Meditation: Just What the Doctor Ordered (For Themself and Their Patients)
Meditation is one of those tried and true therapeutic tools that we all have in the back of our heads and are perhaps routinely recommending to patients in your office. In this article, I’ll be examining the importance of your own self care through meditation as a health care provider. We’ll also look at the latest science and what researchers are seeing on advanced imaging of the brain in people who meditate, and we’ll also look at some of the latest research on groups of people who do not experience the widely touted benefits of meditation. And finally, we’ll explore some practical resources that can help learning and incorporating meditation into a daily routine, both yours and your patients, seamless.
A Time to Be Selfish
First, I want to address the need for tools that aim to help health care providers combat burnout. As natural medicine practitioners, most of us have not had the same experience as frontline medical professionals in the way of COVID-19 burnout. Most of us have not contemplated leaving our chosen professions because it is too overwhelming, nor have most of us been so exhausted that we’ve gone out to our car on our break in order to try to find the energy to go back into work and finish the shift, but ended up sitting and sobbing for 15 minutes (these are all stories I’ve heard from friends and colleagues). One Medscape survey of 7,500 physicians in the U.S. conducted late last year found that 64 percent reported experiencing more intense burnout than any other time in their career and 46 percent reported feeling lonelier and more isolated during the pandemic. We may not be in the same boat as those physicians and nurses, however, we all have our own stressors and we, as health care providers, have had to deal with significant extremes of the last year. And much like the idea that on a plane we have to put our own oxygen mask on before helping others, we have to take the steps to take care of ourselves in order to best care for others. Meditation is one of the tools that we might want to put at the top of the list to help us accomplish that.
Schools, such as Stanford and UMass (University of Massachusetts) Medical School, have long been advocating for mindfulness training for physicians because they have observed the amazing results in physician performance after implementing mindfulness/meditation techniques. Jill Wener, MD, who is said to be world renowned in the area of physician wellness, developed an entire meditation program specifically for doctors, which, due to the pandemic and associated strain on medical professionals, has garnered much attention over the past six months. And while I have not taken the course, the contents appear to address the very issues that the Medscape survey laid out. I would imagine most of the audience reading this article have had some level of training or exposure to meditation and would not necessarily need a step-by-step program in order to effectively implement meditation into your day. We simply need to make it a priority to actually do it.
When You Benefit, Your Patients Benefit
When meditation is part of your self care routine, your brain benefits in a myriad of ways, some of which seem to be tailored to health care practitioners, and there is compelling functional MRI imagery that tells the story. There was data published in Brain and Cognition in March 2020 focusing on 34 healthy subjects.1 The first group consisted of 19 people who meditated for 40 minutes per day (the standard Transcendental Meditation protocol) and the second group of 15 people who did not meditate at all. Each participant completed a psychometric questionnaire, which provided a measure of their anxiety and stress levels and had a fMRI exam to establish their brain’s activity at baseline. Each subject then underwent the same series of tests three months into the study and then once more after the conclusion of the study. In terms of the surveys, the perceived stress and anxiety levels in the meditation group were “significantly lower” than the control. Interestingly, in the meditation group there were specific changes in functional connectivity occurring between different cerebral areas, including the precuneus, left parietal lobe and insula. I don’t know about you but it’s been a while since my CNS course in school, so I needed to revisit the specific roles these areas of the brain play in terms of functionality. The precuneus is activated when people “put themselves in other people’s shoes” and practice empathy and forgiveness. It’s also heavily involved in episodic memories and working memory.
The insula cortex is also involved in emotions, including empathy, as well as the level of emotional intelligence and self-awareness one possesses. There has been extensive research done on the insula cortex and how it differs structurally in those who meditate; two major differences are the thickness of the cortex in those who meditate and the increase in grey matter in that part of the brain in those who meditate.
In addition to the neurological implications, meditation has also been shown to improve cardiac output. One study, published in September 2019 looked at PET imaging to analyze how Transcendental Meditation affected patients who had been diagnosed with coronary heart disease. That data, published in the Journal of Nuclear Cardiology, found that subjects who incorporated meditation into their cardiac rehab protocol actually increased their cardiac blood flow by more than 20 percent.2
So what we’re looking at here is heightened empathy, better working memory, a greater amount of grey matter and better cardiac output—smarter, more energy and more empathetic; what more could a patient want in their health care provider?
A quick side note on Transcendental Meditation (TM): The TM organization has spearheaded a great deal of research (388 articles in 160 journals) and has taught us a great deal about the physiological impact of meditation on just about every system in the body. It is worth noting that there are those who have strong opinions about TM; not necessarily all positive (some have claimed that it is a cult, a scam and wildly overpriced—it is expensive); you may be one of them. This article is not advocating for anyone to practice TM; I am simply using the most compelling data that has been published on the benefits of meditation. And while I did get trained in TM, I advocate for whatever technique, program, app etc. that people connect with, as there is substantial research that has been done on other techniques and even apps, as you’ll see in the following sections of this article.
The (Timely) Immune Benefits of Meditation
In addition to brain and heart health, the benefit that meditation has on the immune system has been well documented as well. Again, immune support is not just for your patients, but is at the forefront of self-care for health care providers as well. And conveniently enough, there is some research that has been conducted on subjects who had been vaccinated and then biomarkers measured in those who meditated vs. those who didn’t. This study, using Mindfulness-Based Stress Reduction (MBSR), which differs from TM as TM is a mantra meditation technique and MBSR is a technique that allows for moment-to-moment awareness of thoughts, feelings, bodily sensations, and surroundings without judgement. The article, which is older but yields good data, was published in 2003 in Psychosomatic Medicine. It looked at 25 subjects that were included in the meditation group and a wait-list control group (N = 16). Brain electrical activity was measured before and immediately after, and then four months after an eight-week training program in mindfulness meditation. These two groups were tested at the same points and at the end of the eight-week period, subjects in both groups were vaccinated with influenza vaccine and then tested at four months. The researchers found “significant increases in antibody titers to influenza vaccine among subjects in the meditation compared with those in the wait-list control group.”3 I revisited this study for this article primarily because of the position we find ourselves and our patients in relative to the COVID vaccine. I think we can all agree that as the vaccine roll out continues, we want to maximize efficacy for ourselves and our patients and this study demonstrates that meditation can help us accomplish that.
As far as additional studies in this area, looking at a wider variety of biomarkers, in 2016, a comprehensive review of randomized controlled trials was published in the Annals of New York Academy of Sciences relative to MBSR and immune function.4 A total of 20 randomized controlled trials met the inclusion criteria. It’s a well written review that contains a great deal of information on immune function and the impact of MBSR. For further information, substantiation and information for patients, that study may be a decent resource.
Meditation Alone May Not Be Customer Service Friendly
When it comes to your patients, there may be specific cases where mindfulness meditation may not yield as much improvement on performance as much of the research has indicated. In March 2021, the Harvard Business Review published an article that outlined the research they conducted and had published in the Journal of Applied Psychology.5 What they were looking at was how mindfulness meditation impacted performance in the customer service sector, specifically in the areas of banking, health care, finance, sales and consulting. It was noted that most research to date that has been conducted on the effect on performance has been done in a lab setting or therapy setting. The customer service work environment, it turns out, has some unique aspects that made heightened awareness and mindfulness more of a burden than a benefit. 1,700 employees were surveyed and one of the key questions they asked related to how often they faked emotions on the job, since we hypothesized that the unpleasant experience of faking emotions could limit the benefits of being mindful. What they found, consistently, was “employees whose jobs frequently required them to display inauthentic emotions, greater levels of mindfulness consistently led to lower self-control and lower overall performance.” Ironically, one of the techniques they recommended for counteracting the potentially negative effect was referred to as “deep acting.” This is the opposite of “surface acting,” which essentially is faking emotions; deep acting is, in short, putting yourself in other people’s shoes. And if we remember the precuneus and insula are implicated in that very concept, we can see how guiding our patients in these fields to pair mindfulness with additional training in deep acting may be an effective approach to maximize performance.
Top Meditation Apps For You & Your Patients
While this is far from a comprehensive review of these apps, I’ll touch on some high points that will hopefully give some degree of guidance as to what to use for yourself and what to recommend to your patients. Headspace and Calm are consistently at the top of any “best of” list of meditation apps. Both cost around $13 per month and both have clinical studies to back their efficacy.
Headspace
Great overall mediation app that caters to all levels of meditator. It’s 100 percent guided and has an explanation with every meditation. And it’s been said that if you aren’t one of those people who like “frills” or like to take the time to explore an app, this would more than likely be the one to lean toward.
Research: Headspace currently boasts 25 published studies demonstrating its efficacy. Among the most impressive was a 14 percent reduction of stress after 10 days of using the app and another study at Northeastern University that found that 10 days also resulted in a 57 percent decrease in aggression.6,7
Calm
Also guided in its meditations, but has a number of unique features, such as the bedtime stories, celebrity-guided exercises (such as Matthew McConaughey and Laura Dern) and has a terrific section for kids. In terms of the user experience, it has a very goal-oriented feel to it—achieving better sleep, less anxious thoughts, heightened focus, etc., and it backs up the commitment to helping you achieve those goals with daily recommendations (that are realistic for most anyone).
Research: With a lesser number of studies published on this app (three vs. Headspace’s 25), the results are no less impressive. One study focused on stress improvement, and another actually looked at the Calm app reducing fatigue in cancer patients.8,9
Bottom Line (TLDR)
With the year we’ve had, the stress we’ve been under and the changes we’ve endured, a therapeutic tool like meditation is something that should be considered as a primary care approach for everyone (with additional guidance for those who may work in environments where mindfulness hasn’t been shown to help people thrive). Self-care through meditation could set you up to bring the best to your patients by supporting specific regions of the brain that promote empathy, memory, self-awareness and emotional intelligence. Immune support through meditation could not come at a better time, especially during the largest vaccination roll out in modern history. If there is a need for a program that is effective and less costly than a program such as TM, Headspace and Calm are two viable options that are evidence based and user friendly.
References:
1 Guilia, A, et al. Reductions in perceived stress following Transcendental Meditation practice are associated with increased brain regional connectivity at rest. Brain and Cognition. Volume 139, March 2020.
2 Bokhari, S., Schneider, R.H., Salerno, J.W. et al. Effects of cardiac rehabilitation with and without meditation on myocardial blood flow using quantitative positron emission tomography: A pilot study. J. Nucl. Cardiol. (2019).
3 Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli SF, Urbanowski F, Harrington A, Bonus K, Sheridan JF. Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med. 2003 Jul-Aug;65(4):564-70.
4 Black DS, Slavich GM. Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Ann N Y Acad Sci. 2016;1373(1):13-24.
5 Lyddy, C. J., et al.The costs of mindfulness at work: The moderating role of mindfulness in surface acting, self-control depletion, and performance outcomes. Journal of Applied Psychology. 2021.
6 Economides, M., Martman, J., Bell, M.J. et al. Improvements in Stress, Affect, and Irritability Following Brief Use of a Mindfulness-based Smartphone App: A Randomized Controlled Trial. Mindfulness 9, 1584–1593 (2018).
7 Desteno, D., Lim, D., Duong, F., & Condon, P. Meditation inhibits aggressive responses to provocations. Mindfulness, 9(4), 1117-1122. (2018).
8 Huberty J, Green J, Glissmann C, Larkey L, Puzia M, Lee C. Efficacy of the Mindfulness Meditation Mobile App “Calm” to Reduce Stress Among College Students: Randomized Controlled Trial. JMIR Mhealth Uhealth. 2019;7(6):e14273. Published 2019 Jun 25.
9 Huberty J, Eckert R, Larkey L, Joeman L, Mesa R. Experiences of Using a Consumer-Based Mobile Meditation App to Improve Fatigue in Myeloproliferative Patients: Qualitative Study. JMIR Cancer 2019;5(2):e14292.
Adam Killpartrick, DC, CNS, CKNS, DACBN is widely-recognized as a leading authority in the dietary supplement industry. His expertise is derived from his extensive work within the supplement industry at all levels, ranging from his start as a clinical consultant for Biotics Research and progressing to the level of chief science officer and leadership executive at FoodScience Corporation, where he oversaw all research and product development for their complete portfolio of brands in both the human and pet divisions. He has had numerous peer reviewed publications on his innovations in the area of novel protein based nutrient delivery systems for poorly absorbed nutrients, including DIM and glutathione. He has also co-authored chapters in multiple food science and functional food textbooks. Dr. Killpartrick has currently shifted his focus to his private functional medicine practice and projects involving food science and nutrient analytics. He currently holds certifications as a Functional Medicine Practitioner, a Certified Nutrition Specialist, a Certified Ketogenic Nutrition Specialist as well as his Diplomate through the American Clinical Board of Nutrition.
