What are the Active Ingredients of Mindfulness-based Interventions?

What are the Active Ingredients of Mindfulness-based Interventions?

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Mindfulness-based interventions typically comprise numerous elements, including some or all of the following: guided mindfulness exercises, guided loving-kindness and compassion meditation exercises, group discussion, psycho-education (sometimes in the style of a university lecture), yoga, one-to-one discussion with the programme facilitator, a CD of guided meditations to encourage at-home practice, and a full or half-day silent group retreat. Given that each of the above techniques arguably have therapeutic utility in their own right, ascertaining why MBIs are effective is problematic because they have numerous ‘active ingredients’.

Not controlling for other active ingredients is a common limitation of MBI intervention studies. Indeed, although scientific evidence demonstrates that certain MBIs are equally or more effective than other treatments for improving specific health conditions, it is currently unclear whether it is mindfulness, or mindfulness in combination with other therapeutic techniques, that results in health benefits. One way to overcome this methodological limitation is to employ a purpose-designed ‘active’ control condition. This is a control intervention that mirrors the main intervention in terms of its design, but does not include any mindfulness techniques. By conducting a randomised controlled trial that compares the effectiveness of an MBI against a suitably formulated active control intervention, we can determine that superior outcomes in the MBI versus control group are caused by mindfulness.

It could be argued that it doesn’t matter whether it is specifically mindfulness or other intervention components that make MBIs effective. If we are only interested in treatment outcomes and adhere to a ‘what works’ approach to alleviating illness symptoms, then establishing which intervention components are most effective becomes less important. However, from the point of view of advancing scientific understanding of how the human mind reacts to given psychotherapeutic techniques, it is useful to establish which ingredients are most active within a given intervention. Such knowledge can also help to inform the development of more effective and ‘therapeutically streamlined’ MBIs.

When designing an active control intervention for MBI efficacy studies, in addition to matching the design of the target and control interventions (i.e., minus the inclusion of mindfulness techniques), it is also important to match the ‘competency’ of the instructor or instructors delivering the two interventions. For example, a number of meditation intervention studies employing an active control condition have used an experienced clinician and meditation teacher to deliver the MBI, whilst leaving a relatively inexperienced student to administer the control intervention. Clearly, such an approach can introduce bias and weaken the strength of the evidence from MBI studies.

In order to overcome the above methodological limitation, in a recent randomised controlled trial that we conducted, the study was designed such that the same instructor delivered the MBI and comparison intervention. To control for potential bias on the part of the instructor, participants in each intervention condition were asked to rate the instructor’s levels of enthusiasm and preparation. Statistical tests were then performed to determine if there were significant differences between how participants from the intervention and control group rated the instructor’s performance.

We decided to control for an ‘instructor effect’ because in our opinion, the mindfulness instructor is one of the most active ingredients in MBIs. Part of our research has involved the development and empirical investigation of a ‘second-generation’ of MBI. Second-generation MBIs (such as Meditation Awareness Training) are designed slightly differently compared to ‘first-generation’ MBIs (such as Mindfulness-based Stress Reduction or Mindfulness-based Cognitive Therapy). More specifically, second generation MBIs are overtly spiritual in nature and teach a greater range of meditative techniques. Given that second-generation MBIs comprise different design elements compared to first-generation MBIs, it is reasonable to assume that these two types of MBIs will result in different outcomes. However, despite the design differences between first- and second-generation MBIs, it is our view that if a mindfulness teacher with authentic spiritual realisation was to administer a first-generation MBI, the outcomes would be very similar to them administering a second-generation MBI.

In other words, if the mindfulness teacher is genuinely rooted in the present moment, the specific design of the MBI becomes less important. As we discussed in our post on The Four Types of Psychologist, we would argue that the same principle applies to the majority of psychological therapies. If the clinician knows their own mind, has genuine compassion for the client, and is skilled in helping the client understand their problems, then the choice of therapy becomes less important.

Although preliminary findings (including from some of our own clinical case studies and qualitative studies) support the notion that the mindfulness teacher is one of the (if not the) most important ingredients of MBIs, there is clearly a need for further research investigating how the instructor influences outcomes. However, in the absence of extensive empirical investigation into this subject, we hypothesise that what participants of MBIs need most (and therefore respond best to), is the unconditional love and spiritual wisdom of a teacher who is without a personal agenda, and whose mind is saturated with meditative awareness.

 

Ven. Edo Shonin and Ven. William Van Gordon

Further Reading

Baer, R., Smith, G., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27-45.

Chiesa, A. (2013). The difficulty of defining mindfulness: Current thought and critical issues. Mindfulness, 4, 255-268.

Chiesa, A., & Malinowski, P. (2011). Mindfulness-based approaches: Are they all the same? Journal of Clinical Psychology, 67, 404-424.

MacCoon, D., Imel, Z., Rosenkranz, M., Sheftel, J., Weng, H., Sullivan, J., . . . Lutz, A. (2012). The validation of an active control intervention for Mindfulness Based Stress Reduction (MBSR). Behavior Research and Therapy, 50, 3-12.

Shonin, E., Van Gordon, W., Dunn, T., Singh, N. N., & Griffiths, M. D. (2014). Meditation Awareness Training for work-related wellbeing and job performance: A randomised controlled trial. International Journal of Mental Health and Addiction, 12, 806-823.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015a). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.

Shonin, E., & Van Gordon, W. (2015). The lineage of mindfulness. Mindfulness, 6, 141-145.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 63, 654.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.

Shonin, E., Van Gordon, W., Compare, A., Zangeneh, M., & Griffiths, M. D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161-1180.

Shonin, E., & Van Gordon, W. (2013). Searching for the present moment, Mindfulness, 5, 105-107.

Does Mindfulness Have a Role in the Treatment of Fibromyalgia Syndrome?

Does Mindfulness Have a Role in the Treatment of Fibromyalgia Syndrome?

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Fibromyalgia syndrome is a poorly understood chronic pain disorder. An estimated 3% of adults are reported to suffer from fibromyalgia, with higher levels of occurrence in females compared to males. The main symptoms of fibromyalgia syndrome are all-over body pain, tiredness, difficulty in sleeping, and cognitive dysfunction such as memory impairment. There is also a high level of association between fibromyalgia syndrome and poor quality of life, mental health issues such as depression and anxiety, irritable bowel syndrome, and unemployment.

Some of the reasons why fibromyalgia syndrome is believed to be a controversial illness are as follows:

  1. Individuals with fibromyalgia are reported to exert a higher burden upon healthcare resources when compared with individuals diagnosed with other chronic illnesses.
  1. Research has shown that individuals with fibromyalgia often experience difficulty in having their illness diagnosed, and often feel that their needs and symptoms are poorly understood by the medical profession.
  1. A diagnosis of fibromyalgia is primarily based upon the exclusion of other illnesses, the patient’s medical history, and their reaction to pressure being gently applied to ‘tender points’. In other words, there isn’t a reliable laboratory test for fibromyalgia syndrome (e.g., blood test, x-ray) and this means that it is difficult to be 100% certain that a given individual is genuinely suffering from the illness.

The current treatment-of-choice for fibromyalgia syndrome is the use of psychopharmacology (principally antidepressants) coupled with non-pharmacological approaches such as physical exercise, cognitive-behavioural therapy, self-help, and/or psycho-education. However, pharmacological treatments for fibromyalgia have shown only a limited degree of effectiveness, and many patients withdraw from treatment due to the side-effects of antidepressants as well as low levels of symptom reduction.

The lack of convincing treatment efficacy outcomes for existing pharmacological and non-pharmacological fibromyalgia interventions has led to the empirical evaluation of alternative treatment approaches. Since there exists evidence (which varies in quality and quantity) supporting the use of mindfulness in treating each of the individual symptoms of fibromyalgia syndrome (e.g., chronic pain, sleep disturbance, fatigue, depression, anxiety, and cognitive dysfunction), mindfulness-based interventions have been an obvious candidate in terms of investigating their effectiveness for treating the illness.

A systematic review and meta-analysis comprising six randomised and non-randomised controlled trials of mindfulness-based stress reduction (MBSR) for individuals with fibromyalgia (674 participants in total) found that individuals receiving MBSR experienced significant short-term improvements in quality of life and pain compared to individuals in the non-meditating control groups. A further systematic review (incorporating a range of intervention study designs) examined the findings from ten studies of mindfulness meditation (702 participants in total). The review concluded that mindfulness led to significant improvements in both physical symptoms (e.g., pain, sleep quality, functionality) and psychological symptoms (e.g. depression, anxiety, perceived helplessness).

In terms of the possible mechanisms by which mindfulness helps to alleviate the symptoms of fibromyalgia syndrome, the most widely proposed explanation is that mindfulness helps to increase perceptual distance from somatic pain and distressing psychological stimuli. By mindfully observing painful bodily sensations, it appears that individuals suffering from fibromyalgia (and other pain disorders) can begin to objectify and almost distance themselves from their pain. The same applies to feelings of psychological distress and fatigue that are often associated with musculoskeletal pain. Mindfully observing feelings of distress, frustration and low mood appears to weaken the intensity of such feelings, and to help create the ‘psychological space’ necessary for other – more psychologically adaptive – feelings and thought processes to arise.

Based on findings from a randomised controlled trial of an online mindfulness-based intervention, it has been suggested that stronger treatment outcomes can actually be achieved by using mindfulness not just as a means of improving patient’s ability to cope with pain and psychological distress, but as a means of helping improve patients’ ability to engage in effective social and interpersonal interactions. In other words, given the complexity of fibromyalgia syndrome, it appears that in order to maximise treatment effectiveness, mindfulness interventions targeting fibromyalgia should be purpose-designed and encourage participants to draw on both psychological and social resources.

In terms of other potential mechanisms of action, there is evidence to suggest that mindfulness leads to changes in neurological pain pathways, reduced levels of ruminative thinking and self-preoccupation, and improvements in spirituality. This latter potential mechanism is important because cross-sectional studies involving individuals with fibromyalgia have specifically identified a positive correlation between spirituality and positive affect (i.e., as levels of spirituality increase so do positive mood states), and a negative association between spirituality and symptoms of depression and anxiety (i.e., as levels of spirituality increase in individuals with fibromyalgia, their levels of depression and anxiety decrease).

Findings indicate that purpose-designed mindfulness-based interventions may have a role to play in the treatment of fibromyalgia syndrome. However, at present the overall quality of the evidence is weak and there is a need to replicate and consolidate findings using methodologically robust randomised controlled trials.

Ven Edo Shonin and Ven William Van Gordon

 

Further Reading

Branco, J. C., Bannwarth, B., Failde, I., Abello Carbonell, J., Blotman, F., Spaeth, M., … Matucci-Cerinic, M. (2010). Prevalence of fibromyalgia: a survey in five European countries. Seminars in Arthritis and Rheumatism, 39, 448-55.

Cramer, H., Haller, H., Lauche, R., & Dobos, G. (2012). Mindfulness-based stress reduction for low back pain. A systematic review. BMC Complementary and Alternative Medicine, 12, 162.

Davis, M. C., & Zautra, A. J. (2013). An online mindfulness intervention targeting socioemotional regulation in fibromyalgia: results of a randomized controlled trial. Annals of Behavioural Medicine, 46, 273-284.

Dennis, N. L., Larkin, M., & Derbyshire, S. W. G. (2013). ‘A giant mess’ – making sense of complexity in the accounts of people with fibromyalgia. British Journal of Health Psychology, 18, 763-781.

Häuser, W., Wolfe, F., Tölle, T., Üçeyler, N., & Sommer, C. (2012). The role of antidepressants in the management of fibromyalgia syndrome: a systematic review and meta-analysis. CNS Drugs, 26, 297-307.

Henke, M., & Chur-Hansen, A. (2014). The effectiveness of mindfulness-based programs on physical symptoms and psychological distress in patients with fibromyalgia: a systematic review. International Journal of Wellbeing, 4, 28-45.

Hickie, I., Pols, R. G., Koschera, A., & Davenport, T. (2004). Why are Somatoform Disorders so Poorly Recognized and Treated? In: G. Andrews & Henderson S. (Eds). Unmet Need in Psychiatry: Problems, Resources, Responses (pp. 309-323). Cambridge: Cambridge University Press.

Hughes, G., Martinez, C., Myon, E., Taïeb, C., & Wessely, S. (2005). The impact of a diagnosis of fibromyalgia on health care resource use by primary care patients in the UK: an observational study based on clinical practice. Arthritis and Rheumatism, 54, 177-183.

Jones, K. D., Sherman, C. A., Mist, S. D., Carson, J. W., Bennett, R. M., & Li, F. (2012). A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients. Clinical Rheumatology, 31, 1205-1214.

Langhorst, J., Klose, P., Dobos, G. J., Bernardy, K, & Häuser, W. (2013). Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials. Rheumatology International, 33, 193-207.

Lauche, R., Cramer, H., Dobos, G., Langhorst, J., & Schmidt, S. (2013). A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome. Journal of Psychosomatic Research, 75, 500-510.

Moreira-Almeida, A., & Koenig, H. G. (2008). Religiousness and spirituality in fibromyalgia and chronic pain patients. Current Pain and Headache Reports, 12, 327-332.

Nüesch, E., Häuser, W., Bernardy, K., Barth, J., & Jüni, P. (2013). Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: network meta-analysis. Annals of the Rheumatic Diseases, 72, 955-962.

Peterson, E. L. (2007). Fibromyalgia – Management of a misunderstood disorder. Journal of the American Academy of Nurse Practitioners. 19, 341-348.

Rimes, K. A., & Wingrove, J. (2013). Mindfulness-based cognitive therapy for people with chronic fatigue syndrome still experiencing excessive fatigue after cognitive behaviour therapy: a pilot randomized study. Clinical Psychology and Psychotherapy, 20, 107-117.

Scott, M., & Jones, K. (2014). Mindfulness in a fibromyalgia population. The Journal of Alternative and Complementary Medicine, 20, A94-A95.

Sicras-Mainar, A., Rejas, J., Navarro, R., Blanca, M., Morcillo, A., Larios, R., … Villarroya, C. (2009). Treating patients with fibromyalgia in primary care settings under routine medical practice: a claim database cost and burden of illness study. Arthritis Research & Therapy, 11, R54. DOI:10.1186/ar2673.

Wolfe, F., Brähler, E., Hinz, A., & Häuser, W. (2013). Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: results from a survey of the general population. Arthritis Care and Research, 65, 777-785.

Wolfe, F. (2009). Fibromyalgia wars. Journal of Rheumatology, 36, 671-678.

Wolfe, F., Anderson, J., Harkness, D., Bennett, R. M., Caro, X. J., Goldenberg, D. L., … Yunus, M. B. (1997a). A prospective, longitudinal, multicenter study of service utilization and costs in fibromyalgia. Arthritis and Rheumatology, 40, 1560-1570.

Wolfe, F., Anderson, J., Harkness, D., Bennett, R. M., Caro, X. J., Goldenberg, D. L., … Yunus, M. B. (1997b). Work and disability status of persons with fibromyalgia. The Journal of Rheumatology, 24, 1171-1178.

Shonin, E., & Van Gordon, W. (2013). Searching for the present moment, Mindfulness, 5, 105-107.

Shonin, E., Van Gordon, W., Compare, A., Zangeneh, M., & Griffiths, M. D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161-1180.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 63, 654.

Shonin, E., & Van Gordon, W. (2015). The lineage of mindfulness. Mindfulness, 6, 141-145.

Mindfulness in Mental Health: A Critical Reflection

Mindfulness in Mental Health: A Critical Reflection

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We were recently invited to write a paper for the inaugural issue of the Journal of Psychology, Neuropsychiatric Disorders and Brain Stimulation. Our contribution (which was co-authored with our friend and colleague Professor Mark Griffiths) was entitled ‘Mindfulness in Mental Health: A Critical Reflection’. In light of the substantial growth of scientific and public interest into the health-related applications of mindfulness, our paper discussed whether the scientific evidence for mindfulness-based interventions actually merits their growing popularity amongst mental health practitioners, scientists, and the public more generally. We concluded that mindfulness-based interventions have the potential to play an important role in mental health treatment settings. However, due to the rapidity at which mindfulness has been taken out of its traditional Buddhist setting, and what is possibly evidence of media and/or scientific hype concerning the effectiveness of mindfulness, we recommended that future research should seek to:

  1. Establish whether the benefits of participating in mindfulness-based interventions are maintained over periods of years rather than just months.
  2. Examine whether there are any risks or unwanted consequences associated with participating in mindfulness-based interventions.
  3. Make sure that research findings are not influenced by what is perhaps best described as a form of ‘intervention effect’. Rather than behavioural and psychological changes arising from actually practising mindful awareness, it is possible that some of the positive outcomes observed by researchers actually reflect a belief amongst participants that they are receiving a very popular and ‘proven’ therapeutic or ‘spiritual’ technique. In other words, rather than mindfulness practice per se leading to health improvements, one of the reasons that mindfulness-based interventions are effective might be due to participants’ expectations, and their belief that mindfulness works.
  4. Investigate the Buddhist position that sustainable improvements to mental and spiritual health typically require consistent daily mindfulness practice over a period of many years (i.e., they do not arise after attendance at just eight two-hour classes with some self-practice in between).

The full reference for the article is shown below, and the article can be downloaded (free of charge) from here: Mindfulness_A critical reflection 2015

Article Reference: Van Gordon, W., Shonin, E., & Griffiths, M. D. (2015). Mindfulness in Mental Health: A Critical Reflection. Journal of Psychology, Neuropsychiatric Disorders and Brain Stimulation, 1(1), 102.

Ven Edo Shonin & Ven William Van Gordon

Just a Thought

Just a Thought

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The term ‘thought’ is widely used in contemporary society. For example, most people probably don’t go for more than a day or two before they say or hear an expression such as ‘I’ve just had an interesting thought’, ‘What are your thoughts on the matter?’, or ‘I’ve thought more about what you said’. However, although common human experience tells us that thoughts definitely exist and are a normal aspect of human functioning, have you ever tried explaining to another person exactly what a thought is? It is difficult to outline in precise terms exactly what constitutes a thought, and even the dictionary definitions of this term are somewhat ambiguous. For example, the Oxford English dictionary describes a thought as ‘An idea or opinion produced by thinking, or occurring suddenly in the mind’. Although this dictionary definition informs us that thoughts are the product of thinking, it doesn’t actually provide us with a definitive account of what constitutes a thought.

An object such as a table can be described to another person without too much difficulty. According to the Oxford English dictionary, a table is ‘a piece of furniture with a flat top with one or more legs, providing a level surface for eating, writing, or working at’. This definition introduces a number of defining characteristics (such as a ‘level surface’, ‘one or more legs’, and ‘surface for eating’) which – whilst allowing for differences in interpretation – would probably make it reasonably easy for a person to picture in their mind what a table is, and then try to locate one should they wish to do so. A thought, on the other hand, doesn’t really have any tangible characteristics that would allow a person to create an accurate picture in their mind. For example, thoughts – as far as we know – do not have a shape, colour, texture, size, sound, or smell. They do not have a top or a bottom and their surface (if indeed they have one) cannot said to be level or undulating.

Neuropsychological studies allow us to study certain aspects of thoughts by measuring (for example) electrical impulses and changes in blood oxygen levels in the brain. However, although such studies provide important information relating to thoughts, they cannot measure thoughts directly (i.e., an electrical signal that corresponds to a thought is not the thought itself) and are not able to observe the ‘raw material’ that thoughts are made of. Likewise, neuropsychological studies are unable to ascertain the precise location from which thoughts originate or how many levels of thought can manifest simultaneously. Therefore, although through scientific study and shared human experience we have learned a lot about thoughts, it is arguably fair to say that contemporary understanding of thoughts is still at an elementary level.

It is perhaps also fair to say that in general, people (and to a certain degree modern science) have a tendency to take thoughts for granted and to overlook their importance. For example, with each and every thought that we have, we change the trajectory of the present moment and reset the future. This may sound like a remark by one of those authors who has jumped on the meditation and mindfulness bandwagon, and who is trying to impress readers by writing a book full of (what they deem to be) deep and meaningful remarks. However, it’s not meant to be a deep or meaningful remark and if you stop and think about it, it’s a perfectly true statement. The world as we know it is shaped by (amongst other things) the words and actions of human beings. Our thoughts influence (and in many cases underlie) our words and actions, and our (and other people’s) words and actions also influence our thoughts. A person’s decision and intention to pursue a particular career might have originated in a single thought. The same applies to the words and actions of leaders such as Mahatma Ghandi or Martin Luther King – perhaps their motivation to inspire political and spiritual change traces back to a single thought that they once had.

From this perspective, it is fair to say that thoughts are incredibly creative. With our thoughts, we shape who we will be in the future. We also shape how other people (and the world more generally) will be in the future. With each new thought, an entirely new future, and an entirely new world, is born. In many respects, thoughts are the creative energy of the universe. In fact, perhaps it is conceivably possible that thoughts are made of the same ‘raw material’ that caused the universe to be created (i.e., during the big-bang). If this statement is correct it would mean that during the process of giving birth to a single thought, the mind draws upon the underlying primordial energy of existence, and that it serves as the strata within which thoughts explode into existence and thus create an entirely new universe. What a marvellous thought!

Ven Edo Shonin & Ven William Van Gordon

The Seat of Self and Consciousness in the Brain: A Buddhist Perspective

The Seat of Self and Consciousness in the Brain: A Buddhist Perspective

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Clicca qui per Italiano

In recent decades there have been major advances in scientific understanding of the human brain. To a large extent these advances have been driven by new neuroimaging technologies that have provided neuroscientists with increasingly refined images or maps of the brain. One specific arm of neuroscientific research has made use of these neuroimaging techniques in order to try to identify the neurological seat of the self or consciousness. Today’s post briefly highlights some of the key findings of this research and discusses them in relation to core Buddhist principles concerning the manner in which the self is believed to exist.

Neuroimaging studies exploring how and where the brain processes information concerning the self have identified associations between certain self-related cognitive processes and the activation of specific areas in the brain. For example, self-referential memories (i.e., memories concerning the self) are associated with increased activation of the medial prefrontal cortex. A further example is the role played by the left cerebral hemisphere in the regulation of self-recognition (i.e., an individual’s ability to recognize itself in, for example, a reflection or visual image).

The ability to distinguish between self and other is a key aspect of adaptive psychosocial functioning and it therefore makes logical sense that there exist areas within the brain that play a role in processing information concerning the “self”. However, despite the fact that neuroimaging studies have provided some valuable data in terms of brain areas that correspond to self-referential processes, the activation of such brain areas does not equate to the location of consciousness or the nucleus of an inherently existing self. Rather, neuron activation in these brain areas simply demonstrates that most individuals have a pronounced sense of self.

According to the Buddhist teachings, there is an ocean of difference between individuals having a sense of self and there actually being a self that inherently exists. Buddhism accepts that a sense of self is essential if society is to function effectively. For example, most elucidations of the practices of loving-kindness and compassion – two core aspects of the Buddhist teachings – are based on the assumption that there is both a giver (i.e., self) and a receiver (i.e., other). If the historical Buddha didn’t have a sense of self that allowed him to identify that his level of spiritual insight was in some way different than most of his followers, then it is reasonable to assume that he would not have felt the need to expound a path to overcome suffering and ignorance.

However, although beings at the stage of enlightenment have a sense of self (and understand fully that this sense of self is necessary if they are to effectively function in the world), they are also fully aware that the “self” is an illusion. The reason why Buddhism teaches that the self is an illusion relates to the principle of emptiness which asserts that beings (and all phenomena) exist only as interdependent and mentally designated constructs. For example, a flower manifests in dependence upon the water and air in the atmosphere, heat of the sun, seed from which it grew, nutrients in the soil, insects and animals that died and decomposed in order to produce those nutrients, and so forth. Consequently, the flower does not exist in isolation of all other phenomena and it is empty of an independent and inherently existing self. Thus, as we discussed in our Zen-style post on Dream or Reality, phenomena certainly appear to be real but the manner in which they are perceived does not actually equate to the manner in which they truly exist.

Enlightened and unenlightened beings both have a sense of self, but a key difference between these two types of being is that the latter is caught up in the belief that they inherently exist. As we discussed in our post on Deconstructing the Self, due to a firmly-embedded (yet scientifically and logically implausible) belief that the self is an inherent and independently existing entity, Buddhism asserts that afflictive mental states arise as a result of the imputed “self” incessantly craving after objects it considers to be attractive or harbouring aversion towards objects it considers to be unattractive. As part of our academic work we have termed this condition ontological addiction and have defined it as “the unwillingness to relinquish an erroneous and deep-rooted belief in an inherently existing ‘self’ or ‘I’ as well as the ‘impaired functionality’ that arises from such a belief”.

The idea that at the ultimate level there is no such thing as a self that intrinsically exists may be a difficult notion to digest. However, scientific experiments have recently been conducted that appear to add credence to the validity of emptiness. For example, a study published in the journal Nature in 2010 demonstrated that a minute metal blade of semi-conductor material can be made to simultaneously vibrate in two different energy states. This is the kinetic equivalent of matter being in two different places at the same time and it demonstrates that at the sub-atomic level, particles (and any property of self that they might possess) can never be absolutely located in time and space (i.e., they exist nowhere and everywhere at the same time).

Using neuroimaging techniques in order to explore where and how we regulate self-referential processes is important for advancing scientific understanding about the human brain. However, from the Buddhist perspective, consciousness and self are absent of intrinsic existence and they abide just as much within the brain as they do outside of it. Therefore, according to Buddhist theory, attempts by some scientists to identify the specific location of self or consciousness in the brain might be considered a somewhat futile endeavour.

 

Ven Edo Shonin & Ven William Van Gordon

Further Reading

Kelley, W.T., Macrae, C.N., Wyland, C., Caglar, S., Inati, S., & Heatherton, T.F. (2002). Finding the self? An event-related fMRI study. Journal of Cognitive Neuroscience, 14, 785-794.

Heatherton, T. F., Macrae, C. N., & Kelley, W. M. (2004). What the social brain sciences can tell us about the self. Current Directions in Psychological Science, 13, 190-103.

O’Connell, A.D., Hofheinz, M., Ansmann, M., Bialczak, R.C., Lenander, M., Lucero, E. …. & Cleland, A.N. (2010). Quantum ground state and single-phonon control of a mechanical resonator. Nature, 464, 697-703.

Shonin, E., & Van Gordon, W. (2014). Dream or reality? Philosophy Now, 104, 54.

Shonin, E., & Van Gordon, W. (2014). Searching for the Present Moment. Mindfulness, 5, 105-107

Turk, D. J., Heatherton, T.F., Kelley, W.M., Funnell, M.G., Gazzaniga, M.S., & Macrae, C. N. (2002). Mike or me? Self-recognition in a split-brain patient. Nature Neuroscience, 5, 841–842.

Shonin, E., & Van Gordon, W. (2015). The lineage of mindfulness. Mindfulness, 6, 141-145.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 63, 654.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.

Shonin, E., Van Gordon, W., Compare, A., Zangeneh, M., & Griffiths, M. D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161-1180.

Shonin, E., & Van Gordon, W. (2013). Searching for the present moment, Mindfulness, 5, 105-107

La sede del Sé e della coscienza nel cervello: una prospettiva buddista

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Negli ultimi decenni ci sono stati grandi progressi nella comprensione scientifica del cervello umano. Per la maggior parte questi progressi sono stati guidati dalle nuove tecnologie di neuroimaging che hanno fornito ai neuroscienziati immagini o mappe sempre più raffinate del cervello. Un ramo specifico della ricerca neuroscientifica ha fatto uso di queste tecniche di neuroimaging per cercare di identificare la sede neurologico del sé o della coscienza. Il post di oggi, in breve, mette in evidenza alcuni dei principali risultati di questa ricerca e li discute in relazione ai principi buddisti fondamentali, riguardante il modo in cui si crede che il sé esista.

Gli studi di neuroimaging, esplorando dove e come il cervello elabora le informazioni riguardanti il sé, hanno identificato associazioni tra determinati processi cognitivi sé-correlati e l’attivazione di specifiche aree del cervello. Ad esempio, le memorie autoreferenziali (cioè, i ricordi riguardanti il sé) sono associati a una maggiore attivazione della corteccia prefrontale mediale. Un altro esempio è il ruolo svolto dall’emisfero cerebrale sinistro nella regolazione dell’auto-riconoscimento (cioè, la capacità dell’individuo di riconoscersi, ad esempio, in una riflessione o immagine visiva).

La capacità di distinguere tra sé e l’altro è un aspetto fondamentale del funzionamento psicosociale adattivo e ha quindi senso logico che esistano aree all’interno del cervello che svolgono un ruolo nell’elaborazione delle informazioni concernenti il “sé”. Tuttavia, nonostante il fatto che gli studi di neuroimaging abbiano fornito alcuni dati importanti in termini di aree cerebrali che corrispondono a processi auto-referenziali, l’attivazione di tali aree cerebrali non equivale alla posizione di coscienza o al nucleo di un sé inerentemente esistente. Piuttosto, l’attivazione dei neuroni in queste aree del cervello dimostra semplicemente che la maggior parte degli individui ha un pronunciato senso di sé.

Secondo gli insegnamenti buddisti, c’è un oceano di differenza tra individui che hanno un senso di sé e il concetto di un sé inerentemente esistente. Il buddismo accetta che un senso del sé è essenziale se la società deve funzionare efficacemente. Ad esempio, la maggior parte delle delucidazioni delle pratiche di amorevole gentilezza e compassione – due aspetti fondamentali degli insegnamenti buddisti – si basano sul presupposto che c’è sia un donatore (cioè, il sé) sia un ricevitore (cioè, l’altro). Se il Buddha storico non avesse avuto un senso di sé che gli avesse permesso di identificare che il suo livello di intuizione spirituale era in qualche modo diverso dalla maggior parte dei suoi seguaci, è ragionevole supporre che non avrebbe sentito la necessità di esporre un percorso per superare la sofferenza e l’ignoranza.

Tuttavia, anche se gli esseri nella fase di illuminazione hanno un senso di sé (e comprendono appieno che questo senso di sé è necessario per poter funzionare efficacemente nel mondo), sono anche pienamente consapevoli che il “sé” è un’illusione. La ragione perché il buddismo insegna che il sé è un’illusione riguarda il principio del vuoto, che afferma che gli esseri (e tutti i fenomeni) esistono soltanto come costrutti che sono interdipendenti e mentalmente designati. Ad esempio, un fiore si manifesta nella dipendenza da acqua e aria, dall’atmosfera, dal calore del sole, dal seme da cui è cresciuto, dalle sostanze nutrienti nel terreno, dagli insetti e gli animali che morirono e si decomposero al fine di produrre tali sostanze nutritive e così via. Di conseguenza, il fiore non esiste isolato da tutti gli altri fenomeni, ed è privo di un sé indipendente e intrinsecamente esistente. Così, come abbiamo discusso nel nostro post di stile Zen il Sogno o la Realtà, I fenomeni certamente sembrano essere reali, ma il modo in cui sono percepiti in realtà non equivale al modo in cui esistono veramente.

Sia gli esseri illuminati sia quelli non illuminati hanno un senso del sé, ma una differenza fondamentale tra questi due tipi di essere è che questi ultimi sono presi dalla convinzione che essi esistono intrinsecamente. Come abbiamo discusso nel nostro post sulla decostruzione del sé, a causa di una convinzione saldamente incorporata (ma scientificamente e logicamente non plausibile) che il sé è un’entità inerente e indipendentemente esistente, il Buddismo afferma che gli stati mentali affliggenti nascono come conseguenza dell ‘”io” figurative, desiderando incessantemente degli oggetti che ritiene di essere attraenti o provando avversione verso gli oggetti che ritiene  essere poco attraenti. Nel nostro lavoro accademico abbiamo defenito questa condizione dipendenza ontologico, per precisare è “la mancanza di volontà di rinunciare a una credenza erronea e radicata in un ‘sé’ inerentemente esistente o ‘io’ e la ‘funzionalità ridotta’ che nasce da questa convinzione “.

L’idea che al livello ultimo non esiste una cosa come un sé che esiste intrinsecamente può essere un concetto difficile da digerire. Tuttavia, di recente sono stati condotti esperimenti scientifici che sembrano aggiungere credibilità alla validità del concetto del vuoto. Ad esempio, uno studio pubblicato sulla rivista Nature nel 2010 ha dimostrato che una lama di metallo molto piccola di materiale semi-conduttore può essere fatta vibrare contemporaneamente in due differenti stati di energia. Questo è l’equivalente cinetico della materia simultaneamente esistente in due posti diversi e dimostra che a livello sub-atomico, le particelle (e qualsiasi proprietà di sé che essi potrebbero possedere) non possono mai essere localizzato nello spazio o nel tempo (cioè, esistono da nessuna parte e ovunque nello stesso momento).

Utilizzare le tecniche di neuroimaging per esplorare dove e come si regolano processi autoreferenziali è importante per far progredire la comprensione scientifica del cervello umano. Tuttavia, dal punto di vista buddista, la coscienza e il sé sono assenti di esistenza intrinseca ed è altrettanto corretto affermare che risiedono sia all’interno del cervello che fuori del cervello. Pertanto, secondo la teoria buddista, i tentativi da parte di alcuni scienziati di identificare la posizione specifica di sé o della coscienza nel cervello potrebbe essere considerato un tentativo un po’ inutile.

 

Ven Edo Shonin & Ven William Van Gordon

Ulteriore lettura

Kelley, W.T., Macrae, C.N., Wyland, C., Caglar, S., Inati, S., & Heatherton, T.F. (2002). Finding the self? An event-related fMRI study. Journal of Cognitive Neuroscience, 14, 785-794.

Heatherton, T. F., Macrae, C. N., & Kelley, W. M. (2004). What the social brain sciences can tell us about the self. Current Directions in Psychological Science, 13, 190-103.

O’Connell, A.D., Hofheinz, M., Ansmann, M., Bialczak, R.C., Lenander, M., Lucero, E. …. & Cleland, A.N. (2010). Quantum ground state and single-phonon control of a mechanical resonator. Nature, 464, 697-703.

Shonin, E., & Van Gordon, W. (2014). Dream or reality? Philosophy Now, 104, 54.

Shonin, E., & Van Gordon, W. (2014). Searching for the Present Moment. Mindfulness, 5, 105-107

Turk, D. J., Heatherton, T.F., Kelley, W.M., Funnell, M.G., Gazzaniga, M.S., & Macrae, C. N. (2002). Mike or me? Self-recognition in a split-brain patient. Nature Neuroscience, 5, 841–842.

What Science Can Tell Us about How Mindfulness Actually Works

What Science Can Tell Us about How Mindfulness Actually Works

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Throughout recent decades there have been increasing attempts by scientists to understand how mindfulness actually works. However, because there are so many factors that could potentially exert an influence, coming to a definitive conclusion over the precise mechanisms of action that underlie the biological, psychological, or spiritual changes caused by mindfulness practice is not an easy task. Consequently, when scientists propose a mechanism in terms of how mindfulness causes change in individuals receiving mindfulness training, these proposals tend to be treated as just one piece of the larger jigsaw rather than as the final verdict. In today’s post, we summarise and discuss a selection – covering numerous remits of scientific enquiry – of the mechanisms of action that have been put forward to date.

  1. Perceptual Shift: Practising mindfulness is believed to create a perceptual shift in terms of how individuals respond and relate to thoughts, feelings, and sensory stimuli (e.g., sounds, sights, smells, pain, etc.). This greater perceptual distance is understood to help individuals objectify their psychological and somatic experiences and to regard them as passing phenomena.
  2. Increase in Spirituality: Some scientists (including ourselves) believe that mindfulness can increase spirituality and that this, in turn, acts as a buffer against feelings of loneliness as well as the various adversities we encounter in life. This growth in spiritual awareness is understood to help broaden an individual’s perspective on life and cause them to re-evaluate their life priorities.
  3. Reduced Autonomic and Psychological Arousal: It has been shown that mindfulness – and in particular conscious breathing – increases vagus nerve output which causes the heart and breathing rate to lower. Keeping the heart and breathing rate under control is understood to go hand in hand with remaining calm and being able to cope with stressful situations.
  4. Neuroplastic Changes: Neuroplasticity refers to changes in the brain neural pathways and synapses. Neuropsychological functional and structural imaging studies have demonstrated that mindfulness practice results in neuroplastic changes in various areas of the brain (including the anterior cingulate cortex, insula, temporo-parietal junction, fronto-limbic network, and default mode network structures). These neuroplastic changes are believed to improve an individual’s ability to regulate and remain in control of their choices, feelings, and behaviours.
  5. Increase in Self-Awareness: Mindfulness is understood to improve self-awareness which, in-turn, is believed to make it easier for people to identify and label negative mood states and thinking patterns. This relates closely to the above ‘perceptual shift’ mechanism because being able to accurately label mental processes makes it easier for people to objectify them.
  6. Addiction Substitution: One recently proposed mechanism of mindfulness (and other forms of Buddhist meditation) is that the peaceful/blissful states associated with mindfulness can be substituted for the highs and various forms of mood modification experienced by individuals with addictive behaviours. This particular mechanism was actually proposed by ourselves and it basically involves a ‘negative addiction’ (e.g., to drugs, alcohol, gambling, etc.) being substituted with a ‘positive addiction’ (i.e., to mindfulness/meditation).
  7. Urge Surfing: Another proposed mechanism of action (not by ourselves this time) relating to how mindfulness works as a treatment for addiction is that of ‘urge surfing’. Urge surfing basically refers to the process of an individual observing and not reacting to mental urges. In other words, they surf the urge and are therefore better able to regulate habitual compulsive responses.
  8. Letting Go: By mindfully observing the coming and going of thoughts and feelings (and other phenomena), it is believed that mindfulness practitioners cultivate a better understanding of the ‘transient’ nature of existence. This helps them to let-go of difficult situations and not to see things as fixed or permanent.
  9. Increase in Patience: Some scientists (including ourselves) believe that mindfulness increases an individual’s levels of patience. This is understood to reduce an individual’s desire for instant gratitude as well as their propensity for anger.
  10. Greater Situational Awareness: Outcomes from our own research have shown that mindfulness can help people feel more in touch with the physical and social environment in which they find themselves. This greater situational awareness is understood to improve decision-making competency, job performance, and the ability to pre-empt how a particular situation might unfold.

It is beyond the scope of today’s post to discuss every single mechanism of action that has been proposed in relation to how mindfulness causes somatic, psychological, or spiritual change. Nevertheless, the above overview represents a mixture of recently proposed mechanisms of action as well as those that are more established. As scientific enquiry continues, it is likley that new mechanisms of actions will be identified and that a more complete picture of ways in which mindfulness leads to positive change will emerge.

Further Reading

Dane, E. (2010). Paying attention to mindfulness and its effects on task performance in the workplace. Journal of Management, 37, 997-1018.

de Lisle, S. M., Dowling, N. A. & Allen, J. S. (2012). Mindfulness and problem gambling: A review of the literature. Journal of Gambling Studies, 28, 719–739.

Derezotes, D. (2000). Evaluation of yoga and meditation trainings with adolescent sex offenders. Child and Adolescent Social Work Journal, 17, 97-113.

Gillespie, S. M., Mitchell, I. J., Fisher, D., & Beech, A. R. (2012). Treating disturbed emotional regulation in sexual offenders: The potential applications of mindful self-regulation and controlled breathing techniques. Aggression and Violent Behavior, 17, 333-343.

Holzel, B., Lazar, S., & Gard, T., et al. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives in Psychological Science, 6, 537-559.

Howells, K., Tennant, A., Day, A., & Elmer, R. (2010). Mindfulness in forensic mental health; Does it have a role? Mindfulness, 1, 4-9.

Rungreangkulkji, S., Wongtakee, W., & Thongyot, S. (2011). Buddhist Group Therapy for diabetes patients with depressive symptoms. Archives of Psychiatric Nursing, 25, 195-205.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Mindfulness-based interventions: Towards mindful clinical integration. Frontiers in Psychology, 4, 1-4. DOI:10.3389/fpsyg.2013.00194. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3629307/)

Shonin, E., Van Gordon W., Slade, K., & Griffiths, M. D. (2013). Mindfulness and other Buddhist-derived interventions in correctional settings: A systematic review. Aggression and Violent Behavior, 18, 365-372.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2015). Managers’ experiences of Meditation Awareness Training. Mindfulness, DOI: 10.1007/s12671-014-0334-y.

Toneatto, T., Pillai, S., & Courtice, E. L. (2014). Mindfulness-enhanced Cognitive Behavior Therapy for problem gambling: A controlled pilot study, International Journal of Mental Health and Addiction, 12, 197-205

Van Gordon, W., Shonin, E., Sumich, A., Sundin, E., & Griffiths, M. D. (2013). Meditation Awareness Training (MAT) for psychological wellbeing in a sub-clinical sample of university students: A controlled pilot study. Mindfulness, 5, 381-391.

Shonin, E., & Van Gordon, W. (2015). The lineage of mindfulness. Mindfulness, 6, 141-145.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 63, 654.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.

Shonin, E., Van Gordon, W., Compare, A., Zangeneh, M., & Griffiths, M. D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161-1180.

Shonin, E., & Van Gordon, W. (2013). Searching for the present moment, Mindfulness, 5, 105-107.

 

A Second Generation of Mindfulness-based Intervention

A Second Generation of Mindfulness-based Intervention

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Clicca qui per l’Iataliano

In one of our research papers that was published this summer in the journal Mindfulness, we identified and discussed a recent development in mindfulness research and practice. Until a few years ago, mindfulness research within psychology has primarily focussed on what have been termed First Generation Mindfulness-Based Interventions (FG-MBIs). FG-MBIs refer to interventions such as Mindfulness-Based Stress Reduction (MBSR) developed by Kabat-Zinn in the late 1970s and Mindfulness-Based Cognitive Therapy (MBCT) developed by Segal, Williams, and Teasdale in 2002. According to Professor Nirbhay Singh and colleagues, one of the primary purposes and achievements of FG-MBIs has been gaining acceptance of mindfulness within Western clinical and scientific domains.

However, due to the speed at which mindfulness has been integrated into western research and public healthcare settings, concerns have been raised by scientists and Buddhist teachers regarding the ‘authenticity’ of FG-MBIs and whether they actually teach mindfulness in a manner that still bears any resemblance to the traditional Buddhist model. These concerns do not detract from the fact that there is a growing evidence-base that supports the efficacy of FGMBIs as clinical and behavioural interventions, but they give rise to a number of questions that have important implications for mindfulness research and practice:

  1. If mindfulness is efficacious when it is taught in isolation of many of the practices and principles that are traditionally deemed to make it effective, then how much more effective will it be when taught in a manner that includes and embodies these supporting elements?
  2. Is it ethically correct to inform service users and members of the public that they are receiving training in a method that is grounded in Buddhist practice (a claim often made about FG-MBIs), when in fact this is not the case?
  3. Is it essential to “de-spiritualise” psychological interventions before they can be used in clinical contexts, or – based on a “what-works approach” – can interventions that are openly spiritual in nature be considered as viable and mainstream public healthcare treatments?

In an attempt to overcome some of the above issues concerning FG-MBIs, efforts have been made in recent years to formulate and empirically evaluate a second generation of mindfulness-based interventions. Second Generation Mindfulness-based Interventions (SG-MBIs) are still intended to be used in public healthcare contexts (i.e., they are still secular in nature)  but – as explained in the following quote from our recently published Mindfulness paper – they are openly spiritual in nature and are more traditional in the manner in which they construct and teach mindfulness:

Due to the suggestion that some individuals may prefer to be trained in a version of mindfulness that more closely resembles a traditional Buddhist approach, recent years have witnessed the development and early-stage evaluation of several Second Generation Mindfulness-Based Interventions (SG-MBIs) … Although SG-MBIs still follow a secular format that is suitable for delivery within Western applied settings, they are overtly spiritual in aspect and teach mindfulness within a practice infrastructure that integrates what would traditionally be deemed as prerequisites for effective spiritual and meditative development. At the most basic (but by no means the least profound) level, such prerequisites include each element of the Noble Eightfold Path. The Noble Eightfold Path comprises each of the three quintessential Buddhist teaching and practice principles of (i) wisdom (i.e., right view, right intention), (ii) ethical conduct (i.e., right speech, right action, right livelihood), and (iii) meditation (i.e., right effort, right mindfulness, right concentration). Each of these three fundamental elements (Sanskrit: trishiksha – the three trainings) must be present in any path of practice that claims to expound or be grounded in authentic Buddhadharma and they apply to (and form the basis of) the Fundamental or Theravada vehicle just as much as they do the Mahayana and Vajrayana Buddhist vehicles. Thus, for mindfulness practice to be effective, it must be taught as part of a rounded spiritual path and it must be taught by a spiritual guide that can transmit the teachings in an authentic manner.

The development and empirical evaluation of a second generation of mindfulness-based intervention appears to represent an emerging trend in mindfulness research. Outcomes from our own research work with the eight-week SG-MBI known as Meditation Awareness Training (MAT) suggest that SG-MBIs may have applications in the treatment of (i) workaholism, (ii) work-related stress, (iii) stress, (iv) anxiety, (v) depression, (vi) schizophrenia, and (vii) pathological gambling. Recent MAT studies that we have conducted have also demonstrated that SG-MBIs can help to improve work effectiveness, decision-making competency, and leadership/management skills more generally. SG-MBI studies by other researchers also indicate a range of clinical and non-clinical applications for SG-MBIs. For example, studies led by Professor Nirbhay Singh indicate that SG-MBIs may have utility as (i) a smoking cessation program for individuals with mild intellectual disabilities, (ii) an anger regulation method for individuals with schizophrenia, and (iii) a training and support program for parents in order to reduce the aggressive and disruptive behaviour of their children/adolescents. However, it needs to be remembered that research into SG-MBIs is still at a very early stage and so although the abovementioned outcomes are promising, further empirical investigation is obviously required. Furthermore, it is our view that rather than directly compete with FG-MBIs, SG-MBIs simply provide an alternative approach to practising mindfulness that – for some individuals – may be more appealing.

Please note: This article provides a summary of, and is adapted from, a discussion that first appeared in a paper we published in the journal Mindfulness.

 Ven Edo Shonin & Ven William Van Gordon

Further Reading

Carrette, J., & King, R. (2005). Selling spirituality: The silent takeover of religion. New York: Routledge.

Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion.

McWilliams, S. A. (2014). Foundations of Mindfulness and Contemplation: Traditional and Contemporary Perspectives. International Journal of Mental Health and Addiction, 12, 116-128.

Rosch, E. (2007). More than mindfulness: when you have a tiger by the tail, let it eat you. Psychological Inquiry, 18, 258-264.

*Shonin, E., & Van Gordon, W. (2014) Manager’s experiences of Meditation Awareness Training. Mindfulness, DOI: 10.1007/s12671-014-0334-y. [Source Article].

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013a). Mindfulness-based interventions: Towards mindful clinical integration. Frontiers in Psychology, 4, 1-4. DOI: 10.3389/fpsyg.2013.00194.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014c). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: The Journal of Science and Healing, 10, 193-195.

Shonin, E., Van Gordon, W., Dunn, T., Singh, N., & Griffiths, M. D. (2014d). Meditation Awareness Training for work-related wellbeing and job performance: A randomized controlled trial. International Journal of Mental Health and Addiction,  DOI 10.1007/s11469-014-9513-2.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014e). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 181-196.

Shonin, E., Van Gordon W., & Griffiths M. D. (2013). Meditation Awareness Training (MAT) for improved psychological wellbeing: A qualitative examination of participant experiences. Journal of Religion and Health, 53, 849-863.

Singh, N. N., Lancioni, G. E., Winton, A. S. W., Singh, J. Curtis, W. J., Wahler, R. G., & McAleavey, K. M. (2007). Mindful parenting decreases aggression and increases social behavior in children with developmental disabilities. Behavior Modification, 31, 749-771.

Singh, N. N., Lancioni, G. E., Winton, A. S. W., Karazia, B. T., Singh, A. D. A., Singh, A. N. A., & Singh, J. (2013). A mindfulness-based smoking cessation program for individuals with mild intellectual disability. Mindfulness, 4, 148-157.

Singh, N. N., Lancioni, G. E., Winton, A. S. W., Karazsia, B. T., & Singh, J. (2014a). Mindfulness-Based Positive Behavior Support (MBPBS) for mothers of adolescents with autism spectrum disorders: Effects on adolescents’ behavior and parental stress. Mindfulness, DOI: 10.1007/s12671-014-0321-3.

Singh, N. N., Lancioni, G. E., Myers, R. E., Karazsia, B. T., Winton, A. S. W., & Singh, J. (2014b). A randomized controlled trial of a mindfulness-based smoking cessation program for individuals with mild intellectual disability. International Journal of Mental Health and Addiction, 12, 153-168.

Singh, N. N., Lancioni, G. E., Karazsia, B. T., Winton, A. S. W., Singh, J., & Wahler, R. G. (2014c). Shenpa and compassionate abiding: Mindfulness-based practices for anger and aggression by individuals with schizophrenia. International Journal of Mental Health and Addiction, 12, 138-152.

Van Gordon, W., Shonin, E., Sumich, A., Sundin, E., & Griffiths, M. D. (2014b). Meditation Awareness Training (MAT) for psychological wellbeing in a sub-clinical sample of university students: A controlled pilot study. Mindfulness, 5, 381-391.

Van Gordon, W., Shonin, E., Zangeneh, M., & Griffiths, M. D. (2014). Work-related mental health and job performance: Can mindfulness help? International Journal of Mental Health and Addiction, 12, 129-137.

Van Gordon, W., Shonin, E., & Griffiths, M. D. (2015). Mindfulness and the Four Noble Truths. In: Shonin, E., Van Gordon W., & Singh, N. N. (Eds). Buddhist Foundations of Mindfulness. New York: Springer.

Shonin, E., & Van Gordon, W. (2013). Searching for the present moment, Mindfulness, 5, 105-107.

Shonin, E., Van Gordon, W., Compare, A., Zangeneh, M., & Griffiths, M. D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161-1180.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 63, 654.

Shonin, E., & Van Gordon, W. (2015). The lineage of mindfulness. Mindfulness, 6, 141-145.

Una nuova generazione di interventi basati sulla Mindfulness

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In uno dei nostri documenti di ricerca che è stata pubblicata questa estate sulla rivista academica Mindfulness, abbiamo identificato e discusso un recente sviluppo nella ricerca e nella pratica della mindfulness Fino a pochi anni fa, la ricerca di mindfulness all’interno della psicologia si è concentrata principalmente su ciò che sono stati definiti Interventi di Prima Generazione cioè First Generation Mindfulness-Based Interventions (FG-MBIs). FG-MBI si riferisce a interventi quali Mindfulness-Based Stress Reduction (MBSR) sviluppato da Kabat-Zinn alla fine del 1970 e Mindfulness-based Cognitive Therapy (MBCT) sviluppato da Segal, Williams e Teasdale nel 2002. Secondo il professor Nirbhay Singh e colleghi, uno degli scopi e conquisti principali di FG-MBI è stato di ottenere l’accettazione della mindfulness all’interno dei domini clinici e scientifici occidentali.

Tuttavia, a causa della velocità alla quale la mindfulness è stato integrato nella ricerca occidentale e nelle strutture sanitarie pubbliche, le preoccupazioni sono state sollevate da scienziati e insegnanti buddisti per quanto riguarda il ‘autenticità’ di FG-MBI e se insegnano effettivamente mindfulness in un modo che ancora oggi porta qualsiasi somiglianza con il modello tradizionale buddista. Queste preoccupazioni non toglie il fatto che vi è una crescente evidenza empirica che sostiene l’efficacia di FGMBIs come interventi clinici e comportamentali, ma danno luogo a una serie di domande che hanno importanti implicazioni per la ricerca e la pratica della mindfulness:

  1. Se la mindfulness è efficace quando si è insegnato in isolamento di molte delle pratiche e principi che sono tradizionalmente considerati a renderla efficace, allora quanto più efficace ne sarà quando insegnato in un modo che include e incorpora questi elementi di supporto?
  2. È eticamente corretto a informare gli utenti del servizio e membri del pubblico che essi ricevono una formazione in un metodo che è radicato nella pratica buddista (un’affermazione spesso fatta dai FG-MBI), quando in realtà questo non è il caso?
  3. È necessaria che gli interventi psicologici vengono “de-spiritualizzate” prima di poter essere utilizzati in contesti clinici, o – basati su un approccio “ciò che funzione” – possono gli interventi che sono apertamente spirituali nella loro natura essere considerati come trattamenti sanitari pubblici attuabile, accettabile e affermati?

Nel tentativo di superare alcune delle questioni di cui sopra riguardanti FG-MBI, si sono compiuti degli sforzi negli ultimi anni per formulare e valutare empiricamente una seconda generazione di interventi basati sulla mindfulness. Interventi basati sulla mindfulness di seconda generazione (SG-MBI) ancora sono destinati ad essere utilizzati in contesti sanitari pubblici (vale a dire, essi sono ancora secolari in natura) ma – come spiegato nel seguente citazione tratta dal nostro articolo recentemente pubblicato nella rivista academica Mindfulness -sono apertamente spirituale in natura e sono più tradizionali nel modo in cui costruiscono e insegnano la mindfulness:

Grazie al suggerimento che alcuni individui possono preferire di essere formati/addestrati in una versione della mindfulness che assomiglia più ad un approccio tradizionale buddista, negli ultimi anni si è assistito alla valutazione di sviluppo e le fasi iniziali di diversi interventi basati sulla mindfulness di seconda generazione (SG-MBI) … Sebbene SG-MBI seguono ancora un formato secolare che è adatto per essere insegnato in tutta una gamma di impostazioni psicologiche, sono apertamente spirituale in aspetto e insegnano la mindfulness dall’interno di un’infrastruttura di pratica che integra quello che è tradizionalmente considerata come prerequisiti per un effettivo sviluppo spirituale e meditativo. Al livello più basilare (ma non il meno profondo), tali prerequisiti includono ogni elemento del Nobile Ottuplice Sentiero. Il Nobile Ottuplice Sentiero comprende ciascuno dei tre quintessenziale principi delle pratiche e degli insegnamenti buddisti di (i) la saggezza (cioè la retta visione, la retta intenzione), (ii) il comportamento etico (cioè la retta parola, la retta azione, il retto sostentamento), e (iii) la meditazione (cioè, il retto sforzo, la retta mindfulness, la retta concentrazione). Ciascuno di questi tre elementi fondamentali (sanscrito: trishiksha – i tre addestramenti) devono essere presente in qualsiasi percorso di pratica che pretende di esporre o di essere radicati nella autentica Buddhadharma e sono applicabili a (e costituiscono la base del) veicolo fondamentale o Theravada tanto quanto sono applicabili ai (e costituiscono la base dei) veicoli Mahayana e Vajrayana buddista. Così, per la pratica più efficace della mindfulness, essa deve essere insegnato come parte di un percorso spirituale comprensivo e deve essere insegnato da una guida spirituale che può trasmettere gli insegnamenti in modo autentico.

Lo sviluppo e la valutazione empirica di una seconda generazione di interventi basati sulla mindfulness sembra rappresentare una tendenza emergente nella ricerca della mindfulness. I risultati dal nostro lavoro di ricerca con Meditation Awareness Training (MAT), un SG-MBI corso di otto settimane, indicano che SG-MBI possono avere applicazioni nel trattamento di (i) workaholism, (ii) stress legato al lavoro, (iii) stress, (iv) l’ansia, (v) la depressione, (vi) la schizofrenia, e (vii) il gioco d’azzardo patologico. Recenti studi MAT che abbiamo condotto hanno anche dimostrato che SG-MBI possono contribuire a migliorare l’efficacia al lavoro, competenza decisionale e capacità di leadership/gestione più in generale. Studi di SG-MBI da parte di altri ricercatori anche indicano una vasta gamma di applicazioni cliniche e non-clinici per SG-MBI. Ad esempio, studi guidati dal Professor Nirbhay Singh indicano che SG-MBI possono avere utilità come (i) un programma di cessazione di fumare per persone con disabilità intellettiva lieve, (ii) un metodo di regolazione ddella rabbia per gli individui con schizofrenia e (iii) un programma di formazione e sostegno per i genitori al fine di ridurre il comportamento aggressivo e dirompente di loro bambini/adolescenti. Tuttavia, è necessario ricordare che la ricerca di SG-MBI è ancora in una fase iniziale e quindi, anche se i risultati di cui sopra sono promettenti, ulteriori indagini empiriche sono ovviamente necessari. Inoltre, è nostra opinione che piuttosto che competere direttamente con FG-MBI, SG-MBI semplicemente forniscono un approccio alternativo alla pratica della mindfulness che – per alcuni individui – può essere più attraente.

Please note: This article provides a summary of, and is adapted from, a discussion that first appeared in a paper we published in the journal Mindfulness.

Ven Edo Shonin & Ven William Van Gordon

Ulteriori letture

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