09 July 2018

Cancer-treatment-Is-it-OK-to-say-no?

Guest blog from Dr Ruth Gawler
My dear 82 year old mum told me this week that following a mammogram she has been diagnosed with probable breast cancer and she does not want a biopsy or any treatment. 
Being her oldest daughter and a doctor, all this came as a bit of a shock; and it raises questions around the right and sensibility of refusing treatment.
Now mum told me her news in a matter of fact, unemotional way; as if she just wanted me to understand this was her decision and she was simply informing me. She has also told the family and is quite open about her diagnosis and choice. 
As it happens, I have another elderly patient who also is saying no, so this week let us examine what is behind these powerful choices - and their wider implications, but first,

                      Thought for the day - mid winter style


       An elderly American Indian was asked by a white man
       How it was he managed to wear so few clothes in Winter.
       “You white people,” he replied
        “Does your face get cold in winter?”
        “No.”
        “We Indians… all face!”  




My mother has been living in an aged-care facility for over 3 years due to relentlessly progressive immobility from a number of causes including longstanding kyphoscoliosis and arthritis, reflex sympathetic dystrophy, chronic muscle atrophy etc etc. 
Yet mum’s mind is clear as a bell, she has a formidable memory and the kind of well-informed, original conversation that has a string of visitors - family and friends - almost queuing to be engaged and entertained regularly. My mother is what they call a real live wire; well-informed, gregarious and with a great sense of humour. 
So, after she had called me with “the news” I went to visit her in her room on the 5th floor of her aged care residential facility overlooking St Kilda Rd. To my pleasant surprise, from her usual sitting position on her bed she greeted me with a big smile; obvious delight to see me all over her face. Her arms extended for a hug and a kiss; I put the shopping I had done for her on the floor, and we embraced. 
Now mum had also made it clear to me that she did not want my medical advice, and I was to refrain from giving my opinion on her medical situation. Not an easy call for someone like myself who has worked intensively with people managing cancer for nearly 2 decades. But, I could do it and had resolved just to talk about other things unless she raised the topic. 
Being a regular meditator makes this kind of plan relatively doable. After all, when we meditate we learn how to place our attention where we want, and to be aware when we are distracted. So it was just a matter of deciding to talk about other things and remembering the plan. 
As it happened, we did talk about many things, including the blanket she was knitting, her conversation on Skype with her sister in Israel, the potato latkes (fried classic Jewish potato cakes) that had been brought for her dinner, and the funny weather we were having.  
Then, at one point she repeated that although her mammogram had shown probable breast cancer she did not want a biopsy or any treatment. 
Like any daughter I was initially surprised and upset. 
Mum told me that she would not cope well with the medical procedures and it was not her wish at this time in her life to be going through more suffering than she already had. 
What would you call that? 
Stupid? Sensible? Crazy?  Self-aware? 
In shock? Denial? Depressed? Rebellious?  
Some would analyse her reaction as “scared of the medical system”, or “ill-informed”. 

Others may say that she has so many other health problems, her life may just be too hard to manage any longer. Mum has a “frozen foot” with severe constant neurogenic pain, recurrent digestive problems and a big swollen tummy, great difficulty walking and needing to shuffle along in a walking-frame, failing eyesight, and so on and so on. Maybe this recent “breast cancer diagnosis” just slipped into the list of all her other physical challenges.
And another factor - my dear mum has been pretty overtly rebellious since she divorced my dad when I was 15 (and had then exploded the lid of her life as a virgin-bride, hardworking mother of 3, and piano teacher who had cooked and cleaned for her family for 16 years). 
But given all this, it may still be quite possible mum is making a very reasonable, rational personal choice to not engage further with the medical industries on this matter. Mum is a double degree, university educated, highly intelligent, well-informed elderly lady with human rights. And here she is telling us all clearly in sound mind that it is her wish is to curtail further medical investigation and treatment.  
So many ways of looking at an old lady saying “No thanks!”
Now in my medical practice is a 78 year old highly educated Swiss lady who was diagnosed with Ovarian Cancer about 4 years ago. 
On medical advice she received chemotherapy that was not deemed to be curative but would “prolong her life and improve her quality of life”. 
She described this treatment to me as “a nightmare” of misery that left her with neurological deficits – numbness in her hands and feet, extreme tiredness, weakness and depression. 
Yet, she told me “it may have done some good because her cancer marker went down” and “maybe it was worth it” at the time.
Now a couple of years later after reading You Can Conquer Cancer and attending a cancer residential program she feels wonderfully well once more, and describes her life as “better than it has ever been”. 
She is eating a clean (organic) wholefood-plant-based meals, she is meditating regularly, using an infra-red sauna regularly, taking certain specifically recommended supplements prescribed by an expert and exercising regularly. 
Her mood and energy levels are excellent she tells me, and her relationships with her daughters and grandchildren are good. 
She has no sense of being unwell. 

However, her cancer marker CA125 is slowly going up. Very slowly going up. This means that she is regularly advised to have “more chemotherapy” albeit something slightly different than the last course. 
It is with great personal effort, courage and resolve that she says “no thank you” to the “very compassionate and caring oncologist” who has been regularly taking care of her. She has had incredible difficulty doing this. 
This great, mature lady has studied the efficacy (effectiveness) of the treatment offered and she has had personal experience of similar treatment. This woman too is university educated and by the by, was a leader in her field of childhood education in her middle years. She is aware that her body is actually doing a good job of minimising the growth and impact of her metastatic cancer with all she is already doing to stay well. She also has the resources and support to manage this lifestyle long-term. 
Both my mum and my Swiss patient are old dames who have left the countries of their birth and childhoods, have seen wars come and go, families grow up and leave and make lives of their own, and been engaged, hardworking members of the communities they live in. 
Of course they are different in many ways but here they are in their twilight years saying “No thanks” to their doctors. 
Do they have this right?  
And could they be right to do so ? 
And if the answer is yes to both these questions, then why is it that we do not make it easier for them?


       Ruth's mother second from left with her two daughters on the right celebrate a milestone birthday.


Ruth Gawler's 
next meditation retreat - with Julia Broome

Meditation - Pure and Simple

Whether burnt out, dealing with physical or mental issues, this retreat provides a unique opportunity to be led and supported by a doctor well versed in Mind-Body Medicine who has a particular expertise with deep relaxation and healing.

Ruth will focus in this retreat upon the meditation techniques of Dr Ainslie Meares and Ian Gawler. 
The only meditation retreat Ruth is leading in 2018 that will be specifically focussed on meditation's therapeutic healing benefits.  

Combine deep relaxation techniques and mindfulness meditation to release the stress we carry in our bodies in this busy and complex modern world. Ideal for healing, rejuvenation and opening our awareness.

Ruth’s teaching style is one of openness and authenticity, and there will be plenty of opportunity for questions and discussion. Techniques covered in this retreat will be accessible and engaging for both beginners and more experienced meditators. This retreat is well suited to all Health Professionals. Certificates of Attendance for CPD points issued, on request at the end of this retreat.

DATES                                    September - Monday 10th to Friday 14th September 2018
VENUE                                   Yarra Valley Living Centre, Rayner Crt, Yarra Junction, Victoria
ENQUIRIES, BOOKINGS     The Gawler Foundation ClientServices@gawler.org
                                                 and 1300 651 211 - Call Mon-Fri 9-5pm





WEBSITE LINK CLICK HERE





25 June 2018

Top-Ten-Reasons-to-Meditate

Many people these days are meditators. Many who read this blog are even regular meditators! Others? Part time. So what motivates us to make time to meditate; to take time to meditate? And how does that compare to others?

This week a top ten list of reasons to meditate, and a question … What motivates you?, but first



         Thought for the day


Learning to focus our attention 
And suspend the stream of thoughts 
That normally occupy our mind


             Definition of meditation 
from the National Centre for Complementary and Alternative Therapies in the USA




People make time in their busy lives to meditate for many and varied reasons.

For some, it is an essential element in their spiritual practice; for others, a far more mundane reason. Here is a suggested the top ten list with an invitation to comment…

Regaining balance
Meditation is a modulator. It brings things into balance. Actually, it brings many things into balance - body, emotions, mind and even spirit. It does this by helping us to let go of the stresses of life and re-establish our own natural, healthy, balanced state. Meditation leads to deep physical relaxation and deep mental calm and peace, and with these two - a natural state of balance.

Relaxation
Most meditation techniques lead of themselves to a good degree of physical relaxation. However, the technique I have found most useful over the years emphasizes and starts with deep physical relaxation.
This leads to a relaxed, healthier, more active, energetic body. This physical relaxation quite effortlessly can flow on to bring relaxation to the mind. And it feels great!

Stress relief
Meditation is well known for it stress relieving properties. Through a combination of relaxing the body and helping us to react differently in our mind to potential stressors, meditation provides rapid relief. This reduces the risks from the many stress related illnesses, has a direct positive benefit with relationships and leads generally to greater efficiency and wellbeing. Again, this also feels great!

Increased concentration
At the heart of good meditation practice is concentration. So as we practice meditation, we develop our concentration. This then flows into all aspects of life, meaning we can apply our minds to better effect.

Increased mindfulness
We all know how good it feels when someone gives us their full attention. And how unsatisfying it is when they do not. We all know how bad feeling judged by others feels; how good it is to be listened to, accepted and worked with collaboratively. All the positives here are to do with mindfulness - another of the core practices we develop as we meditate regularly. Mindfulness - giving whatever we do our full attention free of judgement or secondary commentary.


Increased energy
If we are stressed out, we are burning heaps of energy in the process.

If we are physically tense we are wasting heaps of energy in that tension.

As we meditate and learn to become more relaxed, calmer and clearer, a good deal of the effort goes out of whatever we do.

Things just seem to get easier, and there is more energy available within us for the things that really matter.





Better health
Prevention? Meditation is well proven to assist in preventing most of the things you would rather not have.
Healing? Better Immunity? Faster recovery from injury? Remember, meditation is a modulator, it helps to create the ideal conditions within the body and mind that enable good health - prevention and recovery.

Better decision making
Doubt, confusion, worry, indecision; all these things go hand in hand with stress. Meditation leads to a calm and clear mind. Many people notice once they begin meditation that choices seem easier to make. With a calm and clear mind we are able to think more clearly, what to do seems more obvious, we develop more confidence in the choices we do make and so we follow them through and get good results. This is a key to what we know as “positive thinking”.

Heightened intuition
The active thinking mind and emotions can combine to become a real double edged sword - could be really good, could be really bad - for us and for others. Yet we all know there is this deeper aspect to our mind that has an innate wisdom; that can be relied upon for good advice. When we learn to meditate, slow down the chatter within the thinking mind and allow our emotions to settle a little, we naturally come within closer contact of this inner wisdom. It is as if a veil lifts and that wiser part can speak to us - and be heard. This too can feel really good! And lead to great decisions about all aspects of life.

Heightened spiritual awareness and connectedness

So many lonely, disconnected people these days. So many people seeking some deep relief or inner high through drugs or destructive behaviours.

Many then are turning to meditation as they seek to find meaning and purpose in their lives.

Many seek answers to the great philosophical questions - Who am I?, Where did I come from?, and where am I going to? And What is life?

And the fact is that over millennia meditation is a proven pathway to personally satisfying answers to these questions.

Perhaps we left the best reason to meditate to last? 
What is it that motivates you? Maybe time for a comment below?





12 June 2018

The-Jade-Buddha-in-Bendigo-Home-at-last

Imagine this… A Buddha carved from a million dollars worth of top quality jade now residing in regional Victoria! What a story… Well worth telling…

For those unacquainted, this giant Buddha was carved from one massive piece of pure polar jade found in the Yukon - the far northwest of Canada - 18 years ago.

I had the good fortune to be invited to attend its inauguration when the Jade Buddha arrived at its new home - the Atisha Centre outside Bendigo on Friday 18th May.

So this week, this incredible story and encouragement to visit, plus details of Ruth's upcoming meditation retreat in the Yarra Valley, but first

Thought for the day (a longer poem in honour of the Jade Buddha …)

The Journey

One day you finally knew

What you had to do, 
And began,

Though the voices around you

Kept shouting

Their bad advice-
-
though the whole house

Began to tremble

And you felt the old tug

At your ankles.

"Mend my life!"

Each voice cried.

But you didn't stop.

You knew what you had to do,

Though the wind pried

With its stiff fingers

At the very foundations,

Though their melancholy
was terrible.

It was already late

Enough, and a wild night,

And the road full of fallen

Branches and stones.

But little by little,

As you left their voices behind,

The stars began to burn

Through the sheets of clouds,

And there was a new voice

Which you slowly

Recognized as your own,

That kept you company

As you strode deeper and deeper

Into the world,

Determined to do

The only thing you could do-
-
determined to save

The only life you could save.

Mary Oliver

Some of us may have been fortunate to see the Jade Buddha during its travels or buy a small piece made from the offcuts.

The Jade Buddha is 2.5 metres high and sits on an alabaster throne of close to 1.6 metres. Weighing in around 4 tonnes, it is considered to be priceless and is shown here in its uncut form with Ian Green (on the right), the man behind the whole project.




The Jade Buddha was modelled upon the Buddha inside the Mahabodhi Stupa in Bodh Gaya (India).  This Buddha was chosen because it is recognised by most Buddhists as the closest likeness to the Buddha himself.




The Jade Buddha project 
In early 2003 Ian Green heard about the massive piece of jade known as Polar Pride.



Ian then spoke to his spiritual master, Tibetan Lama Zopa Rinpoche (whose organisation FPMT has a major centre in Melbourne, the Tara Institute - along with many other centres around the world).

That night Lama Zopa had a vision that the boulder would become a Buddha that would illuminate the world.

Lama Zopa then told Ian “you must turn this jade boulder into a Jade Buddha as a holy object to offer to the world”.

            Lama Zopa with the Dalai Lama


The next 5 years were devoted to raising the necessary funds, selecting the best jade master carvers, shipping the boulder to Thailand, preparing a total of 4 prototypes, carving and polishing the Jade Buddha. Completion?  December 2008.

World tour
Commencing early in 2009 the Jade Buddha for Universal Peace toured the world with the objective of inspiring everyone who sees it to find peace in their family; peace at work; peace at school, peace in their community and most importantly peace in their heart.

The Jade Buddha tour travelled to over 120 cities in 20 countries and an estimated 12 million people spent time in its presence.

Atisha and the stupa
The stupa in which this remarkable statue is now the centrepiece, is nearing full completion but already stands 50 metres high and 50 metres wide at its base, making this $20 million building the largest of its type in the western world.



Atisha had its genesis in the advertising career of its now President, Ian Green. Turning his back on the “rat race” and looking to India for solace and meaning, Ian found Buddhism before returning to Melbourne; whereupon his father offered him 50 acres in Myers Flat, near Bendigo.

Over the past 38 years, Ian has supported the Atisha Buddhist centre as it has expanded to over 210 acres and now includes a monastery, a retreat centre and an inter-faith peace garden. There are also plans to create a school and an aged-care facility.

"A little town that runs on Buddhist values of harmony and cooperation and, you know, peace — but that also runs on the grounds of sustainability," Ian said.

Highly recommended for a visit
No doubt the Jade Buddha and the incredible stupa will be a draw card for serious pilgrims and curious tourists - who may just make a connection or have their curiosity aroused and turn towards the dharma.

For any of us; what I do suggest is that whenever you can, make a visit - it is quite extra-ordinary and the atmosphere in the stupa, when you sit in front of the statues of the Jade Buddha and Guru Rinpoche, plus a huge White Tara thangka is quite something.



Well worth making time for…

Jade Buddha    WEBSITE


Ruth Gawler's 
next meditation retreat

Meditation - Pure and Simple

Whether burnt out, dealing with physical or mental issues, this retreat provides a unique opportunity to be led and supported by a doctor well versed in Mind-Body Medicine who has a particular expertise with deep relaxation and healing.

Ruth will focus in this retreat upon the meditation techniques of Dr Ainslie Meares and Ian Gawler

Combine deep relaxation techniques and mindfulness meditation to release the stress we carry in our bodies in this busy and complex modern world. Ideal for healing, rejuvenation and opening our awareness.

Ruth’s teaching style is one of openness and authenticity, and there will be plenty of opportunity for questions and discussion. Techniques covered in this retreat will be accessible and engaging for both beginners and more experienced meditators. This retreat is well suited to all Health Professionals.

DATES                                    September - Monday 10th to Friday 14th 2018
VENUE                                   Yarra Valley Living Centre, Rayner Crt, Yarra Junction, Victoria
ENQUIRIES, BOOKINGS     The Gawler Foundation ClientServices@gawler.org
                                                 and 1300 651 211 - Call Mon-Fri 9-5pm





WEBSITE LINK CLICK HERE



28 May 2018

Are-parachutes-useful?-Evidence-Based-Medicine-and-a-plea-for-common-sense…

We are all making decisions every moment of the day. Some big. Some inconsequential.

So how do we decide what to do?

Current mainstream medicine loves describing itself as “Evidence Based”. The implication is that all decisions are made based upon “good scientific evidence”, with randomized trials being the “gold standard”.

But would you volunteer for a randomized controlled study into the efficacy of parachutes?

Maybe not; so this week, an exploration of what really does constitute “good scientific evidence” - and where does common sense fit in; but first



       Thought for the day

Simple can be harder than complex :
You have to work hard
To get your thinking clean
To make it simple.

But it is worth it in the end
Because once you get there,
You can move mountains.

                         Steve Jobs






To quote the authors of a landmark research paper published in the prestigious British Medical Journal (BMJ) way back in 2003, “As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials.



Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. 

We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.”




Simple really! We use the best available evidence for any decision we face.

In medicine, drugs are one type of intervention that often can be evaluated well using double blind, crossover trials.

But let us not even go into how often drug companies and researchers under all sorts of pressures (both external and internal) have been proven to falsify results.

The truth is that it is estimated around 75% of all recommendations made in common medical practice do not have high level scientific evidence to support them.

A good example is the treatment of early bowel cancer. Everyone accepts surgery is the best option; yet there has never been a randomized trial to confirm this - probably never will be; the fact remains this option is based entirely on clinical experience.

So it may be helpful to point out what the definition for “Evidence Based Medicine is. The commonly accepted definition first appeared in the BMJ, this time back in 1996 :

Evidence based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information.

Key points? 
Not just “best available research”, but “clinical experience and patient values”. This is the definition. This is EMB. Clinical experience is important. And the patient and what is important to them needs to be taken into account. You need a good clinician!

The problem? 
Current medicine in my opinion has been railroaded by those who overly value scientific research.

My sense of it is that many current practitioners have lost confidence in their own abilities.

It seems that unless a test confirms something for them, they are unable to trust their own clinical acumen.

Rather than examining their patients, they send them off for tests - blood tests, XRays, CAT scans; and often it seems the more complex the tests the better.

And this reliance on investigations is certainly driving and being supported by big business in medicine. An MRI costs a lot more than palpating an abdomen.

And the lawyers have a lot to answer for as well. If challenged - as in sued - a doctor has a better chance of defending themselves these days if they can refer to the evidence of pathology and other tests rather then clinical examinations.

So what to do?

Firstly be aware that evidence has a hierarchy.
There is good evidence and bad evidence, or should we say evidence with greater or lesser weight. In science and medicine there is what actually is called “The Hierarchy of Evidence”. This describes the quality of evidence as follows…

1. Systematic reviews and meta-analyses of "Randomised Controlled Studies (RCTs) with definitive results".
2. RCTs with definitive results (confidence intervals that do not overlap the threshold clinically significant effect)
3. RCTs with non-definitive results (a point estimate that suggests a clinically significant effect but with confidence intervals overlapping the threshold for this effect)
4. Cohort studies
5. Case control studies
6. Cross sectional surveys
7. Case reports

No need to bother with the detail of the above unless you are really into it; where a read of Wiki on this matter may be useful (3).

Clearly when it comes to evaluating research evidence, this hierarchy has some use; the implication being that the higher up the hierarchy you go, the better the quality of evidence.

But be aware that even when the research evidence is good, it still needs to be personalised for you as an individual and there may be several if not many other factors to take into account as well as the scientific research.

An example?

It is summed up by what in the definition of EBM was described as “patient values”.



Finally, note how the hierarchy of evidence starts with case reports (reports in journals of individual or similar case histories with details of diagnosis, treatments and outcomes, but no systematic research)- which scientific types commonly describe as “anecdotes” and demean.

However, case reports often are the best evidence available - as in the only evidence available -  and as such they constitute the basis for correctly informed EBM.

An example?
For many years it could well be argued that the best way to treat cancer nutritionally was to follow the diet as recommended in You Can Conquer Cancer (4).

The reason for this assertion is that for many years there was no better evidence; the Foundation through the clinical experience of myself and all my colleagues had amassed more clinical experience with treating cancer with nutrition than anyone else in the country, so to be Evidence based, we had the best evidence!

How do you like that idea???

Anyway, what to do now? 
Now there is more formal research evidence for cancer nutrition, as well as so much bogus stuff floating around the net and in the press. How to make the best decision we can in any circumstances - medical or elsewhere???

So a push for common sense.

That is it.

That is where this post ends.

A push for common sense.

And more trust in, and support for doctors who do actually talk with their patients and do actually physically examine them.



And avoid any suggestion you take part in a RCT to do with parachutes.

REFERENCES 
1. Smith GCS and Pell JP : Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ 2003; 327:1459

2. Sackett DL et al : Evidence based medicine: what it is and what it isn't. BMJ 1996;312:71

3. Greenhaigh T : How to read a paper. Getting your bearings (deciding what a paper is about)  1997  BMJ. 315 (7102): 243–6.

EDITOR’s NOTE This is a very useful paper if you are interested in reading original research papers and interpreting their qualities.

4. You Can Conquer Cancer : First published 1984, revised current edition 2015, Wilkinson Publishing, Melbourne. Also available as a spoken book - from my website...

RELATED BLOG
Just give me the facts


Ruth Gawler's 
next meditation retreat

Meditation - Pure and Simple

This particular retreat will be ideal for everyone seeking deep healing
Whether burnt out, dealing with physical or mental issues, this retreat provides a unique opportunity to be led and supported by a doctor well versed in Mind-Body Medicine who has a particular expertise with deep relaxation and healing 
Ruth will focus in this retreat upon the meditation techniques of Dr Ainslie Meares and Ian Gawler

Combine deep relaxation techniques and mindfulness meditation to release the stress we carry in our bodies in this busy and complex modern world. Ideal for healing, rejuvenation and opening our awareness.

Ruth’s teaching style is one of openness and authenticity, and there will be plenty of opportunity for questions and discussion. Techniques covered in this retreat will be accessible and engaging for both beginners and more experienced meditators. This retreat is well suited to all Health Professionals.

DATES                                    September - Monday 10th to Friday 14th 2018
VENUE                                   Yarra Valley Living Centre, Rayner Crt, Yarra Junction, Victoria
ENQUIRIES, BOOKINGS     The Gawler Foundation ClientServices@gawler.org
                                                 and 1300 651 211 - Call Mon-Fri 9-5pm



WEBSITE LINK CLICK HERE

14 May 2018

Challenging-new-mindfulness-and-meditation-research

Research has shown that we come back refreshed from a holiday but that on average those benefits disappear within 2 weeks! (Reference link).

So is mindfulness longer lasting? What about meditation and other mind training practices? People do seem happier when they do them, they seem to smile more and are nicer to be around. But what does current research say?

Time for an update; there are some real problems yet this may be a good post to share…, but first,


                 Thought for the day

The odd thing about pleasure
Is that instead of fully enjoying what is here,
Being able to be fully present with it,
We are busy looking for more.

We miss the true depth of pleasure 

By being intoxicated with the possibility of more.


                     Zen Roshi Nancy Mujo Baker


Spoiler alert! If you do read on through this post, it may well be challenging! 

The challenge is that while there is some great new research confirming mindfulness and meditation’s many benefits, there are major problems within the research itself. But first, let us start on the bright side with an update…

Recent meditation research findings in brief

1. Meditation eases stress reactions
A new and rigorously designed mindfulness study showed that hormonal and inflammatory reactions to stress were reduced after meditation training.

Hoge EA et al : The effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder Psych Res, Vol 262 April 2018, Pages 328-332


2. Meditation improves quality of life for breast cancer survivors.
Meditation was associated with significant decreases in depression, anxiety, perceived stress, and an increase in quality of life, satisfaction with life, post-traumatic growth and quality of sleep.

Significantly, participants had a high attendance rate in the program, which speaks to the likelihood of the applicability of the meditation program on an outpatient basis.

Yun MR et al : The Effects of Mind Subtraction Meditation on Breast Cancer Survivors' Psychological and Spiritual Well-being and Sleep Quality: A Randomized Controlled Trial in South Korea. Cancer Nurs. 2017 Sep/Oct;40(5):377-385. doi: 10.1097/NCC.0000000000000443.


3. Mindfulness may improve cognitive functioning in the elderly
After reviewing the scientific literature, researchers wrote "There is preliminary evidence that meditation can improve cognitive function."


Investigation of 6 Mindfulness Based Interventions in older people based upon MBSR and MBCT suggested positive effects on memory, executive function and processing speed.

However, most reports had a high risk of bias and sample sizes were small.

The only study with low risk of bias, large sample size and active control group reported no significant findings.


The conclusion?

More research is needed, and while meditation and mindfulness may well be useful for the elderly, maybe it is wise to start practicing at an early age!

Berk L et al : Can mindfulness-based interventions influence cognitive functioning in older adults? A review and considerations for future research. Aging Ment Health. 2017 Nov;21(11):1113-1120. doi: 10.1080/13607863.2016.1247423. Epub 2016 Nov 9.

4. Meditation reduces cortisol
Cortisol is popularly known as the stress hormone. Mental states such as worry and rumination over past or future events may prolong cortisol release, which in turn may contribute to pre-disease pathways and adversely affect physical health.

Meditation training has been suggested to increase self-reported mindfulness, which has been linked to reductions in such states. This is the first study to investigate self-reported mindfulness and resting cortisol output.

The results? Good! Meditation did lower the amount of cortisol in the body. The outcome?  Less cortisol, less stress, more capacity for joy.

Jacobs TL et al: Self-reported mindfulness and cortisol during a Shamatha meditation retreat.
Health Psychol. 2013 Oct;32(10):1104-9. doi: 10.1037/a0031362. Epub 2013 Mar 25.

5. Mindfulness changes brain activity in just 8 weeks

In a landmark study (included here for its significance), Richard Davidson, Ph.D - seen here with HH the Dalai Lama- , and his colleagues at the University of Wisconsin, along with Jon Kabat-Zinn, put a group of stressed biotech employees through Kabat-Zinn's eight-week MBSR program.

They found that the employees who completed the program had more activity in the left prefrontal cortex—the happy, calm zone of the brain—than those who did not do the training.

This was the first study to demonstrate brain changes associated with a mindfulness-based practice.

Davidson RJ et al. Alterations in brain and immune function produced by mindfulness meditation.
Psychosom Med. 2003 Jul-Aug;65(4):564-70.

6. Mindfulness changes brain structure
As well as brain function, it seems mindfulness changes brain structure. In this study higher levels of mindfulness accomplished through practice were associated with decreased grey matter volume in the right amygdala, and decreased grey matter volume in the left caudate.

These are parts of the brain that control anxiety and fear. Less anxiety and fear translates to less stress. Again, less stress means more joy.

Taren AA et al: Dispositional Mindfulness Co-Varies with Smaller Amygdala and Caudate Volumes in Community Adults  PLoS ONE 8(5): e64574. 2013

7. Mindfulness and compassion change brain structure - but differently!
This study used functional MRI scans to investigated the brain changes associated with different types of mind trainings - in this case mindfulness, compassion practices and controls.

In the mindful attention group, the after-training brain scans showed a decrease in activation in the right amygdala in response to all images, supporting the hypothesis that meditation can improve emotional stability and response to stress.

In the compassion meditation group, right amygdala activity also decreased in response to positive or neutral images.

But among those who reported practicing compassion meditation most frequently outside of the training sessions, right amygdala activity tended to increase in response to negative images, all of which depicted some form of human suffering.

No significant changes were seen in the control group or in the left amygdala of any study participants.

We think these two forms of meditation cultivate different aspects of mind,” one of the researchers explains.

Since compassion meditation is designed to enhance compassionate feelings, it makes sense that it could increase amygdala response to seeing people suffer. 

Increased amygdala activation was also correlated with decreased depression scores in the compassion meditation group, which suggests that having more compassion towards others may also be beneficial for oneself. 

‘Overall, these results are consistent with the overarching hypothesis that meditation may result in enduring, beneficial changes in brain function, especially in the area of emotional processing.”

Desbordes G et al : Effects of mindful-attention and compassion meditation training on amygdala response to emotional stimuli in an ordinary, non-meditative state Front Hum Neurosci. 2012; 6: 292.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3485650/


BUT NOW FOR THE BIG QUESTION - and the challenge

Is it the mindfulness/meditation that is bringing about the changes?

Research shows Mindfulness benefits are similar to non-meditation based intervention

Jon Kabat-Zinn’s Mindfulness Based Stress reduction Program (MBSR) has become famous and is now widely used based upon the science supporting it; and the positive experiences reported by those who take it up. There is no doubt it is beneficial.

However, a major question needs addressing… Is it the mindfulness itself or other components of the MBSR program that bring about the positive benefits?

This is the first study comparing MBSR to an active control program that was designed to have no mindfulness component, while being structurally equivalent to MBSR and credible to both patients and providers.

The result? MBSR had a extra benefit in reducing pain, but otherwise the two interventions were just as beneficial!

In other words, this study poses the possibility that it may not be the mindfulness on its own but the whole program package that produces the many benefits!

Given these provocative findings the research authors state “although our results do not undermine the substantial evidence supporting the effectiveness of MBSR, they do suggest that the active ingredient of mindfulness in MBSR is no more effective than alternative active ingredients present in the control program for the measures we employed. This conclusion represents an important shift in how we interpret the vast majority of MBSR outcomes in the extant literature”.

This suggests that future studies investigating mindfulness as a specific ingredient in MBSR include control groups designed to address the questions being addressed, and use behavioral or other more objective measures of intervention-specific skill acquisition.

MacCoon DG et al. The Validation of an Active Control Intervention for Mindfulness Based Stress Reduction (MBSR). Behav Res Ther. 2012 Jan; 50(1): 3–12.


So if Mindfulness is beneficial, how does it stand up to thorough analysis?

Meta-analysis suggests limits to mindfulness benefits
Reviews the findings of 47 trials of the health effects of meditation programs on over 3,500 study participants. After carefully controlling for the placebo effect, the authors found that mindfulness meditation resulted in moderate improvements in anxiety, depression and pain. They also found no evidence or insufficient evidence of an improvement in several other measures of health or well-being, such as mood, substance use, eating habits, sleep, and weight.

At the same time, no evidence of harm from meditation was found.

Clearly there is wide variability in what are collectively described as “meditative practices” and equally clearly, the research published to date has very often overlooked this.

The collective research on mindfulness and meditation has been presented as if all techniques are the same - a bit like suggesting all antibiotics are the same - an obvious fallacy.

Clearly too, we will all know people who have made major beneficial changes in their lives associated with taking up a meditation type practice.


The authors go on to state
 “Many people use meditation to treat stress and stress-related conditions and to promote general health. Meditation training programs vary in several ways, including the type of mental activity promoted, the amount of training recommended, the use and qualifications of an instructor, and the degree of emphasis on religion or spirituality. Some meditative techniques are integrated into a broader approach that includes dietary and/or movement therapies (eg, ayurveda or yoga).

‘Meditative techniques are categorized as emphasizing mindfulness, concentration, and automatic self-transcendence. Popular techniques, such as transcendental meditation, emphasize the use of a mantra in such a way that it transcends one to an effortless state where focused attention is absent.

Other popular techniques, such as mindfulness-based stress reduction, emphasize training in present-focused awareness or mindfulness. Uncertainty remains about what these distinctions mean and the extent to which these distinctions actually influence psychosocial stress outcomes’.

So while this meta-analysis aimed to take these variations into account, it still suffers from major limitations in comparing techniques and amount of practice completed. This is like comparing treatments for pneumonia without stating which drugs are being compared and how much of each was taken. Obviously we are still in early days with meditation research - useful days, but early ones! Now we need more details.

Goyal M et al. Meditation Programs for Psychological Stress and Well-being A Systematic Review and Meta-analysis. JAMA Intern Med. 2014;174(3):357-368. doi:10.1001/jamainternmed.2013.13018


FUTURE DIRECTIONS FOR MEDITATION RESEARCH
The JAMA article that is cited above and forms the basis of this article was itself based on a more comprehensive report, one in a series of Comparative Effectiveness Reviews  (No. 124 : Meditation Programs for Psychological Stress and Well-Being) prepared for the Agency for Healthcare Research and Quality in the U.S. Department of Health and Human Services.)

This report makes good reading, part of the conclusion having great relevance to the therapeutic application of meditation and something we are bound to hear more of as meditation is used more widely for its healing potential.

And another thing… Maybe the studies need to be conducted over longer time frames…

From the above report
Historically, the general public has not conceptualized meditation as a quick fix toward anything. 

It is a skill or state one learns and practices over time to increase one’s awareness, and through this awareness gain insight and understanding into the various subtleties of one’s existence. 

Training the mind in awareness, non-judgmentalness, and the ability to become completely free of thoughts or other activity are daunting accomplishments. 


While some meditators may feel these tasks are easy, they likely overestimate their own skills due to a lack of awareness of the different degrees to which these tasks can be done or the ability to objectively measure their own progress. 


Since becoming an expert at simple skills such as swimming, reading, or writing (which can be objectively measured by others) takes a considerable amount of time, it follows that meditation would also take a long period of time to master. 

However, many of the studies included in this review were short term (e.g., 2.5 hours a week for 8 weeks), and the participants likely did not achieve a level of expertise needed to improve outcomes that depend on a mastery of mental and emotional processes. The short-term nature of the studies, combined with the lack of an adequate way to measure meditation competency, could have significantly contributed to results.

Lots to contemplate in all of this ……

CONCLUSION
The current research is interesting and certainly helps win acceptance for mindfulness and meditation. But we need to be clear. This arena for research is still in its infancy and what is needed now is more detailed investigation into the benefits of different techniques, how those techniques interact with the teachers and groups they are taught within, and how much difference the amount of time spent doing the practice makes to the outcome.

This progression in the quality of research is normal and reasonable, but it is time now for the quality to lift.

In the interim, trust your own experience
Meditation is not always easy. It takes time to learn, persevere, develop skills and receive the many benefits on offer. Trust your own experience. Mine tells me this is something worth doing every day. There is no need for external research to confirm that; my own inner experience is confirmation enough! And I know I need support to maintain the practice...


“Do yourself a favour… “

Ruth Gawler's 
next meditation retreat

Meditation - Pure and Simple


Experience 
. Being more at ease with yourself and your feelings
. The connectedness and clarity of mindfulness
. Profound relaxation into stillness.


Combine deep relaxation techniques and mindfulness meditation to release the stress we carry in our bodies in this busy and complex modern world. Ideal for healing, rejuvenation and opening our awareness.


Ruth’s teaching style is one of openness and authenticity, and there will be plenty of opportunity for questions and discussion. Techniques covered in this retreat will be accessible and engaging for both beginners and more experienced meditators. This retreat is well suited to all Health Professionals.

DATES                                    September - Monday 10th to Friday 14th 2018
VENUE                                   Yarra Valley Living Centre, Rayner Crt, Yarra Junction, Victoria
ENQUIRIES, BOOKINGS     The Gawler Foundation ClientServices@gawler.org
                                                 and 1300 651 211 - Call Mon-Fri 9-5pm
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