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Meditation

Meditation

Common Names

  • Mindfulness-based stress reduction (MBSR)
  • Lovingkindness; Metta
  • Focused attention
  • Open monitoring
  • Transcendental Meditation (TM)
  • Mantra repetition

For Patients & Caregivers

What Is It Minus iconIcon indicating subtraction, or that the element can be closed. Plus IconIcon indicating addition, or that the element can be opened. Arrow (down) icon.An arrow icon, usually indicating that the containing element can be opened and closed.

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.

The Society of Integrative Oncology (SIO) recommends meditation as part of a multidisciplinary approach to reduce stress, depression, fatigue, and mood disturbance, and to improve the quality of life of cancer patients. The American Heart Association also recommends meditation as a lifestyle tool to help reduce heart disease risk.

How It Works Minus iconIcon indicating subtraction, or that the element can be closed. Plus IconIcon indicating addition, or that the element can be opened. Arrow (down) icon.An arrow icon, usually indicating that the containing element can be opened and closed.

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.

Purported Uses Minus iconIcon indicating subtraction, or that the element can be closed. Plus IconIcon indicating addition, or that the element can be opened. Arrow (down) icon.An arrow icon, usually indicating that the containing element can be opened and closed.
  • Anxiety
    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.
  • Depression
    Many clinical trials have shown that MBSR can help reduce depression.
  • Fatigue
    Studies in breast cancer survivors show that MBSR practice decreases fatigue severity.
  • Insomnia
    Clinical data indicate that MBSR training helps relieve insomnia and improves sleep quality.
  • Lifestyle modification
    A few studies indicate that meditation may be helpful to stop smoking or reduce alcohol intake.
  • Mood disturbance
    MBSR practice helps improve mood disturbance in patients including those with cancer.
  • Pain
    A few studies indicate that MBSR is useful in relieving chronic pain.
Is It Safe Minus iconIcon indicating subtraction, or that the element can be closed. Plus IconIcon indicating addition, or that the element can be opened. Arrow (down) icon.An arrow icon, usually indicating that the containing element can be opened and closed.

Meditation is generally considered safe, although there are few cases of adverse effects reported. Both The Society of Integrative Oncology and The American Heart Association recommend meditation as a lifestyle tool.

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Practitioners who teach mindfulness-based stress reduction go through a certification process.

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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

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For Healthcare Professionals

Clinical Summary Minus iconIcon indicating subtraction, or that the element can be closed. Plus IconIcon indicating addition, or that the element can be opened. Arrow (down) icon.An arrow icon, usually indicating that the containing element can be opened and closed.

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. Lovingkindness 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. 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).

The most researched form of meditation is MBSR. It is 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).

Several randomized trials have employed MBSR in the oncology setting, with the majority involving breast cancer patients. These studies report decreased anxiety, depression, fear of recurrence, and fatigue (15) (17), as well as improved sleep quality (15) and reductions in long-term emotional and physical adverse effects associated with medical and endocrine treatments (16). In patients with mixed cancer diagnoses, MBSR improved distress, mood, stress, general well-being, and cancer-related cognitive impairment (13) (18). 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 lowers stress symptoms and positively affects 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 1 year (46).

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). 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).

Meditation has also shown utility in pediatric populations. 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).

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. The Society of Integrative Oncology (SIO) recommends meditation as part of a multidisciplinary approach to reduce stress, depression, fatigue, mood disturbance and to improve quality of life of cancer patients (24) (50). In addition, the American Heart Association recently added meditation to intervention guidelines to reduce heart disease risk (51).

Mechanism of Action Minus iconIcon indicating subtraction, or that the element can be closed. Plus IconIcon indicating addition, or that the element can be opened. Arrow (down) icon.An arrow icon, usually indicating that the containing element can be opened and closed.

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 that mindfulness or presence training increased cortical thickness in prefrontal regions; lovingkindness 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).

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). Mindful breathing was also shown to enhance “decentering” from internal experiences, and to reduce reactivity to repetitive thoughts (34).

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).

Adverse Reactions Minus iconIcon indicating subtraction, or that the element can be closed. Plus IconIcon indicating addition, or that the element can be opened. Arrow (down) icon.An arrow icon, usually indicating that the containing element can be opened and closed.

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).

Case Reports
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 Minus iconIcon indicating subtraction, or that the element can be closed. Plus IconIcon indicating addition, or that the element can be opened. Arrow (down) icon.An arrow icon, usually indicating that the containing element can be opened and closed.

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.

It is important to note that regular practice is essential for sustained benefits.

References Minus iconIcon indicating subtraction, or that the element can be closed. Plus IconIcon indicating addition, or that the element can be opened. Arrow (down) icon.An arrow icon, usually indicating that the containing element can be opened and closed.

  1. Wallace RK, Benson H, Wilson AF. A wakeful hypometabolic physiologic state. Am J Physiol. Sep 1971;221(3):795-799.

  2. Clarke TC BL, Stussman BJ, et al. Trends in the use of complementary health approaches among adults: United States, 2002-2012. Natl Health Stat Report. 2015 Feb 10;(79):1-16.

  3. Zeidan F, Vago DR. Mindfulness meditation-based pain relief: a mechanistic account. Ann N Y Acad Sci. Jun 2016;1373(1):114-127.

  4. Martires J, Zeidler M. The value of mindfulness meditation in the treatment of insomnia. Curr Opin Pulm Med. Nov 2015;21(6):547-552.

  5. Ong JC, Manber R, Segal Z, Xia Y, Shapiro S, Wyatt JK. A randomized controlled trial of mindfulness meditation for chronic insomnia. Sleep. Sep 2014;37(9):1553-1563.

  6. Parswani MJ, Sharma MP, Iyengar S. Mindfulness-based stress reduction program in coronary heart disease: A randomized control trial. Int J Yoga. Jul 2013;6(2):111-117.

  7. Zernicke KA, Campbell TS, Blustein PK, et al. Mindfulness-based stress reduction for the treatment of irritable bowel syndrome symptoms: a randomized wait-list controlled trial. Int J Behav Med. Sep 2013;20(3):385-396.

  8. Carmody JF, Crawford S, Salmoirago-Blotcher E, Leung K, Churchill L, Olendzki N. Mindfulness training for coping with hot flashes: results of a randomized trial. Menopause. Jun 2011;18(6):611-620.

  9. Davis JM, Fleming MF, Bonus KA, Baker TB. A pilot study on mindfulness based stress reduction for smokers. BMC Complement Altern Med. 2007;7:2.

  10. Milbury K, Chaoul A, Biegler K, et al. Tibetan sound meditation for cognitive dysfunction: results of a randomized controlled pilot trial. Psychooncology. Oct 2013;22(10):2354-2363.

  11. Kanitz JL, Camus ME, Seifert G. Keeping the balance—an overview of mind-body therapies in pediatric oncology. Complement Ther Med. Apr 2013;21 Suppl 1:S20-25.

  12. Greenlee H, Balneaves LG, Carlson LE, et al. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr. Nov 2014;2014(50):346-358.

  13. Tang YY, Holzel BK, Posner MI. The neuroscience of mindfulness meditation. Nat Rev Neurosci. Apr 2015;16(4):213-225.

  14. Gotink RA, Meijboom R, Vernooij MW, Smits M, Hunink MG. 8-week Mindfulness Based Stress Reduction induces brain changes similar to traditional long-term meditation practice - A systematic review. Brain Cogn. Jul 15 2016;108:32-41.

  15. Tang YY, Tang R, Posner MI. Mindfulness meditation improves emotion regulation and reduces drug abuse. Drug Alcohol Depend. Jun 1 2016;163 Suppl 1:S13-18.

  16. Zeidan F, Martucci KT, Kraft RA, Gordon NS, McHaffie JG, Coghill RC. Brain mechanisms supporting the modulation of pain by mindfulness meditation. J Neurosci. Apr 6 2011;31(14):5540-5548.

  17. Holzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective. Perspect Psychol Sci. Nov 2011;6(6):537-559.

  18. Holzel BK, Hoge EA, Greve DN, et al. Neural mechanisms of symptom improvements in generalized anxiety disorder following mindfulness training. Neuroimage Clin. 2013;2:448-458.

  19. Gao J, Fan J, Wu BW, et al. Entrainment of chaotic activities in brain and heart during MBSR mindfulness training. Neurosci Lett. Mar 11 2016;616:218-223.

  20. Lengacher CA, Reich RR, Kip KE, et al. Influence of mindfulness-based stress reduction (MBSR) on telomerase activity in women with breast cancer (BC). Biol Res Nurs. Oct 2014;16(4):438-447.

  21. Kuijpers HJ, van der Heijden FM, Tuinier S, Verhoeven WM. Meditation-induced psychosis. Psychopathology. 2007;40(6):461-464.

  22. Chan-Ob T, Boonyanaruthee V. Meditation in association with psychosis. J Med Assoc Thai. Sep 1999;82(9):925-930.

  23. Hwang WC. Qi-gong psychotic reaction in a Chinese American woman. Cult Med Psychiatry. Dec 2007;31(4):547-560.

  24. Xu SH. Psychophysiological reactions associated with qigong therapy. Chin Med J (Engl). Mar 1994;107(3):230-233.

  25. St Louis EK, Lansky EP. Meditation and epilepsy: a still hung jury. Med Hypotheses. 2006;67(2):247-250.

  26. Valk SL, Bernhardt BC, Trautwein FM, et al. Structural plasticity of the social brain: Differential change after socio-affective and cognitive mental training. Sci Adv. Oct 2017;3(10):e1700489.

  27. Boxleitner G, Jolie S, Shaffer D, et al. Comparison of Two Types of Meditation on Patients’ Psychosocial Responses During Radiation Therapy for Head and Neck Cancer. J Altern Complement Med. May 2017;23(5):355-361.

  28. Greenlee H, DuPont-Reyes MJ, Balneaves LG, et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin. May 06 2017;67(3):194-232.

  29. Levine GN, Lange RA, Bairey-Merz CN, et al. Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association. J Am Heart Assoc. Sep 28 2017;6(10).

  30. Cebolla A, Demarzo M, Martins P, et al. Unwanted effects: Is there a negative side of meditation? A multicentre survey. PLoS One. 2017;12(9):e0183137.

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