Mind Body Medicine

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Mind Body Medicine

• Dr. Danielle Eigner, Maj. USAF
• Family Practice

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Scientists are mapping the pathways that link
emotion to health. The challenge for the rest of
us is to put the discoveries to work Newsweek
Sept. 2004
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Buddhist monk, Saigon, October 5th, 1963

• The man sits impassively in the central market
  square, he has set himself on fire performing a
  ritual suicide in protest against governmental
  anti-Buddhist policies.

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Lecture Outline

• Define MBM
• History/Evolution
• Prevalence/Usage
• Mechanism of action/Research
• Practical application

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Define MBM Health

• MBM defined by the NIH as behavioral,
  psychological, social, and spiritual approaches
  to medicine not commonly used meditation,
  hypnosis, guided imagery, relaxation therapies
  biofeedback.
• Health defined by Webster the condition of being
  sound in body, mind or spirit especially
  freedom from physical disease or pain.

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History of MBM

• .

• 2,000 years ago Ayurvedic and Chinese medicine

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History

• 400 b.c. Ancient Greece, Plato and Hippocrates
  integration of mind and soul

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Renaissance/enlightenment

• 1637, Descartes philosophically separated the
  mind and the body with his concept of dualism

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Alternative medicine

• 1920 Walter Cannon fight or flight
• Henry Beecher placebo
• Morphine and saline in World war 2 beaches of
  Anzio
• 1950-60 extensive research
• Renewed interest in mind-body interactions and
  "alternative" medical treatment

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• The separation of psychology from the premises
  of biology is purely artificial because the human
  psyche lives in indissoluble union with the body
• Carl Jung

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USE OF MIND-BODY MEDICAL THERAPIES

• J Gen Intern Med 2004
• Random national telephone survey
• 2,055 adults in US household 1997-1998
• 18.9 had 1 mind-body therapy in the last year
• 20.5 of these therapies involved visits to a MB
  professional
• Meditation, imagery and yoga were the most
  commonly used techniques

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Prevalence

• Jama 1998 trends in alternative medicine use in
  the US
• Eisenberg et al found that over 40 of Americans
  used complementary therapies.
• This increased in people with chronic health
  conditions including chronic pain.
• J Clin Oncol 2001 Determinants of use of
  complementary therapies by patients with cancer
• survey of tumor registry patients
• Paltiel et al reported 51 used at least one
  complementary therapy.

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Mechanism of Action

• Time perception theory
• Control perception theory
• Brain activity theory

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Time perception theory

• Dr Larry Dossey, M.D.
• Space, Time and Medicine
• Formula P k s/t
• P pain Kconstant Snoxious stimulus Ttime

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Control perception theory

• J. of Neuroscience
• Aug. 2004
• Controllability is the variable
• that affects level of pain perceived
• Stimulus constant
• subjects' belief that they had control over a
  stimulus varied
• Perceived controllability
• modulates the neural response to pain

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Functional brain mapping

• Neuroreport, May 2000
• Signal increases in various brain areas during
  meditation
• Meditation activates neural structures involved
  in attention and control of the autonomic nervous
  system

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Alterations in Brain and Immune function

• Increase in left-sided anterior activation
• Pattern associated with positive effect
• Increases antibody titers in mediators
• Correlation between increase in left sided
  activation and antibody titer increase

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Brain Activity

• Richard Davidson, Lab for functional brain
  imaging _at_ U of. Wis.
• FMRI and EEG
• Monks with Left shift
• Meditators can regulate cerebral activity
• Longer practicegreater brain changes

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EEG

• EEG spectral analysis during TM
• Lab for psychiatric research Mass. General
  Harvard
• U of. Wisconsin Lab for affective Neuroscience
• Characteristic alpha, theta and beta waves
• Synchronization of anterior and posterior
  channels
• High amplitude gamma-band oscillations

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Meditation

• Concentration techniques
• Transcendental
• Relaxation response
• Benson
• Mindfulness Meditation
• Kabat-Zinn

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TRANSCENDENTAL MEDITATION

• Most thoroughly researched program in the field
  of human development
• NIH spent gt 21 million on the beneficial effects
  of the TM on heart disease
• gt 600 scientific studies
• 200 independent research institutions
• 35 countries during the past 40 years
• published in more than 100 leading scientific
  journals

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Physiological affects of TM

• Decreased
• Skin conductance
• Respiratory rate
• Total peripheral resistance
• Serum lipid peroxides
• Beta-receptor sensitivity
• Erythrocyte glycolysis and serum lactate
• Increased
• Alpha wave activity on EEG
• Increased frontal and occipital blood flow
• Altered hormone levels

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RELAXATION RESPONSE

• Herbert Benson, MD
• President Mind Body Medical Institute and
  Professor of Medicine Harvard Medical School.
• Spin off of TM
• Easier to implement and learn
• Stress-related disorders 

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Relaxation response

• Clin J Pain 1991 Benson and Caudill
• 36 reduction in clinic visits one year post
  intervention
• Decreased clinic usage followed 2 years post
  intervention.
• Estimated net savings of 12,000 for the first
  year post treatment and 23,000 second year
• Approximately 60 of US medical schools now teach
  the therapeutic use of relaxation-response
  techniques (Friedman, Zuttermeister, Benson,
  1993) 

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When eliciting the relaxation response

• Decreased metabolism
• Slower heart rate
• Muscle relaxation
• Reduced respiratory rate
• Decreased blood pressure
• Increased levels of nitric oxide

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MINDFULNESS MEDITATION

• Developed by Dr. Kabat-Zinn
• Non-judgment moment to moment awareness
• Sitting meditation, body scans, mindful
  movements.
• Psychodynamic mechanism of discerning primary
  sensory experience ( chronic pain, anxiety) from
  secondary emotional/cognitive reaction.
• Secondary processes create distress

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MBM Course

• Guided instruction in mindfulness meditation
  practices
• Gentle stretching and mindful Yoga
• Inquiry exercises to enhance awareness in
  everyday life
• Individually tailored instruction
• Group dialogue
• Daily home assignments
• Two audio-cassette tapes and a workbook
• 8 weekly classes one day long class

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Kabat-Zinn, J., Lipworth, L., Burney, R. and
Sellers, W. Four year follow-up of a
meditation-based program for the self-regulation
of chronic pain Treatment outcomes and
compliance. Clin. J. Pain (1986) 2159-173.

• 240 chronic pain patients studied following
  training in mindfulness meditation.
• improvements were recorded post-intervention in
  physical and psychological status.
• Gains maintained at follow-up in the majority of
  subjects. Follow-up times ranged from 2.5 to 48
  months.

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Kabat-Zinn, J. An outpatient program in
Behavioral Medicine for chronic pain patients on
the practice of mindfulness meditation
Theoretical considerations and preliminary
results. Gen Hosp. Psychiatry (1982) 433-47.

• 10-week Stress Reduction and Relaxation Program
• focused on detached observation.
• 51 chronic pain patients who had not improved
  with traditional medical care.
• pain categories low back, neck and shoulder, and
  headache. Facial pain, angina pectoris,
  noncoronary chest pain, and GI pain were also
  represented.
• At 10 weeks, 65 of the patients showed a
  reduction of gt33 in the mean total Pain Rating
  Index (Melzack) and 50 showed a reduction of
  gt50.

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Who can benefit from MBM?I would rather know
the person who has the disease then know the
disease the person has Hippocrates

• Primary Care The majority of primary care
  patients' complaints lie in a twilight zone
  between body and mind, marked by overlapping
  psychosocial stress, physical discomfort,
  relationship conflicts, life-stage
  dissatisfaction, and unfulfilled aspirations
  Balint
• Susceptible individuals
• Disciplined committed and goal oriented

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Making treatment effective

• Realistic expectations
• Adjunctive treatment
• Therapeutic relationship
• Appropriate setting

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The future

• Military Integrative health clinic
• Chronic disease Self-management Program
  developed jointly by Stanford University and
  Kaiser Permanente.
• HAWC
• Jama 2000
• Mind matters/ matters
• Cost-effective MBM

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• Remember to cure the patient as well as the
  disease
• Dr. Alvan Barach