Mind Body Treatment

“Caroline, a 47-year-old accountant and mother of three, started out with some skepticism about mind body medicine. After she became my patient, she soon learned the tremendous personal benefits of this burgeoning field of medical treatment. Caroline, an experienced squash player, considered her forehand her best shot. But as she whipped forward into the ball, she felt something “give” in her lower back. She thought nothing of the discomfort, which subsided as she continued to play. The morning after the match, however, she awoke with lower-back pain that hardly allowed her to stand. Caroline decided that the pains were somehow related to her habit of bending her back excessively when she was serving. Because she had experienced lower-back pains before—and thought she knew how to deal with them—she immediately reached for an over-the-counter painkiller.

Sure enough, after about 20 minutes the pain began to subside. But the discomfort didn’t completely disappear, and she went to bed that night struggling to find a position that would allow her to go to sleep. The next morning, the pain was still present. Furthermore, when she made a seemingly innocuous movement to turn on the hot water in her bathroom, an excruciating back pain immobilized her. The attack began in the same general area, in the small of her back just above her buttocks, but now seemed to spread across her entire lower back. After suffering the next day at work and finding she couldn’t concentrate, Caroline decided to make an emergency appointment with her physician.

Her doctor, an internist, immediately prescribed a strong prescription painkiller, a narcotic-like opioid. But within a couple of days of taking the medication, Caroline began to experience side effects, including constipation, nausea, and intermittent stomach pains. Although the doctor switched her prescription to another painkiller that had fewer side effects, the new drug continued to upset her digestive system with occasional cramps. More important, the second medication didn’t help as much with the back pain, which returned in force in a day or so. The fact that Caroline was not improving provided additional stress, triggering the “fight-or-flight response.” This physiologic condition, which comes into play when a person is subjected to stress, caused her body to put out excess adrenaline and noradrenaline, secretions that actually increased her sensitivity to pain. The end result was the creation of a vicious mind body cycle of escalating pain, discomfort, and anxiety. Furthermore, the pain was spreading, moving down into her right leg.

According to her physician-internist, this change might be a sign that she was dealing with sciatica. This tentative diagnosis, he explained, meant that the pains might involve her sciatic nerve, which runs from the lower back into the buttocks and the back of the upper leg. Now at the end of his medical options, the internist sent Caroline to an orthopedic surgeon who specialized in diseases and health conditions related to the spine and back. The surgeon scheduled a magnetic resonance imaging examination, which required Caroline to undergo a nuclear scan of her spine in an enclosed, tubelike structure. The computerized MRI images revealed some herniation (abnormal bulging) of one of her disks and the beginnings of osteoarthritic bone buildup in her lower spine. (Osteoarthritis is a wear-and-tear form of bone and cartilage deterioration that occurs in all of us to one extent or another as we place stress on our bones and joints during the aging process.) But these findings weren’t necessarily conclusive about the cause of her pain. “A lot of people have MRIs that look like yours,” the orthopedist explained. “But most aren’t experiencing the kind of pains you’re having. In fact, most aren’t in pain at all. They may have slightly stiff lower backs, but that’s about it.” He also noted that he could find no tumor or other systemic problem that might be causing the pain.

So, unable to identify the source of Caroline’s complaint but well aware of her distress, the orthopedist prescribed an even stronger narcotic painkiller. He also referred her to a physical therapist, who prescribed regular massages and an exercise plan. The new pain medication and the physical therapy helped enough to provide some temporary relief. But side effects from the new drug, including a tendency for Caroline to become drowsy at her desk, forced her to cut down on the dosage. As a result, by the end of the year, Caroline’s back pain had returned. Another MRI and additional diagnostic procedures suggested some deterioration in the condition of the disk in her lower spine. These findings—along with Caroline’s reports that the time she was able to spend at work had steadily decreased—convinced the orthopedist that she was a candidate for back surgery.

As a result, she underwent two operations over a two-year period to relieve pressure that the damaged disk might be exerting on nerves around her lower back. Unfortunately, the surgeries seemed to make matters worse. During her recovery and afterward, Caroline found that she was rarely able to go in to work because of the pain she experienced while driving her car. When she did make it to the office, she couldn’t sit for any extended period in the chair at her desk. The only place she could operate in reasonable comfort was on a sofa in her office, but that wasn’t a location from which she could project proper authority when advising clients.

Finally, Caroline elected to work entirely at home, a decision that effectively placed a cap on her client interactions and on her ability to bring in extra business to her firm—and added markedly to her already high stress levels. She spent most hours during the day on her bed and found that her normal patterns of enjoyment in life had evaporated. Of course, she was unable to play squash: she had given that up even before the surgeries. But there were other issues. An accomplished cellist, she could no longer sit with the instrument for even a few minutes without being immobilized by pain. Finally, she was unable to interact effectively with her teenage children. Fortunately, despite all the medical setbacks and the deterioration in her lifestyle, Caroline was not willing to give up on her treatment options.

The surgeon had told her that her pains could be idiopathic—that is, they could not be linked to any identifiable cause. “We’ve done all that’s medically possible for you,” he said. “We’ve operated on your herniated disk, but you still experience pain. That may mean the pain is coming from some other source, some place that we just can’t identify, given our current medical knowledge.” That conclusion might have been discouraging to some people, but it was actually encouraging to Caroline because she figured, “If he can’t find a cause, that doesn’t mean there isn’t one. Maybe he just doesn’t have the knowledge to find out what’s wrong and prescribe the right treatment.” So she scheduled another meeting with her family physician, who now referred her to a psychiatrist.

Although she was somewhat skeptical about the idea of employing any means other than drugs and surgery to treat her problem, she knew these approaches had not worked, and she was desperate to find some relief. As a result, Caroline was now ready to explore the possibility of an emotional component to her back problem. The psychiatrist, suspecting that she might be wrestling with significant stress problems, referred her to our Institute. That marked the beginning of my relationship with Caroline and a breakthrough in her pain treatment.

In our first meeting, we reviewed her various tests, procedures, and prior diagnoses. “We always want to eliminate all physical possibilities,” I explained, “because if there is a physical cause, drugs or other standard procedures may work. But as you know too well, many diagnostic procedures have turned up no physical cause of your pain. Also, various medications, surgeries, and other medical procedures haven’t worked.” I also explained the phenomenon of phantom limb pain. This refers to the well-documented perception by many who have lost arms or legs that somehow the missing limb is still there. They may even experience feelings in the absent limb, including pain. The reason for the pain perceptions is that sometimes, the pains have been there for such a long period before the loss of the limb that the brain has become restructured or “rewired” to communicate the painful sensation, which continues even after the limb is missing. The same process appears to work in other mind body situations, where the brain becomes wired for certain responses, including pain.

Then I explained to Caroline that I was going to suggest a third treatment option—one that was as well established scientifically as drugs and surgery. It was also an option that carried no side effects and would cost nothing, once she learned how to use it. “I’m talking about the mind body treatment option,” I explained, introducing her to what we have come to call mind body healing. “But before we get into the practical techniques, let me make the science behind this quite clear.” At this point, I briefly described the various research studies that have established beyond any doubt that mind body approaches to treatment have a direct effect on beneficial physiologic and molecular changes in the body. I particularly emphasized those studies that dealt with the application of mind body strategies in treating pain. I also went into some detail describing the nature of the relaxation response as the biological polar opposite of the fight-or-flight response.

A major reason for my explaining the scientific foundation for mind body treatments was to engage one of the most important components of this type of therapy—Caroline’s belief and expectation that the therapy could have a positive, healing effect.* Because a proper understanding of the power of belief and expectancy is so important in mind body healing, I knew that it was essential for Caroline to be convinced that this new concept to which I was introducing her—the use of mind body healing to control her pain—was rooted in scientific fact. Many hundreds of scientific studies have shown that an inner conviction, which the medical community has linked to the phenomenon called “the placebo effect,” can help produce healing for scores of diseases and medical complaints. The placebo effect is a mind body mechanism that may bring about healing through a person’s expectation and belief that a certain treatment will work.

To be certain that Caroline understood, I summed things up by emphasizing that effective mind body treatments must be grounded in two factors: Techniques designed to elicit the relaxation response, and a comprehensive set of inner beliefs and positive expectations. “For you to experience relief from your back pains,” I said, “you must incorporate these two factors into your mind body healing plan.” When it became clear that Caroline was willing to accept what I was saying about the science behind the mind body approach, I introduced her to our two-phase Benson-Henry Protocol* for mind body healing:
1) the Phase One relaxation response trigger, and
2) Phase Two visualization or mental imagery.
PHASE ONE: Relaxation Response Trigger
Step 1: Pick a focus word, phrase, image, or short prayer. Or focus only on your breathing during the exercise.
Step 2: Find a quiet place and sit calmly in a comfortable position.
Step 3: Close your eyes.
Step 4: Progressively relax all your muscles.
Step 5: Breathe slowly and naturally. As you exhale, repeat or picture silently your focus word or phrase, or simply focus on your breathing rhythm.
Step 6: Assume a passive attitude. When other thoughts intrude, simply think, “Oh well,” and return to your focus.
Step 7: Continue with this exercise for an average of 12 to 15 minutes.
Step 8: Practice this technique at least once daily.

Option: Use an optional relaxation response exercise. If you take this option, incorporate three essential components:
1) A mental focusing device to break the pattern of everyday thoughts.
2) A passive, “oh well” attitude toward distracting thoughts.
3) Sufficient time—an average of 12 to 15 consecutive minutes. Important: To ensure beneficial genetic effects

Phase One should be practiced daily for at least eight weeks. For the maximal genetic effect as established by our research, the exercise should be practiced for many years.

PHASE TWO: Visualization Use mental imagery, such as picturing a peaceful scene in which you are free of your medical condition, to engage healing expectation, belief, and memory. This second phase will usually require an average of 8 to 10 minutes. Total time for Phases One and Two will be 20 to 25 minutes per session.

I told Caroline that, in my presence during this initial session, she should engage in a “mind-opening” relaxation response exercise for about 12 to 15 minutes. “This exercise will prepare your mind to receive new positive impressions and information that can lead to healing,” I said. I also reminded her about the molecular, metabolic, respiratory, and brain changes that would occur in her body with this phase. With these facts bolstering her conviction that this unfamiliar approach to treatment might actually work, we moved to the heart of the mind body healing procedure. “It’s essential for you to break the train of your everyday thoughts,” I told her. “The usual way to do this is to repeat a word, prayer, sound, phrase, or movement that’s comforting or pleasant for you. What kind of focus word do you think you’d like to choose? It can be religious or secular.”

Caroline thought a moment and replied, “Peace. That word should be just right for me.” “Okay,” I said. “Now close your eyes and relax your muscles, starting with your toes and feet. Now relax your calves. Next, your thighs. Now your abdomen. Fine. Now shrug your shoulders. Roll your head and neck around. “Now sit at ease without any movement and focus on your breathing. Breathe slowly. On each out-breath, say silently to yourself the word peace. Allow the word to stretch out, to extend itself to the end of your out-breath, so that the peace becomes peacccss. “As you continue with your breathing and the repetition of your focus word, you’re going to find all sorts of thoughts coming into your head. They’re normal. They should be expected. But as you become aware of them, simply say, ‘Oh well,’ and return to the word peace. “Do this for about fifteen minutes, and at the end of that time, I’ll ask you to start thinking regular thoughts. But for now, on each out-breath, peace. When other thoughts occur, ‘Oh well,’ and back to peace. Even if you are ‘oh welling’ very frequently, that’s okay.”

After about 15 minutes, I instructed Caroline to keep her eyes closed for about a minute and then open them slowly. After she opened her eyes, I asked her to describe her experience. She said she had “oh welled it” frequently, but she had been able to return to her focus word. Also, her breathing had slowed markedly. I responded, “Yes, and I actually counted your breathing rate. The number of your breaths decreased by three to four breaths per minute toward the end of the exercise.” In addition, she said she experienced a sense of well-being that had been lacking when she had walked into my office. I asked her whether at any time during that relaxation response exercise she was free of pain. Yes, she said, with some surprise, there had indeed been several very brief moments when she had felt no pain. “Before this, I was in pain all the time,” she noted. I explained to her that, as she practiced the relaxation response regularly, those periods of being free from pain would increase.

I then instructed her to do this exercise at home every day during the next week for 12 to 15 minutes, just after she had awakened in the morning, gone to the bathroom, and showered. “But don’t use an alarm to time yourself,” I cautioned. “That would be too jarring. Instead, place a clock or watch nearby so that you can glance at it every now and then.” This program, I explained, would help her become comfortable with the procedures of eliciting the relaxation response and would also give her a good start in developing the habit of regularly using the technique. “Developing the right habits is essential if you hope to benefit from a mind body treatment,” I said. “The only way to develop solid habits is to do the procedure daily for a period of three to four weeks. Day by day, and week by week, the routine will help you change the ‘wiring’ or neurological structure in your brain.

Even though the process may seem a little strange at first, you’ll soon create new default responses in your mind and body. You will slip into the relaxation response more naturally, as a kind of reflex. So establishing a basic routine this next week will be essential for your improvement.” When it was clear that she understood what was required for success, I told her to return to my office in one week. During her second visit one week later, Caroline reported that the pain was still there, but she said she did have longer periods of relief from it when she was eliciting the relaxation response. Also, once or twice on most days she experienced a glimmer of being free of pain, even when she was not consciously trying to elicit the response.

All this was quite positive and set the stage for Phase Two of the Benson-Henry Protocol: visualization. The Realm of Visualization and Mental Imagery I explained to Caroline that functional magnetic resonance imaging (fMRI) studies have shown that when individual subjects experienced the relaxation response using the techniques she was using, a calming of the mind had occurred, with less mental “static” or inner “noise.”1 “In addition, your mind in this state will become more focused and open to learning and accepting new information,” I continued. “The end result is that you’ll be in a position to make better decisions about your health care and other issues. Also, you’ll be able to employ useful mind body techniques, such as visualization.”

I rarely mention—much less teach—this second, visualization phase of treatment until the patient has become familiar with the basic elicitation of the relaxation response. In fact, just experiencing the relaxation response by itself is often all that is needed to make significant progress in overcoming a health problem. But some complaints, such as Caroline’s chronic back pain, may be particularly stubborn or neurologically “wired.” In such a case, Phase Two of our treatment protocol can be quite helpful. I told Caroline that her mind was now more open and receptive to beneficial change as a result of the relaxation response technique. The technique had triggered healthful biological responses, such as a calming, opening, and focusing of the brain.

To take advantage of this receptive, health-enhanced state, I said, “I want you to find a way to visualize yourself without the pain symptoms. “In effect,” I continued, “for eight to ten uninterrupted minutes you should remember a state of perfect wellness you experienced and enjoyed in the past. You might see yourself totally involved in playing the piano—a time you felt you were at one with your music. As you observe yourself, see yourself as completely pain free, just as you were before pain became such a terrible partner in your life.” This visualization exercise was designed to help Caroline recapture the power of what I have called “remembered wellness.” In effect, this process of remembering prior wellness through visualization techniques served to counter remembered illness, which had taken over Caroline’s mind and life. Caroline’s pain had been with her so long and had exerted such a powerful, negative influence that her nerves, brain synapses, and even her genetic responses had been programmed to produce pain.

The mind body healing treatment was designed to reverse that process, so that she could become re-hardwired to have more controllable and less severe pain. Using appropriate visualizations following the relaxation response is an effective means to create those new nerve connections and capture the power of remembered wellness. Caroline began using this two-phase mind body Benson-Henry Protocol for once-a-day sessions that totaled 20 to 25 minutes each. Within about two weeks she began to experience longer periods during the day in which she felt no back pain at all. When she did have the pain, it bothered her less. These short periods of relief slowly increased to the point where she was able to start spending more time with her children and playing the cello for a few minutes each day.

Within a couple of months, she went back to working part-time.
In less than a year she found that she had to spend no more than about two hours lying down on those days when she sensed the pains might be creeping back. During those rest periods, she employed her mind body healing skills to ward off the pain threat. As for pain medications, she did continue to use them, but in markedly smaller dosages.

To sum up, then, Caroline had taken advantage of our two-phase mind body protocol by going through these steps with her physician: 1. Identification and evaluation of her symptoms by her physician. 2. Evaluation of standard methods of treatment, including drugs and surgery. 3. Determination of scientific support for applying our Benson-Henry Protocol to her condition. 4. Application of our two-phase protocol to her back pain. These four steps also provide a broad mind body healing model, which serves as a treatment paradigm for the many health complaints.
What Can Be Treated by Mind Body Healing? Specific scientific studies show that many common diseases and health complaints can be treated directly with the mind body healing techniques described in this book—and the list is constantly expanding.

Here is an overview of the conditions that we address.

Scientific studies have documented that these conditions have improved through the triggering of the relaxation response and the belief and expectation that healing is possible. Throughout, we include scientific references to substantiate the power of the recommended mind body treatment.

Angina pectoris (chest pains caused by heart disease)
Anxiety Depression Hypertension (high blood pressure)
Infertility, Insomnia, Menopausal, perimenopausal, and breast cancer hot flashes
Nausea Pain—general Pain—variations   Abdominal.”

~ Herbert Benson, Relaxation Revolution: The Science and Genetics of Mind Body Healing