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Effects of mindfulness meditation on serum cortisol of medical students

  • Srinakharinworot University, Bangkok, Thailand


Mindfulness meditation is a method to relax the mind that decreases stress, which otherwise would increase serum cortisol. So, mindfulness meditation should decrease serum cortisol. To study the effect of mindfulness meditation on mental health by using Thai GHQ28 questionaire and study the effect of mindfulness meditation on stress by using serum cortisol. Volunteer subjects were 30 second year medical students, aged 19.1 +/- 0.55 year olds (range 18-20) from Srinakharinwirot University. They were screened by Thai GHQ28 and blood was drawn to measure cortisol at 8:00 am before and after a four-day mindfulness meditation programme. The comparison of Thai GHQ28 scores and serum cortisol levels before and after meditation were analysed by paired t-test. The subjects were 66.77% female and 33.33% male. The average score of Thai GHQ28 before and after the mindfulness meditation was 1.50 (SD 2.53) and 0.77 (SD 2.08) respectively. The average serum cortisol levels before mindfulness meditation was 381.93 nmol/L (SD 97.74) becoming significantly lower after mindfulness meditation 306.38 nmol/L (SD 90.95). The difference was statistically significant in cortisol level, but not statistically significant in Thai GHQ28. Mindfulness meditation lowers the cortisol levels in the blood suggesting that it can lower stress and may decrease the risk of diseases that arise from stress such as psychiatric disorder, peptic ulcer and migraine. Then, mindfulness meditation should be used in combination with standard treatment.
S90 J Med Assoc Thai Vol. 96 Suppl. 1 2013
Correspondence to:
Turakitwanakan W, Department of Psychiatry, Faculty of Medi-
cine, Srinakharinvirot University, 62 Moo 7, Ongkharak, Nakhon
Nayok 26120, Thailand.
Phone: 037-395-085 ext. 80705
J Med Assoc Thai 2013; 96 (Suppl. 1): S90-S95
Full text. e-Journal:
Effects of Mindfulness Meditation on Serum Cortisol
of Medical Students
Wanpen Turakitwanakan MD*,
Chantana Mekseepralard PhD**, Panaree Busarakumtragul PhD***
* Department of Psychiatry, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
** Department of Microbiology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
*** Department of Physiology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
Background: Mindfulness meditation is a method to relax the mind that decreases stress, which otherwise would increase
serum cortisol. So, mindfulness meditation should decrease serum cortisol.
Objective: To study the effect of mindfulness meditation on mental health by using Thai GHQ28 questionaire and study the
effect of mindfulness meditation on stress by using serum cortisol.
Material and Method: Volunteer subjects were 30 second year medical students, aged 19.1 + 0.55 year olds (range 18-20)
from Srinakharinwirot University. They were screened by Thai GHQ28 and blood was drawn to measure cortisol at 8:00 am
before and after a four-day mindfulness meditation programme. The comparison of Thai GHQ28 scores and serum cortisol
levels before and after meditation were analysed by paired t-test.
Results: The subjects were 66.77% female and 33.33% male. The average score of Thai GHQ28 before and after the
mindfulness meditation was 1.50 (SD 2.53) and 0.77 (SD 2.08) respectively. The average serum cortisol levels before
mindfulness meditation was 381.93 nmol/L (SD 97.74) becoming significantly lower after mindfulness meditation 306.38
nmol/L (SD 90.95). The difference was statistically significant in cortisol level, but not statistically significant in Thai GHQ28.
Conclusion: Mindfulness meditation lowers the cortisol levels in the blood suggesting that it can lower stress and may
decrease the risk of diseases that arise from stress such as psychiatric disorder, peptic ulcer and migraine. Then, mindfulness
meditation should be used in combination with standard treatment.
Keywords: Mindfulness meditation, Thai GHQ28, Cortisol
Mindfulness meditation practices have been
examined for their health benefits and used as a
technique to increase longevity(1). Some scientific
attention has focused on the effects of mindfulness
meditation on stress and serum cortisol level which
regulate the stress pathways including hypothalamic-
pituitary-adrenal axis which functions by releasing
corticotrophin-releasing hormone (CRH) from the
hypothalamus to stimulate the pituitary gland to release
adrenocorticotropic hormone (ACTH). Then, ACTH
stimulates the adrenal cortex to release cortisol. The
activation of this stress pathway from psychological
stressors as well as physical stressors(2) stimulates
noradrenalin secretion(3). Both pathways cause several
physiological changes. For example, changes in
cortisol, ACTH and noradrenalin in the blood stream
activate the sympathetic system resulting in an increase
in pulse rate and blood pressure(4,5) which can cause
hypertension. Cortisol is the most prominent
glucocorticoid synthesized from the cholesterol
precursor in the adrenal cortex. Cortisol levels changes
with time according to diurnal variation, having the
highest level in the early morning(6). Plasma cortisol
levels are increased by stress from infection, fever,
prolonged strenuous exercise, and acute anxiety(7).
Previous research have found that persons
who always practice mindfulness meditation have lower
stress(8). So the present study was a before-after with
one comparison group study to investigate whether a
four consecutive day mindfulness meditation course
has any effect on mental health and serum cortisol level
in trainees. Therefore, the authors report the effect of
meditation on mental health by using Thai GHQ28 and
on stress by using serum cortisol.
Material and Method
Study design and participants
The present study was approved by the
J Med Assoc Thai Vol. 96 Suppl. 1 2013 S91
Human Ethics Committees of the Faculty of Medicine,
Srinakharinwirot University, Bangkok, Thailand. All
subjects signed informed consent prior to the study.
The present study group consisted of 30 male and
female second-year medical students. The inclusion
criteria included absence of psychiatric disease, not
being afraid of taking blood sample and having no
history of endocrine disorder. Subjects unable to take
the complete course or to adjust to living in a temple
were also excluded. Before the meditation practice, the
procedure was explained to the students. Firstly, they
were tested by Thai GHQ28 and blood was drawn
for cortisol measurements at 8:00 am. Then, they
required to practice the mindfulness meditation course
at the Sunanthavanaram temple, which consists of
mindfulness meditation for four hours during three
periods (5:30-6:30, 11:00-12:00, 19:00-21:00) mentored
by experienced monks during four days. The meditation
focussed the attention on the breathing in a state of
mindfulness(9). The method consists in observing the
breath as it enters and leaves the nostrils, and at the
same time, trying to notice any sensations felt at the
points of entry and exit. The sensation may be felt
close to the tip of the nose or lips. After completion of
the course, subjects were tested by Thai GHQ28 and
blood was drawn for cortisol measurements at 8:00 am.
Thai general health questionnaire 28 (Thai GHQ-
28) All subjects were assessed in their mental
health using thai general health questionnaire 28 (Thai
GHQ-28). It is a multiple-choice questionnaire to
examine the mental health of Thai subjects developed
by Dr. Thana Nilchaikovit(10) from the psychiatric
department, Faculty of Medicine, Ramadhibodi
Hospital, Mahidol University. This questionnaire was
developed from GHQ, Goldberg 1972(11). This test
consists of 28 items concerning somatic symptoms,
anxiety and insomnia, social dysfunction and severe
depression. Each item consists of 4 choices involving
the severity of symptoms (0-0-1-1). A score > 6 is
considered abnormal. From the research, The General
Health Questionnaire is a widely used screening
instrument(12). We found that Thai GHQ28 can
discriminate mental distress. In the Thai version, the
reliability coefficient (Alpha) is 0.84, Thai GHQ28 has a
sensitivity of 78.7%, a specificity of 89.7% and accuracy
of 87%.
Blood cortisol determination
The volume of 4 mls of venous blood samples
were drawn from the antecubital vein of subjects. Blood
was collected at 8:00 am for all subjects. Serum cortisol
levels were assayed by Electro chemi luminescense
immuno-assay (ECLIA) following the manufacturer’s
The first incubation: 20 μL of sample is
incubated with a cortisol-specific biotinylated antibody
and a ruthenium complex labeled cortisol derivative.
Depending on the concentration of the analyte in the
sample and the formation of the respective immune
complex, the labeled antibody binding site is occupied
in part with sample analyte and in part with ruthenylated
hapten. The second incubation: After addition of
streptavidin-coated microparticles, the complex
becomes bound to the solid phase via interaction of
biotin and streptavidin.
The reaction mixture is aspirated into the
measuring cell where the microparticles are magnetically
captured onto the surface of the electrode. Unbound
substances are then remove with ProCell. Application
of a voltage to the electrode.
Then induce chemiluminescent emission
which is measured by a photomultiplier.
Results are determined via a calibration curve
which is instrument-specifically generated by 2-point
calibration and a master curve provided via the reagent
The mindfulness meditation method
Mindfulness has been described as “paying
attention in a particular way: on purpose, in the present
moment, and non-judgementally”. The mindfulness
meditation method in the present study consists of
observing the breath as it enters and leaves the nostrils,
and at the same time, trying to notice any sensations
felt at the points of entry and exit. The sensation
may be felt close to the tip of the nose or lips. The goal
of mindfulness meditation is to reach a state of
thoughtless awareness, during which a person is
passively aware of sensations at the present moment.
In the present study, the subjects meditated under
the mindfulness meditation courses of the
Sunanthavanaram temple in Kanjanaburi, the western
part of Thailand. This temple holds the famous
meditation courses which are taught and mentored by
well known buddhist monks or supervisors.
Statistical analysis
The descriptive statistics were presented with
percentage, mean, and standard deviation. The
S92 J Med Assoc Thai Vol. 96 Suppl. 1 2013
association between demographic background and
serum cortisol level or Thai GHQ28 scores were
analysed by independent t-test. The comparison of
the Thai GHQ28 scores and serum cortisol level before
and after mindfulness meditation course were analysed
by paired t-test. Value were considered to be statistical
significance when p-value < 0.05.
Subject characteristics
The demographic data of subjects are shown
in Table 1. There are no statistical significance
association between demographic background and
Thai GHQ28 or serum cortical level (data not shown).
Psychological assessment
All subjects had completed Thai GHQ28 test
(100%). The average Thai GHQ 28 score of the 30
students before the meditation practice was 1.50 (SD =
2.53). After the meditation practice, the average score
was 0.77 (SD = 2.08). This showed that the average
Thai GHQ 28 score of the 30 students before the
meditation practice was higher than the average Thai
GHQ 28 score of the 30 students after the meditation
practice but it was not statistical significant.
Cortisol assessment
The average serum cortisol level of the 30
students before the meditation practice was 381.93
nmol/L (SD = 97.94). After the meditation practice, the
average serum cortisol level was 306.38 nmol/L (SD =
90.95) as shown in Fig. 1. This shows that the average
serum cortisol level of the 30 students before the
Fig. 1 Comparison of the serum cortisol before and after
the meditation practice
Factor Number Percent
Male 10 33.33
Female 20 66.67
Age (year) 19.1 + 0.55 (range 18-20)
Parent status
Couple 26 86.70
Divorce/widow 4 13.30
Income (bath)
< 10,000 6 20.00
10,000-30,000 10 33.30
30,000-50,000 8 26.70
> 50,000 6 20.00
No 30 100.00
Yes 0 0.00
Alcohol drinking
No 26 86.70
Yes 4 13.30
Underlying disease
No 28 93.30
Yes 2 6.70
Stressor in previous month
No 6 20.00
Yes 24 80.00
No 24 80.00
Yes 6 20.00
Relationship with parent
Very good 18 60.00
Good 10 33.30
Moderate 2 6.70
Relationship with teacher
Very good 6 20.00
Good 17 56.70
Moderate 7 23.30
Relationship with friend
Very good 12 40.00
Good 16 53.30
Moderate 2 6.70
Relationship with sibling
Very good 18 60.00
Good 10 33.30
Moderate 2 6.70
Table 1. Demographic data of all subjects
meditation practice was higher than after the meditation
practice with statistical significant (p < 0.05).
The present study found that Thai GHQ28
score of Thai medical students decreased after the four
J Med Assoc Thai Vol. 96 Suppl. 1 2013 S93
consecutive days of mindfulness meditation practice
in agreement with previous studies(13-15). The reason
explaining the beneficial effect of mindfulness
meditation is known and is believed to make the mind
peaceful and relaxed(16), and stop all thinking activated
by external stimuli that cause nervous, anxiety, exciting,
stress, and discomfort. However, the paired t-test
indicated that there was no significant difference of
Thai GHQ28 score between pre-and post-meditation.
The post-meditation levels of serum cortisol were
significantly lower as revealed by the paired t-test
(p < 0.05) in agreement with previous studies(17,18). A
recent research(19) concluded that there is accumulating
evidence that plasma and salivary cortisol can be
reduced by mindfulness meditation. Several studies
have looked at immune parameters. In patients with
cancer, mindfulness meditation tended to restore
cytokine levels and natural killer cell activities toward
normal levels(20,21). In healthy people, meditation
increased the antibody titer to influenza vaccine(22),
lowered the stress-induced increase in interleukin-6(23)
and decreased C-reactive protein(24). In addition, a
person who practice meditation has a lower rise in
cortisol levels compared to whom that does not
practice(23,25). In other words, any causes which are out
of our control and not related to our intervention may
be occurred in place, such as relaxation by listening
the flavorite song, drinking black tea(26) or coffee(27),
exercise, sleep deprivation(28), and diet restriction(29).
More rigorous designs should be used to establish a
cause-effect relationship and a randomized controlled
trial in which the control group receives some other
form of mind-body training may suit the purpose. Further
research with rigorous design including long-term
follow-up periods are needed to address the questions
about the role of the mindfulness meditation in clinical
Mindfulness meditation lowers the cortisol
levels in the blood suggesting that it can lower stress
and may decrease risk of diseases that arise from stress,
such as psychiatric disorder, peptic ulcer and
migrainous headache. Then, meditation should be used
in combi-nation with standard treatment.
The present study was funded by HRH
Princess Maha Chakri Sirindhorn Medical Center,
Ongkharak campus, Faculty of Medicine, Srinakharin-
wirot University, Nakhon Nayok, Thailand. The authors
wish to thank the abbot and monks of the forest temple
Sunanthavanaram, and the second year medical
students that participated in this project.
Potential conflicts of interest
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J Med Assoc Thai Vol. 96 Suppl. 1 2013 S95
วันเพ็ญ ธุรกตต์วัณณการ, จันทนา เมฆสประหลาด, ภนาร บุษราคมตระกูล
ภูมิหลัง: การนั่งสมาธิเป็นวิธีผ่อนคลายและลดความเครียด ความเครียดทำให้ระดับคอร์ติซอลในเลือดเพิ่มขึ้น
ดังนั้นการนั่งสมาธิช่วยลดความเครียด จึงช่วยลดระดบคอร์ติซอลในเลือด
วัตถุประสงค์: เพื่อศึกษาผลของการนั่งสมาธิต่อสุขภาพจิตโดยใช้ Thai GHQ28 และเพื่อศึกษาผลของการนั่งสมาธ
วัสดุและวิธีการ: กลุ่มตัวอย่างเป็นนักศึกษาแพทย์ ชั้นปีที่ 2 จำนวน 30 คน อาย 19.1 + 0.55 ปี (18-20 ปี)
จากคณะแพทยศาสตร์ มหาวิทยาลัยศรีนครินทรวิโรฒ ทำแบบทดสอบสุขภาพจิต Thai GHQ28 และเจาะเลือด
เพื่อดูระดับคอร์ติซอลเวลา 8.00 . ก่อนและหลังนั่งสมาธิตามโปรแกรมของวัดครบ 4 วัน วิเคราะห์ทางสถิติด้วยวิธี
paired t-test
ผลการศกษา: กลุ่มตวอยางเปนเพศหญิง 66.77% และเพศชาย 33.33% คะแนน Thai GHQ28 ก่อนนั่งสมาธ เทากับ
1.50 (SD 2.53) และหลงนั่งสมาธครบ 4 วันเทากับ 0.77 (SD 2.08) เมื่อนำมาวเคราะหทางสถิติด้วยวิธี paired t-
test พบว่าไม่มีนัยสำคัญทางสถิติ ระดับคอร์ติซอลในเลือดก่อนนั่งสมาธิเท่ากับ 381.93 nmol/L (SD 97.74)
หลังนั่งสมาธิครบ 4 วัน เท่ากับ 306.38 nmol/L (SD 90.95) เมื่อนำมาวิเคราะห์ค่าทางสถิติด้วยวิธี paired t-test
พบวามีนัยสำคญทางสถิติ (p < 0.05)
สรุป: การนั่งสมาธิช่วยลดระดับคอร์ติซอลในเลือด แสดงว่าการนั่งสมาธิช่วยลดความเครียด ซึ่งเป็นสาเหตุให้เกิดโรค
หลายโรค ได้แก่ โรคทางจิตเวช, โรคกระเพาะอาหาร, โรคปวดศีรษะไมเกรน จึงควรใช้การทำสมาธิ เป็นวิธีเสริมเพิ่ม
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... One meta-analysis reported that mindfulness does not significantly change cortisol level (Carlson, Speca, Faris, & Patel, 2007;O'Leary, O'Neill, & Dockray, 2016). On the other hand, in some studies mindfulness mediation is significantly associated with decreases in blood cortisol levels (Lengacher et al., 2019;Turakitwanakan, Mekseepralard, & Busarakumtragul, 2013). However, cortisol and IL-6 are positively associated with depression, anxiety and sleep disorders. ...
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OBJECTIVE: Mental stress is a major risk factor of metabolic diseases and impairs quality of life in the elderly. The goal of this study was to investigate whether a mindfulness-based intervention can improve health parameters and reduce stress-related hormones in elderly Thais. METHODS: A total of 192 participants were recruited from urban (n = 96) and rural areas (n = 96) in central region of Thailand. Creative visual art relaxation and meditative movement exemplified by Dao De Xin Xi exercise were introduced as monthly workshops and individual participants were encouraged to practice regularly for three months. General health status, levels of blood pressure (BP), fasting blood sugar (FBS), cortisol and dehydroepiandrosteone (DHEA) were evaluated before and after completing the intervention. RESULTS: This mindfulness-based intervention was effective as assessed by several biological health parameters. However, the degree of effectiveness differed between participants in urban and rural groups. In urban group, BPs were significantly reduced in hypertension and pre-hypertension subgroups of participants, and levels of DHEA in low DHEA participants were significantly increased after the intervention. In contrast, FBS levels in diabetic and pre-diabetic participants in the rural group, but not in the urban group, were significantly decreased after the intervention. We found a trend toward improvement of cortisol levels in both groups. However, the levels of glycated hemoglobin in either group remained unchanged. CONCLUSION: This mindfulness-based intervention to elderly people improved health parameters related to metabolic diseases. Therefore, applying the intervention in primary healthcare may help promote the well-being in elderly.
... This may be contributed by its versatility to reach clinical and non-clinical groups, the diversity that provides an alternative to treatment-resistant patients, and its adherence to familiar activities such as yoga and breathing exercises that enhance engagement and adoption of mindfulness meditation-based intervention in our daily lives. Interventions of MM have been shown to reduce stress and improve one's subjective wellbeing in different age groups and ethnic backgrounds (Turakitwanakan et al., 2013;Black et al., 2015;Ghane et al., 2018;Zollars et al., 2019;Liu et al., 2020;Chen et al., 2021). Due to its positive effect in enhancing individuals' wellbeing and resilience, the practice of MM attracts research on the underlying mechanism of its effects in the mental health setting. ...
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Different forms of mindfulness meditation are increasingly integrated in the clinical practice in the last three decades. Previous studies have identified changes in the neurophysiology and neurochemistry of the brain resulting from different mindfulness meditation practices in the general population. However, research on neural correlates of different types of meditation, particularly on the clinical outcomes, is still very sparse. Therefore, the aim of this article is to review the neural impact of mindfulness meditation interventions on different mental disorders via the classification of main components of mindfulness meditation. The clearer classification of mindfulness meditation may inform future clinical practice and research directions.
Introduction Medical students use to deal with high levels of academic stress. Hatha yoga and meditation have been found to reduce variables associated with stress. Objective: To evaluate and compare the effect of Hatha yoga and meditation on academic stress in medical students at a private university in Cali, Colombia. Methods and Materials A total of 27 volunteers were randomly divided into two groups: Hatha Yoga(n=13) and Meditation (n=14). Each group undertook two weekly one-hour sessions for 14 weeks. Study outcomes were salivary cortisol and perceived academic stress. Anthropometric and clinical variables were additionally measured as characteristics of the study sample. Perceived academic stress was estimated via a structured questionnaire. An intra-group analysis was also conducted to compare the outcomes at baseline and post-intervention within the groups. Results At baseline demographic, clinical, and anthropometric variables were similar between the intervention groups. After the intervention, no differences were found between meditation and hatha yoga groups in salivary cortisol measures (time 0, 15, 30, 45 min, and mean of the 4 measures) and perceived academic stress. However, the intra-group analysis showed that only in Hatha yoga there was a significant increase in cortisol measures and improvement in the scale of perceived academic stress. Conclusion Based on the intra-group but not between-group comparisons of outcomes at baseline and post-intervention, Hatha yoga reduced perceived academic stress despite a concomitant significant increase in cortisol levels. Further trials with larger samples of medical students should be conducted to contrast our findings.
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Peptic ulcer is one of the most common gastrointestinal diseases. It is a chronic disease, associated with the formation of a deep abscess in the wall of the gastrointestinal tract, and manifested by pain of variable intensity located mostly below the sternum. The most common causes of the disease are infection with Helicobacter pylori and use of non-steroidal anti-inflammatory drugs, although stress can also be an influencing factor. Gastric ulcers are caused by abnormal function of mucosal defense, which plays an important role in protecting the stomach from aggressive factors. Treatment of peptic ulcers requires the use of “triple therapy”. Patients are also advised to change their lifestyle, especially to eliminate smoking and consumption of alcoholic beverages, and to follow a diet with reduced content of products that stimulate gastric acid secretion. Persisted adherence to these rules may notably alleviate symptoms of the disease and, combined with pharmacology, contribute also to a significant health improvement.
Mindfulness has recently been implemented by advanced military combatants, firefighters, as well as other very intellectually demanding and fast-paced professions. A surgeon, similarly, is faced with many difficult challenges. Whether it be a complex and meticulous surgery, extensive clinical responsibilities, or simply the challenges faced in residency. However, in our current curriculums, we are not trained to introspectively deal with these stressors. Regardless of what we face in our personal lives, the lives of patients are literately in our hands. Would it not be prudent and wise, to train our brain to not only deliver care to our patients but to be able to take care of ourselves and maybe even improve our performance? Regular practice of mindfulness has been shown to decrease rates of burnout, decrease medical errors, improve sleep, and even improve surgical performance. With the ever-changing pandemic situation and increasing stressors in the hospital, mindful meditation is perfectly primed to be added to our armamentarium as surgeons and physicians. This review aims to explain how mindfulness can enhance a surgeon's performance, mindset, interactions and execution through a review of recent scientific advancements and evidence.
Precis: 63% of glaucoma patients agreed to 45-60 minutes of daily meditation. Predictors of accepting meditation included previous meditation practice, a diagnosis of glaucoma <1 year, and having a marital status of "single". Purpose: To explore patients' acceptance and barriers towards 45-60 minutes daily meditation for glaucoma management and to identify glaucoma patients with higher perceived stress levels who may benefit more from meditation practice. Methods: Glaucoma patients attending the Royal Victorian Eye and Ear Hospital, Melbourne, Australia outpatient department were invited to complete a patient survey. This explored if patients would agree to 45-60 minutes of daily meditation and included the Determinants of Meditation Practice Inventory and Perceived Stress Scale questionnaires. Questionnaire scores were compared across participants' clinical and demographic characteristics using student's T-Test, ANOVA, and multiple-linear-regression analysis. Results: Of the 123 eligible patients screened, one hundred completed the survey (81.3%). Sixty-three (63%) patients would agree to 45-60 minutes of daily meditation if advised by their doctor. Univariate analysis showed increased acceptance of meditation (lower Determinants of Meditation Practice Inventory scores) to be associated with agreeing to meditate 45-60 minutes daily (P=0.002), currently or previously practicing meditation (P=0.006 and P=0.0004 respectively), and having a marital status of "single" (P=0.02). Multi variate regression analysis showed previous meditation practice and a glaucoma diagnosis of <1 year to be predictive of accepting meditation (P=0.01 and P=0.03 respectively). There were no predictive factors of Perceived Stress Scale scores. Conclusion: Given the high acceptance rate of 45-60 minutes daily meditation (63% of glaucoma patients sampled), this may be recommended for benefit of patients. Patients who have previously meditated, have a relatively new diagnosis of glaucoma, and are single (marital status) were more accepting of meditation practice.
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Mindfulness-based stress reduction (MBSR) programs have consistently been shown to enhance the psychosocial well-being of participants. Given the well-established association between psychosocial factors and immunologic functioning, it has been hypothesized that enhanced psychosocial well-being among MBSR participants would be associated with corresponding changes in markers of immune activity. The objectives of this study were to examine changes in psychosocial and immunologic measures in a heterogeneous patient sample following participation in a MBSR program. A single-group, pretest/post-test design was utilized. The intervention was conducted at an academic health center. This pilot study involved 24 participants (aged 28-72 years). Inclusion criteria were as follows: > or =18 years of age, English-speaking, and no known autoimmune disorder. The intervention was an 8-week MBSR program. Distress and quality of life (QOL) measures included the Brief Symptom Inventory-18 and the Medical Outcomes Survey Short-Form Health Survey, respectively. Immunologic measures included natural killer (NK) cell cytolytic activity and C-reactive protein (CRP). Patients completed psychosocial assessments and provided a blood sample at baseline (pre-MBSR) and within 2 weeks post-MBSR. Significant improvements in anxiety and overall distress as well as across multiple domains of QOL were observed from baseline to post-MBSR. Reductions in anxiety and overall distress were associated with reductions in CRP. Patients who reported improvement in overall mental well-being also showed increased NK cytolytic activity from pre- to post-MBSR, whereas patients who reported no improvement in mental well-being showed no change in NK cytolytic activity. Positive improvement in psychologic well-being following MBSR was associated with increased NK cytolytic activity and decreased levels of CRP.
A variety of endocrine dysfunctions have been reported for anorexia nervosa, protein caloric malnutrition, and depression. The effect of reduced caloric intake and weight loss on endocrine functions was assessed in an experiment with five healthy female subjects during an initial baseline phase, a 3-week phase of complete food abstinence, weight gain to the original level, and a final baseline phase. During fasting, disturbances in hypothalamic-pituitary-adrenal function were observed, with elevated plasma cortisol levels, increase in the number of secretory episodes, increase in cortisol plasma half-life, and insufficient suppression following 1.5 mg dexamethasone. While all dexamethasone suppression tests (DSTs) were normal at baseline, 7 of 14 DSTs showed insufficient suppression in the fasting phase. During fasting, basal thyroid-stimulating hormone (TSH) values were lowered and the TSH response to thyrotropin-releasing hormone (TRH) was blunted. The plasma level of growth hormone (GH) over 24 hours was elevated during fasting and administration of the α2-adrenergic receptor agonist clonidine resulted in a subnormal GH response after restoration of original body weight. One of the five subjects showed increased irritability, distress, anxiety, and depression as measured by various psychological scales. The results show that reduced caloric intake, weight loss, or catabolic state have powerful effects on several endocrine systems. The specificity of measures of endocrine disturbances (DST, TRH tests, and clonidine tests) as biological markers for certain types of depression must be questioned, and the metabolic state should be given more consideration in future studies.
Integration of the hypothalamo–pituitary–adrenal stress response occurs by way of interactions between stress-sensitive brain circuitry and neuroendocrine neurons of the hypothalamic paraventricular nucleus (PVN). Stressors involving an immediate physiologic threat (`systemic' stressors) are relayed directly to the PVN, probably via brainstem catecholaminergic projections. By contrast, stressors requiring interpretation by higher brain structures (`processive' stressors) appear to be channeled through limbic forebrain circuits. Forebrain limbic sites connect with the PVN via interactions with GABA-containing neurons in the bed nucleus of the stria terminalis, preoptic area and hypothalamus. Thus, final elaboration of processive stress responses is likely to involve modulation of PVN GABAergic tone. The functional and neuroanatomical data obtained suggest that disease processes involving inappropriate stress control involve dysfunction of processive stress pathways.
Major depressive disorder (MDD) is currently ranked the third leading cause of disability in the world. Treatment-Resistant Depression (TRD) causes the majority of MDD's disability. Strikingly, 50% of individuals with MDD will fail to remit with two adequate trials of antidepressant medications, thus qualifying as treatment resistant. Current pharmacological and psychotherapeutic treatment strategies for TRD are limited in effectiveness so new interventions are needed. Mindfulness-Based Cognitive Therapy (MBCT) is a new psychotherapeutic treatment with established efficacy in preventing relapse of depression for individuals in complete remission. MBCT is a group-based, 8-week intervention that uses mindfulness meditation as its core therapeutic technique. It teaches people to have a different relationship to depressive thoughts and feelings. Strategies are focused on decreasing rumination, enhancing self-compassion, increasing acceptance and decreasing avoidance. This modified version of MCBT, which includes the use of metaphor and adaptations of the original intervention will be discussed through the clinical case of a woman with long-standing TRD. A brief review of the current MBCT literature and future directions for the treatment of TRD are discussed.
While much attention has been devoted to examining the beneficial effects of Mindfulness-Based Stress Reduction programs on patients' ability to cope with various chronic medical conditions, most studies have relied on self-report measures of improvement. Given that these measures may not accurately reflect physiological conditions, there is a need for an objective marker of improvement in research evaluating the beneficial effects of stress management programs. Cortisol is the major stress hormone in the human organism and as such is a promising candidate measure in the study of the effects of Mindfulness-Based Stress Reduction programs. In conjunction with other biological measures, the use of cortisol levels as a physiological marker of stress may be useful to validate self-reported benefits attributed to this program. In the current manuscript, we review the available literature on the role of cortisol as a physiological marker for improvement with regards to mindfulness practice, and make recommendations for future study designs.
Meditation practices have various health benefits including the possibility of preserving cognition and preventing dementia. While the mechanisms remain investigational, studies show that meditation may affect multiple pathways that could play a role in brain aging and mental fitness. For example, meditation may reduce stress-induced cortisol secretion and this could have neuroprotective effects potentially via elevating levels of brain derived neurotrophic factor (BDNF). Meditation may also potentially have beneficial effects on lipid profiles and lower oxidative stress, both of which could in turn reduce the risk for cerebrovascular disease and age-related neurodegeneration. Further, meditation may potentially strengthen neuronal circuits and enhance cognitive reserve capacity. These are the theoretical bases for how meditation might enhance longevity and optimal health. Evidence to support a neuroprotective effect comes from cognitive, electroencephalogram (EEG), and structural neuroimaging studies. In one cross-sectional study, meditation practitioners were found to have a lower age-related decline in thickness of specific cortical regions. However, the enthusiasm must be balanced by the inconsistency and preliminary nature of existing studies as well as the fact that meditation comprises a heterogeneous group of practices. Key future challenges include the isolation of a potential common element in the different meditation modalities, replication of existing findings in larger randomized trials, determining the correct "dose," studying whether findings from expert practitioners are generalizable to a wider population, and better control of the confounding genetic, dietary and lifestyle influences.
Meditation practices may impact physiological pathways that are modulated by stress and relevant to disease. While much attention has been paid to meditation practices that emphasize calming the mind, improving focused attention, or developing mindfulness, less is known about meditation practices that foster compassion. Accordingly, the current study examined the effect of compassion meditation on innate immune, neuroendocrine and behavioral responses to psychosocial stress and evaluated the degree to which engagement in meditation practice influenced stress reactivity. Sixty-one healthy adults were randomized to 6 weeks of training in compassion meditation (n=33) or participation in a health discussion control group (n=28) followed by exposure to a standardized laboratory stressor (Trier social stress test [TSST]). Physiologic and behavioral responses to the TSST were determined by repeated assessments of plasma concentrations of interleukin (IL)-6 and cortisol as well as total distress scores on the Profile of Mood States (POMS). No main effect of group assignment on TSST responses was found for IL-6, cortisol or POMS scores. However, within the meditation group, increased meditation practice was correlated with decreased TSST-induced IL-6 (r(p)=-0.46, p=0.008) and POMS distress scores (r(p)=-0.43, p=0.014). Moreover, individuals with meditation practice times above the median exhibited lower TSST-induced IL-6 and POMS distress scores compared to individuals below the median, who did not differ from controls. These data suggest that engagement in compassion meditation may reduce stress-induced immune and behavioral responses, although future studies are required to determine whether individuals who engage in compassion meditation techniques are more likely to exhibit reduced stress reactivity.
Serum cortisol and total protein levels, blood pressure, heart rate, lung volume, and reaction time were studied in 52 males 20-25 years of age practicing Dhammakaya Buddhist meditation, and in 30 males of the same age group not practicing meditation. It was found that after meditation, serum cortisol levels were significantly reduced, serum total protein level significantly increased, and systolic pressure, diastolic pressure and pulse rate significantly reduced. Vital capacity, tidal volume and maximal voluntary ventilation were significantly lower after meditation than before. There were also significant decreases in reaction time after mediation practice. The percentage decrease in reaction time during meditation was 22%, while in subjects untrained in meditation, the percentage decrease was only 7%. Results from these studies indicate that practising Dhammakaya Buddhist meditation produces biochemical and physiological changes and reduces the reaction time.