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Meditation: a possible treatment for stress-related diseases?

Meditation is a term used to describe a diverse array of practices, each with a variety of goals. All of these practices use non-analytical means to focus attention without “discriminating thought,” which means that the mind is calmed in order to focus the attention inward toward the consciousness (7). Meditation usually includes one of the following: freeing the mind of thoughts, focusing on God/Universe, seeking guidance from a higher power, or focusing on a teaching or situation. Meditation requires no particular lifestyle or belief system (i.e. religion) and is often practiced along with (not in place of) other activities in life.

Metabolic, autonomic, encephalographic, and psychological changes occur during and after meditative sessions (7).  These changes lead to decreased stress and anxiety, enhanced motor reflexes, increased motor control, increased exercise tolerance, increased awareness, improved concentration, and an improved sense of personal meaning in the world.  

The positive physiological effects have led researchers to study if meditation can serve as a treatment for stress-related diseases.  Schwartz et al. and Ost et al. studied meditation as a treatment for anxiety.  Both studies concluded that meditation/relaxation therapy was significantly better than cognitive therapy for reducing anxiety (4,6).  Wenneberg et al. and Paul-Labrador et al. studied meditation versus health education on cardiovascular disease.  Both concluded that meditation significantly reduced diastolic blood pressure (5,8). In addition, Paul-Labrador et al. found that meditation significantly reduced insulin resistance (5).   Edelman et al. compared meditation and other relaxation techniques to usual care in patients with 1 or more known cardiovascular risk factors.  The alternative treatment reduced risk significantly (16% to 12% respectively) (2).  

Although meditation is considered an alternative treatment method for clinical diseases, the number of studies showing significant positive health effects is growing.  A case could be made for the inclusion of meditation into the treatment of stress-related diseases.  This article will describe mediation and the application of meditation as it relates to healthy individuals and individuals with hypertension, and CHD.    

HISTORY OF MEDITATION
Meditation is an 2000 year-old practice that originated from Vedic Hinduism (11).  Meditation practice is very diverse; there are many styles of meditation, each with a different goal.  An individual may lie down, sit, stand, or walk as a physical form of meditation.  People might breathe slowly, breath quickly, or chant during meditation.  No matter the form, all meditation practices aim toward quieting the mind in order to reach a mental state of “thoughtless awareness,” or non-analytical observation (7).  Once this state is reached, the meditator can focus the attention inward toward the consciousness or “self.” Meditation requires no religious beliefs or lifestyle modifications; it is practiced along with every-day activities.

Maharishi Mahesh Yogi brought meditation to the West in 1958 by teaching an easy form of meditation called Transcendental Meditation (TM) (10).  A certified instructor teaches the TM technique, and once the technique is learned, people practice individually at their place of choice.  TM involves sitting easily with the eyes closed twice a day for twenty minutes.   The mind’s mental and physiological activity is reduced and a “wakeful hypo-metabolic” state is produced (3).   TM has been described as the “most effective remedy for the ills of modern life (10).”  After TM became relatively popular, scientists began to study its effects on various physiological and psychological problems and found that TM had positive effects on certain conditions.   King et al. compiled various studies on TM, and their conclusions are in the table:

 

MECHANISMS
Meditation promotes relaxation by producing changes in many biological systems.  The responses are noticed in the metabolic, autonomic, endocrine, and neurological systems as well as physiological changes. 

  • Metabolic system.  Meditation decreases the breathing pattern, heart rate, and blood pressure, which decrease oxygen utilization and carbon dioxide elimination by muscles.  This physiological state is opposite of the hyper-metabolic, stressed state (7).
  • Autonomic nervous system.  Meditation produces specific neural activation patterns that lead to a decreased limbic arousal in the brain.  Regular meditators show decreased limbic arousal (7).
  • Endocrine system.  Meditation shows a decrease in blood chemicals such as lactate, cortisol, and epinephrine.  Blood flow to organs in increased as well as levels of gamma aminobutyric acid (GABA), melatonin, and dehydroepiandrosterone sulfate (DHEA-S).  All of this leads to a state of relaxation (7).
  • Neurological system. Meditation produces slower EEG patterns and synchronization of brain waves.  These characteristics of deep relaxation promote signals to be transmitted more easily.  Meditation decreases muscle reflex time and can improve motor performance.  The nerve signal transfer is accelerated and neurotransmitter release is improved (7).
  • Psychology.  Meditation leads to a feeling of “self-transcendence, meaning in the world, a heightened sense of connectedness with the world, and a sense of purpose and meaningfulness (7).”  Meditation promotes feelings of happiness, freedom from anxiety, content with oneself, and greater vitality (11).  

 

Mechanism illustration.  Barnes et al. studied TM and hypertension and found that TM showed significant decreases in systolic blood pressure and total peripheral resistance compared to a control group (1).  The mechanism proposed is illustrated below.  

Meditation promotes a restful, alert state.  The physiological state brought about by “restful alertness” leads to a decrease in blood pressure either by a decrease in endothelin-1 or an increase in nitric oxide (1).  

HYPERTENSION STUDIES
Wenneberg et al. compared TM to cognitive-based stress education in thirty-nine normotensive males (8).   Blood pressure and cardiovascular reactivity to stress was measured using a series of laboratory stressors.  After four months the TM group showed significantly lower diastolic blood pressure than the stress education group (-8.8 +/- 3.0 compared to +2.3 +/- 2.8 p = .044).   

Paul-Labrador et al. compared TM to health education in103 subjects with stable CHD (5).  After sixteen weeks, the TM group showed significantly lower systolic blood pressure than the health education group (-3.4 +/- 2.0 compared to +2.8 +/- 2.1 p = 04).
Barnes et al. compared TM to a control group (resting) in thirty-two healthy adults (1).  Subjects performed two sessions:  eyes open rest (both groups), and either TM (TM group) or eyes-closed rest (control group).  Hemodynamic measurements were taken at the beginning and just before the end of the twenty-minute session.  The TM group showed significantly lower systolic blood pressure and total peripheral resistance than the control group in both eyes-open rest and TM/eyes closed (eyes open:  SBP: p = .01, TPR: p = .004;  TM/eyes closed: SBP p = .04, TPR p = .03).  Cardiac Output was significantly different in the eyes-open rest session (p = .01). (See graph below).   The top graphs are during “eyes-open rest” for both groups.  The bottom graph is either “TM” or “eyes-closed rest.”

These studies show that meditation is more effective than heath education and no intervention in lowering blood pressure.
    

MEDITATION AND DISEASE STUDIES

  • CHD.  Paul-Labrador et al. (see above) also measured insulin resistance differences in individuals with stable CHD (5).  The TM group showed significant improvements in insulin resistance (p = .03) and insulin levels (p = .02) compared to a health education group. (See graph on next page.)
  • Cardiovascular risk factors.  Edelman et al. studied 154 outpatients with one or more known cardiovascular risk factors and compared a personalized health plan (PHP) to “usual care (2).”  The PHP consisted of mindfulness meditation, relaxation training, stress management, motivational techniques, and health education.  The outcome measure was the 10-year risk of CHD by Framingham risk score and was assessed at five and ten months into the treatment.   The PHP group showed a lower 10-year risk for CHD compared to the usual care group (9.8% to 11.1%), and the PHP group improved significantly more (16% compared to 12% for the usual care group).  There was a significant difference in the rate of improvement between the groups; CHD risk decreased to 7.8% for the PHP group compared to 9.8% for the UC group (p = .06 at 5 months, p = .04 at 10 months) (see graph below).The PHP group also had a higher number of exercise sessions per week, a higher proportion preparing to exercise or actively exercising, and a lower BMI than the usual care group.  These data indicate that incorporating alternative care can not only improve health, but can also retain participation in health care.  
  • Coronary artery disease.  Zamarra et al. compared TM to a wait-list control in twenty-one patients with documented coronary artery disease (9).  After eight months of treatment, the TM group had a 14.7 increase in exercise tolerance, an 11.7% increase in maximal workload, an 18% delay in onset of ST-segment depression, and significant reductions in the rate-pressure product at three and six minutes at maximal exercise compared to the control group.     

 

APPLICATION
The studies presented illustrate the effect meditation plays in the treatment and reversal in some adverse health conditions.  Any individual can easily learn Transcendental Meditation (or another form of meditation).  Twenty minutes of TM, twice per day provides health benefits.  If a person was to incorporate TM into their daily routine, they could experience lower blood pressure, decreased anxiety, lower insulin levels, and less insulin resistance.  In addition to the physiological improvements, meditation promotes a sense of well-being, inner peace, and happiness.  In the clinical setting, individuals that meditated or used alternative relaxation techniques showed greater improvements than individuals under health education or usual care.  The meditation groups also have a higher rate of compliance.  Meditation should be considered as a means of enhancing treatment effects as well as improving patient compliance.  

SOURCES

  1.  Barnes VA, FA Treiber, JR Turner, H Davis, WB Strong.  Acute effects of transcendental meditation on hemodynamic functioning in middle-aged adults.  Psychosomatic Medicine.  61:525-531. 1999.
  2. Edelman D, E Oddone, R Liebowitz, W Yancy, M Olsen, A Jefferys, S Moon, A Harris, L Smith, R Quillan-Wolever, T Gaudet.  A multidimensional integrative medicine intervention to improve cardiovascular risk.  J Gen Intern Med.  21: 728-734. 2006.
  3. King M, T Carr, C D’Cruz.  Transcentental meditation, hypertension and heart disease.  Austrailian Family Physician.  31(2):  1-4.  2002.
  4. Ost L, E Breitholtz.  Applied relaxation versus cognitive therapy in the treatment of generalized anxiety disorder.  Behaviour Research and Therapy.  38: 777-790.  2000.
  5. Paul-Labrador M, D Polk, J Dwyer, I Velasquez, S Nidich S, M Rainforth, R Schneider, N Merz.  Effects of a randomized controlled trial of transcendental meditation on components of the metabolic syndrome in subjects with coronary heart disease.  Arch Intern Med.  166:  1218-1224. 2006.
  6. Schwartz G, R Davidson, D Goleman.  Patterning of cognitive and somatic processes in the self-regulation of anxiety:  effects of meditation versus exercise.  Psychosomatic Medicine.  40(4):  321-328. 1978.
  7. Shin J.  The physiology of meditation.  http://epe.lac-bac.gc.ca/100/201/300/ejmaspt/2004/04-11/ejmas.com/pt/pta...
  8. Wenneberg S, R Schmeider, K Walton, C Maclean, D Levitsky, J Salerno, R Wallace.  A controlled study of the effects of the transcendental mediation program on cardiovascular reactivity and ambulatory blood pressure.  Intern J Neuroscience.  89: 15-28.  1997.
  9. Zamarra JW, RH Schneider, I Bessenghini, DK Robinson, JW Salerno.  Usefulness of the transcendental meditation  program in the treatment of patients with coronary artery disease.  Am J Cardiol.  77(10): 867-870. 1996.
  10. http://www.tm.org/maharishi/index.html
  11. http://en.wikipedia.org/wiki/Meditation
     


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