Demystifying meditation in psychotherapy
People who seek therapy often want to get better at relaxing their body and mind. The concept is simple but not so easy to achieve under stressors such as dental surgery, childbirth, or the bread-and-butter challenges of daily life. Given our profession, it would be reasonable to expect that psychologists are the experts at meditation and relaxation, but alas, we do not have a lock on it.
Meditation is a construct that is a bit slippery to pin down but has been described as an altered mental state that can produce a sense of heightened awareness. A robust research literature supports that meditation can evoke the relaxation response with its corollary effects on the parasympathetic nervous system affecting heart rate, respiratory rate, skin temperature, and mood.
Matthew Sacchet of the Meditation Center at Massachusetts General and Harvard Medical School and Judson Brewer of Brown University’s Mindfulness Center, wrote in a recent Scientific American article that “advanced meditation may help inspire people and provide deep insight and clarity about how to achieve meaning in life.”
They noted, “Advanced meditation has potentially broad implications for people’s understanding of what it means to be human and for interventions for mental health and well-being, and it therefore deserves the attention of the scientific community.”
Seminal research aimed at identifying a “neural signature” of advanced meditation experiences has been ongoing at their respective institutions.
My worry with these types of statements is that although they sound very impressive, it makes the concept of meditation less, rather than more accessible to the average person.
Mindfulness meditation (like most psychotherapies) is better than treatment-as-usual, wait-list control or attention-control comparison conditions but about as effective as other active treatments at achieving positive results.
Transcendental meditation, mindfulness-based stress reduction, Zen meditation, hypnosis, acceptance and commitment therapy, yoga, tai chi, and the like can produce similar beneficial effects according to a JAMA study of 47 randomized controlled trials with more than 3,500 participants.
The specific method or technique does not have any inherent power. Much like going to the ice cream shop with 31 flavors, my choice of Rocky Road is not better or worse than your pistachio. It is simply my preference.
Stephen Bacon, Ph.D., author of the 2018 book, “Practicing Psychotherapy in Constructed Reality: Ritual, Charisma and Enhanced Client Outcomes,” makes the argument that altered mental states are examples of constructed reality.
Every culture creates its own view of reality, including what it means, for example, to be human or to achieve meaning in life. Regardless of whether psychotherapy clients perceive themselves to live a more meaningful life through mindfulness meditation (or other similar practice), most people can get better at evoking the relaxation response, even under stressful conditions.
Monks in the Himalayas who meditate in freezing weather and control their core body temperature are examples of people who have developed advanced skills in influencing the autonomic nervous system.
Most of us will not be able to achieve such feats, but we can usually get a bit better at eliciting the relaxation response through practice.
Psychologists have long promoted the idea that Cognitive Behavioral Therapy (CBT) is the “gold standard” as evidenced by the fact that it is the most widely researched. But this conveniently leaves out the many meta-analyses with thousands of subjects showing that CBT is not consistently better at achieving outcomes when compared head-to-head against other active treatments.
It is most widely researched perhaps because CBT researchers were better at operationalizing the techniques and more successful at getting grant funding. IIn recent years, mindfulness meditation researchers have been successful at getting grant funding.
I hope that mindfulness meditation will not be coupled with terms such as “gold standard” or “treatment of choice” as has been the case with specific psychotherapeutic techniques. Given that anxiety (another construct) is the most common psychiatric diagnosis, it would serve the public better if psychologists would collectively put our efforts toward demystifying and deconstructing the relaxation response, rather than promoting any given technique for doing so.