Dr. Reef KarimAssistant Clinical Professor, UCLA Semel Institute for Neuroscience

Founder, Lumion Center Beverly Hills

Psychiatrist, Addiction Specialist, Relationship Therapist

Host: Reef Madness Show (ReefMadnessShow.com)

DoctorReef.com

LumionCenter.com

YouTube: Dr. ReefReef Karim, 2017

Spirituality is the “forgotten dimension” of mental health care.

Spirituality is concerned with people finding meaning and purpose in their lives, as well as the sense of belonging in a community. It’s important in all aspects of medicine as it comes into focus often during times of stress, suffering, physical and mental illness, loss, dying and bereavement.

Spirituality has cognitive, experiential and behavioral aspects including beliefs and values by which an individual lives as well as feelings of hope, love, connection, comfort and support.

Reef Karim, 2017

“If you believe it can happen, there is a higher chance that it will happen.”

Prayer Study 30 patient – CCU; 15 groups of 5 intercessors prayed for ½ patients; 10-15% higher scoring in health and disposition for patients that were prayed for

Byrd South Med J 1988 Jul;81(7):826-9

CCU Study – 990 patients randomized, over 10 months, to an intercessory prayer group or a non prayer control group. The control group required much more ventilatory assistance,

antibiotics and diuretics than patients in the intercessory groupHarris et al Arch Intern Med. 1999;159:2273-2278

Placebo Effect (30-50%) taps into our faith, belief and expectations.

Reef Karim, 2017

Predictors of Placebo Response:

Positive attitude of patient to physician

Suggestion creates expectancy

Side effects associated with improvement

Patient experiences placebo dose to be active

Leuchter, 1999

Reef Karim, 2017

Reef Karim, 2017

Two studies: Medical student and patient (1996) and Dual Diagnosis Inpatient unit and Nursing staff

Med Student and Patient attitudes towards spirituality –They found that medical students responsible for treating substance abuse are significantly less religious and spiritually oriented than the patients they treat. 119 students and 101 patients (dual dx at Bellevue) Used Feagin’s “Orientation to Life and God Scale” Student felt the patient’s would be most concerned with: Housing, Govt benefits, a job, outpatient tx and medical services.

(Goldfarb, 1996)

The patients were most concerned with: Inner peace (4.66) belief in God (4.65), medical services (4.65), AA meetings (4.61) and a strong spiritual connection. (4.48)

Reef Karim, 2017

“Spirituality Increases During Recovery”A University of Michigan Addiction Research Center study measured 154 Adults w/ Alcohol Dependence or Abuse in an outpatient treatment setting. Measured Spirituality at baseline and 6 months (views of God, religious practices, prayer, church attendance, forgiveness, spiritual experiences, coping, existential meaning) They also measured alcohol use and AA attendance. Results: Those patients who had experienced an increase in their daily spiritual experiences were less likely to participate in any heavy drinking because they felt there was more of a purpose to their lives. Over half of the spiritual measures changed significantly including forgiveness, coping and purpose.(Robinson, Univ Michigan)

“Religious Affiliation Associated w/ Less Suicidal Behavior In Depressed Patients”(Kervic, Am J Psych 2004)

Reef Karim, 2017

A social phenomenon An organized structure with

many purposes – one of which is to potentially develop spirituality in it’s members

Shared belief system and history

Ritualistic Collective Identity and Belief Can enhance or conflict with

spirituality The service and worship of

God with an institutionalized system of attitudes, beliefs, and practices

Image from exchristian.netReef Karim, 2017

3,968 adults ages 64-101 followed over 6 months Subjects asked about frequency of religious attendance

(greater than or less than once per week) Depression, Physical Illness and Health Habits (alcohol,

cigarettes, etc) assessed Frequent religious attendees survived longer than less

frequent attendees. Frequent attendees were less likely to have health

problems, depression, or smoke and drink Frequent attendees were more likely to be married and

have strong social support networks. Religious attendance is an independent predictor of

survival.

Reef Karim, 2017

More people to detect illness, encourage treatment

Community identity

Encouragement of a healthy lifestyle

Greater assistance with problem solving

Lower levels of depression, other mental illness

Many studies reveal 27-39% improvement in overall health and survival with regular attendance and

belief in spirituality McCullough, 2000

Image from couragesuccess.comReef Karim, 2017

Meditation is not an “escape from reality,” it is simply being “fully aware” or “awake to reality.”

Being fully aware and awake is being “conscious.”

One must have a degree of mental health to accomplish this, including reality based thinking.

This implies that one’s brain needs to be functioning well… not psychotic, drug induced, too anxious, too depressed, etc.

Reef Karim, 2017

Those who practice daily for 30 minutes or longer, and for many years, show the greatest differences in neural activity (Creswell, Psychos Med 2007)

Mindfulness Meditation is an effective treatment for anxiety and mood disorders (Toneatto, Can J Psych 2007)

Mindfulness Meditation patients treated for pain had significantly greater pain acceptance and improved physical function compared to controls. (Randomized, n 37)(Morone, Pain)

Dhammakaya Buddhist Meditation revealed significant decreases in serum cortisol, blood pressure and heart rate (Sudsuang, Physiology & Behavior 1991)

Reef Karim, 2017

Cortical Thickness: Right Anterior Insula and Right Superior Frontal Sulci (Sensory processing and Attention) These areas were thicker in people meditating than those not meditating – particularly older subjects – which suggests that regular practice of meditation might reduce normal age-related thinning of the brain (Lazar, Harvard MG, Neuroreport 2005)

Serotonin/Spirituality Association: Individuals (15)who scored higher on the spiritual transcendence questionnaire (personality traits) was associated with altered 5HT-1A receptor binding potential (Borg, Am J Psych, 2003)

Serotonin Increase During Meditation – Increases in Serotonin levels during Meditation, especially via the lateral hypothalamic stimulation of the dorsal raphe -correlated by finding of increased serotonin metabolites in urine after. (Walton, 1995)

Reef Karim, 2017

Increased Dopaminergic Tone – A PET study on dopaminergic tone in Yoga Nidra using 11 C-Raclopride showed significant increases in dopamine during meditation (Kjaer, 2002)

Increased Serum GABA - During Meditation(Elias 2000)

Reduced Stress Induced Cortisol Secretion – Decreases stress response, Neuroprotective Effects

12 Step Facilitation = CBT and MI; The Project Match Research Group (1998) found that 12 step facilitation was at least as effective as motivational and cognitive techniques (both developed from empirically grounded research models)

Reef Karim, 2017

Yoga Elevates GABA Levels: With MR spectroscopy imaging, GABA levels were compared in 8 subjects before and one hour after Yoga – compared with 11 subjects who did no Yoga but read for one hour. Results found a 27% increase in GABA levels in the Yoga group after the session – (Depression, Anxiety, Low GABA states) (Streeter, J Complem Med 2007)

Yoga For Stress Management – Psychological and Physiological Measures… Study of 26 women and 7 men – rated on psychological measures (stress, anger, quality of life) and physiologic measures (BP, HR, Salivary Cortisol, Urinary Catecholamines) In comparison to Cognitive Behavioral Therapy – Yoga was equally as effective.

Yoga Nidra facilitated increased dopamine tone during yoga based meditation - ; increased dopamine

Yoga University of Utah Study looking at pain tolerance and pain related brain activity comparison between yoga practitioners, control group and people with fibromyalgia. Yoga practitioner group had significantly higher pain tolerance and lowest pain related brain activity assessed by Functional MRI.

Reef Karim, 2017

Yoga effect on the stress response

University of Utah Study studies participants poorly regulated response to stress as also more sensitive to pain. Studies three groups – 12 yoga practitioners, 14 people with fibromyalgia, 16 healthy volunteers. All groups subjected to painful pressure and tested with fMRI. The fibromyalgia group perceived at lower pressure than the other groups. fMRI showed more activation associated with the pain response. Yoga practitioners showed the highest pain tolerance and lowest pain related brain activity and lowest stress.

Sudarshan Kriya Yoga (SKY)(cyclical breathing patterns – slow & calming to rapid & stimulating) used for depression. Bangalore, India study looked at 60 alcohol dependent men. After a week of detox, the men were put in two groups and given two weeks of SKY protocol treatment or two weeks of the standard alcohol treatment program. After three weeks, scores on a standard depression scale were 75% lower in the SKY group compared to 60% lower in the traditional alcohol treatment program. Cortisol also lowered.

For chronic pain, acupuncture was to be a very effective therapy (cost effective & efficacy) for osteoarthritis, headache, migraine and neck and low back pain. Study with 18,000 patients comparing acupuncture to other non-surgical therapies. (MacPherson, 2017)

With depression, acupuncture was found to be effective for decreasing primary care depression symptomatology. (MacPherson, Vickers, 2017)

For substance abuse, the data is unclear. Some studies find it effective; other studies show no statistical separation from placebo.

Immune System, Sleep, Anxiety, etc.

A Japanese technique for stress reduction and relaxation that promotes healing. Administered by “laying on hands” based on the idea that an unseen “life force energy” flows through us and may have low or high levels. With lower levels in certain areas, we are more prone to feel sick or stressed. Balance energy. Release emotional blockages. (chi (china), prana (india) )

NY Presbyterian Hospital/Columbia University Study looking at the efficacy of Reiki treatments on the autonomic nervous system. Compared Reiki treatment group to “sham” treatment group and a “control” group. The Reiki group showed decreased heart rate, respiration and blood pressure.

Being studied for pain, anxiety, restoration after surgical or stressful procedures. Wellness. Sensation of being well. Muscle Tension. Controversial still among the medical community as many research studies are poor quality.

Daily Spiritual Experiences Long Form (DSES)

Fetzer Measure of Religiousness/Spirituality (BMMRS)

Spiritual Belief Scale (SBS)

INSPIRIT Scale

Spiritual Transcendence Scale (STS)

Royal Free Interview for Spiritual & Religion Beliefs

Spiritual Well Being Scale (SWBS)

Reef Karim, 2017

The Yoga of Breath, Richard Rosen

Wherever you go there you are, Jon Kabat-Zinn

12 Steps on Buddha’s Path, Laura S.

Why God Won’t Go Away, Andrew Newberg, M.D.

The Biology of Belief, Bruce Lipton, PhD

Peace is every step, Thich Nhat Hanh

How God Changes Your Brain, Andrew Newberg, MD

Spirituality and Psychiatry, Chris Cook, RCpsych

Reef Karim, 2017

30 yr old white male with complaints of “going through life too fast”, difficulties with relationships, poor self esteem, lots of sexual partners, difficulty being distracted, interrupts other people, loses keys frequently.

Reef Karim, 2017

42 yr old female with episodes of panic where she gets short of breath, heart palpitations and a fear of choking or dying. The episode lasts about 25 minutes.

Reef Karim, 2017

Dr. Reef KarimAssistant Clinical Professor, UCLA Semel Institute for Neuroscience

Founder, Lumion Center Beverly Hills

Psychiatrist, Addiction Specialist, Relationship Therapist

Host: Reef Madness Show (ReefMadnessShow.com)

DoctorReef.com

LumionCenter.com

YouTube: Dr. ReefReef Karim, 2017