Stress Management: Exploring the Relaxation Response. Herbert Benson, M.D.

Transcription

1 Stress Management: Exploring the Relaxation Response June 20, 2014 Herbert Benson, M.D. Director Emeritus Professor of Medicine Harvard Medical School

2 Learning Objectives Upon completion of this course, participants will be able to: Define the physiology and impact of stress and the stress response Name the tools used to increase self-regulation Review the steps used to cultivate attention and mindfulness Identify the methods used to elicit the relaxation response

3 The Three-Legged Stool Overall Health Pharmaceuticals Surgery Self-care

4 Between 60-90% of healthcare visits are related to M/B stress-induced conditions

5 CONDITIONS CAUSED OR EXACERBATED BY STRESS INCLUDE: Hypertension Cardiac Arrhythmias Chronic Pain Insomnia Side Effects of Cancer Therapy Side Effects of AIDS Therapy Anxiety Hostility Depression Premenstrual Syndrome Infertility Preparation for Surgery and X-Ray Procedures

6 320 Pre Relaxation Response Post OXYGEN CONSUMPTION (cc/min) min. 12 min. 12 min. Psychosomatic Medicine (1974) Vol. 36, No. 2,

7 CARBON DIOXIDE ELIMINATION (cc/min Pre Relaxation Response Post 12 min. 12 min. 12 min. Psychosomatic Medicine (1974) Vol. 36, No. 2,

8 20 Pre Relaxation Response Post RESPIRATORY RATE (breaths/min) min. 12 min. 12 min. Psychosomatic Medicine (1974) Vol. 36, No. 2,

9 Change in Oxygen Consumption (%) 4 O 2 Consumption During Sleep and The Relaxation Response Sleep Relaxation Response Hours

10 TWO BASIC STEPS NECESSARY TO ELICIT THE RELAXATION RESPONSE The repetition of a word, sound, prayer, thought, phrase or muscular activity The passive return to the repetition when other thoughts intrude

11 The train of everyday thought is broken when the two basic steps to elicit the relaxation response are followed.

12 DIFFERENT TECHNIQUES ELICITING THE PHYSIOLOGIC CHANGES OF THE RELAXATION RESPONSE Progressive Relaxation Oxygen Consumption Respiratory Rate Heart Rate Slow Brain Waves Decrease Decrease Decrease Not Measured Blood Pressure Decrease Autogenic Training Not Measured Decrease Decreases Increases Inconclusive Results Zen and Yoga Decrease Decrease Decrease Increase Decrease Presuggestion Phase of Hypnosis Decrease Decrease Decrease Not Measured Inconclusive Results Transcendental Meditation Simple Generic Techniques Decrease Decrease Decrease Increase Decrease Decrease Decrease Decrease Increase Decrease

13 Control Beginning Frontal Control End Frontal RR Beginning Occipital Frontal RR End Occipital Frontal Occipital Occipital Vertical color bars indicate beta % power (white highest, black lowest). Note: At RR End (lower right), beta % power is significantly (p<.0129) decreased in frontal areas. Jacob, et al, 1996

14 Reduced Sympathetic Nervous System Responsivity Associated with the Relaxation Response John W. Hoffman, Herbert Benson, Patricia A Arns, Gene L. Stainbrook, Lewis Landsberg, James B. Young, and Andrew Gill Science, 1982;215:190-2

15 Functional Brain Mapping of the Relaxation Response using 3T fmri S.W. Lazar 1,2, G. Bush 1,2, G. Fricchione 3, R.L. Gollub 1,2, G. Khalsa, H. Benson 3 1 Department of Psychiatry, Harvard Medical School; 2 NMR Center, MGH-East, CNY-9, Charlestown, MA 02129; and 3 Mind/Body Medical Institute, Chestnut Hill MA 02467

16 Experimental Paradigm Two identical 42-minute scans, each with two epochs of meditation and control. Meditation periods (12 min.) consist of observing the breath and repeating a mantra. Control periods (6 min.) consist of silently generating the names of animals. Fix Control Meditation Fix Control Meditation Fix Statistical Comparisons Meditation vs Control compares the entire meditation period to the entire control period. This identifies regions with increased signal during the meditation period relative to the control period. End vs Beginning compares the last 2 minutes of the meditation period to the first two minutes of the meditation period. This identifies regions whose signal increases during the meditation practice.

17 Signal Decreases Subject 4 Meditation vs. Control

18 Signal Increases During Meditation Meditation vs. Control, n = 5

19 fmri Conclusions The Relaxation Response induces specific changes in fmri signal in several structures, including the amygdala, hippocampus, pons, anterior cingulate, and intraparietal sulcus. Many structures display steadily increasing fmri signal Throughout the Relaxation Response periods. Some structures become less active as practice continues, While other structures have a delayed onset of activity.

20 Cortical Thickness A B p < 10-2 p < 10-4 The right BA 9/10 superior frontal and middle gyri and sulci and right anterior insula are significantly thicker in meditators versus age, gender and education matched controls.

21 VO 2 vs Nitric Oxide

22 Genomic Counter-Stress Changes Induced by the Relaxation Response Healthy Individuals: Matched for age, gender, race, height, weight and marital status Group M: 19 Long-term Practitioners of Daily RR Practice Group N 1 : 20 Controls Group N 2 : 20 N 1 individuals who completed 8 weeks of RR training Validation Matched with above Group M: 6 Group N 1 : 5 Group N 2 : 5

23 Techniques Utilized to Elicit the Relaxation Response Vipassna Meditation Mantra Meditation Mindfulness Meditation Transcendental Meditation Breath Focus Kripalu Yoga Kundalini Yoga Repetitive Prayer

24

25 Gene Ontology Analysis

26 Heatmap of 15 Genes in the Intersection of All Three Groups on the Venn Diagram

27 GSEA Analysis

28 Gene Ontology Category Changes of the Relaxation Response Oxidative Phosphorylation Ubiquitin-dependent Protein Catabolism Nuclear Messenger RNA Splicing via Splicosome Ribosome Primary Metabolism Negative Regulation of Metabolism Regulation of Apoptosis Regulation of I-Κ B Kinase/ NF-Κ B Cascade Cysteine-Type Endo-Peptidase Activity Antigen Processing

29 Opposite Common Genomic Expression in PTSD and Relaxation Response Practice Stress Response Inflammation Apoptosis

30 Table: For all the comparison FDR=0.01 and P value <0.05 enriched genesets on short and long term relaxation response gene expression data: (

31 Emergence: The Whole is Greater than the Sum of its Parts For example, when a number of heart cells contract independently of each other, they don t function meaningfully. But, when they contract in a coordinated interactive fashion, they can pump blood. Other emergent examples include: Ant colonies Human cities The Fight-or-Flight Response The Relaxation Response

32 Yerkes-Dodson Law Stress-Performance Curve High PERFORMANCE EFFICIENCY Low Low STRESS / ANXIETY High

33 Relaxation Response Oxygen Consumption and Exercise 10 PRE INTERVENTION POST VO 2 (% Change) Control group Experimental group MINUTES

34 Mean Changes in EEG-Defined Sleep Onset Latencies Minutes Pre-treatment Post-treatment

35 References Benson H, Beary JF, Carol MP. The relaxation response. Psychiatry 1974;37: Benson H. The relaxation response. New York: Morrow, Benson H, Proctor W. Relaxation revolution. New York: Scribner, 2010 Bhasin MK, Dusek JA, Chang BH, Joseph MG, Denninger JW, Fricchione GL, Benson H, Libermann TA. Relaxation response induces temporal transcriptome changes in energy metabolism, insulin secretions and inflammatory pathways. PLOS ONE, 2013, 8(5):e62817.