Health Benefits of Meditation
Research at Harvard Medical School shows that taking a few minutes to focus your mind each day can reduce stress, pain, depression, and more. You don’t need to enroll in a formal program, or even spend a lot of time practicing — 10 to 15 minutes a day will do. Consistency is the key.
Meditation traditions have been practiced throughout the world for thousands of years. Now the techniques and benefits of meditation are being researched by mordern medical science with great interest. A variety of meditation-based programs have been developed in recent years to reduce stress and medical symptoms and to promote wellness. One lingering question is to what extent these programs are similar or different. In a study published in the June issue of Psychosomatic Medicine, a team led by Massachusetts General Hospital (MGH) researchers, in collaboration with members of the two leading mind-body stress-reduction programs, documents the different effects these mind-body practices have in the brain. There are two widely used meditation-based stress-reduction courses. One is based on “The Relaxation Response” — first described by Herbert Benson, director emeritus of the MGH-based Benson-Henry Institute for Mind Body Medicine — which focuses on eliciting a physiologic state of deep rest, the opposite of the “fight or flight” stress response. The other is Mindfulness-Based Stress Reduction, developed by Jon Kabat-Zinn of the University of Massachusetts Medical School, which emphasizes a particular, nonjudgmental attitude termed “mindfulness” as key to stress reduction. Although both interventions are based on meditation, the scientific philosophies and meditative traditions upon which each is founded are different, and these differences are reflected in the instructions and exercises they teach. “If the hypotheses proposed by the programs’ creators are in fact correct, they imply that these programs promote wellness through different mechanisms of action,” says Sara Lazar of the MGH Psychiatric Neuroscience Research Program, senior author of the current report and assistant professor of psychology at Harvard Medical School. “Such a finding would suggest that these programs could potentially have different effects on disease.”
WHEN SCIENCE MEETS MINDFULNESS
How meditation changes the brain in depressed patients.
By Alvin Powell Harvard Staff Writer – April 9, 2018
In 2015, 16.1 million Americans reported experiencing major depression during the previous year, often struggling to function while grappling with crippling darkness and despair.
There’s an arsenal of treatments at hand, including talk therapy and antidepressant medications, but what’s depressing in itself is that they don’t work for every patient.
“Many people don’t respond to the frontline interventions,” said Benjamin Shapero, an instructor in psychiatry at Harvard Medical School (HMS) and a psychologist at Massachusetts General Hospital’s (MGH) Depression Clinical and Research Program. “Individual cognitive behavioral therapy is helpful for many people; antidepressant medications help many people. But it’s also the case that many people don’t benefit from them as well. There’s a great need for alternative approaches.”
Shapero is working with Gaëlle Desbordes, an instructor in radiology at HMS and a neuroscientist at MGH’s Martinos Center for Biomedical Imaging, to explore one alternative approach: mindfulness-based meditation.
In recent decades, public interest in mindfulness meditation has soared. Paralleling, and perhaps feeding, the growing popular acceptance has been rising scientific attention. The number of randomized controlled trials — the gold standard for clinical study — involving mindfulness has jumped from one in the period from 1995?1997 to 11 from 2004?2006, to a whopping 216 from 2013?2015, according to a recent article summarizing scientific findings on the subject.
Studies have shown benefits against an array of conditions both physical and mental, including irritable bowel syndrome, fibromyalgia, psoriasis, anxiety, depression, and post-traumatic stress disorder. But some of those findings have been called into question because studies had small sample sizes or problematic experimental designs. Still, there are a handful of key areas — including depression, chronic pain, and anxiety — in which well-designed, well-run studies have shown benefits for patients engaging in a mindfulness meditation program, with effects similar to other existing treatments.
“There are a few applications where the evidence is believable. But the effects are by no means earth-shattering,” Desbordes said. “We’re talking about moderate effect size, on par with other treatments, not better. And then there’s a bunch of other things under study with preliminary evidence that is encouraging but by no means conclusive. I think that’s where it’s at. I’m not sure that is exactly how the public understands it at this point.”
Researcher Gaelle Desbordes is probing mindfulness meditation’s effect on depression, using functional magnetic resonance imaging (fMRI) to take before and after images of the brains of depressed patients who’ve learned to meditate. The work seeks to understand the internal brain processes affected by mindfulness meditation training in this population.
Desbordes’ interest in the topic stems from personal experience. She began meditating as a graduate student in computational neuroscience at Boston University, seeking respite from the stress and frustration of academic life. Her experience convinced her that something real was happening to her and prompted her to study the subject more closely, in hopes of shedding enough light to underpin therapy that might help others.
“My own interest comes from having practiced those [meditation techniques] and found them beneficial, personally. Then, being a scientist, asking ‘How does this work? What is this doing to me?’ and wanting to understand the mechanisms to see if it can help others,” Desbordes said. “If we want that to become a therapy or something offered in the community, we need to demonstrate [its benefits] scientifically.”
Desbordes’ research uses functional magnetic resonance imaging (fMRI), which not only takes pictures of the brain, as a regular MRI does, but also records brain activity occurring during the scan. In 2012, she demonstrated that changes in brain activity in subjects who have learned to meditate hold steady even when they’re not meditating. Desbordes took before-and-after scans of subjects who learned to meditate over the course of two months. She scanned them not while they were meditating, but while they were performing everyday tasks. The scans still detected changes in the subjects’ brain activation patterns from the beginning to the end of the study, the first time such a change — in a part of the brain called the amygdala — had been detected.
Functional MRI (left) showing activation in the amygdala when participants were watching images with emotional content before learning meditation. After eight weeks of training in mindful attention meditation (right) note the amygdala is less activated after the meditation training.
In her current work, she is exploring meditation’s effects on the brains of clinically depressed patients, a group for whom studies have shown meditation to be effective. Working with patients selected and screened by Shapero, Desbordes is performing functional magnetic resonance imaging scans before and after an eight-week course in mindfulness-based cognitive therapy, or MBCT.
During the scans, participants complete two tests, one that encourages them to become more aware of their bodies by focusing on their heartbeats (an exercise related to mindfulness meditation), and the other asking them to reflect on phrases common in the self-chatter of depressed patients, such as “I am such a loser,” or “I can’t go on.” After a series of such comments, the participants are asked to stop ruminating on the phrases and the thoughts they trigger. Researchers will measure how quickly subjects can disengage from negative thoughts, typically a difficult task for the depressed.
The process will be repeated for a control group that undergoes muscle relaxation training and depression education instead of MBCT. While it’s possible that patients in the control part of the study also will have reduced depressive symptoms, Desbordes said it should occur via different mechanisms in the brain, a difference that may be revealed by the scans. The work, which received funding from the National Center for Complementary and Integrative Health, has been underway since 2014 and is expected to last into 2019.
Desbordes said she wants to test one prevalent hypothesis about how MBCT works in depressed patients: that the training boosts body awareness in the moment, called interoception, which, by focusing their attention on the here and now, arms participants to break the cycle of self-rumination.
“We know those brain systems involved with interoception, and we know those involved with rumination and depression. I want to test, after taking MBCT, whether we see changes in these networks, particularly in tasks specifically engaging them,” Desbordes said.
Desbordes is part of a community of researchers at Harvard and its affiliated institutions that in recent decades has been teasing out whether and how meditation works.
In the 1970s, when transcendental meditation surged in popularity, Herbert Benson, a professor at Harvard Medical School and what was then Beth Israel Hospital, explored what he called “The Relaxation Response,” identifying it as the common, functional attribute of transcendental meditation, yoga, and other forms of meditation, including deep religious prayer. Benson described this response — which recent investigators say is not as common as he originally thought — as the opposite of the body’s adrenalin-charged “fight or flight” response, which was also identified at Harvard, by physiologist Walter Cannon Bradford in 1915.
Eight weeks to a better brain
Meditation study shows changes associated with awareness, stress.
Other MGH researchers also are studying the effects of meditation on the body, including Sara Lazar, who in 2012 used fMRI to show that the brains of subjects thickened after an eight-week meditation course. Work is ongoing at MGH’s Benson-Henry Institute; at HMS and Brigham and Women’s Hospital’s Osher Center for Integrative Medicine; at the Harvard-affiliated Cambridge Health Alliance, where Zev Schuman-Olivier directs the Center for Mindfulness and Compassion; and among a group of nearly a dozen investigators at Harvard and other Northeastern institutions, including Desbordes and Lazar, who are collaborating through the Mindfulness Research Collaborative.
Among the challenges researchers face is defining mindfulness itself. The word has come to describe a meditation-based practice whose aim is to increase one’s sense of being in the present, but it has also been used to describe a nonmeditative state in which subjects set aside their mental distractions to pay greater attention to the here and now, as in the work of Harvard psychologist Ellen Langer.
Another challenge involves sorting through the many variations of meditative practice.
Recent scientific exploration has largely focused on the secular practice of mindful meditation, but meditation is also a component of several ancient religious traditions, with variations. Even within the community practicing secular mindful meditation, there are variations that may be scientifically meaningful, such as how often one meditates and how long the sessions are. Desbordes herself has an interest in a variation called compassion meditation, whose aim is to increase caring for those around us.
Amid this variation, an eight-week mindfulness-based stress reduction course developed in the 1970s by Jon Kabat-Zinn at the University of Massachusetts Medical Center has become something of a clinical and scientific standard. The course involves weekly two- or 2½-hour group training sessions, 45 minutes of daily work on one’s own, and a daylong retreat. The mindfulness-based cognitive therapy used in Desbordes’ current work is a variation on that program and incorporates elements of cognitive behavioral therapy, which involves talk therapy effective in treating depression.
Ultimately, Desbordes said she’s interested in teasing out just what in mindful meditation can work against depression. If researchers can identify what elements are effective, the therapy may be refined to be more successful. Shapero is also interested in using the study to refine treatment. Since some patients benefit from mindfulness meditation and some do not, he’d like to better understand how to differentiate between the two.
“Once we know which ingredients are successful, we can do more of that and less, maybe, of the parts that are less effective,” Desbordes said.
© 1900-2018 Harvard University
WITH MINDFULNESS, LIFE’S IN THE MOMENT
Those who learn its techniques often say they feel less stress
By Liz Mineo Harvard Staff Writer – April 17, 2018
On a cold winter evening, six women and two men sat in silence in an office near Harvard Square, practicing mindfulness meditation.
Sitting upright, eyes closed, palms resting on their laps, feet flat on the floor, they listened as course instructor Suzanne Westbrook guided them to focus on the present by paying attention to their bodily sensations, thoughts, emotions, and especially their breath.
“Our mind wanders all the time, either reviewing the past or planning for the future,” said Westbrook, who before retiring last June was an internal-medicine doctor caring for Harvard students. “Mindfulness teaches you the skill of paying attention to the present by noticing when your mind wanders off. Come back to your breath. It’s a place where we can rest and settle our minds.”
The class she taught was part of an eight-week program aimed at reducing stress.
Studies say that eight in 10 Americans experience stress in their daily lives and have a hard time relaxing their bodies and calming their minds, which puts them at high risk of heart disease, stroke, and other illnesses. Of the myriad offerings aimed at fighting stress, from exercise to yoga to meditation, mindfulness meditation has become the hottest commodity in the wellness universe.
Suzanne Westbrook, a retired internal-medicine doctor, taught an eight-week program that focused on reducing stress.
Modeled after the Mindfulness-Based Stress Reduction program created in 1979 by Jon Kabat-Zinn to help counter stress, chronic pain, and other ailments, mindfulness courses these days can be found in venues ranging from schools to prisons to sports teams. Even the U.S. Army recently adopted it to “improve military resilience.”
Harvard offers several mindfulness and meditation classes, including a spring break retreat held in March for students through the Center for Wellness and Health Promotion. The Office of Work/Life offers programs to managers and staff, as well as weekly drop-in meditation sessions on campus, online guided meditation resources, and even a meditation phone line, 4-CALM (at 617.384.2256).
“We were tasked to find ways for the community to cope with stress. And at the same time, so much research was coming out on the benefits of mindfulness and meditation,” said Jeanne Mahon, director of the wellness center. “We keep offering mindfulness and meditation because of the feedback. People appreciate to have the chance for self-reflection and learn about new ways to be in relationships with themselves.”
More than 750 students have participated in mindfulness and meditation programs since 2012, said Mahon.
Part of mindfulness’ appeal lies in the fact that it’s secular. Buddhist monks have used mindfulness exercises as forms of meditation for more than 2,600 years, seeing them as one of the paths to enlightenment. But in the Mindfulness-Based Stress Reduction program, mindfulness is stripped of religious undertones.
Mindfulness’ popularity has been bolstered by a growing body of research showing that it reduces stress and anxiety, improves attention and memory, and promotes self-regulation and empathy. A few years ago, a study by Sara Lazar, a neuroscientist and assistant professor of psychology at Harvard Medical School (HMS) and assistant researcher in psychiatry at Massachusetts General Hospital, was the first to document that mindfulness meditation can change the brain’s gray matter and brain regions linked with memory, the sense of self, and regulation of emotions. New research by Benjamin Shapero and Gaëlle Desbordes is exploring how mindfulness can help depression.
The pioneer of scientific research on meditation, Herbert Benson, extolled its benefits on the human body — reduced blood pressure, heart rate, and brain activity — as early as 1975. He helped demystify meditation by calling it the “relaxation response.” Benson is director emeritus of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital and Mind/Body Medicine Distinguished Professor of Medicine at HMS.
In the 1980s, mindfulness had yet to become a buzzword, recalls Paul Fulton, a clinical psychologist who has practiced Zen and insight meditation (vipassana) for more than 40 years. In the mid-1980s, when he was working on his doctoral dissertation on the nature of “self” among Buddhist monks, speaking of mindfulness in a medical context among scientists was “disreputable,” he recalled.
“Gradually because of the research, it became chic, no longer disreputable,” said Fulton, a lecturer in psychology in the Department of Psychiatry at HMS and co-founder of the Institute for Meditation and Psychotherapy. “And now you can’t step a foot out of the house without being barraged by mindfulness.”
Melanie Denham, head coach of Harvard women’s rugby team, recently attended a mindfulness workshop, intrigued by the idea of incorporating the techniques into her players’ training regimen to help them cope with the pressures of “expectation and performance.”
“In and out of the classroom, these student-athletes are immersed in a highly competitive culture,” said Denham. “This is stressful. This kind of training can develop a more-skillful mind and a sense of focus and well-being that can help them better maintain control and awareness of their thoughts, emotions, and presence in the moment.”
The growing interest in the field is reflected in Harvard’s course catalog. This spring, Lazar is teaching “Cognitive Neuroscience of Meditation,” Ezer Vierba leads an expository freshmen writing course on “Buddhism, Mindfulness, and the Practical Mind,” and Metta McGarvey teaches “Mindfulness for Educators” at the Graduate School of Education.
Due to high demand, McGarvey, who holds a doctorate in human development and psychology, teaches a three-day workshop for educators. It offers tools to enhance their work and their focus through breathing practices and self-compassion exercises.
Mindfulness meditation made easy
• Settle in
Find a quiet space. Using a cushion or chair, sit up straight but not stiff; allow your head and shoulders to rest comfortably; place your hands on the tops of your legs with upper arms at your side.
• Now breathe
Close your eyes, take a deep breath, and relax. Feel the fall and rise of your chest and the expansion and contraction of your belly. With each breath notice the coolness as it enters and the warmth as it exits. Don’t control the breath but follow its natural flow.
• Stay focused
Thoughts will try to pull your attention away from the breath. Notice them, but don’t pass judgment. Gently return your focus to your breath. Some people count their breaths as a way to stay focused.
• Take 10
A daily practice will provide the most benefits. It can be 10 minutes per day, however, 20 minutes twice a day is often recommended for maximum benefit.
“A lot of them are working in really tough environments, with all kinds of pressures,” said McGarvey. “The rates of burnout in some of the more challenging environments are very high.”
Ayesha Hood, a police officer from Baltimore who is interested in running a day care center, attended McGarvey’s workshop last fall, and found it helpful. “As a police officer, I live in high stress, and as a public servant, I tend to neglect myself,” she said. “I want to calm myself and be conscious about it.”
Christine O’Shaughnessy, a former investment bank executive who lead workshops at Harvard, said, “All day we’re bombarded with social media, colleagues, work, children, etc. We don’t have time to spend it in quiet reflection. But if you practice it at least once a day, you’ll have a better day.”
To skeptics who still view mindfulness as hippie-dippy poppycock, O’Shaughnessy has four words: “Give it a try.” When she first signed up for a mindfulness workshop in 1999, she said she was skeptical too. But once she realized she was becoming calmer and less stressed, she converted. She eventually quit her job and became a mindfulness instructor. (She recently launched a free meditation app.)
“Doing mindfulness is like a fitness routine for your brain,” she said. “It keeps your brain healthy.”
Mindfulness practitioners admit the practice can offer challenges. It requires consistency because its effects can be better felt over time, and discipline to train the wandering mind to keep coming back to the present, without judgment. A 2014 study said that many people would rather apply electroshocks to themselves than be alone with their thoughts. Another study showed that most people find it hard to focus on the present and that the mind’s wandering can lead to stress and even suffering.
© 1900-2018 Harvard University