Absorption and imagery locate immune responses in the body

CHANGES IN OXYTOCIN AND CORTISOL IN ACTIVE-ALERT HYPNOSIS: Hormonal Changes Benefiting Low Hypnotizable Participants

It is increasingly clear that oxytocin and cortisol play an intricate role in the regulation of behavior and emotions impacting health, relationships, and well-being. Their long-term, cross-generational effect makes them an important focus of the present study. This exploratory research examined changes in oxytocin and cortisol levels and their correlations with different phenomenological measures in both hypnotist and subject during active-alert hypnosis. The level of oxytocin increased whereas the level of cortisol decreased in the hypnotist. When comparing the oxytocin changes of subjects with their hypnotizability, those with low hypnotizability scores experienced an increase in oxytocin, and those with medium and high hypnotizability scores showed no change or decrease. This could explain why clients' hypnotizability is not considered an important factor during hypnotherapy.

A randomized controlled trial of the effects of hypnosis with 3-D virtual reality animation on tiredness, mood, and salivary cortisol

Case studies suggest hypnosis with a virtual reality (VR) component may be an effective intervention; although few follow-up randomized, controlled trials have been performed comparing such interventions with standard hypnotic treatments. Thirty-five healthy participants were randomized to self-hypnosis with VR imagery, standard self-hypnosis, or relaxation interventions. Changes in sleep, cortisol levels, and mood were examined. Self-hypnosis involved 10- to 20-min. sessions visualizing a healthy immune scenario. Trait absorption was also recorded as a possible moderator. Moderated regression indicated that both hypnosis interventions produced significantly lower tiredness ratings than relaxation when trait absorption was high. When trait absorption was low, VR resulted in significantly higher engagement ratings, although this did not translate to demonstrable improvement in outcome. Results suggest that VR imagery may increase engagement relative to traditional methods, but further investigation into its potential to enhance therapeutic efficacy is required.

Absorption: an individual difference to consider in mind-body interventions

Given that mind-body interventions constitute a major portion of complementary and alternative medicine used by the public, it seems important to explore those human characteristics that may contribute to the efficacy of mind-body interventions in those who are most likely to benefit. One such characteristic, absorption, reflects an individual's cognitive capacity for involvement in sensory and imaginative experiences in ways that alter an individual's perception, memory, and mood with behavioral and biological consequences. Thus, one's level of absorption may potentially create differential treatment effects in mind-body intervention outcomes. Conducting practical clinical trials helps address the challenge of determining whether a specific mind-body modality intervention may be effective. Such trials may be strengthened by including measures of personality dimensions such as absorption.

Mind-Body Medicine and Immune System Outcomes: A Systematic Review

This study is a systematic review of mind-body interventions that used immune outcomes in order to: 1) characterize mind-body medicine studies that assessed immune outcomes, 2) evaluate the quality of mind-body medicine studies measuring immune system effects, and 3) systematically evaluate the evidence for mind-body interventions effect on immune system outcomes using existing formal tools. 111 studies with 4,777 subjects were reviewed. The three largest intervention type categories were Relaxation Training (n=25), Cognitive Based Stress Management (n=22), and Hypnosis (n=21). Half the studies were conducted with healthy subjects (n=51). HIV (n=18), cancer (n=13) and allergies (n=7) were the most prominent conditions examined in the studies comprising of non-healthy subjects. Natural killer cell and CD4 T lymphocyte measures were the most commonly studied outcomes. Most outcome and modality categories had limited or inconclusive evidence. Relaxation training had the strongest scientific evidence of a mind-body medicine affecting immune outcomes. Immunoglobulin A had the strongest scientific evidence for positive effects from mind-body medicine. Issues for mind-body medicine studies with immune outcomes are discussed and recommendations are made to help improve future clinical trials.

Imagery use by injured athletes: A qualitative analysis

The purpose of this study was to expand our knowledge and increase our understanding of imagery use by athletes in sport-injury rehabilitation using a qualitative approach. The participants were 10 injured athletes who were receiving physiotherapy at the time they were interviewed. During the interviews, the athletes provided extensive information about their use of imagery during injury rehabilitation and it was clear that they believed imagery served cognitive, motivational and healing purposes in effectively rehabilitating an injury. Cognitive imagery was used to learn and properly perform the rehabilitation exercises. They employed motivational imagery for goal setting (e.g. imagined being fully recovered) and to enhance mental toughness, help maintain concentration and foster a positive attitude. Imagery was used to manage pain. The methods they employed for controlling pain included using imagery to practise dealing with expected pain, using imagery as a distraction, imagining the pain dispersing, and using imagery to block the pain. With respect to what they imaged (i.e. the content of their imagery), they employed both visual and kinaesthetic imagery and their images tended to be positive and accurate. It was concluded that the implementation of imagery alongside physical rehabilitation should enhance the rehabilitation experience and, therefore, facilitate the recovery rates of injured athletes. Moreover, it was recommended that those responsible for the treatment of injured athletes (e.g. medical doctors, physiotherapists) should understand the benefits of imagery in athletic injury rehabilitation, since it is these practitioners who are in the best position to encourage injured athletes to use imagery.

Spirituality predicts outcome independently of expectancy following flower essence self-treatment

OBJECTIVE

The aim of this study was to determine whether absorption and spirituality predict the placebo response independently of expectancy.

METHOD

This was an open study of self-treatment with self-selected Bach flower essences. Participants' expectancy of the effect of flower essences, attitudes to complementary medicine, holistic health beliefs, absorption, and spirituality were measured prior to treatment. One month after the start of treatment, participants responded to an e-mail enquiry about symptom change using a single seven-point change scale.

RESULTS

One hundred sixteen participants (97 university undergraduates and 19 staff) completed all assessments. Spirituality and absorption together predicted additional variance compared with a cluster of expectancy measures comprising expectancy, attitude to complementary medicine, and holistic beliefs (increment in R(2)=.042, P=.032), and spirituality alone (but not absorption alone) predicted more additional variance than did the expectancy cluster (increment in R(2)=.043, P=.014).

CONCLUSION

Our data are inconsistent with conventional explanations for the placebo effect. The mechanism underlying the placebo response is not fully understood.

The Effects of Meditation and Visual Imagery on an Immune System Disorder: Dermatomyositis

OBJECTIVE

To analyze the relationship between a patient's "spontaneous recovery" from dermatomyositis and her practice of transcendental meditation and visual imagery without confounding effects of conventional therapies.

DESIGN

Study of time-varying relationships between (1) measures of arm strength and skin condition (rash and pain) and (2) mind-body interventions-controlling for psychologic stress-in a patient with dermatomyositis, using regression analysis to determine half-lives of treatments and stress.

SETTING

Institutional referral center.

INTERVENTION

Transcendental meditation and visual imagery (no drugs).

OUTCOME MEASURES

Daily measurements of arm strength and skin condition over 294 days. Events producing psychologic stress were also rated using a numerical scale.

RESULTS

The patient recovered, which is a low-probability event without conventional therapy. Regression analysis of time dependence between measures of arm strength, rash, and pain and application of mind-body treatments revealed statistically significant relationships for both meditation (p values 0.02 to 0.001) and visual imagery (p values 0.02 to 0.002). Stress had a significant negative impact on skin symptoms but not arm strength. Beneficial effects of meditation had half-lives of 48-59 days for skin condition and no detectable decay for arm strength. Benefits of visual imagery were more transient (half-lives 4-18 days). The effects of stress had half-lives of only 1-3 days.

CONCLUSIONS

The results demonstrate a statistically significant relationship between mind-body therapies and the patient's recovery from dermatomyositis, possibly mediated by influences on the humoral immune system. A key factor in the recovery was the slower decay rate of meditation and visual imagery compared to stress. As dermatomyositis is a humorally mediated immune microvasculopathy, the benefits of meditation and imagery in our patient comport with a growing body of evidence showing that these techniques influence immune system function.

One size does not fit all: aptitude x treatment interaction (ATI) as a conceptual framework for complementary and alternative medicine outcome research. Part 1--what is ATI research?

When multiple treatment choices are available, the question is not just "which treatment is the best?" but more importantly "best or better for whom, when, and why?" Aptitude (or attribute) by treatment interaction (ATI) is a research paradigm that attempts to examine exactly that--how outcome depends on the match or mismatch between patients' specific characteristics and the treatment they receive. The purpose of this two-part paper is to introduce ATI methods as a conceptual framework into complementary and alternative medicine/integrative medicine (CAM/IM) outcome research. Part 1 presents key concepts in ATI research. Part 2 will present ATI research designs and discusses their applications to the examination of the relationships between individuals and therapies, and the illumination of the mechanisms that make therapies differentially effective. Based on this examination, we conclude that ATI research offers invaluable insights into the multifaceted package of care typically delivered in contemporary medicine and therefore should be included in the portfolio of all CAM/IM outcome research.

Electroencephalographic Cordance Patterns Distinguish Exceptional Clinical Responders with Fibromyalgia to Individualized Homeopathic Medicines

OBJECTIVES

To characterize initial central nervous system responses to olfactory administration of homeopathic remedies as biomarkers for subsequently exceptional, simillimum-like clinical outcomes at a systemic level (i.e., both locally and globally).

DESIGN

Double-blinded, randomized, placebo-controlled clinical trial.

SETTING

A private homeopathic clinic in Phoenix, AZ, and a university laboratory in Tucson, AZ.

PATIENTS

Sixty-two (62) persons with physician-confirmed fibromyalgia (FM) (mean age, 49 years; 94% women) enrolled; 53 completed the 3-month assessment visit. Exceptional responders (n = 6, 23% of active treatment group; none on placebo) were those with improvements in the top one-third for both tender point pain and global health ratings after 3 months.

INTERVENTION

Patients took daily oral doses of treatment solution in LM (1/50,000 dilution) potency (active group received individualized remedy; placebo group received plain solvent). Dependent measures: Baseline and 3-month difference scores for initial prefrontal electroencephalographic alpha frequency cordance (EEG-C, a correlate of functional brain activity) during 16 pairs of randomized, double-blinded bottle sniffs (treatment minus control solutions).

RESULTS

Exceptional responders versus other patients exhibited significantly more negative initial EEG-C difference scores at prefrontal sites. Right prefrontal cordance findings correlated with subsequently reduced pain (r = 0.85, p = 0.03), better global health (r =-0.73, p = 0.10), and trait absorption (genetically determined ability to focus attention selectively and fully) (r = 0.91, p = 0.012).

CONCLUSIONS

These observations suggest prefrontal EEG-C as an early biomarker of individualized homeopathic medicine effects in patients with FM who later exhibit exceptional outcomes. Prefrontal cortex controls executive function, including ability to redirect attention. Interactions between executive function, absorption, and the simillimum remedy could facilitate exceptional responses.

Individual Differences in Response to Randomly Assigned Active Individualized Homeopathic and Placebo Treatment in Fibromyalgia: Implications of a Double-Blinded Optional Crossover Design

OBJECTIVE

To assess individual difference characteristics of subgroups of patients with fibromyalgia (FM) patients with respect to the decision to stay in or switch from randomly-assigned verum or placebo treatment during an optional crossover phase of a double-blinded homeopathy study.

DESIGN

Double-blinded, randomized, placebo-controlled, optional crossover clinical trial.

PARTICIPANTS

Fifty-three (53) community-recruited patients with FM entered the optional crossover phase.

INTERVENTION

Two homeopaths jointly selected an individualized homeopathic remedy for all patients. The pharmacy dispensed either verum LM remedy or indistinguishable placebo in accord with randomized assignment for 4 months and the patient's optional crossover decision for an additional 2 months.

OUTCOME MEASURES

Patients completed a battery of baseline state/trait questionnaires, including mood, childhood neglect and abuse, and trait absorption. They rated global health (whole person-centered) and tender point pain on physical examination (disease-specific) at baseline, 3 months, and 6 months.

RESULTS

Rates of optional crossover from verum to placebo or placebo to verum were comparable (p = 0.6; 31%, and 41%, respectively). The switch subgroups had greater baseline psychologic issues (emotional neglect in placebo-switch; depression and anger in verum-switch). The verum-stay subgroup scored highest on treatment helpfulness and included all six exceptional responders who fell, prior to crossover, into the top terciles for improvement in both global health and pain. Patients staying in their randomly assigned groups, active or placebo (n = 34), scored significantly higher in trait absorption than did those who switched groups (n = 19).

CONCLUSION

Individual difference factors may predict better and poorer responders with FM to specific and nonspecific effects of homeopathic and placebo treatment.

Fostering a healing presence and investigating its mediators

The purpose of this paper is the exploration and explication of the complex phenomena of "healing presence" and of appropriately supportive theoretical approaches to integrate emerging models for research design. Healing presence is described as an interpersonal, intrapersonal, and transpersonal to transcendent phenomenon that leads to a beneficial, therapeutic, and/or positive spiritual change within another individual (healee) and also within the healer. An integrated framework merging knowledge from diverse fields of research develops the multiple elements of healing presence, the healer, the healee's capacity for response and the healing effect as an entangled phenomenon. A conceptual systemic model is presented, and questions and dilemmas that emerge are delineated. An integrated qualitative-quantitative research design is proposed. A systemic relationship model, which includes the healer, the healee, and persons within the healee's environment is presented. The challenges are substantial, but the research questions are meaningful and worthwhile. The goal is to foster healing at bio-psycho-social-spiritual levels of the human being.

Depression and HIV infection: impact on immune function and disease progression

Can psychological factors, such as depression, affect human immunodeficiency virus progression? HIV infection is viewed as a chronic illness in which those infected often confront a number of emotional challenges and physical health and disease-related issues. Over the past 20 years, there has been increasing evidence that depression and other mood-related disturbances are commonly observed among HIV-positive individuals. There is also mounting data showing that depressive symptoms might further impact upon specific elements of immune system functioning and influence quality of life and health status. This paper will highlight studies examining the prevalence of depression during HIV infection and review some of the evidence examining the impact of depressive symptoms on immune function and HIV disease progression.

The effects of stress management on symptoms of upper respiratory tract infection, secretory immunoglobulin A, and mood in young adults

OBJECTIVE

To investigate the efficacy of a stress management programme on symptoms of colds and influenza in 27 university students before and after the examination period.

METHOD

The incidence of symptoms, levels of negative affect, and secretion rate of secretory immunoglobulin A (sIgA) were recorded for 5 weeks before treatment, for the 4 weeks of treatment, and for 8 weeks after treatment in treated subjects and in 25 others who did not participate in stress management.

RESULTS

Symptoms decreased in treated subjects but not in controls during and after the examination period. Although sIgA secretion rate increased significantly after individual sessions of relaxation, resting secretion rate of sIgA did not increase over the course of the study. Negative affect decreased after examinations in both groups, but was not affected by treatment.

CONCLUSION

Stress management reduced days of illness independently of negative affect and sIgA secretion rate. Although the component of treatment responsible for this effect has yet to be identified, psychological interventions may have a role in reducing symptoms of upper respiratory tract infection.

Psychological interventions and the immune system: a meta-analytic review and critique

This article reviews evidence for the hypothesis that psychological interventions can modulate the immune response in humans and presents a series of models depicting the psychobiological pathways through which this might occur. Although more than 85 trials have been conducted, meta-analyses reveal only modest evidence that interventions can reliably alter immune parameters. The most consistent evidence emerges from hypnosis and conditioning trials. Disclosure and stress management show scattered evidence of success. Relaxation demonstrates little capacity to elicit immune change. Although these data provide only modest evidence of successful immune modulation, it would be premature to conclude that the immune system is unresponsive to psychological interventions. This literature has important conceptual and methodological issues that need to be resolved before any definitive conclusions can be reached.

Complementary and alternative medicine and psychologic factors: toward an individual differences model of complementary and alternative medicine use and outcomes

CONTEXT

Complementary and alternative medicine (CAM) is in widespread use. Study of the psychologic factors associated with CAM use may provide descriptions of subgroups of health care consumers and give further insight into the reasons for using alternative therapies.

OBJECTIVES

To see if the use of CAM is associated with psychologic factors in two outpatient samples and one community sample.

SETTING

The University of Virginia Hospital and Charlottesville community.

PATIENTS

Patients at the Cancer Center (60) and Pain Management Center (63) and adults from the Charlottesville community (63) for a total of 186 participants.

DESIGN

A survey of CAM with psychologic assessment.

MAIN MEASURES

Level of CAM use, effectiveness ratings of CAM, positive affect, negative affect, and the Absorption Scale, which measures a personality factor associated with the capacity for focused attention and mind-body awareness.

RESULTS

Participants using six or fewer CAM scored an average of 13.9 on the Absorption Scale compared to participants using seven or more CAM, who scored an average of 21.4 on Absorption (F = 48.73, p < .0001). Higher effectiveness ratings of CAM were associated with greater positive affect. Pain Center patients rated alternative therapies as least effective, and reported lower positive affect and greater negative affect compared with the Cancer Center patients and community adults.

CONCLUSIONS

Above average use of CAM is associated with higher education, greater well-being and higher Absorption. The personality traits associated with alternative therapies are compatible with participation in these therapies and may facilitate the capacity to benefit from them.

Potential adjunctive applications of hypnosis in the management of periodontal diseases

Many uses of hypnosis in dentistry have been described in the literature including anesthesia, analgesia, anxiety management, treatment for bruxism, to control gagging, and the alteration of salivary flow and bleeding control during treatment. However, very few references have been made specifically regarding the use of hypnosis with patients who have periodontal disease, a wide spread chronic inflammatory disease affecting the oral cavity of about 80% of the population. The purpose of this paper is to describe potential adjunctive applications of hypnosis in the treatment of patients with periodontal diseases. The supporting literature from two broad areas for potential application, health behaviors and psychoneuroimmunology is discussed, followed by proposed hypnotic strategies and suggestions for use with patients with periodontal diseases.