Thinking yourself well
Our thoughts, feelings and emotions play a big part in our health and whether we get ill. They can even change physical matter, as cutting-edge research is discovering
The researchers were perplexed by the conclusions that the data from their year-long study were telling them: the minds of the patients they were monitoring had a profound influence on their breast cancer. Indeed, the thoughts and attitudes of these individuals were more powerful than their tumours.
The research team of psychologists at Ohio State University in the US had already been tantalized by an earlier study demonstrating 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 push the theory a little 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. But it was noted that the immune system responses rose rapidly in the women who had undergone psychological therapy and, by the end of the 12-month follow-up period, most of them were
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 wellbeing-directly affects the healing process.
The researchers had studied 93 diabetic adults with foot ulcers, complications that can often lead to infection, gangrene and, ultimately, amputation. The researchers monitored the patients' progress over a 24-week period, at the end of which the ulcers should have healed. The patients whose ulcers had not healed recorded higher levels of anxiety and depression; in fact, in depressed patients, the size of their ulcers hadn't even noticeably shrunk.2
Although these results may be perplexing, they are not surprising.
They are the latest in a long tradition starting in the 1960s, demonstrating that our mind-and especially our moods, thoughts, feelings and beliefs-are every bit as powerful as a prescription drug.
Starting with Pavlov
In fact, it was as early as 1926 that researchers began investigating the mind's ability to switch on the immune system as a Pavlovian-type response, although it was another 40 years before systematic research into a mind-body connection actually got underway. 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 immunodeficiency syndrome (AIDS) survivors, discovering that their longevity was due in part to psychological factors like maintaining a positive outlook.
This work also brought him into contact with Norman Cousins, a journalist who became a one-man laboratory when diagnosed with a chronic heart problem. Cousins found that high doses of vitamin C along with a positive attitude-and especially laughing at old 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 psychoneuroimmunology (PNI) to classify the growing evidence of a mind-body connection.
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.
The placebo effect
The best-known form of mind-over-matter medicine is the placebo effect. Placebos are commonly used in double-blind drug trials, when participants don't know whether they're being given a real drug or a sugar pill (placebo). But patients often don't realize that this form of duping is also widespread in general medical practice.
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 one time or another. These figures could be even higher if 'impure' placebo use-the use of inappropriate medicines such as an antibiotic for a viral complaint-is also included.1
In a survey of 233 general practitioners, 72 per cent admitted to often administering a placebo and more than half described the placebo to the patient as a "drug or therapy."2
The placebo effect suggests that our bodies do not distinguish between a chemical process and the thought of a chemical process. Indeed, an analysis of 46,000 heart patients, half of whom were taking a placebo, made the astonishing discovery that patients taking a placebo fared as well as those taking the heart drug. The only factor determining survival seemed to be a belief that the therapy will work and a willingness to follow it religiously.
Those who stuck to doctor's orders and took their drug three times a day fared equally well whether they were taking a drug or just a sugar pill. Patients who tended not to survive were those who had been lax with their regimen, regardless of whether they had been given a placebo or an actual drug.3
But this belief can extend to operations too. Dr Bruce Moseley, a specialist in orthopaedics at the Baylor College of Medicine in Houston, tested the power of a surgical placebo by recruiting 180 patients with severe osteoarthritis of the knee and dividing them into three groups.
Two-thirds were given either arthroscopic lavage (which washes away degenerative tissue and debris with the aid of a little viewing tube) or another form of debridement (removal of fronds of joint material by sucking it out with a tiny vacuum system). The third group was given a sham operation: patients were surgically prepared, placed under anaesthesia and wheeled into the operating room. Incisions were made in their knees, but no actual procedure was carried out.
Over the next two years, during which time none of the patients knew who had received the real operations and who had received the sham treatment, all three groups reported moderate improvement in pain and function. In fact, the placebo group reported better results than some who had received the actual operation.4 The mental expectation of healing was enough to marshal the body's healing mechanisms. The intention, brought about by the expectation of a successful operation, produced the physical improvements.
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Mind changes matter
And it's not just a placebo effect-where you may just think you're feeling better. Magnetic resonance imaging (MRI) scans of practitioners of Zen Buddhism while meditating reveal a thicker brain cortex, making them less susceptible to pain. These meditators also show different patterns in three areas of the brain associated with feelings of pain and discomfort-and the more experienced the meditator, the greater the amount of gray matter, the researchers found.3
But even short-term meditation has an effect on the brain. After just three hours of training, meditators altered their anterior cingulate cortex (ACC), the region of the brain associated with cognitive and emotional tasks and self-regulation. Researchers at the Dalian University of Technology in China, working with scientists in Oregon and Maryland, suggest that meditation might reduce-or even prevent-mental problems and disorders.4
Diabetics who practise yoga nidra-'yoga sleep', a specific form of relaxation-were also better able to reduce their blood sugar levels and other diabetes symptoms after using the technique for 30 minutes a day for 90 days. The experiment compared two groups of patients with type 2 diabetes: yoga nidra adepts vs those using only oral antidiabetic medications.5
Chanting meditation alters brain functioning, Alzheimer researchers have discovered. In a small study of 11 subjects, brain function and cerebral blood flow were both significantly altered during and after chanting.6
One clue as to why the mind can galvanize healing comes from sports.
Athletes of all varieties now routinely employ the power of thought to enhance their level of performance and consistency, and 'mental rehearsal' is now touted in the scientific literature and even the National Academy of Sciences as the decisive element separating the elite sportsperson from the second-division player.1
Research with electroencephalograms (EEGs) has shown that the electrical activity produced by the brain is identical whether we are thinking about doing something or actually doing it. In weightlifters, for instance, EEG patterns in the brain that would be activated to produce the actual motor skills are activated while the skill is simply being simulated mentally.2 Just the thought is enough to produce the neural instructions to carry out the physical act.
Other brain research with electromyography (EMG), which offers a real-time snapshot of the brain's instructions to the body by recording electrical impulses sent from motor neurons to specific muscles, confirms that the brain doesn't differentiate between thought and action.
When a group of athletes including rowers and waterskiers were wired to EMG equipment while carrying out mental rehearsals of their performances, the electrical impulses heading to their muscles were just the same as the ones they used to make turns and jumps when actually performing.3 The brain sent the same instructions to the body whether the skiers were simply thinking of a particular movement or actually doing it.
Thought seems to produce the same mental instructions as action.
When an athlete performs, the nerves that signal to the muscles along a particular pathway are stimulated and the chemicals that have been produced remain there for a short period. Any future stimulation along the same pathway is made easier by the residual effects of the earlier connection.
Scientists have posited that visualization, such as that used in mental rehearsal or visualization, might have a similar effect, creating the neural patterns necessary for the real thing. It is not unlike a train track laid down through wild, inhospitable country.
Future performances improve because your brain already knows the route and follows the track already laid down.
Mental intention has also been shown to produce actual physiological changes. Guang Yue, an exercise psychologist at the Department of Exercise Science at the University of Iowa, carried out research comparing participants who went to the gym with those who carried out a virtual workout in their heads.
Those who regularly visited the gym were able to increase their muscle strength by 30 per cent. But even those who remained in their armchairs and ran through a mental rehearsal of the weight-training in their minds were able to increase their muscle power by 22 per cent.
Volunteers between 20 and 35 years of age imagined flexing their left hands as hard as they could during daily training sessions carried out five times a week for four weeks.
After ensuring that the participants were not doing any actual exercise, including tensing their hand muscles, the researchers discovered an astonishing 10 per cent increase in muscle size and strength after just a few weeks of imagining flexion, an advantage that remained for three months after the mental training stopped.4
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Praying for others
It is difficult enough to understand how our thoughts can affect our body, so it's even more incomprehensible how other people's thoughts 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 hundred years or so that the phenomenon has been scientifically assessed. Although intercessory prayer was discredited in a 2006 study by Herbert Benson and his team at Harvard Medical School,7 subsequent studies have suggested that prayer by a third party can influence us, our behaviour and our health.
If these latter studies are true, then other people's thoughts are affecting
us, suggesting a connection through a field effect.
In one study carried out in Mozambique-where prayer is still one of the most popular alternatives to Western medicine-researchers assessed the status of 24 subjects who had seeing and hearing problems. The research team from the US and South Africa reported that all of the participants experienced "significant" improvements in their hearing and sight after prayer that were well beyond changes achievable through either hypnosis or suggestion.8
Praying by those who have a drinking problem also seems to work. In a study of 1,758 people with various degrees of alcohol dependence, researchers at Florida State University found a direct correlation between prayer frequency and alcohol consumption. Overall, those who prayed every day halved their alcohol consumption over a four-week period compared with a control group.9
Prayer might even reduce your partner's infidelity. In a study of 375 people, prayer reduced cheating on their partner over a six-week period. In a subgroup of 83 participants, prayer was more effective than daily positive thoughts about the errant partner.10
But if prayer works, how does it work?
A study by the late Jeanne Achterberg takes us a little closer to understanding. She recruited 11 healers in Hawaii who used methods including 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, although the recipients never knew when this was happening.
According to the scans, areas of the recipients' brains were activated at exactly the 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 one.11
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 seem to lie at the heart of a complex interplay between the immune system, endocrine system, and central and peripheral nervous systems.
Neurotransmitters, hormones and neuropeptides act as transport mechanisms across these systems and 'deliver' negative and positive thoughts to the various systems, especially to immune cells. In what looks like a symbiotic interrelationship, immune cells communicate with nerve tissues through the secretion of various cytokines.12
In other words, the nervous and immune systems use a common chemical language-comprising peptide and non-peptide neurotransmitters 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, Missouri, believe that the physical and the physiological meet at the blood-brain barrier (BBB), the gatekeeper between the immune and central nervous systems. They suggest that the BBB may be altered by 'neuroimmune' events, which can include psychological trauma.13
Professor J. Edwin Blalock, at the University of Alabama in Birmingham, believes that the complicated process is more easily understood if we think of the immune and nervous systems as the body's 'sixth sense'.
In addition to taste, smell, touch, sight and hearing, he believes that the complex interplay between the nervous and immune systems can be considered an additional 'sense'.
Blalock believes that his theory-which he put forward in 1984-can even explain the placebo effect, where molecules are released even when just 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.14
But the sixth-sense theory still doesn't fully explain how a thought can cause a chemical reaction in the first place. While these theories all offer physical explanations, they still fail to address the issue of what it is about our thoughts that allow them to interfere with our bodily systems. Some clues as to how this all works come from the world of sport (see box, right).
Ultimately, we are left with more questions than answers, albeit from a smarter place. As physicist Sir 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".
Yet, although we still don't know, it's certainly clear that the current biological and medical models are incomplete, and that medicine's tools are often simplistic and sometimes brutish responses to something 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.
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The mind as healer
Mounting evidence shows that our thoughts have the power to both heal us and make us sick
A positive mental attitude is good for the heart. One study, which tracked 1,739 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 attacks.1
The power of the mind can also be used to reduce pain. Guided imagery-a form of meditation-and relaxation were able to dramatically reduce pain levels in 30 osteoarthritis sufferers during a four-month programme. The participants were also able to reduce their use of pain-relieving medication.2
A self-awareness programme that included acknowledging emotions helped a group of 24 fibromyalgia sufferers. At the end of a three-week programme, those who participated reported improvement in pain, tenderness and physical function for at least six months following the exercises, while none of those in the control group reported any improvement whatsoever.3
Mindfulness meditation, where the meditator is quietly aware of all sensations and thoughts, helped IBS (irritable bowel syndrome) sufferers. After 34 patients participated in a 10-week programme of mindfulness meditation, they reported an average reduction in the frequency of symptoms of 41 per cent. Also, half the patients showed significant improvement in the severity of their IBS symptoms, benefits that continued throughout the six-month follow-up.4
The technique 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 just three days, after which they were subjected to daily painful electrical shocks. Every day, the participants reported they were better able to cope with the pain and anxiety associated with the shocks.5
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 aimed at reducing their stress, while the other half attended a seminar on the disease. Over the eight-week period, the seminar attendees noted that their CD4+ T-lymphocyte counts continued to fall, as expected with HIV infection, while the meditating group's levels remained stable.6
Gerda Boyesen's talking therapy, 'biodynamic body psychotherapy' (BBP), is another non-drug intervention that harnesses the healing abilities of the mind. When researchers at the Eta Wegman Academy in Graz, Austria, reviewed the progress of 13,500 BBP patients treated at centres in the UK and Germany between 1985 and 2005, they found that BBP was effective for treating schizophrenia, anxiety and poor mental health, as well as a good support for patients receiving hospital care. Overall, they concluded that the therapy was of enormous therapeutic value and also had no side-effects.7
When researchers at the Sapienza University of Rome tested Norman Cousins' laughter therapy, they concluded that it does indeed help elevate the mood of depressed patients. Not surprisingly, they found it had a direct influence on mood and could help reverse negativity following a stressful event. In fact, they found that laughter has a direct bearing on the brain by altering brain-chemical-related functions.8
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 funny or factual videos. It was then found that the humour group showed lower stress levels and better immune function, including higher levels of natural-killer (NK) cell activity, a type of lymphocyte in the immune system that combats disease.9
Skin conditions also seem to be especially sensitive to emotions and feelings. In a review of two studies of chronic urticaria (hives), 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 patients' skin condition improves.10
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The mind that makes us sick
Our thoughts and feelings don't always help in the fight against disease. A negative mental attitude or stress and depression can encourage 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.1
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 psychological therapies may have as big a part to play in fighting cancer as chemotherapy and radiotherapy.2
A poorly functioning immune system further compromised by stress and depression can also increase the risk of multiple sclerosis (MS), suggesting that these emotional states might even be major causes of the disease.3
Heart disease is the health condition that seems most closely allied to depression and negative thoughts. In one nine-year study of nearly 7,000 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.4
Depression after a heart attack can have a direct impact on survival rates-an effect equivalent to having left ventricular dysfunction and a history of previous heart attacks.5 In one study of 1,017 heart attack patients, those survivors who were chronically depressed were 50 per cent more likely to suffer a second heart attack.6
People who feel guilt and shame are 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 showed raised levels of cytokines, the proteins released by immune cells known to cause inflammation.7
And it may be equally unhealthy to not express your thoughts. In one study, some participants were encouraged to suppress thoughts associated with an emotional experience; blood samples were taken both before and after the exercise. Those who had suppressed their emotional thoughts showed significant decreases in the kind of lymphocytes (CD3 T cells) that fight infection.8
Having a generally pessimistic attitude also suppresses the immune system. In a study of 36 HIV-positive women also 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 concluded that women with a pessimistic outlook are increasing their chances of developing cervical cancer later
Pregnancy and birth
Mothers who are sad can pass ill health on 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 from the BRAC Research and Evaluation Division in Dhaka made the discovery when they assessed the mental health of 720 women in their third trimester of pregnancy living in rural Bangladesh. 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, malnutrition and low socioeconomic status.10
Stress and depression also have major impacts on rheumatoid arthritis and juvenile idiopathic arthritis, both of which are chronic inflammatory disorders. Scientists at the Regensburg University Clinic in Germany have demonstrated that stress releases hormonal and neuronal factors that can make the symptoms of rheumatoid arthritis worse, as first observed by Solomon in the 1960s.11
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.12
Researchers at Brigham Young University in Utah arrived at a similar conclusion when they analyzed 148 studies measuring the frequency of human interactions with overall health over a seven-year period. They estimated that feelings of isolation are the same as smoking 15 cigarettes a day or being an alcoholic, and twice as harmful as being obese. The researchers describe it as one of the biggest-and yet generally unrecognized-causes of all disorders.
On the other hand, having social ties-friends, family, neighbours and social groups-can boost the chances of survival by 50 per cent, although the researchers suspect that the benefits of social interaction may well have even greater protective effects.13
Researchers at the University of California at Los Angeles plotted the impact of social interactions on neural pathways. In a 10-day study, 30 participants who had daily social interactions showed lower cortisol (stress hormone) activity when faced with a stressful situation, while regions of the brain associated with distress due to social separation also did not react in the usual way. This suggests that just the memory of relationships was enough to provide a safeguard for a person when feeling alone.14
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Bryan Hubbard and Lynne McTaggart