THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINEVolume 7, Supplement 1, 2001, pp. S-83–S-92Mary Ann Liebert, Inc.

The Physiology of Mind–Body Interactions: The Stress Response and the Relaxation Response

GREGG D. JACOBS, Ph.D.

ABSTRACT

There are key differences between mind–body medicine and alternative medicine. A centraltenet of mind–body medicine is the recognition that the mind plays a key role in health and thatany presumed separation of mind and body is false. Alternative medicine, however, does notfocus on the role of thoughts and emotions in health and, therefore, is separate from mind–bodymedicine. Also, while there has been little scientific research on alternative medicine, the litera-ture on mind–body medicine comprises more than 2000 peer-reviewed studies published in thepast 25 years. The groundwork for understanding the physiology of mind–body interactions wasestablished by pioneering studies in the 1930s by Walter Cannon, and in the 1950s by WalterHess and by Hans Selye that led to an understanding of the fight-or-flight response. Later workby Holmes and Rahe documented measurable relationships between stressful life events and ill-ness. Other research has shown clinical improvement in patients treated with a placebo for a va-riety of medical problems. The effectiveness of placebo treatment can be interpreted as com-pelling evidence that expectation and belief can affect physiological response. Recent studiesusing spectral analysis and topographic electroencephalographic (EEG) mapping of the relax-ation response demonstrate that by changing mental activity we can demonstrate measurablechanges in central nervous system activity. These, and other, studies demonstrate thatmind–body interactions are real and can be measured.

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It is an honor to be here to represent HarvardMedical School, Harvard Medical Interna-

tional, and the Mind–Body Medical Institute atHarvard Medical School. It is also an honor toaddress our friends, colleagues, and gracioushosts here at the Asan Medical Center. In myfirst talk, I’d like to talk about the physiologyof mind–body interactions.

First of all, let me define mind–body medi-cine. Yesterday, mind–body medicine was de-scribed as part of complementary medicine. Infact, there are some key differences betweenmind–body medicine and complementary or

alternative medicine. First, one of the key def-initions of mind–body medicine is that themind—that is, thoughts and emotions—affectshealth. So one of the central tenets of mind–body medicine is the recognition that the mindplays a key role in health and that Cartesiandualism—that is, separation of mind andbody—is false. The media, the public, andhealth care professionals, however, often con-ceptualize mind–body medicine as alternativemedicine, and include mind–body medicinewith therapies like acupuncture or herbalremedies. In fact, most alternative medicine

Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts.

treatments, such as acupuncture or herbalremedies, have nothing to do with mind–bodymedicine because they do not focus on the roleof thoughts and emotions in health.

A second difference between mind–bodymedicine and complementary or alternativemedicine is that alternative medicine is notonly young in terms of a science, but there iscomparatively little research on alternative andcomplementary medicine relative to mind–body medicine. In fact, mind–body medicine isbased on more than 2000 scientific studies thathave been published in peer-reviewed journalsin the last 25 years.

My contention is that, because mind–bodymedicine involves this kind of empirical re-search base, it should not be considered alter-native and, in fact, should be considered main-stream. For example, in the United States, wehave half a dozen journals—scientific peer-re-viewed journals—that are specifically devotedto mind–body medicine. Some of the journalsinclude biofeedback and self-regulation, be-havioral medicine, psychosomatic medicine,and health psychology. There are dozens ofother journals including the Journal of the Amer-ican Medical Association and even the New En-gland Journal of Medicine that publish studies onmind–body medicine.

Another difference between mind–bodymedicine and alternative medicine is the con-cept of self-care. In fact, Herbert Benson of theHarvard Medical School, who is one of the pi-oneers in mind–body medicine, uses the modelof what he terms the “three-legged stool,” inwhich mind–body medicine is not intended toreplace standard medical care, such as surgeryand drugs, but should be used in conjunctionwith it. In Dr. Benson’s model of the three-legged stool, each leg—pharmaceuticals, sur-gery and procedures, and self-help techniquesin the form of mind-body interventions—allwork to support health (Benson, 1996). One ofthe pluses of mind–body medicine’s self-helptechniques is that patients are actually giventechniques that they learn and practice inde-pendently from an external agent or a health-care professional. Once they have learned thetechniques, they can use the techniques on theirown. That empowers the patient and increasesthe patient’s sense of self-control, which, as I

will talk about in my second lecture, is actuallyimportant for health maintenance. Developinga sense of control is an attitude and a belief thatis associated with improved health and lon-gevity.

I’d like to talk next about some of the scien-tific underpinnings of mind–body medicine bystarting with what is called the fight-or-flightresponse, which, in a very real sense, formedthe basis of the physiology of mind–body in-teractions. First, mind–body medicine is the re-sult of a long history of research on the psy-chophysiological connections between the brainand the nervous, hormonal, and immune sys-tems. This research initially focused on stressand its effects on the body.

The first person to conduct research inmind-body medicine, although they didn’tterm it mind–body medicine then, and whostudied the fight-or-flight response—or whatwe now term the stress response—was Wal-ter Cannon, a physiologist at Harvard Med-ical School who conducted his research in the1930s. Cannon documented the physiologicaleffects of what he termed the “emergency re-action,” which he defined as an acute physio-logic reaction that prepares the organism forfighting or fleeing. Cannon described thephysiologic changes associated with the fight-or-flight response as being characterized byincreased sympathetic nervous system activ-ity, increased central nervous system arousal,and increased skeletal-muscle activity. Hewent on to define specific correlates of thesephysiologic changes, including reduced bloodflow to the gut and extremities during fight orflight; increased blood flow to the muscles,heart, and lungs to aid in fighting or fleeing;and increased blood sugars among manyother changes (Cannon, 1932).

Interestingly, Cannon also hypothesized thatstress not only induces these physiologicchanges, but he also believed that stress pre-cipitates sudden death via ventricular fibrilla-tion based on his studies on voodoo death.Later in the 1950s, the Swiss physiologist, Wal-ter Hess, was awarded the Nobel Prize for hisresearch on electrical stimulation of the hypo-thalamus in cats. Hess initially documentedwhat he termed the “ergotropic responses,”which was his term for the emergency reaction.

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He defined the ergotropic response as a hypo-thalamically mediated response. It is charac-terized by increased sympathetic, cortical, andskeletal muscle activation. Hess would alsodocument an opposite response that we nowterm the “relaxation response,” which I will re-turn to shortly (Hess, 1957).

The other key physiologist credited with theinitial research on the effects of stress and emo-tions on the body is Hans Selye, who, in the1950s, studied the neuroendocrine effects of thefight-or-flight response and the resulting gen-eral adaptation syndrome. Selye conceptual-ized stress and its effects on the body as con-sisting of three phases that make up the generaladaptation syndrome. The first phase is analarm phase in which the fight-or-flight re-sponse is elicited for mobilization and gearingup for fight or flight. A second phase is calleda resistance phase in which the organism fightsthe stressor, but the acute fight-or-flight re-sponse ceases. And then, a third phase, whichhe termed the exhaustion phase, in which theorganism can no longer adapt to the stressor.It is this third phase, the exhaustion phase, thatSelye showed could result in illness, includingshrinkage of thymus, the spleen, and the lymphnodes, also peptic ulcers, and, in some cases,death (Selye, 1956).

After or around the time that Hans Selye wasconducting his research, two scientists devel-oped a model in which they were able to beginto document the effects of stress, in particular,stressful life events, not just on the body, but onmorbidity and mortality. This was the Holmesand Rahe Schedule of Recent Experiences,which is an inventory that assigns numerialranking to various life events, from divorce tochanging jobs, or moving, all the way down toa recent illness (Rahe, 1964). Holmes and Raheand subsequent epidemiologic research on therelationship between stress and illness, docu-mented consistent, measurable relationships be-tween stressful life events and illness. For ex-ample, stressful life events have been linked tosudden cardiac death, pregnancy and birth com-plications, diabetes, and overall susceptibility toillness. In 1992, a review by two National Insti-tutes of Health scientists in the Journal of theAmerican Medical Association noted the role ofstress in autoimmune diseases, coronary heart

disease, gastrointestinal disorders, chronic pain,and a range of other medical as well as psychi-atric disorders (Chrousos and Gold, 1992). In allof these disorders it is believed that the effect ofstressful life events on morbidity and mortalityis mediated by overactivation of the fight-or-flight response.

The other research that supports the idea thatthe mind interacts with the body and affectshealth is research on the placebo effect. This re-search was done initially by Henry Beecher atthe Harvard Medical School in the 1950s. Dr.Eisenberg discussed the placebo effect yester-day, and the fact that he educates his physi-cians and residents about the placebo effect. Iwould like to cover some of Beecher’s findingsconcerning the placebo effect, because thesefindings are powerful evidence of the effectthat thoughts, beliefs, and expectations canhave on the body and on health (Beecher, 1955).

Research on the placebo effect demonstratesthat approximately one third of patients exhibitclinical improvement in response to a placebopill for a variety of medical problems. Much ofthese findings come from randomized, double-blind trials. For example, curative placebo ef-fects have been substantiated in illnesses rang-ing from headaches, angina pain, insomnia,hay fever, and arthritis. Evidence supports theefficacy of the placebo effect in yielding be-tween 20% to 70% of relief of symptoms in con-trolled studies. Beecher’s studies at HarvardMedical School documented that 30% to 40%of pain patients report responding as well to aplacebo pill as they do to 10 mg of morphine.In a review of more than 1000 patients, Beecherfound that 35% of patients would be signifi-cantly relieved of severe pain by the double-blinded administration of a placebo.

Several researchers have found that aplacebo is 50% as effective as any analgesic, in-cluding morphine, and that placebos can actu-ally reverse the action of potent drugs. In fact,several researchers have argued that the his-tory of medicine prior to the twentieth centurywas the history of the placebo effect. Instead ofregarding the placebo effect as a nuisance vari-able, it should be viewed as providing power-ful evidence of mind–body interactions—thatis, the effects of expectation and belief on thebody (Shapiro, 1971).

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I ask you to imagine what it would be like ifa drug was discovered today that had the samecurative properties as the placebo effect. I thinkit would be an impressive drug.

The most recent research on the relationshipbetween the mind and body involves researchin the field of psychoneuroimmunology, whichis the study of the relationship between thebrain, thoughts and emotions, and the immunesystem. These studies demonstrate a connectionbetween the central nervous system and the im-mune system that were until recently believedto act independently (Kiecolt-Glaser and Glaser,1988). These studies, once again, disprove thenotion of Cartesian dualism. For example, psy-choneuroimmunology research over the past 10to 15 years has shown that nerve endings can befound in the thymus, the spleen, and the lymphnodes (Ader et al., 1990). Additionally, the im-mune cells respond directly to chemical signalsproduced by the nervous system.

Robert Ader at the University of Rochestershowed that immune responses can be condi-tioned through the central nervous system bypairing an immunosuppressing drug with sac-charine (Ader et al., 1990). He eventually dem-onstrated that the administration of saccharinealone could cause an immunosuppressive ef-fect and, ultimately, death. Around 1985, theNew England Journal of Medicine published aneditorial in which it characterized the effects ofmental states on the body as folklore. Six yearslater, it published a landmark study that doc-umented a direct link between the mind andthe immune system by showing a relationshipbetween levels of psychologic stress and sus-ceptibility to infection by a common cold virus(Cohen et al., 1991).

It is perhaps ironic that the same fight-or-flight response that was designed to help us inour evolution can now actually harm us. Basedon this large body of evidence, there is grow-ing consensus that mind–body interactions inthe form of excessive activation of the fight-or-flight response, in which it is not possible tofight or flee from modern day stressors, cancause or exacerbate many health problems viathe central nervous system, the peripheral ner-vous system, and the immune system. For ex-ample, concerning cardiovascular disorders,stress has been repeatedly linked to hyperten-

sion, heart disease, heart attacks, and death,primarily in the areas of hostility, job strain,and lack of social support. Stress has also beenlinked to increased cholesterol, constriction ofcoronary arteries, and ischemia, as well as car-diac arrhythmias.

Recently, hostility has been associated withincreased coronary blockage, increased risk ofheart attack, and increased risk of dying fromall causes. Redford Williams, in research atDuke University on the relationship betweenhostility and heart disease, has shown that hos-tile men are seven times more likely to diewithin 25 years from any cause compared toless hostile men (Williams and Williams, 1993).In numerous studies assessing stress in the lab-oratory, stress has been shown to result in in-creased blood pressure, heart rate, and reducedblood flow to the heart.

In the area of musculoskeletal disorders,stress has been linked to muscle contractionheadaches and back pain (Budzynski et al.,1970; Caudill, 1994). For gastrointestinal disor-ders, stress has been implicated in irritablebowel syndrome, which is a syndrome charac-terized by abdominal pain, irregular bowelmovements, constipation, and diarrhea. Stresshas been shown to increase gastric secretion. Italters the contractions of the small intestine andcolon, affects the time required for food tomove through the gastrointestinal tract, and al-ters the balance of sympathetic and parasym-pathetic functioning in the gastrointestinaltract. In one study, two thirds of patients saidthat stress alters their bowel patterns, and 50%of patients reported abdominal pain fromstress. In another study on patients with irrita-ble bowel syndrome, stress caused pain orbowel pattern changes in 85% of those patients(Whitehead, 1993).

Concerning the central nervous system,stress has been linked to a variety of problems,including insomnia (Morin, 1993) and negativeemotions, such as hostility, anxiety, and evendepression (LeDoux, 1996). For example, Mar-tin Seligman’s work on learned helplessnessshows that uncontrollable stressors can lead toa state of apathy and depression (Seligman,1975). Stressful life events are also the primaryprecipitators of insomnia. And recent studiesdemonstrate that increased daytime stress is as-

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sociated with increased nocturnal stress hor-mones, that is, catecholamines (Kiecolt-Glaserand Glaser, 1988). And these increased noctur-nal stress hormones have been shown to be as-sociated with reduced slow-wave sleep and in-creased complaints of insomnia.

In my research on insomnia, I also found thatinsomniacs exhibit elevated presleep corticalarousal, as measured by power spectral analy-sis, and that they not only demonstrate in-creased cortical arousal relative to good sleep-ers, but that this is consistent with centralnervous system activation via the fight-or-flight response (Jacobs et al., 1993).

Concerning the immune system, stress hasrepeatedly been shown to cause immunosup-pression. Particularly, the work of Ron Glaserand Janice Kiecolt-Glaser at Ohio State Uni-versity has repeatedly shown that stress andimmunosuppression can be measured throughjob loss, marital conflict, marital separation, di-vorce, loneliness, academic examinations, be-reavement, and caring for family memberswith a debilitating illness such as Alzheimer’sdisease. Stress has also been shown to increasethe risk of acute, infectious respiratory illnessand herpes virus.

Most of the research on mind–body medicine

concerns the effects of stress on health. An im-pressive body of evidence has also been gath-ered suggesting that it is possible to, at least tosome extent, control mind–body interactions.For example, Edmond Jacobson, in the 1930s inthe United States, published research on pro-gressive muscle relaxation (Jacobsen, 1938), andSchultz and Luthe in Germany in the 1950s, pub-lished their work on autogenic training (Schultzand Luthe, 1959), which are the two earliestmind–body techniques. In progressive musclerelaxation, patients learn to tense and relax var-ious muscle groups throughout their body andto discriminate low levels of tension and relax-ation as they progress in their training aroundthe body, hence progressive muscle relaxation.In autogenic training—autogenic means self-in-duced—patients learn to self-induce relaxationby autosuggesting to themselves phrases ofwarmth and heaviness in the body. Numerouspeer-reviewed scientific studies on these twotechniques document that they are more effec-tive than control conditions in reducing centralnervous system and peripheral nervous systemarousal (Lehrer and Woolfolk, 1984).

Another mind–body technique is biofeed-back, which was researched extensively begin-ning in the 1970s in the United States. Biofeed-

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FIG. 1.

back is the use of electronic instrumentation tomirror, or feed back to individuals, informationthat they are normally not aware of, or infor-mation that is normally unconscious. Biofeed-back was one of the first mind–body techniquesin which a significant amount of scientific re-search documented that it was possible toachieve greater voluntary control over the au-tonomic nervous system and the central ner-vous system, including electroencephalograms(EEGs), heart rate, hand temperature, periph-eral blood flow, galvanic skin response, andother physiologic parameters (Blanchard andEpstein, 1978).

In the 1970s, Dr. Herbert Benson at HarvardMedical School, who initially conducted re-search on blood pressure control in monkeysusing biofeedback, later began to study medi-tation. He demonstrated that meditation, a clas-sic Eastern mind–body technique, was anothertechnique that allowed greater control over theperipheral and central nervous systems (Ben-son et al., 1974). His discoveries were made inthe same laboratory that Walter Cannon usedfor his research 60 years earlier on the emer-gency reaction. It is perhaps ironic that two ofthe key researchers in mind–body medicineconducted their initial research in laboratoriesat Harvard Medical School.

When Walter Hess conducted his NobelPrize-winning research on the cat hypothala-mus, he also noted a contrasting set of re-sponses characterized by reduced sympatheticnervous, cortical, and skeletal muscle activity,which Hess termed the “trophotropic re-sponse.” Hess hypothesized that this parasym-pathetic response was a protective mechanismagainst overstress that promotes restorativeprocesses. Benson drew heavily on Hess’s workand proposed what he termed the “relaxationresponse” model, a model in which Bensonsuggested that all mind–body techniques, in-cluding biofeedback, meditation, progressivemuscle relaxation, autogenic training, tai chi,chigong, yoga, and other techniques, elicit acommon physiologic response that Bensontermed the relaxation response.

Benson hypothesizes that the relaxation re-sponse is hypothalamically mediated and thatit is an inborn counterbalancing mechanism tothe stress response. Benson also suggested that

there are four elements necessary to elicit therelaxation response. They include relaxed mus-culature, a quiet environment, passive disre-gard of everyday thought, and the focus of at-tention on a repetitive mental stimulus, such asa word, a sound, a phrase, or even repetitivebreathing.

Benson’s relaxation response model is nowwidely used to explain the therapeutic effectsof the relaxation response on various healthproblems. Literature reviews generally concurthat all relaxation-response techniques arecharacterized by reduced stress hormones andreduced central nervous system activity in theform of measurable brain wave changes (West,1980). In fact, a literature review by MichaelWest on the brain wave changes associatedwith relaxation response techniques indicatesthat, in the majority of scientific studies on therelaxation response, there is a measurable in-crease in alpha amplitude at the beginning of

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FIG. 2.

the relaxation response, a slowing of alpha fre-quency by one to three cycles per second and,later in meditation, theta trains or increasedtheta activity intermixed with alpha activity.

In my research, using power spectral analy-sis and topographic EEG mapping, I conducteda study in which I trained college students onthe relaxation response, or an appropriate con-trol condition, over an 8-week period (Jacobsand Lubar, 1989). Figure 1 shows compressedspectral arrays of EEG activity. On the hori-zontal axis are the various EEG frequencybands: Delta is 0 to 3, theta is 4 to 7, alpha is 8to 12, and beta is 13 to 32 cycles per second.The vertical axes are epochs of time, with eachepoch representing approximately 15 secondsof EEG activity. The area under each individ-ual curve tells us about the amount of relativepower in various EEG bands.

Figure 1 shows spectral plots of one chan-nel of EEG activity in the left hemisphere andthe right hemisphere in a control subject, inwhich the subject was sitting in a comfortablechair in a quiet room. Subjects were told topassively disregard everyday thought, butwhile listening to a control tape, which wastaped novels. In this plot, you see that the typ-ical EEG pattern for somebody who is very re-laxed initially is the predominant alpha pat-

tern, both during the first 15 minutes of thistrial and then during an additional 15 min-utes. Figure 2 is also a plot of control subjectsin which there is a very consistent alpha pat-tern. Figures 3 and 4 are plots of the relaxationresponse subjects; in the first 15-minute plot,they, too, listened to the taped novels. Weagain see a very predominant consistent alphapattern. After 15 minutes, they were in-structed to elicit the relaxation response andwe see an immediate drop in alpha power fol-lowed by a significant increase in theta, andeven delta, percent total power in both hemi-spheres. This is consistent across the majorityof subjects.

This is a simple, but quantitative demon-stration of the fact that, by altering mental activity in the form of a repetitive mental stim-ulus (in other words, changing cognitive activ-ity), we can demonstrate measurable changes in central nervous system activity. Figure 5 de-picts topographic EEG maps of subjects whocame into our laboratory and had never elicitedthe relaxation response. We wanted to deter-mine if there are measurable changes in centralnervous system activity the first time some-body elicits the relaxation response (Jacobs etal., 1996). Figure 5 is a map of beta EEG activ-ity, which is a measure of cortical activation.

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FIG. 3.

The map on the top left, labeled “Control Be-ginning,” is the first 5 minutes of a 15-minutecontrol condition in which subjects listened toa tape of somebody describing the benefits ofthe relaxation response, but not actually in-structing them on how to elicit the relaxationresponse. (The brighter the color, the more beta

activity.) The last 5 minutes of the control con-dition, labeled “Control End,” on the top right,show that, even when somebody sits in a quietroom, in a comfortable chair, beta activity re-mains relatively constant over 15 minutes.

The experimental subjects exhibit a similaramount of beta activity during the first 5 min-

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Frontal Frontal

Controlbeginning

OccipitalFrontal

RRBeginning

Occipital Occipital

OccipitalFrontal

ControlEnd

RRend

Vertical color bar indicates beta relative power (white highest, black lowest). Topographic maps are displayed in relative spectral power forgreater resolution.

Note: at RR end (lower right), beta relative power is significantly (p<.0164) decreased in frontal areas.

FIG. 5.

FIG. 4.

utes of the relaxation response (labeled “RR Be-ginning,” on the lower left). However, duringthe last 5 minutes of the relaxation response (la-beled “RR End,” on the lower right), theyshowed a significant reduction in anterior brainregions in beta activity, suggesting that eventhe first time that somebody elicits the relax-ation response, we can observe measurable re-ductions in cortical arousal. In fact, this may ex-plain why presurgical patients are able to usethe relaxation response the very first time theypractice it to reduce presurgical anxiety and tolessen the need for medication before, during,and after surgery (Mandle et al., 1990).

Regular elicitation of the relaxation responsenot only appears to mitigate the effects of thestress response. As I will discuss in my secondlecture, the relaxation response has also beenshown to be effective in the treatment of manyhealth problems, which I will review in detail,including musculoskeletal disorders, gastroin-testinal disorders, cardiovascular disorders,and others, including stabilizing blood sugarsin diabetics, reducing nausea associated withchemotherapy, reducing the severity of arthri-tis, insomnia, and also reducing hostility andanxiety (Benson, 1996).

The research on the physiology of mind–body interactions, specifically the stress re-sponse and the relaxation response, demon-strate that mind–body interactions, that is, theeffect of thoughts and emotions on the body,do exist and can be measured. Therefore, thequestion is not whether mind–body interac-tions are real, but rather, can the relaxation re-sponse and mind–body interactions be used toaffect health outcome? This question will be thefocus of my second talk. Thank you.

Question from the audience:

Thank you Dr. Jacobs. I have two questions.One, do you think mind–body technique is al-ternative medicine, or part of conventional med-icine, if you had to put it in one or another cat-egory? Two, are mind–body techniques effectivefor pain management?

Dr. Jacobs:

I do not think that is an easy question to an-swer, as Dr. Eisenberg talked about yesterday.Part of the problem with this new field of alter-

native, complementary, and mind–body medi-cine, which I do not think is actually as new, asI pointed out, is a problem of semantics and def-inition. But based on my initial point—thatmind–body medicine is not only defined differ-ently in terms of its central focus on the rela-tionship between thoughts and emotion andtheir effect on health and on the extensive re-search base that already exists, I do not think itis appropriate to describe it as alternative medi-cine, at least in the context of alternative andcomplementary therapies. And, in fact, it shouldbe considered mainstream when the same guide-lines that are used to evaluate traditional med-ical therapies, that is, controlled studies in peer-reviewed journals, have been applied to the fieldof mind–body medicine. I think it should be con-sidered mainstream for that reason.

There has been extensive literature usingmind–body techniques for back pain. DennisTurk at the University of Pittsburgh and Mar-garet Caudill at Harvard Medical School havecreated programs to treat chronic pain condi-tions, including low-back pain. In these pro-grams, mind–body therapies, including the re-laxation response, and also what’s calledcognitive therapy or cognitive restructuring,which I will be talking about later, have beenfound to be effective for various pain condi-tions, including low-back pain. In fact,mind–body therapies form some of the centralcomponents of those programs. So there is verygood research to date, mainly in applied clinical studies but also in laboratory studiesshowing that mind–body techniques, in theform of the relaxation response and also cog-nitive restructuring techniques, are, in fact, ef-fective for the treatment of pain.

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Address reprint requests to:Gregg D. Jacobs, Ph.D.

Assistant Professor of PsychiatryHarvard Medical School

and Beth Israel Deaconess Medical Center110 Francis Street, Suite 1-A

Boston, MA 02215

E-mail: gjacobs@caregroup.harvard.edu

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