Can Mindfulness Practice Slow the Progression of HIV?
Tom Moon, MFT
In a recent column (“The Power of Mindfulness”) I mentioned that research is now underway to determine whether or not mindfulness meditation practice can slow the progression of HIV. Several people asked for more information about this, so what follows is a more detailed discussion of the question.
Mindfulness has been described as “the practice of not contending with life.” It refers to a state of awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally, to things as they are. In mindfulness, we stop “going with” our thoughts, feelings and impulses and just let them come and go on their own while anchoring our attention in the body. Mindfulness has been practiced by Buddhists for almost twenty-six centuries, but entered the mainstream of western medicine through the pioneering work of Jon Kabat-Zinn in the late 1970’s. He and his associates at the University of Massachusetts Medical School developed an eight-week training called Mindfulness Based Stress Reduction (MBSR), which utilizes various mindfulness meditation and yoga practices to help patients lower stress and cope with pain and illness. The training is so highly effective in relieving stress that it is now offered to patients in over 200 clinics and medical centers in and outside of the U.S.
How is this relevant to the treatment of illness? The relationship between stress and illness is a focus of the relatively new science of psychoneuroimmunology, which has amassed a mountain of data since 1975 demonstrating that stress can produce profound health consequences. When stress is of limited duration it can actually have beneficial effects on the immune system. But when the anxiety, fear, tension, anger or sadness of stress last for a long time or become chronic, the system is unable to maintain its equilibrium, and observable health declines can follow. In one epidemiological study, for example, mortality from all causes increased in the month following a severe major stressor such as the death of a partner or loss of a job. Prolonged stress has also been shown to be linked to increases in total number of white blood cells, as well as decreases in the number and percentage of helper T-cells and suppressor T-cells.
But is the converse true? If stress decreases T-cells, can lowering stress through mindfulness practices reverse that process and slow the progression of diseases such as HIV? It is a reasonable question. Prior research has demonstrated that MBSR improves mood and reduces stress, and other studies have shown that stress and depression are associated with more rapid HIV progression.
In July of 2008, researchers at UCLA reported the results of a study which “provides the first indication that mindfulness meditation stress-management training can have a direct impact on slowing HIV disease progression,” said lead study author David Creswell, a research scientist at the Cousins Center for Psychoneuroimmunology at UCLA. He added “…if this initial finding is replicated in larger studies, it’s possible that such training can be used as a powerful complementary treatment for HIV disease, alongside medications.”
In this study, 48 HIV positive adults went through the standard eight-week MBSR training, while a control group attended a one-day MBSR workshop. Participants in the eight-week training showed no loss of CD4 T cells, while the control group showed significant declines. This is an important finding, because CD4 T cells are the “brains” of the immune system, coordinating its activities when the body is attacked. HIV slowly eats away at these cells, weakening the immune system. The researchers also found a “dose response” relationship between MBSR attendance and CD4 T cells, which means, said Creswell, “the more mindfulness meditation classes people attended, the higher the CD4 T cells at the study’s conclusion.” Researchers found that the overall positive effects held true both for those who were on HIV medications and those who were not.
The team is now examining the underlying pathways through which mindfulness practice reduces stress, using brain imaging, genetics, and immune system measurements. “Given the stress reduction benefits of mindfulness meditation training, these finding indicate there can be health protective benefits not just in people with HIV but in folks who suffer from daily stress,” Creswell said.
So can mindfulness meditating actually slow the progression of HIV? Maybe. We can’t draw definitive conclusions from one small study. Fortunately, a larger research project, called the Staying Well Study, examining the same question as the UCLA project, is currently winding up at the UCSF Osher Center for Integrative Medicine. We will know the results soon. If the findings of this study corroborate those of the UCLA study, we will have impressive evidence that mindfulness meditation actually can serve as one effective aspect of an integrative approach to the treatment of HIV.
In the meantime, for those who would like to find out if MBSR can improve the quality of their lives, instruction in the basic practices of the training are available as four cds in the Guided Mindfulness Meditation audiobook by Jon Kabat-Zinn (available through mindfulnesscds.com and Amazon.com). His book, Full Catastrophe Living, is also recommended as an excellent companion resource.
|Tom Moon, MFT, has been in private practice in San Francisco for over twenty-five years, working with a primarily gay male clientele. The above article was published in his popular column, The Examined Life (printed bi-weekly in the San Francisco Bay Times) and other publications around the country. Tom completed the Hakomi Skills Training for Professionals in 1999.|