aed Mind-Body Intelligence A New Perspective Integrating Eastern and Western m Ellen M. Adelman, PhD The purpose of this article is to introduce a new approach that integrates mindfulness meditation practices and Western psychotherapeutic approaches into a holistic program. KEY WORDS: mind-body intelligence, mindfulness meditation, psychoneuroimmunology, Qigong Holis Nurs Pract 2006:20(3):147-151 WHAT IS THE MIND-BODY INTELLIGENCE APPROACH? Mind-body intelligence (MBI) is a systemat psychological approach that addresses both emotional and physiological healing. MBI combines mindfulness meditation techniques, mindful movement techniques, healing meditation practices, and Western and Buddhist psychology. It is based on the premise that there is a therapeutically accessible interface between mind and body. This interface is the locus for nterventions affecting the whole person. Significant findings in the literature indicate that techniques drawn from Eastern wisdom traditions have a beneficial effect ‘on both psychological and physical conditions.':? From the medical perspective, we see increasing interest in the field of psychoneuroimmunology, the impact of the mind on the functioning of the sympathetic nervous system and the effects of stress on the body's ability to cope with disease. Mindfulness meditation practice has been clearly identified as an effective tool in decreasing stress and enhancing the functioning of the whole parasympathetic nervous system and in particular, the immune system. MBI is a multimodal approach that recognizes the patient as an individual psychological and physiological entity, as well as a member of his family, social, vocational, and medical systems. ‘Treatment is therefore informed by the following rom Psyeare Solutions, Ine, Sage Healing Institue, Philadphi CCoreesponing author: Ellen M. Adelman, PAD, Psyeare Solutions, ne, Sage Healing Insite, Briar House Suite #12, 8302 Old York Rd, Elkins Prk, PA 19027 (email: Ellensage@aol com), Pa psychological theories and techniques. + Family and systems theory + Psychodynamic theory + Cognitive-behavioral techniques + Principles of Buddhist psychology In addition, MBI recognizes the importance of the spiritual aspects of human life and well-being and its, connection to the process of emotional and psychological healing.” The core treatment modality occurs in a group context. ‘The foundation of this group treatment program is based on an 8-week model originally developed by Jon Kabat-Zinn at the University of Massachusetts called, “Mindfulness-Based Stress Reduction.”* A significant body of research over the past 20 years has demonstrated the powerful effectiveness of mindfulness-based programs in treating an array of, both physically and psychologically based issues. Clinical benefits have been seen in conditions ranging from chronic pain, binge-eating disorder, and fibromyalgia.' Also, studies have shown significant enhancement of the immune system function in cancer patients and immunologic reconstitution in HIV-positive gay men, as well as positive changes in the mental status of both groups.**° Significant decreases in psychiatric symptoms such as anxiety and depression have also been shown. In general, both patients and normal subjects (such as medical students), have demonstrated significant benefits through increased quality of life, decrease in pain symptoms, increase in self-esteem, and increase in sleep qual 147148 Housric IRSING PRACTICE # MaYIJUNE 2006 ‘The core skill that the patient must acquire is that of “mindfulness meditation.” This strategy is derived nominally from the Buddhist traditions of India, China, Tibet, and Japan. However, its counterparts exist in all of the major spiritual traditions. Although patients and practitioners may experience MBI practice as a spiritual tradition, its a nonsecular practice. Mindfulness meditation technique has 3 major components in the MBI program. The first i that of diaphragmatic breathing. The second component involves acquisition of the ability to quiet discursive thought and increase moment-to-moment awareness. The third component is the orientation toward the experience of life taught by the principles of Buddhist psychology. These skills provide powerful cognitive and physiological tools to decrease stress, enhance physical well-being, and encourage a life perspective, which is inherently less stressful, decreases anxiety and depression, and provides for a greater sense of fulfillment. Mindfulness meditation helps the meditator develop a greater awareness of the many levels of their experience and the role that mind plays in creating our reality. One begins to develop an attitude of nonjudgment. oneself and others.'®-!! Many practitioners of psychotherapy have been. exploring the integration of Buddhist psychology the issues of spirituality into their traditional practice. There is a call in the literature for the integration of Western psychology and the Eastern meditative and contemplative traditions."”"!? MBI is one answer to that call, ‘The MBI model is informed by the 3 Jewels of Buddhist practice. They are Awakening. Truth, and Community. Awakening or enlightenment is clearly an aspiration shared with Western psychology and Buddhist psychology. The clinician cultivates his or her own ability to be insightful, clear-seeing and skillful in all therapeutic endeavors, In addition, however, we encourage our patients to develop their own cap: to objectively and compassionately examine self These insight skills are developed through a range of mindfulness practices including concentration and insight meditation. This work enhances the patient's ability to enter their inner emotional world. It encourages patients to feel less dependent upon therapy and more empowered to take responsibility for the course of their own lives. Truth or following a path of right action is explicit to spiritual practice and implicit to psychotherapy. y Even though we do not overtly promote “good behavior” as psychotherapists, it is certainly inherent to our value system. We believe that acting in ways that take others into consideration, create healing, healthy relationships and generally contribute to the well-being of humanity and the planet, are behaviors to be valued. As the patient develops “clear-seeing” and an increased sense of compassion for themselves, they are better able to make behavioral choices, which are beneficial to themselves and others. MBI helps to clarify the guidelines of compassion-based behavior. Participants can connect with their healing on a behavioral and a spiritual level simultaneously. Community is crucial for those of us dealing with life’s difficulties, be they emotionally or physically oriented. The MBI program encourages the development of a healing, compassion-based community, through ongoing community medita opportunities. In addition, development of community is fostered for those clinicians who have incorporated a mindfulness practice into their own lives, through ongoing trainings and community meditation. ion THE ROLE OF QIGONG AND MINDFUL MOVEMENT Mindful movement in the form of Hatha yoga is an integral part of the work done by Kabat-Zinn et al.* These practices provide a doorway into meditation for those who have difficulty sitting in physical stillness. In addition, yoga is strengthening and allows one to encounter one’s physical growing edge in the context of a mindfulness practic The MBI program includes Hatha yoga, but places a heavier emphasis on the use of Qigong (pronounced “Chee gung.” This practice is based in Traditional Chinese Medicine and has its roots in Taoism and Buddhism. Itis the parent tradition of Tai Chi and Kung Fu.'> Qigong is a particularly beneficial practice due to its emphasis on guided imagery specifically directed at healing the body in combination with mindfulness meditation and simple but highly effective strengthening exercises Qigong has been the subject of extensive research in China but very little of this literature has been translated into English. In China, there have been reports of cancer remission as a result of Qigong practice.'* We have seen some recent studies inWestern journals indicating positive results with elderly cardiac patients. Their self-report indicated increased physical activity, balance, and coordination." A study of patients with type 2 diabetes mellitus showed that Qigong may improve insulin resistance and improves glucose metabolism.'* Another study showed increased cell mediated immunity in older patients with varicella-zoster virus.! Qigong practice encourages a real intimacy with one’s physical being. The practitioner becomes increasingly familiar with their own internal organs, bones and muscles, and develops greater physical strength and balance, increased and more efficient circulation, and greater vitality. Directed mindful meditations encourage healthy function and healing of targeted areas of the body. ‘We can better understand the mechanism of Qigong through the lens of psychoneuroimmunology. This burgeoning field is at the heart of mind-body medicine. We have learned that there are unified psychophysiological responses occurring in our minds and bodies. These responses are mediated by the biochemicals known as neuropeptides. In a reciprocal relationship, our thoughts and biochemistry are continuously influencing each other. We have also Jeamed that the meditative state is a powerful antidote to the effects of chronic stress. Qigong can be a powerful vehicle for mindful thoughts and movement, in conjunction with the meditative state, to influence the creation of specific neuropeptides and their distribution, which in tum, enhance our immune systems, our ability to heal, our feelings of well-being and ongoing health.!* TREATMENT MODEL Patients who will benefit from the MBI treatment program can be identified in many setting both psychotherapeutic and medical. In the realm of psychotherapeutic treatment, patients identified as suffering from anxiety, panic attacks, and depression, as well as those experiencing adjustment disorders and difficulties with stress management, are good candidates for treatment, Axis I and Axis II patients will benefit. At this time MBI is not recommended for psychotic patients or those with poor ego function. In-patient settings such as drug and alcohol facilities, eating disorder clinies, and psychiatric units for higher functioning patients are all appropriate. Mind-Body Intelligence 149 MBL is a powerful resource for the medical professional as well, Patients managing chronic pain, progressing through life-threatening or terminal illness will benefit psychologically as well as through immune system enhancement.*° Cardiac, pulmonary, and diabetes patients who must change their lifestyle and better manage stress are greatly helped by mindfulness techniques.'® Rehabilitation facility patients are also good candidates for MBI. In addition, patients preparing for surgery have been shown to experience less presurgery anxiety, and have better pain management and overall recovery postoperatively.'7' Patients who are somewhat psychologically minded, open to new modalities and well motivated to change, are most likely to benefit from the program. Many patients are helped by MBL-oriented psychotherapy. These patients may be identified in any of the categories mentioned previously. However, due to issues of social anxiety, physical disability, or time constraints, they may feel unable to participate in a group treatment setting, The trained clinician is able to provide basic meditation training and begin to help the patient change their worldview to include a MBL perspective. These patients begin to experience mindfulness practice and the Buddhist psychological perspective as powerful resources in their lives. Many of these patients go on to participate in the group MBI training. Others avail themselves of the, less formal, community meditation experiences, Patients who opt to participate in MBI-oriented psychotherapy during or after the group experience have the added benefit of individualized help from their psychotherapist. These patients are able to deepen their mindfulness skills, become more insightful in regard to their own psychodynamics, and become more empowered in regard to the management of their own emotional, physical, and spiritual well-being. Ambulatory patients may be referred directly to the Sage Healing Institute for evaluation and participation in the program. Trained MBI clinicians are available to conduct treatment programs at in-patient facilities, or to provide training to mental health professionals on-site at these facilities. 1. Patient Initial Individual Evaluation a, Problem assessment including its manifestation in emotional, physical, medical, and systems spheres b. Initial struction in meditation technique150. HOLISTIC NURSING PRACTICE # MaYJUNE 1008 ¢. Basic introduction to principles of cognitive/ Buddhist psychology and MBI d. Global integration of the problem and presenta- tion of the course of treatment. I. Family Meeting valuation a. Delineation of family patterns that may be problematic b, Development of family strategies necessary to support the healing of the identified patient ¢. Assessment of need for ongoing individual/ family intervention d. Information gathered in I and II will be integrated into specific focus, exercises or instruction for part IIL. Il, Mind-Body Intelligence Group Treatment a, Instruction in mindfulness meditation b. Instruction in mindfulness movement (Hatha Yoga and Active Qigong c. Instruction in cognitive/Buddhist psychology- based methods reducing stress-related thinking patterns 4. Group discussion and support for the applica- tions of all instructions e. Instruction in self-guided Qigong healing meditation f. Instruction in deep body relaxation technique g. Integration of personal growth and spirituality with mindfulness technique h. Introduction to other forms of mindfulness practice i, Structure for home practice j. Encouraging the development of ongoing practice k. Bibliotherapy TV. Assessment Assessment occurs at the initial eval orientation session, during group treatment, and at the conclusion of group treatment. Standard- ized evaluation is conducted pre- and postgroup intervention. a, Assessment of family’s support for patient (and use of techniques). Assessment of patient's status b. Assessment of need for further individual psy- cchotherapy and/or family therapy ¢. Standardized evaluation V. Opportunity for ongoing attendance at supportive ‘community meditation experiences or advanced MBL training program sessions. THE ROLE OF THE TRAINED MIND BODY INTELLIGENCE CLINICIAN The MBI program is designed to be implemented by licensed mental health clinicians who have trained in mindfulness meditation practices and who have a basic foundation for integrating the two. “There are many meditation teachers, who have studied extensively and practiced for many years. Many of them have been ordained or certified by their masters in their respective traditions, and are worthy of great respect. Yet, psychotherapy is not a part of the Eastern meditative or healing traditions.'? It is clear that these meditation practitioners are not trained as psychotherapists, as they would readily admit. They are not skilled in understanding or dealing with the complexities of mental health issues and they are not trained in the art of the psychotherapeutic relationship. To avail ourselves of the great benefits of mindfulness practices in the therapeutic context, properly trained professionals must provide these modalities. TRAINING Training opportunities for clinicians interested in becoming certified in the MBI modality, are available through the Sage Healing Institute. The masters or doctoral level, licensed mental health clinician must complete 4 levels of core training in order to receive certification. Candidates may come from the fields of psychology, psychiatry, nursing, social work, and counseling. The successful graduate of the program, can maintain certification through documented continuing education and the maintenance of a personal meditation practice. Ongoing mindfulness training and professional continuing education opportunities are available through the Institute as well as through many other accredited source Training experiences are also open to professionals, who want to develop or enhance a personal mindfulness practice and to develop skills in MBL-oriented psychotherapy. CONCLUSION ‘The development of the MBI treatment program is an integration of the basic Mindfulness-based Stress Reduction program with both Western and Buddhist Psychological strategies. It includes, as well, a personal growth and a spiritual component, which webelieve are essential to a holistic healing approach. Qigong, a specific meditation and mindful movement tradition, has been incorporated into the approach. It provides essential strategies for addressing specific physical and emotional difficulties, employing the tenets of Traditional Chinese Medicine. MBI aims to provide a means for patients to reduce their emotional and/or physical suffering in the context of a mindfulness-based therapeutic relationship. Working with mental health professionals trained in the MBI modality affords the patient the opportunity to address unresolved emotional material often elicited by mindfulness practice. In addition, this skills-based program, offers the patient a sense of empowerment and the ability to participate actively in their own healing. Research has shown that patients suffering from many types of illness (eg, cancer, diabetes, cardiovascular disease, chronic pain, HIV, anxiety, and depression) have benefited from mindfulness-based techniques. Continued research should explore the relative importance of each of the component treatment aspects of MBI, for example, sitting meditation, mindfulness-oriented psychotherapy, Qigong, Yoga, etc. We should also look at the relative benefits of these submodiatities across medical conditions. Such scientific exploration will be helpful as we continue 10 refine our understanding of this powerful therapy. REFERENCES 1. Grossman P, Niemann L, Schmidt etal. Mindfulnesshased stress reduction and health benefits; a meta-analysis. J Psyehosont Res 2004:57:35-43. 2. Reibel D, Greeson J, Brainard G, Roseneweig S, Mindfulness based ‘tress reduction and health-related quality of Tie in a he patient population. Gen Hosp Psschiatry. 2001:23:183-192, ‘Mind-Body Intelligence 151 3. Antoni M, Cruess D, Klimas N, etal. Suess management and immune system reconstitution in symptomatic HIV-infected gay men overtime effects on transitional naive T cells (CD4*CD4SRA "CD29". Am J Pchianry, 2002:159:143-148, 4. Block K, Boyd D, Gonzalez N, ct al. The immune system in cancer. Integr Cancer Ther. 2002:1(3)294-316, 5. Hidderley M, Holt M. A pilot randomized tral assessing the effets ‘of autogenic traning in early stage eancer patients in relation to psy~ chologi sand immune system responses. Eur J Oncol Nurs 200:8:61-65. 6. Apichartpiyakul C, Sakonwasun C, Aruncharus P Effect of Buddhist ‘meditation onthe T lyraphocyte subpopulation. Chiang Mai Med Bull. 2006: 43(4):163-168, 7. Pert C, Dreher H, Ruif M. The psychosomatic network: foundations of mind body medicine. Alter Ther. 1998:4(4):30-41 8, Kabat-Zinn J Full Catasimphe Living. New York: Bantam Doubleday Del Publishing: 1990 ‘9, Spoca M, Carlson L,Goodey E,etal. A randomized, waits controlled clinical tral the effect of a mindfulness meditaion-based stress rede: tion program on mood and symptoms of stress in cancer outpatients Psychosom Med. 2000:62:613-622. 10, Satran J. Inrxction: psychoanalysis and Buddhism as cu stitutions, In: Safran J. ed. Psychoanalsis and Buddhism an Unjold- ing Dialogue. 1st ed, Massachusets: Wisdom Publications: 2008:1— a 11, Chadron P. Te Wisdom of No Escape and the Path of Love-Kindness Boston: Shambala Publications: 1991 12, Rubin J. Psschotherapy and Buddhism: Toward an Integration. New York: Plenum Press: 1996, 13, Cohen K. The Way af Qigong, The Art and Science of Chinese Energy Healing. New York: Ballantine Books, div. of Random House Inc. 1997 14, Stenlund T Lindstcom B, Granlund M, Bure G. Cardiac rehabilitation forthe elderly: Qigong and group discussions. Eur J Cardiovase Prev Rehabil, 2008:12(1)5-11 15, TsujiuchT, Kumano H, Yoshivehi K, etal. The effect of Qi-gong ela ation exercise onthe contol of type 2 diabetes mellitus: a randomized ‘controled tril. Diaheres Care. 2002:25:241-242, 16, KempC. Qigong asatherapcutic intervention with oer adults. Holis- tie Nurs, 2004;22(4):351-373, 17, Huddleston P, Prepare for Surgery, Heal Faster: A guide of Mind Bod Techniques, Massachusetts: Angel River Press; 1996, 18, Kiecolt-Glaser JK, Page GG. Marucha PT, etal Psyehological influ. fences on surgical recovery. Perspectives from psychoneuroimmunol- ‘ogy, Am Psychol. 1998,5%(11):1209-1218. 19, Mito J, Raich RM. Effects of a briet and economical intervention in proparing patiems for surgery: does coping style matter? Pain. 199983(3)471-475,