These practices form a small part of a large domain (area of knowledge) of CAM: mind-body medicine, which involves the interaction of mind, brain, other body systems, behavior, and, ultimately, health and disease. Some examples of other mind-body practices include relaxation techniques, hypnosis, various forms of meditation, yoga, and tai chi. Mind-body medicine is one of NCCAM's current research priorities. Through this research, the Center seeks to discover means for enhancing and accelerating the healing process beyond the effects of conventional medicine; preventing, treating, and slowing the progression of diseases and disorders; reducing the burden of stress-related chronic illnesses; and enhancing people's resilience and coping--all toward improving public health and well-being.

Many mind-body techniques date back to ancient times. In recent years, science has found evidence that patients faced with chronic and even terminal illnesses--particularly conditions like heart disease and cancer--can learn and utilize a variety of mind-body practices to achieve symptom relief, a better quality of life, and, in some cases, improvements in health outcomes. The clinical reports of these effects are supported by a growing body of basic and clinical research. These studies are aimed at better understanding the underlying mechanisms at work at genetic, molecular, and cellular levels. They look at markers and measures in the body and draw upon an array of high-technology tools and techniques, such as brain imaging.

"The growing body of physiological evidence about these approaches is helping to shatter a long-held cultural belief in the West that mind and body are separate," noted Dr. Straus. "Indeed, the potential exists for safe and effective mind-body practices to add to the repertoire of conventional medicine. NCCAM is working to move study in this important field forward."

Defining Terms

What does NCCAM mean by studies on prayer and spirituality? It is important to start by explaining what CAM is: a group of diverse medical and health care systems, therapies, and products that are not presently considered to be part of conventional medicine as practiced in the United States. Within CAM, prayer is defined by NCCAM as an active process of appealing to a higher spiritual power, specifically for health reasons; it includes individual or group prayer on behalf of oneself or others. Spirituality is broader; it is defined by NCCAM as an individual's sense of purpose and meaning to life, beyond material values. Spirituality may be practiced in many ways, including through religion.

Snapshots of NCCAM Research

NCCAM is funding several studies of prayer and other explicitly spiritual practices. Goals range from improving quality of life, to looking at the impact of these practices on the immune system and on serious chronic health conditions, to assisting people through the end of life.

Spirituality in the Context of Chronic Illness

Joel Tsevat, M.D., Director of Outcomes Research in the Department of Internal Medicine at the University of Cincinnati, is completing a study of the will to live in patients with HIV/AIDS. His team is using several standardized tools that measure different aspects of spirituality, such as a sense of meaning and peace and faith, religious coping measures, and involvement in organized and nonorganized religious activity. They are also looking at measures of health status, health concerns, depression, self-esteem, and social support. The study involves interviews with 350 individuals with HIV/AIDS in Cincinnati and Washington, D.C.

Dr. Tsevat became interested in studying spirituality during earlier research with patients with HIV/AIDS. "Patients were telling us that they had discovered new meaning and purpose in their lives since being diagnosed with HIV," Dr. Tsevat said. "The spirituality theme emerged when we asked patients whether they would choose their health as it is or take a gamble between death and perfect health." People who were spiritual tended to be happier with their current health status and less likely to take the described risk.

"We tend to focus just on what medical professionals can address--physical functioning and mental health," said Dr. Tsevat. "In the scheme of things, I think spiritual well-being is also an important component of someone's quality of life."

Spirituality, Immunity, and Emotional Well-Being

Several NCCAM-supported researchers in New York City are exploring the impact of spirituality on the immune system and its role in emotional well-being among cancer patients.

Barry Rosenfeld, Ph.D., and graduate student Colleen McClain, M.A., of Fordham University, and William Breitbart, M.D., of Memorial Sloan-Kettering Cancer Center, published results in 2003 of an NCCAM-funded study on the effect of spiritual well-being on end-of-life despair in terminally ill cancer patients. They concluded that spiritual well-being offers some protection--a buffer effect--against end-of-life despair in patients for whom death is imminent. These researchers are now studying spirituality-based interventions to establish methods that can help engender a sense of peace and meaning.

"When people despair, they feel nothing they've done has had any meaning. We help them remember things they've forgotten during the throes of their illness so they can realistically place themselves in the world," Dr. Rosenfeld said. The approach is spiritually based, he said, but "we have tried to not have it linked to any particular religious framework, keeping it open to as many individuals who are interested."

To determine whether immune function is a link between spirituality and emotional well-being, the three researchers are also now collaborating, under another NCCAM grant, to measure spirituality and interleukin-6 (IL-6) levels in the blood among terminally ill cancer patients. "There is a small, but growing, body of literature linking immune function to mood, and IL-6 is the immune marker most highly correlated with mood states," Dr. Rosenfeld said. IL-6 is a protein that acts on other cells to regulate immune system function. It is one of several markers of inflammation, an important process in a variety of diseases like heart disease, diabetes, and stroke, and is associated with increased stress and depression.