Journal of Alternative Complementary & Integrative Medicine Category: Medicine Type: Review Article
Predictors of Meditation Success: A Literature Review
- Dawn Michele Kambolis1*
- 1 Department Of Education, University Of British Columbia, British Columbia, Canada
*Corresponding Author:Dawn Michele Kambolis
Department Of Education, University Of British Columbia, British Columbia, Canada
Received Date: Jun 21, 2017 Accepted Date: Sep 06, 2017 Published Date: Sep 21, 2017
It is well established that meditation has shown promise in improving outcomes for a wide array of physical and mental health concerns in adults who regularly adhere to this ancient practice . Meditation has been associated with improvements in individuals with high anxiety, lowered depression and anxiety symptoms for patients with bipolar disorder, and reduced rates of insomnia [2-4]. The physiological effects related to anti-aging management of chronic pain anti-stress, and improved cognitive outcomes for the aged are also well documented and more robust than the current body of research on its therapeutic role in mental health [5-7]. The benefits of meditation extend beyond treating physical and mental illness with a number of studies demonstrating the ways in which meditation enhances overall wellbeing, such as positive emotion, cognitive flexibility and attention and enhanced compassion and ethical awareness [8-10].
The neurobiological mechanisms of action have also been well investigated, suggesting the core reasons for its clinical effectiveness . Studies have shown mindfulness to activate the areas associated with pain management, such as the orbit frontal and cingulated cortices reduce cortisol levels and improve neuroendocrine responses to psychosocial stress [12-14]. Lazar et al., tested the hypothesis that regular meditation practice is associated with differences in the structures in the brain and with magnetic resonance imaging determined the thickness of the cerebral cortex of experienced meditators to be significantly different than non-meditators (significance, p<0.001) . It’s important to note that this study is cross-sectional and it may be that long-term meditators had greater cortical mass in the first place, potentially contributing to greater motivation and perseverance in meditation. Many psychophysiological studies to date fail to determine whether adherence to meditation is specific to a person’s psychological trait or the meditation approach itself. The literature to date also fails to answer whether long-term meditation carries a clear advantage over shorter meditation, and if so how. The present study is a step towards highlighting the link between meditation duration, home practice and potential benefits.
Despite the ambiguity in research in terms of the advantages of short-term versus long-term meditation, the benefits of meditation are well supported. Consequently, the importance of understanding key factors in successful implementation of meditation from a user and service provider perspective is receiving increasing attention. If we are to move towards a culture of greater understanding and acceptance of meditation as a key to mind-body health, then we need to focus greater scientific attention to the ways we can more easily implement this age-old approach to well-being. This article will provide a greater understanding of the clinical impact of dedicated long-term meditation practice, the potential attributes of successful-long term meditators, struggles of those attempting to adhere to meditation and factors that may contribute to successful long-term implementation of meditation techniques. It will also point out that it remains inconclusive as to who would be more prone to adhere to a long-term meditation effort.
Articles published from 2000-2017 were retrieved using PsycINFO, PubMed, MEDLINE, PsycEXTRA, PsycARTICLES, Mary Ann Liebert, Publishers-Alternative and Complementary Therapies, Wiley Online Library and Google Scholar, for full-text articles in the English language. The search strategy included the following key search words: mindfulness, meditation, mindfulness based stress reduction, MBSR, loving kindness meditation, LKM, adherence, home work and long-term meditation. The following inclusion criteria were followed: (a) the study included a meditation intervention; (b) were published in peer-reviewed journals, conference proceedings or theses; (c) included adult participants only; (d) was original research; (e) research was published between 2008-2017 and (f) investigated the experience of meditators or adherence to meditation practice.
After screening criteria, the search netted 56 studies and of those 17 studies investigated the experience of meditators or adherence to meditation practice. Studies included heterogeneous and homogenous samples as warranted by study design and research focus and the bulk of the studies selected were published within the last five years. All studies were included whether they reported adherence or not. The data across these studies was synthesized using thematic tables with three primary themes emerging with similar content deemed important to the research topic. The themes were then checked against the original studies weighing the validity and reliability of each.
Meditation techniques investigated
Types of methodologies
THREE CORE THEMES
Theme 1: The lived experience of the meditator is important to meditation success
In another IPA study researchers examined participant experiences and perceptions of Meditation Awareness Training (MAT) with the aim of evaluating perceived acceptability and effectiveness . A sample of seven females and three males participated in an 8-weeks MAT program encouraging the participant to consider concepts such as emptiness and impermanence. Participants attended 2-hours workshops weekly with one-to-one support sessions made available every four weeks . Data was acquired via face-to-face interviews and analyzed following IPA guidelines with results showing four super ordinate themes: (a) growth in present moment awareness; (b) importance of teacher guidance; (c) increased sense of acceptance and personal well-being and (d) enjoyable group connection . Here we see similar themes to the study by with the first three themes emerging consistently across both studies . Both studies used a more traditional meditation approach such as Vipassana and Buddist meditation. Further research would do well to investigate whether there are additional benefits to be gained, and whether adherence is more successful for traditional practices [18,29].
Two narrative studies explored the distinct internal story of clients participating in various forms of meditation. The first study by Stelter encouraged three participants to meditate daily while taking part in two or three-hour blocks of an eight or six-week meditation course . It’s worth noting, the meditation exercises varied greatly and ranged from mindful daily activity to body scanning to imagery . Body scanning included a process whereby participants learned to become aware of different body parts and imagery included an invitation to imagine oneself in a solidly placed mountain . Researchers conducted three interviews for each participant in the beginning, middle and end of the course with a focus on discovering the felt experience during specific situations throughout meditation. The embodied changes, descriptions of what happens and how change emerges during meditation is worth noting here in that while all three participants expressed an internal story of positive effect and well-being, moving through rumination and elevated worry was a key challenge throughout the meditation process .
In a second narrative study, researchers used content analysis of diary entries to explore the internal story of older adults with chronic low back pain . Twenty-seven adults over the age of 65 participated in weekly MBSR in a group setting for 90 minutes’ duration. The meditation interventions varied from body scanning to walking meditation to sitting practice . Diary entries were assessed using two experienced coders and rendered six primary themes; (a) pain reduction was experienced; (b) perception of focused-attention increased; (c) sleep improved; (d) sense of well-being improved; (e) barriers to meditation emerged and (f) through experience meditation became easier . The most promising effect described by the participants was a global sense of well-being during and after meditation with improved mood and quality of life . Many of the themes reinforce previous IPA studies showing the potential natural rewards that may promote consistent practice as well as the barriers to consistency, such as sleepiness and difficulty finding time in the day to practice [18,26,28,29].
Another study by used the analysis of meditation diaries to investigate the experience of participants of a clinical trial of MBSR . Eight adults with chronic pain related distress that were part of a larger randomized clinical trial, participated in eight weekly 2-2.5 hour sessions led by a certified MBSR instructor with 10 years’ experience . Unique to this study was the use of a two-part method that included grounded theory and close-ended coding . It is the first study of its kind to assess the ways in which participants’ descriptions of their experience changes over the duration of a meditation program. The reported results are particularly rich in that they reveal themes that may inform the process of meditation courses to best ensure supportive structures are in place . For example, all participants described distress at some point in the course with several participants experiencing a spike in reactivity (negative reactionary thoughts, emotions and behaviors) midway through the course, followed by an improvement in reperception (the experience of non-judgment and non-reactivity). Over time participants described their inner experience with greater clarity and detail, and expressed improved affect and a more observing stance to their lived experience. They also focused strongly on their somatic experiences as a way of breaking the rumination link . Based on the researchers’ findings it may be that encouraging greater attention to the deep somatic internal sensations and additional support during a midway spike may encourage meditation success. However, randomized clinical trials are needed to more fully understand the way in which MBSR illicit changes in the ways participants relate to their own experience.
Understanding the phenomenological nature of meditation is arguably a key in discovering the motivators and factors that help ensure consistency of practice. In a recent case study of a long-term meditator of traditional meditation researchers investigated the inner lived experience of a man with 40 years and 20,000 hours of meditative practice . This presented a unique opportunity in that most studies have included participants with less than 10 years of practice or much less. Data from five semi-structured interviews yielded seven categories of states of being that shifted throughout the participant’s meditation process . The stages included a sense of; (a) differentiation between the internal and external; (b) sense of time weakens; (c) the ability to locate oneself in space lessens; (d) sense of self dissolves; (e) the need for control lessens; (f) sense of ownership weakens; (g) the sense of being with one’s body lessens; (h) proprioception weakens and (i) the touching-touched (sense of boundary between one’s body and the world) structure weakens . While the study is limited to one subject the results are novel in that they provide insight into the basic structures achieved with consistent long-term practice. With replicated studies and consistent findings, practitioners may develop the information needed to help new meditators better understand when they are achieving the core states that meditating elicits.
Digital media meditation applications are fast becoming an important user interface for the general public and those in clinical treatment, making meditation guidance and implementation potentially easier and more accessible. A study by Laurie and Blandford  recently made a noteworthy contribution to the current research literature using a reasoned action approach investigating the use of technology based mindfulness meditation techniques. Researchers conducted semi-structured interviews with 16 participants ranging in age from 25-38 . The study was informed by an autoethnogoraphy conducted by one of the authors over the course of 30 days and involved the application of 30-40 days of the popular mindfulness application Headspace . Researchers concluded that the success of the application of mindfulness approaches were associated with user expectations of outcomes, perceptions of time availability, belief systems, and affective states and lifestyles . When participants perceived the application to be effective, exhibited a positive attitude towards mindfulness, had realistic expectations and positive social influences, they were more enabled to use the digital intervention . While this study is limited to digital meditation applications it lines up with previous studies showing that people’s beliefs, affective states and lifestyles should be factored in when designing, implementing and designing a successful, and easily implemented meditation program.
Finally, understanding the experiential challenges associated with meditation is key to addressing a lack of adherence or attrition in meditation programs. One study addressed this question by using maximum variability sampling of male meditators . The study is unique in that it investigates a male population with the theory that they may face difficulties with emotion dis-regulation due to the impact of cultural norms inhibiting emotionality . The 30 participants were recruited using a purposive maximum variation sampling strategy and inclusion criteria included that participants at least 18 years old and were currently practicing meditation of some form . The sample included both clinical and non-clinical populations and the practices ranged in approach. Semi-structured interviews were conducted yielding four main problems; (a) meditation was difficult to learn and put into practice; (b) dis-regulation in the form of troubling thoughts and emotions arose that were hard to manage; (c) meditation exacerbated symptoms of anxiety and/or depression and (d) meditation was linked with psychotic episodes . While few studies have investigated possible deleterious effects of meditation, this study uncovered multiple psychological issues that may be underplayed in the research to date. The reported concerns warrant considerable attention and further investigation into the cost-benefit analysis for high-risk patients and guidelines for particular practices appropriate for specific conditions . Finally, relating to the question of which conditions contribute to a successful meditation practice versus failed meditation, it will be important to uncover protocols for home practice given the potential risks and challenges.
Theme 2: Personality factors are predictors of meditation success
Similarly, in a survey study of 209 business students, highlighted the role of participant attitudes and values in the applications of meditation . With a view to address barriers to the inclusion of meditation in business environments, the authors assessed the participants’ attitudes based on seven statements. The themes that emerged emphasized the importance of the way in which meditation is framed; how it was presented, the perceived contextual legitimacy and participant’s sense of efficacy all influenced openness to its application . Openness to new experience, a core dimension of the big five model, was viewed as a key factor in meditation acceptance.
In a mixed methods study using focus groups, case stories and health-related questionnaires, the impact of sociodemographic status on MBSR effectiveness for participants with chronic pain was recently investigated . While older age stood out as a clear predictor of better pain management, four themes were suggested to enhance effectiveness: being oneself, lessons learned, continuity and permanence were all deemed to be conditions for success . Personality qualities linked to extraversion (positive focus and knowing that you are not alone) and agreeableness (acceptance of chronicity) was identified as potential factors in meditation uptake. While this study was limited to chronic pain sufferers, it also highlights the need for broader investigation matching specific intervention to participant needs.
In a randomized control trial of adults with a history of suicidal depression, mindfulness-based cognitive therapy was implemented to assess factors associated with attrition . Identified a relationship between those who were likely to consistently participate in mindfulness classes versus those who did not remain in class; those participants who were not currently on antidepressant treatment, were younger, showed lower levels of problem solving deterioration post mood change and those deemed to have higher depressive rumination, cognitive reactivity and brooding were found to have more difficulty engaging . Qualities related to the personality variable emotional stability was shown to factor in significantly as a determinant of participants consistent involvement in mindfulness classes. The authors offer their observation that if mindfulness teachers are able to offer pre-class interviews with detailed discussions outlining the rationale for treatment, realistic outcomes and strategies for managing heightened emotional reactions, personality characteristics of motivation and persistence can be enhanced. The findings also illuminate a recommendation consistent across all four studies within this theme; further exploration of factors associated with attrition and acquisition of meditation skills is key to understanding meditation adherence. This study is a particularly important in that it is one of only a few to not only assess predictive factors of attrition in mindfulness-based cognitive therapy, but it also addresses risk processes affecting engagement.
Theme 3: Adherence to a consistent meditation practice influences treatment outcomes
In a recent study using secondary analysis 93 participants were randomized to receive Mindfulness-Based Relapse Prevention (MBRP) to assess the relationship between treatment enactment and substance use outcomes . Alcohol and Drug (AOD) use, substance craving, and amount of home mindfulness practice were measured at baseline, post-treatment and at two and four month’s follow-up . Overall participation MBRP was not only linked with a significantly meaningful increase in home practice, but home practice was associated with significant reduction in AOD craving and use. Researchers noted a decline in home practice at both follow-up periods and encouraged protocols to target the post-treatment decline .
Another first of its kind study was recently conducted comparing changes in bodily pain, psychological symptoms and Health-Related Quality of Life (HRQoL) . Researchers garnered 133 chronic pain patients in a longitudinal investigation derived from a larger prospective cohort study where an 8-week MBSR was taught six times per year . To note is the fact that while instructor qualifications were reported as long-term meditators, the authors did not define what they deemed a long-term meditator to be . Paired t tests were used to determine pre-and post-test changes in pain across various conditions and revealed significant differences in outcomes across chronic pain conditions . Greater home meditation practice was also associated with better outcomes on measures of psychological distress, self-rated health and summarization symptoms . The relationship between greater home practice and pain and other quality of life scales was unremarkable.
In a study using mediation analysis of data from questionnaires, researchers examined the relationship between long-term mindfulness meditation practice and a wide range of psychological qualities thought to be associated with mindfulness . Long-term meditators were defined as individuals engaged in a regular practice of at least once or twice per week; however, it is not reported how long participants had been practicing at this level of consistency . Demographically similar non-meditators had never practiced meditation regularly. Researchers reported long-term meditators to be more mindful in daily life, have higher levels of reflection, self-compassion and well-being and were lower on maladaptive symptoms such as rumination, thought suppression, cognitive failure and emotion dis-regulation . The findings contributed further to the current literature in that they address the role of the potential mechanisms that may contribute to successful application of a meditation practice or the psychological factors that may emerge as a result . Further research is warranted to determine a directional relationship.
Finally, there is little yet known on whether the skills learned in meditation training is maintained over the long term. In a wait-list control study, investigated whether participants continued a consistent meditation practice after a Loving Kindness Meditation intervention (LKM) . At 15-month follow-up a significant number of participants continued a regular practice with ongoing LKM predicting the perception of positive affect and internal resources . The researchers reported that baseline internal resources were not significant predictors of who would continue meditation and who would not, however participants with higher levels of positive emotion and rapid positive emotional response to intervention were more likely to continue meditation long term .
Literature Review Theme Table
|Author’s/Authors’ Names||Form of meditation and duration||Design||Sample size||Measure of success||Themes related to meditation success versus failure|
|Ataria Y et al., ||Satipathana and Theravada Vipassana||20,000 hours of meditation over 40 years||Case study||1 male||English speaking||Living in Israel||Ability to introspect upon ones experience during meditation and produce subtle changes in consciousness under experimental conditions||Long term meditators may achieve unique states of consciousness|
|Barkan T et al., ||Mindfulness based stress reduction||Duration 8 weeks: 7 weekly 2-hour sessions and 1 7-hour intensive session||Mixed method with regression analysis and self-reported journals||100 older adults||62% women97% white86% college education or higherAges 64-91||Living in US||Higher likelihood of using MBSR techniques at 6 month follow-up||Openness and agreeableness predicts better outcomes|
|Cohn MA et al., ||Loving Kindness Meditation||6 60-minute group sessions over a 7-week period20 minutes meditation20 minutes check-in on progress20 minutes instruction||1 year follow up survey of randomized control trial||95 adults from an original study sample of 139 participants (45 from experimental groups and 50 from a waitlist control group)||Mean age 41 years81.1% Caucasian6.3% Asian9.5% South Asian77.9% bachelors degree or higher||Living in US||Long lasting positive emotion skills, enduring capacity to increase personal resources even if they stopped meditating||Greater positive emotion may be a predictor of meditation outcomes|
|Crane C et al., ||Mindfulness based cognitive therapy||8 weekly 2-hour group treatment sessions6 2-hour follow-up classes 6 weeks and 6 months post-treatmentClasses included meditation training with sustained attention on body and breath and depersonalized perspective||Randomized control trial||108 adults with at least 3 episodes of major depression but in remission||94% Caucasian70% FemaleMean age 43.86||Living in UK||Lower hazard of relapse||Greater amount of home practise decreases relapse to depression|
|Crane C et al., ||Mindfulness based cognitive therapy||8 sessions over 9 weeks including an all day practise session (length of weekly session not stated)||Randomized control trial||68 adults||Treatment (n=33)Waitlist (n=36)1 past episode of major depression and a history of active suicidal ideation or attempt, but well asymptomatic at trial entry26 men42 womenMean age 42 years80% had post-secondary training or education||Living in UK||Remaining in the trial without drop out||High cognitive reactivity, depressive rumination and brooding may inhibit response to meditation|
|Grow JC et al., ||Mindfulness based relapse prevention||8 weekly 2-hour sessions||Randomized control trial||93 adults (18-70) with substance use disorders with completed inpatient treatment within two weeks of study||64.5% maleMean age 40.8463.4 Caucasian22.6 African American||Living in US||Greater home practise and less alcohol and other drug craving||Greater home practise decreased AOD use and craving|
|Kerr, CE et al., ||Mindfulness based stress reduction||8 weekly 2-2.5 hour sessions and one full day session||Qualitative: Grounded Theory with close ended coding||7 adults (5 completed)||All womenMean age 315 Caucasian 2 Hispanic1 Asian American||Living in US||Exploratory study on participants ability to describe experience of MBSR||Somatic experiences may break rumination link, distress occurs during meditation, spikes in dis-regulation midway through meditation course was followed by improvement in reperception|
|Laurie & Blandford ||Digital mindfulness application||Self-directed over 30-40 days||Qualitative: Semi-structured interview||16 adults||Ages 25-38Mean age 32.55males11 femalesAll working full-time||Living in UK||Exploratory study to examine enabling factors and barriers to mobile-based mindfulness intervention||Expectations, perceptions of time availability, people’s beliefs, affective states and lifestyles may affect uptake of meditation.|
|Lykins ELB & Baer RA (2009) ||Mindfulness meditation||Meditators: 1-2 sessions per week minimum96% Buddhist based meditation72% 21-45 minutes duration each session19% 1-20 minutes10% 45 minutes or more||Correlational study with mediation analysis||182 adult meditators||Mean age 49.628% male94% Caucasian71% mental health professionalMean education 19 years78 adult non-meditatorsMean age 43.236% male90% Caucasian47% mental health professionalMean education 18.4 years||Mindfulness as a predictor of well-being, reflection, self-compassion, emotional intelligence, and openness to experience||There may be a relationship between long-term meditation and psychological adjustment. With long term practise rumination of new meditators may decrease.|
|Lomas T et al., ||Primarily mindfulness, six element and metta bhavana (loving kindness meditiaon)||Qualitative: In-depth interviews||Ages 18 and older||27 Caucasion1 Mixed British & 2 Asian16 College Education or higher12 ProfessionalCommunity sample23 over 5 years meditation experience||Living in London||Impact of meditation on men’s wellbeing||Meditation was difficult to learn, difficult to practise, was associated with troubling thoughts and emotions and exacerbated mental health symptoms|
|Miller SH & Green S ||Non-required meditation||Survey||209 adults||2.9% males56.7% MBA candidates49.8% full-time employed25.3 part-time employed||Living in US||Values about meditation effect integration||How meditation is framed, presented, perceived contextual legitimacy and participants sense of efficacy influenced openness|
|Morone NE et al., ||Mindfulness Based Stress Reduction||8 90-minute sessions||Qualitative study: Grounded Theory||27 older adults with low back pain||65 years or olderEnglish speakingPrimarily male and Caucasian||Living in US||Investigative study on effects of mindfulness meditation on older adults||Barriers to consistency may include sleepiness and difficulty finding time in the day to practice|
|Petersen M & La Cour P ||Mindfulness based stress reduction||8 2.5-hour sessions with 20 min break1 4.5-hour session40 minutes daily home practise||Mixed methods: questionnaire, focus group interviews and case studies||58 adults in outpatient mental health program||All were English speaking||Living in Denmark||Describe and predict who would benefit from MBSR||Older age and stable living conditions may predict better outcomes.|
|Rosenzweig S et al., ||Mindfulness based stress reduction||8 week||Correlational study: Prospective cohort design||133 adults with chronic pain||Ages 23-78Mean age 49.884% women93% Caucasian54% actively working or students||Living in USA||Assess measures of bodily pain and psychological symptoms and factors associated with compliance of home practise||Increased home meditation was associated with improvement on several outcomes for chronic pain patients.|
|Shaner L et al., ||Shamatha & Vipassana||Practiced meditation for over 10 years – minimum of 20 minutes per day||Interpretive phenomenological analysis||6 Participants||Female||Living in USA||Exploration of the lived experience of long-term meditators||Challenges included leg pain, unusual sensations, drowsiness, boredom, agitation, fear, resistance, and discouragement, lack of concentration, dullness and trying too hard.|
|Shonin E et al., ||Meditation awareness training of Buddhist tradition||8 week 2-hour sessions||Interpretive phenomenological analysis||10 adults||7 female3 maleAges 20-42Mean age 30.170% Caucasian||Living in UK||Exploration of the acceptability and effectiveness of meditation||MAT participants reported improved psychological well being. Traditional course design and group support were important to participants.|
|Stelter R ||Variety of meditation approaches||6-8 weeks||Qualitative: narrative inquiry||3 adults with mild mental health symptoms||2 female1 male||Living in Denmark||Unfold the lived experiences of participants during mindfulness meditation training||Rumination and elevated worry was a described challenge throughout the meditation process|
Discussion and Conclusion
While the body of literature points to a strong link between long-term meditation practice and positive outcomes, several limitations must be noted. First, all scientific studies relied on self-report measures to greater or lesser degrees and while some measures used may have good support for reliability and validity, methods utilizing self-report may be subject to demand effects and biases . The ways in which experienced versus inexperienced meditators interpret or view questions or constructs may also differ rendering the self-report format potentially invalid. Also, many studies did not reveal details about the style of meditation, degree of participants’ previous meditation exposure or experience of the facilitators. Inconsistencies exist within the reviewed articles with regards to time periods of meditation application used, samples used and methodology. No replication studies were garnered and many studies employed bias sampling techniques that likely limit the generalizability of finding. Inconsistent terminology regarding meditation and long-term meditators is used throughout the literature, which negatively impacts the ability to integrate the literature. Finally, none of the studies garnered in the search investigated the differences between the conditions of long-term successful meditators and failed meditators.
So, while the evidence gives reasonable hope that the benefits of successful implementation of long-term meditation are quantifiable there is a significant gap in the literature specific to understanding the difference between those who respond well and those who fail to put mediation into consistent practice. First-line strategy to help practitioners and individuals better understand the conditions for meditation success will rely heavily on further research findings and replication studies confirming the conditions for success.
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Citation: Kambolis DM (2017) Predictors of Meditation Success: A Literature Review. J Altern Complement Integr Med 3: 037.
Copyright: © 2017 Dawn Michele Kambolis, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.