Qigong for Mental Health

APA Annual Meeting May 19, 2015

Colleen Loehr, M.D.Adjunct Assistant ProfessorDepartment of Psychiatry

University of MissouriSchool of MedicineColumbia, Missouri

Colleen.Loehr@dmh.mo.gov

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What is Qigong?

Qi (chee) means Energy or Breath

Pictograph for Qi depicts a steaming pot of rice

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Qi means energy

Gong (gung as in lung)means skill, work, or cultivation

Qigong meansEnergy Cultivation orBreath Work

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Mayo Clinic Definition of Qigong:

"Qigong (“chee-gung”), or "energy-skill", is an ancient Chinese meditation practice, which combines visualization, breath and posture to restore and maintain a natural state of mind-body vibrancy and balance, regardless of age or health condition.” (continued)

mayoclinichealthsystem.org

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Mayo Clinic Definition of Qigong:

"The practice entails coordinating slow movements with breathing to cultivate the flow of energy, or Qi (chee), in a sort of graceful, fluid dance. It is a form of exercise, but is much less a muscle-based workout and more of a mindful energetic-based practice.”

mayoclinichealthsystem.org

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“Practitioners say that Qigong increases energy and deepens their breathing. It can create a very peaceful feeling. Qigong practice teaches us to go into stillness, which in turn improves concentration and memory. Qigong also facilitates core strength, balances blood pressure and helps the body remove toxins.”

mayoclinichealthsystem.org

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Qigong and Tai Chi

“Tai Chi is related to qigong in the same way that Kleenex is related to tissue: All Kleenex is tissue, but not all tissue is Kleenex. Similarly, all tai chi is qigong, an energy exercise, although not all qigong is tai chi.”

David Dorian Ross, Essentials of Tai Chi and Qigong, The Great Courses, p. 35

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Key Components Common to All Qigong Practices

❖ Mindfulness- cultivating full presence and awareness in the moment is a vital part of all qigong practices.

❖ Positive intention- cultivating a felt sense of harmony with life is a foundation of all qigong practices.

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❖ Greater Body Awareness is a key component of all qigong practices.

“There is more wisdom in your body than in your deepest philosophy.”Friedrich Nietzsche

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Research on Qigong

Scientific Evidence:“Claims of Tai Chi’s health benefits are increasingly evidence-based, with more than 700 peer-reviewed, scientific publications in print and more than 180 randomized trials conducted, to date.”

Peter M. Wayne, Ph.D, The Harvard Medical School Guide to Tai Chi, 2013.

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“Tai Chi and Qigong for the Treatment and Prevention of Mental Disorders”Psychiatr Clin North Am. 2013 Mar; 36(1): 109–119.Ryan Abbott, MD, JD, MTOMa and Helen Lavretsky, MD.

Summary of RCTs of Tai Chi and Qigong for mental disorders:

Depression: 13 studies with significant positive findings.1 study did not find an effect on depressive symptoms.

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RCTs of Tai Chi and Qigong:

Stress: 4 studies with significant positive findings. 1 study did not find effect on subjective stress measures.

Anxiety: 8 studies with significant positive effects. 1 study had negative findings on anxiety.

Ryan Abbott, MD, JD, and Helen Lavretsky, MD.,Tai Chi and Qigong for the Treatment and Prevention of Mental Disorders, Psychiatr Clin North Am. 2013 Mar; 36(1): 109–119.

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RCTs of Tai Chi and Qigong:

Mood and psychological well-being: 7 studies with significant positive effects. 1 study did not find positive effect on mood.

Sleep disturbance: 3 studies with significant positive effects. Negative findings: None reported

Substance abuse: 1 study with significant positive effects. Negative findings: None reported.

Ryan Abbott, MD, JD, and Helen Lavretsky, MD.,Tai Chi and Qigong for the Treatment and Prevention of Mental Disorders, Psychiatr Clin North Am. 2013 Mar; 36(1): 109–119.

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“Tai Chi and Qigong are evidence-based approaches to improve health-related quality of life. Evidence from randomized controlled trials suggests that Tai Chi and Qigong may be effective in reducing depressive symptoms, stress, anxiety, and mood disturbances.”

Ryan Abbott, MD, JD, and Helen Lavretsky, MD.,Tai Chi and Qigong for the Treatment and Prevention of Mental Disorders, Psychiatr Clin North Am. 2013 Mar; 36(1): 109–119.

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A Randomized Controlled Trial of Qigong Exercise on Fatigue Symptoms, Functioning, and Telomerase Activity in Persons with Chronic Fatigue or Chronic Fatigue Syndrome T. H. Ho, Ph.D. et alAnnals of Behavioral MedicineOctober 2012, Volume 44, Issue 2, pp 160-170

64 participants were randomly assigned to either a 4 month qigong intervention group or waitlist control group

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Telomerase activity:

Qigong group: 0.102 (start) to 0.178 (end) arbitrary units (p<0.05).

Control group: 0.089 (start) to 0.104 (end).

The change was statistically significant when compared to the control group (p<0.05).

Ho T. H. , Ph.D. et al

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SAMSHA recommends qigong.

“Yoga, tai chi, and qigong produce beneficial emotional, psychological, and biological effects in controlling mood and anxiety, and in improving overall quality of life.”

www.samhsa.gov

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U.S. Dept of Health and Human Services

National Institute of Health

National Center for Complementary and Integrative Health(NCCIH)recommends qigong.

https://nccih.nih.gov

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Center for Disease Control and Prevention recommends Tai Chi

“Exercise programs such as Tai Chi can increase strength and improve balance, making falls much less likely.”

CDC websitehttp://www.cdc.gov/Features/OlderAmericans/

Image from CDC website

First Lady Michelle Obama practicing qigong in China in May 2014

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Qigong instruction is included at:

❖ The Menninger Clinic❖ Sheppard Pratt Health Center❖ The Cleveland Clinic❖ Memorial Sloan Kettering Cancer Center❖ Stanford School of Medicine❖ University of Maryland School of Medicine❖ Many other psychiatric and medical centers

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Tai Chi is recommended on NAMI website.

www.nami.org

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American College of Sports Medicine recommends qigong.

“Multifaceted physical activities such as tai ji (tai chi), qigong, and yoga involve varying combinations of neuromotor exercise, resistance exercise, and flexibility exercise.”

www.acsm.org

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The British Medical Association endorsed Qigong in 2014.

"Health benefits of regular practice of Qigong include reduced stress and improved stamina and balance."

http://bma.org.uk/

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How do we bring qigong practices into our lives and into the lives of our patients?

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An example of a psychiatrist teaching qigong to patients:

Over a 1-year period, 4 refugee survivors of torture being treated at a Boston area torture treatment center participated in simplified qigong and t'ai chi sessions 10–15 minutes prior to and after 1-hour psychotherapy sessions with a psychiatrist trained in qigong. All reported benefits.

Treating Survivors of Torture and Refugee Trauma: A Preliminary Case Series Using Qigong and T'ai Chi, Michael A. Grodin, M.D., et al, J Altern Complement Med. 2008 Sep; 14(7): 801–806.

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What We Can Tell Our Patients About the Benefits of Qigong:

❖ Safe

❖ Low cost

❖ Evidence-based efficacy

Qigong Practices:

❖ Physical movements such as the Eight Silk Brocade

❖ Meditations such as the Microcosmic Orbit and the Inner Smile

❖ Breathing exercises ❖ Relaxation and effortless action- Wei Wu❖ Visualization and imagery practices

(continued)

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Qigong Practices:

❖ Sound Healing- such as Six Healing Sounds❖ Massage- Tui Na❖ Tapping and Acupressure❖ Shaking❖ Positive Intention- such as Gratitude Practices❖ Tai Chi❖ Cultivating sense of oneness with nature

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“Qigong is more than a set of exercises, it is an attitude that works to restructure one’s perspective in life, leading to balance and harmony with the world around us.”

G. Garripoli, Qigong: Essence of the Healing Dance

Key Qigong Principle:

Blockage Imbalance Illness

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“Freud regarded human psychological states as an energy system in which blockages in the flow of thought (repression or suppression, for example) would result in disease or illness, expressed as mental or emotional loss of balance.”

Source: Encyclopedia of mental disorders

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“Essentially all neurodegenerative diseases are associated with the accumulation of cellular waste products.” Glymphatic system discovered in 2012 is a vast system of tubules in the brain for waste removal.

Maiken Nedergaard, M.D., D.M.Sc., co-director of the University of Rochester Medical Center, Center for Translational Neuromedicine

Qigong Principle:

Cultivate the Capacity to Consciously Direct the Flow of Attention

Yi = Attention + Intention“Qi follows Yi”Energy flows where attention goes.

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“If we bring our awareness to something, we connect to it.” Elisha Goldstein

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Key Qigong Principle:Universal Connection

To see a World in a Grain of Sand,And a Heaven in a Wild Flower,Hold Infinity in the palm of your hand,And Eternity in an hour.

William Blake

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“I think that what we're seeking is an experience of being alive...so that we actually feel the rapture of being alive.”

Joseph Campbell

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Wei Wu

“No matter how hard the surfer is working, the ocean is doing most of the work.”

C. Thomas

Gratitude to my mentors:Patricia Gerbarg M.D. and Richard Brown M.D. http://www.breath-body-mind.com/index.php

Robert Peng, http://www.robertpeng.com/

Dr. Effie Chow, http://eastwestqi.com/

Kim Eng,https://www.eckharttolle.com/about/kim/

Chunyi Lin, http://www.springforestqigong.com/

Mingtong Gu, http://www.chicenter.com/Chi/Home/index.cfm

James Gordon M.D., http://cmbm.org/ 41

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DVD qigong exercises used by permission from Sounds True:

DVD “Qi Gong for Self Healing” by Lee Holden, produced by Sounds True

DVD “Qigong Ecstasy” by Robert Peng, produced by Sounds True

DVDs available at: www.soundstrue.com

Images from Public Domain