Meditation as Medicine
The Therapeutic Benefits of an Ancient Practice
Agenda (1)
Mind-Body Medicine Mental States and Disease: (Anger)
Stress Response - Fight vs. Flight - Acute and Chronic
Meditation
- staying present - Transcendental Meditation (T.M.) - Relaxation Response (RR) - Mindfulness Meditation (MM)
Agenda (2)
Medical Research into Meditation
Conditions for which it meditation is effective Meditation instruction Summary
Mind/Body Medicine
How processes of the mind influence the body Bi-directional relationship Hippocrates: 4 humors affect mind and body Descartes: mind-body dualism Modern Medicine: Body in isolation (reductionism) However inevitable influence of the “subject” e.g. placebo effect, emotions (e.g. anger, etc)
Mind/Body Medicine
“The separation of psychology from the
premises of biology is purely artificial because the human psyche lives in indissoluble union with the body”
– Carl Jung
The Stress Response
Stress Hans Seyle (1950’s) – “a non-specific result of any demand upon the body” Engle (1962) – “all processes, external or internal which impose a demand or requirement upon the person” Stress - triggered by a perceived threat or need to adapt - generates a cascade of biochemical events which affect: Autonomic nervous system Musculoskeletal system Psychoneuroendocrine system
Psychoneuroendocrine system
Limbic system : integrates - thoughts (locus cereleus) - feelings - emotions Hypothalamus: regulates - homeostasis - SNS : mind/body feedback
Anger and Cardiovascular Disease
Barefoot - Anger profile of CAD patents - Degree of CA blockage directly related to level of anger
Anger and Cardiovascular Disease
Williams Psychosomatic medicine (1983) - 255 medical students - 2 groups: Hostile Not hostile - 20 yr. later: Hostile Not hostile
- 119 - 136 -16 died - 3 died
Anger and Cardiovascular Disease
Other Studies
- Anger Episodes: Post MI patients E.F. 7% - Hostile Patients: 2-3x mortality rate within first decade after an MI - Anger single most common emotion in two hours preceding an MI
Psychological Stress & Myocardial Ischemia: Possible mechanisms
1. Sympathetically mediated increase in –
Heart rate Blood pressure Myocardial contractility/workload Oxygen consumption
2. Enhanced coronary vasomotor tone caused by circulating vasoconstrictors
Anxiety Syndromes
3 large community studies significant relationship to sudden cardiac death Mechanisms: Vent arrhythmias, Altered cardiac autonomic tone
Chronic Stress and Hypertension
Puerto Rico – urban incidence – 18% - rural incidence – none Increase with “Westernization” of Fiji Islanders Increase in African Zulus moving from rural to urban centers
Chronic Stress
Unresolved, repetitive stress may lead to: Depression Anxiety Associated with:
chronic pain (Turner 1989) susceptibility to common cold (Cohen 1991)
hypertension (Benson 1993) Mortality in cancer patients decreased immune function
Psychological States and Physical Disease
Depression: mortality and cancer immune function
Anger: Anxiety:
Coronary Artery Disease Coronary Artery Disease
Chronic Stress Therapies
Focus of Mind-Body Medicine Techniques: (* most studied)
Meditation * Hypnosis * Spiritual healing Yoga
Guided Imagery * Relaxation therapy * Biofeedback *
Tai-chi Art Therapy Etc.
Don’t Just Do Something, Sit There.
Sylvia Boorstein
Meditation
Self regulation of attention Two general types: Concentration meditation Mindfulness meditation Concentration meditation:
Transcendental meditation (T.M.) Relaxation Response (RR)
Mindfulness Meditation (MM):
Mindfulness based stress reduction program (MBSR)
“If you want to be happy,
be”
Leo Tolstoy
Meditation
Focusing full attention on object of awareness Non judgmental, moment-to-moment awareness When mind wanders, bring it back
Meditation: Object of Awareness
Concentration meditation – image mantra (TM) breath (RR)
Mindfulness Meditation
– breath physical sensation thought patterns emotions (anxiety)
Transcendental Meditation
Mahareshi Mahesh Yogi Vedic Philosophy Authorized teachers Practice 20 minutes, Twice daily Altered state of consciousness: “pure”, content free
Relaxation Response
Herbert Benson
Cardiologist, Boston Physiological effects of T.M.: SNS quieting Relaxation Response: Opposite of Stress Response Developed secular meditation technique: - Four aspectsObject of meditation Passive attitude towards distracting thoughts Comfortable, relaxed posture Quiet environment
Mindfulness Meditation
John Kabat Zinn University of Massachusetts Physiologist Zen practitioner Eight week Stress Reduction Program (MBSR)
Formal sitting Body scan Mindful movement during yoga postures
Aids in distinguishing between
Primary sensory experience (e.g. fear, anxiety,pain) Secondary emotional or cognitive reactions
Meditation Research
“For material progress and physical well being, peace of mind is of utmost importance.”
The Dalai Lama
Meditation Research
Seeman et al (Am Psychologist, 2003) Critical Review of Published Evidence of Biological Effects of Meditation Levels of Evidence: Methodology of Study Flaws Peer Reviewed Journal
Literature Review
Relationship between Meditation and: Blood pressure Cholesterol Stress hormones Oxidative stress Reactive blood pressure Reactive stress hormone Differential patterns of brain activity Better health outcomes in clinical populations
Seeman et al
Reasonable evidence that meditation:
Lowers cholesterol Lowers stress hormones Is associated with differential patterns of brain activity Lowers blood pressure
Seeman et al
Persuasive evidence that meditation is associated with better health outcomes in:
Generalized Anxiety Disorder Psoriasis Carpel Tunnel Pain/Anxiety associated with Femoral Angiography Patients with mild hypertension
Other Clinical Conditions Reported to Improve with Meditation
Addictions: EtOH, tobacco, illicit drugs (T.M.) Premenstrual Syndrome (RR) Chronic Insomnia (RR) Chronic Pain (MM, RR) Psychological Distress in Cancer (MM) Depression Cognitive function & mortality in elders (TM)
Meditation in Healthy Subjects
Astin (1997) 27 healthy patients Eight week MBSR program Increased: sense of control, spiritual experience Decreased: overall psychological symptomatology
Meditation in Healthy Subjects
Shapiro (1998) 225 premed and med students Eight week MBSR program Decreased: anxiety, depression Increased: empathy, spiritual experiences
Concluding Remarks
Deficiencies of modern health care system:
Expensive Disempowering Emphasizes cure over prevention Unsatisfactory management of chronic conditions
Mind/Body Medicine addresses many of these concerns
Benefits of Meditation as Rx
Empowers patient Preventative Inexpensive Restores balance: calm abiding Insights arise into beliefs/behaviors Suitable for primary care practitioner
“Sayings remain meaningless
until they are embodied in habits”
Kahil Gibran
Challenges of Meditation
Requires discipline
daily practice ongoing support benefits take time
Pandora’s Box
Opens mind to subconscious may worsen psychosis
Summary
Meditation is effective in counteracting stress Meditation has shown benefit in:
Stress relief Anxiety and depression Hypertension Chronic pain Psoriasis Procedural pain
Summary
Improved psychological health is the most consistently proven benefit Further research needed to further clarify role of meditation in medicine and health
Suggested Reading
Full Catastrophe Living, John Kabat-Zinn, Delacorte, 1990 The Miracle of Mindfulness, Thich Nat Hahn, Beacon Press, 1987 The Wisdom of No Escape, Pema Chodron, Shambhala, 1991 Religiosity, Spirituality and Health. Seeman T. Am Psych. (58) 2003, p 53 Mind Body Medicine. Barrows K. Med Clin N Am.(86) 2002, p 11
“The mystery of life is not a
problem to be solved but a reality to be experienced”
Aart van der Leew
hypothalamic–pituitary–adrenal (HPA) axis and the autonomic nervous system. The stress system influences other endocrine systems (i.e., those controlling gonadal, thyroidal, and growth functions) and exerts complex effects on the immune/inflammatory reaction. The principal CNS centers of the stress system are the corticotropin-releasing hormone (CRH)/arginine vasopressin (AVP) and locus ceruleus–norepinephrine neurons of the hypothalamus and brainstem, respectively, which regulate the HPA axis and the sympathetic nervous system. The end hormones of these systems, glucocorticoids and the catecholamines, act to maintain behavioral, cardiovascular, metabolic, and immune homeostasis during stress.1,2,5,6 and 7,7a