Mind-Body Medicine Starters

1. Mind-Body Medicine Starters Jessica Valentine December 6, 2011

2. Goals • Be comfortable implementing brief mind-body interventions in an office visit

3. Plan • Brief review of mind-body methods • Physiology • Mind-body medicine in medical conditions • Practice! • Resources

4. Take Home Points • With a few tools, it’s easy to offer patients an effective method to manage their symptoms • It’s a great bridge to therapy and/or medication • There is a lot of research to support • Only good side effects • You can do it.

5. Lets jump in….Technique #1: Belly breathing • As you inhale through your nose, let your belly expand • As you exhale through your mouth, consciously draw your belly inward as flat as possible, exhaling as much as possible • Repeat

6. POP-QUIZ: • What is meant by mind-body connection? • What are some examples of mind-body techniques/therapies?

7. Mind-Body Connection • What is the mind-body connection? • The mind and body are essentially inseparable – via the brain, peripheral nervous system, hormones, and immune system the mind influences the physical body • Our thoughts, feelings, beliefs, and attitudes can positively or negatively affect our biological functioning. From: http://takingcharge.csh.umn.edu/explore-healing-practices/what-are-mind-body-therapies

8. Mind-body connection • What are mind-body techniques/therapies? • Techniques designed to enhance the mind’s positive impact on the body. • U.S. National Center for Complementary and Alternative Medicine (NCCAM) classification that covers a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms

9. Examples • Relaxation training • methods used to reduce sympathetic muscle arousal and muscle tone • Ex: Progressive muscle relaxation • Meditation • Intentional self-regulation of attention to inner and outer experiences • Ex: Mindfulness meditation • Guided Imagery • Use of inner images and symbols with therapies to induce a specific state (such as calmness)

10. examples • Cognitive Behavioral Therapy • A method of replacing inner thoughts and dialogue that may be irrational or that contribute to distress (e.g., depression, anxiety, pain) with a revised, healthier script and frame of reference • Biofeedback • A system of externally generated signals that measure some aspect of physiology (e.g., thermal biofeedback, muscle tension biofeedback, galvanic skin response to sweating) • Hypnosis • The use of aroused, attentive, focused concentration and relative suspension of peripheral awareness to create opportunities for suggestion • Psychoeducational (we do already!) • Combined with other biobehavioral strategies, these methods help patients become more informed about their disease and how to manage it with improved self-efficacy

11. examples • Movement • Qi Gong • Tai Chi • Yoga

12. Technique #2: Relaxation response • Dr. Herbert Benson - 1970s • Found to reverse stress response • Written for patients to easily do on their own

13. physiology

14. Physiology • Increases parasympathetic nervous system/reduces sympathetic nervous system • Wallace & Benson: • Reduced O2 consumption, CO2 elimination, rate and volume of respiration • Decreased blood lactate level • Slowed heartbeat • Increased skin resistance • EEG with slow alpha waves with occasional theta waves

15. Physiology

16. Physiology

17. Physiology • 5 days mindfulness x 20min • Mindfulness group with: • Increased skin conduction • Increased heart rate variability • All markers of increased parasympathetic activity Tang et al. Central and autonomic nervous system interaction is altered by short-term meditation. Proc NatlAcadSci U S A. 2009 Jun 2;106(22):8865-70. Epub 2009 May 18.

18. Physiology • Over a period of months: • Decreased cortisoland catecholamine levels • Different gene expression

19. Technique #3 • Progressive Muscle Relaxation

20. Medical applications

21. depression • Relaxation techniques and depression • Cochrane MetaAnalysis • Relaxation treatment showed improved self-reported depression scores compared to wait list (but non-significant difference in clinician rated depression) • Scores improved more with CBT (but again no difference in clinician scores

22. Dysthymia • Mind Body Group training, Education, Diet/Exercise Training • Improved Becks Depression Score that was sustained • Baseline: 24.8 • At 12 weeks (end of intervention): 11.5 • Four week follow-up: 16.5 • Three month follow-up: 14.5 • Manicavsgaret al. Mindfulness-based cognitive therapy vs cognitive behaviour therapy as a treatment for non-melancholic depression. J Affect Disord. 2011 Apr;130(1-2):138-44. Epub 2010 Nov 20.

23. GAD • Good evidence that relaxation training and meditation improve anxiety • Works as both a long term and short term • Helps with a variety of types of anxiety Manzoni et al. Relaxation training for anxiety: a ten-years systematic review with meta-analysis.BMC Psychiatry. 2008 Jun 2;8:41.

24. Technique #4: Slow breathing • For use at onset of anxiety/panic attacks

25. Chronic insomnia • PET scans show increased glucose metabolism in the brain in insomnia • Glucose metabolismdecreased with relaxation techniques.

26. Headaches • Migraine Headache • AHRQ meta-anaylsis: Behavioral techniques reduced migraine symptoms by 32-49% vs no treatment • Relaxation, biofeedback, CBT, stress management training • Meta-analysis: Similar decrease in number of headaches with B-blockers, CCB, and relaxation training • Kids: relaxation and biofeedback the best

27. Migraine Headaches • Level A Evidence(consistent good quality patient oriented evidence) • CBT • Combined progressive relaxation and biofeedback • Biofeedback • Relaxation training • Level B (inconsistent or limited quality patient oriented evidence) • Behavioral therapy with prophylactic drug therapy

28. Headaches • Tension Headaches • Meta-analysis • Behavioral treatments (biofeedback, relaxation training, CBT, stress management training) showed 37-50% reduction of symptoms vs 2-9% in control groups. • Level A Evidence: • Relaxation training in children and adolescents • CBT in children and adolescents • Level B Evidence: • Stress management training • Progressive Muscle relaxation • Biofeedback • CBT

29. Chronic Pain Effectiveness of an Online Mind-Body Intervention for Older Adults with Chronic pain • Six weeks, six online modules: abdominal breathing, relaxation, writing about positive experiences, writing about difficult experiences, creative visual expression, positive thinking • Improved pain scores, depression, anxiety

30. Physiology of meditation Subjects had 4 meditation sessions (20min each) Pain intensity ratings before and after meditation training compared to controls.

31. Other applications • Pain in kids? • C-section prevention? • Greater volume of breastmilk expression? • Increased pregnancy rates in IVF

32. Other Applications • Qi-gong mind-body therapy and diabetes control a randomized controlled trial. • 12w Qi-Gong vs. standard medical treatment. • Qi-Gong group had improved A1c, other glucose parameters, decreased wt, decreased waist circumference • Complementary use of tai chi chi augments escitalopram treatment of geriatric depression: a randomized controlled trial. • 4 weeks of ecitalopram • Partial responders randomized to 2 hours Tai Chi vs 2 hours health education per week • Tai Chi group had significant improvement in depression, cognitive functioning, and CRP levels

33. Technique #5 • Vacation spot

34. Technque #6 • Gratitude Practice

35. Technique #7 • Mindfulness Scripted Meditation

36. Technique #8 • Loving Kindness Meditation

37. Resources to share

38. resources • Swedish Physical Therapy Department • Mindfulness Based Stress Reduction • Biofeedback • Headache Management • Back on Track Class

40. Resources • The Pain Puzzle • Swedish Outpatient Therapy • 2 session class • Teaches patients about types of pain, how stress modulates perception of pain • Similar classes shown to decrease perception of pain

41. Resources • Swedish Family Medicine Cherry Hill • Mind/Body group led by Dr. Sethi • Monday afternoons • Call for cost/availability info

42. Seattle Children’s • Biofeedback • Headaches • Abdominal Pain • Vomiting • Raynauds

43. Classes • Yoga Classes • Samalya Center • YMCA • Most studios occasionally have free classes • Online, Goodwill Videos, etc • Tai Chi Classes • Qi Gong

44. Resources - Bibliotherapy

45. Resources - Bibliotherapy

46. Resources - Bibliotherapy

47. Resources - Bibliotherapy

48. Resources - Bibliotherpay

49. Resources • Online • Gratitude Meditation • http://www.secretsofmeditation.com/blog/guided/gratitude-meditation/ • 6 min • Progressive Muscle Relaxation: Anxiety and Stress Reduction Center of Seattle • http://asrcseattle.com/asrcdownloads.html • Nice to use during a clinic visit while you step out • 18 minutes

50. Resources - Audio • Online: • www.learningmeditation.com • Many 3-8 minute guided meditations • Quick Getaway • Stress Reduction • Free PodCasts • Meditation Oasis: 20-30 min Guided Meditations. • Other: • Many free podcasts, itunes downloads, CDs at the library and at used bookstores