Mind-Body-Medizin: Stress, Stressmanagement und Gesundheitsförderung

The foundations of mind-body medicine: Love, good relationships, and happiness modulate stress and promote health

Although stress is an everyday fact of life, it can lead to poor health outcomes, particularly when intense or prolonged. However, humans have unique cognitive abilities and thus may be able to combat stress by engaging critical psychological defence mechanisms. In this review, we discuss the field of mind-body medicine, which focuses on improving our understanding of the mechanisms underlying this response and developing interventions that might be used to limit the effects of chronic stress. We review the findings of past and current research in this field that has focused on the impact of psychological, emotional, and behavioural factors, including love, social connectedness, and happiness on human health and the amelioration of pain as well as other signs and symptoms of disease. While these studies have not yet led to confirmed, quantifiable conclusions, the overall weight of evidence suggests that happiness (defined as a personal sense of well-being) may be directly associated with improved health parameters and reductions in debilitating symptoms. Collectively, these findings suggest that interventions designed to promote stress mitigation, notably those that encourage social activity, may lead to significant improvements in human health.

The BERN Framework of Mind-Body Medicine: Integrating Self-Care, Health Promotion, Resilience, and Applied Neuroscience

Background: Mind-body medicine (MBM) focuses on improving our understanding of how the interactions between the brain, mind, body, and behavior can be used to promote health. In this narrative review, we present the basic principles of MBM, including the introduction of a rational framework for the implementation of MBM-based interventions. We also discuss the contributions of MBM to motivation and reward systems in the brain including those that may specifically involve the mitochondria.

Results: MBM can be used to promote health in patients with chronic diseases, especially conditions identified as lifestyle-related. MBM builds on salutogenesis, which is a paradigm that focuses on health (as opposed to disease) determinants and the development of individual resilience and coherence factors as a means to reduce stress, decrease the burden of disease, and improve the quality of life. This approach involves several well-known principles of self-healing and self-care. MBM interventions typically include behavioral modification techniques in conjunction with cognitive work focused on stress regulation, exercise, relaxation, meditation, and nutrition. We suggest the use of the acronym “BERN” (Behavior, Exercise, Relaxation, and Nutrition) to summarize the operational framework of this approach.

Discussion: Different BERN techniques act via shared autoregulatory central nervous system (CNS) reward and motivation circuitries. These systems rely on numerous neurobiological signaling pathways with overlapping effector molecules that converge, e.g., on nitric oxide (NO) as a common effector molecule. NO is critically coupled to reward physiology, stress reduction, and self-regulation as it modulates the responses of various mitochondrial, nuclear, and chromosomal processes within brain cells. NO has also been implicated in relevant outcomes (e.g., the placebo response).

Conclusions: MBM interventions typically follow the BERN model and aim to strengthen health and resilience, and reduce stress. The mechanisms of action of these processes involve the CNS reward systems and correlate with placebo and self-healing pathways.

Bio-Psycho-Socio-Spirito-Cultural Factors of Burnout: A Systematic Narrative Review of the Literature

Background: Burnout is a widespread, multifactorial, and mainly psychological phenomenon. The pathogenesis of burnout is commonly described within the bio-psycho-social model of health and disease. Recent literature suggests that the phenomenon of burnout may be broader so that the three dimensions might not reflect the multifaceted and complex nature of the syndrome. Consequently, this review aims to identify the diversity of factors related to burnout, to define overarching categories based on these, and to clarify whether the bio-psycho-social model adequately describes the pathogenesis of burnout-holistically and sufficiently. Method: Five online databases (PubMed, PubPsych, PsychARTICLES, Psychology and Behavioral Sciences Collection, and Google Scholar) were systematically searched using defined search terms to identify relevant studies. The publication date was set between January 1981 and November 2020. Based on the selected literature, we identified factors related to burnout. We aggregated these factors into a comprehensible list and assigned them to overarching categories. Then, we assigned the factors to the dimensions of an extended model of health and disease. Results: We identified a total of 40 burnout-related factors and 10 overarching categories. Our results show that in addition to biological, psychological, and socio-environmental factors, various factors that can be assigned to a spiritual and work cultural dimension also play an important role in the onset of burnout. Conclusion: An extended bio-psycho-socio-spirito-cultural model is necessary to describe the pathogenesis of burnout. Therefore, future studies should also focus on spiritual and work cultural factors when investigating burnout. Furthermore, these factors should not be neglected in future developments of diagnosis, treatment, and prevention options.

An Empirical Investigation of the Relationship Between Spirituality, Work Culture, and Burnout: The Need for an Extended Health and Disease Model

Apart from biological, psychological, and social factors, recent studies indicate that spirituality and work culture also play an important role in the onset of burnout. Hence, the commonly applied bio-psycho-social model of health and disease might not be sufficient to comprehensively explain and describe burnout. This study empirically investigates the relationship between spirituality (operationalized by perceived meaningfulness of work) and work culture (operationalized by sense of homeliness of the working environment) with burnout risk and work engagement. For this purpose, an anonymous cross-sectional data collection with fully standardized questionnaires and selected socio-demographic and work-related items was conducted among working adults (n = 439) from different industries via social media and local health service centers. For all scales and subscales, we found significant moderate to strong correlations. Furthermore, positive meaning within the perceived meaningfulness of work scale was the largest beta coefficient for burnout (β = -0.65) and work engagement (β = 0.62). Within sense of homeliness, the largest beta coefficient for burnout was needs fulfillment (β = -0.34) and work engagement emotional connection (β = 0.36). The strong associations suggest that the current health and disease model needs to be expanded to a bio-psycho-socio-spirito-cultural model to be able to sufficiently describe burnout. The perceived meaningfulness of work and a sense of homeliness should be adequately considered when examining the onset of burnout, describing burnout as a concept, and explaining work engagement.

[Self-healing in health-care: Using the example of mind-body medicine]

Mind-body medicine (MBM) is based on the assumption that interactions between the brain, mind, body, and behavior can be used to activate health-promoting pathways towards better health. It includes behavioral medical approaches and techniques in conjunction with exercise, relaxation, stress regulation, and nutrition. MBM and MBM interventions are well-established in the US healthcare system. This also includes an exploration of their underlying mechanisms. In Germany, too, a growing body of interventions are now summarized under this generic term.In this narrative review, the emergence of MBM is illuminated in the context of historical developments as well as against the background of the meditation research that has been emerging since the 1970s and the investigation of the stress phenomenon. References to basic research including neurobiological reward/placebo physiology are presented. Distinctions to psychotherapy are made and an implementation framework is described.MBM is related to health promotion and the therapy of chronic, especially lifestyle-related diseases. It is based on the salutogenesis approach, i.e., a paradigm that seeks to explore and reinforce health determinants and resistance resources (individual resilience and coherence factors) and strives to reduce stress. This approach corresponds to self-healing or self-care principles. Neurobiologically, it is associated with the placebo effect. MBM interventions typically follow the BERN model (behavior-exercise-relaxation-nutrition).As a facilitator of self-healing and self-care, MBM can be professionally trained and empowered. For doing so, "health promotion experts" are used.

Changes and interactions of flourishing, mindfulness, sense of coherence, and quality of life in patients of a mind-body medicine outpatient clinic

BACKGROUND

Stress-related, behavioral or chronic diseases require a holistic therapeutic approach. Mind-body medicine (MBM) uses the interaction between mind, body, behavior, and the environment to affect physical and psychological health and function. This integrative strategy can be applied in clinical settings, e.g., in an outpatient clinic, to improve well-being as well as clinical outcomes. We hypothesized an improvement of flourishing, mindfulness, sense of coherence, and quality of life through a comprehensive MBM program. In addition, we hypothesized correlations between the measures themselves as well as between the measures influenced by the intervention.

METHODS

We conducted a longitudinal cohort study in an outpatient clinic setting (n = 48 patients, with various diagnoses). A questionnaire battery, consisting of SF-12, Flourishing Scale (FS, FS-D), Freiburg Mindfulness Inventory (FMI), and Sense of Coherence Scale (SOC9), was used and applied in a pre-to-post format over a period of 18 weeks. The intervention was a 12-week MBM group program, with 1 session of 7 h per week.

RESULTS

The pre-post comparison of the measures showed significant improvements in psychological health, flourishing, mindfulness, and coherence. We were able to verify correlations between the measures themselves, apart from physical health. Coherence correlated with psychological health, influenced by the intervention. Further analyses showed associations between coherence, mindfulness, and flourishing.

CONCLUSIONS

The MBM program improved measures of psychological health and decreased the level of suffering from chronic disease. MBM led to an improvement of disease coping and appraisal of individual ailments, thereby enhancing quality of life. Personal flourishing, coherence, and mindfulness seem to interact with each other.