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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.)

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Meditation as Medicine

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  1. Meditation as Medicine The Therapeutic Benefits of an Ancient Practice

  2. 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)

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

  4. 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)

  5. 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

  6. 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

  7. Psychoneuroendocrine system • Limbic system : integrates - thoughts (locus cereleus) - feelings - emotions • Hypothalamus: regulates - homeostasis - SNS : mind/body feedback

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

  9. 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

  10. 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

  11. 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

  12. Anxiety Syndromes • 3 large community studies • significant relationship to sudden cardiac death • Mechanisms: Vent arrhythmias, Altered cardiac autonomic tone

  13. 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

  14. 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

  15. Psychological States and Physical Disease • Depression:  mortality and cancer  immune function • Anger: Coronary Artery Disease • Anxiety: Coronary Artery Disease

  16. 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)

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

  18. 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)

  19. “If you want to be happy, be”Leo Tolstoy

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

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

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

  23. 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

  24. 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

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

  26. 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

  27. 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

  28. Seeman et al • Reasonable evidence that meditation: • Lowers cholesterol • Lowers stress hormones • Is associated with differential patterns of brain activity • Lowers blood pressure

  29. 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

  30. 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)

  31. Meditation in Healthy Subjects Astin (1997) • 27 healthy patients • Eight week MBSR program • Increased: sense of control, spiritual experience • Decreased: overall psychological symptomatology

  32. Meditation in Healthy Subjects Shapiro (1998) • 225 premed and med students • Eight week MBSR program • Decreased: anxiety, depression • Increased: empathy, spiritual experiences

  33. 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

  34. Benefits of Meditation as Rx • Empowers patient • Preventative • Inexpensive • Restores balance: calm abiding • Insights arise into beliefs/behaviors • Suitable for primary care practitioner

  35. “Sayings remain meaningless until they are embodied in habits”Kahil Gibran

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

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

  38. Summary • Improved psychological health is the most consistently proven benefit • Further research needed to further clarify role of meditation in medicine and health

  39. 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

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

  41. 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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