Chapter 6: Less stress-more energy

One of the most common reasons for taking up nondirective meditation is the need to “recharge one’s batteries.” The positive effects of meditation are often measured by the reduction of stress, fatigue, anxiety, depression, and other negative symptoms.

Several studies indicate that nondirective meditation increases energy by reducing pain and worries associated with the normal stresses of everyday life. Effects are stronger with nondirective meditation than with directive techniques for muscle relaxation, or just relaxing without any specific method.

As described in chapter 5, one of the early studies of nondirective meditation showed that regular practice of the Relaxation Response, a nondirective meditation technique, lowered blood pressure in corporate office workers, indicating a significant stress reduction (Peters et al., 1977a). The study also reported reduced physical and mental stress symptoms. After eight weeks, the scores showed improved self-perception of health, wellness, work performance, and social satisfaction (Peters et al., 1977b). These findings indicate that nondirective meditation reduces psychological symptoms and improves mental health.

Similar results were achieved when two types of nondirective meditation were compared with a directive muscle relaxation technique and a control group waiting to receive instruction after the study (Carrington et al., 1980). A group of 154 New York Telephone employees, self-selected for increased levels of stress, were randomly assigned to learn Clinically Standardized Meditation, the Relaxation Response, or Progressive Muscle Relaxation. All three techniques give relaxation, but the meditator focuses his attention differently, as briefly described in the text box on the next page.

Two types of nondirective meditation and one directive muscle relaxation technique investigated by Carrington and co-workers

(1) Clinically Standardized Meditation is a type of nondirective meditation in which the mental repetition of a self-selected or self-created meditation sound is allowed to proceed at its own pace, independent of the breath (Carrington, 1978). Attention is focused on the mental repetition, allowing spontaneously emerging thoughts and other experiences to come and go, just as in Acem Meditation, Transcendental Meditation, and other nondirective techniques.

(2) The Relaxation Response is another type of nondirective meditation, in which the word “one” (or another preferred word or phrase) is repeated with each outbreath (Benson, 1975; 2000). Attention is gently focused on the mental repetition of the word and the sensation of the breath, allowing spontaneously emerging thoughts and other experiences to come and go.

(3) Progressive Muscle Relaxation is a directive technique in which the participants are taught to alternately tense and relax selected muscle groups. The aim is to eventually be able to release muscle tension without any preliminary tensing. During the practice, attention is directed to the physical task (Jacobson, 1929).

Competent training and follow-up

Several measures were taken to ensure that the participants learned their techniques properly and were supported to practice regularly. Training in the individually assigned technique was carried out by tape-recorded instructions accompanied by reading material. Participants started by themselves at home and were instructed to practice twice daily in 15–20-minute sessions. During the first week after instruction, each participant was contacted by a trainer, who answered questions and checked that the meditators were comfortable with the technical instructions. Two weeks after start-up, participants attended group meetings led by a psychologist who specializes in relaxation. They discussed how to handle problems arising with the practice, how to adjust it to suit personal needs, and how to extend it into “mini-meditations” of 2–3 minutes that could be used whenever needed in their working day, in addition to their regular, planned sessions. The company showed great involvement by allocating a room for meditation, and by allowing the employees to use their ordinary breaks for meditation.

Reduces psychological stress symptoms

Symptoms of stress were measured using a questionnaire that included 90 items related to bodily dysfunction, discomfort in social interaction, depression, anxiety, fatigue, distorted perceptions, and other common psycho-social ailments (SCL-90; Derogatis, 1977). At the outset, participants had a symptom load midway between psychiatric outpatients and “normals” without any diagnosis (Carrington et al., 1980). During the first six weeks of practice, symptom scores fell sharply in all active intervention groups, indicating a solid reduction of stress-related ailments; thereafter, symptoms declined more slowly. When the study was completed after five and a half months, the reduction of stress symptoms was most notable with the two types of nondirective meditation. There was also some reduction with the directive technique, Progressive Muscle Relaxation, but the change did not differ from the control group. These findings show that nondirective meditation was more effective than directive relaxation in reducing symptoms of stress and nervousness.

Notably, symptom scores also fell markedly in the control group of people on the waiting list for instruction, although their scores remained higher than in the normal population. The researchers speculated that this might result from expectations of positive outcomes of the treatment they were about to get, even before they had started training. Alternatively, it could be due to spontaneous improvement, just by the aid of the passage of time. It could also result from some form of self-administered therapy, such as exercise or counseling, or from self-medication by alternative medicine, alcohol, or recreational drugs.

Stress reduction in a working population

- Nondirective meditation improves mental health by reducing symptoms of stress, anxiety, and depression. - Positive effects are typically measured as lower scores in psychological and bodily complaints, such as less tendency to fatigue and worry, and fewer aches and pains. - Results in everyday life are more energy and more confidence in work and relationships.

Increases energy and motivation

In addition to answering questionnaires on ailments and symptoms, the participants were asked to describe in their own words their most important experiences with nondirective meditation. These free-text comments revealed more positive results than just the absence of negative symptoms. “Relaxation” and “calm” were the most frequent benefits, followed by “improved sleep,” ”less irritability,” and “less anxiety.” Interestingly, none of the 92 free-text comments mentioned depressive symptoms, although improvement of the depression score was one of the most marked benefits detected by the questionnaire.

Surprisingly often, depression is not identified as a negative mood, but rather disguised as fatigue, chronic pain, lack of motivation, concentration deficit, sleep disturbances, a tendency to worry, or repetitive thoughts concerning a negative self-image. Thus, the negative mood easily passes under the radar, undiscovered by the conscious mind. Instead of appearing as an important player on the central stage of our emotional lives, it forms a somber backdrop of pessimism in everything that goes on in life. No wonder many experience an increase in energy and mental strength when the fog of depression lifts in response to regular nondirective meditation.

Some of the most positive free-text comments on the effects of nondirective meditation referred to improvement in general mental functioning, such as: “My reasoning process is clearer; I am better able to assign priorities and handle them in proper order.” Others were “greater alertness,” or better social functioning: “I can cope more easily in a social environment,” “I do not feel so defensive in my relationships with others,” and “I am more thoughtful of others.”

The researchers concluded that the free-text comments revealed results in a somewhat different area than the questionnaire, which mainly asked about the reduction of negative symptoms. Even though the improvement in scores were similar in frequent and occasional meditators, the tone of the free-text comments of those who meditated several days per week seemed more confident in topics relating to job performance and general satisfaction in life (Carrington et al., 1980).

Effects of nondirective meditation in a working population

- Deep relaxation and mental processing occur during practice, and stress-related symptoms are markedly reduced within 6–8 weeks. - Results come with regular practice. Those who meditate 3–5 days or more per week have better effects. - Personal learning and follow-up by qualified instructors are important for optimal practice, motivation, and adaptation to individual needs, especially during the first three months after taking up meditation. - Employers can improve stress reduction in their organizations by including introductory courses on nondirective mediation as part of their health, security, and environment (HSE) programs.

Regularity and the value of meditation practice

Positive results were associated with excellent adherence to all three techniques. Systematic evaluation by questionnaires showed that 78 percent were still practicing after five and a half months, either regularly several days per week or more occasionally. Approximately one third of those who abandoned their technique stopped during week one to two, the next third stopped between weeks two and six, and the last third stopped between week six and three months after learning to meditate. Only one person dropped out between three and five and a half months. In this study, Clinically Standardized Meditation was shown to be the most popular and most frequently practiced method, whereas Progressive Muscle Relaxation had less effect and was practiced less frequently.

In summary, the study showed that nondirective meditation reduces a number of symptoms associated with a high level of psychosocial stress, and that it can be a source of energy and motivation for positive behavior and rewarding relationships at work and privately. Improvement in a number of test items was clearly demonstrated for Clinically Standardized Meditation and the Relaxation Response. In contrast, the active control group with Progressive Muscle Relaxation had more limited effects that did not significantly differ from the control group waiting to receive a stress reduction course after the study. This program was highly successful compared to many other measures for improved stress management at the work site, because of the long-term, competent, and systematic follow-up.

Corporate workers in Scandinavia

Quite a few companies have found it useful to offer courses in nondirective meditation as part of stress management programs. In 2018, clinical psychologist Anne Grete Hersoug and her colleagues published a field study from Scandinavia, showing that nondirective meditation could successfully be applied as a simple HSE measure, with modest support from the companies involved (Hersoug et al., 2018). Via internal advertisements, six large companies from insurance, banking, labor and welfare services, and commercial businesses invited their employees to participate in a stress management program that included Acem Meditation.

After a two-hour seminar with general information on stress, stress reactions, and stress management, the participants followed a standard introductory course in Acem Meditation at the workplace. Over an eight-week period, participants followed five two-hour classes led by experienced instructors, including a 30minute meditation session followed by group discussions on how to perform the meditation technique and how to handle the variety of meditation experiences. They also discussed how to overcome barriers to establishing a regular home practice of either two 30-minute sessions per day or one 45-minute sitting.

To evaluate the effects of the stress management program, participants completed questionnaires on physical and mental aspects of stress and well-being before and after the course. At six-month follow-ups, self-assessments from the 73 participants showed significant improvements in mental stress, muscular pain, worries, nervousness, and sleep problems. The changes were greater than in the control group of employees, who only attended the first seminar on stress management without taking the meditation course. Further details of the study are discussed in chapter 9, on stress management for working professionals.

Psychological effects in healthy adults

Similar effects on mental health have been demonstrated in a number of scientific studies of the psychological effects of various types of meditation. In 2012, Peter Sedlmeier and co-workers from Chemnitz University of Technology in Germany conducted an extensive review of the best studies on the psychological effects of meditation in healthy adults (Sedlmeier et al., 2012). The reviewers focused on nonclinical uses of meditation. They excluded studies of meditation as part of clinical therapy trials for people with a medical or mental-health diagnosis. They also excluded all studies that mainly dealt with physiological rather than psychological measures. In addition, they excluded studies that did not fulfill quality criteria for design, control groups, and other best-practice research methods. Results from the 169 remaining studies were then combined into one joint data-set and analyzed together by a special statistical method called meta-analysis.

To get a general impression of the psychological effects of meditation, the researchers first identified symptoms, behavior, and personality traits that had a clear positive or negative dimension, such as stress symptoms, empathy, learning, and memory, and found a beneficial overall impact on the participants. The average effect on all measures was approximately of the same size as psychotherapy and behavior therapy. Studies comparing the practices with directive muscle relaxation techniques showed that meditation was more effective. The same applied to studies comparing meditation with health education and other active control groups.

The meta-analysis also showed that the size of the beneficial impact of meditation differed among various types of psychological effects. To their surprise, the investigators found that the largest positive impact was interpersonal outcomes. In other words, meditating on one’s own had a positive impact on one’s relationships. This effect was closely followed by a reduction in anxiety and negative emotions, and thereafter an increase in mindfulness and attention, reduced stress levels, and an increase in positive emotions and wellness.

For comparison among different types of meditation, the practices were divided into three main categories: nondirective meditation (mainly Transcendental Meditation), mindfulness meditation, and others. The average overall effect of nondirective meditation seemed to be slightly greater than with the other techniques, but the analysis could not prove any superiority when the investigators took into account the differences in how the studies had been carried out. However, there were some differences between nondirective and mindfulness meditation in some of the 21 types of psychological effects studied. Nondirective meditation showed a slightly stronger reduction of negative emotions, anxiety, and neurotic personality traits and was helpful in learning and selfrealization, whereas mindfulness meditation seemed to be slightly more helpful in reducing negative personality traits and stress, and in improving attention and mindfulness. Although intriguing, it is not yet clear how much these differences matter for energy and mental health in everyday life. In contrast, the meta-analysis showed that the psychological effects of both types of meditation were stronger than with directive muscle relaxation techniques and other active control interventions, and markedly stronger than with the waiting list or the control with no intervention. Interestingly, Sedlmeier concluded that the overall impact of meditation on psychological symptoms was about the same as in other reviews and metaanalyses of psychological, educational, and behavioral interventions, including psychotherapy (Sedlmeier et al., 2012).

Meditation-based therapy?

- Meditation can result in a small to moderate reduction of the most common psychological symptoms, such as stress, anxiety, depression, and chronic pain. - Some studies have tested whether meditation may be used as part of or in addition to standard medical and psychological therapies. - Most experts agree that larger studies with stronger designs are needed to determine the role of stress reduction when the severity amounts to a clinical diagnosis. - Many of those who practice meditation feel that it makes it easier to cope with health problems, and that it gives a sense of control over one’s own health (Source: National US Health Review Survey 2012, described in Cramer, 2016).

Psychological effects in clinical populations

Ever since scientific meditation research started in the 1970s, the findings in mostly healthy participants and some patient groups have raised hopes that meditation-based therapies could alleviate disorders associated with psychological factors and stress. The evidence so far suggests that meditation programs can result in small to moderate reductions of the most common psychological symptoms: stress, anxiety, depression, and chronic pain. However, most experts caution that larger studies with stronger designs are needed to determine the importance of the effects and the role of stress reduction with more severe mental health issues.

So far, the best evaluation of meditation programs for psychological stress and well-being is a review and meta-analysis conducted by an independent expert group led by Madhav Goyal at Johns Hopkins University (Goyal et al., 2014). It was published in one of the world’s leading medical journals (JAMA Internal Medicine) and set new standards for the evaluation of the clinical use of meditation for psychological and stress-related mental issues that amount to a clinical diagnosis.

The investigators screened 18 753 unique citations in the eight most important databases for scientific medical and psychological publications, and identified 1651 relevant full-text articles on the effects of nondirective, mindfulness, or other types of meditation. Previous meta-analyses had included studies in which those who learned meditation were compared to so-called passive control groups, meaning people on a waiting list or people receiving usual care. In this meta-analysis, however, the investigators only included studies in which the meditation programs were compared to other interventions in which contact time, attention, and expectations were comparable. In all the studies included, subjects were randomly allocated to a meditation program or another intervention. The meta-analysis also required that the studies include participants with a clinical diagnosis, which was broadly defined as mental health conditions (e.g., anxiety, depression, or stress) or physical conditions (e.g., chronic pain, hypertension, or heart disease). Only 47 trials with a total of 3,515 patients fulfilled the strict criteria that were applied for further analysis.

Despite the limited number and quality of the studies, the meta-analysis suggested that meditation reduces health problems associated with stress, anxiety, depression, and chronic pain. There was insufficient data to support an effect on positive mood, attention, sleep, substance use, weight, or eating habits. Because of the limitations, the investigators cautioned that the meta-analysis could not determine whether there exist any differences between nondirective and mindfulness meditation with respect to their relative psychological impact.

The researchers stressed that the scarcity of high quality studies does not necessarily exclude useful effects; rather, it emphasizes the boundaries of our current knowledge. Until recently, investigations of nondirective meditation have tended to be more focused on physiological changes, blood pressure, cardiovascular disease, and stress in nonclinical populations, whereas trials with mindfulness have focused more on mental disorders, neuroimaging, and stress reduction in clinical settings.

Interestingly, the meta-analysis showed similar effect size for meditation as for other active treatments, such as prescription drugs, exercise, and other behavior therapies. This finding resulted from comparison of trials with specific control groups, including interventions that are known to have positive effects beyond those resulting from positive expectations. The investigators also found it reassuring that the studies did not reveal any major negative results with meditation, compared to established standard therapies or other active control groups.

Mental health and quality of life

In summary, the meta-analysis from Johns Hopkins University—and many other systematic reviews—maintains that the clinical science of meditation should follow the same stringent evaluation criteria as for other new medical and psychological treatments. Determining the role of meditation-based therapies for patients with a clinical diagnosis requires more high-quality studies.

In contrast, the studies from New York and Scandinavia focus on the effects of meditation in a healthy working population. Participants in these studies registered for the programs because they were stressed, but not to an extent that kept them from working. In the New York participants, the load of psychological symptoms was higher than in the normal population, but not as high as in people with a mental health diagnosis. Both studies demonstrated that nondirective meditation reduces psychological symptoms associated with stress. Results from the New York study as well as the meta-analysis from Chemnitz University showed that the effect of nondirective meditation is stronger than that of directive techniques for muscle relaxation. The field study from Scandinavia demonstrated that nondirective meditation may be an effective ingredient in stress management programs at the workplace, with modest support from the companies involved.

For many people, the core of meditation is not about therapy, but personal discovery and development. Many aspects of this endeavor are beyond the type of questions that empirical science is fit to investigate. But as we have seen, many positive effects of nondirective meditation on stress and psychological issues are quantifiable and have already been demonstrated in a number of studies.

References

Benson, H. (1975; 2000). The Relaxation Response. New York: Avon Books.

Carrington, P. (1978). Clinically Standardized Meditation (CSM): Instructor’s kit. Kendall Park N.J.: Pace Educational Systems.

Carrington, P., Collings, G. H., Benson, H., Robinson, H., Wood, L. W., Lehrer, P. M., Woolfolk, R. L. & Cole, J. W. (1980). The use of meditation: Relaxation techniques for the management of stress in a working population. Journal of Occupational Medicine 22(4), pp. 221–231.

Cramer, H., Hall, H., Leach, M., Frawley, J., Zhang, Y., Leung, B., Adams, J. & Lauche, R. (2016). Prevalence, patterns, and predictors of meditatiton use among US adults: A nationally representative study. Scientific Reports 6(3670), pp. 1–9.

Derogatis, L. R. (1977). SCL-90 Manual-I. Baltimore: Johns Hopkins University School of Medicine.

Goyal, M., Singh, S., Sibinga, E. M., Gould, N. F., Rowland-Seymour, A., Sharma, R., Berger, Z., Sleicher, D., Maron, D. D., Shihab, H. M., Ranasinghe, P. D., Linn, S., Saha, S., Bass, E. B. & Haythornthwaite, J. A. (2014). Meditation programs for psychological stress and well-being: A systematic review and meta-analysis. JAMA Internal Medicine 174(3), pp. 357–368.

Hersoug, A. G., Wærsted, M. & Lau, B. (2018). Nondirective meditation used in stress management. Nordic Psychology, 70(4), pp. 290–303. DOI: 10.1080/19012276.2018.1443278.

Jacobson, E. (1929). Progressive Relaxation. Chicago: University of Chicago Press.

Peters, R. K., Benson, H. & Porter, D. (1977a). Daily relaxation response breaks in a working population: I. Effects on self-reported measures of health, performance, and well-being. American Journal of Public Health 67(10), pp. 946–953.

Peters, R. K., Benson, H. & Porter, D. (1977b). Daily relaxation response breaks in a working population: II. Effects on blood pressure. American Journal of Public Health 67(10), pp. 954–959.

Sedlmeier, P., Eberth, J., Schwarz, M., Zimmermann, D., Haarig, F., Jaeger, S. & Kunze, S. (2012). The psychological effects of meditation: A meta-analysis. Psychological Bulletin 138(6), pp. 1139–1171.