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