Mind Over Matters

Studies suggest mind-body surgery prep may reduce anxiety and help healing.

The effectiveness of mind-body surgical preparation has been widely studied and continues to be an area of ongoing research. One study (in which Cohen was involved), published in the Journal of Clinical Oncology, assessed the short- and long-term efficacy of a presurgical stress management intervention at reducing mood disturbances and improving quality of life in patients with prostate cancer who were undergoing a radical prostatectomy.

A total of 159 men were randomly assigned to either a two-session (plus two shorter sessions) presurgical stress management intervention, a two-session (plus two shorter sessions) supportive attention group or a standard care group. Assessments were conducted at set intervals before and after surgery.

The investigators reported less presurgical mood disturbance and some better physical aspects for quality of life in the 12 months after surgery among men who received the stress-management intervention compared with those in standard care, with the supportive-attention group falling in the middle. In a related study published in Psychosomatic Medicine, those who received the stress management education also had signs of increased immune function 48 hours after surgery when compared with the other groups.

Additional studies have shown positive results from the use of mind-body modalities. A pilot study conducted at Beth Israel Deaconess Medical Center in Boston, which was published in the Journal of Alternative and Complementary Medicine, evaluated whether guided imagery had any psychologic and physiologic effects on patients during the first days of hospitalization. Investigators found that those who engaged in guided imagery, compared with those embarking on 20 minutes of quiet time twice a day, experienced reduced anxiety, decreased heart rate and used fewer anti-anxiety medications.

A still-unpublished study conducted at the Lahey Clinic in Burlington, Mass., showed similar results. Patients who received instruction in mind-body surgery preparation were calmer preoperatively and discharged 1.6 days sooner than subjects who did not receive the instruction. In addition, two days after discharge, they reported fewer postoperative complaints and were using 60 percent less pain medication.

But not all studies have uncovered such concrete benefits. A German study of patients undergoing colorectal resections, published in Diseases of the Colon & Rectum, found that patients who received instruction in guided imagery and progressive muscle relaxation showed little difference in analgesic consumption and pain intensity when compared with those who did not receive the intervention.

Though the mechanism behind mind-body surgical preparation is not fully understood, it is believed to inhibit the sympathetic nervous system, which is responsible for the body's stressful fight-or-flight response, and to stimulate the parasympathetic nervous system, which triggers the body's relaxation response, says Adam Perlman, executive director of Duke Integrative Medicine at Duke University Medical Center in Durham, N.C.

"When we're in a sympathetic state, a more pro-inflammatory state, that's not conducive to healing," Perlman says. "In a parasympathetic state, the body tends to release less pro-inflammatory chemicals and less stress hormones."

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