1. Mind-Body Medicine Tara Saenz

2. Learning Objectives 1.Define mind-body medicine. 2.According to the national survey, what are the most common mind-body medicine techniques (besides prayer) used by adults in the U.S.? 3.Why is the western world less accepting of mind-body medicine? 4.What occurred in the early 1900s that sparked an interest in the research of mind-body medicine? 5.What two positive outcomes of mind- body medicine interventions is there considerable evidence for?

3. Introduction Mind-body medicine focuses on the interaction among the brain, mind, body, and behavior, and the powerful ways in which emotional, mental, spiritual, and behavioral factors can directly affect health.

4. Mind-Body Medicine Techniques Cognitive-behavioral therapies Relaxation Hypnosis Imagery Meditation Yoga Biofeedback Tai Chi Qigong Group Support Autogenic Training Spirituality

5. Prevalence According to a national survey* in 2002: –30% of adults in the U.S. were currently using one or more of the following mind-body medicine techniques: Relaxation Visual/Guided Imagery Biofeedback Hypnosis –50% of adults in the U.S. were using prayer Wolsko PM, et al. Use of mind-body medical therapies. Journal of General Internal Medicine. 2004;19:43-50

6. Background The concept of mind-body medicine dates back more than 2000 years –Integral to the healing approaches of traditional Chinese and Ayurvedic medicine –Hippocrates believed that treatment could only occur with the consideration of attitude, environmental influences, and natural remedies.

7. The East vs. The West The acceptance of mind-body medicine is divided between eastern and western cultures –The East still value the integrated approach of mind-body medicine –Beginning in the 16 th and 17 th centuries, the West began to separate the dimensions of the mind from the physical body Redirection of Science Technological Advances Discovery of bacteria and antibiotics Fixing or curing an illness became a matter of science and took precedence over the healing of the soul.

8. Stress Response and Placebo Effect Walter Cannon – “Fight or Flight” –Sympathetic and adrenal activation in response to perceived danger Henry Beecher, M.D. – Placebo Effect –Low supply of morphine during WWII –Found that pain could be controlled by saline injections As a result, since the 1960s, mind-body interactions have become an extensively researched field.

9. Focus of Research Mind-Body Interventions and Disease Outcomes –The treatment of disease –Decrease pain –Improve mood, QOL, and coping –Improve disease or treatment related symptoms Mind-Body Influences on Immunity –Positive and negative effects of emotions on people’s susceptibility to infection Meditation and Imaging –Use of fMRI to investigate the effects of meditation on the activation of regions of the brain Placebo Response –Cognitive and conditioning mechanisms Stress and Wound Healing –Positive and negative effects of mood or stress on the rate of wound healing Surgical Preparation –Reduce discomfort and adverse effects

10. Study #1 The evaluation of mind/body intervention to reduce psychological distress and perceived stress in college students Journal of American College Health 2002;50:281-287

11. Study #1 Specific Aim –The effectiveness of a mind-body intervention on psychological distress and perceived stress in college students Study Design –Randomized, placebo-controlled Subjects –128 college students –25% freshman/sophomores –41% junior/seniors –34% graduate students –Median age = 21 years old

12. Study #1 Treatment –Six 90-minute group-training sessions

13. Study #1 Outcome Measures –Symptom Checklist-90-Revised –Spielberger State-Trait Anxiety Inventory –Perceived Stress Scale –Health-Promoting Lifestyle Profile II –A demographic and health habits survey

14. Study #1 Results –90 students completed the post- assessment measure –Significantly greater reductions in psychological distress, state anxiety, and perceived stress were found in the experimental group

15. Study #1 Conclusions –A 6-week RR and CBI training program for students can significantly reduce self-reported psychological distress, anxiety, and the perception of stress. –Found a trend toward improvements for the intervention group on trait anxiety and health-promoting lifestyle profiles.

16. Study #2 Efficacy of ‘functional relaxation’ in comparison to terbutaline and a ‘placebo relaxation’ method in patients with acute asthma Psychotherapy and Psychosomatics 2001;70:151-157

17. Study #2 Specific Aim –The effectiveness of functional relaxation (FR) on pulmonary function in patients with acute asthma in comparison to inhaled terbutaline (IT) and a placebo relaxation technique (PRT) Study Design –Randomized, prospective, single-blind, placebo-controlled, crossover experimental investigation Subjects –21 asthmatics with acute bronchoconstriction –7 male; 14 female –Average age: 48.9 years

18. Study #2 Treatment –On 3 consecutive days they were given either: A 5-minute verbal standard instruction in elementary exercises of FR, which they were to practice during subsequent body plethysmographic measurement IT (a fast-acting bronchodilator) An unspecific PRT –Each subjects tried all 3 treatments in random order

19. Study #2 Outcome Measures –Standard pulmonary function measurements measured by a body plethysmograph

20. Study #2 Results –There was a significant decrease in specific airway resistance with FR, which was not as pronounced as IT, but it was significantly greater than with the PRT

21. Study #2 Conclusions –This study shows that clinically relevant effects can be achieved for patients with asthma through mind- body interaction, which can be triggered by reproducible procedures –Further development of the FR approach could lead to a non- pharmacological and effective supplementary treatment for asthma

22. Other Evidence Evidence from randomized controlled trials and systematic reviews of the literature suggest: –Mechanisms may exist by which the brain and central nervous system influence immune, endocrine, and autonomic functioning, which is known to have an impact on health. –Multi-component mind-body interventions may be appropriate adjunctive treatments for coronary artery disease and certain pain-related disorders, such as arthritis.

23. Continued –Multimodal mind-body approaches, such as cognitive-behavioral therapy, can be effective adjuncts in the management of chronic conditions –An array of mind-body therapies when employed pre-surgically, may improve recovery time and reduce pain following surgical procedures. –Neurochemical and anatomical bases may exist for some of the effects of mind-body approaches.

24. Summary & Recommendations Considerable evidence that mind- body interventions have positive effects on psychological functioning and QOL Physical and emotional risks are minimal Mind-body interventions can be taught easily Mind-body medicine should be used in conjunction with modern medicine as a combined approach to improving health

25. Questions?