Sunday, January 29, 2012

Osteopathic Body-Coaching as a therapy for depression

Following is an email I wrote in response to a query about what Osteopathic Body-Coaching can offer from a person that suffers from severe depression.

Dear Sir / Madame,

You've asked recently for some more information about my work in relation to stress and depression and thus how body-coaching can help with matters of the mind. Before I try to describe to you my understanding of how the body can displace the mind, I would like to say that as far as I know there is still no consensus of what depression really is or what the physical or psychological cause is. There are good leads such as people with depression have shown abnormal levels of the neurotransmitters norepinephrine, serotonin and dopamine but there other explanations too, including genetic. I think depression can’t be narrowed down to a singular cause but is the result of many factors.
That being said I like to start with how I got interested into the body-mind link.
From the first days as an osteopath my patients, reported after their first visit improvement or complete disappearance of their physical ailments which were mainly neck, shoulder or lower back pains for which they had come to visit me. However many patients also reported improvement of cognitive functions and kept on saying things like, since your treatment: I can focus better, make better decisions and faster, I can concentrate more and feel less anxious when something goes wrong, I have the same amount of stress but I don't care as much, I have more time. 
My response was great but at the same time started to question this positive side effect. What also was given as feedback was that with people who had visited other osteopaths before coming to my practice, that they hadn't experienced that kind of a cognitive improvement. However, that can mean several things like maybe they weren't stressed then.
Still it seemed I was offering something different and I wanted to know why.
The first question I asked myself was what lesions do these patients have in common? Lesions are disorders of function and movement of the body, detected and assessed by careful palpation of the bone structures, joints and soft tissues. I was especially interested in cranial lesion patterns (The cranium is made of different bone structures: occiput, temporal bone, frontal bone, sphenoid etc). 
I reasoned that it was rather the interaction with cranial structures (cognition taking after all place in the head) what was making the main difference rather then the work for example on the knee or foot (osteopathy is a holistic approach). 
I went looking into patient records and did find that certain lesions were indeed nearly always present in various cases. 
The next step was that I explained to new patients - who hadn't mentioned their state of mind and by whom I found the lesion patterns - that people with a pattern like theirs often felt that they had difficulty concentrating, felt a bit lost, had difficulties focusing etc. Most did respond that they also felt like this. After the treatment they also reported improvement in their behavior, state of being. 
The treatment itself is performed with the person fully clothed lying on a massage table. I palpate the different parts of the cranium and the rest of the body in a specific manner, to feel if movement is normal or if there are lesions. Normal movement feels like a wave that goes rhythmically to and fro. This wave is felt but not visible by the eyes. Lesions on the other hand feel more like a palpable pulling into one direction more then another or no movement at all. 
When a lesion is found the hands are kept there and initiate the unwinding process, to reinstall rhythmic movement, ease and relaxation. The process - characterized by three phases: Engagement phase, Fulcrum (dynamic still point), disengagement phase - is carried out by the body itself the role of the osteopathic body-coach is to be there and to let the process unfold. 
These three phases is very similar to what one can find back in the breathing cycle: inspiration (tension of muscles), still point between inspiration and expiration, followed by expiration (relaxation). 
This unwinding process improves among other things the circulation of blood, lymph through the release of tensions. I do like to mention here that I do not exclude that this way of working probably also has an impact on the flow of energy in the Chinese meridian system and other energy centers. (I just don't know and thus do not want to exclude that there is far more going on then that I know or that science can prove.)
The question "Why does Osteopathic Body-Coaching have an impact on the mind?" is still to be answered. I don't have a conclusive answer but found some interesting leads in the book "Why zebras don't get ulcers" from Stanford University professor Robert. Sapolsky
In brief:
The stress (fight & Flight) response, build for acute alarm situations, triggers the release of many hormones including adrenaline and glucocorticoids. Glucocorticoids i.e. mobilizes energy, inhibits storage of energy and suppresses immune function.  Adrenaline, has an influence on i.e. blood pressure, heart rate, breath rate which are increased.  Adrenaline is also a vasoconstrictor in certain parts of the body (ex. digestive system) to have more blood supply to the area's of the body that are needed to act in the fight and flight response.
The stress response however, when chronically stimulated, can become more damaging then the stressor itself: heart disease, diabetes, ulcers, growth problems,...
In the brain chronic stress or the release of glucocorticoids will decrease glucose delivery to the hippocampus (Limbic system: emotion, memory,...) and cortex (neocortex and prefrontal cortex: cognitive region,...) to probably divert it to the more reflexive brain regions (reptilian brain: survival)
I've written to Dr Sapolsky asking if this decrease of glucose delivery was due to a vasoconstriction in parts of the brain. He responded that it was more likely to be a tightening of the blood brain barrier which results in less nutrients entering the extracellular space. Less nutrients in this space means less for the neurons to take up. Neurons are known for their high energy use so if there is lower supply there is also lower functioning and even atrophy can set in.
There is also evidence that prolonged exposure to stress or glucocorticoids can actually kill hippocampal neurons. This is seen in people with major depression where they have noted volume loss of the size of the hippocampus.
The next interesting bit of information is that the hippocampus is also one of the important negative feedback sites in the brain controlling glucocorticoid secretion. Damaged or dysfunctional hippocampal neurons dysregulates the negative feedback system for glucocorticoid secretion and thus there is no 'stop' in the production of it. So when the hippocampus is damaged more glucocorticoids are released which damages the hippocampus further and then even more glucocorticoids are being released, causing a degenerative cascade.
I have no prove of it yet but I believe that the osteopathic body-coaching approach has positive influence on stimulating the parasympathetic nervous system: promoting i.e. relaxation, vasodilation (in those parts of the body that had gone into vasoconstriction due to sympathetic stimulation) and the regulation of the blood brain barrier so that nutrients including glucose is again available in the limbic system and cortical regions of the brain (improves cognitive function). In other words it lowers / regulates the stress response or as I call it 'reasets' (yes with an a) meaning returning to the state of ease.
The feedback I have from my patients seem to point towards this effect although other reasons can not be excluded for why they felt less stressed or depressed and why their cognitive abilities improved.
How many osteopathic body-coaching sessions does one need? I don't know there are so many factors that play a role here. Most people that came to my practice actually came for physical problems so I guess their level of depression wasn't that high. However, left unattended this could have resulted in a more serious problem.
Is osteopathic body-coaching the miracle cure? No, I'm convinced that body-coaching has a place in health and wellbeing. However, if we keep being overstimulated physically, psychologically or create stress through anticipation (to worry ourselves sick) it will only offer short term relieve. This short term relieve however in the long term is not to be underestimated as it opens the gateways for new insights.
For people with PTSD or who are suffering from major depression osteopathic body-coaching should be offered along with psychotherapy or coaching but also with learning specific breathing exercises (from Mindfulness or the Heartmath institute) that are practiced several times a day.

I hope this answers your question but please do not hesitate to contact me if you have any other questions you like to ask.


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