Jim Carmody: Body of Knowledge

Search Google News for the words “mindfulness” or “meditation” and you’ll get page after page of news stories about the effects of mindfulness on health: “Mindfulness eases pain.” “Meditation better than morphine for easing pain.” “In pain? Try meditation.”And, just recently, a flurry of news articles focused on mindfulness and hot flashes: “Mindfulness classes ease symptoms of menopause.” “Menopause symptoms: searching for relief.” “Meditation helps ease hot flashes.”

Since 2002, when the Women’s Health Initiative found that hormone therapy might increase a woman’s risk for stroke and some cancers, menopausal and post-menopausal women have questioned hormone therapy and have been left unarmed against hot flashes and other bothersome symptoms. Physicians and researchers have searched for ways to help women cope with the discomfort, and a new study of mindfulness and hot flashes indicates that, even without reducing the number or severity of their hot flashes, women can better manage the degree to which they are bothered by such symptoms.

Published in the journal Menopause, “Mindfulness training for hot flashes: results of a randomized trial,” by James F. Carmody, PhD, associate professor of medicine, and colleagues in the UMMS Division of Preventive & Behavioral Medicine, included 110 women who had bothersome hot flashes and night sweats every day. Women were assigned to two groups, one of which attended a weekly two-and-a-half hour Mindfulness-based Stress Reduction class run by the UMMS Center for Mindfulness. (The control group did not attend classes and had no intervention.) At the study onset, women reported approximately eight hot flashes each day and three night sweats each night, which they reported as “moderately” to “extremely” bothersome.

By the end of the eight-week program, the women who participated in the mindfulness training reported feeling less stressed and less bothered by their hot flashes. Their levels of bother continued to decrease over the following three months, when they described them as only “slightly” to “moderately” bothersome. Interestingly, the number and intensity of their hot flashes did not change. Instead, Carmody said, “Their increased capacity for mindfulness resulted in their awareness being less consumed with their symptoms, and attention being available for their interests, activities and responsibilities.” In other words, they felt less helpless and better able to cope in the face of their symptoms.

Somewhat surprisingly, Carmody said, women reported marked improvement in their sleep. “They said that before the program, when a night sweat would awaken them they’d get upset and feel stressed and have a difficult time getting back to sleep.” After participating in the program, they would employ the techniques they had learned, he said, to “redirect their attention away from the bother of the hot flash and back to something else, like the sensations of their breathing, facilitating a return to sleep.”

The effects remained several months after the conclusion of the mindfulness classes. Because similar mindfulness training programs are available across the country, this may prove to be a useful option for women coping with menopausal symptoms. Carmody and colleagues recognize, however, that the time commitment for the eight-week mindfulness classes may be problematic for many women and are exploring whether a shorter program might be equally effective.

The hot-flash study came not long after another study of the health effects of mindfulness: Carmody and colleagues at Massachusetts General Hospital found that mindfulness meditation training produced changes in particular areas of the brain, as measured through MRI. The study, published in January in Psychiatry Research: Neuroimaging, was the first longitudinal study to document meditation-produced changes in the brain’s gray matter, or structure.

“The gray matter study was featured in both the New York Times health blog and the Boston Globe in January and went viral,” said Carmody (see sidebar below). Magnetic resonance images were taken of sixteen participants prior to and after their participation in the eight-week MBSR program (similar to the program completed by the hot-flash study participants) and compared with seventeen wait-list control subjects. The final brain scans of the MBSR participants showed measurable changes in regions associated with memory, sense of self, empathy and stress, suggesting that perhaps changes in brain structure may be related to participants’ self-reported feelings of wellness.

What was interesting, Carmody said, was that such a change was noted after just eight weeks. “What is the minimum commitment needed to make a clinically significant change?” He and his colleagues are seeking funding to study the effects of shorter-term mindfulness training programs.

Carmody has undertaken a number of other studies of the effect of mindfulness training on health and behavior and has worked with several colleagues in the division. In one study published in Urology, mindfulness training was successfully integrated into a dietary change program for 36 men with a recurrence of prostate cancer. It found that the men who completed mindfulness training were better able to make and maintain a radical dietary change to the largely vegan prostate-healthy diet, and that the change was associated with improvements in a clinical marker for the disease. Carmody and colleagues are currently seeking funding for a larger trial of the program that includes genomic disease markers. In another study done with Preventive & Behavioral Medicine colleague Lori Pbert, PhD, professor of medicine, mindfulness training was compared to health education classes for more than 80 patients with asthma for its effect on quality of life, respiratory function and asthma-related immune function. Both groups reported an increased quality of life after eight weeks, but only the mindfulness training group maintained that improvement nine months later.

Carmody—whose work has been featured on the ABC World News, National Public Radio and other international radio networks—continues to add to the body of evidence that mindfulness, mind-body training and meditation have a measurable effect on human health and well-being. He is keenly interested in understanding the degree to which—and the reasons why—participants respond to these programs and the degree to which apparently different mind-body training programs such as yoga and tai chi may have common mechanisms by which they affect health. “We’re creatures of habit,” he says, “and as a clinical scientist I’m interested in how patients can be led to recognize that their habitual way of attending and responding to their everyday experience affects their well-being.”