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Qigong in mental healthcare Colorado Integrative Medicine Conference July, 2009 James Lake M.D. www.IntegrativeMentalHealth.net.

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Presentation on theme: "Qigong in mental healthcare Colorado Integrative Medicine Conference July, 2009 James Lake M.D. www.IntegrativeMentalHealth.net."— Presentation transcript:

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2 Qigong in mental healthcare Colorado Integrative Medicine Conference July, 2009 James Lake M.D.

3 Qigong in mental health care What is qigong? Early origins Qigong and Chinese medical theory Western scientific theories of mechanism Safety issues (yes, there are some) Qigong for maintaining good mental health Qigong in Rx of mental illness Formulating a qigong Rx plan Finding a qualified qigong doctor

4 Qigong What it is and where it came from

5 What is qigong? Spiritual practice based on assumptions about “energetic” nature of the body Western medicine assumes universe explainable viz matter and classical forms of energy Chinese medicine posits irreducible energetic “essences” “Balance” between energies determines health or illness A sound mind and a healthy body are inseparable and interdependent

6 Origins Healing forms like qigong widely practiced in China as early as 2000 BCE Evolved from Yoga or Tibetan Buddhist practices Historical and philosophical roots of Qigong inseparable from principles of Chinese medicine “Qigong” first used in its present meaning in early in the 20 th century

7 Qigong according to TCM “Qi” is one of three fundamental kinds of energy needed for health and healing The other two, Shen (Spiritual energy), and Jing (sexual energy), are considered the yang (ascending, bright, active) and yin (descending, dark, passive) aspects of qi Jing, Qi, and Shen can be understood as body, mind, and spirit, respectively

8 Nutritive qi and original qi Qi derives from three basic sources: food, breath, and body’s genetic constitution Food and breath combine to form “nutritive qi,” which flows through meridians and is altered during acupuncture treatments Inherited make-up of physical body is “original qi” Jing is “essence” or “the original source of life and growth”

9 Qigong restores optimum balance Qigong strives to restore optimum balance between yin and yang elements of the biological, spiritual and energetic aspects of the body Three stages in development of skill to “build up” or manipulate and transform qi: converting Jing into Qi (“nourishing the Jing”) converting Qi into Shen (“nourishing the Shen”) refining the Shen to govern emotions (“refining the Shen”)

10 How qigong works Qigong exercises strengthen one or more dan tien or convert one energetic principle into another where deficiency or imbalance exists The three dan tien (“fields of the elixir”) are principle storage sites of jing, qi and shen “Building up,” strengthening, or propelling qi energy to different body regions, and transforming various “types” of energy into others, originate in the dan tien

11 Maintaining optimal balance When qigong done correctly “three treasures” remain in optimal balance Optimum energetic balance manifests as prolonged good health and calm, centered state of mind Individuals who achieve optimum energetic balance may develop capacity to affect energetic balance of people or objects through touch or intention

12 Many qigong styles Hundreds of qigong “styles” for disease prevention or health promotion Different styles use various combinations of physical movements, breathing exercises or directed intention to regulate flow of qi to achieve optimum balance of yin and yang energy for a specific health problem

13 Qigong not widely accepted among TCM practitioners After Cultural Revolution qigong became increasingly popular in the west Many practitioners of Chinese medicine reject qigong and do not use qigong as Rx Probably due to absence of qigong “technology” in contrast to exact protocols for acupuncture, moxa or herbal formulas

14 Role of suggestibility Healer-patient relationship similar in qigong and shamanic healing practices because suggestibility or shared cultural beliefs determine effectiveness (Kleinman) However research findings consistently show that suggestibility does not adequately explain beneficial health effects of qigong

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16 Medical qigong First principles

17 Medical qigong Individuals who learn how to skillfully manipulate qi can learn specific techniques of medical qigong Medical qigong is deliberate manipulation of qi to maintain good health or treat illness Can be self-directed or outwardly directed “emission” qigong

18 Health and illness in Chinese medical theory Health and illness are manifestations of relative strength and balance between energetic principles External field of “protective energy” (wei qi) emanates from all living things Internal stresses (psychological traits, strong emotions) and external “stresses” (disease- causing organisms, toxic substances) damage protective field resulting in illness

19 Wei qi Disruption of wei qi can result in “toxic energy” or “depletion” of desirable energy, manifesting as physical, emotional sx Emotional stress and neglect of physical health result in diminished qi Qigong yields beneficial effects when self- directed qigong practice or emission qigong Rx replenishes or re-balances qi energetic patterns, restoring wei qi

20 Medical qigong—evidence Reports of efficacy in breast cancer, other malignancies, disorders of kidney, lungs and liver, and Parkinson’s Disease May accelerate post-CVA recovery (Weintraub 2001) and reverse cerebral atrophy (Zhao 1988) Standardized Rx protocols developed for select medical and psychiatric disorders

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22 Qigong and mental health Energy and balance

23 Qi and mental health Failure to resolve intense emotions blocks optimum qi circulation, resulting in deficiency or accumulation of “toxic energy” in certain organs or physiological functions Deficient or “toxic” qi manifests as emotional or psychosomatic symptoms Treatment of sx caused by “toxic energy” strives to release excess qi or strengthen deficient qi

24 Qigong in mental health Imbalances of qi, shen or jing manifest as physical, emotional or psychosomatic sx Most psychiatric sx result from “deviations” in Shen energy—an inherent “force” of CNS “Skillful” qigong practice has sustained positive effects on psychiatric disorders

25 Qigong in mental health—concepts Yuan Shen is innate or “inherited” spiritual pattern of the individual and connection to divine energy of the universe Zhi Shen corresponds to beneficial or toxic thought patterns acquired following birth Yuan Shen resides in the brain, while the Zhi Shen resides in the heart

26 Qigong in mental health—concepts Yuan Shen (mind) rules over the Zhi Shen (heart) Imbalances of Yuan Shen and Zhi Shen manifest as different psychological or emotional symptoms Work of the qigong master or qigong practice is to correct imbalances through appropriate qigong exercises

27 Maintaining good mental health Qigong practitioners and individuals who receive qigong Rx report “release” of emotional tension Longer practice improves energetic “balance” and improved physical and mental health Practicing qigong consistently and skillfully brings peacefulness, resilience and improved capacity to cope with stress

28 Maintaining good mental health Qigong practice enhances body awareness including somatic sx of emotional distress Improved awareness of muscle tightness through qigong practice may give insight into stresses or conflicts underlying somatic sx Improved awareness gives choice of changing circumstances or exploring conflicts and can be adjunct to psychotherapy

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30 Medical qigong research Competing theoretical perspectives

31 Theories of mechanism Effects on brain electrical activity or regional cerebral blood flow found with therapeutic effects (Ng & Tsang 2009) Beneficial endocrinological and immunologic effects Beneficial changes in blood pressure, GSR, blood levels of certain neurotransmitters

32 Theories of mechanism Correlations between qi and intensity, frequency and wavelength of sound, heat, light and electromagnetic fields Magnetic field between hands of qigong healers roughly 1000 times stronger than magnetic field generated by beating heart DNA might be capable of generating and detecting weak coherent magnetic fields

33 Qigong—proposed mechanisms Specialized kind of meditation associated with EEG changes corresponding to deep relaxation and improved mental clarity (but cannot explain positive changes from external qigong Rx in randomized protocols) “Rebalances” qi by sending infrasonic vibrational energy into meridians affecting immunologic or autonomic functioning resulting in improved health

34 Verifying existence of qi Problem of verification related to conceptual and methodological differences between TCM and western science Conceptual differences limit study designs on qigong which posits phenomena not explainable or measurable by Western science Chinese researchers accept that qigong practice generates fundamental energetic principle and do not design elaborate controlled studies

35 Optimization of EEG activity Qigong meditation and external qigong increase alpha power, enhance alpha synchronization between brain regions, and shift frontal EEG to dominant alpha frequency (Lee 1999) During qigong practice or external Rx neo-cortex relatively inhibited, autonomic brainstem activity relatively increased Mechanism involves optimization of autonomic fx improving “balance” and “integration” of sympathetic and parasympathetic functions

36 Coherent information “field” Highly organized microscopic biochemical structures, including possibly DNA molecules and constituents of axons in the CNS (Penrose 1994) generate weak coherent magnetic fields Resulting fields “interact” with fields of other organisms, imparting “information” resulting in subtle autonomic changes manifesting as improved “energetic balance” and “health”

37 Limitations on research Difficulty designing double-blind studies on emission qigong therapy “Sham” qigong masters and true masters may appear identical Double-blind studies of emission qigong must be designed so no differences between sham and actual Qigong Masters evident

38 Unresolved research issues Qigong practitioners assigned to “experimental” groups probably have characteristics that improve health General health-promoting factors obscure efficacy of qigong for specific disorders Emission qigong or sham Rx groups not self- selected and do not share values or beliefs that improve outcomes

39 Research on brain function Consistent increases in urinary catecholeamines in eleven subjects practicing qigong (Litscher 2001) Correlation between duration of qigong practice and increase in urinary catecholeamines suggests qigong practice increases sympathetic activity Positive relationship between qigong meditation or emission qigong Rx and enhanced alpha EEG activity in the prefrontal cortex (Litscher 2001)

40 Research on CNS—mechanisms Increased electrical activity in brainstem and hypothalamus following qigong practice, and inhibition of several areas of the cerebral cortex (Litscher 2001) Similar changes in anesthetized cats receiving emission qigong treatments, eliminating suggestion as factor (Liu 1990)

41 Infrasonic sound Infrasonic sound detected from Qigong masters during emission qigong Rx Researchers concluded emitted qi manifested as high-decibel sound energy that “causes” EEG changes in cerebral cortex, brainstem and other brain regions (Liu 1990) Findings limited by small size, absence of controls and no blinded raters

42 Increased alpha activity and metabolism PET and EEG examined relationships between brain electrical activity and regional cerebral blood (rCBF) flow in qigong practitioner (Manabu 1996) Increases in frontal alpha and beta correlated with increased rCBF Findings limited by single subject and no control

43 More studies needed to: Confirm consistent beneficial effects of qigong practice or emission qigong Rx on EEG and rCBF Clarify mechanism(s) of action Examine putative correlations between general CNS effects and apparent clinical improvements in psychiatric or medical disorders

44 Future studies on qigong Need to be rigorously designed including sham qigong masters Should examine EEG, rCBF, and structural CNS effects Should distinguish between individual qigong practitioners and patients receiving emission qigong Rx

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46 Safety Precautions and contra-indications

47 Safety No studies assessing long term safety issues or contra-indications Review of literature from both English and Chinese language sources revealed no absolute contraindications of qigong practice or external qigong Rx

48 Qigong adverse effects Transient AEs : itching, swaying, “clicking” in joints, perspiration, muscle soreness, drowsiness, restlessness Transient nausea, dizziness, tremors, headaches “Qi deviations” are physical or emotional sx resulting from unskillful qigong practice: weak constitution; deviations in posture or respiration; suspiciousness; excessive thinking

49 Qigong relative contra-indications Avoid strenuous qigong practice during pregnancy, menstruation Avoid qigong practices that increase “heat” when inflammatory or infectious condition Avoid passive qigong exercises where hemorrhoids, varicose veins or chronic pain Avoid slow abdominal breathing in diabetes or kidney failure

50 Risks of erroneous qigong Chinese Classification of Mental Disorders describes psychological disturbances due to “erroneous qigong” (Ng 1999) DSM-4 describes “qigong psychotic reaction” as culture-bound syndrome Transient psychosis may result from “erroneous” practice of qigong “Unskillful” or “excessive” practices can cause psychological or somatic sx

51 Can exacerbate psychiatric disorders Fragile patients may report inappropriate laughing and crying, unusual movements, weakness Borderline PD may have dissociative or psychotic sx, suicidal impulses Pts dx’d with psychotic D.O. or severe personality disorder should avoid qigong practice and not receive qigong Rx

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53 Qigong for psychiatric disorders Review of evidence

54 Techniques for treating and preventing mental health problems Medical qigong widely practiced to prevent anxiety, depression and other sx Principle energetic methods for healing emotional trauma: emission” qigong therapy by qigong doctor energetic massage breath-centered work dynamic postural therapy qigong meditation

55 Qigong in maintaining good mental health 35 healthy subjects who regularly practiced qigong reported enhanced “quickness and flexibility” in memory and attention tasks (Wang 1990) 226 healthy subjects who practiced qigong daily reported improved “emotional stability, increased joy of life, decreased selfishness, more open attitude, increased interest, increased will power, and increased care about others (Hayashi 1995)”

56 Qigong adjunct to psychotherapy Case reports of improved outcomes in “neuroses, depression, anxiety, and psychosomatic disorders when qigong used with psychotherapy (Geibler 1998)” But “unskillful” application of qigong in Rx of schizophrenia and other severe mental illness

57 Qigong for depressed mood 122 elderly qigong practitioners and 55 subjects who practiced Taijiquan compared to age-matched subjects who had never practiced qigong or Taijiquan (Tang et al 1990) Qigong group reported improved mood, reduced anxiety, improved sleep Type-A behavior moderated in patients who practiced qigong at least five years

58 Duration of practice Prospective open study (Wang 1993) compared psychological variables in group practicing qigong for less than two years (N = 153) with group practicing longer than two years (N = 119) Variables measured: “somatization, obsessive- compulsive tendencies, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety,” others

59 Duration of practice Significantly greater improvement in group practicing longer than two years for all measures including depression and anxiety Improvements in baseline psychological and emotional state corresponded to the duration of qigong practice

60 Depressed mood in Parkinson’s disease Ten-week open study examined qigong on quality of life, neurologic sx, mood in 17 pts dx’d with P.D. (Schwartzman 1998). 13 pts reported improved mood but no changes in quality of life, neurologic sx 9 experienced 25 to 50% improvement from pre-treatment baseline

61 Qigong for anxiety 2 wk open study on 35 pts dx’d “neurosis, headaches, anxiety” practiced qigong vs matched individuals receiving EMG biofeedback (Li et al. 1988) Outcome measures: ratings of “heating, relaxation, awakening, calm, saliva increase, quick thinking, sense of light body, sense of well-being.” Subjective stress significantly lower among male qigong practitioners but not females

62 Qigong for anxiety Prospective open study examined changes in BP, temperature, HRV and state anxiety in 13 subjects following qigong (Kato 1992) Increased sympathetic and decreased parasympathetic activity (but no changes in BP or temp) corresponding to decreased anxiety

63 Qigong for anxiety Open trial (qigong 15 mins/day) 8 pts dx’d with unspecified DSM-III anxiety D.O.s (Shan et al; 1989) EEG, GSR, respiration rate, pulse and oxygen consumption before and after qigong Findings: increased alpha amplitude, decreased HR, BP, RR, significant sustained improvements in HAM-A in 5 pts

64 Qigong for anxiety 8 wk open pilot weekly Tai-Chi vs progressive muscle relaxation in 8 combat vets dx’d with P.T.S.D. (Hutton et al; 1996) Tai-chi group had significantly greater decrease in subjective distress, greater decrease in heart rate Better adherence in Tai-chi group, which biased toward positive outcomes

65 GAD and panic Anxiety associated with “descent of the Water qi” related to a pathological disturbance of kidney’s Jing energy Mayer (Mayer 1997) developed integrative rx of generalized anxiety and panic attacks combining depth psychotherapy, Western relaxation techniques, cognitive restructuring and qigong

66 Qigong for other psychiatric disorders Review of evidence

67 Qigong for childhood ADHD Open prospective study on effects of qigong breathing exercises on “aggression, attention and restlessness” in primary school-age children (Cousins 1999). Teachers interviewed during and 2 mos after qigong training; no pre- or post-study formal psychological assessments Teachers perceived most children as less restless and more attentive on qigong practice days

68 Qigong for ADHD Many children reported “full of energy” on qigong practice days Teachers able to consistently redirect children from aggressive behaviors using qigong breathing exercises Behavioral changes resulted in significantly greater ease in managing inattentive or disruptive behaviors Findings limited by absence of matched controls, blind raters, absence of formal ADHD diagnoses

69 Qigong for heroin withdrawal 86 heroin addicts randomized to qigong 2 hrs/day vs medication for detox fx symptomatic care (Li et al 2002) Pre-rx and daily EKG, withdrawal sx and anxiety assessed. Qigong group experienced more rapid reduction in withdrawal sx, significantly lower anxiety and greater improvement in sleep quality

70 Qigong for psychosomatic sx Retrospective case review examined 25 selected cases of Shen qigong as a rx of irritable bowel syndrome, premenstrual distress, and psychogenic pain (Pavek 1988) Author reported consistent success relieving migraines, chronic low back pain, other psychosomatic symptoms caused by repressed emotions

71 Formulating qigong treatment plan General principles

72 Prescribing medical qigong Medical qigong does not offer specific standardized treatment protocols Most efficacious emission qigong rx or qigong practice technique depends on unique energetic imbalances of each patient Self-directed and “emission” qigong rx for emotional sx described for phobias, anxiety, stress-related sx, anger, and grief or sorrow

73 Condition-specific qigong rx Important tasks of qigong doctor are educating patient and taking complete “energetic” hx to diagnose underlying energetic imbalance(s) Rx recommendations based on relationships between emotions and five Yin organs (Eg. Liver associated with anger, other “negative” emotions)

74 Planning Rx for psycho-emotional symptoms Most psycho-emotional sx result from Shen disturbances “Calming the Shen” most important goal of emission qigong rx Important to distinguish self-treatment by qigong practice from emission qigong rx from qigong master

75 Qigong for cultivating good mental health Qigong practitioners strive to: – Cultivate good mental health through regular practice of specific meditation and postural techniques – This is called “mental dao yin training” and preserves mental tranquility and emotional balance

76 Advanced techniques Advanced practitioners use specific meditation techniques to transform destructive emotional patterns into “healthy” patterns using visualization Pursuing these teachings with intensity and discipline eventually brings practitioner to deep spiritual insights, and personal transformation

77 Certification and finding qualified qigong doctors Where to look

78 Finding qualified qigong practitioner In China certification requires completion of rigorous three-year program and internship Few rigorous training programs in medical qigong exist in the West Some TCM colleges offer medical qigong courses or certification training programs Western medical qigong training programs highly variable in duration and content

79 Medical qigong certification First free-standing medical qigong clinic Five Branches Institute of TCM, Santa Cruz, 2000 State Medical Boards do not screen medical qigong practitioners because criteria for certification not established Well-known medical qigong instructors certify students based on rigorous examinations and supervised training in clinical settings

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81 Qigong exercises A few simple forms


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