Interview With an Expert in Complementary Therapy: James Gordon, MD

Please tell me about your background.

I am a physician and psychiatrist, Harvard-trained. I am a clinical professor in the Departments of Psychiatry and Family Medicine at Georgetown University and also chair of the White House Commission on Complementary and Alternative Medicine Policy.

I always had a particular interest in how the mind, thoughts, and emotions can affect the body and vice versa. I started the Center for Mind-Body Medicine 10 years ago to try to provide a way for physicians and other health care professionals to learn about mind-body medicine by first integrating it into their own lives and then including it in their work with patients.

Mind-body medicine is very much involved in learning and teaching self-care. I recognized early on in my medical training that there was a missing link in medicine. Medical environments were good at doing things to or for people, but they did not give patients things they could do for themselves.

I came to have a real respect for what patients could do for themselves. I first observed this in dealing with psychiatric patients, but then later also with more chronic physical conditions. I also began to experiment with myself, and 30 years ago, I saw the difference I could make in my own physical and mental health by practicing meditation, yoga, healthful nutrition, and other self-care methods.

We need to balance what we do for or to patients with what we can teach them to do for themselves. There is a great deal people can do whether they are dealing with a chronic illness such as diabetes or a life-threatening illness or just want to take better care of themselves and prevent illness.

You run 12-week mind-body groups with patients who have cancer, AIDS, or other diseases. How do these groups operate?

I believe that small groups are the best way to offer these skills and approaches. The small-group format is designed to teach people that they have the capacity to understand and help themselves.

In these groups, we teach self-awareness through drawing, meditation, journaling, and movement. We also teach self-regulation through relaxation, biofeedback, imagery, yoga, and meditation.

People come because they want to come. It is a safe place to learn about oneself and to decrease stress. In small groups, people can express themselves in an atmosphere of teaching and learning. It gives them support. It is hard to make changes in the way we think and live. These small groups offer support as patients are beginning to make changes.

Group leaders are health care professionals who have been through our certification program and whom we regard as particularly gifted.

What topics are included?

Our groups cover guided imagery, several types of meditation, autogenic training (self-hypnosis), biofeedback, breath work, movement, use of journal writing and drawing, self-awareness, exercise, and nutrition.

What are the benefits to people who attend these group sessions?

We are currently doing research on this topic. We are seeing that people feel more in control of their lives, that they are sometimes able to decrease doses of medications, and that they experience life in a more relaxed way. For example, in people with diabetes who have attended a mind-body group, the stress reduction and healthier eating often result in reductions in the doses of diabetes medications needed to manage their blood glucose. There are also reductions in depression, anxiety, and chronic pain. Many participants experience more optimism and less isolation. The groups give great support.

Do you think these groups hold other benefits for people with diabetes?

Yes, I know they do. Sometimes it is useful for people to be in small groups where all of the participants have the same issues (for example, for cancer patients). But we have found that often when we mix groups and include diverse health conditions and socioeconomic backgrounds, it also works well. Often, people discover that they are more alike than different. Whether it is diabetes or cancer, most people in the groups have some chronic health challenge.

Most of us after a given age are trying to make our way in the world and understand ourselves. These groups, whether they include people with a similar diagnosis or health risk or are composed of people with diverse health conditions, do offer an opportunity to share and learn with others.

One of the benefits of this group work is that it allows people to reclaim some control. In my experience, some people with diabetes tend to have a fatalistic view of life. This group training gives them a sense that they can do something for themselves.

At the purely physiological level, most of these practices reduce levels of cortisol, epinephrine, and norepinephrine, all hormones you might call the counter-regulatory hormones in diabetes. When these levels are high, as they are in acute or chronic stress situations, they will elevate blood glucose levels. Learning to control stress hormones may help better regulate blood glucose as well as work to prevent heart disease. At Harvard, Herbert Benson, MD, has shown that many of these mind-body methods also significantly reduce blood pressure.

What is the cost to patients for your 12-week groups? Does insurance cover the cost?

The cost for the initial 1-hour interview and then 12 2-hour group sessions is $1,140 or about $95/session. We do have a sliding scale, however, and we never turn people away because of cost. Because we bill these groups as group therapy, these costs are covered if participants have insurance that covers group therapy.

You offer training for health care professionals who want to learn more about mind-body techniques and how to introduce them to patients in a group setting. What are the details of these trainings?

We first planned the group training for health care professionals 8 years ago when we needed more skilled group leaders. We did a local training in 1994 and had 30 attendees. Last year, 135 health care professionals from all over the United States and the world attended our training.

Our training is an intensive week. We meet in a large group to convey the latest science on these approaches and how they work. There are also intensive small groups that meet for 20 hours so that participants have the opportunity to experience being in a small group themselves and to practice the techniques and approaches.

We have trained more than 600 people who have started programs all over the world.

There is also an ongoing advanced training and a program of supervision led by our senior faculty.

Do you offer certification?

Yes. While our basic training is open with few prerequisites, we select very carefully for the certification program. This year, we will certify 10 people only, for example.

What is the cost of the basic training and the certification program? Do you also offer continuing education credits?

The initial 1-week training with meals is $2,250. Advanced training is $600. Certification is $3,000 and involves 124 hours of supervised teaching, several papers, and an additional advanced course. Yes, we offer continuing education credits for physicians, psychologists, nurses, social workers, and registered dietitians.

Your center is one of only a few places that train health care professionals to provide mind-body groups. How does your program differ from that of Jon Kabat-Zinn, PhD, at the University of Massachusetts or that of Dr. Benson at the Harvard Mind/Body Medical Institute?

Our training is more eclectic. We give more attention to the individuals who come through the training by helping them to explore what is going on within themselves. Our program teaches a wider array of methods and skills in part because that is how I work. We want to help participants find the approach that works, both for their patients and for themselves. Our work is to help them find their way.

The other two programs are also very good. I am not sure what they offer in this regard, but we may be unique in that we offer ongoing supervision and training.

How do you get reimbursed for your time and expertise?

My hour visit is $180, and patients will pay via insurance or out-of-pocket. Here, too, I have a sliding scale based on economic need. Unfortunately, reimbursement in health care today is so much more based on procedures than on spending time with patients. Certainly, small groups are economically efficient for both patients and providers.

What benefit from the mind-body practices do you find for patients from lower (vs. higher) socioeconomic groups?

The benefits are the same. I have worked a lot with people on welfare. The issue always is how important is it for a person to do these practices, not how much money or education the person has. As an example, there may be an HIV-positive former addict who wants a better quality of life. The person has to want it to reach that point. Of course, it is harder because the costs, transportation, time, and other factors are more challenging to people with little money.

Can you share with us your priorities as Chair of the White House Commission on Complementary and Alternative Policy?

The Commission is clear that its key focus is to integrate teaching of self-care into all aspects of the health care system. The goal is to integrate it not just into hospitals and clinics, but also into other settings, such as grade schools. This view is shared by others on the Commission. Other key goals are for health care professionals to have a critical and open mind and for the public, as well as health care professionals, to have the best, most authoritative references possible on complementary and alternative medicine therapies.