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Mind–Body Medicine
Overview
The National Center for Complementary and Integrative Health defines Mind–Body Medicine as an approach that “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.” Mind–Body Medicine may also be conceptualized as the scientifically based dimension of what was once named “Complementary and Alternative Medicine” (CAM). In 2012, approximately 45% of Americans were using CAM therapies and spending US$30.2 billion in out-of-pocket expenses to pay for them. Mind–body therapies accounted for 17% of this CAM usage. Mind–Body Medicine uses the evidence-based effects of thoughts, beliefs, emotions, and behaviors to positively influence health.
The field of medicine may be thought of as having three component areas: medications, procedures, and self-care. This has been called the “Three-Legged Stool” model. In this schema, Mind–Body Medicine may be conceptualized as the self-care leg, comprised of information derived from the subspecialty of Psychosomatic Medicine. To promote healing, it employs an array of heterogeneous, researched techniques, including meditation, biofeedback, autogenic training, hypnosis, yoga, tai chi, qi gong, and autogenic training ( Table 40-1 ). In this chapter, we will point out the common elements of these techniques and the core elements of the mind–body approach, which can all elicit the relaxation response (RR). The focus on a repetitive activity (such as breathing, or a phrase, word, or prayer) and disruption of the train of everyday thoughts and concerns are the two main features of eliciting the RR; a physiologic state of decreased stress characterized by diminished heart rate, blood pressure, respiratory rate, and oxygen consumption, along with peripheral vasodilatation.
TABLE 40-1
Description of Common Mind–Body Therapies
Data from National Center for Complementary and Integrative Health (NCCIH): Complementary, alternative, or integrative health: what's in a name? Bethesda, 2016, NCCIH. Available from: https://nccih.nih.gov/health/integrative-health and Bertisch SM, Wee CC, Phillips RS, et al: Alternative mind–body therapies used by adults with medical conditions. J Psychosom Res . 2009; 66: 511–519.
| MIND–BODY THERAPY | DESCRIPTION |
|---|---|
| Autogenic training | Uses visualization and affirmation techniques to perform manualized self-relaxation |
| Biofeedback | Use of quantitative sensory modalities (such as heart rate monitoring) to learn to control physiologic processes |
| Hypnosis | Use of suggestion in a relaxed state of consciousness to elicit behavioral change |
| Meditation | One of many practices that focuses attention on a bodily sensation, thought, object, or word to promote observation with a stance of non-judgment |
| Progressive muscle relaxation | Serial contraction and relaxation of muscle groups, often in conjunction with guided imagery and breathing |
| Tai chi | Derived from martial arts, this practice focuses energy on precise choreographed physical movements that are perfected over years of practice |
| Qi gong | A moving meditation and health practice focused on internal organ energy derived from Traditional Chinese Medicine |
| Yoga | One of multiple styles of meditative movement practices based in Indian philosophy utilizing postures, breathing, and relaxation |
Mind–Body Medicine is often seen as a philosophical concept of healing and health, as well as a group of techniques. Many of these techniques originated in ancient Eastern cultural traditions and may have a religious foundation based on a particular conceptualization of human life. However, even though some people attain benefits from the religious aspects, they are not essential for their therapeutic effect. Throughout this chapter, we describe how recent research is providing evidence for the effectiveness of these treatments, establishing their scientific value and facilitating their integration into mainstream medicine.
Mind–Body Medicine approaches are mainly complementary to current allopathic therapies, but for some conditions, they may also be efficacious when used alone. Within this framework, Mind–Body Medicine takes center stage as it stresses a multi-system integrative model.
Stress Physiology
All mind–body strategies utilize focus and a non-judgmental stance to quiet the mind and body. In other words, these techniques modulate the physiologic stress response. Later in this chapter, we discuss various hypotheses that link stress physiology to the efficacy of mind–body techniques. Preliminary research illustrates that diverse mind–body techniques have the effect of dampening the stress response; thus, it has been hypothesized that the downstream effects of chronic stress (and the associated morbidity) may also be alleviated by mind–body strategies. Here, we discuss the broad physiologic impact of chronic stress.
Definition of Stress and Distress
Being alive involves stress as a stimulus; stress requires biological, psychological, and social adaptations. Eustress can be thought of as the normal physiologic workings of the living organism. Pathogenic stress or distress occurs when homeostasis is threatened or perceived to be so in the setting of overwhelming or sustained external and internal stressors. Alterations in the environment may provoke a physiologic stress response mediated by several interconnected physiologic networks constituting the stress system , composed of elements of the central nervous system (CNS), the hypothalamus–pituitary–adrenal (HPA) axis, and the immune system. Stressors, the stress response, and the stress system are the three key elements in this process.
Distress is accompanied by overactivity of the stress response system mediated primarily by hypothalamic corticotrophin releasing hormone (CRH) and locus coeruleus-derived norepinephrine (NE). Walter Cannon, in the early 1900s, did groundbreaking work on one axis of the stress response system, the autonomic nervous system (ANS). He focused on a particular branch of ANS, the sympathetic nervous system (SNS) and its connection to “ the flight–fight response .” Hans Selye, another 20th century stress researcher, focused on the HPA axis.
Autonomic Nervous System
The CNS and the peripheral ANS have opposing sympathetic (SNS) and parasympathetic (PNS) components. While the SNS promotes the stress response, the PNS can dampen this effect and restore balance in the autonomic system. With practice, engaging in mind–body techniques facilitates a switch from SNS to PNS. These interconnected systems maintain homeostasis by modulating different bodily functions and controlling the administration, distribution, and use of energy. In this way, the brain adapts the level of functioning of different organs to global bodily demands, autoregulated by negative feedback and feed-forward mechanisms. The SNS dominant stress response is adaptive in the short term to mediate a fight-or-flight behavior. However, distress occurs when the SNS is overactivated by either chronic or acutely overwhelming stressors that make restoration of homeostasis through balance with the PNS difficult. When this occurs persistently, chronic sympathetic activation (i.e., distress) may lead to chronic diseases in organ systems that are sensitive to prolonged alterations in autonomic control—the cardiovascular, respiratory, gastrointestinal, renal, endocrine, and immune systems, among others.
Activation of the stress response via the SNS stimulates metabolism, cardiac output (through increased heart rate), vascular tone, respiration (through increased breathing rate and oxygen consumption), muscle contraction, increased beta and reduced alpha brain wave activity. Simultaneously, the stress response suppresses the PNS resulting in reduced activity of the excretory, gastrointestinal, and reproductive systems. The neurobiologic pathways for this stress response are detailed below.
The stress response is elicited by efferent pathways from the central nucleus of the amygdala (which stimulates the parabrachial nucleus to increase respiration), the dorsomedial nucleus of the vagus nerve (that suppresses the PNS), and the lateral hypothalamus (which activates the SNS). Through reciprocal neuronal pathways connecting the amygdala to the medial prefrontal cortex (PFC), the specific emotional experience of stress will differ, but is typically associated with fear. During panic attacks, for example, the fear is of imminent death; in social phobia, the fear is of embarrassment; in post-traumatic stress disorder (PTSD), the traumatic memory is remembered or re-experienced; in obsessive–compulsive disorder (OCD), obsessional ideas recur and intrude; and in generalized anxiety disorder, anxiety is ever present and non-specific.
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