Integrative, Participatory Medicine

        The American Academy of Family Physicians has estimated that up to two-thirds of all office visits to family doctors are for stress-related symptoms. Recent research has indicated that up to 60% of all HMO visits are made by people with no diagnosable disorder--the “worried well” (Sobel 1995)--and that many of these presenting symptoms are related to the patient’s psychosocial functioning--things such as depression, anxiety, social isolation, overwork, etc. (Kroenke & Mangelsdorff 1989). At least one third of cardiology patients presenting with chest pain who have normal or near normal coronary arteries have been found to be suffering from panic disorder (Kusher 1989).

Mindfulness training has been shown to be effective in addressing the malaise that often accompanies these presentations (Kabat-Zinn 1982, 1985, 1986, 1992, Miller, 1995, etc.) and further evidence of this can be seen in studies showing reduced need for clinical services following meditation training (Kabat-Zinn,1987, Hellman 1990, Caudill 1991, Tate 1994, Orme-Johnson 1994).

Published research has repeatedly demonstrated that meditation and relaxation training can be powerful adjuncts to the conventional medical treatment of many disorders. Patients who participate in the eight week Mindfulness Stress Reduction Program, developed at The University of Massachusetts Medical School and offered now by The Institute for Mindful Living, are taught to become aware of, and develop, their own resources to support their health, thus becoming more stress hardy, a quality that is associated with better health across the life span. Published evaluations of the medical outcomes resulting from patient participation have shown a 35% reduction in the number of medical symptoms and 40% reduction in psychological symptoms (stable over four years)(Kabat-Zinn 1982, 1985, 1986, 1992, Miller et al, 1995, etc.).

Over the last thirty years, 18,000 patients have completed the Stress Reduction Program at the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical School. Over 4,000 physicians as well as other health care providers have referred their patients to this program with exceptional results. Thousands of people worldwide have entered similar programs offered by practitioners trained by senior staff members at The Center for Mindfulness.

Integrative, participatory medicine is a cooperative model of health care that encourages and expects active involvement by all connected parties (patients, caregivers, healthcare professionals, etc.) as integral to the full continuum of care. As early as 1946, The World Health Organization defined optimal health as “more than the absence of disease, involving mental, physical and social well-being.” Duke University’s Department of Integrative Medicine offers the model below depicting the essential role of mindfulness in overall health and well being.

Coronary Artery Disease

        The addition of meditation training to the standard cardiac rehabilitation regimen has been shown to reduce mortality (41% decrease during the first two years following, and 46% reduction in the rate of recurrence), morbidity, psychological distress, and some biological risk factors (plasma lipids, weight, blood pressure, blood glucose) (Linden 1996, Zammara 1996). Meditation practice alone has been show to reduce exercise-induced myocardial ischemia in patients with coronary artery disease (Zammara 1996, Ornish 1983).

Hypertension

    Meditation training has been shown to reduce blood pressure in amounts comparable to the changes that are produced by medication and other lifestyle modifications such as weight loss, sodium restriction, and increased aerobic exercise (Schneider 1995, Linden & Chambers 1994, Alexander 1994).

Cancer

    A randomized trial with cancer outpatients showed Mindfulness-Based Stress Reduction (MBSR) was effective in significantly decreasing mood disturbance (65%), including depression, anxiety, anger and confusion, and also in decreasing the symptoms of stress such as cardiopulmonary and gastrointestinal symptoms (Speca 2000). These changes were sustained at six month follow up (Carlson 2001). Survival rates of both melanoma and metastatic breast cancer patients have been significantly improved by relaxation and meditation training (Fawzy 1993, Speigal 1989) and psychological distress was lessened in women with early breast cancer (Bridge 1988). Anticipatory nausea and vomiting due to chemotherapy is also inhibited (Green 1991).

Chronic Pain

        Mindfulness meditation has been shown to reduce both the experience of pain and its inhibition of patients’ everyday activities. Further, mood disturbance and psychological symptomatology (including anxiety and depression) are also reduced. Pain-related drug utilization was decreased and activity levels and self esteem increased. This was in marked contrast to a traditional pain clinic comparison group, which showed no change on these dimensions (Kabat-Zinn 1982,1985). These gains were nearly all maintained at four-year follow-up (Kabat-Zinn 1987).

Anxiety

    Mindfulness training has been shown to clinically reduce symptoms of anxiety, psychological distress and secondary depression (Kabat-Zinn 1992). Changes were maintained at 3-year follow-up (Miller 1995).

Depression

          Skills derived from mindfulness training and cognitive therapy have been shown effective in significantly reducing the recurrence of major depressive episodes in patients who have been treated for depression (Ma & Teasdale 2004, Segal 2002, Teasdale 2002, Teasdale 2000).

Asthma/Respiratory Disorders

        Relaxation training has been shown to improve the psychological well-being, functional status and frequency of attacks of asthma patients as well as adherence to treatment (Devine 1996). It has also been shown to have a beneficial effect on dyspnea and psychological well-being among adults with obstructive pulmonary disease (Devine & Pearcy, in press).

Fibromyalgia

            Mindfulness training resulted in clinically significant improvements in physical conditions as well as in both psychological and social spheres (Grossman et al. 2007, Weissbecker 2002).

*CAM: Complimentary & Alternative Medical Treatments

The practice of mindfulness is at center of the Duke Integrative Medicine Model, surrounded by various aspects of self-care. Whatever form of treatment is chosen by the patient--preventive medicine, conventional medicine, complimentary and/ or alternative treatments, or pharmaceuticals and supplements--rests on the foundation of awareness.

There is power and empowerment in participatory, integrative medicine. By adopting practices of mindfulness, patients can collaborate with providers to restore their own health, wholeness and balance and harmony within.

Source material from The Center for Mindfulness in Medicine, Health Care, and Society publication, Issues in the Administration of a Mindfulness-Based Stress Reduction Program, 2010

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