L2-Mind-Body Medicine Flashcards
Define of mind-body medicine
- Emphasizes an approach that enhances a person’s capacity for self-knowledge & self-care
- NCCIH defines it as: “…practices (that) focus on the interactions among the brain, mind, body, and behavior, with the intent to use the mind to affect physical functioning and promote health. “
Indicate 3 terms that can be interchanged w mind-body medicine.
1) Psychosomatic medicine
2) Health-psychology
3) Behavioural medicine
When does the idea of the importance of the mind in the treatment of illness?
-well‐known in the
traditional healing
stems of Chinese medicine and Ayurveda that date back over 2000 years.
When did medicine start to separate the mind and body? What did they start focusing on?
16th and 17th centuries -More of a focus on fixing/curing illness -Technological advances -Disease based model -Reductionistic 
Hx of mind-body medicine.
hint: 1920s, WWII, 1960s
- 1920: Walter Cannon
-“flight or fight response”
-relationship btwn neuroendocrine reflexes in response to perceived danger - WWII: Dr. Henry Beecher
-shortage of morphine & he discovered pain could be controlled by saline injection (aka placebo effect) - 1960: mind-body interventions extensively researched
Placebo effect.
Suggested MOA?
- well-known
- believed to be mediated thru both cognitive (expectation & belief) and conditioning mechanisms
Placebo effect.
Importance with regards to conducting studies?
- Conditioning
- RCTs must be “placebo-controlled” as there are:
- Physiological changes occurring in the body when the mind thinks your taking the pill (“conditioning”)
- Physiological conditioning of taking the pill (lots of involuntary processes going on) - Integrity of study
- If people know then they might not get the same outcome
Placebo effect on “control group”
-improve Sx of 1/3 of control subjects
-can provide from 30-60% relief when compared to active agents for a wide variety of problems including:
>pain, HTN, MS, asthma, depression, headaches, blood cell counts, diabetes, ulcers, colitis, fever
Study 1: “Components of placebo effect: RCT in pts w/ IBS” (Kaptchuck, 2008, BMJ).
What 3 components of the did they investigate?
Why did they choose IBS?
-Assessment and observation
-Placebo treatment
-Supportive patient‐practitioner relationship
-IBS has a high placebo response rate
“Components of placebo effect: RCT in pts w/ IBS” (Kaptchuck, 2008, BMJ)
Describe the study protocol.
- 262 adults w IBS, 6 week RCT
- all groups assessed at baseline 3-6 weeks
- even being part of the trial itself is a placebo effect
- Sham: Device on top of skin but the needle didn’t actually go in the skin.
- Divided into 3 groups:
1. Waiting list: no placebo acupuncture or interaction w HCP
2. Limited interaction: <5 mins w placebo acupuncture (validated sham acupuncture device)
3. Augmented interaction: 45 min interaction (warmth, empathy, communicating postive exception) + placebo acupuncture
“Components of placebo effect: RCT in pts w/ IBS” (Kaptchuck, 2008, BMJ).
Describe the results.
What is the most potent component of non-specific effects?
-clinically sig improvement in Sx severity in augmented arm
>61% of pts at 3wks; 59% of pts at 6wks
>comparable to responder rate in clinical trials for medications used for IBS
-there was progressive improvement in sx among the 3 groups, w augmented interaction being the most significant
-supportive interaction w a practitioner is the most potent component of non-specific effects
Study 2: A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee (Moseley, NEJM 2002).
Describe the study protocol.
-pts randomized to 3 groups:
1) Lavage: wash out joint
2) Debridement: clip off the harsh edges of joint
3) Placebo: fake surgery
>brought pt into OR, made incisions in skin, fake noises & vid of another arthroscopic surgery shown
Study 2: A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee (Moseley, NEJM 2002).
Describe the results.
-No sig diff btwn groups
-Surgeries have potential for powerful placebo effects
>more intense intervention the higher the results can be
List the main ethical consideration w regards to the use of placebos.
Are placebos still used in practice?
-Deception, loss of trust
-Yes, v common to use placebos in practice
-prescribing “placebo txs”: results of a national survery of of US internists and rheumatologists found that 50% prescribe txs that they consider to have no specific effect and used soley as placebos (“impure placebos”)
>ie OTC analgesics, Vitamins, ABs, sedatives, saline, sugar pills
Study 3: “Placebos without deception” (Kaptchuk, 2010)
Describe the study protocol.
=’placebos wo deception’
- study in pts w IBS
- 2 groups:
1) open label placebo pill: placebo pills made of inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS sx through mind-body self-healing processes
2) no tx - both groups had same quality of interaction w providers
Study 3: “Placebos without deception” (Kaptchuk, 2010)
Describe the results.
List the 3 areas of stat sig improvement.
- open label placebo groups had stat sig improvement in:
1. global improvement scores
2. reduced sx severity
3. adequate relief - partly pt “belief” + physiological processes (i.e. conditioning makes a diff)
- therefore placebos administered wo deception may be an effective tx for IBS
Study 4: Carvalho, Pain (2016); Open-label placebo and LBP
Describe research protocol.
- 3wk RCT
- Tx as usual (current tx) +/- OLP (open-label placebo)
- advised as a “novel mind-body clinical study of chronic low back pain
Study 4: Carvalho, Pain (2016); Open-label placebo and LBP
Describe results.
- clinically signif reduction in pain and disability in OCP group
- 30% reduction in both usual and maximal pain in OLP group vs 9% and 16% in tx as usual group
Define the nocebo effect.
Opposite of placebo
- If you’re told something bad is going to happen it is more likely to happen
- a detrimental effect on health produced by psychological or psychosomatic factors such as negative expectations of treatment or prognosis.
Types of mind-body therapies (8).
1. Relaxation and stress reduction >progressive muscle relaxation >breathing exercises 2. Hypnosis 3. Guided imagery 4. Meditation 5. Tai chi/ Qi gong 6. Yoga 7. Biofeedback 8. Cognitive-behavioural theraies (CBT)
Relaxation & stress reduction.
List relaxation techniques.
- meditation, biofeedback, hypnosis, guided imagery and progressive muscle relaxion, Tai Chi, yoga
- any activity pt finds relaxing
Relaxation & stress reduction.
Describe relaxation breathing.
4‐7‐8 breath
- 4 to 8 cycles
- 2times/day
- Anytime feeling anxious
Relaxation & stress reduction.
Who is relaxation breathing good for? How does it work?
-Good for all pt but esp. for:
>Anxiety / panic attacks
-Increases ratio of parasympathetic to sympathetic activity
Meditation.
Define and briefly describe what it is used for.
- variety of techniques aimed to focus or control one’s attention.
- used to increate calmness & relaxation, improve psychological balance, cope w illness, enhance overall health & well-being
Meditation.
List environment factors that are conducive to meditation.
- quiet location
- specific, comfortable position (sitting, lying, standing, walking)
- focus of attention (e.g. on breath, mantra)
- open attitude (letting distractions come & go w/out judging them)
Meditation.
List some is medical conditions is it generally used for?
- anxiety
- depression
- pain
- stress
- insomnia
- coping w emotional/physical sx associated w chronic illness
- overall health and well-being
Meditation.
List the 2 common forms.
- Transcendental meditation (TM)
2. Mindfulness mediation
Meditation.
Describe transcendental meditation.
-focusing attention on the repetition of a mantra
>word, sound or phrase repeated silently
-goal to achieve state of relaxed awareness
Meditation.
Describe mindfulness meditation.
- focusing attention in the present, common to focus on breath
- focus on what is being experienced wo reacting or judging it
- learn to experience thoughts/ emotions w greater balance and acceptance
Meditation.
Define mindfulness.
-means paying attention in a particular way, on purpose, in the present moment, and nonjudgmentally