Meditation, Managed Care, and Mental Health
PSYCHIATRIC VIEWS ON THE NEWS
In 1990, when I started to lead a not-for-profit managed mental health care system, no one paid attention to meditation.1 In recent years, health care insurance companies (and the businesses that use them) have started to invest in mindfulness research and programs.2 What has happened to explain this development?
A look back
Starting with Hindu traditions in India, meditation evolved over thousands of years as a kind of spiritual practice. Much later, Buddha embraced it. Forms of meditation were practiced in Judaism, Christianity, and Islam but they were more mystical than mainstream.
In the 1960s, gurus from India, coupled with the interest of hippies and other new age spiritual seekers, brought meditation to the US. As the fervor of the 60s died down, so did meditation. In the new millennium, the practice of meditation again surfaced for practical rather than spiritual reasons.
As the Internet put people online with little time left to recover from growing workplace productivity demands, burnout increased. Meditation became a practical tool to relax and recover from undue stress.
No matter what the variation, the practice of meditation has 4 fundamental requirements: a quiet location, a comfortable position, a focus of attention, and an open attitude. The overall goal is intense calmness and clarity.
Mindfulness is one of the most popular types of meditation. The aim is to witness and to pay attention to whatever is on one’s mind—no matter how full or distracting those thoughts are. Even with mindfulness, diverse practices can be subsumed under its rubric, including yoga, centering prayer, and Tai Chi.
Daily practice does not require a lot of time. In the Americanization of meditation, one Google executive even claims that 6 seconds of a “mindful breath” can do the trick whenever it is needed, and if a study on dishwashing is generalization, there is some scientific confirmation of that possibility.3
Meditation and the brain
As meditation gained in popularity and neuroimaging techniques became available, research assessed how practice affected the brain. One such study4 reported that after just 8 weeks of meditation for about 30 minutes a day, brain thickening was found in 4 areas: the posterior cingulate, the left hippocampus, the temporaparietal junction, and the pons. Each area involves self-referencing, emotional regulation, compassion, and the regulation of neurotransmitters. On the other hand, the amygdala, which processes the fight-or-flight response, got smaller.
Stimulated by a request by the Dalai Lama, other studies harkened back to the Buddhist tradition by using long-term, intense meditators—such as Buddhist monks—as subjects.5 These studies found that the anterior insula in particular was activated. This area of the brain coordinates the brain-body interaction involved with the immune system. Also found was high-amplitude gamma-oscillation in the brain, indicative of increased neuronal plasticity.
Psychiatric benefits of meditation
Proper meditation induces relaxation, though other techniques, such as exercise and music, are equally valuable. Relaxation, in turn, not only lowers blood pressure, but it relieves tension and anxiety.
Another study went beyond wellness and looked at whether meditation could supplement traditional treatments for depression and other psychiatric disorders.6 Mindfulness-based cognitive psychotherapy was found to be as effective as medication in preventing relapse for those with recurrent depression.
Interestingly enough, virtually all of the prominent researchers on meditation sooner or later embrace the practice for themselves.