Mind Body Medicine Research Update
Compiled by Kevin W Chen
Meditative Therapies For Reducing Anxiety: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials. Depression and Anxiety, June 14, 2012 pre-publication online. By Chen KW, Berger CC, Manheimer E, Forde D. Magidson J. Lejuez CW. from Center for Integrative Medicine, University of Maryland School of Medicine.
Background: Anxiety disorders are among the most common psychiatric disorders and meditative therapies are frequently sought by patients with anxiety as a complementary therapy. Although multiple reviews exist on the general health benefits of meditation, no review has focused on the efficacy of meditation for anxiety specifically. Methods: Major medical databases were searched thoroughly with keywords related to various types of meditation and anxiety. Over 1,000 abstracts were screened, and 200+ full articles were reviewed. Only randomized controlled trials (RCTs) were included. The Boutron (Boutron et al., 2005: J Clin Epidemiol 58:1233–1240) checklist to evaluate a report of a nonpharmaceutical trial (CLEAR-NPT) was used to assess study quality; 90% of the authors were contacted for additional information. Review Manager 5 was used for meta-analysis. Results: A total of 36 RCTs were included in the meta-analysis (2,466 observations). Most RCTs were conducted among patients with anxiety as a secondary concern. The study quality ranged from 0.3 to 1.0 on the 0.0–1.0 scale (mean = 0.72). Standardized mean difference (SMD) was –0.52 in comparison with waiting-list control (p < .001; 25 RCTs), –0.59 in comparison with attention control (p < .001; seven RCTs), and –0.27 in comparison with alternative treatments (p < .01; 10 RCTs). Twenty-five studies reported statistically superior outcomes in the meditation group compared to control. No adverse effects were reported. Conclusions: This review demonstrates some efficacy of meditative therapies in reducing anxiety symptoms, which has important clinical implications for applying meditative techniques in treating anxiety. However, most studies measured only improvement in anxiety symptoms, but not anxiety disorders as clinically diagnosed.
EEG Source Imaging During Two Qigong Meditations. Cognitive Process May 5, 2012 By Faber PL, Lehmann D, Tei S, et al. from The KEY Institute for Brain-Mind Research, Clinic for Affective Disorders, University Hospital of Psychiatry, 8032, Zurich, Switzerland, pfaber@key.uzh.ch
Experienced Qigong meditators who regularly perform the exercises “Thinking of Nothing” and “Qigong” were studied with multichannel EEG source imaging during their meditations. The intracerebral localization of brain electric activity during the two meditation conditions was compared using sLORETA functional EEG tomography. Differences between conditions were assessed using t statistics (corrected for multiple testing) on the normalized and log-transformed current density values of the sLORETA images. In the EEG alpha-2 frequency, 125 voxels differed significantly; all were more active during “Qigong” than “Thinking of Nothing,” forming a single cluster in parietal Brodmann areas 5, 7, 31, and 40, all in the right hemisphere. In the EEG beta-1 frequency, 37 voxels differed significantly; all were more active during “Thinking of Nothing” than “Qigong,” forming a single cluster in prefrontal Brodmann areas 6, 8, and 9, all in the left hemisphere. Compared to combined initial-final no-task resting, “Qigong” showed activation in posterior areas whereas “Thinking of Nothing” showed activation in anterior areas. The stronger activity of posterior (right) parietal areas during “Qigong” and anterior (left) prefrontal areas during “Thinking of Nothing” may reflect a predominance of self-reference, attention and input-centered processing in the “Qigong” meditation, and of control-centered processing in the “Thinking of Nothing” meditation.
The Effect of Qigong on Menopausal Symptoms and Quality of Sleep for Perimenopausal Women: A Preliminary Observational Study. Journal Alternative Complementary Medicine. April 26, 2012 . By Yeh SC, Chang MY.from Dept of Business Management, Institute of Health Care Management, National Sun Yat-sen University , Kaohsiung, Taiwan.
Objectives: The study objectives were to examine the effect of a 12-week 30-minute-a-day Ping Shuai Qigong exercise program on climacteric symptoms and sleep quality in perimenopausal women. Design: This was a prospective observational study. Settings/location: The subjects (N=70) from two communities were women aged 45 years and above who were experiencing menopausal symptoms. Subjects: Thirty-five (35) women from one community were assigned to a Ping Shuai Qigong intervention group, while 35 women from the other community were assigned to the control group. Interventions: This was a 12-week, 30-minute-a-day Ping Shuai Qigong program. Outcome measures: The Greene Climacteric Symptom scale and the Pittsburgh Sleep Quality Index were the outcome measures. Methods: Descriptive analysis and repeated-measures analysis of variance were used. Results: Pretest scores at baseline found no significant group differences in climacteric symptoms or sleep quality. Significant improvements in climacteric symptoms were found at 6 weeks and 12 weeks (t=4.07, p<0.001 and t=11.83, p<0.001) in the intervention group. They were also found to have significant improvements in sleep quality in those times (t=5.93, p<0.001 and t=10.58, p<0.001, respectively). Conclusions: Ping Shuai Qigong improved climacteric symptoms and sleep quality in perimenopausal women at 6 weeks and 12 weeks. The longer a person practiced this form of meditative exercise, the greater the improvement in sleeping quality and climacteric symptoms.
Diaphragmatic Breathing Training Program Improves Abdominal Motion During Natural Breathing In Patients with COPD: A Randomized Controlled Trial. Archives of Physical Medicine & Rehabilitation. 2012 Apr;93(4):571-7. By Yamaguti WP, Claudino RC, Neto AP, et al. from Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
Objective: To investigate the effects of a diaphragmatic breathing training program (DBTP) on thoracoabdominal motion and functional capacity in patients with chronic obstructive pulmonary disease. Design: A prospective, randomized controlled trial. Setting: Academic medical center. PARTICIPANTS: Subjects (N=30; forced expiratory volume in 1s, 42%±13% predicted) were randomly allocated to either a training group (TG) or a control group (CG). Interventions: Subjects in the TG completed a 4-week supervised DBTP (3 individualized weekly sessions), while those in the CG received their usual care. Main outcome measures: Effectiveness was assessed by amplitude of the rib cage to abdominal motion ratio (RC/ABD ratio) (primary outcome) and diaphragmatic mobility (secondary outcome). The RC/ABD ratio was measured using respiratory inductive plethysmography during voluntary diaphragmatic breathing and natural breathing. Diaphragmatic mobility was measured by ultrasonography. A 6-minute walk test and health-related quality of life were also evaluated. RESULTS: Immediately after the 4-week DBTP, the TG showed a greater abdominal motion during natural breathing quantified by a reduction in the RC/ABD ratio when compared with the CG (F=8.66; P<.001). Abdominal motion during voluntary diaphragmatic breathing after the intervention was also greater in the TG than in the CG (F=4.11; P<.05). The TG showed greater diaphragmatic mobility after the 4-week DBTP than did the CG (F=15.08; P<.001). An improvement in the 6-minute walk test and in health-related quality of life was also observed in the TG. Conclusions: DBTP for patients with chronic obstructive pulmonary disease induced increased diaphragm participation during natural breathing, resulting in an improvement in functional capacity.
A Randomized Controlled Trial of 8-form Tai Chi Improves Symptoms and Functional Mobility in Fibromyalgia Patients. Clinical Rheumatology, May 13, 2012 By Jones KD, Sherman CA, Mist SD, Carson JW, Bennett RM, Li F. from Fibromyalgia Research Unit, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239-3011, USA, joneskim@ohsu.edu
Abstract: Previous researchers have found that 10-form Tai chi yields symptomatic benefit in patients with fibromyalgia (FM). The purpose of this study was to further investigate earlier findings and add a focus on functional mobility. We conducted a parallel-group randomized controlled trial FM-modified 8-form Yang-style Tai chi program compared to an education control. Participants met in small groups twice weekly for 90 min over 12 weeks. The primary endpoint was symptom reduction and improvement in self-report physical function, as measured by the Fibromyalgia Impact Questionnaire (FIQ), from baseline to 12 weeks. Secondary endpoints included pain severity and interference (Brief Pain Inventory (BPI), sleep (Pittsburg sleep Inventory), self-efficacy, and functional mobility. Of the 101 randomly assigned subjects (mean age 54 years, 93 % female), those in the Tai chi condition compared with the education condition demonstrated clinically and statistically significant improvements in FIQ scores (16.5 vs. 3.1, p = 0.0002), BPI pain severity (1.2 vs. 0.4, p = 0.0008), BPI pain interference (2.1 vs. 0.6, p = 0.0000), sleep (2.0 vs. -0.03, p = 0.0003), and self-efficacy for pain control (9.2 vs. -1.5, p = 0.0001). Functional mobility variables including timed get up and go (-.9 vs. -.3, p = 0.0001), static balance (7.5 vs. -0.3, p = 0.0001), and dynamic balance (1.6 vs. 0.3, p = 0.0001) were significantly improved with Tai chi compared with education control. No adverse events were noted. Twelve weeks of Tai chi, practice twice weekly, provided worthwhile improvement in common FM symptoms including pain and physical function including mobility. Tai chi appears to be a safe and an acceptable exercise modality that may be useful as adjunctive therapy in the management of FM patients.
A 1-Year Randomized Controlled Trial Comparing Mind Body Exercise (Tai Chi) With Stretching and Toning Exercise on Cognitive Function in Older Chinese Adults at Risk of Cognitive Decline. Journal American Medical Directors Association . May 11, 2012 by Lam LC, Chau RC, Wong BM, et al. From Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong.
Objective: To compare the effectiveness of Chinese-style mind-body exercise (24 forms simplified Tai Chi) versus stretching and toning exercise in the maintenance of cognitive abilities in Chinese elders at risk of cognitive decline. Design: A 1-year single-blind cluster randomized controlled trial. Settings: Community centers and residential homes for elders in Hong Kong. Participants: A total of 389 subjects at risk of cognitive decline (Clinical Dementia Rating, CDR 0.5 or amnestic-MCI) participated in an exercise intervention program. Intervention: A total of 171 subjects were trained with Tai Chi (Intervention [I]) and 218 were trained with stretching and toning exercise (Control [C]). Methods: Cognitive and functional performance were assessed at the baseline, and at 5, 9, and 12 months. Data were analyzed using multilevel mixed models. Primary outcomes included progression to clinical dementia as diagnosed by DSM-IV criteria, and change of cognitive and functional scores. Secondary outcomes included postural balance measured by the Berg Balance Scale neuropsychiatric and mood symptoms measured by the Neuropsychiatric Inventory, and Cornell Scale for Depression in Dementia. Results: At 1 year, 92 (54%) and 169 (78%) participants of the I and C groups completed the intervention. Multilevel logistic regression with completers-only analyses controlled for baseline differences in education revealed that the I group had a trend for lower risk of developing dementia at 1 year (odds ratio 0.21, 95% CI 0.05-0.92, P = .04). The I group had better preservation of CDR sum of boxes scores than the C group in both intention-to-treat (P = .04) and completers-only analyses (P = .004). In completers-only analyses, the I group had greater improvement in delay recall (P = .05) and Cornell Scale for Depression in Dementia scores (P = .02). Conclusion: Regular exercise, especially mind-body exercise with integrated cognitive and motor coordination, may help with preservation of global ability in elders at risk of cognitive decline; however, logistics to promote long-term practice and optimize adherence needs to be revisited.
The Theoretical and Empirical Basis for Meditation as an Intervention for PTSD. Behavioral Modification 2012 Jun 5. By Lang AJ, Strauss JL, Bomyea J, Bormann JE, Hickman SD, Good RC, Essex M.
In spite of the existence of good empirically supported treatments for posttraumatic stress disorder (PTSD), consumers and providers continue to ask for more options for managing this common and often chronic condition. Meditation-based approaches are being widely implemented, but there is minimal research rigorously assessing their effectiveness. This article reviews meditation as an intervention for PTSD, considering three major types of meditative practices: mindfulness, mantra, and compassion meditation. The mechanisms by which these approaches may effectively reduce PTSD symptoms and improve quality of life are presented. Empirical evidence of the efficacy of meditation for PTSD is very limited but holds some promise. Additional evaluation of meditation-based treatment appears to be warranted.
Meditation Increases the Depth of Information Processing and Improves The Allocation of Attention in Space 
Frontiers in Human. Neuroscience. 2012;6:133. By van Leeuwen S, Singer W, Melloni L. from Department of Neurophysiology, Max Planck Institute for Brain Research Frankfurt am Main, Germany.
Abstract: During meditation, practitioners are required to center their attention on a specific object for extended periods of time. When their thoughts get diverted, they learn to quickly disengage from the distracter. We hypothesized that learning to respond to the dual demand of engaging attention on specific objects and disengaging quickly from distracters enhances the efficiency by which meditation practitioners can allocate attention. We tested this hypothesis in a global-to-local task while measuring electroencephalographic activity from a group of eight highly trained Buddhist monks and nuns and a group of eight age and education matched controls with no previous meditation experience. Specifically, we investigated the effect of attentional training on the global precedence effect, i.e., faster detection of targets on a global than on a local level. We expected to find a reduced global precedence effect in meditation practitioners but not in controls, reflecting that meditators can more quickly disengage their attention from the dominant global level. Analysis of reaction times confirmed this prediction. To investigate the underlying changes in brain activity and their time course, we analyzed event-related potentials. Meditators showed an enhanced ability to select the respective target level, as reflected by enhanced processing of target level information. In contrast with control group, which showed a local target selection effect only in the P1 and a global target selection effect in the P3 component, meditators showed effects of local information processing in the P1, N2, and P3 and of global processing for the N1, N2, and P3. Thus, meditators seem to display enhanced depth of processing. In addition, meditation altered the uptake of information such that meditators selected target level information earlier in the processing sequence than controls. In a longitudinal experiment, we could replicate the behavioral effects, suggesting that meditation modulates attention already after a 4-day meditation retreat. Together, these results suggest that practicing meditation enhances the speed with which attention can be allocated and relocated, thus increasing the depth of information processing and reducing response latency.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3351800
The Psychological Effects of Meditation: A Meta-Analysis. Psychology Bulletin 2012 May 14. By Sedlmeier P, Eberth J, Schwarz M, Zimmermann D, Haarig F, Jaeger S, Kunze S.
Abstract: In this meta-analysis, we give a comprehensive overview of the effects of meditation on psychological variables that can be extracted from empirical studies, concentrating on the effects of meditation on nonclinical groups of adult meditators. Mostly because of methodological problems, almost ¾ of an initially identified 595 studies had to be excluded. Most studies appear to have been conducted without sufficient theoretical background. To put the results into perspective, we briefly summarize the major theoretical approaches from both East and West. The 163 studies that allowed the calculation of effect sizes exhibited medium average effects (r = .28 for all studies and r = .27 for the n = 125 studies from reviewed journals), which cannot be explained by mere relaxation or cognitive restructuring effects. In general, results were strongest (medium to large) for changes in emotionality and relationship issues, less strong (about medium) for measures of attention, and weakest (small to medium) for more cognitive measures. However, specific findings varied across different approaches to meditation (transcendental meditation, mindfulness meditation, and other meditation techniques). Surprisingly, meditation experience only partially covaried with long-term impact on the variables examined. In general, the dependent variables used cover only some of the content areas about which predictions can be made from already existing theories about meditation; still, such predictions lack precision at present. We conclude that to arrive at a comprehensive understanding of why and how meditation works, emphasis should be placed on the development of more precise theories and measurement devices.
Kevin Chen, Ph.D., MPH is an associate professor at the Center for Integrative Medicine and Department of Psychiatry, University of Maryland School of Medicine (USA). Dr. Chen was educated in the universities of both China and the United States, and has years of experience and training in blending eastern and western perspectives, and in the practice of life-nurturing methods. As a long-time practitioner of Qigong Yang Sheng, he is one of the few scientists in the U.S. to have both hands-on knowledge of mind-body practice, and an active research career in mind-body medicine, which is funded through grants by the National Institutes of Health (NIH) and various foundations. Dr. Chen devotes his career and life to the practice of Yang Sheng, and promotion of self-healing and mind-body-spirit integration through the non-profit organization, World Institute for Self Healing (WISH) ttp://www.wishus.org