By Luann Fortune, PhD & Shannon McLain Sims, PhD, MS
Not a person on the planet has been untouched by the COVID-19 pandemic. In these articles (Parts 1 & 2), we explain evidence for using mind-body practices to help minimize risk to COVID-19. We also offer an extensive collection of resources in the references list. For the discerning and inquiry reader, we provide a platform for an interdisciplinary, integrative strategy to fight COVID-19 and also come out stronger on the other side.
As of April 26, authorities had reported 2,962,915 cases globally of COVID-19 infections, with 961,969 cases confirmed in the U.S. (Johns Hopkins, 2020). While the numbers sadly change each day, Johns Hopkins reported a total of 205,936 deaths globally, with 53,755 of those in the U.S. alone. With limited testing, experts assume there are far greater numbers of persons infected than reported (Fitzpatrick et al., 2020). Also, early evidence indicates many people are asymptomatic or contract sufficiently mild cases so that they do not even seek medical help. It is still unclear whether those who have recovered from the virus develop immunity. Scientists project that a vaccine is at least a year away (Ercolano, 2020). With the duration and long-term impact of this outbreak so unpredictable, this situation demonstrates more than ever that our world is VUCA: volatile, uncertain, complex, and ambiguous.
While scientists and public health officials race for a cure and vaccine, it is clear that every person needs to adopt a strategy of prevention and to optimize their ability to recover. To boost immunity and mitigate the ever-present inherent stress, myriad self-care practices can be customized and adopted to suit each individual (Fortune, 2019). Amongst the self-care repertoire lie a spectrum of mind-body practices that are evidence based (Fortune, 2019).
Mind-body medicine (MBM) is based on an inherent connection between mind-body-spirit, and includes practices such as mindfulness, biofeedback, and imagery. When faced with the seemingly gargantuan challenges of negotiating a COVID-19 VUCA environment, deep breathing, mediation, or yoga might seem insignificant responses. Yet the benefits associated with mind-body practices could be exactly what we need to tilt our homeostatic balance to fortify resistance to infection and, if needed, more readily cope with an infection. There is some growing indication that mind-body practices can support recovery in those already infected with the virus (Liu et al., 2020). The key mechanisms appear to relate to reducing systematic inflammation and managing the stress response.
Research on Stress & Immunity
The word stress often carries a negative connotation, but the experience of stress is a familiar and unavoidable feature of life. Stress is a constellation of events, including a stressor (i.e., stimulus) and our perception of that stressor (i.e., the reaction on our brain), that activates the body’s natural biological reaction: the fight-or-flight response. While short-term stress (i.e., lasting minutes or hours) is helpful, motivating, and protective, long-term stress (i.e., lasting several hours per day, week, or months) throws the body out of balance and causes unwanted inflammation, which is damaging to both the mind and body (Dhabhar, 2014; Straub & Cutolo, 2018). As it turns out, a prolonged episode of stress will disrupt a wide variety of immune functions (Sapolsky, 2004).
But the good news is that we can reverse, or even prevent, the damage caused by chronic stress by engaging in mind-body practices. Researchers now think they have identified the mechanisms that allow such practices to minimize the harmful effects of stress. The stress response also increases harmful pro-inflammatory cytokines. In re-orienting our stress response, we can enhance our immune system (Dhabhar, 2014), balance our body’s production of cytokines, and be better equipped to resist COVID-19.
Mechanisms to Fight COVID19 Using Mind-body Channels
As research continues to emerge, we are beginning to see the health effects this novel virus. Data suggests that the major way in which the Corona Virus kills is by triggering a cytokine storm (Chen, Zhang, Ju, & He, 2020), a form of systemic inflammation that is triggered in the immune system. In the case of COVID-19, this inflammatory response can attack the lungs and respiratory system leading to further, potentially lethal, complications (Prompetchara et al, 2020). In most cases, this cytokine call to action is a healthy immune response, but a cytokine storm is a damaging overreaction by the immune system (Mau, 2020).
Given what we know about stress’ ability to increase harmful cytokines, one response to COVID-19 might be to use mind-body practices to help support the immune system. Research suggests that mind-body therapies and practices can lower markers of inflammation and cytokine expression (Bower & Irwin, 2015; Creswell et al., 2016; McLain, 2019). It is important to emphasize that such practices cannot replace conventional medical treatment. Still, mind-body practices can prompt the body to respond in a more appropriate, balanced way.
Mind-Body Medicine for COVID-19
MBM focuses on the interactions between the mind and the body and the powerful ways in which you can participate in your own health and healing (NCCIH, 2018). This occurs through the complex psycho-neuro-immunological system (PNI) where mind and body physiology mutually influence the whole (Litrell, 2008; Yan, 2016). MBM remedies share a common function: they initiate a change in one realm to affect a positive change in equilibrium of the whole. That is to say, thoughts, feelings, beliefs, and attitudes can affect and shape every aspect of our psychological and physiological functioning, and in turn, how we care for our bodies can affect how we think, feel and what we believe. This means that we have many opportunities and can do many things to care for ourselves.
In Part 2 of “Tilting our Homeostatic Balance” we suggest specific mind-body practices to help manage the challenges of the COVID-19 pandemic.
Luann Fortune, PhD, LMT is on faculty at Saybrook University in the Department of Mind-Body Medicine, where she also coordinates the specialization in Mindful Leadership in Healthcare. Her research focuses on integrative health and wellness.
Shannon McLain Sims, PhD, MS holds degrees Mind-Body Medicine from Saybrook University’s College of Integrative Medicine and Health Sciences where she currently serves as a post-doctoral fellow.
Bower, J. E., & Irwin, M. R. (2016). Mind–body therapies and control of inflammatory biology: A descriptive review. Brain, Behavior, and Immunity, 51, 1-11. doi: 10.1016/j.bbi.2015.06.012
Chen, C., Zhang, X. R., Ju, Z. Y., & He, W. F. (2020). Advances in the research of cytokine storm mechanism induced by Corona Virus Disease 2019 and the corresponding immunotherapies. Zhonghua shao shang za zhi= Zhonghua shaoshang zazhi= Chinese journal of burns, 36, E005-E005.
Creswell, J. D., Taren, A. A., Lindsay, E. K., Greco, C. M., Gianaros, P. J., Fairgrieve, A., … &Ferris, J. L. (2016). Alterations in resting-state functional connectivity link mindfulness meditation with reduced interleukin-6: A randomized controlled trial. Biological Psychiatry, 80(1), 53-61. doi: 10.1016/j.biopsych.2016.01.008
Dhabhar, F. S. (2014). Effects of stress on immune function: The good, the bad, and the beautiful. Immunologic Research, 58(2-3), 193-210.
Ercolano, J. (2020, April 16). A coronavirus vaccine is in the works – but it will not emerge overnight. Johns Hopkins Coronavirus Resource Center. Retrieved from https://hub.jhu.edu/2020/04/16/coronavirus-vaccine-timeline/L
Fitzpatrick, S., Przybyla, H., De Luce, D., Strickler, L., & Kaplan, A, . (2020, April 17). Coronavirus testing must double or triple before U.S. can safely reopen, experts say. NBC News. Retrieved from https://www.nbcnews.com/news/us-news/coronavirus-testing-must-double-or-triple-u-s-can-safely-n1185881
Fortune, L. (2019, September 13). Self-care: Pursuing the ultimate path to optimal wellbeing. UnBound. Retrieved from https://www.saybrook.edu/unbound/self-care-optimal-well-being/
Johns Hopkins University. (2020).COVID19 dashboard. Retrieved April 25, 2020, from https://coronavirus.jhu.edu/map.html
Littrell, J. (2008). The mind-body connection: not just a theory anymore. Social Work in Health Care, 46(4), 17-37.
Liu, K., Chen, Y., Wu, D., Lin, R., Wang, Z., & Pan, L. (2020). Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complementary Therapies in Clinical Practice, 39, 101132.https://doi.org/10.1016/j.ctcp.2020.101132
Mau, F. (2020). No need for a hammer A guided imagery process for patients suffering from COVID-19. Retrieved from http://0102.nccdn.net/1_5/000/000/05f/b06/Mau-2020-No-Need-for-a-Hammer-revised-4-2-20.pdf
McLain, S. (2019). The impact of mind-body skills training on medical students: A mixed-methods research study (Doctoral dissertation). Available from ProQuest Dissertations & Theses Global database. (Accession Order No. 27738770).
National Center for Complementary and Integrative Health (NCCIH). (2018, July). Complementary, alternative, or integrative health: What’s in a name? Retrieved from https://nccih.nih.gov/health/integrative-health
Prompetchara, E., Ketloy, C., & Palaga, T. (2020). Immune responses in COVID-19 and potential vaccines: Lessons learned from SARS and MERS epidemic. Asian Pacific Journal Allergy Immunology, 38(1), 1-9.
Sapolsky, R. M. (2004). Why zebras don’t get ulcers: The acclaimed guide to stress, stress-related diseases, and coping-now revised and updated. Holt paperbacks.
Straub, R. H., & Cutolo, M. (2018). Psychoneuroimmunology—developments in stress research. Wiener Medizinische Wochenschrift, 168(3-4), 76-84.
Yan, Q. (2016). The translation of psychoneuroimmunology into mind–body medicine. In Psychoneuroimmunology: Systems biology approaches to mind-body medicine (pp. 121-129). Cham, SZ: Springer.