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A New Era for Mind–Body Medicine

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A New Era for Mind–Body Medicine PERSPECTIVE A New Era for Mind–Body Medicine A New Era for Mind–Body Medicine A New Era for Mind–Body Medicine Michelle L. Dossett, M.D., Ph.D., Gregory L. Fricchione, M.D., and Herbert Benson, M.D.​​ ifty years ago, meditation was Concurrent with this growing experience a greater sense of well- Fconsidered fringe, and the public interest is emerging re- being, and are less bothered by idea that it had any role in medi- search describing various neuro- the symptoms that brought them cal treatment, absurd. Neverthe- biologic, physiological, and ge- in. Some patients also note a less, one of us (H.B.) published nomic changes associated with greater sense of spiritual con- research demonstrating that med- mind–body practices, particularly nectedness. itation and similar practices (ini- meditation, including activation of Belief in these techniques is tially from India and later from specific brain regions, increased not necessary to realize benefit. other cultures) reduced oxygen heart-rate variability, and suppres- Indeed, randomized, controlled consumption, lowered blood pres- sion of stress-induced inflamma- trials have suggested improved sure and heart rate, and initiat- tory pathways, among others (see health outcomes and quality of ed a cascade of physiological ef- Supplementary Appendix for a list life in multiple physical and fects that were the opposite of of relevant studies). Though some mental health conditions that are what occurs during the stress re- of these changes appear to occur related to or exacerbated by sponse.1 This coordinated set of with multiple techniques, others stress, including chronic pain, physiological changes was termed may be technique-specific. More anxiety, depression, cancer-related the “relaxation response,” and a research is needed to understand fatigue, tobacco addiction, inflam- general, secular procedure was the implications of these findings. matory bowel disease, and car- described to elicit it. Coinciden- In 1964, John Stoeckle and col- diovascular disease, though these tally, this work took place in the leagues concluded that 60 to 80% tools may not be helpful in the same laboratory that had been of visits to primary care physi- setting of substance use disor- occupied by Walter Cannon 50 cians have a stress-related com- der. Moreover, preliminary find- years earlier when he described ponent.3 Stress is ubiquitous, and ings suggest that integrating these the stress, or “fight or flight,” re- its role when excessive or persis- tools into the health care system sponse. tent as a major contributor to may reduce health care utiliza- Today, meditation and other morbidity and mortality is well tion and may be cost-effective. mind–body practices, such as recognized.4 At the Benson-Henry Nonetheless, not everyone is yoga and mindfulness, are grow- Institute for Mind Body Medicine ready to embrace these tools: ing in popularity, with 14% of at Massachusetts General Hospi- some patients may have concerns the U.S. adult population report- tal, for example, we routinely re- about certain practices contra- ing having used these techniques ceive referrals to our Stress Man- vening their religious beliefs; within the previous year.2 Histori- agement and Resiliency Training others are not ready to engage in cally, these tools have been used (SMART) Program from primary the effort required to maintain a to promote human flourishing, care physicians and specialists who regular practice; still others have insight, peace, enlightenment, and have seen their patients benefit been conditioned to request a pill connection to something larger from these practices. Since many for every ailment. Moreover, these than oneself. Today, many people patients are initially skeptical, we tools may not be appropriate for are drawn to these practices for counsel them regarding how some patients. For example, pa- their perceived physical and men- stress may be exacerbating their tients with severe mental illness tal health benefits and stress re- symptoms, how mind–body tech- may have difficulty learning the lief. All religious traditions and niques can reduce the stress re- necessary skills — or risk losing cultures have some form of med- sponse, and what to reasonably touch with reality when they en- itative or other mind–body prac- expect (e.g., you cannot blank gage in some of these practices. tice, but the current explosion of your mind with meditation, and Despite these barriers, many interest in these practices has mind wandering is normal). With patients are keen to learn more largely occurred within a secular guidance and consistent practice, about mind–body tools. Given context. most patients feel less stressed, the available data and the favor- 1390 n engl j med 382;15 nejm.org April 9, 2020 The New England Journal of Medicine Downloaded from nejm.org at Davis (UCD) on April 12, 2020. For personal use only. No other uses without permission. Copyright © 2020 Massachusetts Medical Society. All rights reserved. PERSPECTIVE A New Era for Mind–Body Medicine able side-effect profiles of these among health care professionals, public health potential. We need practices, we believe that mind– thereby enhancing the quality of to understand whether particular body medicine should be recog- care. Historically, cultivation of approaches are more likely to help nized as potential primary and these mindful and contemplative certain people, temperaments, or secondary prevention and, where practices throughout a society conditions; whether psychologi- possible, routinely incorporated promoted tolerance and mutual cal or genetic factors predict who into primary care. It is not sur- understanding, enhancing the so- will respond best to certain prac- prising that it hasn’t been seen in cial fabric. Research suggests that, tices; what constitutes optimal this light, given that our health on an individual level, mind– “dosing”; and to what extent care system has been predomi- body practices can promote pro- these practices can shift the nantly built on a reactive disease- social behavior. Could wide-scale course of disease and reduce the treatment model rather than a pro- use of these tools by people span- need for pharmaceuticals and ex- active health-enhancement model. ning the sociodemographic strata pensive tests and procedures. More Realization of the potential cost of our country help promote heal- robust, well-controlled prospec- savings and health improvements ing of some of the divisions that tive clinical trials are needed, as afforded by mind–body medicine currently challenge us? well as additional implementation would require insurance compa- Western medicine has pro- and comparative effectiveness tri- nies to cover these services and duced revolutionary health bene- als and basic research into the an educational system to train fits through advances in phar- putative cellular underpinnings of health care professionals in their macotherapies and procedures. It mind–body health effects. There appropriate use. Many medical now faces enormous challenges is much work to be done, but we schools now offer mind–body in battling stress-related noncom- believe the future is promising medicine electives, but only a few municable diseases. More Ameri- for mind–body medicine. have made education in these cans than ever are taking pre- Disclosure forms provided by the au- practices a required part of the scription medications for chronic thors are available at NEJM.org. curriculum. Currently, few Amer- health conditions, many of which From the Department of Medicine (M.L.D., icans have access to these tools have a lifestyle component. Chron- H.B.), the Benson-Henry Institute for Mind in a medical setting, and even ic pain, often perpetuated by Body Medicine (M.L.D., G.L.F., H.B.), and the Department of Psychiatry (G.L.F.), Mas- those who do must often pay for psychosocial stress, has become sachusetts General Hospital, and Harvard them out of pocket. an epidemic that our pharmaceu- Medical School (M.L.D., G.L.F., H.B.) — Given the ubiquity of stress, tical arsenal is poorly equipped both in Boston; and the University of Cali- high rates of anxiety and depres- to handle, and medical costs con- fornia at Davis, Sacramento (M.L.D.). sion among young people, and tinue to soar. 1. Wallace RK, Benson H, Wilson AF. A the necessity of learning effective Mind–body therapies can be wakeful hypometabolic physiologic state. coping skills as part of an essen- a helpful adjunct in managing Am J Physiol 1971; 221: 795-9. 2. Clarke TC, Barnes PM, Black LI, Stuss- tial health-promoting lifestyle (a chronic pain and other stress- man BJ, Nahin RL. Use of yoga, meditation, need that is poorly addressed by related noncommunicable diseas- and chiropractors among U.S. adults aged our current education system), we es by fostering resilience through 18 and over. NCHS Data Brief 2018; 325: 1-8. 3. Stoeckle JD, Zola IK, Davidson GE. The believe it also makes sense for self-care. Though they are not a quantity and significance of psychological these tools to be widely integrat- panacea, they can do much to distress in medical patients: some prelimi- ed into primary and secondary improve well-being and reduce nary observations about the decision to seek medical aid. J Chronic Dis 1964; 17: 959-70. education. Schools that have in- symptoms and the physiological 4. McEwen BS. Neurobiological and sys- corporated them have noted im- effects of stress. As we continue temic effects of chronic stress. Chronic provements in cognitive and socio- to develop models for integrating Stress (Thousand Oaks) 2017; Jan–Dec: 1. 5. Maynard BR, Solis MR, Miller VL, Bren- 5 emotional outcomes for students. these tools into our health care del KE. Mindfulness-based interventions for In addition to the potential and education systems, we have improving cognition, academic achieve- physical and mental health ben- an important opportunity and ment, behavior, and socioemotional func- tioning of primary and secondary school efits of meditation, we envision obligation to study these experi- students.
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