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Meditation refers to a wide variety of techniques of directing one’s thoughts to calm the mind, induce relaxation in the body, access spiritual states, and promote overall mind-body-spirit integration. History The roots of meditation are traced to the world’s religious and spiritual traditions, which, for thousands of years, have taught diverse meditation practices for gaining a pathway to the spiritual dimension of life. Christian, Jewish, and Muslim teachings, in addition to those of Buddhism and Hinduism, all include guidelines for entering into what could be regarded as a contemplative state of consciousness, often in association with prayer. Beyond meditation’s historical identity as a form of spiritual practice, its medical benefits have been fully recognized and embraced for over 5,000 years in the Indian health care tradition known as Ayurveda. The original goal of Ayurveda, which also employs herbal medicine, dietary therapy and massage, was to keep the body healthy so that the person could pursue the spiritual path. Meditation plays an integral role in Ayurveda for its practical benefits, as well: to balance the body’s energy system, relieve stress, and promote healing. Today, western teachers and practitioners of Ayurveda often reduce the emphasis on the spiritual aspect of Ayurveda, choosing instead to regard it mainly as a form of alternative medicine. Meditation has recently been "re-discovered" by modern science as a subtle but powerful means of promoting healing in the body. This renewal of interest has come from the work of researchers exploring the effects of Transcendental Meditation (TM) and traditional Buddhist approaches to meditation. TM, which was introduced to the West by the Indian mystic Maharishi Mahesh Yogi, was the focus of research in the 1960s and 1970s by Herbert Benson, MD, and his colleagues at Harvard Medical School. In these studies, Dr. Benson discovered the "relaxation response," a physiological state now known to promote healing in the body. A traditional Buddhist approach called "mindfulness" was the basis of research by Jon Kabat-Zinn, PhD, at the University of Massachusetts Medical School in the 1970s and 1980s. Kabat-Zinn coined the term "mindfulness-based stress reduction" to describe his group training programs, which have been found beneficial for people with a variety of medical conditions. TM and mindfulness are two major meditation approaches that are incorporated today in many complementary medicine programs for people with a wide range of health conditions, including cancer, HIV, chronic fatigue syndrome, heart disease, chronic pain and others. There are, of course, other varieties of meditation, but all approaches generally have a great deal in common. Key Principles The two basic elements of meditation are: placing the body in a comfortable, upright position; and bringing one’s attention to a certain focus for a prescribed length of time, such as 15 to 30 minutes. The mind may be focused in a number of ways. For example, this may be accomplished by placing one’s full concentration simply on the rise and fall of each breath. It may involve directing the attention to consider each part of the body in a certain orderly sequence ("body scan"), a technique similar to what is used in progressive muscle relaxation exercises. Or, it may involve focusing on the repetition of a word ("peace"), a sound ("om"), a phrase ("God is love"), or a prayer. It is the experience of having a strong mental focus, rather than the details of that focus, that seems to be necessary in order for meditation to have its medical advantages. The key medical benefit is that meditation induces the relaxation response. This is a physiological state that includes decreased blood pressure, respiratory rate, heart rate, oxygen consumption (burning of fuel), blood flow to skeletal muscles and away from the extremities, perspiration, and muscle tension, while encouraging increases in immune functioning. The relaxation response is the opposite of the stress response, and research has found it to promote healing in a variety of ways. Research The greatest number of studies of meditation have examined the effects of TM. This approach has been shown to significantly reduce hypertension(1) and reduce the need for medical services. For example, one study found that TM practitioners had 55 percent fewer visits to a physician’s office or medical center for benign or malignant tumors, 87 percent fewer visits for heart disease, and 30 percent fewer visits for infectious diseases. The study further showed there were 31 percent fewer visits for psychological disorders, and 87 percent fewer visits for diseases of the nervous system(2). A hallmark study showing the benefits of the mindfulness approach involved 90 patients with chronic pain who were given a 10-week group program teaching them how to use mindfulness-based stress reduction for pain occurring in: low back, neck, shoulder, arm, leg, facial, multiple sites, abdomen and chest. The same study also included patients with pain from peripheral nerve disorders, and migraine and tension headaches. There were significant improvements in pain levels, body image, pain-related activity, symptoms, mood, anxiety and depression levels; less use of pain medication; and increases in activity levels and feelings of self-esteem(3). Other studies have shown reduced symptoms in fibromyalgia(4) and improvement in chronic fatigue syndrome(5). What Are the Potential Uses of Meditation? Meditation can be of benefit for many medical conditions, but particularly in chronic and stress-related conditions. Meditation is a natural antidote to the effects of stress, which exacerbates symptoms of many illnesses. Meditation also offers some very specific and effective methods for coping with chronic pain. Even if the pain levels themselves cannot be reduced, the person’s experience and tolerance of the pain can be changed through meditation, which results in less emotional distress and greater quality of life. The strongest areas of research supporting the use of meditation are in cardiovascular diseases such as hypertension and heart disease, and immune-related disorders, which tend to be very sensitive to the effects of stress. Conditions that may benefit from meditation include: Allergy Anxiety Arthritis Asthma Cardiac arrhythmia Chronic fatigue syndrome Chronic pain conditions Depression Diabetes Fibromyalgia Gastrointestinal disorders HIV/AIDS Heart disease Hypertension Stress-related conditions Who Teaches Meditation and What is Their Training? There is no formal licensing required for teachers of meditation, but there are training programs which issue their own credentials. Many practitioners in the health disciplines have had training or experience in meditation and can offer guidance in its practice. Since meditation is not particularly complicated or difficult, it is widely accessible to all. If you are considering taking a complementary medicine program that includes meditation, you should inquire about the health professional or leader’s training, experience and background. Two of the better-known professional training programs are the Mindfulness-Based Stress Reduction program at the University of Massachusetts Medical Center, and the Clinical Training in Behavioral Medicine program at Harvard’s Mind/Body Medical Institute, but there are many others. Finally, a meditation teacher need not be licensed or certified in a health discipline to be an excellent teacher. There are many meditation centers and instructors that are not associated with the health field per se, but can offer knowledge from the experience of many years of personal practice and study with advanced teachers of meditation. Is Meditation Safe? Adverse Effects Meditation is completely safe, with few clear adverse effects. Some stiffness may occur from sitting without moving for a long period of time, but this is easily avoided by adjusting your posture for physical comfort whenever needed. Sometimes powerful emotions that have been suppressed or repressed may arise, but this experience, which may be initially overwhelming, can be a source of greater self-awareness that is beneficial in the long run. Contraindications Meditation is contraindicated in cases of serious mental illness. What to Expect in a Meditation Program Most meditation courses take the form of group classes, and instruction is usually quite straightforward. Basic guidelines are offered for maintaining one’s mental focus, followed by a practice session. There may then be a feedback and discussion period in which to reflect on one’s experience of the meditation process. If the meditation training is in a formal health care milieu, there may be other forms of group support or health education. Or, if the meditation takes place within the context of a certain spiritual or religious tradition, there may also be teachings about spiritual principles. Most people find that meditation is easier when practiced as part of a group. You may find that the sense of being connected socially and having the support of the group make it easier to maintain your concentration, and also to maintain a regular schedule of daily practice at home between group meetings. The two greatest challenges in meditation are directing and holding one’s concentration during the meditation, and maintaining a regular daily practice. Many people become discouraged when they try meditation and find that they can not concentrate, and that their mind wanders uncontrollably. It is natural and normal for the mind to wander, and it is only a problem if you mistakenly judge and criticize yourself for this, or think that you are not meditating properly. The basic instruction for meditation is to maintain a dispassionate, non-judgmental attitude toward your inner process, and gently return to the focus whenever you notice your mind has wandered. It is helpful to maintain a daily practice of meditation because it takes time for the medical benefits to accrue. The body learns to "settle" into a deeper state of relaxation only with practice. This is why it can be quite helpful to have the support of a group, friends, or family members. William Collinge, PhD, MPH Notes 1. Benson, H. Systemic hypertension and the relaxation response. New England Journal of Medicine, 1977, 296, pp. 1152-6. 2. Orme-Johnson, D. Medical care utilization and the Transcendental Meditation program. Psychosomatic Medicine, 1987, 49:493-507. 3. Kabat-Zinn J; Lipworth L; Burney RJ. The clinical use of mindfulness meditation for the self-regulation of chronic pain. Behavioral Medicine, 8(2):163-90 1985 Jun 4. Kaplan KH; Goldenberg DL; Galvin-Nadeau M. The impact of a meditation-based stress reduction program on fibromyalgia. General Hospital Psychiatry, 15(5):284-9 1993 Sept 5. Collinge W; Raskin E; Yarnold P. Functional status and behavioral medicine practice predicts 12-month improvement in chronic fatigue syndrome. Proceedings: American Association for Chronic Fatigue Syndrome Research Conference, October 1996, p. 92

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