by the US National Institutes of Health
Most traditional medical systems make use of the interconnectedness of mind and body and the power of each to affect the other. During the past 30 years there has been a growing scientific movement to explore the mind's capacity to affect the body. The clinical aspect of this enterprise is called mindbody medicine. Mind and body are so integrally related that it makes little sense to refer to therapies as having impact just on the mind or the body.
Mindbody interventions often help patients experience and express their illness in new, clearer ways. Distinctions between curing and healing have little place in contemporary medical practice but are important to patients. Perceived meaning has direct consequences to health. The placebo response is one of the most widely known examples of mindbody interactions in contemporary, scientific medicine, yet it is also one of the most undervalued, neglected assets in medical practice. That the placebo response relies heavily on the relationship between doctor and patient says a great deal about the importance of the doctor patient relationship and the need to provide further medical training on understanding and using this relationship. The therapeutic potential of spirituality, as well as religion, also has been neglected in the teaching and practice of medicine.
Interest in the mind's role in the cause and course of cancer has been substantially stimulated by the discovery of the complex interactions between the mind and the neurological and immune systems, the subject of the rapidly expanding discipline of psychoneuroimmunology. The profound differences in the psychological stances taken by people who survive cancer suggest that there is extreme variation both among cultures and within cultures.
Specific mindbody interventions include psychotherapy, support groups, meditation, imagery, hypnosis, biofeedback, yoga, dance therapy, music therapy, art therapy, and prayer and mental healing.
Psychotherapy directly addresses a person's emotional and mental health, which is, in turn, closely interwoven with his or her physical health. It encompasses a wide range of specific treatments from combining medication with discussion, to simply listening to the concerns of a patient, to using more active behavioral and emotive approaches. It also should be understood more generally as the matrix of interaction in which all the helping professions operate. Conventional psychotherapy is conducted primarily by means of psychologic methods such as suggestion, persuasion, psychoanalysis, and reeducation. It can be divided into general categories. All of the therapies can be undertaken either individually or in groups.
Research indicates that psychotherapeutic treatment can hasten a recovery from a medical crisis and is in some cases the best treatment for it. Psychotherapy also appears to be valuable in the treatment of somatic illnesses in which physical symptoms appear to have no medical cause. These symptoms are often improved markedly with psychotherapy. In addition, psychotherapy has been shown to speed patients’ recovery time from illness. This, in turn, leads to smaller medical bills and fewer return visits to medical practitioners.
Support groups, as the research literature demonstrates, can have a powerful positive effect in a wide variety of physical illnesses, from heart disease to cancer, from asthma to strokes. Indeed, one study found that women with breast cancer who took part in a support group lived an average of 18 months longer (a doubling of the survival time following diagnosis) than those who did not participate. In addition, all the long-term survivors belonged to the therapy group.
Support groups have two other major benefits: they help members form bonds with each other, an experience that may empower the rest of their lives; and they are low cost or even "no cost" (for example, Alcoholics Anonymous).
Mediation is a self directed practice for relaxing the body and calming the mind. Most meditative techniques have come to the West from Eastern religious practices, particularly India, China, and Japan, but can be found in all cultures of the world. Until recently, the primary purpose of meditation has been religious, although its health benefits have long been recognized. During the past 15 years, it has been explored as a way of reducing stress on both mind and body. It is often recommend it as a way of reducing high blood pressure.
Some studies have found that regular meditation can reduce healthcare use; increases longevity and quality of life; reduces chronic pain; reduces anxiety; reduces high blood pressure; reduces serum cholesterol level; reduces substance abuse; increases intelligence related measures; reduces post traumatic stress syndrome in Vietnam veterans; reduces blood pressure; and lowers blood cortisol levels initially brought on by stress.
Imagery is both a mental process (as in imagining) and a wide variety of procedures used in therapy to encourage changes in attitudes, behavior, or physiological reactions. As a mental process, it is often defined as "any thought representing a sensory quality." It includes, as well as the visual, all the senses — aural, tactile, olfactory, proprioceptive, and kinesthetic.
Imagery has been successfully tested as a strategy for alleviating nausea and vomiting associated with chemotherapy in cancer patients, to relieve stress, and to facilitate weight gain in cancer patients. It has been successfully used and tested for pain control in a variety of settings; as adjunctive therapy for several diseases, including diabetes; and with geriatric patients to enhance immunity.
Imagery is usually combined with other behavioral approaches. It is best known in the treatment of cancer as a means to help patients mobilize their immune systems, but it also is used as part of a multidisciplinary approach to cardiac rehabilitation and in many settings that specialize in treating chronic pain.
Hypnosis and hypnotic suggestion have been a part of healing from ancient times. The induction of trance states and the use of therapeutic suggestion were a central feature of the early Greek healing temples, and variations of these techniques were practiced throughout the ancient world.
Modern hypnosis began in the eighteenth century with Franz Anton Mesmer, who used what he called "magnetic healing" to treat a variety of psychological and psychophysiological disorders, such as hysterical blindness, paralysis, headaches, and joint pains. Since then, the fortunes of hypnosis have ebbed and flowed. Freud, at first, found it extremely effective in treating hysteria and then, troubled by the sudden emergence of powerful emotions in his patients and his own difficulty with its use, abandoned it.
In the past 50 years, however, hypnosis has experienced a resurgence, first with physicians and dentists and more recently with psychologists and other mental health professionals. Today, it is widely used for addictions, such as smoking and drug use, for pain controls, and for phobias, such as the fear of flying.
One of the most dramatic uses of hypnosis is the treatment of congenital ichthyosis (fish skin disease), a genetic skin disorder that covers the surface of the skin with grotesque hard, wartlike, layered crust. Hypnosis is, however, most frequently used in more common ailments, either independently or in concert with other treatment, including the management of pain in a variety of settings, reduction of bleeding in hemophiliacs, stabilization of blood sugar in diabetics, reduction in severity of attacks of hay fever and asthma, increased breast size, the cure of warts, the production of skin blisters and bruises, and control of reaction to allergies such as poison ivy and certain foods.
Biofeedback is a treatment method that uses monitoring instruments to feed back to patients physiological information of which they are normally unaware. By watching the monitoring device, patients can learn, by trial and error, to adjust their thinking and other mental processes in order to control bodily processes heretofore thought to be involuntary suchch as blood pressure, temperature, gastrointestinal functioning, and brain wave activity.
Biofeedback is used to treat a very wide variety of conditions and diseases, ranging from stress, alcohol and other addictions, sleep disorders, epilepsy, respiratory problems, and fecal and urinary incontinence to muscle spasms, partial paralysis, or muscle dysfunction caused by injury, migraine headaches, hypertension, and a variety of vascular disorders. More applications are being developed yearly.
Yoga is a way of life that includes ethical precepts, dietary prescriptions, and physical exercise. Its practitioners have long known that their discipline has the capacity to alter mental and bodily responses normally thought to be far beyond a person's ability to modulate them. During the past 80 years, health professionals in India and the West have begun to investigate the therapeutic potential of yoga. To date, thousands of research studies have been undertaken and have shown that with the practice of yoga a person can, indeed, learn to control such physiologic parameters as blood pressure, heart rate, respiratory function, metabolic rate, skin resistance, brain waves, body temperature, and many other bodily functions.
Regular yogic meditation also has been shown to reduce anxiety levels; cause the heart to work more efficiently and decrease respiratory rate; lower blood pressure and alter brain waves; increase communication between the right and left brain; reduce cholesterol levels (when used with diet and exercise); help people stop smoking; and successfully treat arthritis.
Dance therapy began formally in the United States in 1942, and in 1956 dance therapists from across the country founded the American Dance Therapy Association, which has now grown to over 1,100 members. It publishes a journal, the American Journal of Dance Therapy, fosters research, monitors standards for professional practice, and develops guidelines for graduate education.
Dance/movement therapy has been demonstrated to be clinically effective in the following: developing body image, improving self concept and increasing self esteem; facilitating attention; ameliorating depression, decreasing fears and anxieties, expressing anger; decreasing isolation, increasing communication skills and fostering solidarity; decreasing bodily tension, reducing chronic pain, and enhancing circulatory and respiratory functions; reducing suicidal ideas, increasing feelings of well-being, and promoting healing; and increasing verbalization.
Music therapy is used in psychiatric hospitals, rehabilitation facilities, general hospitals, outpatient clinics, daycare treatment centers, residences for people with developmental disabilities, community mental health centers, drug and alcohol programs, senior centers, nursing homes, hospice programs, correctional facilities, halfway houses, schools, and private practice.
Studies have found music therapy effective as an analgesic, as a relaxant and anxiety reducer for infants and children, and as an adjunctive treatment with burn patients, cancer patients, cerebral palsy patients, and stroke, brain injury, or Parkinson’s disease patients.
Art therapy is a means for the patient to reconcile emotional conflicts, foster self awareness, and express unspoken and frequently unconscious concerns about his/her disease. In addition to its use in treatment, it can be used to assess individuals, couples, families, and groups. It is particularly valuable with children who often cannot talk about their real concerns.
Research on art therapy has been conducted in clinical, educational, physiological, forensic, and sociological arenas. Studies on art therapy have been conducted in many areas including with burn recovery in adolescent and young patients, with eating disorders; with emotional impairment in young children, with reading performance, with chemical addiction, and with sexual abuse in adolescents.
Prayer and Mental Healing
Prayer and mental healing techniques fall into two main types. In Type I healing,
the healer enters a prayerful, altered state of consciousness in which he views himself and the patient as a single entity. There need be no physical contact and there is no attempt to "do anything" or "give something" to the person in need, only the desire to unite and "become one" with him or her and with the Universe, God, or Cosmos. Type II healers, on the other hand, do touch the healee and describe some "flow of energy" through their hands to the patient's areas of pathology. Feelings of heat are common in both healer and healee. These healing techniques are offered only as generalities. Some healers use both methodologies, even in the same healing session, and other healing methods could be described.
Many published reports exist, of experiments in which persons apparently were able to influence a variety of cellular and other biological systems through mental means. The target systems for these investigations have included bacteria, yeast, fungi, mobile algae, plants, protozoa, larvae, insects, chicks, mice, rats, gerbils, cats, and dogs, as well as cellular preparations (blood cells, neurons, cancer cells) and enzyme activities. In human "target persons," eye movements, muscular movements, electrodermal activity, plethysmographic activity, respiration, and brain rhythms have been apparently affected through direct mental influence.
These studies assess the ability of humans to affect physiological functions of a variety of living systems at a distance, including studies where the "receiver" or "target" is unaware that such an effort is being made. The fact that these studies commonly involve nonhuman targets is important; lower organisms are presumably not subject to suggestion and placebo effects, a frequent criticism when human subjects are involved.
Many of these studies do not describe the psychological strategy of the influencer as actual "prayer," in which one directs entreaties to a Supreme Being, a Universal Power, or God. But almost all of them involve a state of prayerfulness — a feeling of genuine caring, compassion, love, or empathy with the target system, or a feeling that the influencer is "one" with the target.
In addition to preventing or curing illnesses, these therapies by and large provide people the chance to be involved in their own care, to make vital decisions about their own health, to be touched emotionally, and to be changed psychologically in the process. Many patients today believe their doctor or medical system is too technical, impersonal, remote, and uncaring. The mindbody approach is potentially a corrective to this tendency, a reminder of the importance of human connection that opens up the power of patients acting on their own behalf.
More work needs to be done, but there is already a growing amount of evidence that many of the mindbody therapies discussed in this report, if appropriately selected and wisely applied, can be clinically as well as economicallycosteffectivee, that they work, and that they are safe.
Adapted from Alternative Medicine: Expanding Medical Horizons, a report prepared under the auspices of the Workshop on Alternative Medicine, held in Chantilly VA on September 1416, 1992.
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