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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.)

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meditation as medicine

Meditation as Medicine

The Therapeutic Benefits of an Ancient Practice

agenda 1
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
Agenda (2)
  • Medical Research into Meditation
  • Conditions for which it meditation is effective
  • Meditation instruction
  • Summary
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 medicine1
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 disease1
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 disease2
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)

meditation
Meditation
  • Self regulation of attention
  • Two general types: Concentration meditationMindfulness meditation
  • Concentration meditation:
    • Transcendental meditation (T.M.)
    • Relaxation Response (RR)
  • Mindfulness Meditation (MM):
    • Mindfulness based stress reduction program (MBSR)
meditation1
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 research1
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
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 al1
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
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 subjects1
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
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

summary1
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
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