Self-Care Is the Heart
of All Health Care:
for Our Patients and Ourselves
DIFM Webinar ~ March 14th, 2012
James S. Gordon, MD
Founder and Director:The Center for MindBody Medicine
Dean of the College of Mind-Body Medicine of
Saybrook University
www.cmbm.org
Current
Biomedical
Model
New
Medicine
Drugs & Surgery
CAM Therapies
Therapies that require
a professional
Drugs
Surgery
Psycho social approach
Self
Care
and stimulate capacity
for self healing, e.g.
acupuncture, musculoskeletal manipulation,
herbals, group support
The Central Role of
Self-Care in Integrative Medicine
“Physician: Health Thyself”
- Hippocrates
The Importance of Hope



Helplessness and hopelessness are
hallmarks of and major contributors to
depression, anxiety, stress, and psychiatric
disorders generally.
Hope and acting on our own behalf are
powerful antidotes
Hope begets change
The Importance of Hope


People who are hopeful generally do better and feel
better than those who are not, regardless of
biological status or physical disability.
The mental health professional is not only there to
treat but also to teach, encourage, to transform the
experience of depression from victimization by a
disease to awakening and to transforming an
imbalance.
The Importance of Hope
Engagement:
Langer EJ, Rodin J. The Effects of Choice and Enhanced Personal
Responsibility for the Aged: A Field Experiment in an Institutional
Setting. Journal of Personality and Social Psychology. 1976; 34:191-198.
Attitude:
Buccheri, GF, Ferrigno D, Tamburnini M, Brunelli C. The Patient’s
Perception of His Own Quality of Life Might Have an Adjunctive
Prognostic Significant in Lung Cancer. Lung Cancer. 1995; 12(1-2):45-58.
Greer S, et al. Psychological Response to Breast Cancer and 15-year
Outcome. Lancet. 1990; 335 (8680):49-50.
Challenge, Commitment, and Control:
Kobasa SC. Stressful Life Events, Personality, and Health: An Inquiry into
Hardiness. Journal of Personality and Social Psychology. 1979; 37:1-11.
The Central Role of
Self-Care
We cannot teach self-care to
others if we do not practice it
ourselves
The Central Role of
Self-Care
Everything that occurs on a mental or
emotional level affects the body, and
vice versa.
Mental health and physical health are
best understood as inextricable.
Self-Care is the
Heart of Health Care

Self-awareness and
self-expression
• Journals and
narratives
• Drawings
• Movement and
dance
Relaxation
 Autogenics and biofeedback


Meditation
• Concentrative
• Awareness
• Expressive
Self Care is the
Heart of Health Care


Imagery/self-hypnosis
Exercise
• Improved mood
• Enhanced immunity
• Reduced symptoms
• Increased longevity/decreased risk
of cancer and heart disease
Nutrition
 Prayer

Neuroplasticity
and Neurogenesis
Our brains, contrary to long term teaching, have
the capacity to grow and change anatomically as
well as physiologically.
• Eriksson, PS, et al. Neurogenesis in the adult human hippocampus. Nat Med 1998:4(11):1313-17.
• Kandel, E. A new intellectual framework for psychiatry. Am J Psychiatry 1998:155:457-69.
Neuroplasticity
Natural, non-pharmacological techniques
including psychotherapy, meditation, and
exercise can produce these positive changes.
• Martin, SD, et al. Brain blood flow changes in depressed patients treated with interpersonal psychotherapy or
venlafaxine hydrochloride: preliminary findings. Arch Gen Psychiatry 2001:54(7):641-48.
• Goldapple, K, et al. Modulation of cortical-limbic pathways in major depression: treatment –specific effects
of cognitive behavior therapy. Arch Gen Psychiatry 2004:61(1):34-41. Rhodes, J.S., et al., Exercise increases
hippocampal neurogenesis to high levels but does not improve spatial learning in mice bred for increased
voluntary wheel running. Behav Neurosci, 2003. 117(5): p. 1006-16.
• van Praag, H., G. Kempermann, and F.H. Gage, Running increases cell proliferation and neurogenesis in the
adult mouse dentate gyrus. Nat Neurosci, 1999. 2(3): p. 266-70.
• van Praag, H., et al., Exercise enhances learning and hippocampal neurogenesis in aged mice. J Neurosci,
2005. 25(38): p. 8680-5.
• Lazar, S.W., et al., Meditation experience is associated with increased cortical thickness. Neuroreport, 2005.
16(17): p. 1893-7.
The Central Role of
Self-Care
Self Awareness is or can be crucial to selfcare just as it is in psychotherapy. It’s hard
to know what to do if you don’t know
what’s happening or why. And once you
know you can move ahead.
Self-Awareness and Self-Expression
Journals and Narratives
Amir et al. (1998) Relationship between trauma narratives and trauma
pathology. J Traumatic Stress, 11(2), 385-392.
Pennebaker JW, Kiecolt-Glaser R. Disclosure of traumas and immune function:
health implications for psychotherapy. J Consult Clin Psychol 1988; 56(2):
239-245
Pennebaker JW. Putting stress into words: health, linguistic and therapeutic
implications. Behav Res Ther 1993; 31(6): 539-548.
Smyth JM, Stone AA, Hurewitz A, Kaell A. Effects of writing about stressful
experiences on symptom reduction in patients with asthma or rheumatoid
arthritis: a randomized trial. JAMA 1999; 28(14): 1304-1309
Rousseau C, Drapea A, Lacroix L, Bagilishya D, Heusch N. Evaluation of a
classroom program of creative expression workshops for refugee and
immigrant children. Journal of Child Psychology and Psychiatry. 2005;
46(2): 180-185.
Self-Awareness and Self-Expression
Drawings
Roje J., (1995), LA '94 Earthquake in the Eyes of Children: Art Therapy
with Elementary School Children who were Victims of Disaster. Art
Therapy 12 (4) 237-243.
Stafstrom, C., Rostasy, K., Minster, A., (2002), The Usefulness of
Children's Drawings in the Diagnosis of Headache. Pediatrics 109
(3),460-471
Movement and Dance
“The effect of dance/movement therapy on women with breast cancer.”
(1997). Alternative Therapies in Health & Medicine, 3(2); 1.
Goodill SW. Dance/Movement Therapy for Adults with cystic
Fibrosis: Pilot Data on Mood and Adherence. Alternative
Therapies in Health and Medicine. 2005; 11(1): 76-77.
Relaxation
Relaxation is our Birth Right
Relaxation
Cassileth BR, Vickers AJ, Magill LA. Music Therapy for Mood Disturbance
during Hospitalization for Autologous Stem Cell Transplantation: A
Randomized Controlled Trial. Cancer. 2003; 98: 2723-2729.
DeGuire, S., Gevirtz, R., Hawkinson, D., & Dixon, K. Breathing retraining: a
three-year follow-up study of treatment for hyperventilation syndrome and
associated functional cardiac symptoms. Biofeedback and Self-Regulation,
1996; 21(2), 191-198.
Fried. R. (1990). The Breath Connection. New York: Plenum Press, 58-71, 9193, 171-179, 182-184.
Smolen D, Topp R, Singer L. The Effect of Self-Selected Music During
Colonoscopy on Anxiety, Heart Rate, and Blood Pressure. Applied Nursing
Research. 2002; 16(2): 126-136.
Relaxation
Loewy J, Hallan c, Friedman E, Martinez C. Sleep/Sedation in Children
Undergoing EEG Testing: a Comparison of Chloral Hydrate and Music
Therapy. Journal of PeriAnesthesia Nursing. 2005; 20(5): 323-332.
Syrjala KL et al. (1995). Relaxation and imagery and cognitive-behavioral
training reduce pain during cancer treatment: a controlled clinical trial.
Pain Nov;63(2):189-198.
Wood, C. (1993). Mood Change and Perceptions of Vitality: A
Comparison of the Effects of Relaxation, Visualization, and Yoga.
Journal of the Royal Society of Medicine, 86, 254-258.
Biofeedback
 Approach
to relaxation and selfregulation
– Reduce autonomic nervous system arousal
– Manages stress
– Supports and facilitates the natural selfhealing mechanisms
– Reduced anxiety and depression in cancer
patients
Biofeedback and Autogenic Training
Dienstfrey, H., ed. (1991). Neal Miller, the Dumb Autonomic Nervous
System, and Biofeedback. In H. Dienstfrey, ed., Where the Mind Meets
the Body. New York: HarperCollins, 1991.
Fuller, G.D. (1977). Skin Temperature Feedback. Excerpt from
Biofeedback: Methods and Procedures in Clinical Practice. San
Francisco, CA: Biofeedback Press, 46-52.
Hidderley M, Holt M. A pilot randomized trial assessing the effects of
autogenic training in early stage cancer patients in relation to
psychological status and immune system responses. European Journal
of Oncology Nursing. 2004; 8: 61-65.
Kaushik R, Kaushik RM, Mahajan SK, Rajesh V. Biofeedback assisted
diaphragmatic breathing and systematic relaxation versus propranolol
in long term prophylaxis of migraine. Complementary Therapies in
Medicine. 2005; 13: 165-174.
Biofeedback and Autogenic Training
Linden, W. (1994). Autogenic Training: A Narrative and Quantitative Review
of Clinical Outcome. Biofeedback and Self-Regulation, 19(3), 227-264.
Norris, P.A. & Fahrion, S.L. (1993). Autogenic Biofeedback in
Psychophysiological Therapy and Stress Management. In P.M. Lehrer &
R.L. Woolfolk (Eds.), Principles and Practices of Stress Management.
New York: The Guilford Press, 231-262.
Rickles, W.H., Onoda, L., & Doyle, C.C. Biofeedback as an Adjunct to
Psychotherapy. Biofeedback and Self-Regulation, 1982;7(1), 1-33.
Stetter, F. & Kupper, S. (2002). “Autogenic Training: A Meta-Analysis of
Clinical Studies.” Applied Psychophysiology and Biofeedback, 27(1); 4598.
Meditation in Clinical Practice…
and Life
Meditation is the Heart of Medicine and
of Self-Care
1.
•
Specific therapeutic benefits:
Decreased stress, lowered blood pressure and blood sugar,
improved mood, enhanced immunity, etc.
2. Meditation Transforms Us
•
Meditation enlarges our perspective, allows us to see the
world and ourselves more clearly, less judgmentally, and
more compassionately.
Meditation
 Concentrative
 Awareness
 Expressive
Meditation: Its effect on the brain
Lazar, S. W., Kerr, C. E., Wasserman, R. H., Gray, J. R., Greve, D. N., Treadway,
M. T., et al. (2005). Meditation experience is associated with increased cortical
thickness. Neuroreport, 16(17), 1893-1897.
Meditation
Astin J.A. Stress Reduction through Mindfulness Meditation. Psychotherapy and
Psychosomatics, 1997; 66; 97-106.
Brown, KW & Ryan, RM. (2003). The Benefits of Being Present: Mindfulness
and Its Role in Psychological Well-Being. Journal of Personality and Social
Psychology, 84(4); 822-848.
Carlson,L.E., Ursuliak A;, Goodey E., Angen M., Speca M. the effects of a
mindfulness meditation-based stress reduction program on mood and
symptoms of stress in cancer outpatients; 6-month follow-up. Support Care
Cancer 2001; 9(2); 112-123.
Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction
in relation to quality of life, mood, symptoms of stress and levels of cortisol,
dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate
cancer outpatients. Psychoneuroendocrinology. 2004; 29: 448-474.
Meditation
Curiati JA, Bocchi E, Freire JO, Arantes AC, Braga M, Garcia Y, Guimaraes G, Fo
WJ. Meditation Reduces sympathetic Activation and Improves the Quality of Life
in Elderly Patients with Optimally Treated Heart Failure: A Prospective
Randomized Study. The Journal of Alternative and Complementary Medicine.
2005; 11(3): 465-472.
Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli SF,
Urbanowski F, Harrington A, Bonus K, Sheridan JF. Alterations in Brain and
Immune Function Produced by Mindfulness Meditation. Psychosomatic Medicine.
2003; 65: 564-570.
Dusek, J. A., Otu, H. H., Wohlhueter, A. L., Bhasin, M., Zerbini, L. F., Joseph, M. G.,
et al. (2008). Genomic counter-stress changes induced by the relaxation response.
PLoS ONE [Electronic Resource], 3(7), e2576.
Gordon, J.S. the Inner Life. The Atlantic Monthly; May 1991; 115-118.
Kabat-Zinn, J., et al. (1998). Influence of a Mindfulness Meditation-Based Stress
Reduction Intervention on Rates of Skin Clearing in Patient with Moderate to
Severe Psoriasis Undergoing Phototherapy and Photochemotherapy.
Psychosomatic Medicine, 60; 625-632.
Meditation
Kutz, I., Borysenko, J. & Benson, H. (1985). Meditation and Psychotherapy: A
rationale for the integration of dynamic psychotherapy, the relaxation
response and mindfulness meditation. The American Journal of Psychiatry,
142 (1); 1-8.
Lazar SW, Kerr CE, Wasserman RH, Gray JR, Greve DN, Treadway MT,
McGarvey M, Quinn BT, Dusek JA, Benson H, Rauch SL, Moore CI,
Fischl B. Meditation experience is associated with increased cortical
thickness. Neuroreport. November 2005; 16(17): 1893-97.
Litscher, G., et al. (2001). Effects of QiGong on Brain Function. Neurological
Research, 23; 501-505.
Lutz A, Greischar LL, Rawlings NB, Ricard M, Davidson RJ. Long-term
meditators self-induce high-amplitude gamma synchrony during mental
practice. PNAS. 2004; 101(46): 16369-16373.
Meditation
Newberg, AB & Iversen, J. (2003). The Neural Basis of the Complex Mental
Task of Meditation: Neurotransmitter and Neurochemical considerations.
Medical Hypotheses, 61(2); 282-291
Speca, M., Carlson, L.E., Goodey, E., Angen, M. (2000). A randomized, waitlist controlled clinical trial; the effect of a mindfulness meditation based
stress reduction program on mood and symptoms of stress in cancer
outpatients. Psychosomatic Medicine, 62(5); 613-622.
Schneider RH, Alexander CN, Staggers F, Rainforth M, Salerno JW, Hartz A,
Arndt S, Barnes VA, Nidich SI. Long-Term Effects of Stress Reduction on
Mortality in Persons Greater Than or Equal to 55 Years of Age With
Systemic Hypertension. The American Journal of Cardiology. 2005; 95:
1060-1064.
Imagery is…

The dominant language of the unconscious
mind

A vital source of information and
inspiration

“The beat beneath the music”
Imagery is…

A place where Mind-Body-Spirit Therapies
interact
–
–
–
–
–
Hypnosis
Biofeedback
Meditation
Psychotherapy
Prayer
Imagery is…
the communication mechanism between
perception, emotion, and
bodily change
(Achterberg, 1985)
Types of Imagery
Feeling State Imagery – Imagery that changes one’s
mood or emotional state in a very broad way
End State Imagery – Imagery that highlights concrete
goals one is striving for
Biologically Correct Imagery – Imagery that focuses
on what is actually occurring microscopically in the
cells and organs of the body
(Naparstek, 1994)
Types of Imagery (cont.)
Metaphoric Imagery – Imagery that uses
symbols to describe what is happening
psychologically in the body.
Spiritual Imagery – Imagery that allows for a
connection with a source that is greater than
oneself that can enhance one’s awareness of
inner wisdom and strength
(Naparstek, 1994)
Guided Imagery

Clinical Implications:
– Physiological relaxation
– Stress reduction
– Mood modulation
– Encouraging active participation in own care
– Empowerment
– Discovering meaning/insight into illness
– Enhancing self-awareness
Imagery and Self-Hypnosis
Donaldson, VW. (2000). A Clinical Study of Visualization on Depressed White
Blood Cell Count in Medical Patients. Applied Psychophysiology and
Biofeedback, 25(2); 117-128.
Jeannerod M, Frak V. Mental imaging of motor activity in humans. Current
Opinion in Neurobiology. 1999; 9: 735-739.
Kolcaba K, Fox C. The effects of guided imagery on comfort of women with
early stage breast cancer undergoing radiation therapy. Oncol Nurs Forum
1999; 26(1):67-72.
Krakow B, Hollifield M, Johnston L, Koss M, Schrader R, Warner T, Tandberg
D, Lauriello J, McBride L, Cutchen L, cheng D, Emmons S, Germain A,
Melencrez D, Sandoval D, Prince H. Imagery Rehearsal Therapy for Chronic
Nightmares in Sexual Assault Survivors With Posttraumatic Stress Disorder:
A Randomized Controlled Trial. JAMA. 2001; 286(5): 537-545.
Imagery and Self-Hypnosis
Lotze M, Montoya P, Erb M, Hulsmann E, Flor H, Klose U, Birbaumer N,
Grodd W. Activation of Cortical and Cerebellar Motor Areas during
Executed and Imagined Hand Movements: an fMRI Study. Journal of
Cognitive Neuroscience. 1999; 11(5): 491-501.
Marchioro G, Azzarello G, viviani F, Barbato F, Pavanetto M, Rosetti F,
Pappagallo GL, Vinante O. Hypnosis in the Treatment of Anticipatory
Nausea and Vomiting in Patients Receiving Cancer Chemotherapy.
Oncology. 2000; 59: 100-104.
Montgomery GH et al. (2002). Brief presurgery hypnosis reduces distress and
pain in excisional breast biopsy patients. Intl J of Clin and Experimental
Hypnosis. Jan;50(1):17-32.
Imagery and Self-Hypnosis
Newton BW. The use of hypnosis in the treatment of cancer patients. Am J
Clin Hypn 1982; 25(2-3):104-113.
Rider MS, Achterberg J. Effect of music-assisted imagery on neutrophils and
lymphocytes. Biofeedback Self Regul 1989; 14(3):247-257.
Syrjala KL, Donaldson GW, Davis MW, Kippes ME, Carr JE. Relaxation and
imagery and cognitive-behavioral training reduce pain during cancer
treatment: a controlled clinical trial. Pain 1995; 63(2):189-198.
Tusek, DL, et al. (1997). Guided Imagery: A Significant Advance in the Care
of Patients Undergoing Elective Colorectal Surgery. Diseases of the
Colon and Rectum, 40(2); 172-178.
Imagery and Self-Hypnosis
Walker LG, Walker MB, Ogston K, Heys SD, Ah-See AK, Miller ID et al.
Psychological, clinical and pathological effects of relaxation training and
guided imagery during primary chemotherapy. Br J Cancer 1999; 80(12):262-268.
Wallace KG. Analysis of recent literature concerning relaxation and imagery
interventions for cancer pain. Cancer Nurs 1997; 20(2):79-87.
Whitehouse, W., et al. (1996). Psychosocial and Immune Effects of SelfHypnosis Training for Stress Management Throughout the First Semester
of Medical School. Psychosomatic Medicine, 58; 249-263.
Exercise
Aside from the presence of a
sympathetic and knowledgeable
other person—exercise is probably
the single best treatment for
depression and may be as important
for anxiety.
Exercise and Depression
By itself, exercise is as effective as any known
treatment for depression.
Exercise should always be a significant part of
any integrative approach.
• Nabkasorn C, N Miyai, A Sootmongkol, S Junprasert, H Yamamoto, M Arita, K Miyashita. Effects of
physical exercise on depression, neuroendocrine stress hormones, and physiological fitness in adolescent
females with depressive symptoms. Euro J Pub Health 2006;16(2):179-84.
• Blumenthal, JA, et al. Effects of exercise training on older patients with major depression. Arch Intern Med
1999;159(19):2349-56.
• Babyak M, et al. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months.
Psychosom Med 2000;62(5):633-38.
Exercise and Depression
Exercise alters brain chemistry, increasing
serotonin, norepinephrine, and endorphin
levels.
• Soares, J., M.G. Naffah-Mazzacoratti, and E.A. Cavalheiro, Increased serotonin levels in physically trained
men. Braz J Med Biol Res, 1994. 27(7): p. 1635-8.
• Carr, D.B., et al., Physical conditioning facilitates the exercise-induced secretion of beta-endorphin and betalipotropin in women. N Engl J Med, 1981. 305(10): p. 560-3
Exercise and Depression
Exercise may promote neurogenesis.
• Rhodes, J.S., et al., Exercise increases hippocampal neurogenesis to high levels but does not improve spatial
learning in mice bred for increased voluntary wheel running. Behav Neurosci, 2003. 117(5): p. 1006-16.
• van Praag, H., G. Kempermann, and F.H. Gage, Running increases cell proliferation and neurogenesis in the
adult mouse dentate gyrus. Nat Neurosci, 1999. 2(3): p. 266-70.
• van Praag, H., et al., Exercise enhances learning and hippocampal neurogenesis in aged mice. J Neurosci,
2005. 25(38): p. 8680-5.
Exercise
Improve Mood
Courneya, KS; Friedenreich CM (1999). Physical Exercise and Quality
of life following cancer diagnosis: A Literature Review, Spring,
1999. Annals of Behavioral Medicine, 21(2), 171-9.
Jensen PS, Kenney DT. The effects of yoga on the attention and
behavior of boys with Attention-Deficit/hyperactivity Disorder
(ADHD). Journal of Attention Disorders. 2004; 7(4): 205-216.
LaFontaine, T.P., DiLorenzo, T.M., Frensch , P.A., Stucky-Ropp,
R.C., Bargman, E.P., & McDonald, D.G. (1992). Aerobic Exercise
and Mood. A Brief Review, 1985-1990. Sports Med, 13(3), 160-170.
Mather et al. (2002). Effects of Exercise on Depressive Symptoms in
Older Adults with Poorly Responsive Depressive Disorder:
Randomized Controlled Trial. British Journal of Psychiatry, 180;
411-415
Exercise
Improve Mood
Mock V; Dow KH; Meares CJ; et al. (1997). Effects of Exercise on Fatigue,
Physical Functioning, and Emotional Distress During Radiation Therapy for
Breast Cancer, July 1997. Oncology Nursing Forum, 24(6), 991-1000.
Segar ML; Katch VL; Roth RS; et al. (1998). The Effect of Aerobic Exercise on
Self-Esteem and Depressive and Anxiety SymptomsAmong Breast Cancer
Survivors, Jan-Feb 1998. Oncology Nursing Forum, 25 (1), 107-13.
Stewart et al. (2003). Are fitness, activity, and fatness associated with healthrelated quality of life and mood in older persons? Journal of Cardiopulm
Rehabil, 23(2); 115-121.
Witt C, Becker M, Bandelin K, Soellner R, Willich SN. Qigong for
Schoolchildren: A Pilot Study. The Journal of Alternative and Complementary
Medicine. 2005; 11: 41-47.
Woolery A, Myers H, Sternlieb B, Zeltzer L. A Yoga Intervention for Young
Adults With Elevated Symptoms of Depression. Alternative Therpaies in
Health and Medicine. 2004; 10(2): 60-63.
Yoga and Depression

Brown, R.P. and P.L. Gerbarg. 2005. Sudarshan Kriya Yogic breathing in the treatment
of stress, anxiety, and depression. Part II-clinical applications and guidelines. J Altern
Complement Med 11 (4):711-717

Devi, S. K., J.P.N. Chansauria, and K.N. Udupa. 1986. Mental depression and
Kundalini yoga. Ancient Science of Life 6 (2):112-18.

Khumar, S.S., P. Kaur, and S. Kaur. 1993. Effectiveness of shavasana on depression
among university students. Indian J Clin Psychol 20: 82-87

Krishnamurthy, M.N. and S. Telles. 2007. Assessing depression following two ancient
Indian interventions: Effects of yoga and Ayurveda on older adults in a residential
home. J Gerontol Nurs 33 (2): 17-23
Yoga and Depression

Michalsen, A., et al. 2005. Rapid stress reduction and anxiolysis among distressed
women as a consequence of a three-month intensive yoga program. Med Sci Monit
11(12):CR555-61

Smith, C., et al. 2006. Stress management: a randomized study of cognitive
behavioral therapy and yoga. Cogn Behav Ther 35 (1): 3-10

Woolery, A., et al. 2004. A yoga intervention for young adults with elevated
symptoms of depression. Altern Ther Health Med 10 (2): 60-63
Let Food Be Your Medicine and
Medicine Your Food
Biochemical Individuality—Roger
Williams, PhD
 Nutrition influences every cell and every
system’s function in the body
 Food As Medicine: A Training Program for
Professionals -- June 7-10, 2012 in
Washington, DC
Dr. James S. Gordon, MD ~ Kathie Swift,
MS RD

Nutrition

Possible elimination of caffeine, sugar, and
simple carbohydrates
– Benton D, Donohoe R. The effects of nutrients on mood.
Public Health Nutrition. 1999; 2(3a):403-409.
– Christensen L. The effect of carbohydrates on affect. Intl J
of Applied and Basic Nutritional Sciences. 1997; 13: 504-514.

Elimination of additives and preservatives
Nutrition


Food sensitivities: milk, wheat, corn, soy, etc.
Supplementation with omega-3 fatty acids, B
vitamins, Selenium, and Magnesium
– Hakkarainen R et al. Is low dietary intake of omega-3
fatty acids associated with depression? Am Psych.
2004; 161: 567-69.
– Marangell LB et al. A double blind, placebo-controlled
study of the omega-3 fatty acid docosahexaenoic acid
in the treatment of major depression. Am J Psych. 2003;
160: 996-98.
Nutrition
Bland, J. & Bemum, S. (1999). Genetic Nutritioneering. Los Angles: Keats.
Doll, R. & Peto, R. (1981). The Causes of Cancer: Quantitative Estimates of the
Avoidable Risks of Cancer in the United States Today. New York: Oxford
University Press.
McGovern, G. (1977). Dietary Goals for the United States. A report of the
Select Committee on Nutrition and Human Needs, US Senate, December,
Washington, DC: Government Printing Office.
Willett, W. (2002). Eat, Drink, and Be Healthy: The Harvard Medical School
Guide to Healthy Eating. New York: Free Press.
The Spiritual Dimension
Can be seen as an aspect of life but it is better
understood as that which gives our lives their fullest
meaning and their greatest energy. The spiritual is
not separate from, but intrinsic to who we are…
…and we forget
Spirituality is not Religion.
Religion is the name we give to the ways we
organize our spiritual practices and our beliefs
about the spiritual.
When religion is alive and vital it is the spirit or
spirituality which enlivens it.
Spirituality is intimately connected with
healing in China and India, in Judaism,
Islam, Christianity, and Buddhism, and
among indigenous people.
The Spirit gives life and renews life.
Every aspect of our work is spiritual…
…how we are with ourselves and others,
and with nature,
which allows us to breathe.
Self-Care
Prayer
For oneself-evidence of the efficacy uniformly positive
Cotton SP, Levine EG, Fitzpatrick CM, Dold KH, Targ E. Exploring the
relationships among spiritual well-being, quality of life, and psychological
adjustment in women with breast cancer. Psycho-oncology 1999;8:429-438.
Dwyer JW, Clarke LL, Miller MK. The effect of religious concentration and
affiliation on county cancer mortality rates. J of Health and Social Behav
1990; 31:185-202.
Harrison M.O., Edwards C.L., Koenig H.G., Bosworth H.B., Decastro L., Wood
M. Religiosity/spirituality and pain in patients with sickle cell disease.
Journal of Nervous and Mental Disease. Apr 2005; 193(4):250-7.
Prayer (cont.)
Self-Care
For oneself-evidence of the efficacy uniformly positive
Holt C.L., Klem P.R. As you go, spread the word: spiritually based breast cancer
education for African American women. Gynecological Oncology. Dec 2005; 99(3
suppl 1):s141-2.
Koenig HG, George LK, Peterson BL. Religiosity and remission from depression in
medically ill older patients. American Journal of Psychiatry 1998; 155: 536-42.
Koenig HG, Paragament KI, Nielsen J. Religious coping and health status in medically ill
hospitalized older adults. Journal of Nervous and Mental Disorders 1998; 186: 513-21.
Miller D.K., Chibnall J.T., Videen S.D., Duckro P.N. Supportive-affective group
experience for persons with life-threatening illness: reducing spiritual, psychological,
and death-related distress in dying patients. Journal of Palliative Medicine. Apr 2005;
8(2):333-43.
Wachholtz A.B., Pargament K.I. Is spirituality a critical ingredient of meditation?
Comparing the effects of spiritual meditation, secular meditation, and relaxation on
spiritual, psychological, cardiac, and pain outcomes. Journal of Behavioral Medicine.
Aug 2005; 28(4):369-84.
Prayer
Self-Care
For others-evidence for positive effect is mixed
Astin JA, Harkness E, Ernst E. The efficacy of “distant healing”:a
systematic review of randomized trials. Ann Intern Med 2000;
132(11):903-910.
Benson H, et al. Study of the Therapeutic Effects of Intercessory
Prayer (STEP) in cardiac bypass. American Heart Journal. Apr
2006; 151(4):934-42.
Byrd RC. Positive therapeutic effects of intercessory prayer in a
coronary care unit population. South Med J 1988; 81(7):826-829.
Harris WS, Gowda M, Kolb JW, Strychacz CP, Vacek JL, Jones PG et
al. A randomized, controlled trial of the effects of remote,
intercessory prayer on outcomes in patients admitted to the
coronary care unit. Arch Intern Med 1999; 159(19):2273-2278.
Group Support
A universally applicable
approach: the research is as
good as that for many
standard treatments.
Group Support as a Perennial and
Necessary Part of Healing
1. The Role of the Healer
2. Role of the Family and Community
3. Contemporary Understanding and the Rise of Family
and Group Therapy in 1960’s-1970’s
4. Support Groups
• AA & 12 Step Programs
• Illness Based Groups
Mind-Body Skills Groups

History and Development
– Personal Experience of Mind-Body Approaches
– Scientific Literature on Mind-Body Approaches
– Desire to Teach to Patients/Clients
– Experiences Working with Groups
– Economical: Time and Money
– Group Offers Support
Mind-Body Skills Groups
Principles
• Meditative
• Safe Place
• Respect
• Educational
• Staying in the moment
• Leader as teacher and real person
• Power of each person to know him/herself
• Power of each person to care for him/herself
• Mutual—we are all mirrors for one another
• Group as growth organism
• Balance of structure and flexibility.
Group Support
Antoni H, et al. “Cognitive-Behavioral Stress Management Intervention Buffers
Distress Responses and Immunologic Changes Following Notification of
HIV-1 Seropositivity,” Journal of Consulting and Clinical Psychology, 1991; 59;
906-15.
Berkman LF, Syme SL. Social networks, host resistance, and mortality: a nineyear follow-up study of Alameda County residents. Am J Epidemiol 1979;
109(2):186-204.
Cohen, JA et al. (2000). Treatment of children and adolescents. In E. B. Foa et al
(Eds), Effective treatments for PTSD: Practice guidelines from the
International Society of Traumatic Stress Studies (pp. 106-138). New York:
Guilford Press.
Fawzy FI. (1999). Psychosocial interventions for patients with cancer: what
works and what doesn't. Eur J Cancer; 35(11):1559-1564.
Group Support
Fawzy FI, Fawzy NW, Hyun CS, Elashoff R, Guthrie D, Fahey JL et al.
Malignant melanoma. Effects of an early structured psychiatric
intervention, coping, and affective state on recurrence and survival 6
years later. Arch Gen Psychiatry 1993; 50(9):681-689.
Fawzy FI, Cousins N, Fawzy NW, Kemeny ME, Elashoff R, Morton D. A
structured psychiatric intervention for cancer patients. I. Changes over
time in methods of coping and affective disturbance. Arch Gen Psychiatry
1990; 47(8):720-725.
Fawzy FI, Kemeny ME, Fawzy NW, Elashoff R, Morton D, Cousins N et
al. A structured psychiatric intervention for cancer patients. II. Changes
over time in immunological measures. Arch Gen Psychiatry 1990;
47(8):729-735.
Foy DW et al. (2000) Group Psychotherapy for Post Traumatic Stress
Disorder. In E.B. Foa et al (Eds), Effective Treatments for PTSD
(pp.155-175). New York: Guilford Press.
Group Support
Goodwin PJ, Leszcz M, Ennis M, et al. The effect of group psychosocial
support on survival in metastatic breast cancer. N Engl J Med.
2001;342:1719-1726
Kiecolt-Glaser, JK, Glaser, R, et al. (1986). Modulation of Cellular
Immunity in Medical Students. Journal of Behavioral Medicine, 9(1); 521.
Lantz MS et al. (1997). The Wellness Group: a novel intervention for
coping with disruptive behavior among elderly nursing home residents.
Gerontologist 37(4):551-556.
Layne CM et al. (2001) Trauma/grief focused group psychotherapy:
School-based postwar intervention with traumatized Bosnian
adolescents. Group Dynamics, 5, 277-290.
Maunsell E, Brisson J, Deschenes L. Social support and survival among
women with breast cancer. Cancer 1995; 76(4):631-637.
Group Support
Ornish, D, et al. “Can Lifestyle Changes Reverse Coronary Heart Disease?
The Lifestyle Heart Trial,” Lancet, July 21, 1990; 336; 129-33.
Richardson JL, Shelton DR, Krailo M, Levine AM. The effect of
compliance with treatment on survival among patients with
hematologic malignancies. J Clin Oncol 1990; 8(2):356-364.
Shrock D, Palmer RF, Taylor B. Effects of a psychosocial intervention on
survival among patients with stage I breast and prostate cancer: a
matched case-control study. Altern Ther Health Med 1999; 5(3):49-55.
Simonton SS, Sherman AC. Psychological aspects of mind-body medicine:
promises and pitfalls from research with cancer patients. Altern Ther
Health Med 1998; 4(4):50-54.
Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial
treatment on survival of patients with metastatic breast cancer. Lancet
1989; 2(8668):888-891.
It’s Not What’s Prescribed…
It’s What
You Do
and
How You Do It!
It’s Not What’s Prescribed—
It’s What You Do and How You Do It!
Cunningham AJ, Phillips C, Lockwood GA, Hedley DW, Edmonds CV.
Association of involvement in psychological self-regulation with
longer survival in patients with metastatic cancer: an exploratory
study. Adv Mind Body Med 2000; 16(4):276-287.
Cunningham, AJ. Group psychological therapy: an integral part of care
for cancer patients. Integrative Cancer Therapies 2002; 1(1):67-75.
Cunningham AJ, Edmonds CV, Phillips C, Soots KI, Hedley D, Lockwood
GA. A prospective, longitudinal study of the relationship of
psychological work to duration of survival in patients with
metastatic cancer. Psychooncology 2000; 9(4):323-339.
It’s Not What’s Prescribed—
It’s What You Do and How You Do
It!
Gordon, JS, Staples, J, Blyta, A & Bytyqi, M. (2004)Treatment of
Posttraumatic Stress Disorder in Postwar Kosovo High School
Students Using Mind-Body Skills Groups: a Pilot Study. Journal of
Traumatic Stress, 17(2);143-147.
Gordon, James S. Staples Julie K, Blyta Afrim, Bytyqi Murat, Wilson Amy
T. Treatment of Posttraumatic Stress Disorder in Postwar Kosovar
Adolescents Using Mind-Body Skills Groups: A Randomized
Controlled Trial. Journal of Clinical Psychiatry, 2008 Sep;69 (9):1469-76.
It’s Not What’s Prescribed—
It’s What You Do and How You Do
It!
Ornish D et al. Intensive Lifestyle Changes May Affect the Progression of Prostate Cancer. The
Journal of Urology. 2005; 174(3): 1065-1070.
Staples, Julie K. and James S. Gordon. "Effectiveness of a Mind-Body Skills Training Program for
Healthcare Professionals." Alternative Therapies in Health and Medicine. 11.4. (2005): 36-41.
Saunders, P. A., Tractenberg, R. E., Chaterji, R., Amri, H., Harazduk, N., Gordon, J. S., Lumpkin,
M., & Haramati, A.. Promoting self-awareness and reflection through an experiential MindBody Skills course for first year medical students. Medical Teacher. 2007, 29: 1-6.
Staples, J.K., Abdel Atti, J.A., Gordon, J.S., (2011). Mind-Body Skills Groups for Posttraumatic
Stress Disorder and Depression Symptoms in Palestinian Children and Adolescents in Gaza.
International Journal of Stress Management. 18(3) 246-262
Conclusions
This work begins with us
and
continues with us.
Books
Unstuck: Your Guide to the Seven Stage
Journey Out of Depression
by James S. Gordon, M.D., Penguin Press, 2008.
Comprehensive Cancer Care: Integrating
Alternative, Complementary and Conventional
Therapies.
by James S. Gordon, M.D. and Sharon Curtin,
Perseus Books, 2000.
Manifesto for a New Medicine: Your Guide to
Healing Partnerships and the Wise Use of
Alternative Therapies.
by James S. Gordon, M.D., Perseus Books, 1996.
Questions and Answers
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