Complementary & Alternative Mental Health Exam III

The Mind-Body Connection

- The mind and the body are in constant, bi-directional communication

- Physical health is affected by emotion, thought, and belief

- Mental health is influenced by our physical bodies

- It's not "all in your head!"

Fight or Flight

Mammals under stress demonstrated a reflex - the fight or flight response - adrenal glands secrete norepinephrine and activate the sympathetic nervous system (Cannon, 1932)

Walter B. Cannon

Discovered the relationship between stress (mind) and neuroendocrine activation (body) in mammals

Sympathetic Nervous System

A network of nerves that helps your body activate its fight, flight, freeze, fawn responses

Parasympathetic Nervous System

"Rest and digest" system through the vagus nerve (sends impulses from the brain to body, body to brain), responsible for calming the body and promoting relaxation after stressful situations

Distress

Negative stress

Eustress

Positive stress

Hans Seyle

Studied the physiology of stress (Stress and Disease, 1955). Described the hypothalamic-pituitary-adrenal axis (HPA axis)

General Adaptation Syndrome (GAS)

- Three-stage (Alarm, Resistance, Exhaustion) physiological response to stress, developed by Hans Seyle

- He injected mice with extracts of various organs

- Same response (swelling of adrenal cortex) with a variety of "noxious agents" (included saline, presence of Seyle being in room)

- Coined the word "stress"

Mind-Body Therapies

Balance in parasympathetic and sympathetic nervous system activation supports health by improving self-regulation (1. Increased "top down" cognitive control - thoughts, focused attention intentions, etc., 2. Increased emotional control - inner states, responses to emotions, 3. Increased "bottom up" physical control - physical practices to affect breathing, musculoskeletal exertion, cardiovascular output)

Examples of Mind-Body Therapies

Hypnosis, biofeedback, guided imagery, meditation, mindfulness, yoga, etc.

Dr. Herbert Benson

Cardiologist and proponent of mind-body medicine.

1975: Described the "Relaxation Response"

1990: Studied the ability of monks to regulate their body temperatue, blood pressure, heart rate, breathing

Relaxation Response

"Once or twice a day for 10 to 20 minutes, sit in a relaxed position, eyes closed, and repeat a word or sound as you breathe. Some people use such words as 'love' or 'peace.' Others say traditional prayers. If your thoughts stray -- which is normal and expected -- just refocus on the word repetition."

Why do we breathe?

We breathe to take in oxygen from the air and remove carbon dioxide from our body. Our body needs oxygen for our cells to make energy. Carbon Dioxide is the waste product of this process that must be removed.

Inhalation

- Chest expands

- Diaphragm contracts

- Abdomen expands

Exhalation

- Chest contracts

- Diaphragm relaxes

- Abdomen contracts

Diaphragmatic Breathing (AKA Belly or Abdominal Breathing)

Using only chest muscles for breathing does not fill lungs to full capacity. Diaphragmatic breathing uses both diaphragm AND abdominal muscles. Daily practice can make this technique automatic

Diaphragm

The large, dome-shaped muscle located at the base of the lungs. Most efficient muscle for breathing

Benefits of Diaphragmatic Breathing

- Increases oxygen levels in blood

- Reduces muscle strain

- Improves muscle function

- Increases efficiency of removing carbon dioxide

- Lowers heart rate

- Lowers blood pressure

- Lowers anxiety and stress

- Increases relaxation

Review of Studies on Slow Breathing

2019 review of 3 studies with 880 participants showed that diaphragmatic breathing exercises reduce stress and leads to positive changes in mental health self-evaluations, cortisol levels, and blood pressure

2019 review of 17 studies with 1165 participants engaging in slow breathing exercises

2018 systematic review of any controlled study using a method that reduces respiratory rate less than or equal to 10 breaths per minute

Respiratory Sinus Arrhythmia (RSA)

- A normal reflex of a healthy person's heart and circulatory system: Heart rate increases with inspiration; heart rate decreases with expiration

Sinus Rhythm

Normal beating of your heart

Sinus arrhythmia

When your heart beats normally but the variability between heartbeats is greater than 0.12 seconds because of breathing

Respiratory Sinus Arrhythmia - Why?

Mechanism of this variation are under study and one factor is the automatic nervous system, which has 2 main drivers:

1. Decreased intrathoraic pressure during inhalation, increased venous return (amount of blood flowing back to the heart increases), triggers stretch receptors, increases heart rate

2. Stimulation of pulmonary receptors, inhibits cardiac parasympathetic tone (that slows heart rate), increases heart rate

Respiratory Sinus Arrhythmia - Who Cares?

- Low RSA = low vagal tone = indicator of poor health

- Respiratory sinus arrhythmia decreases with age

Low RSA =

Low heart rate variability

High RSA =

High heart rate variability

High RSA + High HRV

More healthy

Low RSA + Low HRV

Less Healthy

Heart Rate Variability (HRV) Biofeedback

involves receiving data on your heart rate from a device and then using breathing techniques to change your heart rate pattern. Studies show it can lead to less stress, anxiety, and decreased pain

Heart Rate Variability Patterns - Coherence

- Increased harmony between parasympathetic and sympathetic nervous system

- Greater vagal (parasympathetic activity

- Improved self-regulation and psychological well-being

Heart Rate Variability Patterns - Incoherence

- Less vagal (parasympathetic) control

- More activity of sympathetic nervous system

- Deficits in self-regulation and worsened psychosocial functioning

Vagus nerve

Part of your body's nervous system that play an important role in involuntary sensory and motor functions (Digestion, heart rate, blood pressure, and breathing)

Studies show that respiratory sinus arrythmia (RSA) peaks at...

6 breaths a minute, which is the optimal breathing rate from a perfusion-ventilation matching perspective

6 breaths/min compared to 12 breaths/min

- Higher positive energy

- Higher pleasantness

- Increased relaxation, ease, comfort

- Lower arousal and anxiety

- Lower anger and confusion (correlated with EEG changes of alpha/theta waves)

- Improved ability to modify somatic emotional responses

Distressed/angry/panicked related to...

irregular, rapid, shallow breathing

Calm/relaxed/joyful related to...

regular, slow, deep breathing

Regular, slow, deep breaths can:

- Trigger physical and emotional relaxation

- Maximize oxygen entering the bloodstream

- Slow down heart rate, lower blood pressure

- Stimulate the vagus nerve (parasympathetic)

- Increase calm and comfort

- Increase ability to think rationally

James Nestor

Evolutionary changes of human skulls to ones with smaller nasal passages, narrower airways, smaller mouths (hence more crooked teeth) - obstructive breathing

Paced Breathing - applications across age ranges

- 2019 review of 4 studies with 398 participants found that paced breathing can significantly improve hot flashes

- 30 session intervention with daily duration of 5 minutes significantly decreased anxiety in pregnant women experiencing preterm labor

Influence of olfactory bulb

- Nasal breathing leads to mechanical and chemical stimulation of receptors in the nose

- The olfactory bulb influences brain activity independent of chest (thoracic) respiratory activity in both humans and animals when nasal mucosa were anesthetized

- Nasal breathing is correlated with oscillations in brain waves in the piriform cortex, amygdala, and hippocampus

Wim Hof Method

"The Iceman's" breathing technique of periods of hyperventilation followed by voluntary breath holds at low long volume. Advocates for repeated exposure to cold and mental commitment.

Breathwork

- Conscious control of breathing to influence mental, emotional, or physical state in order to facilitate healing and insight

- involves laying down on mats, wearing eyeshades, deep and rhythmic breathing (hyperventilation)

- Often incorporates music

- Can draw on shamanic practices, psycho-spiritual models, transpersonal psychology

- May be helpful for relaxation and stress reduction

- Side effects: tingling of extremities, altered consciousness, sleepiness

- Not recommended for certain conditions (hypertension, cardiovascular disease, glaucoma, severe mental illness, severe asthma, seizure disorders, etc.)

Holotropic Breathwork

- Developed by Christina and Stanislav Grof, MD in 1975, after further restrictions on LSD use in late 1960s

- 1-3 hours of voluntary, prolonged, mindful, deep hyperventilation supported by music

- Nonverbal, no other inverventions

- Concludes with mandala drawing and sharing

- Limited evideince that supports its use

Holotropic Breathwork in the Development of Self-Awareness

Study in Denmark took 20 participants to see if holotropic breathwork would trigger a change in self-awareness. There was found to be a significant temperament change to persistence (lower risk fo obsessional tendencies), significant reduction in interpersonal problems, more sociable and less interpersonal mental distress. Limitations of the study were that it was a small sample size and biased sample of volunteers who were already interested in holotropic breathwork

Cochrane Review

Database of systematic reviews and meta-analyses which summarize and interpret the results of medical research

Systematic Review

uses a repeatable method to search for data and synthesize results

Meta-Analysis

uses statistical methods to combine the results of multiple quantitative studies

Music Therapy for Depression

- Searched multiple databases until June 2016 (Systematic Review)

- Compared music therapy vs. other psychological therapies

- 9 studies

- Conclusions: Music therapy provides short-term beneficial effects for people with depression, decreases anxiety, and improves functioning, music therapy + treatment as usual improves depressive symptoms more than tau alone, music therapy + treatment as usual does not lead to more adverse events than tau alone.