This is where mind-body medicine comes in—a further development of naturopathic organizational therapy. While it deals with the traditional pillars of a healthy lifestyle—more physical activity, a better diet, and sufficient relaxation—mind-body medicine is predominantly focused on having a positive effect on the interrelationships between the psyche, the immune system, and the nervous system. To achieve that, it exercises mental techniques and implements behavioral changes. In that way it supports our body’s abilities of self-regulation and self-healing.
In therapeutic practice, mind-body medicine draws on elements of traditional healing methods like yoga, tai chi, qigong, or meditation, but also on modern relaxation methods and mindfulness techniques, such as progressive muscle relaxation. At the naturopathic hospital in Essen as well as at the Immanuel Hospital in Berlin, mind-body teams work with patients on developing individual strategies they can implement after their discharge from the clinic—in order to transfer the successes achieved during their treatment to their daily lives. The therapists are nutritionists, meditation and yoga instructors, sports scientists, social workers, or psychologists. To me, mind-body medicine is the key to a sustainable effect. Because not only does it counteract stress as an important risk factor, it also helps patients perceive their body in a new way and start taking responsibility for it.
All traditional healing systems ascribe great importance to the connection between mind and body. With the scientific foundation of medicine in the modern age, however, many of these connections have taken a back seat. Suddenly, mind and body were considered separate entities. Only stress research, psychosomatics, and psychoneuroimmunology engaged with the complex relationships between body, soul, and the nervous system. Like the American rheumatologist George Solomon, who in the 1960s discovered that rheumatoid arthritis worsened when the patients were suffering from depression at the same time. He began to examine the correlation between inflammatory diseases, the immune system, and emotions.22
To accommodate ideas like this, the cardiologist Herbert Benson developed a new way of looking at cardiovascular diseases in the 1970s: He did not focus on the organ, but on the emotions that make it sick. It should be possible, Benson thought, to reverse the body’s reactions to stress—to turn the chain reaction of the fight-or-flight impulse into relaxation. He noted the positive effect meditation had on the nervous system and from that he derived a series of relaxation techniques that slow down the heartbeat, lower the blood pressure, and relax the muscles.23 He founded the Benson-Henry Institute for Mind Body Medicine at the Harvard Medical School and has remained one of the most important pioneers in mind-body medicine to this day.
By now, all major hospitals and universities in the United States have their own departments of mind-body medicine. The National Center for Complementary and Integrative Health (NCCIH), part of the national health authority, considers mind-body medicine as an independent component of complementary medicine and supports research projects in this field.
Quite often, experiences from the past—as far back as childhood—come up in conversations with patients. These experiences, if dealt with consciously, constitute an important step toward convalescence. Mind-body medicine, however, goes a step further—or rather, backward. Instead of talking about their past experiences, patients are placed in a room in which they can heal themselves in a “prelinguistic” way, through relaxation, silence, and mindfulness. This sounds esoteric, but it’s not: A lot of recent scientific data proves in an impressive way how effective mind-body techniques are, especially in the treatment of chronic diseases.
Each of these techniques has specific characteristics—not all of them work in the same way and are equally suitable for everyone. For some, qigong, the Chinese moving meditation, is too boring. Others find yoga too athletic or they can’t manage staying in the meditation posture for long. Therefore, you cannot “prescribe” mind-body medicine, you can only demonstrate it and encourage practice. The patients should find techniques that they can easily integrate into their daily routine because there is one unpleasant feature of mind-body medicine: For it to work, it has to be practiced regularly. In the following sections, you’ll find suggestions to inspire you.
YOGA: INDIA’S GIFT TO THE WORLD
Yoga is booming. These days you can find a yoga studio in every major American city. The 2016 Yoga in America study commissioned by the Yoga Journal and Yoga Alliance estimated that more than 36 million people practice yoga in the United States.
Yoga is more than two thousand years old. The word yoga itself comes from Sanskrit, the original language of the literature and philosophy of India. It goes back to the root yui and means to meet, to unite, or to gather the mind. One way of interpreting this is as the body and the consciousness becoming one. Traditional yoga is actually not concerned with therapeutic effects, but rather with reaching a mental and spiritual (nonreligious) goal. The medical effects, however, are an important and useful side effect.
Indians proudly say that yoga was India’s gift to the world. On the initiative of the Indian government and Prime Minister Narendra Modi, himself a practitioner of yoga, the United Nations declared June 21 to be International Day of Yoga in 2015. Modi has even appointed a minister of yoga, who is also responsible for Ayurveda and other traditional healing methods.
Yoga has been examined by science for more than fifteen years and has turned out to be an exceedingly successful therapy—in an unambiguity that has surprised even myself. That said, only a small portion of it is practiced and researched in the West. In my generation, many people set out for India after their university studies or their apprenticeship and went on the legendary hippie trail. Often, the goal was Northern India, holy cities like Rishikesh or Haridwar, where one center for meditation and yoga (ashram) followed the other. And so, it didn’t take long for yoga to reach Europe and America. Maybe you’ll be able to find the book Yoga for Everyone by the Canadian yoga teacher Kareen Zebroff at a flea market. Today it’s become a classic; back then, in the ’70s, it was the first attempt at translating yoga poses into an easily practicable training program.
In the year 2000 I was ready, too. It was a morning, while I was at the new department for naturopathy at the hospitals in Essen-Mitte. I had slept badly, work just wouldn’t end, and my back was aching. I knew that when I slept restlessly and had a lot of stress, my back acted up. Otto Langels, the new director of nursing and a passionate disciple of yoga, took one critical look at me and said: “You really ought to go to a yoga class!” At first, I didn’t take him seriously—when you’re not doing too well, you don’t want to be lectured. But since the pain wouldn’t let up, I sheepishly visited the yoga class as he had suggested—one that followed the teachings of the yoga guru B. K. S. Iyengar.
To my great surprise, those ninety minutes of my life had noticeable consequences: I left with really sore muscles—muscles that I had never felt before and of whose existence I only knew from my anatomy classes at university—and my back pain was gone. I hadn’t expected it to work so immediately. In the following years I’ve been able to observe this time and again. As soon as I stop going to yoga, my back pain returns. I do yoga exercises—and hey, presto!—the pain is gone.
YOGA GIVES YOU ENERGY, REDUCES STRESS, AND RELIEVES PAIN
Almost all participants of the yoga classes I went to had the same experience I did: After a session you feel more energetic, and your mood improves. Yoga gives you energy immediately and does so at an astonishing speed, which I had never found in other forms of exercise in the same fashion. And so, in 2003, I began planning a scientific study on yoga and its effects on stress. We placed an ad looking for participants who were feeling stressed. To my great surprise more than 90 percent of the people who got in touch were women. Many of them were single parents and had an exhausting daily routine.
We decided to conduct the experiment exclusively with women under heavy strain and divided them into two gro
ups. One group received the offer of visiting a ninety-minute Iyengar yoga class one or two times a week for free over the course of three months. We asked the other group to wait, and promised them the same offer once the three months were up. During this period we ascertained their stress level, mental state, and the cortisol levels in their saliva (the cortisol level was actually measured after every single yoga class).
The results were impressive. Yoga led to a pronounced lowering of stress level. Overall mood was improved, as were anxiety and depressiveness. But not only that—many of the participants stated that their head and back pains were reduced to a dramatic extent. For most, even a single class caused a significant lowering of stress hormones. We published this (still small) study and continued with another, bigger study with seventy-two participants.24, 25
This time we were interested in whether practicing more yoga could potentially have an even greater effect. We randomly divided women into three groups. One group was asked to do ninety minutes of yoga once a week, the second twice as much, and the third was once again asked to wait. The result was that the first two groups showed similar effects. It’s likely that more yoga didn’t lead to more effectiveness because for many of the women it simply wasn’t possible to take two classes a week, and they felt additional stress because of our request.
We can conclude that yoga is an excellent remedy for stress and that ninety minutes a week is sufficient. And of course, it’s not a bad thing to take out the yoga mat at home every once in a while. But do go to a class. Patients often ask me if they couldn’t teach themselves—with YouTube, a DVD, or a book. No. The danger of getting into the habit of doing an exercise, a pose, the wrong way is too big, and this can lead to incorrect weight placement or even injury.
Over the following years, research findings kept appearing in quick succession. Particularly where my personal weak spot, back pain, was concerned, numerous studies have proved how efficient yoga is—more effective than most other therapies, that is.26 In cooperation with the Berlin-based Iyengar Institute, we were able to show the same result for chronic neck pain in 2012.27 Other studies have demonstrated the effectiveness of yoga for headaches, hypertension, and soft tissue rheumatism. Yoga also led to the notable relief of symptoms of chronic inflammatory bowel disease according to the findings of our colleagues in Essen.28
YOGA SUPPORTS CANCER TREATMENT
What is most impressive to me is that yoga is also effective as a supplementary therapy for cancer. American researchers were able to prove that women suffering from breast cancer experienced a remarkable increase in their quality of life when they went to yoga classes for serval weeks.29 Up until now, there has been no better remedy against the frequent fatigue and severe tiredness that can occur during and after a cancer treatment and that heavily restricts the patient’s daily life.
A research team in Essen headed by psychologist Holger Cramer has published many meta-studies on the effectiveness of yoga.30, 31, 32 The list of successes spans from menopausal symptoms to complimentary treatment of heart diseases and hypertension. Even atrial fibrillation, a cardiac arrhythmia that is difficult to control with medication, is alleviated. There is hardly any area of medicine in which yoga isn’t useful.
Among the abundance of yoga classes out there, it can be difficult to find the right one. Unfortunately, the term “yoga instructor” isn’t protected. It can mean anything from an intensive training program over the course of many years or just a three-week course. The Iyengar school, however, is quite thorough. I can recommend it. It also works with props like blocks and straps. Iyengar-yoga instructors have definitely undergone several years of training, and for medicinal yoga therapy there are even higher requirements that must be met.
WHAT KIND OF YOGA IS SUITABLE FOR YOU
Where other schools are concerned, it’s important to make sure that they are recognized by the Yoga Alliance. This is a certain seal of quality. Still, the standards should be defined better. There are many good yoga schools, from Iyengar to Ashtanga, from Kundalini to Vini, from Sivananda to Vinyasa—but not everything suits everyone. Use trial lessons to figure out which kind of yoga agrees with you!
Some people fear that there are religious or esoteric elements in yoga. I can reassure you there. The prayer position of the hands and the chanting of Om aren’t necessarily to be equated with religious practice but are merely a part of Hindu tradition. In India, a guru isn’t the leader of a sect, but a teacher (one who is certainly highly revered). If you want to avoid spiritual connotations, you should learn Iyengar yoga, since it’s quite sober and focused on the body. The rooms usually look like they would in a practice for physical therapy. For yoga, you need neither incense nor a Buddha statue, just two square meters to roll out a yoga mat. That’s what makes it so appealing to me. Once you know how it’s done, you can practice it at home easily. It’s cheap and effective.
People with medical problems should choose their yoga practice especially carefully. For example, Bikram Hot Yoga, which involves great exertion in rooms at temperatures of 104 degrees, isn’t suitable for people with health problems. Patients with rheumatism or arthritis, particularly those with damaged knees or menisci, have to tread particularly carefully and should consult an experienced yoga instructor. In 2012, the American journalist William J. Broad published the New York Times best seller The Science of Yoga: Risks and Rewards. In it, the danger of injury from doing yoga was discussed for the first time. People with hypermobility, a genetically determined excessive flexibility of the joints, for instance, should refrain from doing yoga or only practice it under the supervision of very experienced instructors. Similarly, some yoga poses are unsuitable for people suffering from glaucoma, i.e., increased pressure in the eye. But the general rule is that yoga is just as safe and carries as few side effects as normal physical therapy and mild exercise. Remember to pay attention to your body’s signals when doing yoga. It’s not about doing the headstand come what may or reaching your hands as low as you can toward the ground. First and foremost, it’s about being aware of your body.
If it were up to me, I would integrate yoga into school sports. It’s a method of movement that can be practiced for a lifetime without any great effort and that doesn’t cause what school sports normally lead to—frustration. You don’t have to achieve great performances. We are just now testing this in a study with students at a trade school. Yoga is well received, reduces stress, and promotes well-being even in adolescents.
WHAT MAKES YOGA SO SPECIAL
How can yoga be superior to exercise in some areas? Possibly, yoga is so special because it combines five different elements:
It strengthens the muscles.
It connects body coordination to breathing—competitive athletes know how important this is in order to achieve the optimal effect through the interaction of body and circulation.
It leads to deep relaxation—most of all during Shavasana (corpse pose), usually the position that marks the end of a session.
It stretches the body thoroughly, leading to the release of endorphins and thereby calming the autonomic nervous system, which is of immense importance. In a study, U.S. scientists conducted an initial comparison between yoga and physical therapy to treat back pain and discovered that yoga was superior to physical therapy. In a second study, they added intensive, yoga-like stretching exercises to the physical therapy. After that, it was almost as good as yoga.33, 34
Yoga has an effect on the fasciae. With its particular mixture of extending, stretching, and reversing, yoga relaxes and maintains the connective tissue and the fasciae.
THE EIGHT STEPS TO YOGA
In the West, we usually have the physical poses (asanas) in mind when we think of yoga. According to traditional teachings, however, there are eight steps that make up yoga in its entirety. For instance, breathing exercises (pranayama) can have in-depth effects on the body via the autonomic nervous sy
stem—such as cooling down the body in great heat or warming it up when it’s cold. There are special exercises for almost every objective. By now it has been proven that pranayama techniques have a profound effect on lung volume in chronic obstructive pulmonary disease (COPD), that they stabilize the heart rhythm and can even influence gene expression rather swiftly.35 The latter means that inflammations are reduced on a molecular level. Proteins that contribute to diseases such as diabetes and arteriosclerosis are produced less, even though such epigenetic phenomena can usually only be induced with medication. It must be noted, however, that most studies examine the combination of asanas and pranayama, so that it’s not possible to accurately determine which of the two has the healing effect.
I have experienced firsthand how strong an effect breathing can have. A yoga instructor showed me activating breathing exercises, among them the so-called bellows-breathing (bhastrika pranayama). I was excited. The next evening, I was feeling a little exhausted after work and started doing this and other exercises at great speed over the course of forty-five minutes. In the beginning, I felt in top shape and highly alert. But the “reckoning” followed soon: At night I slept quite restlessly, and by the afternoon of the next day I was lying in bed with a cold. Instead of listening to my exhaustion and relaxing, I had started a fire inside my body.
Furthermore, the withdrawal of the senses (pratyahara) and concentration (dharana) belong to the eight-step path of yoga. The Indian scholar Patanjali, who authored the guidelines of yoga, so to say, sometime between the second century BCE and the fourth century CE, perceived focusing as the most important element: “Yoga is the ability to focus the mind exclusively towards an object and sustain that direction without any distraction.”
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