Emotions, mindfulness and meditation – a research review says the more you practice, the better your emotional life

Is practicing mindfulness likely to make you happier? Feel more contentment? More inner peace? Is meditation likely to improve your emotional life? Make you more comfortable with your own emotions and the emotions of others? Improve your relationships?

Intuitively, we probably all would say yes, but what about the research? This week, a review of the literature around emotions, relaxation, mindfulness and meditation, but first

       Thought for the day

I am always inclined to believe that the best way 

Of knowing [the divine] is to love a great deal. 

Love that friend, that person, that thing, whatever you like, 

You will be on the right path; 

That is what I say to myself. 

But you must love with a high, serious intimate sympathy, 

With a will, with intelligence, and you must always seek 

To know more thoroughly, better and more.


                          Vincent van Gogh

Most people these days take up meditation having been inspired by friends or colleagues. They notice them changing; becoming calmer, kinder, more capable, healing faster, seeming happier, more joyful and vibrant. They see all this with their own eyes, and upon enquiry, find out the changes coincided with taking up relaxation, mindfulness and meditation. We all want an easier, more fulfilling emotional life. Meditation makes good sense!

Yet others need the research evidence to be convinced of meditation’s benefits.

 Fair enough. 

While this is an emerging field, and not such an easy one to study, a good deal of published research is building to confirm the direct experience. 

There is a growing body of evidence to validate regular relaxation, mindfulness and meditation practice does lead to healthier, happier emotional states, and that these practices do enhance wellbeing.

So in this literature review of the impact of relaxation, mindfulness and meditation on emotional health and emotional states, key studies are brought together and grouped under major headings. Direct links to the research articles cited are provided. While not exhaustive, this review provides solid evidence that the practices of relaxation, mindfulness and meditation do improve emotional health.

Mindfulness boosts healthy emotions

While there is a growing consensus about mindfulness meditation as an effective treatment for a wide range of somatic illnesses and psychological disorders, little research attention has been paid to promoting healthy and positive outcomes, rather than just to reduce negative outcomes. 

This despite existing research indicating mindfulness is positively related to vitality, life satisfaction, and interpersonal relationship quality. 

This recent, controlled trial amongst staff in a large hospital examined mindfulness training’s effect upon positive outcomes. 

The researcher’s analysis found the intervention program was successful in boosting the existing levels of work engagement, happiness and work performance. 

Coo, C., Salanova, M. 2018. Mindfulness Can Make You Happy-and-Productive: A Mindfulness Controlled Trial and Its Effects on Happiness, Work Engagement and Performance. J Happiness Stud 19, 1691–1711.

Mindfulness Boosts Relationship Satisfaction

Several studies have found a person's ability to be mindful can help predict relationship satisfaction — the ability to respond well to relationship stress and the skill in communicating one's emotions to a partner. Empirical evidence suggests mindfulness protects against the emotionally stressful effects of relationship conflict, is positively associated with the ability to express oneself in various social situations and predicts relationship satisfaction.

Barnes et al., The role of mindfulness in romantic relationship satisfaction and responses to relationship stress. 2007, JMFT Vol33 - 4, 482-500

Brief Mindfulness Intervention Improves Processing of Emotion

Mindfulness-based interventions have previously been shown to have positive effects on psychological well-being. However, the time commitment, teacher shortage, and high cost of classic mindfulness interventions may have hindered efforts to spread the associated benefits to individuals in developing countries. Brief mindfulness meditation (BMM) has recently received attention as a way to disseminate the benefits of mindfulness-based interventions. 

This study compared BMM intervention with ERE (Emotional Regulation Education). It demonstrated that BMM may improve aspects of emotion processing such as emotion intensity, emotional memory, and emotional attention bias. Negative effects on mood state were found in the ERE group but not in the BMM group.

Wu Ran et al. Brief Mindfulness Meditation Improves Emotion Processing; Frontiers in Neuroscience, 2019, Vol 13 – 1074.

Mindfulness makes it easier to be kind to ourselves

This study investigated the role of self-compassion in relation to mindfulness. Two components of mindfulness — nonjudging and nonreacting — were strongly correlated with self-compassion, as were two dimensions of empathy — taking on others' perspectives (i.e., perspective taking) and reacting to others' affective experiences with discomfort. Self-compassion fully mediated the relationship between perspective taking and mindfulness.

Kingsbury, E. (2009). The relationship between empathy and mindfulness: Understanding the role of self-compassion. Dissertation Abstracts International: Section B: The Sciences and Engineering, 70(5-B), 3175.

Mindfulness improves empathy and emotional expression

In this study, researchers found all elements of mindfulness were positively associated with expressing oneself in various social situations. A greater tendency for mindful observation was associated with more engagement in empathy. Mindful description, acting with awareness, and non-judgemental acceptance were associated with better identification and description of feelings, more body satisfaction, less social anxiety, and less distress contagion.

Dekeyser, M et al, 2008. Mindfulness skills and interpersonal behaviour. Personality and Individual Differences, 44(5), 1235–1245.

Do short term interventions work? A meta-analysis

Over the last 10 years, there has been a dramatic increase in published randomized controlled trials (RCTs) of brief mindfulness training (from single-session inductions to multisession interventions lasting up to 2 weeks), with some preliminary indications that these training programs may improve mental health outcomes, such as negative affectivity. This meta-analysis involving 65 RCTs and 5,489 participants aimed to evaluate whether brief mindfulness training reliably reduces negative affectivity. The researchers concluded brief mindfulness training does modestly reduce negative affectivity. 

Schumer MC et al. Brief mindfulness training for negative affectivity: A systematic review and meta-analysis. J Consult Clin Psychol. 2018 Jul;86(7):569-583.

How Mindfulness and Meditation Impact on Romantic Relationships

There is increasing scientific interest in the potential association between mindfulness and romantic relationship wellbeing. This study examined the effect of either guided mindfulness exercises, or guided relaxation exercises. 

The mindfulness intervention significantly promoted relationship wellbeing, for both participants and their partners. However, these findings did not significantly differ from changes in relationship wellbeing in the relaxation condition. 

Karremans JC et al. Comparing the effects of a mindfulness versus relaxation intervention on romantic relationship wellbeing. Sci Rep. 2020 Dec 10;10(1):21696. 

Mindfulness builds gratitude

This PhD dissertation indicated just ten days of mindfulness training increased gratitude, psychological flexibility, and wellbeing. The relation between mindfulness and psychological wellbeing was fully mediated by gratitude and psychological flexibility, both before and after participants underwent training. Results suggest that mindfulness training can increase individuals’ quality of life and psychological flexibility, in part by increasing their ability to appreciate positive aspects of their lives.

Schultz, D, "Effect of Mindfulness on Gratitude and Psychological Wellbeing" (2019). Dissertations. 1704.

Mindfulness Meditation Reduces Emotional Reactivity

In this study of people who had anywhere from one month to 29 years of mindfulness meditation practice, researchers found that mindfulness meditation practice helped people disengage from emotionally upsetting pictures and enabled them to focus better on a cognitive task as compared with people who saw the pictures but did not meditate.

Ortner, C et al. (2007). Mindfulness meditation and reduced emotional interference on a cognitive task. Motivation and Emotion. 31. 271-283.

Mindfulness increases intimate relationship satisfaction

This research studied married couples and examined measures of mindful awareness, emotion skills, and marital quality. Findings suggested that emotion skills and mindfulness are both related to marital adjustment, and that skilled emotion repertoires, specifically those associated with identifying and communicating emotions, as well as the regulation of anger expression, fully mediate the association between mindfulness and marital quality. 

Wachs, K., & Cordova, J. V. (2007). Mindful relating: Exploring mindfulness and emotion repertoires in intimate relationships. Journal of Marital and Family Therapy, 33(4), 464–481.

Mindfulness builds compassion in health professionals

Mindfulness-based stress reduction training has been found to enhance self-compassion among health-care professionals. The literature is replete with evidence that the stress inherent in health care negatively impacts health care professionals, leading to increased depression, decreased job satisfaction, and psychological distress. 

In an attempt to address this, the current study examined the effects of a short-term stress management program, mindfulness-based stress reduction (MBSR), on health care professionals. Results from this prospective randomized controlled pilot study suggest that an 8-week MBSR intervention may be effective for reducing stress and increasing quality of life and self-compassion in health care professionals. 

Shapiro, S. L et al. 2005, Mindfulness-Based Stress Reduction for Health Care Professionals: Results From a Randomized Trial. International Journal of Stress Management, 12(2), 164–176.

The rationale for mindfulness-based anger management

In this paper, the literature in relation to the theory and treatment of problematic anger is reviewed, with the aim of determining whether a rationale exists for the use of mindfulness with angry individuals. It is concluded that anger as an emotion seems particularly appropriate for the application of mindfulness-based interventions, and the potential mechanisms for its proposed effects in alleviating the cognitive, affective and behavioral manifestations of anger are discussed.

Wright, S et al (2009). Mindfulness and the treatment of anger Problems. Aggression and Violent Behavior. 14. 396-401. 10.1016

Meditation improves creativity

One form of meditation - integrative body-mind training (IBMT) - has been shown to improve attention, reduce stress and change self-reports of mood. This study found short-term (30 min per day for 7 days) IBMT improved creativity performance and yielded better emotional regulation compared to Relaxation Training (RT), suggesting that emotion-related creativity-promoting mechanism may be attributed to short-term meditation.

X. Ding et al. Improving creativity performance by short-term meditation. Behav. Brain Funct., 10 (2014), p. 9

Online programs and their benefits – a meta-analysis

The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size. 

For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions. 

The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.

Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114  

CONCLUSION

There is a growing evidence base for relaxation, mindfulness and meditation being used to help people affected by emotional health issues to become less reactive, more expressive and to build better relationships.

Also, there is good evidence online mindfulness - based programs such as the Allevi8 App have positive benefits and these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.

Australia to have 2 University-based Centres for Contemplative Studies

Here is news that has been quietly developing these past 6 months, but is now public. The Universities of Melbourne and Monash are each being funded to establish Australia’s first Centres for Contemplative Studies.

It has been my privilege to work with the philanthropists Martin and Loreto Hosking alongside the Universities to help bring this all about. What a delight to have worked with such exceptional people at both institutions. How wonderful to have lived long enough to witness meditation move from the fringes in the 70s to be embraced by two world ranked Universities here in my own home town. Just wonder full. That is – full of wonder!

So this week, seems the best way to convey the import of all this is to directly share the University’s Press Releases, but first

   Thought for the day

     Knowing others is intelligence;

     Knowing yourself is true wisdom.

     Mastering others is strength; 

     Mastering yourself is true power.

     If you realize you have enough,

    You are truly rich.

                               Tao Te Ching

                                             

                                           PHOTO : Professor Jakob Hohwy with students at Monash

FROM MONASH

Generous donation helps Monash open world-first Centre for Consciousness and Contemplative Studies

Professor Jakob Hohwy will lead a new, world-first Centre for Consciousness and Contemplative Studies at Monash University from early 2022.

Monash University has announced it will develop a first-of-its-kind centre for unprecedented collaboration between philosophy, neuroscience, medicine, education and interfaith dialogue research and studies.

The world-first Monash Centre for Consciousness and Contemplative Studies will bring together humanities and science researchers and be housed in the Faculty of Arts’ School of Philosophical, Historical and International Studies from early 2022, following a transformational donation of $12million from Redbubble co-founder, Martin Hosking and his wife Loreto Hosking.

The Hoskings’ charitable organisation Three Springs Foundation is behind the gift.

By combining consciousness research and contemplative studies, it will be the first of its kind in the world with a broad, interdisciplinary remit covering three interrelated domains:

• Research: enabling multidisciplinary humanities and neuroscience research at the forefront of consciousness science and contemplative studies;

• Education: making philosophical wisdom and contemplative practices relevant and accessible to the broadest possible audience both nationally and globally; and

• Community engagement: fostering understanding  through cross-cultural and interfaith dialogue around contemplative practice traditions

Dean of the Faculty of Arts, Professor Sharon Pickering, said the Centre would enable Monash to set an international benchmark for pre-eminent research, dialogue and outreach for consciousness and contemplative studies.

“Understanding consciousness is one of the great scientific questions of our time, its connection to contemplation and contemplative studies will build our sense of common humanity, so I am thrilled that this new Centre will be based within the Faculty of Arts,” she said.

Centre Director Professor Jakob Hohwy, from Monash’s Cognition & Philosophy Lab, will lead the research stream and said: “We are excited about this unique opportunity to apply philosophical and scientific rigour to provide profound answers about the very essence of consciousness and contemplation.

“Thanks to the Hoskings, we believe we can open doors to greater reflection, curiosity, resilience, wellbeing and meaningful connections. The benefit of the Centre will be significant, across many research areas, for the community, and with future generations firmly in mind.”

Renowned mindfulness expert from Monash’s Faculty of Medicine, Nursing and Health Sciences,
Associate Professor Craig Hassed OAM, will lead the education offering, with contemplative practices - mindfulness, meditation and contemplation - developed as core curriculum subjects and in-depth electives.

“Monash already has a reputation as a world leader in integrating contemplative practices, particularly mindfulness, into staff development and student education,” he said.

PHOTO Myself along with Assoc Prof Craig Hassed and Prof George Jelinek - both very well known and much loved contributors to programs at the Foundation

“Education will be a crucial platform to equip new generations of mindful leaders and contemplative practitioners. We want to provide public-facing educational opportunities for students, staff and industry partners that will allow for broad engagement with contemplative practice.”

Professor Rebecca Margolis from Monash’s Australian Centre for Jewish Civilisation will lead community engagement to actively foster dialogue between the university and the general public and across cultures and religious traditions in meaningful ways, including in-person and online workshops and webinars, international visiting scholars, conferences, guided practice sessions and more.

“This Centre offers a groundbreaking model for a dynamic meeting place around consciousness and contemplative studies that will bring together researchers, educators, students, practitioners of diverse wisdom traditions as well as the general public,” Professor Margolis said.

Mr Hosking said the COVID-19 pandemic highlighted the need for connection and reflection, which led him to consider supporting such a centre.

“I have been interested in unlocking the benefits of meditation and contemplative studies for a number of years. I know the personal benefits of meditation and believe the introduction of study in this area in universities will have a profound impact on our future leaders, professionals and educators. With this centre, Monash has shown a commitment to making research and education in this area a core part of their offerings,” he said.

Monash University President and Vice-Chancellor Professor Margaret Gardner AC said: “This wouldn’t be possible without the generosity and commitment of Three Springs Foundation and the Hoskings. We are deeply grateful for their contribution, and humbled by their passion and enthusiasm for bringing consciousness research and contemplative studies into the public domain.”

From left : Assoc Prof Craig Hassed, Prof Rivke Margolies, Ian Gawler, Martin Hosking, The Dean of Arts Prof Sharon Pickering, the new centre Director Prof Jacob Howhy 

Three Springs Foundation and the Hoskings have also donated funds to the University of Melbourne for a Contemplative Studies Centre, to be established within the Melbourne School of Psychological Sciences. Together these two centres are positioning Victoria, and indeed Australia, as world leaders in this space.

The transformational gift from the Three Springs Foundation contributes to the Change It. For Good. campaign, which is the largest public fundraising initiative in Monash’s history.

FROM MELBOURNE

The University of Melbourne is establishing a Contemplative Studies Centre, which will be the first point of entry into the world of mindfulness, meditation and contemplative practice at the University.

The centre has been made possible by a generous philanthropic gift of $10 million from Redbubble co-founder Martin Hosking and his wife Loreto.

Contemplative studies focus on the variety of religious, spiritual, and secular practices – such as meditation, mindfulness, and prayer – and is at the very heart of what it is to be connected to ourselves, one another, and the world. These practices help people from all walks of life to facilitate wellbeing, and to aid in the development of a meaningful, balanced life.

The Contemplative Studies Centre will be led by Dr Nicholas Van Dam, a recently appointed fellow of the Mind and Life Institute and hosted within the Melbourne School of Psychological Sciences in the Faculty of Medicine, Dentistry and Health Sciences. 

It will have offerings for all audiences, including the general public, students, staff, faith leaders and practitioners.

Dr Van Dam said the last 30 years has seen a boom in contemplative practices. 

However, despite increased popularity, enthusiasm for the practices has outpaced the evidence for how best to use them and commercialisation has jeopardised the potential of these ancient practices in the modern world, excluding those most knowledgeable about how to implement and optimise them.

“In Australia, like the rest of the world, we’ve seen massive growth in meditation and mindfulness practices in schools, workplaces and in just about every aspect of life,” Dr Van Dam said. “The foundations of the practices have often been left behind; platitudes and optimistic thinking have replaced authentic self-exploration and opportunities for people to find balance.

“While there’s no doubt these practices can be transformational, helping people and society to thrive, we need evidence-based research and guidelines to determine how they are best used and when.”

The internationally focused centre will bring together experts from around the world to critically assess contemplative practices to help people discern between the plethora of offerings to ensure connection to authentic practices and optimal outcomes for all.

It will draw on knowledge and expertise from across the University including the Faculty of Arts and the Melbourne School of Graduate Education, to deliver ground-breaking research, innovative educational offerings and a world-class engagement series. It will also offer an opportunity for authentic practice, guided sessions and a place for inter-faith and wisdom discussion.

Vice-Chancellor Duncan Maskell said the University is extremely grateful to Martin and Loreto Hosking for the incredibly generous donation to establish the Contemplative Studies Centre. He said the new centre represents a breakthrough to develop contemplative study, research and practice in the Asia-Pacific region and create purposeful change for our communities.

“Considering the quite extraordinary year that we have all experienced, there is a real need for greater focus on mindfulness and wellbeing in our society. Through the new centre we hope to assist many people who would most benefit from mindfulness and meditative practice,” Professor Maskell said.

Mr Hosking said he has been interested in unlocking the benefits of meditation and contemplative studies for a number of years.  “I know the personal benefits of meditation and believe the introduction of study in this area will have a profound impact on our future leaders, professionals and educators.”

Professor Sarah Wilson, Head of the Melbourne School of Psychological Sciences said the University is committed to achieving exceptional research quality and impact that translates to benefits for people’s everyday lives.

“The research of Dr Van Dam in mindfulness and meditation is world-leading and his interdisciplinary approach will equip the future generation of thought-leaders with the necessary skills to navigate the complexities our society currently faces,” Professor Wilson said.

              PHOTO : Prof Sarah Wilson

“The long lockdown during the pandemic has shown us that now, more than ever, we need skills to help us engage in contemplative practices that enhance our wellbeing and mental health.

“This exciting new centre is a timely gift to our whole community, as it brings the latest research evidence and an interdisciplinary approach to guide us on the most effective ways to contemplate and navigate the complexities of our lives.”

The centre will be located within Melbourne Connect, a newly completed, purpose-built innovation
precinct at the University of Melbourne, ensuring industry collaborations and community engagement is at the heart of its research partnerships.

Melbourne Connect is delivered in partnership with a consortium led by Lendlease, bringing together world-class researchers, start-ups, government, industry, artists, and Science Gallery Melbourne, right in the heart of Carlton and next to the Parkville precinct.

Three Springs Foundation and the Hoskings have also donated funds to Monash University for a Centre for Consciousness and Contemplative Studies, to be established within the School of Philosophical, Historical and International Studies in the Faculty of Arts. Together these two centres are positioning Victoria, and indeed Australia, as world leaders in this space.

Heart disease, mindfulness and meditation - a literature review

Research has confirmed Dr Dean Ornish’s lifestyle and meditation based program can reverse coronary heart disease cheaply and reliably when compared to ordinary medical care. Yet while endorsed in America for Medicare rebates, in Australia few seem to know of this option, let alone have it offered. 

But what of mindfulness and meditation on their own? This week we examine what they have to offer according to recent research. But first

    Thought for the day

Silence is not empty

It is full of answers

So I encourage you - bow eagerly to love. 

Follow its humble stirrings in your heart. 

Let it guide you in this life 

And it will bring you safely to eternal bliss in the next. 

Love is the essence of all goodness. 

Without it, no kind work is ever begun or finished. 

Simply put, love is a good will, in harmony with God.


                                 The Cloud of Unknowing 


THE BACKGROUND of TRAGEDY

Heart disease remains the leading non-communicable lifestyle related illness in Australia and the US Heart disease, leading to 1 in 4 deaths in both countries. 

Consider how many lives this directly and indirectly affects. 

Tragic. 

Yet heart disease is highly preventable, and much can be done for people diagnosed with heart disease. 


THE SCOPE OF THIS LITERATURE REVIEW

This literature review aims to bring together the research evidence around heart disease, mindfulness and meditation. And given the times we are in, it also examines the evidence base for online programs.

Quite a large body of research has been published in this field, but not surprisingly, it varies in quality. Therefore, while not exhaustive, this review aims to reproduce key research (using many direct quotes) that investigates the efficacy of mindfulness and meditation for people affected by heart disease. 

This review includes direct hyper-links to the original articles as published. The review is in three parts –the role of mindfulness and meditation in the prevention of heart disease, in the management of heart disease and evidence for online programs. On prevention, just the one major review of recent research is quoted.

CONTEXT – THE ORNISH STUDIES

For more than 35 years, Dr. Ornish has championed lifestyle modification as a proven approach for reversing heart disease in patients with pre-existing coronary artery disease. 

Based on in-depth scientific research, Dr. Ornish’s approach actually reverses the progression of cardiovascular disease and reduces the need for interventional revascularizations and costly medications for patients with one of several risk indicators, including a prior acute myocardial infarction, CABG surgery, a PCI procedure or stable angina. 

Recognizing the extraordinary results that Dr. Ornish achieved in reversing heart disease, Congress and the Centers for Medicare and Medicaid Services (CMS) in 2010 provided for Medicare reimbursement for individuals enrolled in The Ornish Program for Reversing Heart Disease. Dr. Ornish and Healthways are now deploying a scalable solution that is unmatched in its impact on outcomes and costs. 

The Ornish program uses the following four core elements equally 

1. A very low-fat, whole foods diet

2.  Moderate aerobic exercise

3. Stress management techniques

4. Support groups

The program has proven results documented in peer-reviewed research journals. In these published studies, CHD patients showed greater changes in diet and lifestyle and better clinical outcomes than have ever before been reported for various lifestyle change interventions. These studies showed, for the first time, that the progression of coronary atherosclerosis could be stopped or reversed by making comprehensive lifestyle changes. 

Specifically, these studies demonstrated the following benefits of the lifestyle modification program

• Regression of coronary artery stenosis using quantitative coronary arteriography

• Decreased size and severity of ischemic myocardial perfusion abnormalities (blood flow to the heart) using cardiac positron emission tomography (PET), exercise thallium scintigraphy, and exercise radionuclide ventriculography

• Safe avoidance of revascularization procedures such as coronary bypass surgery, angioplasty, and intracoronary stents in almost 80% of those who were eligible for these procedures, with comparable clinical outcomes

• Significantly greater exercise capacity

• Substantial cardiac risk factor improvements, e.g., reductions in LDL-cholesterol comparable to what can be achieved with statin drugs without the costs and potential side-effects as well as significant reductions in weight, BMI, blood pressure and fasting blood glucose

• Marked, rapid, and often dramatic decreases in the frequency and severity of angina

• Substantial improvements in quality of life by a variety of measures (including decreased emotional stress and depression and increased vitality, physical function, and well-being)

• 2.5 times fewer cardiac events. In addition, we measured significant improvements in other chronic diseases prevalent in the population, including obesity, diabetes, hypertension, hypercholesterolemia, depression, arthritis, prostate cancer, and related illnesses. 

Follow-up analyses revealed even more reversal after five years than after one year. In contrast, patients in the usual-care randomized control group showed worsening (progression) of coronary atherosclerosis after one year and even more worsening after five years. Also, there was a direct correlation between degree of adherence to this lifestyle 5 modification program and changes in coronary atherosclerosis after one year and also after five years. 

So again, given the Ornish program has stress management based upon meditation and yoga as a key element, what does the research have to say regarding heart disease, mindfulness and meditation on their own?

PART 1  -  MINDFULNESS AND MEDITATION IN THE PREVENTION OF HEART DISEASE

The American Heart Association’s major review from 2017

This review was compiled by a large group of leading researchers under the auspices of the AMA. It systematically reviewed the data on the potential benefits of meditation on cardiovascular risk.

Neurophysiological and neuroanatomical studies demonstrate that meditation can have long‐standing effects on the brain, which provide some biological plausibility for beneficial consequences on the physiological basal state and on cardiovascular risk. 

Studies of the effects of meditation on cardiovascular risk have included those investigating physiological response to stress, smoking cessation, blood pressure reduction, insulin resistance and metabolic syndrome, endothelial function, inducible myocardial ischemia, and primary and secondary prevention of cardiovascular disease.

Overall, studies of meditation suggest a possible benefit on cardiovascular risk, although the overall quality and, in some cases, quantity of study data are modest. Given the low costs and low risks of this intervention, meditation may be considered as an adjunct to guideline‐directed cardiovascular risk reduction by those interested in this lifestyle modification, with the understanding that the benefits of such intervention remain to be better established. Further research on meditation and cardiovascular risk is warranted. 

Levine GN et al. Meditation and Cardiovascular Risk Reduction. A Scientific Statement From the American Heart Association; 2017 Journal of the American Heart Association; Vol6: Issue 10.

PART 2  -  MINDFULNESS AND MEDITATION IN THE MANAGEMENT AND TREATMENT OF HEART DISEASE

1. Meditation cuts death risk in half 

From 2012 this 5 year, randomised controlled study of 201 people with coronary disease found those who practiced meditation were 48% less likely to have a heart attack, stroke or die from all causes, compared to a group of study participants who merely attended a health education class over more than five years.

The authors hypothesised reducing stress by managing the mind-body connection would help improve rates of this epidemic disease. They also found the meditators were able to lower their blood pressure and decrease their overall stress and anger.

Schneider RH et al. Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in Blacks. Circ Cardiovasc Qual Outcomes. 2012 Nov;5(6):750-8. 

2. 2019 Major review recommends meditation

In this highly objective paper, the authors screened 3,540 research papers, reducing that number to 45 final papers that met their strict criteria for inclusion in their actual analysis. They point out the quality and quantity of published research in this field is limited and complicated by the different methods taught and studied.

Even so they concluded available data suggest a potential influence of meditation interventions on various factors of cardiovascular disease. The authors state that in clinical practice, meditation as an intervention may be suggested to patients at cardiovascular risk in addition to conservative treatment protocols because of its non-invasive and cost-effective nature. In particular, as recommended by the European Society of Cardiology, treating psychosocial factors can counteract stress, depression and anxiety, and therefore facilitate behaviour change and improve general quality of life. 

The authors reported the quintessence of this expert opinion

• Heterogenous data suggest a link between meditation interventions and cardiovascular disease.

• Meditation can be suggested to patients in addition to conservative treatment or prophylactic protocols.

• In particular, meditation can help to reduce stress, depression and anxiety.

Schnaubelt S et al. Meditation and Cardiovascular Health: What is the Link? European Cardiology Review 2019;14(3):161–4

3. Mindfulness reduces depression and anxiety, improves Quality of life

This review from 2020 searched 7 English and 2 Chinese electronic databases for experimental studies that examined mindfulness-based interventions in adults with heart failure. Five studies involving 467 patients with heart failure met the inclusion criteria. They had weak to moderate quality. 

There were consistent findings that mindfulness-based interventions could significantly reduce depression (three studies) and anxiety (two studies) and improve health-related quality of life (two studies) after intervention. However, the effects on physical symptoms were inconsistent in three studies. 

Zou H et al.  Effects of mindfulness-based interventions on health-related outcomes for patients with heart failure: a systematic review. European Journal of Cardiovascular Nursing. 2020;19(1):44-54.

PART 3  -  ONLINE MINDFULNESS AND MEDITATION PROGRAMS FOR PEOPLE WITH HEART DISEASE

1. Early follow up of online program shows benefits

This study, based upon 12 week follow-up was a pragmatic, randomized, controlled single-blind trial involving 324 patients with heart disease assigned to a 12-week online mindfulness training in addition to usual care (UC) compared to UC alone.

The authors reported mindfulness training showed positive effects on the physiological parameters, exercise capacity and heart rate and concluded it might therefore be a useful adjunct to current clinical therapy in patients with heart disease. Physiological parameters included heart rate, blood pressure, respiratory rate, and NT-proBNP.

Younge JO et al. Web-Based Mindfulness Intervention in Heart Disease: A Randomized Controlled Trial. PLoS One December 7, 2015 : https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0143843

2. Online Mindfulness Based Stress Reduction improves outcomes over 12 months

This 2017 paper, evaluated the effect at 12-month follow-up of 324 patients randomized in a 2:1 ratio to additional 3-month online mindfulness training or to usual care alone. Online delivery of the training was chosen for pragmatic reasons: the training was designed to be self-directed, easily accessible and engaging to a wide audience by keeping practice sessions and lessons short, usually ten to fifteen minutes per exercise. 


Online mindfulness training shows favorable albeit small long-term effects on exercise capacity, systolic blood pressure, mental functioning, and depressive symptomatology in patients with heart disease and might therefore be a beneficial addition to current clinical care.

Gotink RA et al. Online mindfulness as a promising method to improve exercise capacity in heart disease: 12-month follow-up of a randomized controlled trial. PLoS One. 2017;12(5):e0175923. Published 2017 May 9. doi:10.1371/journal.pone.0175923

3. Online programs and their benefits – a meta-analysis

The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size. 

For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions. 

The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.

Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114  

PART 4 - CONCLUSION

There is a solid evidence base for mindfulness and meditation being used to help people affected by heart disease. These interventions can play a part in prevention and they can reduce the associated symptoms of heart disease such as stress, anxiety and depression, as well as assist in recovery. 

Also, there is good evidence online mindfulness - based programs have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.