Brain Check

Scientists are mapping the pathways that link emotion to health. The challenge for the rest of us is to put the discoveries to work

By Herbert Benson, M.D., Julie Corliss and Geoffrey Cowley

Newsweek

Sept. 27 issue - Imagine you're allergic to the oil of the Japanese lacquer tree—so allergic that the brush of a leaf against your skin provokes an angry rash. Strapping a blindfold over your eyes, a scientist tells you she's going to rub your right arm with lacquer leaf and your left arm with the innocuous leaf of a chestnut tree. The rubbing commences, and before long your right arm is covered with burning, itchy welts. Your left side feels fine. No surprise, until you learn that your left arm—not the right—is the one that got lacquered. Or imagine that Parkinson's disease has reduced your walk to a shuffle and left your hands too shaky to grasp a pencil. You enroll in a study and receive an experimental surgical treatment, which dramatically improves both your gait and your grip. You're ready to declare it a miracle of modern medicine, when you discover that the operation was a sham. The surgeons merely drilled a small hole in your skull and then patched it.

That thoughts and feelings can affect our health is hardly news. In the span of a few decades, mind-body medicine has evolved from heresy into something approaching cliche. So why is NEWSWEEK devoting this Health for Life report to the mind-body connection? Because the relationship between emotion and health is turning out to be more interesting, and more important, than most of us could have imagined. Viewed through the lens of 21st-century science, anxiety, alienation and hopelessness are not just feelings. Neither are love, serenity and optimism. All are physiological states that affect our health just as clearly as obesity or physical fitness. And the brain, as the source of such states, offers a potential gateway to countless other tissues and organs—from the heart and blood vessels to the gut and the immune system. The challenge is to map the pathways linking mental states to medical ones, and learn how to travel them at will.

That effort is now burgeoning. The federal government's five-year-old Integrated Neural Immune Program will spend $16 million on mind-body research next year, and private foundations will spend millions more. At least one leading managed-care organization, HIP USA, has started to cover mind-body practices, and Medicare now reimburses for certain relaxation techniques administered by psychologists. Hospitals, for their part, are opening mind-body clinics—and yoga classes are spreading from health clubs into shopping malls. According to a recent government survey, nearly half of all Americans used mind-body interventions in 2002. The respondents embraced practices ranging from deep breathing and progressive muscle relaxation to meditation, hypnosis and guided imagery. Close to half of them also said they prayed—perhaps the oldest and most basic form of mind-body medicine.

They had plenty to pray for. Modern life is rife with potential stressors, and there is now little question that uncontrolled stress can kill. Harvard physiologist Walter Cannon recognized 90 years ago that when confronted by a threat—physical or emotional, real or imagined—the body responds with a rise in blood pressure, heart rate, muscle tension and breathing rate. We now know that this physiological "stress response" involves hormones and inflammatory chemicals that, while valuable in measured bursts, can foster everything from headaches to heart attacks in overdose. Cannon verified that people who believed they'd been hexed by voodoo witch doctors could drop dead from a sudden and massive stress response. We now know that chronic stress, though not always fatal, can disrupt the digestive system, worsen symptoms of menopause and interfere with fertility. Indeed, experts now believe that 60 to 90 percent of all doctor visits involve stress-related complaints.

As researchers chart the health effects of hostility and hopelessness, they're also gaining unprecedented insights into the mind's power to heal. The "placebo response" has been widely recognized since the 1950s, when Harvard's Dr. Henry Beecher described the phenomenon. Until recently, most experts dismissed it as a feat of self-deception, in which people who remain sick (or never were) convince themselves they're better. But we're now discovering that expectations can directly alter a disease process. Consider those Parkinson's sufferers who improved with sham surgery. Using PET scans, researchers compared their brains with those of patients who received an active treatment. As expected, the active intervention caused a significant rise in dopamine, the neurotransmitter that people with Parkinson's lack. But the patients who improved on placebo experienced a similar dopamine surge. A related study found that fake analgesics could boost the brain's own pain-fighting mechanisms. In both cases, the placebo response was not an imaginary lessening of symptoms but an objective, measurable change in brain chemistry.

Placebos are just the beginning. Mounting evidence suggests that any number of soothing emotional experiences can improve our physical health. At Duke University, researchers have found that religious observance is associated with lower rates of illness and hospitalization. In studies of HIV-positive men, researchers at UCLA have found that optimism is associated with stronger immune-cell function. And research at Harvard suggests that the "relaxation response"—the deep sense of calm we can achieve through yoga, prayer or simple deep-breathing exercises—can help counter the effects of chronic stress. We now believe that the body produces more nitric oxide when deeply relaxed, and that this molecule acts as an antidote to cortisol and other potentially toxic stress hormones.

Can we teach ourselves to be healthier? That is the central question of mind-body medicine, and the answer is not an unqualified yes. Stressful life circumstances are sometimes inescapable (no one chooses poverty or discrimination). Heredity and temperament leave some of us more stress-prone than others. And prayer is clearly no substitute for penicillin or a decent diet. Yet mind-body techniques can improve almost anyone's quality of life. Meditation may not cure cancer, but by alleviating fear and softening the side effects of treatment, it leaves many patients feeling less victimized. Stress-related illness often defies conventional remedies, and when we persist with high-tech pills and procedures, the costs of treatment can easily outweigh the benefits. Mind-body medicine offers a saner starting place. If it fulfills half its promise, it could reduce medical costs while improving our health and our lives. And whatever its limitations, it has the advantage of doing no harm.

Benson is the Mind/Body Medical Institute Associate Professor of Medicine at Harvard Medical School and founding president of the Mind/Body Medical Institute in Boston. CORLISS is a medical writer at Harvard Medical School. Cowley is NEWSWEEK's health editor. For more information go to health.harvard.edu/NEWSWEEK.

Relaxation: Ways to Calm Your Mind

By Herbert Benson, M.D., and Julie Corliss

Newsweek

Sept. 27 issue - Over the past three decades, scores of studies have confirmed the benefits of what we call the "relaxation response," a state of mental calm during which your blood pressure drops, your heart and breathing rate slow, and your muscles become less tense. Practicing the relaxation response on your own is simple. Once you're comfortable with it, you can use it to cope better with stresses from road rage to performance anxiety. Kids can benefit, too. Studies of inner-city middle-school students have documented better grades, work habits and cooperation among those who learned the relaxation response.

Here are three simple ways to elicit the relaxation response:

Meditation: Our original approach to evoking the full relaxation response is a form of this ancient practice. Choose a short phrase or prayer that is rooted in your belief system, such as "peace" or "the Lord is my shepherd." Sit quietly in a comfortable position and close your eyes. Relax your muscles, progressing from your feet to your calves, thighs, abdomen, shoulders, neck and head. Breathe slowly and naturally, and as you exhale, say your word or phrase silently to yourself. Don't be concerned when other thoughts come to mind. Just acknowledge them and return calmly to your phrase.

Ideally, you'll continue the exercise for 10 to 20 minutes, but even five minutes of deep relaxation can leave you calm and refreshed. Place a clock nearby if you need to keep track of time—don't set an alarm. And when you're finished, sit quietly for a minute before resuming the day.

Paced respiration: Start by inhaling slowly. As you exhale, say the number "five" silently to yourself. Breaths should be deep enough to cause the belly to expand fully (no points for holding your stomach in here). After pausing briefly, take another slow breath, and think "four" as you exhale. Continue at your own pace, counting down to one. Practice this for 10 to 15 minutes in the morning and again in the evening.

Repetitive activities: You don't always have to sit quietly to evoke the relaxation response. You can do it while walking, jogging, playing a musical instrument or carrying out simple repetitive tasks such as knitting. Yoga, tai chi, meditation and repetitive prayer are other ways to put yourself in this healthful frame of mind.

For more information go to health.harvard.edu/NEWSWEEK.

Buddha Lessons

A technique called 'mindfulness' teaches how to step back from pain and the worries of life

By Claudia Kalb

Newsweek

Sept. 27 issue - For decades, Dalia Isicoff has suffered the agony of rheumatoid arthritis—joint pain, spinal fusion, multiple hip surgeries. Painkillers dull the aches, but it wasn't until she took a course at the University of Maryland's Center for Integrative Medicine that Isicoff discovered a powerful weapon inside her own body: her mind. Using a meditative practice called Mindfulness-Based Stress Reduction, or MBSR, Isicoff learned to acknowledge her pain, rather than fight it. Her negative and debilitating thought patterns—"This is getting worse," "I'm going to end up in a wheelchair"—began to dissipate, and she was able to cut back on her medication. The pain hasn't gone away, but "I view it is an ally now," she says. "Mindfulness is transformational."

With its roots in ancient Buddhist traditions, mindfulness is now gaining ground as an antidote for everything from type-A stress to chronic pain, depression and even the side effects of cancer treatment. At the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical School, where MBSR was developed by Jon Kabat-Zinn, a leader in the field, 15,000 people have taken an eight-week course in the practice; hundreds more have signed up at medical clinics across the country. Studies have shown that mindfulness can reduce pain and anxiety. Now researchers are using brain imaging and blood tests to study its biological effects, and early results are intriguing: this spring, the National Institutes of Health hosted its first conference on the topic. "People in the scientific community used to think that this was a lot of mystical mumbo jumbo," says psychologist Ruth Baer, of the University of Kentucky. "Now they're saying, 'Hey, we should start paying attention'."

Paying attention is the very essence of mindfulness. In 45-minute meditations, participants learn to observe the whirring thoughts of the mind and the physical sensations in the body. The guiding principle is to be present moment to moment, to be aware of what's happening, but without critique or judgment. It is not easy. Our "monkey mind," as Buddhists call the internal chaos, keeps us swinging from past regrets to future worries, leaving little time for the here and now. First attempts may provoke frustration ("I'll never be able to do this"), impatience ("When will this be over?") and even banal mental sparks ("What am I going to make for dinner?"). The goal, however, is not to reach nirvana, but to observe the cacophony in a compassionate way, to accept it as transient, "like bubbles forming in a pot of water or weather patterns in the sky," says Kabat-Zinn.

The keystone of mindfulness is daily meditation, but the practice is intended to become a way of life. At Stanford University, Philippe Goldin encourages patients battling social anxiety disorder to take "meaningful pauses" throughout the day as a way to monitor and take charge of their fears and self-doubts. "It breaks the circuit," says one participant. "I always thought that anxiety had me in its grip, but I realized it's the other way around. I have it in my grip. It's a matter of learning to let it go."

Inner control can be a potent tool in the fight against all sorts of chronic conditions. In a pilot study of 18 obese women, Jean Kristeller, director of the Center for the Study of Health, Religion and Spirituality at Indiana State University, found that mindfulness meditation, augmented with special eating meditations (slowly savoring the flavor of a piece of cheese, being aware of how much is enough), helped reduce binges from an average of four per week to one and a half. Now Kristeller is wrapping up a larger study that she says confirms her earlier findings. Mindfulness helped participant Chuck Cooley, 43, identify anxiety as a trigger for overeating—and cut back on the pizza buffets. "Before, I was on automatic pilot," he says. Now "I can take my time and enjoy a smaller portion."

Mindfulness takes you out of your same old patterns. You're no longer battling your mind in the boxer's ring—you're watching, with interest, from the stands. The detachment doesn't lead to passivity, but to new ways of thinking. This is especially helpful in depression, which plagues sufferers with relentless ruminations. At least half of all patients who have had one or two episodes of clinical depression will relapse into another; the more episodes, the higher the risk. University of Toronto psychiatry professor Zindel Segal combines mindfulness with conventional cognitive behavioral therapy, teaching patients to observe sadness or unhappiness without judgment. In a study of patients who had recovered from a depressive episode, Segal and colleagues found that 66 percent of those who learned mindfulness remained stable (no relapse) over a year, compared with 34 percent in a control group. Now Segal has a $2.1 million grant from the NIH to compare mindfulness against antidepressants as a maintenance therapy after relapse. Segal's patient Suzanne Simoni, 47, says she has learned to identify the early signs of an emotional hurricane—fatigue, irritability, hopelessness—before it hits. "I have the chance to catch it earlier," she says. And possibly steer it away altogether.

The biological impact of mindfulness—on the brain, the blood, the immune system—is the next frontier in scientific research. In an intriguing study published several years ago, Kabat-Zinn found that when patients with psoriasis listened to meditation tapes during ultraviolet-light therapy, they healed about four times faster than a control group. In an effort to understand how this kind of dramatic response is possible, scientists are hunting down mindfulness's biological footprints. Kabat-Zinn and neuroscientist Richard Davidson, of the University of Wisconsin, found that after eight weeks of MBSR, a group of biotech employees showed a greater increase in activity in the left prefrontal cortex—the region of the brain associated with a happier state of mind—than colleagues who received no meditation training. When the techies were given a flu vaccine, those with the greatest left-brain activation mounted the most vigorous antibody assault against the virus.

There's more in the pipeline. The University of Massachusetts' mindfulness center is studying the impact of mindfulness and diet on PSA levels in prostate cancer. Stanford's Goldin is taking brain images of social-anxiety patients to see if the practice affects emotional trigger points, like the amygdala, which processes fear. And at Maryland's Center for Integrative Medicine, director Dr. Brian Berman is tracking measures of inflammation, including gene expression, in patients with rheumatoid arthritis. For Dalia Isicoff, the payoff is already clear: "I'm at peace," she says. Her mind and her body, together.

Forgive and Let Live

Revenge is sweet, but letting go of anger at those who wronged you is a smart route to good health

By Jordana Lewis and Jerry Adler

Newsweek

Sept. 27 issue - Of all the extraordinary events in the life of John Paul II, few can compare with the 21 minutes he spent in a white-walled cell in Rome's Rebibia prison. Just after Christmas, 1983, the pope visited Mehmet Ali Agca, the man who 30 months earlier had shot him in St. Peter's Square. He presented Agca with a silver rosary, and something else as well: his forgiveness.

It requires a Christ-like forbearance to pardon a would-be assassin, of course. But how many of us are ready to forgive an unfaithful lover, a scheming colleague or even the jerk who cut into the line at Krispy Kreme? Persistent unforgiveness is part of human nature, but it appears to work to the detriment not just of our spiritual well-being but our physical health as well. The subject is one of the hottest fields of research in clinical psychology today, with more than 1,200 published studies, up from just 58 as recently as 1997. It even has its own foundation—A Campaign for Forgiveness Research—which sponsored a conference last year with papers on topics like "Exploring Gender Differences in Forgiveness." (The largest number of papers dealt with forgiveness in marital and romantic relationships, which seem to generate an inordinate amount of interpersonal resentment.) Dr. Dean Ornish, America's all-purpose lifestyle guru, regards forgiveness as the tofu of the soul, a healthful alternative to the red meat of anger and vengeance. "In a way," Ornish says, "the most selfish thing you can do for yourself is to forgive other people."

Research suggests that forgiveness works in at least two ways. One is by reducing the stress of the state of unforgiveness, a potent mixture of bitterness, anger, hostility, hatred, resentment and fear (of being hurt or humiliated again). These have specific physiologic consequences—such as increased blood pressure and hormonal changes—linked to cardiovascular disease, immune suppression and, possibly, impaired neurological function and memory. One study examined 20 individuals in happy relationships, matched with 20 in troubled relationships. The latter had higher baseline levels of cortisol, a hormone associated with impaired immune function—which shot up even further when they were asked to think about their relationships. "It happens down the line, but every time you feel unforgiveness, you are more likely to develop a health problem," says Everett Worthington, executive director of A Campaign for Forgiveness Research.

The other benefit of forgiveness is more subtle; it relates to research showing that people with strong social networks—of friends, neighbors and family—tend to be healthier than loners. Someone who nurses grudges and keeps track of every slight is obviously going to shed some relationships over the course of a lifetime. Forgiveness, says Charlotte vanOyen Witvliet, a researcher at Hope College in Holland, Mich., should be incorporated into one's personality, a way of life, not merely a response to specific insults.

In fact, forgiveness turns out to be a surprisingly complex process, according to many researchers. Worthington distinguishes what he calls "decisional forgiveness"—a commitment to reconcile with the perpetrator—from the more significant "emotional forgiveness," an internal state of acceptance. Forgiveness does not require us to forgo justice, or to make up to people we have every right to despise. Anger has its place in the panoply of human emotions, but it shouldn't become a way of life. "When I talk about forgiveness, I mean letting go, not excusing the other person or reconciling with them or condoning the behavior," says Ornish. "Just letting go of your own suffering."

"It's a process, not a moment," says Dr. Edward M. Hallowell, a Harvard psychiatrist and the author of "Dare to Forgive." Forgiveness, he emphasizes, has to be cultivated; it goes against a natural human tendency to seek revenge and the redress of injustice. For that reason, he recommends doing it with help—of friends, a therapist or through prayer. It was from his faith that John Paul drew the strength to forgive Mehmet Agca, setting (as he no doubt intended) an example for the rest of us. The message is the same whether it's couched in the language of Christian charity, clinical psychology or the wisdom of Confucius, as quoted by Hallowell: "If you devote your life to seeking revenge, first dig two graves."

For a Happy Heart

Depression, loneliness and anger all take a toll on your cardiac health. New research shows what can help

By Anne Underwood

Newsweek

Sept. 27 issue - The Japanese have a word for it—karoshi, or "death by overwork." But can stress on the job really do you in? Finnish researchers decided to find out. The years 1991 to 1993 in Finland were as bad as it generally gets economically, with unemployment nearly tripling to 17 percent. Those who survived the downsizing had to assume greater work loads. During this period and for seven years afterward, Dr. Jussi Vahtera and psychologist Mika Kivimaki at the Finnish Institute of Occupational Health in Helsinki followed municipal workers who survived the cutbacks in four towns—from the mayor on down to teachers, nurses and janitors. Their sobering conclusion appeared this February in the British Medical Journal. Kivimaki puts it bluntly: "The only difference in mortality was in cardiovascular deaths. Those in work units with the most downsizing suffered twice the death rate from heart attack and stroke."

It should come as no surprise that emotions affect the heart—and not only in metaphorical terms. Suffer a fright, and your heart begins to pound. Get angry, and your blood pressure rises. Thirty years ago scientists told us that men with type A personalities—hard-charging, competitive and hostile—were more likely to suffer heart attacks. That turned out to be only partly true. Upon further investigation, anger and hostility were a problem, but not simple ambition or competitive drive. Today, scientists are using high-tech instruments to elucidate the mind-body connections that damage the heart. They are searching out the genes that increase our vulnerability to cardiac trouble. And they are applying an understanding of all these mechanisms to help point the way to nonsurgical treatments that may help trim our soaring medical bills.

If belligerence puts people at risk, science increasingly shows that a life of quiet desperation does, too. Study after study has now confirmed that factors like social isolation, depression and poor marital relations can contribute to heart disease. Patients who are depressed at the time of bypass surgery are more than twice as likely to die in the next five years as patients without clinical depression, although their disease is of comparable severity. Heart-attack survivors who live by themselves die at twice the rate of those who live with others. "They're heartbroken in more ways than one," says Dr. Herbert Benson, president of the Mind/Body Medical Institute in Boston and coauthor of "Mind Your Heart: A Mind/Body Approach to Stress Management, Exercise, and

Nutrition for Heart Health." In a major study in the Lancet this month, researchers surveyed more than 11,000 heart-attack sufferers from 52 countries and found that in the year before their heart attacks, the patients had been under significantly more stress—from work, family, financial troubles, depression and other causes—than some 13,000 healthy control subjects. "Severe stress didn't pose as great a risk as smoking," admits Dr. Salim Yusuf of McMaster University, senior investigator on the study. "But it was comparable to risk factors like hypertension and abdominal obesity. That's much greater than we thought before."

At every stage of heart disease, state of mind appears to play a role. It's most obvious in the later phases, where one can easily tally up heart attacks and deaths. "During the 1991 gulf war, fewer fatalities in Israel were due to Scud missiles than to [heart attacks] among frightened elderly people," says Stanford University stress expert Robert Sapolsky. During the 1994 L.A. earthquake, he points out, there was a similar spike. But thanks to high-tech scanning devices, scientists are now able to show that psychosocial factors play a role in the initial phases of the disease process as well. Psychologist Timothy Smith of the University of Utah is using CT scans to detect tiny calcium deposits in coronary arteries, an early sign of arterial damage. At the Society of Behavioral Medicine this year, he reported that couples with no history of heart trouble who were hostile or domineering in their interactions over money, kids, in-laws and household chores were more likely to have this type of damage. "The more strained their relationships, the more severe this silent atherosclerosis tended to be," he adds.

If there's a common explanation for these various effects, it may lie in the stress response. The classic stress condition is the fight-or-flight syndrome, which primes the body to flee from an attacker. The heart shifts into high gear and blood pressure rises, as the body speeds delivery of oxygen and glucose to muscles. Glucose and fatty acids flood the bloodstream for emergency fuel supplies. Platelets in the blood become more "sticky" to aid clotting in the case of a wound. That's perfect for a zebra sprinting from a lion, as stress expert Sapolsky puts it in the new edition of his book "Why Zebras Don't Get Ulcers."

But when the body responds the same way to everyday stressors like honking horns and looming deadlines, the cardiovascular system suffers. Chronic high blood pressure damages blood vessels, leading to inflammation and plaque formation. Excess glucose and fatty acids in the bloodstream can further damage arteries and veins. As if that's not bad enough, turbulent blood flow can rupture a plaque, with the resulting blood clot leading directly to a heart attack or stroke. And that's not all. When blood comes pounding back to the heart with extra force, it causes muscle tissue in the heart's receiving chamber to thicken—leading to an asymmetry in the heart that can produce potentially fatal irregular heartbeats.

The implications are dramatic—not only for our risks of developing heart disease, but also for treating it. Although a number of doctors are using lifestyle programs to help heal heart disease, Dr. Dean Ornish, president of the nonprofit Preventive Medicine Research Institute in Sausalito, Calif., has the most published work in this area. Not surprisingly (coming from the nation's leading proponent of an ultra-low-fat diet), a stringent diet and regular exercise are two pillars of his approach. But stress management is equally important, he insists. Stress reducers like yoga, meditation and group sharing have direct effects on cardiac risk, lowering levels of stress hormones and helping to relax arteries. They also have indirect effects. Participants gain a sense of well-being that helps them stick to a diet and exercise plan. And when their resolve falters, they have each other for support. "You can always call another member when you need help resisting a pastrami sandwich," says John Coleman, a retired MIT physicist who's participating in a spinoff program in Massachusetts. In fact, all the elements of the program bolster one another. If stress reduction makes you more likely to exercise, a half hour on the treadmill, in turn, lowers stress and depression. "Diet and exercise alone are like a two-legged stool," says Dr. Redford Williams, director of the Behavioral Medicine Research Center at Duke University. "It's more stable with the third leg, stress management."

But does it really work? In one trial, patients who adopted Ornish's radical lifestyle changes reduced their atherosclerosis in one year and showed even greater improvements at five years, while those on standard care grew steadily worse. "Patients in our studies showed a 91 percent reduction in angina in a few weeks to a few months without the trauma or expense of angioplasty or bypass," says Ornish. This should logically translate into cost savings, and studies suggest that it does. In one set of published results, Mutual of Omaha applied the Ornish program to 194 heart patients—and saved $30,000 per patient over the next three years, compared with 139 patients on standard care. Medicare is now studying the program and a similar one under Benson's direction at the Mind/Body Medical Institute; the government will start providing coverage if officials conclude that they can reduce medical bills.

Of course, the ultimate cost saver would be prevention. Genetic profiling may help one day by pinpointing the people who could benefit the most from these measures. Williams at Duke is studying a gene that affects metabolism of the neurotransmitter serotonin. Those with a particular variation in this gene have greater changes in heart rate and blood pressure in response to stress, putting them at increased risk of heart trouble. "Three papers have now shown they have a higher incidence of heart attacks," says Williams.

No one is entirely risk-free, however. Given that heart disease is still the nation's leading killer, we could all benefit from an ounce of the prophylactic stuff. Major lifestyle changes may elude those without a gun to their hearts. But even 10 minutes of meditation a day can help with prevention; doctors say consistency of practice is more important than duration. And we can all gain by nurturing close relationships. "Simply looking at the picture of someone you love can help dampen stress responses," says Smith at the University of Utah. In a study this month, he reported that thinking about supportive friends for a few minutes before a stressful test helped participants minimize increases in heart rate and blood pressure. Cardiologist Harvey Zarren, medical director of the Healing Your Heart program at Union Hospital in Lynn, Mass., used to apply a simple version of this technique when he rode in the ambulance with heart patients. He would ask the patient to discuss the thing in life he or she loved most. As if by magic, high blood pressure fell and abnormal heart rhythms diminished. Unlike colleagues, says Zarren, "I never had a cardiac arrest in the ambulance."

It only goes to show, as the Bible stated long ago in Proverbs 17:22, "A cheerful heart is a good medicine." And that's reason for all of us to take heart.

Cut Stress—Cut Sugar

Relaxation exercises may keep diabetes in check

By Mary Carmichael

Newsweek

Sept. 27 issue - Compared with other methods of managing diabetes—strict diets, insulin injections, vigilant blood-sugar monitoring—Richard Surwit's technique seems too easy to be true. It doesn't involve pills or shots. It doesn't technically require a doctor's supervision. And if you're a diabetic reading this, you can start treatment right now, just by taking a deep, relaxing breath. Feel better?

If Surwit is right, you should. By lowering stress, he argues, patients with diabetes, particularly type 2, can keep their illness in check. Stress raises the body's levels of cortisol and epinephrine and, via those hormones, the amount of glucose in the blood. Because diabetics cannot make enough insulin to metabolize the raised sugar levels, the sugar stays high long after the stress has ended.

Surwit, a psychologist, first stumbled on the principle 25 years ago. Mind-body medicine was in its infancy, and he was frankly more interested in its potential for preventing heart disease. But a colleague, a Duke University endocrinologist, came to him with a challenge: a woman with diabetes who couldn't keep her blood sugar low even with a rigorous diet and standard treatment. When her work or home life turned stressful, her glucose levels shot out of control, leaving her hospitalized. The endocrinologist was at a loss to help his patient; after one week of bio-feedback and muscle relaxation with Surwit, she was stable enough to leave the hospital.

Today relaxation is used to combat everything from asthma to labor pains, but there's a stumbling block for diabetic patients: most insurance companies won't pay for Surwit's therapy, classifying it as experimental. Nonetheless, other doctors are starting to pick up the idea, using it in conjunction with more conventional remedies. And this year Surwit has made the treatment widely available in a different manner; he published a book this spring. "The Mind-Body Diabetes Revolution" focuses on easy relaxation techniques, particularly cognitive behavioral therapy and progressive muscle relaxation. "Almost everybody can learn it," Surwit says of the latter, "and it only takes a week or so." Progressive muscle relaxation is just what it sounds like, a sequence of tightening, then slackening, exercises that allows people to monitor their stress levels based on muscle tension. Cognitive behavior therapy, says Surwit, consists of "getting the person to evaluate how they emotionally respond to situations, and to reality-test their response"—in other words, teaching people to think rationally in the face of adversity.

If these sound like techniques nondiabetics could stand to learn, too, that's no coincidence. Surwit says he wanted to design a program similar to others found in a wide variety of self-help manuals. "What's in my book is not magic," he says, although he does have one piece of advice for do-it-yourself types: keep it simple. "Some people try techniques that require almost a religious commitment," he says. "This isn't something you have to go to an ashram in India for."

Surwit's techniques may have a broader medical application, helping physicians diagnose patients at genetic risk for diabetes, allowing them to prepare for it and perhaps ward it off. Patients who don't have diabetes, but do carry some genes for it, respond to stress similarly to diabetics. Native Americans in the Pima tribe, for instance, are extremely susceptible to the disease. Even healthy Pimas have high blood-sugar levels when they're under stress. In the future, patients worried about their genetic risk could undergo a glucose test under lab-induced stress to find out whether they have something to worry about—and then can calm down.

Health for Life MD: Mind Over Matter

Readers sent us their mind-body questions. We asked a Harvard psychologist for some answers

WEB EXCLUSIVE

Newsweek

Sept. 19 - Earlier this month, you wrote to us with queries about the connection between mind and body. We handed them over to Alice D. Domar, Ph.D., director of the Mind/Body Center for Women’s Health at Boston IVF. Here are her responses to some of those questions, including those excerpted in the Sept. 27 issue of NEWSWEEK.

Chicago: Since mid-June, I've had persistent low-grade pain on the left side of my neck and upper back. I've started seeing a chiropractor periodically and am doing the at-home exercises he recommends. I also do yoga 2-3 times a week, and have practiced yoga for three years. I have a stressful, demanding job that I'm becoming increasingly unhappy with. Is it possible that my stress and unhappiness at my job can override the benefits from my chiropractor and my yoga practice? Can a job actually be unhealthy for you?

Alice Domar: Yes, and yes. As much as we would like to think that no matter how tough life gets, wonderful activities like yoga can conquer all, that is often not the case. Yoga can do a lot in terms of strengthening, toning and relaxing but it may not be enough if your job is really getting to you. You didn't say what kind of work-up you have had to make sure that chiropractic care is indeed the best treatment for you, but you might want to check in with your primary-care physician since the pain isn't getting better. He or she may recommend further tests and the solution may range from getting a new pillow and/or sleeping in a different position to physical therapy to continuing with your chiropractor. Recent research does show that job stress leads to a whole host of physical and psychological symptoms, so you might want to rethink your job situation, as well. Can you look for another one? Is there a way to make your current job more palatable? Sometimes we are in situations that are making us sick but we don't take the time to think about how to change things.

Kangwon Province, South Korea: Does a positive attitude boost the immune system to fight cancer and other diseases? I have known a lot of cancer survivors who have attributed their recovery to a positive outlook and trust in divine powers.

This is a really good question and is probably one of the most-asked question about cancer. The research to date has not provided a clear answer. A study by David Spiegel, M.D., in the late-'80s indicated that women with breast cancer who participated in a support group not only were less anxious and depressed but lived twice as long as women who did not participate. Some subsequent research replicated the emotional benefits of groups, but not the survival advantage, while other studies also showed that patients who participated in psychological interventions lived longer. A very recent study (about a week ago!) indicated that indeed psychological therapy was associated with improved immune function. However, there is no definitive evidence that a positive attitude per se can fight off cancer. Pessimists can survive and some optimists do not. My advice to cancer patients is to seek out the support you need and want and not worry that your attitude will truly impact your life span.

Caloocan City, Philippines: My weight is 160 pounds. According to the charts, I am around 15 to 20 pounds overweight. But I am muscular, I lift heavy weights. My waistline is 31 inches. Can I be heavier because I am muscular? I see athletes who are overweight. Is it all right to be overweight if you are muscular?

Muscle indeed weighs more than fat so anyone who lifts weights may well be fit but heavier than the charts suggest you should be. And a study that came out recently showed that being sedentary and thin is worse for you than being fit and overweight. I would suggest examining your eating habits: are you eating lots of fruits, veggies, whole grains and lean meats? If you have solid eating habits and your primary-care physician is satisfied with your weight in terms of your muscle mass, you are most likely in good shape.

Upland, Calif.: I used to get that endorphin kick after my workouts, but no more. Is that proof or refutation of the mind-body connection?

Good question! Actually, a recent study indicated that the early research showing that people get an endorphin high during and after exercise may have been flawed. It raised the question of whether there is an endorphin high after all. That is totally contrary to the experience of many athletes—and to my own personal experience (of course, a study about 10 years ago put into question the existence of PMS, and we all know that must exist!). I would venture a guess that if you no longer get the same satisfaction from your exercise regimen it may be because your body has gotten used to the level of exercise and you might want to push yourself a bit more and see what happens.

Brasilia, Brazil: How much can fitness be responsible for satisfaction and well-being? Can aerobic exercises cure diseases like some cancers?

In my opinion, exercise comes pretty close to the ideal health promoter. If we could develop a pill that does everything exercise does (decrease the risk of heart disease, decrease the risk of certain cancers such as breast, colon and bladder, improve the immune system, decrease the risk of osteoporosis and decrease symptoms of anxiety and depression, to name a few), the whole world would be popping such a pill on a daily basis. Especially if the pill, like exercise, was free and had no side effects. So yes, fitness can definitely contribute to satisfaction and well-being. But no, I don't think we can go so far as to say that it can cure diseases like some cancers. However, patients with diseases such as AIDS and cancer who exercise do have stronger immune systems than patients who don't exercise.

Lakewood, Colo.: I'm pretty substantially overweight, by 60 pounds or so. Every time I lose a few pounds—enough for people to notice and comment on—I seem to lose my focus. Before I know it, I'm back to my old habits, even if my diet had been going really well. I can't help but think there's a connection. What do you say?

I say you are right in that the fact that people comment and compliment you may be a powerful force. In fact, just a few months ago, a new study came out that followed a group of people who were dieting as they lost weight and, unfortunately for most of them, as they gained it back. What the study showed was that as people lost weight, they attracted a lot of good attention (as in comments like: "You look fabulous!"). However, as time went on, the comments decreased in frequency and with the lack of attention, most of the dieting behavior stopped and the weight came back on. It seems that the work of dieting is worth it if people notice and make a fuss over you, but as they get used to the new you and the compliments stop, the effort may just not feel justified. The key to successful dieting may well be to try to make it more dependent on what you think and feel, rather than depending on the comments of others.

Abingdon, Va.: How does the mind-body connection work to reduce the recurrence of breast cancer? (Especially breast cancer that is receptor negative.) And how can you get the mind and body connected?

The mind-body connection can work in a lot of different ways. The goal for any cancer patient is to have an optimal immune system. There are numerous mind-body skills that are associated with improved immune function, including relaxation techniques, exercise, good nutrition, and social support. Relaxation techniques include everything from meditation to progressive muscle relaxation to imagery. The key to integrating relaxation techniques into your life is to try out several techniques and see which one or ones feel comfortable and effective for you.

The easiest way to start is with guidance; either purchase a tape/CD or go to a class. Next is exercise; adopting an exercise routine does not have to mean sweating it out in an aerobics class. Simply putting on a pair of sneakers and walking is an ideal way to start. You might only make it around half the block at first but if you slowly add distance, it will make a difference in your health. Good nutrition is a must for cancer survivors, especially as so many lose weight after surgery and during chemotherapy. Don't feel overwhelmed by suddenly making your diet ideal. There are three easy pieces of advice I had been told by nutritionists. First, balance your plate so instead of it being half meat, one-fourth starch and one-fourth vegetable, try making it half vegetable and one-fourth meat and one-fourth starch. Second, add as many colors as you can. The most healthful fruits and vegetables tend to be colorful. And finally, make three simple changes. Substitute whole grain bread for white, use brown rice instead of white, and when you make a salad, throw in lots of interesting things such as dried cranberries, grapes, different kinds of nuts, etc. Finally, seek out others who can provide support to you and to whom you can give support. Friends are crucial. In one study on breast cancer patients, the women who had numerous close friends were less likely to die than those who had few or no close friends. If you try any or all of these approaches, you will be happier and healthier.

Atlanta: I have been suffering some constipation and have also been feeling particularly moody even though I’ve gotten plenty of rest. Could the two be connected?

The two could be connected but in more ways than one. My advice is to get checked out by your primary-care physician to make sure there is no physical cause. Thyroid conditions can cause both constipation and mood changes so before we assume that this is a mind-body thing, let's make sure it is not a purely physical thing. If your doctor finds no physical cause, there are several things which could be going on. Stress can contribute to constipation so the two could be connected. Also, when people are feeling sad or depressed, they tend to move around less and eat poorly, which can cause constipation. Assuming that your doctor finds nothing physically wrong with you, I would recommend several approaches including exercise, making sure you drink plenty of water and eats lots of fruits and vegetables, and addressing what is going on in your life that may be contributing to your moodiness. Has anything changed lately? Are you in your 40s and experiencing perimenopause, which can actually cause hot flashes at night that can make you moody by day? Have you ever experienced this kind of moodiness before and if so, what helped you then? Finding a good therapist can help address these issues and cognitive-behavioral approaches can help treat the moodiness.

Austin, Texas: I am 57 years old and divorced. I left my husband two years ago to pursue a spiritual path. I was fairly healthy, enthusiastic and very excited to be free to follow my dreams of becoming a Native American Sundancer and Kundalini Yoga teacher. My brother, 48 years old, became ill within three months and was dying with cancer and wanted me there. I lived in hospitals and nursing homes for the following six months, being at his side 24/7, which was a blessing beyond explanation. I had done the same for my mother in 1990, except that she was at home. Anyway, something changed within me. Since that time, I have developed rheumatoid arthritis, lupus and chronic obstructive pulmonary disease. I could care not less if I get up in the mornings, and nothing I seem to do can restore my enthusiasm for life and my dreams. I know that there has to be a mind-body connection here, but I just cannot seem to break the code. Do you have any suggestions for me?

I would tend to agree with you that there is a mind-body connection here. Losing a close relative can cause all sorts of physical and psychological problems. My first guess is that you may be depressed. There are numerous symptoms of depression and the focus for diagnosis used to be what were called "vegetative signs" such as not being able to get out of bed, changes in appetite, etc. However, recently there has been more attention paid to changes in mood. Some of the more common symptoms are feeling hopeless about the future and not enjoying things you used to enjoy. That does sound similar to what you are describing. It is very common to experience symptoms of depression as part of a grief reaction. And depression is associated with decreases in immune function as well as a host of other physical ailments. In addition, rheumatoid arthritis and lupus are both autoimmune diseases which tend to worsen under conditions of stress. The good news is that you have a history of being a healthy, upbeat person and you clearly have an expertise in techniques such as yoga which can decrease stress levels. I would suggest that you also pursue treatment for your depressive symptoms. What I recommend to my patients is to start with antidepressant medication to get you over the hump, and then quickly start cognitive-behavior therapy (CBT). Research shows that the combination of these two treatments can get you healthy quickly and the CBT skills can keep you that way.

New York: I have minor headaches, dizziness and neck discomfort on and off all the time, especially when I'm anxious. I've had blood tests and even an MRI, which are normal. I try to relax and breathe and yet I often feel very debilitated by this. Any suggestions? I'm tired of going to doctors and suffering each day with this.

I don't blame you. Pain is exhausting and it is discouraging not to know why you feel so lousy all the time. Normally, if I have a patient with your symptoms, I make them see a physician for a complete work-up to make sure there is no physical cause. But since you have already done this, it makes sense to assume that mind-body techniques are a logical next step. The good thing about a mind-body approach is that the techniques involve minimal investment of time or money and they have no side-effects. And the worst thing that can happen is that don't help. But they usually do offer relief, both physically and psychologically. Since you report that the symptoms are worst when you are anxious, treating your anxiety is a logical first step. You might want to keep a diary for a week or so of your symptoms to see if there are any triggers. For example, if you find the symptoms are worst when driving, then learning to decrease anxiety while driving would help. Other common triggers of symptoms like yours can be work situations (such as confrontations with your boss or presenting before your colleagues), family members who "push your buttons," and even physical situations such as lifting groceries or sitting on the floor, or poor posture. Once you identify when you feel your worst and what might make you feel that way, you can concentrate on relieving your symptoms. Relaxation techniques would be a good place to start. Relaxing and breathing, as you are already doing, are a good start, but I would advise a more formal regular practice. Research shows that when you practice a regular relaxation technique, within a few weeks you experience a "carry-over" effect so you feel better throughout the day, not just while relaxing. Try hatha yoga, meditation, autogenic training, or imagery, and I wouldn't be surprised if you felt better within weeks.

We All Need a Dose of the Doctor

The healing relationship between patient and physician plays a vital role in medical care

By Michael C. Miller, M.D.

Newsweek

Sept. 27 issue - You're the doctor. Your patient feels ill, but you don't have anything curative in your medicine bag. What do you do? That question has long stymied physicians. But as the Hungarian psychoanalyst Michael Balint recognized a half century ago, persistent or mystifying symptoms are not necessarily untreatable. Listen to patients' stories, Balint urged his colleagues. Treat them as friends. They may need a dose of the strongest drug of all: the doctor.

Balint's prescription is as timely today as it was in the 1950s. A founding insight of mind-body medicine is that everyone needs a dose of the doctor, even when state-of-the-art tests and treatments are available. Patients who have a good and trusting relationship with a clinician are more satisfied, studies show—and satisfied patients get better clinical results. They're more motivated to take care of themselves, more comfortable seeking help when problems arise, and more willing to follow advice and take medication as prescribed. A healthy doctor-patient relationship can also give consolation when bad news comes. Whether the diagnosis is HIV or heart disease, a patient whose doctor is a comrade doesn't have to worry about being scolded or abandoned. The relationship itself provides an emotional safety net.

Yet as science confirms the power of the healing relationship, other forces are conspiring to undermine it. Our health system can leave both patients and doctors feeling stressed out and alienated from one another. Relationships take time—and time is short in the world of managed care. Fifteen minutes may be long enough for a skilled practitioner to diagnose an infection and dash off a prescription or a referral to a specialist. It's rarely long enough to make sense of another person's experience, convey that understanding or act as an advocate. At its worst, our system of managed care can turn the doctor-patient encounter into an anonymous retail transaction.

The medical profession, to its credit, is struggling to revive the healing relationship. The medical schools at Harvard, Columbia, Duke and the University of Arizona have all created programs intended to pull medicine away from an exclusive focus on disease and toward the promotion of wellness, stressing the doctor's role as partner, teacher and coach. And at least two thirds of all U.S. medical schools now devote some part of their curriculum to integrating conventional care with complementary and alternative therapies that patients find more friendly. With the right reorganizing of priorities, the system can still cultivate a deeper role for physicians.

Consumers, for their part, are not waiting passively for the medical system to change. They're venturing outside of it in search of healing practices that involve less technology and more of the human touch. Few of these patients would give up effective drugs or surgery in favor of more sympathy, but most recognize that pills and procedures are an incomplete model of care. They want a dose of the healer who remembers their name.

Even the best doctor-patient relationship has boundaries, of course. No one should expect a parent's love from an internist (or a shaman, for that matter). But anyone with access to health care can take steps to improve the therapeutic exchange. Step one is to communicate freely. Educate yourself about whatever condition ails you, and share the information you find. Don't hold back for fear of being a nuisance. A good clinician is eager to teach and learn, and willing to acknowledge medicine's limits. In fact the healing relationship sometimes grows stronger when a doctor runs out of more treatments to offer. In that moment, he or she sheds authority and becomes a peer who is struggling forthrightly with the emotional consequences of illness. Doctor and patient become allies in an effort to sustain hope and find meaning in suffering.

For a healing relationship to thrive, then, patients must be experts about their needs, values and objectives. Doctors must be experts on wellness and illness and have finely attuned eyes, ears and hands. Few physicians emerge from training without some qualms about caring for other people. We become good at what we do by learning that even when we can't cure illness, we can make it less baffling and less onerous. The value of the doctor-patient relationship is not always easy to measure, but it is always immeasurable.

Miller is editor in chief of the Harvard Mental Health Letter (health.harvard.edu).

The Serenity Workout

Regular exercise can strengthen the mind as well as the muscles, and studies show it improves mood, too

By Karen Springen

Newsweek

Sept. 27 issue - It's now clear that emotions can affect our physical health, but what about the reverse? Can physical activity affect the health of our minds? Hippocrates thought so. He advised melancholy Greeks to get out and walk, and modern science suggests he was on to something. In fact, getting off the couch may help some people as much as Prozac or psychotherapy. "Exercise can improve anyone's mood and mental performance," says Carl Cotman, director of the Institute for Brain Aging and Dementia at the University of California, Irvine. "It's free, it's fun and it doesn't take a whole lot of time."

Whether they survey children or adults, researchers find that active people are happier than sofa jockeys, and less prone to depression and suicide. That doesn't prove that exercise makes people happy (it could be that happiness makes people exercise), but studies are now confirming the therapeutic effects. When Duke University psychologist James Blumenthal placed depressed patients on a supervised exercise regimen, 60 percent of them got better within four months—the same proportion that recovered on antidepressants. And though 30 percent of the medicated became depressed again within 10 months, only 9 percent of the exercisers relapsed.

The research on mental performance tells a similar story. Researchers have long noticed that active seniors suffer less cognitive decline than sedentary ones, and recent studies suggest that aerobic exercise may make us sharper at any age. When sedentary people become active, they perform better on tests of executive function—the ability to focus on important things and tune out distractions—says Art Kramer, a University of Illinois neuroscientist who uses magnetic resonance imaging to see how exercise affects the brain. They also get better at switching from one task to another, and their memories improve.

The benefits accrue quickly, but they require constant reinforcement. In one recent study, Ohio State University psychologist Charles Emery tested volunteers' ability to fire off words that start with a particular letter. Then he placed them on a supervised exercise program for 10 weeks. The result: more words. A year later, only the ones who had stuck with the regimen retained their "enhanced cognitive function," says Emery. Exercises that challenge the brain as well as the body may provide further benefits. In a study published in the journal Nature this year, German researchers reported that people who practiced juggling for three months actually enlarged a region of the cerebral cortex that handles the processing of motion.

How does exercise work these wonders? Besides improving circulation, it causes an array of chemical changes within the brain. It boosts the activity of mood-enhancing neurotransmitters such as dopamine and serotonin. It increases the production of brain-derived neurotrophic factor, a chemical that helps neurons multiply and form new connections. And it triggers the release of endorphins—morphinelike chemicals that blunt pain and foster relaxation. Studies show that even 10 minutes of vigorous exercise (producing a pulse rate of 100 to 120 beats per minute, depending on your age) can raise endorphin levels for an hour. "You feel tired, but you feel good," says John Morley, professor of internal medicine and geriatrics at St. Louis University. "It's the endorphin high."

Exercise may be a tonic for the psyche, but that doesn't mean more is always better. Competitive swimmers and other endurance athletes can become gloomy and irritable during periods of intense training, notes Jack Raglin, professor of kinesiology at Indiana University. Their moods typically improve when they taper off before a big competition. Five to 10 percent develop "staleness syndrome," a condition in which even a taper doesn't ease the depression. If you want to avoid overexertion, experts recommend taking the "talk test"—that is, making sure you can still speak comfortably during a workout. Then all you'll have to worry about is getting hooked. Athletes often "become dependent on those chemical messenger levels in the brain," says Dr. JoAnn Manson of Harvard Medical School and Brigham and Women's Hospital. Many experience a kind of withdrawal when they can't work out. Ed Ryan, director of sports medicine for the U.S. Olympic Committee, confirms that impression, noting that his players are "more grouchy than normal" when they're sidelined.

But dependency is no vice when the habit is healthful—and you don't have to be an Olympian to benefit. So pick an activity you enjoy, and stick with it. You have nothing to lose but your sorrows, your fogginess and a few extra pounds.

Combination Therapy

Mind-body techniques may not cure cancer, but they make living with it a whole lot easier

By Peg Tyre

Newsweek

Sept. 27 issue - Mary Peterson stands in a conference room at the Dana-Farber Cancer Institute in Boston with her arms stretched above her head. As her instructor intones directions, she visualizes energy pouring into her liver, leans against a wall, then lets out a resounding exhalation. Peterson, who has metastatic breast cancer, receives regular chemotherapy. She and three other women are also taking part in another form of cancer treatment called qigong, an ancient Chinese movement and meditation technique. So far, she says, qigong has reduced her muscle pain and anxiety. Her cancer, which has spread to her liver, is under control for now.

Qigong, says Peterson, has given her "a wonderful sense that I'm participating in my own recovery." And she's not alone. These days tens of thousands of cancer patients are using mind-body practices like conscious relaxation, talk therapy, music therapy, visualization, tai chi, qigong and prayer to help them deal with their disease. Eighty percent of cancer patients report using some kind of complementary medicine, a category that includes mind-body techniques as well as nutritional supplements and other holistic approaches. And no wonder. Scientists have found that mind-body practices help patients sleep better and cope with the pain, anxiety and depression often associated with traditional cancer treatments. Recent research has shown that mind-body practices can subtly enhance a cancer patient's immune system, too. While there's no evidence to suggest that yoga practice can defeat melanoma, cancer patients say they're eager to do everything they can to stay as healthy as possible.

Among doctors, skepticism is gradually giving way to support. For decades data-driven oncologists ignored the largely untested mind-body practices. But in the last few years, "patients have made it clear that they were eager to try it. And oncologists began looking for ways to combine it with the best medicine possible," says Dr. Barrie Cassileth, chief of integrative medicine at Memorial Sloan-Kettering Cancer Center in New York. Of the nation's 26 major cancer centers, 14 now offer complementary-medicine programs, mostly in the form of nutritional counseling, support groups and instruction in guided imagery. Cassileth recently helped found the Society for Integrative Oncology in order to bring together top oncologists and alternative practitioners working with cancer patients. The group will hold its first international conference this fall. Lorenzo Cohen, head of integrative medicine at the M.D. Anderson Cancer Center in Houston, predicts that mind-body techniques will soon become as much a part of standard cancer care as chemotherapy or radiation. "In the not-so-distant future," says Cohen, "oncologists will send patients to learn tai chi or yoga the way cardiac specialists now send patients to stress-management courses after they've had a heart attack."

Although many of these techniques have been around for thousands of years, scientists have only recently been exploring how they can be used in the fight against cancer. In 1989 research efforts got a boost when Stanford University psychiatrist David Spiegel published a much-ballyhooed study showing that terminal cancer patients who attended support groups were not only happier but actually lived 18 months longer than those who didn't. Almost overnight, cancer-support groups sprang up around the nation. That initial burst of enthusiasm waned quickly, though, as follow-up studies found that mind-body techniques had little or no effect on survival rates. What did improve markedly, however, was the patients' attitudes. In a five-year study published in The New England Journal of Medicine in 2001, doctors at the University of Toronto found that breast-cancer patients who attended weekly support groups and talk therapy in addition to undergoing conventional chemotherapy reported much less anxiety and pain than patients who went through standard treatment without such help.

Quality of life became nearly as important as quantity of life for Mary McGovern, a former international-health-care consultant who was diagnosed with chronic bladder cancer in 1999. Within five years McGovern had had two relapses and multiple rounds of chemo. She left her job and lost touch with many of her friends. Her blood pressure rose, and she began suffering from headaches, back pain and depression. In desperation, she enrolled in a course for cancer patients at the Mind/Body Medical Institute in Boston. There she learned conscious relaxation, visualization and the benefits of keeping a journal. At first McGovern, a no-nonsense woman, didn't see how writing down her feelings would make her feel better. "My first reaction was, 'You can't be serious'," she says. But after 14 weeks, her blood pressure dropped and her headaches and backaches improved. "These therapies," says McGovern, "helped me live with the uncertainty of having chronic cancer."

Researchers say McGovern's gains aren't just in her mind. Repeated studies have shown that conscious relaxation and meditation can counteract stress by lowering heart rate and blood pressure, and reducing levels of the stress hormones cortisol, epinephrine and norepinephrine in the bloodstream. They also enhance immune function. In a study published this month, researchers at the Ohio State University Comprehensive Cancer Center observed 227 breast-cancer patients for 10 years. Scientists found that the patients who received regular relaxation training and attended therapy and a support group had higher T-cell function than those who didn't participate in mind-body training.

Motivational speaker Maureen Murray of Pittsburgh says she doesn't need a bar graph to convince her of the power of prayer. When she was diagnosed with breast cancer four years ago, she was terrified. Shortly before her surgery, a friend gave her a prayer chain—a schedule of people who prayed around the clock for her recovery. Although there's no science to show that prayer can extend survival, Murray felt comforted and began her own deep, regular conversations with God—and it helped. Last year the Oncology Nursing Society published her book of prayers for breast-cancer patients, "You Are Never Alone." "I want my book to give cancer patients a little serenity," says Murray. And along with lifesaving drugs, a little serenity may be exactly what the doctor ordered.