Impact of a Novel, Non-Pharmaceutical, Cognitive - Behavioral Stress Management Technique "Pythagorean Self – Awareness Intervention" on the Stress Levels of Adult Patients with Non – Communicable Diseases: A Systematic Review

Background: Non – communicable diseases (NCDs) are the main cause of morbidity and mortality in a worldwide range, accounting for 71% of all deaths, each year. A bidirectional link between NCDs and the stress system appears to exist, as stress system dysfunction negatively affects the human organism. Pythagorean Self – Awareness Intervention (PSAI) is a novel, non-pharmaceutical, cognitive behavioral-based, stress management technique, employed in many studies in Greece. Objective: The main aim of this systematic review is to examine the impact of PSAI on the stress levels in adults (≥ 18 years old) with NCDs. Methods: A systematic search of the medical literature for published papers was conducted from June 28, 2023 to present using the following electronic databases: PubMed, Embase Scopus, Cochrane library and SCIRP. The systematic review was conducted following the PRISMA guidelines, using prespecified MESH terms, such as “pythagorean self-awareness intervention” and “PSAI”. Results: The initial search yielded 35 studies, while the last step of the screening procedure resulted in 7 Randomized Control Trials (RCTs). Six of them had statistically significant outcomes concerning the reduction of stress and anxiety levels. Also, there were secondary outcomes regarding the improvement of the quality of life. Conclusions: PSAI seems to be useful as an holistic stress management technique and seems to have the potential to improve various health outcomes, by enhancing self empowerment, self–efficacy and healthy lifestyle decisions. Key words: Pythagorean self-awareness intervention, PSAI, NCDs, stress levels, stress management, lifestyle medicine