The BERN Framework of Mind-Body Medicine: Integrating Self-Care, Health Promotion, Resilience, and Applied Neuroscience

Abstract

Background: Mind-body medicine (MBM) focuses on improving our understanding of how the interactions between the brain, mind, body, and behavior can be used to promote health. In this narrative review, we present the basic principles of MBM, including the introduction of a rational framework for the implementation of MBM-based interventions. We also discuss the contributions of MBM to motivation and reward systems in the brain including those that may specifically involve the mitochondria. Results: MBM can be used to promote health in patients with chronic diseases, especially conditions identified as lifestyle-related. MBM builds on salutogenesis, which is a paradigm that focuses on health (as opposed to disease) determinants and the development of individual resilience and coherence factors as a means to reduce stress, decrease the burden of disease, and improve the quality of life. This approach involves several well-known principles of self-healing and self-care. MBM interventions typically include behavioral modification techniques in conjunction with cognitive work focused on stress regulation, exercise, relaxation, meditation, and nutrition. We suggest the use of the acronym "BERN" (Behavior, Exercise, Relaxation, and Nutrition) to summarize the operational framework of this approach. Discussion: Different BERN techniques act via shared autoregulatory central nervous system (CNS) reward and motivation circuitries. These systems rely on numerous neurobiological signaling pathways with overlapping effector molecules that converge, e.g., on nitric oxide (NO) as a common effector molecule. NO is critically coupled to reward physiology, stress reduction, and self-regulation as it modulates the responses of various mitochondrial, nuclear, and chromosomal processes within brain cells. NO has also been implicated in relevant outcomes (e.g., the placebo response). Conclusions: MBM interventions typically follow the BERN model and aim to strengthen health and resilience, and reduce stress. The mechanisms of action of these processes involve the CNS reward systems and correlate with placebo and self-healing pathways.

Keywords: behavioral medicine; integrative medicine; meditation; mitochondria; placebo; salutogenesis; self-healing; stress management.

Figure 1

The BERN framework of mind-body medicine (MBM). The four principles of integrative multimodal MBM and stress management programs include Behavior, Exercise, Relaxation, and Nutrition.

Figure 2

The shared neurobiology of BERN approaches. Different BERN techniques and MBM (self-care) practices may have a direct impact on physiologic regulatory reward and motivation circuitries in the central nervous system (CNS). This commonality may represent overlapping functions associated with the general neurobiological principles of autoregulation (i.e., the potential for self-healing). MBM engages numerous CNS signaling pathways and effector molecules to promote healing, many of which converge on nitric oxide (NO) as an example for a common effector (i.e., a secondary or tertiary messenger). NO is critically coupled to the reward physiology and stress reduction/self-regulation and has a decisive impact on various processes within the cells and their organelles (i.e., chromosomes, nucleus, mitochondria). NO has also been specifically implicated in pathways leading to the placebo response (for further information and references: see text).