0272%7358/85 $3.00 + .W Copyright 0 1985 Pergamon Press Ltd.

MEDITATION AND ANXIETY REDUCTION: A LITERATURE REVIEW

M. M. Delmonte

Psychosomatic Unit St. James4 Hospital

Dublin 8.

ABSTRACT. Meditation is increasingly bring @u?icud as a therapeutic technique. The

effects of pv-actirf on psychometrically assrssed unxipty leuel,s hazer been Pxtmsiuely researched.

&-osfiPcti-i,u meditators tend to r+ort aboz,P allCrap ie-oek of anxiety. In gPnPv-al, high anxiety

Gvels @dirt a subsequent low ,frequrncy of kracticp. Howczler, the e_ckLencu suggests that

those who pa&P regularl? tend to .show significant drcreusrs in anxiety. Meditation does

not appear to br more pfffctz-ilp than comparative intpnlmtions in reducing anxiety. There is

ezlidence to suCgpt that hypnotizability and exppctuncy may both play a role in reported anxiety

decrPmPnt.s. Cprtain indi-rJidua/.c, with a capacity to engage in uu~tonomous .selfabsorbed

rrlaxation, may bmpfit vnost from meditation.

Meditation is becoming more prevalent as a self-management and self-mastery technique, as well as an adjunct to psychotherapeutic intervention (Candelent & Candelent, 1975; Delmonte 8c Braidwood, 1980; Glueck 8c Stroebel, 1975). To date, there has been no extensive review of the research literature in relation to the effects of meditation on self-reported anxiety levels.

TYPES OF MEDITATION

For the most part, this review will be limited to those forms of meditation in which one’s attention is focused (restricted), such as in Transcendental Meditation (TM) and Zen Meditation, as opposed to the various “opening-up” exercises. The former “concentrative” techniques are widely practiced in North America and Western Europe, whereas the latter “mindfulness” approach is less well known and has only occasionally been the subject of research in the West. In concentrative meditation one’s attention can be focused on a variety of objects such as a sound (mantra), a candle tlame, one’s breath, and so on. The above two types of meditation are not

Requests for reprints should be addressed to Dr. M. M. Delmonte, St. James’s Hospital,

Psychosomatic Unit, Dublin 8. Ireland.

91

;~l~)ltite cate,gorics as fhcrc ia :I cc.t-lain ;ii~tot~ttl of ocedap (SW Orristein, 1972, toi

;I mow c~otnplrl~ disc-ttssiott).

MODELS OF MEDITATION

Mctlitalioti has Iwrn viewed frotii both psychoan:ilytic attd l~ehavioral perspectives.

For csatriplc, tiiedilatiott is secti as adapti\e regi~essioti in the service of‘ the ego

(Shalii, 1973) ot as “;I wrt of. Ko)xl Koxl to the ttttconscious” (Jung, 19.58, p. 508).

(~olctnmt (197 I) buggc3tetl that tt~ecliratioti nt;i): be (3)ticeptualiad as SIOM’ self-paced

s~sletnatic clesctisitil.~ttioti. Othrrs have tltwrtbrd meditation as 2 techttiqur that

itiwlvcs t-cc-iprocal inhil)itiott 2nd cottntt’r cotttlitiotiitig Iwtlittg lo tlesensitization

of. atixit.ty rvokittg Ihoughta (Ue1-~4%k Lb OAel. 1973; Mikdis, I98 1; Shapiro &

%if‘f~rhlatt. IW6). hledit~triott is also twcisagect as ;I r~lasatioti techtiique (C;r-ren-

wootl SC Bensott, I977; Sltapiro &I Ziff’erl~Litt, 1976). Iti fact, (;rcettwood and ISenso~t

( 1977) h;tw at-gttetl that tneditati\~e relax;ttioti is ittore appropriate 1 hi abbreviared

rclaxatiott traittitig as ;I t~eciprod itthil~iror itt systematic tlesetisitiz~ttiort. Koals

(1!)7H) c-ontcticlrd that c-Ltssicdl contiitiotiitig elicit5 cltanges iii the direction of. re-

Lixatiott when the. tttattlrii I~ecotncs ;t cotitlitiottetl id~txatiott ariniulus. Delniontc

( 197!I) provitlcd tGtl~ttc_r tltat ;I tiiiititm may hecome ;t contlitiotied stiniulus eliciting

;I condition;il relaxation respotisc in terms of frotitalis lCYl(;. ‘l‘he sane tionrtiedi-

tatol-s had signif’iwtt~ly lowt~ lChf(i leccls while tdtxittg \vith closrtl eyes than wldc

suhvcally repeating ;I tn;tt1tr;1. .1lantr;t rcpetitiott had pt-eGottsly been pail-d with

fl-ontalis Ehl(; biof’cctllmck training dttring fi)tir sessiotta wet- f’our consecutive

days. Finally, CLirpctiter- ( I977) sttygsted that tneditati\~c rxercises provide tht-eta

therapeutic gains, ttamcly insight into repetitive self-defeating patterns of behavior

and thinking (e.g., cravings), desensitization of painful thoughts, and “condition-

ing” of’ the wtttt-al tierwus systcvti.

.lltt3y arc fl-equettt ;ttiecdolal tqwr(s of“‘ttttstI-cssittg” ~i~~ottt~);iti~.ing: the practice

of meditation. (Iat-ringtott antI L’.phroti (1075) suggest that rttistrcssing is ;I fi)rni

of catharsis by nicatts of which pwvious triiittiiatic or stressf‘ul events are released

slJotit;ttteottsl~. LTnstrrssing is the littk hetwectt the tJs)“‘tio;tti;t1!.tic- and the heha\:-

ioral tnotlelb of‘ twditarion, as it invokes hotlt rhc 1Js)~llo(lvtt;t~~~i~ concept of

“breaching the rcpressioti harti~r” and I he behavioral noCon of‘ ctesetisitizatioli.

Smith (l!US). in mi vxtcttsivc review of‘ the ps~~hotliet-~iI,~ttti~ effects of niedi-

ratiott. noted that “vit-~tt;tl1! c\ery schoc~l of’~~s~~~~~ologic~;tl thought” has I)een invoked

to supl)otA tItt> cl;titit Ihat tneclitatioti practice is iwwfici;il. lHe coticltrdctl, rather

~~;it~sirtionioirsl~, however, I haI thr thci-apeittic ktiefits fbutitl could t)c the result

of exlwctatioti of’ t-dief or of’ simply silting on ;I regular basis. I le later produced

evidence to strppor( this cotttettlioti (see “Nott-Sprcif’ic Factors”).

TYPES OF ANXIETY/AROUSAL

Handron ( 19.59) and Huss ( I96L’), 1)): f’aclor att;tlyhg attxiety SC‘OI~~S obtained f’rotn

psychiatric patienls, ohtaincd two faclors (‘psychic’ and ‘somatic anxiety) which

;ic-couttttd fbr- the ~tii~jor pot-lions ot‘ the vat~iancr iti anxiety qucstiorimire scores.

Sc~hallitig, (~rotiholnt. ;ttid Asher,q (1975). antI SchwatY/. I)avidsoti. and <;oleman

(197X), having extctisicely reviewed the literattirt., hypothrsi/etl thar anxiety is made

up of cognitive and somatic components. Davidson and Schwartz ( 197(i), with theil “multi-process” model, postulated that somatic and cognitive components of arousal would differentially respond to different forms of relaxation. More precisely, they posited that the different relaxation techniques, (i.e., primarily cognitive versus somatic) “will be more effective in reducing same mode vs. other mode anxiety” (p. 426). Similarly, Schwartz et al. (1978) argued in favor of “differential effects of a somatic (physical exercise) and a cognitive (meditation) relaxation procedure” (p. 321). In other words, they contend that specific suhcomporlents of anxiety may be differentially associated with relaxation techniques engaging primarily cognitive versus somatic subsystems. They offered some (poor) retrospective evidence that subjects practicing physical exercise reported relatively less somatic and more cog- nitive anxiety than meditators (the two groups were neither matched nor formed by random assignment). The above multi-process 1node1 is opposed by the 01de1 unitary relaxation response model of Benson, Heal-y. and Carol (l974), who posit that the various relaxation techniques all elicit a general relaxation (trophotropic) response involving all systems in concert.

METHODOLOGICAL ISSUES

Anxiety can be evaluated in terms of several criteria (e.g., behavioral, psychophys- iological, and psychometric measures). This review focuses primarily on the effects of meditation in terms of psychometric (i.e., self-report) ratings of anxiety. Phys- iological and biochemical outcome criteria have been reviewed elsewhere by the author. The studies reviewed in this paper range from the methotlologically weak to the sophisticated. The review commences with the weakest designs and finishes with the best studies (e.g., cross-sectional designs with various degrees of matching, simple pre-post designs, pre-post designs with prospective meditators as controls, random assignment to meditation and control groups, random assignment to med- itation and comparison groups with control for credibility and expectancy, and so on).

A major problem with the cross-sectional studies is that individuals attracted to meditation may differ in certain respects from those who are not so inclined. Hence, differences found between meditators and nonmeditators may not be attributable to practice per se. This problem can be partly overcome 1~): using prospective meditators as controls, or by randomly assigning metlitation-naive subjects to med- itation and control groups, in pre-post research paradigms. However, with this design there still remains the problem that those assigned to the meditation and control conditions will have different expectations. Expectancy of relief should be considered in meditation research outcome (Delmonte, 198 la; Smith, 1975, 1976).

In general, there has been a paucity of research on personality variables and their relationship to the practice of meditation. On the contrary, however, anxiety and/or neuroticism have been featured in numerous (i.e., in approximately 40) studies on meditation. It will not be possible to give detailed accounts of these studies; rather, a general overview will be attempted. LJnless otherwise specified, state, trait, cognitive, and somatic anxiety, together with neuroticism, will be col- lectively referred to as ‘anxiety.’ Similarly, the word ‘anxious’ will include ‘neurotic’ unless otherwise indicated. This is purely a pragmatic decision and does not imply any theoretical position.

94

STUDIES WITH CROSS-SECTIONAL DESIGNS

Some authors report that experienced meditatoi-s are significatttl) less atisious than

comparison groups of‘ controls ((;otetnan 82 Sctiwart~. 1076; IIjrllC. l%~l: vat1 den

Berg 8c Mulder, t!)f(i). In all the abo\,th stu(lies the control iubjccta were eithei

prospective meditators (i.e., Hjelle, tC)7G; \:att tlrn Bet-g & hlultlet-, 1!176) or ‘in-

terested’ in meditation (Goleman & Schwartz, 1976). In this respect these studies

controlled for predisposition to meditatioti. Ho~~e\.er. thev did not cotitrol for setf’-

selection, as attrition from nieditation practice. ma\ accoutit f’or the rxpet‘ienced

meditators being different from thc cotttrol subjc.c.ts. .I‘ttesc stutties do not provide

evidence that meditation practicr actualI\ dccrcasrs attsiet),.

There is considerable evidence 10 suggest ttiat prospcctt\ c’ meditators arc sig-

nificantly more anxious than l~uf~lislird l~ol~ulatioti tiorms or 1ti;iti c.otitr01 groups

(l)etnionte, l#O; Ferguson X- (knva~i. IW~i: Katias & Iloro\vit/, tC177; Otis, t!G3:

Rogers 8c Livingston, I Cj77; West, 1 !MO; Witli;tms, Fratic-is, & l)urtiatri, 1076).

STUDIES WITH SIMPLE PRE-POST DESIGNS

Several researchers reported that arixiety decreased in a group ot tiieditators from

pre-initiation to ~otlo~~-ill,-rI_atiging front 1 to I(i monttts later (Blackwelt et al.,

1976; Tjoa, 1975; Williams et al., lC)76). Ho\vever. none of‘ these stud& included

;I cotiCr01 group.

It appears that those subjects who drop out (betwceti 30%-.3JC~8 af’tet- 1 year)

tend to be significantly more anxious than those \vtro cotttittur (l)eltnont~, 1X30;

Otis, 1973; Smith, 107X; West. ICMO; M~iltiants ct. at., 1076). ‘l‘hesc findings at-e

consistent with reports that those who drop-out of‘ tneditatiott score significantly

higher on measures of‘ psychopat hology (Nystul & (Garde, I W9: Sttiit tt, 1(_)76, t<)iH)

and lower on self-esteem (Rivers & Spanos, 1% I ). The question now remains, cm the prc/post c-tratigc iii ;ittsict\, t)e totally x-

counted for by this self’-selection process, or dora the tqutar l~ractic-e of mcditatioti

per se mediate ;I reduction in such scores? Otis (15173) stated that “the peopfr in

each of‘ these groups (i.e., ‘regulars, ‘irregulars ’ mttl ‘drop-outs’) may tt;iw dif‘ferrd

f‘rom each other in those particular attributes I)ef’orc starting ‘l‘hl” (1). i).

In an attempt to address this question, bottt nietfit;itot~a and c.otitrots wcrc pre-

tested and followed up for periods rattging f‘rom 6 to IO \vcc’E; ( Fct-guson & (knvm, tY76; Rogers 8c Li\~ingston, lC177; Van dtvt Het-g &c hlulder. 15)7(i). Itt these studies

anxiety was significantly reduced f’or meditatot3 only. IIow~\~et; subjects had not

been randomly assigned to conditiotts. ‘I‘herc was thus thy l~rot~teti~ ot votutiteet

status and predisposition to meditation. Vati tlr~t Berg and ?rlttltlct- tat-gel\, ovc‘rc;mte

this problem by using prospective mrditators as c.ontrol subjects.

PRE-POST DESIGNS WITH RANDOM ASSIGNMENT TO GROUPS

Several authors improved on the above ~xpet-imrntal design b! ratttlomly assigning

subjects to either nieclitatioti ot~coml~~irisoti procetturc5. On fi)tto\V-up (lvliich varied

from I to 12 months later) only the meditators stto~vrd sigttific-atttty pt-e- to posttest

reductions in anxiety (Bali, 1979); Carrington ct at., I!#(); Leht-er. Schoickec. C:ar--

rington, 8c WootfiAk, 1MO; l’uryear. Caycc. kk ‘I‘tiurstott. I Wfi: Zut-of‘f’ ti ScliM.arz,

197X). This finding is particutarly interesting in the c.asc’ of‘ttt? %urot‘tattd 5chwat.z

(1978) and the Lehrer et al. ( 1980) reports, because, as well as control groups, these studies also employed parallel progressive relaxation groups which showed no significant changes in anxiety.

Several authors who had also allocated subjects, at random, to either meditation or other forms of intervention found significant reductions in anxiety for both med- itation and comparison conditions, including the following: :10 minutes of rest- the dependent measure being state anxiety in this case (Bahrke 8c Morgan, 197X; Michaels, Parra, McCann, SC Vander, 1979), 2 to 5 weeks of progressive relaxation (Boswell & Murray, 1979; Busby 8c DeKoninck, 1980; Parker, Gilbert, 8c Thoreson, 1978), 6 weeks of muscle biofeedback (Raskin, Bali, SC Van Peeke, 1980), 3 weeks of rest using alcoholics as subjects (Parker, et al., 1978) and from 1 week to 6 months of highly credible “anti-meditation” or “mock-meditation” (Boswell & Murray, 1979; Goldman, Domitor, & Murray, 1979; Smith, 1976). Thus, although the meditators demonstrated significant decreases in anxiety, these decreases were not greater than those found with established relaxation techniques, or with physical exercise (Bahrke 8c Morgan, 1978) or with highly credible control procedures. This finding contradicts other, :ilreacIy quoted, reports that the practice of meditation, unlike that of progressive relaxation, is associated with significant decrements in anxiety.

Other studies, in which random assignment \vas used, showed not only that meditation experience-ranging from 1 to 1 X weeks-was associated with signif- icant reductions in anxiety, but also that this reduction was significantly greater than that observed in a parallel control group which engaged in eyes-closed rest practice over 2 weeks (Dillbeck, 1977) or which formed a no-treatment comparison group (Heide, Wadlington, & Lundy, 1080; Linden, 1973). The Linden study also included 18 weeks of counselling as a comparison condition. Meditation was also significantly superior to this condition in reducing (test) anxiety.

CLINICAL STUDIES

There have also been several reports of decreased anxiety following meditation practice in a clinical context. (Benson et al., 1978; Candelent 8c Candelent, 1975; Daniels, 1975; Glueck 8c Stroebel, 1975; Kirsch & Hem-y, 1979; Shapiro, 1976). Some of the above studies were poorly designed and were more like case histories. However, there were exceptions as in four studies both random assignment and longitudinal design were used. Benson et al. (1978), f ound that meclitation relax- ation and self-hypnosis were equally ef-fective over 8 weeks in reducing anxiety in patients with anxiety neurosis. Patients who had moderate-high hypnotic respon- sivity, independent of the technique used, significantly improved. Kirsch and Henry (1979) found that meditation, systematic desensitization, and systematic desensi- tization with meditation replacing progressive relaxation did not differ in their efficacy in reducing anxiety. Smith (1976) found that meditation, although effective in reducing anxiety in “anxious college students,” was no more so than highly credible procedures which were designed to control for expectation of relief and for the ritual of sitting twice daily. Raskin et al. (1980) reported that, although meditation was effective in reducing chronic anxiety, it was not superior to muscle biofeedback in this respect. ‘l-here are, therefore, at least four longitudinal studies, with random assignment of high anxious subjects, in which substantial decrements in anxiety were reported following meditation practice. It thus appears that med-

itation is as ef‘fectiw as some other clinical iii~erventions in reducing ele\ated levels

of anxiety, Ijut that expec‘tmcy a~itl ritual may acco~~nt for these findings-in part,

at least.

In ;I stud!; without co~i~rol subjects, (;irodo (1974) used ;I sinirilatecl ‘I‘M technique

with nine patients diagnosed as anxiety 1ieurotic. md, afier 4 months, five patients

improved significantly and the rcnwining four showed no appreciable decline in

aixiety. Girodo stated rliat his mialvsis showed that meditation tended to be ben-

eficial for those patie11ts with ;I shol’t history of illness (;LI = .I‘= 14.2 months) and

not f’or those four subjects with ;I long history (A1 = sPl.2 nlonths). Kaskin et al. (1980) argued that the rf’f&:tiwness of‘ nleditation in the tre;1tnlent of chronic

anxiety is limited i11 that onI) 40% of‘ liis sul’Jects sl~owecl “marked clinical i1n-

proven~ent.” I fowcv~r Kaskin et al. ( I9XO), urlhkr (;irodo, (lid not investigate the

role of. chronicity iti intervention outcome.

NON-SPECIFIC FACTORS

Smith (1978) f’ound that those who 111ai11tain nleditation practice and who display

the greatest reduction in trait anxiety scored high on the 16 PF Factors of‘Sizothymia

and Autia. Simthymic i1itlividuals tend to he “i~eservrd,” “detached,” “~~loof‘,” and so on, W~KI-ras Autia descriks ;I tentlenc~~ to IX “iniag-iriatively eiitliralled by inner

actions.” “ char1r~ed by works of‘ thv iniaginatioti, ” “completely ;ibsot~bed” and to

dernonstr;ite ;I capacity to dissoc-iate and ctigage in “it1ito1io1iio1is, self-absorbed

relaxation.” ‘I‘his report is co1isistc11t with relial~lc f‘indirigs that subjects high on

hypnotic- responsivit) are more likel) to show substatltial decwments in anxiet)

(Renson et al., 107X; Heide t’t al., 19X0). It is also relevant to note that suggestibility increasc~s during the practice of‘ meditation per se (IMmonte, 198 1 b). Both cred-

ibility and expectancy are positively related to improved self’-reports. Highly cred-

ible control procedures were ,just as effective as meditation (Smith. 1076). In an ingenious double-blind study, Smith randomly assigned subjects to meditation or

to a placelm condition (designed to match the form, complexity and expectation f’osrering aspects of TI\/I,” but which incorporated an exercise that involved sitting twice daily rather than meditation. 1~0th groups were equ;illy eftecrive in reducing

trait anxiety, striated ni11scle tension. ad skill cond~~ctance reactivity. Smith also coInpared two other groiips which iweived similar fostering of expectations. &gain

he fi,und no significant tlif‘fbw~cw hetwrcrl thv groups on the above outcome 1neiisures even tho~igli one‘ groiip incorporated ;1 “‘I‘Mlike nwclitation exercise”

and rhe other “an exercise designed to he the near mltithesis of‘awditation (p. 630). I~elrnonte (198 1 a) found that expectancy of‘ Iwnefit fi~oni nieditatio11 practice as-

sessed prior to initiation is related both to the f’requency of‘ practice and to the

reported benefits of‘ such piwticc. Sin~il;irl~, Kirsch a11tl Henr! ( 1979) reported

that high rationale credibility of 1neditatio11 was significantly related to reduced

anxiety. It coiild, tlierefiwe, he AI-guecl that the reductions in anxiety reflect a pl~~l~o cf’ftct. Only Zui-off and Schwarz ( 197X) f’ound that expec.tations of benefit

were not significantly carrelated bith such rcductio1is. ~I‘liis inconsistent finding

could be cl~le to the relatively I,ro;id and general assessment ot‘cxpec‘tancy eniployed by Zuwf‘f’ mid Schwirz. In conclusioii, ; t strong case can be ~nade tar taking “non- specific” Lictors into accourit in any corlcef,tu~tli/ation of. the therapeutic- ett‘ects of nieditatiotr.

97

AN EVOKED STRESS-RESPONSE STUDY

Goleman and Schwartz (1976) found that meditators, compared with controls, reported significantly less state anxiety, both before seeing a stressful film and again after exposure. However, as the meditators also scored significantly lower than the controls on both trait anxiety and neuroticism, the above finding could represent a sampling effect, as there were no pre-initiation scores available. However, the finding that meditators showed lower state anxiety after stressor exposure is con- sistent with reports that meditators show more rapid post-stressor recovery in physiological responsivity (see Delmonte, in press-b). Unfortunately, this area has received little empirical attention.

ANXIETY REDUCTION AND FREQUENCY OF MEDITATION PRACTICE

Decreases in anxiety were found to be positively related to frequency of practice (Fling, Thomas, 8c Gallagher, 1981; Tjoa, 1975; Williams, et al., 1976). However, Zuroff and Schwarz (1978) did not find such a relationship. Delmonte (1981), as with anxiety, found that an improved “present-self” was correlated with frequency of practice. It is possible that, although practice frequency is in general related to the benefits claimed, there may, nevertheless, be a “ceiling effect” above which little further improvement is reported. For example, Peters, Benson, and Porter (1977) found that less than three practice periods per week produced little change, whereas two daily sessions appeared to be more practice than was necessary for many individuals to achieve positive changes. Similarly, Carrington et al. (1980) reported that “frequent” and “occasional” practitioners did not differ in terms of improve- ment.

BIOCHEMICAL, MOTORIC, AND PHYSIOLOGICAL MEASURES OF ANXIETY/AROUSAL

‘rhis review has primarily focused on changes in self-reported anxiety. It is worth noting that reductions in self-reported anxiety, following meditation practice, are not always accompanied by decrements in behavioral or physiological measures of anxiety. For example, Raskin et al. (1980) found that, although meditation, relax- ation and muscle biofeedback were all associated with reductions in clinically as- sessed chronic anxiety, these reductions were not related to changes in EMC;. Kirsch and Henry (1979) randomly assigned speech anxious subjects to (a) meditation; (b) desensitization with meditation replacing progressive relaxation (as suggested by Greenwood & Benson, 1977); (c) systematic desensitization, or (d) no treatment, and found that all three treatments were equally effective in reducing self-reported anxiety and produced a greater reduction in self-reported anxiety than found in the untreated subjects. However, there were no concomitant improvements in be- havioral measures of anxiety, and reliable changes in physiological (heart rate) manifestations of anxiety were found only in subjects who rated the treatment rationale as highly credible. Zuroff and Schwarz (1978) randomly assigned subjects to Transcendental Meditation, muscle relaxation training, or no treatment. Whereas all three groups improved on a behavioral measure of trait anxiety, only the med- itation group showed significant decreases in a self-report measure of anxiety.

‘l‘hese last three studies show that riieclitators readily show ciec-rtmes in self-report

~neasures of‘ anxitTy hut that these decrenients may, 01‘ may not, receive convergent validity in terms of behavioral and physiological nleasures. If‘ the effects of Ined-

itation are Inode specific, iib proposed by Schwartz et al. (1978) with their multi- process niotlel, thtm it may indeed he that the ef’fects ot‘metlitation are more readily apparent with self-report (predominantly cognitive?) as opposed to behavioral or psychological, measures of‘ arixiety. There is also the more parsimonious interpre- tation that it is easier to “f’bke good” with self-report, than with either behavioral or physiological markers of‘ anxiety. Hounw-, the outcome of the Zurof’f and Schwarz study, in which only the meditation group reported significant reductions in both self-report arid Iwhavioral nieasurc’s of‘ anxiety, is not consistent with the

latter iriter~,retatioIi.

Most investigations of’biochernical nwrkers of’ rel~txation-arousal, associated with

the practice 01‘ meditation. were in tertns of state cfftcts, as in those immediate

responses precipitated duririg nietlitation per se. The outconie of ;I recent review (IIelmonte, in press-a) is that meditation is only marginally superior (at most) to eyes closed rest in terms of‘biochemic~il indices of activation. ‘I‘he reported decreases in lactate, cortisol, dof’iltiiine-t)et;l-h~clr-oxl~tse, rcnin, alclosterone and cholesterol, and the reported increases in phenylalanine and prolactin, although of‘ interest, do not attribute special state ef‘fects to Ineclitation. ‘Ilie niost strongly supported

long-twrri (i.e., trait) effect of’ Ineditation is ;i reductioIl in seruni cholesterol levels.

This findirlg is in acco~-tl with the rather comp~lfing evidence that the practice of meditation is associated with long-term reductioms in Mood pressure (see Delmonte, in press-b For review). No significant effects were obtained using testosterone, growth hormones and catechol~~mines as indices of charlge.

‘Ilie outcome ofanother extensive review-this time ofstudies with physiological markers of’ a~~o~~s;~l-will I)e xunlnlari/rtl hew, as it also offers cross validational

rvitlenc-e on nneditation as an intervention strategy (see Delnionte, in press-b).

Mfdit;ttiori practice is associated with lowered acti\wion in ternis of state (i.e., in

situ) ef‘f’~cts-~~~~~-tic.ul~~~-l~~ with I-egartl to f’rontalis EhlG mcl respiratory indices (such as oxygen consumption, carbon dioxide eliniination , aritl respiration rate)- and in terrris of’ trait (i.e., lonp-tcrui) effects-es~,eci;lll~ with I-egxd to Mood pres-

sure reduction. llowever, thew effects are not ot estal~lished superiority to those

of‘ other relaxation pro~td~~res.

‘I‘hc outconic of‘ these two reviews is consistent with Be~ison’s relaxation response

model. Benson et al. ( 1974) postulated that ;i unitary relaxation response c;m be precipitated by one of‘several rrlaxation procctlures (including meditation) meeting certain niinirnal criteri;l such as closed eies, 1ow riir~scle tonus, ;I “mental device,”

;I passive attitude, and ;I quiet en\ironnient. Fiowever, as already mentioned, self- report reductions in anxiety do not alwaj,s recei1.e convergent validity in terms of behavioral or physiologic~;il mdices of ac.tivdtioIl. ‘l‘liis may suggest that the effects of meditation are largely mode specific, in that somatic. componrtits of anxiety (as ~iie;~su~-t~l by physiological 2nd betia\~ior:il indices) may be less responsive to ;I “mental” technique than the cognitive components of’ arousal as assessed by self’- reports. If‘ f’urther evitlt7ice suhstantiatrs this \Gzw then tlierc will be increased support for the S&wart/ et al. ( 197X) multi-process model. ‘Ii) rrcapitulate, Schwartz ct al. predicted that meditation woulcl be more rf‘fbctivc in reducing cognitive than somatic sul,coIrlf>on~Ilts of‘ anxiety. ‘I‘aking ;I glotd view of‘ anxiety, that is. inte- grating the findings of‘ studirs usilig sdf-report. physiologic-al, biochemical mid

Meditation and Anxirly Reduction 99

motoric measures, leads to the conclusion that, although meditation is associated with decrements in both subjective and objective indices of anxiety, there is no compelling evidence that these reductions are of established superiority to those elicited by other interventions.

SYNOPSIS

In summary, it appears that prospective meditators tend to show higher anxiety scores than equivalent population norms. The regular practice of meditation ap- pears to facilitate a reduction in anxiety for subjects with high or average level of anxiety provided they meditate regularly. However, there appears to be a “ceiling effect” at the higher practice frequencies. Meditation is probably less effective in cases where subjects have a relatively long history of anxiety neurosis. There is evidence that the anxiety scores of prospective meditators could be used to predict their response to meditation, the drop-outs tending to score the highest, and the regulars the lowest, on pre-initiation scores. Meditation does not appear to be more effective than comparitive interventions in reducing anxiety-with the possible exception of progressive relaxation. Nevertheless, meditation does seem to be ef- fective, for many subjects, in reducing clinically elevated levels of anxiety. Those who benefit most appear to demonstrate a capacity for autonomous self-absorbed relaxation and/or to be relatively hypnotizable. Intervention credibility and ex- pectancy also appear to play a role in outcome. It thus appears that cognitive set is central to the effects of meditation and that neither the psychodynamic nor the behavioral models of meditation suffice in this respect. Smith (1978) may have been correct when he wrote that “meditation is quite likely a heterogeneous phe- nomenon, producing effects ranging from sleep to enlightenment, and incorpo- rating such diverse processes as insight, desensitization, and suggestion” (p. 278).

As none of the above reviewed studies-and many of them were well designed- failed to report significant decrements in anxiety, it must tentatively be concluded that meditation practice is associated with anxiety reduction. However, prospective meditators tend to report elevated anxiety. Although practice is associated with decrements in anxiety to a level comparable with that of the norm, there is insuf- ficient evidence to suggest that the scores obtained are significantly lower than those of the norm. Reductions in anxiety associated with the practice of meditation do not always receive convergent validity in terms of behavioral or physiological measures. This finding may suggest that the effects of meditation are mode specific, and is thus in accord with the multi-process model. As there is no compelling evidence that meditation is of significant superiority to other relaxation procedures in terms of anxiety reduction, the case for unique (state or trait) effects is not supported. Unfortunately, almost all the self-report measures were of trait anxiety and as such no comment on the relative effectiveness of meditation on state versus trait anxiety can be made. This might be an interesting area for future research.

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