LA PROMOZIONE DELLA SALUTE NELLE SCUOLE: IL PROGETTO HEARTBEAT - Prevenzione della morte improvvisa nei giovani attraverso indagini ...

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

Stress e medicina integrata

               Roma, 28 aprile 2016

                    Andrea Geraci

                  Dipartimento del Farmaco
       Reparto Sostanze Naturali, Medicine Tradizionali
              Istituto Superiore di Sanità, Roma

Terapie/Medicine
          Tradizionali/Complementari/non Convenzionali
                        Medicina Integrata

                   Definizione
Traditional medicine (TM) refers to “somma
 di conoscenze, abilità e pratiche basate su
 teorie, credenze ed esperienze appartenenti a
 differenti culture, usate per il mantenimento
 della salute, come pure per la prevenzione, la
 diagnosi e la cura di malattie fisiche o
 mentali. (WHO, 2000)

Riferimenti internazionali

                        NCCIH
                     National Center for
              Complementary and Integrative Health

                   National Institutes of Health

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

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 una
    persona.
•   Il chiropratico osserva una tendenza alla dislocazione vertebrale (squilibrio psico-fisico
    in generale).
•   L’agopuntore fa diagnosi di stasi di “chi/qi” (energia vitale) di fegato, per rabbia
    repressa.
•   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 paziente
a trovare la causa originaria del sintomo,
indirizzandolo anche verso lo psicoterapeuta

Il paziente “vedrà” il muro genitori/figli, la crisi di
coppia, la rabbia repressa nei confronti del superiore,
vecchi nodi emozionali ecc.  che bloccano il fluire
della 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

Life Skill

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

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 che
spesso 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 rappresentazione
   della vita interiore attraverso movimenti, gesti, comportamenti che tendono a rendere manifesti
   problematiche 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.

INTERVENTI SULLA CONNESSIONE MENTE-CORPO

              YOGA

Yoga
• Rilassamento, esercizi di respirazione, posture particolari, ripetizione di
  mantra. È parte integrante della Medicina Ayurvedica. Termine sanscrito che
  significa legame e sottintende un’unione della componente fisica, psichica e
  spirituale 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 valido
   aiuto 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
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)

Yoga e ricerca al NCCIH
• 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
                           http://nccih.nih.gov/health/yoga

Meditazione

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

• Nell’antichità la meditazione era un’attività
  terapeutica, 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 that
  9.4 percent of respondents (representing more than 20 million people) had used meditation in the past
  12 months — compared with 7.6 percent of respondents (representing more than 15 million people) in a
  similar survey conducted in 2002. The 2007 survey also asked about CAM use in a sample of 9,417
  children; 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 Research
                              http://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 situations
Building skills to manage your stress
Increasing self-awareness
Focusing on the present
Reducing negative emotions
                                               Meditation and illness
                                        Meditation may help such conditions as:
Allergies
Anxiety disorders
Asthma
Binge eating
Cancer
Depression
Fatigue
Heart disease
High blood pressure
Pain
Sleep problems
Substance 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
Many antihypertensive medications and lifestyle changes are proven to reduce blood pressure. Over the past few decades, numerous additional modalities have been evaluated
in regard to their potential blood pressure-lowering abilities. However, these nondietary, nondrug treatments, collectively called alternative approaches, have generally undergone
fewer and less rigorous trials. This American Heart Association scientific statement aims to summarize the blood pressure-lowering efficacy of several alternative approaches and
to provide a class of recommendation for their implementation in clinical practice based on the available level of evidence from the published literature. Among behavioral
therapies, Transcendental Meditation (Class IIB, Level of Evidence B), other meditation techniques (Class III, Level of Evidence C), yoga (Class III, Level of Evidence C), other
relaxation therapies (Class III, Level of Evidence B), and biofeedback approaches (Class IIB, Level of Evidence B) generally had modest, mixed, or no consistent evidence
demonstrating their efficacy. Between the noninvasive procedures and devices evaluated, device-guided breathing (Class IIA, Level of Evidence B) had greater support than
acupuncture (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), and
isometric 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 all
individuals 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 of
evidence for blood pressure lowering, risk-to-benefit ratio, potential ancillary health benefits, and practicality in a real-world setting. Finally, recommendations for future
research priorities are outlined.

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

                 Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, Fuchs FD, Hughes JW, Lackland
                     DT, 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.

Meditazione
Si dimostra che la meditazione determina delle modificazioni anatomico
funzionali in sede cerebrale, in particolare nella corteccia, nell’area pre-frontale,
nel giro cingolato, poi a livello della sostanza bianca, sul sistema limbico, sul
sistema nervoso autonomo. Sono poi riscontrati variazioni del valore di alcuni
neurotrasmettitori, citochine, ormoni, endorfine ecc.
Jindal V, Gupta S, Das R. Molecular Mechanisms of Meditation. Mol Neurobiol. 2013 Jun 5
Cytokines
Cytokines are the immunomodulators and controller of the defense system of our body. There levels are definitely
affected 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.

Neuroendocrinology
One possible mechanism is that this meditation could influence neurotransmitter control of hypothalamic peptide release and therefore alter pituitary hormone secretion through increased
secretion of inhibitory hypothalamic factors, such as somatostatin or dopamine, or decreased secretion of stimulatory factors, such as thyrotropin-releasing hormone or growth hormone
releasing factor. As age advances, the thyroidstimulating hormone (TSH) level gradually increase in the body with no presentation of hypothyroidism; it is a physiological phenomena most
likely 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 with
aging, 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 during
meditation; 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, the
paragigantocellular nucleus of medulla decreases innervations of locus ceruleus which itself produces and distributes norepinephrine (NE). This reduction in NE reduces stimulation of
hypothalamic paraventricular nucleus, in turn decreases corticotrophin-releasing hormone which would ultimately decrease cortisol level. Beta endorphin is an endogenous opioid peptide
neurotransmitter; 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 calmness
with increased tolerance.

MEDITAZIONE

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. The
   increasing 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 undergoing
   outpatient 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. Of
   these, 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 symptoms
   were 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 majority
   of 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 an
   integrative 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 physical
   fitness, 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 rate
   and 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 lavoro
  conferma questo nelle malattie cardiovascolari.
In particolare lo yoga, il Qigong, alcuni tipi di meditazione e/o tecniche di
  rilassamento migliorano l’ipertensione, la frequenza cardiaca, la frequenza
  respiratoria, e in generale migliora la sopravvivenza

MEDITAZIONE
 A 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 MBSR
 program 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, as
 well 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 in
 the 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 breast
 cancer 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 exhibited
 continued 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-MBSR
 group. 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 beneficial
 effects 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 della
 cell NK cell activity (NKCA) della produzione di IFN-ɣ e aumento della
 produzione di IL-4, IL-6, and IL-10 e cortisolo plasmatico, riportando un
 normale livello delle citochine. Poi si conferma una migliore QoL, un
 migliore 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 ea
rly stage breast cancer. Brain Behav Immun. 2008 Aug;22(6):969-81. doi: 10.1016/j.bbi.2008.01.012. Epub 2008 Mar 21.

MEDITAZIONE
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 Breast
  Cancer 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 breast
   cancer patients would benefit most from mindfulness-based stress reduction (MBSR)-facilitated stress relief. The purpose of this study was to assess whether baseline biomarker
   levels predicted symptom improvement following an MBSR intervention for breast cancer survivors (MBSR[BC]). This randomized controlled trial involved 41 patients assigned to
   either 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 included
   common 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. Spearman
   correlations were used to identify univariate relationships between baseline biomarkers and 6-week improvement of symptoms. Next, backward elimination regression models were
   used to identify the strongest predictors from the univariate analyses. Multiple baseline biomarkers were significantly positively related to 6-week symptom improvement. The
   regression models identified B-lymphocytes and interferon-γ as the strongest predictors of gastrointestinal improvement (p < .01), +CD4+CD8 as the strongest predictor of
   cognitive/psychological (CP) improvement (p = .02), and lymphocytes and interleukin (IL)-4 as the strongest predictors of fatigue improvement (p < .01). These results provide
   preliminary 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 del
 programma mindfulness-based stress reduction su alcuni biomarkers: B-
 lymphocytes e interferon-γ come predictors di miglioramento
 gastrointestinale. +CD4+CD8 predictor di miglioramento cognitivo/psicologico
 e linfociti e interleukin (IL)-4 come i migliori predictors di miglioramento della
 fatigue.

MEDITAZIONE
Marchand WR. Neural mechanisms of mindfulness and meditation: Evidence from
 neuroimaging 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 being
  increasingly 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 neuroimaging
  studies are beginning to provide insights into neural processes associated with the practice of mindfulness. A review of this literature revealed
  compelling evidence that mindfulness impacts the function of the medial cortex and associated default mode network as well as insula and
  amygdala. Additionally, mindfulness practice appears to effect lateral frontal regions and basal ganglia, at least in some cases. Structural
  imaging 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 with
  mindfulness.

Concetto Chiave: correlazione tra pratica di mindfulness e variazioni
 anatomo-funzionali del SNC (corteccia, insula, amigdala) attestati da
 studi di neuroimaging.

MEDITAZIONE

Wells RE1, Burch R, Paulsen RH, Wayne PM, Houle TT, Loder E. Meditation for Migraines: A Pilot
 Randomized 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 adults
  with 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 statistically
  significant changes in migraine frequency or severity, secondary outcomes demonstrated this intervention had a beneficial effect on headache
  duration, disability, self-efficacy, and mindfulness. Future studies with larger sample sizes are warranted to further evaluate this intervention for
  adults with migraines. This study was prospectively registered (ClinicalTrials.gov identifier NCT01545466).

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

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 ora
Da “La medicina integrata nel paziente oncologico”, a cura di Simonetta Marucci. Cap. IX. Bianca Pescatori. Associazione Avulls onlus. Novembre 2013.

MEDITAZIONE

                         Utilizzata sempre più spesso negli hospice

                               Gestione del dolore fisico e psichico

                                            MEDICINA INTEGRATA

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

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 the
  interplay of mind, brain, other body systems, and behavior.
                                               Goal 4
• Explore commonalities and physiological correlates of personal characteristics, such as
  spirituality, resilience, altruism, and forgiveness that are associated with enhanced health
  and the amelioration of disease processes.

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

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

Pubmed 20 aprile 2016

     Forgiveness  764

Forgiveness and health  297

Forgiveness
Sanchez-Gonzalez MA1, May RW, Koutnik AP, Fincham FD. Impact of negative
 affectivity and trait forgiveness on aortic blood pressure and coronary
 circulation. Psychophysiology. 2014 Sep 5.
Results indicate that NA significantly predicts ABP and decreased SVI. Conversely, forgiveness seems to provide cardioprotection by evoking
  decreased ABP while improving SVI.

Farrow TF1, Zheng Y, Wilkinson ID, Spence SA, Deakin JF, Tarrier N, Griffiths
 PD, Woodruff PW. Investigating the functional anatomy of empathy and
 forgiveness. 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) is
   mediated by medial prefrontal cortex. Little is known about the anatomy of empathy and forgiveness. We used functional MRI to detect
   brain regions engaged by judging others' emotional states and the forgivability of their crimes. Ten volunteers read and made judgements
   based on social scenarios and a high level baseline task (social reasoning). Both empathic and forgivability judgements activated left superior
   frontal gyrus, orbitofrontal gyrus and precuneus. Empathic judgements also activated left anterior middle temporal and left inferior frontal
   gyri, while forgivability judgements activated posterior cingulate gyrus. Empathic and forgivability judgements activate specific regions of the
   human brain, which we propose contribute to social cohesion.

Forgiveness
Ferrell B, Otis-Green S, Baird RP, Garcia A. Nurses' responses to requests for
 forgiveness 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 regarding
  how best to address these concerns.

                                                                                ***

Toussaint L, Shields GS, Dorn G, Slavich GM. Effects of lifetime stress exposure on
mental and physical health in young adulthood: How stress degrades and
forgiveness 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 were
assessed in 148 young adults. Greater lifetime stress severity and lower levels of forgiveness each uniquely predicted worse mental and physical health. Analyses
also revealed a graded Stress × Forgiveness interaction effect, wherein associations between stress and mental health were weaker for persons exhibiting more
forgiveness.
These data are the first to elucidate the interactive effects of cumulative stress severity and forgiveness on health, and suggest that developing a more forgiving
coping 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.

7° Livello
                                                                                     curare il
Consigli da antiche                                                                rapporto col
                                                                                  trascendente
tradizioni mediche                                                  6° Livello
                                                                    curare la
                                                                   spiritualità
                                                     5° Livello
                                                      curare i
                                                    rapporti col
                                                      passato
                                       4° Livello
                                       curare la
                                        mente
                          3° Livello
                          curare le
                          emozioni
             2° Livello
             curare la
              vitalità
1° Livello
curare il
                                                    Ascoltiamo i consigli
  fisico                                            che «ci risuonano»

Medicina Integrata e salute
Dalla medicina tradizionale cinese, tibetana o ayurvedica, dagli insegnamenti di
 Ildegarda 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 cuce
 addosso: 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 mondo
     senza pregiudizi (Empatia).
2.   Retto giudizio, giusto proposito, giusta risoluzione Prendere una decisione dopo matura e seria riflessione (Senso
     critico, Gestione dello stress).
3.   Retta parola Parlare di ciò che ha senso e importanza, dire la verità, evitare chiacchiere inutili, dire cose che non
     producano 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 suoi
     frutti, 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 con
     mezzi che non possano arrecare danno o sofferenza agli altri (Senso critico, Capacità di risolvere problemi, Gestione dello
     stress).
6.   Retto sforzo  Condurre la propria vita e attività in modo logico, artistico e morale. Lasciare andare gli stati non salutari
     e coltivare quelli salutari (Capacità di risolvere problemi, Creatività)
7.   Retta presenza mentale, giusta memoria  Capacità di mantenere la mente priva di confusione, non influenzata dalla
     brama e dall'attaccamento (Senso critico, Autocoscienza).
8.   Retta concentrazione, giusta meditazione  Capacità di mantenere il corretto atteggiamento interiore che porta alla
     corretta padronanza di sé stessi durante la pratica della meditazione (Senso critico, Capacità di risolvere problemi,
     Gestione dello stress, Gestione delle emozioni)

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

                        Esistono
approcci, pensieri, atteggiamenti, modi di vivere e di
                      relazionarsi
 che fanno stare bene in salute e aiutano a guarire

Life Skills in età precoce =

la migliore medicina preventiva