When I set down to write on the topic of yoga, mindfulness and their relation to the immune system I was planning on writing one short blog post. A blog post that could potentially help people deal with the stress of the COVID-19 pandemic and its consequences. However, as I started to write, I soon realized I wanted to give a more detailed overview of the scientific studies that underlie the claims I make. Since I didn’t want to burden you with a lengthy post, the one brief post seems to have morphed into a series of - hopefully digestible size - posts. Also, since I’m about 37 weeks pregnant, I can’t sit in front of my computer for hours on end (nasty back pain…), so the necessity of breaking the topic into smaller bits is also a personal one.
How to deal with stress at times of COVID-19
As the popular and widely shared article of The Economic Times’ title reads: Harvard Medical School recommends yoga, meditation to deal with coronavirus anxiety (1). The Harvard Medical School’s blog post (2) about how to deal with stress gives readers reasonable tips on what to do and what not to do when we feel anxious about the current coronavirus situation. For instance, they suggest to reach out to friends and family on video calls and read information only from reliable sources to minimize media-induced stress. Because let’s be honest, the media doesn’t tread in information but in fear and anxiety. John Sharp, MD, author of the blog post, has three main suggestions for relaxation: yoga, meditation and controlled breathing. Overall, the post is a brief and well balanced guide to how to deal with stress and anxiety. What he fails to mention is why reducing stress and anxiety is so important. Of course, most of us don’t find stress particularly enjoyable but most of us have accepted it as a necessary part of modern life. So why is it so important, besides the desire to feel better, to reduce stress when faced with health challenges?
“Boost your immune system”
The expression “boosting your immune system” has become somewhat controversial. As I was reading through comments and watching vlogs on this issue I realized that people have such different definitions on what “boosting” means in this context, that the expression pretty much became meaningless. According to the Cambridge Dictionary “to boost” simply means “to improve or increase something”. Can we, then, boost our immune system, according to this definition? YES, we absolutely can. Sure enough, if our immune system works already optimally, we have no stressors in our lives, there’s not much we can do to enhance our immune system further, nor should we worry about getting sick. However, many of us don’t have an optimally working immune system due to many factors, which is why there’s usually something that we can do to help our immune system work somewhat better. I know, at times of crisis many try to take advantage of our fears, snake-oil vendors are on the loose, so it makes all the sense in the world to be suspicious and skeptical about people giving immuno-boosting advice. This blog post series is my humble attempt to bring some valid information into the debate. Through several posts, I will describe briefly scientific studies that show that yoga, mindfulness meditation and breathing exercises (pranayama) can, indeed, help us get healthier.
Stress and the immune system
It is well documented in the scientific literature that the reduction of stress and anxiety revitalises the immune system, which we need to rely on for physical and mental health. When we are under continuous stress (induced by physical or mental stressors), our body experiences inflammation and our immune system becomes impaired. Segerstrom and Miller (3) analyzed the results of 293 independent studies on how psychological stress affects the immune system. They concluded that chronic psychological stress (stress experienced over days or weeks) was associated with the overall suppression of the immune system.
How do yoga, meditation and breathing exercises come into the picture?
Let me start with a slight correction to Dr Sharp’s bullet point list. Yoga, meditation and breathing exercises are not three independent items. Even though many in the West are most familiar with the physical practice of yoga and equate yoga with the practice of odd poses that tie one’s body into a pretzle and carry funny names, that is just one slice of the yogic path. In fact, it is the newest (but not for that reason any less important) part of yoga, which hasn’t appeared until the XIXth century. Yoga, however, is much more than physical exercise. It is a complex philosophical and, dare I say, psychological system that was developed over centuries in India and contains many parts besides physical exercise. I like to think of yoga as a “how-to” manual for human existence. Without going into a lengthy description, yoga consists of eight limbs according to the Yoga Sutras of Patanjali — one of the main texts of yoga. 1) Yama, that talks about ethical standards for yoga practitioners, 2) niyama, that offers suggestion on self-discipline necessary for embarking on the yogic path, and a healthy life, for that matter, 3) asana, the physical practice of yoga postures, 4) pranayama, exercises of controlled breathing, 5) pratyahara, withdrawal from external stimuli, 6) dharana, conscious focus of our attention or concentration, 7) dhyana, meditation or uninterrupted flow of concentration, and 8) samadi, transcending the self. Asana, pranayama, pratyahara, dharana and dhyana go hand in hand. They are practices that build on one another and have attentional control at their hearts. As scientific studies show, they all induce very real physiological changes in the brain and throughout the body that help us come back to an optimal state of health.
“Well-being is a skill.”
Richard J. Davidson, professor of psychology and psychiatry and founder and director of the Center for Healthy Minds at the University of Wisconsin-Medison, after decades of research concludes that well-being is not a state that we are in if we get lucky, rather it is a skill that we can cultivate. Davidson and his colleagues, in a 2003 study (4), investigated how mindfulness meditation can affect the way our brain processes emotions and our immune response. The research group randomly created two groups from a pool of healthy participants — an experimental and a control group. The experimental group took part in an 8-week mindfulness-based stress reduction (MBSR) course developed by Jon Kabat-Zinn, professor of medicine at the University of Massachusetts Medical Centre. The control group was wait-listed for the same course and received no MBSR training until after the experiment ended. The training program is based on the development of mindfulness through seated meditation (similar to zazen, a Zen Buddhist practice). As its developer, Jon Kabat-Zinn, describes
“[it] uses a combination of mindfulness meditation, body awareness, yoga and exploration of patterns of behaviour, thinking, feeling and action. Mindfulness can be understood as the non-judgemental acceptance and “open-hearted” investigation of present experience, including body sensations, internal mental states, thoughts, emotions, impulses and memories, in order to reduce suffering or distress and to increase well-being.”
Throughout the course, volunteers met for a weekly, 2.5-3-hour class of mindfulness, had a one hour long daily home practice (at least 6 days a week) and took part in a 7-hour silent retreat at week 6 of the course. Experimenters recorded electric brain activity via electroencephalogram (5) (EEG) during a task where participants wrote about one of their most positive and most negative experiences. This recording took place i) before the training, ii) immediately after and iii) 4 months after the training. All volunteers (both in the meditation and control groups) were vaccinated with influenza vaccine after the meditation group’s training. 3-5 weeks and 8-9 weeks after the vaccination, the experimenters performed an antibody count to see immune reaction to the vaccine. The results of the study showed an increase in the electric activation pattern of the brain that is associated with positive emotions in the meditation group both when they described positive and negative experiences. This pattern wasn’t present for the control group. Authors also found a greater rise in antibody count compared to the control group. Among the volunteers in the meditation group those who showed greater increase in the electric brain activity typical of positive emotional processing also displayed a larger rise in antibody count. A greater antibody count means a quicker, more efficient response of the immune system. These results, therefore, indicate that a short training program in mindfulness meditation can produce brain activity associated with reductions in anxiety and negative emotions and an increase in positive emotions. These results also show that practicing mindfulness can have a positive impact on the immune system.
Footnotes and references
(1) https://economictimes.indiatimes.com/news/international/world-news/harvard-medical-school-recommends-yoga-meditation-to-deal-with-coronavirus-anxiety/articleshow/74646695.cms?from=mdr (2) https://www.health.harvard.edu/blog/coping-with-coronavirus-anxiety-2020031219183 (3) Segerstrom, S. C., & Miller, G. E. (2004). Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychological bulletin, 130(4), 601. (4) Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., … Sheridan, J. F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65(4), 564–570. https://doi.org/10.1097/01.PSY.0000077505.67574.E3 (5) “The EEG is an electrophysiological technique for the recording of electrical activity arising from the human brain. Given its exquisite temporal sensitivity, the main utility of EEG is in the evaluation of dynamic cerebral functioning. EEG is particularly useful for evaluating patients with suspected seizures, epilepsy, and unusual spells.” Britton JW, Frey LC, Hopp JLet al., authors; St. Louis EK, Frey LC, editors. Electroencephalography (EEG): An Introductory Text and Atlas of Normal and Abnormal Findings in Adults, Children, and Infants [Internet]. Chicago: American Epilepsy Society; 2016. Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK390346/