A Perspective on the Emergence of Meditation Techniques for Medical Disorders

Abstract

709 This editorial discusses recent systematic reviews on yogic meditation techniques used for treating medical disorders and contrasts the results with two recent very large multisite state-of-the-art pharmacologic trials (one for depression,1–4 the other for schizophrenia5–7) funded by the National Institutes of Mental Health (NIMH). The intent here is to put the new emerging interest in meditation techniques into a larger perspective to help clarify the need for potential novel therapies. The review in this journal by Arias, et al. (817–832) entitled a “Systematic Review of the Efficacy of Meditation Techniques as Treatments for Medical Illness” is timely, important, and the fourth published systematic review since 2005 on yogic meditation techniques as therapies solely for specific disease states. This review does not include meditation studies on healthy subjects, nor does it focus only on a single type of meditation technique that was the focus of a recent 2004 review on hypertension,8 or another in 2004 on all forms of complementary and alternative medicine (CAM) therapies for anxiety.9 Arias, et al., state their interests for conducting this systematic review, writing that “meditation techniques are sought frequently by patients coping with medical and psychologic problems . . . their increasingly widespread appeal, and the potential for use as medical therapies.” The authors identify 82 studies, and 20 randomized controlled trials (RCTs) met their final inclusion criteria with a total of 958 subjects (397 experimentally treated subjects and 561 control subjects). The authors state that “no serious adverse events were reported in any of the included or excluded clinical trials.” And they conclude that “results support the safety and potential efficacy of meditative practices for treating certain illnesses, particularly in nonpsychotic mood and anxiety disorders.” They also state that “lastly, because of possible experimenter bias, research by Maharishi Transcendental MeditationTM (TM)–associated researchers has not been included unless it was performed at a more neutral institution, and the majority of the researchers were not affiliated with the Maharishi organization.” Arias et al. call TM “a commercial technique.” Clearly, the only access to a TM mantra is via substantial payment by an individual. Therefore, no one outside the organization can replicate TM trials independently because the mantras are kept secret. This leaves the scientific community limited in its understanding for any potential value of TM as a therapy for medical disease states. I do not recall any pharmacologic trial in which the identity of a drug has been withheld. Another review in 2005 focused solely on yogic meditation techniques for depression.10 That review located five RCTs meeting their inclusion criteria. All studies showed positive results using different forms of yogic meditation, with the severity of depression ranging from mild to severe. However, the authors reported that important methodological details on randomization, compliance, and attrition rates were missing.10 The authors reported that the only adverse effects were fatigue and breathlessness in participants in one study.10 The researchers concluded that “overall, the initial indications are of potentially beneficial effects of yoga interventions on depressive disorders. Variation in interventions, severity and reporting of trial methodology suggests that the findings must be interpreted with caution.”10 Two other reviews focused solely on anxiety disorders.11,12 The first of these two11 reviewed eight studies, all with positive results, although there were many with methodological inadequacies. The reviewers stated that “owing to the diversity of conditions treated and poor quality of most of the studies, it is not possible to say that yoga is effective in treating anxiety or anxiety disorders in general. However, there are encouraging results, particularly with obsessive compulsive disorder (OCD).”11 The second