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Mind-Body Medicine

by Steven Rosenzweig, MD

Mind-body medicine is based on the theory that mental and emotional factors influence physical health through a system of neuronal, hormonal, and immunologic connections throughout the body. Behavioral, psychologic, social, and spiritual techniques are used to preserve health and to prevent or cure disease.

Because scientific evidence supporting the benefits of mind-body medicine is abundant, many of these approaches are now considered mainstream, although they remain underused. Techniques such as biofeedback, guided imagery, hypnotherapy, meditation, and relaxation are used in the treatment of chronic pain, coronary artery disease, headaches, insomnia, and incontinence and as aids during childbirth. These techniques are also used to help patients cope with disease-related and treatment-related symptoms of cancer and to prepare patients for surgery. Efficacy of mind-body medicine in patients with asthma, hypertension, or tinnitus is not as clear.

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).

Uses

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.

Uses

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.

Uses

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.

Uses

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

  • Reducing activity of the sympathetic nervous system

  • Lowering BP

  • Easing muscle tension

  • Slowing metabolic processes

  • Altering brain wave activity

Relaxation techniques may be used with other techniques, such as meditation, guided imagery, or hypnotherapy.

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