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Cover page of the Journal of Health Sciences


 
 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 14  |  Issue : 2  |  Page : 181-187

Effectiveness of meditation programs in empirically reducing stress and amplifying cognitive function, thus boosting individual health status: A narrative overview


Department of Physiology, RUHS College of Medical Sciences, Jaipur, Rajasthan, India

Date of Submission12-Apr-2020
Date of Acceptance20-May-2020
Date of Web Publication31-May-2021

Correspondence Address:
Dr. Reshu Gupta
Department of Physiology, RUHS College of Medical Sciences, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_108_20

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  Abstract 


Meditation is increasingly being used to promote general health, to treat stress and stress-related conditions, and is also beginning to find its feet in cognitive therapeutics. This article intends to evaluate its impacts on stress and cognitive function, aiming to augment the understanding of the mechanisms and subsequent implications for individual health. A multistep approach was used for the purpose of selection of articles, which was based on shortlisting of titles, then abstracts and further full texts. Subject to selection criteria, keywords “Meditation,” “stress,” “cognition,” “reducing,” “health,” and “effectiveness” were used to search online databases and conduct hand searches. The results indicated a stress-lowering effect by neural, endocrine, and humoral changes, evidenced by multiple parameters such as heart rate variability, blood pressure, galvanic skin response, salivary cortisol, and cytokines, and a psychological improvement in emotional regulation and perseverative cognition, with clinical implications in daily life and clinical settings such as hypertension, cancer stress, chronic pain, posttraumatic stress disorder, glaucoma, and anxiety disorders. The positive effect on cognition occurs through mechanisms such as altered regional blood flow, brain remodeling, functionally altered connections, and reduced emotional vulnerability. Increased secondary organization of thoughts is noted with implications in student settings, work output, neurodegenerative disorders, learning disorders, and attention deficit disorders. Meditation thus potentially offers a modality which could boost all aspects of health in a cost-effective, low time-consuming manner to a wide spectrum of individuals. While the evidence thus far is constructive, further studies with larger samples, stronger study designs, and offering more conclusive evidence are required.

Keywords: Cognition, health, meditation, memory, mindfulness, stress


How to cite this article:
Arora R, Gupta R. Effectiveness of meditation programs in empirically reducing stress and amplifying cognitive function, thus boosting individual health status: A narrative overview. Indian J Health Sci Biomed Res 2021;14:181-7

How to cite this URL:
Arora R, Gupta R. Effectiveness of meditation programs in empirically reducing stress and amplifying cognitive function, thus boosting individual health status: A narrative overview. Indian J Health Sci Biomed Res [serial online] 2021 [cited 2021 Aug 3];14:181-7. Available from: https://www.ijournalhs.org/text.asp?2021/14/2/181/317394




  Introduction Top


Meditation had long been believed to possess a multitude of beneficial effects which it could bestow upon its practitioner; however, rigorous increase in randomized controlled trials (RCTs) on mindful interventions has been observed in the past two decades. It has been shown, with increasing evidence, to harbor a myriad of positive effects, a few being stress reduction, cognition enhancement, an increase in memory, boosted intelligence, etc. Such profound positive influences have led to it being rather commonly deployed to promote general health and treat stress and stress-related conditions.[1],[2] There exists a great degree of variability in meditation programs, with differences in mental activity promoted, training required, qualification and requirement of an instructor, and emphasis on spirituality or religion while some approaches may even include dietary (Ayurveda) and movement (yoga) therapies. Certain popular modalities such as transcendental meditation follow the use of a mantra such that one transcends to a state where focused attention is absent.[3],[4],[5] In contrast, others such as mindfulness-based stress reduction are based on present focused awareness or mindfulness. While uncertainty exists if these differences influence the result of practice,[5],[6] all classes are broadly considered “meditation” and studied as such.

Stress, in a medical or biological context, is a physical, mental, or emotional factor that causes bodily or mental tension. It has been linked to the occurrence of several diseases which contribute largely to the health burden of the society and result in a large amount of morbidity and mortality throughout all age groups.[7] It is believed to incur a hidden cost to the body which accumulates over time and subject to environmental and genetic predispositions results in occurrence of disease with variations in allostatic loads expressed physically through neural, neuroendocrine, and immune mechanisms.[8] This is evidenced by the increase in incidence of depression in stressed individuals, in whom incessant exposure to stress results in adaptive changes in the brain through neurogenesis, structural remodeling, and synaptic plasticity occurring in lieu of dysregulation of hormonal mediators, which results in permanent remodeling of the limbic system and disease accompanied by hormonal imbalances.[9]

Cognitive functions are mental processes that allow us to carry out any task. They allow the subject to have an active role in the processes of receiving, choosing, transforming, storing, processing, and retrieval of information, allowing the subject to navigate the world around him. Memory, recall and learning can be considered an adequate representation of core cognitive function as they illustrate the action and articulation of the 8 core cognitive functions. The term working memory refers to a brain system that provides temporary storage and manipulation of the information necessary for such complex cognitive tasks as language comprehension, learning, and reasoning and reflects a key concept for the understanding and interpretation of the indicators in purview. It is a plastic parameter which can be influenced by factors to result in an increased quality of life, as a consequence of the potential of increase in the working memory itself, cognitive functions, and psychological health.[10]

Both the components under observation are interlinked as stress results in reduction of memory, it is retrieval in particular, while reduction in working memory indirectly influences the quality of life by affecting the spectrum of activities a person carries out and thus influences stress.[11] These factors thus also contribute to development of diseases, whether it be communicable through psychoneuroimmunology based mechanisms or non-communicable through excessive adaptive changes themselves forming a disease entity.[12]

A growing body of literature has been now exploring the underlying physiological mechanisms of the effect of meditation on stress and cognition. This article evaluates the increasing evidence of mindfulness intervention by reviewing and discussing the effects of mindfulness interventions on boosting memory, recall, learning, and reducing stress levels along with the psychological and neurobiological mechanisms of such interventions. This shall provide a robust understanding of the process involved in the benefits of practicing mindfulness


  Methodology Top


A multistep approach was used for the purpose of selection of articles, which was based on shortlisting of titles, then abstracts and further full texts. The keywords “Meditation,””stress,” “cognition,” “reducing,” “health,” and “effectiveness” were used for searches using online databases including PubMed, Web of Science, Google Scholar, Scopus, and Cochrane, to retrieve studies conducted from 1970 to April 2020. Potentially relevant titles were selected and articles were retrieved. The references of the articles were also searched to find relevant articles, if any. The studies were further subjected to the following selection criteria: (i) those studies that articulated clearly their research design, methods, sample size and sampling techniques; (ii) the studies that were published in English in a peer reviewed journal; and (iii) studies commented on one of effectiveness, mechanisms or clinical applications pertaining to stress or cognition.

The exclusion criteria used were: (i) studies not relating meditation to stress or cognition, and linked pathology; (ii) studies investigating the changes during meditation and their mechanisms in isolation without relating stress or cognition.

Flowchart of literature retrieval and screening is as illustrated in [Figure 1].
Figure 1: Flowchart of methodology

Click here to view


Total number of articles identified was 857 from electronic database search and 932 from the reference list of these. Seventy-eight duplicates were removed. From the remaining 1711 articles, 750 full texts of potentially relevant titles were assessed for their eligibility to be included in the review. After quality assessment, 74 articles met the inclusion criteria. In these studies, the effect of meditative practices on boosting memory, recall, learning and reducing stress levels was studied for their effectiveness, neurobiological mechanisms or applicability in clinical conditions.


  Discussion Top


Among the 49 published studies on the effect of meditative practices on boosting memory, recall, learning, and reducing stress levels studied, the best evidence was obtained from Quach D, Mano KE, and Alexander K's RCT examining the effect of meditation on working memory in adolescents confirmed that it significantly improves working memory, while also positively impacting stress and anxiety levels.[13] The study supports the recommendations for the use of meditative practices in school settings and integration of the practice into existing treatment protocols. Regarding side effects, no adverse effects have been reported. Larger studies are suggested to be conducted to check whether it is totally safe.

Effect of meditation on stress

The effects of meditative practice on stress levels has shown to have a cross cutting effect reducing stress at multiple levels, most notably the autonomic nervous system (ANS) and the endocrine system, also affecting the levels of blood components, is indicative of direct antagonism of the stress response. With this antagonism coupled with the psychological adaptations triggered, it proves to be a useful adjunct in management of stress and a variety of stress linked conditions.

The dysfunction of ANS is a key component in the development of various cardiovascular diseases which are the leading cause of morbidity and mortality globally.[14] It is also involved in various major respiratory[15] and psychiatric[15],[16] diseases among a host of many other diseases. Heart rate variability (HRV) is considered an important positive marker of autonomic function representing the sympathovagal balance, and substantial evidence supports that low HRV precedes the appearance of risk factors while high HRV is indicative of a lower profile of risk.[17] Meditative practices show a profound effect in increasing the value of this variable through a variety of meditative procedures.[18],[19] There is an increase in high frequency domain, indicative of parasympathetic activity, along with a decreased value in the low frequency domain, indicative of lowering of sympathetic activity, is suggestive of a state of increased relaxation.[20] WHO estimates that 1.13 billion people around the globe suffer from hypertension, which is a major risk factor for a plethora of cardiovascular diseases.[21] Meditative procedures result in the lowering of systolic blood pressure (BP), along with lowering of total peripheral resistance[22] via lowering muscle sympathetic nerve activity,[23] resulting in the reduction in the ambulatory diastolic BP[24] accompanied with a reduction in BP responses to a physical stressor.[25] This effect is consistent with the time of practice and scales with increasing duration.[26] Galvanic skin response (GSR) is an indicator of cognitive load[27] and thus the stress an individual is under. By directly providing autonomic stability, as evidenced by rapid GSR habituation while allowing low levels of spontaneous GSR, meditation provides less susceptibility to a variety of stresses as well as reducing the chances of acquisition of conditioned stress responses.[28]

Endocrine mechanisms also act to reduce stress as evidenced in changes in salivary cortisol, which is a biomarker closely tied to stress,[29] is representative of the hypothalamic–pituitary–adrenal (HPA) axis activity[30] and sensitively represents the bodies levels of stress as well as being an accepted as marker suitable to study stress changes due to interventions such as meditation.[31] Lowering of this biomarker[32] occurs in a dose dependent manner in correlation with meditative practices by producing changes occurring in the basal endocrine system larger acute changes occur with increase in the dose of practice.[33] Reduction in adrenocorticotropic hormone (ACTH) secretion directly indicates lowering of the HPA axis activity.[34]

An immunologic mechanism also contributes to the lowering of stress as evidenced by the reduction of circulating pro-inflammatory cytokines including interleukins, C-reactive protein, tumor necrosis factor alpha, and reactive oxygen species.[34],[35],[36],[37] Increases in β-endorphins, brain derived neurotrophic factor and total antioxidant capacity, secondary to altered gene expression, is indicative of a decrease of stress levels at psychological and physiological levels.[37]

At a psychological level, the stress reducing effects of meditation can be narrowed down to improvement of two “transdiagnostic” processes of the mind, emotional regulation and perseverative cognition.[38] Cognitive emotion regulation augmentation by adoption of adaptive strategies and rejection of maladaptive strategies results in faster recovery from stressful conditions.[39] There is also evidence of it providing increased resilience to stress over longer periods of time compared to other relaxation techniques.[40]

Stress, besides being a symptom in itself, produces a wide array of psychosomatic symptoms the relief from which is a crucial component of the treatment of a multitude of diseases. The various modalities of meditation have proven effective in reducing stress linked symptomatology in cancer patients by serving as mood stabilizers.[41] This has been found to occur irrespective of age, sex or stage of disease,[42] alleviating sleep disturbances.[43] It bolsters a person's psychological strength as showcased by the reduction in psychological symptomatology, increased sense of control and greater spiritual sensations experienced by people suffering from chronic pain.[44] Through a variety of mechanisms such as increased attentional control, present-focus, non-judgment, reduced physiological arousal along with increased positive emotion and social connectedness,[45] meditation provides great relief to patients suffering from Posttraumatic stress disorder[46],[47],[48] and anxiety disorders[49],[50] by directly counteracting the cognitive model of panic[51] by the aforementioned mechanisms. During the practice, no adverse effects were reported by any study, implying safety of practice and suitability for a larger scale of use, which was however, limited by there being a small percentage of non-responders.

Effect of meditation on cognitive function

The effects on cognitive function were evaluated through the prism of working memory, recall and attention, which showed a positive impact in the said measures, stemming from an alteration of brain structure via neural plasticity and alterations in functional connections, altered regional brain flow and psychological adaptations. Also noted was a decreased rate of decline of cortical thickness among practitioners. Through a multipronged improvement as well as preservation of cognitive functions, it provides a potential adjunct for augmenting the quality of life of people, especially those experiencing cognitive deficits.

Working memory[52] is an interface between memory and cognition and is impaired in neurodegenerative disorders such as Alzheimer's disease and Parkinson's disease due to neuronal degeneration resulting in difficulty in working and strategic memory.[53] Besides these disease entities, it ties in closely with the quality of life affecting a person's education and socioeconomic status directly. Large numbers of studies over the last few years have led to tremendous increase in knowledge of cognitive changes associated with meditative practice. The positive impact of meditative practices[13] on working memory is present after as little as 4 weeks of 13 min meditation,[54] by augmenting visuospatial processing and executive functioning[55] is produced by alterations in neural pathways by means of neural plasticity in the anterior cingulate regions white matter,[56] resulting in increased processing efficiency and lower emotional vulnerability.[57] A protective effect on working memory is exerted by lowering stress related impairments as well as raising the threshold of mind wandering required for blunting it.[58]

Recall refers to the action or faculty of remembering something learned or experienced. It is a key component of the cognitive functionality and exists in two forms-long term recall and short term recall,[59] the dysfunction of which is seen in psychiatric and neurological disorders. By increase in the secondary organization of information within the brain and thus enhancing memory and abstract thinking, short term recall is greatly bolstered.[60] Dream recall[61] as well as long term recall are also enhanced.[62] These modalities thus have potential implications in learning disorders, neurodegenerative disorders, attention deficit disorders etc.

Cognitive functions are also nurtured through brain plasticity as well as a decrease in the decline of cortical thickness of certain areas of the brain indicating a protective effect of the practice.[63] There is increased cerebral blood flow to the prefrontal, superior frontal, and superior parietal cortices consistent with improvements in cognition.[64]

Attention as well as cognitive flexibility are also enhanced by meditative practices[65] resulting a higher level of mental function and thus a better quality of life by mechanisms such as increased perfusion, increased myelination, restructuralization, decreased stress levels, maintenance of telomeres, and reduction of oxidative stress and thus vascular damage.[66] Structural changes such as increased functional connectivity between auditory and visual areas, coupled with stronger anticorrelation between them, and increased functional connection of areas associated with attentional and self-referential processes to the auditory cortex also contribute to improved attention by enhancing sensory processing and enhancing sensory experience.[67] Automated emotional and cognitive reactivity is reduced by altering the neurophysiologic processes handling attentional engagement as evidenced by reduced P3a amplitude on electroencephalography.[68] An increase in frontal theta coherence and parietal P3b latency suggests a shift toward improved attentional control[69] while the suppression of long range temporal correlations of neuronal oscillations augments it as well.[70]

Meditation thus protects against and retards the progression of various neurodegenerative disorders. It is also linked with an improved job performance,[71] improved cardiovascular fitness,[72] improved coherence of emotions, cognition, and decision-making.[73]

Limitations

While the review does it's best to explain the impact, mechanisms and applications of meditative practice with respect to stress and cognition, and recommends its usage as an adjunctive modality during management of such conditions, neither is its applicability to a large scale on a healthy population elucidated, nor is it explained if individuals with low stress levels and high cognitive functioning benefit from the practice. There is also a lack of understanding over the quantifiable extent to which such practice can aid in reducing stress or impacting cognition, while uncertainties also exist with regards to the method, duration, and frequency of meditation which would be optimum for desired results.


  Conclusion Top


This review showed convincing evidence of effectiveness of meditative practices in potentially offering a modality which could cater to the physical, mental, emotional, and social aspects of health in a cost-effective, low time-consuming manner to a very wide spectrum of individuals and possess a capacity to provide all levels of prevention, be it primary, secondary or tertiary, offering an uncomplicated alternative means of approaching health and well-being of the human being as a whole considering all dimensions of his health with evidence pointing toward effectiveness against diseases which have assumed a pandemic scale.

The explorations made thus far into the applications of meditation as a tool for countering stress and positively impacting cognitive function. They offer an answer which affirms that there is at least a degree of correlation between the practice and improvements in the said scales. However, before there is an acceptance that utilization of meditation as a mainstream method for these aims, there is a long way to go. Further studies with larger samples, stronger study designs, and offering more conclusive evidence are required. While the present for it remains positive, yet ambiguous, it leaves a lot of scope for further investigation and offers significant potential which must be probed to gauge the extent of its usefulness.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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