Dr Raj Persaud in conversation with Dr Madhav Goyal from Johns
Hopkins University USA on scientific research investigating whether
meditation has psychological benefits
A recent review of research on meditation comes to surprising
conclusions about whether it actually works in terms of mental
health objectives - Raj Persaud discusses the findings with lead
author Dr Madhav Goyal from Johns Hopkins University.
Dr.Goyal is an assistant professor in the division of general
internal medicine at Johns Hopkins University. He is a
practicing internist, with research interests in patients dealing
with chronic pain and non-pain symptoms that have been refractory
to conventional care.
He completed his undergraduate studies at UC Berkeley, medical
school at UC San Diego, masters in public health at Harvard School
of Public Health, and his fellowship in General Internal Medicine
at Johns Hopkins.
The most recent comprehensive review of research on the benefits of
meditation concludes that rigorous clinical trials find only,
'small to moderate reductions of multiple negative dimensions of
'Mantra' based meditation programs such as 'Transcendental
Meditation' did not significantly improve any of the outcomes
examined. Transcendental Meditation, unlike other meditation
techniques, emphasizes the use of a mantra in such a way that it
'transcends one to an effortless state where focused attention is
This latest analysis entitled 'Meditation Programs for
Psychological Stress and Well-being, A Systematic Review and
Meta-analysis', was published in the prestigious 'Journal of the
American Medical Association Internal Medicine'. It was conducted
because many now use meditation to treat stress-related conditions
and promote general health.
Madhav Goyal, Jennifer Haythornthwaite, and a team from Johns
Hopkins University and Medical School in the USA, reviewed 47
separate studies with 3515 participants. Their analysis found that
'Mindfulness' meditation programs had moderate evidence of improved
anxiety, depression, and pain, but low evidence of improved stress
and mental health-related quality of life. They found no evidence
that Transcendental meditation improved any outcomes.
These relatively small effects of 'Mindfulness' meditation are
comparable with what would be expected from the use of an
antidepressant, but without the associated toxicities. The review
did conclude that meditation does appear free of possible harms or
harmful side-effects compared with other treatments.
'Mindfulness' meditation derives from aspects of Buddhism, and
involves learning to become aware of thoughts and internal states,
but not be affected emotionally by them - so-called non-judgemental
awareness. Mindfulness has been described as the next new wave in
psychological treatment - following on from CBT or Cognitive
This latest review however found there was little to no evidence of
any significant effect of any kind of meditation on positive mood,
attention, substance use, eating habits, sleep, and weight. There
was no evidence that meditation programs were better than any
active treatment (ie, drugs, exercise, and other behavioural
therapies). Behavioural treatments tend to emphasise performing an
action eg confronting what is making you anxious - while
'Mindfulness' meditation appears to encourage facing challenges,
but from a different mental angle - you aren't judging it, you are
not reacting to it.
'Mindfulness' meditation techniques did appear most effective in
dealing with a particular kind of pain referred to as 'visceral',
in other words pain coming from organs such as the stomach or
bowels, but it was less effective with pain from muscles and bones.
This suggests that perhaps certain techniques of meditation may be
useful in particular conditions, but they are not universal
In 20 Randomised Controlled Trials examining comparative
effectiveness, mindfulness and mantra programs (such as
Transcendental Meditation) did not show significant effects when
the comparison was a known treatment or therapy. In some cases it
appeared that the meditation program may have been as effective as
the known therapy, and in other cases less effective than it.
The authors of this new review ended up excluding an enormous
number (18,706 studies) because, for example, many of the studies
did not adequately allow for possible placebo effects, by using an
adequate comparison group. Also much of the research didn't
randomise people in to groups having meditation, or a placebo, as
properly conducted drug trials should.
Just studying people who have themselves chosen meditation, is
prone to another bias. The problem of 'self-selection' - people who
believe in the benefits of meditation are more likely to enrol in a
meditation program, and then perhaps report positively. Allowing
for this bias involves allocating subjects randomly to meditation
or comparison treatments. This takes out the self-selection bias of
just studying those who had already themselves already chosen
meditation, and therefore might be more highly motivated or biased
to declare it helpful.
Because of such self-selection problems, randomisation is now a key
part of properly conducted clinical trials on treatments such as
The authors of this latest review point out that medical research
may end up being unfair to meditation. There are challenges in
acquiring such mental skills or meditative states, and Randomised
Controlled Trials tend to be time-limited.
Meditation is a skill or state learned and practiced over time,
increasing awareness and gaining insight and understanding into the
various subtleties of existence. Training the mind in awareness, in
nonjudgmental states, or in the ability to become completely free
of thoughts or other activity are 'daunting accomplishments'. The
authors of the study recommend longer term trials with an emphasis
on greater amounts of mental training.
They also point out that the interest in meditation that has grown
during the past 30 years in Western cultures derives from Eastern
traditions emphasizing lifelong growth. The West may have
fundamentally misunderstood the basic point of meditation, and
trying to do short term trials just compounds the
On the other hand, Kristin Barker of the University of New Mexico,
has just published a critique of 'Mindfulness' meditation, pointing
out several inherent contradictions in the practice. Her paper
entitled 'Mindfulness meditation: Do-it-yourself medicalization of
every moment', points out that 'Mindfulness' meditation contends
one is healed through accepting things as they are, even (or
especially) in the presence of illness; yet many of the books and
recordings advocating the technique boast descriptions of seemingly
phenomenal cures through mindfulness.
Published in the academic journal 'Social Science & Medicine',
the critique points out a host of contradictory phrases arising
from 'Mindfulness': "One needs to try less and be more" and
"intentionally cultivating the attitude of non-striving", and, one
must engage in "doing nothing, on a regular basis, on systematic
basis, in a disciplined way".
Madhav Goyal, Jennifer Haythornthwaite and the team from Johns
Hopkins University conclude from their review that meditation
programs could help reduce anxiety, depression and pain, but only
in some people.
They argue that doctors should still be prepared to discuss with
patients the role that a meditation program could have in
addressing some strains, particularly pain, anxiety and depression.
These were the conditions for which 'Mindfulness' meditation was
found to be most effective.
Raj Persaud is joint podcast editor for the Royal College of
Psychiatrists and also now has a free app on iTunes and google play
store entitled 'Raj Persaud in conversation',
which includes a lot of free information on the latest research
findings in mental health, plus interviews with top experts from
around the world.