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Is it All in Your

Head?
Advances in Mind Body Medicine

Dr Hien Nguyen MD MPH


Research Associate
Benson Henry Mind Body Medicine Institute
Harvard Medical School | Massachusetts General Hospital
“Problems cannot be solved by the same level of thinking that created
them.”
 Albert Einsten

 “Cure sometimes, treat often, comfort always”


 - Hippocrates

“You ought not to attempt to cure the body without the soul… For this
is the greatest error of our day in the treatment of the human body,
that physicians separate the soul from the body.”
 Plato
Mind Body Medicine - Definitions

 Hard to Define

 “Doing something with your mind that affects your body”

 NCCAM definition:
 “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”
 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

www.nccam.nih.gov
Mind Body Medicine - Definitions

 Alternative Medicine or
mainstream?
 Many forms of MBM,
practices include
 Placebo
 Tai chi/yoga
 Meditation
 Mindfulness
 Concentration
 Social support
 Relationship Interactions
Who uses it?
Usage of MBM among adults
Costs of Complementary and Alternative Medicine and
Frequency of Visits to CAM Practitioners: United States 2007
Nahin RL et al
National Health Statistics Reports (18) July 30, 2009

 38.1 million adults made an estimated 354.2 million visits


to practitioners of CAM
 Total costs: $33.9 bn
 Self Care Costs $22.0 bn
 Practitioner costs $11.9 bn
Evolution of a Field: Unanswered
Questions

 The Placebo Effect


 Analgesics – 1 in 3 respond, recent study can reproduce placebo in
up to 90% of patients (N Engl J Med 2001, 344:1594–1602.,
 Osteoarthritis/arthroscopy (N Engl J Med 2002; 347:81-88)
 Antidepressants
 Affected by provider interaction (BMJ. 2008 May 3; 336(7651): 999–
1003. )
 Spontaneous Remission – International Medical Commission, IONS

 Nocebo
 Up to 25% of patients on placebos (JAMA. 2002;287:622-627. )
Cardiovascular Studies

 Takotsubo/Stress Cardiomyopathy (N Engl J Med 2005; 352:539-548)

 The Roseto Effect (Am J Public Health 1992 82: 1089-1092)

 Social Isolation and Lack of Social Support


 Small networks associated with 2-3x RR CD/MI

 Depression and Hopelessness (Circulation. 1999;99:2192-2217)


 Up to 13x RR for CD, MI

 Personality Factors in Cardiac Disease


 Type A personality
 Later refined for anger and hostility traits (Western Collaborative Study Group) –
stronger predictors, not only of CHD but also of cancer and other causes of death
Social Support
 David Spiegel – Women with breast cancer in support groups live for 18
months longer on average
 The Lancet, Volume 334, Issue 8668, Pages 888 – 891
 Cancer 113: 3450-3458, 2008
 J Clin Oncol. 2007 25(19):2702-08

 Epidemiological evidence – healthy aging, post stroke, depression

Social Disparities and Health


• Biggest Risk factor in behvioural medicine – CV Disease, respiratory disease,
ulcers, rheumatoid disorders, psychiatric disease, cancer – up to 10x the
prevalence

• Whitehall studies, animal studies

• Lithuanian men – 4 times CHD incidence following collapse of soviet union


(Psychosom Med. 1998 May-Jun;60(3):277-82.)
Other Psychological Factors

 Control

 Predictability

 Loneliness and Depression

 Meaning and Purpose

 Emotions
Stress: A Unifying Mechanism

 Stress Theory
 Challenge-Stimulus-Hyperarousal
 Fight or Flight Response – Walter B Cannon – 1915
 General Adaptation Syndrome – Hans Selye – 1940-50s
 Relaxation Response – 1970’s and 1980’s
 Allostasis – Sterling and Ayer 1988; McEwen 1998
What is Stress?

 Psychological Stress
 Cognitive Process
 Primary and
Secondary Appraisal
 Demands vs Abilities

 Allostatic Load
 HPA effects
 SNS effects
 Epigenetic effects
Allostasis
 Sterling and Ayer 1988; McEwen 1998

 Maintaining stability through change

Allostatic Loading
 Wear and tear due to repeated cycles of allostasis

 Accumulated effects on body of inefficient turning on and shutting off

 Diseases of allostatic load can include depression, anxiety, as well as


metabolic syndrome and related diseases – hypertension, truncal
obesity, hypercholesterolemia, atherosclerosis, CAD, CCF, chronic
pain, headache, healthy aging, cognitive decline
Mind Body Hypothesis

 Hypothesis:
 Mind-Body is a unity
 Psychosocial (chronic or acute) stress leads to cellular
oxidative stress
 Cellular Oxidative Stress leads to disease vulnerability

 Also – health behavior effects, lifestyle effects


Diseases affected by Stress

 Hypertension  Anxiety

 Cardiac Arrhythmia  Hostility

 Chronic Pain  Depression

 Insomnia  PMS

 Side Effects of Cancer  Infertility


Therapy
 Preparation for XR and
 AIDS Surgical Procedures
Effect of Stress on Performance
What is the RR
 “A wakeful hypometabolic
physiologic state”
 Elicited by:
 The repetition of a word, sound,
thought, phrase or muscular
activity
 The passive return to the repetition
when other thoughts intrude

 Benefits when elicited for 15-20


minutes, 1-2 times a day
Techniques that elicit the RR
 Vipassana Meditation

 Mantra Meditation

 Mindfulness Meditation

 Transcendental Meditation

 Breathing Meditation

 Kripalu Yoga

 Kundalini Yoga

 Repetitive/Centering Prayer
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 31Department of Psychiatry, Harvard Medical School; 2NMR
Center, MGH-East, CNY-9, Charlestown, MA 02129; 3Mind/Body Medical
Institute, Chestnut Hill MA 02467
Genomic Counter Stress Changes Induced by the
Relaxation Response
(PLoS One. 2008 Jul 2;3(7):e2576)
• Healthy Individuals
• Matched for age, sex, gender,
race, height, weight and
marital status
•Group M – Long Term Daily RR
Practitioners
• 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
Gene Ontology Category Changes of the
Relaxation Response
Stress/Vulnerability Hypothesis
Efficacy
 Many studies for varying techniques and conditions
 In Brief
 Strong to Moderate RCT evidence (Pelletier 2004)
 Cardiovascular disease – Metaanalysis – 41% reduction in all cause mortality, 46% reduction in
non-fatal recurrence at 2 years
 Hypertension
 Insomnia
 General pain syndromes
 Low back pain
 Headache
 Fibromyalgia
 Arthritis
 Incontinence
 Surgical outcomes
 Adjunctive treatments in cancer
BHI MBM Programs

 Programs in
 General Wellness
 Medical Symptom Reduction
 Fertility
 Menopause/Perimenopausal
 Cardiac Rehabilitation
 Mind Body Chronic Pain Service
 Mind Body Program for Cancer
Program Structure
 Initial Integrative Medicine Consultation – 1 hour

 Education – about the stress response, relaxation response

 8 week program – 1 evening per week

 Different methods of eliciting the RR


 Bodywork/Yoga
 Cognitive Restructuring Techniques
 CBT
 Social Support
 Formation of Peer Support Groups
 Social Skill Building
 Emotional Regulation Skills
 Sleep
 Nutrition
Cardiac Wellness Program
Cardiac Wellness Program
Cardiac Wellness Program
Why use MBM?

 Perspective encourages patient centered care

 Encourages a more thorough, deep approach to healthcare

 Offers cheap, safe methods to reduce morbidity and


increase health – cost effective
 Encourages self care

 Enhances body/mind’s natural self healing capacities

 Emphasizes Salutogenesis rather than Pathogenesis

 Able to relieve suffering rather than just ‘fix’ disease


Questions?
Hien.Nguyen@post.harvard.edu

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