Dr Ramesh Manocha recently had a paper published titled “Using meditation for less stress and better wellbeing; A seminar for GPs”. The paper detailed a study in which 293 doctors were taught meditation in order to reduce stress and increase wellbeing. The abstract and full paper can be found here.

Using meditation for less stress
and better wellbeing
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An extensive search of the scientific literature identified 3,500 peer-reviewed publications that featured “meditation” as a key word. Yet, of these, only 135 (approximately 4%) fulfilled the very basic requirements of experimental evaluation, i.e. they were prospective trials using control groups and random allocation. Importantly, even within this subset of more rigorous studies, there is no convincing evidence that meditation has a specific effect. In fact within this set of randomised controlled trials (RCTs), there appeared to be an inverse relationship between methodological rigour and likelihood of an outcome that is favourable to meditation.

Dr Ramesh Manocha

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For my systematic analysis of meditation studies, because of the relatively small number of studies available for analysis, the many different meditation techniques were grouped into 5 thematically related categories. These were:

  1. Relaxation Response and studies describing the intervention as based on it.
  2. The MBSR and studies describing the intervention as based on it.
  3. TM and studies describing the intervention as based on it.
  4. Multimodal interventions of which meditation is one part, such as yoga, lifestyle strategies etc.
  5. Miscellaneous, where only a few studies had been conducted on a particular technique and/or when a technique did not easily fall into one of the previous categories.

Dr Ramesh Manocha

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The effects of meditation on anxiety and stress are comparable to effect sizes described in conventional meta-analyses of psychotherapy field studies. For example Mattick’s (1990) review of psychotherapy for neurotic patients reported a mean effect size of 0.74 for verbal psychotherapy and 0.97 for behavioural psychotherapy vis-a-vis a mean effect size of 0.55 for placebo. My review of meditation on the other hand found a mean effect size of 0.90. It should be noted however that the meditation studies focused on participants with non-pathological anxiety states, raising the possibility that the potential impact of meditation may be limited by a “ceiling effect” due the recruited sample’s relatively mild symptomatology and hence minimal scope for clinical improvement.

Dr Ramesh Manocha

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Meditation studies published on medline

This graph shows the number of meditation studies considered as serious explorations of meditation’s effects published per year in the MEDLINE database.

The maximum yearly output was in 2000–2001 when 12 RCTs were reported in MEDLINE. In the same time period 106 RCTs for fluoxetine, as an example of a mainstream medication, and 98 RCTs for acupuncture, as an example of a complementary medicine, were published. The rate of publication of RCTs on meditation is poor in comparison to other therapeutic modalities in either the mental health or complementary and alternative medicine genres.

Dr Ramesh Manocha

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Sahaja Yoga meditation (SYM) may be helpful in mitigating the experience of hot flushes (HFs) in menopause via a number of possible pathways. First, like many other forms of meditation, SYM has been shown to reduce arousal in laboratory experiments. An interesting study on stress-induced HFs however, suggests that simple reduction of arousal may not be the only explanation. Swartzmann (1990) used objective measuring strategies and found that menopausal women exposed to various experimental stressors, experienced not only greater sensitivity to pre-existing symptoms, but also more episodes. Unexpectedly however, the additional HFs neither occurred in acute association with the stressor nor were they directly associated with elevated sympathetic arousal. Rather, the data suggested that the effects were mediated by a mechanism that is considerably slower than the sympathetic adreno-medullary system. This implies that a neuro-endocrine pathway may be involved in reducing central sympathetic activation. SYM may exert its effect by disrupting that part of the HF mechanism which is associated with increased central sympathetic activation.

Dr Ramesh Manocha

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Neki (1975) describes the sahaja state as a mental health ideal in more detail, asserting that it combines the elements of illumination (the direct experience of reality, devoid of the filtering effect of the mind), equipoise (the absence of emotional turbulence) and its replacement with a sense of underlying joy and spontaneity. It creates a personality that is well adjusted but without pretence, affectation or hidden agenda and also freedom from the desires and motivations that give rise to frustration and destructive behaviours. It leads to harmonisation of the subtle inner rhythms of one’s being and the greater cosmos, a sort of suprasensory perception. All of this suggests a positive, robust and fully functional state of health combined with ongoing and continuous perception of the deeper significance of reality.

Dr Ramesh Manocha

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Despite the scientific establishment’s equivocal conclusions about the efficacy of meditation, positive perceptions are evident among the Western lay population because of the increasing popularity of the philosophy, metaphysics and folklore associated with the ancient and traditional Indian ideas of meditation. So it is important to develop an understanding of meditation, in the words of Taylor (2005) in the context of its:

“…particular spiritual tradition, situated in a specific historical time period, or codified in a specific text according to the philosophy of some particular individual.”

While the biomedical Cartesian worldview that developed in the West from the mid-19th century weakened the connection between health and spirituality, this did not occur in India. There strong associations between health and spirituality were made and utilised to promote better physical wellbeing and quality of life. Typical of this health philosophy was the practice of yoga, which combined spiritual teachings with more mundane health factors such as lifestyle, diet, physical exercise and positive psychology in order to achieve its ultimate aim, the development of consciousness (this will be explained at greater length below). Similarly, the ancient and still widely used Ayurveda health epistemology was used to cure illness and enhance wellbeing by combining spiritual practices such as meditation, mantras and prayer with lifestyle measures such as exercise, diet and massage. Proponents of this epistemology also advocated the use of an extensive herbal pharmacopoeia, while its diagnostic system was based on psychological predisposition and personality type (Chopra Et al., 2002). In fact the followers of Ayurveda proposed a perspective of the human corpus in which the mind was not contained within the confines of the brain, as in Western perceptions. Instead, it was seen to be closely intertwined with the physical body, thus forming a body-mind whole in which physical health status was seen to be a direct reflection of consciousness and vice versa.

Dr Ramesh Manocha

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Despite an absence of reliable evidence, complementary and alternative treatments are rapidly increasing in popularity in the treatment of Attention-deficit hyperactivity disorder (ADHD). They include dietary modification, the use of nutritional supplementation (such as essential fatty acids, zinc, magnesium, amino acids, megavitamins) and herbs (such as ginseng and ginkgo). Also important are environmental therapies (which involve eliminating pollutants such as lead, and manganese from the environment), biofeedback, relaxation training, and meditation. Arnold’s review (2001) of alternative approaches to the management of ADHD noted that meditation was one of a number of promising strategies and warranted further systematic assessment. However, so far there have been only two unpublished dissertations suggesting that in children with ADHD, meditation may mitigate tendencies to impulsiveness both at home and in the classroom.

The EEG studies of Aftanas & Golocheikine (2001, 2002) suggest that meditation might influence those parts of the brain that govern attention. Furthermore, anecdotal feedback from teachers and meditation practitioners has indicated that meditation could help to focus attention, enhance concentration and memory and improve children’s performance at school. Given the background of neurological, physiological, and psychological research as well as practical experience, it seemed reasonable to evaluate the potential of meditation as a useful alternative treatment for children with ADHD.

Dr Ramesh Manocha

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There is widespread agreement in the literature that meditation reduces sympathetic activation and increases parasympathetic activation of the ANS, that is, it reduces physiological arousal thereby triggering a characteristic spectrum of simultaneous physiological changes: reduced respiratory rate (RR), reduced heart rate (HR), reduced blood pressure (BP), reduced electrodermal activity (EDA) and increased skin temperature (ST). Many studies of non-meditative practices such as relaxation, listening to music and sitting quietly have demonstrated the same pattern, leading to the assumption that meditation can be defined merely as a method of rest or relaxation — no different to other methods.

The significance of my research is that it has challenged current thinking by demonstrating that Sahaja Yoga meditators manifest changes that in some part are opposite to that which one would expect to see in participants who simply undergo rest/relaxation. Specifically, while the “relaxation” explanatory paradigm for meditation predicts that meditators’ ST should increase, this study found that it decreases and that this decrease correlates with the degree of mental silence reported by the meditator. A review of the literature indicates that this pattern of changes is difficult to mimic consciously. The observations in this study correspond closely with other studies on Sahaja Yoga meditation reported in the “grey literature”. Taken together these findings suggest that the mental silence experience may be associated with a relatively unique pattern of physiological activity.

Dr Ramesh Manocha

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