jessica valentine december 6, 2011. be comfortable implementing brief mind- body interventions in an...

MIND-BODY MEDICINE STARTERS

Jessica Valentine

December 6, 2011

GOALS Be comfortable implementing brief

mind-body interventions in an office visit

PLAN Brief review of mind-body methods Physiology Mind-body medicine in medical

conditions Practice! Resources

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.

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

POP-QUIZ: What is meant by mind-body

connection? What are some examples of mind-body

techniques/therapies?

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

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 an

d Alternative Medicine (NCCAM) classification that covers a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms

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)

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

EXAMPLES Movement

Qi GongTai Chi Yoga

TECHNIQUE #2: RELAXATION RESPONSE Dr. Herbert Benson - 1970s Found to reverse stress response Written for patients to easily do on their

own

PHYSIOLOGY

PHYSIOLOGY Increases parasympathetic nervous

system/reduces sympathetic nervous systemWallace & 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

PHYSIOLOGY

PHYSIOLOGY

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 Natl Acad Sci U S A. 2009 Jun 2;106(22):8865-70. Epub 2009 May 18.

PHYSIOLOGY Over a period of months:

Decreased cortisol and catecholamine levels

Different gene expression

TECHNIQUE #3 Progressive Muscle Relaxation

MEDICAL APPLICATIONS

DEPRESSION Relaxation techniques and depression

Cochrane MetaAnalysisRelaxation 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

DYSTHYMIAMind 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

Manicavsgar et 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.

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.

TECHNIQUE #4: SLOW BREATHING For use at onset of anxiety/panic attacks

CHRONIC INSOMNIA PET scans show increased glucose

metabolism in the brain in insomnia Glucose metabolism decreased with

relaxation techniques.

HEADACHES Migraine Headache

AHRQ meta-anaylsis: Behavioral techniques reduced migraine symptoms by 32-49% vs no treatment Relaxation, biofeedback, CBT, stress

management trainingMeta-analysis: Similar decrease in number

of headaches with B-blockers, CCB, and relaxation training

Kids: relaxation and biofeedback the best

MIGRAINE HEADACHES Level A Evidence(consistent good

quality patient oriented evidence)CBTCombined progressive relaxation and

biofeedbackBiofeedbackRelaxation training

Level B (inconsistent or limited quality patient oriented evidence)Behavioral therapy with prophylactic drug

therapy

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

CHRONIC PAINEffectiveness of an Online Mind-Body

Intervention for Older Adults with Chronic painSix 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

PHYSIOLOGY OF MEDITATIONSubjects had 4 meditation sessions (20min each)Pain intensity ratings before and after meditation training compared to controls.

OTHER APPLICATIONS Pain in kids? C-section prevention? Greater volume of breastmilk

expression? Increased pregnancy rates in IVF

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

TECHNIQUE #5 Vacation spot

TECHNQUE #6 Gratitude Practice

TECHNIQUE #7 Mindfulness Scripted Meditation

TECHNIQUE #8 Loving Kindness Meditation

RESOURCES TO SHARE

RESOURCES Swedish Physical Therapy Department

Mindfulness Based Stress ReductionBiofeedbackHeadache ManagementBack on Track Class

RESOURCES The Pain Puzzle

Swedish Outpatient Therapy2 session classTeaches patients about types of pain, how

stress modulates perception of painSimilar classes shown to decrease

perception of pain

RESOURCES Swedish Family Medicine Cherry Hill

Mind/Body group led by Dr. SethiMonday afternoonsCall for cost/availability info

SEATTLE CHILDREN’S Biofeedback

HeadachesAbdominal PainVomitingRaynauds

CLASSES Yoga Classes

Samalya CenterYMCAMost studios occasionally have free classesOnline, Goodwill Videos, etc

Tai Chi Classes Qi Gong

RESOURCES - BIBLIOTHERAPY

RESOURCES - BIBLIOTHERAPY

RESOURCES - BIBLIOTHERAPY

RESOURCES - BIBLIOTHERAPY

RESOURCES - BIBLIOTHERPAY

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

RESOURCES - AUDIO Online:

www.learningmeditation.com Many 3-8 minute guided meditations

Quick Getaway Stress Reduction

Free PodCastsMeditation Oasis: 20-30 min Guided

Meditations. Other:

Many free podcasts, itunes downloads, CDs at the library and at used bookstores

REVIEW THE PLAN Brief review of mind-body methods Physiology Mind-body medicine in medical

conditions Practice! Resources you can give your patients

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.

THANK YOU!