Mind/Body Approaches to Stress and Anxiety

Jennifer Phelps, MDPhelps MD Integrative Medicine

Peace:

It does not mean to be in a place where there is no noise, trouble or hard work, it means to be in the midst of those things and still be calm in your heart.

Author unknown

• Economic burden in 1998 $63.1 Billion– Missed work, inc medical morbidity– Treatment of panic disorder decreases healthcare

utilization and costs by 94%(Langlieb, 2005)

– Anxiety has lifetime prevalence 25.1% 13-18 yr olds

– 18% adults in any given year( NIMH,n.d.)

Mind-Body Modalities

• Biofeedback• Autogenic training• Guided imagery• Hypnosis• Yoga• Tai Chi• Meditation-Mindfulness, PMR, breathwork

Guided imagery

• Deliberate, directed daydreaming• Imagery is a specific kind of hypnosis, a type of

meditation

Clinical Hypnosis

• Inner absorption, concentration and focused attention

• Like a magnifying glass to focus the rays of the sun and make them more powerful

Biofeedback

• Trains people to improve their health by controlling certain bodily processes that normally happen involuntarily such as heart rate, blood pressure, muscle tension and skin temperature

• Heart rate variability, EMG, thermal biofeedback, and EEG

• Benefits-BP, headaches, anxiety, depression, pain

Mindfulness

From a mind-body perspective, mindfulness appears to "institute" a left-sided shift in frontal electrical activity to support an approach state as opposed to a withdrawal state.

Mindfulness Meditation

• Shift to left frontal dominance• Increased thickness of middle prefrontal

region• Activation of middle prefrontal areas• Activation of the Anterior cingulate cortex

Mind body practices

• Increased coordination of firing• Activation of the superior temporal region• Emotion regulation• Capacity to disengage from top down brain

processes—caused by enhanced function of the middle prefrontal areas of the brain that arises from mindfulness practices

Mind

• The human mind is a relational and embodied process that regulates the flow of energy and information

• Knowing that our minds regulate this flow enables us to feel the reality of these two forms of mental experience and to act on them instead of get lost in them

• We can learn to become more skilled at altering our mind and brain by mind body practices.

After one month mind-body training

Neuroplasiticity

Brain Plasticity

• Emerging research in neuroendocrinology links stress and anxiety effects on neuronal replacement, synapse turnover and dendritic remodeling and the detrimental effects of untreated anxiety (McEwen, 2012)

• This highlights the importance of effective treatment approaches

• As Woody Allen said in the movie Manhattan,"You know I can't express emotions. I internalize, I grow a tumor."

Freud

neurogenesis

• 5-10K neurons each day average adult done in animal models

• Impacts neurogenesis—stress inhibits growth• Physical exercise enhances growth

Mental exercise

• Short amounts of practice can help• If stop practicing after 2 weeks affects

Emotion Regulation

• Can be taught and aquired• Important to manage everyday life• Resilience maintenance of high levels of well

being in the face of adversity• Positive emotions is associated with better health • Brain heart synchronicity in certain kind of

meditation-compassion meditation a fairly dramatic synchronicity not in novices

• Neurons that fire together wire together

Mindful attention

5 Major Diagnostic Groups

• Generalized anxiety• Panic attacks• Phobias• Obsessive compulsive disorder• Post traumatic stress disorder

Conventional treatment

• Psychopharmacology-complete list of FDA approved found at

NIH website• Antidepressants

-SSRI/SNRI, tricyclics, MAO, Benzos, B Blockers• Psychotherapy

-talk therapy, cognitive behavioral therapy-caution with internet based therapy

Integrative Care for Anxiety

• Important to screen for any medical conditions that could mimic anxiety

• Examine meds and supplements• Lifestyle changes• Mind body or psychotherapy approaches• Discuss risks and benefits of any therapy

Disease States assoc w anxiety• Hypo/hyperthyroidism• Vestibular dysfunction• CHF/COPD/PE• Cardiac arrhythmia• Pheochromocytoma• Pneumonia• Hyperventilation• Vit B12 Deficiency• Porphyria• Neoplasm• Encephalitis• Hyperadrenalism• Substance OD• Munchausen's• Lead or pesticide toxicity

Exacerbating Factors

• Sympathomimetics• Beta agonists• Corticosteroids• Thyroid hormone supplement• Estrogen therapy• ADHD drugs• CAFFEINE/energy drinks• SAM-e

Lifestyle Factors

• Physical Activity• Herring MP, Jacob ML, Suveg C, Dishman RK, O'Connor PJ.

Feasibility of Exercise Training for the Short-Term Treatment of Generalized Anxiety Disorder: A Randomized Controlled Trial. Psychother Psychosom. 81(1):21-28. Nov 22, 2011

• Ströaut;hle A, Stoy M, Graetz B, Scheel M, Wittmann A, Gallinat J, Lang UE, Dimeo F, Hellweg R. Acute exercise ameliorates reduced brain-derived neurotrophic factor in patients with panic disorder. Psychoneuroendocrinology 35(3):364-8 Apr, 2010Nutrition

NutritionCheatham RA, Roberts SB, Das SK, Gilhooly CH, Golden JK, Hyatt R, Lerner D, Saltzman E, Lieberman HR. Long-term effects of provided low and high glycemic load low energy diets on mood and cognition. Physiology & behavior 98(3):374-9 Sep, 2009

• Bercik P, Denou E, Collins J, Jackson W, Lu J, Jury J, Deng Y, Blennerhassett P, Macri J, McCoy KD, Verdu EF, Collins SM. The intestinal microbiota affect central levels of brain-derived neurotropic factor and behavior in mice. Gastroenterology.141(2):599-609 2011 Aug

• Sleep• van der Helm E, Yao J, Dutt S, Rao V, Saletin JM, Walker MP

REM Sleep Depotentiates Amygdala Activity to Previous Emotional Experiences. Curr Biol. Nov 22, 2011• Gujar N, McDonald SA, Nishida M, Walker MP.

A role for REM sleep in recalibrating the sensitivity of the human brain to specific emotions. Cereb Cortex. 21(1):115-23. Jan, 2011

Mind-Body Techniques for Anxiety

• Mindfulness and meditation• Yoga• Prayer/Spirituality• Biofeedback• Hypnotherapy• Massage• Music Therapy• Energy Medicine• Aromatherapy