Effects of Compression of the 4th Ventricle (CV4) Treatment on Medical Student Anxiety

Abstract

Abstract Introduction: This study explores the effects of one Compression of the 4th Ventricle (CV4) treatment performed by experienced osteopathic physicians on reactive anxiety in healthy medical students. Anxiety was assessed with heart rate, blood pressure, and the Hamilton Anxiety Scale (HAM-A). Methods: Western University of Health Sciences IRB #15/IRB/113 was obtained for this single blind study. Volunteer first and second year medical students naïve to Osteopathic Cranial Manipulative Medicine, both in curriculum and as a patient, were recruited for this two-day study. Students were de-identified and demographic information was collected. On the first day, all 64 students received a sham treatment. Eight practitioners agreed on CV4 and sham techniques (mastoid cranial hold). In the CV4 technique, the operator’s thenar eminences contact the lateral angles of the occiput, and the operator encouraged the extension phase and discouraged the flexion phase of the CRI. Compression continued until a still point was reached in each student as identified by the practitioner. Students were evaluated before and after treatment using heart rate, blood pressure, and the Hamilton Anxiety Rating Scale (HAM-A). Results: No significant difference was found in demographics of the two groups. A significant difference between sham and CV4 treatments was found for heart rate (p=0.036), but not for systolic or diastolic blood pressure (p=0.446 and p=0.799, respectively). Average heart rate reduction of CV4 group was 3.11 and of sham group was 1.12, with p=0.036 (Mann Whitney U = 1271). Heart rate increased in a few students after both CV4 and sham treatments. Average HAM-A score for students before and after CV4 treatment were 21.9 and 18.3, with an average net reduction of 3.58 compared to the sham’s 2.77, but results were not found to be statistically significant (p=0.09, U=1172). Conclusion: A statistically significant average reduction in heart rate, but not in blood pressure or HAM-A scores, was found after CV4 treatment compared to sham treatment. More studies with larger samples are needed to further investigate the effects of CV4.