Meditation is consistently identified by GPs as one of their most accepted “non-medical” interventions. Therapeutic meditation has widespread acceptance, largely due to what is perceived to be a large body of positive research. Of course, in clinical experience, many doctors have witnessed the wide range benefits flowing into meditator’s lives.
But what interesting new research is there? And what does closer scrutiny using meta-analysis techniques reveal? To counsel people appropriately, meditation teachers and clinicians alike need to know the answers, so this week we ask the hard question… Does meditation and mindfulness really work?
Also, good news with the widely updated and improved version of my meditation app ready for release in a week or two (details will follow on the next blog post), but first
Thought for the day
A Black Swan Event
1. Is an outlier, as it lies outside the realm of regular expectations, because nothing in the past can convincingly point to its possibility.
2. It carries an extreme 'impact'.
3. In spite of its outlier status,
human nature makes us concoct explanations
for its occurrence after the fact,
making it explainable and predictable.
In summary, this is what characterises
a Black Swan Event - rarity, extreme 'impact',
and retrospective (though not prospective) predictability.
A small number of Black Swans explain
almost everything in our world,
from the success of ideas and religions,
to the dynamics of historical events,
to elements of our own personal lives.
Nassim Taleb
PART 1 Some interesting recent research
1. Mindfulness changes brain structure and improves mental health
Building upon earlier research and following a brief 8 weeks Mindfulness Based Stress Reduction (MBSR) training program, researchers identified significant brain changes - cortical thickness increase in the right insula and the somatosensory cortex - coupled with a significant reduction of several psychological markers related to worry, state anxiety, depression and alexithymia.
Taken together, these findings also provide new and plausible neurobiological evidence of a major role of the right insula in mediating the observed psychological changes.
Santarnecchi et al. Interaction between Neuroanatomical and Psychological Changes after Mindfulness-Based Training. PLoS ONE 9(10): e108359. doi:10.1371/journal.pone.0108359
2. Meditation is anti-inflammatory
A new and rigorously designed mindfulness study, by the Georgetown University Medical centre, showed that hormonal, inflammatory reactions to stress were reduced after meditation training.
Hoge EA et al. 2018, The effect of mindfulness training on biological acute stress responses in generalised anxiety disorder. Psychiatry Res; 262, 328-332.
3. Meditation improves quality of life for breast cancer survivors
Women who had been treated for breast cancer and were cancer free were taught to meditate and the effects evaluated.
Over time, the group that meditated reported significant decreases in depression, anxiety, perceived stress, and an increase in quality of life, satisfaction with life, post-traumatic growth and quality of sleep.
Significantly, participants had a high attendance rate in the program, which speaks to the likelihood of the applicability of the meditation program on an outpatient basis.
Yun MR et al. The Effects of Mind Subtraction Meditation on Breast Cancer Survivors' Psychological and Spiritual Well-being and Sleep Quality: A Randomized Controlled Trial in South Korea. Cancer Nurs. 2017 Sep/Oct 40(5); 377-385.
PART 2 The analysis
In scientific circles, one study is a bit like one swallow - it does not a summer make. To analyse a number of studies in the one field, complex, modern techniques use what is called meta-analysis to tease out wider and hopefully more accurate conclusions. While there is increasing criticism of the way in which meta-analyses are conducted, they do remain a “gold-standard” for current researchers.
Given the huge increase in the number of meditation and mindfulness studies, meta-analyses are becoming more possible. Here we reveal 2 specific reviews, and one wider one.
1. Does meditation improve cognitive function in the elderly?
Well this is good news - even if a little cautious!
With so many people worried about loss of mental capacity with aging, and so many actually developing dementia, researchers analysed the scientific literature on meditation and concluded : "There is preliminary evidence that meditation can improve cognitive function."
They then investigated the results of 6 Mindfulness Based Interventions in older people based upon MBSR and MBCT. They reported preliminary positive effects on memory, executive function and processing speed.
However, most reports had a high risk of bias and sample sizes were small. The only study with low risk of bias, large sample size and active control group reported no significant findings.
The conclusion? More research is needed, and while meditation and mindfulness may well be useful for the elderly, maybe it is wise to start meditation at an early age!
2. Does meditation reduce stress and anxiety in college students?
We hear a good deal about meditation and mindfulness providing effective self-help solutions for stress and anxiety. Many studies have focused on the impacts upon students, so how do those studies stack up when researched objectively?
In this analysis of 57 studies, researchers examined anxiety in 40 studies, self-reported stress in 34, physiological stress in 11, and mindfulness in 24.
Thirty-three of 40 and 25 of 34 studies showed significant decreases in anxiety and stress respectively; 22 of 24 showed an increase in mindfulness.
Physiological stress had inconsistent results indicating a need for further research.
Overall, the researchers concluded that mindfulness meditation shows promise in reducing stress and anxiety in college students. Additionally, there are a number of differences in mindfulness interventions including frequency, duration, instructional method, and inclusion of yoga, that need quantitative examination (meta-analysis) to determine which is most effective.
Bamber MD, Kraenzle Scheider J, Mindfulness-based meditation to decrease stress and anxiety in college students: A narrative synthesis of the research. Education Research Review, May 2016; Vol 18, P1-32. doi:10.1016/j.edurev.2015.12.004
3. Therapeutic meditation - is it effective?
This is the big one! A large group of investigators from Johns Hopkins University’s Evidence-based Practice Center in Baltimore, set out to determine the efficacy of meditation programs in improving stress-related outcomes in a wide range of adults. They used very stringent standards for their investigation.
Remarkably, they were able to examine 18,753 studies! But then they selected only randomized clinical trials with active controls for placebo effects. Next the strength of evidence was graded using risk of bias, precision, directness, and consistency, and then the group determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, meta-analyses were conducted using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals.
Only 47 trials (with 3515 participants) met the criteria to be included in the final analysis. Perhaps saying “only” here is a bit unkind, given the stringent criteria set for this meta-analysis.
What does the meta-analysis show?
Mindfulness meditation programs had moderate evidence of improved anxiety at 3-6 months,
depression at 8 weeks and at 3-6 months, and pain and low evidence of improved stress/distress and mental health-related quality of life.
The analysis found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight.
Significantly, no evidence was found to demonstrate that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioural therapies).
Conclusions and Relevance
The researchers suggested clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behaviour.
It is worth noting most studies only evaluated short-term effects, and there may well be significant differences between different techniques and different times people spend practicing these techniques - see the next article…
Goyal, M et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014 Mar;174(3):357-68. doi: 10.1001/jamainternmed.2013.13018.
FUTURE DIRECTIONS FOR MEDITATION RESEARCH
The JAMA article that is cited above and forms the basis of this article was itself based on a more comprehensive report, one in a series of Comparative Effectiveness Reviews
(No. 124 : Meditation Programs for Psychological Stress and Well-Being) prepared for the Agency for Healthcare Research and Quality in the U.S. Department of Health and Human Services.
http://effectivehealthcare.ahrq.gov/ehc/products/375/1830/Meditation-report-140106.pdf
That report makes good reading, part of the conclusion having great relevance to the therapeutic application of meditation and something we are bound to hear more of as meditation is used more widely for its healing potential. A quote from the report…
Historically, the general public has not conceptualized meditation as a quick fix toward anything. It is a skill or state one learns and practices over time to increase one’s awareness, and through this awareness gain insight and understanding into the various subtleties of one’s existence.
Training the mind in awareness, non-judgmentalness, and the ability to become completely free of thoughts or other activity are daunting accomplishments.
While some meditators may feel these tasks are easy, they likely overestimate their own skills due to a lack of awareness of the different degrees to which these tasks can be done or the ability to objectively measure their own progress. Since becoming an expert at simple skills such as swimming, reading, or writing (which can be objectively measured by others) takes a considerable amount of time, it follows that meditation would also take a long period of time to master.
However many of the studies included in this review were short term (e.g., 2.5 hours a week for 8 weeks), and the participants likely did not achieve a level of expertise needed to improve outcomes that depend on a mastery of mental and emotional processes. The short-term nature of the studies, combined with the lack of an adequate way to measure meditation competency, could have significantly contributed to results.
Lots to contemplate in all of this ……
But what interesting new research is there? And what does closer scrutiny using meta-analysis techniques reveal? To counsel people appropriately, meditation teachers and clinicians alike need to know the answers, so this week we ask the hard question… Does meditation and mindfulness really work?
Also, good news with the widely updated and improved version of my meditation app ready for release in a week or two (details will follow on the next blog post), but first
Thought for the day
A Black Swan Event
1. Is an outlier, as it lies outside the realm of regular expectations, because nothing in the past can convincingly point to its possibility.2. It carries an extreme 'impact'.
3. In spite of its outlier status,
human nature makes us concoct explanations
for its occurrence after the fact,
making it explainable and predictable.
In summary, this is what characterises
a Black Swan Event - rarity, extreme 'impact',
and retrospective (though not prospective) predictability.
A small number of Black Swans explain
almost everything in our world,
from the success of ideas and religions,
to the dynamics of historical events,
to elements of our own personal lives.
Nassim Taleb
PART 1 Some interesting recent research
1. Mindfulness changes brain structure and improves mental health
Building upon earlier research and following a brief 8 weeks Mindfulness Based Stress Reduction (MBSR) training program, researchers identified significant brain changes - cortical thickness increase in the right insula and the somatosensory cortex - coupled with a significant reduction of several psychological markers related to worry, state anxiety, depression and alexithymia.
Taken together, these findings also provide new and plausible neurobiological evidence of a major role of the right insula in mediating the observed psychological changes.
Santarnecchi et al. Interaction between Neuroanatomical and Psychological Changes after Mindfulness-Based Training. PLoS ONE 9(10): e108359. doi:10.1371/journal.pone.0108359
2. Meditation is anti-inflammatory
A new and rigorously designed mindfulness study, by the Georgetown University Medical centre, showed that hormonal, inflammatory reactions to stress were reduced after meditation training.
Hoge EA et al. 2018, The effect of mindfulness training on biological acute stress responses in generalised anxiety disorder. Psychiatry Res; 262, 328-332.
3. Meditation improves quality of life for breast cancer survivors
Women who had been treated for breast cancer and were cancer free were taught to meditate and the effects evaluated.Over time, the group that meditated reported significant decreases in depression, anxiety, perceived stress, and an increase in quality of life, satisfaction with life, post-traumatic growth and quality of sleep.
Significantly, participants had a high attendance rate in the program, which speaks to the likelihood of the applicability of the meditation program on an outpatient basis.
Yun MR et al. The Effects of Mind Subtraction Meditation on Breast Cancer Survivors' Psychological and Spiritual Well-being and Sleep Quality: A Randomized Controlled Trial in South Korea. Cancer Nurs. 2017 Sep/Oct 40(5); 377-385.
PART 2 The analysis
In scientific circles, one study is a bit like one swallow - it does not a summer make. To analyse a number of studies in the one field, complex, modern techniques use what is called meta-analysis to tease out wider and hopefully more accurate conclusions. While there is increasing criticism of the way in which meta-analyses are conducted, they do remain a “gold-standard” for current researchers.
Given the huge increase in the number of meditation and mindfulness studies, meta-analyses are becoming more possible. Here we reveal 2 specific reviews, and one wider one.
1. Does meditation improve cognitive function in the elderly?
Well this is good news - even if a little cautious!With so many people worried about loss of mental capacity with aging, and so many actually developing dementia, researchers analysed the scientific literature on meditation and concluded : "There is preliminary evidence that meditation can improve cognitive function."
They then investigated the results of 6 Mindfulness Based Interventions in older people based upon MBSR and MBCT. They reported preliminary positive effects on memory, executive function and processing speed.
However, most reports had a high risk of bias and sample sizes were small. The only study with low risk of bias, large sample size and active control group reported no significant findings.
The conclusion? More research is needed, and while meditation and mindfulness may well be useful for the elderly, maybe it is wise to start meditation at an early age!
Berkl L et al. Can mindfulness-based interventions influence cognitive functioning in older adults? A review and considerations for future research. Aging Mental Health 2017 Nov : 21 (11):1113-1120.
2. Does meditation reduce stress and anxiety in college students?
We hear a good deal about meditation and mindfulness providing effective self-help solutions for stress and anxiety. Many studies have focused on the impacts upon students, so how do those studies stack up when researched objectively?
In this analysis of 57 studies, researchers examined anxiety in 40 studies, self-reported stress in 34, physiological stress in 11, and mindfulness in 24.Thirty-three of 40 and 25 of 34 studies showed significant decreases in anxiety and stress respectively; 22 of 24 showed an increase in mindfulness.
Physiological stress had inconsistent results indicating a need for further research.
Overall, the researchers concluded that mindfulness meditation shows promise in reducing stress and anxiety in college students. Additionally, there are a number of differences in mindfulness interventions including frequency, duration, instructional method, and inclusion of yoga, that need quantitative examination (meta-analysis) to determine which is most effective.
Bamber MD, Kraenzle Scheider J, Mindfulness-based meditation to decrease stress and anxiety in college students: A narrative synthesis of the research. Education Research Review, May 2016; Vol 18, P1-32. doi:10.1016/j.edurev.2015.12.004
3. Therapeutic meditation - is it effective?
This is the big one! A large group of investigators from Johns Hopkins University’s Evidence-based Practice Center in Baltimore, set out to determine the efficacy of meditation programs in improving stress-related outcomes in a wide range of adults. They used very stringent standards for their investigation.
Remarkably, they were able to examine 18,753 studies! But then they selected only randomized clinical trials with active controls for placebo effects. Next the strength of evidence was graded using risk of bias, precision, directness, and consistency, and then the group determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, meta-analyses were conducted using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals.
Only 47 trials (with 3515 participants) met the criteria to be included in the final analysis. Perhaps saying “only” here is a bit unkind, given the stringent criteria set for this meta-analysis.
What does the meta-analysis show?
Mindfulness meditation programs had moderate evidence of improved anxiety at 3-6 months,
depression at 8 weeks and at 3-6 months, and pain and low evidence of improved stress/distress and mental health-related quality of life.
The analysis found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight.
Significantly, no evidence was found to demonstrate that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioural therapies).
Conclusions and Relevance
The researchers suggested clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behaviour.
It is worth noting most studies only evaluated short-term effects, and there may well be significant differences between different techniques and different times people spend practicing these techniques - see the next article…
Goyal, M et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014 Mar;174(3):357-68. doi: 10.1001/jamainternmed.2013.13018.
FUTURE DIRECTIONS FOR MEDITATION RESEARCH
The JAMA article that is cited above and forms the basis of this article was itself based on a more comprehensive report, one in a series of Comparative Effectiveness Reviews
(No. 124 : Meditation Programs for Psychological Stress and Well-Being) prepared for the Agency for Healthcare Research and Quality in the U.S. Department of Health and Human Services.
http://effectivehealthcare.ahrq.gov/ehc/products/375/1830/Meditation-report-140106.pdf
That report makes good reading, part of the conclusion having great relevance to the therapeutic application of meditation and something we are bound to hear more of as meditation is used more widely for its healing potential. A quote from the report…
Historically, the general public has not conceptualized meditation as a quick fix toward anything. It is a skill or state one learns and practices over time to increase one’s awareness, and through this awareness gain insight and understanding into the various subtleties of one’s existence. Training the mind in awareness, non-judgmentalness, and the ability to become completely free of thoughts or other activity are daunting accomplishments.
While some meditators may feel these tasks are easy, they likely overestimate their own skills due to a lack of awareness of the different degrees to which these tasks can be done or the ability to objectively measure their own progress. Since becoming an expert at simple skills such as swimming, reading, or writing (which can be objectively measured by others) takes a considerable amount of time, it follows that meditation would also take a long period of time to master.
However many of the studies included in this review were short term (e.g., 2.5 hours a week for 8 weeks), and the participants likely did not achieve a level of expertise needed to improve outcomes that depend on a mastery of mental and emotional processes. The short-term nature of the studies, combined with the lack of an adequate way to measure meditation competency, could have significantly contributed to results.
Lots to contemplate in all of this ……
Great analysis of the current research into mindfulness and meditation. Keep on doing what you do Ian...it does make a difference to many of us!
ReplyDeleteHi Ian,
ReplyDeleteThank you for all the regular information in the blog. I've just come from our weekly meditation group in Hawthorn which I led today; people who return again and again to enjoy the fruits of a group meditative experience. Certainly everyone in the group has been meditating for more than 8 weeks so there is no difficulty convincing them that meditation is beneficial to their state of mind. They know this.
I try to put myself back into the frame of mind of a beginner meditator and I think I kept going with the practice because I experienced some lovely moments that I wanted to repeat. Over time, I came to see that whatever happened in a particular session was fine - that I didn't need to chase a particular experience - and then the benefits of clear thinking, feeling settled, compassion, a more open heart, feeling connected and at one at the same time, to name a few benefits, rolled into my life. That certainly didn't happen overnight and really there is no end in sight since I think of regular meditation as a journey where one gets closer and closer to one's authentic self.
It appears that many people opt out of meditation before they experience the full benefit of the experience and it therefore seems to me that the trick is to make the experience such that they want to keep coming back. If it seems too hard, or it makes them too uncomfortable, much like a beginner yoga student in a class that makes them feel out of their depth, insecurities may lead them to give up. For the beginner yoga student it is about accomplishing the poses and usually it is only later that the full benefits for the mind kick in. It's step by step. So it is with meditation, I think.
I suspect those that get past the first few months of regular meditation often belong to a group where they can feel supported; where self-compassion and all meditative experiences are seen of value. Coming up against your own mind is at first quite confronting, or I found it to be so, and having the opportunity to share the places that scare you (as Pema Chodron might say) may well make all the difference in establishing a meditative practice. Reading material that supports meditation was invaluable for me.
It is a difficult thing to quantify the benefits of meditation. All I can say is that I have seen the benefits for myself and others and that then fans out to all those others who interact with us. If you somehow measured me eight weeks in you would have seen a small to moderate gain. Now, the results would be infinitely greater. Then again, if you measured my cooking abilities 8 weeks in, you might not have wanted to eat my dinners. Happily, no one is complaining these days.
Beautifully, eloquently put Robyn :)
Delete