Reseachers Explore Connections Between Mind, Body in Health by Carolyn Cosmos The mind-body connection in health care is a hot topic these days. A Jan. 19, 2004, Time magazine article on the power of love and sex says that happily married people live longer, and just a year earlier, Time also devoted its January issue to exploring ìHow Your Mind Can Heal Your Body.î Itís not just a matter of media hype either: Noting that ìnumerous studiesî have linked psychological stress to health outcomesóincluding those for heart disease and immune system functioningóthe National Institutes of Health (NIH) in 1999 provided $10 million to fund five mind-body research centers, including one at the University of Pittsburgh and another at the University of Michigan. One of these centers is also located at the University of Miami, where researchers have been looking into the role of cognition and emotions on cancer. Meanwhile at the University of Wisconsin, projects have focused on the differences between resilient and vulnerable individuals, as well as on meditation practices, fibromyalgia, arthritis patients, and the effects of exercise and emotional factors on women with breast cancer. And at Ohio State University, NIH-funded rese archers have been examining the way psychological, social and behavioral factors can influence wound healing. In 2004, the School of Medicine at the Washington University in St. Louis will be launching its own Center for Mind-Body Research, in part supported by NIH, to explore ways that ìimproving mental health might improve physical health.î Last December, one of its co-directors, Dr. Patrick J. Lustman, announced findings showing that depressed patients with diabetes were twice as likely to develop serious complications as those who were not depressed. Lustmanís studies also demonstrated the practical application of this discovery: Ten weeks of therapy to relieve depression in diabetes patients helped with not only their depression, but also their diabetes. Closer to home, Lydia R. Temoshok, professor of psychiatry at the University of Marylandís School of Medicine and director of the Behavioral Medicine Program at the universityís Institute of Human Virology, has been examining the relationship between psychological and spiritual attitudes and health outcomes in people infected with HIV. She is currently conducting research into the chemical and molecular mechanisms that lie behind the poorer health of HIV-infected people with a ìtype Cî personality. People with this type of personality tend to ignore stress rather than deal with it and are less apt, spiritually, to ìforgive and forget,î Temoshok explained. Thus they deregulate their immune systems and wind up with lower levels of natureís own HIV-blocking agents in their bodiesóthat is, certain kinds of immune-system messenger proteins called ìcytokinesî that are produced by white blood cells. In the future, Temoshok said, ìIíd like to see if we change the type C-coping style, can we get the body to reverse itself and produce more of these HIV-blocking [cytokines].î Once an untouchable research topic and still suspect in some scientific circles, spiritual and religious factors in health care are increasingly included in mind-body research studies, as the Temoshok work suggests. The well-known Mayo Clinic based in Rochester, Minn., conducted several such studies and an overview of the then-emerging field, which was published in the December 2001 issue of Mayo Clinic Proceedings. The clinic found that 75 percent of studies looking at the effect of spirituality and religion on health reported ìa positive effect,î while 17 percent reported no effect and only 7 percent a negative one. More recently, the January 2003 issue of American Psychologist, published by the American Psychological Association (APA), presented a series of articles discussing the links between spirituality and health. The research found that church-goers live longer than those who do not regularly attend church, linking religious practices to changes in blood pressure and immune function, although the studies did not find that religion or spirituality slowed the progression of cancer or improved recovery from an acute illness. There was strong evidence, however, pointing to the physical benefits of meditation. Supporting this positive connection between health and meditation was a study conducted by the University of Wisconsin last August, which found that people who meditated produced more flu antibodies than those who simply took a flu vaccine, and that meditation also resulted in more activity in areas of the brain related to positive emotion. Although hospitals have traditionally provided chaplains and chapels to patients who wished spiritual advice or consolationóas well as social worker access, discharge planning and counseling assistance in some casesómany institutions are now deploying complex psychosocial and spiritual support networks based in part on this new research. Such hospital and outpatient support ìbeyond a shadow of a doubt helps patients and their families feel better and makes them better able to tolerate treatments,î said Miriam Ratner, a clinical social worker who heads the Department of Psychosocial Oncology at the Washington Cancer Institute, part of the Washington Hospital Center in Washington, D.C. Ratner and her team of three residents provide cancer patients and their families with individual and family counseling, crisis intervention services, and a variety of other therapeutic and educational programs, including complementary and alternative options, such as guided imagery, relaxation training and touch therapy (Reiki). Such services, she said, clearly help patients relax, sleep better, plan better and function with less anxiety, visibly reducing the stress of illness. ìThereís enough research data for doctors to support it now,î she said. Ratner and her teamís efforts to alleviate stress can include finding transportation to and from treatments or making sure that there is food in the house when a patient returns home. These efforts can also involve psychotherapy for depression and anxiety, or counseling ìto help patients come to terms with the end of life.î The key focus, Ratner emphasized, is helping people feel more in control of an illness. All incoming patients to the Washington Cancer Institute are given a questionnaire that measures their psychosocial distress, and those with high scores are offered the services of Ratnerís team, which currently fields four cancer-patient support groups and provides 42 patients with psychotherapy or other individualized services. Ratner has plenty of collegial company in her efforts. In addition to offering pastoral services through the Department of Spiritual Care, the Washington Hospital Center offers a variety of inpatient, outpatient and community-based mental health services. As Dr. Stephen Peterson, chairman of the hospitalís Department of Psychiatry, explained, these behavioral health programs include inpatient hospital services for people with conditions such as schizophrenia or severe depression, a partial hospitalization program, several psychiatric outpatient programs for different levels of need, an outpatient medical counseling center that provides individual, group and family therapy, and a ìcore service agencyî program for a wide array of mental health services including substance abuse treatments. ìWe have a comprehensive program, and weíre able to provide care to all patients with psychiatric issues, including chemical dependency,î said Dr. Lourdes Griffin, administrator of the Outpatient Behavioral Health Services for the Washington Hospital Center. ìWe can help in a lot of different ways, whether itís individual counseling for depression or practical help for someone losing their job.î Another area hospital exploring the mind-body connection is Childrenís National Medical Center (CNMC) in Washington, D.C., which has specialty clinics and programs devoted to areas such as hyperactivity, attention and learning problems, developmental disorders and immunology issues. Kathleen Ennis-Durstine, senior chaplain at CNMC, said there has been an increasing recognition in the medical community of spiritual matters over the last 10 years, fueled by research and the general consensus that ìthereís something important about your sense of self, sense of place and the meaning in your life that does affect healing.î Ennis-Durstine and CNMC are currently involved in a new study that will evaluate the effects of prayer and meditation on children and families when a child suffers from gastrointestinal problems. However, when it comes to spirituality, she cautions that it is often difficult or impossible to quantify such matters. Ennis-Durstine heads up the hospitalís Office of Interfaith Chaplain Services staffed by herself and up to 10 interns and graduate students in training. ìWe provide supp ort, crisis interventions, education, bereavement counseling and advice to staff,î she explained. Her office works closely with the hospitalís ethics board and other psychological service providers. She also contributes to a bereavement program for families that have lost a child, which provides up to two years of follow-up care. This spring, Ennis-Durstine said CNMC plans to launch a new psychosocial event that will be a ìcelebration of all the lives saved,î she said. ìWe do lose children here, but we send many more home healthier than they were when they arrived,î she added. And if current research on the mind-body connection pans out, it should be a tonic that will not only improve patient health but lift the spirits as well. Carolyn Cosmos is a contributing writer for The Washington Diplomat.