Neurophysiology of cognitive behavioural therapy, deep breathing and progressive muscle relaxation used in conjunction with ART treatments: a narrative review

Abstract

BACKGROUND Infertility is defined as the failure to achieve clinical pregnancy after 12 months of regular unprotected intercourse. It could be due to male or female factors, each requiring different treatment options. ART treatment exposes couples to numerous psychological stressors. Therefore, it has been recommended by the ESHRE Psychology and Counselling Guideline Development Group recently that psychosocial support should be offered as a complementary therapy during infertility treatments. In this context, the efficiency of different psychological interventions, such as cognitive behaviour therapy (CBT), deep breathing (DB), and progressive muscle relaxation (PMR), was evaluated in several clinical trials in terms of couples’ mental health and pregnancy outcomes. OBJECTIVE AND RATIONALE The neurophysiology of CBT, DB and PMR, which are used in interventional studies, in both men and women undergoing ART, has not yet been fully elucidated. This review represents a comprehensive report, aiming to collate novel insights into the neurobiological processes and physiological mechanisms that occur during the practice of CBT, DB and PMR. SEARCH METHODS PubMed, Google Scholar and Cochrane Library were interrogated to conduct this comprehensive literature review. The search was carried out using combinations of MeSH terms and keywords: infertility, assisted reproductive techniques, IVF, ICSI, emotions, psychological stress, cognitive behavioural therapy, mind-body therapies and relaxation. Relevant information related to the mechanism of action of stress management techniques were obtained from original articles and reviews published in English without taking into consideration the time of publication. Moreover, as it was not the major focus of the review, only recent systematic reviews (2015–2019) pinpointing the effects of psychological interventions on infertility treatment outcomes were also retrieved from the above-mentioned databases. OUTCOMES CBT, DB and PMR may modify the activity of stress-related brain regions such as the prefrontal cortex, amygdala, hypothalamus and hippocampus, as demonstrated by functional MRI and electroencephalogram studies. Furthermore, applying these techniques was associated with mood improvements and a decline in stress biomarkers, and, hypothetically, reducing stress biomarkers attenuates the stress-induced effects on ART outcomes. WIDER IMPLICATIONS Increasing the knowledge of fertility staff, researchers and physicians regarding the mechanisms of action of these stress management techniques has several advantages. For instance, understanding the underlying neurophysiological pathways would assist practitioners to engage ART couples in the practice of these techniques. Also, it may enhance the quality of the support programmes and psychological research. Accordingly, this will ensure that these interventions reach their full potential and therefore improve clinical outcomes.

Global Research Trends on Infertility and Psychology From the Past Two Decades: A Bibliometric and Visualized Study

“…Infertility counselors use the best methods to educate couples about medical, legal, and psychological issues regarding the concept of a third party. It can be beneficial to improve the quality of life of couples while also giving them more confidence in choosing treatment options ( 44 , 58 ).…”

“…Cognitive-behavioral therapy (CBT) is a type of psychotherapy based on cognitive models. This therapy has been extensively tested and proven effective in various mental illnesses, psychological problems, and medical problems ( 58 ). For patients that need to undergo cognitive remodeling, it is necessary to understand the current treatment of infertility actively and the development of technology (such as the application of microfluidic technology in IVF\IUI\ICSI), and then carry out relaxation training and guide patients to choose daily relaxation methods according to their preferences, such as reading, painting, and aerobic exercise.…”

“…Progressive muscle relaxation (PMR), as one of the methods of exercise, can inhibit the hypothalamic-pituitary-adrenal axis and reduce the release of excitatory hormones and neurotransmitters, thereby regulating the calcium ion concentration of skeletal muscle cells and improving muscle tone. The reticular structure (RF) mediates and reduces muscle tension, improves cerebral cortex and limbic system activity, and reduces stress ( 58 ). Aerobic exercise and yoga are examples of good choices for activities to relax the muscles.…”

“…Aerobic exercise and yoga are examples of good choices for activities to relax the muscles. Deep breathing relieves emotional tension and regulates the nervous system ( 58 ). It has been particularly pointed out that infertility caused by polycystic ovary syndrome often presents endocrine disorders such as being overweight and hirsutism.…”

Family‐building and parenting considerations for people with cystic fibrosis

“… 84 Limited evidence exists regarding effective psychological interventions to address psychological distress, coping, relationship functioning, and parenting in those facing subfertility or infertility and considering alternative options for family‐building. 85 , 86 , 87 , 88 , 89 …”