for Our Patients and Ourselves - Dietitians in …...2016/02/03 · All Health Care: for Our Patients and Ourselves James S. Gordon, MD Founder and Director: The Center for Mind-Body

Self-Care Is the Heart of

All Health Care: for Our Patients and Ourselves

James S. Gordon, MD

Founder and Director: The Center for Mind-

Body Medicine

www.cmbm.org

DIFM Webinar ~ February, 2016

Low Morale and Burnout in Health Care Professionals

Survey conducted on 1,205 physicians in 2006

Out of 1,201 respondents – Scale of 1-10 (1 – very low, 10 – very high)

– 46% rated their own overall morale as a physician working in the US healthcare as 5 or lower; 55% reported a 6 or higher

– Contrarily, 60% rated the morale of physicians they supervise or work with as a 5 or lower, and 40% as a 6 or higher

Causes of diminishing morale: – Low reimbursement rates (21.9% of respondents)

– Loss of autonomy (21.2%)

– Bureaucratic red tape (16.8%)

– Patient overload (12.1%)

– Loss of respect (11.8%)

– Medical malpractice environment (10.5%)

– However many doctors wrote that it’s a combination of all these factors affecting their morale

Bill Steiger. Doctors say morale is hurting (survey). The Physician Executive. 2006; p.6.

Low Morale and Burnout in Health Care Professionals

Results of several studies show 21-67% of mental health

workers may be experiencing high levels of burnout

Of 7,288 physicians, 45.8% reported at least1 symptom of

burnout; highest rates of burnout among physicians at front line

of care access--family medicine, general internal medicine, and

emergency medicine

67% of the 266 physicians surveyed from academic medical

hospitals reported experiencing high levels of Burnout

Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in Mental Health Services: A Review

of the Problem and Its Remediation. Administration and Policy in Mental Health, 39(5), 341–352. doi:10.1007/s10488-011-0352-1 Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., ... & Oreskovich, M. R. (2012). Burnout and satisfaction with work-

life balance among US physicians relative to the general US population. Archives of internal medicine, 172(18), 1377-1385.

Glasheen JJ, Misky GJ, Reid MB, Harrison RA, Sharpe B, & Auerbach A. (2011). CAreer satisfaction and burnout in academic hospital

medicine. Archives of Internal Medicine, 171(8), 782–790. http://doi.org/10.1001/archinternmed.2011.153

CAM Therapies

Drugs, Surgery Self-Care

Current Biomedical Model New Medicine

Therapies that require a professional and also stimulate one’s

capacity for self-hearing, e.g. acupuncture, herbal medicine,

musculoskeletal manipulation, group support, etc.

Drugs, Surgery

Psycho-social

approach

Mind-Body Skills Groups Techniques

Self-Care Relaxation

Meditation

Exercise

Imagery/Self-Hypnosis

Prayer

Self-Awareness

Autogenics and Biofeedback

Nutrition

The Central Role of

Self-Care in Integrative Medicine

“Physician: Heal Thyself”

- Hippocrates

Soft Belly Breathing

The Importance of Hope

Helplessness and hopelessness are hallmarks of and

major contributors to depression, anxiety, stress,

and psychiatric disorders generally.

Hope and acting on our own behalf are powerful

antidotes

Hope begets change

The Importance of Hope

People who are hopeful generally do better and feel

better than those who are not, regardless of

biological status or physical disability.

The mental health professional is not only there to

treat but also to teach, encourage, to transform the

experience of depression from victimization by a

disease to awakening and to transforming an

imbalance.

Engagement: The Effects of Choice

Nursing Home Study

One floor was asked to take responsibility for making choices in their living environment and for making their complaints known to staff.

Control group was told that the staff were taking full responsibility for their satisfaction.

Participants selected furnishings, decorations, engaged in menu planning, and cared for plants, etc.

Decision making, active participants showed significant increase in activity, happiness and longevity. Control group became more debilitated in just 3 weeks.

Langer EJ, Rodin J. The effects of choice and enhanced personal responsibility for the aged: a field experiment in an institutional

setting. Journal of Personality and Social Psychology. 1976; 34:191-198.

Challenge, Commitment, and Control

Personality and Illness Study

Executives completed stress and illness questionnaires to

determine if they were either high stress/low illness or high

stress/high illness.

Three months later, a second set of questionnaires containing

several personality tests were sent to the executives.

This study found that high/stress low illness executives show,

by comparison with high stress/high illness executives, more

hardiness, that is, have a stronger commitment to self, an

attitude of vigorousness towards the environment, a sense of

meaningfulness, and an internal locus of control

Kobasa SC. Stressful life events, personality, and health: an inquiry into hardiness. Journal of Personality and

Social Psychology. 1979; 37:1-11.

The Central Role of

Self-Care

We cannot teach self-care to

others if we do not practice

it ourselves

The Central Role of

Self-Care

Everything that occurs on a mental or

emotional level affects the body, and

vice versa.

Mental health and physical health are

best understood as inextricable.

Self-Care is the

Heart of Health Care

Self-awareness and

self-expression

Relaxation

Autogenics and biofeedback

Meditation

• Journals and narratives

• Drawings

• Movement and dance

• Concentrative

• Awareness

• Expressive

Self Care is the

Heart of Health Care

Imagery/self-hypnosis

Exercise

Nutrition

Prayer

• Improved mood

• Enhanced immunity

• Reduced symptoms

• Increased longevity/decreased risk

of cancer and heart disease

The Central Role of

Self-Care

Self Awareness is or can be crucial to self-

care just as it is in psychotherapy. It’s

hard to know what to do if you don’t

know what’s happening or why. And once

you know you can move ahead.

7 Pillars: Self-Care A. Self-Expression

Expressive Writing

Not speaking of traumatic events is associated with

long- term stress and disease

After writing about the traumatic event over four days,

students confronting the experience showed significant

improvement in subjective distress and immune

function, and a decrease in health center visits

Those who held back less and disclosed more showed

the greatest improvement in immune function

Pennebaker, J.W.,& Beall, S. Confronting a traumatic event: toward an understanding of inhibition and disease. Journal

of Abnormal Psychology. 1986. 95, 274‐281.


Written Expression For Physical Health

Group 1: disclosed personal traumatic experience via body movements for 10 minutes/day for 3 consecutive days & then wrote about it for 10 minutes

Group 2: Danced but did not write about trauma

Group 3: Engaged in routine exercise program

Results: over 3 month period, members of all groups reported that they felt happier and healthier

– Only Group 1 showed better physical health and improved grade average

Conclusion: Combining movement and written expression is superior to movement alone

Krants AM & Pennebaker JW. Expressive Dance, Writing, Trauma, and Health: When Words Have a Body. Whole Person Healthcare 3 (2007):201-29.


Mindfulness-Based Art Therapy 42 women with cancer diagnosis randomized to 5 week

art therapy treatment group or wait-list control group

Each session was led by one of two trained art therapists. The aim of the intervention was to – 1) offer time and space for expression and reflection

– 2) give support in the process of restoring body image

– 3) reduce stress and supporting agency 6 months after the start of radiotherapy treatment

women who participated in the individual art therapy sessions significantly improved their overall QoL and general health compared with the control group

SVENSK, A.-C., ÖSTER, I., THYME, K. E., MAGNUSSON, E., SJÖDIN, M., EISEMANN, M., … LINDH, J. (2009). Art

therapy improves experienced quality of life among women undergoing treatment for breast cancer: a randomized controlled study.

European Journal of Cancer Care, 18(1), 69–77.

Relaxation

Relaxation is our

Birthright

7 Pillars: Self-Care B. Relaxation

Relaxation Techniques for Anxiety

Meta analysis of 27 RCT studies showed that relaxation techniques (Jacobson’s progressive muscular relaxation, autogenic training, “applied relaxation” and meditation) were all significantly and consistently effective in reducing anxiety

In general both concentrative and mindfulness meditation proved superior to other relaxation techniques

Manzoni, GM., Pagnini, F., Castelnuovo, G., Molinari, E. relaxation training for anxiety: a ten-years systematic review

with meta-analysis. BMC Psych. 2008;8:41.

Biofeedback Approach to relaxation and self-

regulation

– Reduce autonomic nervous system arousal

– Manages stress

– Supports and facilitates the natural self-

healing mechanisms

– Reduced anxiety and depression in cancer

patients

7 Pillars: Self-Care

C. Biofeedback

Used In Conjunction With Other Forms of Therapies

Biofeedback, when used in conjunction with other forms of relaxation therapies such as music, autogenic and imagery training, significantly improved physiological functions including respiratory and heart rate and athletic performance in a professional speed skating team.

The integration of mental skills (e.g., relaxation, imagery, self-talk, focus, breathing, reaction time readiness, music relaxation) and biofeedback self-regulation may have improved athletes performance for the World Cup competitions and the 2010 Vancouver Olympic Games

Beauchamp, M. K., Harvey, R. H., & Beauchamp, P. H. (2012). An integrated biofeedback and psychological skills training

program for Canada’s Olympic short-track speed skating team. Journal of Clinical Sport Psychology, 6(1), 67.


C. Biofeedback With Autogenic Training for Migraine

Migraine patients had high levels of anxiety and depression. Negative mood states such as anxiety and depression were related to physical complaints and headache.

The anxiety and depression scores in the migraine patients were reduced after 4 weeks of biofeedback treatment with autogenic training as compared to control (which received no active treatment, except simple biofeedback measurements)

>50% reduction in headache scores in treatment group vs. monitored group

Kang EH. Effect of biofeedback-assisted autogenic training on headache activity and mood states in korean female

migraine patients. J Korean Med Sci. 2008 Oct; 24(5):936-40.


C. Biofeedback Other Kinds of Biofeedback

Heart Rate Variability Biofeedback (HRV-BF)

– 154 patients with coronary artery disease exhibited

restoration of cardiac autonomic balance and decreased

hostility following HRV-BF

Neurofeedback (NF)

– The results indicate that NF effectively reduced

inattention symptoms on ADHD scales and reaction time

in neuropsychological tests among children with ADHD

Lin, I. M., Fan, S. Y., Lu, H. C., Lin, T. H., Chu, C. S., Kuo, H. F., ... & Lu, Y. H. (2015). Randomized controlled trial of heart rate

variability biofeedback in cardiac autonomic and hostility among patients with coronary artery disease.Behaviour research and

therapy, 70, 38-46.

Bakhshayesh, A. R., Hänsch, S., Wyschkon, A., Rezai, M. J., & Esser, G. (2011). Neurofeedback in ADHD: a single-blind randomized

controlled trial.European child & adolescent psychiatry, 20(9), 481-491.

Meditation in Clinical Practice…

and Life

1. Meditation is the Heart of Medicine and

of Self-Care

• Specific therapeutic benefits:

Decreased stress, lowered blood pressure and blood

sugar,

improved mood, enhanced immunity, etc.

2. Meditation Transforms Us

• Meditation enlarges our perspective, allows us to see the

world and ourselves more clearly, less judgmentally, and

more compassionately.


229 women after surgery, chemotherapy, and radiotherapy for

breast cancer. were randomly assigned to the 8-week

mindfulness-based stress reduction (MBSR) program or

standard care

Results showed decreased anxiety, anger, depression,

confusion and overall symptoms of stress

MSBR improved mood, breast- and endocrine-related quality

of life, and well-being more effectively than standard care in

women with stage 0 to III breast cancer, and these results

persisted at three months.

Hoffman, C. J., Ersser, S. J., Hopkinson, J. B., Nicholls, P. G., Harrington, J. E., & Thomas, P. W. (2012). Effectiveness of mindfulness-based stress

reduction in mood, breast-and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: a randomized, controlled trial. Journal of

Clinical Oncology, 30(12), 1335–1342.

D. Meditation Mindfulness-Based Stress Reduction in Cancer Patients


Treatment: 8-week Mindfulness-Based Stress Reduction (MBSR)

Program

Magnetic resonance images taken of treatment and control groups’

brain structure 2 weeks before and after the MBSR program

Results: analysis of MR images found increased grey-matter density in

hippocampus, important for learning and memory, and in structures

associated with self-awareness, compassion, and introspection &

decreased grey-matter density in amygdala

– Participants reported reductions in stress while none of these changes seen in control

group

Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (n.d.). Mindfulness practice

leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, 191(1), 36–43.

http://doi.org/10.1016/j.pscychresns.2010.08.006

D. Meditation Changes Brain Structure

Meditation

Concentrative

Awareness

Expressive

Meditation Changes Our Brain Anatomy

Areas of increased thickness in red: insula,

Brodmann area (BA) 9/10, somatosensory

cortex, auditory cortex.

Lazar, S.W., Kerr, C.E., Wasserman, R.H., Gray, J.R., Greve, D.N., Treadway, M.T., McGarvey, M., Quinn,

B.T., Dusek, J.A., Benson, H., Rauch, S.L., Moore, C.I., Fischl, B. Meditation experience is associated with

increased cortical thickness. Neuroreport. 2005 Nov; 16(17): 1893-97

Cortical Thickness

The brains of typical western meditation practitioners (about 2-6 hours weekly) were compared to those with no experience of meditation

Brain regions associated with attention, interoception (perception of internal sensation) and sensory processing were thicker in the meditation group

Among those who meditate cortical thickness increased with years of meditation

Lazar, S.W., Kerr, C.E., Wasserman, R.H., Gray, J.R., Greve, D.N., Treadway, M.T., McGarvey, M., Quinn,

B.T., Dusek, J.A., Benson, H., Rauch, S.L., Moore, C.I., Fischl, B. Meditation experience is associated with

increased cortical thickness. Neuroreport. 2005 Nov; 16(17): 1893-97

Cortical Thickness

Neuro-imaging quantified white matter integrity in the brains of 46 experienced meditators compared with 46 matched meditation-naive volunteers.

Meditators showed greater cortical thickness in the anterior regions of the brain, located in frontal and temporal areas and thinner cortical thickness of brain regions in the lateral and medial parietal areas

These adaptations are involved with enhanced

– control and execution of voluntary motor functions

– emotional regulation (critical for social adaptation)

– egocentric processing of one’s own body’s in spatial context

– cognitive functions such as improved attention and self-perception

Kang, D.-H., Jo, H. J., Jung, W. H., Kim, S. H., Jung, Y.-H., Choi, C.-H., … Kwon, J. S. (2013). The effect of

meditation on brain structure: cortical thickness mapping and diffusion tensor imaging. Social Cognitive and

Affective Neuroscience, 8(1), 27–33.

Meditation Increases Brain Matter

Density in Specific Regions

A longitudinal study analyzed the brains of meditation-naive participants before and after an 8-week Mindfulness-Based Stress Reduction course.

Results showed significantly increased gray matter concentration in regions involved in learning and memory processes, emotion regulation, and perspective taking:

– Left Hippocampus

– Posterior Cingulate Cortex

– Temporo-parietal Junction

– Cerebellum

Hölzel, B.K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S.M., Gard, T., Lazar, S.W. Mindfulness

practice leads to increases in regional brain gray matter density. Psychiatry Res. 2011 Jan;191(1):36-43.

Meditation Increases Brain Matter

Density in Specific Regions

Gray matter concentration in the left hippocampus.

Meditation’s Effect on Genetic Expression

Researchers tracked men with low risk prostate cancer who had opted-out of conventional treatment and instead chosen an intensive 3-month lifestyle and nutritional program

Treatment: 60 minutes of stress management included yoga, breathing, meditation, imagery and progressive relaxation; a low fat, plant based diet

Results:

– Improvements in weight, abdominal obesity, BP, and lipid profile

– Patients reported significant reduction in psychological distress

– Down-regulation of a set of RAS family oncogenes, some of which may be normally increased in tumor tissues

– Significant modulation of biological processes that have critical roles in tumorigenesis, including protein metabolism and modification, intracellular protein traffic, and protein phosphorylation

Ornish, D., et. al. Changes in prostate gene expression in men undergoing an intensive nutrition and

lifestyle intervention. PNAS. 2008 Jun;105(24): 8369-74

Imagery is…

The dominant language of the unconscious

mind

A vital source of information and

inspiration

“The beat beneath the music”

Imagery is…

A place where Mind-Body-Spirit Therapies

interact

– Hypnosis

– Biofeedback

– Meditation

– Psychotherapy

– Prayer

Imagery is…

the communication mechanism between

perception, emotion, and

bodily change

(Achterberg, 1985)

Types of Imagery

Feeling State Imagery – Imagery that changes one’s

mood or emotional state in a very broad way

End State Imagery – Imagery that highlights concrete

goals one is striving for

Biologically Correct Imagery – Imagery that focuses

on what is actually occurring microscopically in the

cells and organs of the body

(Naparstek, 1994)

Types of Imagery (cont.)

Metaphoric Imagery – Imagery that uses

symbols to describe what is happening

psychologically in the body.

Spiritual Imagery – Imagery that allows for a

connection with a source that is greater than

oneself that can enhance one’s awareness of

inner wisdom and strength

(Naparstek, 1994)

Guided Imagery

Clinical Implications:

– Physiological relaxation

– Stress reduction

– Mood modulation

– Encouraging active participation in own

care

– Empowerment

– Discovering meaning/insight into illness

– Enhancing self-awareness


13 RCT studies on cancer patients’ (n = 1357) response to

guided imagery and hypnosis in women with breast cancer,

breast cancer survivors, and in women undergoing diagnostic

breast biopsy.

Results: This systematic review found promising evidence for

the effectiveness of hypnosis in breast cancer care.

– In women undergoing diagnostic breast biopsy (3 RCTs), hypnosis

positively influenced pain and distress

– 1 RCT on breast cancer surgery found effects of hypnosis on pain, distress,

fatigue, and nausea.

– For women undergoing radiotherapy (3 RCTs), hypnosis combined with

cognitive-behavioral therapy improved distress and fatigue.

– 3 RCTs on women with and without a history of breast cancer experiencing

hot flashes, hypnosis improved hot flashes and distress.

– Three RCTs on women with metastatic breast cancer found effects on

pain and distress

Cramer, H., Lauche, R., Paul, A., Langhorst, J., Kümmel, S., & Dobos, G. J. (2014). Hypnosis in Breast Cancer Care A Systematic Review of Randomized

Controlled Trials. Integrative Cancer Therapies, 1534735414550035.

E. Imagery and Self-Hypnosis Systematic Review of Effect on Cancer

Exercise

Aside from the presence of a

sympathetic and knowledgeable

other person—exercise is probably

the single best treatment for

depression and may be as important

for anxiety.

Exercise and Depression

By itself, exercise is as effective as any known

treatment for depression.

Exercise should always be a significant part of

any integrative approach.

• Nabkasorn C, N Miyai, A Sootmongkol, S Junprasert, H Yamamoto, M Arita, K Miyashita. Effects of physical

exercise on depression, neuroendocrine stress hormones, and physiological fitness in adolescent females with

depressive symptoms. Euro J Pub Health 2006;16(2):179-84.

• Blumenthal, JA, et al. Effects of exercise training on older patients with major depression. Arch Intern Med

1999;159(19):2349-56.

• Babyak M, et al. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months.

Psychosom Med 2000;62(5):633-38.

Exercise alters brain chemistry, increasing

serotonin, norepinephrine, and endorphin

levels.

• Soares, J., M.G. Naffah-Mazzacoratti, and E.A. Cavalheiro, Increased serotonin levels in physically trained

men. Braz J Med Biol Res, 1994. 27(7): p. 1635-8.

• Carr, D.B., et al., Physical conditioning facilitates the exercise-induced secretion of beta-endorphin and beta-

lipotropin in women. N Engl J Med, 1981. 305(10): p. 560-3



Exercise may promote neurogenesis.

• Rhodes, J.S., et al., Exercise increases hippocampal neurogenesis to high levels but does not improve spatial

learning in mice bred for increased voluntary wheel running. Behav Neurosci, 2003. 117(5): p. 1006-16.

• van Praag, H., G. Kempermann, and F.H. Gage, Running increases cell proliferation and neurogenesis in the

adult mouse dentate gyrus. Nat Neurosci, 1999. 2(3): p. 266-70.

• van Praag, H., et al., Exercise enhances learning and hippocampal neurogenesis in aged mice. J Neurosci,

2005. 25(38): p. 8680-5.


F. Exercise Depression

In a longitudinal study of over 9000 people,

regular physical activity was associated with a

reduced likelihood of depressive symptoms at

follow-up (Da Silva et al., 2012)

Mechanisms for the protective factor of exercise on depression have been studied

Lopresti, A. L., Hood, S. D., & Drummond, P. D. (2013). A review of lifestyle factors that contribute to important pathways associated

with major depression: Diet, sleep and exercise. Journal of Affective Disorders, 148(1), 12–27. http://doi.org/10.1016/j.jad.2013.01.014

7 Pillars: Self-Care F. Exercise

Depression in Older Adults

At 10 weeks a significantly higher proportion of the

exercise group (55% v. 33%) experienced a greater

than 30% decline in depressive rating scale as

compared to those in the health education classes

Mather et al. Effects of Exercise on Depressive Symptoms in Older Adults with Poorly Responsive Depressive Disorder:

Randomized Controlled Trial. British Journal of Psychiatry. 2002;180:411-415


F. Exercise

Yoga and PTSD

64 women with chronic, treatment-resistant

PTSD randomly assigned to two groups:

trauma-informed yoga or supportive

women’s health education

Results showed yoga significantly reduced

PTSD symptomatology, comparable to

psychotherapeutic/psychopharmacologic

approaches

van der Kolk, BA, Stone L, West J, Rhodes A, Emerson D, Suvak M, Spinazzola J. Yoga as an adjunctive treatment for

posttraumatic stress disorder: a randomized controlled trial. Journal of Clinical Psychiatry. Jun 2014; 75(6):559-96.

7 Pillars: Self-Care F. Exercise

Tai Chi Based on Forty studies, totaling 3817 subjects, Tai Chi appears to be associated

with improvements in psychological well-being including reduced stress, anxiety, depression and mood disturbance, and increased self-esteem

Wang, F., Lee, E.-K. O., Wu, T., Benson, H., Fricchione, G., Wang, W., & Yeung, A. S. (2014). The effects of Tai Chi on depression,

anxiety, and psychological well-being: a systematic review and meta-analysis. International Journal of Behavioral Medicine, 21(4),

605–617.

Tai chi, also called taiji or tai chi chuan,

is a form

of mind–body exercise that originated

from China. It combines

Chinese martial arts and meditative

movements that

promote balance and healing of the mind

and body, involving

a series of slowly performed, dance-like

postures that flow

into one another.

Nutrition

A crit ical element in

psychological health

and prevention and

treatment of chronic

i l lness

Nutrition

Hunter-gatherers 10,000 years ago

Increased caloric demand due to physically

vigorous lifestyle

Genetic make-up today is virtually unchanged

Typical diet consisted of wild game proteins

(30% of diet), nuts, fruits, legumes, and grains

Eaton, S, Konner, M. Paleolithic nutrition. A consideration of its nature and current implications. N Engl J Med.

1985;312(5):283-289.

Paleolithic Diet

Nutrition

Paleolithic Diet Wild protein source is lean 12% fat content and far less influential

in raising serum cholesterol as compared with high-fat

domesticated sources today

Low sodium-to-potassium ratio is now inverted. Was

768mg:10,500mg/dl and now average 4000mg:2500mg/dl

Just minimal sodium increases above 768mg are required to cause

a high frequency of hypertension in populations

Much higher fiber intake 100mg/dl as compared to 20g/dl today.

High fiber favorably affected lipid metabolism

Nutrition

Changes in Human Diets with Intensified Agriculture, Cooking,

and Food Processing

Increased Glycemic Load

Decrease in Omega 3 Fatty Acid Composition

Loss of Micro-nutrient Density

Shift in Acid-Base Balance to Chronic Acid Load

Inverted Sodium-Potassium Ratio

Dramatic Drop in Fiber Content

Cordain et al. Origins and evolution of the western diet: health implications for the 21st century. Am J Clin Nutr

2005;81:341-54.

Paleolithic Diet

Nutrition

Paleolithic Diet

Current Clinical Implications

Participants consumed a paleolithic type diet comprised of lean meat, fruits, vegetables and nuts, and excluded non-paleolithic type foods, such as cereal grains, dairy or legumes, for 10 days.

Even short-term consumption of a paleolithic type diet improves BP and glucose tolerance, decreases insulin secretion, increases insulin sensitivity and improves lipid profiles without weight loss in healthy sedentary humans.

Meditate on the implications. Share the information.

Frassetto et al. Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet. Eur J

Clin Nutr. 2009 Aug;63(8):947-55. 2009 Feb 11.

Nutrition

Changes in Our Diet that Trigger Inflammation

Sugar – refined grain flours, processed – high

glycemic foods with high “carbohydrate

density.”

Increased O-6/O-3 EFA intake

Food sensitivities such as gluten, dairy

Not enough vegetables, fruit, fiber

GMO and foods contaminated with

environmental toxins such as game fish

(mercury), non-organic fruits and vegetables

with pesticide residues, BPA in plastics

The Spiritual Dimension

Can be seen as an aspect of life but it is better

understood as that which gives our lives their

fullest meaning and their greatest energy.

The spiritual is not separate from, but

intrinsic to who we are…

…and we forget

Spirituality is not Religion.

Religion is the name we give to the ways we

organize our spiritual practices and our beliefs

about the spiritual.

When religion is alive and vital it is the spirit

or

spirituality which enlivens it.

Spirituality is intimately connected with

healing in China and India, in Judaism,

Islam, Christianity, and Buddhism, and

among indigenous people.

The Spirit gives life and renews life.

Every aspect of our work is spiritual…

…how we are with ourselves and others,

and with nature,

which allows us to breathe.

Spiritual Practice & Prayer

Religion & Depression

Effect of religious belief relates to speed of

remission of clinical depression in hospitalized

older patients

94 depressed patients were followed every 12

weeks for 48 weeks

Intrinsic religiosity was significantly and

independently related to time of remission but

church attendance and private religious activities

were not

For every 10 point increase in intrinsic religiosity

there was a 70% increase in speed of remission

Koenig HG, George LK, Peterson BL. Religiosity and remission from depression in medically ill older patients. American

Journal of Psychiatry. 1998; 155: 536-42.

Mind-Body Skills Groups Principles

• Meditative

• Safe Place

• Respect

• Educational

• Staying in the moment

• Leader as teacher and real person

• Power of each person to know him/herself

• Power of each person to care for him/herself

• Mutual—we are all mirrors for one another

• Group as growth organism

• Balance of structure and flexibility.

Our Model Mind-Body Skills Groups

• 8-10 people

• 10 sessions - 2 hours each

Small group format - highly structured

Integrates well with existing systems

Mind-body approaches - experiential

• biofeedback, meditation,

guided imagery, yoga

Educational vs. Medical

Group Support

Psychological Self-Care

Self-Expression

• Words, drawings, movement

CMBM Model • Engages people in actively helping themselves

Focuses on strengths and capacity for self-reliance

rather than psychopathology

• Optimism rather than past trauma

• Builds resiliency and recovery

• Group format naturally reproduces camaraderie

• Interfaces well with therapeutic and educational

approaches

• Integrates well within existing structures: clinics,

hospitals, community group

Mind-Body Skills Groups

provide perhaps the most

effective and most acceptable

way to deal with population

wide psychological trauma.

It’s Not What’s Prescribed…

It’s What You Do and

How You Do It!

It’s Not What’s Prescribed—

It’s What You Do and How You Do It!

Cunningham AJ, Phillips C, Lockwood GA, Hedley DW, Edmonds CV.

Association of involvement in psychological self-regulation with

longer survival in patients with metastatic cancer: an exploratory

study. Adv Mind Body Med 2000; 16(4):276-287.

Cunningham, AJ. Group psychological therapy: an integral part of care

for cancer patients. Integrative Cancer Therapies 2002; 1(1):67-

75.

Cunningham AJ, Edmonds CV, Phillips C, Soots KI, Hedley D, Lockwood

GA. A prospective, longitudinal study of the relationship of

psychological work to duration of survival in patients with

metastatic cancer. Psychooncology 2000; 9(4):323-339.



Gordon, JS, Staples, J, Blyta, A & Bytyqi, M. (2004)Treatment of

Posttraumatic Stress Disorder in Postwar Kosovo High School

Students Using Mind-Body Skills Groups: a Pilot Study. Journal of

Traumatic Stress, 17(2);143-147.

Gordon, James S. Staples Julie K, Blyta Afrim, Bytyqi Murat, Wilson Amy

T. Treatment of Posttraumatic Stress Disorder in Postwar Kosovar

Adolescents Using Mind-Body Skills Groups: A Randomized

Controlled Trial. Journal of Clinical Psychiatry, 2008 Sep;69 (9):1469-76.



Ornish D et al. Intensive Lifestyle Changes May Affect the Progression of Prostate Cancer. The

Journal of Urology. 2005; 174(3): 1065-1070.

Staples, Julie K. and James S. Gordon. "Effectiveness of a Mind-Body Skills Training Program for

Healthcare Professionals." Alternative Therapies in Health and Medicine. 11.4. (2005): 36-41.

Saunders, P. A., Tractenberg, R. E., Chaterji, R., Amri, H., Harazduk, N., Gordon, J. S., Lumpkin,

M., & Haramati, A.. Promoting self-awareness and reflection through an experiential Mind-

Body Skills course for first year medical students. Medical Teacher. 2007, 29: 1-6.

Staples, J.K., Abdel Atti, J.A., Gordon, J.S., (2011). Mind-Body Skills Groups for Posttraumatic

Stress Disorder and Depression Symptoms in Palestinian Children and Adolescents in Gaza.

International Journal of Stress Management. 18(3) 246-262

“Stress Biomarkers in Medical Students Participating in a Mind-

Body Medicine Skills Program”

Georgetown Medical Students enrolled in Mind Body Skills Group

were tested for biomarkers of stress. Compared to control, they

displayed:

Significant reduction in Salivary Cortisol Levels

Lower levels of exam-time stress measures

Decreased dehydroepiandrosterone-sulfate levels (DHEA-S)

Decreased testosterone levels

Maclaughlin, B.W., Wang, D., Noone, A.M., Liu, N., Harazduk, N., Lumpkin, M., Haramati, A., Saunders,

P., Dutton, M., Amri, H. Stress biomarkers in medical students participating in a mind body medicine skills

program. Evid Based Complement Alternat Med. 2011;2011:950461

Mind-body skills groups for medical

students Paper describes the Mind-Body Skills Groups

model designed by CMBM and surveys its use in

15 medical schools

Published research demonstrates Mind-Body Skills

groups model’s effectiveness in reducing stress in

medical students, enhancing students’ experience

of medical education, and in helping them look

forward more confidently and hopefully to

becoming physicians

Gordon JS. Mind-body skills groups for medical students: reducing stress, enhancing commitment, and

promoting patient-centered care. BMC Medical Education. 2014. 14:198.

Mind-Body Skills Groups & PTSD

in Postwar Kosovar Adolescents 82 high school students met criteria for PTSD

measured by Harvard Trauma Questionnaire

Program conducted by teachers in an

educational, supportive small group setting and

included meditation, guided imagery,

breathing techniques, biofeedback, and self-

expression through words, drawings, and

movement

Results: students having symptoms indicating

PTSD was significantly reduced from 100% to

18%; reduction in symptoms maintained at 3

month follow-up

Gordon JS, Staples JK, Blyta A, Bytyqi M, Wilson AT. Treatment of Posttraumatic Stress Disorder in Postwar

Kosovar Adolescents Using Mind-Body Skills Groups: A Randomized Controlled Trial. Journal of Clinical

Psychiatry. 2008. 69(9):1469-76.

Mind-Body Skills Groups & PTSD in Gaza’s Children

500 children participated in mind-body skills groups

Prior to program, 26% of children had PTSD symptoms

56% of those qualifying as having PTSD also qualified as having depression using Children’s Depression Inventory

PTSD symptom scores were significantly decreased following the program (by 56%); improvement partially maintained at 7 month follow-up with a 39% decrease in scores compared to baseline

Depression scores significantly decreased following program (29%); improvement partially maintained at 7 month follow-up with a 20% decrease in scores compared to baseline

Children felt more hopeful about their future and their lives –statistically significant decrease in hopelessness scores (28% decrease); improvement fully maintained at follow-up

Staples JK, Abdel Atti JA, Gordon JS. Mind-body skills groups for posttraumatic stress disorder and

depression symptoms in Palestinian children and adolescents in Gaza. International Journal of Stress

Management. 2011;18(3):246-62.

Many different kinds of people can lead

these groups, so long as they are highly

motivated, intelligent, self-aware,

courageous, aware of their limitations, and

willing to work collaboratively and in

supervision with others.

“The Center for Mind-Body Medicine’s program…is

the most comprehensive of all [treatments], giving

participants a variety of different strategies to choose

from: breathing, meditation, guided visual imagery, bio-

feedback, self-awareness, dance, self-expression,

drawing. And it is the one with the strongest evidence

that it works to cure PTSD.”

The New York Times, Sept 26, 2012

Conclusions

This work begins with us and

continues with us.

CMBM Uses the “Unstuck” Approach to

Trauma

Unstuck: Your Guide to the Seven Stage Journey Out of

Depression

Shows you how to reduce your stress, break-up fixed

patterns by engaging the body and mind, and utilize your

innate wisdom to facilitate creative solutions and promote

growth and healing.

Video on CBS 60 Minutes – “The lessons of War” -

http://cmbm.org/cmbm-stories/stories/cbs-gaza/

Upcoming Programs

Mind-Body Medicine PTP

– PORTLAND, October 14 –

18, 2016

Upcoming Trainings

Mind, Mood, and Food

Kripalu Center for Yoga &

Health

Stockbridge, MA, March

10 – 13, 2016

Food As Medicine

PORTLAND, OR

June 2 – 5, 2016

Questions and Answers

Sign up for our Mailing List at

www.cmbm.org

http://www.cmbm.org/

Documents

for Our Patients and Ourselves - Dietitians in …...2016/02/03 · All Health Care: for Our Patients and Ourselves James S. Gordon, MD Founder and Director: The Center for Mind-Body