S T A N F O R D M E D I C I N E
Volume 16 Number 3, SPRING 1999
INTRODUCING THE TREATMENTS OFFERED AT STANFORD'S COMPLEMENTARY MEDICINE CLINIC.
by Heather Rock Woods
Why do some alternative therapies work? Modern science doesn't have many explanations, yet. But here's a look at how several of the therapies offered at Stanford's new clinic are carried out.
Sometimes the connection between the mind and the body breaks. Something stresses the body, releasing a cascade of hormones, but the mind thinks everything is normal.
If this disconnect continues, people at risk for stress-related diseases may indeed develop one. A technique called biofeedback can help people with such ailments, especially chronic fatigue syndrome, headaches, irritable bowel syndrome, jaw joint pain, menstrual problems, phobias, post-traumatic stress disorder and sexual dysfunction.
"People with stress-related diseases are stuck in fight or flight mode, but often are unaware of being stuck," says Ian Wickramasekera, PhD, a consulting professor of psychiatry and behavioral sciences, current president of the National Association for Applied Psychophysiology and Biofeedback, and a founder of this 30-year old field.
During biofeedback, patients wear electrode patches on the forehead and fingers and a heart rate monitor, all hooked up to a laptop computer that measures and continuously updates nine physiological factors, including skin conductance (i.e., sweatiness), skin temperature, blood pressure, muscle tension and brain electrical activity (EEG).
"The first step is you have to know you're disconnected from your body. Then we teach you to improve your perception of your body with moment- to-moment feedback from your body. Most of these biological functions are outside of our consciousness," Wickramasekera says.
But the biological functions can be willfully controlled, and patients learn this skill with biofeedback. Once the symptoms are relieved, patients use biofeedback to discover what causes them stress and to learn cognitive-emotional coping skills. "I like Wickramasekera's philosophy of 'skills not pills,' " says patient David Atchison. "Between genetics and how we were raised, my siblings are all on medication."
Atchison came to the clinic for hand tremors and sleepless nights before big meetings. With biofeedback he learned: "I was out of touch with how my conscious emotions differed from my body's reaction. I mentally downplayed an important meeting, but the monitor showed my body going 'whoop-whoop-whoop.' "
When Michael Fredericson, MD, needed approval to start administering acupuncture to Stanford patients, "some doctors didn't think it would be a good idea," he says.
But six years later, medical acupuncture is the most used service at the new Complementary Medicine Clinic and is the most likely to be paid for by an insurance company.
Fredericson, an assistant professor of functional restoration who specializes in rehabilitation without surgery and is a physician for Stanford's athletic teams, learned acupuncture at the UCLA Medical Acupuncture for Physicians Program.
The technique uses thin, stainless steel needles that are inserted into the body at key points and left there for 30 minutes. The needles hurt only slightly when first put in, with no side effects. Fredericson considers acupuncture one of several non-surgical tools, such as massage, physical therapy and stress management, to use either alone or in conjunction with other therapies.
Acupuncture speeds up healing of chronic and acute injuries, Fredericson says. "Acupuncture is very good at decreasing pain and the inflammatory response, so it helps expedite the rehabilitation process."
A National Institutes of Health panel reviewed the medical literature and concluded in 1997 that acupuncture is effective for postoperative and chemotherapy nausea and vomiting, nausea of pregnancy and postoperative dental pain. The panel also agreed that acupuncture can be helpful with many pain-related conditions as a complementary therapy.
Fredericson is working on several small studies to widen knowledge about acupuncture's effectiveness. The Society for Acupuncture Research has published a small book collecting the randomized, controlled studies on how well it works for specific conditions.
"If you believe the Chinese system, acupuncture stimulates energy flow called Qi. It's hard to study that," Fredericson says. "There is also an effort to understand acupuncture points from an anatomical standpoint: which muscles and nerves it stimulates. I combine the anatomical knowledge and use some of the more, well, mystical qualities of the points."
Research shows that our bodies release chemicals that increase pain and inflammation in many medical disorders when we feel stressed. Relaxing the mind and body through mindfulness meditation reduces the release of these irritating chemicals.
Mark Abramson, DDS, a Redwood City dentist experienced with chronic pain and TMJ (temporomandibular joint syndrome), teaches mindfulness-meditation based stress reduction at the Complementary Medicine Clinic.
"Mindfulness is moment-to-moment nonjudgmental awareness. The primary focus of attention is breathing, which automatically brings you in the moment," he says.
Participants learn to relate to their bodies and minds in a wise and caring manner, Abramson says. This takes mindfulness from a spiritual to a medical realm. The technique is useful for AIDS, anxiety and panic disorders, arthritis, cancer, depression, fatigue, headaches, chronic pain, sleep problems, stress, type A behavior and gastrointestinal distress.
For a tension headache, "We teach people to apply nonjudgmental awareness to the pain sensation to be with the pain one moment at a time," says Abramson. "They don't have to react to the pain, they can just watch it and experience it. They can recognize the tension of their muscles is optional and they can relax and be present. As they do this, many times, the headache goes away."
Using the technique medically dates back 20 years, when Jon Kabat-Zinn, PhD, set up the Stress Reduction Clinic at the University of Massachusetts Medical Center. His program was featured in Bill Moyer's PBS series Healing and the Mind in 1993 and mindfulness meditation has since surged in popularity.
Nurses now receive continuing education hours for taking the course, and Stanford medical students can take an elective course on mindfulness from Abramson. Starting this fall, medical students will be required to take a two-hour seminar in meditation techniques.
David Spiegel, MD, had already shown that women with metastatic breast cancer participating in psychosocial therapy groups experienced less distress and pain, but he was completely surprised to find in 1989 that patients in groups lived twice as long -- 18 months longer -- as women receiving only standard cancer treatment.
Group therapy for cancer patients is "more accepted now, but by no means the standard of care. I think it should be," says Spiegel, a professor of psychiatry and behavioral sciences, and medical director of the Complementary Medicine Clinic.
The clinic offers groups for patients with breast cancer, Hodgkin's disease and chronic illnesses. The groups focus on reducing the stress associated with diagnosis, adjusting to a new lifestyle and new priorities, coping with treatment and disease progression, improving family relationships and communication with physicians.
The groups are led by Pat Fobair, a licensed clinical social worker who, at Mt. Zion in San Francisco in 1970, started one of the first therapy groups for cancer patients in a hospital setting.
"The principles of the therapy we use help people look at their negative feelings and stay with those feelings," she says. "Cancer is a life threat. It's like a gun at your head. It's scary. Therapy allows fears to be expressed and experienced and let go and forgiven."
Stanford Hospital offers groups for newly diagnosed patients still undergoing treatment. The groups at the Complementary Medicine Clinic are primary designed for patients finished with treatment but still struggling with issues arising from their illness, Fobair says.
One important issue is the meaning of life. "People realize, 'Oh, I didn't die. Now what do I do with the rest of my life?'" says Fobair, who experienced the same existential question when she was recovering from breast cancer.
Kathryn Christy, in remission from breast cancer diagnosed a year ago, has found the therapy group extremely comforting, she says.
"I thought it would be sad, scary, depressing -- not fun at all," she remembers. "The stories can be sad and bring tears, and then we're laughing the next moment. We're all feeling our feelings. It's very, very real." SM