MIND-BODY TECHNIQUES Which, When, How…and a bit about language use David Becker, MD, MPH, MA, LMFT Clinical Professor, UCSF Department of Pediatrics UCSF Osher Center for Integrative Medicine Co-Medical Director, Pediatric Pain Management Clinic
DISCLOSURES • Mine is one voice among many that are more accomplished, more experienced, and better communicators. • Personal experiences and practices • The complete breadth and depth of mind-body practices, language use in clinical care, and the ‘common factors’ in clinical I have no financial psychology are beyond the scope of this talk. relationships or conflicts of interest to disclose • I hope to bring several of these threads together to help inform clinical practice, inspire curiosity, and engage in dialog
OBJECTIVES ¡ Describe the similarities and differences among guided imagery, clinical hypnosis, mindfulness and others ¡ Understand how specific language influences patient experience ¡ Learn ways to apply these components to individual patients
OUTLINE ¡ Self-regulation skills vs Mind-Body techniques ¡ Characterize some differences/similarities among MB techniques ¡ Describe the common factors research and how it applies to clinical practice of mind-body modalities ¡ Summarize key factors in the clinical encounter
SELF-REGULATION SKILLS ¡ A complex set of mental capacities that help with: ¡ Impulse control ¡ Emotion control ¡ Planning ¡ Self-reliance ¡ Socially responsible behavior ¡ Self-guidance of thought and behavior ¡ Fundamental to personality, behavioral adjustment, school readiness, and ability to cope manage stress ¡ Control over oneself, by oneself
Progressive relaxation/Body scan Routines (sleep, meals, exercise, regular Meditation practices activities) Biofeedback Positive self-talk Self- Mind-body regulation Journaling Autogenics techniques practices Humor Clinical Hypnosis Taking a break Guided imagery Talking to someone Yoga, Tai Chi, others you trust
SELF-REGULATION VS MIND-BODY SKILLS Techniques that facilitate one’s ability to direct behavior, modulate physiologic changes in desired directions, and control thoughts… …so we don’t cut in line at Starbucks ( self-regulation ) …for the purpose of symptom control, attaining and maintaining health and wellness, and improving functioning or enhancing performance ( mind- body skills )
MIND-BODY TECHNIQUES Autogenics Biofeedback Guided imagery Meditation: Clinical Hypnosis Insight (vipassana) Concentration (shamatha) Yoga, Tai Chi, others Transcendental “Mindfulness” Progressive relaxation/Body scan
MEDITATION - DEFINITION “ A good meditation practice is any one that develops awareness or mindfulness of our body and our senses, of our mind and heart. It does not really matter which kind you choose. ” Jack Kornfield Among the perhaps 80,000 estimated types
MINDFULNESS?
MINDFULNESS - DEFINITION “ the awareness that emerges through paying attention in a particular way, on purpose , in the present moment , Jon Kabat-Zinn and without judgment , to the unfolding of experience from moment to moment ”
MINDFULNESS - DEFINITION Amy Saltzman: “Mindfulness is paying attention, here and now, with kindness and curiosity, so that we can choose our behavior”
MINDFULNESS ~ AWARENESS atlasofemotions.org
SPECIFIC MEDITATION PRACTICES ¡ Compassion (metta) ¡ Forgiveness meditation: meditation: For any way I have hurt myself May I be filled with loving-kindness Through action, inaction, fear, pain or confusion May I be well I offer myself forgiveness May I be safe from inner and outer dangers To the extent I can in this moment May I be peaceful and at ease
MEDITATION/MINDFULNESS ¡ What does it do? ¡ Improves awareness of thoughts and emotions ¡ Increases the space between stimulus and response ¡ Facilitates acceptance of what may not be under our control ¡ Trains us to choose what we attend to
PEDIATRICS Volume 1 37, number 1 , January 2016
Crum A, Langer. Psych Sci 2007 “After only 4 weeks of knowing that their work is good exercise, the subjects in the informed group lost an average of 2 pounds,6 lowered their systolic BP by 10 points,7 and were significantly healthier as measured by body-fat percentage, BMI, and WHR.”
MINDSET ¡ How is Mindset utilized? ¡ Psycho-education about various conditions ¡ Shifting attention ¡ Positive self-communication ¡ Holding alternative beliefs ¡ Pain analogies and metaphors ¡ “Hurt not harm” ¡ Yes! It feels really uncomfortable (awful, bothersome…) doesn’t it! What’s happening in that leg when you feel that sensation?
BIOFEEDBACK The use of electronic equipment to measure and then feed back information about physiologic processes that can then be voluntarily modulated in a therapeutic direction. - Tim Culbert
THE BIOFEEDBACK LOOP Sensory information Computer processes from patient and presents back Attend to and Modulate the process
BIOFEEDBACK – POTENTIAL ROLES ¡ Learn how to ‘listen’ to the body ¡ Experience and See/Witness a relaxation response (or physiological change), and begin to believe in the value and possibilities… ¡ Feel (see, hear) the difference between a tense and a relaxed muscle ¡ See skin temperature increase ¡ Experience the difference between a belly and a chest breath
Guided Imagery
CLINICAL HYPNOSIS “Hypnosis is a state of awareness, often but not always associated with relaxation, during which the participant can give [oneself] suggestions for desired changes to which [one] is more likely to respond than when in the usual state of awareness. Spontaneous self-hypnosis may happen while reading, listening to music, watching television, jogging, dancing, playing a musical instrument, doing tai chi, doing yoga, or performing similar activities.” Olness K, Clev Clin J Med 2008
CLINICAL HYPNOSIS ¡ The utilization of an altered state of consciousness (trance, focused concentration, in the "zone“)... ¡ Usually, but not always, involving a state of relaxation (which may or may not be evident)... ¡ Facilitated by a heightened concentration on a particular image or idea... ¡ During which language, images, metaphor and/or dissociation are utilitzed... ¡ For the purpose of altering a symptom, disease or physiologic parameter… ¡ That the patient has already conceptualized and wants to happen/change.
CLINICAL HYPNOSIS: Misconceptions ¡ Patient is under the control of the hypnotherapist ¡ Patient is asleep ¡ Only a few people can be hypnotized ¡ Hypnosis masks symptoms ¡ All the psychiatric defense mechanisms of the patient are abolished in trance ¡ Therapist as coach; non-directive ¡ Children encouraged to “be the boss of their bodies” ¡ ”Hypnotists”
¡ 53 patients 8-18 yrs ¡ FAP/IBS by Rome II criteria for > 12 mo ¡ Hypnotherapy or SMT ¡ Six 50-min sessions over 3 months ¡ SMT: education, dietary advice, extra fibers, pain meds or PPI ’ s. Plus 6 30-min counseling sessions over 3 months
Vlieger et al: Hypnotherapy for FAP/IBS – Gastroenterology 2007
Vlieger et al: Hypnotherapy for FAP/IBS – Gastroenterology 2007
• 49 of 52 original subjects surveyed 5 years after initial trial • Clinical remission: decrease of the PIS and PFS of > 80 % compared with baseline • Remission rate at 5 years: • SMT: 20% • HT: 68%
• Larger study size • CD non-inferior to iHT • Differences: • negative pain beliefs • problem-focused coping
HYPNOSIS: Brain imaging studies ¡ Suggestions in trance selectively activate specific perceptual neural systems ¡ Visual suggestions: ¡ changes in visual centers ¡ Altering pain suggestions: ¡ changes in somatosensory and ACC ¡ changes in subjective appraisal regions ¡ Post-hypnotic suggestions: ¡ changes in regions associated with higher processes concerns with perception and valence judgments Landry M, Raz A. Hypnosis and Imaging of the Living Human Brain. Am J Clin Hypn 2015
FORMAL STEPS IN CLINICAL HYPNOSIS ¡ History ¡ Rapport (validation) - Attunement ¡ Assessment of Context , purpose, Goals , development and competing interests (family dynamics) ¡ Facilitating a Focused state of concentration ¡ Reframing the problem ¡ Language ¡ Suggestion/Metaphor
FORMAL STEPS IN CLINICAL HYPNOSIS: An invitation “You’ve been so wrapped up in feeling bad, you’ve been so focused on all those things that are so hurtful to you, wouldn’t it be valuable [or, I wonder what it would be like] to be able to start to focus on other things that can help you feel better? So, to help you shift your focus and get absorbed in a different way of experiencing yourself , why not close your eyes, take in some deep, relaxing breaths, and…” - Michael Yapko, Mindfulness and Hypnosis. 2011. p.6
AUTOGENTIC TRAINING ¡ Developed in the 1930’s through observation of the states and experiences of people in hypnosis ¡ Often taught gradually: ¡ My arms and legs are heavy and warm ¡ My heartbeat and breathing are calm and steady ¡ My belly is soft and warm ¡ My forehead is cool ¡ I feel calm and at ease
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