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Mind And Body Therapies Essay, Research Paper
The mind and body are so completely connected that physical activities such as yoga and dance have healthful effects not only on the body but also on mental ailments such as depression and anxiety. Conversely, mental approaches such as hypnosis and imagery benefit physical problems such as hypertension and immune deficiency. Having an understanding of the mind-body connection helps us to see why CAM interventions prove helpful in the treatment of depression. For example, according to the stress-diathesis model of depression, episodic extreme mental stress can predispose to depression (Nowak, 1991). By using a mind-body therapy such as meditation, one protects the psyche from damage and hence reduces the risk of future depressions. Following is a discussion of mind-body interventions with a brief history, description and evaluation of techniques.
The power of therapeutic affiliation is one of the most widely known examples of mind-body interactions in contemporary scientific medicine, yet it is often undervalued and neglected. It focuses on the subjective healing power of the relationship between the clinician and client and is also referred to as the Placebo Response. This terminology is often misleading due to its use in scientific trials. Therapeutic affiliation is a concept that is well understood in most CAM approaches to healing (Benson & Friedman, 1996).
Controlling for placebo response is a primary factor in drug testing where if the drug proves no better than placebo it is dismissed as ineffective. Yet research shows that in practically any disease, about one-third of all symptoms improve when patients are treated with placebo only (Goleman and Gurin, 1993).
The nocebo response is a toxic or negative placebo occurrence. For example, in a controlled study by the British Stomach Cancer Group it was found that 30 percent of the control (placebo-only) group lost their hair, and 56 percent of the same group had “drug-related” nausea or vomiting (Fielding, Fagg, & Jones, 1983). This is also a clear example of the powerful negative effects of the mind-body connection.
In most depression related drug studies the placebo, or therapeutic affiliation, used has been effective in reducing or ameliorating depression in from 30 to 45 percent of cases. Considering this significant effect, it would hold that understanding and using therapeutic affiliation in depression treatment is warranted.
Hypnosis has been used in healing for thousands of years and was an important part of the early Greek healing rituals. The advent of modern hypnosis began in the 18th century with Franz Mesmer who proposed what he called “magnetic healing” to treat many ailments such as paralysis, headaches, and joint pains. Sigmund Freud used hypnosis in the treatment of hysteria yet abandoned it when he observed sudden powerful emotions in his patients. Recently physicians, dentists and psychologists have brought hypnosis back into use in their practice (Fromm, & Nash, 1992).
Hypnosis is the creation of a trance-like state where the subject develops focused concentration to the point of becoming mostly unaware of their surroundings except critical occurrences. In this trance-like state subjects are often responsive to outside suggestion yet it is found they don t follow suggestions against their wishes. People with vivid fantasy lives are known to have a better potential to respond well to this type of therapy. During the hypnotic trance there is an overall decrease in sympathetic nervous system activity, oxygen consumption and carbon dioxide elimination. Also blood pressure and heart rate are lowered and certain kinds of brain wave activity is increased (Spiegel, Bloom, Kraemer, Gottheil, 1989).
In hypnosis the therapist can act as a teacher of self-hypnosis techniques or as an active participant who leads clients through the whole process. Three major steps of hypnosis are becoming absorbed in the words or images presented by the therapist; becoming dissociated from one’s ordinary critical faculties; and responding to suggestions. Many therapists provide audiotapes for their clients so they can practice the guided therapy at home. The sessions or audiotapes are aimed at reaching the subjects specific needs and the words and images suggested are specifically created for them (Cochrane, 1991).
Research to support hypnotherapy s efficacy in depression treatment is scarce. One study by Gould and Krynicki (1989) showed that 16 of 17 depressed subjects had a 40 percent improvement in depressive symptoms after three weeks of hypnotherapy. Hardaway (1990) did a meta-analysis of 60 placebo controlled studies with 2500 subjects, including 110 depressives, that used the hypnotic technique called visual subliminal suggestion. The symbiotic suggestion of “mommy and I are one” was flashed on a screen for about 1/100th of a second 12 times in two weeks. This Freudian based suggestion is thought to evoke the fantasy of unity with the symbolic “good mother” of infancy. The surprising results of this research showed very significant results in the reduction of depressive symptoms. This research is evidence there is a place for hypnotherapy in treating depression. A need for continued research is indicated.
Guided imagery and visualization
Horowitz (1983) defined imagery as any thought that denotes a sensory quality. These sensory qualities include visual, aural, tactile, olfactory, proprioceptive, and kinesthetic. Imagery and visualization are different in that the latter is seeing in the mind where imagery may use all the senses. Those therapies that use fantasy to encourage, solve problems, or evoke a heightened awareness and consciousness use imagery. These may include hypnosis, desensitization, neurolinguistic programming, gestalt therapy, biofeedback, and rational emotive therapy. Mental images can have either a direct or an indirect effect on ones health. This is often done by using images that reduce sympathetic nervous system arousal, and in general enhance relaxation. “End state” imagery is where clients imagine themselves in a state of being where they have perfect health or have achieved their goals (Stephens, 1993).
Research suggests that imagery is either a remedy for feelings of helplessness or a method of provoking a desired physical effect. Some imagery research findings are from controlled studies, but many are reports of single cases or small studies that have not been replicated. Because some practitioners of imagery see their protocols as their own and don t disclose them it is impossible to replicate them. A small study by Brown (1977) showed that visualization could alter brain wave patterns leading to relaxation and improved mood states. This promising area of imagery research is in need of further and more precise investigation.
Historically meditation s principal use was within religious tradition. It has been an important part of this tradition for centuries. In modern times the West has embraced meditation and adopted it as an individual practice of mind-body relaxation. In the last decade it has been looked at scientifically as a powerful tool for stress reduction and as a hypotensive agent in cardiology.
Meditation can be defined as a focused effort on a single peaceful thought or a physical practice such as breathing; or repeating a sound used to calm the ruminations of the mind. If practiced regularly meditation brings about a rise in unconscious behaviors and habits that result in physical and psychological benefits (Smith, Compton, & West, 1995).
The effects of meditation have been documented for the past 30 years. Miller, Fletcher, and Kabat-Zinn (1995) did a 3 year follow-up study on 18 anxiety disorder subjects to probe the long-term effects of mindfulness meditation. They concluded that an intensive but time-limited group stress reduction intervention based on mindfulness meditation can have long-term beneficial effects in the treatment of people diagnosed with anxiety disorders. Brooks and Scarano (1985) reported the use of meditation in the treatment of post traumatic stress syndrome in Vietnam veterans with positive results. A study by Delmonte showed that meditation was very helpful for those who suffer chronically from mild depression (1984). In a controlled study, 76 mildly depressed subjects improved significantly within six weeks of learning to meditate. The control group which did not meditate improved only slightly (Carrington, 1980).
In contrast, a study by Shapiro (1992) shows that meditation can temporarily worsen depression. He likens the psychic material that works its way out of the unconscious to a splinter which can bring up negative effect such as anxiety and depersonalization. He suggests that long term meditation may increase interpersonal conflicts or a meditation addiction syndrome. Because meditation appears to be as potent as many psychoactive drugs, caution and moderation must be used.
In India, yoga has been practiced for thousands of years, and for the past 80 years, western scientists have studied its use as a therapy in various disorders. A session of yoga lasts about 20 minutes and includes a secession of postures progressing from simple to complex with simultaneous, structured, deep breathing. Yoga enables a person to control many physiological aspects including metabolic rate and brain waves as well as other functions which allow a rebalance of sympathetic and parasympathetic nervous system responses and an increase in brain endorphins, enkephalins, and serotonin (Sahay, Sadasivudu, Yogi, Bhaskaracharyulu, Raju, Madhavi, Reddy, Annapurna, & Murthy, 1982).
Since it began in the 1920s, an enormous amount of scientific research on Yoga has been done. Monroe, Ghosh and Kalish of the Yoga Biomedical Trust in Cambridge, England (1989) have listed nearly 1,600 studies on the subject. Following are a few examples: Schell, Allolio, and Schonecke (1994) measured heart rate, blood pressure, cortisol, prolactin and growth hormone and certain psychological criteria in a yoga group and a control group of young female subjects. Significant differences were found in psychological parameters. The yoga group showed markedly higher scores in life satisfaction, increased mood and coping with stress.
In another study, Wood (1993) tested the effects of a 30 minute program of yogic breathing and stretch (pranayama) with a group of 71 normal subjects on perceptions of physical and mental energy and on positive and negative mood states. Pranayama produced a significant positive effect on the subject s mood states and increased their perceptions of mental and physical energy and feelings of alertness and enthusiasm.
Music has been known for thousands of years to influence emotional states and health. The ancient Greeks prescribed singing and playing musical instruments to change emotional states. US government programs began to use Music therapy in the 1940s and the National Association for Music Therapy, Inc. (NAMT), was established in 1950. This organization has fostered the therapeutic use of music and promoted an extensive amount of research. Today, music therapy is used in virtually all types of treatment and rehabilitation facilities from psychiatric hospitals to hospices to private practice (Heller, & Solomon, 1992).
Altshuler (1948) taught that music has increased effectiveness in reaching the emotions compared to words due to the brain s ability to process it through different “logic filters” than are used to understand language. He theorized that music was processed in a different, more primitive part of the brain; the limbic system.
Recent research shows significant efficacy for music therapy in depression. A 13-week randomized trial of Bonny Method of Guided Imagery and Music (GIM) was done with 28 healthy adults. Participants in both GIM and control groups completed the Profile of Mood States (POMS) and had lab tests before and after the trial and again at a 6-week follow-up. GIM participants reported significant decreases in depression, fatigue, and total mood disturbance and had significant decreases in cortisol level by follow-up (McKinney, Antoni, Kumar, Tims, & McCabe, 1997).
Thirty depressed older adults were trialed using a music-facilitated psychoeducational approach for 8 weeks. The experimental group performed significantly better than controls on standardized depression tests. These improvements were maintained over a 9-month follow-up period (Hanser & Thompson, 1994).
A group of 34 depressed older adults on antidepressive drugs were treated with daily music therapy for 8 weeks. The control group of 34 was treated with drugs only. Subjects in the test group showed improvement at the end of the first week while patients in the control group were only moderately improved at the 3rd-4th week (Chen, 1992).
Music therapists believe that melancholy music may actually be helpful to depressives by resonating with their mood and validating their feelings, although from there a move toward more empowering and stimulating music should be made. A prescription for music therapy might start with somber pieces such as Faur s “Pelleas et Millesande,” or perhaps Blues songs, and progress to songs with a moderate tempo like “Pachelbels Canon” or Bach s “Air On a G String,” or certain Folk/Rock songs. From there a move to uplifting and stimulating tunes such as Beethoven s “Ode to Joy,” or Verdi s “March from Aida,” or World, Pop or Rock music. This “mood progression” can be potent medicine for many with depression (Wigram, 1995).
Historically people have used dance to celebrate, express sentiments, and in ritual healing ceremonies. The use of dance as a medical therapy in the United States began in 1942 through the pioneering efforts of Marian Chace. In 1956, dance therapists from across the country founded the American Dance Therapy Association.
A major idea behind Dance Therapy is that movement is equivalent to ones personality, and by changing movement, personality functioning also changes. In Dance Therapy healing is brought about by changing music and rhythm which thereby alters mood and thoughts, and reawakens blocked memories and feelings. Group dance helps reduce isolation and improves socialization. Also, a state of well being is created by increased beta endorphin levels promoted by the physical activity involved in dancing.
In a study by Fisher and Stark (1992), Dance Therapy was demonstrated to be clinically effective in ameliorating depression. Through extensive clinical practice the efficacy of Dance Therapy has been demonstrated to generally improve mood and reduce depression.
A connection between the use of art and mental health was recognized in mental institutions in the late 1800s and the early 1900s. Many patents in these institutions spontaneously produced paintings and drawings which sparked interest in using them for diagnosis and rehabilitating their mental health. Later in the century, Art Therapy was used as a psychoanalytic interpretive tool to uncover expression of the unconscious mind and used the symbolic experience of creating art to bring unconscious material closer to the surface. Art therapy was formalized in the founding of the American Art Therapy Association in 1969.
Barbee (1996) did a descriptive pilot study with 5 inpatient male subjects with depressive symptoms using questionnaires and art therapy. Prior to the study the subjects completed the Beck Depression Inventory, the Depression Coping Questionnaire, the Bem Sex-Role Inventory, 4 drawings portraying themselves in male roles and 2 drawings that reflected their self-concept. After doing the art therapy all five subjects were rescored and a significant reduction of depressive symptoms was noted.
In another study hospitalized suicidal adolescents tested the efficacy of an art future-image intervention aimed at increasing self-esteem, improving future time perspective, and decreasing depression. Pretest- posttests were used with both the experimental and placebo groups. The experimental group exhibited greater positive changes than the placebo group. Enthusiasm from the participants along with shorter hospital stays justify further testing and refinement of this type of therapy (Walsh, 1993).
As early as the 1300s, Henri de Mondeville, professor of surgery wrote “Let the surgeon take care to regulate the whole regimen of the patient s life for joy and happiness allowing his relatives and special friends to cheer him, and by having someone tell him jokes.” (Walsh 1928)
Patty Wooten, founder of “Jest For the Health Of It” said, “humor is flowing, involving basic characteristics of the individual and expressed in the body, emotions, and spirit. The experience of laughter momentarily banishes feelings of anger and fear and provides moments of feeling carefree, light hearted and hopeful.” She states that, “We are less likely to succumb to feelings of depression and helplessness if we are able to laugh at what is troubling us… Laughter provides an opportunity for the release of those uncomfortable emotions which, if held inside, may create biochemical changes that are harmful to the body.” (1996, p 49).
Norman Cousins (1979) noted the therapeutic effects of humor and laughter during his treatment for ankylosing spoendylitis. It sparked his theory that negative emotions had a negative impact on health. He theorized that the opposite was also true — that positive emotions would have positive physiological effect. He established the Humor Research Task Force, which coordinated and supported world-wide clinical research on humor s effect on health (Cousins, 1989).
Laughter induces a number of physiologic effects similar to those induced by narcotics and anxiolytics, without the threat of addiction or adverse reaction. A good, hard belly laugh causes a brief rise in pulse and blood pressure followed by a reduction in pulse and blood pressure lasting an hour or more (Fry 1992). It is known that during stress the adrenal gland releases corticosteroids of which prolonged secretion may induce depression. Laughter lowers levels of corticosteroids. It also reduces other catecholemines, improves arterial oxygen levels and enhances endorphin production (Berk 1989). There are beneficial effect of humor on lymphocyte function and IgA secretion. (Dillon 1985)
It is unlikely that any single pharmacologic agent will match the therapeutic effects of laughter, but encouraging patients to have fun and laugh more sounds almost silly. It s not. Positive emotional states are as beneficial to emotional health and mood as any antidepressant.
Depression is a complex condition and optimal therapy must be holistic. Ideal treatment should be a regime tailored to the client s beliefs, values, and lifestyle. It may include medication, yet should also consider the many safe and beneficial CAM therapies available. In this age where many psychiatric and general practitioners prescribe Prozac and other antidepressants for even mild forms of depression, after just a 30 minute consult, it is no wonder that most clients are led to think of pharmaceuticals as the “magic pill” that cures depression. Many of them are disappointed. Considering the “alternatives,” potentially inexpedient drug therapy may not always be indicated.
CAM practices offer remedies that apply to more than just the physiological. They are not only a “cure” for a disease but they add the dimension of personal involvement and a sense of having some control over ones health. Many of them stress the need for social connection that is lacking in much of biomedicine today.
While expanded effort to further establish efficacy, safety, and cost-effectiveness are necessary in CAM, there is already enough evidence for us to consider it for our personal and professional lives. By using these techniques ourselves and imparting them to our clients we set in motion a powerful healing process that benefits all involved. It is time to get back to the roots of healing and open our minds to new possibilities in bringing light into the dark worlds of those with depression.
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Agency for Health Care Policy and Research. (1993). Clinical Practice Guideline No. 5, Depression in Primary Care: Vol. 1. Detection and Diagnosis; Vol. 2. Treatment of Major Depression. Rockville, Md: Agency for Health Care Policy and Research.
Alpert, J. & Fava, M. (1997). Nutrition and Depression: The Role of Folate. Medscape Mental Health, 2(1).
Altshuler, I. (1948). A psychiatrist’s experience with music as a therapeutic agent. In D. Schullian and M. Schoen, eds. Music as Medicine. New York: Henry Schuman,.
American Botanical Council. (1997). St. John’s Wort Monograph. American Herbal Pharmacoepea and Theraputic Compendium HerbalGram, 40, 37-45.
American Psychiatric Association. (1993). Practice Guideline for Major Depressive Disorder in Adults. Supplement to American Journal of Psychiatry, 150(4).
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