Thursday, August 21, 2008

The Relaxation Response (RR)

There are non-drug therapies that have been documented to be at least as effective as drugs in the treatment of mental disorders, as well as physical disorders. One is the relaxation response (RR).

Studies have shown that employment of the RR on a regular basis can alleviate symptoms of anxiety, depression, and posttraumatic stress disorder. The RR has been shown to reduce blood pressure and heart rate, reduce insomnia, alter metabolic processes (how much oxygen we consume, the movement of molecules into and out of cells, the rate of mitochondrial respiration, formulation of the energy-storing molecule ATP, etc.) reduce inflammation (by reducing oxidative stress, for one) (omega-3/omega-6 ratio isn't the only way to reduce inflammation), increase immunity (by increasing levels of cytokines and related molecules, for one), reduce pain ... so much more.

Even if it IS genes that are the primary determinant of our mental and physical health, the RR may be able to change what our body does with those genes, that is, change how those genes get expressed.

In a study published last month, researchers from Harvard provided some of the best evidence of that to date. 1

They compared gene expression in 19 long-term practitioners of daily RR practice to 19 people who had never engaged in such practices.

They found that employment of the relaxation response changed the expression of over 2200 genes in the RR group compared to the control group (P<0.05. Statistically, the difference in gene expression was not due to chance.) - upregulating some, downregulating others.

In case there was something about the RR group that was different enough from the control group to obscure results, the researchers gave all participants in the control group 8 weeks of RR training - then measured their gene expression. Even in these short-term practitioners, 1561 genes were expressed differently after engaging in an RR practice than before, with significant overlap to genes that were expressed differently in the long-term practitioners.

The genes in question (which were targeted more often than would be expected by random distribution) are known to be involved in:
  • Inflammatory processes
  • Metabolism (oxidative phosphorylation, the production and neutralization of free radicals)
  • Programmed cell death (also known as apoptosis - cancer growth is naturally limited by apoptosis or cell death)
  • Immunity (antigen processing, autoimmune disorders)
  • Stress response - both within a cell and among cells
The growing body of evidence that practices such as meditation, biofeedback, progressive muscle relaxation, etc., can profoundly impact physiology puts into question (at least in my mind) findings of previous studies, primarily epidemiological studies, that sought to account for confounders via statistical adjustment. It's easier to adjust for variables such as age, body mass index (BMI), smoking, even exercise, which can be measured. It's more difficult to adjust for a confounder such as body changes elicited by an RR.

For example:
  • Was it intake of omega-3 fatty acids that resulted in reduced inflammation? Or was it regular employment of the RR?

  • Was it the intake of an SSRI that ameliorated depression? Or was it initiation of a meditation practice? A move to a less stressful job or location? The resolution of an interpersonal conflict?

  • In Dr. Dean Ornish's studies, was it consumption of a low-fat, vegetarian diet that reversed heart disease (a disease of inflammation)? Or was it the incorporation of his required, integrated, daily stress-management techniques?

How To Generate The Relaxation Response

I've been exposed to a number of approaches over the years that can elicit the relaxation response. How effective one method is over another depends on the person - it's a very individual match-up.

They include (but are not limited to):
  • Breathing exercises*
  • Progressive muscle relaxation (e.g. body scan)
  • Various forms of meditation*
  • Repetitive prayer*
  • Mantra*
  • Mindfulness*
  • Various forms of yoga*
  • Tai chi
  • Qi Gong
  • Guided imagery
  • Biofeedback
* Noted as used by the long-term practitioners in this study.

The 8-week training in this study involved:
  • Information about reducing daily stress
  • Educational overview of the stress response (SR), and the relaxation response (RR)
  • Instruction on how to elicit the RR
  • Individual RR-training sessions from an experienced clinician*
  • Listening to a 20-minute RR-eliciting CD daily
  • Weekly meetings with clinician to review progress, assess daily RR practice, fine-tune RR
* The session included: "diaphragmatic breathing, body scan, as well as mantra and mindfulness meditation, while subjects passively ignored intrusive thoughts."
1 Genomic Counter-Stress Changes Induced by the Relaxation Response, Public Library Of Science, July 2008

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