meditation as medicine
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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.) - PowerPoint PPT PresentationTRANSCRIPT
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