By Sara Davin, PsyD, MPH
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In the last two decades, references to mindfulness-based treatments have proliferated. Its benefits are touted for many medical conditions and seem to be universally accepted as a technique to improve mental health across diverse populations. Mindfulness could be a powerful tool for not only our patients, but also medical providers.
However, what truly is the science behind mindfulness and the evidence base supporting its use? Evidence-based practice is the goal standard for us all, so let’s take a look at what we know at this point:
Evidence supporting benefits of mindfulness
Brain/immune health: Mindfulness can make a real impact on the brain. Meditators show increases in left-sided anterior activation (a pattern associated with positive affect) and changes in grey matter concentration within the left hippocampus. Additionally, research supports improvements in neural processing related to attentional core processes with as little as 10 to 15 minutes of mindfulness-based meditation a day. Mindfulness-based meditation may also impact our immune system. Individuals completing mindfulness-based training programs show reductions in inflammatory cytokines’ AUC concentration.
Mental health: Optimization of mental health not only impacts one’s sense of emotional well-being, but moderates most to all medical outcomes. Mindfulness may be a tool to enhance emotional health and reduce stress. A systematic review of more than 20 randomized controlled trials in 2011 successfully demonstrated improvements in overall mental health, as well as its benefit for reducing risk of relapse from depression. Similarly, substantial evidence exists that mindfulness has a positive impact on anxiety disorders such as post-traumatic stress disorder.
Chronic pain: Chronic pain has been named a major public health problem, independently from (as well as directly related to) the opioid crisis. Alternative tools are needed to manage pain. Mindfulness-based approaches demonstrate a positive impact. Specifically, meditators show decreased pain and functional pain-related limitations with benefits being comparable with those from cognitive behavioral therapy, lasting up to one year.
Sleep: Poor sleep and sleep disorders are linked to a plethora of negative medical and psychiatric outcomes. Mindfulness-based interventions offer promise. Randomized, controlled trials have demonstrated a reduction in total wake time and decreases on the Insomnia Severity Index, a tool commonly used to assess for insomnia.
Healthcare providers: We can only care for others as well as we care for ourselves. There is a significant literature on burnout and stress among healthcare providers. We all know that uncontrolled stress will lead us to be less effective caregivers and employees. It is reassuring to know that RCT trials demonstrate that brief mindfulness practice results in positive changes in levels of stress, anxiety, mindfulness, resiliency and burnout symptoms among healthcare providers. Such interventions may also successfully used in medical and pre-med students, with research finding less depression and anxiety and increased empathy with mindfulness training.
How does it work exactly?
The theory behind mindfulness connects its practice to an enhanced ability to self-regulate cognitive, emotional and behavioral responses. It is postulated that self-awareness (arising from increased attention to the moment-to-moment experience) and acceptance of experiences play a crucial role in self-regulation. Extinction and reappraisal are postulated to play a significant role in emotion regulation. The model by Perry-Parrish et al. is a useful representation of the potential changes associated with mindfulness and how improved coping and psychological functioning enhances self-regulation.
Neural Mechanisms: Evidence suggests that mindfulness practice is associated with neuroplastic changes in the anterior cingulate cortex, insula, temporo-parietal junction, fronto-limbic network and default mode network structures. This is what allows for improved self-regulation, as described above.
Science supports practice – patients and providers
The evidence for the benefits of mindfulness for patients and providers (yes, us too) is accumulating and promising.
Certainly, studies can always be better (i.e. better methodology, longitudinal study, etc). So as consumers and/or advocates of mindfulness, we must continue to remain abreast of the literature. Take home point: The evidence base for mindfulness-based treatments among a number of health conditions, populations and intensities is something at least worth trying. The risks are minimal, the science base is decent and all the evidence points to positive impacts such as being less reactive, less stressed and feeling better overall.
Certainly we could all benefit from that.
Sara Davin, PsyD, MPH, is a pain psychologist and Director of Behavioral Medicine for the Back on Trek Program within the Neurological Institute. Dr. Davin integrates mindfulness-based therapies into her treatment of persons with chronic pain and has personally practiced mindfulness-based meditation for the past eight years.
- Davidson, R. J. et al (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosom. Med. 65, 564–570.
- Hölzel BK, Carmody J, Vangel M, Congleton C, Yerramsetti SM, Gard T, Lazar SW. Mindfulness practice leads to increases in regional brain gray matter density.Psychiatry Res. 2011 Jan 30;191(1):36-43. doi: 10.1016/j.pscychresns.2010.08.006.
- Moore A, Gruber T, Derose J, Malinowski P. Regular, brief mindfulness meditation practice improves electrophysiological markers of attentional control.Front Hum Neurosci. 2012 Feb 10;6:18. doi: 10.3389/fnhum.2012.00018.
- Hoge EA, Bui E, Palitz SA, Schwarz NR, Owens ME, Johnston JM, Pollack MH, Simon NM. The effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder. Psychiatry Res. 2017 Jan 25
- Fjorback LO, Arendt M, Ornbøl E, Fink P, Walach H. Mindfulness-based stress reduction and mindfulness-based cognitive therapy: a systematic review of randomized controlled trials. Acta Psychiatr Scand. 2011 Aug;124(2):102-19.
- Hilton L, Maher AR, Colaiaco B, Apaydin E, Sorbero ME, Booth M, Shanman RM, Hempel S. Meditation for posttraumatic stress: Systematic review and meta-analysis. Psychol Trauma. 2017 Jul;9(4):453-460.
- Schütze R, Rees C, Preece M, Schütze M. Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain. Pain. 2010 Jan;148(1):120-7. doi: 10.1016/j.pain.2009.10.030.
- Cherkin DC, Sherman KJ, Balderson BH, Cook AJ, Anderson ML, Hawkes RJ, Hansen KE, Turner JA. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA. 2016 Mar 22-29;315(12):1240-9. doi: 10.1001/jama.2016.2323.
- Cherkin DC, Anderson ML, Sherman KJ, Balderson BH, Cook AJ, Hansen KE, Turner JA. Two-Year Follow-up of a Randomized Clinical Trial of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care for Chronic Low Back Pain. JAMA. 2017 Feb 14;317(6):642-644.
- Ong JC, Manber R, Segal Z, Xia Y, Shapiro S, Wyatt JK. A randomized controlled trial of mindfulness meditation for chronic insomnia. Sleep. 2014 Sep 1;37(9):1553-63. doi: 10.5665/sleep.4010.
- Gilmartin H, Goyal A, Hamati MC, Mann J, Saint S, Chopra V. Brief Mindfulness Practices for Healthcare Providers – a Systematic Literature Review. Am J Med. 2017 Jul 4.
- Shapiro SL, Schwartz GE, Bonner G. Effects of mindfulness-based stressreduction on medical and premedical students. J Behav Med. 1998 Dec;21(6):581-99.
- Goodman MJ, Schorling JB. A mindfulness course decreases burnout and improves well-being among healthcare providers. Int J Psychiatry Med. 2012;43(2):119-28.
- Hölzel 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. 2011 Nov;6(6):537-59.
- Perry-Parrish et al. Mindfulness-Based Approaches for Children and Youth. Curr Probl Pediatr Adolesc Health Care. 2016. Jun;46(6):172-8.