The fact that the mental silence construct, more than any other factor my research, correlated positively with a wide range of health measures raises interesting implications in several areas of study. The findings emanating from my research imply that the notion of mental silence and its associated yogic philosophy, may be important in the ongoing development of our understanding of meditation and the various definitions and taxonomies that relate to it. It also provides some new clues for scholars interested in the “essential factors” of religiosity and the question as to why some forms of religiosity are beneficial and others not. Furthermore, it provides empirical data that may help to progress the ongoing debate about the theoretical differences between “religiousness” and “spirituality”. Perhaps most important of all they provide empirical evidence of a positive relationship between a well-defined state of consciousness and health and wellbeing. That, it is asserted, constitutes a significant contribution to the nascent field of consciousness research as well as our understandings of health. It implies a nexus between religiosity, consciousness and health that is accessible to measurement. The practical ramifications are that meditation may have a valuable role to play in the promotion of mental health and the prevention of mental illness primarily as a result of the beneficial impact of the mental silence experience.

Dr Ramesh Manocha

one

The diversity, and apparent impotence, of many meditative practices makes the construction of sham meditation quite feasible since researchers can develop rationales to justify almost any method that approximates the expectations of trial participants.

For instance, Smith’s (1995) RCT compared TM to an imitation exercise designed to closely mimic the entire technique, except for the proprietary mantra. Forty four participants practiced one of the 2 techniques for 24 weeks, with the same instructions for frequency and duration only to find that no difference between the 2 methods was detectable. This study used well validated self-reporting measures shown in other studies to be quite sensitive to the effects of meditative practices.

Similarly Dua (1992) compared a form of meditation that he developed to a “negative thought reduction” method as well as to a “negative thought enhancement placebo” for the management of anger in a small RCT and found no differences between the practices in any of the outcome measures at the end of the treatment period.

On the other hand, Wolf (2003) compared a meditation based on a traditional Sanskrit mantra (the maha mantra) with a pseudo mantra and observed substantial differences in post treatment outcomes.

In smaller trials, Rai (1988, 1993) observed a number of significant differences when he compared Sahaja Yoga meditation to “mimicking exercises” in the treatment of asthma, hypertension and stress.

Dr Ramesh Manocha

none

It may not be practically possible to devise and implement an ideal control method for meditation trials, nevertheless it is important to select a strategy that approximates that ideal. The bare minimum criteria for a control process in meditation research should therefore be:

• First, high face validity as a therapeutic/stress management intervention in its own right. It should actually appear to be a credible meditation technique if that is the expectation of participants.
• Second, a process that involves relaxation and reduction of somatic arousal since this is the nearest conventionally understood phenomenon that meditation resembles and from which it needs to be distinguished.

Given these considerations there are two ideal strategies: sham meditation and the head-to-head comparison.

none

Examining randomised controlled trials exploring meditation in my review, control methods were presumptively categorized according to their face-validity into low, moderate or high face validity categories.

The low face-validity controls used strategies that were:
Passive and unstructured: Participants were involved in minimal or no activity relating to the trial and had no interaction with researchers as a result of being allocated to the control group (e.g. waiting list, no treatment, self-directed reading, or referral to community resources). This kind of comparator controls for minor non-specific effects, such as regression to the mean, the natural history of disease states and environmental factors common to all participants. It does not however, control for any non-specific effects that may be elicited by behaviour therapies.

The moderate face-validity controls use strategies:
Passive and structured. These involved some sort of regular and structured interaction with personnel associated with the experiment (e.g. regular lectures, specific reading, structured educational sessions on unrelated topics, regular blood pressure checks). This controls for the same confounders as Category 1 in addition to the effects of therapeutic contact and sense of active involvement.
• That were active in nature and generated some expectation of benefit but did not have effects or credibility as either a method of relaxation or meditation e.g. support groups, education about health factors measured in the study, or lectures on stress and lifestyle management. This controls for the same as Categories 2 and 3 in addition to the effects of social support, improved lifestyle, etc. Social support has been repeatedly demonstrated to be effective in improving mood and quality of life and reducing the severity of disease symptoms. “Standard treatment” was included in this category.

High face-validity controls use strategies that were:
• That were active in nature but not designed to generate significant expectation of therapeutic benefit (e.g. exercise). This controls for the same as Category 2 in addition to the effects of regular physical activity. Regular physical exercise has been shown to improve mood.
Active in nature, generated some expectation of benefit and elicited the simple physiological effects on rest but did not have specific credibility as a meditative method (e.g. progressive muscle relaxation, other relaxation methods, hypnosis, biofeedback, psychotherapy).
• The same as above but also had credibility as a meditative method (e.g. meditation techniques, strategies designed to convincingly mimic meditation) or constituted a legitimate form of psychotherapy (e.g. desensitisation, cognitive behaviour therapy, counselling).

Dr Ramesh Manocha

none

In view of the seriousness of some of the reactions described above it is questionable whether all forms of meditation can be viewed as “generally safe for general consumption”. Moreover, given that recent reviews of meditation have clearly demonstrated a lack of convincing evidence for a specific effect, the importance of developing a comprehensive understanding of meditation’s adverse effects, and the risk to both healthy and unwell populations is of considerable importance. I propose that a more cautious set of clinical recommendation guidelines be considered until more thorough, independent studies are done.

A simple guideline may be that candidates should be recommended to experienced instructors with health professional backgrounds and that referring clinicians should screen for history/susceptibility to serious mental illness. It may be also appropriate to avoid recommending methods in which commercialisation or similar considerations may lead to a conflict of interest. There are many meditation techniques that can be accessed on a low fee/non-commercial or free of charge basis and these ought to be recommended over expensive, commercialised methods. Should negative experiences occur, novices should be advised to cease practising the techniques immediately.

Dr Ramesh Manocha

none

In my systematic review of 120 randomised controlled trials, twenty eight trials used a “multimodal” approach in which meditation was used as part of a “blunderbuss” of interventions woven into a single coordinated program. Most of these programs involved other practices aimed at reducing stress such as yoga postures, exercise, breathing techniques, or group support. Such approaches may be more clinically effective but the adjunctive use of non-meditative techniques obscures any effect that may be specifically attributed to the meditation component. They are therefore not useful in trying to understand the nature of meditation per se. Similarly, examining the 16 trials that were more or less based on Kabat Zinn’s Mind Body Stress Reduction Program (MBSR) clearly indicates that this interventions is only one component of a larger collection of practices including hatha yoga, simple cognitive therapy and breathing exercises. Therefore, although the MBSR is frequently equated with Mindfulness, for scientific purposes it would be more appropriately relegated to the multi-modal category.

Dr Ramesh Manocha

none

Follow-up data, data obtained some time after the trial, is important as it gives an indication of how durable the effects of meditation might be. Unlike modern Western therapeutic thinking however, meditation was not originally designed to be used as a course of treatment so much as to be part of an ongoing lifestyle thus implying that the benefits of meditation are likely to persist in the follow-up phase only so long as the person chooses to meditate regularly. Meditation instructional programs are usually relatively intense and it is therefore worthwhile determining whether changes brought on by the instructional program can be maintained when participants are left to continue unsupervised with whatever skills they have acquired in the more formal phase of their training. Given that consistent evidence for a specific effect is lacking even within the intervention phase of the 120 randomised controlled trials my review, it is even more unlikely that evidence for an effect will be detectable in the follow-up phases. Of the entire sample of 120 studies in my review, 76 studies did not include any follow-up assessment strategies.

It might also be argued that, since researchers tend to be hampered by lack of resources, the primary question as to whether meditation has any specific effects ought to take priority over questions about the durability of its effects, if there are any. It is therefore understandable that many trials have not included follow-up assessments in their design. For this reason, it was decided that more in depth analysis of follow up data would be of little value to the primary questions set out in my review.

Dr Ramesh Manocha

none

In order to effectively tease out the effects of mental silence as opposed to the effects of other aspects of Sahaja Yoga meditation it was obviously necessary to use randomised controlled trial methodology. Having refined the practical approach in previous clinics it became possible to develop a standardised, instructional strategy whose structure could also be mirrored in control strategies in order to optimise the exclusion of non-specific effects.

The first attempt at this was a well-designed RCT involving 59 participants in which SYM was compared to a standard stress management programme for sufferers of moderate to severe asthma (on pre-stabilised, optimised treatment but who remained symptomatic). This trial was designed to compare two similarly active and credible interventions in which the main critical difference was the use of mental silence in the SYM group. While both groups experienced similar improvements in a number of outcome measures, the SYM group demonstrated significantly greater improvements in clinically important subjective measures such as aspects of asthma specific quality of life, mood state and, notably, an objective measure of disease severity known as airway hyper-responsiveness. The outcomes suggest: first, that mental silence does appear to have a specific effect on mood as well as some aspects of quality of life; second, that mental silence also has some effect on pathophysiology itself. Although well designed the sample size was small and drop out rates were somewhat higher than expected thereby raising the possibility that important effects were not detectable because of type 2 errors in the statistical analysis. A larger sample size was needed to overcome this possibility. Moreover, although mental silence had been compared to stress management, it would be more informative to determine its effect in comparison to an intervention that more closely resembled a non-mental silence approach to meditation.

Taking these considerations into account, a second, larger RCT of mental silence orientated meditation is reported. SYM, as an example of the mental silence approach, was compared to a “non-mental silence” approach to meditation. SYM was, on average, twice as effective as the comparator in reducing work related stress, general depressive symptoms and anxiety.

Thus in two well-designed RCTs in which the mental silence approach to meditation was compared to highly credible and active controls, substantial differences in therapeutic effects were observed, clearly suggesting that a specific effect is associated with mental silence orientated meditation techniques.

Dr Ramesh Manocha

none

A national survey of Sahaja Yoga meditation practitioners using standardised measures revealed that meditators experienced significantly better levels of quality of life and mental health as compared to population data drawn from national health surveys using the same instruments. Similar surveys of populations practising Western forms of religiosity also reported better health than the general population but the meditators appeared to experience substantially greater advantages. Remarkably, analysis revealed a robust and consistent relationship between reported frequency of mental silence experience and health scores, especially mental health, thereby providing support for my central hypothesis that is that the experiential mental silence aspect of meditation is associated with health benefits. An association however does not prove causality and so it became necessary to conduct observational experiments to determine if meditation, and more specifically, mental silence, was specifically responsible for the health benefits observed in the health survey.

Dr Ramesh Manocha

one

While the strong metaphysical linkage between Eastern religiosity, its psycho-spiritual practices, and health may offer important new perspectives on the relationship between religiosity and health, there are a number of practical difficulties associated with studying the epidemiology of non-Western forms of spirituality. These include:

  • differing criteria of religiosity
  • new confounding variables relating to language, culture, ethnicity, diet and environment
  • an absence of validated and reliable measures
  • accurate data regarding the background population may be unavailable.

Given these considerable limitations, the study of a Western sub-population that has adopted a well-defined aspect of Eastern religiosity may be particularly useful as it allows comparison with well-developed, validated databases and commentary while avoiding a number of the confounders mentioned above. Studies such as this may provide important conceptual bridges by which researchers can extend their understandings of the relationship between religiosity and health in non-Western groups using a common set of empirical scientific tools.

Dr Ramesh Manocha

none

archives