Exploring the Effects of Yoga and Mindfulness Meditation Practice on Modulating Stress Responses and Long Term Health Outcomes

Exploring  the  Effects  of  Yoga  and  Mindfulness  Meditation  Practice on  Modulating  Stress  Responses  and  Long-­‐Term  Health  Outcomes   Stress  Mechanisms     Introduction    The  body  responds  to  stressful  experiences  through  multiple   signaling  systems  that  have  evolved  to  manage  perceived  threats  to   survival.  However,  in  human  society  the  “gight  or  glight”  response   may  be  engaged  in  situations  non-­‐threatening  to  life  [1].  Some   stressful  activation  of  these  response  mechanisms,  which  include   the  HPA  axis  and  inglammatory  pathways—may  be  positive  or   tolerable.  Through  allostasis—the  process  of  achieving  stability  or   homeostasis  through  physiological  or  behavioral  change—these   mechanisms  respond  to  manage  these  non-­‐acute,  short-­‐term   stressors.  The  experience  of  toxic  stress,  however,  places  acute  and   often  chronic  demands  on  stress  signaling  and  includes  such   stressors  as  discrimination,  emotional  and  physical  abuse,  and  living   with  a  chronic  illness.  All  these  have  been  linked  to  major  causes  of   adult  morbidity  and  mortality,  including  cardiovascular  disease,   obesity,  cancer,  and  anxiety-­‐related  disorders  [2,3,4]. Why  Mindful  Meditation  and  Yoga?    Mindfulness  Meditation  (MM)  and  Yoga  are  mind-­‐body  disciplinary   practices    originating  in  Buddhist  and  Hindu  contemplative  traditions  and   known   to   modulate   autonomic   nervous   system   function,   particularly   through  attention  to  the  breath.     Integration  with  Western  Medicine        In  recent  decades,  MM  and  yoga  have  been  popularized  in  the  West   as   forms   of   preventative,   low-­‐cost,   and   wellness-­‐based   complementary   therapies  that  mitigate  the  effects  of  chronic  stress.  Several  studies  indicate   that   these   practices   offer   physiological   and   psychological   benegits   including:   ²  Self-­‐reported  decreases  in  stress  and  anxiety   ²  Improved  cognitive  functioning   ²  Cardiovascular  health   Future  Research   ²   Despite   burgeoning   interest   in   the   stress-­‐reducing   effects   of   MM   and   yoga,  most  studies  are  rife  with  methodological  problems   ²   Focus   should   be   placed   on:   increasing   sample   size,   teasing   out   variations   in   quantity   and   qualities   of   MM   and   Yoga   practice,   standardizing  biomarker  collection  procedures  and  control  groups.     Mindfulness  Meditation  as  a  Path   to  Stress  Reduction       What  is  Mindfulness  Meditation  (MM)?   The  Hypothalamic-­‐Pituitary-­‐Adrenal  (HPA)  Axis   ²  Responsible  for  the  “gight  or  glight”  response   ²  Its  hormone  signaling  cascade  suppresses  reproductive,   digestive  and  immune  system  function   ²  Chronic  over-­‐activation  of  the  HPA  axis  causes  [2]   •  Decreased  immunity  and  digestive  function   •  Increased  production  of  pro-­‐inRlammatory  cytokines  (IL-­‐1,  IL-­‐6,   TNF-­‐α),  which  elicit  symptoms  of  anxiety/depression,  and  may   provoke  neuroendocrine  and  neurotransmitter  changes  that  are   interpreted  by  the  brain  as  being  stressors  (feedback)  [5]   •  High  blood  pressure  and  obesity   •  Decreased  hippocampal  volume  and  function—disruptive  of   learning,  memory  and  emotional  experience   ²  Glucocorticoid  cascade  hypothesis  [6]   •  Exposure  to  stress  hormones  reduces  cellsʼ  ability  to  resist   injury  and  attrition,  causing  them  to  be  damaged  or  die  at  an   increased  rate     •  Increased  rate  of  oxidative  stress  –  process  occurring  when   when  an  imbalance  occurs  between  the  production  of  free   radicals  and  a  cellʼs  antioxidant  capabilities   •  Thought  to  be  a  risk  factor  in  developing  several   neurodegenerative  diseases,  including  Parkinsonʼs  and   Alzheimerʼs  disease   ²  Mindfulness  is  the  non-­‐judgemental  drawing  of  oneʼs  attention  to   experiences/sensations  happening  in  the  present  moment,  often  beginning   with  awareness  of  oneʼs  breath  [1].   •  Mindfulness  meditation  (MM)  is  rooted  in  Buddhist  contemplative   traditions  that  cultivate  conscious  awareness  through  specigic,  mind-­‐ body  techniques  valuing  non-­‐judgement,  acceptance,  and  compassion.     •  This  mindfulness  framework  distinguishes  MM  from  other  activities   which  may  modulate  stress  only  through  induction  of  a  Relaxation   Response  [2].     !"#$%&'(&)&*+&,-./(-0(11( Many   c linical   [ 4]   a nd   c ommunity-­‐ 2.#%$)2.3(4&5&+672..8/(19!:(   based   [5]  meditation  programs     derive  from  Mindfulness-­‐based   stress  reduction  (MBSR)  [1,3]   developed  by  Dr.  Jon  Kabat-­‐Zinn  at   UMass  Medical  Center.   ²  Eight-­‐week  program   ²  Mindfulness  training,  seated   meditation,  mindful  yoga  and  body-­‐ scan,  home  assignments     Studies:  Self-­‐Reported  and  Bio-­‐indicators  of  Stress  Reduction   ²  Biomarkers:  A  2007  study  [4]  investigated  the  effects  of  participation   in  an  MBSR  program  on  self-­‐reported  stress  symptoms,  mood,  endocrine,   immune  and  autonomic  parameters  in  early  stage  breast  and  prostate   cancer  patients.  At  6-­‐  and  12-­‐month  follow-­‐up,  significant  improvements   in  symptoms  of  stress  were  found  and  maintained,  including:   •  A  reduction  in  cortisol  levels   •  A  reduction  in  pro-­‐inflammatory  cytokines   •  A  decrease  in  systolic  blood  pressure   •  Decreased  self-­‐reported  symptoms  of  stress   ²  Self-­‐reporting:  A  2010  study  [5]  considering  the  usefulness  of  MBSR  as   a  community-­‐based  practice  for  low-­‐income,  predominately  African   American  women  with  history  of  PTSD  and  Intimate  Partner  Violence   •  MBSR  was  much  more  accessible  than  psychiatric  PTSD  treatments   •  Women  reported  that  mindfulness  practices  reduced  day-­‐to-­‐day   stress,  promoted  self-­‐care,  sleep,  attention,  and  healing  from  trauma   Mindfulness  Meditation  and  Brain  Morphology   ²  Neuroimaging  studies  of  experienced  MM  practitioners  show  increased   hippocampal  and  right  anterior  insular  volume  and  prefrontal  cortical   thickness  (offsetting  age-­‐related  cortical  thinning)  [6,7]. The  Role  of  Yoga  in  Stress  Relief   What  is  Yoga?     ²  Means  “to  unite”  or  “to  unify”     ²  Aims  to  integrate  the  mind,  body  and  spirit   ²Six  main  branches  –  Hatha  yoga  most  popular  in  the  West     •  Places  the  most  focus  on  balancing  mind  and  body   •  Achieved  through  physical  poses  (“asanas”),  breathing   techniques  (“pranayama”),  and  meditation.  [1]   Studies     The   focus   on   mind-­‐body   integration   distinguishes   yoga   practice   from   other   forms   of   physical   exercise   and   may   also   explain   the   wide   range   of   its   effects   on   those   with   conditions   stemming   from   chronic   stress.     1.  Effects  on  coronary  risk  factors  (all  exacerbated  by  chronic  stress)  –   2003  review  [2]   ²  As  effective  as  controlling  blood  pressure  pharmacologically    in   hypertensive  subjects   ²   Helped   restore   baroreglexes   –   the   homeostatic   mechanism   to   maintain  blood  pressure  –  to  a  normal  state   ²  Improved  serum  lipid  progiles  and  weight  management   ²  Decreased  urinary  excretion  of  adrenaline  and  noradrenaline   ²  Increased  cortisol  excretion   2.  Effects  on  anxiety  –  2005  study  [3]   ²   Self-­‐reported   distressed   women   put   into   three-­‐month   Hatha   yoga   intervention  program     ²  Depression  and  anxiety  reduced  by  50%  and  30%,  respectively     ²Back  pain  and  frequent  headaches  completely  eliminated   Proposed  Mechanisms  of  Action       The   benegits   derived   from   yogic   practice   may   be   due   to   the   repetition  of  postures  and  slowed  breathing,  which  both  stimulate  the   relaxation   response   and   other   physiological   changes.   Slowed   and   metered  breathing  re-­‐synchronizes  inherent  cardiovascular  rhythms,  a   phenomenon   observed   in   people   reciting   mantras   or   the   Holy   Rosary,   and   the   postures   repeatedly   occlude   and   open   peripheral   vessels,   altering  blood  glow  and  changing  endothelial  function.  As  a  result,  nitric   oxide,  a  cellular  signaling  molecule  involved  in  cytokine  production,  is   decreased.   The   relaxation   induced   from   yoga   may   also   stimulate   the   production  of  endogenous  opiates  and  cannabinoids.  [4]   Conclusions   ²  Mind-­‐body  techniques  of  Mindfulness  Meditation  and  Yoga  have   salutary  effects  being  researched  with  increasing  sophistication  in   relation  to  self-­‐reported  and  bio-­‐markers  of  stress   ²  Yoga  and  MM  are  unique  from  regular  exercise  and  practices  merely   eliciting  relaxation,  due  to  breath-­‐centeredness  and  rigorous   mindfulness   ²  Many  risk  factors  for  stress-­‐related  morbidity  and  mortality  can  be   reversed  or  minimized  through  lifestyle  changes  including  MM  and  yoga   ²  Yoga  and  MM  are  associated  not  only  with  biochemical  mechanisms   of  stress  reduction  (increasingly),  but  also  with  self-­‐reported  decreased   distress,  and  with  greater  sense  of  control  and  quality  of  life Stress  and  “Why?”  References   [1]  Boyce,  T.  &  Ellis,  B.  Biological  sensitivity  to  context:  I.  An   evolutionary–  developmental  theory  of  the  origins  and   functions  of  stress  reactivity.  Development  and   Psychopathology.  2005;  17,  271-­‐301.     [2]  McEwan,  B.  Physiology  and  Neurobiology  of  Stress  and   Adaptation:  Central  Role  of  the  Brain.  Physiol  Rev  2007;  87:   873–904.         [3]  Felitti  V,  et  al.  Relationship  of  Childhood  Abuse  and   Household  Dysfunction  to  Many  of  the  Leading  Causes  of   Death  in  Adults:  The  Adverse  Childhood  Experiences  (ACE)   Study.  American  Journal  of  Preventive  Medicine.  1998;  14(4).     [4]  Friedman  MJ,  McEwen  BS.  Posttraumatic  stress  disorder,   allostatic  load,  and  medical  illness.  In:  Schnurr  PP,  Green  BL,   eds.  Trauma  and  health:  Physical  health  consequences  of   exposure  to  extreme  stress.  Washington,  DC,  US:  American   Psychological  Association;  157-­‐188.     [5]  Anisman  H,  Merali  Z.  Cytokines,  stress  and  depressive   illness:  brain-­‐immune  interactions.  Annals  of  Medicine.   2003;35(1):2-­‐11.     [6]  Pratico  D.  Oxidative  stress  hypothesis  in  Alzheimerʼs   disease:  a  reappraisal.  Trends  Pharmacol  Sci.  2008;  29(12): 609-­‐615.         Mindfulness  Meditation  References   [1]  Kabat-­‐Zinn,  J.  et  al.  Effectiveness  of  a  meditation-­‐based  stress  reduction   program  in    the  treatment  of  anxiety  disorders.  American  Journal  of  Psychiatry.   1992;149,936-­‐43.         [2]  Dobkin,  P.  and  Zhao,  Q.  Increased  Mindfulness—The  active  component  of  the   mindfulness—based  stress  reduction  program?    Complementary  Therapies  in   Clinical  Practice.  2011;17,22-­‐27.     [3]  Carmody,  et  al.    Invited  Commentary:  evolving  conceptions  of  mindfulness  in   clinical  settings.  Journal  of  Cognitive  Psychotherapy.  2009;23,  270-­‐80.     [4]  Carlson  LE,  et  al.  One  year  pre–post  intervention  follow-­‐up  of  psychological,   immune,  endocrine  and  blood  pressure  outcomes  of  mindfulness-­‐based  stress   reduction  (MBSR)  in  breast  and  prostate  cancer  outpatients.  Brain,  Behavior,   and  Immunity.  2007;21(8):1038-­‐1049.       [5]  Dutton,  et  al.  Mindfulness-­‐Based  Stress  Reduction  for  Low-­‐Income,   Predominantly  African  American  Women  With  PTSD  and  a  History  of  Intimate   Partner  Violence.  Cognitive  and  Behavioral  Practice.  2011       [6]  Hölzel  BK,  et  al.  Mindfulness  practice  leads  to  increases  in  regional  brain   gray  matter  density.  Psychiatry  Research:  Neuroimaging.  2011;  191(1):36-­‐43.       [7]  Lazar,  S.  et  al.  Meditation  experience  is  associated  with  increased  cortical   thickness.  Neuroreport.  2005;  16(17):  1893–1897.         Yoga  Section  References   [1]  NCCAM  publication.  Yoga  for  health:  an  introduction  NCCAM   Publication  2008;  Pub  D412.       [2]   Jayasinghe   SR.   Yoga   in   cardiac   health   (a   review).   Eur   J   Cardiovasc  Prev  Rehabil.  2004;  11(5):  369-­‐375.       [3]   Michalsen   A,   Grossman   P,   Aycil   A,   Langhorst   J,   Lüdtke   R,   Esch   T,     Stefano   GB,   Dobos   GJ.   Rapid   stress   reduction   and   anxiolysis   among   distressed   women   as   a   consequence   of   a   three-­‐month   intensive   yoga   program.   Med   Sci   Mont.   2005;   11 (12):  CR555-­‐561.       [4]West   J.   Otte   C.   Gher   K.   Johnson   J.   Mohr   DC.   Effects   of   Hatha   Yoga  and  African  Dance  on  Perceived  Stress,  Affect  and  Salivary   Cortisol.  Ann  Beh  Med.  2004;  28(2):  114-­‐118.