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Mind-Body Medicine

 

Mind-Body Medicine: An Overview

About This Series

"Mind-Body Medicine: An Overview" is one of five background papers on the major

areas of complementary and alternative medicine (CAM). The series was prepared

as part of the National Center for Complementary and Alternative Medicine's

(NCCAM's) strategic planning efforts for the years 2005 to 2009. These brief reports

should not be viewed as comprehensive or definitive reviews. Rather, they are

intended to provide a sense of the overarching research challenges and

opportunities in particular CAM approaches. To find out more about topics and

resources mentioned in this fact sheet, see "For More Information."

"I would rather know the person who has the disease than know the disease the person has."

- Hippocrates

Introduction

Mind-body medicine focuses on the interactions among the brain, mind, body,

and behavior, and on the powerful ways in which emotional, mental, social,

spiritual, and behavioral factors can directly affect health. It regards as

fundamental an approach that respects and enhances each person's capacity

for self-knowledge and self-care, and it emphasizes techniques that are

grounded in this approach.

Definition of Scope of Field

Mind-body medicine typically focuses on intervention strategies that are

thought to promote health, such as relaxation, hypnosis, visual imagery,

meditation, yoga, biofeedback, tai chi, qi gong, cognitive-behavioral therapies,

group support, autogenic training, and spirituality.The field views illness as an

opportunity for personal growth and transformation and health care providers

as catalysts and guides in this process.

Certain mind-body intervention strategies listed here, such as group support for cancer survivors,

are well integrated into conventional care and, while still considered mind-body interventions, are

not considered to be complementary and alternative medicine.

Mind-body interventions constitute a major portion of the overall use of CAM by the public. In

2002, mind-body techniques, including relaxation techniques, meditation, guided imagery,

biofeedback, and hypnosis, were used by about 17 percent of the adult U.S. population. Prayer

was used by 45 percent of the population for health reasons.1

Background

The concept that the mind is important in the treatment of illness is integral to the healing

approaches of traditional Chinese and Ayurvedic medicine, dating back more than 2,000 years. It

was also noted by Hippocrates, who recognized the moral and spiritual aspects of healing, and

believed that treatment could occur only with consideration of attitude, environmental influences,

and natural remedies (ca. 400 B.C.). While this integrated approach was maintained in traditional

healing systems in the East, developments in the Western world by the 16th and 17th centuries led

 to a separation of human spiritual or emotional dimensions from the physical body. This
separation

began with the redirection of science, during the Renaissance and Enlightenment eras, to the purpose

of enhancing humankind's control over nature. Technological advances (e.g., microscopy, the stethoscope,

the blood pressure cuff, and refined surgical techniques)

demonstrated a cellular world that seemed far

apart from the world of belief and emotion. The
discovery of bacteria and, later, antibiotics further dispelled

 the notion of belief influencing health.
Fixing or curing an illness became a matter of science (i.e., technology)

and took precedence over, not a place beside, healing of the soul. As medicine separated the mind and the body,

scientists of the mind (neurologists) formulated concepts, such as the unconscious, emotional impulses, and

cognitive delusions, that solidified the perception that diseases of the mind were not "real," that is, not based

 in physiology and biochemistry.

In the 1920s, Walter Cannon's work revealed the direct relationship between stress and

neuroendocrine responses in animals.2 Coining the phrase "fight or flight," Cannon described

the primitive reflexes of sympathetic and adrenal activation in response to perceived danger

and other environmental pressures (e.g., cold, heat). Hans Selye further defined the deleterious

effects of stress and distress on health.3 At the same time, technological advances in medicine

that could identify specific pathological changes, and new discoveries in pharmaceuticals,

were occurring at a very rapid pace. The disease-based model, the search for a specific

pathology, and the identification of external cures were paramount, even in psychiatry.

During World War II, the importance of belief reentered the web of health care. On the beaches

of Anzio, morphine for the wounded soldiers was in short supply, and Henry Beecher, M.D.,

discovered that much of the pain could be controlled by saline injections. He coined the term

"placebo effect," and his subsequent research showed that up to 35 percent of a therapeutic

response to any medical treatment could be the result of belief.4 Investigation into the placebo

effect and debate about it are ongoing.

Since the 1960s, mind-body interactions have become an extensively researched field. The

evidence for benefits for certain indications from biofeedback, cognitive-behavioral

interventions, and hypnosis is quite good, while there is emerging evidence regarding their

physiological effects. Less research supports the use of CAM approaches like meditation and

yoga. The following is a summary of relevant studies.

Mind-Body Interventions and Disease Outcomes

Over the past 20 years, mind-body medicine has provided considerable evidence that

psychological factors can play a substantive role in the development and progression of

coronary artery disease. There is evidence that mind-body interventions can be effective in the

treatment of coronary artery disease, enhancing the effect of standard cardiac rehabilitation in

reducing all-cause mortality and cardiac event recurrences for up to 2 years.5

Mind-body interventions have also been applied to various types of pain. Clinical trials

indicate that these interventions may be a particularly effective adjunct in the management of

arthritis, with reductions in pain maintained for up to 4 years and reductions in the number of

physician visits.6 When applied to more general acute and chronic pain management,

headache, and low-back pain, mind-body interventions show some evidence of effects,

although results vary based on the patient population and type of intervention studied.7

Evidence from multiple studies with various types of cancer patients suggests that mind-body

interventions can improve mood, quality of life, and coping, as well as ameliorate disease and

treatment-related symptoms, such as chemotherapy-induced nausea, vomiting, and pain.8

Some studies have suggested that mind-body interventions can alter various immune

parameters, but it is unclear whether these alterations are of sufficient magnitude to have an

impact on disease progression or prognosis.9,10

Mind-Body Influences on Immunity

There is considerable evidence that emotional traits, both negative and positive, influence

people's susceptibility to infection. Following systematic exposure to a respiratory virus in the

laboratory, individuals who report higher levels of stress or negative moods have been shown

to develop more severe illness than those who report less stress or more positive moods.11

Recent studies suggest that the tendency to report positive, as opposed to negative, emotions

may be associated with greater resistance to objectively verified colds. These laboratory

studies are supported by longitudinal studies pointing to associations between psychological

or emotional traits and the incidence of respiratory infections.12

Meditation and Imaging

Meditation, one of the most common mind-body interventions, is a conscious mental process that

induces a set of integrated physiological changes termed the relaxation response. Functional

magnetic resonance imaging (fMRI) has been used to identify and characterize the brain regions

that are active during meditation. This research suggests that various parts of the brain known to

be involved in attention and in the control of the autonomic nervous system are activated,

providing a neurochemical and anatomical basis for the effects of meditation on various

physiological activities.13 Recent studies involving imaging are advancing the understanding of

mind-body mechanisms. For example, meditation has been shown in one study to produce

significant increases in left-sided anterior brain activity, which is associated with positive

emotional states. Moreover, in this same study, meditation was associated with increases in

antibody titers to influenza vaccine, suggesting potential linkages among meditation, positive

emotional states, localized brain responses, and improved immune function.14

Physiology of Expectancy (Placebo Response)

Placebo effects are believed to be mediated by both cognitive and conditioning mechanisms.

Until recently, little was known about the role of these mechanisms in different

circumstances. Now, research has shown that placebo responses are mediated by conditioning

when unconscious physiological functions such as hormonal secretion are involved, whereas

they are mediated by expectation when conscious physiological processes such as pain and

motor performance come into play, even though a conditioning procedure is carried out.

Positron emission tomography (PET) scanning of the brain is providing evidence of the release of

the endogenous neurotransmitter dopamine in the brain of Parkinson's disease patients in

response to placebo.15 Evidence indicates that the placebo effect in these patients is powerful and

is mediated through activation of the nigrostriatal dopamine system, the system that is damaged

in Parkinson's disease. This result suggests that the placebo response involves the secretion of

dopamine, which is known to be important in a number of other reinforcing and rewarding

conditions, and that there may be mind-body strategies that could be used in patients with

Parkinson's disease in lieu of or in addition to treatment with dopamine-releasing drugs.

Stress and Wound Healing

Individual differences in wound healing have long been recognized. Clinical observation has

suggested that negative mood or stress is associated with slow wound healing. Basic mindbody

research is now confirming this observation. Matrix metalloproteinases (MMPs) and the

tissue inhibitors of metalloproteinases (TIMPs), whose expression can be controlled by

cytokines, play a role in wound healing.16 Using a blister chamber wound model on human

forearm skin exposed to ultraviolet light, researchers have demonstrated that stress or a

change in mood is sufficient to modulate MMP and TIMP expression and, presumably, wound

healing.17Activation of the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal

medullary (SAM) systems can modulate levels of MMPs, providing a physiological link among

mood, stress, hormones, and wound healing. This line of basic research suggests that

activation of the HPA and SAM axes, even in individuals within the normal range of depressive

symptoms, could alter MMP levels and change the course of wound healing in blister wounds.

Surgical Preparation

Mind-body interventions are being tested to determine whether they can help prepare patients

for the stress associated with surgery. Initial randomized controlled trials—in which some

patients received audiotapes with mind-body techniques (guided imagery, music, and

instructions for improved outcomes) and some patients received control tapes—found that

subjects receiving the mind-body intervention recovered more quickly and spent fewer days in

the hospital.18

Behavioral interventions have been shown to be an efficient means of reducing discomfort and

adverse effects during percutaneous vascular and renal procedures. Pain increased linearly

with procedure time in a control group and in a group practicing structured attention, but

remained flat in a group practicing a self-hypnosis technique. The self-administration of

analgesic drugs was significantly higher in the control group than in the attention and

hypnosis groups. Hypnosis also improved hemodynamic stability.19

Conclusion

Evidence from randomized controlled trials and, in many cases, systematic reviews of the

literature, suggests that:

Mechanisms may exist by which the brain and central nervous system influence immune,

endocrine, and autonomic functioning, which is known to have an impact on health.

Multicomponent mind-body interventions that include some combination of stress

management, coping skills training, cognitive-behavioral interventions, and relaxation

therapy may be appropriate adjunctive treatments for coronary artery disease and certain

pain-related disorders, such as arthritis.

Multimodal mind-body approaches, such as cognitive-behavioral therapy, particularly

when combined with an educational/informational component, can be effective adjuncts

in the management of a variety of chronic conditions.

An array of mind-body therapies (e.g., imagery, hypnosis, relaxation), when employed

presurgically, may improve recovery time and reduce pain following surgical procedures.

Neurochemical and anatomical bases may exist for some of the effects of

mind-body approaches.

Mind-body approaches have potential benefits and advantages. In particular, the physical and

emotional risks of using these interventions are minimal. Moreover, once tested and

standardized, most mind-body interventions can be taught easily. Finally, future research

focusing on basic mind-body mechanisms and individual differences in responses is likely to

yield new insights that may enhance the effectiveness and individual tailoring of mind-body

interventions. In the meantime, there is considerable evidence that mind-body interventions,

even as they are being studied today, have positive effects on psychological functioning and

quality of life, and may be particularly helpful for patients coping with chronic illness and in

need of palliative care.

References

1. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults:

United States, 2002.CDC Advance Data Report #343. 2004.

2. Cannon WB. The Wisdom of the Body.New York, NY: Norton; 1932.

3. Selye H. The Stress of Life.New York, NY: McGraw-Hill; 1956.

4. Beecher H. Measurement of Subjective Responses. New York, NY: Oxford University Press; 1959.

5. Rutledge JC, Hyson DA, Garduno D, et al. Lifestyle modification program in management of patients with coronary

artery disease: the clinical experience in a tertiary care hospital. Journal of Cardiopulmonary Rehabilitation.

1999;19(4):226-234.

6. Luskin FM, Newell KA, Griffith M, et al. A review of mind/body therapies in the treatment of musculoskeletal

disorders with implications for the elderly. Alternative Therapies in Health and Medicine.2000;6(2):46-56.

7. Astin JA, Shapiro SL, Eisenberg DM, et al. Mind-body medicine: state of the science, implications for practice.

Journal of the American Board of Family Practice.2003;16(2):131-147.

8. Mundy EA, DuHamel KN, Montgomery GH. The efficacy of behavioral interventions for cancer treatment-related

side effects. Seminars in Clinical Neuropsychiatry.2003;8(4):253-275.

Reviewed October 2004 D239

Updated May 2007

9. Irwin MR, Pike JL, Cole JC, et al. Effects of a behavioral intervention, Tai Chi Chih, on varicella-zoster virus specific

immunity and health functioning in older adults. Psychosomatic Medicine.2003;65(5):824-830.

10. Kiecolt-Glaser JK, Marucha PT, Atkinson C, et al. Hypnosis as a modulator of cellular immune dysregulation during

acute stress. Journal of Consulting and Clinical Psychology.2001;69(4):674-682.

11. Cohen S, Doyle WJ, Turner RB, et al. Emotional style and susceptibility to the common cold. Psychosomatic Medicine.

2003;65(4):652-657.

12. Smith A, Nicholson K. Psychosocial factors, respiratory viruses and exacerbation of asthma.

Psychoneuroendocrinology.2001;26(4):411-420.

13. Lazar SW, Bush G, Gollub RL, et al. Functional brain mapping of the relaxation response and meditation.

Neuroreport.2000;11(7):1581-1585.

14. Davidson RJ, Kabat-Zinn J, Schumacher J, et al. Alterations in brain and immune function produced by

mindfulness meditation. Psychosomatic Medicine.2003;65(4):564-570.

15. Fuente-Fernandez R, Phillips AG, Zamburlini M, et al. Dopamine release in human ventral striatum and

expectation of reward. Behavioural Brain Research.2002;136(2):359-363.

16. Stamenkovic I. Extracellular matrix remodelling: the role of matrix metalloproteinases. Journal of Pathology.

2003;200(4):448-464.

17. Yang EV, Bane CM, MacCallum RC, et al. Stress-related modulation of matrix metalloproteinase expression. Journal

of Neuroimmunology. 2002;133(1-2):144-150.

18. Tusek DL, Church JM, Strong SA, et al. Guided imagery: a significant advance in the care of patients undergoing

elective colorectal surgery. Diseases of the Colon and Rectum.1997;40(2):172-178.

19. Lang EV, Benotsch EG, Fick LJ, et al. Adjunctive non-pharmacological analgesia for invasive medical procedures: a

randomised trial. Lancet.2000;355(9214):1486-1490.

For More Information

NCCAM Clearinghouse

The NCCAM Clearinghouse provides information on CAM and on NCCAM, including

publications and searches of Federal databases of scientific and medical literature. The

Clearinghouse does not provide medical advice, treatment recommendations, or referrals to

practitioners.

Toll-free in the U.S.: 1–888–644–6226

TTY (for deaf and hard-of-hearing callers): 1–866–464–3615

Web site: nccam.nih.gov

E-mail: info@nccam.nih.gov

This publication is not copyrighted and is in the public domain.

Duplication is encouraged.

NCCAM has provided this material for your information. It is not intended to substitute

for the medical expertise and advice of your primary health care provider. We encourage

you to discuss any decisions about treatment or care with your health care provider. The

mention of any product, service, or therapy is not an endorsement by NCCAM.

National Institutes of Health

♦♦♦

U.S. Department of Health and Human Services

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