Meditation, Managed Care, and Mental Health

May 4, 2016

In recent years, health care insurance companies (and the businesses that use them) have begun to invest in mindfulness research and programs What has happened to explain this development?

PSYCHIATRIC VIEWS ON THE NEWS

In 1990, when I started to lead a not-for-profit managed mental health care system, no one paid attention to meditation.1 In recent years, health care insurance companies (and the businesses that use them) have started to invest in mindfulness research and programs.2What has happened to explain this development?

 

A look back

Starting with Hindu traditions in India, meditation has evolved over thousands of years as a kind of spiritual practice. Much later, Buddha embraced it. Forms of meditation were practiced in Judaism, Christianity, and Islam, but they were more mystical than mainstream.

In the 1960s, gurus from India, coupled with the interest of hippies and other new age spiritual seekers, brought meditation to the US. As the fervor of the 60s died down, so did meditation.

In the new millennium, the practice of meditation again surfaced for practical rather than spiritual reasons. As the Internet put people online with little time left to recover from growing workplace productivity demands, burnout increased. Meditation became a practical tool to relax and recover from undue stress.

Techniques

No matter what the variation, the practice of meditation has 4 fundamental requirements: (1) a quiet location, (2) a comfortable position, (3) a focus of attention, and (4) an open attitude. The overall goal is intense calmness and clarity.

Mindfulness is one of the most popular types of meditation. The aim is to witness and to pay attention to whatever is on one’s mind-no matter how full or distracting those thoughts are. Even with mindfulness, diverse practices can be subsumed under its rubric, including yoga, centering prayer, and tai chi.

Daily practice does not require a great deal of time. In the Americanization of meditation, one Google executive claims that even 6 seconds of a “mindful breath” can do the trick whenever it is needed.2 If the results of a study on dishwashing can be generalized, there is some scientific confirmation of that possibility.3

Meditation and the brain

As meditation gained in popularity and neuroimaging techniques became available, research assessed how daily practice affected the brain. One such study reported that after only 8 weeks of meditation for about 30 minutes a day, brain thickening was found in 4 areas: the posterior cingulate, the left hippocampus, the temporoparietal junction, and the pons.4 Each area involves self-referencing, emotional regulation, compassion, and regulation of neurotransmitters. On the other hand, the amygdala, which processes the fight-or-flight response, became smaller.

Stimulated by a request by the Dalai Lama, other studies harkened back to the Buddhist tradition by using long-term, intense meditators-such as Buddhist monks-as subjects.5 These studies found that the anterior insula in particular was activated. This area of the brain coordinates the brain-body interaction involved with the immune system. High-amplitude gamma-oscillation in the brain, indicative of increased neuronal plasticity was also found.

 

Psychiatric benefits of meditation

Proper meditation induces relaxation, although other techniques-such as exercise and music-are equally beneficial. Relaxation not only lowers blood pressure, but also relieves tension and anxiety.

Another study went beyond wellness and looked at whether meditation could supplement traditional treatments for depression and other psychiatric disorders.6 Mindfulness-based cognitive psychotherapy was found to be as effective as medication in preventing relapse for persons with recurrent depression.

It is interesting to note that, sooner or later, virtually all prominent researchers on meditation embrace the practice for themselves.

Managed care and meditation

A well-known goal of managed care is to reduce rising health care costs that threaten business profitability. As managed care emerged in the 1980s and has now morphed into a component of affordable care, the objective has been to eliminate unnecessary and ineffective traditional treatments. Early on-and to this day-psychiatry has been a particular target.

Having achieved some success, companies have sought other ways to save costs. Research indicates that meditation can reduce chronic stress, a key contributor to high medical expenses. In one study, half of a group of high-cost patients practiced Transcendental Meditation® for 5 years. Costs decreased by 28%.7

In addition, meditation is much less expensive than most traditional treatments. Some people try to learn it on their own, and others turn to apps. Even a reputable trainer is affordable.

No wonder, then, that many health care organizations are incorporating meditation into their plans.8 Embraced by the chief executive officer and management of Aetna, mindfulness programs were introduced first to employees and then to customers after it was found that they correlated with lower stress levels. Google offers multiple mindfulness courses designed to enhance emotional intelligence. And there are others.

Possible detriments

Like all interventions, there can be occasional “side effects.” Some teachers are charlatans or unethical and take advantage of pupils.

The benefits may come more from a short-lived placebo effect. It can be overdone and become an addiction of sorts. More rare, but more devastating, is that meditation can unleash primitive, confused, and psychotic-like thoughts that can lead to suicidal ideation in vulnerable people.9

Then, there is the challenge of how much stress-rather than too much or even too little-is good for you and good for productivity. And from my own experience in the managed care industry, I sometimes wonder whether companies feel they can ratchet up the work pressure because meditation can ameliorate the ensuing stress.

 

This article was originally published on 2/3/2016 and has since been updated.

References:

1. Moffic HS. The Ethical Way: Challenges and Solutions for Managed Behavioral Healthcare. San Francisco: Jossey-Bass; 1997.

2. Rosin T. Why Aetna, Google, and other corporations are investing in mindfulness. Becker’s Hospital Review. December 30, 2015. http://www.beckershospitalreview.com/hospital-management-administration/why-aetna-google-and-other-corporations-are-investing-in-mindfulness.html. Accessed February 1, 2016.

3. Hanley AW, Warner AR, Dehili VM, et al. Washing dishes to wash the dishes: brief instruction in an informal mindfulness practice. Mindfulness. 2015;6: 1095-1103.

4. Hölzel BK, Carmody J, Vangel M, et al. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Res. 2011; 191:36-43.

5. Davidson R, Begley S. The Emotional Life of Your Brain: How Its Unique Patterns Affect the Way You Think, Feel, and Live-and How You Can Change Them. London: Penguin Books; 2012.

6. Kuyken W, Hayes R, Barrett B, et al. Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomized control trial. Lancet. 2015;386:63-73.

7. Herron R. Changes in physician costs among high-cost Transcendental Meditation practitioners compared with high-cost nonpractitioners over 5 years. Am J Health Promot. 2011;26:56-60.

8. Gelles D. Mindful Work: How Meditation Is Changing Business From the Inside Out. New York: Houghton Mifflin Harcourt Publishing Company; 2015.

9. Rocha T. The dark night of the soul. The Atlantic. June 25, 2015. http://www.theatlantic.com/health/archive/2014/06/the-dark-knight-of-the-souls/372766. Accessed February 1, 2016.

10. Moffic HS. Is our profession breaking our hearts? A Valentine’s Day concern. Psychiatric Times. February 11, 2016. http://www.psychiatrictimes.com/blogs/our-profession-breaking-our-hearts-valentine-day-concern. Accessed February 11, 2016.