The document outlines the therapeutic potential of meditation as a stress reduction strategy, highlighting the need for further research and quality studies to differentiate it from relaxation techniques. While various forms of meditation exist, such as transcendental meditation and mindfulness, there is insufficient evidence to compare their efficacy or define meditation clearly. The authors emphasize the necessity of educating general practitioners on meditation and the potential risks associated with certain techniques.

1. Why meditation?
BACKGROUND While many general practitioners perceive meditation as an acceptable, even
mainstream, health care strategy, it is paradoxically a poorly understood discipline.
OBJECTIVE To define meditation, outline the broad types of meditation and give an overview of the
extent and validity of available evidence for its efficacy.
DISCUSSION The basic question of what constitutes meditation and what separates it from relaxation
therapy has been an impediment to formulating quality studies in order to research meditation
techniques. Examining the literature using evidence based criteria reveals that, while meditation does
appear to have therapeutic potential, there is a great need for further research before definitive
conclusions can be made. Researchers have yet to systematically compare different techniques of
meditation to compare their profiles.
M
e ditatio n is se e n by a numbe r of The need f or an evidenced based
rese arche rs as po te ntially o ne o f the approach
most effective forms of stress reduction.1 A recent survey of A ustralian general practition-
While stress reduction techniques have been culti- ers showed that while GPs perceived meditation as
vated and studied in the West for approximately an acceptable, even mainstream, health care strat-
Ramesh M anocha
70 years, the data indicates that they are not con- e gy, it is parado xically a po o rly unde rsto o d
sistently effective.2 discipline. In view of this, the authors concluded
Meditation however, has been developed in that we ll de signe d trials and e ducatio n are
Eastern cultures and has a documented history of urgently needed to inform GPs’ decision making.6
more than several thousand years. Eastern medita-
M editation vs relaxation
tive techniques have been developed, trialed and
refined over hundreds of generations with the spe- Implicit in the fact that the term ‘meditation’ exists
cific intention of developing a method by which separately from that of ‘relaxation’ suggests that
the layperson can regularly attain a state of mental there should be clear differences between the two
peace and tranquillity, ie. relief from stress. It is a phenomena. However, there is as yet insufficient
strategy that can easily be adapted to the needs of evidence to draw a clear distinction. Moreover,
clinicians and their patients in the West. researchers have yet to systematically compare dif- Ramesh Manocha,
A U S study for example, showed that a short fe re nt technique s o f me ditatio n to de te rmine MBBS, BSc, is Barry
Wren Fellow, Royal
course of behaviour modification strategies that whether or not these techniques use different or Hospital for Women,
included meditation led to significantly fewer visits similar mechanisms or have differing effect profiles. New South Wales.
to physicians during the six months that followed.
Lack of quality research
The savings we re e stimate d at ove r $200 pe r
patie nt.3 A study of insurance statistics showed Despite the breadth of information available on med-
that the use of medical care was significantly less itation, a report of the US National Research Council
for meditators compared to nonmeditators.4 (NRC) on meditation raised concerns about weak
The growing emphasis on: methodology and poor definition of the process.7
• quality of life outcomes Examining the literature using evidence based
• concepts such as psychoneuroimmunology or criteria reveals that while meditation does appear
mind–body medicine,5 and to have therapeutic po te ntial, the re is a gre at
• reducing healthcare costs need for further research before definitive con-
suggest that stress reduction and improving mental clusions can be made . The body of knowle dge
he alth are becoming incre asingly re le vant to currently suggests that not all meditation tech-
healthcare. ni que s are the same ; mo st te chnique s are
Australian Family Physician Vol. 29, No. 12, December 2000 • 1135

2. ■ W h y m e d it a t io n ?
pro bably e labo rate re laxation me tho ds while Meditatio n is popularly perceived to be any
there are others that may well involve physiologi- activity in which the individual’s attention is pri-
cal processes unique to meditation. marily focused on a repetitious cognitive activity.
The Meditation Research Program (MRP) is This very broad definition is, in the opinion of the
o ne o f the o ngo ing activitie s o f the N atural MRP, the main cause for much of the inconsistent
Therapies U nit at the Royal Hospital for Women outcomes seen in meditation research.
in Sydney. The MRP is committed to thorough sci-
entific evaluation of meditation, its physiological ‘Thoughtless aw areness’
effects and its potential for healthcare. If one closely examines the authentic tradition of
meditation it is apparent that meditation is a discrete
What is m edit at ion? and well defined experience of a state called ‘thought-
There are many forms of meditation, ranging in less awareness’. This is a state in which the excessive
complexity from strict, regulated practices to general and stress producing activity of the mind is neutralised
recommendations. If practised regularly, meditation without reducing alertness and effectiveness.
is thought to help develop habitual, unconscious A uthentic meditation enables one to focus on
microbehaviours that can potentially produce wide- the ‘present moment’ rathe r than dwe ll on the
spread positive effects on physical and psychological unchangeable past or undetermined future. It is
functioning. Meditation even for 15 minutes twice a this state of equipoise that is said to be therapeutic
day has been shown to bring beneficial results.3 both psychologically and physically and which fun-
damentally distinguishes meditation from simple
How does meditation w ork? relaxation, physical rest or sleep.
Parasym pathetic response
Reducing ‘background m ental noise’
Most theories are based on the assumption that A cco rding to this pe rspe ctive , stre ss is the
meditation is a sophisticated form of relaxation inevitable byproduct of an overactive mind. The
involving a concept called the parasympathetic unsilenced mind is responsible for almost continu-
response. Psychological stress is associated with o us ‘background me ntal no ise ’ the co nte nt o f
activation of the sympathetic component of the which is mostly unnecessary and unproductive. Yet
autonomic nervous system which, in its extreme, it is this ‘mental noise’ that impinges on our other-
causes the ‘fight or flight response’. Meditation and wise natural te nde ncy toward psycho lo gical,
any form of rest or relaxation acts to reduce sym- mental and spiritual health.
pathetic activation by re ducing the re lease o f
Quasi-meditation
catecholamines and other stress hormones such as
cortisol, and promoting increased parasympathetic Most commercialised meditation techniques do not
activity which in turn slo ws the he art rate and reliably give the key experience of mental silence
improves the flow of blood to the viscera and away or ‘thoughtless awareness’ hence they can more
from the periphery. precisely be described as ‘quasi-meditative’. These
include methods that use constant repetition of
Other neurophysiological effects syllables (such as mantras), visualisations or other
Other proponents claim that meditation involves thought forms.
unique neurophysiological effects; however, this This does not mean they may not be useful as
remains to be proven. Research at the MRP sug- they do encourage relaxation by reducing or simplify-
gests the limbic system may be involved in Sahaja ing mental activity or focusing attention. However,
yoga meditation (SYM) since significant effects well designed physiological and clinical trials have, on
invo lving mo o d state have be e n co nsiste ntly the whole, shown little difference between these tech-
observed. niques and physical rest or relaxation.8
Defining w hat w e mean by meditation Types of m edit at ion
The most important issue that must be addressed in There are many meditation techniques available to
this field of research is to clearly define meditation consumers. Three notable examples include trans-
and then subject that definition to scientific testing. cendental meditation, mindfulness and Sahaja yoga.
1136 • Australian Family Physician Vol. 29, No. 12, December 2000

3. W h y m e d it a t io n ? ■
Transcendental meditation time. There is no fee for these retreats but ‘recom-
Transcendental meditation (TM) is the commonest mended donations’ are described. These retreats
form of mantra meditation. It aims to prevent dis- are unsuitable for the average person, particularly
tracting thoughts by use of a mantra. Students are tho se unfamiliar with me ditatio n, due to the
instructed to be passive and, if thoughts other than e xtre me physical and psycho logical de mands.
the mantra come to mind, to notice the m and A dverse events associated with Vipassana have
return to the mantra. A TM student is asked to been described although it is unclear as to which
practise for 20 minutes in the morning and again in form these reports refer.17
the evening.
Sahaja yoga meditation
Transcendental meditation is said to be associ-
ated with clinical outcomes such as blood pressure Sahaja yoga meditation (SYM) is the technique of
re d u c t i o n9 and physiolo gical change s such as choice in the MRP. Sahaja yoga meditation aims to
lowered blood cortisol levels.10 promote the experience of ‘thoughtless awareness’
base d o n the o riginal me ditative tradition.
Adverse effects Meditators in the MRP consistently describe the
There are however, a number of case reports in the ability to achieve this experience. They are encour-
mainstream medical literature describing occasional aged to practise twice daily for approximately 15
adverse psychological11,12 and physical effects13 that minutes. Sahaja yoga meditation is well suited for
appe ar to be causally re late d to the te chnique. the general population and for research, because it
These adverse events range from mild to severe and is easy to learn and is taught free of charge. Sahaja
warrant further systematic investigation.14 yoga meditation is currently used in three Sydney
hospitals for patients, staff and public. Feedback
Cost issues from management teams and anecdotal reports
The technique is taught using a commercial system from patients and carers are favourable. A s yet no
in which o ne be gins by purchasing a mantra. adverse effects have been reported in the MRP’s
Further instruction entails an escalating system of trials, clinics or in the literature.
fees that can be cost prohibitive. Moreover, the TM The MRP has conducted a number of small and
organisation has on occasion been implicated in large trials on SYM which have generated promis-
unethical and cultic practices.15 In light of this infor- ing results in A ustralian conditions. A randomised
mation, medical practitioners have no choice but to co ntro lle d trial o f me ditatio n for mo derate to
recommend caution with regard to this method. se ve re asthma compare d SYM to a re laxatio n
control. SYM was more effective in a number of
M indfulness and Vipassana meditation objective and subjective endpoints.
Mindfulness is a general method that serves as a A number of locally conducted pilot studies
basis for techniques such as Vipassana meditation. examining the effect of SYM suggest that it may
It aims to use focused attention (often by using a have a beneficial role in menopausal hot flushes,
physical sensation such as the breath) to cultivate se ve re migraine and psycho lo gical stre ss.
mental calmness. Regular practice enables one to Randomised controlled trials are underway in order
objectively observe one’s thoughts and therefore to obtain definitive data. Studies in India suggest
enhance one’s self unde rstanding. Mindfulne ss that SYM is more beneficial than mimicking exer-
approaches have be en shown to be effective in cises in the treatment of epilepsy and hypertension.18
certain clinical applications such as chronic pain.16
Vipassana is both a general term referring to a Recom m ending m edit at ion
specialised form of mindfulness meditation and
t echniques t o pat ient s
also a specific brand name. The following informa- General practitioners must exercise commonsense
tion re fers to the latter. Vipassana is taught in and discrimination when recommending medita-
A ustralia via a number of Vipassana retreats and tion to their patients as they have a duty of care to
centres. The retreats involve up to 10 days of inten- ensure the safe ty of their patients’ he alth and
sive meditation, several hours per day, and other finances. Meditation is contraindicated in those
strict observances such not talking and encourage- suffe ring fro m psycho sis and sho uld o nly be
ment to maintain strict postures for long periods of applied with great caution in those with severe psy-
Australian Family Physician Vol. 29, No. 12, December 2000 • 1137

4. ■ W h y m e d it a t io n ?
chological problems. The medicolegal implications contemporary perspectives. New York: Alden, 1984.
15. Skolnick A. Maharishi Ayur-Veda: Guru’s marketing
of re commending a te chnique that leads to an scheme promises the world eternal perfect health!
adverse event have not been explored. JAMA 1991; 266(10):1741–1750.
A simple and e ffe ctive rule o f thumb when 16. Kabat-Zinn J, Lipworth L, Burney R, et al. The clinical
use of mindfulness meditation for the self regulation of
choosing or recommending a meditation technique is chronic pain. J Behav Med 1998; 8(163):190.
to assume that ‘the best things in life are free’. 17. Shapiro D, Deane H. Adverse effects of meditation: A
Organisations involved in the commercialisation and preliminary investigation of long term meditators. Int J
Psychosom 1992; 39:1–4; SI:62–67.
marketing of often costly ‘meditation’ techniques,
18. Panjwani U, Selvamurthy W, Singh S H, Gupta H L,
courses and ‘master classes’ are least likely to be Thakur L, Rai U C. Effect of Sahaja yoga practice on
selling an authentic method. Unfortunately in these seizure control & EEG changes in patients of epilepsy.
situations the welfare of the individual and the com- Ind J Med Res 1996; 103(3):165–72.
munity usually become secondary to profit or fame.
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