Mind Body Medicine

Therapies that target the mind may be as important as those that affect the body for people with ITP. Scientists are finding that positively affecting the interactions between the mind, brain/nervous system, endocrine and immune systems—the major focus of mind-body medicine (psychoneuroimmunology)—is associated with reductions in levels of stress and inflammation, and re-balancing of the immune system.

Mind-body techniques can play a significant role in healing, reducing treatment side effects, managing pain and lowering the risk for complications. These powerful techniques improve self-mastery, self-confidence, peace of mind, locus of control and quality of life. There is evidence that managing the mind-body interaction is very important for healing and staying well.20


How does the mind affect physical functioning?

Our perceptions, through our thoughts and senses, create instantaneous responses in the body, relayed via signaling molecules in the brain. To the mind, everything is real. You can be in a wonderful, peaceful place, but if you focus on something upsetting you may have a physical stress response of fear or anxiety, which releases the stress hormone cortisol. Likewise, when you face stressful events with thoughts of optimism, you may experience the release of happiness and relaxation-associated chemicals (known as serotonin and dopamine) in the brain, accompanied by elevated mood and increased positive energy.

Stress is a normal part of daily life, and in most circumstances it resolves within a few hours or days without lasting effects. However, prolonged and high levels of unmanaged stress—such as constant worries about work-related problems—can lead over time to an imbalance in the immune system that can contribute to the development of autoimmune disease or a suppressed immune response.8 Other stress-related physical problems include increased inflammation, increased pain, and slow healing, as well as cell death.19

Research suggests that physical or psychological stress and the resultant oxidative stress in the body may also trigger episodes of ITP,7 exacerbate fatigue15 and prolong duration of the platelet disorder in children.1,21 Research has shown people with ITP appear to face greater levels of  fear, mental turmoil and exhaustion and are more emotionally taxed than those without the disease.14

Unmanaged stress may also be associated with the adoption of unhealthy lifestyle behaviors as individuals attempt to cope and self-soothe. Harmful habits such as smoking; abusing alcohol, pain relievers and other substances; eating for comfort; physical inactivity and other negative coping mechanisms, can lead to obesity, heart disease, diabetes, high blood pressure, high cholesterol, cancer and other serious diseases.


How can mind-body medicine benefit people with ITP?

Mind-body techniques designed to address the symptoms of ITP can be used alone, in combination, or to complement other therapies. Studies have shown that certain mind-body techniques can help increase feelings of well-being,11 and reduce stress and inflammation—the very conditions that contribute to low platelets and low quality of life for people with the rare platelet disorder.

Because the autoimmune disease tends to react to the emotional and psychological aspects of stress, finding a form of therapy that addresses these factors may be very helpful. As with many types of complementary medicine, however, research involving a particular mind-body technique may be limited, while research on more widely used forms—such as acupuncture, meditation and yoga—may be more abundant. Scientists have done many studies on acupuncture, yoga, spinal manipulation, and meditation, but there have been fewer studies on some other practices. More research is required to establish the benefits of many of these less common therapies.


What are examples of types of mind-body therapy?

Most of the many types of mind-body approaches are administered or taught by trained practitioners. Among these techniques and procedures are practices such as meditation, guided imagery, self-hypnosis, breath work, yoga, autogenic training (a relaxation technique) and biofeedback. Exercise and self-expression tools such as journaling, drawing, other expressive arts, are also included in this category. A few of the more widely used mind-body techniques that have been helpful for individuals with ITP include:


Meditation

Meditation can take various forms, but it usually involves concentrating on a single sound, object or image while attempting to eliminate stray thoughts and other distractions. When attention strays, practitioners simply call it back to the stimulus, gradually strengthening the brain’s ability to focus. The practice may seem difficult at first, but with repetition it gradually becomes easier to control the mind.

Dr. Herbert Benson, founder of the Mind Body Medical Institute of Harvard University Medical School, pioneered the scientific study of meditation in the 1960s and 70s. He termed the positive results he found the ‘relaxation response.’ Since his initial work, he and his team have continued researching the subject and have provided a compelling body of evidence highlighting the many benefits of meditation and similar techniques. His work and that of other scientists suggests that these techniques can lower blood pressure, reduce stress, enhance well-being, reduce inflammation, improve immune function, and induce positive changes in the brain.3,4,16  Dr. Benson’s well-regarded book, Relaxation Revolution (Scribner, 2010), shows that breath work and meditation can alter genetic expression.


Guided Imagery, Positive Thinking & Positive Attitude

In PDSA’s Survey of Non-Traditional Treatments of ITP approximately 40 percent of the respondents believed that meditation, imagery (visualization) and positive thinking helped their platelet count and their bleeding symptoms. Thirty-seven percent of respondents felt that positive thinking was instrumental in providing a sustained response, the highest ranking of the three options.

The mind-body technique of guided imagery aims to increase optimism and reduce stress and anxiety by using words, images, or other means to evoke positive mental images. Studies have shown that the practice can have a direct effect on the blood. In one study, guided imagery reduced the number of white blood cells to improve the immune response.17 In another study, guided imagery tapes improved immune function as measured by IgA, an antibody in the blood.13

Studies at the Ohio State University College of Medicine showed the benefits of guided imagery on immune response10 and many studies show the positive benefits of using guided imagery in association with surgical procedures to help reduce surgical stress and improve wound healing.5,6,18 


Yoga

Yoga, an ancient Hindu discipline, involves the adoption of specific bodily postures, breath control and meditation to induce feelings of calm and relaxation. For thousands of years yoga has been included with other life-extending practices and used with great success in India and Tibet.11 While in its ancient roots yoga encompassed a strong spiritual and philosophical component, today it is often seen as a breathing/stretching/relaxation mind-body exercise. Its practitioners believe that yoga is very effective in quieting the mind, calming the body, re-oxygenating muscles/tissues/organ systems and improving the interactions of the body and mind.

Research shows that those who consistently practice yoga have reduced levels of the inflammatory cytokine IL-6 compared to novice practitioners.9 It is important to note that IL-6 is the same cytokine that is elevated in people with ITP who have the greatest difficulties with fatigue.15


Risks

A small percentage of people who engage in mind-body practices may experience some dizziness or mild anxiety when first learning the techniques. Moving into a deeper state of relaxation too quickly may cause dizziness, while some individuals may experience mild anxiety at the first sensations of relaxation due it feeling somewhat foreign and uncomfortable. Some experts recommend simply placing the feet on the floor or imagining standing on firm ground to relieve this sensation, or simply adjusting to the feeling with time and practice.

Always consult your healthcare provider before beginning mind-body techniques. For more information on mind-body medicine, visit the National Institutes of Health (NIH).

 

Resources

1. Akbayram S et al. “The association of oxidant status and antioxidant capacity in children with acute and chronic ITP.” J Pediatr Hematol Oncol. 2010 May;32(4):277-81. http://www.ncbi.nlm.nih.gov/pubmed/20404751

2. Astin JA, et al. “Mind-body medicine: state of the science, implications for practice.” J Am Board Fam Pract. 2003 Mar-Apr;16(2):131-47. http://www.ncbi.nlm.nih.gov/pubmed/12665179

3. Dusek JA et al. “Genomic counter-stress changes induced by the relaxation response.” PLoS One. 2008 Jul 2;3(7):e2576. http://www.ncbi.nlm.nih.gov/pubmed/18596974

4, Dusek JA, Benson H. “Mind-body medicine: a model of the comparative clinical impact of the acute stress and relaxation responses.” Minn Med. 2009 May;92(5):47-50. http://www.ncbi.nlm.nih.gov/pubmed/19552264

5. Hart RR. “Benefits of guided imagery for surgery.” International Journal of Clinical and Experimental Hypnosis 28, 1980, 324-332.

6. Holden-Lund C. “Effects of Relaxation with Guided Imagery on Surgical Stress and Wound Healing.” Research in Nursing and Health. 1988 Aug;11(4):235-44. http://www.ncbi.nlm.nih.gov/pubmed/3043570

7. Imbach P. “Oxidative stress may cause ITP.” Blood. 2011 Apr 28;117(17):4405-6. http://www.ncbi.nlm.nih.gov/pubmed/21527538

8. Keicolt-Glaser, J.K and Glaser, Psychological influences on surgical recovery: perspectives from psychoneuroimmunology, American Psychologist, 1998; 53 (11): 1209-1218. http://www.ncbi.nlm.nih.gov/pubmed/9830373

9. Kiecolt-Glaser JK et al. “Stress, inflammation, and yoga practice.” Psychosom Med. 2010 Feb;72(2):113-21. http://www.ncbi.nlm.nih.gov/pubmed/20064902

10. Kiecolt-Glaser JK, et al. “Psychoneuroimmunology: psychological influences on immune function and health.” J Consult Clin Psychol. 2002 Jun;70(3):537-47. http://www.ncbi.nlm.nih.gov/pubmed/12090368

11. Olivo EL. “Protection throughout the life span: the psychoneuroimmunologic impact of Indo-Tibetan meditative and yogic practices.” N Y Acad Sci. 2009 Aug;1172:163-71.http://www.ncbi.nlm.nih.gov/pubmed/19735248

12. Praissman S. “Mindfulness-based stress reduction: a literature review and clinician's guide.” J Am Acad Nurse Pract. 2008 Apr;20(4):212-6.http://www.ncbi.nlm.nih.gov/pubmed/18387018

13. Rider MS et al. “Effect of immune system imagery on secretory IgA.” Biofeedback Self Regul. 1990 Dec;15(4):317-33. http://www.ncbi.nlm.nih.gov/pubmed/2125839

14. Snyder CF et al. “Health-related quality of life of immune thrombocytopenic purpura patients: results from a web-based survey.” Curr Med Res Opin. 2008 Oct;24(10):2767-76.  http://www.ncbi.nlm.nih.gov/pubmed/18715526

15. Solomon, J et al. “Impact Of Cytokine Levels On Hrqol In Patients With ITP.” June 11, 2010.  Poster at 15th Congress of the European Hematology Association. http://www.eventure-online.com/eventure/publicAbstractView.do?id=137910&congressId=3446

16. Tang YY et al. “Short-term meditation induces white matter changes in the anterior cingulate.” Proc Natl Acad Sci U S A. 2010 Aug 31;107(35):15649-52. http://www.ncbi.nlm.nih.gov/pubmed/20713717

17. Trakhtenberg EC. “ The effects of guided imagery on the immune system: a critical review.” Int J Neurosci. 2008 Jun;118(6):839-55. http://www.ncbi.nlm.nih.gov/pubmed/18465428

18. Tusek D et al. “Guided imagery as a coping strategy for perioperative patients.” 1997 Oct;66(4):644-9. http://www.ncbi.nlm.nih.gov/pubmed/9337466

19. Vilasco M et al. “Glucocorticoid receptor and breast cancer.”Alternative Medicine Breast Cancer Res Treat. 2011 Aug 5 http://www.ncbi.nlm.nih.gov/pubmed/21818591

20. Vitetta et al. “Mind-body medicine: stress and its impact on overall health and longevity.” Ann N Y Acad Sci. 2005 Dec;1057:492-505. http://www.ncbi.nlm.nih.gov/pubmed/16399915

21. Zhang B et al. “The role of vanin-1 and oxidative stress-related pathways in distinguishing acute and chronic pediatric ITP.” Blood. 2011 Apr 28;117(17):4569-79. http://www.ncbi.nlm.nih.gov/pubmed/21325602

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