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

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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.

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A head-to-head comparison is where two different approaches to meditation are compared. They are easier to conduct then sham meditation comparisons since elaborate deception strategies are not required, they have inherent authenticity and ethical problems are much less likely. Head-to-head trials are important and valuable because they allow comparison of different definitions, paradigms and approaches to meditation. They are especially useful given that there is no consensus even on what exactly meditation is. A disadvantage of such comparisons is that they may not necessarily allow for a clear distinction between meditation-specific and non-specific effects.

a head-to-head comparison where two different approaches to meditation are compared. They are easier to conduct since elaborate deception strategies are not required, have inherent authenticity and ethical problems are much less likely. Head-to-head trials are important and valuable in the current context because they allow comparison of different definitions, paradigms and approaches to meditation. They are especially useful given that there is no consensus even on what exactly meditation is. A disadvantage of such comparisons is that they may not necessarily allow for a clear distinction between meditation-specific and non-specific effects.
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Sham meditation involves designing control strategies that overtly resemble the intervention, but which do not actually trigger the effects purported to be specifically associated with meditation.

Sham techniques are used in research when the researcher wishes to examine the specific effects a meditation technique may elicit, while controlling for the non-specific effects.

Sham meditation procedures necessarily involve deception of participants and the ethicality of this in clinical trials is open to dispute. Further, this kind of strategy can be logistically challenging and there is always a risk that the deception might be uncovered, thereby immediately invalidating the entire study.

Ramesh Manocha.

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