Incorporating mindful meditation with gentle stretching and mindful communication skills, Jon Kabat-Zinncreated the Mindfulness-Based Stress Reduction (MBSR) program in 1979. MBSR was initially created as a treatment for individuals with chronic pain. Longitudinal studies of patients completing this 8-week program show that the majority of class participants demonstrate moderate to great improvements in pain status at 6 months, 1 year, and 3 years (Kabat-Zinn, et al, 1984, Kabat-Zinn et al, 1987). Further, over 75% of patients maintain a formal meditation practice (at least once weekly) at 12 months. A treatment modality creating such high success rates in a population so refractory to treatment (due to lack of effective surgical interventions or effective pharmaceutical interventions without adverse side effects) was unheard of at the time, catching the attention of the health care community. MBSR was subsequently implemented in hospitals and clinics across the country. Over the past 35 years, MBSR has been proven effective for a myriad of other health-related issues. The first randomized, controlled study on the effects of mindfulness on immune function was conducted in 2003, when a group of healthy employees in a work environment underwent a traditional 8-week course in MBSR (Davidson et al, 2003). Results showed that those taking MBSR increased antibody production after being vaccinated with the influenza vaccine, when compared to a wait-list control group. Today, we are coming to a greater understanding as to how our immune system improves with MBSR. After taking an MBSR class, breast cancer survivors demonstrated increased levels of telomerase activity (which is linked to cell longevity at the cellular level), compared wait-listed controls (Lengacher et al, 2014). More research is to be done to more clearly understand this phenomenon. There is evidence of a strong connection between psychological health and cardiovascular functioning. Negative affect has been associated with elevated blood pressure (Raikkonen, Matthews & Kuller, 2001), lower vagal input to the heart (Martens, Nyklicek, Szabo, & Jupper, 2008), and altered function of the hypothalamus-pituitary-adrenocortical (HPA) axis (Pruessner, Hellhammer, Pruessner, & Lupien, 2003). Mindfulness based interventions are therefore more frequently being incorporated within cardiac rehabilitation programs. According to Nyklicek (2013), people who participated in an MBSR class demonstrated larger pre to post intervention decreases in blood pressure, and smaller stress related changes after being exposed to an acute stressor (mental arithmetic and speech tasks) than a waitlist control group. Studies supporting the use of meditation to improve our cognitive abilities have been equivocal, largely due to methodological limitations, differences in study design, study duration and patient populations. However, some patterns are beginning to emerge. In general, meditation training cultivates two disparate types of meditation; concentrative attention (e.g. focusing on one specific thing, like the breath), and receptive attention (e.g. choiceless awareness). The former appears to be a precursor for the latter. This is likely why concentrative attention is the first type of meditation taught in an MBSR class, with choiceless awareness being introduced weeks later. In 2007, Jha found support for the presence of these two types of attention, in that experienced meditators were more efficient than novice meditators at concentrative attention, novice meditators improved their concentrative attention after taking an 8-week MBSR class, and experienced meditators completing a month-long meditation retreat demonstrated greater efficiency in receptive awareness than the group of novices completing MBSR. Lutz et al (2009) found that experienced meditators were better able to sustain their attention on a dichotic listening task, and had more consistent EEGs than a group of novice meditators. In another study by Jensen et al (2012), subjects participating in an MBSR group demonstrated better vigilance on an attention task than a non-mindfulness-based stress reduction group, and a control group incentivized to perform well. Taken together, these findings support the theory that mindfulness training improves attention, while simultaneously reducing the task demands of brain functioning. Further high quality studies investigating more standardized mindfulness meditation programs are needed. Mindfulness-based interventions are also being incorporated in the treatment of aggression for individuals with developmental disabilities, such as Autism. “Meditation on the Soles of the Feet” (SoF) (Singh et al, 2011) shows great promise in teaching autistic adolescents to self-manage their aggression. It is a treatment that is easily generalized beyond the treatment setting, can be maintained without extensive programming, and is not reliant on external agents (parents, caregivers, teachers, or medication). Many studies support the use of mindfulness-based interventions in mental health. In one randomized clinical trial of psychiatric patients, participation in an 8-week MBSR class produced significant reductions in symptoms of depression and anxiety, and these gains were maintained at six-month follow-up (Vollestad et al, 2011). Meta-analysis shows meditation to be just as effective as antidepressants, but without the associated toxicities (Goyal, et al., 2014), prompting the medical journal, JAMA Internal Medicine, to recommend that clinicians be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. In the field of addictions, an 8-week program in Mindfulness-Based Relapse Prevention (MBRP) provided benefits over and above traditional (12-step) or cognitive-behavioral therapy (RP) groups at reducing drug use and heavy drinking at 12-month follow-up (Bowen, 2013). In this study, MBRP participants, compared to RP participants, reported 31% fewer drug use days, and a significantly higher probability of not engaging in any heavy drinking. MBSR has also proven effective in reducing stress and enhancing spirituality values in healthy people. In 2009, Chiesa and Serretti’s review of 10 studies found significant reductions in ruminative thinking, as well as increased empathy and self-compassion when compared to interventions that were structurally equivalent to the meditation program. Bibliography
Beach, D., Korthuis, P., Epstein, R., Sharp, V., Ratanawongsa, N., Cohn, J., Eggly, S., Sankar, A., Moore, R., and Saha, S. (2013). A Multicenter Study of Physician Mindfulness and Health Care Quality. Annals of Family Medicine, 11 (5), 421-428.
Chiesa, A., Serreti, A. (2009). Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. Journal of Alternative Complementary Medicine, 15 (5), 593-600.
Davidson, R., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S., Urbanowski, F., Harrington, A., Bonus, K., & Sheridan, J. (2003). Alterations in Brain and Immune Function Produced by Mindfulness Meditation. Psychosomatic Medicine, 65, 564-570.
Dobkin, P., & Hutchinson, T. (2013). Teaching mindfulness in medical school: where are we now and where are we going? Medical Education, 47, 768-779. Doi: 10.1111/medu.12200.
Goyal, M., Singh, S., Sibinga, E., Gould, N., Rowland-Seymour, A., Sharma, R., Berger, Z., Sleicher, D., Maron, D., Shihab, H., Ranasinghe, P., Linn, S., Saha, S., Bass, E., Haythornwaite, J. (2014). Meditation Programs for Psychological Stress and Well-Being: A systematic Review and Meta-analysis. JAMA Internal Medicine. doi 10.1001/jamainternmed.2013.13018
Harrison, R., Westwood, M. (2009). Preventing Vicarious Traumatization of Mental Health Therapists: Identifying Protective Practices. Psychotherapy Theory, Research, Practice,Training, 46 (2), 203-219. doi: 10.1037/a0016081.
Jha, , A., Krompinger, J., & Baime, M. (2007). Mindfulness training modifies subsystems of attention. Cognitive, Affective, and Behavioral Neuroscience, 7 (2), 109-119).
Jensen, C., Vangkilde, S., Frokjaer, V., & Hasselbalch, S. (2012). Mindfulness Training Affects Attention-Or is It Attentional Effort? Journal of Experimental Psychology: General, 141 (1), 106-123. doi:10.1037/a0024931
Kabat-Zinn, J., Lipworth, L., Burney, R. (1984). The Clinical Use of Mindfulness Meditation for the Self-Regulation of Chronic Pain. Journal of Behavioral Medicine, 8 (2), 163-189).
Kabat-Zinn, J., Lipworth, L., Burney, R. & Sellers, W. (1987). Four-Year Follow-Up of a Meditation-Based Program for the Self-Regulation of Chronic Pain: Treatment Outcomes and Compliance. The Clinical Journal of Pain, 159-173.
Keidel, G. C. (2002). Burnout and compassion fatigue among hospice caregivers. American Journal of Hospice and Palliative Care, 19 (3), 200-205.
Krasner, M., Epstein, R., Beckman, H., Suchman, A., Chapman, B., Mooney, C., & Quill, C. (2009). Association of an Educational Program in Mindful Communication with Burnout, Empathy, and Attitudes Among Primary Care Physicians. JAMA, 302 (12), 1284-1293.
Lengacher, C., Reich, R., Kip, K., Ramesar, S., Paterson, L. L., Moscoso, M. S., Carranza, I., Budhrani, P., Kim, S. J., Park, H. Y., Schell, M. J., Jim, H. S., Post-White, J., Farias, J. R., & Park, J. Y. (2014). Influence of Mindfulness-Based Stress Reduction (MBSR) on Telomerase Activity in Women with Breast Cancer (BC). Biological Research for Nursing. doi:10.1177/1099800413519495
Lutz, Antoine, Slagter, H., Rawlings, N., Francis, A., Greischar, L., & Davidson, R. (2009). Mental training enhances attentional stability: Neural and behavioral evidence. Journal of Neuroscience, 29 (42), 13418-13427. doi: 10.1523/NJNEUROSCI.1614-09.2009.
Martens, E. J., Nyklicek, I., Szabo, B. M., & Kupper, N. (2008). Depression and anxiety as predictors of heart rate variability after myocardial infarction. Psychological Medicine, 38, 375-383. doi:10.1017/s0033291707002097
Najjar, N., Davis, L., Beck-Coon, K., & Doebbeling, C. (2009). Compassion Fatigue: A Review of the Research to Date and Relevance to Cancer-care Providers. Journal of Health Psychology, 14 (2), 267-277. doi: 10.1177/1359105308100211.
Pruessner, M., Hellhammer, D. H., Pruessner, J. C., & Lupien, S. J. (2003). Self-reported depressive symptoms and stress levels in healthy young men: Associations with the cortisol response to awakening. Psychosomatic Medicine, 65, 92-99. doi:10.1097/01psy0000040950.
Raikkonen, K., Matthewa, K. A., & Kuller, L. H. (2001). Trajectory of psychological risk and incident hypertension in middle-aged women. Hypertension, 38, 798-802.
Shapiro, S., Astin, J., Bishop, S., Cordova, M. (2005). Mindfulness-Based Stress Reduction for Health Care Professionals: Results From a Randomized Trial. International Journal of Stress Management, 12 (2), 164-176.
Singh, N., Lancioni, G., Manikam, R., Winton, A., Singh, A., Singh, J., & Singh, A. (2011). A mindfulness- based strategy for self-management of aggressive behavior in adolescents with autism. Research in Autism Spectrum Disorders, 5, 1153-1158. doi:10.1016/j.rasd.2010.12.012
Thieleman, K., Cacciatore, J. (2014). Witness to suffering: Mindfulness and compassion fatigue among traumatic bereavement volunteers and professionals. Social Work, 59 (1), 34-41. doi:10.1093/sw/swt044.
Vøllestad, J., Sivertsen, B., Nielsen, G. H. (2011). Mindfulness-based stress reduction for patients with anxiety disorders: Evaluation in a randomized controlled trial. Behaviour Research and Therapy, Vol. 49 (4), Apr 2011, 281-288.