- Mindfulness-based stress reduction (MBSR)
- Lovingkindness; Metta
- Focused attention
- Open monitoring
- Transcendental Meditation (TM)
- Mantra repetition
For Patients & Caregivers
What Is It
Meditation has been practiced for thousands of years in many traditions around the world. Common goals include inner calmness, physical relaxation, psychological balance, and improved vitality and coping. The majority of practices involve focused attention, regulated breathing, and developing a non-judgmental awareness of one’s thoughts and feelings.
Among the types of meditation, there may be differences in focus as well as overlap. Mindfulness based stress reduction (MBSR) uses attention to continually return to the present moment. Compassion or lovingkindness meditation focuses on directing positive feelings toward yourself and others. Observing-thoughts or perspective meditation allows for thoughts to flow without judging or engaging with them. Mantra or mantram meditation involves repeating words that have a unique sound and symbolic quality. In addition, there are movement meditative practices such as tai chi (taiji) and qigong that are components of traditional Chinese medicine, and yoga, which originated from ayurvedic medicine.
Both the American Society of Clinical Oncology (ASCO) and the Society of Integrative Oncology (SIO) recommend meditation as part of a multidisciplinary approach to reduce stress, depression, and mood disturbance, and to improve the quality of life in cancer patients. The American Heart Association also recommends meditation as a lifestyle tool to help reduce heart disease risk.
How It Works
The most researched form of meditation is mindfulness-based stress reduction (MBSR). It is typically offered as an 8-week program and uses sitting meditation, a sensing practice called body scan to reestablish the connection of mind to body and breath, and walking meditation to apply these practices in moving form. Clinical trials show that MBSR helps to manage many physical and mental symptoms in women with hot flashes and patients with AIDS. In patients with cancer, MBSR reduces distress and improves cancer-related mental impairment, mood, sleep, and well-being. Tibetan Sound Meditation (TSM), which uses sound to promote healing, also improved mental health and cognitive impairment caused by chemotherapy. Mindfulness Based Cancer Recovery (MBCR), a modification of MBSR that involves meditation and gentle yoga, decreased stress and improved quality of life in breast cancer survivors.
Meditation can benefit children too. Guided mantram meditation was shown to produce relief from acute pain in children with cancer. And MBSR practice improved self-confidence and optimism in children coping with cancer illness.
Several studies show that meditation reduces anxiety associated with many diseases including cancer.
Cancer-associated cognitive impairment
MBSR practice resulted in improvements in cognitive impairment resulting from cancer and its treatments.
Many clinical trials have shown that MBSR can help reduce depression.
Studies in breast cancer survivors show that MBSR practice decreases fatigue severity.
Clinical data indicate that MBSR training helps relieve insomnia and improves sleep quality.
A few studies indicate that meditation may be helpful in making lifestyle changes or modifying behaviors.
MBSR practice helps improve mood disturbance in patients including those with cancer.
A few studies indicate that MBSR is useful in relieving chronic pain. Larger trials are needed.
Is It Safe
Meditation is generally considered safe, and few cases of adverse effects have been reported. Various medical panels have endorsed meditation as a useful lifestyle tool, including the American Society of Clinical Oncology (ASCO), the Society of Integrative Oncology, and the American Heart Association.
Who Can Provide this Service
Where Can I Get Treatment
Meditation classes are offered in communities, at hospitals, and at universities. Cancer centers across the country also offer programs that are led by experienced teachers. Meditation courses are also offered at MSK for our patients and caregivers. It is important to note that regular meditation practice is essential for continued benefits.
For Healthcare Professionals
Meditation has been practiced for millennia in many traditions around the world. According to the 2012 National Health Interview Survey, nearly 18 million adults and 927,000 children practice meditation (2). It is defined as “a wakeful hypo-metabolic physiologic state” (1) in which the practitioner is relaxed but focused and alert. In addition to developing attention, most formats include regulated or conscious breathing, and increasing nonjudgmental awareness. Common goals include inner calmness, physical relaxation, psychological balance, and improved vitality and coping.
There may also be differences in the types of attention emphasized: Mindfulness based stress reduction (MBSR) involves present moment awareness and interoception. Loving kindness or metta (affect) meditation focuses on compassion and empathy for oneself and others. Observing-thoughts or perspective meditation allows for the nonjudgmental observation of thoughts or feelings without engaging with them. Data from randomized trials have shown that developing an orientation of acceptance toward present-moment experiences, the central mechanism of mindfulness interventions, helps promote positive emotions (65). Further, attention-based training has also been reported to reduce burnout, stress and anxiety in emergency department staff (66). MRI studies of these specific techniques suggest they correlate with training-induced behavioral improvements in attention, compassion, and cognitive perspective-taking, respectively (44). Other approaches include mantra or mantram meditation, which involves the repetition of words or sounds with phonetic significance, and movement meditative practices such as tai chi (taiji) and qigong, which are components of traditional Chinese medicine (TCM), and yoga, which originated from ayurvedic medicine.
The most researched form of meditation is MBSR, typically offered as an 8-week program. Elements include sitting meditation, a technique known as body scan, which reorients the mind to sense the connection with body and breath, and walking meditation, which applies these practices in moving form. Current data show the value of MBSR in managing chronic pain (3), insomnia (4) (5), stress, depression, and anxiety associated with vascular disease (6), coronary heart disease (7), diabetes (8), and irritable bowel syndrome (9), and distress associated with hot flashes in perimenopausal women (10). In patients with AIDS, MBSR helped improve psychological functioning, coping with adverse effects, and stability of CD4 T-cell counts (12). Preliminary data also suggest an association between MBSR compliance and smoking cessation (11) or reduced alcohol consumption (45). Other analyses suggest that mindfulness-based interventions may be helpful for eating behavior changes and disorder-specific symptoms (61) (62).
Several randomized trials have employed MBSR in the oncology setting, with the majority involving breast cancer patients. These studies reported decreased anxiety, depression, fear of recurrence, and fatigue (15) (17), as well as improved sleep quality (15) (54), enhanced psychosocial adjustment and quality of life (59), and reductions in long-term emotional and physical adverse effects associated with medical and endocrine treatments (16). MBSR was also reported to afford psychological benefit along with optimizing immune function in those newly diagnosed with breast cancer (67); and to affect short-term reductions in salivary cortisol and interleukin-6 levels in breast cancer survivors (68). In patients with mixed cancer diagnoses, MBSR improved distress, mood, stress, general well-being, and cancer-related cognitive impairment (13) (18); and in partners of cancer patients, it improved psychological functioning (14). A modification of MBSR known as Mindfulness Based Cancer Recovery (MBCR) that involves mindfulness meditation and gentle yoga also lowered stress symptoms and positively affected quality of life (20) (21). In one of the largest long-term studies of distressed breast cancer survivors, MBCR was superior to supportive expressive group therapy, with benefits lasting over one year (46).
Conclusions from systematic reviews and meta analyses indicate benefits of mindfulness-based interventions as adjuvants for managing cancer-related symptoms such as anxiety, depression and fatigue in both patients and survivors (70) (71). Although brief mindfulness interventions (BMBIs) have shown promise in relieving acute pain, a systematic review cited the need for large scale studies to recommend BMBIs for addressing acute or chronic pain (69).
Other studies show that Tibetan Sound Meditation, which uses sound to promote healing, improves short-term memory, cognitive function and mental health in breast cancer patients with chemotherapy-induced cognitive impairment (19). Guided meditation during core-needle breast biopsy significantly lowered pain, without compromising radiologist-patient communications, and reduced post-procedure anxiety and fatigue (47); as well as reduced anxiety during stereotactic breast biopsy (72). In head and neck cancer patients undergoing radiation therapy, both coached meditation or utilization of a more cost-effective meditation CD were equally effective in reducing distress (48). Mindfulness practice during chemotherapy in colorectal cancer patients reduced cortisol blunting typically seen in these patients (49). Preliminary data also suggest benefits of a combination of somatic yoga and meditation in improving balance and quality of life in cancer survivors with chemo-induced peripheral neuropathy (73).
Meditation has shown utility in pediatric populations as well. Guided mantram meditation relieved acute pain in children with neuroblastoma undergoing anti-GD2 monoclonal antibody therapy (22), and a review of mind-body therapy studies including MBSR in pediatric oncology revealed greater self-confidence and optimism in coping with illness (23). In another systematic review, mindfulness-based interventions were found to confer psychological benefits in patients with advanced cancer (55), but many of these studies are limited by the study design (56) (57) (58). Future trials with stronger methodologies can help validate the use of mindfulness practices (60).
Meditation is a safe practice and can be learned in classes offered in the community or at hospitals. Cancer centers across the country now offer meditation programs that are typically led by experienced teachers. It is important to note that regular, ongoing meditation practice is essential for sustained benefits.
Both the American Society of Clinical Oncology (ASCO) (63) and Society of Integrative Oncology (SIO) (24) (50) recommend meditation for anxiety, stress reduction, depression, mood disturbance, and improved quality of life in cancer patients. In addition, the American Heart Association recently added meditation to intervention guidelines to reduce risk of heart disease (51).
Mechanism of Action
Emerging evidence indicates that meditation may affect changes in structural and functional aspects of the brain involved in regulating attention, emotion, and self-awareness (25). An MRI study showed mindfulness or presence training increased cortical thickness in prefrontal regions; loving kindness or metta (affect) meditation induced plasticity in frontoinsular regions; and observing-thoughts or perspective meditation induced changes in inferior frontal and lateral temporal cortices (44). Mindfulness meditation also elicits brain responses (28) similar to traditional long-term practices such as Zen and Tibetan meditation, which are associated with differences in the prefrontal cortex, sensory cortices and insula, and the hippocampus and cingulate cortex, regions that play important roles in regulating emotion and controlling response (26) (27).
Among mechanisms underlying stress reduction effects of mindfulness, acceptance training has been identified as a pertinent component (64). Mindful breathing was also shown to enhance “decentering” from internal experiences, and to reduce reactivity to repetitive thoughts (34). The improved self-control, emotion regulation, and stress reduction in smokers who practiced meditation were attributed to increased activity in anterior cingulate cortex (ACC), adjacent prefrontal cortex (mPFC), and other brain areas, as ACC/mPFC activity is diminished in smokers (29). Mindfulness meditation also significantly reduced neural activation in brain regions that are crucial for facilitating and modulating nociceptive information (30). In healthy volunteers, MBSR practice was associated with changes in brain regions involved in learning and memory processes, perspective taking and self-referential processing along with emotion regulation (31). In patients with generalized anxiety disorder, significant symptom improvements with MBSR were attributed to changes in the fronto-limbic areas of the brain, which play key roles in emotion regulation (32). Further, EEC and ECG measures determined that MBSR produced entrainment of chaotic activities of the brain and heart (33).
MBSR practice induces shifts in the immune system as well. In a study involving breast and prostate cancer patients, MBSR practice reduced the ratio of T1 pro-inflammatory to T2 anti-inflammatory lymphocytes (35). Mindfulness meditation also increased telomerase activity, a known marker of cellular aging and psychological risk (36); and reduced nuclear factor-kappa B activity, a precursor to increases in proinflammatory cytokines and circulating levels of C-reactive protein (37).
Meditation is generally considered safe and effective, and few side effects have been reported. However, individuals who have experienced past traumas or abuse may respond negatively to some forms of meditation. Appropriate confidential screening may be needed to determine suitability of particular meditation practices in certain populations (52). In one survey, unwanted effects were transitory, and occurred more with focused attention meditation, when practicing longer than 20 minutes, and while being alone (53).
Psychosis: Following meditation (38) (39) and qigong practice (40) but some of these events occurred in concert with other issues including sleep loss, drug withdrawal, or pre-existing psychotic disorders.
Acute psychosis: In patients with schizophrenia after intensive meditation (41).
Qigong deviation syndrome: In patients following inappropriate qigong training, psychophysiological effects such as changes in heart rate, illusions, and pseudohallucinations (42).
Epilepsy: In a young woman after meditation (43).
Practitioners and Treatments
Meditation classes are offered in the community, at hospitals or at universities. Cancer centers across the country also offer programs that are typically led by experienced teachers. Meditation courses are also offered at MSK for our patients and caregivers.
Practitioners who teach mindfulness-based stress reduction go through a certification process. They may also have specific training and experience with certain patient populations, such as cardiac or cancer patients.
It is important to note that regular practice is essential for sustained benefits.