Meditation – Part 2
How can meditation help as a source of alternative and holistic therapy for certain diseases and medical conditions?
Dr. Miroslav Sarac, Chiron Wise Centaur – holistic and integrative healing center
Scientific medical (conventional), complementary, integrative and functional medicine provided substantial research data related to meditation as a part of holistic or complementary treatment in many pathological conditions. Recent scientific medical research data showed that meditation could be an excellent addition to conventional medicine as a complementary, integrative treatment for many medical conditions and diseases such as pre-surgical and post-surgical treatment, major depressive disorder, depression and treatment-resistant depression, hypertension (particularly systolic), obesity, multiple sclerosis, in geriatric depression, post-traumatic stress disorder, diabetes, Alzheimer’s disease, and bodily distress syndrome. I collected recent data just in the past several years.
Recently, Packiasabapathy S. and colleagues exhibited in their research that cardiac surgical procedures are associated with postoperative neurological complications such as cognitive decline and delirium, which can complicate recovery and impair quality of life. Peri-operative depression and anxiety may be associated with increased mortality after cardiac surgeries. Proper preparation for cardiac surgery is an emerging concept that includes pre-operative interventions to reduce post-operative complications potentially. While most current preparatory interventions focus on optimizing physical health, mind-body interventions are an area of growing interest. Preoperative mind-body interventions such as Isha Kriya meditation may hold significant potential to improve postsurgical outcomes (Packiasabapathy S. et al., 2019).
Mindfulness meditation is increasingly incorporated into mental health interventions including major depressive disorder
Mindfulness meditation is increasingly integrated into mental health interventions, and theoretical concepts associated with it have influenced basic research on psychopathology (Wielgosz J. et al., 2018). Major depressive disorder (MDD) is one of the principal causes of disability in the world, no doubt about that. Major depressive patients that do not respond to the first and second drugs are about 67% and 33%, respectively (Turakitwanakan W. et al., 2017). According to Tolahunase M.R. and colleagues, there is growing evidence suggesting that both genetic and environmental factors modulate treatment outcome in, a highly heterogeneous, major depressive disorder (MDD) (Tolahunase MR et al., 2018). Specifically, the genetic analysis of a 5-HTTLPR variant of the serotonin transporter gene (SLC6A4) and MTHFR 677C>T polymorphisms have been strongly linked to the pathogenesis of major depressive disorder, and antidepressant treatment response. In patients with MDD who have 5-HTTLPR and MTHFR 677C>T polymorphisms and less likely to respond to medications (SSRIs) (Tolahunase MR et al., 2018). Evidence on whether meditation’s core aspect of building and nurturing calm and peace serves as a mood stabilizer for current and recurrent episodes of depression through the acute and maintenance phases of treating bipolar disorder II affected patients. Meditation helped alleviate guilt, depressed mood, and helplessness-hopelessness significant concerns in patients who suffer from depression (Pandya S.P., 2018). Wahbeh H. and colleagues found that late-life depression (LLD) is a disorder causing severe disability and conventional antidepressant therapeutics are ineffective in as many as 60% of cases. Converging evidence shows a strong correlation between LLD and subsequent risk of cardiovascular disease. There is a need for new, well-tolerated, non-pharmacological augmentation interventions that can treat depressive symptoms as well as improve heart rate variability (HRV), an important prognostic marker for the development of subsequent cardiovascular disease (Ionson E. et al., 2018). Older adults, a rapidly growing population in the United States, have fewer physiological reserves and are more likely to be affected by stress, making them especially susceptible to depression symptoms. Meditation offers promising potential as an effective treatment (Wahbeh H. et al., 2018).
Several authors had provided us with incredibly valuable results regarding meditation and its positive influence on hypertension
Several authors had provided us with incredibly useful results regarding meditation and its impact on hypertension. Benefits of mindfulness meditation in reducing and controlling blood pressure and stress in patients with arterial hypertension were described from Ponte Márquez PH and colleagues in 2018 (Ponte Márquez PH et al., 2018). Even though numerous advances in the prevention and treatment of atherosclerosis, cardiovascular diseases are available in conventional medicine (Western medicine), all these diseases remain a leading cause of morbidity, disability, and mortality. Some holistic, alternative therapies, inexpensive and affordable interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of the high interest of complementary medicine. Numerous scientific medical studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may be a potentially attractive, cost-effective adjunct to more traditional medical therapies, simply as a complementary treatment. Accordingly, this American Heart Association scientific statement systematically reviewed the data on the potential benefits of meditation on cardiovascular risk (Levine G.N. et al., 2017). The practice of meditation every day or several times per week, if adequately applied along with the conventional antihypertensive therapeutics, could substantially alleviate the burden of stroke in the U.S. To design an effective meditation program, policy-makers may prioritize funding to the programs that aim to encourage older individuals to practice meditation. Also, recently Ambavane R.A. and colleagues reported that meditation exhibited promise in clinical trials in reducing systolic hypertension, one of the main risk factors for stroke (Ambavane R.A. et al., 2019).
Meditation as a supplement therapy in neuropsychiatric diseases
Pathophysiologically, neuroinflammation is a complex process involving both the peripheral circulation and the central nervous system and is considered to underlie many neurological and psychiatric disorders including depression, anxiety, schizophrenia, and pain. Also recently, Lurie D.I. and colleagues explained that stressors including early-life adversity, psychosocial stress, and infection appear to prime microglia toward a pro-inflammatory phenotype (Lurie D.I., 2018). Subsequent inflammatory challenges then drive an exaggerated neuroinflammatory response involving the upregulation of pro-inflammatory mediators that are associated with CNS dysfunction. Several pharmacologic inhibitors of pro-inflammatory cytokines including (tumor necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β) exhibit good clinical efficacy in terms of improving neuroinflammatory processes. Mind/body and plant (herbal)-based interventions and treatments such as yoga, breathing exercises, meditation, and herbs/spices have also been demonstrated to reduce pro-inflammatory cytokines and have a positive impact on depression, anxiety, cognition, and pain. As the intricate connections between the immune system and the nervous system continue to be elucidated, successful therapies for reducing neuroinflammation will likely involve an integrated approach combining drug therapy with non-pharmacologic interventions (Lurie D.I., 2018).
Transcendental meditation has the potential for treating symptoms of posttraumatic stress disorder (PTSD)
Generally, we can define transcendental meditation as a mental technique using a mantra to facilitate meditation. Transcendental meditation has the potential for treating symptoms of posttraumatic stress disorder (PTSD), but its clinical efficacy remains to be clarified. Indeed, further clinical studies are necessary for this field. Kang S.S. and colleagues exhibited in 2018. results of evaluating the acceptability, preliminary effectiveness, and neurophysiology of transcendental meditation for veterans with PTSD (Kang S.S. et al., 2018). In the same study, from baseline to posttreatment, participants reported reductions in PTSD symptoms, experiential avoidance, and depressive and somatic symptoms, as well as increases on measures of mindfulness and quality of life (Kang S.S. et al., 2018).
Psycho-affective conditions or traits such as stress, depression, severe anxiety, and neuroticism are known to affect normal patterns of sleep, cognition and mental health and well-being in aging populations and to be associated with increased risk for Alzheimer’s disease (AD). Mental training for stress reduction and emotional and attentional regulation through meditation practice might help reduce these adverse factors. So far, studies on the impact of meditation practice on the brain and cognition in aging are scarce and have limitations but the findings are encouraging, showing a positive effect of meditation training on cognition, perception, especially on attention and memory, and on brain structure and function primarily in frontal and limbic structures and insula (Chételat G. et al., 2018).
Diabetes is associated with significant psychological distress, can meditation help?
Diabetes is associated with significant chronic psychological distress. There is one of the most important interventions to ensure the physical and emotional as well as psychosocial wellbeing of individuals living with diabetes. Meditation-based strategies have been evaluated for their complementary role in several chronic disorders including depression, anxiety, obesity, hypertension, cardiovascular disease, and diabetes. The practice of meditation is associated with a reduction in stress and negative emotions and improvements in patient attitude, health-related behavior, and coping skills. There is increased parasympathetic activity with a decrease in sympathetic vascular tone, stress hormones, and inflammatory markers.
Additionally, several studies including Priya G. and colleagues in 2018 evaluated the role of mindfulness-based stress reduction in diabetic individuals and demonstrated some modest improvements in body weight, glycemic control, and control of blood pressure. Mindfulness meditation-based interventions can lead to improvements across all domains of holistic care – biological, psychological, spiritual and social. Priya G. and colleagues proposed that most of the studies have been of relatively short duration and included small numbers of patients – human subjects, meditation strategies, and the practice could be useful holistic, alternative and complementary treatments to lifestyle modification and pharmacological management of diabetes and help improve patient wellbeing (Priya G. et al., 2018).
Mindfulness in Motion proved to be a possible program yielding positive results to improve quality-of-life outcomes for people with multiple sclerosis
Many scientific findings show that mindfulness-oriented meditation improves a person’s mental health, positively influencing even practitioners’ personality profiles as well. Unfortunately, a limited number of studies are beginning to show that this type of meditation may also be a helpful therapeutic holistic and complementary option for persons with multiple sclerosis (MS) (Crescentini C. et al., 2018). Gilbertson R.M. and colleagues in a published article in 2017 stated that due to the uncertainty in disease progression associated with multiple sclerosis, and the multiplicity of mental and physical symptoms related to that particular disease, programming that addresses anxiety, depression, and fatigue is a crucial area of future research in MS disease management. Mindfulness in Motion proved to be a possible program yielding positive results, supporting the need for research to determine the extent to which the program can improve quality-of-life outcomes for people with MS (Gilbertson R.M. et al., 2017).
Yoga has been an object researched in hundreds of randomized controlled clinical trials as a viable antihypertensive lifestyle therapy, reducing stress, improving symptoms of depression
Cramer A. and colleagues in 2017 published data regarding yoga. They stated that as a traditional, alternative health care system, yoga combines physical activity, breathing techniques, and meditation as well. It is increasingly used as a preventive or therapeutic means as a complementary, alternative and holistic therapy. So far, it is essential to state that yoga has been an object researched in hundreds of randomized controlled clinical trials. Positive effects of practicing yoga are especially found for chronic pain conditions, hypertension, depression and in supportive cancer care. While there are case reports of serious adverse events associated with yoga, the risk seems to be extremely low and comparable to other forms of physical activity. Yoga can be considered as a safe and useful adjunct, supplement therapy for some conditions (Cramer H., 2017). Results indicate that yoga is a viable antihypertensive lifestyle therapy that produces the most significant blood pressure benefits when breathing techniques and meditation/mental relaxation are included (Wu Y et al., 2019).
Meditation has been exhibited to decrease anxiety and stress, and improve the wellbeing and quality of life of people with chronic illness
Always was a great concern about how to make a better life to patients who are under dialysis. Their extreme conditions such as coping with the stress and anxiety caused by end-stage kidney disease symptoms and dialysis treatment, their restrictions, and social, financial, family and other significant stressors, consumes many people afflicted with kidney disease or end-stage kidney disease. Meditation has been shown to decrease anxiety and stress, and improve the wellbeing and quality of life of people with chronic illness (Bennett P.N. et al., 2018).
Generally, cardiovascular diseases continue to be the leading cause of morbidity, disability, and mortality around the world. Yoga, as a powerful combination of physical postures, breathing exercises, and meditation, has gained increasing recognition as a form of mind-body practice.
Recently, in 2019 Wells R.E. and colleagues showed fascinating results of their research regarding migraine. Although many studies had significant methodological challenges that limit interpretation and possible generalization, several studies reported decreased headache frequency, improved quality of life, or less effective responses to pain. The evidence is currently most promising for the mind/body treatment options of mindfulness, yoga, and tai chi. Mindfulness meditation may be as effective as a treatment for medication-overuse headache after the offending medication is withdrawn. Wells R.E. and colleagues stated: ” While older research has shown magnesium, riboflavin, feverfew, and butterbur to be helpful in migraine treatment, new study is promising to suggest potential benefit with melatonin, vitamin D, higher dosages of vitamin B6 (80 mg)/folic acid 5 mg combinations, and the combination of magnesium 112.5 mg/CoQ10 100 mg/feverfew 100 mg. Omega 3s have limited evidence of efficacy in migraine. Butterbur needs to be free of pyrrolizidine alkaloids to ensure safety given their hepatotoxicity. Physical therapy continues to have strong evidence of support, and acupuncture is superior to sham acupuncture and placebo. Side effects and risks reported were minimal and well tolerated overall, except the life-threatening danger of cervical artery dissection with high-velocity chiropractic manipulation and hepatotoxicity with the PAs in butterbur. Several studies are ongoing to further evaluate mindfulness, melatonin, physical therapy, exercise, chiropractic manipulation, and acupuncture.”
The American Academy of Neurology and American Headache Society (https://www.aafp.org/afp/2013/0415/p584.html) are currently updating the guidelines for integrative treatment options for migraine so that additional recommendations may be available soon. In conclusion, many complementary and integrative treatment options may be helpful for patients with migraines, and understanding potential efficacy, benefits, and risks can help providers discuss these modalities with their patients. Such a conversation can empower patients, build a therapeutic relationship, and increase self-efficacy, thus improving outcomes and patient-centered care (Wells R.E. et al., 2019).
Bodily distress syndrome or bodily stress is the term which according to its definition unifying numerous and various conditions such as fibromyalgia, chronic fatigue syndrome, and somatization disorder. Bodily distress syndrome patients may have been ill and in high risk for a social decline five and ten years before they received a proper diagnosis and treatment. The social and economic consequences of bodily distress syndrome are significant, and mindfulness therapy may have a potential to improve function significantly, quality of life and symptoms, prevent a social decline and reduce societal costs (Fjorback LO, 2012).
Spirituality has a significant role in the lives of most palliative and hospice patients
It was nice to read an article written by Steinhorn D.M. and colleagues regarding spirituality. Spirituality has a substantial role in the lives of most palliative and hospice patients whether or not they officially belong to a particular religion or spiritual tradition. As a result, the palliative and hospice care teams are frequently called upon to additionally support families who are experiencing their extremely challenging time and extreme struggling to make sense of their lives during a healthcare crisis. While conventional and everyday religious practices and services provide a useful resource of comfort and support for many of palliative and hospice patients, a significant number of palliative and hospice patients do not have an active religious community to which to turn and service for end-of-life spiritual care and support.
Interestingly, over twenty years, more people in Western countries identify themselves as spiritual but not necessarily religious, and do not belong to an organized religious community. For patients who express a strong spiritual connection or sense of “something greater” or “a higher power,” there are limited available resources (Steinhorn D.M. et al., 2017).
There is a significant health issue with rates of obesity continuing to increase despite research and clinical standard behavioral weight loss programs. According to the results, Spadaro K.C. and colleagues meditation enhanced weight loss by 2.8 kg potentially through more significant improvements in eating behaviors and dietary restraint (Spadaro K.C. et al., 2017).
Yoga and meditation are getting very popular among the general public and as topics of research as well
Benefits associated with practicing yoga have been found on physical / body health, mental health, and cognitive performance. Clinical studies and theories that would possibly clarify better the underlying mechanisms are still lacking. Gerritsen R.J.S. and colleagues in 2018 provided us with data and explanations regarding various contemplative activities have in common that breathing is regulated or attentively guided. This respiratory discipline, in turn, could parsimoniously explain the physical and mental benefits of meditative practices through changes in autonomic balance. Gerritsen R.J.S. and colleagues proposed a neurophysiological model that describes how these specific respiration styles could operate, by physically and tonically stimulating the vagal nerve: respiratory vagal nerve stimulation. The vagal nerve, as a proponent of the parasympathetic nervous system, is the prime candidate in explaining the effects of contemplative practices on health, mental health and cognition (Gerritsen R.J.S. et al., 2018).
Burnout and stress in healthcare practitioners are increasing; emergency department staff are particularly susceptible to such poor outcomes
Mantra meditation could contribute to improved well-being. Lynch J. and colleagues showed that emergency department staff described the demands of their work and voiced a need for a workplace well-being program. Their results suggest that mantra meditation might represent a viable tool to develop attention and awareness, improve emotion regulation and improve their capacity to cope with stress, which may impact their workplace well-being, more comprehensive health service, patient safety and quality of care. Support from the organization is considered to be integral to the embedding of a workplace well-being program, such as the practice of meditation into their daily lives (Lynch J. et al., 2018).
Interestingly, numerous studies show that personal spirituality developed through prayer positively influences mental health. Larrivee D. and colleagues published an exciting article in 2018. The authors stated that phenomenological and neuroscientific studies of mindfulness, an Eastern meditative prayer form, reveal significant health benefits now yielding important insights useful for guiding treatment of psychological disorders. By contrast, and despite its practice for millennia, Christian meditation is mainly unrepresented in studies of clinical efficacy. Resemblances between mindfulness and disciplinary acts in Christian meditation taken from the ancient Greek tradition of askesis suggest that Christian meditation will prove similarly beneficial; furthermore, psychological and neuroscientific studies indicate that its retention of a dialogical and transcendent praxis will additionally benefit social and existential psychotherapy. This paper thus argues that survey of contemplative meditation for its therapeutic potential is warranted (Larrivee D. et al., 2018).
Not all authors agree that meditation is beneficial as an alternative and holistic therapy
Farias M and colleagues published an article in 2016, and they tried to explain that meditation does not have any benefits. The authors stated: “The excitement about the application of mindfulness meditation in mental health settings has led to the proliferation of literature permeated by a lack of conceptual and methodological self-criticism. In this article, we raise two major concerns. First, we consider the range of individual differences within the experience of meditation; although some people may benefit from its practice, others will not be affected in any substantive way, and some individuals may suffer moderate to serious adverse effects. Second, we address the insufficient or inconclusive evidence for its benefits, particularly when mindfulness-based interventions are compared with other activities or treatments. We end with suggestions on how to improve the quality of research into mindfulness interventions and outline key issues for clinicians considering referring patients for these interventions” (Farias M, et al., 2016).
Van Dam N.T. and colleagues stated in their article published in 2018 that in the last twenty years, mindfulness meditation has gone from being a fringe topic of scientific investigation to be an occasional replacement for psychotherapy, a tool of corporate well-being, widely implemented educational practice, and “key to building more resilient soldiers.” Further authors stated that “the mindfulness movement and empirical evidence supporting it have not gone without criticism. Misinformation and poor methodology associated with past studies of mindfulness may lead public consumers to be harmed, misled, and disappointed.” Addressing such concerns, the present article discusses the difficulties of defining mindfulness, delineates the proper scope of research into mindfulness practices, and illustrates crucial methodological issues for interpreting results from investigations of mindfulness. For doing so, the authors draw on their diverse areas of expertise to review the present state of mindfulness research, comprehensively summarizing what we do and do not know, while providing a prescriptive agenda for contemplative science, with a particular focus on assessment, mindfulness training, possible adverse effects, and intersection with brain imaging. Our goals are to inform interested scientists, the news media, and the public, to minimize harm, curb poor research practices, and staunch the flow of misinformation about the benefits, costs, and prospects of mindfulness meditation (Van Dam NT, et al., 2018).
What is meditation research?
Loizzo J. in one article published in 2014 stated: “Although perspectives like the one shared here may not be common in today’s research circles and literature, I believe there is nothing new or controversial in what I have shared. Rather, I submit that the simple anthropology of respecting traditional know-how and practical expertise has been a secret ingredient to successful meditation research for decades. In a sense, I am simply suggesting that our young field has proven its rigor and relevance enough that we are ready to enter a new phase of open, rigorous, and systematic interdisciplinary dialogue with traditional contemplative science. My vision for the future of the field is that such an open, mutually respectful, and rigorous partnership promises to speed the advancement and align the direction of our field toward optimal science and maximal human benefit, as much or more than any conventional line of advancement through technical breakthroughs and new methodologies” (Loizzo J., 2014).
Packiasabapathy S, Susheela AT, Mueller A, Patxot M, Gasangwa DV, O’Gara B2, Shaefi S, Marcantonio ER, Yeh GY, Subramaniam B. Guided meditation as an adjunct to enhance postoperative recovery after cardiac surgery: study protocol for a prospective randomized controlled feasibility trial. Trials. 2019 Jan 11;20(1):39.
Wielgosz J, Goldberg SB, Kral TRA, Dunne JD, Davidson RJ. Mindfulness Meditation and Psychopathology. Annu Rev Clin Psychol. 2018 Dec 10. doi: 10.1146/annurev-clinpsy-021815-093423.
Turakitwanakan W, Pongpaplud P, Kitporntheranunt M. The Effect of Home Buddhist Mindfulness Meditation on Depressive Symptom in Major Depressive Patients. J Med Assoc Thai. 2017 Nov;99 Suppl 8:S171-S178.
Tolahunase MR, Sagar R, Dada R. 5-HTTLPR and MTHFR 677C>T polymorphisms and response to yoga-based lifestyle intervention in major depressive disorder: A randomized active-controlled trial. Indian J Psychiatry. 2018 Oct-Dec;60(4):410-426.
Pandya SP. Meditation for treating adults with bipolar disorder II: A multi-city study. Clin Psychol Psychother. 2018 Dec 10.
Ionson E, Limbachia J, Rej S, Puka K, Newman RI, Wetmore S, Burhan AM, Vasudev A. Effects of Sahaj Samadhi meditation on heart rate variability and depressive symptoms in patients with late-life depression. Br J Psychiatry. 2018 Nov 28:1-7.
Wahbeh H, Nelson M. iRest Meditation for Older Adults with Depression Symptoms: A Pilot Study. Int J Yoga Therap. 2018 Oct 24.
Ponte Márquez PH, Feliu-Soler A, Solé-Villa MJ, Matas-Pericas L, Filella-Agullo D, Ruiz-Herrerias M, Soler-Ribaudi J, Roca-Cusachs Coll A, Arroyo-Díaz JA. Benefits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension. J Hum Hypertens. 2018 Nov 13.
Levine GN, Lange RA, Bairey-Merz CN, Davidson RJ, Jamerson K, Mehta PK, Michos ED, Norris K, Ray IB, Saban KL, Shah T, Stein R, Smith SC Jr; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; and Council on Hypertension. Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association. J Am Heart Assoc. 2017 Sep 28;6(10).
Ambavane RA, Khademi A, Zhang D, Shi L. Modeling the Impact of Transcendental Meditation on Stroke Incidence and Mortality. J Stroke Cerebrovasc Dis. 2019 Mar;28(3):577-586.
Lurie DI. An Integrative Approach to Neuroinflammation in Psychiatric disorders and Neuropathic Pain. J Exp Neurosci. 2018 Aug 13;12:1179069518793639.
Kang SS, Erbes CR, Lamberty GJ, Thuras P, Sponheim SR, Polusny MA, Moran AC, Van Voorhis AC, Lim KO. Transcendental meditation for veterans with post-traumatic stress disorder. Psychol Trauma. 2018 Nov;10(6):675-680.
Chételat G, Lutz A, Arenaza-Urquijo E, Collette F, Klimecki O, Marchant N. Why could meditation practice help promote mental health and well-being in aging? Alzheimers Res Ther. 2018 Jun 22;10(1):57.
Priya G, Kalra S. Mind-Body Interactions and Mindfulness Meditation in Diabetes. Eur Endocrinol. 2018 Apr;14(1):35-41.
Crescentini C, Matiz A, Cimenti M, Pascoli E, Eleopra R, Fabbro F. Effect of Mindfulness Meditation on Personality and Psychological Well-being in Patients with Multiple Sclerosis. Int J MS Care. 2018 May-Jun;20(3):101-108.
Gilbertson RM, Klatt MD. Mindfulness in Motion for People with Multiple Sclerosis: A Feasibility Study. Int J MS Care. 2017 Sep-Oct;19(5):225-231.
Cramer H. Where and How does Yoga Work? – A Scientific Overview. Dtsch Med Wochenschr. 2017 Dec;142(25):1925-1929.
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Bennett PN, Ngo T, Kalife C, Schiller B. Improving wellbeing in patients undergoing dialysis: Can meditation help? Semin Dial. 2018 Jan;31(1):59-64.
Guddeti RR, Dang G, Williams MA, Alla VM. Role of Yoga in Cardiac Disease and Rehabilitation. J Cardiopulm Rehabil Prev. 2018 Nov 27.
Wells RE, Beuthin J, Granetzke L. Complementary and Integrative Medicine for Episodic Migraine: an Update of Evidence from the Last 3 Years. Curr Pain Headache Rep. 2019 Feb 21;23(2):10.
Steinhorn DM, Din J, Johnson A. Healing, spirituality and integrative medicine. Ann Palliat Med. 2017 Jul;6(3):237-247.
Upchurch DM, Johnson PJ. Gender Differences in Prevalence, Patterns, Purposes, and Perceived Benefits of Meditation Practices in the United States. J Womens Health (Larchmt). 2019 Feb;28(2):135-142.
Spadaro KC, Davis KK, Sereika SM, Gibbs BB, Jakicic JM, Cohen SM. Effect of mindfulness meditation on short-term weight loss and eating behaviors in overweight and obese adults: A randomized controlled trial. J Complement Integr Med. 2017 Dec 5;15(2).
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Larrivee D, Echarte L. Contemplative Meditation and Neuroscience: Prospects for Mental Health. J Relig Health. 2018 Jun;57(3):960-978.
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