What Is It?
How Does It Work?
What You Can Expect
How To Choose a Practitioner
Evidence Based Rating Scale
What Is It?
Mind-body medicine combines the precision of modern science with the wisdom of ancient healing. Unlike conventional Western medicine, which typically classifies disease as either biological or psychosomatic in nature, the field of mind-body medicine prefers to look at the whole being of the person, acknowledging that emotional, mental, social, and spiritual factors are as important as physical symptoms in understanding and treating disease. Mind-body medicine believes that people can be active participants in their own healthcare and views illness as an opportunity for personal growth, self-awareness, and psychological transformation. Mind-body skills instructors are catalysts and guides in this process.
Today those who practice mind-body medicine and/or teach mind-body skills include integrative and holistic physicians, nurses, psychologists, social workers, and counselors, as well as chiropractors, hypnotists, bodyworkers, and traditional Chinese and Ayurvedic medicine practitioners. In addition, health coaches, Lamaze instructors, doulas, and other educators may teach mind-body skills. (See also "How to Choose a Practitioner," below)
Not surprisingly, because the mind-body field is so broad-based, it includes a wide range of therapeutic strategies. These include breathing, meditation, the relaxation response, somatic (body) movement education practices, cognitive-behavioral strategies, Biofeedback, Guided imagery, and self-hypnosis, as well as ages-old healing practices such as qigong and yoga. Therapeutic modalities such as acupuncture, homeopathy, and massage, while being primarily physically based, often stimulate emotional releases and healing as well. While good clinical practitioners will incorporate mind-body medicine into their one-on-one therapy plans, there is also an increasing demand for practitioners who can teach these skills to groups of people interested in improving their vitality and coping skills, as well as addressing specific health concerns.
For more information on the specific therapies mentioned above, see their entries in the WholeHealthMD Reference Library.
How Does It Work?
Researchers are only beginning to understand what happens on the physiological level when mind-body techniques are employed. In many mind-body approaches, the conscious mind is used to directly affect how the brain and the rest of the body work; while in others such as massage, the physical modality seems to directly affect mental and emotional function. Mind-body techniques work on the endocrine (glandular) system, the immune system, the connective tissue that holds bones and muscles together, and the hypothalamus, which is the switching station in the brain that controls the autonomic nervous system (heart rate, blood pressure). For example, functional Magnetic Resonance Imaging (fMRI) has confirmed brain regions that control the autonomic nervous system are active during meditation. (1) Some forms of mindfulness meditation may affect cellular aging by positively affecting the protective caps on the ends of chromosomes known as telomeres. Telomere length has been linked to chronic stress exposure and depression. There is some evidence that mindfulness meditation techniques may positively affect telomere length and aging by reducing cognitive stress and stress arousal and increasing positive mind states and hormonal factors that promote telomere maintenance. (2)
The nature of mind-body skills instruction and the learning commitment that is necessary depend on the nature and seriousness of your condition. A person facing an acute challenge, such as childbirth or elective surgery, for example, might require a shorter and more focused training program than a person with a chronic medical condition such as heart disease or someone just interested in improving their quality of life.
While mind-body skills can be taught in a one-on-one setting, most instructors prefer to work in larger classes, workshops, or retreats to encourage group interaction. You may be asked to sign up for six weeks of a weekly three-hour class with homework, or be invited to go on a two- to seven-day retreat, or attend a three- to six-hour one-day seminar or workshop. The goal is to give individuals the tools to apply specific mind-body skills in their everyday lives and help them take advantage of the mutual support and common learning experience of the group.
What You Can Expect
Mind-body skills instructors view and respect a client as a whole person who is much more than their symptoms. The initial visit will include a holistic evaluation of social, family, emotional, physical, cultural, and spiritual development and cognitive history. The client's goals and strengths will be assessed and, for cognitively based processes, the client may be advised that they will be taking an active role in the therapeutic process. The instructor will devise a treatment plan that may be coordinated with treatment by physicians and other healthcare professionals if it meets the client’s needs. Effective communication is essential and clients are encouraged to voice any questions or concerns at any time during the therapeutic process. (3)
Mind-body skills have been found to help those who suffer from the physical and emotional pain of a number of chronic conditions. In a 2003 article, "Mind-Body Medicine: State of the Science, Implications for Practice," published in the Journal of the American Board of Family Practice, the authors concluded that, "There is now considerable evidence that an array of mind-body therapies can be used as effective adjuncts to conventional medical treatment for a number of common clinical conditions." According to the article, conditions for which there is evidence that mind-body therapies may be helpful include Coronary artery disease (e.g., cardiac rehabilitation), headaches, insomnia, incontinence, chronic low back pain, postsurgical outcomes, and the disease and treatment-related symptoms of cancer. The authors also found moderate evidence of efficacy for mind-body therapies in the areas of Hypertension and arthritis. (4)
Earlier, a 2000 JAMA review article on the cost-effectiveness of mind-body medicine showed mind-body therapies to be safe and relatively inexpensive interventions that can improve health outcomes and reduce the need for more expensive medical treatments. The article proposed that mind-body medicine is not something separate or peripheral to the main tasks of medical care but should be an integral part of evidence-based, cost-effective quality health care. (5)
In addition to being used to treat chronic conditions, which are often made worse by anxiety and stress, mind-body skills are also frequently employed to relieve stress itself. In a recent study, 67 patients who regularly engage in meditation as mind-body training had lower stress and higher positive affects than the control group. (6) Indeed, many people who turn to mind-body therapies simply want to find ways to relax in their daily lives and improve their overall mental attitude.
Specifically, a mind-body skills instructor can design a program to benefit:
Anxiety and Panic. Meditation may reduce anxiety caused by conditions such as cancer, heart disease, and psychiatric illness. (7-9) Cognitive-behavioral therapies (CBT) may improve the efficacy of conventional anxiety treatment. In a study of 232 individuals with panic disorder, those treated with CBT had 60 more anxiety-free days over the course of a year than individuals who were treated with medication alone. (10-11).
Attention Deficit Hyperactivity Disorder (ADHD). A form of biofeedback called EEG biofeedback or neurofeedback is showing promise in the treatment of ADHD. Children, teens and adults have experienced significant long-term relief using this therapy. (12) A 2007 review found large-scale studies support neurofeedback as a promising alternative treatment for ADHD that is comparable to treatment with stimulant medications. (13)
Back pain. A number of mind-body techniques have been successful in treating back pain. In a study of 11,630 patients, researchers found that three months of acupuncture treatments eased chronic low back pain, improved back function, and was cost-effective. (14-15) While all studies did not show the same benefit, this study showed acupuncture should be considered a safe, effective, and economical treatment for back pain. In addition, massage therapy has been effective in subacute and chronic back pain. (16)
Cancer. Mind-body skills such as guided imagery, music therapy, meditation, and self-hypnosis have been shown to decrease pain and anxiety associated with cancer. (17) (see also the WholeHealthMD Reference Library entry on Guided Imagery for the work of Carl Simonton on cancer).
Chronic pain. The mind-body techniques hypnotherapy, biofeedback, guided imagery, and certain forms of meditation have shown benefit in the treatment of chronic pain associated with interstitial cystitis, fibromyalgia, rheumatoid arthritis, and abdominal pain in children. (18-22)
Depression. For patients over age 65, the slow gentle movements of qigong have improved their biopsychosocial health. (23) Preliminary research suggests acupuncture, music therapy, and massage therapy may possibly benefit persons suffering from depression. (24-26)
diabetes. Programs in Mindfulness-Based Stress Reduction (MBSR), meditation, and biofeedback have been shown to be able to teach individuals with diabetes how to handle stress and health challenges with grace and poise, as well as positively affect the outcomes of their condition. (27-28) Studies with guided imagery and diabetes indicate improved dietary management. In one study, patients showed improvement in blood testing, regular exercise habits, weight management, and maintenance of a restricted lifetime diet. (29)
Heart disease. A mind-body approach has shown benefit in cardiac rehabilitation programs. From 1997 to 2005, 637 men and women with coronary artery disease were included in a 3-month intervention program that included smoking cessation, moderate aerobic exercise, nutritional counseling, relaxation response training, and cognitive/behavioral skills. At the end of three months, both sexes had improvements in blood pressure, exercise conditioning, lipid levels, anxiety, depression, and hostility, as well as less frequent symptoms of chest pain and shortness of breath. Patients who were in the "higher risk" category for cardiac events moved to a lower category; while younger and female patients showed even greater improvements than older and male patients. (30)
A famous example of a major program that includes mind-body skills instruction is the Dean Ornish Program for Reversing Heart Disease, developed by the Preventive Medicine Research Institute, and now available at various hospital centers. The Ornish program has three main components:
1. A very low-Fat high fiber plant-based (vegetarian) nutrition plan with less than 10% of calories from fat.
2. Improved physical and aerobic conditioning through light, low-impact exercise, such as a minimum of 30 minutes of walking per day.
3. Stress management through relaxation techniques such as yoga or meditation.
According to Dr. Ornish, all three components are equally important and best outcomes occur with use of all of the components of the program. (31)
high blood pressure. The deep breathing and gentle stretches of yoga have been shown to reduce blood pressure while numerous studies indicate tai chi benefits essential hypertension. (32-34) Mindfulness Based Stress Reduction (MBSR), meditation, and biofeedback each teach patients to lower their blood pressure during practice and demonstrate effects lasting beyond the practice session. (35-38) Eurhythmy therapy (EYT) is a mind-body oriented therapy that can lead to long-term alleviation of chronic disease symptoms and improve quality of life. In a study of 20 healthy individuals, heart rate variability (HRV) was measured before, during, and after EYT exercises. Individuals experienced improved relaxation during rest after therapy. These results suggest EYT may benefit heart rate variability—a measure of heart and overall health. (39)
Hypothyroidism. Mind-body training may benefit the management of hypothyroidism, a condition where the thyroid gland produces too little thyroid Hormone. In a 2009 Australian study, two case studies were presented where the mind-body neuro-emotional technique (NET) was implemented for the management of hypothyroidism. In both case studies, patients showed improved levels of thyroid stimulating hormone (TSH) and thyroxin (T4), both of which returned to normal. Patients also reported improvements in feelings of tiredness and general well-being. (40)
Irritable Bowel Syndrome (IBS). Study results on the effectiveness of acupuncture on IBS are mixed. However, the National Institutes of Health recommend acupuncture as a safe effective treatment for improving muscle spasms and bowel function in patients with IBS. (41) More studies are needed before other mind-body techniques such as massage, meditation, and reflexology can be recommended for IBS.
Memory Loss/Impairment. Studies indicate yoga may improve memory and problem-solving skills while preliminary studies suggest acupuncture may improve memory function and recovery. (42-45)
menopause. Deep breathing/progressive relaxation may be a helpful mind-body therapy in dealing with hot flashes without medications and supplements. In one study, individuals experienced a 60% reduction in hot flash frequency after six months of training in progressive muscle relaxation. (46) A pilot study of 15 women reporting a minimum of seven severe to moderate hot flashes per day found that Mindfulness Based Stress Reduction (MBSR) helped decrease the severity of hot flashes by 40% over an 11-week period. (47)
Migraines. In a pilot study of 26 patients suffering from either chronic daily headaches or migraines, intervention with acupuncture reduced the severity and frequency of their headaches. The improvements continued for at least 12 weeks after the last acupuncture treatment. (48) Studies also indicate biofeedback reduced migraine frequency as well as the anxiety and depression associated with migraines. Improvements were observed to be maintained fourteen months after treatments. (49)
Parkinson's Disease. The term "Placebo effect" was coined during World War II by Dr. Henry Beecher when he discovered that most of the wounded soldiers' pain could be controlled by saline injections. His subsequent research showed that up to 35 percent of a therapeutic response to any medical treatment could be the result of belief. (50) Today, positron emission tomography (PET) scanning is providing evidence of the release of dopamine in the brain of individuals with Parkinson's disease in response to the placebo effect. This result suggests response to placebo involves dopamine secretion and indicates mind-body strategies could be used to treat Parkinson's disease in lieu of or in addition to dopamine-releasing drugs. (51)
Surgery Strategies. Mind-body techniques such as guided imagery, hypnosis, and music have been shown to reduce the use of pain medications after surgery. (52-54) Guided imagery is helpful for patients preparing for and recovering from surgery. A 1996 study at the Cleveland Clinic showed that patients who used guided imagery prior to colorectal surgery had less anxiety before and less pain after the surgery than did the control group. The members of the guided imagery group used 37% less pain medication, regained their bowel function sooner, and were released from the hospital an average of a day and a half earlier. (55)
Weight Management. Meditation and Mindfulness Based Stress Reduction (MBSR) have been shown to reduce stress and increase the ability to control impulses and routine reactions. In conjunction with diet and exercise, acupuncture, hypnosis, and cognitive-behavioral therapy may also benefit weight management. (56-57)
While additional research is needed to clarify the relative efficacy of different mind-body therapies and to determine factors, such as specific patient characteristics that might predict more or less successful outcomes, it is clear that mind-body skills can help people take an active role in their own wellness and well being.
How To Choose a Practitioner
Many of the therapies now termed "mind-body skills" were originally developed by licensed health-care practitioners or traditional healers or were taught as specialized courses to groups of health-seeking patients. As the value of these methods has gradually been recognized, many short courses, workshops, and programs have been designed to "train more trainers" to offer these services to the public. Each program has its own standards for its graduates, but most involve a standardized "teacher" or "facilitator" training that typically includes a supervised practicum or "student-teaching" component. This allows the graduates to offer a basic, uniform content and quality experience to future students.
The following offer excellent credentialing programs for instructors, as well as workshops for individuals seeking therapy:
The Mind/Body Medical Institute (M/BMI). Incorporated in 1988, the Institute (located in Chestnut Hill, MA) evolved from more than three decades of work in the field of mind-body medicine by Herbert Benson, M.D. and his colleagues at Harvard Medical School. Their research led to the definition of the "relaxation response", which has been found to be an effective therapy for a wide range of ailments. Today the Mind/Body Medical Institute brings relaxation response-based programs to classroom teachers and students, the corporate sector, and the general public. It also trains medical students, postdoctoral fellows, and other researchers in mind-body interactions. Call (866) 509-0732.
The Center for Mind-Body Medicine. Founded and directed by James S. Gordon, M.D., who has devoted more than 30 years to mind-body medicine, the center (in Washington, D.C.) offers a certification program in Mind-Body-Spirit Medicine for professionals in medicine, psychology, social work, nursing, and other healing professions. Graduates have applied this training to their work with patients and clients, and to the establishment of mind-body programs in private practice, in hospitals, cancer centers, educational settings, and academic medical centers throughout North America and the world. Call (202) 966-7338.
The Center for Mindfulness in Medicine, Health Care, and Society (CFM). An outgrowth of the Stress Reduction and Relaxation Program, founded by Jon Kabat-Zinn, Ph.D. in 1979, the Center, which is part of the University of Massachusetts Medical School in Worcester, MA, offers a comprehensive Teacher Certification Program in Mindfulness-Based Stress Reduction (MBSR). The CFM is the oldest and largest academic medical center-based stress reduction program in the country. Call (510)-981-1710.
The Middendorf Breath Institute. Dedicated to furthering the work of Professor Ilse Middendorf, who founded the Institute for the Perceptible Breath (now called the Experience of Breath) in Berlin in 1965, the Institute (located in Berkeley, CA) certifies practitioners in Middendorf Breathwork, an artistic form of breathing education. The three-year training program is designed for professionals working in the somatic, psychological, artistic, or educational fields, or for persons who want to further their own growth. Call (510) 981-1710.
Peggy Huddleston Prepare for Surgery, Heal Faster Workshop. Peggy Huddleston, an educator and psychotherapist from Cambridge, MA, offers two-day training and certification workshops for health-care professionals working with patients facing surgery and chemotherapy. Research shows that her method of preparing for surgery helps people to feel peaceful before surgery, use less pain medication, and heal faster. Call (617) 497-9431.
To find a qualified mind-body skills instructor, ask a trusted personal health-care advisor or contact a nearby hospital, integrative health and wellness center, or pain clinic. You can also call one of the organizations mentioned above.
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29. Wichowski HC, Kubsch SM. Increasing diabetic self-care through guided imagery. Complement Ther Nurs Midwifery. 1999 Dec;5(6):159-63.
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Evidence Based Rating Scale
The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.
Anxiety and Panic
Meditation may reduce anxiety caused by conditions such as cancer, heart disease, and psychiatric illness while cognitive behavioral therapies may improve the efficacy of conventional treatments. (7-11)
|Attention Deficit Hyperactivity Disorder (ADHD)
A review of several large-scale studies indicates efficacy for neurofeedback. (13)
A number of mind-body techniques have shown benefit including acupuncture, chiropractic, and massage. (14-16)
Techniques including guided imagery, music therapy, meditation, and self-hypnosis have been shown to decrease pain and anxiety associated with cancer. (17)
Studies show qigong improves biopsychosocial health in patients over 65; preliminary studies suggest acupuncture, music therapy, and massage therapy may possibly benefit persons suffering from depression (23-26)
MBSR and meditation may help reduce stress and thereby reduce hormonal cycles that lead to impaired glucose metabolism. (28)
Studies indicate mind-body skills improved blood pressure, exercise conditioning, lipid levels, anxiety, depression, and hostility in patients with coronary artery disease. (30-31)
|High Blood Pressure
Numerous studies indicate yoga, tai chi, MBSR, meditation, and biofeedback lower blood pressure. (32-38)
In two case studies, mind-body techniques increased thyroid hormone levels and reduced feelings of tiredness; large studies needed (40)
|Irritable Bowel Syndrome (IBS),
Acupuncture is recommended by NIH for IBS; more studies are needed before other mind-body techniques such as massage, meditation, and reflexology can be recommended for IBS. (41)
Small studies suggest yoga may improve memory and problem-solving skills while preliminary studies suggest acupuncture may improve memory function and recovery (42-45)
Small studies indicate relaxation and MBSR significantly reduced hot flashes (46-47)
Small studies indicate acupuncture and biofeedback reduced severity and frequency of headaches; larger studies needed. (48-49)
Preliminary studies suggest placebo effect releases dopamine indicating mind-body strategies may be useful in lieu of or in addition to stimulant drugs. (50-51)
Small studies indicate mind-body training lowered stress and increased positive effects. (6)
Studies indicate guided imagery, hypnosis, and music have been shown to reduce the use of pain medications after surgery. (52-55)
Small studies suggest acupuncture and hypnosis in combination with diet and exercise may benefit weight management. (56)