Four common bad habits combined — smoking, drinking too much, inactivity and poor diet — can age you by 12 years, sobering new research suggests. The findings are from a study that tracked nearly 5,000 British adults for 20 years, and they highlight yet another reason to adopt a healthier lifestyle.

Overall, 314 people studied had all four unhealthy behaviors. Among them, 91 died during the study, or 29 percent. Among the 387 healthiest people with none of the four habits, only 32 died, or about 8 percent.

The risky behaviors were: smoking tobacco; downing more than three alcoholic drinks per day for men and more than two daily for women; getting less than two hours of physical activity per week; and eating fruits and vegetables fewer than three times daily.

These habits combined substantially increased the risk of death and made people who engaged in them seem 12 years older than people in the healthiest group, said lead researcher Elisabeth Kvaavik of the University of Oslo.

The study appears in Archives of Internal Medicine.

The healthiest group included never-smokers and those who had quit; teetotalers, women who had fewer than two drinks daily and men who had fewer than three; those who got at least two hours of physical activity weekly; and those who ate fruits and vegetables at least three times daily.

“You don’t need to be extreme” to be in the healthy category, Kvaavik said. “These behaviors add up, so together it’s quite good. It should be possible for most people to manage to do it.”

For example, one carrot, one apple and a glass of orange juice would suffice for the fruit and vegetable cutoffs in the study, Kvaavik said, noting that the amounts are pretty modest and less strict than many guidelines.

Study participants were 4,886 British adults aged 18 and older, or 44 years old on average. They were randomly selected from participants in a separate nationwide British health survey. Study subjects were asked about various lifestyle habits only once, a potential limitation, but Kvaavik said those habits tend to be fairly stable in adulthood.

Death certificates were checked for the next 20 years. The most common causes of death included heart disease and cancer, both related to unhealthy lifestyles.

Kvaavik said her results are applicable to other westernized nations. June Stevens, a University of North Carolina public health researcher, said the results are in line with previous studies that examined the combined effects of health-related habits on longevity. The findings don’t mean that everyone who maintains a healthy lifestyle will live longer than those who don’t, but it will increase the odds, Stevens said.

One night during my training, long after all the other doctors had fled the hospital, I found a senior surgeon still on the wards working on a patient note. He was a surgeon with extraordinary skill, a doctor of few words whose folksy quips had become the stuff of department legend. “I’m sorry you’re still stuck here,” I said, walking up to him.

He looked up from the chart. “I’m not working tomorrow, so I’m just fine.”

I had just reviewed the next day’s operating room schedule and knew he had a full day of cases. I began to contradict him, but he held his hand up to stop me.

“Time in the O.R.,” he said with a broad grin, “is not work; it’s play.”

For several years my peers and I relished anecdotes like this one because we believed we knew exactly what our mentor had meant. All of us had had the experience of “disappearing” into the meditative world of a procedure and re-emerging not exhausted, but refreshed. The ritual ablutions by the scrub sink washed away the bacteria clinging to our skin and the endless paperwork threatening to choke our enthusiasm. A single rhythmic cardiac monitor replaced the relentless calls of our beepers; and nothing would matter during the long operations except the patient under our knife.

We had entered “the zone.” We were focused on nothing else but our patients and that moment.

But my more recent conversations with surgical colleagues and physicians from other specialties have had a distinctly different timbre. While we continue to deal with many of the same pressures that my mentor dealt with — decreasing autonomy, increasing administrative requirements, less control over our practice environment — the demands on our attention have gone, well, viral.

Extreme multitasking has invaded the patient-doctor relationship.

Now, along with the piles of forms to fill and blinking lights of phone calls on hold, are threads of text messages, columns of e-mails and lists of electronic medical record alerts to attend to. In this ever-widening sea of distractions, all that once gave meaning to our work and allowed us to enter the zone — the operations, the diagnostic saves, the lifetime relationships — have turned quaintly insufficient.

As one surgical colleague confided, “I still like operating, but it’s not enough. There are so many hassles it’s hardly worth practicing.”

Or as another doctor said to me recently while simultaneously typing an electronic medical record note, checking e-mail and holding a phone to his ear, “It used to never bother me to put in extra time at work. But I cannot do that anymore.”

The time pressures and demands that drive this endless multitasking and loss of focus on patients have contributed to high rates of burnout among physicians. Depending on the study, anywhere from one out of every three to more than half of all doctors is suffering from burnout, with potentially devastating clinical implications. Doctors who are burned out are more likely to depersonalize their patients and treat them as objects rather than as individuals suffering from disease. They are less professional, exhibit less empathy and are more prone to making errors. And these physicians are also more likely to become depressed, commit suicide and leave a profession that is already facing severe shortages in specialties like primary care.

As with most other occupations and aspects of our lives, it is probably impossible to hold back the rising tide of demands on our attention. But within the clinics, the wards and the operating rooms, is there a way for physicians to do all their work and maintain their focus on the patient in front of them, without accelerating the rate of burnout?

It turns out that working and living in the zone, not just getting into it on occasion, may be one solution.

Last month, The Journal of the American Medical Association published the results of a study examining the effects of a year-long course for primary care physicians on mindfulness, that ability to be in the zone and present in the moment purposefully and without judgment. Seventy physicians enrolled and participated in the four components of the course — mindfulness meditation; writing sessions; discussions; and lectures on topics like managing conflict, setting boundaries and self-care.

The effects of the sessions were dramatic. The participating doctors became more mindful, less burned out and less emotionally exhausted. But two additional findings surprised the investigators. Several of the improvements persisted even after the yearlong course ended. And, those changes correlated with a significant increase in attributes that contribute to patient-centered care, such as empathy and valuing the psychosocial factors that might affect a patient’s illness experience.

I asked Dr. Michael S. Krasner, lead author of the study and an associate professor of clinical medicine at the University of Rochester, about mindfulness and its effects on physician burnout and the patient-doctor relationship.

“We all use mindfulness at some point,” Dr. Krasner said. “It’s not something that you go out and get, but it’s something you can cultivate.” Some examples of mindfulness in everyday life include nursing a baby, attending to a young child in distress or, for surgeons, being engrossed in an operation. “Mindfulness allows us to be in a whole host of situations with a sense of equanimity. We don’t get sucked into how charged an experience is but are simply having that experience.”

While many physicians try to be present for their patients, “there are so many other distractions and traps that pull us away,” Dr. Krasner observed. Those distractions can make practicing mindfulness particularly difficult. “It’s one thing to sit and be comfortable with oneself. But trying to be mindful in a busy clinical practice can be really challenging.”

Over time, the persistent distractions of such a practice can lead to burnout. For many of the study participants, “they barely recognized certain experiences as either powerful or challenging before they moved to the next experience,” Dr. Krasner noted. The word “silo” came up again and again during the course, and the physicians recounted how they “kept their nose to the grindstone” and rarely reflected on their work. “It becomes easy to look at our patients as objects,” Dr. Krasner said, “rather than appreciating the meaning and joy of an experience, even if that experience is difficult. But lack of meaning goes hand in hand with ineffectiveness and a lack of well-being as a physician.”

Acquiring the ability to be mindful in the most challenging circumstances can do more than improve a physician’s well-being; it can also sharpen clinical skills. “If something goes wrong and you fail to notice,” said Dr. Krasner, “you end up going down one path in your care. But if you fully accept these challenges — not resign yourself to them but fully accept them — you can see more clearly and proceed down a path where you have a better chance of success.”

Dr. Krasner acknowledges that courses like his may not be helpful for every doctor. “There are people who aren’t going to be interested because it may seem different, even a little frightening, to get together with colleagues and be silent for a while, then talk about these things with one another.” Instead, he proposes offering physicians in the future a “menu of options” to choose from to help prevent burnout. “But I think mindfulness should be among the menu of educational interventions that are evidence-based.”

“Patients know when their doctors are or are not present,” Dr. Krasner said. “As a practitioner, I know when I’m really there for my patients and when other things are pulling me away and I’m not.” It seems fitting then that physicians, who are constantly asking their patients to be mindful — asking them to talk about how they feel — should also be able to do so themselves.

“One of the most wonderful things about practicing medicine,” Dr. Krasner said, “is that you have the opportunity to be in the middle of challenging events. Reflecting on those events while also holding them in your thoughts has to do with not only physician well-being but also patient healing.”

“If we can be mindful in the midst of those challenging circumstances,” Dr. Krasner reflected, “we can derive a greater sense of meaning from even the most demanding situations.”

Ken Jacobs wasn’t looking for a ticket to nirvana when he embarked on a journey into the ancient spiritual tradition of yoga.

As a partner at Gray Robinson PA, long hours and high stress had begun to take a toll on his body. He took to running for relief from tension in his neck, shoulders and back, but instead ended up with knee pain and shin splints.

Like a good attorney, he switched strategies and headed for a yoga class at his gym. Three years later, he and a dozen other attorneys at his firm were practicing yoga together on a hotel lawn to get focused before an intense year-end law firm meeting.

Among the 16 million Americans practicing yoga, they represent a new class of yogis. They are neither the obnoxious yoga yuppie breed sporting $98 Lululemon yogawear, nor the incense-burning, Maharishi-loving hippie in search of enlightenment. These overworked corporate types are finding a practical application for yoga in their work life: balance.

Every year, millions of workers suffer disabling injuries and thousands lose their lives to work-related stress.

In the movie “Network,” a stressed out news anchor loses it on live television, “I’m as mad as hell, and I’m not going to take this anymore,” he screams as he storms off set.

Other movies feature employees crashing computers and bashing fax machines.

But are these examples of art imitating life?

Three-quarters of Americans in a new study say they experience nerve-racking moments at work — though few people are aware that those hostile job conditions can be deadly.

“Repeated exposure to workplace stress can definitely increase the risk of a heart attack, death or stroke,” said Dr. Pk Shah, director of cardiology at the Cedar Sinai Medical Center.

The Journal of American Medical Association study, whose results were published on Oct. 10, found people who return to a stressful job after recovering from a heart attack are twice as likely than those without stress to experience another one.

“This should be a wake up call not only for patients,” Shah said, “but also for employers, because employers should recognize that chronic exposure can have a very adverse effect on their employees’ health.”

Inner city high school teachers, police officers, miners and air traffic controllers are among those with the most stressful jobs in America, according to Health magazine.

“Four controllers that I have known over the years I’ve have been at O’Hare have died of a heart attack,” former air traffic controller Bob Richards said. “And you say, ‘Well, people die; that happens. Let me give you the ages — 29, 30, 38, 39. Now if that’s normal, then I must be missing something.”

And if someone thinks they can escape the stresses of work by going home, they should think again. A second study of 4,000 men and women published in the journal Psychosomatic Medicine said how someone argues with a spouse could also affect their heart.

Women who don’t speak their minds are four times more likely to die than those who do.

“One of the biggest coping mechanisms is not keeping your feelings bottled up,” ABC News workplace contributor Tory Johnson said. “By not venting by not making their feelings known whether it’s at home or work they are at greater risk for stress and all kinds of physical and mental illness.

ABC’s Andrea Canning contributed to this report.

Moreover, the added impact of stress and anxiety seem to linger, causing the second day of a stressed person’s allergy attack to be much worse.

Janice Kiecolt-Glaser

Ronald Glaser

The finding, the latest in more than three decades of study on stress and immunity, is important since allergic reactions are the fifth-most-common chronic disease in America, and medical costs to treat them can reach $3.4 billion each year.

In a report presented today (8/14) at the annual meeting of the American Psychological Association in Boston, Ohio State University researchers described recent experiments meant to gauge how psychological stress might affect allergy sufferers.

“Allergies are not minor problems,” explained Jan Kiecolt-Glaser, a professor of psychology and psychiatry at Ohio State.  “A huge number of people suffer from allergies and, while hay fever, for example, is generally not life-threatening, allergy sufferers often also have asthma which can be deadly.”

Some data suggest that 38 percent of the people who suffer from allergic rhinitis also have asthma, and that 78 percent of asthma sufferers have allergic rhinitis.

Kiecolt-Glaser and Ronald Glaser, professor of molecular virology, immunology and medical genetics at Ohio State, recruited 28 men and women.  All of the volunteers had a history of hay fever and seasonal allergies.

The volunteers spent two half-days in a research unit at the Ohio State University Medical Center.  Each time, they were given the standard skin prick test several times to determine their reactions to various allergens, and blood, saliva and serum samples were taken before, after and at several times during the research project.

All of the participants were given a battery of psychological questionnaires to determine their levels of stress, anxiety, self-confidence and feelings of control over situations.

On the day that individuals were assigned to the low-stress control condition, they were given the skin prick test and then asked to read from a magazine.  Then they were asked to tape themselves reading the same material aloud.

During the day that people were assigned to the experimental condition, however, they had a much tougher time.

“We used a ‘speech stressor test’ used in a lot of psychology research,” Kiecolt-Glaser said.

“Basically the participants each appeared before a panel of several ‘evaluators’ who supposedly were behavioral experts.  Participants had to give a 10-minute speech, which was videotaped, and then are asked a series of math questions they had to solve without paper or pen.”

Afterwards, they had to watch their videotaped performance.

“The whole exercise is a nice stress experiment in the laboratory,” she said.

The researchers measured the raised “wheals” that formed on the arms of the participants before and after they were stressed, as well as the next day.

“The wheals on a person who was moderately anxious because of the experiment were 75 percent larger after the experiment, compared to that same person’s response on the day when they were not stressed,” Kiecolt-Glaser said, signifying a stronger reaction.

“But people who were highly anxious had wheals that were twice as big after they were stressed compared to their response when they were not stressed.  Moreover, these same people were four times more likely to have a stronger reaction to the skin test one day later after the stress,” she said.

This next-day change – labeled a “late-phase reaction” – is important because it signals an ongoing and strengthening response to the allergens, and even suggests that sufferers may react strongly to other stimuli that previously hadn’t caused them to develop an allergic reaction.

Gailen Marshall, a co-investigator on the project and professor of medicine and pediatrics at the University of Mississippi, said that late phase, or delayed, reactions are typically unresponsive to the most common forms of allergy treatment, such as antihistimines.

“Late phase reactions also occur in allergic asthma and can, in the proper settings, be potentially life-threatening.

“The results of this study should alert practitioners and patients alike to the adverse effects of stress on allergic reactions in the nose, chest, skin and other organs that may seemingly resolve within a few minutes to hours after starting, but may reappear the nest day when least expected,” he said.

Partner Ronald Glaser, director of the University’s Institute for Behavioral Medicine Research, said that they stimulated cells taken from study participants and then measured the levels of cytokines like interleukin-6 (IL-6) that the cells produced.

Lymphocytes taken from participants during the study showed increased levels of cytokines like IL-6.  High levels of IL-6 are part of the allergic response to an allergen, Glaser said.  The researchers also measured levels of stress hormones called catecholamines and they were elevated as well.

He suggests that the raised levels of these compounds are to blame for the residual effects seen in the late-phase reaction.

“What’s interesting about this is that it shows that being stressed can cause a person’s allergies to worsen the next day,” she explained.

“This is clinically important for patients since most of what we do to treat allergies is to take antihistimines to control the symptoms – runny nose, watery, itchy eyes, and congestion.

“Antihistimines don’t deal with those symptoms on the next day.
People may be setting themselves up to have more persistent problems by being stressed and anxious when allergy attacks begin,” Kiecolt-Glaser said.

The researchers estimate that Americans pay $2.3 billion for allergy medications each year and $1.1 billion for doctor visits to treat allergy attacks.  Those amounts don’t include approximately 3.5 million workdays lost as well.

Working along with Kiecolt-Glaser, Glaser and Marshall on the project were William Malarkey, professor of internal medicine; Stanley Lemeshow, professor and dean of public health; Kathi Heffner from Ohio University; Kyle Porter, Cathie Atkinson and Byron Laskowski, all from Ohio State.

The research was supported in part by the National Institutes of Health.

The idea that the mind affects health and illness is thousands of years old, but only in recent decades have scientists tracked down the data. Now Ohio State University’s Dr. Janice Kiecolt-Glaser is adding to the growing evidence on the health consequences of stress. In her talk “How Stress Kills: New Perspectives on Stress and Inflammation,” she offered recent findings to a packed house in Lipsett Amphitheater.“She has done seminal work in a field with a long name,” said NIDCR’s Dr. Nadya Lumelsky in her introduction. That field is psychoneuroimmunology, the interdisciplinary study of brain, mind and immune system. “There was lots of anecdotal evidence, but Dr. Kiecolt-Glaser has shown a causal relationship between stress and other diseases.”

	Dr. Janice Kiecolt-Glaser

A clinical psychologist, Kiecolt-Glaser collaborates with her husband, virologist Dr. Ronald Glaser, at OSU’s Mind/Body Center, and has received support for 3 clinical trials from NCI, NCCAM and NIA. She was invited to speak by NIDCR as part of its translational seminar series.

How do scientists prove the effects of stress on health? One path is to follow the cytokines, among the most crucial proteins in the body. Cytokines, including the interleukins, carry messages vital to immune response. Part of that response is inflammation. As one of the body’s normal defenses against infection, injury, irritation or surgery, inflammation is not the same as infection. And acute inflammation is not the same as chronic.

“We need good inflammation,” said Kiecolt-Glaser, “because cytokines attract immune cells. With acute inflammation, good things happen. With chronic inflammation, you have troubles, because of its association with tumor cell survival” and other harms.

It’s an intricate process. Imagine tumbling down a ladder in a cascade of negative effects:

• Chronic stress can cause immune dysregulation.
• This dysregulation causes increased risk of disease.
• And that risk in turn increases the proinflammatory cytokines, including interleukin-6 (IL-6).

Kiecolt-Glaser’s studies show that “you can skip all the steps and go directly from stress to cytokines.”

Some highlights on how chronic stress affects health:

• Chronic stress substantially accelerates age-related changes in IL-6, a cytokine linked to some cancers, cardiovascular disease, type II diabetes, osteoporosis, arthritis, frailty and function decline. “It’s a new paradigm,” Kiecolt-Glaser said. “Cholesterol and the immune system work together to cause heart disease and stroke.”
• At 71 or older, age interacts with stress, and “the older you are, the more stress really matters.” It impairs vaccine responses in older adults.
• Turning to the young: When dental students on vacation were compared to those taking “a particularly dreaded exam—immunology,” no student healed as rapidly during exams. Oral wound-healing took them 40 percent longer.
• Personal relationships influence immune/endocrine function and health. Hostile couples’ wounds healed more slowly after conflict.
• Women show larger response to interpersonal stress.
• In caregivers (for example, spouses caring for their aging/ailing mates) the average rate of increase for IL-6 was about 4 times larger than that of non-caregivers.

Chronic stress increases proinflammatory cytokines, says OSU’s Kiecolt-Glaser.

“What happens when caregiving ends?” an audience member queried.

“Normal bereavement decreases after 2 years,” said Kiecolt-Glaser. “It doesn’t create a change in mood, long term.”

But for those exhausted by extended caregiving, “they lose part of their social networks, becoming increasingly depressed. You lose part of your life.”

A vicious cycle takes hold. “Patients with major depression will have even more depressive symptoms. The stressed get more stressed, serving as substrate for more inflammation. They are primed to respond more strongly to subsequent challenges.”

And although we know we’re supposed to take care of ourselves, “what we tend to do is to turn to high-fat diet, less exercise, poor sleep and smoking,” she said. “Stress promotes poor health behaviors…and sleep is one of the first things to go. If you didn’t sleep well last night, your IL-6 is higher today.”

Meanwhile, “Adipose belly fat secretes as much as three times the level of IL-6. Those fat cells act like little IL-6 factories.”

Moderate physical activity can help attenuate inflammation, she said. “Of course, when you’re stressed, that’s the last thing you want to do.”

Kiecolt-Glaser is also investigating the ability of omega-3 fatty acid supplementation to alter mood and inflammation.

There is, of course, good fat and bad fat. The history of dietary changes, along with epidemiological evidence, shows that “countries that eat more fish are better off,” she said. Also healthful are fish oil, walnuts, wheat germ and flax seed.

There is also the correct ratio of different types of fatty acids—in this case, omega-3 and omega- 6. That ratio is implicated in depression, cardiovascular disease and inflammation.

“This is nutritional neuroscience and psychoimmunology: interdisciplinary science at the crossroads,” she said. Depressive symptoms interact with diet to enhance inflammation. During Q&A, an audience member asked: When it comes to the stress of caregiving, does the individual have any control?

A big theme is the lack of control, she said. Changes in a spouse’s health status can be unpredictable and are some of the worst stressors, since treatments can be “hard to implement in real life.”

Her ongoing work includes how mind-body interventions such as yoga may modulate endocrine and immune responses.

Photo (AP)

(AP)

It’s no surprise that constant stress can make people sick, and now a team of researchers has figured out how.

A study focused on 119 men and women taking care of spouses with dementia. The health of the caregivers was compared with that of 106 people of similar ages not living under the stress of constant care giving.

Blood tests showed that a chemical called Interleukin-6 sharply increased in the blood of the stressed caregivers compared with blood of the others in the test. Previous studies have associated IL-6 with several diseases, including heart disease, arthritis, osteoporosis, type-2 diabetes and certain cancers.

The study also found the increase in IL-6 can linger in caregivers for as long as three years after a caregiver had ceased that role because of the spouse’s death. Of the test group, 78 spouses died during the survey.

“This really makes a link to why chronic stress can actually kill people,” said Janice Kiecolt-Glaser, professor of psychology and psychiatry at Ohio State University. “We haven’t had a good mechanism before.”

She explained that people under stress tend to respond by doing things that can increase their levels of IL-6.

For example, they may smoke or overeat; smoking raises IL-6 levels, and the chemical is secreted by fat cells. Stressed people also may not get enough exercise or sleep, she added. Exercise reduces IL-6, she said, and normal sleep helps regulate levels of the chemical.

It clearly points to the need to control stress better, she said.

The findings by the research group, headed by Kiecolt-Glaser and her husband, Ronald Glaser, a professor of molecular virology, immunology and medical genetics at Ohio State, appear in this week’s issue of Proceedings of the National Academy of Sciences.

OHSU scientists are exploring alternative treatments for post-combat stress as part of five-year study

Oregon Health & Science University is beginning a research study to examine the different aspects of mindfulness meditation as part of an effort to find new ways to treat combat-related post-traumatic stress disorder (PTSD).

An estimated 15 percent to 50 percent of all veterans returning from deployment suffer from PTSD, although the exact number is unclear. In the case of veterans from Iraq and Afghanistan, 62,929 (21.8 percent) were diagnosed with post-traumatic stress disorder (PTSD) from 2002 to 2008 according to one University of California San Francisco study. Thousands of additional combat veterans from other wars also suffer from the disorder. PTSD causes veterans to experience increased anxiety, trouble sleeping, difficulty in relationships, and recurring unwanted thoughts and dreams about their past traumas that impair their normal functioning.

Mindfulness meditation has been shown to help people deal with anxiety, intrusive thoughts and sleep difficulties, issues similar to what people with PTSD face. OHSU scientists believe the therapy may help combat veterans as well. The university has begun a five-year study funded by the National Center for Complementary and Alternative Medicine, a component of the National Institutes of Health.

“People who suffer from PTSD have greater activation in the emotional processing part of their brain called the amygdala,” says Helané Wahbeh, N.D., a naturopathic physician-researcher at OHSU. “And they have less activation in their frontal lobe, which modulates their emotional response. Mindfulness meditation has been shown to help reorient the brain, so the frontal areas of the brain are better able to process over-reactive emotional responses that hinder people from leading normal lives.”

For example, a Vietnam veteran might be walking down the street when they hear a helicopter, and be overcome by intrusive thoughts related to their time in combat. If they suffer from PTSD, they may experience a flashback where they temporarily believe they are back in Vietnam. Mindfulness meditation should help them realize they are dealing with a memory or flashback, and not the actual combat situation, Wahbeh explained.

OHSU is seeking veterans between the ages of 25 and 65 to participate. Interested veterans can call 503-494-7399. The study is part of an ongoing series at OHSU’s Oregon Center for Complementary & Alternative Medicine in Neurological Disorders that seeks to identify complementary and alternative therapies that will effectively treat PTSD.

“The project described was supported by Award Number K01AT0004951 from the National Center for Complementary & Alternative Medicine. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Complementary & Alternative Medicine or National Institutes of Health.”

About OHSU

Oregon Health & Science University is the state’s only health and research university, and Oregon’s only academic health center. OHSU is Portland’s largest employer and the fourth largest in Oregon (excluding government)… OHSU’s size contributes to its ability to provide many services and community support activities not found anywhere else in the state. It serves patients from every corner of the state, and is a conduit for learning for more than 3,400 students and trainees. OHSU is the source of more than 200 community outreach programs that bring health and education services to every county in the state.

Some companies find that healthy workers are better for the bottom line

updated 12:04 p.m. ET, Mon., June 29, 2009

Given the economic downturn and accompanying layoffs over the past year, you might think company wellness programs would be going the way of the matching 401(k). Not so.

In fact, many companies that have tried to trim their workers’ waistlines — and health care costs — may find themselves in a better position than ever to give workers a little nudge.

“The rising cost of medical care is unsustainable and is a huge and legitimate concern to employers that pay for it,” says labor attorney Hanan Kolko. “During the past decade or so, health care costs have been rising at three times the rate of inflation. Every nickel that goes to pay for rising medical costs can’t pay for raises, pensions or 401(k) matches.”

The median health care expense per employee last year was $7,173, according to a recent survey by Watson Wyatt and the National Business Group on Health.

But companies save from $1.49 to $4.91 in health-related expenses for every dollar spent on wellness programs, according to the U.S. Department of Health and Human Services.

That may be part of the reason why, despite the downturn, employers don’t seem to be skimping on their health and wellness initiatives.

A survey of about 500 human resources and benefit executives by professional services firm Towers Perrin found:

• 50 percent of companies have or will introduce or increase investments in wellness and health promotion in 2009 and 2010.
• 32 percent have or will introduce or increase financial incentives, such as bonuses or premium discounts, for wellness or health promotion activities in 2009 and 2010. Another 30 percent are considering this action.
• 45 percent say they are considering introducing or increasing penalties for nonparticipation in wellness or health promotion activities.

This is an opportune time for employers to focus on wellness, says Dave Guilmette, managing director of the Towers Perrin Health and Welfare practice. Employees, he says, are going to think: “If I want to keep my job, I better pay attention to what my employer is asking me to do.”

Treadmills in the office
Financial services firm USAA has been running a wellness program for five years.

“We think 50 to 80 percent of our medical costs are related to people who are overweight,” says Dr. Peter Wald, enterprise medical director for the firm, which has 20,000 employees.

While the San Antonio, Texas-based firm saw some improvements thanks to the wellness programs, the company had little success actually getting people to lose weight, Wald says.

Previously, workers received a lump sum of money just for participating, but now the company is tying incentives to actual weight loss. Employees have a year to lose 10 percent of their body weight. If they can pull it off, they’ll get $300.

At AstraZeneca US, saving money on medical costs and improving worker productivity are among the key reasons for a continued focus on promoting employee health.

Despite expected layoffs of 15,000 globally through 2013, the pharmaceutical firm has, for the most part, not allowed their wellness efforts to wane.

Due to economic issues, the company did end financial incentives for participation. However, AstraZeneca added a new program to encourage workers to ride their bikes to work every Friday. They also now offer a free two-week trial membership to the fitness center and encourage managers to lead by example by adopting healthy behaviors such as eating right and exercising.

“We know people are more pressured for time,” says Dr. Joe Henry, executive director of US Safety, Health and Environment for the Wilmington, Del.-based company. “If we are going to ask people to work harder and longer hours, we have to give them something.”

So AstraZeneca is making it easier for employees to exercise by scheduling morning meetings later — so workers can hit the gym — and also implementing ‘walk stations’ that allow employees to walk at a slow pace on a treadmill while working or in a meeting.

Ministry Health Care in Milwaukee is hoping financial incentives do the trick.

The hospital and clinic network has seen a cost increase of about 8 percent in its 2008 health insurance premiums and expects a 12 percent rise this year.

But Michael Knitter, director of total rewards at Ministry, is hoping to shave up to 4 percent off costs thanks to a rewards-based weight management program the company implemented last year.

Workers who take part in the program will get $5 every quarter and $5 for every 1 percent of weight loss up to 10 percent per quarter, he says. Also, by participating in the program and agreeing to a blood draw and testing, they can take $240 annually off their premiums.

Cathy Young, a 50-year-old Ministry employee, signed up because she wanted to lose 20 pounds.

“I’m one of those people that when I’m stressed, I eat,” she says. She credits the program with helping her stay on track.

“They give you e-mail reminders every single day to do things like get up and walk around, or grab a glass of water rather than soda,” she explains. “It’s been a big help.”

So far, Knitter says, the program has been successful with a 40 percent participation rate.

But during the latter part of 2008, the hospital saw an actual increase in weight gain among workers because of stress related to the bad economy. “That quarter was when the economy was tanking and people were losing money in their 403(b)s and 401(k)s,” he says. “Now we seem to be on track.”

Stressed-out employees
The recession has caused a lot of stress for workers, and some have seen their healthy habits go right out the window as a result. A recent survey from ZoneDiet.com found that 25 percent of Americans are turning to comfort food more because of the economy.

“Along with emotional eating, I am finding alcohol intake has increased considerably,” says Stephanie Middleberg, a New York dietitian. Many of her clients that used to have healthy food options at work, thanks to their employers, have seen most of those disappear.

Some workers whose companies offer few programs or incentives are taking matters into her own hands.

Judy Podvin, 45, a residential real estate agent from Howell, Mich., has gained about 10 pounds in the last year and says it’s partly due to the economic collapse that has hit Michigan hard.

“No one has any money, people are losing their homes, and half the deals don’t make it to the table even after months of work,” she explains. “It’s so depressing and stressful. You go home and feel sorry for yourself and wait for the next meal.”

She’s trying to eat better and has hired personal trainer Lori Wengle.

“I’ve only gone down 10 pounds and a size and a half, but I feel a million times better,” she explains. “It’s absolutely helped my jobs performance.”

Eve Tahmincioglu writes the weekly “Your Career” column for msnbc.com and chronicles workplace issues in her blog, CareerDiva.net.

Lawyers work at an increasingly frenetic pace, leaving limited time for contemplation and reflection. Little in our work seems to provide for opportunities to attune to one another, allowing for appropriate attention and awareness. This toxic pace and pattern increases our tendency to run on auto pilot.

“Living on automatic places us at risk of mindlessly reacting to situations, without reflecting on various options of response,” according to Dr. Jon Kabat-Zinn, founder of the University of Massachusetts Medical School’s Center for Mindfulness in Medicine, Health Care, and Society.

As an alternative approach, Kabat-Zinn and the center’s work concentrates on the benefits of mindfulness. Defined on the center’s Web site, mindfulness is “a way of learning to relate directly to whatever is happening in your life, a way of taking charge of your life, a way of doing something for yourself that no one else can do you for you — consciously and systematically working with your own stress, pain, illness and the challenges and demands of everyday life.”

Such an approach may serve our profession well.

During the past decade, researchers have found that of all professionals, lawyers are the most prone to stress, depression and alcohol problems. In the U.S., 15 to 18 percent of all lawyers abuse alcohol. Some believe that the problems stem from the inherent personalities of those drawn to our profession, whereas others believe that they are related to the nature of the job. Adding insult to injury, lawyers face the pressure of longer working weeks as well as juggling their roles of practitioners and office managers.

According to Sacha Pfeiffer, writing for the The Boston Globe in June 2000 and citing the Boston-based Lawyers Concerned for Lawyers, depression and anxiety have equaled or surpassed alcohol and drugs as what the group calls a “presenting problem” for five of the past 10 years. In 2005, depression or anxiety was cited by 26 percent of all lawyers who sought counseling, while alcohol or drugs were cited by 21 percent. The number of lawyers seeking depression counseling jumps to 60 percent when the tally includes those wanting help with “career/practice management.”

The American Bar Association’s Commission on Lawyer Assistance Programs reports that many try to cope with stress by turning to tobacco, alcohol, caffeine, herbal remedies and legal or illegal drugs, as well as other
harmful behaviors as diversions.

Some practitioners cope with more extreme action. Suicide ranks among the leading causes of premature death among lawyers. Surveys of lawyers in Washington and Arizona show that most lawyers suffering from depression
also have suicidal thoughts. The 1992 Annual Report of the National Institute of Occupational Safety and Health reported that male lawyers are twice as likely as the general population to commit suicide.

The mindlessness brought on by the crippling stress of our profession negatively impacts our ability as a whole to develop relationships with colleagues, to succeed in fair negotiation, and to sustain objectivity—all negatively affecting our ability to serve as counsel in a civil manner. We’ve all seen incivility in our colleagues or ourselves in the midst of a deposition, courthouse corridors, correspondence and conversations with opposing counsel or in many other unhealthy professional exchanges. Incivility impedes the administration of justice and reflects poorly upon our profession. In May 2006, the Massachusetts Bar Association’s House of Delegates addressed this topic in part by adopting Civility Guidelines for Family Law Attorneys.

Beyond such guidelines and efforts to regulate our behavior and manner, each of us has to take the matter into our own hands and be more aware of our professional behavior — be more mindful.

Kabat-Zinn writes, “to provide effective counsel we need a mind that knows and sees in new ways — that is motivated differently — that aspires to compassion and empathy.”

Eighteen thousand people have attended Kabat-Zinn’s eight-week Mindfulness Based Stress Reduction clinic at UMass Medical School. The program has served as a national model, being replicated throughout the country and around the world. Studying Kabat-Zinn’s and similar work, I seek a better understanding of how to practice being mindful.

I look forward to Massachusetts attorneys bringing further clarity and compassion to our daily interactions. Reducing conflict and enabling better communication and understanding can only benefit our noble profession and better serve the interests of our clients.

To conclude, I leave you with a quote from William Butler Yeats:

We make our minds so like still water that beings gather about us that they may see, it may be, their own images, and so live for a moment with a clearer, perhaps even with a fiercer life because of our quiet.

The Celtic Twilight: Earth, Fire & Water (1902)

• Chris Shaw
• Edited By: Leigha Baugham – myfoxatlanta.com

When Donnie Apted came home from the war, he dreamed he would come home to a happy life with his wife and two sons. For two years, that happy life was just a dream for Apted.

Apted served with the National Guard in Iraq during a violent period in 2004. Apted was stationed just north of Baghdad.

“We were getting hit just about everyday with mortar fire,” recalled Apted.

Like so many men and women who have served in Iraq and Afghanistan, Apted unintentionally brought terror and anguish back home with him. Apted’s condition made the life he returned home to almost unrecognizable.

“I had rage, issues with rage, and you would ask anybody that knew me before I left they would say, ‘Donnie, he was laid back,’” said Apted.

“So I always felt like I was trying to make up for that or trying to cover for him or make excuses for him being the way he was,” said Apted’s wife, Kari.

Things took a turn for the worse more than a year after Apted returned home. During dinner one evening, the family dog snatched a piece of pizza from Apted’s son’s hands.

“And he screeched. And I lost control and I went in, and I pinned my dog to the ground and I was just wailing on her. And it was like I couldn’t control myself,” Apted.

Apted sought help from an experimental treatment at Atlanta’s Emory Hospital after therapy and medication both failed to treat his PTSD.

The experimental treatment is called mindfulness based stress reduction and it is being tested on other service men and women who suffer from PTSD. The treatment incorporates meditation and relaxation techniques. Instead of trying to forget memories of war, patients are taught to handle their emotions when those thoughts arise.

“What’s important is developing a new relationship to these symptoms, so they change, so they’re not as scary anymore,” said therapist Kaye Coker.

Coker, the lead investigator in the study, said brain scan images show the treatment can work. The treatment is a potential breakthrough. Some estimates claim as many as 20 percent of Iraq War vets have PTSD.

“We don’t have a treatment that is uniformly helping most of the people most of the time,” said Dr. J. Douglas Bremmer. “I think it’s possible we could be getting better results than we’ve had with previous treatments.”

Apted called the breathing techniques he learned in the treatment a life-saver.

“Sometimes I’ll still get startled by something, but I’m aware enough to catch it early on and say, ‘that’s what that was, it’s nothing else,’” Apted said.

Some of the peace dreamed of after the war has returned to Apted’s family.

“We’re sort of new and improved, I guess. We’ve been through hell together. And we’ve made it through the other side,” said Kari Apted.

Researchers said the number of troops returning home from the wars in Iraq and Afghanistan with PTSD is about the same as it was during the Vietnam War. The disorder is better diagnosed these days.

Apted said his father served in Vietnam and his PTSD went untreated until just a couple of years ago.

For more information on PTSD and where you can find help, go to: FOX 5′s PTSD Information Page

Providers can participate in this exciting opportunity as an Originating Site Facility or a Distant Site Facility. An Originating Site is the site where an eligible TRICARE beneficiary is located when the service is being furnished via a videoconferencing system. A Distant Site is the location where a TRICARE provider will render services being furnished via a videoconferencing system. TRICARE will reimburse for both types of services.

One of the areas in which we need to augment existing access to providers is in the area of behavioral health prescribers. Our TRICARE beneficiaries, particularly those located in rural areas, would benefit from additional access to those distant providers who can prescribe medications to behavioral health patients. Only network providers located in the West Region are currently eligible to participate in the demonstration project with TriWest.

From The Yahoo! Newsroom Blog

Washington, DC — With the Senate health committee convening daily to craft a comprehensive health reform bill, the basic outline of this landmark legislation is now clear.

Yes, it will ensure access to affordable, quality care for every American.  But, just as important, it will hold down health care costs by creating a sharp new emphasis on disease prevention and public health.

As the lead Senator in drafting the Prevention and Public Health section of the bill, I view this legislation as our opportunity to recreate America as a genuine wellness society – a society that is focused on prevention, good nutrition, fitness, and public health.

The fact is, we currently do not have a health care system in the United States; we have a sick care system.  If you’re sick, you get care, whether through insurance, Medicare, Medicaid, SCHIP, community health centers, emergency rooms, or charity.  The problem is that this is all about patching things up after people develop serious illnesses and chronic conditions.

We spend a staggering $2.3 trillion annually on health care – 16.5 percent of our GDP and far more than any other country spends on health care – yet the World Health Organization ranks U.S. health care only 37th among nations, on par with Serbia.

We spend twice as much per capita on health care as European countries, but we are twice as sick with chronic disease.

How can this be so?  The problem is that we have systematically neglected wellness and disease prevention.  Currently in the United States, 95 percent of every health care dollar is spent on treating illnesses and conditions after they occur.  But we spend peanuts on prevention.

The good news in these dismal statistics is that, by reforming our system and focusing on fighting and preventing chronic disease, we have a huge opportunity.  We can not only save hundreds of billions of dollars; we can also dramatically improve the health of the American people.

Consider this:  Right now, some 75 percent of health care costs are accounted for by heart disease, diabetes, prostate cancer, breast cancer, and obesity.  What these five diseases and conditions have in common is that they are largely preventable and even reversible by changes in nutrition, physical activity, and lifestyle.

Listen to what Dr. Dean Ornish told our Senate health committee: “Studies have shown that changing lifestyle could prevent at least 90 percent of all heart disease.  Thus, the disease that accounts for more premature deaths and costs Americans more than any other illness is almost completely preventable, and even reversible, simply by changing lifestyle.”

It’s not enough to talk about how to extend insurance coverage and how to pay for health care – as important as those things are.  It makes no sense just to figure out a better way to pay the bills for a system that is dysfunctional, ineffective, and broken.  We also have to change the health care system itself, beginning with a sharp new emphasis on prevention and public health.

We also have to realize that wellness and prevention must be truly comprehensive.  It is not only about what goes on in a doctor’s office.  It encompasses workplace wellness programs, community-wide wellness programs, building bike paths and walking trails, getting junk food out of our schools, making school breakfasts and lunches more nutritious, increasing the amount of physical activity our children get, and so much more.

I am heartened by the fact that the major players in this endeavor – Democrats and Republicans alike – all “get it” when it comes to prevention and public health.  We all agree that it must be at the heart of reform legislation.

As President Obama said in his speech to Congress earlier this year: “[It is time] to make the largest investment ever in preventive care, because that’s one of the best ways to keep our people healthy and our costs under control.”

No question, comprehensive health reform is an extraordinarily ambitious undertaking.  But what makes me optimistic is that all the major groups are playing a constructive role, including those that opposed the 1993-94 heath reform effort.  Everyone agrees that the current system is broken.

Winston Churchill famously said that “Americans always do the right thing – after they’ve tried everything else.”  Well, we’ve tried everything else, and it has led us to bad health and the brink of bankruptcy.

Comprehensive health reform legislation is our opportunity to change the paradigm.  We are going to extend health insurance to every American.  And we are going to give our citizens access to a 21st century health care system – one that is focused on helping us to live healthy, active, happy lives.

Sen. Tom Harkin (D-Iowa) is a senior member of the Senate Health, Education, Labor and Pensions Committee and chairs the Senate panel that funds medical research and health care..

According to the white paper, telemedicine would help curb cost inflation and provide other benefits that would significantly outweigh the costs.

In a statement, lead authors Rashid Bashshur of the University of Michigan and Gary Shannon of the University of Kentucky said, “While not a panacea, telemedicine offers significant opportunities to address the issues of inequities in access to care, cost containment and quality enhancement” (United Press International, 6/23).

The white paper is available online (.pdf).

The measure, sponsored by Maine Rep. Anne Perry (D), covers health care services provided through interactive audio, video and other electronic media (Maine Public Broadcasting Network, 6/11).

In a statement, Baldacci said, “Telemedicine offers opportunities to increase the accessibility of health care, ensure that appropriate medical information is available, reduces medical errors and reduces health care costs,” adding, “This bill makes sense and I am pleased to sign it.”

The new law goes into effect 90 days after the close of the legislative session (Office of the Governor release, 6/11).

10 yoga poses to help heal your body and release your pain

By Liz Owen

Anyone who has lived with chronic pain knows how physically, mentally and emotionally debilitating it can be. We can become unable to understand how one part of our body could “do this to us.” We can feel frustrated, angry, and ultimately hopeless.

Yoga includes a range of practices that can help. Rather than seeing the body as a number of different parts, with some that are comfortable and strong while others are weak and painful, yoga considers the body to be an organic, connected entity whose parts are constantly in moving relationship to each other. Yoga teaches awareness of proper body alignment and posture, an important aspect of a well-functioning body. At the same time, the mindfulness training of yoga provides tools for engaging with our pain in a way in which we can listen to it, come to understand it, and abide it while healing is in process. Stress reduction, a well-known benefit of yoga, can further facilitate the release of negative and damaging emotions to help you move towards healing.

This sequence of yoga asanas (poses) is designed to both stretch and strengthen your body. While you practice the sequence, remember that you are not responsible for your pain, but you must be responsible to it. Decide which poses help you to feel better. Offer mental comfort to your painful areas and listen closely to them: You may be surprised by a sense of delight and accomplishment as you help your body become more vital, healthy, and happy.

Liz Owen is a certified Iyengar yoga instructor and has taught yoga for over 17 years. Liz teaches in the Boston area and throughout New England. LizOwenYoga.com.

Hints for Practice

Above all, it is important to listen to the wisdom within your body when dealing with chronic pain. The body can tell you what it needs and what should be avoided. Choose the poses from this sequence that speak to your body in a positive way, and avoid movements that cause stress or discomfort. Also:

· Have a yoga mat, one belt, a blanket, one block and an eye bag (optional) nearby. Props can provide support so that your body can move into a comfortable stretch rather than too much stretch or strain in a pose. You can always go with less support once you understand how much your body can comfortably do.

· Hold each pose from 20-30 seconds when you are first starting. Breathe deeply and fully, with even inhales and exhales. If the pose is comfortable, you may stay longer. If you experience pain in a pose, it is time to come out – your body won’t benefit from pushing through pain.

Lying Leg Stretch

Lie on your back with your legs on the floor. Draw your right knee into your chest and place a belt around your right foot. Stretch your right leg straight and upward towards the ceiling. Stretch your leg upwards as you inhale and draw your foot towards your head as you exhale. Then take your right leg to the right and down towards the floor while you keep your left hip grounded. To balance your hips, place a folded blanket against your outer right hip. Repeat with the left leg.

Reflection: Know Your Body
Yoga practice provides time and mental space for you to develop intuition and understanding about your body. While in this deep stretch to the legs, hips and lower spinal muscles, notice where your body holds pain as well as excess tension, which can amplify pain and discomfort. As you remain in the pose, see if your body can let go of tension and holding. Honor
these sensations as guides that bring you
into your potential for healing.

Eagle Shoulder/Back Stretch

Sit comfortably on a folded blanket or in a chair. Lift your arms forward and to shoulder height and cross your right arm over your left arm above the elbow. Lift your forearms up towards the ceiling and bring your palms together, or hold a belt with both hands. As you inhale, raise your elbows upward and feel a powerful stretch to the upper back and shoulders, places we typically hold tension. You can tuck your chin towards your chest to add a stretch to the back of your neck. Repeat with left arm over right.

Reflection: Calm The Mind To
Calm The Body
While in this pose, inhale deeply into an area of discomfort and hold the breath a few moments. Exhale very slowly and deeply, letting any anxiety or emotional stress that is accompanying the pain release along with the out breath. Ask each exhale to bring calmness and quiet to your mind and nervous system. As well as calming your emotional responses to pain, your brain will send messages of calming to your body, and you will find insights into dealing with physical pain.

Bridge Pose

Lie on your back with the soles of your feet on the floor, hips’ distance apart from each other, hands by your sides. With an inhale, lift your hips upward starting from your tailbone, then from your buttocks, and then lift your back ribs. Lift the tip of your tailbone strongly upward to elongate your lower back. Feel how this pose strengthens the back, hips, and legs. Release slowly with an exhalation keeping the tailbone tucked and coming down vertebra by vertebra.

Reflection: The Importance Of Movement
Gentle movements support the body’s healing process on many levels. The body’s structural system of bones and muscles is kept strong yet fluid, the lungs receive and distribute more healing oxygen throughout the body, the organic body is massaged, and the body produces chemicals that help you feel psychologically better and enhance the experience of movement.

Wide-Leg Seated Pose

Sit upright on a folded blanket with your legs wide apart from each other. Hold your feet with your hands or with belts. Elongate your spine upward as you inhale, and as you exhale bend from your hips to come into a forward bend with your spine long and soft. Feel how this pose gives a stretch to the legs and hips while it tones the abdominal muscles and back.

Reflection: Honor Limitations
Pain is often a message of physical limitation which must be honored for the body to heal. In daily life as well as in yoga, be mindful of movements that create or intensify pain. If there isn’t a way to modify painful activities for more comfort, let go of them for the present. Being responsive to present limitations is more important than what or how much you do. As your body heals, you will be able to enjoy a wider range of movement and activity.

Modified Boat Pose

Lie down on your back with hands under your head, and place your feet flat on the floor. Feel that your lower back is relaxed and elongating along the floor. Moving with an exhale, take your right leg straight out at a 45-degree angle to the floor and curl your shoulders up. Be mindful not to move from or strain your neck; rather, support your head fully in your hands and curl up using your abdominal muscles. Feel strength and warmth coming into your abdomen. Rest a few moments, then repeat with left leg lifting.

Reflection: Be In The Present
Visit an area of discomfort and ask how that area is feeling at that moment. Move on to the next moment, and then the next, each time with a fresh mind, asking again how the area feels. Release the pain of each past moment as if you are watching a cloud that moves through the sky and then dissolves. Feel your emotions around pain becoming less reactive and calmer in each moment, coming to understand how to abide and take care of pain.

Half Forward Bend

Stand facing a wall and place your fingertips on the wall at waist height. Slowly step your legs back until your spine is parallel to the wall and your hips are over your ankles. Release your shoulder blades down towards your waist, look down, and elongate through the crown of your head. Press your hips away from the wall. Feel your spine, waist, and ribcage lengthening. To come out, bend your knees, walk towards the wall and come back to standing. Feel your spine tall and open.

Reflection: Cultivate Kindness And Compassion
Sometimes it is unavoidable that the mind becomes anxious and fearful when pain is present. Observe your thoughts in a non-judgmental way and replace them with thoughts that your body/mind isn’t overwhelmed by. Instead of “My body just doesn’t cooperate with me anymore!” consider “My body is not ready to move right now as I would like to. I trust that as it heals, day-by-day, my body will show me what it is ready to do.”

Mountain Pose with Shoulder Stretch

Stand with your feet and legs together and lift up from the base of your hips through the crown of your head. Reach your left arm around to your back. Lift your right arm upward and take the right hand down to the nape of your neck. Now walk the hands towards one another and clasp. If you can’t clasp, hold a belt with both hands. Keeping your spine tall and your chest broad, lift the right elbow strongly upward and enjoy length and space at the right arm, ribs, and through the shoulder girdle. Repeat on the other side.

Reflection: Body/Mind Connection
The body and the mind each have their own natural wisdoms. Creating dialogue and understanding between the two integrates their wisdoms and creates a powerful union. Then you live in a state of “embodied presence,” where relationship to pain is focused on nurturance and becoming whole, rather than in a disembodied existence where pain is ignored and misunderstood.

Supported Triangle

Stand with your feet 4 feet apart, hands on your hips. Turn your right leg and foot outward and turn your left foot slightly inward (to your right). Stretch your arms up to shoulder height at your sides. Reach your spine upward with a deep inhale, and as you exhale reach to your right through your right arm, right ribs, and spine. Place your right hand on a chair. Lift your left arm up towards the ceiling, and, if it’s comfortable in your neck, look up at your left hand. Feel length through your legs and the left side of your spine while your hips become open and fluid. Repeat to the left.

Reflection: The Color Of Pain
Using color imagery at an area of pain is a mental tool for relieving emotions surrounding pain. The intensity of lumbar pain might be fuchsia, for example; a migraine might be brown or gray. Imagine the color of your pain lessening in intensity, changing from fuchsia to red, to golden orange, to soft pastel yellow, and finally to white. As the intensity of the color lessens observe how the intensity of your emotions about pain can also change.

Seated Twist and Forward Bend

Sit in a chair with the right side of your body adjacent to the chair’s back. Plant your feet squarely on the floor and inhaling, lift your spine upward. While exhaling, turn to your right, placing your hands on the back of the chair. Turn evenly from the sides of your waist, your ribs, and chest. Feel your spinal muscles receiving a gentle massage. Release any tension that might have appeared during this sequence with each exhale, moving more deeply into the twist. Repeat to the left. Then, sit squarely in the chair facing forward with your legs apart. Keeping your spinal muscles supple from the Seated Twist, bend forward letting your spine soften and dangle down towards the earth like a glowing string of pearls. Close your eyes.

Reflection: Discover The Causes
During your yoga practice, mindfully review situations that trigger your chronic pain. Consider keeping a journal of what kinds of stressors create mental or physical discomfort. Understanding the causes of pain will empower you to live mindfully off the yoga mat as well as on it and will help you to create protocols for pain-free living.

Deep Relaxation

Lie down with a folded blanket under your head and your calves on the seat of a chair. Your thighs should be perpendicular to the floor. Place a folded blanket across your abdomen (optional) to encourage softness in your belly and place an eyebag over your eyes to relax both your eyes and your mind. Let your breath become natural and even while you let your body deeply let go into the support of the earth. Rest is crucial for the health of the mental and emotional bodies while coping with chronic pain.

Reflection: The Power Of Spirit

Moving into the unknown territory of chronic pain can be daunting and sometimes frightening. Yet spiritual belief asks us to trust that beyond the known, to believe that the unknown is actually better: It is a place of clarity and wisdom. This can help us to visualize that beyond pain and discomfort may be a new way of being where the body is a flowing synergistic entity, larger than the sum of its parts, healthy and free.

Ryan, 35, sits on a floor cushion, closes his eyes, focuses on his breath and tries to detach from any thoughts, just observing them like clouds moving across the sky — a practice he learned at a retreat. “I find it makes me a better listener, and my concentration is sharper. I get less distracted when I’m reading,” he says. “It’s like you see through the clutter of life and can penetrate to what’s really going on.”

Once thought of as an esoteric, mystical pursuit, meditation is going mainstream. A government survey in 2007 found that about 1 out of 11 Americans, more than 20 million, meditated in the past year. And a growing number of medical centers are teaching meditation to patients for relief of pain and stress.

More than 240 programs in clinics and hospitals teach the same type of meditation that Ryan learned, says Jon Kabat-Zinn, who developed mindfulness-based stress reduction 30 years ago at the University of Massachusetts Medical Center. Other types, such as transcendental meditation, use a mantra or repeated phrase.

‘A colossal shift in acceptance’

Some kind of meditative practice is found in all the world’s religions, says Shauna Shapiro of Santa Clara (Calif.) University, co-author with Linda Carlson of the new book The Art and Science of Mindfulness. Most include focusing attention and letting thoughts and emotions go by without judgment or becoming involved.

Kabat-Zinn credits “a colossal shift in acceptance” to accelerating research on the benefits of meditation.

Studies suggest the practice can ease pain, improve concentration and immune function, lower blood pressure, curb anxiety and insomnia, and possibly even help prevent depression. Newer research tools, such as high-tech brain scans, show how meditation might have diverse effects.

In a brain-scan study of long-time meditators compared with a control group that never meditated, the meditators had increased thickness in parts of the brain associated with attention and with sensitivity to internal sensations of the body. “These are people who would notice their muscles tensing when they’re angry or butterflies in their stomach if they’re scared,” says study leader Sara Lazar, a neuroscientist at Massachusetts General Hospital.

And a UCLA study out in May found that, compared with a non-meditating control group, meditators’ brains have larger volume in areas important for attention, focus and regulating emotion. They also have more gray matter, which could sharpen mental function, says study leader Eileen Luders, a neuroscientist.

Of course, nobody knows whether these meditators’ brains were different to begin with. And that’s the problem with much of the meditation research so far. Although studies have improved, most still aren’t large and lack good control groups, says Richard Davidson, a pioneering meditation researcher and neuroscientist at the University of Wisconsin.

His research shows that even novice meditators have greater activation in a part of the brain tied to well-being. The more activation, the greater their antibody response to a flu vaccine, which makes the vaccine more protective. By changing the brain, meditation could affect many biological processes, he says.

Settling down, not lashing out

A cutting-edge approach to meditation practice starts with children. In scattered pockets across the USA, students are learning meditation at school.

Steve Reidman, a fourth-grade teacher at Toluca Lake Elementary School in North Hollywood, Calif., says teaching meditation to children has curbed fighting while sharpening their focus. “You can just watch them breathe deeply and settle down rather than lashing out.”

Susan Kaiser Greenland, whose InnerKids Foundation teaches in Los Angeles-area schools, works with Reidman’s class.

Preliminary research shows that Los Angeles preschoolers who were taught meditation improved in their ability to pay attention and focus. For early elementary school kids, improvement came only in those who had attention problems at the start, says Susan Smalley, a UCLA behavioral geneticist who did the research with psychologist Lisa Flook. Very young brains may be more malleable, she speculates.

As research expands, scientists expect to unlock more of the mysteries around meditation. Meanwhile, for those such as Ryan, proof of benefit is already evident. “I’m much more aware now than I used to be,” he says. “I enjoy my life more because you notice, and you really appreciate.”

(CNN) — “Just the facts” has always been Lillian Waugh’s motto. A historian and former professor of women’s studies at West Virginia University, Waugh is a stickler for facts and details. And because she was always the “go to” person at WVU, she was constantly in demand — and busy.

“I was a multitasker at work,” she said.

Waugh’s job was so stressful it started to affect her health. So when the university began a study on how to handle stress at work, she jumped at the chance to participate.

The study included 103 participants. Half were given written instructions on how to handle stress at work; the others, including Waugh, were taught techniques to cultivate mindfulness, such as yoga poses, breathing methods, stretches and meditation — all designed to help workers cope with too many e-mails, ringing phones and the occasional nasty co-worker.

Lead investigator Kimberly Williams said the goal was to relieve stress. “Mindfulness means to pay full attention to what you are doing, moment by moment,” she said. “We taught them how to recognize sources of stress, how stress impacts them, and then what they could do to come out of the vicious cycle of stress reactivity.”

The program lasted eight weeks and participants were followed for an additional three months. Williams said they found those who received the mindfulness training “had significantly less daily hassles, psychological distress and significantly fewer medical symptoms” — like lower blood pressure and fewer aches and pains — than those who were handed a pamphlet.

Waugh says she was thrilled to find that after practicing mindfulness techniques, the back pain that had plagued her for almost a decade went away. She also said she “communicated better with fellow employees and actually had a better attitude towards my job.”

“The one thing I came away with was the ability to put myself in a place where I could gain perspective on everything I was doing at the moment,” she said.

Mindfulness is not new. It goes back to the time of Buddha, who believed that the mind should always be fully in the present — not looking back at the past or anticipating the future. Being mindful of the here-and-now, Buddha said, reduces stress and brings inner peace.

Today, mindfulness training involves learning to become aware of mind, body and emotions. Yoga, tai chi, and meditation all teach mindfulness.

Williams said the popularity of mindfulness techniques is a positive development, because when done correctly, the methods have been shown to “actually lift stress from your body.”

Numerous studies have shown that stress can take its toll on the human body. “[Stress] increases your heart rate, your blood pressure and your respiration; you go into a state of hyper-arousal,” said Williams. “And over the long-term, we internalize the response, which can lead to neck pain, back pain, digestive disorders, sleeplessness. … And many people deal with those problems by overeating, drinking or smoking.”

The mindfulness exercises in the WVU study included “deep tasting,” where participants spent time eating a raisin: They looked at it, smelled it, and took small bites to savor the taste. “It brings an awareness to the body that normally is always being rushed,” said Williams, who emphasized the need to slow down.

“If you give all of your attention to something, you get deeply touched by that experience,” she said. “We all know what it’s like to eat our favorite food: We slow down, we savor it, we take our time. And that is what makes it so enjoyable.”

Study participants were also taught to breathe by taking deep breaths through the nose, feeling the air fill their lungs and exhaling fully. Williams said that with a couple of those breaths, not only does “your blood pressure go down, and you stay calm,” but you can better handle annoying colleagues or situations. “You often can bring out the best in people if you stay calm and loving.”

Along with the breathing techniques, participants were also taught how to meditate — even at their desks. They were told to find a comfortable time, free of distractions, and quiet their mind.

According to the study, even 10 minutes of meditation can help. “[Meditation] can take the anxiety out of a stressful workday,” said Williams.

West Virginia University is not the first — or only — institution in the country that has tested the effects of mindfulness techniques on stress. UCLA completed a study a few years ago that found the same thing the WVU study found: Mindfulness exercises are excellent stress-busters.

Other researchers are looking at ways to mitigate the dangerous side effects of stress by using mindfulness exercises. Yale University is recruiting patients for a smoking cessation study that includes a mindfulness training component. The six-week program will focus on learning mindfulness techniques to deal with stressors and triggers that cause people to light up.

For Waugh, mindfulness training was a life-saver. Although she is no longer a full-time professor, she still practices mindfulness and attends yoga classes every week. She also has gone back to playing the cello, another mindfulness exercise that soothes her soul. She said these methods have helped her stay healthy and improve her outlook on life — and those are “just the facts.”

The study, published in the journal NeuroImage, found certain regions in the brains of long-term meditators were larger than in a control group.

“We know that people who consistently meditate have a singular ability to cultivate positive emotions, retain emotional stability and engage in mindful behavior,” lead author Eileen Luders, a postdoctoral research fellow at the UCLA Laboratory of Neuro Imaging, said in a statement. “The observed differences in brain anatomy might give us a clue why meditators have these exceptional abilities.”

Those who meditated showed significantly larger volume of the hippocampus and areas within the orbito-frontal cortex, the thalamus and the inferior temporal gyrus — all regions known for regulating emotions.

Luders and colleagues examined 44 people — 22 control subjects and 22 who had practiced various forms of meditation — including Zazen, Samatha and Vipassana, among others.

© 2009 United Press International, Inc. All Rights Reserved.

By Irene S. Levine

Managing workplace stress is an ongoing challenge for scientists–busy, task-oriented, ambitious people who often feel they don’t have enough hours in the day, at home, or at work. But managing stress doesn’t have to take a big chunk of time. Small chunks can work just as well–and that’s one of the keys to managing stress in a busy life.

Short breaks and exercise are both known stress-reducers, says Rachel Permuth-Levine, deputy director of the Office of Strategic and Innovative Programs at the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH) in Bethesda, Maryland. “Research has shown that all types of physical activity, whether light, moderate, or vigorous, have the capability to reduce anxiety, depression, and both self-reported and physiological levels of stress,” she says. There’s not much data on the benefits of combining the two, but if short breaks and short bursts of exercise are good by themselves, she figures, combining them can’t hurt. “We do know that when people have control of their schedules and have the flexibility to take small health breaks during their day, their mood can improve and the day just seems to flow better,” she says.

Based on this premise, NHLBI instituted an innovative program aimed at combating stress by allowing employees to exercise in short bursts. Dubbed “Take 10 Rooms,” these getaways–the institute has three of them–are equipped with recumbent bikes, elliptical cross-trainers, resistance bands, small weights, mats, and flat-screen TVs. Employees are encouraged to take one or two 10- to 15-minute breaks a day for physical activity.

Programs like this one have another potential benefit, apart from stress reduction: improved health. A team of researchers from the Translational Medicine Branch of NHLBI hypothesized that a sedentary work force is at increased risk for future cardiovascular disease. They looked at the effects of staff engaging in a 15-minute-per-day exercise program at these work-site exercise facilities at NIH on the endothelium, the thin layer of cells that line blood vessels that is a biomarker of risk. They found that even in the absence of weight loss, relatively brief periods of exercise daily during the workday improved endothelial function.

Wellness in the workplace

(Image: National Science Foundation)

A global survey of 600 organizations in 25 countries conducted last year found that workplace wellness programs are growing globally, particularly in North America. Yet, as the NHLBI investigators noted, nearly two out of three American adults say they don’t engage in routine exercise, “possibly because of demands of work and family.” Despite the benefits of regular exercise, it’s easy for a busy scientist to find excuses. Some wellness facilities are located off-site, making their use inconvenient during the workday. A small proportion of scientists still work in dinosaur-age academic settings that don’t even offer wellness programs.

Permuth-Levine is the four-star general of the institute’s war on stress, overseeing wellness and disease-prevention programs for 1500 NHLBI employees. Her approach is practical. She wants people to have options, realizing that only a certain proportion of employees are going to walk, run, or bicycle to work; go to the gym during evenings; or take advantage of the Take-10 rooms. The rooms have about 30 users–5% of the NHLBI workforce. About three out of four people who use the rooms are regular users, Permuth-Levine says.

So that no stressed-out person is left behind–including those who don’t make it to the Take-10 rooms–Permuth-Levine has come up with a five-point plan for reducing stress that can be practiced at employee workstations or in laboratories. She suggests the following:

1. Become better at managing your time

“Invest in an egg timer,” says Permuth-Levine. “Not for cooking, but for giving yourself 5 to 10 minutes to write down what you need to do that day, in priority order if possible.” Many of us turn on our computers then automatically respond to e-mails, even if we know that’s not the most critical thing we could be doing. “The egg timer helps you get in the habit of effective time management by prioritizing your work before your day gets ahead of you,” she says.

2. Stretch

Even if your organization doesn’t have yoga classes, you can benefit from your own yoga session right in your chair. Simple stretching sends impulses to the brain that evoke a relaxation response, Permuth-Levine says. “One of the best ways to decrease eye strain and tension in your neck is to do some slow, deliberate neck rolls,” she adds. “You start with a deep inhalation and slowly bring your head to one side, like laying your head down on your shoulder like a pillow. Roll your chin to your chest as you exhale and slowly move your head to the other side. Repeat. Go slowly, taking time at those more tender spots to explore tension.”

3. Relax

Because our eyes are open most of the day, staring at people, paper, an instrument, or a computer screen, we need to rest them. “Start by turning away from your computer or other work,” says Permuth-Levine. “Rub the palms of your hands together vigorously until you create some heat. Close your eyes and gently place your cupped hands over your eyes. Take 10 slow, deliberate breaths in and out and relax. Repeat as often as needed throughout the day,” she says.

4. Play music

Tune in, “but not to just any old music. Choose tunes that you really enjoy and you associate with positive feelings,” Permuth-Levine says, then listen as you work. Music with a moderate or slow tempo makes it easier to relax. “Fast and frenetic music might have the opposite effect you want, making you rushed and harried.” Listening to music doesn’t work for everyone; music commands some people’s attention, distracting them from their work. For those people, music at work can be a source of stress and not a stress reliever.

5. Focus on the present

According to the April 2009 issue of Harvard Women’s Health Watch, there is mounting evidence that mindfulness–focusing on the present rather than the past or future–can relieve stress and alleviate a number of chronic health problems, such as high blood pressure, pain, sleep problems, and gastrointestinal difficulties. Mindfulness can be practiced through meditation or by just slowing down your everyday activities. The publication suggests sitting quietly for 20 to 30 minutes, using a repeated phrase, breathing, or focusing on an image; this will help you focus your attention and free your mind of distracting thoughts. Slowing down can be achieved by “devoting your full attention to the thoughts, sensations, and feelings you’re experiencing” when you are feeling impatient.

Reframe negative thoughts. “Most of us have a tape player in our heads telling us that our work is overwhelming, and it becomes self-fulfilling,” Permuth-Levine says. Such thinking evokes a physiological stress response. She suggests reminding yourself to tackle one task at a time, even if the list of tasks is long.

In times like these, we’re lucky just to have good jobs and be able to make ends meet. Yet the stress of living in such times isn’t limited to the people who lost their jobs. For those who are still employed, layoffs mean working harder to make up for the staffing shortage. At state universities, staff layoffs mean scientists have less administrative support, and teaching loads are larger because departed faculty members are not being replaced. Meanwhile, principal investigators and administrative staff at research institutions are working long hours at a frenzied pace to meet the stimulus act’s accelerated grant deadlines, and the workloads of NIH staff members are increasing proportionately as they seek to handle the flood of inquiries and applications and manage the review process.

During such times, “each person needs to find something that makes them feel good and stick to it, whether it’s exercise, dancing, meditation, Pilates, or yoga. The benefits of these tools reach well beyond your office into every aspect of your life: family, friends, and overall health and wellness,” Permuth-Levine observes.

Resources:

- Save the dates 8-11 September for NIH Mind/Body Week and explore the science and practice of yoga, meditation, and stress management. All events are free and open to the public.

- For a free meditation each morning

- Four Steps to Managing Your Stress from the Stanford Health Promotion Resource Center

Photo (top): Judepics

We are addressing the effects of war by creating a community-based network of services, resources and education.

This network includes:

1. consultation with specially trained counselors and mental health clinicians for veterans and families;
2. workshops and programs for veterans, couples and families, community gatherings and training for professionals;
3. outreach and mentoring by trained, seasoned veterans;
4. community education and involvement.

This work is influenced by concepts found in the book, War and the Soul, by Edward Tick.

We believe that:

• There is healing for the invisible wounds of war-related PTSD*
• The core work is the nurturing of a positive warrior identity
• The suffering of families must be addressed, including the unaddressed wounds of war passed down through generations of families that have experienced war.
• The citizens of our communities, those who are protected and guarded, must share the burden of the wounds of those who have gone to war.

“Veterans are the light at the tip of the candle, illuminating the
way for the whole nation. If veterans can achieve awareness,
transformation, understanding, and peace, they can share
with the rest of society the realities of war. And they can teach
us how to make peace with ourselves and each other, so we
never have to use violence to resolve conflicts again”.
-Thich Nhat Hahn

We invite all to begin the journey toward healing and resolution, recovery and reconciliation, moving towards a mature, peaceful and balanced Warrior identity for our veterans.

Veteran’s Heart Georgia has no political agenda, no goals beyond fostering healing from the effects of war. Our work is focused right here, on this healing.

A provocative new book from a Harvard psychologist suggests that changing how we think about our age and health can have dramatic physical benefits.

Anne Hubbard has not lost her job, house or savings, and she and her husband have always been conservative with money.

But a few months ago, Ms. Hubbard, a graphic designer in Cambridge, Mass., began having panic attacks over the economy, struggling to breathe and seeing vivid visions of “losing everything,” she said.

She “could not stop reading every single economic report,” was so “sick to my stomach I lost 12 pounds” and “was unable to function,” said Ms. Hubbard, 52, who began, for the first time, taking psychiatric medication and getting therapy.

In Miami, Victoria Villalba, 44, routinely slept eight hours a night until stories of desperate clients flooding the employment service she runs began jolting her awake at 2 a.m. No longer sleepy, she first began to respond to e-mail, but that caused sleeping colleagues’ BlackBerrys to wake them, so now she studies business books and meticulously organizes her closets.

“I’m embarrassed,” she said. “Normal people aren’t doing this.”

With economic damage expected to last months or years, such reactions are becoming common, experts say. Anxiety, depression and stress are troubling people everywhere, many not suffering significant economic losses, but worrying they will or simply reacting to pervasive uncertainty.

Some are seeking counseling or medication for the first time. Others are resuming or increasing treatment, or redirecting therapy for other issues onto economic anxiety.

“The economy and fear of what’s going to happen is having a huge effect,” said Sarah Bullard Steck, a Washington therapist who also directs the employee assistance program at the Commerce Department. “People are coming in more” with “severe anxiety” or “more marital strife, some domestic violence, some substance abuse.”

Alan A. Axelson, a Pittsburgh psychiatrist, said he was seeing first-time patients and infrequent ones experiencing “relapse and needing more therapy and medication” even though, he said, “Pittsburgh’s actually doing pretty good economically.”

It is early to measure the recession’s consequences, but surveys suggest a growing impact. In an American Psychological Association poll in September, 80 percent reported the economy’s causing significant stress, up from 66 percent last April. The National Sleep Foundation said 27 percent of people surveyed last fall had sleeplessness because of economic anxiety.

National Suicide Prevention Lifeline calls jumped to 50,158 in January 2009 from 39,465 a month in January 2008, and economic stress more frequently “played a central role,” said Richard McKeon, the group’s federal project officer.

The Treasury, Labor and other departments started a Web site for people experiencing stress. The Substance Abuse and Mental Health Services Administration is training counselors who usually assist people devastated by tornadoes and floods to now help people with what they “are going through with the economy,” said Dr. McKeon, an agency adviser.

And while a New York Times/CBS News poll found fewer people saying the economy had worsened, most did not think it was improving. People overwhelmingly thought the recession would last another year or more, and 70 percent were concerned that a household member would be jobless.

Anxiety is not just troubling those with much to lose, like older people and homeowners. Elizabeth Dewey-Vogt, 25, a paralegal whose bills and shrinking overtime made her move in with her parents in Alexandria, Va., said she began “constantly worrying about finances,” and having panic attacks, “rapid heart beat, choking sensation, chills or sweating, numbness and tingling in my fingers,” and feeling “almost removed from my body.”

Ms. Dewey-Vogt said that she now took anxiety medication, and that a therapist advised her to pull over or “concentrate on the license plate ahead” if she began panicking while driving and to grip on the handles of her chair when panicking at work.

Even children show signs.

Daniel A. Cohen, a Manhattan psychiatrist, said he saw “more families in crisis,” with children experiencing “increased signs of anxiety and depression” and more nightmares and acting out.

Joshua Batista, 16, of Queens, who was treated for depression and post-traumatic stress after a taxi accident, said he had “gotten more depressed and stressed” since “the recession and that stuff started.” In school, he said he experienced “a nervous breakdown where I was pulling out my hair, hitting my head.” Joshua, a singer-guitarist, said the economy limited his music purchases and earnings. Therapy and medication have increased. Asked to leave school, he will be taught at home. “He noticed it was happening at the same time as the economy,” said his mother, Elissa Levine.

Even for insured people, the economy both causes anxiety and makes help less affordable.

Susan Bandrowsky, 30, a photographer in Wilmington, Del., with bipolar disorder, said she felt strain because her husband, having lost a long-term consulting contract, worked short-term jobs requiring travel, unsettling their 4-year-old autistic son. Fearing the loss of insurance, Ms. Bandrowsky would like more therapy, but to save co-payments she spaces appointments, which, she said, “ups the anxiety.”

Many seeking help are fearful, not actually incurring economic difficulty, said Joseph Ojile, founder of Clayton Sleep Institute in St. Louis, where patients increased 25 percent since October.

Steven Craig, a psychologist in Birmingham, Mich., said “people of less means” were handling some of this better because “their identity is not as caught up in how much money they have.”

Many ask primary physicians for medication, not therapy referrals, because they fear that employers will consider them unstable or resent counseling during work hours, said Allen J. Dietrich, a family doctor in Lebanon, N.H. He said he broached the subject of emotional stress gently because many had come in with physical complaints like arthritis or headaches.

Still, a survey of employee assistance programs found a jump in stress-related requests. “The stress level has increased a lot,” said Suzanne Greenlee, human resources benefits director at Sodexo Inc., a food services company.

Even for Ms. Greenlee, who said she “realized how tense I was” after trying Sodexo’s stress-management coach. She e-mailed the coach, “Today I’m feeling totally overwhelmed.”

During therapy recently, Marcy Krust, 39, told Dr. Craig, “People say it’s going to be better, but I don’t feel that way yet.” A divorced mother and on-and-off patient, Ms. Krust said she had not needed therapy for months until, with layoffs affecting her technology firm’s clients and fellow hockey moms, she felt “out of control” and “started to forget things.” Now twice-monthly sessions focus on the economy. Dr. Craig advises writing down worries, and making decisions about controllable things, like vacations.

Scott Schuck, 43, a Minneapolis business owner who had consulted Dr. Craig only for career coaching, began twice-weekly phone sessions after stress started waking him and creating “a lot of anxiety” in his relationship with his girlfriend.

Ms. Villalba, wary of medication, started meditation classes, even meditating in her car outside her office.

Ms. Hubbard, knowing “financially we were fine,” said she believed “I shouldn’t feel like this, I’m lucky.” She cried visiting her primary doctor, who recommended therapy and medication, hard to accept, she said, because her Depression-era parents believed “you pull yourself up.”

“I felt like a neurotic middle-class, middle-aged woman too weak to deal with life on my own,” she said. “I should be stronger, it was simply money, and why do I have to take pills to not worry about money.”

But treatment and further organizing family finances helped. She said the weakening economy made her “fear that even if you do everything right, something bad can happen to you.”

The evidence is mounting that diet and lifestyle are the best cures for our worst afflictions.

By DEEPAK CHOPRA, DEAN ORNISH, RUSTUM ROY and ANDREW WEIL

The Wall Street Journal, page A13, Jan 9, 2009

In mid-February, the Institute of Medicine of the National Academy of Sciences and the Bravewell Collaborative are convening a “Summit on Integrative Medicine and the Health of the Public.” This is a watershed in the evolution of integrative medicine, a holistic approach to health care that uses the best of conventional and alternative therapies such as meditation, yoga, acupuncture and herbal remedies. Many of these therapies are now scientifically documented to be not only medically effective but also cost effective.

President-elect Barack Obama and former Sen. Tom Daschle (the nominee for Secretary of Health and Human Services) understand that if we want to make affordable health care available to the 45 million Americans who do not have health insurance, then we need to address the fundamental causes of health and illness, and provide incentives for healthy ways of living rather than reimbursing only drugs and surgery.

Heart disease, diabetes, prostate cancer, breast cancer and obesity account for 75% of health-care costs, and yet these are largely preventable and even reversible by changing diet and lifestyle. As Mr. Obama states in his health plan, unveiled during his campaign: “This nation is facing a true epidemic of chronic disease.

An increasing number of Americans are suffering and dying needlessly from diseases such as obesity, diabetes, heart disease, asthma and HIV/AIDS, all of which can be delayed in onset if not prevented entirely.”

The latest scientific studies show that our bodies have a remarkable capacity to begin healing, and much more quickly than we had once realized, if we address the lifestyle factors that often cause these chronic diseases. These studies show that integrative medicine can make a powerful difference in our health and well-being, how quickly these changes may occur, and how dynamic these mechanisms can be.

Many people tend to think of breakthroughs in medicine as a new drug, laser or high-tech surgical procedure. They often have a hard time believing that the simple choices that we make in our lifestyle — what we eat, how we respond to stress, whether or not we smoke cigarettes, how much exercise we get, and the quality of our relationships and social support — can be as powerful as drugs and surgery. But they often are. And in many instances, they’re even more powerful.

These studies often used high-tech, state-of-the-art measures to prove the power of simple, low-tech, and low-cost interventions. Integrative medicine approaches such as plant-based diets, yoga, meditation and psychosocial support may stop or even reverse the progression of coronary heart disease, diabetes, hypertension, prostate cancer, obesity, hypercholesterolemia and other chronic conditions.

A recent study published in the Proceedings of the National Academy of Sciences found that these approaches may even change gene expression in hundreds of genes in only a few months. Genes associated with cancer, heart disease and inflammation were downregulated or “turned off” whereas protective genes were upregulated or “turned on.” A study published in The Lancet Oncology reported that these changes increase telomerase, the enzyme that lengthens telomeres, the ends of our chromosomes that control how long we live. Even drugs have not been shown to do this.

Our “health-care system” is primarily a disease-care system. Last year, $2.1 trillion was spent in the U.S. on medical care, or 16.5% of the gross national product. Of these trillions, 95 cents of every dollar was spent to treat disease after it had already occurred. At least 75% of these costs were spent on treating chronic diseases, such as heart disease and diabetes, that are preventable or even reversible.

The choices are especially clear in cardiology. In 2006, for example, according to data provided by the American Heart Association, 1.3 million coronary angioplasty procedures were performed at an average cost of $48,399 each, or more than $60 billion; and 448,000 coronary bypass operations were performed at a cost of $99,743 each, or more than $44 billion. In other words, Americans spent more than $100 billion in 2006 for these two procedures alone.

Despite these costs, a randomized controlled trial published in April 2007 in The New England Journal of Medicine found that angioplasties and stents do not prolong life or even prevent heart attacks in stable patients (i.e., 95% of those who receive them). Coronary bypass surgery prolongs life in less than 3% of patients who receive it. So, Medicare and other insurers and individuals pay billions for surgical procedures like angioplasty and bypass surgery that are usually dangerous, invasive, expensive and largely ineffective. Yet they pay very little — if any money at all — for integrative medicine approaches that have been proven to reverse and prevent most chronic diseases that account for at least 75% of health-care costs. The INTERHEART study, published in September 2004 in The Lancet, followed 30,000 men and women on six continents and found that changing lifestyle could prevent at least 90% of all heart disease.

That bears repeating: The disease that accounts for more premature deaths and costs Americans more than any other illness is almost completely preventable simply by changing diet and lifestyle. And the same lifestyle changes that can prevent or even reverse heart disease also help prevent or reverse many other chronic diseases as well. Chronic pain is one of the major sources of worker’s compensation claims costs, yet studies show that it is often susceptible to acupuncture and Qi Gong. Herbs usually have far fewer side effects than pharmaceuticals.

Joy, pleasure and freedom are sustainable, deprivation and austerity are not. When you eat a healthier diet, quit smoking, exercise, meditate and have more love in your life, then your brain receives more blood and oxygen, so you think more clearly, have more energy, need less sleep. Your brain may grow so many new neurons that it could get measurably bigger in only a few months. Your face gets more blood flow, so your skin glows more and wrinkles less. Your heart gets more blood flow, so you have more stamina and can even begin to reverse heart disease. Your sexual organs receive more blood flow, so you may become more potent — similar to the way that circulation-increasing drugs like Viagra work. For many people, these are choices worth making — not just to live longer, but also to live better.

It’s time to move past the debate of alternative medicine versus traditional medicine, and to focus on what works, what doesn’t, for whom, and under which circumstances. It will take serious government funding to find out, but these findings may help reduce costs and increase health.

Integrative medicine approaches bring together those in red states and blue states, liberals and conservatives, Democrats and Republicans, because these are human issues. They are both medically effective and, important in our current economic climate, cost effective. These approaches emphasize both personal responsibility and the opportunity to make affordable, quality health care available to those who most need it. Mr. Obama should make them an integral part of his health plan as soon as possible.

Dr. Chopra, the author of more than 50 books on the mind, body and spirit, is guest faculty at Beth Israel Hospital/Harvard Medical School. Dr. Ornish is clinical professor of medicine at the University of California, San Francisco. Mr. Roy is professor emeritus of materials science at Pennsylvania State University. Dr. Weil is director of the University of Arizona Center for Integrative Medicine.

The patient sat with his eyes closed, submerged in the rhythm of his own breathing, and after a while noticed that he was thinking about his troubled relationship with his father.

“I was able to be there, present for the pain,” he said, when the meditation session ended. “To just let it be what it was, without thinking it through.”

The therapist nodded.

“Acceptance is what it was,” he continued. “Just letting it be. Not trying to change anything.”

“That’s it,” the therapist said. “That’s it, and that’s big.”

This exercise in focused awareness and mental catch-and-release of emotions has become perhaps the most popular new psychotherapy technique of the past decade. Mindfulness meditation, as it is called, is rooted in the teachings of a fifth-century B.C. Indian prince, Siddhartha Gautama, later known as the Buddha. It is catching the attention of talk therapists of all stripes, including academic researchers, Freudian analysts in private practice and skeptics who see all the hallmarks of another fad.

For years, psychotherapists have worked to relieve suffering by reframing the content of patients’ thoughts, directly altering behavior or helping people gain insight into the subconscious sources of their despair and anxiety. The promise of mindfulness meditation is that it can help patients endure flash floods of emotion during the therapeutic process — and ultimately alter reactions to daily experience at a level that words cannot reach. “The interest in this has just taken off,” said Zindel Segal, a psychologist at the Center of Addiction and Mental Health in Toronto, where the above group therapy session was taped. “And I think a big part of it is that more and more therapists are practicing some form of contemplation themselves and want to bring that into therapy.”

At workshops and conferences across the country, students, counselors and psychologists in private practice throng lectures on mindfulness. The National Institutes of Health is financing more than 50 studies testing mindfulness techniques, up from 3 in 2000, to help relieve stress, soothe addictive cravings, improve attention, lift despair and reduce hot flashes.

Some proponents say Buddha’s arrival in psychotherapy signals a broader opening in the culture at large — a way to access deeper healing, a hidden path revealed.

Yet so far, the evidence that mindfulness meditation helps relieve psychiatric symptoms is thin, and in some cases, it may make people worse, some studies suggest. Many researchers now worry that the enthusiasm for Buddhist practice will run so far ahead of the science that this promising psychological tool could turn into another fad.

“I’m very open to the possibility that this approach could be effective, and it certainly should be studied,” said Scott Lilienfeld, a psychology professor at Emory. “What concerns me is the hype, the talk about changing the world, this allure of the guru that the field of psychotherapy has a tendency to cultivate.”

Buddhist meditation came to psychotherapy from mainstream academic medicine. In the 1970s, a graduate student in molecular biology, Jon Kabat-Zinn, intrigued by Buddhist ideas, adapted a version of its meditative practice that could be easily learned and studied. It was by design a secular version, extracted like a gemstone from the many-layered foundation of Buddhist teaching, which has sprouted a wide variety of sects and spiritual practices and attracted 350 million adherents worldwide.

In transcendental meditation and other types of meditation, practitioners seek to transcend or “lose” themselves. The goal of mindfulness meditation was different, to foster an awareness of every sensation as it unfolds in the moment.

Dr. Kabat-Zinn taught the practice to people suffering from chronic pain at the University of Massachusetts medical school. In the 1980s he published a series of studies demonstrating that two-hour courses, given once a week for eight weeks, reduced chronic pain more effectively than treatment as usual.

Word spread, discreetly at first. “I think that back then, other researchers had to be very careful when they talked about this, because they didn’t want to be seen as New Age weirdos,” Dr. Kabat-Zinn, now a professor emeritus of medicine at the University of Massachusetts, said in an interview. “So they didn’t call it mindfulness or meditation. “After a while, we put enough studies out there that people became more comfortable with it.”

One person who noticed early on was Marsha Linehan, a psychologist at the University of Washington who was trying to treat deeply troubled patients with histories of suicidal behavior. “Trying to treat these patients with some change-based behavior therapy just made them worse, not better,” Dr. Linehan said in an interview. “With the really hard stuff, you need something else, something that allows people to tolerate these very strong emotions.”

In the 1990s, Dr. Linehan published a series of studies finding that a therapy that incorporated Zen Buddhist mindfulness, “radical acceptance,” practiced by therapist and patient significantly cut the risk of hospitalization and suicide attempts in the high-risk patients.

Finally, in 2000, a group of researchers including Dr. Segal in Toronto, J. Mark G. Williams at the University of Wales and John D. Teasdale at the Medical Research Council in England published a study that found that eight weekly sessions of mindfulness halved the rate of relapse in people with three or more episodes of depression.

With Dr. Kabat-Zinn, they wrote a popular book, “The Mindful Way Through Depression.” Psychotherapists’ curiosity about mindfulness, once tentative, turned into “this feeding frenzy, of sorts, that we have going on now,” Dr. Kabat-Zinn said.

Mindfulness meditation is easy to describe. Sit in a comfortable position, eyes closed, preferably with the back upright and unsupported. Relax and take note of body sensations, sounds and moods. Notice them without judgment. Let the mind settle into the rhythm of breathing. If it wanders (and it will), gently redirect attention to the breath. Stay with it for at least 10 minutes.

After mastering control of attention, some therapists say, a person can turn, mentally, to face a threatening or troubling thought — about, say, a strained relationship with a parent — and learn simply to endure the anger or sadness and let it pass, without lapsing into rumination or trying to change the feeling, a move that often backfires.

One woman, a doctor who had been in therapy for years to manage bouts of disabling anxiety, recently began seeing Gaea Logan, a therapist in Austin, Tex., who incorporates mindfulness meditation into her practice. This patient had plenty to worry about, including a mentally ill child, a divorce and what she described as a “harsh internal voice,” Ms. Logan said.

After practicing mindfulness meditation, she continued to feel anxious at times but told Ms. Logan, “I can stop and observe my feelings and thoughts and have compassion for myself.”

Steven Hayes, a psychologist at the University of Nevada at Reno, has developed a talk therapy called Acceptance Commitment Therapy, or ACT, based on a similar, Buddha-like effort to move beyond language to change fundamental psychological processes.

“It’s a shift from having our mental health defined by the content of our thoughts,” Dr. Hayes said, “to having it defined by our relationship to that content — and changing that relationship by sitting with, noticing and becoming disentangled from our definition of ourselves.”

For all these hopeful signs, the science behind mindfulness is in its infancy. The Agency for Healthcare Research and Quality, which researches health practices, last year published a comprehensive review of meditation studies, including T.M., Zen and mindfulness practice, for a wide variety of physical and mental problems. The study found that over all, the research was too sketchy to draw conclusions.

A recent review by Canadian researchers, focusing specifically on mindfulness meditation, concluded that it did “not have a reliable effect on depression and anxiety.”

Therapists who incorporate mindfulness practices do not agree when the meditation is most useful, either. Some say Buddhist meditation is most useful for patients with moderate emotional problems. Others, like Dr. Linehan, insist that patients in severe mental distress are the best candidates for mindfulness.

A case in point is mindfulness-based therapy to prevent a relapse into depression. The treatment significantly reduced the risk of relapse in people who have had three or more episodes of depression. But it may have had the opposite effect on people who had one or two previous episodes, two studies suggest.

The mindfulness treatment “may be contraindicated for this group of patients,” S. Helen Ma and Dr. Teasdale of the Medical Research Council concluded in a 2004 study of the therapy.

Since mindfulness meditation may have different effects on different mental struggles, the challenge for its proponents will be to specify where it is most effective — and soon, given how popular the practice is becoming.

The question, said Linda Barnes, an associate professor of family medicine and pediatrics at the Boston University School of Medicine, is not whether mindfulness meditation will become a sophisticated therapeutic technique or lapse into self-help cliché.

“The answer to that question is yes to both,” Dr. Barnes said.

The real issue, most researchers agree, is whether the science will keep pace and help people distinguish the mindful variety from the mindless.

A variety of meditative practices have been studied by Western researchers for their effects on mental and physical health.

Tai Chi

An active exercise, sometimes called moving meditation, involving extremely slow, continuous movement and extreme concentration. The movements are to balance the vital energy of the body but have no religious significance.

Studies are mixed, some finding it can reduce blood pressure in patients, and others finding no effect. There is some evidence that it can help elderly people improve balance.

Transcendental Meditation

Meditators sit comfortably, eyes closed, and breathe naturally. They repeat and concentrate on the mantra, a word or sound chosen by the instructor to achieve state of deep, transcendent absorption. Practitioners “lose” themselves, untouched by day-to-day concerns. Studies suggest it can reduce blood pressure in some patients.

Mindfulness Meditation

Practitioners find a comfortable position, close the eyes and focus first on breathing, passively observing it. If a stray thought or emotion enters the mind, they allow it to pass and return attention to the breath. The aim is to achieve focused awareness on what is happening moment to moment.

Studies find that it can help manage chronic pain. The findings are mixed on substance abuse. Two trials suggest that it can cut the rate of relapse in people who have had three or more bouts of depression.

Yoga

Enhanced awareness through breathing techniques and specific postures. Schools vary widely, aiming to achieve total absorption in the present and a release from ordinary thoughts. Studies are mixed, but evidence shows it can reduce stress.

First, ask yourself how hungry you are, on a scale of 1 (ravenous) to 7 (stuffed).

Next, take time to appreciate the food on your plate. Notice the colors and textures.

Take a bite. Slowly experience the tastes on your tongue. Put down your fork and savor.

“Most people don’t think about what they’re eating — they’re focusing on the next bite,” says Sasha Loring, a psychotherapist at Duke Integrative Medicine, part of Duke University Health System here. “I’ve worked with lots of obese people — you’d think they’d enjoy food. But a lot of them say they haven’t really tasted what they’ve been shoveling down for years.”

Over lunch, Ms. Loring is teaching me how to eat mindfully — paying attention to what you eat and stopping just before you’re full, ideally about 5½ on that 7-point scale. Many past diet plans have stressed not overeating. What’s different about mindful eating is the paradoxical concept that eating just a few mouthfuls, and savoring the experience, can be far more satisfying than eating an entire cake mindlessly.

It sounds so simple, but it takes discipline and practice. It’s a far cry from the mindless way many of us eat while walking, working or watching TV, stopping only when the plate is clean or the show is over.

It’s also a mind-blowing experience: I’m full and completely satisfied after three mindful bites.

The approach, which has roots in Buddhism, is being studied at several academic medical centers and the National Institutes of Health as a way to combat eating disorders. In a randomized controlled trial at Duke and Indiana State University, binge eaters who participated in a nine-week mindful-eating program went from binging an average of four times a week to once, and reduced their levels of insulin resistance, a precursor to diabetes. More NIH-funded trials are under way to study whether mindful eating is effective for weight loss, and for helping people who have lost weight keep it off.

One key aspect is to approach food nonjudgmentally. Many people bring a host of negative emotions to the table — from guilt about blowing a diet to childhood fears of deprivation or wastefulness. “I joke with my clients that if I could put a microphone in their heads and broadcast what they’re saying to themselves when they eat, the FCC would have to bleep it out,” says Megrette Fletcher, executive director of the Center for Mindful Eating, a Web-based forum for health-care professionals.

Using food as a reward or as solace also interferes with eating mindfully; if you’re eating to satisfy emotional hunger, it’s hard to ever feel full. “Ask yourself, what do you really need and what else can you do it fulfill it?” says Ms. Loring.

Chronic dieters in particular have trouble recognizing their internal cues, says Jean Kristeller, a psychologist at Indiana State, who pioneered mindful eating in the 1990s. “Diets set up rules around food and disconnect people even further from their own experiences of hunger and satiety and fullness,” she says.

Mindful eaters learn to assess taste satiety. A hunger for something sweet or sour or salty can often be satisfied with a small morsel. In one exercise, Ms. Kristeller has clients mindfully eat a single raisin — noticing their thoughts and emotions, as well as the taste and texture. “It sounds somewhat silly,” she explains, “but it can also be very profound.”

Mindful eating also means learning to ignore urges to snack that aren’t connected to hunger. And it’s critical to leave food on your plate once you are full; pack it to go, if possible.

In contrast to other diet programs, the researchers involved with mindful eating avoid making weight-loss claims; that’s still being investigated. But some practitioners say it’s life-changing.

“I don’t think about food anymore. It’s totally out of my mind,” says Mary Ann Power, age 50, of Pittsboro, N.C., a lifelong dieter who thinks she’s lost eight or 10 pounds in two weeks since learning the practice at Duke. “I think you could put a piece of chocolate cake in front of my nose right now, and it wouldn’t tempt me. Before, I could eat three pieces.”

One mindful meal at Duke made a big impression on me — I was satisfied with minimal meals for days afterward. But it’s hard to sustain. I find myself eating mindlessly again in front of the TV, or at the computer.

“Try to eat one meal or one snack mindfully every day,” advises Jeffrey Greeson, a psychologist with the Duke program. “Even eating just the first few bites mindfully can help break the cycle of wolfing it down without paying any attention.”

For effective and lasting weight loss, ditch the scale and grab a pencil and paper instead.

So you’re ready to try again. You’ve got the books, the healthy snacks in the fridge, and, yes, you even threw away that secret stash of Oreos in the back of the pantry. Ah, the familiar rush of a new weight-loss plan: a heady mix of hope, promise, and fantasy shopping. But how can you make this time different, and finally step off the diet merry-go-round?

Grab a pen. Writing — everything from keeping a food log to free-association journaling — is a powerful tool when it comes to healthy eating and shedding pounds. Putting pen to paper helps break the momentum during a rush to the pretzel jar, and studies show that writing down what you eat can help you lose weight and keep it off. “Two of the most important factors in weight loss are intention and monitoring,” says Sasha Loring, a psychotherapist with Duke Integrative Medicine at Duke University. “Writing can help with both.”

Take intention. Often, people approach weight loss with a fuzzy notion that they’d like to drop a few pounds or look good in a bathing suit, says Loring. “But just saying you want to lose weight won’t work,” she says. Journal writing, however, can help you move away from vague ideas and focus on concrete steps. The more detailed and practical your writing, the better. You might, for example, brainstorm a list of strategies to sidestep your problem areas — outlining a route to work that steers clear of your favorite drive-through doughnut shop, for instance, or shopping on Sundays to make sure you have healthy snacks and lunches for the upcoming week.

Of course, even the best-laid eating plans are no good if you make a beeline for the potato chips every time you get an e-mail from your ex. Here, too, putting pen to paper can help. A regular writing practice, one that allows you to offload your feelings, can shift your emotions from the fridge to the page, says creativity maven Julia Cameron, author of “The Writing Diet.” Sometime during her 25 years of teaching people to unlock their creativity in “The Artist’s Way” seminars and books, Cameron started noticing something: Her students were doing more than getting in touch with their inner artiste; they were shedding pounds, too. “I would see people start to transform, physically,” she says. “It took me a long time to see this as a weight-loss tool, but it was showing up all along as people looking more fit.”

At the heart of Cameron’s classes is a technique called “morning pages,” in which you rise early and write three longhand pages of absolutely anything — no thinking, no worrying, no editing. Although Cameron instructs her students to write freely, she says people often use morning pages as an emotional outlet, one they were accustomed to finding in food. “You take a look at your fear, anxiety, and nervousness directly instead of eating something to squelch it, she says. “You don’t need to focus on it; it will just come up. Morning pages are remarkable in how they get to the underside of what’s bothering you.”

And the more you give voice to your emotions, the less you’ll need food to keep your real feelings quiet. “When you do morning pages,” says Cameron, “you start to take your likes and dislikes a little more seriously. It helps with speaking your mind.”

Keeping Track of Eating

If journal writing is an intimate form of writing for weight loss, food logs are a basic one — which doesn’t mean they’re less effective. A simple list of when and what you eat (scratched on­to a napkin if necessary), food logs act as monitoring tools that keep you aware of what you’re taking in. In one study, people lost far more weight in the two weeks they used food logs most consistently compared with the two weeks they were least consistent. In another study, the only participants to lose weight during the diet-treacherous holiday season were those diligent with their food logs. “They help you be clear about what you are actually doing versus what you think you are doing,” says Loring. “We are very good at fooling ourselves. Writing it down is sort of a truth monitor.

“Food logs prove especially effective when you write down how you feel (both emotionally and physically) when you eat. It doesn’t have to be a long or elaborate entry, just a few words — perhaps “angry and tired” or “anxious about work” scrawled next to your less-than-ideal snack of a bag of Cheez-Its and leftover tuna casserole. “You start to see patterns,” says Loring. “Anything that makes you more aware of what you’re doing helps.”

And awareness is the first step. In making the connections between your emotions and behavior, writing of any sort can lead you to your own strength and wisdom, says Cameron, and even deepen your sense of spiritual connection: “You start to see solutions, and your intuition sharpens,” she says, which in turn can lead to “a heightened level of synchronicity” that helps support healthy changes. Indeed, Cameron insists that there’s often a direct connection between our spiritual lives — or lack thereof — and our eating habits. “Sometimes,” she says, “what we’re trying to fill with food is actually something that you might call a God-shaped hole.”

The news that antidepressants may not be very effective could open the door for online therapy

Type “online counsellor” into any internet search engine and hundreds of thousands of results will appear: with a click of the mouse, and a glance at a screen, you, too, can be cured of your depression, phobias and eating disorders, go the claims. Unbelieveable? Perhaps not. A growing body of research has found that when – and this is crucial – it is carried out responsibly, and kept specific, online therapy is one of the most effective ways of dealing with the rising levels of mental ill-health.

That there is a need for treatments other than pills is undoubted. As many as one person in five suffers depression at some point. And of the estimated 1.3 million people who suffer from its severest form, only around 10 per cent receive treatment. According to Mind, the mental-health charity, many depressed patients wait a year or more before getting an appointment with a medical professional on the NHS. Now, though, there are other options, such as self-help CD-roms or, increasingly, online counselling with a professional via internet chatrooms and e-mail correspondence.

The evidence to support the validity of this new approach is mounting, notably in the area of computerised cognitive behavioural therapy (CCBT), an electronic version of cognitive behavioural therapy (CBT). In normal practice CBT works by helping people to unlearn obstructive and destructive thought processes and behavioural patterns. Similarly, CCBT uses prompts and cues to alter the way someone perceives and reacts to a given situation. So long as the online therapist belongs to a reputable body such as the British Association for Counselling and Psychotherapy (BACP), experts say there is no reason why mild depression should not be treated in this way. A study by City University in London indicated that more than three people in five with mild depression could stop treatment after eight days of the online approach. Another, by Swedish researchers, found that computer therapy is as effective as face-to-face treatment for moderate to mild depression.

Computer-based therapies have gained a positive reputation already, paving the way for web-related treatments, especially if the problem is specific. Two years ago the Government’s own medical treatment watchdog, the National Institute for Health and Clinical Excellence (NICE), gave its backing to two computer-based packages proven by researchers to help to treat anxiety, phobias and mild depression: Beating the Blues, a self-help software package for treating anxiety and depression, and FearFighter, a web-based package aimed at people with panic and anxiety disorders or phobias.

FearFighter, developed in conjunction with Isaac Marks, Professor Emeritus of the Institute of Psychiatry (IoP) at King’s College London, teaches patients to recognise the signs that trigger phobias and panic attacks in the hope that they will learn to prevent one. Patients need a referral for access and are also shown how to cope with their fears if an attack occurs. “Repetitive parts of the therapy are done by a computer, which can then make decisions based on their answers,” says Marks. “A computer can train them to think in different ways.” Once they have a logon ID number, usually issued by a practice nurse at their GP’s surgery, and have received 15 minutes of training on the system, patients can access FearFighter from anywhere and at anytime, which is surely part of the appeal for the time-crunched.

At the IoP, experts are assessing the effectiveness of a similar treatment for people with eating disorders. In collaboration with Beat (formerly the Eating Disorders Association) and with funding from the Medical Research Council, they are conducting a trial among 13 to 20-year-old sufferers of bulimia nervosa to see if an interactive self-help program, Overcoming Bulimia, helps them to improve their behaviour. A separate study has already shown the computer program, which involves eight sessions and assigns an e-mail support clinician to each patient, to be successful in adults with bulimia. “It may appeal to younger women who don’t seek help through conventional health service routes because they are ashamed about their abnormal eating patterns,” says Professor Ulrike Schmidt, who is heading the study. Results are expected later this year.

Phillip Hodson, a BACP spokesman, says that in many ways online therapy is one of the more promising developments of the internet because it opens up treatment options to people in rural areas as well as to those with a disability. “If you live in deepest Wales, say, your access to a counsellor is limited,” Hodson says. “There are more registered therapists in the London NW3 postcode area than there are in all of Wales.” Anyone who feels too stigmatised to seek treatment for a mental health problem might also benefit. “It has the potential to be particularly useful for young men who are notoriously unwilling to sit on a therapist’s couch,” he adds. “If they can hide behind a computer screen, they feel less exposed.”

But there are inevitable pitfalls. As a profession, counselling remains unregulated, meaning that vulnerable people seeking help can easily fall prey to fraudulent practitioners. “Anyone can legally set themselves up as a therapist and it is especially common on the internet,” Hodson says. “It can be difficult for people to work out the good sites from the bad ones.” Dearbhla McCullough, a psychologist at Roehampton University in London, says that, in the wrong hands, approaches such as CBT are potentially dangerous.

“There are companies offering two-day courses in what is essentially quite a powerful psychological tool when used correctly,” she says. “Well-qualified CBT practitioners undergo two years of intense training. To be treated by someone who does not have this level of understanding could actually worsen a patient’s mental health problems.”

Critics also argue that the anonymity of computer therapy provides a smokescreen for someone’s true emotions, allowing them to hide rather than reveal their innermost feelings. There are also fears that people with psychiatric problems too complex to be cured by a computer, such as severe depression, bipolar disorder and suicidal tendencies, might gain access to a site that gives improper advice. Jesse Wright, a researcher in psychiatry at the University of Louisville who has studied the trend, says the click of a mouse is never going to replace human interaction. “A real-life therapist is creative in each situation, doing the things a computer can’t, such as expressing empathy and responding to the idiosyncracies of a person’s life situation and individual history.”

But the experience of the Buckinghamshire-based chartered psychologists Sue Wright and Nadine Field, both of whom work within the NHS, suggests otherwise. Having set up a service called Psychology Online, in which patients can receive real-time counselling via the internet, Wright says that she has been surprised at the responses of many of those who have used it.

“Because of the anonymity, we have found that people tend to reveal more about themselves online,” says Wright. “People with anxiety-based disorders often find it too traumatic to visit a counsellor in person. It is an approach that is also very good for conditions that might cause people to feel a degree of shame, such as drugs or alcohol addiction.”

Currently the subject of a trial by the University of Bristol, the site is being used by GPs who are referring patients with psychological issues to Psychology Online for free treatment. The hope is that this is another approach that may be adopted more widely within the NHS.

Hodson says that the Government is in the process of enforcing stricter regulations about psychological therapies that “should make it easier for the general public to ensure their own safety”. However, he adds, the internet remains riddled with loopholes. “People just need to be cautious and careful, doing research before they sign up for treatment online,” he says. “A good online therapist can be as beneficial as a session face-to-face in some circumstances. What you lose in eye contact with a therapist you can gain in other ways.”

By Melissa Healy
Los Angeles Times Staff Writer
December 31, 2007

CLOSE your eyes and think of someone who has hurt you. The offense may be profound or small but deeply painful, a single arrow to your heart or a thousand wounding slights. The perpetrator may be a stranger — the guy who caused your accident, the gang-banger who took your child. More likely, it will be someone close and trusted. The sister who killed herself. The parent who lashed out, the spouse mired in addiction, an unfaithful lover.

Maybe it’s the boss who’s a tyrant, the business partner who’s an idiot, the trickster who seduced you. It might even be yourself.

Let all the anger, hurt and resentment you feel for that wrongdoer bubble to the surface. Seethe, shout, savor it. Feel your heart pounding, your blood boiling, your stomach churning and your thoughts racing in dark directions.

OK, stop. Now, forgive your offender. Don’t just shed the bitterness and drop the recrimination, but empathize with his plight, wish him well and move on — whether he’s sorry or not.

University of Wisconsin psychologist Robert D. Enright, the guru of what many are calling a new science of forgiveness, calls this final step “making a gesture of goodness” to a wrongdoer. It’s the culmination of a process that, he insists, “you’ve got to be able to see through to the end.”

But why, exactly, would you do that? For the good of your soul? To hold the family or business together, to make the world a better place?

A growing corps of researchers thinks they have it. Forgiveness — a virtue embraced by almost every religious tradition as a balm for the soul — may be medicine for the body, they suggest. In less than a decade, those preaching and studying forgiveness have amassed an impressive slate of findings on its possible health benefits.

They have shown that “forgiveness interventions” — often just a couple of short sessions in which the wounded are guided toward positive feelings for an offender — can improve cardiovascular function, diminish chronic pain, relieve depression and boost quality of life among the very ill.

An AIDS patient who has forgiven the person presumed to have transmitted the virus is more likely to care for him or herself and less likely to engage in unprotected sex. Those more inclined to pardon the transgressions of others have been found to have lower blood pressure, fewer depressive symptoms and, once they hit late middle age, better overall mental and physical health than those who do not forgive easily.

Collectively, researchers say, these findings suggest that failure to forgive may, over a lifetime, boost a person’s risk for heart disease, mental illness and other ills — and, conversely, that forgiving others may improve health. Like proper nutrition and exercise, forgiveness appears to be a behavior that a patient can learn, exercise and repeat as needed to prevent disease and preserve health.

“Who would have thunk it — that something locked away in religious culture could be turned into a secular training program,” says psychologist Fred Luskin, director of Stanford University’s Forgiveness Projects and a leading researcher in the field who teaches groups — many of them bound together in the workplace — to forgive offenses large and small. “It’s a skill that can be taught.”

Health-forgiveness link

Psychologist Loren Toussaint of Luther University in Decorah, Iowa, and colleagues were the first to establish a long-term link between people’s health and their propensity to forgive.

Their national survey, published in the Journal of Adult Development in 2001, found forgiveness rare enough: Only 52% of Americans said they had forgiven others for hurtful acts. But willingness of young respondents to forgive showed no link to health; that propensity began to make a difference as respondents approached middle age. The survey found that those 45 and older who forgave others were more likely to report having better overall mental and physical health than those who did not.

Everett Worthington, a professor of psychology at Commonwealth Virginia University and a leading researcher on the links between forgiveness and health, has put many a study subject through the paces of pardoning and measured the resulting physiological effect.

Worthington is a believer, both in the goodness of forgiveness and its power to influence health and wellness. The first part of that conviction springs from his Christian upbringing, he says. But he insists the latter has been forged by studies that rigorously test whether forgiveness — including the replacement of hostility and negative feelings with “compassion, empathy or love” for the offender — can blunt or reverse the physiological stress of chronic anger.

“We are limited in what we can conclude,” Worthington acknowledges. As a means of diffusing stress and its negative health effects, finding a way out of anger and resentment clearly yields benefits, he says. But it’s not so clear that developing good feelings for your transgressor — the standard many of those conducting forgiveness research embrace — will enhance health. “It’s a lot easier to document the reduction in bad effects than to document the increase in good effects,” he says.

Worthington’s own ability to forgive was put to the test in 1996, when his elderly mother was killed in her apartment by a crowbar-wielding intruder. Although a suspect was arrested and police said he initially confessed to the crime, irregularities in the handling of evidence resulted in the suspect being released. Nevertheless, Worthington says, he had run the full course of shock, anger and grief and was ready to forgive in less than a month after his mother’s death.

“I look back and I think, for me, what a mercy from God that I could spend eight years examining forgiveness before I had to deal with it. I had already thought through so many of these issues before I had to apply them.”

Efforts to put forgiveness to a rigorous scientific test have been funded largely by a pair of philanthropies long associated with research on faith, religion and science: the Michigan-based Fetzer Foundation and the John Templeton Foundation of Pennsylvania, which effectively created the field in 1997 with a pledge of $2 million for research on forgiveness. The leading thinkers on the subject, including Worthington, are clinical and academic psychologists whose devotion to the goal of forgiveness either springs from religious teachings or verges on the religious.

These origins raise discomfort and controversy among both scientists and those who help the physically and mentally wounded heal. For if forgiveness is first a virtue — as it is in Christianity, Judaism, Islam and Buddhism — it is an objective to be striven for irrespective of self-interest. If it is to be a means of enhancing health, treating illness or preventing disease, forgiveness must be abandoned as a virtue, tested with scrupulous neutrality and valued only inasmuch as it serves a patient’s needs.

For many scientists, the value of forgiveness in physical and mental health remains an intriguing prospect in the earliest stages of rigorous study — but far from a prescription for maintaining health or treating illness. To many in mental health who fear that traumatized patients face pressure to forgive when doing so is premature or ill-advised, the new science of forgiveness is deeply worrisome.

“The whole Christian, 12-step mentality has permeated our culture, and the emphasis on forgiveness is part of that,” says Jeanne Safer, a New York psychoanalyst and author of “Must We Forgive?” “For many patients, forgiveness is a double-whammy: First someone screws you, and then it’s your fault you don’t want to embrace them in heaven. I’m not against forgiveness; I’m against compulsory forgiveness with no choice. And I’m against ‘forgiveness lite,’ which keeps you from feeling the intensity of the experience, from deeply grappling with what’s been done to you.”

Among victims of incest — many of whom have turned blame inward or fear that forgiveness entails reconciliation with an abuser — pressure to forgive can be extremely stressful, and sometimes impossible, says Linda Davis, the executive director of Survivors of Incest Anonymous. “I always tell ministers, ‘Don’t use the F-word.’ ”

“You have to get to a place of acceptance,” says Davis. “Forgiveness is a bonus. You don’t have to get there.”

Self versus others

Scientific scrutiny has a way of upending pious notions, and the science of forgiveness is no exception. While much of the field’s early work has focused extensively on forgiveness of others, academic psychologists and clinicians are turning up evidence that forgiving oneself might have a more powerful effect on overall health and well-being.

Eruptions of anger at others have been shown, clearly, to increase the risk of heart arrhythmias, heart attacks and high blood pressure, says Dr. Douglas Russell, a Veterans Administration cardiologist who, in a 2003 study, found that the coronary function of patients who had suffered a heart attack improved after a 10-hour course in forgiveness. But when anger is turned inward, bottled up and directed at oneself, lack of forgiveness appears likely to have an ongoing, toxic health effect that may be even more corrosive to physical and mental health than anger directed outward.

“Sometimes people hurt us, and we move on, and it might fade,” says Toussaint, the psychologist. As he has refined that work with better definitions of forgiveness, however, Toussaint says he has been surprised to learn that those who hold onto self-blame may suffer more. “Forgiveness of self holds the more powerful punch,” says Toussaint. “The effects are dramatic.”

In work not yet published, Toussaint found that men who do not forgive themselves readily are seven times more likely to meet the full diagnostic criteria for clinical depression than men who do. Highly self-forgiving women are three times less likely to have the symptoms of clinical depression — a risk factor for a host of ills — than their sisters who are prone to regret and self-blame. Those more forgiving of themselves also get more sleep and are in better overall health, he has found.

It’s an effect that Toussaint has seen extensively — with related health effects — in combat veterans who come home unable to forgive themselves for what they did, or did not do, in battle. Other researchers have studied self-blame and forgiveness in cancer patients, those living with HIV/AIDS and victims of incest and abuse, many of whom blame themselves for their plight.

“The human mind is sometimes an instrument of misery. When you’ve done wrong to others and regret it, it bubbles up again and again,” says Toussaint. “There’s no escaping the perpetrator.”

If forgiveness rings false

Findings as this, some say, could pose a problem for what Safer, the New York psychoanalyst, calls “the forgiveness lobby” — the loose congregation of researchers, faith-based advocates and motivational gurus devoted to the promotion of forgiveness and its benefits.

These early pioneers of the forgiveness field have focused largely on an unselfish, altruistic version of forgiveness — one that replaces ill will toward hurtful others with positive feelings. By contrast, while the health benefits of forgiving oneself for past mistakes or misdeeds may be considerable, there is arguably little altruism in it, says Safer. Does that, she wonders, make it a less appealing object of research or a less worthy goal for clinicians to foster?

And then there is the complex relationship, for many people, between forgiveness of others and self-blame.

Clinicians skeptical of forgiveness as a necessary endpoint of therapy say they are quick to recognize them: Many of those who are quickest to forgive others, often at the urging of a relative or clergy member, do so because they blame themselves for the bad things that have happened to them. Others forgive too quickly because they are unwilling to acknowledge their general feelings of shame and anger or simply because they feel unworthy of better treatment.

Safer calls this “fake forgiveness.” It allows victims to continue blaming themselves, she says. And it’s a dangerous side effect of what Safer sees as a bid to sell forgiveness as a panacea.

Lydia Temoshok, a clinical and social psychologist at University of Maryland’s Institute of Human Virology, has seen and studied plenty of chronic self-blamers only too willing to forgive others who have wronged them. In her study of patients infected with HIV, Temoshok knows these as “Type Cs.” They are not the hard-charging, angry Type A’s who are given to heart disease or the easy-rolling, deal-with-it Type Bs who tend to enjoy better health, but the ones who deny problems, suppress strong feelings and tend to stay in stressful situations longer, putting their health at greater long-term risk.

Emerging research suggests that a person’s Type C designation, says Temoshok, is a powerful predictor of HIV’s progression to AIDS, as well as the progression of melanoma — a fact that strongly suggests that this mode of coping can wreak havoc on the immune system.

Temoshok says these are the patients in her lab whose mouths utter the words of forgiveness but whose central nervous systems tell the real story. They may believe their willingness to forgive with all their hearts, she says, but their hearts are working overtime to sustain the fiction. “They’re going to have the high physiological reactivity of a Type A without knowing,” says Temoshok, “which is why it’s so lethal, because you can’t do anything about it when Type Cs are pushing away a lot of that useful feedback.”

Letting go of anger

Jeffrey R., a Maryland man whose father sexually molested him and three siblings as children, acknowledges that self-blame and denial after the abuse has exacted a terrible cost on his family. Two older brothers — both of whom have refused to discuss their father’s actions — have had seven heart attacks between them before the age of 60. One is a drug addict for whom a longtime stomach ailment now threatens to become deadly. Another lives alone, “eats unhealthy, lives unhealthy,” says Jeffrey, a member of Survivors After Incest who spoke on condition that his full name not be revealed.

“When you have this background, you become very skilled at pretending things are OK, just ignoring it,” says Jeffrey. Meanwhile, the guilt, shame and anger, he says, “are just consuming.”

After nine suicide attempts and decades of contending with crippling temper and suspicion toward others, Jeffrey says he’s not ready to forgive the father who did it, the mother who looked the other way or the aunts and uncles who, after the abuse came to light, refused to discuss it. His sister, who was raped by her father at 5, has embraced forgiveness, says Jeffrey, telling her brother God will judge their father. Jeffrey insists he’s let go of the anger and bitterness caused by his abuse, and it “has saved my life.”

But forgiveness on the same level as his sister’s? “I’m not really there yet,” he says.

melissa.healy@latimes.com

From: Bariatric Times
Nov/Dec 2007

INTRODUCTION
Although bariatric surgical procedures are powerful tools in the treatment of obesity, patients and healthcare providers alike can feel frustrated by the difficulties of actually achieving postoperative weight loss objectives, particularly postoperative weight loss maintenance. One result of these surgical interventions is to bring the feeling of fullness into the patient’s consciousness in a dramatically amplified way. However, many obese patients have learned to actively ignore their inner regulatory signals concerning eating. Well established habits of disordered eating and dieting are supported by, and inextricably connected to, a chronic lack of attention to the psychophysiologic experiences of hunger, eating, and satiety. Although surgery can be extremely helpful in reversing these habits, it has limitations in combating years of dysfunctional eating patterns. In order to fully benefit from surgery, patients must retrain themselves to be attentive to their subjective experiences of hunger, eating, and satiety. Learning to eat mindfully—with full attention to the experience of eating—is an invaluable skill for individuals who have had, or are considering, bariatric surgery.

WHAT IS MINDFULNESS?
The word mindful is synonymous with paying attention or taking care. Mindful eating can be a powerful tool for individuals embarking on lifestyle changes. The Center for Mindful Eating published The Principles of Mindful Eating, which describes mindfulness as being composed of three parts.1 The first aspect of mindfulness is deliberately paying attention, without judgment, to one’s experiences. The second aspect of mindfulness is cultivating an openness to, and acceptance of, all experience. The third aspect of mindfulness is that it happens in the present moment.

Most individuals who have struggled with obesity for much of their lives are accustomed to judging themselves, their food cravings, and their food choices. Consequently, these individuals tend to experience strong emotional responses to anything involving food, eating, or weight. This emotional activation can interfere with the ability to make deliberate, wise decisions. Becoming a non-judgmental witness to one’s own thoughts and reactions is an important step in creating the opportunity for change. When incorporating mindfulness, a person begins to train the mind to nonjudgmentally observe reactions during the stages of meal planning, food preparation, and eating. This lack of internal self criticism supports the ability to increase, sustain, and broaden his or her awareness, leading to more empowered decisions with regard to food.

The second aspect of mindfulness is cultivating an openness to and acceptance of all experience. Thus, mindful eating involves an awareness of the whole eating experience, including emotions, thoughts, judgments, tastes, colors, aromas, and textures. By remaining more receptive to the multi-layered experience of eating, an individual can learn what foods might satisfy his or her hunger, be guided to stop eating by his or her own inner experience of satisfaction and satiety, and, finally, experience the pleasures of eating. Both preoperative and postoperative patients can benefit from learning what it feels like to be satiated rather than “full.”

The third aspect of mindfulness is to put aside events from the past and thoughts and hopes for the future, and instead focus for the moment on the here and now. Eating then becomes the activity of the moment and the mind is fully engaged in it. The individual attempts to recognize and let go of worry, anger, fear, rushing, or other mental states that distract from the eating experience. By doing so, he or she can be truly attentive to his or her experiences while eating and can be guided by the understanding of nutritional needs, hunger, and satiety, rather than by hopes, fears, and past experience. The benefits of eating slowly and chewing fully also become apparent.

To help patients bring the concept of mindfulness into their daily eating habits, they are encouraged to adopt an understanding that they have the power to make their own food decisions, even immediately postoperative. Although these choices may be extremely limited at first, choice does exist. Awareness of choice is essential in encouraging the individual to take control.

BRINGING MINDFULNESS TO PROBLEMATIC EATING
Long-term patterns of disordered eating can diminish an individual’s capacity to attend to cues about appetite, enjoyment, and fullness. Many people, including postoperative patients, find it difficult to stop emotional eating. This coping mechanism is not always broken by surgery. Fortunately, using mindfulness to teach awareness of the emotional states surrounding eating has been shown to be effective. Mindfulness skills are a critical foundation for emotion regulation and distress tolerance.2 Frequently, mindful eating is taught in conjunction with meditation and relaxing breathing techniques, which increase the tolerance of difficult emotions. Furthermore, patients are encouraged to explore new behaviors that may lead to the resolution of those emotions that they are currently using food to relieve.

MINDFULNESS TRAINING FOR THE PREOPERATIVE PATIENT
Given its ability to bring awareness back into the eating process, mindfulness can be especially helpful with binge eating in preoperative patients. There is still controversy regarding the prevalence of eatingdisordered behavior among the obese, as well as the impact of this behavior on postoperative outcomes. Many studies have found a higher incidence of disordered eating in preoperative patients than in the general population, and many bariatric professionals prefer that the patient address this behavior prior to surgery. While the prevalence of binge eating disorder (BED) is estimated to be approximately 1.5 percent among females in the general population,3 a study by Dymek- Valentine, et al.,4 found that 14 to 27 percent of bariatric surgery candidates in their sample met full criteria for BED. Powers, et al.,5 found a BED prevalence rate of 16 percent in their sample of 116 individuals presenting for surgery. Other studies have found a high rate of “grazing” in preoperative patients. Burgmer, et al.,6 found that 19.5 percent of its preoperative patients were engaging in regular grazing behavior. Although grazing is not necessarily a diagnosable eating disorder, it can still be classified as “disordered” or “mindless” eating, and can definitely lead to weight gain both before and after surgery. For these reasons, it is important to consider more structured preoperative interventions, such as mindfulness training, to help these patients following surgery.

Kristeller, et al.,7 reported in their original study of 20 women who met criteria for BED that both the rate of bingeing and the amount of food consumed during binges dropped significantly following seven sessions of manualized mindfulness training. Furthermore, these participants reported that their control over eating, mindfulness, and the recognition of hunger and satiety cues increased, while their levels of depression and anxiety decreased. The authors also showed that the magnitude of binge eating decreased substantially with mindfulness training. They found that the strongest predictor of improvement in eating control was the amount of time participants reported engaging in eatingrelated meditations.

Patients who have learned to practice mindfulness often report that it is impossible to engage in binge eating behaviors when they are eating mindfully. Typically, participants in mindful eating programs report a greater sense of control over their eating behaviors. Given these findings, mindfulness training may prove to be an effective tool in assisting weight loss surgery patients who struggle with binge eating, which would in turn greatly benefit patients’ health, wellbeing, and weight loss results, both preoperative and postoperative.

MINDLESS DIETING
As noted, disordered eating comprises a wide spectrum of behaviors that prevent one from becoming aware during the meal. Compulsive dieting, at the other end of the spectrum, has an equally deleterious impact on an individual’s ultimate ability to regulate his or her eating. Chronic dieters often have complex views of, and barriers to, the integration of hunger and fullness cues. It is not uncommon for the caregiver to meet resistance from an individual who has had an extensive dieting history. Diets utilize external guides, such as caloric content, portion size, or planned or pre-packaged meals, to dictate food choice. These experienced dieters may be externally motivated by the specific numerical weight that they see on the scale. Following surgery, the restrictive postoperative meal plan and the tendency for patients to focus on the number on the scale can reactivate the same dysfunctional beliefs and views of themselves and their weight loss efforts. Moreover, individuals who have a history of chronic dieting may not trust their own internal cues and may believe that listening to them is what causes weight gain. These individuals are actually unable to include their subjective experience in their decisions around eating and can feel controlled by the weight loss plan, rather than feeling in charge of their own food choices.

Exploring, accepting, and learning to utilize body cues is an evolving process that increases with practice. Even though it is an essential aspect of healthy eating, diet-fixated individuals may find it challenging to consider the possibility of eating with awareness and making food decisions based on internal awareness, hunger, satiety cues, and their own wisdom. Feelings of anxiety may surface when an individual is asked to be aware of hunger. During counseling, patients may disclose a personal narrative in which, during much of their lives, they have felt that their weight status and wellbeing has depended on their ability to suppress their awareness of hunger and fullness. In fact, these individuals may have difficulty paying attention to any emotional distress or discomfort. Incorporating mindfulness training may offer these diet-hardened individuals a new tool to include subjective information regarding food, fullness, and eating into their decisionmaking process.

It is important for the bariatric clinician to remember that patients can need a great deal of help learning to mindfully respect the new feelings of fullness that are generated by the surgery. Postoperative patients still have ingrained habits of ignoring fullness and will gradually do so after the surgery unless they can learn to honor and guide themselves with this experience. As an additional benefit of mindfulness, taste satiety, which can lag far behind fullness—especially for the postoperative patient—is increased by actually paying attention to the whole experience of eating. Mindfulness helps people derive more pleasure from eating and reduces the need to continue eating beyond fullness.

CONCLUSION: MINDFUL EATING IS HEALTHY EATING
Mindful eating can be the cornerstone of a new relationship with food for the bariatric patient. Awareness of the present moment often helps an individual gain insight into achieving specific health goals. This happens in part because he or she becomes more attuned to the direct experience of eating and his or her own feelings of health and wellbeing. Introducing the concept of mindfulness systematically to individuals pre- and postoperatively may benefit many patients.

These concepts are uncomplicated and accessible, and yet their impact on an individual’s life can be profound. As is commonplace now, patients are also asked to have between 3 and 12 months of a nonsurgical, structured weight loss program prior to bariatric surgery. Weaving these principles into existing programs for people battling overeating or eating disorders prior to surgery can facilitate a more joyful eating experience, one of our primary life pursuits.

As new research emerges, mindful eating can be seen as a viable option in helping to satisfy these requirements. Patients will inevitably benefit from this training after surgery, especially as they begin to feel hunger again and a wider range of food choices is available to them. Additionally, the individual may apply these concepts beyond food, allowing them to help shape a new approach to daily life in general. Promoting broader integration of these principles can assist in improved self care after weight goals have been achieved. Mindful eating training has been shown to promote self acceptance, which is necessary for our patients both before and after weight loss surgery, to help them achieve maximum success.

REFERENCES
1. The Center for Mindful Eating. Principles of Mindful Eating. 2005. Available at www.tcme.org.
2. Linehan M. Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press; 1993.
3. Gotestam KG, Agras WS. General population- based epidemiological study of eating disorders in Norway. Int J Eat Disorders 1995;18:119–26.
4. Dymek-Valentine M, Hoste R, Engelberg M. Psychological assessment in bariatric surgery candidates. In Mitchell JE & de Zwaan M (Eds). Bariatric Surgery: A Guide for Mental Health Professionals. Oxford (UK): Routledge. 2005:101–18.
5. Powers PS, Perez A, Boyd F, Rosemurgy A. Eating pathology before and after bariatric surgery: A prospective study. Int J Eat Disorders 1999;25:293–300.
6. Burgmer R. The influence of eating behavior and eating pathology on weight loss after gastric restriction operations. Obes Surg 2005;15(5):684–91.
7. Kristeller J, Hallette C. An exploratory study of a meditation-based intervention for binge eating disorder. J Health Psychology 1999;4(3):357–63.

ABOUT THE AUTHORS
Terri Elofson Bly, PsyD, conducts preoperative psychological assessments for surgical weight loss programs in the Minneapolis-St. Paul area and leads several monthly bariatric support groups.

Megrette Hammond, MEd, RD, CDE, is a registered dietitian and diabetes educator with Wentworth- Douglass Hospital in Dover, New Hampshire, and the Executive Director of the Center for Mindful Eating (www.tcme.org).

Roger Thomson, PhD, is on the faculty of Northwestern University Feinberg School of Medicine and is Codirector of Integrative Health Partners, a practice group which offers mindfulness- informed psychotherapy and courses in mindful eating. He can be reached through his website, www.integrativehealthpartners. org.

OKLAHOMA CITY (Jan. 4) – With a button-popping spread of cornbread, sausage and gravy, chicken fried steak and pecan pie designated as Oklahoma’s official state meal, it’s no surprise that Oklahoma City’s mayor wants to put the city on a diet.

Mick Cornett has challenged the city to shed 1 million pounds as its New Year’s resolution.
Prompted in part by his own struggle to lose weight, Cornett wants to end Oklahoma City’s dubious distinction as one of America’s fattest cities.

“The message of this obesity initiative is that we’ve got to watch what we eat,” Cornett said Thursday. “Exercise is part of it and the city is trying to change into a city that is less sprawling, has more density and is more pedestrian friendly, but you’re not really going to take on obesity unless you acknowledge that we eat too much and don’t eat the right foods.”

As part of the initiative, residents can sign up and track their weight loss on a new Web site, http://www.thiscityisgoingonadiet.com. More than 2,600 people had registered by Thursday. They’ve lost more than 300 pounds.

Besides a body mass index calculator, the site includes recipes and links to metro-area fitness centers. Plans call for expanding the site to include the opportunity to blog and network with other participants, Cornett said.

“It’s always easier if you’re doing something hard if you have other people to do it with,” he said.

The mayor timed the start of the weight-loss program to the beginning of the new year, when many people begin exercise programs after holiday feasts.

Oklahoma City ranked 15th in a 2007 survey of America’s fattest cities conducted by Men’s Fitness magazine. The survey examined lifestyle factors in each city, including fast-food restaurants per capita and availability of city parks, gyms and bike paths.

“I can’t tell you exactly where you rank in our 2008 survey, but I can tell you that Oklahoma City is in the top 10,” magazine spokeswoman Jennifer Krosche said. “That’s not good.”

The Oklahoma Legislature designated an official state meal in 1988. The menu also includes fried okra, squash, barbecue pork, biscuits, grits, corn, strawberries and black-eyed peas.

Cornett, 49, stands about 5-foot-10 and weighs 183 pounds. He began a personal fitness initiative eight months ago when he weighed 217 pounds.

“I would like to get down to 175, so I’ve made a goal to lose 8 pounds over 8 weeks,” he said.

Carrie Snyder-Renfro, a 44-year-old teacher working out at a fitness center Thursday, said she made a resolution last month to eat healthier and exercise. While she was unaware of the mayor’s Web site, she said she would consider signing up.

“Last year I dieted and lost about 10 pounds a month for three months, but I left out a key component,” she said, huffing and puffing on an elliptical machine. “I didn’t exercise regularly. I ended up losing muscle mass instead of fat, and I ended up gaining almost all of it back.

“Now I’m making it more of a priority to put everything in balance. I have to get the eye of the tiger back.”

Cornett wants to make exercise more attractive to residents by increasing the number of bike trails and sidewalks in the sprawling city, where public transportation is minimal, most people are wedded to their cars and outdoor activities for some might be limited to watching a football game.

“In Colorado, you ski, you climb, you run … something,” said Karen Massey, community nutrition coordinator at Integris Baptist Medical Center. “In Oklahoma, we’re either involved in competitive sports or we do nothing. We’re spectators.”
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2008-01-04 08:16:03