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MIND BODY MEDICINE AND CANCER Theo Richter
Founder Psycho-Genomics Research Institute
What is Mind Body Medicine? How does it apply to cancer? Is there any real science
behind it? More importantly, how does it apply to YOU, to those you love and care about?
How can you, or someone you love, use the principles and practices of Mind Body Medicine
(MBM) to live better and live happier with less depression, less anxiety and less stress?
These are the sorts of questions those who work in this area of medicine run into every day—
and these are the sorts of questions we hope to answer for you in this eBook.
First, some definitions:
WHAT IS MIND BODY MEDICINE?
In the US, the National Center for Complementary and Alternative Medicine
(NCCAM), a part of the National Institute of Health (NIH) has defined Mind Body Medicine
as a number of different techniques designed to enhance the mind’s ability to affect symptoms.
Some of the techniques in MBM include support groups, cognitive-behavioral therapy,
meditation, prayer, positive visualization, movement re-education, creative therapies,
aromatherapy, yoga and others. MBM is a holistic and humanistic approach, centering on the
patient and the patient’s feelings, emotions, needs and comfort.
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Mind Body Medicine is defined by Swinburne University, in Australia, as focusing‖
particular therapeutic attention upon the role of the mind-body relationship in illness and
health. The essential therapeutic aim is to promote bodily health and healing via the modality
of mind - and through the mind-body relationship.‖1
The Australasian Integrative Medicine Association defines Mind Body Medicine
(Interventions) as including ―patient support groups, meditation, prayer, spiritual healing, and
therapies that use creative outlets such as art, music, or dance.―2
In Mind Body Medicine, practitioners and patients believe in the ability of the mind to
overcome or improve physical, mental and emotional limitations. The patient takes a central
role in Mind Body Medicine—ultimately, the patient is in charge of their physical, mental and
emotional self and can work to improve their outlook or choose not to. This does NOT imply
that if a cancer patient has, for example, a new metastatic tumor, that they have somehow
―failed‖. The success of MBM lies in less quantifiable measurements. If a cancer patient feels
less depression, less anxiety, is able to enjoy their lives, is able to laugh and visit with friends
and family—the treatment is considered successful because the mental and emotional
difficulties HAVE been overcome!
A POSITIVE OUTLOOK
A positive outlook is often recommended…but what is it? For some people, it’s a sort-of
laissez faire attitude of ―No worries‖ or ―It’s all good‖ or ―Never mind—I’m fine with it‖. It is
sometimes regarded as ―being polite‖ or pleasant. Sometimes this may work, but the fact of the
matter is….there ARE worries and it’s NOT all good and sometimes….well, we’re NOT fine
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with the situation. In these cases, it may only be irritating –in fact, stressful—to hear this sort
of thing. While being polite and considerate for someone else’s feelings is important and
necessary—YOUR feelings count as well. What is sometimes regarded as cooperation may, in
fact, be co-dependent and enabling.
Sometimes, to be positive just means finding some useful lesson from a situation. For
a cancer patient, that moment you hear the diagnosis is traumatic. You thought it would never
happen to you, you think your life is over, you blame yourself, you blame your job—all sorts
of things may be running through your head. That’s all very normal and maybe even
necessary. There comes a time when the next step becomes necessary—what are you going to
do? How are you going to face this new reality?
God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.
Living one day at a time; Enjoying one moment at a time;
Accepting hardships as the pathway to peace; Taking, as He did, this sinful world
as it is, not as I would have it; Trusting that He will make all things right
if I surrender to His Will; That I may be reasonably happy in this life
and supremely happy with Him Forever in the next.
Amen
--Reinhold Niebuhr
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You can curl up and give up. That is a choice. Or, you can decide to make absolutely
the most of the situation and do your best to BE your best. This is not wishful thinking or
simply making the best of a bad situation—this is a conscious decision to control what you can
control and let go of what you cannot control.
Many 12-step addiction programs use The Serenity Prayer as a model, and it is a
healthy approach. Often, only the first part of the prayer is used, but the entire text is worth
remembering. This is not a call to any particular belief or religion—this is a call to the
meaning of the prayer/meditation.
There are things we can choose to change and there are other things where we have no
choice. When this reality is recognized, it is often much easier to proceed with the choices we
do have.
As an example, a physician graduates medical school, and ironically their health is in
shambles. As they recover, they realize that they could choose to use that experience for the
benefit of their patients. It is a much different thing to experience overwhelming fatigue or
pain than to simply read or hear about it. Now, when someone tells them how they are
grieving for the person they used to be, there is a different understanding and empathy. When
someone talks to them about fatigue and not being able to do the simplest things, they can
understand and empathize—and not just pat the patient on the back and hand off yet another
anti-depressant. You, too, can choose to regard your cancer experience in a way that is
positive and hopeful. Instead of worrying about what you are NOT doing (the yardwork, the
housework, the job that gave your life meaning and a sense of worth …) you may want to try
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to focus on what you CAN do. You can read that book you’ve been meaning to, you can
watch that movie everyone is talking about—or, maybe, you can just get better! Maybe, you
can work with a support group and help others cope with the cancer diagnosis. Perhaps you
can take some time to teach others how to successfully run a business or how to build that
cabinet. None of these approaches will necessarily come easily, but they do get easier with
practice. And, which, after all would you rather be doing? Worrying over what’s not been
done—or doing something more fun, more useful and perhaps more meaningful?
It may sometimes be important to seek professional help—perhaps a counselor,
a therapist or a health professional who is willing and able to spend some time
working with you on what you can do rather than what you can’t do.
There’s another important thing to remember about a positive outlook. There
are some who seem to ―blame‖ a patient for their condition—―stop being so negative,
you’ll make yourself sick!‖ is valid advice—but the opposite is not always true. If
you have been diagnosed with cancer—you ARE sick, but you are NOT to blame for
your condition and it DOESN’T mean you should be blamed for being negative!
There are many things that factor in—and, ultimately, being blamed or feeling
shamed about your health is NOT healthy. The fact is, anyone can get sick, and it’s
not just a reflection of how positive and upbeat they are, but also a reflection of
family history, personal history, the environment and any other number of factors.
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IS THERE ANY SCIENTIFIC EVIDENCE FOR MIND BODY MEDICINE?
The short answer to this question is yes—there is increasing scientific support for the
effects of the mind on improving the physical, mental and spiritual well-being and health of
individuals who practice certain techniques. The opposite is also true—there is much evidence
suggesting that stress and ―negative‖ attitudes can actually put someone at greater risk for
cancer and other chronic diseases.
A BRIEF HISTORY OF MBM
In 1975, Ader3 coined the term ―psychoneuroimmunology‖, or PNI to describe a newly
discovered communication system between the brain, the mind and the immune system. When
it was first described, many in the mainstream medical community found it difficult to accept.
To many outside the mainstream medical community, it seemed pretty obvious—doctors and
patients alike knew quite well that when someone was depressed or grieving over the loss of a
loved one, they tended to get sick more often and took longer to recover. When someone was
under a lot of stress at home or at work, they were at greater risk for heart disease. In the
world of science, however, it is important to understand that these ideas needed proof. The
concept of PNI finally gave scientists a theory to test.
Soon, studies on PNI began to be seen in the scientific journals around the world.
These studies were able to definitely prove that, for example, if you are dealing with a
spouse how has Alzheimer’s Disease, any injuries you suffered took longer to heal.4 If
there was conflict in your marriage or your relationship, your immune system was
suppressed5. If you were a medical student taking exams, your immune system was also
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suppressed.6 People in grief and under various other forms of stress were also found to
have decreased immunity and increased stress hormones such as cortisol.7 Cancer
patients who did not have a community or group to support them were shown to have
decreased Natural Killer (NK) cell immunity.8
Other researchers showed significant reduction in pain in over 4000 arthritis patients
who were involved in mind-body support groups.9 Patients who had had a heart attack and
went to facilitated mind-body groups had over 50% less of a chance of a second heart attack
than those who didn’t attend a mind-body group.10
When mind body approaches are examined over the last 25 years, an even clearer
picture emerges. A number of studies have shown major benefits, particularly for cancer
patients. Some of the benefits studied included a longer life, a better quality of life and a better
and happier outlook on life.11, 12, 13, 14
The ―placebo‖ effect has provided another line of evidence for the positive effects of
MBM. The placebo effect can be defined as a beneficial effect in a patient after an ―inert‖
treatment. The placebo effect is thought to come from the patient's expectations concerning
the treatment—and not the treatment itself. It has always been considered to be almost a
nuisance, not really ―real‖ –or an effect that ―got in the way‖ of interpreting the data. Well, it
turns out that not only is it ―real‖ but it can be localized to a real part of the brain and
controlled by normal receptors in the brain—the same types of receptors that respond to, for
example, pain medications.15
In all those studies over the years where the placebo effect was
used to explain improvements in outcome after a specific therapy, some portion of the patients
improved because they believed they could improve. This is not just some ―fluffernutter‖,
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hand-waving pie-in-the-sky thinking—this is a real effect and happens repeatedly in every
clinical trial of a particular drug or therapeutic approach—there is always some proportion of
individuals who improve just because they believed they could. The body has an incredible
potential for self-repair and the mind is a powerful tool in that repair process.
In a recent review of the literature, it was acknowledged that the mind—and the state of
the mind – is critically important to how the body responds, how it heals and how the body is
able to rid itself of an infection, a tumor or any condition.16
To many people, again, this really
didn’t come as a great surprise—there are stories everywhere of the more depressed you are,
the sicker you get or the more ―negative‖ you are the more likely to get cancer or a heart
attack. We have long known that certain personality ―types‖ are more likely to have heart
attacks. Many talked about a business man with a ―Type A personality‖ who was headed for a
heart attack. What is different now is that there is much more data to support what many of us
already suspected.
Another recent review connected not only the psychological, the nervous and the
immune systems, but added information about stress—what stress does to a person’s body,
mind and spirit and what stress can cause—heart conditions, depression, nervous conditions,
glandular imbalances, cancer and more.17, 18, 19
We all have stress—and, within limits, we can
all cope with stress. There does come a point for many where the stress begins to affect both
our mental and our physical health.
BALANCE AND STRESS
In MBM, individuals are viewed as being in-balance or out-of-balance. Various factors
can influence this balance. One of the important things to consider is the environment one
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finds oneself in. This environment includes not only man-made chemicals in the air and soil,
or in the food we eat, but in the
internal environment as well. The
body has an enormous capacity to
re-establish balance after any
number of stresses. Wound
healing is a response to the stress
of injury—but, it may leave a scar.
A fever is a response to the stress
of an infection—but, if a fever runs too long and too hot, damage may occur. Various organs
of the body work to alter chemicals in the environment and make them harmless (or just less
harmful) and then get rid of them—but, if those organs become overwhelmed, they may shut
down. The inflammatory response is a normal part of any immune response—but, if it
becomes chronic and long –term, it can cause damage as well. Just as in the figure, if one side
of a seesaw has too much weight on it, the other side is left ―hanging‖. In this ―Allostasis
Model‖ 20, 21
the body can, for years, maintain the balance in the face of all sorts of stressors—
whether they are environmental, community-related, home-related, emotional or physical.
There is a great deal of flexibility built into the system. Just as on a seesaw, you can
continuously shift your position to balance with a heavier or lighter counterweight, but
eventually, if the weights are too different, the balance is lost. In a similar way, the body can
deal with a large number of shifts in its own internal seesaw, but there may come a point where
it is simply too much to overcome.
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AR
H
ACT
H
Cortisol,
Adrenaline
Cortisol,
Adrenaline
↑Heart Rate
↑ Respiratory
Rate
↑ Blood flow to
vital organs:
lungs, brain,
heart, skeletal
muscle
↑ Blood sugar
and oxygen to
tissues
↓Blood flow to
stomach, intestines.
Stress, when it goes unchecked for too long is damaging. One of the most important
things any cancer patient can do for themselves is minimize their stress levels. As explained
earlier, there is strong evidence that stress reduction can be helpful. Even more recently, there
has been some exciting and important work done in the field of epigenetics and it is providing
a model for an even sounder scientific basis for MBM.
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Epigenetics can be defined as the ―heritable changes in gene expression that occur in
the absence of alterations in DNA sequences‖22
―Epi‖ is a prefix that means ―upon‖, ―over‖
and ―above‖. It has be found that the environment, stress, disease and even the food we eat can
change our DNA in measurable ways—and that these changes can be handed down to our
children.23,
24,25
Different genes that are known to be involved in the appearance and
progression of cancers have been found to be affected by these types of epigenetic changes.26,
27, 28, 29 Many of these changes have been related to environmental,
30,31 foods
32, 33, 34 and
various lifestyle choices.35, 36, 37
Epigenetic research has also begun to focus on how it may be
involved not only in the cancer itself, but how cancer begins38
and is dependent on
environmental and nutritional factors39
, how epigenetic factors can affect tumor spread and
recurrence40
and how epigenetic factors can change the risk or likelihood of a particular
disease or condition.41
Various experiments and clinical research have identified links between stressors and
psychological, psychosocial, environmental factors and genes which may provide a basis for
treatment and prevention of cancers. Existing research into cancer shows some predisposing
genes and the psychological, psychosocial, and environmental factors which may be involved.
A stress hypothesis, including the epigenetic alterations, was investigated in a study
that reported sustained stress environment (SSE) investigations, noted in the table below, by
different natures of stress impacts (Karpinets, & Foy, 2005).
The following table, adapted from my paper on Stressors, psycho-genomic pathways
and cancers42
shows just some of the epigenetic changes that have been described.
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What is most important for cancer patients is the research showing that various factors,
including environmental43, 44, 45
, dietary46, 47
lifestyle48, 49, 50
—and emotional51, 52, 53, 54, 55
factors
can play a large role in the epigenetic control of various diseases. In other words, it is
becoming apparent that not only ―you are what you eat‖ and ―man does not live by bread
alone‖, but we also are what we think and what we feel.
It has been remarked that ―Technological advances make it feasible to envisage that in
the future personalized drug treatment and dietary advice and possibly tailored food products
can be used for promoting optimal health on an individual basis, in relation to genotype and
lifestyle.‖56
Ornish and others 57
conducted a pilot study to examine changes in prostate gene
expression after intensive nutritional and lifestyle interventions. The nutritional interventions
included whole, organic foods. The lifestyle interventions included support groups, meditation
Epigenetic alterations Nature of stress
Hypermethylation of tumor suppressor and other
genes known to be involved in cancer
Tobacco smoke, cadmium, dioxin
exposure
Hepatitis B virus and hepatitis C virus
infection in liver with chronic
inflammation
Hypomethylation of genes known to be involved in
cancer
Exposure to Phenobarbital and
carcinogens such as cadmium, arsenite,
dichloroacetic acid and trichloroacetic
acid.
Radiation
Damage to DNA structure and introduction of new
elements into the DNA
Exposure with nickel, oxidative stress
(free radicals), lack of oxygen
Hypermethylation of genes necessary for normal
repair of DNA
Chronic inflammation (chronic ulcerative
colitis)
Epigenetic silencing of genes Proliferation under stress
Aberrant methylation SV40 virus infection
Epstein–Barr virus-associated gastric
carcinoma
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yoga and TaiChi. They were able to show a positive correlation between a significant clinical
improvement with the up-regulation of 48 gene transcripts and the down-regulation of 453
gene transcripts. Consistent with other studies, they also saw significant improvements in
weight, abdominal obesity, blood pressure, and lipid profiles. Their analysis showed
significant modulation of biological processes that play a critical role in cancer and cancer
progression. Translation? Eating healthier foods, living a healthier life and communicating
and sharing your emotional life with others resulted in an improvement without any drugs or
surgery. Now, this is not to suggest that you ignore your doctor’s advice. This is to suggest
you add to that advice and find ways to be happier and healthier as you do it.
A recent paper ―Beyond clinical phenotype: The biologic integratome‖58
stated
―Beyond the clinical phenotype, the biological integratome theoretically has the potential to
transform human disease classification, illuminate our understanding of drug action, and set a
new dawn for personalized medicine.‖ The‖integretome‖ refers to the complete set of genetic
and epigenetic information about an individual combined with information about their
responses to all forms of stressors. The idea is to personalize medicine and to recognize that
each individual responds differently to therapeutic interventions. Part of the response is
genetic, part of it has to do with the total life experience of an individual incorporating all
phases of experience—physical, mental, emotional and spiritual.
Nutritional genomics is also a part of that potential future.59
It is the study of the
relationship between food, the human genome and health. Just as many people cannot digest
milk sugar (lactose), and many people find that removing gluten from their diet improves their
health, nutritional genomics studies what foods can affect a individual’s health and risk for a
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certain disease or condition. Further, it is believed that eating certain foods—beyond the
obvious basic nutritional benefits—can improve a condition.
Ultimately, these and other studies have provided support for what ancient traditions
from around the world have long believed—that our thoughts, our prayers, our foods, our
activities and our beliefs can and do provide us with healing. Patients with emotional
repression have been shown to have poorer immune responses and have a higher death rate
from their cancer.60
Psychological stress causes decreased immunity as well—there is a drop
in NK (Natural Killer) cells and changes in the amounts of cytokines61
(the cellular messenger
service).
DIFFERENT APPROACHES IN MIND BODY MEDICINE
Let Food be thy
Medicine and
Medicine be
thy Food.
Hippocrates, ca. 460
BCE – ca. 370 BCE,
considered the Western
Father of Medicine
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Fat: Vegetable oils, nuts, fish,
butter. High in Omega 3, 9
Fruit Juices and water
Carbohydrate: whole grains (gluten free):
millet, barley, rice, oat, buckwheat, quinoa
1 type of protein: sesame, tofu, mushroom,
almond, eggs, seaweed, fish, poultry. Limit red
meat.
5 types of vegetables: Include 2 “greens” and 1 “yellow”
4 types of fruit: berries, citrus, pomegranates,
apricots,
pineapple, apples, grapes, papaya, plums
Diet:
We hear so much about a good diet—but what does that really mean? In the ―Pyramid‖
shown, the base of the pyramid represents what should be the greatest type of food eaten every
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day—the vegetables. A good ―rule of thumb‖ to follow is to include at least 2 types of leafy,
green vegetables and at least 1 yellow vegetable. In general, the more raw vegetables you eat,
the more nutrients you get—cooking diminishes or destroys many of the nutrients. The second
level of the pyramid is fruit. Try for 4 servings a day. Obviously, not every fruit or vegetable
is in season all the time—dried fruits and frozen vegetables, while not the ideal, are good
substitutes. The third level is high quality protein that contains the essential amino acids—
those amino acids that humans can’t make from others. Try to limit red meat—but, keep in
mind that grass fed beef has high quality protein AND has the correct ratio of omega fats.
(Corn fed beef has ~70% more of the heart-clogging fats) The fourth level of the pyramid, fats,
includes nuts, vegetable oils and fish—high in omega 3 fats (which are anti-inflammatory) and
low in omega-6 fats (which increase inflammatory responses).
In general, the less processed food you eat, the better. Also, the more fresh, organic food
you eat, the better! It all has to work for YOU, so try to find your best blend of raw, fresh,
organic food with prepared foods that are easier to get or make. Another point to keep in
mind, though—cooking turns out to be a pretty relaxing and fun activity—as long as you’re
not in competition for the Top Chef award!
Exercise
Exercise includes the sweat-drenched workout and the stretching of yoga and tai chi.
The idea is to find what works for you and to do it consistently. It is not always necessary—
nor wise—to start out with the more intense programs. After a few days of aching muscles,
the end result may be to quit! One of the cardinal rules of MBM is to be kind to yourself! It is
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often wise to get started by walking, increasing the time and amount of walking every week. If
you want to join a gym, that’s fine too—just make sure you don’t overdo it—or over reach.
Remember, our grandparents stayed in pretty good shape, weighed less and had fewer chronic
diseases without gyms—they walked and they physically worked.
Yoga has been shown to reduce fatigue in cancer patients and has been
shown to reduce the stress hormone, cortisol.62
It has also been proven to
be of both physical and emotional benefit, particularly to cancer patients.
The stretching increases blood and lymph flow, thought to help eliminate
waste and reduce the toxic side effects of some chemotherapeutic agents,
helps relieve pain and insomnia, appears to reduce the risk of recurrence of
some cancers and lowers the risk of depression.
Tai chi is actually a martial art—the story told around dojos
(martial art studios) is that Tai chi was originally practiced by
many as a martial art, but that an early Chinese emperor was
concerned that too many of his people could fight—perhaps
against his rule! He therefore decided to ban the martial art. The people responded by slowing
down the forms (the practice routine) so that they were regarded as exercise, and Tai chi
continued as a slow, almost dance-like exercise. There are many different forms of Tai chi, but
they all include slow, controlled movement that gently stretches the muscles, increases muscle
mass and tone, improves posture and balance, flexibility, stamina, and strength particularly in
older adults. Tai chi has also been shown to reduce stress and can provide the cardiovascular
benefits such as lowered blood pressure and heart rate. Tai chi is a mental exercise as well,
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closely related to the Chinese practice of Qigong, specifically medical Qigong. (Click here for
a video lesson in Qigong, here for Tai Chi and here for Yoga)
Relaxation Techniques
Relaxation: includes autogenic training, deep muscle relaxation, meditative
techniques, biofeedback, relaxation response, hypnosis.
Autogenic training:
Autogenic training teaches individuals how to achieve deep muscle relaxation along
with a calm mind and spirit. It was originally developed by a German physician, Johannes
Schultz.63
It can be self-taught, but you should understand that to get best results, a trained
teacher may be important.
Spiritual Connection and Connection of Purpose
This includes prayer, spiritual or religious support groups. Many people achieve a
greater understanding not only of their personally held religious or spiritual beliefs, but those
of the community as well.
Imagery and Cognitive Restructuring
This includes visualization, guided imagery and self-talk. The idea is to imagine, or
picture yourself as a happier, healthier person and you can become that person. Studies 64
have
shown a benefit to many cancer patients, increasing comfort and decreasing anxiety.
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Cognitive restructuring is an approach used to get rid of ―stinkin’ thinkin’ ―as it is
sometimes referred to. It is a technique used to understand negative thoughts and moods and a
specific plan to deal with those thoughts and moods and ―convert‖ them into positive thinking.
It involves reflection, identification, writing, analysis and observation and has proven to be
very useful in re-focusing people’s attitudes.
Emotive-Expressive Techniques, Expressive arts and Humor
These may include art and music therapy, self-expression through theater or journaling.
Energy Medicine
Energy medicine is a broad and emerging category of Mind Body Medicine. It is an
approach that attempts to utilize the biomagnetic energy fields surrounding all of us and
includes Eye Movement Desensitization Reprocessing (EMDR), Emotional Freedom
Techniques (tapping), Reiki, Healing Touch and other modalities.
The techniques used in MBM are non-invasive and non-drug based. These modalities
involve self-reflection, meditation and intention, and are experiential. They involve the mind
and body in the process of reflection and intention, in the experiential and learning process and
in the active process of a ―change of state‖. In MBM, the patient is central to the process and
chooses the goal. The patient also provides the information necessary to achieve that goal and
finally, the patient actively pursues the goal of healing that area that they themselves have
determined needs to be healed. The responses to the various MBM modalities may be
immediate or may extend over a longer recovery period, yet no matter how long the practice,
the patient is intimately and actively involved in the full healing process.
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NEW AREAS OF MIND BODY MEDICINE AND CANCER RESEARCH
One of the areas that is actively being explored is the emerging field of
psychogenomics. Most simply put, psychogenomics is the study of the effect of genetics on
behavior and health. Recent studies in epigenetics imply that that we could also define
psychogenomics as the study of behavior and health on genetics. As with so much in science
and medicine, there is a balance to be achieved and understood.
Within the umbrella term of psychogenomics can be included other ―omics‖. The
proteome is the proteins coded for by the genome. The transcriptome is the array of messenger
RNAs (mRNAs) that are transcribed into the proteins. Finally, the metabolome is the entire
complex of metabolic pathways and networks within which all the proteins, hormones, lipids,
signaling messengers and other molecules of the body function to produce overall health—or,
if malfunctioning, disease. The metabolome is the ―end-result‖ of all the other ―omics‖ and
can also be affected by the state of the mind.
This is a vast—and mostly untapped—area of research. A sampling from
psychogenomics research facilities around the world reveal a wide diversity of approaches and
conditions studied. At the world-renowned Mayo Clinic psychogenomics lab, studies are
underway examining the genetic relationship between certain forms of liver enzymes and the
response to the anti-cancer drug tamoxifen, the genetics of some auto-immune gastrointestinal
disorders, the dependence on genetics of the response to anti-depressant medications and how
genetics can affect the response to bone marrow transplantation in leukemia patients. A recent
review of psychogenomics in psychiatry reveals it as a ―hot topic‖. It is also thought to be
important in the study of addiction. In multiple sclerosis and Alzheimer’s disease, researchers
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are discovering that ―cognitive reserve‖ is important in how these diseases affect people.
Cognitive reserve is defined as the ―degree of spare cognitive capacity available to protect
against the effects of disease or trauma to the brain.‖65
There seems to be a disparity in the
amount of neurological damage and outward symptoms in some people—even though by, for
example, imaging techniques, they ―should‖ be suffering serious symptoms, the cognitive
reserve they have appears to be protective. This cognitive reserve appears to develop as a
function of an individual’s interest in learning and having new experiences.66
In the area of
heart disease and depression, Jiang et al presented the findings of a global symposium on the
relationship between depression and heart disease67
, suggesting that the results of the
symposium supported the concept of a psychogenomics approach. More recently, in a large
study of veterans, the authors concluded that depression, anxiety disorder, panic disorder, and
PTSD were independent risk factors for a heart attack 68
again, supporting the concepts of a
psychogenomics approach.
Regarding studies where mind-body approaches have been implemented, particularly
regarding cancer treatments, there have been increasing positive results. For example, a recent
paper studied 115 cancer patients who were randomly assigned to either mindfulness sessions
or were wait-listed.69
The study lasted 10 weeks, at which point both groups were assessed for
depression, anxiety, distress and quality of life. Those who participated in the mindfulness
sessions scored significantly better than those who had not participated. It was concluded that
the mindfulness participation had important clinical benefits. In another study of cancer
patients70
, stress reduction lead to a clinical improvement in health outcomes.
It is the intention behind the writing of this eBook through the Psycho Genomics
Research Institute to set up a research program into psychogenomics and cancer71
.
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So, where are we, what do we know, what don’t we know and where do we go from here?
What we know:
We know that how you feel, emotionally, mentally and spiritually can affect your risk
for cancer and your survival of cancer.
We know that certain lifestyle habits can put you at greater risk of cancer.
We know that at least some genes can be altered in such a way as to increase the risk of
cancer and, decrease the risk of cancer.
We know that we, by the choices we make in food, lifestyle and attitude, can make a
difference in which genes are altered and how.
What we don’t know:
We don’t know exactly which genes affect cancer and how they affect cancer.
We don’t know exactly how and which behaviors are most influential on the
predisposition or development of cancer.
We don’t know what bio-markers to look for or how they might be affected by changes
in behaviors.
We don’t know which interventions can affect the predisposition or development of
cancer.
Where do we go from here?
The Psycho-Genomics Research Institute through the release of this eBook hopes to attract
interest to further this research to include a clinical trial. Anyone interested should email us at
[email protected] to further develop the research necessary to answer some of
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the most important basic questions in this important and rapidly emerging field. The Institute
proposes to further the research in such a clinical trial in order to:
The hypothesis under which this proposed research will be carried out is that ―…there is a
different and measurable genome RNA expression change and/or impact following the
psychological intervention on cancer, survivals and non-cancer populations.‖
It is believed that a study that undertakes a cross sectional examination from
psychological factors through our immune system to our DNA may positively impact
both cancer treatment and progression.
There are two main streams of research findings dealing with the immune system and genetics
that will be interwoven with psychological intervention to potentially improve clinical
outcomes in cancer treatment.
The immune system may be utilized to more efficiently minimize cancer growth as
noted in a 2007 research finding by a researcher from the MacCallum Cancer
Immunology Program in Melbourne;
Identify gene expression and gene mutation marker differentials between
cancer and non-cancer population
Undertake a study over several years looking for blood markers of cellular
dysfunctions which predispose to cancer, i.e. a step before the current screening
phase, and
Identify psychological/psychosocial intervention affects on those blood
markers over time in order to treat cancers to increase survivorship and prevent
initiation of cancers.
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Psychological factors, such as stress, depression and social support are able to
modulate many of the immunologic activities relevant to patients with malignant
disease;
Psychological interventions can enhance psychological adjustment and improve
immune function.
The emerging information on epigenetic factors and how lifestyle, diet and
environment can impact on the epigenetics of cancer will provide a method to follow
the effect of the psychological interventions.
Cancer patients, cancer survivors and their families, as well as any interested persons are invited
to join us on our discussion forum at:
http://www.psycho-genomics.com
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1 http://courses.swinburne.edu.au/subjects/Introduction-to-Mind%2FBody-Medicine-HIM205/local
2 http://www.aima.net.au/resources/what_is_integrative_medicine.html
3 Ader, R & Cohen,N. (1975) Behaviorally conditioned immunosupression. Psychosomatic Medicine;
37(4), 333-40. 4 Christian LM, Graham JE, Padgett DA, Glaser R, Kiecolt-Glaser JK. (2006) Stress and wound healing.
Neuroimmunomodulation.;13(5-6):337-46. 5 Kiecolt-Glaser JK, Loving TJ, Stowell JR, Malarkey WB, Lemeshow S, Dickinson SL, Glaser, R., (2005
) Hostile marital interactions, proinflammatory cytokine production, and wound healing. .Arch Gen
Psychiatry. Dec;62(12):1377-84. 6 Kiecolt-Glaser JK, Garner W, Speicher C, Penn GM, Holliday J, Glaser R. (1984) Psychosocial modifiers
of immunocompetence in medical students. Psychosom Med. Jan-Feb;46(1):7-14. 7 Bartrop, RW, Luckhurst, E. Lazarus L. Kiloh, LG & Penny, R. (1977) Depressed lymphocyte function
after bereavement. Lancet, (8016). 834-836. 8 Lutgendorf SK, Sood AK, Anderson B, McGinn S, Maiseri H, Dao M, Sorosky JI, De Geest K, Ritchie J,
Lubaroff DM. (2005 ) Social support, psychological distress, and natural killer cell activity in ovarian
cancer. J Clin Oncol. Oct 1;23(28):7105-13. 9 Lorig KR, Ritter PL, Stewart AL, Sobel DS, Brown BW, Bandura A, et al. (2001) Chronic Disease Self-
Management Program: 2-Year Health Status and Health Care Utilization Outcomes. Medical Care, 39(11),
1217-1223. 10
Frishman, WH , Beravol, P, Carosella,C., (2009) Alternative and Complementary Medicine for
Preventing and Treating Cardiovascular Disease, Disease-a-Month - Volume 55, Issue 3. 11
Andersen BL, Yang HC, Farrar WB, Golden-Kreutz DM, Emery CF, Thornton LM, Young DC, Carson
WE 3rd (2008). Psychologic intervention improves survival for breast cancer patients: a randomized
clinical trial. Cancer, Dec 15, 113 (12),3450-8. 12
Anderson K.O., Cohen M.Z., Mendoza T.R., et al: (2006) Brief cognitive-behavioral audiotape
interventions for cancer-related pain. Cancer 107. (1): 207-214. 13
Spiegel D, Butler LD, Giese-Davis J, Koopman C, Miller E, DiMiceli S, et al.( 2007 ) Effects of
supportive-expressive group therapy on survival of patients with metastatic breast cancer: a randomized
prospective trial. Cancer, 110(5):1130-8. 14
Spiegel D, Moore R. (1997) Imagery and hypnosis in the treatment of cancer patients.
Oncology;11(8):1179-89. 15
Diederich NJ. (2008) The placebo treatments in neurosciences: New insights from clinical and
neuroimaging studies, Neurology 71(9): 677-84. 16
Friedman, HS, (2008) The Multiple Linkages of Personality and Disease, Brain, Behavior, and
Immunity, 22(5):668–675. 17
Irwin, MR,( 2008) Human psychoneuroimmunology: 20 Years of Discovery, Brain, Behavior, and
Immunity, 22, (2): 129-139. 18
Goncharova, LB, Tarakanov, AO, (2007) Molecular Networks of Brain and Immunity, Brain Research
Reviews, 55, (1):155-166. 19
Malarkey, WB, Mills, PJ, (2007) Endocrinology: The active partner in PNI Research, Brain, Behavior,
and Immunity, 21(2):161-168. 20
McEwen BS.(1998)Protective and damaging effects of stress mediators. N Engl J Med; 338(3):171–9. 21
McEwen BS. (2008) Central effects of stress hormones in health and disease: Understanding the
protective and damaging effects of stress and stress mediators. Eur J Pharm 583(2-3):174-85. 22
Miller, RL, Ho, SM., (2008) Environmental epigenetics and asthma: current concepts and call for
studies, Am J Resp CritCareMed(6):567-73. 23
Epel ES, Blackburn EH, Lin J, Dhabhar FS, Adler NE, Morrow JD, Cawthon RM. (2004) Accelerated
telomere shortening in response to life stress..Proc Natl Acad Sci U S A. Dec 7;101(49):17312-5. 24
Macnee W, (2007) Pathogenesis of Chronic Obstructive Pulmonary Disease, Clin Chest Med , 28(3):
479-513, v.
27
25
Taïeb, A., Hanifin,J., Cooper, K., Bos, JD, Imokawa, G., David, TJ.,et al (2006)Proceedings of the 4th
Georg Rajka International Symposium on Atopic Dermatitis, Arcachon, France, September 15-17, , J
Allergy Clin Immunol 117(2): 378-90, 2006. 26
Fleming JL; Huang TH; Toland AE., The role of parental and grandparental epigenetic alterations in
familial cancer risk. Cancer Res - 15-NOV-2008; 68(22): 9116-21. 27
Mathews LA; Crea F; Farrar WL. Epigenetic gene regulation in stem cells and correlation to cancer.
Differentiation - 01-JUL-2009; 78(1): 1-17 28
Iacobuzio-Donahue CA. Epigenetic changes in cancer. Annu Rev Pathol - 01-JAN-2009; 4: 229-49. 29
Clark SJ Action at a distance: epigenetic silencing of large chromosomal regions in carcinogenesis. Hum
Mol Genet - 15-APR-2007; 16 Spec No 1: R88-95 30
Weidman JR; Dolinoy DC; Murphy SK; Jirtle RL. Cancer susceptibility: epigenetic manifestation of
environmental exposures. Cancer J - 01-JAN-2007; 13(1): 9-16. 31
Hitchler MJ; Domann FE. Metabolic defects provide a spark for the epigenetic switch in cancer.
Free Radic Biol Med - 15-JUL-2009; 47(2): 115-27. 32
Davis CD Nutritional interactions: credentialing of molecular targets for cancer prevention. Exp Biol
Med (Maywood) - 01-FEB-2007; 232(2): 176-83. 33
Dutkiewicz MC - Lifting a fork to heart health. Whole foods as a treatment intervention. Adv Nurse
Pract - 01-FEB-2008; 16(2): 57-60 34
Ross SA Nutritional genomic approaches to cancer prevention research. Exp Oncol - 01-DEC-2007;
29(4): 250-6. 35
Herceg Z Epigenetics and cancer: towards an evaluation of the impact of environmental and dietary
factors.
Mutagenesis - 01-MAR-2007; 22(2): 91-103. 36
.Choudhuri S - Molecular targets of epigenetic regulation and effectors of environmental influences
Toxicol Appl Pharmacol - 15-JUN-2010; 245(3): 378-93 37
Nystrom M - Diet and epigenetics in colon cancer. World J Gastroenterol - 21-JAN-2009; 15(3): 257-
63. 38
Feinberg AP, The epigenetics of cancer etiology.
Semin Cancer Biol - 01-DEC-2004; 14(6): 427-32 39
Herceg Z Epigenetics and cancer: towards an evaluation of the impact of environmental and dietary
factors.
Mutagenesis - 01-MAR-2007; 22(2): 91-103 40
Lujambio A; Esteller MHow epigenetics can explain human metastasis: a new role for microRNAs. Cell
Cycle - 1-FEB-2009; 8(3): 377-82 41
Feinberg AP Phenotypic plasticity and the epigenetics of human disease. Nature - 24-MAY-2007;
447(7143): 433-40 42
Theo Richter, Stressors, psycho-genomic pathways and cancers, 2007, www.psycho-genomics.com. 43
Ege MJ, Bieli, C., van Strien, RT, Riedler, J., Ublagger, E, Schram-Bijkerk, D et al (2006) Prenatal Farm
Exposure is Related to the Expression of Receptors of the Innate Immunity and to atopic sensitization in
school-age children, J Allergy Clin Immunol; 117(4): 817-23. 44
Vercelli, D.,(2004) Genetics, epigenetics, and the environment: switching, buffering, releasing., J.
Allergy Clin Immunol;113(3):381-6. 45
Waterland RA , (2006)Epigenetic Mechanisms and Gastrointestinal Development- J Pediatr ; 149(5
Suppl); S137-S142. 46
Trujillo E, Davis, C., Milner, J. (2006) Nutrigenomics, proteomics, metabolomics and the practice of
dietetics, J Am Diet Assoc; 106(3): 403-13. 47
Reynolds E, (2006) Vitamin B12, folic acid, and the nervous system, Lancet Neurol; 5(11): 949-60. 48
Macnee W, (2007) Pathogenesis of Chronic Obstructive Pulmonary Disease, Clin Chest Med , 28(3):
479-513, v. 49
Herzeg, Z., (2007) Epigenetics and Cancer: Towards an evaluation of the impact of environmental and
dietary factors, Mutagenesis, 22(2), 91-103. 50
Crews, D., (2008) Epigenetics and its implications for behavioral neuroendocrinology, Frontiers in
Neuroendocrinology, 29(3), 344-357.
28
51
Yoo GJ; Aviv C; Levine EG; Ewing C; Au A, Emotion work: disclosing cancer. Support Care Cancer -
01-FEB-2010; 18(2): 205-15 52
Kreuter MW et al What makes cancer survivor stories work? An empirical study among African
American women. - J Cancer Surviv - 01-MAR-2008; 2(1): 33-44 53
Eliott JA; Olver IN Hope and hoping in the talk of dying cancer patients. Soc Sci Med - 01-JAN-2007;
64(1): 138-49. 54
Schroevers M; Kraaij V; Garnefski N, How do cancer patients manage unattainable personal goals and
regulate their emotions? Br J Health Psychol - 01-SEP-2008; 13(Pt 3): 551-62 55
Meyerowitz BE; Kurita K; D'Orazio LM, The psychological and emotional fallout of cancer and its
treatment. Cancer J - 01-NOV-2008; 14(6): 410-3 56
Desiere, F. (2004) Towards a systems biology understanding of human health: Interplay between
genotype, environment and nutrition, Biotechnology Annual Review, 10:51-84. 57
Ornish, D., Magbanua MJ, Weidner G, Weinberg V, Kemp C, Green C, Mattie MD, Marlin R, Simko J,
Shinohara K, Haqq CM, Carroll PR , (2008) Changes in prostate gene expression in men undergoing an
intensive nutrition and lifestyle intervention., PNAS, 105(24):8369-74, (Epub) . 58
Grimaldi D; Claessens YE; Mira JP; Chiche JD Beyond clinical phenotype: the biologic integratome.
Crit Care Med - 01-JAN-2009; 37(1 Suppl): S38-49. 59
Ordovas JM, Corella D. Nutritional genomics Annu Rev Genomics Hum Genet. 2004;5:71-118. 60
Giese-Davis J, Sephton SE, Abercrombie HC, Durán RE, Spiegel D (2004 ) Repression and high anxiety
are associated with aberrant diurnal cortisol rhythms in women with metastatic breast cancer. Health
Psychol. Nov;23(6):645-50. 61
Holden RJ, Pakula IS, Mooney PA. (1998) An immunological model connecting the pathogenesis of
stress, depression and carcinoma. Med Hypotheses. Oct; 51(4):309-14. 62
Kamei T, Toriumi Y, Kimura H, Ohno S, Kumano H, Kimura K. Decrease in serum cortisol during yoga
exercise is correlated with alpha wave activation. PerceptMotSkills 2000 Jun;90(3 Pt 1):1027-32. 63
Schultz, J. H., & Luthe, W. (1959). Autogenic training: A psychophysiologic approach in psychotherapy.
New York: Grune and Stratton. 64
Roffe L Schmidt K; Ernst E A systematic review of guided imagery as an adjuvant cancer therapy. -
Psychooncology - 01-AUG-2005; 14(8): 607-17. 65
Arnett PA, in Does cognitive reserve apply to multiple sclerosis? Neurology - 15-JUN-2010; 74(24):
1934-5. 66
Sumowski JF, Wylie GR, Chiaravalloti N, DeLuca J: Intellectual enrichment lessens the effect of brain
atrophy on learning and memory in multiple sclerosis. Neurology 74. 1942-1945.2010. 67
Jiang W, Glassman A, Krishnan R, O'Connor CM, Califf RM. Depression and ischemic heart disease:
what have we learned so far and what must we do in the future? Am Heart J. 2005 Jul;150(1):54-78.
Review. 68
Scherrer JF; Chrusciel T; Zeringue A; Garfield LD; Hauptman PJ; Lustman PJ; Freedland KE; Carney
RM; Bucholz KK; Owen R; True WR, Anxiety disorders increase risk for incident myocardial
infarction in depressed and nondepressed Veterans Administration patients. Am Heart J - 01-MAY-
2010; 159(5): 772-9. 69
Foley E; Baillie A; Huxter M; Price M; Sinclair E., Mindfulness-based cognitive therapy for
individuals whose lives have been affected by cancer: a randomized controlled trial. J Consult Clin
Psychol - 01-FEB-2010; 78(1): 72-9. 70
Andersen BL; Farrar WB; Golden-Kreutz D; Emery CF; Glaser R; Crespin T; Carson WE, Distress
reduction from a psychological intervention contributes to improved health for cancer patients.
Brain Behav Immun - 01-OCT-2007; 21(7): 953-61. 71
www.psycho-genomics.org