Mind-Body-Spirit Medicine

[Music] my name is Kevin barow and I'm a physician at the oer center for Integrative Medicine um I'm director of mindfulness programs there and I'm also a physician in the clinic um practicing integrative medicine and tonight um we've got this topic that I love um and I hope you'll enjoy it with me um there's a lot we can do I'm hoping it'll be interesting and some fun and um and I hope to have good dialogue with you along the way as well um do you normally take a break or is it just all the way through okay all right let's do that then and um if at any point you can't hear me or something raise your hand cuz I'm this thing's in my back pocket and if it if it cuts out let me know um all right let's jump in let me show you um an outline of what I'd like to do talking about mindbody medicine Mind Body Spirit medicine um first of all the history and definition how how how would you define this I think we all have sort of an intuitive sense of what this is but um it's fun to sort of think of it from different angles and also what's the history of this there's also a lot of different lines of evidence that the the mind is affecting our health and vice versa the body affecting the mind and that's really um I think surprising to go through and see and then my favorite part the clinical part is actually look at some of these therapies meditation biof feedback and um review some of the studies that prove that these things work or don't work and then at the bottom here and I know I know for the video thing I'm not supposed to stray too far from the podium but it's very much my nature to be moving around so um I'll try to keep on a short leash um but this this era 3 medicine this is an idea of Dr Larry dossy um who's an author I'll explain more as we get to that part of our talk and it's just really interesting it's a really fun thought experiment that we can do together that's very relevant to this and then try to come to some conclusion and and have a discussion so you know as I think about this topic the thing that impresses me just a few General ideas one is that it's just everywhere and I think of all the different clinical settings I've worked in and even not even in medicine just in life um I feel like I think we could pretty much all find an examples of this in our own lives where your mind and body um it's it's very apparent that they're influencing each other you can think of times when you've been very emotionally um agitated or maybe feeling very emotionally well uh or maybe uh the body was ill and what effect that had on the mind or certain medicine you could take and how that can affect both body and mind so I think even in our own lives we can see that this is everywhere it's also not completely understood uh that's an understatement um it's and actually it's part of the reason I think that it's very exciting this field it's mysterious in this way and it's also the parts of medicine that I especially like I feel like maybe are attributable to this this phenomenon of Mind Body Spirit medicine you know you've all heard stories or maybe you've lived a story where the doctor someone say oh the doctor said I had six months and that was 10 years ago this kind of thing or or if you if you haven't heard such stories go to um there's a uh famous conference called cancer as a turning point it's a very large one they just had it in San Francisco last year and um it's mostly cancer survivors and and clinicians involved with Cancer Care and Family members of people with cancer and uh the stories are incredible just the woman who runs it uh is up there and she's you know amazing she had breast cancer with eight recurrences and each time you know with this horrible prognosis and yet there she is you know 12 years later so um there's something mysterious going on and it's good and I also think that some of the really human and humanistic aspects of Medicine come out of this um kind of mysterious phenomenon our capacity to transcend our circumstances our outward physical health circumstances I think uh this is this is what we're talking about um you might have heard the the old uh notion the distinction between healing and curing um that um and you might have known people or you yourself have gone through something where the the disease or or whatever is not not completely cured or or removed and yet the person can find uh deep deep wholeness deep healing even though not cured so this area of Mind Body Spirit medicine I think is very rich very hopeful um and to me it's it's one of the most attractive parts of of healthcare so I feel like you know I wasn't there uh how many hundreds of thousands of years ago when um Homo sapiens started but I really believe that this kind of relationship must have always been present in fact it might not just be humans it's very possibly animals as well I don't know but um I feel like talking about how the mind influences the body and how the body influences the mind this is uh almost certainly been present ever since the very beginning even even preverbal uh man I would I would posit however for our purposes it was in the 1950s really but 60s when it kind of went it came out of Academia and was actually um part of uh something that we would experience in the general public uh there was this Renaissance but let me put something in perspective first um the reason we had to put the Mind Body Connection back together is because we took it apart um and most other um cultures uh uh and and and actually if you look at um if you look chronologically at human history um the vast majority I mean it would probably literally be something like 99 99.5% of human history um mind body that concept uh wouldn't have even existed because it would just have been inherent in the whole notion of healing and even today where we have had this split that we're bringing back together most cultures I would say on the planet right now most people are using systems of healing where this notion uh has always been present so here's a here's a um a medicine man from I don't know which Plains Indians I don't know which tribe um this is a female uh Shaman from um maybe Nepal um I love the caption on this one struggle of a mahot against death when you go to your doctor this is not what happens you know this he's grabbing you and your your it's you know you got allergies it gives you a nasal spray or something um so this I love the drama of this this is the doctor I want to be here's a very happy Shaman from Namibia um I believe this one's from Guatemala another Plains Indian um very moving photograph holding the the buff skull uh to the spirits so really just to remember before we start talking about you know guided imagery and all the little things we're so excited about in the last uh 50 years here in our system really the rest of the world and and and even our ancestors for most of History um this split was was never made so back again so so in the 60s is really when this uh first came out of Academia and really caught uh interest and you know it fit in with everything else going on in the 60s um empowerment and Awakening and New Frontiers so let's get to a definition now um I think most of us if you don't examine this this um you know deeply and someone just says well what do you think mindbody medicine is you'd probably say something like this well it's when you do something with your mind that influences the health of your body and that's that's a fine definition um it's it's a good working definition to start with but I well let me also point out um all right the NIH definition I must have cut it out of here is is also unsatisfying um it's it's a it's a um definition of exclusion it says something like mindbody medicine is um or mindbody therapies are um therapies uh with behavioral psychological or spiritual um orientation not commonly used so that's that's really just a big catch all basket not not things that are commonly used um that's an interesting definition too because it's fluid you know once something becomes commonly used it wouldn't fit in the definition anymore but the limitations to thinking about it this this way and and the NIH definition is it's dualistic for starters so mind body so even that term Mind Body medicine so already just inherent in that term the mind is separate from the body let's talk about how they're related see already we we enter into the language that implies they're separate so let's pretend whenever I say Mind Body today um there's a hyphen between them and it's one word Mind Body that's the best I can do um there's also another um something we're missing in this traditional definition and that is the directionality so yes okay my mind can affect my body but what about vice versa we all have experienced with this there's a lot of good scientific literature on this too you can do things with your body that influence your mind so very simply um aerobic exercise reduces depression that's an example by and actually affecting levels of neurotransmitters um if you've done yoga you know you feel very lovely and very different after yoga and so what's going on there so we're doing something with the body that's affecting the mind so it's it's um it's not separate um the worst joke about this is the mind and the body are linked it's the neck um but I think to think of it as just one unit okay let me give you some some quotations and you guess who's saying this these are these are these are my my um professional elders and they're they're saying uh what we're saying so who might have said this you ought not to attempt to cure the body without the soul for this is the greatest error of our day in the treatment of the human body that Physicians separate the soul from the body what do you think oh oh is it in the handout I oh man I asked them not to do that okay don't look don't look don't look anymore see oh you okay what you would have said if you didn't have the answer is someone more contemporary you would have said um you know I don't know not Aristotle even more contemporary than that so you know because it to me this quotation it sounds oh yes this is um you know um you know you could hear this from a doctor these days right um so all right so stop looking at your notes all right how about this one for those of you who haven't looked at your notes the separation of Psychology from the premises of biology is purely artificial because the human psyche lives in an indisoluble Union with the body really good guess who would be after Freud your next young young it's more important to know what sort of person has a disease than to know what sort of a disease a person has this is often attributed to Sir William Osler but it actually goes back further hypocrates so this is not a new idea you know the father of of Western medicine hypocrates so so this is not a new idea is it um that's my point with this and I really feel like it's it's been it's been present probably it's just inherent in who we are as organisms and how we how we uh heal so let's look um at some of the evidence that's I think really interesting and before we look at some of the clinical matters so there these different levels of evidence um um and a lot of this material that I'm about to present I got from i' I've looked into it um independently but but it's put together in um John kabid zin's book full catastrophe living if you know that book so there's these different levels of evidence the way we think that that can be affecting our health our emotions that that could be affecting our health the level of social uh expression social engagement that we have that that's affecting our health and finally our um expression of spirituality the all at these different levels sort of going from the most sort of personal private that is your thoughts to the outward community in terms of the society and um religious group um and there's also some miscellaneous medical phenomena that you're familiar with that I'll I'll present as another line of evidence okay so first of all just just a few things um uh in terms of uh examples of this that are you know just off the top of my head that I think you'll all recognize so the placebo effect we're familiar with that normally it's been treated in science as a nuisance because we want to see if our drug or our therapy works and darn it that placebo effect that works too so we have to make sure our new therapy does better than the placebo so it's always been this kind of nuisance thing um and and it's been studied independently um along the way for years now but I think Integrative Medicine um which this series is sort of tackling topics in Integrative Medicine integrative medicine as a field has especially embraced this and there are there's a lot more act research activity now in this what is the placebo effect how does it work and you know it's it's a completely different perspective to look at it instead of a nuisance like we have to prove that it works better than aspirin or rather we have to prove that our aspirin works better than the placebo um it's my goodness Placebo works that's great that it's certainly a safe medicine and so how's it working how can we how can we optimize it I should have put a cartoon in here that I have I just thought of it um the guy goes to the pharmacist and uh let think how it goes um it's kind of funny too because the pharmacist is way up the counter is way up high and it's almost like this you know and the patient's there and the patient's looking up and the pharmacist says um says all the medicines are very cheap here because they're placebos or something like that so the placebo is very real in fact in some St it's typically you know it's this is a broad stroke um generalization but um 30% effect 30 30% better or 30% of the time you'll get better with Placebo but this varies and it goes as high as 80% in some studies um particularly I remember studies of knee um osteoarthritis of the knee there's I remember reading a study where there was a therapy a topical uh therapy um and um the application of the placebo yielded an 80% benefit and I think that's because you can imagine there's more uh sort of um psychological effect that you're actually touching your own knee you're rubbing this thing on your knee and you're wanting it to be better and you're thinking maybe this is a you don't know it's the placebo you maybe this is a really good medicine and so that placebo effect was especially strong but really in almost any situation there Placebo surgery you know if you if you if usually this is unintentional but you can you put under and um everything uh leading up you go through preoperative evaluation you do the whole thing and you're put under no surgery you're brought out and you're a certain percentage of the time you're better I don't know specifically the studies on that because usually like I say it's a mistake you know that something's gone wrong so they can't do the surgery so it's not like someone has embarked on a on a study to say okay let's look at all the let's look at all the part this particular surgery type and we'll randomize people to really get the surgery in these ones we won't really give it to them that would be unethical so but so as it as the data presents just from um just from you know trial and error of of clinical medicine there's evidence for that cyto kindes are chemicals that your cells uh secrete to to to um communicate with other parts of the body other cells and nerves and um uh I'll use interferon as an example interferon comes from your white blood cells and but we've also now produced it um with the the advances in um Rec combinant DNA technology so that it's a it's a medicine and it's useful for uh hepatitis uh chronic hepatitis and other things so here's here's a chemical that your own body makes so you get you get a virus say you get infected with a cold or flu your white blood cells get very excited and they do s all sorts of things one thing is they secrete this interferon the interferon has specific effects on how the white blood cells are going to behave that are beneficial presumably to you fighting that virus but the interferon also causes depression it makes you mood go down and isn't that your experience like when you get the flu or or something you know you you kind of you don't want to go to parties do you you know you want to just sort of just kind of crunch down and stay alone for a day or two um so it's It's You could argue it's actually adaptive I don't know but it's so interesting that this this this um well it's a medicine and it's it's a natural cyto kind is affecting your mind and of course you've taken medicines I'm sure before I mean even just like badril or something think it'll sedate you or it can even change your uh your personality a little bit so it's very obvious uh that um this is one package here Mind Body there are lots of medical conditions too where the you where it's it's sort of well known and documented that um your State of Mind actually affects the disease process so irritable bowel syndrome is one where this is common and these are generalizations I'm not saying every case of irritable bow Etc um there are a lot of dermatologic conditions like eczema and psoriasis where your emotional state can affect the disease and again it's not every patient but it's common and it's and if you do a study it's happening to enough patients that it's showing up in the study autoimmune diseases as well so um those are just some miscellaneous examples of how how this mind is connected to this body now I'd like to examine these different levels and and by the way my slides here are going to be that's occasionally a little bit different I made some changes since this came out so there's just a few couple of typos were corrected and I've added just a couple of things um oh and by the way there are more quotations at the end of the talk so don't look ahead and see who made the quotations so so first of all the fact that the way you think can affect your health we'll do that one first then we'll look at how your emotions affect your health and then we'll look at um uh social and spiritual so attributional style we know this as pessimism pessimistic and optimistic those are attributional Styles the so so you know we use those terms in in our lay language but they have specific psychological meaning uh for the research psychologists so I'll give you an example the distinction um there are three well um personalizing generalizing and catastrophizing are three um habits of mind that will distinguish the two the pessimistic and the optimistic attributional style so personalizing let me give you an example um say say right now my computer goes out here it just goes dead and we lose the slides personalizing would be um oh God this always happens to me I have such bad luck you know my my life is such a struggle and da d d da um and you can imagine that's that's going to create lot of suffering um uh generalizing is taking this and then assuming everything is so for example the slides go out oh no you know I wonder if the lights maybe the TV's not going to work and the mic's going to go dead and people are going to start throwing Tomatoes or something so um this idea once one thing goes wrong and your mind has the habit of well now you know maybe now everything's going to go wrong and then catastrophizing is a similar phenomenon where um the slides go out and I immediately go to the catastrophe oh that's it the the lecture it's going to be a bomb there's no chance it's going to be hor you know um so doing that is is are characteristics of the pessimistic attributional style not doing that or characteristics of the optimistic uh attributional Style and what I'm about to describe these are these are correlations and we have to be so careful about causality and correlation in fact if there's one thing I like to tell people when you're reading you know the newspaper and The Time Magazine and all this the 's a lot of what I call pseudo science and um and you just it just there's it's never ending it's just um uh don't you wonder like in the newspaper you read about all these incredible studies and stuff and then nothing ever comes of it right um and this is why two things can be correlated and not necessarily have a causal relationship causal relationship is a much more profound relationship so here's the example you always learn in medical school um if you uh did a study of who are carrying matches for lighting a fire who are carrying matches in their pocket and then follow them and see how many of them get lung cancer you'd notice oh people who carry matches are more likely to get lung cancer that's accurate but it's not accurate to conclude matches cause lung cancer right it's the smoking so so there's a there would be a correlation between match carrying matches and getting lung cancer but there's but it's not necessarily causal so these are these are correlational um you're pessimistic or or optimistic attributional style if you have cancer it correlates with your um life expectancy so in other words um say I have uh lung cancer and my twin Kevin here has a lung cancer and he's the pessimist and I'm The Optimist um typically you know you want to do this on on a larger scale like take a thousand such Kevin um but this the likelihood of the pessimist with cancer dying sooner is is significantly higher than The Optimist does that mean pessimism is contributing to death that that would be a causal inference and we don't know but but it's certainly very strikingly clearly observed also overall mortality so for all of us who are going to die um uh the attri there's a correlation between you're pessimistic or optimistic and life expectancy um and obviously depression you can imagine I mean someone with a pessimistic attributional style or when any of us has a pessimistic attributional style we're more likely to get major depression um there's a so that's one way in which your thinking is potentially influencing your health or at least is related another is this um another psychological construct um known as self-efficacy this was developed by I think I think Dr bandura at Stanford and um self-efficacy is mostly your sense of that that you can do something that you can make a difference that you can affect your situation so it's most striking in people who' have had a heart attack if they if you interview them if they feel like oh okay I've had this heart attack but I know you know if I improve my diet and if I exercise and I you know um attend to the the emotional relationships in my life you know I know I can live I'll be okay it's going to help if I do those things this sense of of um I can do something about this I can impact this correlates with uh fewer with less death and less repeat heart attack whereas the folks who feel like oh my God I had this heart attack there and there's like you know it just came out of the blue and you it it could happen again there's nothing I can do about this more more likely to die after their heart attack and you could say well if they don't think they can do anything then maybe they're not engaging in the good diet and the exercise and all that but but these these studies control for that so uh it actually appears possible that the way you're thinking about how well you how much control you have uh how much influence you have is is affecting your your actual uh lifespan sense of coherence is another one this was developed by Dr antonovsky I forget where he is anyway he looked at um concentration camp survivors from World War II and he found correlation there the ones who survived had a much higher sense of coherence and their sense of coherence is um has different characteristics but I say the central one is meaning the people that could find meaning in what was happening survived more so you know who knows it be you know can you imagine I mean that's sort of extreme situation but um you know to to find some meaning in it what maybe it would be uh oh this is you know this is this is God's test for me or or you know something like that where you can put it into a context that has some kind of meaning for you that's correlated finally uh this another psychological construct called stress hardiness this has three elements to it control commitment and challenge control is very similar to to the self-efficacy bandura's self-efficacy idea the fact that you could actually have some control over your future uh commitment is the the sense of how how committed you are just to the things you do in your life like do you you know your work and your relationships and just do you feel this is important I'm I'm engaged in this that sense of commitment and finally challenge um this almost fits into the pessimistic optimistic attributional style but when when uh when something happens unexpected which is you know so many things do you see it as a challenge or do you see it as oh no and you know here's a problem here's a disaster here's so seeing it more as a challenge as something that can be that has opportunity and that can be overcome and can even improve things that's uh that was that's one of the characteristics of stress hardiness and in this in these studies they looked at people who had stressful jobs um well really stressful jobs and um and they watched them over many years and their health outcomes and the people who scored higher on these three who had greater stress hardiness control commitment challenge um had much less uh detrimental Health outcomes than the folks who who scored lower and stress hardiness so it's pretty pretty um pretty strong correlational I don't know if you really could ever do a causal you know this kind of experiment was almost impossible to do so this body of evidence and more you know that I don't even know about probably is uh is pretty compelling I'd say it's just it's quite clear so that's the way we think how about the way we feel our emotions well for many years the research was all on how negative emotions affect your health negatively and that's we have lots of uh evidence for that now let me take a sip of water and then we'll talk more so um Dr Meer Friedman was a cardiologist here in San Francisco he was at the Mount Zion on campus I don't know if any of you knew him or heard of him he was famous for this was in the 70s um uh he was a cardiologist and and you know I think heart disease was uh I think in terms of its toll uh it's still you know the number one killer but I think uh I just remember reading you know uh learning about heart disease in the 70s as being very just devastating like we didn't know every you know it was it was just epidemic we weren't making progress like we are now with it and you know it was occurring at a younger age and it's very severe and lots of deaths so there was this um kind of scary uh uh epidemic hitting home especially and Dr fredman was noticing wow a lot of the patients with these poor heart outcomes these heart attacks and such I'm noticing they're very uh you know aggressive hostile kind of personalities so I wonder if that is contributing somehow to the heart disease and he did studies correlational studies that showed Oh Yes actually it is and then over time now it's been refined the psychologists you know teased this out because they found people with that sort of profile of hostility that that were not uh having increased heart disease so they teased it out and the hostility had different different elements to it this type A personality I'll call you know that term this type A personality had different elements to it it was the hostility element it wasn't the hard drive driving or the impatience or the other parts of type A it was the hostility so sort of being perpetually angry uh that's the one that is is most clearly correlating still to this day with increased heart disease um and that's the development of heart disease so um the next thing I'll talk about is is what this would be called what's primary prevention of heart disease or primary development of heart disease rather than secondary meaning you've already got it now how do we prevent you from from it getting worse from you dying from it so so hostility increases heart disease depression and this is more recent um but very solid uh research data on this both primary and secondary heart disease is worsened with depression so if you're depressed you're more likely to develop heart disease and if you're depressed and have heart disease you're much more likely to die of the heart disease than someone who has heart disease and is not depressed three up to three and a half times more likely in some studies this is huge um this is this to me is one of the most doctors who who might not be as attentive to this Mind Body idea know this this is like this is this is a very striking and and since cor aryy disease is such a a major medical entity in our country this is noticeable uh by by everyone more recent and very interesting are the study of positive emotions so we know negative emotions can negatively affect your health can positive emotions positively affect your health um probably yes so there's a a study called the nun study um where they looked at 180 Catholic nuns somewhere like Pennsylvania or something and when they went into the monastery they had to write lengthy um part of their intake process and they're interviewing everything was to write this very lengthy um essay and answer these questions and some researchers uh scored all those essay this you know 60 years later some researchers scored all those essays for positive content so they'd pull you know Janes uh essay and and how they describe um negative events in their life um how they looked at coming into the monastery you know and they would objectively as possible uh score it for for how positive it sounded and then they looked at um mortality for these women 60 years later and people the these are all like in their 20s the average age was 22 when they did this um people who scored higher in the I think they broke it into quartiles into fourths the highest fourth the people who were most positive were two and a half times more likely to still be alive 60 years later and the ones who are in the bottom quti who were kind of negative in their essays at at that early age were more likely to be dead two and a half times more likely to be dead so that's that was an eye opener for people there's another study much larger over 2,000 patients of Mexican American Elders in border states like California Arkansas and or sorry Arizona and um Texas I think and um they only followed him for two years but already they found an effect and it's the same idea they did interviews and they gave them a a um a questionnaire known as the the cesd so for those of you who are clinicians that's the center for epidemiologic studies depression scale which has some positive affect questions and negative affect questions and the overall score we use to to assess depression they they interviewed these elders and they scored them on the cesd and uh then they follow them for just two years and in two years they found again the ones who who sort of reported their life experiences more positively were less likely to be dead and much more likely to be independent still uh this ADLs that's some um a medical term activities of daily life the really basic things you need to do to be to live independently like uh you know uh feeding yourself and getting to the toilet and being able to walk a short distance so that's another impressive study and then one of my colleagues at the oer center um Judy moscowitz she looked at uh this is San Francisco me San Francisco men's health study um which was a study of men who are HIV positive and and followed them I think four 400 men um and followed them they also did this cesd which which is a scale that has some positive questions and some negative questions and Judy went back this data had already been looked at and they showed Oh yes depression correlates with with development of AIDS and dying from AIDS so that was impressive the Judy that just took out the positive questions and it turns and then and the negative ones she separated them and it turned out it was the positive aect that was protective it wasn't that the negative aect was harmful so let me explain so for The Men Who reported uh in in this scale the ones who measured more positive were less likely to be dead 3 years later even less um the um the ones who and then there there was actually no difference on the negative subscale of the cesd so presumably the positive affect was explaining the whole effect uh of these men uh living or dying with HIV Okay so we've done thoughts how thinking affects your health emotions how emotions might affect your health so now we'll go sort of to the next level and that's social so we know people again this is not necessarily causal um but unmarried people have more health problems and die sooner than married people it's just a fact so that's one sort of superficial uh correlation um more in-depth research has been done and so first the studies were well let's look at the number of social relationships people have and clearly people who were socially isolated were more likely to be be ill and die um and then someone said well wait maybe instead of the number of social relationships we should be looking at the quality of the social relationships they so they did that and that was also positive so it seems both correlate uh with health and finally uh I'm I love dogs and so if you um it turns out if you're a dog owner you live longer after your heart attack um there's I found when I was reviewing for this I I did find one study that refuted this from Australia um but it was um there many more studies showing the positive correlation people with animals uh maybe the the inference the implication is just that relationship is enough to to um Foster this effect of social connection improving Health when you do this when you search for this in the U in the the the PubMed Library System pet what you'll mostly get positron emission tomography studies um so you have to put in like pet doggy or something um okay actually an actually if you really want to do search I think it's called Animal Companions and that'll bring up all the research on this so how about again at a more communal level how our relationships with one another affects our health um and I know Dr rabo gave a great lecture on this I didn't go to that one but I've heard him do it before and it's very thorough and um so all I'll say about it is this simple fact that frequency of religious attendance correlates with health okay so that's that's that's a surrogate marker right for spirituality because maybe you're going to church or Temple or mosque out of guilt you know or out of obligation I mean there might be not good reasons that you're going um but but if you just take allc comers everybody who's going the frequency of religious attendance actually predicts uh health and the NIH even says specifically with with these um these conditions the correlation been shown um again it's it's a very crude marker um and as we know Spirit spirituality can be very different than religion um but it's just it's just a uh a kind of a a crude snapshot measure to look at this issue um I would also say these studies are controlled people people who um adhere to a religion more often don't don't have such negative health habits like drinking smoking UNS unsafe sex so um you those are controlled for uh and still this correlation is found I was told that we do questions at the end is that in the format or do you want to that's what it's okay okay so so that's the evidence um some of the evidence for how our health is being affected by these mental emotional spiritual um Dimensions let's go to these actual therapies that try to exploit this relationship so like meditation and biof feedback and hypnosis and stuff in fact I'd like to do a meditation with you let me 745 Let's see we have until 845 okay so we'll do a brief very brief meditation um so first of all the definition I love this definition the self-regulation of attention so you can do whatever you want with your attention like right now you might be paying attention to me or you might you might be thinking about you know dessert or you might be thinking you know or you could be you know looking at the something else I don't know um but this where you put your attention is is very powerful and is is in your control so meditation is just you regulating what you do with that attention in a more kind of disciplin away there there are different kinds of meditation I won't get into mindfulness meditation um and concentration meditations are the two major categories when you look at all the studies that have been done on meditation for health conditions um far away mental health is the one that is very obviously positive specifically major depression anxiety disorders but also chronic pain and what's interesting here with chronic pain is when you look at the chronic pain studies some some people get less pain yay some people don't get less pain but they get less suffering that's that to me speaks a lot about meditation so so even if it's not necessarily changing the outward circumstance that's causing distress it changes the inward response to that external so we're we're sort of addressing more the internal response to the external circumstance which we know sometimes we can't control those external circumstances um cancer and I don't mean Here length of your life but rather the quality of your life with cancer sleep fatigue um a lot of emotion anxiety depression anger um so let's do a little meditation right now and so for the the video thing I'm going to I'm going to stray here so just so you know so this will just take I don't know 5 minutes and I'd like you to just find a position that's comfortable for you and I'll use my magic bell here to to start us and to end and at the end I'll I'll hit it three times a little bit louder each time so we can sort of come out gently um so here we [Music] go so if you're comfortable closing your eyes right now that's that's the best way to harness uh your full attention and let's start let's bring our attention to the most uh basic aspect of our experience the the body the physical experience of being here so just bring your awareness to your body just feel your body it's that simple you can feel for example where you're pressing against the chair you know your buttocks bearing weight your back touching the back of the chair perhaps and the trick with um meditation is we're trying to develop a sustained attention so for example let's go to the feet and feel the the feet touching the flooor um I think normally we're in the habit of mind where we just go there feel the feet for a moment and then our mind wanders off feeling like it's accomplished what it was supposed to but for now I'd like you to go to your feet and let's stay there for a few seconds or longer if you can see if you can get into it with great sensitivity and discover the the Nuance of experience for example is the weight distributed did evenly foot to foot or even just within one foot just something just a subtle question you can examine by feeling your feet as they contact the floor right now and then um due to time I'll just bring us now to sort of the whole whole body so we were feeling the buttocks and the back and the feet but see if you can just get a sense for a moment of the body is a whole if you notice any tension that you want to let go of please do but unlike when we're preparing for sleep we'll let the body be at ease but we're going to try to keep mentally alert it's a very um interesting and can be pleasurable State we call restful Al alertness letting yourself be at ease letting the body relax and yet the mind is still sharp feeling this body as a whole maybe you can notice your pulse in different parts of your body maybe you can feel the quality of En energ maybe there's a tense vibrating energy or maybe maybe you're tired and it's a heavy solid energy when we get distracted by noises or by other thoughts or physical Sensations we just remind ourselves to come back and now instead of just the body I'd like us to come back to the bread breath so feeling the the belly feeling the breath in the belly again with a sustained attention really feeling the whole process of breathing the whole breath cycle your mind almost certainly will wander and so you just come back to the belly to the breath you don't have to breathe in any particular way you just observe you just feel this breath breathe itself before we leave the breath I just want to um offer something experienced meditators claim that no two breaths are exactly alike there's a subtle difference in some way from one breath to the next see if that's true in your experience right now as you're observing the breath in the belly and then before we leave the breath one more question to sort of heighten your awareness assuming you're breathing through your nose Can You Feel the exhalation current coming out of the nose and touching ing the skin above your upper lip is that possible for you right now and then when you're ready will make one last transition paying attention just as we were to the body now to the mind again and not trying to change anything we're just here to observe and experience so just noticing in the emotional realm anything that's present are you irritated are you contented are you happy are you sad neutral just noticing not needing to change anything just [Music] noticing similarly your thoughts just noticing are they thoughts about as as the mind has wandered inevitably during this exercise where has it wandered or two thoughts about food thoughts about work about friends or family it's interesting I'll ring the bell to end soon so I'd like you to come back to your breath and just let go of everything that we've done you you don't have to hold on to anything you don't have to remember anything or plan anything or write anything down just come back to the very very utterly simple experience of just feeling your breath in your belly for these last moments [Music] e and if you haven't already opened your eyes you can open them now and bring your awareness back to the room let me take two minutes of our question time and insert it now and just hear anything about your experience with that anything at all honesty please anything you noticed or was interesting to you yeah good I I um it's not always so some people might not have had that um any individual meditation anything could come up you know um but overall it's tends to be relaxing and and we're not going to have time to get into this but you might already know the the sympathetic and parasympathetic limbs of the nervous system the sympathetic is the fight ORF flight one that gets us all ready to to Run for Our Lives um the parasympathetic does the opposite it It prepares us to sort of uh rest and restore and nourish and um when we meditate this is from data in the 70s um our parasympathetic nervous system is stimulated and our sympath athetic tone decreases so we literally relax our muscle tone decreases our respiratory rate slows our metabolism slows yes yesen and we just had like you know so much time left so they did a meditation and then we never got to to De with stuff so I mean I enjoy it but I've just seen it you know I yeah so the um you might have noticed in this meditation there was no directive except to be aware in other words um this is a fundamental thing about about at least mindfulness meditation um we're not trying to actually do anything um we often talk about being versus doing we spend most of our waking hours doing doing doing and so meditation is more being so there was no I wasn't unlike the other therapies I'm about to mention there was no uh specific goal really you didn't have to relax and you didn't have to do anything except try to be aware and even if your mind is wandering well then you're aware of that so you pretty much can't lose and I'm not asking you to do anything it's really just an invitation to step into your present moment in your awareness um whereas the next therapies let me let me use that as a segue uh oh first first of all you know it's meditation is big now so here's a lot of things I've noticed lately I'll skip these um so say for example um biof feedback although the the nurse I work with at um the osher center she does this very skillfully with a kind of psychological um approach where it's not necessarily always trying to achieve a certain end but typically biop feedback is used in that way for example uh you have migraine headaches and you want to go see the biof feedback person to learn how to reduce those migraine headaches you know that's very clearly what you're trying to do and so the therapy is used to try to achieve this outcome very very deliberately um so the meditation is different that way anyway so what is bio feedback um it's a system whereby some function some physiological function of yours is measured by a computer and then fed back to you um and the exciting thing is by doing that we can perhaps gain control over functions in our nervous system that were not previously under conscious control so for example um Teresa who I work with at the oer center she can measure your muscle tension there's a little thing that um when your muscles contract they emit a little bit of electricity so you can put on an EMG Monitor and and we can see so for example she typically puts them up here because when people are stressed you know they're like this um and so that helps people determine like say someone has chronic neck pain or something she can help them they can see on the computer screen oh yeah my right shoulder is you know very is very tense my left one's not and they can start to in their mind relax it and then they can see oh yeah it's working so there's that feedback thus the term biof feedback um if oh I should mention besides the muscle tension also skin temperature which is a a Sur get for how stressed you are like when you got relaxed probably you got a little bit warmer and so the bio feedback would would tell you that also your heart rate your heart rate variability which is a is a a measure of how your sympathetic and parasympathetic nervous systems are are ultimately balancing out how how what's the overall tone um uh what else uh brain waves can be measured uh that's called neuro feedback um uh U not not so much research on that yet um um also um oh galvanic skin resistance which is how much you're sweating which you say well I'm not sweating well you are microscopically you are and that's a measure also of how stressed you are the more stressed you are the more you sweat so um as the resistance goes down that means you're getting more stress so Teresa hooks you up and it's all on the computer and sometimes it's it's it's um especially with kids it comes back it's a game it's not just like numbers you can do that too but it can be a game you know and like you're in a hot air balloon and the more relaxed you get the higher up the balloon goes and if the more stressed you get the balloon starts to come down and gets stuck in a tree or something so using biof feedback in medicine here's what's been shown um and this is done not at our Center but at at the um uh also at the Mount Zion campus um um feal incontinence and um uh let's see if um actually it's not here but urinary incontinence also is effective for this um there's certain kinds of constipation actually where it's due to chronic constipation where it's due to the pelvic floor the muscles of the pelvic floor they don't relax like they're supposed to so defecation is actually a complex process that requires some contraction of the colon some relaxation of certain muscles in the pelvis and contraction of others and so if that's not all done in a coordinated fashion uh then people have chronic constipation so bi feedback is effective for that kind of constipation in uresis this is bed wedding and kids you might know the bed wedding alarm it's a very it's a very simple bio feedback system really home biof feedback um blood pressure controversial people argue about this I I I've tried to review everything I could on this and I feel like um the the when people really put all the data together there is a positive effect for hypertension it's small but it's significant and every every millimeter of mercury counts when you're treating hypertension uh some some pain and um rods phenomenon which is a a contraction an exaggerated contraction of the arteries in your fingers um it cuts off the blood supply with biof feedback um you can uh relax those arteries open and um not suffer the consequences of rain outs um let's see what else I want to say bio feedback oh you can do it at home now because all the technology that we're developing so you can put a biof feedback programming on your laptop um it's there are two popular programs out there $300 300 think one's about 300 both of them and um you can do this at home you get a sensor it's the whole thing um it's not as elaborate of course as what we can do in the in the center but it's still pretty good and um a lot of people now they even have a little it's like an iPod version um where you can just measure a few things and so people travel I actually have some patients who are um you know traveling businessman kind and they have high blood pressure they don't want to take medicines and they're giving a try with these little things there's also a new um relatively new thing that uh um helps it's a bio feedback thing again it's like a little iPod that measures your breathing and and trains you you do this for 15 minutes a day it trains you to breathe in a particular way very slow with very long exhalation and that lowers your blood pressure at least six out of seven studies on it show that it does so more research would be better but but that's um I think that's like $200 thing so exciting biof feedback Works um I must say though it it in the 60s this was started at Yale in the 50s and then when it came out in the 60s people got so excited like wow we're going to be able to if you do bio feedback you can control like all these different things you'll be like the the the swamis and in India you know where they can you know completely shut down their metabolism for a month or something um it this this did not come to be true yet um bu feedback the the the drawback starts expensive um because you have to go back uh at least a few times but then you then you're train then you can do it yourself um and um it's finding use but not quite as broadly as we had but for these conditions um and actually Lots others these are the ones uh that are where studies of good quality have been done and there's a lot areas that haven't been studied hypnosis again here's unlike meditation we're trying to do something with hypnosis you know you have an objective and and the hypnotherapist is trying to help you achieve that objective hypnosis works by bypassing your critical discursive mind going right to the subconscious and it's nothing mysterious it's not like on the you know on the TV shows and the movies and stuff where you know snap your fingers and then you act like a chicken or something um this you do not lose control you're fully awake you get relaxed and focused and there's something about that state that makes the subconscious mind more um uh available more attentive to the suggestion so typically the the hypnotist will ask you you know what what what would you like why are you here and try to learn a little bit about you and then and it's preferable it's it's actually I would insist that the hypnotherapist be someone with um mental health psychology training because it's important to know the psychology of the person to give them the right suggestion that's going to be effective to sort of speak at that subconscious level so hypnosis has especially been proven in pain uh like things in procedures things in the hospital Burns changing the wound dressings on these poor kids get these Burns um also for people undergoing treatment for cancer the nausea anxiety and pain elements have been improved with hypnosis irritable bowel syndrome and uh something called functional dyspepsia which is basically um some disorder of the upper gastrointestinal system maybe the stomach or the esophagus but that's not showing up on standard tests you know you you you have discomfort um you might call it indigestion um but there's no it's not a it's not a reflux it's not an ulcer it's we can't we're not actually sure what it is this also can at least early studies show this response to hypnosis um guided imagery this this is I think you've all heard of this one especially in the context of again Cancer Care um using the imaginative capacity of the mind and a guided image recession it was similar to hypnosis um a guided image recession will try to recruit all your senses so you whatever image you're using they'll try to tap into your imagine what the smells are like and what it looks like what it feels like and what it sounds like and that actually does a little bit of research showing that actually enhances the efficacy of the intervention so um uh again in the in the in the hospital this is effective for people undergoing surgery and after Sur surgery um and other other causes of pain so guided imagery is especially useful for that people use it for all sorts of things and it hasn't been studied these these are all understudied so just because I list these three things doesn't mean gued imager is not useful for other things um I'm going to go a little quicker on this last two here taii and yoga so I like this twist somebody said well remember I was talking about the directionality of of uh if if we go with this idea of Mind Body and we fall into that dichotomy then um then uh taii and yoga and you know other such things are um Body Mind therapies rather than Mind Body Therapies because here you are deliberately doing something with the body uh and it's perhaps affecting mind taichi if you look at the research studies and this is very important for elders decreases fall prevention and fractures fractures are serious business you probably know people who've had fractures uh hip the classic things a hip fracture and an older woman with osteoporosis um that's that can be quite an ordeal uh because it's not just the hip it's um going into the hospital and getting out of the hospital that's that's a big deal and then the rehab my my U beloved grandmother had a hip fracture when she was in like 90 and uh it was quite an ordeal um taichi is is I love it um I I especially I'm director of the mindfulness meditation programs at the oer center and so I love ta it's a form of mindful movement you bring your full awareness to the to the movement of your body um it's very elegant gentle and yet it has these positive effects it's good for recovering if you've been debilitated or gone through a surgery or something um actually studies showing if you've had a dramatic if you had a bypass coronary artery bypass graft um it can help you recover from that great for stress reduction we have a a master at the ooser center doing this uh Joseph for 30 years um yoga the I love yoga everyone loves yoga but the studies are poor it's just starting now that to be studied in the west there are a lot of studies from India um most scientists here don't don't accept the quality the the level of rigor of those studies so these are conditions that have been looked at in India and shown to have benefit um in the US uh yoga research at just beginning there are four or five studies on back pain one of which came out of our Center and um which are promising so people with chronic back pain um might benefit from yoga it looks like um not to mention all the rest of us um and I can't help noticing I have a colleague of mine in the audience who does a massage therapy this would be another mindbody therapy um in fact some people are explicit about that and and practice what they call somatic Psychotherapy so working with the body and eliciting um psychological content that can be then worked with one word about integration because we're I'm at the oer center for Integrative Medicine um let's combine these things it works um the famous One Dr Dean ornish uh put together uh diet exercise meditation guided imagery and progressive muscle relaxation and different combinations you know we didn't know that heart disease could be reversed we thought I was taught this as a medical student you get a plaque that's it and it's a question of how much further the plaque progresses than you have your heart attack he was the first one in my knowledge to show you can reverse the plaque you can have an atherosclerotic plaque and it can regress and he did it with with mindbody therapies and and uh diet and exercise um Meer Freedman I'd mentioned to you already he he when he saw these type a heart disease patients doing so perly he decided okay well let's let's get some psychologists in here and try to help these type A people and he did and it helped um David Spiegel at Stanford a psychiatrist did a famous study um showing he he compared women with metastatic breast cancer to get their um Regular oncology care and then another group got their regular oncology Care Plus they were in a group that did self hypnosis and um and some group therapy there they lived 18 months longer on average than people in the um standard oncology group now so that's what striking in a lot of headlines and stuff to be to be fair about this this idea that these therapies could actually extend your life this is not established and this study by Spiegel there are pretty much by my assessment equal studies on both sides studies there three or four others like his showing wow you do these mindbody interventions people live longer and their studies refuting that same same design so open question I can say this for sure from all the other stuff I presented to you and just my own experience these mindbody therapies can absolutely improve the quality of your life whatever that is illness or where wherever wherever you are um and integrating um I think is really a lovely opportunity that we have right now so some conclusions and then I want to uh spend a few minutes on on just a thought experiment with you that that's really I think provocative and fun so this phenomenon of mindbody medicine it's just inherent to who we are it's just I think it's always been present and it's still present and we got away from it for you know 400 years and just put it back together and so we're all excited because we're back together um the way we think affects our health or or or is related to our health I'll be clear the um our emotional state is related to our health our degree of Social and spiritual expression also there are specific therapies some of which I reviewed with you that can be of benefit for certain conditions and I'm not try to use them for other conditions um most of these I've have uh very limited side effects I didn't spend any time talking about that there are some side effects you I wouldn't send everybody to a meditation class or everybody to to bio feedback you have to you have to select people and and there are some very small risks but there risks nonetheless and um the big message these can be used in conjunction you don't have to give up anything you can still do your good standard Western medicine and and add these things and get get benefit okay so now I want to talk about um let's just think together let's wildly fantasize together there there's we can do whatever we want there's no adult supervision it's just you and me and um I want to talk about this work Larry dossy is a physician who's editor of um well at the time he did this stuff he was editor of a um alternative Therapies in health and medicine and now he's editor of explore and he's written several books and that's in I think I was asked to make a bibliography and I put it I put it in your thing so these are his ideas but I'm just captivated by them so he says there are three eras of medicine the first era say most most of medicine is era one and it's mechanical or physical um and it follows the the the laws of of nature that we're so accustomed to to Newtonian physics and um you know the relationships of space and time that we're used to so I you know something it's mechanical so you've got a tumor I go in with my scalpel and I cut it out or um you have a bacterial infection I give you this pill you put it in your mouth and it goes and it kills the bug um very very literal occurring in time as we know it in space as we know it sort of very simple clear um uh radiation xrt is is radiation therapy physical therapy so basically all the stuff you think of about medicine you know straightforward makes sense no no mystery and um I would also say this that the scientific method that we've developed to study this is also constrained by is is era one is also constrained by by our Notions of of space time and Newtonian physics era 2 and I actually quibble about points but I'll just present his his view on this era 2 is Mind Body medicine which he says has happened in the last you know I don't know 30 years or so with the stuff that we spent most of our time on tonight um where this is beyond uh the basic physics now and it's and it's you know the Mind affecting the body um but that's still um it's still happening in time as we know it like I do something now and it affects my health now and maybe maybe in the future so the the time relationship is still as we expect and as we know um then he proposes um ira3 medicine so let me say something about this first let me say a couple of things so this is based on some findings in quantum physics and this has become a hazardous popular thing to do is to take quantum physics and apply it to like everything and and some someone wrote a good piece in the New Yorker or New York Times um calling this Quantum mysticism and the idea that yeah you know you can you can control the world just by how you think um and I I would I I disagree with that um halfway I I do think our thoughts influence things but um but I think people take it too far and um we really it's it's it's still ultimately a mystery and you can't control everything and as as much as you want to and you can't just take the principles of quantum physics and plop them into you know your your um you know your lunch break um so having said that let me describe first this word local and non-local so that the and and I'm no physicist so I can e just correct me when when it's appropriate um but um uh as I understand it um locality non-locality even so so we have Newtonian physics quantum physics and then this issue of locality or non-locality um is actually um potentially this is I know it's controversy about this but it's potentially challenging our Notions of quantum physics just like quantum physics challenged our Notions of Newtonian physics and an Irish physicist John Bell uh you know these guys always start with thought experiments and then later it gets proven you know uh experimentally Einstein all his stuff was was that was all in his head it was all thought experiment and then later we observe the planets and this and that and turns out wow he was right so Bell's thought experiment which later was proven experimentally um was or suggests this this possibility of non-locality so if you look at subatomic particles and I'm I'm as dumb on this as you but they have some characteristics some electromagnetic character they can have some electromagnetic characteristic called spin and two subatomic particles um that in relation to each other will have um uh complimentary uh Spin and it's just design at as plus or minus so imagine and it's always in in when you're writing it designated as an up arrow and a down arrow so these are two subatomic particles who have some relationship with each other and they have electromagnetic property called spin that's that's uh complimentary or opposite those if you if you separate those and change the spin on one the spin on the other one will change simultaneously not quickly or very soon but simultaneously okay so that's important so time there's no time there it's simultaneous the space question so the time uh Paradigm is question there space Paradigm is question because it doesn't matter where they are in relation to each other you can even put an electromagnetic barrier between them and it still happens which suggests that the whatever's going on between them is not happening in the way that we normally see things happen between things you know if I um there's there's there's no apparent transfer of energy so this breaks all the rules plus the fact that it's simultaneous means it's faster than the speed of light which breaks Einstein's rules and so this is this this was very um shocking and threatening but it kept coming up experimental data and um so and and then there's controversy about that and I'm not a physicist but that's just my Layman's understanding of it and so it creates this possibility that Larry dossy fools around with and that's what I want to do with you it suggests that there are um non-local forces that that we don't um we can't even imagine basically because you and I we have Notions of space and time that we're very used to because almost everything we do apparently is in space and time that's so you know it's predictable as we you know we like I know you know I'm so many I'm so far from you and if I hop skip I'll reach you you know I know the space between us or um I know you know I got to wrap up in so many minutes because we're all marking our time the same way and this sort of thing but this is totally different and so I know um Mike rabbo was looking at some of the studies for prayer and a lot of them are negative you know it's not very clear that praying helps people their health when you look at studies but doesn't that seem peculiar to you to study that it does to me because or at least to study it the way we're studying it that's Ira one method um if prayer is working or if any if the way I think affects you and vice versa I could imagine that happening somehow out of space and time I mean if if we're going to get out there let's just go all the way out there you know in terms of our thinking on this so era3 medicine is this this idea and it's just it's just a fun idea I don't I don't think we can say anything more than that that Consciousness is something we share and so it's a it's maybe maybe a medium between us it's like we're all in the same soup and whatever I do in the soup might affect you and vice versa let me let me develop this a little bit more oh let's do some more quotes too don't look in your thing um so actually this guessing the authors on this I won't we won't waste time on that but um Consciousness is a singular of which the plural is unknown there is only one thing and that which seems to be a plurality is merely a series of different aspects of one thing produced by a deception as an a gallery of mirrors is that some new age spiritualist on the street corner no it's one of the leading scientists of our lifetime how about this the the idea of a universal mind or logos that's the Greek term for this the Greeks had this idea would be I think a fairly plausible inference from the present state of scientific theory at least it is in harmony with it this is a British um uh physicist one of the one of the sort of grandfathers of uh this here's here's another partial quote and a little story a human being is part of the whole called by us Universe a part Limited in time and space he experiences his thoughts and feelings as something separate from the rest a kind of optical delusion of his Consciousness wow so I think I'm separate from you my body's over here after all and my thoughts and my feelings are mine and you know I don't even have to reveal them to you so I'm I'm clearly separate from you right well or is this an optical delusion and I I bring up this thing um I got from a meditation teacher um so that's the Big Dipper right and so here's the universe of stars and we look up and there's the bazillion stars and we say oh there's the Big Dipper but it's not really a big dipper right it's not a big like gravy Ladle in the sky it is just the way we we've made a convention that okay that we'll put those stars in a group and call it the Big Dipper and then when I say Big Dipper you'll know what I'm talking about but if you but that's that's totally arbitrary so this quotation it's the same idea a human being is part of the whole a part Limited in time and space he experiences his thoughts and feelings as something separate from the rest the Big Dipper is separate from the a kind of optical delusion of his Consciousness so I I like that let me finish the quote um a kind of optical delusion of his Consciousness this delusion is is a kind of prison for us restricting us to our personal decisions and to affection for a few persons nearest us our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty the stars in the Big Dipper if the Big Dipper is just an arbitrary thing you shouldn't the stars in the Big Dipper be friends with the other stars in the area you know um so who knows who knows who said this Albert Einstein wow wow so so here's my just wild unscientific um conjecture the phenomenon of mindbody medicine I for me is pointing to um an idea of unity between us and and all things that is not only consistent potentially with our best science right now but also with all the what the spiritual what our our best wisdom Traditions have told us for thousands of years so that's compelling we've got our best modern science and leading scientists saying this is possible and then we've got the best wisdom that we can pull on short of science you know it's like two sources of information there's the ancient wisdom that we've developed over thousands of years and then there's science and they're agreeing so to me it's very very um I don't know I just I feel like um it's all a big mystery and but it's it's all very big hopeful mystery and um when you get ill as we all will get ill just just I don't know just remember that just remember remember that I got this off the web this was this was this was the mere space station had an Art Exhibit can you the first Art Exhibit in space and and this this was on it I love it the woman the developing fetus in the womb is like connected to the sun is connected to the universe so kind of new Agy but I like it okay so I should end there I think um thank you for your [Applause] attention [Music] [Music] good

Channel: University of California Television (UCTV)

Views: 82,373

Keywords: alternative, medicine, mindfulness, mind-body-spirit

Id: 8UmteTW868I

Length: 86min 0sec (5160 seconds)

Published: Thu Dec 20 2007