By Traci Pantuso, ND, MS

Adjunct Faculty, Bastyr University, Seattle, WA; Owner Naturopathic Doctor Harbor Integrative Medicine, Bellingham, WA

Dr. Pantuso reports no financial relationships relevant to this field of study.

Summary Points

  • Eighteen million adults in the United States report using some form of meditation.
  • A variety of meditation techniques are
    practiced worldwide.
  • Research investigating the clinical effectiveness of meditation practices is rapidly growing.

Meditation has gained popularity not only as a practice to gain awareness and maintain calmness but also as an integrative mind-body treatment for a multitude of different clinical conditions.1-3 In a survey of people 50 years of age and older, 11% of individuals between the ages of 50-64 reported using mind-body practices while only 5% of individuals 65 and older did.2

Meditation is derived from the Latin word “meditatri,” which is defined as engaging in contemplation or reflection.3,4 The practice of meditation is found in most spiritual traditions and cultures throughout the world and has been practiced in some cultures for more than 5000 years.3,4

A multitude of different meditation techniques are practiced worldwide, and most techniques are based on realizations of a specific group or teacher within a traditional cultural framework (see Table 1). According to the National Institutes of Health, “there are many types of meditation, but most have four elements in common: quiet location, specific comfortable posture, focus of attention, and an open attitude.”5

Table 1: Types of Meditation, Techniques, and Traditional Background

 

Name of Meditation Technique

Treatment

Traditional Background/Founder

Mantra

Transcendental meditation

Personalized mantra

Vedic Hindu

Relaxation response

Mantra

Herbert Benson; 1970s

Clinically standardized meditation

Mantra

Patricia Carrington; 1970s

Mindfulness Meditation

Vipassana

Mindfulness

India

Zen Buddhist meditation

Zazen

Japanese/Chinese

Mindfulness-based stress reduction

Sitting meditation, walking meditation, hatha yoga, and body scan

Jon Kabat-Zinn of the

University of Massachusetts

Mindfulness-based
cognitive therapy

Mindfulness meditation and cognitive behavorial therapy

Zindel Segal, Mark Williams, and John Teasdale

Contemplative Centering Prayer

Contemplative/centering prayer

Sacred word; prayer; lectio divina

Catholic/Christian

Adapted from: Rakel D. Integrative Medicine. Philadelphia: Elsevier/Saunders, 2012. ISNBN 978-1-4377-1793-8

Mantra meditation incorporates the use of a word or phrase, which is repeated either silently or aloud during the meditative practice while sitting in a comfortable position with eyes closed.3,4 There are numerous types of mantra meditation — three that are standardized with directions published in manuals and include transcendental meditation (TM), relaxation response (RR), and clinically standardized meditation (CSM).3,4

TM developed from the Vedic tradition, and cardiologist Herbert Benson developed RR in the 1970s.3,4 Patricia Carrington developed CSM in the early to mid-1970s as more flexible and accessible than TM.3,4

Another category, mindfulness meditation (MM), generally refers to practices that cultivate awareness, paying attention to the present moment, practicing non-judgment, and acceptance.3,4 The types of MM include Vipassana, Zen Buddhist meditation, mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT). Developed for patients with chronic pain and stress-related complaints, MBSR is an 8-week group program with weekly 2.5-hour sessions and one all-day silent retreat.3,4 MBSR also incorporates sitting meditation, walking meditation, Hatha yoga, and a body scan, which is a mindfulness practice in which attention is sequentially focused on different parts of the body.3,4

Meditation Research

Prior research investigating the clinical efficacy of meditation includes studies of poor methodological quality, making interpretation of the overall research difficult.3-6 There has also been a strong positive bias toward publishing positive results.7 Many research studies that have shown positive effects with meditation have yet to be replicated.3-6 Other issues that are rampant throughout the larger body of literature include lack of randomized controlled trials (RCT), absence of control or comparative control groups, studies of short duration that are cross-sectional not longitudinal in design, and post-hoc analysis.3-6 More recently, a number of methodologically sound meditation studies have been published that investigated the effect of meditation in clinically relevant populations.5,6 More methodologically sound research is needed to be able to understand the clinical effectiveness of different meditation techniques.

Mechanism of Action

The mechanisms that impart the effects of meditation are still unknown, although some studies have reported effects in multiple brain regions, such as cerebral cortex, subcortical grey and white matter, brain stem, and cerebellum.3,4 There is evidence to demonstrate that meditation improves attention and that areas in the brain involved in attention also demonstrate structural and functional changes. Emotional regulation has demonstrated improvements with mindfulness meditation.6

Clinical Conditions and the Evidence for Meditation

Anxiety, Stress Reduction, and Depression. In a 2014 meta-analysis investigating the effects of mindfulness meditation on anxiety, depression, pain, stress, and mental health-related quality of life, 17,801 citations were reviewed with 47 trials included.5 A total of 3320 participants were included in the study, and the authors found that mindfulness meditation programs have moderate evidence to improve anxiety (effect size, 0.38; 95% confidence interval [CI], 0.12-0.64 at 8 weeks), depression (effect size, 0.30; CI, 0.00-0.59 at 8 weeks), and pain (effect size, 0.33; CI, 0.03-0.62), and a low level of support for the improvement of mental health-related quality-of-life and stress.5 The authors found either low evidence or insufficient evidence of any effect of meditation programs on substance use, eating, positive mood, attention, sleep, and weight.5 The effect size for mindfulness meditation programs’ improvement in depression is comparable to those found in a primary care population treating depression with antidepressants.8

Sleep. A 6-week RCT in 49 older adults ( 55 years old) investigated “mindfulness awareness practice,” a weekly 2-hour, 6-week intervention, and compared it to a sleep hygiene intervention. The mindfulness awareness practice improved the Pittsburgh Sleep Quality Index by 1.8 points (95% CI, 0.6-2.9).9 The authors also found a clinically relevant improvement in sleep quality (effect size, 0.89) compared to the sleep hygiene intervention.9 In comparison, behavioral interventions for improvement in sleep quality have an effect size of 0.76 in older adults.9 Another RCT that investigated MM in 54 adults with chronic insomnia also found MM to be an effective treatment for chronic insomnia.10 In a 2014 meta-analysis, there was insufficient evidence that MM improved sleep.5 MM may be a clinically effective intervention to improve sleep and will require more methodologically sound trials to demonstrate its efficacy in systematic reviews.

Substance Abuse Disorders and Tobacco Cessation. The evidence for meditation as an effective treatment for substance abuse disorders is mixed; there are a number of research studies demonstrating benefit, though also studies showing little or no effect. More rigorous research needs to be conducted to further understand the role of meditation in treating substance abuse disorders.4,11

An RCT investigating the effects of a form of mindfulness meditation called integrative body-mind training compared to relaxation training in smokers showed a significant reduction in the smoking amount in the integrative body-mind training group (P < 0.01) but not in the relaxation training group (P > 0.05).12

In another RCT investigating a specific mindfulness training developed for active smoking cessation compared to the American Lung Association’s Freedom From Smoking (FFS) program for smoking cessation, mindfulness training demonstrated a greater decrease in cigarette smoking than FFS (F = 11.11, P = 0.001).13

Hypertension and Cardiovascular Disease (CVD). In 2009, an RCT investigating TM in 298 university students demonstrated the effectiveness of TM in reducing blood pressure -2.0/-1.2 (systolic blood pressure/diastolic blood pressure) mmHg (P = 0.15) in comparison to a wait-list control group (+0.4/+0.5 mmHg) (P = 0.15).14 This significantly reduced blood pressure was found in association with reduced psychological stress with increased coping.

TM is associated with significant reductions in both systolic and diastolic blood pressure in a number of studies. In a 2008 meta analysis with 367 individuals in the active group and 344 in control groups with a study duration between 8-52 weeks, TM was associated with significant reductions in systolic (-4.7 mmHg; 95% CI, -1.9 to -7.4) and diastolic (-3.2 Hg; 95% CI, -1.3 to -5.4) blood pressure compared with the control group.15 These reductions were demonstrated similarly in individuals with hypertension and those with normal blood pressure.15

The American Heart Association supports the use of TM to lower blood pressure and gives it a Class IIB, Level of Evidence B for its blood pressure lowering efficacy.16 Due to the paucity of data regarding other meditation techniques, only TM is graded as Class IIB; other meditative techniques were given Class III, no benefit, Level of Evidence C recommendation.16

Meditation has also shown some promising effects in CVD, as it has demonstrated reductions in improved quality-of-life outcomes, such as anxiety and depression, and has demonstrated survival benefits.17 Meditation is an activity that many individuals with CVD are able to participate in at home and has benefit in reducing anxiety associated with CVD.17

Pain. A 2013 meta-analysis that retrieved 133 studies investigating the affects of mindfulness meditation on pain included 16 trials that met their inclusion criteria.18 According to the authors, 58 of the 133 studies did not have pre- and post-pain intensity ratings and were excluded.18 The authors concluded that mindfulness-based interventions reduce pain intensity with a medium effect size.18 These findings were further supported by a 2014 meta-analysis which found that mindfulness interventions reduce pain to a small degree with an effect size of 0.33.5 There was variability in the effect size depending on the condition: two studies were in musculoskeletal pain patients, one was in patients with irritable bowel syndrome, and one was in a non-pain population.5

Visceral pain had a large and statistically significant relative 30% improvement in pain severity, while musculoskeletal pain showed 5-8% improvements that were considered non-significant.5 Cramer et al found inconclusive evidence that MBSR improved low back pain in a 2012 systematic review that included three trials with 117 participants.19 More research is required to understand why mindfulness meditation is demonstrating improvements in pain in certain populations and not in others, and whether this is due to the type of pain or other variables.

Gastrointestinal. A 2014 systematic literature review investigating the use of mindfulness meditation on irritable bowel syndrome (IBS) symptoms found 119 studies; however, 106 studies excluded and only seven randomized studies were included in the review.20 The results indicated that there was an IBS symptom severity decrease that ranged from 23% to 42%.20 In a 2011 prospective RCT with 75 women, the mindfulness training group showed a greater improvement in IBS symptoms compared to the support group/control (26.4% vs 6.2% reduction, respectively; P = 0.006).21 The effectiveness of mindfulness in inflammatory bowel disease has shown improvement in quality of life but not on other parameters.22

Immune Parameters. There are a number of immune markers that appear to be influenced by mind-body therapies.23 Psychological stress and depression are known to affect the immune system by decreasing antiviral responses and modifying innate immune responses.23 The sympathetic nervous system and the hypothalamus pituitary adrenal (HPA axis) are believed to be the effector pathways through which psychological stress, depression, and mind-body interventions may modulate the immune response.24 A 2014 meta-analysis, which the authors report as the first in the literature, found a number of effects of mind-body therapies after 7 to 16 weeks of practice on the immune system, including a reduction in C-reactive protein (effect size 0.58; 95% CI, 0.04-1.12), and negligible effects on natural killer cells (effect size 0.12, 95% CI -0.21 to 0.45) and CD4+ cells (effect size 0.15; 95% CI, -0.04 to 0.34).23 More research is needed to further understand the effects of mind-body therapies on the immune response.

Taking immune system effects to the next step, researchers are now connecting meditation with clinical outcomes. For example, Barrett et al demonstrated a decrease in acute respiratory illness (ARI) severity (P < 0.05; coefficient range, 333.1 to 484.5) and a reduction in ARI duration (P < 0.05) in a mindfulness meditation group.25

Menopausal Symptoms. In a 2011 randomized trial investigating the effects of MBSR and severity of hot flashes, MBSR treatment demonstrated a significant decrease in severity of hot flashes compared to the control group.26 More research needs to be performed to assess the effectiveness of meditation on vasomotor symptoms in perimenopausal women.

Conclusion

There are promising results for meditation and its clinical efficacy, even though there is the need for more evidence (see Table 2). More rigorous research is required to further understand which types of meditation practices are beneficial for which conditions and how individual people respond. Delineating the mechanism of action of meditation practices may prove to be useful in future research and may also help to guide clinical recommendations.

Table 2: Summary Table of Meditation Techniques and Clinical Effectiveness

Condition

Treatment

Clinically Effective

Hypertension

Transcendental meditation

Yes

Cardiovascular disease

Mindfulness meditation

Yes for improvements in quality of life, anxiety, and overall survival

Anxiety, depression

Mindfulness meditation

Yes

Sleep

Mindfulness meditation

Most likely; however more research is needed

Substance abuse disorders

Mindfulness meditation

Insufficient Evidence

Smoking cessation

Mindfulness meditation

Relaxation training

Most likely, however more research is needed

Pain

Mindfulness meditation

Yes, in certain types of pain; more research is needed to better define which types of pain respond best

Inflammatory bowel disease,
irritable bowel syndrome

Mindfulness meditation

Improvement in quality of life and may improve symptom severity

Vasomotor symptoms in
menopausal women

Mindfulness meditation

More research is needed

There are large numbers of U.S. adults using integrative therapies to not only prevent disease and promote wellness but also to treat painful conditions and to treat specific conditions. Meditation may be effective in promoting wellness, helping to reduce pain, and serving as an adjunctive therapy in treating specific conditions. TM has demonstrated efficacy in treating hypertension, and the American Heart Association has concluded that it may be considered in clinical practice to lower blood pressure. Unfortunately, more research needs to be done to understand if TM is actually clinically superior to other meditative practices for blood pressure lowering.

Meditative practices are safe, relatively easy to learn, can be performed at home, carry low emotional and physical risks, and are inexpensive. Patients can take an active role in treatment by using meditative techniques that are safe and may be effective in treating different conditions.

On the down side, meditative practices do require adherence and time commitment depending on the type of meditation technique. Some forms of brief meditative practices (5 days to 8 weeks) have demonstrated improvement in neuropsychological, metabolic, and clinical profiles. To further understand, how meditation fits into treatment in different conditions more longitudinal, RCTs with large numbers of participants that have comparative control groups will be of importance.

References

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