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Department: Wellness Mention

Mindfulness meditation

Creating positive changes in the brain

Perkins, Amanda DNP, RN

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doi: 10.1097/01.NME.0000653224.00489.d7
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We live in a stress-filled world where we're running constantly, rarely taking the time to relax and maintain our health. Although there are a variety of ways to manage stress, meditation is beneficial because it can be done anywhere, it's free, and it has no adverse reactions. Meditation involves relaxing the body and stilling the mind through a variety of techniques to promote health and wellness. One technique called mindfulness meditation is based on Buddhist practices and has been used for at least 2,600 years. However, the medical community didn't begin to recognize the benefits of meditation until the 1970s. Fast forward to today when meditation is used by a variety of specialties, including psychiatry, psychology, neuroscience, medicine, business management, sports, and education.

This article explores the effects of stress and how nurses can implement a mindfulness meditation program to improve health and wellness for our patients and ourselves.

Negative effects of stress

Eight out of 10 Americans experience stress, difficulty relaxing, and difficulty clearing their minds—all of which can be improved through the practice of mindfulness meditation. When a person experiences stress, his or her body reacts with the fight-or-flight response—a survival mechanism that's used in dangerous situations. When the body perceives a threat, the hypothalamus sets off an alarm, which leads to the adrenal glands releasing hormones such as adrenaline and cortisol. When adrenaline is increased, heart rate, BP, and energy supplies rise. When the primary stress hormone cortisol is released, glucose is increased to be used for added energy and nonessential functions slow. The body does these things to prepare for danger; however, it can react with the fight-or-flight response even when a threat isn't present such as in the case of stress from an increased workload.

Individuals who are in chronic stress states primarily stay in the fight-or-flight stage. This results in chronically elevated cortisol levels, which, in turn, increases the risk of anxiety, depression, digestive issues, headaches, heart disease, stroke, sleep difficulties, weight gain, and problems with memory and concentration.

What's meditation?

There are many different ways to meditate and the associated changes may vary depending on the type of meditation being practiced. With mindfulness meditation, the person meditating learns to focus on the present, becoming aware of his or her thoughts, feelings, body, and the surrounding environment. An individual practicing mindfulness meditation learns how to be present in an accepting and nonjudgmental way. When practicing mindfulness meditation, the person is able to notice thoughts without judgment, in addition to noticing what happens in each moment. The key to mindfulness is the nonjudgmental lens through which the person meditating views him- or herself and the outside world.

Meditation consists of four components: form, object, behavior of mind, and attitude. Form is the form one takes while meditating, such as sitting, lying, walking, or standing. The form most commonly associated with meditation is sitting, although everyone has a form that they prefer.

While meditating, the object is the object of attention during the meditative practice. Breathing is an object that's frequently used. For example, a person who's meditating may focus on the breaths going in and breaths going out or he or she may focus on the rise and fall of the chest with breathing. Additional objects may be visualization, the chakras, or mantras.

Behavior of mind is the process by which the mind selects the content, providing awareness of the things that the person meditating is thinking about. Concentration and awareness fall under this component. Attitude is the mental set that a person uses when meditating. Examples include moods, expectations, and intentions.

Changes in the brain

Research has shown that there are changes in behavior, brain activity, and brain structure when a person meditates. Regularly practicing meditation is associated with the most significant changes in the brain. Interestingly, these changes become permanent, even when the person isn't meditating.

The following are some, but not all, of the areas of the brain that may change in a person who meditates regularly: the amygdala, gyrus, frontal cortex, and gray matter. The amygdala is the area of the brain that processes emotions. It also plays a role in the fight-or-flight response and is associated with anxiety, fear, and stress. In individuals who meditate regularly, this area has been shown to decrease in size, which is associated with decreased levels of stress. Meditation has also been shown to increase the folds in the outer layer of the brain. This is known as gyrification and it may increase the brain's ability to process information.

As we age, our prefrontal cortex begins to shrink. In individuals who meditate regularly, the shrinking of the prefrontal cortex associated with aging has been found to slow. Additionally, meditation has been shown to increase the density of gray matter in the areas of the brain responsible for learning, memory, regulation of emotions, and empathy. Research has also shown increased gray matter in the frontal cortex—the area of the brain associated with executive decision-making.

Long-term meditation has been associated with improvements in resting cerebral blood flow. It has also been associated with decreased activation of the sympathetic nervous system and increased activation of the parasympathetic nervous system. Basically, meditation decreases the fight-or-flight response and increases relaxation and restfulness.

There have also been some brain imaging studies that have shown decreased activity in the area of the brain associated with cravings. This is why we may see some patients able to quit smoking after beginning a meditation program. Although this area of patient care is promising, more research needs to be conducted to confirm effectiveness. It may also be beneficial to conduct research regarding meditation and other cravings, such as food cravings or substance abuse.

Benefits of meditation

Mindfulness meditation has been shown to have positive effects on both physical and mental health, as well as overall well-being. Meditation has been associated with improved relaxation, calmness, psychological balance, coping strategies, mood, and well-being and decreased stress and anxiety. Additionally, when symptoms such as anxiety are present, meditation may lessen the severity of these symptoms.

Mindfulness meditation has been shown to be beneficial for a variety of medical conditions, such as hypertension, irritable bowel syndrome, fibromyalgia, psoriasis, anxiety, depression, chronic pain, insomnia, and posttraumatic stress disorder. Interestingly, some studies have shown that when practicing meditation, patients may have a reduced need for antihypertensives, thyroid medications, antidepressants, and antianxiety medications. Of the conditions associated with improvements after meditation, depression, chronic pain, and anxiety are the three with the most research/evidence showing positive effects.

Meditation may also increase cardiovascular health. Much of the research conducted on meditation has shown that it may be as beneficial as current treatments offered for a variety of medical conditions. This is promising, especially when taking into account the fact that individuals using meditation will have no adverse reactions.

In addition to the medical conditions improved through meditation, benefits can be seen physiologically, such as decreased BP, heart rate, and brain activity. Meditation has also been associated with decreased cortisol levels, which, as discussed previously, can have a beneficial effect on a person's overall health. It's also been associated with improved immune function and sleep quality.

Meditation has been shown to improve attention, cognitive performance, memory, self-regulation, and empathy. Practicing meditation can also improve a person's ability to focus. Research has shown that individuals who regularly practice meditation may be better able to handle stress effectively when compared with the general public. Practicing meditation has been shown to improve resiliency, which affects how a person copes with and manages stress. Meditation has also been shown to increase compassion for self and others.

Implementing a meditation program

The implementation of a meditation program can be fairly easy because it requires no equipment or additional space and doesn't cost any money. Additionally, meditation can be used by anyone and can be utilized anywhere. When implementing this type of program, it's important that patients learn how to meditate and be accepting of self, others, and the world around them.

Mindfulness meditation is comprised of three components: enhanced attention control, improved emotional regulation, and altered self-awareness. With regular meditation practice, a person becomes skilled in controlling attention and emotions. Interoceptive awareness, or the ability to notice body sensations, has also been identified as an important aspect of meditative practice. Additional considerations are quiet space, comfortable position, receptive attitude, and attention/focus.

Patients learning how to practice mindfulness meditation need to learn to regulate attention. With this in mind, it's important to understand the facets of attention, which are alerting, orienting, and conflict monitoring. Alerting is being ready for an impending stimulus, orienting is selecting specific information from multiple sensory stimuli, and conflict monitoring is monitoring and resolving conflict at the neural level (executive attention).

There are also three stages of mindfulness meditation: early, intermediate, and advanced. As a person gains more experience meditating, he or she progresses from the early stage to the advanced stage. An individual who's reached the advanced stage of meditation will gain the most benefit from the practice. Advanced meditators have an easier time meditating in general and are able to meditate for longer periods of time.

When patients are just beginning to practice mindfulness meditation, it's important to educate them that at first it may be hard to focus, but this will improve over time. The more practice a person has with meditation, the better at it he or she will become. Research has shown that meditation is most effective when it's practiced regularly and over a long period of time. In fact, individuals who meditate regularly have a higher quality of life and functional health scores compared with those who don't meditate.

It may be helpful to teach patients mindful breathing in which they pay attention to their breaths and the sensation of the breaths going in and out or the chest rising and falling. You can also teach your patients to complete a body scan in which they pay attention to the body from head to toe. They scan downward or upward, paying attention to any sensations they're feeling such as their feet on the ground. Focusing on the breath and the body scan are important because they allow the person meditating to be mindful of his or her body.

Patients may require or request learning materials pertaining to meditation. In these instances, the nurse can recommend meditation apps that provide educational resources and guided meditations. For patients who enjoying watching videos, the Omega Institute for Holistic Studies has a YouTube channel offering information on meditation. Additionally, a quick Internet search provides a plethora of information on meditation, including books and podcasts. Nurses interested in educating patients about meditation should become familiar with the resources available so they can provide appropriate information.

Focus on self-care

To be safe and effective nurses, we need to practice self-care. One way to do so is mindfulness meditation. Many nurses experience stress at work for a variety of reasons, such as complex healthcare settings, increasingly complex patients, high-acuity patients and workloads, rotating shifts, low staffing levels, pressures on time, and safety concerns. As a result of stress, nurses can experience fatigue, insomnia, hypertension, depression, and anxiety. If stress remains unaddressed, it can lead to burnout, mental health problems, work injuries, decreased ability to focus, and increased medical errors. Stress can also lead to substance use/abuse, absenteeism, tardiness, turnover, and a decreased ability to provide quality care.

Nurses who practice mindfulness may be better able to cope with stress and connect with patients. Mindfulness meditation can help nurses decrease stress, gain insight, and enhance performance. Although mindfulness meditation is promising, it's important to understand that interventions intended to decrease stress and burnout among nurses haven't been well studied and more research needs to be conducted.

Get started!

With all the possible benefits of mindfulness meditation, what are you waiting for? The best time to encourage your patients to start meditating or start meditating yourself is right now. Research has shown that the changes in the brain associated with meditation can occur in as little as 8 weeks. The hope is that meditative practices will spill over into everyday life, decreasing stress and improving quality of life. We've seen tremendous growth in research surrounding mindfulness meditation, and meditation in general. Research should be ongoing to enhance current knowledge.

consider this


You're working in a primary care office and Ms. A comes in with complaints of generally feeling unwell, an upset stomach, and difficulty sleeping. She tells you that she's been very busy and has felt quite a bit of stress recently. She's a single mother and works a full-time job and a part-time job, in addition to caring for her three young children. She tells you that she can't take medication for stress because it makes her feel “foggy” and less able to care for her children. She asks you if there's anything she can do to help relieve her stress that doesn't involve medication. How would you respond?

did you know?


Meditation can be practiced while walking. Often practiced on a path where you can walk back and forth, walking meditation entails focusing on the movement of your body with each step.

Practicing mindfulness meditation

cheat sheet


When practicing mindfulness meditation or teaching someone how to do so, consider these tips:

  • Choose your meditation location. This can be anywhere, including a quiet or noisy environment.
  • Find a comfortable position.
  • Carve out some time. This can be as little as 1 minute or as long as desired.
  • Pay attention to your breathing. It may be beneficial to focus on the rise and fall of your chest or count your breaths in and out.
  • Notice the sensations that you're feeling.
  • Recognize your thoughts.
  • Recognize your emotions.
  • Pay attention to bodily sensations.
  • If your mind wanders, it's okay. Just recognize that your mind has wandered and return focus to your breathing.
  • For some, it may be beneficial to mentally repeat a mantra, which is a sound, prayer, or meaningful phrase, as opposed to focusing on breathing.
  • Don't become discouraged if your mind frequently wanders because it takes practice and patience to become proficient at meditation.


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