By Dr. Alan C. Logan, ND, FRSH

Mind-body medicine is a broad term used for a number of techniques and therapies which consider that the mind (thoughts and emotions) can influence behavior and health status. Mind-body medicine also considers the influence of a disordered body on thoughts and emotions. The techniques of mind-body medicine are a virtual buffet and include meditation, hypnotherapy, biofeedback, guided imagery and visualization, yoga, prayer, tai chi, breathing exercises, therapeutic writing and art, music and dance, and cognitive-behavioral therapy. Mind-Body Medicine has evolved into its own medical discipline and perhaps no other branch of medicine is more suited to address stress management.

Stress can be defined as… the thoughts, feelings, behaviors and physiological changes that occur when demands placed on the individual exceed the perceived ability to cope.

There is an abundance of research which shows that stress compromises physical and mental health. Higher levels of daily stress prime the sympathetic nervous system and can lead to interference with treatment outcome in most human health conditions. Learning effective coping skills can change the perception of demands in daily life; these same skills empower the individual in the context of situation which would normally promote stress.

Addressing more global aspects of the stress management in your life can have tremendous collateral benefits. Consider that those with anxiety disorders and/or depression, both males and females, have an increased risk of cardiovascular disease and fatal heart attacks. Psychological stress, depression and phobic anxiety are also associated with increased generation of free radicals which are intricately tied to most chronic illneses. Stress management applications will not only increase the potential for effective treatment of existing illnesses, they will contribute to overall health and well-being and energy levels in healthy adults and children. As research continues to mount, it is becoming clear that stress contributes to the progression of many illnesses. From arthritis, to Crohn’s disease, from multiple sclerosis to irritable bowel syndrome, stress management interventions have been found to be an important component to remission or preventing progression. A 20-year Kaiser Permanente study showed that 60% of all medical visits are by the “worried well” with no diagnosable medical condition. Many “worried well” patients sit on the continuum between worry, health anxiety, and a diagnosable anxiety disorder.

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The stress response and its physiological cascade of stress hormones (cortisol, norepinephrine, epinephrine etc) occur in response to perceived threats. There are numerous self-generated thoughts which go along with the physiological response – this can set up a vicious cycle.  In the stress hardy humans, the stress response is well regulated, the threat is extinguished and equilibrium is maintained. Maladaptive coping involves a stress response that is altered and not well regulated. The consequences are worsening of anxiety, particularly in those prone to anxiety disorders, and a worsening of physical health.

It has been estimated that the average American experiences 50 brief stress response episodes per day. Usually triggered by daily hassles, work and home stressors, these are mini versions of the stress response that is triggered in the phobic/anxious situation. The reasons for a deregulated stress response in those with anxiety disorders are multifactorial. To enhance stress coping, and “recondition” the stress response, a variety of techniques are employed. Helping anxiety patients with cognitive restructuring is at the core of contextual therapy. Given that life stress is about perception, the negative or irrational thoughts (inner dialogue) that occur in anxious and stressful situations are often used more globally in the patient’s life. Ultimately the negative self-talk, which often takes shape as cognitive distortions, makes stress loom larger than it is. This in turn promotes stress in daily life and interferes with health prmotion. It also drives inappropriate food choices such as high sugar and fat items. The first target of most stress management programs is dealing with cognitive distortions.

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Cognitive Distortions:

All-or-nothing thinking: Things are either good or bad, there is no middle ground.

Overgeneralization: Stress-prone individuals may view negative events as a continuous pattern of defeat. 

Mental filter/discounting positives: Stress-prone individuals may filter the world with glasses that ignore the positive and let the negative events gain access to the brain. Accomplishments are discounted and are not used to enhance coping for future events. 

Jumping to conclusions: Stress-prone individuals may conclude that events will always end badly. They do so without any definite evidence. For example, the headache is a brain tumor. Turbulence is mechanical difficulties or an incompetent pilot on a plane.

a. Mind reading: Assuming that people are reacting negatively to you.

b. Fortune-telling: Predicting that things will turn out badly. 

Magnification: Stress-prone individuals may consider events or challenges to be much more challenging than they really are.

Emotional reasoning: You reason from how you feel: "I feel incompetent, so I must actually be incompetent." 

"Should" statements: Stress-prone individuals may criticize themselves or others with definitive "shoulds," "shouldn't," "musts," "oughts," "and "have-tos." 

Labeling: Everyone makes mistakes and struggles, however, the stress-hardy individual will say “I made a mistake,” stress-prone will say, "I am not a strong person" or “I am so incompetent." 

Blame: stress-prone individuals may blame themselves for something they were not entirely responsible for, or, may blame others.

The 3 C’s

The stress-hardy have been found to embrace 3 C's into their world view. 

Change: They view change as a challenge and not something to be feared. Change is viewed as normal, and a stimulus for growth and maturity rather than a threat.  

Commitment: They are engaged in life. They have something that they are committed to. We know all too well that those who are committed to recovery are those that excel in contextual therapy.

Control: Hardy personalities believe their effort makes a difference. They believe that they have control and are not just a victim of luck or fate. Stress-hardy individuals have no more control over most events than those who are stress-prone... they just believe they do.

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The Relaxation Response

Harvard University has a program in mind-body medicine which is centered on the “relaxation response”, an innate physiological and psychological response which can be turned on as needed.  Harvard physician Dr Herbert Benson was the first to scientifically document this phenomenon. Just as there is a stress response with all of its associated physiological and emotional consequences, so too is there a relaxation response. The relaxation response has been shown to reduce central nervous system (CNS) activity and reduce stress hormone release, and in turn, the response to stress is more appropriate, more adaptive and more self-limited. When you dampen down over activity in the CNS, the mind and body are calmed, and the stress response can become reconditioned to enhance coping in those of us who are stress-prone. Studies show the relaxation response to be helpful in a number of stress related conditions.

The relaxation response is not difficult to invoke, through years of research, Dr. Benson has determined that the relaxation response can be initiated by the following;

1. A quiet, comfortable environment, with you in a comfortable position.
2. Conscious relaxation of the muscles of the body.
3. Repetition of a simple mental stimulus such as a word, phrase, image or prayer.
4. A passive mental attitude toward the process itself and any intrusive sounds or thoughts.
5. Duration of 10-20 minutes.

The relaxation response can bring about a reduction in sympathetic nervous system activity, lowered blood pressure, decreased muscle tension, and lower respiratory rate. The effects of the relaxation response have been documented using objective brain imaging and brain wave studies. Changes on functional MRI and EEG are associated with states of relaxed wakefulness and awareness.

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Mindfulness

Mindfulness meditation keeps an individual in the here and now. It is the practice of paying attention to what you are experiencing in the current moment, without drifting off to the worry of the future, or the negative experiences of the past. It is the perfect an Mindfulness involves suspending judgment and letting go of opinions so that you will be a less reactive person. This fosters acceptance, self-reflection, and a greater ability to handle difficulties without avoidance. There is a wealth of research related to mindfulness meditation. Recent reviews of structured programs, mindfulness based stress reduction (MBSR) programs show that they are highly effective in lowering stress, decreasing anxiety, and lifting depressed mood. A recent study showed that an 8-week mindfulness course was associated with a greater activation of areas of the brain associated with positive mood/happiness/optimism. Those who shifted to greater activity in this area of the brain after the intervention had a better immune response to the flu vaccine four months later. MBSR has been shown to improve well-being and coping skills among nursing students, and decrease the tendency to to take on the negative emotions of others. Researchers from the University of Rochester found that among 1500 adults surveyed, higher scores on a mindfulness scale was associated with improved mood, optimism, life satisfaction, and willingness to try new experiences. Mindfulness meditation can be performed while seated or while walking and requires no special equipment. Meditative breathing (abdominal breathing) is used to ground the individual into the present moment, short circuiting the stress cycle.

Using Visualization

Part of the process that feeds stress is mental imagery in future thinking. Just like self-talk, negative mental imagery is used by stress-prone individuals to play out worst-case scenarios in their minds. Negative mental imagery leads to physiological stress responses and associated thoughts. Negative mental imagery promotes the production of stress hormones such as cortisol and other physiological changes associated with stress. It also works the other way - positive imagery can do the opposite and dampen down sympathetic activity. There are numerous studies on guided imagery (by health professionals) and its ability to improve various medical conditions, particularly chronic states related to stress such as headaches, fibromyalgia, pain management and states of anxiety.  Visualization can focus on pleasant scenes (nature etc); it can also be used to as a means to play out scenes of accomplishment.  For example, the completion of stressful tasks (or entering the phobic/anxious situation) can be visualized.

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Exercise

This one is obvious. A prescription for exercise is extremely important for stress management, depression and anxiety disorders. Exercise programs have been found to come close to matching the gains of cognitive interventions alone in cases of psychological complaints, burnout and fatigue. Exercise is helpful in alleviating medically unexplained fatigue and appears to increase the threshold for panic.

Music Therapy

Music has been used for centuries as a means to enhance mood and well-being. Different types of music means different things to different people, but some observations have been made regarding different types of music. Researchers from the Institute of HeartMath have extensively researched the effects of music on mood and emotion. They have noted music that designed/composed to produce benefical physiological/psychological effects, increased caring, relaxation, mental clarity, and vigor. The so-called designer music also decreased hostility, fatigue sadness and tension. Researchers have also shown that certain typoes of music can promote sleep and can prevent sharp rises in cortisol after a psychological stressor. Finally, a new study showed that ‘techno’ music significantly increases the cortisol response when playing challenging video games vs. games with no music accompanying the game.

Aromatherapy

Our olfactory (smell) system is intricately connected to the limbic system, the emotional center of the brain. Even simply talking or thinking about an aroma can bring up emotions and memories to the conscious level. Essential oils are capable of reducing stress, promoting relaxation, and enhancing cognitive function – it all depends on the oil itself and personal preferences. Peppermint oil, for example, has been shown to improve alertness and diminish daytime sleepiness, and rosemary has been shown to improve cognitive performance in a work environment. Lavender, on the other hand, diminished cognitive performance in the workplace. Orange aroma has been shown to reduce anxiety in a dental office. Low levels of jasmine oil have been found to dampen down sympathetic nervous system activity, improve sleep and cognitive performance. Personal preferences come into play, because in those who disclosed before the study that they do not like the smell of jasmine, high levels induced a stress response. Essential oils can serve as wonderful tools to keep an individual in the here and now.

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References:

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