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KEY CLINICAL UPDATES IN MEDITATION

A 2020 meta-analysis over 3000 patients found that mindfulness-based interventions were associated reductions in anxiety for at least 6 months after the intervention in adults with a cancer diagnosis.

DEFINITION

Meditation is a broad term that incorporates features of self-regulation, awareness, attention, and presence that is typically cultivated through an intentional practice. In lay contexts, the word “mindfulness” is often interchanged with or joined to “meditation.” This reflects the ambiguity in the interpretation of these words as well as their cultural origins. In health care settings, one popular application of mindfulness meditation is the mindfulness-based stress reduction (MBSR) program. This program and its derivatives have been extensively studied in medical populations.

The essential exercise of meditation is focusing one's full attention on a designated object of meditation, such as one's breath. When it is noticed that the mind has wandered from this object, attention is returned to the object. Training the mind, beginning with this basic exercise, has many effects including relaxation, metacognition, cognitive flexibility, uncoupling of painful physical sensations from maladaptive cognitive patterns, and revelation of previously subconscious content. In meditation practices, after initial training with the breath, the objects of meditation can include other aspects of human experience, such as physical sensations (eg, pain) or mental and emotional states (eg, anxiety).

HISTORY

In 1979, mindfulness meditation practice was introduced into US medical settings with the development of the MBSR program by Jon Kabat-Zinn, PhD. It is an 8-week program that introduces mindfulness practice in a secular, practical form to participants in the context of their life circumstances. This program is intended to create a deliberate, sustained, nonjudgmental way of paying attention to one's experience in order to enhance self-awareness, change maladaptive thinking, increase the capacity for skillful response to challenges, and reduce suffering. There are now hundreds of MBSR programs in the United States and other countries. A close derivative of MBSR, mindfulness-based cognitive therapy (MBCT), was developed exclusively for people with recurrent major depression and has been widely applied to other psychiatric populations. These programs have also been adapted for use in patients with borderline personality disorder (Dialectical Behavior Therapy), eating disorders, substance use disorders (mindfulness-based relapse prevention), and childbirth preparation.

MECHANISM OF ACTION

There have been extensive cardiac, respiratory, metabolic, endocrine, and central nervous system studies of individuals during meditation. Though much remains unknown, it is clear that meditation works in part through modulation of the autonomic nervous system, as demonstrated in the late 1960s and early 1970s by Dr. Herbert Benson. Its effects are different from sleep. From a psychological perspective, it is thought that meditation enables the mind to establish a stable platform from which all events in the field of awareness can be viewed (eg, emotions, thoughts, physical sensations) without reactivity. Meditation ...

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