December 2009 Newsletter
A Newsletter for Complementary Treatments

Complementary treatments can be integrated with conventional medical practices to offer patients the best of both worlds. As clinician/researchers we seek new approaches to relieve emotional and physical problems while reducing medication side effects.The goal of this newsletter is to share with you Integrative Treatments we find to be safe and beneficial. We welcome your comments and contributions.


Missing Key: Metabolic Syndrome, Type 2 Diabetes, Cardiovascular Risks

In all that is being written about reducing the risks factors related to insulin resistance, metabolic syndrome, Type 2 Diabetes, and cardiovascular disease, the role of Mind-Body Practices and the Parasympathetic Nervous system have been overlooked by many investigators and health experts, with a few important exceptions.

Kim Innes reviewed 70 studies on possible protective effects of yoga and found evidence to suggest that yoga may reduce many risk factors for Insulin Resistance Syndrome (IRS) and Cardiovascular Disease (CD) (J Am Board Fam Pract 2005; 18:491-519). She noted that, “increased sympathetic activity, enhanced cardiovascular reactivity, and reduced parasympathetic tone have been strongly implicated in the pathogenesis of IRS.” Furthermore, stress and negative emotions are associated with the development of insulin resistance, glucose intolerance, high blood pressure, and elevated serum lipid levels. She also reviewed 25 studies of adults with Type 2 Diabetes suggesting beneficial changes in risk indices, including glucose tolerance, insulin sensitivity, lipid profiles, blood pressure, oxidative stress, coagulation profiles, sympathetic activation, pulmonary function, and clinical outcomes (Advance Access Publication 11 December 2006 eCAM 2007;4(4)469–486). Due to limitations in the size and methodology of many of these studies, additional high-quality RCTs are needed to confirm the benefits of yoga programs for reducing risk factors.

It is widely recognized that stress contributes to weight gain and increases the risks for metabolic syndrome and diabetes. Many of us tend to eat more when we feel stressed, tired, lonely, or depressed and we tend to escape by sitting with a TV or computer when we could be exercising. While these effects of stress on health behaviors are obvious, there are also other effects of stress on our nervous systems that are more subtle, but powerful.

Follow the link, “Integrative Psychiatry Mental Health and CAM,” from our homepage to our discussion, “How Breathing Balances the Stress Response System.” In brief, an important part of the stress response system is the autonomic nervous system consisting of two branches. The sympathetic branch turns on quickly whenever we feel threatened. It increases the heart rate, respiratory rate, and metabolic rate preparing for fight or flight. When the threat has passed, the sympathetic system is supposed to quiet down while the parasympathetic system is activated to slow down the heart and respiratory rates, repair cellular damage, calm the mind, and replenish energy supplies. However, for many people, chronic stress keeps the sympathetic system in overdrive such that it is very hard to turn off. At the same time, the parasympathetic system tends to be under active. Consequently, the system stays out of balance leading to exhaustion of energy supplies, cumulative cellular damage, inflammation, anxiety, illness, depression, and increased risk factors for insulin resistance, obesity, and cardiovascular disease.

The autonomic nervous system carries messages back and forth between the body and the brain so that the brain is constantly informed about the ever changing internal state of the body. The vagus nerves are the main parasympathetic pathways carrying information about gut sensations, digestion, organ functions, air hunger, pain, temperature, and respiratory functions. These body perceptions are called interoceptions.

The vagus nerves play a crucial role in all aspects of hunger, eating, satiety, digestion, insulin release, and glucose metabolism. When your stomach grumbles and aches for food, those sensations are carried to the brain via the vagus nerves. When you put food in your mouth, chew, swallow, and distend your stomach with a meal, the vagus nerve carries all of that interoceptive information to parts of the brain involved in hunger, satiety, pleasure, decision making, and food-seeking behavior initiation. In response, the brain sends messages back down the vagus nerve to the body to direct the release of digestive enzymes and the activation of stomach and intestinal motility. Beyond the mechanics of digestion, the vagus nerve has branches directly into the pancreas where it regulates the release of insulin and blood sugar levels, as well as affecting the tissue metabolism of glucose and fat.

When we are under stress and the sympathetic part of the nervous system is overactive, insulin release is shut down. Conversely, increased activation of the parasympathetic system enhances insulin release, improves glucose metabolism, and maintains normal blood sugar levels. How can we subdue the sympathetic stress reactions and boost the parasympathetic influence?

This is where mind-body practices can be helpful. Gentle stretching, certain breath practices, and meditation all can potentially strengthen the parasympathetic, soothing, recharging part of the nervous system. For most people, breath practices are the most rapidly effective method to balance the activity of the sympathetic and parasympathetic systems.

All of the functions affected by the autonomic system occur automatically: heart rate, blood flow distribution, blood pressure, breathing, digestions, glandular functions, reactions of the immune system. There is only one that can be controlled either voluntarily or involuntarily: breathing.

The lungs, airways, throat, chest wall, and diaphragm contain thousands of receptors (pressure, stretch, chemical) sending thousands of messages about your breathing through the vagus nerve. These messages travel through pathways leading to the emotion processing centers (limbic system, amygdala, hippocampus), hormone regulation centers (hypothalamus), and processing centers for perceptions and thoughts throughout the cortex (via the thalamus). Through these routes, breathing patterns exert a strong influence on how we think, feel, react, and perceive ourselves and others. By voluntarily changing the pattern of the breath, we can change the messages the body is sending to the brain and thereby change the way we think, feel, and react.

Skillful control of breath patterns can be used to calm the emotions, eliminate anxiety, stop obsessive worry, reduce stress over-reactivity, and induce greater mental clarity and focus. There are many forms of breathing derived from Yoga, QiGong, Buddhism, Christianity, Judaism, Zen, American Indians, martial arts, and other traditions. One of the simplest methods is to slow the breath rate down to between 5 and 6 breaths per minute using a CD chime track or other biofeedback device. This is best done lying down with eyes closed, breathing through the nose, focusing the mind on the breath itself. Start with 10 minutes twice a day and gradually increasing to 20 minutes if possible. In most traditions, a combination of practices is considered to be most effective starting with movement, followed by breath practices and ending with meditation and rest.

Mind-body practices to balance the stress response system may one of the keys to reducing risk factors for insulin resistance, metabolic syndrome, Type 2 Diabetes, and cardiovascular disease. In addition, the mental calmness that can be attained can be used as part of a therapeutic or self-healing program to relieve feelings of anxiety, depression, and loneliness that can lead to overeating and other adverse health behaviors.


Current Projects & Workshops

Serving Those Who Serve (STWS) is a non-profit group providing services to people who are still suffering from physical and emotional illnesses related to the NY September 11th World Trade Center Attacks. The 9/11 Community includes First Responders, Ground Zero workers, WTC workers, and area residents. STWS sponsors our new Breath~Body~Mind© program for relief of physical and emotional distress as well as for personal development. Workshops are open to the public and a portion of the profits are donated to STWS. In addition to positive feedback from participants, our preliminary research data indicate significant improvement in measures of anxiety, depression and post-traumatic stress symptoms (Martin Katzman and Monica Vermani, in process). See www.stws.org.

Breath~Body~Mind© Courses with Dr. Richard Brown

Dr. Brown teaches a fusion of modern and ancient practices to rapidly balance the stress response system, relieve stress and anxiety, and enhance physical and mental health. Training includes QiGong breathing and movement, Christian monk breath moving techniques, Coherent Breathing, and Open Focus Meditation. Proceeds from these courses will be used to benefit the 9/11 Community.

Manhattan, NY. Save the Dates: May 1 and May 2

Location and details to be announced. This will be the first Breath~Body~Mind Workshop open to the public, health practitioners, and members of the 9/11 community to be given in NYC in 2010. Proceeds will benefit Serving Those Who Serve. Watch for registration information in April at www.stws.org.


Professional Lectures and Conferences

Integrative Healthcare Symposium
February 25, 2010 at the Hilton New York
9:00 – 10:30 am Plenary Session Brain and Mind Health: Roberta Lee, MD (mod), David Perlmutter, MD, Richard Brown, MD, Jay Lombard, DO
4:30 – 5:45 pm Richard P Brown, MD CAM Practice Movement and Breathing
Information & Registration: http://www.ihsymposium.com/


March 6 2010, Anxiety Disorders Association of America
Baltimore Marriott Waterfront, Baltimore, MD.

Session #150 Title: Breath-Body-Mind Practices for Treatment of Anxiety Disorders
Richard Brown, Patricia Gerbarg, Martin Katzman, Monica Vermani
3/6/2010 10:30:00 AM - 12:00:00 PM

Integrative treatments are needed to improve outcomes for anxiety disorders and to reduce the burden of medication side effects. By combining specific mind-body practices with standard treatments (psychotherapy, CBT, and medication) it is possible to obtain more rapid and more complete resolution of symptoms. Mental health practitioners are subject to caregiver stress and burn-out. Mind-body practices can help protect caregivers from the effects of professional stress. The goals of this symposium are to present the theoretical background, research evidence, and clinical applications of powerful self-regulation strategies to enable participants to improve their own well-being and the mental health of patients suffering from anxiety disorders including Generalized Anxiety Disorder and Post Traumatic Stress Disorder due to childhood abuse, military service, and mass disasters. How to build upon this knowledge and use it in clinical practice will be discussed.

Session# 195 Experiential Training in Breath-Body-Mind Practices for Stress Reduction
Richard Brown, Patricia Gerbarg
3/6/2010 4:00:00 PM - 5:30:00 PM
Information & Registration: www.adaa.org


March 17-19, 2010 Integrative College of Medicine


March 26-27 Psychotherapy Networker Symposium: The Power of the Breath Neurophysiological Tools for Self-Regulation
Washington, DC
All-Day Workshop: Breath-Body-Mind Practices for Caregivers and Clients to Enhance Empathy and Relieve Stress, Anxiety, and PTSD
Richard Brown MD and Patricia Gerbarg MD

There may be no clinical strategy as simple, effective, and useful as teaching clients soothing and healing breathing techniques. In fact, there’s now a large body of research demonstrating that a few easily learned breathing practices have powerful self-regulating effects that often quickly alleviate the symptoms of stress, insomnia, pain syndromes, anxiety disorders, and treatment-resistant PTSD without medication. In this workshop, we’ll review the neurophysiological research demonstrating the effectiveness of breathing techniques and their impact on cardiopulmonary function and the parasympathetic nervous system. You’ll learn a range of experiential breath-body-mind techniques, including “coherent” or “slowing down” breathing, Breath Moving, “ocean breathing”—a Yoga-based practice—and Open-Focus meditation. We’ll then explore a variety of strategies for integrating these tools into work with anxious and traumatized clients.

Information & Registration: www.psychotherapynetworker.org


April 16 Ackerman Institute, New York
Richard Brown, MD


May 7, 2010 Neuropsychoanalytic Study Group, New York
1:45-3:00 pm Neuro-psychoanalysis and Yoga for Treatment of PTSD
Patricia Gerbarg, MD


May 22-235, 2010 American Psychiatric Association Annual Meeting
New Orleans

Full Day Course #CO07 Saturday, May 22 9am-4pm: Complementary and Integrative Treatments for Stress, Depression, Anxiety PTSD, Mass Trauma, Cognitive Function, ADD, and Schizophrenia

Participants will learn how to integrate complementary treatments with standard treatments in psychiatry practice. The course focuses on research and clinical applications of complementary treatments for which there is sufficient evidence of safety and efficacy. The authors have selected those treatments that are the most useful for clinicians to integrate into their practices from the following categories: herbs, adaptogens, nutrients, nootropics, hormones, mind-body practices, cranial electrotherapy stimulation, and neurotherapy. Evidence for efficacy and clinical practice guidelines for integrative approaches will include the following diagnostic categories: Anxiety Disorders, PTSD, Depression, Bipolar Disorder, Cognitive Enhancement, Brain Injury, ADD, and Schizophrenia.Participants will have an introduction to the experience breath techniques that rapidly relieve stress and anxiety.

Full Day Course #CO28 Sunday, May 23 2010, 9am-4pm: Yoga of the East and West: Integrating Breath Work and Meditation into Clinical Practice: Participants will learn the theoretical background and applications of two powerful self-regulation strategies to improve their own well-being and the mental health of their patients. A program of non-religious practices will enable participants to experience “Coherent Breathing,” Victorious Breath, Bellows Breath, and “Open Focus” meditation. Through a sequence of repeated rounds of breathing and meditation with gentle movements and interactive processes, participants will discover the benefits of mind/body practices. How to build upon this knowledge and use it in clinical practice will be discussed. An in-depth case of a patient with posttraumatic stress disorder who benefited from the addition of yoga breathing to her ongoing therapy will be explored from the perspective of neuro-psychoanalytic theory. This will also highlight clinical issues to consider when introducing mind/body practices in treatment. This course builds upon introductory material presented in the Course “Complementary and Integrative Treatments for Stress, Anxiety, Post-traumatic Stress Disorder, Depression, Bipolar, Cognitive Enhancement, Brain Injury, Attention Deficit Disorder, and Schizophrenia.” This course is suitable for novices as well as experienced practitioners.


Publications & Reviews

Effects of a Yoga-Breath Intervention Alone and in Combination with an Exposure Therapy for PTSD and Depression in Survivors of the 2004 Southeast Asia Tsunami.

Descilo T, Vedamurtachar A, Gerbarg PL, Nagaraja D, Gangadhar BNG, Damodaran B, Adelson B, Braslow LH, Marcus M, Brown RP. Acta Psyciatr Scand 2009 [in press].

Richard P Brown and Patricia L Gerbarg. Part I. Longevity and Aging Advancements. Yoga Breathing, Meditation, and Longevity. Annals of the New York Academy of Sciences. 2009, 1172:54-62.

"Yoga for Anxiety and Depression" Harvard Mental Health Letter April 2009 https://www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter/2009/April/Yoga-for-anxiety-and-depression

Review of How to Use Herbs, Nutrients, and Yoga in Mental Health Care, by Cathy Durga, LA Yoga magazine, June 2009.


About the Authors

Richard P. Brown, MD, Associate Professor in Clinical Psychiatry, Columbia University Medical Center, NY is a psychopharmacologist and a certified teacher of Aikido (4th Dan), Yoga, Qi Gong, and meditation.

Patricia L. Gerbarg, MD, Assistant Professor in Clinical Psychiatry, New York Medical College, has a clinical practice in psychiatry and provides consultation for research on mind-body practices.