Sierra Clinic ~ Oriental Medicine

Functional medicine and integrative health care

Dennis R Tucker, Ph.D., L.Ac.

Meditation, Stress Reduction, and the Body-Mind Connection

Human beings are unique among all creatures for our capacity to create unnecessary stress. In varying degrees, we all worry about events in the future which we have no control over and often replay past events in our life that are painful. We are often so preoccupied with our thoughts and feelings that “our minds are elsewhere” even as we go about our busy days. In neuroscience it is said that stress is like Velcro and pleasure like Teflon. Although this tendency affects us differently, we are all susceptible, and when emotional and physical pain or illness comes into the picture, we can easily become preoccupied with worry and negative emotions which culminate in a sense of being “stressed out”. This can create a kind of feedback loop that greatly amplifies our mental distress and perception of pain, as well as promoting negative changes in our health.

The good news is that there is a great deal we can do, irrespective of age or health, to improve our brain/mind health, physical health, and quality of life. As you will discover, learning how to use meditation to lower the stress response and live more in the present is one of the most effective means available of improving our health and sense of wellbeing.

Read on, and don’t get bogged down in the short science review; a step by step program for integrating stress reduction and meditation into your life will follow, as well as practical information, including web site links to videos and a resource guide.

Brain/Mind Health

As with our physical health, long before we develop a diagnosable disease, compromised brain/mind health can begin to have proven clinical effects such as depression, anxiety, high blood pressure, poor digestion, sexual dysfunction, hormone imbalance, compromised immune function, fatigue, sleep disturbance, and abnormal pain perception ... as well as an increased risk for problems down the line.

Learning how to use the “Relaxation Response” to reduce the damaging effects of stress on your health and “Meditation” and “Mindfulness Training” to become more aware and present in your daily life is a scientifically validated path to better health and an improved quality of life.

These programs are commonly taught in pain clinics, hospitals, and other institutional settings in a lecture-practice format. I have not found similar programs designed for use in clinical practice, but it very clearly is needed to improve the care of our patients and as a means of providing healthcare information that we should all be aware of. I have been impressed and gratified with how well my patients have responded to informal instructions on stress reduction and mindfulness meditation over the years, so this is an attempt to both share the medical story of how our minds interact with our bodies (for good or bad) and (more importantly) to provide a “how to” manual for folks that wish to immediately begin learning the “Relaxation Response” and “Mindfulness Meditation.”

Meditating as little as 20 minutes a day has been shown in numerous studies to reduce stress, boost working memory, increase the capacity to focus, reduce emotional reactivity, boost immune function, assist in the prevention and recovery from disease, and, by stimulating the growth of neurons in the brain, help protect against age-related loss of mental function.

Patients often report a lessening of the stress response and an enhanced sense of clarity and wellbeing soon after initiating a regular program. We now have numerous studies that demonstrate, in fact, that measurable beneficial changes begin within weeks of starting a daily program.

Meditation and Health: an Overview of the Scientific Research

These are very large claims and it is only reasonable that you want some proof. How about taking a minute, right now, to scan a representative portion of research on the use of meditation for the treatment and prevention of disease? Read as much as you like. If you have specific health complaints, you will notice links at the right of the web page that will show you a list of representative studies for your condition, or take a minute to quickly scroll through these 600 studies by disease category to give you some idea as to the scope and breadth of the research: Research Overview at mindfulnet.org.

There is also a great deal of research on the effects of meditation on brain/mind health that I hope all my patients will ponder. Meditation has cumulative, long tern effects on the health of the brain which include stimulating the growth of new neurons (neurogenesis) and growing those parts of the brain that control emotional regulation, attention, focus, empathy, and compassion (neuroplasticity).

Meditation is not just for stress, pain, and illness. Meditation is for anyone who wants to cope better with stress, live more in the present, enhance their mental clarity and attention, improve their emotional wellbeing, and keep their brain in good shape for the long haul.

An Overview of Recent Research on How Meditation Affects the Brain

Excerpts from the article “Meditation and Brain Changes: Recent Research and New Applications”, from the journal Nature Neuroscience :

“Meditation repairs damage (by making new brain cells) to the amygdala (the emotional center related to fear), the hippocampus (memory and learning), and the prefrontal cortex (decision making).” “Meditation decreases anxiety and fear, and increases memory and cognitive abilities.”

The Nature Neuroscience article also noted increased activity in regions of the brain related to empathy and compassion. Mindfulness meditation also showed neurogenesis (new brain cells) in the right frontal lobe (concentration) and the insula (emotions) and “...increased density of axons which means more ability to signal and more connectivity” (faster processing speed and improved mental function) and “...more myelin” (myelin surrounds and protects mature neurons against age-related damage and also increases the speed of signal transmission.)

These structural changes to the brain — density of the axons, increased myelin, and “...increased blood flow to the cingulate cortex (focus, attention, self-regulation)” — “all started to occur within weeks of starting a daily meditation program.” All this boils down to a happier, healthier, and more efficient brain with faster brain processing, improved memory, focus, and mood state, and enhanced capacity to deal with stressful situations.

There are now many articles that not only confirm that meditation increases grey matter (cortical thickening) in several important areas of the brain responsible for sensory, cognitive, and emotional processing, but, to some degree, can also repair and prevent age-related loss of brain cells and processing speed. In one study, “Meditation experience is associated with increased cortical thickness .... cortical thickness in the average 40 to 50 year old meditators was similar to the thickness of 20 to 30 year old meditators ... meditation might offset age decline in cortical structure.”

Researchers at UCLA had found in an earlier study that specific regions in the brains of long-term meditators were larger and had more grey matter than the brains of individuals in a control group. Now, a follow-up study has suggested that people who regularly meditate also have stronger connections between brain regions and show less age-related brain atrophy over large parts of the brain. This is good news for everyone because the aging process (unchecked) involves loss of brain cells and brain efficiency.

The take-home message is that, with consistent daily practice, we can all benefit from cumulative improvement in the health and efficiency of the brain and experience greater emotional equanimity and wellbeing.

These functional changes in our health, insofar as they are related to stress and brain health, are also helped by acupuncture. There is a significant body of research that demonstrates the importance of acupuncture in regulating receptors and neurotransmitters that, in turn, have effects on balancing the autonomic nervous system which can restore the delicate balance between the brain and physical health. For patients that suffer from pain, illness, and stress symptoms such as anxiety, mood disturbance and insomnia, acupuncture is useful because it not only address pain and other physical symptoms that induce chronic stress, but also helps to reverse the effects of stress both physically and mentally. Everything I do clinically in this area is more effective if the patient understands how to become a partner in this process. The next section explains how the program works.

The First Step: Inducing the Relaxation Response

The effect of chronic stress, whether of an emotional or physical origin, is over activation of the “sympathetic” side of our autonomic nervous system. In effect, this “fight or flight” response can become our default “normal” state with all of the attendant health consequences we have discussed. In many cases, the chronically stressed patient may not even be aware that they are stressed; it has literally become their “normal state.”

I have found, in working with many patients over the years, that it is important to start with the basics and to emphasize the physical elements in the relaxation response which includes careful attention to learning how to develop slow, complete breath cycles that utilize abdominal breathing and deep relaxation of the muscles. The cardinal symptoms of the stress response are rapid shallow breathing (chest breathing) and chronic muscle tension which feed back into the perception of distress. Simply learning to induce the relaxation response 20 minutes a day often provides some degree of immediate felt improvement in stress-related symptoms.

Once you are comfortable with this, returning to abdominal breathing and induced relaxation for even a couple of minutes throughout the day, when you become aware that you are feeling stress, will both provide relief and help you to progress more quickly. Additionally, for those of you with respiratory problems like asthma or emphysema, you are also practicing a form of respiratory therapy and learning how to breathe more fully and efficiently. Make it a habit, whenever you wish to rest, to fully engage the relaxation response. You will find that this will be a more effective means of restoring your energy, mentally and physically, than napping, and it will not disturb your sleep cycle.

For patients in acute stress from emotional and/or physical pain, I prefer that they stick with this part of the program with daily practice for the first month until they no longer have to “struggle” with abdominal breathing and induced relaxation. Once this becomes familiar and easier to implement, you can decide if you want to integrate the full program of Mindfulness Meditation. But, I hope all of you will at least learn how to induce the relaxation response; it is a lifeline for preserving our health and wellbeing when times are tough.

Learning to Induce the Relaxation Response: The Core Technique

It is important to practice at least 20 minutes a day, with a timer (so you are not concerned with time). For those of you who are suffering emotionally or physically, you can extend the time, and/or engage the full practice twice a day. For patients with sleep disorders, you can also use the basic practice to prepare for sleep. In addition to the core practice, continue to use the basic breathing/relaxation technique frequently for a minute or two throughout the day to keep resetting the relaxation response. If you are stuck in traffic or are circumstantially stressed, use these negative moments as prompts to use the focused relaxation on the breath to clear and re-center you awareness. The more you use it, the more proficient you will become. After a while, it will become natural. Learning how to practice focused abdominal breathing and deep relaxation will also help you learn how to “let go” of distractive and stressful repetitive thought and develop mindful awareness in your daily life.

“Stress management” is now considered a key element in the treatment of chronic pain and the prevention and treatment of disease. I encourage all of my patients to use these simple guidelines, but I consider it an essential part of treatment for those patients who are stressed. When you induce the relaxation response while you rest in treatment, the treatment itself will further assist you in feeling the physical and mental shift out of the stress response and help you learn to do this for yourself more quickly.

Beyond the Relaxation Response: The Next Step

Learning to induce the relaxation response only for stress management is, in fact, a narrowly targeted use of mindfulness meditation. Mindfulness meditation is not simply a buffer against stress. Rather, it is a lifelong practice for cultivating awareness in the moment to moment passing of our lives, good times and bad. Learning to be more aware and present in our lives can be learned by anyone. Like exercise, it involves making it a part of your life. Try to meditate daily and practice mindfulness as you go through the day. Although stress reduction is a great first step, mindfulness meditation is a deeper and more effective practice for realizing the proven myriad effects on Brain/Mind health and wellbeing.

If you decide, as many of my patients have, to develop a daily meditation practice, you will notice that, as your mindfulness meditation practice matures, the deep “letting go” and focused immersion in the breath will have a strong carry-over effect into your daily life. Over time, open, nonjudgemental awareness and being more present in your life can increasingly become a natural state of mind that is part of your daily experience. We can practice mindfulness whatever we are doing and it can deepen into a greater sense of connection with life, each other, and our everyday world of experience.

For those of you who are interested and wish to integrate mindfulness meditation into your life, what follows will serve as a resource guide and “how to manual” using both this program and support from the medical system of Mindfulness Based Stress Reduction (MBSR).

On a personal note: I have practiced meditation for most of my adult life, many years of which involved formal training. MBSR is generally taught in institutional settings; I have designed this program for use in my office as an integral part of your treatment (if you so choose). It is similar in many respects to MBSR but differs in its use of directed, focused breath meditation. This is perhaps the most common traditional meditation practice and is also widely used for stress reduction. In my experience, it has been more effective in developing the meditation skills that help patients integrate mindfulness into their lives. But, with this exception, MBSR is complementary to my program and I encourage you to use their resources as well, if you so choose.

I have learned over many years of helping patients deal with the stress of emotional and physical pain and illness that this structured and focused attention on the breath and induced relaxation of tension is the most effective means of moving them on to a path of recovery. Once you experience how to focus and release physical tension, even in the midst of emotional and physical stress, it is much easier to transition from “stress management” to effectively integrating mindfulness meditation into your life. As you become more adept at maintaining this object-focused meditation on the breath, it will become easier and more natural to be “mindful” in your daily life, living more of your life in the present rather than “lost in thought,” pain, or negative feelings. “Mindfulness” is sometimes referred to as “open awareness” which simply means learning to be aware and present with our moment-to-moment lives.

Please take a few minutes now and listen to this short video from Dr. Zinn which will bring much of what we have covered down to earth. This is the most widely practiced form of medically integrated mindfulness meditation and it was largely developed by Dr. Zinn at Harvard and Massachusetts General Hospital.

As of this writing, there is an 8 week MBSR program offered at Sierra Nevada Memorial Hospital in the Wellness Center. This course is taught by Marty Cottler, PhD and information can be obtained by contacting Suzanne Koliche at suzannekoliche@gmail.com or calling (530) 265-5729, extension 227. The MBSR course is intermittent and is recommended only for those patients who feel they need more support in integrating the program I have designed for you.

Two important points before we proceed:

For those patients who are suffering acutely from stress, pain, personal loss, and persistent negative mood states, I recommend Full Catastrophe Living by Jon Kabat-Zinn. This is also available as a free audio book. Please read this book during the first month of treatment while learning the relaxation response. I also recommend Wherever You Go, There You Are, also by Dr. Zinn, as a helpful guide for everyone who wishes to begin a meditation practice.

For those of you who wish to pursue mindfulness meditation as a daily practice, the following are tips and guidance that I hope you will find helpful. This section is especially intended for patients who have already practiced the relaxation response for one month and wish to more fully integrate mindfulness meditation into their lives.

Questions and Answers

• Is this some kind of religion?

Although medically based mindfulness meditation is non-sectarian, it developed out of research directed at understanding how eastern forms of religious meditation affected the body. As the evidence demonstrating that mindfulness meditation has numerous beneficial effects on mental and physical grew, “mindfulness meditation” (minus all religious affiliation), developed into an evidenced based program for improving mental and physical health and wellbeing and an important element in preventive medicine.

We owe much to Professor Herbert Benson, who first documented the effects of religious meditation on a host of diseases such as high blood pressure, heart disease, and ulcers. This pioneering research was done at Harvard half a century ago and kicked off a whole new direction in medical research that you are now the beneficiary of.

• How does focusing on the breath lead to greater awareness in our daily lives?

As you will immediately notice, when you attempt to cultivate awareness, the mind is so active that you are frequently distracted. This tendency to be “lost” in our thoughts and feelings can be improved by developing awareness in the here and now. Breath meditation is one of the most effective means of cultivating moment-to-moment focused awareness, which allows us to let go of the constant flow of mental content and become more present and mindful in our daily lives. We learn, as one patient put it, “that we are not just our thoughts and emotions.” We can learn to live our busy lives in a more focused, aware, and relaxed state. In fact, mindfulness can become the new normal.

• Isn't mindfulness meditation just another way to distract ourselves away from the pressures of life?

Mindfulness meditation is precisely the opposite of distraction or escaping from stress. By developing our capacity to live more in the present we are able to deal with the stresses of life more effectively and with greater equanimity.

• When I am suffering or in pain why do I want to become more aware of my discomfort?

Remember, in focused meditation, you are neither grasping nor rejecting the contents of the mind but constantly returning awareness to the breath as soon as you notice that the mind has strayed. In fact, in study after study, developing the capacity for sustained relaxed focus or awareness markedly reduces the perception of both emotional and physical pain, increases our sense of wellbeing, enhances our focus and mental performance, and improves our health. Invariably, when we are resisting uncomfortable thoughts and sensations, we set up a feedback loop between the brain and the body which amplifies stress hormones and increases tension, pain, and emotional distress.

• I frequently worry because I care. Is this a method to bypass feelings?

Our feelings and emotions arise spontaneously. It is not the feelings and emotions that are the problem; it is what we do with them. The problem with respect to chronic stress is that our minds (unchecked) can endlessly dwell in our emotional upset and worries which then create more of the same. This is the “Velcro” part of the human brain that creates the unhealthy (and unhelpful) negative circular thinking that causes so much of our emotional and physical suffering which then impacts our health and wellbeing. We all know that we best express our compassion and concerns through constructive action. But this is not always possible. Often we feel powerless and helpless when we are in a “stuck place” and feel unable to “fix” our problems. This is the most common cause of chronic stress and, rather than leading to solutions, contributes to poor health and less ability to deal with the challenges we all must face in life. By learning how to not get stuck in circular thinking and negative emotions and becoming more present and fully engaged in our moment-to-moment lives, we are more able to deal with life’s challenges in a healthy and constructive manner.

• How do I know I'm practicing correctly?

As long as you follow the basic directions you are practicing correctly. Remember, the most important point is to become skilled at returning to the basic instructions as soon as you realize you are “lost in thought,” and to give yourself enough time every day to meditate. It takes time for the mind to settle. Usually meditation periods are 30 minutes (or longer). I have had many patients progress well with 20 minute daily practice sessions and the practice of mindfulness during the day.

Practicing mindfulness during the day means letting go of negative repetitive thoughts and extended distractive “day dreams” when you become aware that you are “lost in thought,” and “dropping” into awareness. The more you practice, the faster you will understand and grow comfortable with mindfulness practice. As time goes on, it will be part of your life.

Over time, and with daily practice, you may notice some of the following subjective changes as you meditate, which also correlate with objective shifts in brain waves (EEG). Don’t get too caught up in this model. It is just another way of understanding the process of developing focus and mindfulness in your daily meditation practice.

Stress and High Beta

When we are stressed (which will often feel “normal” to the chronically stressed individual), and we first begin to induce the relaxation response, we may notice that the neck and shoulders feel tense, the respiration is shallow and relatively rapid and we may also notice a subjective sense of unease, with jumbled thoughts and feelings crowding the mind. This is the stress response in action.

In neurofeedback (EEG), this state has the characteristic signature of rapid, tightly spaced beta waves (high beta). At this stage, it is initially quite difficult to focus on and reduce muscle tension. In fact, even the act of “trying” to focus the mind and relax the muscles may, at first, feel unpleasant. But keep returning to the basic instructions, and the slow, full, abdominal breathing and tension release of the muscles will usually begin to have effect within five to ten minutes. Even in your first week of practice you will likely feel less like you’re fighting the process and, as respiration slows and deepens, begin to have some luck following the breath. You may also notice that your thoughts become more extended and less fragmented. This is the shift into a slower and lower brain frequency called Alpha.

Alpha Dominance: The Relaxation Response

The Alpha Dominant State is something we all commonly experience when we are relaxed and immersed in an activity or “daydreaming.” It is often a brain state that is conducive to creative thought and imagination and it is relatively pleasant. It signals a shift into the parasympathetic portion of our nervous system and is characterized by less physical and mental tension. Even patients who are chronically stressed can usually learn to induce the relaxation response soon after starting breath meditation. This is progress. Your blood pressure, heart, and immune system are grateful and you probably are feeling periods of less mental agitation. You may find that you are mindfully aware for short periods and then are lost in more coherent thoughts and imagination. For patients who are chronically stressed, it is welcome relief. But don’t get stuck in the “alpha dream state.” Remember, the skill set is to keep returning to the core mindfulness meditation practice as soon as you notice you are off track. As you do so, over time, you may become aware that your breath cycle has slowed and deepened, your body is less tense, and you are now having longer periods where you more completely follow your breath.

When you begin to feel this absorption in the breath, there is a sense of surrender or of letting go of all of the initial instructions I have given you as well as other mental content. There is clear awareness of the breath with the thoughts and feelings well into the background. Ironically, we have to stop consciously directing the process in order to deeply immerse ourselves into the breath meditation. This occurs naturally as a felt sense of effortlessly “falling into” or becoming “absorbed” in the breath. This can be developed with consistent practice and sets the stage for the transition into Synchronous Alpha.

Synchronous Alpha: Beyond the Relaxation Response

Under most circumstances, our brains are “lighting up” here and there and the brain waves are not highly synchronous. With deep absorption, large sections of the brain develop synchronous alpha waves, which mean that the peaks and valleys of the alpha waves are perfectly matched. When this begins to occur over large sections of the brain there is a felt sense of mental clarity, presence, and equanimity. 23 out of 25 studies that measured brain wave activity in seasoned meditators recorded a predominance of synchronous alpha. This is not a common state in our normal consciousness. Once you start to experience this non-directed “effortless” absorption, it is easier to practice mindfulness during your busy days. In neurofeedback, this is referred to as “open focus,” and is characterized by a non-directed relaxed awareness that allows us to more fully engage in the present and more fully attend to all the normal activities of life. With this comes more mental clarity, equanimity, a greater capacity to deal with stressful situation and an enhanced sense of wellbeing.

Much of this information is from the Open Focus Mind, by Les Fehmi, PhD, and Jim Robbins.

• What can I do if my concentration just won’t gel?

The more agitated we feel, the more difficult it seems initially to meditate. Here are two approaches that are often helpful: (1) try allowing the exhalation to be audible and focus on the sound as well as the physical sensation of the breath entering and leaving the body, or (2) another method commonly used in many forms of meditation is counting the breath. If you feel “stuck” I am here to help you. For patients who are in extreme stress, herbal and nutritional neurotransmitter support can also be helpful, as is acupuncture. Persistence and patience are the necessary ingredients for success. I have yet to have a patient, who is practicing daily, not respond.

Variations of mindfulness meditation are now widely used throughout medicine and psychology as a component of treatment in pain clinics, hospital-based stress reduction programs, and in the treatment of cancer and heart disease, anxiety, depression, and PTSD to name a few. But, beyond the treatment of stress and disease, the larger revolution in neuroscience and medicine, is the role that mindfulness meditation plays in disease prevention and enhancing and protecting brain function and quality of life for all of us.

The hope is that you will refer back to this internet based program for reminders, assistance, and inspiration. Reread the sections that address your questions and uncertainties. Repetition will give you a clearer mental picture of the “what” and the “why” of your practice.

For more on the most commonly used application of meditation, referred to as “Mindfulness Based Stress Reduction” (MBSR) in medicine and clinical psychology, including a comprehensive resource guide: www.mindfulnet.org. You may also find The Buddha's Brain (also available as an audio book) an interesting and informative resource.

Some Final Thoughts

Remember, optimizing mental and physical health is always synergistic. Diet and exercise also bear directly on the health of our brain/mind. You will progress more quickly and achieve better results if you consider a healthy diet, exercise, and mindfulness meditation as a whole.

Although “mindfulness meditation,” in the secular form that I have introduced you to, was largely developed from Buddhist forms of meditation, it is good to remember that all of the major world religions (including Christianity and Judaism) also have meditation traditions. In fact, it is widely thought that meditation may well have predated recorded history. Meditation is the legacy of our shared humanity and is not proprietary to any religion. The emergence of scientifically validated and medically based meditation has opened the door for all of us to integrate mindfulness meditation into our lives, whatever our religious persuasion might be. But, it is also important to note that religiously based meditation practices are not primarily concerned with health, but rather with resolving spiritual questions that are as old as mankind. The mindfulness meditation program which I offer you (and other medically based programs) is intended to guide you in developing mindfulness in your life. It is only one approach among many and you may find many other resources that will support and direct your practice.

I have presented you with a self-contained program for this specific approach to mindfulness meditation and training. You can start today if you wish. You have everything you need. I invite you to try today or tonight, by taking the first step in moving towards better mental and physical health. Give yourself one month and practice the “first step” daily. See for yourself if it gives you a felt benefit. If you stick with this program, my hope is that you come to a point where you understand, beyond the scientific and medical model, that open awareness in the present moment is always available, in good times and bad. We not only can learn to more effectively deal with stress, but we can also live our lives with more open awareness and equanimity in our “real life,” the one that is always before us.

There are many approaches to meditation: some religious, some not. Reach out to your own religious tradition, or, if you are not religious but wish to learn more about mindfulness meditation, consider reading where your interests take you. But please remember, no amount of intellectual “understanding” can replace mindfulness practice. Your “real understanding” will come through direct experience.

Lastly, I cannot end without paying deep heartfelt respect to my meditation teachers, Yamada Mumon Roshi and Harada Joshu Roshi, as well as countless researchers and clinicians who have opened the door for everyone to experience greater health and wellbeing.

I hope you will derive benefit from this program.

To your health and wellbeing,

Dennis Tucker, Ph.D., L.Ac.

 

Thank you for reading about the program offered at our clinic. If you have the time now, sit in a comfortable chair with reasonably good posture, close your eyes, so you can focus on Dr. Zinn’s voice, and start the following short guided meditation: MBSR Mindfulness Meditation Intro.

If you are going to begin the program at our clinic, begin with “step one” and follow the guidelines. That’s all there is to it!