L2-Mind-Body Medicine Flashcards

1
Q

Define of mind-body medicine

A
  • 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. “
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2
Q

Indicate 3 terms that can be interchanged w mind-body medicine.

A

1) Psychosomatic medicine
2) Health-psychology
3) Behavioural medicine

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3
Q

When does the idea of the importance of the mind in the treatment of illness?

A

-well‐known in the
traditional healing
stems of Chinese medicine and Ayurveda that date back over 2000 years.

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4
Q

When did medicine start to separate the mind and body? What did they start focusing on?

A
16th and 17th centuries
-More of a focus on fixing/curing illness
􏰂-Technological advances 􏰂 
-Disease based model
-Reductionistic

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5
Q

Hx of mind-body medicine.

hint: 1920s, WWII, 1960s

A
  1. 1920: Walter Cannon
    􏰂-“flight or fight response”
    􏰂-relationship btwn neuroendocrine reflexes in response to perceived danger
  2. WWII: Dr. Henry Beecher
    -shortage of morphine & he discovered pain could be controlled by saline injection (aka placebo effect)
  3. 1960: mind-body interventions extensively researched
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6
Q

Placebo effect.

Suggested MOA?

A
  • well-known

- believed to be mediated thru both cognitive (expectation & belief) and conditioning mechanisms

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7
Q

Placebo effect.

Importance with regards to conducting studies?

A
  1. 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)
  2. Integrity of study
    - If people know then they might not get the same outcome
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8
Q

Placebo effect on “control group”

A

-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

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9
Q

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?

A

-Assessment and observation
-Placebo treatment
􏰂-Supportive patient‐practitioner relationship

-IBS has a high placebo response rate

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10
Q

“Components of placebo effect: RCT in pts w/ IBS” (Kaptchuck, 2008, BMJ)
Describe the study protocol.

A
  • 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
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11
Q

“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?

A

-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

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12
Q

Study 2: A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee (Moseley, NEJM 2002).
Describe the study protocol.

A

-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

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13
Q

Study 2: A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee (Moseley, NEJM 2002).
Describe the results.

A

-No sig diff btwn groups
-Surgeries have potential for powerful placebo effects
>more intense intervention the higher the results can be

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14
Q

List the main ethical consideration w regards to the use of placebos.
Are placebos still used in practice?

A

-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

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15
Q

Study 3: “Placebos without deception” (Kaptchuk, 2010)

Describe the study protocol.

A

=’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
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16
Q

Study 3: “Placebos without deception” (Kaptchuk, 2010)
Describe the results.
List the 3 areas of stat sig improvement.

A
  • 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
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17
Q

Study 4: Carvalho, Pain (2016); Open-label placebo and LBP

Describe research protocol.

A
  • 3wk RCT
  • Tx as usual (current tx) +/- OLP (open-label placebo)
  • advised as a “novel mind-body clinical study of chronic low back pain
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18
Q

Study 4: Carvalho, Pain (2016); Open-label placebo and LBP

Describe results.

A
  • 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
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19
Q

Define the nocebo effect.

A

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.
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20
Q

Types of mind-body therapies (8).

A
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)
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21
Q

Relaxation & stress reduction.

List relaxation techniques.

A
  • meditation, biofeedback, hypnosis, guided imagery and progressive muscle relaxion, Tai Chi, yoga
  • any activity pt finds relaxing
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22
Q

Relaxation & stress reduction.

Describe relaxation breathing.

A

4‐7‐8 breath

  • 4 to 8 cycles
  • 2times/day
  • Anytime feeling anxious
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23
Q

Relaxation & stress reduction.

Who is relaxation breathing good for? How does it work?

A

-Good for all pt but esp. for:􏰂
>Anxiety / panic attacks
􏰂-Increases ratio of parasympathetic to sympathetic activity

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24
Q

Meditation.

Define and briefly describe what it is used for.

A
  • 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
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25
Q

Meditation.

List environment factors that are conducive to meditation.

A
  • 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)
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26
Q

Meditation.

List some is medical conditions is it generally used for?

A
  • anxiety
  • depression
  • pain
  • stress
  • insomnia
  • coping w emotional/physical sx associated w chronic illness
  • overall health and well-being
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27
Q

Meditation.

List the 2 common forms.

A
  1. Transcendental meditation (TM)

2. Mindfulness mediation

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28
Q

Meditation.

Describe transcendental meditation.

A

-focusing attention on the repetition of a mantra
􏰂>word, sound or phrase repeated silently
􏰂-goal to achieve state of relaxed awareness

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29
Q

Meditation.

Describe mindfulness meditation.

A
  • 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
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30
Q

Meditation.

Define mindfulness.

A

-means paying attention in a particular way, on purpose, in the present moment, and nonjudgmentally

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31
Q

Meditation.

What is the aim of mindfulness?

A
  • aimed at increasing one’s awareness of thoughts, emotions, and maladaptive ways of responding to stress
  • thus helping to learn to cope w stress in a healthier, more effective way
32
Q

Meditation.

Describe the mindfulness course offered for practising M.D.s.

A

-CME course for practicing physicians that focused on self-awareness
-included 8-wk mindfulness course
-improvement in:
>personal well being
>burnout (emotional exhaustion, depersonalization and personal accomplishment)
>mood
>attitudes associated w pt centered care

33
Q

Meditation.

Describe mindfulness based stress reduction (MBSR).

A

-8wk structured program teaching mindfulness meditation
>basically do everything in a midful way (ie eating, walking, ect)
-help ppl manange stress, pain, and illnesses
-courses offered several times a year through the Canadian Mental health Association of Winnipeg
-intensive and expensive
-has been shown to help w chronic diseases/ conditions

34
Q

Meditation.

Does meditation have an effect on student performance?

A

YES!

35
Q

Meditation.

Describe the study performed to support the beneficial effect of meditation on student performance.

A
  • students in intro psychology courses randomized to receive brief meditation training vs rest prior to a lecture-> listened to a lecture-> took post-lecture quiz to assess knowledge retention
  • meditation group retained more info from the lecture - better scores on the quiz
36
Q

Meditation.

List some daily mindfulness activities.

A
  • mindful eating
  • mindful walking
  • mindfulness during routine activities (shower, washing hands)
  • brain hygiene
37
Q

Meditation.

How does meditation work?

A
  1. Works thru by affecting the ANS
    >decreases SNS activity & increasing PNS
  2. May alter brain and immune fxn
  3. Neuroplasticity: brain is not static- it changes w experiences and learning skills (growth of new connections, creation of new neurons)
    -long term meditation can alter the structure and fxn of the brain (functional MRI studies)
38
Q

Hypnosis.

Describe.

A
  • well studied mind-body therapy; known since 18th cent
  • state of consciousness involving focused attention & reduced peripheral awareness characterized by an enhanced capacity for response to suggestion
39
Q

Hypnosis.

Describe the general process.

A

-involves guided phases of physical relaxation and attention control:
>progressive relaxation using imagery-> induction
>deepening techniques (further relaxation)
>sx specific suggestions

40
Q

Hypnosis.

Describe its effects on pain.

A
  • beneficial for many chronic pain conds and painful medical procedures
  • highly “hypnotizable” participants experience more pain relief than low hypnotizable participants
41
Q

Hypnosis.

T/F: Children are more hypnotizable than adults.

A

TRUE.

  • W>M
  • respond better to hypernotherapy for both acute and chronic pain (less boundaries btwn imagination and reality)
42
Q

Hypnosis.

What is it useful in treating?

A
  • Painfulmedicalprocedures (Eg. Bone‐marrow aspirations and lumbar punctures)
  • Post‐oppainandanxiety
  • Chronic headaches
  • Chronic functional abdominal pain
  • Chemotherapy induced N/V
  • Cancer pain
  • Fibromyalgia
43
Q

Guided Imagery.

Define.

A

-form of deliberate, directed day-dreaming: using imagination in purpseful way to support health and healing

44
Q

Guided Imagery.

How does it work?

A
  • creates sensory images by the mind (perceived by body to be almost as real as the actual events)
  • relaxed, trance-like state: relaxation response
45
Q

Guided Imagery.

List 3 benefits for the patient.

A
  1. Technique that gives power back to the pt
  2. Portable
  3. Studies show some beneficial effects for pain surgical prep, depressive sx, anxious sx, and QOL
46
Q

Biofeedback.

Define.

A

-measures body parameters throughout your automatic responses (ie when stressed or relaxed)

47
Q

Biofeedback.

T/F: This therapy is common

A

FALSE.

-machines are expensive

48
Q

Biofeedback.

Describe process.

A

-tech trains ppl to control certain involuntary, bodily processes to improve one’s health.
>e.g. HR, bp, muscle tension and skin temp
-electrodes attached to skin or scalp measure these processes and then are displayed on a monitor (giving you “feedback” from your body “bio)

49
Q

Biofeedback.

Provide an example of how a pt is taught to control involuntary processes.

A

-pts taught to change their HR/bp through breathing exercises or techs to control their emotions and increase their awareness

50
Q

Biofeedback.

What is it useful in treating? List 2 examples.

A
  1. HTN:
    - relaxation-assisted biofeedback significantly reduced bp
  2. Heart disease
    - can be used along w stress management in cardiac rehab programs
51
Q

Progressive muscle relaxation.

Define.

A

-systemically isolating a particular muscle group, creating tension for 8-10secs, then letting the muscle relax and the tension release (create state of relaxation/ relaxation response)

52
Q

Progressive muscle relaxation.

What is it useful in treating?

A

insomnia, caregiver stress, adherance to CPAP in pts w sleep apnea

53
Q

Tai Chi.

Define.

A
  • chinese martial art involving gentle, controlled movements, generally practiced now for exercise, stress management and health benefits
  • like a moving meditation
54
Q

Tai Chi.

What is it useful in treating?

A

-research shows improvements in balance, strength, attentiveness, sleep, anxiety, bp, and pain

55
Q

Qi Gong.

Define.

A
  • type of moving meditation
  • slow, coordinated postures, movements, breathing and meditation
  • practiced for exercise, relaxation, meditation, wellness, and training for martial arts
56
Q

Qi Gong.

Traditionally used to cultivate Qi or ____

A

“life energy”

57
Q

Yoga.
Define.
What is it useful in treating?

A
  • widely practiced
  • exercises involving controlled breathing, physical postures and meditation
  • evidence for: back pain, depression, stress, HTN
58
Q

Cognitive behavioural therapies.
Define.
What is it useful in treating?

A
  • pt works w a therapist to identify maladaptive cognitions (thoughts) and replace them w healthier thoughts and behaviours
  • research has shown benefits for: anxiety and depression, insomnia, IBS, and chronic pain
59
Q

State the general goal of mind-body techniques.

A

-general goal of triggering a “relaxation response”
>a set of physiological reactions including decreased HR, resp rate and bp
-many use breath to help elicit relaxation response

60
Q

Why is it difficult to concretely prove the effectiveness of mind-body therapies?

A

difficult to do double-blind RCT for mind-body therapies
>how to compare to a “true placebo” (ie what is a placebo for meditation? You either meditate or you do not)
>many studies have “methodological flaws” so that firm conclusions cant be drawn

61
Q

Mind-body medicine and CVD.

Describe the connection btwn negative emotional states and CVD.

A

-evidence shows psychological factors play a significant role in the development and progression of CAD
-negative emotional states (depression, anxiety, hostility, social isolation, stress) linked to pathophysiological processes underly CVD
>increase in CV risk factors (increased HR, bp, lipid levels and cardiac reactivity)

62
Q

Mind-body medicine and CVD.

T/F: Depression is ass w/ increased risk of cardiac death & recurrent cardiac events in pt w/ CVD. Explain.

A

TRUE

  • risk can be equal to that of having a prev MI
  • hostility is predictive of recurrent cardiac events
  • lack of social supports associated w a 3x increase in the risk of recurrent events and mortality post-MI
63
Q

Mind-body medicine and CVD.

Evidence has shown that mind-body interventions can be effective in the Tx of CVD. Explain how.

A
  • decrease cardiac risk factors, morbidity, mortality, and recurrence rates
  • cost-effective adjunctive tx
64
Q

Mind-body medicine and CVD.

Describe the effects of relaxation therapies and secondary prevention in pt w/ IHD.

A

(meta analysis of 27 studies):
1. decrease resting HR, increased HR variability, improved exercise tolerance, increased HDL
2. decreased anxiety and depression
3. decrease angina, arrhythmias, and exercise induced ischemia
4. decrease freq of cardiac events and cardiac deaths
5. return to work improved
-

65
Q

Mind-body medicine and CVD.
T/F: intenstive relaxation therapy (at least 9h instruction/ supervision) improves recovery from an ischemic event and contributes to secondary prevention.

A

TRUE!

66
Q

Mind-body medicine and CVD.
Addition of ______ (e.g. cognitive-behavioral Txs) to usually care for cardiac has shown to:
1. ____
2. ____

A

(meta analysis of 46 RCTs)

  • addition of psych txs (ie CBT) to ususal care for cardiac pts
    1. 27% reduction in mortality in the first 2yrs
    2. 43% reduction in event recurrence at >2yrs follow up
67
Q

Mind-body therapies & other conditions.

Which other conditions are mind-body therapies effective? List 8 examples.

A
  1. Headaches
  2. Insomnia
  3. IBS
  4. Chronic low back
  5. Arthritis (OA, RA)
  6. Asthma
  7. Cancer
  8. Immunity
68
Q

Mind-body therapies & other conditions.

Headache.

A
  • biofeedback, CBT, hypnosis, meditation and relaxation training can be effective tx for H/As
  • meta-analyses of RCTs show use of mind body therapies (alone or in combo) signif decreases sx of migraine, tension and mixed-type H/As
69
Q

Mind-body therapies & other conditions.

Insomnia.

A
  • good evidence for progressive muscle relaxation, CBT

- some evidence for biofeedback

70
Q

Mind-body therapies & other conditions.

IBS

A

-8wk mindfulness course vs support group:
>signif improvement in QOL, psych distress and visceral anxiety)
>improvement persisted for at least 3m after training

71
Q

Mind-body therapies & other conditions.

Chronic low back pain.

A

-evidence of benefit for stress management, coping skills training, CBT, yoga

72
Q

Mind-body therapies & other conditions.

Arthritis.

A
  • (OA, RA)

- moderate evidence for benefit of relaxation, imagery, biofeedback, CBT

73
Q

Mind-body therapies & other conditions.

Asthma.

A
  • breathing exercises beneficial

- some evidence that hypnosis improves asthma sx especially in children

74
Q

Mind-body therapies & other conditions.

Cancer.

A

-while it may not cure cancer, it can improve ses:
>improve anxiety, depressive sx ad qol
>improve pain and fatigue
>improve anticipatory n/v in chemo pts

75
Q

Mind-body therapies & other conditions.

Immunity.

A
  • emotional traits (both neg and pos_ can influence ppl’s susceptibility to infection
  • indivs who reported pos emotions had greater resistance to developing a cold after systematic exposure to a resp virus in a lab
76
Q

T/F: Mind-body therapy is generally safe.

A

TRUE.

  • mind-body therapies are generally safe
  • ssame cautions for yoga as for any other exercise program
  • caution decreasing pain via hypnosis that may be physiologically useful (ie sign of infection or underlying organic pathology)