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Testimony on Mind/Body Interactions and Health by Norman B. Anderson, Ph.D.
Office of Behavioral and Social Sciences Research
Office of the Director
National Institutes of Health
U.S. Department of Health and Human Services

Before the Senate Committee on Appropriations, Subcommittee on Labor, Health and Human Services, and Education
September 22, 1998

Mr. Chairman, it is my pleasure to participate in the hearing today on mind/body approaches to health. This area of research is particularly relevant to the mission of the Office of Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health (NIH). Thank you for the opportunity to discuss the commitment of NIH to conducting and disseminating this vital research.

I am a clinical psychologist with training in behavioral medicine, and I have served as the first Associate Director of NIH for Behavioral and Social Sciences Research for the past three years. I am also an Associate Professor (on leave) at Duke University, and President of the Society of Behavioral Medicine. In my role as Director of the OBSSR, I work with all the Institutes and Centers of NIH on issues related to basic behavioral and social science research, and to research on behavioral treatment and prevention approaches. These areas of research have produced some of the strongest evidence for the role of the mind in healing and health.

I will focus my remarks on two questions: What are some recent developments in research on the role of the mind in healing and health? And what are the implications of this research for treatment and prevention?

To address the first question, I direct your attention to the picture on the easel (see Figure 1, attached). The figure illustrates how the seemingly independent factors affecting health outcomes are, in fact, integrated and dependent. Please note the three large boxes on the poster. NIH has a long and revered tradition of funding research in the physiological realm, and more recently, there is tremendous excitement in the realm of genetics research. But equally important is the recognition of the role that behavioral, psychological, sociocultural and environmental factors play in health. Our beliefs, our emotions, our behavior, our thoughts, our family and cultural systems, as well as the environmental context in which we live, all are as relevant to our health as our genetic inheritance and our physiology.

Some might say that there is nothing really new in this model--that we have long known that the mind, the body, and the context in which we live influence health. But this model brings a new oneness to our vision of the determinants of health. This oneness is captured not so much by the boxes in the poster, but by the arrows between the boxes, which denote unity of the factors that affect health. These arrows make salient the interaction and interdependence of the various influences on health. Health science has reached a point where it is no longer accurate to talk about psychology versus biology; the mind versus the body; or nature versus nuture. These processes are inextricably linked. When I talk about mind/body medicine, I am referring to these linkages. That is, the connections between psychological, behavioral, and sociocultural processes with all levels of biological functioning -- from the organ systems, to the cellular, to the molecular -- and with health.

The figure not only illustrates the factors affecting health, but it also makes salient a number of scientific questions. For example, we know that social, psychological, and behavioral variables are risk factors for illness, but the question now is: How do they affect health? That is, how do psychosocial and behavioral variables affect neuroendocrine activity, the immune system, or gene expression? How can we capitalize on discoveries in these areas to improve the treatment and prevention of disease? These are some of the key questions facing mind/body research today.

Interdisciplinary Research

Our next challenge is to seek a deeper understanding of mind/body interactions, and to do this we need research that cuts across disciplinary boundaries. That is, research that combines expertise from such social and behavioral science fields as psychology, sociology, demography, and anthropology, with expertise from the various fields of biomedicine. The OBSSR has made advancing this type of cross-disciplinary research one of its three primary goals. In cooperation with the NIH Institutes and Centers, we have recently issued a Request for Applications (RFA) to fund educational workshops designed to create a larger contingent of scientists who are broadly trained in the methods, procedures, and theoretical perspectives of disciplines outside their own. The goal is not to turn, say, geneticists into psychologists or vice versa, but to provide researchers with sufficient understanding of other fields in order to better foster collaboration across disciplines. We believe this collaborative research will transcend the contributions of single disciplines, and produce entirely new ways of thinking about health.

In recent years, we have made significant advances in the field of mind/body medicine. Let me provide some examples of studies that exemplify the influence of psychological, behavioral, and social processes on all levels of biological functioning and health

• Asthma--For persons suffering from asthma, especially children, the experience of breathlessness is a very traumatic symptom that can lead to panic which may aggravate the symptoms or make the person unable to assess symptoms to determine appropriate treatment, such as whether to use an inhaler or go to the emergency room. Studies funded by the National Heart, Lung, and Blood Institute have shown that stress management training can reduce the fear and anxiety associated with the asthma experience. This has been shown to result in more effective management of asthma attacks and more appropriate use of health services, e.g., fewer visits to the emergency room.
  
  
• Breast Cancer--Many studies supported by the National Cancer Institute have demonstrated the positive effects of psychosocial group therapy for cancer patients, including improvements in mood, adjustment, and pain. It is also possible that psychotherapy can actually extend one=s life, as well as improve its quality. In one study, patients with metastatic breast cancer who received weekly supportive group therapy actually lived an average of 18 months longer than did those who did not participate in the group treatment.
  
  
• Coronary Disease--Although smoking and hypertension have long been documented as very important risk factors for the development of coronary disease, they do not fully account for the timing and triggering of heart attacks and sudden death. Recent research has shown that the onset of acute coronary syndromes does not occur at random. For example, between 17% and 30% of heart attacks appear to be triggered by external and behavioral factors. These include emotional stress, strenuous physical exercise, cold weather, cocaine abuse, sexual activity, or anger. Reducing trigger activities can provide protection against heart attack and coronary deaths. Preliminary studies funded by the National Heart, Lung, and Blood Institute suggest that certain cardioprotective interventions, such as those utilizing stress management and aerobic exercise training, show promise in reducing cardiovascular morbidity.
  
  
• Touch and Preterm Infant Survival Research funded by the National Institute of Mental Health and the National Institute of Child Health and Human Development has demonstrated the beneficial effects of touch in both animals and humans. When newborn rats are separated from their mothers, they are deprived of tactile stimulation. That deprivation of touch results in a decrease of hormones that are critical for growth and development. When the newborn is returned to its mother and touching resumes, these hormones return to normal levels. Animal research of this type has led to the development of behavioral interventions for human pre-term infants, resulting in improved growth and earlier hospital discharge.
  • Personality and Health--A number of personality factors have been linked to mortality in several studies. One characteristic, cynical hostility or lack of trust, was found to predict death from all causes in several prospective epidemiological studies including a 20-year study of corporate executives; a 25-year study of physicians; and a 25-year study of attorneys. Recently, using data from a 70-year longitudinal study of gifted and talented children, scientists funded by the National Institute of Aging have discovered that participants with childhood personality characteristics of high social dependability or conscientiousness were, as adults, 30% less likely to die in a given year than those low on these characteristics. These findings on personality and health could not be explained by differences in traditional disease risk factors among participants.
    
    
  • Behavior, Experience, and the Brain--Several NIH Institutes, including The National Institute of Mental Health, the National Institute of Neurological Diseases and Stroke, the National Institute of Child Health and Human Development and others, have funded research on how behavior and experience may alter brain structure and intellectual functioning. Exposure to relatively enriched, complex, or stimulating environments can produce substantial changes in cellular functioning in the brain. Rats housed in environments with a variety of toys and objects with which to interact have increased brain weight and synapses (connections between brain cells). These findings have been extended to human populations, where intensive preschool interventions have led to demonstrable improvements in later intellectual functioning and lower rates of mental retardation.
  
  
  
• Chronic Pain--Finally, because chronic pain afflicts so many in our society, NIH recently held a consensus conference to evaluate the use of behavioral medicine approaches in combating chronic pain and insomnia. The conference yielded the following conclusions. First, there is strong evidence for the efficacy of relaxation approaches in reducing chronic pain associated with a variety of medical conditions. Second, there is moderately strong evidence for the efficacy of cognitive behavior therapy for chronic pain syndromes. Importantly, the literature indicates that cognitive behavior therapy is superior to placebo and to routine care for alleviating low back pain and pain associated with rheumatoid arthritis and osteoarthritis. Finally, there is strong evidence for the efficacy of combined behavioral medicine treatments (e.g., cognitive therapy, relaxation, biofeedback, or hypnosis) for several categories of pain, including back and neck pain, dental or facial pain, joint pain, and migraine headaches.
  
  
• Other Advances--Behavioral and social treatment and prevention approaches have also been used successfully for problems such as diabetes, arthritis, gastrointestinal problems, violence, depression, and alcohol and drug abuse. I would be happy to answer any questions you have about these areas.

My concluding remarks will briefly address the second question, "What are the implications of mind/body research for both treatment and prevention?@ The NIH, and my office in particular, takes very seriously its responsibility to ensure that our scientific findings actually reach the people they are intended to benefit. For example, I have organized a special task force to develop a plan for working with health care providers and managed care companies to incorporate scientifically-validated behavioral treatment approaches into medical care. As you know, many proven behavioral treatments are not reimbursed by insurance companies. This must change--and I believe it will, as companies become more aware of the dramatic cost savings they will accrue by covering behavioral treatments and therapies for conditions ranging from arthritis, diabetes, depression, and recovery from surgery. Furthermore, approximately half of the nation=s annual premature deaths can be directly attributed to modifiable risk factors such as tobacco use, unhealthy diet, lack of exercise, alcohol and drug abuse, and risky sexual behavior. These and other behavioral and psychosocial risk factors have been linked to higher ambulatory care and hospitalization costs, with preventable illness accounting for as much as 70 percent of all medical care spending.