Mind – Body – Medicine

Mind-body medicine focuses on the interactions among the brain, mind, body, and behavior, and the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health.

It regards as fundamental an approach that respects and enhances each person’s capacity for self-knowledge and self-care, and it emphasizes techniques that are grounded in this approach.

Background

The concept that the mind is important in the treatment of illness is integral to the healing approaches of traditional Chinese and Ayurvedic medicine, dating back more than 2,000 years. It was also noted by Hippocrates, who recognized the moral and spiritual aspects of healing, and believed that treatment could occur only with consideration of attitude, environmental influences, and natural remedies (ca. 400 B.C.).

While this integrated approach was maintained in traditional healing systems in the East, developments in the Western world by the 16th and 17th centuries led to a separation of human spiritual or emotional dimensions from the physical body.

This separation began with the redirection of science, during the Renaissance and Enlightenment eras, to the purpose of enhancing humankind’s control over nature. Fixing or curing an illness became a matter of science (i.e., technology) and took precedence over, not a place beside, healing of the soul. As medicine separated the mind and the body, scientists of the mind (neurologists) formulated concepts, such as the unconscious, emotional impulses, and cognitive delusions, that solidified the perception that diseases of the mind were not “real,” that is, not based in physiology and biochemistry.

During World War II, the importance of belief re-entered the web of health care. On the beaches of Anzio, morphine for the wounded soldiers was in short supply, and Henry Beecher, M.D., discovered that much of the pain could be controlled by saline injections. He coined the term “placebo effect,” and his subsequent research showed that up to 35 percent of a therapeutic response to any medical treatment could be the result of belief. Investigation into the placebo effect and debate about it are ongoing.

Since the 1960s, mind-body interactions have become an extensively researched field. The evidence for benefits for certain indications from biofeedback, cognitive-behavioral interventions, and hypnosis is quite good, while there is emerging evidence regarding their physiological effects. Less research supports the use of other complementary & Alternative Medicine approaches, like meditation and yoga. The following is a summary of relevant studies.

Mind-Body Interventions and Disease Outcomes

Mind-body interventions have been applied to various types of pain. Clinical trials indicate that these interventions may be a particularly effective adjunct in the management of arthritis, with reductions in pain maintained for up to 4 years and reductions in the number of physician visits. When applied to more general acute and chronic pain management, headache, and low-back pain, mind-body interventions show some evidence of effects, although results vary based on the patient population and type of intervention studied.

Physiology of Expectancy (Placebo Response)

Placebo effects are believed to be mediated by both cognitive and conditioning mechanisms. Until recently, little was known about the role of these mechanisms in different circumstances. Now, research has shown that placebo responses are mediated by conditioning when unconscious physiological functions such as hormonal secretion are involved, whereas they are mediated by expectation when conscious physiological processes such as pain and motor performance come into play, even though a conditioning procedure is carried out.

Surgical Preparation

Mind-body interventions are being tested to determine whether they can help prepare patients for the stress associated with surgery. Initial randomized controlled trials–in which some patients received audiotapes with mind-body techniques (guided imagery, music, and instructions for improved outcomes) and some patients received control tapes–found that subjects receiving the mind-body intervention recovered more quickly and spent fewer days in the hospital.

Conclusion

Evidence from randomized controlled trials and, in many cases, systematic reviews of the literature, suggest that:

• Mechanisms may exist by which the brain and central nervous system influence immune, endocrine, and autonomic functioning, which is known to have an impact on health.
• Multicomponent mind-body interventions that include some combination of stress management, coping skills training, cognitive-behavioral interventions, and relaxation therapy may be appropriate adjunctive treatments for coronary artery disease and certain pain-related disorders, such as arthritis.
• Multimodal mind-body approaches, such as cognitive-behavioral therapy, particularly when combined with an educational/informational component, can be effective adjuncts in the management of a variety of chronic conditions.
• An array of mind-body therapies (e.g., imagery, hypnosis, relaxation), when employed presurgically, may improve recovery time and reduce pain following surgical procedures.
• Neurochemical and anatomical bases may exist for some of the effects of mind-body approaches.

Mind-body approaches have potential benefits and advantages. In particular, the physical and emotional risks of using these interventions are minimal. Moreover, once tested and standardized, most mind-body interventions can be taught easily. Finally, future research focusing on basic mind-body mechanisms and individual differences in responses is likely to yield new insights that may enhance the effectiveness and individual tailoring of mind-body interventions.

In the meantime, there is considerable evidence that mind-body interventions, even as they are being studied today, have positive effects on psychological functioning and quality of life, and may be particularly helpful for patients coping with chronic illness.