Meditation as Medicine: 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 (1)


Agenda (2): Medical Research into Meditation Conditions for which it meditation is effective Meditation instruction Summary Agenda (2)


Mind/Body Medicine: 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: 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: 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: Psychoneuroendocrine system Limbic system : integrates - thoughts (locus cereleus) - feelings - emotions Hypothalamus: regulates - homeostasis - SNS : mind/body feedback


Anger and Cardiovascular Disease: Anger and Cardiovascular Disease Barefoot - Anger profile of CAD patents - Degree of CA blockage directly related to level of anger


Anger and Cardiovascular Disease: Anger and Cardiovascular Disease Williams Psychosomatic medicine (1983) - 255 medical students - 2 groups: Hostile - 119 Not hostile - 136 - 20 yr. later: Hostile -16 died Not hostile - 3 died


Anger and Cardiovascular Disease: 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: 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: Anxiety Syndromes 3 large community studies significant relationship to sudden cardiac death Mechanisms: Vent arrhythmias, Altered cardiac autonomic tone


Chronic Stress and Hypertension: 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: 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: Psychological States and Physical Disease Depression:  mortality and cancer  immune function Anger: Coronary Artery Disease Anxiety: Coronary Artery Disease


Chronic Stress Therapies: Chronic Stress Therapies Focus of Mind-Body Medicine Techniques: (* most studied) Meditation * Spiritual healing Hypnosis * Yoga Guided Imagery * Tai-chi Relaxation therapy * Art Therapy Biofeedback * Etc. (*most studied)


Don’t Just Do Something, Sit There. Sylvia Boorstein: Don’t Just Do Something, Sit There. Sylvia Boorstein


Meditation: 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 : “If you want to be happy, be” Leo Tolstoy


Meditation : Meditation Focusing full attention on object of awareness Non judgmental, moment-to-moment awareness When mind wanders, bring it back


Meditation: Object of Awareness : Meditation: Object of Awareness Concentration meditation – image mantra (TM) breath (RR) Mindfulness Meditation – breath physical sensation thought patterns emotions (anxiety)


Transcendental Meditation: Transcendental Meditation Mahareshi Mahesh Yogi Vedic Philosophy Authorized teachers Practice 20 minutes, Twice daily Altered state of consciousness: “pure”, content free


Relaxation Response: Relaxation Response Herbert Benson Cardiologist, Boston Physiological effects of T.M.: SNS quieting Relaxation Response: Opposite of Stress Response Developed secular meditation technique: - Four aspects- Object of meditation Passive attitude towards distracting thoughts Comfortable, relaxed posture Quiet environment


Mindfulness Meditation: 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: Meditation Research “For material progress and physical well being, peace of mind is of utmost importance.” The Dalai Lama


Meditation Research: 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: 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


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 Seeman et al


Other Clinical Conditions Reported to Improve with Meditation: 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: 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: Meditation in Healthy Subjects Shapiro (1998) 225 premed and med students Eight week MBSR program Decreased: anxiety, depression Increased: empathy, spiritual experiences


Concluding Remarks: 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: 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: “Sayings remain meaningless until they are embodied in habits” Kahil Gibran


Challenges of Meditation: Challenges of Meditation Requires discipline daily practice ongoing support benefits take time Pandora’s Box Opens mind to subconscious may worsen psychosis


Summary: Summary Meditation is effective in counteracting stress Meditation has shown benefit in: Stress relief Anxiety and depression Hypertension Chronic pain Psoriasis Procedural pain


Summary: 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: 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: “The mystery of life is not a problem to be solved but a reality to be experienced” Aart van der Leew


Slide45: 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–norepi-nephrine 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