significantly higher in the study
group in only few items (Tab.2) as well as con-
cerning depressive symptoms (Tab.3) and life
satisfaction scores (Tab.4).
After 3 weeks of the experiment more signif-
icant differences in each items of all tree scales
were observed (Tab.2-4).
In the experimental group significant reduc-
tion of 13 from 14 HARS items were observed
(10 items: p<0.001; Genitourinary symptoms:
p<0.05). Only gastrointestinal symptoms did
not improve significantly. Concerning the HDRS
items, it was the reduction in most of the items at
the level of 0.001 except guilt feelings, early wak-
ing, psychomotor retardation and hypochondri-
as on the level below 0.01. Only gastrointestinal
symptoms and body mass did not change with-
in 3 weeks.
The significant improvement concerning anx-
iety mood, tension and behaviour from HARS
(n=34) p-value
Women 22(84.6%) 31(91.2%) NS
Age 47.04(SD=13.05) 40.88(SD=11.90) NS
7(20.6%) NS
Havingchildren 17 25 NS
Livingalone 3(11.5%) 3(8.8%) NS
No.ofworking 7(28%) 7(20.6%) NS
14(41.2%) NS
52 Joanna Rymaszewska, David Ramsey
Archives of Psychiatry and Psychotherapy, 2008; 2: 49–57
Measures I II
Group Study Control p-value Study Control p-value
1. Anxiousmood 2.77
(0.83) NS
(0.73) NS
2. Tension 3.27
(0.60) NS
(0.48) 0.000
3. Fears 1.58
(1.18) NS
(1.10) NS
4. Insomnia 3.12
(1.21) 0.04
(1.21) 0.002
5. Intellectual 2.38
(1.10) NS
(1.07) 0.015
6. DepressedMood 2.73
(1.09) NS
(0.99) NS
7. SomaticComplaints:Muscular 1.96
(1.05) NS
(0.99) NS
8. SomaticComplaints:Sensory 1.50
(1.07) NS
(1.05) 0.008
9. CardiovascularSymptoms 1.96
(0.89) NS
(0.81) 0.000
10. RespiratorySymptoms 2.00
(1.19) NS
(0.99) 0.027
11. Gastrointestinalsymptoms 1.77
(1.30) NS
(1.20) NS
12. Genitourinarysymptoms 1.85
(1.17) 0.012
(0.95) 0.009
13. AutonomicSymptoms 2.04
(0.93) NS
(0.82) 0.032
14. BehavioratInterview 2.35
(1.07) 0.031
(0.99) NS
were observed in control group (p<0.05; p<0.01;
p<0.05, respectively), without significant chang-
es in HDRS items and life satisfaction items.
Concerning life satisfaction scale significant
improvement in mental health (p<0.001), phys-
ical health, hobbies and overall life satisfaction
(p<0.01), vocational activity, everyday activities,
and sexual life (p<0.05) was noticed. No signifi-
cant improvement were observed in case of fam-
ily, social and spiritual life as well as of materi-
al conditions.
Comparing changes of means within the treat-
ment period between both groups, there were
observed significantly higher changes of HARS
scores in the experimental group than in the
control group, except gastrointestinal and geni-
tourinary symptoms (Tab. 5). Changes of HDRS
scores during observation period were also sig-
nificantly higher (p<0.0001) except gastrointes-
tinal symptoms, which means that reduction of
depressive symptoms was better in experimen-
tal group (Tab.6).
Higher increase in life satisfaction scale items
was observed in the experimental group in com-
parison to the control group in several items:
mental health, everyday activities and hob-
bies (p < 0.001), vocational activity and overall
Whole body cryotherapy as a novel adjuvant therapy for depression and anxiety 53
Archives of Psychiatry and Psychotherapy, 2002; 2 : 49–57
Measures I II
Group Study Control p-value Study Control p-value
1. Depressedmood 1.96
(1.19) NS 1.15
(1.05) 0.00
2. Guiltfeelings 1.65
(0.61) NS 1.15
(0.61) 0.00
3. Suicide 0.69
(0.78) NS 7.7e-02
(0.54) 0.00
4. Insomnia-early 1.77
(0.61) NS 0.62
(0.61) 0.00
5. Insomnia-middle 1.54
(0.74) 0.002 0.46
(0.70) 0.00
6. Insomnia-late 1.35
(0.68) NS 0.69
(0.64) 0.00
7. Workandactivities 2.12
(0.77) NS 0.62
(0.69) 0.00
8. Retardation-psychomotor 0.69
(0.65) NS 0.38
(0.65) 0.00
9. Agitation 1.19
(0.81) NS 0.65
(0.81) 0.00
10. Anxiety-psychological 2.19
(0.57) NS 1.46
(0.54) 0.00
11. Anxiety-somatic 1.92
(0.85) NS 0.88
(0.78) 0.00
12. Gastrointestinalsymptoms 0.42
(0.66) NS 0.35
(0.66) NS
13. Generalsomaticsymptoms 1.38
(0.65) NS 0.42
(0.61) 0.00
14. Sexualdysfunction/menstrualdisturbance 1.69
(0.81) 0.004 1.19
(0.81) 0.00
15. Hypochondrias 1.19
(0.93) NS 0.88
(0.92) 0.00
16. Weightloss 0.42
(0.51) NS 0.31
(0.51) NS
Measures I II
Group Study Control p-value Study Control p-value
1. Physicalhealth -0.73
(1.12) NS 0.35
(1.11) 0.00
2. Mentalhealth -1.15
(0.85) NS -0.22
(0.88) 0.00
3. Familylife 1.12
(1.69) 0.05 1.13
(1.61) 0.01
4 Socialrelationship 0.54
(1.61) NS 0.87
(1.48) 0.006
54 Joanna Rymaszewska, David Ramsey
Archives of Psychiatry and Psychotherapy, 2008; 2: 49–57
5. Everydayactivities -0.50
(1.66) NS 0.30
(1.70) NS
6. Vocationalactivity -1.19
(1.64) NS -0.61
(1.64) NS
7. Hobbies -0.69
(1.84) NS 8.7E-02
(1.47) 0.015
8. Sexuallife -1.35
(1.84) NS -0.96
(1.79) NS
9. Materialconditions -8.E-02
(1.64) NS 0.22
(1.56) NS
10. Spirituallife 0.96
(1.21) NS 1.17
(1.22) NS
11. Overalllifesatisfaction -0.65
(1.19) NS 0.13
(1.78) 0.008
Items Group MeanII-I p-value
1.Anxiousmood Experimental 0.85 0.001
Control 0.21
2.Tension Experimental 1.23 0.000
Control 0.26
3.Fears Experimental 0.38 0.032
Control -6.E-02
4.Insomnia Experimental 1.73 0.000
Control 0.18
5.Intellectual Experimental 0.88 0.000
Control 8.8E-02
6.epressedmood Experimental 1.0 0.000
Control 2.9E-02
7.Somaticcomplaints:muscular Experimental 0.8 0.001
Control 0.18
8.Sensory Experimental 0.69 0.007
Control 0.21
9.Cardiovascular Experimental 0.77 0.001
Control 0.18
10.Respiratory Experimental 0.69 0.001
Control 8.8E-02
11.Gastrointestinal Experimental 0.23 NS
Control -3.E02
12.Genitourinary Experimental 0.27 NS
Control 0.18
13.Autonomic Experimental 0.69 0.005
Control 0.15
14.Behaviorininterview Experimental 0.65 0.002
Control 0.15
Whole body cryotherapy as a novel adjuvant therapy for depression and anxiety 55
Archives of Psychiatry and Psychotherapy, 2002; 2 : 49–57
Items Group MeanII-I p-value
1.Depressedmood Experimental 0.8 0.000
Control 5.9E-02
2.Guiltfeelings Experimental 0.5 0.000
Control 0.0
3.Suicide Experimental 0.62 0.000
Control 0.12
4.Insomnia-early Experimental 1.15 0.000
Control 0.0
5.Insomnia-middle Experimental 1.08 0.000
Control 8.8E-02
6.Insomnia-late Experimental 0.65 0.000
Control 8.8E-02
7.Workandactivities Experimental 1.5 0.000
Control 0.0
8.Retardation-psychomotor Experimental 0.31 0.001
Control 0.0
9.Agitation Experimental 0.54 0.000
Control 0.0
10.Anxiety-psychological Experimental 0.73 0.000
Control 2.9E-02
11.Anxiety-somatic Experimental 1.04 0.000
Control 2.9E-02
12.Gastrointestinalsymptoms Experimental 7.7E-02 NS
Control -3.E-02
13.Generalsomaticsymptoms Experimental 0.96 0.000
Control -6.E-02
Experimental 0.5 0.000
Control 0.0
16.Hypochondrias Experimental 0.31 0.000
Control -3.E-02
17.Weightloss Experimental 0.12 0.000
Control 0.0
life satisfaction (p < 0.01) and physical health
(p < 0.05).
Summing up, both efficacy criteria were ful-
filled for the depression scale in 12 of the 16
items of HDRS except gastrointestinal and geni-
tourinary symptoms, hypochndriasis, body mass
and criticism. Concerning the HARS scale, the
mean reduction was significantly bigger and the
mean final status was better in the experimen-
tal group in comparison to the control group in
11 of the 14 anxiety items (except gastrointes-
tinal and genitourinary symptoms and behav-
ior). As for the life satisfaction scale, efficacy was
proved in the experimental group in 6 of the 11
items: physical and mental health, everyday ac-
tivity, vocational activity, hobbies and general
life satisfaction.
There is a lack of evidence based findings on
whole body cryotherapy as a method for treating
mental disorders except one paper of Rymasze-
wska and al. [15]. Only few studies proved the
positive role of WBCT in fibryomyalgia [
] and
other diseases of the motor system [1, 2, 5].
Concerning mental disorders, several new bio-
logical treatment methods are being developed.
56 Joanna Rymaszewska, David Ramsey
Archives of Psychiatry and Psychotherapy, 2008; 2: 49–57
Methods involving neurostimulation include re-
petitive transcranial magnetic stimulation, mag-
netic seizure therapy, vagus nerve stimulation,
deep brain stimulation and transcranial direct
current stimulation. These methods may be ef-
fective in treating depression and have minimal
side effects [
21, 24
The presented findings indicate that cryother-
apy may play a positive role in the process of
treating patients with affective and anxiety dis-
orders, since the decrease of anxiety and depres-
sive symptoms were significantly higher in the
group of patients who were exposed onto ex-
tremely low temperature sessions.
Comparing to controls. Analysis of the long
term observations will indicate whether this ef-
fect is long lasting. Even if the follow-up results
indicate that the long term effects of treatment
are the same in both groups, the rapid initial im-
provement achieved using cryotherapy means
that such adjunctive treatment may be of value.
It may be assumed, that the physiological
mechanisms of WBCT such as those associated
with HPA axis and endogenous opioids can ex-
plain the positive influence of WBCT on mood
and other symptoms. However, it is highly pos-
sible that also other, not yet recognized mecha-
nisms can be associated with WBCT effect.
Those hypotheses need to be confirmed in fur-
ther research. Limitations of the current study
(small sample size and the lack of a procedure
randomly assigning patients to a group) forced
the authors to emphasize the need of caution in
interpreting and generalizing the presented find-
ings. The continuation of the study is planned
involving several biological diagnostic methods
as neuroimaging and biochemical measures with
the aim of clarifying the effect of WBCT on men-
tal health.
1. YamauchiT.WholeBodyCryo-TherapyisMethodofextreme
tis.Z.Phys.Med.Baln.Med.Klim.1989,15:311. 
5.SchroederD,AndersenM.Kryo-und Thermotherapie.
11. RomukE, BirknerE,Skrzep-Poloczek B,Jagodzinski L,
12.Korzonek-Szlacheta I, Wielkoszyński T, Stanek A,
Whole body cryotherapy as a novel adjuvant therapy for depression and anxiety 57
Archives of Psychiatry and Psychotherapy, 2002; 2 : 49–57
19. OffenbacherM,StuckiG.Physicaltherapyinthetreatmentoffi-
20. GrunhausL,DannonPN,SchreiberS,DolbergOH,AmiazR,
... The effectiveness of cryogenic temperature treatments is proven in the treatment and rehabilitation of several diseases like multiple sclerosis, arthrosis, chronic back pain, or fibromyalgia (14)(15)(16)(17). We also know that WBC is widely used in sports medicine (18) and may have a potentially positive effect on affective disorders (19)(20)(21), deterioration of cognitive functions (22), and worsen sleep quality (23,24) as well. The potential mechanisms of action still remain unclear. ...
... Total scores between 0 and 11 indicate the lack of depressive symptoms, 12-26-mild depressive episode, 27-49-moderate depressive episode, and 50-63-severe depressive episode. Authors also (40) identified two dimensions within BDI-II of self-reported depression for psychiatric outpatients in general: cognitive-affective (BDI-II D1; first 13 items) and somatic dimensions (BDI-II D2; items [14][15][16][17][18][19][20][21]. The Polish version of the BDI-II has good psychometric characteristics (42). ...
... Indeed, our present findings confirm the results of earlier studies of Rymaszewska et al. (19,20), and also our preliminary report (21). In 2012, Misiak et al. (52) suggested translation WBC into the prevention of MCI and Alzheimer's disease. ...
Full-text available
IntroductionAccumulating evidence indicates the effectiveness of cryogenic temperature interventions in rheumatoid arthritis, ankylosing spondylitis, fibromyalgia, multiple sclerosis, and chronic low back pain. The application of whole-body cryotherapy (WBC) in psychiatric aspects of medicine was also noted. Nevertheless, the exact mechanisms explaining the beneficial effect of WBC on mood disorders remain unclear. The study aimed to assess the efficacy of repetitive short exposure to extremely low temperatures (WBC) on mood, quality of life as well as on biochemical measures among people diagnosed with depressive episode undergoing pharmacological treatment.Materials and Methods Prospective randomized, double-blind sham-controlled protocol was used. The study enrolled 92 medically stable adults (aged 20–73 years) with a diagnosis of a depressive episode. The participants were randomly allocated and exposed to 10 whole-body cryotherapy (WBC) sessions (−110°C till −160°C [the experimental group (EG)] or to low, but not cryogenic temperatures −50°C [the control group (CG)]. Thirty participants in the EG and 26 in CG completed the whole study. The primary outcome measures were depressive symptoms evaluated with the Beck Depression Inventory-II (BDI-II) as well as the Hamilton Depression Rating Scale (HAM-D 17). The quality of life, quality of sexual life, acceptance of the disease and self-reported mood, vitality, and sleep quality were assessed as secondary outcome measures. The study was registered at Australian New Zealand Clinical Trials Registry (ACTRN12619001600134).ResultsThe results show evidence for a statistically significant difference in the clinical assessment of depressive symptoms according to HAM-D 17 scale (T4 by group interaction p=0.02), BDI-II (T2 time by group interaction p=0.01), cognitive-affective BDI dimension (T4 by group interaction p=0.00), and somatic BDI dimension (T4 by group interaction p=0.028). Significant improvement was also noticed in life quality (p < 0.05), self-assessed mood (p=0.035), and disease acceptance (p=0.007). There were no statistically significant changes related to sexual satisfaction, self-assessed vitality, and sleep (p > 0.05).Conclusions Whole-body cryotherapy is a useful method to improve standard pharmacological treatment. The WBC intervention reduces mental health deterioration, especially in mood disorders, such as depression, and can be beneficial for well-being and quality of life.
... It is possible that such a multi-system reaction could play a role in the treatment of mental disorders. The WBCT is successfully used in clinical work in several countries; however, very limited data are available [11]. ...
... More research is needed about the relation between cryotherapy and physical immunity. (11). More research is needed about the relation between cryotherapy and sleep disturbances. ...
Full-text available
Background Tension-type headache and stress are common students’ problems suffering. Alternative and complementary medicine, as cryotherapy, is effective for relieving physical and psychological pain; using ice compresses by placing it at the back of the neck, leads to relief of tension and anxiety, and gives feeling of relaxation and full of energy for doing daily life activities. The findings from this study will provide the basis for the formulation of future research questions that can explore the effect of cryotherapy for treatment of many psychological problems, specifically, researches that consider the role of cryotherapy for treatment of physical and psychological problems. Aim of the study This study aimed to assess tension-type headache, its relation to stress, and how to relieve it by cryotherapy, among academic students . Results Results revealed that there is an association between stress and tension-type headache, as the level of stress increased, the occurrence of tension-type headache increased. Conclusion Academic students experience stress appearing as physical and psychological symptoms that affect their daily life activities. There is a significant relationship between level of stress and TTH, with diurnal pattern, location, severity, and duration of TTH. After applying cryotherapy (ice compresses) in relieving TTH, students feel analgesia, relaxation, increased effort, and alertness, added to that decreased mental tension and recurrence of headache to a minimum level.
... Little is known about the improvement of sleep efficiency and duration after WBC [17,18]. Similarly, the influence of WBC on mood disorders has not been the purpose of many research [19,20] and the mechanisms of action are still unknown. ...
... Moreover, 10 sessions of WBC caused not only reduction in depressive symptoms but also simultaneous increase in general well-being, quality of life and ability to experience pleasure (reduction in anhedonia). This evidence confirmed the beneficial impact of WBC on depressive disorders [19,20], fatigue and functional status [28] as well as mental state and quality of life [29] of people undergoing cryostimulation. ...
Objective: More effective, tolerable interventions for unipolar depression treatment are needed. Whole-body cryotherapy (WBC), which is a treatment using cryogenic temperature, is a novel therapeutic modality in neurology and rheumatology. The objective of this study was to determine the efficacy and safety of WBC as an add-on treatment for unipolar depression. Methods: 30 adults diagnosed with unipolar depressive episode were recruited to an observational, prospective study. 21 participants (17 women, 81%), mean age 46.1 (±16.7), completed the whole study procedure. Hamilton Depression Rating Scale and the Beck Depression Inventory were used to assess the severity of depressive symptoms. Additionally quality of life and anhedonia were assessed with WHOQoL-BREF and SHAPS. Participants undertook 10, 2-minutes (-110 C till -135 C) WBC sessions on weekdays. Results: Patients after WBC sessions showed significant improvement compared to their baseline scores taking into account depressive symptoms measured by HDRS (p<0.00001) in total scores between T1 (16.94±4.3) and T4 (4.50±4.2) and by BDI-II (T1: 13.48±4.6; T4: 6.14±6.7, p<0.03), lower anhedonia level on SHAPS (p=0.011) and higher quality of life between T1 and T4 in: physical health (p=0.024), psychological health (p=0.016) and environmental (p=0.003) domains. Pre/post comparison of self-report well-being measured by VAS scale showed a significant increase (p<0.00001). It was shown that WBC have no effect on cytokine, NO, hsCRP, ESR and TAS in blood (p>0.05). Conclusions: In the pilot study, WBC was an effective, safe, and tolerable add-on intervention for this small unipolar depression sample. Further RCT trials should examine WBC efficacy in a larger group.
... In total ten studies met the inclusion criteria. [68][69][70][71][72][73][74][75][76][77] Not all articles provided means, SDs and correlations in their tables. Within eight months time we managed to obtain all the necessary means and SDs that were missing from the corresponding or primary authors. ...
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Objective To give an overview of the nature and methodological quality of studies on whole body cryotherapy (WBC) as add-on intervention for mental health problems. Methods A meta-analysis according to PRISMA guidelines was conducted (Prospero registration: CRD42020167443). Databases MEDLINE, PsycINFO and the Cochrane Library were searched. Risk of bias was scored according to the Cochrane ROBINS-I-tool to which an extra bias-dimension of allegiance bias was added. Within and between Hedges’ g pooled effect sizes were calculated for the main aspect of mental health measured. Treatment efficacy was examined using a random effects model. Heterogeneity was examined through identification of visual outliers and by I² statistics. Results Out of 196 articles coming up from the search, ten studies met all inclusion criteria, six of which were (randomized) controlled trials. Together these studies report on a total of 294 participants receiving WBC. The within-group pooled effect size for mental health problems is large (Hedges’ g = 1.63, CI: 1.05-2.21), with high heterogeneity (I² = 93%). Subgroup analyses on depressive symptoms and quality of life (QOL) showed a diminution of heterogeneity to moderate. Effect sizes for depressive symptoms are very large (Hedges’ g = 2.95, CI: 2.44-3.45) and for QOL medium (Hedges’ g = 0.70, CI: 0.15-1.24). The between-group pooled effect size is medium (Hedges’ g = 0.76, CI: 0.17-1.36). Conclusions Results indicate preliminary evidence for WBC as efficacious add-on intervention for mental health problems, especially depressive symptoms. Further research in the form of RCTs with larger numbers of participants is needed.
... Lately WBC is more and more often used in healthy subjects as a method to promote well-being (Stanek et al., 2016(Stanek et al., , 2019. Preliminary evidence of WBC benefits in the mental health area, including improving quality of life (Szczepańska-Gieracha et al., 2014), reducing depressive symptoms (Rymaszewska et al., 2019(Rymaszewska et al., , 2020Rymaszewska and Ramsey, 2008) and improving cognitive functions, as well as biochemical blood parameters, have been reported in people with MCI (Rymaszewska et al., 2018). ...
Background Whole-Body Cryotherapy (WBC) - a repetitive, short-term exposure to extremely low temperatures – may become an effective early intervention for mild cognitive impairment (MCI). It is a heterogeneous group of symptoms associated with cognitive dysfunction which is estimated to transform into dementia in 50% cases. Study design The prospective randomised double-blind sham-controlled study aimed to determine the efficacy of WBC on cognitive functioning and biological mechanisms. The study was registered with Australian New Zealand Clinical Trials Registry (ACTRN12619001627145). Methods Participants with MCI (n = 62; (20 26) were randomly allocated to cryogenic temperatures (−110 °C till −160 °C) (EG, n = 33) or placebo-controlled group (CG, n = 29). Cognitive functions were measured at baseline (T1), after the 10th WBC session (T2) and after 2 week-break (T3) with DemTect, SLUMS and Test Your Memory (TYM). Secondary outcome measures included quality of life (WHOQoL–BREF), self-reported well-being (VAS) and depressive symptoms (GDS). Whole blood samples (10 ml) were collected at T1 and T2 to evaluate levels of cytokines, neurotrophins, NO and biochemical parameters CRP total cholesterol, prolactin). Results There were significant differences between groups measured at T2 in immediate recall (DemTect) and in orientation (TYM) in favour of WBC group. Improvement in mood was detected in self-reported depressive symptoms level (WHOQoL-26; T2 p = 0.04; VAS mood T2 p = 0.02; T3 p = 0.07). The significant reduction of BDNF level was observed (p < 0.05). Conclusions WBC may increase the performance of cognitive functions. It seems promising to combine WBC with existing behavioural and cognitive trainings in the future studies investigating early interventions methods in MCI.
... In practice, there are two options for carrying out WBC procedures in multi-seat and single-seat installations [7,[22][23][24]. The cooling conditions in these installations differ significantly; therefore, the technology of group and individual WBC should be developed separately. ...
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Whole-body cryotherapy (WBC) is a highly effective treatment method of a number of serious diseases. The therapeutic effect of WBC is achieved by stimulating cold receptors of the patient's skin, which provide supercooling of the skin surface to the level of À2°C. To achieve such a temperature of the skin surface, it is necessary to ensure heat removal with intensity not less than 3500 W/m 2. Such a heat flux can remove gas with the temperature not higher than À130°C. Procedures lasting less than 2 minutes do not form therapeutic effect. Procedures lasting more than 3 minutes are dangerous for the patient's health. WBC procedures are carried out in single-and multi-seat devices. Due to the compact placement of the patient in the WBC area, the share of useful heat load on the cryostatting system is up to 70%. In multi-seat installations, the useful heat load share is not more than 50%. During the WBC procedure, consumption of liquid nitrogen per patient is 3.77 kg. For the effective use of WBC technology, it is necessary to determine the general requirements for the power of cooling systems and the temperature of cryostatting of the WBC area.
Aim: To evaluate the therapeutic effect of a series of 10 treatments of whole-body cryotherapy combined with kinesitherapy on the cervical spine pain in the course of degenerative disease. Evaluation of the adverse effects occurrence during stay in a cryogenic chamber in patients of different ages. Materials and Methods: For the study, based on the inclusion and exclusion criteria, 29 patients were qualified out of 231 patients who underwent the procedure of whole-body cryotherapy combined with kinesitherapy during the period of observation. The following data were used in the study: data from medical records, a sociodemographic questionnaire, standardized methods – the VAS scale and a modified questionnaire of pain indicators according to Laitinen. Results: In the VAS scale in about 93.1%, and based on the modified questionnaire of pain indicators according to Laitinen, in as many as 96.5% of patients, a reduction in the intensity of pain of the cervical spine after 10 sessions of whole-body cryotherapy combined with kinesitherapy was observed. On average, pain symptoms decreased by 2.9 points on the VAS scale and the average score according to modified questionnaire of pain indices according to Laitinen was by 2.8. Conclusions: A series of 10 procedures of whole-body cryotherapy combined with kinesitherapy reduces the intensity of pain in the cervical spine in the course of degenerative spine disease. Cryogenic chamber treatment is safe and well tolerated, regardless of the age.
The sleep apnea syndrome (SAS) is a sleep related-breathing disorder with several features such a systemic inflammation, oxidative stress, a cognitive impairment and a poor sleep quality. Patients with SAS present an increased incidence of cardiovascular diseases. There is no real effective treatment that prevents and treats all of these illness symptoms. Cooling therapies are often used in sport medicine and in athletes after training and competitions to reduce inflammation, oxidative stress and to enhance sleep quality. In this short article, we hypothesize that the use of cooling therapies (whole body cryotherapy, cold-water immersion...) could be an efficient strategy to facilitate the treatment of SAS’ patients by reducing the level of systemic inflammation and oxidative stress and enhancing sleep quality.
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Objectives: Subjective Cognitive Decline (SCD) and Mild Cognitive Impairment (MCI) are common in elderly population, and constitute a high-risk group for progression to dementia. Innovative, complex, and engaging non-pharmacological methods of cognitive stimulation, implementable at this stage, are needed. The aim of the study was to determine the effect of Computerized Cognitive Training (CCT) combined with Whole Body Stimulation (WBC) on cognitive functions of older adults with SCD and MCI. Methods: A 9-week single-blind pre/post case control trial was conducted. The study enrolled 84 adults aged 60 or older, allocated to one of two intervention groups: EG; CCT with psychoeducation, EG2; CCT with psychoeducation and 10 WBC sessions, or the control group (CG), which comprised patients receiving usual care. The primary outcome measures were cognitive functions evaluated with MoCA scale and several other neuropsychological tools. Depressive symptoms assessed with the GDS scale constituted the secondary outcome measures. Results: The results show evidence for increased performance in the assessment of general cognitive functioning in both EGs ( p ≤ 0.05). Significant improvement was also visible in several cognitive domains, such as verbal fluency (EG1 & EG2), learning ability and immediate memory (EG1 & EG2), delayed memory (EG2), attentional control (EG1), and information processing (EG2) ( p ≤ 0.05). However, only in the group with combined interventions (CCT + WBC) the participants presented significantly less depressive symptoms ( p ≤ 0.05). Conclusions: The results of the study suggest that CCT, especially in combination with WBC, might be a practical and effective method of improving cognitive performance. Moreover, this combination leads to a reduction of depressive symptoms.
Conference Paper
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Whole-body cryotherapy (WBC) and partial-body cryotherapy (PBC) are two methods that expose a patient to extreme cold for a short time, and both require a specialised cold chamber or cabin. Little known a few years ago, these therapies have recently been the subject of tremendous interest. According to PubMed, there were approximatively 30 scientific studies concerning this topic before 2010 and there have been over 120 since then. The two most investigated domains are improvements in mental and physical health and improvements in recovery after physical exercise (Bouzigon et al., 2016). The populations studied include patients suffering from traumatologic, inflammatory or mental diseases, healthy individuals, and athletes (all levels) as well as active participants (moderate level of sport activity). Several technologies of PBC and WBC have emerged and, there are approximately fifteen producers worldwide. The differences between the two methods involve the exclusion of the head in PBC treatment, different ways to create cold, and different device sizes and mobility possibilities, which can attract different populations of users. PBC uses a moderate-sized mobile device, whereas WBC employs a larger fixed device. Thus, PBC is used more in the field with sport teams, and WBC is used more often in rehabilitation or athletic sport centres. WBC and PBC were first used to relieve rheumatic and inflammatory diseases such as rheumatoid arthritis (Hirvonen et al., 2006), fibromyalgia (Bettoni et al., 2013) or ankylosing spondylitis (Stanek et al., 2015). Currently, these methods are also being used to provides benefits for fatigue and functional status in multiple sclerosis patients (Miller et al., 2016), in psychiatry to improve mental well-being (Szczepanska-Gieracha et al., 2013) and to relieve depression and anxiety syndromes (Rymaszewska and Ramsey, 2008). WBC and PBC were later used in the sports domain to enhance physical exercise recovery (Rose et al., 2017).
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The aim of the study was to search the influence of cryotherapy on liver enzyme activity in experimental rat model. The first group of rats was exposed 1 min daily to - 90°C for 5 d, the second group was exposed 1 min daily to - 90°C for 10 d and the control group was not exposed to low temperature. A statistically significant increase in the activity of glutamate dehydrogenase, sorbitol dehydrogenase, malate dehydrogenase, ornithine transcarbamoylase and arginase was observed in the plasma and liver. The obtained results indicate the influence of low temperature on liver metabolism.
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Repetitive transcranial magnetic stimulation (rTMS), a new method for the stimulation of the central nervous system, is being proposed as a potential new treatment in patients with major depressive disorder (MDD). We tested the hypothesis that rTMS would be as effective as electroconvulsive therapy (ECT) in patients with MDD. Forty patients with MDD referred for ECT were randomly assigned to either ECT or rTMS. Repetitive transcranial magnetic stimulation was performed at 90% power of the motor threshold. The stimulation frequency was 10 Hz for either 2 sec (first eight patients) or 6 sec (final 12 patients) for 20 trains. Patients were treated for up to 20 treatment days. Electroconvulsive therapy was performed according to standard protocols. Overall patients responded best to ECT (chi(2) = 3.8, p <.05). Patients with MDD and psychosis responded significantly better to ECT (chi(2) = 9.2, p <. 01), whereas MDD patients without psychosis responded similarly to both treatments (chi(2) = 0.0, ns). The analysis of variance with repeated measures of clinical variables for the whole sample revealed significant treatment effects for both groups; however, interaction between group and treatment was seen only for the Global Assessment of Function and the Sleep assessment. When the psychosis-nonpsychosis grouping was considered, patients with psychosis responded dramatically better to ECT in all assessments, whereas those without psychosis responded similarly to both treatments. Overall ECT was a more potent treatment for patients with MDD, this being particularly evident in patients with MDD and psychosis; however, in patients with MDD without psychosis the effects of rTMS were similar to those of ECT. The results we report are encouraging and support an important role for rTMS in the treatment of severe MDD; however, additional blinded studies are needed to precisely define this role.
In a cold air chamber with pre- and main chamber patients are treated in bathing suits with covered ears, hands, feet and an operation mask for 1/2 min up to 3 min at -110°C. Therapeutic effects are lowering of pain, improvement of joint function, as well as improvement of well being. Heartbeat and blood pressure will be influenced only very little in persons with normal RR. Admittance to the cold air chamber is possible when hypertension is well under control. Bronchospasm will decrease. Stenocardia was not observed. The cold air chamber treatment does not provoke stress. Neither ACTH nor cortisone or adrenalin increase after treatment. They rather decrease. The noradrenalin level is on the other hand increasing in serum. In rheumatoid arthritis T-helper lymphocytes decrease over more than 3 hours, while T-suppressor lymphocytes increase during that period. Indications for the whole body cryotherapy are chronic joint inflammation and chronic inflammation of the cervical spine, fibrositis and fibromyositis, connective tissue diseases and autoimmune diseases.
Background: Cryotherapy has a long tradition in somatic medicine. Yet we know very little about its impact on psyche and mood disturbances in particular. Therefore there is a real need for scientific investigations into this problem. Objective: The study reported here was an initial approach to whole-body cryotherapy (WBCT) as a potential treatment modality for depression and was expected to provide rough data helping to design a future project with extended methodology, larger sample groups and longer follow-up. Methods: Twenty-three patients aged 37–70 years gave informed consent to participate in the study. Ten WBCT procedures (160 s, −150°C) were applied within 2 weeks. Participants were recruited from depressed day hospital patients. Antidepressive medication was not ceased. Symptoms were rated at the beginning and end of this intervention using the 21-item Hamilton Depression Rating Scale (HDRS). Changes in scores were analyzed in the group of patients for every item separately as well as for the sum of all items for each patient. Results: Almost for each individual HDRS item, the overall score for all patients together was significantly lower after WBCT. This means that all symptoms, except for day–night mood fluctuations, were presumably positively influenced by cryotherapy. The HDRS sum-score for each patient after WBCT was lower than that of the baseline and reached statistical significance in a paired samples t-test. Every patient was therefore considerably relieved after WBCT. Conclusions: It appears that WBCT helps in alleviating depression symptoms. Should this be confirmed in the extended study we are currently implementing, WBCT may become an auxiliary treatment in depression.
The effect of whole-body cryotherapy (WBC) on rectal and skin temperatures was measured in healthy subjects before, during and after WBC exposure. WBC did not cause any significant change in rectal temperature. The lowest local skin temperatures were recorded in the forearm, 5.2 (2.8)°C, and in the calf, 5.3 (3.0)°C. WBC involves no risk for frostbites. After WBC, all skin temperatures recovered rapidly, indicating that the analgetic effects of WBC only occur during a limited period after the exposure.
A limited number of experiments have shown that treatment of rheumatoid arthritis by means of cooling the entire body in cryogenic chamber reduces the pain in joints affected by inflammatory process and increases their mobility. The aim of the present thesis was to try explain the mechanisms responsible for the observed improvement of the patients' condition, and an investigation of the treatment's effect on selected hemodynamic indices. Tests were carried out on 63 patients with rheumatoid arthritis mainly in the 3rd and 4th stage of illness, all of whom had been treated for 14 days, once daily, by cooling the body for two-minute periods in cryogenic chamber with temperatures ranging from -110 degrees C to -160 degrees C, followed by kinesitherapy. It was demonstrated that after a single session in the cryogenic chamber, after 7 and 14 days the level of ACTH, cortisol and beta-endorphins in blood serum rises. The level of TSH, T4, T3, GH and 6-keto-PGF1 alpha+, however, remains unchanged. The cryogenic chamber treatment does not affect the heart rate, arterial blood pressure nor the value of the left ventricle fractional shortening index and its ejection, neither does it cause of arrhythmias and ischemic changes of the heart.
Vagus Nerve Stimulation (VNS) delivered by the NeuroCybernetic Prosthesis (NCP) System was examined for its potential antidepressant effects. Adult outpatients (n = 30) with nonpsychotic, treatment-resistant major depressive (n = 21) or bipolar I (n = 4) or II (n = 5; depressed phase) disorders who had failed at least two robust medication trials in the current major depressive episode (MDE) while on stable medication regimens completed a baseline period followed by NCP System implantation. A 2-week, single-blind recovery period (no stimulation) was followed by 10 weeks of VNS. In the current MDE (median length = 4.7 years), patients had not adequately responded to two (n = 9), three (n = 2), four (n = 6), or five or more (n = 13) robust antidepressant medication trials or electroconvulsive therapy (n = 17). Baseline 28-item Hamilton Depression Rating Scale (HDRS(28)) scores averaged 38.0. Response rates (> or =50% reduction in baseline scores) were 40% for both the HDRS(28) and the Clinical Global Impressions-Improvement index (score of 1 or 2) and 50% for the Montgomery-Asberg Depression Rating Scale. Symptomatic responses (accompanied by substantial functional improvement) have been largely sustained during long-term follow-up to date. These open trial results suggest that VNS has antidepressant effects in treatment-resistant depressions.
Unlabelled: Cryotherapy as a whole-body cold therapy (with cold air cooled by addition of nitrogen blown on the patients in an open cabin) for treatment of inflammatory rheumatic diseases already started in Bad Säckingen in 1986. In 1996, a new cold chamber (this time a closed chamber without any addition of nitrogen) based on compressor technology was introduced. The aim of our study was to test whether significant pain relief could be achieved by means of this cold therapy. Furthermore, we were interested in the practicability and acceptance of this new technique. Wellbeing during the treatment application and pain level were assessed using verbal and numerical rating scales. The sample consisted of 120 consecutive patients (75% women, age: 30-67 yrs, M = 52.6 yrs). These patients were suffering from primary fibromyalgia (40.7%), rheumatoid arthritis (17.3%), chronic low back pain (16.4%), ankylosing spondylitis (10.9%), osteoarthritis (9.1%), secondary fibromyalgia (3.6%) and other autoimmune diseases (1.8%) (mean duration of symptoms: 4 yrs). The patients were treated 2.5 minutes on average in the main chamber (mean temperature: -105 degrees C). The patients' statements concerning their pain level were analyzed by means of analyses of variance with repeated measures and paired-sample t-tests. Results: The pain level after application of the cold therapy decreases significantly. The pain reduction lasts about 90 minutes. The initial pain level decreases during the whole time of treatment, no significant improvement, though, can be shown from the middle to the end of the four-weeks treatment. According to the results of our study, there is evidence that the whole-body cold therapy generates important short-term effects and somewhat weaker effects over the treatment period as a whole. Short-term pain reduction facilitates intensive application of physiotherapy and Occupational Therapy. The treatment procedure is practicable, and all in all well tolerated. From the patients' point of view, whole-body cold therapy is an essential part of the rehabilitation programme.
Fibromyalgia (FM) is a syndrome of unknown etiology characterized by chronic wide spread pain, increased tenderness to palpation and additional symptoms such as disturbed sleep, stiffness, fatigue and psychological distress. While medication mainly focus on pain reduction, physical therapy is aimed at disease consequences such as pain, fatigue, deconditioning, muscle weakness and sleep disturbances and other disease consequences. We systematically reviewed current treatment options in the treatment of fibromyalgia. Based on evidence from randomized controlled trials cardiovascular fitness training importantly improves cardiovascular fitness, both subjective and objective measures of pain as well as subjective energy and work capacity and physical and social activities. Based on anecdotal evidence or small observational studies physiotherapy may reduce overloading of the muscle system, improve postural fatigue and positioning, and condition weak muscles. Modalities and whole body cryotherapy may reduce localized as well as generalized pain in short term. Trigger point injection may reduce pain originating from concomitant trigger points in selected FM patient. Massage may reduce muscle tension and may be prescribed as a adjunct with other therapeutic interventions. Acupuncture may reduce pain and increase pain threshold. Biofeedback may positively influence subjective and objective disease measures. TENS may reduce localized musculoskeletal pain in fibromyalgia. While there seems to be no single best treatment option, physical therapy seem to reduce disease consequences. Accordingly a multidisciplinary approach combining these therapies in a well balanced program may be the most promising strategy and is currently recommended in the treatment of fibromyalgia.
The paper presents a little known issue about the influence of wholebody cryotherapy on mental health. Observations of patients' behaviour after passing the cryogenic chamber leads to an interesting hypothesis. Short exposition to extreme cold has doubtless a profitable influence on man's frame of mind. Immediately after passing the cryogenic chamber, apart from the well known analgetic effect, we detect changes in patients' mental state such as improvement of mood, deep relaxation, freshening up, consolation, euphoria. This unusual state lasts for a long time after ending the cycle of cryotherapy. Different mechanisms of this effect are considered. New possibilities of this method have been presented. Durability of such an advantageous phenomenon are investigated in our research centre in Wrocław.