Relaxation Response

In“Relaxation Response, Beyond Relaxtion Response and “Relaxation Revolution,” Harvard Cardiologist Herbert Benson discusses how mind-body techniques lower blood pressure, calm brain activity, and balance healthful emissions of nitric oxide in the body’s cells.

Next, he wanted to determine whether mind-body techniques might alter gene expression. Which, if any, of the body’s 54,000 genes were “turned on” or “turned off” by mind-body techniques. Epigenetics is the turning on or off of genes by life situations. 

His team discovered 2,209 genes that are affected by mind-body techniques. These genes affected by mind-body training are associated with stress-related medical problems involving immune response, inflammation, aging, thinning of the brain’s cortex, and oxidative stress-causing damage to physical tissues by the release of destructive oxygen molecules known as free radicals. 

Mind-body practices take a bad gene and make it better. The benefits of mind-body practices include healthful regulation of the immune system, lowered psychosocial stress levels, less destructive oxidative stress, and a reduced tendency toward premature aging. These benefits are associated with healthful gene activity, the opposite of that found in cardiovascular diseases and other medical conditions.

Benson was aware that his relaxation response was due at least in part to the placebo response. But all medication and treatment effects are at least thirty percent due to the placebo effect. The placebo response is the body using its own resources to heal, and healing without medication or surgery is the most natural way of healing.

Rather than discard the placebo response, Benson established the Benson-Henry Institute for Mind-Body Medicine (BHI) at Massachusetts General Hospital in Boston. Ongoing research employs evidence-based techniques to strengthen the natural healing capacities of the body and mind. BHI clinicians serve as a resource in the areas of mind-body and integrative medicine available to all departments of the hospital and community.

A part of Benson’s program engenders belief, expectation, and faith, by explaining how mind-body healing works. His explanation promotes faith and encourages belief and expectancy of a positive outcome. Educating the client regarding the efficacy and value of the program had best be an ongoing part of the program. Of course, the treatment must effectively warrant belief, faith, and expectation.

Benson’s relaxation response can be set off while walking or running and paying attention to the cadence of your feet on the ground. Cadence might be left and right, left and right. Swimmers can pay attention to the tempo of their strokes, cyclists to the repetitive sound of pedaling, dancers to the music, or you can pay attention to the rhythm of your breathing. The focusing of the mind in meditation with any repetitive activity causes a decrease in heart rate, breathing rate, blood pressure if elevated, and metabolic rate. This is the opposite effect of an adrenaline stress fight-or-flight response.

Benson and his team ran an eight-week mind-body training session and found gene expression of the trainees shifted close to gene expression signatures of a group with more than nine years of mind-body practice. After eight weeks of mind-body training, 433 gene expression signatures are now similar in both groups. It does not take a lifetime or even nine years to make positive changes at the genetic level. Statistically, the probability of these gene signatures of the eight-week trainees and the more than nine-year veteran meditators coming together accidentally is less than one in 10 billion. 

Significant positive genetic changes occur in just eight weeks. Mind-body practices such as the relaxation response, breathing meditation, mindfulness, yoga, and prayer have profound effects at the genetic level. The related field is called psychoneuroimmunology. “Psycho” refers to states of the mind including thinking, emotions, and mood states. “Neuro” refers to the neurological and neuroendocrine systems. “Immunology” refers to the immune system.

Benson found mind-body practices affect cancer cells. The gene expression for long-term relaxation response is counter to the gene expression in various cancers including lymphoma, neuro tumors, liver, and leukemia. Even for the eight-week trainees, gene-set expression signatures countered the gene signatures of cancerous neuro tumors, multiple myeloma, and leukemia.

That doesn’t necessarily mean you can cure cancer with mind-body relaxation practices. The trainees in this study did not have cancer. Benson compared their genes with cancer databases compiled by the Broad Institute of Massachusetts Institute of Technology, Harvard, and the Weizmann Institute of Science in Israel. With these databases, Benson determined how gene sets in their relaxation-response subjects correlated with cancer-associated gene sets in cancer patients. 

According to Benson, the results are “rather startling and highly encouraging for future research and possible medical treatment.” Gene-set activity in cancer patients ran in one direction, while the activity of the same group of genes in the relaxation response practitioners ran in the opposite direction. Future investigations are needed to directly compare cancer patients who practiced or did not practice the relaxation response and other forms of mind-body meditation.

Heal Thyself 

“The Secret” by Rhonda Byrne sold over nineteen million copies. Want to be driving a Jaguar convertible sports car? According to “The Secret”, all you need to do is picture yourself driving it, parking it in your garage, owning it; belief in all of that. You can pretty much get or do anything in life with “the power of attraction.”

Byrne was supposedly influenced by Wallace Wattle’s 1910 book, “The Science of Getting Rich.” His “Certain Way” is to form what you want in your mind, believe it is yours, and it will be created out of “Formless Substance.”

Wattle was influenced by Phineas Quimby’s mental healing. A medical doctor who lived from 1802 till 1866, Quimby saw patients and traveled about, lecturing. He did not write much but kept a journal – interesting reading when you get past his ego. He said that he was not religious, but throughout his journal made reference to Christ. He said Christ, the secular man, was the ultimate teacher. Quimby felt that he was a Christ, the ultimate secular teacher in his field of mental healing.

Though a medical doctor himself, he was the anti-medical establishment of his time. He believed disease was an error, and truth or wisdom the cure. Disease is the result of a wrong direction given to the mind, sometimes by doctors. The doctor tells you have a disease and what the disease can do to you. Autosuggestion takes over from there, sometimes instantaneously creating symptoms that match the diagnosis.

His method of healing was sitting with the patient and discussing their error that binds them to a depleted state of mind and body. He worked with his patient to destroy beliefs that were attached to the disease, replacing these beliefs and opinions with “truths and wisdom.” His ideas were, of course, in opposition to the established ideas of the day. His ideas are in opposition to today’s medical practitioners who have at most fifteen minutes to spend with each patient. One hundred years later, most doctors write a prescription and move on to the next patient.

After seeing patients daily and corresponding with them for years, he decided he could not spend sufficient time with individual patients and so took his talk on the road to reach large audiences with two-hour talks in hope of persuading others to understand and practice what he labored for, and to reduce his theories to a science. 

He said that man’s happiness and misery is the effect of his/her belief and that all medical remedies affect the body through the mind. The one who takes the medicine must believe in the medicine and anticipate the desired result. The result is then created by the believer.

Phineas Quimby died in 1866, but it would not be until 1978 when the neurobiology of the placebo effect was born. Up to then, it was known that the placebo sugar pill could block pain (analgesic effect). Now it was shown that the placebo analgesia could be blocked by the opioid antagonist naloxone. This indicated the involvement of opioids produced in the body (endogenous) that were blocking the pain. The expectation of an effect induces the release of endogenous opioids. 

That takes a bit of unpacking. What it means is that since the placebo effect of pain relief was blocked by giving an opioid blocker, the placebo effect must be caused by an opioid produced by the body. If it were not an opioid, the opioid blocker would not have blocked it.

Being All There

Wherever you put your mind, your body will follow.

Ellen Langer

Ellen Langer, Harvard psychologist said that with thirty years of research to back it up. In a 1981 study, she took two groups of men in their seventies and eighties to live in a sprawling monastery in New Hampshire for two weeks. Everything where they stayed, the music, movies, books, magazines, even the black and white TV, vintage radio, was staged back in the 1950s. One group was told to pretend they were young men back in the 1950s. The control group just was told to live in the present.

The results were surprising even to Langer. For the group who lived back in the 1950s, height, weight, gait, posture, hearing, vision, even performance on IQ tests had improved. She said at the end of the study she was playing touch football with the men, some of whom gave up their canes.

In another study by Langer with hotel maids, half were told the work they do is good exercise and satisfies the Surgeon General’s recommendations for an active lifestyle. The maids in the control group were not given this information. After four weeks the informed group perceived themselves as getting significantly more exercise than before. As a result, compared with the control group, they showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index. The results support the hypothesis that exercise affects health in part or whole via the placebo effect.

Most people Langer says, are in a fixed state of mindlessness. They are not all there. When you are not there, you are more likely to end up where you are being led and where you may not want to be. She defines mindfulness as being aware of everything around you.

She attributes the results of the elderly men and hotel maids to mindfulness. Most of us act mindlessly, including in deference to doctor’s opinions, accepting diagnosis and disease, which is pretty much what Phineas Quimby was saying. If you learn to be mindful, you will perceive choices available to you with a better chance of fulfilling your potential and improving your health.

Langer’s mindfulness is noticing specific ongoing changes around you. It is comparable with Attention Training Therapy (ATT), where you shift from sound to sound, and Open Focus where you shift from space to space. Mindful individuals are less likely to become fixed in an objective reality. They will be open to a completely different point of view. They will be less likely to take a medical diagnosis as the only possible evaluation.

In 1957, when Langer was ten years old, Bruno Kopfler’s journal article, ”Psychological Variables in Human Cancer” told about a Mr. Wright, a stage four cancer patient who heard about a “miracle drug” Krebiozen, part of a study at the hospital where he was bedridden. Dr. Philip West, his doctor, would not include him in the study because to be eligible the patient must have a life expectancy of at least three months. A prognosis of one week might have been seriously stretching it for Wright, who was immobile with a high fever and gasping for air.

Expectation

Wright begged so hard, though, for what he called this “golden opportunity” that West, against the rules of the drug committee, injected him with the drug on a Friday to satisfy the last wish of his dying patient. Monday morning, to his amazement, Dr. West found him moving about the ward without his cane, spreading the good news to anyone who might listen. Upon examining Wright, Dr. West found all of the tumors had melted to half their size. 

Wright had received no other medication or treatment besides the one-shot of Krebiozen. He had fully expected the drug to make him well. He had read about the miracle drug in the newspaper. He had no doubt whatsoever that Krebiozen was his ticket to recovery and a speedy one at that. 

The injections were continued three times weekly for ten days. They were stopped when all symptoms of the disease were completely gone. In ten days he went from a terminally ill patient gasping through an oxygen mask for his last breaths, to a fully active recovery. He was discharged and took off piloting his plane at 12,000 feet with no discomfort. 

None of the other patients improved and after two months all of the other clinics reported the discouraging news about the effectiveness of Krebiozen. Newspapers all picked up on this and when Wright read this news, he became discouraged again, began to lose weight, and after two months of practically perfect heath, tumors grew back and he slid back to where he started.

By now Dr. West realized that it was Wright’s optimism. His expectation, not Krebiozen was responsible for his amazing recovery. West decided no harm would come in lying to Wright and using his optimism in the hope of another recovery. The alternative was Wright dying within a short time.

Conditioning

He told Wright not to believe the news reports. The reason for the failure of the trials was the drug had lost potency due to its short shelf life. The clinic would be getting a fresh doubly potent batch the next day, which he expected to produce even more astounding results. Doctors reported Wright was “almost ecstatic and his faith was very strong.”

The next day Dr. West administered a shot of freshwater. The results were more astounding than the first time. This time around, it was both expectancy and conditioning. Tumor masses melted and chest fluid vanished. In a short time, in perfect health, he was discharged and took up piloting his plane.

Two months later the AMA came out with their final announcement: “Nationwide tests show Krebiozen to be a worthless drug in the treatment of cancer.”  Wright read the report in the newspaper, was readmitted to the hospital, and in less than two days of his admission, he died.

Pure Conditioning

With a conditioned placebo effect, first, the active drug is administered. Later, an inactive compound that looks just like the first drug is administered. If conditioning works, the inactive compound produces the effect of the active drug. Wright’s second cure was likely due to a mix of expectation and conditioning. It is difficult to know with a human subject whether the cure might have been due to expectancy, conditioning, or some mixture of both. 

The way to rule out expectancy is through animal research. In 1975, Dr. Robert Adar, the research psychologist who coined the name psychoimmunology, gave one group of rats saccharine-sweetened water accompanied by an injection of Cytoxan, a chemical used to treat malignant diseases that can cause significant suppression of immune responses and stomach pain. A control group got just the sweetened water.

When he later gave the animals the sweetened water on its own they refused to drink it after the painful association with Cytoxan.

He did not want the rats to die, so he force-fed them water, but they died anyway. They died from the water, from suppression of immune response and bacterial and viral infections that their immune system could not fight off, just as if they had received a lethal dose of cyclophosphamide. They died from a conditioned placebo response that made the body react as though it had been poisoned.

A more recent conditioned placebo study with dogs was published in the October 2014 issue of Applied Animal Behavior Science. The dog is introduced to a new room with its owner. The owner leaves and two minutes later a stranger comes in who attempts to interact with the dog. Then the stranger leaves and the owner returns. This is the “Strange Situation” and rating scale developed by Mary Ainsworth to assess the level of parent-child attachment, this time with owner-dog.

In the next part of the study, before each trial, half the same dogs were given a dose of Sedalin (a tranquilizer) hidden in a piece of liverwurst. The other dogs got a vitamin inside a piece of liverwurst. As expected, the dogs given the tranquilizer were more relaxed.

Both groups were separated from owners in the same room as before. Both groups received a vitamin. The conditioned group (the dogs who had been previously given a tranquilizer) showed less active signs of distress (separation anxiety) and a relaxed passive behavior when the owner left the room. These dogs responded as if they had again been given the sedative.

Meaning

Meaning is an important factor setting us apart from most, if not all other animals. Much of the meaning in our lives originates in the stories we tell ourselves. From an early age, we construct stories to make sense of our lives. Though we all have emotional and physical pain and suffering, the stories we create determine the degree and kind of suffering. 

The stories we tell ourselves can be a part of our placebos and healing. If we think we are taking aspirin, the placebo effect will be different than if you think you are taking morphine. In most cases, the placebo response is 55 to 60 percent as effective as the treatment. If you “know” you are taking aspirin, the placebo effect will be 54 percent as effective as aspirin. If you “know” you are taking morphine, the placebo effect will be 56 percent as effective as the morphine. Amazing, since morphine is many times stronger and effective as aspirin. Your body puts out a placebo effect geared to the effect of the treatment drug (even though you are just taking a sugar pill).

Drug companies know that different color pills have different effects on our bodies, so they color the pills according to the desired effect. Taking a red pill or blue pill, once, twice, or three times a day can activate a different placebo response.

Performance

Performance is the “doing” part of the placebo response and can mean a lot of things. For example, the performance of the doctor in making the diagnoses and prognoses can activate a placebo or nocebo response, beyond serving as a nonreactive forecast.

Placebo effects are not limited to pills and injections. Perhaps the most extreme studies of the placebo effect are with sham surgery. Patients do not know whether they are getting actual or sham surgery. With the sham surgery, the performance involves the complete surgical team, anesthetizing, and making the incision.

In 1939, an Italian surgeon performed a surgical procedure that involved tying off of the mammary artery to treat angina. In America, the procedure was tested on dogs and showed that blood flow through the coronary arteries significantly increased when surgery closed off the nearby mammary artery. Tying off the mammary artery that supplies blood to the anterior chest wall and breasts means more blood available to the heart. This surgery was commonly done in America throughout the nineteen forties, fifties, and into the sixties. It effectively relieved pain in three-quarters of patients undergoing the procedure.

In 1959, Leonard Cobb a young cardiologist decided to put this procedure to the “gold standard” test with a double-blind, placebo-controlled study. One group of patients received the surgery where the mammary artery was tied. Another group was put to sleep, opened up, and sewed back up again. Both groups believed they had the same standard surgery for angina. The surgery was equally as effective in the group that had the sham surgery as the mammary artery-tying procedure.

In 2000, sham or placebo therapy was done with patients with Parkinson’s Disease. In the actual surgery, holes are bored into the skull so that cells can be injected into the brain as transplants. In the placebo surgery, holes are bored into the skull, also under general anesthesia, but no cell transplant cells are injected. Both surgeries were equally effective.

The July 2002 issue of the New England Journal of Medicine reported a placebo-controlled trial of arthroscopic surgery for osteoarthritis of the knee. In this controlled study, patients who received arthroscopic treatment surgery were no better off than a placebo sham surgery.

Who is Doing the Healing and Sabotaging?

Wright was seemingly cured of stage-four cancer because of his expectation and belief in the efficacy of the drug Krebiozen. When he heard the drug was ineffective, cancer returned. When Dr. West convinced him he would be injected with a twice as potent, fresh batch of Krebiozen, once again he was miraculously cured.

Alas, when he read in the newspaper of the American Medical Society (AMS) final declaration that Krebiozen was worthless, his condition deteriorated rapidly and he died. The placebo had worked miracles until Wright discovered it was a placebo response and not the efficacy of the drug.

Because the placebo response is based upon expectation and conditioning, when Wright learned that he received a medication the AMA called worthless, all the positive effects of the placebo based on expectation and conditioning instantly vaporized. The brain has the power to generate effects in response to whatever it believes to be true, positive, or negative.

Since studies have shown the brain can heal the body, and it is our brain and our body, why don’t we just heal ourselves? Just as in Wright’s case, even when a treatment is producing positive results, you nullify these results if you discover the treatment is a placebo. This is called “the placebo paradox.” Our brain has miraculous healing powers, but we have the power to sabotage the brain’s powers. Who is curing and who is sabotaging? No controller located anywhere in the brain, just billions of neurons firing with more than one quadrillion interconnections.

You would think knowing the possibilities of the placebo response, more studies would combine treatment with a placebo to enhance the overall effect of the treatment. The placebo is being used, but primarily as the gold standard of research studies where one group receives the experimental treatment and a control group does not receive the treatment. To prove the treatment is effective, results must be better than a placebo or inert treatment. If the treatment is not better than the placebo, it fails the test and is considered ineffective.

Few studies have been done to explore the possibilities of combining the placebo to enhance the overall effect of the treatment or to use the placebo to reduce the amount of drug to get an effect equal to the full dose of the drug alone.

The placebo effect is not just in the mind. Its effect mirrors that of the drug. The difference is the drug is a chemical substance manufactured by the drug company, while the placebo response is triggered by natural endogenous chemicals produced by the body including opioids and dopamine.

Self-help books that help:

Total Self-Renewal through Attention Therapies and Open Focus

The Open-Focus Brain: Harnessing the Power of Attention to Heal Mind and Body