The role of meditation and mindfulness in psychiatric treatments

Victoria Clark
St Martin’s Hospital, Canterbury

Psychiatric Wellbeing

Psychiatric wellbeing encompasses feelings of contentment, enjoyment and self-confidence. It includes maintaining healthy relationships and engagement with the world around us. It is impacted on by our physical and spiritual wellbeing, creating a lens through which we perceive the world.

As a Psychiatrist, I find that many of my patients are caught in a cycle of negative thinking based on their interpretation of the world which has been skewed by their traumatic past. They are unable to see the reality of the surroundings that they now occupy, or to be in their present moment due to distress caused by their negative thought patterns.  Psychological distress is driven by unwillingness to see things as they really are.  It isn’t until true reality is acknowledged and accepted that change can happen. Mindfulness can facilitate this process.

Daily experiences provide repeated external, as well as internal, stressors triggering chronic physiological stress reactions involving the nervous and hormonal systems. This reduces immunity and can cause physical illness, as well as mental strain (1).  If the stressors are not acknowledged with acceptance, then distraction techniques are often employed, such as the use of drink or drugs.  These distractions are used as an attempt to drive the associated thoughts and feelings deep into the unconscious. This often leads to psychological distress and ill health as the body and mind are interdependent. A key aspect to managing stress with a mindful approach is acceptance of how things are, rather than how we want them to be.

Mindfulness teaches us to be less judgemental of ourselves, encouraging self- compassion which is a difficult mind-set to develop. Mental illness is often driven by a negative self commentary which is so embedded that it is often not acknowledged as a problem to be addressed.

Meditation and Mindfulness

Mindfulness is the overarching term for a way of being; paying attention to the present moment without judgement while acknowledging thoughts, feelings and bodily sensations. Mindfulness can be applied throughout daily life with meditation providing intense periods of mindful practice.  This trains the mind to be present during the rest of the day.  We now have evidence to support that which has been known by practitioners of the Zen tradition of mindful meditation for thousands of years; that meditation and mindfulness maintain physical and mental wellbeing. This evidence will be discussed in this article.

Effects on Mental Health

The space provided between thought and reaction, developed by meditation, is useful in the management of emotional distress. Emotional pain is ever-present; it is our reaction which is important for our psychological wellbeing. Becoming mindful teaches us to take control of the negative stories that we tell ourselves, causing psychological distress, including anxiety and depression.  Mindfulness teaches us to be aware of the actual reality of the moment and to avoid attaching ruminating thoughts which tend to be anxiety-laden. Awareness and acceptance of the present moment experience allows change and healing. It is often painful to face the present moment which leads to a desire to run away and distract ourselves, but this is a temporary fix.

There is often fear attached to the experience of the emotional pain, compounding the wish to avoid it. Turning towards the emotional pain takes courage but can lead to a change in the experience of the pain when the associated thoughts around it are shrugged off. In the example of sadness linked to the ending of a relationship, mindfulness encourages us to sit with the feeling of sadness with acceptance and a non-judgemental attitude. Losing the associated fearful commentary (how will I cope without him? What will people say?) alters the experience of the pain and allows change.

Mindfulness develops inner resources for dealing with stress. The stresses may not be removable but our reaction to them is adaptable with mindful training.  Being mindful creates a space between the thought and the reaction which teaches us to respond to stressors rather than automatically reacting to them.  A key aspect of mindful practice is noticing the stressor along with the bodily response to it, and having the ability to let go of the associated thoughts and feelings without negative interpretation.

There is now plenty of evidence supporting mindfulness as a means of managing emotional distress. Kuyken et al (2) designed a randomised controlled trial which compared mindfulness and meditation to antidepressant use in 123 people with recurrent depression. After 15 months, 60% of the participants taking medication had relapsed compared to 50% who had received mindfulness training which showed it to be as effective as medication in this group. The training was also found to be more effective in enhancing quality of life and equally cost effective.

Mindfulness also teaches us how to avoid time pressure stress, grounding us in the present reality and focusing us on the wonder of everyday activities. Unity of the mind and the body can lead a state of ‘flow’, a term coined by Csikszentmihalyi to describe a state of consciousness in which a person is completely absorbed in his or her actions and experiences. This appreciation for everyday activities improves our quality of life and emotional wellbeing. It encourages us to simplify our lives, reducing the distractions and allowing focus on the things that are important to us.

Effects on Physical Health

Loss of the mental commentary due to mindfulness can be helpful in reducing the distress caused by physical pain which is often connected to emotional pain.  By having a ‘welcoming’ approach to pain with acceptance, the change in attitude can significantly alter the experience.  Evidence of the reduction in pain experience with the practice of mindfulness was shown by a study by Kabat-Zinn et al in 1985 (3). This group showed that a 10 week programme based on mindful practice for stress reduction led to statistically significant reductions in the present moment pain experience of patients, increased activity and improved psychological symptoms associated with physical pain. Several subsequent studies have shown similar results. Grant and Rainville (4) showed that Zen meditators have lower pain sensitivity, both in and out of a meditative state, suggesting an adaption to their processing of painful stimuli. Work by Brown and Jones (5) showed, by using brain scans, that areas of the brain associated with the anticipation of pain (prefrontal cortex) were less active in meditators when exposed to pain.

The concept of the ‘double arrow of pain’ explains how pain is often exacerbated by the thought processes associated with the pain such as the worry of anticipated pain. Mindfulness teaches us to lose the associated negative thought processes which come with pain, focusing solely on the sensation and noticing how it is felt. Just paying attention to the feeling with a welcoming attitude can lead to a change in the experience of the feeling and a recognition of the transient nature of feelings. This is thought to be the mechanism by which mindfulness and meditation cause a reduction in the distress experienced with painful sensations. ‘Pain is inevitable, suffering is optional’, is a phase which helps with understanding this concept. Resistance to the pain often leads to the suffering.  Meditation is also associated with relaxation which can reduce pain.

There is emerging evidence that meditation can positively influence the physiological aging of our bodies. Wallace et al. (1982) (5) found that a group who had meditated regularly for at least 5 years, when compared to a control group, were 12 years younger physiologically. This finding has been replicated in other studies.(%)

Conclusion

Mindfulness and meditation do not just prevent ill health, they can also elevate our functioning. Many of the greatest achievers practice mindfulness and use the skills that it develops to their advantage. An example is Jonathon Rowson, the British Chess Champion who describes how mindfulness allows him to remain calm and centred whilst competing. He is able to ‘just play’ the game without worrying about the result. Sridevi et al (7) looked at how meditation affects personality growth and found a significant increase in positive personality traits, including increased confidence, conscientiousness and less anxiety.

In summary, there is now extensive evidence supporting the positive impact of mindfulness and meditation on our physical and mental health. This way of being improves our quality of life, allowing us to live in the true reality of the present moment.

References

  1. Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychological Bulletin. 2004; 130(4): 601-630.
  2. Kuyken W, Byford S, Taylor RS et al. Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. Journal of Clinical Psychology. 2008 Dec; 76(6):966-78.
  3. Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioural Medicine. 1985 June; 8(2):163-90.
  4. Grant JA, Rainville P. Pain sensitivity and analgesic effects of mindful states in zen meditators: a cross sectional study. Psychosomatic Medicine. 2009; 71:106-114.
  5. Brown CA, Jones AKP. Meditation experience predicts less negative appraisal of pain: Electrophysiological evidence for involvement of anticipatory neural responses. Pain [Internet]. 2010 Sept; 150(3): 428-438. Available from doi:10.1016/j.pain.2010.04.017.
  6. Wallace RK, Dilbeck M, Jacobe E, Harrington B. The effects of the Transcendental Meditation and TM-Sidhi program on the aging process. International Journal of Neuroscience.1982; 16: 53–58.
  7. Sridevi K, Rao P, Krisha V. Temporal effects of meditation and personality. Psychological Studies. 1998; 43(3): 95–105.