Dr Simon Whitesman
South African Journal of Natural Medicine
Over the last 40 years meditation has been increasingly utilised in the context of Western health care to generate relaxation, enhanced awareness of mind-body phenomena and insight into the nature of the mind and its relation to the body.
While the use of meditative disciplines is deeply integrated into the culture and psyche of the East, it is only recently that this profound and ancient practice has gained a foothold in the West, initially on the fringes of society, and currently as an accepted self-help tool in both psychology and medicine. Much of this diffusion has occurred through the investigation of meditative practices by medical and behavioural scientists, and the consequent recognition that enormous therapeutic benefit may be derived through its regular utilisation.
Meditation is defined as the self-regulation of attention from moment to moment. While many schools exist, there are essentially two forms: concentration (one-pointed) meditation and mindfulness meditation, or an integration of these two. Concentration meditation implies the focusing of attention on a single focus, such as the breath or mantra (a Sanskrit sound), while mindfulness meditation is the application of attention to the present moment in a changing field of awareness. Generally speaking, the capacity to retain awareness in a changing field requires an initial stabilisation of attention, therefore concentration forms the basis for the effective application of mindfulness.
Concentration meditation elicits a psychobiological state that is characterised by specific neurological and peripheral physiological changes associated with cellular/molecular relaxation. This state, often termed the relaxation response, is mediated predominantly (although not exclusively) by the hypothalamus, a collection of neurons in the basal forebrain. This neural locus is a significant junction between the brain and the rest of the body and is central to the generation of the stress response. The peripheral biological effects of concentrated awareness are perceived systemically through an impact on a variety of neurotransmitters, neuropeptides and hormones and their cellular receptors. For example, researchers have shown that concentration meditation reduces the sensitivity with which noradrenaline binds to its receptor on white blood cells.
Because the neurotransmitter noradrenaline is central to the stress response, this line of research suggests that meditation utilises similar pathways to the stress response, but significantly, the impact of these molecular/cellular changes is therapeutic rather than pathogenic as would be the case in chronic stress.
The clinical effectiveness of concentration meditation has been described in diverse disease processes including hypertension, ischaemic heart disease, carotid atherosclerosis, arrhythmias, asthma, anxiety, chronic pain and infertility. Generally speaking the impact has been in the direction of symptom reduction, but has also been shown in some cases to reverse partially the pathophysiological mechanisms underlying the disease process.
Mindfulness meditation, the second broad form of meditative practice, presupposes a concentrated attention as a foundation on which a deeper exploration of mind-body phenomena may be explored. For example, enhanced momentary awareness allows a broader range of choice to bring about conditioned modes of functioning: distressing states may be held in awareness and responded to with a spacious perspective rather than a mindless repetition of habitual patterns of reactivity. Interestingly this clinical observation is borne out by brain imaging studies that have shown that the pathways between the emotion-processing limbic brain region and the rational, reasoning prefrontal cortex are optimised in mindfulness meditation.
Clinical studies have shown the value of the cultivation of mindfulness in a variety of chronic disorders including anxiety, chronic pain syndrome, fibromyalgia, psoriasis, depression, and the stress associated with malignant disease. Significantly, long-term follow up studies have shown a maintenance of therapeutic gain at 3 and 4 years, which lends credence to the practical applicability of mindful attention in the context of a modern lifestyle.
A final caveat regarding the therapeutic application of meditation is that these self-regulatory strategies, as for any intervention, should be viewed as a component of a broad approach to disease management in which externally generated (medication, surgery etc.) and internally generated healing responses are integrated to optimise the therapeutic outcome.