Meditation and Mental Health
Does the science support the hype?
Posted Jul 17, 2019
Fittingly, it turns out that this focus on breath may be just what the doctor ordered.
Meditation, particularly mindful meditation, teaches those who practice it to focus on the present moment, breath by breath. Suzanne Westbrook, a retired internal medicine doctor at Harvard, describes it as a means of “noticing what happens moment to moment, the easy and the difficult, and the painful and the joyful. It’s about building a muscle to be present and awake in your life.”
While meditation has been practiced by individuals from all over the world for thousands of years, it has only become a popular topic among practitioners of conventional medicine in recent years, largely because research has shown that meditation does not merely make one feel better or less stressed. There are physical benefits that appear to be backed up by clinical evidence. According to these studies, meditation can help individuals sleep better, cope with some symptoms associated with mental disorders like depression and anxiety, reduce some of the psychological difficulties associated with chronic pain, and even improve some cognitive and behavioral functions.
Sleep disturbances are extremely common, particularly among older Americans. Roughly half of all Americans over the age of 55 have difficulties either initiating or maintaining sleep, which can lead to fatigue, disturbed mood, and reduced quality of life. Younger Americans also have difficulties sleeping, though the problem is not as pronounced.
To see if meditation could be used as an effective tool to improve sleep, a team of researchers in California conducted a randomized clinical trial on 42 middle-aged and older adults during the entire calendar year of 2012. Half of the participants received training in mindful awareness practices (MAPS), which include mindful exercises such as “mindful sitting meditation, mindful eating, appreciation meditation, friendly or loving-kindness meditation, mindful walking, and mindful movement.” The other half received sleep hygiene education (SHE), which does not include meditation training.
While both were effective at improving sleep, the MAPS program “resulted in improvement in sleep quality at post-intervention relative to a highly active and standardized SHE program,” the researchers wrote in a paper published in JAMA Internal Medicine in 2015. These numbers were quantified by relying on the Pittsburgh Sleep Quality Index, a 19-item self-report questionnaire of sleep disturbances. Those involved within the MAPS program saw an improved mean of 2.8, while the SHE group only saw a mean decrease of 1.1 (the range of the global score is 0-21, with higher scores indicating worse sleep quality).
More research into the correlation between meditation and sleep will be needed to corroborate these claims, but the initial findings are promising. “Mindfulness meditation appears to have a role in addressing the prevalent burden of sleep problems among older adults by remediating their moderate sleep disturbances and deficits in daytime functioning,” the paper’s authors wrote, “with short-term effect sizes commensurate with the status quo of clinical treatment approaches for sleep problems.” More clinical studies will need to take place to determine if these same tools can be used to address long-term sleep problems and if they are as effective for younger individuals.
Depression and Anxiety
Numerous studies have tested the efficacy of mindfulness meditation on depression and anxiety disorders, including panic disorder and agoraphobia (fear of being in a place or situation where escape might not be possible or help may not be available in the event of a panic attack). One paper published in the American Journal of Psychiatry found that mindfulness meditation significantly reduced anxiety and depression levels among the 22 participants in the study. Perhaps more importantly, 20 out of the 22 participants were still practicing the stress reduction techniques that they learned while undergoing the study at their three-month follow-up, while 21 of the 22 were still using mindfulness of breathing techniques in their daily lives. If nothing else, this suggests that the practice is relatively easy to learn and to maintain.
A more recent systematic review and meta-analysis of the effects of mindfulness meditation on symptoms of anxiety was more cautious in its findings than the above paper, largely because the 36 randomized control trials they considered contained numerous limitations. However, despite these issues with the studies, the review was still able to claim that the evidence suggests that meditation “works significantly better than TAU [treatment as usual] or attention control and works as well as other active therapies used in these studies for reducing anxiety.”
Furthermore, they concluded that, “Given the fact that meditative therapies are so easy to carry out without any known adverse effect, and the fact that no existing treatment is effective for all patients or for all anxiety disorders, clinicians may consider recommending meditation for patients of anxiety and promoting meditative therapies for anxiety and related disorders.”
Yet another meta-analysis of the effects of mindfulness meditation on symptoms of both anxiety and depression came to a similar conclusion. Writing in JAMA Internal Medicine, the authors said, “Despite the limitations of the literature, the evidence suggests that mindfulness meditation programs could help reduce anxiety, depression, and pain in some clinical populations. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress.”
A systematic review and meta-analysis on the effects of mindfulness meditation on chronic pain published in 2017 found that meditation may not be the most effective analgesic. However, the impact of chronic pain on one’s quality of life is not limited to the pain itself; it can also lead to depressive symptoms and other issues that affect one’s mental wellbeing. Mindfulness meditation was found to be an effective means of mitigating these problems—though not the pain itself.
According to the paper, “Meditation significantly lowered depression scores as compared with treatment as usual, support, education, stress management, and waitlist control groups.” They added, “The quality of evidence was rated as high due to lack of heterogeneity, consistent study results, and precision of effect (small confidence intervals).” The quality of evidence to support the claim that mindfulness meditation significantly improved quality of life was rated as moderate, while the quality of the evidence to support the claim that it improved physical health-related quality of life was low.
The conclusion suggests that meditation is not particularly effective at eliminating chronic pain, but it does seem to improve the mental health of those who are dealing with it. This would seem to corroborate other studies that have produced evidence suggesting that meditation does have some benefits for mental health. Furthermore, as noted above, because meditation can be practiced without fear of side effects or adverse events, this makes it an attractive option for patients.
Recent studies, particularly the work of Harvard-based neuroscientist Sara Lazar, have found that mindfulness meditation may physically change numerous parts of the brain. Writing in 2011, Lazar and others reported that mindfulness-based stress reduction altered gray matter concentration within the left hippocampus, the posterior cingulate cortex (PCC), the temporoparietal junction (TPJ), and the cerebellum. These changes in the brain were detectable after participating in a mindfulness training program for just eight weeks, and could theoretically impact cognitive faculties that include, “learning and memory processes, emotion regulation, self-referential processing, and perspective taking.”
In a separate interview with Josh Summers, Lazar said that mindfulness meditation can also affect “the area of the brainstem where a lot of neurotransmitters that are related to mood are released … We think that the changes there may be related to the changes in mood.”
Lazar has also found that mindfulness meditation may reduce the density of the amygdala, a part of the brain integral to processing fear, stress, and anxiety. Though it is not entirely clear why this is taking place, Lazar noted that animals that have endured a great deal of stress and fear throughout their lives tend to have highly developed amygdalae. This would suggest a correlation between the two, and that the circuitry within the amygdala becomes more robust in brains that have been exposed to greater amounts of stress and fear. A reduction in density, Lazar theorizes, may come about because of stress reduction, which, in turn, leads to synaptic pruning. However, additional studies will have to be conducted with highly sophisticated instruments to validate this theory.
While the initial evidence that has come from these studies indicates that the effects of mindfulness meditation are widespread, it remains too early to tell if all these claims will be corroborated by more concrete research. However, even if meditation is not as effective at reducing anxiety or improving moods as some of its most ardent defenders claim it is, there seems to be virtually no downside to meditative therapies. Consequently, there does not seem to be any harm in trying it.
I report no conflict of interest. I am not a speaker, advisor, or consultant and have no financial or commercial relationship with any biopharmaceutical entity whose product/device may have been mentioned in this post.