The Relaxation Response and Physical Health
Omdat Mind Body Medicine technieken helpen stress en
angst te verminderen, hebben ze ook een directe impact
op stress-geassocieerde fysieke ziekten zoals cardio-vasculaire
ziekten en kanker, de 2 meest belangrijke doders van
a. Reducing Blood Pressure.
Benson, H. (1977). Systemic hypertension and the
relaxation response. New England Journal of Medicine,
This article reviews research on
the relaxation response and blood pressure (BP). In
one of the studies reviewed, subjects were taught to
elicit the relaxation response by meditating for 20
minutes twice/day. After two weeks, BPs were measured
every two weeks for 6 months (BP's never measured after
meditation). Among meditating subjects, there was an
average drop in systolic BP (SBP) during 6 months of
7 mmHG lower than at baseline and diastolic BP (DBP)
was 4 mmHG lower than at baseline. Subjects served as
their own controls, with a 6-week run-in period when
no BP changes were observed before start of study. For
subjects who "chose to stop meditation", both SBP and
DBP returned to initial high levels within 4 weeks of
the end of the study. This review also discusses one
study (published in 1973 in Lancet) that showed Yoga
combined with biofeedback reduced SBP by 20 mmHG and
DBP by 14 mmHG in hypertensive patients treated with
antihypertensive medication, compared with no statistically
significant change in a matched control group. A third
study using a control group and Buddhist meditation
reported reductions of 15 mm SBP and 10 mm DBP in patients
with hypertension (NEJM, 1976). Other studies have also
shown significant decreases in both SBP and DBP with
the relaxation response in normotensive working populations.
Chesney, M.A., Agras, s., Benson, H., Blumentha1,
J.A., Engel, B.T., Foreyt, J.P., Kaufmann, P.G., Levenson,
R.M., Pickering, T .G., Randall, W .C., Schwartz. P.J.
(1987). Task Force 5: Nonpharmacological approaches
to the treatment of hypertension. Circulation, 76 (Suppl
This is a more recent review of the
literature. Authors conclude that since 20 million people
in the U .S. alone have mild hypertension (HTN) and
drug treatments for HTN have many potential negative
side-effects, non-pharmacological treatments must be
explored vigorously" (P 104). Suggests that for the
standard care of hypertensive individuals that "Relaxation-based
treatments should also be given early consideration
in light of the evidence of their efficacy.(p.105).
Linden, W ., & Chambers. L (1994). Clinical effectiveness
of non-drug treatment for hypertension: A meta-analysis.
Annals of Behavioral Medicine, 16, 35-45.
one of the best reviews ever performed of mind-body
medicine strategies for reducing blood pressure . This
review is unique in that the authors control for initial
blood pressure levels. In previous reviews, persons
with normal blood pressure were included (in such populations
it is difficult to demonstrate an effect for mind-body
strategies on blood pressure because the blood pressure
cannot be reduced much further). The authors concluded
that these approaches were equivalent to single drug
therapy for hypertension.
Schneider, R.H., Staggers, F ., Alexander, C., Sheppard,
W ., Rainforth. M. Kondwani, K.. Smith. S., & King,
C.G. (1995). A randomized controlled trial of stress
reduction for hypertension in older African Americans.
Hypertension, 26, 820-829.
African Americans in
Oakland. CA, ages 55-85 with baseline blood pressures
< =179/104 mmHg (mild hypertension). Subjects were
enrolled in a randomized, controlled single-blind trial
of Transcendental Meditation (TM) compared with progressive
muscle relaxation (PMR) and a life-style modification
education control program. TM and PMR sessions lasted
1.5 hours initially and 1.5 hours/month for 3 months;
data collected every month. Investigators found that
TM had significantly greater effects on systolic blood
pressure (p=.02) and diastolic blood pressure (p=.03)
than PMR; SBP was reduced by 10.7 mmHG (p< .003)
and DBP reduced by 6.4 mm (p< ,.0001) for TM. The
investigators concluded that TM was twice as effective
as PMR in reducing systolic and diastolic blood pressures.
Koenig HG, George I.K. Cohen HJ, Hays JC. Blazer
DG. Larson DB. Larson DB (1998). The relationship between
religious activities and blood pressures in older adults.
International Journal of Psychiatry in Medicine 28.189-213,
Epidemiological study of 4,000 randomly selected
older adults in North Carolina (NIA-supported Establishment
of Populations for Epidemiologic Studies of the Elderly
(EPESE). Persons who both attended religious services
regularly and who prayed/meditated regularly were 40%
less likely to have diastolic hypertension than those
who did not (p< .0001, after controlling for age,
sex, race, education, smoking, physical functioning,
and body mass index). Among Black persons in the sample
(54% of subjects), the effects on blood pressure were
even greater. Religious activities (especially regular
prayer and scripture reading) at one wave predicted
lower blood pressure levels three years later, after
controlling for baseline blood pressure and other compounding
b. Heart Disease and Other Cardiovascular
Zamarra, ].W. Schneider. R.H.. Besseghini. I. Robinson,
d.K, &. Salerno, J.W. (1996). Usefulness of the
transcendental meditation program in the treatment of
patients with coronary artery disease. American Journal
of Cardiology. 77,867-870.
A clinical trial that
tested the hypothesis that stress reduction intervention
with TM could reduce exercise-induced myocardial ischemia
in patients with known CAD (coronary artery disease).
21 pts with known CAD were recruited from the Buffalo.
NY VA Hospital and prospectively Studied. Subjects were
randomly assigned to TM (n-12) or waitlist control group
(n-9). TM group received 10 hrs of basic instruction
and follow-up. including personal instruction for 60
minutes initially and 30 min twice/week for first month
and monthly thereafter. Subject were instructed to practice
TM 20 min twice/day for 6-8 months. After 8 months.
the TM group had a 14.7% increase in exercise duration
(p=.01), an 11.7% increase in maximal workload (p=.004).
and an 18.1% delay of onset of ST depression (p=0.029),
whereas control subjects showed no substantial changes
in these outcomes. Furthermore, the TM group showed
significantly greater reduction in rate-pressure products
after 3 and 6 minutes of exercise (p= .02). compared
Leserman,J., Stuart, e.M., Mamish, M.E., & Benson,
H. (1989). The efficacy of the relaxation response in
preparing for cardiac surgery .Behavioral Medicine,
In this study, 27 cardiac surgery
patients (mean age 68) were randomly assigned to either
educational information + Relaxation Response vs. educational
information only. On the Profile of Mood States scale,
the relaxation response group experienced significantly
greater reductions in tension and anger than the education
only group. More importantly, the experimental group
had lower incidence of supraventricular tachycardia
(SVT) (p=.04), a dangerous heart rhythm often complicating
Sudsuang, R., Chentanez, V., & Veluvan, K. (1991).
Effect of Buddhist meditation on serum cortisol and
total protein levels, blood pressure, pulse rate, lung
volume and reaction time. Physiology &. Behavior,
This was a clinical trial involving
52 males ages 20-25 years practicing Dhammakaya Buddhist
meditation (similar to Zen or transcendental meditation).
Control group was 30 males of the same age group not
meditating. Serum cortisol levels were significantly
reduced in treatment group (combined A and B), and was
different from controls(p<.01, all comparisons).
Serum protein levels increased after 6 weeks for combined
group (p<.01)and different from controls (p< .05).
Systolic and diastolic blood pressures both significantly
different in combined treatment group (p < .01) and
significantly different from controls (p<.01).Heart
rate significantly different at 3 and 6 weeks (p<
.01) and from controls (p< .01 at 3 wks, p< .05
at 6 wks). Pulmonary function (vital capacity, tidal
volume and maximum voluntary ventilation) significantly
different at 3 and 6 weeks (p < .05) before and after
in treatment group.
Alexander. C.N., Robinson. P.. Orme-Johnson. D.W.,
Schneider, R.H.. &. Walton, K.G. (1994). Effects
of transcendental meditation compared to other methods
of relaxation and meditation in reducing risk factors,
morbidity and mortality. Homeostasis, 35, 243-264.
Review of research showing that TM is associated with
reduced cardiovascular risk factors such as hypertension,
c. Preventing Cancer.
Koenig HG, George LK, Coben HJ, Hays JC, Blazer DG,
Larson DB (1998). The relationship between religious
activities and cigarette smoking in older adults. Journal
of Gerontology (medical sciences), in press (November).
Cigarette smoking and religious activities were assessed
in a probability sample of 3,968 persons age 65 years
or older participating in the Duke EPESE survey. Data
were available for Waves I-III of the survey (1986,
1989, and 1992). Analyses were controlled for age, race,
sex, education, alcohol use, physical health, and in
the longitudinal analyses, smoking status at prior waves.
Participants who frequently attended religious services
were significantly less likely to smoke cigarettes at
all three waves. Likewise, elders frequently involved
in private prayer and meditation were less likely to
smoke (Waves II and III). Total number of packyears
smoked was also inversely related to both attendance
at religious services and private prayer/meditation.
Among those who smoked, number of cigarettes smoked
was inversely related to frequency of attendance at
religious services and private prayer/meditation. Retrospective
and prospective analyses revealed that religiously active
persons were less likely to ever start smoking, not
more likely to quit smoking. Those who both attended
religious services at least once a week and prayed/meditated
at least daily were almost 90% more likely not to smoke
than persons less involved in these religious activities.
The likely impact of religious beliefs and activities
like payer on smoking-related diseases - like lung cancer
and chronic lung disease - is considerable.
d. Limiting Cancer Spread.
Spiegel, D., Bloom, J.R., Kraemer, H.C., & Gotthei1,
E. (1989). Effect of psychosocial treatment on survival
of patients with metastatic breast cancer. The Lancet,
This clinical trial examined the
effects of a psychosocial intervention on survival among
86 women with metastatic breast cancer. The 1-year intervention
consisted of weekly supportive group therapy with self-hypnosis
and relaxation for pain. At 10-year follow-up, only
3 patients were alive and death records obtained for
the other 83 deceased patients. Among those receiving
the intervention, average survival was 36.6 months compared
to 18.9 months in the control group (p< .0001, Cox
model). Interestingly, differences in survival began
8 months after the intervention ended.
e. Enhancing Immune Function (indirectly
affecting cancer risk).
Carson, V.B. (1993). Prayer, meditation, exercise,
and special diets: Behaviors of the hardy person with
HIV/AIDS. Journal of the Association of Nurses in AIDS
care, 4(3), 18-28.
Investigators studied 100 subjects
who were either HIV positive or had AIDS. A Persona1
Views Survey developed by Kobasa was used to determine
"hardiness" (related to longer survival in this population).
Level of spirituality was measured by responses to questions
concerning participation in prayer, meditation, use
of imagery or visualization, reading religious literature,
spiritual retreats, and church services. A single item
examined the frequency of prayer. Spirituality (total
score) was significantly related to greater hardiness
(r=O.18, p=.04), although only prayer (r=O.233. p=.O1)
and meditation(r=O.262) were related to hardiness when
individual items were examined. Hardiness is seen as
an indirect measure of immune system functioning.
Woods, T.E., Antoni, M.H., Ironson, G.H., & Kling,
D. W. (1998). Religiosity is associated with affective
and immune status in symptomatic HIV-infected gay men.
Journal of Psychosomatic Research, in press.
investigators examined in the association between religious
beliefs and behaviors and immune functioning in 106
HIV seropositive gay men. Religious activities -prayer
or meditation, religious attendance, spiritual discussions,
reading religious/spiritual literature - were associated
with significantly higher CD4+ counts and CD4 + percentages
(T -helper-inducer cells) (controlling for self-efficacy
and active coping with health situation, using regression
modeling). The effects of religious behaviors on immune
function was not confounded by disease progression (i.e.,
as disease worsened and immune function decreased, persons
unable to participate in religious activity).