A recent study by Linda Luecken and her colleagues at Duke University
Medical Center in North Carolina provides the first solid evidence of
the physical impact of “role overload” among working mothers–
evidence that the increased demands on working moms often result in
physiological changes associated with ill health.

The study examined 109 women with full-time clerical and customer-service jobs. Some had children at home, some did not. Urine samples were collected over 2 days to measure levels of stress hormones. The women were also asked to rate their jobs and their home lives in terms of these questions: How hectic is the pace? How psychologically demanding is it? How much privacy do you have? How much control do you have over how to spend your time? How much freedom do you have to make decisions?

The results: Employed women with children at home, when compared to employed women with no children at home, have:

• higher levels of cortisol excretion. Cortisol is a stress hormone that is thought to reflect “distress,” lack of personal control, and increased risk for cardiovascular disease.
  
• similar levels of work strain but higher levels of home strain including both greater demands and less control

The increased strain in working mothers comes from the reality that women still carry most of the child-rearing and household responsibilities. They come home from work to the “second shift”– laundry, cleaning, cooking, chauffeuring, tutoring. Working women have up to an estimated 21 hours of work more per week than men have.

Another factor is that working mothers seldom have a chance to “unwind,” so they have increased sympathetic nervous system arousal both during and after work. While many husbands may be pitching in more at home, they often finish their assigned tasks and then relax. A working mom is virtually always on call and responsible for managing the details of home. There’s always something unexpected to cope with– spilled milk, lost homework, a sick child, the search for new child care.

Does marriage or social support at home protect working mothers? Apparently not. The presence of a spouse or significant other at home did not buffer the physiological and psychological consequences of stress in working mothers. Higher income, ethnicity, or the number of children at home also did not influence the levels of stress.

Rx: Self-Care Tips


Here are a few suggestions for working moms to help balance the demands of job and home:

• Set limits. Schedule and honor your own time to relax, put your feet up, and play. Learn to say no.
  
• Cultivate a mental picture of the many sides of “you” besides your “other-centered” roles at home or at work–e.g. artist, lover, poet, gardener, runner.
  
• Make frequent written lists of your own priorities, from the largest (spend time with my children, go to work) to the smallest (take out the recycle boxes). Put them in the order you want and match up your activities and commitments to make sure you’re getting the things done that are truly most important to you. Let the rest go.
  
• Ask for help: Say exactly what you want from your spouse, significant other, or children; then negotiate to share responsibilities at home.
  
• Remember that perfection is the enemy of happiness. Be willing to accept less than perfect performance on household chores.
  
• Team up with other parents to share the load — child care, dinner clubs, or shuttling.
  
• Celebrate the healthy pleasures of parenting. Pay attention to the moments of joy that make all the effort worthwhile. Plan regular, specific activities– no matter how small or trivial– to connect with your spouse, child and significant other.

For More Information


Luecken LJ et al: Stress in Employed Women: Impact of Marital Status and Children at Home on Neurohormonal Output and Home Strain. Psychosomatic Medicine 59:352-359, 1997.

Light KC: Stress in Employed Women: A Women’s Work Is Never Done If She’s a Working Mom. Psychosomatic Medicine 59:360-61, 1997.

Excerpted with permission from the Quarterly Newsletter, Mind/Body Health Newsletter. For subscription information call 1-(800)-222-4745 or visit the Institute for the Study of Human Knowledge website.

In a recent article in the British Medical Journal, Doll says the
evidence of a health benefit from one or two drinks a day is now
“massive.” A host of studies indicate a reduction of mortality from
heart disease by about a third. Because heart disease is such an
important cause of death in middle and old age, moderate drinking
reduces total mortality. And though even moderate alcohol consumption
can have a downside, such as an increased risk of breast cancer in
women, it appears that the beneficial effects on total mortality
outweigh the harmful effects.

All this is not exactly news, with the first scientific reports
appearing as early as 1926. But, says Doll, “the belief that alcohol
was bad for health was so ingrained that the idea that small amounts
might be good for you was hard to envisage, and it is only in the past
10 years that cardiologists and specialists in preventive medicine
have begun to take it seriously.”

Doll cites a number of key studies during the past decade. A
California prepaid health plan studied 20,000 men and women over an
eight-year period. The American Cancer Society studied 490,000
Americans age 30 and over. Doll and his associates conducted a study
of 12,000 middle-aged and elderly British doctors.

Even after
adjusting for risk factors such as dietary fat, smoking and
socioeconomic standing, these studies establish a strong link between
moderate drinking and reduced mortality.

Is wine better?


According to Doll, the only proven benefit is from ethanol in alcohol,
so it doesn’t matter whether your drink of choice is wine, beer or
spirits. Experiments have shown that ethanol has a number of helpful
effects including raising of the “good” cholesterol and acting on
platelets in the blood to prevent clotting.

As a way of explaining the “French Paradox”- Frenchmen who eat lots of saturated fat but still live a long time-other researchers have suspected added health benefits from wine. Results of a new study by Serge Renaud of 34,000 middle-aged men living in eastern France may offer supporting evidence. Renaud reported a 30% reduction in death from all causes with 2-3 glasses of wine a day, a 35% reduction from heart disease and 18-24% reduction from cancer. The latter finding, he claims, is due to the antioxidant action of polyphenol compounds in grapes.

And of course, the very pleasure and relaxing effect of a drink or
two, especially in the company of friends, may partly account for the
health benefit-a possibility that deserves more research.

How much is enough?


Regardless of what you drink or why it’s good for you, Drs. Doll and Renaud both emphasize that moderation is the key. Virtually all the research supports a “U” or “J” shape relationship between drinking and mortality. This means the mortality risk is higher for “teetotalers”, dips for consumers of one or two drinks a day, and rises sharply for those who drink “excessively,” putting themselves at risk from alcohol-related accidents, cancers and liver disease.

What actually constitutes moderation or excess is not so easy to define. In the French study, adverse effects on death rates begin to occur after four glasses of wine a day. In the studies discussed by Doll, the optimal consumption levels varied. There are a number of reasons says Doll. Both heavy and moderate drinkers tend to understate how much they imbibe-especially in societies where alcohol consumption is in general disrepute. And the definition of “one drink” varied among the studies. For most Americans, one drink is a 12-ounce glass of beer, a 4-ounce glass of wine or a 1-ounce shot of spirits.

Further studies will refine the details, but meanwhile, the basic message is clear: once we reach middle age, enjoying some small amount of alcohol in the range of one or two drinks a day reduces the risk of premature death. Salut!

For More Information


Doll R: One for the heart. British Medical Journal 1997;315.

Renaud S: Epidemiology February 1998.

Excerpted with permission from the Quarterly Newsletter, Mind/Body Health Newsletter. For subscription information call 1-(800)-222-4745 or visit the Institute for the Study of Human Knowledge website.

We all know people who have been very successful at aging – not just the “super
elders” who run marathons, but ordinary people who maintain vital, active lives, even in the face of chronic illness.

What are the predictors of healthy aging? The results of a 16-year study of nearly 400 older men and women age 65-95 shed interesting light on some of the key factors.

Successful aging was defined for this study as having little or no difficulty with daily physical activities such as bathing, eating, dressing, shopping, cooking, doing housework, walking a flight of steps or half a mile, lifting or carrying 10 pounds, writing or handling small objects. At the beginning of the study in 1984, nearly 60% of those surveyed scored as successfully aging. By 1990, 16 years later, only 35% still qualified.

What predicted successful aging? Clearly more than just the absence of disease:

• Income: Those with income above the lowest quarter of the group were nearly twice as likely to age successfully.
  
• Education: Those with 12 or more years of education also did better.
  
• White ethnicity: Whites aged more healthfully than blacks.
  
• Chronic disease: Those without diabetes, chronic lung disease, arthritis, or hearing problems fared better.
  
• Depression: The absence of depressed feelings made successful aging twice as likely.
  
• Personal contacts: Those reporting five or more close personal contacts nearly doubled the rates of successful aging.
  
• Exercise: Seniors reporting that they walked often for exercise were nearly twice as likely to enjoy healthy aging.

We may not have much personal control over the first four factors. But behavior and lifestyle can make a significant difference in the last three. In this study, those who were not depressed, had close personal contacts and walked often, tripled their chances of healthy aging.

What are the lives of healthy agers like? The successful agers were also surveyed to give us a glimpse of what old age could be like. Their responses paint a much brighter picture than the usual stereotypes. These seniors were very active: doing more paid and volunteer work, exercising or playing sports, driving a car, and participating in more community activities such as attending religious services. They saw the physician a lot less, spent less time sick in bed, napped less, and were much less apt to feel too tired to do the things they enjoy doing. Successful agers were also less depressed and often felt excited or pleased. If this is the future you want for yourself, there are things you can do today to increase your chances. To some degree, the choice is yours.

Rx Self-Care Tips


For anyone wishing to enjoy healthy aging:

Watch out for depressed feelings. Get help early. Medications, psychotherapy, and self-help most often can alleviate depression. Plan for pleasurable activities and events. Learn how to monitor and change negative and pessimistic thinking. Accentuate the positive.

Maintain frequent personal contact with five or more friends or family members. Friends can be good medicine.

Exercise regularly. The simplest, and often easiest exercise-walking-provides outstanding health benefits. Any amount of physical activity is better than none. In short, move it or lose it.

For More Information


Strawbridge WJ, Cohen RD, Shema SJ, Kaplan GA: Successful aging: Predictors and associated activities. American Journal of Epidemiology 1996;144:135-141.

Excerpted with permission from the Quarterly Newsletter, Mind/Body Health Newsletter. For subscription information call 1-(800)-222-4745 or visit the Institute for the Study of Human Knowledge website.

An interactive, PC-based system with color graphics and a user-friendly format, CHESS is easy to use — even for people with no computer experience. Patients diagnosed with serious conditions such as breast cancer or AIDS/HIV infection are given a computer at home. At their own convenience, patients can access timely, comprehensible information about their disease and take advantage of a variety of non-threatening and anonymous support opportunities.

They can read brief answers to hundreds of commonly asked questions, detailed articles about their health problem and descriptions of services available. They can ask questions of experts anonymously and receive confidential responses. They can read real-life, personal stories of others living and coping with similar problems and communicate directly with these people.

Using problem-solving tools to monitor their health status and risk behaviors, they can think through difficult and important decisions, plan how to overcome obstacles and implement those decisions.

With traditional health education, patients often have little control over the extent, depth or speed of information they receive. CHESS overcomes many of these barriers. Patients get assistance 24-hours a day, 7 days a week. They can proceed at their own pace, deal with issues when, how, in what order, and in as much detail as they wish. Facilitated, online support groups help reduce the sense of isolation and helplessness for patients and their families.

Preliminary results of the CHESS system — one of the first computer-based patient education and support programs to be evaluated scientifically — are very promising:

• Women with breast cancer who used CHESS noted that the system was very valuable and easy-to-use. They reported more positive emotions and fewer negative emotions. CHESS was used extensively by both older and younger women, as well as by both college- and high school-educated women.
  
• In controlled studies over a six-month period, HIV-infected men and women used the system an average of 132 times per person (more than once a day on average) for an average total of 39 hours per person. Minority subjects used CHESS as much as Caucasian subjects. Compared to controls, CHESS users reported significantly improved mental functioning, more social support, less negative emotion, more active participation in their health care, and, in general, a more active life. They spent less time during out-patient visits and reported shorter hospitalizations resulting in an estimated reduction in health care costs.
  

The early lessons from CHESS are clear, with the right motivation (in this case a serious health crisis), encouragement and support, people with no knowledge or even a fear of computers can learn the system quickly and begin reaping the benefits.

Computer systems can go beyond delivery of information and help people connect with others who share a similar life experience. And well-designed computer systems can measurably improve health status and reduce health care costs.
CHESS is now being converted to operate on the Internet which will reduce the cost and offer greater, continuing access.

Patient comments on CHESS:


“One thing I learned from CHESS is how much I don’t know about my diagnosis and prognosis. I can’t begin to tell you how useful CHESS has become for me. So much of fighting this disease is to find a way to get back in charge of my body. This program has been the prime factor in doing that. I feel really in control.”

“I ask more intelligent questions when I see my doctor. I feel more in charge of my health care. I have met people who are in the same situation I am in. This has helped. CHESS has allowed me to give of myself in a way that otherwise would not have been possible.”
“My biggest benefit was the relief I felt after using CHESS that I had made the right decision as far as surgery for me. I wish every woman had CHESS the minute she had a breast cancer diagnosis.”
“This machine came alive and became real, and now suddenly these real people really know me, WOW! I’ve finally started going to groups and meeting lots of new people, and getting my life going again. I guess when I found out I had this disease I decided I was dying. Well, now I’m back with the living.”

For More Information



Gustafson DH, et al. CHESS: A computer-based information and support system for people facing health-related crises or concerns. 17th Annual SCAMC Proceedings American Medical Infomatics Association, 1993.

Gustafson DH, et al. The use and impact of a computer-based support system for people living with AIDS and HIV infection. 18th Annual SCAMC Proceedings American Medical Infomatics Association, 1994.

CHESS (Comprehensive Health Enhancement Support System), Center for Health Systems Research and Analysis, University of Wisconsin-Madison, 610 Walnut Street, Room 1109 WARF Building, Madison, WI 53705-2397.

Excerpted with permission from the Quarterly Newsletter, Mind/Body Health Newsletter. For subscription information call 1-(800)-222-4745 or visit the Institute for the Study of Human Knowledge website.

One recent study – the first to look beyond the direct cost of treating depression to the use of medical services in general – suggests that in the long run these cuts may be costing the health-care system far more than they save.

Examining accounting records of some 12,000 HMO patients of Group Health Cooperative of Puget Sound, researchers found annual medical costs for patients with diagnosed depression to be double those of patients not diagnosed with depression. The twofold difference persisted for at least 12 months after the patients began receiving treatment for depression.

The estimated price tag for this increased medical service utilization was a whopping $8.9 million over 1 year – compared to just $3.8 million spent on this group for mental health care services. Even among patients treated with antidepressant drugs, costs of these prescriptions accounted for less than half the difference in pharmacy costs.

Significant cost increases were identified in every category of care including
primary care, medical specialty, medical inpatient, pharmacy and laboratory.
Researchers also looked at how chronic disease might bias their findings, assuming that chronically ill patients could be expected to have higher medical costs and a greater likelihood of depression. Even after adjusting for chronic conditions, costs for the depressed group were typically 1.5 times those of the comparison group.

Researchers also point out that since only patients with recognized depression were included in the test group, and since depression often goes undiagnosed and untreated, the real cost differences may be far greater than even their data indicate. Unfortunately, the increase in costs in the depressed patients occurred despite recognition and initiation of treatment of depression. This means that we still need to improve the management of the complex problems and learned pattern of frequent medical visits of depressed patients if overall costs are to be decreased.

Clearly, depression must be taken as seriously as any other chronic medical disease for impact on overall medical costs – and, of course, for the suffering, disability, work loss and impaired quality of life this disease brings in its wake.

All of us must be concerned about the rising cost of health care. These figures suggest that increasing and improving treatment of depression – not cutting services – is the right thing to do.

For More Information


Simon GE, VonKorff M, Barlow W: Health Care costs of primary care patients with recognized depression. 0 1995;52:850-856.

Excerpted with permission from the Quarterly Newsletter, Mind/Body Health Newsletter. For subscription information call 1-(800)-222-4745 or visit the Institute for the Study of Human Knowledge website.

The greatest discovery of my generation is that human beings, by changing the inner attitudes of their minds, can change the outer aspects of their lives.- William James (1842-1910)

You may assume that “imagination” means “not real.” But the thoughts, words, and images that flow from your imagination can have very real physiological consequences for your body. Your brain often cannot distinguish whether you are imagining something or actually experiencing it.

Perhaps you’ve had a racing heartbeat, rapid breathing, or tension in your neck muscles while watching a movie thriller. These sensations were all produced by images and sounds on a film. During a dream, maybe your body responded with fear, joy, anger, or sadness – all triggered by your imagination. If you close your eyes and vividly imagine yourself by a still, quiet pool or relaxing on a warm beach, your body responds to some degree as though you are actually there.

Your imagination can be a very powerful resource in relieving stress, pain, and other unwanted symptoms.

You can learn to use the power of your imagination to produce calming, energizing, or healing responses in your body. You can use imagery and hypnosis to reduce anxiety, fear, and panic; decrease chronic muscle tension; decrease pain and need for pain medications; improve comfort during medical, surgical, and dental procedures; reduce the length of labor and discomfort of childbirth; control bleeding; speed healing and recovery from surgery, injury, or skin conditions such as warts and psoriasis; ease sleep problems; improve management of chronic illnesses such as diabetes, asthma, lung, and heart disease; boost your immune function; increase sense of control and mastery; change bad habits and maintain healthy ones.

Practicing Imagery and Visualization

With guided imagery, you deliberately focus your mind on a particular image. While imagery most often uses your sense of sight with visual images, you can also include the rich experiences of your mind’s other senses. Adding smells, tastes, sounds, and other sensations makes the guided imagery experience more vivid and powerful.

Some people are very visual, and easily see images with their mind’s eye. But if your images aren’t as vivid as a really great movie, don’t worry. It’s normal for imagery to vary in intensity. The important thing is to focus on as much detail as possible, and strengthen the images by using all your senses. Adding real background music can also increase the impact of guided imagery.

Remember, with guided imagery, you are always completely in control. You’re the movie director. You can project whatever thought or feeling you want onto your mental screen. If you don’t like a particular image, thought or feeling you can redirect your mind to something more comfortable. Or you can use other images to get rid of unpleasant thoughts (you might put them on a raft and watch them float away on a river, sweep them away with a large broom, or erase them with a giant eraser). Or you can open your eyes and stop the exercise.

Included here are basic scripts for several imagery exercises. Scores of other scripts and tapes are available. You may want to tape record yourself (or someone else) reading the script so that you can concentrate fully on the imagery. Feel free to change, modify, and personalize the script any way you please. Make it your own.

Skill, Not Magic

To practice these imagery exercises you will need 10 to 30 minutes of quiet, undisturbed time. You may need to put up a “Do Not Disturb” sign and turn off the telephone. Wear loose, comfortable clothing. Sit in a comfortable chair or lie on a pad or carpeted floor with a pillow under your head. Do whatever you can to enhance your comfort. Dim the lights. Put on soft music if you like. You may wish to use a guided imagery audiotape (see below).

Don’t expect miracles. Some relief may come immediately, but often these skills take time to acquire. You may need several weeks of practice before you really start to notice benefits. Practice the techniques once or twice a day, or if that’s not possible, at least three to four times a week.

Watch Out

Imagery techniques are generally very safe. However, if you have symptoms such as pain, diarrhea, dizziness, nervousness, or depression, make sure you first have an appropriate medical evaluation. These imagery techniques may also change your need for certain medications, so be sure to check with your doctor. Don’t practice imagery or self-hypnosis while in a car or in any situation where your safety requires full alertness and quick responses. If you experience very distressing sensations or feelings while practicing these techniques, stop and get professional help.

The Juicy Orange

You are standing in your kitchen. Imagine the time of day, the color of the countertops, the appliances, the cupboards. You hear the hum of the refrigerator. You notice a large, plump, juicy orange lying on the cutting board. You pick it up and feel its weight. You feel the texture of its dimpled, glossy skin. With a sharp knife, you carefully cut a large slice.

As you cut into the orange you notice the rich, liquid, fragrant juice trickle onto the counter top. You see the bright whiteness of the pulp in contrast with the orange flesh. You see the small drops of orange juice forming on the cut surface. Now imagine lifting this dripping slice of orange to your mouth, and smelling its sweet, fresh scent. Your mouth begins to water as you slowly bite into the orange. It releases a flood of sweet tangy juice into your mouth.

This juicy orange imagery exercise causes most people to salivate. Just the words and multi-sensory images are enough to trigger a physiological response.

In this case it’s the flow of saliva. You can learn to use the power of your imagination to control other body functions.

Rx Create Your Special Place

The purpose of this guided imagery exercise is to help you imagine a special place where you feel safe, comfortable, and relaxed. This place can be anywhere.

It might be somewhere you have been, or a place you know well. It could be a place you create from scratch, or by taking bits and pieces from places you know. You may choose to put a dwelling in your landscape: a cabin, a castle, or a cave. Here’s what to do:

• Begin by closing your eyes (or if you prefer, keep your eyes open). Take several slow, deep breaths, exhaling completely after each.
• Now see if you can imagine a place where you feel completely comfortable and peaceful. It might be real or imaginary, one from your past, or someplace you’ve always wanted to go (it doesn’t really matter, just so long as this place feels very safe and peaceful to you).
• Allow that special place to take shape slowly (there’s no rush).
• As your place begins to take shape, look around. Look to your left, to your right, and all around you. What do you see?
• Enjoy the scenery: the colors, the textures, the shapes.
• Listen to the sounds of your special place – perhaps waves gently lapping at the shore, the call of a distant bird, the sound of the wind in the trees.
• Now just listen to the sounds of this wonderful place – a place that is so comfortable and peaceful to you.
• Perhaps you feel a breeze touch your face, or warm sun gently soothing your skin.
• You may feel the crunch of gravel or soft sand beneath your feet, or the comforting support of a favorite chair.
• Now touch or pick up some favorite object from your special place. Allow your fingertips to gently explore its surface (Is it smooth or rough? Wet or dry? Warm or cold?).
• Now take in a deep breath through your nose, and notice all the rich fragrances around you. Perhaps your favorite flower is in bloom. Or you may smell the pungent scent of a pine forest, or the tangy salt sea air, or the aroma of your favorite food.
• Relax and enjoy the peace, comfort and safety of your special place.
• This is your place, and nothing can harm you here. Relax, feeling thankful and happy to be here, in your special place, at this moment.
• Begin to sense that something wonderful is about to happen. Feel the tingling sensation of expecting something good.
• Know the sense of certainty. Everything is right, just as it should be.
• Now notice a soft glow of golden light from above. It begins to bathe your body.
  A tingling, shimmering, vibrant energy surrounds you, energizes you, soothes you, heals you.
• You are washed in bright goodness, and draw everything you need to you, as a powerful magnet. Good wishes and kind thoughts come. This goodness and healing energy seeps into your body, infusing you with a generous, boundless energy and sense of well-being.
• Feel it move through the layers of your body, deeper and deeper into each and every organ, down to the bone.
• Feel it in each and every cell, dissolving any blockages, correcting any imbalances. Enjoy this free-flowing, healthy energy sweeping through your body. Now you are relaxing; healing.
• Your body remembers how to be well, and savors this feeling of well-being. You feel peaceful and easy in your special place – a healing place – one that is always here. You know it’s a place you can visit anytime, and feel this healing energy and peace.
  When you are ready to return, take a deep breath and exhale fully. Open your eyes and spend a few moments savoring this relaxed, healthy, comfortable feeling.
• You may want to explore different special places each time you do this exercise, or one special place may emerge as your favorite. Remember, you can visit this place any time you want to, in your mind.

Script adapted from Belleruth Naparstek

Rx Create Your Inner Advisor

You can use this type of imagery to explore the meaning of your symptoms or illness, and what you can do to improve your health. This imagery is a means of two-way communication between your mind and your body.

Begin with a general imagery exercise such as Creating a Special Place. Once you have entered your special place, invite an inner advisor to come and visit you.

Use all your senses to watch for your advisor, as the advisor may take any shape or form. Or you may have several inner advisors. They may be a person, a voice, an object, or a symbol. If you are not comfortable with what emerges, send him/her/it away, and invite another advisor.

Once you are comfortable with your advisor, ask questions. Feel free to ask anything, such as:

• Are you my inner advisor?
• How can I relax?
• What is causing my tension? Pain? Symptom?
• What do I need to do to feel better?
• Who can help me?

Then wait for the answers. Be patient. They may come in any form: a picture, image, sound, word, phrase, feeling. They can come at any time. Think about what they mean to you.

Sometimes you may be surprised at the directness and clarity of an answer. In response to “What is causing my anger” one person heard back, “You need to learn to say no.” If the meaning or usefulness is not clear to you right away, don’t worry. It may become clearer in the days or weeks ahead.

You can use a similar technique to have an inner dialogue with a symptom you are having. For example, if you are in pain, give it a color, shape or form. Then ask your pain questions:

• Why are you here?
• What can I learn from you?
• When will you go away?
• How can we live more peaceably together?
• How can I get better?

Wait for responses. This dialogue can be done with any symptom or problem.

You have untapped knowledge, insight, and wisdom which is often drowned out by the incessant chatter of a busy mind. You can use imagery techniques to give voice to your inner wisdom, and consult your own inner advisor. There is nothing mysterious or magical about it. Simply by quieting down and bringing your mind into a focused and receptive state, valuable insights can emerge. These include suggestions on how to improve your health and well-being.

Adapted from Martin Rossman, MD and the Academy for Guided Imagery

Rx Imagine Yourself Well

You have the ability to create special imagery to alleviate specific symptoms or illnesses. Use any image that is strong and vivid for you (this often involves using all your senses to create the image), and one that is meaningful to you.

The image does not have to be physiologically accurate for it to work. Just use your imagination and trust yourself. Here are examples of images that some people have found useful. Use any of these images, or make up your own.

Remember, the best ones are vivid and have meaning to you.

For Tension and Stress

• A tight, twisted rope slowly untwists
  Wax softens and melts
  Tension swirls out of your body and down the drain

For Healing of Cuts and Injuries

• Plaster covers over a crack in a wall
• Cells and fibers stick together with superglue
• A shoe is laced up tight
• Jigsaw puzzle pieces come together

For Arteries and Heart Disease

• A miniature Roto Rooter truck speeds through your arteries and cleans out the clogged pipes
• Water flows freely through a wide, open river
• A crew in a small boat all row together, easily and efficiently pulling the slender boat across the smooth water surface

For Asthma and Lung Disease

• The tiny elastic rubber bands that constrict your airways pop open
• A vacuum cleaner gently sucks the mucus from your airways
• Waves calmly rise and fall on the ocean surface

For Diabetes

• Small insulin keys unlock doors to hungry cells, and allow nourishing blood sugar in
• An alarm goes off and a sleeping pancreas gland awakens to the smell of freshly brewed coffee

For Cancer

• A shark gobbles up the cancer cells
• Tumors shrivel up like raisins in the hot sun, and then evaporate completely into the air
• The faucet that controls the blood supply to the tumor is turned off, and the cancer cells starve
• Radiation or chemotherapy enter your body like healing rays of light; they destroy cancer cells

For Infections

• White blood cells with flashing red sirens arrest and imprison harmful germs
• An army equipped with powerful anti-biotic missiles attacks enemy germs
• A hot flame chases germs out of your entire body

For a Weak Immune System (Immune deficiency disorders: HIV, AIDS, and others)

• Sluggish, sleepy white blood cells awaken, put on protective armor, and enter the fight against the virus
• White blood cells rapidly multiply like millions of seeds bursting from a single, ripe seed pod

For an Overactive Immune System (Allergies, asthma, arthritis, etc.)

• Hyperalert immune cells in the fire station are reassured that the allergens have triggered a false alarm, and they can go back to playing their game of poker
• The civil war ends with the warring sides agreeing not to attack their fellow citizens

For Pain

• All of the pain is placed in a large, strong metal box, closed, sealed tightly and locked with a huge, strong padlock
• You grasp the TV remote control and slowly turn down the pain volume until you can barely hear it; then it disappears entirely
• The pain is washed away by a cool, calm river flowing through your entire body

For Depression

• Your troubles and feelings of sadness are attached to big colorful helium
  balloons, and are floating off into a clear blue sky
• A strong, warm sun breaks through dark clouds
• You feel a sense of detachment and lightness, enabling you to float easily through your day

For Behavior Change

• If you are somewhat shy, imagine a vivid, detailed picture of yourself walking up to people and chatting with them confidently
• If you want to be more physically active, see yourself walking in the park, riding a bike, taking a dance class, or joining a sports team

This article was adapted from The Healthy Mind, Healthy Body Handbook by David S. Sobel and Robert Ornstein. Publisher: DRx, Los Altos, CA, 1996. May not be reproduced without written permission.

This approach does not mean dissuading those who are truly sick from seeking care. In fact, physical illness is not a good predictor of medical utilization and expense. Many people with disease do not seek care, while others with little apparent disease tend to visit the doctor frequently. The decision to seek care is more determined by anxiety, worry, stress, lack of confidence, lack of information, job dissatisfaction, and unhealthy lifestyles than it is by the presence or absence of physical disease. Therefore, it is reasonable to think that mind/body interventions which address the underlying distress that prompts visits to physicians, might reduce distress and medical expenses.

A recent, preliminary study in Quebec, Canada suggests that the practice of one common such mind/body intervention meditation and relaxation may indeed reduce the cost of physician services. The study focused on Transcendental Meditation (TM), a practice introduced by Maharishi Mahesh Yogi which involves focused concentration and relaxation for 15 to 20 minutes twice daily. This practice tends to produce physical and mental effects that are opposite to the stress response.

In this study, payments to physicians were analyzed for 677 patients practicing TM. For the three years before starting to practice TM, adjusted payments to physicians did not change significantly. After beginning TM practice, patients expenses tended to decline 507% annually.

These impressive results must be viewed with caution. There was no comparison or control group. The patients chose to start and continue TM practice and elected to participate in the study. Therefore, it is unclear whether the results would apply to other groups of people.

Unanswered Questions

What led to the reductions in physician costs? Less stress? Increased self-confidence and less dependence on professional medical care? Improved health habits such as less smoking and substance abuse or better diet and exercise? A shift away from conventional medical care to alternative medicine?

Do the findings only apply to the use of TM or to other daily meditation, mindfulness and relaxation practices?

Even with these questions still to be answered, the preliminary results of this study suggest that mind/body interventions hold real promise for improving health and reducing costs.

For More Information:

Herron RE, Hillis SL, Mandarino JV, et al: The impact of the Transcendental Meditation program on government payments to physicians in Quebec. American Journal of Health Promotion 1996:10:208-216.

Excerpted with permission from the Quarterly Newsletter, Mind/Body Health Newsletter. For subscription information call 1-(800)-222-4745 or visit the Institute for the Study of Human Knowledge website.

When faced with a surgical decision, who better to be than a physician? You would be among the best informed consumers. You would be well aware of the risks, benefits, and alternatives to the proposed procedure. And, according to the results of a new study, you would be less likely to have surgery at all.

Researchers compared surgical rates for physicians, lawyers, and their families to the general public in a large population in Switzerland. They looked at rates for the surgical removal of tonsils, gallbladder, uterus, hemorrhoids, appendix as well as repair of hernias and D&C (dilatation and curettage of the uterus).

For all of the operations except appendectomy, the general public went under the knife much more frequently than physicians or their families. For example, if you don’t have a physician in the family you are 50% more likely to have had a tonsillectomy, hysterectomy, or hernia repair and 80% more likely to undergo removal of hemorrhoids or gall bladder. If you want to avoid surgery, it also helps to have a lawyer in the family. Their surgical rates were almost identical to physicians!

These differences don’t seem to be due to financial barriers since all patients were covered by the public insurance programs and even the poorest had access to needed surgical services. Nor does it appear to be differences in how sick the general public was compared to physicians and lawyers. While some disease rates do vary by level of income and occupation, there is little evidence of variation in the specific types of disease for which these surgical procedures are indicated.

It appears that the more informed you are, the less likely you are to ask for or agree to elective surgery. Lawyers seem to have a special immunity to surgery. Lawyers may be more likely to challenge the surgeon’s authority and have greater potential for causing legal problems. Physicians may tend to be more cautious and prudent about recommending elective surgery to these “risky” patients.

We don’t know for sure the optimal rate of these surgical procedures that yields the best overall outcomes for patients. Nor do we know whether the reversal of financial incentives from fee-for-service to prepaid, managed care will lead us closer to optimal surgical rates. Nevertheless, we suspect that more operations are performed than are needed and that we would all do well to more closely follow the example of the most informed consumer, the physician-patient.

For More Information:


Sobel D, Ornstein R: Preparing for Surgery, Mind/Body Health Newsletter, Volume V, Number 2, 1996.

Domenighetti G, et al: Revisiting the most informed consumer of surgical services: The physician-patient. International Journal of Technology Assessment in Health Care 1993;9(4):505-513.

Domenighetti G, Casabianca A: Rate of hysterectomy is lower among female doctors and lawyers’ wives. British Medical Journal 1997 May 10;314(7091):1417.

Excerpted with permission from the Quarterly Newsletter, Mind/Body Health Newsletter. For subscription information call 1-(800)-222-4745 or visit the Institute for the Study of Human Knowledge website.

Fifteen minutes is hardly enough time to uncover psychological and social factors that may be causing symptoms or be key to the solution. There’s little time for learning about the disease and how to manage it, or for exploring how the disease may be affecting the patient’s moods, emotions, and ability to function at home. Brief office visits certainly do not provide social support or the opportunity for patients to experience how others cope with day-to-day challenges. In fact, both patient and physician often emerge from traditional visits feeling time-pressured and shortchanged – a situation getting worse as pressures to reduce costs force doctors to serve more and more patients.

What if you could have a full two-hour visit with your physician every month? And what if during that visit you could learn not only from your doctor, but from other members of the health care team as well as from other patients with similar problems?

These were the questions that led John Scott, MD, and his colleagues at Kaiser Permanente Medical Care Program in Colorado to rethink the office visit and try a completely different model: the group visit. The pilot project for their “Cooperative Care Clinic” involved group meetings of 20 elderly patients with multiple chronic conditions, their personal physicians, and a nurse team. The patients met once a month for two and one-half hours and were encouraged to bring a spouse, other family member, or caregiver.

The group appointments allowed time for socializing, interactive educational sessions, extensive questions and answers, blood pressure checks, x-ray and lab test ordering, review of medications, and discussion of preventative medicine, nutrition and exercise, living wills and advance directives, stress and relaxation, coping with grief, loss, and chronic pain. Time was reserved (but not always needed!) for brief, one-to-one visits with the physician for physical exams and symptom evaluation.
The patients began to take over the group, setting the agendas for future meetings. If they were concerned about medications and drug interactions, a pharmacist was brought in. If they wanted to learn more about safe exercise, a physical therapist was scheduled for a future group appointment. The patients began to feel more confident, involved, and responsible for being informed, active partners in their own care.

As group trust developed, most members eventually felt comfortable discussing very personal matters, including sexuality, death, and disability. Physicians noted that the patients often raised concerns they hesitated to discuss in individual office visits. Group support blossomed. When one member was ill or hospitalized, others rushed to help. Patients learned as much from each other as they did from the professionals. Physicians and nurses got to know their patients and could share their own personal sides. As one care team member commented: “We taught them medicine and they taught us life.”
The pilot results supported these observations. When compared to a similar group of patients who continued to receive traditional, one-to-one care, the Cooperative Health Care Clinic patients were more satisfied, reporting that their health care needs were better met and overall access to care was improved. Physicians, too, were more satisfied, noting that they felt they had more time to deal with the patients and that patients were more informed, helping the physicians to better diagnose and treat their conditions.

Medical costs and utilization decreased; group patients made fewer individual doctor visits, visits to the emergency room, and spent fewer days in the hospital and skilled nursing facilities. Preventative care also improved. More group patients received influenza and pneumonia immunizations. And more group patients had completed a living will or durable power of attorney to designate someone to make decisions on their behalf if they were too ill to do so.

Most patients could not conceive of going back to the old way of care. The pilot has been extended into a larger, three-year evaluation and the model is being tried for patients with diabetes, hypertension, and routine well-baby visits.

The Cooperative Health Care Clinic appears to be a win-win solution. With careful structuring and evaluation, this group model offered better-quality care – care that is more satisfying for patients and physicians – while significantly lowering costs.

For More Information


Scott, John C. and Robertson, Barbara J.: Kaiser Colorado’s Cooperative Health Care Clinic: A Group Approach to Patient Care. Managed Care Quarterly 1996;4(3):41-45.

Excerpted with permission from the Quarterly Newsletter, Mind/Body Health Newsletter. For subscription information call 1-(800)-222-4745 or visit the Institute for the Study of Human Knowledge website.

Researchers selected 29 women and 14 men with mild sleep complaints for a 16-week controlled study. All participants were age 50 to 74, lived sedentary lives, and suffered no cardiovascular disease, stroke or other clinically diagnosed disorder known to cause sleep disorders. All were non-smokers and moderate drinkers. None were seriously overweight or taking hormone replacement therapy, sleep medications or other medications known to affect sleep.

Participants exercised at least four times a week. Twice a week they participated in an organized aerobics class, which included 30 minutes of endurance training. The other two times they exercised on their own, doing 40 minutes of brisk walking or stationary bike riding. To assess impact on sleep, researchers looked at factors such as how long it takes to fall asleep, total hours of sleep per night, how often one wakes up, how one feels when waking up, and daytime function.

The link between aerobic exercise and sleep may seem obvious, but until this study, there has been very little controlled research to support this “conventional wisdom.” Researchers were especially concerned about the overemphasis on sedative hypnotic medications for older adults.

Though they are only 20% of the population, older Americans receive almost half the medications prescribed to aid sleep. The potential side effects of these drugs-confusion, falls, extended drowsiness, agitation, and interactions with other medications-can be especially problematic for this age group. Until this study, there have been very few attempts to identify effective non-drug approaches to treating mild sleep disorders.

The study also provides further evidence of the interactions of mind and body. In this case improving physical health shows a positive impact on the mind.

RX: Self-Care Tips

Try exercise to help your sleep. Here are some tips.

• A drop in body temperature aids sound sleep. So time your exercise five to six hours before bedtime.
• Make your exercise vigorous enough to make you sweat a little. Previous studies have shown that non-aerobic stretching and concentration exercises alone did not impart sleep.
• Stick with it! Participants in this study did not report improved sleep until they had been exercising for 16 weeks.

Excerpted with permission from the Quarterly Newsletter, Mind/Body Health Newsletter. For subscription information call 1-(800)-222-4745 or visit the Institute for the Study of Human Knowledge website.