ArticlePDF Available

Effects of mindfulness meditation on serum cortisol of medical students

Authors:
  • Srinakharinworot University, Bangkok, Thailand

Abstract

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
E-mail: wanpen2550@yahoo.com
J Med Assoc Thai 2013; 96 (Suppl. 1): S90-S95
Full text. e-Journal: http://jmat.mat.or.th
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
instruction.
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
barcode.
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.
Results
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
Gender
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
Smoking
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
Hobby
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).
Discussion
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
practice.
Conclusion
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.
Acknowledgement
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
None.
References
1. Dhar HL. Newer approaches in increasing life span.
Indian J Med Sci 1999; 53: 390-2.
2. Stout SC, Owens MJ, Nemeroff CB. Regulation of
corticotropin-releasing factor neuronal systems
and hypothalamic-pituitary-adrenal axis activity by
stress and chronic antidepressant treatment. J
Pharmacol Exp Ther 2002; 300: 1085-92.
3. Herman JP, Cullinan WE. Neurocircuitry of stress:
central control of the hypothalamo-pituitary-
adrenocortical axis. Trends Neurosci 1997; 20: 78-
84.
4. Duncko R, Novakova L, Notova P, Stepankova O,
Jezova D. Behavioral and neuroendocrine changes
during mental stress and repeated treatment with
antidepressants in healthy men. Ann N Y Acad Sci
2004; 1018: 524-32.
5. Traustadottir T, Bosch PR, Matt KS. The HPA axis
response to stress in women: effects of aging and
fitness. Psychoneuroendocrinology 2005; 30: 392-
402.
6. Widmaie PE, Raff H, Strang KT. Vander’s human
physiology: the mechanisms of body function. 11th
ed. New York: McGraw-Hill; 2008: 319-21.
7. Berne RM, Levy MN, Koeppen BM, Stanton BA.
Physiology. 5th ed. St Louis, MO: Mosby; 2004:
890-901.
8. Xiong GL, Doraiswamy PM. Does meditation
enhance cognition and brain plasticity? Ann N Y
Acad Sci 2009; 1172: 63-9.
9. Ajahn Buddhadasa Bhikkhu, Phra Thepwisut-
thimethi, Santikaro Bhikkhu, Rosenberg L.
Mindfulness with breathing: a manual for serious
beginners. Boston: Wisdom Publications; 1988.
10. Tana N, Chakkrit S, Chatchawan S. Reliability and
validity of the Thai version of the general health
questionaire. J Psychiatr Assoc Thai 1996; 41: 2-
17 (in Thai).
11. Goldberg DP. The detection of psychiatric illness
by questionnaire. Maudsley Monograph. London:
Oxford University Press; 1972.
12. Kilic C, Rezaki M, Rezaki B, Kaplan I, Ozgen G,
Sagduyu A, et al. General Health Questionnaire
(GHQ12 & GHQ28): psychometric properties and
S94 J Med Assoc Thai Vol. 96 Suppl. 1 2013
factor structure of the scales in a Turkish primary
care sample. Soc Psychiatry Psychiatr Epidemiol
1997; 32: 327-31.
13. Coppola F. Effects of natural stress relief
meditation on trait anxiety: a pilot study. Psychol
Rep 2007; 101: 130-4.
14. Lee SH, Ahn SC, Lee YJ, Choi TK, Yook KH, Suh
SY. Effectiveness of a meditation-based stress
management program as an adjunct to pharmaco-
therapy in patients with anxiety disorder. J
Psychosom Res 2007; 62: 189-95.
15. Williams KA, Kolar MM, Reger BE, Pearson JC.
Evaluation of a wellness-based mindfulness stress
reduction intervention: a controlled trial. Am J
Health Promot 2001; 15: 422-32.
16. Cardoso R, de Souza E, Camano L, Leite JR.
Meditation in health: an operational definition.
Brain Res Brain Res Protoc 2004; 14: 58-60.
17. Sudsuang R, Chentanez V, Veluvan K. Effect of
Buddhist meditation on serum cortisol and total
protein levels, blood pressure, pulse rate, lung
volume and reaction time. Physiol Behav 1991; 50:
543-8.
18. Carlson LE, Speca M, Patel KD, Goodey E.
Mindfulness-based stress reduction in relation to
quality of life, mood, symptoms of stress and levels
of cortisol, dehydroepiandrosterone sulfate
(DHEAS) and melatonin in breast and prostate
cancer outpatients. Psychoneuroendocrinology
2004; 29: 448-74.
19. Matousek RH, Dobkin PL, Pruessner J. Cortisol as
a marker for improvement in mindfulness-based
stress reduction. Complement Ther Clin Pract 2010;
16: 13-9.
20. Witek-Janusek L, Albuquerque K, Chroniak KR,
Chroniak C, Durazo-Arvizu R, Mathews HL. Effect
of mindfulness based stress reduction on immune
function, quality of life and coping in women newly
diagnosed with early stage breast cancer. Brain
Behav Immun 2008; 22: 969-81.
21. Carlson LE, Speca M, Patel KD, Goodey E.
Mindfulness-based stress reduction in relation to
quality of life, mood, symptoms of stress, and
immune parameters in breast and prostate cancer
outpatients. Psychosom Med 2003; 65: 571-81.
22. Davidson RJ, Kabat-Zinn J, Schumacher J,
Rosenkranz M, Muller D, Santorelli SF, et al.
Alterations in brain and immune function produced
by mindfulness meditation. Psychosom Med 2003;
65: 564-70.
23. Pace TW, Negi LT, Adame DD, Cole SP, Sivilli TI,
Brown TD, et al. Effect of compassion meditation
on neuroendocrine, innate immune and behavioral
responses to psychosocial stress. Psychoneuro-
endocrinology. 2009; 34: 87-98.
24. Fang CY, Reibel DK, Longacre ML, Rosenzweig S,
Campbell DE, Douglas SD. Enhanced psychosocial
well-being following participation in a mindfulness-
based stress reduction program is associated with
increased natural killer cell activity. J Altern
Complement Med 2010; 16: 531-8.
25. Eisendrath S, Chartier M, McLane M. Adapting
Mindfulness-Based Cognitive Therapy for
Treatment-Resistant Depression: A Clinical Case
Study. Cogn Behav Pract 2011; 18: 362-70.
26. Steptoe A, Gibson EL, Vuononvirta R, Williams
ED, Hamer M, Rycroft JA, et al. The effects of tea
on psychophysiological stress responsivity and
post-stress recovery: a randomised double-blind
trial. Psychopharmacology (Berl) 2007; 190: 81-9.
27. Lovallo WR, Farag NH, Vincent AS, Thomas TL,
Wilson MF. Cortisol responses to mental stress,
exercise, and meals following caffeine intake in men
and women. Pharmacol Biochem Behav 2006; 83:
441-7.
28. Leproult R, Copinschi G, Buxton O, Van Cauter E.
Sleep loss results in an elevation of cortisol levels
the next evening. Sleep 1997; 20: 865-70.
29. Fichter MM, Pirke KM, Holsboer F. Weight loss
causes neuroendocrine disturbances: experimental
study in healthy starving subjects. Psychiatry Res
1986; 17: 61-72.
J Med Assoc Thai Vol. 96 Suppl. 1 2013 S95
ผลของการนั่งสมาธิต่อระดบคอร์ติซอลในเลอดของนกศกษาแพทย
วันเพ็ญ ธุรกตต์วัณณการ, จันทนา เมฆสประหลาด, ภนาร บุษราคมตระกูล
ภูมิหลัง: การนั่งสมาธิเป็นวิธีผ่อนคลายและลดความเครียด ความเครียดทำให้ระดับคอร์ติซอลในเลือดเพิ่มขึ้น
ดังนั้นการนั่งสมาธิช่วยลดความเครียด จึงช่วยลดระดบคอร์ติซอลในเลือด
วัตถุประสงค์: เพื่อศึกษาผลของการนั่งสมาธิต่อสุขภาพจิตโดยใช้ Thai GHQ28 และเพื่อศึกษาผลของการนั่งสมาธ
ต่อความเครียดโดยใช้ระดับคอร์ติซอลในเลือด
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
จากการรักษาตามมาตรฐาน
... Salivary or serum cortisol levels have also been analyzed to investigate the effect of mindfulness meditation and MBIs on cortisol secretion. Medical students who participated in 4 days of MBI showed a decrease in serum cortisol level at eight in the morning (Turakitwanakan et al., 2013). Another study in healthy participants similarly reported a trend decrease in salivary cortisol levels measured after awakening, following 8 weeks of an MBSR program (Jensen et al., 2012). ...
... This result supports the notion that OM meditation induces a state of mindfulness that is related to stress reduction. The effect of mindfulness meditation and MBIs on cortisol secretion varies across studies, where there have been reports of significant decreases (Turakitwanakan et al., 2013), trend decreases (Jensen et al., 2012), and no significant changes (Klatt et al., 2009) in cortisol levels following participation in MBSR programs. On the basis of our results, it appears that the inconsistent results of previous studies are attributed to the difference in the ratio of FA and OM meditation in MBSR programs. ...
Article
Full-text available
Mindfulness-based interventions (MBIs) have been used widely as a useful tool for the alleviation of various stress-related symptoms. However, the effects of MBIs on stress-related physiological activity have not yet been ascertained. MBIs primarily consist of focused-attention (FA) and open-monitoring (OM) meditation. Since differing effects of FA and OM meditation on brain activities and cognitive tasks have been mentioned, we hypothesized that FA and OM meditation have also differing effects on stress-related physiological activity. In this study, we examined the effects of FA and OM meditation on autonomic cardiac modulation and cortisol secretion. Forty-one healthy adults (aged 20–46 years) who were meditation novices experienced 30-min FA and OM meditation tasks by listening to instructions. During resting- and meditation-states, electrocardiogram transducers were attached to participants to measure the R-R interval, which were used to evaluate heart rate (HR) and perform heart rate variability (HRV) analyses. Saliva samples were obtained from participants pre- and post-meditation to measure salivary cortisol levels. Results showed that FA meditation induced a decrease in HR and an increase in the root mean square of successive differences (rMSDD). In contrast, OM meditation induced an increase in the standard deviation of the normal-to-normal interval (SDNN) to rMSSD ratio (SDNN/rMSSD) and a decrease in salivary cortisol levels. These results suggest that FA meditation elevates physiological relaxation, whereas OM meditation elevates physiological arousal and reduces stress.
... 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. ...
Article
Full-text available
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.
... Among various hormones, DHEA, cortisol and melatonin are considered as a metric to assess the effect of meditation practice on the humoral system 25 and these hormones are also involved in the regulation of sleep 26 . An increase in melatonin levels 23,24,27,28 and reduction in the cortisol response to a stressor 17,22,29,30 is reported immediately after a meditation session. However, with the long-term practice of mindfulness meditation, enhanced melatonin and reduced cortisol are observed at the basal level [31][32][33] . ...
Article
Objectives: Meditation practices positively influence the neural, hormonal and autonomic systems. We have demonstrated that long-term practice of mindfulness meditation increases N3 and rapid eye movement (REM) sleep stages and bring efficient autonomic modulation during sleep. In the present study, the probable humoral correlation that could bring about these changes is evaluated. Material and Methods: Long-term Vipassana meditators (n=41) and controls (n=24) (males, 30-60 years of age) underwent a two-day consecutive whole night polysomnography recording. During the second day, with exposure to 100Lux brightness, blood was sampled from the antecubital vein between 8-9 PM and in subsequent early morning. Sleep stage was scored as per American Society of Sleep Medicine (ASSM) guidelines for the second-day recording. Sleep-related hormones were estimated - melatonin by radioimmunoassay; dehydroepiandrosterone (DHEA), cortisol, growth hormone (GH) and prolactin with enzyme-linked immunosorbent assay (ELISA); DHEA/cortisol ratio was calculated. Percentage of sleep stages and hormonal levels were compared between both groups using independent ‘t’ test and Pearson’s correlation was estimated between sleep stages and hormonal levels. Results: Meditators showed increased N3, REM sleep stages. Though evening cortisol was comparable between the two groups; early morning cortisol, diurnal DHEA and melatonin were significantly higher in meditators. Diurnal DHEA correlated significantly with the N3 sleep stage in meditators. Discussion: Higher diurnal DHEA despite variations in corresponding cortisol in meditators demonstrates that long-term Vipassana meditation practice modulates the hypothalamicpituitary-adrenal (HPA) axis and thereby influences sleep. Thus, the study provides evidence to explore the mechanism most likely involved with mindfulness meditation intervention in insomnia.
... These findings supported the benefits of the MindCAN program particularly for subjective and objective stress. A study in Thailand reported a significant decrease in serum cortisol (stress biomarker) in medical students after mindfulness practice (Turakitwanakan et al., 2013). Similarly, a systematic review of 29 studies reported that mindfulness interventions helped minimize subjective stress in cancer patients and survivors (Xunlin et al., 2019). ...
Article
Full-text available
Objectives Cancer survivors face multiple challenges associated with cancer and its treatments. This study aimed to examine the initial effect of the Mindfulness-Based Psychoeducation for Cancer Survivors (MindCAN) program, which emphasizes the application of mindfulness to cancer-related matters. Methods A single group, quasi-experimental study was conducted from 2018 to 2020. A convenience sample was recruited from a tertiary hospital in Singapore. Eligibility criteria included adult cancer survivors who had finished curative treatments from 2 weeks to 2 years. Power analysis was used to estimate an adequate sample size. Participants attended the 8-week, group-based MindCAN program which comprised two components, education and mindfulness practice. Self-reported questionnaires and physiological measures were used to elicit participants’ responses. Data were analyzed using descriptive statistics and analysis of variance. Results In total, 61 cancer survivors completed the 8-week sessions. Most participants were Singaporean, female, and Chinese. As compared to pretest scores, participants reported significant reduction in objective stress, subjective stress, anxiety, and depression. They also had significant improvement in perceived relaxation, mindfulness, and psychological well-being. Effect size (ηp²) ranged from medium to large (0.06 to 0.40) across the outcome variables. Conclusions Our findings suggested that the MindCAN program had the potential to improve psychological outcomes among cancer survivors. Future randomized controlled trials are required to further test the effectiveness of the MindCAN program.
... This acute response makes cortisol a useful clinical marker to determine physiological responses to stress [20]. Demonstrable reductions in cortisol following four days of mindfulness training have been observed in Thai medical students [26]. In contrast, a study in students from a range of faculties at Cambridge University found no relationship between plasma cortisol levels and mindfulness training [27]. ...
Article
Full-text available
Background Medical students demonstrate higher levels of psychological distress compared with the general population and other student groups, especially at exam times. Mindfulness interventions show promise in stress reduction for this group, and in the reduction of cortisol, an established clinical marker of the body’s stress response. This study investigated the relationship of mindfulness to exam-induced stress, salivary cortisol and exam performance in undergraduate medical students. Methods A controlled pre-post analysis design with within-groups comparisons. 67 medical students completed the five facet mindfulness questionnaire (FFMQ) and provided saliva samples, from which cortisol was extracted, during group work (control/baseline) and immediately prior to end of year 2 examinations (experimental). Academic performance data was extracted for comparison with measures. Results Exam-induced salivary cortisol concentration showed a significant negative relation with exam performance. Total FFMQ score showed a significant positive relation with exam performance and a significant negative relation with exam-induced salivary cortisol. The specific mindfulness facets of acting with awareness, non-judging and non-reacting also showed a positive correlation with exam performance. Conclusions This study suggests that there exists an important relationship between mindfulness and the physiological biomarker of stress, cortisol, and this manifests into improved assessment outcomes potentially through healthier, more adaptive coping and stress management strategies. In particular, this study identifies the acting with awareness, non-judging and non-reacting facets of mindfulness to be significantly associated with exam performance suggesting that these may be important facets for clinical educators to target when helping students with mindfulness practice.
... Zum anderen kommt es zu einer stressbedingten Lymphozytenverminderung (T-Zellen) aufgrund des hohen Kortisolspiegels, welcher eine Inhibition der Zellprofileration auslöst (Ebbing, 2005;Fauci, 1975Fauci, , 1976Weicker & Werle, 1991). Entspannungsbasierte Therapieverfahren, zu denen auch die Hypnose zählt, beeinflussen unmittelbar und nachhaltig die Kortisolkonzentration (Brown et al., 2002;Dolbier & Rush, 2012;Johansson & Uneståhl, 2006;Turakitwanakan et al., 2013) und können so einer stressbedingten Reaktion im Körper durch Reduktion der Stressmarker entgegenwirken und sich dementsprechend positiv auf das Immunsystem auswirken (Black & Slavich, 2016;Karrasch et al., 2020). Eine mögliche Erklärung für die Modulation des Immunsystems durch Hypnose ist eben dieser induzierte Entspannungszustand. Miller und Cohen (2001) gehen in ihrer Metaanalyse davon aus, dass eine durch Entspannung erreichte Reduktion von negativen Emotionen zur Abschwächung einer stressinduzierten immunologischen Dysregulation führen kann (Miller & Cohen, 2001). ...
... This acute response makes cortisol is a useful clinical marker to determine physiological responses to stress [18]. Demonstrable reductions in cortisol following four days of mindfulness training have been observed in Thai medical students [24]. In contrast, a study in students from a range of faculties at Cambridge University found no relationship between plasma cortisol levels and mindfulness training [25]. ...
Preprint
Full-text available
Background Medical students demonstrate higher levels of psychological distress compared with the general population and other student groups. Mindfulness interventions show promise in stress reduction for this group, and in the reduction of cortisol, an established clinical marker of the body’s stress response. This study investigated the relationship of mindfulness to perceived stress, salivary cortisol and assessment performance in undergraduate medical students in response to stressful and non-stressful events. Methods A controlled pre-post analysis design with within-groups comparisons. 67 medical students completed the Five Facet Mindfulness Questionnaire (FFMQ) and provided perceived stress ratings and saliva samples, from which cortisol was extracted, during group work (control/baseline) and immediately prior to end of year 2 examinations (experimental). Academic performance data was extracted for comparison with measures. Results Salivary cortisol and perceived stress were significantly increased prior to examinations. The change in cortisol levels from baseline (non-stressful, group work conditions) to experimental (stressful, pre-exam conditions) showed a significant negative correlation with exam performance. FFMQ score showed a significant positive correlation with exam performance and a significant negative correlation with salivary cortisol concentration. Conclusions This study suggests that there exists an important relationship between mindfulness and biomarkers of stress, which may manifest into improved assessment outcomes potentially through healthier, more adaptive coping and stress management strategies. A novel strength of the present study is the identification of individual facets of mindfulness associated with stress and exam performance (acting with awareness and non-judging) suggesting that these may be important targets for improving medical students’ stress management and exam performance.
... We can measure the levels of stress hormones before and after meditation. 1 We can measure the length of telomeres at the end of our chromosomes 2 and see that physical activity results in younger telomeres. We can measure the modulation of brainwaves in response to yoga practices. ...
... Cortisol, one of the reliable markers of stress, has been found to increase in patients with ocular hypertension and glaucoma. 25 In 2018, Dada et al 4 provided a confirmatory evidence of an association between stress and glaucomatous neurodegeneration, indicating that stress is a major causal factor of IOP elevation. Moreover, they reported that stress reduction through relaxation techniques not only normalizes IOP but also improves stress biomarkers, gene expression changes, and quality of life. ...
... Future studies on the mental impact of pregnancy loss should consider e.g. measurements of salivary cortisol (Christopher et al., 2018, Turakitwanakan et al., 2013. ...
Article
Full-text available
Research question Can participating in a tailored 7-week meditation and mindfulness program with additional standard supportive care versus only standard supportive care reduce perceived stress for women with recurrent pregnancy loss? Design A two-armed randomized controlled trial with 12-month follow-up. In total 76 patients were enrolled and randomly assigned to either standard supportive care or to a 7-week meditation and mindfulness program led by an instructor in addition to standard supportive care. Results At intervention completion (7 weeks after) perceived stress decreased significantly both in the intervention group; p = < 0.001 and in the control group; p = < 0.006. The decrease in perceived stress in the intervention group was significantly larger; p = 0.027 compared with the control group. At the 12-month follow-up perceived stress was still significantly decreased in both groups compared with baseline; p = < 0.0001 in the intervention group and p =0.002 in the control group. Conclusion This first RCT of a tailored meditation and mindfulness intervention for women with RPL document that a 7-week daily at-home meditation and mindfulness program combined with group sessions reduced perceived stress significantly more than our standard supportive care program. Future studies should address the most effective format and the “dose” needed for an impact on perceived stress levels. The trial is registrated on Clinicaltrial.gov as NCT03905395.
Article
Full-text available
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.