Mind-Body MedicineMind-body Medicine Success: power of the mind to heal •1989: David Spiegel, M.D....
Transcript of Mind-Body MedicineMind-body Medicine Success: power of the mind to heal •1989: David Spiegel, M.D....
Mind-Body Medicine
Ana Maria Lopez, MD, MPH, FACP Professor of Medicine and Pathology
University of Arizona Cancer Center
Integrative Medicine Fellow
University of Arizona College of Medicine
What is mind-body medicine?
• Mind-body practices focus on the interactions of mind, body, and behavior, with the intent to use the mind to affect physical functioning and promote health.
– National Center for Complementary and Alternative Medicine
If the mind can help heal… does stress lead to illness?
Injury/Infection
• Rush of immune cells to the area
• Resultant inflammation
• Induce “sickness behavior”
Stress and the Hypothalamus
• Under physical or emotional stress: release of cortisol
• Cortisol as response to inflammation
– suppresses the immune system
• Data in caregivers, med studs during exams, couples under marital stress:
– Prolonged healing time
– Increased susceptibility to infection
Clinical Impact of Stress
• Worsen asthma
– parental stress increase risk of asthma in child
• Headaches
• Depression: stress-related work 80% higher risk of depression
• Worsen ulcers, GERD, IBS
• Premature death: elderly caregivers 63% higher rate of death
Stress and Illness
• Tense muscles
• Rapid heart rate
• Elevated BP
• Fast breathing
• Tight belly
• Feel apprehensive, irritated, frustrated
• Loss of control
How does mind-body medicine make a difference?
Historical Perspective
• Western thought: mind-body duality
• Other traditional systems of thought: mind body links
Clinical Observations
• 1964: George Solomon, MD, psychiatrist, noted that people with RA were “worse” when depressed.
• 1970s: Herbert Benson, MD studied impact of meditation on blood pressure
• 1975: Robert Ader, PhD demonstrated the impact of mental and emotional cues on immune system
Birth of psycho-neuro-immunology
Mind-body Medicine Success: power of the mind to heal
• 1989: David Spiegel, M.D. at Stanford University School of Medicine – 86 women with late stage breast cancer – Randomized to standard care or to standard care plus
weekly support sessions (share grief and triumphs) – Participants in the social support group lived twice as
long as the women in standard care alone
• 1999, similar study design in breast cancer patients: – helplessness and hopelessness are associated with
lesser chance of survival.
Mind-Body Practices Examples
• Meditation
• Mindfulness
• Yoga
• Qi Gong
• Spirituality
• Use of drawings, journal, movement to express thoughts/feelings
• Deep breathing
• Visualization
• Guided Imagery
• Mindful eating
• Biofeedback
• Progressive muscle relaxation
• Listening to music
• Enjoying nature
All mind-body techniques
• Train the mind to focus
– Develop focused concentration
• Reconnect with the body
– Promote presence
– Allow for reflection/creating meaning
Clinical Observation I
• Patients feel disconnected from their bodies
– “My body betrayed me.”
– “I can’t trust my body.”
– “My body feels alien to me.”
Clinical Observation II
• So when asked to take care of their bodies- – May feel foreign to them
• Not accustomed to taking care of the body
• Do not nurture: – Drink when thirsty
– Eat when hungry
– Stop if it hurts
– Sleep when tired
– Laugh when happy
– Speak your mind
Clinical Interest
• How to reconnect with the body
– Benefits for patients
– Benefits for physicians
• Reconnecting with the body
– Being em-bodied—
• Being present
• Allows for reflection
• Create meaning
Mind-Body Examples
Biofeedback
• Train people to control bodily practices that are normally involuntary i.e. BP, HR, muscle tension.
• Treat tension/migraine HA, chronic pain.
Cognitive Behavioral Therapy
• Work with patient to recognize and change harmful thoughts
• e.g. progressive exposure to phobias
Relaxation Techniques
• Autogenic training: use visual imagery and body awareness to create a deep state of relaxation
• Progressive muscle relaxation: tensing and releasing each muscle group from toes to head
• Meditation: may repeat a mantra, may focus on a sensation ie breath
• Hypnosis: state of deep concentration. Used to treat: addictions, pain, anxiety disorders
Mind-body Techniques
• Encourage relaxation
• Improve coping skills
• Reduce tension and pain
• Lessen need for medication
• Decrease anxiety and depression
Effectiveness Data
• Cancer
• Chemotherapy induced nausea
• HTN
• Asthma
• GI problems
• Fibromyalgia
• Menopause sx
• CAD
• Obesity
• Pain
• Insomnia
• Diabetes
• Anxiety
• Depression
Ornish, D et al
• Lancet Oncology
– Prostate cancer: low grade
– Elected surveillance
– Usual care or usual care plus lifestyle intervention
• Improvements in telomere length
Telomeres
• Length decreases with:
– Aging
– Cancer
– CVA
– Dementia
– Obesity
– Osteoporosis
– Diabetes
Lifestyle Intervention
• Nutrition: – Plant based diet, low fat
• Physical activity: – Walk 30 min, 6 d of wk
• Mind-body: – Yoga, breathing, imagery, progressive relaxation
– 60 min/daily
• Support: – 60 min/wk
5 year follow-up
• Statistically significant lengthening of telomere length
• p<0.005
• Small study
• Needs larger study
We are not our genes!
Who?
• Patient who is
– Interested in mind-body approaches
– Willing to be active/proactive in own health care
– Willing to practice
Mind-Body Practices and Re-discovering Joy in Practice
• Remember to breathe
– Be present
– Reflect
– Connect to meaning
The natural healing force within each one of us is the greatest force in getting well.
-Hippocrates
Thank you! [email protected]