Integrative Medicine: Stress and Beyond

by Tim Brunson PhD

For a very long time I have been fascinated by the relationship between the mind and body. In fact, despite resistance from much of the medical community, the field of integrative medicine is rapidly gaining a foothold. (The Joint Commission, which accredits hospitals in the U.S. has mandated that all hospitals adopt integrative medicine programs by 2007.) This trend is being documented almost daily by the United States National Institutes of Health. Professionally I spend a considerable amount of time documenting such research for The International Hypnosis Research Institute. This is especially true when integrative research involves hypnosis.

One of the most important concepts involving integrative concepts is that of stress. Interest in stress can be traced back to the 1920's when Walter Cannon's work revealed the direct relationship between stress and neuroendocrine responses in animals. He coined the phrase "fight or flight" to describe the primitive reflexes of sympathetic and adrenal activation in response to perceived danger and other environmental pressures such as cold and heat. Hans Selye further defined the deleterious impact of stress and destress on health. It is noteworthy that these findings went on the "back burner" as simultaneously technological advances in the identification of specific pathological changes and new pharmaceutical discoveries were advancing at a rapid pace.

During World War II, stress again emerged as a health care issue. In response to the shortage of morphine in combat zones, Henry Beecher, M.D. discovered that when injecting a saline solution soldiers could obtain pain relief just as if they had received morphine. This belief factor, which he coined as a "placebo response", is now generally considered the cause of approximately 30-35% of cures within the allopathic medical community. While I recognize the roll of the placebo effect in medicine, I have seen too many cases in which positive results exceed the 30% placebo threshold. For instance with psychosomatic illnesses such as fibromyalgia, irritable bowel syndrome, and dermal disorders, I have read voluminous results highlighting credible scientific research supporting an 80-90% cure rate or significant symptom reduction. In my clinical practice I have been able to duplicate or exceed these results. Furthermore, I have seen interesting research investigating stress reduction and guided imagery with other, non-psychosomatic illnesses.

If I were to give justice to the issue of stress in medicine I would have to cover several topics. However, in the interests of space I wish to give an example of the relationship between stress and wound healing. Medical doctors have long recognized the differences in wound healing. Clinical observations have suggested that negative moods or stress is associated with slow wound healing. Basic integrative medical research is now confirming this observation. Matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases (TIMPs), whose expression can be controlled by cytokines, play a role in wound healing. Using a blister chamber wound model on human forearm skin exposed to ultraviolet light, researchers have demonstrated that stress or change in mood is sufficient to modulate MMP and TIMP expression and presumably, wound healing. Activation of the hypothalamic-pituitary-adrenal (HPA) and sympmathetic-adrenal medullary (SAM) systems can modulate levels of MMPs, providing a physiological link among mood, stress, hormones, and wound healing. This line of research suggests that patients even in the normal range of depressive symptoms, could alter MMP levels and change the course of wound healing in blister wounds. Furthermore, this would then lead to the possible conclusion (or at least a series of relevant theories and hypotheses) that by controlling what we think, how we handle stress, and what we allow our senses to absorb (i.e., environment -- such as watching too much CNN) can and will affect our health. Then, this leads us to a logical question of the ability of the mind to affect the health of a specific organ, cholesterol level, blood pressure, etc. Frankly, I don't feel that we are too far from the ancient Tibetan beliefs of being able to move subtle energies in our body through the use of our thoughts and our awareness.

I have a hard time answering such as question about stress and the mind body nexus without throwing in a mention of the latest research proposed by one of my teachers, Ernest Rossi, Ph.D. of San Diego, California. In his latest work, The Psychobiology of Gene Expression (2002), Rossi discusses the role of arousal, a significant component of stress, as a factor in the "reprogramming" of our DNA. Surely, this must be a significant factor in understanding any integrative concept. He admits that this is merely a hypothesis at this point. However, it is based upon his extensive research into breakthroughs derived from the recent mapping of the human genome.

Also, consider the research documented by E. L. Santacangelo and L. Sebastini in 2004 in the American Journal of Clinical Hypnosis when they stated that there is a relationship between highly hypnotizabiity (e.g., susceptibility) people and their ability to protect themselves against cardiovascular hazards due mostly from an onset of stress. Another significant research was presented by Catalina Lawsin, M.D., of the Mount Sinai School of Medicine in 2007, when she recognized that the use of stress reduction techniques were a major factor in the survival of colorectal cancer, especially among the younger patients. And lastly, I wish to cite the recent findings of a recent Italian study (University of Pisa, Pisa, Italy), in which the researchers found that certain specific emotional numbing suggestions were the main factor in the hypnotic modulation of the experience of fear. They found that the suggestions were manifested in a reduction of heart rate, heart rate variability, and blood pressure.

It is clear to me that we are still only starting the see the beginning of a revolution of health care. This revolution will fully recognize that all medicine must have a mind-body, integrative quality. While I fantasize daily that someday medical doctors and psychologists will actually converse in the same language as partners in the healing process, I recognize that this dream has a long way to go. Indeed, there are too many "professionals" in both fields that have achieved premature closure about the role of the other. (For instance, those qualified medical professionals that still insist that "hypnosis has its place, but not in modern medicine." This is despite the fact that the American Medical Association approved hypnosis in 1958; the American Psychological Association did so in 1959.) I am committed to the prophecy that allopathic medicine will be revolutionized within the next 25 years. Even though the "profit motive" of the pharmaceutical-medical complex appears to have a strangle hold of medical evolution, recent surveys by the National Institutes of Health are reflecting that medical consumers are demanding alternative modalities. Ever since iatrogenic illnesses (that is, illnesses resulting from medical malpractice) were determined to be the leading cause of death in America in 2003, it has been obvious that a change is in order and long overdue.

Other than the references that I specifically mentioned above, I would like to add the following references:

Cannon WB. The Wisdom of the Body. New York, NY: Norton; 1932.

Selye H. The Stress of Life. New York, NY: McGraw-Hill; 1956.

Beecher H. Measurement of Subjective Responses. New York, NY: Oxford University Press; 1959.

Stamenkovic I. Extracellular matrix remodelling: the role of matrix metalloproteinases. Journal of Pathology. 2003;200(4):448-464.

Stamenkovic I. Extracellular matrix remodelling: the role of matrix metalloproteinases. Journal of Pathology. 2003;200(4):448-464.

Of course, The International Hypnosis Research Institute Web site (http://www.hypnosisresearchinstitute.org) is a great resource on this subject.

The International Hypnosis Research Institute is a member supported project involving integrative health care specialists from around the world. We provide information and educational resources to clinicians. Dr. Brunson is the author of over 150 self-help and clinical CD's and MP3's.