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Mind Body Medicine

Dr. Ranjan Choudhary (Solanki)*

What is mind-body medicine?
The connection between the mind and body has often been regarded by Western medicine as something ascribed to the mystical and a topic residing outside the scope of scientific thought. However, it has been a long-term integral tenet in the medical practice of many other cultures. It could be argued that the reliance of Western thought on the concept of dualism in which Plato, Aristotle, and other classical philosophers separated the body as a physical entity from the mind as a “spiritual” force has ultimately discouraged health care professionals from serious consideration of what has appeared to be a vague and even mysterious connection between the mind and body. Nevertheless, a growing body of research has progressively identified the mechanistic building blocks that demystify the reciprocal mind-body interaction and show that it is clearly a physical rather than mystical connection. Descriptions of neurovisceral changes in which readily demonstrated structural alterations in the brain, heart, and other organ systems arise in response to stress and a variety of emotional states provide further demonstration of the true organic mind-body connection. Mind-body medicine uses the power of thoughts and emotions to influence physical health. As Hippocrates once wrote, "The natural healing force within each one of us is the greatest force in getting well." This is mind-body medicine in a nutshell.

What is the history of mind-body medicine?
Most ancient healing practices, such as Traditional Chinese Medicine and Ayurvedic medicine, emphasize the links between the mind and the body. Western medical views were shaped by systems of thought that emphasized the opposite -- the mind and body are separate.
In 1964, psychiatrist George Solomon noticed that people with rheumatoid arthritis got worse when they were depressed. He began to investigate the impact emotions had on inflammation and the immune system in general. The new field was called psychoneuroimmunology. In the 1960s and early 1970s, a physician named Herbert Benson, who coined the term "relaxation response," studied how meditation could affect blood pressure. More understanding of the mind-body link came in 1975, when psychologist Robert Ader showed that mental and emotional cues could affect the immune system.  Today, there is renewed interest in age old traditions such as yoga and meditation. No longer viewed with suspicion, mind-body programs are now established at prestigious medical schools in the United States and around the world.

What are mind-body techniques?
The key to any mind-body technique is to "train" the mind to focus on the body without distraction. In this state of "focused concentration," a person may be able to improve his health. Some of the most commonly used techniques include:

Biofeedback
For this technique, electronic devices are used to provide information to patients about biologic functions (eg, heart rate, BP, muscle activity, skin temperature, skin resistance, brain surface electrical activity). With the help of a therapist or with training, patients can then use information from biofeedback to modify the function or to relax, thereby lessening the effects of conditions such as pain, stress, insomnia, and headaches. Biofeedback is also used in patients with fecal or urinary incontinence, chronic abdominal pain, tinnitus, Raynaud's syndrome, or attention or memory disorders (eg, attention-deficit/hyperactivity disorder, traumatic brain injury). Generally, biofeedback does not seem to be useful in asthma; a possible exception is heart rate variability biofeedback, which may help reduce asthma symptoms and drug use and improve pulmonary function. Guided imagery Mental images, self-directed or guided by a practitioner, are used to help patients relax (eg, before a procedure) and to promote wellness and healing (to try to effect physical changes—eg, by mobilizing the immune system). The images can involve any of the senses. Imagery used with relaxation techniques (muscle relaxation and deep breathing) may help reduce pain and improve quality of life in patients with cancer. Imagery has also been used in patients with psychologic trauma.

Hypnotherapy
Hypnotherapy is derived from western psychotherapeutic practice. Patients are put into an advanced state of relaxation. They become absorbed in the images presented by the hypnotherapist and are relatively distracted from but not unconscious of their surroundings and the experiences they are undergoing. Some patients learn to hypnotize themselves. Hypnotherapy is used to treat pain syndromes, phobias, and conversion disorders and has been used with some success to manage smoking cessation and weight loss. It can reduce pain and anxiety during medical procedures in adults and children. It may be useful in irritable bowel syndrome, headaches, asthma, and some skin disorders (eg, warts, psoriasis). It may help lower BP. Hypnotherapy helps control nausea and vomiting (particularly anticipatory) related to chemotherapy and is useful in palliative cancer care. Some evidence suggests that hypnotherapy helps lessen anxiety and improve quality of life in patients with cancer.

Meditation
In meditation, patients regulate their attention or systematically focus on particular aspects of inner or outer experience. The most highly studied forms of meditation are transcendental meditation (TM) and mindfulness meditation. Although research is incomplete, results to date suggest that meditation could work via at least 2 mechanisms:

  • Producing a relaxed state that counters excessive activation of neurohormonal pathways resulting from repeated stress
  • Developing the capacity for metacognitive awareness (the ability to stand back from and witness the contents of consciousness), thus theoretically helping patients not react to stress automatically (with highly conditioned, learned patterns of behavior) and helping them tolerate and regulate emotional distress better

Most meditation practices were developed in a religious or spiritual context; their ultimate goal was some type of spiritual growth, personal transformation, or transcendental experience. However, studies suggest that as a health care intervention, meditation can often be beneficial regardless of a person's cultural or religious background. Meditation has been used to relieve anxiety, pain, depression, stress, insomnia, and symptoms of chronic disorders such as cancer or cardiovascular disorders. It is also used to promote wellness.

Relaxation Techniques
Relaxation techniques are practices specifically designed to relieve tension and strain. The specific technique may be aimed at
1. Reducing activity of the sympathetic nervous system, 2.  Lowering BP, 3. Easing muscle tension  
4. Slowing metabolic processes and  5. Altering brain wave activity.
Relaxation techniques may be used with other techniques, such as meditation, guided imagery, or hypnotherapy.

Does mind-body medicine work?
While phrases such as "mind over matter" have been around for years, only recently have scientists found solid evidence that mind-body techniques actually do fight disease and promote health. In 1989, for example, a clinical study by David Spiegel, M.D. at Stanford University School of Medicine demonstrated the power of the mind to heal. Of 86 women with late stage breast cancer, half received standard medical care while the other half received standard care plus weekly support sessions. In these sessions, the women were able to share both their grief and their triumphs. Spiegel discovered that the women who participated in the social support group lived twice as long as the women who did not. A similar clinical study in 1999 showed that in breast cancer patients, helplessness and hopelessness are associated with lesser chance of survival. Other clinical studies also show how meditation affects mood and symptoms in people with different conditions (such as high blood pressure, irritable bowel syndrome, and cancer). It also improves quality of life.

How does mind-body medicine work?
When you are physically or emotionally stressed, your body releases stress hormones that can affect all your systems and organs. For example, stress related to hostility and anxiety can result in disruptions in heart and immune function. Similarly, depression and distress may diminish the body's natural capacity to heal. Certain emotions have been associated with disease. For example, hostile attitudes may increase your risk for coronary heart disease, obesity (especially around the waist), insulin resistance (which can lead to diabetes), and abnormal cholesterol (specifically, high triglycerides and low levels of high density lipoprotein or HDL -- the good kind of cholesterol).
There is no evidence that negative emotions actually cause disease. But research shows that being stressed and having negative emotions can be unhealthy. One study found that unconsciously being defensive or stifling feelings may result in medical consequences, such as high blood pressure. High blood pressure is also associated with feelings of hopelessness. How a person deals with emotions may also affect how long they survive with a chronic illness.

The goal of mind-body techniques is to get the body and mind to relax and to reduce the levels of stress hormones in the body, so that your immune system is better able to fight off illness.
What is mind-body medicine good for?

Mind-body techniques can be helpful for many conditions because they encourage relaxation, improve coping skills, reduce tension and pain, and lessen the need for medication. For example, many mind-body techniques are used along with medication to treat pain. Symptoms of anxiety and depression also respond well to mind-body techniques.
Mind-body techniques may help treat many different diseases, including: Cancer, High blood  pressure, Asthma, Coronary heart disease, Obesity, Pain and nausea/vomiting related to chemotherapy, Insomnia, Diabetes, Stomach and intestinal problems (including indigestion, irritable bowel syndrome, constipation, diarrhea, ulcerative colitis, heartburn, and Crohn's disease), Fibromyalgia, Menopausal symptoms such as hot flashes, depression, and irritability and Mental health issues, such as anxiety and depression
In an analysis of mind-body studies, researchers found that cognitive behavioral therapy is the most long lasting treatment for tinnitus (ringing in the ears). Relaxation techniques, hypnosis, and biofeedback also helped. Some researchers believe that chronic fatigue syndrome, which affects the immune system, can be treated with mind-body medicine.
The scientific evidence for the mind's influence on the body now comes from three converging areas of research:

  • Physiological research, which investigates the biological and biochemical connections between the brain and the body's systems. The key physiological question is whether the biological changes that stem from psychological factors actually make a difference to health. For example, even if stress or depression does lower the effectiveness of the immune system, is the drop in activity great enough to increase the risk of illness?
  • Epidemiological research, which shows correlations between certain psychological factors and certain illnesses in the population at large. Some researchers are now trying to unravel the reasons why upsetting experiences are associated with illness and why strong social networks are linked to better health.
  • Clinical research, which tests the effectiveness of mind/body approaches in preventing, alleviating, or treating diseases. For instance, support groups for patients might work because they encourage better compliance with what their physicians tell them to do, or because the emotional changes the groups produce help boost immunity directly.

Although many questions remain to be answered, we believe mind/body approaches can and should become more widely used as a regular part of medical care, for several reasons:  (1) The physical and emotional risk of using these techniques is minimal, while the potential benefit is high, (2) The economic cost of most mind/ body approaches is low; many can be taught by paraprofessionals and involve no high-tech interventions, (3) These techniques can and should be used along with standard medical care. They are not alternative measures, but can easily be applied in the context of conventional medicine, rather than standing in opposition to it.
More and more people are looking for medical care that takes into account their thoughts and emotions as well as their overt medical problems - in short, mind/body medicine

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*Dr. Ranjan Choudhary (Solanki) is working as Assistant Professor, Dept of Community Medicine, MGIMS. Her areas of interest are mind body medicine, integrated healing model and public health management. She researched on issues related to better understanding of mental health and emotional intelligence and their association with physical health. She has organized Breathe life workshop on stress management, emotional intelligence and communication skill for medical and nursing students. She is closely associated with all activities at Arogyadham, Centre for Rejuvenation & Promotion of Positive Health.

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