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AIS is a non profit organization. The site includes a library of information and reprints on all stress-related topics culled from scientific and lay publications. They offer a monthly newsletter on the latest advances in stress research and relevant health issues.
The American Society of Clinical Hypnosis is an organization for health and mental health care professionals using clinical hypnosis. However, their site has a section for the general public that includes a definition of hypnosis, myths, benefits and uses in medicine, psychotherapy and dentistry. You can search for a professional in your area as well.
NCCAM is 1 of the 27 institutes and centers that make up the National Institutes of Health (NIH) within the U.S. Department of Health and Human Services. It is the Federal Government's lead agency for scientific research on complementary and alternative medicine (CAM). The site offers comprehensive information on mind-body medicine. Online chat with a health information specialist is available. Review Mind-Body Medicine: An Overview. This fact sheet provides basic information about mind-body medicine, including relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, tai chi, qi gong, cognitive-behavioral therapies, group support, autogenic training, and spirituality.
This agency within the National Cancer Institute, a National Institute of Health arm, spends roughly the same amount annually as NCCAM to look into alternative therapies for preventing and treating cancer, as well as those that might lessen discomfort and in other ways improve the quality of life for cancer patients. The section of their web site for patients is at http://www.cancer.gov.
Episode number: 
513

Can positive thinking, prayer or yoga help heal your body as well as your mind? It depends who you ask.  Research into the connection between the mind and the body is both fascinating and controversial.

Can your mind cure what ails you?  Or conversely, can it make you sick?  Well, yes – and no.     

We get sick for a whole host of reasons – genetics, aging, nasty organisms like viruses and bacteria, toxins in our environment, the luck of the draw.  Sometimes we raise our risk factors for illness with an unhealthy diet, too little exercise, tobacco, alcohol, illegal drugs or unprotected sex.  Then there is the growing body of evidence that shows people who are stressed are more prone to illness and also tend to heal more slowly. 

Bottom line: mind-body medicine is not about magically thinking yourself well.  A cheery outlook can not change the hereditary hand you have been dealt nor can it stop you from aging.  However, a can-do attitude can keep you focused on developing a healthy lifestyle.  And mind-body techniques can play a powerful role in your physical well being by helping you manage stress, reduce chronic pain, improve coping skills and practice relaxation.

The National Center for Complementary and Alternative Medicine (NCCAM) identifies mind-body medicine as a sub-category of complementary and alternative medicine (CAM). They define it as "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 concept is centuries old.  Hippocrates, considered to be the father of Western medicine, wrote, "Natural forces within us are the true healers of disease," and "It is more important to know what sort of person has a disease than to know what sort of disease a person has."  As important strides were made in biomedicine – such as a greater understanding of human anatomy, the germ theory of disease, and the discovery of genes and their role in heredity and disease – scientists of the time came to believe the mind and body were separate.  They began to look upon the body as a machine and life as a mechanical process.  Traditional Chinese medicine and Ayurveda, the traditional Indian medicine, have always been based on integrating mind and body approaches to promote healing.   

Because of the dearth of research to support the validity of many CAM techniques, some physicians have called it the woo-ification of health care.  Enter a new category, called integrative medicine (IM).  IM is defined as the combination of mainstream medical therapies with selective complementary therapies for which there is high-quality scientific evidence of safety and effectiveness.  With integrative medicine's goal of "separating the wheat from the chaff," more medical professionals are buying in and medical schools are even beginning to incorporate integrative medicine into their curricula.  A study of data extracted from relevant systematic reviews, meta-analyses, and randomized controlled trials, published in 2003 in The Journal of the American Board of Family Practice, concluded that there is considerable evidence of efficacy for several mind-bodytherapies in the treatment of coronary artery disease, headaches, insomnia, incontinence, chroniclow back pain, disease- and treatment-related symptoms of cancer,and improvement of post-surgical outcomes...and moderate evidencefor mind-body therapies for hypertensionand arthritis."1

According to a 2004 report from the Centers for Disease Control and Prevention, 36 percent of U.S. adults aged 18 years and over use some form of complementary and alternative medicine (CAM).  The surge in popularity for CAM has been driven by several factors including:

  • The perceived limitations of conventional medicine to prevent disease, treat chronic and degenerative disease and improve quality of life
  • The higher relative importance of stress in developed countries versus those where people are challenged with more basic concerns like food shortages, unhealthy living conditions and widespread violence 
  • Positive news reports about mind-body medical research
  • A need to feel more in control of one's own destiny

 1 John A. Astin, PhD, Shauna L. Shapiro, PhD, David M. Eisenberg, MD and Kelly L. Forys, MA; Mind-Body Medicine: State of the Science, Implications for Practice; The Journal of the American Board of Family Practice 16:131-147 (2003).  

Quick Facts

  • Mind-body medicine is a sub-category of complementary and alternative medicine (CAM). It is "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."   
     
  • Integrative medicine is the combination of mainstream medical therapies with selective CAM therapies for which there is high-quality scientific evidence of safety and effectiveness.
  • A phenomenon called the "fight-or-flight response" is a set of physiological changes, such as increases in heart rate, arterial blood pressure, and blood glucose, initiated by the sympathetic nervous system to mobilize body systems in response to stress.  Your body releases a surge of stress hormones (cortisol, epinephrine and norepinephrine).
  • You do not have to be physically threatened for the fight-or-flight response to occur.  The daily stresses of modern life can leave us with our fight-or-flight response in a permanent "on" position.
  • Between 75 and 90 percent of all visits to primary care physicians are for stress related problems.
  • One-third of Americans are living with extreme stress and nearly half of Americans (48 percent) believe that their stress has increased over the past five years. 
  • Stress is linked to the six leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver and suicide.
  • Stress differs for each of us. Things that are distressful for some individuals can be pleasurable for others. We also respond to stress differently. 
  • Mind-body medicine offers an array of strategies that support the body's natural ability to heal itself.  Methods include biofeedback, cognitive behavioral therapy, guided imagery, hypnotherapy, meditation, meditative movement therapies such as tai chi and yoga, and other relaxation techniques.  They can be used alone or in combination.  Also, there is substantial overlap between them.
  • A study of data extracted from relevant systematic reviews, meta-analyses, and randomized controlled trials, published in 2003 in The Journal of the American Board of Family Practice, concluded that there is considerable evidence of efficacy for several mind-bodytherapies in the treatment of coronary artery disease, headaches, insomnia, incontinence, chroniclow back pain, disease- and treatment-related symptoms of cancer,and improvement of post-surgical outcomes...and moderate evidencefor mind-body therapies for hypertensionand arthritis."1

1 John A. Astin, PhD, Shauna L. Shapiro, PhD, David M. Eisenberg, MD and Kelly L. Forys, MA; Mind-Body Medicine: State of the Science, Implications for Practice; The Journal of the American Board of Family Practice 16:131-147 (2003).  

Many of the quick facts above were adapted from information available from the National Center for Complementary and Alternative Medicine (NCCAM), the American Institute of Stress and the American Psychological Association.

 

Ask Your Doctor

This list of questions is a good starting point for discussion with your doctor; however, it is not a comprehensive list.

  • What do you know about mind-body treatments?
  • How do I know if I am selecting the correct treatment for my needs?
  • How confident are you that this treatment will help me?
  • What is the treatment supposed to do? Does it work in combination with a standard therapy, or would it replace it?
  • Are there dangers to this treatment I should know about?
  • Has research to support the treatment's effectiveness been published in peer-reviewed medical journals?
  • If the therapy is used instead of a conventional treatment or clinical trial, will it delay the standard treatment?
    • Could this delay be harmful?
    • How does this therapy affect the chances of being effectively treated later?
  • What kind of medical professional offers this treatment? 
    • Are they certified and by whom?
    • How do I find one that is right for me?
  • How much will it cost?  Will my health care plan cover treatment?

Key Point 1

Research into the mind/body connection is both fascinating and confusing.  The notion that stress – and how you respond to it – can affect your health is supported by substantial evidence. 

Time magazine's June 6, 1983, cover story labeled "Stress! Seeking Cures for Modern Anxieties" and referred to it as our leading health problem. Things have not improved in the intervening decades.  The American Stress Institute estimates that, in 2008, between 75 and 90 percent of all visits to primary care physicians are for stress related problems.1  

Why is stress such a big deal?  Because it can affect virtually every organ and system in your body.  Stress is linked to the six leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver and suicide.2   

Your body is hard-wired by nature to react to stress in a way originally meant to protect you.3   Early 20th century scientist Walter Cannon demonstrated that when an animal is frightened, its neuroendocrine system springs into action and releases hormones. He called the phenomenon the "fight-or-flight response." 4 In humans, just as with animals, these stress hormones help you react faster, run more swiftly, fight harder and fixate on a threat.  They increase your heart rate and respiration, inhibit digestion, increase sugars in the bloodstream, and constrict blood vessels in some parts of the body and dilate others. The body is supposed to return to normal once the threat is gone.

While all these reactions are useful if you are being chased by a sabertooth tiger, they are not so useful for the way most people live today.  However, it turns out that you do not have to be physically threatened for the fight-or-flight response to kick in.  It can happen when you are overworked, when you are forced to juggle conflicting responsibilities, when you worry about money, when unpleasant surprises crop up, when relationships go bad, when you have difficult choices to make and when you are ill or injured.  The bad news for modern man and woman is that these kinds of stressors are omnipresent, leaving your fight-or-flight response in a permanent "on" position.  Your body never reaches "normal" and your levels of stress hormones (cortisol, epinephrine and norepinephrine) remain persistently high.  

A growing body of research seems to support the premise that stress hormones, which are associated with unhealthy emotions like anger, hostility, anxiety and depression, can put you at increased risk for a range of health problems.  There are some in the medical field who believe existing evidence is insufficientto change clinical practice – that there have been too few rigorously controlled and scientifically sound studies and that positive results may be the result of a placebo response.  The opposition argues that a placebo response is, itself, proof of the mind-body connection and that, when taken in its totality, the positive evidence is substantial.  They suggest that, rather than a lack of evidence to support mind-body medicine, lack of exposure to the evidenceis the problem.  A 2003 review of mind-body studies includes the following examples of research the reviewers deemed to be methodologically sound:5 

  • Infection:  Several studies have shown that emotional traits, both negative and positive, can influence people's susceptibility to infection.6-7

  • Pain:  A 1996 NIH consensus panel statedthat there was strong evidence that relaxation techniqueswere effective in the treatment of chronic pain.8 
  • Headache:  Multiple studies have shown the efficacy of relaxation and biofeedback in treating migraine and tension headaches.9-12

  • Cancer:  Study results have been mixed.  Evidence from multiple studies suggests that mind-body interventions can improve mood, quality of life, and coping, 13-16 and disease- and treatment-related side effects such as nausea and pain.17-21  However, the potential for improvements in disease prognosis remains unclear.  Some trials show improvement22-24 and some do not.25-28
  • Cardiovascular Disease and Hypertension: Studies have demonstrated that depression, hostility, and stress can play a significant rolein the development and progression of cardiovascular disease.29-34

To get the bigger picture on research into mind-body medicine search the web with general terms like integrative medicine, complementary medicine, mind-body therapy and stress management or specific terms for mind-body techniques like biofeedback and relaxation therapy.  Start with the National Center for Complementary and Alternative Medicine web site to learn about the research they sponsor.  Also check their "News and Highlights" section.    

1 American Institute of Stress, Why is there more stress today?
2 APA, 2004 
3 Mayo Clinic.  Stress: Win control over the stress in your life.
4 Cannon WB. The Wisdom of the Body. New York, NY: Norton; 1932.
John A. Astin, PhD, Shauna L. Shapiro, PhD, David M. Eisenberg, MD and Kelly L. Forys, MA; Mind-Body Medicine: State of the Science, Implications for Practice; The Journal of the American Board of Family Practice 16:131-147 (2003).
6 Cohen S, Doyle WJ, Turner RB, et al. Emotional style and susceptibility to the common cold. Psychosomatic Medicine. 2003;65(4):652-657.
7 Smith A, Nicholson K. Psychosocial factors, respiratory viruses and exacerbation of asthma. Psychoneuroendocrinology. 2001;26(4):411-420.
8 Integraton of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. JAMA 1996; 276: 313–8.
9 Holroyd KA, Penzien DB. Pharmacological versus non-pharmacological prophylaxis of recurrent migraine headache: a meta-analytic review of clinical trials. Pain 1990; 42: 1–13.
10 Haddock CK, Rowan AB, Andrasik F, Wilson PG, Talcott GW, Stein RJ. Home-based behavioral treatments for chronic benign headache: a meta- analysis of controlled trials. Cephalalgia 1997; 17: 113–8.
11 Holroyd KA, Penzien DB. Psychosocial interventions in the management of recurrent headache disorders. I: Overview and effectiveness. Behav Med 1994; 20: 53–63.
12 Holroyd KA, O'Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA 2001; 285: 2208–15
13 Classen C, Butler LD, Koopman C, et al. Supportive-expressive group therapy and distress in patients with metastatic breast cancer: a randomized clinical intervention trial. Arch Gen Psychiatry 2001; 58: 494–501.
14 Simonton SS, Sherman AC. Psychological aspects of mind-body medicine: promises and pitfalls from research with cancer patients. Altern Ther Health Med 1998; 4: 50–64.
15 Cunningham AJ, Tocco EK. A randomized trial of group psychoeducational therapy for cancer patients. Patient Educ Counsel 1989; 14: 101–14.
16 Cain EN, Kohorn EI, Quinlan DM, Latimer K, Schwartz PE. Psychosocial benefits of a cancer support group. Cancer 1986; 57: 183–9.
17 Burish TG, Jenkins RA. Effectiveness of biofeedback and relaxation training in reducing the side effects of cancer chemotherapy. Health Psychol 1992; 11: 17–23.
18 Syrjala KL, Cummings C, Donaldson GW. Hypnosis or cognitive behavioral training for the reduction of pain and nausea during cancer treatment: a controlled clinical trial. Pain 1992; 48: 137–46.
19 Vasterling J, Jenkins RA, Tope DM, Burish TG. Cognitive distraction and relaxation training for the control of side effects due to cancer chemotherapy. J Behav Med 1993; 16: 65–80.
20 Syrjala KL, Donaldson GW, Davis MW, Kippes ME, Carr JE. Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: a controlled clinical trial. Pain 1995; 63: 189–98.
21 Mundy EA, DuHamel KN, Montgomery GH. The efficacy of behavioral interventions for cancer treatment-related side effects. Seminars in Clinical Neuropsychiatry. 2003;8(4):253-275.
22 Fawzy FI, Fawzy NW, Hyun CS, et al. Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Arch Gen Psychiatry 1993; 50: 681–9.
23 Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989; 2: 888–91.
24 Richardson JL, Shelton DR, Krailo M, Levine AM. The effect of compliance with treatment on survival among patients with hematologic malignancies. J Clin Oncol 1990; 8: 356–64.
25 Goodwin PJ, Leszcz M, Ennis M, et al. The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med 2001; 345: 1719–26.
26 Ilnyckyj A, Farber J, Cheang M, et al. A randomized controlled trial of psychotherapeutic intervention in cancer patients. Ann R Coll Physicians Surgeons Canada 1994; 27: 93–6.
27 Cunningham AJ, Edmonds CV, Jenkins GP, Pollack H, Lockwood GA, Warr D. A randomized controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer. Psycho-oncology 1998; 7: 508–17.
28 Linn MW, Linn BS, Harris R. Effects of counseling for late stage cancer. Cancer 1982; 49: 1048–55.
29 Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999; 99: 2192–217.
30 Dusseldorp E, van Elderen T, Maes S, Meulman J, Kraaij V. A meta-analysis of psychoeduational programs for coronary heart disease patients. Health Psychol 1999; 18: 506–19.
31 Linden W, Chambers L. Clinical effectiveness of non-drug treatment for hypertension: a meta-analysis. Ann Behav Med 1994; 16: 35–45.
32 Linden W, Stossel C, Maurice J. Psychosocial interventions for patients with coronary artery disease: a meta-analysis. Arch Intern Med 1996; 156: 745–52.
33 Blumenthal JA, Babyak M, Wei J, et al. Usefulness of psychosocial treatment of mental stress-induced myocardial ischemia in men. Am J Cardiol 2002; 89: 164–8.
34 Rutledge JC, Hyson DA, Garduno D, et al. Lifestyle modification program in management of patients with coronary artery disease: the clinical experience in a tertiary care hospital. Journal of Cardiopulmonary Rehabilitation. 1999;19(4):226-234.

Key Point 2

The mind affects the way the body deals with the world – specifically with disease.  You can learn techniques that may help your mind help your body.

Mind-body medicine offers an array of strategies that support the body's natural ability to heal itself.  In addition, it can:    

  • Give you a greater sense of control over your health care
  • Improve body awareness
  • Improve quality of life
  • Help reduce your need for medication
  • Lessen both physical and emotional pain
  • Allow you to choose treatments from the widest array of proven approaches possible  

Mind-body medicine methods include biofeedback, cognitive behavioral therapy, guided imagery, hypnotherapy, meditation, meditative movement therapies such as tai chi and yoga, and other relaxation techniques.  They can be used alone or in combination.  Also, there is substantial overlap between them. For example, many guided imagery exercises begin with progressive muscle relaxation and involve deep breathing and meditation, while various forms of meditation incorporate breathing exercises and imagery.1

  • Biofeedback: Biofeedback is used to help you become aware of normally involuntary body processes and then consciously control them. These processes include heart rate, muscle tension, stomach acidity, respiration patterns or rate, blood pressure, body temperature and brain activity.  Sensors measure the physiological effects of your thoughts, emotions, attitudes, perceptions, and mental processes and feed the information back in real time.   A therapist coaches you to control the reaction.  Biofeedback can help patients relax or activate muscles, adjust blood flow and change their heart rates.  It has been successfully used to treat headaches, circulatory disorders, high blood pressure, cardiac arrhythmias, irritable bowel syndrome and nausea, insomnia, chronic pain, asthma, hot flashes, incontinence and epilepsy, and to retrain muscles after injury. 
  • Cognitive behavioral therapy:  CBT is a form of psychotherapy.  It helps you examine pessimistic and distorted thought patterns, replace them with less stress-inducing alternatives, and finally, translate those more positive thoughts into everyday behavior.  It has proven to be effective in treating depression, anxiety insomnia and pain.
  • Guided imagery.  Also called visualization, guided imagery teaches you to use your imagination to focus your mind.  It allows you to become deeply relaxed while conscious.  There are active styles of guided imagery, where the patient mentally creates the image(s), as well as more passive styles in which a guide describes the images while the patient listens.1   Proponents believe that by lowering stress, this technique can lead to improvements in blood pressure and immune system function.  When patients are able to envision potentially stressful events, such as an upcoming surgery, in positive ways they are better able to manage anxiety. 
  • Hypnotherapy:  Hypnotherapy is a combination of hypnosis and therapeutic intervention. During hypnosis, you become deeply relaxed but remain wakeful and attentive.  During this state you are highly responsive to suggestion, including behavioral change.  Hypnosis can not, however, make people act against their wills.  Some scientists believe that hypnosis can cause the brain to release natural pain killers to alleviate pain.2 Hypnotherapy has been used to counter the nausea of pregnancy and chemotherapy; to cure phobias, to help people lose weight or quit smoking.  Patients can be taught to practice self-hypnosis to reinforce new behaviors.
  • Meditation:   Meditation is used to put the body in a state of deep rest by stilling the mind.  The goal is to achieve a sense of calm, peace and emotional stability. There are two basic categories – concentration practices and mindfulness.  In the concentration type of meditation, you focus on an object or word or phrase (mantra); in the mindfulness type of meditation, you strive for awareness of your present thoughts, emotions and physical sensations.  Research has shown that the ability to concentrate attention can promote deep relaxation in the body, and that the ability to be more mindful in each situation can help break the destructive habitual reactions to stress.3    Other studies have shown that meditation:
    • Reduces the brain's reaction to pain and increases pain tolerance.  It has been shown to be helpful for chronic back pain and pain associated with fibromyalgia and rheumatoid arthritis.4
    • Strengthens the immune system by helping the body produce antibodies against illness.5   
    • May enhance memory and attention.  Parts of the brain's cerebral cortex, which tends to thin with age, tends to thicken in people who have practiced meditation about 40 minutes a day for several years.6
    • Can significantly reduce the severity of congestive heart failure.7
    • Can control high blood pressure.8

  • Meditative movement therapies:   Therapies that are based on the controlled movement of the body and conscious breathing, such as tai chi and yoga, can reduce stress and anxiety.  They help you release tension, strengthen weak muscles and stretch tight ones, and improve balance and stability.  There are many types – some gentle and some physically strenuous.  Studies have been done to determine if these therapies can help patients with conditions such as asthma, heart disease, arthritis, chronic pain, multiple sclerosis, epilepsy, diabetes, gastrointestinal disorder, etc. but results are not totally clear.  A 2004 analysis of 47 studies on tai chi uncovered reported benefits in balance and strength, cardiovascular and respiratory function, flexibility, immune system, symptoms of arthritis, muscular strength, and psychological effects.  However, the reviewers noted that limitations or biases existed in most studies, that it was difficult to draw firm conclusions about the benefits reported and more research is needed.9 
  • Other relaxation techniques:  These include techniques such as deep breathing (also referred to as conscious respiration), progressive muscle relaxation and autogenic training.
    • Deep breathing is a quick and easy stress reliever and can be done anytime, anywhere.  With it you can ease tension headaches, help lower your heart rate and blood pressure and improve symptoms from asthma or other lung problems.  It is a core component of most other relaxation techniques.   
    • Progressive muscle relaxation. With this technique you simply isolate one muscle group at a time, create tension in those muscles for a few seconds, then consciously relax them.  It is usually done by progressing from your toes to your head.  It is particularly helpful in easing muscle pain, reducing anxiety, and helping you fall asleep more easily.
    • Autogenic training. This technique consists of a series of mental exercises where you "tell" your body to relax and control breathing, blood pressure, heartbeat, and body temperature.  Practitioners believe that it works in ways that are similar to hypnosis and biofeedback. 

1 Hilary Tindle, M.D., M.P.H.;  Dealing with Chronic Pain: The Mind Body Solution.
2 Duke Integrative Medicine.
3 Duke Integrative Medicine. Commonly Asked Questions About Meditation & Stress Reduction
4 Los Angeles Times, Doctor's orders: Cross your legs and say ‘Om';  Andrea R. Vaucher, October 29, 2007.
5 Psychosomatic Medicine; Alterations in brain and immune function produced by mindfulness meditation. 2003 Jul-Aug;65(4):564-70.
6 Jeremy Gray, et.al., NeuroReport 16: 1893-1897; November 28, 2005.
7 University of Pennsylvania School of Medicine; Penn Study Shows Transcendental Meditation Can Help Combat Congestive Heart Failure; Press Release, March 12, 2007.
8 University of Kentucky,Meditation Impacts Blood Pressure, Study Shows, Press release, March 14, 2008. 
9 Chenchen Wang, MD, MSc; Jean Paul Collet, MD, PhD; Joseph Lau, MD; The Effect of Tai Chi on Health Outcomes in Patients With Chronic Conditions A Systematic Review; Arch Intern Med. 2004;164:493-501.

Medline Plus

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Conduct an off-site search for Mind-Body Medicine information from MedlinePlus.  These up-to-date search results are based on search terms specific to Second Opinion Key Points.

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