The Center for Integrative Mind Body Medicine


The Situation

Medical treatment options remain inadequate for many chronic, difficult to treat medical conditions. With increasing budget constraints, the cost of the military health system has continued to grow at an alarming rate. A large portion of our resources are consumed to treat costly chronic illnesses linked to or exacerbated by stress. 60-90% of all ambulatory visits are estimated to be for issues attributed to stress. That stress fuels a sense of hopelessness that immobilizes the patient from taking care of themselves physically, emotionally and spiritually. It is a priority of the Military Health System to recapture care from the network through a strategy of improving the patient’s customer experience.

A Solution

Mind Body Medicine is an evidence-based medical discipline focused on the inseparable connection between the mind and the body and incorporates:

• Relaxation response – the physical state of deep rest that changes the physical and emotional response to stress through scientifically proven methods (meditation, mindfulness, progressive muscle relaxation, tai chi, qigong and yoga)

• Resiliency Building – remembered wellness through guided imagery techniques, cognitive-behavioral and positive psychology therapeutic modalities

• Healthy Living – Physical activity, nutrition and sleep

• Social support

Daily elicitation of the relaxation response for 15-20 minutes has been demonstrated to lead to the following:

• Reduced heart rate, breathing rate, oxygen consumption, and overall metabolic rate

• Reduced oxidative stress

• Improved attention and focus

• An observable modification at the genetic level through changed expression correlated with improved immune and inflammatory function

Mind Body Medicine improves medical conditions caused by or exacerbated by stress. The end result for the patient is better self-care, leading to symptom reduction and enhanced well-being. Evidence is mounting for the clinical benefit for several conditions. Strong to moderate evidence is seen in various pain conditions, hypertension, cardiovascular disease, surgical outcomes, cancer treatment tolerance and incontinence. Evidence is growing supporting mind body medicine approaches for allergies, asthma, diabetes, HIV, psoriasis, irritable bowel syndrome, obstetrics, chronic obstructive pulmonary disease, and mental health disorders. Reducing stress has even been found to be effective in treating tinnitus, a condition that leads to billions in disability claims within the VA.

Evidence is also growing that mind body interventions as a complementary treatment to conventional medicine reduces the overall cost of care for several conditions. Of note, Caudil et al. (1991) demonstrated that 109 patients who participated in a mind body medicine course had 36% fewer physician visits leading to savings of $12,000 in the first year and $23,000 by year two. Lorig, Mazonson & Holman (1993) used a mind body approach focused on self-management of arthritis leading to a 19% reduction in pain and a 43% reduction in physician visits.

The Program

Our program, based on the model provided by the Benson-Henry Institute in Boston, MA is a multi-week group course to teach and reinforce the four main principles of mind body medicine with a goal of incorporating and sustaining healthy lifestyle and cognitive habits in the patients. We envision a program seamlessly integrated with the various medical disciplines maximizing treatment responses for chronic, difficult to treat conditions and providing greater resiliency to various beneficiaries from new mothers to the war wounded to our own staff. Our center will support the development of mind body medicine courses tailor made for the unique needs and challenges of groups of patients with similar conditions. Although the center will take the lead in design and implementation of these particular courses, the medical specialties most involved with the conventional treatment of the condition will also actively participate in the design and execution of the courses. Through collaboration with traditional medicine leaders, we hope to create buy-in from these providers leading to a strong referral base and robust use of these evidence-based interventions.

The Pilot Program

To create a successful integrated mind body medicine program, we propose an initial implementation at Naval Medical Center San Diego (NMCSD) limited to the chronic pain population. This population was selected based on an already high acceptance of mind body medicine within the pain specialty clinic, a high demand for pain services within NMCSD including many wounded warriors and strong to moderate evidence in the literature for the efficacy of a mind body approach in this challenging patient population. A six to eight week course will be designed with guidance from the Benson-Henry Institute and implemented for a group of 18-22 patients. Pre, post and four month post-treatment outcome measures will be collected looking at mental health, somatic complaints and quality of life. Data will also be collected on outpatient, inpatient, emergency room and medication utilization during that period. Qualitative data will be collected through focus groups to look at aspects of the program that the patients found helpful or confusing, areas of resistance or challenge in compliance with the program and suggestions to ensure the concepts are readily understood.

After completing two to three cycles of a mind body medicine course tailored toward pain, the program will be expanded to the NMCSD HIV population . This population was selected based on similar high acceptance of mind body medicine principles with the NMCSD HIV clinic, a high cost of care to serve this population and evidence supporting its use. Similar pre, post and four month post-treatment measures will be collected on mental health, somatic complaints, quality of life and medical service utilization as well as other objective measures such as viral load.

Based on the results of this pilot and utilizing the lessons learned, we plan on expanding tailor-made mind body medicine programs to various other chronic patient populations as well as a focus on provider wellness.

Conclusion

Our program vision outlines a truly integrative and collaborative approach to bringing proven mind body medicine techniques efficiently to the patient populations that have the most potential benefit from these interventions. Through refinement and testing, a successful program implemented at a Navy major treatment facility could readily be replicated at other major treatment facilities from all service branches. The potential for a well crafted program to enhance overall health, operational readiness and reduce the cost of health care is enormous.

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