In Brief to Practice Research From / Complementary & Integrative Medicine Mind-body interventions utilize the mind’s capacity to affect the body and its physiological responses. They thereby influence health. The response to stress (the “fight or flight” reaction) may be automatic, but recovery toward relaxed parameters (“the relaxation response”) can be learned through self-regulation and the regular use of mind-body interventions. Many of these interventions originate from Eastern healing practices. Western science has found some of them to be helpful as adjunct modalities in the treatment of disease, and their use is increasing. Mind-Body Interventions Mind-body medicine focuses on the pens even without our planning or communication between mind and effort. In scientific studies, it has been body and the powerful ways in which shown to interfere with clinical out- Birgitta I. Rice, MS, RPh, CHES emotional, mental, social, and spiritu- comes. It is often looked upon as puz- al factors can directly affect health. zling or confusing and unfortunately Western, or allopathic, medicine tends has thereby been undervalued.2 A to consider the scientific, or medical, positive placebo response typically model of medicine superior to mind- improves a patient’s trust and hope body therapies. It often has negated for an affirmative outcome. the fact that one’s mind has any affect Mind-body therapies regard as on the body. But in the last genera- essential an approach that acknowl- tion, with the meeting of Eastern and edges each person’s capacity for self- Western healing practices, we have knowledge and self-care. It empha- come to accept and understand that sizes the person’s openness to partici- mind and body are powerfully related. pate and his or her desire to succeed. Between 1990 and 1997, the num- It often has been said that mind-body ber of patients using alternative prac- medicine views illness not as an obsta- tices increased from 36 to 46%.1 cle but as an opportunity for personal Quality clinical research has grown growth and transformation. steadily since 1970. The National Further training of medical health Center for Complementary and professionals is needed to improve Alternative Medicine (NCCAM), understanding of the benefits of the founded in 1998 as part of the mind-body therapies. Likewise, practi- National Institutes of Health, is now a tioners of spirituality and mind-body vital organization for disseminating interventions need to be more appre- information and providing funding ciative of the successes that the scien- options for complementary or alterna- tific practice of medicine has made tive medical research. available. Together, they can help Mind-body interventions include augment clinical outcomes whenever relaxation, imagery, biofeedback, possible. meditation, hypnosis, tai chi, yoga, Dean Ornish, MD, a cardiologist and others. They often help patients and founder of the Preventive experience healing for their illnesses in Medicine Research Institute in new and different ways. Sausalito, Calif., has done just that. A mind-body modality we often He showed that comprehensive experience, many times unbeknownst lifestyle changes (low-fat vegetarian to us, is the placebo response. It hap- diet, smoking cessation, stress-man- 213 Diabetes Spectrum Volume 14, Number 4, 2001 agement training, and moderate exer- facilitating the uptake of oxygen. The ing with two interdependent variables cise) for patients with heart disease body achieves a sleep-like rest (an here, mind and body, which then have can actually reverse coronary heart altered state of consciousness) in a to interact with all the other bodily disease.3 brief period of time. functions. Table 1 lists many of the mind- Conversely, the stress response, or It is not easy to design research body therapies and offers a brief the “fight or flight” response, includes methodologies that produce signifi- description of their potential physio- increased levels of heart rate, breath- cant outcomes in such challenging sit- logical benefits. ing, blood pressure, blood glucose, uations. Grant opportunities have How do these therapies work? and stress hormones. Excess stress- been few compared to those available What is the trigger? In many, if not induced levels of adrenaline or corti- for drug research, reflecting the limit- all, methodologies, the basic dynamic sol may damage the blood vessels and ed profit potential of complementary feature is the “relaxation response.” also compromise the immune sys- and alternative medicine research. The Herbert Benson, MD, of the Mind- tem.5,6 remainder of this article describes Body Medical Institute at Harvard Keeping excess stress hormones in some of the therapies that have been University4 coined the phrase “relax- check with relaxation may help stabi- researched and published in peer- ation response” after carrying out lize glucose levels and at the same reviewed journals. As expected, there research on the effects of meditation time provide some protection for the are a variety of studies both with and in collaboration with national and heart.3 These are both very important without positive results regarding international scholars. The relaxation issues for people with diabetes. their effect on diabetes. response is a state in which the body Mind-body therapies work for slows down and heart rate, blood some people, but they may not work Relaxation and Biofeedback-Assisted pressure, and breathing slow down, for everyone. Remember, we are deal- Relaxation Techniques Feelings of stress raise blood glucose Table 1. Overview of Mind-Body Interventions levels in people with diabetes. This is because of an increased production 7 Modality Description and potential physiological benefits of stress hormones, which reduces insulin action. In addition, patients Relaxation A state of altered consciousness, a slowing of breath and under perceived stress may find that heart rate. caring for their diabetes is less of a Meditation A process of training one’s mind to be attentive, to focus priority, leading to poor glycemic in a nonanalytical way, an attempt to refrain from rumi- 4 control, which further exacerbates the nation, as in relaxation. situation. Hypnosis The induction of trance states by therapeutic suggestion, It is therefore important for dia- a state of altered consciousness. Facilitates behavior and betes health professionals to be aware lifestyle changes, overcoming addictions. of and to check with their patients Imagery The formation of images in perception, thought, feeling, about how stress may be affecting memory, and fantasy, all in the absence of sensory stim- their lives. Health care professionals ulants (seeing, hearing, feeling, smelling, tasting). May can then offer advice specific to their improve immune function, speed surgical recovery. patients’ situation. Perhaps some Visualization Active imagery to influence attitude, behavior, or physi- additional lifestyle changes could be ological responses. Even faint intentional imagery of recommended for stress reduction. As thought activates the brain to release neurotransmitters noted earlier, decreasing stress reac- to the corresponding neural and hormonal pathways. tions may lead to better glucose con- Autogenic Training Relaxation and self-hypnosis using a specific, tested trol and improvement in immune sys- sequence of wording. tem function. Aromatherapy Stimulation of the sense of smell to encourage relax- Glucose management. With in- ation, well-being, or other physiological benefits. creased glycemic control, there is Biofeedback Adjustment of thinking processes and regulation of always a risk for hypoglycemia. When physiological functions with feedback from monitoring in a relaxed state, the body metabo- instruments. Helps to control blood pressure, muscle lizes carbohydrate more efficiently, tension, heart rate, brain waves, and skin temperature. thereby lowering blood glucose Psychotherapy Treatments ranging from simple listening to combina- levels.8,9 Patients with type 1 diabetes tions of medication, counseling, and discussion, using may potentially develop hypoglycemia behavioral/emotive approaches. following relaxation.9,10 Therefore, Support Groups Group interventions that promote bonding and belong- such patients should be told of the ing, being understood, self-expression, learning, stress possibility for low blood glucose lev- relief, and longevity. Decreases anxiety and isolation.35 els after relaxation and instructed to Dance and Exercise Movement to improve self-esteem, facilitate attention, promptly treat it as directed by their express anger, and develop a more positive body image. health care professional. Yoga A system of developing discipline to achieve body pos- In published, peer-reviewed re- tures, control breathing, and reduce stress and stress search studies featuring diabetes and hormones, thereby boosting the immune system. blood glucose, the most common Music and Art Pursuits that help in developmental disabilities and are alternative treatment is relaxation effective as an analgesic or relaxant. training or biofeedback-assisted relax- ation training. Many case and con- 214 Diabetes Spectrum Volume 14, Number 4, 2001 trolled studies using biofeedback- sion to the peripheral blood vessels, thermal biofeedback. On the other to Practice Research From / Complementary & Integrative Medicine assisted relaxation training with type thereby increasing blood flow to the hand, in mind-body therapies, “think- 1 diabetic patients showed significant-