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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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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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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With regard to the physiology of meditation, research designs can be divided into 3 categories:

1) Case studies of meditation featuring small numbers of participants in which there is no attempt to control for confounding variables. While these are useful for generating hypotheses, they do not provide scientifically valid insights into meditation’s purportedly unique effects.

2) Own-control studies use participants in time sequential series (ie ab, aba or similar designs) in which the “a” condition is pre-meditation or non-meditation and the “b” condition is meditation. The “a” and “b” conditions are then compared. These studies have generally demonstrated significant differences (interpreted to be in favour of meditation) but they suffer from substantial limitations because they compare meditation to non-meditation and then assume that any differences are due to meditation, whereas they may in fact be due to methodological factors not specific to meditation at all (such as rest, expectancy, researcher demand and environmental issues). Further, this design is vulnerable to the possibility that one condition might be contaminated by carry-over effects from the preceding condition. A further important consideration applies especially to the case of novices — if the meditator is not sufficiently skilled then they may have difficulty in generating physiological changes and the effects (although potentially real) may not become detectable.

3) Experimental control studies are much more reliable as they involve two independent groups in which one meditates and the other engages in a control activity such as rest. There are however, methodological difficulties associated with this approach as well. First, use of novices (who are introduced to meditation during the trial) may mean that the effects of meditation are not large enough to generate a detectable change. Second, while use of advanced meditators (those who have practiced meditation over many years) may ensure that the necessary magnitude of effect is achieved, the question of selection bias becomes a significant consideration.

An ideal strategy would involve an experiment in which participants are randomly assigned from the same sample to either a meditation or a control group. This approach is rarely feasible however, since it would conventionally require many months or even years of practice before the participants achieved competence. With such lengthy time-lines the accumulation of drop-outs may in any case lead to selection bias. Therefore, a reasonable compromise strategy might involve using experienced meditators and comparing them to non-meditators who have either been matched for parameters including interest in meditation, or have been randomly selected from the population. This latter design was selected for the study described in this chapter.

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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The observed relationship between Sahaja Yoga meditation (SYM) practices and mental health are not similarly as strong for measures of physical health. In many ways this might be expected since the intervention is primarily focused on a mental experience with the specific aim of reducing negative affect, thinking patterns and related behaviours. Mood, thoughts and behaviour patterns are in constant flux, much of it reflecting (and influencing) brain electrical activity and other neuro-behavioural phenomena which change from moment to moment. Aftanas (2001) has shown that the practice of SYM, and the experience of meditation, is strongly reflected in both brain electrophysiology and mood. This might explain why mental health factors are much more likely to be immediately responsive to such an intervention whereas physical health factors, which rely significantly on anatomical structures and mechanical function, will take much longer to manifest (if at all) and are subject to a vast number of other environmental confounders that may obscure any such relationship.

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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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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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Reports such as those described previously call for a deeper examination of meditation’s potential adverse effects. Thorough, systematic surveys post marketing surveillance-style studies need to be conducted, For this to be done properly, meditation instructors and organisations may be required to cooperate by providing comprehensive lists of those who have learnt or who currently practice meditation. In practice this may be difficult to achieve given the commercial interests of some organisations, the somewhat anti-establishmentarian views of those who practice in or participate in these organisations as well restrictions arising from privacy laws.

When decisions about a new intervention are being made, the net clinical benefit needs to be carefully assessed by balancing reported benefits and side effects. The CONSORT check-list includes reporting of such adverse events as item 19 of the CONSORT statement. Only proper and systematic reporting of side effects will allow adequate assessment of the potential net benefit of any intervention.

Dr Ramesh Manocha

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