Richard Horowitz, MD

Richard Horowitz MD

Why Can’t I Get Better?

Meditation and Mindfulness: Part I, Calm Abiding Meditation

Mindfulness based meditation techniques help with anxiety and depression.

Posted Jan 26, 2014

Over the years, I have found that the pain and suffering associated with Lyme disease and tick-borne disorders not only manifest as physical symptoms, but have a strong emotional component. The vast majority of my patients share their emotional life with me, and their experiences range from mild sadness to severe depression, with elements of anxiety, shame, anger, guilt, fear and grief.

Sometimes these emotions are directly related to their physical symptoms and dealing with their ongoing illness. However, some experience post-traumatic stress disorder that comes from issues completely unrelated to their Lyme disease. This can often include emotional, physical, and sexual abuse. These are the patients who are the most challenging to treat. There is evidence that early trauma can damage the immune system, and makes these individuals, once infected, more vulnerable to the worst ravages of the disease. However, I know that once they have gathered up the courage to go into their own pain and suffering and transform it, they will have an easier time healing. I have seen this happen over and over again.

When patients tell me about their migraines, irritable bowel syndrome, and asthma, I know it is possible that some underlying emotional wound might be contributing to the illness. This phenomenon has been described in detail in the scientific literature. I’m not saying that migraines can’t be triggered by food allergies, lack of sleep, stress, hypoglycemia and nutritional deficiencies, as well as Lyme disease with co-infections. Yet my clinical experience has convinced me that we are carrying around our emotions within our bodies, and that they have a profound effect on our health.

Books such as Bruce H Lipton’s THE BIOLOGY OF BELIEF, and Candace Pert's MOLECULES OF EMOTION, discuss studies on psychoneuroimmunology, the complex interaction between psychosocial factors like stress and trauma and the nervous, cardiovascular, endocrine, and immune systems. We know that the immune system can be influenced by the outside world. For example, high levels of the stress hormone cortisol can trigger cell death of white blood cells and other changes in inflammatory processes during traumatic experiences. In this way the mind and body work as one. Working with the mind and learning to find peace in the midst of pain and suffering is essential when dealing with significant illness. This is where the practice of meditation can be of immense benefit.

Meditations to Calm the Mind and Heal the Body:

Those who practice meditation know that it is accessible to all of us. I have had the opportunity to study meditation for more than 30 years with meditation masters of the Kagyu school of Tibetan Buddhism. They have passed down an unbroken lineage of teachings from 2500 years ago that is still accessible and fresh today. These teachings allow us to develop greater loving kindness and compassion for ourselves and others, and allow one to directly experience a deep peace and joy that may not have been previously known to the individual, by having a direct experience of mind itself. As you learn to calm your mind and listen to the body, the body will speak its "truth,” allowing our hidden innate potential to surface, ultimately having a healing effect.

Meditation has been proven to have scientific health benefits which can assist us in our healing and in maintaining our well-being. We all are living in a fast paced world, challenged by circumstances that are potentially stressful. Stress management techniques that include relaxation demonstrate the most consistent benefits.  Meditation may be one way to mute the impact of stressful events on our lives and gives us a chance to experience this deep relaxation. It is like taking a mini-vacation in the midst of a busy working life.

The health benefits of meditation were first studied by Dr. Herbert Benson at Harvard, when he studied the relaxation response. He found that there were numerous beneficial effects of meditation on our physiology, including decreased sympathetic nervous system activity with a decrease in our heart rate, respiratory rate, and cortisol levels, as well as decreased oxygen consumption, decreased blood lactate levels, implying better metabolic activity, with an increase in alpha and theta waves on the EEG (deeper, calmer states of consciousness), with hemispheric symmetry (symmetric  brainwave patterns in both the right and left brain) .

Since Benson's introduction of the Relaxation Response in 1975, other researchers have demonstrated the benefits of meditation on health and healing. For example, one 2008 study published in the Journal of Personality and Social Psychology, found that the practice of loving-kindness meditation produced increases over time in daily experiences of positive emotions, which produced increases in a wide range of personal resources (e.g., increased mindfulness, purpose in life, social support). In turn, these increments in personal resources predicted increased life satisfaction and reduced depressive symptoms, as well as decreasing symptoms of the patient’s illness. Similar studies verified earlier work, where mindfulness based stress meditation has been found to have health benefits, such as decreasing anxiety, allowing patients to better cope with their illness.

A simple meditation practice that I often share with my patients has three parts. The first part is the motivation behind meditation, the second part is the meditation practice itself, and the third part involves a dedication of merit after completing the practice.

The motivation behind the meditation is important. We are certainly meditating because we want to find peace and happiness and relieve our own suffering. But others are also suffering, and if we develop a broader motivation of loving-kindness and compassion for others, then according to my teachers, the meditation practice will bear the greatest fruit. Love is wanting others to be happy and compassion is wanting others to be free from suffering. Loving-kindness and compassion are the highest level of motivation, and prepares the ground for a successful practice.

Next we have the meditation practice itself, which is also divided into three parts. The first part is calm abiding meditation, the second part is insight meditation, and the third part is Mahamudra meditation, which integrates calm abiding and insight meditation simultaneously. We will be discussing calm abiding meditation in this article, and insight/Mahamudra meditation in part II of this series.

Finally, when we are done with the meditation practice, we dedicate the merit for the sake of all beings limitlessly throughout time and space. Whatever qualities you may develop from this meditation, use them to benefit yourself and others, which is the essence of virtue. By following this three step process, you will learn to access the deeper states of meditation by calming the mind and then examining the nature of what arises in that state.

Before You Begin

You can start to practice meditation in short, five minute sessions, and eventually expand this to a half hour per day. All you need is a space where you can be quiet and alone during your practice.

Your physical posture is important when meditating. This allows the proper flow of energy to take place during the practice so that we do not fall asleep or become too agitated. Be free and easy and deeply relaxed with the posture! Do not force the posture, and do not hold the body too tight or too loose. Simply be aware of the posture of your body and gently try and keep the following seven essential points in mind while performing the different meditation exercises.

1.       Sit with the legs cross legged on a cushion (sattva posture), or if you are an experienced meditator and have experience doing yoga, you can sit in a full lotus posture (vajra posture). Never force the position. If either of those are too difficult, simply sit in a chair.

2.       Position your arms and hands so that the hands are folded on the lap with the right hand resting in the left hand (“gesture of equanimity”), or the hands are placed on the knees, palms down, with the fingers extended towards the ground (“the gesture of ease”).

3.       Sit with the back straight and upright in either a chair or cushion. This allows the energies in the subtle channels to flow more freely and straight, allowing the mind and attention to remain at ease.

4.       Extend the shoulders and elbows until they are straight.

5.       Slightly tilt the neck, and tuck the chin in slightly towards the chest.

6.       Connect the tip of the tongue to the palate. This helps stop the flow of excessive saliva.

7.       Keep your eyes open, gazing towards the tip of the nose (45 degrees downward)

The First Meditation: Calm Abiding Meditation

In the seated posture described above, you will perform the following meditation for five minutes, three times a day. Over time, you can combine these sessions into one longer session, working your way to a total length of one, 30 minute session once a day. If you are new to a meditation practice, work with this exercise until you are not distracted by your own thoughts and feelings. When this occurs, you will know that you are ready to move to insight meditation.

There are two different techniques which can be used: calm abiding meditation with a support, and calm abiding meditation without a support. The first is practiced by choosing a mental support as a physical object, such as a small pebble, flower, picture, statue, or staying focused on your breath. The technique is simply to gently place your awareness on the object. Don't examine the object and mentally discuss its qualities, just use the object as a way of anchoring your attention. Don't follow thoughts of the past (the past is gone), don't follow thoughts of the future (where fear lies), and don't follow thoughts of the present (which are gone the moment you notice it). Just place enough attention on the object to anchor the mind and not be distracted. Constant mindfulness and awareness are necessary. If you lose your mindfulness and your attention wanders off of the object of meditation, as it is likely to do, once you notice that you have been distracted, bring your attention back to the object.

One simple way to practice calm abiding meditation is to focus on your breath. Watch your breath go in through the nostrils, and watch it go out. Breathe naturally, and try and follow the breath non-distractedly for several minutes while the mind is in an open and relaxed state. Another variation of this practice is to count your breath twenty one times, where an in breath and an out breath are counted as one breath. If you make it to twenty one without being distracted, start over again. If you notice that you have forgotten what number you are on, or are no longer watching the breath, start counting again. This method allows us to track our progress, and see how far we can get before we are distracted.

Once you have attained some level of stability with the meditation practice where your mind is no longer frequently distracted while observing the object, you can practice calm abiding meditation without a support. This means that you simply fix your attention on the mind, without the support of the breath or a physical object. If you get distracted by thoughts, bring your attention back to the mind. Again, do not follow thoughts of the past, thoughts of the present, or thoughts of the future. Do not block thoughts and do not analyze them in a conceptual manner. Be natural and simply rest non-distractedly looking at your mind, resting in the nature of whatever arises. You can alternate doing calm abiding on an object and calm abiding meditation without an object during the same meditation session. You can also keep it fresh by occasionally changing the objects of meditation during the same session, or in different sessions.

Obstacles to Overcome

There are two main obstacles which frequently arise in meditation which both cause distraction: drowsiness and agitation. If you become drowsy, straighten your posture, and raise your gaze. If this does not work, imagine a white lotus at the level of your heart with a small bright sphere the size of the pea which sits in the center of the lotus. This pea is white on the outside and red on the inside and represents your mind and awareness. It is the nature of light, and should not to be visualized as a solid object. With a forceful exhale, imagine shooting this small sphere up through the top of your head into space. Continue to visualize this bright white sphere in space above your head until the drowsiness resolves.

The second obstacle to meditation is agitation: when you try to settle your mind, its gets caught up in thoughts.  Remedies for this include cutting thoughts at their root: take the attitude from the beginning that you are not going to get involved in any thoughts whatsoever during the meditation, no matter how interesting. If you become too agitated, relax your posture, lower your gaze, and if this is ineffective, imagine a four petal black lotus upside down at the level of the heart (also of the nature of light) with a dark pea sized sphere of light in its center. Imagine this sphere slowly travelling down through the body into the earth. Continue to visualize this heavy and dark sphere non-distractedly until the agitation resolves.

Practice makes perfect. Take several minutes out of every day to practice these simple meditation instructions. Do not judge your progress, because we all have the habit of allowing our minds to wander towards the past or the future, and get caught up in the endless chatter of the mind. Its takes time to develop non-distractedness and familiarize yourself with the open, relaxed natural state of mind, so be patient. In our fast paced, stressful world, taking a “time out” to connect with ourselves and get to a deeper, calmer state of mind is not just a good idea. For our mental, emotional and physical health, it is an important step on the road to health and healing.

Dr. Richard Horowitz

These meditation instructions are excerpted from Dr. Richard Horowitz’s recently released book “Why Can’t I Get Better? Solving the Mystery of Lyme and Chronic Disease”, available through St Martin’s press.

Scientific references:

Coe, C.L. (2010). All roads lead to psychoneuroimmunology. In J.M. Suls, K.W. Davidson, & R.M. Kaplan (Eds.), Handbook of health psychology and behavioral medicine (pp. 182-199). NY: The Guilford Press

Benson, H. (1975). The relaxation response. NY: Morrow.

Kiecolt-Glaser, J.K., McGuire, Robles, & Glaser, R.  (2002). Psychoneuroimmunology and psychosomatic medicine: Back to the future. Psychosomatic Medicine. 64, 15-18.

Segerstrom, S.C., & Miller, G.E. (2004).  Psychological stress and the human immune system: A meta-analysis study of 30 years of inquiry. Psychological Bulletin, 130, 601-630.

Robles, T.F. ,Glaser, R., Kiecolt-Glaser, J. K. Out of balance: A new look at chronic stress, depression, and immunity. Current Directions in Psychological Science, 14, 111-115, 2005.

Wallace, R. K., & Benson, H. (1972). The physiology of meditation.  Scientific American, 226, 84-90.

Alexander, C. N., Robinson, P., Orme-Johnson,  D. W., Schneider,  R.H., & Walton, K.G.  (1994). The effects of transcendental meditation compared to other methods of relaxation and meditation in reducing risk factors,  morbidity, and mortality. Homeostasis, 35, 243-263.

Carrington, P., Collins, G.H., Benson, H. et al.  (1980). The use of meditation-relaxation techniques for the management of stress in a working population. Journal of Occupational Medicine, 22, 221-231.

Fredrickson, B. et al. (2008). Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Journal of Personality and Social Psychology, 95,( 5), 1045–1062.

Grossman P., et al. (2004). Mindfulness-based stress reduction and health benefits. A meta-analysis. Journal of Psychosomatic Research 57 , 35–43

Davidson, R.  J., Kabat-Zinn, J., Schuacher, J., et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564-570.

Davidson, R. J., & McEwen, B.S.   (2012). Social influences on neuroplasticity: Stress and interventions to promote well-being. Nature Neuroscience, 15 (5), 689- 695.

Goyal M., et al. (2014). Meditation programs for psychological stress and well-being. A systematic review and meta-analysis. JAMA Internal Medicine, Accessed on line January 26th, 2014.

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