Mind over matter: using reason before emotion

03/24/2014 6:35 AM

03/24/2014 9:52 AM

Imagine this scenario: You come home from work tired and frazzled, and your kids are running wild. People in such situations might find solace in a popular meditative practice called mindfulness.

With mindfulness, you train your mind to focus on the present and respond with reason before emotion. It’s about taking a pause and guiding yourself to become “aware enough in the moment so that before you react, you’re aware of how you’re responding to a situation,” says Ronald Epstein, a professor of family medicine at the University of Rochester Medical Center in New York. “That gives you the choice to blow up or not to blow up. You recognize and say, ‘I’m about to lose my temper’ rather than losing your temper.”

In our high-stress culture, the idea has caught on. Mindfulness is being practiced not just by New Age-types, celebrities and executives. Education leaders in many states have received training for how to incorporate mindfulness into K-12 curricula. Most medical schools now offer an elective in mindfulness in medicine, Epstein says.

For the rest of us, a popular way to learn the technique is through eight-week mindfulness-based stress reduction courses, says Kirk Warren Brown, a psychologist at Virginia Commonwealth University in Richmond who has been studying and practicing mindfulness for more than 20 years. MBSR courses are often held in churches, schools, hospitals and community centers. For faster, less expensive options, you can find mindfulness courses online and tutorials on mobile device apps such as Buddhify.

Popularity is not necessarily a gauge of effectiveness, of course. So what’s the science behind mindfulness: Is it really a powerful life-coping skill?

“It’s not a cure-all; it doesn’t take all the problems away,” says Luke Fortney, a family medicine doctor in Madison, Wis., who has conducted clinical studies on the practice. “But it can help reframe our focus around how we approach these stresses.”

Research shows that being mindful can have tangible benefits, such as alleviating chronic pain and helping to curb depression and anxiety. Various studies have linked mindfulness practice to improvements in attention, eating and sleeping habits; weight management; and recovery from substance abuse. Research also suggests that mindfulness can help people cope better with heart disease, breast cancer, fibromyalgia, asthma and other conditions.

One way to assess the validity of studies is to do a meta-analysis, a comprehensive review of multiple studies. One such analysis published this year in JAMA Internal Medicine found “moderate evidence” that mindfulness meditation programs can have small but significant effects on anxiety, depression and pain. But the review did not find sufficient evidence that mindfulness could help with other health problems.

This doesn’t mean that mindfulness can’t help people with other conditions but just that stronger study designs are needed to know whether it is effective, says Madhav Goyal, an assistant professor of general internal medicine at Johns Hopkins School of Medicine and lead author of the meta-analysis. The important message from the study, he says, is that after evaluating thousands of people, including patients with anxiety, fibromyalgia, low back pain, HIV and heart disease who underwent approximately eight weeks of mindfulness training, “we were seeing a fairly consistent but small effect of improvement in all of those populations for anxiety, depression and pain.”

Brown points out that these moderate reductions are “nothing to sneeze at.” The meta-analysis demonstrates “that the average person may be able to cut back on anti-anxiety, antidepressant or other medications they are taking, which is not insignificant given the side effects and other issues such as tolerance that many psychotropic medications have,” he says. And as the authors note in their paper: “these small effects are comparable with what would be expected from the use of an antidepressant in a primary care population but without the associated toxicities.”

Last year, Brown published one of the first studies to look at how mindfulness practice affects the early unfolding of emotional reactions. By studying how brain waves change in response to emotional stimuli such as unpleasant images, he and his colleagues found that individuals deemed to be more mindful had lower stress responses than less-mindful individuals.

Mindfulness practice seems to alter how emotional centers in the brain are activated, Brown says. “Rather than simply helping people cope better with negative emotions and stress – which is certainly important – mindfulness seems to help inoculate against the arising of stress in the first place.”

The beauty of mindfulness is that once it’s learned, it can be done easily, while doing other things. “It’s something that can be applied under any kind of circumstance: washing the dishes, doing child care, driving, sitting in front of the computer,” Brown says.

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