October 2009 Article of the Month
Epel, E., Daubenmier, J., Moskowitz, J. T., Folkman, S. and Blackburn, E. "Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres." Annals of the New York Academy of Sciences 1172 (August 2009): 34-53.
SUMMARY and COMMENT: The 2009 Nobel Prize in Medicine was awarded last week to three researchers for their investigation of how cellular aging is linked to telomeres (DNA "caps" at the end of chromosomes) and telomerase (a protein responsible for telomere length and maintenance): namely, how longer telomeres and more telomerase activity indicates greater cellular longevity, and shorter telomeres and less telomerase activity is associated with cell death. One of the Nobel laureates, Elizabeth Blackburn, is a co-author of our featured article this month, which is partly a review, partly a report of the authors' original research, and partly a theoretical speculation supporting the idea that meditative practice may slow cellular aging. Chaplains should be well-served by some familiarity with this work, both because it is presently a "hot topic" and because it holds out much to consider regarding the nature of meditation pertinent to the functioning of the body.
Telomeres have been likened by Dr. Blackburn (elsewhere -- see her essay, "Telomeres and Telomerase in Health and Disease" in Related Items of Interest, below) to the caps on the tips of shoelaces, which keep the shoelaces from becoming frayed over time. By analogy, the shorter or more "worn away" are such protective "caps" on chromosomal strands (from the cumulative effects of cell division), the greater the incidence of cell death. Previous research by the authors has drawn connections between the shortening of telomeres and stress reactions in the body, and so the present article takes those connections one step further to explore how certain forms of meditation may ameliorate stress reactions affecting telomere length, in turn affecting cellular longevity.
The authors focus on stress arousal in the body and on two types of stress cognition that influence it: threat appraisals (which "enhance negative emotional responses to a stressor by construing it as a threat to oneself and amplifying the significance of the stressor" [p. 34]) and rumination (a repetitive thought process by which negative appraisals -- and the stress reaction resulting from them -- are prolonged, and by which a person may feel distress about the emotional response itself). To reduce these destructive responses to stress, the authors consider mindfulness meditation, described as a secular adaptation of traditional Buddhist meditation techniques.
The practice of mindfulness is outlined:
Instructions for the formal practice of mindfulness meditation entail purposefully directing attention to one's experience in the present moment with an attitude of open curiosity and acceptance. An upright sitting posture with minimal movement is encouraged (with eyes either open or closed) to allow the body to relax and the mind to remain alert. Attention is directed to a pre-determined object, usually localized sensations involving respiration, such as those at the tip of the nose (external objects can also be used, such as a picture). Novice practitioners usually report that after a short period of time, they become distracted by thoughts, feelings, sounds, or physical sensations and their focus on the intended object is lost. At this point, the instruction is to notice these experiences ("distractions") fully without judgment, to "let them go," and return attention back to its intended object. Instructions for attending to "distractions" vary -- from silently applying a specific label to the object (e.g., anger, anticipation, sound) to applying the general term "thinking" to any thought, to not making any mental notation whatsoever. Labeling an experience is believed to strengthen recognition of it and this may be particularly helpful for some individuals or when experiencing intense distractions. The process of becoming distracted and returning to the attention is repeated over and over again during formal mindfulness practice. The goal is to increase awareness of present-moment experience to increasingly subtle levels and to strengthen stability of attention. The goal is not to ignore or "get rid" of thought in order to have a "blank" mind, but to notice with full attention whatever arises. In this sense, there are no distractions; whatever is noticed in the field of awareness can be observed. Interestingly, it can be painful to observe thoughts one wishes to avoid, so in this sense, the practice cultivates a willingness to experience discomfort and reduces attempts to escape it. At the other extreme, the goal is not to indulge in pleasant thought or achieve a pleasant experience (although this may occur), but to remain aware of each experience as it occurs. [p. 41]
One product of this practice is that a person may become aware of thought per se [i.e., the experience of thinking itself] rather than being simply aware of individual thoughts, and that shift in perspective on thinking may lead to a more positive and resilient response to stressors, effectively making stressors seem less of a treat and triggering a more healthy stress arousal. "Mindfulness may [also] serve to increase a sense of control, not simply by reacting more 'coolly'…, but by lessening one's perceived need to be in control, especially when situations are determined to be uncontrollable" [p. 43]. Moreover, "[i]ncreasing awareness of present-moment experience may disrupt ruminative thought processes that play a role in prolonged stress reactivity" [p. 44]. Mindfulness, as a kind of "metacognitive awareness," may "interrupt ruminative thinking, increase the ability to evaluate the accuracy of thoughts, and allow greater freedom of choice in responding to thoughts and emotions" [p. 44]. The authors point out that this "practice of changing how one relates to thoughts and emotions contrasts with cognitive behavioral therapies that emphasize changing the content of thoughts": "Mindfulness practice involves first allowing awareness of thought and then becoming less engaged or attached to the thoughts themselves before attempting to evaluate their accuracy" [p. 44].
…[W]e speculate that certain types of meditation can increase awareness of present moment experience leading to positive cognitions, primarily by increasing metacognitive awareness of thought, a sense of control (and decreased need to control), and increased acceptance of emotional experience. These cognitive states and skills reduce cognitive stress and thus ability for more accurate appraisals, reducing exaggerated threat appraisals and rumination, and distress about distress. These positive states are thus stress-buffering. Increasing positive states and decreasing stress cognitions may in turn slow the rate of cellular aging. [p. 48]
The authors concentrate on the practice of mindfulness meditation and on a program of Mindfulness-Based Stress Reduction (MSBR), but they acknowledge that other types of meditation may have similar effects: mantra meditation [such as has previously been highlighted in our November 2005 Article-of-the-Month] and Tai Chi. However, the article does not address other forms of meditation that are explicitly religious, and there is no mention of "prayer." In addition, there is no assertion that adopting any form of meditation will yield quick results in terms of cellular longevity --in fact, the model here assumes that the interplay between meditation, stress, and telomere-related cellular aging is a slow process over time, and that meditative practice is effective only when it has been so deeply incorporated into one's life that it causes a fundamental shift in how one perceives the world and relates to an awareness of it. [But, see below, in Related Items of Interest, §I., the study by Ornish, et al., which suggests that an intervention that includes a meditation component may affect telomere length in as little as three months.]
For chaplain researchers, this work holds out a number of questions and opportunities: What other forms of meditation or prayer might influence cellular aging? Would some practices produce results at the cellular level more quickly than others? Could the ability to measure telomere length help identify health-specific traits of a variety of spiritual practices by sampling religious populations with strongly identifiable "prayer lives"? Would a premeditated attempt to influence cellular aging introduce a utilitarian motive that could complicate the meditative process and make it less effective in that regard? Could mere cognizance of connections between meditation and imperceptible physiological processes enhance or diminish the meditation experience? Is there an assumption here that mindfulness meditation is a kind of superior form of practice, and how might such an assertion itself be a stressor -- with theological implications -- for people from other spiritual/religious traditions? Could mindfulness meditation be more effective for cellular longevity when it is not divorced from its (Buddhist) spiritual roots?
The article obviously delves into highly technical material, but this reader (who had no foreknowledge of the topic) found it to be quite accessible and thought-provoking. Most helpfully, the authors provide a graphic model of their theory at the outset (--see Figure 1, p. 35). Co-author Blackburn once commented in an interview in the New York Times about how her work was unexpectedly branching out into an exploration of meditation: "Ten years ago, if you'd told me that I would be seriously thinking about meditation, I would have said one of us is loco" [--from "A Conversation With Elizabeth H. Blackburn: Finding Clues to Aging in the Fraying Tips of Chromosomes," published July 7, 2007]. For this reader, a chaplain, I might have had a similar response if someone had said that I'd be pondering telomeres. Yet, such is now the interdisciplinary nature of the field of spirituality & health research.
Suggestions for the Use of the Article for Discussion in CPE:
CPE students might not be predisposed to tackle this article, but it should be within their grasp. The material generally confronts pastoral care providers with an important issue: What do you think about meditation being related to physiological processes at the cellular level? Does it make the process of meditation more or less rich or appealing? Is research that attempts to find such links necessarily reductionistic about spirituality itself?
In a more substantive exploration of the article, students might be challenged to think about connections between meditation (or other spiritual practices) and stress. How do meditative or spiritual exercises help people to cope with stresses? Discussion could go beyond the article to consider what spiritual practices and religious outlooks might lessen -- or heighten -- negative threat appraisals or rumination. Also, what spiritual practices and religious outlooks might enhance "psychological thriving"? [See p. 38, regarding "psychological thriving."]
Related Items of Interest:
I. For more background material on telomeres, see:
II. This month's article refers [p. 44] to a study on mantra meditation by Jill Bormann. For more on that form of meditation and on Bormann's research, see our November 2005 Article-of-the-Month.
III. This month's featured article is part of a theme issue of the Annals of the New York Academy of Sciences on Longevity, Regeneration, and Optimal Health Integrating Eastern and Western Perspectives. Most of the articles deal with yoga practice and Indo-Tibetan meditation and healing traditions. Among those of possible interest:
IV. Processes of threat assessment have figured into a number of our Articles-of-the-Month, but see especially the selections for February 2008, regarding evolutionary theories of the structure of the brain, and October 2006, which looks particularly at the role of the amygdala in processing emotions.
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