. Author manuscript; available in PMC: 2021 Apr 9.
Published in final edited form as: N Engl J Med. 2020 Apr 9;382(15):1390–1391. doi: 10.1056/NEJMp1917461
Michelle L Dossett
1, Gregory L Fricchione
1, Herbert Benson
1
PMCID: PMC7486127NIHMSID: NIHMS1625959PMID: 32268025
The publisher's version of this article is available at N Engl J Med
Fifty years ago, meditation was considered fringe, the idea that it had any role in medical treatment, absurd. Nevertheless, one of us (H.B.) published research demonstrating that meditation and similar practices (initially from India and later from other cultures) reduced oxygen consumption, lowered blood pressure and heart rate, and initiated a cascade of physiological effects that were the opposite of what occurs during the stress response.1 This coordinated set of physiological changes was termed the “relaxation response,” and a general, secular procedure was described to elicit it. Coincidentally, this work took place in the same laboratory that had been occupied by Walter Cannon 50 years earlier when he described the stress, or “fight or flight,” response.
Today, meditation and other mind–body practices, such as yoga and mindfulness, are growing in popularity, with 14% of the U.S. adult population reporting having used these techniques within the previous year.2 Historically, these tools have been used to promote human flourishing, insight, peace, enlightenment, and connection to something larger than oneself. Today, many people are drawn to these practices for their perceived physical and mental health benefits and stress relief. All religious traditions and cultures have some form of meditative or other mind–body practice, but the current explosion of interest in these practices has largely occurred within a secular context.
Concurrent with this growing public interest is emerging research describing the neurobiologic, physiologic, and genomic changes associated with mind–body practices, particularly meditation, including activation of specific brain regions, increased heart rate variability, suppression of stress-induced inflammatory pathways, and increased telomerase expression (see Supplementary Appendix for a list of relevant studies). Though some of these changes appear to occur with multiple techniques, others may be technique-specific. More research is needed to understand the implications of these findings.
In 1964, John Stoeckle and colleagues concluded that 60 to 80% of visits to primary care physicians have a stress-related component.3 Stress is ubiquitous, and its role when excessive or persistent as a major contributor to morbidity and mortality is well recognized.4 At the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, we routinely receive referrals to our Stress Management and Resiliency Training (SMART) Program from primary care physicians and specialists who have seen their patients benefit from these practices. As many patients are initially skeptical, we counsel them regarding how stress may be exacerbating their symptoms, how mind-body techniques reduce the stress response, and what to reasonably expect (e.g., you cannot blank your mind with meditation and mind wandering is normal). With guidance and consistent practice most patients feel less stressed, experience a greater sense of well-being, and are less bothered by the symptoms that brought them in. Some note a greater sense of spiritual connectedness.
Belief in these techniques is not necessary to realize benefit. Indeed, randomized controlled trials have suggested improved health outcomes and quality of life in multiple physical and mental health conditions that are related to or exacerbated by stress, including chronic pain, anxiety, depression, cancer-related fatigue, tobacco addiction, inflammatory bowel disease, and cardiovascular disease, though these tools may not be helpful in the setting of substance use disorder. Moreover, preliminary findings suggest that integrating these tools into the health care system may reduce health care utilization and be cost-effective.
Nonetheless, not everyone is ready to embrace these tools: some patients may have concerns about certain practices contravening their religious beliefs; others are not ready to engage in the effort required to maintain a regular practice; still others have been conditioned to request a pill for every ailment. Moreover, some patients may not be appropriate for these tools. For example, patients with severe mental illness may have difficulty learning these skills or risk losing touch with reality when they engage in some of these practices.
Despite these barriers, many patients are keen to learn more about these tools. Given the available data and the favorable side-effect profiles of these practices, we believe that mind–body medicine should be recognized as potential primary and secondary prevention and routinely incorporated into primary care. It is not so considered because our health care system is, to a large extent, predominantly built on a reactive disease-treatment model rather than a proactive health-enhancement model. Realization of the potential cost savings and health improvements afforded by mind–body medicine would require insurance companies to cover these services and an educational system to train health care professionals in the appropriate use of these tools. Many medical schools now offer mind–body medicine electives, but only a few have made education in these practices a required part of the curriculum. Currently, few Americans have access to these tools in a medical setting, and even those who do must often pay for them out of pocket.
Given the ubiquity of stress, high rates of anxiety and depression among young people, and the necessity of learning effective coping skills as part of an essential health-promoting lifestyle (a need that is poorly addressed by our current education system), it also makes sense for these tools to be widely integrated into primary and secondary education. Schools that have incorporated these tools have noted improvements in cognitive and socioemotional outcomes for students.5
In addition to the potential physical and mental health benefits of meditation, there are also potential societal benefits. Meditation and related tools can promote empathy and mindful presence among health care professionals, thereby enhancing the quality of care. Historically, cultivation of these mindful and contemplative practices throughout a society promoted tolerance and mutual understanding, enhancing the social fabric. Research suggests that, on an individual level, mind–body practices can promote prosocial behavior (see Supplementary Appendix). Could widescale use of these tools by people spanning the various sociodemographic strata of our country help promote healing of some of the divisions that currently challenge us?
Western medicine has produced revolutionary health benefits through advances in pharmacotherapies and procedures. It now faces enormous challenges in battling stress-related noncommunicable diseases. More Americans than ever are taking prescription medications for chronic health conditions, many of which have a lifestyle component. Chronic pain, often perpetuated by psychosocial stress, has become an epidemic that our pharmaceutical arsenal is poorly equipped to handle, and medical costs continue to soar.
Mind-body therapies can be a helpful adjunct in managing chronic pain and other stress-related noncommunicable diseases by fostering resilience through self-care. Though they are not a panacea, they can do much to improve well-being and reduce symptoms and the physiologic effects of stress. These underused tools thus have much to offer on both the individual and societal levels. As we continue to develop models for integrating these tools into our health care and education systems, we have an important opportunity and obligation to study these experiments so that we can learn how best to personalize these approaches and maximize their public health potential. We need to understand whether particular approaches are more likely to help certain people, temperaments, or conditions; whether psychologic or genetic factors predict who will respond best to certain practices; what constitutes optimal “dosing”; and to what extent these practices can shift the course of disease and reduce the need for pharmaceuticals and expensive tests and procedures. More robust, well-controlled prospective clinical trials are needed as well as additional implementation and comparative effectiveness trials and basic research into the putative cellular underpinnings of mind-body health effects. There is much work to be done, but we believe the future is promising for mind–body medicine.
Supplementary Material
Supplementary Appendix
NIHMS1625959-supplement-Supplementary_Appendix.docx (16.4KB, docx)
Footnotes
Disclosure forms provided by the authors are available at NEJM.org.
References
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Associated Data
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Supplementary Materials
Supplementary Appendix
NIHMS1625959-supplement-Supplementary_Appendix.docx (16.4KB, docx)