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! alopez@uacc.arizona.edu