Coping with psychological complaints

A number of studies indicate that various types of meditation may reduce psychological problems like anxiety and depression.

There is increasing awareness that meditation makes it easier to cope with these common psychological complaints.

From time to time, most people encounter stressful situations and need to find ways of dealing with emotional pressure. Without regular release of inner tension, they may suffer increased worry, nervousness or physical symptoms such as aches and pains. A common reaction is to try to ignore the problem by keeping busy, living at a fast pace, seeking distractions or, as a last resort, consuming large quantities of alcohol.

J. Astin, an American researcher on meditation, claims that excessive stress may exacerbate or be a significant etiological factor in anxiety; that depression may be symptomatic of psychophysiological stress; and that about half those who consult general practitioners have stress-related problems (Astin 1997). Medical treatment is not always necessary, and for people wanting a systematic method of coping with the challenges and stresses of their lives, meditation may be a good alternative. The motivation for learning meditation is often related to possible health benefits, and an increasing number of people practise meditation to reduce their psychological problems (Solberg 2004a). Experience indicates that stress reduction and mental calm are common short-term effects of meditation. Daily residues and undigested experiences are worked through, and an outlet is provided for emotional preoccupations. When stress is alleviated and tension released, they no longer represent such a drain on energy.

Empirical descriptions of the effects of meditation are not enough, however. Research on meditation is also required, in order to provide sound scientific documentation.

The stress reduction programme

Astin (1997) investigated whether psychological problems in non-clinical populations (28 students) could be reduced through a stress reduction programme developed by J. Kabat-Zinn (1982). Kabat-Zinn’s programme, which is described in more detail below, has been applied in studies of patients with a range of symptoms and diseases. Astin’s subjects had various psychological problems, but were not in need of medical treament, so his study is relevant to healthy individuals with minor psychological complaints. Even for people who are far from needing clinical treatment, methods for relaxing may be valuable. Astin found that those who practised meditation and relaxation techniques obtained greater alleviation of anxiety and depression than the control group. They also acquired an improved capacity for coping with difficult feelings, as well as better sleep and fewer headaches. Astin’s study has attracted international interest and is frequently cited.

Astin expected meditation to have a positive impact on psychological problems; especially in terms of reducing anxiety and depression. He also expected those practising meditation to show a reduced tendency to somatisation (i.e. the conversion of psychological complaints to physical disorders).

All participants filled in forms about their psychological problems before and after the 8-week programme, in order to measure changes.

The participants in the meditation group were instructed in the following three relaxation techniques:

1. Mindfulness meditation: turning the attention to the breathing or other spontaneous experiences, such as sounds, thoughts and bodily sensations. Meditators neutrally observe their own mental activity from one moment to the next, without any particular focus. They try to become aware of whatever comes to consciousness, without evaluation, judgement or interpretation.

2. Body scanning, i.e. directing the attention to one area of the body after another.

3. Yoga exercises, in order to stretch muscles and relax.

These participants were asked to practise the methods at home for 45 minutes a day, 5 days a week, and were given an audio-cassette tape with instructions and were asked to practise at home. At weekly group meetings, they listened to pedagogical presentations about physiological and psychological stress reactions, and discussed how the different techniques might be applied in order to obtain stress reduction.

The participants in the control group received no interventions and had no contact with the researcher between the two occasions when they filled in the forms. They were offered the prospect of becoming active participants in the project at a later date.

The form used was the Symptom Check List (SCL 90-R)

- a commonly used form, which makes it possible to compare results across different studies. It contains 90 questions on a number of issues, including anxiety, depression and interpersonal sensitivity. The seriousness of anxiety is measured with questions like: How much has this problem bothered or distressed you? (1) nervousness or shakiness inside (2) feeling afraid in open spaces or on the streets (3) suddenly scared for no reason (4) worrying too much about things (5) feeling of being trapped or caught (6) feeling afraid to travel on buses, subways or trains

The seriousness of depression is measured with questions like: How much has this problem bothered or distressed you? (1) feeling low in energy or slowed down (2) blaming yourself for things (3) feeling no interest in things (4) feeling hopeless about the future (5) trouble concentrating

Reducing psychological problems

In Astin’s study, the meditation group improved much more on the summary score for psychological symptoms than the control group. In the meditation group, the symptom score was reduced by 64% from before to after the project. In the control group, the difference was only 14%. Anxiety problems improved by 60% in the meditation group, but only 10% in the control group. Depressive tendencies decreased by 59% in the meditation group, compared to only 7% in the control group. The tendency to somatisation was reduced by 73% in the meditation group, but only 23% in the control group. On the score for interpersonal sensitivity (hypersensitivity), the meditators became less vulnerable to criticism and daily friction in relation to other people (59% versus 23%). Overall, the meditation group obtained improved psychological health, with fewer problems and better quality of life. The meditators tended to sleep better and suffer fewer headaches.

Figure. Improvement in minor psychological complaints: everyday psychological problems in a normal population may be reduced with a meditation-based stress reduction programme. Those who practised meditation and relaxation techniques obtained greater alleviation of minor psychological complaints like anxiety and depression than the control group. They also acquired improved capacity for coping with difficult feelings, as well as better sleep and fewer headaches. Instead of feeling paralysed by difficult emotions, they developed the ability to step back and put stressful situations in perspective. They also showed increased self-confidence and higher self-esteem.

On the basis of this study, Astin maintained that meditation has considerable potential for effective reduction of minor psychological complaints such as anxiety and depression among people who are not in need of professional treatment. The results are illustrated in the figure above.

Positive control

Astin et al. also examined the participants’ experience of control in important areas of their lives. The participants filled in a form, Shapiro Control Inventory, SCI (Shapiro 1992), with 187 questions regarding the following 4 customary modes of exercising control: positive assertive, positive yielding (accepting), negative assertive (overcontrol) and negative yielding (too little control). The SCI includes questions on desire (motivation) for control, and the agency (or source), i.e. whether the locus of control is internal or external. Internals tend to attribute outcomes of events to their own control, whereas externals tend to attribute outcomes of events to outside circumstances.

A positive experience of control is assumed to be associated with better mental health (Strupp 1970). Shapiro suggested that psychological health is reflected in higher scores on, as well as a balance between, positive assertive and positive yielding modes of control, and lower scores on negative assertive and negative yielding modes.

The participants in the meditation-based stress reduction programme obtained significantly greater change in overall sense of control compared to the non-meditators. The meditators improved significantly with regard to a positive yielding mode of control, and their preference for acceptance as a response mode increased more than in the non-meditators. They also showed an increased sense of self as the source of control.

The control group showed only a minor improvement and did not obtain a positive experience of control. Overall, the findings confirmed that a positive sense of control can serve as an indicator of psychological health, and demonstrated that meditation can contribute to this aspect of mental well-being.

Reducing everyday stress

Another study of stress management looked into whether meditation could reduce (1) daily stress-related problems, (2) psychological problems, and (3) medical symptoms (Williams et. al. 2000). The stress reduction programme was similar to the one described above. It lasted 8 weeks, with instruction in mindfulness meditation at the beginning. The participants were asked to practise the mindfulness method in daily situations that they experienced as difficult and stressful.

The study was carried out at an American university, with 103 participants recruited through the media. Fifty-nine of them, chosen at random, learned meditation, and 44 were in the control group, which only filled in forms and received information about stress-management resources in the area. The forms used are described below.

- Daily stress problems were measured with the Daily Stress Inventory (DSI, Brantley et al. 1989). DSI measures stressful experiences of various kinds, ranking them in intensity from ”very stressful, it made me panic” to ”it happened, but was not stressful”.

- Medical symptoms were measured with the Medical Symptom Check List (MSCL). MSCL contains 115 yes-no questions to determine which medical problems have troubled the participants during the last month.

- The participants’ psychological problems were measured with SCL-90 R, which is described above.

The results indicated that the sense of stress arising from daily hassles was reduced in the meditation group to a significantly greater degree than in the control group. In the meditation group, stressed feelings were reduced by 24% from before to after the study, versus 7% in the control group. Psychological problems were reduced by 44% in the meditation group, whereas the control group did not obtain significant improvement. There was a 46% reduction in medical symptoms in the meditation group, while the control group, rather than improving, actually scored 0.4% higher afterwards.

This study indicates that meditation has a positive effect on both stress in everyday life and psychological problems for ordinary people. Williams also found an association between practising meditation and improvement of medical symptoms. One should, however, be cautious about drawing conclusions until further documentation from other studies is available. Certain medical symptoms may be associated with stress and psychological problems. In such cases, it seems realistic to expect alleviation of medical symptoms as psychological problems decrease.

Concentrative vs. nondirected techniques

Different relaxation techniques produce different results. One meta-analysis indicated that nondirected techniques yield more stress-management benefits than concentrative techniques (Eppley 1989). Nondirected techniques are characterised by an open, non-concentrative mental attitude, which does not exclude anything from the spontaneous activity of the mind. These techniques seem to be most effective in reducing stress, and further investigations focusing on their psychological effects are desirable.

In another study among students and staff at an American university, 83 participants were randomly assigned to three groups, learning either (1) meditation (TM, a sound-based technique); (2) progressive relaxation (alternately tightening and releasing the muscles, and observing the process of muscle relaxation); or (3) a cognitive behaviour strategy (guidance in how to study better, tackle exams, manage better in the university setting and think positively about oneself) (Gaylord et al. 1989). The project investigated stress reactivity over a one-year period. The participants’ mental health was assessed before and after the study. A combined score for mental health was calculated, reflecting the degree of anxiety (both state-dependent and trait anxiety) and neuroticism (i.e periodic or continuous patterns of maladaptive behaviour in response to worry or tension).

The results indicated that mental health improved significantly in the meditation group and those who practised progressive relaxation, but not in the cognitive behaviour group. Furthermore, the meditation group obtained greater reduction in neuroticism compared to both of the other groups. After evaluating all the findings, Gaylord concluded that meditation had a broader effect than muscle relaxation alone.

Meditation and sustained alertness

Do different meditation techniques have differing impacts on our attention? This question was addressed in a study of the capacity to perceive series of sound signals (Valentine et al. 1999). The purpose of the study was to investigate our ability to control our attention, or to select relevant from irrelevant stimuli, which is assumed to have implications for mental health.

Valentine’s study distinguished between two types of meditation, described as concentrative versus receptive meditation (Brown 1977). Half of the participants practised concentrative meditation, which involves concentrating on one thing to the exclusion of everything else (one-pointedness, zoom lens attention). The other half practised mindfulness meditation, attempting to include all impressions that come to one’s mind, and treating nothing as a distraction (wide-angle lens attention). The participants were selected because they already practised one of these techniques, and the groups were about equally sized. A control group was recruited among college students, selected to be comparable in intellectual level with the meditators.

Valentine has previously conducted research indicating that meditation contributes to increased concentration, and she refers to other studies with similar findings (Valentine 1988). This, however, is the first study to compare the effects of two different meditation techniques on the capacity for sustained alertness.

Valentine examined the number of sounds the participants perceived when listening to sound-series that were presented at a relatively slow speed (Wilkin’s counting test: sustained attention). The concentrative meditators were told to make the auditory stimuli the focus of their attention. Mindfulness meditators were asked to adopt their usual meditative technique while perfoming the task (“I expand my attention/awareness to as many events as possible. I regard nothing as a distraction. Any new event, physical or mental, is considered part of my meditation”). The meditators were given an additional test: a set of sounds presented at a higher speed than in the first sets, in order to test their perception when this aspect of the stimulus was unexpected.

The results indicated that both groups of meditators performed better than the control group, and that experienced meditators performed better than those who had practised for only a short time. When the stimulus was unexpected, mindfulness meditators performed better than concentrative meditators. When the sounds were presented at the expected speed, however, there was no difference between the two groups of meditators. No one in the meditation group experienced the task as boring, whereas those in the control group did. Valentine interpreted the results as indicating that the meditators were used to ignoring distracting thoughts, and that flexibility of attention may be an important effect of meditation.

One limitation of this study is the very small number of participants. The 19 persons in the meditation group were assigned to 4 subgroups: 2 groups of people who had been meditating for a short time (up to 2 years), and 2 groups of more experienced meditators (over 2 years); thus, each group had only 4-6 participants. More studies with larger groups are needed before firm conclusions can be drawn about the effects of concentrative versus receptive, or nondirected, meditation on alertness.

Meditation as complementary treatment

The American researcher J. Kabat-Zinn has performed many studies of various groups of patients who benefit from meditation as a complementary treatment. In one study, he examined the effect of meditation on anxiety in a group of patients at an outpatient clinic (Kabat-Zinn et al. 1992). The patients improved during the study, and the positive effect was maintained throughout the 3-month follow-up period. Among the participants, 22 patients completed the programme and filled in all the forms according to the study design. Three years later, 18 of these 22 were located and took part in a further study (Miller et al. 1995), which revealed that the psychological effects were still stable even after the passage of so much time. Miller concluded that meditation can yield substantial long-term effects for patients suffering from anxiety. Anxiety and panic-symptoms were explored in a study of 136 individuals with a variety of health problems: chronic pain, cancer, high blood pressure, asthma/allergy and indigestion (Reibel et al. 2001). Two thirds of the participants had two or more diseases. Their psychological symptoms were primarily depression and various forms of anxiety. During the 8-week stress-reduction programme they learnt a number of forms of mindfulness meditation and practised daily for 20 minutes 6 days a week. At weekly meetings, they were given instructions in breathing exercises, yoga and body-scanning. The results indicated that the participants’ anxiety was reduced by 44% and depression by 34% from before to after the project.

Health-related quality of life was also measured, through factors like vitality, social functioning, physical pain and role limitation due to bodily disease. The participants’ quality of life was significantly enhanced during the study. At followup one year later, several of the results were stable. The overall result indicates that a group of patients with various diseases had benefited from meditation along with medical treatment. Reibel et al. concluded that meditation contributed to better functional status, enhanced well-being, fewer bodily symptoms and fewer psychological problems.

Another American group of patients practising the same type of meditation obtained similar results (Roth & Creaser 1997). They showed a reduction in both psychological symptoms such as anxiety and depression and medical symptoms. Furthermore, they experienced positive changes in behaviour, habits and attitudes which had the potential to improve their health directly and/or increase their amenability to medical treatment.

The existing studies indicate that providing instruction in meditation alongside medical treatment may produce valuable results for patients. There are potential benefits in making combined treatments more widely available.

In a Norwegian pilot project, patients with breast cancer learnt and practised Acem Meditation as well as receiving medical treatment (Nesvold 2000). The participants reported that Acem Meditation was an opportunity for mental rest which alleviated inner tension, helped them relax, gave them more energy and increased their ability to cope with their difficulties. This was probably a combined effect of meditation and sharing experiences in the group. The pilot project provided promising evidence of Acem Meditation’s benefits for quality of life and increased well-being in individuals with a serious medical condition. Several American research projects have reported good results in these areas for similar groups of cancer patients. This indicates the potential benefits of using meditation more systematically for such groups.

Summary

Only a few studies to date have examined the effects of meditation on healthy individuals suffering from minor psychological problems, but the existing research results indicate that meditation has a positive impact on common psychological conditions like anxiety, nervousness, stress and depressive symptoms. Other well-attested results of meditation include increased well-being, better quality of life and more emotional stability. The effects of meditation as an additional, complementary treatment for different groups of patients are also promising.