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Decluttering the Mind with Mindfulness.

MANY DISCUSSIONS ABOUT MEDITATION start with discussion of its origins in Buddhist religion. However, meditation--particularly mindfulness meditation--has come a long way from its religious roots. The goal of mindfulness meditation, also known as insight meditation or, traditionally, Vipassana meditation, is to cultivate a nonjudgmental awareness of the present moment without letting the mind become distracted by thought. (1) Secular meditation practitioners and mental health professionals have identified mindfulness meditation and other mindfulness-based techniques and therapies as beneficial for overall health and managing specific conditions.

Currently, there is one widely used therapeutic intervention that has been developed using mindfulness meditation. This program, called mindfulness-based stress reduction (MBSR), was developed in 1979 by Dr. Jon Kabat-Zinn. MBSR is a structured group program of mindfulness training that guides participants through sessions of meditation and yoga with emphasis on integrating mindfulness and bodily awareness into everyday life. (2) It is currently the most studied form of mindfulness training in the United States. (3) Increasing interest in MBSR and the growing body of research surrounding it have led to the development of MBSR-based programs for conditions such as depression, insomnia, and cancer-related emotional wellbeing. (4)

EVIDENCE-BASED BENEFITS

Research on mindfulness meditation and other mindfulness-based therapies have produced promising results in people with depression, stress and anxiety, chronic pain, sleep troubles, high blood pressure, and/or loneliness.

Depression. Currently, research on mindfulness-based therapeutic interventions for depression has provided some of the strongest evidence of measurable benefits of meditation. In 2015, the American Psychological Association (APA) discussed mindfulness-based cognitive therapy (MBCT) as a viable management tool for people dealing with depression. (5) MBCT uses the methods employed in MBSR with added elements of cognitive behavioral therapy. (6) The APA explains that 80 percent of people who experience a major depressive episode are at risk of relapse, but by altering thought patterns through MBCT, these individuals can decrease their risk of relapse. The APA discussed two studies--a randomized, controlled trial published in JAMA Psychiatry that found MBCT was just as effective as medication and more effective than placebo in preventing relapse, and a systematic review published in JAMA Internal Medicine that concluded meditation programs can result in "small to moderate reductions of multiple negative dimensions of psychological stress." (7,8)

A later study published in the Lancet in 2015 found similar results. (9) Here, MBCT also helped prevent depression recurrence as effectively as maintenance antidepressant medication. The lead author of this study explained that mindfulness training helps prevent relapse by teaching the individual how to identify negative thoughts, feelings, and beliefs about themselves than can lead to a backward slide into depressive relapse. Meditation allows individuals to recognize these negative thoughts and engage with them in a more productive way.

Additional research shows promising results for individuals with active depression who practice meditation, but more research is needed in this area. (10)

The APA describes meditation and other mindfulness-based techniques as "adjunct therapies," meaning that they won't cause side effects and can be used in conjunction with medication and cognitive-behavioral therapy, if necessary. Since studies referenced by the APA suggest that meditation can be just as effective as medication in some patients, medication could be an effective tool against depression when added to conventional therapies.

Anxiety. The Journal of Clinical Psychiatry conducted a randomized, controlled trial that included 93 individuals with diagnosed generalized anxiety disorder (GAD), a condition characterized by frequent worry and anxiety that is difficult to control." Half of the group completed at least one MBSR session and the other half completed stress management education without a mindfulness component. While both approaches reduced anxiety in the participants, those who completed MBSR showed added benefits of improved stress reactivity and increases in positive self-statements. (12)

Pain management. The Centers for Disease Control and Prevention (CDC) report that 50 million adults in the United States (20% of the population) had chronic pain in 2016. Eight percent had high-impact chronic pain--meaning their pain limited at least one major life activity. (13) The high prevalence of chronic pain, paired with the current national awareness of the detriments of potent pharmacological opioid use, has individuals and their doctors seeking alternatives to aid in the management of chronic pain. One controlled study of 78 people funded by the United States Department of Health and Human Services reported that mindfulness meditation appeared to increase resilience to pain independently of opioid neurotransmitter mechanisms, which suggests that a combination of mindfulness meditation and pharmacologic/nonpharmacologic pain-relieving approaches that rely on opioid signaling might be particularly effective in treating pain. (14)

Sleep. A small study published in JAMA Internal Medicine in 2015 focused on older adults (N=49) with moderate sleep problems. These participants underwent a six-week intervention; half completed a program of mindfulness awareness practices and the other half completed sleep hygiene education without a mindfulness component. The group who completed the mindfulness awareness practices reported greater improvements in sleep quality than the sleep hygiene education group. From their results, the researchers concluded that mindfulness meditation has the potential to improve quality of sleep and reduce sleep-related daytime impairment, thus improving quality of life. (15,16)

Blood pressure. A systematic review and meta-analysis evaluated the effects of mindfulness meditation and yoga on patients who have hypertension. The researchers included 13 studies in their review. Six of

these studies evaluated yoga and seven evaluated meditation. The reviewers report that both meditation and yoga appear effective in decreasing systolic and diastolic blood pressure. Interestingly, the reviewers found that meditation appeared to noticeably decreas blood pressure in iondividuals over the age of 60 years, while yoga appeared more effective in decreasing blood pressure among those under age 60 or younger. (17)

Loneliness. A small study at Carnegie-Mellon University recruited 40 healthy adults aged 55 to 85 years and introduced them to mindfulness techniques through an eight-week MBSR course. Before beginning the program, the participants provided blood samples and were assessed using an established loneliness test. After the course, which consisted of weekly two-hour meetings during which the participants learned mindfulness techniques, performed daily 30-minute meditations at home, and participated in one day-long meditation retreat, the assessments showed decreased loneliness among the participants. In addition, post-program blood samples showed a decrease in proinflammatory gene expression in the immune cells of the participants, suggesting a decreased risk for inflammatory disease. The researchers in charge of this study note that more research is needed, but these results indicate a possible utility for mindfulness meditation programs in staving off loneliness and preventing disease. (18)

Disclaimer. Though uncommon, there have been reports of meditation causing or worsening symptoms of anxiety or depression. (19) If you'd like to start a meditation program and are currently managing a psychiatric condition such as anxiety, depression, schizophrenia, or post-traumatic stress disorder, the National Institutes of Health (NIH) recommends discussing your plans with your healthcare providers. In addition, the NIH implores prospective or current meditators to avoid using meditation as a replacement for conventional mental healthcare. Remember that conventional therapy and meditation have been shown to work together to improve mental health!

SOURCES

(1.) Uzar SW, Ken CE, Wasserman RH, et al. Meditation experience is associated with increased cortical thickness. Neuroreport. 2005;16(17):1893-1897.

(2.) University of Massachusetts Medical School. History of MBSR. Available at: https://www.umassmed.edu/cfm/mindfulness-based-programs/mbsr-courses/about-mbsr/history-of-mbsr/. Accessed Dec. 4, 2018.

(3.) Goldin PR, Gross JJ. Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion. 2010;10(1):83-91

(4.) Reich RR, Lengacher CA, Alinat CB, et al. Mindfulness-based stress reduction in post-treatment breast cancer patients: immediate and sustained effects across multiple symptom clusters J Pain Symptom Manage. 2017 Jan;53(1):85-95.

(5.) Lu S. Mindfulness holds promise for treating depression. American Psychological Association, https://www.apa.org/monitor/2015/03/cover-mindfulness. March 2015. Accessed February 2019.

(6.) Sipe WE, Eisendrath SJ. Mindfulness-based cognitive therapy: theory and practice. Can J Psychiatry. 2012 Feb;57(2):63-69.

(7.) Segal ZV, Bieling P, Young T, et al. Antidepressant Monotherapy vs Sequential Pharmacotherapy and Mindfulness-Based Cognitive Therapy, or Placebo, for Relapse Prophylaxis in Recurrent Depression .Arch Gen Psychiatry. 2010;67(12):1256-1264.

(8.) Goyal M, Singh S, Sibinga EMS, et al. Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis. JAMA InternMed. 20l4;174(3):357-368.

(9.) Kuyken W, Hayes R, Barrett B. Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomized controlled trial. Lancet. 2015 Jul 4;386(9988):63-73.

(10.) Powell A. When Science Meets Mindfulness. The Harvard Gazette, https://news.harvard.edu/gazette/story/2018/04/harvard-researchers-study-how-mindfulness-may-change-the-brain-in-depressed-patients/. April 2018. Accessed February 2019.

(11.) Locke AB, Kirst N, Shultz CG. Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician. 2015 May 1;91(9):617-624.

(12.) Hoge EA, Bui E, Marques L, et al. Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity. J Clin Psychiatry. 2013;74(8):786-792.

(13.) Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults--United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001-1006. https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm?s_cid=mm6736a2_w

(14.) Zeidan F, Adler-Neal AL, Wells RE, et al. Mindfulness-meditation-based pain relief is not mediated by endogenous opioidsJ(Veurosc/.20l6;36(1l):3391-3397.

(15.) Black DS, O'Reilly GA, Olmstead R, Breen EC, Irwin MR. Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial. JAMA Intern Med. 2015;175(4):494-501.

(16.) Corliss J. Mindfulness meditation helps fight insomnia, improves sleep. Harvard Health Publishing. https://www.health.harvard.edu/blog/mindfulness-meditation-helps-fight-insomnia-improves-sleep-201502187726. Updated December 22,2015. Accessed February 2019.

(17.) Park SH, Han KS. Blood Pressure Response to Meditation and Yoga: A Systematic Review and Meta-Analysis. J Altem Complement Med. 2017 Sep;23(9):685-695.)

(18.) Creswell JD, Irwin MR, Burklund LJ, et al. Mindfulness-Based Stress Reduction training reduces loneliness and pro-inflammatory gene expression in older adults: a small randomized controlled trial. Brain Behav Immun. 2012;26(7):1095-101.

(19.) U.S. Department of Health and Human Services. National Institutes of Health. National Center for Complementary and Integrative Health. Meditation: In Depth, https://nccih.nih.gov/health/meditation/overview.htm#hed3. Updated April 2016. Accessed February 2019.
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Publication:Nutrition Health Review
Date:Mar 22, 2019
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