Explanatory factors for the observed effects of meditation and their particular importance in behaviour therapy research include the following 3 categories:

Category 1. Factors which are common to all strategies such as social support or therapeutic contact. Many clinical researchers have observed that controls with high face validity seem more likely to generate effects of similar magnitude to the intervention. Expectancy alone has also been shown in a number of studies positively to influence the apparent effect of meditation. An important factor which relates to the plausibility of the control interventions is the participant’s expectation that they will experience a benefit (or detriment)45. Despite this, only 24 studies took specific steps to gauge either the participants’ expectation of benefit or the perceived credibility of the various interventions.

Category 2. The possibility that strategies that draw volunteers from the community without using a predetermined threshold of dysfunction end up recruiting samples containing significant proportions of participants with sub-clinical scores. These “worried well”46 have little scope to improve, exerting a ceiling effect on the chosen measures and thus dilute any apparent effect of the intervention. In other words, behaviour therapy trials, especially trials that recruit from the general community, and even more especially those community-recruited trials seeking to demonstrate behavioural changes in normal participants (i.e. those with no diagnosed psychopathology) are fundamentally prone to type 2 errors in study design47. Since meditation was developed as a practice for everyday use by normal people rather than those with psychopathology, researchers have frequently recruited from the community. This issue is therefore of particular relevance to the work presented in this thesis.

Category 3. Other factors include regression to the mean. This is a phenomenon that most commonly occurs in studies in which participants are selected because they have extreme values on a certain variable, such as in clinical trials for which specific eligibility criteria are set. In this case, the participants will manifest an improvement simply because of the natural tendency for variables to approach the population mean over time, regardless of any effect (or lack thereof) from the intervention being studied48,and poor choice of outcome measures which are not specific and sensitive enough to detect change.

Dr Ramesh Manocha

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Sample size is obviously a key factor in determining the validity and generality of trial outcomes. It needs to be determined carefully to ensure that the research time, effort and support costs invested in any clinical trial are not wasted. Ideally, clinical trials should be large enough to detect reliably the smallest possible differences in the primary outcome with treatment that are considered clinically worthwhile. My review found that it was common for studies to be “underpowered”, failing to detect even large treatment effects because of inadequate sample size suggesting that resources may have been wasted for want of a slightly larger sample. Some ethics committees may object to recruiting patients into a study that does not have a large enough sample size for the trial to deliver meaningful information. Despite the importance of appropriate sample size, only 12 studies reported the use of a sample size calculation.
It is a widely accepted rule of thumb that trials with 30 or less participants per treatment arm are unsuited to conventional statistical analysis. In fact trials with less than 15 participants per treatment arm, while useful for generating hypotheses for further research, are not at all reliable for making conclusive statements. In my review, 78 studies used 30 participants or less per treatment arm . In fact 17 studies used 10 or less participants per treatment arm, making any kind of analysis futile (although this did not stop the investigators from conducting statistical analyses), whereas only 42 studies used more than 30 participants per treatment arm.

Dr Ramesh Manocha

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The Jadad scoring system is a widely used method of rating RCTs for basic methodological rigour. However it seems to be inadequately structured to meaningfully discern the methodological standard of meditation trials. For instance, while all trials might be randomised, only a minority described randomisation methods and few use the term “double blind”.

The blinding process in meditation trials is complex since it involves blinding of participants, raters, instructors, statisticians and other investigators.

It also demands that the comparator intervention is properly able to control for non-specific effects. Many trials feature some of these steps and others actually feature them all. And yet the Jadad score only applies one point for this crucial but complex and multifaceted factor. Similarly, very few trials described drop-outs.

The Jadad score of the studies in my review mostly ranged between 0 and 2. Trials with high scores did not seem to be much better designed than trials with lower scores. Thus the Jadad system does not usefully differentiate between trials with a methodology of a sufficient standard to discern effects specific to meditation, and those that do not have such a methodology. Despite evaluating other methodological rating systems none were appropriately orientated to be useful in discerning meditation research.

Dr Ramesh Manocha

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Meditation and its underlying ideas are increasingly popular in Western society but the practice itself has been subjected to little high quality scientific scrutiny.

This website describes the outcomes of the Meditation Research Programme, a serious scientific endeavour aimed at addressing this deficiency.

Some of our key projects, and their implications for meditation research include:

A comprehensive systematic review and meta-analysis of the entire English-speaking database of randomised controlled trials clearly demonstrates that the extant data is characterised by a number of methodological and conceptual flaws. As a result there is currently no consistent evidence of a specific effect associated with meditation. The most fundamentally important of these flaws, we propose, is the lack of a consistent and meaningful definition of meditation.

To explore the salience of the mental silence concept we conducted a survey of 348 meditators who used a single homogenous form of meditation called Sahaja Yoga which focuses on the experience of mental silence as its defining feature, to assess their functional health and its relationship with their meditative practices. This survey demonstrated that these meditators had not only better mental and physical health but also that a consistent relationship between health, especially mental health, and self-reported experience of mental silence existed.

To investigate the possibility of whether or not this relationship was causal, a series of increasingly rigorous clinical studies were implemented. Two separate observational and case control studies of participants suffering from 1)menopausal symptoms, and 2) attention deficit hyperactivity disorder demonstrated promising outcomes. These were followed by a small but well-designed RCT of meditation for asthma, then the largest RCT of meditation for occupational stress currently in the literature. The latter two studies were specifically designed to exclude non-specific “placebo” effects. The outcomes of these studies provided strong evidence that mental silence is associated with a specific, therapeutic effect.

Finally, in a heuristic physiological study mental silence meditators manifested reductions in skin temperature during meditation thereby contradicting the “reduced physiological arousal” conceptualisation of meditation. This and other data are discussed and the possibility that the mental silence experience is associated with a unique pattern of physiological activity is proposed.

In conclusion, there is credible evidence to support the idea that Sahaja Yoga meditation, and hence the mental silence experience that typifies it, is associated with unique effects.

Future studies that focus on further examination of the mental silence state and potential mechanisms by which its specific effects may occur with emphasis on immunogenetic markers and neuroimaging are now under consideration.

Dr Ramesh Manocha

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In Australia, a survey of a randomly selected but representative sample drawn from the state of Western Australia (n = 1,033) found that 11% of respondents had practiced meditation at least once. This reflects trends in other countries. In the United States for instance, a survey administered to 31,000 representative adults, conducted in 2002 as part of the National Health Interview Survey (NHIS) of the Centers for Disease Control and Prevention (CDC), showed that 8% of respondents had practiced meditation at some time.
Dr Ramesh Manocha

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In some ways the fact that specific effects appear to be associated with the mental silence experience poses a challenge to the philosophical underpinnings of Western culture by not only describing a state of non-thought, but also demonstrating that this state is accessible and of practical importance to the general population.

The cogito ergo sum argument essentially states that “I am thinking therefore I exist”. To some extent Western culture’s difficulty in apprehending the idea of non-thought is the result of its Cartesian underpinnings — the idea that one cannot exist if one is not thinking. The metaphysical implications of Descartes’ phrase, which equate thinking activity with self identity contrast sharply with the Eastern metaphysical idea that existential reality can be perceived only when one is not thinking, which might be stated in Latin as sum cogito ergo (I am, therefore I think)!

The ancient Eastern perspective on meditation, the mind, consciousness and health has here been demonstrated to have an important potential role to play in the health and wellbeing of people both in the East and West.

Dr Ramesh Manocha

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Of great interest is that the yoga tradition does not just describe philosophical, moral, metaphysical associations between mind, behaviour and health but actually describes the mechanism by which they are interconnected. This is the system of chakras (energy plexuses) and nadis (energy channels). Described since ancient times, the physical body is said to be energized via a complex network of 72,000 nadis and their associated chakras, not unlike the ancient Western understandings of the four “humors”—blood, bile, phlegm and pneuma. Yogic exercises and disciplines are directed at manipulating the subtle energetic system in order to bring about shifts in energy flux which not only impact on physical function, but also on cognitive style, mood and consciousness.

States of enlightened consciousness, whether they be described as self-realization, moksha or sahaja can be characterized by the awakening of an energy called kundalini. This energy is said to lie dormant at or near the base of the spine. At the time of awakening it rises through the spine to enter the brain and then exit via the crown of the head. The kundalini has been described variously and has been compared to many other psycho-cultural and archetypal symbols. For a useful diagramme, see Subbarayappa, 1997.

The ancient subtle-energetic mechanics of the chakra system may offer important clues in the quest to comprehensively describe and integrate the otherwise rather disparate psycho-physiological pathways that are coming to be recognized in modern science.

Dr Ramesh Manocha

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The popularity of meditation in the West has grown in parallel with the mainstreaming of alternative health and the New Age movement and is now fuelled by a potent combination of traditional anecdote, selective misreadings of the scientific database and marketing hyperbole. Popularity with consumers may well be encouraged by apparent acceptance amongst health professionals.

The scientific evidence clearly shows that prevalent definitions of meditation do not have much of an effect beyond that of simple rest. This is primarily because the original understandings of meditation and its relationship to mental silence have not been successfully translated into the West.

The current lack of clarity about definition is used by the New Age industry and entrepreneurs to perpetuate a misunderstanding of a form of meditation that is basically no more effective than sitting quietly, listening to music or walking in the park. In contrast the traditional understanding of meditation as mental silence does appear to generate scientifically verifiable effects and is therefore likely to be if considerable value to health professional and indeed modern consumers. Sahaja Yoga meditation is an example of such an approach to meditation.

Dr Ramesh Manocha

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In light of the number of studies reporting adverse effects from meditation broad based surveys need to be conducted, and given that studies such as Kaldor’s (2002) suggest that up to 10% of the population may have tried meditation at some time, a direct-to-public cross sectional survey may be sufficiently effective in quantifying adverse effect rates. Also important are controlled observational studies with a specific focus on detecting, characterising and quantifying adverse reactions. Moreover, meditation should not be the only modality assessed but instead, the opportunity should be taken to assess the effects of all related quasi therapeutic practices including hypnosis, faith healing and Qigong, Reiki and other new age practices. Combining the outcomes from these different data gathering strategies on a wide variety of contemplative and new age practices will not only help us understand adverse effects associated with meditation but also provide a perspective with regard to related practices. Such information will hopefully help to explain why a practice traditionally described as beneficial seems to be associated with a consistent reporting rate of adverse events.

Dr Ramesh Manocha

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In a letter to the American Heart Journal, Kothari et al. (1973) described a remarkable feat in which an ECG was attached to a yogi before he entered an eight day meditative trance. Remarkably, on the second day of the yogi’s trance, the ECG recorded minimal heart activity indicating that the meditative trance had slowed the yogi’s heart dramatically. The authors of the study ruled out mechanical disturbance or failure, and concluded that a likely cause was that the meditative trance allowed the yogi great control of his heart rate, however conceded that feat could have been a cleverly disguised trick.

The study can be found here.

Tristan Boyd, Dr Ramesh Manocha.

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