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 psychological stress'.
'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 absent'.
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 Behavioral Therapy.
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 panaceas.
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 drugs.
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 misunderstanding.
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.