Meditation Research Paper

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Over the past several decades, hundreds of scientific studies have documented the deleterious effects of psychological stress on the psychological, behavioral, and physiological functioning of humans. Upon exposure to psychological stress a series of central and peripheral nervous system changes occurs that compromise our ability to think effectively and behave appropriately. Psychological stress also causes physiological changes that can cause and exacerbate somatic illness. Not surprisingly, attempts have been made to develop strategies to minimize the adverse effects of stress. Some of these management strategies are related to cognitive restructuring and other therapeutic approaches within the context of Western psychology; others, such as meditation, are related to older Eastern traditions. This research paper discusses meditation; its psychological, behavioral, and physiological effects; and how it can be effectively incorporated into the routine care of individuals who require mental and medical interventions.

Meditation Research Paper Outline

I. Historical Perspective

II. Physiology of Stress and the Relaxation Response

III. Meditation, the Relaxation Response, and Physiological Changes

IV. Rationale and Technique for Elicitation of the Relaxation Response

V. The Relaxation Response in Psychotherapy

VI. The Relaxation Response and Behavior Change

VII. Integrating the Relaxation Response into Health Care

I. Historical Perspective

The concept of meditation, as well as its therapeutic value, is frequently misunderstood. For centuries meditation has been associated with positive psychological benefits. Although many Eastern cultures have embraced the concept that regular meditation practice can alter one’s state of consciousness or enhance one’s perception of reality, the mystical or metaphysical overtones associated with meditation have inhibited Western societies from adopting it more extensively.

Twenty-five years ago, Benson and his colleagues began to examine the psychological and physiological components of meditation within a Western scientific and medical framework. After studying the cultural, religious, philosophical, and scientific underpinnings of meditation, Benson and his colleagues concluded that meditation requires only two specific steps: (1) focusing one’s attention on a single repetitive word, sound, prayer, phrase, image, or physical activity; and (2) passively returning to this focus when distracted. When one engages in these two steps, a set of predictable physiological events occurs within and outside the central nervous system (CNS) that promote a sense of calm and behavioral inactivity. Benson labeled this set of physiological events the relaxation response. The relaxation response is the biological consequence of a wide variety of mental focusing techniques, one of which is meditation. This widely applicable and beneficial concept should be routinely integrated into psychological, behavioral, and medical treatments.

To appreciate the short- and long-term effects of eliciting the relaxation response and its clinical use it is necessary to understand the physiology of stress.

II. Physiology of Stress and the Relaxation Response

More than 50 years ago, Cannon observed that mammals faced with life-threatening situations respond with predictable physiological arousal of the sympathetic nervous system (SNS) that prepares them to either face the threat or run away from it. He labeled this the now-familiar ‘‘fight-or-flight response.’’ This response stimulates physiological changes to facilitate vigorous skeletal muscle activity. SNS arousal, mediated by the release of epinephrine and norepinephrine, increases heart rate and blood pressure, which in turn accelerates blood circulation to meet the increased demand for oxygen, nutrients, and waste removal. Platelet activity also increases to enhance coagulation in the event of potential injury with blood loss.

Numerous psychological events (e.g., the perception of physical danger) can automatically elicit the fight-or-flight response. For primitive man, this response was necessary for survival. Today, faced with everyday stresses, such as being kept waiting in line or on the phone, we experience the same response to varying degrees.

The behavioral and physiological opposite of the fight-or-flight response is the relaxation response which is believed to be an integrated hypothalamic response that depresses SNS activity in a generalized manner. Forty years ago, Hess described this effect as the trophotropic response. By electrically stimulating the anterior hypothalamus of cats Hess was able to elicit signs of reduced sympathetic nervous system arousal including decreases in muscle tension, blood pressure, and respiration. This response was the opposite of what he termed ‘‘ergotropic’’ responses, which corresponded to the heightened state of SNS activity described by Cannon as the fight-or-flight response.

The early experimental work of Cannon and Hess, combined with the more recent observations of Benson and his colleagues, suggests that these two responses are actually symmetrical. Although both involve central and peripheral nervous system changes, the fight-or-flight response prepares the organism for action while the relaxation response prepares the organism for rest and calmness, behavioral inactivity, and restorative physiologic changes. Whereas repeated or prolonged elicitation of the fight-or-flight response has been implicated in illness related to stress and SNS arousal, repeated elicitation of the relaxation response appears to prevent or ameliorate stress-related disorders.

III. Meditation, the Relaxation Response, and Physiological Changes

Benson and his colleagues were among the first to use Western experimental standards to study the physiology of meditation and its potential clinical benefits. In experiments involving Transcendental Meditation conducted at the Harvard Medical School and at the University of California at Irvine, physiological parameters were monitored in subjects in both meditative and nonmeditative states. Measures of blood pressure, heart rate, rectal temperature, and skin resistance as well as electroencephalographic (EEG) events were recorded at 20-minute intervals. During the meditative states oxygen consumption, carbon dioxide elimination, respiratory rates, minute ventilation (the amount of air inhaled and exhaled in a 1-minute period), and arterial blood lactate levels (an indication of anaerobic metabolism)were reduced. These acute changes are all compatible with reduced SNS activity and were not evident when the subjects simply sat quietly. Since these initial demonstrations, others have documented that elicitation of the relaxation response results in important physiological changes that are mediated by reduced SNS activity.

In addition to the SNS effects of the relaxation response, its central nervous system effects have been dramatically illustrated in a controlled study of frontal EEG beta-wave activity. Novice subjects listened to either a tape designed to elicit the relaxation response or a control tape that provided a discussion of the relaxation response and its benefits. Using topographic EEG mapping, researchers found that elicitation of the relaxation response appeared to reduce cortical activation in anterior regions of the brain.

Another study has also provided evidence of the effect of the relaxation response on CNS indices of arousal. Jacobs, Benson, and Friedman examined the efficacy of a multifactor behavioral intervention for chronic sleep-onset insomnia. The interventions included education about sleep (e.g., sleep states, sleep architecture) and sleep hygiene (e.g., abstaining from alcohol, caffeine, and nicotine use in the evening), sleep scheduling, and modified stimulus control (restricting use of the bed to sleeping). The subjects were taught relaxation-response techniques and were instructed to practice them at bedtime. Those insomniacs exposed to the intervention exhibited significant reductions in sleep-onset latency and were indistinguishable from normal sleepers. More importantly, the insomniacs showed a marked reduction in cortical arousal, as assessed EEG power spectra analyses; specifically, the percentages of beta total power decreased from pre- to post-treatment.

The relaxation response training most likely mediated these reductions in cortical arousal and were therefore probably responsible for the dramatic decrease in sleep-onset latency. These findings in insomniacs support the contention that regular elicitation of the relaxation response leads to physiological changes opposite to those seen during the fight-or-flight response (i.e., decreased vs. increased cortical arousal, respectively).

Since the physiological changes and therapeutic effects of the regular elicitation of the relaxation response lead to significant beneficial physiological changes and these effects appear to be the same as those associated with rest and sleep, what extra benefits does this practice offer above and beyond those derived from sleeping? Actually, the two activities are quite different. Although oxygen consumption plummets within the first few minutes of eliciting the relaxation response (in this example through meditation), oxygen consumption during sleep decreases appreciably only after several hours. The concentration of carbon dioxide in the blood increases significantly during sleep, whereas during meditation it decreases. The electrical conductivity of the skin tends to increase during sleep, indicating reduced sympathetic activity. However, the rate and magnitude of sleep-related increases in skin conductivity are much smaller than those observed during meditation and other relaxation- response techniques. Researchers have demonstrated that CNS effects of the relaxation response also differ from those observed during sleep.

IV. Rationale and Technique for Elicitation of the Relaxation Response

A variety of techniques can be used to elicit the relaxation response, including meditation, progressive muscle relaxation, autogenic training, yoga, exercise, repetitive prayer, and the presuggestion phase of hypnosis. Although all of these strategies result in the same physiological response, two components appear to be essential to achieving the relaxation response: mental focusing and adopting a passive attitude toward distracting thoughts.

The following is an instructional set developed by Benson and his colleagues for elicitation of the relaxation response.

Step 1. Pick a focus word or short phrase that’s firmly rooted in your belief system.
Step 2. Sit quietly in a comfortable position.
Step 3. Close your eyes.
Step 4. Relax your muscles.
Step 5. Breathe slowly and naturally, and as you do, repeat your focus word, phrase or prayer silently to yourself as you exhale.
Step 6. Assume a passive attitude. Don’t worry about how well you’re doing. When other thoughts come to mind, simply say to yourself, ‘‘Oh, well,’’ and gently return to the repetition.
Step 7. Continue for 10 to 20 minutes.
Step 8. Do not stand up immediately. Continue sitting quietly for a minute or so, allowing other thoughts to return. Then open your eyes and sit for another minute before rising.
Step 9. Practice this technique once or twice daily.

Sample focus words, prayers, phrases include: One, Ocean, Love, Peace, Calm, Relax, ‘‘The Lord is my shepherd,’’ ‘‘Shalom,’’ ‘‘Insha’Allah,’’ or ‘‘Om.’’ Regular practice at eliciting the relaxation response has been shown to produce chronic physiological changes by at least two research groups. With repeated practice, patients can experience the benefits of relaxation throughout the day not only during actual practice periods.

It is the clinician’s responsibility to help the patient develop a personally relevant and effective technique. It is important to emphasize that adherence to relaxation regimens will be maximized by selecting a strategy that is compatible with the patient’s belief system and customary practices. It is useful to ask patients about their belief systems and to adapt an approach compatible with them. For example, a religious person might be more comfortable focusing on a familiar repetitive prayer, while someone interested in physical exercise might be more comfortable performing a repetitive exercise. The manner in which the response is elicited is immaterial since the psychological and physiological results are the same.

V. The Relaxation Response in Psychotherapy

For many patients with psychological disturbances, who might be hesitant to enter therapy, relaxation response training is a nonthreatening intervention that can be introduced prior to other more rigorous forms of therapy such as cognitive therapy or medication. Meditation and other modes of eliciting the relaxation response can be a means of preparing for standard psychotherapy by allowing the patient to observe thoughts and mental events.

In 1985, Kutz and colleagues were the first to systematically study the relationship between psychotherapy and meditation. They studied the change in psychological well-being and the impact on psychotherapy of a 10-week meditation program in 20 patients. The intervention consisted of weekly 2-hour group sessions and daily home practice. Patients showed significant decreases in psychological symptoms from pre- to post-treatment as measured by the Symptom Checklist 90 Revised (SCL-90R), a standard psychological inventory, and the POMS. Subjects experienced the largest decrease in depression and anxiety. These results suggested that meditation facilitated the goals of the psychotherapeutic process. It is worth considering why such meditation training may have been helpful.

Patients were instructed in mindfulness meditation and were taught how to become detached observers of their thoughts. This form of meditation helps patients increase their insight regarding how mental categories are developed. With the enhanced awareness patients can detach themselves from their habitual ways of thinking, and through therapy they can progress to greater cognitive flexibility and more adaptive self-images and lifestyle changes. Much of what occurs in psychotherapy is intended to bring about these changes. While meditation alone cannot obviate skilled therapy and is no substitute for a therapeutic alliance, it may be the case that the CNS changes that occur when meditation is used to elicit the relaxation response set the stage for more rapid and persistent psychotherapeutic change.

For many types of disorders such as anxiety and other stress-related disorders, elicitation of the relaxation response via meditation or other techniques can help reduce sympathetic nervous system activity, which can be a part of the treatment. Researchers have examined the effectiveness of meditation-based stress reduction program in a pilot study on patients with anxiety disorders.

Patients participated in an 8-week course in which they attended weekly 2-hour classes. In the sixth week they also attended an intensive 7.5-hour retreat. Patients showed significant reductions in anxiety, panic symptoms, and depression from pre- to post-treatment and results were maintained 3 years later. It has been suggested that, unlike those who participate in cognitive therapy, patients who practice mindfulness meditation are not asked to substitute one thought pattern for another. Instead, patients observe the ‘‘inaccuracy, limited nature, and intrinsic impermanence of thoughts in general and anxiety-related thoughts in particular.’’

While meditation and other techniques used to elicit the relaxation response can play an important role in the treatment of some psychological problems, such interventions might not be recommended for patients with certain personality disorders, dissociative disorders, or schizophrenia.

VI. The Relaxation Response and Behavior Change

Relaxation-response training can be used to facilitate behavior modification goals. Most patients who begin a diet or a smoking cessation program are able to stay with the program for short periods of time. When stresses arise, however, it generally becomes more difficult to maintain the new routine. Coping with stress and anxiety has a ‘‘psychic cost’’ that takes the form of a diminished capacity for self-regulation. Presumably, the cause of this ‘‘stress disinhibition effect’’ is a depletion in the cognitive and emotional resources required to maintain self-regulation. Increased stress and anxiety lead to immediately gratifying, but ultimately damaging behaviors, such as dietary indiscretions, alcohol or drug abuse, and an increase in smoking. Relaxation training has proved to be effective as an acute coping strategy to reduce anxiety.

The extent to which stress-related relapses are prevented is directly related to the degree to which relaxation- response training alleviates stress and anxiety. For example, smoking-cessation programs are unsuccessful in about 60 to 80% of cases and stress has been identified as a major contributor to this high rate of failures. In a recent study, smokers who had completed a smoking-cessation program were assigned to either a relaxation training or a control group each of which met for 3 months. The relaxation-based intervention included audiotapes for home training in guided imagery techniques. The relaxation group was asked to practice 20 minutes a day at least four times a week. Relaxation-trained subjects reduced stress, enhanced imagery effectiveness, and, perhaps most importantly, were more successful in abstaining from smoking compared with control subjects who were not exposed to the training. During a 3-month follow-up only 28% of the relaxation-trained subjects relapsed whereas 49% of the control subjects resumed smoking.

Since relaxation training is often taught as a part of behavior-change programs with multiple components it is difficult to measure to what degree the beneficial effects are attributable to relaxation training alone. The effect of relaxation training was evaluated in one of the most successful behavior-change programs, the Lifestyle Heart program, developed by Ornish. In this program relaxation training is combined with diet and exercise regimens as well as group support to reduce symptoms in patients with coronary heart disease. In a controlled trial patients attended a weeklong retreat followed by two 4-hour sessions each week thereafter. They performed 1 hour of aerobic exercise and participated in 1-hour sessions of stress management techniques which consisted of relaxation, yoga, stretching, breathing techniques, meditation, and guided imagery.

Among the participants the mean degree of coronary artery stenosis regressed from 61.1 to 55.8%. These results were compared with those in a group of nonparticipating patients in whom the mean degree of stenosis actually progressed from 61.7 to 64.4%. Analysis also showed that diet alone could not account for the beneficial effects. While almost all the patients maintained a healthier diet, those who practiced stress management more often showed greater stenotic regression.

In another study involving 156 patients who had had a myocardial infarction, relaxation response training augmented the effects of concurrent therapeutic strategies. Patients were randomized into two groups: one was given physical exercise training alone and the other was given both physical exercise and relaxation training. Several questionnaires were administered: the State-Trait Anxiety Inventory (a 40-item standardized anxiety inventory); a sleeping habits questionnaire (a 10-item questionnaire concerning hours of sleep, sleep quality, etc.); a functional complaints questionnaire (a 25-item inventory concerning complaints frequently expressed by cardiac patients); and the Heart Patients Psychological Questionnaire (HPPQ) (including scales on well-being, subjective invalidity, displeasure, social inhibition). Patients in the exercise-only group reported no change in psychological measures, whereas the group who received relaxation training reported less anxiety and subjective invalidity. The two groups also differed on physical outcomes as measured by exercise testing. Improvement was defined as the absence of signs of cardiac dysfunction that required treatment and was greater in the relaxation-training-and-exercise group compared with the exercise-only group.

VII. Integrating the Relaxation Response into Health Care

The relaxation response has been associated with improvements in many medical conditions including: hypertension, cardiac arrhythmias, chronic pain, insomnia, side effects of cancer therapy, side effects of AIDS therapy, infertility, and preparation for surgery and X-ray procedures. It is also important to indicate that more recently, the overall implications of integrating relaxation response in routine clinical treatments has been examined. Some relevant examples will be discussed.

The effect of a behavioral group intervention that included relaxation response training on chronic pain patients. One hundred and nine patients who were members of an HMO participated in the study. The average duration of pain among the patients was 6.5 years. The interventions consisted of 90-minute group sessions, which were held once a week. At the end of the 10-week intervention period, participants in the group showed decreases in negative psychological symptoms including anxiety, depression, and hostility. This study also showed that such an intervention could result in significant cost savings. Group participants showed a 36% decrease in clinic use during the first and second year following the intervention. This latter result is particularly pertinent. There is a growing interest in the use of nonpharmacologic interventions such as elicitation of the relaxation response to not only facilitate psychological and medical goals but to help reduce medical utilization and costs. The above study is simply an example of the way in which such interventions can have this positive economic effect while at the same time have beneficial clinical outcomes.

Relaxation-response training was shown to improve outcomes among a group of patients with peripheral vascular disease who underwent femoral angiography. Forty-five patients participated in the study. Patients listened to either a relaxation tape that included instruction in progressive muscle relaxation and cognitive relaxation involving mental focusing or to a tape of recorded music. A third group of patients listened to a blank tape. Patients who listened to a relaxation- response tape experienced less anxiety and pain during the surgical procedure and requested significantly less medication that those patients who listened to the tape of recorded music or the blank tape. This study also showed that relaxation-response training can be administered very inexpensively and in ways that are practical for staff and patients.

Clearly, there is substantial research that shows that meditation and other relaxation-response techniques can be effective components in psychotherapy, behavior- change programs, and in medical treatment. Resistance to adjunctive use of such treatments, especially elicitation of the relaxation response, appears to be waning. A recent survey of medical schools found that approximately two-thirds now include discussions of relaxation techniques in their medical training. Knowledge of relaxation-response training can be helpful to physicians not only for the physiological benefits to patients but because many patients who present with medical problems really have a psychological disorder. Such patients may feel uncomfortable about seeing a mental health professional or participating in psychotherapy. Relaxation techniques can be a means for the physician to start a dialogue about dealing with psychological disorders.

While the use of relaxation training is unquestioned in psychological treatment, there are still barriers to its use in medical settings. One barrier is a misunderstanding of the relaxation-response interventions and why they are used. Meditation and other introspective procedures bring about important central and peripheral physiological changes because they elicit the relaxation response. These central and peripheral changes are compatible with better mental and physical well-being. However, no single intervention can work for everyone. More research to define under what specific circumstances relaxation-response training would be most beneficial and cost effective for which patients still needs to be completed.

Many practitioners, insurers, and patients remain confused about the differences between the use of such services and psychotherapy. Relaxation training alone and when used with other types of behavioral therapies is more focused than traditional psychotherapy. It is often conducted in groups settings, and sessions are limited to 8 to 10 sessions. The important difference is that while the goal of psychotherapy is to change psychological symptoms, the goal of relaxation-response training with medical conditions is to change somatic manifestations. Relaxation training should be better understood, more routinely used, integrated, as well as paid for in medical settings. Such integration is imperative to the clients/patients and society.

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