RESEARCH ACTIVITIES

Stress and Health

McEwen, B.S., & Stellar, E.  (1993).  Stress and the individual mechanisms leading to diease.  Archives of International Medicine, 153, 2093-2101.  Examines diseases associated with stress, including asthma, diabetes, gastrointestinal disorders, myocardial infarction, hypertension, cancer, viral infections, and autoimmunity; discusses mechanisms, including neurochemistry (serotonin) and immunology (natural killer cell activity and cancer).  See recent update in:  McEwen, B.S. (1998).  Protective and damaging effects of stress mediators.  New England Journal of Medicine, 338, 171-179.

Kiecolt-Glaser, J.K., Marucha, P.T., Malarkey, W.B., Mercado, A.M., & Glaser, R. (1996).  Slowing wound healing by psychological stress.  Lancet, 346(8984):1194-1196.  Thirteen women (mean age 62) caring for demented relatives (high stress) were compared with 13 controls matched for age (60 yo) and family income.  Ball subjects underwent a 3.5 mm punch biopsy.  Healing was assessed by photography of wound and response to hydrogen peroxide (healing defined as no foaming).  Wounds in stressed caregivers took significantly longer to heal (48.7 vs. 39.3 days, p<.05).  Furthermore, peripheral blood leukocytes (white blood cells) of caregivers produced significantly less interleukin-1 beta mRNA in response to lipoplysaccharide stimulation (suggesting impaired functioning).

Koenig H.G., George L.K., Peterson B.L. (1998).  Religiosity and remission from depression in medically ill older patients.  American Journal of Psychiatry, 155,536-542.  One year prospective study of 87 medical inpatients with depressive disorder to determine predictors of be to remission.  Twenty-eight physical health, mental health, social, and treatment factors were examined.  Investigators found that depressed patients who had strong intrinsic religious belief recovered over 70% faster from depression than did those with weaker religious commitment.  In a subgroup of patients whose physical illness was not improving (not responding to medical treatments), intrinsically religious patients recovered over 100% faster.  Other investigators have reported similar findings in children (Miller et al 1997) and elderly persons in Europe (Braam et al 1997).

Propst, L.R., Ostrom, R., Watkins, P., Dean, T., & Mashburn, D. (1992).  Comparative efficacy of religious and cognitive-behavior therapy for the treatment of clinical depression in religious individuals.  Journal of Consulting and Clinical Psychology, 60, 94-103.  Examined the effectiveness of using religion-based psychotherapy in the treatment of 59 depressed religious patients.  The religious therapy involved use of religious beliefs to counter irrational thoughts associated with depression.  Religious belief therapy resulted in significantly faster recovery form depression compared to standard secular cognitive-behavioral therapy.  What was surprising was that the benefits from religious-based therapy were evident among patients who received religious therapy from non-religious therapists.

Rabins, P.V., Fitting, M.D., Eastham, J., & Zabora, J. (1990).  Emotional adaptation over time in caregivers for chronically ill elderly people.  Age and Aging, 19, 185-190.  Followed 62 caregivers of persons with either Alzheimer’s disease or recurrent metastatic cancer, examining factors that predicted adaptation two years later.  Strong religious belief (p<.0001) and frequent social contacts were the two major predictors of adaptation in this group.

Reducing Anxiety

Kabat-Zinn, J., Massion, A.O., Kristeller, J., Peterson, L.G., Fletcher, K.E., Pbert, L., Lenderking, W.R., & Santorelli, S.F.  (1992).  Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders.  American Journal of Psychiatry, 149, 936-943.  Study of 22 patients referred for meditation and relaxation program who had generalized anxiety disorder or panic disorder (ages 26-65, 17 women).  The intervention consisted of a 8-week long course involving weekly 2-hour classes and a 7.5 hour intensive meditation retreat session in week six.  Subjects were assessed at the start and end of intervention and at monthly intervals for 3 months after treatment.  A significant reduction in symptoms of anxiety and depression was identified during treatment and maintained for at least 3 months after treatment ended.  The authors indicated that a 3-year follow-up showed that 18/22 subjects maintained these beneficial effects.

Azhar, M.Z., Varma, S.L., 7 Dharap, A.S. (1994).  Religious psychotherapy in anxiety disorder patients.  Acta Psychiatrica Scandinavia, 90, 1-3. Investigators randomized 62 Muslim patients with generalized anxiety disorder to either traditional treatment (supportive psychotherapy and anxioltyic drugs) or traditional treatment plus religious psychotherapy.  Religious psychotherapy involved use of prayer and reading verses of the Holy Koran specific to the person's situation.  Patients receiving religious psychotherapy experienced more rapid improvement in anxiety symptoms than those receiving traditional therapy.

Koenig, H.G., Cohen, H.J., Blazer, D.G., Pieper, C., & Meador, K.G., Shelp, F., Goli, V., & Dipasquale, R. (1992).  Religious coping and depression in elderly hospitalized medically ill men.  American Journal of Psychiatry, 149, 1693-1700.  In a consecutive sample of 850 elderly men acutely admitted to the hospital, investigators found that patients who used prayer and religious belief to help them cope were significantly less depressed; among a subgroup of 201 subjects, extent of prayer and belief predicted lower depression scores 6 months later.  There are over 100 other studies showing that those who are more religiously active experience lower rates of depression, commit suicide less often, and have greater well-being (Koenig et al 2000).

Reducing Chronic Pain

Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985).  The clinical use of mindfulness meditation for the self-regulation of chronic pain.  Journal of Behavioral Medicine, 8, 163-190.  Investigators compared patients in two hospital clinics involving.  One hospital clinic treated patients using "mindfulness meditation"; 90 chronic pain patients received 10 weeks of a Stress-Reduction and Relaxation Program (SSRP).  In these patients, investigators found statistically significant reductions in pain symptoms, mood disturbance, and psychological symptoms.  Pain-related drug utilization also decreased and self-esteem increased.  Improvements was independent of sex, source of referral or type of pain.  A comparison group of patients in the other hospital pain clinic (n-21) and referrals to the SRRP from the pain clinic (n=21) did not show similar improvement after traditional treatment protocols.  At follow-up improvements were maintained for 15 months for all measures except on measure of pain; the majority of subjects reported high compliance with daily meditation.

Preventing and Treating Substance Abuse

Gelderloos, P., Walton, K.G., Orme-Johnson, D.W., 7 Alexander, C.N. (1991).  Effectiveness of the transcendental meditation program in preventing and treating substance misuse: A Review.  International Journal of the Addictions, 26, 293-325. These investigators reviewed 24 studies on the benefits of Transcendental Meditation in treating and preventing substance abuse.  They concluded from this review that "all studies showed positive effects of the TM program".  Only two studies, however, used longitudinal experimental designs with random assignments of subjects.  Myers & Eisner (1974) randomly assigned young male students from a community college (selected from a large pool of volunteers.  Sixty were assigned to TM, 60 to karate, and 60 to a no-treatment control group.  After 4 months, investigators compared groups on use of marijuana, psychedelics, uppers, downers, and hard drugs.  There was a significant drop in one or more categories or substance abuse in TM participants relative to controls.  The second study (Bounouar), (1989), examined 925 TM participants and 6,145 controls who attended an introductory lecture on TM.  Subjects were followed for 20 months, examining tobacco consumption levels.  Over 80% of those who meditated twice a day quit or decreased smoking after 20 months vs. 55% of irregular mediators and 33% of controls (p<.0001).  Also see Alexander, C.N., et al (1994).  Treating and preventing alcohol, nicotine, and drug abuse through transcendental meditation:  A review and meta-analysis.  Alcoholism Treatment Quarterly, 11(1/2), 13-87.

Cochran, J.K., Beeghley, L., E.W. (1988).  Religiosity and alcohol behavior: an exploration of reference group theory.  Sociological Forum, 3, 256-276.  These investigators used survey data from General Social Surveys conducted between 1972-1984.  During this time, 7,581 adults ages 18 or older were surveyed.  Results indicated that four measures of religiousness (attendance at services, belief in life after death, strength of religious belief, and religious group memberships) were all inversely related to alcohol use or misuse, after controlling for age, race, sex, urbanity, religion, education, income, & prestige.  This study involved a large random national sample of Americans of all ages.

Amey, C.H., Albrecht, S.L., & Miller, M.K. (1996).  Racial differences in adolescent drug use: The impact of religion.  Substance Use and Misuse, 31, 1311-1332.  These investigators surveyed a random sample of 11,728 senior high school students.  The dependent variable was substance use (LSD, cocaine, amphetamines, barbiturates, tranquilizers, heroin, other narcotics, and inhalants).  Religious involvement was inversely related with all substances.  Frequent church attendance was associated with 29% less cigarette smoking, 45% less alcohol use, 33% less marijuana use, 21% less other drug use.  Importance of religious beliefs was associated with 25% less cigarette smoking, 55% less alcohol use, 22% less marijuana use, and 12% less other drug use.

Reducing Blood Pressure

Benson, H. (1977).  Systemic hypertension and the relaxation response.  New England Journal of Medicine, 296, 1152-1156.  This article reviews research on the relaxation response and blood pressure (BP).  In one of the studies reviewed, subjects were taught to elicit the relaxation response by meditation for 20 minutes twice/day.  Ater two weeks, BPs were measured every two weeks for 6 months (BP's never measured after meditation).  Among meditation subjects, there was an average drop in systolic BP (SBP) during the 6 months of 7 mmHG lower than at baseline and diastolic BP (DBP) was 4 mmHG lower than at baseline.  Subjects served as their own controls, with a 6-week run-in period when no BP changes were observed before start of study.  For subjects who "chose to stop meditation", both SBP and DBP by 14 mmHG in hypertensive patients treated with antihypertensive medication, compared with no statistically significant change in a matched control group.  A third study using control group and Buddhist meditation reported reductions of 15 mm SBP and 10 mm DBP in patients with hypertension (NEJM, 1976).  Other studies have also shown significant decreases in both SBP and DBP with the relaxation response in normotensive working populations.

Chesney, M.A., Agras, S., Benson, H., Blumenthal, J.A., Engel, B.T., Foreyt, J.P., Kaufmann, P.G., Levenson, R.M., Pickering, T.G., Randall, W.C., Schwartz, P.J. (1987).  Task Force 5: Nonpharmocologic approaches to the treatment of hypertension.  Circulation, 76 (Suppl I), 104-109.  This is a more recent review of the literature.  Authors conclude that since 20 million people in the U.S. alone have mild hypertension (HTN) and drug treatments for HTN have many potential negative side-effects, non-pharmacological treatments "must be explored vigorously" (p 104).  Suggests that for the standard care of hypertensive individuals that "Relaxation-based treatments should also be given early consideration in light of the evidence of their efficacy" (p 105).

Linden, W., & Chambers, L. (1994).  Clinical effectiveness of non-drug treatment for hypertension:  A meta-analysis.  Annals of Behavioral Medicine, 16, 35-45.  Perhaps one of the best reviews ever performed of mind-body medicine strategies for reducing blood pressure.  This review is unique in that the authors control for initial blood pressure levels.  In previous reviews, persons with normal blood pressure were included (in such populations it is difficult to demonstrate an effect for mind-body strategies on blood pressure because the blood pressure cannot be reduced much further.  The authors concluded that these approaches were equivalent to single drug therapy for hypertension.

Schneider, R.H., Staggers, F., Alexander, C., Sheppard, W., Rainforth, M. Kondwani, K., Smith, S., & King, C.G. (1995).  A randomized controlled trial of stress reduction for hypertension in older African Americans.  Hypertension, 26, 820-829.  Study involved 111 African Americans in Oakland, CA, ages 55-85 with baseline blood pressured < =179/104 mmHg (mild hypertension). Subjects were enrolled in a randomized, controlled single-blind trial of Transcendental Meditation (TM) compared with progressive muscle relaxation (PMR) and a life-style modification education control program.  TM and PMR sessions lasted 1.5 hours initially and 1.5 hours/month for 3 months; data collected every month.  Investigators found that TM had significantly greater effects on systolic blood pressure (p=.02) and diastolic blood pressure (p=.03) than PMR; SBP was reduced by 10.7 mmHG (p<.003) and DBP reduced by 6.4mm (P<,.0001) for TM.  The investigators concluded that TM was twice as effective as PMR in reducing systolic and diastolic blood pressures.

Koenig H.G., George L.K., Cohen H.J., Hays J.C., Blazer D.G., Larson D.B. (1998).  The relationship between religious activities and blood pressure in older adults.  International Journal of Psychiatry in Medicine 28, 189-213.  Epidemiological study of 4,000 randomly selected older adults in North Carolina (NIA-supported Establishment of Populations for Epidemiologic Studies of the Elderly (EPESE).  Persons who both attended religious services regularly and who prayed/meditated regularly were 40% less likely to have diastolic hypertension then those who did not (p<.0001, after controlling for age, sex, race, education, smoking, physical functioning, and body mass index).  Among Black persons in the sample (54% of subjects), the effects on blood pressure were even greater.  Religious activities (especially regular prayer and scripture reading) at one wave predicted lower blood pressure levels three years later, after controlling for baseline blood pressure and other confounding variables.

Heart Disease and Other Cardiovascular Risk Factors

Leserman, J., Stuart, E.M., Mamish, M.E., & Benson, H. (1989).  The efficacy of the relaxation response in preparing for cardiac surgery.  Behavioral Medicine, Fall, 111-117.  In this study, 27 cardiac surgery patients (mean age 68) were randomly assigned to either educational information + Relaxation Response vs. educational information only.  On the Profile of Mood States scale, the relaxation response group experienced significantly greater reductions in tension and anger than the education only group.  More importantly, the experimental group had lower incidence of supraventricular tachycardia (SVT) (p=.04), a dangerous heart rhythm often complicating cardiac surgery.

Sudsuang, R., Chentanez, V., & Veluvan, K. (1991).  Effect of Buddhist meditation on serum cortisol and total protein levels, blood pressure, pulse rate, lung volume and reaction time.  Physiology & Behavior, 50, 543-548.  This was a clinical trial involving 52 males ages 20-25 years practicing Dhammakaya Buddhist meditation (similar to Zen or transcendental meditation).  Control group was 30 males of the same age group not meditating.  Serum cortisol levels were significantly reduced in treatment group (combined A and B), and was different from controls (p<.01, all comparisons).  Serum protein levels increased after 6 weeks for combined group (p<.01) and different from controls (p<.05).  Systolic and diastolic blood pressures both significantly different in combined treatment group (p<.01) and significantly different from controls (p<.01).  Heart rate significantly different at 3 and 6 weeks (p<.01) and from controls (p<.01 at 3 wks., p<.05 at 6 wks.).   Pulmonary function (vital capacity, tidal volume, and maximum voluntary ventilation) significantly different at 3 and 6 weeks (p<.05) before and after in treatment group.

Alexander, C.N., Robinson, P., Orme-Johnson, D.W., Schneider, R.H., & Walton, K.G. (1994).  Effects of transcendental meditation compared to other methods of relaxation and meditation in reducing risk factors, morbidity and mortality.  Homeostasis, 35, 243-264.  Review of research showing that TM is associated with reduced cardiovascular risk factors such as hypertension, smoking, and cholesterol. 

Goldbourt, U., Yaari, S., & Medalie, J.H. (1993).  Factors predictive of long-term coronary heart disease mortality among 10,059 male Israeli civil servants and municipal employees.  Cardiology, 82, 100-121.  This was a prospective study of 10,059 Jewish males aged 40 or over working as civil servants or municipal employees in Israel.  Subjects were first assessed in 1963 and mortality from heart disease (coronary artery disease) (CAD) was assessed in 1986 (23 year follow-up).  Religious orthodoxy was measured by 3 items (religious vs. secular education; self-definition as orthodox believers, traditional believers, or secular believers; and frequency of synagogue attendance) summed to crate an orthodoxy of belief index.  The most orthodox group had lowest rate of mortality form CAD (38 vs. 61 per 10,000) and other causes (135 vs. 168 per 10,000) than did non-believers.  The risk of death from CAD among most orthodox believers during the 23-year follow-up was at least 20% less than among non-orthodox Jews or non-believers.  These results remained significant after controlling for age, blood pressure, cholesterol, smoking, diabetes, body mass index, and baseline coronary heart disease.

Koenig, H.G., George, L.K., Cohen, H.J., Hays, J.C., Blazer D.C., Larson D.B., (1998).  The relationship between religious activities and blood pressure in older adults.  International Journal of Psychiatry in Medicine 28, 189-213.  (noted earlier) This was a study of 4,000 randomly selected older adults in North Carolina participating in the NIA-sponsored EPESE study.  Persons who both attended religious services regularly (reflecting belief) and who did not (p<.0001, alter controlling for age, sex, race, education, smoking, physical functioning, and body mass index).  Among Black persons in the sample (54% of subjects) and younger elderly (ages 65-74), the effects on blood pressure were even greater.  In these groups, religious activities at one wave predicted blood pressure levels three years later, after controlling for baseline blood pressure and other compounding variables.

Oxman, T.E., Freeman, D.H., & Manheimer, E.D. (1995).  Lack of social participation or religious strength and comfort as risk factors for death after cardiac surgery in the elderly.  Psychosomatic Medicine, 57, 5-15.  These investigators at Dartmouth followed 232 adults for six months after open-heart surgery, examining predictors of mortality.  The mortality rate in persons with low social support network who relied heavily on religion, after other covariates were controlled.  Even when social factors were accounted for, persons who depended on religious beliefs were only about one-third as likely to die as those who did not.

Preventing Cancer and Limiting Cancer Spread

Spiegel, D., Bloom, J.R., Kraemer, H.C., & Gottheil, E. (1989).  Effect of psychosocial treatment on survival of patients with metastatic breast cancer.  The Lancet, 2(8668), 888-891.  This clinical trial examined the effects of a psychosocial intervention on survival among 86 women with metastatic breast cancer.  The 1-year intervention consisted of weekly supportive group therapy with self-hypnosis and relaxation for pain.  At 10-year follow-up, only 3 patients were alive and death records obtained for the other 83 deceased patients.  Among those receiving the intervention, average survival was 36.6 months compared to 18.9 months in the control group (p<.0001, Cox model).  Interestingly, differences in survival began 8 months after the intervention ended.

Dwyer, J.W., Clarke, L.L., & Miller, M.K. (1990).  The effect of religious concentration and affiliation on county cancer mortality rates.  Journal of Health and Social Behavior, 31, 185-202.  These investigators used county-level cancer mortality data from the National Center for Health Statistics (3,063 counties) for 1968-1970, 1971-1974, and 1975-1980 to examine the relationship between religious affiliation and death from cancer.  Investigators found that religion (defined as % of population with full membership or as degree of religious conservativeness) had a significant impact on mortality rates from cancer, even after controlling for 15 factors known to affect cancer mortality.  Conservative Protestants and Mormons had the lowest mortality rates and counties with higher concentrations of Jews or liberal Protestants had the highest cancer mortality.  Investigators concluded that the general population in areas with high concentrations of religious participants may experience health benefits resulting from diminished exposure to or increased social disapproval of behaviors related to cancer mortality.

Enhancing Immune Function 

Woods, T.E., Antoni, M.H., Ironson, G.H., & Kling, D.W. (1998).  Religiosity is associated with affective and immune status in symptomatic HIV-infected gay men.  Journal of Psychosomatic Research, in press.  These investigators examined in the association between religious beliefs and behaviors and immune functioning in 106 HIV seropositive gay men.  Religious activities – prayer or meditation, religious attendance, spiritual discussions, reading religious/spiritual literature – were associated with significantly higher CD4+ counts and CD4+ percentages (T-helper-induced cells) (controlling for self-efficacy and active coping with health situation, using regression modeling).  The effects of religious behaviors on immune function was not confounded by disease progression (i.e., as disease worsened and immune function decreased, persons unable to participate in religious activity).

Koenig H.G., Cohen H.J., George L.K., Hays J.C., Larson D.B., Blazer D.G. (1997).  Attendance at religious services, interleukin-6, and other biological indicators of immune function in older adults.  International Journal of Psychiatry in Medicine 27:233-250.  First study to examine the relationship between religious activities and immune system functioning.  Investigators found that frequent religious attendance (reflecting religious belief) in 1986, 1989, and 1992 predicted lower plasma interleukin-6 (IL-6) levels in a sample of 1,718 older adults followed over six years.  IL-6 levels are elevated in patients with AIDS, osteoporosis, Alzheimer’s disease, diabetes, lymphoma and other cancers.  High levels of IL-6 indicate a weakened immune system.  Findings suggest that persons who attend church frequently have stronger immune systems (lower levels of IL-6) than less frequent attenders, and may help explain why better physical health is characteristic of frequent church attenders.

Woods, T.E., Antoni, M.H., Ironson, G.H., & Kling, D.W. (1998).  Religiosity is associated with affective and immune status in symptomatic HIV-infected gay men.  Journal of Psychosomatic Research, in press.  (noted earlier) Study of 106 HIV seropositive gay men; religious activities – prayer or meditation, religious attendance, spiritual discussions, reading religious/spiritual literature (indicators of religious belief) – were associated with significantly higher CD4+ counts and CD4+ percentages (T-helper cells)(controlling for self-efficacy and active coping with health situation, using regression modeling).

Extending Overall Survival