Effects of Transcendental Meditation on Academic Physician Burnout and Depression: A Mixed Methods Randomized Controlled Trial.

INTRODUCTION: Burnout is pervasive among physicians and has widespread implications for individuals and institutions. This research study examines, for the first time, the effects of the Transcendental Meditation (TM) technique on academic physician burnout and depression. METHODS: A mixed methods randomized controlled trial was conducted with 40 academic physicians representing 15 specialties at a medical school and affiliated VA hospital using the TM technique as the active intervention. Physicians were measured at baseline, 1 month, and 4 months using the Maslach Burnout Inventory, Beck Depression Inventory, Insomnia Severity Index, Perceived Stress Scale, and Brief Resilience Scale. Repeated measures analysis of covariance was used to assess adjusted mean change scores for the 1- and 4-months posttests. Qualitative interviews were conducted at baseline and 4 months and compared with the quantitative measurements. RESULTS: Significant improvements were found for the TM group compared with controls at 4 months in total burnout ( p = .020) including the Maslach Burnout Inventory dimensions of emotional exhaustion ( p = .042) and personal accomplishment ( p = .018) and depression ( p = .016). Qualitative interviews supported quantitative outcomes. Physicians reported classic burnout and depression symptoms in baseline interviews. Those regularly practicing the TM technique reported relief from those symptoms. The control group did not state similar changes. DISCUSSION: Mixed methods findings suggest the TM technique is a viable and effective intervention to decrease burnout and depression for academic physicians. Larger longitudinal studies with a wider range of health care providers are needed to validate these findings for extrapolation to the greater medical community.

Transcriptomics of Long-Term Meditation Practice: Evidence for Prevention or Reversal of Stress Effects Harmful to Health.

Background and Objectives: Stress can overload adaptive mechanisms, leading to epigenetic effects harmful to health. Research on the reversal of these effects is in its infancy. Early results suggest some meditation techniques have health benefits that grow with repeated practice. This study focused on possible transcriptomic effects of 38 years of twice-daily Transcendental Meditation® (TM®) practice. Materials and Methods: First, using Illumina® BeadChip microarray technology, differences in global gene expression in peripheral blood mononuclear cells (PBMCs) were sought between healthy practitioners and tightly matched controls (n = 12, age 65). Second, these microarray results were verified on a subset of genes using quantitative polymerase chain reaction (qPCR) and were validated using qPCR in larger TM and control groups (n = 45, age 63). Bioinformatics investigation employed Ingenuity® Pathway Analysis (IPA®), DAVID, Genomatix, and R packages. Results: The 200 genes and loci found to meet strict criteria for differential expression in the microarray experiment showed contrasting patterns of expression that distinguished the two groups. Differential expression relating to immune function and energy efficiency were most apparent. In the TM group, relative to the control, all 49 genes associated with inflammation were downregulated, while genes associated with antiviral and antibody components of the defense response were upregulated. The largest expression differences were shown by six genes related to erythrocyte function that appeared to reflect a condition of lower energy efficiency in the control group. Results supporting these gene expression differences were obtained with qPCR-measured expression both in the well-matched microarray groups and in the larger, less well-matched groups. Conclusions: These findings are consistent with predictions based on results from earlier randomized trials of meditation and may provide evidence for stress-related molecular mechanisms underlying reductions in anxiety, post-traumatic stress disorder (PTSD), cardiovascular disease (CVD), and other chronic disorders and diseases.

On the Neurobiology of Meditation: Comparison of Three Organizing Strategies to Investigate Brain Patterns during Meditation Practice.

Three broad organizing strategies have been used to study meditation practices: (1) consider meditation practices as using similar processes and so combine neural images across a wide range of practices to identify the common underlying brain patterns of meditation practice, (2) consider meditation practices as unique and so investigate individual practices, or (3) consider meditation practices as fitting into larger categories and explore brain patterns within and between categories. The first organizing strategy combines meditation practices defined as deep concentration, attention to external and internal stimuli, and letting go of thoughts. Brain patterns of different procedures would all contribute to the final averages, which may not be representative of any practice. The second organizing strategy generates a multitude of brain patterns as each practice is studied individually. The rich detail of individual differences within each practice makes it difficult to identify reliable patterns between practices. The third organizing principle has been applied in three ways: (1) grouping meditations by their origin-Indian or Buddhist practices, (2) grouping meditations by the procedures of each practice, or (3) grouping meditations by brain wave frequencies reported during each practice. Grouping meditations by their origin mixes practices whose procedures include concentration, mindfulness, or effortless awareness, again resulting in a confounded pattern. Grouping meditations by their described procedures yields defining neural imaging patterns within each category, and clear differences between categories. Grouping meditations by the EEG frequencies associated with their procedures yields an objective system to group meditations and allows practices to "move" into different categories as subjects' meditation experiences change over time, which would be associated with different brain patterns. Exploring meditations within theoretically meaningful categories appears to yield the most reliable picture of meditation practices.

Does the MRI/fMRI Procedure Itself Confound the Results of Meditation Research? An Evaluation of Subjective and Neurophysiological Measures of TM Practitioners in a Simulated MRI Environment.

Early research into meditation, including Transcendental Meditation (TM), relied exclusively on EEG to measure brain activity during meditation practice. Since the advent of neural imaging, MRI, and later fMRI, have dominated this field. Unfortunately, the use of this technology rests on the questionable assumption that lying down in a confining tube while exposed to very loud sounds would not interfere with the meditation practice. The present study was designed to assess the effects of the fMRI procedure on both the subjective and neurophysiological responses of short and long-term TM practitioners. Twenty-three TM practitioners volunteered to participate in this study: 11 short-term meditators, averaging 2.2 years practice, and 12 long-term meditators, averaging 34.8 years. The repeated-measures design included two activities for each participant, eyes-closed rest, and TM practice, in each of three conditions: sitting quietly in an upright position (normal TM practice); lying quietly in a supine position; and lying, with earplugs, inside a simulated fMRI tube (simMRI), while exposed to 110 dB recordings of an actual fMRI machine. Subjective experiences were collected after each activity in each condition. Physiological arousal was recorded using skin conductance levels. Scalp EEG was averaged into eight frequency bands within frontal and parietal leads; eLORETA software was used to explore the 3-D cortical distribution of EEG sources. During the simMRI condition, participants reported having more shallow meditation experiences, and greater agitation/distraction. Skin conductance levels paralleled self-reports, decreasing least during the simMRI condition. Frontal and parietal power decreased from sitting to simMRI in the alpha2 through gamma bands. Parietal power was higher during rest compared to TM in the alpha1 through beta2 bands. Frontal and parietal alpha1 coherence were highest during the simMRI condition. The eLORETA analysis revealed that the default mode network was more active during TM when sitting compared to the simMRI condition. The responses to the supine condition were generally between sitting and simMRI, with some significant exceptions. In conclusion, these data indicate that the fMRI procedure itself (high dB noise; lying down) strongly influences subjective and neurophysiological responses during meditation practice, and may therefore confound the interpretation of results from fMRI studies.

Effects of Maharishi Light Technology with Gems: A random-assignment, placebo-controlled, blinded pilot study.

OBJECTIVES: This blinded random-assignment, placebo-controlled pilot study investigated the effects of Maharishi Light Technology with Gems on three self-report measures: a questionnaire with a 5-point Likert-type scale, the Profile of Mood States (POMS), and an open-ended question. This pilot is the beginning of a research program to test the effects of this therapy. METHODS: In total, 18 meditating subjects received two treatments on consecutive days, randomly either Maharishi Light Technology or placebo, then 2 weeks rest, and then the other treatment on consecutive days. RESULTS: In comparison to placebo treatments, Maharishi Light Technology treatments were (1) rated as being significantly more settled, (2) higher on the Positive Self-Esteem subscale of the POMS and (3) described by the terms: healing, wholeness, and bliss. CONCLUSION: These treatments lead to significant improvements on self-report measures. Future research could assess their effects across both meditating and nonmeditating populations, using physiological measures to probe possible mechanisms of the effects.

Reductions in perceived stress following Transcendental Meditation practice are associated with increased brain regional connectivity at rest.

Transcendental Meditation (TM) is defined as a mental process of transcending using a silent mantra. Previous work showed that relatively brief period of TM practice leads to decreases in stress and anxiety. However, whether these changes are subserved by specific morpho-functional brain modifications (as observed in other meditation techniques) is still unclear. Using a longitudinal design, we combined psychometric questionnaires, structural and resting-state functional magnetic resonance imaging (RS-fMRI) to investigate the potential brain modifications underlying the psychological effects of TM. The final sample included 19 naïve subjects instructed to complete two daily 20-min TM sessions, and 15 volunteers in the control group. Both groups were evaluated at recruitment (T0) and after 3 months (T1). At T1, only meditators showed a decrease in perceived anxiety and stress (t(18) = 2.53, p = 0.02), which correlated negatively with T1-T0 changes in functional connectivity among posterior cingulate cortex (PCC), precuneus and left superior parietal lobule. Additionally, TM practice was associated with increased connectivity between PCC and right insula, likely reflecting changes in interoceptive awareness. No structural changes were observed in meditators or control subjects. These preliminary findings indicate that beneficial effects of TM may be mediated by functional brain changes that take place after a short practice period of 3 months.

Temporal and spatial characteristics of meditation EEG.

OBJECTIVE: This article discusses the importance of decisions made about the temporal and spatial characteristics of EEG during recording and analysis of meditation practices. ISSUE: A recent meta-analysis averaged EEG in the alpha1 and alpha2 bands to characterize mindfulness practices. This ignored known differences in cognitive processing associated with these two bands, and so confounded their conclusion about brain patterns during mindfulness. Another paper averaged EEG from central electrodes, which reflect activity of motor cortices, and frontal electrodes, which reflect activity of the frontal association cortices, to characterize Transcendental Meditation practice. This averaged the signals from motor and frontal cortices, which respond to different behaviors, and so confounded any conclusion about the nature of brain patterns during Transcendental Meditation practice. Also, both of these papers reported power-derived measures. This misses the connectivity information that is captured in coherence analysis. CONCLUSION: Meditation researchers should (a) investigate narrow frequency bands, especially theta1, theta2, alpha1 and alpha2, which are known to reflect different cognitive processes, (b) average EEG over theoretically known spatial areas, and (c) employ power as well as coherence analysis to more accurately define different categories of meditation practices and more reliably apply meditation practices to specific subject populations. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Effects of Maharishi Yoga Asanas on Mood States, Happiness, and Experiences during Meditation.

CONTEXT/BACKGROUND: Many studies showed positive effects of Yoga Asanas. There is no study on Maharishi Yoga Asanas yet. This research replicated and expanded observed improvements on the profile of mood states (POMS) as a result of 2-week Maharishi Yoga Asanas course. Thirteen college students taking part in a 4-week course on Maharishi Yoga Asanas were matched with 13 students taking other courses at the university. AIMS AND OBJECTIVE: The main objective of the study was to assess the effects of Maharishi Yoga Asanas on mood states, degree of happiness, and experiences in Transcendental Meditation (TM) practice. METHODS: All students were given two psychological tests and additional question before and after their 4-week course: POMS, Meditation Depth Questionnaire, and question about the degree of happiness. RESULTS: Repeated measure MANOVA showed the 4-week Maharishi Yoga Asanas course resulted in significant increase in happiness during the day and significant improvements in (1) sense of personal self, (2) transpersonal qualities, and (3) transpersonal self during their TM practice. CONCLUSION: This research shows that Maharishi Yoga Asanas affect more than body and mind. Rather they influence much deeper levels of one's subjectivity including one's transpersonal self.

A Systematic Review of Transcendent States Across Meditation and Contemplative Traditions.

BACKGROUND: Across cultures and throughout history, transcendent states achieved through meditative practices have been reported. The practices to attain transcendent states vary from transcendental meditation to yoga to contemplative prayer, to other various forms of sitting meditation. While these transcendent states are ascribed many different terms, those who experience them describe a similar unitive, ineffable state of consciousness. Despite the common description, few studies have systematically examined transcendent states during meditation. OBJECTIVES: The objectives of this systematic review were to: 1) characterize studies evaluating transcendent states associated with meditation in any tradition; 2) qualitatively describe physiological and phenomenological outcomes collected during transcendent states and; 3) evaluate the quality of these studies using the Quality Assessment Tool. METHODS: Medline, PsycINFO, CINAHL, AltHealthWatch, AMED, and the Institute of Noetic Science Meditation Library were searched for relevant papers in any language. Included studies required adult participants and the collection of outcomes before, during, or after a reported transcendent state associated with meditation. RESULTS: Twenty-five studies with a total of 672 combined participants were included in the final review. Participants were mostly male (61%; average age 39 ± 11 years) with 12.7 ± 6.6 (median 12.6; range 2-40) average years of meditation practice. A variety of meditation traditions were represented: (Buddhist; Christian; Mixed (practitioners from multiple traditions); Vedic: Transcendental Meditation and Yoga). The mean quality score was 67 ± 13 (100 highest score possible). Subjective phenomenology and the objective outcomes of electroencephalography (EEG), electrocardiography, electromyography, electrooculogram, event-related potentials, functional magnetic resonance imaging, magnetoencephalography, respiration, and skin conductance and response were measured. Transcendent states were most consistently associated with slowed breathing, respiratory suspension, reduced muscle activity and EEG alpha blocking with external stimuli, and increased EEG alpha power, EEG coherence, and functional neural connectivity. The transcendent state is described as being in a state of relaxed wakefulness in a phenomenologically different space-time. Heterogeneity between studies precluded any formal meta-analysis and thus, conclusions about outcomes are qualitative and preliminary. CONCLUSIONS: Future research is warranted into transcendent states during meditation using more refined phenomenological tools and consistent methods and outcome evaluation.

EEG microstates during different phases of Transcendental Meditation practice.

Two phases of Transcendental Meditation (TM)-transcending and undirected mentation-were compared to each other and to task-free resting using multichannel EEG recorded from 20 TM practitioners. An EEG microstate analysis identified four classes of microstates which were labeled A, B, C and D, based on their similarity to previously published classes. For each class of microstates, mean duration, coverage and occurrence were computed. Resting and transcending differed from undirected mentation with decreased prominence of Class A and increased prominence of Class D microstates. In addition, transcending showed decreased prominence of Class C microstates compared to undirected mentation. Based on previous findings on the functional significance of the microstate classes, the results indicate an increased reference to reality and decreased visualization during resting and transcending compared to undirected mentation. Also, our results indicate decreased saliency of internally generated mentations during transcending compared to undirected mentation reflecting a more detached and less evaluative processing. It is proposed that the continuous cycling through these two phases of meditation during a TM session might facilitate and train the flexible modulation of the parameters of these microstates of these particular classes which are known to be altered in psychiatric disorders. This might promote beneficial stabilizing effects for the practitioner of TM.

Higher theta and alpha1 coherence when listening to Vedic recitation compared to coherence during Transcendental Meditation practice.

This study compared subjective experiences and EEG patterns in 37 subjects when listening to live Vedic recitation and when practicing Transcendental Meditation (TM). Content analysis of experiences when listening to Vedic recitation yielded three higher-order code. Experiences during Vedic recitation were: (1) deeper than during TM practice; (2) experienced as an inner process; and (3) characterized by lively silence. EEG patterns support these higher-order codes. Theta2 and alpha1 frontal, parietal, and frontal-parietal coherence were significantly higher when listening to Vedic recitation, than during TM practice. Theta2 coherence is seen when attending to internal mental processes. Higher theta2 coherence supports subjects' descriptions that the Vedic recitations were "not external sounds but internal vibrations." Alpha1 coherence is reported during pure consciousness experiences during TM practice. Higher alpha1 coherence supports subjects' descriptions that they "experienced a depth of experience, rarely experienced even during deep TM practice." These data support the utility of listening to Vedic recitation to culture deep inner experiences.

Default mode network activation and Transcendental Meditation practice: Focused Attention or Automatic Self-transcending?

This study used subjective reports and eLORETA analysis to assess to what extent Transcendental Meditation (TM) might involve focused attention-voluntary control of mental content. Eighty-seven TM subjects with one month to five years TM experience participated in this study. Regression analysis of years TM practice and self-reported transcendental experiences (lack of time, space and body sense) during meditation practice was flat (r=.07). Those practicing Transcendental Meditation for 1month reported as much transcending as those with 5years of practice. The eLORETA comparison of eyes-closed rest/task and TM practice/task identified similar areas of activation: theta and alpha activation during rest and TM in the posterior cingulate and precuneus, part of the default mode network, and beta2 and beta3 activation during the task in anterior cingulate, ventral lateral and dorsolateral prefrontal cortices, part of the central executive network. In addition, eLORETA comparison of rest and TM identified higher beta temporal activation during rest and higher theta orbitofrontal activation during TM. Thus, it does not seem accurate to include TM practice with meditations in the catgory of Focused Attention, which are characterized by gamma EEG and DMN deactivation. Mixing meditations with different procedures into a single study confounds exploration of meditation effects and confounds application of meditation practices to different subject populations.

Transcending as a driver of development.

This paper draws from three different bodies of research to discuss the hypothesis that age-appropriate experiences enhance brain and cognitive development throughout the life span. These age-appropriate experiences could be considered as the drivers of development at each age, including drivers to foster development beyond adult abstract thinking, as described in Piaget's formal operational stage. We explore how a nurturing caregiver is the driver in the first 2 years of life, how language learning is the driver from 3 to 10 years, and how problem solving is the driver in the teenage years. To develop beyond adult rational thinking, we suggest that the driver is transcending thought, which can result when practicing meditations in the automatic self-transcending category, such as Transcendental Meditation.

Dosha brain-types: A neural model of individual differences.

This paper explores brain patterns associated with the three categories of regulatory principles of the body, mind, and behavior in Ayurveda, called Vata, Pitta, and Kapha dosha. A growing body of research has reported patterns of blood chemistry, genetic expression, physiological states, and chronic diseases associated with each dosha type. Since metabolic and growth factors are controlled by the nervous system, each dosha type should be associated with patterns of functioning of six major areas of the nervous system: The prefrontal cortex, the reticular activating system, the autonomic nervous system, the enteric nervous system, the limbic system, and the hypothalamus. For instance, the prefrontal cortex, which includes the anterior cingulate, ventral medial, and the dorsal lateral cortices, would exhibit a high range of functioning in the Vata brain-type leading to the possibility of being easily overstimulated. The Vata brain-type performs activity quickly. Learns quickly and forgets quickly. Their fast mind gives them an edge in creative problem solving. The Pitta brain-type reacts strongly to all challenges leading to purposeful and resolute actions. They never give up and are very dynamic and goal oriented. The Kapha brain-type is slow and steady leading to methodical thinking and action. They prefer routine and needs stimulation to get going. A model of dosha brain-types could provide a physiological foundation to understand individual differences. This model could help individualize treatment modalities to address different mental and physical dysfunctions. It also could explain differences in behavior seen in clinical as well as in normal populations.

Transcendental experiences during meditation practice.

This article explores transcendental experiences during meditation practice and the integration of transcendental experiences and the unfolding of higher states of consciousness with waking, dreaming, and sleeping. The subject/object relationship during transcendental experiences is characterized by the absence of time, space, and body sense--the framework that gives meaning to waking experiences. Physiologically, transcendental experiences during Transcendental Meditation practice are marked by slow inhalation, along with autonomic orientation at the onset of breath changes and heightened α1 (8-10 Hz) frontal coherence. The integration of transcendental experiences with waking, dreaming, and sleeping is also marked by distinct subjective and objective markers. This integrated state, called Cosmic Consciousness in the Vedic tradition, is subjectively marked by inner self-awareness coexisting with waking, sleeping, and dreaming. Physiologically, Cosmic Consciousness is marked by the coexistence of α1 electroencephalography (EEG) with delta EEG during deep sleep, and higher brain integration, greater emotional stability, and decreased anxiety during challenging tasks. Transcendental experiences may be the engine that fosters higher human development.

Comparison of coherence, amplitude, and eLORETA patterns during Transcendental Meditation and TM-Sidhi practice.

This random-assignment study compared coherence, amplitude, and eLORETA patterns during practice of the Transcendental Meditation (TM) and the TM-Sidhi programs. The TM technique involves systematic transcending of contents of experience to a state of pure consciousness. The TM-Sidhi program involves sanyama-the simultaneous experience of dharana (fixity), dhyana (transcending) and samadhi (pure consciousness). Thirty-two channel EEG was recorded from experienced TM subjects randomly assigned to two consecutive 10-min TM sessions or to a 10-min TM session followed by 10-min TM-Sidhi practice. Compared to TM practice, TM-Sidhi practice was characterized by higher frontal alpha1 and beta1 amplitudes, and eLORETA-identified sources of alpha1 EEG in right-hemisphere object recognition areas including the right parahippocampus gyrus, right fusiform gyrus, lingual gyrus, and inferior and medial temporal cortices. These cortical areas are involved in specific/holistic representation of words. The observed brain patterns support the descriptions of sanyama as including both specificity (sutras or verses), as suggested by higher frontal beta1 EEG amplitude and by eLORETA sources in right-hemisphere object-recognition areas, and holistic experience (pure consciousness) as suggested by higher frontal alpha1 EEG amplitude. These EEG patterns fit the complex description of sanyama.

Cross-sectional and longitudinal study of effects of transcendental meditation practice on interhemispheric frontal asymmetry and frontal coherence.

Two studies investigated frontal alpha lateral asymmetry and frontal interhemispheric coherence during eyes-closed rest, Transcendental Meditation (TM) practice, and computerized reaction-time tasks. In the first study, frontal coherence and lateralized asymmetry were higher in 13 TM subjects than in 12 controls. In the second study (N = 14), a one-year longitudinal study, lateral asymmetry did not change in any condition. In contrast, frontal coherence increased linearly during computer tasks and eyes-closed rest, and as a step-function during TM practice--rising to a high level after 2-months TM practice. Coherence was more sensitive than lateral asymmetry to effects of TM practice on brain functioning.

Psychological and physiological characteristics of a proposed object-referral/self-referral continuum of self-awareness.

This research extends and confirms recent brainwave findings that distinguished an individual's sense-of-self along an Object-referral/Self-referral Continuum of self-awareness. Subjects were interviewed and were given tests measuring inner/outer orientation, moral reasoning, anxiety, and personality. Scores on the psychological tests were factor analyzed. The first unrotated PCA component of the test scores yielded a "Consciousness Factor," analogous to the intelligence "g" factor, which accounted for over half of the variance among groups. Analysis of unstructured interviews of these subjects revealed fundamentally different descriptions of self-awareness. Individuals who described themselves in terms of concrete cognitive and behavioral processes (predominantly Object-referral mode) exhibited lower Consciousness Factor scores, lower frontal EEG coherence, lower alpha and higher gamma power during tasks, and less efficient cortical preparatory responses (contingent negative variation). In contrast, individuals who described themselves in terms of an abstract, independent sense-of-self underlying thought, feeling and action (predominantly Self-referral mode) exhibited higher Consciousness Factor scores, higher frontal coherence, higher alpha and lower gamma power during tasks, and more efficient cortical responses. These data suggest that definable states of brain activity and subjective experiences exist, in addition to waking, sleeping and dreaming, that may be operationally defined by psychological and physiological measures along a continuum of Object-referral/Self-referral Continuum of self-awareness.