Good thinking

Sydney Morning Herald , July 24 2003

Meditation is playing an important role in modern medicine. Guy Allenby reports.

Until three years ago, Heidi Castro had suffered from "very, very intense" migraines that she'd put up with for about 10 years. She tried acupuncture and various pain-relief medications with mixed success, then she signed on to a migraine study at Sydney's Royal Hospital for Women.

As part of the study, Castro attended a meditation workshop every Tuesday and Thursday for three months and meditated for five minutes twice a day.

"The first month the migraines and the number of migraines were reduced," she says. "The following month they were reduced to about four in a month [10 was typical before the workshop], then after that I didn't have any."

She continued meditating for another two months and thought: "OK, I'm cured" and stopped. "I then started getting them back," she says. "So I started meditating again. It has helped permanently."

Dr Craig Hassed, a senior lecturer in the Faculty of Medicine, Nursing and Health Sciences at Melbourne's Monash University, says: "Meditation is a great adjunct for a lot of things, from chronic pain to improving sleep, helping reduce blood pressure and coping with stress, anxiety and depression."

At Monash, meditation is in the undergraduate curriculum for students, he says.

Research into meditation's physiological and therapeutic effects has turned up some impressive results, and increasingly the technique is seen to have a role to play in modern medicine.

For instance, a study of Australia's oncologists published in the Medical Journal of Australia in 2000 found that 82 per cent of respondents believed relaxation, meditation and visual imagery therapies were "helpful" for palliative cancer patients (the figure was 69 per cent for patients on the mend).

A University of Melbourne survey published the same year found that 80 per cent of Victorian GPs had referred patients for complementary therapies, with acupuncture, hypnosis and meditation considered the most effective.

At the Pain Management Centre at Sydney's Royal Prince Alfred Hospital, patients are taught "mindfulness" meditation to manage their chronic pain. Tony Merritt, the centre's clinical psychologist, says they use it as part of their program "to help people think about their pain differently", saying that meditation helps patients to see that pain is something "you don't have to be afraid of and is something that you can live with and cope with".

The method of meditation used at the centre is based on Buddhist teachings and was developed in the United States by Dr Jon Kabat-Zinn, emeritus professor of medicine and founding director of the Stress Reduction Clinic and the Centre for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts medical school.

"You meditate on your breathing and you watch what comes into your mind," says Merritt. "What people see is that they have the pain . . . and then there's a whole lot of other stuff around it - fear of the pain, distress.

"What they get to see is that the fear and the distress are actually separate [from the pain].What it can also tell people is that they are not their pain. And I think that's a real problem for people with chronic pain, because it becomes their life."

Meditation can take many forms, either attached to a spiritual tradition or practised as pure method. It typically includes techniques such as "watching" the breath, concentrating "one-pointedly" on something (a sound, an object), visualisations, repeating a mantra or observing or being "mindful" of your thoughts without "following" or being swept up in them.

Overseas, the early results of clinical research into those adept at meditation are, as one scientist has put it, tantalising.

The University of Wisconsin's Dr Richard Davidson has tested the brainwaves of meditating Buddhist monks, with extraordinary results. Testing the abbott of a Tibetan Buddhist monastery in India with an electroencephalograph, Davidson discovered more activity in the area of the brain associated with positive emotions - the left prefrontal lobes - than his laboratory had ever measured. And that wasn't only while his subject was meditating.

In tests on another monk, Dr Paul Ekman of the University of California discovered they could let off an explosive sound, equivalent to a gun going off, beside the monk's ear while the monk was practising one-pointedness meditation, and his heart rate and blood pressure would actually decrease.

During another test, the same monk didn't even startle (that is, his facial muscles didn't move) when the sound went off. Classic research tells us the startle reflex is impossible to prevent.

Here's the rub: there's good clinical evidence starting to emerge of the extraordinary physiological effects of meditation; there's plenty of anecdotal evidence on the efficacy of various techniques; plus there's considerable support for its use in the medical community. All that's considered lacking now is the weight of research on its therapeutic effects to help direct and share its benefits.

"The important new frontier is looking at clinical outcomes," says Monash University's Hassed.

Not that this is a straightforward undertaking by any means.

Dr Ramesh Manocha, a clinical research fellow at the Sydney Royal Hospital for Women's Natural Therapies Unit, says: "One of the problems with meditation research is that the definitions are very imprecise, and that has led to very mixed and mediocre results under scientific conditions."

Manocha headed a research team that conducted a randomised controlled trial on using Sahaja yoga meditation in the management of moderate to severe asthma. The results were published in the world's leading asthma journal, Thorax.

"We selected a very specific definition that is a very traditional definition of meditation - Sahaja Yoga."

Sahaja Yoga meditation was founded by Shri Mataji Nirmala Devi in India in 1970.

It is, says Avinash Nichkawde, Sahaja Yoga's national co-ordinator, based on an understanding of "a subtle energy system that exists within each one of us ... that governs all aspects of our life - physical, mental, emotional and spiritual," he says. "With the techniques of Sahaja Yoga you can understand how it works. It's practical in nature, very results orientated, very genuine, very scientific."

Nichkawde provided Manocha with meditation tutors free of charge for the study. Manocha is at considerable pains to point out that he is indebted to Nichkawde for being able to use the technique, and for his expert guidance during his research.

"My name gets out there in connection with this technique," says Manocha, "and people think that I developed it."

The trial compared two groups of people with moderate to severe asthma over 16 weeks.

The first group was taught a standard form of stress management, says Manocha, while the second group was taught Sahaja Yoga meditation techniques.

Each group practised twice a day for 10 minutes during the trial period.

"What we found was that the meditators improved more psychologically, and they showed significant improvements in physical dimensions of the disease process as well," he says.

The same improvement wasn't seen in the people doing the stress management.

What this means, says Manocha "is that this mental silence approach to meditation isn't just making people feel better, they are also doing something that is reducing the severity of the disease process."

All subjects were tested for airway hyper-responsiveness ("considered the best and most objective measure currently available to assess disease severity in the asthmatic lung") over the 16 weeks.

Manocha says the results of the study were remarkable, because often meditation trials compare "meditation to nothing", while this study compares meditation with stress management. Trials that measure the effectiveness of meditation alone, he says, will show "that meditation does something", but that often "more conventional approaches to reducing stress come out looking equally effective".

"What that really means is that the scientific evidence [until now] doesn't support the idea that meditation is anything better than a placebo effect," he says. "The main aim of our research at the Royal Hospital for Women is to what effect there is above and beyond the placebo effect and simple relaxation and rest.

"With this technique called Sahaja Yoga," he says, "we have actually found that there is an effect, and it is quite substantial in the areas that we looked at. It's better than any research that's been done in the world."

It's a big call. And as well as being published in Thorax magazine, Manocha's trial is also mentioned in an editorial, The Therapeutic Effects of Meditation, in the British Medical Journal in May.

The editorial agrees that Sahaja meditation "improved some outcomes in patients with poorly controlled asthma", although it maintains that "differences were not maintained at two months".

But it goes on to conclude that "current evidence for the therapeutic effectiveness of any type of meditation is weak".

Manocha says he is happy that the editorial has appeared and is writing a paper in response.

"We can follow through and say, 'OK, you guys are complaining about the standards of meditation research,here's a paper that satisfies more, if not all, of your requirements. We are totally committed to addressing all those scientific issues."

British Medical Journal
bmj.com/cgi/content/full/326/7398/1049

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