Mindfulness-Based Meditation May Help Reduce Inflammation

Janis C. Kelly

January 31, 2013

Mindfulness meditation techniques designed to reduce emotional reactivity also reduce poststress inflammatory responses and might be useful in chronic inflammatory conditions such as rheumatoid arthritis, psoriasis, inflammatory bowel disease, and asthma, according to a study by Melissa A. Rosenkranz, PhD, and colleagues at the University of Wisconsin-Madison.

In an article published in the January issue of Brain, Behavior, and Immunity, the authors present a comparison between an 8-week mindfulness-based stress reduction program (MBSR) and an 8-week active control health enhancement program (HEP) that included walking, balance, agility, core strength, nutritional education, and music therapy in 49 community volunteers randomly assigned to 1 of the 2 groups.

The intervention and active-control groups had similar levels of stress-evoked cortisol response and similar reductions in psychological distress, but the group trained in mindfulness-based stress reduction had significantly smaller poststress inflammatory responses.

Dr. Rosenkranz told Medscape Medical News, "Because of the experimental design, we were not able to determine whether both interventions reduced stress-evoked cortisol responses or whether participants simply became habituated to the stressor. It is true to say that the postintervention cortisol responses to the stressor declined an equivalent amount for both groups. The MBSR group had significantly smaller postintervention inflammatory responses compared to the HEP group."

The investigators used the Trier Social Stress Test (TSST) to induce psychological stress and a topical application of capsaicin cream to induce inflammation.

The TSST induces psychological stress by requiring participants to give a 5-minute impromptu speech on a given topic, followed by 5 minutes of mental arithmetic.

According to the authors, "[C]apsaicin-sensitive sensory nerves and the neuropeptides they contain, together with local sympathetic nerves and mast cells, have been identified as important contributors to the relationship between psychological stress and symptom expression in inflammatory skin diseases.... Therefore, in the present study, a capsaicin-induced inflammatory response and an acute laboratory stressor were used as a model in which to investigate psychological stress and neurogenic inflammation in the skin."

Mindfulness-based stress reduction, originally designed for patients with chronic pain, consists of continuously focusing attention on the breath, bodily sensations, and mental content while seated, walking, or practicing yoga. The goal is to focus on the present experience to help change one's relationship to it in a beneficial way.

Although interest in meditation as a means of reducing stress has grown over the years, there has been little evidence to support benefits specific to mindfulness meditation practice. This was the first study designed to control for other therapeutic mechanisms, such as supportive social interaction, expert instruction, or learning new skills.

The researchers measured local inflammation by applying vacuum pressure to the skin of the volar forearm just below the cubital fossa to raise suction blisters. The forearm area, including the acrylic blister template with eight 6-mm holes, was wrapped in a heating pad to facilitate the formation of the blisters, which took an average of 53.6 minutes. The vacuum pressure was removed and fluid was collected from 4 blisters using a tuberculin syringe and immediately frozen for analysis by enzyme-linked immunosorbent assay. The researchers applied capsaicin cream around the perimeter of, but not touching, the remaining 4 blisters for 45 minutes and then extracted and froze fluid from those blisters.

Blister fluid was assayed by enzyme-linked immunosorbent assay for levels of tumor necrosis factor alpha and of interleukin 8 because these cytokines are sensitive to modulation by psychological stress and because neuropeptides released from capsaicin-sensitive nerve endings trigger their release.

Despite the group difference in change in cortisol slope after training, the researchers found no change in cortisol reactivity to the TSST. The researchers were surprised to find that more time spent in MBSR practice was associated with lower blister fluid cytokine levels, whereas more time spent in HEP practice was associated with higher blister fluid cytokine levels.

Dr. Rosenkranz said, "This was not an effect that we predicted, but upon further exploration, it seems that the postintervention potentiation of the flare response in the HEP group was related to increased skin irritability associated with colder, drier winter weather in Wisconsin. The preintervention data collection occurred during warmer months, and the daily temperature on the day of data collection was correlated with the size of the flare response. So you could see this as the MBSR group being protected from that seasonal increase in skin irritability."

Dr. Rosenkranz added, "Key points would be that MBSR may be beneficial to those with chronic inflammatory conditions by changing the way they relate to their condition and their symptoms, and in so doing, may reduce emotional neural reactivity and the contribution of this reactivity to further symptom expression. Our data suggest that those with conditions which have a neurogenic inflammatory component (eg, psoriasis, dermatitis, irritable bowel syndrome, asthma) may benefit more, in terms of decreased inflammatory potential, from this type of intervention."

Alex J. Zautra, PhD, who has studied cognitive behavioral and mindfulness meditation interventions in patients with rheumatoid arthritis, reviewed the study for Medscape Medical News. Dr. Zautra, who was not involved in this inflammation study, is professor of psychology at Arizona State University in Tempe.

Dr. Zautra said, "This is an interesting study, and the authors examine their data thoroughly and with sound understanding of the complexities involved in charting changes in inflammatory responses pre- and postintervention. They are to be commended for using an active treatment group, but missing is a no-contact contract. That absence makes any difference pre- to post- for which the groups do not differ suspect...this is acknowledged, but easily overlooked in their lengthy discussion. The sample size was also small, which makes the chance of chance findings a bit more likely, especially with so many dependent measures. Missing were changes in cytokines and cortisol that could explain the differences in flares between groups pre- to post-. The absence of findings in these putative mechanisms of action casts doubt over the findings that the mindfulness intervention was more beneficial."

This work was supported by the National Center for Complementary and Alternative Medicine, the National Institute of Mental Health, the National Institutes of Health, the Waisman Center, the Fetzer Institute, and gifts from Adrianne and Edwin Cook-Ryder, Bryant Wangard, Keith and Arlene Bronstein, and the John W. Kluge Foundation. Dr. Rosenkranz and Dr. Zautra have disclosed no relevant financial relationships.

Brain Behav Immun. 2013;27:174-184. Abstract