Recipients of a NEA research grant discuss their study
A research team at Emory University was awarded a NEA Research Grant for their pilot study of the efficacy of meditation for treatment of chronic pruritus (itch). Following is an interview about the study and results, with investigators Mamta Javari, M.D., and Suephy Chen, M.D.
Where did the idea come from to study meditation and eczema?
Positive outcomes from previous meditation studies inspired us to see if meditation could help improve the quality of life and decrease the intensity of itch in people with eczema.
We know that eczema can flare due to emotional stressors. Eczema has also been shown to impact quality of life by interfering with sleep and normal day-to-day activities, resulting in anxiety, depression, and sleep deprivation.
We hoped that meditation would provide our subjects with a coping mechanism during flares, help improve concentration, and give them a sense of control over their itch.
Additionally, scratching alters local hormones in the skin, as well as changing the way our mind feels. Eczema and chronic itch have been shown to activate areas of the brain similar to chronic stress and pain. In patients with eczema, these areas of the brain remain overactive, leading to the release of stress hormones and markers of inflammation.
Using MRI, previous studies have shown that meditation can de-activate these areas of the brain. Based off these studies, we hypothesized that meditation could reset the activated areas of the brain leading to a decreased intensity of itch and, eventually, to decreased release of inflammatory and stress hormones.
Did you or your team have experience with meditation personally?
Dr. Mamta Jhaveri grew up practicing yoga, which includes a component of meditation through breathing control. She has seen improvement in her asthma control, especially during flares, with deep breathing. Dr. Jhaveri was more formally introduced to meditation during her study of Integrative Medicine at Georgetown University. She was motivated to help incorporate the two fields when she saw the significant impact eczema and chronic itch had on quality of life.
Why is it important for NEA to fund research like this?
Due to the funding from NEA, we were able to investigate if people with eczema can successfully sit through a meditation session or if the sensation of itch would interfere. Answering this integral question opens the door for further research on meditation use for eczema.
This type of research is crucial because if meditation can improve the quality of life of people suffering from eczema, it can provide our community with a resource that is openly accessible. It can also be used in addition to current medical regimens.
How were participants taught to meditate?
The subjects were enrolled in an eight-week meditation course taught by the Emory Tibet Partnership. Cognitive-Based Compassion training is a meditation technique derived from the Tibetan Buddhist tradition of lojong, the practice of training the mind.
The class met once a week for two hours and participants were required to practice independently between classes. Participants were taught attention stability and breathing control. Once this was achieved, they were encouraged to let thoughts pass by, embrace empathy, and cultivate the art of visualization. The meditation practice strived to remap emotional responses through contemplative practices.
How did participants track their response to meditation?
The subjects in our study were asked to complete a validated questionnaire to measure the impact of itch on quality of life before and after the course. They also completed a visual analog scale to rate the intensity of their itch at the beginning and end of their course. Each week they recorded their home practice hours.
What were the conclusions of the study?
All of the subjects that started the course were able to complete a two-hour session without the severity of their eczema or the sensation of itch interfering with their experience.
The subjects stated that during meditation their skin bothered them less than at baseline and they subsequently did not need to scratch during class. Subjects noticed an improvement in their quality of sleep and their ability to cope with stress and relationships. They reported that they were better able to recognize stressful triggers and use quiet time to prevent the sensation of itching from becoming overwhelming.
One of our participants commented that the “feeling of teeth clenching anger towards my itch has improved; and now when that sensation comes I don’t feel as angry and can let the itch pass faster.”
In general, the participants that completed the course said that although meditation did not cure their skin disease, they felt more in control of their skin by the end of the course. They were eager to share the experience with close friends and family.
Statistically, meditation led to a significant improvement in the quality of life of participants that completed the course. Attending more classes and practicing more between classes resulted in a more significant impact. Using our quality of life questionnaire, we found that the meditation class lessened the emotional impact of itch. Participants showed significant improvement in response to statements such as “I am embarrassed by my itchy skin condition,” “My itchy skin often makes it difficult to concentrate,” and “My itchy skin condition makes me angry or irritable.”
Finally, during our study our participants enjoyed being in a class with other subjects that have also been battling chronic eczema and itch. They were relieved to know that they were “not alone” and enjoyed discussing their experiences with their eczema and different treatments after the class.
What, if any, were the negative comments from subjects?
We feared that quieting the mind using meditation might result in the sensation of itch becoming too overwhelming, preventing the participant to sit through class. However, we did not experience this with any of our participants. One patient was hesitant to start the course because her skin was flaring. When she joined the following week, she was able to attend the two-hour class without difficulty.
The biggest roadblock we encountered was the time commitment required for completing the meditation course. Our subjects often had conflicting personal and work-related commitments that made attendance difficult. Without attendance and practice, however, meditation did not result in improvement.
What are the next steps for you and your team with this field of research?
Now that we know that subjects with eczema can successfully complete meditation classes, we hope to conduct a larger study that has the power to determine the impact of meditation on eczema control and symptoms.
We also hope to work with practitioners and eczema treatment centers to incorporate meditation as an additional treatment modality to help address the secondary effects of eczema including ADHD, insomnia, anxiety, stress, and depression.
Are there any studies of the positive benefits of meditation on other chronic conditions?
In previous studies, meditation has been shown to decrease levels of stress hormones such as cortisol, interleukin 6, and total stress distress scores. A study conducted in 2012 at the University of Massachusetts reported a significant improvement in quality of life in subjects suffering from asthma, including improvement in activity limitations, symptoms, and emotional function. Other studies have shown improvement in control of high blood pressure, rheumatoid arthritis, and chronic back pain with meditation practice. In many studies, results are more pronounced after six months of meditation use.
In regard to eczema, progressive muscle relaxation has previously been shown to decrease itch, anxiety, and insomnia.
The National Institute of Integrative Medicine offers this Introduction to Meditation: https://nccih.nih.gov/health/meditation/overview.htm
Free guided meditations are available through UCLA’s Mindful Awareness Research Center: http://marc.ucla.edu/body.cfm?id=22
One of the most commonly available techniques practiced in the United States currently is called Mindfulness Based Stress Reduction (MBSR). MBSR is a mindfulness-based meditation program that was developed by Jon Kabat-Zinn at the University of Massachusetts.
MBSR Practice Audio Files can be accessed through UC San Diego’s Center for Mindfulness: http://health.ucsd.edu/specialties/mindfulness/programs/mbsr/Pages/audio.aspx
Dr. Mamta Jhaveri completed her dermatology residency at Emory University and will be practicing at Johns Hopkins University. She completed a Masters in integrative medicine at Georgetown University. She is interested in conducting research in herbal use and alternative modalities in dermatology.
Dr. Suephy Chen is Vice Chair and Associate Professor at Emory Dermatology. She is the director of the Dermatology Clinical and Outcomes Research Unit. She is interested in clinical research in eczema, chronic itch, melanoma, and teledermatology.