Reprinted in this month’s issue of Harvard Business Review, and originally published in that publication’s November 2005 issue.

An interview with Dr. Benson by Bronwyn Fryer

Managers apply pressure to themselves and their teams in the belief that it will make them more productive. After all, stress is an intrinsic part of work and a critical element of achievement; without a certain amount of it, we would never perform at all.

Yet the dangers of burnout are real. Studies cited by the National Institute for Occupational Safety and Health (NIOSH) indicate that some 40% of all workers today feel overworked, pressured, and squeezed to the point of anxiety, depression, and disease. And the problem is getting worse, thanks to intensified competition, rapid market changes, and an unending stream of terrible news about natural disasters, terrorism, and the state of the economy. The cost to employers is appalling: Corporate health insurance premiums in the United States shot up by 11.2% in 2004—quadruple the rate of inflation—according to survey figures from the Henry J. Kaiser Family Foundation. Today, the American Institute of Stress reports, roughly 60% of doctor visits stem from stress-related complaints and illnesses: In total, American businesses lose $300 billion annually to lowered productivity, absenteeism, health-care, and related costs stemming from stress.

So the question is: When does stress help and when does it hurt? To find out, HBR senior editor Bronwyn Fryer talked with Herbert Benson, M.D., founder of the Mind/Body Medical Institute in Chestnut Hill, Massachusetts. Also an associate professor of medicine at Harvard Medical School, Benson has spent more than 35 years conducting research in the fields of neuroscience and stress. He is best known for his 1975 bestseller, The Relaxation Response. He first described a technique to bring forth the complex physiologic dance between stress and relaxation, and the benefits to managers of practices such as meditation, in “Your Innate Asset for Combating Stress” (HBR July–August 1974). His most recent book is The Breakout Principle (Scribner, 2003) with William Proctor.

Benson and Proctor have found that managers can learn to use stress productively by applying the “breakout principle”—a paradoxical active-passive dynamic. By using simple techniques to regulate the amounts of stress one feels, a manager can increase performance and productivity and avoid burnout. In this edited conversation, Benson describes how managers can tap into their own creative insights, boost their productivity at work, and assist their teams to do the same. He is quick to acknowledge the large part Proctor’s thinking has played in the ideas he discusses here.

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BHI is pleased to report on the following advancements in the realm of research:

* BHI research colleague Ana-Maria Vranceanu, PhD, received a clinical research award to test the BHI Stress Management and Resiliency Training (SMART) program with adolescents ages 12-18 who have neurofibromatosis, a genetic disorder that causes tumos to grow along various types of nerves. If the program demonstrates significant benefits,  Dr. Vranceanu plans to extend the program to develop similar services for children and for deaf patients.

*  Psychiatry residents Deanna Chaukos and Tom McCoy, and in internal medicine resident Laura Byerly, along with Darshan Mehta and John Denninger of our BHI staff have been awarded an MGH Education and Teaching Grant to implement and study the long term benefits of the SMART program for psychiatry and internal medicine interns. We are hopeful that the BHI program can provide long-term resiliency skills to these young physicians that they can use to help sustain their own busy medical careers, while also providing stress-reduction and resiliency building tools that they can use with their patients.

The extreme weather in New England this winter has tested even the most resilient among us. Hours-long commutes, weather-related closures, and bitter cold has translated to a lot of added stress. I usually find shoveling snow to be relaxing but even I have had my fill. Even before this tough winter, however, the American Psychological Association’s 8th annual Stress In America survey reported that Americans are feeling more stress than we believe to be healthy, with women and millenials (those age18-35) experiencing more stress than anyone else.

Not surprisingly, money tops the list of stressors, with 64 percent saying it is a significant source of stress. Work, the economy, family responsibilities and personal health concerns are also high on the list.

From a broad perspective, this survey reinforces the need to address the growing income gap, gender inequality, and the difficulty that young people face in finding good jobs and paying off college loans. But at a more personal level it spurs us to consider how much we might be able to reduce our experience of stress, improve health and quality of life simply by improving our ability to better cope with life’s stressors.

The unfortunate irony is that the more stress we feel, the less likely we are to do things that help us cope with stress. No matter how well we understand that healthy lifestyle and feeling socially connected are important in relieving stress, it’s also true that these helpful behaviors are just the things that fall by the wayside when we are overwrought with challenges. Thirty-two percent of those surveyed said that finances or lack of money prevent them from living a healthy lifestyle, or even making necessary visits to a doctor. Stress leads to increased social isolation, which itself leads to an increased sense of stress, creating a downward spiral of stress-inducing behavior that results in increasingly intractable problems.

Our mission at BHI is to invert this downward spiral to an upward one, in which shifting to positive thoughts and behaviors reduces stress, improves health and builds long-term resilience. We seek to disseminate this knowledge and to encourage good mind body health practice in our patients, their families and in the doctors, nurses and professional caregivers who provide care every day in stressful settings. Toward this end we were excited to learn recently that residents in psychiatry (Deanna Chaukos, Tom McCoy), and in internal medicine  (Laura Byerly) along with Darshan Mehta and John Denninger of our BHI staff have been awarded an MGH Education and Teaching Grant to implement and study the long term benefits of our SMART program for psychiatry and internal medicine interns. Internship is a stress “trial by fire” and we are hopeful we can have a positive lasting impact on the lives of these young physicians.

While studies consistently show that mind-body practices significantly improve health and quality of life, like anything that’s good for you, the practices are only as good as our ability to stick with them.

So how do we get those helpful behaviors to become habits? It turns out that enjoying an experience is a key factor in our ability to commit to them. And a key to enjoying an experience is doing it with mindful awareness. If it’s exercise we’re talking about this means being fully present in the activity, whether biking, hiking walking or whatever. Rather than staring at the clock until your 20-minute workout is over or drifting off into thoughts of what to make for dinner, you are gently alert to the sights and sounds around you, the sensations in your body, your breath entering and leaving your mouth and nose. While exercise isn’t always comfortable, when done mindfully, it becomes more enjoyable, and thus easier to keep to a routine.

Once we learn to approach one component of our lives with this sense of attention and calm curiosity, we can more easily translate it to other aspects in a process that is truly transformative.

In this issue of BHI News, we explore the application of mindful awareness and other relaxation response elicitation techniques in the workplace with a reprint a 2005 interview with Dr. Benson that appears in this month’s issue of Harvard Business Review. We look at the research that is moving the field of mind-body medicine ahead as seen from the perspective of Research Director John Denninger, and we get a sneak peak at some of the research and educational programming with which BHI is currently involved.

A conversation with BHI’s Director of Research.

Q: What drew you to the field of mind-body medicine research?
Denninger:

Well, I’ve always been interested—even back when I was in high school—in the mind, brain and behavior, but it wasn’t until I went to China on the Boston-Hangzhou Sister City program right after I graduated from Boston Latin School that I had any exposure to what we think of now as mind-body medicine. While studying at Hangzhou University, we had daily sessions with a tai chi master. Although my 18-year-old self was a little thick about the focus on breathing, intentionality and chi (I think I had been expecting something a little more martial arts and less meditation), I like to think that I internalized some of the wisdom in that practice and have carried it with me since.

When I was getting my MD/PhD at the University of Michigan, my dissertation work focused on the kind of science where we looked at one protein—one enzyme—at a time in a test tube. After my psychiatry training here in the MGH/McLean Psychiatry Residency Training Program, I decided that I really wanted to shift my research to something that would be more directly applicable to helping patients. I spent four years at MGH’s Depression Clinical and Research Program, doing both clinical and research work with patients struggling with depression. Coming to BHI, I was excited by the idea of being able to integrate research on mind-body medicine at a number of levels—from public health to individual patients to understanding the molecular details of how mind-body approaches work.

At BHI we are clinician-researchers, so we combine expertise in developing and delivering mind-body programs with expertise in conducting scientific research. Both of these areas inform and complement each other so that we can improve both over time. One example of this is our current work to identify outcome measurements that will be most useful for future mind-body medicine research.

It’s also tremendously exciting to be able to work collaboratively with a some of the top researchers in the field, whether in genetics, neuroimaging or in the clinical application of the work. There are over 600 integrative medicine researchers at Harvard alone who are making tremendous advancements in the field, and Boston continues to evolve into a truly international hub for this work.
Q: What areas of research are leading to new understandings in the field?

Denninger: I’m always excited by research into the biology underlying the approaches that we teach. Being able to say something very specific on a molecular level about what happens when people practice meditation is important to me, to the institution and to the field in general. It’s some of the most exciting work that we do.

For the past several years, we’ve been exploring with Dr. Towia Libermann and Dr. Manoj Bhasin, our partners at Beth Israel Deaconess Medical Center, the effect of the relaxation response and BHI’s mind-body intervention on how genes are turned on and off. We’ve already established that the regulation of NF-B, an important molecule in the immune system, is altered by the mind-body approaches. Our focus now is on higher level questions; for example, can BHI’s resiliency program improve patient outcomes and potentially prevent development of disease by directly affecting physiology.

Along with collaborators here at MGH, at Dana Farber Cancer Institute, Beth Israel Deaconess Medical Center and Newton-Wellesley Hospital, we are about halfway through a study of patients who have conditions that are precursors of multiple myeloma (a cancer of plasma cells—a type of white blood cells—which accumulate in the bone marrow) to see whether the BHI’s mind-body program can help these patients become more resilient in the face of the stress of having these conditions’ physiology and possibly—and this would be the home run—alter gene regulation in a way that might help slow the progression of these conditions.

In the larger field, there have been great strides in neuroimaging and meditation. The October 2014 Scientific American magazine does a nice job of summarizing some of that exciting research.

We’re also starting work to get at costs—answering the question of how much our program can save money for the system. That’s important research to do, but it takes time and can be difficult to do well.

The reality is that we still have a long way to go in the research arena before policymakers and planners are ready to recommend mind-body approaches to patients with the same universality that they recommend exercise and eating right. But I think that day will come: The fact is that the science continues to lead us toward further integration into mainstream healthcare. It’s an incremental process, but eventually, as I see it, mind-body medicine will be widely perceived as an effective tool in the healthcare tool belt.
Q: Do you have a personal practice?

Denninger: Yes, but it’s taken me a while to really integrate it into my life. I came to BHI attracted by the science; over my years here I’ve fallen in love with the practice. Now my daily meditation—okay, almost every day—is one of the things I look forward to most.

Leslee Kagan, MS, FNP, is Director of BHI women’s health programs and co-director of the BHI Stress Management and Resiliency Training Program. Here she shares a body scan meditation

Stress and the Relaxation Response: The Fundamentals of Mind Body Medicine

This interactive 4-week course provides valuable, evidence-based insights on the basic principles of mind body medicine. Enhance your clinical practice by helping your patients understand the science of how stress impacts health.

The course provides an overview of mind/body interactions and a deeper understanding of how mind body therapies decrease stress and enhance well-being. It strengthens your knowledge and clinical skill set for recognizing early warning signs, weighing the relative risks of various conditions, and ultimately helping your patients alleviate stress and either prevent or relieve medical conditions.

This is the first in BHI’s three-part online course catalogue and a requirement for participation in a SMART Implementation Training.

Next online course begins: April 3, 2017

It also features interactive discussion boards and weekly call-in hours with world-renowned faculty from the Benson-Henry Institute for Mind Body Medicine, including Mind Body Medicine pioneer Dr. Herbert Benson. Research shows that stress is a contributing factor in many common conditions and diseases, such as obesity, type 2 diabetes mellitus, hypertension, pain and fatigue syndromes as well as mood disorders. Engage faculty with questions about your clinical challenges and cases, and bridge the gap between the science underlying the principles of mind body medicine and applying that evidence to clinical practice to help patients tackle their serious health issues.

Course assignments include online lectures, recommended readings, interactive discussion forums, and weekly conference calls with faculty and all participants. The course content is 100% mobile-friendly so you can participate whenever your schedule allows. New course assignments are released each week, and you can finish the preceding week’s materials at any time to unlock the next week’s materials.

This four-week online course, “Using Mind Body Techniques in Your Health Care Practice” provides CME/CE credits, and is appropriate for both beginners and those with some experience in eliciting the relaxation response.

The course provides both a broad and deep look at the many methods to elicit the relaxation response. Participants learn how to build their own meditation practice along with effective approaches for instructing their clients/patients to do the same.