The Indian view does not relegate spirituality to an isolated corner of life; rather it proposes that spirituality is the underlying engine and uniting force of the entire system, which constitutes a dynamic, seamless “theo-psychosomatic” model of health. In terms of this model, one’s level and state of consciousness is both the key influencing factor as well as the ultimate recipient of influences from the body, mind and behaviour.

Dr Ramesh Manocha.

So it is important to develop an understanding of meditation, in the words of Taylor in the context of its:
“particular spiritual tradition, situated in a specific historical time period, or codified in a specific text according to the philosophy of some particular individual.”

While the biomedical Cartesian worldview that developed in the West from the mid-19th century weakened the connection between health and spirituality, this did not occur in India. There strong associations between health and spirituality were made and utilized to promote better physical wellbeing and quality of life. Typical of this health philosophy was the practice of yoga, which combined spiritual teachings with more mundane health factors such as lifestyle, diet, physical exercise and positive psychology in order to achieve its ultimate aim, the development of consciousness.

Similarly, the ancient and still widely used Ayurveda health epistemology was used to cure illness and enhance wellbeing by combining spiritual practices such as meditation, mantras and prayer with lifestyle measures such as exercise, diet and massage. Proponents of this epistemology also advocated the use of an extensive herbal pharmacopoeia, while its diagnostic system was based on psychological predisposition and personality type.

In fact the followers of Ayurveda proposed a perspective of the human corpus in which the mind was not contained within the confines of the brain, as in Western perceptions. Instead, it was seen to be closely intertwined with the physical body, thus forming a body-mind whole in which physical health status was seen to be a direct reflection of consciousness and vice versa.

Dr Ramesh Manocha.

Of particular importance in this regard are South Asian cultural themes embodied in ideas such as yoga, moksha, and sahaja. It is argued that Western conceptualizations and definitions of meditation need to be reshaped to more accurately reflect the original meaning of the practice, particularly the experience of mental silence.

Editor Dr Ramesh Manocha.

The maximum yearly output was in 2000–2001 when 12 RCTs were reported in MEDLINE. In the same time period 106 RCTs for fluoxetine, as an example of a mainstream medication, and 98 RCTs for acupuncture, as an example of a complementary medicine, were published.

The rate of publication of RCTs on meditation is poor in comparison to other therapeutic modalities in either the mental health or complementary and alternative medicine genres. Thus although meditation is often a topic of superficial discussion amongst scientists and clinicians, it is rarely the subject of in-depth scientific examination.

Dr Ramesh Manocha.

Second - the use of high face-validity control groups is critical in meditation research because of the need to exclude the important confounding effects of non-specific factors that relate to plausibility of the intervention (such as placebo, expectancy, or therapeutic contact).

Third - there is at the moment no systematic comparison of different conceptualizations of meditation. Only Carrington has compared two kinds of meditation in the context of work stress and found that there were no major differences between the two36. It should be noted however that the different meditations in her trial both belong in the same “relaxation meditation” category.

These observations could lead to three possible conclusions:
1. Meditation is in fact no more effective than other approaches to rest and relaxation. Yet that meditative traditions have existed for thousands of years and at least in India, are widely perceived to have specific and unique features. In other words history and culture do not agree with the idea that meditation is simply a method of mundane relaxation. While this “test of history” does not provide proof of efficacy, it does encourage the undertaking of a thorough examination of the phenomenon before it is discarded as mere folklore and superstition.

2. The measures which have so far been used to assess the effects of meditation are not sensitive to the specific effects of meditation. The wide variety of outcome measures used means that if the specific effects of meditation are not detectable, then the effects are either too small or too esoteric for mundane study.

Yet classical descriptions of meditation suggest that despite the metaphysical basis of meditation, its effects do manifest themselves in mundane dimensions such as health and behaviour, implying that at least some of the many measures available to researchers should be able to detect a differential effect.

Again, while this might be satisfactorily applied to the genre as a whole, there appear to be isolated exceptions which suggests that certain as yet undetermined categories may be able to generate specific effects. Yet our analysis of the aggregated data has not yet yielded a pattern with sufficient clarity to identify the features of that category.

3. The methods that have been labelled as “meditation” in the trials do not consistently reflect the true nature of meditation. This is the most interesting and important issue and therefore merits considerable discussion. The functional and conceptual definition determines the nature of the intervention, which in turn influences the choice of the control method that ought to be used and therefore the validity and generality of the findings.

Yet defining meditation has proven to be a difficult challenge for modern researchers. While early empirical reports seemed to show that measurable distinctions between meditation and rest or simple relaxation existed, rigorous trials did not support these perceptions74. As a result, much of the research work on meditation has been based on the assumption that meditation techniques are much the same despite minor external and superficial differences.

Indeed Western researchers have proposed that most meditative processes are physiologically similar to simple rest and relaxation75 and the high quality physiological trial data seems to support this76. These perceptions have thus given rise to an assumption of “psycho-physiological uniformity”.

This last idea, it is contended, is the key to the problem because in fact, both Western meditation enthusiasts and Western scientists, despite their opposing views, have failed to apprehend a key factor that underlies the ancient tradition of meditation: The idea that meditation necessarily involves the experience of mental silence.

Dr Ramesh Manocha.

For example Andrews’ review of psychotherapy for neurotic patients reported a mean effect size of 0.74 for verbal psychotherapy and 0.97 for behavioural psychotherapy vis-a-vis a mean effect size of 0.55 for placebo56.

It should be noted however that the meditation studies focused on participants with non-pathological anxiety states, raising the possibility that the potential impact of meditation may be limited by a “ceiling effect” due the recruited sample’s relatively mild symotomatology and hence minimal scope for clinical improvement.

Dr Ramesh Manocha.

Meditation instructional programs are usually relatively intense and it is therefore worthwhile determining whether changes brought on by the instructional program can be maintained when participants are left to continue unsupervised with whatever skills they have acquired in the more formal phase of their training. Given that consistent evidence for a specific effect is lacking even within the intervention phase of the studies, it is even more unlikely that evidence for an effect will be detectable in the follow-up phases.

Like any other evaluation of therapeutics, the detectable effect of the intervention will be determined by the degree to which the participant complies with the treatment. This is particularly important in meditation research because meditation requires considerable active involvement and commitment. There are several ways to assess compliance, including attendance rates at supervised treatment sessions, home-practice diaries and subjective experience reports.

Dr Ramesh Manocha.

The fact that some techniques elicit detectable effects when compared to sham procedures while others do not implies that some meditation techniques may not have specific effects whereas others may well have such effects. This logically suggests the possibility that the genre is not homogenous and that the use of meditation versus sham studies offers a method by which specifically effective techniques may be separated from those that are not.

Dr Ramesh Manocha.

The bare minimum criteria for a control process in meditation research should therefore be:
• First, high face validity as a therapeutic/stress management intervention in its own right. It should actually appear to be a credible meditation technique if that is the expectation of participants.
• Second, a process that involves relaxation and reduction of somatic arousal since this is the nearest conventionally understood phenomenon that meditation resembles and from which it needs to be distinguished.

Given these considerations, two strategies with high face validity are worth discussing in further detail.

Sham meditation involves designing control strategies that overtly resemble the intervention, but which do not actually trigger the effects purported to be specifically associated with meditation.

Dr Ramesh Manocha.

The low face-validity controls used strategies that were:

• Passive and unstructured: Participants were involved in minimal or no activity relating to the trial and had no interaction with researchers as a result of being allocated to the control group (e.g. waiting list, no treatment, self-directed reading, or referral to community resources). This kind of comparator controls for minor non-specific effects, such as regression to the mean, the natural history of disease states and environmental factors common to all participants. It does not however, control for any non-specific effects that may be elicited by behaviour therapies.

The moderate face-validity controls use strategies:

• Passive and structured. These involved some sort of regular and structured interaction with personnel associated with the experiment (e.g. regular lectures, specific reading, structured educational sessions on unrelated topics, regular BP checks). This controls for the same confounders as Category 1 in addition to the effects of therapeutic contact and sense of active involvement.
• That were active in nature and generated some expectation of benefit but did not have effects or credibility as either a method of relaxation or meditation e.g. support groups, education about health factors measured in the study, or lectures on stress and lifestyle management. This controls for the same as Categories 2 and 3 in addition to the effects of social support, improved lifestyle, etc. Social support has been repeatedly demonstrated to be effective in improving mood and quality of life and reducing the severity of disease symptoms. “Standard treatment” was included in this category.

High face-validity controls use strategies that were:

• That were active in nature but not designed to generate significant expectation of therapeutic benefit (e.g. exercise). This controls for the same as Category 2 in addition to the effects of regular physical activity. Regular physical exercise has been shown to improve mood.
• Active in nature, generated some expectation of benefit and elicited the simple physiological effects on rest but did not have specific credibility as a meditative method (e.g. PMR, other relaxation methods, hypnosis, biofeedback, psychotherapy).
• The same as above but also had credibility as a meditative method (e.g. meditation techniques, strategies designed to convincingly mimic meditation) or constituted a legitimate form of psychotherapy (e.g. desensitization, CBT, counselling).

Dr Ramesh Manocha.