<p>The union of samatha (tranquility meditation) and vipasyana (insight meditation) is the unique Buddhist path to deliverance. This dissertation explores various schemes of samatha developed in distinct meditation systems, so as to analyze the different degrees of sam adhi which affect the power of insight in eradication of defilements. The nature of dhyana/jhana is explained quite different in the canonical and commentarial materials of Buddhist schools. How a meditator practices mindfulness of breathing is based on how a meditator interprets what the dhyana/jh ana is. This dissertation provides various possible explanations for the diverse dispositions of meditators in meditation practice. In insight meditation, when consciousness acts with skillful mental qualities, one is able to penetrate the true nature of all physical and mental phenomena; in the cycle of rebirth, consciousness links the present existence and the next. The different roles of consciousness in rebirth, and deliverance are investigated. This dissertation is mainly based on the Chinese Canon to examine key issues in meditation practice, revolving around the significance of tranquility meditation and insight meditation.</p>
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Mindfulness-based meditation interventions have become increasingly popular in contemporary psychology. Other closely related meditation practices include loving-kindness meditation (LKM) and compassion meditation (CM), exercises oriented toward enhancing unconditional, positive emotional states of kindness and compassion. This article provides a review of the background, the techniques, and the empirical contemporary literature of LKM and CM. The literature suggests that LKM and CM are associated with an increase in positive affect and a decrease in negative affect. Preliminary findings from neuroendocrine studies indicate that CM may reduce stress-induced subjective distress and immune response. Neuroimaging studies suggest that LKM and CM may enhance activation of brain areas that are involved in emotional processing and empathy. Finally, preliminary intervention studies support application of these strategies in clinical populations. It is concluded that, when combined with empirically supported treatments, such as cognitive-behavioral therapy, LKM and CM may provide potentially useful strategies for targeting a variety of different psychological problems that involve interpersonal processes, such as depression, social anxiety, marital conflict, anger, and coping with the strains of long-term caregiving.
Highlights
► We review the literature on loving-kindness and compassion meditation.
► Neuroendocrine studies suggest that compassion meditation reduces subjective distress and immune response to stress.
► Neuroimaging studies suggest that both meditation practices enhance activation of emotion centers of the brain.
► Preliminary intervention studies support the application of these strategies in clinical populations.
► We conclude that these techniques are effective for treating social anxiety, marital conflict, anger, and strains of long-term caregiving.
Patients in the placebo arms of randomized controlled trials (RCT) often experience positive changes from baseline. While multiple theories concerning such “placebo effects” exist, peculiarly, none has been informed by actual interviews of patients undergoing placebo treatment. Here, we report on a qualitative study (n = 27) embedded within a RCT (n = 262) in patients with irritable bowel syndrome. Besides identical placebo acupuncture treatment in the RCT, the qualitative study patients also received an additional set of interviews at the beginning, midpoint, and end of the trial. Interviews of the 12 qualitative subjects who underwent and completed placebo treatment were transcribed. We found that patients (1) were persistently concerned with whether they were receiving placebo or genuine treatment; (2) almost never endorsed “expectation” of improvement but spoke of “hope” instead and frequently reported despair; (3) almost all reported improvement ranging from dramatic psychosocial changes to unambiguous, progressive symptom improvement to tentative impressions of benefit; and (4) often worried whether their improvement was due to normal fluctuations or placebo effects. The placebo treatment was a problematic perturbation that provided an opportunity to reconstruct the experiences of the fluctuations of their illness and how it disrupted their everyday life. Immersion in this RCT was a co-mingling of enactment, embodiment and interpretation involving ritual performance and evocative symbols, shifts in bodily sensations, symptoms, mood, daily life behaviors, and social interactions, all accompanied by self-scrutiny and re-appraisal. The placebo effect involved a spectrum of factors and any single theory of placebo—e.g. expectancy, hope, conditioning, anxiety reduction, report bias, symbolic work, narrative and embodiment—provides an inadequate model to explain its salubrious benefits.
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<p>Patients in the placebo arms of randomized controlled trials (RCT) often experience positive changes from baseline. While multiple theories concerning such “placebo effects” exist, peculiarly, none has been informed by actual interviews of patients undergoing placebo treatment. Here, we report on a qualitative study (n = 27) embedded within a RCT (n = 262) in patients with irritable bowel syndrome. Besides identical placebo acupuncture treatment in the RCT, the qualitative study patients also received an additional set of interviews at the beginning, midpoint, and end of the trial. Interviews of the 12 qualitative subjects who underwent and completed placebo treatment were transcribed. We found that patients (1) were persistently concerned with whether they were receiving placebo or genuine treatment; (2) almost never endorsed “expectation” of improvement but spoke of “hope” instead and frequently reported despair; (3) almost all reported improvement ranging from dramatic psychosocial changes to unambiguous, progressive symptom improvement to tentative impressions of benefit; and (4) often worried whether their improvement was due to normal fluctuations or placebo effects. The placebo treatment was a problematic perturbation that provided an opportunity to reconstruct the experiences of the fluctuations of their illness and how it disrupted their everyday life. Immersion in this RCT was a co-mingling of enactment, embodiment and interpretation involving ritual performance and evocative symbols, shifts in bodily sensations, symptoms, mood, daily life behaviors, and social interactions, all accompanied by self-scrutiny and re-appraisal. The placebo effect involved a spectrum of factors and any single theory of placebo – e.g. expectancy, hope, conditioning, anxiety reduction, report bias, symbolic work, narrative and embodiment – provides an inadequate model to explain its salubrious benefits.</p>
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<p>Abstract The performance of concentrative and mindfulness meditators on a test of sustained attention (Wilkins' counting test) was compared with controls. Both groups of meditators demonstrated superior performance on the test of sustained attention in comparison with controls, and long-term meditators were superior to short-term meditators. Mindfulness meditators showed superior performance in comparison with concentrative meditators when the stimulus was unexpected but there was no difference between the two types of meditators when the stimulus was expected. The results are discussed in relation to the attentional mechanisms involved in the two types of meditation and implications drawn for mental health.</p>
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Many philosophical and contemplative traditions teach that “living in the moment” increases happiness. However, the default mode of humans appears to be that of mind-wandering, which correlates with unhappiness, and with activation in a network of brain areas associated with self-referential processing. We investigated brain activity in experienced meditators and matched meditation-naive controls as they performed several different meditations (Concentration, Loving-Kindness, Choiceless Awareness). We found that the main nodes of the default-mode network (medial prefrontal and posterior cingulate cortices) were relatively deactivated in experienced meditators across all meditation types. Furthermore, functional connectivity analysis revealed stronger coupling in experienced meditators between the posterior cingulate, dorsal anterior cingulate, and dorsolateral prefrontal cortices (regions previously implicated in self-monitoring and cognitive control), both at baseline and during meditation. Our findings demonstrate differences in the default-mode network that are consistent with decreased mind-wandering. As such, these provide a unique understanding of possible neural mechanisms of meditation.
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The present study was designed to examine mindfulness and stress levels in beginner and advanced practitioners of Hatha Yoga. Participants (N = 52) were recruited through Hatha Yoga schools local to western Massachusetts. Beginner practitioners (n = 24) were designated as those with under 5 years (M = 3.33) experience and advanced practitioners (n = 28) as those with over 5 years (M = 14.53) experience in Hatha Yoga. The participants completed the Mindful Attention Awareness Scale (MAAS; Brown and Ryan 2003) and the Perceived Stress Scale (PSS; Cohen et al. 1983) directly preceding a regularly scheduled Hatha Yoga class. Based on two independent-samples t-tests, advanced participants scored significantly higher in mindfulness levels (P < .05) and significantly lower in stress levels (P < .05) when compared to beginner participants. Additionally, a significant negative correlation (r = —. 45, P = .00) was found between mindfulness and stress levels. No significant correlations were found between experience levels and mindfulness and stress levels. Hatha Yoga may be an effective technique for enhancing mindfulness and decreasing stress levels in practitioners.
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Mindfulness-based interventions have been shown to alleviate symptoms of a wide range of physical and mental health conditions. Regular between-session practice of mindfulness meditation is among the key factors proposed to produce the therapeutic benefits of mindfulness-based programs. This article reviews the mindfulness intervention literature with a focus on the status of home practice research and the relationship of practice to mindfulness program outcomes. Of 98 studies reviewed, nearly one-quarter (N = 24) evaluated the associations between home practice and measures of clinical functioning, with just over half (N = 13) demonstrating at least partial support for the benefits of practice. These findings indicate a substantial disparity between what is espoused clinically and what is known empirically about the benefits of mindfulness practice. Improved methodologies for tracking and evaluating the effects of home practice are recommended.
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<p>Mindfulness refers to a set of practices as well as the psychological state and trait produced by such practices. The state, trait, and practice of mindfulness may be broadly characterized by a present-oriented, nonjudgmental awareness of cognitions, emotions, sensations, and perceptions without fixation on thoughts of past or future. Research on mindfulness has proliferated over the past decade. Given the explosion of scientific interest in this topic, mindfulness-based therapies are attracting the attention of clinical social workers, who seek to implement these interventions in numerous practice settings. Concomitantly, research on mindfulness is now falling within the scope and purview of social work scholars. In response to the growing interest in mindfulness within academic social work, the present article outlines six conceptual and methodological recommendations for the conduct of future empirical studies on mindfulness. These recommendations have practical importance for advancing mindfulness research within and beyond social work.</p>
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Mindfulness practice is an ancient tradition in Eastern philosophy that forms the basis for meditation, and it is increasingly making its way into Western approaches to health care. Although it has been applied to the treatment of many different mental health disorders, it has not been discussed in the context of therapy for sexual problems. In a previous qualitative study of female meditation practitioners who did not have sexual concerns, mindfulness practice was found to be associated with greater sexual response and higher levels of sexual satisfaction. We have recently developed a psychoeducational program for women with sexual arousal disorder subsequent to gynecologic cancer and have included a component of mindfulness training in the intervention. In this paper, we will attempt to provide a rationale for the use of mindfulness in the treatment of women with sexual problems, and will include transcript excerpts from women who participated in our research trial that illustrate how mindfulness was effective in improving their sexuality and quality of life. Although these findings are preliminary, they suggest that mindfulness may have a place in the treatment of sexual concerns.
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Classical Tibetan meditation texts are used to specify the most important variables in meditation that can be subjected to empirical test. There are 3 kinds of variables: (a) nonspecific variables, common to all meditation systems; (b) specific variables, limited to spec & types of meditation practice; and (c) timedependent variables, changing over the course of meditation practice. The latter, time-dependent variables, comprise the majority of meditation variables. One set of time-dependent variables for classical concentrative meditation is explored. Using the semantic-field method of translating, technical terms most important in each level of the entire phenomenology of concentrative meditation are discussed. These terms are translated into hypotheses, which are worded in terms of traditional constructs from cognitive psychology. Supporting empirical research is presented and suggestions for further research are made. Certain similarities are noted between the Yogic texts and the constructivist theories of perception, information-processing, and affect. The overall direction of change in concentrative meditation follows an invariant sequence of levels of consciousness.
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Objective To explore participants’ experience in placebo-controlled randomized clinical trials (RCTs) specifically in relationship to their expectations. Background Aspects of being in RCTs, such as informed consent, perception of benefit and understanding of randomization, have been examined. In contrast, little is known concerning the formation of patient expectations before and during trials. Methods Qualitative methods using in-depth interviews with a semi-structured interview guide of nine patients from four different RCTs. Data analysis was conducted using a codebook format arranging participant responses under broad analytical headings. The interviewer used a semi-structured interview guide to direct the conversation from one broad topic to the next within the context of the ongoing conversation. A checklist of topics encouraged participants to describe their experiences in RCTs. Narratives concerning expectation, blinding and placebo were compared to identify common themes. Results Patient anticipatory processes were influenced and modified both before and during the trial from multiple inputs. Such factors as past experiences in RCTs, past experiences of ineffective treatment, stress of being off regular medications, fear of being a ‘placebo responder’, input of non-study doctors or other health professionals, the experience of other participants, measurements of health parameters made during the trial and the presence or absence of side-effects all affected patient expectation. Conclusion Expectations in RCTs are not fixed and instead may be viewed as continuously shaped by multiple inputs that include experience and information received both before and during the trial. Variability in placebo response observed in previous studies may be related to the fluid nature of expectations. Trying to control and equalize expectations in RCTs may be more difficult than previously assumed.
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Evidence that placebo acupuncture is an effective treatment for chronic pain presents a puzzle: how do placebo needles appearing to patients to penetrate the body, but instead sitting on the skin’s surface in the manner of a tactile stimulus, evoke a healing response? Previous accounts of ritual touch healing in which patients often described enhanced touch sensations (including warmth, tingling or flowing sensations) suggest an embodied healing mechanism. In this qualitative study, we asked a subset of patients in a singleblind randomized trial in irritable bowel syndrome to describe their treatment experiences while undergoing placebo treament. Analysis focused on patients’ unprompted descriptions of any enhanced touch sensations (e.g., warmth, tingling) and any significance patients assigned to the sensations. We found in 5/6 cases, patients associated sensations including “warmth” and “tingling” with treatment efficacy. The conclusion offers a “neurophenomenological” account of the placebo effect by considering dynamic effects of attentional filtering on early sensory cortices, possibly underlying the phenomenology of placebo acupuncture.
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BACKGROUND: Despite the apparent high placebo response rate in randomized placebo-controlled trials (RCT) of patients with irritable bowel syndrome (IBS), little is known about the variability and predictors of this response.
OBJECTIVES: To describe the magnitude of response in placebo arms of IBS clinical trials and to identify which factors predict the variability of the placebo response.
METHODS: We performed a meta-analysis of published, English language, RCT with 20 or more IBS patients who were treated for at least 2 weeks. This analysis is limited to studies that assessed global response (improvement in overall symptoms). The variables considered as potential placebo modifiers were study design, study duration, use of a run-in phase, Jadad score, entry criteria, number of office visits, number of office visits/study duration, use of diagnostic testing, gender, age and type of medication studied.
FINDINGS: Forty-five placebo-controlled RCTs met the inclusion criteria. The placebo response ranged from 16.0 to 71.4% with a population-weighted average of 40.2%, 95% CI (35.9-44.4). Significant associations with lower placebo response rates were fulfillment of the Rome criteria for study entry (P=0.049) and an increased number of office visits (P=0.026).
CONCLUSIONS: Placebo effects in IBS clinical trials measuring a global outcome are highly variable. Entry criteria and number of office visits are significant predictors of the placebo response. More stringent entry criteria and an increased number of office visits appear to independently decrease the placebo response.
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Abstract Background: Despite the apparent high placebo response rate in randomized placebo-controlled trials (RCT) of patients with irritable bowel syndrome (IBS), little is known about the variability and predictors of this response. Objectives: To describe the magnitude of response in placebo arms of IBS clinical trials and to identify which factors predict the variability of the placebo response. Methods: We performed a meta-analysis of published, English language, RCT with 20 or more IBS patients who were treated for at least 2 weeks. This analysis is limited to studies that assessed global response (improvement in overall symptoms). The variables considered as potential placebo modifiers were study design, study duration, use of a run-in phase, Jadad score, entry criteria, number of office visits, number of office visits/study duration, use of diagnostic testing, gender, age and type of medication studied. Findings: Forty-five placebo-controlled RCTs met the inclusion criteria. The placebo response ranged from 16.0 to 71.4% with a population-weighted average of 40.2%, 95% CI (35.9–44.4). Significant associations with lower placebo response rates were fulfilment of the Rome criteria for study entry (P = 0.049) and an increased number of office visits (P = 0.026). Conclusions: Placebo effects in IBS clinical trials measuring a global outcome are highly variable. Entry criteria and number of office visits are significant predictors of the placebo response. More stringent entry criteria and an increased number of office visits appear to independently decrease the placebo response.
The experience of pain arises from both physiological and psychological factors, including one's beliefs and expectations. Thus, placebo treatments that have no intrinsic pharmacological effects may produce analgesia by altering expectations. However, controversy exists regarding whether placebos alter sensory pain transmission, pain affect, or simply produce compliance with the suggestions of investigators. In two functional magnetic resonance imaging (fMRI) experiments, we found that placebo analgesia was related to decreased brain activity in pain-sensitive brain regions, including the thalamus, insula, and anterior cingulate cortex, and was associated with increased activity during anticipation of pain in the prefrontal cortex, providing evidence that placebos alter the experience of pain.
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