A key concept for which 17th century philosopher René Descartes is remembered is that of mind-body dualism: the belief that the immaterial mind and the physical body are two entirely distinct entities made of contrasting substances.

Although Descartes’ philosophical writings also explored how the two elements can influence each other through causal interaction, the key message that resonated with readers at the time—so much so that it directed the focus of science and medicine for nearly 400 years—was that the body and the mind were separate things, requiring isolated attention and even existing in different realms.

In many non-Western traditions, the concept of mind-body interconnectedness has long been endorsed in medical therapies. And recently, the power of the mind to influence the body’s physical experience through biofeedback and cognitive behavioral therapy has gained momentum in the U.S. A growing body of clinical research studies led by Cedars-Sinai scientists and others in virtual reality (VR), augmented or mixed reality, and medical extended reality (MXR) have now challenged the notion of requiring separate approaches for the mind and body.

The Science of the Mind-Body Connection

“We keep learning more about the power of the mind to meaningfully alter physiological functions affecting a wide range of health conditions, from eating disorders and childbirth pain to migraine onset and cognitive function,” said Brennan Spiegel, MD, MSHS, director of Health Services Research for Cedars-Sinai.

A combined form of mind-body medicine that harnesses the connections between brain signals and physical experiences can result in a meaningful therapeutic effect—even helping patients reduce the need for pain medications after surgery or burn trauma.

Brainwave research shows that VR noticeably reduces preperceptual brain activity (called N-1 activity) and perceptual brain activity (called P-3 activity) in response to pain or negative stimulation, resulting in a reduced experience of physical pain.

Although data are still emerging, other conceptual ways to explain VR’s powerful capability for providing pain relief include what is essentially distraction—subtracting from the brain’s ability to focus on the pain and any emotions associated with it—as well as a more complex “pain matrix” explanation, in which reduced input to the attention, memory, emotion and sense-based (sight, touch, etc.) perception pathways of pain results in less pain. It can also blunt physiological arousal, such as increases in heart rate.

“MXR is tapping into the brain’s power to modulate the autonomic nervous system, which holds sway over blood pressure, heart rate, airway constriction, digestion and more, with downstream effects on conditions such as chronic pain, immune-mediated disorders and inflammation,” said Spiegel, who has literally written the book on the topic: VRx: How Virtual Therapeutics Will Revolutionize Medicine. He also directs the Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), which investigates digital health technologies’ ability to improve outcomes and reduce costs.

While current applications for virtual therapeutics are clearest in pain management, addressing mental health conditions, and training simulations for clinicians, there are many potential directions for it.

“VR allows us to combine the disciplines of psychology, neurology and physiology to open a whole new world of therapeutic potential,” Spiegel said. “Now it’s a matter of fine-tuning it—customizing it to optimize a patient’s experience based on their personal health or education needs.”

Growing VR Applications in the Clinic

Spiegel and his colleagues in CS-CORE have already obtained numerous grants to grow this area of investigation in earnest. One such grant, funded by the National Cancer Institute, applies VR-based immersive experiences for hospitalized patients with advanced gastrointestinal cancers.

The grant will explore the use of biofeedback and machine learning during VR interventions to titrate the experience, via cameras and wearable biosensors that monitor pupil dilation, heart rate variability and so on. The goal is to learn how to best target the autonomic nervous system and neuroendocrine system through live, tailored management of the patient’s experience. The team will then study the impact of these combined technologies on pain, opioid use and activity levels.

Cedars-Sinai’s widespread and longstanding collection and analysis of data from patients’ wearable biosensors, apps and remote-monitoring tools facilitate a large portion of CS-CORE’s research efforts. For example, wearable devices helped CS-CORE investigators link postoperative step count with functional outcomes in cancer patients, leading to the creation of tailored interventions such as virtual exercise programs and art tours in surgical recovery units.

“Our goal is to use a full array of nonpharmacologic digital tools to complement and extend clinical care and research efforts, including earlier detection, prevention and control of cancer as well as improved cancer outcomes—like helping patients get diagnosed sooner or recover faster from surgery or cancer treatments,” said Gillian Gresham, PhD, a research scientist in Cedars-Sinai Cancer who works closely with, and has been mentored by, Spiegel in this field.

Gresham is involved in numerous studies that employ wearables for oncology patients. “Having this extra knowledge in the hands of both patients and providers can open discussions about physical activity, sleep disturbance, symptoms and toxicity, and health-related quality of life so that physicians can intervene sooner and with better information,” she said.

Gresham’s ongoing endeavors include studies funded by the Pancreatic Cancer Action Network and the U.S. Department of Defense to determine whether wearable-reported activity predicts functional outcomes in advanced cancer patients.  

“No matter what has happened to the body, your brain can fight back—it can block signals and send out hormones and neurochemicals that affect the rest of your body,” explained Spiegel, who is helping define best practices for evaluation of VR and digital technologies in medicine. “Basic discovery is the next step, and for that, we need to break down the traditional siloed disciplines and our usual ways of thinking about health to understand how the brain can help us fight back against disease.”

In time, Spiegel’s group and others investigating the power of the brain on the body are poised to drastically expand the variety of therapies available in everyday medical management of complex health conditions.

“We are gaining a better understanding of how virtual experiences can soothe pain and inflammation, stimulate learning, and have lasting impacts on physiological processes,” Spiegel said. “As this continues, the world of medicine stands to gain a tremendous asset for augmenting and supplementing our current arsenal of pharmaceutical treatments.”

This intersection of numerous disciplines is a key example of Cedars-Sinai Cancer’s emphasis on convergent science—a focused, deliberate nurturing of a deep multidisciplinary approach to solving challenges in oncology through forward-thinking, silo-free collaborations involving mathematics, computer science and engineering meshing with health and biological sciences.

“At its heart, the application of computational science, sensors and virtual reality techniques to pain management in oncology exemplifies the progress that can be made when we think outside the box, together,” said Dan Theodorescu, MD, PhD, PHASE ONE Foundation Distinguished Chair and director at the Samuel Oschin Comprehensive Cancer Institute. “The boundary-free approach to improving cancer outcomes and experiences enables our clinician-scientists to explore the most promising therapeutic options in a way that places patients at the center of everything we do. The results have been tremendous…and we’re just getting warmed up!”

References

1. Beams R, Brown E, Cheng WC, et al. Evaluation challenges for the application of extended reality devices in medicine. J Dig Imaging. 2022;15(5):1409-1418.
2. Spiegel B, Liran O, Gale R, et al. Qualitative validation of a novel VR program for irritable bowel syndrome: A VR1 study. Am J Gastroenterol. 2022 Mar;117(3):495-500.
3. Birckhead B, Eberlein S, Alvarez G, et al.Home-based virtual reality for chronic pain: Protocol for an NIH-supported randomised-controlled trial. BMJ Open. 2021;11:e050545.
4. Wong MS, Spiegel BMR, Gregory KD. Virtual reality reduces pain in laboring women: A randomized controlled trial. Am J Perinatol. 2021 Aug;38(S 01):e167-e172.
5. Spiegel B, Fuller G, Lopez M, Dupuy T, Noah B, Howard A, Albert M, Tashjian V, Lam R, Ahn J, Dailey F, Rosen BT, Vrahas M, Little M, Garlich J, Dzubur E, IsHak W, Danovitch I. Virtual reality for management of pain in hospitalized patients: A randomized comparative effectiveness trial. PLoS One. 2019 Aug 14;14(8):e0219115.