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Visualize a classroom full of eager students learning a simple, yet astonishingly complex form of meditation that primarily involves giving one’s attention to breathing. Visualize now that many, if not most of those students, have cancer, heart disease, or diabetes. Now take the final leap of faith — visualize that those students are learning this profoundly life-changing form of meditation at a major medical center.
It’s happening now. In 200 medical centers throughout the United States, mindfulness meditation, often known as insight meditation or by the Buddhist term, vipassana, is rapidly gaining popularity as an adjunct therapy for many patients with chronic disease, including cancer, diabetes, and heart disease.
Some experts suggest that the effects of meditation of various types may go far beyond the documented beneficial effects of stress relief into creating physiological changes that combat disease, including reduced prostate-specific antigen (PSA) levels in prostate cancer patients and elevated melatonin levels in patients with prostate and breast cancer.
Mindfulness meditation, considered by some to be the heart of Buddhist meditation practice, is widely taught in the United States by Jon Kabat-Zinn, PhD, professor of medicine at the University of Massachusetts Medical Center in Worcester. "The key of mindfulness is not so much what you choose to focus on, but the quality of the awareness you bring to each moment," he says.
In the practice of mindfulness, says Kabat-Zinn, the student focuses one-pointed attention to cultivate calmness and stability, ability to live in the present, and ability to keep in contact with whatever is happening in body and mind at the precise moment it is happening. The student later moves to a wider scope of observing as a nonjudgmental witness and finally to an element of spiritual inquiry.
Kabat-Zinn is director of UMass’s Center for Mindfulness in Medicine, Health Care, and Society. The center’s goal, he says, is "helping our patients mobilize their own inner resources of mind and body, heart and soul, for learning, growing, for healing, for moving to greater levels of well-being and health, and for taking charge in a new way in their lives, inwardly and outwardly."
Many of the patients at the Stress Reduction Clinic are heart and cancer patients who are not responding completely to medical treatment or where "something is needed for a higher quality of life in order to better manage stress and the pain of chronic diseases," says Kabat-Zinn.
He and colleague Saki Santorelli guide the center (founded in 1995) and its affiliated Stress Reduction Clinic (founded in 1979) and have supervised the treatment of thousands of patients and the training of hundreds of professionals to teach mindfulness meditation.
Patients with cancer respond particularly well to mindfulness meditation, says Barrie Cassileth, PhD, a psychologist and chief of the integrative medicine service at Memorial Sloan-Kettering Cancer Center in New York City.
Memorial offers meditation classes that have proven to be "very effective for the many unique challenges of cancer patients, particularly for relieving anxiety, depression, and fatigue," says Cassileth. In fact, says Cassileth, some patients enjoy the classes so much they return over and over again. "People do better when they feel they are doing something to help themselves, and it’s something they enjoy."
"I see mindfulness meditation as a way of not only coping with illness but as a way of moving through it," says Atlanta-based psychotherapist Kaye Coker, MSW, who wrote a paper on meditation-induced melatonin production when she worked at the Emory University Clinic in Atlanta.
Coker says research suggests that increased melatonin production inhibits the growth of cancer cells. Unpublished laboratory studies have shown that meditators produce more melatonin than nonmeditators. "The inference here is that you can have an effect on the growth of cancer cells if you can somehow get the pineal gland to manufacture more melatonin," says Coker.1
Coker uses mindfulness techniques in her daily psychotherapy practice and receives frequent referrals from primary care physicians. She says even a beginner’s practice of the meditation brings about a sense of relaxation and the associated effects of reducing cortisol, thereby reducing stress, whether it is related to a disease condition or other factors.
She says this form of meditation also is extremely valuable in changing the presence of classically recognized stress indicators: neck pain, chronic bowel irritability, high blood pressure, anxiety, depression, insomnia, and lack of mental focus. The practice takes dedication and effort on the part of the practitioner, says Coker.
Typically, students of mindfulness meditation are enrolled in an eight-week course in which classical sitting meditation is taught. They are encouraged to practice every day for approximately 45 minutes, with the clear message that the more they meditate, the more profoundly they will experience results. Standing, walking, and body scan meditations also are integrated into the mindfulness practice.
Almost any form of meditation will produce relaxation and stress relief, says Coker, but mindfulness meditation has the added dimension of bringing the practitioner to a new level of awareness of body and mind.
And while mindfulness traditionally is taught as a quiet sitting meditation, the technique can be translated to any activity and make it uniquely suitable to the busy Western lifestyle, says Shachi Shantinath, PhD, a psychologist in private practice and an editor for the Novartis Foundation Web site in Bern, Switzerland. Shantinath works on weight control with numerous patients with Type 2 diabetes.
"Meditation is a tool kit that offers new ways of thinking about life and health and how we respond to the stressors around us," she says.
"You don’t have to sit in the lotus posture to meditate," she says. "Any activity in which you become totally focused and totally absorbed can become a meditation. You can meditate while washing dishes or reading a book. It’s the one-pointed nature of meditation that makes it so valuable as a life-change tool."
Shantinath teaches patients to bring their newfound moment-to-moment self-awareness to an understanding of their relationship with food. "Many people with weight problems have a guilty relationship with food," she explains. "Eating is not sinful. Eating is meant to be an act of pleasure as well as simply nourishing the body."
Continuous dieting and failed diets lead a patient into a negative spiral that prophesies inevitable failure. The first time the patient falls off the healthy eating plan, the good intentions are usually abandoned in a storm of self-recrimination. Shantinath uses mindfulness meditation, and a particular "spin" of her own invention, to show patients that the enjoyment of eating is not related to the amount they consume, but to the degree of consciousness with which the food is eaten.
Shantinath applies mindfulness to the act of eating a small square of chocolate as an example to show how much pleasure can be derived from a tiny amount of a much-loved food.
She makes the consumption of this tiny piece of chocolate a sensual act. Using sight, smell, touch, and finally taste, she directs students to take a full five minutes to eat the chocolate. "I tell them to let it melt completely in their mouths, to savor every bit of the flavor," she says. "I tell them to think of nothing else but how wonderful this chocolate is. I tell them to ignore any distracting thoughts or negative self-talk and simply revel in eating the chocolate."
What happens without fail, says Shantinath, is that patients "get it" that they don’t have to eat huge quantities of food to get the pleasure they are seeking.
"For people with diabetes, food is such a conflicted theme. They are required to think about it all the time, and yet when they get too wrapped up in food, they begin to fantasize and overeat or eat things that in quantity are harmful to them. Mindfulness helps them to balance out and find the center — both spiritually and physically."
(For more information, contact: University of Massachusetts Center for Mindfulness in Medicine, Health Care and Society Web site: www.umassmed.edu/cfm. Mindfulness-Based Stress Reduction Web site: www.mbsr.com — includes listing of trained mindfulness meditation instructors.)
1. Coker KH. Meditation and prostate cancer: Integrating a mind/body intervention with traditional therapies. Semin Urol Oncol 1999; 17:111-118.
• Kabat-Zinn J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. New York City: Dell; 1990.
• Santorelli, S. Heal Thyself: Lessons on Mindfulness in Medicine. New York City: Bell Tower, Random House; 1999.