Could meditation make part of psychiatric treatment ?

This is an integrative review relating the effects of meditation in the brain and its possible use as preventive alternative medicine and an adjuvant in the psychiatric treatment. Studies have associated meditation and spirituality with increased life quality for being linked to emotional control and self-preservation behaviors, such as ethical practices, emotional regulation, attention improvement, stress and anxiety reduction and cognitive functions improvement in a general fashion, which is also evidenced by studies that analyzed morphological changes in correlated brain areas. This work proposes an integrative review in order to prove the hypothesis that meditation could be used as a practice in alternative and preventive medicine aiming to diminish the harmful effects of diseases and psychopathologies in general.


Introduction
The idea of spirituality can be associated directly with quality of life (Comstock & Partridge, 1972;Levin & Vanderpool, 1987;O'Regan & Hirshberg, 1993;Levin, 2003;Stroppa & Moreira-Almeida, 2008;Rocha & Fleck, 2011;Barricelli et al., 2012;Melo et al., 2015), putatively because of the behaviour generated by religiosity/spirituality in people, such as abstaining from drinking, other moral and ethical practices, emotional and physical well-being (Rocha & Fleck, 2004), offering a net of social support, nutrition, financial help (Ellison & George, 1994) and an explanation about suffering, as well as motives generating faith and hope (Bowker, 1975) that can reduce the effects of diseases and harm from mental illness (Idler, 1987).
The concepts of religiosity and spirituality present differences (Angerami-Camon, 2008;Murakami & Campos, 2012;Paiva, 2001) that are important to separate for the purpose of this work.
Spirituality is associated with a deep feeling in life, a search for a life purpose but not necessarily associated with beliefs.
When religiosity is associated with beliefs and practices in a doctrine, this can be shared by a group where there is a kind of faith (Murakami & Campos, 2012).
In addition to these concepts, the practice of meditation is linked to spirituality mainly and the scope of life quality, and could be a good alternative method for preventive medicine, since meditation is related to a group of complex emotional and attentional practices (Kang et al., 2013), projecting a self-regulation of body and mind (Boccia, Piccardi & Guariglia, 2015), or even body control because meditators show high tolerance for pain (Grant & Rainville, 2009;Zeidan et al., 2012). Meditation could be used for the clinical treatment of pain (Zeidan et al., 2012), therefore relating the benefits of spirituality and meditation, which are close in terms of concepts and health improvement.
In general, meditation, independent of any kind of techniques, provides relaxation, the regulation of attention and thought control (Sperduti, Martinelli & Piolino, 2012), and decreases the emotional interference to face unpleasant situations (Boccia, Piccardi & Guariglia, 2015).
In this way, the practice of meditation could be used for the prevention of mental illness or disturbances such as stresses, dementias in general, depression, anxiety, for instance, or to avoid and/or to slow senile dementia, i.e., could be used an adjuvant in psychiatric treatment.
The objective of this review is to study the effects of meditation on the body and mind and to associate these data with the possibility of using meditation techniques as an alternative medicine method to improve health.

Methodology
For the purpose of this manuscript, a systematic review methodology was used, considering the indexers meditation, meditation and the brain, meditation and psychiatric disorders and spirituality and psychiatric disorders, totalling 5603 articles from PubMed, 4253 articles from Scopus and 178 results from Scielo for the same indexers. After the verification of the duplicates, there were 352 articles remaining, which were studied and 45 chosen according to their relation to the inclusion criteria. Books and papers about spirituality and about neurological processes were also incorporated. The exclusion criteria were Research, Society andDevelopment, v. 10, n. 9, e26810917929, 2021 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v10i9.17929 3 papers older than 2000 and papers outside the scope of this manuscript. A total of 57 papers were chosen for the purpose of this study.

Results and Discussion
To effect this work, 17 articles were studied about meditation and 13 about religiosity after a scrutinising a total of 10034 papers among the descriptors meditation, meditation and the brain, meditation and psychiatric disorders, spirituality and psychiatric disorders.
Accordingly, just the papers pertinent to the objective were considered and they are indicated in Tables 1 and 2. Most of the papers presented experimental designs (12+7) into a various type of meditation and 7 used diagnostic images for meditation papers. experimental fMRI MBSR participants showed improvement in anxiety and depression symptoms and selfesteem. During the breath-focused attention task they also showed decreased negative emotion experience, reduced amygdala activity, and increased activity in brain regions implicated in attentional deployment. This reduction in negative emotion was not perceived using distraction-focused attention.
Barnhofer (2009)  Studies show that there are differences in gray matter (GM) volume, density and cortical thickness between long-term Yoga practitioners and control groups. These studies also investigated regions such as hippocampus, which showed greater volume in comparison to the non-practitioner group, as well as many other brain regions that had significant differences between the two groups. Other studies sought to investigate short-term effects of Yoga practice in the brain, with consistent findings of GM volume changes in certain brain regions, such as hippocampus and dorsal anterior cingulate cortex. The fMRI findings reveal that Yoga practitioners show different task related brain activation in comparison to non-practitioners in different brain areas such as the ones mentioned above. Kober (2019) n=17, participants going through both "react" and "accept" cycles of stimuli and response. When participants were told to "react" to a certain painful or not stimuli, they were instructed to react naturally Mindfulness acceptance experimental fMRI and MRI Participants self reported feeling less negative affect when exposed to both negative images and a painful stimuli when instructed to perform a mindful acceptance as they were prior instructed to do, whereas participants reported a higher negative affect when instructed to react naturally. fMRI shows a decreased activation on the right amygdala in response to negative visual and physical stimuli when participants were instructed to accept the feeling. Furthermore, brain scans show a widespread decreased activation of regions associated with pain processing in mindfulness acceptance in comparison to natural reaction.  women about intrinsic and extrinsic religiosity. In the field "General health", men with intrinsic religion presented a positive difference. Byrd (1988) n=393, 192 to an intercessory pray group and 201 to a control group experimental no use The intercessory prayer group presented lower severity outcomes after entry. Ventilatory assistance, antibiotics and diuretics were less frequently required in IP group than in patients in control group. 85% in the prayer group were considered to have a good hospital course after entry vs 73% in the control group; 1% of the prayer group showed intermediate hospital course in contrast to 5% of the controls, and a bad hospital course was observed in 14% of the prayer group vs 22% of the controls. Comstock (1972) not applicable review no use To provide basic information about church attendance the study used a nonofficial census made in Washington County. The findings showed that the risk of dying from arteriosclerotic heart disease was higher to infrenquent church attenders than to frequent ones, and the death rates for emphysema, cirrhosis and suicide did not differ between these two groups. For Catholic males, heavy drinking and cirrhosis had the same death rates regardless of frequency of church attendance. Ellison (1994) n=2956 from a southeastern community experimental no use Frequent church attenders report more types of social support, more social networks, more frequent social interaction and more positive perceptions of their relationships quality than those who do not go to church. Ellison (1996) not applicable review no use The study used data from the National Survey of Black Americans to analyze religious coping among African Americans. Approximately 80% reported using prayer as a coping resource to confront serious personal problems, such as praying or asking someone to pray for. In addition to that, people that are dealing with a health problem are more likely to use religion as a coping mechanism than people with other kinds of problems; women are more likely to turn to prayer, and the use of religion coping is unrelated to access to social network, such as family and friends. Farris (2011) not applicable review no use The study analyzed religion and religious practice in the light of psychology and based on studies that considered religion as part of human behavior. Among the conclusions: religion is generally beneficial to mental health and there are some types of religion that can harm health. Religion has the potential to have a positive or negative effect on health, but it is not an expression of mental illness. The study also discusses Allport's studies, about intrinsic and extrinsic religion, personality construction and mature or immature religious feeling. Fleck (2003) Idler (1987) n=2756, 1319 elderly men and 1637 elderly women, interviewed face-to-face and composing the database for the study. The study analyses religious engagement and two measures of health status, functional disability and psychological distress, both analysis controlling for chronic diseases (self reported by patients) experimental no use Study found that for both men and women there is an inverse association of public religiousness (attendance to religious service and number of other congregation members known to the respondent) and disability. When participants received explanations on the four hypotheses brought up in the study, the inverse association had a slight reduction in the model controlling for chronic disabilities. This is probably due to the fact that the disability itself hampers the ability to attend to religious services and engage in such services. Koenig (1988) n=836 older adults divided in five groups: patients of a university-affiliated geriatric outpatient clinic, participants in a state-sponsored seniors' lunch program, older members of a group of conservative protestant churches, participants in a Jewish seniors' lunch program, and a group of retired Dominican and Franciscan nuns experimental no use Women were highly more likely than men to score high in religiosity measures. Inverse correlation between age and religiosity, and a significant inverse correlation between age and morale. Social support was positively correlated with morale, subjective coping, and organized religious activities (ORA). Financial status and subjective health measures were strongly correlated with coping and morale and were associated with ORA.  not applicable review no use Studies have been approaching religious factors and health over the last two centuries. In contrast, there are still plenty of academic claims suggesting a scarcity of studies concerning religious factors and health. Some studies suggest a lower risk of certain illnesses such as hypertension and some cancers in those with religious involvement. Studies' results point to a better health and life quality in people with religious involvement. Levin, Vanderpool (1987) not applicable review no use Studies reveal an association between religious attendance and health, despite being a weak and methodologically contestable association that in fact reveals the need for more research. The authors' believe that more studies will shed light upon the raised question and that the answer found will be an association between religious attendance and health. Medeiros (2010)  Studies show changes in brain activity in meditation practitioners, with thicker areas such as the prefrontal medial cortex, orbitofrontal cortex and the frontal superior cortex, and thinner posterior areas (Kang, 2013;Hölzel, 2007;Gothe, 2019).
Meditation practices can bring about changes in the human behavioural reaction to pain perception: experienced meditators show greater tolerances to pain (Zeidan, 2012), as well as a possible tolerance to negative physical and visual stimuli (Kober, 2019), which is also related to changes in brain activity, with less activation of the amygdala (Goldin, 2010), the centre of response to negative stimuli of the brain.
Considering these altered brain regions and behaviour, related to the processing of emotions, decision making and cognition (Hölzel, 2007;Gothe, 2019) which generates, for human physiology, putatively, changes to a less inflammatory state in the body, via modulation of cytokine production (Larouche, 2015), the practice of meditation should be an ally to the treatment of diseases in which pathophysiology involves the brain areas (Ives-Deliperi, 2013;Menezes, 2015;Boccia, 2015).
Some subjective effects related to meditation are emotional regulation and disengagement from distractors and repetitive thoughts (Kang, 2013;Boccia, 2015). These effects, taken alone, are themselves related to improvements in symptoms related to psychiatric disorders such as anxiety and depression, conditions that are often associated with difficulties in emotional control and in disengagement from negative thoughts (Dalgalarrondo, 2018;Lutz, 2008;Menezes, 2015).
This became more important for cases of depression refractory to medicines, mainly in considering that studies evaluating the effects of mindfulness-based cognitive therapies (MBCT) reveal that patients who underwent such treatment had fewer relapses or recurrent episodes of depression, with an efficacy comparable to that of medications (Ives-Deliperi, 2013;Chen, 2015). The results of these studies are consistent with fMRI studies revealing that MBCT affects grey matter and the connectivity in several different areas of the pre-frontal cortex, which is the main area affected in mental disorders (Chen, 2015).
In addition, there are positive effects on quality of life and sleep in cancer patients (Carlson, 2003), and it may have positive effects on patients with ADHD and even Alzheimer's (Brewer, 2011).
Although it is still a new area in neuroscience and needs further studies to state more conclusively, the evidence so far suggests a positive correlation of meditation practice with an improvement of the symptoms in diseases such as depression and anxiety mainly, along with an overall positive effect in cognition (Lutz, 2008;Maclean, 2010) and working memory capacity (Jha AP, 2010).
In this sense, meditation practices are a source of advantages as part of the treatment of anxiety and depression and for other diseases that present these morbidities, at least as an adjuvant therapy.
Mental morbidities are increasing in the world from specific and stochastic factors and, despite the pharmacological evolution in the direction to ameliorate patient conditions, some adverse effects have added to the refractory conditions to medicines. Alternative therapies are used across the world by many classes of population, in some cases without effects or with scarce ones.

Conclusion
The alternative therapy has demonstrated proven effects, so it must be indicated for patients with medicine problems and for patients in general, and that is the case for meditation practices.
Accordingly, this work shows that meditation practices could be an adjuvant for psychiatric/psychological therapy and should be indicated by the Aesculapius for patients.
Indeed, more studies about meditation with medical objectives could be performed to obtain more data to use this therapy as a psychiatry/psychology adjuvant.