Meditate, Don’t Medicate

Meditate Instead of Medicate for Anxiety Relief

The world is in a stressful and anxious state, and our society is full of high-performance people who are trying to have it all, along with those who are impoverished, wondering where their next meal is coming from. Can people get on a bus or train, go to a house of worship or a concert, and not worry that a suicide squad will destroy them? All this fear and anxiety creates stress that erodes health. Although many look first to a pill, meditation is an alternative healing method proven to safely decrease symptoms of anxiety. Its versatility and affordability allow for easy implementation into anyone’s daily routine. Therefore, its appeal crosses all boundaries and can be successfully used alone or as an adjunct or replacement for addictive medications.

Everyone experiences some form of anxiety at one time or another, and they are relieved when it finally resolves. “Anxiety Disorders: An Integrative Approach”¹ describes anxiety as “an unpleasant complex combination of emotions often accompanied by physical sensations, such as heart palpitations, nausea, angina (chest pain), shortness of breath, tension headache and nervousness”.^1(p338) Not all anxiety is created equal. There is mild, passing anxiety, which may occur due to a precipitative event, such as a job interview or speaking engagement (performance anxiety), and which can occur alongside other illnesses, whether mental (substance abuse or psychiatric disorders) or physical (surgery, cancer, heart attack or stroke). This type of anxiety may be acute or chronic.

Anxiety lasting more than six months or more with no other co-morbidities is considered to be a generalized anxiety disorder.^1(p338) This longer-lasting anxiety can also be worsened by other psychiatric co-morbidities, such as obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder or social anxiety.

I am an internal medicine triage nurse in New York City. Outside my office, which is situated on a busy street, there are people experiencing the anxieties of homelessness, joblessness and physical disabilities and in dire need of professional help they may refuse or not be able to afford. Inside my office, I’ve observed other anxieties: patients who are unable to get on a plane or lie inside an MRI machine without wanting to run, and others who cannot cope with their day-to-day stress and anxiety and look to highly addictive medications, benzodiazepines such as Valium and Ativan, as their treatment option. However, medication is not always the first and only solution.

There are a variety of other treatment options for anxiety. Cognitive Behavioral Therapy (CBT) is a specialized therapy that is preferred,^1(p340) but access to it can be limited, as it requires significant financial resources. CBT and other forms of psychotherapy can be used alone or as an adjunct to medication, and sometimes, medication may be the first and only choice, especially if the patient has true diagnosed mental disease, such as schizophrenia, multiple personality disorder or dissociative disorders.^1(p340)

Some patients explore alternative healing methods for their anxiety as a complement to or in replacement of traditional Western medicine solutions. Herbal pharmacology and supplements are some of the most familiar and easily accessible of those methods. Many of these products can be purchased at local health food stores, pharmacies and specialty supermarkets, but let the buyer beware: These should only be used under professional supervision. Since herbal supplements fall under the category of “food supplements,” any manufacturer can make claims regarding their efficacy and safety without a regulating body monitoring them for purity or veracity.² Other alternative therapies, such as medical hypnosis, “hands-on” modalities (therapeutic touch, acupressure, acupuncture and reflexology, spinal manipulation, connective tissue manipulation), body movement techniques (Tai Chi, Qi Gong, Alexander, Yoga), and those of energy fields (Reiki and Chakra) are useful for anxiety relief but require a practitioner or instructor, limiting access to many patients. However, meditation is an easily accessible alternative healing method proven to decrease symptoms of anxiety. One can meditate privately, use a trained practitioner to guide the meditation, or attend a class to share energy with other participants. Meditation may involve some or no cost, and its long-term effects on health are clearly beneficial. A study reported by Dr. Aisworth and his colleagues3 regarding the brain pathways involved in the anxiety response confirm that highly addictive benzodiazepines and meditation follow the same brain roadmap,^3(p121) thus explaining why meditation is effective for anxiety as an adjunct or replacement for these medications.

Even for an extreme form of anxiety, such as post-traumatic stress disorder (“PTSD”), meditation has been effective. PTSD is intense fear and loss of control occurring after a traumatizing event. Levels of anxiety seen in patients with PTSD are far greater and longer lasting than those seen with general anxiety due to the intensity and nature of the trauma, such as military combat, domestic violence or sexual abuse. In a study group of 74 military personnel affected by PTSD and anxiety, half of the group practiced Transcendental Meditation (“TM”) and the other half, the control group, did not participate. Initially, half of the control group (non-meditating) showed a decrease or discontinuance of their anti-anxiety medications, but a review done at six months not only showed an escalation in PTSD symptoms for the control group, but 40% of this group actually increased their medication doses! In contrast, results from the meditating group showed positive results, with a majority decreasing or discontinuing their anxiolytic medications.⁴ Another group, suffering anxiety due to unemployment was studied, with half being taught a formal meditation technique and the other half instructed in simple stretching and talking as a form of distraction from stress and anxiety. Although participants from both groups claimed they felt decreased anxiety and stress, follow-up brain scans showed otherwise: Only those participants in the formal meditation group showed “more activity, or communication, among the portions of their brains that process stress-related reactions and other areas related to focus and calm.”⁵ The evidence is clear that meditation successfully decreases the symptoms of anxiety.

Although meditation had its start in medical settings in the 1970s, there has been recent growing scientific interest in mindfulness meditation. In 2012 alone, approximately 500 scientific papers concerning mindfulness meditation were published, “more than the entire number of papers…published between 1970 and 2000.”⁶ Of the many interesting meditation techniques that exist, mindfulness is considered one of the “most powerful” for stress and anxiety reduction. Zeidan, Martucci, Kraft, McHaffie & Coghill7 studied mindful meditation methodology and determined its effectiveness was due to its ability to harness those areas that control cognition and regulation of emotions; it also reduced rumination.^7(p757) While addictive benzodiazepines are usually the first choice for patients with a clinical anxiety disorder, the Zeidan, et al. study concludes that this medication may help only half of those patients. For healthy, albeit anxious, persons, medication did not improve their anxiety; yet with just 20 minutes of meditation, this population had their anxiety reduced by 22%. With continued practice, even more benefit is realized7 due to the malleability of the brain. J. David Creswell, an associate professor of psychiatry, led a recent study that “brings scientific thoroughness to mindful meditation and for the first time shows that, unlike a placebo, it can change the brain.”⁵ This powerful modality clearly shows effectiveness for anxiety reduction by decreasing the physiological stress response.

Another meditation style, Natural Stress Relief (“NSR”), brings the participant into a state of deep rest and is self-taught using an audiotape. It can be learned and practiced in complete privacy. Miller, DeCicco, Dale & Murkar8 studied the effects of NSR on depression and anxiety and report it to be as effective as Transcendental Meditation. Participants who practiced NSR for just one week showed a decrease in both depression and anxiety scores,^8(p99) and continued practice for eight weeks or more of regular meditation changed brain structures, reducing the “fight or flight” portion (the amygdala), which affects anxiety, fear and stress.⁹⁽²³⁾ Participants also show “an increase in autonomy, creativity, inner satisfaction, alertness and productivity” just by reducing their anxiety.^8(p99) Meditation gently brings the brain into a more relaxed state and guides the participant toward achieving his or her full potential.

Often, the key to offering meditation as an effective alternative for anxiety and stress relief is adapting it to one’s individual needs and interests. Meditation can be incorporated into anyone’s day, whether alongside a favorite hobby, eating, walking, sitting or even cycling. In a 2014 study analyzing the use of mindful meditation during yoga and cycling, participants incorporating meditation into their exercise period reported an increase in positive feelings and a decrease in the negative.¹⁰ We are all aware that exercise increases endorphins, which are good brain chemicals. By adding meditation into any exercise routine, further positive benefits to overall health and well-being are realized.

According to Dr. Herbert Benson, a guru in the field of meditation, the common feature of all meditation techniques is the ability to “induce the ‘relaxation response,’”^9(p22) using the steps outlined below:

• Sit quietly in a comfortable position, close your eyes.
• Deeply relax all your muscles, from your feet up to your face.
• Breathe through your nose and listen to your breath, breathing easily and naturally.
• Continue for 10 to 20 minutes.You can check the time, but do not use an alarm.
• Afterwards, sit quietly for several minutes, with eyes closed or opened.
• Do not stand up for a few minutes.

(Benson & Klipper, 2000)^11(pp12-13)

Because meditation clearly reduces anxiety and stress, people who practice it can show improved health, thus cutting down on sick visits to doctors’ offices, urgent care clinics and emergency rooms. Dr. Benson and his colleagues at the Benson-Henry Institute for Mind Body Medicine support the use of mindfulness-based stress reduction programs as well as the Relaxation Response Resiliency Program (“3RP”) for their effectiveness in “reducing and managing the clinical manifestations of stress, reducing anxiety and increasing patients’ resiliency.”¹² 3RP is an eight-session program that helps participants use techniques such as meditation and yoga, and develop skills to elicit the relaxation response, reduce the stress response and enhance resiliency.¹² 3RP and mindfulness-based stress reduction programs not only improve pain, chronic stress, anxiety and those organ systems imposed upon, e.g., cardiac, pulmonary, etc., but also build a patient’s overall mental strength and resiliency, which not only positively impacts overall health and wellness, but serves to decrease healthcare costs as well. “Benson states over 60% of doctors’ visits are in the mind-body, stress-related realm that are poorly treated by drugs and surgeries.”^9(p22) Stahl and his colleagues quote a cost savings of about $2,360 per patient per year, just in terms of emergency room visits! Due to the low cost of mind-body interventions as well as their clinical value, policy recommendations have been made regarding the inclusion of these interventions as part of preventive care for patients.¹² Just as smoking cessation, alcohol consumption and healthful diet are reviewed at patients’ annual well visits, so should meditation for anxiety and stress reduction. “Two-thirds of GPs are willing to support a public campaign to promote the health benefits of meditation,”⁶ and some doctor’s offices are even beginning to offer on-site yoga and meditation classes for patients – a definite step in the right direction. Meditation programs have also been in place at prisons and homeless rehabilitation programs in major cities throughout the United States, but they need more funding and awareness to expand offerings. “If mindfulness meditation techniques can be taught effectively…it is possible that this may lead to improvements in self-care,”^10(p306) while decreasing healthcare over-utilization.

Dr. Benson recommends the beginning meditator should start with only one to five minutes and eventually work up to 20 minutes per meditation period.^9(p23) If you are tech savvy, short on time and have a smartphone, Brian Hamman offers suggestions for free to low-cost apps such as Calm, Headspace and Mindfulness Daily, as well as apps with more bells and whistles, such as The 10% Happier app, which comes with a personal coach who will text you.¹³ A subway ride in Manhattan was a great place to test drive a meditation app. I chose a two-minute meditation on the Calm app and was amazed at how it blocked out all the hustle and bustle of the train. It was an easy, quick and healthy way to start my day and it definitely reduced the stress and anxiety of the commute.

Conclusion

We all know someone who suffers from anxiety, or you may even suffer from it firsthand. Explore meditation as an effective alternative to anti-anxiety medications. It decreases anxiety symptoms, builds resilience, strengthens one’s constitution, and boosts creativity and productivity, making it beneficial to overall patient health and wellness. Its versatility makes it easy to incorporate into anyone’s daily regimen. If you don’t have time to attend a class or practice at home, you can meditate on the go by downloading an app! There are so many ways to bring meditation into your own life. All you need to start is to take a few minutes and just think “RELAX.”

References

1. Anxiety Disorders: An Integrative Approach: A Natural Standard Monograph. Altern Complement Ther. 2014; 20(6); 338-346. doi:101089/act201420603.
2. Pereira K. Herbal supplements: widely used, poorly understood. Nursing 2016. 2016; 46(2); 55-59.
3. Ainsworth B, Marshall JE, Meron D, et al. Evaluating psychological interventions in a novel experimental human model of anxiety. J Psychiatr Res. 2015; 63; 117-122.
4. Barnes VA, Monto A, Williams JJ, Rigg JL. Impact of Transcendental Meditation on psychotropic medication use among active duty military service members with anxiety and PTSD. Mil Med. 2016; 181(1); 56-63.
5. Reynolds G. How meditation changes the brain and body. The New York Times. February 18, 2016. http://www.nytimes.com. Accessed April 1, 2016.
6. Shonin E, Van Gordon W, Griffiths MD. Meditation as medication: are attitudes changing? Br J Gen Pract, 2013; 63(617); 654.doi:10.3399/bjgp13X675520M.
7. Zeidan F, Martucci KT, Kraft RA, McHaffie JG, Coghill RC. Neural correlates of mindfulness meditation-related anxiety relief. Soc Cogn Affect Neurosci. 2014; 9(6); 751-759.
8. Miller NJ, DeCicco TL, Dale AL, Murkar A. Assessing the effects of meditation on dream imagery, depression and anxiety. International Journal of Dream Research. 2015; 8(2); 99-104.
9. Vadnais E. The power of meditation. Advance for Nurses. 2016; 6(2); 22-23.
10. Bryan SZ, Zipp GP. The effect of mindfulness meditation techniques during yoga and cycling. Altern Complement Ther. 2014; 20(6); 306-316.
11. Benson H, Klipper MZ. The Relaxation Response. New York, NY: Harper Collins Publishers Inc; 2000.
12. Stahl JE, Dossett ML, LaJoie AS, et al. Relaxation response and resiliency training and its effect on healthcare resource utilization. PLoS One. 2015; 10(10). doi:10.1371/journal.pone.0140212.
13. Hamman B. How to pick a meditation app. The New York Times. November 14, 2015. http://www.nytimes.com. Accessed April 7, 2016.