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

This graph shows the mental health of people sorted by how frequently they meditate with the mental silence based Sahaja Yoga. The graph depicts a correlation between the frequency of meditation for people who meditate and their mental health score. Mental health was measured by the mental health subscale of the Short Form 36 questionnaire.

The correlation was analysed and found to have a correlation coefficient of +0.36 with p<0.001.

Dr Ramesh Manocha

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

I propose that one of the main reasons for the paucity of convincing evidence with regard to meditation is because Western scientists have failed to apprehend the key idea that underlies the meditation tradition: meditation is traditionally defined in Eastern cultures as the experience of mental silence. Modern Western understandings of meditation vary, but probably the most common understanding is that it is a method for eliciting reduction in physiological arousal. The notion that meditation involves a state of consciousness “beyond thought” seems all but absent from modern Western scientific literature on meditation.

Dr Ramesh Manocha.

It is difficult to make conclusions about meditation when the definition of the independent variable itself varies from study to study, if not from person to person. A homogeneous definition of meditation is essential for further progress in this field and yet, after almost 40 years of research the scientific community is unable to provide a truly consensus definition. Some argue that this is because meditation is actually a broad collection of disparate methods however it might be equally argued that the lack of consistent definition is symptomatic of our poor understanding.

More discussion on the definition of meditation can be found at Dr Ramesh Manocha’s blog.

Researching meditation poses a unique challenge, since participants receiving the “inert” (or “placebo”) treatment must be involved in a placebo-like activity that nevertheless requires their active, conscious and conscientious involvement. They must also be sufficiently convinced of its authenticity to motivate them to participate at a level necessary to maintain the validity of the study.

More information about placebos can be found at Dr Manocha’s blog.

It seems logical that experienced meditators would be more likely to be able to generate the experiential and physiological changes associated with meditation at a magnitude sufficient for detection; however selecting them from the wider population necessarily precludes the use of randomisation. This weakens the likelihood that the intervention and comparison groups are truly homogenous. In order to compensate for this comparison participants can be selected to match key parameters. In the case of meditation research, these parameters should include an interest in and motivation to practice meditation.

Ramesh Manocha

Dr Ramesh Manocha explains why strong controls are necessary when researching the real-world relevance of meditation in this excerpt from his thesis:

“Some might argue that controlling for non-specific effects is an academic exercise with little real-world relevance. This is supposedly because factors such as the placebo effect, expectancy of relief and demand characteristics are a critical component of most health interventions when administered to patients in the field. Thus trials directed at assessing the ecological (“real-world”) relevance and validity of an intervention have no need to control for factors which will be operating in conjunction with the intervention effect anyway. Authors of such reports add that studies with these kinds of controls reflect real-world scenarios since study participants offered either meditation or the “usual care” (i.e. usually nothing) reflect the reality of their environment. This line of argument assumes that the only value of proper controls is its ability to help answer theoretical questions about meditation, but that such controls fail to allow meditation to demonstrate its “practical relevance”.

“Yet commercial purveyors of meditation frequently claim that their often expensive proprietary techniques are uniquely effective in order to justify expensive fees. Moreover, many meditation techniques can be arduous and culturally challenging. It is important to determine whether it is justifiable to demand these significant costs and efforts or whether the same effects might be elicited by simpler strategies that are similarly rich in non-specific effects but possibly cheaper and easier to implement. By controlling for non-specific effects, it is possible not only to provide important theoretical information about whether meditation has any unique effects, but also whether it is an economically justifiable option, whether it offers any more of an advantage over accepted strategies and whether the claims of meditation enthusiasts have any basis.”

More information about Dr Manocha’s research can be found at his website.

The following is a summary of a study by Dusek et al. published in The Journal of Alternative and Complementary Medicine in 2008.

Summary: compares the relaxation response method of meditation against educational classes on a sample with hypertension gathered from the community. The sole outcome measure was physiological blood pressure. The study had a sample size of 122 participants who underwent 8 sessions of treatment over 8 weeks. A t-test change score was used to analyse the results.

Results: The study found no significant difference between the treatment and the control.

Strengths: large sample size; double-blind; solid treatment duration; intent-to-treat used.

Weaknesses: single outcome; unclear results; only a moderately credible comparator.

Dusek, J.A., Hibberd, P.L., Buczynski, B., Chang, B.H., Dusek, K.C. Johnston, J.M. Wohlhueter, A.L., Benson, H. and Zusman, R.M. (2008). Stress Management versus Lifestyle Modification on Systolic Hypertension and Medication Elimination: A Randomized Trial. The Journal of Alternative and Complementary Medicine Vol 14(2), 129–138.

Read the rest of this entry…

The many reviews thorough and reliable reviews of of meditation enable us to make some basic generalisations:

First, there is insufficient evidence to support the idea that meditation, as conceived and tested by scientific researchers in the West, is any more effective than simple relaxation or rest.

Second, the use of high face-validity control groups is critical in meditation research because of the need to exclude the important confounding effects of non-specific factors that relate to plausibility of the intervention (such as placebo, expectancy, or therapeutic contact).

Third, there is at the moment no systematic comparison of different conceptualizations of meditation. Only a few researchers have compared two kinds of meditation and found that there were no major differences between the two.

These observations could lead to three possible conclusions:
1. Meditation is in fact no more effective than other approaches to rest and relaxation. Yet that meditative traditions have existed for thousands of years and at least in India, are widely perceived to have specific and unique features. In other words history and culture do not agree with the idea that meditation is simply a method of mundane relaxation. While this “test of history” does not provide proof of efficacy, it does encourage the undertaking of a thorough examination of the phenomenon before it is discarded as mere folklore and superstition.
2. The measures which have so far been used to assess the effects of meditation are not sensitive to the specific effects of meditation. The wide variety of outcome measures used means that if the specific effects of meditation are not detectable, then the effects are either too small or too esoteric for mundane study. Yet classical descriptions of meditation suggest that despite the metaphysical basis of meditation, its effects do manifest themselves in mundane dimensions such as health and behaviour, implying that at least some of the many measures available to researchers should be able to detect a differential effect. Again, while this might be satisfactorily applied to the genre as a whole, there appear to be isolated exceptions which suggests that certain as yet undetermined categories may be able to generate specific effects. Yet our analysis of the aggregated data has not yet yielded a pattern with sufficient clarity to identify the features of that category.
3. The methods that have been labelled as “meditation” in the trials do not consistently reflect the true nature of meditation. This is the most interesting and important issue and therefore merits considerable discussion. The functional and conceptual definition determines the nature of the intervention, which in turn influences the choice of the control method that ought to be used and therefore the validity and generality of the findings. Yet defining meditation has proven to be a difficult challenge for modern researchers. While early empirical reports seemed to show that measurable distinctions between meditation and rest or simple relaxation existed, rigorous trials did not support these perceptions. As a result, much of the research work on meditation has been based on the assumption that meditation techniques are much the same despite minor external and superficial differences.  These perceptions have thus given rise to an assumption of “psycho-physiological uniformity”

This last idea, it is contended, is the key to the problem because in fact, both Western meditation enthusiasts and Western scientists, despite their opposing views, have failed to apprehend a key factor that underlies the ancient tradition of meditation: The idea that meditation necessarily involves the experience of mental silence.

Dr Ramesh Manocha