Category Archives: mindfulness

Meditation for Happiness, Stress, Anxiety, Addiction, and Depression

img_3231

The Dalai Lama’s Advice

By 
WebMD Feature
Reviewed by Louise Chang, MD

Have your job, your mortgage — your life — pushed you into depression? The Dalai Lama can help.

The ancient practices of Tibetan Buddhism — meditation, mindfulness, empathy, and compassion — are offering world-weary Americans a better perspective on life and its hardships.

By feeling compassion for others — seeing even our enemies in a new light — we can ease our own stress and anxiety, the Dalai Lama told a crowd of thousands, gathered for his visit to Atlanta in October 2007. Through “inner disarmament” — reducing anger, hatred, and jealousy — we create a path to our own happiness and world peace, he said.

The Dalai Lama has long shown the world that, even in adversity, inner peace is possible. In his many books, he has taught us The Power of CompassionThe Power of Patience, and The Art of Happiness. As the spiritual leader of Tibet, he has toured the world, inspiring multitudes to embrace this philosophy of compassion.

He has also inspired leading scientists at Emory University and elsewhere to study traditional Tibetan Buddhist practices and ethics, researching them as a treatment for depression.

Much of our inner turmoil is due to negative feelings like fear and anger, the Dalai Lama said during his Atlanta visit. “Those emotions that disturb our peaceful mind must be eliminated. In times of great distress, our best friend is inside the heart … it is our compassion.”

A compassionate attitude sustains one’s good health, whereas feelings of anger, hate, and fear can hurt the immune system, he said. Trust develops between people when there is evidence of genuine concern and warm-heartedness. Good creates more good — even if it comes slowly.

Cultivating Compassion as Depression Therapy

In developing compassion and inner peace, daily meditation is key, explains Geshe Lobsang Tenzin Negri, PhD, a senior lecturer and director of the Emory-Tibetan Partnership.

During meditation, one becomes mindful of one’s thoughts and feelings, he tells WebMD. “Meditation is a moment-by-moment awareness of your thoughts. Then, we work to change those negative feelings — to view other people and their actions differently.”

It is a human tendency to react to certain thoughts and feelings in a preconditioned way, says Geshe Lobsang. “We all have aversions and cravings, likes and dislikes. If a thought of a person comes up, we tend to immediately react based on whether we like or dislike them. That sets up a chain reaction about what’s wrong with that person.”

That cycle of preconditioned reactions is what we seek to change. “When people cause us difficulty, we can learn to see that they have difficulties in their own lives — and that they act from ignorance or weakness,” he says. “It’s not about condoning injustice. What’s wrong is wrong. But we can see them as our spiritual teachers, teaching us lessons like patience.”

We can also look for “unintentional kindness” from people who help us survive — providing the food we eat, the clothes we wear, etc., he explains. “We need to see beyond the superficial relationships to connect at a deeper level, where we all share the same aspirations.” The world begins to feel less harsh, more nurturing.

“The challenge is to develop a deep sense of empathy for all people we interact with — whether they are friends, people who give us difficulty, or people who are neutral to us,” says Geshe Lobsang. “It’s all about recognizing that they, too, have misfortunes and difficulties in their daily lives — and that all beings want to be free of these difficulties, for their own happiness.”

Through these practices, we can develop a real sense of connectedness with other beings, which is the source of empathy, compassion — and, ultimately, our happiness. “That’s how Martin Luther King Jr., Gandhi, and the Dalai Lama can feel compassion for their enemies,” he says.

You’ll notice the spillover effect into your daily life, Geshe Lobsang adds. “When certain thoughts arise that might disturb you, you are able to notice them so you don’t get stuck with them. You move on with the job at hand.”

Meditation in Depression Therapy

Regularly meditating on compassion can also help preventdepression by reducing a person’s emotional and physical reaction to stress in his or her daily life, says Charles L. Raison, MD, a psychiatry professor and co-director of Emory’s Collaborative for Contemplative Studies.

“We look at compassion meditation as a protective strategy, sort of like exercise,” he tells WebMD.

Over the past three decades, research has shown that meditation produces a relaxation response that helps decrease metabolism, lowers blood pressure, and improves heart rate, breathing, and brain waves. As the body receives a quiet message to relax, tension and tightness seep from muscles.

Inner peace is a gift — nurtured through meditation, empathy, and compassion.

Meditation has gained millions of converts, helping them ease anxiety, stress, and chronic pain, improve heart health, boost mood and immunity, and resolve pregnancy problems.

By learning the Tibetan practice of “mindfulness meditation,” it is possible to break the cycle of negative thinking that feeds depression, says John D. Dunne, PhD, co-director of Emory’s Contemplative Practices and Studies programs.

“Negative thoughts are very real to depressed people,” says Dunne. “They interpret their own actions in a very negative way … have a very negative sense of self. They hold onto these thoughts very, very strongly.”

Because a depressed person is so self-focused, it’s difficult to convince them that their negative thoughts are not reality, he adds. “The goal of mindfulness meditation and compassion is to end this self-focus, this negative tone.”

Learning to Be Compassionate

A secularized version of the practice called compassion training is a step-by-step method for developing compassion. It is being used in Emory’s research studies to examine the health benefits of meditation and compassion, says Geshe Lobsang.

At its essence, compassion requires that we develop a sense of connectedness to others, which will give us empathy for them, he explains. “If we are genuinely able to feel empathy for others, then compassion is the natural outcome.”

In compassion training, students focus on developing that sense of deep connection with all beings, he says. “We develop a way of seeing how others are kind to us, even if it’s unintentional kindness. Whether they intended to be kind to us or not, we can choose to perceive it as kindness.”

Compassion Training Transforms the Mind

Using MRI brain scans, scientists have begun tracking the effects of compassion training.

“We are finding that we can transform the brain by changing the mind,” says Richard J. Davidson, PhD, director of the Laboratory for Affective Neuroscience and the Keck Laboratory for Functional Brain Imaging and Behavior at the University of Wisconsin at Madison. The brain region related to compassion, the insula, “is quite special,” he explains. “It is the only brain area that monitors the body and provides the brain with information on what is going on in the body. It sends signals to the body that might change during emotional distress.”

Compassion training can generate a state in which loving and compassion envelops the whole brain, he says. When people meditate on compassion, the signals to the insula and other brain regions involved in empathy and understanding are changed. The change is more dramatic among advanced practitioners, compared with novice practitioners, he adds.

His studies have shown that with even a little compassion training, people can reap a physical benefit.

Volunteers who received compassion training online — and practiced it for 30 minutes a day for two weeks — showed significantly greater propensity to want to help people who were suffering. They also reported a higher level of well-being, confidence, and positive feelings. MRI brain scans of these volunteers showed greater activation in the insula, Davidson reports.

Raison has studied the effects of compassion training in Emory freshmen — examining the body’s stress response system, specifically inflammation that links stress with depression. These same inflammatory processes are risk factors for other diseases including heart diseasestrokediabetescancer, and Alzheimer’s disease.

In one of his studies, freshmen who got six weeks of compassion training had less physiological stress response in a test — heart rates, blood pressure, stress hormone levels, and other stress-related markers — compared with students who participated in a discussion group instead.

Not only that, students in the “compassion group” who actually practiced the meditation — rather than just taking the training classes — fared the best in the stress test. They had the least stress reaction, he reports.

“They came in the door a little different than the other kids who didn’t practice it,” Raison says. “These types of meditations help people reduce their reaction to stress.”

Meditation: No Magic Depression Treatment

While meditation can help many who are depressed, it’s not a sure-fire cure, Raison tells WebMD. “In fact, many people with mood disordersfind they can’t do meditation when they’re depressed.” Their thoughts are too overwhelming. They are anxious, nervous, and can’t sit — and likely they need antidepressants, he says.

“For people who are seriously depressed — or whose depression involves too much internal focus and rumination — meditation can make their depression worse,” he tells WebMD. “Early on, they begin to realize things about themselves they are uncomfortable with.”

Meditation provides true insight into why we behave as we do, Raison says. “There can be a shocking realization when you start watching your thoughts. You see the junk that’s in there, and it can be very distressing. Every individual case is different. With depression, which can be so disabling and overwhelming, we need to use wisely all treatment modalities to give people the best outcomes.”

Practice Meditating:

A Few Things That Therapy May Do Better Than Medication, According To Science

960x0

By: Alice G. Walton on Forbes.com

In the last couple of weeks, there have been some big announcements from the medical and mental health communities about the wisdom of using drugs over behavioral methods for various disorders. The meds vs. therapy debate has been an active one for a number of years. But these days, some experts and organizations are questioning, more and more, whether popping pills should really be our go-to treatment, based on the literature. And it seems that for some that have historically used meds as the first line of treatment, the evidence for behavioral methods has mounted to the point where recommendations have shifted in their favor. At least for some things.

“Considering behavioral interventions (therapy) prior to medication is a long-overdue recommendation,” says psychologist Shannon Kolakowski, and author of the book When Depression Hurts Your Relationship. “I am thrilled to see this progress, as it reflects what I see in my daily practice. People make tremendous strides with therapy alone. Having therapy be officially recommended as a first line of treatment reduces the stigma about therapy and adds validity to an already established, vetted treatment.”

And research is, as it should be, what’s driving the trend. Studies are making more rigorous comparisons between methods, and learning more about how to determine various measures, like the benefit vs. risk ratio and relapse rate, of each one.

“Over the past two decades, the field of psychology has become a more rigorously tested science, with treatment outcomes measured and reproduced, and therapy guidelines have followed,” says Kolakowski. “This has led to effective, evidence-based treatment people receive in therapy sessions. The changing recommendations are a reflection of how effective therapy is for a host of behavioral and emotional problems.”

Here are a few things for which recent research has prompted changes in go-to treatments.

Behavioral Interventions for ADHD/ADD in Kids

There’s been a big backlash in recent years regarding the advisability of prescribing stimulants like Ritalin and Adderall for children, especially very young ones. The numbers of kids with ADHD have risen markedly in recent years, with many questioning whether this is a true rise in incidence, or it’s a result of diagnosis-eager physicians or even shortcomings in our education system. In any case, the CDC has just released a new recommendation that behavior therapy, rather than medication, should be the first line of treatment for children with ADHD.

“Parents may feel overwhelmed with decisions about their child’s treatment for ADHD, but healthcare providers, therapists and families can all work together to help the child thrive,” said Anne Schuchat, Principal Deputy Director, CDC. “Parents of young children with ADHD may need support, and behavior therapy is an important first step. It has been shown to be as effective as medicine, but without the risk of side effects. We are still learning about the potential unintended effects of long-term use of ADHD medicine on young children. Until we know more, the recommendation is to first refer parents of children under 6 years of age with ADHD for training in behavior therapy before prescribing medicine.”

Cognitive Behavior Therapy for Insomnia

As of this week, the American College of Physicians believes that for insomnia, cognitive behavior therapy for insomnia (CBT-I) should be the first line of treatment, rather than meds, since it has better scientific evidence behind it. And meds can come with all sorts of negative side effects. As per the new recommendations, CBT-I should be used first as a matter of course.

“Cognitive behavioral therapy for insomnia is an effective treatment and can be initiated in a primary care setting,” said ACP President Wayne J. Riley. “Although we have insufficient evidence to directly compare CBT-I and drug treatment, CBT-I is likely to have fewer harms. Sleep medications can be associated with serious adverse effects.”

The experts add if that if the behavioral strategy alone doesn’t work, then the pros and cons of medication can be discussed. And if it’s deemed necessary by both patient and doctor, it can used for four to give weeks, while still doing CBT-I.

Therapy for Depression

The U.S. Preventive Services Task Force recently recommended that everyone aged 12-18 be screened for depression. The first line of treatment for depression is still somewhat up for grabs, but the effectiveness of antidepressants is being called into question more and more, while the research behind the value of behavioral interventions is growing. Last week, a study suggested that mindfulness-based cognitive therapy (MBCT) was as effective in preventing relapse in chronic depression as antidepressants. This is not the first to suggest a similar thing. There are of course certain cases in which medication is absolutely necessary. But in some cases, perhaps in many cases, behavioral strategies should be the first line of treatment instead of medication for certain mood or anxiety disorders. And doctors are beginning to realize that.

“I’ve noticed that many of my referrals come from physicians and pediatricians, who are now recognizing that therapy should be used for treatment of behavioral issues before they prescribe medication,” says Kolakowski. “This is further evidence of the trend we are seeing, and I see many people in my practice who would not have sought out therapy had not their doctor recommended it as a first line of treatment. The exception is with severe cases, sometimes medication and therapy in conjunction is best. But again, I think medication alone is a disservice.”

So far, the shift in attitude is promising. And insurance companies are slowly beginning to reflect the changing tides. “Mental health parity laws which ensure that therapy is covered by insurance companies just as any medical treatment is covered,” says Kolakowski, “are also in line with the change in recommendations. Parity laws recognize that mental health is a medical condition that affects people as a disease, and should be covered and treated as such.”

Time will tell whether more experts and guidelines recommend behavioral methods as a first treatment for other disorders. If you’re dealing with any kind of mental health issue, the most important thing is to talk with a professional, and understand all the pros and cons of each treatment, before making the best decision for your, or your kids’, specific situation.

Follow me on Twitter or find me on Facebook.

Lines from “Song of Myself”

Why-did-wlat-whitman-write-Leaves-of-Grass

Poem: Lines from “Song of Myself,” by Walt Whitman.

6

A child said What is the grass? Fetching it to me with full
hands;
How could I answer the child? I do not know what it is any
more than he.

I guess it must be the flag of my disposition, out of hopeful
green stuff woven

Or I guess it is the handkerchief of the Lord,
A scented gift and remembrancer designedly dropt,
Bearing the owner’s name someway in the corners, that we
may see and remark, and say Whose?

And now it seems to me the beautiful uncut hair of graves.

This grass is very dark to be from the white heads of old
mothers,
Darker than the colorless beards of old men,
Dark to come from under the faint red roofs of mouths.

All goes onward and outward, nothing collapses,
And to die is different from what any one supposed, and
luckier.

Mindfulness Meditation & Addiction

5Benefits_Meditation_V2

One of the first steps in dealing with addiction is to discover the emotional cause of it, whether it is fear, depression, anxiety, or pessimism.  Many times these unwholesome thoughts and beliefs come from what I call the “wanting mind.”  In wanting mind, we feel that our current state of unhappiness could be cured if only we could have the money, job, relationship, recognition, or power we had and lost, or never had and strongly desire.  Often we cause ourselves suffering when we ache for something that lies out of our grasp or cling in vain to something that has already passed away. Sometimes, wanting mind involves tightly holding on to something negative: an unwholesome belief about how things ought to be or should have been, or an unwholesome emotion such as anger, sadness, or jealousy. Mindfulness practice helps us develop the capacity to see clearly exactly what we’re attached to so that we can let go of it and end our suffering. The hidden areas of resistance that emerge into our awareness can be noted and examined later so that we can make the conscious choice to reject them.

You can never completely avoid the wanting mind or any other hindrance. Desire is part of being human. It causes us to strive toward bettering our lives and our world, and has led to many of the discoveries and inventions that have provided us with a higher quality of life. Yet despite all that we can achieve and possess, we can become convinced that we won’t be happy or contented unless we acquire even more. This unwholesome belief can lead to competitiveness and feeling resentful toward, or envious of, those who seem to have an easier life.

If I have a patient who is using drugs or even food to manipulate their moods I first refer them to a nutritionist; a psychiatrist or psychopharmacologist; or a holistic doctor, such as an integrative medical doctor, to break this habit.  In addition to this I recommend mindfulness meditation, yoga practice, and regular exercise as they are all excellent to help mood regulation.  These types of activities lower the levels of the stress hormone cortisol in your bloodstream, increase your interleukin levels (enhancing your immune system and providing you with greater energy), and streamline your body’s ability to cleanse itself of chemical toxins, such as lactic acid in your muscles and bloodstream, which can affect neurotransmitter receptors and alter your mood (Chopra 1994; Rossi 1993).

The challenge to altering addictions is the fear that you can’t change which can push you into denial and cause you to minimize the consequences of your unproductive behaviors. Whatever you discover about yourself and however painful your discovery, dramatic breakthroughs are always possible. Research on mindfulness meditation indicates that qualities we once thought immutable that form temperament and character can actually be altered significantly. By retraining your mind through mindfulness practice, you create new neural networks. If you’re aggressive, you can find ways to temper that aspect of yourself, becoming assertive and clear about your boundaries without entering into a competitive and possibly even hostile mind-set that will sabotage you.

For many years, scientists believed that the brain’s plasticity, that is, its ability to create new structures and learn, was limited after childhood. However, new research shows that we can alter the structure of the brain and reap the benefits well into adulthood. Sara Lazar, a researcher at Massachusetts General Hospital, discovered that the more one practices mindfulness meditation, the thicker the brain becomes in the mid-prefrontal cortex and in the mid-insular region of the brain. Changing your mind (or thought processes) actually causes changes in the brain (Lazar et al. 2005). Lazar found that, while people who’ve practiced meditation for ten or twenty years are adept at quickly achieving a state of concentration and mindful awareness, newcomers who engage in mindfulness meditation as little as four hours a week can achieve and sustain a state of mindfulness that leads to creative flow, or what I call “open-mind consciousness.” She discovered that even beginning meditators in their early twenties were able to achieve advanced states of concentration and insight (what I refer to as “mindstrength”) equal to that of senior meditation practitioners. Intention and attention of focus were the keys to reaching these states, not the number of hours spent on a meditation cushion (Lazar and Siegel 2007). From my own experience and work, I know that regular mindfulness practice allows us to set aside distractions and enter the transformative state of open mind.

Mindfulness practice may positively affect the amount of activity in the amygdala, the walnut-sized area in the center of the brain responsible for regulating emotions (Davidson 2000). When the amygdala is relaxed, the parasympathetic nervous system engages to counteract the anxiety response. The heart rate lowers, breathing deepens and slows, and the body stops releasing cortisol and adrenaline into the bloodstream; these stress hormones provide us with quick energy in times of danger but have damaging effects on the body in the long term if they’re too prevalent. Over time, mindfulness meditation actually thickens the bilateral, prefrontal right-insular region of the brain (Lazar et al. 2005), the area responsible for optimism and a sense of well-being, spaciousness, and possibility. This area is also associated with creativity and an increased sense of curiosity, as well as the ability to be reflective and observe how your mind works.

By building new neural connections among brain cells, we rewire the brain, and with each new neural connection, the brain is actually learning. It’s as if we’re adding more RAM to a computer, giving it more functionality. In The Mindful Brain, leading neuroscientist Daniel Siegel (2007, 5), defines the mind as “a process that regulates the flow of energy and information.” His early brain research showed that “where neurons fire, they can rewire” (2007, 291); that is, they create new neural pathways or structures in the brain. He postulates that one of the benefits of mindfulness meditation practice is this process of creating new neural networks for self-observation, optimism, and well-being. Through mindfulness meditation, we light up and build up the left-prefrontal cortex, associated with optimism, self-observation, and compassion, allowing ourselves to cease being dominated by the right-prefrontal cortex, which is associated with fear, depression, anxiety, and pessimism. As a result, our self-awareness and mood stability increase as our harsh judgments of others and ourselves decrease. By devoting attention, intention, and daily effort to being mindful, we learn to master the mind and open the doorway to the creativity available in open-mind consciousness.

It’s entirely possible that the same effects can be achieved through other practices that appear to open up new neural pathways, such as tai chi, yoga, and other forms of meditation, but thanks to researchers studying mindfulness meditation, we now know that we can actually remap the brain and affect the way it functions, as well as the way it influences the body.

Ronald Alexander, Ph.D. is the author of the widely acclaimed book, Wise Mind, Open Mind: Finding Purpose and Meaning in Times of Crisis, Loss, and Change. He is the Executive Director of the OpenMind Training® Institute, practices mindfulness-based mind-body psychotherapy and leadership coaching in Santa Monica, CA, for individuals and corporate clients. He has taught personal and clinical training groups for professionals in Integral Psychotherapy, Ericksonian mind-body healing therapies, mindfulness meditation, and Buddhist psychology nationally and internationally since 1970. (www.openmindtraining.com)

For Depression Treatment, Meditation Might Rival Medication

s

By : Alice G. Walton for Forbes.com

On the list of ways in which meditation appears to benefit the brain, depression treatment may be the latest to gain scientific backing. A new review study, out yesterday in the Journal of the American Medical Association (JAMA) Internal Medicine, finds that mindfulness meditation may rival antidepressants in easing the symptoms of depression. The review is noteworthy for this reason: Its authors combed thousands of earlier studies on meditation, arriving at a small number of randomized clinical trials (the gold standard in science) for use in the analysis. Mindfulness meditation may not cure all, the research found, but when it comes to the treatment of depression, anxiety, and pain, the practice may be just as effective as medication.

The team, led by Johns Hopkins’ Madhav Goyal, MD, MPH, looked back over almost 18,000 earlier studies. They ultimately arrived at 47 randomized clinical trials, which together assigned over 3,500 participants to practice meditation (either mindfulness or mantra) or to enroll in another treatment, like exercise.

Some define mindfulness as paying attention to one’s internal processes (thoughts and/or bodily sensations) in a curious, but nonjudgmental, way. “A lot of people have this idea that meditation means sitting down and doing nothing,” said Goyal. “But that’s not true. Meditation is an active training of the mind to increase awareness, and different meditation programs approach this in different ways.”

 In the current study, the effect size for meditation on depression was found to be moderate, at 0.3.

There was no evidence for an effect of meditation on other measures, like attention, positive mood, substance use, eating habits, sleep and weight. Mantra meditation didn’t seem to carry the same effect as mindfulness meditation, but it may be in part because there were too few studies in the former to draw real conclusions.

But the results are more impressive when you keep in mind that the average effect size of antidepressant medication, the go-to method in the country, is also 0.3. So when it comes to treating depression, which has a notoriously low treatment success rate, the effect size for meditation in the current study is actually pretty impressive.

Asked if he’s encouraged by the results, Goval tells me, “Yes, very encouraged.” Particularly so, he says, since most of the studies included in the review used very short training periods – often eight weeks or less – and one might expect even more robust results with longer training periods. “Compared to other skills that we train in,” he says, “the amount of training received by the participants in the trials was relatively brief. Yet, we are seeing a small but consistent benefit for symptoms of anxiety, depression, and pain. So you wonder whether we might see larger effects with more training, practice, and skill.”

Goval’s next studies will look into this question, along with whether the expertise of the trainer and the length of practice of the trainee have an influence on how meditation might affect depression.

One clear benefit of meditation is that it doesn’t carry the side effects that can accompany drug treatments.

“Also relevant for physicians and patients is that there is no known major harm from meditating, and meditation doesn’t come with any known side effects,” said Goyal. “One can also practice meditation along with other treatments one is already receiving.” It’s important to mention that psychotherapy or talk therapy, particularly cognitive behavioral therapy (CBT), is known to be at least as effective as antidepressants (and the two are most effective when paired).

Though the mechanisms behind the effect of meditation on depression aren’t totally clear, researchers have wagered some guesses. Mindfulness may enhance “attention regulation, body awareness, emotional regulation, and changes in self-perspective (e.g., decentering),” which may all play a role in depression. On a purely biological level, MRI studies have shown that meditation is linked to a reduction in activity in the amygdala, the brain area that governs the stress response, and to reduced activity in the default mode network, the brain network that’s “on” when your mind is wandering from thought to thought, which is often linked to feelings of unhappiness and stress.

The evidence for meditation’s effects on the brain is becoming more and more convincing. If you’re interested in giving it a try, here’s one link to find resources in your area.

Follow @alicewalton or find her on Facebook.