Mind Body Medicine - 2014 COSC Symposium

Mind Body Medicine

Christian Carter, Ph.D.Mojgan Jahan, Psy.D.

Naval Medical Center San Diego

DisclaimerThe opinions expressed in this article are the author's own and do not necessarily reflect the view of the United States Government, the United States Department of Defense, The United States Navy, or The United States Navy Bureau of Medicine and Surgery. 

The study protocol was approved by the Naval Medical Center San Diego Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects.

I am an employee of the U.S. Government. This work was prepared as part of my official duties. Title 17 U.S.C. §105 provides that ‘copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C §101 defines U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

Disclosures/Conflicts of Interest

• None to report

Acknowledgements• Benson Henry Institute for Mind Body

Medicine• CDR Jeffrey Millegan, MD,MPH

Sometimes, being a health care provider can feel like this…

What is Mind-Body Medicine?

• Medical discipline based upon the inseparable connection between the mind and the body

• Unmanaged and overwhelming stress can turn into illness, dysfunction and possibly disease

Allostasis vs Allostatic Load Constructive/adaptive Coping: arousal reactions return to a healthy

baseline after stressor is dealt with.

Maladaptive Coping: arousal reaction continues after stressor has been dealt with. Baseline of arousal reaction moves steadily upward causing progressive “wear and tear.”

stressor stressor stressor

Str

ess

Resp

on

se

Stress Warning Signs

PhysicalHeadaches, Back Pain, Tightness

in neck or shoulders, Racing Heart, Restlessness, Tired

BehavioralSmoking, Bossiness, Compulsive

eating or drinking, Critical of others, night-time grinding of teeth, not getting things done

EmotionalCrying, Nervous, Anxious, Angry,

Lonesome, Boredom, Powerless, Easily upset

CognitiveForgetfulness, Lack of creativity,

Thoughts running away, Loss of sense of humor, Inability to make decisions, Worry

What is Mind-Body Medicine?

• Medical discipline based upon the inseparable connection between the mind and the body

• Unmanaged and overwhelming stress can turn into illness and dysfunction and possibly disease

• There are self-care modalities that can increase one’s capacity to manage stress and increase resilience

The Three Legged Stoolof

Mind Body Medicine

Overall Health

ProceduressMedication Self-care

Low self-care will reduce the benefits of everything else

Overall Health

Medication ProceduresSelf-care

The Goal

Overall Health

Medications Self Care Procedures

Goals of Mind Body Medicine

1. To enhance resiliency skills

2. To promote adaptive living through:

a) Learning relaxation techniques

b) Decreasing stress reactivity

c) Building positivity

Reversing the cycle

Learning to be “In The Zone”

A state of relaxed, passive attention to a repetitive or absorbing stimulus that turns off the “inner dialogue” thereby decreasing arousal of the sympathetic nervous system.

TWO BASIC STEPS TO THE RELAXATION RESPONSE(In The Zone)

1. A mental focusing tool, such as watching your breath, or repeating a word, phrase, prayer or thinking of a soothing image

2. A quiet, aware, ‘nonjudging’ attitude, gently directing your mind back to your point of focus when you notice yourself caught up in other thoughts.

Recuperative Sleep

• Stimulus Control• Sleep hygiene• Positive sleep thoughts

Retrain Cognitive & Emotional Instincts

• Practice cognitive restructuring– STOP– BREATHE– REFLECT– CHOOSE

• Practice positive psychology– Find a purpose to focus

on during suffering

Cognitive Restructuring is based on two premises:

1. Much of our stress and emotional suffering comes from the way we think

2. The thoughts that cause stress are often negative, unrealistic and distorted

Stress

1. Perception of a threat

- either physical or psychological

and….

2. Perception that you can’t cope

The Negative Stress Cycle

Stress

Negative Moods &

Emotions

Automatic ThoughtsPhysical Symptoms

and/orUnhelpful Behaviors

AttitudesBeliefs

Assumptions

Cultivate Social Connection

• Identify and seek out connection

• Be mindful of communication style during stress

Increasing Scientific Evidence for Multiple Conditions

Strong to moderate evidence• Cardiovascular disease• Hypertension• Insomnia• Pain

– Chronic– Low back pain– Arthritis– Acute pain– Fibromyalgia

• Surgical outcomes• Cancer treatment tolerance• Depression• Anxiety

Limited evidence• Allergies• Dermatological disorders• Diabetes• HIV progression• Irritable bowel syndrome• Post-stroke rehabilitation• Peptic ulcer• Pregnancy outcomes• Chronic obstructive pulmonary

disease• Tinnitus

Online Resources

Experiential Groups

Staff Wellness CME Series

Mind Body Medicine Course

Mind Body Medicine at NMCSD

Online Resources

Experiential Groups

Staff Wellness CME Series

Mind Body Medicine Course

Mind Body Medicine at NMCSD

www.sdihc.org

Online Resources

Experiential Groups

Staff Wellness CME Series

Mind Body Medicine Course

Mind Body Medicine at NMCSD

MIND BODY MEDICINE

Mindfulness, Balance, Renewal

Meditation Groups (20-30 minutes)

MON & TUES @ 1200 in Bldg 6, 1st Deck, Lg Conf Rm

WED @ 0730 Bldg. 26, 1st Deck, Small Classroom across the hall from Health &Wellness office

WED at 1230 in Bldg. 3, 1st Deck, OB/GYN Conf Rm in center of bldg. 3, next to C-5 Physical Therapy

Drop in, no appointment needed

Online Resources

Experiential Groups

Staff Wellness CME Series

Mind Body Medicine Course

Mind Body Medicine at NMCSD

Online Resources

Experiential Groups

Staff Wellness CME Series

Mind Body Medicine Course

Mind Body Medicine at NMCSD

Seven Week Programbased on Resilient Warrior

• Session I: Stress Physiology and Relaxation Techniques• Session II: Established “In The Zone” Techniques and the Power of Journaling• Session III: Recuperative Sleep and Cognitive Restructuring• Session IV: Qigong and Healing Beliefs lead to Positive emotions• Session V: Yoga and Cognitive Restructuring • Session VI: Enhancing Social Connection and

Communication• Session VII: Putting It All Together

Goals of the MBM Course

Participants • Understand that managing stress improves

health and functioning

• Believe that they CAN put the skills taught in the course into practice

• Put the skills into practice

Why this model?

• Teaches core concepts that can be useful with diverse populations

• Is modifiable

• Can be taught by anyone (it is a course, not therapy)

MBM Course Catalog

Current• MBM for Pain• MBM for Pain (IOP)• MBM for Stress Resilience• MBM for Mothers To Be• MBM Workshop for NMCSD

Staff• MBM OASIS• MBM Neurology

On the Horizon• Inpatient Mental Health• SARP• Naval Hospital Camp

Pendleton• Operational Fleet-ex: Meditation Resiliency Training onboard DDG • Other?

Mind Body Medicine Course feedback Overall5/2013 – 4/2014

AVG RANGEOverall Rating of Program (1=very poor, 2=poor, 3=fair, 4=good 5=excellent)

4.66 4 – 5

Refer friend to Program? (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree)

4.74 4 – 5

Plan to continue using cognitive restructuring? (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree)

4.54 3 - 5

Plan to continue meditating? (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree)

4.61 3 - 5

n=63

MBM CoursesPreliminary Findings

• MBM Pain (6 cycles)– Statistically significant

improvement in• Perceived disability• Time to sleep onset• Depression• Physical, psychological and

relationship quality of life

• MBM Mothers To Be (2 cycles)– Statistically significant

improvement in• Depression• Perceived disability• Anxiety• Physical quality of life

• MBM Stress Resilience (3 cycles)– Statistically significant

improvement in• Perceived stress• Post-traumatic stress• Sleep quality• Healthier coping with stress• Anxiety• Depression• Somatization• Physical and relationship

quality of life

MBM CoursesPreliminary Findings

• MBM Pain (6 cycles)– Statistically significant

improvement in• Perceived disability• Time to sleep onset• Depression• Physical, psychological and

relationship quality of life

• MBM Mothers To Be (2 cycles)– Statistically significant

improvement in• Depression• Perceived disability• Anxiety• Physical quality of life

• MBM Stress Resilience (3 cycles)– Statistically significant

improvement in• Perceived stress• Post-traumatic stress• Sleep quality• Healthier coping with stress• Anxiety• Depression• Somatization• Physical and relationship

quality of life

MBM CoursesPreliminary Findings

• MBM Pain (6 cycles)– Statistically significant

improvement in• Perceived disability• Time to sleep onset• Depression• Physical, psychological and

relationship quality of life

• MBM Mothers To Be (2 cycles)– Statistically significant

improvement in• Depression• Perceived disability• Anxiety• Physical quality of life

• MBM Stress Resilience (3 cycles)– Statistically significant

improvement in• Perceived stress• Post-traumatic stress• Sleep quality• Healthier coping with stress• Anxiety• Depression• Somatization• Physical and relationship

quality of life

MBM CoursesPreliminary Findings

• MBM Pain (6 cycles)– Statistically significant

improvement in• Perceived disability• Time to sleep onset• Depression• Physical, psychological and

relationship quality of life

• MBM Mothers To Be (2 cycles)– Statistically significant

improvement in• Depression• Perceived disability• Anxiety• Physical quality of life

• MBM Stress Resilience (3 cycles)– Statistically significant

improvement in• Perceived stress• Post-traumatic stress• Sleep quality• Healthier coping with stress• Anxiety• Depression• Somatization• Physical and relationship

quality of life