Mind Body Medicine
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IV 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 het Westen.

a. Reducing Blood Pressure.

Benson, H. (1977). Systemic hypertension and the relaxation response. New England Journal of Medicine, 296, 1152-1156. 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 1), 104-109. 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. Perhaps 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 variables.

b. Heart Disease and Other Cardiovascular Risk Factors.

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 to controls.

Leserman,J., Stuart, e.M., Mamish, M.E., & Benson, H. (1989). The efficacy of the relaxation response in preparing for cardiac surgery .Behavioral Medicine, Fall, 111-117. 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 cardiac surgery.

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, 50, 543-548. 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, smoking, cholesterol.

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, 2(8668), 888-891. 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. These 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).