STRESS
August 2, 2010

Meditation: Hype or Help?

Science is putting the ancient practice to the test. It appears that being mindful can change your brain and your behavior.

If you’ve noticed that more people are toting around yoga mats than they used to, and water-cooler conversation turns to Buddhism instead of the Bear market, it’s not just you. Alternative practices like yoga and meditation seem to be making a come-back – although, admittedly, it’s not so much a come-back as a powerful (and perhaps long overdue) entré into the Western world. Some practices, like certain types of meditation, date back at least 2,500 years, and are just now beginning to creep into our collective Western consciousness – and into modern medicine. Perhaps this is partly because we need help now more than ever in dealing with the stresses of the 24/7 world we live in.

Meditation, acupuncture, yoga, and biofeedback are just some of the methods that have attracted attention in recent years. But what are we to make of them? Are they just hype, or can they actually benefit health and well being without drugs and enormous medical expense?

And who can resist the appeal of better quality relaxation, especially when it is related to techniques that have been around for a few thousand years?

We’ve probably all heard of the health benefits of complementary and alternative medicine (CAM) from our family, friends, or the media. Meditation, acupuncture, yoga, and biofeedback are just some of the methods that have attracted attention in recent years. But what are we to make of them? Are they just hype, or can they actually benefit health and well being without drugs and enormous medical expense?

The popularity of alternative medicine and the research technologies available today mean that some of these techniques, which often stem from ancient Eastern medical and spiritual practices, have begun to be tested scientifically by researchers and clinicians in many different areas and specialties.

Meditation has recently gained a lot of popularity, and perhaps for good reason. The public has begun to embrace it as a spiritual path and as a way of dealing with everyday stressors like job and family problems, as well as more serious issues like chronic health problems and psychological disorders like depression and anxiety. Advances in technology have meant that the research community has made some major steps in understanding exactly what meditation does to the body and brain, as well as what types of conditions it may be effective in treating.

One of the more useful and certainly well-researched methods (and, of course, the oldest), is meditation, specifically, mindfulness meditation, which helps people train their minds to be more present and focused. An offshoot of this method is a newer technique called Mindfulness-Based Stress Reduction (MBSR), which, as the name suggests, uses meditation to target stress specifically, and has shown to be very effective in a range of stress-related maladies. We will look at how these techniques help individuals cope with problems in their lives, as well as some of the scientific evidence that backs the methods up.

What Mindfulness Meditation and Mindfulness Training Are

What exactly is mindfulness meditation? Yale researcher and mindfulness expert Judson Brewer, MD, PhD studies mindfulness training (MT) and its ability to help people deal with everyday stresses, as well as how it may help people battling more serious conditions like drug and alcohol addiction and depression.

Mindfulness meditation comes from the 2,500 year old Buddhist tradition, and has been practiced by countless individuals across the millennia. There are a couple of different ways to describe mindfulness briefly. One translation of the Pali, the language in which the Buddhist teachings were written, is “remembering,” says Brewer. Remembering what, exactly? It’s about remembering to be present, or “to be here now”, rather than letting our minds skip about from subject to subject, which is what so many of us tend to do in this cell phone- and Internet-driven day and age.

Mindfulness has people focus on paying attention and accepting both external events and our own thoughts, rather than rejecting or suppressing the ones that we perceive as negative. Put another way, says Brewer, quoting John Kabat-Zinn (more on this guy later), mindfulness is “paying attention on purpose, in the present moment – but not judgmentally.”

Our stresses, desires, and cravings are like the screaming child in the store. And our solutions (lollipop or gag) are not only short term, but also provide fuel for the fire to keep burning.

An example might help make this idea clearer. Imagine, says Brewer, that your child is screaming in the grocery store while you’re shopping. Obviously this is not an ideal situation, so what do you do to respond? You have a few choices: you can give the child a lollipop, which may momentarily stop the screaming. Ultimately, though, your child will make the association that screaming leads to lollipops, which may make the situation worse in the end. Option two is to try to stifle the outburst, perhaps by putting your hand over the child’s mouth – but in the end, this won’t work either, because it just adds a different kind of energy to the outburst.

But what happens if you simply pick up your child and hold him? If you, the parent, simply nonjudgmentally acknowledge the screaming, it will eventually stop. This way your child does not get a reward for his behavior (i.e., the lollipop), nor does she experience the unsatisfying and frightening feeling of being stifled. It's like a fire that you want to go out: the surest way to make that happen is to let it burn out on its own.

And this, says Brewer, is what mindfulness is all about. Our stresses, desires, and cravings are like the screaming child in the store. And our solutions (lollipop or gag) are not only short term, but also provide fuel for the fire to keep burning. But rather than feeding the behavior or trying to squelch it, if we simply pay attention to it – nonjudgmentally – it will stop of its own accord, because ultimately, most things do. Paying attention to our thoughts in a nonjudgmental way is a central goal in MT, and according to the research, can have big implications in everyday stresses including addiction and depression.

So how does this kid in the grocery store dilemma relate to our daily stressors and the unpleasant thoughts in our own minds that we want to “put out” or alleviate? Take the example of stopping smoking, which many of us may have been acquainted with at some point in our lives. It’s a prime example of a stressor or “suffering” that we must cope with for some period of time before it goes away.

Brewer says that when he and his team counsel people to be mindful in the quitting process, they encourage a person to “pay attention to what the craving looks like and, more importantly, to what it actually feels like in the body.” Mentally noting or labeling the feelings from moment to moment is key. Is the craving a feeling of tightness, aching, or pressure? Writing the feelings down may also be helpful in pointing out how they are constantly changing.

If you pay attention to the “wave” of craving – again, nonjudgmentally, and not caving into it – then you can get on top of it, and stay with it as it peaks and bottoms out. In other words, being mindful of these feelings, and observing them impartially (just as with the child in the grocery store), is a central idea in mindfulness. It doesn’t matter what the suffering is: whether it’s craving a cigarette or being stressed about work or worried about finances, they key is observing and accepting one’s thoughts as okay, rather than viewing them as bad or trying to suppress them.

Studying The Effectiveness of Mindfulness

Does mindfulness meditation work in the real world? That is, does it really help people who are battling serious life stresses? And is it possible to teach people who are addicted to cigarettes, alcohol, or cocaine to use mindfulness to recover from their additions?

Mindfulness training targets your “relationship” with your thoughts, whereas the focus of cognitive behavioral therapy is to examine and change what those thoughts are in the first place.

Some studies have compared mindfulness training to what is considered the “gold standard” in substance abuse disorders, cognitive behavior therapy (CBT). Briefly, the goal of CBT, which is a blend of cognitive therapy and behavioral therapy, is to identify the specific thought-processes that are creating problems for the individual, and to teach the person to figure out better ways to think about and react to his or her stressors. (See Stressed Out: Part II, for more information on CBT.)

A central difference in the two therapies is that mindfulness training targets your “relationship” with your thoughts, whereas the focus of CBT is to examine and change what those thoughts are in the first place. For example, suppose you are trying to lose weight and have started going to the gym to exercise. This may not be the most pleasant activity to you at first (it may be downright miserable), but you know it has to get done. With CBT you might be trained to think, “Exercise is not unpleasant, it’s fun. I know I have to do it. It will make me feel better.” With mindfulness training, you would simply note the thoughts and feelings that the idea of exercising brings about (perhaps it’s mental stress, anxiety, feelings of dread, and so on), and in so doing reduce the emotional power of those thoughts and feelings.

One study looked at how each method helped addicts deal with stress – and stress is a big part of addiction. In fact, it is a common reason that people start using again after they have quit doing a certain drug or stopped a certain behavior (just think of how an ex-smoker might reach for a cigarette when a stressful situation hits, or even how many of us tend to reach for the ice cream when we’ve had a stressful day). It also plays a key role in people using a drug in the first place – rather than seeking help to learn to deal with the stressors or unhappiness in one’s life, it may seem “easier” to self-medicate. And acute stressors definitely tend to increase drug use.

In the study people who were addicted to alcohol and/or cocaine had cognitive-behavioral or mindfulness therapy for a period of 12 or 9 weeks, respectively. Afterwards, stress was “provoked” in the lab, to see how the former addicts were able to cope. There were no differences between the two groups in drug use or how much the patients liked their respective programs. But patients in the MT group had much healthier responses to stress: they responded better physiologically (their heart rates were lower) and psychologically (they rated themselves as being less angry, anxious, sad, and fearful, than people in the CBT group).

Mindfulness therapy seems to affect activity in the part of the nervous system that governs the fight-or-flight response. It actually reduces the sort of revved-up body response you might get if car cut into your lane or your neighbor started mowing his lawn at 7 am. The authors say that their findings illustrate how MT helps people deal with stressors without being overcome by being in the middle of it . “[A]s individuals are able to engage but are not “caught up” in thoughts or emotions, they are more able to adapt to changing internal and external environmental cues and conditions.” In other words, and MT helps us step back and see the situation more clearly, seeing the forest rather than being focused on the trees.

So we know that MT helps addicts respond better to stress, but the obvious question is: did it help them with their drug use? Yes, it did. People in the CBT and the MT group reduced their drug or alcohol use by about the same amount in both treatments, which is good news for MT. If mindfulness therapy can stand up to the “gold-standard”, CBT, in terms of helping people reduce their stress and conquer their habits, then this is an approach to coping with stress that may actually help people overcome addiction—a very tangible benefit

Brewer is continuing to work on how MT works both in practice and in the brain, particularly how it can help smokers quit smoking, and how they respond to stress. Though these studies are still underway, the techniques are promising.

Mindfulness-Based Stress Reduction

Speaking of stress, a relative of mindfulness meditation is a program that specifically teaches people how to deal with their stress: it is called, not surprisingly, Mindfulness-Based Stress Reduction (MBSR). The program was developed thirty years ago by Dr. Jon Kabat-Zinn at the University of Massachusetts Medical School. An offshoot of the classic method described above, MBSR teaches people to target their stressors specifically by becoming more aware and mindful of their situations, and approaching the problems and sources of stress in their lives deliberately, rather than “mindlessly” (we’ll get to an example of this in a minute). The MBSR program has been shown to be effective in reducing stress and anxiety, both in healthy people and those who are suffering from illness.

In other words, a mindful reaction to the loss of a job would involve acknowledging your angry, depressed, and anxious feelings, not just experiencing them, and taking an overview of them rather than being overcome by them.

When we are stressed, we have a tendency to react mindlessly – and this can really impact how we cope with the situations that life throws at us. Take the example of being laid off from your job. It's a terrible thing and very stressful. Reacting mindlessly to a stressful situation like this might involve feeling helpless, inadequate, depressed, and incapable of fixing the situation. You might throw up your hands and think, “What’s the point?” “This is so @$*# unfair,” or “I hate my life.”

But reacting “mindfully” might involve a different kind of thought process. Rather than simply reacting to the negative thoughts, you would acknowledge them, robbing them of some of their power over your emotional state. For example, in a mindful reaction to the job loss, you might say to yourself, “Yes, it’s hard – and a little scary – to be unemployed. It’s natural to feel discouraged, but these feelings will pass when I begin looking for something new and find a good lead to pursue.”

In other words, a mindful reaction to the loss of a job would involve acknowledging your angry, depressed, and anxious feelings, not just experiencing them, and taking an overview of them rather than being overcome by them. Then you can approach the situation more objectively, so that you stay in charge of your feelings – rather than the other way around. That way you can move forward, actively and productively. So clearly the concept of MBSR is very similar to classic mindfulness, but the thrust is more on dealing with the specific stressors in one’s life in an immediate, deliberate way.

Science Shows That There’s Something to It
There have been many studies that show that mindfulness-based stress reduction can reduce stress, anxiety, and depression, both in the general public and among people battling more serious problems. In one study of premed and medical students who enrolled in an eight-week MBSR program, stress symptoms were significantly reduced – and this is a fairly stressed-out population of individuals. Another study found that cancer patients scored lower on measures of stress, depression, and anger after completing a similar MBSR program. Others have found good evidence that MBSR works not only for stress and psychological issues, but also for physical ailments: one study found that taking an MBSR program significantly reduced chronic pain in older adults, as well as improved several other factors related to their quality of life.

These types of studies underline the fact that the effects of mindfulness training are not only psychological, but that the changes can also be measured physiologically as well.

Research into the long-term benefits of MBSR is also promising. A study of people battling more acute cases of anxiety and panic disorders found that mindfulness-based stress reduction successfully reduced the severity and frequency of attacks. Even better, in the three-year follow-up of the same study, patients were still less anxious, panicked, and depressed, which suggests that a standard eight-week training course can have some impressive long-term benefits.

How Mindfulness Helps the Body
Some recent studies have looked at what’s happening in the bodies of people who have reported benefits from taking an MBSR course. For example, breast and prostate cancer patients' stress symptoms were significantly reduced after they took part in the program. The authors say that the MBSR program seems to have led to beneficial changes in the brain-body system that governs the stress response – the hypothalamic-pituitary-adrenal (HPA) axis. Another study found that cancer patients had reduced levels of the stress hormone cortisol, fewer immune system markers related to inflammation (pro-inflammatory cytokines), and lower blood pressure up to a year following completion of an MBSR program. These types of studies underline that the effects of mindfulness training are not only psychological, but that the changes can also be measured physiologically as well.

Mindfulness training can also help prevent health problems before they occur. A group of people in another study took an MBSR course and were then vaccinated for the flu. Those who had had MBSR training had higher levels of antibodies to the flu than did subjects who had not had the training. The MBSR participants' brains also showed more activity in the regions reflecting positive mood, a finding that actually predicted how well their immune systems responded to the flu vaccine. The immune system would seem to be only distantly related to the stress response, so findings like this indicate that mindfulness meditation can affect other body systems in fascinating and surprising ways.

How Does Mindfulness Change the Brain?
You may be thinking, this body stuff is all well and good, but what’s happening in the brains of people who practice mindfulness? The short answer is that it’s still under investigation, but there is some preliminary research pointing at some interesting answers so far. We asked Brewer to help us understand what kinds of brain changes might be occurring when people meditate.

One of these “me” centers of the brain, the medial PFC, was less active in the people who simply noticed their thoughts, compared to those who ran with them. This shows that there are real, physiological changes associated with the behavioral changes that mindfulness brings about.

Brewer suggests that what’s happening in people who practice meditation is likely that the “’me’ centers of the brain are being deactivated.” In other words, since meditation teaches people to notice and accept their thought processes in a more objective/nonjudgmental way, the centers that are known to be associated with thoughts related to the self become less active (for example, the medial prefrontal cortex, or PFC). And there is evidence to back it up.

One study looked at the differences in the brains of people who were instructed to simply notice their thoughts without reacting to them (to be mindful) and people who were told to dig into those thoughts and elaborate on them (not practice mindfulness). One of these “me” centers of the brain, the medial PFC, was less active in the people who simply noticed their thoughts, compared to those who ran with them. Again, this shows that there are real, physiological changes associated with the behavioral changes that mindfulness brings about. It will be interesting to see what other discoveries are made as researchers continue to delve into the mechanisms behind meditation.

Mindfulness: “Stepping out of a Me-Orientation”

The value of mindfulness is that it teaches us a way to be less caught up in the endless buzz of our own thoughts and worries. The discipline of meditation, particularly mindfulness meditation, gives us practice in stepping out of ourselves a bit, which we can then use to gain perspective on our situation. This is a useful skill to have when facing the frustrations and problems life throws our way. Brewer sums it up nicely: “MT helps us step out of me.” Being able to look at your thoughts and feelings in a nonjudgmental way, without reacting or caving into them, puts you in a much better position to deal with stress. Using mindfulness, says Brewer, “Your life improves. You can learn to tolerate all sorts of distress.”

By helping us tolerate distress, meditation and mindfulness-based stress reduction aim to put people back in control of their experience, reducing anxiety, and increasing resilience. More and more studies provide evidence that mindfulness meditation – and other forms of meditation – really does affect the brain and body in a positive way. Western medicine is just beginning to integrate alternative techniques like mindfulness into conventional treatments. Clearly there is something to mindfulness; it’s been practiced by millions of people for thousands of years. We Westerners may be a little late in jumping in, it certainly benefits us to research it scientifically. As we come to understand it more thoroughly, we just may find it is even more useful than we suspected.

For More Information
What’s the best way to learn more about mindfulness meditation? NIH’s website, the National Center for Complementary and Alternative Medicine, is a good place to start. It’s important to get information from reliable sources – preferably government or academic websites. Many of sites are now working hard to bring mindfulness to the public in a clear, tangible way. As Brewer points out, “that’s one thing that [NIH] is trying to do, and they are doing a fabulous job at it.”

And if you are interested in learning about the benefits of mindfulness in stress reduction specifically, MBSR programs are offered at various institutions across the country. The University of Massachusetts Medical School’s Center for Mindfulness website offers a search feature to locate MBSR programs in your area.

For more information on addiction treatment at Yale School of Medicine's Neuroscience Clinic see:
http://medicine.yale.edu/psychiatry/YTNC/

For guided mindfulness meditations, go to:
http://medicine.yale.edu/psychiatry/ytnc/care/resources.aspx

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