Dr. Greco

There is growing evidence of the benefits of meditation, especially when it comes to treating certain medical conditions. Carol Greco, PhD, Associate Professor of Psychiatry at the University of Pittsburgh School of Medicine, discusses the meditation research underway at UPMC and the University of Pittsburgh, and how it could change medicine.

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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.

– Mindfulness and meditation. They have been around for centuries and are now getting lots of attention in the world of medicine. So, what does the research show? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat podcast. And joining us right now is Dr. Carol Greco. She’s an associate professor of psychiatry at the University Pittsburgh School of Medicine and a certified trainer in the Mindfulness-Based Stress Reduction program. Thank you so much for joining us.

– Thank you, and it’s great to be here.

– We are glad that you are back. We did a podcast a while ago just about mindfulness and meditation, and let’s begin by really telling folks, reminding them what each of those are and what the differences are.

– Sure. I guess I would describe mindfulness as simply a way of being in the world. It’s a particular kind of awareness, and it’s the awareness that we all have, but it is particularly around being clear about the present moment, being in the present moment, paying attention to what is happening right now and, as best we can, without judgment. So, it’s kind of an intentional type of awareness, where we sort of let go of judgment. And it often involves being aware of our sensory experience. So, maybe the feeling of the breath in the body, or just noticing the wind on our skin if we’re outside – those kinds of things – which we’ve all had that kind of an experience.

– Right, so, and then therefore, what is meditation?

– There’s probably many definitions of both mindfulness and meditation, but what I would say about meditation is that it is a practice or a method that we can engage in. It’s a behavior that we can engage in that can help to cultivate this mindful attitude or this mindful awareness. So, how do we do that? What does meditation actually involve? It tends to involve focusing one’s attention. So, maybe focusing one’s attention on the feelings of breath in the body and when the mind wanders, just bringing it right back gently without judgment or blame. Or, it might be that you could meditate on the sounds that are in the room and just really let yourself focus in on that. Or, another method might be focusing on some tactile sensory experience, like the feeling of your feet in your shoes. And then, when the mind wanders, which it typically does all the time, you just gently bring it back. So, this is a way to kind of train the mind and also cultivate this ability to be present for what’s actually here, other than just thinking all the time and judging everything all the time.

– And so, a very long time it was thought about, oh this new age stuff, this mindfulness, this meditation. Now, in the world of medicine, lots of attention is being placed on these two. And why? What is research in general showing?

– Yeah, yeah, it’s interesting, isn’t it, that something that’s so ancient would be studied and be found to be helpful for medical conditions, for symptoms of chronic illness, but it actually has. So, over the last several decades, there have been more and more research studies, and of course here in the west, we know how to do research. We have the way to set it up and control groups and such like that. But in the world of medicine, and research on mindfulness and meditation, what’s been shown over many studies is that there are several things that mindfulness and meditation can be helpful with. So, one of those is simply the kind of emotional distress that can happen if you have a chronic illness or if you have psychiatric issues or just a lot of stress in your life. So it can really help to dial down one’s anxiety or stress, and maybe help to lift somebody out of being depressed. So, that’s more the mental health side. But, then, the physical health side, the findings are quite strong – so strong that in the area, for example, of pain, there have been enough positive research studies on mindfulness and meditation that the American College of Physicians recommends meditation as one of the early first-line types of treatment for chronic pain, if you want a non-pharmacological approach. So that is pretty amazing.

– Right, and you talk about, we certainly know how to research here at UPMC and the University of Pittsburgh. We are the home of research. There are lots of projects, research projects, going on here. Many of them are yours. Let’s talk about some of the research that’s going underway here at Pitt and UPMC.

– Sure. It’s really wonderful to be at such a strong research institution. And as a meditator, I’m really proud to be here, too, because this is a way to blend two things that are really important to me: research, and meditation, and mindfulness. And so, I’m going to put on my glasses so I can read what I wrote down. But yes, there are several studies here at the University of Pittsburgh and UPMC. One of my favorites is something called the OPTIMUM study. And this is a chronic pain study. So, you might not know, but low back pain is one of the – it probably is the most disabling condition and the most costly here in the United States. So in the OPTIMUM study, we are kind of blending mindfulness classes – which I’m one of the teachers of that – with doctor visits. So, the doctor and I lead an online group that each person with back pain gets to meet with that doctor for a few minutes. And then we do our mindfulness class. We decided we wanted to do this study because it’s already been shown that mindfulness-based stress reduction can be helpful for chronic low back pain, for those who are interested. And we wanted to find a way to bring it into primary care, blend it with something that would be interesting to participants and that primary care would be interested in, too.

– And what’s the initial reaction when you present this to patients or the doctors present this to patients? Are they in so much pain, they’re like, “Hey, I’ll try anything?”

– Well, we get a variety of folks that are interested, and some of them have moderate levels of pain, but they’re very interested in helping themselves and in learning to manage their pain and also their stress. So, those are wonderful folks to have in our study. And on the other hand, we also have many folks that sign up for our study who not only have quite severe chronic back pain, but they have many other chronic illnesses and other conditions, as well as a lot of burdens in their life just from difficult life circumstances. So, it’s really the gamut: from people that are really interested to learn how to meditate, to people that are like, “Please, I need something.”

– Right. Right.

– And one of the wonderful things about that particular study and most meditation studies when they’re done in a group is that people support one another and they learn from one another as we’re also learning meditation.

– Right. So how long has this study been going on, and when do you expect that you will have results? And how would those results be framed? What do you hope to take away from this?

– In that study, it’s still going on and we have another year, year and a half. And again, we can’t look at the results until we’re pretty much at the end. We’re hoping that it reduces the amount that pain actually interferes with people’s life and with their function. And we also hope that the medical system is happy to have one more thing to provide to their patients. So, we really would hope that it would spread and become something that can be offered at UPMC and other sites.

– Right, and the physician you’re working with on this, how excited –

– Oh my goodness, she’s great.

– Yeah, to take part in. And what was sort of her approach, and why was she so excited about this?

– She’s a wonderful person. This is Dr. Anna White, who’s a primary care physician, and she, I think, was already interested in helping her patients to do what they can to help themselves. And she’s a very curious person, and she actually participates in the mindfulness classes, which is great. And she gives her words of wisdom as a physician and as a person in every session.

– That makes a big difference.

– Yeah.

– And there are also studies underway for adolescents.

– Yes, yes.

– Let’s talk about those.

– So, there are some studies, one by a colleague, Danella Hafeman, called the BEAM study. And this is very interesting. And it’s taking kids that are 11 to 13 years old who are interested in being part of a study where they learn meditation skills. Or, the control group is somewhat different from that. And the hope for that one – these are folks, these are kids who might be at risk for having mood problems because maybe their parent has a a mood issue like depression. And so the hope is that they would learn some skills that would reduce the probability that they would have a mood disorder later in life. And Dr. Hafeman is actually doing brain imaging, too, to see the effects on the brain. So, that’s pretty exciting.

– That is pretty exciting. And, in general, if someone’s listening to this, how does someone get involved in one of these studies?

– Well, generally, in most studies that are funded by the federal government, we reach out in many ways to potential participants. We also reach out to the docs. So, we put flyers in exam rooms if we’re allowed to, but then we also have a website, and people can check on our website and perhaps answer a few screening questions. And then we would talk to them personally. Another very exciting one that I’ve been involved with a little bit is a brief mindfulness training and transcranial direct current stimulation. Now doesn’t that sound –

– OK, that sounds something. Tell me about the two, tell me about that.

– So, this is a study for folks who who have a urinary urge incontinence. So, it’s an issue that affects maybe, especially women as they get older, where they would see, they’re getting home to their driveway, and they they have this urge to get to the bathroom, and they have trouble getting. This might be too much information, but anyways, this can be a real problem for the people. And so, this study combines a brief meditation with stimulation on the surface of the head. It combines meditation with this transcranial direct current stimulation. And so, they’re looking at that and are hoping to do a larger study. But they found that when you combine those two things, it really reduces some of the symptoms that these folks have.

– Wow. And that’s an area of medicine that you wouldn’t typically, that I wouldn’t have typically first thought of. Same with irritable bowel syndrome.

– Right.

– Some work is underway there as well.

– Yes. There’s another study, my colleagues mainly at Carnegie Mellon University, have teamed up with folks in gastroenterology here at Pitt – UPMC, I should say. And this is an interesting study. So, some of the studies I’ve told you about have to at least come into a room or on a Zoom meeting. They were all together. In the STAR IBS study, which is the name of that one, they’re actually learning meditation on their cell phone. So, it’s an app-based program. So instead of needing to come somewhere, they’re doing this program on their phones. So, one of the things that I guess I’d like to point out is that, you know, while meditation with a teacher and with a group I think is ideal, that’s not OK for everyone. Not everyone can or wants to. So, there are lots of methods for learning meditation. And, also, now the research is supporting various methods.

– Right. The COMMENCE study.

– Yes.

– What is that?

– Yeah, so that is one of mine. So, I’m very proud of that. This is not one that is actually around helping people with a medical disorder. But in research, we need to be able to measure things from the patient’s perspective. And so, the COMMENCE study, what we are doing is we are fine-tuning and developing better patient report measures – paper and pencil tests of “What is mindfulness?” So, if I’m teaching you mindfulness, how do I know that you actually got anything? I might know by having you answer my questions from the COMMENCE study.

– And so, then, how are you determining, and is there anything you’ve learned so far? Or do we still have to wait till we get all the results in? Any sneak peaks?

– Well, for COMMENCE, we’re almost finished. We just have a lot of papers to publish. But what we found, we did a very intricate style of measurement. So, we have very brief questionnaires that are really easy to understand, that are very precise in terms of being able to measure the concepts that they’re trying to measure. And what we found, we did a validation study, and people that are starting a meditation class and then finishing it, we saw that these measures really were sensitive to the changes that take place in a person after they’ve taken a course.

– Right. Stress and anxiety. And you’re really, you’re bringing some Pitt students into this. And the physics class.

– That is another really –

– As a writer, nothing would stress me out more than a physics class.

– Oh, yeah.

– So go ahead and tell me about –

– If you could imagine how it might be for a first-year Pitt student coming in, and there’s new environment, everything’s new and maybe overwhelming. And so, physics, maybe if you really haven’t studied science very much in high school, the physics classes at the university level can be very stressful for the person. They might feel anxious. They might not feel like they can cope. And so, this study is for folks that are in their early physics class, and if they want to, they can sign up for this study, and they do a brief meditation training on that. So, I can’t wait to see the results of that, too, because I think we want to see more and more kids, especially young girls, taking STEM classes, right? This is the mathematics and engineering. And so, this would be a way to perhaps foster that.

– Yeah. And you touched on this briefly earlier. All of these studies are funded by the National Institutes of Health. What does that say about, just in general, the broader medical community recognizing how important this is?

– Yeah. Thank you for bringing that up. So the National Institutes of Health, this is the federal government saying this research is important. So, it’s really putting a stamp of approval. Now, we have to do the research in a really careful way, and they’re not going to let us do it unless we’ve already planned to do it in a very careful way.

– Well, it’s incredible to hear all the different studies going on, and when you learn these results, then I’m sure more research will take place. If someone’s listening to this, I know we’ve talked about this before, what are the very basics you would say to them about getting started in meditation? What should someone think about? What should be their approach?

– I think probably as a first step, maybe they would download, if they have a smartphone, download a meditation app on their phone and see what they think. What it will do is it’ll guide them in some brief meditations, and then if they feel that they’re interested, maybe they want to sign up for a class. And, of course, at our Center for Integrative Medicine, we offer classes. And so, you know, that might be a nice way.

– I love when people bring props. So even outside of the app, tell me what you brought here today.

– Yeah, so this is just a meditation bowl. And I can ring it, and you’ll – this is how I typically start and end a meditation. It’s not necessary, but it’s kind of nice.

– OK.

– Would you like to try it?

– Yeah. Yeah. Show us what you would normally do.

– OK.

– What’s the purpose of it?

– I’ll ring, and then I’ll just say a few words that might help you to kind of focus your attention in the way that I would teach it in my Mindfulness-Based Stress Reduction course. OK? And then I’ll ring it again.

– OK, all right.

– So, gathering your attention to your breathing or to a touchpoint in the body, like the soles of your feet, the fingertips, and just settling the focus right there. Bringing the attention back when it wanders, which it will. Just opening to the experience of this present moment, whatever it is. And returning the attention when it wanders without judgment or blame.

– That definitely sets the scene for calmness. You have been working in this area for so long. And, what sort of reactions you gotten from patients? Did you have, you know, doubting Thomases at first who are now saying, this has changed my life?

– Yeah, absolutely. Not everyone. And I want to also just make the point, even though these research studies are quite positive, not every single person has benefit, OK? But, yeah, so I actually like it when somebody is skeptical because it’s like, “OK, you’re skeptical, let’s just take a look.” And, recently a person that is just finishing up a class was very skeptical that this would be helpful for her. And she’s like, “I’ve learned that I might not be able to reduce my actual pain,” because she has like a congenital issue with her spine where it has curves in it, and it’s going to probably continue to cause some pain. But what she noticed, she can change her attitude, and she doesn’t let it take over her life. She still does the things she wants to do and takes care of herself in a way that lets her do that.

– And that’s amazing. Tell me a little bit more about the Center for Integrative Medicine.

– Yeah, the Center for Integrative Medicine, we have been here at UPMC for, I think, by now, oh my goodness, maybe around 20 years by now? But we’re a little bit little-known. And so at the Center for Integrative Medicine, we offer acupuncture, chiropractic, meditation classes, massage and other body work programs, naturopathic physician consultations, various things. And some of them are covered by insurance. Some are not. It would be our hope that eventually it all could be, but we’re over in the Shadyside hospital campus, and it’s a wonderful place with great clinicians.

– Right, and maybe the more and more that the medical community is paying attention to this, that we will get to a point where all of those are funded.

– Yeah.

– And we mentioned in the beginning, I was telling people how you’re a certified trainer in the Mindfulness-Based Stress Reduction program. Let’s tell folks about that.

– So, this is an eight-weeks-long program. We offer it several times a year at the Center for Integrative Medicine. And right now, we’re offering it online because, you know, COVID. And, we’re offering it in person, so people can kind of take their pick as to what’s of most interest to them. And what I would say about that program, I’ve been teaching it since 2005, and I absolutely love teaching it because it brings benefit to people that maybe hadn’t had much hope for being able to help themself. And we happen to have people with chronic illnesses, chronic pain conditions, or a lot of stress and anxiety in their lives. And it can be quite transformative. You do have to practice the meditations. You know, we make you come to an orientation. It’s like, look, this is what the expectations are.

– There’s homework involved.

– There’s homework involved. And, you know, not everybody does all the homework, but doing some is good.

– Yeah, and what, at the end of the training period, do you hope that folks walk away with?

– Well, actually, they sort of set their intentions at the beginning of the class. The hope that I have is that they have met their goals in terms of better ability to face the stressors that are going to going to come, you know, or that they actually have a different relationship to their pain. And what we often see is that the pain intensity dials down, or how much it interferes with life dials down. Also, the symptoms of a chronic illness, they’re less kind of overwhelmed with all that. And so, they might feel lighter, less reactive to stress. And those might sound like little things, but they’re actually pretty huge in people’s life.

– Let’s remind folks how long you’ve been meditating and how you got involved in meditation.

– Yeah. I think I learned how to meditate starting in around 1994, something like that. And I got started because I was interested to learn the method for my patients. But then, when I began to practice meditation, I found out how helpful it was for me. It makes me happier, you know, and to be open to whatever is coming, whether or not it’s something I like or don’t like, it just helps, you know, with everyday life, I would say. And so, I’ve been excited to be able to offer this to other people in a way that is, I think, very consumable for a western audience, a secular audience. And so, I’m very happy that my personal practice of meditation and my research career have kind of gone like this.

– Right, and it’s just exciting to think what all of this research, what it can offer and help patients in the future.

– Yeah.

– Well, some great information once again. And it’s really amazing to hear how this research is underway and what that could potentially mean for medicine in the future. Thank you so much for coming in and spending time with us today.

– Thank you.

– I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.

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