Meditation is a topic that occasionally pops up in conversation, blogs and more recently news. It’s certainly trending. Every time I bump into the meditation topic I do a quick look around for scientific papers concerning the subject, find some okay evidence which results in a half-hearted motivation to practice it for a few days, followed by completely forgetting about it for the next few weeks. Twenty or more minutes per day is a big time investment, so it better be worth it. And “okay” evidence is not enough motivation for such a time-commitment.
An author who interviewed 200 world-class performers discovered that 80% perform some sort of meditation/relaxation routine. In a more general sense successful people are mindful about how they spend their time. “Everyone else has an agenda for your time, so if you’re in a reactive mode, if you’re playing defense instead of offense, you’re going to get at best, average results”.
There are also lot of blogs posts out there about meditation’s supposed benefits. But there’s an agenda from the get-go which is to show how meditation is beneficial. This bias results in showing hand-picked articles that confirm that agenda. Examples: Liveanddare, HealthLine, PsychologyToday. It might not even be consciously biased. Just a google search of “science benefits of meditation” is enough to only show biased results. In a way, I don’t blame them, we’re all looking for simple ways to improve our lives. But being that meditation involves a significant time investment, I’d rather have a high degree of certainty that it is well spent.
So for this article I focused on systematic reviews and meta-analysis (studies that study and summarize the findings of several studies). There are many studies with methodological limitations (shortcomings in the method used to draw conclusions). For example, one problem with many studies is that they don’t account for selection bias. I want to find people for this meditation study I’m doing, and I don’t want them to dropout because that means I have to include more people, and that’s more costly. So I go to a meditation group or only recruit people that in the pre-screening reported that they were interested in meditation.
This is were systematic reviews and meta-analysis come in handy, because the authors analyze the quality of the studies and try to compare the findings to see if under similar conditions the results were replicable. In fact, systematic reviews “adhere closely to a set of scientific methods that explicitly aim to limit systematic error (bias), mainly attempting to identify, appraise and synthesize all relevant studies (of whatever design) in order to answer a particular question (or set of questions)” (Petticrew and Roberts,2006). Great!
Let’s get our hands dirty and dive into the scientific meta-studies. The one thing most of what I read had in common is that meditation does appear to have a significant benefit in reducing experienced anxiety and in some cases depression and its relapse. On a systematic review Manzoni et al. (2008) found consistent and significant efficacy of meditation in reducing anxiety. A later review by Chen et al. (2012) however then “(…) demonstrates some efficacy of meditative therapies in reducing anxiety symptoms.” This means that meditation appears to be effective in reducing how anxiety presents itself, but it’s still unclear whether it prevents its onset (as most studies focused on measuring the symptoms only).
Another systematic review by (Gu et al.,2015) identified “strong, consistent evidence for cognitive and emotional reactivity [meaning people who meditate tend to become less reactive to external stimuli, become calmer], moderate and consistent evidence for mindfulness, rumination, and worry, [worry less] and preliminary but insufficient evidence for self-compassion and psychological flexibility.” They end the paper by stating that “Most reviewed mediation studies have several key methodological shortcomings which preclude robust conclusions regarding mediation.” Hence why a lot of studies need to be taken with a grain of skepticism.
Loving kindness meditation systematic review reports that meditation practice “was moderately effective in decreasing self-reported depression, and increasing mindfulness, compassion, and self-compassion against passive controls. Positive emotions were increased against progressive relaxation.” (Galante et al.,2014).
Another systematic review found that “mindfulness meditation improves pain and depression symptoms and quality of life” (Hilton et al.,2017). Mars and Abbey (2017), state “the higher quality studies analysed in this review have demonstrated replicated statistically significant improvements in spirituality and positive health measures and decreases in depressive relapse, depressive recurrence and psychological distress” for the practice of mindfulness meditation.
Mindfulness based therapy is an effective treatment for a variety of psychological problems, and is especially effective for reducing anxiety, depression, and stress (Khoury et al.,2013)
Jacob et al. (2012) on their systematic review stated that the existing studies vary considerably in terms of quality, but on the high quality ones “there appears to be some positive evidence (…) to support the use of Mindfulness Based Therapy for cancer patients and survivors with symptoms of anxiety and depression”
In another review, Piet (2011) found mindfulness based cognitive therapy to be an effective way to prevent relapses in people with major depression.
Mindfulness based cognitive therapy (TEDx Talk by Dr. Zingel, U. Toronto and MBCT website) was designed to help people who suffer repeated bouts of depression and chronic unhappiness. It combines the ideas of cognitive therapy with meditative practices and attitudes based on the cultivation of mindfulness (being consciously aware and accepting of one’s own present state, physical and emotional feelings and surroundings). The heart of this work lies in becoming acquainted with the modes of mind that often characterize mood disorders while simultaneously learning to develop a new relationship to them (basically Cognitive Behavioral Therapy + Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction program).
Another systematic review reported that mindfulness meditation “decreases binge eating across a variety of samples; reduces emotional eating for individuals engaging in this behavior” but does not “consistently produce significant weight loss”. (Katterman et al.,2014). However an earlier review found no such effect… “We 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.” (Goyal et al.,2014). Auch, this one is hard to digest. This same review, though, finds that “Mindfulness meditation programs had moderate evidence of improved anxiety, depression, and pain and low evidence of improved stress/distress and mental health-related quality of life.”
(Gard et al.,2014) “While most studies were small pilot studies, they provide preliminary evidence that a variety of meditation techniques may be able to offset age-related cognitive decline and perhaps even increase cognitive capabilities in older adults.”
Winbush et al., (2007) didn’t find any clear demonstration that mindfulness meditation improves sleep quality and duration.
Even though the findings reviewed provided initial evidence that suggests that meditation could enhance cognitive functions (namely attention, memory and motor functions), this should be considered with caution and further high quality studies are needed (Chiesa et al.,2011).
Black and Slavish (2016) found “possible effects of mindfulness meditation on specific markers of inflammation, cell-mediated immunity, and biological aging” but that the results were still shaky and needed further research.
A systematic review concerning heart disease (Dixhoorn and White, 2005) found usefulness in “supervised relaxation practice as a treatment per se and warrants the inclusion of full relaxation therapy in cardiac rehabilitation, because it enhances recovery from an ischaemic event and it contributes to secondary prevention, independently of the effect of psycho-
education and of exercise.”
Another systematic review evaluated the efficacy of stress reduction programs in patients with elevated blood pressure (Rainforth et al.,2008) and found reductions on the order of -2 to -5 mm Hg for systolic (the higher pressure) and -1 to -3 mm Hg for diastolic (the lower one) pressure for progressive muscle relaxation, stress management training, and the Transcendental Meditation program, being that the latter one resulted in the highest values.
Findings from individual studies
Systematic reviews and meta analysis are hard to execute and they need a good number of high quality studies analyzing the same things, which limits the number of subjects that get studied by these meta-papers. Because of this I decided to include a few studies concerning other subjects. Three that I find particularly interesting and that weren’t analyzed by the meta-studies is how it impacts the ability to focus, to be creative and how it influences social relationships.
This article shows that a group randomly assigned to 5 days of meditation practice with the integrative body–mind training method shows significantly better attention and control of stress than a similarly chosen control group given relaxation training. (…) Compared with the control group, the experimental group of 40 undergraduate Chinese students given 5 days of 20-min integrative training showed greater improvement in conflict scores on the Attention Network Test, lower anxiety, depression, anger, and fatigue, and higher vigor on the Profile of Mood States scale, a significant decrease in stress-related cortisol, and an increase in immunoreactivity. (Tang et al., 2007)
One such paper (Davidson and Lutz, 2008) stated that “expert meditators also showed less activation than novices in the amygdala during FA meditation in response to emotional sounds. Activation in this region correlated negatively with hours of practice in life. This finding may support the idea that, advanced levels of concentration are associated with a significant decrease in emotionally reactive behaviors that are incompatible with stability of concentration.” What this means is that the more they found people to meditate the more non-reactive they became to emotional sounds
Meditation appears to have some positive influence on intimate relationships. The findings of a study I found interesting suggest that “couples who are more mindful appear to be more likely to enjoy greater relationship health and stability, and within that, increases in satisfaction and affectionate behavior, as well as greater inter-partner harmony on a range of life issues. Examination of several emotion skill domains in conjunction with mindfulness further suggests that at least one of the avenues to enhanced relationship functioning may be through partners’ more relationally skillful emotion repertoires. We posit that mindfulness puts one in closer contact with one’s own experience relative to the more typical mode of consciousness which, according to Buddhist thinking, is akin to a perpetual state of distraction, if not full-on experiential avoidance.” (Wachs and Cordova,2007). In other words, in mindfulness meditation we practice the act of being conscious of how we are feeling. Thus it does make sense that this results in us becoming more aware of distress feelings that may arise, which in turn enables us, for example, to prevent those feelings of spiraling out of control.
Another study expands on this ideia: “Study 1 found that higher trait mindfulness predicted higher relationship satisfaction and greater capacities to respond constructively to relationship stress. Study 2 replicated and extended these findings. Mindfulness was again shown to relate to relationship satisfaction; then, using a conflict discussion paradigm, trait mindfulness was found to predict lower emotional stress responses and positive pre- and postconflict change in perception of the relationship. State mindfulness was related to better communication quality during the discussion” (Branes et al.,2007)
To end, I also stumbled upon another study that suggests that meditation improves creativity: “These findings lend support to the notion that mindfulness involves cultivation of a “beginner’s mind”, and demonstrate that mindfulness practice reduces cognitive rigidity via the tendency to overlook simple novel solutions to a situation due to rigid and repetitive thought patterns formed through experience. [that is, improves creativity]. (…) The present findings coincide with previous findings in which meditators outperformed non-meditators in tasks such as verbal fluency, and visual perspective switching, in the respect of exhibiting an improved ability to generate varied responses to the same stimuli following mindfulness practice. (…) Our findings additionally converge with findings regarding decreased rumination in the sense of a reduction in repetitive and perseverative negative thoughts.” (Greenberg et al. 2012)
While these claims are not as convincing as the ones from the systematic reviews, they at least point us to a few possibilities. If nothing else, we may try this and improve the placebo effect.
Meditation vs Relaxation
Maybe meditation is not that much better than simply relaxing. Maybe the reported benefits of meditation come from the fact that you’re sitting down, relaxing, not thinking about your worldly concerns for a few precious moments. If only we could compare both meditation and relaxing… And we can, thanks to a study by Jain et al., (2007).
In this study, they compared a group of people meditating with another group of people simply relaxing. They had four 1.5 hour sessions, spread over four weeks. The exercises included “(…)
- body scan meditation, in which the practitioner focuses attention on each part of the body to notice sensations that arise;
- sitting meditation, where the practice is focusing non-judgmental awareness on whatever arises moment by moment;
- Hatha yoga, where one practices gentle stretching while maintaining attention on subtle movements in the body;
- walking meditation, where one practices walking slowly, with awareness;
- and loving-kindness meditation, where one focuses attention on feelings of caring and love for one’s self and others to cultivate compassionate awareness and action in everyday life.”
The relaxation exercises “[integrate] techniques of autogenic relaxation using the six autogenic phrases used by Schultz,
- progressive muscle relaxation (using tension and release of muscles throughout the body to relax),
- simple breathing techniques (such as simple diaphragmatic breathing and breathing with counting),
- and guided imagery to give a comprehensive course on stress reduction via a focus on bodily relaxation.”
It concludes that “both meditation and relaxation groups experienced significant decreases in distress as well as increases in positive mood states over time, compared with the control group. There were no significant differences between meditation and relaxation on distress and positive mood states over time.” They continue by saying the effect was significant in terms of distress reduction for both but that the meditation group showed a larger effect size for positive states of mind than relaxation”.
In a way, meditation is basically relaxing without ruminative thoughts. If we think of meditation as an improved for of relaxation, and being that relaxation in itself is self-evident to be healthy, then it becomes obvious that meditations needs to, at least, borrow some of the benefits from simply relaxing.
How to Relax/Meditate
Most types of meditation follow this general process:
|Being in a comfortable, relaxed state.|
|Directing and sustaining attention on X.|
|Detecting mind wandering and distractors (e.g. thoughts).|
|Disengagement of attention from distractors and shifting of attention back to X.|
|Cognitive reappraisal of distractor (e.g. ‘just a thought’, ‘it is okay to be distracted’).|
As for getting into a relaxed state, here’s a process that was recommended by a friend and which has worked best for me personally:
- Diaphragmatic breathing – breathing with your belly, not your chest. When you’re doing this on autopilot, proceed to 2).
- Progressive muscle relaxation – Start on the head or feet. Notice those muscles and relax them. As you feel them resting, move on to the next nearby muscles or body part and do the same. A slight variation is to imagine each body part with a different color (which requires more brain power, making it harder to drift from the relaxation and to start thinking about random things). At the end merge all the colors into white or black and feel yourself into a deeply relaxed state, as your mind, too, relaxes, as if it were a muscle.
Now that we’re relaxed, this is where most meditative practices tend to diverge. Let’s define X, from the table above, according to the type of meditation:
Focused Attention – Pick one thing (object, sound, breath, …). Focus on it (texture, colors, design, smell, …)
Transcendental (Mantra) – Pick a word or sound. Repeat it over and over again.
Loving Kindness – Think of someone. Wish them, from the bottom of your heart, well. Cultivate compassionate awareness and action for everyday life.
Body scan – Focus your attention on specific parts of your body and notice sensations.
Open Monitoring / Mindfulness – Monitor non-judgmentaly and non-reactively the content of experience from moment-to-moment. Recognize the nature of emotional and cognitive patterns.
As for everything in science, we need to maintain our skeptic glasses on, because not all that we wish were true, is. And despite a lot of miraculous claims about the benefits of meditation in various fields, currently the most strong evidence points to meditation having some benefits in reducing anxiety symptoms. Being that anxiety is in itself, a inhibitor of physical well-being, it becomes apparent, even if for no other reason, that meditation and relaxation do provide health benefits.