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Protection throughout the Life Span
The Psychoneuroimmunologic Impact of
Indo-Tibetan Meditative and Yogic Practices
Erin L. Olivo
Columbia University, College of Physicians and Surgeons, New York, New York, USA
Protection throughout the Life Span
The Psychoneuroimmunologic Impact of
Indo-Tibetan Meditative and Yogic Practices
Erin L. Olivo
Columbia University, College of Physicians and Surgeons, New York, New York, USA
Protection throughout the Life Span
The Psychoneuroimmunologic Impact of
Indo-Tibetan Meditative and Yogic Practices
Erin L. Olivo
Columbia University, College of Physicians and Surgeons, New York, New York, USA
The Psychoneuroimmunologic Impact of Indo-Tibetan Meditative and Yogic Practices Erin L. Olivo Columbia University, College of Physicians and Surgeons, New York, New York, USA The Indo-Tibetan tradition claims that prociency in the suggested longevity practices of meditation, diet, and physical exercise (yoga), will result in profound anti-aging, stress-mediating and health enhancing effects. Western biomedical research has begun to demonstrate that the psychobiological states induced and cultivated by cognitive behavioral practices which are emblematic of those contained within the Indo-Tibetan tradition (hypnosis, meditation, visualization, systematic relaxation), indeed do have a profound impact on the bodys protective and regulatory systems. Although continued study is necessary, much of the early research illuminating the mechanisms responsi- ble for the life-span extending and health-enhancing effects of these cognitive behav- ioral practices points to the importance of their anti-inammatory, anti-stress, and antioxidant effects as well as their impact in enhancing the production of endogenous substances that possess general longevity-enhancing, regenerative properties. Key words: meditation; psychoneuroimmunology; preventative health Extensive research in the elds of neu- roendocrinology and psychoneuroimmunol- ogy (PNI), over the past decade has resulted in the development of a new paradigm of health, which has begun to elucidate the multidirec- tional and multidimensional nature of health and the stress response. This PNI paradigm, which begins to illuminate the complex inter- actions among emotions, the central nervous system (CNS), and the immune and endocrine systems, is astoundingly congruous with the holistic view of health at the center of Ti- betan medicine and indeed provides a body of evidence descriptive of the mind-body connec- tion proposed by this 12-centuries-old healing tradition which is a continuation of the 2,500- year-old Indian Buddhist tradition. Indeed, Ti- betan medicine does not establish (as Western medicine historically has) a duality between the Address for correspondence: Erin L. Olivo, Ph.D., M.P.H., Columbia University, College of Physicians and Surgeons Department of Psychi- atry, Division of Behavioral Medicine, 1150 St. Nicholas Avenue, New York, NY 10032. Voice: 917-974-1488. elo4@columbia.edu mind and the body, but instead, views mind and body as a single totality in which the somatic and the psychic interact with one another. 1 The Indo-Tibetan tradition claims that prociency in the suggested longevity prac- tices of meditation, diet, and physical exer- cise (yoga), will result in profound anti-aging, stress-mediating, and health-enhancing effects. Western biomedical research has begun to demonstrate that the psychobiological states in- duced and cultivated by cognitive behavioral practices which are emblematic of those con- tained within the Indo-Tibetan tradition (hyp- nosis, meditation, visualization, systematic re- laxation), indeed do have a profound impact on the bodys protective and regulatory systems. Although continued study is necessary, much of the early research illuminating the mecha- nisms responsible for the life-span extending and health-enhancing effects of these cognitive behavioral practices points to the importance of their anti-inammatory, anti-stress, and antiox- idant effects as well as their impact inenhancing the production of endogenous substances that Longevity, Regeneration, and Optimal Health: Ann. N.Y. Acad. Sci. 1172: 163171 (2009). doi: 10.1111/j.1749-6632.2009.04415.x C 2009 New York Academy of Sciences. 163 164 Annals of the New York Academy of Sciences possess general longevity-enhancing, regenera- tive properties. Impact on Immune Function and Inammatory Process Aging is characterized by the simultaneous heightening of baseline inammation and re- duced antimicrobial effectiveness, and many investigators now believe that such immunose- nescence may be in large part responsible for the fundamental processes of aging itself. 2,3 In- ammation has been linked to a broad spec- trum of conditions associated with aging, in- cluding cardiovascular disease, type II diabetes, Alzheimers disease, rheumatoid arthritis, and various cancers. 4 The groundbreaking work of Kevin Tracey in the area of immune function and inam- matory processes has set the stage for fur- ther research into how the cognitive behav- ioral practices of the Indo-Tibetan tradition may modulate dangerous inammatory mech- anisms, while at the same time up-regulate the bodys innate antimicrobial capacities and reverse immunosenescence. At the heart of this action may well lay the interrelation, elu- cidated by Dr. Tracey and others, between stress, the inammatory response, and specic tracts of the CNS. The observation that inam- matory challenge activates pituitary-dependent adrenal responses and alters neuronal signal- ing in the hypothalamus, alerts us to the pres- ence of a central nervous component of in- ammatory regulation. 5 The CNS receives both humoral and neural input from periph- eral inammatory loci, and in turn exerts immunomodulatory effects through parasym- pathetic efferent activityvagus nerve activa- tion drives acetylcholine release in the liver, spleen, heart, and GI tract, which effectively inhibits the release of inammatory cytokines from tissue macrophages. These linkages work together in a neural pathway that reex- ively monitors and adjusts the inammatory response. Documentation of this cholinergic anti- inammatory pathway provides further proof of the connection between mind and body and offers guidance in the development of potential interventions that may target components of this pathway. For example, Dr. Tracey has sug- gested that biofeedback, hypnosis, meditation, and acupuncture may all potentially be used to regulate autonomic function (through va- gal activation) and thereby modulate cytokine release. 5 Indeed, studies of meditation and meditation-like practices (self-hypnosis, sys- tematic relaxation, guided imagery, etc.) have demonstrated a range of anti-inammatory effects. Reductions in levels of tumor necrosis factor- (TNF-), 6 interleukin-2 (IL-2), 7 and interferon- (INF-), 7,8 as well as attenuations in inammatory responses to a range of antigens, allergens, and irritants, including lipopolysaccharide (LPS), 9 histamine, 10 cap- saicin, 11 Varicella zoster, 12 and ultraviolet B, 13 have all been shown to result from the use of these cognitive behavioral practices. Interestingly, practices such as these may also have import into recent treatment mod- els of neurodegeneration, which focus on the use of cholinesterase inhibitors to enhance acetylcholine-mediated neural transmission. 14 Though the potential impact of Indo-Tibetan cognitive behavioral practices on age-related neurodegeneration is discussed in depth below, at this point it should be noted that this treat- ment strategy, as well as the association of anti- cholenergic drug treatment with cognitive de- cline in the eldery 15 suggest a role for practices which enhance parasympathetic tone in neu- roprotection, as acetylcholine is the principle parasympathetic neurotransmitter. Resistance to Trauma and Infection Cognitive behavioral techniques might not only exert ongoing, chronic anti- inammatory effects, but also acute anti- inammatory effects in response to challenges Olivo: Protection throughout the Life Span 165 or traumas such as burns, surgery, and other forms of injury. 10,13,16,17,19 In fact, there is a small but signicant body of research show- ing that, with training and prociency, an impressive, even extraordinary level of resis- tance to stress, inammation, and the as- sociated tissue damage, is achievable for practitioners of these cognitive behavioral techniques. 2027 Enhanced secretion of endogenous mela- tonin (MT) and dehydroepiandrosterone (DHEA), as well as of acetylcholine (AcH), alpha-melanocyte stimulating hormone (alpha- MSH), and growth hormone (GH), appear to be signicant components of a neuroen- docrine response triggered by cognitive be- havioral practices such as meditation. 2835 The anti-inammatory and anti-shock properties of these substances have been established in a number of clinical and experimental trials. 3645 Interestingly, these substancesespecially MT and DHEAappear to exert either direct or indirect antimicrobial actions on a wide range of disease-causing pathogens, such as West Nile virus, 46 schistosomiasis, 47 and many oth- ers. In addition to their overt antimicrobial actions, these substances also appear capable of counteracting the inammation-mediated pathological changes induced by these and other major infectious diseases, such as tuberculosis. 48 It is also interesting to note that the cholin- ergic anti-inammatory pathway identied by Dr. Tracey and described above is in many ways isomorphic with the pathway that more gener- ally mediates stress and relaxation. A number of studies have shown that animals and hu- mans subjected to prolonged, heightened stress can be at considerably greater risk for devel- oping disease when infected by viruses, bac- teria, and other pathogens. 4951 This highlights the interaction between the autonomic nervous system (and the associated stress response) and immune modulation, and suggests the possible role of anti-stress cognitive behavioral practices in conferring immunity to a host of harmful pathogens. Psychological ImpactStress and Aging Central to the PNI paradigm(andthe holistic view maintained within the Indo-Tibetan tra- dition) is the role of emotions, psyche, and stress in both the development of disease and the aging process. Numerous studies have demon- strated that negative affect, depression, anxiety, and perceived stress are implicated in the de- velopment and exacerbation of diseases such as cancer, cardiovascular disease, 5254 metabolic syndrome, and multiple sclerosis 55 to name a few. In addition, several recent controlled stud- ies have demonstrated that in some popula- tions, depression can increase risk of death by as much as four times as compared with non- depressed controls. 5660 It is only recently that physiological mechanisms capable of explain- ing the link between negative affect and mor- tality have begun to be elucidated. The ground- breaking research of Dr. Elizabeth Blackburn and Dr. Elissa Epel has recently demonstrated an association between the experience of stress and both telomere lengtha basic indicator of cellular agingand telomerase activitya measure of cellular capacity for ongoing repli- cation. 6163 Researchers have only recently begun to measure the impact meditation and related cognitive behavioral practices may have on psy- chological variables with a focus on symptoms such as subjective feelings of stress, depression, anxiety, panic attacks, and chronic pain. While this body of research is handicapped by small sample sizes and a relative paucity of controlled studies, overall, it does appear that preliminary evidence supports the usefulness of meditation in decreasing these symptoms. The majority of research in this area has been conducted using the mindfulness-based stress reduction paradigm (MBSR) developed by Kabat-Zinn. 64 For reviews of the MBSR literature, more extensive than is possible here, see Baer 65 and Bishop. 66 However, it is worth noting that investigations of the MBSR program have demonstrated its effectiveness in 166 Annals of the New York Academy of Sciences decreasing stress, anxiety, and depressive symp- toms in the general population, in the absence of clinically-dened mood disorder. 6769 Within clinical samples, MBSR training is capable of reducing total mood disturbance and stress symptoms (in a group of cancer patients), 70 and a combined program utilizing cognitive- behavioral therapy in conjunction with MBSR has been shown to reduce rates of relapse among formerly depressed patients. 71 There have been numerous uncontrolled studies of the impact of meditation on psy- chological symptoms. Kabat-Zinn 7274 reports ndings from several studies of his MBSR program with chronic pain patients that in- dicate reductions on self-report measures of present-moment pain, negative body image, in- hibition of activity by pain symptoms, mood disturbance, and psychological symptomology including depression and anxiety. In addition, in Kabat-Zinns research studying the impact of MBSR programs on anxiety and panic dis- order, 75,76 clinically and statistically signicant post-treatment reductions were found in both subjective and objective symptoms of anxiety and depression and these results were main- tained at the three-year follow-up. A recent pilot study conducted at Stan- ford demonstrated that a program of med- itation and yoga could signicantly impact the perception of caregiver stress and the re- lated symptoms of depression and anxiety. 77 It is worth noting that this is exactly the type of challengeperceived caregiver stress linked by Blackburn and Epel to telomere shortening. Impact on Neuroendocrine Function The research of Dr. Bruce McEwen and oth- ers has begun to elucidate the role played by glucocorticoids (GCs) in the deleterious effects of stress on health and aging. 78,79 The glu- cocorticoid cascade hypothesis (established through investigation in rat models), suggests that basal levels of glucocorticoids and ACTH rise with age and that aging is associated with a loss of sensitivity in the adrenocortical axis to feedback inhibition, presumably due to degen- erative changes within the aging brain, specif- ically in the hippocampal region of the limbic system. 78 In addition, this model suggests that cumulative exposure to basal concentrations of glucocorticoids lead to the degenerative loss of neurons and GC receptors in the senescent hippocampus, and that chronic stress, with its resultant increases in GC concentrations, ac- celerates this process. 78 The overall results of research in the area of the neuroendocrinologic impact of cogni- tive behavioral practices suggest that practices such as meditation induce a complex neu- roendocrine response. Research demonstrates acute declines in several hormones implicated in the deleterious effects of the stress response in response to meditation and related prac- tices, such as cortisol and thyroid stimulating hormone (TSH). 8083 Additionally, several lon- gitudinal studies conrm that these effects are long lasting in subjects who regularly practice meditation. In addition to the reduction of the above-mentioned harmful substances, endoge- nous neuroendocrine substances with proven anti-inammatory, anti-stress, and general longevity-enhancing properties such as MT, DHEA, and alpha-melanocyte stimulating hor- mone (alpha-MSH) have all been shown to be enhanced by cognitive behavioral practices, as mentioned above. 8488 In the context of this discussion, it is relevant to note that among the broad range of protective and regenerative ef- fects they are found to have on the body, MT and DHEA both appear to counteract the GC- mediated deleterious effects of stress. 8991 Impact on Autonomic FunctionStress and ANS Since Herbert Bensons description of the stress response, a substantial body of research has been devoted to elucidating the role of the autonomic nervous system in both health Olivo: Protection throughout the Life Span 167 maintenance and disease processes. A pri- mary set of ndings of this research impli- cate increased sympathetic reactivity and de- creased parasympathetic tone as contributing factors to the development of cardiovascular disease. There has been considerable research in- vestigating the acute and long-term impact of meditation on autonomic activity. The over- all results indicate decreased activation and in- clude such ndings as decreased spontaneous electrodermal response (EDR) and decreased heart rate (HR). 9295 A meta-analysis of 31 studies comparing physiological differences be- tween Transcendental Meditation (TM) and rest control groups indicated that those subjects who had been practicing TM for a long time exhibited signicantly lower baseline levels of spontaneous skin resistance responses, respira- tion rate, heart rate, and plasma lactate prior to meditation than comparison subjects did prior to rest. 96 Yet another group of studies investigated the impact of meditation on recovery from stress- ful stimulation. Several researchers have re- ported signicantly faster habituation or return to baseline (as measured by GSR, EDR, and HR) after exposure to stressful stimuli in medi- tators as compared to controls. 97,98 Hemodynamic variables such as systolic and diastolic blood pressure (SBP, DBP), cardiac output (CO) and total peripheral resistance (TPR) have also been a focus of study in re- gard to how they are impacted by the prac- tice of meditation. Individuals practicing TM have been found to have lower resting SBP and DBP than matched controls. 99101 Because blood pressure is the product of cardiac out- put and total peripheral resistance, changes in these variables have also been studied during meditation. An investigation of circulation that utilized dye-dilution and radioactive clearance methods yielded results that demonstrated a small but signicant increase in CO (15%) dur- ing TM. 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