Meditation as Medicine

The Therapeutic Benefits of an Ancient Practice

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)

Medical Research into Meditation

Conditions for which it meditation is effective

Meditation instruction

Summary

Agenda (2)

Mind/Body Medicine

How processes of the mind influence the bodyBi-directional relationshipHippocrates: 4 humors affect mind and bodyDescartes: mind-body dualismModern 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 ResponseStressHans Seyle (1950’s) – “a non-specific result of any

demandupon the body”Engle (1962) – “all processes, external or internal whichimpose 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 systemMusculoskeletal systemPsychoneuroendocrine system

Psychoneuroendocrine system

Limbic system : integrates - thoughts(locus cereleus) - feelings

- emotionsHypothalamus: 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 - 119

Not hostile - 136

- 20 yr. later: Hostile -16 diedNot hostile - 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 rateBlood pressureMyocardial contractility/workloadOxygen consumption

2. Enhanced coronary vasomotor tone caused by circulating vasoconstrictors

Anxiety Syndromes

3 large community studiessignificant relationship to

sudden cardiac deathMechanisms: Vent arrhythmias,

Altered cardiac autonomic tone

Chronic Stress and Hypertension

Puerto Rico – urban incidence – 18%- rural incidence – none

Increase with “Westernization” of Fiji IslandersIncrease in African Zulus moving from rural to urban centers

Chronic Stress

Unresolved, repetitive stress may lead to:DepressionAnxietyAssociated with:

chronic pain (Turner 1989)susceptibility to common cold (Cohen 1991)hypertension (Benson 1993)Mortality in cancer patientsdecreased immune function

Psychological States and Physical Disease

Depression: mortality and cancer immune function

Anger: Coronary Artery Disease

Anxiety: Coronary Artery Disease

Chronic Stress TherapiesFocus of Mind-Body MedicineTechniques: (* 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

MeditationSelf regulation of attentionTwo 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 YogiVedic PhilosophyAuthorized teachersPractice 20 minutes, Twice daily

Altered state of consciousness: “pure”,

content free

Relaxation ResponseHerbert Benson

Cardiologist, BostonPhysiological effects of T.M.: SNS quietingRelaxation Response: Opposite of Stress ResponseDeveloped secular meditation technique:

- Four aspects-Object of meditationPassive attitude towards distracting thoughtsComfortable, relaxed postureQuiet environment

Mindfulness Meditation

John Kabat ZinnUniversity of Massachusetts PhysiologistZen practitionerEight week Stress Reduction Program (MBSR)

Formal sittingBody scanMindful movement during yoga postures

Aids in distinguishing betweenPrimary 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

FlawsPeer Reviewed

Journal

Literature Review

Relationship between Meditation and:

Blood pressureCholesterolStress hormonesOxidative stressReactive blood pressureReactive stress hormoneDifferential patterns of brain activityBetter health outcomes in clinical populations

Reasonable evidence that meditation:Lowers cholesterolLowers stress hormonesIs associated with differential patterns of brain activityLowers blood pressure

Seeman et al

Persuasive evidence that meditation isassociated with better health outcomes in:

Generalized Anxiety DisorderPsoriasisCarpel TunnelPain/Anxiety associated with Femoral AngiographyPatients with mild hypertension

Seeman et al

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)DepressionCognitive function & mortality in elders (TM)

Meditation in Healthy Subjects

Astin (1997)27 healthy patientsEight week MBSR programIncreased: sense of control,

spiritual experienceDecreased: overall psychological symptomatology

Meditation in Healthy Subjects

Shapiro (1998)225 premed and med studentsEight week MBSR programDecreased: anxiety, depressionIncreased: empathy,

spiritual experiences

Concluding Remarks

Deficiencies of modern health care system:ExpensiveDisempoweringEmphasizes cure over preventionUnsatisfactory management of chronic conditions

Mind/Body Medicine addresses many of these concerns

Benefits of Meditation as Rx

Empowers patientPreventativeInexpensiveRestores balance:

calm abidingInsights arise into beliefs/behaviorsSuitable for primary care practitioner

“Sayings remain meaningless until they are embodied in

habits”

Kahil Gibran

Challenges of Meditation

Requires disciplinedaily practiceongoing supportbenefits take time

Pandora’s BoxOpens mind to subconsciousmay worsen psychosis

SummaryMeditation is effective in counteracting stress

Meditation has shown benefit in:

Stress reliefAnxiety and depressionHypertensionChronic painPsoriasisProcedural 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, 1990The Miracle of Mindfulness, Thich Nat Hahn, Beacon Press, 1987The Wisdom of No Escape, Pema Chodron, Shambhala, 1991Religiosity, Spirituality and Health. Seeman T. Am Psych. (58) 2003, p 53Mind 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–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