MIND
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A SCIENTIFIC LOOK AT ALTERNATIVE MEDICINE
Mind-Body Medicine; Approaches Related to Mental Health
Thomas J. Wheeler, PhD
Associate Professor (retired), Department of Biochemistry and Molecular Biology,
University of Louisville School of Medicine, Louisville KY
thomas.wheeler@louisville.edu
Revised 2015
This was originally part of a handout for an elective course given to medical students at the University of Louisville.
Copyright 2015. Permission to copy for non-profit uses is granted as long as proper citation of the source is given.
DISCLAIMER: The material presented here is not medical advice. It represents the author's summary of scientific evidence concerning various topics. For medical advice, see your physician.
MIND-BODY MEDICINE
"Mind-body medicine focuses on the interactions among the brain, mind, body, and behavior, and on the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health. It regards as fundamental an approach that respects and enhances each person's capacity for self-knowledge and self-care, and it emphasizes techniques that are grounded in this approach." (National Center for Complementary and Alternative Medicine (NCCAM), "Mind-Body Medicine: An Overview" (2007))
Theory
Emotional and mental states can influence body's ability to fight disease; usually thought to involve the immune system.
Stress may cause or contribute to various diseases:
1. The body naturally turns down the immune system in a stressful situation in order to conserve resources. If done chronically, this could reduce the ability to fight disease.
2. Other physiological responses that are useful in stress (increased pulse and blood pressure, increased blood glucose, decreased GI tract activity) can be harmful if continued chronically.
Thus, relief of stress may relieve an underlying cause or contributing factor for various conditions.
"Complex stimuli such as social and physical stressors influence susceptibility to disease by activating a variety of CNS pathways simultaneously." (E. Sternberg (1997) Nature Medicine 3, 264-7) Such overstimulation can cause the release of glucocorticoids (via the hypothalamic-pituitary-adrenal axis) to down-regulate the immune system and lead to increased disease susceptibility.
In a review, McEwen (New Engl. J. Med. 338, 171-179 (1998)) discussed “the long-term effect of the physiologic response to stress, which I refer to as allostatic load.” “One speculation is that allostatic load over a lifetime may cause the allostatic systems to wear out or become exhausted. A vulnerable link in the regulation of the HPA axis and cognition is the hippocampal region. According to the ‘glucocorticoid-cascade hypothesis,’ wear and tear on this region of the brain leads to dysregulation of the HPA axis and cognitive impairment.” “...inadequate responses by some allostatic systems trigger compensatory increases in others. When one system does not respond adequately to a stressful stimulus, the activity of other systems increases, because the underactive system is not providing the usual counterregulation. For example, if cortisol secretion does not increase in response to stress, secretion of inflammatory cytokines (which are counterregulated by cortisol) increases.”
A 2003 study found that stress increased levels of interleukin-6, which is in turn associated with heart disease, arthritis, osteoporosis, diabetes, and some forms of cancer.
Techniques
• Meditation or visualization of soothing scenes to reduce stress, induce relaxation.
"There are many types of meditation, most of which originated in ancient religious and spiritual traditions. Generally, a person who is meditating uses certain techniques, such as focusing attention (for example, on a word, an object, or the breath); a specific posture; and an open mind toward distracting thoughts and emotions. Meditation can be practiced for various reasons - for example, with an intent to increase physical relaxation, mental calmness, and psychological balance; to cope with one or more diseases and conditions; and for overall wellness." (NCCAM, "Meditation for Health Purposes" (2006))
"Functional magnetic resonance imaging (fMRI) has been used to identify and characterize the brain regions that are active during meditation. This research suggests that various parts of the brain known to be involved in attention and in the control of the autonomic nervous system are activated, providing a neurochemical and anatomical basis for the effects of meditation on various physiological activities. Recent studies involving imaging are advancing the understanding of mind-body mechanisms. For example, meditation has been shown in one study to produce significant increases in left-sided anterior brain activity, which is associated with positive emotional states. Moreover, in this same study, meditation was associated with increases in antibody titers to influenza vaccine, suggesting potential linkages among meditation, positive emotional states, localized brain responses, and improved immune function." (NCCAM, "Mind-Body Medicine: An Overview" (2007))
• In Transcendental Meditation, “practitioners repeat a silent word or phrase (a mantra) with the goal of quieting (and ultimately transcending) the ordinary stream of internal mental dialogue” (Astin et al., J. Am. Board Fam. Pract. 16, 131-147 (2003)). From the Vedic tradition of India.
• Silent repetition of a neutral word or phrase (as in transcendental meditation), or of a meaningful word or phrase (possibly associated with one's religious belief). Slow, rhythmic breathing. Herbert Benson - relaxation response.
• Repetition of positive affirmations
• Guided imagery (may be guided by therapist or tape). Said to help deal with chronic pain, tumors, infections. Patients may visualize harmful cells being killed by antibodies or white cells.
• Relaxation. In progressive muscle relaxation, muscles are sequentially tensed and relaxed.
• Mindfulness - "originated in Buddhism. It is based on the concept of being mindful, or having an increased awareness and total acceptance of the present. While meditating, the meditator is taught to bring all her attention to the sensation of the flow of the breath in and out of the body. The intent might be described as focusing attention on what is being experienced, without reacting to or judging that experience. This is seen as helping the meditator learn to experience thoughts and emotions in normal daily life with greater balance and acceptance." (NCCAM, "Meditation for Health Purposes" (2006)) Promoted by Jon Kabat-Zinn, Univ. Massachusetts Medical Center Stress Reduction Clinic.
• Prayer, spirituality, religious observation
• Support groups
• Psychotherapy
• Music therapy - certain types of music appear capable of lowering heart rate and blood pressure, reducing need for anesthesia, etc. Can also be used to assist in physical or neurological therapy.
• Toning - chanting of vowel sounds
• Laughter therapy - humor may improve blood flow, enhance levels and activities of immune cells and endorphins, and decrease stress hormones. (It is speculated that laughter is linked to the emotions of social connections.)
• Yoga (discussed in handout on Eastern approaches)
• Pet therapy
Some promoters (through books, lectures, workshops, etc.)
• Deepak Chopra - endocrinologist, promoter of ayurvedic medicine. Author, Creating Health; Perfect Health; Quantum Healing; Ageless Body, Timeless Mind.
• Bernie Siegel - surgeon; author, Love, Medicine and Miracles and Peace, Love and Healing.
• Jon Kabat-Zinn - stress reduction (see above). Author of Full Catastrophe Living.
• Herbert Benson - cardiologist, Harvard Medical School. Founded Mind/Body Medical Institute. Relaxation response (see above). Author of The Relaxation Response; co-author of Timeless Healing.
• Larry Dossey - promoter of effects of prayer and spirituality. Author, Healing Words.
• Candace Pert (died 2013) - researcher in psychoneuroimmunology. Author, Molecules of Emotion.
• James Gordon - Director, Center for Mind-Body Medicine.
• Templeton Foundation - funds work related to religion and spirituality.
Arguments in favor
Evidence for connections between brain and immune system has produced an area of research called psychoneuroimmunology.
Communication between the brain and the immune system:
1. The brain can release peptide hormones (neuropeptides) that can affect the immune system.
2. There are also nerves connecting the brain directly to some cells of the immune system.
3. The immune system can release hormones (e.g., the cytokine interleukin-1) that affect the brain and other organs.
Animal studies showed that disruptions in these communications (by mutation, pharmacological intervention, or surgery) increases the susceptibility to inflammatory disease, as the brain does not properly down-regulate the immune system.
"There is considerable evidence that emotional traits, both negative and positive, influence people's susceptibility to infection." (NCCAM, "Mind-Body Medicine: An Overview" (2007))
Studies on animals and people indicate that stress can affect the immune system (however, effects are complex, and do not always suppress the immune system). Stressful lifestyle associated with increased infection and poorer health in general (disputed by some studies). Hostility associated with more heart attacks.
However, it should be noted that "large, well-controlled studies do not support the widespread belief that emotional factors...lead to cancer or accelerate its spread" (Holland (1996) Scientific American, Sept., 158-161). Garssen and Goodkin (Psychiatry Res. 85, 57-61 (1999)) concluded that “The role of psychological factors is more convincingly demonstrated for cancer progression...than for cancer initiation.”
"Evidence from multiple studies with various types of cancer patients suggests that mind-body interventions can improve mood, quality of life, and coping, as well as ameliorate disease and treatment-related symptoms, such as chemotherapy-induced nausea, vomiting, and pain." (NCCAM, "Mind-Body Medicine: An Overview" (2007))
Studies on recovery from, or susceptibility to, various diseases and conditions:
• M. Friedman - better recovery with reduced hostility
• D. Spiegel - study of breast cancer patients - support group, self-hypnosis for pain control doubled survival time (but see below)
• Study of hypertension - lower blood pressure with relaxation techniques
• Study of minor surgery - guided imagery prior to surgery produced faster recovery, less pain
• Correlation of increased survival time with more optimistic attitude in studies of leukemia and heart attacks; with social support in study of leukemia
• Evidence that muscle relaxation can reduce stress-related pain, including headache and back pain
• R. Surwit - improved glucose control in Type II diabetes with muscle relaxation
• F. Fawzi - increased survival with support groups in study of melanoma (but see below)
• J. Blumenthal (1997) - reduced heart attack risk in heart patients under stress management program.
• S. Cohen (1997) - people involved in social activities less likely to catch colds.
• J. Barefoot (1997) - depression correlated with increased risk of stroke.
• Sephton et al. (Spiegel group) - abnormal cortisol rhythm associated with increased breast cancer mortality.
• Depression linked to heart disease (2004).
• Stress linked to obesity (2004)
• Stress linked to DNA damage in immune cells (2004)
• Christakis et al. (New Engl. J. Med. 354, 719-730 (2006)): "Among elderly people hospitalization of a spouse is associated with an increased risk of death."
• Anxiety increased the risk of myocardial infarction in older men (Shen et al., J. Am. Coll. Cardiol. 51, 113-119 (2008)).
• Loneliness was associated with increased expression of genes related to inflammation (Cole et al., Genome Biology 8, R189 (2007)
• Andersen et al. (Cancer 113, 3450-3458 (2008)): psychological intervention improved the survival of breast cancer patients.
• Paul-Labrador et al. (Arch. Intern. Med. 166, 1218-1224 (2006)): Transcendental Meditation improved components of metabolic syndrome in heart disease patients (but see Ospina et al. below).
"Multicomponent mind-body interventions that include some combination of stress management, coping skills training, cognitive-behavioral interventions, and relaxation therapy may be appropriate adjunctive treatments for coronary artery disease and certain pain-related disorders, such as arthritis." (NCCAM, "Mind-Body Medicine: An Overview" (2007))
NIH panel (1995) recommended meditation, hypnosis, relaxation, biofeedback and cognitive-behavioral therapy for chronic pain and insomnia.
Astin et al. (J. Am. Board Fam. Pract. 16, 131-147 (2003)) concluded that the evidence of effectiveness of mind-body medicine was strong for treatment of myocardial infarction, cancer symptoms, incontinence disorders, surgical outcomes, insomnia, headache, and chronic low back pain.
"There are several conditions where the evidence for mind-body therapies is quite strong such as migraine headache. Mind-body therapies for other neurology applications have limited evidence due mostly to small clinical trials and inadequate control groups." (Wahbeh et al., Neurology 70, 2321-2328 (2008)).
Evidence suggests that mind-body techniques, "such as progressive muscle relaxation and yoga, may effectively treat insomnia and low back pain." (Bertisch et al., J. Psychosom. Res. 66, 511-519 (2009))
"Mindfulness meditation appears to be a viable treatment option for adults with chronic insomnia." (Ong et al., Sleep 37, 1553-1563 (2014))
May improve quality of life for patient even if disease not overcome
"...the physical and emotional risks of using these interventions are minimal. Moreover, once tested and standardized, most mind-body interventions can be taught easily." (NCCAM, "Mind-Body Medicine: An Overview" (2007))
Some reasons for caution concerning the claims of mind-body medicine:
Study of advanced cancer patients (Cassileth, 1985) found no relationship between mental attitude and survival or reoccurrence.
Patients may blame themselves for causing the disease or for failing to get well.
May raise false hopes of recovery.
In some studies, techniques were combined with other factors (diet, exercise) so difficult to evaluate effect of mental aspect.
For subjective outcomes (e.g., perception of pain), placebo effects are possible.
Correlation of recovery or survival with attitude or social support may be misleading - patients with better attitude and support may comply better with medication, recommended exercise, etc.
Tesman and Tesman (Science 276, 369-370 (1997)) found serious flaws in the evidence used by Herbert Benson in support of his "relaxation response."
Related to cancer: "Some studies have suggested that mind-body interventions can alter various immune parameters, but it is unclear whether these alterations are of sufficient magnitude to have an impact on disease progression or prognosis." (NCCAM, "Mind-Body Medicine: An Overview" (2007))
Sampson (Semin. Oncol. 29, 595-600 (2002)) criticized Spiegel's study of breast cancer patients, noting that the survival rates for the patients in the support groups were no better than those typical of the time (i.e., Spiegel's controls had abnormally low survival times). Goodwin et al. (New Engl. J. Med. 345, 1719-1726 (2001)), attempting to replicate Spiegel’s results, found no effect on survival. A 2004 study found no connection between optimism and lung cancer survival.
A review by Petticrew et al. (BMJ 325, 1066-1075 (2002)) concluded that “There is little consistent evidence that psychological coping styles play an important part in survival from or recurrence of cancer.”
Coyne et al. (Psychol. Bull. 133, 367-394 (2007)) criticized studies of cancer survival, such as those of Spiegel et al. and Fawzi et al.: "...the evidence that after a diagnosis of cancer people generally benefit from receiving psychosocial interventions is shown to be a lot weaker than it first appeared." "As an overview, the idea that psychotherapy prolongs the survival of people with cancer remains 'inherently improbably' (Spiegel, 2004, p. 133) despite an accumulation of more than 15 years of research."
Coyne conducted his own study of about 1100 head and neck cancer patients. There was no effect of emotional state on survival (Coyne et al., Cancer 110, 256-2575 (2007)).
O’Malley et al. (New Engl. J. Med. 343, 1298-1304 (2000)) - study of Army personnel found no relationship between stress and coronary artery calcification.
A meta-analysis of effects of psychological intervention on the immune system (Miller and Cohen, Health Psychol. 20, 47-63 (2001)) concluded that there was “only modest evidence that interventions can reliably alter immune parameters.”
"But despite several decades of concerted research in the field of psychoneuroimmunology, to my scrutiny no robust effects of meditation or other relaxation techniques that could combat illnesses like cancer or AIDS have been identified." ("Faith and Healing," J. Groopman, New York Times, Jan. 27, 2008)
The study of Andersen et al. on breast cancer survival was criticized (Skeptimedia blog, Nov. 18, 2008): "...the number of women in the study is relatively small, while the duration of the study is arbitrary."
Ospina et al. (Evid. Rep. Technol. Assess. 155 (2007)): "Scientific research on meditation practices does not appear to have a common theoretical perspective and is characterized by poor methodological quality. Firm conclusions on the effects of meditation practices in healthcare cannot be drawn based on the available evidence." "TM® had no advantage over health education to improve measures of systolic blood pressure and diastolic blood pressure, body weight, heart rate, stress, anger, self-efficacy, cholesterol, dietary intake, and level of physical activity in hypertensive patients; RR [relaxation response] was not superior to biofeedback in reducing blood pressure in hypertensive patients; Yoga did not produce clinical or statistically significant effects in blood pressure when compared to nontreatment; Zen Buddhist meditation was no better than blood pressure checks to reduce systolic blood pressure in hypertensive patients. Yoga was no better than physical exercise to reduce body weight in patients with cardiovascular disorders."
Adverse psychological effects from meditation have been reported.
Prayer, spirituality
Spirituality is defined by NCCAM as “an individual’s sense of purpose and meaning to life, beyond material values. Spirituality may be practiced in many ways, including through religion.” (CAM at the NIH 12(1), 1-4 (2005))
Various studies show beneficial effects of religious faith, prayer, and church attendance in health and recovery from illness, especially in elderly. This need not involve a supernatural explanation, but could be due to effects of positive attitude and social support, as discussed above.
Sloan et al. (Lancet 353, 664-667 (1999)) charged that these studies were seriously flawed; their points were rebutted by Koenig et al. (Int. J. Psychiatry Med. 29, 123-131 (1999)). A later review (Sloan and Bagiella, Ann. Behav. Med. 24, 14-21 (2002)) concluded that “there is little empirical basis for assertions that religious involvement or activity is associated with beneficial health outcomes.” Again, there was a rebuttal: Weaver et al., Altern. Ther. Health Med. 9, 42-46 (2003). King et al. (Social Science & Medicine 48, 1291-1299 (1999)), found that stronger religious belief was associated with poorer outcome in hospitalized patients.
Blumenthal et al. (Psychosom. Med. 69, 501-508 (2007)): "We found little evidence that self-reported spirituality, frequency of church attendance, or frequency of prayer is associated with cardiac morbidity or all-cause mortality post AMI [acute myocardial infarction] in patients with depression and/or low perceived support."
Intercessory prayer is discussed in another handout, along with faith healing.
Placebo effects
Many studies show positive results in 30 to 70% of patients receiving placebos. However, in a reexamination of the literature, Kienle and Kiene (1997) J. Clin. Epidemiol. 50, 1311-1318, stated: “Having analyzed a total of 800 articles on placebo, we have not found any reliable demonstration of the existence of placebo effects...There can be no doubt that the extent and frequency of placebo effects as published in most of the literature are gross exaggerations.”
A widely-publicized meta-analysis (Hróbjartsson and Gøtzsche (2001) New Engl. J. Med. 344, 1594-1602) found little evidence for the placebo effect, except possibly in pain and other subjective responses. However, numerous criticisms of their analysis have been raised (e.g., letters in New Engl. J. Med. 345, 1276-1279 (2001)). For example, the analysis pooled results from many different types of studies, which likely differ in the importance of placebo effects.
"Just as responses following drug treatment do not necessarily indicate true drug effects, so responses to placebo do not necessarily constitute placebo effects. Patients receiving placebos either in clinical practice or in clinical trials may have improved, or appeared to have improved, for a variety of reasons other than any causal connection (via some psychological neurobiological mechanism) between the placebo and the outcome. These may include spontaneous remission, the natural course of waxing and waning of symptoms, regression to the mean in repeated measurements, and biased patient reports that do not reflect real improvement." (Miller and Kaptchuk, J. Roy. Soc. Med. 101, 222-225 (2008))
"The placebo response depends on the subject's beliefs which determine their expectations and response. Their beliefs will depend on the placebo message delivered by the therapist who will usually be enthusiastic and convey an optimistic message by word and body language reinforced by mechanical, electrical stimuli and the 'laying on of hands' as in massage and, in Western and Chinese medicine, simply taking the pulse. The response will also be conditioned by previous beliefs and by peers who offer advice embellished by phrases such as 'I swear by it'." (Wigley, Clin. Med. 7, 450-452 (2007))
Waber et al. (JAMA 299, 1016-1017 (2008)) found that greater placebo effects on pain were seen if subjects thought that the pills were more expensive.
Kaptchuk et al. (PLoS ONE 5, e15591 (2010)) reported a beneficial effect of placebos in irritable bowel syndrome even when patients were told that the pills were placebos ("placebos without deception"). The study was criticized by "Orac" ("Respectful Insolence" blog, Dec. 23, 2010), who felt that deception was still involved.
A Cochrane Database Systematic Review (CD003974 (2010)) concluded that "We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important."
Changes in activity in certain regions of the brain in response to placebos have been identified.
“Now, research has shown that placebo responses are mediated by conditioning when unconscious physiological functions such as hormonal secretion are involved, whereas they are mediated by expectation when conscious physiological processes such as pain and motor performance come into play, even though a conditioning procedure is carried out." (NCCAM, "Mind-Body Medicine: An Overview" (2007))
Both opioid and non-opioid (such as dopamine) mechanisms are involved in placebo effects. "Neurophysiology and neurochemistry suggest that there are multiple placebo effects, with different neurobiological mechanisms, depending on the organ system and the target illness." (Brody and Miller, JAMA 306, 2612-2613 (2011))
We can divide placebo effects into two types:
1. Patients may perceive subjective improvement (e.g., in pain) in the absence of objective improvement in the condition.
2. Mind-body interactions as discussed above could produce objective improvement.
These effects may be involved in successes of some alternative practitioners. "Some commentators have suggested that alternative therapies with elaborate procedures and distinct environmental cues might have pronounced and clinically significant placebo effects. Recent RCTs of acupuncture, although not designed to study placebo effects, have provided results that lend support to this hypothesis." (Finniss et al., Lancet 375, 686-695 (2010))
Ethical questions: should doctors give placebos on purpose? Should we condone alternative methods that "work" only via placebo effects, since they may be helping patients?
A 2007 survey of U.S. physicians found that about half "reported prescribing placebo treatments on a regular basis" and 62% "believed the practice to be ethically permissible" (Tilburt et al., BMJ 337, a1938 (2008)).
Other points
The National Institutes of Health established ten centers for mind-body medicine research.
Nerurkar et al. (Arch. Intern. Med. 171, 862-853 (2011)) analyzed National Health Interview Survey data from 2007. They found that increasing use of mind-body medicine was a large factor in the increase in complementary and alternative medicine. Usage of physician-referred mind-body therapies (P-MBT) was 2.9% of Americans, vs. 15.5% for self-referred usage (S-MBT). "Deep breathing exercises were the most common P-MBT used (84.4%), followed by meditation (49.3%), yoga (22.6%), progressive muscle relaxation (19.9%), and guided imagery (13.9%); similar trends were seen in the S-MBT group." A story on the study quoted Dr. Nerurkar: "What we learned suggests that providers are referring thier patients for mind-body therapies as a last resort once conventional therapeutic options have failed. It makes us wonder whether referring patients for these therapies earlier in the process could lead to less use of the health care system, and possibly, better outcomes for these patients." (Newswise, May 9, 2011)
Bertisch et al. (J. Psychosom. Res. 66, 511-519 (2009)), analyzing 2002 data, found that mind-body therapies were most frequently used for anxiety/depression, back pain, and various other types of pain.
"There are nearly 1,000 certified MBSR [mindfulness-based stress reduction] instructors teaching mindfulness techniques (including meditation), and they are in nearly every state and more than 30 countries." (Pickert, Time, Feb. 3, 2014, 40-46)
"But mindfulness has reached far more people than those who have attended an MBSR class. Whereas tens of thousands of individuals have enrolled in an MBSR program, several millions have read or listened to mindfulness self-help books or recordings." (Barker, Soc. Sci. Med. 106, 168-176 (2014))
SUMMARY: A growing body of evidence indicates that mental attitudes can affect the incidence and progress of disease, though many results need to be confirmed with more research. Applying the various techniques described above may help patients, as long as they do not have unrealistic expectations.
HYPNOSIS
Background
Can be broadly defined as an altered state of mind associated with greatly increased suggestibility; exact definition is controversial. Research is attempting to identify changes in the brain associated with the hypnotic state. “Brain scans show that the control mechanisms for deciding what to do in the face of conflict become uncoupled when people are hypnotized. Top-down processes override sensory, or bottom-up information” (Blakeslee, New York Times, Nov. 22, 2005).
"The typical pain signal follows a well-worn path from the brain stem through the midbrain and into the cortex, where conscious feelings of pain arise. In [Sebastian] Schulz-Stübner's study, the hypnotized group showed subcortical brain activity similar to that of nonhypnotized volunteers, but the primary sensory cortex stayed quiet." (Song, Time, Mar. 26, 2006, 47)
"Some 60% of patients are hypnotizable to some degree, [David] Spiegel says; an additional 15%, highly so. The rest seem to be unresponsive." (Song, ibid)
Hypnotherapy is practiced by more than 10,000 health professionals. However, it is also taught to, and practiced by, nonprofessionals (one can get a "Ph.D." in hypnotherapy in a 2-week course!).
Practice and scope
Hypnotic state induced by having subject focus on mental image, object, or soothing voice. Therapist then gives suggestions relating to the desired change in behavior.
Advocated for smoking cessation, weight control, stress management, motivation, pain control, etc.
Has been tested as an alternative to anesthesia for patients who are allergic to anesthetics, or to be used in conjunction with lower anesthesia levels in order to reduce side effects. "Hypnosis for analgesia is often superior to other non-pharmacologic treatments for producing changes in pain reports. Also, patients undergoing surgery with hypnosis need significantly less chemical analgesia." (Wahbeh et al., Neurology 70, 2321-2328 (2008))
“The pain-relieving effect of hypnosis is often substantial, and in a few cases the degree of relief matches or exceeds that provided by morphine.” (Nash (2001) Scientific American, July, 47-55)
"...hypnosis has potential as a clinically valuable intervention for procedure-related pain and distress in pediatric cancer patients." (Richardson et al., J. Pain Symptom Manage. 31, 70-84 (2006))
"...while both structured empathy and hypnosis decrease procedural pain and anxiety, hypnosis provides more powerful anxiety relief without undue cost and thus appears attractive for outpatient pain management." (Lang et al., Pain 126, 155-164 (2006))
It also appears to be effective for nausea and vomiting in pediatric chemotherapy (Richardson et al., Eur. J. Cancer Care 16, 402-412 (2015))
Hypnosis "provided long-term adequate symptom relief in 54% of patients with irritable bowel syndrome refractory to conventional therapy." (Schaefert et al., Psychosom. Med. 76, 389-398 (2014))
“Hypnosis can boost the effectiveness of psychotherapy for some conditions...patients who received cognitive behavioral therapy plus hypnosis for disorders such as obesity, insomnia, anxiety and hypertension showed greater improvement than 70 percent of the patients who received psychotherapy alone.” (Nash (2001) Scientific American, July, 47-55)
“...a task force of the American Psychological Association validated hypnosis as an adjunct procedure for the treatment of obesity. But the jury is still out on other disorders with a behavioral component. Drug addiction and alcoholism do not respond well to hypnosis, and the evidence for hypnosis as an aid in quitting smoking is equivocal...there is strong, but not yet definitive evidence that hypnosis can be an effective component in the broader treatment of other conditions...these include a subgroup of asthmas; some dermatological disorders, including warts; irritable bowel syndrome; hemophilia; and nausea associated with chemotherapy...claims that hypnosis increases immune function in any clinically important way are at this time unsubstantiated.” (Nash, ibid)
Hypnosis is also used as a tool to help recall repressed or "lost" memories. This is sometimes used in psychotherapy. However, hypnosis is not a magic route to the truth; subjects can (and do) recall things incorrectly and construct fantasies. (see also “Recovered memories” below)
Two pseudoscientific applications of hypnosis
1. Past-life therapy - under hypnosis, patient is "regressed" through childhood and then back to alleged previous lives. (Some practitioners even claim to be able to "progress" the subject through future lives!) Events in these lives are held to underlie psychological problems in the present life. As in psychoanalysis, the reliving of these traumatic events is held to be therapeutic.
Arguments against:
• The concept of reincarnation is unsupported by scientific evidence, and, if true, would present important philosophical problems.
• Hypnosis is a state of relaxation and compliance, leading to increased suggestibility and desire to please the hypnotist. Under such conditions fantasization can occur. Using fragments of old memories, elements of books and stories, learned historical and geographical information, etc., the subject may create a convincing story. The subject may be unaware of the source of these "hidden memories" (cryptomnesia).
• Careful examination of cases of alleged past lives has revealed either historical inaccuracies or inconsistencies, or information which the subject could have obtained readily earlier in life.
• As with hypnosis in general, the techniques can be applied by people who have no training in psychotherapy, and may therefore be subject to abuse.
2. UFO abductee regression - it has been claimed that thousands of Americans have been abducted by aliens; often they allegedly have been subjected to sexual and reproductive experimentation. These instances are usually "remembered" only after the victims are hypnotically regressed, often many years later. This allegedly can lead to resolution of psychological problems. Promoted by author Budd Hopkins (died 2011) and Harvard psychiatrist John Mack (died 2004).
Arguments against:
• Problems with the general idea of alien visits include lack of corroborating physical evidence and the vast distances to other stars.
• If aliens did visit, why would they contact and abduct obscure individuals rather than government leaders or scientists?
• Idea that aliens could interbreed with humans is scientifically preposterous (and if they are so advanced, why would they want to?).
• Hypnosis does not necessarily lead to truthful reports; it can be a medium in which fantasy-prone individuals are encouraged to generate stories which will please the hypnotist.
• Hypnogogic (when falling asleep) and hypnopompic (when waking up) hallucinations may provide the bases for some reports.
• Some individuals may generate the reports to gain the fame (e.g., talk-show appearances) and possible financial rewards which go to "victims." Others may simply find it rewarding to have their normally secretive fantasy lives validated by the investigator.
• With the huge numbers of people allegedly abducted, there should have been many witnesses, unless the aliens have mastered such supernatural powers as making people invisible and allowing them to pass through walls.
BIOFEEDBACK
Definition
"Biofeedback employs electronic sensors to inform people of variations in physiological processes whose activities are not normally accessible to consciousness (e.g., brain or muscle electrical activity, blood pressure, etc.)." (Beyerstein, Skeptical Inquirer 10, 42-59 (1985)) Subjects then use mental state to manipulate the process in the desired direction.
Two major types:
1) One type includes measurement of muscle tension and skin temperature (higher temperature associated with relaxation). These techniques are not controversial (at least for some applications) and have been incorporated into many treatment programs. Used for treatment of chronic pain and migraine headaches, to help regain movement of limbs, and incontinence.
Allen (Ped. Annals 33, 241-245 (2004)) wrote, “Research demonstrated that biofeedback can be an effective treatment for a variety of stress-related disorders, including chronic headaches, hypertension, Raynaud’s disease, irritable bowel syndrome, and fibromyalgia.” (The article advocates the use of biofeedback for children with recurrent headaches.)
A meta-analysis by Nakao et al. (Hypertens. Res. 26, 37-46 (2003)) concluded that biofeedback “was more effective in reducing blood pressure in patients with essential hypertension than no intervention. However, the treatment was only found to be superior to sham or non-specific behavioral intervention when combined with other relaxation techniques.”
2) Brain wave biofeedback (or neurofeedback). Sensors on scalp and earlobes detect brain waves. Subject is given feedback through earphones or video display. Generally, subject tries to maximize alpha and theta waves, associated with resting, meditation, and creativity, in contrast to beta waves, associated with excitation, stress, or narrowly focused states. (Thus, other techniques such as meditation, guided imagery, or psychotherapy may achieve the same results.)
Uses include inspiration of creativity in corporate settings; reduction of stress; improved attention span (and reduced hyperactivity) in children with attention-deficit disorder (here the goal would be to reduce alpha); reduction of depression; recall of repressed memories (memories associated with intense emotional states are held to be linked to theta waves); overcoming addictions; and dealing with insomnia and phobias; dealing with head injuries, cerebral palsy, autism, epilepsy.
Many of these applications are controversial, and benefits are not well documented.
"EEG neurofeedback has been widely used as a nonpharmacologic treatment in children and adults with ADHD but still has a limited amount of strong empirical evidence." (Wahbeh et al., Neurology 70, 2321-2328 (2008))
"The procedure is controversial, expensive and time-consuming. An average course of treatment, with at least 30 sessions, can cost $3,000 or more, and few health insurers will pay for it." (Ellison, New York Times, Oct. 4, 2010)
Various electronic devices are also used to induce relaxation and produce desired brain states. These may be used in practitioners' offices, in stress-reduction salons, or in the home. The FDA has taken action against some of these. They can produce seizures in some individuals, even with no prior history of epilepsy or seizures.
A critical evaluation was provided by B. Beyerstein (1985), "The Myth of Alpha Consciousness," Skeptical Inquirer 10, 42-59. Some of his points:
• Just because alpha is associated with a certain state doesn't mean that it causes it.
• An increase in alpha during a session may simply be due to decrease in the novelty of the initial situation, in addition to the relaxation that occurs with time in the quiet, monotonous setting.
• About 10-15% of normal subjects did not produce any alpha, yet seemed no more stressed than others. Conversely, some very anxious individuals had high alpha.
• In one study, subjects could be induced to increase alpha under stressful conditions (threat of electric shock)
• Lack of controls for placebo effect in some studies. Patients may simply believe the treatment will help them.
• Possibly distractive effect in pain control.
• Subjects reported transcendent experiences when given feedback to suppress alpha.
TREATMENT OF AUTISM
The dramatic increase in diagnosed cases of autism spectrum disorders (ASD) in recent decades led to a corresponding increase in the use of unconventional methods for treatment. Some of these may once have had plausible rationales, though they were lacking in support from clinical trials. Now that it appears that autism is caused by a combination of genetic and environmental factors in early development, there is even less reason to attempt to cure autism through methods such as chelation or special diets.
Some surveys have found that 30% to 75% of autistic children are treated with alternative methods; one by Owen-Smith et al. (Res. Autism Spectr. Disord 17, 40-51 (2015)) found that "Approximately 88% of the sample had either used CAM in the past or had recently used some type of CAM." These authors noted that "many children with ASD may be concurrently taking both vitamins/supplements and prescription psychotropic medications and thus may be at risk for possible interactions."
"The most commonly used CAM treatments for ASD...are: With natural products: 13% to 54%. Special diet: 17% to 33%. Mind and body practices: 25% to 30%...It is most notable that families reported that they rarely asked physicians for information about CAM. The proliferation of Internet-based lay communities and Web sites that are promoting untested treatments have increased the exposure of families to large volumes of information about treatments with potential harm." (Levy and Hyman, Child Adolesc. Psychiatric Clin. N. Am. 24, 117-143 (2015)) "Children with ASD use more CAM when they have co-existing gastrointestinal symptoms, seizure disorders, and behavior problems." (Perrin et al., Pediatrics 130, S77-S82 (2012))
"The four most frequently used CAMs (>25% of respondents indicated having tried in the past or currently using) were the gluten-free/casein-free (GF/CF) diet, probiotics, omega-3 fatty acids, and melatonin." (Hall and Riccio, Complement. Ther. Clin. Pract. 18, 159-163 (2012))
"Case series...have suggested that children with autism may have an increased prevalence of gastrointestinal symptoms...As a result, restrictive diets and other nutritional or gastrointestinal therapies, such as the gluten-free, casein-free diet, intravenous secretin, prescription of antifungal medications to treat purported fungal overgrowth in the gut, and dietary supplementation with vitamins, minerals, or omega-3 fatty acids have become widely popular interventions for children with autism, despite a lack of evidence regarding their safety or efficacy." (Ibrahim et al., Pediatrics 124, 680-686 (2009))
A review by Brondino et al. (Evid. Based Complement. Alternat. Med. 2015, 258589 (2015)) found that "There is no conclusive evidence supporting the efficacy of CAM therapies in ASD. Promising results are reported for music therapy, sensory integration therapy, acupuncture, and massage."
Antioxidants - in 2010 the FDA stopped the marketing of OSR#1, an unapproved drug marketed to fight "oxidative stress." More recently, N-acetylcysteine (NAC) has been popular.
Auditory Integration Training (AIT) - controlled trials found not useful (Sinha et al., Arch. DIs. Child. 91, 1018-1022 (2006)).
Chelation therapy - the rationale has been to remove mercury. Vaccinations with thimerosal, a mercury-containing preservative, have been alleged to cause autism, but this claim has been disproven (see "Antivaccination Efforts" in the handout "Overview of Complementary and Alternative Medicine"). In 2005 a 5-year-old died after chelation. A planned NIH trial of chelation was cancelled in 2008 over safety concerns. A 2013 review concluded that "evidence to support the use of chelation as a treatment for children with ASD is extremely weak." Moreover, "Because empirical evidence does not support the hypothesis that the core ASD symptoms are associated with specific levels of metals in the body, the use of chelation to remove metals from the body in order to ameliorate ASD symptoms could be seen as unfounded and illogical." (Davis et al., Res. Autism Spectrum Disorders 7, 49-55 (2013))
DAN! (Defeat Autism New!) Protocol - DAN! was a project (closed in 2011) of the Autism Research Institute. The protocol began "with a choice of four general directions. The subsequent choices include chelation therapy and more than 50 dietary supplements, medications, dietary strategies, and other modalities." (Barrett, "A Critical Look at Defeat Autism Now! and the 'DAN! Protocol'," Quackwatch web site (2015))
Dietary supplements - Stewart et al. (J. Acad. Nutr. Diet. 115, 1237-1248 (2015)) found that dietary supplements frequently given to children with autism did not correct common micronutrient deficiencies; rather, they provided excessive levels of certain nutrients.
Digestive enzymes - a trial found no benefit (Munasinghe et al., J. Autism Dev. Disord. 40, 1131-1138 (2010)).
Dimethylglycine (DMG) - controlled studies found not useful
Gluten- and casein-free diets - "Diet modification as a treatment for ASD is based on the as-yet-scientifically unproven hypothesis that opioid peptides, formed from the incomplete breakdown of foods containing gluten...and casein...may enter the bloodstream due to increased intestinal permeability, cross the blood-brain barrier and impede central nervous system development and function...Currently there is a lack of evidence to support the use of GFCF diets as an effective intervention for children with ASD." (Whitehouse, J. Paediatr. Child Health 49, E438-E442 (2013))
Hyperbaric oxygen therapy - a study by Rossignol et al. (BMC Pediatrics 9, 21 (2009)) gave positive results. However, criticisms were raised: the authors were practitioners of hyperbaric oxygen therapy, and blinding may not have been successful. Replication by an independent group found no evidence of benefit.
Intravenous immunoglobulin - based on the premise that autism is related to neuroinflammation. Professional organizations have concluded that it is ineffective. It has significant risks.
Lupron - a drug used for chemical castration. Based on the scientifically invalid idea that autistic children have high testosterone levels and precocious puberty.
Massage therapy - no good evidence of effectiveness (Lee et al., J. Clin. Psychiatry 72, 406-411 (2011))
Melatonin - used to deal with sleep problems.
Omega-3 fatty acids (such as EPA and DHA) - involved in brain function and development. Evidence in support is weak.
Probiotics - little supporting evidence to date.
Secretin - "...the administration of secretin for ASD is based on the unproven hypothesis that secretin may aid digestion, thus restricting the flow of harmful opioid peptides crossing the blood-brain barrier." (Whitehouse, J. Paediatr. Child Health 49, E438-E442 (2013)) A 2012 Cochrane review (CD003495) found no good evidence of effectiveness.
Sensory Integration Therapy - "...based on the premise that adequate processing and integration of sensory information by the central nervous system plays a significant role in an individual's ability to participate in daily activities." (Polenick and Flora, Skeptic 17(2), 28-35 (2012)) Includes various devices and types of clothing to produce a range of sensory experiences. Professional organizations have concluded that there is no good evidence of effectiveness.
Stem cells - "done overseas because not approved in the U.S." (Shute, Scientific American, Oct. 2010, 80-85)
Taurine - in 2002 the FDA took action against a marketer of taurine for autism.
Vancomycin - a preliminary study found temporary benefits, but symptoms soon reappeared.
Vitamin B6 - no evidence of benefit
TREATMENT OF OTHER CONDITIONS
Alzheimer's - supplementation with docosahexaenoic acid (DHA), an omega-3 fatty acid, provided no benefit (Quinn et al., JAMA 304, 1903-1911 (2010))
Attention deficit hyperactivity disorder - dietary supplements are being marketed to treat this condition. In 2000 and 2002 the FTC took action against marketers of essential fatty acids, pycnogenol, and other products for unsupported claims. A review by Sarris et al. (Complement. Ther. Med. 19, 219-227 (2011)) concluded that Ginkgo biloba and St. John's wort were ineffective. A Cochrane review of polyunsaturated fatty acids (CD007986 (2012)) found that "The majority of data showed no benefit of PUFA supplementation, though there were some limited data that did show an improvement with combined omega-3 and omega-6 supplementation." Bloch et al. (Child Adolesc. Psychiatric Clin. N. Am. 23, 883-897 (2014)) concluded that "Melatonin is effective in improving chronic insomnia in children with ADHD but has little evidence for efficacy in improving core ADHD symptoms."
A 2007 study (McCann et al., Lancet 370, 1560-1567) found that artificial colors or the preservative sodium benzoate increased hyperactivity in children. However, the effects were quite small compared to the differences between normal and ADHD children.
Neurofeedback for ADHD is discussed in the "Biofeedback" section.
Down syndrome - nutritional therapy (with vitamins, minerals, amino acids, antioxidants, and other components) has been advocated as a treatment. Supplementation with antioxidant vitamins and folinic acid provided no benefit (Ellis et al., BMJ 336, 594-597 (2008)).
OTHER UNCONVENTIONAL PRACTICES RELATED TO MENTAL HEALTH
(Unless otherwise noted, quotes are from S. Barrett, "Mental Help: Procedures to Avoid."
http://www.quackwatch.org/01QuackeryRelatedTopics/mentserv.html (2003))
Attachment therapy - assumes that "most, if not all, childhood mental health disturbances are caused by failure of normal development of emotional attachment to caregivers...AT practitioners also share the belief that re-enactment of typical episodes of early infancy can recapitulate and repair failed attachment development. AT practitioners and parents carry out these re-enactments by physically holding or restraining children, by feeding older children by spoon or by baby bottle and preventing them from obtaining food by themselves, and by requiring children to gaze into the eyes of parents or therapists, in the mistaken belief that eye contact causes attachment rather than following it. Most of the attention paid to AT methods has focused on Holding Therapy (HT), a method that uses physical restraint and intrusive physical contact as well as verbal provocation." (Mercer, Institute for Science in Medicine White Paper, "Attachment Therapies and Associated Parenting Techniques" (2013)) These claims and methods have been rejected by professional organizations of psychologists and psychiatrists. Injuries and at least one death have resulted from holding therapy.
"Brain Games" - "computer-based cognitive training software" is promoted for preventing declines in mental function with aging. However, according to "A Consensus on the Brain Training Industry from the Scientific Community" (http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community-2/), "claims promoting brain games are frequently exaggerated and at times misleading...there is little evidence that playing brain games improves underlying broad cognitive abilities, or that it enables one to better navigate a complex realm of everyday life."
Brain Gym - "nonprofit organisation promoting a series of exercises claimed to improve academic performance. The 26 Brain Gym activities are claimed to improve eye teaming (binocular vision), spatial and listening skills, hand–eye coordination, and whole-body flexibility, and by doing this manipulate the brain, improving learning and recall of information." (Wikipedia) "The program's theoretical basis has been researched and fully discredited; there is simply no evidence that the Brain Gym works - or even that it could work." (Radford, Skeptical Inquirer, Sept.-Oct. 2009, p. 31)
Eye Movement Desensitization and Reprocessing (EMDR) - "promoted for the treatment of post-traumatic stress, phobias, learning disorders, and many other mental and emotional problems. The method involves asking the client to recall the traumatic event as vividly as possible and rate certain feelings before and after visually tracking the therapist's finger as it is moved back and forth in front of the client's eyes...Recent reviews have concluded that the data claimed to support EMDR derive mostly uncontrolled case reports and poorly designed controlled experiments and that the theory of EMDR clashes with scientific knowledge of the role of eye movements." According to promoters, 60,000 therapists have been trained worldwide, and they have treated 1 million patients.
Facilitated communication - used to help an autistic or otherwise disabled person communicate. A "facilitator" helps the subject spell out messages. However, controlled studies show that the messages are actually produced unintentionally by the facilitator.
Lilienfeld et al. (Evid. Based Communication Assess. Intervention 8, 62-101 (2014)) wrote: "...in the early 1990s, FC became immensely popular in educational and clinical circles as a means of establishing expressive communication among non-speaking individuals with autism and other disorders...by the mid- to late-1990s, FC had been convincingly refuted by controlled research and overwhelmingly rejected by the scientific community...Professionals in the fields of communication disorders and mental health may therefore be surprised to learn that FC remains alive and well in much of the mainstream autism and developmental disabilities community, and that it seems to be staging a broader comeback..." Leading FC promoter Douglas Biklen has been promoted to Dean of the School of Education at Syracuse University.
Feingold diet - based on idea that hyperactivity and many other conditions arise from salicylates, artificial colors, and artificial flavors in the diet. However, blinded tests show that food additives have little effect on behavior.
Neural Organization Technique - developed by a chiropractor; purports to realign skull bones to heal mental disorders.
Neuro Emotional Technique (NET) - based on releasing emotional blocks which produce adverse health effects. Involves applied kinesiology, chiropractic adjustments, and other invalid methods in diagnosing and dealing with these blockages.
Neurolinguistic programming - "a variable system of procedures purported to enable people to communicate more effectively and influence others. Proponents claim that NLP has cured phobias, allergies, and other problems in one or a few brief sessions. Its core postulates are: (a) people are most influenced by messages that reflect how they internally represent whatever they are doing; and (b) this representation is reflected by eye-gaze patterns, posture, tone of voice, and language patterns... A National Research Council committee has found no significant evidence that NLP's theories are sound or that its practices are effective."
Optometric Visual Training - "based on the idea that learning can be improved by exercises that improve coordination of the eye muscles or improve hand-eye coordination. Its proponents assume that the basic problem that leads to reading disability is some deficit in the visual system. The American Academy of Pediatrics and the American Academy of Ophthalmology have criticized this approach and cautioned that no eye-muscle defects can produce the learning disabilities associated with dyslexia."
Patterning (psychomotor patterning; Doman-Delacato Treatment) - for treatment of mental retardation, learning disabilities, etc. Based on scientifically discredited idea that putting patient through series of passive motions (e.g., crawling) can stimulate brain development to more advanced stages. Trials in the 1960's and 1970's showed little or no value.
Recovered memories - during therapy (possibly involving hypnosis), subject "remembers" early events (e.g., childhood sexual abuse). There have been many cases of alienation within families or even criminal prosecution as a result of such "memories." However, many of them are false, created in response to the promptings of the therapist. (see also "past-life regression" and "UFO abductee regression" in the Hypnosis section above)
Single-photon emission computed tomography (SPECT) (brain mapping) - used in imaging the brain. Promoted by Daniel Amen for diagnosis of ADHD and other conditions. "However, Amen's use of SPECT scans to aid in psychiatric and neurological clinical diagnosis is based on unproven claims and has been widely criticized." (Wikipedia)
Thought Field Therapy (TFT) - psychological problems are alleged to involve disturbances in “energy fields” (or “thought fields”) in the body. These are supposedly corrected through sequences of tapping on various acupressure points, plus other sensory activities. No controlled studies in support.
Vagus nerve stimulation - a pacemaker-like device is implanted in order to stimulate the vagus nerve with the aim of treating depression. The FDA approved one such device against the recommendation of its own review committee. However, Medicare decided not to provide reimbursement: "'Vagus nerve stimulation is not reasonable and necessary for treatment of resistant depression,' and research 'provides little evidence that a patient will experience a health benefit as a direct result of VNS therapy.'" (Barglow, Skeptical Inquirer 32(5), 35-40 (2008))
READING
Mind-body medicine - overview
National Center for Complementary and Alternative Medicine (2007) "Mind-Body Medicine: An Overview"
National Center for Complementary and Integrative Health (2015) “Mind and Body Practices”
Astin, J.A., Shapiro, S.L., Eisenberg, D.M., and Forys, K.L. (2003) “Mind-Body Medicine: State of the Science, Implications for Practice” J. Am. Board Fam. Pract. 16, 131-147
Bertisch, S.M., Wee, C.C., Phillips, R.S., and McCarthy, E.P. (2009) "Alternative Mind-Body Therapies Used by Adults With Medical Conditions" J. Psychosom. Res. 66, 511-519
Nerurkar, A., Yeh, G., Davis, R.B., Birdee, G., and Phillips, R.S. (2011) "When Conventional Medical Providers Recommend Unconventional Medicine: Results of a National Survey" Arch. Intern. Med. 171, 862-864
Pennisi, E. (1997) "Tracing Molecules That Make the Brain-Body Connection" Science 275, 930-1 [abstract]
McEwen, B.S. (1998) “Protective and Damaging Effects of Stress Mediators.” New Engl. J. Med. 338, 171-179
Miller, G.E. and Cohen, S. (2001) “Psychological Interventions and the Immune System: A Meta-Analytic Review and Critique” Health Psychol. 2-, 47-63 [abstract]
Garssen, B. and Goodkin, K. (1999) “On the Role of Immunological Factors as Mediators Between Psychosocial Factors and Cancer Progression” Psychiatry Res. 85, 51-61 [abstract]
Petticrew, M., Bell, R., and Hunter, D. et al. (2002) “Influence of Psychological Coping on Survival and Recurrence in People With Cancer: Systematic Review” BMJ 325, 1066-1075
Reiche, E.M., Nunes, S.O., and Morimoto, H.K. (2004) “Stress, Depression, the Immune System, and Cancer” Lancet Oncol. 5, 617-625 [abstract]
O’Malley, P.G., Jones, D.L., Feuerstein, I.M., and Taylor, A.J. (2000) “Lack of Correlation Between Psychological Factors and Subclinical Coronary Artery Disease” New Engl. J. Med. 343, 1298-1304
Wassertheil-Smoller, S., Shumaker, S., Ockene, J. et al. (2004) “Depression and Cardiovascular Sequelae in Postmenopausal Women” Arch. Intern. Med. 164, 289-298
Shen, B.-J., Avivi, Y.E., Todaro, J.F. et al. (2008) "Anxiety Characteristics Independently and Prospectively Predict Myocardial Infarction in Men" J. Am. Coll. Cardiol. 51, 113-119
Christakis, N.A. and Allison, P.D. (2006) "Mortality after the Hospitalization of a Spouse" N. Engl. J. Med. 354, 719-730
Wahbeh, H., Elsas, S.-M., and Oken, B.S. (2008) "Mind-Body Interventions: Applications in Neurology" Neurology 70, 2321-2328 [abstract]
Cole, S.W., Hawkley, L.C., Arevalo, J.M. et al. (2007) "Social Regulation of Gene Expression in Human Leukocytes" Genome Biology 8, R189
Mind-body medicine - techniques
National Center for Complementary and Alternative Medicine (2006) "Meditation for Health Purposes" [pdf file]
Ospina, M.B., Bond, K., Karkhaneh, M. et al. (2007) "Meditation Practices for Health: State of the Research" Evid. Rep. Technol. Assess. 155, 1-263
Ricard, M., Lutz, A., and Davidson, R.J. (2014) "Neuroscience Reveals the Secrets of Meditation's Benefits" Scientific American, Nov., 39-45 [preview]
Barker, K.K. (2014) "Mindfulness Meditation: Do-it-Yourself Medicalization of Every Moment" Soc. Sci. Med. 106, 168-176 [abstract]
Ong, J.C., Manber, R., Segal, Z. et al. (2014) "A Randomized Controlled Trial of Mindfulness Meditation for Chronic Insomnia" Sleep 37, 1553-1563
Aucoin, M., Lalonde-Parsi, M.-J., and Cooley, K. (2014) "Mindfulness-Based Therapies in the Treatment of Functional Gastrointestinal Disorders: A Meta-Analysis" Ev. Based Complement. Alternat. Med. 2014, 140724
Castillo-Richmond, A., Schneider, R., Alexander, C.N. et al. (2000) “Effects of Stress Reduction on Carotid Atherosclerosis in Hypertensive African Americans” Stroke 31, 568-573 [Transcendental Meditation]
Sutoo, D. and Akiyama, K. (2004) “Music Improves Dopaminergic Neurotransmission: Demonstration Based on the Effect of Music on Blood Pressure Regulation” Brain Res. 1016, 255-262 [abstract]
Rousch, W. (1997) "Herbert Benson: Mind-Body Maverick Pushes the Envelope" Science 276, 357-359 [abstract]; letter in response by I. Tessman and J. Tessman, Science 278, 561; reply by Benson, Science 278, 1694-1695
Mind-body medicine - critiques
Sampson, W. (2002) “Controversies in Cancer and the Mind: Effects of Psychosocial Support” Semin. Oncol. 29, 595-600 [abstract]
Coyne, J.C., Stefanek, M. and Palmer, S.C. (2007) "Psychotherapy and Survival in Cancer: The Conflict Between Hope and Evidence" Psychol. Bull. 133, 367-394 [abstract]
Coyne, J.C., Pajak, T.F., Harris, J., et al. (2007) "Emotional Well-Being Does Not Predict Survival in Head and Neck Cancer Patients" Cancer 110, 2568-2575
Spirituality
Mitka, M. (1998) “Getting Religion Seen as Help in Being Well” JAMA 280, 1896-1897 [excerpt]
Sloan, R.P., Bagiella, E., VandeCreek, L. and Poulos, P. (2000) “Should Physicians Prescribe Religious Activities?” New Engl. J. Med. 342, 1913-1916 [excerpt]
Groopman, J. (2004) “God at the Bedside” New Engl. J. Med. 350, 1176-1178 [excerpt]
Critiques of the link between spirituality and health:
• Sloan, R.P., Bagiella, E., and Powell, T. (1999) "Religion, Spirituality, and Medicine" Lancet 353, 664-667 [excerpt] (for rebuttal, see Koenig, H.G., Idler, E., Kasl, S. et al. (1999) "Religion, Spirituality, and Medicine: a Rebuttal to Skeptics" Int. J. Psychiatry Med. 29, 123-131 [pdf file])
• Sloan, R.P. and Bagiella, E. (2002) "Claims About Religious Involvement and Health Outcomes" Ann. Behav. Med. 24, 14-21 [abstract].
Blumenthal, J.A., Babyak, M.A., Ironson, G. et al. (2007) "Spirituality, Religion, and Clinical Outcomes in Patients Recovering From an Acute Myocardial Infarction" Psychosom. Med. 69, 501-508 [abstract]
Placebo effects
Dodes, J. (1997) "The Mysterious Placebo" Skeptical Inquirer, Jan./Feb.
Nordenberg, T. (2000) “The Healing Power of Placebos” FDA Consumer, Jan.-Feb., 14-17
Holden, C. (2002) “Drugs and Placebos Look Alike in the Brain” Science 295, 947, 949
Wigley, R. (2007) "When is a Placebo Effect Not an Effect?" Clin. Med. 7, 450-452 [pdf file]
Tilburt, J.C., Emanuel, E.J., Kaptchuk, T.J., Curlin, F.A., and Miller, F.G. (2008) "Prescribing 'Placebo Treatments': Results of a National Survey of US Internists and Rheumatologists" BMJ 337, a1938
Miller, R.G. and Kaptchuk, T.J. (2008) "The Power of Context: Reconceptualizing the Placebo Effect" J. R. Soc. Med. 101, 222-225
Kaptchuk, T.J., Friedlander, E., Kelley, J.M. et al. (2010) "Placebos Without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome" PLoS ONE 5, e15591
Gorski, D. ["Orac"] (2010) "More Dubious Statements About Placebo Effects" Respectful Insolence blog, Dec. 23 [critique of preceding paper]
Finniss, D.G., Kaptchuk, T.J., Miller, F. and Benedetti, F. (2010) "Biological, Clinical, and Ethical Advances of Placebo Effects" Lancet 375, 686-695 [abstract]
Brody, H. and Miller, F.G. (2011) "Lessons From Recent Research About the Placebo Effect - From Art to Science"JAMA 306, 2612-2613 [extract]
Feinberg, C. (2013) "The Placebo Phenomenon" Harvard Magazine, Jan.-Feb., 36-39 [profile of Ted Kaptchuk]
Tavel, M.E. (2014) "The Placebo Effect: the Good, the Bad, and the Ugly" Am. J. Med. 127, 484-488 [abstract]
Wager, T.D., Rilling, J.K, Smith, E.E. et al. (2004) “Placebo-Induced Changes in fMRI in the Anticipation and Experience of Pain” Science 303, 1162-1167 [abstract]
Zubieta, J.-K., Bueller, J.A., Jackson, L.R. et al. (2005) “Placebo Effects Mediated by Endogenous Opioid Activity on μ Opioid Receptors” J. Neurosci. 25, 7754-7762
Kienle, G.S. and Kiene, H. (1997) “The Powerful Placebo Effect: Fact or Fiction?” J. Clin. Epidemiol. 50, 1311-1318 [abstract]
Hróbjartsson, A. and Gøtzsche, P.C. (2001) “Is the Placebo Powerless? An Analysis of Clinical Trials Comparing Placebo With No Treatment” New Engl. J. Med. 344, 1594-1602; letters in response, 345, 1276-1279
Hrobjartsson, A. and Gotzsche, P.C. (2010) "Placebo Interventions for All Clinical Conditions" Cochrane Database Syst Rev. CD003974 [abstract]
Chvetzoff, G. and Tannock, I.F. (2003) “Placebo Effects in Oncology” J. Natl. Cancer Inst. 95, 19-29
Hypnosis
Carroll, R.T. "Hypnosis" The Skeptic's Dictionary
Stalpers, L.J.A., da Costa, H.C., Merbis, M.A. et al. (2005) “Hypnotherapy in Radiotherapy Patients: a Randomized Trial” Int. J. Radiation Oncology Biol. Phys. 61, 499-506 [abstract]
Richardson, J., Smith, J.E., McCall, G., et al. (2007) "Hypnosis for Nausea and Vomiting in Cancer Chemotherapy: a Systematic Review of the Research Evidence" Eur. J. Cancer Care 16, 402-412 [abstract]
Schaefert, R., Klose, P., Moser, G. and Häuser, W. (2014) "Efficacy, Tolerability, and Safety of Hypnosis in Adult Irritable Bowel Syndrome: Systematic Review and Meta-Analysis" Psychosom. Med. 76, 389-398 [abstract]
Biofeedback
Nakao, M., Yano, E., Nomura, S., and Kuboki, T. (2003) “Blood Pressure-Lowering Effects of Biofeedback Treatment in Hypertension: a Meta-Analysis of Randomized Controlled Trials” Hypertens. Res. 26, 37-46 [abstract]
Allen, K.D. (2004) “Using Biofeedback to Make Childhood Headaches Less of a Pain” Pediatr. Ann. 33, 241-245 [abstract]
Autism
Barrett, S. (ed.) “Autism Watch”
FDA Consumer Health Information (2014) "Beware of False or Misleading Claims for Treating Autism"
Hall, S.E. and Riccio, C.A. (2012) "Complementary and Alternative Treatment Use for Autism Spectrum Disorders" Complement. Ther. Clin. Pract. 18, 159-163 [abstract]
Perrin, J.M., Coury, D.L., Hyman, S.L. et al. (2012) "Complementary and Alternative Medicine Use in a Large Pediatric Autism Sample" Pediatrics 130, S77-S82
Hendron, R.L. (2013) "Autism: Biomedical Complementary Treatment Approaches" Child Adolesc. Psychiatric Clin. N. Am. 22, 443-456 [abstract]
Whitehouse, A.J.O. (2013) "Complementary and Alternative Medicine for Autism Spectrum Disorders: Rationale, Safety and Efficacy" J. Paediatr. Child Health 49, E438-E442
Brondino, N., Fusar-Poli, L., Rocchetti, M. et al. (2015) "Complementary and Alternative Therapies for Autism Spectrum Disorder" Ev. Based Complement. Altern. Med. 2015, 258589
Levy, S.E. and Hyman, S.L. (2015) "Complementary and Alternative Medicine Treatments for Children with Autism Spectrum Disorders" Child Adolesc. Psychiatr. Clin. N. Am. 24, 117-143 [abstract]
Owen-Smith, A.A., Bent, S., Lynch, F.L. et al. (2015) "Prevalence and Predictors of Complementary and Alternative Medicine Use in a Large Insured Sample of Children with Autism Spectrum Disorders" Res. Autism Spectr. Disord. 17, 40-51 [abstract]
Sinha, Y., Silove, N., Wheeler, D., and Williams, K. (2006) "Auditory Integration Training and Other Sound Therapies for Autism Spectrum Disorders: a Systematic Review" Arch. Dis. Child. 91, 1018-1022 [abstract]
Barrett, S. (2010) "Boyd Haley Ordered to Stop Illegal Marketing of OSR#1" Autism Watch
Davis, T.N., O'Reilly, M., Kang, S. et al. (2013) "Chelation Treatment for Autism Spectrum Disorders: a Systematic Review" Res. Autism Spectr. Disord. 7, 49-55 [abstract]
Barrett, S. (2015) "A Critical Look at Defeat Autism Now! and the 'DAN! Protocol'" Quackwatch
Stewart, P.A., Hyman, S.L., Schmidt, B.L. et al. (2015) "Dietary Supplementation in Children with Autism Spectrum Disorders: Common, Insufficient, and Excessive" J. Acad. Nutr. Diet. 115, 1237-1248 [abstract]
Sturmey, P. (2005) “Secretin is an Ineffective Treatment for Pervasive Developmental Disabilities: a Review of 15 Double-Blind Randomized Controlled Trials” Res. Dev. Disabil. 26, 87-97 [abstract]
Barrett, S. (2015) “Secretin Found Ineffective for Treating Autism” Quackwatch
Polenick, C.A. and Flora, S.R. (2012) "Sensory Integration and Autism: Science or Pseudoscience?" Skeptic Magazine 17(2), 28-35
Treatment of Other Conditions
van der Watt, G., Laugharne, J. and Janca, A. (2008) "Complementary and Alternative Medicine in the Treatment of Anxiety and Depression" Curr. Opin. Psychiatry 21, 37-42 [abstract]
Chan, E. et al. (2003) “Complementary and Alternative Therapies in Childhood Attention and Hyperactivity Problems” J. Dev. Behav. Pediatr. 24, 4-8 [abstract]
Sarris, J., Kean, J., Schweitzer, I. and Lake, J.(2011) "Complementary Medicines (Herbal and Nutritional Products) in the Treatment of Attention Deficit Hyperactivity Disorder (ADHD): A Systematic Review of the Evidence" Complement. Ther. Med. 19, 216-227
Gillies, D., Sinn, J.K., Lad, S.S., Leach, M.J., and Ross, M.J. (2012) "Polyunsaturated Fatty Acids (PUFA) for Attention Deficit Hyperactivity Disorder (ADHD) in Children and Adolescents" Cochrane Database Syst. Rev., CD007986 [abstract]
Bloch, M.H. and Mulqueen, J. (2014) "Nutritional Supplements for the Treatment of ADHD" Child Adolesc. Psychiatr. Clin. N. Am. 23, 883-897 [abstract]
Nahas, R. and Sheikh, S. (2011) "Complementary and Alternative Medicine for the Treatment of Major Depressive Disorders" Can. Fam. Physician 57, 659-663
Peck, K.R., Smitherman, T.A., and Baskin, S.M. (2015) "Traditional and Alternative Treatments for Depression: Implication for Migraine Management" Headache 55, 351-355 [abstract]
Mental health - unconventional practices
Barrett, S. (2003) “Mental Help: Procedures to Avoid” Quackwatch
Laures, J.S. and Shisler, R.J. (2004) “Complementary and Alternative Medical Approaches to Treating Adult Neurogenic Communication Disorders: a Review” Disabil. Rehabil. 26, 315-325 [abstract]
Koocher, G.P., McMann, M.R., Stout, A.O., and Norcross, J.C. (2015) "Discredited Assessment and Treatment Methods Used with Children and Adolescents: A Delphi Poll" J. Clin. Child Adolesc. Psychol. 44, 722-729 [abstract]
Murray, L.L. and Kim, H.-Y. (2004) “A Review of Select Alternative Treatment Approaches for Acquired Neurogenic Disorders: Relaxation Therapy and Acupuncture” Semin. Speech Lang. 25, 133-149 [abstract]
Mercer, J. (2013) "Attachment Therapies and Associated Parenting Techniques" Institute for Science in Medicine White Paper [pdf file]
Federal Trade Commission (2000) “Marketers of Various Dietary Supplements Settle FTC Charges That They Made Unsubstantiated Claims That Their Products Could Cure ADHD” Press release, May 11
Barrett, S. (2009) "A Skeptical Look at Linda Schaumleffel's 'Power Brain Fitness' Program" Quackwatch
Max Planck Institute for Human Development and Stanford Center on Longevity (2014) "A Consensus on the Brain Training Industry from The Scientific Community". For a response, see: "Cognitive Training Data"
Leshin, L. (1998) "Nutritional Supplements for Down Syndrome: A Highly Questionable Approach" Quackwatch
Lilienfeld, S.C., Marshall, J., Todd, J.T. and Shane, H.C. (2014) "The Persistence of Fad Interventions in the Face of Negative Scientific Evidence: Facilitated Communication for Autism as a Case Example" Ev.-Based Commun. Assess. Intervention 8, 62-101
Novella, S. (1996, revised 2008) “Psychomotor Patterning” Connecticut Skeptic 1(4)
Hall, H. (2008) "SPECT Scans at the Amen Clinic - A New Phrenology?" Science-Based Medicine, April 8
Hall, H. (2013) "Dr. Amen's Love Affair with SPECT Scans" Science-Based Medicine, Mar. 19
Gaudiano, B.A. and Herbert, J.D. (2000) “Can We Really Tap Our Problems Away? A Critical Analysis of Thought Field Therapy” Skeptical Inquirer 24(4)
Pignotti, M. (2007) "Thought Field Therapy: A Former Insider's Experience" Res. Soc. Work Pract. 17, 392-407 [abstract]
Barglow, P. (2008) "Corporate Self Interest and Vagus Nerve Stimulation for Depression" Skeptical Inquirer 32, Sept./Oct., 35-40; response from G. Parker (Cyberonics, Inc.) and follow-up from Barglow, Skeptical Inquirer 33, Jan./Feb., 60-62