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Hypnotic Suggestibility
Hypnotic suggestibility is influenced by a number of personal attributes, among them the capacity for concentration, the ability to surrender one's attention to commanding images, the tolerance of unusual experiences, and the trust of the hypnotist or induction program involved. Because meditation depends in large part on concentration [34] and the tolerance of unusual experiences, it is not surprising that several contemporary studies have shown a relationship between it and suggestibility.
Delmonte (1981) tested thirty-six subjects using Barber's Scale for Hypnotic Suggestibility during both meditation and rest, with subjects acting as their own controls, and found that during meditation subjects were significantly more suggestible. This finding was similar to one made by Davidson et al. (1976a), who reported that higher absorption scores among meditators was due to the practice of meditation.
Walrath and Hamilton (1975) reported that there is some indication that TM is related to hypnotic susceptibility. In their study, although only 44% of the non-TM volunteer subjects were rated as highly susceptible, with scores of 10 or higher on the Stanford Hypnotic Susceptibility Scale, 100% of the TM practitioners received scores of 11 or 12 on the Stanford Scale. Walrath and Hamilton concluded that either the practice of TM increases susceptibility to hypnosis or only highly susceptible subjects find sufficient reinforcement in the technique to continue its practice. Using the Harvard Group Scale of Hypnotic Susceptibility and the Field Depth of Hypnosis Inventory to test hypnosis, Van Nuys (1973) also found that hypnotic susceptibility correlated with subjects' initial skill at meditating.
On the other hand, Rivers and Spanos (1981) assessed 147 students on absorption, hypnotic susceptibility, three measures of psychological well-being, and their response to meditation, concluding that differences between meditators and nonmeditators may be due to self-selection. Earlier, Spanos et al. (1980a) and Spanos et al. (1978) found that hypnotic susceptibility correlated significantly with subjects' initial skill at meditating.
Recent studies have shown that meditation and practices such as Progressive Relaxation reduce both acute and chronic anxiety. This finding agrees with the assertion in nearly all traditional teachings that contemplation reduces unwarranted fear. The various traditions give somewhat different (though related) reasons for this, however. For example, Buddhism maintains that the eight-fold path or its variations relieve suffering (including fear) by eliminating egotism and desire; Vedanta and Samkhya claim that yoga removes the anxieties born of false attachments; and some Christian mystics say that union with God drives away the concerns of the world. Contemporary studies, on the other hand, interpret meditation's success in reducing anxiety with clinical terms such as lowered arousal of the sympathetic system or the reduction of cognitive dissonance. Modern and traditional understandings of the matter do share certain features, though, among them the observations that calming mental activity helps produce calmer bodies, that concentration helps unify scattered feelings and thoughts, that introspection facilitates catharsis, that self-mastery builds a self-confidence that mitigates fear.
It is important, however, to note a fundamental difference between the aims of modern therapy and most spiritual traditions, namely that the latter generally aim to remove suffering rather than alleviate it. In this, they often regard affliction as an aid to spiritual transformation and therefore something to be learned from. Even when therapies try to deepen self-awareness through continued focus on presenting symptoms, they do not seek the deep liberation that the great ways of enlightenment promote. On the other hand, by promoting liberation, contemplation may eliminate symptoms automatically.
Delmonte (1985b) reviewed the literature on meditation and anxiety reduction, and concluded that those who practice meditation regularly tend to show significant decreases in anxiety, although meditation does not appear to be more effective than other types of intervention, such as hypnosis [see Edwards (1991) and Eppley et al. (1989)].
Davidson and Schwartz (1984) argued that different relaxation techniques (progressive relaxation, hypnotic suggestion, autogenic training, and meditation) activate different major modes or systems, and that the effects of a particular relaxation technique can be meaningfully understood only after determining the type of dependent variable employed. For example, progressive relaxation, a somatic technique, was significantly superior to hypnotic relaxation, a cognitive technique, on a number of somatic measures, while the results on a cognitive measure yielded no significant differences. They demonstrated that the cognitive and somatic contributions to anxiety can be meaningfully separated, and they stated that two general principles pertaining to relaxation and anxiety reduction apply: first, that self-regulation of behavior (including voluntary focusing of attention) in a given mode will reduce (or inhibit) unwanted activity in that specific mode; and second, that self-regulation of behavior in a given mode may, to a lesser degree, reduce unwanted activity in other modes.
These researchers hypothesized that forms of Zen meditation that require that the person count his breaths or say a mantra in synchrony with breathing are particularly effective because they simultaneously attenuate both cognitive and somatic anxiety. They suggested that meditation involving the generation of cognitive events (TM's mantra) should elicit greater changes on measures of cognitive processing than meditation on somatic events (breathing), which would result in greater changes on measures of somatic activation. They concluded that it is valuable to assess anxiety in a more systematic way so as to uncover the specific modes in which the unwanted behavior is occurring. Only then will it be possible to determine which relaxation technique might be most effective in reducing anxiety for a given patient in a given state. In addition, the procedure selected must be acceptable to the patient, since his or her motivation to faithfully practice a given technique is crucial to the outcome of treatment.
The following studies have analyzed the relationship between meditation and anxiety:
Kabat-Zinn et al. (1992) Twenty-two study participants were screened with a structured clinical interview and found to meet the DSM-III-R criteria for generalized anxiety disorder or panic disorder with or without agoraphobia. The subjects participated in an eight-week meditation-based stress reduction and relaxation program with a three-month follow-up period. The study found significant reductions in anxiety and depression scores and a reduction in panic symptoms after treatment for twenty of the subjects—changes that were maintained at follow-up.
Edwards (1991) A meta-analysis was conducted to determine the effects of meditation and hypnosis techniques on psychometric measures of anxiety. The chief measure employed in the evaluated research was the State-Trait Anxiety Inventory (Spielberger, 1970; 1983). The analysis included twenty-one hypnosis studies and fifty-four meditation studies. Both techniques were effective in reducing measures of state anxiety. However, for measures of trait anxiety, meditation was more effective.
Steptoe and Kearsley (1990) This study evaluated the influence of meditation and physical exercise on cognitive and somatic anxiety, using 340 meditators, competitive athletes, recreational exercisers, and sedentary controls. Results did not confirm that meditation is associated with reduced cognitive anxiety or that exercise is linked with lower somatic anxiety.
Eppley et al. (1989) The authors conducted a meta-analysis of studies on the effects of relaxation techniques on trait anxiety. Effect sizes for the different treatments (e.g. progressive relaxation, biofeedback, meditation) were calculated. Most treatments produced similar effect sizes, although Transcendental Meditation produced a significantly larger effect size than other forms of meditation and relaxation. A comparison of the content of the treatments and their differential effects suggests that this may be due to the lesser amount of effort involved in TM. Meditation that involved concentration had a significantly smaller effect than progressive relaxation.
Muskatel et al. (1984) Fifty-two undergraduates who had volunteered to receive meditation training were placed into either high or low time-urgency groups based on their scores on Factor S of the Jenkins Activity Survey. Subjects then either received training in Clinically Standardized Meditation followed by three-and-one-half weeks of practice or waited for training during that period. Analyses of scores on a time-estimation task and of self-reported hostility during an enforced waiting task indicated that meditation significantly altered subjects' perceptions of the passage of time and reduced impatience and hostility resulting from enforced waiting.
Beiman et al. (1984) Fifty-two respondents to an ad for anxiety reduction therapy were randomly assigned to TM, behavior therapy, self-relaxation, or a waiting-list control group. They were evaluated before and after treatment on multiple self-report and psychophysiological measures. The results of multivariate analyses of variance indicated there were no significant differerential treatment effects. The results of stepwise multiple regression analyses performed separately for each experimental condition indicated that client characteristics accounted for significant portions of the variance in one or more of the dependent variables for each treatment. Clients who reported perceiving more internal locus of control benefited more from TM than clients who reported greater external locus of control.
Heide and Borkovec (1983) This study was designed to document the occurrence of relaxation-induced anxiety. Fourteen subjects suffering from general tension were given one session of training in each of two relaxation methods, progressive relaxation and mantra meditation. Four subjects, plus one other who terminated prematurely, displayed clinical evidence of anxiety reaction during a preliminary practice period, while 30.8% of the total group under progressive relaxation and 53.8% under focused relaxation reported increased tension due to the relaxation session. progressive relaxation produced greater reductions in subjective and physiological outcome measures and less evidence of relaxation-induced anxiety.
Kindlon (1983) Thirty-five undergraduate volunteers were randomly assigned to either a meditation group or a sleep/rest control group balanced for expectancy to compare the function of these treatments in the alleviation of test anxiety. Self-report, performance, and physiological indices were assessed, as moderated by gender, Scholastic Aptitude Test score, frequency of practice, repression, and expectancy of relief. The treatments were equally effective in reducing test anxiety.
Lehrer et al. (1983) Physiological and self-report data were collected on sixty-one anxious subjects who were recruited from newspaper ads and randomly assigned to a Progressive Relaxation, mantra meditation, or control group. Both progressive relaxation and meditation generated positive expectancies and produced decreases in a variety of self-reported symptoms and on EMG, but no skin conductance or frontal EEG effects were observed. progressive relaxation produced bigger decreases in forearm EMG responsiveness to stressful stimulation and a generally more powerful therapeutic effect than meditation. Meditation produced greater cardiac-orienting responses to stressful stimuli, greater absorption in the task, and better motivation to practice than Progressive Relaxation, but it also produced more reports of increased transient anxiety.
DeBerry (1982) Thirty-six female volunteers ranging in age from sixty-three to seventy-nine years participated in a twenty-week study designed to evaluate the effects of meditation/relaxation on symptoms of anxiety and depression. Subjects, 83% of whom were widows, were selected because of complaints of anxiety, nervousness, tension, fatigue, insomnia, sadness, and somatic complaints. Subjects were randomly assigned to one of three groups: (1) relaxation/meditation, (2) relaxation/meditation with a ten-week follow-up consisting of practice on a daily basis using relaxation/meditation tapes, and (3) a pseudorelaxation control group (N=12 per group). The treatment groups received one week of baseline evaluation, ten weeks of weekly thirty-minute training sessions, and a ten-week follow-up, with taped relaxation sessions for group 2. The control group followed an identical schedule for ten weeks but did not participate in the follow-up. The Spielberger Self-Evaluation Questionnaire and the Zung Self-Rating Depression Scale were administered before treatment, at the end of the ten weeks of training, and again at the end of the follow-up period (for the treatment groups). In comparison to the control group, the treatment groups manifested a significant pre- to posttreatment decrement for both state and trait anxiety. When the treatment groups were compared as to the efficacy of the follow-up practice sessions, it was found that the practice group continued to show a decrement in state anxiety while the nonpractice group exhibited a return toward baseline levels. However, trait anxiety continued to decrease for both groups. In terms of depression, there was a tendency toward a decrease in mean symptom scores that failed to reach significance. Yet, when questions that correlated highly with anxiety and somatic symptoms were removed and analyzed separately, a significant pre- to posttreatment decrement was noted.
Woolfolk et al. (1982) Thirty-four subjects were recruited from advertisements in local newspapers and received training in meditation or progressive relaxation, or were assigned to a control group. Subjects were tested using the SCL-90, IPAT Anxiety Inventory, and the Lehrer-Woolfolk Anxiety Symptom Questionnaire. Their behavior was also rated weekly by a spouse or roommate. The Progressive Relaxation and meditation treatments resulted in a significant reduction of stress symptomatology over time.
Fling et al. (1981) Sixty-one undergraduate volunteers were randomly assigned to clinically standardized meditation, quiet sitting, or waiting-list groups. Nineteen others were assigned either to a group practicing "open focus," a technique that begins with awareness exercises focusing on bodily spaces and continues to an expanded awareness of space permeating everything, or to a waiting list. All subjects were tested before training and again eight weeks later. All groups except the waiting list decreased significantly on Spielberger's Trait Anxiety.
Throll (1981) The Eysenck Personality Inventory, the State-Trait Anxiety Inventory, and two questionnaires on health and drug usage were administered to thirty-nine subjects before they learned TM or progressive relaxation. All subjects were tested immediately after they had learned either technique and then retested five, ten, and fifteen weeks later. There were no significant differences between groups for any of the psychological variables at pretest. However, at posttest the TM group displayed more significant and comprehensive results (decreases in Neuroticism/Stability, Extraversion/Introversion, and drug use) than did the progressive relaxation group. Both groups demonstrated significant decreases in State and Trait Anxiety. The more pronounced results for meditators were explained primarily in terms of the greater amount of time that they spent on their technique, plus the differences between the two techniques themselves.
Carrington et al. (1980) The authors studied 154 New York Telephone employees, self-selected for stress, who learned one of three techniques—clinically standardized meditation, respiratory one method meditation, or progressive relaxation—or who served as waiting-list controls. At 5.5 months, the treatment groups showed clinical improvement in self-reported symptoms of stress using the SCL-90-R Self-Report Inventory, but only the meditation groups showed significantly more symptom reduction than the controls. The authors concluded that meditation training has considerable value for stress-management programs in organizational settings.
Lehrer et al. (1980) Thirty-six volunteer subjects were assigned to a progressive relaxation group, a clinically standardized meditation group, or a waiting-list control group asked to relax daily without specific instructions. Subjects were given the state and trait scales of the State-Trait Anxiety Inventory and the IPAT Anxiety Inventory two times, separated by five weeks, during which the two treatment groups received four weekly sessions of group training. At the end of the five-week period all subjects were tested in a psychophysiology laboratory where they were exposed to five very loud tones. Using the techniques they had learned while anticipating the loud tones, the meditation group exhibited higher heart rates and higher integrated frontalis EMG activity. However, they also showed greater cardiac decelerations following each tone, more frontal alpha, and fewer symptoms of cognitive anxiety than the other two groups, according to the two inventories.
Raskin et al. (1980) Thirty-one chronically anxious subjects were studied to compare their responses to muscle biofeedback, TM, and relaxation therapy. The study consisted of a six-week baseline period, six weeks of treatment, a six-week posttreatment observation period, and later follow-up. Each subject was ranked according to the degree of improvement on five anxiety variables: Taylor Manifest Anxiety Scale Score, Mean Current Mood Checklist score, situational anxiety, symptomatic distress, and sleep disturbance. The results indicate that neither EMG feedback nor TM is any more effective in alleviating the symptoms of chronically anxious patients than relaxation therapy. Additionally, the three treatments were similar with respect to both the time course for obtaining therapeutic results and the subjects' ability to maintain these results once they were obtained.
Kirsch and Henry (1979) This study examined the effect of self-desensitization and meditation in the reduction of public speaking anxiety. Thirty-eight speech-anxious students were assigned to a control group or one of the following self-administered treatment conditions: systematic desensitization, desensitization with meditation replacing progressive relaxation, or meditation only. The results indicated that the three treatments were equally effective in reducing anxiety, and all of them produced a greater reduction in self-reported (but not behavioral) anxiety than that found in untreated subjects. Reliable changes in physiological manifestations of anxiety were found only in those subjects who rated the treatment rationale as highly credible. High credibility ratings were also associated with significanty greater reductions in self-reported anxiety.
Benson et al. (1978b) This study explored the efficacy of two nonpharmacological techniques for therapy of anxiety: a simple, meditational relaxation technique and a self-hypnosis technique. Thirty-two patients were divided into two groups and instructed to practice the assigned technique daily for eight weeks. Change in anxiety was determined by psychiatric assessment, physiological testing, and self-assessment. There was essentially no difference between the two techniques in therapeutic efficacy according to these evaluations. Psychiatric assessment revealed overall improvement in 34% of the patients, while self-rating assessment indicated improvement in 63% of them.
Thomas and Abbas (1978) Using the Middlesex Hospital Questionnaire (which measures free-floating anxiety and obsessions) and the Spielberger State-Trait Anxiety Inventory, this study found TM and progressive relaxation to be equally effective in reducing anxiety among a group of anxious subjects. The authors suggested that the only way to evaluate claims made by TM practitioners was to compare them with others who are using alternative treatments (or coping mechanisms) with measurement criteria strictly defined.
Davies (1977) Spielberger's State-Trait Anxiety Inventory and Shostrom's Personal Orientation Inventory were completed by three groups of undergraduates. A group of twenty-five was taught TM, a group of forty was taught progressive relaxation, and a group of twenty-seven acted as controls. Seven weeks later, both inventories were readministered to all groups. Only the subjects who regularly practiced TM showed a significant reduction in trait-anxiety scores compared with controls.
Stern (1977) The Trait Anxiety Scale of Spielberger's State-Trait Anxiety Inventory was administered to an experimental group of thirty-seven subjects practicing the TM technique and to a control group of fifteen subjects not practicing TM. The meditators were found to be significantly less anxious than the nonmeditators.
Lazar et al. (1977) Four weeks after learning the TM technique, eleven subjects showed a significant decrease in mean anxiety scores on Campbell and Stanley's Recurrent Institutional Cycle Design and the IPAT Anxiety Scale Questionnaire. Similar results were obtained in a second experiment.
Ross (1977) Seventeen students who practiced TM regularly and thirteen who learned TM but did not practice it regularly were given the IPAT Anxiety Scale and the Psychoticism, Neuroticism, Extroversion, and Lie scales of the PENL before and three to four months after starting the TM program. Analyses of covariance showed that neuroticism declined significantly more among the regular meditators. There was a similar trend of greater decreases for the regular meditators in anxiety and psychoticism, although these differences in changes over the three- to four-month period only approached significance. No changes were observed in the other scales.
Kanas and Horowitz (1977) This study experimentally tested the claimed stress-reducing effects of TM. Two stress films were shown to a group of sixty meditators and nonmeditators. Stress response was observed through the use of cognitive and affective measures, employing content analysis techniques and self-ratings. On several self-rating scales, a group of subjects who had signed up to be initiated into TM rated themselves significantly more emotionally distressed than either a control group or other meditators. There was a trend for meditators who meditated during the experiment to show less stress response to the films than meditators who were told not to meditate. However, this difference was significant on only one measure, a subjective stress scale.
Shapiro (1976b) This study combined the self-control techniques of Zen meditation and behavioral self-management, and applied them to a case of generalized anxiety. The subject was a female undergraduate student who complained of "free-floating anxiety" and who described her feelings of loss of self-control and anxiety as an "overpowering feeling of being bounced around by some sort of all-powerful forces." Intervention consisted of training in behavioral self-observation and functional analysis, a weekend of Zen experience, and three weeks of formal and informal meditation. Results indicated a significant decrease in daily feelings of anxiety and stress during the intervention phase.
Nidich et al. (1973) The State-Trait Anxiety Inventory A-State Scale was administered to eight experimental subjects and nine control subjects two days before the experimental subjects began the practice of TM. Six weeks later the subjects were asked to carry out a demanding task, after which the control group was instructed to sit with eyes closed and the experimental group was instructed to meditate for fifteen minutes. The anxiety scale was then readministered. Mean anxiety scores for the two groups were not significantly different on the first administration of the test. The reduction in anxiety between the two tests was significantly greater for the meditators than for the nonmeditators. Since both groups were exposed to knowledge about the TM program but only the experimental group was instructed in the technique, it appeared that the reduced anxiety in the meditators was due to the experience of TM rather than knowledge about it.
Puryear et al. (1976) One hundred fifty-nine Association of Research and Enlightenment members were randomly assigned to either a treatment or control group, with the former learning a new meditation technique (Edgar Cayce's approach) and the latter continuing their customary daily pattern. Analysis of variance was used to compare group means of the scale scores yielded by the IPAT Anxiety Scale and the Mooney Problem Check List. Unlike the control group, the treatment group reported highly significant reductions on the IPAT Anxiety Scale scores after twenty-eight days of meditation with the new approach. No significant differences were found on the checklist variables for either the treatment or control group.
Davidson et al. (1976a, 1976b) Attentional absorption and trait anxiety in fifty-eight subjects divided into four groups: controls who were interested in but did not practice meditation, beginners who had meditated for one month or less, short-term meditators who had practiced regularly for one to twenty-four months, and meditators who had practiced for more than two years. Subjects were administered the Shor Personal Experiences Questionnaire, the Tellegen Absorption Scale, and the Spielberger State-Trait Anxiety Inventory. The results indicated reliable increases in measures of attentional absorption, in conjunction with a reliable decrement in trait anxiety across groups as a function of length of time meditating.
Goleman & Schwartz (1976) This study compared meditation and relaxation for their ability to reduce stress reactions in a laboratory threat situation. Thirty experienced meditators and thirty controls either meditated or relaxed, with eyes closed or with eyes open, then watched a stressor film. Stress response was assessed by phasic skin conductance, heart rate, self-report, and personality scales. Meditators habituated heart rate and phasic skin-conductance responses more quickly to the stressor impacts and experienced less subjective anxiety (as indicated by the Activity Preference Questionnaire, State-Trait Anxiety Inventory, and Eysenck Personality Inventory).
Smith (1975c) In this study, two experiments were conducted to isolate the trait-anxiety-reducing effects of TM from expectation of relief, and the concomitant ritual of sitting twice daily. Experiment 1 was a double-blind study in which forty-nine anxious college student volunteers were assigned to TM and fifty-one were assigned to a control treatment, "periodic somatic inactivity" (PSI). PSI matched form, complexity, and expectation-fostering aspects of TM, but incorporated a daily exercise that involved sitting twice daily rather than sitting and meditating. In experiment 2, two parallel treatments were compared, both called "cortically mediated stabilization" (CMS). Twenty-seven volunteers were taught CMS 1, a treatment that incorporated a TM-like meditation exercise, and twenty-seven were taught CMS 2, an exercise designed to be the near antithesis of meditation (deliberate cognitive activity). The dependent variables were self-reported trait anxiety measured by the State-Trait Anxiety Inventory A-Trait Scale and anxiety symptoms of striated muscle tension and autonomic arousal as measured by the Epstein-Fenz Manifest Anxiety Scale. Results show six months of TM and PSI to be equally effective and eleven weeks of CMS 1 and CMS 2 to be equally effective. Differences between groups did not approach significance. The results strongly support the conclusion that the crucial therapeutic component of TM is not the TM exercise.
Girodo (1974) In this study, nine patients diagnosed as anxiety neurotics were monitored for anxiety symptoms with an anxiety symptom questionnaire before practicing yoga meditation at each training session. After approximately four months of practice, five patients improved significantly, while the other four failed to show any appreciable decline in anxiety symptoms. These four then meditated while engaged in imaginal flooding, where they imagined the worst thing that could happen to them. During meditation and imaginal flooding a decrement in anxiety occurred. Analysis of patient characteristics suggested that yoga meditation was beneficial for patients with a short history of illness and that flooding was effective for those with a long history.
Hjelle (1974) Fifteen experienced TM meditators and twenty-one novice meditators were administered Bendig's Anxiety Scale, Rotter's Locus of Control scale, and Shostrom's Personal Orientation Inventory of self-actualization. As predicted, experienced meditators were significantly less anxious and more internally controlled than beginning meditators. Likewise, experienced meditators were significantly higher, i.e., more self-actualized, on seven of Shostrom's twelve subscales.
Nidich et al. (1973) The State-Trait Anxiety Inventory A-State Scale was administered to eight experimental subjects and nine control subjects two days before the experimental subjects began learning the TM technique. Six weeks later the subjects were asked to carry out a demanding task; immediately afterward the control group was instructed to sit with eyes closed and the experimental group to meditate for fifteen minutes. The anxiety scale was then readministered. Mean anxiety scores for the two groups were not significantly different on the first administration of this test. At the second administration of the test, however, the reduction in anxiety was significantly greater for the meditators.
Vahia et al. (1973) In this study, ninety-five outpatients, diagnosed as psychoneurotic, acted as subjects. All of them had failed to show improvement as a result of previous treatments. Half were taught yoga and meditation, and they practiced these techniques for one hour a day for four to six weeks. The other half, the controls, were given a pseudotreatment consisting of exercises resembling yoga asanas (postures) and pranayamas (breathing exercises). Control subjects were asked to write down all the thoughts that came into their minds during treatment, and they followed the same daily schedule as the experimental group. Both groups were given the same support, reassurance, and placebo tablets, and were assessed clinically before, during, and after treatment. Following treatment, the experimental group exhibited a significant mean decrease in anxiety, measured on the Taylor Manifest Anxiety Scale. The control group exhibited no significant change on this scale. Overall, 74% of the experimental group were judged to be clinically improved after treatment as against only 43% of the control group (improvement in the control group being attributed to a combination of involvement in research and therapist's time). The authors concluded that meditation and yoga are significantly more effective than a pseudotherapy in the treatment of psychoneurosis.
For other studies examining the relationship between meditation and anxiety, see: Alexander et al. (1993), Weinstein and Smith (1992), Snaith et al. (1992), Fulton 1990), Coleman (1990), Traver (1990), DeBerry et al. (1989), Soskis et al. (1989), Collings (1989), Agran (1989), Kalayil (1989), Jangid et al. (1988a), Sawada and Steptoe (1988), Delmonte and Kenny (1987), Delmonte (1986a), Shaw (1986), Benson (1986), Callahan (1986), DeLone (1986), van Dalfsen (1986), Benson (1985a), Blevins (1985), Kutz et al. (1985a, 1985b), Delmonte and Kenny (1985), Delmonte (1985a, 1985d), Hungerman (1985), Gilmore (1985), Norton et al. (1985), Scardapane (1985), Steinmiller (1985), Maras et al. (1984), Benson (1984b), Clark (1984), Cummings (1984, Gitiban (1983), Hirss (1983), Goldberg (1982), Kindlon (1982), Schuster (1982), Borelli (1982), DeBlassie (1981), Jones (1981), Denny (1981), Zeff (1981), Curtis (1980), Gordon (1980), Bridgewater (1979), Joseph (1979), Diner (1978), Bahrke (1978), Comer (1978), Goldman (1978), Hendricksen (1978), Lewis (1978a), Pelletier (1976b, 1978), Scuderi (1978), Wampler (1978), Wood (1978), Berkowitz (1977), Traynham (1977), Weiner (1977), Fabick (1976), Schecter (1975), and J. Shapiro (1975).
Psychotherapy and Addiction
Psychotherapy as we know it now did not exist when the major contemplative traditions developed, so comparisons between its effects and those of meditation cannot be made precisely. Contemplative activity, however, has generally been said to have a healing effect on mind and body. More than fifty contemporary studies argue for this connection, showing that meditation has helped relieve addiction, neurosis, obesity, claustrophobia, headache, anxiety, and other forms of distress. It is important to remember that, although traditional contemplative teachings may give the same reasons for these healing effects that contemporary psychology and medicine do, they generally aim at a more radical liberation from suffering.
Craven (1989) suggests there are several factors that need to be kept in mind when evaluating various studies. These include: the length of time and training of meditation; the context within which it is practiced; personality differences between meditators and the general population; variability in outcome measures and the difficulty in operationalizing psychotherapeutic change. Another variable that should be considered is that various meditation practices may produce different psychological effects. Epstein (1990a) discusses meditation as involving two distinct attentional strategies (Goleman, 1977), the first being concentration on a single object and the second moment-to-moment awareness of changing objects of perception (mindfulness). The concentration practices are used to provide enough stability of mind to attempt the second type of practice (mindfulness). Like free-association and evenly suspended attention, mindfulness practices encourage the development of an observing self and initially promote the emergence of unconscious material. As meditation progresses, however, emphasis shifts from intrapsychic content to intrapsychic process, and proceeds to illuminating the actual representational nature of the inner world. In very advanced mindfulness meditation, one can become aware of the relationships between one’s behavior, physiological functioning, and mental activity. See Delmonte (1990b) for a discussion of the effects of concentration and mindfulness practices. As can be seen from the discussion above, there is a developmental aspect to meditation practice, therefore, psychological effects can vary with length of practice. See Shapiro (1992a, 1992b) and Epstein (1990a, 1990b).
Psychiatry and Psychotherapy
Delmonte and Kenny (1987) evaluated meditation as an adjunct to psychotherapy. They concluded that meditation practice may be associated with the acquisition of useful skills (focused attention) and may be physiologically relaxing. They also concluded that meditation may decrease anxiety, insomnia, and drug usage, while enhancing hypnotic induction and self-actualization. However, they concluded that there is still no compelling evidence that meditation practice is associated with unique state effects compared with other relaxation procedures. Furthermore, they concluded that the long-term objectives of meditation are not generally congruent with those of mainstream psychotherapy, since they go beyond therapeutic gain in the clinical sense [see also Delmonte and Kenny (1985)]. Earlier, Delmonte (1986a) concluded that meditation as an intervention strategy was successful with anxiety and hypertension, but of doubtful effectiveness in the treatment of most other therapeutic disorders.
Kutz et al. (1985a) presented a framework for the integration of meditation and psychotherapy. The author saw a synergistic advantage in the combination of the two practices:
The intensification of the psychotherapeutic process by this ancient/new mind-body discipline should not be viewed as a revolution in psychotherapy but as an evolution of the ideas of its founders. Freud and Jung were each searching for more direct ways of expanding consciousness and self-awareness. With the information available in their time, they both were justified in disqualifying the nonselective acceptance of mystical teachings. Such a cultural transformation is as incompatible with the world view of our time as it was with theirs. However, today the hindsight of more than half a century and its accummulated alteration of our biological and psychological perspectives offers a unique vantage point for synthesizing disparate existing constructs into more comprehensive models of self-exploration in the same way that Freud and Jung used the knowledge blocks available in their era. [35]
Epstein (1990a) finds that meditation can be used in the therapeutic setting as an aid to relaxation, as an adjunct to psychotherapy, as a self-control strategy, for promoting regression in service of the ego, and for encouraging greater tolerance of emotional states.
Shapiro (1992a) sees meditation as being therapeutic in a number of ways including:
1. A self-regulation strategy in addressing stress and pain management and enhancing relaxation and physical health (Benson, 1975; Shapiro and Zifferblatt, 1976; Shapiro and Giber, 1978; Kabat-Zinn et al., 1982, 1985, 1986; Orme-Johnson, 1987);
2. A self-regulation strategy (cf. Ellis, 1984) comparable to other cognitive focusing, relaxation, and self-control strategies such as guided imagery, hetero-hypnosis, biofeedback, progressive relaxation, and autogenic training (Shapiro, 1982, 1985; Holmes, 1984; Dillbeck and Orme-Johnson, 1987);
3. An adjunct to psychotherapy (Kutz et al., 1985b). Psychodynamic therapists have used meditation for controlled regression in service of the ego and as a means to allow repressed material to come forth from the unconscious (Carrington and Effron, 1975b; Shafii, 1973b). Humanistic psychologists have used it to help individuals gain a sense of self-responsibility and inner directedness (e.g., Keefe, 1975; Schuster, 1975-1976; Lesh, 1970c). Behaviorists have used it for stress management and self-regulation (e.g., Stroebel and Glueck, 1977; Shapiro, 1985; Woolfolk and Franks, 1984).
Recently several researchers have reviewed previous studies and evaluated the use of meditation in psychotherapy practice. See Bogart (1991), Delmonte (1990b), and Craven (1989).
Earlier, West (1979b) observed that meditation has become increasingly popular as a therapy and that a number of theoretical papers have appeared in journals comparing Zen and psychotherapy, including: Dean (1973), Haimes (1972), Van Dusen (1961), Becker (1961), Fromm (1959), and Sato (1958). Single case studies have also been published describing the use of meditation; 73); for claustrophobia (Boudreau, 1972); for insomnia (Miskiman, 1977b and 1977d, and Woolfolk et al., 1976); for hypertension (see previous section); for headache (Benson et al., 1973a); and for anxiety (see previous section).
C.P. Allen (1979) and McIntyre et al. (1974) reported that stutterers were helped by TM. More detailed cases of the use of meditation as an adjunct to psychotherapy have been done by Carrington (1977), Carrington and Ephron (1975), and Shafii (1973a). West (1979b) cited the work of Vahia et al. (1973) as an example of a well-controlled study in which meditation and yoga were shown to be significantly more effective than a pseudotherapy in the treatment of psychoneurosis. West (1979b) argued that most recent investigations of meditation's use in the psychiatric setting were inadequately controlled and conducted [studies by Candelent and Candelent (1976) and Glueck and Stroebel (1975), which used meditation in psychiatric hospitals, might be cases in point, because in both cases meditation was taught indiscriminately to patients representing a broad range of diagnostic categories].
The usefulness of meditation in psychotherapeutic practice has been much debated, and studies indicate that whereas it may be helpful in some conditions it is contraindicated in others. Several researchers warn that meditation is probably not useful for some patients. Craven (1989) states that meditation may be contraindicated for patients who are likely to be overwhelmed and decompensate with the loosening of cognitive controls on the awareness of inner experience. This would include patients with a history of psychotic episodes or dissociative disorder. Delmonte (1990b) states that meditation may not be suitable for patients who are withdrawn or disengaged from daily activities such as depressed, schizoid, or psychotic individuals. Engler (1984) believes that meditation will only be effective when a patient has a relatively intact, coherent, and integrated sense of self, and thus would not be helpful for autistic, psychotic, schizophrenic, borderline, or narcissistic conditions.
Miller (1993) warns of the possibility of emergence of hitherto repressed traumatic memories of abuse in individuals referred to stress-reduction programs which utilize meditative techniques.
For a discussion of the potential misuses of meditation by the person who meditates and possible psychotherapeutic treatment strategies, see Gregoire (1990). See also Epstein (1989, 1990), Wilbur, Engler, and Brown (1986), and Epstein and Lieff (1981) for discussions of psychiatric complications of meditation practice.
It has been suggested that meditation may have benefits for therapists as well as patients. Studies suggest that meditation is useful in developing empathy and a quality of listening ability that emphasizes a detached wide-focus attention as well as other qualities that may be helpful in therapeutic practice. See Dubin (1991), Delmonte (1990b), Dreifuss (1990), Sweet and Johnson (1990), Walker (1987), Rubin (1985), Keefe (1975), and Leung (1973).
These studies also examined the usefulness of meditation in psychiatry and psychotherapy:
Kutz et al. (1985b) The authors studied the effect of a ten-week meditation program on twenty patients who were undergoing long-term individual explorative psychotherapy. Results obtained from patients' self-ratings (Hopkins Symptoms Checklist, Profile of Mood States, and the Table of Level of Activity Interference), and the therapists' objective ratings (Clinical Rating Scale and an open-ended questionnaire) demonstrated substantial improvement in most measures of psychological well-being.
Woolfolk (1984) The author reported the case of a twenty-six-year-old construction worker who suffered from chronic and debilitating anger. He was taught to meditate twice a day for fifteen minutes and to employ one or two minutes of self-control meditation whenever anger might be forthcoming. The overall pattern of results suggested that the client's ability to cope with anger was unaffected by meditation practiced in the standard twice-a-day fashion. On the other hand, self-control meditation seemed to result in substantial alterations in the client's anger. The author concluded that brief meditation employed within a self-control framework may be of great clinical value.
Woolfolk and Franks (1984) The authors see great potential for cross-fertilization between behavior therapy and meditation research. However, they believe there is a necessity to divest the scientific study of meditation from the "shrouds of mystery" that are part of its origin. Removing meditation from the arcane might enable it to become an integral part of behavior therapy.
Jichaku et al. (1984) The author examined the relationship between the Zen koan and the double-bind theory of schizophrenia, and suggested that koan practice creates a psychological state in which an individual can reorganize inner psychological complexities. Meditation's beneficial effects in this regard indicate that perhaps other pathogenic double-bind contexts might be transformed to beneficent ones.
Muskatel et al. (1984) The authors studied fifty-two undergraduates who had volunteered to receive meditation training and who were placed into either high or low time-urgency groups based on their scores on Factor S of the Jenkins Activity Survey. Subjects then received training in Clinically Standardized Meditation followed by three-and-one-half weeks of practice or waited for training during that period. Analyses of scores on a time-estimation task and of self-reported hostility during an enforced waiting task indicated that meditation significantly altered subjects' perceptions of the passage of time and reduced impatience and hostility resulting from enforced waiting.
Ellis (1984) The author suggested that meditation can be seen as one of many cognitive behavioral methods that are employed in cognitive behavior therapy and rational emotive behavior. He described it as a mode of cognitive distraction or diversion that enables one to temporarily interfere with anxiety, self-damnation, depression, or hostility. He described it as "profoundly therapeutic." He warned, however, against meditation as a form of spiritual discipline, since it might interfere with an individual's acceptance of the true human condition, which is "fallible, screwed-up."
Delmonte (1984g) The author administered tests to out-patients before learning meditation. High pretest scores on sensitization, suggestibility, introversion, neuroticism, and perceived symptomatology predicted a low practice frequency. Gender, expectation, credibility, locus of control and self-esteem were unrelated to outcome. By two years, 54% had stopped meditating. Meditation appeared to be more rewarding for subjects with milder complaints.
Delmonte (1980) The author conducted a prospective study in which personality scores taken prior to meditation initiation were used to predict responses to meditation. Eysenck's Personality Inventory, Byrne's Repression-Sensitization Scale, Rotter's Locus of Control, and Barber's Suggestivity Scale were completed by fifty-five prospective meditators. Subjects were recontacted after eighteen months and grouped according to how frequently they meditated as "regulars," "irregulars," and "drop-outs." Eight subjects remained "uninitiated." Statistical analysis of preinitiation scores and frequency of meditation practice showed: (1) Frequency of meditation was negatively correlated with both neuroticism and sensitization. (2) Neuroticism and sensitization were positively correlated independent of meditation practice. (3) Prospective dropouts scored significantly higher on both neuroticism and sensitization than prospective regular meditators and uninitiated subjects, and were signifi cantly more neurotic than Eysenck's norms. (4) Scores of regular meditators and uninitiated subjects were not significantly different from Eysenck's norms for neuroticism. (5) Regular meditators and uninitiated subjects did not differ significantly with regard to neuroticism and sensitization. (6) Meditators-to-be were significantly more neurotic than uninitiated subjects and than Eysenck's norms. No significant differences were found for extraversion, locus of control, and suggestivity. The maintenance of the practice of meditation was not related to one's gender, but dropouts tended to be younger. More recently, Delmonte (1983a) concluded that there was no evidence to support the claim that the "it" between mantra and meditator is of central importance to the effects of meditation practice.
Zuroff and Schwarz (1980) The authors conducted a questionnaire survey to measure the outcome among twenty students randomly assigned to muscle relaxation training and nineteen assigned to Transcendental Meditation at one year and two-and-one-half years. At both follow-ups there were no differences between the groups in frequency of practice or satisfaction. In both groups, less than 25% reported more than moderate satisfaction, and less than 20% practiced as much as once per week. Subjects' expectancies at nine weeks predicted their satisfaction and frequency of practice at two and one-half years. The authors concluded that, although some subjects (15-20%) do enjoy and continue to practice Transcendental Meditation, it is not universally beneficial.
Solomon and Bumpus (1978) The authors studied the combination of slow, long-distance running with Transcendental Meditation as a way of enhancing peak experiences and altered states of consciousness, and suggested that this combination could be used as an adjunct to formal individual and group psychotherapy.
Lazarus (1976) The author stated that, although TM proves extremely effective when applied to properly selected psychiatric cases, there are clinical indications that the procedure can precipitate serious psychiatric problems such as depression, agitation, and even schizophrenic decompensation.
Smith (1975b) The author claimed that research on meditation has yielded three sets of findings: (1) experienced meditators who are willing to participate without pay in meditation research appear happier and healthier than nonmeditators, (2) beginning meditators who practice meditation for four to ten weeks show more improvement on a variety of tests than nonmeditators tested at the same time, and (3) persons who are randomly assigned to learn and practice meditation show more improvement over four to ten weeks than control subjects assigned to some form of alternate treatment. However, he suggested that meditation's benefits might come from expectation of relief or from simply sitting on a regular basis.
For other studies examining the relationship between meditation and psychiatry/psychotherapy, see: Dua and Swinden (1992), Compton (1991), Castillo (1990), Delmonte (1990b), Kokoszka (1990), Delmonte (1989), Driskill (1989), Aranow (1988), Epstein (1988), Boerstler and Kornfield (1987), Delmonte (1987), Burnard (1987), Bleick (1987), Bowman (1987), Dubs (1987a, 1987b), Boerstler (1986), Delmonte (1986), Deikman (1986), Ellis (1986), Levy (1986), Seer (1986), Kokoszka (1986), Nespor and Maloney (1985), Choudhary (1985), Kahn (1985), Chen (1985), Finney (1985), Shafii (1985), Simon (1985), Zika (1985), Rosenbluh (1984), Assad (1984), Claxton (1984), Goodpaster (1984), Chriss (1984), Fenwick (1984), Engler (1984), Finney (1984), O'Connell (1984), Sagert (1984), Vassallo (1984), Fertig (1983), Harvey (1983), Norwood (1983), Rhead and May (1983), Alexander (1982), Aron and Aron (1982b), Lester (1982), Rachman (1981), Bacher (1981), Kobayashi (1982), Ling (1982), West (1980b, 1980c), Fritz (1980), Hattauer (1981), Progoff (1980), Green (1980), King (1979), Lourdes (1978), Glueck and Stroebel (1978), Bunk (1979), Handmacher (1978), Marcus (1978), Pelletier (1978), Benson et al. (1977b), MacMuehlman (1977), Orme-Johnson et al. (1977), Bloomfield (1977), Fehr (1977), Avila and Nummela (1977), Carpenter (1977), Jackson (1977), Tsakonas (1977), Kline (1976), Reed (1976), Schmidt (1976), Williams, Francis and Durham (1976), Carson (1975), Hirai (1975), Keefe (1975), Hendricks (1975), Mayer (1975), J. Shapiro (1975), Smith (1975b), West (1975), Murase and Johnson (1974), Timmons and Kanellakos (1974), Chang (1974), Neki (1973), Gellhorn and Kiely (1972), Seeman et al. (1972), Veith (1971), Goleman (1971), Gattozzi and Luce (1971), Lesh (1970a, 1970b), Timmons and Kamiya (1970), Kretschmer (1969), Malhotra (1962), Becker (1961), Fromm et al. (1960), and Kondo (1958).