Meditation Practices for Health

472 Pages·2007·2.73 MB·English

Evidence Report/Technology Assessment
Number 155

Meditation Practices for Health: State of the Research

Prepared for:
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
540 Gaither Road
Rockville, MD 20850
www.ahrq.gov

Contract No. 290-02-0023

Prepared by:
University of Alberta Evidence-based Practice Center
Edmonton, Alberta, Canada

Investigators:
Maria B. Ospina, B.Sc., M.Sc.
Kenneth Bond, B.Ed., M.A.
Mohammad Karkhaneh, M.D.
Lisa Tjosvold, B.A., M.L.I.S.
Ben Vandermeer, M.Sc.
Yuanyuan Liang, Ph.D.
Liza Bialy, B.Sc.
Nicola Hooton, B.Sc., M.P.H.
Nina Buscemi, Ph.D.
Donna M. Dryden, Ph.D.
Terry P. Klassen, M.D., M.Sc., F.R.C.P.C.

AHRQ Publication No. 07-E010
June 2007
This report is based on research conducted by the University of Alberta Evidence-based Practice
Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ),
Rockville, MD (Contract No. 290-02-0023). The findings and conclusions in this document are
those of the author(s), who are responsible for its contents, and do not necessarily represent the
views of AHRQ. No statement in this report should be construed as an official position of AHRQ
or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and others
make informed decisions about the provision of health care services. This report is intended as a
reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for development of clinical practice
guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage
policies. AHRQ or U.S. Department of Health and Human Services endorsement of such
derivative products may not be stated or implied.
This document is in the public domain and may used and reprinted without permission except
those copyrighted materials noted for which further reproduction is prohibited without the
specific permission of copyright holders.

Suggested Citation:
Ospina MB, Bond TK, Karkhaneh M, Tjosvold L, Vandermeer B, Liang Y, Bialy L, Hooton N,
Buscemi N, Dryden DM, Klassen TP. Meditation Practices for Health: State of the Research.
Evidence Report/Technology Assessment No. 155. (Prepared by the University of Alberta
Evidence-based Practice Center under Contract No. 290-02-0023.) AHRQ Publication No.
07-E010. Rockville, MD: Agency for Healthcare Research and Quality. June 2007.

The investigators have no relevant financial interests in the report. The investigators
have no employment, consultancies, honoraria, or stock ownership or options, or
royalties from any organization or entity with a financial interest or financial conflict
with the subject matter discussed in the report.

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Preface

The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based
Practice Centers (EPCs), sponsors the development of evidence reports and technology
assessments to assist public- and private- sector organizations in their efforts to improve the
quality of healthcare in the United States. This report was requested and funded by the National
Center for Complementary and Alternative Medicine (NCCAM). The reports and assessments
provide organizations with comprehensive, science-based information on common, costly
medical conditions and new healthcare technologies. The EPCs systematically review the
relevant scientific literature on topics assigned to them by AHRQ and conduct additional
analyses when appropriate prior to developing their reports and assessments.
To bring the broadest range of experts into the development of evidence reports and health
technology assessments, AHRQ encourages the EPCs to form partnerships and enter into
collaborations with other medical and research organizations. The EPCs work with these partner
organizations to ensure that the evidence reports and technology assessment they produce will
become building blocks for healthcare quality improvement projects throughout the Nation. The
reports undergo peer review prior to their release.
AHRQ expects that the EPC evidence reports and technology assessments will inform
individual health plans, providers, and purchasers as well as the healthcare system as a whole by
providing important information to help improve healthcare quality.
We welcome comments on this evidence report. They may be sent by mail to the Task Order
Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road,
Rockville, MD 20850, or by email to [email protected].

Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H.
Director Director
Agency for Healthcare Research and Quality Center for Outcomes and Evidence
Agency for Healthcare Research and Quality
Ruth L. Kirschstein, M.D.
Acting Director Beth A. Collins Sharp, Ph.D.,R.N.
National Center for Complementary and Director, EPC Program
Alternative Medicine Agency for Healthcare Research and Quality
National Institutes of Health
Margaret Coopey, R.N., M.G.A., M.P.S.
EPC Program Task Order Officer
Agency for Healthcare Research and Quality

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Acknowledgments

We are grateful to members of the technical expert panel for their consultation with and
advice to the Evidence-based Practice Center during the preparation of this report. The members
of the panel include John Astin, Ph.D., Ruth Baer, Ph.D., Vernon Barnes, Ph.D., Linda E.
Carlson, Ph.D., C.Psych., Jeffery Dusek, Ph.D., Thierry Lacaze-Masmonteil, M.D., Ph.D.,
F.R.C.P.C., Badri Rickhi, M.D., Ph.D., and David Shannahoff-Khalsa, B.A.
We would like to thank the peer reviewers, who provided valuable input into the draft report:
Dr. Kirk Warren Brown (Virginia Commonwealth University, Richmond, VA), Dr. Bei-Hung
Chang (Boston University School of Public Health, Boston, MA), Dr. Thawatchai
Krisanaprakornkit (Khon Kaen University, Khon Kaen, Thailand), Dr. T. M. Srinivasan (The
International Society for the Study of Subtle Energies and Energy Medicine, Chennai (Madras),
India), Dr. Harald Walach (The University of Northampton, Northampton, United Kingdom), Dr.
Ken Walton (Maharishi University of Management, Fairfield, IA), and Dr. Gloria Yeh (Osher
Institute at Harvard Medical School, Boston, MA).
We thank Dr. Richard L. Nahin and Dr. Catherine Stoney from the National Center for
Complementary and Alternative Medicine for their insight, recommendations, and support of this
work. We are grateful to the Agency for Healthcare Research and Quality for granting the
contract for this work and the Task Order Officer, Margaret Coopey, for facilitating the
collaboration of the three organizations.
We are grateful to Lisa Hartling for her guidance when preparing the Work Plan for this
report; Amy Couperthwaite, Lisa Malinowsky, and Kenneth Moreau for their assistance with
article retrieval; Denise Adams, Mauricio Castillo, Carol Spooner, and Kate O’Gorman for their
assistance with data extraction and quality assessment; and Christine Tyrell and Kelley Bessette
for their administrative support.

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Structured Abstract

Objective: To review and synthesize the state of research on a variety of meditation practices,
including: the specific meditation practices examined; the research designs employed and the
conditions and outcomes examined; the efficacy and effectiveness of different meditation
practices for the three most studied conditions; the role of effect modifiers on outcomes; and the
effects of meditation on physiological and neuropsychological outcomes.
Data Sources: Comprehensive searches were conducted in 17 electronic databases of medical
and psychological literature up to September 2005. Other sources of potentially relevant studies
included hand searches, reference tracking, contact with experts, and gray literature searches.
Review Methods: A Delphi method was used to develop a set of parameters to describe
meditation practices. Included studies were comparative, on any meditation practice, had more
than 10 adult participants, provided quantitative data on health-related outcomes, and published
in English. Two independent reviewers assessed study relevance, extracted the data and assessed
the methodological quality of the studies.
Results: Five broad categories of meditation practices were identified (Mantra meditation,
Mindfulness meditation, Yoga, Tai Chi, and Qi Gong). Characterization of the universal or
supplemental components of meditation practices was precluded by the theoretical and
terminological heterogeneity among practices. Evidence on the state of research in meditation
practices was provided in 813 predominantly poor-quality studies. The three most studied
conditions were hypertension, other cardiovascular diseases, and substance abuse. Sixty-five
intervention studies examined the therapeutic effect of meditation practices for these conditions.
Meta-analyses based on low-quality studies and small numbers of hypertensive participants
showed that TM®, Qi Gong and Zen Buddhist meditation significantly reduced blood pressure.
Yoga helped reduce stress. Yoga was no better than Mindfulness-based Stress Reduction at
reducing anxiety in patients with cardiovascular diseases. No results from substance abuse
studies could be combined. The role of effect modifiers in meditation practices has been
neglected in the scientific literature. The physiological and neuropsychological effects of
meditation practices have been evaluated in 312 poor-quality studies. Meta-analyses of results
from 55 studies indicated that some meditation practices produced significant changes in healthy
participants.
Conclusion: Many uncertainties surround the practice of meditation. Scientific research on
meditation practices does not appear to have a common theoretical perspective and is
characterized by poor methodological quality. Firm conclusions on the effects of meditation
practices in healthcare cannot be drawn based on the available evidence. Future research on
meditation practices must be more rigorous in the design and execution of studies and in the
analysis and reporting of results.
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Contents

Executive Summary........................................................................................................................1

Evidence Report............................................................................................................................7

Chapter 1. Introduction and Background........................................................................................9
Definition and Types of Meditation................................................................................................9
Meditation Practices as a Part of Healing and Healthcare............................................................10
Objectives of the Review..............................................................................................................11

Chapter 2. Methods......................................................................................................................13
Overview.......................................................................................................................................13
Key Questions and Analytic Approach.........................................................................................13
Topic I. The Practice of Meditation.........................................................................................13
Topic II. State of Research on the Therapeutic Use of Meditation Practices in Healthcare....14
Topic III. Evidence on the Efficacy and Effectiveness of Meditation Practices.....................14
Topic IV. Evidence on the Role of Effect Modifiers for Meditation Practices.......................15
Topic V. Evidence on the Physiological and Neuropsychological Effects of Meditation
Practices............................................................................................................................15
Literature Review Methods...........................................................................................................17
Development of Operational Parameters to Define Meditation Practices................................17
Literature Search and Retrieval................................................................................................17
Criteria for Selection of Studies................................................................................................18
Study Selection Process............................................................................................................19
Evaluating the Methodological Quality of Studies...................................................................20
Data Collection.........................................................................................................................21
Literature Synthesis......................................................................................................................22
Data Analysis and Synthesis.....................................................................................................22
Peer Review Process.....................................................................................................................25

Chapter 3. Results........................................................................................................................27
Topic I. The Practice of Meditation.............................................................................................27
Main Components.....................................................................................................................27
Mantra Meditation........................................................................................................................28
Transcendental Meditation®.....................................................................................................29
Relaxation Response.................................................................................................................30
Clinically Standardized Meditation..........................................................................................31
Mindfulness Meditation................................................................................................................32
Vipassana..................................................................................................................................32
Zen Buddhist Meditation..........................................................................................................34
Mindfulness-Based Stress Reduction.......................................................................................35
Mindfulness-Based Cognitive Therapy....................................................................................37
Yoga..............................................................................................................................................38
Tai Chi..........................................................................................................................................43
Qi Gong.........................................................................................................................................44
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Characteristics of Meditation Practices........................................................................................46
Main Components.....................................................................................................................46
Breathing...................................................................................................................................47
Attention and Its Object............................................................................................................47
Spirituality and Belief...............................................................................................................48
Training.....................................................................................................................................49
Criteria of Successful Meditation Practice...............................................................................49
Search Results for Topics II to V..................................................................................................54
Topic II. State of Research on the Therapeutic Use of Meditation Practices in Healthcare........56
General Characteristics.............................................................................................................56
Methodological Quality............................................................................................................56
Meditation Practices Examined in Clinical Trials and Observational Studies.........................61
Control Groups Used in Studies on Meditation Practices........................................................69
Meditation Practices Separated by the Diseases, Conditions, and Populations for Which They
Have Been Examined................................................................................................................82
Outcome Measures Used in Studies on Meditation Practices..................................................96
Summary of the Results..........................................................................................................105
Topic III. Evidence on the Efficacy and Effectiveness of Meditation Practices.......................107
Hypertension...............................................................................................................................107
Description of the Included Studies........................................................................................109
Methodological Quality of the Included Studies....................................................................110
Results of Direct Comparisons...............................................................................................112
Transcendental Meditation®...................................................................................................115
Relaxation Response...............................................................................................................122
Qi Gong...................................................................................................................................123
Yoga........................................................................................................................................124
Zen Buddhist meditation.........................................................................................................127
Mixed Treatment and Indirect Comparisons..........................................................................128
Analysis of Publication Bias...................................................................................................133
Cardiovascular Diseases.............................................................................................................133
Description of the Included Studies........................................................................................133
Methodological Quality of Included Studies..........................................................................134
Results of Direct Comparisons...............................................................................................137
Indirect Comparisons..............................................................................................................141
Analysis of Publication Bias...................................................................................................141
Substance Abuse.........................................................................................................................141
Description of the Included Studies........................................................................................141
Methodological Quality of Included Studies..........................................................................142
Results of Quantitative Analysis.............................................................................................145
Analysis of Publication Bias...................................................................................................145
Summary of the Results..............................................................................................................148
Hypertension...........................................................................................................................149
Cardiovascular Diseases.........................................................................................................154
Substance Abuse.....................................................................................................................150
Topic IV. Evidence on the Role of Effect Modifiers for the Practice of Meditation................152
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Hypertension...........................................................................................................................152
Cardiovascular Diseases.........................................................................................................154
Substance Abuse.....................................................................................................................155
Summary of the Results..............................................................................................................156
Topic V. Evidence on the Physiological and Neuropsychological Effects of Meditation
Practices..................................................................................................................................157
General Characteristics...........................................................................................................157
Overall Methodological Quality.............................................................................................157
Outcome Measures..................................................................................................................159
Results of Quantitative Analysis.............................................................................................159
Methodological Quality of Included Studies..........................................................................161
Transcendental Meditation®...................................................................................................165
Relaxation Response...............................................................................................................170
Yoga........................................................................................................................................172
Tai Chi....................................................................................................................................183
Qi Gong...................................................................................................................................186
Summary of the Results..............................................................................................................187
Transcendental Meditation®...................................................................................................187
Relaxation Response...............................................................................................................188
Yoga........................................................................................................................................188
Tai Chi....................................................................................................................................188
Qi Gong...................................................................................................................................189

Chapter 4. Discussion.................................................................................................................193
The Practice of Meditation..........................................................................................................193
Demarcation............................................................................................................................193
Classification...........................................................................................................................194
Universal Components of Meditation Practices.....................................................................195
Complexity..............................................................................................................................196
Criteria of Successful Meditation Practice.............................................................................196
Training...................................................................................................................................197
State of Research on the Therapeutic Use of Meditation Practices in Healthcare......................197
Quality of the Evidence..........................................................................................................198
Types of Interventions............................................................................................................199
Types of Control Groups........................................................................................................200
Types of Study Populations....................................................................................................200
Types of Outcome Measures..................................................................................................201
Evidence on the Efficacy and Effectiveness of Meditation Practices.........................................201
Evidence on the Role of Effect Modifiers for the Practice of Meditation..................................203
Evidence on the Physiological and Neuropsychological Effects of Meditation Practices.........204
Strengths and Limitations...........................................................................................................205
Future Research..........................................................................................................................208
Conclusions.................................................................................................................................209

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