Our mind/body program for HIV/AIDS uses a behavioral medicine model for health care providers who work with HIV and AIDS patients. The program was developed at Beth Israel Deaconess Medical Center/Harvard Medical School in Boston. Our research has shown that there is a link between stress and anxiety and diminished immune functioning, which can be understood from the model below:

Stress

increases anxiety, depression, isolation, loneliness

Increases stress hormones
(norepinephrine, epinephrine and cortisol)

decreases CD4/CD8 ratio
Decreases natural killer cells

increases disease progress and opportunistic infections

Our program deals with the unique psychological, social, behavioral and physical complexities of HIV disease, the stressors associated with health maintenance and compliance with treatment, as well as the overwhelming need to maintain hope. We teach a combination of relaxation techniques, cognitive restructuring, yoga exercise, nutrition, and training in interpersonal skills that enable people to continue to lead meaningful lives. Described below are the components of our ten-week program, and examples illustrating the variety of changes that have occurred in participants.

Mind/Body Connections

The first session presents a mind/body model, meaning that health is considered to be the result of complex interactions between physical symptoms, attitudes, and behaviors. Participants are taught to recognize the physical, emotional, cognitive, behavioral and spiritual warning signs of stress. Research from psychoneuroimmunology, which has demonstrated a link between stress and diminished immune functioning (and thus, possibly, a link with opportunistic infection and the speed of disease progression), is reviewed. Also presented are the characteristics of long-term survivors of AIDS.

The Relaxation Response

This program teaches various techniques that elicit the Relaxation Response, a psychological state of deep rest that is the opposite of a stress response. Several of these techniques - such as meditation, progressive muscle relaxation, and visualization - are described. Participants practice a relaxation technique at each session. They are provided wit an audio tape and are expected to listen to it daily. With practice, participants' physical and emotional symptoms improve, we see decreased anxiety headaches, neuropathy pain, and nausea, for example, and improved sleep and appetite.

For a list of available tapes, please visit our website at http://mindbody.harvard.edu/ordering.htm.

We also teach "mini's", which are short relaxation techniques that you can do without a tape.

Creating Passion in Your Life

Because a diagnosis of HIV disease can lead to a serious reappraisal of one's life and of what gives it meaning, coping well requires looking at one's goals and commitments, then setting clear priorities and pursuing them. This keeps you focused on the future and helps you develop resistance to the stressors associated with HIV disease. We guide participants through an experimental exercise in clarifying commitments and creating passion in their lives. We ask people to focus on eight areas of their lives, and ask themselves what they want in each category.

Yoga Exercise

Body awareness and stretching exercises are important tools for influencing health and well-being. Many people with HIV disease experience loss of energy and fatigue; for them, simple yoga exercises provide a safe and easy way to stretch the muscles and maintain flexibility. Several yoga exercises practiced in the program increase lung capacity, massage gastrointestinal organs, and reduce pain by releasing tension.

How Thoughts Can Affect Your Health

Behavioral Medicine recognizes the interaction between mind and body and the fact that stress affects us physically, emotionally, cognitively, and in terms of our behaviors. And our thoughts, beliefs and attitudes about a stressful situation affect us in many ways.

In our program, we teach cognitive restructuring, a technique that enables you to see that your stress does not always come from an outside event or situation - it may have very much to do with how you perceive or think about the situation. While people may be unable to alter the stressful event, they can change their perception of that stress, and their thoughts and attitudes about it. We learn to recognize our negative thoughts and how they have become distorted or illogical, then to challenge those negative thoughts and replace them with more positive statements. For more information on this technique, refer to The Wellness Book, Chapter 11 (Simon & Schuster, 1992).

The Importance of Nutrition

Nutrition is playing an increasingly important role in the maintenance of good health in people with HIV disease. It is crucial for patients to keep weight up, as severe weight loss and muscle wasting are common and lead to an increase in dangerous symptoms. It is also vital for people with AIDS to be aware of potentially risky foods.

Dealing With Emotions

The program presents the work of James Pennebaker, Ph.D., a psychologist in texas who has conducted research to determine the extent to which it is health to express powerful emotions that we have stored away. Inhibited emotional expression results in chronic stress and increases health problems. Pennebaker has found that writing about traumatic events in ones life can have a beneficial impact on the immune system and on physical and emotional health. Our journal writing exercise based on this research is taught.

Spirituality and Health

A life-threatening illness raises existential issues, often for the first time. Universal questions about the meaning and purpose of life, a sense of spirituality, and a belief in a higher power become increasingly important. A person who has no purpose in life can endure very little. He or she can experience a great deal of psychological stress and thus become susceptible to stress-related illnesses or suffer a diminished ability to recover. The program asks three questions: What is Hope? Where do we find Hope? How do we know when we have Hope? You can ask yourself these questions and do some writing about the. There is enormous HOPE now for people with HIV, and we need to focus on that.

Copyright (c) 1996 Ann Webster, Ph.D., Director, The Mind-Body Medical Clinic for HIV-Positive and AIDS Related Disorders, offered by The Division of Behavioral Medicine, Beth Israel/Deaconess Medical Center, 110 Francis Street, Ste 1A, Boston, MA 02215. For further information, please call (617) 632-7373. Visit our website at http://mindbody.harvard.edu/.