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This randomised clinical study assessed the effects of spiritually focused meditation (SpM) and secularly focused meditation on adjustment to illness, relative to a control condition for people in treatment for metastatic melanoma (N = 83). Physical and psychological well-being was assessed at baseline, post-intervention, two, and four months later. Meditation home practice was assessed as an additional predictor. Repeated Measures ANOVA found no interactive effects but there were two group effects. Averaged across time, SpM reduced depression and increased positive affect relative to the other two conditions. Rates of home practice were not associated with adjustment for any condition. Unexpectedly, practicing SpM was associated with a decrease in perceived support. Additionally, program evaluations indicated that most participants preferred programs that included spiritually based material, across all three group conditions. The results highlight the potential importance of providing spiritually based meditation programs to the terminally ill, and the need for further study. [ABSTRACT FROM AUTHOR]