In women, loving-kindness meditation linked with marker for longevity

Loving-kindness meditation might slow the aging process in women, based on a small study by researchers at Harvard Medical School.

Loving-kindness is a type of meditation shown to induce positive emotions, help relieve stress and chronic back pain, and potentially ease symptoms of serious mental illness.

In the new study, scientists analyzed white blood cells from 37 adult men and women, of whom 15 had practiced loving-kindness meditation almost every day for at least four years.

The researchers measured length of participants’ telomeres — regions at the end of  chromosomes. Shortened telomeres have been linked in humans to chronic stress, mood disorders and accelerated aging.

The scientists found that women who practiced lovingkindness meditation had significantly longer telomeres than women who did not. But telomere length in men was the same whether or not they practiced loving-kindness.

The results for women remained significant when researchers controlled for differences in body mass index (BMI) and history of depression between meditators and nonmeditators.  (The groups resembled each other in terms of age, gender, race, education level and  history of  trauma.)

Why was the positive result seen only for women? The study’s authors noted that female participants had practiced lovingkindness meditation longer than their male counterparts, although the difference wasn’t statistically significant.

“We could also speculate,” they wrote, “that [loving-kindness] practice leads to greater psychological, and therefore physiological, changes in women because they are able to utilize it better.”

Loving-kindness focuses on emotions, not thoughts, and brain scans of women show they rely more on the “emotional” parts of their brain for performing certain tasks. When women are shown pictures and asked to label and assign emotions, for example, they use their amygdalas more than men do. The amygdala is a brain structure that helps regulate and interpret emotions.

The study’s limitations included its small sample size and the fact that the loving-kindness practitioners also practiced insight meditation. In addition, researchers did not measure participants’ self-reported stress levels, only telomere length.

The study appears in the journal Brain, Behavior and Immunity.

Heads up, Harvard: A closer look reveals problems with study on yoga for stroke patients

Health news websites — including a Harvard health blog — buzzed last week with news that yoga can help stroke survivors improve their balance and quality of life. But a closer look reveals problems with the study’s design and calls those conclusions into question.

Photo by Joseph Renger.

In the study, e-published last week by the journal Stroke, researchers randomly assigned stroke survivors to one of two groups. One group participated in twice-weekly, hour-long yoga sessions, while the control (or comparison) group didn’t do yoga or any other kind of rehab. The scientists reported that after eight weeks of yoga, patients’ balance improved, they weren’t as afraid of falling, they felt more independent and had better quality of life.

Sounds great, right?

Hang on. Researchers found no significant difference in outcomes between the yoga group and the control group, according to the study. Instead, they based their positive conclusions on a method called within-group comparison: They looked just at the yoga group to see how much participants improved. The problem with this approach is the yoga group could have improved for any number of reasons. Research has showed that simply participating in a study can affect how ill people experience and describe their systems. That’s why the yoga group needed to be compared to the control group — and when the researchers did that, they came up short. An Oxford University statistician called within-group comparisons “conceptually wrong, statistically invalid, and consequently highly misleading.”

Second, the physical therapist who evaluated the study participants knew who did yoga and who didn’t. She even helped out during the yoga sessions. In well designed medical studies, researchers often don’t know the specific theory the study is testing, much less which group a patient was assigned to. Failing to “blind” researchers this way can lead to observer bias – without intending to, the physical therapist could have evaluated the yoga participants differently than the control group.

The final word? Yoga might help stroke survivors, but we can’t conclude that based on this study.

Garden your troubles away

The songbirds returned about a month early here in south-central Wisconsin, and in honor of spring, I’m updating a post from last year about gardening’s mental health benefits.

I hope this spring brings you fresh energy and many happy hours outside on — and in! — the earth.

Photo by Laura Berman.

When you’re stressed, when you go to the garden, you feel different.
It helps you hold onto life.
– Southeast Toronto resident, 2007 study on health benefits of community urban gardening

Summer’s finally here in south-central Wisconsin, ushered in by one of the coldest springs we’ve had in years. Though I grumbled about trudging through snow flurries on May 1, our garden loved the cool, wet weather. Now, in mid-June, Red Russian kale stands tall in raised beds, its smooth curled leaves jostling with green cabbages, Di Cicco broccoli and Early Snowball cauliflower. The heirloom tomatoes I grew from seed back in February are beginning to flower, and pea vines climb a trellis so fast I swear I can see them move.

When I’m in my garden, life’s troubles crumble away with the rich black soil between my fingers. I’m fully in my body, out of my head, my worries banished. My garden is my church, my time there sacred.

We 21st-century humans so often find ourselves adrift in technologies that wall us off even as they keep us connected. Our gardens are antidotes to that, places where we abandon the filters of cell phones and computers and contact life directly, sensually, touching and smelling plants and bugs and worms and the billions of microorganisms that make garden soil so rich. Biologist E.O. Wilson spoke to these feelings with his biophilia hypothesis, the idea that humans have an “innately emotional affiliation… to other living organisms.”

While far scarcer than studies on psychotherapy or psychiatric medications, research on gardening’s health benefits has found that working with plants can ease mental suffering. There’s even a term for this process — horticultural therapy. As we tend our gardens, sowing seeds, watering, pulling weeds, pruning and, months later, harvesting, so too we sow seeds of patience, hope and optimism within ourselves. A 2008 paper in Nursing Times called such hope “an intrinsic requirement of gardening,” and key to how this activity heals.

Gardening as a therapy for mental illness hasn’t been thoroughly researched, but what has been published shows promise. A paper from 2011 summarized two studies in which patients with depression who gardened for 12 weeks felt better at the end of the intervention and three months later (note that both studies lacked control groups, so we don’t know how much the patients might have improved on their own). In the United Kingdom, a program called Rethink Green Growers helps people with mental illness ranging from mild depression to schizophrenia grow their own food on land plots in Wiltshire, Somerset and Dorset. The program organizers say gardening not only gets the patients out of bed and into the sunshine, but  helps them connect with each other and eat healthier diets — which, in turn, further stabilizes their moods.

Horticultural therapy isn’t only being used as adjunctive treatment for mental illness. A 2005 study found gardening reduced stress in patients undergoing cardiac rehabilitation, and a study of patients with dementia found that gardening twice weekly for six weeks helped them interact more with others.

I’ll sign off for now — my garden beckons. How has gardening helped you feel better?  Please share your experiences! (And read more from a wonderful blog called The Storied Mind!)

Reduce anxiety by learning to accept life’s uncertainties

Life so often bucks and plunges beyond our control. Its pleasures and rewards can evaporate in an instant, demolished by a car accident, a pink slip, a friend’s betrayal.

Image by Luca Z.

By the time we reach adulthood, most of us have seen firsthand how damningly unsure life can be. But knowing this is one thing. Accepting it is another.

Though we all struggle at times to make peace with life’s unexpected twists and turns, studies show that people with high levels of anxiety — including conditions like panic disorder, generalized anxiety disorder, obsessive-compulsive disorder and social phobia — tend to have a much harder time accepting uncertainty than others. (A study published last month also found some association between intolerance of uncertainty and hypochondria, or chronic, unfounded health concerns.)

This connection makes sense when you think about it. Excessive worry can be a subconscious attempt to control life — to try to prevent mishaps by imagining and trying to sidestep everything that could go wrong.

People who can’t tolerate uncertainty may develop counterproductive behaviors, too, like refusing to delegate tasks, re-reading every email before sending it, and triple-checking their work, even on small projects. They may constantly ask friends or family members for reassurance. In severe cases, they may fear the unexpected so much that they avoid routine activities, like driving, meeting new people or traveling.

Of course, such efforts to control life usually don’t work. They just confine us to ever-shrinking comfort zones, reducing our potential and stifling both learning and pleasure. What’s more, chronic, unrelenting anxiety and tension have been linked to a host of emotional and physical health problems, from insomnia and digestive problems to a weakened immune system and even heart attacks.

Learning to accept uncertainty can significantly reduce anxiety. But how to do it? Changing ingrained beliefs takes time and sustained effort. Here’s what the research shows helps:

- Cognitive behavioral therapy helps anxious people learn to identify distorted, negative thoughts and replace them with more realistic ones. For example, someone who lives in a safe neighborhood but constantly worries he’ll be assaulted can learn to identify this thought as “fortune telling” and replace it with a more realistic one, such as, “It’s very unlikely I’ll be attacked, and I can reduce the risk further by keeping my head up and looking around when I walk.” Or someone who constantly overworks herself because she fears negative feedback can notice the underlying beliefs that drive her behavior, such as, “If someone criticizes me, it means I’m a bad person,” and respond with healthier self-talk, such as, “I don’t need to be perfect. Constructive criticism is useful and can help me grow, and I get to decide whether or not I agree with others’ feedback.” Group cognitive behavioral therapy can also help people with social phobias better tolerate uncertainty, according to a small study published this month.

- Whether you do it on your own or as part of therapy, seeking out situations you’ve habitually avoided is one of the best ways to teach yourself that you can tolerate uncertainty and solve problems on your feet when they arise. This process usually involves a gradual immersion into a new experience: If you’d like to one day feel able to travel internationally by yourself, perhaps you start by spending a day alone in a city within driving distance. And if you’d like to meet new friends, but you fear rejection, you might experiment with smiling at strangers and silently wishing them well, and then, once you’re comfortable with that, practice striking up a conversation.

- Mindfulness meditation can be a powerful tool for learning to accept uncertainty. Simply sitting and feeling your breath — the interplay between long and short inhalations and exhalations — reveals life’s mercurial essence. And noticing habitual thoughts helps you choose how you’ll respond to them. By cultivating an alert but passive attitude in meditation, you can begin, breath by breath and thought by thought, to relinquish the need to control life — and taste the profound peace that comes with letting go.

Studies: metta (loving-kindness) meditation eases symptoms of schizophrenia

What if something as simple as well-wishing could lessen symptoms of schizophrenia?

I listened to a talk the other day by a Buddhist monk who teaches meditation in the West. He told a story suggesting just that.

The monk said that when a woman with schizophrenia came to him to learn intensive mindfulness meditation, she quickly destabilized. Something about focusing deeply on her breath, her body, her thoughts and feelings made her psychotic. She had to stop meditating and take more medication.

(NOTE: people with schizophrenia are known to have become acutely psychotic on intensive meditation retreats. Read more here.)

The monk told the woman she should give up learning to meditate. But she refused. She was committed to the practice, convinced it could help her.

So she kept trying, with the same results.

Image from Flickr

Then the monk had an idea. He told the woman to abandon mindfulness practice. Instead she sat quietly and thought to herself,

May I feel safe and protected from harm.
May I feel happy.
May I feel strong and free from pain.
May I feel at ease.

She repeated these phrases again and again, wishing herself well.

May I feel safe and protected from harm.
May I feel happy.
May I feel strong and free from pain.
May I feel at ease.

Then, slowly, she began extending those wishes to others — first to someone for whom she felt uncomplicated affection. Then to someone she’d seen before, but didn’t know. Then to someone she’d fought with. And finally to all people.

May you feel safe and protected from harm.
May you feel happy.
May you feel strong and free from pain.
May you feel at ease.

This is metta meditation, also called loving-kindness. It develops concentration in the gentlest of ways. You don’t work to focus on your breath, risking frustration or even self-hatred when your attention strays. You simply cultivate goodwill.

And something about that switch changed everything for this woman. She could now meditate safely for long periods. What’s more, after years of metta practice, she again tried intensive mindfulness meditation. Now she could do it without becoming psychotic.

Does this make loving-kindness a cure-all for schizophrenia? Certainly not. But it does suggest metta practice initiated some profound changes in this woman’s brain.

Studies support that idea. In 2008, researchers at the University of Wisconsin-Madison used brain imaging to show that people without mental illness who practiced loving-kindness had increased activity in the insula, a part of the brain that helps detect the body’s response to emotion, and in the right temporoparietal junction, which helps people feel empathy and perceive others’ thoughts and emotions as separate from their own.

These brain regions are affected in people with schizophrenia. Researchers have proposed that insular dysfunction may contribute to schizophrenic hallucinations, and multiple studies have found that people with schizophrenia can have decreased activity in the right temporoparietal juncture, which may contribute to difficulty interacting socially.

Clinicians have now begun studying metta to treat schizophrenia. In a pilot study published last July, 18 outpatients with schizophrenia-spectrum disorders showed marked increases in positive emotions, empathy, and the ability to experience pleasure after six weeks of loving-kindness practice. In another article, the same clinicians reported that loving-kindness helped some patients strengthen their ability to pay attention to the present. As a result, they were able to enjoy feeling the wind on their faces when cycling and use mindful breathing to calm themselves when they had hallucinations.

I’ll never meet that woman; she persevered with metta practice long before researchers began studying its potential to help her. But I’m inspired by her story. Her fearlessness and persistence paid off. She forged her own path to freedom.

Surviving the holidays when you’re grieving, stressed or living with mental illness

The holiday season is in full swing as I write this. Lights glitter from windows and rooftops. Parties abound. And when I stopped at the mall for coffee last Sunday, I thought I’d be overrun by throngs of irritable shoppers.

Image from Chicagonow.com

We all know the holidays can be stressful. Social and financial obligations pile up just when the days (in the northern hemisphere) are at their shortest and darkest. Meanwhile, we’re inundated with holiday carols and advertisements telling us we should be rich, beautiful, in love and deliriously happy.

It’s no wonder this time of year can be especially hard for people who struggle to keep their moods on an even keel. So much so, in fact, that one large study found a 40 percent increase in suicide attempts after Christmas.

When you’re grieving or sad or sick, it can hurt so much to contrast the season’s fervent hopes and expectations with your own experience. Perhaps a wish you’ve always carried — that your family would get along, that you could stop drinking, that an estranged child would return home — feels unbearable against all the tinsel.

Or perhaps you or your partner has been laid off, or you’re afraid one of you will be, and you’re weighing that possibility against your children’s gift lists. Or maybe you lost a loved one this year, and you can’t believe you’ll never celebrate New Year’s Eve with him or her again.

Perhaps you’re worried about spending future holidays alone.

Maybe you’re alone now, and wish you weren’t.

The internet teems with advice about how to care for yourself during the holidays. Eat healthily, exercise, drink in moderation, lower your expectations. It all makes sense, but really, who needs any more pressure at this time of year?

So here’s what I wish for you, if you’re stressed or sad, grieving or struggling with mental illness this holiday season. I hope you’ll let yourself cry as much as you need to. That you’ll take a walk and just feel your feet, solid on the earth. That you’ll tell someone you care about them, and why. And most of all, that you’ll remember that we all fear isolation, illness and death. None of us is as happy as we seem.

The holidays will pass, and crocuses will pop up again from the snow.

Deciding whether to take antidepressants? Careful of ‘expert’ advice

(Updated Dec. 29)

The idea that patients with depression should eschew antidepressants for other remedies has gained popularity lately, sparking vehement debates in some corners of the web.

Take an interview of Dr. Andrew Weil this week on NPR’s Science Friday. Weil promoted his new book recommending non-prescription remedies, such as exercise and supplements, for people with mild to moderate depression.

Research does suggest that both aerobic exercise and fish oil may ease symptoms of depression. But a number of listeners criticized Weil, who has trademarked himself as “Your Trusted Health Advisor” while also selling his own line of customized vitamins and supplements (just $74.99 for his 30-day “Energy Support” pack).

Weil, I noted, didn’t correctly answer Science Friday host Ira Flatow when asked whether farmed fish (the source of much fish oil) tend to be fed a diet low in omega-3 fatty acids, the component of fish oil thought to combat depression.

Instead, Weil answered an unrelated question, saying that most fish oil is free of contaminants like mercury and PCBs.

(Flatow was right, by the way, according to this National Academy of Sciences article. The authors state that during the last decade, farmed fish were increasingly fed vegetable oils, which cause fish to have lower concentrations of omega-3 fatty acids.)

While researching the excellent PBS series This Emotional Life, I also found this article on the series homepage decrying the use of antidepressants.

“Love — not drugs — can save you and your relationship,” wrote marriage and family therapist Deb Schwarz Hirschhorn, adding that “partners can learn how to inject serotonin into each other’s brains with just a well-placed smile and a thoughtful gesture.”

“That’s so much more powerful than drugs, isn’t it?” she asked.

Hirschhorn raised some important points: in some studies, antidepressants have performed no better than placebos; industry-funded research should generally be interpreted with caution; and antidepressants can increase risk of suicide, especially in adolescents.

But she didn’t acknowledge that the increase in risk appears to be small, and that talk therapy can’t effectively replace medication for everyone.

The true picture of both depression and its treatment appears far more complex than that portrayed by Weil or Hirschhorn.

In one health care consumer study, for example, patients tended to report the most benefit from a combination of medication and talk therapy. But other studies found that patients were more likely to get better if they received the type of treatment they asked for, whether or not that included medication.

And in yet another study published this month, depressed patients tended to respond no better to medication or talk therapy than to placebo pills — except African-American men, who responded best to talk therapy.

The bottom line? Watch out for ‘experts’ with straightforward answers about treating depression. No matter where they fall on the spectrum of debate about antidepressants, they’re probably not telling the whole story.

Read more: Buddhist communities in the West have long criticized antidepressants, but that’s changing. Check out this 2009 article by physicians and long-time meditators Roger Walsh, Robin Bitner, Bruce Victor, and Lorena Hillman, published in the quarterly magazine Buddhadharma.

Roundup of mental health news and research

Some recent developments in mental health research:

• About 24 in 1,000 people worldwide will develop bipolar disorder in their lifetime, and most won’t receive effective treatment, according to a 2011 study of more than 50,000 adults from Japan, Brazil, New Zealand, Romania and the United States. The United States had the highest prevalence of bipolar disorder — nearly twice the worldwide average.

• Researchers at the University of Canberra in Australia announced they’ve developed a computer program to diagnose depression by analyzing facial expressions. Researchers say the technology is 80 percent accurate and describe it as an important step toward developing more cost-effective and objective methods to diagnose mental illness. Scientists are now working on more advanced versions of the technology that will incorporate analyses of patient’s gaits and voices.

• Physical exercise spurs new brain cells to form, a process called neurogenesis.

  

  Antidepressants also trigger neurogenesis, leading researchers to speculate that neurogenesis may be the reason  physical exercise can help prevent and reduce depression. On NIH Radio in Bethesda, listen to Drs. Michael Lehmann and Robert Schloesser describe the results of a study in mice that’s the first to directly link neurogenesis to physical exercise’s antidepressant effects.

• News flash: integrating primary and mental health care can save lives and cut health care costs. Sound obvious? I thought so too, but in many U.S. health care systems, the concept of a “medical home” — in which providers communicate and coordinate on all aspects of patient care — remains largely a theory.

More on bipolar disorder: Bipolar Kids May Focus on Different Facial Features

Seasonal affective disorder – choosing a light box and other tips for beating wintertime blues

Yesterday was the first day of fall — a season resplendent with colors, brimming with scents and sounds. Leaves crunch underfoot, apple crisp bubbles away in the oven, and here in the United States, fans shout and cheer at college football games.

Image courtesy of Sportige.com

But for about one to ten percent of people, fall’s shorter days trigger early symptoms of seasonal affective disorder (SAD) — an episodic depression in which you typically gain weight, sleep more than usual, and feel down and irritable during the year’s shorter months, according to PubMed Health.

The good news is that people with SAD can often feel much better without medication. In honor of fall, here’s a summary of what you should know if you or a loved one has SAD.*

“Thoughtless awareness” — meditation eases job stress, depressed mood

Does your brain ever feel like this?

Source: Eikongraphia

I know mine does. Some days, I feel like journalist John McManamy, who wrote,”my mind… is like a Circuit City showroom, with TVs and VCRs and home sound systems blaring all at once from all sides, and K-mart blue light specials and beepers and police radios going off against a truckload of gongs clattering down marble steps.”

And nothing sends me into showroom mode faster than a high-pressure workday. Even after I drag myself home, I still seem to hear the phones ringing and the meetings droning.

What’s more — surprise! — studies show residual work stress is all too common.

Source: CDC NIOSH

Which is why it’s exciting that a certain type of meditation can help full-time workers reduce job stress, anxiety and depressed mood, according to an Australian study published this summer in the journal Evidence-Based Complementary and Alternative Medicine.

In the study, researchers randomly assigned 178 full-time workers to one of three groups — a meditation group, a group that learned a relaxation technique, and a control group that received no treatment.

The meditation group spent several hours a week practicing “mental silence meditation,”which resembles forms of mindfulness meditation taught more commonly in the United States. The technique cultivates “thoughtless awareness” — that is, the meditator focuses on the breath or another aspect of the present moment instead of losing herself in thoughts.

After eight weeks, significantly more meditators reported decreased job stress and depressed mood compared to the other groups. Meditators also reported feeling less anxious, although the difference wasn’t as striking.

I’ve tasted “thoughtless awareness” during meditation. Worries and desires ceased, replaced by a sense of profound peace. And as the study’s results suggest, the effects sometimes lingered for hours after I’d left the meditation cushion — even into the next workday.