Meditation comprises a group of self-administered techniques aiming at mental and physical relaxation, and sometimes even self-discovery.
These techniques are distinguished from each other by the type of attention addressed to the meditation object or vehicle. In some techniques, attention is focused or concentrative; in others it is nondirected or open. The differences in attitude account for major differences in outcome. In this paper, the effects of Acem Meditation and other techniques are reviewed in the light of recent scientific research.
Meditation activates areas of the brain that focus awareness and integrate mind and body. During meditation, muscle tension is released and breathing becomes slower and more relaxed. Stress responses controlled by the autonomic nervous system decrease, and over time, the body’s production of stress hormones is reduced. Chronic muscular pain in the head, neck, shoulders and back is often alleviated, and blood pressure tends to go down.
In parallel with these physiological benefits, Acem Meditation reduces the psychological symptoms of tension. It does this, not by suppressing stressful thoughts and emotions, but by cultivating increased awareness and acceptance of them. By becoming more aware of the spontaneous mental activity that normally goes on in the background of our conscious lives, we can develop more effective ways of coping with anxiety and stress. Regular meditation over the course of months or years can significantly improve the quality of our lives.
From a traditional to a scientific approach
There are lots of relaxation methods that take advantage of the close relationship between mind and body. People have been meditating, doing breathing exercises and practising yoga for at least 2500 years. In modern Europe, relaxation techniques evolved out of experiences with hypnosis in the beginning of the twentieth century. Autogenic training, progressive relaxation and other similar methods were based on concentration, self-induction and muscular control (see below).
In the late 1960s, transcendental meditation (often referred to as TM) gained a widespread following in the West through the Indian guru Mahesh Yogi. The technique, which involves mental repetition of a mantra, was popularised by The Beatles and other celebrities. The Harvard physiologist Herbert Benson researched transcendental meditation for several years and attributed its effects to a natural mechanism that helps our minds and bodies to rest and prevents stress from reaching harmful levels. He coined the phrase “The Relaxation Response” for this mechanism, and described it in a book of the same name that became a bestseller in the United States (Benson 1975).
In 1966 the Norwegian psychologist and physician Are Holen founded a school of Acem Meditation based on Eastern and Western sources. The technique entails a free mental attitude and promotes a psychological understanding of mental processes. Holen suggested that Acem Meditation and other techniques practised with a free mental attitude enhance our capacity for psychological processing and stress management more than those based on goalorientation and control (Holen & Eifring 2007).
From about 1980 onwards, various relaxation methods of Buddhist origin (e.g. mindfulness and Zen meditation) became popular as complementary medical treatments in the US. Some are associated with the concept of “mindfulness”, which has some similarities with the free mental attitude that characterises Acem Meditation. These techniques encourage neutral observation of the meditator’s own mental processes and psychological structures. Other practices revolve around specific goals and involve concentrated focusing of attention. Those methods may be less effective in the long run because they lack the free mental attitude and neutral observation. It is also worth being cautious about the various relaxation techniques and alternative therapies that come and go in the healthcare marketplace with little investigation or documentation.
What constitutes a meditation technique? The stress-management benefits of Acem Meditation, TM and other practices based on a free mental attitude are reported in a significant body of scientific literature (Eppley et al. 1989, Westlund 1993, Schneider et al. 1995, 2005a, Murphy 1996). We know that such techniques have marked effects on psychological and physiological symptoms of stress over time, but it is important to identify which elements of the techniques are responsible for these benefits. In order to do this, we need to compare their similarities and differences with respect to practice, outcomes and the contexts in which they are taught and practised.
In its scientific study of the health effects of meditation, a research group at the University Clinic of São Paulo, Brazil, compiled the following list of criteria for a meditation technique (Cardoso et al. 2004):
1. The use of a specific, clearly defined method.
2. An element of physical relaxation.
3. A non-intellectual process (they called this “logic relaxation”). No intentional attempts to analyse, explain, understand or judge the process during meditation. No intentional attempts to induce or avoid certain physiological effects, mental states or emotions.
4. A self-administered method, which may be taught by an instructor but can be performed on one’s own. No hypnotic induction or dependence on the instructor.
5. A meditation vehicle or object such as a meditation sound, a mantra, the breathing, a bodily sensation or a visual object. Whenever meditators find themselves engaging in any kind of thought or other mental activity, they shift their attention back to the vehicle.
This definition of a meditation technique revolves around a procedure or method of practice. It is not founded on a special experience or feeling.
Free mental attitude
As we have seen, a defining characteristic of Acem Meditation and similar techniques is a free mental attitude. This aspect of practice determines the delicate balance between volitional and spontaneous (or involuntary) activities during meditation (Holen & Eifring 2007). Appropriate volitional activity in Acem Meditation consists of letting the awareness rest gently on the vehicle without directing it towards any particular goal or expectation. Spontaneous activities are those that occur without our active participation. Some take the form of physical sensations, but most are mental or psychological. These include vague associations and images that pass almost imperceptibly through the mind; pleasant daydreams and fantasies; trivial thoughts about everyday life; and suppressed anxieties or issues we tend to avoid.
The mental attitude involved in a given meditation practice defines the way we handle spontaneous activities of the mind.
Concentrative techniques aim to calm the mind by excluding disturbing thoughts and experiences. Such practices typically focus on breathing, a bodily sensation, a meditation sound (mantra) or an image to block spontaneous mental activity or “wandering of the mind”. Well-documented concentration techniques in Euro-American culture include autogenic training and progressive relaxation. Many meditation techniques practised in contemporary oriental culture are based on concentration. Some examples of concentrative mindfulness and Buddhist methods are given below.
Nondirected meditation accepts that spontaneous mental activitiy is part of the meditation process. The basis is gentle, effortless focusing on the vehicle, allowing thoughts and associations to emerge, even if they might seem distracting or disturbing. Such techniques do not aim for any particular state of mind, whether vacant, free of thoughts and emotions, or positive. Instead, they encourage neutral acceptance of any spontaneous activity as it may pass through the mind, without any intentional analysing, censoring or judging. Well-documented nondirected meditation techniques include Acem Meditation, transcendental meditation, Benson’s relaxation response and certain kinds of Zen and mindfulness meditation. Some mindfulness techniques and Buddhist forms of meditation include elements of a free mental attitude, while others are directed towards certain feelings and specific states of mind and involve concentration (see the examples below).
Cultivating an accepting attitude towards spontaneous mental activity forms a psychological basis for better stress management and self-understanding. As in psychodynamic psychotherapies, a neutral, accepting attitude is important for mental processing. Stressful thoughts and images may come to awareness and pass in a relaxed atmosphere that diminishes their emotional impact and reduces the need for psychological defences that often involve increased involuntary muscular tension.
Mindfulness meditation
The term “mindfulness” is not a unitary concept but has been defined in several different ways. The overarching principle is nonjudgmental awareness of thoughts and other activities of the mind, accepting their presence without active engagement such as censoring or analysing (KabatZinn 1994). Acem Meditation and other methods that are not based on concentration have much in common with this definition of mindfulness (Delmonte 1987, Cahn & Polich 2006).
A common form of mindfulness meditation is focusing the attention on breathing. This technique is discussed by Bishop (2002): “Whenever attention wanders to inevitable thoughts and emotions as they arise, the participant simply acknowledges and accepts each thought and feeling, then lets go of them as the attention is directed back to the breath. This process is repeated each time that attention wanders to thoughts and feelings”. There is an emphasis on “simply observing and accepting each thought or feeling without making judgements about it, elaborating on its implications, additional meanings, or need for action”. Another mindfulness technique is to focus the awareness on different parts of the body while reclining (“body scanning”). The basic procedure is the same, but the meditation object is the body – or a specific body part – itself.
Concentrative “mindfulness” techniques
In contemporary culture, mindfulness also alludes to the common goal of practices related to Zen and other Buddhist traditions, which aim to enhance our awareness of our thoughts, emotions and motives, and encourage us to reflect on how these constructs may affect the way we see ourselves and live our lives (Delmonte 1987). Such practices span a wide range of activities, from becoming more aware of ourselves in everyday situations (e.g. while doing chores and during “walking meditation”) to formal meditation techniques. As is indicated by the following examples, some of these practices seem to involve reflective thinking or the induction of special emotional states and may not fulfil some criteria of “mindfulness meditation” or a free mental attitude. Physiological changes and long-term effects may also vary.
Su-soku is a group of Zen meditation techniques in which subjects count their breaths when exhaling. If other thoughts occur, these are allowed to pass without becoming the focus of attention; the concentration remains directed towards the process of counting (Takahashi et al. 2005). Dhammakaya is another example of a contemporary Buddhist meditation technique. “This method signifies the concentration of the mind and thoughts upon a round clear glass ball object, free from all traces of wavering and distraction” (Sudsuang et al. 1991).
Mindfulness is a common goal in these techniques, but it is not obvious that they are practised with a free mental attitude. The same may be true of Buddhist meditation in which long-term practitioners generate a state of “unconditional loving-kindness and compassion” or an “unrestricted readiness and availability to help living beings” (Lutz 2004). The research concerning this technique does not describe exactly how this state of mind is achieved. In training sessions, control subjects were asked to “think of someone they care about, such as their parents or beloved, and to let their mind be invaded by a feeling of love and compassion”. After some practice, they were asked to “generate such feeling toward all sentient beings without thinking specifically about anyone in particular”. It is clear that Buddhist methods of this kind aim at inducing a specific emotional state rather than enhancing nonjudgmental awareness of the contents of the mind. While nondirected meditation practices do not seek to induce particular sentiments, some mindfulness techniques contain clear suggestive elements.
Consciousness and brain activity
From a neuroscience perspective, consciousness is how we experience activity in groups of neurons (nerve cells) in the brain (Tassi & Muzet 2001). Every single experience is probably associated with a unique neuronal activity pattern, and consciousness arises when these patterns are connected via specific centres of the brain.
General patterns of brain activity can be measured by attaching electrodes to specified locations on the scalp (electro-encephalography or EEG). Electrical activity in the brain is measured in terms of frequency (oscillations per second or Hz) and amplitude. Sensory activity, problem solving and other forms of intellectual activity induce fast oscillations (13–25 Hz) with low amplitude (beta waves). Even faster synchronous gamma waves may be associated with alertness and integrative brain functions like learning. Measurements of brain activity during meditation indicate a wakeful, relaxed state of mind characterised by episodes of slow alpha waves (8–12 Hz). When the mind wanders (spontaneous mental activity), alpha waves tend to become slower, more irregular and of smaller amplitude. The transition from wakefulness to sleep is characterised by even slower theta waves (3.5–7.5 Hz), and deep sleep is associated with very slow delta waves (< 3.5 Hz) with large amplitude.
During meditation, alpha waves occur more frequently and are slower, more regular and of larger amplitude than during wakeful rest with eyes closed. Meditation is also characterised by theta waves, which rarely occur during regular wakeful states, indicating deep relaxation (Tassi 2001). These observations confirm that meditation is associated with wakeful, relaxed brain functioning, and not with intellectual activity or specific emotional states.
Brain centres of awareness
Advanced brain imaging techniques based on the interaction between oxygen and haemoglobin provide insights into which brain areas are active during meditation. Functional magnetic resonance imaging (fMRI) is also casting new light on how the brain functions during meditation. Research using these techniques suggests that Acem Meditation and similar methods increase neuronal activity in areas involved in attention, awareness and higher mental functions, while centres that process sensory input, motor activity and language are relatively inactive during meditation.
Two main areas located in the frontal part of the brain show increased activity during meditation, namely the prefrontal cortex and the cingulum (Newberg & Iversen 2003, Cahn & Polich 2006). The prefrontal cortex is a major centre for mental surveillance functions such as self-conception and emotions. This centre monitors and regulates activity in other parts of the brain. The cingulum is a smaller area located near the mid-line which focuses attention and regulates emotions. It also controls body functions which are beyond voluntary control, e.g. breathing, heart activity, blood pressure and hormone secretion.
Several investigators suggest that the pleasant experience of calm during meditation and its beneficial health effects may be associated with activation of the prefrontal cortex and cingulum (Newberg & Iversen 2003, Cahn & Polich 2006). A recent study demonstrates that these centres are a likely source of the alpha-wave activity during transcendental meditation (Yamamoto et al. 2006).
The effects of meditation seem to be more pronounced in long-standing practitioners who regularly attend retreats with long meditations (Jevning et al. 1992). EEG recordings show greater changes in the neural activity of experienced meditators during meditation than in that of control subjects who sit with their eyes closed and repeat a simple sound (Yamamoto 2006). A recent study of meditation using breathing as a vehicle demonstrates greater cortical thickness in the prefrontal area and in the insula, an area which may connect bodily sensations, emotions and more conscious thoughts (Lazar et al. 2005). This suggests that the brain centres that are active during meditation may be enhanced in function, or at least prevented from withering, by regular use.
Relaxation response
Acem Meditation and similar methods attenuate chronic physical stress reactions that are usually beyond voluntary control and of which we are normally not even aware. In fact they seem to induce physical changes that are the opposite of those associated with stress, and that have some characteristics in common with deep rest during sleep. Breathing and heart rate drop, muscle tension is released, metabolism is lowered and over time blood pressure is reduced.
In The Relaxation Response, Benson suggested that physiological changes during meditation resemble a response pattern previously described by the Swiss Nobel laureate Walter Hess (Benson 1975, 2000). In 1957 Hess published a study showing that he could induce physiological stress and the opposite response by stimulating distinct areas of the hypothalamus. This part of the brain regulates a number of important functions via nerve impulses and hormones independent of our conscious, voluntary control (e.g. breathing, heart rate, blood pressure, metabolism and emotions). According to Benson (and Hess), the relaxation response is an adaptive biological mechanism that helps the body rest and protects it against harmful levels of stress. Studies of brain and nerve activities during meditation may explain how regular practice reduces psychological and physical symptoms of stress.
Nerve activity and meditation
Many of the relaxation effects of meditation result from reduced activity in nerves transmitting stress impulses from the brain to other parts of the body. Heart rate, blood pressure, cardiac output, sweating, sexual arousal and many other physiological functions are regulated by two types of autonomic nerves.
Sympathetic nerves are activated during physical exercise and mental stress. They increase heart rate, blood pressure, cardiac output and sweating. When we are stressed or angry, they cause muscle cells in the vessel wall to contract, thereby reducing blood flow to the skin. Sympathetic nerves usually react very quickly. At the beginning of physical exercise, a brief activation of the sympathetic nerves mobilises our physical resources and enhances our performance. At the onset of a stressful situation, sympathetic nerve activity can increase within seconds, and it usually returns to baseline within minutes when the challenge is over. However, chronic tension and stress often lead to low-grade sympathetic activation, which may increase resting blood pressure and predispose for cholesterol deposits in the arteries. Over months and years, chronic sympathetic activation may accelerate the development of arterial disease in the heart, brain, kidneys and other organs.
Several studies indicate that meditation reduces sympathetic nerve activity and therefore results in a slower heart rate and lower blood pressure. Blood concentration of noradrenaline, which is the main transmitter released from sympathetic nerves, is lower in regular meditators. Higher galvanic skin resistance (i.e. lower activity in the sweat glands) also indicates reduced sympathetic nerve activity as a result of meditation (Wallace et al. 1971, Jevning et al. 1996).
Parasympathetic nerves are usually activated during relaxation and other enjoyable activities. After a good meal and during the initial phases of sexual arousal, parasympathetic nerves enhance blood flow to the intestines and sexual organs. Parasympathetic nerve activity may also function as a safety valve which inhibits cardiac pump activity, thereby reducing the heart rate and blood pressure.
Several studies suggest increased parasympathetic activation during meditation. A study conducted at the University of Fukui, Japan, indicated increased parasympathetic activity and reduced sympathetic nerve activity during su-soku (Takahashi et al. 2005). The researchers also reported an association between relaxed brain activity (alpha and theta EEG waves) and a reduced level of nervous stress activity (lower sympathetic activity, higher parasympathetic activity). This evidence of altered nerve activity was indirect, being based on mathematical analysis of subtle variations in heart rate. Moreover, an important caveat to this conclusion was raised by comparison of three meditation techniques, demonstrating different patterns of heart-rate variability depending on the type of breathing pattern associated with the specific practice (Peng et al. 2004).
Overall, research suggests that meditation alleviates physiological stress by reducing the sympathetic nerve activity associated with stress or exertion and increasing the parasympathetic nerve activity connected to relaxation.
Stress hormones
Meditation reduces production of stress hormones such as cortisol, adrenaline and noradrenaline. During physical activity and mental stress, noradrenaline is released from sympathetic nerves and adrenaline from the adrenal glands. Secretion of these substances is usually brief and may vary from minute to minute. Resting concentrations of these hormones in the blood indicate the short-term stress level of the individual. A study from Cordoba and Granada, Spain, reported that meditators had lower levels of adrenaline and noradrenaline in the blood at rest, which suggests superior stress tolerance during everyday life (Infante et al. 2001).
Regular meditation practice also reduces cortisol production (Sudsuang et al. 1991, MacLean et al. 1997). Cortisol is secreted from the adrenal glands in response to a signalling hormone that is released from the brain during stress. It helps the body adapt during physical challenges and acute illness. Sustained elevated levels can be associated with chronic stress, which may predispose one to psychological symptoms, high blood pressure and cardiovascular disease.
To sum up, lower levels of stress hormones in regular practitioners of meditation indicate that it is an effective form of everyday stress management and may prevent or alleviate conditions in which psychological stress plays a role.
Transmitter substances
Meditation increases production of transmitter substances associated with mental calm and well-being. A recent study has reported that experienced practitioners of Acem Meditation had higher levels of melatonin and serotonin in the blood (Solberg et al. 2004b). A review of neurobiological changes in the brain during meditation suggests that melatonin may contribute to feelings of calm and decreased awareness of pain (Newberg & Iversen 2003). Moderately increased levels of serotonin appear to correlate with positive affect, while low serotonin often signifies depression. Meditation also markedly increases vasopressin, which should result in a decreased feeling of fatigue and an increased sense of arousal (Newberg & Iversen 2003).
These pilot studies indicate that some of the psychological effects of meditation are associated with changes in the levels of signalling molecules that modulate brain function. However, further investigation is required in order to confirm the role played by these transmitter substances in health and well-being.
Blood pressure
Psychological stress is often associated with hypertension (high blood pressure), and it seems that some of the health benefits of meditation arise from its ability to reduce blood pressure. A study of 40 train drivers from Stockholm, Sweden, who started regular relaxation because of occupational stress, demonstrated greater reductions in blood pressure and stress symptoms with Acem Meditation than with progressive relaxation, a muscle relaxation technique (Westlund 1993, cf. Westlund & Holen’s contribution to this volume). Participants were randomly assigned to either an eight-week beginner’s course in Acem Meditation, or to a tape-recorded course in progressive muscle relaxation. Both groups were examined before the training commenced and then again after six months. There was a control group comprising an equal number of train drivers exposed to the same background and occupational stress, but who did not participate in relaxation training. Similar results have been reported in a study of 127 hypertensive patients from Iowa (Schneider et al. 1995). Three months of regular meditation reduced systolic and diastolic blood pressure twice as much as progressive relaxation. A follow-up study of 150 hypertensive patients indicated that a similar difference was maintained between the techniques after one year of practice. Use of antihypertensive medication was reduced with meditation whereas it was increased with progressive relaxation (Schneider et al. 2005a).
Cardiovascular disease
The goal of treating hypertension is to prevent cardiovascular disease. Hypertension is one of the main factors associated with cardiovascular disease, along with smoking, high cholesterol, glucose intolerance, diabetes, physical inactivity and occupational stress. A study of arteries in 60 people from Los Angeles with high normal to moderately elevated blood pressure suggests that meditation may reduce the risk of cardiovascular disease (Castillo-Richmond et al. 2000). At six to nine months follow-up, meditators showed less thickening of the arterial wall than non-meditators. The findings indicate lower cholesterol deposits and a reduced tendency for disease in coronary arteries and arteries of the brain.
The medical objectives in the treatment of cardiovascular disease are reduced mortality and an improved quality of life. The first survival study suggests that, measured by these standards, meditation has beneficial effects. 202 hypertensive patients over the age of 55 were observed for 7.5 years (Schneider et al. 2005b). Survival analysis revealed that those who practised TM had 23% lower mortality, implying better health. The control group included people who practised either progressive relaxation or mindfulness meditation, or who did not practise any relaxation technique. Owing to the small number of participants and certain limitations in the design of the study, these findings should be regarded as preliminary.
Stress tolerance
A common experience from meditation courses is that several conditions associated with stress improve after some weeks of regular meditation, although the exact mechanism by which this occurs is not clear either to instructors, therapists, or to the subjects themselves. Sometimes it is possible to identify a relationship between symptoms of stress and causes such as personal circumstances, conflicts with other people and challenging transitions in life. In other cases, symptoms seem to arise without any identifiable cause. Consequences of stress range from a temporary inability to work, problems with relationships and reduced self-esteem to long-term absenteeism, occupational disability, permanent breakdown of relationships and nervous collapse.
Stress tolerance – by which we mean the threshold of negative reaction, or how strong we are in coping with stress – varies from person to person and according to circumstances. How we react to stress may influence how we perform under challenging conditions: the less anxious we are inclined to become, the better our performance. Regular meditation can increase our stress tolerance and therefore improve our performance under pressure. For instance, a study of elite sharpshooters indicated that they performed better under stress as a result of practising Acem Meditation (Solberg et al. 1996).
Psychological symptoms of stress
Several studies indicate that meditation reduces psychological symptoms of stress. Such symptoms can be assessed by standardised questionnaires (e.g. Symptom Check List 90) filled in by participants before a stress-management programme begins, and after a practice and follow-up period. At the University of Calfornia, Irvine, a stress-management programme based on mindfulness meditation and yoga produced a marked reduction in the psychological symptoms of stress (Astin 1997). After eight weeks, participants showed less anxiety in terms of inner tension and tendency to worry. Meditation also alleviated depressive symptoms including fatigue, lack of energy, low self-esteem, oversensitivity (tendency to perceive neutral comments as criticism) and somatising (emotional preoccupation with bodily sensations). Similar improvements were observed in Swedish train drivers who practised Acem Meditation (see Westlund & Holen’s article in this book). Subsequently, a meta-analysis of studies on TM has indicated more significant reductions in psychological symptoms through methods practised with a free mental attitude than with progressive relaxation and meditation techniques involving concentration (Eppley et al. 1989).
Collectively these results suggest that meditation practised with a free mental attitude is most effective in reducing psychological symptoms. The explanation may be that cultivating a free mental attitude enhances our capacity for mental processing (Holen 2007). A review of stress-management interventions at the worksite suggested that, with outcome measures relating to psychological stress symptoms and somatic complaints, meditation produces more consistent results than relaxation methods based on voluntary muscle relaxation or physiological monitoring, i.e. biofeedback (Murphy 1996).
Muscular pains
Prevention and treatment of muscular pain is a significant challenge in reducing absenteeism and occupational disability and improving overall quality of life. Several studies suggest that meditation and relaxation may yield substantial favourable effects. A study of 50 hospital cleaners in Kuopio, Finland, demonstrated that a 15-minute relaxation programme including breathing exercises and muscle relaxation during the working day relieved muscular tension in the neck and shoulders and reduced absenteeism and the psychological symptoms of stress (Toivanen et al. 1993). Muscular tension in the shoulder muscle (trapezius) was measured by electro-myography (EMG) at rest and during exercise before the programme began and at a six-month follow-up. Nearly all participants in the relaxation programme normalised their muscular tension at rest and significantly reduced their tension levels during work, while most of those in the control group still had pathologically elevated muscular tension.
Several other studies have demonstrated a close association between stress, muscular tension, fatigue and pain in the shoulders, head and neck (Bancevicius et al. 1999). The beneficial effect of meditation on muscle pain may partly result from reduced sympathetic nerve activity, which regulates muscular tension via sensors within the muscles. In addition, lower stress levels may increase the threshold for and tolerance of pain.
Extensive training and regular practice seem to maintain results. A ten-week programme including mindfulness meditation reduced pain intensity and frequency in the majority of patients with chronic muscle pain (Kabat-Zinn 1985). 90 patients had suffered from pain in the neck, shoulders or head for a minimum of six months (average eight years) before entering the study. 50% were using painkillers when the programme started; by the time it ended, the majority were taking fewer or none. Participants were advised to continue meditating for 45 minutes six days a week. At oneyear follow-up, the initial results were maintained. A control group of patients who stayed on standard treatment, including physiotherapy, nerve-blocking injections and painkillers, did not improve.
Quality of life
Chronic illness or serious health conditions invariably have a detrimental effect on the quality of life. They frequently cause secondary physical complaints and psychological problems including stress, anxiety, depression and reduced tolerance of pain. Standard medical treatments are frequently ineffective in relieving these conditions, so many people try alternative and complementary remedies.
Recent controlled studies indicate that meditation and relaxation may help stabilise well-being and reduce psychological symptoms of stress. A study of cancer patients from Calgary, Canada, reported reductions in anxiety, depression and other symptoms after a seven-week programme which included mindfulness meditation (Speca et al. 2000). The programme is similar to a beginner’s course in Acem Meditation, including information on how relaxation and mental processing may affect mental and physical health, regular practice at home and group discussions of personal experiences. A recent review by Deng & Cassileth (2005) reports the conclusions of several studies which showed similar results: “Given patient interest, these therapies are likely to reduce troubling physical and emotional symptoms, offer patients a measure of control over their wellbeing, enhance quality of life, and improve both patient satisfaction and the physician–patient relationship.”
From hypotheses towards acceptance
Scientific research on the clinical effects of meditation is still at an early stage. Professionals often describe the initial results as encouraging (Parati & Steptoe 2004), but further studies are required before meditation is accepted as a standard treatment. Such studies need to be rigorous and extensive in order to demonstrate the benefits of meditation beyond reasonable doubt (Canter & Ernst 2004). So far the most thoroughly studied benefit is reduction in hypertension. Longitudinal, randomised, controlled studies of other effects in thousands of subjects need to be carried out in order to demonstrate the clinical efficacy of meditation.
Proponents of meditation do not always provide a balanced view of its potential therapeutic benefits. Marketing may be particularly unrealistic when professional and commercial interests are involved. A case in point is the transcendental meditation movement, which since the 1970s has been repeatedly criticised for encouraging people to sign up for expensive courses. (In 2007, a beginner’s course in TM costs about 2,000 euros.) Research literature relating to TM has also been criticised even by scientists who are generally positive towards complementary and alternative therapies for making uncritical or inaccurate use of medical studies (Canter & Ernst 2005).
In contrast, research on various forms of mindfulness meditation and other Buddhist techniques has been favourably received by the medical establishment, despite flaws in some of the studies with respect to the design of experiments and the presentation of results (Bishop 2002). There may be several reasons for this paradox. For one thing, Buddhist tradition is respected as ascetic and selfless. For another, investigators are careful to make reservations about their results and often use the term “pilot study”. Their programmes frequently revolve around pain reduction and selfhelp for challenged patient groups with chronic disorders, which naturally evokes sympathy and goodwill. Other investigations have used advanced brain imaging techniques to monitor the brain function of Buddhist monks in deep meditation. People are fascinated by what happens in the brain when we approach the boundaries of consciousness, so these studies have achieved a high profile in reputable medical journals and the wider media, even though their design is preliminary and the number of participants is small. It seems that research on mindfulness and Buddhist meditation may be riding a tide of novelty and sympathy, and that to date, the biomedical establishment has not yet applied the same standards of critical evaluation to these methods as it has to transcendental meditation.