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Meditation, not medication, to relieve anxiety

Cettina, Lou Ann, RN-BC

doi: 10.1097/01.NURSE.0000541390.29234.0b
Feature

Practical, nonpharmacologic meditation strategies to help patients manage anxiety.

Lou Ann Cettina is a primary care triage nurse at Weill Cornell Medicine in New York, N.Y. She is also certified in Clinical Meditation and Imagery.

The author has disclosed no financial relationships related to this article.

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EVERYONE EXPERIENCES some form of anxiety at one time or another. For patients seeking a medication-free relief alternative, meditation is easy to implement into a daily routine and can be successfully used alone or as an adjunct to medications. Involving little or no cost, meditation gently brings the brain into a more relaxed state and guides a participant toward greater personal growth and development. This article examines the use of meditation to manage anxiety and discusses a practical approach that nurses can share with patients.

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Examine the evidence

All meditation techniques have one feature in common: the ability to induce relaxation.1 To do this, take these four key steps: Relax-Focus-Accept-Notice. Relax in a comfortable position; focus attention on a point of reference, such as an object or the breath; accept and be open to the experiences in the moment; and notice what happens.2 For example:

  • Sit quietly in a comfortable position and close your eyes.
  • Deeply relax all your muscles, from your feet to your face.
  • Breathe through your nose and listen to your breath, breathing easily and naturally.
  • Continue for 10 to 20 minutes. You can check the time, but do not use an alarm.
  • Afterward, sit quietly for several minutes, with eyes closed or open.
  • Do not stand up for a few minutes.3

People new to meditation could start with 1 to 5 minutes of meditation and work up to 20 minutes per session.1 For those who are tech-savvy and short on time, commercial smartphone meditation apps are available.

Research has shown that meditation can decrease anxiety symptoms as well or better than benzodiazepines, a commonly prescribed medication for anxiety that can be associated with physical dependence and addiction. Research into brain pathways involved in anxiety responses found that benzodiazepines and meditation follow the same brain roadmap, explaining why meditation can effectively supplement or even replace these medications.4

Although meditation has been practiced in various forms for many centuries, it has been used in Western medical settings only since the 1970s. In recent years, scientific interest has grown in mindfulness meditation, which is described as a fully present state of focus and observation, without judgment.5 Of the many interesting meditation techniques that exist, mindfulness is considered one of the most powerful for stress and anxiety reduction.2 Researchers at the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital found that mindfulness-based stress reduction programs induce the relaxation response, described as a reduction in heart rate, breathing, and brain activity through meditation.3

Mindful meditation methodology has been found to harness areas of the brain that control cognition, regulate emotions, and decrease negative thought processes.6 While potentially addictive benzodiazepines are often the first medication of choice for patients with a clinical anxiety disorder, a study in 2014 found that only half of those patients benefited from treatment.6 Medication did not improve anxiety in otherwise healthy patients who participated in the study, yet their anxiety reduced by 22% with just one 20-minute session of meditation. With continued practice, our malleable brains can adapt to changes in the environment and build emotional resilience.

Meditation has also been effective in cases of post-traumatic stress disorder (PTSD), an extreme form of anxiety characterized by intrusive thoughts, nightmares, and flashbacks following a traumatic event. Due to the intensity and nature of the trauma, patients with PTSD have anxiety levels that are far greater and longer-lasting than in patients with a general form of anxiety. These intense traumatic events can include military combat, domestic violence, or sexual abuse.

In a study of 74 military personnel affected by PTSD or another anxiety disorder, half of the group took part in a 20-minute transcendental meditation (TM) session and the other half, a control group, did not. (See Styles of meditation explained.) Participants slowly moved from an active, analytical state into a more relaxed state, then slowly returned to active thinking.7 The authors found that at 1 month, most patients (84%) in the TM group had stabilized, decreased, or ceased medications, compared with 59% of patients in the control group. Only 11% of patients in the TM group increased their medication dosage, compared with nearly 41% of patients in the control group. This pattern continued after 2 and 6 months. In addition, at 6 months the authors found a 21% difference between groups in symptom severity, with patients in the control group experiencing an increase in severity compared with those in the TM group.7

In a study of people experiencing stress and anxiety due to unemployment, half were taught a formal meditation technique while the other half were instructed in simple stretching and talking as forms of distraction. Although participants from both groups claimed they felt less anxiety and stress, follow-up brain scans found that only those participants in the formal meditation group showed more activity, or communication, among the parts of their brains that process stress-related reactions and other areas related to focus and calm.8

Another meditation style, natural stress relief (NSR), involves participants entering a 15-minute state of deep rest using an instructional audiotape. A recent study found it to be as effective as TM for those experiencing depression or anxiety. Both depression and anxiety scores decreased in participants who practiced NSR for 1 week. Continued practice for 8 or more weeks changed brain structures and reduced the “fight or flight” response in the amygdala.9 Participants' autonomy, creativity, inner satisfaction, alertness, and productivity also increased.9

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Incorporating meditation into daily life

Adapting meditation for anxiety and stress relief to a person's individual needs and interests is key. One can choose to meditate privately, use a trained practitioner to guide the meditation, or attend a class and share energetic connections with other participants.

Meditation in its various forms can be incorporated into anyone's day, whether it is done alongside a favorite hobby, eating, walking, sitting, or even cycling. We are all aware that exercise increases endorphins, chemicals released by the brain that reduce pain perception and trigger a positive feeling in the body. A 2014 study that analyzed participants using mindfulness meditation during yoga and cycling reported a greater increase in positive feelings and decrease in negative feelings compared with participants using exercise alone.10

Along with benefiting overall health and well-being, incorporating meditation into one's daily routine can also help keep healthcare costs down. Stahl and colleagues quote a cost savings of about $2,360 per patient per year, just in terms of reduced ED visits.11 Due to the low cost of mind-body interventions as well as their clinical value, policy recommendations have been made regarding the inclusion of these interventions as part of preventive care for patients. Like education on smoking cessation, alcohol consumption, and diet, information about meditation could be incorporated into patients' annual well visits. One study indicated that two-thirds of general practitioners are willing to support a public campaign to promote the health benefits of meditation.5 Meditation programs have also been in place at prisons and homeless rehabilitation programs in major cities throughout the United States, but they need more funding and awareness to expand.

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Taking meditation to the bedside

There are so many ways to introduce this technique into one's own life. Nurses can introduce meditation at the bedside and coach patients through anxious episodes, no matter the cause, and patients who realize the ease and effectiveness of meditation will be encouraged to continue the practice at whatever level is comfortable. All that is needed to start is to take a few minutes and just think, “Relax.”

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Styles of meditation explained

MINDFULNESS—This is a focused-based meditation with the goal of obtaining a state of wakeful, relaxed, non-judgmental awareness and presence. The most common focus is on your breathing, which serves as your center of awareness. Allowing yourself to feel the sensation of the breath flowing in through your nostrils or your mouth and noticing how it makes the chest or abdomen rise and fall in rhythmic fashion releases distractions from the mind.12

TRANSCENDENTAL MEDITATION (TM)—This is a mantra-based style of meditation with a goal of pure consciousness. With TM, your mantra, which is a word or a phrase chosen for you by your teacher, serves as your center of awareness. To begin, relax and close your eyes, allowing thoughts to flow into the mind. State your mantra, allowing the mind to clear. By continuing to focus on your mantra, your body and mind will gently transcend into deeper levels of consciousness. Until a student is able to self-direct, intensive practice with a certified instructor is required.12,13

NATURAL STRESS RELIEF (NSR)—NSR is another mantra-based style of meditation, created as a self-taught alternative to TM. Instruction is done in the home over a three-day period with the use of an instructional manual and audio file. A single NSR mantra draws the mind from active thinking into a more quiet state with the goal being inner peace by decreasing stress and anxiety. This technique should be practiced twice daily for 15 minutes each time.14

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REFERENCES

1. Vadnais E. The power of meditation. Adv Nurs. 2016;6(2):22–23.

2. Rabin J. Mindfulness-Based Stress Reduction (MBSR). Orient Med. 2016.

3. Benson H, Klipper MZ. The Relaxation Response. New York, NY: Harper Collins Publishers Inc.; 2000.

4. Ainsworth B, Marshall JE, Meron D, et al Evaluating psychological interventions in a novel experimental human model of anxiety. J Psychiatr Res. 2015;63:117–122.

5. Shonin E, Van Gordon W, Griffiths MD. Meditation as medication: are attitudes changing. Br J Gen Pract. 2013;63(617):654.

6. Zeidan F, Martucci KT, Kraft RA, McHaffie JG, Coghill RC. Neural correlates of mindfulness meditation-related anxiety relief. Soc Cogn Affect Neurosci. 2014;9(6):751–759.

7. Barnes VA, Monto A, Williams JJ, Rigg JL. Impact of transcendental meditation on psychotropic medication use among active duty military service members with anxiety and PTSD. Mil Med. 2016;181(1):56–63.

8. Creswell JD, Taren AA, Lindsay EK, et al Alterations in resting-state functional connectivity link mindfulness meditation with reduced interleukin-6: a randomized controlled trial. Biol Psychiatry. 2016;80(1):53–61.

9. Miller NJ, DeCicco TL, Dale AL, Murkar A. Assessing the effects of meditation on dream imagery, depression and anxiety. Intern J Dream Res. 2015;8(2):99–104.

10. Bryan SZ, Zipp GP. The effect of mindfulness meditation techniques during yoga and cycling. Altern Complement Ther. 2014;20(6):306–316.

11. Stahl JE, Dossett ML, LaJoie AS, et al Relaxation response and resiliency training and its effect on healthcare resource utilization. PLoS One. 2015;10(10):e0140212.

12. Parente M. Healing Ways: An Integrative Health Sourcebook. Hauppage, NY: Barron's Educational Series, Inc.; 2016.

13. Goswamee G, Dey AK. Effect of transcendental meditation on classroom management in Maharishi organization with special reference to Maharishi Vidya Mandir Schools. The Clarion. 2017;6(1):60–63.

14. Coppola F, Spector D. Natural Stress Relief Meditation as a tool for reducing anxiety and increasing self-actualization. Soc Behav Pers. 2009;37(3):307–312.

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RESOURCES

Anxiety disorders: an integrative approach: a natural standard monograph. Altern Complement Ther. 2014;20(6):338–346.

Barnes VA, Monto A, Williams JJ, Rigg JL. Impact of transcendental meditation on psychotropic medication use among active duty military service members with anxiety and PTSD. Mil Med. 2016;181(1):56–63.

Pereira K. Herbal supplements: widely used, poorly understood. Nursing. 2016;46(2):54–59.

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