Stress Management: Exploring the Relaxation Response

Professor of Medicine Harvard Medical School

Herbert Benson, M.D. Director Emeritus

June 20, 2014

Learning Objectives

Upon completion of this course, participants will be able to: • Define the physiology and impact of stress and the

stress response • Name the tools used to increase self-regulation • Review the steps used to cultivate attention and

mindfulness • Identify the methods used to elicit the relaxation

response

The Three-Legged Stool

Overall Health

Pharmaceuticals Surgery

Self-care

Between 60-90% of healthcare visits are

related to M/B stress-induced

conditions

CONDITIONS CAUSED OR EXACERBATED BY STRESS INCLUDE:

• Hypertension

• Cardiac Arrhythmias

• Chronic Pain

• Insomnia

• Side Effects of Cancer Therapy

• Side Effects of AIDS Therapy

• Anxiety

• Hostility

• Depression

• Premenstrual Syndrome

• Infertility

• Preparation for Surgery

and X-Ray Procedures

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12 min. 12 min. 12 min.

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Pre Post Relaxation Response

Psychosomatic Medicine (1974) Vol. 36, No. 2, 115-120

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12 min. 12 min. 12 min.

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Psychosomatic Medicine (1974) Vol. 36, No. 2, 115-120

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Psychosomatic Medicine (1974) Vol. 36, No. 2, 115-120

O2 Consumption During Sleep and The Relaxation Response

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Hours

Change in Oxygen Consumption (%)

Relaxation Response

Sleep

TWO BASIC STEPS NECESSARY TO ELICIT THE RELAXATION RESPONSE

•The repetition of a word, sound, prayer, thought, phrase or muscular activity •The passive return to the repetition when other thoughts intrude

The train of everyday thought is broken when the two basic steps to elicit the

relaxation response are followed.

DIFFERENT TECHNIQUES ELICITING THE PHYSIOLOGIC CHANGES OF THE RELAXATION RESPONSE

Oxygen Consumption

Respiratory Rate

Heart Rate

Slow Brain Waves

Blood Pressure

Progressive Relaxation

Decrease Decrease Decrease Not Measured

Decrease

Autogenic Training

Not Measured

Decrease Decreases Increases Inconclusive Results

Zen and Yoga Decrease Decrease Decrease Increase Decrease

Presuggestion Phase of Hypnosis

Decrease Decrease Decrease Not Measured

Inconclusive Results

Transcendental Meditation

Decrease Decrease Decrease Increase Decrease

Simple Generic Techniques

Decrease Decrease Decrease Increase Decrease

Frontal Frontal

Occipital

Frontal

Occipital

Frontal

Occipital Occipital

Control Beginning

Control End

RR Beginning

RR End

Vertical color bars indicate beta % power (white highest, black lowest).

Note: At RR End (lower right), beta % power is significantly (p<.0129) decreased in frontal areas. Jacob, et al, 1996

Reduced Sympathetic Nervous System Responsivity Associated with the Relaxation Response

John W. Hoffman, Herbert Benson, Patricia A Arns, Gene L. Stainbrook,

Lewis Landsberg, James B. Young, and Andrew Gill

Science, 1982;215:190-2

Functional Brain Mapping of the Relaxation Response using 3T fMRI

S.W. Lazar1,2, G. Bush1,2, G. Fricchione 3, R.L. Gollub1,2, G. Khalsa, H. Benson 3

1Department of Psychiatry, Harvard Medical School; 2NMR Center, MGH-East, CNY-9, Charlestown, MA 02129; and 3Mind/Body Medical Institute, Chestnut Hill MA 02467

Experimental Paradigm Two identical 42-minute scans, each with two epochs of meditation and control. Meditation periods (12 min.) consist of observing the breath and repeating a mantra. Control periods (6 min.) consist of silently generating the names of animals.

Fix Control Meditation Fix Control Meditation Fix

0 1 7 19 22 28 40 42

Statistical Comparisons

“Meditation vs Control” compares the entire meditation period to the entire control period. This identifies regions with increased signal during the meditation period relative to the control period. “End vs Beginning” compares the last 2 minutes of the meditation period to the first two minutes of the meditation period. This identifies regions whose signal increases during the meditation practice.

Signal Decreases Subject 4

Meditation vs. Control

Signal Increases During Meditation Meditation vs. Control, n = 5

fMRI Conclusions

The Relaxation Response induces specific changes in fMRI signal in several structures, including the amygdala,

hippocampus, pons, anterior cingulate, and intraparietal sulcus.

Many structures display steadily increasing fMRI signal

Throughout the Relaxation Response periods.

Some structures become less active as practice continues,

While other structures have a delayed onset of activity.

The right BA 9/10 superior frontal and middle gyri and sulci and right anterior insula are significantly thicker in meditators versus age, gender and education matched controls.

B

p < 10-4 p < 10-2

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3

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Cortical Thickness

VO2 vs Nitric Oxide

Genomic Counter-Stress Changes Induced by the Relaxation Response

• Healthy Individuals: Matched for age, gender, race, height, weight and marital status

• Group M: 19 Long-term Practitioners of Daily RR Practice

• Group N1: 20 Controls

• Group N2: 20 N1 individuals who completed 8 weeks of RR training

Validation – Matched with above

• Group M: 6

• Group N1: 5

• Group N2: 5

Techniques Utilized to Elicit the Relaxation Response

• Vipassna Meditation

• Mantra Meditation

• Mindfulness Meditation

• Transcendental Meditation

• Breath Focus

• Kripalu Yoga

• Kundalini Yoga

• Repetitive Prayer

Gene Ontology Analysis

Heatmap of 15 Genes in the Intersection of All Three Groups on the Venn Diagram

GSEA Analysis

Gene Ontology Category Changes of the Relaxation Response

• Oxidative Phosphorylation

• Ubiquitin-dependent Protein Catabolism

• Nuclear Messenger RNA Splicing via Splicosome

• Ribosome

• Primary Metabolism

• Negative Regulation of Metabolism

• Regulation of Apoptosis

• Regulation of I-Κ B Kinase/ NF-Κ B Cascade

• Cysteine-Type Endo-Peptidase Activity

• Antigen Processing

Opposite Common Genomic Expression in PTSD and Relaxation Response Practice

• Stress Response

• Inflammation

• Apoptosis

Table: For all the comparison FDR=0.01 and P value <0.05 enriched genesets on short and long term relaxation response gene expression data: (

Emergence: The Whole is Greater than the Sum of its Parts

For example, when a number of heart cells contract independently of each other, they don’t function meaningfully. But, when they contract in a coordinated interactive fashion, they can pump blood.

Other emergent examples include:

Ant colonies Human cities The Fight-or-Flight Response The Relaxation Response

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STRESS / ANXIETY

Yerkes-Dodson Law Stress-Performance Curve

Relaxation Response Oxygen Consumption

and Exercise

10 20 30

MINUTES

VO2

(% Change)

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Control group

Experimental group

PRE INTERVENTION POST

Mean Changes in EEG-Defined Sleep Onset Latencies

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References

• Benson H, Beary JF, Carol MP. The relaxation response. Psychiatry 1974;37:37-46.

• Benson H. The relaxation response. New York: Morrow, 1975. • Benson H, Proctor W. Relaxation revolution. New York: Scribner,

2010 • Bhasin MK, Dusek JA, Chang BH, Joseph MG, Denninger JW,

Fricchione GL, Benson H, Libermann TA. Relaxation response induces temporal transcriptome changes in energy metabolism, insulin secretions and inflammatory pathways. PLOS ONE, 2013, 8(5):e62817.