In fact, the research team-psychologists from Ohio State University in the US-had already been tantalized by an earlier study that had demonstrated something similar. In that study of 227 women recently diagnosed with breast cancer, the researchers discovered that psychological therapies could reduce the rate of recurrence.
So, using the same data, the scientists now wanted to take their premise a stage further. Could psychological therapy help the 62 women whose cancer had returned to live longer with the disease?
Not surprisingly, all the women were feeling distressed that their cancer had come back. However, it was observed that the immune-system responses rose rapidly in those women who had undergone psychological therapy and, by the end of the 12-month follow-up period, most of them were still alive (Clin Cancer Res, 2010; 16: 3270-8).
Only a few weeks later, a team of researchers at Nottingham University in the UK published their own study, which pointed to a similar conclusion: our mind-and especially our sense of mental well-being-directly affects the healing process.
In this UK study, the subjects were 93 diabetic adults with foot ulcers, complications that can often lead to infection, gangrene and, ultimately, amputation. The researchers didn't intervene in the healing process, but merely monitored the patients' progress over a 24-week period, at the end of which the ulcers should have healed. Interestingly, the patients whose ulcers had not healed also recorded higher levels of anxiety and depression; in fact, in depress-ed patients, the size of their ulcers hadn't even noticeably shrunk (Diabetologia, 2010; 53: 1590-8).
Although these results may be perplexing, they are not surprising. These studies are simply the latest in a long tradition, starting in the 1960s, demonstrating that our mind-and especially our mood states, thoughts, feelings and beliefs-are every bit as powerful as a prescription drug.
In fact, it was as early as 1926 that researchers began investiga-ting the mind's ability to switch on the immune system in a Pavlovian-type response (Annales de l'Institut Pasteur, 1926; 40: 893-900), although it was another 40 years before systematic research into a mind- body connection finally got under-way. In the 1960s, psychiatrist George Solomon monitored patients who were suffering from rheumatoid arthritis, and noted that their condition worsened whenever they were depressed.
Although his work was largely ignored, he continued his research and, in the 1980s, shifted his focus to long-term acquired immuno-deficiency syndrome (AIDS) surviv-ors, discovering that their long-evity was due, in part, to psychol-ogical factors, such as maintaining a positive outlook.
This work also brought him into contact with Norman Cousins, a journalist who became a one-man laboratory when he was diagnosed with a chronic heart problem. Cousins found that high doses of vitamin C along with a positive attitude-and especially lots of laughter while he watched Marx Brothers' films-kept his heart problem in check. Cousins eventually died in 1990 from heart failure, but this was 36 years after doctors had diagnosed the condition.
Solomon's research attracted the attention of psychologist Robert Ader, at the University of Rochester School of Medicine and Dentistry, who came up with the cumbersome title of psychoneuro-immunology (PNI) to classify the growing evidence of a mind-body connection.
Recently, the World Health Organization (WHO) has also recognized the importance of the mind over the body, and has cited depression as one of 10 factors that can contribute to disease.
Since the time of Solomon's pioneering work, research into the body-mind connection has been gaining momentum. What follows is a review some of the latest discoveries of the mind's abilities to both heal and cause, or worsen, disease.
The mind as healer
A positive mental attitude is good for the heart. One study, which tracked 1739 adults over a 10-year period, found that a positive outlook combined with only rare lapses into depression or anxiety was a powerful protective agent against chronic heart disease and heart attack (Eur Heart J, 2010; doi: 10.1093/eurheartj/ehp603).
The power of the mind can also be used to reduce pain. Guided imagery-a form of meditation-and relaxation was able to dram-atically reduce pain levels in 30 osteoarthritis sufferers during a four-month programme. The par-ticipants were also able to lower their dosages of pain-relieving medication (Pain Manag Nurs, 2010; 11: 56-65).
A self-awareness programme, which included acknowledging emotions, helped a group of 24 fibromyalgia sufferers. At the end of a three-week programme, those who participated reported improve-ments in pain, tenderness and physical function for at least six months following the exercises, while none of those in the control group reported any improvements whatsoever (J Gen Intern Med, 2010; doi: 10.1007/s11606-010-1418-6).
Another form of mental discipline-so-called 'mindfulness meditation'-helped IBS (irritable bowel syndrome) sufferers. A group of 34 patients participated in a 10-week programme of mindfulness meditation, following which they reported an average reduction in symptoms of 41 per cent. Also, half the patients showed significant improvements in IBS symptoms, benefits that continued throughout the six-month follow-up (J Behav Ther Exp Psychiatry, 2010; 41: 185-90).
Mindfulness meditation can be a powerful pain reliever even when it's tried for just a few days. In one experiment, participants practised mindfulness meditation for 20 minutes a day for three days, after which they were subjected to daily painful electrical shocks. Every day, the participants reported that they were better able to cope with the pain and anxiety associated with the shocks (J Pain, 2010; 11: 199-209).
Perhaps the most impressive results from a course of mindfulness meditation were reported when the technique was tested on a group of HIV-positive adults. Half the group participated in an eight-week meditation programme, with the aim of reducing stress levels, while the other half attended a seminar on the disease. During the eight-week period, the seminar attendees noted that their CD4+ T-lymphocyte levels continue to fall, as is expected with HIV infection, whereas the meditation group's levels remained stable (Brain Behav Immun, 2009; 23: 184-8).
Gerda Boyesen's well-document-ed technique-dubbed 'biodynamic body psychotherapy' (BBP)-is another non-drug intervention that harnesses the healing abilities of the mind. When researchers at the Ita Wegman Clinic in Graz, Austria, reviewed the progress of 13,500 BBP patients, who had been treated at centres in the UK and Germany between 1985 and 2005, they found that BBP was an effective means of treating schizophrenia, anxiety and poor mental health, as well as supporting patients who had received hospital care. Overall, they concluded that the therapy was of enormous therapeutic value, and came with no side-effects (Int J Adolesc Med Health, 2009; 21: 281-97).
Researchers at the Sapienza University in Rome tested Norman Cousins' laughter therapy, and concluded that it can help to elevate the mood of depressed patients. Not surprisingly, they found that it has a direct influence on mood, and could help to reverse negativity following a stressful event. In fact, laughter has a direct bearing on the brain by altering brain-chemical-related functions, they found (Riv Psichiatr, 2010; 45: 1-6).
Laughter has proved to be the best medicine when it comes to boosting the immune system, too. In one study, 33 women were shown either humorous or factual videos. It was then found that the humour group showed lower stress levels and improved immune function, including higher levels of natural-killer (NK)-cell activity, a type of lymphocyte in the immune system that combats disease (Altern Ther Health Med, 2003; 9: 38-45).
Skin conditions appear to be especially sensitive to emotions and feelings. In a review of two studies of chronic urticaria (hives), the researchers at Auckland City Hospital in New Zealand noted that clinicians are reluctant to entertain the idea of a body-mind connection with skin diseases. Yet, when they do-and are able to sympathize with the patients' 'stories', as the researchers call it-the condition diminishes (Postgrad Med J, 2010; 86: 365-70).
The mind that aids sickness
Our thoughts and feelings do not always help to fight against disease. A negative mental attitude, or stress and depression, can encour-age disease and prolong its duration. A pair of researchers at Ohio State University noted that stress plays a leading role in the development of cancer (Drugs Today, 2009; 45: 115-26).
Similarly, scientists at Londrina University in Brazil consider that chronic stress and depression contribute to the development and progression of some cancers, as these states suppress the immune system. If this is so, they say, then behavioural strategies and psychol-ogical therapies may have as big a part to play in fighting cancer as do chemotherapy and radiotherapy (Int Rev Psychiatry, 2005; 17: 515-27).
A poorly functioning immune system that is further compromised by stress or depression can also increase the risk of multiple sclerosis (MS), suggesting that these could be major causes of the disease (Immunol Allergy Clin North Am, 2009; 29: 309-20).
Heart disease appears to be the health condition that is most closely allied to depression and negative thoughts, as has been demonstrated by a number of studies. In one nine-year study of 20,000 people, those who were lonely and socially isolated were two to three times more likely to die of heart disease than those who felt socially connected (Am J Epidemiol, 1979; 109: 186-204).
Depression as a consequence of heart attack is also dangerous and has a direct impact on the survival rate. In such cases, depression has an effect that is equivalent to left ventricular dysfunction and a history of previous heart attacks (JAMA, 1993; 270: 1819-25).
In another study of 1017 heart-attack patients living in the San Francisco area, those survivors who were chronically depressed were 50-per-cent more likely to suffer a second heart attack (JAMA, 2008; 300: 2379-88).
People who feel guilt and shame are also affecting the healthy functioning of their immune system. In one experiment involving 49 healthy participants, 31 of them were asked to write about traumatic experiences for which they blamed themselves, while the rest were told to write about a neutral experience. Those in the self-blame group exhibited raised levels of cytokines, proteins released by immune-system cells that are known to lead to inflammation (Psychosom Med, 2004; 66: 124-31).
In addition, it may be equally as unhealthy not to express your thoughts. In one experiment, some of the participants were encouraged to suppress the thoughts that were associated with an emotional experience; blood samples were taken both before and after the exercise. Those who had suppressed their thoughts showed significant decreases in the type of lympho-cytes that fight infection (J Pers Soc Psychol, 1998; 75: 1264-72).
The placebo effect
Having a generally pessimistic attitude also suppresses the immune system. In a study of 36 HIV-positive women co-infected with human papillomavirus (HPV), it was found that pessimism and negative life experiences resulted in a compromised immune system and, in particular, low levels of the NK cells that protect the body against disease. The researchers, from the University of Miami, concluded that such women are at greater risk of developing cervical cancer later in life (Psychosom Med, 1998; 60: 714-22).
Even mothers who are sad can pass on ill health to their newborn babies. Clinical depression and anxiety during pregnancy can affect the size of the baby and increase the child's chances of dying in infancy. Researchers at the Karo-linksa Institute in Sweden made the discovery when they assessed the mental health of 720 women living in rural Bangladesh who were in their third trimester of pregnancy. The researchers believe that depression in the mother is the primary cause of infant mortality and poor child health, and could be as significant as poverty, malnutri-tion and low socioeconomic status (BMC Public Health, 2010; 10: 515).
Stress and depression have a major impact on rheumatoid arthritis and juvenile idiopathic arthritis, both of which are chronic inflammatory diseases. Scientists at Regensburg University in Germany have demonstrated that stress releases hormonal and neuronal factors that can worsen the symptoms of rheumatoid arthritis, as first observed by Solomon in the 1960s (Med Klin [Munich], 2005; 100: 794-803).
In fact, a 10-year study of 388 depressed people (and 404 matched controls) demonstrated that the chances of developing any disease are two-thirds greater in those who are depressed (J Affect Disord, 2010; 123: 222-9).
Researchers at Brigham Young University in Utah and University of North Carolina at Chapel Hill arrived at a similar conclusion after analyzing 148 studies that meas-ured the frequency of human interactions with overall health over a seven-year period. They estimated that feelings of isolation are the equivalent of smoking 15 cigarettes a day or being an alcoholic, and are twice as harmful as obesity. Indeed, the researchers describe it as being one of the biggest-and yet generally unrecognized-causes of all diseases.
Conversely, having social connec-tions-friends, family, neighbours and social groups-can increase the chances of survival by 50 per cent. However, the researchers suspect that this figure is somewhat con-servative and that the benefits of social interaction could well have a far greater protective effect (PLoS Med, 2010; 7: e1000316).
Researchers at the University of California at Los Angeles have plotted the impact of social interactions on neural pathways. In a 10-day study, 30 participants who had frequent social interactions were found to have lower cortisol (stess hormone) activity when faced with a stressful situation, and regions of the brain associated with distress when socially isolated did not react in the usual way. This suggests that just the memory of relationships was a sufficient safe-guard when the person was alone (Neuroimage, 2007; 35: 1601-12).
The best-known form of mind-over-matter medicine is the placebo effect. The placebo is commonly used in double-blind drug trials, when participants are not to know whether they are being given a real drug or a sugar pill (placebo). However, patients often don't realize that this form of duping is also widespread in general medical practice.
In one survey, 60 per cent of doctors admitted to prescribing a placebo, and more than half these doctors found them to be effective (BMJ, 2004; 329: 944-6). A more recent review of the literature suggests that the practice has increased. Researchers at the University of Zurich in Switzerland estimate that up to 80 per cent of all physicians have used a placebo-such as a saline injection-while other estimates reckon that every nurse has resorted to a placebo at some time or another. Yet, these figures could be even higher if 'impure' placebo use-the use of inappro-priate medicines such as an anti-biotic for a viral complaint-is also included (BMC Med, 2010; 8: 15).
In a survey of 233 general practitioners, 72 per cent admitted that they often administered a placebo. Of these, 64 per cent admitted to having described the placebo to the patient as a "drug
or therapy" (BMC Health Serv Res, 2009; 9: 144).
However, placebo therapy is not always just a case of wishful thinking on the part of the patient. Often, the thoughts generated by the placebo have a physical effect, as has been demonstrated by experienced meditators.
Mind changes matter
Magnetic resonance imaging (MRI) scans of practitioners of Zen Buddhism while meditating reveal a thicker brain cortex, rendering them less susceptible to pain. In particular, researchers noted that these meditators have different patterns in three areas of the brain that are associated with feelings of pain and discomfort. Indeed, according to researchers at the University of Montreal, the more experienced the meditator, the greater the amount of gray matter (Emotion, 2010; 10: 43-53).
But even short-term meditation has an effect on the brain. After just three hours of training, meditators achieved changes to the anterior cingulate cortex (ACC), the region of the brain that is associated with cognitive and emotional tasks, and self-regulation. Researchers at the Dalian University of Technology in China suggest that meditation might reduce-or even prevent-mental problems and disorders (Proc Natl Acad Sci USA, 2010; Epub ahead of print).
Diabetics who practise yoga-nidra-('yoga sleep', a specific form of relaxation-were able to lower their blood sugar levels after using the technique for 30 minutes a day for 90 days.
In this study, 20 patients with type 2 diabetes who practised yoga-nidra were compared with 21 others who were taking oral antidiabetic medications (Indian J Physiol Pharmacol, 2009; 53: 97-101).
Chanting meditation alters brain functioning, Alzheimer researchers have discovered. In a small study
of 11 subjects, brain function and cerebral blood flow were altered significantly both during and after the chanting (Nucl Med Commun, 2009; 30: 956-61).
So what's going on?
Research has demonstrated that our thoughts-whether they are mood states, beliefs, emotions, anxiety or depression-can directly affect the immune system. Specifically, thoughts appear to be at the heart of a complex interplay between the immune system, the endocrine system, and the central and peripheral nervous systems. Neurotransmitters, hormones and neuropeptides act as the transport mechanisms between these systems, and 'deliver' the negative and positive thoughts to the various systems, especially to immune cells. In what appears to be a symbiotic interrelationship, cells communi-cate with nerve tissues through the secretion of cytokines (Dermatol Ther, 2008; 21: 22-31).
In other words, the nervous and immune systems use a common chemical language-comprising peptide and non-peptide neuro-transmitters and cytokines-to 'talk' to each other.
But how does the brain impact on the central nervous system in the first place? Researchers at the Veterans Affairs Medical Center in St Louis, MO, believe that the physical and the physiological meet at the blood-brain barrier (BBB), the gatekeeper between the im-mune and central nervous systems. They suggest that the BBB could be altered by 'neuroimmune' events, which can include psychological trauma (Immunol Allergy Clin North Am, 2009; 29: 223-8).
Professor J. Edwin Blalock, at the University of Alabama in Birming-ham, believes that the complicated process is more easily understood if we think of the immune and nervous systems as the body's 'sixth sense' (see box, page 11).
However, although these theories all offer a physical explanation, they still do not address the issue of what it is about our thoughts that allow them to interfere with our bodily systems.
The waters are made murkier still by the possibility of prayer as a therapeutic force. Although prayer was discredited in a 2006 study by Herbert Benson and his team at Harvard Medical School (Am Heart J, 2006; 151: 934-42), subsequent studies have suggested that prayer by a third party can influence us, our behaviour and our health (see box, page 12). If these latter studies are true, then other people's thoughts are also affecting us, suggesting a connection through a field effect.
Behavioural kinesiologist Dr John Diamond offers a more meta-physical explanation with his model of Life Energy, the innate healing power that we all possess that is activated or suppressed, depending on our ability to feel connected to life and love-especially the love of our mother (see box, page 11).
Ultimately, we are left with more questions than answers, albeit from a smarter place. As physicist Arthur Eddington once said, "Something unknown is doing we don't know what". Holistic healer Dr Larry Dossey put the same thought in another way when he said, "Our ignorance about healing vastly exceeds our understanding" (Explore [NY], 2008; 4: 341-52).
Yet, although we don't know, it's certainly clear that the current biological and medical models are incomplete, and that medicine's tools are simplistic and sometimes brutish responses to something that is complex and intangible. It also suggests that disease isn't just something that happens to us, but a process in which we play a pivotal role.
Does the body have a sixth sense?
One explanation for the mind-body connection is offered by Professor J. Edwin Blalock, of the University of Alabama, who argues that the body has a sixth sense. In addition to taste, smell, touch, sight and hearing, he believes that the complex interplay between the nervous and immune systems constitutes a sixth sense.
Blalock believes that his theory-which he first posited in 1984-can even explain the placebo effect in that molecules are released when a sugar pill is taken, triggering a very low-level reaction in the brain (hypothalamus). "It does not seem particularly farfetched that an individual's personality and outlook might have a real and explainable impact on their susceptibility to health," he said (J Intern Med, 2005; 257: 126-38).
Nevertheless, the sixth-sense theory still does not fully explain how a thought could cause a chemical reaction in the first place.
An alternative theory, suggested by holistic healer Dr John Diamond, is that our Life Energy, as he describes the body's innate healing ability, directly influences our health. Our Life Energy can be activated or suppressed by our thoughts and emotions, and especially by our sense of 'connectedness' to the world and of feeling loved. The key relationship for Diamond is the one between our mother and ourselves: if we believe our mother did not love us, then we can neither feel loved in the world nor properly express love.
This primary relationship-among others-determines the level of our Life Energy, and our ability to stay well and combat disease.
Whether or not this is true, Dr Diamond's holistic model at least explains how the mind and body could interconnect and influence each other. See his book Your Body Doesn't Lie (New York: Time Warner, 1989) for a more complete description of his work and methodology.
Does prayer work?
It is difficult enough to understand how our thoughts can affect our body, so it's even more incomprehensible how other people's thinking can influence our health and behaviour.
For thousands of years, people of faith have prayed for others, but it's only been in the last one hundred years or so that the phenomenon has been scientifically tested. Although prayer studies are infrequent, several recent ones suggest that prayer is an effective healing force.
In one study carried out in Mozambique-where prayer is still one of the most popular alternatives to Western medicine-researchers assessed the improvement in 24 subjects who had eyesight and hearing problems. The research team-from the US and South Africa-reported that all of the participants had experienced "significant" improvements in their hearing and sight after prayer that were well beyond changes achievable through either hypnosis or suggestion (South Med J, 2010; 103: 864-9).
Praying for someone with a drinking problem also appears to work. In a study of 1758 people with various degrees of alcohol dependence, researchers at Florida State University found a direct correlation between prayer frequency and alcohol consumption. Overall, prayer halved alcohol consumption over a four-week period (Psychol Addict Behav, 2010; 24: 209-19).
Prayer can even reduce your partner's infidelity. In a study of 375 people, prayer reduced infidelity over a six-week period. In a subgroup of 83 participants, prayer was more effective than daily positive thoughts about the partner (J Pers Soc Psychol, 2010, August 16; online at www.unboundmedicine.com/ medline/ebm/record/20718545/abstract/Faith_and_unfaithfulness:_Can_praying_for_your_partner_reduce_infidelity).
But if prayer works, how does it work?
A study by Jeanne Achterberg takes us a little closer to understanding. She recruited 11 healers in Hawaii, who described their methodology variously as sending prayers, intention and wishing the best for their subjects. Eleven 'recipients' were then scanned by functional magnetic resonance imaging (fMRI) while isolated from any type of contact with the healer. On their part, the healers sent healing thoughts at random two-minute intervals of which their targets were unaware.
On the scans, areas of the recipients' brains were activated exactly at the precise moment the healers were sending prayers. Achterberg and her team put the chances of such an exact correlation between prayer and brain response at 10,000 to 1 (J Altern Complement Med, 2005; 11: 965-71).
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