Greg Thorkelson, MD with Ryan Reagan, PhD(c), LPC

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Meditation is certainly having its moment.  Apps like Headspace are increasingly common and worth sampling if you have any interest in developing a meditation practice.  The word “practice” is important here.  Anything practiced tends to improve in terms of efficiency or proficiency (skill).  We emphasize the word practice here because a common refrain at the mention of meditation is “yeah, I tried that, it doesn’t work.”  And this may be 100% true, you may have tried meditation and indeed found that it did not work.  You may have tried again, maybe even a handful of times, and nothing. So, the first question I would ask is what were your expectations?

If you had the expectation that divine wisdom was to be revealed, then you may have set your expectations just a bit too high.  You could be forgiven. The popular imagery of meditation often presents a serene and jolly figure seated in the lotus position.  The reality is more frequently what the Buddhist’s call “monkey mind,” the experience of going from thought to thought.  Forget about even sitting in lotus position, many of us can’t.  It is also unnecessary, but you should sit comfortably.  It is much harder to do meditation in an uncomfortable position or setting.

The term meditation actually covers a broad range of practices.   It is true that many religions have practices that are meditative.  Arguably, prayer could be considered a type of meditation, and it is not too different from reciting a mantra.  Chanting is also a practice observed in both Buddhist and Christian monks.  There is scientific support for these practices.  Both rhythm and breathing help to regulate the autonomic nervous system.

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Although meditation probably emerged within spiritual traditions, the practices are easily reconcilable as a cognitive exercise for those more secularly minded.  Mental health practitioners that recommend meditation of get asked the question—“But, what is the goal? What or where am I trying to get to?” This is a fair question.  I suspect that the expert John Kabat-Zin might say “home.”  His book Wherever You Go, There You Are implies that in title alone. This answer may sound evasive, but that is probably because there is a lot of mental baggage tied to the action words “practice.”  Additionally, we often use terminology like “journey,” which can imply that there is a destination point. We live in a culture that is highly fixated on outcomes, measurements, and results.

It is not that these things don’t matter, they do, but “results” can be devilishly difficult to pin down, especially when we are talking about a subjective experience.  Few people would disagree with the statement that results vary and that the vary over time.  How do we conclude that meditation is working when the insight might hit after several weeks?  It is hard to tell a person who wants an answer “it will come, you just have to try it and see what you find.”

To help avoid this frustration it can help to have a framework.  The book Aware by Daniel Siegel, MD is an excellent place to start if you have interest in developing a meditation practice, specifically because he provides a visual framework to follow.  The title also helps to answer that stubborn question—“what is the goal of meditation?”  This book suggests that the goal is to deepen awareness.  Next question—awareness of what? Yeah, we had to go there. Awareness of reality is probably the best answer.  The frustrating thing about the topic of reality: we all think we know it, but none of us can claim it.

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You may be surprised to find out that a large amount of mental work occurs outside of conscious awareness.  There is simply no way to take it all in.  We have neither the time nor the bandwidth.  What we do have is the ability to attend. There is a certain level of conscious control over what we choose to attend to. This is where the term “mindfulness” relates to our present discussion.  You will often hear the two terms “mindfulness” and “meditation” in conjunction.    To clarify, mindfulness is a certain type of meditation practice that seeks awareness of the present moment.

You may be wondering why this is important.  The words “being in the moment” are becoming a bit of a punchline.  But, here is an important point, when we are fully immersed in the present moment the mind is full of that experience.  It has no room for anything else.  This includes worry, dread, fear, regret, all those things that occupy a great amount of our mental space when we are struggling.  This is not to suggest that the things that generate worry and regret don’t matter.  They may or they may not.  The point is that they will still be there after you leave your mindful moment.  You don’t have to spend all of your time with them.

Another common complaint is “all my mind does is wander.”  In the book Why Buddhism is True, Robert Wright recounts the experience of bringing this complaint to his meditation instructor.  The response was “good, it sounds like you are very aware that the mind wanders.”  There is a lot of wisdom packed into that response. Being aware that your head is filled with a bunch of thoughts, feelings, ideas, all vying for your attention is the first step.

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In fact, one style of meditation called open-monitoring approaches this problem by encouraging holding an awareness specifically on the wandering.  A Zen instructor once described the practice as picturing the mind as an empty parking lot, and the thoughts were loose dogs. The idea is not to chase the dogs across the parking lot, but just to observe them.  Just notice their presence.  The human habit is to engage each thought until a new thought takes our attention.  If you slow this process down you sometimes see that not all thoughts are worth chasing.  

Another very important point to mention before we get to some of the health benefits of meditation is that mindset matters.  It is absolutely appropriate to approach any new practice with skepticism, but if you are silently telling yourself “this is stupid” and “what’s the point,” you may discover that voice wins out. For this reason, you will often hear meditation instructors talk of “intent.”  Research supports that when we start from a position of “intention” we set the mental framework for discovery. This brings us to the other basic style of meditation called focused attention. This can be as simple as sustaining the attention on breath, mantra, calming music or sound, etc.

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This is Your Brain on Meditation

There is a considerable body of research accumulating around what happens with the brain during meditation.  Scientists have identified that the brain has a network of neurons that are active when the mind wanders.  This is referred to as the Default Mode Network.  If it helps to think of it this way, it is the network that we default to when we are not present.  This phenomenon may take a variety of names including autopilot, zoning out, brain fog, day dreaming.  It is difficult to determine if we are all speaking of the same experience, but the terms above do reflect something opposite of present and engaged.

If we are being honest, most of us would probably agree that we spend a considerable amount of time in this network.  One day, we may even discover that there are some functional benefits to this, as in the case with grief.  During grief emotions often feel unbearable and yet somehow we make plans for funerals, cleaning, going to work, and many other things that sound almost unthinkable when we ponder the totality of the grief experience.  Now, the problem with the default mode network—research supports that overactivity in this region is associated with a wandering mind.  A wandering mind is associated with higher levels of unhappiness (Killingsworth & Gilbert, 2010).

The other problem that is associated with the default mode network is that it is highly self-referential.  This means that incoming information is processed in reference to the self.  Anyone who has experienced depression knows that negative information hurts with an extra weight.  All that extra mental weight accumulates.  It should come as no surprise that depression comes with fatigue, loss of motivation, and hopelessness—the brain is in a position primed to see this.

The good news is that we have a better understanding of the neurology underpinning suffering.  One of the most widely available therapies—Cognitive Behavioral Therapy (CBT) is highly effective in altering the thought patterns associated with mental activity.  CBT is not a magic bullet, there are times when other modalities are more appropriate, but it is an evidence-based practice with a considerable body of research supporting its efficacy.  CBT may prove helpful in altering the neural architecture of the suffering brain. CBT in combination with daily meditation may have a synergistic effect, enhancing the impacts of both.

There is enough research to support that meditation has a positive impact on the brain.  Following an 8- week course in mindfulness-based meditation participants had increased volume in the areas associated with memory and other cognitive tasks, and decreased activity around the amygdala which is associated with emotional arousal.  Long-term effects have been noted as well.  As we age, the volume of grey matter begins to decrease.  One study showed sizable difference in the volume of those who meditated for at least 20 years versus non-meditators.

Some of the benefits of meditation even appear to accrue quickly.  One study demonstrated improved cognitive functioning—task completion and performance in as a little as two weeks of practice.  Attention span showed improvement in as little as 13 minutes of daily meditation practice over an 8-week period.  Similar results have been achieved in the treatment of anxiety disorders.  The effect size in one study was comparable to antidepressants.

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This is Your Body on Meditation

The physical benefits of meditation have been are likely attributable to decrease in stress.  Stress reduction has both physical and emotional benefits.  The body responds to stress by producing specific hormones.  Excessive amounts of these hormones lead to inflammation.  Stress also contributes to hypertension.  Meditation helps to damper the neural activity that increases blood pressure and contributes to hyperarousal.  The state of hyperarousal makes it particularly difficult to regulate emotions since the body is primed for “fight or flight.”

Many chronic ailments respond to stress reduction, including irritable bowel syndrome, fibromyalgia, and PTSD.  Meditation is increasingly used as component in the treatment of chronic pain.  It should be stressed that none of this easy, especially when these conditions are daily source of misery.  This is precisely where meditation is valuable—it can help to reduce misery.  Pain and misery have a close relationship, even mild, low-level pain can make life miserable when it occurs daily.  Pain is the body’s signal that something is injured.  Misery is the mental interpretation of pain, a response to either physical or emotional pain.   Meditation does not cure pain; it helps diminish the intensity of pain as it is experienced.

This brings us to some final points on meditation.  One of the popular forms of meditation, sometimes referred to as metta, is focused specifically on cultivating compassion.  This includes self-compassion as well as encouragement to extend compassion outwardly as kindness.  Research even supports that there is benefit to this outward extension.  Meditation appears to activate the brain region associated with self-referential thinking.  It seems likely that this area of the brain would be highly activated at times of suffering.  Suffering is an isolating experience, it is essentially “me-centric.”  Mental activity that runs in the opposite direction may help to diminish suffering.  It turns out that kindness may be more than just a virtue.

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