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.

Fearlessness on the Path of Meditation

Fearlessness on the Path of Meditation

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Some people are of the view that in order to enter the spiritual path one has to forget about the world and everything we know. However, rather than forgetting about or turning one’s back on the world, a true meditation practitioner is a person that completely surrenders themselves to, and becomes fully immersed in, the world. In order to surrender ourselves to the world we first have to abandon hope and fear. When we have hope, we leave ourselves exposed to suffering. We suffer when our hopes and expectations are not met. Wherever there is hope, there is also fear – the fear that our hopes will not be realised.

Many people think that in order to be happy they need hope. But this kind of happiness is very conditional and is reliant upon the presence of external factors. Relying for our happiness on external factors will never lead to lasting happiness because situations and phenomena are changing all of the time – there is no way we can control them all. By always hoping to be somewhere else, be someone else, or have something else, we effectively turn our back on the present moment and deep spiritual peace can never take root in the mind. This is not to say that we should not make efforts to improve our current situation, but we should do so in such a way that we do not allow the mind to intoxicate itself with hope that our efforts will bear fruit. In other words, if we wish to change or improve our current circumstances, we should do so with absolute focus to the task at hand but remain completely unattached to expecting that we are somehow going to gain something or get somewhere.

It is by engaging in, yet remaining completely unattached to, all that we experience that we create the correct conditions for gaining our first taste of unconditional fearlessness. When they have become adept at abandoning hope and desire, absolutely nothing can shake the meditation practitioner’s confidence. Without trying, they begin to emanate strength, courage, and contentedness. They remain centred and un-phased by any situation. People can’t help but notice the fearlessness that exudes from the person walking the path of meditation. However, because the meditator’s fearlessness stems from a place of calm, compassion, and non-attachment, people invariable feel reassured and safe in their presence.

Of course, there will always be some people who feel threatened and unsettled in the presence of a person that has wholeheartedly entered the path of meditation. However, rather than actually being afraid of the meditation practitioner, it is more the case that such people are afraid of themselves. Due to being free of hope and the idea of being somewhere else or being somebody else, the mind of an accomplished meditator is calm and completely clear. When others encounter this clear awareness, it acts as a mirror and reflects back upon them that which is prominent in their mind. Therefore, upon meeting a genuine meditation practitioner, some people are forced to face up to the fact they are living a meaningless soap opera and that they are effectively devoid of spiritual awareness. Understandably, this is a difficult pill to swallow but having it pointed out is a good thing because it gives people the opportunity to examine their life choices and to make changes where appropriate. However, it is often the case that people don’t want to admit that there is no substance to the self they have worked so hard to create. They become angry at themselves and at what is reflected in the meditation practitioner’s mind.

As referred to above, the quality of fearlessness that arises naturally as part of walking the path of meditation stems from a place of wisdom, compassion, and having abandoned all hopes. Consequently, it has absolutely nothing to do with being macho or deliberately trying to be courageous. These types of fearlessness are very much reliant on the presence of a ‘me’, a ‘mine’, and an ‘I’. The fearlessness that exudes from the authentic meditation practitioner is what is left after the ‘me’, ‘mine’, and ‘I’ are removed from the equation. For this reason, the fearlessness that the meditator experiences is completely devoid of aggression and is without a personal agenda.

An important source of the authentic meditation practitioner’s fearlessness is absolute commitment to the path that they are walking. They do not make a distinction between spiritual practice and time at work or time with the family. Whatever they are doing and wherever they find themselves, they strive to perfect each breath, moment, and activity of their lives. This unremitting commitment to their chosen path provides them with access to an immense resource of spiritual energy. It is the energy of the present moment that flows through and connects all phenomena. By tapping into and nourishing themselves in this energy, the authentic meditation practitioner is able to respond with fearlessness and take whatever happens in their stride. Everything that they encounter forms part of their practice. It doesn’t matter if they are seen as a national hero or if the whole country despises and rises against them – a person that has truly entered the path of meditation has absolute confidence in what they are doing. This is a beautiful and invigorating way to live.

Ven Edo Shonin and Ven William Van Gordon

Further Reading

Chah, A. (2011). The Collected Teachings of Ajahn Chah. Northumberland: Aruna Publications.

Dalai Lama. (2001). Stages of Meditation: Training the Mind for Wisdom. London: Rider.

Khyentse, D. (2007). The Heart of Compassion: The Thirty-seven Verses on the Practice of a Bodhisattva. Boston: Shambhala Publications.

Nanamoli Bhikkhu. (1979). The Path of Purification: Visuddhi Magga. Kandy (Sri Lanka): Buddhist Publication Society.

Santideva. (1997). A Guide to the Bodhisattva Way of Life. (V. A. Wallace, & A. B. Wallace, Trans.) New York: Snow Lion Publications.

Tsong-Kha-pa. (2004). The Great Treatise on the Stages of the Path to Enlightenment (Vol. 1). (J. W. Cutler, G. Newland, Eds., & The Lamrim Chenmo Translation committee, Trans.) New York: Snow Lion Publications.

Trungpa, C. (2002). Cutting Through Spiritual Materialism. Boston: Shambala.

Exactly what is the Present Moment?

Exactly what is the Present Moment?

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The practice of mindfulness is fundamentally concerned with becoming more aware of the present moment. Mindfulness techniques such as observing the breath, walking meditation, working meditation, eating meditation, scanning the body, mindful writing, deep listening, mindfully cradling our thoughts and feelings, and observing mind with mind, are all methods of cultivating an awareness of the ‘here and now’. In effect, these techniques are a type of ‘meditative anchor’ that help to slow the mind down and provide a reference point for maintaining an unbroken flow of awareness throughout the day. As we discussed in our post on ‘Mindwithness’, the word mindfulness, which is a translation of the Pali word sati, essentially means ‘to remember’ (i.e., ‘to remember’ to be aware of the present moment). However, believe it or not, from the Buddhist perspective, the whole point of remembering to become aware of the present moment is so that we can remember to let go of it.

Having made great efforts to follow the meditation instructor’s teachings and strive to be aware of the present moment, to now hear that we should ultimately be aiming to let go of the present moment might seem a little confusing or even alarming. However, if we take a moment to investigate what actually constitutes the present moment and whether it actually exists, then these words may start to take on more meaning.

In a recent paper we published in Thresholds, we argued that if a person wants to become proficient in the practice of mindfulness, then they need to “have some grounded realisation of the true and absolute mode in which the present moment exists”. Most teachings on mindfulness explain that the present moment is the moment of time that exists between the past and future, and since the future never arrives and the past is history, then the only place where we can truly experience life is the present moment. From the conventional or relative perspective, this statement is perfectly true. As we discussed in our post on Life is a Precious Happening, if, like most people, we allow the mind to constantly ruminate about the past or fantasise about the future, then before we know it our lives will have slipped us by in a blur of unawareness.

However, from the absolute perspective, the above affirmation of an identifiable and intrinsically-existing present moment is untenable. Imagine you decide to take a trip to the countryside and have a picnic in your favourite tree-lined spot next to a river. From the time of your arrival until the time you pick up your picnic basket and start to make your way home, we’re sure it won’t come as a surprise to you to hear that you have not been sitting in a static environment. At any given instant when you found yourself gazing at the river, you were observing a dynamic and continuously flowing phenomenon. Thus, between any given instant of time and the next, the river undergoes change. However, not only does the river change between two separate instances of time, but it also changes within the same instant of time. The reason for this is because time is a relative concept, it is a man-made construct that human-beings employ to try to add structure and order to their world.

The truth is, any given moment of time can be continuously divided into ever smaller instants – and this process of division can continue ad infinitum. For example, a second can be divided by 1000 to form a millisecond, and a millisecond can be further divided to form a microsecond (one millionth of a second). However, the microsecond can be divided to form an attosecond (one quintillionth of a second), and the attosecond can be divided to form a yoctosecond (one septillionth of a second). But even the yoctosecond can be divided again and again. Scientists call the shortest physically meaningful moment of time a Planck. The Planck is an indescribably fleeting moment of time. It is 5.4×10-44 seconds to be exact – which is even quicker than the time it takes the novice monks to arrive in the dining hall after they hear the gong sound to announce that it’s meal time. Although it’s difficult to imagine the brevity of a Planck, the fact is that the Planck could also be divided into infinitely smaller and smaller units of time.

So returning to the river analogy, not even for the most miniscule moment of time could we say that the river ever stands still. It’s not just rivers that are subject to this continuous process of change, but every single phenomenon that we encounter. In many respects, we could actually view the present moment and all that it contains as one enormous flowing river. A graceful and swirling flood of interwoven mind and matter that continuously flows yet never actually goes anywhere. Now then, as we discussed in our post about the practice of impermanence, here is where an opportunity to make a small intuitive leap arises. If there is never a point in time when the river stands still, how can a thing that doesn’t ever become static undergo any change? Change implies that something changes from one state or position to another. But since phenomena never truly come to rest in a fixed state, then it is illogical to assert that such a transient and ‘permanently unfixed’ entity can undergo change. That which never is cannot be said to change between one moment of time and next.

This method of investigating the present moment stems from a certain system of Buddhist philosophy and is perhaps a little mind-boggling. So don’t worry if you feel you’re getting left behind. There are many other keys that can be used to help you catch a glimpse of reality. Essentially, what we are trying to get at is quite simple:  the present moment is just a concept. It doesn’t exist in the manner in which we have accustomed ourselves to believing. The present relies for its existence on the notions of past and future. But earlier in this post we already discussed that the future is a fantasy that never actually arrives (because it is always the present), and the past exists as nothing other than a memory – it has no substance. So if there is no future and no past, then how can it be said that there is a present?

It’s not the case that these ideas are just crazy theories hatched-out by peculiar Buddhist teachers living thousands of years ago. In fact, in recent years, there have been some break-through scientific discoveries that have begun to verify the validity of such theories. For example, for a number of decades now, quantum theorists have posited that at the sub-atomic level, there can never be absolute certainty that a particle exists at a given position in time or space. This effectively implies that it is possible for sub-atomic particles to exist in multiple places simultaneously and to be nowhere and everywhere at the same time. However, until recently, there was no observable scientific proof for this theory. This changed in 2010 when a team of physicists, led by Professor Andrew Cleland of the University of California Santa Barbara, published in the journal Nature the results of an experiment that demonstrated that a tiny metal paddle made of semi-conductor material (just visible to the human eye) can simultaneously vibrate in two different energy states. In kinetic terms, this is equivalent to being in two different places at the same time.

Another interesting area of quantum mechanics that seems to add validity to a number of long-standing Buddhist principles regarding the nature of reality is that of String Theory. String Theory, a topic frequently discussed by physicists such as Professor Stephen Hawking, basically asserts that reality has multiple dimensions to it. This is very similar to models taught in certain systems of Buddhist cosmology that assert that there are multiple world systems and world dimensions in addition to our own. Although String Theory is still quite limited from the Buddhist perspective (because it restricts the number of concurrently-existing dimensions to just eleven), it is a major leap forward in terms of establishing a common ground between modern science and Buddhist thought. So the next time you collect your mind and bring it to rest in the present moment, perhaps you should ask yourself exactly in which present moment you are currently dwelling.

Perhaps in years to come discoveries in the field of quantum mechanics will narrow the gap between Buddhism and science even further. Perhaps scientists will discover that a single universe can contain an infinite number of multi-dimensional universes and that infinite expanses of time can exist within a single second. Rather than thinking about existence as something that began at the time of the big-bang, perhaps scientists will start to view the birth and death of our universe as just a small blip in a beginningless and eternally enduring cycle of formation and dissolution. Just a single phase of expansion and contraction within the realm of unconditioned truth (Sanskrit: dharmadatu). This would help to transcend the limiting notion of there being a fixed beginning and a definite end. Without a beginning and an end, the whole construct of time falls apart. Then, instead of concepts such as past and future or beginning and end, perhaps we would have to use other words to describe existence such as ‘isness’, ‘thatness’, or ‘suchness’.

You may find the idea of simultaneously existing present moments or simultaneously existing dimensions to be a bit far-fetched. But it’s actually not that difficult to imagine and there are plenty of more accessible examples that we can use to help us do so. For instance, there are approximately seven billion people currently living on this planet. Each person is completely different and experiences the present moment in a unique manner. So that’s seven billion different present moments that are simultaneously happening right here and now. It’s an inexpressibly greater number if you consider all of the present moments experienced by other sentient life forms such as animals and insects.

The whole point of what we have been discussing so far is to introduce the idea that the present moment may not exist exactly how we think it does, or that it may not exist at all. If we can adopt a slightly less rigid view of things then we have a much greater chance of being able to transcend limiting concepts such as the present moment. Please don’t misunderstand what is being said here, we’re not advising that people should stop practising mindfulness and become content with living a life of corpse-like unawareness. That’s definitely not what is needed. Rather, what we’re suggesting is that in order to truly taste and embrace the essence of the present moment, we have to relinquish any kind of attachment to it. Mindfulness helps to bring the mind into the present moment, but that’s only half the work. Having allowed the mind to settle into an awareness of the here and now, we then need to make a small intuitive leap and pierce through the present moment to taste the underlying fabric of reality itself. As we discussed in our post on the Top Ten Mistakes Made by Meditation Practitioners, it’s not the case that we should make extreme efforts or strain ourselves in order to do this. Rather, just by relaxing the mind and being open to the possibility of a reality beyond our current manner of perceiving, we already begin to dispel some of the mental obscurations that prevent this self-existing truth from emerging.

So when you observe your breath during meditation practice, rather than just follow the breath in and out, you might like to try observing the space and time between the in-breath and the out-breath (and between the out-breath and the in-breath). As you allow the mind to come to rest in its natural state and begin to let go of the normal conceptual mode of perceiving things, you may begin to notice that the space and time between your in-breath and out-breath starts to expand exponentially. With a single breath in and out you can experience an entire lifetime, your view can extend beyond the limits of space and time. The boundary between you the observer and the present moment that is being observed can start to disintegrate. Perceiver and perceived can merge as one. Perhaps we could say that this is the difference between ‘being in’ the present moment and simply ‘being’ the present moment. Be alive by living in the present moment, but liberate yourself completely by letting go of it.

Ven Edo Shonin and Ven William Van Gordon

Further Reading

Gyatso, T. (XIV Dalai Lama) (1985, 1989). Hopkins, Jeffrey, ed. Kalachakra Tantra: Rite of Initiation for the Stage of Generation, a Commentary on the text of Kay-drup-ge-lek-bel-sang-bo by Tenzin Gyatso, the Fourteenth Dalai Lama, and the Text Itself . London: Wisdom Publications

Lieu, R., & Hillman, L.W. (2003). The phase coherence of light from extragalactic sources: Direct evidence against first-order planck-scale fluctuations in time and space. The Astrophysical Journal, 585, L77-L80.

Hawking, S. (2005). A Briefer History of Time. Reinbek (Germany): Rowohlt

Hawking, S. & Mlodinow, L., (2011). The Grand Design. London: Bantam

Hawking, S. (Ed). (2011). The dreams that stuff is made of: The most astounding papers of quantum physics – and how they shook the scientific world. Philadelphia: Running Press

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

Penrose, R. (2006). The Road to Reality: A Complete Guide to the Laws of the Universe. London: Vintage.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Mindfulness-based therapy: A tool for Spiritual Growth? Thresholds. Summer Issue, 14-18.

Acknowledgment: This post was used as a platform for developing themes, insights, and elucidations to be included in an expanded article written for the Mindfulness in Practice section of the journal Mindfulness.