THE MIND-BODY CONNECTION

Relaxation and its affect on physical well being 

Physicians and psychologists have been aware for many years that emotional states and psychological stress have profound effects on physical health.  Well documented evidence converging from several areas of research has only recently, however, demonstrated the efficacy of mind-related interventions in the treatment of certain physical conditions.  These mind-body techniques can in fact be useful for individuals with health related problems other than mental illness or psychological difficulties.

Results of Recent Research

 Some of the most convincing clinical evidence in the form of meta-analyses (a statistical comparison of the results of multiple studies) indicate that individuals suffering from conditions such as insomnia, osteoarthritis, rheumatoid arthritis, headache and chronic low back pain can benefit from techniques such as guided imagery, muscle relaxation, stress management and cognitive-behavioral therapy (1).

 Migraine Headache

A 1990 comparison of the efficacy of relaxation and biofeedback (34 trials) with drug therapy (25 trials) for recurrent migraine headache indicated that both types of treatment were similarly effective each yielding about 43% reduction in headache activity (2, 3).  Recent evidence has also shown stress management training to be as effective as the use of tricyclic antidepressants in the management of tension-type headache and the use of both treatments was more effective than either one alone (4).

 Arthritis

In the case of arthritis, treatment modalities including a combination of relaxation, biofeedback, cognitive therapy and education, all directed toward coping with pain, resulted in a significant reduction in visits to physicians (5).

 Lower Back Pain 

For low back pain, analysis of multiple studies indicated that interventions such as cognitive modification of response to pain and progressive muscle relaxation techniques showed a moderately positive effect on pain intensity (6).

 Insomnia

Techniques that meet the American Psychological Association (APA) criteria for “empirically supported” or “probably efficacious” treatment for insomnia include progressive muscle relaxation, biofeedback and cognitive-behavioral therapy.  This recommendation is supported by several meta-analysis indicated that an average of 5 hrs of psychological interventions produced reliable improvements in sleep-onset latency and time awake after sleep (7). 

 Attention and Performance

In addition to relaxation and cognitive-behavioral therapies, cranial electrotherapy stimulation (CES) has been shown to be beneficial for specific therapeutic applications.  Recent studies have suggested beneficial results in the treatment of anxiety, insomnia and increased attention.  Some of the most convincing results for the reduction of anxiety have been shown in patients undergoing routine dental procedures. This double-blind placebo-controlled study used both patient and dentist evaluations to measure relative levels of patient anxiety (8).  In another double-blind placebo-controlled study, participants suffering from fibromyalgia showed significant improvement in their rating scores for quality of sleep (9).  Although there have been numerous anecdotal reports for CES enhancement of attention and ability to learn, a recent study has documented these results through the use of standardized performance tests (10). 

It is clear from recent reviews of the literature that relaxation, biofeedback and cognitive-behavioral techniques can be effective adjuncts for the treatment of a number of physical conditions.       

References

1. Astin, JA, Shapiro, SL, Eisenberg, DM and Forys, KL.  Mind-Body Medicine: State of the Science, Implications for Practice.  J. Am. Board Fam. Pract.  16 (2003) 131-147.

2. Holroyd, KA and Penzien, DB.  Psychosocial interventions in the management of recurrent headache disorders: Overview and effectiveness.  Behav. Med.  20 (1994) 53-63.

3. Haddock, CK, Rowan, AB, Anrasik, F, Wilson, PG, Talcott, GW and Stein, RJ.  Home-based behavioral treatments for chronic benign headache: a meta-analysis of controlled trials.  Cephalalgia 17 (1997) 113-118.

4. Holroyd, KA, O’Donnell, FJ, Stensland, M, Lichik, GL, Cordingley, GE and Carlson, BW.  Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy and their combination: a randomized controlled trial.  JAMA 285 (2001) 2208-2215.

5. Lorig, KR, Mazonson, PD and Holman, HR.  Evidence suggesting that health education for self-management in patient with chronic arthritis has sustained health benefits while reducing health care costs.  Arthritis Rheum. 36 (1993) 439-446.

6. Van Tulder, MW, Ostelo, R, Vlaeyen, JW, Linton, SJ, Morley, SJ, Assendelft, WJ.  Behavioral treatment for chronic low back pain: a systematic review within the framework of the Cochrane Back Review Group.  Spine 2000 (25) 2688-2699.

7. Morin, CM, Culbert, JP and Schwartz, SM. Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy.  Am. J. Psychiatry 151 (1994) 1172-1180.

8. Winick, RL.  Cranial electrotherapy stimulation (CES): a safe and effective low cost means of anxiety control in a dental practice.  Gen. Dent. 47 (1999) 50-55.

9. Schroeder, MJ and Barr RE.  Quantitative analysis of the electroencephalogram during cranial electrotherapy stimulation.  Clin. Neurophysiol.  112 (2001) 2075-2083.

10. Lichtbroun, AS, Raicer, —MC and Smith RB.  The treatment of fibromyalgia with cranial electrotherapy stimulation.  J. Clin. Rheumatol.  7 (2001) 72-78.