MEDITATION

Presented by Dr Pavan Kumar Kadiyala Chaired by Dr V K Bhat

INTRODUCTION

Definition

The word meditation derived from Latin meditari, which means to engage in contemplation or reflection. Synonyms meditate - think - ponder - consider - reflect - muse contemplate The word meditation comes from the same Greek and Latin root as the word medicine.

 Manocha (2000) described meditation as a discrete and well-defined experience of a state of thoughtless awareness or mental silence, in which the activity of the mind is minimized without reducing the level of alertness.

 Walsh and Shapiro (2006) defined meditation from cognitive and psychological perspective, as a family of self-regulation practices that - aim to bring mental processes under voluntary control - through focusing attention and awareness. A voluntary and alert hypometabolic state of parasympathetic dominance with suspension of logical thought processes, and maintenance of self-observing attitude (Craven, 1989).

 difficult to capture the essence of meditation in one definition. Cardoso et al. (2004) - operational definition encompassing both traditional and clinical parameters. Meditation (1)utilizes a specific & clearly defined technique, (2) involves muscle relaxation somewhere during the process (3) involves logic relaxation i.e., not to intend to analyze possible psychophysical effects, to judge the possible results, to create any expectation regarding the process (4) a self induced state, and (5) the use of a self-focus skill or anchor for attention.

 Mikulas (1990) classified meditative practice into 4 components. Form refers to the setting of meditation and the activity of body during the meditation, Object refers to object of ones attention during the meditation. Attitude is the mental set with which one approaches meditation. Behaviours of mind connotes whether the meditation is based on concentration or mindfulness.

HISTORY
Meditation has been prevailing throughout the human history among diverse cultures Yoga, an ancient science of India, with components of physical activity, instructed relaxation and interoception. Yoga includes diverse practices, such as physical postures (asanas), regulated breathing (pranayama), meditation & lectures on philosophical aspects of yoga. Meditation - 7th of 8 steps prescribed to reach an ultimate stage of spiritual emancipation. (Patanjali, circa 900 BC)

 The Buddha approached spiritual awakening from a more empirical perspective; this approach is encapsulated in his Four Noble Truths and Eightfold Path. The Buddha, in brief, regarded suffering as an essential part of existence, attributed suffering to improper behavior, thought, and understanding, and introduced a system of ethics, conduct, meditation and philosophy as a means by which to transcend suffering and attain enlightenment.

HISTORY IN MODERN WORLD

introduction to the western world by Indian spiritualist Paramahansa Yogananda in 1920 1960s - scientific studies started focusing on the clinical effects of meditation on health by behavioural scientists academic curiosity within psychology came in 1977 when APA stated meditation may facilitate the psychotherapeutic process.

Types of meditation
Meditation techniques practiced presently can be grouped into 2 basic approaches Concentrative / Focused attention (FA) meditations and Mindfulness / Insight / Diffuse / Open monitoring (OM) meditations. distinguished by their focus of attention and organized by attentional style along a continuum, with concentrative techniques on one end & diffuse techniques on the other.

Concentration meditation
aims at single pointed focus on some sound, image or sensation to still the mind and achieve greater awareness. Most popular form is transcendental meditation(TM) developed by Maharshi Mahesh Yogi in1958. TM is generally done by focusing the mind on some mantra (sound) to achieve transcendental state of consciousness.

TM allows a practitioner to access the original source of thought, a claim that is difficult, if not impossible, to test experimentally.

Concentrative techniques
Clinically standardized meditation (CSM) a noncultic meditation technique devised by Patricia Carrington mental repetition of a sound selected from a list of sounds (or self-created) allowed to proceed at its own pace is not systematically linked with the breath. During CSM, attention is directed solely to a mental stimulus

 Respiratory one method (ROM) Noncultic meditation technique devised by Herbert Benson mental repetition of the word "one" (or another preferred word or phrase) is systematically linked with each outbreath. During ROM, attention is directed both to mental and physiological stimuli.

Mindfulness meditation
involves opening up or becoming more alert to the continuous passing stream of thoughts, images, emotions and sensations without identifying oneself with them. developing non-reactive state of mind, triggering a shift in perspective; what was previously subject (thoughts and feelings that make up a sense of self) now becomes the object of awareness.

 Instead of narrowing the focus (concentration) practitioner becomes alert to the entire field of consciousness. His or her focus is on the process, or flow of psychic content, rather than on the content itself. Vipassana and Zen meditations belong to this category.

Philosophical component
Buddhist meditations are not merely diffuse or concentrative; they are also profoundly philosophical. with the therapist encouraging the participant to develop a detached view of phenomena (I am not my thoughts) to realize that most sensations, thoughts, and emotions are transient, fluctuating, and ultimately neutral. These insights facilitate a stance whereby even very difficult thoughts and feelings come to be calmly noticed, contemplated, and then allowed to pass on, with the participant maintaining his or her attention on the present moment.

Modern meditations
modern group-based standardized meditations, such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), MBSR uses training in mindfulness meditation as the core of the program. MBSR- a formalized psychoeducational intervention that helps individuals self-manage and reframe worrisome and intrusive thoughts MBCT incorporates cognitive strategies.

Dilectical behavioral therapy

(DBT) (Marsha Linehan), is an ex of the successful integration of mindfulness meditation with psychotherapy for the treatment of character pathology, depression, addictions, and eating disorders. DBT has helped legitimize meditation as a credible component of psychiatric treatment. The central dialectic of DBT is between acceptance and change; accepting oneself as one is and yet working toward change at the same time.

Acceptance and Commitment Therapy, ACT

teaches skills that are consistent with mindfulness training. Participants are encouraged to develop detachment from internal and external phenomena; to experience and accept emerging thoughts and emotions without judgment, evaluation, or a desire to change them; and to develop a neutral observational capacity. As in DBT, to simultaneously accept their thoughts and feelings as they are, and to change their behaviors in constructive ways to improve their lives.

Relapse prevention therapy

RPT is not a mindfulness-based treatment, but it uses mindfulness training as a strategy to cope with cravings. In the exercise of urge surfing, participants learn to experience urges as waves that grow gradually until they crest and subside; the participant comes to realize that urges will always pass and that new urges may always come. These new urges, when they arrive, are accepted nonjudgmentally and are dealt with in adaptive ways.

List of all existing meditations

Vipassana. Dhyana. Zen Budhhist meditation (Zazen). Kinemantra meditation (KM). Anapana sati. Mindfulness-based stress reduction (MBSR). Mindfulness-based cognitive therapy (MBCT). Transcendental Meditation technique (TM). Mindfulness meditation (MM). Relaxation response (RR). Progressive muscle relaxation (PMR). Unilateral forced nostril breathing. Yoga (any). Kundalini yoga. Raja yoga. Hatha yoga. Sudarshan kriya yoga. Yogic breathing. Pranayama. Kapalabhati. Centering prayer. Qigong. Tai chi. Samadhi. Visual imagery. Guided imagery. Guided visualization. Creative visualization. Mantra. Pratyahara. Dharana. Tae eul ju. Hesychasm. Lectio divina. Silva method.Naam. Dialectical behavior therapy. Autogenic training. Clinically standardized meditation. Sound chanting. Sufic practices

 The variations in style, may have significant clinical consequences; different practices may lead to distinct short- and longterm effects on the brain, as well as to specific benefits. In a study comparing Kundalini (mantra-based and concentrative) or Vipassana (insight-oriented and diffuse) meditation, Lazar and colleagues found that each style was associated with a different pattern of brain activity by functional MRI (fMRI) during active meditation.

Other meditations
Cyclic meditation (CM) (H.R. Nagendra), a technique of 'moving meditation', combines the practice of yoga postures with guided meditation has its' origin in ancient Indian text, Mandukya Upanishad. CM states: 'In a state of mental inactivity awaken the mind; when agitated, calm it; between these two states realize the possible abilities of the mind.

 If the mind has reached states of perfect equilibrium do not disturb it again'. The underlying idea is that, for most persons, the mental state is routinely somewhere between the extremes of being 'inactive' or of being 'agitated' and hence to reach a balanced/relaxed state the most suitable technique would be one which combines 'awakening' and 'calming' practices.

 In CM, the period of practicing yoga postures constitutes the 'awakening' practices, while periods of supine rest comprise 'calming practices'. Combination of stimulating and calming techniques may reduce psycho physiological arousal more than resting in a supine posture for the same duration.

Effects of Meditation: Physiological

meditation though a mental activity, had effects on human physiology Heart rate: slows down during quite meditation and quickens in the moments of ecstasy during meditation (Tamini, 1975)

 Blood pressure and hypertension: lowers BP for the people who are normal or moderate hypertensive (Sears & Raeburn, 1980; Swami Karmananda Saraswati, 1982; Wallace et al., 1983). studies indicate that the benefit disappears once practice is discontinued (Patel, 1976).

 Metabolism and respiration Oxygen consumption is reduced (sometime up to 50%), carbon dioxide elimination is reduced (sometime up to 50%) and respiration rate is lessened Skin resistance Low skin resistance (measured in terms of galvanic skin response) is a good indicator of stress. high skin resistance has been documented by many researchers especially among TM practitioners

CORTICAL ACTIVITY: EEG

alpha activity (8-12Hz) increases significantly Indicating deep relaxed state of mind Long term meditation practitioners also exhibit theta brain wave activity (5-7Hz) during which they report peaceful and pleasant experience with intact self awareness During QiGong (a Chinese meditation exercise) predominant EEG activity was witnessed in the anterior half of the brain while it silently occurred in the posterior half (considered the cerebral ying and yang)

 Studies show theta, alpha, and gamma activation along with increased EEG coherence involving predominantly the anterior cingulate and frontal lobes in experienced meditators

Neural activity
Neural activity (inc fMRI signal) evolve during meditation and is dynamic. During yoga nidra, using H2O-PET, Lou et al.(1999) found a decreased flow in the executive system of the brain, i.e., dorsolateral prefrontal, also anterior cingulate, orbital frontal cortices, striatum, thalamus, brain stem and cerebellum.

HEMISPHERIC PREDOMINENCE
Research also indicates that during meditation right brain activity increases (Pagano & Frumkin, 1977). Delmonte (1984b) reported that meditation practice may begin with left-hemisphere activity, which then shifts towards the right hemisphere, while in advanced meditation both left- and righthemisphere activity are largely inhibited or suspended.

HIGHER CORTICAL FUNCTIONS

Schwartz & Goleman (1975,76) pointed that meditation lead to heightened cortical arousability and simultaneous decreased limbic arousability, which lead to heightened perception and reduction of emotional activity.

 With long-term, consistent meditation, these changes are no longer circumscribed to the active meditative state and generalize to normal activity Research performed on the monks of Dharamsala, proved that their prefrontal lobes (responsible for positive emotions) is lit even when not meditating (Davidson et al., 2003).

NEURAL PLASTICITY
Young and colleagues have hypothesized that the hypometabolic state, consciously induced during TMstyle meditation, serves an hibernation-like role that allows for successful adaptation and plasticity in the midst of environmental change and stress. Long-term practitioners of insight meditation had significantly greater cortical thickness in areas associated with interoception, attention, and sensory processing, including the PFC and right anterior insula

BLOOD FLOW
TM has also been found to be associated with increased cerebral perfusion to the frontal and occipital regions during active meditation

NEUROTRANSMITTERS
The dopaminergic system seems to play an important role in the suppression of executive system during relaxation meditation. found GABA levels in the brain increase significantly after a 60-minute yoga session. Potential increase in GABA - possible mechanism explaining the benefit that TM and yoga on certain disorders associated with low GABA, such as depression, anxiety, and epilepsy

NEUROENDOCRINE RESPONSE
Long-term (duration of four months or greater) TM has been shown to result in decreased cortisol levels, as well as a heightened cortisol response to acute stresswhich has been interpreted to suggest that TM can protect against the impact of chronic stress. potentially enhancing brain-derived neurotrophic factor (BDNF) function

FINAL OUTCOME
Unique style of brain functioning with increased orderliness, integration and coherence in enlightened people. While a relative excitement is continuously present in the brains of non-enlightened subjects, the enlightened people maintain a low level of excitation until s/he confronts the very moment when it is appropriate to make a decision. This exactly matches with their subjectively felt and narrated experience of persistent immovable inner calmness, even while engaged in dynamic outer activity

Effects of meditation: Psychological

Apart from the act of attending to the present moment, there are also the acts of sitting still (or abstaining from movement), structuring ones life around a disciplined practice, and allying oneself with a social system that provides the meaning and values that the practitioner uses to conceptualize his or her experience

Heightened perceptual receptivity

normal to paranormal perceptual and cognitive abilities Perceptual ability significant improvement in visual sensitivity (Brown 1984) increased auditory acuity (McEvoy et al,1980) increased visual imagery abilities (Heil, 1983), enhanced attentive ability (Linden, 1973), reduction of perceptual noise (Walsh, 1978), increased reaction time (Robertson, 1983), and enhanced perceptual motor speed (Jedrczak 1986)

The act of attending

The act of attending to this moment in meditation separates the observer from the contents of awareness results in 2 fundamental primary consequences an increased perceptual receptivity and the segregation of awareness from the contents of awareness induces a therapeutic split in the ego, in which the observing self comes to experience its true nature devoid of the contents of awareness This action is called disidentification, because the empty self is disidentified with the contents of awareness

 The act of attending prevents habituation and increases cognitive flexibility experience of seeing things differently than before a type of regression to a pre-verbal state of consciousness in which primary-process cognition predominates regression in the service of ego,- stimulated by the psychoanalytic process

 The quality of attention given to ones experience is crucial; it should be acceptant and caring, regardless of how distasteful the contents of awareness. In this way, patients provide a therapeutic service to themselves

 meditators do notice that attending to experience stimulates observing ego functions of thinking about our experience. This is called meta-cognition. This is the level of thinking at which psychological insight takes place.

 Enhanced awareness of feelings includes awareness of pain. Here the act of focusing attention on suffering is counter-reflexive and requires conscious effort. But to do so is to replace neurotic suffering with legitimate suffering as the practitioner encounters feelings of fear, rage, emptiness, which were previously hidden from awareness. Although painful, this process promotes healing by enabling mourning, abreaction, and coping.

Empty awareness.
Prolonged practice of meditation when one can sit and observe the world without any thinking for an extended period of time. This state of consciousness can be called pure awareness or empty mind, because it has no cognitive content.

 The observing self, which is content-less, is to be distinguished from the observing ego of traditional psychoanalytic thought, which is that complex of functions constituting metacognition or reflexive awareness, and is filled with content namely the secondary reactions to, and elaborations of, our immediate sensory/affective/ cognitive experience. therapeutic split of awareness from ego, contribute to psychological healing & promote a restructuring of the superego.

Enhanced concentration
Meditation is a practice of concentration. As the ability to concentrate improves, patients may become more productive at tasks that require concentration, especially when fatigued or in pain. Concentration allows the person in pain to continue to attend to that pain and thus nurture a developing ability to bear what is painful.

The act of abstinence.

Sitting still, or abstaining from movement, can actually be thought of as a behavioral technique. The meditator inhibits him- or herself from responding to any impulse for the period of meditation unless there is a risk of physical damage. Response prevention, or the delinking of action from impulse, has profound implications for healing.

 When sitting motionless is associated with anxiety, tension, or restlessness, delinking maintains an in-vivo exposure and enables desensitization so that relaxation can occur. The association of quiescence with discomfort causes autonomic desensitization and blunting of the sympathetic response to stress

This may nurture compassion for both self and others because of an enhanced ability to attend to both ones own as well as others suffering. As psychiatrists, this capacity to attend allows us to just sit, with presence and compassion, with suffering patients when little else can be done

 practicing abstinence enhances appropriate spontaneity spontaneity is distinguishable from impulsivity by the quality of attentive awareness with which it is endowed

The act of routine practice

Practicing meditation routinely has three immediate consequences: increased discipline, regularization of ones lifestyle, and increased commitment to ones own self care. Meditation is a practice of psychological weightlifting

Memory and intelligence

higher performance on nonverbal intelligence test improvements in cognitive abilities, intelligence, school grades, learning ability, short and long term memory (Cranson et al., 1991).

Creativity and self actualization

Mixed results have been reported regarding creativity and meditation. Self actualization is thought to be the major goal of dedicated meditation practitioner. Measured through affective maturity, integrative perspective on the self and world, and resilient sense of self. effect size of TM on self actualization is approximately three times larger than other forms of meditation and relaxation practices

Mechanisms for the therapeutic effects of Meditation

Helminiak (1981) described six possible mechanisms through which meditation works.

(1) Relaxation:
induce a pleasant and deep relaxed state of body & mind Herbert Benson (1976) developed a therapeutic technique called relaxation response a form of meditation to reduce stress & HTN by inducing a state of deep relaxation. He measured series of physiological parameters in response to relaxation response, include-decrease in the BMR, decrease in HR, muscle relaxation, slow and rhythmic breathing, decrease in BP, and so on. All this effects help in balancing physiological abnormalities and promotes healing.

(2) Systematic desensitization

Joseph Wolpes BT - instrumental in reducing anxiety. This therapy involves 3 steps. Client is thought to induce deep state of muscle relaxation. Hierarchical list of stimuli inducing anxiety is prepared . Finally, in a deep relaxed state client confronts (either by imagination or by presentation of actual stimuli) each of the anxiety producing stimuli progressing in hierarchy. This therapy is based on the principle of reciprocal inhibition. Since anxiety and relaxation are incompatible to each other, the stimuli loose their anxiety provoking quality.

 In meditation also a practitioner undergoes similar steps. Every meditation involves induction of a relaxed state. In meditation, the practitioner first enters in deep relaxation and suspends conscious thoughts by either detached observation or concentration. As a result, many anxiety provoking repressed memories, thoughts, and feelings arise in the mind. When one confronts them in a deeply relaxed state, these factors loose their power to induce anxiety and finally get eliminated.

(3) Release of repressed psychic material:

With regular practice of meditation, release of repressed unconscious thoughts, emotions, and images. This is very similar to the release of unconscious phenomenon during free association in psychoanalysis. This could be initially disturbing, but with constant practice unconscious mind gets cleaned of such memories and healthy mind is achieved. During meditation, the practitioner remains under low arousal and sensory deprivation for a long time and under such condition repressed feelings and thoughts arises (Benson, 1976).

(4) Unstressing
Parallel to release of repressed memories, many practitioner reports many physical reactions during intense meditation. This could be involuntary muscular-skeletal movements such as repeated twitches, spasms, gasps, tingling, tics, jerking, swaying, pains, shaking, aches, internal pressures, headaches, weeping, and laughter. The experience covers the range from extreme pleasure to acute distress . TM practitioner calls this as unstressing. Goleman (1971) interprets this phenomenon on the basis of psycho-physiological principle contemplating that all psychic and emotional phenomena have parallel physiological processes.

(5) Dissolution of habitual patterns of perception

Human beings are mostly governed by rigid and fixed patterns of thinking, feeling, and reactions. Many of these patterns are unhealthy and cause neurotic and psychotic problems. Most of the unhealthy habitual patterns are due to our identification with emotions that we are not able to control and regulate. With detached observation, emotions and thoughts loose their power and practitioner is able to identify the unhealthy patterns of behavior and replace them with healthy ones.

(6) Cosmic consciousness

Attainment of cosmic consciousness is a mystical concept and not available for scientific investigation. Many terms represent cosmic consciousness - samadhi, nirvana, satori, and moksha. highest goal achieved by meditation in esoteric traditions where a person transcends his personal ego. In the state of cosmic consciousness a person realizes that he/ she is one with the whole cosmos and is not separate from others. As a result, a tremendous sense of love and compassion arises in him and highest state a human can achieve.

Meditation and health

meditation have been used as health-enhancing techniques for centuries. Their use has been investigated more recently in the context of more conventional, allopathic medical approaches

 The medical benefits of meditation include improving hypertension, managing the stress of chronic illness, and promoting cardiovascular health. Long-term meditation may have a role, too, in slowing and perhaps stopping cortical atrophy and cognitive decline . meditations possible benefits may include ameliorating depression, improving anxiety, promoting abstinence from drugs of Abuse, and reducing the self-injurious behaviors of personality disordered patients.

Cardiovascular health
decreased blood pressure in both pharmacologically treated and untreated hypertensive patients and reduction in premature ventricular contractions in patients with stable ischaemic heart disease. It has been used in the treatment of coronary artery disease; angina pectoris Decreased stress and hypertension have been related to decreased autonomic arousal or reactivity

 Dyslipidemia, diabetes, psoriasis, fibromyalgia etc are other conditions with mixed results.

MEDITATION AND CHRONIC ILLNESS

Meditation practice can positively influence the experience of chronic illness and can serve as a primary, secondary, and/or tertiary prevention strategy Meditation has been studied in populations with fibromyalgia, chronic pain, cancer, hypertension, and psoriasis evidence regarding the efficacy and effectiveness of meditation practices for the three most studied conditions in the scientific literature: hypertension, cardiovascular diseases, and substance abuse.

Meditation and psychiatry

Meditation may, in some cases, be compatible with, and effective in, promoting the aims of psychotherapy for example, cognitive and behavioral change, or access to the deep regions of the personal unconscious. A framework for the integration of meditation and psychotherapy is presented through a consideration of the psychobiological nature of meditation (the relaxation response) and discussion of a traditional meditation practice (mindfulness meditation) as an effective cognitive technique for the development of self-awareness.

positive emotions, reduced oxidative damage, and enhanced immune functioning, by which meditation may preserve cognition and reduce age-related allostatic stress and neuronal loss, thereby promoting brain longevity, plasticity, and learning.

 MBCT has been found effective in reducing relapse in patients with major depression MBCT may be an acceptable and potentially effective treatment for reducing anxiety and mood symptoms and increasing awareness of everyday experiences in patients with GAD MBSR is also therapeutic for healthcare providers, enhancing their interactions with patients

Meditation and sleep

sleep can be improved by mindfulness-based stress reduction (MBSR), Meditation also provide a longer term reduction in sleep need roughly equal to the time spent in meditation.

 Engler notes that people with narcissistic or borderline character structures may attempt to use meditation to make themselves pure or to recast feelings of emptiness and fragmentation as the voidness or selflessness of enlightenment.

 Metta practices have been shown to increase selfcompassion (Shapiro et al., 2005; Shapiro et al., 2007). Self-compassion, in turn, has been associated with a variety of desirable endpoints, including reductions in perceived stress, burnout, depression, and anxiety as well as increases in life satisfaction

Meditation and addiction

MBSR is now used as an adjunctive treatment in the treatment of addiction. In addition to MBSR, mindfulness-based interventions, used in a context of addictive disorders, include Mindfulness-Based Cognitive Therapy (MBCT), Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT). Recent modifications of these approaches, developed specifically for substance abusing populations, include Mindfulness- Based Relapse Prevention (MBRP) and Mindfulness-Based Therapeutic Community (MBTC) treatment .

 Informal, nonspecific meditation, for example, is encouraged in the highly spiritual, 12-step programs; the eleventh step involves engaging in prayer or meditation regularly.

Hinders during starting meditation

novce attempts to meditate directly, there could be two responses based on the quality of the mind viz., (i) a rajasic active (personality) mind would be restless all through the session and (ii) a tamasic a mind with inertia could fall asleep Can be overcome by CM

Limitatons for meditation practice

First, Western psychotherapists are culturally unfamiliar with the various meditative traditions, which have been uprooted from their ancient Asian culture. As such, it was a technique not for the neurotic, psychotic, or character-disordered person. But useful for patients with neuroses and mild to moderately severe character disorders who are plagued by defensiveness, lack of self awareness, vulnerability to intense and painful affects, and self-destructive behaviors

 meditation can actually be harmful; it can precipitate psychosis or release a debilitating flood of painful affect in some seriously disturbed individuals. it can exacerbate obsessive and schizoid traits. meditation can cause depersonalization and derealization Like a drug, meditation must be prescribed with careful attention to the psychological status of the patient. meditation is a safe and well-tolerated practice

Prescription
To whom, for what symptom, in what form, in what dose, and for how long? sufficient motivation to resolve their difficulties and work through their ambivalence about changing to practice meditation. The therapists experience and understanding are important here. The therapist must be able to present meditation with clear instructions and with a sensible explanation of the effects.

Monitoring
Part of the intelligent use of meditation as a psychotherapeutic tool is the monitoring of its effects on the patient. Complications or difficulties have to be noted and corrected, such as dealing with negative feelings about the practice or restlessness during practice, impatience, and doubt or frustration at not being able to do it right

Research in meditation
The majority of studies on meditation practices identified in this review have been conducted in Western countries and published as journal articles within the past 15 years. The majority of research in meditation practices has been conducted as intervention studies (67 percent), with 49 percent being RCTs or NRCTs.

Limitations in research
methodological quality of meditation research to be poor. Observational studies -33 percent of all the studies. systematic error such as selection bias, detection bias, and attrition bias. Intervention studies that used designs with pre-post treatment comparisons within the same group (or uncontrolled trials) are not as rigorous as designs that use between-group comparisons because they do not allow investigators to determine whether the results are due to the meditation practice or to other factors.

 Studies with stronger designs such as RCTs and NRCTs allow a greater sense of confidence in study results; however, found the quality of reporting to be poor

Future work
More sophisticated studies are needed to define sample populations more thoroughly, adequately isolate the independent variable (the act of meditating) for scrutiny, and then use appropriate control groups.

SUMMARY
as a practice that self-regulates the mind and body by engaging a certain attentional set; wakeful hypometabolic state of parasympathetic dominance and sympathetic attenuation meditation may promote the diminishment of psychiatric illness, character change, and the resolution of neurosis when used adjunctively with psychotherapy Investigators have yet to fully identify, with controlled studies, the benefits that are attributable specifically to the act of meditating.

THANK U