Samueli Institute Blog Mon, 12 Dec 2016 18:35:08 +0000 en-US hourly 1 On Human Flourishing is the official podcast for Samueli Institute, a Washington, D.C. based research center that focuses on the science of healing. The show features interviews with thought leaders in the areas of medicine, research, military and veteran care, integrative medicine and other spheres of focus that contribute to a flourishing society. Samueli Institute Blog clean Samueli Institute Blog (Samueli Institute Blog) Samueli Institute Samueli Institute Blog Celebrating 15 Years Exploring the Science of Healing Mon, 12 Dec 2016 18:09:22 +0000 To celebrate its 15-year anniversary, Samueli Institute invited guests to gather and share stories of the positive impact the Institute’s research has had in helping patients, policymakers, service members and veterans find evidence-based alternative, complementary and integrative treatments for chronic pain and illness.

In 2001, Henry & Susan Samueli launched Samueli Institute to explore the science of healing and expand the evidence base for complementary and integrative medicine. In the ensuing decade and a half, Institute researchers published more than 700 peer-reviewed articles and hosted scientific conferences of global experts, developed programs for pain, stress and performance for the military and supported healthy communities across the United States.


Now, after 15 years of service to the integrative health, healthcare, and military communities, Samueli Institute will cease research and programmatic operations in 2017.


“I am enormously proud of the work that Samueli Institute and all of its staff, fellows and grantees have accomplished. And I am grateful to Henry and Susan Samueli for their investment in time, money and expertise in supporting the work of the Institute,” said Wayne Jonas, MD, Samueli Institute President & CEO.

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State of the Evidence on Training Programs for Self-Management of Emotional Stress Tue, 04 Oct 2016 14:38:25 +0000 Limiting the stressors in our lives is not always possible; however, managing HOW we deal with the stress can be within our control. Nearly half of Americans report that their stress levels have increased in the last five years making effective treatments to decrease psychological distress in demand. Even more so, are mind-body programs that provide individuals the opportunity to have greater control over their own health. This focus on the self-management of health is a global phenomenon with increasing usage of complementary and integrative health practices being reported in the United States, United Kingdom, Canada and Europe.


In 2008, 19% of U.S. adults (more than 55 million people) reported using at least one mind-body therapy during the previous 12 months and in 2012, deep-breathing exercises, meditation, yoga, tai chi and qi gong were among the most frequently used techniques. These therapies are based on the biopsychosocial model, a perspective that acknowledges that biological, psychological (e.g., thoughts, emotions, and behaviors), and social factors all play a significant role in human functioning in the context of wellness and illness. It is often used to describe the concept of the “mind–body connection.”


In 2008, 19% of U.S. adults (more than 55 million people) reported using at least one mind-body therapy during the previous 12 months.


A recent Samueli Institute report evaluated the existing body of randomized controlled trials on biopsychosocial training programs for the self-management of emotional stress. The report is especially impactful for researchers, clinicians and policy-makers as they develop new programs and assess the utility of existing ones.


“This evidence helps us to focus on the programs that work, and retire those that don’t,” said Wayne B. Jonas, MD, President and CEO of Samueli Institute. “By allowing the evidence to guide our decisions, we empower patients to gain control over the stress in their lives.”


A full copy of the report including an evidence breakdown, complete methodology and analysis is available for download, but read on for a short summary of some of the findings.


In the pool of well-studied, effective programs were Mindfulness-based Stress Reduction and Cognitive Behavioral Stress Management. Both are well-established programs that require a substantial amount of training before the learned skills can become self-management skills. Multi-modal yoga-based studies were of good quality and found to be effective for stress reduction. There is reasonably sound evidence for program directors to incorporate these practices into their programs.


There were mixed results for relaxation-based techniques, both in terms of research quality and effectiveness. Autogenic Training studies showed moderately good quality, yet mixed effectiveness.


Limited evidence existed for many other programs including Easwaran’s Eight Program of Passage Meditation, dialectical behavioral therapy, FRIENDS program and several others. Researchers should focus on expanding the body of evidence for these programs to determine their efficacy.


The self-care programs described in the report have potential benefits for both clinical and healthy populations experiencing emotional distress. These self-management skills can help to empower individuals, since they can be practiced in virtually any environment, with minimal time required and at low cost.  This may be especially helpful for individuals who are likely to refuse, delay or feel stigmatized by seeking conventional therapies.


Such self-management programs are cost-effective strategies to prevent or manage stressors and because they are multi-modal, they may also offer greater appeal than single-modal programs. There are very few to no adverse effects when these self-management skills are properly learned and practiced.

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What Works for PTSD? Research is Key Tue, 27 Sep 2016 06:00:26 +0000 A recent article in the New York Times on alternative treatments for post-traumatic stress disorder (PTSD) highlights a key question: how do we know what alternative therapies work to treat our veterans suffering from PTSD?

Dr. Barbara Rothbaum is a psychologist at Emory University who runs an intensive two-week PTSD treatment program that includes complementary and alternative treatments. While compiling a National Academy of Sciences report on therapies for PTSD, she encountered a key issue: “We met a lot of well-meaning clinicians around the country creating programs with equine therapy or wilderness therapy or whatever, and there was no way to know if any of it worked,” said. “Because of that, we couldn’t recommend it.”

This is not to say that the programs do not work—but the evidence base is not strong enough yet. Part of that is a question of research funding. Drug companies have a vested interest in funding multi-million dollar clinical trials. However, many of the organizations running these alternative programs barely have enough funding to carry out the programs, and therefore do not have the extra funding available for the evaluation of these programs—creating a cyclical problem.

“We need to get what doesn’t work OUT and what DOES work IN the regular treatment for PTSD,” said Wayne B. Jonas, MD. “But we can’t do that unless we build evaluation into each program.”

Two recent projects of Samueli Institute are helping to build the evidence base for complementary and alternative treatments for pain, stress and health.

  1. Stress Management – A new report by Samueli Institute boils down more than a decade of research on stress management. It builds upon an earlier study that focused on military-related programs.
  2. Massage– Samueli Institute recently published a systematic reviews and meta-analysis series that is the first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life for pain, cancer and surgical patients.

In his article entitled The Evidence of Enough, Dr. Jonas explains the challenge and the imperative of managing and evaluating the growing body of evidence: “A more rigorous management of the judgment processes for evidence is needed. Lives, money and the mitigation of suffering depend on it.” Read more.

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Nutrition Education: The Doctor is Out Wed, 14 Sep 2016 12:00:41 +0000 Having a healthy, flourishing life is often as simple as eating right. Yet, many people lack the knowledge, resources and access to healthy food they need to ensure their own wellbeing. About 38 percent [i] of Americans admit to not maintaining healthy diets. This has lead to more than half of the population being classified as obese in previous years and a surge in cardiovascular and endocrine diseases. What’s worse is that the healthcare specialists they go to for help often lack basic nutrition training themselves.

As a result, many populations are at odds with health and wellbeing. According to the 2016 Global Nutrition Report produced by the World Health Organization (WHO), 44 percent of the 129 countries surveyed had severe malnutrition and obesity. [ii] The United States is among 14 nations that have the highest rates of obesity and malnutrition.

These results come after years of implementing developmental project models. Some have been successful, but considering the current state of health in America, it is clearer than ever that we need to take more innovative measures.

Modernizing Medical Education

Disease and premature death have both been linked to nation-wide problems with proper nutrition.[iii] This phenomenon is closely related to the limited or lack of nutrition training for doctors. Some experts refer to this void as a “deficiency of nutrition education.” [ii]

Medical students receive less than two hours of nutrition education over a four-year period. [ii] Most of their essential nutrition training is from basic classes, which occur in the earlier years of medical school. [ii] A Samueli Institute article capped the medical school hours dedicated to nutrition at 19.6 hours, in 2013. [iv] That is less than 1 percent of students’ total lecture hours. In a study conducted by researchers at the University of North Carolina, Chapel Hill, 80 percent of medical schools provide inadequate nutrition training for future doctors. [v] Once these doctors begin practicing, they usually receive no additional nutrition training.

A 2010 survey revealed that only 14 percent of physicians considered themselves adequately trained to counsel patients on nutrition. [v] Still most of the general public is willing to consult their doctor for advice on healthy eating. One survey calculated that figure to about 61 percent. [ii] In light of these statistics, Samueli Institute recommends:

  • Provide nutrition education to medical students in the first two years of training
  • Repeat nutrition education once medical students begin a specialty
  • Pass the training from properly trained physicians to patients.

Making Information Available

Nutrition education is not readily available for the general public. This is true for adults and school-age children alike. For children, however, the truth is much harsher. More than 17 percent of children in the United States are obese. [vi] This number increases when factors like race/ethnicity and economics come into play.

Socioeconomics determines not only what people know about nutrition, but access to nutritious foods in their communities. [vii] Considering this reality, teaching nutrition alone cannot solve the country’s problem. As a nation, we must pass policies that promote health and human flourishing in our neighborhoods.

Nutrition and National Security

The United States military is already making strides to improve the resilience and readiness of service members by implementing dietary changes for active duty service members. Working with Samueli Institute, the Teaching Kitchens framework provided a training approach to cooking in a military environment. In just three phases, orchestrators of the Teaching Kitchens could help make healthier I’ve tied it to Teaching Kitchens. foods accessible, change eating behaviors and improve the overall quality of life to military servicemembers.

The Department of Defense (DoD) has now made regulations for the use of dietary supplements in meals. [viii] Some food additives, even those that come from natural sources like plants, have been found to have no nutritional significance. The DoD decided that what doesn’t help one’s diet, should not be consumed. More importantly, the DoD is educating service members on the reasons behind these nutritional regulations.

Nutrition starts with education. Health policies should be in education policies, and this education should be for everyone.

[i] Matthews J, (2011). 2011 Food & Health Survey: Consumer Attitudes Toward Food. International food Information Council Foundation.
[ii] Global Nutrition Report (2016). From Promise To Impact: Ending Malnutrition by 2030. World Health Organization.
[iii] Devries S, Dalen J, Eisenberg D, Maizes V, Ornish D, Prasad A , Sierpina V, Weill, A, and Willett W. (2014) A Deficiency of Nutrition Education in Medical Training, The American Journal of Medicine. Vol. 127, I-9, PP 804-806.
[iv] Eisenberg D, and Burgess J (2013). Nutrition Education in the Era of Global Obesity and Diabetes: Thinking Outside the Box. Journal of the Association of American Medical Colleges. Vol 90-I:7 pp 854-860.
[v] Adams K, Kohlmeier M, and Seisel S (2010). Nutrition Education in the U.S. Medical Schools Latest Update of a National Survey. Acad Med. Doi: 10.1097/ACM.0b013e3181eab71b.
[vi] Cluss P, Ewing L, King W, Reis E, Dodd J, and Penner B (2013). Nutrition Knowledge of Low-Income Parents of Obese Children. Society of Behavioral Medicine. Doi: 10.1007/s13142-013-0203-6.
[vii] Food Research & Action Center (FRAC) (2015). Why Low Income and Food Insecure People are Vulnerable to Obesity.
[viii] Department of Defense (2013). Dietary Supplements: Policy, Science and the DoD.

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Getting a Healthy Sleep: Tips and Advice for Military Caregivers Mon, 12 Sep 2016 12:00:48 +0000 Sleep restores the body from a day of work and play. Sleep is essential to your health and wellbeing. Yet for caregivers, sleep disturbances are prevalent, resulting in decreased function, physical pain, fatigue and serious medical problems. [i] Sleep loss in caregivers can be directly related to the stress of caregiving. [i] This is because caregivers are likely to put the needs of others ahead of their own and sometimes, neglect to care for themselves altogether. [ii]

Sleep problems and related issues are more common in female caregivers. [iii] Did you know that 40% of female caregivers who care for a veteran or service member suffer from insufficient sleep? iii Luckily, there are ways to prevent sleep deprivation.

Sometimes the conventional ways of falling asleep when you are having a difficult time don’t help at all. However, mind-body practices, supplements and herbs are known to be aids in getting a healthier sleep. [iv]

Mind-Body Therapies for Sleep

The connection between your mind and body is essential to your state of wellbeing. The following mind-body therapies are recommended by the U.S. Department of Health and Human Services as helpful sleep-inducing therapies.

  • Progressive relaxation
  • Music therapy
  • Yoga
  • Hypnotherapy
  • Massage therapy
  • Acupuncture

Getting a good sleep is not only determined by what you do to rest your body and mind. What you put into your body or what you fail to consume, also affects your sleep patterns.

Herbs and Supplements

Your body needs certain nutrients to function properly. Sleeping on the daily basis means that your body is functioning well. Often, low levels of melatonin in the body cause the inability to sleep or interrupted sleep. Melatonin supplements or other supplements that produce melatonin can be an effective sleep aid.iv However, it is important to know that dietary supplements aren’t for everyone. Some bodies reject supplements. Others experience side effects, like nausea. [v]

There are more natural ways to sleep. Herbs come from plants and are less likely to cause side effects, with a few exceptions. These herbs have been tested by scientists and are known to treat insomnia:

  • Chamomile
  • Kava
  • Valerian

Herbs are not only ingested. For some people, aromatherapy may be more helpful in aiding sleep than drinking herb infused teas or eating them with food.

Why Can’t You Sleep

Are you unable to sleep because your wounded warrior is unable to sleep? The best way to deal with this challenge is to understand the cause.

Sometimes Post Traumatic Stress Disorder (PTSD) or severe combat-related injuries like Traumatic Brain Injury (TBI) cause service members and veterans to lose sleep or have interrupted sleep. The U.S. Department of Veterans Affairs finds that these sleepless nights are likely due to the following reasons [vi]:

  • They are expecting an attack
  • They are thinking negative thoughts
  • They are abusing substances
  • They are having nightmares or disturbing dreams
  • They have underlying medical issues (pain, PTSD, etc.)

If you notice that the service member or veteran that you care for is not sleeping, it is important to take action and seek help. You can try changing the place where you sleep or keeping an exact bedtime.

Maybe it is YOU that is experiencing PTSD. This is not uncommon. However, just like the tips for your wounded warrior, try adding self-care to your routine, a change of setting or staying on schedule. If the sleepless nights for you or your wounded warrior continue, see a medical professional. [vi]

Why Sleep Is So Important

Sleeping resets your body. There are specific areas of the body that are especially affected when you do not get enough rest. They are:

  1. The Nervous System

    Sleeping helps your memory, mood and ability to learn. With eight full hours of sleep, this system is completely restored.

  2. The Cardiovascular System

    Like every other part of your body, the heart needs rest. During sleep, your heart rate  and blood pressure lowers. Though your heart rate may rise during REM sleep because of dreaming, this exercise has been found to be excellent for cardiovascualr health.

  3. The Endocrine System

    Your hormones are balanced through good REM sleep, as it prompts the release of growth hormones for youth and allows for the mass repairs of cells and tissues. Also, as you sleep, your body produces more cytokines, which are cellular hormones that contribute to your immune system. REM sleep restores the Endocrine System, preventing stunted growth in children, illnesses and even miscarriges for women.

As a caregiver, you need sleep in order to have the strength and focus to perform your daily duties. Practice self-care and improve your quality of sleep to ensure that you are able to live a happy and healthy life. Your happiness and healthy lifestyle will sure be passed along to your wounded warrior.

This article is a part of Samueli Institute’s Caregiver series. Read more articles. Also be sure to download “The Caregiver’s Companion: Self for Health in Mind, Body and Spirit,” a guidebook written especially for military caregivers in October.

[i] McCurry S, Song Y, Martin J, (2015). Sleep in Caregivers: What we Know and What we Need to Learn. Curr Opin Psychiatry, 28(6):497-503. doi: 10.1097/YCO.0000000000000205.
[ii] TanielanT, Ramchand R, Fisher M, Sims C, Harris R, and Harrell M, (2013). Military Caregivers: Cornerstones for Our Wounded, Ill, and Injured Veterans. RAND Corporation.
[iii] Institute for Veteran and Military Families, Syracuse University (2013). Womens Health Issues; 23(4), 225-232.
[iv] U.S. Department of Health and Human Services (2014). Sleep Disorders and Complementary Health Approaches: What You Need To Know. National Institutes of Health, NCCIH.
[v] Bruso J, (2015). Why Might You Feel Nauseous After Taking Vitamins?
[vi] Department of Veterans Affairs. Sleep and PTSD. PTSD: National Center for PTSD.

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Art Therapy for Military Caregivers: Connect with Your Inner-being Mon, 05 Sep 2016 12:00:52 +0000 The role of art in healing has existed since the beginning of time. The oldest cave painting is over 40,000 years old, located in Cantabria, Spain. [i] In the years following, there is documented evidence of more expressive art from all over the world. Since the 1940s, art in therapeutic form has been a successful treatment, by helping individuals better understand and express inner thoughts and emotions. [ii]

Support for art therapy has gotten a boost with backing from the White House. First Lady Michelle Obama and Second Lady Dr. Jill Biden endorsed the practice of art therapy for veterans, caregivers and their family members, through the creation of Operation Oak Tree. They believed that art therapy would help empower, and strengthen the veteran and military family population. But for caregivers especially, art therapy is one way to practice self-care. [iii]

Who are Military Caregivers?

You are a military family caregiver if you are in the circle of support surrounding a wounded, injured or disabled service member or veteran. Roles include being a husband or wife, parent or child, friend, relative, neighbor or acquaintance.

As a caregiver, so often you hear that it’s important to take care of yourself. But for caregivers like you, who spend so much time and effort caring for someone else, it’s important to explore self-care options that work for you and your family. Art therapy is one of many options.

How is Art Therapy Used?

The key is to create or verbalize images, coming from inside of yourself rather than those that surround you.

Art therapy uses art media and the process of creation to express invisible wounds. This therapy form is being used by the Department of Defense (DoD) and Department of Veterans Affairs (VA), to help service members, veterans and their families deal with both post-traumatic stress (PTS) and the daily stresses and strains of life.[iv] Research shows that expressive art therapy can be useful for treating Post Traumatic Stress Disorder (PTSD), and is most effective when combined with different forms of therapy.iii However, art therapy is not merely for mental health; it is also used in other areas [v]:

  • Medicine
  •  Education
  • Forensics
  • Wellness
  • Private practice

Art Therapy Techniques

Techniques within the practice of art therapy differ. In the “creation of art” technique, you are creating images, whereas, during “active imagining,” you are creating the images in your mind or visualizing them. Other techniques like “gestalt” methods, requires art therapists to use the imagery to inspire a discussion. The gestalt method is meant to create awareness. Last, the “third-hand approach” involves you and your therapist creating an image together, without the therapist interrupting your true thoughts or feelings.

Because the hardships of deployment and other challenges of military life radiate out to the entire military family, using art therapy can help you and your children cope or heal. To appeal to both children and adults, there are different ways to express oneself through art. [v]

Ways to Express Yourself with Art

  • Painting
  • Finger Painting
  • Doodling
  • Scribbling
  • Drawing
  • Using molding clay
  • Carving
  • Making pottery
  • Making cards
  • Using textiles
  • Making collages

Though the various ways of being artistic require different skills, they all work towards a common goal. Art therapy is designed to increase self-awareness, enhance cognitive abilities, and help you cope with symptoms of stress and trauma. [vi]

Is It Really Effective?

The ability of art therapy to help people is measured by the kind of intervention, and length of the treatment. [vii] The progress of individuals being treated through art therapy significantly increases with more than 8 weeks of therapy but decreases when the treatment is longer than two years. In the end, those who use art therapy to heal from stress, symptoms of pain, mental illnesses, addiction and other ailments, usually see some improvement. [viii]

The benefits of art therapy are mostly personal, involving an understanding of one’s self, and painting a picture of your inner being. This portrait is essential for you to be able to thrive in the outside world.

[i] Art Therapy Journal, ” The History of Art Therapy.” 

[ii] Fjorback L, Wallach H, “Meditation Based Therapies: A Systematic Review and Some Critical Observations. Religions 2010, 3, 1-18; doi:10.3390/rel3010001. 
[iii] Art Therapy Blog, “Operation Oak Tree Helps Military Families by Integrating Therapy Through Arts.” 
[iv] Art Therapy Blog, “Art Therapy: A Useful Treatment for Veterans with PTSD.”
[v] American Art Therapy Association, “What is Art Therapy?”
[vi] Good Therapy, “Art Therapy.”
[vii] Art Therapy Blog, “What is Art Therapy.”
[viii] Uttley L, Scope A, Stevenson M, “Clinical Effectiveness of Art Therapy.” NIHR Journals Library, Health Technology Assessment No. 19.18.

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Study Clarifies Traumatic Brain Injuries and Headache Connections Fri, 19 Aug 2016 18:30:00 +0000 A recent study confirmed the link between traumatic brain injury and headaches or migraines.

The article published in the July 2016 Medical Surveillance Monthly Report also shows how the prevalence of headaches for service members with TBI increases with the severity of the injury.

“Compared to service members without TBI, those who sustained a mild TBI were 3.99 times more likely to have a headache or migraine, and those with a moderate/severe TBI were 8.89 times more likely.”[i] – Vincent P. Beswick-Escanlar, MD, MPH et al. (July 2016, MSMR)

Source: Medical Surveillance Monthly Report

Source: Medical Surveillance Monthly Report

This highlights the importance of finding sustainable treatment options for service members experiencing headache due to mild to moderate TBI. Another study also published this year provided evidence that acupuncture should be a standard form of treatment for chronic headaches due to TBI. Researchers discovered that both Traditional Chinese Acupuncture (TCA) and Auricular Acupuncture (AA) were more effective for reducing pain and improving headache-related quality of life than usual care without acupuncture.

Learn more about the Samueli institute study on acupuncture for headache here.

[i] Increasing Severity of Traumatic Brain Injury Is Associated with an Increased Risk of Subsequent Headache or Migraine: A Retrospective Cohort Study of U.S. Active Duty Service Members, 2006–2015

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Individualizing Prevention: A Response to Obama’s Precision Medicine Initiative Wed, 17 Aug 2016 13:00:12 +0000 A message from Wayne B. Jonas, MD

A message from Wayne B. Jonas, MD

Samueli Institute has long supported the exploration of how healing happens. But exploring the linked question—how preventable disease happens—is also a priority. Diseases don’t merely pick and choose individuals. They arise when our continuous healing processes breakdown.

Scientists are searching for an answer to the question of why some people are affected by diseases like addiction, diabetes and cancer, while others are not. What’s the interplay between genes, behavior, social determinants of health and perhaps as of yet unknown factors? Could we prevent chronic illnesses if we could track and enhance how the body operates to keep us free of them?

Current statistics suggest that white Americans are more susceptible to certain diseases like breast cancer and addiction, according to the Department of Health and Human Services. Individuals who are African American, Mexican American, American Natives, or Asian American and Pacific Islander are more likely to suffer from Diabetes (Type II), Hypertension, Heart Disease and Stroke. Race/ethnicity is only one of the many factors that contribute to one’s chances of contracting diseases. The issue is that no one knows what the definitive factors are and why they matter.

To finally find an answer, the White House has launched the Precision Medicine Initiative (PMI), a new research effort to improve the American healthcare system. The initiative will include studies, infrastructure building, and health policy efforts to streamline preventative healthcare measures and uncover the many determinants of health.

The PMI, which President Obama first announced in 2015, was launched in response to the upsurge of preventable disease in the country. Obama stated that the idea of there being an “average patient,” is unrealistic and that “one size does not fit all,” when it comes to both preventative care and treatment for disease. The PMI study will be one of the first studies to look at disease prevention in such a broad way.

One cohort that has emerged as a result of Obama’s PMI, is a series of studies conducted by the National Institutes of Health (NIH), who have contributed $55 million to the study of disease prevention that focuses on the genetic and biological differences in humans. Perhaps this part of PMI should be called Precision Prevention.

“This range of information at the scale of one million people from all walks of life will be an unprecedented resource for researchers working to understand all of the factors that influence health and disease. Over time, data provided by participants will help us answer important health questions, such as why some people with elevated genetic and environmental risk factors for disease still manage to maintain good health, and how people suffering from a chronic illness can maintain the highest possible quality of life. The more we understand about individual differences, the better able we will be to effectively prevent and treat illness.” –NIH Director, Francis S. Collins, M.D., Ph.D.   

Past Research

Previously, large studies like the Human Genome Project (HGP) discovered that it was possible to activate and deactivate genes by changing lifestyle. This means that the pre-existing genes for conditions like obesity can be redirected by nutrition and exercise. The question that the PMI cohort seeks to answer that the Genome project did not is, does this remain true when factors like ethnicity, location and culture are brought into the equation?

The widespread belief is that these differences do contribute to health. But so far, the only issue researchers have looked into is health disparities associated with ethnicity and income.

Creating Human Flourishing

At Samueli Institute we acknowledge health disparities as issues that can, for the most part, be solved with health policy change and through advocacy, and multi-sector involvement in the promotion of health and wellbeing. Also, through integrating more holistic and integrative practices into everyday care, more Americans can be resilient and remain healthy throughout their life. Most of our work in this area falls under one important initiative, Wellbeing in the Nation (WIN).

Wellbeing in the Nation (WIN)

The Institute has gathered leaders from all levels of the public and private sectors to write recommendations for improving the health and wellbeing of the nation. This includes fusing health with determinants like socioeconomics, providing recommendations for leadership and deciding which healthcare costs are essential and which can be eliminated with preventative health measures.

The Creating Wellbeing Leadership Group, which oversees WIN, not only identifies the key problems with the American healthcare system but also recommends ways to improve it. Part of that is through advocating for evidence-based research for individualized care.

What is Precision Medicine?

The White House has described precision medicine as “healthcare tailored for you.” This description is important, as it recognizes people’s unique characteristics, which often contribute to their health and wellbeing.

NIH hopes to draw participation from various agencies in the federal government to ensure its success. The PMI study will begin in late 2016 and is expected complete by 2020.

We at Samueli Institute are pleased that our continued priority of health prevention and healthcare improvement are priorities of the White House as well. When patients receive individualized, patient-centered care in a health system in which preventative health measures are just as important as the treatment of disease, we will all prosper.

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New Legislation to Address Opioid Crisis Mon, 18 Jul 2016 13:49:06 +0000 A message from Wayne B. Jonas, MD

A message from Wayne B. Jonas, MD

Each day more than 50 people in the U.S. die from prescription pain relievers. When you add the deaths related to heroin, that number jumps to 80 per day.[i]  Last week Congress passed legislation that hopes to reduce those figures. The Comprehensive Addiction and Recovery Act (CARA), S. 524 was passed by the Senate in a nearly-unanimous (92-2) vote.  Having been previously passed by the House, it was recently signed by President Barack Obama.

Update: President Obama signed the Comprehensive Addiction and Recovery Act of 2016 on July 22nd. Read the White House press release.

In these days of bipartisan politics, passage of the act shows the depth and breadth of the opioid crisis. No one is safe from the opioid epidemic as it crosses both racial and socio-economic lines.

What New Opioid Legislation Means for Pain Care and Integrative Medicine

According to the Community Anti-Drug Coalitions of America (CADCA), the Comprehensive Addiction and Recovery Act is long overdue. But with it comes a solution that encompasses what CADCA refers to as the “six pillars.”

“This is the first major federal addiction legislation in 40 years, and is the most comprehensive effort undertaken to address the opioid epidemic, encompassing all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal.” -CADCA

The bill aims to address the link between substance abuse and prison, and expand access to other drugs that can reverse opioid overdoses (naloxone) and treat addiction (buprenorphine).

Now that the legislation has been signed, the challenge remains for the funding issues to be resolved. Critics of the bill site the lack of funding available to make these changes substantial, but note that passage of the legislation is a step in the right direction.

Need for Integrative Options for Pain

Although this legislation starts to effect changes necessary to combat opioid addition, as an addiction doctor in Kentucky said: “Without integrated care and treatment, adequate resources, societal change and… harm-reduction strategies, etc. — without successful implementation of these things we will continue losing.” -Dr. Mina “Mike” Kalfas in an article in USA Today.[ii]

Many of the individuals who inadvertently became addicted to opioids had been prescribed them to combat acute or chronic pain. It’s clear that both doctors and patients need better pain treatment options. This legislation has a major gap for helping people with pain – non-drug treatments that work for pain.

Integrative Medicine for Military and Veterans

The Department of Defense (DoD) and Veterans Health Affairs (VHA) are leading the way in filling this gap. Section 912 of the Act describes how a new Department of Defense Joint Executive Committee (Pain Management Working Group) will include a focus on non-drug treatments for pain. According to Congress, the working group must work collaboratively with other non-DoD groups and employ complementary and integrative treatments to be successful in pain management for the military and veteran population.

This adds to innovate efforts already in progress by the DoD and VHA.

Education, Research and Patient Options

CARA mentions that there will be additional steps in the areas of education, research and patient-centered treatment. Prior to beginning opioid therapy, non-pharmacological treatments will be offered either in place of, or in addition to opioid therapy. CARA also recommends that training in medical school should be provided on evidence-based pain management therapies.

The bill also states the importance of examining the need, evidence for and use of non-pharmacological opioid treatments. This is of special importance to organizations like Samueli Institute and others who work to build the evidence base for healing and wellbeing.

For example, our latest study showed how acupuncture can treat a common pain symptom of Traumatic Brain Injury in our warfighters. Read the article in the American Academy for Pain Management’s Blog: Acupuncture More Effective than Usual Care for Headaches due to Traumatic Brain Injury.  These alternatives to opioids are many and they deserve attention, study and respect within the medical community. An additional example is a series of analyses the Institute conducted showing that massage impacts chronic pain.

As a first step, we are hopeful that passage of this bill shines the spotlight on the needs of doctors, patients and researchers to find and use more integrated and integrative care for pain as we move from treatment to healing.



[i] Center for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Mortality File. (2015). Number and Age-Adjusted Rates of Drug-poisoning Deaths Involving Opioid Analgesics and Heroin: United States, 2000–2014. Atlanta, GA: Center for Disease Control and Prevention. Available at 2014.pdf.


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The 3 a.m. Grandpa: A Father’s Day Blog Fri, 17 Jun 2016 12:30:24 +0000 A message from Wayne B. Jonas, MD

A message from Wayne B. Jonas, MD

I love 3 a.m. It was probably ingrained in me from my medical practice. Thirty years ago, during residency, I was on call every third night and I got up multiple times at 3 a.m. to attend to patients. Even later, after the training, if a patient called, I got up and went in to see them. I am used to getting up at 3 a.m. and, frankly, I love that time; a time so silent and calm, when most humans are asleep.

So when my first grandchild was born, I volunteered to do the 3 a.m. shift. My daughter-in-law was recovering from a traumatic birth injury and she, my son and new grandson moved to our home until she could get back on her feet.

Taking the 3 a.m. shift involved sleeping in the baby’s room and when he awoke, going down and warming up a bottle of breast milk, feeding him, changing him and getting him back to sleep. After about three or four times of this, we got to know each other, my grandson and I. First he would want to eat, then be changed, then be held. I held him with his head down in the crook of my elbow and we stared at each other in the silence and semi-darkness. At first, I thought that he would have gone back to sleep at that point – but usually, he didn’t.

First he would want to eat, then be changed, then be held. I held him with his head down in the crook of my elbow and we stared at each other in the silence and semi-darkness. At first, I thought that he would have gone back to sleep at that point – but usually, he didn’t.

So often we would simply look at each other. He is a bright, open, curious person; that sort of deeply-staring-type of baby and I was mesmerized. Even in the semi-darkness, we would just stare deeply into each other’s eyes. It was then that an incredible magic would come over me – a deep, meditative, relaxed feeling. I guess you could call it love on steroids, or love with a kick.

I’ve been a life-long meditator, but this was more than the deepest type of meditation I’d ever experienced. He would always win the staring contest and the first-to-fall-asleep contest. It was then that my mind would begin to wander, and where it wandered was to the wonder about this child – my first grandchild; and about other children being born.

I wondered what was going on in his little brain and how many millions of neuro-connections were happening per minute. I wondered if he had enough nutrition to make those connections high quality. He was, thanks to the toughness and resilience of his mother and to modern breast pumps, getting breast milk exclusively. I wondered if she had enough Omega-3 fatty acids in her breast milk for him.

So many children don’t get enough nutrition or they get exposed to toxic substances, so those millions of connections don’t happen properly. I wondered if he felt safe and loved; actually, there was little to doubt about that. We had a houseful of people to love him and he seemed happy and content most of the time. I thought about the hundreds of thousands, perhaps millions of children who don’t have that, whose childhood from the very beginning is full of toxic stress that we know can set them off on a life-long course of floundering rather than flourishing.

But mostly I wondered how many more times I would get to witness the miracle of being “The 3 a.m. Grandpa”. Probably not many, I thought, and indeed that was true. Soon I lost the privilege of having the 3 a.m. shifts when his mother recovered and they moved back to their own home.

Soon he grew up to the ripe old age of five months and no longer wanted to sit and stare at night; he wanted to get up and do things. Now am a “double father” – a father to my son and daughters and a grandfather to my grandson. I can now appreciate what I couldn’t the first time as a father: the wonder and miracle of 3 a.m.

I still wake up periodically at 3 a.m. Sometimes it’s because I’m worried, or have too much to do, or have drunk too much coffee. But now when that happens I think about the memory of that deep dive into those few precious times that I was “The 3 a.m. Grandpa.”

Happy Father’s Day 2016 from Wayne B. Jonas, MD and Samueli Institute!

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A NATO Special Edition of Medical Acupunture Wed, 08 Jun 2016 12:30:28 +0000 The U.S. military is working closely with its allies to improve how soldiers heal from the invisible and visible wounds of war. This requires a shift from a traditional approach to more integrative care. Currently, the U.S. Military is making strides to implement this new model for healing.

In support of this effort, the journal Medical Acupuncture published a special edition, solely focused on innovative ideas for the future of military health with a focus on integrative medicine (IM). These ideas sprang from the North Atlantic Treaty Organization’s (NATO) Task Force on Integrative Medicine, established in 2011.

“This Special Issue of Medical Acupuncture…presents the first guidelines for NATO to incorporate IM into medical systems to meet future health challenges,” said Richard C. Niemtzow, MD, PhD, MPH.[i]

As part of the NATO Task Force, subject matter experts represented France, Italy, Hungary, Germany, The Netherlands, and the United States. Guests from the United Kingdom and Korea also participated to explore the use of integrative medicine in the military.[ii]

In the executive summary, Richard P. Petri, Jr., MD, FAAPMP, FAAIM, COL MC, highlighted the years of “grassroots” implementation of Complementary and Alternative medicine within the U.S. Military infrastructure. Although these articles are in the Medical Acupuncture journal, acupuncture is but one aspect of the big picture of integrative care.

It is time to make integrative care our primary choice for not only treating our warriors but also by preventing illness in the first place.

The special edition includes the history of NATO’s Task Force on Integrative Medicine (HFM TF 195,); the efficacy of Battlefield Acupuncture (BFA) in treating pain; and information about BFA’s latest effort, the Acupuncture Training Across Clinical Settings (ATACS) program.

What follows are summaries of the articles that Samueli Institute helped author:

Historical and Cultural Perspective on Integrative Medicine

Richard P. Petri, Jr., MD FAAPMR, PAAIM, COL, MC, Roxana Delgado, PhD, MS, and Kimberly McConnell, EdD

Modern healthcare systems stand on traditions from the world’s medical past. Because these traditions are passed down, old health systems are adopted and implemented into new systems. With examples from Ancient Mesopotamia, India, China, Ancient Greece and Ancient Rome, this journal article questions the very institutions upon which our healthcare systems are built, leaving the question: Is tradition a bad thing for healthcare?

There are lessons to be learned when studying past medical institutions. As this article reads, “mistakes can be avoided,” and to build an impenetrable institution, we must know if the foundation is sound. Read the article here.

Integrative Medicine Experience in the U.S. Department of Defense

Richard P. Petru, Jr.,MD, FAAIM, COL MC and Roxana Delgado, PhD, MS

The U.S. Military by reputation is innovative. In recent years, there has been a global healthcare evolution in which health systems are leaning more toward integrative medicine and away from standard methods of care. As a result, the usage of integrative medicine services has increased by about 34 percent in the United States. The military has followed this civilian shift with 45 percent of service members, veterans and their families seeking integrative care services.

The current goal of the U.S. Department of Defense is to pile innovation on top of innovation. This process will involve telemedicine and the use of mobile technology to track the health of active duty service members in order to increase readiness across the military population. Read the article here.

Integrative Health and Healing Practices Specifically for Service Members: Self-Care Techniques

Richard P. Petri, Jr., MD, FAAPMR, FAAIM, COL MC, Joan A.G. Walter, JD, PA, and Jon Wright

Healthcare and health are different things. One of the components of health that allows systems to succeed is aligning the services (found in healthcare) with the need of each individual patient. This is known as patient-centered care. In NATO, patient-centered care can be difficult because what the patient need varies across different cultures.

The job of the Task Force for Integrative Medicine in NATO has been to centralize self-care to ensure that each service member receives the type of care they need and have the opportunity to live a life of good health. This method of integrative health involves the use of different integrative modalities, which guide patients in their self-care journey. The modalities include:



Energy Practices

Herbal Medicine

Meditative Practices

Movement Practices

This article holds that self-care places the healing power in the hands of the patients themselves. This, in turn, causes patients to take responsibility for their health, helping them to make better life choices that improve their overall wellbeing. Read the article here.

Integrative Medicine and the Trauma Spectrum Response

Wayne Jonas, MD, Joan Walter, JD, and Richard P. Petri, Jr., MD FAAPMR, FAAIM, COL MC

Global conflict is a recipe for trauma. The long wars in Iraq and Afghanistan unsurprisingly produced veterans who had “long-term symptomatic and functional difficulties” coping with trauma.  These cases of Post-traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI), lead to a chain reaction known as the Trauma Spectrum Response (TSR).

Trauma can have both mental and physical effects, which can lead to problems like chronic pain or substance abuse.Read the TSR article.

Among these four articles in which Samueli Institute contributed research and thought leadership, are many others that highlight the current state of global health, the state of health in the military and how IM is the key to building a flourishing society. Access the full supplement here.




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Creating the Optimal External Healing Space Tue, 07 Jun 2016 19:24:49 +0000 Your external environment is where you live, work and play. Having great experiences in these places requires a bit of creativity. Perhaps you change the color of the walls in your home, or decorate your workplace with greenery. Maybe in your backyard, you plant flowers that give off a wonderful aroma. All of these originally normal spaces become healing spaces when you use your creativity to make them your own.

Healing spaces are those that minimize stress, allowing you to feel comfortable and happy. Some external environments do not promote healing and sometimes, people don’t realize that it is causing them harm. The key is to be aware of your surroundings. With awareness, you can brainstorm on what you can do to improve the things that you have the ability to change.

Inside Spaces

There are many places that you spend a lot of time in. Your home, you classroom, your office, and even your car can potentially become healing spaces. To decide if these spaces are good for you or not, ask yourself the following questions:

  1. What does each place look, sound, smell or feel like?
  2. What feelings do they evoke?

Once you answer these questions, it will become very clear to you that some of your spaces are healing spaces and some are not. Making small changes to these spaces, for example, keeping them cleaner or perfuming them with a pleasant aroma, can transform them into healing spaces. However, for some inside spaces, which may be surrounded by people, it is important to have an oasis.

Healing spaces should awaken spirituality, especially at home. In some cases, the best way to awaken spirituality is through connection to nature. So at home, your retreat may be outdoors.

Outside Spaces

Just as you sought out healing inside spaces, search for outside spaces that nurture you. If you cannot find permanent outside spaces that evoke healing, consider these outdoor activities:

Gardening 600_400

  • Gardening
  • Watching sunrise/sunset
  • Eating lunch outside
  • Walking through the park
  • Bird watching
  • Sitting by a fountain
  •  Going to the beach

Exposure to nature is great for your health and there are ways to track your improved wellbeing as you visit these outside healing spaces. Ask yourself, how does this place affect your mood, or, how does it affect your energy level.

Exploring Mindfulness Outdoors

Sometimes visiting places just isn’t enough. But when you arrive, the things you choose to do can change your perception and transform that space into a healing space. Meditate in the garden or on the beach and you’ll find yourself renewed in a transformed space.

You can learn more about the external environment in our book Optimal Healing Environments: Your Healing Journey.

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Meditation and the Relaxation Response Wed, 01 Jun 2016 12:30:20 +0000 In our current healthcare system, a person’s overall health is balanced by pharmaceuticals, surgery, and self-care, according to Herbert Benson, MD, author of “The Relaxation Response.” As a result of this healthcare model, between 60-90% of healthcare visits are for conditions likely caused by chronic stress. It is his professional belief, that through meditation and eliciting the relaxation response, the harmful effects of chronic stress can be reduced or even eliminated.

The Relaxation Response

The Relaxation Response is defined as the state of deep rest that alters one’s emotional and physical responses to stress.

“The train of our everyday thought is broken when two basic steps that elicit the relaxation response are followed.” Dr. Benson

The two steps, to which Dr. Benson refers, begin the process of transporting a person into this place of deep rest. They are:

  1. The repetition of a word, sound, prayer, thought, phrase or muscular activity.
  2. The passive return to the repetition when other thoughts intrude.

There is no single way to meditate, and no form of meditation is better than the other. Meditation can be a calm or a state of activity. It all depends on the person. What is most important, however, is the healing mechanism in meditation, which is known to relieve stress and cure stress-related illnesses.

How Meditation Helps

It is believed that meditation as a method for relaxation leads to a physical response. In many cases, that physical response initiates a healing process. Meditation can be applied to anyone’s life and has come to be recognized as a helpful therapy for the following illnesses:

  • Chronic Stress
  • Hypertension
  • Cardiac Arrhythmia
  • Chronic Pain
  • Insomnia
  • Anxiety
  • Hostility
  • Depression
  • Premenstrual Syndrome
  • Infertility
  • and more…

How To Meditate

The goal of meditation is not to empty your thoughts, as is the common misconception; the goal is actually to focus on one particular thought repetitively. To begin, Dr. Benson recommends following these first five steps (see all), which lead to the relaxation response:

  1. Sit quietly in a comfortable position
  2. Close your eyes
  3. Relax all the muscles in your body
  4. Breathe through your nose
  5. Continue for 10 to 20 minutes

Overtime life’s changes become more profound and as stress increases so does the potential for poor health. Meditation can be the key to wellbeing for families and in work environments. Practitioners like Dr. Benson are recommending meditation even to children, who during their adolescent years have a hard time managing stress.

Samueli Institute recently launched to bring together the evidence behind integrative medicine, explore the implementation of mind-body practices in standard care and discuss how the role of the brain and the mind in health and resilience can positively impact the future of our healthcare system. Be sure to visit the site.


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Creating Healing Spaces for Service Members and Veterans with Dr. Joseph Bobrow Wed, 25 May 2016 13:00:44 +0000 Waking Up From War Joseph Bobrow

In this episode of On Human Flourishing, Joseph Bobrow, Roshi, Ph.D. talks to host, Wayne B. Jonas, MD to discuss creating healing spaces for service members and veterans.

A clinical psychologist and psychoanalyst Joseph was Chief of Psychology and Director of Training of the Department of Psychiatry at Kaiser Hospital and Medical Center in South San Francisco. He is also a Zen Master and served on the Board of Directors of the Interfaith Center at the Presidio of San Francisco, located at the Main Post Chapel. Joseph teaches and writes on the interplay of Western psychology, Buddhism, and the beloved community in transforming human suffering, including war-related trauma. Dr. Bobrow’s latest book “Waking Up From War,” is the story behind his non-profit organization, the Coming Home Project.

The research was featured by the DCoE in its review of reintegration programs and was the only program with a research evidence base.

Bio Credit: Coming Home Project 

On Human Flourishing is the official bi-weekly podcast of Samueli Institute, hosted by Wayne B. Jonas, MD. Subscribe to our podcast on iTunes.

]]> 0 In this episode of On Human Flourishing, Joseph Bobrow, Roshi, Ph.D. talks to host, Wayne B. Jonas, MD to discuss creating healing spaces for service members and veterans. A clinical psychologist and psychoanalyst Joseph was Chief of Psychology and Dir... In this episode of On Human Flourishing, Joseph Bobrow, Roshi, Ph.D. talks to host, Wayne B. Jonas, MD to discuss creating healing spaces for service members and veterans. A clinical psychologist and psychoanalyst Joseph was Chief of Psychology and Director of Training of the Department of Psychiatry at Kaiser Hospital and Medical Center in South San Francisco. He is also a Zen... Samueli Institute Blog clean 19:23
The Healing Intention: Battling Habitual Behavior Wed, 25 May 2016 12:30:00 +0000 Let’s face it—we all do things that we know are not healthy. What is important is that these behaviors don’t become habits that negatively affect our wellbeing.

“Habits play an important role in our health. Understanding the biology of how we develop routines and embrace new ones, could help us changes our lifestyles and adopt healthier behaviors.” –Nora Volkow, MD, National Institutes of Health

Forming Habits

In many cases, habits are formed from repetition or routine. There are certain activities that we do so often, we begin to do them unconsciously. Once we lose consciousness, routines become habits that are very difficult to quit. But difficult does not mean impossible.

Good habits and bad habits in the brain would look surprisingly similar if we were to view them under a microscope.  But according to Dr. Russell Poldrack, a neurologist at the University of Texas-Austin, certain habits, like those that bring pleasure, require much more work to curb.

“There’s one important difference-If you do something over and over, and dopamine is there when you’re doing it, that strengthens the habit even more. When you’re not doing those things, dopamine creates the craving to do it again. This explains why some people crave drugs, even if the drug no longer makes them feel particularly good once they take it.”

Breaking Bad Habits

Bad habits, even those formed by pleasurable experiences, can be broken. This is achieved by developing a healing intention. This is a conscious mental choice to improve your health and it is accomplished through awareness, intention and reflection.


Awareness is a component of your internal environment, which can dictate your behaviors and thereby prevent or end habits. Being aware means understanding your body and the signs it sends to you, as well as being able to interpret your thoughts and feelings. Ask yourself; why do I smoke? Why do I binge drink? Why do I over-eat? Once you have answers, you can begin to set goals that will get rid of your bad habits.


Getting in touch with your inner-self is a challenge, but it is the key to develop the intention to heal. Some do this by prayer, meditation or by sitting quietly and relaxing. By making this connection, it is possible to direct your intention to bring this sense of peace and healing to yourself and others in your life.


Looking back at your experiences allows you to learn from them. A way to do this is to record your life’s events in a journal. Reflection on these past experiences, especially on occurrences that lead you to habits like addiction, can help you to understand who you are, what you believe in and what your place is in the world.

Experiencing Personal Wholeness

Personal wholeness is the sense of wellbeing that you feel when the mind, body and spirit are balanced. At this point, you will feel like you most authentic self and your consciousness is heightened, allowing you to prevent bad habits from reforming and live a healthier life.


You can learn more about habits and behavior in our book, Optimal Healing Environments: Your Healing Journey

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HOPE for Pain: From Treatment to Healing Mon, 16 May 2016 12:00:27 +0000
A message from Wayne B. Jonas, MD

A message from Wayne B. Jonas, MD

The woman (we will call her Joan) was 45 years old, and she did everything she could for her health. She ate right, worked out, took vacations, worked hard, and had a great family. But 15 years ago she was in a motor vehicle accident and sustained whiplash on her right side.  Although there was no severe physical damage, she began to develop neck stiffness and pain down her shoulder that was intractable.  It was then that her 15-year journey of pain began.

Over that 15-year period, Joan was diagnosed with multiple other conditions including depression, anxiety, post-traumatic stress disorder (PTSD), neuropathic pain and neurosis.  She continued trying to maintain as healthy a life as possible through exercise, physical therapy, eating nutritious meals and cultivating relationships with friends and family, but like many other patients with chronic pain, it was a challenge for her.

At one point, Joan was taking more than five medications including the opioid Oxycontin. With its strong properties and its tendency to cause addiction, she experienced some trouble quitting the drug. With the help of an inpatient pain specialist, she was able to get off Oxycontin and began taking other medications including Neurontin and Lamictal, which improved both her neuropathic pain and crying episodes.

Still, her pain averaged from 5-7 on a 10-point scale every day and resulted in spasms and stiffness in her neck and right shoulder. So she reached outside the doctor’s office and entered a parallel journey with complementary and alternative medicine. She saw chiropractors, acupuncturists, herbalists, homeopaths and mind-body practitioners. Similar to the effect of the physical therapy, injections and electrical stimulators she got from the regular pain clinics, all of the treatments helped temporarily. Could healing happen, she wondered, after 15 years of suffering?

Finding HOPE

Joan came to me with skepticism to learn how to enhance her own healing capacity using the Healing Oriented Practice and Environment (HOPE) approach. HOPE is a framework for bringing optimal healing practices and environmental practices, especially those that can induce the inherent healing capacity through self-care practices in the life of those with chronic illnesses.

A HOPE assessment involves exploring the inner environment to the outer environment including:

  1. The spiritual environment – finding the meaning or purpose for one’s life
  2. The social environment – nurturing social support, friendship and intimacy
  3. The behavioral environment – medical treatment, lifestyle and alternative practices
  4. The physical environment- the space and place where one lives, works and receives care

A HOPE assessment explores with patients what they are already doing to enhance their wellbeing and uses good science to build upon that and integrate it with medical treatment.

Two things emerged in the assessment of this patient with 15 years of chronic pain:

First, Joan noticed that the acupuncture treatments seemed to provide significant relief – over 95%. However, she said that it didn’t last for more than a few days. During the interview, she mentioned that she wasn’t able to get over the threshold of responding to acupuncture in a longer term way.

Second, she felt that she had been getting better less rapidly after a second motor vehicle accident that occurred about five years after the first. During the second crash, she had struck her head on the dashboard, but had not lost consciousness and the doctors said she had recovered after a few weeks. But it was then that the crying episodes began – she was reminded of the fear she had experienced in her previous accident. She was then diagnosed with PTSD and placed on drugs for depression and to help her sleep. More medication, continued pain.

The Root of her Chronic Pain

When asked about mind-body practices, Joan explained that she had been taught mindfulness and had practiced it for a little while, but with her busy schedule and responsibilities, she found it very difficult to continue.

Her care team and I got together and looked at the situation. Clearly, the acupuncture was stimulating her brain’s pain killers – so-called endogenous opioids. But, as the levels of those natural pain killers went down after each acupuncture session, her brain and spinal cord were no longer holding the pain relief. One suggestion by the team was that the density of opioid receptors in her brain was not sufficient for the repeated acupuncture to “take.” We wondered if the head injury had caused that problem. A PET brain scan demonstrated a reduction in glucose metabolism in the left frontal lobe, just in the area where some of the inhibitory pathways on pain might have been damaged. Research shows that engaging in mind-body practices, such as mindfulness or meditation, 20 minutes a day for at least eight weeks can cause those areas of the frontal lobe to grow and repair. What if we were to regrow the brain and then tried the acupuncture?

A discussion with Joan about our recommendations showed that she was excited to try.  She felt much better and had less anxiety when she engaged in mind-body practices, but it was a matter of being able to integrate it into her daily life.

A behavioral and health coach came in next and worked with her and her family to design a process for 20 minutes of meditation (enhanced with biofeedback) every day. The first attempts were a challenge because as long as she was in her house, she felt overwhelmed by responsibility and family requirements. The behaviorist, therefore, helped her organize a special place in her house, which turned out to be a corner of a bedroom, where she constructed her own little meditation corner. The team worked with the family to ensure this place was isolated and not invaded by the rest of the household. It was her own little healing environment.

A set of reminders supported by both the family and by a phone app resulted in her finding time to engage in more than 30 minutes of mind-body practices every day for more than two months. At that point, a repeat PET brain scan revealed improved neurological growth in the frontal lobe.

Healing from Chronic Pain

Research indicates that it takes 8-12 weeks for opioid receptor density to change after acupuncture, but the hope was that at least now Joan had the right neurological foundation to maintain the acupuncture’s effects. A series of 20 acupuncture sessions using a combination of body and ear points in which ear studs were left in place overnight were initiated. She began a journal to record her response and any other changes she noticed. During a two-month period of twice weekly acupuncture, the swift return of pain after acupuncture she had experienced before began to lessen. Within three months, her pain levels were down to 2 or 3. More importantly, her quality of life, functional capacity, PTSD and ability to tap into her own self-healing capacity had increased. From then on, when she noticed the pain rising, she realized (from her journaling) that often it was because she had not engaged in sufficient self-care, either from inadequate sleep or excess stress to allow her body to stay well and maintain lower levels of pain. She now knew how to “catch it early,” tap into her recovery rituals and prevent the downslide that she had struggled with for the previous 15 years.

Joan had gone from a patient dependent on medical treatments to an individual who had fully integrated healing into her own life.

The chronic pain issue required reframing, provided by the HOPE assessment and a team including a neurologist, an acupuncturist, a behaviorist and a pharmacologist. This was the team most appropriate for the patient; however, it is not the formula for every patient with chronic illness or chronic pain who walks through my door. The HOPE approach provides a process to walk those unique paths toward healing.

The healthcare system of the future will use team-based integrated approaches like this, drawing from both science and the patients experience to help the patient and their unique circumstances and tap into their own healing power. HOPE helps us move from healthcare to self-care and from treatment to healing.

Dr. Wayne Jonas is a leader in integrative medical research and clinical care. Follow Dr. Jonas on Twitter.

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Planting Seeds for National Wellbeing with Senator Tom Harkin Wed, 04 May 2016 18:13:34 +0000 Having a healthy community relies on so much more than the healthcare industry according to former Senator Tom Harkin. The ideal system is one in which entities that control commerce, education, transportation and defense all work together to promote wellness and prevent illness.

“Health is not just in the hospital and doctors offices; it’s in your workplace, school, family, community and even in your church.” -Harkin

As a man from a small farm in Iowa, Harkin grew up understanding that nutrition and exercise play a role in a person’s wellbeing. Serving in Congress from 1975 to 1985, then in the Senate, Harkin supported the notion that Americans had a greater chance at flourishing in a country with a better healthcare system and set out to help build that country.

Preventative Care

As one of the delegators of the Affordable Care Act, Harkin looked at the American health system as a complex institution that needed improvement. This is due, in part, to what Harkin calls “short-sightedness,” or a misconception that health care is about treating patients rather than preventing illness in the first place.

“We’re talking about keeping people healthy, keeping them well, in the first place.” –Sen. Harkin

When trying to put his vision into action, Congress members who, despite the evidence, could not see the benefits to funding preventative healthcare often stonewalled Harkin. In addition, lobbyists who represented pharmaceuticals companies, hospitals, and even medical schools halted his plans.

Our host Wayne B. Jonas, MD with Sen. Tom Harkin

Our host Wayne B. Jonas, MD with guest former Sen. Tom Harkin

Policy and Progress

Realizing that players in the healthcare industry had “their own agendas,” Sen. Harkin took his own agenda one step further by forming the National Prevention Council. This council is comprised of about 16 organizations from various industries that recognize that preventative healthcare will benefit the entire country.

The National Prevention Council monitors the Prevention Fund, and therefore has the power to influence that future of healthcare. Senator Harkin counts on this power, as he believes that the key to human flourishing is self-care and self-management that starts in the home and is also practiced in schools and in the community.

On Human Flourishing is the official bi-weekly podcast of Samueli Institute, hosted by Wayne B. Jonas, MD. Subscribe to our podcast on iTunes.


]]> 0 Having a healthy community relies on so much more than the healthcare industry according to former Senator Tom Harkin. The ideal system is one in which entities that control commerce, education, transportation and defense all work together to promote w... Having a healthy community relies on so much more than the healthcare industry according to former Senator Tom Harkin. The ideal system is one in which entities that control commerce, education, transportation and defense all work together to promote wellness and prevent illness. “Health is not just in the hospital and doctors offices; it’s in your workplace, school, family, community... Samueli Institute Blog clean 33:52
A Response to the CDC Opioid Guidline: Implementing Integrative Therapies into Chronic Pain Care Mon, 25 Apr 2016 13:00:11 +0000 A message from Wayne B. Jonas, MD President & CEO Samueli Institute

A message from Wayne B. Jonas, MD President & CEO Samueli Institute

Opioids are commonly prescribed for pain. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills. But opioid pain medication use presents serious risks, including overdose and opioid use disorder. From 1999 to 2014, more than 165,000 people died from overdose related to opioid pain medication in the United States.

This increased risk for overdose and opioid use disorder drove the Center for Disease Control (CDC) to create a Guideline providing recommendations for safer prescribing practices for clinicians, including the conviction that patients should receive appropriate pain treatment based on a careful consideration of the benefits and risks of treatment options. Although the guideline does not focus broadly on pain management, appropriate use of long-term opioid therapy must be considered within the context of all pain management strategies (including non-opioid pain medications and non-pharmacologic treatments). Supporting the CDC, the Food and Drug Administration (FDA), has launched an action plan due to the concern of the growing opioid overuse, abuse, and overdose in the country.

“Patients with pain should receive treatment that provides the greatest benefit. Opioids are not the first-line therapy for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. Evidence suggests that non-opioid treatments, including non-opioid medications and non-pharmacological therapies can provide relief to those suffering from chronic pain, and are safer.” –Center for Disease Control and Prevention

The CDC guideline has also inspired conversation in the field of integrative medicine about providing alternatives to opioids for chronic pain care. Samueli Institute recently led a dialogue explaining the guideline and non-pharmacologic approaches to chronic pain care.

SI Webinar Looks Into New Approaches

In a webinar hosted to motivate discussion on the integrative, non-pharmacological approaches to chronic pain care, Samueli Institute (SI) and other experts shared the changes that need to occur in the area of pain care.

“What we really need to work towards is a cultural transformation that puts the patient at the center of a personalized, integrated, multi-disciplinary model that emphasizes self-care practices know to reduce pain.” –Bonnie Sakallaris, PhD, RN

The CDC is recommending practice transformation in three key areas:

1.     When to initiate or continue opioids
2.     How to select, determine dosage, choose duration, follow-up or discontinue
3.     How to assess risk and addressing harm

In each of these areas, the CDC recommends working with patients to understand their goal and educate them on the risks and benefits of the treatment proposed.  The recommendations emphasize the importance of non-pharmacologic therapy as a first line approach and in combination with pharmacological therapy.

In SI’s informational webinar, experts discussed not only the importance of the CDC’s opioid guideline but the implementation of the recommendations it provides.

“How would we change the processes in each of our clinics that would support implementation of these guidelines?” asked Diane Flynn, MPH, FAAFP

Additionally, Dr. Flynn suggested that clinics look at the whole person when treating pain. Considering that pain causes other medical issues and often stems from other medical issues, accessing the patient’s level of pain is only one step in treating them. Most importantly, it was decided that limiting the number of days in which a patient is medicated with opioids is best practice.

Dr. Diane Flynn noted that if symptoms of acute pain persisted following three or four days of opioid therapy, a deeper, underlying problem needed to be addressed. Non-pharmacologic therapies, including self-care therapies, allow pain patients to unmask core issues that lead to their pain symptoms; allowing them to heal.

Read Samueli institute’s pain management supplement on self-care; one of the references used to support the data in the CDC’s new guideline.

Samueli Institute’s Chronic Pain Breakthrough Collaborative is now seeking enrollment. Learn more.

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Shattering the Myth of Immutable Genes with Dr. Pamela Peeke Wed, 20 Apr 2016 14:00:42 +0000 For a long time, scientists considered genetics to be the predisposition of a person’s health. In other words, whatever genes a person was born with, determined if that person would develop a hereditary disease, addiction or obesity. New scientific studies have shown that genes are not determinant of a person’s wellbeing. The lifestyle choices a person makes including exercise and eating habits can deactivate the genes that originally would have lead to disease.

Genetics Do Not Define Health

“You thought DNA was your destiny,” said Pamela Peeke, MD, MPH, FACP, FACSM. The science shows that lowering stress hormone levels through exercise and Cortisol levels through therapies like yoga, are the keys to tapping into your good genes. This comes first; everything else is epigenetics, according to Peeke.

The term Epigenetics refers to any process that alters the activity of a gene, without altering the DNA sequence to which that gene belongs.


“We found out that the mass majority of these genes actually have what I kind of call a dimmer switch. We can activate or deactivate the gene based upon our environment.” –Dr. Peeke

Changing Your Destiny

Referencing the genome project conducted by the National Institutes of Health (NIH), Dr. Peeke asserts that you can alter your destiny by accessing the methyl donors, which dampen genes. The methyl donors are accessed through repeated practices that work against bad genes. Failure to practice proper nutrition and exercise routines can apparently have the reverse effect:

“Genetics may load the gun, but epigenetics pulls the trigger.” –Dr Peeke

Because epigenetics can go two ways, Dr. Peeke tells the audience of On Human Flourishing to “assume the vertical,” when it comes to physical activity. And for complete wellness, people can use their minds to set the tone for their overall wellbeing. In closing, Dr. Peeke asks, “When’s the last time you checked in with yourself?”

(i) Epigentics: The Science of Change, Bob Weinhold. Environmental Health Perspectives 2006 Mar; 114 (3): A160-A167

]]> 0 For a long time, scientists considered genetics to be the predisposition of a person’s health. In other words, whatever genes a person was born with, determined if that person would develop a hereditary disease, addiction or obesity. For a long time, scientists considered genetics to be the predisposition of a person’s health. In other words, whatever genes a person was born with, determined if that person would develop a hereditary disease, addiction or obesity. New scientific studies have shown that genes are not determinant of a person’s wellbeing. The lifestyle choices a person makes including exercise and... Samueli Institute Blog clean 45:09
Extended Consciousness: Going Beyond the Five Senses Mon, 18 Apr 2016 11:00:34 +0000 Consciousness is a state of being fully connected. The traditional form of consciousness includes connections with others and also to one’s own thoughts and feelings. But to understand extended consciousness, humans must study the unseen and the unknown.

Harnessing Extended Consciousness

In the real world, harnessing extended consciousness may help relieve pain and suffering from chronic illness through meditative stages and mantras. In other communities, like the military, the ability to tap into one’s extended consciousness could be the difference between life and death.

“A few moments of advance notice could help soldiers take cover before an explosion, help first responders make course corrections for vehicles, and benefit any life-or-death task where seconds count,” -Julia Mossbridge, PhD, Department of Psychology at Northwestern University. Mossbridge is the lead author of a groundbreaking study published in 2012 that showed that the human body can anticipate emotional future events as much as 10 seconds before they occur.

Consciousness is not among the popular mind-body practices, and is often thought of as an illusion or delusion within the medical population. This is despite the scientific research which shows that consciousness is a cognitive ability, accessible to all humans, and is magnified for some.

The Science Behind Consciousness

Science has provided evidence that consciousness includes abilities like anomalous cognition, giftedness, and the ability to change the direction and lapse of time. Though it may seem like a mysticism, research shows that not only do these abilities exist in humans, sometimes it is triggered, without them even knowing. The scientific research on extended consciousness is ongoing and is looking into the following theories:

  •  Quantum mechanics
  •  Ultraweak light emissions
  • Standard physics or cognitive neuroscience
  • New understandings about time
  • Artifact, error or bias

The Future of Extended Consciousness

Scientists believe that understanding extended consciousness and harnessing the ability, could be especially beneficial for the military population. If soldiers are able to tap into knowledge beyond the five senses, the theater of war could be forever changed.




Samueli Institute recently launched to bring together the evidence behind integrative medicine, encourage the implementation of mind-body practices in standard care and discuss how the role of the brain and the mind in health and resilience can positively impact the future of our healthcare system. Be sure to visit the site.


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The Future of Resilience in the Military Fri, 15 Apr 2016 11:00:43 +0000 Resilience is all about being able to function at an appropriate level in any situation with which you are faced, says Geoffrey Ling, MD, PhD, DARPA Biological Technology Office. For the military, the idea of resilience differs from the civilian world, because a person’s community or support system is in a state of constant change. When in the theatre of war, a service member’s community is his or her unit, we members return home, their families become their beacon or focal point. Whether at home or in theatre, resilience can be built through preparation and training in mind, body and spirit– which is guiding the future of technology in military medical research.

Preparedness Leads to Resilience

Building resilience in the military requires service members to be prepared for all that they will face physically, spiritually and morally according to Dr. Ling. This mental preparedness is developed through training: the foundation of how service members learn within these various military communities.

“A prepared mind is really one of the most important things.” -Dr. Geoffrey Ling

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Geoffrey Ling - BMH

“There’s an old saying in the military…train like you fight; fight like you train.”

–Dr. Geoffrey Ling

Repetitive and consistent training leads to preparedness in combat. The same tactic can be applied to everyday life, because the more often a person encounters a certain situation, the more familiar they are with the outcomes and will know how to react to them in a way that is in line with their beliefs.

Morality and the Future of Technology and Military Medical Research

Dr. Ling believes that being prepared morally for the harsh conditions in the theatre of war helps service members when they come home. If service members are trained to stay true to their belief system,  it helps them to do their job in a way that honors themselves and which they can be proud of when they return home. Future technology training tools need to incorporate this facet to fully prepare service members.

“I’d say that’s the biggest gap area in research in technology right now: How do you put the things in it that we all value; the morality, the ethics, the belief system.”

 Training in Mind, Body, and Spirit

Understanding morality within the context of war and in the function of military life is a standing challenge. In efforts to help service members prepare for and heal from traumatic occurrences, the military is incorporating more mind-body therapies into its medical care and training. This can help with increasing performance and post-war difficulties like moral injury, which is caused by disconnect between actions of war and a person’s beliefs, causing a rift between their mind-body and spirit.


Samueli Institute recently launched to bring together the evidence behind integrative medicine, explore the implementation of mind-body practices in standard care and discuss how the role of the brain and the mind in health and resilience can positively impact the future of our healthcare system. Be sure to visit the site.

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Resilience in the Community: How it Works Wed, 13 Apr 2016 11:00:40 +0000 In theory, community resiliency occurs when communities are taught useful steps, which guide them toward wellbeing. However, early into Samueli Institute’s Well-Community Project, it became clear that theory is only the beginning of the solution. To be useful, theory-based project models must be implemented by not only the efforts of governing bodies, organizations, and volunteers; but also by the community members themselves. Success means engaging the strengths of a community and allowing for dialogue across all stakeholders.

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BSakallaris Samueli Institute BMH

Putting Science into Action

After a decade of studying wellbeing in individuals, health systems, and the military; Samueli Institute (SI) experts applied that knowledge to communities, exploring: “What does a well community look like?” as part of a unique program to foster community wellness, the Well Community Project.

The program aimed to go beyond public health and medical care to understand what community wellness is, and how it is developed and sustained. Samueli Institute began by convening stakeholders from communities, as well as activists, academics, and policymakers to probe the process fostering wellness.

The working group adopted a framework first built for the military called Total Force Fitness to intensify their effort. In that initial meeting , participants learned that frameworks were not the core need nor at the heart of the process. Indeed, many frameworks had been developed and they usually left out some of the most important social and historical causes of illness and wellness. What was needed was a much more basic model of human flourishing. Even more important than any model was fostering a process in which the strengths of a community were tapped and a deep dialogue was created across all stakeholders.

Once this process was developed, the communities began to create their own wellness. Samueli Institute worked with three communities from around the country, drawn from locations with some of the worst health metrics. Each was offered an opportunity to receive assistance in a community wellness improvement project of their choice.

A Framework of Community Wellbeing

Experts found that community wellbeing must address the following six pillars to be a resilient and well community: psychological, physical, social, economic, environmental and cultural. A weakness in one of these areas limits the ability of the community members to achieve their full potential.



When experts went to Indianola, MS, a town of 12,000 in the Mississippi Delta region, applied its theory for community wellbeing, those involved saw that the path to resilience could not begin until healing occurred to overcome generations of racism and segregation. This realization, according to Samueli Institute’s VP of Optimal Healing Environments, Bonnie Sakallaris, PhD, RN, changed SI’s approach to building resilience in communities. A group of community leaders met every month for three or four hours at a time to discuss big topics: health, economics, education and race. Through these facilitated conversations, healing began.

“We had to rethink and we had to redefine community wellness, in terms that provided communities with the ability to do their work and measure their work,” Bonnie Sakallaris, PhD, RN, Vice President, Samueli Institute.


The role of community members is just as important and often even more important than that of governing bodies, officials, and activists. Accountability means that the members of the community recognize their part in the destruction or hindrance of their community, as well as the redevelopment and prosperity of their community. Without the input of the people most affected by poor health care services, social-economic injustice, and other factors that contribute to their state of wellbeing; it is impossible to move forward.

“Until the community expresses their needs and gets engaged in the work, the work doesn’t move forward.” Bonnie Sakallaris, PhD, RN

How We Helped

Combining Samueli Institute’s whole-systems research with the existing grassroots efforts within the community, a difference was made. Learning through the process, the Well Community Project became a step-by-step path to resiliency. The steps SI took were as follows:

Step 1: Breaking the Silence

Step 2: Reconciliation, Reparation, and Recovery

Step 3: Moving Forward Through Shared Purpose

Step 4:  Creating Authentic Partnerships

Step 5: Envisioning Possibilities

Step 6: Creating Integrated Networks

What’s Still Missing?

What we know is that resilience is a state of indefinite wellbeing. A resilience community is able to push through, even when times are difficult. In the United States, especially on the subject of healthcare, certain communities still lack the fundamental means to even begin their journey toward resilience. SI believes that understanding the unseen forces behind health and resilience can help.


Samueli Institute recently launched a new website, to materialize the evidence behind integrative medicine, encourage the implementation of mind-body practices in standard care and discuss how mind-body medicine can positively impact the future of our healthcare system. Be sure to visit the site.

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Kevin Berry, MD on Resilience: “We Need to Look Beyond Bouncing Back.” Mon, 11 Apr 2016 11:00:33 +0000 Resilience means different things for individuals, for communities and for the military. Over the last 15 years, Samueli Institute and its expert partners have explored a wider understanding of resilience than was previously understood. During this exploration, it was discovered that resilience is indubitably more complex than its traditional definition of being able to recover from trauma. Real resilience involves preparedness –the ability to adjust to upcoming trauma and stress.

 “Often times people think of resilience as bouncing back, I think we need to think beyond bouncing back.” –Kevin Berry, MD of Samueli Institute

Resilience requires stages of evolution and preparation. It also requires the individuals or communities involved to make an overall transformation from their previous state to the state of well-being. Also, resilience is dependent upon a well environment and the perception of the individuals or communities involved. This is obviously more complex than the standard “bouncing back” theories of the past.


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Kevin Berry MD



On the subject of resilience, experts have developed the term “resilience thinking,” which refers to the idea of eventually being able to transform. Evolution as a prerequisite for resilience suggests that the mind has more power during the path to wellbeing than most other factors. This is because, without the thought that one can prosper, their perception is perturbed, making resilience just a word, having nothing to do with the life of an individual or the state of community.


Preparedness is a common theme in communities like the U.S. Military, but not as common in others. Being prepared for the positive changes that come with resilience is as simple as being aware of the past and present. For individuals, understanding the current and past states and learning from them, is preparation. For communities, understanding their past and present circumstances, what caused them and the role certain individuals may have played, allows the community to recognize when similar issues arise in the future.


“The idea of being able to transform–about being able to pick up and move on,” as Dr.  Berry explains, is a sound example of resilience thinking. The process of transforming requires an alternate mindset, which motivates new actions for better outcomes.

Resilience works when all of the factors that contributed to the trauma or stress are understood and overcome; and when the individual or communities except that trauma and stress are almost impossible to avoid.

The most important component of resilience to understand is the future. Trauma or stress may re-occur, but true resilience leaves individuals or communities fully equipped to handle future circumstances.


Samueli Institute recently launched a new website, to materialize the evidence behind integrative medicine, encourage the implementation of mind-body practices in standard care and discuss how mind-body medicine can positively impact the future of our healthcare system. Be sure to visit the site.

What role does leadership play in military resilience? Watch video of Dr. Kevin Berry at the 2016 Military and Veteran Resiliency Summit in San Deigo: WATCH

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PODCAST: An Interview with Henry Samueli, PhD Thu, 07 Apr 2016 11:00:19 +0000 Simply understanding how the am/fm radio works; that was the assignment for Henry Samueli’s 7th-grade electric shop class, the point in his life that turned out to be the beginning of it all. In the latest episode of On Human Flourishing, Samueli sits with Wayne B. Jonas, MD, to discuss the long path of life, which later led him to dive into the world of integrative medicine.

Samueli’s journey in integrative health began on the home front, as he watched his wife, Susan, nurse their children to health using homeopathy, Chinese herbs, and nutrition. He admits that he found it mystical at first, but later, after watching his children flourish, he came to appreciate it.

“I’m a complete believer that these alternative therapies have a lot of efficacy.” –Henry  Samueli, PhD


Samueli’s successes in engineering allowed him to act philanthropically, investing in science education for young people. Much of his philanthropic work was executed through the Samueli Foundation, a charity organization started by his wife, Susan Samueli, PhD. The Samueli Foundation endeavors to create value within society by endowing innovation, entrepreneurial and sustainable ideas. Mr. and Mrs. Samueli later began investing in organizations and projects having to do with complementary and alternative medicine, the only thing missing according to Henry Samueli, was the science that supported this form of medical care.

“That became another area of interest for us; to try to develop some scientific evidence behind it.” -Henry Samueli

To unveil the science behind the esoteric world of integrative medicine, Henry and Susan Samueli first started a research center at University of California, Irvine. Later, the Samueli’s partnered with Dr. Jonas to start the Samueli Institute for Information Biology, now called Samueli Institute.

Jonas believes that Samueli has “a passionate drive to enhance human flourishing,” and there is much more in the future for the Samueli Foundation in the area of integrative health. Henry Samueli’s “primary motivation,” in starting Samueli Institute and pursuing his other philanthropic projects was to understand how integrative medicine works, just like the radio from his electric shop class. Today, he continues to transcend mere curiosity, by helping Samueli Institute in exploring the science of healing to create a flourishing society.

Subscribe to the podcast on iTunes to get automatic downloads of On Human Flourishing to your devices. Subscribe here.

]]> 0 Simply understanding how the am/fm radio works; that was the assignment for Henry Samueli’s 7th-grade electric shop class, the point in his life that turned out to be the beginning of it all. In the latest episode of On Human Flourishing, Simply understanding how the am/fm radio works; that was the assignment for Henry Samueli’s 7th-grade electric shop class, the point in his life that turned out to be the beginning of it all. In the latest episode of On Human Flourishing, Samueli sits with Wayne B. Jonas, MD, to discuss the long path of life, which later led him to dive... Samueli Institute Blog clean 27:18
Understanding Bioenergy Medicine with Dr. John Ives Mon, 04 Apr 2016 11:00:41 +0000 Thanks to Einstein, we know that all living matter is made up of energy. But there is a difference between traditional energy used in sound, light and magnetic therapies and the more ancient concept of subtle energy that may be behind the healing practices of therapeutics touch, healing touch, Reiki, and Qi Gong.

“All living things, all living cells-plants, animals, every living thing on this planet actually emits light. That light maybe carrying information.” –John Ives, PhD

Practitioners and patients are finding value in self-care practices with roots in bioenergy medicine. While once reserved for those interested in non-traditional or alternative forms of healing, bioenergy medicine is now working its way into more traditional medicine. Even the military has taken interest by adding Reiki and Tai Chi into its offerings.

Challenges of Bioenergy Medical Practice

In a medical system focused on pills and procedures, this shift to self-care can be challenging for patients. Beginning the healing process requires making a commitment to self-care according to our experts.

What’s perhaps more challenging for practitioners who promote bioenergy healing is backing up their practice with science. Though the knowledge of bioenergy itself has settled within the medical community, the idea of tapping into bioenergetics to actually treat and heal patients is fairly new. Samueli Institute’s Senior Director of Research, John Ives, PhD, believes that there is still much more information to be gathered on the topic.

“We’re still figuring out what the information is–what the Rosetta Stone would be.” –Dr. John Ives

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Dr John Ives on Bioenergy medicineThe questions that still exist about Bioenergy are questions that allow understanding of just how powerful human energy is. Can humans detect the heartbeats of other humans without medical machinery? This is a thought Dr. Ives has about Bioenergy, but to get to the answer, the field needs more time.

Understanding Bioenergy Medicine

In the military, the are therapies being used by service members and veterans to tap into their own bioenergetics. According to the science, these complementary, integrative medicine modalities have been proven to be a more of an efficient treatment form than prescription medications for chronic conditions like pain, depression, and sleep disturbances. These therapies include:

  • Art therapy
  • Music therapy
  • Reiki
  • Yoga therapy
  • Tai Chai
  • Qi gong
  • Other meditative modalities

The science behind bioenergy medicine is still developmental and therefore, a lack of understanding about how bioenergy medicine can improve practices in our healthcare system still exists. SI’s goal is to play a part by better understanding bioenergy as it relates to healing, which, according to Dr. Ives, is not a far-off goal.

In the next 10 years, Dr. Ives believes that the medical population will be able to define and measure bioenergy in a way that will be acceptable to the majority of the population. He argues that once bioenergy can be measured, it can then be implemented into normal medical practice.

“My prediction is that there will be interface between scientific understanding and the human experience of bioenergy.” – Dr. John Ives


Samueli Institute recently launched the mind-body website to materialize the evidence behind mind-body medicine, encourage the implementation of mind-body practices in standard care and discuss how mind-body medicine can positively impact the future of our healthcare system. Be sure to visit the site

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Dr. James Gordon on the Future of Mind Body Medicine Mon, 28 Mar 2016 11:00:45 +0000 The modern challenges in health are closely associated with a disconnection between the mind and body. James S. Gordon, MD, founder of the Center for Mind-Body Medicine, professes a clear understanding of how the mind and body work together to create wellness within humans. According to Dr. Gordon, in order to know the future of mind-body medicine, it is best to look at the past and make note of the exact period in time where the science was lost.

“The problem is that we lost sight of it. We began to separate the mind from the body and to see and believe that they were different.” –Dr. James Gordon

Gordon puts the time around the 1960s, when the mind was thought to be one with the spirit and the body, a completely separate entity. This was when treating people became more difficult and was the beginning of an enormous dependence on prescription medication.

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James Gordon, MD Mind Body Medicine Samueli Institute

“The body became the concern of doctors and the mind and spirit was the concern of the priests and the clergy and different faiths.” –Dr. James Gordon

Leaning towards the future, Dr. Gordon finds that a focus on self-care can reverse the issues that come along with practitioner-administered care. Stating that, “we’ve been drugging the whole population,” Gordon believes that many of the prescription remedies are not helpful and cause other health problems. So for the future, Dr. Gordon wants the responsibility of care to move out of the hands of practitioners and into the hands of the patients themselves. Through mind-body therapies, self-care is rather simple for patients and limits the need for doctor visits.

“The next step for us as a society is to make self-care the true primary care.”

Promoting self-care doesn’t mean excluding practitioners altogether, but in the future, as seen through Dr. Gordon’s eyes, practitioners assist patients in practicing self-care. This form of doctoring is based on “the understanding that we have a very great capacity to do things on our own behalf.” Based on Dr. James Gordon’s insightful interview, the future of mind-body medicine is in your own hands.


Samueli Institute recently launched the mind-body website to materialize the evidence behind mind-body medicine, encourage the implementation of mind-body practices in standard care and discuss how mind-body medicine can positively impact the future of our healthcare system. Be sure to visit the site

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Dr. Adam Perlman Aims to Improve the Business of Chronic Pain Care Wed, 23 Mar 2016 16:00:12 +0000 Chronic pain management often excludes helpful integrative treatments like acupuncture, massage therapy, self-care and mind-body practices. Integrative care helps relieve the suffering of patients and by extension is good for business noted Adam Perlman, MD, MPH, Executive Director, Duke Integrative Medicine. In the competitive industry of health care, integrative care can improve market share through quality of care and differentiation. It positively impacts the bottom line through improved patient satisfaction scores, HCAHPS, as well as decreased length of stay and readmission rates.

“Organizations that are early adopters of integrative care will have the experience, track record and refined processes, and will be in a better position to take advantage of bundled payments and other aspects of value-based care that are continuing to evolve,” said Dr. Perlman.

As the chair of Samueli Institute’s Chronic Pain Collaborative, Dr. Perlman guides clinics as they shift towards incorporating more integrative practices. After one year of implementing mind-body, self-care and other integrative treatments within these clinics, the participating organizations saw the following improvements:

  • A decrease in the number of patients relying on opioids for chronic pain.
  • An increase in the number of patients using non-pharma and self-care therapies    for pain.
  • An increase in quality of life and patient function.

Dr. Perlman is not alone in his pursuit of patient-centered, evidence-based integrative pain care. Faculty members of the Chronic Pain Breakthrough Collaborative have integrated many of these treatments at clinics and hospitals across the United States. The breakthrough change James Lehman, DC, MBA, FACO is implementing at the University of Bridgeport Health Sciences division has the potential to improve patient care, boost patient and provider satisfaction while cutting the cost of provider pain care by 33%.  The CPBC’s Dr. Vinny Francio also has a success story about his implementation of integrative practices in Oklahoma City.

“This breakthrough collaborative is an opportunity for healthcare systems to rapidly develop programs that they can implement and ultimately grow and that will have an almost immediate impact.” – Dr. Perlman

Read our three case studies on integrative pain care:


There is scientific evidence which shows that mindfulness and other mind-body therapies treat and prevent chronic pain. Samueli Institute recently launched the mind-body website to bring together the evidence behind mind-body medicine, encourage the implementation of integrative practices in standard care and discuss how the role of the brain and the mind in health and resilience can positively impact the future of our healthcare system. Be sure to visit the site.


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Dr. Wayne B. Jonas Explains The Placebo Effect Mon, 21 Mar 2016 11:00:15 +0000 Since Medieval times, traces of placebo can be found in medical practice. It began as a way to ease symptoms, but over the years has been found to be a way to actually treat patients. According to Dr. Jonas, the placebo effect, is a form of healing that modern doctors should pay attention to and that healthcare system should begin assimilating into everyday practice.

Blog-Video-ButtonWayne B. Jonas, MD of Samueli Institute, Placebo Effect video

“The placebo effect tells us that there are some underlying processes around how we go about healing, that are separate from the what.”

What We Know About Placebo

In any healthcare setting, clinicians can maximize healing and the effects placebo has on the patient, has much to do with what Jonas refers to as the 80/20 rule.

Only 20 percent of healing comes from the medical treatment itself. The remaining 80 percent comes from how the treatment is given. In other words, giving a patient an herb alone, can only make them optimistic about the possibility of being treated, however telling the patient what the herb will do for them will enhance their healing experience. Experts suggest that four additional approaches bring about the placebo effect:

  1. Acupuncture
  2. Pill color
  3. Number of pills
  4. How and where patient is treated

Jonas calls the use of placebo in patient care, a ritual and encourages clinicians to perform the ritual in an ethical way as a standard practice.

“If we can optimize those rituals and minimize the negative components of those rituals, then we could reduce side effects and enhance healing.”


Samueli Institute recently launched the mind-body website to bring together the evidence behind mind-body medicine, encourage the implementation of mind-body practices in standard care and discuss how the role of the brain and the mind in health and resilience can positively impact the future of our healthcare system. Be sure to visit the site.

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Samueli Institute Launches Brain, Mind and Healing Website Thu, 17 Mar 2016 11:00:44 +0000 Samueli Institute has launched, a website dedicated to exploring mind-body medicine and its unparalleled healing capacity. Modern medicine, with its many innovations, is still missing several components that if used, would heal patients and leave them with a more promising future.

The future of medicine, as Samueli Institute views it, is a future in which patients can tap into their body’s own healing capacity through self-care and with the assistance of practitioners who understand the importance of evidence-based treatments, patient-centered care, and resiliency.


A Thriving Nation

There are ways in which society can predict, track and improve resilience. Samueli Institute’s experts have researched the cases of trauma and stress that have been turned around through the implementation of mind-body practices in patient care. As one of the organizations helping with the integration of mind body medicine in the military, SI has looked into the factors that contribute to resilience, for the military community, and in the nation.

In life and in the military, trauma is unavoidable, therefore preparing for life in the military should include exercises that teach service members how to cope with what is happening around them. Geoffrey Ling, MD, PhD says “a prepared mind is really one the most important things.” Outside of the military, the path to flourishing requires more than just preparation, as sometimes, the state of a community is the result of issues occurring outside of that community. SI’s VP of Optimal Healing, Bonnie Sakallaris, PhD, RN asserts that the key to resiliency within a community is to understand the needs of the community and work from there. Learn more.


The Placebo Effect

The process of healing extends far beyond actual treatment, and through research, we’ve come to understand that the encounter between a patient and a practitioner is an important part of the healing process.

Salutogenesis begins when a healer makes the simplest of gestures. SI’s Wayne B. Jonas, MD explains that putting a positive spin on the patient’s situation, or informing them that the condition is likely to improve, all affect how the patient to begins to heal.


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Wayne B. Jonas, MD of Samueli Institute, Placebo Effect video

“The placebo effect tells us that there are some underlying process around how we go about healing, that are separate from the what.” -Dr. Wayne B. Jonas


Mindfulness/Mind Body Medicine

Mindfulness is a consciousness therapy, which leads to the mind-body connection. Science has discovered that 80% of all non-communicable disease is related to stress, therefore, most diseases are preventable through self-care.

It is as simple as breathing, and thinking; these are everyday tasks, which humans do mindlessly. But to consciously think, feel and breathe, is to fuse the mind and body and experience life as a whole person. Learn more.



Both science and religion describe a world in which humans have the inherent power to influence their lives through Extended Consciousness. How humans perceive the world, behave and interact with the world, all affect how their lives will play out; it’s all about connection.

Extended Consciousness involves forming a connection with oneself, with others and with the universe. Learn more about consciousness here.


Bioenergy Medicine

With a goal to help with the integration of mind-body medicine into standard care, Samueli Institute is exploring Bioenergy Medicine. With the expertise of SI researchers John Ives, Ph.D. and partner experts like Capt. George J. Ceremuga, DO, we have been able to skim the surface and predict what future exploration into the science of bioenergy can do for medicine. Learn more.


Samueli Institute recently launched the mind-body website to materialize the evidence behind mind-body medicine, encourage the implementation of mind-body practices in standard care and discuss how mind-body medicine can positively impact the future of our healthcare system. Be sure to visit the site.

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PODCAST: An Interview With Dr. James Gordon Tue, 15 Mar 2016 13:56:37 +0000 James Gordon, MD, started the Center for Mind Body Medicine (CMBM) based on his interest in creating what he calls “a community of healers.” He wanted to bring together the doctors who practiced medicine in a different way than the drug-based practices for which they were trained. These doctors were helping patients heal themselves with mind-body therapies. In his interview with Samueli Institute’s President and CEO Wayne B. Jonas, MD, Dr. Gordon explains his vision for building his healing community:

“To make self-awareness, self-care, and group support central to all healthcare-the training of health professionals and the education of our children.”

 Mind Body Medicine vs. Conventional Medicine

The recognizable difference between healing through mind-body medicine and with conventional practices is the use of modern technologies and artificial remedies as opposed to plant-based medications and mind-body therapies. Not all doctors are healers, according to Gordon’s testimony of what lead him to his current role. In fact, healers are not limited to those who actually studied medicine, and self-care can sometimes be more effective in treating patients than practitioner evoked treatment.

What sets mind-body medicine apart from other practices, according to James Gordon, is establishing a name for it that speaks directly to its function within society. Mind-body medicine is meant to treat using traditional forms of healing; these are healing forms, which he considers “indigenous,” and efficient.

“By calling it mind-body medicine, we are saying that we are in line with the deepest understanding of how human beings function. And we’re also committed to those approaches and those techniques that make it possible for each person to experience that connection and have a positive effect on it.”

In the conventional world, practitioners, academics and others have compared mind-body medicine to standard methods and decided that it seemed, “soft,” but Dr. Gordon finds that the reputation of mind-body medicine doesn’t quite match the evidence from mind-body research or the patient results.

 The Challenge of Mind Body Medicine

In response to the way much of the Western world views mind-body medicine, Dr. Gordon has a wake- up call. According to the Dr. Gordon, “soft” is a poor word to describe mind-body medicine becomes “soft” does not mean effective. Instead he says it’s not the mechanisms for healing that are present in mind-body therapies but the people criticizing the treatments who need to change.

 “No matter how much research you and I and others produce, people look at them as soft. And it’s their minds that need to change.”


Samueli Institute recently launched a new website to materialize the evidence behind integrative medicine, encourage the implementation of mind-body practices in standard care and discuss how mind-body medicine can positively impact the future of our healthcare system. Be sure to visit the site


]]> 0 James Gordon, MD, started the Center for Mind Body Medicine (CMBM) based on his interest in creating what he calls “a community of healers.” He wanted to bring together the doctors who practiced medicine in a different way than the drug-based practices... James Gordon, MD, started the Center for Mind Body Medicine (CMBM) based on his interest in creating what he calls “a community of healers.” He wanted to bring together the doctors who practiced medicine in a different way than the drug-based practices for which they were trained. These doctors were helping patients heal themselves with mind-body therapies. In his interview... Samueli Institute Blog clean 43:48
Behavioral Environment: What You Do Matters For Your Health Thu, 03 Mar 2016 14:15:14 +0000 It is often stated that “actions have consequences,” but when it comes to your health, it is much deeper than that. The behavioral environment is defined by Samueli Institute’s experts as actions executed to prevent illness, improve health and engage in self-care.All of these actions are performed in a natural way, to encourage the body’s healing. In some cases, people find their lives void of healthy actions, and this is when the behavioral environment must be re-activated.

Practicing a healthy lifestyle can enhance your overall well-being. This includes both preventing disease and fighting off an existing disease. In the United States, many people do not pay attention to their behavioral environments, which has lead to 7 out of 10 deaths being the result of preventable chronic illnesses. For individuals who struggle with maintaining a healthy behavioral environment, there are four key components worth recognizing. These components are:

  1. Motivation to change
  2. Nutrition and exercise
  3. Balance
  4. Acceptance

Motivation to Change

Motivating oneself to change can be difficult but is worth the trouble. Encouraging oneself to change is also the most important component for the wellbeing of one’s behavioral environment, because, without it, the other components cannot endure. Motivation is especially required when considering nutrition and exercise.

One of the keys to maintaining a nutritious diet is to use your mind. Instead of stressing yourself about all of the things you cannot eat; think about all the healthy foods you can add to your diet to give yourself variety and lead you to a more healthy lifestyle. Exercise is just as easy to stay on top of by using your mind to encourage continued work.

Balance, as tackled in a previous article, is the alignment of the whole person. Having balance means that when you work hard, you also play hard as a reward for your work and to keep you mentally well. How do you maintain balance? SI’s Optimal Healing Environments: Your Healing Journey makes suggestions on how to find your perfect balance.

“Find activities that are fun and rewarding so that you want to do them regularly. They can be anything from walking with friends, playing with your kids, playing a team sport or going on picnics to joining a club or religious organization, volunteering in your community or learning a new skill or craft.”


It is important to accept that as a human, some of your habits will not be the best for you. However, the important step to experiencing healing even with poor habits, it is to first acknowledge that they exist. By remaining aware that there is an issue and making a mental note to work toward better habits, your well on you way.

You can read more of Optimal Healing Environments: Your Healing Journey here.

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Mind-Body for Performance and Resilience: Advice for Leaders Tue, 23 Feb 2016 14:41:43 +0000 We know mind-body practices improve performance. Mind-body techniques are based on recognizing the stress response and engaging in purposeful activities to stimulate the restorative relaxation response. These responses – stress on the one hand and relaxation on the other – are controlled by the autonomic nervous system, and can be regulated by the mind. Mind-body techniques can be mastered and leaders can help their teams learn when and how to use appropriately.

How can we as leaders make these tools more accessible to our teams? The barriers can seem overwhelming when trying to effect change. But by overcoming barriers of language and imagery; challenges of limited resources and making one degree of change at a time, leaders on all levels can improve the performance and resilience of their teams.

Overcome the Language Barrier

Not everyone connects with the typical language of mind-body practices. In fact, it alienates many who might benefit from it. To overcome this, leaders must normalize the language and make it un-mystical. By “de-mystifying” it, any religious or negative connotations associated with the mind-body connection are removed as barriers. We can use neutral language that relies on evidence and communicates to our teams in their language. This will drive policy change and increase utilization of beneficial mind-body tools.


It’s just training

"Soldier, take a knee."

“Soldier, take a knee.”

In the military, we don’t call it mind-body, we call it training. However, mind-body practices can be seen throughout training. Breath control is an essential component of marksmanship and weapons training. Team leaders often calm on-edge Service members by saying: “Soldier, take a knee.” This allows the Soldier to take a breath and relax thereby resetting their stress response.


Sports stars also use mind-body skills to achieve greatness. However, rather than calling the process “guided imagery,” sports stars call it “visualization” avoiding any spiritual or religious connotations. Athletes have long-relied on presence of mind to get through the most difficult physical challenges. Long-distance runners often rely on the mind-body connection to maximize the ability to perform under pressure.

Put it to work. Don’t wait for perfection.

How can you immediately get mind-body techniques into your clinic, your office, or your “squad” even with limited resources?

It only takes a moment. Leaders could teach all staff simple exercises to help center the patient and set intentions. An example is to teach staff language to encourage the patient to do a breath exercise when just before taking a blood pressure measurement. It’s as simple as saying: “We find that we get more valid readings if while you breathe, you think of a person or a situation that brings you joy.” Adding mind-body to well visits, vaccines, and other patient encounters is a small step within a leader’s control and requires no more time or resources.

The Bounce Back Project in Buffalo, Minnesota, takes a mind-body approach to help patients with anxiety and mood disorders. Patients were prescribed to do three good things and then report back. Their symptoms were more improved than those in treatment as usual.

And its not just in medical settings that Bounce Back is making an impression, it is also in the justice system. Police and judges are making a difference, too. A judge caught on to this idea and sentenced people to do three good things a day and journal it. These very real activities are mindfulness in action.


Aim High. Invest Now for Later

USUHS_Meditation1webHealth care leaders can make the most of their efforts by targeting residence training. By investing early in a young doctor or a nurse’s career, the payoff will include increased energy, optimized performance, decreased stress and improved health. Paying attention to the stress of their charges, leaders will help prevent stress from becoming burnt out. Military medical schools are working to provide this type of training to new health care professionals.

Leaders should consider incorporating mind-body training into daily meetings. Take a moment to set an intention and take a breath; this models the behavior for all present.

In 2012 CAPT Lori Laraway wrote in Proceedings, the official journal of the Naval Institute Press, about the “Navigating Operational Stress.” CAPT Laraway noted the pressures on active and reserve Service members and families due to the operating tempo of military operations such as wars in Afghanistan and Iraq, humanitarian and disaster relief deployments after the devastating earthquake in Haiti and the tsunami that hit Japan.


These pressures, whether due directly to dangers of war or difficulties related to frequent, lengthy deployments away from home and family, have significant costs that are manifested in multiple ways, including higher divorce rates, an uptick in DUI and alcohol-related incidents, increased illegal drug use, more frequent spouse or child abuse, and even, most regrettably, more suicides.”  CAPT Laraway

The solution, she says, required re-thinking about stress and recovery, moving away from the culture of believing a Sailor or Marine was either a “full up round” or “broken,” to embracing the idea that stress is normal affecting people differently. Navy operational stress management doctrine changed shifting more responsibility to leaders who needed more knowledge and skills identifying and managing adverse consequences of stress injuries and illness preventatively.

  • Read more: Samueli Institute studies have shown that emergency responders and Service members can learn to self-calm in the face of a crisis.

Leaders have a responsibility to incorporate mind-body practices into the everyday rituals of those under your command.

Watch video of Dr. Kevin Berry at the 2016 Military and Veteran Resiliency Summit in San Deigo: WATCH

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Team Approach Improves Chronic Pain Care in Oklahoma Clinic Mon, 22 Feb 2016 12:01:08 +0000 Providing chronic pain patients with seamless access to non-pharmacological therapies and self-care skills requires clinics to re-think business as usual. Dr. Vinny Francio, DC, MS, practices Integrative Spine Care and Integrative Pain Management for Essential Integrative Health in Oklahoma City, an integrative spine and pain management clinic, in collaboration with orthopedic spine surgeon and integrative physician Dr. Art Conley, MD.

Improving chronic pain care for his patients is especially important to Dr. Francio because the state of Oklahoma is one of the leading states in prescription drug overuse with nearly 800 deaths per year due to drug overdose according to the Center for Disease Control.

Earlier this month, Dr. Francio shared his story in a Virtual Congress as part of Samueli Institute’s Chronic Pain Breakthrough Collaborative.

“Our patients were tired of traditional pain management,” said Dr. Francio, whose team created a model of care that better serves his patients. This effort was part of Essential Integrative Health’s participation in the Chronic Pain Breakthrough Collaborative, a systematic approach to health care quality improvement.

Assessment Looks at the Bigger Picture of Chronic Pain

The first step of the chronic pain care model is an integrative treatment intake. The new intake includes a physical assessment, a medical assessment, a behavioral assessment and nutritional assessment.

“By the end of the treatment assessment, we sit down with the patient and explain our entire treatment protocol, including medication management strategies, physical medicine strategies, behavior, and nutrition,” said Dr. Francio.


Integrating the multidisciplinary assessments in a single visit helps to minimize patient burden and optimize reimbursement, in addition to facilitate the patient’s transition from a traditional pain management program to an integrative model.

“At the same time patients see us for medical treatment; they also get an adjunctive assessment with one of our other pillars—physical medicine, behavior, or nutritional medicine.” -Dr. Francio.

By developing this integrative assessment and making time for a weekly meeting to collaborate on administration and clinical needs, Dr. Francio found that his team was able to maximize their current resources to provide better chronic pain care to patients in the Oklahoma City and surrounding metro area.

Teamwork Benefits Patients and Providers

An integrative pain practitioner for over 20 years, Heather Tick MA, MD, believes that working in teams is important for both the patients and the providers.

“Patients with pain complaints are some of our most frequent and our most challenging patients. They’re very difficult in terms of the complexity that they present when it’s chronic pain, and this applies to every single specialty. So, when we feel inadequately prepared to deal with the complexity, and unsupported in the work, that adds to physician stress. Working in teams is a chance to mitigate the situation.” –Dr. Heather Tick



Dr. Tick guides discussion at the Chronic Pain Breakthrough Collaborative Learning Session

“Patients want seamless care,” said Dr. Tick. “They want to know that their team members speak to each other and collaborate, so that even when there are times when there are different team members who want to approach a problem differently, patients are fine with that as long as they know that there’s dialogue and that their wellbeing is at the center of the conversation.”

Dr. Tick serves as an integrative pain care subject matter expert as part of the Chronic Pain Breakthrough Collaborative faculty. Faculty guided participants through the components of team-based chronic pain care:

  • creating and strengthening interdisciplinary pain management teams;
  • promoting an understanding of self-care and non-pharmacologic treatment options, and
  • developing shared intake assessments and care planning processes that include the patient as an expert in their own care.

Dr. Mittman, Chronic Pain Breakthrough Collaborative learning session

Like Dr. Francio, Paul Mittman, ND, of the Southwest College of Naturopathic Medicine Medical Center found that participating in the Chronic Pain Breakthrough Collaborative helped his team to become more integrated in their approach to care.

We took three people from very different backgrounds—an acupuncturist, a medical doctor and a naturopathic doctor and through this process really started to unite as a team,” said Dr. Mittman.

This increased integration of interdisciplinary care providers is part of the solution to decrease the number of patients relying solely on opioids for chronic pain. When providers are connected in meaningful ways to each other around patient care, it leads to more choices of disciplines and strategies available for the benefit of the patient.

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Webinar: A Collaborative Approach to Tackling Challenges in Chronic Pain Care Wed, 10 Feb 2016 12:00:01 +0000 *This article was recently updated to include the latest activity within the Chronic Pain Breakthrough Collaborative*

The February 3rd and February 17th webinars for Samueli Institute’s Chronic Pain Breakthrough Collaborative touched on the many approaches for treating patients with chronic pain, using holistic medicine. With new practitioners present, the goal of Samueli Institute in the webinar, was to explain; why the chronic pain collaborative exists, our results from previous year and how interested individuals can get involved.

In a country where over 100 million people experience chronic pain and where opioid addiction has reached a massive high, the Chronic Pain Breakthrough Collaborative is getting results. In 2015, collaborative participants achieved results in reducing the amount of pain sufferers, optimizing human performance, and improving qualify of life. In the new 2016 collaborative, Samueli Institute has another responsibility for pain management education.

“Our charge is to provide guidance and advice on what works in chronic pain management.” -Bonnie Sakallaris, Vice President

During the recent webinar, a gripping question arose, bringing the purpose of the collaborative and the aspirations of those involved into focus. What is your biggest challenge regarding pain care

With a brief moment of silence to ponder, doctors then flooded the line with responses to the standing question. Perhaps the most relevant challenges resonated with all who were present:

  • Low-income patients have little or no access to integrative medical practices for chronic pain.
  • Not knowing what works in pain management and what doesn’t

The solution for all of the challenges facing practitioners who deal with chronic pain patients is clear in the collaborative. Simply changing the way pain is managed in the United States will help pain practitioners write fewer prescriptions. Increasing access to integrative care, improving the integration of medical care teams and encouraging self-care, will ultimately shift the healthcare system into preferring integrative practices over the old practices that do not get the necessary results.

“Chronic pain is a complex condition that has physical, emotional, spiritual, behavioral implications. Without really addressing those significant issues, we aren’t going to solve this problem. We need a holistic approach.” -Sakallaris

The next webinar for the Chronic Pain Breakthrough Collaborative is Feb. 17th. You may RSVP here.

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How To Experience The Mind Body Connection At The Gym Tue, 09 Feb 2016 12:00:18 +0000 Energy is what drives the body, and is therefore what drives the mind. When exercising, the mind and body aline in what Samueli Institute refers to as the “energetic connection.” This is an experience of wholeness that when properly channeled, can lead you to have an amazing gym workout. The key to experiencing the mind-body connection at the gym is to mentally prepare for it, before you arrive. Here’s how:

Focus your attention- Prepare to leave all of you worries and inhibitions at the door. If you find it hard to clear your mind before your workout, take a few minutes to relax or meditate.

Try something new- Doing the same routine each time you visit the gym will cause your mind to easily wander. This is because, once something becomes a routine, it is done subconsciously and leaves plenty of room in the mind for other thoughts.

Create a workout plan- Plan what exercises you are going to perform in the gym ahead of time. Having an itinerary for the gym will allow you to focus on each particular task, preventing your mind from wandering.

Self-motivate- Uplift and drive yourself by thinking positively. Self-motivation at the gym can be like telling your body what to do and how to keep going simply by thinking.

The National Institutes of Health (NIH) defines mind-body medicine as a practice that focuses on treatments that improve health by way of relaxation, hypnosis, visual imagery, meditation, yoga and biofeedback. In an atmosphere like a gym or fitness center, many of these therapies are easily found.

There’s much more to the mind-body connection than a workout session. Once you discover your personal trick to aligning your mind and body, you will find balance, and everything else in life will fall into place.

Learn more about the “energetic connection,” and mind-body by reading our book Optimal Healing Environments: Your Healing Journey.

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Increase Patient Power In Pain Care Mon, 08 Feb 2016 12:12:17 +0000 Problem-solving is a key skill at work, at home and in the classroom. But problem-solving is also important for patients when managing chronic pain.

Licensed Massage Therapist Martha Menard, PhD demonstrates a form of massage

Licensed Massage Therapist Martha Menard, PhD demonstrates a form of massage

Samueli Institute’s Chronic Pain Breakthrough Collaborative teams met in January to celebrate and share what worked to increase the number of patients using non pharma and self-care therapies for chronic pain—one of the goals of the 2015 learning collaborative. Participants found that moving from a clinician-driven model of care to one that empowers patient’s self-management of chronic pain required a new outlook and skill set for both the providers and the patients.

Measures of Success in Chronic Pain Care: Empowering Patients with Self-Care Strategies

“Pain care doesn’t always involve providers,” explained Martha Menard, PhD, LMT, Executive Director of the Crocker Institute, and a faculty member for the 2015 Chronic Pain Breakthrough Collaborative.

In a recent study (published Jan 2016), Menard found a common characteristic of those living well with chronic pain was their perseverance and openness: “People were very open to trying new things and kept trying until they found what worked for them, putting together these highly individualized packages of care for themselves. They became skilled at noticing the connection between feeling stressed and making their pain worse, so they found lots of ways to incorporate self-care into their daily routine.”

According to Menard, these individuals looked for opportunities to take action to change the things in the daily life over which they did have control. These included eating a healthy diet, being more physically active, engaging in meaningful activities that gave them pleasure, and were often high users of integrative therapies like chiropractic, acupuncture, massage, and mind-body therapies like meditation or yoga.

Self-care in practice: Massage and Yoga

Pain clinics like Madigan Army Medical Center in Tacoma, Washington, employ self-care into their treatment programs to improve patient self-efficacy.

According to Diane Flynn, MD, MPH, FAAFP, the Primary Care Pain Management Advisor at Madigan Army Medical Center, a typical patient going through their three to six week pain program called IMPACT (Integrative Modalities Pain Care Team) received twice weekly acupuncture, chiropractic care, health psychology, physical therapy and occupational therapy, and once weekly foam roller massage instruction and yoga.

Foam roller massage is a type of self-massage using a dense foam roller device that can be taught to patients, and focuses on myofascial, or connective tissue pain.

Staying active is another important form of self-care, which is why the IMPACT program offers yoga.

The military and VA have recognized the value of yoga and are working to increase its availability. Outcomes studies show the potential benefits of yoga especially for chronic low back pain.

  • Learn more about Tai Chi, music therapy, and other self-care modalities in Samueli Institute’s Supplement to “Pain Medicine” summarizing the available evidence for self-care complementary modalities in chronic pain.

Developing Self-Efficacy Key to Positive Outcomes

Menard (right) and Sakallaris (left) on a panel discussion at the 2015 Chronic Pain Breakthrough Collaborative

Menard (right) and Sakallaris (left) on a panel discussion at the 2015 Chronic Pain Breakthrough Collaborative

According to Menard, one way to help patients develop a sense of self-efficacy is through social role modeling where people can learn from others’ experiences of success.

“People who may be struggling need to see models of living well with pain to know that it is possible. Seeing and hearing positive stories from other people who are living a satisfying and fulfilling life enhances their own belief that ‘Hey, maybe I could do this, too.’”

She encouraged engaging community stakeholders and local providers to collect individual success stories: “People who are living well with chronic pain are a largely untapped resource. They can serve as positive role models for people who are struggling in almost every community.”

Shared Tools to Help Patients Understand Chronic Pain

When dealing with chronic pain, it can be easy for patients to narrowly focus on the pain rather than zooming out to understand the human brain and its relationship with acute and chronic pain.

Collaborative participants shared resources, including a video explaining how to retrain the brain to heal and manage pain. The video explores the different components of pain including medical options; thoughts/ emotions; diet/lifestyle; personal history; physical activity and function.

Called “Understanding Pain”, the video was developed to provide individuals, family members, and clinicians with general strategies for managing acute and chronic pain. Based on an Australian concept for pain education, “Understanding Pain” is a product of the Department of Defense (DoD) – Veterans Health Administration (VHA) Joint Pain Education Project (JPEP).

At the final meeting of the 2015 Chronic Pain Breakthrough Collaborative, executive sponsor Bonnie Sakallaris, PhD, RN, expressed her satisfaction in the progress the teams made:

“The pain practitioners we work with share one common passion and that is for the relief of suffering and a passion to go beyond moving the needle on pain intensity scores to enable those suffering with chronic pain to manage their own health and fulfill their life’s goals. They are transforming chronic pain care through rapid cycle tests of change that lead to seamless, integrative, person-centered care.

Learn more about the process at

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SI Researchers Build A Database Of 146 Comprehensive Chronic Pain Trials Fri, 05 Feb 2016 15:46:48 +0000 Evidence is the new word in healthcare research.

“More holistic, active, self-care, complementary, and integrative medicine therapies, should be more sustainable and cost-effective than drug and practitioner dependent treatments.” –Wayne B. Jonas, MD

Current chronic pain management typically consists of prescription medications or provider-based, behavioral or interventional procedures which are often ineffective, may be costly and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, spirit), complementary and integrative medicine therapies can potentially provide more efficient and comprehensive pain management as they acknowledge the person as a whole, considering the interplay of biological, psychological and social/cultural factors and recognizing the patient’s own capacity to heal as an integral component in disease management.

Such patient-centered therapies allow for diverse treatment of complex symptoms, have been associated with improved health outcomes, lower health care costs, higher patient and provider satisfaction and increased self-efficacy. Using their Rapid Evidence Assessment of the Literature (REAL©) methodology, Samueli Institute recently conducted a systematic review to investigate the effect of active, self-care complementary and integrative (ACT-CIM) therapies on pain intensity/severity in chronic pain populations.

Given the importance of transparency in evidence based decision making, Samueli Institute has created a comprehensive and state-of-the-art database to house the evidence gathered and assessed in this systematic review. Users are able to manipulate the database’s information to not only view the current state of science as it pertains to ACT-CIM therapies for chronic pain management but also further examine the data to answer specific questions of interest. For example, users can:

  • Search for specific keywords
  • Sort by ACT-CIM therapy or pain condition
  • View the most common pain outcomes used
  • Filter studies by methodological quality
  • View detailed information for each article

The Samueli Institute ACT-CIM for Chronic Pain Research database is now fully operational.

This article was written for Samueli Institute by Courtney Boyd, Research Manager. For questions regarding the Pain Management Database or any ongoing research, please contact her by email at

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The Mind-Body Connection: How To Find Your Balance Tue, 02 Feb 2016 12:00:00 +0000 Your internal environment is your inner being; the place in which your emotions connect with your thoughts, controlling how you react to situations and how you relate to the world. Because the mind, body and spirit are connected, any weakness in one of the spheres can cause overall unhealthiness; this is called imbalance. In the case of wellness, balance means that the mind, body and spirit are all alined.

Just like exercising and other essential activities, finding and maintaining your balance requires routine steps.

Step One: Develop Your Healing Intention

To begin, make a conscious mental decision to achieve an overall sense of wellness for yourself. This decision process is completed through awareness, intention and reflection.

Your body gives subtle signs about its wellness level, be it how energized you are, or whether or not you feel uncomfortable. Because the mind, body, spirit are one, often times experiencing physical pain can lead to stress and even depression. The fact that your body warned you, is called awareness.

Intention is more challenging as it requires you to communicate intensely with your inner self. It is common to start this part of the process through prayer, meditation or quiet time. When you focus on your goal, commit to reaching it in your mind, and encourage yourself to keep up the work along the way, you have developed intention.

As you may have guessed, reflection is simply looking back on your experience.This step will do much more than just remind of the perils along the way and your level of strength. During reflection, ask yourself the following questions.

  • Who am I?
  • What is my purpose?
  • How do I fit into my family, my community, my life?
  • What are my spiritual beliefs?

Reflection is a way to bring you closer to your inner self and help you to fully understand yourself, your life and purpose.

Step Two: Experience Personal Wholeness

Personal wholeness is a sense of well-being that is a direct result of harmony between your mind, body and spirit. As long as this harmony remains, you can continue to generate mind-body healing. There are two important components that must be fully understood to achieve personal wholeness.

First, is the integration of mind, body and spirit. To integrate them, picture a time when you felt the most comfortable, happy and authentic. Whatever you were doing spiritually to achieve that feeling should be used continually to achieve personal wholeness.

Last is positive thinking, which is much more difficult than it seems. Being critical of yourself and others can negativity effect your well-being and stunt your journey to personal wholeness.

The mind-body connection is essential to your well-being and once you have finally integrated the mind, body and spirit through , awareness, intention, positive thinking, and reflection, you will experience a healing presence.

You can commit to developing a mind-body practice.

Learn more mind-body wellness examples by reading Samueli Institute’s Optimal Healing Environments book.

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Innovation In Chronic Pain Care At University of Bridgeport Fri, 29 Jan 2016 12:40:50 +0000 The breakthrough change James Lehman, DC, MBA, FACO is implementing at the University of Bridgeport Health Sciences division has the potential to improve patient care, boost patient and provider satisfaction while cutting the cost of provider pain care by 33%.

His big idea is to implement a new guideline for the use of chiropractic specialists as gatekeepers for the diagnosis and treatment of back pain.

By tapping into the evidence base in patient-centered chiropractic care, Dr. Lehman’s goals are to reduce the use of opioid medications, medical errors, cost of care, unnecessary tests and treatments, while improving patient and provider satisfaction.

The new proposed guidelines are an effort to build on past successes. Thanks to successful pilot projects, U of Bridgeport knows it’s possible to integrate chiropractic services in primary care sites within federally qualified health centers, patient medical homes and community health center organizations.

Integrating Evidence-Based Treatments into Standard Care

Innovations like those being discussed at the University of Bridgeport and the Community Health Center, Inc. are an effort to integrate evidence-based treatments like chiropractic care into the traditional health care system.

Despite efforts to advance the science and to broaden the aperture of accepted treatments, there are major barriers that continue to be encountered in the world of the practice and delivery of care to patients with chronic pain.


Dr. Perlman (with microphone) a guide the Chronic Pain Breakthrough Collaborative. 2015

In response, Samueli Institute stood up an effort to build effective team-based, patient-centered care, across the spectrum of modalities that may be available, both within the conventional and complementary world. A group of subject matter experts launched a multi-sided, multidisciplinary, both civilian and military approach to the problem of comprehensive management of chronic pain.

This effort is called the Chronic Pain Breakthrough Collaborative. The team is led by an expert faculty—including Adam Perlman, MD, of Duke Integrative Medicine and —who will guide and mentor participating  organizations through the 12-month improvement process. Currently participants are being recruited for its second year.

Collaborative provides forum for big ideas to percolate

“The nice thing about our participation with the breakthrough collaborative was that I finally had chance to be away from the daily activity with the university and the community health center to sit with people with common goals and then brainstorm. Without this time away I don’t think I would have ever come up with the concept, which I think is innovative, relative to changing these recommended guidelines. So, that’s been very, very valuable to the University of Bridgeport. I appreciate the whole faculty and all the people involved enabling us to look outside the box.” – Dr. Lehman

Through in person learning sessions, team calls, and one-on-one mentoring, participants worked to improve the main drivers of an integrative healthcare environment in an effort to combat the opioid crisis in America.

Through innovative thinkers like Dr. Lehman and the other participants in the Breakthrough Collaborative, the approach is beginning to shift.

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Podcast-An Interview With Dr. Robert Bonakdar Thu, 28 Jan 2016 12:00:17 +0000 Dr. Bonakdar recently visited Samueli Institute to discuss his journey in integrating the practices of integrative medicine. He currently holds the title, Director of the American Academy of Pain Management in addition to working as a Director of Pain Management at the Scripps Center for Pain Management in California. When asked how he got started, Dr. Bonakdar explained that what Americans call alternative medicine, is not as foreign to him.

Born in Iran, Dr. Bonakdar learned of integrative medical practices like mind-body therapy and Tai Chi at a young age. In his homeland, these practices are primal and others like prescription medication are secondary and sometimes forbidden. His vision for pain management practice is to help make so-called alternative medicine, more prominent in the United States.

“We need a huge transformation. We need more individualized pain care, not just specifically what the guidelines say; and a lot more self-care.”

His current approach involves offering alternative pain management treatment as a first choice or after patients have exhausted all other forms of treatment, including medication. In his practice, he often finds that many patients are not healing from conventional practices because the root of their problem is not what it appears. Sometimes chronic pain comes from injuries and strain, but other times, it comes from stress. Dr. Bonakdar strives to look at the whole picture to heal his patients.

“How can condition ‘X’ fit the entire picture and how can you then approach this complex picture in a way that’s patient’s centered.”

Acknowledging that there has been considerable evidence that integrative medicine heals patients, Dr. Bonakdar is looking for ways to make some integrative treatments standard in healing patients with chronic pain.

]]> 0 Dr. Bonakdar recently visited Samueli Institute to discuss his journey in integrating the practices of integrative medicine. He currently holds the title, Director of the American Academy of Pain Management in addition to working as a Director of Pain ... Dr. Bonakdar recently visited Samueli Institute to discuss his journey in integrating the practices of integrative medicine. He currently holds the title, Director of the American Academy of Pain Management in addition to working as a Director of Pain Management at the Scripps Center for Pain Management in California. When asked how he got started, Dr. Bonakdar explained that what... Samueli Institute Blog clean 25:58
Are Your Relationships Making You Physically Ill? Tue, 26 Jan 2016 15:46:09 +0000 Humans by nature are social, and with that culture comes the instinct to connect with other people. Scientists have discovered a link between relationships and physical illness, and have found that some relationships can literally make humans sick. This brings up the question, how can people distinguish between healthy ‘healing’ relationships and unhealthy relationships?

There are three key elements to a healthy relationship that if absent can cause someone to become ill or for their current illness to retrograde. These elements are truth, honesty and compassion. To determine if a relationship has the necessary elements, use the following check list.

  • I feel emotionally and physically safe.
  • I don’t have to be on guard against being hurt by the other person.
  • Both the other person and I can reveal true feelings without harm to either of us.
  • Both the other person and I have the ability and willingness to understand one another and express kindness.

In the event that some of the checklist items are not true for your relationship, do not assume that the person must be removed from your life. There are many ways to heal toxic relationships, and the most important component of a healthy relationship is communication.

Heal By Communicating

Communication that is open and truthful makes for the ideal relationship. When dealing with family members, friends and coworkers, etc., there are simple communication techniques that will help you and the other person to find common ground and begin a healthy “healing” relationship.

First, verify that you and the other person understand one another. Ask “Let me see if I understand what you are saying.” Next, use “I” statements to openly express how you feel about the discussion. For example, “This is how I feel.” Finally, you must firmly express any disagreements you have with the other person. Tell them, “I disagree and this is why.” Following these techniques will put you on a path to healing through healthy relationships.

Create Healing Groups

Camaraderie comes in many forms, but when placed in groups of like-minded individuals, a person can improve their overall well-being. Such groups can be school groups, work groups and even religious or community organizations. But just like relationships between two individuals, group relationships must foster a culture of healing. To be sure that your group has a healing relationship, the following characteristics must be present:

  • Respect for individuals, including their inner lives
  • A system of values that is present at all levels
  • Honest and open communications at all times
  • A climate of trust
  • A focus on learning rather than blame
  • Opportunities for self-care, like exercise and yoga

At Samueli Institute, self-care is considered essential for every individual’s well-being. We encourage you to improve your relationships by acting as a leader and getting involved in your community.

You can share your story with us and participate in a global healing community. Learn more.





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SI Experts And Partners Publish Article On SEaRCH Process For Evidence-Based Care Wed, 20 Jan 2016 18:37:46 +0000 On a quest to discover which healthcare practices are the most effective and nominal in cost, leaders from Samueli Institute’s Scientific Evaluation and Research of Claims in Healthcare SEaRCH™ Program have published an article on how to get evidence-based medical practices into mainstream care. We have found that expert panels from SI and partnered organizations are the best option to guide the research process.

Who’s Involved?

Samueli Institute’s SEaRCH™ program has several expert panels which include article co-authors Wayne Jonas, MD and Senior Psychologist, Pamela Elfenbaum. The Clinical Expert Panel (CEP), Research Expert Panel (REP), the (PoEP) which is designed for policy and the PaEP which is for patient experts. Partners of SI are also closely involved in streamlining evidence-based patient care:

National Institute of Health (NIH) Consensus Panels -Since 1977, the panel has been congregating on occasions to answer standing questions on how to resolve the controversies surrounding data management.

Institute of Medicine (IOM)- The IOM summarizes the medical evidence into reports to make the data more clear and more readily available to be used by practitioners.

RAND Expert Panel– RAND focuses on clinical experts rather than scientific experts to add diversity to the evidence. RAND’s Ian Coulter, PhD is working closely with SI’s SEaRCH™.

Consciousness and Healing Initiative (CHI)- Director of the initiative, Dr. Shamini Jain has partnered with SEaRCH™ for this article.

The article titled, SEaRCH™ expert panel process: streamlining the link between evidence and practice, is published in the journal BioMed Central.

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Faculty Announced For 2016 Chronic Pain Breakthrough Collaborative Wed, 20 Jan 2016 16:37:48 +0000 Last year, Samueli Institute launched the Chronic Pain Breakthrough Collaborative with a plan to assist the many Americans who suffer from chronic pain, and to support the health care leaders working to reverse the opioid epidemic.

With 46 deaths each day from opioid overdoses, it’s clear that providers need more options for their patients. Many of these options are already evidence-based, however, integrating them into practice remains a challenge.

In a special virtual congress on Chronic Pain [watch the recording here] President and CEO Wayne B. Jonas, MD, acknowledged that Samueli Institute plays a special role in the process.

“Samueli Institute’s Chronic Pain Collaborative does the important work so that the research doesn’t just sit on the shelf.”

To continue that work, Samueli Institute has brought together a group of experts to lead the collaborative.

Chronic Pain Collaborative Faculty are the following:

Adam Perlman, M.D., MPH, FACP, Chair

Executive Director, Duke Integrative Medicine

Chair (past) for the Consortium of Academic Health Centers for Integrative Medicine

Diane Flynn, MD, MPH, FAAFP

Primary Care Pain Management Advisor
U.S. Army, Madigan Army Medical Center

Vinny Francio, DC, MS

Essential Integrative Health

Doctor of Integrative Spine Care, Pain Management and Physical Medicine and Rehabilitation.

Heather Tick, M.A., M.D.

Clinical Associate Professor at the University of Washington, Departments of Family Medicine, Anesthesia and Pain Medicine

The learning collaborative is currently seeking participants to join the expert faculty to identify and implement innovative ways to reduce chronic pain and optimize quality of life through timely delivery of team-based, person-centered, integrative pain management.

If participating in a high-level, results-oriented learning collaborative on integrative pain management would be valuable to you and your organization, please contact us today at


Who Should Join?

The Collaborative is appropriate for pain practices within organizations and clinical sites that want to offer a more integrative approach to pain management. Typically these organizations are:

  • Health systems with integrative pain clinic sites
  • Hospitals with integrative pain clinic sites
  • Group pain management practices
  • Primary care organizations utilizing at least one integrative modality.

The first collaborative meeting will take place in Spring 2016. Learn more online or schedule a call:

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3 Opportunities for Integrative Medicine Tue, 19 Jan 2016 14:39:55 +0000 headshot of Dr. Jonas

Wayne B. Jonas, MD, President and CEO, Samueli Institute

In his interview with the Natural Medicine Journal, an electronic peer-reviewed journal and open access website dedicated to the field of integrative medicine, Wayne B. Jonas, MD, describes three opportunities for the field of health and wellness and how Samueli Institute and others are working to make progress in these areas.

1. Establish an evidence base

Providers and patients are constantly faced with claims about therapeutic and healing practices. Trying to sort out what works and what does not is often done in a haphazard and unreliable manner—or the information is not available at all.

The evidence gap poses a challenge to health professionals, educators, funders and patients seeking to establish whether a health claim is supported by valid clinical evidence. Over the last decade Samueli Institute researchers have tackled the evidence gap for these and other topics:

  • Breast Cancer: A review uncovered specific interventions (i.e., pharmacological, behavioral, psychological, complementary and alternative medicine, multi-modal) aimed at mitigating the fatigue-sleep disturbance-depression symptom cluster in breast cancer patients and survivors.
  • Resilience in the Military: Samueli Institute rigorously assessed the quantity, quality, effectiveness, and safety concerns on multi-modal, biopsychosocial training programs used for the self-management of emotional stress.
  • Supplements: Samueli Institute’s reviews have uncovered how supplements can improve performance and sustain health for omega 3’s, melatonin for sleep, and others.

As more non-traditional health care treatments are accepted, this research becomes even more important to inform providers, guide policy and empower patients.

2.  Incorporate healing practices into large systems

hands_forblogMerely having the evidence is not enough. Most patients undergoing surgery still cannot access post-surgical acupuncture more than a decade after it was deemed effective. Ensuring that large hospital systems are successfully able to integrate these evidence-based practices into standard care is needed to move the field forward.

Complementary and integrative practices like acupuncture, massage, manipulative therapies, and education on diet, nutrition, and other self-care approaches are not very integrated, with conventional medicine or themselves. They are not part of normal medical training, are usually delivered in silos of practice, often aren’t found in the same place, are not part of a patient centered medical home, are not incorporated into national guidelines and are not paid for by insurance. Therefore, integrative practices tend to operate in isolation.

The need to improve quality of care is fueling Samueli Institute’s work in the Chronic Pain Breakthrough Collaborative. Health care systems and clinics receive consultative support in process improvement to integrate care which results in better outcomes for both patients and providers.

3. Show impact on the bottom line

Dr. Jonas discusses the need to demonstrate how complementary and integrative practices are cost effective within large health care systems.

Progress can only be achieved by knowing the return on investment of wellness behaviors and programs, and the success rates of traditional health interventions like medications and surgeries and how they compare with alternative treatments.

When Valley Hospital in Ridgewood, New Jersey decided to train their nursing staff in using holistic integrative care – for themselves and with their patients, a look at the operating margin of 9.64%, nine times the average for New Jersey confirmed that the decision to incorporate integrative, holistic care was clearly on target.

More success stories like this will provide a powerful financial driver for wellness.

Listen to the full interview to hear the biggest advances and future predictions for the field of Integrative Medicine.

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Combatting Chronic Pain with Acupuncture Mon, 11 Jan 2016 13:07:57 +0000 Opioid use has reached epidemic proportions in military and civilian populations and in 2014 the Centers for Disease Control and Prevention (CDC) designated opioid overdose prevention one of the top five public health challenges[i].

Most notably, 80% of heroin users report that their opioid use began with prescription pain relievers.[ii], [iii]

Chronic Pain in the Military

In one Army infantry brigade, 44% of soldiers reported chronic pain, and 15.1% regularly used opioids three months after return from combat.[iv] These rates are much higher than the 26.0% and 4.0% respectively in the general civilian population.

Rates of chronic pain in veterans (estimated at 48%) exceed those of the general civilian population,[v] and in one study, almost half of the veterans being treated for chronic pain also met diagnostic criteria for PTSD.[vi]

Limitations in pain management both in terms of controlling severe pain states and reducing the duration of pain are two factors that have been hypothesized to contribute to related issues such as the chronification of pain, posttraumatic stress disorder (PTSD), anxiety, and insomnia.

As a result, military and veteran groups have a strong interest in finding non-drug treatments for chronic pain.

Acupuncture Emerges as a Promising Treatment

Acupuncture is a potentially promising treatment of interest to the Department of Defense (DoD) and Veterans Health Affairs (VHA). The Pain Task Force’s 2010 document identified acupuncture as a Tier I modality that has the potential to reduce medication overuse in pain management.

A number of studies have found that acupuncture decreases pain in civilian populations with a variety of chronic pain conditions—including back and neck pain.

In addition, studies have found that acupuncture may be helpful for wounded warrior’s and veterans’ most common non-pain complaints including insomnia and post-traumatic stress disorder.

Researchers Find Near Immediate Pain Relief with BFA

Samueli Institute and its military partners are interested in Battlefield acupuncture (BFA). BFA in particular has great military relevance due to its feasibility, portability, low side effect profile, and potential to decrease opioid reliance to achieve pain relief.

Designed to be practiced in both clinical and operational environments, BFA may be of particular value during critical military missions where the use of opioids is not possible.

In clinical environments, the introduction of BFA may help to reduce pain with less medication, thereby reducing the incidence of drug and pain related depression and the numerous side effects of chronic opioid use.

Moreover, both in clinical practice and observational studies of BFA in military populations have demonstrated near immediate pain relief that is durable over days-weeks in some cases. 

BFA AcupunctureA Simplified Treatment

Although traditional acupuncture is based on more than 2,000 points along 20 pathways in the body called meridians; Battlefield Acupuncture (BFA) simplifies the treatment by focusing on five easy-access points on the ear to provide pain relief.

The needles used, ASP needles, are small and do not interfere with day-to-day or military tasks.

BFA’s name captures its ability to be easily and rapidly practiced and trained, even in a battle environment. The treatment takes minutes; the patient can remain fully clothed; and the patient may be fully functional and able to stay in the field and complete his/her mission.

BFA Acupuncture 2015

2015 BFA training at Camp Lejeune, NC

The BFA treatment is easy to learn and more than 1,500 DoD practitioners were trained as part of a two-year long pilot training program in BFA within the DoD and VA health care systems.

If found to be effective, the treatment could be quickly implemented across the Department of Defense (DoD) and Veterans Health Administration (VHA) at minimal cost.


Currently, acupuncture is often used as a treatment of last resort. More research is needed to help medical professionals to better integrate acupuncture into the treatment of pain and guide the allocation of training, staffing, scheduling and supplies.

Learn more about Samueli Institute’s work in combating pain.


[i] Kolodny A, Courtwright DT, Hwang CS, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36:559-574.

[ii] Muhuri P, Gfroerer J, Davies C. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. In: Administration SAaMHS, ed. Center for Behavioral Health Statistics and Quality Data Review 2013.

[iii] Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821-826.

[iv] Toblin, R. L., et al. “Chronic Pain and Opioid Use in Us Soldiers after Combat Deployment.” JAMA Intern Med 174.8 (2014): 1400-1.


[vi] Pain Medicine News:  High Prevalence of PTSD seen in Veterans with Chronic Pain (May 2009; 7(05))

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Podcast – An Interview with Dr. George Isham Fri, 08 Jan 2016 22:20:08 +0000 George Isham, MD, Chief Health Officer of HealthPartners, a nonprofit health provider that covers more than 1.5 million lives in Minnesota and Wisconsin, joins Samueli Institute President and CEO Wayne Jonas, MD, this week for a podcast interview on the future of healthcare.

Clinical Care Accounts for Only 20% of Health

In a 20 minute interview, Isham and Jonas discuss the groundbreaking work of Dr. David Kindig, who argued that clinical care is responsible for as little as 20 percent of overall health. The vast majority of factors influencing health, he said, come from social determinants, such as socioeconomic factors, the environment, and the health behaviors of individuals.

It is through this lens of the importance of what happens outside the doctor’s office that Jonas and Isham consider the future of care and wrestle with real world questions of promoting health within a system that reimburses prescriptions, procedures and clinical treatments.

“If you change the way that people are paid such that you reward the outcomes, then doctors are free to figure out based upon good science what works and what they should begin to do,” explained Isham.

“This will increase satisfaction not just in patients, but in clinicians as well. People are highly motivated when you have a mission that is larger than self. That’s why doctors went to medical school and why nurses trained to be nurses.

]]> 0 George Isham, MD, Chief Health Officer of HealthPartners, a nonprofit health provider that covers more than 1.5 million lives in Minnesota and Wisconsin, joins Samueli Institute President and CEO Wayne Jonas, MD, George Isham, MD, Chief Health Officer of HealthPartners, a nonprofit health provider that covers more than 1.5 million lives in Minnesota and Wisconsin, joins Samueli Institute President and CEO Wayne Jonas, MD, this week for a podcast interview on the future of healthcare. Clinical Care Accounts for Only 20% of Health In a 20 minute interview, Isham and Jonas discuss... Samueli Institute Blog clean 31:23
What Is A Collaborative? Thu, 07 Jan 2016 15:00:28 +0000 Collaboratives are gaining popularity as a way to drive breakthrough improvement in a specific topic area. But what exactly is a collaborative? 

Breakthrough Collaboratives 101

A collaborative is not just a training program; it is a change management and process improvement initiative that includes team learning.

Participating organizations build their own capacity for continuous improvement and spread best practices from one site to many.

Topics for collaboratives vary but typically focus on healthcare practices where a gap has been identified between knowledge and practice such as chronic pain care. Samueli Institute developed the collaborative programs in partnership with a leader in promoting change in healthcare, the Institute for Healthcare Improvement (IHI).

As shown in the graphic, a Breakthrough Collaborative uses a systematic approach to health care quality improvement in which organizations and providers test and measure innovations and then share their experiences in an effort to accelerate learning and widespread implementation of best practices.Collab_Samueli-infographic-April-2015-WEB600x600

The Details

A collaborative involves organizations working together at a high level of intensity for a specific period of time, typically 6-18 months.

During that time, the group participates in learning sessions, and maintains continual contact with each other and faculty members via selected in person site visits, over the phone through conference calls and online with webinars, a listserv and a dedicated website.

Teams are led by an expert faculty who guide and mentor participants throughout the process.

How Change Happens

The first learning session focuses on learning state of the art ideas, best practice methodology and approaches, measurements, and creating a customized plan for breakthrough organizational improvement through rapid cycle tests of change.

Action periods are the time between learning sessions where implementation occurs. Teams work within their organization to perform rapid cycle testing and implement changes toward major breakthrough improvements.

Although participants focus on their own organizations, they remain in continuous contact with the other collaborative participants and faculty. Teams share the results of their improvement efforts in monthly reports and also participate in shared learning through communication channels such as conference calls, e-mail discussion groups, webinars, and a web-based data-sharing platform, the Extranet

Participation in action periods is not limited to those who attend the learning sessions, but includes all other organizational team members and supporters.

The second learning session explores results among the participants, and participants will learn how top-performers achieved their outcomes.

Rapid-Cycle Change Continues

Teams then focus on additional rapid-cycle tests of change during the second action period and convene at a third learning session to share what has been learned, and to create a plan for organizational spread with the successful changes that were made.

Samueli Institute’s Chronic Pain Breakthrough Collaborative is currently seeking enrollment. Learn more.


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The Future of Integrative Medicine, an Interview with Dr. Jonas Wed, 06 Jan 2016 21:08:00 +0000 What does the future hold for health and wellness research? Wayne B. Jonas, MD, discusses this and more with the staff at the Natural Medicine Journal, an electronic peer-reviewed journal and open access website dedicated to the field of integrative medicine (IM).

Listen to the interview in Episode 6 of the
Integrative Medicine Research Series.

Mainstreaming of Healthy Values

In recent years it seems there is little “health” in the nation’s health care system. By its actions, the health care system showed its laser focus on disease and illness management rather than health promotion.

However, as we look ahead, we begin to see the wellness-focused values of those in the non-traditional wellness field appearing in the lexicon of the mainstream health care system.

Wellness, well-being, health and health promotion are becoming valued by the health care system in its efforts to improve patient care. As the focus shifts from disease-centered care to person-centered care, patients benefit and the nation becomes healthier.

Consumers Demand Health and Wellness

TK SAT-53webSeeing these values in action is as easy as entering the supermarket, where the demands for organic, hormone-free, antibiotic free products have surged. Health and wellness are part of the everyday quest for many consumers who are showing their interest with their wallets, purchasing healthier protein options such as bison, salmon and quinoa.

As these values of health and wellness become mainstream, they continue to have ripple effects as choices are not always an individual behavior, but influenced by the social and physical environments as well.[i]

Mainstreaming of Alternative Practices

The health care system cannot ignore the interest in promoting wellness. This leads to the next trend of mainstreaming practices that were once considered non-traditional by the health care industry.

Once on the fringes, massage and chiropractic care are now more accepted. Even the current administration is discussing how non-drug approaches to chronic pain might alleviate the opioid crisis in America.

BFA Acupuncture needlesThe connection between nutrition and brain function is a focus point of Samueli Institute’s work with the military. As is exploring the value of acupuncture and guided imagery for the signature wounds of the war in the Middle East—post-traumatic stress and traumatic brain injuries.

Researchers and practitioners must continue to show the value of these non-traditional practices for the health industry to adopt them.

But knowing that something works is merely part of the equation.

Knowing how to implement that knowledge within the current system of care is also critical. The term “integrative care” surfaces as a buzz word in the industry; however many health care systems struggle to provide care that combines the best of traditional and non-traditional medicine.

Improving the patient’s experience of care through a focus on integration is highlighted in Samueli Institute’s work in chronic pain care.

Listen to the full interview including the biggest advances and opportunities in the field of Integrative Medicine.



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5 Steps to Wellness: A Commonsense Rx Mon, 04 Jan 2016 11:13:24 +0000 Wellness without any pills, potions, or procedures? It can be possible according to CAPT George Ceremuga, DO.

Before his current assignment, Dr. Ceremuga was the Chief of the Integrative Holistic Medicine program at Fort Belvoir Community Hospital. He led the inpatient substance abuse program where they had a saying:

“Just for today, do the next right thing and good things happen.”

New health data released late 2015 shows that we need this advice now more than ever.

A Generation in Distress

For the first time in decades, mortality rates have increased for middle-aged non-Hispanic white men and women.[i] Mid-life distress is on the rise as can be seen by “declines in self-reported health, mental health, and ability to work, increased reports of pain, and deteriorating measures of liver function” (Case et al., 2015, p. 1).

But in the midst of this distressing news is a kernel of hope.

Overwhelming evidence shows that good lifestyle choices in diet, physical activity, tobacco and alcohol use, stress management and social connections improve overall health and reduce the impact due to chronic illness and mental disease.[ii]

This means that the choices you make today matter.

5 Steps to Wellness

Dr. Ceremuga’s prescription for wellness includes 5 simple and common sense choices. But choosing healthy habits takes discipline especially since our medical system can make you feel that your health is outside of your control. But most of this time, that’s not true. Studies have shown that up to 70% of health comes from everyday decisions.

As the New Year brings a moment of reflection, consider Dr. Ceremuga’s 5 Pillars of Wellness:

1. You are what you drink.

The human body is made up of 60-70% water. Sufficient water intake impacts weight loss, muscle fatigue, skin health, kidneys, bowel function and more. Remember to drink water by carrying it with you everywhere you go and drink it with every snack and meal.

2. Eat good, whole foods.

A healthy anti-inflammatory diet like the Mediterranean diet with a focus on vegetables and fruits will keep your body powered up. Focus on adding good food rather than depriving yourself of things you shouldn’t have. An added bonus: since vegetables and fruits contain mostly water, they will add to your hydration levels.

3. Move more! Motion is a lotion.

We all know the therapeutic benefits to exercise so be sure to fit movement into your day. At least 30 minutes a day of exercise is important. Ask your doctor for ways to move more and for advice on how much exercise is right for you especially if you are trying to lose weight or have certain physical conditions.

4. Recharge at night.

Get 7-9 hours of sleep to reconstitute your body. Getting enough sleep may have surprising benefits including a better sex life, better overall health, less pain, clearer memory and better weight control.[iii]

5. Nourish your spiritual self.

Focus on love and forgiveness—and start with yourself. If you are not loving and forgiving of yourself, it’s hard to inspire, motivate and encourage others. Try a loving kindness meditation and see how it makes you feel.

And a bonus: Check your relationships.

Maintaining positive social connections is essential to a healthy life. Read our article to see if you are in a healing relationship.

Just one positive change will put you on the path to wellness. See what resonates with you and start there because as Dr. Ceremuga says:

“Do the next right thing, and good things happen.”

Related article:

How can I change to Healthy Habits


[i] Case A, Deaton A. (Nov 2015) Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences of the United States of America.

[ii] Kvaavik, Elisabeth (April 2010). “Influence of Individual and Combined Health Behaviors on Total and Cause-Specific Mortality in Men and Women: The United Kingdom Health and Lifestyle Survey”JAMA Internal Medicine 170 (8). PMID 20421558. Retrieved 7 July 2015.



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Should You Go Under the Knife? A Review of Sham Surgery Tue, 15 Dec 2015 11:10:38 +0000 Patients dealing with chronic pain and obesity have a difficult decision to make when facing surgery or minimally invasive procedures. With the help of their doctors, patients weigh the risks of the procedure including infection, cost, and the side effects, including those of anesthesia. However, a recent study by researchers showed that in some cases, surgery is no better than placebo, and in other cases that doctors and patients may not have all the information they need to make proper decisions.

Some Procedures No Better than Placebo

Researchers from Samueli Institute, National Institutes of Health, Harvard Medical School, Houston Methodist Hospital, the University of Maryland and the University of Munich, Germany systematically reviewed 55 studies comparing patient outcomes from actual surgical procedures to outcomes after “sham” procedures. Sham procedures mimic the ritual and process of surgery without actually performing the procedure.

The review encompassed more than 3,500 patients and showed that outcomes for surgery were about the same as placebo in the included procedures for pain, and marginally better in cases of obesity.

The results of the systematic review, which was published this month in the journal BMJ Open, have implications for clinical research and practice by arguing against the continued use of ineffective, invasive procedures—especially in the field of chronic pain – until more rigorous research is done on these procedures.

Limited Information Available for Decision-Making

Minimally invasive surgical procedures have expanded for treating conditions such as low-back pain, arthritis, endometriosis, Parkinson’s disease, gastro-oesophageal reflux and obesity, but rarely are these procedures evaluated using rigorous research designs using randomized, placebo-controlled trials, the gold standard of medical research.

This limits the ability of doctors and patients to make proper evidence-based decisions when deciding whether the risks outweigh the benefits.

Wayne B. Jonas, MD, President and CEO of Samueli Institute and an author of this review, has been studying the effects of placebo for more than a decade. His research works to uncover the role of placebo, meaning and context in the healing process.

“We need to uncover how much of the healing is due to the specific treatment and how much can be attributed to other factors like the ritual, the setting, and the communication style of the provider,” says Dr. Jonas. “This understanding will help us to maximize the effective factors and limit the risk of invasive treatments.”

Read the full study here.

BMJ Open 2015;5:e009655 doi:10.1136/bmjopen-2015-009655:  To what extent are surgery and invasive procedures effective beyond a placebo response? A systematic review with meta-analysis of randomised, sham controlled trials. View article.

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