For Patients & Caregivers

What Is It

Meditation has been practiced for thousands of years in many traditions around the world. It is used to increase calmness and to improve overall well-being by intentional training of the mind in awareness and attention. There are several types of meditation that include mantra or mantram meditation, which involves repeating words with phonetic significance; mindfulness meditation, in which participants pay attention or continually return to the present moment; and tai chi and qigong, movement meditative practices that are components of traditional Chinese medicine. The majority of practices involve focused attention, regulated breathing, and developing a non-judgmental awareness of one’s thoughts and feelings with the goals of achieving inner calmness, physical relaxation, psychological balance and improved vitality and coping.

The Society of Integrative Oncology (SIO) recommends meditation as part of a multidisciplinary approach to reduce stress, depression, fatigue, mood disturbance and to improve the quality of life of cancer patients.

How It Works

The most researched form of meditation is a practice known as mindfulness-based stress reduction (MBSR). It is typically offered as an 8-week program with a focus on practices including 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. Clinical trials show that it helps in managing chronic pain, insomnia, stress, depression and anxiety associated with vascular disease, coronary heart disease, diabetes and with irritable bowel syndrome, and in reducing distress associated with hot flashes in perimenopausal women. In patients with AIDS, MBSR helped improve psychological functioning, coping with adverse effects and stabilizing immune cell count.

Participation in an MBSR program decreased distress, stress, improved mood and general well-being in patients with mixed cancer diagnoses. Studies of breast cancer patients showed reductions in anxiety and depression, along with improvements in sleep quality and decrease in the long-term emotional and physical adverse effects associated with medical and endocrine treatments. MBSR also reduced anxiety, fear of recurrence and fatigue severity in breast cancer survivors. In addition, it improved cancer-related cognitive impairment in breast and colorectal cancer patients. Another study of breast cancer patients with chemotherapy-induced cognitive impairment showed that Tibetan Sound Meditation (TSM), which uses sound to promote healing, improved short-term memory, cognitive function and mental health. A modification of MBSR known as Mindfulness Based Cancer Recovery (MBCR) that involves mindfulness meditation and gentle yoga was recently shown to decrease symptoms of stress and positively affect the quality of life in breast cancer survivors. MBCR offered online also showed significant improvements in mood disturbance, stress symptoms and mindful awareness. 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 coping with illness in pediatric cancer patients.

Purported Uses

  • Anxiety
    Several studies show that MBSR 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.
  • Mood disturbance
    MBSR practice has been shown to help improve mood disturbance in patients including those with cancer.
  • Pain
    A few studies indicate that MBSR is useful in alleviating chronic pain.

Is It Safe

Meditation is generally considered safe with a few exceptions.

Case Reports

  • Psychosis: Following meditation and qigong practice, but some of the events occurred along with other issues including sleep loss, drug withdrawal, or pre-existing psychotic disorders.
  • Acute psychosis: In patients with schizophrenia after intensive meditation.
  • Qigong deviation syndrome: In patients following inappropriate qigong training.
  • Epilepsy: In a young woman after meditation.

Who Can Provide this Service

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

Where Can I Get Treatment

Meditation classes are offered in communities, at hospitals or at universities. Cancer centers across the country also offer programs that are led by experienced teachers. It is important to note that regular meditation practice is essential for continued benefits.

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For Healthcare Professionals

Clinical Summary

Practiced for millennia in many traditions around the world, meditation is used to increase calmness and to improve overall well-being by intentional training of the mind in awareness and attention. It is defined as “a wakeful hypo-metabolic physiologic state” (1) in which the practitioner is relaxed but focused and alert. According to the 2012 National Health Interview Survey, nearly 18 million adults and 927,000 children practiced meditation (2).

There are several variants of meditation which include mantra or mantram meditation, which involves the repetition of words with phonetic significance; mindfulness meditation, in which participants pay attention or continually return to the present moment; and tai chi and qigong, movement meditative practices that are components of traditional Chinese medicine. The majority of practices involve focused attention, regulated breathing, and developing a non-judgmental awareness of one’s thoughts and feelings with the goals of achieving inner calmness, physical relaxation, psychological balance and improved vitality and coping.

The role of meditation in health care has been the subject of many scientific investigations over the past three decades. The most researched form of meditation is a practice known as mindfulness-based stress reduction (MBSR). It is typically offered as an 8-week program with a focus on practices including 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), irritable bowel syndrome (9), and in reducing distress associated with hot flashes in perimenopausal women (10). Preliminary data also suggest an association between MBSR compliance and smoking cessation (11). In patients with AIDS, MBSR helped improve psychological functioning, coping with adverse effects, and stability of CD-4 T-cell counts (12).

Several randomized trials have employed MBSR in the oncology setting, with the majority of studies involving breast cancer patients. Participation in an MBSR program resulted in reductions in distress, improved mood and stress, and general well-being in patients with mixed cancer diagnoses (13). Improved psychological functioning and mindfulness were also reported in partners of cancer patients following MBSR training (14). Studies of breast cancer patients reported significant lowering of anxiety and depression, along with improvements in sleep quality (15) and decrease in the long-term emotional and physical adverse effects associated with medical and endocrine treatments (16). MBSR also reduced anxiety, fear of recurrence as well as the physical symptoms of fatigue severity and fatigue interference in breast cancer survivors (17). In addition, a small study of breast and colorectal cancer patients reported that MBSR practice resulted in robust and sustained improvements in cancer-related cognitive impairment (18). Another study involving breast cancer patients with chemotherapy-induced cognitive impairment showed that Tibetan Sound Meditation (TSM), which uses sound to promote healing, improved short-term memory, cognitive function and mental health (19).

A modification of MBSR known as Mindfulness Based Cancer Recovery (MBCR) that involves mindfulness meditation and gentle yoga has recently been used in breast cancer survivors. A controlled trial showed that MBCR lowers symptoms of stress and positively affects the quality of life (20). The effectiveness of offering MBCR online was also explored in a small RCT which revealed significant improvements in mood disturbance, stress symptoms and mindful awareness (21). A few studies have evaluated meditation in pediatric populations as well. Guided mantram meditation was shown to produce relief from acute pain in children with neuroblastoma undergoing anti-GD2 monoclonal antibody therapy (22). A review of mind-body therapy studies including MBSR in pediatric oncology revealed greater self-confidence and optimism in coping with illness (23).

Accumulating evidence suggests that meditation as an adjunct therapy can improve both physical and psychological parameters associated with many diseases including cancer. However, a major limitation of meditation research is low quality of methodology. Future trials are needed with stronger study design and larger sample sizes, and should include patients with all cancer types as most trials thus far have focused on breast cancer.

Meditation is a safe practice and can be learned in classes offered in the community, at hospitals or at universities. 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).

Mechanism of Action

The mechanisms underlying the beneficial effects of mindfulness meditation have not been fully elucidated. But emerging evidence indicates that it may affect changes in the structural and functional aspects of brain that are involved in regulating attention, emotion and self-awareness (25). Over the past few years, neuroimaging techniques have helped further the understanding of neuroplasticity of the brain, and of individual brain regions involved in meditation.

Traditional long-term practices such as Zen and Tibetan meditation have been shown to be associated with structural and functional differences in various regions including the prefrontal cortex, the sensory cortices and insula, the hippocampus and the cingulate cortex, which play important roles in regulating emotion and controlling response (26) (27). A new study has reported that mindfulness meditation also elicits similar brain responses (28). Meditation was shown to improve self-control abilities in emotion regulation and stress reduction in smokers. These changes were associated with increased activity in anterior cingulate cortex (ACC), adjacent prefrontal cortex (mPFC) and other brain areas (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 the activity of nuclear factor-kappa B, transcription factor that is a precursor to increases in pro-inflammatory cytokines, and circulating levels of C-reactive protein, which also promotes pro-inflammatory effects (37).

Adverse Reactions

Meditation is generally considered safe and effective, and few side effects have been reported.

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

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. 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


  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.

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