Depression and anxiety disorders are the most common disorders that people experience. According to the World Health Organization (WHO) survey results, the worldwide prevalence of depression in 2015 (1) is estimated to be 4.4%. The total number of people with depression is approximately 322 million. It is more common among women (5.1%) than men (3.6%). The worldwide prevalence of anxiety disorders in 2015 is estimated to be 3.6%. The total number of people living with anxiety disorders is approximately 264 million. It is more common among women (4.6%) than men (2.6%), the same with depression.
Depression is characterized by:
- Depressed mood
- Feeling hopeless
- Loss of interest in activities
- Low self-worth
- Poor concentration
- Loss of appetite
- Disturbed sleeping
- Impaired ability to function at school, work, or social life.
Anxiety experience depends on every person; yet, there are still some common symptoms the person experiences when he or she faces a problematic situation for him or her. These are:
- Distress and fear
- Feeling dizzy
- Increased heart rate
- Difficulty in falling asleep
- Disturbed concentration
- Rapid breathing
- Impaired ability to function at work, school, or social life (2).
Since these disorders are common for a lot of people, it is significant to find helpful techniques or ways to heal and get better. In this paper, meditation, as an alternative therapy technique, will be considered to help people with depression or anxiety disorders.
- Why do meditation-based practices recently become popular for the treatment of depression and anxiety?
- Depression Treatment and Meditation
- Anxiety Treatment and Meditation
Why do meditation-based practices recently become popular for the treatment of depression and anxiety?
Recently, a lot of people, experiencing anxiety and/or depression, prefer nonpharmacologic and conventional practices, which are easy to reach and apply and have no severe side effects, such as meditation, yoga and Tai Chi. In addition, there is increased attention to the effectiveness of those practices in the scientific area (3). Meditation-based practices are taken into consideration as helpful ways to reduce anxiety and distress in people (4).
Mindfulness is based on to increase one’s attention to his or her internal and external experiences at the moment without judging them, and accept them as they are (5). When it is practiced correctly, it can lead to the development of cognitive skills, such as acceptance, meta-cognition, and objectivity (6,7). In addition, dysfunctional and negative self-referential thinking plays an important role in the etiology of anxiety and mood disorders so mindfulness practices are intended to develop experiential self-reference, thereby, reduce self-referential ruminations that lead to a decrease in depressive, anxiety and pain symptoms (8).
One of the mostly used meditation practices is mindfulness-based stress reduction (MBSR). It is ‘a standardized practice, which aims to increase mindfulness through meditation by systematically focusing attention on each part of the body in sequence, practicing gentle Hatha yoga, and participating in group discussion’ (3).
Depression Treatment and Meditation:
Dysfunctional schemas and rumination are cognitive dimensions, which lead to vulnerability to develop and relapse into depression (9). Dysfunctional schemas are negative and extreme presumptions and beliefs about the self (10). While dysfunctional attitudes represent the content (what a person thinks), rumination represents the process of the mind (how a person relates the content). When a person’s dysfunctional attitudes are negative and depressive, his or her rumination becomes associated with focusing on negative states like depression, its symptoms and thinking about the causes, consequences over and over (11). In a study, practicing meditation helped the subjects to reduce their ruminative thoughts and increase attentional control, thereby, is found to be beneficial for the treatment of depression. Also, it was observed a decrease in non-beneficial cognitive processes (e.g. ruminative thinking) in another study (9). MBCT aims to reduce ruminative thinking by increasing awareness and monitoring of thoughts, thus, it can also prevent the onset of the first episode of depression in people beside decreasing the relapse (12).
In some other studies, it was observed that patients who had Mindfulness-Based Cognitive Therapy (MBCT) training experienced fewer relapses and a reduction in the symptoms of chronic depression (13,14). In another study conducted with 14 subjects in MBCT and 14 other subjects in the control group, it was observed a reduction from severe to mild level in depression symptoms in the MBCT group. This result supports the idea of the possibility to get healed from chronic depression via meditation practices (13).
Meditation can work in two ways for depressed people. These are:
- It increases awareness of the present moment; thus, people with depression can shift their attention from ruminative or negative thoughts to objective and available ones.
- It helps people to accept their emotions without judgments and reduce these emotions’ influence on dysfunctional cognitive schemas (6,7).
To view the side of neurobiology, a study looked at brain morphologies before and after an 8-week meditation program. It was found increases in grey matter in the left hippocampus (involved in muscle control, and sensory perception such as seeing and hearing, emotions, decision-making, and self-control), the posterior cingulate cortex (helps to regulate the balance between internally and externally-focused attention), the temporoparietal junction (works for reorientation attention, conflict resolution, memory, self-referential thinking, self-body awareness, mentalizing, emotion regulation) and the cerebellum (coordinates voluntary movements) in MBSR practitioners when compared to the control group (15).
A study suggested meditation with the help of music. Punkanen et al. (2011) found that depressed people rated sad and mad music more deeply than happy and tender parts of music (16). People with depression may be unresponsive to positive emotions. Gladding (2010) indicated that music listening can be used to support self-healing, increase self-awareness and reach the clients in conflict to communicate verbally so music can help the person to put his or her emotions into words easier (17). In a previous study with a structured music listening program showed a helpful change in physical and psychological symptoms of depression, such as fatigue, low self-esteem and so on (18).
Focusing on the past or future can result in one’s feeling of anxiety or depression (19). On the other hand, mindfulness helps the person to focus on the present ‘with curiosity, acceptance, and openness as a way of observing one’s own thoughts and emotions from moment to moment’ (6). John Kabat-Zin suggests that during sitting meditation, you can practice meditation with music, hearing each note and the spaces between the notes, and breathe the sounds into your body and let them flow out again on the out breath by imagining your body as transparent to the music (17).
Anxiety Treatment and Meditation:
Anxiety is a reflect the inadequacy to manage ruminative cognitive processes. It is related to decreased executive-level brain activity in the bilateral prefrontal cortex and anterior cingulate cortex, which regulate control ruminative thinking (20,21). Two emotion regulation strategies, distraction, and reappraisal are stated to decrease anxiety by controlling cognitive mechanisms (22). Distraction gives the person a chance to shift his or her attention to emotionally provoking stimuli rather than focusing on negative mental states and anxiety (23,24). Reappraisal helps the person to reduce his or her anxiety level by changing the meaning of sensory events in a cognitive way, thereby down-regulating the affective reaction to the sensory events (25,26).
It was found that anxiety medications reduced the level of anxiety by 50% in affective disorder patients; however, these medications didn’t work for anxiety in healthy people (27,28). On the contrary, it was found that 20 minutes of meditation decreased the level of anxiety by 22% in healthy people in a study (29).
Zuroff and Schwartz (30) conducted a study with college students who had no prior meditation training. They were separated into three groups, (1) transcendental meditation group, (2) muscle relaxation group, and (3) no-treatment group. A decrease in anxiety level was observed in the first group so it shows that gradual decreases in anxiety level can be provided by meditation.
Kozasa et al. (31) observed a decrease in anxiety and depression symptoms and an increase in the feeling of well-being in subjects who joined a program including meditation and yoga breathing practices. Additionally, it was reported that hormone levels and neurotransmitters related to stress were regulated in subjects practiced transcendental meditation (32).
In a study conducted by Koszycki et al. (33), it was aimed to investigate the effectiveness of MBSR in people with a generalized social anxiety disorder (SAD). 53 participants diagnosed with SAD were separated into two groups: (1) 8-week MBSR program and (2) 12-week CBGT (cognitive-behavioral group therapy). According to the results, while CBGT participants showed a decrease in fear of interacting with others and avoidance of phobic situations, MBSR participants showed a release in social anxiety symptoms and depression level. Also, they reported an improvement in the quality of their lives. In a study carried out with 93 people randomized to either Stress Management Education or to MBSR, it was found a decreased anxiety in both groups; however, MBSR training had a stronger influence on anxiety (34).
In a study conducted with 14 patients experiencing anxiety (35), it was found a decrease in the level of blood pressure, depression and anxiety after they have joined Mindfulness-based Stress Reduction (MBSR) program.
The reason to use meditation practices in the treatment of anxiety is mostly driven by arousal and attention theories of anxiety. According to these theories, anxious people see the environment through threat-related information and misinterpret these as direct threats to them (36) Meditation-based interventions lead people to observe their thoughts and physical sensations without judgment and objectively accept them as they are (5). Additionally, people practicing meditation have less muscle tension, less blood pressure level, and other symptoms of anxiety (37,38).
Many studies were conducted about the effect of meditation in the treatment of depression and anxiety. There usually have been supporting results that suggest the meditation has an improving influence on the treatment of depression and anxiety. Focusing on the present moment, relaxing, accepting the things as they are and treating yourself with compassion are the key techniques that encourage people with depression and/or anxiety to heal and lessen their symptoms.
MBSR is an 8-week program developed by Jon Kabat-Zinn and conducted in a group. Instead of joining an MBSR program, or transcendental program, or getting help via MBCT, you can now try some meditation practice on your own. You should be patient and give yourself a time to practice regularly and for a long time. If you give it a try, please read and apply the following tips.
Typical meditation practice is mentioned by Penman (39) with these steps:
- Sit upright in a straight-backed chair, with your spine about an inch from the back of the chair, and your feet flat on the floor.
- Close your eyes. Watch your breath as it flows in and out. Observe your sensations without judgment. Do not try to alter your breathing.
- After a while, your mind will be full of other thought and imaginations. When it happens, don’t let them get your attention and gently bring your attention back to your breath. This cycle is the key thing in the meditation.
- Your mind will eventually become calmer.
- Repeat every day for 20-30 minutes.
Body scan meditation is also mostly used the technique by meditation practitioners. The steps (40):
- Lie down in a comfortable place.
- Follow your body sensations, for instance, how your body part feels against the base and try to clear your mind.
- It is time to start a body It is like a tour in your body. First of all, focus on your feet (how they feel; if they are cold or warm), then legs and more upper parts of your body. Focus one by one and let other parts disappear for you.
- When it is finished, connect all parts together.