Stress Management

Mind-Body Medicine

The majority of all visits to primary care doctors are for stress-related conditions. (1)  The field of Mind-Body Medicine has emerged as an essential part of health care, for it is often the most effective way to promote health and prevent stress-related illness.


Stress Management and Resiliency Training  (SMART) is an extraordinary healthcare program based on scientific principles and practices of mind-body medicine.  It is an evidence-based course designed to strengthen physical health and interpersonal relationships.  SMART is the culmination of over 40 years of clinical practice and research in the field of Mind-Body Medicine, led by Dr. Herbert Benson.

Dr. Benson’s Findings

Dr. Benson is currently a Mind-Body Professor of Medicine at the Harvard Medical School.  He has been at the forefront of his field since the late 1960s.  As a young cardiologist, Dr. Benson and his colleagues established a scientific basis for the mind-body connection by studying the effects of stress on blood pressure.  They also found that a variety of meditation techniques reduced metabolism, rate of breathing, heart rate, and brain activity.  Dr. Benson labeled these changes the “relaxation response.”

The Relaxation Response

Use of relaxation response techniques is at the foundation of the SMART program.  The program strives to reduce the negative impact of stress through skill-building exercises and lifestyle modifications. Participants are taught how to elicit the “relaxation response” and learn how to restructure their thoughts and beliefs to decrease activation of the stress response.

Turning Genes On and Off

The relaxation response is the physiological and psychological opposite of the stress response. Research carried out by the Benson-Henry Institute for Mind Body Medicine and Mass General Hospital has shown that SMART training is an effective therapeutic intervention to counteract the adverse effects of stress in cognitive disorders, anxiety, hypertension, cardiovascular disease, inflammatory bowel disease, and aging.  Recent genetic studies by the Harvard-based group show that eliciting the relaxation response acts at the cellular level.  The relaxation response evokes healthy changes in gene expression and turns off genes associated with stress and disease vulnerability. (2,3)

An Integrated Curriculum

The SMART course begins by reviewing the history of mind-body medicine, introducing the physiologic underpinnings of the stress response and then focuses on the stress response’s opposing force – the relaxation response. By learning relaxation response techniques, stress awareness and adaptive strategies, course participants can develop “resiliency.”  Resiliency is characterized by several abilities, including the ability to create adaptive thoughts and positive expectations, the ability to appreciate the little things in daily life, and the ability to develop a sense of connectedness through social support, empathy, and compassion. Landmark research studies that support the effectiveness of the training in reducing autonomic arousal and stress-hormone related responses are interwoven into the sessions.

What You’ll Learn

Participants learn reliable techniques to elicit the relaxation response.  These techniques focus on the development of self-awareness, insight, and contemplation.  We explore mindfulness meditation, loving-kindness meditation, guided imagery, and sample basic practices in yoga.  By learning relaxation response techniques, you’ll learn to reduce the stress response, and ultimately enhance resiliency.

Resiliency is characterized by several factors:

  • Awareness of the stress response
  • The ability to bring about the relaxation response
  • The ability to recognize negative thoughts
  • The ability to create adaptive thoughts and positive expectations
  • A heightened awareness the of life’s simple pleasures
  • An appreciation for the role of empathy in creating social connectedness and support
  • Healthful sleep, eating, and exercise habits

Meditation Training

SMART participants learn to regulate their mental states using EEG-based neurofeedback.

Learning to meditate is not straightforward and there are no easily discernible outward signs of successful performance. In addition, there is a significant neurophysiological difference between “trying to meditate” and meditating.

Dr. Harlin uses an alpha training protocol, proven to reduce stress and anxiety and improve memory and cognitive performance. (4) SMART participants quickly learn to control their brain states and experience effortless awareness (a major component of meditation).  Sometimes a minor shift in emphasis can facilitate your achieving what research has shown to produce functional and structural changes in the brain.

Neurofeedback DeviceMuse: A neurofeedback device

Muse® is an affordable electroencephalography (EEG) based neurofeedback device that provides real-time feedback on what’s happening in your brain while you meditate.  Muse’s guided meditation exercises walk you, step by step, through the process —  making it easy to start and maintain a regular and rewarding meditation practice.

Certified by the Benson-Henry Institute

Dr. Harlin was the first of a handful of physicians certified by the Benson-Henry Institute to implement their Stress Management and Resiliency Training program.  The course includes 8 weekly small group sessions taught by Dr. Harlin.

  1. Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital and Perkins, A. (1994). Saving money by reducing stress. Harvard Business Review. 72(6):12.
  2. Bhasin MK, Dusek JA, Chang BH, Joseph MG, Denninger JW, Fricchione GL, Benson H, Libermann TA. Relaxation response induces temporal transcriptome changes in energy metabolism, insulin secretion and inflammatory pathways. PLoS One. 2013 May 1;8(5):e62817.
  3. Kuo B, Bhasin M, Jacquart J, Scult MA, Slipp L, Riklin EI, Lepoutre V, Comosa N, Norton BA, Dassatti A, Rosenblum J, Thurler AH, Surjanhata BC, Hasheminejad NN, Kagan L, Slawsby E, Rao SR, Macklin EA, Fricchione GL, Benson H, Libermann TA, Korzenik J, Denninger JW. Genomic and clinical effects associated with a relaxation response mind-body intervention in patients with irritable bowel syndrome and inflammatory bowel disease. PLoS One. 2015 Apr 30;10(4):e0123861.
  4. Marzbani,H, Marateb,H Mansourian,M. Neurofeedback: A Comprehensive Review on System Design, Methodology and Clinical Applications. Basic Clin Neurosci. 2016 Apr; 7(2): 143–158.
  5. Razavi M, Fournier S, Shepard DS, Ritter G, Strickler GK, Stason WB. Effects of lifestyle modification programs on cardiac risk factors. PLoS One. 2014 Dec 9;9(12):e114772.
  6. Centers for Medicare & Medicaid Services’ Office of Research, Development, and Information (ORDI) [Link]