Meditation Therapy

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Meditation Therapy

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Is meditation therapy right for everyone? A quick look at the app Insight Timer tells you thousands of people are doing it worldwide. But are you? Should you? It has become the chic thing to do for some. You can find classes in yoga studios, cafes, and parks. You can even find one at your local library. For others, it is a path to healing....

Key Takeaways

  • This article explains What is Meditation Therapy? A Definition in simple medical language.
  • This article explains Research and Studies in simple medical language.
  • This article explains 6 Proven Benefits in simple medical language.
  • This article explains 8 Techniques Used in Meditation Therapy in simple medical language.
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Is meditation therapy right for everyone? A quick look at the app Insight Timer tells you thousands of people are doing it worldwide. But are you? Should you?

It has become the chic thing to do for some. You can find classes in yoga studios, cafes, and parks. You can even find one at your local library. For others, it is a path to healing. Perhaps their doctor or therapist suggested it.

In this article, we provide some of the research supporting this age-old practice.

What is Meditation Therapy? A Definition

Meditation therapy is “a method of relaxation and consciousness expansion by focusing on a mantra or a keyword, sound, or image while eliminating outside stimuli from one’s awareness” (Mosby’s Medical Dictionary, 2009).

There are many types of meditation. Examples include mindfulness, body scan, loving-kindness, walking, Zen, mantra, and transcendental meditations. They can be further categorized into insight or calming and guided or unguided. In the world of meditation, there is an approach for everyone.

Each type of meditation has a few things in common: choosing a quiet spot, finding a comfortable posture, and focusing your attention while remaining open (National Center for Complementary and Integrative Health, n.d.).

The duration of meditation practice is as short as one minute to several hours. There also is not a “right” or “only” way to practice. It is as diverse as the people who practice it.

Research and Studies

Several studies are touting the benefits of meditation (NCCIH, n.d.). The degree to which a practice helps with various ailments has come into question. The primary issues have been small sample sizes and weak experimental design.

Goyal and colleagues (2014) conducted a review of 47 trials with 3,515 participants. The researchers found:

  • Mindfulness meditation programs improve anxiety, depression, and pain at eight weeks and 3-6 months. They cite “moderate evidence” for these improvements.
  • Low evidence for improved stress/distress and mental health-related quality of life.
  • Low-to-no evidence of any effect on positive mood, attention, substance use, eating habits, sleep, or weight.
  • No evidence that meditation programs were better than any active treatment (drugs, exercise, behavioral therapies.)

The authors point out that the studies up to June 2013 did not typically specify the level of expertise of the instructors, the number of training patients received, or the amount of at-home practice patients did (Goyal et al., 2014).

Studies since their review have found connections between:

  • Relaxation response training and reduced blood pressure (Bhasin et al., 2018). Note: This study did not include a control group of non-meditators.
  • Mindfulness training and reduced cravings to smoke (Elwafi, Witkiewitz, Mallik, Thornhill, & Brewer, 2013).
  • MBSR and CBT training and reduced chronic low pain: Back pain means pain in the spine, muscles, discs, joints, or nerves of the back. সহজ বাংলা: পিঠ/কোমরের ব্যথা।" data-rx-term="back pain" data-rx-definition="Back pain means pain in the spine, muscles, discs, joints, or nerves of the back. সহজ বাংলা: পিঠ/কোমরের ব্যথা।">back pain. Both were equally effective and resulted in “greater improvement in back pain and functional limitations at 26 weeks” when compared to the person’s regular care routine (Cherkin et al., 2016).
  • Compassionate responses to another person’s suffering increase among meditation practitioners who have practiced for eight weeks (Condon, Desbordes, Miller, & DeSteno, 2013).
  • Mindfulness meditation and alleviation of insomnia when compared to an eight-week self-monitoring condition (Ong et al., 2014).

6 Proven Benefits

To say something is “proven” in scientific terms is almost impossible. Social science researchers hesitate to say “x causes y.” They speak in terms of confidence intervals (CIs). The Association for Psychological Science has a fabulous article explaining this topic (Kalinowski, 2010).

Researchers use the term correlation when describing their results. This means that they have found a connection or no connection between the variables in question. For example, one might find that an 8-week mindfulness meditation training negatively correlated with a decrease in insomnia. As the person continued to use mindfulness meditation, their experience of insomnia lessened.

Does this mean that there are no “proven” effects of using meditation therapy? As the prior section indicated, the research is promising.

Here are six more studies:

  1. The amygdala changes after two months of meditation training. Desbordes and colleagues (2012) found that there is less activation in this area after learning meditation.
  2. Meditation has a stronger effect than relaxation training to reduce smoking and cravings (Tang, Tang, & Posner, 2013).
  3. Ramsburg and Youmans (2014) found that meditation improves the retention of information. In their experiments, college students received brief meditation training or rest. Then they listened to a lecture followed by a quiz. Students who received meditation training retained more information. Unaffected variables included mood, relaxation, and class interest.
  4. A 2015 study by Ching, Koo, Tsai, and Chen found that a semester-long mindfulness course improved learning effectiveness. It also enhanced participants’ attention and memory.
  5. Loving-kindness meditation reduces implicit bias against blacks and homeless people (Kang, Gray, & Dovidio, 2013). The researchers compared this result against a loving-kindness discussion group and a waitlisted group.
  6. Goldin, Ziv, Jazaieri, Hahn, and Gross (2013) compared MBSR to an aerobic exercise stress reduction program. They found that “meditation practice was associated with decreases in negative emotion and social anxiety symptom severity and increases in attention-related parietal cortex neural responses when implementing attention regulation of negative self-beliefs.”

8 Techniques Used in Meditation Therapy

A mental health professional may use a variety of techniques based on the patient’s needs. One exercise might work for one person but be ineffective for another. Fortunately, there are several options.

The University of Minnesota (n.d.) recommends these:

  1. Diaphragmatic (belly) breathing. Sit or lie comfortably on your back. Breathe in through your nose with your mouth closed. Exhale slowly through your mouth with your lips pursed. Try to make your exhalation longer than your inhalation.
  2. Straw breathing is a great way to extend your exhalation. Breathe in through your nose. Using a plastic straw, exhale through it until all the air leaves your lungs. Repeat this for anywhere from 2-5 minutes.
  3. 2-minute relaxation. Start by taking a few deep breaths. Remember to exhale slowly and fully. Be mindful of the air as it leaves your lungs. Scan your body for tense areas. Imagine warm light loosening the muscle. Allow your head to fall forward gently. Rotate to the left and right. Raise your head. Rotate left and right. Look up and then slowly return your head to a neutral position. If at any point you feel pain, stop. Roll your shoulders forward and back. Recall something pleasant. Take a few more deep breaths exhaling slowly.
  4. Exercise your shoulder and neck muscles to reduce tension. Stand or sit. Shrug your shoulders to your ears for a count of ten then release. Repeat as needed. Stretch your arms up and overhead without locking your elbows. Swing your arms at your sides forward and back, and side to side.
  5. Engage the relaxation response. Choose a quiet spot with little-to-no distractions. Get into a comfortable position. Choose a focal point such as your breath, a word, a sound, or a prayer. If you get distracted, imagine the distraction as a cloud sweeping across the sky. Let it float past without judgment or emotion. Return your attention to your focal point.
  6. Georgia Tech (n.d.) advises students to use the above techniques and Progressive Muscle Relaxation (PMR). Sit or lie in a comfortable position. Take a few deep breaths and close your eyes. Beginning at the top of your body, slowly tense and then release the muscles in your body. For a more detailed explanation, visit the Georgia Tech Division of Student Life.
  7. Body scanning is useful for reducing pain. To start, lie on your back in a comfortable position, close your eyes, and breathe deeply. Focus on your left foot. Allow yourself to feel all the sensations. Do this for each part of your body. If you experience pain in any area as you move through your body, acknowledge it, and breathe through the pain. Refrain from judging yourself or the pain (Harvard Health Publishing, 2016).
  8. Guided Imagery is using words and music to evoke imaginary scenarios in the listener. The goal is to assist the person in “see” and “feel” the imagined experience.

If you would like to experience a guided imagery meditation, listen to Jason Stephensen’s, Guided meditation for anxiety and stress.

A Look at Stillness Meditation Therapy

Developed by psychiatrist Dr. Ainslie Meares, this form of meditation involves “the natural regulation of the nervous system through the repeated experience of mental rest” (Stillness Meditation, n.d.) Unlike many other forms of meditation, stillness meditation is non-sectarian. It helps practitioners relieve stress and anxiety without drugs.

Stillness meditation is about allowing the mind to come to rest on its own. There are no specific breathing techniques. One does not need to listen to music, chant, visualize, or focus on emptying one’s mind. You are free to allow your mind to wander. It involves no effort. You are not trying to achieve anything.

Facilitated sessions might involve therapeutic touch. This helps the teacher communicate safety to the client allowing the client to experience successful mental rest (Stillness Meditation, n.d.).

Using Somatic Meditation in a Therapeutic Setting

Somatic meditation is body-centered. The goal is to identify and release negative tension throughout the body. To do this, a practitioner incorporates talk therapy, mind-body exercises, and physical techniques (Psychology Today, n.d.).

Practitioners believe that negative emotional experiences manifest through the body. This is not limited to physical pain. It also includes anger, frustration, and other emotions. During a therapy session, a client relives those negative emotions by recalling memories.

The therapist assists the person by integrating some of the following:

  • Yoga
  • Dance
  • Vocal work
  • Massage
  • Exercise
  • Deep breathing
  • Relaxation exercises
  • Meditation

Suggested Reading on the Topic

If you are interested in reading more on the topic, I have some suggestions below.

I recommend the following by Buddhist teacher and scholar, Reginald Ray:

  1. The Awakening Body: Somatic Meditation for Discovering Our Deepest Life (Amazon)
Amazon Best Seller
The Awakening Body: Somatic Meditation for Discovering Our Deepest Life
  • Ray, Reginald (Author)
  • English (Publication Language)
  • 176 Pages - 12/20/2016 (Publication Date) - Shambhala (Publisher)
  1. The Practice of Pure Awareness: Somatic meditation for awakening the sacred (Amazon)
Amazon Best Seller
The Practice of Pure Awareness: Somatic Meditation for Awakening the Sacred
  • Ray, Reginald A. (Author)
  • English (Publication Language)
  • 304 Pages - 08/28/2018 (Publication Date) - Shambhala (Publisher)

Manuela Mischke-Reeds, MA, MFT, is an international teacher of mindfulness-based somatic psychology and has an interesting workbook you can find below.

  1. Somatic psychotherapy toolbox: 125 Worksheets and exercises to treat trauma and stress (Amazon)
Amazon Best Seller
Somatic Psychotherapy Toolbox: 125 Worksheets and Exercises to Treat Trauma & Stress
  • Mischke-Reeds, Manuela (Author)
  • English (Publication Language)
  • 279 Pages - 07/10/2018 (Publication Date) - PESI (Publisher)

How to Use Guided Meditations in Therapy

As a therapist, having one’s practice is helpful. Doing so allows you to understand better the challenges and rewards a meditation practice offers. This will increase your compassion toward your client. It also allows you to share your experiences, as appropriate. For example, how you acknowledge distractions without judgment.

Tara Brach (n.d.) suggests having clients work with a meditation teacher. Then, when the client returns to a session, the discussion can include how to incorporate meditation into their therapy.

Using Meditation Therapy for Depression

One evidence-based approach is mindfulness-based cognitive therapy (MBCT). Borrowing from the MBSR format, Segal, Williams, and Teasdale developed MBCT to combat depression (Lu, 2015).

Like MBSR, MBCT is an 8-week program that includes yoga, body awareness, and daily homework. According to the Center for Mindfulness in Medicine, Health Care, and Society (n.d.), “the key difference in MBCT is an explicit focus on turning toward low mood and negative thoughts.

Research (Lu, 2015) has shown that,

  • People with early-onset depression, or who experienced abuse as a child are more likely to benefit.
  • People who are “ready to engage” also benefit. These are people who’ve tried medication and or other therapies but still struggle.
  • Recurring depressive episodes decrease with the use of MBCT. When compared to medication, the results were similar and better than a placebo.

Dimidjian and colleagues (2015) adapted MBCT for perinatal women. They found an “18% relapse/recurrence rate through 6 months postpartum.” For pregnant women battling depression, this research provides hope.

A 2014 study by Raes, Griffith, van der Gucht, and Williams found that MBCT is well-suited for adolescents. Their randomized, controlled study was a first of its kind and included 408 students ages 13-20. Results showed that the intervention group experienced “significantly greater reductions in depression compared with the control groups at 6-month follow-up.”

How Can Meditation Therapy be Used for PTSD and Anxiety Disorders?

In 2015 the US Department of Veterans Affairs issued the Evidence Map of Mindfulness report. It summarized the research through February 2014 (Hempel et al., 2014). At that time, the report indicated some support for MBCT and MBSR interventions in the following areas:

  • depression
  • overall health and psychological outcomes
  • chronic illness
  • mental illness
  • somatization disorders

Researcher Anthony King and colleagues (2013; 2016) studies mindfulness as a treatment for PTSD and anxiety. Through his various research projects, he found that:

  • MBCT has the potential to “reduce avoidance symptom cluster and PTSD cognitions.”
  • People receiving the intervention experience less self-blame.
  • They have a decreased perception that the world is a dangerous place.
  • Default Mode Network (DMN) activity increased along with activity in the executive system after mindfulness-based exposure therapy (MBET).

Neuroscientist, Jud Brewer has spent more than twenty years studying how the brain forms negative behavior patterns (Brewer, 2019). In doing this, he and his colleagues have developed tools that assist clients in breaking away from addiction and anxiety.

After learning about feedback loops like cue > routine > reward, the key ingredient is mindfulness training. In the case of anxiety, he explains, we have a thought/emotion that leads to worry thinking that then leads to avoidance/over-planning. This is the anxiety habit loop.

Through the intentional shifting of our attention, we can change this loop.

Meditation Therapy Training and Certification

Are you interested in teaching others how to manage the ups and downs of daily life through meditation therapy? There are many certification programs available worldwide.

Here are three you can explore:

1. Center for Mindfulness – UMass Medical School

MBSR teacher education and certification. This program offers a 5-course pathway to becoming a certified MBSR teacher. The process usually takes 36 months. The 8-week Fundamentals course is available in person and online. Costs are around $9,165 US.

2. UCSD Center for Mindfulness

Certifications include MBSR, MBCT, MSC (Mindfulness self-compassion), and ME-CL (Mindful Eating-Conscious Living). The process for each program is lengthy, and estimated costs are $9,510 US for MBCT to $12,520 US for MBSR certification. The other two programs are less than the MBCT cost.

3. Mindfulness Meditation Teacher Certification – Jack Kornfield and Tara Brach

This two-year program focuses on mindfulness, loving-kindness, and compassion meditation. It is completed online but does include two in-person events. They also include two three-day workshops for those who can attend. You must complete The Power of Awareness before applying for this program. Costs: $6,700 US.

There are many others. Please add suggestions in the comments for programs with which you are familiar.

A Take-Home Message

Meditation, be it mindfulness or more traditional, is a healthy habit. Young and old can benefit from meditation therapy. If you want to feel less anxious, more grounded, and happier, then a meditation practice is an effective approach.

You do not need to spend hundreds of dollars learning to meditate. There are apps, YouTube videos, CDs, and books at a low-to-no cost that will get you started on your journey.

If you want to use meditation to relieve PTSD or anxiety symptoms, then seek professional help from a trained therapist.

Meditation teachers are easy to find. Certification requirements vary, so be sure to choose your instructor with care.

How will you incorporate meditation into your life so that you can reap the benefits?

REFERENCES

  • Bhasin, M. K., Denninger, J. W., Huffman, J. C., Joseph, M. G., Niles, H., Chad-Friedman, E., … & Libermann, T. A. (2018). Specific transcriptome changes associated with blood pressure reduction in hypertensive patients after relaxation response training. The Journal of Alternative and Complementary Medicine24(5), 486-504.
  • Brach, T. (2016, August 30). Guidelines: Introducing meditation practices to psychotherapy clients [Blog post]. Retrieved from https://www.tarabrach.com/introducing-meditation-practices/
  • Brewer, J. (2019, March 9). Habit loops & everyday addictions [Blog post]. Retrieved from https://drjud.com/habit-loops-everyday-addictions/
  • Center for Mindfulness in Medicine, Health Care, and Society. (n.d.). MBCT & MBSR: The differences [Blog post]. Retrieved from https://www.umassmed.edu/cfm/mindfulness-based-programs/mbct-courses/about-mbct/mbct-mbsr-differences/
  • Cherkin, D. C., Sherman, K. J., Balderson, B. H., Cook, A. J., Anderson, M. L., Hawkes, R. J., … & Turner, J. A. (2016). Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on pain: Back pain means pain in the spine, muscles, discs, joints, or nerves of the back. সহজ বাংলা: পিঠ/কোমরের ব্যথা।" data-rx-term="back pain" data-rx-definition="Back pain means pain in the spine, muscles, discs, joints, or nerves of the back. সহজ বাংলা: পিঠ/কোমরের ব্যথা।">back pain and functional limitations in adults with chronic low back pain: A randomized clinical trial. Jama315(12), 1240-1249.
  • Ching, H., Koo, M., Tsai, T., & Chen, C. (2015). Effects of a mindfulness meditation course on learning and cognitive performance among university students in Taiwan. Evidenced-Based Complimentary and Alternative Medicine. Retrieved from https://www.hindawi.com/journals/ecam/2015/254358/
  • Condon, P., Desbordes, G., Miller, W. B., & DeSteno, D. (2013). Meditation increases compassionate responses to suffering. Psychological Science24(10), 2125-2127.
  • Desbordes, G., Negi, L. T., Pace, T. W., Wallace, B. A., Raison, C. L., & Schwartz, E. L. (2012). Effects of mindful-attention and compassion meditation training on amygdala response to emotional stimuli in an ordinary, non-meditative state. Frontiers in Human Neuroscience6.
  • Dimidjian, S., Goodman, S. H., Felder, J. N., Gallop, R., Brown, A. P., & Beck, A. (2015). An open trial of mindfulness-based cognitive therapy for the prevention of perinatal depressive relapse/recurrence. Archives of Women’s Mental Health18(1), 85-94.
  • Elwafi, H. M., Witkiewitz, K., Mallik, S., Thornhill IV, T. A., & Brewer, J. A. (2013). Mindfulness training for smoking cessation: Moderation of the relationship between craving and cigarette use. Drug and Alcohol Dependence130(1-3), 222-229.
  • Georgia Tech Division of Student Life. (n.d.). Meditation and relaxation techniques [Blog post]. Retrieved from http://www.counseling.gatech.edu/content/meditation-and-relaxation-techniques
  • Goldin, P., Ziv, M., Jazaieri, H., Hahn, K., & Gross, J. J. (2013). MBSR vs aerobic exercise in social anxiety: fMRI of emotion regulation of negative self-beliefs. Social Cognitive and Affective Neuroscience8(1), 65-72.
  • Goyal, M., Singh, S., Sibinga, E. M., Gould, N. F., Rowland-Seymour, A., Sharma, R., … & Haythornthwaite, J. A. (2014). Meditation programs for psychological stress and well-being: A systematic review and meta-analysis. JAMA Internal Medicine174(3), 357-368.
  • Harvard Health Publishing. (2016, December 24). Body scan mindfulness exercise for pain [Blog post]. Retrieved from https://www.health.harvard.edu/pain/body-scan-for-pain
  • Hempel, S., Taylor, S. L., Marshall, N. J., Miake-Lye, I. M., Beroes, J. M., Shanman, R., …Shekelle, P. G. (2014) Evidence map of mindfulness. Retrieved from https://www.hsrd.research.va.gov/publications/management_briefs/default.cfm?ManagementBriefsMenu=eBrief-no88
  • Kalinowski, P. (2010, April 1). Understanding confidence intervals (CIs) and effect size estimation. Retrieved from https://www.psychologicalscience.org/observer/understanding-confidence-intervals-cis-and-effect-size-estimation
  • Kang, Y., Gray, J. R., & Dovidio, J. F. (2014). The nondiscriminating heart: lovingkindness meditation training decreases implicit intergroup bias. Journal of Experimental Psychology: General143(3), 1306-1313.
  • King, A. P., Block, S. R., Sripada, R. K., Rauch, S., Giardino, N., Favorite, T., … & Liberzon, I. (2016). Altered default mode network (DMN) resting state functional connectivity following a mindfulness‐based exposure therapy for posttraumatic stress disorder (PTSD) in combat veterans of Afghanistan and Iraq. Depression and Anxiety33(4), 289-299.
  • King, A. P., Erickson, T. M., Giardino, N. D., Favorite, T., Rauch, S. A., Robinson, E., … & Liberzon, I. (2013). A pilot study of group mindfulness‐based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder (PTSD). Depression and Anxiety30(7), 638-645.
  • Lu, S. (2015). Mindfulness holds promise for treating depression. Monitor on Psychology, 46(3), 50.
  • Meditation therapy. (n.d.). In Mosby’s Medical Dictionary. Retrieved from https://medical-dictionary.thefreedictionary.com/meditation+therapy
  • National Center for Complementary and Integrative Health. (n.d.). Meditation: In Depth. Retrieved from https://nccih.nih.gov/health/meditation/overview.htm
  • Ong, J. C., Manber, R., Segal, Z., Xia, Y., Shapiro, S., & Wyatt, J. K. (2014). A randomized controlled trial of mindfulness meditation for chronic insomnia. Sleep37(9), 1553-1563.
  • Psychology Today. (n.d.). Somatic therapy. Retrieved from https://www.psychologytoday.com/us/therapy-types/somatic-therapy
  • Raes, F., Griffith, J. W., Van der Gucht, K., & Williams, J. M. G. (2014). School-based prevention and reduction of depression in adolescents: A cluster-randomized controlled trial of a mindfulness group program. Mindfulness5(5), 477-486.
  • Ramsburg, J. T., & Youmans, R. J. (2014). Meditation in the higher-education classroom: Meditation training improves student knowledge retention during lectures. Mindfulness5(4), 431-441.
  • Stillness Meditation. (n.d.). Retrieved from http://stillnessmeditation.com.au/
  • Tang, Y. Y., Tang, R., & Posner, M. I. (2013). Brief meditation training induces smoking reduction. Proceedings of the National Academy of Sciences110(34), 13971-13975.
  • University of Minnesota. (n.d.). Taking charge of your health and wellbeing [Blog post]. Retrieved from https://www.takingcharge.csh.umn.edu/activities/other-relaxation-methods.

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Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Orthopedic doctor, rheumatologist, or physiotherapist depending on cause.

What to tell the doctor

  • Write which joints hurt, swelling, morning stiffness duration, fever, injury, and walking difficulty.
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Questions to ask

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Tests to discuss

  • Joint examination and range of motion
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This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

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Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Orthopedic / spine specialist, physical medicine doctor, or qualified clinician
Tests to discuss with doctor
  • Neurological examination for leg power, sensation, reflexes, and straight leg raise
  • X-ray only if injury, deformity, long-lasting pain, or doctor suspects bone problem
  • MRI discussion if severe nerve symptoms, weakness, bladder/bowel problem, or persistent symptoms
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
  • Is physiotherapy, posture correction, or activity modification needed?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

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Back pain care roadmap

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • New leg weakness, numbness around private area, or loss of bladder/bowel control
  • Back pain after major injury, fever, unexplained weight loss, cancer history, or severe night pain
Doctor / service to discuss: Orthopedic/spine specialist, physical medicine doctor, physiotherapist under guidance, or qualified clinician.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Discuss neurological examination first. X-ray or MRI may be needed only when red flags, injury, nerve weakness, or persistent severe symptoms are present.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.
  • Avoid forceful massage or bone-setting when there is weakness, injury, fever, or nerve symptoms.

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What is Meditation Therapy? A DefinitionMeditation therapy is “a method of relaxation and consciousness expansion by focusing on a mantra or a keyword, sound, or image while eliminating outside stimuli from one’s awareness” (Mosby’s Medical Dictionary, 2009).There are many types of meditation. Examples include mindfulness, body scan, loving-kindness, walking, Zen, mantra, and transcendental meditations. They can be further categorized into insight or calming and guided or unguided. In the world of meditation, there is an approach for everyone.Each type of meditation has a few things in common: choosing a quiet spot, finding a comfortable posture, and focusing your attention while remaining open (National Center for Complementary and Integrative Health, n.d.).The duration of meditation practice is as short as one minute to several hours. There also is not a “right” or “only” way to practice. It is as diverse as the people who practice it.Research and StudiesSeveral studies are touting the benefits of meditation (NCCIH, n.d.). The degree to which a practice helps with various ailments has come into question. The primary issues have been small sample sizes and weak experimental design.Goyal and colleagues (2014) conducted a review of 47 trials with 3,515 participants. The researchers found:Mindfulness meditation programs improve anxiety, depression, and pain at eight weeks and 3-6 months. They cite “moderate evidence” for these improvements. Low evidence for improved stress/distress and mental health-related quality of life. Low-to-no evidence of any effect on positive mood, attention, substance use, eating habits, sleep, or weight. No evidence that meditation programs were better than any active treatment (drugs, exercise, behavioral therapies.)The authors point out that the studies up to June 2013 did not typically specify the level of expertise of the instructors, the number of training patients received, or the amount of at-home practice patients did (Goyal et al., 2014).Studies since their review have found connections between:Relaxation response training and reduced blood pressure (Bhasin et al., 2018). Note: This study did not include a control group of non-meditators. Mindfulness training and reduced cravings to smoke (Elwafi, Witkiewitz, Mallik, Thornhill, & Brewer, 2013). MBSR and CBT training and reduced chronic low back pain. Both were equally effective and resulted in “greater improvement in back pain and functional limitations at 26 weeks” when compared to the person’s regular care routine (Cherkin et al., 2016). Compassionate responses to another person’s suffering increase among meditation practitioners who have practiced for eight weeks (Condon, Desbordes, Miller, & DeSteno, 2013). Mindfulness meditation and alleviation of insomnia when compared to an eight-week self-monitoring condition (Ong et al., 2014).6 Proven BenefitsTo say something is “proven” in scientific terms is almost impossible. Social science researchers hesitate to say “x causes y.” They speak in terms of confidence intervals (CIs). The Association for Psychological Science has a fabulous article explaining this topic (Kalinowski, 2010).Researchers use the term correlation when describing their results. This means that they have found a connection or no connection between the variables in question. For example, one might find that an 8-week mindfulness meditation training negatively correlated with a decrease in insomnia. As the person continued to use mindfulness meditation, their experience of insomnia lessened.Does this mean that there are no “proven” effects of using meditation therapy? As the prior section indicated, the research is promising.Here are six more studies:The amygdala changes after two months of meditation training. Desbordes and colleagues (2012) found that there is less activation in this area after learning meditation. Meditation has a stronger effect than relaxation training to reduce smoking and cravings (Tang, Tang, & Posner, 2013). Ramsburg and Youmans (2014) found that meditation improves the retention of information. In their experiments, college students received brief meditation training or rest. Then they listened to a lecture followed by a quiz. Students who received meditation training retained more information. Unaffected variables included mood, relaxation, and class interest. A 2015 study by Ching, Koo, Tsai, and Chen found that a semester-long mindfulness course improved learning effectiveness. It also enhanced participants’ attention and memory. Loving-kindness meditation reduces implicit bias against blacks and homeless people (Kang, Gray, & Dovidio, 2013). The researchers compared this result against a loving-kindness discussion group and a waitlisted group. Goldin, Ziv, Jazaieri, Hahn, and Gross (2013) compared MBSR to an aerobic exercise stress reduction program. They found that “meditation practice was associated with decreases in negative emotion and social anxiety symptom severity and increases in attention-related parietal cortex neural responses when implementing attention regulation of negative self-beliefs.”8 Techniques Used in Meditation TherapyA mental health professional may use a variety of techniques based on the patient’s needs. One exercise might work for one person but be ineffective for another. Fortunately, there are several options.The University of Minnesota (n.d.) recommends these:Diaphragmatic (belly) breathing. Sit or lie comfortably on your back. Breathe in through your nose with your mouth closed. Exhale slowly through your mouth with your lips pursed. Try to make your exhalation longer than your inhalation. Straw breathing is a great way to extend your exhalation. Breathe in through your nose. Using a plastic straw, exhale through it until all the air leaves your lungs. Repeat this for anywhere from 2-5 minutes. 2-minute relaxation. Start by taking a few deep breaths. Remember to exhale slowly and fully. Be mindful of the air as it leaves your lungs. Scan your body for tense areas. Imagine warm light loosening the muscle. Allow your head to fall forward gently. Rotate to the left and right. Raise your head. Rotate left and right. Look up and then slowly return your head to a neutral position. If at any point you feel pain, stop. Roll your shoulders forward and back. Recall something pleasant. Take a few more deep breaths exhaling slowly. Exercise your shoulder and neck muscles to reduce tension. Stand or sit. Shrug your shoulders to your ears for a count of ten then release. Repeat as needed. Stretch your arms up and overhead without locking your elbows. Swing your arms at your sides forward and back, and side to side. Engage the relaxation response. Choose a quiet spot with little-to-no distractions. Get into a comfortable position. Choose a focal point such as your breath, a word, a sound, or a prayer. If you get distracted, imagine the distraction as a cloud sweeping across the sky. Let it float past without judgment or emotion. Return your attention to your focal point. Georgia Tech (n.d.) advises students to use the above techniques and Progressive Muscle Relaxation (PMR). Sit or lie in a comfortable position. Take a few deep breaths and close your eyes. Beginning at the top of your body, slowly tense and then release the muscles in your body. For a more detailed explanation, visit the Georgia Tech Division of Student Life. Body scanning is useful for reducing pain. To start, lie on your back in a comfortable position, close your eyes, and breathe deeply. Focus on your left foot. Allow yourself to feel all the sensations. Do this for each part of your body. If you experience pain in any area as you move through your body, acknowledge it, and breathe through the pain. Refrain from judging yourself or the pain (Harvard Health Publishing, 2016). Guided Imagery is using words and music to evoke imaginary scenarios in the listener. The goal is to assist the person in “see” and “feel” the imagined experience.If you would like to experience a guided imagery meditation, listen to Jason Stephensen’s, Guided meditation for anxiety and stress.A Look at Stillness Meditation TherapyDeveloped by psychiatrist Dr. Ainslie Meares, this form of meditation involves “the natural regulation of the nervous system through the repeated experience of mental rest” (Stillness Meditation, n.d.) Unlike many other forms of meditation, stillness meditation is non-sectarian. It helps practitioners relieve stress and anxiety without drugs.Stillness meditation is about allowing the mind to come to rest on its own. There are no specific breathing techniques. One does not need to listen to music, chant, visualize, or focus on emptying one’s mind. You are free to allow your mind to wander. It involves no effort. You are not trying to achieve anything.Facilitated sessions might involve therapeutic touch. This helps the teacher communicate safety to the client allowing the client to experience successful mental rest (Stillness Meditation, n.d.).Using Somatic Meditation in a Therapeutic SettingSomatic meditation is body-centered. The goal is to identify and release negative tension throughout the body. To do this, a practitioner incorporates talk therapy, mind-body exercises, and physical techniques (Psychology Today, n.d.).Practitioners believe that negative emotional experiences manifest through the body. This is not limited to physical pain. It also includes anger, frustration, and other emotions. During a therapy session, a client relives those negative emotions by recalling memories.The therapist assists the person by integrating some of the following:Yoga Dance Vocal work Massage Exercise Deep breathing Relaxation exercises MeditationSuggested Reading on the TopicIf you are interested in reading more on the topic, I have some suggestions below.I recommend the following by Buddhist teacher and scholar, Reginald Ray:The Awakening Body: Somatic Meditation for Discovering Our Deepest Life (Amazon)[amazon box="1611803713"]The Practice of Pure Awareness: Somatic meditation for awakening the sacred (Amazon)[amazon box="1611803810"]Manuela Mischke-Reeds, MA, MFT, is an international teacher of mindfulness-based somatic psychology and has an interesting workbook you can find below.Somatic psychotherapy toolbox: 125 Worksheets and exercises to treat trauma and stress (Amazon)[amazon box="1683731352"]How to Use Guided Meditations in TherapyAs a therapist, having one’s practice is helpful. Doing so allows you to understand better the challenges and rewards a meditation practice offers. This will increase your compassion toward your client. It also allows you to share your experiences, as appropriate. For example, how you acknowledge distractions without judgment.Tara Brach (n.d.) suggests having clients work with a meditation teacher. Then, when the client returns to a session, the discussion can include how to incorporate meditation into their therapy.Using Meditation Therapy for DepressionOne evidence-based approach is mindfulness-based cognitive therapy (MBCT). Borrowing from the MBSR format, Segal, Williams, and Teasdale developed MBCT to combat depression (Lu, 2015).Like MBSR, MBCT is an 8-week program that includes yoga, body awareness, and daily homework. According to the Center for Mindfulness in Medicine, Health Care, and Society (n.d.), “the key difference in MBCT is an explicit focus on turning toward low mood and negative thoughts.”Research (Lu, 2015) has shown that,People with early-onset depression, or who experienced abuse as a child are more likely to benefit. People who are “ready to engage” also benefit. These are people who’ve tried medication and or other therapies but still struggle. Recurring depressive episodes decrease with the use of MBCT. When compared to medication, the results were similar and better than a placebo.Dimidjian and colleagues (2015) adapted MBCT for perinatal women. They found an “18% relapse/recurrence rate through 6 months postpartum.” For pregnant women battling depression, this research provides hope.A 2014 study by Raes, Griffith, van der Gucht, and Williams found that MBCT is well-suited for adolescents. Their randomized, controlled study was a first of its kind and included 408 students ages 13-20. Results showed that the intervention group experienced “significantly greater reductions in depression compared with the control groups at 6-month follow-up.”How Can Meditation Therapy be Used for PTSD and Anxiety Disorders?

In 2015 the US Department of Veterans Affairs issued the Evidence Map of Mindfulness report. It summarized the research through February 2014 (Hempel et al., 2014). At that time, the report indicated some support for MBCT and MBSR interventions in the following areas: depression overall health and psychological outcomes chronic illness mental illness somatization disorders Researcher Anthony King and colleagues (2013; 2016) studies mindfulness as a treatment for PTSD and anxiety. Through his various research projects, he found that: MBCT…

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