LA PROMOZIONE DELLA SALUTE NELLE SCUOLE: IL PROGETTO HEARTBEAT

Prevenzione della morte improvvisa nei giovani attraverso indagini elettrocardiografiche e dei livelli di stress. Promozione delle Life Skills

Roma, 28 aprile 2016

Roma, 28 aprile 2016

Andrea Geraci

Dipartimento del Farmaco

Reparto Sostanze Naturali, Medicine Tradizionali

Istituto Superiore di Sanità, Roma

Stress e medicina integrata

Terapie/Medicine Tradizionali/Complementari/non Convenzionali

Medicina Integrata

Definizione

Traditional medicine (TM) refers to “sommadi conoscenze, abilità e pratiche basate suteorie, credenze ed esperienze appartenenti adifferenti culture, usate per il mantenimentodella salute, come pure per la prevenzione, ladiagnosi e la cura di malattie fisiche omentali. (WHO, 2000)

Riferimenti internazionali

https://nccih.nih.gov/www.who.int

National Center forComplementary and Integrative Health

National Institutes of Health

NCCIH

Classificazione delle Terapie Tradizionali/non Convenzionali

Approcci Integrati

1. SISTEMI MEDICI STRUTTURATI

2. TERAPIE BIOLOGICHE

3. MANIPOLAZIONI FISICHE E GINNASTICHE

4. MEDICINA ENERGETICA

5. INTERVENTI SULLA CONNESSIONE MENTE-CORPO

Non solo farmaci dalle medicine tradizionali

Sostanze naturali (Enormi Farmacopee a volte da uniformare a quelle occidentali) di origine vegetale, animale, minerale.

Terapie fisiche (Ginnastiche, Moxibustione, Massaggi, Agopuntura, Elioterapia)

Terapie artistiche (Musica, Canto, Pittura, Modellaggio, Scultura, Euritmia)

Indicazioni per corretti stili di vita e approcci alla vita (Dieta, Approccio Olistico e Spirituale, Autodeterminazione, Meditazione, Yoga, Rapporto macro-microcosmo)

Il ruolo del terapeuta e della medicina (integrata): alleato e specchio della persona malata che ha “voglia” di guarire

• L’osteopata osserva una tensione muscolare da insofferenza verso una situazione o unapersona.

• Il chiropratico osserva una tendenza alla dislocazione vertebrale (squilibrio psico-fisicoin generale).

• L’agopuntore fa diagnosi di stasi di “chi/qi” (energia vitale) di fegato, per rabbiarepressa.

• Il terapeuta shiatsu vede che un’emozione blocca la spalla sinistra.• Il fitoterapeuta ti migliora per un breve periodo l’insonnia.• Una seduta di Yoga e/o Meditazione ti rilassa per un certo periodo di tempo.

Ci si può limitare al sintomo……. ma

Il vero terapeuta sarà quello che avrà aiutato il pazientea trovare la causa originaria del sintomo,indirizzandolo anche verso lo psicoterapeuta

Il paziente “vedrà” il muro genitori/figli, la crisi dicoppia, la rabbia repressa nei confronti del superiore,vecchi nodi emozionali ecc. che bloccano il fluiredella vitalità e portano allo squilibrio.

Una attuale prescrizione in medicina integrata

Farmaco di sintesi

Fitoterapico/Integratore

Rimedio omeopatico

Ciclo di agopuntura/osteopatia/chiropratica/massaggio

Consiglio dietetico

Consiglio comportamentale / approccio psicoterapeutico

In futuro...lo stesso ma in senso inverso

Classificazione delle Terapie Tradizionali/non Convenzionali

Approcci Integrati

1. SISTEMI MEDICI STRUTTURATI MTC/Agopuntura – Ayurveda – Omeopatia – Medicina Antroposofica

2. TERAPIE BIOLOGICHE Integratori alimentari, floriterapia di Bach

3. MANIPOLAZIONI FISICHE E GINNASTICHE Shatzu, Osteopatia, Chiropratica

4. MEDICINA ENERGETICA Cromoterapia,

5. INTERVENTI SULLA CONNESSIONE MENTE-CORPO Yoga, Meditazione, Arteterapia,

Fitoterapia

Da Capasso F, Grandolini G, Izzo A A – FITOTERAPIA – Ed Springer, 2006.

5. Interventi sulla connessione mente-corpo(enorme letteratura scientifica)

• Psicoterapia

• Biofeedback

• Attività creative – Arte-terapia

• Yoga

• Meditazione

• Perdono

Gestione dello stress: competenza nel riconoscerele cause di tensione e di stress della vita quotidianae nel controllarle, sia tramite cambiamenti nell'ambiente o nello stile di vita. Capacità di rilassarsie gestire le tensioni.

Life Skill

5. Interventi sulla connessione mente-corpo

TERMINI da ricercare:

Mind body

Mindfulness / “CONSAPEVOLEZZA”

Biofeedback

Occupational therapy

Yoga therapy

Prayer

Meditation

Forgiveness

Music therapy

Interventi sulla connessione mente-corpo

Attività creative. Negli ultimi tempi si è venuta a delineare la figura del terapista artistico e/o occupazionale chespesso affianca il medico nella cura di pazienti con disturbi psico-comportamentali.

a. Musica

b. Canto

c. Pittura

d. Modellaggio

e. Scultura

f. Euritmia curativa sono interventi particolarmente utilizzati per i bambini e gli adolescenti.

g. Biodramma: la “drammatizazione della vita” elaborata da Lorenzo Ostuni. Si tratta di una rappresentazionedella vita interiore attraverso movimenti, gesti, comportamenti che tendono a rendere manifestiproblematiche interiori di tipo psico-comportamentali. È una forma di psicoterapia.

Biofeedback. Si possono gradatamente regolare alcune funzioni come il battito cardiaco, la pressione arteriosa,la vasodilatazione periferica, la tensione muscolare. È considerata una tecnica terapeutica e anche riabilitativa.

YOGA

INTERVENTI SULLA CONNESSIONE MENTE-CORPO

• Rilassamento, esercizi di respirazione, posture particolari, ripetizione dimantra. È parte integrante della Medicina Ayurvedica. Termine sanscrito chesignifica legame e sottintende un’unione della componente fisica, psichica espirituale dell’uomo.

a. Hatha-Yoga, detto yoga fisico, tende a controllare le componenti corporee.

b. Raja-Yoga che è molto più mentale: si cerca invece di potenziare il pensiero.

c. Il Bhakti-Yoga ha nell’estrema devozione verso la divinità il suo nucleo.

d. Il Kundalini-Yoga è molto praticato in occidente dove rappresenta un validoaiuto per chi conduce una vita frenetica

e. Kriya-Yoga di Yogananda (1893-1952)

f. Yoga integrale di Aurobindo (1872-1950)

g. Yoga nidra e Kundalini Tantra di Swami Satyanada Saraswati (1923 - 2009)

Yoga

• Anusara Yoga - fluire con grazia. Jonh Friend, 1977

• Ashtanga Yoga - numero 8 come gli 8 rami dello Yoga. Pattabhi Jois, 1948

• Bikram Yoga - Hot Yoga, in stanza calda. Bikram Chudhury, 1985

• Vinyasa Flow Yoga - Flusso. Tirumbalay Krishnamacharya inizi ‘900

• Laya Yoga - dissoluzione. 2200 a.C.

• Power Yoga - Hatha+fitness. Bender Birch, 1995

• Jnana Yoga - conoscenza. III secolo a.C. - IV capitolo Bhagavad Gita

• Lo Yoga della Risata - respiro. Madan Kataria, 1995

• Bhakti Yoga - devozione/amore. III secolo a.C. XII capitolo Bhagavad Gita

• Shakti Yoga - energia creativa della femminilità. V secolo d.C.

• Yantra Yoga - movimento corporeo. VIII secolo D.C. dal maestro Vairocana

Yoga

Yoga

Patanjali, padre della medicina ayurvedica formalizzò nel 150 AC, nel trattato Yoga-Sutra gli otto punti principali del percorso yogico

1. yama e

2. niyama (aspetti morali ed etici)

3. asana (posture)

4. pranayama (controllo del respiro)

5. pratyahara (interiorizzazione dei sensi)

6. dharana (concentrazione)

7. dhyana (meditazione)

8. samadhi (controllo mentale)

• Mind and Body Approaches for Smoking Cessation: A Review

• Pilot Study Suggests Yoga May Help Women Quit Smoking

• Weekly and Twice-Weekly Yoga Classes Offer Similar Low-Back Pain Relief in Low-Income Minority Populations

• Study Quantifies Physical Demands of Yoga in Seniors

• Iyengar Yoga May Improve Fatigue in Breast Cancer Survivors

Yoga e ricerca al NCCIH

http://nccih.nih.gov/health/yoga

Meditazione

Meditazione

•Meditare, dal latino “meditari”, derivato di“mederi”, che significa curare.

•Nell’antichità la meditazione era un’attivitàterapeutica, sia per il corpo che l’anima.

•Radice “MED” Medicare - Medicina - Meditazione

Dal sito del National Center for Complementary and Integrative Health (NCCIH) di Bethesda

Uses of Meditation for Health in the United States

A 2007 national Government survey that asked about CAM use in a sample of 23,393 U.S. adults found that9.4 percent of respondents (representing more than 20 million people) had used meditation in the past12 months — compared with 7.6 percent of respondents (representing more than 15 million people) in asimilar survey conducted in 2002. The 2007 survey also asked about CAM use in a sample of 9,417children; 1 percent (representing 725,000 children) had used meditation in the past 12 months.

People use meditation for various health problems, such as:

Anxiety

Pain

Depression

Stress

Insomnia

Physical or emotional symptoms that may be associated with chronic illnesses (such as heart disease,HIV/AIDS, and cancer) and their treatment.

Meditation is also used for overall health and well-being.

http://nccam.nih.gov/sites/nccam.nih.gov/files/meditation.pdf

NCCAIH-Funded Researchhttp://nccam.nih.gov/research/results

Some recent NCCIH-supported studies have been investigating meditation for:

Mindfulness Meditation May Reduce Risk of Suicidal Thoughts in Middle Schoolers

Mindfulness May Be Helpful for People With Ulcerative Colitis (February 14, 2014)

Experienced Practitioners Reap Genetic Changes After a Day of Mindfulness Meditation

Mind and Body Approaches for Smoking Cessation: A Review

Meditation Training Program Shows Brain Effects Even Outside a Meditative State Relieving stress in caregivers for elderly patients with dementia

Reducing the frequency and intensity of hot flashes in menopausal women

Relieving symptoms of chronic back pain

Improving attention-related abilities (alerting, focusing, and prioritizing)

Relieving asthma symptoms.

http://www.mayoclinic.org/healthy-living/stress-management/in-depth/meditation/art-20045858

Meditation and emotional well-being

Gaining a new perspective on stressful situationsBuilding skills to manage your stressIncreasing self-awarenessFocusing on the presentReducing negative emotions

Meditation and illness

Meditation may help such conditions as:AllergiesAnxiety disordersAsthmaBinge eatingCancerDepressionFatigueHeart diseaseHigh blood pressurePainSleep problemsSubstance abuse

Meditazione

Alcune caratteristiche generali:

Un ambiente tranquillo

Una postura comoda

Focalizzazione dell’attenzione/pensiero o annullamento del pensiero

Meditazione

Vari tipologie in rapporto a tradizioni, scuole, insegnanti.

Alcuni esempi:

Indù (nell’ambito dello yoga) Buddhista (ottuplice sentiero, retta consapevolezza) Vipassana (compassionevole) Zen (allontanare da noi la mente per vedere senza di essa) Taoista (non agire, assecondare la natura) Trascendentale (Maharishi Maesh Yogi) Secondo le indicazioni antroposofiche Ebraica (Cabala, testi sacri, nomi = energia, preghiera = Mantra, vibrazioni superiori) Islamica (Sufismo, insegnamenti segreti, simbolismi ermetici, nel Corano) Cristiana (La preghiera meditativa)

Meditazione e sistemi medici strutturati

La meditazione viene consigliata/ è parte integrante in alcuni sistemi medici strutturati:

• Medicina ayurvedica

• Medicina tradizionale cinese

• Medicina antroposofica

• Naturopatia

Meditazione

Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, Fuchs FD, Hughes JW, LacklandDT, Staffileno BA, Townsend RR, Rajagopalan S. Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the American heart association. Hypertension. 2013 Jun;61(6):1360-83.

Many antihypertensive medications and lifestyle changes are proven to reduce blood pressure. Over the past few decades, numerous additional modalities have been evaluatedin regard to their potential blood pressure-lowering abilities. However, these nondietary, nondrug treatments, collectively called alternative approaches, have generally undergonefewer and less rigorous trials. This American Heart Association scientific statement aims to summarize the blood pressure-lowering efficacy of several alternative approaches andto provide a class of recommendation for their implementation in clinical practice based on the available level of evidence from the published literature. Among behavioraltherapies, Transcendental Meditation (Class IIB, Level of Evidence B), other meditation techniques (Class III, Level of Evidence C), yoga (Class III, Level of Evidence C), otherrelaxation therapies (Class III, Level of Evidence B), and biofeedback approaches (Class IIB, Level of Evidence B) generally had modest, mixed, or no consistent evidencedemonstrating their efficacy. Between the noninvasive procedures and devices evaluated, device-guided breathing (Class IIA, Level of Evidence B) had greater support thanacupuncture (Class III, Level of Evidence B). Exercise-based regimens, including aerobic (Class I, Level of Evidence A), dynamic resistance (Class IIA, Level of Evidence B), andisometric handgrip (Class IIB, Level of Evidence C) modalities, had relatively stronger supporting evidence. It is the consensus of the writing group that it is reasonable for allindividuals with blood pressure levels >120/80 mm Hg to consider trials of alternative approaches as adjuvant methods to help lower blood pressure when clinically appropriate.A suggested management algorithm is provided, along with recommendations for prioritizing the use of the individual approaches in clinical practice based on their level ofevidence for blood pressure lowering, risk-to-benefit ratio, potential ancillary health benefits, and practicality in a real-world setting. Finally, recommendations for futureresearch priorities are outlined.

Concetto Chiave: per la “American heart association”. Chi presentaipertensione e medita o pratica altre forme di rilassamento, può avere un giovamento

MeditazioneSi dimostra che la meditazione determina delle modificazioni anatomicofunzionali in sede cerebrale, in particolare nella corteccia, nell’area pre-frontale,nel giro cingolato, poi a livello della sostanza bianca, sul sistema limbico, sulsistema nervoso autonomo. Sono poi riscontrati variazioni del valore di alcunineurotrasmettitori, citochine, ormoni, endorfine ecc.

Jindal V, Gupta S, Das R. Molecular Mechanisms of Meditation. Mol Neurobiol. 2013 Jun 5

CytokinesCytokines are the immunomodulators and controller of the defense system of our body. There levels are definitelyaffected in meditation, producing beneficial effect in autoimmune disorders, breast cancers, etc. IL-6 and TNF-alpha are increased, IL-4 and IL-12 levels remain stable, interferon-gamma-secreting cells increased and IL-10-secreting cells decreases.

NeuroendocrinologyOne possible mechanism is that this meditation could influence neurotransmitter control of hypothalamic peptide release and therefore alter pituitary hormone secretion through increasedsecretion of inhibitory hypothalamic factors, such as somatostatin or dopamine, or decreased secretion of stimulatory factors, such as thyrotropin-releasing hormone or growth hormonereleasing factor. As age advances, the thyroidstimulating hormone (TSH) level gradually increase in the body with no presentation of hypothyroidism; it is a physiological phenomena mostlikely representing decreased biologic activity of the secreted peptide hormone or impaired functioning of the thyroid by increasing resistance to TSH. But opposite effect to that is seen withaging, in long-term practitioner of meditation, which may be due to more efficient functioning of the pituitary–thyroid axis. Nitric oxide has also been associated with increased levels duringmeditation; nitric oxide may crucially contribute to potentially beneficial outcomes and effects in diverse pathologies, exerting a global healing effect through meditation. During meditation,there is an increase in parasympathetic activity of the brain which decreases in heart rate (HR), blood pressure, and respiratory rate (RR). Due to decrease in HR and RR, theparagigantocellular nucleus of medulla decreases innervations of locus ceruleus which itself produces and distributes norepinephrine (NE). This reduction in NE reduces stimulation ofhypothalamic paraventricular nucleus, in turn decreases corticotrophin-releasing hormone which would ultimately decrease cortisol level. Beta endorphin is an endogenous opioid peptideneurotransmitter; it is an agonist of the opioid receptors and produce analgesic effect. Levels of beta endorphins are also increased during meditation producing a state of deep calmnesswith increased tolerance.

Prasad K1, Sharma V, Lackore K, Jenkins SM, Prasad A, Sood A. Use of complementary therapies in cardiovascular disease.Am J Cardiol. 2013 Feb 1;111(3):339-45. doi: 10.1016/j.amjcard.2012.10.010. Epub 2012 Nov 24.

The aim of the present study was to assess the use of complementary and alternative medicine (CAM) treatments in outpatients with cardiovascular disease and their interest in future use. Theincreasing popularity of CAM therapies highlights the need to explore their use among patients with cardiovascular disease. Data were collected with a prospective, point-of-care, anonymous, 17-question survey about basic medical information and previous use and interest in the future use of dietary supplements and other CAM interventions among patients undergoingoutpatient cardiology evaluation at a Midwestern tertiary care center. The survey was completed by 1,055 patients (655 men, 351 women; mean age 63.5 years) of whom 98.1% were white. Ofthese, 36.8% had cardiac symptoms for >10 years, 48.2% had coronary artery disease, and 82.5% reported use of CAM therapies. Of these patients, 75.4% reported using dietary supplements, 31.5%chiropractic therapy, 23.9% mind-body therapies, and 19.2% massage. Only 14.4% had discussed the use of CAM treatments with their physicians. The top 4 treatments used for cardiac symptomswere relaxation techniques, stress management, meditation, and guided imagery. Also, 48.6% were interested in participating in a future clinical trial of an alternative treatment. The great majorityof patients seen in current practice use CAM therapies, and a large proportion expressed an interest in participating in research with CAM therapies. In conclusion, research directed with anintegrative approach to cardiovascular care might prove beneficial when designing future studies. Mind-body therapies. For example, yoga has been shown to lower blood pressure, improve physicalfitness, and increase absolute and relative maximum oxygen uptake by 7% and 6%, respectively, after 8 weeks in a controlled setting. Qigong, an energybased modality, improved the respiratory rateand heart rate in 76 patients after myocardial infarction. In another study testing qigong, hospitalization was reduced in post myocardial infarction patients learning qigong relaxation techniques.Several styles of meditation have been tested and found to reduce blood pressure, improve heart rate variability, slow the respiratory rate, and, even, provide survival benefit.

Concetto Chiave: oggi si parla sempre più di medicina integrata. Questo lavoroconferma questo nelle malattie cardiovascolari.

In particolare lo yoga, il Qigong, alcuni tipi di meditazione e/o tecniche dirilassamento migliorano l’ipertensione, la frequenza cardiaca, la frequenzarespiratoria, e in generale migliora la sopravvivenza

MEDITAZIONE

MEDITAZIONEA non-randomized controlled design to evaluate the effect and feasibility of a mindfulness based stress reduction (MBSR) program on immune function, quality of life (QOL),and coping in women recently diagnosed with breast cancer. Early stage breast cancer patients, who did not receive chemotherapy, self-selected into an 8-week MBSRprogram or into an assessment only, control group. Outcomes were evaluated over time. The first assessment was at least 10 days after surgery and prior to adjuvant therapy, aswell as before the MBSR start-up. Further assessments were mid-MBSR, at completion of MBSR, and at 4-week post-MBSR completion. Women with breast cancer enrolled inthe control group (Non-MBSR) were assessed at similar times. At the first assessment (i.e., before MBSR start), reductions in peripheral blood mononuclear cell NK cell activity(NKCA) and IFN-ɣ production with increases in IL-4, IL-6, and IL-10 production and plasma cortisol levels were observed for both the MBSR and Non-MBSR groups of breastcancer patients.Over time women in the MBSR group re-established their NKCA and cytokine production levels. In contrast, breast cancer patients in the Non-MBSR group exhibitedcontinued reductions in NKCA and IFN-ɣ production with increased IL-4, IL-6, and IL-10 production.Moreover, women enrolled in the MBSR program had reduced cortisol levels, improved QOL, and increased coping (gestione attiva) effectiveness compared to the Non-MBSRgroup. In summary, MBSR is a program that is feasible for women recently diagnosed with early stage breast cancer and the results provide preliminary evidence for beneficialeffects of MBSR; on immune function, QOL, and coping.

Concetto Chiave: un programma detto mindfulness based stress reduction(MBSR) può influire sull’attività del sistema immunitario (riduzione dellacell NK cell activity (NKCA) della produzione di IFN-ɣ e aumento dellaproduzione di IL-4, IL-6, and IL-10 e cortisolo plasmatico, riportando unnormale livello delle citochine. Poi si conferma una migliore QoL, unmigliore coping (gestione attiva dello stress).

Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newlydiagnosed with early stage breast cancer. Brain Behav Immun. 2008 Aug;22(6):969-81. doi: 10.1016/j.bbi.2008.01.012. Epub 2008 Mar 21.

Reich RR, Lengacher CA, Kip KE, Shivers SC, Schell MJ, Shelton MM, Widen RH, Newton C, Barta MK, Paterson CL, Farias JR,Cox CE, Klein TW. Baseline Immune Biomarkers as Predictors of MBSR(BC) Treatment Success in Off-Treatment BreastCancer Patients. Biol Res Nurs. 2014 Jan 28. [Epub ahead of print]

Because the quantity and function of lymphocyte subsets change during stress, we hypothesized that these subsets would serve as stress markers and therefore predict which breastcancer patients would benefit most from mindfulness-based stress reduction (MBSR)-facilitated stress relief. The purpose of this study was to assess whether baseline biomarkerlevels predicted symptom improvement following an MBSR intervention for breast cancer survivors (MBSR[BC]). This randomized controlled trial involved 41 patients assigned toeither an MBSR(BC) intervention group or a no-treatment control group. Biomarkers were assessed at baseline, and symptom change was assessed 6 weeks later. Biomarkers includedcommon lymphocyte subsets in the peripheral blood as well as the ability of T cells to become activated and secrete cytokines in response to stimulation with mitogens. Spearmancorrelations were used to identify univariate relationships between baseline biomarkers and 6-week improvement of symptoms. Next, backward elimination regression models wereused to identify the strongest predictors from the univariate analyses. Multiple baseline biomarkers were significantly positively related to 6-week symptom improvement. Theregression models identified B-lymphocytes and interferon-γ as the strongest predictors of gastrointestinal improvement (p < .01), +CD4+CD8 as the strongest predictor ofcognitive/psychological (CP) improvement (p = .02), and lymphocytes and interleukin (IL)-4 as the strongest predictors of fatigue improvement (p < .01). These results providepreliminary evidence of the potential to use baseline biomarkers as predictors to identify the patients likely to benefit from this intervention.

Concetto Chiave: influenza dello stress sul sistema immunitario e influenza delprogramma mindfulness-based stress reduction su alcuni biomarkers: B-lymphocytes e interferon-γ come predictors di miglioramentogastrointestinale. +CD4+CD8 predictor di miglioramento cognitivo/psicologicoe linfociti e interleukin (IL)-4 come i migliori predictors di miglioramento dellafatigue.

MEDITAZIONE

Marchand WR. Neural mechanisms of mindfulness and meditation: Evidence fromneuroimaging studies. World J Radiol. 2014 Jul 28;6(7):471-9. doi:10.4329/wjr.v6.i7.471.

Abstract

Mindfulness is the dispassionate, moment-by-moment awareness of sensations, emotions and thoughts. Mindfulness-based interventions are beingincreasingly used for stress, psychological well being, coping with chronic illness as well as adjunctive treatments for psychiatric disorders.However, the neural mechanisms associated with mindfulness have not been well characterized. Recent functional and structural neuroimagingstudies are beginning to provide insights into neural processes associated with the practice of mindfulness. A review of this literature revealedcompelling evidence that mindfulness impacts the function of the medial cortex and associated default mode network as well as insula andamygdala. Additionally, mindfulness practice appears to effect lateral frontal regions and basal ganglia, at least in some cases. Structuralimaging studies are consistent with these findings and also indicate changes in the hippocampus. While many questions remain unanswered,the current literature provides evidence of brain regions and networks relevant for understanding neural processes associated withmindfulness.

Concetto Chiave: correlazione tra pratica di mindfulness e variazionianatomo-funzionali del SNC (corteccia, insula, amigdala) attestati dastudi di neuroimaging.

MEDITAZIONE

Wells RE1, Burch R, Paulsen RH, Wayne PM, Houle TT, Loder E. Meditation for Migraines: A PilotRandomized Controlled Trial. Headache. 2014 Jul 18. doi: 10.1111/head.12420. [Epub ahead of print]

Abstract

OBJECTIVE:

Our objective was to assess the safety, feasibility, and effects of the standardized 8-week mindfulness-based stress reduction (MBSR) course in adultswith migraines.

CONCLUSIONS:

MBSR is safe and feasible for adults with migraines. Although the small sample size of this pilot trial did not provide power to detect statisticallysignificant changes in migraine frequency or severity, secondary outcomes demonstrated this intervention had a beneficial effect on headacheduration, disability, self-efficacy, and mindfulness. Future studies with larger sample sizes are warranted to further evaluate this intervention foradults with migraines. This study was prospectively registered (ClinicalTrials.gov identifier NCT01545466).

Concetto Chiave: la mindfulness-based stress reduction (MBSR) faabbassare la durata e l’intensità degli attacchi cefalalgici.

MEDITAZIONE

Protocolli MBSR Mindfulness Based Stress Reduction e Psicoterapia

Programma clinico ideato nel 1979 dal Prof. Jon Kabat-Zinn di Boston

Aiuta a coltivare alcune qualità mentali: pazienza, attenzione non giudicante, accettazione, curiosità,chiarezza mentale, serenità, decentramento, compassione, gioia

Concetti assorbiti dal Buddhismo e coscienza della sofferenza umana

Consapevolezza – presenza mentale

La mindfulness non agisce sui contenuti dolorosi, ma sulla relazione che noi abbiamo con essi

PROGRAMMA

• 8 incontri di gruppo – 1 a settimana – 2,5 ore + 4 incontri di follow-up

• Meditazione Vipassana (di origine Buddhista – detta “auto-regolazione intenzionale dell’attenzione”)

• Momenti di condivisione di gruppo sul vissuto dei partecipanti

• Movimento corporeo (yoga, streching) e consapevolezza del movimento

• Materiale teorico relativo a stress, attenzione, connessione mente-corpo

• Metodi per favorire la capacità di comunicazione

• Compiti a casa giornalieri di circa 1 oraDa “La medicina integrata nel paziente oncologico”, a cura di Simonetta Marucci. Cap. IX. Bianca Pescatori. Associazione Avulls onlus. Novembre 2013.

Mansky PJ, Wallerstedt DB. Complementary medicine in palliative care and cancer symptom management. Cancer J. 2006 Sep-Oct;12(5):425-31.

MEDITAZIONE

Utilizzata sempre più spesso negli hospice

Gestione del dolore fisico e psichico

MEDICINA INTEGRATA

Forgiveness and Strategic Plan 2005-2009

Mind-Body Medicine and forgiveness

• Of all cam domains, the most widely practiced is mind-body medicine, which involves theinterplay of mind, brain, other body systems, and behavior.

Goal 4

• Explore commonalities and physiological correlates of personal characteristics, such asspirituality, resilience, altruism, and forgiveness that are associated with enhanced healthand the amelioration of disease processes.

• Explore the effects of cam therapies on these characteristics and how they relate to healthoutcomes.

• Characterize the specific biological mechanisms that link these characteristics withimprovements in wellness and in the prevention, mitigation, and treatment of diseases anddisorders and their symptoms.

Pubmed 20 aprile 2016

Forgiveness 764

Forgiveness and health 297

ForgivenessSanchez-Gonzalez MA1, May RW, Koutnik AP, Fincham FD. Impact of negative

affectivity and trait forgiveness on aortic blood pressure and coronarycirculation. Psychophysiology. 2014 Sep 5.

Results indicate that NA significantly predicts ABP and decreased SVI. Conversely, forgiveness seems to provide cardioprotection by evokingdecreased ABP while improving SVI.

Farrow TF1, Zheng Y, Wilkinson ID, Spence SA, Deakin JF, Tarrier N, GriffithsPD, Woodruff PW. Investigating the functional anatomy of empathy andforgiveness. Neuroreport. 2001 Aug 8;12(11):2433-8.

Previous functional brain imaging studies suggest that the ability to infer the intentions and mental states of others (social cognition) ismediated by medial prefrontal cortex. Little is known about the anatomy of empathy and forgiveness. We used functional MRI to detectbrain regions engaged by judging others' emotional states and the forgivability of their crimes. Ten volunteers read and made judgementsbased on social scenarios and a high level baseline task (social reasoning). Both empathic and forgivability judgements activated left superiorfrontal gyrus, orbitofrontal gyrus and precuneus. Empathic judgements also activated left anterior middle temporal and left inferior frontalgyri, while forgivability judgements activated posterior cingulate gyrus. Empathic and forgivability judgements activate specific regions of thehuman brain, which we propose contribute to social cohesion.

Ferrell B, Otis-Green S, Baird RP, Garcia A. Nurses' responses to requests forforgiveness at the end of life. J Pain Symptom Manage. 2014 Mar;47(3):631-41.

CONCLUSION:

Nurses provide clinical care for patients with advanced illness who struggle with issues of forgiveness. Nurses would benefit from additional education regardinghow best to address these concerns.

***

Toussaint L, Shields GS, Dorn G, Slavich GM. Effects of lifetime stress exposure onmental and physical health in young adulthood: How stress degrades andforgiveness protects health. J Health Psychol. 2014 Aug 19.

To examine risk and resilience factors that affect health, lifetime stress exposure histories, dispositional forgiveness levels, and mental and physical health wereassessed in 148 young adults. Greater lifetime stress severity and lower levels of forgiveness each uniquely predicted worse mental and physical health. Analysesalso revealed a graded Stress × Forgiveness interaction effect, wherein associations between stress and mental health were weaker for persons exhibiting moreforgiveness.

These data are the first to elucidate the interactive effects of cumulative stress severity and forgiveness on health, and suggest that developing a more forgivingcoping style may help minimize stress-related disorders

Forgiveness

Green M, Decourville N, Sadava S. Positive affect, negative affect, stress, and social support as mediators of the forgiveness-health relationship. J Soc Psychol. 2012 May-Jun;152(3):288-307.

Jennifer P. Friedberg. The impact of forgiveness on cardiovascular reactivity and recovery. International Journal of Psychophysiology. 2007;65(2):87-94.

Forgiveness

Ascoltiamo i consigli che «ci risuonano»

1° Livellocurare il

fisico

2° Livellocurare la vitalità

3° Livellocurare le emozioni

4° Livellocurare la mente

5° Livellocurare i

rapporti col passato

6° Livellocurare la

spiritualità

7° Livellocurare il

rapporto col trascendente

Consigli da antiche tradizioni mediche

Medicina Integrata e salute

Dalla medicina tradizionale cinese, tibetana o ayurvedica, dagli insegnamenti diIldegarda di Bingen (1098-1179), riceviamo consigli utili come quelli secondo cui

il giusto distacco (impermanenza) dagli eventi stressanti,

una sana moralità,

i pensieri positivi,

il perdono,

creano salute

perché sciolgono quei nodi emozionali che la vita inevitabilmente ci cuceaddosso: un “ bene-essere” per il benessere.

Medicina Tradizionale Tibetana e Ottuplice sentiero, (Gautama Buddha 566 a.C. - 486 a.C.)

1. Retta visione, giusta rappresentazione Capacità di ascoltare l’altro, facendo silenzio dentro di noi, guardare il mondosenza pregiudizi (Empatia).

2. Retto giudizio, giusto proposito, giusta risoluzione Prendere una decisione dopo matura e seria riflessione (Sensocritico, Gestione dello stress).

3. Retta parola Parlare di ciò che ha senso e importanza, dire la verità, evitare chiacchiere inutili, dire cose che nonproducano effetti nocivi sugli altri e di conseguenza a noi stessi (Capacità di relazionarsi con gli altri, Assertività).

4. Retta azione Evitare l'azione non motivata dalla ricerca di egoistici vantaggi, svolta senza attaccamento verso i suoifrutti, libera e morale, dettata dall’amore (Capacità di risolvere problemi).

5. Retto sistema di vita Vivere in modo equilibrato evitando gli eccessi, procurandosi un sostentamento adeguato conmezzi che non possano arrecare danno o sofferenza agli altri (Senso critico, Capacità di risolvere problemi, Gestione dellostress).

6. Retto sforzo Condurre la propria vita e attività in modo logico, artistico e morale. Lasciare andare gli stati non salutarie coltivare quelli salutari (Capacità di risolvere problemi, Creatività)

7. Retta presenza mentale, giusta memoria Capacità di mantenere la mente priva di confusione, non influenzata dallabrama e dall'attaccamento (Senso critico, Autocoscienza).

8. Retta concentrazione, giusta meditazione Capacità di mantenere il corretto atteggiamento interiore che porta allacorretta padronanza di sé stessi durante la pratica della meditazione (Senso critico, Capacità di risolvere problemi,Gestione dello stress, Gestione delle emozioni)

Esistonoapprocci, pensieri, atteggiamenti, modi di vivere e di

relazionarsi che fanno stare bene in salute e aiutano a guarire

Life skills… intraprendere azioni positive per sé promuovendo relazioni sociali costruttive ed efficaci

Life Skills in età precoce =

la migliore medicina preventiva