Complementary Medicine

A growing body of scientific evidence shows that mindful-based therapies, such as meditation, can lower psychological stress and boost both mental and physical health. Now findings recently published in PLoS One suggest that such practices may also change gene activity.

In the small study, researchers recruited individuals who had no prior meditation experience and examined participants’ genetic profile prior to their adoption of a basic daily relaxation practice. The 10- to 20-minute routine included reciting words, breathing exercises and attempts to exclude everyday thought. The New Scientist reports:

After eight weeks of performing the technique daily, the volunteers gene profile was analysed again. Clusters of important beneficial genes had become more active and harmful ones less so.

The boosted genes had three main beneficial effects: improving the efficiency of mitochondria, the powerhouse of cells; boosting insulin production, which improves control of blood sugar; and preventing the depletion of telomeres, caps on chromosomes that help to keep DNA stable and so prevent cells wearing out and ageing.

Clusters of genes that became less active were those governed by a master gene called NF-kappaB, which triggers chronic inflammation leading to diseases including high blood pressure, heart disease, inflammatory bowel disease and some cancers.

Even more interesting was that researchers found evidence to suggest that such changes can occur quickly and that regularly meditating can have lasting health effects:

By taking blood immediately after before and after performing the technique on a single day, researchers also showed that the gene changes happened within minutes.

For comparison, the researchers also took samples from 26 volunteers who had practised relaxation techniques for at least three years. They had beneficial gene profiles even before performing their routines in the lab, suggesting that the techniques had resulted in long term changes to their genes.

Previously: How mindfulness-based therapies can improve attention and health, Study offers insights into how yoga eases stress, Stanford scientists examine meditation and compassion in the brain and Study shows meditation may alter areas of the brain associated with psychiatric disorders
Photo by Georgie Sharp

Past research has suggested that teaching soldiers meditation exercises prior to their deployment can help them better cope with the trauma of war. Now, new findings show that mindfulness-based therapies can also be effective in helping treat veterans diagnosed with post-traumatic stress disorder (PTSD) after they return home.

In the study (subscription required), researchers assigned veterans with chronic PTSD to either a mindfulness-based cognitive therapy group or traditional treatment program. Individuals in the mindfulness treatment groups completed in-class exercises, such as “body scanning,” where they focused on pain, tension and other physical sensations in various parts of their bodies, and were instructed to perform activities at home. According to a story posted on PsychCentral today:

After eight weeks of treatment, 73 percent of patients in the mindfulness group displayed meaningful improvement compared to 33 percent in the treatment-as-usual groups.

[Anthony King, PhD, the study’s lead author said in a release] the most noticeable area of improvement for patients in the mindfulness group was a reduction in avoidance symptoms.

One of the main tenets of mindfulness therapy is a sustained focus on thoughts and memories, even ones that might be unpleasant.

“Part of the psychological process of PTSD often includes avoidance and suppression of painful emotions and memories, which allows symptoms of the disorder to continue,” King said. “Through the mindfulness intervention, however, we found that many of our patients were able to stop this pattern of avoidance and see an improvement in their symptoms.”

The findings are noteworthy considering the growing demand for PTSD treatment among soldiers returning from combat.

Previously: U.S. consortium launches effort to identify PTSD biomarkers to improve diagnosis and treatment, Using a mobile-based app to help manage PTSD and Stanford and other medical schools to increase training and research for PTSD, combat injuries
Photo by felicito rustique

There’s a thought-provoking feature story in the latest issue of Scientific American about the growing body of scientific evidence showing that mindfulness training lowers psychological stress and boosts both mental and physical health.

In the piece (subscription required), University of Miami psychologist Amishi Jha, PhD, systematically outlines the history of mindfulness research from the late 1970s when Jon Kabat-Zinn, PhD, began teaching the Mindfulness-Based Stress Reduction program at the University of Massachusetts Medical School to present day. In the past three decades, have shown that mindfulness-based therapies can be useful in treating anxiety disorders, preventing recurrence of depression and easing chronic pain.

Jah writes in the piece that she and colleagues recently completed a study involving U.S. Marines that suggested mindfulness training can both sharpen focus and improve mood:

Research published today in Pediatrics finds that the use of complementary and alternative medicine (CAM) is common among children, especially those who have been diagnosed with chronic health conditions such as asthma.

In the study, Canadian researchers surveyed 926 parents at two hospitals about their child’s CAM use. The pediatrics patients were being treated for health conditions in one of the following areas: cardiology, neurology, oncology, gastroenterology or respiratory health. Healthland reports:

… half said their children had used the therapies at the same time they were taking conventional drugs, while 10% tried alternative therapies before turning to conventional treatments and 5% used CAM in place of conventional medicine. Yet many parents weren’t telling pediatricians that their children were using CAM, which could increase the possibility of dangerous interactions.

The most commonly used CAM therapies included massage, faith healing, chiropractic and aromatherapy, while the most popular products to treat conditions ranging from cancer to asthma and inflammatory bowel disease were vitamins and minerals, herbal remedies and homeopathic medicines.

…

In the U.S., a recent survey found that one in nine children had used alternative therapies to treat a health condition. Vohra says parents’ own beliefs about and reliance on CAM therapies is a major factor behind its use in children, as is parents’ desire to provide their children with every possible health option. “For most parents, their number one priority is the health of their children so they’re interested in exploring all options to promote their children’s health,” says [Sunita Vohra, MD, lead author of the study.] “Many parents consider all products that are available and seek out not only conventional health care but also complementary health care.”

Previously: NIH to host Twitter chat on complementary medicine and children, Study shows meditation may lower teens’ risk of developing heart disease, New NIH series offers consumer-friendly tips on complementary health practices and Report highlights how integrative medicine is used in the U.S.
Photo by Wellcome Images

Many of us, myself included, turn to yoga, meditation, tai chi or other mind body practices to reduce stress and relieve anxiety. While past studies provide insights into how these approaches can put us at ease, researchers are still working to understand exactly how such psychosocial interventions can lessen the adverse effects stress on our physical and mental health.

Tomorrow, the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health is hosting a Twitter chat on managing holiday stress and what recent research says about the safety and effectiveness of mind body practices for de-stressing. The chat will be held at 12:30 PM Pacific Time. To join participate in the discussion, use the hashtag #nccamchat or follow @NCCAM. Joining the conversation will be NCCAM program officer John Glowa, PhD, who oversees the center’s behavioral health research portfolio, and Daniel Pine, MD, from the National Institute of Mental Health.

On a related note, the latest Ask Stanford Med Q&A features David Spiegel, MD, director of the Stanford Center for Stress and Health and medical director of the Stanford Center for Integrative Medicine, responding to questions about managing seasonal stress and depression. In the piece, Spiegel discusses the scientific evidence relating to the use of natural remedies, including fish oil and St. John’s wort, in treating holiday stress and depression.

Previously: Ask Stanford Med: David Spiegel answers your questions on holiday stress and depression, Report highlights how integrative medicine is used in the U.S., More hospitals offering complementary medicine and Meditate and call me in the morning: Study looks at doctors’ referrals for mind-body therapies
Photo by Toby Gray

Approximately one in ten adults in the United States experience some symptoms of depression, according to the latest data from the Centers for Disease Control and Prevention. Over the years, complementary interventions have been gaining in popularity among Americans, and a report published earlier this year showed that depression was among the top health conditions for which such treatments appeared to be most effective.

On Friday, the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health will host a Twitter chat to discuss the safety and effectiveness of these and other complementary health treatments for depression. The chat will be held at 10 AM Pacific time. To join the conversation, use the hashtag #nccamchat or follow @NCCAM.

Participants will be able to ask questions about the use and potential negative effects of various medicines and practices, as well as general questions about depression and its treatment. Joining the conversation will be NCCAM expert Wendy J. Weber, PhD, and Matthew Rudorfer, MD, from the National Institute of Mental Health.

As a friendly reminder, David Spiegel, MD, director of the Stanford Center for Stress and Health and medical director of the Stanford Center for Integrative Medicine, is currently taking questions about managing holiday stress and depression as part of our Ask Stanford Med series. Questions can be submitted to Spiegel by either sending a tweet that includes the hashtag #AskSUMed or posting a question in the comments section of this entry.

Previously: Report highlights how integrative medicine is used in the U.S., More hospitals offering complementary medicine and Meditate and call me in the morning: Study looks at doctors’ referrals for mind-body therapies

The holiday season is fast approaching; soon we’ll be sitting down at the table for Thanksgiving feasts, gathering and sharing gifts with loved ones, and raising a glass to toast the New Year. While holidays are often joyful occasions, the time can also raise stress levels as we try to find time in our already-busy schedules to prepare elaborate meals, wrap presents and travel to visit family. Factor in winter’s short, dark days, inclement weather and the high emotions that can run when we’re around family, and it’s no wonder the holidays are often fraught with feelings of anxiety, stress, depression and loneliness.

Now is the time to take action to minimize the stress that accompanies the holidays. To help you keep calm and carry on, we’ve asked David Spiegel, MD, director of the Stanford Center for Stress and Health and medical director of the Stanford Center for Integrative Medicine, to respond to your questions about managing stress and depression.

Spiegel is internationally known for his work in gauging the effects of the mind on physical health. During his career, he has authored more than 500 research papers and chapters in scientific journals and books and has won numerous awards for his research on stress and health.

Questions can be submitted to Spiegel by either sending a tweet that includes the hashtag #AskSUMed or posting your question in the comments section below. We’ll collect questions until Friday (Nov. 9) at 5 PM Pacific time.

When submitting questions, please abide by the following ground rules:

• Stay on topic
• Be respectful to the person answering your questions
• Be respectful to one another in submitting questions
• Do not monopolize the conversation or post the same question repeatedly
• Kindly ignore disrespectful or off topic comments
• Know that Twitter handles and/or names may be used in the responses

Spiegel will respond to a selection of the questions submitted, but not all of them, in a future entry on Scope.

Finally – and you may have already guessed this – an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: David Spiegel discusses the healing properties of hypnosis, Emotional, social support crucial for cancer patients, How to stay fit and active this holiday season, Stanford study shows depression symptoms may predict breast cancer survival and Stanford psychiatrist David Spiegel’s path west
Photo by matt

Yesterday, I wrote about a new hypnosis study from David Spiegel, MD. In a recently posted video, Spiegel, medical director of the Stanford Center for Stress and Health, talks more about his work - and shares a story from when he was in medical school:

I found that among the times when I could make a difference was when I walked into a room with an asthma patient who was unable to breathe. I had just taken a hypnosis class at Mass General and I said, ‘Do you want to learn a breathing exercise?’ and she nodded. And so I got her hypnotized; within five minutes she’s lying back in bed [and her] wheezing is audibly better, and I figured that anything that can help a patient that much had to be worth looking into.

After this experience, he said, he saw again and again that if “you can just help patients control their pain, control their anxiety, manage some of these symptoms better, you can make a big difference.”

Previously: Not everyone can be hypnotized – and researchers are one step closer to understanding why, Easing pain and improving recovery with hypnosis, More patients turning to hypnosis to help ease symptoms and Stanford psychiatrist David Spiegel’s path west

I’ve never tried it, but I’ve always assumed it would be difficult for me to be hypnotized. I’m somewhat of an anxious person, and it’s nearly impossible to for me to shut down my mind - so much so that I got a C minus (a C minus!) in the “techniques of relaxation” class I took in college. (It was the only C I ever got as an undergrad. I’m still bitter!) What I recently learned from a Stanford psychiatrist who treats patients with hypnosis, though, is that hypnotizability is not linked with any specific personality trait; it is, as David Spiegel, MD, told me, “less about personality variables and more about cognitive style.”

(Two other interesting nuggets supplied by Spiegel: About tw0-thirds of adults are very capable of being hypnotized, and a person’s hypnotizability is unlikely to change in adulthood. He calls it an “amazingly stable trait.”)

Now, Spiegel and those in his field are on the verge of identifying a brain signature of being hypnotized. In an imaging study (subscription required) published in the current issue of Archives of General Psychiatry, he and colleagues show how the areas of the brain associated with executive control and attention tend to have less activity in people who cannot be put into a hypnotic trance. I explain more in a release:

For the study, Spiegel and his Stanford colleagues performed functional and structural MRI scans of the brains of 12 adults with high hypnotizability and 12 adults with low hypnotizability.

The researchers looked at the activity of three different networks in the brain: the default-mode network, used when one’s brain is idle; the executive-control network, which is involved in making decisions; and the salience network, which is involved in deciding something is more important than something else.

The findings, Spiegel said, were clear: Both groups had an active default-mode network, but highly hypnotizable participants showed greater co-activation between components of the executive-control network and the salience network. More specifically, in the brains of the highly hypnotizable group the left dorsolateral prefrontal cortex, an executive-control region of the brain, appeared to be activated in tandem with the dorsal anterior cingulate cortex, which is part of the salience network and plays a role in focusing of attention. By contrast, there was little functional connectivity between these two areas of the brain in those with low hypnotizability.

Spiegel, who told me he was “surprised and pleased” by how clear the findings were, is planning more research in this area. And he said a better understanding of what happens in the brain during hypnosis - which is used to help patients manage pain, control stress and anxiety and combat phobias - would be helpful in the clinical setting.

Spiegel talks more about his work in an Author Interview on the journal’s website.

Previously: Easing pain and improving recovery with hypnosis and More patients turning to hypnosis to help ease symptoms
Photo by Dave-F

An estimated 12 percent of children use some form of complementary medicine, such as herbs and dietary supplements, massage or acupuncture, according to the latest data from the National Center for Complementary and Alternative Medicine (NCCAM). But few large studies have been completed on the safety of such therapies in children, leaving some people with questions about the potential benefits or harm of the practices.

In an effort to provide answers to the questions of parents, practitioners and others, NCCAM is hosting a Twitter chat tomorrow at 10 a.m. Pacific time. To join the conversation, use the hashtag #nccamchat or follow @NCCAM.

During the chat, Twitter users will have an opportunity to ask questions about the use and safety of complementary health approaches in children. Lawrence Rosen, MD, a founding member and chair of the American Academy of Pediatrics Section on Integrative Medicine, and NCCAM expert Wendy J. Weber, PhD, will participate in the conversation.

Previously: Study shows meditation may lower teens’ risk of developing heart disease, New NIH series offers consumer-friendly tips on complementary health practices and Report highlights how integrative medicine is used in the U.S.
Photo by Wellcome Trust