"Tips On How To Apply The Mind-Body Medicine: A Balanced Approach"

Inner IDEA: Dr. Herbert Benson and colleagues talk about the Relaxation Response and the current role of mind-body techniques in wellness and medical care.

“My goal has always been to promote a healthy balance between self-care approaches and more traditional approaches—medical and surgical inter­ventions that can be magnificent and lifesaving when appropriate. However, self-care is immensely powerful in its own right. The elicitation of the Relaxation Response, stress management, regular exercise, good nutrition, and the power of belief all have a tremendous role to play in our healing.”

—Herbert Benson, MD
The Relaxation Response

Herbert Benson, the doctor who defined the Relaxation Response, is hailed as a visionary, a pioneer, a dedicated cardiologist who has devoted much of his nearly 40-year career to the fields of behavioral medicine and mind-body studies. Director emeritus of the Benson-Henry Institute for Mind Body Medicine (BHI) at Massachusetts General Hospital and associate professor of medicine at Harvard Medical School’s Mind/Body Medical Institute, he continues to teach and lead cutting-edge research on ways to counteract the harmful effects of stress. Dr. Benson recently agreed to an interview with IDEA Fitness Journal.

Seeds of Change

Benson’s own journey establishing the mind-body connection began, as he recalls, “in the middle 1960s, when I noticed that people’s blood pressures were higher during visits to my office than at other times and wondered whether stress wasn’t causing that rise. Stress wasn’t on the radar then, so I began investigating a connection between stress and hypertension.” To this end, he returned to physiology research at Harvard to develop a model for stress-induced hypertension using biofeedback technology with monkeys.

On hearing of Dr. Benson’s work on stress and hypertension with animals, a group of Transcendental Meditation (TM) practitioners met with him, stating that they could lower their blood pressure simply by meditating. After what he terms “considerable hesitation,” he agreed to study them. “I collaborated with Robert Keith Wallace of the University of California, Irvine, who was performing similar experiments.” After compiling the data, he and Wallace found that “with meditation alone, the TM practitioners brought about striking physiologic changes—a drop in heart rate, metabolic rate and breathing rate—that I would subsequently label ‘the Relaxation Response.’” [Drs. Wallace and Archie F. Wilson simultaneously conducted similar studies with TM practitioners in California. Later, Wallace joined Dr. Benson at Harvard, where they continued their collaboration.]

Coincidentally, it was in the very room where Benson studied the TM adherents that 60 years earlier Harvard physiologist Walter B. Cannon discovered the “fight-or-flight” response, also known as the stress response. Human beings developed this primitive physiologic response as a mechanism for surviving stressful situations. As Benson explains, “Our bodies release hormones—adrenaline and noradrenaline, or epinephrine and norepinephrine—to increase heart rate, breathing rate, blood pressure, metabolic rate and blood flow to the muscles, gearing our bodies either to do battle with an opponent or to flee.” Benson’s own research showed that the polar opposite was also true: “The body is imbued with what I termed the Relaxation Response, an inducible, physiologic state of quietude.” Teaching people why that quietude is important and how to induce it has been a major focus of Dr. Benson’s work ever since.

“The world is so fast-paced, and it is excitatory,” says Benson. “People think they need more and more excitement to shut their minds off. But, in truth, it is just the opposite. They have to find periods of quietude to rejuvenate, to rebuild their resiliency. People are undergoing changes in the way they think, . . . cognitive restructuring, because they are always looking for [something] new and exciting.” What they really need is to find a balance in their lives, he says, and one of the most effective means of doing that is by incorporating the Relaxation Response into their daily activities.

It has to be something they do daily, he explains, to have “its long-term effects, to have the physical changes in the body—such as brain thickening, such as changes in metabolism. . . . It is what people used to do. Think of our parents or grandparents—they used to pray regularly or they used to do routine exercise. This has left our modern world.”

For instructions on Dr. Benson’s method of relaxation, see the sidebar “How to Elicit the Relaxation Response.”

Integrative Health Care: The Three-Legged Stool

When Dr. Benson founded the Mind/Body Medical Institute in 1988 at Beth Israel Deaconess Medical Center in Boston, his goal was to enhance traditional medical approaches, such as pharmaceuticals and surgery, by cultivating people’s natural capacity to heal. The BHI (at Massachusetts General) opened on December 1, 2006, an important next step that Benson’s colleagues say provides huge growth potential, especially for cutting-edge research in behavioral medicine. The institute’s current literature describes it as a nonprofit scientific and educational organization dedicated to research, teaching and the clinical application of mind-body medicine and its integration into all areas of health. The “Henry” in the name is John Henry, principal owner of the Boston Red Sox and a member of the BHI’s board of trustees.

Benson likens his ideal model for optimal health care to a “three-legged stool.” This model provides a means of achieving better, more balanced care for the patient, he believes. One leg of the stool represents pharmaceuticals; a second represents surgery and procedures; and the third is self-care, the strategies the patient uses to enhance his or her natural capacity to heal.

“Health and well-being is an end-point,” he says, “and to achieve that, most people believe that drugs and surgeries are necessary steps, but there has to be a third leg to that stool, and that is self-care. Self-care is so important because 60%–90% of visits to doctors are related to stress and [are] poorly treated, if treated at all, by drugs or surgeries. So you need that self-care leg, and within self-care you obviously have the Relaxation Response, nutrition, exercise and socialization, and we also have belief and spirituality. What we have to do is learn to respect [self-care’s] importance and then integrate pharmaceuticals, surgery and self-care together.” Benson firmly believes that self-care “is a vital next step” in our current medical environment.

An important key to adequate health and well-being, Benson emphasizes, is integration. “There is no substitute for good surgery, there is no substitute for appropriate drugs, and there is no substitute for helping yourself help yourself. They work together. This is a vital point because it would be inappropriate and inaccurate to believe there is a one-legged stool, where self-care was all you needed.”

Could the self-care approach save the patient and the medical system money? “Oh, without question,” Benson says. “Why should you be spending for drugs that you don’t need or surgeries that you don’t need? But you need a doctor making that decision. I mean it would be tragic if one believed only in self-care and gave up, for example, penicillin that could save your life.”

For patients’ views on how BHI programs are applying the principles of integration, see the sidebar “A Sustainable ‘Whole-Life’ Approach.”

Stress and Resilience

In Benson’s view, understanding stress is a critical element in self-care and mind-body medicine—and a necessary step in learning to appreciate the healing capacities of the Relaxation Response. He defines stress as “any situation that requires behavioral adjustment, whether it is good or bad. A marriage is stressful; so is a divorce. In other words, [stress] is anything to which you have to adjust, and sometimes those changes to which you have to adjust are life-threatening: to avoid an accident, to avoid an attack by another; sometimes they’re worries about your health, your family’s health, worries about your financial situation, which means an adjustment. They all require behavioral adjustment.”

Nurse practitioner Peg Baim, MS, is the clinical director of the Center for Training in Mind/Body Medicine and a researcher at the BHI. As part of Harvard Medical School’s department of continuing education, she teaches classes and seminars with Dr. Benson on the science of stress and how self-care strategies work. Baim says, “If you think about the stress system, it’s the physiology within the body that gets recruited to bring it back into balance whenever it has been challenged. So, if we are too cold, or hungry, or if we are experiencing anxiety or sadness, all of that is going to change the body in such a way as to activate the stress system, which then works harder to get the body back into the narrow parameters of health.”

Baim explains that we have an intricate network of communications “within our hormones, our neuropeptides, and within ourselves.” (Neuropeptides—some of which are endorphins—influence neural activity or functioning.) She describes the communication network as a delicate system of checks and balances that, if taxed too much, depending on our biology, our inherited features and our environmental vulnerabilities, “becomes ‘disregulated,’ and we lose those extremely delicate feedback loops and start expressing illnesses or symptoms.” Allostatic systems allow our bodies to remain healthy by their capacity for change and adaptation; they include parts of the nervous system that control heartbeat, blood pressure and similar functions, as well as glands that collaborate to produce hormonal responses. The wear and tear that results from chronic overactivity or underactivity of allostatic systems, says Baim, is called our allostatic load.

On the other hand, she notes that allostasis is the equivalent of resilience. Resilience, Baim clarifies, “is adaptation through change. That’s really what our body is doing; our body is constantly adapting. We’re adapting to our signals of hunger, low blood sugar, inactivity, or to an individual’s anger, or to being cut off in traffic. When we adapt successfully and we can still stay within the narrow parameters of health, that’s referred to as allostasis or resilience.”

To support resilience, Baim says, people need recuperative sleep, stress man­agement in terms of cognitive re­struc­turing, stress management in terms of methods that elicit the Relaxation Response, a healthy diet, physical activity and social support. She says the Relaxation Response fits into the health equation because “you can’t be psychologically activating the stress system when you are in the Relaxation Response. So it is as if you can’t be hot and cold at the same time.”

When you practice the Relaxation Response, according to Baim, you are actually activating the areas of the brain that have been positively conditioned, rather than those that have been negatively conditioned. “You tend to feel compassion, forgiveness and oneness as opposed to the stress response, where you feel hatred, resentment and [separation]. It is as if we have two different brains.” She says people can elicit the Relaxation Response, using a variety of serviceable techniques, including contemplation, imagery and mindfulness (see the sidebar “How to Elicit the Relaxation Response”).

Baim thinks that many people have lost the positive behaviors that promote resilience, leaving them vulnerable to their negatively conditioned habits and beliefs. The result is chronic activation of the stress response: “It is amazing to me how easily people get angry, how quickly people become impatient; you see, people are really living off their last nerve. The more you live in this stress response, the more you are depleting your serotonin, your dopamine. There is less activation of the cells that secrete serotonin, dopamine and your endogenous opiates, and so it doesn’t feel good to be alive. I think it is very telling that we have an epidemic of depression in school-age children in the United States, for example; that’s a scandal.”

At the BHI, therapeutic cognitive restructuring techniques [changing the way we think and perceive a given event] are taught to assist people in beginning to think positively again. Therapists suggest that the best way to do this is first to identify thoughts and beliefs that are irrational and self-defeating; next to learn about new ways of thinking; and finally to practice them until they become second nature.

The Role of Exercise in Allostasis

Exercise, Baim says, has always played a major role in bolstering the resilience we need to keep stress in check. “Exercise is in and of itself an antioxidant, and stress is an oxidant. Stress is wearing and tearing the body down with more inflammatory molecules, and exercise is actually allowing the body to release molecules that will deactivate that inflammation.”

Jim Huddleston, MS, physical therapist, exercise physiologist and researcher at the BHI, says the idea is for people to find their own balance in the realms of exercise, diet, relaxation and dealing with life stresses. “It is about trying to develop a good homeostasis and balance. That’s why I like yoga, tai chi and Pilates so much; they really help you physically, emotionally and spiritually get better balance. Applying the Relaxation Response to exercise also brings you to that better balance. There is always some new inherent learning experience in a mindful exercise practice.

“The Eastern traditions have that inherent mindfulness built in,” he says, “but you can do it with aerobic exercise, with resistance training; as long as you have the mindset, you can do it with any type of exercise. I like adding that other mindfulness element because [it makes exercise] about total health rather than just fitness, because you are involving the whole body in the process.”

Huddleston notes that there are two criteria for eliciting the Relaxation Response during exercise: focus and an open attitude. These can be accomplished by paying attention to either the breath or the cadence of the activity. “If walking, [people] can focus on the cadence, and if they need to make that more concrete and objective, they can count their steps,” says Huddleston. “People can develop a mantra that they say over and over to themselves in the rhythm of the breath and the rhythm of their walk. This can be accomplished with a standard four-beat count or, if their mind tends to wander, a three-beat count, which puts them off a bit—as long as they have something on which to focus their awareness, so they are not caught up in the extra thinking that we always do, either in the past or in the future. That tends to get us into problems.

“The other criterion, open attitude,” he adds, “is about the experience they are having—not being judgmental or critical or setting certain expectations for themselves about the experience. It is observing what happens with the experience.”

Partnering for Prevention

An integral member of the BHI’s Cardiac Wellness and Lighten Up: Weight Management programs, Huddleston reiterates Dr. Benson’s belief in integration as the foundation for their philosophy. “It is really about helping the [patients] become more responsible for themselves,” he says.

He believes that the healthcare habits people develop can help them maximize their potential. Raising their awareness of what’s healthy and what’s not is a theme that underlies all the BHI programs. “When [people] are more aware, they have more control, and when they have more control, they can make better choices,” he says. Huddleston adds that the medical system needs to “move more into a preventative mode and out of the reactive mode. It is not a healthcare system; it is a sick-care system. We need to concentrate more on being a healthcare system and encourage people to be more responsible for taking care of themselves.”

Asked whether mind-body medicine is presently an equal, fully respected partner in Western medicine, Dr. Benson responds: “No, but it is on the table, and many people are accepting it as an important feature within the medical profession. We are now part of Mas­sachusetts General [the oldest and largest teaching hospital of Harvard Medical School], and that shows where [the BHI] should be based—within a medical establishment. Mass General is world-class with respect to its surgery and with respect to its pharmaceuticals. This institution has now recognized that they want to be experts in self-care.”

For four decades Dr. Benson has stayed true to his goal of changing our concept of health and well-being, using evidence-based medicine. “I’m emeritus director, but I am still working,” he says. “It’s a title. I still put in a full day, and I am delighted with the way things are evolving.” Harvard Medical School has honored his many contributions with the establishment of the Herbert Benson Professorship in Medicine, which will be activated upon his retirement.

SIDEBAR: How to Elicit the Relaxation Response

Two basic components are involved in eliciting the relaxation response:

1. repeating a word, sound, phrase, prayer or muscular activity
2. passively disregarding everyday thoughts that inevitably come to mind and returning to your repetition

The actual steps necessary to evoke the response are as follows:

1. Pick a focus word, sound, short phrase or prayer that is firmly rooted in your belief system.
2. Sit quietly in a comfortable position.
3. Close your eyes.
4. Relax your muscles, progressing from your feet to your calves, thighs, abdomen, shoulders, head and neck.
5. Breathe slowly and naturally, and as you do, say your focus word, sound, phrase or prayer silently to yourself as you exhale.
6. Assume a passive attitude. Don’t worry about how well you are doing. When other thoughts come to mind, simply say to yourself, “Oh well,” and gently return to your repetition.
7. Continue for 10–20 minutes.
8. Do not stand immediately. Continue sitting quietly for a minute or so, allowing other thoughts to return. Then open your eyes and sit for another minute before rising.
9. Practice the technique once or twice daily. Good times to do so are before breakfast and before dinner.

Techniques to Elicit the Relaxation Response

diaphragmatic breathing

meditation

body scan

mindfulness

repetitive exercise

repetitive prayer

progressive muscle relaxation

imagery

Permission to reprint these instructions was granted by Dr. Herbert Benson.

SIDEBAR: A Sustainable “Whole-Life” Approach

A graduate of the BHI’s Lighten Up: Weight Management program, Mary Hardy weighed more than 200 pounds and suffered from some major life stresses when she started at the institute. She believes the program provided her with a sustainable “whole-life” approach. “There was no ‘cookie cutter’ prescription. They didn’t have answers. Instead they modeled the process of personal exploration and seated it in the most up-to-date research in nutrition, exercise and stress reduction,” she says.

Now in her mid-50s and perimenopausal, Hardy says she feels better than she did in her 30s. Her blood pressure and cholesterol are now normal. She is well rested, has lost 60 pounds and says, “I am doing things I haven’t done in years—like hiking, snow shoeing, distance swimming and biking. [BHI] helped me tap into what had personal meaning and frame it in a healthy way of living.”

Mary Hadley, a 50-year-old who completed the BHI’s 13-week Cardiac Wellness program as an outpatient and still attends bimonthly sessions, is also definitive in her praise of the institute’s methods: “That program is lifesaving. It completely changed my quality of life, absolutely 100%. It taught me a new way to think.”

Hadley—who suffers from heart disease, has had two surgeries for chronic back pain and has two children with medical problems—was bedridden when she found the BHI with the assistance of her physician. She says the institute not only helped her manage her pain but got her moving again: “I started on the treadmill for only 3 seconds with my cane and kept working my way up. Now I can go on the treadmill for 30 minutes without help and without my cane. Believe me, it was a painfully slow process.”

Reflecting on her experience, Hadley affirms, “It is an integrative program, a holistic approach; the chronic pain, the cardiac problems and the anxiety are all considered just as important. You’re a person with all kinds of issues, and they are there to help you with each one.”

SIDEBAR: Resources

• Benson, H. 1979. The Mind/Body Effect. New York: Simon and Schuster.
• Benson, H., with Klipper, M.Z. 2000. The Relaxation Response. Updated and expanded edition. New York, HarperCollins.
• Benson, H., & Proctor, W. 2003. The Breakout Principle: How to Activate the Natural Trigger That Maximizes Creativity, Athletic Performance, Productivity, and Personal Well-Being. New York: Scribner.
• Benson, H., with Proctor, W. 1984. Beyond the Relaxation Response. New York: Times Books.
• Benson, H., with Stark, M. 1996. Timeless Healing: The Power and Biology of Belief. New York: Scribner.
• Benson, H., & Stuart, E.M. (with the staff of the Mind/Body Medical Institute). 1992. The Wellness Book: The Comprehensive Guide to Main­taining Health and Treating Stress-Related Illness. New York: Citadel.
• Casey, A., & Benson, H. 2005. The Harvard Medical School Guide to Lowering Your Blood Pressure. New York: McGraw-Hill.
• Casey, A., & Benson, H., with MacDonald, A. 2004. Mind Your Heart: A Mind/Body Approach to Stress Management, Exercise, and Nutrition for Heart Health. New York: Free Press.

Reference: Rosalind Gray Davis

By, Natalie Pyles

Fitness Expert, Nutritionist, Wellness Coach, Lifestyle Consultant, Author, Speaker