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
4 com

Like any other evaluation of therapeutics, the detectable effect of the intervention will be determined by the degree to which the participant complies with the treatment. This is particularly important in meditation research because meditation requires considerable active involvement and commitment. There are several ways to assess compliance, including attendance rates at supervised treatment sessions, home-practice diaries and subjective experience reports.

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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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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Sahaja is one of a number of terms that have been used to describe the trans-mind condition. Sahaja is derived from the Sanskrit saha, meaning “together” and ja, meaning “born” and can be translated to mean “innate”. It is a term that has long been associated with Indian mystical thought and practice, although its popularity has fluctuated as different Indian spiritual movements encouraged, revised or ignored it. Davidson provides seven contexts in which sahaja has been used over the recorded history of Indian, especially Buddhist, spiritual thought. The most pertinent to this discussion include the assertion that sahaja is:

“[A] fundamental, irreducible condition, decidedly a noun. It is roughly equivalent to svabh¯ava or svar ¯upa, and is used to described the inherent and inalienable attributes that exist irrespective of accidental circumstances.”

And,

“The present moment when one thing occurs with another, a temporal value differentiated from the prior and subsequent moments, when the two items were not associated.” (Davidson, 2002)

Synonymous terms and ideas include jivan mukta, “Buddha state” and “liberation”. Modern Western equivalent descriptions might include, but are not restricted to, “unitive state”, “self-realisation”, “self-actualisation”, “peak experience”, “sainthood” and “state of grace”.

Sahaja signifies one’s natural or spontaneous self, divested of all external influences and the mental conditioning produced by them. This natural state is demonstrated by young children, for example, who are free of the complex adult mind and its attendant pretences, “hang-ups” and neuroses. The sahaja state flows naturally to the one who has attained the depths of meditation and is therefore a logical consequence of the mental silence or “trans-mind” principle — a kind of renascent freedom. It can be described as the optimal state in which the body, the psyche and the soul find a synergistic integration to realise the potentiality that exists within each human being.

Dr Ramesh Manocha

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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

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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

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relationship between mental silence and health

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

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Meditation is widely perceived in the West as an effective method of reducing stress, and enhancing wellbeing. In Australia, a survey conducted by Kaldor (2002) 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. The Australian Community Survey (ACS), conducted by the National Church Life Survey (2004) found that 1.5 million Australians had tried meditation within 12 months of the time of the survey and that while 29% of those surveyed found prayer to be a source of peace and wellbeing, 24% had used meditation to achieve the same effect! Only 21% reported church attendance as a source of peace or wellbeing. In fact the ACS reports that although only about 20% of Australians attend church monthly or more often “around 33% of Australians pray or meditate at least weekly”.

This situation in Australia reflects trends in other Western countries. In 2002 a National Health Interview Survey (NHIS), undertaken by the Centers [sic] for Disease Control and Prevention (CDC) in the United States administered to 31,000 representative adults, demonstrated that 8% of respondents had practiced meditation at some time. That biomedically trained physicians in Australia were also advising patients about the therapeutic effects of meditation, was demonstrated when Pirrotta conducted a survey of Australian GPs in 2000.

Dr Ramesh Manocha

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