Center for Meditation and Healing Integrates Psychiatric Health

The department of psychiatry at Columbia-Presbyterian Medical Center (CPMC) in New York City has opened one of the first facilities in the country that brings the techniques of complementary medicine to psychiatry. The Center for Meditation and Healing, which opened this March, emphasizes traditional meditative methods used for thousands of years in Asian cultures, particularly those of India and Tibet.

"What we do here in complementary psychiatry combines the best of modern psychiatry with time-tested meditative traditions," said Joseph Loizzo, M.D., an assistant professor of psychiatry at CPMC and the director of the center. "Our aim is to foster self-care by offering health education that allows participants to learn, grow and change. The ultimate goal is to support and teach people so they become more independent and develop self-healing attitudes, habits and skills."

Loizzo said that four segments of the population should be especially attracted to the therapies the center is offering:

• People who want an alternative to conventional treatment, who have gone through psychotherapy or psychopharmacology and had some adverse reaction, who benefited only partially, or who found the treatment successful but wanted something they could do on their own to maintain health.
  
• Alternative health enthusiasts who are interested in self-healing, who desire help with emotional problems but avoid psychiatric care because they value natural methods and remedies.
  
• Basically healthy people who are interested in stress reduction, wellness and attaining a more optimal state of health.
  
• People with medical problems such as heart disease, chronic pain, cancer or arthritis.

"We won't be taking primary medical responsibility for them but we can offer them complementary techniques that current research suggests may help them cope with those conditions," said Loizzo.

• Theory and Practice

The center is currently offering an eight-week group-educational program coupled with individual consultation for participants. The program consists of two four-week segments, with 10 to 15 people gathering for two hours each Wednesday in the Psychiatry Suite at Columbia-Presbyterian's east-side facility. Class time is split between theory and practice, and classes are supplemented by homework and contact with an instructor.

Segment A, "Self-Healing and Mindful Relaxation," focuses on pain, illness and stress, the stress cycle and the compulsive self; breaking the compulsive cycle, and developing a self-healing personality and lifestyle. Participants learn and practice posture and breathing exercises to help them relax and become attentive to their minds and bodies while also using positive thoughts and images to balance their autonomic nervous systems.

Segment B, "Healing Lifestyle and Insight," is directed toward changing life habits, transcending the compulsive self, learning the art and science of meditation, and incorporating meditation into daily life. The aim is to help participants become aware of their counterproductive habits and guide them as they go about changing the habits and attitudes that contribute to many mental and physical illnesses.

Those participating in the educational program have access to individual consultation with a member of the center faculty. Individual consultations, said Loizzo, are aimed at helping people integrate medication, psychotherapy and self-help with their life goals and plans. He notes that the consultations are also useful for people in 12-step recovery programs and for those who want referrals to a network of alternative and traditional mental health providers.

In addition, the center offers a second-opinion service to people not in the program to help them decide whether they might benefit from the complementary therapies offered by the center or by other practitioners.

Eventually, said Loizzo, "We hope to develop more services, including programs that are more specific to particular problems. We also want to start training programs for physicians and other caregivers and publish a training manual as a resource for others to apply in similar programs."

As for the reaction of his psychiatric colleagues to the center, "There was a good deal of skepticism, but also some serious interest," Loizzo said. The problem, he contends, is that complementary and traditional medicine "are not sciences that most psychiatrists know about because they don't fit the conventional biomolecular model. But there is actually a ton of science to support the impact of these sorts of methods on mental as well as physical health."

He cites the following examples:

• Work by Herbert Benson, M.D., (author of The Relaxation Response, the best-selling book that advocated meditation for dealing with the stresses of modern life) has shown that the relaxation response could decrease blood pressure.
  
• Jon Kabat-Zinn, Ph.D., has shown that mindful relaxation decreases anxiety and increases the pain threshold (1995).
  
• Studies by Dean Ornish, M.D., have shown that meditation and yoga combined with exercise and a low-fat diet can halt and even reverse coronary artery disease (1995).
  
• Researchers have found physiological connections between the brain and the immune system, and their findings have given rise to the rapidly growing field of psychoneuroimmunology.
  
• Studies by Spiegel and others (1989) have shown that stress can affect immune function and health.
  
• Benson's studies of Indo-Tibetan yogis have shown that people can regulate their body temperatures through meditation and can also reduce their metabolic rate by as much as 60%.

The center, said Loizzo, "has been a long time in gestation." In fact, he said, the philosophy behind the center was inspired by his father, also a psychiatrist. "As a boy, I saw him in practice and I thought 'How fascinating, he sits down with these really interesting people and they come back feeling better,"' said Loizzo. "But my Dad lived like a doctor-always running around and stressed out, working until 10 o'clock every night and never relaxing. He had to stop practicing because he really just burnt himself out. I saw there was something very wrong in his giving up many of the things that made him a happy person and a good doctor," said Loizzo.

His father's example made Loizzo realize that patients-as well as doctors-might benefit from a different healing approach, one involving not just hard science, but including art and the wisdom of ancient, non-Western civilizations. "To this end," said Loizzo, "I've tried to incorporate science and the humanities throughout my education, training and clinical practice."

Loizzo majored in comparative philosophy and religion at Amherst College, where he completed independent study coursework comparing the Indian and Tibetan traditions of psychology with developments in Western psychology. "When I went to medical school and, later, into psychiatric training, I always knew that I didn't want to practice the conventional way," said Loizzo. "I was looking for alternatives derived from the Indian and Tibetan traditions. They were so different from Western medicine yet extremely sophisticated, with an elegant internal logic."

While getting his medical degree at New York University Medical School and before graduating in 1982, Loizzo spent his fourth year at Beth Israel Deaconess Hospital in Boston working with Benson-where he won the Wortis Prize for Neuropsychiatry and Medicine. "At that time, Benson was beginning his work on mind-body medicine and finding that relaxation helped in treating high blood pressure and other conditions," said Loizzo.

He stayed in the Boston area to do his psychiatric residency at Harvard-Cambridge Hospital, later taught at Boston University and ran an inpatient psychiatric service at Carney Hospital, a Catholic hospital with a strong pastoral care department that emphasized a multidisciplinary approach to psychiatry. He then went to California, where he taught and developed the fourth-year residency program at the state hospital in Napa, affiliated with the University of California at Davis.

Loizzo returned to New York in 1996 to begin a graduate program in Indian and Tibetan studies and went to work at CPMC's Intensive Outpatient Program. He was later appointed medical director of psychiatry at Columbia-Presbyterian Eastside. When Loizzo broached the subject of a meditation and healing center to Ellen Stevenson, M.D., the associate director of the department of psychiatry at Columbia-Presbyterian Hospital, he found a sympathetic ear.

"Dr. Stevenson was open to the fact that I was interested in Eastern traditions and the notion of combining them with contemporary science and the cognitive-behavioral style of psychotherapy," said Loizzo. He began developing the concept of the center with Ina Becker, M.D., Ph.D., the assistant director of the Intensive Outpatient Program and now the assistant director of the center. Becker has studied yoga for many years and has used Eastern techniques with patients in individual therapy. Late last year, the center received the go-ahead from Fred Kass, M.D., the chairman of the department of psychiatry at Columbia-Presbyterian Hospital.

"This was the right place and the right time for a complementary psychiatry center," said Loizzo. Columbia University already has two of the nation's first alternative medicine facilities: the College of Physicians and Surgeons' Rosenthal Center for Alternative and Complementary Medicine, which opened in 1994, and CPMC's Complementary Care Center, which opened in 1995. And, said Loizzo, "There's now this new climate of interest in and openness toward alternative and complementary methods of healing."

A nationwide telephone survey conducted last November for Landmark Healthcare Inc. found that 42% of American adults had used some type of alternative treatment during 1997.

At present, the center is staffed by Loizzo and Becker. "We intend to start small and select additional faculty as we add more programs," said Loizzo, who adds that he has been busy fielding calls from mental health professionals interested in working at the center.

• Teaching Mindfulness

Is the center unique in what it offers? "Jon Kabat-Zinn, at the University of Massachusetts Medical Center in Worcester, is doing something similar by relying on the Buddhist tradition and teaching people mindfulness meditation to improve health and for medical problems," said Loizzo. "But we're using several meditative traditions and multiple meditation techniques and adopting them in a more comprehensive way."

As for Benson and his mind-body medical institute at Beth Israel Deaconess, "What he has done is to isolate a single technique-transcendental meditation-from a whole traditional belief system and graft it into the Western setting," said Loizzo. "Our center is based on his work but we've gone several steps further. We're looking more seriously at the whole paradigm of self-healing that these alternative traditions offer, studying meditation as a self-healing science and combining alternative traditions with current developments in neuroscience, medicine and psychotherapy."

Although the center has an alternative emphasis, treatment outcomes will be monitored so that therapeutic techniques can be constantly improved. "We'll be collecting data that can be used for clinical research, and every patient coming in and going out will be evaluated," said Becker. "We'll be using standard instruments such as the Hamilton Depression Scale to assess various medical symptoms and quality of life. The idea is to build a database and conduct research that will be sufficiently rigorous to publish in mainstream journals."

The center is applying for grants to fund clinical trials. As for other funding sources, "We're getting advice about the kinds of foundations that might be interested in supporting our work," said Loizzo. "We've recently submitted three grant proposals, each of which could provide us with more than one year's funding, and we have high hopes that at least one of them will come through. Additional revenue will come from patients to fund our programs and provide administrative support and promotional activity."

The "key thing" about the center, said Loizzo, is that it doesn't involve "just a single active intervention." Instead, he said, "the idea here is that you marshal many subtle, self-healing strategies into a whole package, where together they can have a profound effect on mental and even physical health."

References:

• References 1.Benson H (1982), Body temperature changes during the practice of g Tum-mo yoga. Nature 295(5846):234-236.
  2.Benson H (1996), Mind over maladies. Can yoga, prayer and meditation be adapted for managed care? Hosp Health Netw 70(8):26-27.
  3.Kabat-Zinn J, Miller JJ, Fletcher K (1995), Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry 17(3):192-200.
  4.Ornish D, Gould KL, Scherwitz L et al. (1995), Changes in myocardial perfusion abnormalities by positron emission tomography after long-term intense risk factor modification. JAMA 274:894-901.
  5.Spiegel D, Bloom JR, Kraemer HC, Gottheil E (1989), Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 2(8668):888-891.