Ep. 12 Mindfulness and Meditation in Medicine

Introduction

I like to refer to Matthew McAdam as the “most zen person” in our class. It is hard to even imagine him upset. One day during lunch, he told me about his training as meditation instructor and about his current project bringing meditation to health care providers.

I reached out hoping to learn more about meditation and mindfulness and what role it could play in medicine.

Background Information

  1. In his book Full Catastrophe Living, Jon-Kabat Zinn, the developer of the mindfulness-based stress reduction (MBSR) program, defines mindfulness as “the awareness that arises by paying attention on purpose, in the present moment, and non-judgmentally” (Kabat-Zinn, 1991).
  2. Mindfulness meditation was originally taught by the Buddha, Siddhartha Gautama, as a means of ending suffering through the transformation of human consciousness (Kabat-Zinn, 1991).
  3. There is a large body of literature documenting high levels of anxiety, depression, and stress in medical students compared to the general population (Sarid, Anson, Yaari & Margalith, 2004).
    1. Educators are turning to health promotion interventions to decrease stress and promote resilience in university students (Regehr, Glancy, & Pitts, 2013)
  4.  Mindfulness and Mediation seems like a promising, low-cost intervention for stress, anxiety and depression. Unfortunately many of the studies are not large clinical trials.
    1. . Across the four studies (n’s = 65 to 141), the authors concluded that higher levels of mindfulness are associated with lower levels of depression, anxiety, and stress (Weinstein, Brown, & Ryan, 2009)
    2. In a study of 45 clinicians caring for patients infected with HIV, patients rated clinicians with higher mindfulness scores more highly on clinician communication and on overall satisfaction (Beach et al., 2013)
    3. Conclusions from systematic review of 19 studies included 1815 participants: Mindfulness-based interventions decrease stress, anxiety, and depression and improve mindfulness, mood, self-efficacy, and empathy in health profession students (McConville, McAleer, & Hahne, 2016)
  5. The role of mindfulness on pain reduction seems less convincing. A review of three randomized control trials with a total of 117 chronic low back pain patients found inconclusive evidence of effectiveness of mindfulness in improving pain intensity or disability in chronic low back pain patients (Cramer, Haller, Lauche, & Dobos, 2012)
  6. The role of mindfulness on inflammation has contradictory findings. In a systematic review of 20 RCT studies with a total of 1602 participants, the authors concluded possible effects of mindfulness meditation on specific markers of inflammation, cell-mediated immunity, and biological aging, but these results are tentative and require further replication (Black, & Slavich, 2016)
    1.  In a study with 64 depressed females, two groups were created with half the participants assigned to a 4-week mindfulness-based intervention or a contact-control group. For both groups, salivary cytokines and depressive symptoms were assessed at baseline and posttreatment. Authors found that both groups showed similar reductions in depression. However, mindfulness group (vs. control) had greater reductions in IL-6 and TNF-α; changes in IL-6 were sustained at 3-month follow-up (Walsh, Eisenlohr-Moul, & Baer, 2016).
    2. Matt mentioned the following study: Thirty-seven patients with psoriasis about to undergo ultraviolet phototherapy (UVB) were randomly assigned to one of two conditions: a mindfulness meditation-based stress reduction intervention guided by audiotaped instructions during light treatments, or a control condition consisting of the light treatments alone with no taped instructions. Analysis showed that subjects in the tape groups reached the Halfway Point and the Clearing Point significantly more rapidly than those in the no-tape condition for UVB treatments. (Kabat-Zinn et al., 1998)
  7. Some other claims made on the podcast, supported below.
    1. Killingsworth and Gilbert (2010). developed an app to find out how often people’s minds wander, what topics they wander to, and how those wanderings affect their happiness. They analyzed samples from 2250 adults. Mind wandering occurred in 46.9% of the samples and multilevel regression revealed that people were less happy when their minds were wandering than when they were not [slope (b) = –8.79, P < 0.001].
    2.  Matt mentioned a famous psychology study by Brickman et al (1978) comparing happiness between lottery winners, paraplegic patients and controls. Study 1 compared major lottery winners with controls and also with paralyzed accident victims who had been interviewed previously. Lottery winners were not happier than controls. Study 2 indicated that these effects were not due to preexisting differences between people who buy or do not buy lottery tickets or between interviews that made or did not make the lottery salient.

Additional Resources

  1. Mindfulness and Meditation in Medicine schedule for VGH and MSAC https://mmmatubc.wordpress.com/
  2. Jon Kabat-Zinn’s book – Full Catastrophe Living https://www.goodreads.com/book/show/589455.Full_Catastrophe_Living
  3. Free MBSR online course – https://palousemindfulness.com/
  4. Free meditation retreats – dhamma.org
  5. Apps for guided meditation – Headspace, and 10% Happier

Summary

Mindfulness and mediation is a cheap, non-pharmaceutical intervention with some evidence of benefits for stress and anxiety reduction with negligible side-effects. Seems like a useful tool for medical students. May even be helpful for patients as an adjunct to medical therapy (not as a replacement). In short, it seems like something worth trying out.

References

Black, D. S., & Slavich, G. M. (2016). Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Annals of the New York Academy of Sciences.

Beach, M. C., Roter, D., Korthuis, P. T., Epstein, R. M., Sharp, V., Ratanawongsa, N., … & Saha, S. (2013). A multicenter study of physician mindfulness and health care quality. The Annals of Family Medicine, 11(5), 421-428.

Brickman, P., Coates, D., & Janoff-Bulman, R. (1978). Lottery winners and accident victims: Is happiness relative?. Journal of personality and social psychology, 36(8), 917.

Cramer, H., Haller, H., Lauche, R., & Dobos, G. (2012). Mindfulness-based stress reduction for low back pain. A systematic review. BMC complementary and alternative medicine, 12(1), 162.

Kabat-Zinn, J. (1991). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell Pub.

Kabat-Zinn, J., Wheeler, E., Light, T., Skillings, A., Scharf, M. J., Cropley, T. G., … & Bernhard, J. D. (1998). Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing photo therapy (UVB) and photochemotherapy (PUVA). Psychosomatic medicine, 60(5), 625-632.

Killingsworth, M. A., & Gilbert, D. T. (2010). A wandering mind is an unhappy mind. Science, 330(6006), 932-932.

McConville, J., McAleer, R., & Hahne, A. (2016). Mindfulness Training for Health Profession Students—The Effect of Mindfulness Training on Psychological Well-Being, Learning and Clinical Performance of Health Professional Students: A Systematic Review of Randomized and Non-randomized Controlled Trials. Explore: The Journal of Science and Healing.

Regehr, C., Glancy, D., & Pitts, A. (2013). Interventions to reduce stress in university students: A review and meta-analysis. Journal of affective disorders, 148(1), 1-11.

Sarid, O., Anson, O., Yaari, A., & Margalith, M. (2004). Academic stress, immunological reaction, and academic performance among students of nursing and physiotherapy. Research in nursing & health, 27(5), 370-377.

Walsh, E., Eisenlohr-Moul, T., & Baer, R. (2016). Brief mindfulness training reduces salivary IL-6 and TNF-α in young women with depressive symptomatology.

Weinstein, N., Brown, K. W., & Ryan, R. M. (2009). A multi-method examination of the effects of mindfulness on stress attribution, coping, and emotional well-being. Journal of Research in Personality, 43(3), 374-385.

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