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2015 Cancer Survivorship Conference - Spiritual, Physical & Mental Health

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2015 Cancer Survivorship Conference - Spiritual, Physical & Mental Health

  1. 1. Moving Toward Wholeness: The Relationship Between Spiritual, Physical, and Mental Health Andrew Newberg, M.D. Director of Research Myrna Brind Center of Integrative Medicine Thomas Jefferson University and Hospital
  2. 2. What is Wholeness? Wholeness refers to the sense of unity or connectedness people can feel with other things Wholeness can refer to a person’s physical health and well being Wholeness can refer to a person’s spiritual experience or spiritual well being Wholeness relates to certain brain structures and functions
  3. 3. The Brain and Wholeness First we must understand how and where wholeness is experienced Use phenomenological analysis to understand wholeness Correlate wholeness with brain processes Use modern scientific methods to better understand biological correlates of wholeness Neurotheology as a framework for this discussion
  4. 4. When and Where Does Wholeness Occur? Wholeness is central part of every religious and spiritual tradition Central tenet is that we are separated from the source (i.e. something sacred or absolute) The goal is to reconnect and become whole with God or Absolute reality Primary means for attaining wholeness is through various practices Ritual, meditation, prayer
  5. 5. Wholeness in the Brain Binary function of the brain (inferior parietal lobe) Orientation area of the brain (superior parietal lobe) Rituals, meditation and prayer can alter activity in the parietal regions Brain scan studies of meditation and prayer practices These practices also affect the body creating health and wholeness
  6. 6. Other Brain Areas Involved in Wholeness Emotions related to limbic system Amygdala and hippocampus Frontal lobes associated with increased attention and willfulness Modulates emotion Sense of surrender Thalamus regulates brain functions and consciousness
  7. 7. Functional Areas of the Brain
  8. 8. Orientation Area Orientation Area Baseline Meditation SPECT Images at Baseline and During Meditation
  9. 9. SPECT Images at Baseline and During Meditation Baseline Meditation Attention Area Attention Area
  10. 10. Superior Parietal Lobe Superior Parietal Lobe Baseline Scan Prayer Scan Comparison of Baseline to Prayer
  11. 11. How Do Spiritual Practices Change Your Brain over time? Combine imaging and other scientific measures with subjective and phenomenological evaluation Longitudinal findings Comparison of long-term meditators with non- meditators Do spiritual practices affect the brain over time? Kirtan Kriya and memory study
  12. 12. Kirtan Kriya Meditation Study A C B D
  13. 13. Neuroemotional Technique NET is a program that utilizes several different concepts to provide a sense of wholeness and reduce stress and anxiety NET utilizes concepts from acupressure, biofeedback, and cognitive therapy NET has been particularly effective in helping patients with various health and psychologically related traumas
  14. 14. Cancer and Stress Stress can manifest in a variety of physical and psychological symptoms Referred to in the cancer literature as “Distressing Recollections” About 1/3 of cancer patients have distressing recollections These distressing recollections cause as much morbidity as PTSD The two primary psychological symptoms of distressing recollections are avoidance and intrusive thoughts
  15. 15. Avoidance Avoidance is driven by strong unpleasant feelings (primarily fears) triggered by trauma- related thoughts, places (i.e. hospitals, doctor’s offices, etc.) Likely associated with increased amygdala activity Avoidance is manifested through staying away and escaping these provocative cues
  16. 16. Intrusive Thoughts Involuntary, unwanted thoughts, memories or images Intrusive thoughts are usually upsetting and often indicate an ongoing coping and mental processing of an unresolved stressful event
  17. 17. Jefferson-NET Study To assess the effect of the NET program on cancer patients with a history of distressing trauma To evaluate the effect of the NET on brain function Patients must have a history of cancer and a related distressing psychological trauma Patients are screened, evaluated for inclusion criteria, undergo psychological evaluation, and then scanned in the fMRI After the NET program patients again undergo psychological evaluation and fMRI
  18. 18. Study Design-Subjects Inclusion Criteria Age ≥18 years of age Distressing cancer-related recollection that causes physiological reactivity (i.e., increased heart rate >5% and/or increased skin conductance level >33%). Received a cancer diagnosis between 6 months and 3 years prior to participating in study Exclusion Criteria Any current major psychiatric disorder History of depression before the cancer diagnosis Current diagnosis of substance abuse or dependence Use of some psychotropic medications are allowed such as SSRIs and certain sleep aids Currently receiving chemotherapy or radiation
  19. 19. fMRI Protocol Structural scan – required to provide anatomical information Resting functional connectivity scan (BOLD) (pre) – shows how different structures are connected to each other Diffusion tensor imaging (DTI) scan – shows actual connecting tracts within the brain Resting perfusion (Arterial Spin Labeling) scan (pre) – shows the brain’s activity at rest before the stressor task Neutral perfusion (ASL) scan – shows the brain’s activity while listening to a control stimulus Stressor perfusion (ASL) scan – shows the brain’s activity while listening to the stressor stimulus Resting functional connectivity scan (BOLD) (post) – shows how different structures are connected to each other
  20. 20. fMRI Results
  21. 21. Perfusion fMRI Stressor – Neutral Pre NET Treatment
  22. 22. Perfusion fMRI Stressor – Neutral Post NET Treatment
  23. 23. Functional Connectivity Between the Amygdalas Pre NET Treatment Pre- Stressor Induction Post- Stressor Induction LR R L R=0.36 R=0.50
  24. 24. Functional Connectivity Between the AmygdalasFunctional Connectivity Between the Amygdalas Post NET TreatmentPost NET Treatment LR R L R=0.37 R=0.34 Pre- Stressor Induction Post- Stressor Induction
  25. 25. Diffusion Tensor Imaging (DTI)Diffusion Tensor Imaging (DTI) After the NET program, the fiber density increased between the frontal lobes and amygdala by ~50%.
  26. 26. NET Conclusions The data show marked changes in the fMRI results between the pre and post NET scans The amygdala is highly reactive pre-NET and actually decreases in reactivity post-NET The frontal lobe appears to be able to modulate the amygdala’s reactivity post-NET The NET program normalizes the brain’s reaction to trauma (stressor) We now await more data to confirm and augment these initial findings
  27. 27. Final Conclusions: Can we foster wholeness and well being? We can turn to practices and beliefs that foster more compassion, wholeness and well being Find practices that work best for you and are consistent with your belief system Specific practices such as meditation and prayer affect the wholeness areas of the brain Practices like NET lower stress response and anxiety Wholeness can ultimately fill your brain, health, and life
  28. 28. The End Andrew Newberg Jefferson-Myrna Brind Center of Integrative Medicine 215-955-2221 Andrew.newberg@jefferson.edu 215-503-3422

Editor's Notes

  • Two monks were arguing about the temple flag waving in the wind. One said, “The flag moves.” The other said, “The wind moves.” They argued back and forth but could not agree. Hui Neng, the Sixth Patriarch said, “Gentlemen! It is not the flag that moves, it is not the wind that moves, it is your mind that moves.” The two monks were struck with awe!
    This is the basis for the discussion about why God won’t go away.
    It is the mind that allows for all of our experiences.
    We must understand how the mind works in order to understand religious and spiritual experience and why they are so tenacious.
  • Frontal lobe is interpretive structure which is decreased during trauma. Frontal lobe is not controlling amygdala.

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