Mind-Body Medicine – Mind–Body Approaches
There are four main mind-body approaches in Western medicine: meditation and relaxation, guided imagery, clinical biofeedback and hypnosis. In addition, there are a number of other therapies recommended throughout the ailment section of this website. Some therapies overlap. Relaxation and stress-management techniques, in particular, are essential components of all of the therapies. Physiological benefits of relaxing include:
• Decreased levels of adrenaline, sugar and cholesterol in the blood.
• Reduced blood pressure and less stress on the cardiovascular system.
• Slower breathing with improved lung function and metabolic rate.
• Relaxed muscles, which contain less lactic acid.
• Improved digestion.
• Skin cools down with less activity from the sweat glands.
Meditation and relaxation
Meditation is a long-standing feature of various spiritual and religious traditions. In the secular context, it is a self¬directed practice that quietens the mind and relaxes the body, bringing benefits for health and a sense of well-being. The heightened awareness and inner peace that meditation brings can combat stress and anxiety, relieve headaches and fatigue, and help people to cope with long-term pain.
During the 1960s, reports reached the West about yogis and practitioners of meditation in India and elsewhere who were able to achieve an extraordinary degree of control over supposedly involuntary bodily functions such as breathing, pulse rates and blood pressure. Studies by myself and my colleagues at medical research centres, including Harvard Medical School, UCLA, Menninger Foundation and the University of California School of Medicine in San Francisco, substantiated the reports of these remarkable abilities of self-regulation.
While there are major philosophical differences under¬pinning the hundreds of forms of meditation, at a biological level they have very similar effects on human biochemistry and on the nervous and immune systems.
The benefits that research has discovered are based mainly on studies into transcendental meditation, but they can be attributed equally to other types of meditative practice.
One of the most prominent meditation movements in the US in the 1960s was Transcendental Meditation (TM), developed by the Maharashi Mahesh Yogi and popularised by the Beatles. This practice consists of sitting and silently repeating a mantra (a word or a sound) twice a day for 20 minutes, for the stated purpose of achieving “restful alertness” and a state of “unifying capacity”.
Studies by Professor Herbert Benson (of the Mind/Body Medical Institute of Harvard Medical School in the US) and others in the late 1960s showed that TM brings about a healthy state of relaxation. An individual in this relaxed state exhibits a decreased responsiveness of the autonomic nervous system, a reduced heart and respiration rate, a decreased output of cortisol released by the adrenal glands and an increased occurrence of alpha waves, the brainwave frequency associated with a relaxed state. Eventually,
Benson developed a generic relaxation method which he termed the “relaxation response”.
Among the most commonly used and well-documented forms of meditation in clinical research is “mindfulness” meditation. The art of this Buddhist-based practice is to maintain awareness, in the present moment, of the bodily sensations and flow of thoughts but without passing judgment on them. It differs from concentrative meditation, such as TM, which maintains passive attention on a word, a bodily process (such as breathing) or other stimulus.
Imagery is a flow of thoughts the embody sensory qualities. It has been used for millennia in every indigenous culture and country of the world as part of shamanic healing practices. As a mind-body therapy, it enlists an individual’s imagination in evoking one or more of the senses, usually sound, vision, warmth and movement. In modern clinical settings the therapist generally guides the individual’s creation of images. Individuals may also employ imagery on their own without any instruction or supervision from health practitioners. Sometimes spontaneous imagery in sleep or daydreaming episodes can provide profound personal insights and can be the basis for creativity and scientific discoveries.
Imagery is often incorrectly referred to as visualisation, but it can equally entail imagining smell, touch, hearing, taste, proprioception (the unconscious perception of movement and spatial orientation) and motion.
Many mind-body therapies contain a spontaneous and/or a “guided” imagery component. Guided imagery is purely psychological and can occur with or without a physically quiet state. Biofeedback, desensitisation and aversion techniques, hypnosis, autogenic training, gestalt therapy, Jacobson’s progressive relaxation, neurolinguistic programming (NLP) and rational emotive behaviour therapy (REBT) include guided imagery in their approach.
Meditation that involves focusing on a mantra, imagined sound, or object of contemplation also uses imagery, as do relaxation techniques that include sensory instructions. Imagery is also related to hypnosis in that they both elicit similar states of consciousness and have similar uses in practice. In fact, research has discovered that there is a correlation between the ability to imagine and the capacity to enter into an altered or hypnotic state.
Practise the following steps for 10-20 minutes every day (but not within two hours of eating a meal) to help ease tension and relieve stress.
• Find a comfortable position, sit quietly and close your eyes.
• Starting at your feet, relax your muscles. Work your way up your legs, torso, hands, arms, neck, face and head, relaxing the muscles as you go. Keep all the muscles relaxed.
• Inhale through your nose and focus on your breathing. As you exhale, silently say “ONE” in your mind. Continue breathing consciously but naturally for 10-20 minutes. Thoughts will try to distract you – just repeat “ONE” as you exhale and continue your breathing.
• To finish, sit quietly for a few minutes – at first with closed eyes and then with them open.
Imagery for better health
Imagery may be used early on in a therapy session to help the practitioner with diagnosis. A person may be asked to describe his or her condition or problem in sensory terms. Often, the resulting description can provide a basis for the kinds of therapeutic treatments that are chosen and give a significant insight into the person’s subjective experience of their condition. Imagery is also a powerful aid in achieving insight and perspective into a person’s health and in making contact with emotions.
One way of doing this is to use imagery in a receptive mode, in which the person has an imaginary dialogue with an image that represents his or her symptoms or illness, and the image communicates information about the meaning of sensations and symptoms.
Imagery work can also be used by therapists to put patients in touch with an “inner advisor” who helps them to achieve insight into their medical problems.
EXERCISES FOR IMAGERY AND AUTOSUGGESTION
Imagery can help you to relax and deal with pain or other problems by imagining positive images and desired outcomes. Here are some suggestions for images:
• Imagine your symptoms as a slowly melting block of ice.
• Picture the affected part of your body working perfectly.
• To induce serenity, try a “focused daydream”. Imagine walking up a sunlit path alongside a waterfall, or picture a stormy sea that slowly quietens down as you sail into port.
Practise the following up to three times a day:
• Choose an image or desired outcome that you wish to visualise.
• Find a quiet place and either lie down or sit comfortably so that your whole body can relax and you can let your mind go.
• Inhale and exhale slowly through your nose until you relax.You can learn to hypnotise yourself safely and effectively with the following autosuggestion technique. Make sure you are clear about the purpose of the self-hypnosis – for example, to ease your asthma, be less anxious or become more confident – and be prepared to practise it every day.
• Sit or lie in a comfortable position, close your eyes and relax your whole body.
• Concentrate on your chosen image for as long as you can. Focus on every detail. What can you hear? How do you feel?
• Count from ten to zero and imagine yourself walking down a flight of stairs or along a clearly defined woodland path.
• Repeat words that positively summarise what you want to achieve, such as “the pain is getting less”. Alternatively, listen to a recording of the words.
• When you have finished, count from zero to ten as you walk up the flight of stairs or return along the path.
• Rest for a minute with your eyes closed.
In a technique called mental or psychological rehearsal, imagery is used to help the person prepare for medical procedures, such as invasive diagnostics or surgery. The technique can help to relieve pain and anxiety, and prevent side-effects from procedures, such as chemotherapy, which may be aggravated by intense emotional reactions. When imagery is used in this way, the patient is generally guided by a therapist into a relaxed state and then led through a series of images in which the treatment and the recovery process are described in sensory terms, along with the desired outcome.
Patients may be encouraged to create their own system of images involving the healing process, or they may be guided through a series of images to relax, divert their attention or diminish sympathetic nervous system arousal. Preparatory imagery work can help patients to experience less pain following surgery. It can encourage them to relax the muscles around the incision site as well as hasten the return of bowel function and prevent excessive blood loss by redirecting blood flow to other parts of the body. Mental rehearsal imagery also helps patients deal with anxiety-producing diagnostic procedures, such as CAT scans, which can make some people feel claustrophobic because they have to spend time inside a scanner.
Research with mental rehearsal has yielded highly positive and often dramatic results, which include: reduced pain and anxiety, shorter hospital stays, less need for medication and a reduction in the number and intensity of side-effects from treatment. Mental rehearsal is also used regularly to help prepare mothers-to-be for natural childbirth.
Clinical biofeedback is a training technique in which people learn to consciously regulate bodily functions, such as heart rate or blood pressure, that are not normally accessible to voluntary control. It applies to any process that measures and reports back information about the system that the individual is attempting to control, with the goal of improving or eliminating a symptom or illness.
Biofeedback dates back to the late 1930s, when Dr O. Hobart Mowrer invented an alarm that could be triggered by urine as a way to train children to stop bedwetting. In 1961, noted psychologist Dr Neal Miller from Yale University in the US explored the unorthodox hypothesis that responses of the autonomic nervous system, such as heart rate and bowel movement, could be conditioned. He conducted a series of groundbreaking experiments that demonstrated how control of autonomic processes could be learned through biofeedback techniques.
In the early 1960s, Dr Joe Kaniya of the University of California School of Medicine in San Francisco, Dr Barbara Brown at the Veterans Administration Hospital in Sepulveda, California, and Dr Elmer and Dr Alyce Green at the Menninger Foundation, Kansas, used biofeedback devices to monitor and record self-regulatory feats of yogis. It was through these remarkable experiments that biofeedback began to attract wider attention.
Measurements and devices
Most commonly, clinical biofeedback is a feature of several measurements and devices. Electrocardiographs (ECGs), for example, reveal the electrical activity of the heartbeat and echocardiographs provide ultrasound scans of the heart muscle. Electroencephalographs (EEGs) provide feedback on electrical brainwave activity and electromyographs (EMGs) monitor muscle tension via visual or auditory signals. Skin temperature gauges measure the heat generated at the surface of the skin and galvanic skin response (GSR) sensors detect the electrical conductivity of the skin which increases when the skin sweats because of stress.
In a typical biofeedback session, people are wired up to biofeedback devices and then use breathing, muscle relaxation and other techniques to help them relax. The machines transmit signals when this is achieved. In this way, people learn to relax at will and and so achieve their desired outcome, such as reducing blood pressure, relieving headaches and coping with asthma. It takes practice, but soon people can attain a slow but even heartbeat, plenty of alpha brainwaves, low-level muscle activity and a warm skin with little activity in the sweat glands.
With the development of increasingly sophisticated monitoring devices and computerised, multiple-channel instrumentation, new possibilities have been opened up for clinical biofeedback training. For example, sensors can monitor and feed back the activity of the rectal sphincter and the muscles controlling the bladder to help people who are incontinent. Oesophageal motility can be monitored to provide feedback on the muscles of the oesophagus since oesophageal spasms are very painful and can be self¬regulated through hypnosis and/or clinical biofeedback. Other instruments can monitor gastrointestinal functions and stomach acidity.
Hypnosis and hypnotherapy
In the late 18th century, the practice of the power of suggestion was introduced to medicine by the French physician Dr Franz Anton Mesmer under the name of Mesmerism. He attributed the effects of hypnosis to the presence of a universal fluid that produced disease when it was out of balance in the body. After his ideas were discredited, the name was changed to hypnosis (from the Greek word hypnos, meaning sleep). Dr James Esdaile, an English surgeon stationed in India, performed surgery using hypnotic anaesthesia. In the late 19th century, hypnosis became popular when Sigmund Freud used it in his early psychiatric practice.
A hypnotherapist guides an individual from ordinary consciousnesses into a state of focused concentration, in which the individual is highly responsive to suggestion. Hypnotherapy, as the practice of hypnosis has come to be called, was recognised as a valid medical treatment by the
British Medical Association in 1955 and by the American Medical Association in 1958.
Today, the American Society of Clinical Hypnosis (ASCH) is the main professional organisation in the US, with more than 4,000 members who must be licensed health professionals and have achieved a minimum of 20 hours of training in hypnotherapy. There are between 3,000-6,000 other practitioners of hypnotherapy, including nurses, social workers and lay therapists.
In the UK, there are about 300 qualified hypnotherapists registered with the UK Council for Psychotherapy (UKCP), with a larger number registered with other organisations, such as the General Hypnotherapy Register and the National Council for Hypnotherapy (NCH).
Benefits of hypnosis
Physiologically, the hypnotic state, which does not necessarily involve a trance, is similar to other forms of deep relaxation, with reduced sympathetic nervous system activity, decreased blood pressure, slowed heart rate and increased activity of the alpha and theta brainwaves. Compared to guided imagery, self-hypnosis is much more purely physical and can occur without the use of any imagery – guided or otherwise.
Hypnosis has come to be viewed as a way of gaining access to deep levels of the mind in order to bring about changes in behaviour or alterations in psychological states. Hypnotherapy often uses imagery to modify feelings of pain, anxiety and fear, or to introduce suggestions regarding the behaviour required to achieve therapeutic goals. Once out of the hypnotic state, the subject is expected to practise these new behaviours.
How hypnosis works
Doctors, psychotherapists, dentists and other healthcare providers use hypnotherapy to treat a wide variety of medical and psychological problems. Methods of hypnotic induction and specific suggestions and imagery are tailored to meet the needs of the individual client. It can be used as a form of analgesia in surgery, to control allergies, reduce stress and produce changes in behaviour for better health, for example it can help people to quit smoking.
Hypnotherapy can be employed either by itself or in conjunction with other forms of treatment. When used in the treatment of chronic illness, hypnosis can help to alleviate anxiety, decrease the need for medication and make medical procedures more comfortable. In 1989, one study showed that hypnosis could increase pain tolerance by 113 per cent among highly hypnotisable subjects when compared to a control group.
When employed by qualified practitioners (see above), hypnosis is very safe, but it is a powerful technique that must be used with caution. Consequently, individuals who have a history of serious psychiatric problems are not appropriate candidates for hypnotherapy.
Individuals vary greatly in their “hypnotisability” – their susceptibility to hypnosis. According to a 1983 World Health Organisation estimate, 90 per cent of people can be hypnotised and 20-30 per cent are susceptible enough to enter the deep state that makes them ideally responsive to hypnotic suggestion. Most people can learn to hypnotise themselves, either from a book with audio tapes or from a hypnotherapist, with a technique called autosuggestion. You may be able to use this self-hypnosis to relieve pain, boost self-confidence and ease an attack of asthma
Experimental evidence suggests that elderly people are less susceptible to hypnosis, and hence they may not make such good candidates for hypnotherapy as younger subjects. A 1972 study tested susceptibility to hypnosis among different age groups and produced evidence that confirmed hypnotisability decreases with age. Other factors that may influence hypnotisability include a compromised autonomic nervous system, which is also characteristic of some elderly people. Many studies of hypnosis have been based on research with students and other young people, which may mean the results are inapplicable to the elderly.
Other mind-body techniques
As well as the four main approaches described above, a number of other mind-body therapies are suggested on this website. In addition, yoga, t’ai chi and other movement therapies have mind-body components and there is also an overlap between mind-body therapies and psychological techniques.
Autogenic training (AT)
This is a series of six mental exercises that switch off the body’s stress responses and encourage calmness in the mind and relaxation in both involuntary and voluntary muscles. The name is derived from Greek and means “generated from within”. Devised by German neurologist and psychiatrist Dr Johannes Schultz in Berlin in the 1920s, AT is normally taught by a practitioner in eight weekly sessions that last for 90 minutes each. AT can help various ailments, from stress and anxiety to high blood pressure and eczema. The length of treatment does not seem to affect clinical outcome.
In this technique, which is also used in humanistic psychotherapy, a practitioner helps the client to gain self-awareness of habitual thoughts, feelings and actions, and express any thoughts and emotions that may be repressed. The name derives from German and means “organised whole”. Developed by German psychoanalyst Fritz Perls in the 1960s, gestalt therapy sessions are held weekly, either on a one-to-one basis or in groups, and may involve recalling a dream and role playing.
Eye-movement desensitisation and reprocessing (EMDR)
This information-processing therapy is a technique that integrates elements of various psychotherapies, such as cognitive behavioural therapy, psychodynamic therapy, experiential therapy and interpersonal psychotherapy. EMDR was discovered by US psychologist Francine Shapiro in 1987 and has proved useful in treating traumatic disorders, such as PTSD, phobias and anxiety.
During treatment, patients move their eyes from side to side while simultaneously discussing their anxieties with the therapist. The eye movement is thought to help the brain process painful thoughts. Sessions are held on a one- to-one basis and vary according to an individual’s needs.
Jacobson’s progressive relaxation
US physiologist Edmund Jacobson developed his relaxation method in the 1930s. It involves systematically tensing and relaxing every major muscle group in their body.
Neurolinguistic programming (NLP)
Developed in the 1970s by US psychotherapists John Grinder and Richard Bandler, this technique combines cognitive behavioural therapy with elements of humanistic psychotherapy and hypnotherapy. An NLP practitioner helps a person to consciously reprogramme their patterns of speech and body language with the aim of improving their communication skills and bringing about personal change. Sessions may be held weekly on a one-to-one basis and vary according to an individual’s needs.
By using books, brochures, illustrations, videos and/or audio tapes the patient can literally be educated on the specific nature of their condition to give them a sense of greater mastery and control through better understanding. This can be an important method of providing advice and information about a person’s psychological or behavioural problems. Psychoeducation benefits the person and their families so that they are better informed about the kinds of treatment that are required and better prepared for the treatment itself. The technique has proved useful for people with cancer, eating disorders, ADHD and depression.
Rational emotive behaviour therapy (REBT)
This cognitive behavioural technique aims to replace the irrational thinking behind negative emotions with more positive and flexible patterns of thought to help people to attain their goals and objectives. It was developed by US psychoanalyst Albert Ellis in 1955 and is useful for anxiety, stammering, depression and addictions. Generally, REBT sessions lasting up to an hour may take place once a week, with homework assignments designed to help patients learn skills faster.
More correctly known as imagery, visualisation encourages people to imagine positive images and desired outcomes in order to help them change negative attitudes and overcome various ailments, such as stress, pain, anxieties and phobias, and to cope with chronic illnesses, such as cancer.
Summary of Research Evidence
Dr John A. Astin of the Complementary Medicine Program at the California Pacific Medical Center, San Francisco, has conducted one of the best designed overviews of the applications of mind-body medicine. He writes “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”. Astin’s 2002 review underscores the fact that mind-body therapies can be readily integrated into the treatment of many conditions, often combining self-care practice with clinical care.
Moderate to strong evidence
Extensive randomised controlled trials and/or systematic reviews (critical statistical analysis of previously published research) reveal that there is moderate to strong evidence of the clinical efficacy of mind-body therapies for the following 11 conditions: coronary artery disease; high blood pressure; insomnia; general pain syndromes; low back pain; headaches; fibromyalgia; arthritis self-care; living with cancer; incontinence; and recovery from surgery.
Mind-body therapies are at least as good as, if not better than, many common conventional treatments. Given their relative simplicity, low cost and absence of side-effects, the findings are particularly significant.
Most current randomised controlled trials indicate that mind-body therapies are useful for the following conditions: allergies; asthma; chronic obstructive pulmonary disease; dermatological disorders; diabetes; living with HIV; irritable bowel syndrome; peptic ulcers; post-stroke rehabilitation; pregnancy and labour; and tinnitus.
FINDING A PRACTITIONER
Many practitioners work in the field of mind-body medicine so before arranging a consultation make sure they are qualified and registered. Contact the relevant professional organisation for details and lists of practitioners in your area. Some psychologists working within the NHS practise hypnosis – your doctor may be able to refer you. Classes for meditation and other self-help mind-body skills are widely available – check your local listings for details.