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January 25, 2007

Researcher advocates meditation for pain, stress reduction

Once an hour, a soft chime sounds in Carol Greco’s office. The melodic tone is a subtle signal, reminding her to pause briefly regardless of what she’s doing, take a breath and be “mindful” of the moment.

Greco, a lupus researcher and assistant professor in the School of Medicine’s Department of Psychiatry, has been practicing mindfulness meditation for nearly a dozen years.

The practice, which has its roots in Buddhist vipassana meditation, emphasizes observing and focusing on the present moment.

“You learn to look at things differently and you experience things in a more full sense,” Greco said. For instance, by concentrating on an action as basic as breathing and the sensations associated with it, “You realize what a rich internal landscape there is,” she said.

Appreciating the moment without worrying about the past or rehearsing for the future, and developing the capacity to observe increases the joy of experiences one might previously have thought undeserving of attention.

The practice of mindfulness meditation also is gaining attention as scientific research shows its usefulness in managing stress, pain and other symptoms of chronic illness.

Jon Kabat-Zinn, of the University of Massachusetts Medical Center, in the 1970s developed a Mindfulness-Based Stress Reduction (MBSR) program. A 1985 study he co-authored found research subjects with chronic pain showed statistically significant reductions in measures of present-moment pain, negative body image, inhibition of activity by pain, symptoms and mood disturbance, and psychological symptoms including anxiety and depression following a meditation-based program. In addition, their use of pain medication decreased while activity levels and self-esteem increased.

A four-year follow-up found many of the research subjects continued using the meditation techniques and, although pain ratings tended to revert to pre-intervention levels, many of the physical and psychological improvements were maintained.

A 1992 study Kabat-Zinn co-authored found that a group stress reduction program based on mindfulness meditation reduced anxiety and depression symptoms in patients diagnosed with anxiety disorders. A 1995 follow-up study showed a significant number of those patients maintained the improvements.

Other studies have found MBSR can speed healing in psoriasis patients and can improve symptoms in patients with fibromyalgia.

Greco, a clinical psychologist, has been part of a team of Pitt researchers who studied its effect on patients with chronic lower back pain. Other researchers at Pitt are studying the practice to determine whether it may be useful in smoking cessation and in relief from hot flashes.

Today, more than 300 practitioners worldwide offer MBSR courses.

A new eight-week session based on MBSR principles is set to begin Feb. 7 at UPMC Shadyside’s Center for Integrative Medicine.

“Mindfulness is becoming a very big movement in psychotherapy,” Greco said, adding that increasing numbers of therapists use it in their work. Greco has studied non-pharmaceutical methods of stress and pain management, including biofeedback and cognitive behavioral therapy. She began investigating mindfulness meditation as a way to help her patients who have the autoimmune disease lupus. She found it has changed her life as well.

“Like many in academia, I was more anxious than I wanted to be,” Greco said. “The practice was infinitely helpful to me,” she said, noting that it has become a central part of her life.

Her personal practice includes occasional group meditation as well as daily periods of sitting alone undisturbed during which she focuses inward and pays attention to her breathing and the associated sensations she experiences.

While her personal meditation practice has a spiritual element, mindfulness can be practiced as well in a strictly secular sense.

Greco began teaching the practice in 2004, initially as part of the pilot study of older adults with chronic lower back pain, followed by the introduction of the public class in 2005. The class focuses on meditation-based stress reduction, Greco said, adding that it contains nothing that would be incompatible with a participant’s organized religion.

Greco met MBSR program inventor Kabat-Zinn at a 1994 conference. “I was blown away by the entire concept of using mindfulness practice to help people with chronic pain conditions that Western medicine hasn’t been able to touch well enough,” she said.

MBSR emphasizes that mindfulness is an innate ability that exists universally within humans. As such, it merely needs to be rekindled rather than acquired, MBSR teachers say.

Greco has seen improved quality of life in some of her lupus patients who have developed mindfulness meditation practices, and in participants in the chronic pain study, results of which are being prepared for publication. She recalls one participant who experienced such a huge improvement in his ability to walk that could stop using the cane he once needed. “By the end it looked like he took 20 years off his age,” she said. Others who continued to have pain after learning the meditation techniques showed a different attention and acceptance toward their experience, she observed.

Stacy Hoffman, an administrative coordinator in the University of Pittsburgh Cancer Institute development office, took Greco’s class last spring. “I’ve pretty much my whole life had a lot of problems with anxiety,” she said, adding that she’d read articles about handling stress but had no real skills to use in combating it.

Although she had no trouble with chronic pain, Hoffman said she found it interesting that others had found meditation helpful. A self-described pessimist, she figured the skills might come in handy someday, “so I’d know how to take control of things if something like that should happen,” she said.

Hoffman said she gauges the effectiveness of the course by her reaction to two biopsies she needed last year. With the first biopsy, in February, “I was just bouncing off the walls. I had such tension about it and didn’t know what to do about it,” she said.

Because the second procedure, in December, was a surgical biopsy, “I thought that would cause more anxiety, but I was better equipped to deal with it,” she said. Remembering the tenets of dealing with one thing at a time and not allowing anxiety to snowball by racing into future thoughts, “I was much better able to handle it,” she said.

She admitted she was not as diligent as some classmates at practicing, but has found the skills she learned to be of continuing use. Hoffman said she attends monthly meditation meetings to help keep in mind the idea that there is a difference between thoughts and facts, and to avail herself of the group discussions that accompany the meditation.

“I think it’s a great thing to have. With all the other kind of medicine that goes on here, there’s one that addresses the mind-body connection,” she said.

Greco said the class itself is challenging, consisting of weekly two-hour sessions. She offers a free orientation class to allow would-be students to find out whether it’s for them. Orientation for the upcoming session is set for 7:30 p.m. Jan. 31 at the Center for Integrative Medicine in Shadyside.

Information on the class is available online at or by calling (412) 623-3023.

Meditation practice comes at the beginning and end of each class. In between, there’s discussion. “It’s always centered around meditation and noticing what we do,” Greco explained. “A lot of the class is bringing meditative practice into daily life,” she said.

“It’s definitely not group psychotherapy. We don’t talk about our mothers,” she said. Personal situations may come up as participants discuss their practice and the challenges they are having, but Greco said she makes the point early on that the class is not an opportunity to solve someone else’s problems. “Sharing is helpful, but it’s different from telling people what they should do,” she said.

Students also learn about stress and how much of it people tend to put onto themselves.

“Metta,” or loving-kindness, meditation in which participants consciously draw up feelings of compassion for themselves and others is introduced later in the class, Greco said. She notes that it’s been a well-received addition.

The in-class meditation takes several forms: sitting is one part; mindful movement — including some yoga stretches and postures — is another. Walking meditation is included, as is body scan practice, in which students slowly focus on various parts of the body one at a time and contemplate how they are feeling.

The tool of mindfulness develops one’s ability to observe the body’s reactions and accept that the feelings being experienced are okay. “You learn how not to be married to your thoughts,” she said.

Like any other exercise, meditation is enjoyable but also hard, Greco said. “You’re learning what you can do, and you can develop confidence in reducing or dealing with pain.”

Regardless of your condition, Greco said, “There is more right with you than what is wrong with you.”

—Kimberly K. Barlow

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