Mind Body Background

Health care interventions which respect the mind and body as an integral whole will represent the future of medicine. By respecting the interaction among the brain, mind, body, and behavior we learn the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health. This has implications not only in the area of self-care and self-knowledge, but also leads to an increased number of techniques that can be available to the allopathic practitioner.

Mind-body medicine typically focuses on strategies such as relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, tai chi, qi gong, cognitive-behavioral therapies, group support, autogenic training, and spirituality.

Mind-body as a concept is not new. It has been used as an integral part of the treatment of illness of Chinese and Ayurvedic medicine, dating back more than 2,000 years. It was also noted that Hippocrates used such techniques around 400 B.C.E. However, even though mind-body concepts were prevalent in the East, developments in the Western world by the 16th and 17th century led to a separation of human spiritual and emotional dimensions from the physical body. During the Renaissance and Enlightenment eras, this led to a redirection of science. As a result, the belief was that as a race we could master (rather than work with) nature. Technological advances (e.g., microscopy, the stethoscope, the blood pressure cuff, and refined surgical techniques) demonstrated a cellular world that seemed far apart from the world of belief and emotion. The discovery of bacteria and later, antibiotics further dispelled the notion of belief influencing health.

During the last century scientists began realizing that the mind-body connection was much more than just beliefs and emotion. In the 1920s, Walter Cannon's work revealed the direct relationship between stress and neuroendocrine responses in animals. Coining the phrase "fight or flight", Cannon describes the primitive reflexes of the sympathetic and adrenal activation in response to perceived danger and other environmental pressures. Hans Selye further defined the deleterious effects of stress and distress on health. At the same time, technological advances in medicine that could identify specific pathological changes, and new discoveries in pharmaceuticals, were occurring at a very rapid pace. The disease-based model, the search for a specific pathology, and the identification of external cures were paramount, even in psychiatry.

Since the 1960's, 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. There is emerging evidence regarding their physiological effects.

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 and in need of palliative care.