meditation as medicine the therapeutic benefits of an ancient practice
TRANSCRIPT
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Meditation as Medicine
The Therapeutic Benefits of an Ancient Practice
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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)
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Medical Research into Meditation
Conditions for which it meditation is effective
Meditation instruction
Summary
Agenda (2)
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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)
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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
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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
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Psychoneuroendocrine system
Limbic system : integrates - thoughts(locus cereleus) - feelings
- emotionsHypothalamus: regulates - homeostasis
- SNS : mind/body feedback
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Anger and Cardiovascular Disease
Barefoot - Anger profile of CAD patents- Degree of CA blockage directly related to level of anger
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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
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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
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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
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Anxiety Syndromes
3 large community studiessignificant relationship to
sudden cardiac deathMechanisms: Vent arrhythmias,
Altered cardiac autonomic tone
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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
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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
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Psychological States and Physical Disease
Depression: mortality and cancer immune function
Anger: Coronary Artery Disease
Anxiety: Coronary Artery Disease
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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)
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Don’t Just Do Something, Sit There.
Sylvia Boorstein
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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)
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“If you want to be happy, be”
Leo Tolstoy
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Meditation
Focusing full attention on object of awareness
Non judgmental, moment-to-moment awareness
When mind wanders, bring it back
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Meditation: Object of Awareness
Concentration meditation – image mantra (TM) breath (RR)
Mindfulness Meditation – breath physical
sensation thought
patterns emotions (anxiety)
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Transcendental Meditation
Mahareshi Mahesh YogiVedic PhilosophyAuthorized teachersPractice 20 minutes, Twice daily
Altered state of consciousness: “pure”,
content free
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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
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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
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Meditation Research
“For material progress and
physical well being, peace of mind
is of utmost importance.”
The Dalai Lama
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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
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Literature Review
Relationship between Meditation and:
Blood pressureCholesterolStress hormonesOxidative stressReactive blood pressureReactive stress hormoneDifferential patterns of brain activityBetter health outcomes in clinical populations
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Reasonable evidence that meditation:Lowers cholesterolLowers stress hormonesIs associated with differential patterns of brain activityLowers blood pressure
Seeman et al
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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
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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)
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Meditation in Healthy Subjects
Astin (1997)27 healthy patientsEight week MBSR programIncreased: sense of control,
spiritual experienceDecreased: overall psychological symptomatology
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Meditation in Healthy Subjects
Shapiro (1998)225 premed and med studentsEight week MBSR programDecreased: anxiety, depressionIncreased: empathy,
spiritual experiences
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Concluding Remarks
Deficiencies of modern health care system:ExpensiveDisempoweringEmphasizes cure over preventionUnsatisfactory management of chronic conditions
Mind/Body Medicine addresses many of these concerns
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Benefits of Meditation as Rx
Empowers patientPreventativeInexpensiveRestores balance:
calm abidingInsights arise into beliefs/behaviorsSuitable for primary care practitioner
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“Sayings remain meaningless until they are embodied in
habits”
Kahil Gibran
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Challenges of Meditation
Requires disciplinedaily practiceongoing supportbenefits take time
Pandora’s BoxOpens mind to subconsciousmay worsen psychosis
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SummaryMeditation is effective in counteracting stress
Meditation has shown benefit in:
Stress reliefAnxiety and depressionHypertensionChronic painPsoriasisProcedural pain
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Summary
Improved psychological health is the most consistently proven benefit
Further research needed to further clarify role of meditation in medicine and health
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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
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“The mystery of life is not a problem to be solved but a reality to be experienced”
Aart van der Leew
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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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