INT’L. J. PSYCHIATRY IN MEDICINE, Vol.

40(4) 461-468, 2010

THE EFFECT OF MEDITATION ON PSYCHOLOGICAL

DISTRESS AMONG BUDDHIST MONKS AND NUNS*

GAURI VERMA, MB CHB

RICARDO ARAYA, MRCPSYCH, PHD

University of Bristol

ABSTRACT

Objective: This study aimed to ascertain whether there is an association

between meditation and psychological distress. Method: Within a cohort of
meditating Monks and Nuns who have accomplished varying levels of skill
in the art of meditation, we studied whether there are varying degrees of
psychological distress, and if so, whether this correlates to how advanced the
meditators are. In this cross-sectional study, Monks and Nuns were recruited
from monasteries, nunneries, and volunteer centres throughout Dharamshala,
Northern India. A total of 331 Monks and Nuns participated. Psychological
distress was measured using the GHQ-12, and the expertise on meditation
was assessed through the number of years practising meditation and the
maximum length of time held in concentration in one sitting. Results: A dose
response association was found with more years meditating associated with
increasingly lower GHQ scores. There was 0.21 points drop in GHQ scores
for every year meditating (p = 0.001). Conclusion: This study shows that
Monks and Nuns who are more advanced in practicing meditation show
fewer signs of psychological distress than Monks and Nuns who are less
advanced in the art of meditation. The practice of meditation may have

*We are grateful for the generous support of the Wellcome Trust, The Royal College of
Psychiatrists, and The University of Bristol Faculty of Medicine for the funding of this research.

461

Ó 2010, Baywood Publishing Co., Inc.

doi: 10.2190/PM.40.4.h
http://baywood.com
462 / VERMA AND ARAYA

therapeutic value in the management of psychological distress, and could

be offered as a non-pharmacological treatment alternative in patients with
anxiety and depression. This is a preliminary study with limitations. More
robust evidence is needed before we can confidently establish a causal
link between meditation and psychological wellbeing. Our findings should,
however, encourage further research in this area to generate better evidence
for the health benefits of what is a long established practice in Buddhist
communities.
(Int’l. J. Psychiatry in Medicine 2010;40:461-468)

Key Words: meditation, mindfulness, anxiety, depression

INTRODUCTION

Buddhist Monks and Nuns lead a unique lifestyle, whereby mind control forms
a pivotal part of routine life through meditation. Meditation has been defined as
“the careful, nonjudgmental attentiveness to whatever is occurring in the present
moment” [1]. Meditation, as a term, refers to a specific variety of mind training
practices. The different types vary amongst practicing cultures. One-pointed
concentration requires the mind to focus on a single object of concentration,
commonly breathing. Visualisation is a form of meditation whereby the focus rests
on constructing a detailed image of a Buddhist deity in the mind. The mind’s focus
fully rests with detailing the intricate components of an image. Meditation on
compassion involves the wholehearted dedication of the mind to loving kindness,
reflecting on the suffering of living beings and how all living beings strive to
alleviate their suffering and achieve happiness. Meditation encourages insight and
identification of the “emergence, transformation, and manifestation in awareness
of the discrete components that make up an emotional state” [2]. The practice
requires effort and concentration. It is known that with experience, it is possible
to improve one’s ability to meditate, one measure of which is for how long one
can hold concentration. With experience and dedicated practice, meditators can
hold their concentration for longer lengths of time in one sitting.
There is significant potential to apply the principles of meditation to affective
states, such as anxiety and depression. Some evidence suggests meditation may
alleviate psychological distress [3-5]. There are a wide array of benefits speculated
amongst practicing meditators as well as neuroscientists about the functional
neurobiological effects of meditation [6]. There is, however, little in the way of
scientific evidence from population studies investigating the benefits of any
functional adaption. This study hopes to elicit whether Monks and Nuns who are
more practiced in the art of meditation experience less anxiety and depression
in comparison with Monks and Nuns who are less advanced meditators.
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METHOD

There are approximately 1,000 Buddhist Monks and Nuns living in 15

monasteries and nunneries in the region of Dharamshala in Northern India. We
conducted a cross-sectional study in Dharamshala using the 12-item General
Health Questionnaire (GHQ-12) as our main outcome measure [7]. We opted to
use the total score (range 0-36) rather than adopt an arbitrary cut-off point because
there were no validity studies in this population. The following questions were
added to ascertain meditation levels: Do you meditate on a regular basis? How
long ago did you start meditating on a regular basis? In one sitting how long can
you keep your attention during meditation? How long have you been a Monk
for? We also enquired if they had contact with family or friends, if they had
become Monks/Nuns voluntarily, and if they had migrated. The completed ques-
tionnaire was translated into Tibetan by Tibetan- and English-speaking people.
We contacted the principal of the College for Higher Tibetan Studies who
provided us with a list of potential institutions to approach. GV approached
monasteries, nunneries, and a volunteer centre to recruit Buddhist Monks and
Nuns. A translator was enlisted who contacted each institution to arrange a
convenient time for distribution. On arrival, the head of office introduced us to
the congregation of Monks or Nuns at the institution. Simultaneously, translated
introductory speeches were then given by GV, explaining the background to the
study. Participants were recruited opportunistically. Translated versions of an
information leaflet and the questionnaires were distributed. Additional copies
were left with the institution heads for those not present. Most questionnaires were
collected by the heads and returned. A small proportion was obtained through
a contact, who personally distributed, retrieved, and returned the questionnaires.
As the information is potentially sensitive, all questionnaires were anonymous,
and no registry of names was kept, as per ethical requirements. Consent was
sought with the assistance of a liaison local Monk who was fluent in English and
Tibetan language. Ethical approval was granted by the Faculty of Medicine
and Dentistry Committee for Ethics (FMDCE) at the University of Bristol, UK.

RESULTS

Out of 480 questionnaires distributed to Monks, 167 were returned (32.5%).

Among Monks, 312 questionnaires were distributed of which 164 were returned
(52.6%). Two variables had substantial missing data; namely, the numbers of
minutes that attention was held in meditation (n = 203) and number of years
meditating (n = 211). For all the other variables, missing data was less than 5%.
The mean GHQ score (range 0 to 36) was 13.6 (95% CI 13.0-14.2). Mean
number of years as a Monk/Nun were 14 (13-15), years meditating was 7.2
(6.4-8.1), and attention whilst meditating was 9 (7.1-11.2) minutes. Sixty-five
percent (59-70) admitted to meditating regularly. There was a low correlation
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between years as a Monk and years meditating (r = 0.11). As for contacts, most
had family (94%) and friends (83%). Most had migrated (77%) and chosen their
lifestyle as a religious practitioner voluntarily (89%).
The only variable that showed a clear association with total GHQ scores in
univariate regression models was the number of years meditating, with 0.21 points
drop in GHQ scores for every year meditating (B = –0.21, 0.059, p = 0.001).
There was a clear dose response association with more years meditating associated
with increasingly lower GHQ scores (see Table 1). Both meditating regularly
(B = –1.20, 0.66, p = 0.07) and years as a Monk (B = –.06, 0.03, p = 0.07) had
borderline values. The minutes able to sustain meditation was not associated
with GHQ total scores (p = 0.19). In a model adjusting for years meditating,
regular meditation, and years as a Monk, the associations with GHQ total score
remained almost unchanged for years mediating (B = –.20, 0.06, p = 0.001)
but were further attenuated for regular meditation (p = 0.58)] and years as a Monk
(p = 0.44). There were no significant associations (p < 0.05) between GHQ score
and sex, contacts with family or friends, and migration in the univariate analysis.

DISCUSSION
This is one of very few studies investigating meditation in this population.
Results of the current study demonstrate that those Monks and Nuns who have
meditated for more years report less psychological distress.

Table 1. The Association between GHQ-12 Total Scores and

Number of Years Meditating and as Monk/Nuns

GHQ total score as main outcomea

n (%) Coef. [95% C.I.] Std. Err. p Values

Number years
meditating
0-2 46 (21) — — — —
3/5 57 (26) –.9940711 –3.14 to 1.15 1.086951 0.361
6/9 54 (24) –1.938127 –4.11 to 0.23 1.101139 0.080
10 or greater 60 (28) –3.251124 –5.37 to –1.13 1.074072 0.003

Number of years
as Monk/Nun
0-7 86 (27)
8-12 79 (25) 0.7305195 –.96 to 2.42 .8572517 0.395
13-19 76 (24) –2.075397 –3.79 to –.358 .8726435 0.018
20 or greater 79 (25) –1.951465 –3.63 to –0.27 .8543799 0.023
aAll linear regression models were adjusted by years meditating, regular meditation,
and years as a monk.
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Current literature has not established an adequate evidence base for clarifying
the effects of meditation for anxiety and depression [8, 9]. A Cochrane systematic
review conducted in 2006 analysed data on the effectiveness of meditation therapy
in treating anxiety disorders [3]. The authors were unable to conclude significant
findings because of the insufficiently small number of studies. There is a need to
extend the scope of research into this potentially beneficial therapeutic inter-
vention. Applying non-pharmacological methods such as meditation for anxiety
and depression, if proved beneficial, could enhance management of these dis-
orders. Meditation comes with minimal side effects and costs little except time
and training. For these reasons, further research appears warranted.
Few studies have examined the monastic community to investigate the asso-
ciation between meditation and psychological distress. The lifestyle and circum-
stances of members of this community are unique, and as such introduce
confounding factors to the findings, which would then limit the generalis-
ability of our results to the secular community, and to Western populations. In
particular, confounders we felt could influence psychological wellbeing include
their contact with family or friends, whether they became members voluntarily or
involuntarily, and whether they had migrated. Our data indicate these confounders
played a statistically insignificant role. In the current study, the most important
variable influencing psychological distress was the number of years the person
had been meditating. Other potential confounders of the association between
meditation and psychological distress were minimized in the study by restricting
the sample to Monks and Nuns from the same community.
The results add a new finding to the debate on meditation, which, together
with the available studies from Western populations, only make the argument
stronger that more robust study designs are warranted. This is a small study with
some important limitations so the results should be interpreted with caution. The
cross-sectional design does not allow us to establish the causal direction of this
association. It is possible that a selection bias may have applied, insofar as those
who are psychologically healthier were more likely to meditate. There were
difficulties in retrieving questionnaires, and there is considerable missing data,
especially regarding time meditating in minutes, perhaps suggesting difficulties
in understanding this question.
The questionnaires did not collect information from the Monks and Nuns
on the subtype of meditation they practiced. Discussions with some individual
Monks revealed they practice several types, including one-pointed meditation,
mindfulness, loving kindness meditation, and visualisation meditation. We are
unable to draw any distinction in the therapeutic benefits of the different subtypes
in this article.
There is growing literature supporting an association between mindfulness
techniques and psychological well-being. Mindfulness refers to a state of mind
which brings a certain quality of attention to moment-by-moment experience [10].
Aspects of mindfulness meditation have to some degree been introduced to
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Western psychiatry, for example, in the way of mindfulness-based cognitive

therapy (MBCT). There is growing evidence supporting the benefits of MBCT
[11-15]. A recent RCT by Foley and colleagues randomised 115 participants
with a diagnosis of cancer into a mindfulness meditation group and a control group
[16]. The intervention group meditated for up to an hour every week for 2 months.
The trial found significant improvements in depression, anxiety, distress, and
quality of life in the intervention group. This RCT supports the suggestion that
MBCT should be offered to patients in the oncology setting, in the context of
addressing associated psychological distress.
MBCT is a treatment that has been derived from mindfulness-based stress
reduction (MBSR), which incorporates mindfulness as its central feature [10].
Some evidence supports the benefits of MBSR [17-22], which is used widely
to manage and reduce psychological morbidity associated with chronic ill-
nesses, and additionally as a treatment for emotional and behavioural disorders
[23]. A meta-analysis on the efficacy of MBSR found that much of the evidence
is affected by methodological limitations [24]. Nevertheless, authors con-
cluded that this intervention has shown significant therapeutic benefits. A
study by Smith and colleagues in 2008 compared the efficacy of MBSR with
cognitive-based stress reduction. Outcome measures, including perceived
stress, depression, and psychological well-being, were significantly improved
with MBSR [25]. While mindfulness forms a component of some meditation
practices, it can be distinguished from one-pointed meditation, visualisation,
and compassion meditation. These mind training practices may also have
therapeutic value.
The speculated mechanism of meditation is its propensity to encourage
greater control over one’s mind. Through the practice of meditation, one refines
the art of acknowledging one’s thoughts, which in turn allows a distinction to
be made between the mind as a subject and the mind as an object. Meditation
provides a calm environment for the mind, which allows one to observe the
mind as a neutral on-looker. This allows a more objective perspective of
the subject of thought, and as such, the associated emotions that are linked
to thought. Our results suggest that meditation could be considered as an
alternative remedy for psychological distress, or even as a lifestyle choice for
the healthy to prevent the onset of psychological distress. Meditation could
also be suggested in the primary care setting in the initial management plan
of people presenting with mild depression or anxiety, in the same way that
exercise has been. Regular meditation, even for a few minutes every day, may
have significant benefits. Despite these promising results there is still insuffi-
cient scientific evidence to prove the effectiveness of meditation to prevent
or reduce psychological distress. Our findings should encourage further research
in natural populations where practices in favour of mental health are a habitual
part of the culture, as well as provide motivation for more studies in Western
populations.
 MEDITATION AMONG BUDDHIST MONKS AND NUNS / 467

ACKNOWLEDGMENTS

We are extremely grateful for the assistance and dedication shown by

Geshe Jampel Dakpa and Damchoe Gashon. Without their generous help this
research would not have been possible. The following people played a
crucial role in the undertaking of this project: Anupam Verma, Bhaarat Verma,
Dinesh Sharma, and Tenzin Choekyi. The following monasteries and nunneries
took part in the project: Tsecholing, Lha, Gyatso, The Institute of Buddhist
Dialectics, Dormaling, and the Sarah College for Higher Tibetan Studies.
We thank Sonam Tsomo, Lhadon, Dawa Tsering, and Tsering Dorjee for their
assistance with translations.

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Dr. Gauri Verma
School of Community and Social Medicine
Cotham House
Cotham Hill
Bristol BS6 6JL
e-mail: gauriverm@gmail.com