Spring 2009

The Power of the Mind to Heal the Body




Heading home from work, eyes closed, headphones on, Jose Martinez looks like a typical bus commuter. But the 47-year-old isn’t just listening to music on his iPod—he’s healing himself.

Martinez has suffered from irritable bowel syndrome for more than a decade, often leaving him in severe pain and vulnerable to depression and fatigue. Like many IBS sufferers, medication alone has not helped.

“It was a vicious cycle,” said Martinez, his voice trembling. “If my IBS got bad, then I got anxious. If I got anxious, then my IBS got bad. It was so intrusive in my day-to-day life because I never knew how my body would react to food or stress.”

To alleviate his symptoms, Martinez, a pseudonym to protect his privacy, sought a type of therapy that even today is seen with some suspicion in medical circles: hypnosis.

In just four sessions of hypnosis therapy under the care of Dr. Mark Jensen, a psychologist with the University of Washington Medical Center’s Rehabilitation Clinic, Martinez learned to better manage his illness, harnessing the mind’s ability to focus intently. Now, Martinez listens to recordings of the sessions three times daily.

“The hypnosis has really helped,” he said. “I’m less susceptible to having stomach trouble and I’m more energetic.”

Hypnosis, meditation, massage, yoga, acupuncture, guided imagery and other less conventional therapies—often referred to as integrative or complementary medicine—have gained a foothold with the public. So much so that a 2007 survey showed that 38 percent of adults and 12 percent of children in the United States used some form of complementary medicine.

Acceptance has been slower among the purveyors of Western medicine, where many doctors still view such therapies with skepticism and suspicion. But continued research is tipping the balance in favor of implementing these therapies in the medical world to improve the lives of patients, including those who are undergoing cancer treatment.

“Physicians and academic researchers finally have the science to understand the connection between the brain and the immune system, emotions and disease,” said Dr. Esther Sternberg, a National Institutes of Health senior scientist and author of “The Balance Within: The Science Connecting Health and Emotions.”

Sternberg has done groundbreaking work on interactions between the brain and the immune system, and she said that technological breakthroughs in science during the past decade have convinced even skeptics that the mind-body connection is real.

“That newfound knowledge may help doctors to see why an integrative approach is important,” she said.

Some of this supporting evidence is coming from places such as the Hutchinson Center, where scientists are fine-tuning measurements to test the value of these therapies.

Biological measures are important, said Dr. Karen Syrjala, head of Biobehavioral Sciences at the Hutchinson Center. “If we expect that psychological or behavioral strategies will have health outcomes, we must be able to show the pathway or mechanism through which that occurs,” she said.

“Our ability now to measure the biologic changes in things like stress hormone levels or skin response is so critical for adopting these strategies in a medical setting,” Syrjala said. “Being able to measure these markers of the process from psychological to physiological is very exciting.”

As research into complementary therapies increases, science is confirming what many adherents have long believed. Such studies have proven meditation and guided imagery decrease anxiety; massage therapy lowers blood pressure; music therapy increases peripheral blood flow and decreases cardiac complications; acupuncture and acupressure improve osteoarthritis; and spiritual support and prayer boost the immune system.

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No longer under the medical radar

Integrative or complementary medicine refers to non-invasive, non-pharmaceutical techniques that accompany standard medical treatments such as medications and surgery. Proponents prefer to use these terms to emphasize that such treatments are used with mainstream medicine, not as replacements or alternatives.

Americans have been ahead of the curve with alternative therapies, often under the medical radar, which is why the National Institutes of Health established the National Center for Complementary and Alternative Medicine in 1992 to explore these healing practices in the context of rigorous science. So far, it has funded more than 1,200 research projects.

Public interest has not waned. The 2007 National Health Interview Survey that tracked use of complementary or alternative medicine found that a large percentage of Americans took non-vitamin natural products like fish oil and ginseng, and participated in deep breathing exercises, meditation, chiropractic or osteopathic manipulation, massage, and yoga.

With hard science, acceptance is becoming more widespread. More than one-third of U.S. hospitals now offer one or more complementary therapies, according to a 2007 survey by the American Hospital Association. The hospitals with these approaches tend to be located in urban areas, with the southern Atlantic states offering the most. More than 80 percent of patients at these hospitals requested complementary services, even though some are not covered by insurance.

To promote integrative medicine at the national level, 42 academic health centers, including the University of Washington, formed the Consortium of Academic Health Centers for Integrative Medicine. And medical schools have added courses on less conventional therapies like acupuncture, hypnosis and traditional Chinese medicine.

But not without critics

Not all doctors are jumping onboard, though. Some critics contend that integrative medicine is driven largely by market forces and public fascination with alternative treatments. In a national survey of hospitals that offer complementary therapies, almost half listed physician resistance as one of the top three hurdles in implementing programs, along with budgetary constraints and lack of evidence-based research.

Dr. Bonnie McGregor
Dr. Bonnie McGregor, a Hutchinson Center psychologist who tests stress-reduction techniques to heighten immune function, has faced such doubters.

“I think some doctors are so focused on saving lives that they believe there’s no scientific evidence for the rest,” she said. “I am a skeptic, too. That’s why I went into this area. I wanted behavioral medicine researchers to be doing good science.”

Some physicians are single-minded about cures and consider dealing with the psychological side of illness unnecessary, she said. However, the therapies that have become part of integrative medicine are “very solidly based in science.” Some doctors “think this stuff is kind of superfluous or something nice, like giving someone a more comfortable pillow,” she said. “But the reason I do this research is that I think it can help with survival and with these really important biological outcomes that they’re looking at.”

McGregor is currently studying whether reducing stress in women with an elevated risk of breast cancer improves immune response to a vaccine. She also just completed a study looking at the effects of academic stress on the immune system. One of her studies examined how women with and without a family history of breast cancer process cancer-related words.

“It was an interesting way to discover how these women react to these words and gave us some clue about how they’re processing this information,” she said. “If they’re having this strong of a reaction just reading individual words, how are they affected by reading paragraphs about risk and how to manage their risk for breast cancer? So we’re looking to see if our intervention can change that response.”

In all of these studies, McGregor collects biological measures of stress like cortisol levels in saliva samples to lend hard data to the often-subjective science of assessing feelings.

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The appeal of integrative medicine

What makes integrative medicine appealing? Advocates point to deep dissatisfaction with a health care system that often leaves doctors feeling rushed and overwhelmed, and patients feeling as if they’re nothing more than their diseased hearts or worn hips. Integrative medicine seems to promise more time, more attention, and a broader approach to healing—one that is not based solely on the Western biomedical model, but also draws from other cultures.

“I think people are interested in learning about different techniques that have very potent and long-lasting effects that don’t involve taking a pill,” McGregor said.

“Patients want to be considered whole human beings in the context of their world,” the NIH’s Dr. Sternberg said.

However, the interest in integrative medicine makes it clear that solid evidence is needed to help medical professionals, and the public, understand which therapies help and which don’t.

As a result, researchers across the country are studying complementary and alternative therapies for safety and effectiveness. For example, the Duke Center for Integrative Medicine is looking at whether stress-reduction techniques, such as meditation and writing in a journal, can help prevent preterm labor, which can be precipitated by stress-related hormones.

In other clinical trials, researchers are trying to determine, among other things, how acupuncture affects brain activity, how biofeedback can better treat incontinence, and whether the medicinal herb valerian improves sleep in patients with Parkinson’s disease.

One study by Ohio State University’s Drs. Janice Kiecolt-Glaser and her immunologist husband Ronald Glaser found that people who are under stress take longer to heal. In another mind-body study at the university, breast cancer patients who were taught stress-management techniques to cope with side effects of treatment stayed on their chemotherapy longer, and a had a long-term survival advantage.

The data is so strong in some cases that even insurers are looking at integrative medicine to lower costs. Blue Shield of California found that surgical patients who participated in guided imagery exercises (via video and CD recordings) experienced less anxiety before surgery and less pain after surgery than non-participants. They also had significantly shorter hospital stays and needed less medication, saving the insurer about $654 per patient.

Despite these successes, McGregor said people should be wary of nontraditional therapies. Integrative medicine doesn’t entail blindly advocating for alternative approaches and rejecting conventional ones. A lot of quackery exists, as well as practitioners who overstate their abilities, she said.

“People should be skeptical, but they haven’t had a lot of tools,” McGregor said. “There haven’t been a lot of efficacy studies yet and they can’t ask their physician about it. They’re left with, ‘If it feels good and it seems to work for me, then great.’ We want people to get the best possible care in both conventional and complementary therapies.”

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Integrative medicine and cancer

Even in cancer treatment, where life-threatening conditions require some of Western medicine’s biggest guns—chemotherapy, surgery, transplants, radiation—there’s room for complementary medicine, said the Hutchinson Center’s Syrjala.

“The evidence is far too strong and it is now well recognized that patients need to manage their psychological and behavioral needs in addition to their physical health,” she said.

“My clinical experience shows that the majority of cancer patients look for any strategies that either might improve their disease treatment or provide well-being during treatment. I think we will see only an increasing adaptation of these mind-body strategies as part of routine health care.”

The Seattle Cancer Care Alliance offers hypnosis, guided imagery, yoga, meditation, massage therapy, spiritual and social support, exercise programs, music therapy and nutrition counseling, along with referrals to acupuncturists and naturopaths.

However, self-medication without a doctor’s input is not advisable—and contrary to the values of integrative medicine. Syrjala warns that it’s especially important for cancer patients to let their doctors know of any treatment that involves ingesting something.

“Supplements that seem benign—and may be so in people not receiving cancer treatment—can interact and be dangerous,” she said. “We really don’t want to see somebody blocking the efficacy of their chemotherapy because it happens to bind to the chemotherapy itself or to the cells we’re targeting for the tumors.”

Also, some supplements simply don’t work. More than 2 million men with benign prostate hyperplasia, a noncancerous enlargement of the prostate gland, take the herb saw palmetto as an alternative to drugs. But a large, federally funded study showed that the herb did not improve the condition.

Brain power

It’s the power of the mind that drives integrative medicine. The Hutchinson Center’s biobehavioral science researchers have conducted studies on hypnosis, guided imagery and exercise. They’ll soon begin a clinical trial that looks at a combination of coping skills like meditation, exercise and guided imagery for people undergoing bone-marrow transplants.

McGregor believes there’s a shift happening in the way we view the world right now. “Ancient medicine held a more holistic view of health and our relationship with the rest of the world,” she said. “Then the scientific revolution happened and it became, ‘If we can’t see it, we’re not going to believe it.’

“The pendulum has swung so far that we’ve lost spiritual and energy awareness—things that people used to know intuitively. I think we’re starting to come back to a more holistic view and we’re dragging scientists along, kicking and screaming,” she said.

She hopes that if people are taught to manage their stressors better and how to take better care of their bodies with diet, exercise and complementary techniques, the population will be healthier.

“I am a hard-nosed scientist, but I am open to the possibility that there are things out there that we can’t yet measure that have important effects,” she said.

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