Thursday, January 30, 2014

Relaxation Response Resiliency Program Session # 4 - half way there!

I can't believe session 4 of the 3RP program is tonight. Wow, time has flown by! I feel very lucky as a smoldering myeloma patient to have the opportunity to be a part of this and I am really enjoying the program/study. As much as the focus of the program is learning different ways to elicit the relation response through mindfulness, meditation, and other methods, what I really appreciate about the program is that it truly is a comprehensive "mind/body" approach to managing stress. The focus is not only on eliciting the relaxation response (though, a very important aspect!), but also on how to improve other important areas of life: social connectedness, nutrition, sleep, and exercise. Through this program I am learning about acute and chronic stress as well as the physical, cognitive, emotional, behavioral, and relational components/warning signs of stress. The program also has great information about optimizing social support and how there are different forms of social support such as emotional, informational, tangible, self-esteem/affirmational, and belonging.

This week, our "homework" was to continue daily practice of eliciting the relaxation response, record 3-5 appreciations daily, work toward 3 goals related to nutrition, exercise, sleep, or social support, and practice "mindful awareness" in daily living. Practicing "mindful awareness" could be many different things - even "mindful awareness of others" or "mindful eating" or "mindful exercise". In the session last week we practiced "mindful eating" with a Hershey's dark chocolate kiss. We examined the wrapper and tag, noticed the smell, and slowly ate it. During times of stress I often do "mindless" eating, meaning eating lots of (junk) food and not even tasting it! Hopefully being more mindful while eating (all the time, but even more in times of stress) may help me manage that particular stress response in my life.

Friday, January 24, 2014

And the "relaxation" begins!

Let's recap: Last summer Dr. R told me about a clinical trial starting in the fall for high risk MGUS and smoldering myeloma patients at the Benson-Henry Institute for Mind/Body Medicine at Mass General Hospital in Boston. The study was going to, "Measure the genomic and psychosocial effects of the Relaxation Response Resiliency Program (3RP) on patients with MGUS and Smoldering Multiple Myeloma". Well, I'm in the study and so far so good!

More information, from the clinical trial listing:

"This research study is evaluating the effects of a mind body medicine intervention called the Relaxation Response Resiliency Program (3RP) on stress and stress related symptoms in patients with monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). This research study is a supportive care trial. This means that the intervention program may improve general well-being and comfort, but is not considered a treatment or "cure" for MGUS or SMM. It is considered an investigational intervention because the investigators are examining the effectiveness of a new program - the 3RP - on reducing stress and stress-related symptoms in patients with MGUS and SMM. Standard management of MGUS and SMM involves regular monitoring without chemotherapy. Mind-body medicine, as defined by the National Institutes of Health, "focuses on the interactions among the brain, mind, body, and behavior, and on the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health." The 3RP is a newly designed group therapy program that through a variety of mind body principles and self-care interventions seeks to buffer stress and promote psychological resiliency and physical well-being. This study will examine the effectiveness of the 3RP in reducing stress and symptoms associated with stress in patients diagnosed with MGUS or SMM. Data from this study will also be used to assess changes in gene expression that result from 3RP intervention, particularly genetic pathways that are known to be dysregulated in MM."

Here is a little background on the Relaxation Response, from the Benson-Henry Institute's website:

The Relaxation Response

In the late 1960s, in the same room in which Harvard Medical School's Walter Cannon performed fight-or-flight experiments 50 years earlier, Herbert Benson, MD, found that there was a counterbalancing mechanism to the stress response. Just as stimulating an area of the hypothalamus can cause the stress response, so activating other areas of the brain results in its reduction. He defined this opposite state the "relaxation response."

The relaxation response is a physical state of deep rest that changes the physical and emotional responses to stress (e.g., decreases in heart rate, blood pressure, rate of breathing, and muscle tension).

When eliciting the relaxation response:

Your metabolism decreases
Your heart beats slower and your muscles relax
Your breathing becomes slower
Your blood pressure decreases
Your levels of nitric oxide are increased

If practiced regularly, it can have lasting effects. Elicitation of the relaxation response is at the heart of the BHI's research and clinical mind/body programs.

So, I was actually accepted into the study in October but I was randomized to the "wait" group. I passed the psychological evaluation (heh) and the program just started a few weeks ago. I have been to the first three sessions of the 3RP program. I have never really meditated before - or tried to elicit the "relaxation response" as BHI calls it - so this has been very new and different for me.

During each of the sessions the psychologist leads the group through a few different methods of eliciting the relaxation response. We also discuss our goals and progress as each participant has to set goals related to exercise, nutrition, sleep, and social connectedness -  social support and prosocial behavior. During the week in between sessions, we have to work on 3 SMART goals related to those areas. Each day we record progress toward those goals, as well as what we do each day to elicit the relaxation response. We were given CDs with guided recordings that we can listen to, but we can also use other recordings via YouTube or other sources that we find that we may prefer. Another part of the "homework" is to record 3-5 "appreciations" each day. Last week we also had to keep a sleep diary and record the time we went to bed and woke up, how many times we woke up in the night, how we felt when we got up, how alert/tired we felt the next day, and how many hours of sleep we got each night. I realized how bad my sleep habits are and how little sleep I get!

I am hopeful that throughout the next several weeks while I am in the program I will gain a lot of tools that I will use for the rest of my life. I'm learning both traditional/formal and simple/practical ways to elicit the relaxation response to counter the stress response. AND... hopefully influence the genetic pathways dysregulated in myeloma. Wouldn't that be nice?!

Monday, January 13, 2014

TED Talk: All it takes is 10 mindful minutes

I love TED talks. I found this talk featuring Andy Puddicombe which compliments what I'm learning in the mind body supportive care trial for smoldering myeloma. It's definitely worth watching and it's short... less than 10 minutes! ;)

Thursday, January 9, 2014

No, no, no doctor - I'm not crazy!

I am headed to Mass General for my second blood draw and to fill out another set of worry / stress / anxiety inventories before starting the 3RP mind/ body supportive care trial for smoldering myeloma. I also have to meet with the psychologist who is running the program. Hmmm. I was told this was just for her to get to know me and my goals for the study.

Fingers crossed after the psych eval they don't kick me out of the study! ;)

Thursday, January 2, 2014

Mind Over Medicine

A good friend of mine gave me a book called, "Mind Over Medicine: Scientific Proof That You Can Heal Yourself" by Dr. Lissa Rankin, MD.

Now, after just reading the title I was already a bit skeptical! But, since I am participating in a Mind/Body Supportive Care Trial for Smoldering Myeloma, I should probably learn how the mind affects the body, right? After reading this book, I am in no way abandoning the world of Western Medicine, but some parts of the book did give me pause.

This is a little summary of the beginning of the book:

"Through her research, Dr. Rankin discovered that the health care she had been taught to practice was missing something crucial: a recognition  of the body's innate ability to self-repair and an appreciation for how we can control these self-healing mechanisms with the power of the mind. In an attempt to better understand this phenomenon, she explored peer-reviewed medical literature and found evidence that the medical establishment had been proving that the body can heal itself for over 50 years. 

Using extraordinary cases of spontaneous healing, Dr. Rankin shows how thoughts, feelings, and beliefs can alter body's physiology. She lays out the scientific data proving that loneliness, pessimism, depression, fear, and anxiety damage the body, while intimate relationships, gratitude, meditation, spirituality/religion, and authentic self-expression flip on the body's self healing processes."

This book contains tons of stories about the placebo and nocebo effects and spontaneous remissions. Just a couple of the examples, which I found absolutely fascinating:

An article from the New England Journal of Medicine featured an orthopedic surgeon who specialized in surgeries for patients who had debilitating knee pain. "The patients in one group of the study got Dr. Moseley's famous surgery. The other group of patients underwent an elaborately crafted sham surgery, during which the patient was sedated, three incisions were made in the same location as in the real surgery, and the patient was shown a prerecorded tape of someone else's surgery on the video monitor. Dr. Mosley even splashed water around to mimic the sound of the lavage procedure. Then he sewed the knee back up. As expected, one third of the patients getting the real surgery experienced resolution of their knee pain. But what really shocked the researchers was that those getting the sham surgery had the same result! In fact, at one point in the study, those getting the sham surgery were actually having less knee pain than those getting the real surgery, probably because they hadn't undergone the trauma of the surgery. What did Dr. Moseley's patients think about the study results? As one World War II veteran who benefited from Dr. Moseley's placebo knee surgery said, 'The surgery was two years ago and the knee has never bothered me since. it's just like my other knee now.' "

"One study showing that patients in a control group for a new chemotherapy drug were given nothing but saline, yet they were warned it could be chemotherapy, and 30 percent of them lost their hair. In another study, hospitalized patients were given sugar water and told it would make them throw up. Eighty percent of them vomited." 

This is just a small sampling of the studies referenced in the book. Mind Over Medicine also references the "relaxation response" which was discovered by Dr. Herbert Benson of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, where I am completing the smoldering myeloma mind/body study using the Relaxation Response Resiliency Program (3RP). Dr. Benson named the physiological changes that meditating people experienced "the relaxation response," which is the counterbalance to the "fight or flight response." These physiological changes that occur during the "relaxation response" include sharp drops in heart rate, respiratory rate, metabolic rate, and blood pressure.

Something to think about! ;)