Exploring the Neurobiology of Mind-Body-Spirit Unityfiles.academyofosteopathy.org/convo/2019/... ·...
Transcript of Exploring the Neurobiology of Mind-Body-Spirit Unityfiles.academyofosteopathy.org/convo/2019/... ·...
ExploringtheNeurobiologyofMind-Body-SpiritUnity
StaceyPierce-TalsmaDO,MS,RYT-500,FNAOMETouroUniversityCaliforniaCollegeofOsteopathicMedicine
Mind-Body-SpiritUnit
“Thereisoneadditionthatisindispensabletocontrolthisactive
body,ormachine,andthatisthemind.Withthatadded,thewholemachinerythenworksasman.Thethree,when
unitedinfullaction,areabletoexhibitthethingdesired-complete”
A.T.StillDO
Ouremotionsandstressesbecomethefabricofourphysiology
Ourthoughtsandfeelingsbecomechemicalsandhormones
Ourfearsneuralimpulsesreachingouttoallareasofourbody
MoodEffectsonInpatientOutcomes
• 73%riskofbeingreadmitted• twofoldincreaseriskofdeath• Heartfailurepatientswithmoreadverseprognosis• Longerlengthofstay• Morefalls• Predictorofmortalityindialysispatients
MoodEffectsonOutpatientHealth
DepressionandAnxiety
•Strongestpredictorofdeclineinhealthstatus
•COPDpatients-worseQOLandincreased3yrmortality
•DM-increasedriskofmortality,increasedriskofmicro/macrovascularcomplications
•Increasedriskofstroke,MIandcardiacdeath
•Increasedriskofall-causemortality
•Severementaldisordersexperiencea10-20yearlifeexpectancyreduction
Mechanisms
• healthbehaviors• nonadherencetotreatmentplans• Alterationsinphysiology• heightenedSNSactivity• Increasedinflammationandhypercoagulability• Endothelialdysfunction
STRESSPrimaryStressHormones(HPA
Axis)
DisregulationofBiologicalPathways(insulin,glucose,lipids,neurotransmitters)
Impacttoallmajorsystems(organs,tissues,cells,DNA)
Trauma• Alteredchemical&hormonalnetworks,nervefiringpatternsandprocessingofsensoryinformation• pre-verbal• Functionchanges:
• DLPFC• hippocampus• Thalamus• Amygdala• MPFC• Insula
Shifttreatmenttofocuson
strategiesthatbringregionsofthebrainback
on-line
Still Senses•5senses
•Chemicalandelectricalsignalsleadingtoalertness,fear,danger,comfort,security,love
•Oursensesarelinkedtomultiplepathways•Smell•Hearing•Touch
•Oxytocin
Vagus nerve• 80%Afferent
• Interconnectedwithpathwaysthataffectmood,memoryandsenseofself
• VagalNerveStimulation
• Polyvagaltheory• Autonomicnervoussystemintegratedvianeuralcircuitstostriatedmusclesofthefaceandhead• Socialengagementsystem• Neuroception
Movement
Howcanwealterourneurobiology?Processtrauma?
Improveresilienceanddecreasestress?
Exercise
• Depression-neurobiologicalchangesinthemonoaminesystem,HPAaxis,neurogenesisandneuroimmunesystem
•Monoamines• EndogenousOpioids,serotonin,NE,EPI,dopamine
• IncreaseGrowth(Neurotrophicfactors)• VEGF,BDNF,GDNF
• PreventDegeneration(Neuroprotective)• Serotonin,Kynureninepathway,Inflammation(cortisol&immunefunction),oxidativestress
• ComplexNeuroCircuitry• multisynapticcircuitstomovement,cognitionandadrenalmedulla
• Neuroplasticity• exerciseleadstobloodflow,trophicfactors,immunefunction
MindfulMovement• WindowofTolerance
• Howyoushowuponyourmatishowyoushowupinlife
• DefaultModeNetwork
• ChallengeVs.Threat
• “TheAsanabeginsthemomentyouwanttocomeoutofit”B.K.SIyengar
PowerPoses• “Whereourbodieslead,ourmindsandemotionswillfollow”
• Slumpedvs.uprightposture• Confidence,selfesteem,mood,productivity,memory,painperception
• Proprioceptive,interoceptive,vagal
• Canpostureeffectnotonlyourmusculoskeletalhealthandemotions-butdecreaseourstressresponse
Meditation•Disrupts
• stresspathways• automaticreactionsandpatterns
• Focusedattention• strengthenneurologicpathways
BrainStructural&FunctionalChanges
• Thickercortices• diminishedagerelatedatrophy• Increasedgyrification• Largerprefrontalcortex,insula,hippocampusandcingulatecortex• Smalleramygdala• Areasofmoodregulation,responsecontrol,learningandmemory
Mindful,stabilizedattentioncreatesstrongerpathwaystoourself,identityandconsciousness
• TopDownApproach• Consciousness
• BottomUpApproach• Interception• Physiologicsafety
• Neuroplasticity
Telomere-TTAGGG
Breath“Whatwecall“I”isjustaswinging
door,whichmoveswhenweinhaleandwhen
weexhale”
~SHENRYUSUZUKI
WithineachbreathisaStillpoint
DysfunctionalRespiration
• mouthbreathing• hyperventilation
• alteredph• alteredSNS• lessO2delivery• increaseinanxiety
• thoracicbreathingpattern-increasedtension
Thewaywebreathdirectlyeffectsouremotionalstate
• RespiratorySinusArrhythmiaandoscillations
• Slowdeepbreathingincreasesparasympathetictone
• ImprovesHRV-autonomicflexibility
• 6breathsperminuteisthemagicfrequency• highestoscillationsinheartratevariability• Mostefficientgasexchange
• Altersbaroreceptoractivity• Connectionwiththeamygdala
• VagalAfferents
• Oscillationsintreatment
• Vagusnervemediated• Pacedbreathing• Alterscerebralbloodflow• Maypromoteimprovedpulmonaryfunction
• Mayeffectimmunefunction• Vibratoryenergy
“Idon’tsingbecauseI’mhappy-I’mhappybecauseIsing”~WilliamJames
Community• Lonelinessleadstohigherhealthcareutilizationinelderly• SocialisolationassociatedwithanincreasedriskofCADandstroke• comparabletosmoking• greaterthanobesityandhypertension
• LonelinessandsocialstressactivatestheHPAaxis• Canleadtobrainchanges• Powerfulprotectionagainsttrauma
Movement,Breath,Meditation,Mantra• Getpeoplemoving• AndEncouragegoodposture
• Teachthemhowtobreathe• Beginadailymeditationpractice• Chant,sing,pray• Becomepartofacommunity• Socialsupport
• Foryourneurobiology,physiologyandlife!
Bibliography• Slide1Introduction
• AshtangaYogaOpeningPrayerhttps://sharathjois.com/the-practice/opening-prayer/• Slide2Mind,Body,SpiritUnit
• A.T.Still“ThePhilosophyandMechanicalPrinciplesofOsteopathy”1892• Slide3MoodEffectonInpatientOutcomes
• Pederson,Warkentin,Majumdar,McAlister.Depressivesymptomsareassociatedwithhigherratesofreadmissionormortalityaftermedicalhospitalization:asystematicreviewandmeta-analysis.JHospMed.2016May;11(5):373-80
• Sherwood,Blumenthal,Trivedi.Relationshipofdepressiontodeathorhospitalizationinpatientswithheartfailure.ArchInternMed.2007;167(4):367-373
• Haines,Tetal.Depressivesymptomsandadverseoutcomesfromhospitalizationinolderadults:Secondaryoutcomesofatrialoffallspreventioneducation.ArchivesofGerontologyandGeriatrics.2015;60(1):96-102
• Farrokhi,etal.Associationbetweendepressionandmortalityinpatientsreceivinglong-termdialysis:asystematicreviewandmeta-analysis.AmericanJournalofKidneyDisease,2014:63(4):623-635Slide6MoodeffectsonOutpatient
• Slide4MoodEffectonOutpatientHealth• Fan,Ramsey,Giardino.Sex,Depression,andriskofhospitalizationandmortalityinchronicobstructivepulmonarydisease.Arch
InternMed.2007;167(21):2345-2353• Rumsfeld,Jetal.Depressivesymptomsarethestrongestpredictorsofshort-termdeclinesinhealthstatusinpatientswithheart
failure.JournaloftheAmericanCollegeofcardiology.2003;42;(100):1811-1817• Sullivan,etal.Depressionpredictsall-causemortalityepidemiologicalevaluationfromtheACCORDHRQLsubstudy.Diabetes
Care2012;35:1708-1715• Linetal.DepressionandIncreasedMortalityinDiabetes:unexpectedcausesofdeath.AnnFamMed2009;7:414-421• Watkins,L.etal.Associationofanxietyanddepressionwithall-causemortalityinindividualswithcoronaryheartdisease.JAm
HeartAssoc2013• Prematuredeathamongpeoplewithseverementaldisorders.WorldHealthOrganization.
Bibliography• Slide5Stress
• McEwen,B.Nasca,C.Gray,J.Stresseffectsonneuronalstructure:hippocampus,amygdala,andprefrontalcortex.Neuropsychopharmacology2016;41(1):3-23
• Lupien,S.,Juster,RP.,Raymond,C.,Marin,MF.Theeffectsofchronicstressonthehumanbrain:fromneurotoxicity,tovulnerability,toopportunity.FrontiersinNeuroendocrinology.April2018;49:91-105
• Felitti,V.etal.RelationshipofChildhoodabuseandhouseholddysfunctiontomanyoftheleadingcausesofdeathinadults.AJPM.May1998;14(4):245-258• Herman,J.etal.Regulationoftheyhypothalamic-pituitary-adrenocorticalstressresponse.CompPhysiol.2016;6(2):603-621Slide7Trauma
• Slide6Trauma• BesselVanDerKolk.Thebodykeepsthescore-brain,mind,andbodyinthehealingoftrauma.PenguinBooksNY,NY2014
• Slide7ATStill’sThoughtsontheSenses• A.T.Still“ThePhilosophyandMechanicalPrinciplesofOsteopathy”1892• Lehrner,J,etal.Ambientodorsoforangeandlavenderreduceanxietyandimprovemoodinadentaloffice.Physiology&Behavior2005;86:92-95• Lotsch,etal.Smellofpain:intersectionofnocieptionandolfaction.Pain2016;157:2152-215• Hole,J.etal.Musicasanaidforpostoperativerecoveryinadults:asystematicreviewandmeta-analysis.TheLancet2015;386(10004):1659-1671• Raglio,A.etal.Effectsofmusicanmusictherapyonmoodinneurologicalpatients.2015:WorldJPsychiatry;5(1):68-78• Hertenstein,M.Touch:Itscommunicativefunctionsininfancy.HumanDevelopment2002;45:70-94• Hertenstein,M.etal.Touchcommunicatesdistinctemotions.Emotion2006;6(3):528-533• Light,K.etal.Morefrequentpartnerhugsandhigheroxytocinlevelsarelinkedtolowerbloodpressureandheartrateinpremenopausalwomen.Biological
psychology.2005;69:5-21• Colino,S.Thehealthbenefitsofhugging.U.S.News&WorldReport.Feb3,2016https://health.usnews.com/health-news/health-wellness/articles/
2016-02-03/the-health-benefits-of-hugging• 8VagusNerve
• Lehrer,P.,Gevierts,R.Heartratevariabilitybiofeedback:howandwhydoesitwork?FrontPsychol.2014;5:756• Porges,S.Thepolyvagaltheory:newinsightsintoadaptivereactionsoftheautonomicnervoussystem.CleveClinJMed.2011;72(suppl2):S86-S90• Porges,S.Thepocketguidetothepolyvagaltheorythetransformativepoweroffeelingsafe.2017W.W.Norton&Company
• Slide9MovementIntroduction
Bibliography• Slide10-Exercise
• Eyre,H.,Baune,B.Neuroimmunologicaleffectsofphysicalexerciseindepression.Brain,Behavior,andImmunity.September2011
• Petzinger,etal.Exercise-enhancedneuroplasticitytargetingmotorandcognitivecircuitryinParkinson’sdisease.LancetNeurol2013;12(7):716-726
• McDonnell,etal.Asingleboutofaerobicexercisepromotesmotorcorticalneuroplasticity.JAppPhysiol2013;114:1174-1182
• Ahlskog,J.Doesvigorousexercisehaveaneuroprotectiveeffectinparkinsondisease?Neurology2011;77(3):288-294
• Dum,Levinthal,Strick.Motor,cognitive,andaffectiveareasofthecerebralcortexinfluencetheadrenalmedulla.PNAS.2016
• Slide11-MindfulMovement
• Baptiste,B.PerfectlyImperfecttheartandshouldofyogapractice.HayHouseInc2016
• Robin,M.Aphysiologicalhandbookforteachersofyogasana.FenestraBooks2002
• Slide12PowerPosing• Cuddy,AmyPresenceBringingyourBoldestSelftoyourBiggestChallenges.BackBayBooksLittle,BrownandCompany,NY2015
• Nair,S.etal.Doslumpedanduprightposturesaffectstressresponses?Arandomizedtrial.HealthPsychology-AmericanPsychologicalAssociation2014
• Slide13-MeditationIntroduction
Bibliography• Slide14MeditationandBrainchangesStructural&Functional
• Tang,Holzel,Posner.Theneuroscienceofmindfulnessmeditation.NatureReviewsNeuroscience.2015• Gotink,Etal.8-weekmindfulnessbasedstressreductioninducesbrainchangessimilartotraditionallong-termmeditationpractice-asystematicreview.BrainandCognition2016;108:32-41
• Luders,Clark,Narr,Toga.Enhancedbrainconnectivityinlong-termmeditationpractioners.Neuroimage2011;57(4):1308-16• Luders,E.etal.Theuniquebrainanatomyofmeditationpractioners:alterationsincorticalgyrification.Front.HumNeurosci2012
• Slide15MeditationandBrainChanges-Thepathway• Slide16MeditationandTelomeres
• Epel,etal.Acceleratedtelomereshorteninginresponsetolifestress.ProcNatlAcadSciUSA2004;101(49):17312-5• Epel,etal.Canmeditationslowrateofcellularaging?Cognitivestress,mindfulnessandtelomeres.AnnNYAcadSci2009:1172:34-53• Hoge,etal.Loving-kindnessmeditationpracticeassociatedwithlongertelomeresinwomen.Brain,Behavior,andImmunity.2013;32:159-163• Conklinetal.Insightmeditationandtelomerebiology:theeffectsofintensiveretreatandthemoderatingroleofpersonality.Brain,Behaviorand
Immunity.2018;70:233-245• Ornish,etal.Effectofcomprehensivelifestylechangesontelomeraseactivityandlengthinmenwithbiopsy-provenlow-riskprostatecancer:5yearfollow-
upofadescriptivepilotstudy.LancetOncology2013
• Slide17-Breath• Baptiste,B.Perfectlyimperfecttheartandsoulofyogapractice.HayHouse2016• Xun-chao,L.etal.Effectsofyogatraininginpatientswithchronicobstructivepulmonarydisease:asystematicreviewandmeta-analysis.JThoracDis.
2014;6(6):795-802• Ali,A.etal.theinfluenceofsnoring,mouthbreathingandapneaonfacialmorphologyinlatechildhood:athree-dimensionalstudy.BMJOpen;5(9)• Vleeming,Mooney,Stoeckart.MovementStability&lumbopelvicpainintegrationofresearchandtherapy2ndedition.ChurchillLivingstoneElsevier2007
Bibliography• Slide18BreathandPhysiology
• Bergland,C.DiaphragmaticBreathingexercisesandyourvagusnerve.PsychologyToday.May16,2017• Lehrer,P.,Gevirtz,R.Heartratevariabilitybiofeedback:howandwhydoesitwork?Front.Psychol.July2014• Wang,S.Etal.Effectofslowabdominalbreathingcombinedwithbiofeedbackonbloodpressureandheartratevariabilityinprehypertension.JAlternComplementMed2010;16(10):1039-45
• Nelson,K.etal.RecordingtheRateoftheCranialRhythmicImpulse.JAOA;2006;106:337-341• Minassian,A.etal.Associationofredeploymentheartratevariabilitywithriskofpyostdeploymentposttraumaticstressdisorderinactive-dutymarines.JAMAPschyiatry.2015;72(10):979-86
• Slide19PhysiologyofChanting• Bernardi,L.etal.Effectofrosaryprayerandyogamantrasonautonomiccardiovascularrhythms:comparativestudy.BMJ2001;323(7327):1446-1449• Kalyani,B.etal.Neurohemodynamiccorrelatesof‘OM’chanting:apilotfunctionalmagneticresonanceimagingstudy.IntJYoga.2011Jan-Jun;4(1):3-6• Khalsa,D.etal.Cerebralbloodflowchangesduringchantingmeditation.NuclearMedicineCommunications,2009;30(12):956-961• Mooventhan,A.EffectofBhramaripranayamandOMchantingonpulmonaryfunctioninhealthyindividuals:aprospectiverandomizedcontrolledtrial.IntJYoga.2014;&(2):104-110
• Torkamani,F.etal.Effectsofsingle-sessiongroupmantra-meditationonsalivaryimmunoglobulinAandaffectivestate:apsychoneuroimmunologyviewpoint.Explore201814(2):114-121
• Slide20Community• Valtoraetal.Lonelinessandsocialisolationasriskfactorsforcoronarydiseaseandstroke:systematicreviewandmeta-analysisonlongitudinalobservationalstudies.BMJ2016
• Gerst-Emerson,Jayawardhana.Lonelinessasapublichealthissue:theimpactoflonelinessonhealthcareutilizationamongolderadults.AmJPublicHealth,2015;105(5):1013-1019
• Donovan,N.Okereke,O.,Vannini,P.Associationofhighercorticalamyloidburdenwithlonelinessincognitivelynormalolderadults.JAMAPsychiatry2016;73(12):1230-1237
• Slide21Howtochangeyourpatientsneurobiology