A new study of acupuncture — the most rigorous and detailed analysis of the treatment to date — found that it can ease migraines and arthritis and other forms of chronic pain.

The findings provide strong scientific support for an age-old therapy used by an estimated three million Americans each year. Though acupuncture has been studied for decades, the body of medical research on it has been mixed and mired to some extent by small and poor-quality studies. Financed by the National Institutes of Health and carried out over about half a decade, the new research was a detailed analysis of earlier research that involved data on nearly 18,000 patients.

The researchers, who published their results in Archives of Internal Medicine, found that acupuncture outperformed sham treatments and standard care when used by people suffering from osteoarthritis, migraines and chronic back, neck and shoulder pain.

“This has been a controversial subject for a long time,” said Dr. Andrew J. Vickers, attending research methodologist at Memorial Sloan-Kettering Cancer Center in New York and the lead author of the study. “But when you try to answer the question the right way, as we did, you get very clear answers.

“We think there’s firm evidence supporting acupuncture for the treatment of chronic pain.”

Acupuncture, which involves inserting needles at various places on the body to stimulate so-called acupoints, is among the most widely practiced forms of alternative medicine in the country and is offered by many hospitals. Most commonly the treatment is sought by adults looking for relief from chronic pain, though it is also used with growing frequency in children. According to government estimates, about 150,000 children in the United States underwent acupuncture in 2007.

But for all its popularity, questions about its efficacy have long been commonplace. Are those who swear by it experiencing true relief or the psychological balm of the placebo effect?

Dr. Vickers and a team of scientists from around the world — England, Germany, Sweden and elsewhere — sought an answer by pooling years of data. Rather than averaging the results or conclusions from years of previous studies, a common but less rigorous form of meta-analysis, Dr. Vickers and his colleagues first selected 29 randomized studies of acupuncture that they determined to be of high quality. Then they contacted the authors to obtain their raw data, which they scrutinized and pooled for further analysis. This helped them correct for statistical and methodological problems with the previous studies, allowing them to reach more precise and reliable conclusions about whether acupuncture actually works.

All told, the painstaking process took the team about six years. “Replicating pretty much every single number reported in dozens of papers is no quick or easy task,” Dr. Vickers said.

The meta-analysis included studies that compared acupuncture with usual care, like over-the-counter pain relievers and other standard medicines. It also included studies that used sham acupuncture treatments, in which needles were inserted only superficially, for example, or in which patients in control groups were treated with needles that covertly retracted into handles.

Ultimately, Dr. Vickers and his colleagues found that at the end of treatment, about half of the patients treated with true acupuncture reported improvements, compared with about 30 percent of patients who did not undergo it.

“There were 30 or 40 people from all over the world involved in this research, and as a whole the sense was that this was a clinically important effect size,” Dr. Vickers said. That is especially the case, he added, given that acupuncture “is relatively noninvasive and relatively safe.”

Dr. Vickers said the results of the study suggest that people undergoing the treatment are getting more than just a psychological boost. “They’re not just getting some placebo effect,” he said. “It’s not some sort of strange healing ritual.”

In an acco Dr. Andrew L. Avins, a research scientist at Kaiser Permanente who focuses on musculoskeletal pain and preventive medicine, wrote that the relationship between conventional medical care “and the world of complementary and alternative medicine remains ambiguous.” But at least in the case of acupuncture, he wrote, the new study provides “robust evidence” that it provides “modest benefits over usual care for patients with diverse sources of chronic pain.”

Specifically, the science behind how your brain changes the longer you meditate. I think this is important for many reasons, but one of the most salient is that this information serves as a great motivator to keep up a daily practice (or start one).

I’m sure you’ve heard people extol the virtues of meditation. You may be skeptical of the claims that it helps with all aspects of life. But, the truth is, it does. Sitting every day, for at least 15-30 minutes, makes a huge difference in how you approach life, how personally you take things and how you interact with others. It enhances compassion, allows you to see things more clearly (including yourself) and creates a sense of calm and centeredness that is indescribable. There really is no substitute.

For those of you who are curious as to how meditation changes the brain, this is for you. Although this may be slightly technical, bear with me because it’s really interesting. The brain, and how we are able to mold it, is fascinating and nothing short of amazing. Here are the brain areas you need to know:

• Lateral prefrontal cortex: the part of the brain that allows you to look at things from a more rational, logical and balanced perspective. In the book, we call it the Assessment Center. It is involved in modulating emotional responses (originating from thefear center or other parts of the brain), overriding automatic behaviors/habits and decreasing the brain’s tendency to take things personally (by modulating the Me Center of the brain, see below).

• Medial prefrontal cortex: the part of the brain that constantly references back to you, your perspective and experiences. Many people call this the “Me Center” of the brain because it processes information related to you, including when you are daydreaming, thinking about the future, reflecting on yourself, engaging in social interactions, inferring other people’s state of mind or feelingempathy for others. We call it the Self-Referencing Center.

What’s interesting about the Medial PreFrontal Cortex (mPFC) is that it actually has two sections:

• Ventromedial medial prefrontal cortex (vmPFC) – involved in processing information related to you and people that you view as similar to you. This is the part of the brain that can cause you to end up taking things too personally, which is why we referred to it as the unhelpful aspect of the Self-Referencing Center in the book. (In reality, this brain area has many important and helpful functions – since we were focusing on overcoming anxiety, depression and habits you want to change, we referred to it as unhelpful because it often causes increases in rumination/worry and exacerbates anxious or depressive thoughts/states/feelings.)

• Dorsomedial Prefrontal Cortex (dmPFC) – involved in processing information related to people who you perceive as being dissimilar from you. This very important part of the brain is involved in feeling empathy (especially for people who we perceive of as not being like us) and maintaining social connections.

• Insula: the part of the brain that monitors bodily sensations and is involved in experiencing “gut-level” feelings. Along with other brain areas, it helps “guide” how strongly you will respond to what you sense in your body (i.e., is this sensation something dangerous or benign?). It is also heavily involved in experiencing/feeling empathy.

• Amygdala: the alarm system of the brain, what most refer to as the “Fear Center.” It's a part of the brain that is responsible for many of our initial emotional responses and reactions, including the “fight-or-flight” response. (Along with the Insula, this is what we referred to as the Uh Oh Center.)

The Brain Without Meditation – Stuck on Me

If you were to look at people’s brains before they began a meditation practice, you would likely see strong neural connections within the Me Center and between the Me Center and the bodily sensation/fear centers of the brain. This means that whenever you feel anxious, scared or have a sensation in your body (e.g., a tingling, pain, itching, whatever), you are far more likely to assume that there is a problem (related to you or your safety). This is precisely because the Me Center is processing the bulk of the information. What's more, this over-reliance on the Me Center explains how it is that we often get stuck in repeating loops of thought about our life, mistakes we made, how people feel about us, our bodies (e.g., “I’ve had this pain before, does this mean something serious is going on?) and so on.

Why is the Me Center allowed to process information this way, essentially unabated? The reason this happens, in part, is because the Assessment Center’s connection to the Me Center is relatively weak. If the Assessment Center was working at a higher capacity, it would modulate the excessive activity of the vmPFC (the part that takes things personally) and enhance the activity of the dmPFC (the part involved in understanding other’s thoughts and feelings). This would lead us to take in all the relevant information, discard erroneous data (that the Me Center might want to focus on exclusively) and view whatever is happening from a more balanced perspective – essentially decreasing the overthinking, ruminating and worrying that the Me Center is famous for promulgating. One helpful way to think of the Assessment Center is as a sort of “brake” for the unhelpful parts of the Me Center.

The Brain on Meditation – I Can See Clearly Now

In contrast, if you meditate on a regular basis, several positive things happen. First, the strong, tightly held connection between the Me Center (specifically the unhelpful vmPFC) and the bodily sensation/fear centers begins to break down. As this connection withers, you will no longer assume that a bodily sensation or momentary feeling of fear means something is wrong with you or that you are the problem! This explains, in part, why anxiety decreases the more you meditate – it’s because the neural paths that link those upsetting sensations to the Me Center are decreasing. Said another way, your ability to ignore sensations of anxiety is enhanced as you begin to break that connection between the unhelpful parts of the Me Center and the bodily sensation/fear centers. As a result, you are more readily able to see those sensations for what they are and not respond as strongly to them (thanks to your strengthened Assessment Center).

Second, a heftier, healthier connection forms between the Assessment Center and bodily sensation/fear centers. This means that when you experience a bodily sensation or something potentially dangerous or upsetting, you are able to look at it from a more rational perspective (rather than automatically reacting and assuming it has something to do with you). For example, when you experience pain, rather than becoming anxious and assuming it means something is wrong with you, you can watch the pain rise and fall without becoming ensnared in a story about what it might mean.

Finally, an added bonus of meditating is that the connection between the helpful aspects of the Me Center (i.e. dorsomedial prefrontal cortex) – the part involved in processing information related to people we perceive as being not like us – and the bodily sensation center – involved in empathy – becomes stronger. This healthy connection enhances your capacity to understand where another person is coming from, especially those who you cannot intuitively understand because you think or perceive things differently from them (i.e., dissimilar others). This increased connection explains why meditation enhances empathy – it helps us use the part of the brain that infers other people’s states of mind, their motivations, desires, dreams and so on, while simultaneously activating the part of the brain involved in the actual experience of empathy (insula). The end result is that we are more able to put ourselves in another person’s shoes (especially those not like us), thereby increasing our ability to feel empathy and compassion for everyone.

Daily Practice is Important

Essentially, the science “proves” what we know to be true from the actual experience of meditating. What the data demonstrate is that meditation facilitates strengthening the Assessment Center, weakening the unhelpful aspects of the Me Center (that can cause you to take things personally), strengthening the helpful parts of the Me Center (involved with empathy and understanding others) and changing the connections to/from the bodily sensation/fear centers such that you experience sensations in a less reactive, more balanced and holistic way. In a very real way, you literally are changing your brain for the better when you meditate.

In the end, this means that you are able to see yourself and everyone around you from a clearer perspective, while simultaneously being more present, compassionate and empathetic with people no matter the situation. With time and practice, people do truly become calmer, have a greater capacity for empathy and find they tend to respond in a more balanced way to things, people or events in their lives.

However, to maintain your gains, you have to keep meditating. Why? Because the brain can very easily revert back to its old ways if you are not vigilant (I’m referencing the idea of neuroplasticity here). This means you have to keep meditating to ensure that the new neural pathways you worked so hard to form stay strong.

To me, this amazing brain science and the very real rewards gained from meditation combine to form a compelling argument for developing and/or maintaining a daily practice. It definitely motivates me on those days I don’t “feel” like sitting. So, try to remind yourself that meditating every day, even if it’s only 15 minutes, will keep those newly formed connections strong and those unhelpful ones of the past at bay.

Addendum: For those wanting to start a meditation practice or who might be experiencing emotional issues, memories, etc. when meditating, please seek out an experienced medtiation teacher. I have received some comments from people stating they do not believe meditation works (which is likely true for some people) or that it could be harmful if done incorrectly. Obviously, meditation has been very positive for me, but I have always worked with a meditation teacher or mentor and I would suggest you do the same, as a teacher can help you figure out what is right for you and guide you through any difficulties you may be having.

"Delusions are states of mind which, when they arise within our mental continuum, 
leave us disturbed, confused and unhappy. 
Therefore, those states of mind which delude or afflict us 
are called 'delusions' or 'afflictive emotions'."
His Holiness the Dalai Lama

THE FEELING AGGREGATE

"Monks, there are beings who suffer not from disease of body for 1 year, for 2 years… even for 100 years. But it is hard to find in the world beings who can admit freedom from mental disease even for one moment, save only those who have destroyed delusions." 
The Buddha [Anguttara Nikaya (A.II:143); Samyutta Nikaya (S.III.:2)]

 Buddhist psychology describes four Mental Aggregates: Feeling, Discrimination, Primary Consciousnesses (5 senses and mental awareness) and the other aspects, gathered as the Compositional Factors.

The Feeling Aggregate is defined as 'an omnipresent factor of the mind which labels experiences into three categories: pleasant, unpleasant or neutral':

• When the label of pleasant is given to an object, we develop attachment.
• When the label of unpleasant is given to an object, we develop aversion, and sometimes even anger or hatred.
• When the label of neutral is given to an object, we often don't care about the object or even ignore it.

The process of labelling by the Feeling Aggregate usually only takes a fraction of a second. After applying the label, we tend to create a static opinion and image of the object in our mind. At this stage, the seed for prejudice is usually planted. Once we have established the opinion that something is pleasant or unpleasant, we often need a large amount of evidence before we are willing to change our mind – that is, if we are prepared to change our mind at all. 
Once we labelled an object unpleasant or bad, it appears as if the object is all bad by itself, as if badness is an inherent quality. We may label a person "bad", but the friends of this person would certainly not agree! 
Therefore, we need to realise that "good" and "bad" are merely subjective opinions of our mind, and the opinion is often founded on nothing more than a first glance and an almost automatic label. Things and people change quicker than our labels! Everyone tends to prejudice. Labelling is a convenient way to quickly make some sense of our surrounding world by categorising things in being "good" or "bad" to us. The main problem is that we tend to react to the world merely via these (over) simplified labels.

A practical example to reflect on would be medicines: most of them are poisonous in a large dose, but can still be healing in small doses. Every living being requires salt to live, but try eating half a kilo of it, and no doctor can prevent your speedy death.

From Chagdud Rinpoche's 'Gates to Buddhist Practice':

"To understand how delusion arises, practice watching your mind. 
Begin by simply letting it relax. Without thinking of the past or the future, without feeling hope or fear about this thing or that, let it rest comfortably, open and natural. In this space of the mind, there is no problem, no suffering. 
Then something catches your attention–an image, a sound, a smell. Your mind splits into inner and outer, self and other, subject and object. In simply perceiving the object, there is still no problem. 
But when you zero in on it, you notice that it's big or small, white or black, square or circular; and then you make a judgment– for example, whether it's pretty or ugly. Having made that judgment, you react to it: you decide you like it or don't like it. That's when the problem starts, because "I like it" leads to "I want it." We want to possess what we perceive to be desirable. Similarly, "I don't like it" leads to "I don't want it." If we like something, want it, and can't have it, we suffer. If we don't want it, but can't keep it away, again we suffer. Our suffering seems to occur because of the object of our desire or aversion, but that's not really so — it happens because the mind splits into object-subject duality and becomes involved in wanting or not wanting something. 
We often think the only way to create happiness is to try to control the outer circumstances of our lives, to try to fix what seems wrong or to get rid of everything that bothers us. But the real problem lies in our reaction to those circumstances. What we have to change is the mind and the way it experiences reality."

From The Art of Happiness: A Handbook for Living by His Holiness the Dalai Lama and Howard C. Cutler:

"We can see that there are many ways in which we actively contribute to our own experience of mental unrest and suffering. Although, in general, mental and emotional afflictions themselves can come naturally, often it is our own reinforcement of those negative emotions that makes them so much worse. For instance when we have anger or hatred towards a person, there is less likelihood of its developing to a very intense degree if we leave it unattended. However, if we think about the projected injustices done to us, the ways in which we have been unfairly treated, and we keep on thinking about them over and over, then that feeds the hatred. It makes the hatred very powerful and intense. Of course, the same can apply to when we have an attachment towards a particular person; we can feed that by thinking about how beautiful he or she is, and as we keep thinking about the projected qualities that we see in the person, the attachment becomes more and more intense. But this shows how through constant familiarity and thinking, we ourselves can make our emotions more intense and powerful. 
We also often add to our pain and suffering by being overly sensitive, overreacting to minor things, and sometimes taking things too personally. We tend to take small things too seriously and blow them up out of proportion, while at the same time we often remain indifferent to the really important things, those things which have profound effects on our lives and long-term consequences and implications.
So I think that to a large extent, whether you suffer depends on how you respond to a given situation."

SOME NOTES ON HABITUATION

On top of the above problems related to labelling, the aspect of habituation comes in to reinforce our opinions and prejudices. Strictly spoken, habituation is not negative; in fact it can be extremely positive. Note that the Tibetan word for meditation means "habituation". However, within the context of problematic emotions, habituation can cause exponential growth of problems. If we just look at the results of racial and religious discrimination and hatred, it is sadly obvious how extreme opinions can arise and create havoc, simply because they have become habitual. Once something is a habit, we do not question our behaviour anymore, it becomes automatic and extremely hard to change.

A story by the Buddha to illustrate habituation and the resulting closed-mindedness:

"A young widower, who loved his five year old son very much, was away on business when bandits came who burned down the whole village and took his son away. When the man returned, he saw the ruins and panicked. The took the burnt corpse of an infant to be his son and cried uncontrollably. He organised a cremation ceremony, collected the ashes and put them in a beautiful little bag which he always kept with him.
Soon afterwards, his real son escaped from the bandits and found his way home. He arrived at his father's new cottage at midnight and knocked at the door. The father, still grieving asked: "Who is it?" The child answered, it is me papa, open the door!" But in his agitated state of mind, convinced his son was dead, the father thought that some young boy was making fun of him. He shouted: "Go away" and continued to cry. After some time, the child left. Father and son never saw each other again."  After this story, the Buddha said: "Sometime, somewhere, you take something to be the truth. If you cling to it so much, even when the truth comes in person and knocks on your door, you will not open it."

Or, in terms of our general attitude, His Holiness the Dalai Lama notes in "Beyond Dogma – The Challenge of the Modern World":

"We all know that on days when we are in a good mood, when the whole world seems to be smiling at us, we can accept predicaments or bad news more easily than if our mind is already upset, frustrated or troubled, when the slightest incident might cause us to explode with negative emotions. If we make a habit of being governed by these negative emotions, we will lose our appetite, sleep badly, perhaps become ill, and lose a few years of our life as a result. So mental calmness is very important."

THE THREE POISONS

The three most important negative mental attitudes or delusional emotions are called the Three Poisons, these are anger,attachment and ignorance. Underlying all negative emotions are one or more of these three, with ignorance at the bases of all negative emotions (see also the page on mind). Ignorance here, mainly refers to the Buddhist concept of lack ofwisdom, or insight into the actual way that things exist.

His Holiness the 7th Dalai Lama (from 'Songs of spiritual change' translated by Glenn Mullin) wrote on attachment and anger:

"Merchants come from the north and south,
To gather in the trading center;
But after three days have passed,
Each goes his separate way.
Meeting for but a flash in time,
They should avoid fights and fancies.

Hooked by karmas from previous lives,
Love and hatred run fierce,
But soon we all go our own ways,
And each takes his suited rebirth.
Right now abandon interpersonal discrimination
Made on the basis of attachment and aversion."

HOW TO TRANSFORM NEGATIVE EMOTIONS

Sogyal Rinpoche writes in Glimpse of the Day:

"Two people have been living in you all your life. One is the ego, garrulous, demanding, hysterical, calculating; the other is the hidden spiritual being, whose still voice of wisdom you have only rarely heard or attended to. As you listen more and more to the teachings, contemplate them, and integrate them into your life, your inner voice, your innate wisdom of discernment, what we call in Buddhism “discriminating awareness,” is awakened and strengthened, and you begin to distinguish between its guidance and the various clamorous and enthralling voices of ego. The memory of your real nature, with all its splendor and confidence, begins to return to you.

You will find, in fact, that you have uncovered in yourself your own wise guide, and as the voice of your wise guide, or discriminating awareness, grows stronger and clearer, you will start to distinguish between its truth and the various deceptions of the ego, and you will be able to listen to it with discernment and confidence."

Poisonous 
By Jeniffer Edwards

Why cling to the arrows shot at you? 
Insults 
Wounds 
Time heals you see. 
Why hold so tightly 
Do these things define you? 
Do these things set you free? 
Why inject yourself with these poisons of the mind 
Anxiety 
Greed 
Anger 
Despair 
Why not let them go 
Set them free. 
Accept the choices you have 
And your responsibilities. 
Accept all that is, rather than "as it should be" 
For what does define "you" 
What will set you free 
What if you never find great meaning 
What if, in not clinging, 
You find stillness 
Calm 
Honesty 
Health 
Peace

In the Tibetan tradition, the most basic method to reduce our negative emotions is via analytical meditation. The reasoning is that the negative emotions are delusions – misunderstandings of reality. If one analyses the process of how they come about, we can discover where real problem lies. Analytical meditation appears a very good method, as one avoids emotional excitement in meditation, and very calm observation of the workings of our own mind usually presents answers quite easily.

So, simply by being calm and quiet, analyze what is behind these destructive emotions and learn where the fault really lies. In Buddhism, the fault never lies ultimately with the outside world! As all our positive and negative experiences are results of our own karma, only our failure to behave more positive causes us problems.

One of the biggest obstacles to rid ourselves of these delusions is habituation. Although it is possible to analyse afterwards why it may have been unjust to become angry at someone, it is not simple to stop oneself before anger comes up. More pages on specific negative emotions and how to deal with them are given under the heading of Delusional Emotions in the top left corner of this page. The 'Summary' page describes the general approach in detail.

It should be noted that the ultimate antidote to negative emotions is the wisdom of emptiness. As all distinctions of 'self' and 'other' vanish with this realisation, when all duality vanishes, things like good and bad, or pleasant and unpleasant become meaningless. Due to the way our mind works, it is quite difficult to make this wisdom 'breakthrough', and analytical meditation is a good starter to work on our day-to-day negative emotions and actions.

"This is the radical discovery of Buddhist psychology. You don't have to resign yourself to ordinary suffering, to being always unconscious of what is really going on, helpless before not only society and space and time and others, but more importantly before your own inner drives, impulses and demands. You need not give up and allow yourself to be buffetted here and there by passions and angers. You can become conscious of what you were formerly unconscious. You can understand your drives, see where they come from, block the source, and divert the energy for your own use. You can resist all imperatives and learn to wield the underlying energies. You can reclaim those energies for your life, for your happiness and the happiness of your loved ones."
Robert Thurman from "Anger"

In the way that a gardener knows how to transform compost into flowers, 
we can learn the art of transforming anger, depression, and racial discrimination into love and understanding.
This is the work of meditation.
Thich Nhat Hanh from "Touching Peace"

Instead of analysis, one can also learn to deal with negative/problematic emotions by practicing awareness of them, for a brief introduction see eg. the introductory article The Second Arrow: The Practice of Emotional Awareness, by Ken Jones. In fact this is a form of Vipassana whereby one focuses on emotions and feelings rather than eg. the sensations of the body. 
The basic instruction is simple: 'just observe', but to actually do that is a different story altogether, as we need to stay on the subject and not end up in endless conversations with ourselves. These kind of awareness practices form a major part of the Theravada tradition (with which I have limited experience, and therefore cannot elaborate much about).

IS IT POSSIBLE TO RID OURSELVES COMPLETELY OF DELUSIONAL EMOTIONS?

This is actually a unique feature of Buddhist psychology: everyone can basically become a Buddha. A Buddha can be defined as a sentient being who has no negative (delusional) aspects of mind, and who has developed all positive aspects of mind to the greatest possible extent. So, as a Buddha has no delusional emotions at all, and we can all become a Buddha, it is logical that we can all rid ourselves of delusional emotions that are the basic cause of all our suffering.

As His Holiness the Dalai Lama explains in Healing Anger: The Power of Patience from a Buddhist Perspective :

What premises or grounds do we have for accepting that mental afflictions can be ultimately rooted out and eliminated from our mind? 
In Buddhist thought, we have three principal reasons for believing that this can happen. 
One is that all deluded states of mind, all afflictive emotions and thoughts, are essentially distorted in their mode of apprehension, whereas all the antidotal factors such as love, compassion, insight, and so on not only are undistorted, but they also have grounding in our varied experience and in reality.
Second, all these antidotal forces also have the quality of being strengthened through practice and training. Through constant familiarity, one can enhance their capacity and increase their potential limitlessly. So the second premise is that as one enhances the capacity of these antidotal forces and increases their strength, one is able to correspondingly reduce the influences and effects of delusory states of mind.
The third premise is that the essential nature of mind is pure; in other words, there is the idea that the essential nature of mind is clear light or Buddha-nature.
So it is on these three premises that Buddhism accepts that delusions, all afflictive emotions and thoughts, can be ultimately eliminated through practice and meditation.

This is where Buddhist psychology departs from general modern-style psychology, which is aimed at reducing our problematic emotions to an 'acceptable level', until we can fit into society without too much trouble. The Buddhist idea that our mind can be totally free from attachment, aversion and ignorance, and all derived negative feelings and problems gives a totally different outlook on what we can achieve. The only problem is of course that we need to make a lot of effort to develop our minds to reach this perfect state of Buddhahood.

Spiritual practices have been proposed to have many beneficial effects as far as mental health is concerned. The exact neural basis of these effects is slowly coming to light and different imaging techniques have elucidated the neural basis of meditative practices. The evidence though preliminary and based on studies replete with methodological constraints, points toward the involvement of the prefrontal and parietal cortices. The available data on meditation focus on activated frontal attentional network. Neuroimaging studies have shown that meditation results in an activation of the prefrontal cortex, activation of the thalamus and the inhibitory thalamic reticular nucleus and a resultant functional deafferentation of the parietal lobe. The neurochemical change as a result of meditative practices involves all the major neurotransmitter systems. The neurotransmitter changes contribute to the amelioration of anxiety and depressive symptomatology and in part explain the psychotogenic property of meditation. This overview highlights the involvement of multiple neural structures, the neurophysiological and neurochemical alterations observed in meditative practices.

Keywords: Anxiety and Psychotic states; Depression; Functional Imaging; Meditation; Prefrontal Hypothesis; PSPL Deafferentation; Spirituality

Introduction

Spirituality is defined as that relating to or consisting of or having the nature of spirit. The nature of spirit is intangible or immaterial. The English word 'spirit' comes from the Latin ' spiritus ' meaning breath. The spiritual realm deals with the perceived eternal realities regarding man's ultimate nature, in contrast to what is temporal or worldly. Spirituality involves as its central tenet a connection to something greater than oneself, which includes an emotional experience of religious awe and reverence. Spirituality is therefore an individual's experience of and relationship with a fundamental, nonmaterial aspect of the universe that may be referred to in many ways – God, Higher Power, the Force, Mystery and the Transcendent and forms the way by which an individual finds meaning and relates to life, the universe and everything.





Religious experience and religion forms only a part of a person's spiritual quest. Religion is an organized belief system promulgated and sustained by a human institution, ethnic group, tribe or culture and involves definite rules of behaviour, practices and rituals. The English word religion comes from the Latin ' religio ' meaning reverence, though a deeper study reveals it to be a combination of two words, ' Re ' meaning return and ' Ligare ' meaning 'to bind'. Though closely related, religions probably originated as a way of meeting humanity's possible innate need for spirituality.





Spirituality and religion are not interchangeable or always linked. Therefore a person may have religion without spirituality or spirituality without religion. It is noted that spirituality can have both positive and negative effects on physical health, mental health and coping. The studies on how religion and spirituality affect the brain, though inconclusive, still give vital pointers to the neural mechanisms of such practices. Some of these are reviewed in this article.





 

Spirituality and Mental Health

The role of spirituality as a resource for finding meaning and hope in suffering has also been identified as a key component in the process of psychological recovery. Most studies have shown that religious involvement and spirituality are associated with better health outcomes, including greater longevity, coping skills and health-related quality of life (even during terminal illness) and less anxiety, depression and suicide. Several studies have shown that addressing the spiritual needs of the patient may enhance recovery from illness (Mueller, et al. , 2001). A recent meta-analysis, which summarized the results of 147 independent investigations involving a total of 98,975 subjects on the association between religiousness and depressive symptoms, found that religiousness is modestly but robustly associated with lower level of depressive symptoms. It was also noted that two specific measures of religiousness, namely extrinsic religious orientation and negative religious coping had a positive association with high frequency of depressive symptoms, while intrinsic religious orientation was associated with low levels of depression (Moreira-Almeida, et al. , 2006). A study of the impact of religion and spirituality in schizophrenics showed that religion was used as a positive way of coping by 71% of patients and as a negative way of coping by 14%. The study found that religion and spirituality lessened (54%) or increased (10%), psychotic symptoms and may reduce (33%) or increase (10%), the risk of suicide attempts. It may also reduce (14%) or increase (3%), substance use and foster adherence to (16%) or be in opposition to (15%), psychiatric treatment (Mohr, et al. , 2006).





Of the 120 identified studies published prior to 2000 investigating religiousness and alcohol/drug use/abuse, most of them found a clear inverse correlation between these variables. A study conducted on students in a large metropolitan area showed that religious factors were strongly associated with lower drug abuse, even after controlling for the relevant socio-demographic and educational variables (Moreira-Almeida, et al. , 2006). The role of spirituality in addiction was also reflected upon in a study, which found that smoking and frequent binge drinking were negatively correlated with spirituality scores (Leigh, et al. , 2005).





A review of the 68 studies identified through 2000 found lower rates of suicide or more objections to suicide, among the more religious subjects. It was also noted that the level of religiousness was inversely associated with the acceptance of euthanasia and physician-assisted suicide in the general population in Britain, among the elderly in the US and cancer patients in a palliative care service in the US (Moreira-Almeida, et al. , 2006). A meta-analysis focusing on the usefulness of meditation therapy for anxiety disorders showed that transcendental meditation showed a reduction in anxiety symptoms and electromyography score comparable with electromyography-biofeedback and relaxation therapy (Krisanaprakornkit, et al. , 2006). A study also found that the relationships between religion/spirituality and mental health were generally stronger or more unique, for males and older adolescents than for females and younger adolescents (Wong, et al. , 2006). The evidence thus far points to a clear association, both positive and negative, between spirituality/religion and mental health.





 

Neurobiological Explorations into Spirituality

There is a paucity of evidence regarding the neural correlates of spiritual practices and most studies that have explored spirituality have concentrated on meditative practices. Most of the studies examining them used functional imaging as the investigation tool, to delineate the neural mechanisms involved in these practices. They include the Positron Emission Tomography (PET) studies on Yoga, Tantric Yoga and Yoga Nidra; the Magnetic Resonance Imaging (MRI) study on Kundalini Yoga; and the Single Photon Emission Computerized Tomography (SPECT) study on Tibetan meditation. The studies point to prefrontal activation, transient hypofrontality, increased frontal lobe and decreased parietal lobe activity and also to a deafferentation of the posterior superior parietal lobule (PSPL) in spirituality [Table 1] (Newberg and Iversen 2003; Muramoto, 2003; Azari et al. , 2001).





 

Prefrontal Hypothesis and Transient Hypofrontality

The frontal lobe, though not involved in the generation of religious experiences like vision, voice and unification with the divine, is however known to affect personality and social function. The study on 12 healthy volunteers', six of whom religious and six non- religious, showed that religious experience may be a cognitive process, mediated by a pre-established neural circuit, involving dorsolateral, prefrontal, dorsomedial, frontal and medial parietal cortex. There is substantial evidence from the psychology of religion to suggest that people are prepared 'for religious experiences and this readiness' is probably mediated by the dorsomedial frontal cortex, leading to the commonly reported felt immediacy of religious experience (Azari et al ., 2001). The experience, however, becomes religious when people consciously identify the experience as consistent with their own religious schema. This cognitive process most probably involves the dorsolateral, prefrontal and medial parietal cortex. Therefore, the prefrontal regions mediate both the preparedness of religious experience and conscious cognitive process involved in the appreciation of religious experience (Azari, et al. , 2001).





Imaging study of meditation reveals that the process of meditation which requires intense focus of attention, seems to activate the PFC (prefrontal cortex) (bilaterally but more on the right), as well as the cingulate gyrus. Thus, meditation appears to begin by activating the prefrontal and cingulate cortex associated with the will or intent to clear one's mind of thoughts or to focus on an object. Studies on the guided type of (externally guided word generation) meditation however show a decrease in frontal activity when compared to volitional (internal) word generation. Thus, prefrontal and cingulate activation may be associated with the volitional aspects of meditation (Newberg and Iversen, 2003).





Further, it is proposed that a balanced function of the medial PFC is needed to maintain balanced religious activities. The specific functions involved in this regulation of religion are those mediating compliance to rules and customs, self-reflection and the understanding of thoughts and feelings of others with compassion and empathy (theory of mind). Theory of mind (ToM) or mentalization is the ability to recognize that someone else has a mind different from one's own. It involves the ability to infer someone else's mind by facial expression, tone of voice and non-verbal communication. It involves the area concerned with action imitation, face imitation and intention understanding (IFG). The neural structures involved in ToM include IFG, STS and IPL on the right side, medial prefrontal cortex including the anterior cingulate cortex (ACC) orbitofrontal cortex (OFC), precuneus, somatosensory cortex, amygdala and the occipital cortex. Therefore the MNS is integral to the theory of mind (Gabbard, 2005; Siegal and Varley, 2002). The medial PFC is involved in error detection and monitoring and compliance to social norms and therefore is involved in mediating compliance to rules and customs. The medial PFC along with the posterior cingulate is involved in self-reflective thought and this helps the person to have an insight into his own experience and the perception of self in relation to the divine being. The third regulatory function, which includes the theory of mind, involves the medial PFC, especially the orbitofrontal cortex, the lesion of which impairs theory of mind tasks. Based on this it is hypothesized that the hypofunction of the medial PFC results in decreased religiosity (hyporeligiosity). This would result from a combination of reckless and lawless behaviour (impaired error detection), self-indulgence (loss of self reflection) and an inability to consider the thoughts of others (impaired theory of mind). Hyperfunction of the medial PFC, on the other hand, will lead to rigid conformity with rules and customs, excessive concern over oneself and one's existence and excessive interpretation of the mind of others, all of which results in heightened religiosity (hyperreligiosity). A balanced function of the medial PFC results in normal error detection, self-reflection and theory of mind resulting in a balanced religious activity (Muramoto, 2003).





It is also hypothesized that the mental states commonly referred to as altered states of consciousness seen during certain spiritual/religious practices are principally due to transient prefrontal cortex deregulation. Supportive evidence for this comes from psychological and neuroscientific studies of dreaming, endurance running, meditation, daydreaming, hypnosis and various drug-induced states. It is proposed that transient hypofrontality is the unifying feature of all these altered states and that the phenomenological uniqueness of each state is the result of the differential viability of various frontal circuits; and the hallmark of altered states of consciousness is the subtle modification of behavioural and cognitive functions that are typically ascribed to the prefrontal cortex (Dietrich, 2003). There is also evidence from a Positron Emission Tomography study of Yoga Nidra relaxation meditation, when compared with the normal resting conscious state, that meditation is accompanied by a relatively increased perfusion in the sensory imagery system: hippocampus and sensory and higher order association regions, with decreased perfusion in the executive system: dorsolateral prefrontal cortex, anterior cingulate gyrus, striatum, thalamus, pons and cerebellum (Lou, et al. , 2006).





So there is considerable evidence from imaging studies of many spiritual practices to suggest a role for the PFC in the mediation of spiritual and religious experiences.





 

Thalamic Activation and PSPL Deafferentation

The PFC, when activated (functional imaging during meditative practices) via the glutamatergic projections, can activate the thalamus, especially the reticular nucleus of the thalamus, as part of a more global attentional network. The thalamus mediates the flow to the cortex of sensory information both visual and information needed to determine the body's spatial orientation via the lateral geniculate body (LGB) and the lateral posterior nucleus (LPN), respectively. The visual information is relayed via LGB to the striate (visual) cortex and the spatial information is relayed via LPN to the PSPL. When excited, the reticular nucleus via inhibitory GABAergic (gamma amino butyric acid) projections to the LGB and LPN cuts the input to the striate cortex and the PSPL (especially right). This functional deafferentation means a decrease in the arrival of distracting stimuli to the striate cortex and PSPL, enhancing the sense of focus during meditation.





The PSPL is involved in the analysis and integration of higher order visual, auditory and somaesthetic information and is also part of the complex attentional network including the PFC and thalamus. The PSPL helps construct a complex three-dimensional image of the body in space, helps distinguish objects and helps identify objects that can be grasped and manipulated. These functions help distinguish self and the external world and a deafferentation of this area is important in the physiology of meditation. This deafferentation results in an altered perception of self-experience during spiritual or meditative practices. The PSPL deafferentation is supported by three neuroimaging studies, all of which showed decreased activity in the region during intense meditation [Figure 1] (Newberg and Iversen, 2003).





 

Activation of Hippocampus and Amygdala and the Hypothalamic and Autonomic Changes

Limbic stimulation is also implicated in experiences similar to meditation. The hippocampus modulates cortical arousal and responsiveness via its connections and hippocampal stimulation decreases cortical arousal and responsiveness. However, if cortical arousal itself is at a low level initially, then hippocampal stimulation augments cortical arousal. The partial deafferentation of the right PSPL during meditation results in the stimulation of the right hippocampus due to the inverse modulation of the hippocampus in relation to cortical activity. The right hippocampus influences the right lateral amygdala and they interact with each other in the generation of attention, emotion and certain types of imagery which are part of the experience of meditation. Functional imaging study (MRI) in Kundalini Yoga supports this notion of increased activity of hippocampus and amygdala in meditation (Newberg and Iversen, 2003). Stimulation of the right lateral amygdala results in stimulation of the ventromedial hypothalamus with stimulation of the peripheral parasympathetic system. The increased parasympathetic activity is associated with a subjective sensation, first of relaxation and later, a more profound sense of quiescence. Activation of parasympathetic system results in decreased heart and respiratory rate. All these physiological responses are observed during meditation. There is a decrease in innervation of the locus coeruleus (LC) by the paragigantocellular nucleus (PGN) when the heart rate and respiration slows down. This results in decreased noradrenaline, a finding seen in urine and plasma studies of subjects practicing meditation. The decrease PGN and LC stimulation cuts the supply from LC to the PSPL and LPN (via decreased noradrenaline) and decreases the sensory input on the PSPL contributing to the deafferentation. The LC also delivers less noradrenaline to the hypothalamic paraventricular nucleus (PVN) and decreases the production of corticotrophin releasing hormone (CRH) and cortisol. The urine and plasma studies show decreased cortisol level during meditation [Figure 2] (Newberg and Iversen, 2003).





 

Sympathetic Activation: Breakthrough and Left PSPL Activation

There is evidence from a recent study for the mutual activation of parasympathetic and sympathetic axis in meditation (Newberg and Iversen, 2003). The evidence was based on the analysis of two meditative practices, which showed an increased variability of heart rate, suggesting the activation of both arms of the autonomic system. This also fits the descriptions of meditative states, which are associated with a sense of overwhelming calmness as well as significant alertness. The proposed mechanisms of the sympathetic activity include the breakthrough of sympathetic activity and the notion that some meditative practices activate the lateral hypothalamus via left hemispheric stimulation resulting in sympathetic drive.





The intense stimulation of either the sympathetic or parasympathetic axis, if continued, could ultimately result in simultaneous discharge of both systems. This is considered as a 'breakthrough' of the other system. Meditative practices predominantly activate the parasympathetic system characterized by the low heart rate and respiratory rate associated with meditation. The continued parasympathetic stimulation ultimately results in a breakthrough of the other arm resulting in a sympathetic drive [Figure 3].





There is lack of clarity as to the hemispheric stimulation that initiates the sequence of neural events during meditation. The model shows that the activity begins in the right hemisphere, but meditative practices might activate the left hemisphere first or cause bilateral activation. Further breakthrough might help with the stimulation of brain structures in both hemispheres. The left PFC activates the thalamus leading to a deafferentation of the left PSPL, which, via left hippocampus and amygdala, activates the lateral hypothalamus. The lateral hypothalamus in turn activates the sympathetic system; additionally it activates the serotoninergic dorsal raphae and the melatoninergic pineal gland [Figure 4].





 

Temporal Lobe and Spirituality

Medical literature has all too frequently highlighted the temporal lobe as an area implicated in religious activity. The evidence for this is drawn from observations that temporal lobe epilepsy is characterized by religious experiences as part of the ictus and the inter ictal behaviour. Further, many psychophysiological ictal phenomena, like hallucinations, dιjà vu, depersonalization etc are tagged to limbic system activation. These observations were analyzed and a limbic marker hypothesis of religion was proposed (Saver and Rabin, 1997). This states that limbic system tags ordinary experiences as profoundly important, as detached, as united into a whole and as joyous and such profound experiences could form the basis of religious experience. There are also suggestions that the superior temporal lobe may play a more important role than PSPL in body spatial representation (Karnath, et al. , 2001). However, this needs to be substantiated and the relationship between temporal and parietal lobe need to be further elucidated. In spite of the evidence pointing to a temporal lobe involvement, there is no literature, which shows that lesions or removal of temporal lobe resulted in a change in religious activity. It is therefore possible that temporal lobe, though associated with the psychophysiological phenomena interpreted with religious meaning, may not be necessary in maintaining religious activity (Newberg and Iversen, 2003; Muramoto, 2003).





 

Neurochemistry of Spirituality

The dopaminergic system, via the basal ganglia, is involved in cortical subcortical interactions and a PET study on the dopaminergic tone in Yoga Nidra using 11 C-raclopride showed significant increase of dopamine during meditation (Kjaer, et al. , 2002). During meditation, 11C-raclopride binding in ventral striatum decreased by 7.9%. This corresponds to a 65% increase in endogenous dopamine release. It is hypothesized that the increase in dopamine is associated with the gating of cortical-subcortical interactions, leading to an overall decrease in readiness for action that is associated with this type of meditation. However more studies are needed to elucidate the role of dopamine and its interaction with other neurotransmitters in meditation (Kjaer, et al. , 2002).





There is also an increase in the serotonin levels during meditation, especially via the lateral hypothalamic stimulation of the dorsal raphae. This is correlated by findings of increased serotonin metabolites in the urine after meditation (Walton, et al. , 1995). Serotonin has effects on depression and anxiety and 5HT ₂ receptor stimulation can result in hallucinogenic effects. Serotonin, via the mechanism of inhibition of the LGB, greatly reduces the passage of visual information and this results in visual hallucinations, a phenomena seen when psychedelics with serotoninergic mechanism, like lysergic acid diethylamide (LSD) and psilocybin, are taken. This decrease in LGB action, along with increased reticular nucleus inhibition, increases the fluidity of temporal visual associations in the absence of sensory input, resulting in internally generated imagery described during certain meditative states. Serotonin increase can interact with dopamine and this link may enhance the feelings of euphoria seen during meditation. Serotonin, also in conjunction with glutamate, can result in the release of acetylcholine from Nucleus Basalis. While no studies have evaluated the role of acetylcholine in meditation, it appears that this neurotransmitter enhances attentional processing and spatial orientation during progressive deafferentation of input to PSPL (Yoshida, et al. , 1984; Newberg and Iversen, 2003).





Meditation associated with a decrease in the levels of noradrenaline, the mechanism of which as described earlier, is due to increased parasympathetic activity dampening PGN and resulting in decreased activity of the LC. The breakdown products of noradrenaline are generally found to be low in the urine and plasma during meditation (Walton, et al. , 1995).





There is an increase in the levels of the amino acid neurotransmitters, namely glutamate and GABA, during meditation. The increased PFC activity produces an increase in the level of free synaptic glutamate in the brain. Glutamate activates the N-methyl-D-aspartate (NMDA) receptors (NMDAr), but an excess of glutamate can kill these neurons through excitotoxicity. It is proposed that if glutamate levels reach excitotoxic levels during intense meditation, the brain might limit the production of N-acetylated-a-linked-acidic dipeptidase, the enzyme that converts the endogenous NMDAr antagonist N-acetylaspartylglutamate (NAAG) to glutamate (Thomas, et al. , 2000). NAAG is analogous to the dissociative hallucinogens like ketamine and phencyclidine and can produce such states. Therefore the NMDAr antagonist accumulation can produce a variety of states, like out of body and near death experiences, that are characterized as schizophrenomimetic or mystical (Newberg and Iversen, 2003). Reticular nucleus activation is the chief mechanism responsible for increase in GABA. Several studies have demonstrated an increase in serum GABA during meditation (Elias, et al. , 2000). GABA of course plays an important role in PSPL deafferentation.





Meditation is associated with a sharp increase of plasma melatonin (Tooley, et al. , 2000). Stimulation of the pineal gland by the lateral hypothalamus is responsible for the hike in melatonin. The increased melatonin may result in the calmness and decreased awareness of pain seen during meditation. It is also noted that during heightened activation, pineal enzymes synthesize 5-methoxy-dimethyltryptamine (DMT), which is a powerful hallucinogen. Several studies have linked DMT to out of body experience, time space distortion and other such mystical states (Strassan and Clifford, 1994).





Parasympathetic activation and decreased LC stimulation of the PVN of the hypothalamus as discussed above also results in decreased CRH and cortisol levels during meditation. The parasympathetic activation also results in decreased baroreceptor stimulation and secondarily releases its inhibition of the supraoptic nucleus, leading to the release of arginine vasopressin (AVP) and returns the blood pressure to normal. There is a dramatic AVP increase during meditation, which plays a role in decreasing self-perceived fatigue, increases arousal and helps consolidate new memories and learning. Increase in glutamate also stimulates the arcuate nucleus of the hypothalamus and causes the release of β -endorphin (BE). This is probably responsible for effects such as decreased pain and joyous and euphoric sensations during meditation along with other chemical mediators (Newberg and Iversen, 2003).





 

Spirituality and Psychiatric Disorders: Neural Correlates of Anxiety

Meditation due to the neurochemical changes can produce an anxiolytic effect. The factors decreasing anxiety during meditation are an increased parasympathetic activity, decreased LC firing with decreased noradrenaline, increased GABAergic drive, increased serotonin and decreased levels of the stress hormone cortisol. The increased levels of endorphins and AVP also contribute to the anxiolytic effects of meditation (Newberg and Iversen, 2003).





 

Depression

Spiritual practices can have considerable antidepressant effects due to the associated increase in serotonin and dopamine. Additional factors like increased levels of melatonin and AVP contribute to the antidepressant effects. There is an observed increase of β -endorphin as also NMDAr antagonism during meditation, both of which have antidepressant effects. The decreased level of CRH and cortisol also plays an important role in allaying depression. Thus, via multiple neurochemical changes, spiritual practices can counteract depression [Table 2],[Table 3] (Newberg and Iversen, 2003).





 

Psychotic States

Meditation can induce psychotic states via mechanism such as increased 5HT ₂ receptor activation, increased DMT, increased NAAG and increased dopamine. The mechanisms include the 5HT inhibition of LGB, the hallucinogenic effects of DMT, the dissociative hallucinogenic effects of NAAG and the action of increased dopamine in the temporal lobe. A variety of schizophrenomimetic effects can be seen as a result of these complex neurochemical changes.





 

Meditation and Neuroplasticity

A recent study using MRI was conducted to assess the cortical thickness in 20 participants with extensive Insight meditation experience involving focused attention to internal experiences. The participants were typical Western meditation practitioners who incorporated their meditation practices with their careers and family life. The study showed that brain regions associated with attention, interoception and sensory processing like the PFC and right anterior insula were thicker in meditation practitioners in comparison with matched controls. The prefrontal cortical thickness was most pronounced in older participants, suggesting that meditation probably offsets age-related cortical thinning. It was also noted that the thickness of PFC and right anterior insula correlated with meditation experience. The data provides structural evidence for experience-dependent cortical plasticity associated with meditation practice implying that meditation practices promote neuroplasticity (Lazar et al ., 2005).





 

Conclusion

Spiritual practices have shown definite neuroanatomical and neurochemical changes in the few studies that have been conducted so far to explore the neurobiology of such phenomenon. The evidence has been drawn mainly from studies that have examined meditation. However, they are replete with investigational constraints, methodological errors, small sample size and the results of many of the studies have not been replicated. There is need for further exploration of many of the prevalent spiritual/religious practices to clearly elucidate the neural correlates of the positive and negative effects they produce on physical and mental health.^[25]





Take Home Message





Meditative practices have a positive impact on mental health. The neurobiological correlates during meditation partly explain the beneficial role. Meditative practices may augment psychotherapeutic interventions.





Declaration





This is my original unpublished article, not being considered for publication elsewhere.





 

Questions That This Paper Raises

1. What are the neural changes brought about by the different spiritual practices (meditation and others)?
2. Can all the beneficial effects of meditation be solely explained by the proposed neurochemical alterations?
3. What are the confounding variables that influence the neuroimaging study of meditation?
4. Is it possible to do real time neuroimaging studies on meditative/spiritual practices on a large sample of practitioners?
5. Is the right brain more important than left in spiritual practices?
6. What is the contribution of the left-brain as far as spiritual experience is concerned?

About the Author








E. Mohandas, Postgraduate in psychiatry from the All India Institute of Medical Sciences, Delhi, India. Has served as consultant in Zambia. For the last 23 years, working as senior consultant at Elite Mission Hospital, Trichur, Kerala. Currently Chairman, Indian Association of Biological Psychiatry; CME director, South Asia Forum for Mental Health International; Award Committee Chairperson, Indian Psychiatric Society. Past President, Indian Association for Private Psychiatry.





























 

References

1.	Azari N.P., Nickel J., Wunderlich G., Niedeggen M., Hefter H., Tellmann L., Herzog H., Stoerig P., Birnbacher D., Seitz R.J., (2001), Neural correlates of religious experience, Eur J Neurosci, 13: 8, p1649-1652.
2.	Cahn B.R., Polich J., (2006), Meditation states and traits: EEG, ERP and neuroimaging studies, Psychol Bull , 132 :2, p 180-211.
3.	Dietrich A., (2003) , Functional neuroanatomy of altered states of consciousness: the transient hypofrontality hypothesis, Conscious Cogn , 12 : 2, p231-256.
4.	Elias A.N., Guich S., Wilson A.F., (2000), Ketosis with enhanced GABAergic tone promotes physiological changes in transcendental meditation, Med Hypotheses,54 , p 660-662.
5.	Gabbard G.O., (2005), Mind brain and personality disorder, Am J Psychiatry, 162, p 648-655.
6.	Karnath H.O., Ferber S., Himmelbach M., (2001), Spatial awareness is a function of the temporal not the posterior parietal lobe, Nature , 411 : 6840, p 950-953.
7.	Kjaer T.W., Bertelsen C., Piccini P., Brooks D., Alving J., Lou H.C., (2002), Increased dopamine tone during meditation-induced change of consciousness, Brain Res Cogn Brain , 13 :2,p 255-259.
8.	Krisanaprakornkit T., Krisanaprakornkit W., Piyavhatkul N., Laopaiboon M., (2006), Meditation therapy for anxiety disorders, Cochrane Database Syst Rev, 25: 1, CD004998.
9.	Lazar S.W., Kerr C.E., Wasserman R.H., Gray J.R., Greve D.N., Treadway M.T., McGarvey M., Quinn B.T., Dusek J.A., Benson H., Rauch S.L., Moore C.I., Fischl B., (2005), Meditation experience is associated with increased cortical thickness, Neuroreport , 16 : 17, p 1893-1897.
10.	Leigh J., Bowen S., Marlatt G.A., (2005), Spirituality, mindfulness and substance abuse, Addict Behav , 30 :7, p 1335-1341.
11.	Lou H.C., Nowak M., Kjaer T.W., (2005), The mental self, Prog Brain Res , 150 , p 197-204.
12.	Mohr S., Brandt P.Y., Borras L., Gillieron C., Huguelet P., (2006), Toward an integration of spirituality and religiousness into the psychosocial dimension of schizophrenia, Am J Psychiatry , 163 :11, p 1952-1959.
13.	Moreira-Almeida A., Lotufo Neto F., Koenig H.G., (2006), Religiousness and mental health: a review, Rev Bras Psiquiatr , 28 :3, p 242-250.
14.	Mueller P.S., Plevak D.J., Rummans T.A., (2001), Religious involvement, spirituality and medicine: implications for clinical practice, Mayo Clin Proc , 76: 12, p 1225-1235.
15.	Muramoto O., (2004), The role of the medial prefrontal cortex in human religious activity, Med Hypotheses , 62 :4, p 479-485.
16.	Newberg A.B., Iversen J., (2003), The neural basis of the complex mental task of meditation: neurotransmitter and neurochemical considerations, Med Hypotheses , 61 : 2, p 282-291.
17.	Orme-Johnson D.W., Schneider R.H., Son Y.D., Nidich S., Cho Z.H., (2006), Neuroimaging of meditation's effect on brain reactivity to pain, Neuroreport , 17:12, p 1359-1363.
18.	Saver J.L., Rabin J., (1997), The neural substrates of religious experience, J Neuropsychiatry Clin Neurosci , 9 :3, p 498-510.
19.	Siegal M., Varley R., (2002), Neural systems involved in theory of mind, Nature reviews , 3 , p 463-471.
20.	Strassan R.J., Clifford R., (1994), Dose-response study of N, Ndimethyltrypamine in humans. I: Neuroendocrine, autonomic and cardiovascular effects, Arch Gen Psychiatr , 51 , p 85-97.
21.	Thomas A.G., Vornov J.J., Olkowski J.L., Merion A.T., Slusher B.S., (2000), N-acetylated a-linked acidic dipeptidase converts N-acetylaspartylglutamate from a neuroprotectant to a neurotoxin, J Pharmacol Exp Ther , 295 , p 16-22.
22.	Tooley G.A., Armstrong S.M., Norman T.R., Sali A., (2000), Acute increases in night-time plasma melatonin levels following a of meditation, Biol Psychol , 53 , p 69-78.
23.	Walton K.G., Pugh N.D., Gelderloos P., Macrae P., (1995), Stress reduction and preventing hypertension: preliminary support for a psychoneuroendocrine mechanism, J Altern Complement Med , 1 , p 263-283.
24.	Wong Y.J., Rew L., Slaikeu K.D., (2006), A systematic review of recent research on adolescent religiosity/spirituality and mental health, Issues Ment Health Nurs, 27 : 2, p 161-183.
25.	Yoshida M., Sasa M., Takaori S., (1984), Serotonin-mediated inhibition from dorsal raphe neurons nucleus of neurons in dorsal lateral geniculate and thalamic reticular nuclei, Brain Res , 290 , p 95-105.

Research now shows that the way you handle minor daily stressors – those little annoyances – has a tremendous impact on your long-term health.

Human nature is to justify the nasty little moods, childish reactions and general grumpiness because "life is so stressful." We act like we can't help it. Human nature is leading us to an early grave.

A study conducted at University of Pennsylvania reminds us that the stressful events themselves are not the real problem. Our reactions to those events are the problem – and a serious one at that.

"Our research shows that how you react to what happens in your life today predicts your chronic health conditions and 10 years in the future, independent of your current health and your future stress," said David Almeida, professor of human development and family studies at University of Pennsylvania.

"For example, if you have a lot of work to do today and you are really grumpy because of it, then you are more likely to suffer negative health consequences 10 years from now than someone who also has a lot of work to do today, but doesn't let it bother her.

"The research was rigorous, including eight consecutive daily interviews, along with four saliva-based cortisol tests during those eight days. For each participant, the test was conducted again ten years later to determine any changes in stress handling as well as to assess health outcomes.The results were clear. Those who handled stress better had fewer overall health issues, especially chronic pain and cardiovascular problems.

Can we get attached to a stressful, negative way of being?

Pioneering psychiatrist Edmund Bergler, MD, observed that we do get attached to negativity and stress. In fact, he called such attachments a reflection of our basic neurosis, suggesting that we actually – subconsciously – learn to prefer the displeasure of stress rather than the pleasure of happiness. If you look at the world from this perspective, it makes so much sense.

Deep down (very, very deep down) we prefer being controlled, rejected and deprived to simple contentment. Think about it. What does it take to be happy? Not much. Food, clothing and shelter. A calm mind, nature, perhaps a few friends. So simple.

Discontent has become more familiar and tolerable than happiness for far too many people.

The world we live in and the people who inhabit it – myself included – are anything but "simply content" to live in the moment, even though doing so is easy and always available. We want more. We want power. We want stuff. We want fame.

Our incessant desire for more power, possessions and fame only leaves us feeling more powerless, deprived and rejected. We understand this, for the most part. Yet, we greedily continue to pursue that which cannot fulfill.

It makes us cranky. It's depressing. Yet, we keep it up. Our attachment to misery is more compelling that we can imagine.

Have you ever tried to get someone to change a behavior that is making them miserable, only to be resisted at every turn?

Have you struggled to give up reactions or behaviors that cause you misery, only to return to them again and again?

Do you realize that allowing yourself to get stressed out is adversely affecting your health, yet you continue to stress your way through the day regardless?

It is obvious we are attached to negativity and stress. Now, how do we deal with it?

The first step is to recognize what is going on – to get out of denial. This is 90% of the battle, as denial is the most elegant and effective defense mechanism ever conceived. It's brilliant! Just deny the truth – hide it from yourself by convincing yourself that the source of the problem is ANYTHING but you.

.

A previous post in March 2012, Meditation and Neuroplasticity, outlined research about meditation causing changes in the brain, including new brain cells, axons, dendrites and synapses.  These studies showed dramatic brain alterations for all of the major traditions of meditation.  A brief summary of that previous research follows.

This post will look at the most recent studies that continue to show new effects of meditation on the brain, as well as new applications.

Some of the information summarized in the previous post appeared in a recent review article in the journal Nature Neuroscience.  This article additionally describes that severe stress causes increase in some of the regions of the amygdala, (emotional center related to fear) and decrease in regions of the hippocampus (memory and learning), and pre frontal cortex (decision-making).  It notes that meditation counteracts these stress related brain changes. Meditation decreases anxiety and fear, and increases memory and cognitive abilities.

This Neuroscience review reported additionally that compassion meditation (summarized in previous post and below) increased gamma oscillations and synchrony, as well as increased activity in brain regions related to empathy.  It also emphasized that changes in the brain from mindfulness meditation can occur in just eight weeks.

The article raised the question whether meditation research is complicated by the fact that changes in the brain could also be from daydreaming, and self-reflection. Daydreaming has been recently linked to creativity (see research and discussion below) and self-reflection might also cause brain changes.  Social learning in children, including self-reflection, significantly helped academic achievement.

Brief Summary of Previous Meditation Post

The previously described brain changes for three major types of meditation are:

Compassion: In meditation emphasizing a focus on compassion and “loving-kindness” there was increased concentration.  There was also increased activity in frontal brain regions (positive emotions and self control) and thalamus (filters sensory- motor signals), and a decrease in the parietal region (visual and spatial).

Mindfulness: Mindfulness meditation showed increased neurons and connections in right frontal cortex, (concentration), insula (emotions) and right parietal and temporal (sight and sound).   It showed a decrease in amygdala (stress), and increase in hippocampus (memory)

Transcendental: Transcendental meditation showed more activity in frontal and parietal (attention), and decrease in thalamus, (sensory) and basal ganglia (choosing actions).  The brain waves showed increased coherence and more synchronous oscillations throughout the brain.

Default Network:  In all types of meditation a very important finding was that the Default Mode Network (DMN) was changed, briefly in novice meditators and permanently in experienced meditators.  The DMN is the part of the brain that operates with non-focused internal thought and daydreaming (memories, future planning, wondering, thinking about others). This new default network caused by meditation now included new brain centers (dorsal anterior cingulate and dorsolateral prefrontal cortex) and was associated with increased control of behavior and thought.

Basically, meditation of all types increased focus and self-monitoring of thought and emotion.

Wide Range of New Research

As the research into meditation has expanded, there are new findings in brain connectivity, neuroplasticity (brain changes and brain region growth), multitasking, and emotional monitoring.  Other research has focused on the specific uses of meditation in cancer, cardiovascular disease, depression, and war related stress.

As these new results are incorporated into brain science, a broad question arises about the relation of meditation, daydreaming, sleep, physical exercise and creativity. These are discussed below.

General Brain Changes with Meditation

Gyrification

Gyri in the cortex are the folded regions of the cortex that allow for increased complexity and increased connectivity of the neurons. A recent study showed that with all of the different meditation techniques there are increased folding of the cortex, that is, increased “gyrification.”  Significantly, the longer people had practiced the various forms of meditation, the more this effect of increased cortical surface area was evident. This correlates with increase brain effectiveness.

Increased Axon Density and Myelin

A study using advanced diffusion tensor fMRI showed that one month of Chinese mindfulness training, called IBMT (Integrative body-mind training) increased the density of axons, which means more ability to signal and more connectivity (see post on Connectivity).  These changes in the neurons of the anterior cingulate, a center for focus, attention, concentration, and self-regulation, also included an increase in myelin (myelin surrounds mature neurons and increases the speed of transmission of the signal).  The increase in axons occurred after two weeks, and the increased myelin in one month.  In early development axons also develop first, followed later by myelin.

This study of Chinese mindfulness meditation also found decrease in stress, measured by hormones in the blood.  Other findings included less anxiety, depression, anger and fatigue.  There was an increase in blood flow for the cingulate cortex after five days of 20 minutes meditation.  The subjects had lower heart rates, decreased skin conductance, decreased breathing rates with increased belly breathing.

Subliminal Messages

Study groups of meditators and non-meditators were given questions with multiple answers (for example, “Name one of the seasons”), then one of the correct answers was flashed on a screen either in a way that could be seen consciously or for only 16 milliseconds, a rate that is too fast to be consciously seen.  The meditation group was able to see the subliminal, unconscious, words better.  Either they were aware of unconscious material or their concentration was better.

Multitasking

New research with mindfulness meditation shows an improved ability to multitask after the meditation session.  The study included simultaneous work with emails, calendars, instant messaging, telephone and word-processing tools to perform common office tasks. They measured speed, accuracy and the extent of switching between tasks. The meditation group showed an ability to stay focused on a task longer with less distraction.  They were able to concentrate better, and switch less.  They also had decreased stress, increased memory and equal or better productivity

Meditation and Disease

Meditation has now been used to help treat a variety of medical problems.  The recent studies include anxiety from cancer, cardiovascular risk in teens, and depression.

Cancer

Approximately 40% of cancer patients have severe anxiety or depression.  This increases time in the hospital, and greatly affects quality of life and suicide risk.

An analysis of 22 studies involving 1400 patients from Denmark showed that cancer patients had less anxiety and depression with mindfulness meditation.  The result lasted at least six months after the study period.

Cardiovascular Risk in Teens

In a study of 62 black teens with high blood pressure, meditation showed positive effects on their heart.  With fifteen minutes of transcendental meditation a day, their heart’s left ventricle became smaller (an enlarged heart is a sign of weakness with an extra workload from the higher blood pressure).  The deep rest of the sympathetic nervous system during meditation lowered blood pressure and heart size.

Anxiety and Depression

A new study shows meditation has long-term effects on emotional stability, and decreased anxiety and depression.  As in previous studies there was a change in the default network related to daydreaming and self-oriented thought with long-term meditators.  This new study of experienced and novice meditators showed weaker synchronization between two regions of the medial prefrontal cortex – the dorsal (cognitive) and the ventral (emotion, self evaluation). This correlates with improvement in depression, because depressed people have hyper connectivity between these two areas.  There was also a greater synchronization to the right parietal lobe, which is related to attention.

 Physical Exercise, Meditation, Sleep, Daydreaming, and Creativity

The complex relationships between physical exercise, meditation, sleep, and creativity are not yet fully understood, but are intriguing.  Physical exercise and meditation are both noted to increase brain regions and increase new learning.  Sleep is noted to increase learning and memory as well as creativity.  Meditation is also shown to increase creativity.  Are these similar or different mechanisms?

Previous studies have shown that sleep during the time of slow waves stimulates increased memory for learned material. This learning could include athletic skills.  When exposed to sound and odor cues during sleep the memory of specific locations was increased.  Sleeping and dreaming are also correlated with  increased creativity. Just recently a tune was played to musicians during slow wave sleep and this enhanced their ability to play the tune when they awoke.

Daydreaming and the Wandering Mind

Daydreaming is important because it allows us to imagine future events, to flesh out ideas, and to create.

A recent study asked subjects to list as many uses as possible for everyday objects such as toothpicks, clothes hangers and bricks.  One group then did an undemanding task that encouraged daydreaming.  Other groups did focused work, or nothing. The daydreaming group did much better on the next round of creative questioning. 

Other studies show that when a person’s mind is wandering they perform better in creativity, association and insight tasks.  These include imagination games, original thinking and invention.  A recent study showed that people report a wandering mind 47 percent of the time.

Top Athletes, Musicians and Managers

Increased brain coherence is noted in meditation, but is also demonstrated in elite managers, musicians and athletes.

To measure exceptional performances with high brain integration a variety of measures are used.  One measure of brain performance is increased coherence of brain waves measured by EEG (see post on Brain Oscillations).  This measures how different parts of the brain are in sync with each other and work together.  Another EEG measure, that of alpha waves, is related to alertness.  The third is a measure of how efficient and effective the brain operates.

By these measures high-level managers, as well as elite professional and amateur musicians showed much more brain integration than less qualified managers and musicians.  The most recent study shows that elite athletes also have this high brain integration by the three measures.  They also shared a cluster of subjective experienced often referred to as “peak experience,” which includes inner calm, effortlessness, extreme wakefulness, ease of functioning, absence of fear, and a sense of perfection.  Some athletes and musicians refer to this feeling as a performance “high”.

It remains for future studies to relate this “peak experience” to meditation states

In Elderly Tai Chi Increases Brain Size, Improves Cognition

Tai Chi is a meditative physical exercise, which is less aerobic than other forms of exercise. Research has already shown that exercise increases brain growth factors to make new cells.  Seniors who engaged in Tai Chi three times a week for eight months had increases in brain volume, and better memory and thinking.  One of the control groups that used lively discussions instead of the Tai Chi, showed some increase in brain size but less cognitive improvement.  The other control group with no intervention had brain shrinkage.  Previous trials showed increases in brain with exercise (new brain cells for new learning), increase in memory, but not as much cognitive improvement.

Neuroscience, Meditation, Yoga, and Performance in War

Just as the great American Indian warrior Crazy Horse did many years ago, the new soldier is learning to concentrate his mind for battle using meditative techniques. Martial arts, such as Tai Chi, Karate, and Kung Fu, have always used meditative techniques for superior focus, balance, power and muscular coordination.

Yoga and meditation are now being used in the military to help soldiers become calmer and better decision-makers in order to avoid trauma.  Meditation is used before mock training that attempts to simulate the chaos of war scenes.  While most military research has been related to brain injury and post traumatic stress, new brain studies, including brain imaging and blood tests for stress markers before and after simulated combat, are being done at the Warfighter Performance Lab to determine stress affects decision-making.  Meditation techniques including breathing exercises are being applied to help the soldiers regain a state where good decisions can be made.

The psychological terms used in these military studies include “resiliency”, “psychological hardiness” or “mental toughness”.  The new training called Comprehensive Soldier Fitness program increasingly includes these emotional, and psychological elements. Most soldiers have signs of stress, but only 20% have great difficulty in dealing with it.  Training in elite forces, like the SEALS, simulate severe states such as near drowning to see who can tolerate this very high level of stress.

The most elite group remaining after very grueling SEAL training shows more activation in the insula, an area related to self-awareness, pain and emotion.  The insula also helps relieve stress with awareness.

One early study, called the Trojan Warrior Project, included 10 days of meditation, yoga, and martial arts.  After these sessions, soldiers performed much better in biofeedback tests of muscular and neurological reactions to stress.  They were also able to learn a foreign language faster, learn complex technical weapons systems better and were better marksman.

Currently, SEALs are using meditation in training, based upon neuroscience data of increased gray matter volume and better synapses in the pre frontal cortex.  These brain changes lead to improved ability to have attention control triggers of the amygdala fear responses. The Mindfulness Based Stress Reduction program showed decreased stress, and improvement in concentration, memory, performance of complex tasks, and regaining focus after stress.

Another meditation study for eight weeks, using fMRI, blood markers and saliva markers, showed a better recovery from stress.  After the study period soldier’s brains were more likely to resemble the brains of elite SEALS and Olympians.

Conclusion

 Previous posts have focused on how attention, and suggestion, as well as meditation, change the brain. The recent understanding is that the brain is much more “plastic” or changeable than previously thought and will change in any way that we choose to exercise it.

In normal function any mental event creates rapid changes in neurons, including building and rebuilding very complex structures almost instantly. (see post).

Meditation is a specific training that builds a “muscle” of mental concentration with increased memory, creativity and cognitive abilities.  These new abilities include being able to control the effects of severe stress and include a variety of different subjective internal states.

As mechanisms of these changes are elucidated in the future, hopefully the details of subjective meditative states can be correlated with molecular changes in the brain.