William Hayden first noticed a few small red spots on his leg and abdomen three years ago. He expected the strange rash to go away, but the spots soon covered most of his body.
Doctors told Hayden he had guttate psoriasis. They treated him with antibiotics, steroids and topical medications. Eventually, ultraviolet light B treatments brought the psoriasis under control.
At the time, the Washington, D.C., resident was also struggling with changes in his personal and professional life. The psoriasis made things worse.
"I couldn't sleep at night because the itching was bad, and that was starting to make me nutty," recalls Hayden, 37. "I felt self-conscious about having flaky skin all over my body and being red and blotchy."
He turned to a set of guided meditation tapes he had come across more than a decade earlier.
After a few weeks of practicing the instructions on the tapes, Hayden found himself sleeping better. His psoriasis seemed to improve.
"I really learned to appreciate [psoriasis] as a marker or a pointer that something within me is not quite right," he said. "When I have a conflict within myself and it's eating away at me, one of the ways I know I am in that state is that the psoriasis wants to come out. Meditation has given me the opportunity, even if it is just for 15 minutes at a time, to let a lot of that [stress] go."
Mindfulness meets medicine
The meditation recordings William Hayden listened to were produced more than 30 years ago by Dr. Jon Kabat-Zinn, founder of the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts and author of several bestselling books.
A longtime proponent of "mindfulness" meditation, Kabat-Zinn is near the forefront of a growing effort to understand how meditation and other stress-reduction practices can contribute to health and healing.
In his books, Kabat-Zinn defines mindfulness as "paying attention in a particular way on purpose: in the present moment, and nonjudgmentally."
Now 67, Kabat-Zinn became interested in mindfulness as a graduate student in the late 1970s.
Through personal experience and observing others, he came to believe that learning to pay attention to sensations in the body, and accepting those sensations without labeling them as good or bad, can make people emotionally and physically healthier.
To test his theories, Kabat-Zinn connected with dermatologists in the psoriasis phototherapy clinic at the University of Massachusetts School of Medicine.
In a pilot study and then a full trial with several dozen participants, psoriasis patients receiving ultraviolet light therapy were divided into two groups. One group listened to recordings of mindfulness instructions while receiving light therapy; another group went through the therapy without the recordings.
Patients who listened to the recordings saw their psoriasis clear significantly faster than those assigned to the group that did not hear the recordings. For example, patients undergoing PUVA [the light-sensitizing drug psoralen and ultraviolet light A phototherapy] while listening to recordings had 50 percent skin clearing in an average of 48.5 days, compared with 85 days for the group that did not listen to the tapes.
The study results were published in 1998 in the academic journal Psychosomatic Medicine.
Though the psoriasis studies were small by scientific standards, the results encouraged Kabat-Zinn to use the recordings as part of a program he was developing called Mindfulness Based Stress Reduction [MBSR].
Now in use at medical centers around the world, this stress-reduction program is increasingly seen as a litmus test of how meditation can affect medical outcomes.
Delivered either through an eight-week class or through independent study, the program teaches mindfulness through recorded instructions that direct participants to notice what is happening in their bodies and minds in the present moment, while either lying down, engaging in a gentle movementbased practice or practicing a seated meditation.
In a phone interview from his home near Boston, Kabat-Zinn explained why he chose to study psoriasis: "There is no better way to scientifically understand [the effects of mindfulness] than to test it on something you can see and measure, like psoriasis."
Ted Robles, an assistant professor of psychology at the University of California, Los Angeles (UCLA), is in the early stages of replicating Kabat-Zinn's experiments with psoriasis patients. He says psoriasis is a good model for studying mindfulness for other reasons as well.
"One of the biggest challenges for [psychological experiments] in the context of chronic illness is that it's another appointment for people who have a lot of appointments. People doing phototherapy are in a light box anyway, so why not deliver something like mindfulness? It is well-suited to the environment they are in."
Scientists at the University of Rochester in New York are also replicating Kabat-Zinn's experiments with psoriasis patients as part of a five-year study on healing and the mind, funded through a grant from the National Institutes of Health.
Kabat-Zinn says not only is psoriasis suited for the study of mindfulness, but mindfulness practice may be particularly applicable to the complexities of the disease.
"The skin has significance on so many physical, medical and metaphorical levels. It really is important to try to come to terms with [psoriasis] emotionally and cognitively, so you don't feel entirely victimized by it."
Meditation and psoriatic arthritis
Other forms of mindfulness practice include seated meditation and movement-based techniques.
Linda Cheu is a 26-year-old living near San Francisco. Four years ago, she developed such severe psoriatic arthritis that she had to be hospitalized.
Forced to leave her studies at the University of California-San Diego and move back to her parents' home, Cheu found herself living with tremendous stress and physical pain. She began listening to a guided meditation recording she had received in a class several years before.
"When I was going through all of this I went back to the CDs, which had you visualizing your body healing itself. It definitely had a positive effect and it helped me control the stress and anxiety that was going on at the time."
Cheu says she used the CDs off and on for about six months. She still turns to them occasionally, but is now learning the Chinese practice of qigong [pronounced CHEE-kung], a form of meditation that incorporates movement, breath and energy.
"I am just the type of person who worries a lot, and that triggers the arthritis," she said. "I think the more calm I am and the more positive I am, the more I am not experiencing as much pain. It's kind of a cycle—the mental and emotional states affect the physical and that goes back and affects the emotional, so you can easily go downward in a negative spiral. Or it can be a positive spiral."
Meditation and inflammation
Although clinical and anecdotal evidence point to benefits from the Mindfulness Based Stress Reduction program and other meditation techniques, Kabat-Zinn says researchers have yet to figure out why the practices work.
Dr. Craig Raison, a researcher at Emory University in Atlanta, believes the answer lies in the relationship between mental health, stress and inflammation.
In experiments with students at Emory, Raison is testing the impacts of a technique called compassion meditation. Participants use mindfulness techniques similar to those used in Kabat-Zinn's MBSR program, along with reflections on how they feel about themselves and others. He says the more the students practice the meditation, the lower the inflammation present in their bodies.
In theory, this should help keep the students healthier, according to Raison.
"Psychiatric conditions in many people appear to be related to a state of overactive inflammation. This is one of the ways [stress] leads to sickness."
According to UCLA researcher Ted Robles, psoriasis works well for studying the influence of the mind on immune response and inflammation because the connection between stress and inflammation in psoriasis is already well established scientifically.
A complement to medical treatment
Jon Kabat-Zinn says he's surprised meditation isn't more widely prescribed as an adjunct to medications and ultraviolet light treatment for psoriasis.
Though he made CDs available to dermatology clinics, none have picked up on the psoriasis studies, Kabat- Zinn said. "If you can use the mind to help clear the skin in fewer treatments, that is saving money. And since [ultraviolet light] itself is a risk factor for skin cancer, you are also lowering your risk."
Kabat-Zinn says he's hopeful that through the newer studies, more people with psoriatic disease will learn about the potential benefits of mindfulness.
Linda Cheu says meditation is just one of many things she is doing to keep herself as healthy as possible as she attempts to manage psoriatic arthritis without systemic medications.
"It is hard to tell exactly what is working, but something is working and I am getting better. One thing I can say for sure is that on the days I do [qigong], I feel a lot better than the days I don't do it."
Psoriasis patient William Hayden recently completed a master's degree in social work and is now offering trainings to other mental health professionals on using meditation and mindfulness with their patients. He wonders why mental health in general isn't considered more of a front-line factor in treating people with psoriasis and psoriatic arthritis.
"For me, the meditation works as a component of my health practice. One's happiness and self-esteem diminish with psoriasis and that stress in turn increases the psoriasis. Meditation gives a person the opportunity, however brief, to step outside the process and see it with new eyes. The more you do it, the more you understand that you have some control over your circumstances."