Mindfulness May Improve Medical Efficacy in Rheumatology Patients

The goal of mindfulness is to maintain awareness moment by moment, disengaging oneself from strong attachment to beliefs, thoughts or emotions, thereby developing a greater sense of emotional balance and well-being.
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Every day, rheumatology patients live with the realities of having a chronic disease that requires a lifetime of treatment. This knowledge can be an emotional burden, and some people deal with it better than others. Emerging research is showing that those patients who exhibit emotional control are better able to cope and ultimately experience a greater quality of life relative to their treatment. The skill of being able to see past intense emotions, to focus on reality in the moment and to respond unemotionally is known as mindfulness.

The concept—and practice—of mindfulness has been around for thousands of years, and its benefits in medicine are being increasingly recognized. A growing body of research links mindfulness practices to improved outcomes in chronic disease and chronic pain. In rheumatology, studies have shown benefits among patients with rheumatoid arthritis (RA), fibromyalgia and psoriasis.

The Mindfulness Story

Most commonly associated with Buddhism, mindfulness is also mentioned in the Old Testament, Hindu texts and yogi texts, says AnneMarie Rossi, executive director and founder of Be Mindful, a Denver-based nonprofit that teaches mindfulness to children and young adults, and a recent TED Talks presenter. However, “mindfulness practice doesn’t have to be spiritual. It can be a way to connect to a particular religion, but it doesn’t in any way shape or form have to do that. … For me, it’s exercising to train your brain to have focus, attention and emotional regulation. It’s a way of engaging in the present moment without attachment and without judgment.”

In medicine, mindfulness is a “form of meditation that requires no particular religious or cultural belief system,” according to a paper coauthored by Jon Kabat-Zinn, PhD, the founding executive director of the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts, Worcester.1 Dr. Kabat-Zinn is widely credited with bringing mindfulness to medicine in the form of mindfulness-based stress reduction (MBSR), which can be learned through training.

“The goal of mindfulness is to maintain awareness moment by moment, disengaging oneself from strong attachment to beliefs, thoughts, or emotions, thereby developing a greater sense of emotional balance and well-being. The original purpose of mindfulness in Buddhism—to alleviate suffering and cultivate compassion—suggests a potential role for this practice with medical patients and practitioners.”¹

Benefits in Medicine

Over the past few decades, numerous studies have linked mindfulness practice to improved patient outcomes and quality of life. In fact, there’s enough emerging research that the American Mindfulness Research Association sends out a monthly research bulletin and maintains a database and resource repository in support of mindfulness practices.

“Mindfulness is really beneficial for individuals with chronic pain or long-term illness to give them some semblance of power and control over their own feelings and emotions [about their disease and] the pain they’re having,” Ms. Rossi says. “The mind affects the brain and immune system and body as a whole. … It’s important to understand these things are connected, and no matter how much pain medication you give someone, if they can’t deal with the stress of being in pain, that will amplify their pain.”

Mindfulness training can help patients with acceptance of pain, physical functioning, general medical symptom severity and the ability to cope with daily life.1 “An aim of mindfulness practice is to take greater responsibility for one’s life choices. Thus, mindfulness may promote a more participatory medicine by engaging and strengthening an individual’s internal resources for optimizing health in both prevention of and recovery from illness.”¹

Recent research has shown that mindfulness has application for:

• Treating anxiety and mood problems in clinical populations (i.e., cancer, generalized anxiety disorder, depression, other psychiatric or medical conditions);²
• Remediating sleep problems among older adults and reducing sleep-related daytime impairment;³
• Significantly reducing symptoms of anxiety and depression among cancer patients and survivors with symptoms of anxiety and depression;⁴ and
• Significantly improving function and quality of life and symptoms, preventing a social decline, and reducing societal costs among patients with bodily distress syndrome (i.e., unifying definition of various conditions, such as fibromyalgia, chronic fatigue syndrome and somatization disorder).⁵

With regard to rheumatology, mindfulness practices have shown application for:

• Improving psychological distress, self-efficacy pain and symptoms, emotional processing, fatigue, self-care ability, and overall well-being in patients with inflammatory rheumatic joint diseases;⁶
• Protecting against psychological distress associated with disability in patients with RA;⁷
• Complementing medical disease management in patients with RA by improving psychological distress and strengthening well-being;⁸
• Alleviating symptoms in patients with fibromyalgia;⁹ and
• Improving the efficacy of traditional therapies for psoriasis.¹⁰

Ultimately, evidence suggests what may be common sense—those who are in control of their emotions are more successful at dealing with adversity, such as living with a chronic disease, and they tend to be more successful professionally than those who are ruled by their emotions. In fact, research shows that physicians also may benefit from practicing mindfulness. In one study, medical students who underwent mindfulness training exhibited reduced psychological distress and increased empathy compared with the control group.¹¹

More investigation is needed to solidify the link between mindfulness and medicine, but the evidence to date is encouraging and suggests that mindfulness could improve medicine for patients and practitioners alike. According to Dr. Kabat-Zinn and his coauthor, Dr. David S. Ludwig, “Mindfulness may hold promise as a potential way to help prevent and treat disease, increase ability to cope with pain and chronic illness, reduce stress in patients and practitioners, foster compassion, improve quality of care and reduce medical errors.”¹

Kimberly J. Retzlaff is a medical journalist based in Denver.

References

1. Ludwig DS, Kabat-Zinn J. Mindfulness in medicine. JAMA. 2008 Sep 17;300(11):1350–1352. doi: 10.1001/jama.300.11.1350.
2. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 2010 Apr;78(2):169–183.
3. Black DS, O’Reilly GA, Olmstead R, et al. Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: A randomized clinical trial. JAMA Intern Med. 2015 Apr;175(4):494–501.
4. Piet J, Würtzen H, Zachariae R. The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: A systematic review and meta-analysis. J Consult Clin Psychol. 2012 Dec;80(6):1007–1020.
5. Fjorback LO. Mindfulness and bodily distress. Dan Med J. 2012 Nov;59(11):B4547.
6. Zangi HA, Mowinckel P, Finset A, et al. A mindfulness-based group intervention to reduce psychological distress and fatigue in patients with inflammatory rheumatic joint diseases: A randomised controlled trial. Ann Rheum Dis. 2012 Jun;71(6):911–917.
7. Nyklíček I, Hoogwegt F, Westgeest T. Psychological distress across twelve months in patients with rheumatoid arthritis: The role of disease activity, disability, and mindfulness. J Psychosom Res. 2015 Feb;78(2):162–167.
8. Pradhan EK, Baumgarten M, Langenberg P, et al. Effect of Mindfulness-Based Stress Reduction in rheumatoid arthritis patients. Arthritis Rheum. 2007 Oct 15;57(7):1134–1142.
9. Jones KD, Mist SD, Casselberry MA, et al. Fibromyalgia impact and mindfulness characteristics in 4986 people with fibromyalgia. Explore (NY). 2015 Apr 28; 2015;11(4):304–309.
10. Talbott W, Duffy N. Complementary and alternative medicine for psoriasis: What the dermatologist needs to know. Am J Clin Dermatol. 2015 Jun;16(3):147–165.
11. Shapiro SL, Schwarz GE, Bonner G. Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med. 1998 Dec;21(6):581–599.