The Association of Minimally Invasive Gynecologic Surgeons
…dedicated to safe, state-of-the-art surgery and health life-styles for women of all ages
R. Wayne Whitted MD, MPH
Paul A. Pietro MD
8740 N Kendall Dr. Suite 101
Miami, Florida 33176
Phone: 305-596-3744
Mind-Body Medicine
Mind-body medicine focuses on the interactions among the brain, mind, body, and behavior, and the
powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect
health. It regards as fundamental an approach that respects and enhances each person’s capacity for self-
knowledge and self-care, and it emphasizes techniques that are grounded in this approach.
Definition of Scope of Field
Mind-body medicine typically focuses on intervention strategies that are thought to promote health, such
as relaxation, hypnosis, visual imagery, music, meditation, yoga, biofeedback, tai chi, qi gong, cognitive-
behavioral therapies, group support, autogenic training, spirituality, and prayer.
The field views illness as
an opportunity for personal growth and transformation, and health care providers as catalysts and guides
in this process.
The concept that the mind is important in the treatment of illness is integral to the healing approaches of
traditional Chinese and Ayurvedic medicine, dating back more than 2,000 years. It was also noted by
Hippocrates, who recognized the moral and spiritual aspects of healing, and believed that treatment could
occur only with consideration of attitude, environmental influences, and natural remedies (ca. 400 B.C.).
While this integrated approach was maintained in traditional healing systems in the East, developments in
the Western world by the 16th and 17th centuries led to a separation of human spiritual or emotional
dimensions from the physical body. This separation began with the redirection of science, during the
Renaissance and Enlightenment eras, to the purpose of enhancing humankind’s control over nature.
Technological advances (e.g., microscopy, the stethoscope, the blood pressure cuff, and refined surgical
techniques) demonstrated a cellular world that seemed far apart from the world of belief and emotion. The
discovery of bacteria and, later, antibiotics further dispelled the notion of belief influencing health. Fixing
or curing an illness became a matter of science (i.e., technology) and took precedence over, not a place
beside, healing of the soul. As medicine separated the mind and the body, scientists of the mind
(neurologists) formulated concepts, such as the unconscious, emotional impulses, and cognitive delusions,
that solidified the perception that diseases of the mind were not “real,” that is, not based in physiology
and biochemistry.
In the 1920s, Walter Cannon’s work revealed the direct relationship between stress and neuroendocrine
responses in animals.
Coining the phrase “fight or flight,” Cannon described the primitive reflexes of
sympathetic and adrenal activation in response to perceived danger and other environmental pressures
(e.g., cold, heat). Hans Selye further defined the deleterious effects of stress and distress on health.
At the
same time, technological advances in medicine that could identify specific pathological changes, and new
discoveries in pharmaceuticals, were occurring at a very rapid pace. The disease-based model, the search
for a specific pathology, and the identification of external cures were paramount, even in psychiatry.
During World War II, the importance of belief reentered the web of health care. On the beaches of Anzio,
morphine for the wounded soldiers was in short supply, and Henry Beecher, M.D., discovered that much
of the pain could be controlled by saline injections. He coined the term “placebo effect,” and his
subsequent research showed that up to 35 percent of a therapeutic response to any medical treatment
could be the result of belief.
Investigation into the placebo effect and debate about it are ongoing.
Since the 1960s, mind-body interactions have become an extensively researched field. The evidence for
benefits for certain indications from biofeedback, cognitive-behavioral interventions, and hypnosis is
quite good, while there is emerging evidence regarding their physiological effects. Less research supports
the use of other, more clearly CAM approaches, like meditation and yoga.
The following is a summary of relevant studies.
Mind-Body Interventions and Disease Outcomes
Over the past 20 years, mind-body medicine has provided considerable evidence that psychological
factors can play a substantive role in the development and progression of coronary artery disease. There is
evidence that mind-body interventions can be effective in the treatment of coronary artery disease,
enhancing the effect of standard cardiac rehabilitation in reducing all-cause mortality and cardiac event
recurrences for up to 2 years.
Mind-body interventions have also been applied to various types of pain. Clinical trials indicate that these
interventions may be a particularly effective adjunct in the management of arthritis, with reductions in
pain maintained for up to 4 years and reductions in the number of physician visits.
When applied to more
general acute and chronic pain management, headache, and low-back pain, mind-body interventions show
some evidence of effects, although results vary based on the patient population and type of intervention
Evidence from multiple studies with various types of cancer patients suggests that mind-body
interventions can improve mood, quality of life, and coping, as well as ameliorate disease- and treatment-
related symptoms, such as chemotherapy-induced nausea, vomiting, and pain.
Some studies have
suggested that mind-body interventions can alter various immune parameters, but it is unclear whether
these alterations are of sufficient magnitude to have an impact on disease progression or prognosis.
Mind-Body Influences on Immunity
There is considerable evidence that emotional traits, both negative and positive, influence people’s
susceptibility to infection. Following systematic exposure to a respiratory virus in the laboratory,
individuals who report higher levels of stress or negative moods have been shown to develop more severe
illness than those who report less stress or more positive moods.
Recent studies suggest that the
tendency to report positive, as opposed to negative, emotions may be associated with greater resistance to
objectively verified colds. These laboratory studies are supported by longitudinal studies pointing to
associations between psychological or emotional traits and the incidence of respiratory infections.
Meditation and Imaging
Meditation, one of the most common mind-body interventions, is a conscious mental process that induces
a set of integrated physiological changes termed the relaxation response. Functional magnetic resonance
imaging (fMRI) has been used to identify and characterize the brain regions that are active during
meditation. This research suggests that various parts of the brain known to be involved in attention and in
the control of the autonomic nervous system are activated, providing a neurochemical and anatomical
basis for the effects of meditation on various physiological activities.
Recent studies involving imaging
are advancing the understanding of mind-body mechanisms. For example, meditation has been shown in
one study to produce significant increases in left-sided anterior brain activity, which is associated with
positive emotional states. Moreover, in this same study, meditation was associated with increases in
antibody titers to influenza vaccine, suggesting potential linkages among meditation, positive emotional
states, localized brain responses, and improved immune function.
Physiology of Expectancy (Placebo Response)
Placebo effects are believed to be mediated by both cognitive and conditioning mechanisms. Until
recently, little was known about the role of these mechanisms in different circumstances. Now, research
has shown that placebo responses are mediated by conditioning when unconscious physiological
functions such as hormonal secretion are involved, whereas they are mediated by expectation when
conscious physiological processes such as pain and motor performance come into play, even though a
conditioning procedure is carried out.
Positron emission tomography (PET) scanning of the brain is providing evidence of the release of the
endogenous neurotransmitter dopamine in the brain of Parkinson’s disease patients in response to
Evidence indicates that the placebo effect in these patients is powerful and is mediated through
activation of the nigrostriatal dopamine system, the system that is damaged in Parkinson’s disease. This
result suggests that the placebo response involves the secretion of dopamine, which is known to be
important in a number of other reinforcing and rewarding conditions, and that there may be mind-body
strategies that could be used in patients with Parkinson’s disease in lieu of or in addition to treatment with
dopamine-releasing drugs.
Stress and Wound Healing
Individual differences in wound healing have long been recognized. Clinical observation has suggested
that negative mood or stress is associated with slow wound healing. Basic mind-body 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
Using a blister chamber wound model on human forearm skin exposed to ultraviolet light,
researchers have demonstrated that stress or a change in mood is sufficient to modulate MMP and TIMP
expression and, presumably, wound healing.
Activation of the hypothalamic-pituitary-adrenal (HPA)
and sympathetic-adrenal medullary (SAM) systems can modulate levels of MMPs, providing a
physiological link among mood, stress, hormones, and wound healing. This line of basic research
suggests that activation of the HPA and SAM axes, even in individuals within the normal range of
depressive symptoms, could alter MMP levels and change the course of wound healing in blister wounds.
Surgical Preparation
Mind-body interventions are being tested to determine whether they can help prepare patients for the
stress associated with surgery. Initial randomized controlled trials—in which some patients received
audiotapes with mind-body techniques (guided imagery, music, and instructions for improved outcomes)
and some patients received control tapes—found that subjects receiving the mind-body intervention
recovered more quickly and spent fewer days in the hospital.
Behavioral interventions have been shown to be an efficient means of reducing discomfort and adverse
effects during percutaneous vascular and renal procedures. Pain increased linearly with
procedure time in a control group and in a group practicing structured attention, but remained flat in a
group practicing a self-hypnosis technique. The self-administration of analgesic drugs was significantly
higher in the control group than in the attention and hypnosis groups. Hypnosis also improved
hemodynamic stability.
Evidence from randomized controlled trials and, in many cases, systematic reviews of the literature, suggest
• Mechanisms may exist by which the brain and central nervous system influence immune, endocrine,
and autonomic functioning, which is known to have an impact on health.
• Multicomponent mind-body interventions that include some combination of stress management,
coping skills training, cognitive-behavioral interventions, and relaxation therapy may be appropriate
adjunctive treatments for coronary artery disease and certain pain-related disorders, such as arthritis.
• Multimodal mind-body approaches, such as cognitive-behavioral therapy, particularly when combined
with an educational/informational component, can be effective adjuncts in the management of a variety
of chronic conditions.
• An array of mind-body therapies (e.g., imagery, hypnosis, relaxation), when employed presurgically,
may improve recovery time and reduce pain following surgical procedures.
• Neurochemical and anatomical bases may exist for some of the effects of mind-body approaches.
Mind-body approaches have potential benefits and advantages. In particular, the physical and emotional
risks of using these interventions are minimal. Moreover, once tested and standardized, most mind-body
interventions can be taught easily. Finally, future research focusing on basic mind-body mechanisms and
individual differences in responses is likely to yield new insights that may enhance the effectiveness and
individual tailoring of mind-body interventions. In the meantime, there is considerable evidence that mind-
body interventions, even as they are being studied today, have positive effects on psychological functioning
and quality of life, and may be particularly helpful for patients coping with chronic illness and in need of
palliative care.
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