Loving Kindness Meditation and Empathy: A prescription for the doctor and the patient? Depends…
Listen up: Especially you medication-bashers…but you sciency types need to pay attention, too
By definition, pharmacists are the pharmacotherapy experts within the healthcare spectrum. This expertise is the result of a laser-like focus on the biomedical aspects of health and disease during the 5- to 6-years of intense education, and is maintained by rigorous licensing, regulatory and association standards. The ability to bridge physiological and pathophysiological knowledge with the complexities of pharmacological therapies, in a way that transfers the information directly to the patient (i.e., patient counseling), has been viewed by many as the primary, if not the exclusive, ‘value add’ of pharmacists.
I’ve been a practicing pharmacist for >25 years now so I feel I have a rather ‘experienced’ voice you might listen to.
But I’m not just a pharmacist.
I’m also a positive psychology coach (through www.WholeBeingInstitute.com), holistic wellness fanatic, healthy eating ultramarathoner and yogi, author and entrepreneur.
Critically, my opinions are backed by objectivity and reason AND passion, compassion and intuition. That’s how the mindbody works: holistically; as should we.
We shouldn’t discount the use of medication because medicine ONLY modifies what is already inherent in the mindbody. Medications do not ‘create physiological function’ — neither does naturopathic concoctions nor psychology. They all work with and within the mindbody. How we craft our mindbody to work, however, changes how the medication works inside us.
Seeing how we give and receive healthcare is as important as the healthcare itself: A quick backgrounder
A few recent studies are beginning to challenge the tenet that the sole purpose and impact of pharmacists revolves around the dispensing function — i.e., picking up your prescription from them. Pharmacists now focus on deciding the best course of pharmaceutical intervention, conducting what are known as medication-therapy management (MTM) or drug-utilization reviews (or DURs).
The historical focus on the medication during counseling is in alignment with the primary role of the pharmacist as the overseer of medication use. It is in this light that associations like American Society of Hospital Pharmacists have developed guidelines on patient education and counseling that detail the disease and medication issues that must be covered to result in an acceptable patient counseling session. The focus on the medication is, however, not all that is mentioned in the guide. For sure, the first of the recommended ‘process steps’ involves “Establishing caring relationships with patients as appropriate to the practice setting and stage in the patient’s health care management.” It is only after this relationship is established that the exchange of medication information should continue.
How much time is dedicated to establishing that relationship during a counseling session has, unfortunately, not been widely researched. A 2014 paper used three artificial counseling scenarios to look at the type of interaction and how much time is spent in various activities during counseling sessions. Overall their study indicates that the majority of counseling time is spent discussing biomedical issues, with significantly smaller time is spent gathering additional information, building rapport and hitting psychosocial topics. While this fits in with the “medication focus” role of the pharmacist, research from other healthcare professions suggests we — and our patients — might be better served if we shift our focus, or at least our approach, a bit.
This changing role of pharmacists is not unique in this regard. ALL members of the healthcare spectrum are being seen as important parts. RELATIONSHIP BUILDING AND MUTUAL RESPECT ARE CRITICAL FOR EVERYONE INVOLVED.
For example, a 2011 study showed that physician empathy is associated with improved outcomes of diabetic patients, outcomes that included better overall control of A1C and LDL-C biometric screening results. This extended earlier studies showing the quality of the physician-patient relationship has positive influences on self-reported patient outcomes. The following year, a meta-analysis study extended the findings to show “There is a good correlation between physician empathy and patient satisfaction and a direct positive relationship with strengthening patient enablement. Empathy lowers patients’ anxiety and distress and delivers significantly better clinical outcomes.”
A new study by Emma Seppala and her colleagues extends these findings even further and indicates what is good for the patient may be good for the practitioner. The study investigated the relative effectiveness of a short, 10-minute session of loving-kindness meditation (LKM) to increase compassion and positive affect and compared LKM to a non-compassion positive affect induction (PAI) and a neutral visualization condition. Importantly, the results showed LKM improves well-being and feelings of connection over and above other PAIs, at both explicit (stated) and implicit (unstated) levels. This is certainly important because numerous indicators show increasing numbers of healthcare practitioners are experiencing stress-related job burnout and decreases in the quality of care they provide. Previous studies by Seppala and other researchers show LKM activates empathy and emotional processing in the brain and has positive impacts on neuroendocrine, innate immune and behavioral responses to psychosocial stress. LKM, thus, represents a viable, practical, and time-effective solution for maintaining high quality counseling sessions as well as building resiliency in those who practice it. This is not to suggest that you and your pharmacist will launch into a 10-minute LKM with each other when you pick up your prescription (although that might be nice!), it suggests that people who practice LKM have health benefits and these translate into better quality counseling sessions.
Even more recent studies have begun to look directly at how the brain itself is modulated by LKM practices. Previous findings showed that positive emotional perceptions and healthy emotional intelligence (EI) are important for social functioning; this study wanted to further these and looked into the potential impact of LKM and direct stimulation of the brain (a noninvasive procedure called anodal transcranial direct current stimulation — tDCS). In my field of pain management, tDCS has been shown to increase a person’s empathy for someone else in pain: in other words, brain stimulation from an outside source can make us kinder to someone else’s suffering. Key to the latest studies — LKM, in a very similar fashion to tDCS, can make us more empathtic.
Unfortunately, there is STILL no panacea
I personally think this is exciting (as a scientist) and I’m hoping it is exciting for the masses, too. But in a similar vein to ALL medicines, the devils are in the details. The high-level take: No medication, including LKM, is a 100%, sure-fire fully effective cure-all for everyone. Cautious optimism should rule the day, always. And even for me.
WHY?
On the exciting/positive side: Because LKM is part of a larger part of my life — yoga, mindfulness, mindfulness-based stress reduction, resiliency building, pain management, coaching and more. I get atwitter when studies come out supporting physiologically the more ancient philosophical practices that have been ‘believed’ to work by countless millions along the way. I use them all in my work so it’s nice to see validation on that level of what I do!
There is, however, a very real neutral side that can easily become a negative side: LKM, and meditation more generally, may not be for everyone — and by this I don’t mean certain people might not prefer it/them as a practice, certain people might not benefit from them. Hanging your hat on an approach that is neutral is not inherently negative, YET if other effective therapies might be used instead, the neutral can be viewed as negative. LKM an meditation may very well fall into that camp, too.
WHAT? My meditating yogi friends are saying?
If we were religious we’d be yelling “Blasphemy!”
Here’s the detail’s devils: Close inspection of all different kinds of meditation practices have yet to show full positive impact in all measurements. For example, earlier this year, Nature, one of the most highly regarded science magazines, published a meta-analysis study that showed:
…moderate increase in prosociality following meditation, further analysis indicated that this effect was qualified by two factors: type of prosociality and methodological quality. Meditation interventions had an effect on compassion and empathy, but not on aggression, connectedness or prejudice. We further found that compassion levels only increased under two conditions: when the teacher in the meditation intervention was a co-author in the published study; and when the study employed a passive (waiting list) control group but not an active one.
I agree with the authors in their assessment that there are “a number of biases and theoretical problems that need addressing to improve quality of research in this area.”
What we want to believe we can manifest to a certain extent, but data (i.e., outcome studies) will ultimately show us what is real and what isn’t. There may be additional explanations why the studies show what they do — but we need to not throw out the baby with the bathwater (or the meditation with the music in this case?) just yet.
WHY?
Because we’re still discovering all of the subtle, but absolutely significant, variables that we don’t normally think of, let alone control, in any situation: scientific or metaphysical. Some of these studies likely inadvertently included confounding factors beyond their study’s control.
For example, looking just at the potential impact of meditation on aggression and connectedness we need to dispel some of the misinformation we have on the topics.
Brilliantly summarized by Robert Sapolsky in his seminal book, “Behave: The biology of humans at our best and worst,” aggression in both men AND women is a complex, dynamic and far from clear-cut story, especially when it comes to certain hormones like testosterone and oxytocin. Focusing on these two quickly dispel the “testosterone = aggression” and “oxytocin = bonding/connectedness” grossly oversimplified stories.
Testosterone:
“…has far less to do with aggression than most assume. Within the normal range, individual differences in testosterone levels don’t predict who will be aggressive. Moreover, the more an organism has been aggressive, the less testosterone is needed for future aggression. When testosterone does play a role, it’s facilitatory — testosterone does not “invent” aggression. It makes us more sensitive to triggers of aggression, particularly in those most prone to aggression…”
Oxytocin:
“…facilitate(s) mother-infant bond formation and monogamous pair-bonding, decrease(s) anxiety and stress, enhance(s) trust and social affiliation, and make(s) people more cooperative and generous. But this comes with a huge caveat — these…increase prosociality only toward an Us (in-group members). When dealing with Thems (out-group members), (it) make(s) us more ethnocentric and xenophobic. Oxytocin is not a universal luv [sic] hormone. It’s a parochial one.”
Previous mental and physical stress, in childhood or adulthood, socio-economic status, perceived or real economic or social capital inequities, cultural upbringing, genetic and epigenetic factors, belief systems, and a whole lot more craft the overall biopsychosocial milleaux of a person. Thus, both nature and nurture shape every individual in completely unique ways. These all impact how that person might respond, or not, to something like LKM.
How many men and women in the studies behind the meta-analysis study were individually parceled out according to these factors is unknown but I’d bet my whole collection of meditation soundtracks that the answer is absolutely not enough to clearly and neatly decide if LKM or other types of meditation absolutely don’t work on aggression or connectedness in all people.
Hopeful for the future
The first thing I hope is that this writing is viewed as more positive than negative! The more we question, openly investigating our world and our role in the world, the more we can learn; the more we learn, the more we can craft better ways to make the world a better place.
I hope more medical practitioners will read this and develop better coping mechanisms for themselves because they (meditative practices) might just help the patients they’re trying to help. I also hope more patients will read this and see their role in all of this and that they (the patients) can begin the same practices that will help them help the people who are trying to help them.
I also hope that everyone will begin to see that all of our stories are, at a minimum, far from complete — yet this doesn’t mean we can’t try to make things better right now. We don’t need to have the full story in order to live a full life — or to impact others in the greatest positive ways we can.
Please let me know your thoughts — do you agree or disagree? What would you add or delete or change? Comment and keep the discussion going so that we can all grow together?
