Volume 4, Issue 5 , Pages 295-299, September 2008
Mind-Body Medicine at the Mayo Clinic
Article Outline
- A Deeper Understanding
- Personal Practice
- Meeting the Challenges
- Online Hospice Available to Those in Need
- Program in Integrative Medicine Earns Center of Excellence Designation
- Hospitals Change Food Practices
- Goldrosen to Head the Division of Extramural Activities of NCCAM
- Noncommunicable Diseases the World's Biggest Killers
- Biography
- Copyright
On Wednesday, April 16, 2008, the Mind & Life Institute presented “Investigating the Mind-Body Connection: The Science and Clinical Applications of Meditation” featuring the Dalai Lama at the Mayo Clinic in Rochester, New York.
The Mind & Life Institute focuses on collaboration and research partnerships between modern science and Buddhism to advance understanding of the nature of reality and promote human well-being. The morning speakers set the stage, as Mind & Life faculty explained that a person's moment-to-moment quality of life and experience is caused by inner conditions of his or her mind. Modern research is showing that these inner conditions and qualities can be cultivated to a much greater extent than previously thought.
In the afternoon, the Dalai Lama addressed the audience, telling the medical practitioners how important it was that they be fully cognizant of the nature and nobility of their work. “The work you are doing is directly related to relieving suffering of a person who is there right in front of you, who is helpless, who is suffering, and who has no refuge. Recognizing that value of your work will instill or reinforce your sense of joy in what you do and may help sustain the motivation.”
He then spoke openly of how a trained, compassionate mind is helpful when facing illness and physical pain. “A more compassionate mind, this openness or inner strength, may be useful or helpful to overcome pains, even immediately. The mental level experience can subdue physical pain,” he said.
The Dalai Lama suggested that it might be helpful for patients who are undergoing difficult situations to compare themselves to others who are even in a more unfortunate position and to practice feeling compassion for these other people. “There's a Tibetan expression which says that suffering is what brings joy and happiness into relief, because when you experience pain and suffering, you know what happiness is,” he said, explaining that if people are able to shift their focus from themselves to someone more unfortunate then not only will they feel compassion but they will also recognize that they aren't that bad off. “So you can appreciate the situation you are in with a different perspective,” he said. When asked about prayer, his comment was that, “Prayer is a mystery.”
Talking further about compassion, the Dalai Lama explained that there are two primary types. One has an element of wishing another person to be free of suffering. This type of compassion “remains only on this level of a wish,” he said. The other type of compassion is more active. “In addition to this wish, there is an element of wanting to do something to help that person be free from suffering.”
He noted that within the Buddhist tradition, the second type of compassion focuses more on the causes and conditions of suffering rather than the actual suffering itself. The suffering is “a resultant state of many conditions that have preceded it, which may include karmic conditions as well,” he explained. So when you look at the causes and conditions of the suffering, “the realization arises in the individual of a possibility that this person or this being can be saved, can be helped, because by changing the causes and conditions one can prevent the currents of the resultant suffering state.”
Compassion, he stressed, is a vital and necessary component of good care. “In Tibet we have a saying,” he laughed. “The physician is a great scholar, but his medicine is not effective because his heart is not that good.”
When asked if he saw a conflict between religion and science, the Dalai Lama replied, “I don't think so. In the case of God, creator. Difficult to prove. At the same time it is difficult to disprove, isn't it? It is beyond science!”
For more information about the Mind & Life Institute, please visit http://www.mindandlife.org.
Addressing the role of the mind in developing illness or in healing and maintaining health has become a mainstay of all care delivered through the Complementary and Integrative Medicine Program at the Mayo Clinic. Founded in July 2001 within the Department of Medicine and integrated throughout the entire Mayo Clinic, the program was initially created to address a burgeoning patient interest in complementary medicine and cross-cultural approaches to healthcare. But from that simple beginning of “researching and answering questions” has grown a sophisticated understanding of the interdependent relationship between mind and body and an approach to care that often yields significant results in terms of improved patient health.
“We quickly recognized that the people we were seeing had a tremendous amount of stress,” explains Brent Bauer, MD, director of the Complementary and Integrative Medicine Program. In response, the team began to investigate mind-body approaches that would reduce stress and started offering tai chi, guided imagery, and meditation classes through the patient education programs.
Brent Bauer, MD
At first there was some skepticism. “I've been asked many times why the Mayo Clinic would be interested in meditation,” says Bauer. “But if you know our values it should be a self-evident answer. One of those values is a deeply abiding philosophy that the needs of the patient come first and that's something that is part of our culture through and through.”
Although the initial mind-body activities were helpful and did address a need, the team's continued investigations led them to a deeper understanding about how the mind influenced health and healing.
A Deeper Understanding
“It's not just about having patients participate in a meditation or Qi gong class, although we do that,” explains Amit Sood, MD, the program's leading mind-body physician. “It's really about getting people to understand how they spend time with their own mind throughout the day.” This is where the real power is, he says.
When patients at the clinic are referred to Sood for an integrative medicine consultation, he first tries to understand who they are in their entirety. “My basic strategy is to create a common center of gravity so the patient and I are together in a circle that includes us both as human beings,” he explains. He then tries to meet them where they are without judgment and without expectations, being mindful of their needs, desires, hopes, and passions.
Amit Sood, MD
“Once I am able to connect with them and step into their shoes, I begin to understand what is preventing them from healing,” Sood explains. “It's at that point that I can guide them to an alternate way of thinking about their situation that is more conducive to peace and healing.”
Once patients understand how rigid and fixed their attention has been and how that has contributed to their stress levels, Sood teaches them to cultivate qualities that will actually change the way they think and how their minds behave—qualities such as mindfulness, compassion, kindness, forgiveness, connection to others, and engagement in a meaningful life. The basic idea from a neurological viewpoint, he explains, is to move a person's mental activities from the limbic system into the higher centers of the brain, including the left prefrontal cortex. “This is what mind-body medicine is really all about,” he says.
Dr Sood and others at the Mayo Clinic have had some stunning results with this approach. One patient, an elderly man in his 70s, had been experiencing vigorous shaking episodes for several years that had grown severe enough as to interfere with his ability to be self-sufficient. He was on several medications and extremely depressed. In the initial consultation, Sood came to understand that the patient had two pressing emotional issues—he was angry about his increasing dependence on others and he was saddened over a growing lack of connection with his children.
Sood also noticed that whenever the patient started to experience a negative emotion, he would completely block it with his mind, which always resulted in a small jerking movement. It was this “tick” that had eventually grown into the violent shaking episodes. When Sood explained his theory, the stoic, “nonemotional” patient broke down into tears.
Once the areas of maladaptive thinking were uncovered and released, Sood taught his patient meditative techniques that would develop acceptance of the present, forgiveness of those things past, and how to find meaning in life to create a future. To deal with the cognitive dysfunction, Sood taught the patient an exercise in which the man would choose one object each morning and spend about 15 minutes minutely studying that object and writing down his observations. Although some of the cognitive dysfunction remained, the end result of the mind-body intervention was that the violent shaking episodes completely subsided and the man was able to reduce his medications.
“Every patient is different; their minds are different,” Dr Sood warns, “so you have to tailor the intervention to the individual. It's not one size fits all.”
Personal Practice
Part of his ability to resonate with patients comes from the training of his own mind. Sood meditates at least one hour a day. He has tried many different types of meditation but has now settled on a breath-based meditative process that also utilizes his knowledge of neural anatomy. He strives to move his awareness from the lower reptilian complex (physical systems) to the mammalian/limbic brain (emotions) to the neocortex (logic and intelligence), wherein he engages the prefrontal cortex with the intention of improving blood flow to the brain cells and improving top-down control.
“If you are able to cultivate that circuit through meditation, then you will have much better control over your limbic system, allowing you to cultivate mindfulness, acceptance, forgiveness, and compassion,” says Sood.
Meeting the Challenges
“People come from all over and they typically aren't here at the Mayo Clinic for very long, so we can't put them through an eight-week mindfulness course,” says Bauer. “Consequently, we have had to work hard to find meditative processes that we can teach them in a short period and that they can continue to do at home.” The program has now developed a four-stage meditation process that Sood and others use with Mayo patients. These are backed by several DVDs that are available to the patients.
The program's focus on research continues, especially for mind-body medicine. “We are currently involved in several research studies concerning the mind-body connection, which are being conducted in conjunction with other departments at the Mayo Clinic,” explains Bauer. Studies are currently underway looking at the efficacy of breath control and progressive muscle relaxation for lowering blood pressure and for reducing relapse rate after tobacco cessation, as well as at the beneficial effects meditation has on patients undergoing stem cell transplant and on patients with uncontrolled diabetes. In the near future, the team will also be conducting research into the utility of a meditation DVD in large health plan populations, WarmFeet biofeedback to improve peripheral circulation, the efficacy of HeartMath in treating fibromyalgia, and the efficacy of Healing Rhythms meditation programs, among others.
“One of our goals is to help people help themselves,” says Dr Sood. “Lives of some of the highest spiritual leaders show that real success in life is dependent not just on physical or mental resilience, but spiritual resilience. That's why, no matter what a person's faith, our focus is to offer tools that train people to be spiritually resilient.”
For more information about the Complementary and Integrative Medicine Program at the Mayo Clinic, please visit http://www.mayoclinic.org/general-internal-medicine-rst/cimc.html.
Online Hospice Available to Those in Need
The Four Winds Society has recently organized and opened on online hospice service. Dying Consciously: The Greatest Journey, located at http://www.dyingconsciously.org, is a free service dedicated to helping people die consciously.
“We have forgotten how to die,” explains Alberto Villoldo, PhD, founder of the Four Winds Society and of Dying Consciously: The Greatest Journey. “We shuttle the dying off to hospitals where death is considered a ‘disease’ and extraordinary measures are taken to prolong life at all costs. Families do not know how to come to closure with the passing of a loved one and we no longer remember how to die with grace and dignity. The message of Dying Consciously: the Greatest Journey is that you can come to the end of a life with grace.”
Alberto Villoldo, PhD
The site's primary purpose is to present information about how to prepare and assist any person making the journey beyond death achieve a peaceful transition. The processes used are based on the great death rites practiced in shamanic traditions, and the site provides specific steps to follow that will bring reconciliation and healing both to the loved ones and to the person dying. The processes are nondenominational and can be used by anyone of any religion.
Villoldo has organized a cadre of trained volunteers across the United States and around the world who are willing to assist people through the process on a pro bono basis. These volunteers are listed on the site, as well as a host of resources that will help people prepare medically, emotionally, and spiritually. The site also offers videos that people can watch that explain the dying process and the death rituals.
For more information please visit http://www.dyingconsciously.org.
Program in Integrative Medicine Earns Center of Excellence Designation
The Arizona Board of Regents recently conferred Center of Excellence status on The University of Arizona College of Medicine's Program in Integrative Medicine—a move that reaffirms the positive impact integrative medicine is having on healthcare system transformation.
Now known as the Arizona Center for Integrative Medicine, the program underwent an intensive evaluation process and earned unanimous endorsements from University of Arizona health sciences program directors and college deans. The new designation formally recognizes the center's achievements in the field over the past 14 years. Founded in 1994 by Andrew Weil, MD, the Arizona Center for Integrative Medicine joins nine other Centers of Excellence at the University of Arizona College of Medicine.
Andrew Weil, MD
“Having our work recognized in this way is among our greatest accomplishments to date,” Dr Weil said. “The Center of Excellence designation formally recognizes us as an innovator in educating the next generation of physicians and health-care professionals. Our challenge now is to remain at the forefront of innovation so as to make integrative medicine available to everyone, regardless of economic or geographic limitation.”
University of Arizona President Robert N. Shelton lauded the regents' decision, saying, “What began as a small, pioneering program has now inspired the development of scores of similar programs across the country.”
Since its founding, the center has created five integrative medicine fellowships, received more than $7 million in federal funding, and graduated nearly 300 integrative medicine fellows. Many of these fellows are now academic leaders in other prestigious centers, including Johns Hopkins University, Stanford University, Duke University, Tufts University, the University of Wisconsin, and the University of Maryland.
The center is currently launching its most ambitious program to date: the Integrative Medicine in Residency (IMR) program. The center's integrative medicine curriculum soon will be incorporated into standard three-year family medicine residency programs across the nation. Residents will learn to incorporate integrative medicine concepts into their practices, including patient-centered care techniques that facilitate lifestyle change. Through funding raised from both public and private sources, an IMR pilot program will be launched in July at eight family medicine residency programs nationwide, including the University of Arizona; Beth Israel Medical Center, New York City, NY; Carolinas Medical Center, Charlotte, NC; Maine Medical Center, Portland, Me; Maine-Dartmouth, Augusta, Me; University of Connecticut, Storrs, Conn; Hennepin County Medical Center, Minneapolis, Minn; and the University of Texas Medical Branch, Galveston, Tex.
“This will be the first program in the nation to create a required curriculum in integrative medicine for physicians during residency,” said Victoria Maizes, MD, executive director of the Arizona Center for Integrative Medicine. “Over the next 10 years, development of IMR into the national model for residency education is a major goal for the center. We will gradually move beyond primary care into subspecialty training.”
For more information about the Arizona Center for Integrative Medicine, please visit the Web site at http://www.integrativemedicine.arizona.edu, or call (520) 626-6417.
Victoria Maizes, MD
Hospitals Change Food Practices
Hospitals across the nation are changing their food buying practices by using more locally produced food and providing healthier menu choices for patients, staff, and visitors. According to the recently released report by Healthcare Without Harm, 127 hospitals across the United States are taking concrete steps to improve not only the health of their patients through improved nutrition, but also the health of their local communities and the environment by implementing greener purchasing strategies.
The report details the concrete food purchasing steps these facilities are making. For example:
“By serving nutritious, local, sustainably grown food to their patients, staff and visitors, hospitals are practicing good preventive medicine,” stated David Hutchinson, MD, president of the Minnesota Academy of Family Practice. “The purchase of meat and poultry raised without non-therapeutic antibiotics, milk produced without recombinant bovine growth hormones, organic, whole grain and less processed foods and support for community supported agriculture and farmers markets are important investments for the healthcare sector to make in the health of people, communities and the environment.”
“These numbers are just the beginning,” adds Jamie Harvie, National Coordinator of the Healthy Food in Healthcare Initiative. “This initiative is not yet a year and a half old and more hospitals are signing every month. We've jumped from 19 to 21 states and added eight more facilities in the last month.”
Hospitals around the country are linking their operations to impacts on human and environmental health, and an emerging part of this trend is increased attention to food service. Healthcare Without Harm is not alone in its work to encourage support for local, sustainable food. In 2007, the American Public Health Association recognized the urgency of transforming our food system and passed a policy to promote environmental sustainability, improve nutritional health, and ensure social justice. That same year, the California Medical Association passed a resolution that encourages hospitals to adopt policies that increase the purchasing and serving of local, sustainable food.
Health Care Without Harm, an international coalition of more than 473 organizations in 52 countries, is working to transform the healthcare sector, without compromising patient safety or care, so that it is ecologically sustainable and no longer a source of harm to public health and the environment. For more information on the healthy food pledge, see http://www.noharm.org/us/food/pledge.
To learn more about Heath Care Without Harm's work on food and other issues related to healthcare, please visit the Web site at http://www.healthyfoodinhealthcare.org.
Goldrosen to Head the Division of Extramural Activities of NCCAM
Martin H. Goldrosen, PhD, was recently appointed director of the Division of Extramural Activities at the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health (NIH).
The Division of Extramural Activities coordinates the receipt, referral, and scientific review of grants, cooperative agreements, and research contracts, and oversees the processing of grant, cooperative agreement, and contract awards. It also coordinates meetings and directs committee management activities for the National Advisory Council for Complementary and Alternative Medicine.
In announcing Dr Goldrosen's appointment, Josephine P. Briggs, MD, NCCAM director, said “The Division of Extramural Activities is crucial to NCCAM's ability to review and fund high-quality research, as well as coordinate grant management and advisory committee activities. Dr Goldrosen's experience and his extensive research background make him well-suited for this important work for NCCAM.”
Dr Goldrosen began his NIH career in 1991 as a health scientist administrator within the Grants Review Branch of the Division of Extramural Affairs at the National Cancer Institute. Prior to joining NIH, Dr Goldrosen was a cancer research scientist at the Roswell Park Cancer Institute in New York and a research professor of experimental pathology at the State University of New York, Buffalo, NY.
Noncommunicable Diseases the World's Biggest Killers
A new World Health Organization (WHO) report issued in May 2008 warns that the global burden of disease has shifted from infectious diseases to noncommunicable diseases, with chronic conditions such as heart disease and stroke now being the chief causes of death.
The report, World Health Statistics 2008, is based on data collected from WHO's 193 members and includes 73 health indicators in countries around the world. The trends indicate that deaths from leading infectious diseases–diarrhea, HIV, tuberculosis, neonatal infections, and malaria–will continue to diminish over the next 20 years, whereas deaths from heart disease and stroke will rise.
The statistical report documents in detail the levels of mortality in children and adults, patterns of morbidity and burden of disease, prevalence of risk factors such as smoking and alcohol consumption, use of healthcare, availability of healthcare workers, and healthcare financing. It also draws attention to important issues in global health, such as:
The full report can be found on the WHO Web site: http://www.who.int/whosis/whostat/2008/en/index.html.
Matters of Note is written by Bonnie J. Horrigan, editorial director for EXPLORE and author of Voices in Integrative Medicine: Conversations and Encounters (Elsevier 2003).
PII: S1550-8307(08)00211-5
doi:10.1016/j.explore.2008.07.002
© 2008 Elsevier Inc. All rights reserved.
Volume 4, Issue 5 , Pages 295-299, September 2008
