Psyc

The Psychology
of Meditation
Research and Practice
The Psychology
of Meditation
Research and Practice
Edited by
Michael A. West
1
1
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Preface
In 1987 Oxford University Press published a book entitled The Psychology of

Meditation, which reviewed research on the effects of meditation upon arousal,
brain wave activity, and personality. It also described the very limited research
examining the application of meditation in clinical settings. It was a privilege
for me to edit that book and to learn from the content. But more than 30 years
have gone by since its publication. I have continued to practice meditation but
had not kept abreast with what psychological research had discovered about
meditation processes and outcomes. Like many others I was curious about how
our knowledge has developed.
The motivation to edit a new book with the same focus was selfish, therefore.
I wanted to learn from those who could best contribute to a volume reviewing
from a psychological perspective what we know about research into and the
practice of meditation. Finding the key researchers and inviting them to give of
their time to write a chapter was the major challenge. I am fortunate that all of
the contributors, who come from many different countries, are people who are
not only deeply immersed in the challenge of understanding meditation from a
psychological perspective, but who also have practiced meditation (for the
most part) over many years. Not only do they review research but they also pro-
vide a personal account of their meditation experience and, in some cases, jour-
neys. It is a privilege for me to be able to learn from their rich contributions. My
selfish motivation in editing this volume has been rewarded by the outcome.
My hope is that readers will find much to savor and will also have a sense of
privilege in the enlightenment that I have found in reading the contents of the
chapters that these generous contributors have crafted.
Sheffield, United Kingdom, April 2015
Acknowledgments
Eleanor Hardy took on the task of reviewing the contents of the book and
checking layout, references, consistency, and the many similar tasks I am too
lazy or unskilled to manage effectively. I am grateful for her generosity and
patience in doing this. Gillian Hardy, as ever, was a great source of wisdom and
generosity. Charlotte Green has provided helpful, patient, and light-touch sup-
port on behalf of Oxford University Press. The warmest acknowledgements go
to the contributors to this volume, who were so generous and responsive in
preparing their chapters.
Contents
List of contributors xi
Part 1 Meditation perspectives

1 The practice of meditation 3
Michael A. West
2 Meditation: Practice and experience 27
Martine Batchelor
3 How conscious experience comes about, and why
meditation is helpful 49
Guy Claxton
4 Fish discovering water: Meditation as a process
of recognition 73
James Carmody
5 Psychology of meditation: Philosophical perspectives 93
Loriliai Biernacki
Part 2 Therapeutic and clinical applications

of meditation
6 Traditional and secular views of psychotherapeutic
applications of mindfulness and meditation 119
Lynn C. Waelde and Jason M. Thompson
7 Meditation and the management of pain 153
Vidyamala Burch
8 Addictive disorders 177
Sarah Bowen, Matthew Enkema, Corey Roos, Haley Douglas,
Erin Harrop, Tatyana Kholodkov, and Katie Witkiewitz
9 Meditation and physical health 193
Linda E. Carlson
10 The cognitive and affective neurosciences
of meditation 221
Antonino Raffone
x Contents
Part 3 Meditation in workplaces and schools

11 Mindfulness and meditation in the workplace: An acceptance
and commitment therapy approach 241
Frank W. Bond, Paul E. Flaxman, and Joda Lloyd
12 Mindfulness in education 259
Katherine Weare
Part 4 Conclusions
13 Meditation: Future theory and research 285
Peter Sedlmeier, Juliane Eberth, and Maika Puta
14 How meditation changes lives: Practice, research, and personal
journeys 311
Michael A. West
Name index 327

Subject index 337
List of contributors
Martine Batchelor was born in France in 1953. She was ordained as a Bud-
dhist nun in Korea in 1975. She studied Zen Buddhism under the guidance
of the late Master Kusan at Songgwang Sa monastery until 1984. Her Zen
training also took her to nunneries in Taiwan and Japan. From 1981 she
served as Kusan Sunim’s interpreter and accompanied him on lecture tours
throughout the United States and Europe. She translated his book, The Way
of Korean Zen. Following Master Kusan’s death she returned her nun’s vows
and left Korea. She returned to Europe with her husband, Stephen, in 1985.
She worked as a lecturer and spiritual counselor both at Gaia House and
elsewhere in Britain. She was also involved in interfaith dialogue and was a
Trustee of the International Sacred Literature Trust until 2000. In 1992 she
published, as co-editor, Buddhism and Ecology. In 1996 she published, as
editor, Walking on Lotus Flowers, which in 2001 was reissued under the title
Women on the Buddhist Path. She is the author of Principles of Zen, Medita-
tion for Life (an illustrated book on meditation), The Path of Compassion (a
translation from the Korean version, with reference to the original Chinese,
of the Brahmajala Sutra), Women in Korean Zen, and Let Go: A Buddhist
Guide to Breaking Free of Habits. Her latest book is The Spirit of the Buddha.
She leads meditation retreats worldwide and lives in France.
Loriliai Biernacki is Associate Professor in the Department of Religious Stud-
ies at the University of Colorado at Boulder. Her research interests include
Hinduism, ethics, gender, and the interface between religion and science.
Her first book, Renowned Goddess of Desire: Women, Sex and Speech in Tan-
tra (Oxford 2007) won the Kayden Award in 2008. She is co-editor of Panen-
theism across the World’s Religious Traditions (Oxford 2013). She is currently
working on a study on the eleventh-century Indian philosopher Abhinav-
agupta within the framework of wonder, the new materialisms, and ideas of
the body and the body–mind interface.
Frank W. Bond is the Director of the Institute of Management Studies at
Goldsmiths, University of London. His research and consultancy seek to
identify the processes by which acceptance and commitment therapy (ACT),
leadership, and organizational interventions improve productivity and well-
being in the workplace. The ESRC, UK government, charities, and industry
have funded his research, and the academic publications stemming from
xii List of contributors
that research have been cited nearly 7000 times in academic papers and
books. Because of the ACT randomized controlled studies he has published,
the UK government, the British Olympic team, the BBC, and other private
and public sector institutions have asked Professor Bond to consult with,
and conduct ACT-related research in, their organizations. Professor Bond
has been elected President and Fellow of the ACT-focused Association of
Contextual Behavioural Science.
Sarah Bowen is an Assistant Professor at Pacific University in Portland, Ore-
gon, and a licensed clinical psychologist. Over the past decade, her primary
clinical and research interests have centered on mindfulness-based treat-
ments for addictive behaviors. She has conducted several clinical trials
examining effects of mindfulness-based interventions, as well as possible
mechanisms underlying the change process, funded by the National Insti-
tute of Health. Currently, Dr. Bowen is working both locally and internation-
ally to provide training in mindfulness-based therapies to health
professionals, and to assist in the adaptation of protocols to serve diverse
settings, populations, and cultures. Her research has been supported by
grants from the National Institute on Mental Health, the National Institute
on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism,
and the National Cancer Institute.
Vidyamala Burch is an ordained member of the Triratna Buddhist Order, as
well as founder and co-Director of Breathworks, an organization devoted to
offering mindfulness and compassion to people suffering from pain, illness,
and stress (www.breathworks-mindfulness.org.uk). Breathworks teachers
now offer courses in over 20 countries. Vidyamala teaches and speaks inter-
nationally in both her Buddhist and Breathworks roles. She specializes in
mindfulness and compassion retreats and workshops. In 2008 she wrote Liv-
ing Well with Pain and Illness—the mindful way to free yourself from suffering
and in 2012 she co-authored Mindfulness for Health with Danny Penman
(published as You are Not Your Pain in the USA). This won first prize in the
BMA book awards 2014 in the “Popular Medicine” category—clinical books
aimed at the general public. She has also published a number of guided
meditation CDs and DVDs. Vidyamala has been instrumental in initiating
research projects that provide an evidence-base for the efficacy of the Breath-
works’ approach. This is guided by a board of respected academic leaders
under the auspices of the Breathworks Foundation (http://www.breathworks-
foundation.org.uk). Breathworks grew out of Vidyamala’s personal experi-
ence of managing chronic pain following spinal injuries and surgery in her
teens. She learned mindfulness and compassion meditations when she was
List of contributors xiii
25 and has used these over the subsequent 30 years to create a fulfilling qual-
ity of life, despite ongoing pain and disability.
Linda E. Carlson holds the Enbridge Research Chair in Psychosocial
Oncology and is Full Professor in Psychosocial Oncology in the Depart-
ment of Oncology, Cumming School of Medicine at the University of Cal-
gary. Dr. Carlson trained as a Clinical Health Psychologist at McGill
University in Montreal, researching the area of psychoneuroendocrinol-
ogy. Her current research focuses on developing and testing complemen-
tary therapy interventions to help people cope with cancer. Dr. Carlson
received the Kawano New Investigator Award from the International
Psycho-Oncology Society in 2006, the William E. Rawls Prize in cancer
control from the National Cancer Institute of Canada/Canadian Cancer
Society in 2007, a New Investigator Award from the Canadian Psycho-
logical Association Health Section in 2009, the inaugural Research Excel-
lence award from the Canadian Association of Psychosocial Oncology in
2010, the Arete Award for Research Excellence from the Department of
Oncology at the University of Calgary in 2012, and was shortlisted for the
Dr. Rogers Prize in Complementary and Alternative Medicine in 2013.
She is a fellow of the Society for Behavioral Medicine and the Mind and
Life Institute. Dr. Carlson’s research in mindfulness-based cancer recov-
ery has been published in many high-impact journals and book chapters,
and she published a patient manual in 2010 with Michael Speca, entitled
Mindfulness-Based Cancer Recovery: A step-by-step MBSR approach to
help you cope with treatment and reclaim your life, in addition to a profes-
sional training manual in 2009 with Shauna Shapiro entitled The Art and
Science of Mindfulness: Integrating mindfulness into psychology and the
helping professions. She has published over 150 research papers and book
chapters in the area of psycho-oncology, holds several millions of dollars
in grant funding, and is regularly invited to present her work at inter-
national conferences.
James Carmody studied and practiced in the Zen, Tibetan, Theravada, and
Advaita traditions in a number of countries for over 40 years. He is an Asso-
ciate Professor of Medicine at the University of Massachusetts Medical
School and has been principal investigator on several NIH-funded clinical
trials of the effects and mechanisms of mindfulness and other mind-body
trainings. He has been a therapist, an instructor in the UMass Mindfulness-
Based Stress Reduction program, and Director of Research for the UMass
Center for Mindfulness. Instead of a dharma narrative, he places human
angst in the adaptive attending processes resulting from evolutionary and
xiv List of contributors
biological imperatives, and describes the psychological mechanisms by

which mindfulness, and other mind-body and psychotherapeutic modali-
ties, operate to recognize and counter these default processes to reduce dis-
tress. He also teaches courses for clinicians with the goal of making the
conceptualization and practice of mindfulness and mind-body processes
clear and jargon-free, so that they can be meaningfully introduced in the
context of a typically brief patient visit and be practicably accessible in the
lives of patients. His work has been featured in national and international
media including the New York Times, NPR, and ABC. He also enjoys build-
ing in stone.
Haley Douglas was introduced to vipassana meditation in 2008 in a college
course on Behavioral Neuroscience. She eagerly sought out other resources
on meditation and completed a course in Mindfulness-Based Stress Reduc-
tion. Following the personal changes in stress that Haley noticed, she began
working in several labs, investigating the effects of mindfulness on health
and substance use. Now a graduate student in Clinical Psychology, Haley
continues her meditation practice to bolster her health and well-being.
Additionally, she has attended several retreats and continues to work in the
field of mindfulness and health.
Guy Claxton is a cognitive scientist who writes about mind, body, creativity,
and learning. Much of his work has been in education, trying to persuade
schools to weave the building of positive learning habits and attitudes
(“Building Learning Power”) into everyday lessons and school activities. As
a cognitive science writer, his books concern the importance of unconscious
and bodily underpinnings of human intelligence. His latest book in this field
is Intelligence in the Flesh: Why Your Mind Needs Your Body Much More Than
It Thinks. He has also written about Buddhism and the relationship between
Eastern religious traditions and contemporary psychology over many years.
He is retired from full-time university life, being now a Visiting Professor of
Education at King’s College London and Emeritus Professor of the Learning
Sciences at the Centre for Real-World Learning, University of Winchester.
He is the author of a dozen well-respected books on the mind, including
Hare Brain, Tortoise Mind: Why Intelligence Increases When You Think Less
(1997), Wise Up: The Challenge of Lifelong Learning (1999), and The Way-
ward Mind (2005). His Building Learning Power approach has influenced
youngsters’ lives throughout the UK, as well as in Singapore, Sweden, Brazil,
Australia, and New Zealand. Guy Claxton holds degrees from Cambridge
and Oxford, and is a Fellow of the British Psychological Society and of the
Academy of Social Sciences.
List of contributors xv
Juliane Eberth studied psychology at Technische Universität Chemnitz from

2005 to 2010. Her diploma thesis comprised a meta-analysis of the effects of
meditation on psychological variables, for which she received an award
from the German MBSR-MBCT association. After receiving her diploma
she started working on her dissertation, which deals with the effects of
mindfulness meditation. This research is being financed by a scholarship of
the Free State of Saxony. Together with Peter Sedlmeier she published two
meta-analyses on the effects of meditation in general and on the effects of
mindfulness meditation.
Matthew Enkema is a pre-doctoral student of Clinical Psychology at the Uni-
versity of Washington. His interests include treatment for addiction, crav-
ing, and mechanisms of action in mindfulness-based treatments for
addiction. He began formal meditation practice in 2007, informed primarily
by the Theravada tradition, and has been working with individuals strug-
gling with substance use problems and addiction since 2011.
Paul E. Flaxman is a Senior Lecturer in Organisational Psychology at City
University London. He has previously held research and teaching positions
at London Guildhall University and Goldsmiths College (University of Lon-
don). While at Goldsmiths, he helped to implement a series of work redesign
interventions for improving staff well-being in financial services and local
government organizations. Dr. Flaxman was also involved in two separate
research projects designed to promote and develop the Health and Safety
Executive (HSE) Management Standards for work-related stress. He is cur-
rently the Programme Director of City’s Organisational Psychology Group.
Dr. Flaxman specializes in adapting cognitive behavioral therapy (CBT)
interventions to help improve employees’ psychological health. Most nota-
bly, he has taken a prominent role (alongside Professor Frank Bond) in
developing and evaluating acceptance and commitment therapy (ACT) as a
worksite training intervention.
Erin Harrop is a social welfare doctoral student at the University of Washington
School of Social Work. She graduated with her Master of Social Work in 2014
from the University of Washington, after completing her clinical internships at
Seattle Children’s Hospital Adolescent Medicine Clinic and at Fairfax Hospital.
Her primary clinical interests include women’s mental health, particularly
issues of eating disorders, substance abuse, and size-related stigma. Erin is also
completing a teaching practicum with the Skillful Meditation Project, and
believes in the integration of mindfulness practices into her therapeutic work.
Tatyana Kholodkov completed her Bachelor’s degree in Psychology at the
University of Wyoming and her Master’s in Experimental Psychology at Old
xvi List of contributors
Dominion University. She is currently a clinical psychology intern at the

Durham VAMC, where much of her direct patient care involves implemen-
tation of mindfulness interventions. She completed her Clinical Psychology
Ph.D. from the University of Wyoming in August 2015, and shortly there-
after started a full-time clinical psychology post-doctoral fellowship through
Integrative Medicine at Duke Medical Center. Her research interests include
difficulties with emotion regulation (and behaviors such as non-suicidal
self-injury), treatment outcome studies, and the role of mindfulness in psy-
chotherapy. She enjoys helping those she works with to find fulfillment in
life and attend to holistic wellness. She maintains a personal mindfulness
meditation practice in the tradition of Thich Nhat Hanh, and is also a prac-
titioner of yoga. In her free time, you can find her wandering in wilderness,
cooking for others, and hanging upside-down on aerial silks.
Joda Lloyd is a lecturer and researcher in occupational psychology at Gold-
smiths’ Institute of Management Studies (IMS). She is a chartered psychologist
with the British Psychological Society (BPS), and a registered occupational
psychologist with the Health and Care Professions Council (HCPC). Dr.
Lloyd’s research focuses on the application of a contextual cognitive-behavioral
theory, known as acceptance and commitment therapy (ACT), and its under-
lying mechanism of change—psychological flexibility—to workplace health
and performance. Major projects have included the application of ACT-
focused psychological skills interventions to improving client-focused atti-
tudes and burnout in the human services, as well as the development of new
methods to assess psychological flexibility in the workplace. More recent pro-
jects concern the application of ACT-based technologies to performance
coaching in the workplace, as well as examinations of how ACT and psycho-
logical flexibility can inform our understanding of minority status, identity
management, and prejudice and discrimination in the workplace. Dr. Lloyd
regularly presents on her research in both UK and international conferences,
and is involved in a number of special interest groups and societies concerned
with the promotion and dissemination of ACT-focused research and practice.
Maika Puta studied psychology at the Technische Universität Dresden from
2005 to 2010 and specialized in applied health psychology afterwards. Since
2011 she has been a Ph.D. candidate at the Technische Universität Chem-
nitz, carrying out research on the Three-Guna-Modell from Indian Psych-
ology. This research is being financed by a scholarship of the Foundation of
the German Economy. She has published a chapter on the Gunas (with
Peter Sedlmeier) in the book Meditation: Neuroscientific approaches and
philosophical implications (Springer Press 2014). Since 2015 she has been
List of contributors xvii
the head of the Sattva Center in Berlin, which offers seminars relevant to
psychological health.
Antonino Raffone completed a Ph.D. in Psychology at the Sapienza Univer-
sity of Rome, and the European Diploma in Cognitive and Brain Sciences.
He holds a position of Associate Professor at the Department of Psychology
of the Sapienza University of Rome. Both the research and teaching of Dr.
Raffone are mainly focused on consciousness, attention, and mindfulness,
and their neural correlates, with different methods of investigation. Dr. Raf-
fone has been the author of several international research articles on these
topics and related aspects, including publications in the Journal of Cognitive
Neuroscience, Psychological Review, and Consciousness and Cognition. He
has also edited a theme issue of Philosophical Transactions of the Royal Soci-
ety B on perceptual awareness. He is active in promoting the practice of
mindfulness and meditation in several contexts, including prisons, and in
related research. He has organized several national and international events
about mindfulness, and directs the Master in “Mindfulness: Practice, Clin-
ical Applications and Neuroscience” at the Sapienza University of Rome. Dr.
Raffone started to study and practice Buddhism and meditation in 2004
with Professor Peter Harvey, and then became a dedicated Soto Zen Bud-
dhist practitioner (with Ven. Dario Doshin Girolami), a tradition in which
he received a lay ordination in 2009. He also assists Henk Barendregt in
vipassana meditation retreats.
Corey Roos is currently a doctoral student in Clinical Psychology at the Uni-
versity of New Mexico and his mentor is Dr. Katie Witkiewitz. He is inter-
ested in mindfulness-based interventions for substance use disorders, the
application of technology in the delivery of empirically-supported treat-
ments, and the role of emotion regulation in alcohol and substance use
behavior change.
Peter Sedlmeier is Professor of Psychology at the Technische Universität
Chemnitz. There, he mainly teaches research methods and cognitive psych-
ology. Apart from being involved in meditation research, together with his
group, he conducts research in music psychology, psychology of time, spe-
cial aspects of psycholinguistics, and judgment under uncertainty. He has
held positions at the University of Salzburg, the University of Chicago, the
University of Münster, and the University of Paderborn, and has spent sev-
eral of his sabbaticals at Pondicherry University, India.
Jason M. Thompson was born in England and as an undergraduate studied
English Language and Literature at Oxford University. After university he
spent six years researching and producing documentaries for the BBC and
xviii List of contributors
Channel 4 in London. Following emigration to the United States in 1999, he

taught at public elementary, middle, and high schools in inner-city Oakland,
California, prior to embarking on a Ph.D. in Clinical Psychology at Palo Alto
University, California, with emphases on the psychology of meditation and
community mental health. His dissertation (“Neural and linguistic correl-
ates of decentering in focused attention and open monitoring meditation”)
examined the neurophenomenology of meditation-related self-awareness
changes, using data he collected in a research assistant capacity from a
National Institutes of Health-funded fMRI study of meditation and hypno-
sis at Stanford University School of Medicine. He is currently completing his
pre-doctoral internship in the Child and Adolescent Services Multicultural
Clinical Training Program in the Department of Psychiatry at the University
of California, San Francisco, based at San Francisco General Hospital.
Lynn C. Waelde is a professor at the Pacific Graduate School of Psychology of
Palo Alto University and a consulting professor in the Department of Psy-
chiatry and Behavioral Sciences at the Stanford University School of Medi-
cine. She is director of the Inner Resources Center, a specialty clinic of the
Gronowski Psychology Center, and Director of the Meditation and Psych-
ology Area of Emphasis in the Clinical Psychology Ph.D. program at Palo
Alto University. Dr. Waelde’s clinical and research interests focus on thera-
peutic applications of mindfulness and meditation and on predictors and
manifestations of stress disorders. Dr. Waelde developed the Inner Resources
program so that the powerful techniques of mindfulness, mantra, and medi-
tation could be adapted to meet the specialized needs of people with health
and mental health issues. As an affiliated scholar of the Stanford Center on
International Conflict and Negotiation, Dr. Waelde works collaboratively to
integrate trauma and mindfulness perspectives into peace-building. Dr.
Waelde is a New Orleans native who received a Bachelor’s degree in Psych-
ology and a Master’s degree in Anthropology from Louisiana State Univer-
sity. She received a doctorate in Developmental Child Clinical Psychology
from the University of Colorado at Boulder. She completed a pre-doctoral
internship at the Veterans Affairs Medical Center in New Orleans, where she
completed training as a post-traumatic stress disorder specialist. Dr. Waelde
has been a lifelong student of hatha yoga and meditation.
Katherine Weare is Emeritus Professor at the University of Southampton,
and Honorary Visiting Professor at the University of Exeter. She is known
internationally for her work on mental health, well-being, and social and
emotional learning in schools, including mindfulness and compassion. She
has published widely in the field, engaging in research projects, reviewing
List of contributors xix
the evidence base on “what works,” advising policy makers, and developing
practical strategies in schools. Her book, Developing the Emotionally Literate
School, remains a bestseller in the field. She was a key player in developing
the UK’s national whole school SEAL (Social and Emotional Aspects of
Learning) program. She continues to develop and evaluate cutting-edge
work and is currently working with mindfulness programs such as the
Mindfulness in Schools Project, the Plum Village Community, and Mind
and Life to develop and evaluate new programs and approaches, and is
advising agencies such as the EU, WHO, and the UK government on ways
forward. She is on the core development group of an international network,
SMiLE, the School Mental Health Leadership Exchange. As an adoptive par-
ent she is currently working with key agencies in developing new work on
mindful parenting, including in connection with attachment and trauma.
Michael A. West is Professor of Work and Organizational Psychology at Lan-
caster University Management School, Senior Fellow at The King’s Fund in
London, Senior Fellow of The Work Foundation, and Emeritus Professor at
Aston University. He was formerly Executive Dean of Aston Business
School. He graduated from the University of Wales in 1973 and received his
Ph.D. in 1977 for work on the psychology of meditation. He has authored,
edited, or co-edited 25 books, including The Psychology of Meditation (1987),
The Psychology of Work and Organizations (2010), The Essentials of Team-
working: International Perspectives (2005), Effective Teamwork (2012), the
first edition of which has been translated into 12 languages, and The Inter-
national Handbook of Organizational Teamwork and Cooperative Working
(2003). He has also published over 200 articles for scientific and practitioner
publications, as well as chapters in scholarly books. He is a Fellow of the
British Psychological Society, the American Psychological Association
(APA), the APA Society for Industrial/Organizational Psychology, The
Academy of Social Sciences, the International Association of Applied Psy-
chologists, and the British Academy of Management, and is a Chartered
Fellow of the Chartered Institute of Personnel and Development. His areas
of research interest are team and organizational innovation and effective-
ness, particularly in relation to compassionate cultures and leadership of
health services. He lectures widely both nationally and internationally about
the results of his research on reflexivity, meditation, mindfulness, culture,
compassion, and leadership, and his solutions for developing effective and
innovative organizations.
Katie Witkiewitz is an Associate Professor of Psychology at the University of
New Mexico with a joint appointment at the Center on Alcoholism,
xx List of contributors
Substance Abuse, and Addictions. The underlying theme of her research is

the development of empirically-based models of substance use, with an
emphasis on applying advanced quantitative research methods to better
understand changes in substance use behavior over time. Dr. Witkiewitz is
also a licensed clinical psychologist and has worked extensively on the
development of a theoretical model of biopsychosocial influences on sub-
stance use relapse. This research has led to her collaborative work on the
development and evaluation of mindfulness-based relapse prevention for
substance use disorders. She has conducted numerous empirical studies on
the prediction of alcohol relapse following treatment for substance use dis-
orders, mechanisms of successful alcohol treatment outcomes, and the
development of interventions to prevent alcohol and substance use relapse.
Her research has been supported by grants from the National Institute on
Mental Health, the National Institute on Drug Abuse, the National Institute
on Alcohol Abuse and Alcoholism, and the National Cancer Institute.
Part 1
Meditation perspectives
Chapter 1
The practice of meditation

Michael A. West
Introduction
Blessed (or cursed) with self-awareness and consciousness, humans are faced
with the simple, stunning reality of our existence: With a planet teeming with
life in a universe vaster than our imaginations can encompass. And we are faced
with the miracle of our individual births and the ever-present inevitability of
our deaths. We can contemplate the history of our species, responsible for the
destruction of most large mammalian species and countless others besides, and
now threatening the viability of the ecosystem that sustains us. And we busy
ourselves, in the context of all this, with politics, economics, social media, soap
operas, and newspapers; with our neighbors’ transgressions and our plans for
TV viewing; with football teams and holiday destinations; with fashion choices
and religious wars. Busy humans, exercising huge influence on this planet, and
busily preoccupied with our busy stuff—with our desire to increase our pleas-
ure and reduce our pain and vaguely aware that we are not quite getting it right,
either individually or collectively. And working hard to avoid confronting the
fact that we may be getting it very wrong indeed.
All of this experience is mediated through our minds—actually through our
bodies and minds as a single system—but how we understand, cope with, make
sense of, come to terms or fail to come to terms with our existence and experi-
ences is through the functioning of our minds. To truly appreciate our situation,
our predicaments, our paths forward, to more directly engage with experience
and existence, therefore, we also need to understand and perhaps better nurture
the functioning of our minds.
The practice of meditation is a way of coming to experience more fully our
moment-by-moment existence by encountering the mind directly. Meditation
involves increasing awareness of the body (sensations), emotions, thoughts, the
mind, and mental qualities (e.g., turgid, clear, focused). Through practice, the
aim is for this awareness to be increasingly non-reactive though more acute to
events and experiences—the sound of a bird, a shout in the distance, a sensation
of minor physical discomfort, an angry thought, a worry about an unfinished
task, a desire, a fundamental fear. It offers a means of opening to or connecting
4 The practice of meditation
with all experience, whether positive, negative, or neutral, in a (relatively) unfil-

tered, unprocessed way. It offers the ability, with practice, to enable the develop-
ment of awareness of awareness itself. The aim is also to reduce suffering as a
consequence of this greater openness, through reduced reactivity to experience
and increasing well-being (Germer et al. 2005; Hogan 2014; Woodruff
et al. 2014). There is a wealth of experience and knowledge of meditation that
stretches back thousands of years.
In this chapter, we will consider the practice of meditation in different reli-
gious contexts, in human history, across cultures, and in literature. The chapter
describes the growth of research in psychology into meditation and charts the
huge rise in interest in “mindfulness” over the last 15 to 20 years. And the chap-
ter will offer a way of understanding meditation and mindfulness as overlap-
ping and distinct approaches, before concluding with a brief description of the
subsequent contents of the book.
Meditation may be defined as an exercise in which the individual turns atten-
tion or awareness to dwell upon a single object, concept, sound, image, or
experience, with the intention of gaining greater spiritual or experiential and
existential insight, or of achieving improved psychological well-being (West
1987). And to move from definitional concept to experience, the reader may try
the simple breathing meditation, described in Box 1.1.
Box 1.1 Openness and contentment in meditation

Sit quietly in an upright position in a place where you are unlikely to be
disturbed.
Close your eyes and then become aware of the sensation of your whole
body, letting go of any obvious tightness or tension.
Enjoy the sensation of your body being still and sit quietly like this for
about half a minute.
Now let your attention go to your breathing—perhaps where your stom-
ach moves with your breath, or where your chest rises and falls with each
breath, or in the windpipe, or in your nostrils, or at the point where the
breath enters and leaves the nostrils. It doesn’t matter where.
And then each time you breathe out, say the word “one” silently to
yourself.
You don’t have to concentrate hard on the breath or repeating the word
“one.” You don’t have to try to think the word clearly at all times to the exclu-
sion of everything else.
VARIETIES OF MEDITATION PRACTICES 5
Box 1.1 Openness and contentment in meditation (continued)
Continue the meditation in this way for a quarter of an hour, remembering

that you don’t have to achieve some deep level of meditation or relaxation.
The key is to have an attitude of openness and contentment with the
practice.
From time to time there will be thoughts that distract you from the sensa-
tion of your breathing and repeating the word “one” on the out-breath.
Thoughts are a key part of the practice rather than mistakes or something to
be strenuously resisted.
Treat thoughts (or noises) as you would treat clouds drifting across the
blue sky. You don’t hold on to them and you don’t push them away either.
You just watch them come and go and, when you become aware that you
have drifted away from dwelling on the sensation of breathing, very gently
and easily return your attention to the breathing.
Not with some sharp self-remonstration but in a gentle, open, contented way,
accepting the fact that you had drifted away on a succession of thoughts and
then comfortably moving very smoothly back to watching your breathing.
Remember to take it easily, quietly, and simply. And with an attitude of
openness and contentment.
Varieties of meditation practices

Traditionally meditation has been practiced to achieve a direct experiential
knowledge of an absolute such as God, Being, Oneness, Buddha nature—each
of these labels being a product of a religious or personal belief system. In the last
60 years, large numbers of people in Europe and North America have learned
and practiced meditation, many of them with a quite different purpose in mind:
To relieve distress or improve psychological well-being.
By what methods do people seek these differing outcomes? One of the more
common forms of meditation involves repeating a sound (sometimes called a
“mantra”) either silently or aloud, and the meditator is taught to focus attention
on the sound, not favoring other thoughts, external stimuli, and desires. The
sound or mantra may be chosen by the meditation teacher as being particularly
suitable or powerful for the individual; it may be the name or attribute of a god
(Krishna, Ram), or it may be the name of a revered teacher (other examples are
“so-hum,” “om,” “she-am”). The degree of focus or concentration on the mantra
varies according to teachers, schools, and systems. In some the meditator is urged
almost to grit the teeth and strenuously push away thoughts and sensations that
intrude during meditation. But most practitioners are taught to develop a more
relaxed awareness, neither driving thoughts nor sensations away, but not holding
on to them either. Rather, the idea is to persistently and easily return attention to
the central focus (Hewitt 1978).
Objects of meditation can also be visual such as a candle flame, a picture of a
teacher or “guru,” or meaningful visual symbols such as the Christian cross or
the Judaic star. Even movement can be used as a focus of meditation; the repeti-
tive touching of the tips of the four fingers with the thumb or the simple act of
walking are both movements used as a focus for attention in meditation. There
are meditation practices that focus on our impermanence and death; others
that focus on transmitting compassion to our loved ones, to enemies, to our
communities, to all sentient beings, and to all beings in the universe. There are
practices that involve visualizing oneself as a revered god or teacher such as
Krishna, Buddha, or Ganesh. And in Zen Buddhism, one practice is “just sit-
ting” or shikantaza in the meditation hall and experiencing all that arises in an
accepting and attentive way. The practitioner is urged to be diligent in main-
taining awareness and curiosity in order to learn about the nature of the mind
and, thereby, the nature of existence.
In the last 20 years there has also been an exponential growth in the use of
“mindfulness” techniques in which the meditator may attempt to let the atten-
tion dwell on “all that is here and now” in his or her environment and con-
sciousness (Ie, Ngnoumen, and Langer 2014a,b). We will return to discuss
mindfulness later in this chapter and it is addressed by many of the contributors
later in the volume. And, as we review historical and cross-cultural practices of
meditation, still further varieties of meditation practice are revealed.
Meditation across cultures and through history

Meditation has been practiced in various forms for at least 2500 years and prob-
ably for very much longer. It is striking that these practices have been sustained
for so long and across many different cultures. Curious too is how elaborate
methods from one culture resemble techniques in other cultures. Native Ameri-
cans practiced a form of meditation similar to the shikantaza of Japan. In Bot-
swana, the people of the Kung Zhu/twasi practice a form of ritual dancing that
they believe activates an energy (n/um) located at the base of the spine and
which produces an ecstasy experience (Katz 1973, 1999). According to Hindu
philosophy and yoga teachings there are subtle psychic sense organs and a par-
ticular force called the Kundalini located at the base of the spine. In Kundalini
yoga, the meditator focuses attention on this energy source and, through con-
centration, arouses this energy. The energy is then believed to travel up the spine
MEDITATION ACROSS CULTURES AND THROUGH HISTORY 7
through six centers or chakras, evoking at each stage a higher state of conscious-
ness. Eventually it reaches the seventh chakra (the crown chakra) and the medi-
tator achieves a state of perfect enlightenment.
Many groups on the African continent have practiced ritual dancing coupled
with chanting to produce an altered state of consciousness. In shamanism, a
holy person (the shaman) intones a sacred chant to achieve trances (Benson
1975) that offer insights and enable healing; it is widely practiced in North and
South America, Indonesia, Siberia, and Japan. Freuchen (1959) describes how
the Polar Inuit people in Greenland would sit facing a large soft stone and, using
a small hard hand stone, continuously carve a circle in the large stone for peri-
ods stretching to days, to produce a spiritual trance state (for descriptions of
more meditation practices see Benson et al. 1974; Goleman 1977; Hewitt 1978;
Ornstein 1972; White 1974).
However, meditation techniques are not confined to the religions of the East
or to those of simpler societies; meditation has long been part of Christianity. St
Augustine (ad 350–430) wrote of a method of contemplating that he used to:
. . . pass even beyond this power of mine which is called memory; yea I will pass beyond
it, that I might approach unto thee, O sweet light (Butler 1922).
Another example of Christian meditation comes from an anonymously writ-

ten fourteenth-century work called The Cloud of Unknowing (Progoff 1969).
The author writes that the way to attain union with God is to beat down thoughts
through the repetition of a single-syllable word such as “God” or “love”:
Clasp this word tightly in your heart so that it never leaves it no matter what may hap-
pen. This word shall be your shield and your spear whether you ride in peace or in war.
With this word you shall beat upon the cloud and the darkness, which are above you.
With this word you shall strike down thoughts of every kind and drive them beneath
the cloud of forgetting. After that, if any thoughts should press upon you . . . answer him
with this word only and with no other words.
Fray Francisco de Osuna, a tenth-century monk, writing in The Third Spirit-

ual Alphabet, describes an exercise very similar to Buddhist techniques:
Keep (your eyes) fixed steadily on the ground, like men who are forgetful and, as it
were, out of themselves, who stand immovable, wrapt in thought . . . it is better . . . to
keep our gaze fixed on the ground, on some places where there is little to look at so
there may be less to stir our fancy and our imagination. Thus, even in a crowd you may
be deeply recollected by keeping your gaze bent, fixed on one place. The smaller and
darker the place, the more limited your view will be and the less will your heart be dis-
tracted (Osuna 1931).
Among the earliest Christians, the Desert Fathers practiced silently repeating
the “kyrie eleison” to help them achieve a state called “quies”—a state of rest
where “nowhereness and nomindness” purified the soul. They sustained this
silent repetition throughout their daily lives “until it became as spontaneous
and instinctive as their breathing” (Merton 1960). In the fifth century AD,
Hesychius gave instruction in the “Prayer of the Heart,” the practice of which
was intended to provide a “sure knowledge of God, the Incomprehensible”
(French 1968). The instructions are indistinguishable in their mechanics from
many practices we call meditation:
Sit down alone and in silence. Lower your head, shut your eyes, breathe out gently, and
imagine yourself looking into your own heart. Carry your mind, i.e. your thoughts,
from your head to your heart. As you breathe out say “Lord, Jesus Christ, have mercy on
me.” Say it moving your lips gently or say it in your mind. Try to put all other thoughts
aside. Be calm, be patient and repeat the process very frequently (French 1968).
In the Judaic religion, it is common to repeat a simple prayer accompanied by

swaying movements in order to bring exaltation. There are practices involving
mental focusing on body posture and techniques of concentration on magic
seals. In the Chandogya upanishad of Hinduism, devotees are urged to “rever-
ence meditation.” In the Sutrakritanga sutra, Jains are taught that “he whose
soul is purified by meditating is compared to a ship in water. Like a ship reach-
ing the shore, he gets beyond misery.”
In the Sufi tradition, Al-Ghazali describes the practice of Dhikr:
. . . as he sits in solitude, let him not ease saying continuously with his tongue, “Allah,
Allah” keeping his thought on it. At last he will reach a state where the motion of his
tongue will cease, and it will seems as though the word flowed from it. Let him perse-
vere in this until all trace of motion is removed from his tongue, and he finds his heart
persevering in the thought. Let him still persevere until the form of the word, its letters
and shape, is removed from his hear, and there remains the idea alone, as though cling-
ing to his heart, inseparable from it (Nicholson 1914, p. 48).
It is clear that meditation practices are or have been widely used in all the
world’s major religions over many centuries.
What evidence is there of meditation practice outside of established reli-
gions? In an exploration of mysticism in English literature, Spurgeon (1970)
explored the writings of Bronte, Wordsworth, and Tennyson to illustrate her
theme. Her evidence suggests that meditation experiences have been seen as
significant by many outside the religious and mystical traditions. Wordsworth
believed a passive attitude, beyond the intellect and desires and above petty
disputes, would enable one to reach a “central peace subsisting for ever at the
heart of endless agitation.” Such practice would lead to:
. . . that serene and blessed mood
In which the affections gently lead us on
Until the breath of this corporeal frame
Meditation across cultures and through history 9
And even the motion of our human blood

Almost suspended, we are laid asleep
In body, and become a living soul;
While with an eye made quiet by the power
Of harmony, and the deep power of joy
We see into the life of things.
Tennyson would mentally repeat his name continually to encourage experi-

ence of the “unity of all things, the reality of the unseen, and the persistence of
life.” Lines from The Ancient Sage illustrate his experience:
. . . more than once when I
Sat all alone, revolving in myself
The word that is the symbol of myself
The mortal limit of the Self was loosed
And passed into the nameless, as a cloud
Melts into heaven . . .
No doubt many experience something of such states, perhaps sitting on a

hilltop on a summer’s day, savoring the stillness of the hills and trees, or per-
haps in other moments of deep peace and relaxation. Meditation, when prac-
ticed regularly, is a way of more easily evoking feelings of equanimity,
wholeness, intuitive understanding, and a sense of connection with the exter-
nal world.
In Zen Buddhism, the practice of shikantaza—simply a quiet awareness,
without comment, of whatever happens to be here and now—is proposed to
lead to a vivid sensation of “nondifference” between oneself and the external
world, between the mind and its contents—the various sounds, sights, and
other impressions of the surrounding environment (Watts 1957).
In the Rinzai Zen school, the meditator is asked to hold in his or her mind an
illogical question (“koan”) such as “What is the sound of one hand clapping?”
or “What did my face look like before I was born?” or “What am I?” As a result
of persistently interrogating the question, the individual (it is claimed) will
eventually achieve a sudden and intuitive understanding—“One seeks and
seeks, but cannot find. One then gives up, and the answer comes by itself ”
(Watts 1957).
Questions, dances, candle flames, movements, sitting quietly, secret sounds,
repetition—can all these be subsumed under the same heading of meditation
techniques, or is there a danger of categorizing together quite dissimilar behav-
iors? Naranjo (1974, p. 19) proposed that all these practices have a common
element:
Just as we do not see the stars in daylight, but only in the absence of the sun, we may
never taste the subtle essence of meditation in the daylight of ordinary activity in all its
complexity. That essence may be revealed when we have suspended everything else but
US, our presence, our attitude, beyond any activity or the lack of it . . . Against the back-
ground of the simplicity required by the exercise, we may become aware of ourselves
and all that we bring to the situation, and we may begin to grasp experientially the
question of attitude.
Why do we practice meditation?

Do people share fundamentally similar objectives in their persistence with
meditation practice or do those from different traditions have unique aims?
Interviews with those practicing meditation suggest a variety of reasons (often
unclear) but with one underlying theme: that people generally seek a clearer
understanding of existence or closer connection to the spiritual, and that the
increasing clarity and connection help in the experience of daily living (West
1986, 1987). Here are some explanations for why they meditate offered by long-
term meditators from a variety of different traditions:
It’s my central belief, the heart of me. I feel I should honour that part of me . . . all of it
leads up to the purest expression of me.
I enjoy meditation because physically it feels good and it’s interesting in terms of the
insight that I get into myself and the more I can watch all this stuff going on and accept
it, the more I can reveal myself to others.
It’s the heart of life . . . It makes life whole . . . you can make it take in the whole day or
everybody you know or everything you have to do. It has the sense of pulling every-
thing together, so it’s a real centre.
I meditate because it calms me down and I see it as the only real hope to get rid of
suffering by gaining complete control over the mind so that eventually your thoughts,
feelings and actions are totally positive.
It’s a way of being in touch with the Universe.
Meditation provides me with space. It’s a time of caring for myself, free from demands
and needs and a time of being peacefully alone and still to allow my pure and perfect
self to open more and more.
(West 1987, p. 11)
To what extent is there a consensus of objectives amongst the many tradi-

tions that encourage the practice of meditation? Goleman (he of emotional
intelligence fame!) argued that there is a common objective hidden in the
differing folds of customs, language, and symbols (Goleman 1977). In the
Hindu Bhakti tradition it is believed that love for the deity, which is
expressed in regular meditation on the name of the god, changes to a tran-
scendental love:
‘. . . the devotee loses all sense of decorum and moves about the world unattached . . .
His heart melts through love as he habitually chants the name of his beloved lord . . .’
(Srimad Bhagavata)
Why do we practice meditation? 11
Eventually, beyond this state, the devotee will arrive at a point where he or she
perceives the divine in everything and everyone:
The devotee need no longer observe any special forms or symbols for worship. He wor-
ships in his heart, the world having become his altar (Goleman 1977).
In the Jewish Kabbalah, it is believed that there are multiple levels of reality
with corresponding levels of consciousness. Most of us are at the lowest levels
and live very mechanical lives of habit and routine with little awareness of our
existence. Through meditation, according to the Kabbalist view, we first become
disillusioned with the mechanical games of life, and then begin to break free
from the bondage of our egos. The ultimate goal along the path of the Kabbalist
is “devekut,” in which the seeker’s soul becomes one with God. At this point, the
Kabbalist is now a supernatural saint who has equanimity, indifference to praise
and blame, a sense of being alone with God, and the gift of prophesy. All of his
or her behavior is directed to serving God’s purpose not the ego; there is a union
between the individual and the essence of existence (Halevi 1976).
In Christian Hesychasm and other Christian mystic traditions, meditation
was practiced to enable “the old superficial self to be purged away and (permit)
the gradual emergence of the true, secret self in which the Believer and Christ
were ‘one spirit’” (Merton 1960). St Isaac describes the enlightened Christian as
one who:
. . . has reached the summit of all virtues, and has become the abode of the Holy
Spirit . . . when the Holy Spirit comes to live in a man, he never ceases to pray, for then
the Holy Spirit constantly prays in him (Kadloubovsky and Palmer 1969).
In the Sufi tradition of Islam, meditation is a central practice in the attempt to

reach a state called fana or “passing away in God.” According to Sufi doctrine, our
lives are a thin illusion of habitual reactions, imprisonment by desires, and end-
less suffering (almost identical in content to Buddhist teachings). We are asleep
but we do not know it. Through regular practice of meditation and remembrance
of God we can achieve an increased absorption in God. The goal of Sufi medita-
tion or “zikr” is to overcome the mind’s waywardness and random play, and to
achieve one-pointedness on God, so that God pervades the mind’s activity.
Perhaps there is an echo across these different paths of a merging or submer-
ging of the self in some absolute. A similar notion exists at the heart of the
teaching of the Transcendental Meditation organization. Through this form of
meditation, the meditator can achieve the experience of pure Being, devoid of
content, thoughts, specific sensations, memories, reactions; one experiences
simply what it is to be (Yogi 1995). With regular practice the meditator will
achieve “cosmic consciousness,” in which state, awareness of pure Being perme-
ates all of his or her activities during waking, sleeping, and dreaming. In this
state of permanent pure awareness, the individual is free from desire and needs
for personal gain. He or she acts spontaneously, in accordance with a divine
cosmic purpose as an instrument of God. Beyond this, at the highest states of
consciousness, the meditator experiences all things without illusion and experi-
ences a complete unity with God and all creation.
Goleman (1977) concluded that there are commonalities both of method and
of objectives across these disparate traditions and approaches. He sees the need
to retrain attention during meditation as the “single invariant ingredient in the
recipe for altering consciousness of every meditation system. At their end the
distinction between meditation avenues melts.” Although each path uses differ-
ent names, Goleman (1977, pp. 117–18)believes that they “. . . propose the same
basic formula in an alchemy of the self: the diffusion of the effects of meditation
into the meditator’s waking, dreaming and sleep states . . . As the states pro-
duced by his meditation meld with his waking activity, the awakened state rip-
ens. When it reaches full maturity, it lastingly changes his consciousness,
transforming his experience of himself and of his universe.”
So far we have examined what meditation is, how it is practiced, and what the
purpose of meditation is in the various traditions. Now we pause to see how
psychologists have understood and categorized these practices.
Typologies of meditation
Naranjo (in Naranjo and Ornstein 1971) distinguished between three types of
meditation called respectively the Way of Forms, the Expressive Way, and the
Negative Way. The Way of Forms includes meditation upon external symbols
and objects such as candle flames, mandalas, koans, questions, and mantras.
Naranjo calls this the way of concentration, absorption, union, outer-directed,
and Apollonian meditation. One example of concentrative meditation is Ramana
Maharshi’s method of meditating upon the question “Who am I?” There is a
focusing of attention and a centeredness on the question (which could be substi-
tuted by a mandala, flame, lotus flower, mantra, or focus on breathing).
The Expressive Way includes those meditations that involve receptivity to the
contents and processes of consciousness. In this type the meditator “dwells upon
the form that springs from his own spontaneity, until he may eventually find that
in his own soul lies hidden the source of all traditions” (quoted in Naranjo and
Ornstein 1971). Naranjo describes the Expressive Way as the way of freedom,
transparency, surrender, inner-directed, and as the Dionysian way. It involves
letting go of control and being open to inner voices, feelings, and intuitions.
Naranjo suggests that the best illustration is to be found in shamanism—“Not
only is shamanism in general a mysticism of possession, but the shaman’s trance
Typologies of meditation 13
is usually content-oriented . . . He is one who has attained communication with

the supernatural and may act as a mediator between spirits or gods and man,
making the desires of each known to each other” (quoted in Naranjo and
Ornstein 1971, p. 97).
Finally, there is the Negative Way—involving elimination, detachment, emp-
tiness, centering. The meditator puts effort into moving away from all objects
and not identifying with anything perceived:
By departing from the known he thus allows for the unknown, by excluding the irrele-
vant he opens himself up to the relevant, and by dis-identifying from his current self
concept, he may go into a conceptual awakening of his true nature (quoted in Naranjo
and Ornstein 1971, p. 29).
In this approach the aim is to withdraw attention from both external percep-
tions and internal experience “to cultivate a detachment toward psychological
acting in general” (Naranjo 1974, p. 29). Thus, a good example of the Negative
Way is vipassana meditation, a Buddhist approach involving “bare attention.” In
this method the meditator merely registers sense impressions, feelings, and
mental states without reacting to them by deed, speech, or mental comment:
By cultivating a receptive state of mind, which is the first stage in the process of percep-
tion, bare attention cleans the mind and prepares the mind for subsequent mental pro-
cesses (Naranjo and Ornstein 1971).
Ornstein (1972) describes two major types of meditation—concentrative and

“opening-up” meditations. The first type he sees as developing one-pointedness
of mind and gives as an example the technique of Zen breath counting. This
involves counting the breaths from one to ten and then repeating the process.
When the count is lost the meditator returns to one and begins again. He sees
the “opening-up” exercises not as attempting to isolate the practitioner from
ordinary life processes but rather as involving those processes in the training of
consciousness. Thus the Zen practice of shikantaza or “just sitting” is an exem-
plar of this type of meditation. Watts (1957, p. 175)describes it as:
. . . not therefore, sitting with a blank mind which excludes all the impressions of the
inner and outer senses. It is not “concentration” in the usual sense of restricting the
attention to a single sense object, such as a point of light or the tip of one’s nose. It is
simply a quiet awareness, without comment, of whatever happens to be here and now.
This awareness is attended by the most vivid sensation of “non-difference” between
oneself and the external world, between the mind and its contents —the various
sounds, sights and other impressions of the surrounding environment. Naturally this
sensation does not arise by trying to acquire it.
Shapiro (1982) describes three major attentional strategies—a focus on a

whole field (wide-angle lens attention), a focus on a specific object within a field
(zoom-lens attention), and a shifting back and forth between the two. The first
type would include mindfulness techniques such as “just sitting.” Another
example would be vipassana, which Ross (1981, p. 159)describes as the central
practice of Buddhism:
. . . the continual effort to at first note and later to just be one with the immediacy of
one’s situation; to break the adhesive of one’s constant train of conceptual thought
about past, present and future; and to bring oneself with clarity to the touch and con-
sciousness of the present. The practice of mindfulness greatly deepens the power of
concentration and the ability to stay with one’s life situation.
Zoom-lens attention is what both Ornstein and Naranjo call concentrative

meditation but the third type, shifting back and forth, is a novel category quite
different from Naranjo’s, and includes passive concentrative techniques such as
transcendental meditation (TM). It is argued that in TM there is both concen-
tration and mindfulness and that with increasing adeptness, mindfulness
becomes more dominant (Brown and Engler 1980; Welwood 1982).
Goleman (1977) distinguishes two paths of meditation, essentially the same
as those identified by Ornstein; he calls them the paths of concentration and
insight. Not only are the meditation types different, he argues, but the experi-
ences along the paths of meditation practice will be quite distinct too. On the
path of concentration the meditator will develop deeper and deeper absorption
and one-pointedness, going through eight “jhanas” (full absorptions) to achieve
a final state “so subtle that it cannot be said whether it is or not” (p. 19). The path
of insight involves developing deeper mindfulness and insight through stages of
“pseudonirvana,” realization, and effortless insight to nirvana, in which state
the meditator “will have utterly given up the potential for impure acts” (p. 32).
And confronting all of these is Krishnamurti (1987), who held that all tech-
niques are an obstacle to the unfettered, unblemished experience of existing
here and now. Meditation systems with mantras, techniques, teachings, tradi-
tions, and stipulations simply lead us to exchange one illusion for another. He
argued that we are in a constant state of mental conflict as a result of making
comparisons between what is and what should be. Consequently, we hide away
in a construction of daily habits, mechanical repetition, dreams of the future,
and memories; we do not live in the present moment. Krishnamurti urged the
development of a kind of opening-up meditation—“choiceless awareness”—a
clear and direct perception of experience now, without imposing names, pre-
conceptions, and habitual perceptions upon our experience. It is only by watch-
ing the contents of consciousness that we can perceive the ways of our minds and
begin to understand experience directly and not through symbols created by our
intellects (Krishnamurti 1987). Freed from conditioned habits of perception
The “mindfulness” revolution 15
and cognition one can be free of the self and therefore free to love. This leads to
a state of aloneness beyond loneliness and an ability to attend without motive;
thus one can live in the world with clarity and reason (Coleman 1971).
Krishnamurti’s approach is mirrored to some extent by the huge increase in
interest in what has come to be called mindfulness—this increase in interest can
be seen as a revolution in interest in meditation and has taken place over the
course of the last 15 years.
The “mindfulness” revolution

“Whether you walk, stand, sit, lie down, or sleep, whether you stretch or bend your limbs,
whether you look around, whether you put on your clothes, whether you talk or keep
silent, whether you eat or drink—even whether you answer the call of nature—in these
and other activities you should be fully aware and mindful of the act performed at the
moment. That is to say, that you should live in the present moment, in the present action.”
(Rahula 1959)
Mindfulness as a concept is not new, as the quotation from Rahula reveals.

However, the explosion of interest in mindfulness, to the point where it is now
such a well-known concept, very much is. Formal definitions include “moment
by moment awareness” (Germer et al. 2005); “paying attention with purpose,
non-judgmentally, and while in the present moment” (Kabat-Zinn 2005); and
“the bringing of one’s awareness to current experience through observing and
attending to the changing field of thoughts, feelings and sensations from
moment to moment” (Bishop et al. 2004).
The growth in interest in mindfulness arose from clinical applications, led
particularly by Jon Kabat-Zinn (1990, 1994, 2003), who saw it as a practice to
promote full awareness of the present moment with the intention of embodying
an orientation of calm and equanimity. At the same time another stream of
mindfulness research in psychology was flowing, and not springing from a
meditation source. The work of Ellen Langer contrasted mindfulness and
choice with mindlessness, and prescribed actively drawing novel distinctions in
our experience of the world by being in the present moment, staying open to
novelty, maintaining alertness to distinctions, nurturing sensitivity to different
contexts, and developing awareness of multiple perspectives (Ie et al 2014a).
This less well known concept of mindfulness involves a heightened sense of
awareness through maintaining an open awareness of novel information and
forming new categories out of one’s experience.
Here we focus on the concept of mindfulness springing from the meditative
traditions—the more widely known approach and most germane to the content of
this book. Kabat-Zinn initially defined this as “placing one’s attention and aware-
ness in the present moment with an attitude of non-judgemental acceptance”
(Kabat-Zinn et al. 1985). Research by Kabat-Zinn and others suggested that mind-
fulness practice could be helpful for those experiencing chronic pain (Kabat-Zinn
1982), major depression (Teasdale et al. 2000), anxiety (Kabat-Zinn et al. 1992),
and substance abuse (Bowen et al. 2006; Brewer et al. 2009). This mindful practice
has four elements:
1 Awareness—of all possible experiences such as sensations in the body,
thoughts, emotions, sights, and sounds. It might include awareness of what
otherwise would be behaviors we would not normally be aware of, such as
intergroup bias: “I am having thoughts and reactions to this person because
I know this person is a Muslim and I would not normally be aware of react-
ing automatically in this way.”
2 Sustained attention—this involves gently but firmly bringing attention back
to the current moment; reducing rumination; reducing anxious thoughts
about the future; and bringing attention back to the here and now.
3 Focus on the present moment—rather than becoming immersed or lost in
thoughts about the past, the future, plans, and preoccupations.
4 Non-judgmental acceptance—this involves not making judgments about
experience; not labeling or reacting to experience in the current moment as
good or bad, desirable or undesirable, but instead allowing experiences to
arise without blocking, controlling, changing, or avoiding them.
Mindfulness practice has since been applied in a wide range of clinical settings—

in therapy (McCracken 2014), anxiety (Woodruff et al. 2014), post-traumatic stress
disorder (Wahbeh 2014), chronic illness (Phillips and Pagnini 2014), eating dis-
orders (Kristeller and Epel 2014), pregnancy (Zilcha-Mano 2014), women’s sexual
dysfunction (Brotto and Smith 2014), and, of course, stress (Crum and Lyddy 2014).
Meditation versus mindfulness—what is the difference then? It is clear from
our review of meditation practices across cultures and history that mindful-
ness has long been a practice in many different traditions. And part of mind-
fulness practice in modern settings is having times of formal practice of
mindfulness—time sitting and focusing on the breath, the body, sensations, or
awareness, as well as mindfulness of experience through the day. So medita-
tion and mindfulness overlap. Many meditation practices, if not all, involve
mindfulness—awareness, sustained attention, focus on the present moment,
and non-judgmental acceptance.
Therefore, when we try to distinguish between meditation and mindfulness
we are distinguishing between the water flowing at overlapping stretches of the
same stream. Yes, mindfulness practice is very much about developing aware-
ness of each moment throughout the day, but the purpose of sitting meditation
is also to increase the meditator’s awareness of the moment (or God, love,
This book 17
compassion, or whatever). Mindfulness practiced in clinical settings is secular

rather than spiritual in orientation, so there is that difference.
However, the reality is that meditation and mindfulness are simply different
names for overlapping concepts and practices. Meditation refers mostly (but far
from exclusively) to sitting in formal meditation practice, silent and still. Mind-
fulness mostly refers to maintaining awareness moment by moment in daily
living (but this is usually only possible through the regular practice of sitting
meditation). They are fundamentally interwoven concepts.
In this book, the contributors will use the terms they choose and make clear
what practice they are describing, regardless of the name they choose (medita-
tion or mindfulness).
This book
Part 1 of the book explores meditation as a process informed by cognitive, Bud-
dhist, empirical, and philosophical perspectives. Chapter 2 by Martine Batche-
lor, who for many years led a life as a Buddhist nun in South Korea and now
lives and teaches in France, focuses on what happens when we meditate. She
proposes that meditation involves two fundamental processes—concentration
and enquiry. Through an exploration of these processes, informed by the
insights of Buddhist teachers over the centuries, we can understand how medi-
tation practice changes our experience and our relationship with the world we
find ourselves in, both the physical and human environments. The chapter
offers profound insights into our condition and how meditation can help us
through these twin processes of concentration and enquiry.
Guy Claxton has brought together his long experience as a practitioner of
meditation, a writer on Buddhism, and a leading cognitive psychologist in the
UK to explore, in Chapter 3, the subtle but powerful processes that occur dur-
ing meditation. From the perspective of the new science of “embodied cogni-
tion,” he explores two processes he calls “unfurling” and “welling up.” Through
the identification of these subtle processes, he explains how meditation comes
to offer us more accurate perceptions of our inner and outer worlds, and how
we achieve greater congruence of action and experiences, enhanced creativity,
and the recovery of core values to guide our living and being.
James Carmody offers another perspective in Chapter 4 on our understand-
ing of meditation in the context of human evolution and development. He pro-
vides a clear and parsimonious description of meditation processes and links
this to psychological distress. The adaptations for survival and safety that served
us well for millennia are no longer appropriate and lead to chronic unease or
dissatisfaction. He shows how meditation practice can change this but does so
in a way that is demystifying, offering conceptual coherence rather than mys-

tical ambiguity. He concludes by alerting the reader to the potential dangers in
the discourse of some meditative traditions in inuring us to our socio-political
contexts.
Loriliai Bernacki, Associate Professor and Director of Graduate Studies in the
Department of Religious Studies, University of Colorado at Boulder (USA),
provides in Chapter 5 a review of the emergence of meditation in Jainism, Bud-
dhism, and Hinduism. The role of meditation becomes clear in these traditions
as a fundamental component of the philosophical understanding of the self and
of subjectivity. She provides a phenomenological account (an account based on
subjective experience) from the perspective of these disciplines. Noting that the
interpretations of effects of meditation vary across traditions, she alerts us to
the need to be aware of the filters that philosophy and doctrine place on medi-
tation experience. She explores in some depth the sense of wonder evoked by
meditation in a Tantric context.
Part 2 explores therapeutic and clinical applications of meditation and mind-
fulness practice. In Chapter 6, Lynn Waelde, Professor of Psychology at Palo
Alto University and Consulting Professor at Stanford University School of
Medicine, and her colleague Jason Thompson examine the use of meditation
and mindfulness with clinical populations. They describe how the rationale for
the application of mindfulness in clinical populations has been based on the
rationale that the development of cognitive processes of attention and equa-
nimity can have important therapeutic applications. The chapter reviews
research on the clinical applications of mindfulness and explains the methodo-
logical challenges involved, before identifying the importance of future research
to help us identify when to use and when to avoid the use of mindfulness and
meditation practices with clinical populations.
Vidyamala Burch has spent 20 years managing her pain through using
meditation and mindfulness. She set up Breathworks in 2001 to ensure the
learning from research on meditation and pain management and her own
experience could be communicated to others. Chapter 7 explores the physi-
ology of pain and the psychological burden before showing how meditation
and mind/heart training can help. The chapter reviews relevant research and
provides a description of the approach used by Breathworks—Mindfulness
Based Pain Management—to manage pain.
The application of meditation in another therapeutic context is addressed in
Chapter 8 by Sarah Bowen, Assistant Professor of Psychology at Pacific Univer-
sity, Oregon, and her colleagues. They describe the use of meditation in the
“cyclical trappings and anguish caused by addictive behaviors.” Their chapter
addresses the nature of addiction and the role of mindfulness and meditation in
This book 19
addictive behaviors. They review the use of mindfulness-based relapse preven-

tion, acceptance and commitment therapy, and dialectical behavior therapy,
and present encouraging evidence for the effects of these meditation and
mindfulness-based approaches in the treatment of drug addiction, eating dis-
orders, and smoking.
In Chapter 9, Linda Carlson, Enbridge Research Chair in Psychosocial
Oncology at the University of Calgary, Canada, provides a review of research
on meditation training for people living with a variety of chronic medical con-
ditions, including cancer, chronic pain conditions, fibromyalgia, cardiovascu-
lar disease, diabetes, irritable bowel syndrome, HIV/AIDS, rheumatoid
arthritis, and organ transplant. The chapter describes the challenges of living
with chronic or life-threatening illnesses and explores why meditation and
mindfulness-based interventions might help. The chapter then reviews key
research studies and concludes that mindfulness-based interventions hold real
promise for relieving suffering amongst those with chronic diseases.
The final chapter in Part 2, by Antonino Raffone, offers a neuroscience per-
spective on meditation. Antonino is Associate Professor of Psychology at the
Sapienza University of Rome and, in Chapter 10, he provides an overview of the
neural correlates of meditation. He shows how emerging research on neuro-
plasticity (the hitherto ill-understood capacity of the brain to continually adapt
over the life-span) helps us to understand how meditation practice changes
brain functioning, consciousness, and awareness. This reinforces research find-
ings suggesting structural changes in human experience as a result of medita-
tion practice. He distinguishes between focused attention types of meditation
and “opening up” meditation and shows that there are distinct neurophysio-
logical processes associated with each, with consequent implications for our
understanding of the effects of these different styles of meditation.
Part 3 explores the application of meditation in the workplace and in school.
Bond and colleagues in Chapter 11 discuss how acceptance and commitment
therapy (ACT) conceptualizes mindfulness and show how ACT can be used to
promote mental health and behavioral effectiveness at work. They focus on the
key construct in ACT of psychological flexibility, which results from mindful-
ness. The chapter reviews research on the influence of ACT on employee mental
health, innovativeness, emotional burnout, and attitudes toward client groups.
The chapter describes in detail the approach the authors use to enhance well-
being at work using ACT and, in particular, mindfulness.
Chapter 12 by Katherine Weare, Emeritus Professor at the School of Educa-
tion, University of Southampton in the UK, describes how meditation and
mindfulness are being deployed in school settings. In this chapter, she explains
the major growth of interest in the use of mindfulness for children and young
people and explores ways in which mindfulness is developing in interventions

for children and adults in education in the UK and internationally. The chapter
assesses the evidence base for mindfulness practice in schools and describes
associated impacts and outcomes in relation to mental health problems, well-
being, and learning. The chapter suggests a long-term vision of mindfulness at
the heart of a whole school approach to the education of both the hearts and
minds of young people.
Part 4 offers two sets of conclusions. In Chapter 13, Peter Sedlmeier and col-
leagues from the Technische Universität of Chemnitz, Germany, review research
on the psychology of meditation. They conclude that though great progress has
been made and results in many domains are very positive in indicating benefi-
cial effects of meditation practice, future research must offer more powerful
insights. They propose that research should be more comprehensive in approach
rather than narrow and fractionated; that there is great value in adopting East-
ern philosophical and spiritual perspectives to guide research designs; and that
there is great value in researchers co-designing research with those people who
have considerable experience of practicing meditation and of using single case
study designs to study such people. Finally, in Chapter 14, I offer insights based
on a synthesis of the core messages to emerge from this volume and assess the
extent to which we, as contributors, have answered these questions:
◆ What is meditation and how can we understand this practice or experience
from a psychological perspective?
◆ What are the key psychological processes involved in shaping experience
and outcomes from meditation practice?
◆ What does the research evidence tell us are the potential therapeutic/clinical
applications of meditation?
◆ How might meditation be more broadly applied in society to the benefit of
human communities?
◆ What can we conclude overall in terms of our understanding of meditation
from research and practice to date?
◆ And where next for those seeking to understand meditation and
mindfulness?
Before we begin the journey of discovery in relation to these questions, one
other aspect of the book is worthy of the reader’s attention. All of the contribu-
tors have practiced meditation—some of them for more than 40 years—and
they offer a considerable amount of experience of practice of many different
methods and traditions. Each has written a brief account of their own experi-
ence with meditation, offering a fascinating glimpse of the range of experiences
Personal Meditation Journey 21
and meanings they have derived. This book therefore contains the main content
of chapters on meditation research and practice, an account of the contributors’
own experience, and an implicit body of knowledge based on the many years of
practice in aggregate of those who have contributed to the book.
Personal Meditation Journey
When a friend talked of learning meditation in my first year at university, my reaction

was immediate and unequivocally positive. The idea of focusing on and exploring the
mind in order to find peace was compelling. I was instructed and told my mantra by a
TM instructor in rooms above a butcher’s shop in Pimlico, London in 1971. Two years
later, my undergraduate psychology research dissertation focused on skin resistance
during meditation and comparison conditions. I completed a Ph.D. on the psychology of
meditation in 1977, publishing a number of research papers over subsequent years. The
practice of meditation was an anchor in my troubled seas during those years when I
went from student to coal miner to university researcher and father. I practiced with
varying regularity out of both a faith in the practice and because the “still complete-
ness” of the meditation was both refuge and stability.
There was an enriching shift in 1984. A group of psychologists with a shared interest in
Buddhism and meditation formed, including John Crook and David Fontana (sadly, both
have died), Guy Claxton (a dear friend since), and Sue Blackmore (a leading conscious-
ness explorer in the UK). We met regularly for weekend retreats in John’s primitive
farmhouse, Maen Llwyd, in wild mid-Wales—now a center for Western Chan Fellow-
ship, which follows John’s teachings. There I began to practice zazen (“just sitting”) for
hours, relishing the clear simplicity and directness of the practice. This pure awareness
sitting remains the mainstay of my practice.
The group staged a wonderful conference on Eastern Approaches to Mind and Self in
1986 at the University of Wales, attended by both inspirational academics and teachers
from a variety of meditative traditions. And the following year, I edited, and Oxford Uni-
versity Press published, The Psychology of Meditation—the precursor to this volume.
Over the following three years, I attended diverse retreats at Tibetan Buddhist centers
in the UK and France. In a time of personal turbulence, the practice again provided both
challenge and refuge.
For the next 20 years, I practiced meditation with varying degrees of commitment over the
course of a busy career, rich family life, and extensive travelling. Meditation is now core to
my days. And for the last eight years, I have practiced more regularly, for an hour or more
a day. Sometimes this is in separate sittings of 30 or 40 minutes, and sometimes sitting by
the pond in my garden for an hour at a time. I sit in meditation on train journeys and on
flights—both valuable opportunities to practice without taking time away from others.
I have occasionally augmented my meditation practice with what Buddhists call Ton-
glen or with mettā bhāvanā ; both practices of developing compassion for self and oth-
ers that develop new dimensions to relationships with others and also with myself. Just
sitting to cultivate a pure awareness of nowness is the content of my practice at present,
along with a gently growing mindfulness, unforced, in daily life of the breadth and
immediacy of our existence. Gradually, my awareness has become clearer—of my wild
mind, the wayward and depleting journeys of thoughts, of the drive to plan continually,
of circular concerns with impression management, and of the constant impulse to
entertain the mind.
And awareness of awareness itself has subtly changed the hue of mind and experience.
Gradually, ever so slightly, more and more, changing the experience of mind and of
awareness. Clearer, lighter, peaceful, contented, tender, and more and more open. And
gradually, slightly, but more and more, changing my need to grasp at social approval, to
continually find ways to entertain the mind, to judge others, to feel angry, to fuel fear,
to pursue success and to be depleted rather than enriched by moments. Awareness of
thoughts, impulses, and the underlying rationale for them has become clearer. And the
ability to focus in an uncontrived way on the present moment has become stronger,
simpler, more stable, and easier. I have experienced too a growing sense of huge privil-
ege in life. Gratitude for the many benefits, opportunities, friends, family, and life itself
has deepened considerably.
Having the capacity and the knowledge to practice meditation and to strengthen my prac-
tice each day is a precious gift. And I am deeply curious to discover where the journey
goes—its landscapes, way stations, and new vistas (editing this book is a station on that
journey too). This meditation journey has no destination—the journey is the destination.
Acknowledgment
This chapter is a revision and update of West, M. (1987). Traditional and psy-
chological perspectives on meditation. In M. West (Ed.). The psychology of
meditation. Oxford: Oxford University Press.
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Chapter 2
Meditation: Practice
and experience
Martine Batchelor
Introduction
In this chapter the fundamentals of meditation and their relevance to well-
being are described. It is proposed that the basis of Buddhist meditation lies in
a combination of concentration and enquiry, regardless of the way in which
they are cultivated in different Buddhist traditions. If one considers a certain
technique of meditation better than any other due to conceptual or theological
convictions, there is the danger of ignoring other techniques that could be use-
ful for some people. By starting from the universal basis of concentration and
enquiry, we can see how meditation works across practices and traditions. This
chapter explores and explains how being mindful of the breath or asking a ques-
tion can have a profound effect on people.
The chapter addresses the question: What happens when we meditate? In
order to answer this question, it presents the basic principles of concentration
and enquiry in reference to different techniques of meditation. The chapter
broadens the view to place these two main elements in terms of simple Buddhist
psychology. It refines the definitions of concentration as anchoring and of
enquiry as experiential and, in doing so, offers a detailed description of mind-
fulness. It proposes that creative awareness or mindfulness arises from the cul-
tivation of concentration and enquiry.
The chapter concludes by using the framework of concentration and enquiry
to examine three types of meditation—listening meditation, mindfulness of
feeling tones, and questioning meditation. This analysis demonstrates the
applicability and advantages of the framework for understanding the psycho-
logical benefits of meditation.
The basis of meditation: concentration and enquiry

From an early age I had been concerned by the state of society, its competitive-
ness and lack of peace and harmony. Then I was struck by a passage in a
28 Meditation: Practice and experience
Buddhist text where the Buddha suggested that if you could not change yourself,
you would not be able to change others. Thus, aged 18, I decided to transform
my mind but did not succeed. I found that wishing it idealistically or trying to do
this rationally did not seem to make any difference. I could say to myself repeat-
edly: Do not be egotistical! Do not be jealous! This had no effect on my feelings
or behavior. Finally, at the age of 22, I decided to try meditation, becoming a nun
in a Korean Seon (Zen) monastery and meditating ten hours a day for three
months at a time. For the first three months I did not see immediate differences
but after the second three months I started to become more self-aware of my
thoughts in a beneficial way and to be more compassionate by thinking of others
before myself. This happened while meditating using a questioning practice as
taught in the Korean Seon tradition. After I left Korea and the monastic life, I
encountered mindfulness practices and understood that the common basis of
most Buddhist meditation practices was a combination of concentration and
enquiry, also known in Pali (early Buddhist language in which ancient Buddhist
texts were memorized and then written) terms as samatha and vipassana.
In Korean Seon questioning meditation one asks repeatedly “What is this?”
Concentration is cultivated by returning to the question again and again, and
enquiry by asking the question vividly. This means that as one sits in medita-
tion, one asks the question “What is this?” in a questioning way (not like a man-
tra) as a means to developing a sensation of questioning in the whole body–mind
complex (a full explanation of this practice is given in the section on “Medita-
tive questioning”).
In analytical meditation in Tibetan Buddhism, the meditator can focus on a
theme like death by returning to this subject throughout the length of the medi-
tation, and enquires by reflecting experientially on two aspects of death—that
death is certain and that the time of death is uncertain. Based upon these two
facts, the meditator considers what are the most important things to do now?
In visualizing meditation, also found in the Tibetan tradition, concentration
is developed by visualizing a three-dimensional image of a Buddha and enquiry
by seeing oneself as having the quality of the Buddha residing in the center of
that image. This can be seen as representing enquiry because if the meditator
sees herself as having the same compassion as the Buddha, it leads her to ques-
tion the way she feels when she is not loving or compassionate. The meditator
challenges the assumption that her compassion is limited by opening her mind
to the idea that she could have as much compassion as a Buddha.
In mindfulness practice the meditator takes as a focus an element of his or her
own experience—either the breath, physical sensations, sounds, feeling tones,
or thoughts. Enquiry is cultivated by looking deeply into the impermanent and
conditioned nature of the breath, physical sensations, sounds, etc.
Definition of the foundations of consciousness from a Buddhist perspective 29
There are spectra of both concentration and enquiry in the meditative tradi-
tions. Some meditation techniques emphasize a narrow focus and others advo-
cate no focus such as “sky gazing” in the Tibetan tradition or just sitting with no
object of attention as in the Soto Zen tradition. With a narrow focus, tension can
arise; with no focus the attention can become vague. A medium focus provides
something in the foreground to anchor our attention (such as the breath, taking
sounds as an object of attention, or the question “What is this?”) and enables a
wide-open awareness in the background so that the mind is not constricted.
In relation to the enquiry component, the orientation depends on the philo-
sophical position the technique is derived from. Is the practitioner looking for
transcendence beyond conditions, as in trying to experience or return to prim-
ordial consciousness or original mind? Or does the meditator see herself as
embedded in a network of conditions that she is trying to understand in order
to determine their influence on her and how she could respond to these condi-
tions differently? This chapter considers principally the second point of view, as
it is more relevant to psychological well-being and has greater applicability to
daily life.
If concentration and enquiry are common elements to many different Bud-
dhist meditation practices, how do they work psychologically? What are their
impacts on one’s state of mind? Before answering these questions, we need to
widen the perspective and look at the Buddhist psychological frame of refer-
ence and associated definition of terms.
Definition of the foundations of consciousness

from a Buddhist perspective
In The Connected Discourses of the Buddha as translated by Bodhi (2000, p. 602),
it is stated:
Then, monks, it occurred to me: “When what exists does consciousness come to be? By
what is consciousness conditioned?” Then, monks, through careful attention, there
took place in me a breakthrough by wisdom: “When there is name-and-form, con-
sciousness comes to be; consciousness has name-and-form as its condition.”
In this quote, the Buddha posits that consciousness (Pali: vinnana) is an emer-
gent property of name-and-form (Pali: namarupa). Name-and-form was used
in the pre-Buddhist Upanishads to denote the multiplicity of the world that
sprang from the unity of Brahman (God). In the early Buddhist tradition it was
used to refer to the material and mental conditions that generated conscious-
ness. “Form” (as in form and matter) refers to the material world that impacts
the senses; “name” refers to the primary mental processes triggered by our
moment-to-moment encounters with the world.
“Name” is constituted by five elements—contact, feeling, perception, inten-

tion, and attention. Contact refers to the initial impact of the world on one of the
six sense organs. Feeling is the experience of that impact as pleasurable, painful,
or neutral. Perception is that which identifies the object as this object rather than
that object (e.g., a cat versus a jug) by differentiation. Intention is our movement
toward and engagement with the world (as well as our recoiling and disengaging
from it). Attention is that which apprehends and focuses on an object. These are
seen as the foundations of consciousness. Asanga (Buddhist scholar, possibly
fourth century) postulated that when these are compounded with the five “deter-
mining” functions, which are aspiration, mindfulness, appreciation, concentra-
tion, and intelligence in meditation, over time psychological well-being can arise.
This framework suggests that we have all these five abilities required to medi-
tate. People often complain that they cannot sustain attention or concentrate in
general or in meditation. However, often it is because they try too hard to pay
attention (to concentrate too much), for example when they become obsessed
by one person, one idea, or one situation and cannot think of anything else. In
meditation we are trying to cultivate the ability to pay attention in a directed
manner and in a way that allows stability and calm to arise.
Intention is another important capacity. Good intentions seem to have little
power when our repeated New Year resolutions of eating less, not smoking, or
doing more exercise fail. However, the ability to intend something in medita-
tion sets up a direction that can be quite powerful and create change over time
(as related research in psychology shows—for example Gollwitzer and Sheeran
2006). I could decide to just sit and do nothing, and my mind would simply be
in its un-restful resting state. Or I could decide to be aware of my thoughts and
suddenly there is no thought as I try to look at them. Or I could have the inten-
tion to be aware of my feeling of stress every time I am late and I could learn to
become less stressed as a result of increasing my awareness of the conditions
that lead to stress, enabling me to change them. Once I started to notice that
whenever I would try to catch a bus when teaching in Rome I would become
irritable. Then I decided to set the intention to be aware of my feelings when
trying to take a bus. This enabled me to become more aware of the moment
when I would move from being calm to becoming fretful. Thus, I became more
mindful of my relationship with catching transport in general and on many
occasions this intentional awareness then diminished the rushing and the
irritability.
Perception is about meaning. We are meaning-making machines; things,
events, and people need to make sense to us. Meditation helps us to see this pro-
cess more clearly and dissolve the negative automaticity of much of it. Awareness
of negative reactions to people, events, sounds, places, etc. helps us to let go of
Concentration: focusing and anchoring 31
those reactions rather than being driven by them. Contact is where our reactions
begin and feelings influence us to react in a particular way (angrily, happily etc.).
Mindfulness is key in enabling us to come to see how all of this happens.
Now we can return to the two components of meditation—concentration and
enquiry—with the recognition that these innate abilities can be honed during
meditation.
Concentration: focusing and anchoring

Meditation aims to develop a specific type of concentration—it is focusing and
anchoring but not tensing. The idea is to stabilize and calm the mind. In every-
day life, either our attention wanders a lot or we can be too focused on one thing
(for example when we become obsessed with a perceived slight from a friend).
If we sit in meditation and try to be aware of the breath, quickly we think of
something else. The focusing in meditation is not to stop the thoughts but to
develop a different relationship to them. So, we pay attention to the breath and
then our attention wanders away. It is the focus on the breath and the intention
to focus on the breath that bring us back again and again to the experience of
breathing. Each time we come back to the breath we are avoiding reinforcing our
habitual patterns of thinking and at the same time we are diminishing their
power of automatism or “stickiness” (“stickiness” refers to our tendency to be
trapped by particular trains of thought). Thus, with practice, thoughts revert to
their creative functions of thinking, reflecting, imagining, planning, or judging.
Warren (2013) describes the preliminary results of a recent experiment using
fMRI undertaken by Dave Vago, a neuroscientist, and Shinzen Young, a medi-
tation teacher, at Brigham and Women’s Hospital and Harvard Medical School
in Boston. They were researching the “real” resting state of the brain, which
scientists have shown is actually quite active. The experiment focused on medi-
tation practitioners, with meditation experience ranging from a few years to
more than 20 years. They found that the veteran meditators could achieve a
“real” resting state well but not a contrasting non-resting state, where they were
asked to let their minds freely wander. They had trained their minds not to
ruminate and worry and, though they could still think, their thoughts had a
different feel, “an un-fixated quality,” as Warren described it.
This FRMI experiment reveals different levels of thinking. One level is fairly
automatic and has a lot to do with self-referencing. This is what shocked me
most when for the first time I saw what was in my mind, that it was all so
self-referential and repetitive. This is the level that disappears over time when
meditating. Then we are not left with an empty mind but a better functioning
mind. If we want to imagine something, or reflect on some subject, or plan
some new organizational process, we can but not in an obsessive manner. We

also realize that a calmer mind leads to a more creative mind. As the mind is less
occupied with self-referencing, it is more present to respond creatively to the
environment. This is why people on retreats often report thinking and listening
more creatively. Taking listening as an example, we can listen in different ways.
We listen but we are actually waiting for the person to stop so that we can say
something so much more interesting. Or we look in the right direction but are
actually thinking of something else, so that when the person stops and asks us:
“What do you think?” We have no idea what they have said. Or we listen and
overreact to what we hear and amplify what the person is saying. However, if we
listen with creative awareness, we are listening 100%, totally focused on what
the person says, as well as bringing an element of curiosity and bright attention.
Thus, when the person stops, what we say is appropriate and relevant to the
moment and that conversation. What one says is something unique, some
words, reflections, or suggestions one has never thought or said before. It is cre-
ative awareness in action, creating space and relevance, and at the same time
grounded in the wisdom and compassion developed over time. In summary,
creative awareness is the honing and manifesting of potential capacities and
abilities, unhampered by fixations around self and others.
Often people think meditation is about having no thoughts at all but concen-
tration enables the thought process to return to its innate creative functioning
without the automatism or the “stickiness” that characterizes much thought
activity. In this way the mind can become more spacious, like a room with less
furniture. It is easier to be stable and calm when the nervous system is less agi-
tated as a result of our reducing continuous rumination and worrying.
Another aspect of this concentration is that when we come back to the breath,
we do not just come back to the breath but also to the whole moment. Instead of
being lost in abstractions (what happened in the past or what might happen in
the future) we are present to the breath in the foreground and, in parallel, with
the background—with its sounds, physical sensations, feeling-sensations, etc.
The more we experience this, the more we start to develop a wider sense of our
identity. Imagine that for five minutes we are thinking about something negative
in our past. It will feel as if we are back there and consequently we bring the
negative feelings into the present. But if after one minute we come back to the
breath and are mindful that right now everything is still, calm, complete, and
positive, we feel fine, as a result of being more in that current reality. Even if a
minute later we think again about the past, we can come back again and so not
stay long enough to fix our current identity in that past negative experience. The
more we come back to the breath and a multi-perspectived experience of our-
selves, the less we fixate on single trains of thought, single physical sensations, or
Experiential enquiry 33
single meanings of emotions and the stories that could be associated with them
in the past and future. Our identity is less dictated by these memories of the past
and more determined by a range of present-moment experiences and particu-
larly the now of breath in meditation.
When we try to concentrate in meditation, we are not taking the orientation
that we would have if we did this in everyday life. Generally concentration is
associated with narrowing the focus and tensing the body and mind, which
would have the opposite effect of what we are trying to develop in meditation.
Here we are trying to rest the attention on an object in our experience (such as
the breath) and use it like the anchor of a boat. The anchor is there to ensure that
the boat does not drift away but the boat is not motionless. It is the same in
meditation. We are not trying to stop thinking, feeling, or sensing. To think,
feel, and sense are necessary, fundamental, and inevitable human functions. We
are trying to develop a different relationship to them by using the breath as an
anchor to ensure that our thoughts do not carry us too far away from the pres-
ent moment. As in the experiment described above, the veteran meditators in
the FMRI machine could think and be conscious (“there is noise right now”)
but without the need to do anything with it. The thought arose and passed away
without leading to commentary, anxiety, or self-doubt.
We achieve this by sitting still in meditation with the intention to use the
breath as an anchor, in a comfortable posture on a cushion on the floor or on a
chair, with an upright but relaxed posture. We try to relax the shoulders and
jaws, and also the way we use our mind to meditate. It is called “effortless effort”
in the Zen tradition. It is compared to tuning a guitar’s strings, not too tight, nor
too loose. So in this instance we are using the ability we have to pay attention in
a way that does not make us exclude anything nor bring tension. To cultivate
such a balanced, poised concentration, we need to see the difference between
aspiration and expectation. Aspiration toward positive changes helps by giving
us energy and an open-ended, clear intention when we try to concentrate.
Expectations limit us to what we know and want immediately, bringing judg-
ments and comparisons, and thus often tension and frustrations, which detract
from a stable and still focus.
Experiential enquiry
The Buddhist term for experiential enquiry is vipassana. It is defined thus by
Analayo (2009, p. 672)
Vipassana and the corresponding word vipassati stand for the development of a form of
vision that sees, “passati,” in an intensified and also analytical manner, vi-, hence vipas-
sana stands for “insight” . . . The basis for growing insight into the true nature of
existence is penetrative awareness of its impermanence and therewith conditioned

nature . . . Such comprehensive seeing with insight will ensure that the entire gamut of
what is usually experienced as “I” and “mine” is instead seen with insight as a product
of conditions and subject to change and alteration . . . Whereas in the thought world of
the early discourse vipassana stands for a quality to be developed, in modern day usage
vipassana represents mostly a particular form of meditation . . .
The early usage of the term implied a quality to be developed. Concentration

alone will not give us the means to transform ourselves. It can make us feel bet-
ter, in that we will feel more stable and calm if we cultivate meditative concen-
tration in a balanced way, but another quality is needed for radical transformation.
That is the quality that uses the mind’s capacity to question and to look deeply
into our experiences to see what is happening instead of submerging into com-
menting and ruminations.
We have a tendency to generalize—or even permanentize. When something
happens, especially something negative, we extrapolate that “it has always been
like this and always will be.” For example, we may feel tongue-tied in a social
situation and then “permanentize” this experience in relation to expectations of
sociability in future situations, rendering us even less capable of engaging posi-
tively, comfortably, and openly with others. This fixes the experience in a per-
manent and negative way. The Buddha emphasized exploring with mindfulness
our experience and knowing for ourselves that things, events, and sensations
change, in order to counteract that tendency to generalize, fix, and thereby limit
our experience.
In the Tibetan tradition vipassana is seen more as analytic meditation; in the
Zen tradition as a question or a non-grasping attitude; and in early Buddhism it
is connected to the experiential understanding of change, unreliability, unsatis-
factoriness, pain, not-self, and conditionality. I am going to explore change and
conditionality here, again because this is relevant particularly to a psychological
understanding of meditation processes.
Experiential enquiry enables us to be more in accordance with what is hap-
pening as it occurs and to develop a processual awareness. Research has shown
that for most people the resting state of the brain is not restful. We spend a lot
of our time working in our heads. Experiential enquiry aims to make us more
aware of our body, our senses, and the impact of the environment on our senses
and to experience for ourselves how long things last. We can ask: “How long is
this (sensation, feeling, sound, or situation) going to last?” (e.g., how long is this
feeling of anger/fear going to last?). If we do not do anything with it and it goes
by itself, we do not need to do more with it. If it repeats itself, we need to pay
more attention to what gave rise to it. What was the trigger? What were the con-
ditions? What were the contributory factors such as stress, sleeplessness, or
Creative awareness as meditative mindfulness 35
tiredness? For example, I used to be irritable when I was tired. When I dis-
covered that mechanism through experiential enquiry, I started to rest more
when tired and thus became less irritable. If the intensity continues, then it
means that something happened that was shocking or frustrating, for example,
and we need to find a way to address the situation. Enquiry thus enables us to be
both more aware of and to have more choice over our experiences.
Experiential enquiry can also enable us to go into the experience itself and
show us that this too is changing. There are momentary changes as sensations
arise and pass away and there are organic changes when sensations or sounds
are changing. When I experience physical pain, if I go inside the experience to
the specific part of the body where it resides, I can see that it is not fixed and
solid but that it fluctuates; it ebbs and flows. It is not exactly the same all the
time. When one is aware of this, the pain still exists but it seems to be a more
diffuse sensation than an attack on well-being. It is then easier to relate to it in a
non-reactive, non-intensifying way.
At a simpler level, take the experience of an itch on the cheek. You sit still in
meditation and suddenly you feel this itch. It is so itchy that you have the
impression that it is going to be itchy and almost unbearable like this forever; it
is that intense. You do not scratch it, however, and wait to see how long it is
going to last. And then as suddenly as it came, it is totally gone. It is so gone, it
is as if it was never there. Experiential enquiry helps us to become more familiar
with this phenomenon that something can be so there and then so not there.
And we can know for ourselves that things do change and this in itself can be
quite transformative, as we no longer assume immediately that things will
always stay the same.
Experiential enquiry brings brightness and clarity to the meditation at the
same time that we are developing calm and stability with the steady develop-
ment of concentration. The two together seem to produce a different kind of
awareness that I call “creative awareness.” This awareness does not make us
radar-like, fixedly staring at reality, but more easily living in our moment-to-
moment conditions in the present and creatively engaging with them. I see the
cultivation of these two abilities together—concentration and enquiry—as dis-
solving the rigid framework of our habits and patterns to enable them to return
to their original helpful functions and creative usages.
Creative awareness as meditative mindfulness

Sati is the Pali term that was translated as “mindfulness” by early Buddhist
scholar T. W. Rhys Davids (1843–1922). This general term “mindfulness” has a
broad range of meaning, though nowadays it has become understood as
“present-centered and non-judgmental” awareness. However, the Buddhist

scholar Dreyfus (2013, p. 47) questions this definition:
Mindfulness is then not the present-centered non-judgmental awareness of an object
but the paying close attention to an object, leading to the retention of the data so as to
make sense of the information delivered by our cognitive apparatus. Thus, far from
being limited to the present and to a mere refraining from passing judgment, mindful-
ness is a cognitive activity closely connected to memory, particularly to working mem-
ory, the ability to keep relevant information active so that it can be integrated within
meaningful patterns and used for directed goal activities (Jha et al. 2010). By paying
close attention, practitioners of mindfulness strengthen their cognitive control because
they increase their ability to retain information and thus see their true significance
rather than being carried away by their reactions.
The original meaning of sati was to remember. For example, one finds this quote
in The Middle Length Discourses of the Buddha as translated by Bodhi (Bodhi
and Nanamoli 1995, p. 463):
He has mindfulness; he possesses the highest mindfulness and skill; he recalls and rec-
ollects what was done long ago and spoken long ago.
This aspect of mindfulness is useful when trying to come back to the object of
concentration and remember our intention to be aware of the breath. But sati is
also seen as bringing a wider perspective and balance. In the Lohicca sutta
found in The Connected Discourses of the Buddha (Bodhi 2000, pp. 1203–1204)
it is said: “He dwells without having set up mindfulness of the body, with a
limited mind . . . He dwells having set up mindfulness of the body, with a meas-
ureless mind.” As Analayo points out in his definition of sati in The Encyclopae-
dia of Buddhism (2007, p. 8): “It represents the ability to simultaneously
maintain in one’s mind the various elements and facets of a particular situation.”
In another text, mindfulness is compared to a watchful charioteer, who can sur-
vey the road and the surroundings from a higher position and at the same time
holds the reins of his horses in a balanced manner.
Analayo (2007, p. 8) makes an interesting connection between sati and atten-
tion, one of the constituents of the mind, in his entry on sati in The Encyclopae-
dia of Buddhism:
Sati can be understood as a further development of this type of attention, thereby add-
ing clarity and depth to the usually much too short fraction of time occupied by bare
attention in the perceptual process.
Mindfulness therefore serves different functions. It is at the same time some-

thing to cultivate, the effect of that cultivation, and the tool used to cultivate it.
To meditate we need to remember to focus on the object of meditation and also
to look deeply into the experience. This enables us to be mindful and this allows
Tools of creative awareness 37
us to be aware of what is happening in this moment. This in turn enables us to

creatively engage with what is happening in the moment and to transform our
relationship to it.
Thus mindfulness can be at different times recollected intention, presence
of mind, or creative awareness. One of its functions is to make things that are
arising truly conscious. Mindfulness has to be balanced—neither repression
nor proliferation of sensation or experience. In a meditative context it is also
being caring and careful in relation to experience. Finally, meditative mind-
fulness is based on ethical discernment. It helps us to be aware of actions,
thoughts, and intentions and to answer such questions as: Is this wholesome
or unwholesome? Is this beneficial for myself and others, or not? Does this
bring pain or not? It is fundamentally about the causes and conditions of
suffering.
Mindfulness thus enables us to become more attentive and alert, but also
careful and caring. It also has a probing quality like a doctor delineating a
wound, a simile used in early texts. Another simile is that of a ploughman,
where mindfulness is compared to a ploughshare and a goad. The ploughshare
reveals by digging and the goad serves to keep the cows in the proper direction
to make a straight furrow. Moreover, the ploughman needs to use the right pres-
sure on the plough so that it is not too heavy or too light.
Tools of creative awareness

In this section we explore how the two qualities of concentration and enquiry
can be cultivated with different methods. Meditation methods are tools serving
us in different contexts rather than ends in themselves or even methods for cre-
ating certain states while one is meditating. The value of meditation tools and
creative awareness resides in helping us to cultivate our potential, to deal with
difficulties, and to have meaning in our daily life. We will examine three ways
(listening, mindfulness of feeling tones, and questioning) in which one can
meditate, to demonstrate the application of the model of concentration and
enquiry and also the multi-perspectived approach of developing creative
awareness.
Listening
Listening meditation is an effective method for people who have difficulty with
mindfulness of the breath or the body, and also for people who are sensitive to
noises. The specificity of this meditation is that the focus is much wider than
with many other meditation practices and the focus is outside of oneself. In this
exercise one just listens to whatever sounds arise and pass away. It is like
listening to the famous piece of music composed by John Cage called 4’33”,
which is silent and where one hears the music of life at that moment. Artist
Irwin Kremen (1994), to whom John Cage gave this piece for his birthday, has
this to say about the musical score that was dedicated to him:
In this score, John made exact, rather than relative, duration the only musical charac-
teristic. In effect, real time is here the fundamental dimension of music, its very ground.
And where time is primary, change, process itself, defines the nature of things. That
aptly describes the silent piece—an unfixed flux of sounds through time, a flux from
performance to performance.
When one listens meditatively, one does not comment on, identify, or grasp at
the sounds one hears. One just listens mindfully as they arise and pass away. Or
if they continue, one notices that they change within themselves. Listening is an
easy way to cultivate vipassana or penetrative awareness as Analayo (2009)
defines it. The idea is not to define or name the sounds or collect them in a tick
list like spotting endangered birds. It is just to be aware of them as they come
and go. If the conditions are quiet, then one can listen and rest in the silence that
happens between the rare sounds occurring. This will enable us to develop
receptivity without expectations as sounds arise in an unpredictable manner.
I would not recommend this meditation in a noiseless room if one has tinni-
tus, though outside in nature it could work. However, it can be useful for people
who are sensitive to sounds and feel bombarded by noise, be they natural or
industrial sounds. A person on one retreat felt that any sounds were “out to get
her” and she would wear earplugs in the daytime to protect herself. She tried
this sound meditation and it helped her to realize that sounds were impersonal
and not designed to torment her. When sounds are not seen as enemies, the
degree of hearing sensitivity diminishes. This, combined with the calming
influence of the meditation, might lower the general level of sensitivity and thus
calm the whole nervous system.
Listening meditation broadens our view of what we can concentrate on. Mind-
fulness does not refer only to what happens inside us; it must also be applied to
events outside of ourselves. Moreover, when we listen it is easy to apply the
experiential enquiry described above, as sounds continuously arise and pass away.
Mindfulness of feeling tones (Pali: vedana)

Mindfulness of feeling tones is a revelatory practice. The Pali term vedana refers
to the hedonic tone of experience. Analayo (2009, p. 513) defines it in the Ency-
clopaedia of Buddhism as: “Feeling ‘feels’ in the sense that it feels such affective
tones as pleasure, displeasure and hedonic neutrality.” When we come into con-
tact, through one of our six senses, with the environment and experience a
smell, a taste, a sight, a physical sensation, a sound, or a thought, is the experi-

ence pleasant, unpleasant, or neither pleasant nor unpleasant (which I will call
neutral for short)? Brewer et al. (2012) distinguish between affective tone, feel-
ing tone, and valence: “The valence of this affective tone is conditioned by asso-
ciative memories that were formed from previous experiences.”
Here I shall use the term “feeling tone” to refer to the tonality of our affective
experience, rather like musical tones refer to musical sounds. Musical tones are
qualified by their duration, pitch, intensity, and quality. It is the same with the
feeling tones; they can be light, habitual, or intense. At any given moment we are
assailed by numerous feeling tones coming from our senses, which are being
impacted by the inner or outer world. It is important to see that feeling tones are
constructed; they are not a given, they do not reside in the object we come into
contact with. So, different people can experience different feeling tones when
they come into contact with the same object, for example a painting or a piece
of music. Moreover, they will be different according to our circumstances.
When we are in a good mood, children’s sounds can be experienced as pleasant;
if you are exhausted they can be unpleasant.
Feeling tones arise quickly and have a profound impact on our behavior.
Once I had an unpleasant experience and an hour later I found myself talking
unpleasantly to my husband, who had nothing to do with the previous experi-
ence. Feeling tones, especially unpleasant ones, have a tendency to seep side-
ways and propagate in other things—people, situations, and objects from which
they did not originate.
We can experience many feeling tones at any given moment, so in formal
meditation it helps to narrow the focus of our attention to one of our senses in
order to perceive feeling tones more clearly. Thus we can cultivate mindfulness
of feeling tones in association with just one object of concentration. The medita-
tor can be mindful of the breath, and then add one more element to this with an
experiential focus led by the question “How does the sensation of the air in the
nostrils feel?” Generally it will feel neutral and thus this meditation will enable
the meditator to become more aware of this and other neutral feeling tones.
In The Middle Length Discourses of the Buddha, Bodhi (Bodhi and Nanamoli
1995, p. 401) translates a nun’s teaching:
Pleasant feeling is pleasant when it persists and painful when it changes. Painful feeling
is painful when it persists and pleasant when it changes. Neither-painful-nor-pleasant
feeling is pleasant when there is knowledge and painful when there is no knowledge.
We can have a conflicted relationship with neutral feeling tones, as they are gen-
erally associated with boredom. But if we consider them from a meditative per-
spective, they are restful (or at least nothing bad is happening). If there is a
neutral feeling tone, we can choose to know it fully and it can then become the
source of a peaceful state of being in the moment. Or we can connote it nega-
tively and even confabulate: “Nothing is happening . . . This is boring . . . I am
bored . . . I am boring . . . Nothing works in my life!” Thus we can quickly go
from neutral to unpleasant feeling tones. This is one of the challenges of formal
meditation, especially sitting meditation, as most of the time nothing is hap-
pening and this can be experienced as boring. But if we know the peacefulness,
clarity, and restfulness of a neutral feeling tone, we can know for ourselves quiet
contentment both within and outside meditation.
When we meditate, we can become aware of unpleasant feeling tones. When
we have a thought, this is a contact with a new object, which can produce a
pleasant, unpleasant, or neutral feeling tone. Our thoughts have some trigger
words, which lead to strong unpleasant feeling tones like “this is unfair,” “this is
wrong,” “he does not respect me.” The process proceeds from trigger words to
unpleasant feeling tones to emotional upset. It can be difficult for us to notice or
be mindful of the first contact with the trigger words that generated the feeling
tone, and still less to observe how the feeling tone develops into more elabor-
ated and magnified upset through our generation of looping stories and mean-
ings. Physical sensations are clearer because as soon as we experience an
unpleasant sensation, we are aware that we do not want it (this, of course, is a
survival mechanism). The problem in reacting strongly to unpleasant feeling
tones is that when we add to that experience by confabulation and “catastro-
phizing,” we make it even more unpleasant. This is what the Buddha points out
in the Sallatha Sutta found in The Connected Discourses of the Buddha (Bodhi
2000, p. 1264):
When the uninstructed worldling is being contacted by a painful feeling, he sorrows,

grieves, and laments; he weeps beating his breast and becomes distraught. He feels two
feelings—a bodily one and a mental one.
Mindfulness of unpleasant feeling tones helps us to be with the experience

without adding anything to it through “creative engagement.” Sometimes we
realize that all we can do is accept things as they arise. At other times we see
clearly that we can do something to transform them, either inwardly or out-
wardly. Mindfulness will not take the pain away but it can change the way we
engage with it.
Neutral feeling tones are the baseline that is the mid-point between pleasant
and unpleasant feeling tones. If we were to assume (as people do) that the base-
line should be a pleasant feeling tone of, let us say, a minimum of five on a ten-
point scale of pleasure (one being low levels of pleasure and ten being very
high), then we only have a five-up-to-ten range of pleasant experience and the
rest is interpreted as neutral or unpleasant. If instead we perceive that the base-

line is neutral then we have a range of potential positive feeling tone from at
least one to ten. We are not grasping for relatively strong positive feeling tones
in our moment-to-moment experience but are able to derive peace and pleas-
ure from neutral feeling tones right up through the full range of positive feeling
tones. And with practice, negative feeling tones, particularly less intense nega-
tive feeling tones, can become areas of growth as a result of concentration and
enquiry. We are more acutely aware of unpleasant feeling tones than pleasant
ones due to the positive–negative asymmetry effect (Taylor 1991) but by
increasing awareness of neutral feeling tones and therefore the full range of
pleasant feeling tones, we effectively re-equilibrate how we feel. In this manner
we discover more opportunity to appreciate happiness and joy in our lives. And
we appreciate experientially that quiet contentment in the neutral state is
positive.
Another method is to repeat inwardly and silently these sentences:
I appreciate my efforts
I rejoice in my success
I am grateful for my existence
Mudita means finding joy and happiness in others’ happiness and can be con-
trasted with envy and with taking joy from others’ suffering. The phrases can
therefore also be used in relation to different categories of people: those we like
and who support us, or those we have difficulty with, etc. We can also add to the
list things in nature and animals:
I appreciate your efforts
I rejoice in your success
I am grateful for your existence
In this type of practice, concentration resides in repeating the sentences and

experiential enquiry is cultivated when we genuinely see the goodness in our-
selves and others. It helps us to shift our focus from only what is difficult and
negative. Those who do not like to repeat sentences silently inwardly while
meditating can connect with the resonance of the quality of the exercise by
experientially asking: “What is it I can appreciate right now about this experi-
ence? What is it I can rejoice in? What can I be grateful for, however small?”
To conclude, when trying to be mindful of feeling tones, we focus on contact
with an object in experience such as a sound or a visual object, and deepen that
focus to be aware of the quality that arises upon that contact. The experiential
enquiry element resides in noticing how the feeling tone changes over time or
how the feeling tone changes when there is contact with a different object (such
as a thought, a new sound, or a new visual object). In this manner we become
progressively more aware of different feeling tones that arise with different
objects and also of how these feeling tones change within themselves. This
growing awareness of feeling tones both during and outside meditation practice
enables us to be more aware of and freer from their impact on our mood, com-
munication, and actions.
Another aspect of our “feeling” life is more intense “feeling-sensation” or
“affective sensation.” The feeling tone is the tonality we experience immediately
upon contact. That can be followed by a more intense feeling or affective sensa-
tion. We quickly give a meaning to this feeling-sensation, calling it sadness or
anger for example, and then it becomes a full-blown disturbing emotion because
it appears to associate with some previous event or period of intense sadness or
anger.
Rather than analyze the meaning of the intense feeling and the stories associ-
ated with that meaning, it helps to stay with the feeling-sensation, focusing on
the location within the body where it is felt. Then one can concentrate on it and,
with experiential enquiry, examine it. Is it heavy or light, agitated or calm, solid
or fluid, hot or cold? Is it still there in the same way? How long does it last?
On one occasion I visited a flower shop and the cashier seemed to look at me
as if I was stupid when I did not understand what she said to me. I felt some-
thing intense and unpleasant in my chest area so I paid and left but decided to
observe mindfully the unpleasant feeling-sensation without falling into the
reactive storyline of “I will never go back to this shop.” The feeling-sensation
continued for about ten minutes as I observed it. Over the next two hours,
whenever I thought about the incident, the feeling-sensation returned for a few
seconds and stopped when I stopped thinking about it. I deliberately took time
to focus on and experience the sensation in my chest. After two hours, even
when I thought about the incident, the feeling-sensation did not return. By
being mindful in a questioning way, the feeling-sensation did not settle and
intensify into a disturbing emotion. It just evaporated. There are many light
feeling-sensations that we experience throughout the day that we do not need
to embed and make stronger than they need to be. By focusing and using
experiential enquiry, we can free ourselves from much emotional negativity
and turmoil.
When there is great emotional intensity, it is generally because something has
shocked our whole system—mental, physical, and emotional. Then we have to
accept the need to process such a shock and that it will take time for its effect
and reverberations to pass. When my brother and my father died, each time it
took my system a year to begin to recover from these losses. Meditation and
mindfulness helped me to be with these feeling-sensations and not to magnify
them unnecessarily. With such intensity, creative meditative distractions can
remind us that we are not only this intense feeling-sensation but that we can still
enjoy nature, help others, and receive their support.
Meditative questioning
The final meditation method I want to explore in terms of concentration
and enquiry is the questioning meditation I learned in Korea. It involves just
asking the question: “What is this?” Sitting, walking, lying down, and stand-
ing, one keeps asking this question silently. The anchor is the question itself.
As soon as the meditator is distracted, she comes back to the question.
Returning to the question brings us back to the whole present moment.
When we are lost in abstraction, mulling and musing, we are not present but
caught in small, often repetitive, parts of our story. Coming back to the
question, we come back to mindfulness of the specific experience of this
current moment.
Experiential enquiry is not repeating the question like a mantra but each time
asking the question with perplexity. This meditation involves developing a
questioning orientation, which one can feel in the body. Teachers suggest locat-
ing the questioning in the belly, so that the question does not go to the head,
become over-intellectual, and even create intensity and headaches. This is not a
psychological, analytical, or existential enquiry. It is practicing becoming like a
question mark. It is as if one was asking the question of the whole moment with-
out trying to define any part of that moment.
It is a questioning practice and not an answering practice. We are not looking
for an answer and this is challenging as it goes against our usual tendency to ask
a question in order to receive or find an answer. The effect of this meditation is
to help us become more creative and flexible. It helps to dissolve certainty and
fixity and fosters wonderment and openness.
Nevertheless, while doing this questioning practice, one needs to keep a bal-
anced state of mind, and cultivate both focus and enquiry in a stable way. In
Great Doubt, Great Enlightenment (Gou et al. 2014, p. 202), this citation from
Yung-chia states:
If one remains in deep calm without being aware, it means sinking into dullness and if
one remains aware without being calm, it means becoming entangled in one’s thoughts.
If one is in a state of being neither aware nor calm, then one is not only entangled in
one’s thoughts but also submerged by dullness.
Here the pitfalls of meditation are pointed out. Although it is helpful to be calm
and it can be one effect of meditating (whatever the method used), if we are too
calm without a bright awareness we can become dull. It is essential not to use
the meditation as a way to dissociate and become unconcerned. On the other
hand, if there is not enough calm then it becomes easy to be either distracted by
thoughts or exhilarated by them.
In Straight Talk on the True Mind from the Collected Works of Chinul (tr.
Buswell), Chinul (1158–1210) points out:
As Yung-chia said, “the alertness of calmness is correct; the alertness of deluded thoughts
is wrong. The calmness of alertness is correct; the calmness of blankness is wrong.” Since
blankness is not present in calmness, and distracted thoughts are not engaged during
alertness, how will any deluded thoughts be able to arise? (Chinul 1983, p. 172)
Meditation involves a balance between concentration and enquiry. It is import-

ant to cultivate and experience both alertness and calmness, and both quietness
and clarity. We develop a grounded sensation of questioning not only when we
do formal meditation practice but also in daily activities, when we walk, work,
or relate. We are trying to infuse our life with a direct and beneficial sense of
perplexity.
These different meditation practices are tools for daily living. Each has a spe-
cific usage and a certain effect. Meditation is not sacred and nor are any of the
tools. The question we need to ask ourselves is: “Does this work?” Does regular
meditation practice help me to become calmer and clearer? Does it help me to
relate better to myself and others? The aim is to dissolve over time the fixed and
restrictive habits of mind, body, and heart so that they can go back to their cre-
ative functioning. We are trying to loosen the rigid framework that develops
over time as a means of coping with the vicissitudes of life in order to enable our
capacities to blossom.
Cultivating meditative concentration and enquiry produces a creative aware-
ness that is characterized by acceptance and transformation. When we are
mindful we see as much our good qualities as our painful tendencies. When we
know for ourselves and experience our positive capacities, it is possible for
them to flower and for us to develop them skillfully. When we understand that
we are not always bad or in difficulties but that identifiable factors and condi-
tions cause difficulties to arise, we can engage creatively with those habits that
cause us difficulty. Their intensity and duration can be reduced and some can
disappear completely.
Conclusions
In this chapter I have shown that the two main elements of meditation are con-
centration and enquiry. This way of looking at meditation enables us to circum-
vent certain restrictive views around meditation that see it as a strictly religious
exercise belonging in the temples with professionals or aligning it only with the
method of one Buddhist school of meditation. Furthermore, by exploring its
essential elements, meditation becomes relevant to a scientific, psychological

framework, as well as something practical and easy to develop in our daily life.
This way of looking at meditation has allowed me the possibility of widening
the range of meanings of mindfulness and of its applications using the different
tools of awareness. I put some emphasis on the practice of mindfulness of feel-
ing tones because to explore that particular practice will show the propitious
connection between Buddhist meditation and psychology.
In summary, concentration helps us to focus and anchor in our experience
with the possibility of less unnecessary self-referencing, cogitating, and self-
doubt. Experiential enquiry allows us to come into contact with the processual
nature of our experiences, thereby mitigating fixations and overgeneralization.
Not only that, but by cultivating both equally, we develop a creative awareness
that can make a great difference in our life. This creative awareness leads us to
dissolve the habitual patterns that limit us. By dissolving something, we do not
just create an empty space but a creative space where new things can emerge. It
is like the bell (i.e., a metal bowl) used to time a group meditation session. If you
hit the bell with a stick, it resonates because the metal bowl is empty. If you fill
the metal bowl with a small cushion and again try to hit it with a stick, the sound
will be flat and unmelodious and will not resonate. In the same way, when the
non-restful resting state of the mind has quietened down there are many more
opportunities for thinking, acting, and speaking in a creative way while
responding to our environment in an appropriate and skillful manner. This is
the power and the promise of meditation.
I became interested in meditation in 1971 aged 18 and in 1975 I decided to travel to

Asia. Along the way I went to Nepal, India, and Thailand. In Thailand I met some Korean
monks who told me there was an opportunity to learn meditation in Korea. I decided to
stop there for a month and stayed for ten years. Early on in my stay I decided to become
a Seon (Zen) Buddhist nun. This entailed being a postulant working in the kitchen for a
year, but being one of the rare Westerners at the time and not speaking the language I
was allowed to enter the Seon hall quite quickly. This means that for about ten years I
meditated ten hours a day for six months of the year (three months in summer and three
months in winter). We would sit for 50 minutes and walk for 10 minutes throughout the
day, interspersed with eating times and daily working period. The method of meditation
was Seon questioning.
After ten years I stopped being a nun and returned to lay life. Later on I married my
husband and we joined a Buddhist community in England where most community
members practiced insight meditation. I joined a few insight meditation retreats (also
known as mindfulness or vipassana retreats) to learn this technique and found it quite
useful. It was while doing these insight retreats, where actually both samatha (concen-
tration) and vipassana (enquiry) were taught, that I realized the essential elements of
insight meditation were not different from the essential elements I had learned in the
Seon tradition. It was then that I found the formulation of “creative awareness.” After
a while I was asked to teach retreats with my husband, Stephen Batchelor. We decided
to teach two types of retreats: regular Seon retreats following a Seon format; and secu-
lar Buddhist retreats that combined an insight approach with a Seon approach follow-
ing an insight retreat format.
Every time I teach I join in all the sitting periods of the retreat. In meditation I find myself
doing a combination of both mindfulness meditation and questioning meditation. Gen-
erally the main focus will be the sensation of questioning in the belly grounded by
awareness of the breath, sounds, sensations of the body, or thoughts arising and pass-
ing away in the background. Through teaching many different people over 25 years, I
have seen clearly that any technique of meditation (however great) will not suit all
people. Thus, I became a multi-choice teacher, suggesting different ways to do any tech-
nique, as well as suggesting that no method is the only method for everyone. Moreover,
for a book on women and Buddhism I interviewed 40 Buddhist women, from Asia,
Europe, and America, both laywomen and nuns. What I learned from that experience
was that what was important was not the specific Buddhist framework or the technique
of meditation but the sincere application and dedication of the practitioner.
I am grateful for my years of nun training in South Korea. It gave me a good foundation
to develop the practice further in daily life. My main interest has always been to develop
wisdom and compassion in all aspects of my life. And I did find and continue to find that
meditation is very helpful in that regard.
References
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psychologytomorrowmagazine.com/inscapes-enlightenment-and-science/
Chapter 3
How conscious experience

comes about, and why
meditation is helpful
Guy Claxton
Introduction
This chapter applies recent thinking in the fields of consciousness studies and
embodied cognition to the subject of meditation. In particular, I will sketch an
answer to the question “How does conscious experience (CE) come about?”
and then use this to make some suggestions about what meditation is and why
it should turn out to be helpful in promoting human flourishing and compas-
sion. The main focus will be on mindfulness as it has come to be practiced in
secular Western contexts, as well as in the context of monastic Buddhism.
Metaphors of mind, old and new

Meditation is designed to alter the quality and/or the content of consciousness,
as well as of behavior. Specifically, many meditation practices attempt to focus
attention more acutely than usual on the phenomenology of experience: How it
arises, unfolds, and passes away. Attention is paid to these and other aspects of
the nature of conscious experience, as well as (as is more normally the case) its
content. If we are to begin to understand how meditation “works,” therefore, it
is useful to see what cognitive science has to say about these matters. If
scientifically-based approaches to the arising of conscious experience are valid,
they may then offer useful pointers to practice: where and how it is most advan-
tageous to focus one’s attention, for example.
But are these scientific models valid? One test is empirical: do they account for
observed phenomena and predict new ones? Another, though, relates to the extent
to which their pre-theoretical presuppositions unquestioningly import, and
merely embellish upon, folk models of the mind. Are we sometimes merely adding
a scientistic veneer to old images of mental processes? We will return to empirical
matters later; here I want to begin by making some remarks on the second point.
50 How conscious experience comes about, and why meditation is helpful
In science, as in folk psychology, buried metaphors often drive thinking. Con-

sciousness and conscious experience are no exception: they tend to be construed
through metaphor. For some, consciousness is a kind of brightly-lit chamber or
theater stage in the mind, and conscious experience is the contents that happen
to be “on-stage” at any moment. Some cognitive psychologists have associated
this “chamber of consciousness” with constructs such as working memory, or the
“central executive,” in which case the stage becomes a workshop where processes
are applied to the contents (e.g. Baddeley 2007). This metaphor invites one to
think about other “dark” regions of the mental theater where the same contents
(props, actors, and so on) may exist, and maybe carry on functioning, but out of
sight of the “viewer”—the “I”—who is some combination of stage director and
audience member. If the actors start to behave badly, the “I” can also act as a cen-
sor, banishing (“repressing”) taboo performances from appearing on the stage.
Alternatively, consciousness has been seen as a kind of screen or display-
board in the mind, on which certain information—the contents of conscious
experience—can be posted. The viewer of this information might again be the
first-person “I,” or, in the case of Barrs’ (2005) “global workspace theory,” might
be other processing modules in the mind, not necessarily conscious, which can
pick up the posted information and, perhaps, contribute their own expertise or
perspective to ongoing problem-solving. The “I” could be seen as the computer
operator, watching the activity on the screen and pressing keys to determine
future processing, while the chips and processors on the computer’s mother-
board constitute a kind of “cognitive unconscious.” Sometimes this metaphor
has been used to make a strong distinction between the objects in mental stor-
age (“declarative memory,” capable of being made conscious) and the processes
and programs that can be applied to that database (called “procedural memory,”
usually not conscious).
Consciousness (or “conscious awareness,” I’ll use those terms interchangea-
bly) could also be seen as a roving spotlight that sequentially highlights (or
“lights up”) different contents in memory (e.g. Crick 1984). In this image, men-
tal contents are not moved around between different locations, some of which
are conscious and some not, but “stay put” and are illuminated in situ. Some-
times this illumination is seen as a form of neural activation—people often talk
about different parts of the brain “lighting up”—and the activation itself is cap-
able of altering the activated representation. This metaphor, often used in the
context of creativity, allows the source of illumination to be narrow, focused,
and intense, or diffused, more all-encompassing, but perhaps of a lower level of
intensity (or, sometimes, “arousal”).
All of these metaphors suggest interesting ways of thinking about conscious-
ness, and are capable of being applied to “mindfulness.” Some suggest, for
Metaphors of mind, old and new 51
example, that mindfulness is like turning up the brightness on the stage lights,
or varying the focus of the spotlight. Or that mindfulness involves learning to
shift the perspective of the viewer from actor on the stage, to stage director, or
even to a dispassionate observer in the audience, unmoved by the drama
unfolding before her. But all of these images are limiting and capable of being
misleading (if taken too seriously or pushed too far), as all metaphors are. Some
are more biologically plausible than others—there is no evidence, for example,
that there are real locations in the brain that correspond to the central executive
or the global workspace, to which passive “contents” get sent for processing, like
books being recalled from the stacks of a university library and placed on a
student’s desk.
However, my purpose here is not to offer a detailed critique of these depic-
tions. (That job has been well done by Blackmore 2003, Shanon 2001, and oth-
ers). Instead, I want to explore the potential of a different perspective on
consciousness that is emerging from the hybrid study of “embodied cognition.”
This newly constellated focus of enquiry is an offshoot of cognitive science,
drawing principally on philosophy, psychopathology, experimental psychology,
neuroscience, robotics, and evolutionary theory. Its focus is on the detailed
interactions between body, brain, and mind, with a growing research base that
suggests that no satisfactory account of human experience and behavior can be
given if the body is not taken fully into account. The computationalist idea that
we are like computers or virtual machines that can be instantiated or embedded
in a variety of different “housings” and “carriers,” and that what matters is really
the “logic” of the machine, not its physical constitution, is hotly contested. This
new discipline is still in formation, and those involved certainly do not speak
with a single voice. Many would consider the perspective I am going to explore
here a rather tame version of embodied cognition (e.g. Chemero 2011). Never-
theless, I hope to show its utility in thinking about meditation.
I shall interweave two new metaphors for this perspective that I will call
“welling up” and “unfurling.” They are very similar, but emphasize slightly dif-
ferent aspects of the underlying view. To illustrate unfurling, imagine the
growth of a plant, a fern say, or perhaps a white rose. The fern starts from an
invisible spore in the ground, and then grows over time into a large, visible,
highly differentiated mass of fronds. Let’s say the spore is the original seed of an
intention, and that motivational seed unfurls into a complex physiological and
behavioral expression of that “germ of an idea.” Take a time-lapse film of the
growing fern, and speed it up, so that the whole process now takes a quarter of
a second. It will be hard to spot the stages of growth. It will look like one moment
there was no fern, and then, suddenly, there is a fully formed fern-thought, or
action, or emotion.
This perspective on the formation of ideas, acts, and experiences was ori-
ginally dubbed “microgenesis” by Heinz Werner (1956). Werner saw the gen-
eration of a thought or an utterance not as a process of assembling
word-meanings according to syntactic rules (the dominant cognitivist image
at the time), but as a process of rapid evolution from a subcortical glimmer or
meaning to an elaborated complex of sensory and motor activations across
the brain as a whole, and thence back again to the muscles and the viscera of
the body. Jason Brown (1991, 1999) has developed the idea of microgenesis
further, and linked it to the cognitive psychology found in various traditional
Buddhist teachings such as the Abhidharma, in a range of publications on
which I am drawing here.
Nothing in this image suggests when or how, or even whether, consciousness
appears. It is perfectly possible that the seed germinates into an action rapidly
and effortlessly without any self-consciousness, or even conscious awareness.
For example, we may we walking down the pavement deep in conversation with
a friend, completely oblivious to the subtle maneuvering of our bodies as they
chart an intricate trajectory between the oncoming pedestrians; or eating a
bowl of cornflakes whilst totally engrossed in a movie. If we wanted to add con-
sciousness to the metaphor, we can swap the fern for the rose-bush, and call the
growth of the foliage “unconscious,” and the blooming of the white flower “con-
scious experience.” (This of course explains nothing by itself, but may direct us,
as metaphors often do, toward more compelling considerations.)
To capture the experiential side of microgenesis more fully, I will make use of
another metaphor, that of welling up—as, for example, when we well up with
emotion and know that we are on the verge of tears. Sometimes we “well up”
with feeling without clearly knowing why, as when we are suddenly touched or
moved by an image of starving children on the evening news, or by an unex-
pected moment of forgiveness or gentleness in a film, or by a piece of music.
(Adele’s song “Someone Like You” catches a number of people by surprise in
this way (Doucleff 2012).) We might be able to rationalize the response after the
event, but at the time we are, as we might say, “caught unawares.”
Most people have this experience of “welling up” occasionally. But my more
radical suggestion is that these special moments are actually prototypical of our
conscious experience as a whole. All our thoughts and sensations well up from
visceral and unconscious origins in the same way, but we habitually become
aware of our experience only when it is already well formed, and miss the dis-
tinctive feeling of an event unfolding within us over time, over which we may or
may not have control. One of the effects (and intentions) of various forms of
mindfulness training (as we will see later) is to bring conscious awareness to
earlier and earlier stages of this up-welling.
Welling up of gesture and thought 53
Welling up of gesture and thought

Psycholinguist David McNeill at the University of Chicago has chronicled the
unfurling or welling up of overt actions and conscious experience in great detail
in the context of speech formation (McNeill 2005). His research focus was on
the relationship between what we say—for example, when we are describing a
cartoon we have just watched to a third party—and the hand gestures that spon-
taneously accompany the speech. Through detailed analysis of videotapes,
McNeill and his collaborators have discovered that speech and gesture emerge
from the same root, and carry complementary aspects of the meaning we want
to convey. For example, describing one scene, one observer said, “Sylvester was
in the Bird Watchers’ Society building, and Tweetie was in the Broken Arms
Hotel . . . ” As she referred to Sylvester she gestured to her right-hand side, and
as she referred to Tweetie she gestured to her left, indicating that the two loca-
tions were on opposite sides of the street. A few seconds later, she reported that
“He then ran across the street,” and gestured to her right as she did so—indicating
that it was Sylvester who crossed the street, not Tweetie. Speech and gesture
were woven seamlessly and unconsciously together in order to resolve the
potential ambiguity of the pronoun. Speech and gesture were unfurling together
from a common root of understanding, like two fronds of the same fern.
More generally, we might imagine—if we could slow the “movie” of our own
experience back down sufficiently—that a desire to communicate something of
what we have experienced begins to stir deep in the brain and the body. It might
involve a need for approval or a desire to impress—to want to be a “good sub-
ject” in Professor McNeill’s experiment—or a wish to convey involvement and
amusement in the cartoon, or a dozen other intentions. When I say to my wife
“I think the front lawn needs cutting,” I can trace the source of that casual com-
ment back to a small archaic tremor of potential shame about being disap-
proved of by meticulous neighbors. When she says to me, “Shall we go for a
walk if it’s nice tomorrow?” I can, I fancy, hear a faint echo of anxiety about my
health and the sedentary nature of my work.
These initial spurts of concern then ripple out, recruiting memories and mus-
cles into an intricate pattern of activation. In McNeill’s study, there are memories
of the cartoon, and emotional concomitants that cause the voice quality to inten-
sify, a chuckle to form in the chest, and the corners of the mouth to arch upwards.
At the same time, the internal images are activating appropriate patterns of
words, and the muscles to shape the voice box and expel air so as to make the
right sounds, and eye contact with the listener is held in order to judge whether
we are being successful in conveying the meaning and the feeling that we want . . .
and so on. And arms and hands begin to form gestures that carry other aspects
of the picture I want to convey. A whole-body state fans out from the originating
impulse, unfolding into an intricate pattern of embodied meaning.
The broad architecture of these channels of communication is determined by
genetic programs, though the actual expression of these genetic guidelines is
modulated by environmental and experiential factors. The fine details of how
these ripples of activation develop, however, are heavily experience-dependent.
Synaptic connections are changed and chemical responses throughout the body
are altered by learning, so the pathways along which meanings unfurl are indi-
vidual and variable. At the risk of creating metaphorical overload, the tidal
surge of electrochemical activation is channeled by the embodied formations
that thousands of previous tides have sculpted and left behind.
Some of these ripples will engage visceral and autonomic processes: Blood
pressure and heart rate might go up; respiration volume might become shal-
lower; background processes of digestion might be inhibited; hormones such as
adrenaline or cortisol might be released into the bloodstream. All of these
changes will be signaled to the brain and will alter levels of arousal, as well as the
focus of attention (what we are on the lookout for) and the memory contents
that are recruited into the unfolding meaning. The brain alerts muscle groups to
the kinds of action that might be required, and facial expression and patterns of
body tension are altered accordingly. Some of these muscular changes might
involve coordinated patterning of throat, mouth, and lips, at the same time as
the lungs are expelling air in synchronized bursts—resulting in the utterance of
a sigh or a sentence. Some more muscular activity might result in simultaneous
movements of shoulders and arms that produce gestures that disambiguate or
augment the meaning of the utterance. And so on.
It will be clear that this kind of embodied description of how conscious con-
tent comes to emerge takes us in different directions from the “central execu-
tive” or “spotlight” metaphors, and thus offers complementary perspectives on
the process, the experience, and the benefits of meditation. We will come to this
later, but let me offer one illustration here. Meditation is undertaken with the
intention of improving (however that is defined) the quality of both experience
and behavior. I might be hoping, for example, to feel more peaceful and to
become a kinder person. I might be hoping, also, to become more authentic—
that is, to feel that my actions and my awareness, which have often felt dis-
located or at odds, are become more congruent. Part of the unsatisfactoriness of
my life might be that my “kindness” feels forced; that it sometimes emerges
along with a sense of reluctant or resentful duty rather than a whole-hearted
desire to help or to serve. The earlier metaphors do not seem to offer me much
of a purchase on this desire to reunite thought and body, but the unfurling
metaphor does. At the very least, we can ask how (and why) the integrity of the
Espaliered experience 55
original “seed” becomes lost, and I end up with a white lotus of consciousness
apparently grafted on to a much pricklier kind of plant. Let’s pursue this line of
metaphorical thought a little further.
Espaliered experience
If and when an original intention starts to form a linguistic utterance (or a writ-
ten or signed sentence), all kinds of syntactic and semantic considerations come
into play. Through spreading activation, the unfurling meaning—the felt sense,
as Eugene Gendlin calls it—starts to recruit candidate words and syntactic
frames to carry the intended meaning (Gendlin and Rychlak 2000). But it could
be that no readily available words or frames are capable of accurately conveying
the underlying intention, so, if the utterance is to proceed, some of the nuances
and subtleties of the meaning may be lost in transcription, and what eventually
comes out is only an approximation—perhaps a crude a pproximation—to what
was intended. The horticultural term espalier refers to the process of training a
plant—often a fruit tree—into a particular shape as it grows, through selectively
pruning off-shoots and tying other shoots to a frame that directs their growth.
Language acts as a kind of espalier for the meaning that is developing within the
body-mind.
If the visceral seed is relatively simple and conventional, then the translation
from meaning into words may be good enough. The process of espalier does not
do significant damage to the original intent. But if the intended meaning is
novel, unusual, or sophisticated, then the transcription into language may fail
more seriously. Accuracy of transcription will depend on the mental vocabu-
lary and range of grammatical constructions that are potentially available and
the subset of those that are actually, in the moment, accessible. It will also
depend on the extent to which the speaker is (both dispositionally and momen-
tarily) sensitive to any misfits between pre-verbal intention and the evolving
utterance, and whether they consider it important to “get it right,” or whether,
in a particular case, “near enough is good enough.” And this in turn will need to
take account of the length of time that is available for monitoring, editing, and
reformulating the requisite bodily action-programs.
One kind of “training” that happens to the germinating intent is so common
that it is rarely noticed. It involves the linguistic conventions present in many
(but not all) languages adding a kind of “self ” to the equation. Instead of just
experiencing a thought, perhaps one that said “We need some more milk,” we
say “I think we need more milk.” Added to the thought is a somewhat gratuit-
ous thinker—just as, when we say “It is raining,” there is no “It” that is doing
something called raining. “I,” like the “It,” is a linguistic convention. Yet, over
time, as a child learns to use the dummy word “I” correctly and fluently—“I
saw,” “I tried,” “I decided,” and so on—it comes to seem that it does indeed
betoken some kind of ever-present ghostly observer, instigator, or narrator
lurking behind appearances. We get used to adding this ghostly espalier to
each meaning as it unfurls. Eventually it appears self-evident to us that there
is a (real, albeit ghostly) observer who is capable of watching thoughts and
experiences as they appear in and disappear from consciousness, whereas
both “I” and “thought” emerge, in the moment, as aspects of the same up-
welling experience. (For a traditional Buddhist rehearsal of this argument, see
Kalupahana 1987. For a contemporary philosophical treatment, see Parfit
1986. For a more detailed psychological exposition, see Claxton 2005).
In daily life, the assumption that the “I” in a linguistic construction such as “I
tried but failed” refers to a real inner entity makes personal judgments of (in
this case, lack of) self-worth or self-efficacy feel both more serious and more
“sticky.” There is apparently something (or someone) to which the judgment can
adhere, and which therefore feels culpable for the “failure.” Meditation, like psy-
chotherapy, often attracts people who are particularly plagued by such debilitat-
ing judgments, and may be helpful in reducing their stickiness, and therefore
their air of validity and seriousness. Mindfulness-based stress-reduction and
cognitive therapy have both proven to be effective in this regard (Teasdale and
Chaskalson 2011a,b).
Habits of attention
The process of welling up can take quite different time courses. Sometimes it
takes only a tenth of a second, in which case it is very difficult to catch the
unfurling as it happens. And sometimes the development of a germ of an idea
into a communicable train of thought can take seconds, or minutes, or even
longer. We may have to “um” and “er” while we wait for the mot juste to come to
mind. Sometimes the unfurling is blocked, as when our brain refuses to come
up with the name of a dear friend when we are having a “senior moment.” In
many of the familiar stories of creative insight, the solution to a problem can
hang elusively just out of our grasp for months or years, until exactly the right
set of triggers come together and the answer is propelled into consciousness like
a circus performer shot from a cannon.
However, overlaid on these different time-scales there may be habits of atten-
tion that make us more or less sensitive to the unfolding dynamics within. We may
develop a generalized habit of not paying attention to the early stages of the unfurl-
ing so that, whatever its intrinsic time-course, we do not become consciously
aware of what is welling up until late in its development. We come habitually to
Habits of attention 57
notice aspects of experience that are already well-formed and elaborated, but do
not notice the hazier or more undifferentiated precursors. Thus, instead of
noticing the gradual clarification and differentiation of a thought or a feeling, we
experience our own experience in terms of a step-wise distinction between things
that are unconscious and those that are conscious. They appear to “pop into” our
minds—or even, in a magnificent sleight-of-hand, to seem to spring, fully formed,
out of the mouth of the “inner I.” Thus—referring back to the earlier discussion
about different metaphors for consciousness—what looks like a structural separ-
ation between conscious and unconscious can actually be a reflection of an
acquired cognitive habit. We think we see a sharp distinction because we are
inattentive to the slope that actually leads from unconscious to conscious.
We might also develop a habit of speeding up the unfurling process itself. We
know that our embodied cognitive system is capable of registering regularities in
its own processing, and therefore able to predict (with greater or lesser accuracy
and/or confidence) what mental states are about to happen, on the basis of what
mental states are already happening (Clark 2013). (The thought “I failed”
becomes doom-laden, for example, as it has become a harbinger of an upsurge of
negative self-judgments. Or, to use a more prosaic example, the glimpse of what
looks like the tail of next-door’s cat disappearing round the corner of the house
leads us to expect, were we to run and peek round the corner, that we would see
the whole cat; or even just to assume it is Felix without bothering to check.)
This ability to predict future states of mind makes it possible for us to take
short-cuts in unfurling, and leap to conclusions about what probably or usually
follows the current state. When we have to respond fast, this “quick best guess”
can be advantageous; it can even save our lives. But if leaping to conclusions
becomes habitual, we are likely to miss detail and novelty. We construct our
own world based not on the unprecedented particularities of the moment, but
on what is normal and conventional. Thus we can come to see in terms of rather
ghostly stereotypes and generalizations rather than the vivid, complex indi-
viduality of what is actually present. (We experience a shadowy stand-in for
Felix. Were we to have checked, we might have seen that it was in fact an entirely
different cat for which, we have just read in the local paper, a distraught owner
has offered a substantial reward.) In effect we are trading vitality and inquisi-
tiveness for normality and predictability.
Going too far in this labor-saving, top-down direction obviously incurs risks
and costs. We might try to make the world conform to our expectations, and
thus persist in applying methods of thinking and acting that worked once but
are not, in a new situation, appropriate or effective. (Applicants for jobs at Goo-
gle are often asked if they have a track record of success in their field. Those who
boldly say “Yes” are unlikely to be hired, because experience has taught Google
that such self-confidence often leads to people trying to replicate those suc-
cesses by forcing new predicaments to fit old patterns; they are interested in
people who can think from scratch and “flounder intelligently” in the face of
quite new challenges (Friedman 2014).)
Language can certainly exacerbate this problem. There are many studies
showing how a verbal label often leads to a kind of “functional fixedness” in
which alternative ways of looking at or categorizing an object are rendered
invisible by the label. In one classic study, Carmichael et al. (1932) gave sub-
jects ambiguous pictures to remember with one of two suggestive verbal
labels, e.g. “dumb-bells” versus “spectacles.” When asked to draw the shapes
they had seen, the labels had a marked effect in skewing what they thought
they had seen. This is one way in which creativity is reduced by leaping to con-
clusions. Creativity also suffers in other ways. We can become deaf to our own
inklings and hunches, which recent research has shown are vital aspects of
our creativity (Martindale 1995). Being able to access and tolerate what some
researchers refer to as “low ego-control” or “low arousal” mental s tates—those
that are uncertain, provisional, ambiguous, or vague—is demonstrably con-
ducive to creative insight.
The process of unfurling can be slowed down as well as speeded up. As we saw
earlier, the process of checking candidate actions or utterances for accuracy and
completeness may be subject to strategic control. We can allow the “stream of
consciousness,” or we can monitor and edit more carefully. When speaking a
foreign language, for example, people may dive in and “give it their best shot”
(especially in convivial company or after a drink or two), while on other occa-
sions (or temperamentally more cautious people) we may self-monitor to the
point of becoming tongue-tied (Krashen 1982). When candidate utterances are
being held back for checking, the motor programs for producing the speech can
be run “off-line”; that is, the sequence of articulatory muscle movements can be
run in a way that produces muted versions of both the muscle movements
themselves and their sensory consequences. (As part of children’s language
learning, their brains develop a complex matrix of correspondences between
“what it would take to produce a sound,” and “what the sound produced by
those small movements would sound like.”) These muted effects are very often
associated with conscious experience (though they may not be).
Before we come to the question of when, how, and why aspects of the unfurl-
ing message are accompanied by (or rendered into) conscious awareness, let me
summarize the major branches of the developing “fern” of experience. One
branch creates ramifications of internal, “interoceptive” body states: visceral,
hormonal, immunological, and neural. A second alters the direction and acuity
of incoming sensation, via modulation of the “exteroceptive” perceptual
The emergence of consciousness 59
systems. A third branch begins to ready muscle groups for action. A fourth
branch heads in the direction of linguistic and other kinds of symbolic outputs
such as gestures. In meditation, we can focus on any or all of these facets.
Mindfulness can be viewed as a kind of psychological training that enables us
to gain greater awareness of these habits of attention—speeding up or slowing
down the perceptual process—and thus allows us to regain a great flexibility
and control over our own ways of sensing. This in turn allows us to avoid some
of the costs such as over-monitoring or leaping to conclusions.
One function of mindfulness, as we will see, is to enable us to separate aware-
ness from judgment. We often avoid awareness of our inner process because
along with awareness comes some kind of reflex judgment—we “like” it or we
“loathe” it. A whiff of anxiety, and we may immediately tell ourselves we are
being “stupid” for being anxious. An inconvenient feeling of tiredness in the
middle of dinner with friends may leave us feeling angry with ourselves, or
embarrassed, and inclined to “push away” the original feeling.
The emergence of consciousness

None of these complementary areas of ramification is originally or necessarily
conscious. But along the way, different kinds of “experiences” may be produced
that either enter consciousness directly, or are easily available to consciousness
should we turn our attention to them. They can include:
◆ a perceptual world (the phenomenological world of sights, sounds, and so
on that we inhabit)
◆ more or less clear bodily feelings, emotions, and moods
◆ inklings, hunches, promptings, and other kinds of intuition
◆ verbal or symbolic thoughts
◆ internal sensory and muscular images
◆ “memories” (images that come tagged as recollections of past events)
◆ expectations and intentions (feelings of readiness or anticipation).
It is widely agreed in neuroscience that conscious awareness—whatever it is
and whatever it is for—emerges alongside complex neurochemical states of bio-
logical organisms like us (e.g. Kinsbourne 1997). To a rough approximation,
consciousness seems to emerge when there is:
1 Intensity: External events are sufficiently abrupt or intense, for example, the
sudden ringing of an alarm bell or appearance of a bright light.
2 Persistence: Intensity seems to interact with the persistence of a stimulus: Less
intense events become conscious if they persist for more than around half a
second (Libet 1982). (At longer levels of persistence, consciousness often

fades through habituation, of course.)
3 Reverberation: Persistence may occur not due to physical continuation of an
external event but to conditions within the brain that allow activation to
reverberate, for example round a well-worn neuronal circuit where resist-
ance is low and activation can, so to speak, re-ignite itself. It is argued, for
example, that we can easily retain a sensible sentence in mind because its
elements “fit together” and create such a reverberating circuit; on the other
hand, a list of random numbers needs to be continually rehearsed if its elem-
ents are not to “fade away” and become inaccessible (Johnson et al. 2013).
4 Significance: Consciousness seems to be attracted by experiences that are of
personal significance. These may be threats to physical well-being or sur-
vival, or to possessions or personal attributes with which one is identified.
Even events weak in physical intensity gain access to consciousness under
these conditions: A creaking floorboard in a sleeping household; a disap-
proving expression on one face in an otherwise positive audience. Authors
such as Edelman and Tononi have suggested that self-related events attract
consciousness because they connect with a constantly active representation
of the “core self ” in the brain, and thus become part of a massively (and con-
stantly shifting) reverberating circuit (Edelman and Tononi 2000).
5 Checking: If functionally connected to the core self, even apparently neutral
or only very mildly significant events can potentially be subjected to more
extensive “security checks.” Candidate courses of action (such as a contribu-
tion to a conversation, as explored above) can be “held back,” if time allows
and if the cost of a (social) error is assessed as high. Dispositionally anxious
people may be constantly on the look-out for remote threat possibilities, and
thus become highly self-conscious or “inhibited” (Wells 2008).
The concept of the “core self ” needs a little more explication in this context.
First, it is not an aspect of experience, as was the sense of “I” that we talked
about earlier; it is a theoretical construct. It is seen as essentially a motivational
and emotional concept, representing a semi-stable plexus of self-related con-
cerns that “sets” or sensitizes the brain-body system to certain kinds of events.
These events become seen as potential threats to personal projects or self-
concerns, or as “grist to the mill” of these concerns. Sensitivity to criticism may
make that lecturer particularly prone to detecting disapproval in facial expres-
sions, or even to misinterpret neutral expressions as disapproving. Compulsive
flirts are “set” to notice attractive members of the audience who might be
approached and “chatted up” over coffee, or to imagine (correctly or mistak-
enly) that a friendly smile is an invitation to introduce some sexual banter or
The emergence of consciousness 61
innuendo into the conversation. So the core self consists of centers of activation
in the body-brain system that embody hopes, fears, assumptions, and beliefs
about the world, often derived from earlier life experiences. Having been
laughed at for making mistakes, for example, may leave error/ignorance as a
threat to the core self, and thus induce strategies of avoidance or perfectionism
as ways of warding off the perceived threat (Bucci 2011).
Some of the defense mechanisms, as just illustrated, involve tactical action in
and on the world so that the threatening circumstances do not occur. Other
defenses, though, involve protecting one’s self from the conscious experience of
threat or disappointment rather than from the occurrence itself (Hamilton
1983). For example, the ability to anticipate upcoming aspects of the unfolding
meaning patterns means that road-blocks and diversionary tactics of various
kinds can be set up, so that the anticipated experience of failure or fear does not
actually come about. We are able to “switch the attentional points,” as it were, so
that an up-welling train of thought is diverted onto a safer (more anodyne)
track. Through the deployment of cortical inhibitory processes, we become
able, as Daniel Goleman has put it, to ignore (inconvenient or threatening
aspects of) experience, and then ignore the fact that we have ignored it (Gole-
man 1985). Thus, what gets incorporated into conscious experience, or deliber-
ate descriptions of experience, may be not just a normalization of the original
seed of meaning (as described above) but (at a pre-conscious level) an expurga-
tion of it as well.
A final set of pre-conscious defensive strategies involve dampening visceral
and muscular signals of fear or anxiety in the body, so that they do not arrive at
the brain areas involved in the generation of consciousness—or do so only in an
attenuated state. Muscles can be tensed, for example, so that upper lips do not
quiver, as they otherwise might in the face of fear or distress. The throat can be
constricted, and muscles of the chest clamped, so that up-welling vocalizations of
distress can be contained (Trimble 2012; Vingerhoets 2012). (The feeling of
“choking up” that often precedes a burst of sobbing reflects this reflex attempt to
contain or disguise the impending expression of distress; it may be successful, or
it may be over-ridden by the irresistible strength of the original body-mind state.)
This has been a necessarily brief outline of the processes and phases that a
meaning-seed can go through, on its developmental journey from the visceral
core to its full-blown expression in body, action, speech, and mind. Even so, it
will be clear that the unfurling of meaning is potentially a whole body-mind
event, and also that the extent to which this event recruits processes that prod-
uce conscious experience is extremely variable. The conscious experience that
arises may be incomplete, edited, and distorted in a variety of ways. It may also
contain ingredients added along the way that are only there because we have
leapt to conclusions, or unconsciously stirred in beliefs and assumptions

designed to make the expression more palatable to any real or imagined audi-
ence (including ourselves). The Oxford English Dictionary defines “sophisti-
cated” as “mixed with some foreign substance, adulterated, not pure or genuine.”
Human consciousness is often highly sophisticated in this sense.
There is both Bad News and Good News in this picture. The Bad News is that
our conscious perceptions are not a reliable guide either to the way the world is,
or to the internal world of felt concerns, and it is therefore highly desirable—a
form of basic sanity, we might say—to have a tentative and rather skeptical rela-
tionship with our own consciousness. The Good News is that a good deal of this
unreliability stems from our own mental habits, and we are therefore in a posi-
tion, as we are with any habits, to practice alternatives and see if they stand us in
better stead. That, as I understand it, is what meditation is for.
How meditation helps

“I wonder if the Wise Lady from Philadelphia is still around?” I said.
“Who?”
“There once was a family who put salt instead of sugar into a cup of tea. Their name was
Peterkin, as I remember. So they went to the doctor and the grocer and the pharmacist
and God knows who else, trying to make salt taste like sugar. Nothing worked. Finally
they went to the Wise Lady from Philadelphia.”
“And?”
“She told them what to do.”
“What?”
“Pour a new cup of tea.”
Padillo leaned back in his chair and put his feet on the desk and looked up at the ceiling.
“You don’t remember her name, do you? If you do we’ll give her a call.”
Ross Thomas (2011)
The model I have outlined suggests several ways in which our attentional hab-
its change the nature of our experience, which can be both beneficial and
trouble-making. A degree of trouble is particularly likely to ensue if these
attentional habits become too rigid. We stir into our experience, as it is being
fabricated by the body-mind, a variety of assumptions that place unnecessary
constraints on our fluidity and equanimity, and then wonder why our experi-
ence, like the Peterkins’ cup of tea, is distasteful. Like the Peterkins, we are
inclined to go chasing after various nostrums for making life taste better, with-
out realizing that the key lies not in addition but in subtraction. Our left hand
added the salt whilst we were not looking, and the cure involves making a fresh
cup of tea, but this time without the unconscious adulteration. In fact we can
How meditation helps 63
be worse than the Peterkins. They just got it wrong once. We are capable of
behaving more like people who have been fed a post-hypnotic suggestion:
Whenever you make a cup of tea, surreptitiously add some salt, and then forget
that you have done so.
From my experience, mindfulness meditation involves a set of practices
designed to retrain these attentional habits so we can break the hypnotic spell.
Then we are able to see what we have been doing to ourselves, notice what our
inadvertent tampering has cost us, and try to change the habit. Basically, mind-
fulness training strengthens our ability to do three things:
1 To catch our experience earlier in the process of unfurling
2 To slow down the process of unfurling
3 To stabilize attention so that we can hold it still at different points in the evo-
lution of an experience and take a good look at what is going on there.
A lot of mindfulness training starts with trying to pay closer attention to the
physical sensations of the body, and/or the non-verbal world around us. Attend-
ing to the body enables us to dwell with greater awareness at the origin of our
experience, so that one becomes more capable of being in at the beginning of
the unfurling process. Two meditations I have been taught capture this aspect
well. One involves sitting on the brink of your own “unconscious” with the
same degree of dedicated vigilance and stillness that a cat might have as it waits
by a mouse-hole—except in meditation you have no idea what kind of creature
might emerge from the hole!
The second, similar practice is best done by people who have had the real
experience of travelling on the London Underground. You stand at the end of
the platform nearest to the tunnel from which the train is going to emerge,
and you attend very carefully to see if you can catch the very first, tiniest
intimation that a train might be on its way. Is that a slight stirring in the air
that I feel on my skin? Is there the faintest rumble of sound? Is that a minimal
gleam of light on the tunnel wall? Then you feel in as much detail as you can
the gathering intensity and detail of the experience, and finally the train
rushes out of the tunnel and hurtles past you . . . Having practiced this in the
real situation for a while, you then try to carry the same acute attentiveness to
the observation of your own “trains of thought” as they make their way toward
full awareness. A reverse practice is to ring a bell, and try to listen to it as it
fades away until there is a moment where you are not sure if it has gone or
not—and then to hang in the silence that ensues . . . All of these practices give
you a taste for what that open, attentive, expectant quality of attention feels
like, so that you can recognize it when it happens and thus work to make it
more frequent and more steady.
As we become more sensitive to subtle changes in breathing, or to the sweati-

ness of our skin, or to the feelings in our stomach, we are able to sense more
clearly how those feelings, in what Antonio Damasio (2011) refers to as the
visceral core of our being, relate to what is going on “center stage” in awareness.
We can slowly begin to notice more clearly the quality of sounds, sights, smells,
and so on, training ourselves not to rush too quickly into categorization. Some-
times, people develop a mental habit in which they only sample their experi-
ence of the world just enough to make a recognition or a categorization. Oh,
that’s just a bus going by. Or: Oh, that’s just my wife! The habit of rushing to a
secure identification means that we can ignore much of the detail that could
make those experiences more novel or interesting (stereotypically, we fail to
notice a new hair-style or pair of spectacles). I am certainly aware, at the end of
a week’s meditation retreat, that colors are brighter, sounds sharper, and food
tastier than it was before.
The practice of trying to maintain focus on some particular body sensation—
often the feeling of the rise and fall of the chest and abdomen as we breathe, or
the slight sensations of touch and temperature as air flows in and out of the
nostrils—gradually helps to retrain the skittery nature of attention, and
strengthens our ability to maintain a more constant focus. The butterfly nature
of much mental experience can be one of those defensive strategies that prevent
us from noticing what we don’t notice. Constantly surfing our own experience,
we don’t stay anywhere long enough to subject a particular moment to any
degree of scrutiny.
As these new habits begin to take hold, so the processes involved in the
unfurling or welling up of experience become more visible. We can begin to
notice the hand that has been slipping in the salt. This potentially has the same
kinds of benefit as therapeutic interactions such as Cognitive Behavioral Ther-
apy (CBT). People who are prone to depression, for example, often do not notice
(or if they do, do not question) the “little voice in the head” that threatens to
turn an instance of fallibility into a profound indictment of one’s self-worth. “I
forgot your birthday . . . Again . . . there you are, you see: further proof that I am
a selfish and unreliable friend . . . How could you like someone like me? Actually
you probably don’t . . . you probably just feel sorry for me . . . That’s what I am—
pitiful . . .” Mindfulness training is proven to be successful at cutting off this
downward spiral by enabling a person to bring these generalized and destruc-
tive self-judgments to light and reframe them as “passing mind-chatter . . . an
old tape that might have been relevant once, but which I neither need nor
deserve any longer . . .” (Teasdale et al. 2000).
Being able to “catch” your experience earlier can also help to prevent the over-
hasty conversion of the holistic “felt sense” of an issue into a familiar, rather
How meditation helps 65
formulaic, description. American philosopher and psychotherapist Eugene

Gendlin has investigated this process of heeding the embodied felt sense at an
earlier stage, staying with it, and allowing time for fresh words to emerge that do
better justice to the tangle of feelings that may be there (Gendlin and Rychlak
2000). He has found that clients who make good progress in resolving issues in
therapy are often able to sink into this kind of meditative thinking, while those
who stay stuck tend to trot out their “stories” with greater speed, clarity, and
certainty. Such stories may be self-justifying (and often are), but they do not
evolve or explore, and so they do not help you to make progress. Gendlin has
also found, however, that this knack of attending slower and earlier, which he
calls focusing, can be taught, and has demonstrable benefits. Mindfulness prac-
tice is not identical to focusing practice, but the attentional habits that mindful-
ness develops are of great use in the context of fruitful exploration of vexing
personal issues.
Gendlin has found that a similar shift in attitude toward the products of one’s
own mind is also conducive to more intellectual kinds of creativity (Gendlin
2004). He calls this process “Thinking at the Edge” (TAE), and again has shown
that this can be taught to good effect. The core process is similar to focusing:
One stays patiently with “an issue about which you know you have something
to say, but for which you do not yet have adequate words,” and allows different
formulations to arise, which are constantly checked back against the underlying
embodied sense of the issue. Both focusing and TAE cultivate the ability to
allow the fern of embodied meaning to well up at its own speed, rather than
rushing to neaten it up—and thereby losing some, or maybe all, of what was
fresh and valuable in the thought.
These shifts in attention also bring with them a greater tolerance for, and
interest in, ways of knowing that are not clear-cut and logical. Hunches and ink-
lings are more likely to be heeded, and given time to unfold, by a mind that is
not impatient for clarity and certainty. The poet John Keats called this attitude
“negative capability,” and described it as “when a man is capable of remaining in
doubts, mysteries and uncertainties, without any irritable reaching after fact
and reason” (Keats 1969). We know that (a) intuitions are often wrong, and (b)
they often contain valuable seeds of creative ideas, so they need to be treated
with a mixture of caution and credence. We also know that logical reasoning (a)
often leads to stupid conclusions, because in order to make logic work, you have
to leave out an awful lot of details, some of which may turn out to have been
crucial, and (b) often leads to valuable conclusions and predictions, so . . . ditto
(Claxton 1997). Mindfulness increases intelligence, we might argue, by encour-
aging a more accurate and balanced view of our ways of knowing. Instead of
explicit rational thinking being the cuckoo in the nest, trying to hoof out all the
other ways in which our interior signals to the exterior what is going on, we are
able to accept and heed them all— adjust spacing thinking, feeling, imagining,
acting, intuiting—as all being both potentially valuable and potentially flawed.
The effects of meditation on perception and creativity are nicely demon-
strated in a study of the reaction to Rorschach images by two groups of experi-
enced meditators by Daniel Brown and Jack Engler (1984). One group had been
developing the ability to keep attention fixed for long periods on a physical
stimulus, without their minds wandering. When asked “What do you see in the
pictures?” this group gave detailed physical descriptions, but very few associa-
tions. By contrast, the group who had been developing open, accepting
mindfulness—just watching the meanderings of their own minds without judg-
ment or restraint—gave dozens of bizarre, and sometimes taboo, reactions to
the pictures, but with great humor and equanimity. Their reaction was, “Well,
it’s just my mind at play; why should I get upset about it?”
In general, mindfulness seems to enhance this kind of equanimity. One is able
to observe the shenanigans of one’s own mind without either “attachment” or
“aversion” (as Buddhists would put it). Instead one can be just interested,
amazed, and often amused by its firework display. Indeed, because “self ” and
“conscious experience” are both seen as aspects of a spontaneous process of
welling up, the sense of being an observing (or instigating) self itself wells up
just as much as the content of consciousness does. The sense of an abiding self
who tries to own or control the rest of the mind is replaced by a feeling that both
self and mind arise simultaneously out of a deeper, larger, and in some ways
more impersonal process. So the fear of being “let down” by one’s own mind,
and of having to guard against the awful possibility that Freudian leaks will
betray you to your neighbors, begins to melt away somewhat. The endless battle
between Ego, Super-ego, and Id runs out of steam as they all wearily admit to
being fictitious, and a kind of fond or gently ironic humility replaces it, due to
the fact that you know your world to be substantially based upon a tissue of
assumptions, all of human construction, and all capable of being contested.
There is a sense of being more at home in (and with) a view that embraces more
fluidity, multiplicity, and uncertainty. Alan Watts once wrote a book called The
Wisdom of Insecurity (Watts 1954). It is that kind of wisdom that mindfulness
practice seems to offer.
Last, and most importantly, mindfulness seems to lead to a recapturing of
greater closeness, kindness, and tolerance for other people, as well as ourselves
(see Brown et al. 2012). I say “recapturing” because this mixture of intimacy and
care seems to be innate. Young children are naturally empathic, altruistic (up to
a point), and helpful (Svetlova et al. 2010). Apparently we are designed to be
part of what Jerome Bruner once called the web of social reciprocity (Bruner
2006; Trevarthen and Aitken 2001). The science of embodied cognition has
generated a lot of research on the multiple (but often unconscious) ways in
which we are connected to each other “below the waterline,” so to speak (e.g.
Thompson 2007). But as we grow up, and the self comes to seem more real, and
its complicated plexus of self-related concerns and anxieties more urgent and
intractable, so those natural virtues become things we need to remind ourselves
to value, rather than things that just well up when called for. As mindfulness
does its lubricant and solvent work, so those virtues, in abeyance but seemingly
not lost, come forward once more and play a larger part in our portfolio of felt
concerns.
Conclusion
With a few conspicuous exceptions (such as the work of Teasdale and Chaskal-
son 2011a,b), research on meditation has not linked as strongly as it might with
research on cognitive science and the study of consciousness. This is partly
because some of the most common core metaphors for thinking about con-
scious experience—the central executive, the computer operator, and the
spotlight—do not seem to offer much of a purchase on the processes, experi-
ences, and outcomes that are associated with meditation. In particular, they
have no obvious role for acquired habits, especially habits of attention, in con-
structing conscious experience, so it is less clear in those models exactly what
psychological processes are undergoing change through meditation, and how
that change happens. Nor do they suggest how experiential and behavioral
change might be linked. The metaphors of unfurling and up-welling, however,
seem to offer promising avenues of enquiry in this regard. In particular, we have
identified a variety of attentional and perceptual habits that might be involved
in creating the unsatisfactoriness (dukkha) of experience that brings people to
meditation in the first place, and which also seem amenable to alteration
through the practices of meditation. On the view I have sketched here, we seem
to have the beginning of an explanation as to how mindfulness can contribute
to making people kinder, more relaxed, more creative, and more perceptive. As
the Buddha might have said, “What’s not to like?”
I remember when I was an undergraduate at Cambridge going to a talk in Trinity Col-

lege about transcendental meditation given by a graduate student. I was intrigued, not
least because this chap, whose name I have long forgotten, was studying chemistry, like
me. I think I was reassured that, if another chemist (tweed-jacketed and quite nerdy; I
do recall that) was interested, it couldn’t be too wacky. (I now know that this touching
faith was quite false, and that physical scientists are if anything more prone to believing
weird things than your average bear.) Never one to rush in, it was two years later when
I presented myself, a clean handkerchief and two pieces of fruit, at a house in Oxford
and was given my secret TM mantra.
I didn’t stay with TM long—I liked the practice but not the organization. After my D.Phil.
I moved to London and got involved in all kinds of personal development pursuits—
encounter groups, the est training, you name it—and started doing meditations at a
center in Chalk Farm called Kalptaru run by followers of an Indian guru named Bhag-
wan Shree Rajneesh (as he was known then, later Osho). Bhagwan had become the sort
of patron saint of many of the therapists I’d worked with and admired. I’d motorbike
over from my flat in South Kensington at 6 o’clock in the morning to do “dynamic medi-
tation,” which was about as far from sitting sedately on a cushion watching your breath
as you could get. There was wild music and you wore a blindfold and danced chaotically
and cathartically for three-quarters of an hour, and then on the gong you froze where
you were and stood in silence for ten minutes . . . and then finished off with a gentle
floating dance to bring you back. I loved the physicality and the contrast between the
wildness and the stillness.
(Bhagwan was of the view that Westerners had such busy minds that it was impossible
for us just to sit still—you had to expel the accumulated thoughts and concerns through
physical activity before you could really enter silence—and I certainly found that to be
true. He also said that too many people tried to use meditation as a short-cut to escap-
ing from neurotic patterns, and that was a misuse. I’ve certainly found that lots of
retreat-goers—myself included—are in flight from unwelcome realities. A kind of
superimposed equanimity isn’t worth much.)
Then I’d go and have a bacon sandwich and a coffee and go to give lectures at the
University of London. I ended up “taking sannyas,” as it was called, which meant
becoming a follower myself, and making trips to Bhagwan’s ashram in Pune, India.
He developed a controversial reputation, but it was all good, emotionally-releasing
stuff for a rather uptight, clever Englishman, and when I disrobed seven years later it
was with nothing but gratitude and good memories. But I had got fed up with the
uniform. You had to wear “orange”, which, in those days, included everything from
brown to pink.
It wasn’t all wild; I remember doing a classical silent ten-day vipassana retreat on the
roof of a mansion near the ashram. Something of that must have got into my blood
References 69
(along with a lot of itchy chemicals from the clouds of mosquitoes feasting on us),
because I moved, over the next few years, from the white-water rides of sannyas into an
exploration of many different Hindu, Sufi, and especially Buddhist forms of meditation.
I did Zen retreats with Maezumi Roshi and Thich Nhat Hanh; Tibetan retreats with Sog-
yal Rinpoche and Namkhai Norbu; vipassana retreats with Christopher Titmuss and
Sharon Salzberg; and one wonderful retreat in Devon with Ram Dass, who epitomized
for me the synthesis of the red-blooded, iconoclastic aliveness of Bhagwan and the
authentic peace of the best Buddhists. I never joined anything for long, but I learned a
lot along the way, and ended up with a simple, open mindfulness practice that I do in
odd moments. I still have a zafu and a cushion in my office at home, but rarely use them.
I like to think it has all seeped somehow into my bones and given me a richer register
of ways of being an ordinary human being than I had when I was the cocky, clever, cal-
low young man who went to that talk in Trinity.
Acknowledgments
I am grateful to my friend Michael West for his very helpful suggestions and
encouragement. This chapter formed the basis of Chapter 8 of Claxton, G.
(2015). Intelligence in the flesh: Why your mind needs your body much more than
it thinks. New Haven and London: Yale University Press.
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Chapter 4
Fish discovering water:

Meditation as a process
of recognition
James Carmody
Introduction
Forty-some years practicing in the three main Buddhist traditions and Advaita,
together with teaching meditation and researching the psychological effects
and neural mechanisms of mindfulness training, has shown me the need for
a clear and parsimonious description of the attending processes associated with
meditation practices that address psychological distress. In this chapter I have
aimed for such a description: an uncluttered and jargon-free explanation using
cultural constructs and principles familiar to non-practitioners. It is one I would
have liked to have had access to when first introduced to practice.
To do this, I place the description in a broader context of human development
and use the lens of natural selection pressures that have resulted in default and
habitual vigilance-related attending processes serving the survival and safety-
related needs of the social creatures we are. Central also in these processes is the
sense of personal agency and ownership that has evolved along with a reflective
capacity to imagine that things could be better for me than they are. The affect-
ive downside of this biological imperative is the sense of unease or dissatisfac-
tion in the mind-body. Mind training practices used in the meditation traditions
are designed to relieve this everyday malaise.
I then describe the psychological processes and principles that these skills draw
upon and develop in supporting the recognition or regulation of these default
attending processes, and the role these skills play in the cultivation of a more salu-
brious experience of everyday life. A number of ostensibly different meditation
practices draw upon these generalizable principles, as do Western psychothera-
peutic modalities; one or more of them can be seen at play in the arousal- and
distress-reducing effects of the training exercises used in mindfulness, TM, mantra,
tai chi, yoga, and reiki, as well as such psychotherapeutic modalities as progressive
muscle relaxation, symptom monitoring, CBT, biofeedback, and loving-kindness.
74 Fish discovering water: Meditation as a process of recognition
To clarify terms, I describe two senses in which meditation “practice” is used

in discussions of meditation and the unnecessary confusion created for begin-
ners when these become conflated. I then go on to discuss the advantages of
embedding the mechanisms by which meditation systems have their effect on
stress/distress within this broader ecosystem of mind-body attending pro-
cesses. It draws attention to the common processes in the training exercises of
apparently disparate meditation traditions, demystifies the idiosyncratic lan-
guage and terminology of specific modalities, and highlights the commonal-
ities these traditions have with psychotherapeutic systems.
This approach provides the clinician with a useful conceptual coherence and
a more synergistic understanding of the mental processes associated with vari-
ous mind-body programs and the extent to which they can affect stress/distress.
It also affords a few relatively simple principles clinicians can use to tailor
explanations and presentations coherent with a patient’s interests and back-
ground, so making the skills that meditation represents more meaningful,
approachable, and accessible to the patient.
I end by raising issues I think are worth considering but that receive little
attention in the meditation literature. These include the cultural and political
values that derive from East Asian cultures that may remain embedded in
meditation as it is taught and practiced in the West, and the assumptions
often made about the effect that wider use of meditation may have upon the
broader culture. Removing meditation and its mechanisms from traditional
and dharma-related language and assumptions in this way also allows us to
consider afresh the broader context in which it finds its place; to ask anew
such questions as why we are not naturally at ease and why something like
meditation is needed in the first place, and how it is that we do not recognize
or remember the formation of the habits of attending that shape the valence
of our lives.
I begin by considering these fundamental questions:
What is the origin of human angst? Why is ease

not a natural condition of everyday life? Why should
we even need something like meditation?
The experience of human suffering and angst has not unreasonably occupied
human beings for millennia—probably since we developed the sense of an
ongoing “I” with its accompanying existential dread and the capacity to
imagine that things could be different for me than they are. And because our
perception of problems is shaped by the analytic glasses through which we
view the world, our imagined solutions also flow from the ascribed source of
the problem.
Introduction 75
Throughout much of history this suffering has been ascribed to one or more
deities taking offense at our individual or collective behavior, and the methods
and programs prescribed to appease these capricious animations in order to
obtain relief have ranged from the somewhat reasonable to the bizarre. Episodi-
cally, however, more rational analyses ascribing suffering to naturalistic causes
and effects have arisen.
During the time of the European Enlightenment, for example, critics focused
on environmental deficiencies. These have included the system of education or
parenting, the political institutions and systems under which we live, and the
stressful economic and time pressures on family life that result. Such critiques
gave rise to the enduring and familiar social/political movements that have
become part of the accepted fabric of modern life.
Analyses ascribing the roots of suffering to individual and interior psychic
processes also have a long history in both the East and the West, and were per-
vasive and enduring in South Asia. Among these, the Buddhist explanation was
radically internal and firmly located the source of suffering in a fundamental
ignorance of the way perceptions are shaped in the human psyche, with its
attendant craving and downstream experiential fallout. Meditation, the term
that has become a grab-bag of reflective practices designed to make this process
apparent, was an integral part of a prescribed eight-faced escape route. But on
the more fundamental question of why this ignorance-based misperception
should be initially present in the psyche, the Buddhist analysis offers little more
than the construct of karma.
Every age describes the psychic process in terms of the cultural beliefs, lan-
guage, and constructs of the time. And, although the notion of karma can be
a convenient story in addressing everyday unease, it amounts to little more
than whatever happens does so for a reason also rooted in ignorance in some
near or far personal past. Such a circular narrative provides little explanatory
power in the face of the question of why the initial ignorance should be present
and is unlikely to hold much water with skeptical minds. Questions such as
this gain importance in our secular world, where the accessibility and coher-
ence of the conceptual framework within which meditation is presented can
make the goals and challenges a beginner may face in getting started more or
less meaningful.
In this respect, evolutionary theory and the pressures that have shaped our
organism, as well as advances in social science since the Buddhist psychic map
was laid down, enable a framework that more broadly responds to the question
of why, after so many millennia of evolution, we inhabit an organism so ignor-
ant of its own fundamental psychic processes that, having attained adulthood,
it requires an experiential educational recall.
The formative role of evolutionary pressures

in everyday attending
Evolutionary theory allows us to consider and appreciate the body-mind as an
ecological system developed in the service of meeting our human needs, the
most primal of which are for survival and reproduction. And the advantages
bestowed by some measure of safety in supporting survival has given rise to the
attendant second-order social needs for relationships, power, and status that
exert such entangled pressures, shaping the cooperative-competitive creatures
we have evolved to be. Given that our senses and nervous system detect and
process large amounts of possibly useful information, attention—the capacity
to consciously experience some portion of this information—is vital in the sys-
tem’s design for meeting our needs.
This capacity to focus attending resources and give priority to parts of experience
perceived as supporting, or having the potential to support, our human needs has
clear survival value. And accomplishing this with reactive immediacy rather than
through more slowly-operating deliberative cognitive functions bestows even
greater value. Unfortunately, even as this automatic and rapidly moving attention
serves its vigilance function by highlighting threats and opportunities for the satis-
faction of needs, we experience an attendant downside in the affective realm.
The affective downside of these default attending

processes
The experiential downside of these automatic movements of attention results
from two associated features. First, its vigilance function means that attention’s
everyday focus is more or less threat-based. The second feature derives from the
automaticity with which biological arousal levels follow the valence of the
object of attention, meaning that the threat-based perceptions result in some
measure of arousal-related bodily constriction. The feeling tone associated with
these constriction- or tension-related sensations is to some degree unpleasant,
with the degree of constriction-related unpleasantness depending upon both
the perceived level of threat and our perceived capacity to deal with it.
These very rapid default movements of attention would not be a problem to
our ongoing felt sense if the alerts were transitory and arousal naturally rapidly
returned to a quiescent state. This appears to happen with animals in the wild,
and possibly did for earlier hominids when physical survival was their primary
concern. Survival in the face of immediate physical danger required attention to
be predominantly awake to their senses and, the changing conditions of their
bodies, and the physical surroundings (sights, sounds, tastes, and tactile and
Recognizing these threat-based themes in everyday angst 77
kinesthetic sensations). The physical danger of the proverbial saber-toothed

tiger was seen, arousal levels spiked, it was dealt with in some way, and arousal
levels went down once again.
Today, with our needs for physical survival largely met through the institu-
tions of society, concerns associated with the second-order social safety-related
needs for relationships, status, and power have become predominant in our
attention. And, unlike immediate physical safety, satisfying and maintaining
these needs entails ongoing cognitive activity involving imagination and com-
plex planning. Because these also depend upon the indeterminate behavior of
others, even a momentary satisfaction is then threatened by changing circum-
stances. And so this cognitively-driven vigilance never stops; attention con-
tinues to scan for imagined threats and circumstances perceived as important
in maintaining the need’s satisfaction.
The result of attention repeatedly defaulting to, and dwelling upon, threat-
based themes is some degree of elevated arousal, its accompanying measure of
muscular tension, and the attendant less-than-pleasant sensations of constric-
tion. The everyday rub, then, of this gift to our survival is that we rarely feel
completely relaxed and at ease in life, and at times experience the intense men-
tal suffering that can result from this tendency.
Recognizing these threat-based themes

in everyday angst
These default mind-body processes can be recognized experientially by noticing
where, and to what, our attention goes from moment to moment. When unreg-
ulated, or not required for the completion of some physical task, attention rarely
rests upon immediate sense impressions and bodily sensations. Rather, it
defaults to cognitions: thoughts about these and a myriad other things. And our
social safety-related needs for relationships, status, and power mean those
thoughts often concern the welfare of family and friends, whether we are in
some way loved or sufficiently loving, or livelihood and money. This concerns-
based cognitive commentary is experienced as the internal monologue.
Based in memory and imagination and often only peripherally related to sen-
sory function, the internal narrative relentlessly plans, seeks, compares, judges,
and regrets. Its needs-related function is seen in those emotionally-tinged thoughts
and images experienced as concerns, worries, and transitory joys about family and
friends, work, money, and one’s own social standing. Attention preoccupied exclu-
sively with this cognitive monitoring is experienced as rumination.
The power of the biological imperative driving attention’s vigilance role in this
way can be experienced when we attempt to bring some degree of self-regulation
in the face of these processes. For although we have the capacity to deliberately
bring attention to many parts of experience, attempting to keep it on one con-
sciously selected object makes its own persistent intentions apparent.
Meditation practices cultivate mindfulness

of this dilemma
Meditation practices are designed to bring awareness to and/or modify these
default mental processes; to become mindful of them dwelling on threat-based
themes and the resultant less-than-pleasant felt sense characterizing so much of
life. Unsurprisingly, then, these practices usually begin with an attention-
related exercise. We may, for example, be asked to direct attention to the sensa-
tions of breathing and to keep it there. But despite our resolve, we notice that
within seconds it shifts to some other facet of experience; a phenomenon we
refer to as a wandering mind.
Wandering is a misnomer, however, for it implies no clear destination. And if,
instead of taking the wandering designation for granted, we become curious
about what our “wandering” attention moves toward and what drives it to move
in this automatic way, we begin to experientially understand the role this won-
drous capacity plays in supporting our lives and the biological imperative that
drives it. We begin to experientially recognize something of the ecology of our
minds. This improved understanding allows us to be more sympathetic toward
it and to work with it more skillfully, rather than regarding it as just an unfortu-
nate obstacle we must train or in some way overcome in order to “meditate.”
However, before discussing further how meditation practices support deal-
ing with these default processes, it would be as well to specify the way in which
I am using the terms “meditation” and “practice”.
Clarifying the terms “meditation” and “practice”

One of the issues this volume will no doubt grapple with is the wide-ranging
uses of the term “meditation” and their associated connotations. In both popu-
lar and scholarly literature these extend from evoking the supernatural, spirit-
ual, mystical, and exotic, to the more mundane experience of a quiet moment
listening to music or taking in a landscape, or quietly thinking about some-
thing. Each of these uses of the term attracts some people.
As a jumping off point I use the Wikipedia definition of meditation: “a prac-
tice in which an individual trains the mind or induces a state of consciousness
either to realize some benefit, or as an end in itself.” It is a useful starting point
because it is bare and unadorned and does not attempt to describe and define
the possible benefits or states of consciousness. I like it also because it places
Meditation as “practicing my jump-shot to get better at it during a real game” 79
“practice” upfront and artfully goes on to describe two different meanings of

practice that can be used in reference to meditation.
In the first meaning, meditation practice is used in the sense of “I’m prac-
ticing my jump-shot to get better at it during a real game.” In the other it is used
in the sense of “I’m practicing my profession, having preceded this with an
apprenticeship during which I gained competence in the skills it entails and
which I now execute with expertise.”
While these two meanings of practice overlap and intertwine, either explicitly
or implicitly, both academic and popular writing and instruction on meditation
refer to practice in both senses and in ways that are not often made clear. Some-
times also they are conflated, with an apparent or stated assumption that the
meanings are not in fact different or fruitfully distinguished between, invoking
catchphrases such as “not doing,” “no effort,” or “just being.” But invoking para-
dox to explain away the apparent and sometimes obvious contradictions in these
ways of approaching meditation is not helpful to those first approaching the
field, even in the interest of pre-empting a beginner’s tendency to separate “life”
from “practice.” Rather, making the distinction clear in instructions can be use-
ful for beginners, especially in clinical settings. For, as I discuss below, the psy-
chological processes involved in each sense of the word are different in important
ways, and competent instruction can fruitfully support the development of each.
I focus initially on the first sense of meditation practice as “practicing my
jump-shot to get better at it during a real game”. I describe the psychological
processes activated by the attending skills embedded in the beginning instruc-
tions commonly used in a variety of meditation traditions, and the connection
they have with the experience of distress and well-being. I then go on to discuss
the second sense in which meditation practice is used, as in “practicing my pro-
fession with expertise, having gained competence in the skills it entails,” by
describing the recognitions that can be established as a result of this kind of
attending and the effects these too can have in everyday life.
Meditation as “practicing my jump-shot to get better

at it during a real game”
In order to meaningfully describe the psychological process through which men-
tal distress is experienced, and the process by which the practices people are usu-
ally asked to do under the name of meditation address these, it is useful to recall
the three phenomenological components that Buddhist analysis incisively lists as
comprising experience. These are sensations, cognitions, and the pleasant/
unpleasant feeling tones associated with those. Everyday experience and emotions
are a symphony of the interplay of these most fundamental experiential elements.
Fearful
Thought /Image
Sensations of Unpleasant
Constriction Feeling Tone
Fig. 4.1 Components of

experience are undifferen- In its vigilance function unregulated attention
tiated experience appears maintains distress-related cycles of association
seamless. ‘I feel tense/anxious all the time... This is who I am’
While this seems straightforward enough, for reasons I discuss below, a fea-
ture of the root ignorance referred to earlier is that these components are not
usually recognized as differentiated in everyday experience. And to make things
even more difficult, they are locked in apparently seamless, conditioned cycles
of association; these can start with any of the components. For example,
a thought may be associated with a particular feeling tone and bodily sensation.
The sensation then reminds us again of the thought and off the cycle goes,
sometimes for lengthy periods.
Figure 4.1 illustrates one of these cycles operating in the experience of
worry. An alarming thought is associated with some sensation of bodily con-
striction, which results in an unpleasant feeling tone; the unpleasant feeling
tone then reminds us again of the thought. This undifferentiated and distress-
ing cycle forms and reforms millisecond by millisecond and, by compelling
attention in its adapted vigilance function, becomes self-sustained, some-
times for hours.
So how do the mental tasks people are asked to perform in “meditation prac-
tice” as a “jump-shot” result in experiential benefit in the face of the psycho-
logical processes sustaining the dilemma illustrated in Figure 4.1? They are
actually familiar psychological mechanisms.
The initial and fundamental practice used in many meditation traditions is to
introduce some measure of control of attention by directing it to a specific sen-
sation, thought, or feeling; in meditation parlance these are called mental events
or objects. This may involve attending to bodily sensations such as those of the
breath, the kinesthetic sensations of a sitting posture or sequence of move-
ments, the aural sensations of a mantra, the visual sensations of an image, or
a specific thought or feeling. In learning to attend to them singly, or in combin-
ation, the components comprising experience are explicitly or implicitly recog-
nized and differentiated, so creating an opportunity for some measure of
self-regulation. This is illustrated in Figure 4.2.
Meditation as “practicing my jump-shot to get better at it during a real game” 81
Fearful
Thought/Image
Fig. 4.2 Opportunity

opens for self-regulation as
Sensations of Unpleasant components of experience
Constriction Feeling Tone
are recognized as differen-
tiated and connected.
This is not done with the intention to push the experience away but to recog-
nize it for what it is and how it is created. A profound acceptance is implicit
within this recognition.
Next, the deliberate re-direction of attention from its default predilection
toward an arousal-neutral mental object interrupts the conditioned cycle of
association maintaining distress, and sets up a more arousal/affect-neutral
cycle. This is illustrated in Figure 4.3.
The process of differentiation of the components of experience, and recogni-
tion of their nature as mental phenomena, is sometimes supported by mentally
labeling or noting these events as thoughts, sensations, or feelings as they are
occurring. Attention is usually directed toward the content or meaning of the
components and their conditioned associational cycles as in Figure 4.1. Bring-
ing attention instead to a cognitive evaluation of their nature as events in the
mind draws attention from their distress-maintaining content or meaning,
while simultaneously functioning as an arousal-neutral evaluation of them.
This is sometimes called meta-awareness.
This, then, is the generic mechanistic picture of the psychological nuts and
bolts of meditation practices as they affect everyday arousal levels. Feedback
from clinicians attending my courses on introducing mind-body principles
into clinical care indicates the utility of these principles as a conceptual
Fearful
Thought/Image
Sensations of
Fig. 4.3 Conscious redirec-
breathing
Meta-awareness
tion of attention to chosen
Mantra/Prayer
Visualization
affect-neutral/positive
Loving kindness object of attention inter-
Sensations of Unpleasant rupts cycle and forms a
Constriction Feeling Tone new more affect-neutral or
positive cycle.
framework for both beginning the clinicians’ own experience of mindfulness

and mind-body practice, and in presenting and teaching these to their patients
within the time constraints of a typical primary care appointment.
John Lennon once wrote that life is what happens to us while we are busy
making other plans. And given that so much of life is spent with attention pre-
occupied by infinitely varying combinations of these angst-inducing cycles of
mental components, it is useful to ask why the process is not ordinarily appar-
ent to us. Why should we need to undertake these kinds of remedial classes?
Why these angst-inducing patterns of attending

are not ordinarily apparent to us
In considering the question of why these kinds of mental exercises should be
needed to support recognition of these patterns and habits of attending that
shape so much of our felt sense of everyday life, it is useful to reflect on the way
we attend when we first come into the world, and how this incrementally
changes during development. As any parent can attest, we start off as sensate
creatures; attention focuses on bodily sensations—touching, tasting, hearing,
seeing, and their pleasant and unpleasant feeling tones. Parents get to hear
loudly when it is unpleasant. As language and socialization develop, cognitive
processes become gradually integrated into the perception of sensations and
feelings, and woven into the fabric of the emerging “I”; an implicitness that
makes them inaccessible through the usual processes of memory recall, and so
invisible to us. In this way, these patterns become the everyday water of experi-
ence we swim in and are not noticed in the way water is invisible to a fish.
The developmental process of this moment-to-moment forming and reform-
ing of conditioned perceptual mental processes implicitly shaping our felt sense
in the everyday world can be illustrated through the parallels it shares with the
process of learning to read. When, as adults, we see a sentence such as “The cow
jumped over the moon,” some thought or image is immediately created in our
minds, probably involving a cow and the moon. We are not consciously aware
of the process of recognizing the letters and their combinations as words com-
prising the sentence—it has become automatic. We may not even be consciously
aware that we are reading. But of course we did not start off with this immediate
recognition. Rather, we went through a painstaking process of learning letters
and how they combine to form words that can then be joined in sentences to
abstractly represent the world and our experience of it.
Meditation practices are designed to help us recognize perceptual processes
that have become as automatic as reading. To torture the metaphor a little fur-
ther, they help the practitioner to recognize that everyday experience is
Practitioners use meditation to suit their individual purposes and interests 83
comprised of sentences constructed from the letters that are fundamental

components of experience: thoughts/images, sensations, and their pleasant/
unpleasant feeling tones. Meditation practices support this recognition in
three interconnected ways: (1) cultivating curiosity about how the valence of
experience is constructed from moment to moment—without this interest the
rest does not follow; (2) experientially recognizing and discriminating
between the components comprising experience and the near-immediate for-
mation of their closely associated conditioned cycles; and (3) developing some
capacity for self-regulation of attending in the face of this.
Before going on to the second sense in which meditation practice is used, it is
useful to consider for a moment the widely varying goals people have in mind
when approaching meditation and how these variations may shape the way it is
described and approached.
Practitioners use meditation to suit their individual

purposes and interests
People approach meditation with different levels of interest and with diverse
aims and ends in mind. This has been true throughout its history. In the clinical
context a person may be satisfied with learning to direct their attention to the
sensations of breathing or a mantra in a way that interrupts attention’s preoccu-
pation at times of stress. Or through something like the body scan, hatha yoga,
or tai chi they may discover greater delight in everyday life as a result of atten-
tion being less preoccupied with the vigilance-based cognitive process and
more attuned to their bodily/sensory experience. Still others will make skillful
use of the associational cycles of thoughts, sensations, and feelings to cultivate
a preferred suite of these as in metta (loving kindness) practices, affirmations,
and prayer. Most people probably use some combination of these. Some also are
interested in ideas of enlightenment, transcendence, and spirituality and this
leads into the second sense in which meditation practice is used in the working
definition.
Being vigilance-based, the cognitions associated with seeing are often associ-
ated with some degree of arousal. But occasionally, circumstances are such that
we find ourselves in a situation where the thought associated with vision stops,
such as when a beautiful sunset or the face of a child captures our undivided
attention, and wonder and awe naturally come to the forefront. These were
always available behind our preoccupation with the cognitions. Meditation
then becomes about bringing curiosity to the everyday process by which this
occurs so that the experience of awe and wonder is less dependent upon ran-
dom circumstance and becomes part of our everyday experience. Both the
exercises and the curiosity are needed; without the exercises, the curiosity tends
to become once again preoccupied with cognitions about the process and so
more of the same. And without the curiosity, the exercises become an end in
themselves with little spill-over into everyday life. This brings us to meditation
practice in the second sense.
Meditation practice in the second sense

As described in the first sense in which meditation practice is used, the training
exercises result in some level of recognition; the extent and depth of this will
vary according to the kind of interest the practitioner brings to it and their level
of ongoing curiosity. Some will be satisfied with recognition of the automatic
perceptual processes and the capacity to redirect their attention to an affect/
arousal-neutral mind object and the accompanying reduction in distress. Oth-
ers will have gained a deeper awareness of these ongoing mental processes and
will remain curious to take the enquiry further.
This is meditation practice in the sense of “I’m practicing my profession, hav-
ing preceded this with an apprenticeship during which I gained competence in
the skills it entails, so that I am now able to execute them with expertise.” This
second sense of practice is often regarded as its original intent, and the many
forms it takes are shaped by the culture and traditions within which the person
developed their attending skills and also their temperament; factors that are
themselves probably not unrelated.
Cognition is the most challenging mental component to recognize clearly
since, as I described above, it is intimately and implicitly woven into the fabric
of experience and identity. And so, while the most obvious thoughts, such as
“Mary is wearing a red dress” or even “I’m noticing a fearful thought,” are read-
ily observed and labeled, the more subtle cognitions also become more and
more apparent as the enquiry proceeds, including into that of “practitioner”
and “observer-noticer.”
Experience through practice in this sense also makes apparent the essential
translucency of cognitions as mental phenomenon; a recognition that results
in attention no longer being automatically captured by their content—what
they are about or mean. As a result, attention’s preoccupation with the cogni-
tive processes of memory and imagination, which often prevents us from see-
ing things and people with freshness and curiosity, is undermined. Recognition
of the tyranny that ruminative preoccupation has been exerting over life, per-
ception, and well-being is a great release; cognition can now be engaged with,
or not, as the situation merits. The person is using thought instead of being
used by it.
The qualities of presence 85
Happily, this recognition is a lasting change; lasting in the way a fish’s relation-
ship with water might be permanently changed when, having being taken out of
the water for an instant, it is returned to it. The fish has no organ for the perception
of water; it was born into it and can only see things within water; recognition
comes through its momentary absence, opening the mind to awe and wonder.
Some will be satisfied with the greater freedom and enjoyment deriving from this.
Those curious to investigate further may engage in a more penetrating inves-
tigation into the “I”-ness of things—the sense of ownership of I-related experi-
ence and the moment-to-moment creation of the sense of personal agency.
Here a more contemplative approach is required, since every attempt to frame
and investigate the question cognitively leads back into the familiar territory of
memory and imagination. And instructions, being language-based, inevitably
lead into the same cul-de-sac of infinite cognitive regress. Zen literature is
replete with stories of teachers attempting to bypass this dilemma as they try to
foster the particular kind of interest and curiosity required in their students.
Meditation practice in this sense leaves behind canonical vessels and
approaches the pathless referred to in a number of traditions. The direct experi-
ence emerging from this kind of enquiry bestows clear, and at times jaw-
dropping, recognition of how the world as we know it is created and that “mind”
is the name we give to our interpretive experience. When meaning imbues eve-
rything, words like “spiritual” become redundant; even time past and future is
recognized as a creation of memory and its partner imagination.
The difference between the two approaches to practice may be summed up in
the following way. The first recognizes the principles and rearranges the compo-
nents of the cycles so that they are more salubrious (less arousal-inducing), even
if the cycle is one that assures one that this is passing and you can just “watch it.”
The second seeks to undermine even this perceptual cycle by transferring inter-
est to the knowing itself. As such, it encompasses a more penetrating interest and
curiosity in addition to the cultivation of attending skills. That which knows
begins to become of more interest than that which is known and deep levels of
satisfaction and peace integrate themselves into everyday life as a result. Nothing
in the world encourages this shift in interest—in that sense it is truly unworldly.
The qualities of presence

As the narrative meaning of mental contents (thoughts, sensations, feelings)
arising in awareness no longer automatically compels attention in the old way,
the presence of awareness itself becomes intuitively recognized. Awareness can-
not be perceived or cognitively apprehended; perception and attention are
designed only to recognize objects arising within it. It is an intuitive recognition,
accompanied by ease sweeping through the body-mind. I prefer the term “pres-
ence” to “awareness,” which has established associations and meanings, although
other people will have their own, different names for this.
A number of other previously masked features of mind become gradually or
startlingly apparent with this recognition. Among these is that presence itself is
imbued with qualities of meaning and peace, faith, gratitude, as well as joy—
their companion and fellow-traveler—and a deep empathy for the suffering
embedded in nature. We recognize how these were missed as interest and curi-
osity were instinctively preoccupied with the mental objects arising in this field;
that the meaning and joy in the seeing itself have been apprehended through,
and attributed to, the narratives and mental constructions reflecting them, and
that the same preoccupation has diluted empathy and responsiveness.
As tribal creatures, this should not be surprising to us. Our adapted capacity
for the cooperation upon which our very lives, and the lives of our children,
depend is powerfully bound to and dependent upon our collective, and more
intimate and personal, imagined narratives and stories; rich narratives of iden-
tity and connection that infuse our loving. These impulses, deeply-rooted in the
more primitive past of our nervous system, also form the basis of ongoing
human conflict and divisions and do not readily surrender their fascination to
a more recent cerebral interest in reflective enquiry of unproven survival value.
The elusiveness of freedom becomes apparent when just the suggestion that
these are collective imaginings, albeit essential ones, and that they can be appre-
ciated as such without compromising the relationships they suffuse turns out to
be a bridge too far for many if not most.
The imagery and language used to describe this process of recognition and
direct experience reflect the cultural ground and narratives that surround it, as
well as the practitioner’s beliefs and temperament. This is seen in the interpret-
ive reflections contemplatives through the ages have offered around certain of
these qualities. Buddhism refers to awakening, Plato in his enquiry refers to
non-material ideal forms, Saint Paul to no longer seeing through a glass darkly,
still others to the presence of god. The list is long and diverse. And while the
initial descriptor is a more or less awkward attempt to allude to the unspeaka-
ble, the metaphors and processes described by the founders to approach it seem
to inevitably gather a narrative of their own and we’re off to the races again;
preoccupied and fascinated by the narrative in a way that truncates curiosity,
enquiry, and exploration, it becomes dogma and the basis for fruitless argu-
ments among adherents.
Here I have presented a narrative using psychological and evolutionary prin-
ciples that I hope rescue the process from sectarianism and ill-defined language
and is less pandering to our emotional needs for certainty and identity.
The yin and the yang of it 87
The yin and the yang of it

Although the meditation training exercises are relatively simple and straight-
forward in themselves, the act of practicing them does not appear to be of
interest, or accessible, to all. Patient samples in my clinical trials of meditation-
based programs are predominantly relatively well-educated white women.
Likewise, women regularly comprise the majority of the courses I teach for
clinicians. I’ve wondered why this should be. What makes it seem so less imme-
diately attractive to men and other groups, and how could it be made more
initially attractive? No doubt the sign on the door determines to a large degree
who enters and is introduced to meditation. In this sense its portrayal in popu-
lar media of people sitting on cushions with their eyes closed has something to
do with the very term meditation invoking an aversive impression of passivity
and implicit receptivity, an image the ubiquitous sitting Buddharupa does
nothing to diminish.
Interestingly, when I began practicing meditation some 40 years or so ago,
interest was more evenly divided across the genders. In fact Zendos had quite
a martial air that emphasized sitting through pain and discomfort, and getting
by on less sleep. And some Burmese vipassana retreats included encourage-
ment for retreatants to make a “firm resolve” not to move a muscle for increas-
ingly long periods of sitting practice; as those periods went on, the silent air in
the hall became increasingly charged and tense. And while metta practices were
a part of other vipassana retreats, it was increased interest in Tibetan traditions
and the centrality they placed on relationships and the feminine that has been
largely responsible for the present emphasis in meditation programs on com-
passion and connection, and the introduction of terms such as tenderness and
healing into the process. The veneration people feel for the Dalai Lama is no
doubt related to that. On the other side of this emphasis on connection run the
attempts to use meditation for what is referred to as the “spiritual bypass”; see-
ing it as a way of avoiding the complexity, ambiguity, and uncertainty these
feminine qualities represent, and bypassing the necessity of resolving uncom-
fortable preoccupations that develop when internal conflict is present.
This situation refers back to the first part of this chapter and the discussion of
the mind as a needs-meeting apparatus where the internal narrative functions
as part of the cognitive apparatus serving that end. It is essential that the narra-
tives through which we live our everyday lives are coherent, functional, and
integrated with those of others in order to fulfill our obligations, and that they
are seen as leading to goal satisfaction. Conflicting themes in the narrative and
its surrounding life circumstances mean that attention becomes inordinately
preoccupied with them as we attempt to find an internal coherence recognized
as leading toward the satisfaction of important needs, be they for relationships,

status, or power. Attention, in its role of vigilance for opportunities for resolu-
tion, repeatedly returns to the conflicted narrative and its distress in such a way
that it is unavailable for anything else.
While meditation can provide some necessary stability in the process of
exploring and living through this, attempting to use it to bypass these inter-
active life tasks results in withdrawal into relentless concentration practice as an
emotional analgesic that does not address the underlying problem. It becomes
the role of something like psychotherapy to unveil the conflicting elements of
the narrative and find some resolution. With its conflict reduced, the narrative
no longer needs to preoccupy attention in such a compelling manner and inter-
est is sufficiently available for other activities such as meditation practice.
It is the sense of seeking to undermine the very root of the internal narrative
that most clearly distinguishes meditation from psychotherapy, which is gener-
ally aimed at altering some feature of the internal narrative, or resolving con-
flicts embedded within it that are perceived to be preventing the person from
fulfilling their goals. As such, psychotherapy may at times be an essential
adjunct to the process of enquiry.
Meditation occurs within a broader social

and political landscape
As psychologists, we endeavor to map mental territory, and just as geographic
maps reflect political territory, our mental maps also in some way reflect the tacit
political and social priorities of the day. Likewise, meditation has always been
something of a Rorschach test in the sense that each age understands, interprets,
and utilizes it in ways that suit prevailing values and ideology. And so it remains
in the twenty-first century; the dharma wheel is being re-imagined to take radial
tires and chrome hubcaps. As evidence of the personal and health benefits that
can derive from meditation practice becomes more widely discussed, it is find-
ing an increasingly accepted place in mainstream health care. One result of this
is the uneasy relationship between the internal and phenomenological investi-
gation of meditation’s practices and the external, sense-based empirical methods
of assessing outcomes and mechanisms in Western clinical medicine.
Meditation programs are also being employed by some large companies with
the aim of reducing stress and so increasing workplace productivity. It is even
being introduced into explicitly political settings such as the British House of
Commons. And while the assumption seems to be that these developments can
only be an unalloyed good, it is worth considering the changing broader social,
political, and economic landscape within which this increase in interest is
Meditation occurs within a broader social and political landscape 89
occurring. The rise in popularity of meditation-based stress reduction pro-

grams in health and business settings in the US in the 1970s and 1980s closely
tracked falling middle-class incomes and rising levels of personal debt as people
tried to maintain their standards of living. Even as these programs become
more widely used, conditions and economic circumstances become increas-
ingly dire for workers and families.
While it would be unreasonable to suggest that the use of meditation by an
ever-increasing number of people could alone be expected to result in social
and political change, it is worth critically analyzing and discussing the embed-
ded values that may be associated with meditation practice and instruction and
how these relate to the personal desires that create cultural or political change.
Is there is a danger that these skills and world view just result in getting people
to be more “productive” even if their pay does not increase along with this prod-
uctivity, or result in coping better with conditions that, to initiate change,
require resistance rather than acceptance?
The increasingly popular mindfulness meditation programs have roots in the
politically passive and authoritarian societies in which East Asian Buddhism
evolved and the social conditions in countries with long Buddhist traditions do
not offer promising role models. Judeo-Christian traditions have, painfully and
bloodily, evolved to be more democratic with ideals of justice, tolerance, and
equality, and with solid ideas of sin; actions are seen as right and wrong rather
than skillful and unskillful. So, as Buddhism-based meditation becomes more
integrated into Western societies, it is worth examining without prejudice
whether and in what ways the values that tolerate and support the societal
structures in which it evolved may be present in the practice, the way it is taught,
and its assumptions about change and well-being.
The contrasting roots struck me clearly in a venue in which I found myself
teaching. A Buddhist organization had acquired what was once a Catholic
monastery. The old chapel had been converted into the meditation hall and,
while readily accessible Christian iconography had been removed, the stained
glass windows in the clerestory depicted Christ and various martyrs in some
form or another grimly shedding blood and dying. These images contrasted
starkly with the imposing eight-foot Buddharupa dominating what had been
the altar and depicting the Buddha sitting quietly with a beatific smile. And
while bodhisattvas are at times depicted wielding weapons, these symbolize the
slaying of ignorance, not other people. It is worth noting also that the Buddha
was not politically radical himself; rather, he appears to have been a pragmatist,
careful to cultivate the support of the rich and powerful.
Do such differences bear upon views of acceptance and compassion? The
practice of refraining from changing experience is a cognitive stance adopted in
meditation practice. But acceptance can occur implicitly at a deeper level. In

this understanding, when sensations or thoughts are recognized for what they
are, and it is recognized that they will by their nature change of their own
accord, the acceptance is implicit. At this level the cognitive/affective stance is
recognized as a mental activity comprised of the components of experience.
And while the dynamic quality of compassion is emphasized in meditation
training programs, and studies show that exercises to foster self-compassion
have a salubrious effect upon happiness, an assumption that this will impact the
broader social and political fabric needs to be critically examined.
The principles of practice are straightforward

even as the world is not
In this chapter I have endeavored to draw together some of what I have learned
through the threads and circumstances of my own personal, professional, and
scientific experience with meditation. I hesitate to ennoble the process by call-
ing it a “journey”; it was more akin to muddling along in the face of confusion,
incomplete knowledge, and spotty instruction. My object is to provide a con-
ceptual framework that may be useful in understanding meditation in a rela-
tively straightforward way; a description unencumbered by the narratives of
religious traditions and instruction that often mask its essential simplicity by
conflating the practices engaged to cultivate the ground for recognition and
that which is recognized as a result of them. It is a description I think I would
have found helpful.
In extracting and describing in this way some of the fundamental mental
principles at work in the shaping of our experience of the world, and making
a clear distinction between the relatively straightforward mental training exer-
cises used to experientially recognize some of those principles in real time from
that which can result from their practice, I do not mean to imply that the world
itself is simple. But it does have a number of advantages.
First, it is easy for the actions and material objects related to the execution of
the enquiry to become ritualized and/or fetishized, diverting and truncating
the curiosity that is the heart of enquiry. This description appropriately trans-
fers the mystique that the attending skills and dharma narrative associated with
meditation practice are often given toward the mystery we find ourselves in.
This does not exclude the skills and process from the mystery, but neither does
it make precious the means by which the mystery is better appreciated.
Second, it values the cognitive function as an aid to penetrating into this mys-
tery. Conflating meditation’s means and ends can lead practitioners to under-
value their thinking function, concerned that it will just lead them further into
the cognitive weeds and distract them from the real work of meditation, which
is often seen as beyond thinking, or stopping thought. Instruction in some tra-

ditions repeatedly caution against “over-thinking things,” invoking the Zen
admonition to not mistake the finger pointing to the moon for the moon itself,
as though attempting to think critically about meditation is to attempt to reduce
the ineffable to the cognitive. Certainly the cognitive is slippery mental terri-
tory to yoke, but any of our human functions that remain underdeveloped or
under-utilized limits us in the enquiry; not taking full advantage of critical and
analytic thinking only limits the resources available to us in penetrating to the
heart of the question.
Third, it makes clear the distinction between meditation means and ends.
Conflation of these contributes to confusion in discussions of meditation as it
becomes popular in clinical and business settings. Here, people’s initial curiosity
is oriented in some way toward the goals of obtaining clinical or productivity
effects rather than about the “I-ness” embedded in the perceptual process that
interests long-term meditators in the Buddhist and other insight traditions; an
interest that requires a deeper enquiry and level of understanding in the
instructor. Nevertheless, terms and practices from one interest carry over into
the other. For example, the common exhortation to 45-minute practice periods
is a holdover from monastic traditions but without any evidential base for clin-
ical or business settings. As such, this and other practices may serve only to make
the process appear forbidding to some who might benefit from short periods of
practice. Another example relates to my remarks above about the cautionary
stance toward the thinking function, which results in beginners not being given
a clear conceptual framework from which to approach meditation practice; this
stance finds expression in the admonition that “it’s best to learn this by direct
personal experience.” While this is undoubtedly true, the sign above the door is
an important determinant of who enters and a clear explanation can arouse the
interest of more than those with a high tolerance for ambiguity.
I have also raised some questions about the cultural values and assumptions
that may be embedded in meditation practice as it travels and finds expression
in Western countries. The iconographies and approaches to change are quite
different and it is important to extract, examine, and discuss their implications
without prejudgment.
In 1961, I found myself travelling through India. It was a fortuitous series of events that
took me there, and the vibrancy and chaos was jaw-dropping for a very young man
raised as a Catholic in a small, remote, and provincial country.
Most memorable among the wonders was the sight of a stark-naked man walking
nonchalantly along a crowded street. Just as remarkable was the minimal attention
he drew. I learned he was a seeker of something called enlightenment. The idea fas-
cinated me.
A year later, the Maharishi Mahesh Yogi, on a world tour, spoke at my university. He
talked about the root of suffering, and meditation as a path to enlightenment. I was
skeptical, but a friend who attended the practice session taught me what she had
learned. And that was the start of it. Since childhood my interest has gone to how things
work, the underlying causes, and here was something practical I could experiment with.
I found the mantra meditation emotionally soothing for my turbulent emotional life, but
it created more questions than it answered.
Something called yoga was also popular at the time and I found its claims intriguing
also. Practical instruction was hard to come by, however. So, once again I headed off to
India, this time to live in an ashram that offered yoga training. It was a demanding pro-
gram but left unanswered questions.
While there I heard of a Burmese instructor who taught vipassana meditation courses
and I travelled north to try it. The slender insight it provided into my mind captured my
interest and offered a means to continue. I stayed on in the Japanese temple in Bodh
Gaya taking instruction in Zen from the roshi. It was the start of a decades-long immer-
sion in Buddhist practice that included long periods of solitary retreat.
Advaita’s contemplative approach later provided a third leg for the stool and in making
apparent the limitations of a path-based approach to meditation, facilitated recogni-
tion of the qualities of presence I allude to in my chapter.
Chapter 5
Psychology of meditation:
Philosophical perspectives
Loriliai Biernacki
Veil’d Melancholy has her sovran shrine,

Though seen of none save him whose strenuous tongue
Can burst Joy’s grape against his palate fine;
His soul shall taste the sadness of her might,
And be among her cloudy trophies hung.
Keats, “Ode to Melancholy”
Introduction
This chapter addresses the emergence of meditation as a practice and as a com-
ponent of philosophical understandings of selfhood and subjectivity within the
religious and philosophical discourses of early Hinduism, Buddhism, and Jain-
ism. What I present here will offer only piecemeal contours of these traditions;
a dim outline of what is an altogether far more rich reality than can be stitched
together for this general work. I use as my linking thread for these multivalent,
complex traditions an attention to psychology, in order to patch the inevitable
gaps of this weave with what is the basic premise for the focus of this book: a
psychology of meditation.
The psychology of meditation in these early contexts is fundamentally a phe-
nomenology. This phenomenology aims to map and make sense of the inner
experiences that arise from these early forays into introspection, as they become
formulated, reflected-upon, and then sifted through contextualizing philo-
sophical schemata. There is also, of course, no way that we can talk about a
psychology of meditation without situating it within conceptions of selfhood.
Self-reflection and introspection, hallmarks of meditation practice, necessarily
come to bear on that most proximate object of one’s reflection: the sense of self.
This chapter will chart the evolution of an idea of a self through these early
94 Psychology of meditation: Philosophical perspectives
Indian traditions of meditation, particularly noting historical development of a

notion of self as a transcendent, abstracted ideal of self, separated from materi-
ality. The formulation of a transcendent self also undergoes various permuta-
tions in this history, with, for instance, a Buddhist rejection of ideas of a self,
and with Tantric attempts to reconnect the transcendent self to the body.
I begin with an overview of the major moments in these early religious tradi-
tions, and then analyze several important classifications for these Indian tradi-
tions historically, specifically as they relate to ideas of selfhood. I address these
in roughly chronological order, beginning from the early period, called the
Vedic period, through the rise of Jainism and Buddhism. Following this, I
address the evolutionary trajectory that meditation practices and, with this, the
formulation of subjectivity undergo with the advent of new forms of religiosity,
namely devotional movements and Tantra. One interesting observation that
this comparative analysis reveals is that while many of the same meditation
techniques (e.g., visualization, use of mantras, body awareness) are employed
across different religious traditions, nevertheless, the interpretations of the
effects and meanings of meditation differ across the traditions. We may under-
stand this as the historical over-coding that philosophy and doctrine exert on
the formulation of conceptions of self in meditation. No doubt, there is also a
mutual influence at work, with philosophy and doctrine shaping the results of
meditation practice and at the same time, with insights from meditation reflect-
ing back upon philosophical formulations of self. The final section of the chap-
ter addresses a particular formulation of subjectivity within a Tantric meditative
context, the sense of wonder, which is somewhat akin to the experience I relate
in the section about my own experience of meditation.
By way of my own self-disclosure, I outline my personal sensibility, with my
own particular biases, even as I acknowledge no real sturdy foundation for
holding them: namely, my own sense that forms and formulations of meditative
experience, at least regarding the psychological components of these, evolve as
cultures evolve. Adhering more to a Darwinian conception of meandering,
rather than a Hegelian notion of aufheben, my own predilection is not in line
with a transcendental model of a divine spirit or an omniscient, omnipotent
deity. This no doubt works against traditional Western notions of God, and
works also against many Indian notions of both deity and ideas of a kind of
untouched absolute, the satcidānanda of the Advaita Vedanta tradition of India,
for instance. It could perhaps be argued that this sort of model of an emerging
self through meditative practice might be amenable to a model of that pan-
India pervasive concept of causality, karma. It might also be made to at least
resonate with some forms of Indian philosophy such as Utpaladeva and Abhi-
navagupta’s tenth- and eleventh-century ruminations on a dynamic emergence
Overview 95
of divinity. In any case, my own preference for a model of evolving meditative

experience will influence the portrait I present.
Overview
It is probably fair to say that some of the very first systematizations of medita-
tion in history—systematizations that are still utilized today—derive from the
early writings of Hinduism, Buddhism, and Jainism dating back to the middle
of the first millennium BCE (before the Common Era). The early writings of the
Ṛg Veda in the centuries prior to this attest to what looks like meditation, with
the vipra, the sage who would quake with insights and knowledge derived from
perhaps the ritual, perhaps the soma, perhaps his encounter with gods like
Indra, the thunder-wielding ruler, or Viṣṇu of the wide-step, or perhaps through
his own transformative insight. Moreover, beginning as early as the seventh
century BCE, Sanskrit writings in the Upaniṣads draw from meditation prac-
tices to theorize conceptions of cosmos and self. Early Buddhist writings in
texts like the Dīghnikāya add to these early Indian reflections on the nature of
the self and conceptions of subjectivity. Such Buddhist writings reflect what was
claimed as the Buddha’s seminal meditative insight: that the postulation of a self
is a motivated fiction, and that meditation allows us to let go of this fiction. We
find with these writings both phenomenological descriptions of meditative
experiences and philosophical formulations of their implications for ideas of
the self.
Later developments in religious expression, such as the bhakti or devotional
traditions beginning in the first millennium CE, and Tantra, a complex religio-
ritual system beginning also in the first millennium CE, expanded upon the
phenomenology of meditation developed earlier. These later movements
incorporated an integration of aesthetic elements and, in the case of Tantra, a
reformulation of the relationship between the body and altered states of aware-
ness. Both the bhakti movements and Tantra present pan-India evolutions of
meditation practices. Both these later movements transcend religious and sect-
arian boundaries.
One other formative distinction ought to be mentioned: the relationship
between the use of meditation practices for the goal of shifts in awareness, dir-
ected inwardly, and the use of meditation practices for the attainment of a cap-
acity to affect the physical world through non-mechanical interventions, known
as siddhis, or powers derived from meditation practices. These include powers
like the ability to read the minds of others, the ability to levitate, and the capacity
to stop the effects of poison on the body. The development of siddhis through
meditation practices operates as a fundamental selling point influencing the
historical acceptance of meditative praxis within wider social arenas, as Tantric

practitioners from across the spectrum of Indian religious traditions used the
seemingly magical powers derived from their practices to influence kings and
polity. At the end of this chapter, I focus especially on a particular Tantric “easy”
practice, the Pratyabhijñā or “Recognition” school, which offered an integrative
attempt to bring ideas of transcendent divinity into the mundane.
Vedic period
The writings left from the early nomadic inhabitants of India in the middle of
the second millennium BCE, termed the Vedic period, mark the beginnings of
what we can track linguistically of early Indian practices. The primary religious
practice of this period focused on rather elaborate rituals for fire accompanied
by oral recitations of hymns and offerings made into the fire. For instance, the
jyotiṣṭoma sacrifices, a class of seven different sacrifices involving offerings of a
sacred plant, the soma, could last for one day in the case of the agniṣṭoma, or for
many days, with as many as 16 priests participating, for the agniṣṭoma. The
agniṣṭoma and the jyotiṣṭoma are the names of Vedic rituals using fire as the
medium for offerings to the Vedic gods. The sacrifices were made to a variety of
gods, most notably Indra, the god of thunder and lightning, and Agni, the god
of fire, who served to carry human offerings to the gods in heaven via the smoke
of the fire. Frequently fire sacrifices followed a model of shorter rituals embed-
ded in longer rituals, requiring offerings of plant foods, milk, and animal sacri-
fices. These early Vedic practices set the parameters for subsequent religiosity,
which tended toward either aligning with the earlier Vedic traditions, as in the
case of Brahmanism and what eventually later became lumped under the rubric
of Hinduism, or conversely, against Vedic practices, as in the case of Buddhism
and Jainism. Early Vedic practices rely on an implicit polytheism and call on
various deities to intervene on behalf of human requests.
Certainly, the early Vedic rites invoked a potent psychology for the practi-
tioner, as for instance where the sacrificer wore a black deer skin symbolizing
the placenta to effect a ritual rebirth in the Aitareya Brahmaṇa (Haug 1863).
However, should we understand the pervasive ritual practice of the Vedic
period as a form of meditation? Does meditation require a silence and inward-
ness that we might suspect to be absent in a ritual space? Is it possible to be
outwardly engaged in verbal recitation and making offerings into a blazing
flame, invoking the formulas of ritual and at the same time still achieve a state
of meditation? Whatever the case—which may ultimately turn upon a semantic
understanding; that is, how we go about defining meditation—the hymns of the
Ṛg Veda do offer us images of what looks something like a transformed
VEDAˉ NTA 97
consciousness akin to the results of what we think of as meditation. We see, for

instance, the wild-haired keṣin, the meditative figure who is called “the light of
stars, seen in the heaven, in all space, girdled with the wind, who goes where the
gods have gone,”1—even if we must wait for Buddhism and the Upaniṣads to
extract a notion of meditation divorced from the idea of anthropic deity.
Vedaˉnta
The final section of the Vedic corpus in terms of chronology brings us the
Upaniṣads, also called Vedānta, beginning around the eighth century BCE.
These texts usher in a novel approach to ritual practice, emphasizing introspec-
tion. In brief, they reformulate the relationships between humans and deities
via ritual practice, articulating what has come to be considered some of the
earliest practices of meditation. We might even say that the Upaniṣads discover
meditation proper. The texts of the Upaniṣads have historically been under-
stood as secret teachings. The power of these secret teachings lies in a particular
notion, the concept of bandhu, the idea that a person contains within him or
herself the totality of the cosmos. If one knows the secret inner expression, then
one is able to control external phenomena, the wind, fire, as expressions of that
internal presence. So, Yajñavalkya tells his interlocutor Gautama in the Great
Forest Secret Text (Bṛhadāraṇyaka Upaniṣad):
that self of yours who is present within but is different from the fire, whom the fire does
not know, whose body is the fire, and who controls the fire from within—he is the inner
controller, the immortal (Olivelle 1996, Bṛhadāraṇyaka Upaniṣad 3.7.5, p. 42).
By meditating on the internal presence, the inner controller (antaryāmin), one

could sidestep the onerous process of external ritual and achieve simultan-
eously a similar, if not better, efficacious result without external ritual. Here the
idea of knowledge becomes paramount; knowledge becomes a shortcut. The
secret teachings of the Upaniṣads propose that the operative principle bringing
about the effects of the ritual really derive from an inner knowledge. How does
one acquire this knowledge? In a word: meditation. Meditation is the favored
technique, if not the sole means.
We might understand this type of meditation on the inner controller as entail-
ing a psychological shift in awareness. Rather than a focus on objects in their
externality, the shift in awareness toward an inner subjectivity that resides within
and controls from within points to a pervasive, if elusive, sense of subjectivity as
1
From GRETIL, Gottingen Register of Electronic Texts in Indian Languages: http://gretil.
sub.uni-goettingen.de/gretil/1_sanskr/1_veda/1_sam/1_rv/rv_hn10u.htm. Translation modi-
fied from Griffith (1889)–92.
the basis of knowledge. This foundation as a kind of self-knowledge can really

only be approached through an inner introspection, through the self-reflection
of meditation. I say elusive because it becomes a trope within these texts and the
tradition as a whole that the self, known as the ātman, which often translates as
self,2 and the inner controller, antaryāmin, is the seer that can nevertheless itself
not ever be seen. We see for instance Yajñavalkya explaining to his wife Maitreyī
the secret of immortality in the self:
This self, you see, is imperishable; it has an indestructible nature. For when there is a
duality of some kind, then the one can see the other, the one can smell the other, the one
can taste the other, the one can greet the other, the one can hear the other, the one can
think of the other, the one can touch the other, and the one can perceive the other.
When, however, the Whole has become one’s very self (ātman), then who is there for
one to see and by what means?. . . Who is there for one to perceive and by what means?
By what means can one perceive him by means of whom one perceives this whole
world?
About this self (ātman), one can only say “not—, not—” (Olivelle 1996,
Bṛhadāraṇyaka Upaniṣad 4.5.14–15, p. 71).
This famous apophasis of Yajñavalkya’s, where he tells Maitreyī that the self is
“not—, not—” (neti, neti), becomes one of the signature “great statements”
(mahāvākya) of Hindu tradition, signaling a presence that can be felt, known—
through meditation—but not discursively, objectively pinned down. However
one might try to point to the sense of self to contain it within an objective pic-
ture, one fails. The self is the driver of the engine of perception, but cannot itself
be seen. Here we see especially the idea that meditation offers a window into a
psychology of self that cannot be accessed via rational enquiry.
Yajñavalkya also hints at another component of subjectivity that plays a large
role in later tradition, namely, a collapse of the subject-object polarity into an
essential monism. This insight of Yajñavalkya’s, that the immortal, indestruct-
ible self sees nothing that is not its own self, becomes a guiding principle for
some schools of nondualism that develop in India, most famously Advaita
Vedanta. For our purposes here, it represents another element of the psych-
ology of meditation; it refocuses attention to subvert our pervasive mental per-
ception of duality. And at the same time that we find that the idea of self cannot
be boxed into a definitive object, we also see that discovery of self leads one to
recognize its omnipresence. In another early Upaniṣad, the Chāndogya
Upaniṣad, we see Śvetaketu learning from his father about the nature of the self.
2
But note that Patrick Olivelle (1996) in his translation provocatively goes against later Hin-
duism’s assertion of ātman as transcendental self by on some occasions translating ātman
as “body.”
VEDAˉ NTA 99
Here, rather than telling his son not to try to point to it, instead Āruṇi tells him
that it pervades throughout. Giving his son an embodied teaching, he says:
“Put this chunk of salt in a container of water and come back tomorrow.” The son did
as he was told, and the father said to him: “The hunk of salt you put in the water last
evening—bring it here.” He groped for it but could not find it, as it had dissolved
completely.
“Now, take a sip from this corner,” said the father. “How does it taste?” “Salty.” “Take
a sip from the centre. How does it taste?” “Salty.” “Take a sip from that corner. How does
it taste?” “Salty.” “Throw it out and come back later.” He did as he was told and found
that the salt was always there. The father told him: “You, of course, did not see it there,
son; yet it was always right there. The finest essence here—that constitutes the self of
this whole world; that is the truth; that is the self (ātman). And that’s how you are,
Śvetaketu.” (Olivelle 1996, Chāndogya Upaniṣad 6.13.1–3, p. 154–155)
The self is omnipresent, if seemingly invisible. Here the teaching is passed on

from a father to his son. For the tradition that follows, the crucial insights trans-
mitted through these secret texts attest to a shift in understanding of the nature
of self. Moreover, this shift does not primarily come about through logic and
reasoning, but rather is facilitated by a psychology of self-attention—accessed
through meditation. Whether this is an insight that can be reached by training
the mind, or whether the training of the mind that meditation involves simply
frees it to stumble upon this crucial insight into the nature of self, is debated
within the tradition. Yet, the expression of a meditative experience, the realiza-
tion of oneness in particular, becomes one key litmus test for onlookers to
ascertain whether or not a meditating sage has accessed the desired goal of
enlightenment. In terms of a psychology of self, this particular strand of the
Indian meditation traditions promotes a sense of expanded selfhood, both
through a via negativa (we can only say what it is not) as a self that cannot be
pointed out, as Yajñavalkya tells his wife Maitreyī, and as a self that is a non-
obvious substratum of all that we encounter, as Āruṇi tells his son Śvetaketu.3
So, these early thinkers articulated a conception of subjectivity that imputed a
pervasive, if non-visible, sense of self divorced from an idea of anthropic deity.
Self-reflection and meditation became the tools to gain this shift in perspective.
Thus, the chronologically latter part of the Vedic corpus, the secret forest texts of
the Upaniṣads, emphasize a move away from the elaborate rituals for gods
enjoined in the Vedas in favor of meditative practices, often re-enacting ritual
principles internally for the meditator. This functions on the one hand to relocate
the essence and efficacy of external deity to the self within. On the other hand, it
steers away from a simple formulation of human as worshipper and god(s) as
3
See also Claxton’s chapter in this volume, which addresses this idea.
worshipped in a dualistic and fundamentally hierarchic relation. The implication

of this for a psychology of meditation is that we discover in these early thinkers a
sophisticated use of meditation as a means for reformulating—even, we might
say, appropriating—an idea of deity as primarily a subjective experience within a
psychology of self.
We might also understand this early venture into meditation as a psycho-
logical practice that enables a transcendental self to emerge as foundation in
contrast to the multiplicity we see here in the world. This becomes a sine qua
non of much classical Indian exploration of meditation and a primary focus of
debate, especially with the Buddhist doctrine of anātman, “no-self,” seeking to
unravel this foundational postulation of self. The notion of self, ātman, operates
as a psychology of subjectivity writ large through the sustained reflection of self
in meditation.
Jainism
Another strand of Indian meditation practice that begins to take form not so
long after the Upaniṣads can be found in Jainism. As a religious tradition, Jain-
ism boasts an extensive literary history and a heightened attention to asceti-
cism. Jain doctrine, like Buddhism, rejects the extensive sacrificial ritual of
Vedism, in this case especially because Jainism’s central tenet of nonviolence
(ahiṃsā) opposes the harm toward other life required in ritual sacrifice. This
rejection of harm is taken to its logical conclusion in the Jain adoption of
extreme austerity in food practices. One could argue that the quintessential Jain
practice is asceticism, fasting in particular, yet this asceticism is usually coupled
with meditation practices. Meditation (dhyāna, sāmāyika) is considered one of
the six internal austerities that a Jain undergoes; practices around limiting food
constitute several of the external austerities. One of the most important figures
for Jainism, the twenty-fourth and last great sage, the tīrthaṅkara (“bridge-
maker”) Mahāvīra, who lived in approximately the sixth century BCE, prac-
ticed meditation in conjunction with austerities for 13 years in order to reach
the goal of Jain practice, kaivalya, a supreme state of “aloneness.” Sitting in a
squatting position, fully exposed to sun and weather, he persisted in medita-
tion, concentrating the mind (ekāgramanaḥsaṅniveśana) until he reached his
goal. Jain meditation seeks as its hopeful result of this practice the lessening of
the dross of karma, which holds the soul and the body down.
Not monist, like the Advaita Vedanta interpretation of the Upaniṣads, Jainism
nevertheless, like Brahmanism and other forms of Hinduism, hangs on to an
idea of soul or self. In the case of Jainism, all beings have separate souls and each
has a very material form, as does the negative karma that sullies it and weighs it
Jainism 101
down. For Jainism doctrinally, the current world age is too dark a period for any
person living now to achieve the final goal, kaivalya, or “aloneness.” However,
the twenty-fourth and last great sage, the tīrthaṅkara Mahāvīra, who achieved
this state in the sixth century BCE, also acquired (for one strand of Jainism) a
diamond body, impervious to suffering and hunger, as a result of his practice of
asceticism and meditation. Jainism certainly stresses meditation as a practice
historically, even if asceticism takes pride of place. Jain meditation is less con-
cerned with watching the breath or concentrating on it, which is a key compo-
nent of Upaniṣadic speculation on ideas of self and which becomes an important
fulcrum for later yoga practices, such as we see in forms of Buddhism and in
elements of Patañjali’s Yoga Sūtras. Meditation for Jainism does in some cases
involve some visualization, such as in a classic Jain meditation, the piṇḍasthā
dhyāna, which focuses on the elements of earth, fire, water, and air, situated in
a cosmic ocean. Jain meditation, often a 48-minute period in the morning, aims
to “isolate the mind from all earthly desires and suffering and to put it in a state
of quietude” (Glasenapp 1999). Jainism, like Brahmanism and varied forms of
later Hinduism, as well as Buddhism, relies on repeated recitation of scriptural
texts in addition to study of the tradition.
With regard to notions of subjectivity, ideas of the body and materiality are
deeply wrapped up in Jain conceptions of selfhood, even as Jainism offers a pic-
ture of subjectivity that seeks to leave behind the materiality of the body, or at
least to use a combination of meditation and asceticism to free the physical
body from weakness. Hearkening to its early Sāṃkhya philosophical roots, Jain
efforts in meditation strive toward an extrication of subjectivity out of materi-
ality, with a dualist conception of self in opposition to the materiality of the
body. So, for instance, entrance into the fourteenth stage of meditation brings
about vyuparatakriyā nivṛtti, a state of “cessation of even the slightest amount of
activity.” The ideal of a complete cessation of physical activity signals the separ-
ation of self from matter, with the notion of activity historically connected with
the body. So, this advanced stage of meditation points to a psychology of extri-
cation of the subject; its isolation from the change and decay necessarily entailed
in all matter. The meditation goal of Jainism, kaivalya, or “aloneness,” is thus an
articulation of a transcendent self, isolated from interaction with others. This is
graphically represented in the Digambara Jain image of Mahāvīra, with his
impenetrable, diamond-hard body, not eating, that is, not taking anything in,
not speaking, as his body simply emits a vibrational hum that is translated for
his followers by his close attendants. The enlightened sage presents a self that is
above and closed off to interaction with worldly intercourse. It may thus be
helpful here to point out that we see again a reiteration of the theme that medi-
tation practices lead to a discovery of notions of a transcendent self; that part of
the impetus behind a meditation praxis is precisely access to a transcendent self.

We should also remember that Jain meditative and ascetic practices are funda-
mentally intertwined, in an asymptotic effort, at least for our current age, to rise
above the limitations of embodiment, precisely as an expression of a transcend-
ent self.
Buddhism
Buddhism aligns with Jainism as both are early traditions that reject the author-
ity of the Vedas as scripture and reject Vedic sacrificial practices.4 Still, in con-
trast to Jainism, Buddhism proposes a path rejecting the extreme austerities
enjoined in Jainism. The tradition links the Buddhist rejection of asceticism to
the well-known story of the Buddha’s attempts to reach enlightenment through
fasting, which becomes a favored subject of Buddhist iconographic statuary
centuries later. Frustrated with the lack of progress from fasting, the Buddha
rejects austerities in favor of the “middle way,” which becomes the signature
descriptor of Buddhist practice. The “middle way” emphasizes the Buddha’s
discovery that meditation itself—not the austerities of Jainism’s sleep depriva-
tion, fasting, and bodily mortifications—leads one to awakening and enlighten-
ment. Indeed, from the Abhidharma texts of the early tradition through the
Mahāyāna and the Tantric practices of Tibet, Buddhism presents an extraordin-
ary complexity of praxis centered especially around the core experience of
meditation.
If Jainism promises a path of meditation and austerity that will lead to an
extrication of subjectivity out of the messy world of matter, Buddhism, in con-
trast, reformulates the problem. Rather than using meditation to discover a
transcendent subjectivity that can rise above material concerns, Buddhism calls
into question the motives for postulating a transcendent self in the first place. In
a profound psychological insight, the Buddha’s famous “no-self ” doctrine
(anātman, anattā) asserts that any notion of a self is driven by our desire to posit
a stable sense of self persisting through time. This desire presents as human
mental clinging to a notion that has no basis in phenomenological experience.
Meditation as a practice allows one to gain insight into the fundamentally
“empty” (śūnyatā) character of all postulation of a self. That is, all phenomena
arise interdependently; there is no foundational self that exists as a permanent
refuge from suffering and impermanence. In specific practice, the aspirant uses
4
This typology, which classes together traditions rejecting the authority of the Vedas, is rec-
ognized early in the exegetical literature, with those rejecting Vedic authority called
“nāstikas,” literally, the “the ones who advocate there is not.”
Buddhism 103
the fundamental insights of the Buddha, the Four Noble Truths of universal
suffering and impermanence, as a referential frame for transforming our psy-
chologically driven and incorrect conceptions of self through meditation on
these truths.
Lest one worry that positing an idea of “emptiness” as the interdependence
of all phenomena might lead to a slippery ungrounded ontology that lacks a
capacity to underwrite a behavioral ethics, the tradition uses the Buddha’s
initial insights themselves as foundation. These insights that disclose the
essential impermanence of all phenomena do not open up to a wholesale rela-
tivism in this case. The Four Noble Truths themselves anchor the process of
meditation.5 With this, meditation on the Four Noble Truths reveals the con-
tingent nature of what appears—erroneously—so blatantly self-obvious: the
postulation of a self. The practitioner seeking to realize in him or herself the
Four Noble Truths in the Mahāyāna tradition,6 cultivates deep concentration
(samādhi) on these truths by contemplating them with attention (sādara),
without interruption (nairantarya) over an extended length of time
(dīrghakāla) (Woo 2009). This results in a three-step process including first
intensification, then termination, and then the final result of direct meditative
vision (yogipratyakṣa) into these truths (Woo 2009). The process involves
both a constructive activity, the contemplation of aspects of the Four Noble
Truths, and a deconstructive component, a loosening and rejection of the lay-
ers of unwarranted mental postulations of an abiding self and its persistence
through time.
The psychology employed in this meditative exercise certainly employs a cog-
nitive element, both in the constructive contemplation of Buddhist truths and
in the agile contemplative efforts to free the mind from the cultural overwriting
(vikalpa) that traps one into believing in incorrect ideas that ultimately lead to
suffering. It would be too much to try to outline here the transformations that
the Buddha’s “no-self ” doctrine undergoes as the tradition grapples with
numerous ideas—explanations of reincarnation, how to reconcile a doctrine of
momentariness with the experience of memory, ideas of an essence-like
Buddha-nature that eventually takes a prominent position in later Buddhist
exegesis. In terms of a psychology, the Buddhist exploration of meditation,
from its early formulations in Abhidharma that put forth different practices for
different psychological types (upāya) (one person might be instructed to medi-
tate in a small cave, while another might be instructed to meditate under the
5
As Jeson Woo notes regarding the Four Noble Truths, “[s]uch aspects are considered true
since they are subject to neither destruction nor alteration over time” (Woo 2009).
6
Following the seventh century CE Indian Buddhist scholar Dharmakīrti in this case.
open sky), to Tibetan practices of visualizing oneself as deity—all through,

Buddhist praxis underwrites a keen appreciation of human psychology. As a
tradition that locates meditation praxis as part of its founding mythos in the
story of the Buddha’s enlightenment, Buddhism takes quite seriously the phe-
nomenology of a psychological self that becomes a primary object of self-
reflection; the practice of meditation unfolds and helps to formulate this
psychology of subjectivity, even as it discounts the notion of permanent
self (ātman).
Advaita Vedānta, later Hinduism

We can also see the impact of Buddhist ideas of the “no-self ” doctrine on later
forms of Hinduism. The eighth century philosopher Śaṅkara borrows exten-
sively from Buddhist rejections of self as he synthesizes from earlier sources a
particularly prominent school of Indian philosophy, Advaita Vedānta, still
popular today. Through his commentaries on the Upaniṣads, he espouses an
idea of subjectivity as a cosmic and depersonalized self-awareness, proposing a
notion of self as transcendent subjectivity, a bare, stripped-down subjectivity,
satcidānanda, “being, consciousness and bliss.” Śaṅkara’s phenomenology of a
self as a pure subjectivity, abstracted out from the material trappings of person-
ality, was by no means universally accepted, as he was accused by later Hindu
commentators of being a crypto-Buddhist (pracchanna bauddha) (Isayeva
1992). The decoupling of self from notions of personality was, no doubt, formu-
lated at least in part in response to Buddhist doctrinal articulations of “no-self.”
Particularly influential was the Vijñānavāda, the Buddhist school dubbed
“mind-only,” that is, the idea that all reality is internal to the mind. These later
understandings of a universal, abstract self, the ātman of Advaita Vedanta,
assert the necessity for a concept of self, even as they refine the idea of self away
from any particular or personal formulation of self. Moreover, the schools of
Hinduism that offer a universal and abstract conception of self tend also to
emphasize meditation as key in the process of enlightenment. One sees with
this also the notion that the awareness of a transcendent self presents as a dis-
covery arising out of meditation practice. Here we see a process similar to what
we find in Buddhism, which offers a constructive component as a basic truth,
which the aspirant then also discovers through meditation. In tandem with this
is also a deconstructive mental component of meditation where, as with Bud-
dhism, meditation practice affords insight also through filtering away the
obscuring mental conceptualizations (vikalpa).
So philosophical conceptions of self and subjectivity influence how medita-
tion, and especially the goal of meditation, is framed within particular
Bhakti 105
traditions in India. India offers a rich history of philosophical perspectives on

the idea of selfhood, which is expressed in the writings of different philosoph-
ical schools, such as Nyāya, the school of logic, and Sāṃkhya, an early philo-
sophical school that offered a basic cosmology of matter and spirit as bifurcated.
Indeed, a great deal of philosophical discourse hovers around conceptions of
self (ātman) or its rejection, and its relationship to the world and to divinity,
which, one might argue, derives from the parameters set by the Buddhist doc-
trine of “no-self.” Also, much subsequent debate focuses on epistemology,
which, at least in part, grounds itself on the correspondence of meditation
insights with canonical texts. At a minimum, the phenomenology of self that
one encounters in the process of meditative self-reflection is shaped by and
shapes philosophical conceptions of self.
We can see in this discussion a plethora of different perspectives on what it is
precisely that one discovers in the process of meditation. The ontological frame-
work varies, yet oddly, the practices employed across these traditions are gener-
ally quite similar (with perhaps the exception of a greater intensity of asceticism
found in Jainism). Generally, we find techniques involving visualizations, both
of self and external figures, such as deities, recitation of canonical texts, recita-
tion of short formulas called mantras, techniques associated with awareness of
self and body as persistent practices, including in this last category vipassana, or
insight, and śamatā, calming practices that have made their way from Bud-
dhism to the West. In addition, Hindu particularly but also some forms of Bud-
dhist and Jain traditions incorporate ritual as a component of meditation
practices. These rituals frequently present as rituals of hospitality (pūjā), mak-
ing offerings such as food, incense, water, and so on. We also see some use of fire
rituals (homam), particularly in Hindu traditions.
Bhakti
Bhakti, or devotion, also begins to play a large role in the Indian subcontinent
in the early medieval period and devotional meditation practices are absorbed
within nearly all religious traditions in India as an adjunct to meditation prac-
tices proper. These devotional practices entail cultivation of love for a deity or
religious figure as a method for enhancing practice. Certainly, practices of
devotion and love incorporate a potent psychology in relation to goals of spirit-
ual transformation. In terms of method, expressions of devotion often utilize
devotional singing and ritual offerings (pūjā). Moreover, we see devotional
practices across the board, in Buddhism, Jainism, and Hinduism. Even where
we find purist expressions of meditation, for instance in the twentieth-century
figure of Ramana Maharshi, who represents perhaps one of the strictest
examples of an enlightened figure practicing and advocating meditation, still

we find the incorporation of bhakti, devotion. Ramana Maharshi also com-
posed poems of devotion to Arunachala, the deity of the mountain where he
lived as a form of the god Śiva. He spent years in silent meditation and advo-
cated a path of self-enquiry, posing the question, “Who am I?” and following
the awareness of the “I” back to its source. Ramana Maharshi is classed as a
“jñānī,” that is, someone who follows the path of knowledge, as opposed to
paths of devotion or ritual performance. He was not trained in classical Indian
philosophy, though one might imagine that living in South India, even in the
early twentieth century, he was exposed to general philosophical conceptions,
especially the quite popular nondual Advaita Vedanta that his teaching
resembles.
For our purposes here, we might note two points. First, Ramana Maharshi’s
teaching of meditation centers on a self-reflection that explores the phenomen-
ology of subjectivity; the guiding, repeated focus of attention is “Who am I?” It
is probably important to point out that again we see meditation as coupled with
working out ideas of selfhood and subjectivity. Secondly, he also eventually
incorporates a devotional component to his practice. Even though he is con-
sidered by no one to be an example of bhakti, devotion—even this exemplary
icon of meditation also incorporates a component of devotion. This leads to
another consideration; might it make sense to posit that the relationality of
bhakti, devotion, which necessarily entails a sense of the “other,” helps to bal-
ance the emphasis on self that arises in meditation’s necessary self-focus? We
might even go so far as to say that a psychology of meditation requires these two
balancing elements. The self-reflection and exploration of the phenomenology
of the self that meditation frequently engenders needs its counterpart in the
relationality to an “other” that bhakti adds to the mix. As a side-note, we may
observe that as Indian meditation practices become imported more and more
into contemporary Western settings, the subtraction of devotion as not relevant
to our contemporary Western context may be missing something crucial in the
dynamics of meditation. Perhaps as a response to this lack, we do see an increas-
ing number of meditation practices offered to Westerners with an emphasis on
generating compassion, such as those of Kristin Neff, John Makransky, and Paul
Gilbert, for instance.
Yoga
Like bhakti, it is probably fair to say that yoga practice has historically been con-
nected with most, though perhaps not all, philosophical schools and religious
traditions in India. Also, as we see with early Buddhist texts, yoga offers a
Yoga 107
psychology of meditation par excellence. In its earliest textually available forms,

the school of yoga is first and foremost a path of meditation. Patañjali’s Yoga
Sūtra, a text dating to roughly the fifth century CE, offers one of the early for-
mulations of the path of yoga and most contemporary readers are surprised to
find that the text spends most of its time describing techniques for engaging the
mind in meditation, not outlining the various physical postures we associate
with yoga classes today in the West. In fact, Patañjali devotes only three lines to
yoga postures, telling us that for the practice of yoga, the posture, āsana, should
be just easy (sukha) and steady (sthira).7 The commentary on the verses, the
Yoga Sūtra Bhāṣya, adds the specificity of traditional postures, pointing to sev-
eral well-known postures, including the lotus posture (padmāsana).8
The Yoga Sūtra functions in general as a kind of nuts and bolts handbook for
dealing with the mind in meditation, as the text describes step-by-step processes
involved in disciplining the mind for the practice of meditation. Presenting a
sophisticated psychology, we see on the one hand how the Yoga Sūtra offers
descriptions of how the mind works and how thought works. There are five
modalities of mental activity, including valid judgment, error, conceptualiza-
tion, sleep, and memory (Āgāśe 1904, 1.6). On the other hand, the Yoga Sūtra
also gives prescriptive teachings, for instance, instructing the reader on how to
prevent distractions from meditation by focusing on a single principle (Āgāśe
1904, 1.32), or how one can make the mind tranquil by a measured exhalation
and retention of the breath (Āgāśe 1904, 1.34), or by cultivating positive thoughts
in order to counter the influence of a mind racing with negative thoughts (Āgāśe
1904, 2.33). Even as the Yoga Sūtra offers a variety of psychological techniques
for working with the mind, its primary understanding of yoga is defined by
stopping the flow of thoughts (Āgāśe 1904, 1.2: cittavṛtti nirodhaḥ). The tech-
niques and practices for meditation that yoga outlines are similar to what we see
in Buddhism. Both of these, and Jainism as well, include preliminary steps
involving avoiding negative behaviors like stealing, lying, and violence, along
with cultivating positive qualities like cleanliness and contentment.
The Yoga Sūtra also discusses what look like magical powers that result from
the practice of yoga. By meditation on specific places in the body, one acquires
7
Patañjali Yoga Sūtra, 2.46. in Patañjali: Yogasutra with Bhasya (= Pātañjalayogaśāstra),
Pātañjalayogasūtrāṇi (Vācaspatimiśraviracitaṭikā, saṃvalitaVyāsabhāṣyasametāni . . . tathā
BhojadevaviracitaRājamārtaṇḍābhidhanavṛttisametāni. Edited by Kāśinātha Śāstrī Āgāśe,
Anandasrama Sanskrit Series, no. 47, 1904.
8
Traditionally understood to be authored by Vyāsa, the same fabled prolific author of the
epic Mahābhārata; however, it may be that the Bhāṣya commentary is an auto-commentary,
as Philipp Maas argues, by the great sage of yoga, Patañjali himself (Maas 2006).
different abilities. For instance, meditation, the text tells us, “on the throat
affords control over hunger and thirst” (Āgāśe 1904, 3.30: kaṇṭhakūpe
kṣutpipāsānivṛttiḥ). Similarly, meditation on the vital breath rising in the body
affords the ability to walk on water (Āgāśe 1904, 3.39), a feat we see popularized
across continents in the Gospels of Mark and Matthew in Christianity. The Yoga
Sūtra ultimately discounts these magical powers as a distraction from the real
goal of meditation (Āgāśe 1904, 3.37 and 3.50). Following the cosmology of
Sāṃkhya with its dualistic separation of matter and spirit, with which the school
of yoga is classically connected, the Yoga Sūtra’s philosophical legacy from
Sāṃkhya tends to undercut the importance of powers over matter and the body.
So, despite likely teasing curious readers with an entire chapter devoted to the
powers attainable by yoga, or perhaps precisely to let would-be practitioners in
on the worldly practical, if not spiritually desirable, benefits of yoga, the Yoga
Sūtra ultimately discards the powers it promises.
Rather, yoga proposes using meditation to attain a freedom of spirit detached
from material constraints. Indeed, the ultimate, desired state resulting from
meditation in yoga is signified by the term “kaivalya,” the “aloneness” we saw
earlier in Jainism, which was also deeply influenced by the dualistic cosmology
of Sāṃkhya. Thus, the concluding verse of the Yoga Sūtra tells us: “final alone-
ness occurs when the evolutionary flowing forth of nature’s qualities is curbed,
as they lack purpose for the spirit. With this the energy of consciousness rests in
its own true nature” (Āgāśe 1904, 4.34: puruṣārthaśūnyānāṃ guṇānāṃ
pratiprasavaḥ kaivalyam svarūpapratiṣṭhā vā citiśaktir iti). Apart from the
apparent irony in that the path of yoga, literally “union,” leads to “aloneness,” we
see again that classical meditation focuses fundamentally on a phenomenology
of subjectivity, of the self. A person commits to the hours of self-reflection that
yoga advises in order to ascertain “one’s own true nature” (svarūpa) as separate
from the messy psychology of mind, body, and materiality entangled within
conceptions of self. So, again, we see that meditation fundamentally invokes an
examination of the nature of the self and that this subjectivity is thickly inter-
twined with a psychology. Moreover, a primary impetus of yoga techniques
focuses on isolating the sense of subjectivity from components of self that con-
nect to mind or body.
Tantra
Tantra presents a watershed moment in one key regard: It pushes back against
the pervasive tendency that opposes the self to the materiality of body and
world. Like yoga and bhakti, Tantric practices also find their way into much of
Indian philosophy and meditation, including the varied forms of Hinduism,
Tantra 109
Buddhism, and even, if only to a small degree, Jainism as well. Indeed, the influ-
ence of Tantra on later forms of Buddhism, Tibetan Tantric Buddhism, for
instance, leaves in its wake a Buddhism almost unrecognizable by the criteria of
early forms of Buddhism connected with the Pali tradition. Medieval expres-
sions of Tantra, of course, vary from religion to religion and sect to sect. How-
ever, we see a point of convergence across various traditions in the inner logic
of Tantra’s resistance to the abstracted, transcendent self set against ideas of
body and matter. We find an incorporation of the body within Tantric medita-
tion practices and philosophy, for instance encoded in the yabyum of Tibetan
Buddhism, and in the elevation of goddesses in Bengali Tantra (and elsewhere).
We see it again in the incorporation of a plethora of physical postures in the
haṭha yoga so popular today as a Tantric infusion into yoga, in the idea of the
serpent power of kuṇḍalinī as a bodily experience leading to enlightenment. We
also see it in the use of the body as receptacle when a meditator ritually inserts
various deities in his or her arms and torso in the practice of nyāsa, “installing
deity.” For this final section, I want to focus on one particular ancillary element
of the Tantric incorporation of matter into its conception of self: its use of
wonder.
For this I draw from the tradition called Pratyabhijñā, or “Recognition”
school, a subset of ninth- to eleventh-century Kashmiri nondual Śaiva Tantra,
which offered a philosophically sophisticated articulation of Tantra’s incorpor-
ation of materiality into its conception of the absolute. I am choosing this con-
cept of wonder because I feel it reflects in some measure the personal experience
I describe in the Personal Meditation Journey. Also, I suspect that the experi-
ence of wonder may be accessible to a contemporary Western sensibility in a
way that most ritual practices taken from India are not. Moreover, it offers a
not-so-well-known component of Indian meditation practices, which serves as
counterpart to the already widely popular promulgation of practices of
mindfulness.
Nondual Kashmiri Śaiva Tantra presents a philosophical high point for
Indian thought, generating an efflorescence of literary and ritual culture that
migrated throughout most of India in the succeeding centuries. This was
masterfully articulated by ninth- to eleventh-century Kashmiri thinkers,
including particularly Abhinavagupta, his teacher’s teacher, Utpaladeva, and
his disciple, Kṣemarāja, among others. The philosophy that comes out of this
period offered a profound challenge to Buddhist and Advaita Vedantin formu-
lations of mind and the world. Particularly we might point to the Pratyabhijñā,
a panentheistic doctrine that suggests that the highest absolute reality is one we
can always instantly access, simply by “recognizing” its immanent presence in
our own selves, in all of our material surroundings.
The novel signature component of this nondual Kashmiri Tantra is an asser-

tion of an always already inherent consciousness within matter. This has the
added effect of affording a new reverence for the body and the material world.
They are not separate from our own sentient self-comprehension. This philoso-
phy also lends itself to a reconceptualization of the very nature of the divine, by
inserting a dynamism into it. Thus, consciousness, which is the nature of the
absolute, is not static or transcendent. Rather, it unfolds itself through its evolu-
tionary articulation as matter, in this case as divine Māyā, with a double move-
ment of veiling over the innate consciousness of everything here and unfolding
into the multiplicity (vicitra) of the world.
We can see right away the profound psychological implications that the idea of
an evolving consciousness has for a practice of meditation. To begin with, con-
necting the absolute state to the idea of consciousness (cit) makes it in some sense
accessible to awareness, linking it to mind and psychology, something we see also
in earlier forms of Buddhism and Vedanta, for instance. In this case, attaining a
transcendent, unchanging state above the ever-changing flow of mind and the
unstoppable decay of matter is a long-standing and traditional goal of many
Indian meditation practices—for this perspective, however, it is no longer an
ideal. Instead, we encounter an embrace of the flow and change within subjectiv-
ity as an inherent power that consciousness possesses. This is the power of Māyā,
no longer in this Kashmiri Tantra tradition demonized as a beguiler. Instead
Māyā represents an essential creativity of consciousness. This energy of Māyā is
what generates an initial sense of subject and object. The Pratyabhijñā allows one
to recognize the game of hide and seek that the self plays with itself. This also
hints toward a revisioning of selfhood that leaves space for an evolutionary com-
ponent, an element that offers a resonance with our own current world concep-
tions of a changing human psyche. At the same time, this dynamism also leaves
space for the expression of magical powers, siddhis, which likely is one of the
reasons that Tantra became so popular, especially with rulers.9 Along with this,
Tantric practices across the board do not simply promise enlightenment or lib-
eration; rather, Tantra explicitly promises both, in a pithy memorable rhyme,
“bhukti-mukti,” worldly enjoyment with power and liberation.
In any case, the incorporation of dynamism and change into the idea of the
absolute substratum is something that earlier traditions, like Advaita Vedanta,
for instance, take pains to avoid. They do this precisely in order to maintain a
pristine sense of transcendent self, unblemished by the change and imperman-
ence that functioned as the source of suffering for the ancient world. We should
9
Alexis Sanderson has discussed this in his masterful historical surveys of Tantra. See espe-
cially Sanderson (1988).
Wonder 111
keep in mind that “impermanence” might be read as a code word for the idea of
inevitable death of all things that time reveals. It will take us too far afield here
to pursue the incorporation of time into ideas of divinity;10 however, we may
note that this bold step is akin to philosophically taking the tiger by the tail.
Rather than refining ideas of selfhood away from change and the body, instead
embracing these elements shifts the formulation of selfhood in just as dramatic
a way as did the Buddha’s early rejection of an idea of self altogether. For one, it
answers the dilemma of impermanence, which, indeed, may have been one of
the primary drivers for an idea of a transcendent abstracted sense of selfhood in
the first place. The answer this Tantric shift gives, to embrace the body with all
its impermanence, does not render the question null and void as does the Bud-
dha’s early rejection of self; however, it does propose an astute psychological
understanding of the underlying psychological motivation that leads to an
abstracted and transcendent sense of self.
Wonder
The answer this nondual Kashmiri Śaiva Tantra gives is essentially panenthe-
istic, so it does not discard the idea of transcendent self, but rather rewrites it.
For this, the idea of wonder acts as a bridge between the numinosity of tran-
scendence and the mundane materiality here. Wonder serves to act as a bridge
between a transcendent sense of self and an embodied materiality. What, then,
is wonder? Wonder calls forth awe and a transcendence of our mundane mental
processes. For a Western context, wonder references two poles. On the one
hand, an opening, the beginnings of philosophy, as for Plato and Socrates
(Rubenstein 2008). On the other hand it also points for Aristotle to a degenerate
sense of curiosity, a puzzle that must be solved and hence must ultimately spell
its own demise (Bynum 1997). I focus here on the Sanskrit term camatkāra,
which does not have the dual meaning inherited from the Greek genealogy.
Here, Plato’s idea of wonder resonates more closely to the term camatkāra;
camatkāra does not evoke the sense of curiosity, but rather a kind of suspension
of ordinary mental engagement. So, for our context, we may leave aside Aris-
totle’s conception of wonder in favor of Plato’s.
It may be fair to say that for both us today and for our medieval Kashmiris,
wonder is, above all, a bodily experience, even if the experience of wonder often
feels as though it is taking us out of our bodies. Wonder causes our ordinary
mental rambling (vikalpa) to stop. The awe of wonder connects us to a kind of
rapture that seems at least in part other-worldly. For these Kashmiri authors,
10
I discuss this at greater length in Biernacki (2013).
the other-worldly feeling of wonder is not so much that it belongs to another

world, but rather that it reminds us of an innate subjectivity that transcends our
habitual subject-object distinctions. Wonder arises when one accesses the sense
of self in its fullness. That is, wonder expands the sense of self beyond its ordin-
ary limitations to connect it to the world in a juxtaposition that stops the ordin-
ary operation of the mind. In his “Fifteen Verses on Awakening” Abhinavagupta
tells us:
Knowledge of the principle of pure consciousness that manifests as one’s own
freedom—this is the highest state, which cannot be surpassed. It arises when wonder
(camatkāra) blossoms through the feeling of the complete fullness of the “I” as the
whole universe (viśva). That, in fact, is liberation, enlightenment (mokṣa).11
This medieval Kashmiri, deeply schooled in meditation practices, proffers a

psychological coding of wonder. Wonder is the link between the sense of self
as subject and the multiplicity of the world. Wonder is certainly a state of
mind, in this case a psychological awareness that transcends the human pro-
pensity toward mental classification of the world. The mind seems to stop,
but it is not that the mind ceases, nor that objects merge into the self, but
rather wonder suspends the mind’s capacity to dichotomize. In the experi-
ence of wonder, the two poles, world and self, mapped to object and subject,
form a dizzy unity that does not collapse either pole. So wonder breaks our
habitual pattern of dichotomous thinking with self in opposition to the
world. In this capacity, it also works against a conception of self as transcend-
ent and abstracted.
Indeed, the highest awareness for this Tantric philosophy understands the
self as wrapped in the fullness of the world. We see this spelled out explicitly in
the commentary that Kṣemarāja, Abhinavagupta’s disciple, gives for the Vijñāna
Bhairava. He tells us that one’s true nature, which is Bhairava, “consists of the
wonder of the fullness of the world, which contains the whole, in a nondual
apprehension with nothing left out.”12 Here again we see the idea of wonder
coupled with the apprehension of the world. Wonder works its magic precisely
through not collapsing the self and world into a unity, precisely by not allowing
the flight of the self up and out, away from the messy plurality of the world, iso-
lated into a perfect and impenetrable solitude of self.
The root text here that Kṣemarāja comments upon in the eleventh century is
the Vijñāna Bhairava, a key scriptural text for this Tantric tradition, likely
11
“yadanuttarasaṃvittattvasya parijñānaṃ viśvaparipūrṇahaṃbhāvacamatkārollāsena
svasvātantryābhivyaktiḥ sa eva mokṣaḥ” (Jagaddhar 1947).
12
“bharito’śeṣaviśvābhedacamatkāramaya ākāraḥ svarūpaṁ” (Anonymous 1918, p.12, line 268)
Wonder 113
composed in the seventh or early eighth century CE. The author of the Vijñāna
Bhairava is unknown and the text is considered scriptural revelation. The text
outlines a series of 112 different techniques for tapping into this space of won-
der, nearly all of them in relation to some sense of the external world. These
include techniques like savoring and meditating on the joy that arises from the
pleasure of eating and drinking, which brings about a divine bliss (Anonymous
1918, verse 72, p. 60–61). Another holds that if the practitioner imagines that
the entire world is being burnt by the fire of the destruction of time and does not
allow his or her mind to think of anything else, then such a person attains the
highest state of humans (Anonymous 1918, verse 53, pp. 44–45). A third tech-
nique involves meditating on one’s state at the beginning or end of a sneeze, or
in a state of terror, or sorrow, or in flight from a battlefield, or in a state of keen
curiosity, or when very hungry or just feeling sated from food, then a person
attains a divine meditative awareness (Anonymous 1918, verse 118, p. 102). The
Vijñāna Bhairava itself does not develop this theology of wonder; it takes the
later exegesis of the tradition’s scholar-mystics, like Abhinavagupta, Utpal-
adeva, and Kṣemarāja, to spell out the logic of wonder as numinous container
of self and world in a rapture of awareness that leaves behind the mind’s ten-
dency to dichotomize into self and others.
To wrap up this discussion I will offer one other quote from Kṣemarāja’s com-
mentary on this text, which takes us back to the epigraph from Keats at the
beginning of this chapter. This also speaks to a pressing question—how might
one cultivate wonder as a meditative practice? The Vijñāna Bhairava gestures in
various places to adopting an introspective awareness while in the middle of
engagement with the world. We also see in the Vijñāna Bhairava the power of
aesthetic appreciation to generate wonder. Commenting on verse 73, which
instructs the yogī to meditate on a beautiful song, to be absorbed in it, Kṣemarāja
tells us that:
. . . through the function of the sense of hearing, one grasps the words of a song with the
wonder generated in that. In this way, by seeing this exceedingly beautiful form, won-
der arises. From that, one tastes and relishes (carvaṇa, literally chewing) the sap of that
sweetness and so on.13
Poetry and song, wrapped in a sensuous encounter that readily transcends the
mental capacity to dichotomize, are especially potent in generating a sense of
wonder. Beauty has a power to shift us out of our normal sense of subject and
object. By bringing to bear an aesthetic concentration, a kind of metaphorical
13
Anonymous (1918), verse 73, p. 62: śravaṇendriyavṛttyā gītaśabdagrahaṇaṁ taccamatkāraṇam,
evam atisundararūpavaddarśanacamatkāraḥ, tathā madhurādirasacarvaṇisvādaḥ).
immersion in the sap of beauty, we tap into wonder, a wonder that intrinsically
arises out of the materiality of the world.
In this sense, Keats’ reflection on melancholy points to a similar transform-
ation of self that occurs even in dark moments of introspection. Joy has as its
core a melancholy that overwhelms and transforms the soul. “None save him
whose strenuous tongue / Can burst Joy’s grape against his palate fine . . .” In this
context our Kashmiri mystics tell us something similar: At the core of sensuous
experience we find a portal into wonder, a wonder that transforms the self
beyond its ordinary sense of limitation into a sense of the fullness of the “I”
(pūrṇāhaṃbhāva). The wonder that the aesthetic experience enables expresses
itself as a melting and expansion of the heart. Abhinavagupta tells us:
When the rasa or flavor comes into one’s purview, then it is enjoyed. This enjoyment is
differentiated from what is encountered through memory or direct experience. It is
characterized by melting, expansion and opening [of the heart].14
The aesthetic experience, then, is especially productive of wonder; it is an enjoy-

ment unlike ordinary experience, unlike memory or experience, anubhāva, in
general. It involves a melting and an opening of the heart and it is comparable
to the state of the highest bliss, the supreme Brahman. In this context, we reach
a conception of selfhood that does not isolate itself in a transcendent abstrac-
tion beyond the world, but rather one that embraces the world.
This relates to an early experience I had at the very beginning of my decades-long jour-
ney into meditation. I was in my last year at college at the end of the semester, uncon-
sciously struggling, no doubt, with anxiety about my future and displacing this anxiety
into a host of other distant and tragic disaster scenarios as unwelcome futures for
planet Earth and its inhabitants. I remember this part of my life and recognize in it the
fascination of others today, some friends, some not, online-trollers following with a
rabid and frozen compulsion the latest unfolding of Ebola, the spread of Fukushima
radiation to the California coast, zombie apocalypse movies, my conspiracy-theorist
friends’ worries of GMO’s taking over our food supply, chemtrails, our water fracked
away, and an impending global climate change looming ominously, desperately grap-
pling in the midst of this with the darkness of human nature . . . And projecting this
anxiety onto the vast and distant reaches of the globe with a grandiosity and drama that
14
Abhinavagupta, DhvanyālokaLocana 2.4; p. 83.
REFERENCES 115
only a young adult in his or her early twenties can pull off. So, beset with a deep sense
of suffering in the world, I looked inward (it’s hard not to think of that A. E. Housman
poem, “When I Was One-and-Twenty”, and makes one wonder, are we all inherently
Buddhists in our early twenties?). At the time I was also reading a great deal of romantic
poetry, Keats, Shelly, and Wordsworth, as well as the metaphysical poetry of Donne,
Herbert, and Marvell. Certainly the mood of these poetic strands and certainly the com-
bination of the memento-moribund metaphysicals with the emotionally high-flying
romantics fueled an emotional tempest as I turned 21. Feeling a sense of despondency,
I decided that if depression was emotional ground zero, then, in stoic fashion I would
acclimate myself to this baseline and not swerve from depression. I memorized Keats’
“Ode on Melancholy,” reciting it over and over many times every day, determined to
stay steadfast at least with an emotional low. So, I lived on canned tuna fish and carrots,
easy food to keep for a stretch of time and cheap to boot, not leaving my room for
weeks, and living the kind of resolve that only a 21-year-old can accomplish with a
straight face, I embraced my depression. After about three weeks, though, something
odd happened. Partly perhaps from the sonorousness of Keats dancing around my
brain, and partly perhaps from the necessary stillness needed to maintain a mood of
sadness, one morning I oddly woke up happy, ebullient, and, try as I might, unable to
shift into despondency over my plight and the world’s. From this I understood a sort of
reverse of Keats’ notion of melancholy at the heart of the essence of joy; rather joy, as
the inner throb, the life at the heart of everything, even sadness. Some years later I came
upon this idea in the writings of Utpaladeva and Abhinavagupta, the idea of
cidānandaghana, a “dense mass of consciousness entangled with joy,” as the under-
lying substratum of experience. In any case, the indelible etching of joy as the soul of
even depression set me on a new course.
References
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ies, 47). Input into GRETIL, Gottingen Register of Electronic Texts in Indian Lan-
guages, by Philipp Maas.
Anonymous (1918). Vijñānabhairava with commentary by Kṣemaraja and Śivopādhyāya.
Kashmir Series of Texts and Studies, Volume 8. Bombay: Research Department of
Jammu and Kashmir State. Downloaded from Muktabodha Indological Research Insti-
tute, www.muktabodha.org.
Biernacki, L. (2013). Panentheism and Hindu Tantra: Abhinavagupta’s grammatical cos-
mology. In L. Biernacki and P. Clayton (Eds.). God’s body: Panentheism across the
world’s religious traditions. New York: Oxford University Press, pp. 161–176.
Bynum, C. W. (1997). Presidential address: Wonder. American Historical Review, February, p. 4.
Glasenapp, H. Von (1999). Jainism, an Indian religion of salvation. New Delhi: Motilal
Banarsidass, p. 413.
Griffith, R. T. H. (1889–92). The hymns of the Rig-Veda translated with a popular commen-
tary. Benares: E. J. Lazarus and Co.
Haug, M. (1863). Aitareya Brahmaṇam of the Rigveda, translation with notes, Volume 2.
Bombay: Government Central Depot, p. 9.
Isayeva, N. (1992). Rāmānuja, Śrībhāṣya II.II.27, in Saṅkara and Indian philosophy. New
York: State University of New York Press, p. 4.
Jagaddhar, Z. (Ed.) (1947). Abhinavagupta, Bodhapañcadaśikā with commentary by
Harabhaṭṭaśāstrī. Kashmir Series of Texts and Studies, Volume 76. Srinagar: Research
Department of Jammu and Kashmir State, p.16. line 673. Downloaded from Mukta-
bodha Indological Research Institute, www.muktabodha.org.
Maas, P. (2006). Samādhipāda: Das erste Kapitel des Pātañjalayogaśāstra zum ersten Mal
kritisch ediert. Aachen: Shaker.
Olivelle, P. (1996). Upaniṣads: Translated from the original Sanskrit. New York: Oxford.
Rubenstein, M-J. (2008). Strange wonder: The closure of metaphysics and the opening of awe.
New York: Columbia University Press, p.11.
Sanderson, A. (1988). Śaivism and the Tantric traditions. In S. Sutherland et al. (Eds.). The
world’s religions. London: Routledge and Kegan Paul, pp. 660–704.
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later Indian Yogācāra school. Journal of Indian Philosophy, 37, 179–188.
Part 2
Therapeutic and clinical

applications of
meditation
Chapter 6
Traditional and secular views of

psychotherapeutic applications
of mindfulness and meditation
Lynn C. Waelde and Jason M. Thompson
Introduction
Over the past several decades mindfulness and meditation (MM) have become
increasingly incorporated into psychotherapeutic and clinical settings. Early
studies of clinical outcomes have given way to broad-ranging investigations of
physiological and neurophysiological outcomes of a large number of different
types of practice. There has been explosive growth in the rate of published
mindfulness research, expanding from less than a dozen articles a year prior to
1998 to almost 500 per year by 2012 (Black 2014). Despite this rapid growth and
greatly expanded interest in clinical practice, there has been little consensus
about definitions of MM (Chiesa 2013). The difficulty stems in part from uncer-
tainties about how to classify the many different meditation techniques in cur-
rent clinical and traditional usage and from tensions between traditional and
modern secular definitions and practices. There have been many attempts to
classify secular meditation techniques based on differences in the religious or
philosophical origins of the practices (Chiesa 2013; Sedlmeier et al. 2012), but
these attempts grapple with issues of making generalizations to clinical practice
based on descriptions of highly experienced or monastic meditators; grouping
diverse traditions and techniques into broad and overlapping categories such as
“Hindu,” “Buddhist,” and “secular mindfulness”; and creating distinctions
among traditions whose philosophical origins may differ but whose techniques,
particularly for the beginners who have populated some of the studies and most
of the clinical applications, may for all practical purposes be identical.
What is a busy psychotherapist to do? As reviewed below, there are some well-
standardized meditation and mindfulness-based intervention (MMBI) protocols,
such as mindfulness-based stress reduction (MBSR; Kabat-Zinn 2005),
mindfulness-based cognitive therapy (MBCT; Segal et al. 2002), and transcendental
120 Traditional and secular views of psychotherapeutic applications
meditation (TM; Orme-Johnson and Barnes 2014), for which there is an impressive
evidence base and established clinical training, but there are indications that psy-
chotherapeutic applications of MM outstrip both the standard protocols and the
evidence base. Given the lack of definitional consensus and degree of eclecticism in
clinical applications, we will explore issues in classification of MM types in current
psychotherapeutic usage, with attention to growing utilization, historical origins,
clinical applications, theoretical rationales, and evidence base. In addition, we con-
sider directions for future research and practice.
Growing utilization of mindfulness and meditation

The expanding implementations of MM parallel growing consumer demand.
National surveys have consistently noted that meditation and related practices
are among the most commonly used complementary and alternative medicine
(CAM) modalities in the United States to address health and mental health
issues. The 2007 National Health Interview Survey (NHIS) found that 38.4% of
adults in the United States had used some type of CAM in the past 12 months,
with deep breathing exercises, meditation, and yoga being among the most
common, used by 12.7%, 9.4%, and 6.1%, respectively, and showing increases
from the rates of usage in the 2002 survey (Barnes et al. 2008). An in-depth ana-
lysis of the 2007 NHIS CAM data reported that a quarter of the 16.3% who used
meditation and relaxation practices did so to treat a specific medical condition.
In addition, those with greater psychological distress were more likely to use
meditation and relaxation (Lee and Yeo 2013), so clearly there is a growing con-
sumer perception that MM practices can be therapeutic.
Clinicians likewise increasingly embrace MM as therapeutic. Some work
suggests that mindfulness is considered a theoretical orientation by many ther-
apists. In a survey of more than 2000 North American practicing psychother-
apists, mindfulness was the third most frequently endorsed theoretical
orientation, utilized by 41%. It followed cognitive behavioral therapy (CBT;
79%) and family systems (49%) in popularity. More than a fifth of therapists
taught skills such as meditation to at least half of their clients (Cook et al. 2010).
MM has also been incorporated into regular clinical care on a broad scale. A
survey of veterans’ hospitals in the United States found that 72% offer medita-
tion to their patients (VA Office of Research and Development 2011). Despite
the fact that MM research for post-traumatic stress disorder (PTSD) is still an
emerging area, MM appears to be in widespread usage among trauma therap-
ists. A survey of expert clinicians about best practices in the treatment of
complex PTSD identified MM as an appropriate second-line intervention,
used in place of standard trauma therapy because of patient preference or
Issues in modern secular classifications of mindfulness and meditation 121
treatment non-response (Cloitre et al. 2011). A recent trauma therapist survey

found that the majority use MM in some form in psychotherapy with trauma-
tized patients, typically integrated into standard psychotherapy sessions rather
than being offered in standardized forms such as MBSR or MBCT as an adjunct
or stand-alone treatment (Waelde et al. in press). As reviewed below, existing
research has primarily addressed the effects of standardized protocols, so these
indications of widespread acceptability and individualized applications sug-
gest that, for the moment at least, the practice has exceeded the evidence base.
Issues in modern secular classifications

of mindfulness and meditation
Although the terms mindfulness and meditation are often used interchangea-
bly, there are important distinctions between them. Mindfulness can be defined
as a method, or as a state that represents the outcome of practice of the method,
or as a stable trait (Nash and Newberg 2013). Many definitions of mindfulness
emphasize it as a set of techniques that cultivate cognitive control skills leading
to a state of ongoing present-moment attention. For example, Bishop and col-
leagues (2004) defined mindfulness as involving the self-regulation of attention
on the immediate experience of mental events with an attitude of curiosity,
openness, and acceptance. They regard mindfulness as a form of mental train-
ing developed by meditation practice, though psychotherapy that interferes
with experiential avoidance can also cultivate this skill. This latter point, that
meditation practice is not necessary to cultivate mindfulness, is an important
one for clinical applications of mindfulness because, as reviewed below, some
therapeutic applications involve mindfulness skills but not mindfulness medi-
tation as such.
Meditation is a broader term, encompassing a set of practices and their asso-
ciated outcomes. Because meditation has been practiced for many millennia in
many cultures throughout the world, a unitary definition is difficult, even
within the circumscribed domain of clinical applications of MM. Part of the
confusion arises from the use of the term meditation to refer to both methods
and resultant states of awareness (Nash and Newberg 2013). For example, medi-
tation refers to techniques, such as breath focus or mantra repetition, but also
to outcomes, such as refined states of consciousness. Walsh and Shapiro (2006)
defined meditation as a family of self-regulation practices that focus on training
attention and awareness to bring mental processes under greater voluntary con-
trol. The outcome of these practices is to develop general mental well-being and
capacities such as calm, clarity, and concentration. This definition, with its
emphasis on control of mental processes for psychological well-being, though
intended to be integrative of Eastern and Western traditions, probably better

describes secular meditation as used in clinical practice rather than encompass-
ing Eastern meditation traditions in general, which tend to espouse meditation
as techniques for ultimately transcending mental processes to achieve nondual
awareness (Dunne 2011; Josipovic 2010; Travis and Shear 2010a).
Concentrative versus mindfulness meditation

There have been notable efforts to classify meditation practices based on tech-
niques. Many attempts distinguish between concentrative and mindfulness
meditation. Concentrative meditation refers to practices that involve focus on a
particular stimulus, such as the breath, whereas mindfulness refers to unselect-
ive attention to the flow of thoughts, sensations, and experiences. In this classi-
fication, concentrative meditation involves the narrowing and mindfulness the
expansion of attention (Ivanovski and Malhi 2007). In actual practice, it is diffi-
cult to distinguish these two broad types of meditation with regard to the use of
a specific attentional focus. For example, Bishop and colleagues (2004, p. 238)
defined concentrative meditation as “restricting the focus of attention to a sin-
gle stimulus such as a word, sound, or sensation. When attention wanders, it is
redirected back to that single stimulus.” This definition of concentrative medi-
tation is very similar if not identical to their description of mindfulness medi-
tation: “The client . . . attempts to maintain attention on a particular focus, most
commonly the somatic sensations of his or her own breathing. Whenever atten-
tion wanders from the breath to inevitable thoughts and feelings that arise, the
client will simply take notice of them and then let them go as attention is
returned to the breath. This process is repeated each time that attention wan-
ders away from the breath” (p. 232). Thus, breath-focused attention is variously
referred to as a concentrative or mindfulness form.
To complicate matters, when a mantra is used, that is, the repetition of words,
sounds, or phrases as an attentional focus, it is typically regarded as concentra-
tive meditation (Cahn and Polich 2006; Ospina et al. 2007), despite the fact that
definitions of mindfulness meditation do not specify the breath as the sole
focus, mantra is often repeated in synchrony with the breath (Braboszcz
et al. 2010), and conceptualizations of mantra describe it as a method to enhance
present moment (Waelde 2015) and expanded states of awareness (Cahn and
Polich 2006). Mantra repetition, like breath-awareness meditation used in
mindfulness, tends to slow breathing and may alter autonomic tone (Braboszcz
et al. 2010). Moreover, mantra meditations such as TM can produce increases in
mindfulness (Tanner et al. 2009). These definitions of concentrative and mind-
fulness meditation leave open the question of whether mindfulness meditators
practice concentrative meditation and whether those who use concentrative
techniques such as breath awareness and mantra ever experience mindfulness

as an outcome.
The dichotomy between concentrative and mindfulness techniques has led to
distinctions between entire schools of meditation and their respective practi-
tioners. For example, a review classified TM, yogic, and samatha meditation as
concentrative and Zen and vipassana as mindfulness (Ivanovski and Malhi
2007), even though Zen and vipassana rely on concentrative techniques (Lutz
et al. 2008). One unfortunate outcome of this classification practice is the diffi-
culty in specifying what mindfulness is and is not. In neuroimaging studies of
meditation, experimental tasks involving meditation on a specific sensory
focus may be classified as mindfulness or concentrative apparently depending
on the school of meditation of the research participants. In one study, partici-
pants who had received 8 weeks of MBSR training focused on scanner sounds
during the “mindfulness” meditation scan (Kilpatrick et al. 2011); in another,
Tibetan Buddhists performed a “concentration” meditation task involving
focus on a dot on a screen (Brefczynski-Lewis et al. 2007). Studies of different
meditation techniques have often confounded technique with school and thus
it is difficult to evaluate the results of studies and meta-analyses of the compara-
tive effectiveness of different meditation types.
Focused attention, open monitoring, and nondual

awareness
Fortunately, there is now general consensus that meditation styles can involve
more than one technique. A widely cited classification offered by Lutz and col-
leagues (2008) referred to some Buddhist meditation types and their Western
secular derivatives (i.e. mindfulness) as including both focused attention (FA)
and open monitoring (OM). FA is a method of attentional training in which the
meditator practices maintaining focus on a meditative object such as the breath,
while OM is a form of non-discriminative awareness in which the meditator
allows each experience to arise and dissipate in consciousness without either
averting from or over-identifying with any one thought, feeling, or sensation
and without maintaining any specific attentional focus. OM is considered the
hallmark practice of mindfulness because of its non-reactive attention to
present-moment experience. FA practice stabilizes attention and prepares the
practitioner for OM, though the two practices are often used together within a
single meditation session and over the course of training (Lutz et al. 2008). This
definition clarifies matters by recognizing that mindfulness meditation includes
both concentrative techniques and more openly receptive forms but does not
address the issue of whether FA and OM might be involved in meditation forms
that are not derived from Buddhist traditions. Subsequent reviews of the
distinction between FA and OM assume that mantra and visualizations are

forms of FA (e.g., Braboszcz et al. 2010; Hölzel et al. 2011), thus raising the pos-
sibility that FA may be entailed in different traditions and techniques. In
research and clinical practice, however, meditation that involves breath focus
(with or without OM) is usually classified as mindfulness meditation, and
meditation that includes alternate FA forms such as mantra and visualization,
even if they include breath focus, are referred to as concentrative or “non-
mindfulness” types, as though they never lead to OM and mindfulness. Inter-
estingly, the mindfulness component of hatha yoga is recognized in its inclusion
in MBSR (Dunn et al. 2013), showing that practices deriving from the Hindu
tradition may include mindfulness. Thus, the concentrative versus mindfulness
distinction persists in meditation research and the question of whether other
forms of meditation besides those deriving from the Buddhist tradition ever
involve mindfulness practices or states is inadequately addressed.
Criticism of the FA/OM taxonomy has stressed the imperative to incorporate
an understanding of mental state changes as a factor in the conceptualization of
meditation. Travis and Shear, for example, have proposed a third category in
addition to FA and OM: automatic self-transcending meditation (Travis and
Shear 2010a). By grouping meditation forms in terms of the cortical electrical
activity most notably associated with each one, Travis and Shear noted that TM
differentiated from other meditation forms they categorized as FA (loving-
kindness meditation, qigong, and Zen) or OM (vipassana, sahaja yoga, qigong,
and Zen) by exhibiting patterns of alpha-1 activity that were not observed in the
other types. The authors inferred that TM was a form of meditation with tech-
niques that, unlike FA and OM, are designed to transcend their own activity in
an effortless way. In support of this conjecture, the authors cited an earlier study
(Travis and Pearson 2000) in which phenomenological analysis of TM self-
reports noted prominent themes of attenuated spatial and time awareness that
were consistent with the authors’ conceptualization of pure consciousness, dis-
tinct from phenomenological descriptions of FA and OM. This and other work
have begun to address nondual awareness (NDA), a meditative state in which a
critical distinction is lost or greatly attenuated: The distinction between the
meditator as subject observing the contents or object(s) of awareness. NDA is
distinct from FA and OM states that maintain the dualism of subject versus
object (Dunne 2011; Josipovic 2010; Travis and Shear 2010b). Despite the fact
that Lutz and colleagues defined FA and OM as hallmarks of mindfulness medi-
tation, Dunne (2011) asserted, without any evidence or illustration, that MBSR
involves NDA, which may make it similar to TM and other types of meditation
that are thought to produce NDA. Although the TM tradition regards the NDA
state as attained effortlessly (Travis and Shear 2010a), as reviewed below,
traditional sources regard NDA as an advanced state of meditation, so it is

unclear whether and how states of NDA are involved in MMBI.
Traditional versus secular

The preceding review of classification issues was drawn from the secular MM
literature. Recently, there has been controversy about the extent to which defin-
itions, practices, and descriptions of meditative states should be guided by fidel-
ity to Buddhist teachings or whether secular MM constitutes a distinct domain
that may draw upon wisdom traditions but is also guided by scientific and prac-
tical considerations. Several authors have called for fidelity to Buddhism, based
on the fact that mindfulness is at the heart of Buddhist teaching, and have
emphasized that MM clinicians and researchers should have mindfulness train-
ing, personal meditative attainment, and collaborations with qualified Bud-
dhist teachers (Grossman and Van Dam 2011; Van Gordon et al. 2015). Other
authors have pointed out constraints involved in scientific and clinical applica-
tions of mindfulness, such as the need to operationally define and measure key
constructs and present techniques in a secular way in order to render them
more broadly acceptable (Baer 2011). Kabat-Zinn (2003) takes the position that
Buddhist mindfulness teachings are dharma, universal truths, like the laws of
physics, and as such are not exclusively Buddhist. Thus, aside from the question
of whether there should be a separate, secular mindfulness domain, this contro-
versy raises the issue of which wisdom and secular traditions may contribute to
the science and practice of mindfulness. Kabat-Zinn’s dharma perspective con-
tends that mindfulness concerns the universal human capacity of attention,
which implies that it has likely been explored by various traditions throughout
the course of human history. In sum, who owns mindfulness? Is it an exclusively
Buddhist practice? Is mindfulness entailed in other religious or philosophical
traditions? Is there a new type of secular mindfulness, which has been drawn
but yet is distinct from its historical origins? Recent commentary suggests that
the distinction between secular mindfulness and traditional Buddhism is not a
clear one, especially to the extent that the secular mindfulness community has
equated mindfulness with Buddhism teachings (Purser 2015).
In clinical practice, the interchange between wisdom and secular traditions
raises many issues, such as the sort of training required for competent clinical
practice, the boundaries between one’s personal, spiritual, or religious practice
(or lack thereof) and therapeutic procedures, and ethical issues about the “Tro-
jan horse” practice of employing techniques that may seem explicitly Buddhist
but are presented as though they are free from any religious connotations that
may be inconsistent with clients’ own faith traditions. To the first point, although
standardized MMBIs such as MBSR, MBCT, and TM have training programs,
many therapists may not be using the standardized protocols in therapy. As

reviewed above, MM techniques are in widespread use and there are indica-
tions that psychotherapeutic applications may be incorporated into standard
psychotherapy in individualized ways. This eclecticism means that psychother-
apists may see spiritual teachers as appropriate clinical trainers in the MM
domain, which would distinguish it from other forms of psychotherapy prac-
tice that are generally understood to require professional training (Waelde
et al. in press). Labeling mindfulness (and by extension meditation) as Buddhist
also implies that these therapeutic procedures represent the integration of reli-
gion into psychotherapy, raising important issues about therapeutic boundar-
ies, such as how to frame MM procedures for the client, whether MMBI
therapists remain therapists or become meditation teachers, and whether psy-
chotherapy clients should be invited to meditation classes in the therapist’s own
dharma community (Pollak et al. 2014).
There may be several advantages to maintaining the distinction between reli-
gious and clinical practice. Fundamentally, the aims of Buddhist and clinical
MM practice are different. Despite Van Gordon et al.’s (2015, p. 7) call for Bud-
dhist and scientific communities to work together to validate interventions that
are “effective according to both clinical and spiritual criteria,” the aim of Bud-
dhist meditation practice, namely experience of “the single, unchanging, and
all-pervasive nature of emptiness” (Van Gordon et al. 2015, p. 4) does not seem
a close match with the immediate clinical needs of psychotherapy clients. Part
of the issue seems to be the conflation of the Buddhist concept of suffering, duk-
kha, with the sorts of suffering clients present in psychotherapy (Lindahl 2014).
Moreover, the reasoning that “the Buddha’s teachings can be likened to an all-
purpose medicine” (Van Gordon et al. 2015, p. 5) reflects a mind-body dualism
common in religious and philosophical teachings (Forstmann and Burgmer
2015) that would have us prescribe Buddhism in place of psychotherapeutic,
but not medical, intervention.
Much research has been conducted with meditation adepts from different
religious or spiritual traditions and it is not clear what implications these stud-
ies have for clinical practice. Participants in these studies are often monastics or
persons with many thousands of hours of practice time in spiritual or religious
contexts. Although studies of meditation adepts have shed light on the neuro-
science of advanced meditative states, there are fundamental differences from
clinical applications in terms of the types of participants and the aims, types,
and amount of practice. For example, Lutz and colleagues investigated the
neural circuitry of compassion meditation among experts (Lutz et al. 2008).
The participants in this study were selected because they were recognized as
experts in Buddhist meditation, with between 10,000 and 30,000 hours
of meditation practice. In contrast, participants in clinical MMBI studies are

typically selected because of a diagnosed disorder or condition. Likewise, the
aims of MM practice among adepts are different from clinical aims. In the Lutz
et al. (2008) study, “the long-term goal of meditators undergoing such training
is to weaken egocentric traits so that altruistic behaviors might arise more fre-
quently and spontaneously” (p. 1). In contrast, psychotherapy clients typically
participate in MMBI with a goal of symptom reduction. The two types of prac-
titioners may be exposed to different types of practices, with experts typically
receiving instruction from religious/spiritual teachers (rather than psychother-
apists) in contexts such as retreat settings that allow for extended practice peri-
ods, in contrast to the brief meditation training usually allocated in MMBI.
Although comprehensive descriptions of experts’ training experience were not
provided, it seems reasonable to speculate that the experts in the Lutz et al.
(2008) study had received instruction in a variety of meditation practices over
the course of their training, in preparation for and flowing from the specific
compassion meditation that was the focus of the investigation. Finally, there
can be no doubt that psychotherapy does not involve thousands or tens of thou-
sands of hours of meditation instruction and practice. Evidence is mounting
that mechanisms of meditation may be very different for novices versus experts
(Chiesa et al. 2013). As Lutz and colleagues pointed out, studies of experts are
vital for understanding the long-term mechanisms and outcomes of medita-
tion, but implications for clinical practice are not straightforward.
Given these fundamental differences between spiritual and clinical MM
practice, differentiating the two would clarify matters greatly. Questions about
whether MM training in clinical practice should incorporate elements of the
spiritual traditions would be guided by clinical necessity and acceptability.
Adaptations of traditional practices to clinical problems would be guided by a
keen understanding of the match between the mechanisms and outcomes of a
particular practice and the nature of the problems to be treated. Similarly, dis-
tinctions among MM practices would be guided by specifics of the techniques
and their mechanisms of outcome for particular disorders or conditions, rather
than by classification into broad traditions such as Buddhist and Hindu. As a
very practical matter, interpretation of neuroimaging data or clinical trials out-
comes must make reference to clear behavioral descriptions of meditation tasks
that were employed. Breath-focused meditation among beginning practitioners
may for all practical purposes be identical across traditions. Further, medita-
tion techniques used in clinical practice may bear incomplete similarity to their
wellspring traditions. Several recent reviews have criticized definitions and
methods of mindfulness in clinical practice as insufficiently representing the
breadth of the tradition (Chiesa 2013). It is unclear to what extent clinical and
research applications of meditation with novices resemble advanced techniques

and mental states described in traditional accounts. In addition, broad tradi-
tions cannot be parsed according to technique. As reviewed below, both Hindu-
and Buddhist-inspired meditations include a succession of techniques that flow
from FA as attention training through increasingly refined states of awareness
involving nondual awareness, or suspension of the distinction between the self
as the observer and the object being observed (Dass and Diffenbaugh 2013;
Dunne 2011). Both broad traditions employ mantra repetition, movement
techniques, and philosophical frameworks that may shape the idioms used to
describe meditation experiences, so differentiating Buddhist and Hindu tradi-
tions with reference to specific techniques such as mindfulness or mantra is
problematic.
Contemporary conceptualizations of MM reflect a range of techniques and
resulting states of awareness, from meditation on a specific focus as a means to
stabilize attention, to nonselective attention to the phenomenal field, to surren-
der to nondual awareness. These conceptualizations have largely been drawn
from Hinduism and Buddhism, both of which are vast traditions containing
diverse schools of thought. However, for the purposes of addressing the types of
MM in contemporary psychotherapeutic usage, it is worth considering a few
overlaps between these two broad traditions in terms of the FA/OM/NDA dis-
tinction and the developmental trajectory of meditation training.
A brief consideration of historical origins

of clinically applied MM
Clinical applications of MM are primarily drawn from the Buddhist and Hindu
traditions, particularly Buddhist teachings about mindfulness. Both root tradi-
tions are vast and include substantial heterogeneity across their several millen-
nia of history, so the following review addresses some features of these two
traditions that have particular relevance to psychotherapeutic applications.
Buddhist tradition
The term mindfulness, first used in English as a translation of the Pali noun sati
(Bodhi 2000), denotes a state of present moment nonreactive awareness that is
associated with some forms of meditation. Historically, mindfulness has been
regarded in the Buddhist tradition as a foundational state of enhanced awareness
that plays a pivotal role in methods to reduce suffering and achieve human lib-
eration. The amelioration of the suffering associated with the human condition
was a common aim of the Hindu and Buddhist meditation traditions from which
the modern clinical use of mindfulness is derived (Eberth and Sedlmeier 2012).
A brief consideration of historical origins of clinically applied MM 129
Several ancient texts are central to the meditation traditions that inspired
early clinical applications of mindfulness. An important work in the canonical
texts of early Buddhism, the Satipatthana Sutta (foundations of mindfulness)
(Walshe 1987) is especially instructive in the present discussion. The Satipat-
thana Sutta explained that mindfulness is a method for the elimination of suf-
fering and outlined four focal points for mindfulness: Breathing, feeling,
consciousness, and mental objects. The mental objects include negative emo-
tions (e.g. anger); perceptual processes with which the mind identifies; sensory
stimuli; positive emotions conducive to spiritual development (such as tran-
quility, equanimity, and concentration); and the Four Noble Truths (the reality
of suffering, the link between suffering and clinging, the possibility of relin-
quishing clinging, and the method used to do so). The importance placed on FA
in MMBI is reflected in breath-focused Buddhist meditative techniques.
Other early texts where the Four Noble Truths are explained in depth, for
example the Mahasatipattana Sutta (greater discourse on the foundations of
mindfulness), emphasized the inherently transient nature of existence, the
inevitability of hardship, the compounded nature of all phenomena including
the self, and the use of meditation to develop increasingly refined states of con-
sciousness predicated on foundational awareness of the reality of suffering
(Walshe 1987). That is, mindfulness is an awareness technique, but the texts
were also quite specific about broader psychological and existential themes
beyond the breath to which this enhanced awareness should be subjected,
including the necessity of ethical behavior and insights regarding the inter-
dependence of the self with all phenomena (Williams 2000). A later Buddhist
movement, the Mahayana, emphasized the necessity of compassionate behav-
ior as integral to this enhancement of awareness, which in turn was supported
by the practitioner’s acquisition of a non-clinging attitude (Williams 2009).
Scrutiny of the contemplative traditions from which mindfulness derives sug-
gests that meditation can induce states of awareness that extend upon a spec-
trum that is not adequately captured by the FA/OM taxonomy or the term
mindfulness. For example, an early Buddhist text, the Ariyapariyesana Sutta,
outlines a spectrum of meditative development that begins with mindfulness
and equanimity, and then proceeds via a series of increasingly refined absorp-
tions (jhanas) to a dimension of consciousness in which all mental activity and
self-awareness cease altogether (Walshe 1987), a state sometimes described as
NDA (Dunne 2011). In these Buddhist texts the development of awareness
takes place alongside insights into the nature of existence and the necessity for
compassionate and ethical conduct. Despite the fact that secular writing has
emphasized mindfulness as a hallmark of Buddhist meditation, a review indi-
cates that in the Buddha’s original teachings, mindfulness serves the purpose of
regulating attention on the object of meditation (Van Gordon et al. 2015). Thus,
in the Buddhist canon at least, it may not be accurate to make a sharp distinc-
tion between concentrative and mindfulness meditation.
Hindu tradition
These ideas about types of meditative awareness and the need for ethics and
insight have their parallels in ancient meditation texts drawn from Hindu tra-
ditions. The earliest reference to breath-focused meditation is in the Ṛg Veda,
the oldest text in the Hindu canon, which dates from about 1200 BCE (Flood,
1996). The earliest meditation reference in the Upaniṣads is in the oldest one,
the Pre-Buddhist Brhadāranyaka Upaniṣad, which states that after becoming
calm and focused, the meditator can perceive unity with all things. The Maitrī
Upaniṣad, dating from about 600 to 300 BCE, contains an early formulation of
the facets of yoga, involving prānāyama (breathing techniques), tarka (inquiry),
pratyāhāra (sense withdrawal), dhāranā (concentration), dhyāna (meditation),
and samādhi (absorption). Patañjali’s Yoga Sūtra, dating from about 100 BCE to
500 CE, added certain preparations for meditation practice, such as yama (eth-
ical principles), niyama (self-restraint), and āsana (yoga posture) to these six
facets to formulate eight-limbed or ashtānga yoga (Flood 1996).
In the Yoga Sūtra, dhāranā is the first level of awareness and involves medita-
tion on a particular object, such as a feeling, thought, or image. In this stage of
meditation, the focus is at times broken and thus concentration is not uninter-
rupted. It is important to note that concentration becomes increasingly subtle;
that is, the initial focus is on the object’s gross aspects and over time concentra-
tion reveals increasingly subtle aspects of the object. When dhāranā is continu-
ous, it becomes dhyāna, the uninterrupted flow of mental effort. The one-pointed
concentration involved in dhyāna requires control of desires, because they con-
stitute a distraction (Dass and Diffenbaugh 2013). These first two stages may
correspond to degrees of FA because they involve training the attention to focus
on an object of meditation.
With practice, dhyāna develops into samādhi, or high consciousness, with
different stages of samādhi reflecting degrees of what might elsewhere be
described as OM and NDA. The initial stages of samādhi are termed
samprajñāta samādhi, or the samādhi of wisdom. In samprajñāta samādhi the
mind is still fluctuating in gross levels of object-based cognition. The first
stage of samādhi (savitarka samādhi; absorption with reasoning) involves
ordinary mental functions, such as experiences of the senses and thoughts
and feelings that accompany those sense perceptions (Dass and Diffenbaugh
2013). Savitarka samādhi resembles the description of OM because it entails
awareness of the flow of experience. As meditation experience progresses, the
A brief consideration of historical origins of clinically applied MM 131
meditator transcends all fluctuations of the mind and no longer relies on an

object of meditation; subject and object of meditation no longer exist in
asamprajñāta samādhi. Samādhi results in knowledge about the nature of
existence itself (Dass and Diffenbaugh 2013).
The Yoga Sūtra are generally interpreted as descriptive of concentrative medi-
tation because they appear to describe stages of meditation on a concrete object.
Indeed, at the initial stages, the focus may be concrete but progresses through
successive refinements. The transition from focus on a particular object in
dhyāna to savitarka samādhi is quite distinct and is predicated upon achieve-
ment of vairāgya, or detachment from “the colorings pertaining to objects in
the mind” (Dass and Diffenbaugh 2013, p. 39). Thus, the Sūtra describes stages
of meditation that begin with focus on a particular object such as the breath,
progress to awareness of the flow of experience without clinging to a particular
object of attention, and culminate in states of NDA. The “objects of meditation”
described in the Sūtra refer to all the contents of awareness prior to loss of the
self–object distinction in asamprajñāta samādhi, rather than necessarily refer-
ring to specific concrete objects.
Correspondences with the categories of FA, OM, and NDA

The correspondences of the terms FA, OM, and NDA to meditative states in the
Yoga Sūtra and in Buddhist literature are approximate at best. Hindu and Bud-
dhist teachings are vast, living traditions and the cited texts do not represent
these traditions in their entirety. These traditions offer the accumulated wis-
dom of meditation masters over millennia and as such may offer valuable
insights about the nature and development of awareness. The three broad cat-
egories of FA, OM, and NDA describe ways that attention is deployed, but both
Hindu and Buddhist traditions describe additional gradations of awareness and
aspects of the practice, such as the development of qualities such as self-restraint
and detachment. Further, correspondences between these three categories and
Buddhist and Hindu writings do not imply that the aim of Buddhist or Hindu
practice corresponds to the aim of meditation in MMBI. Descriptions of the
developmental trajectory of meditation in the traditional literatures may have
little direct clinical relevance because the context, types, and degree of practice
in MMBI may bear little resemblance to these root traditions. The correspond-
ences do suggest that there is overlap among traditions; mindfulness may not
occur exclusively in the course of Buddhist meditation, though of course some
forms of Buddhist meditation may be particularly effective ways to learn mind-
fulness. One session of both sham and mindfulness meditation have been
shown to produce increases in mindfulness relative to control (Johnson
et al. 2013), lending credence to the idea that mindfulness is a natural human
capacity that can be cultivated by religious and spiritual activities but develops
outside of these contexts as well.
These brief considerations of some aspects of the Hindu and Buddhist origins
of contemporary MM practice should reassure clinicians that although medita-
tion traditions offer much insight about ways to cultivate qualities and atten-
tional states conducive to well-being, the capacity for being present in the
moment is a human one, cultivated by a variety of means, including periods of
dedicated practice called meditation. Psychotherapeutic applications are a
recent development in this millennia-old tradition and can make use of tech-
niques that have withstood the test of time.
Applications of MM in psychotherapy
The preponderance of research about the clinical utility of MM has used stand-
ardized MMBIs such as MBSR, MBCT, TM, and others. However, in actual
clinical practice, the use of standardized protocols may be the exception rather
than the norm. A recent survey indicates that individualized use of MM tech-
niques, such as breath-focused awareness, may be the most common clinical
application of MM (Waelde et al. in press), and there is a growing clinical litera-
ture about applications of MM techniques within conventional psychotherapy
(Germer 2005; Pollak et al. 2014). Applications of MM in psychotherapy might
be thought of as occupying a continuum of usage intensity, ranging from the
use of mindfulness by the therapist only to standardized protocols applied as
adjuncts or stand-alone treatment.
A spectrum of usage intensity

A burgeoning literature describes the benefits of MM practice for psychother-
apists themselves. Recent work shows that a brief training program can increase
therapist skills and knowledge related to mindfulness (Aggs and Bambling
2010). A prospective study found that psychotherapists in training who partici-
pated in nine weeks of Zen meditation had better therapeutic course and treat-
ment outcomes than non-meditating controls (Grepmair et al. 2007). In
post-disaster settings, MM training may address therapists’ trauma symptoms
related to their own disaster exposure and losses and promote coping self-
efficacy (Hechanova et al. 2015; Waelde et al. 2008). It has been suggested that
mindfulness training can enhance therapist qualities related to common factors
of effective treatment, such as affect tolerance, acceptance, empathy, equanim-
ity, paying attention, and accepting the limits of psychotherapy (Fulton 2005).
Moreover, therapist training is thought to be a prerequisite to the applications
of MM in psychotherapy, particularly for the more involved applications.
Applications of MM in psychotherapy 133
Perhaps the most common application of MM in psychotherapy is the ad hoc

use of breath-focused attention to help the client become more aware of inner
experience, thoughts, and feelings during the session. In this implementation,
the therapist integrates MM techniques into conventional psychotherapy with
the aim of helping the client to tolerate other therapeutic procedures, such as
exploration of trauma memories (Waelde 2015). The therapist may also intro-
duce everyday mindfulness exercises, such as a practice of breath awareness
during daily activities or stressful moments. Breath awareness in daily life may
be a particularly accessible practice for clients; it was used by a majority of
MBSR participants three years after the program, whereas only a minority prac-
ticed sitting meditation (Miller et al. 1995). Depending on client need and
motivation, the therapist may teach very brief, breath-focused sitting medita-
tion to develop present moment awareness and cultivate acceptance, with a
focus on developing ways for the client to practice that are easy and pleasant
(Germer 2005). Standardized MM protocols teach clients to use longer periods
of daily MM practice. Research has shown that the amount of daily sitting
meditation practice is associated with increases in mindfulness and decreases
in psychological symptoms (Carmody and Baer 2008; Waelde et al. 2004, 2008).
Although there has been much speculation that standardized protocols such as
MBSR might be useful adjuncts to conventional psychotherapy, one study
showed greater termination among clients receiving adjunctive MBSR relative
to those who received psychotherapy alone (Weiss et al. 2005). Most of the
research about MMBI has examined it as a stand-alone treatment, though as
reviewed below, only a subset of studies have included participants with diag-
nosed disorders.
Standardized applications of MMBI

The mindfulness-based interventions that have received the most attention in
clinical applications are all multi-component interventions. MBSR includes
instruction in sitting mindfulness meditation, body scan meditation, hatha
yoga, and mindfulness in daily life, though the cultivation of present moment
awareness is considered to be the common factor of all these activities. The pro-
gram is a group-based eight-week intervention that includes discussion about
how to apply the practice in daily life and involves recommended homework of
formal sitting mindfulness meditation and mindfulness in daily life (Kabat-
Zinn 2005). MBSR, unlike many of the MMBIs that were derived from it,
doesn’t include conventional psychotherapy. MBCT is a group-based eight-
week program that integrates elements of MBSR with psychoeducation and
cognitive-behavioral strategies for depression (Segal et al. 2002). Mindfulness-
based relapse prevention (MBRP) integrates the components of MBSR with
relapse prevention, based in CBT, for substance dependence treatment (Bowen

et al. 2011).
Other psychotherapies have incorporated mindfulness without including
formal practice of sitting meditation. Acceptance and commitment therapy
(ACT) integrates mindfulness with concepts of valued living, willingness, and
the distinction between self-as-context versus self-as-content (Hayes and Stro-
sahl 2010). Dialectical behavior therapy (DBT), also considered a mindfulness-
based approach, involves mindfulness exercises to promote self-monitoring as
part of emotional regulation skills training in the treatment of borderline per-
sonality and other disorders (Linehan 1993).
The classification of MMBI according to the religious origins of the practice
has led some forms of meditation, such as kindness-based meditation (KBM),
to be regarded as mindfulness because they have historically been practiced
alongside mindfulness meditation in Buddhist tradition. A recent review indi-
cated that KBM includes several related types of meditation, such as loving-
kindness and compassion meditation, that focus on generating feelings of
loving-kindness or compassion toward others (Galante et al. 2014). KBM dif-
fers from mindfulness approaches because the aim of the meditation is not to
just observe experience but to create a different type of experience involving
loving and compassionate feelings toward others.
As mentioned earlier, MMBIs that involve mantra repetition have been long
regarded as “non-mindfulness” types. TM, the best-researched among them,
uses the silent repetition of a mantra or sound to produce transcendental con-
sciousness, or heightened awareness of self and the world; mindfulness is pre-
sumed to be a by-product of that heightened awareness (Tanner et al. 2009).
Implementations of TM in clinical studies have used a combination of individ-
ual and group-based formats and the intervention does not include elements of
hatha yoga or conventional psychotherapy (Orme-Johnson and Barnes 2014).
Inner resources for stress (IR) is a group-based eight-week intervention that
uses mindfulness meditation, breath-focused imagery and mantra repetition,
and mindfulness in daily life with practices for letting go of thoughts, feelings,
and sensations as they arise. In IR, breath-focused mantra and imagery, as more
structured forms of FA than simple breath awareness, are used to provide help-
ful structure for practitioners who otherwise would not be able to tolerate
mindfulness practice because of intrusive thoughts and feelings (Butler
et al. 2008; Waelde et al. 2004, 2008).
The mantram repetition program (MRP), which has been used for military
veteran PTSD and other conditions, is a group-based meditation intervention
that uses a client-selected sacred word, repeated silently throughout the day, as
a method to train attention and regulate emotion. In MRP, mantram is
Theoretical rationale for MMBI 135
deliberately spiritual, to call on spiritual resources, and does not rely on sitting
meditation, to increase the portability of the practice. Mantram helps to man-
age unwanted thoughts by directing “attention away from negative thoughts in
advance, thereby reducing emotional distress” (Bormann et al. 2013, p. 260).
With the exception of MRP, these standardized MMBIs all incorporate mind-
fulness in some way, though MRP includes the FA form of mindfulness prac-
tice, and mindfulness in TM practice is thought to be a result of the NDA
achieved by the practice. Mindfulness itself, like the MMBI in which it is
incorporated, may contain multiple components that produce distinct treat-
ment mechanisms.
Theoretical rationale for MMBI

Mindfulness has been previously defined as comprising four components:
Attention regulation, body awareness, emotion regulation, and change in per-
spective on the self (Hölzel et al. 2011). As a set of self-regulatory mechanisms,
mindfulness has been theorized to comprise at least two distinct neurophysio-
logical pathways. The first, top-down pathway involves enhanced attention cap-
acity attenuating automatic emotional reactivity, while the second, bottom-up
pathway involves attenuated limbic activity without the need for conscious con-
trol. Neuroimaging evidence indicates that FA primarily recruits top-down
processing, and OM recruits bottom-up processing (Chiesa et al. 2013).
Attention regulation and reappraisal

The attention regulation component of mindfulness (Hölzel et al. 2011) is
theoretically congruent with the concept of top-down processing (Chiesa
et al. 2013) and can be understood as an enhancement of top-down appraisal
mechanisms that remediate negative attributional biases (Beck 2008). This
aspect of the clinical utility of mindfulness is consistent with the theory that
appraisal can refine the meaning of emotions and reduce the perceived
unpleasantness of negatively valenced stimuli (Panksepp 1998). It is this
reappraisal dimension that Kabat-Zinn stressed in his formulation of mind-
fulness as a practice of enhanced, deliberate, directed attention that entails
“paying attention in a particular way: On purpose, in the present moment,
and nonjudgmentally” (1994, p. 4). Several subtly contrasting empirical con-
structs subsequently emerged that similarly emphasized this reappraisal
dimension. Hayes (2004), for example, described this process as cognitive
defusion, while other related constructs included reperceiving (Carmody
et al. 2009). Bishop and colleagues’ (2004) definition emphasized an attitude
of openness and acceptance. Baer and colleagues (2008) outlined a five-facet
model of mindfulness in which two of the facets are non-judging of inner

experience and non-reactivity to inner experience. All of these definitions
emphasize the appraisal function of present moment attention.
Emotion regulation
The emotion regulation component of mindfulness (Hölzel et al. 2011) is theor-
etically congruent with the concept of bottom-up processing (Chiesa et al. 2013)
and can be understood in terms of the capacity of mindfulness to reduce the
automaticity of dysfunctional emotion-cognition processing and induce emo-
tional stability. Neuroimaging evidence supports this view. For example, one
study showed that mindfulness beneficially impacts core physiological stress
regulatory processes, the hypothalamic-pituitary-adrenal axis and the neuro-
endocrine system (Kasala et al. 2014). Studies of the physiological impact of
loving-kindness meditation are similarly consistent with a framework of the
clinical utility of mindfulness in which enhanced emotional awareness is a
highly salient factor. Long-term practitioners of Theravadan loving-kindness
meditation demonstrated increased gray matter volume relative to novices in
the right angular and posterior hippocampal gyri, structures associated with
empathy and social cognition (Leung et al. 2013). Desbordes and colleagues
(2014) operationalized mindfulness in clinical terms as equanimity, which the
authors defined as a form of emotional regulation strategy characterized by
rapid disengagement from an emotional stimulus followed by a quick return to
physiological baseline.
Body awareness
Like emotional awareness, the body awareness component of mindfulness
(Hölzel et al. 2011) is also theoretically congruent with the concept of bottom-
up processing (Chiesa et al. 2013). Indeed, the emotional and body awareness
components can be conceptualized as closely overlapping, based on the theory
that emotions are bodily-based signals that drive decision making (Damasio
1996). Body awareness and emotional awareness in these terms would overlap
closely based on the theory of emotions as encoding bodily action tendencies.
The role of mislabeled body states in some clinical disorders (Critchley
et al. 2013) and the role of mindfulness in increasing interoceptive accuracy
(Farb et al. 2013) provide a framework for conceptualizing the clinical utility of
the body awareness component of mindfulness. Neuroimaging evidence sup-
ports a view that regular meditation is associated with functional changes in
interoceptive processes. For example, meditation has been associated with
functional changes in interoceptive and homeostatic processes, including
enhanced prefrontal cognitive reappraisal of pain unpleasantness marked by
Meta-analyses of MMBI 137
increased anterior cingulate cortex activity and dorsal anterior insula (Lutz
et al. 2013), reduced activity in the prefrontal cortex and thalamus (Orme-
Johnson et al. 2006), and by structural changes including prefrontal cortical
thickening (Kang et al. 2013), increased white matter fractional anisotropy
(Tang et al. 2012), and higher gray matter density in the supplementary motor
area, ventral palladium, and brain stem (Kumar et al. 2014). It should be noted,
however, that both top-down and bottom-up conceptualizations of mindful-
ness treatment mechanisms have been proposed as salient in the clinical effi-
cacy of mindfulness for disorders characterized by problems with body
awareness (Lutz et al. 2013; Zeidan et al. 2012).
Changes in self-perspective
Mindfulness is also thought to produce changes in self-perspective consistent
with detachment from identification with a static sense of self (Hölzel
et al. 2011). One proposed common factor in MMBIs is a principle known as
decentering, defined as the capacity to observe thoughts and feelings as mental
events rather than as permanent truths about the self or reality (Fresco
et al. 2007), and as the decoupling of reflective self-awareness from experiential
awareness (Hayes 2004). Decentering is a key concept in several MMBIs includ-
ing ACT, DBT, and MBSR (Hayes 2004; Kabat-Zinn 2005; Linehan 1993). One
of the central components of ACT’s theory of therapeutic change is that mind-
fulness can create a distance between a maladaptive reified sense of self and the
sensory reality of the present moment, creating a more adaptive sense of self
that is less attached to any single perspective. Preliminary evidence regarding
the neural correlates of this decoupling of sensory and reflective modes of self-
awareness has indicated the role of the functional interrelationship of two bio-
logical neural networks serving experiential and reflective modes of
self-awareness, respectively, and their anti-correlation as the mechanism of
decentering (Farb et al. 2007).
In sum, there is accumulating evidence that mindfulness meditation works
on multiple components of functioning that may be relevant to psychotherapy.
Do the effects of mindfulness extend to symptom relief and improved psycho-
logical well-being? The next sections review evidence for effectiveness and the
impact of individual MMBI treatment components.
Meta-analyses of MMBI
Hundreds of studies have been conducted about the effectiveness of MMBI and
there are numerous meta-analyses that offer an overview of treatment effects.
Goyal and colleagues (2014) examined the effects of structured MMBI, including
mindfulness, mantra, and other meditation programs, in 47 randomized con-

trolled trials (RCTs) with active control conditions involving 3515 participants.
This meta-analysis of MMBI for psychological stress and well-being concluded
that mindfulness programs had small pre/post effects on depression, anxiety, and
pain, but no effects relative to active control groups. The mantra programs did
not improve any of the outcomes, but there was insufficient evidence to evaluate
them, owing to the small number of trials that were included and the fact that
some mantra studies included patients with very low symptom levels at pretreat-
ment (Goyal et al. 2014).
Some meta-analyses have examined effects of mindfulness programs specif-
ically. A recent meta-analysis of 209 psychological and medical outcome stud-
ies of mindfulness-based therapy (MBT) conducted with a total of 12,145
participants found that MBT was associated with improvements in depression
and anxiety. MBT was moderately effective in pre/post studies, was more effect-
ive than supportive therapies, but was not significantly more effective than
relaxation, psychoeducation, traditional CBT, or behavior therapy at follow-up.
However, mindfulness was associated with positive clinical outcomes across
the 45% of studies that included a mindfulness measure, suggesting that mind-
fulness has some role in MBT effects (Khoury et al. 2013).
The effects of MBT for current diagnoses of depression or anxiety were
addressed in a meta-analysis of 12 RCTs involving 578 participants. MBTs were
moderately more effective than control conditions for primary symptom sever-
ity related to depressive, but not anxiety, disorders. Like the Khoury et al. (2013)
and Goyal et al. (2014) meta-analyses, MBTs weren’t significantly more effective
than active control conditions. In addition, MBCT, but not MBSR, showed sig-
nificant effects on primary symptom severity (Strauss et al. 2014). Both the
Khoury et al. (2013) and Strauss et al. (2014) studies found similar average attri-
tion rates (approximately 15–16%), which were similar to those observed in
CBT studies (Strauss et al. 2014).
The effects of KBM were addressed in a meta-analysis of 22 studies involving
1747 participants, of which only three studies recruited patients and seven
included an active control condition. In comparison to inactive control condi-
tions, KBM was moderately effective in decreasing depression, and in increas-
ing mindfulness, compassion, and self-compassion, but results against active
controls were inconclusive. The authors noted that KBM may be challenging for
some, at least at the beginning stages of practice (Galante et al. 2014).
Overall, meta-analyses indicate that MMBIs produce pre/post changes in
mindfulness, some psychological symptoms, and other indicators of well-
being, but evidence for comparative effects among currently diagnosed patients
is sparse, indicating that the MM component of studies does not seem to add to
Treatment component studies: Are treatment mechanisms specific to MMBI? 139
treatment effects beyond what is gained from participation in other active treat-
ments, such as CBT, behavior therapy, or psychoeducation. The lack of super-
iority is not evidence for the equivalence or non-inferiority of MMBI relative to
active control conditions; such conclusions require results from specifically
designed and well powered clinical trials (Goyal et al. 2014; Greene et al. 2008).
Research addressing the effects of specific MMBI treatment components would
allow interventions to be more closely tailored to specific psychotherapeutic
applications and could perhaps lead to more successful interventions.
Treatment component studies: Are treatment

mechanisms specific to MMBI?
As the foregoing review indicates, there is accumulating evidence that MMBI
may affect therapeutic change through attention regulation, enhanced body
awareness and emotion regulation, and changes in the sense of self. Because
MMBIs are group-based multi-component interventions, dismantling studies
are needed to isolate the treatment components and differentiate them from
non-specific effects of treatment, such as therapist effects or the benefits of
group support, and from other active treatment components, such as breath-
focused awareness practiced outside of mindfulness meditation, exercise, and
cognitive therapy. Dismantling and other treatment component studies could
also address questions about whether mindfulness as a form of attending to the
present is specific to Buddhist-based mindfulness interventions or is a more
broadly evoked capacity.
Some studies of MMBI components suggest that mindfulness may be the
product of both attention and breath regulation that is not specific to mindful-
ness meditation. A single-session mindfulness versus sham meditation study of
college students found that both were associated with increased states of mind-
fulness and improved mood and distress relative to a book-reading control
group. A convincing sham condition would control for the demand characteris-
tics and expectancy effects associated with mindfulness practice; in this study
the sham and mindfulness groups did not differ in the extent to which they felt
they were meditating during the exercises (Johnson et al. 2013). The sham dir-
ections to sit quietly and breathe deeply suggest that attention to breath regula-
tion may be associated with increased mindfulness and other outcomes, a
possibility explored by studies of the effects of breathing exercises. A study of
inhalation/exhalation (i/e) ratio found that lower ratio breathing was associated
with greater mindfulness than the high ratio condition (Van Diest et al. 2014).
Although mindfulness instruction typically doesn’t suggest modifications to
respiratory rate, mindful awareness of breathing often results in spontaneous
breath slowing (Kristeller and Rikhye 2008), which is in turn related to a shift
toward lower i/e ratio (Van Diest et al. 2014). Even a brief, 15-minute period of
breath-focused attention was associated with better mood and emotion regula-
tion among college students relative to unfocused attention and worrying (Arch
and Craske 2006), suggesting that breath-focused attention, rather than exten-
sive training in OM mindfulness, was associated with better outcomes.
The effects of MMBI components on psychological well-being have been
tested in sham-controlled designs. For example, a three-session mindfulness
intervention with college students significantly reduced overall negative mood
and heart rate relative to sham meditation and a control, though the sham
meditation also produced pre/post reductions in state anxiety and tension (Zei-
dan et al. 2010), suggesting there was a common factor to both conditions.
Physical exercise is a component of MBSR and related MMBI in the form of
hatha yoga. Exercise is well known to produce substantial treatment effects on
depression (Josefsson et al. 2014), which raises the question of the relative con-
tributions of MMBI treatment components to mood and well-being outcomes.
Pre/post comparisons of participants in MBSR classes revealed that practice
time for mindful yoga was associated with more improvements in outcome
variables than body scan, sitting meditation, or practice in daily life; notably,
amount of practice in daily life was unassociated with pre/post improvements
(Carmody and Baer 2008). Similar findings of the differential effectiveness of
hatha yoga come from a randomized study of the three primary components of
MBSR-related MMBI, namely sitting mindfulness meditation, mindful yoga,
and body scan, which found that yoga was associated with greater improve-
ments in psychological well-being than the other two components, and that
both sitting meditation and hatha yoga were associated with greater pre/post
improvements in emotion regulation than body scan. Participants in the sitting
meditation condition had greater improvements in non-evaluative attention
than the body scan participants, as might be expected given the repeated and
explicit instructions against judging experience in mindfulness meditation
(Sauer-Zavala et al. 2012). Intriguingly, an RCT of MBSR versus aerobics for
social anxiety disorder found that MBSR and aerobics had equal therapeutic
outcomes (Jazaieri et al. 2012). Similarly, a comparison of MBSR and Argentine
tango for major depression reported nearly identical effect sizes for MBSR and
tango in terms of depression but found that only tango reduced stress levels
(Pinniger et al. 2012). In addition, pre/post increases in mindfulness were asso-
ciated with being in the tango, but not the mindfulness, class. These two studies
in which outcomes of physical activities matched those of the mindfulness con-
ditions suggest the possibility that the physical exercise component of MMBI
contributes much to the observed treatment effects.
Future directions for research and clinical practice 141
Likewise, CBT is known to have potent treatment effects and is a component of

MMBIs such as MBCT and MBRP. A randomized dismantling trial of MBCT for
depressive remission found that relapse rates were equivalent across the three
treatment arms of MBCT (46%), an active cognitive treatment (50%), and
treatment-as-usual (53%), though when considering those with a history of severe
childhood trauma, MBCT was associated with lower relapse rates (41%) than
treatment-as-usual (65%) and cognitive treatment (54%) (Williams et al. 2014).
Taken together, studies indicate that components of MMBI that promote cap-
acities such as attention and emotion regulation are effectively taught in MMBI,
though these capacities can be evoked through other means, such as practice of
breath-focused attention in non-meditation contexts, hatha yoga and other
types of exercise, and CBT. Much of the work in isolating treatment compo-
nents has used college students as participants, so implications for work with
persons with symptoms of clinical severity are unclear.
Future directions for research and clinical practice

There is much attention to MM as potential psychotherapeutic tools. There is
accumulating evidence that MMBI can increase mindfulness and well-being,
and decrease psychological symptoms. However, the unanticipated results of
dismantling trials suggest that the components of MMBI should be more care-
fully defined. Without successful dismantling trials there can be no definitive
demonstration that the outcomes of MMBI are related to MM active interven-
tion components and are not the result of common therapeutic factors. There
are several directions for future research that might clarify the active ingredi-
ents of MMBI and lead to more effective deployment of these techniques in
therapy.
One of the implications of taking a traditional or religious view of MM is that
the techniques should be used in toto, rather than being extracted from their
philosophical and religious underpinnings (Grossman and Van Dam 2011).
Distinguishing explicitly clinical uses would aid in defining the active ingredi-
ents of MM and their match to the specific needs and capacities of persons with
different sorts of health and mental health issues, in a manner that is grounded
in theories of the disorder or condition and its treatment. An example is the way
that DBT uses mindfulness as a set of self-monitoring skills to enhance emotion
regulation in a way that is specific to the therapeutic needs of persons with bor-
derline personality disorder (Linehan 1993). The growing evidence that differ-
ent techniques are associated with different outcomes (Carmody and Baer
2008; Hölzel et al. 2011; Sauer-Zavala et al. 2012) could be deployed in very
specific adaptations of MM techniques to particular disorders and conditions.
A sound understanding of how the different techniques work would allow for
prescriptive uses or matching of clients to techniques. The clinical descriptive
literature abounds in suggestions for ways to match techniques to therapist and
client needs and preferences (e.g., Germer 2005; Waelde 2015). Distinguishing
traditional and secular perspectives would also encourage recognition that
diversity may make a difference in the acceptability and usefulness of MMBI.
Diversity factors such as culture, religious affiliation, ethnicity, age, and gender
have scarcely been addressed in research about MMBI, despite the fact that cul-
ture influences mechanisms of emotion regulation (Su et al. 2014) and thus
diversity factors may influence mechanisms of MMBI.
Research should address the primary psychotherapeutic uses of MM, rather
than making generalizations to clinical practice from studies of standardized
stand-alone interventions. It is not unique to the meditation field that clin-
icians prefer flexibility and modularity in treatment over adherence to manual-
ized interventions (Borntrager et al. 2009). Research has not yet adequately
addressed what is perhaps the most commonly implemented form of MM in
therapy: The use of breath-focused awareness and other MM techniques in
individualized ways during the course of other types of therapy. It is concern-
ing that informal practice in daily life, as perhaps the most common form of
long-term practice (Miller et al. 1995), does not seem to be strongly related to
outcomes (Carmody and Baer 2008). Because previous research has demon-
strated that treatment outcomes are associated with the degree of practice of
the techniques, intervention development and testing should attend to dosing
effects. Psychotherapy process research methods (Ramseyer et al. 2014) may be
brought to bear on the issue of how MM practice influences the course and
outcomes of therapy.
An explicitly clinical orientation would not mean abandoning studies of spir-
itual and religious MM practice. It seems very likely that scientific investigation
of MM mechanisms and outcomes among adepts or religious practitioners can
yield useful information about the nature of the mind and the developmental
trajectories of long-term practice. To this end, the practice of treating different
meditation traditions in entirely separate literatures serves soteriological more
than scientific purposes. Davis and Vago (2013) suggested operationalizing
traditional constructs across many traditions into common psychological and
neurocognitive terms. In this enterprise—which holds promise for increasing
understanding of the mechanisms and trajectory of meditative attainment—we
should not prematurely conflate terminology across traditions, though we may
hope to avoid additional centuries of scholarly dispute about distinctions
among traditions by using methods drawn from neuroscience, phenomenol-
ogy, and cognitive and clinical science in these pursuits.
PERSONAL MEDITATION JOURNEYS 143
Personal Meditation Journeys

Lynn C. Waelde
I was in elementary school during a time when yoga began to be very popular in the
United States. My first exposure to it was when I found books about yoga and medita-
tion in our public library, but gaining access to the material was difficult. It was exciting
for me to sneak into the adult side of the library and position myself in the stacks in such
a way that the librarian couldn’t see me. I had to be exceedingly careful as I moved from
one row to another, because if she caught me I would be expelled and there would be
no hope of reading anything interesting for the next several weeks. I dreaded the sound
of her chair scraping the floor. How many times I hid with my heart pounding in my
throat while she helped a patron find a book! Many a time she caught me and escorted
me back to the children’s side of the library, gesturing to a stack of books just two feet
from the floor. My hope each visit was to escape detection until I found something good
and added it to the family pile of books on the circulation desk. Even then I wasn’t safe
because she got adept at detecting my selections and would ask my father if such and
such a book was one of ours. My father had no objection to me reading about these
topics but he did have an objection to lying (and so wouldn’t say that the book was one
of his, for example) and, most importantly, he wanted me to defend my choices. I was
often speechless in these interactions and watched with my face burning as she tossed
my book into the return bin. If only all obstacles on the spiritual path were so easily
overcome! I started at the top of the bookshelf containing the yoga and meditation
books, intending to read my way down to the bottom over a series of visits. On the top
shelf were books on tarot card reading, phrenology, palmistry, handwriting analysis,
numerology, mental telepathy, witchcraft, voodoo, and even a book on Hippocratic
humors. I found them engaging but decided they were not true. On the second shelf
were yoga and meditation books. I found them much less easy to engage and didn’t
understand much of what I read, but decided that the essence of what I did understand
was true.
While I was in college, I took meditation classes for years without knowing that I was
doing so. I was a student of a yoga center in Baton Rouge, Louisiana where meditation
sessions were euphemistically referred to as “breathing exercises.” These were my very
favorite part of the classes, which were otherwise agonizing because of the teacher’s
exacting technique, honed from years of training in India in a location she would not
divulge, and my difficulties in overcoming years of incorrect, self-taught asana practice. I
had started with such high hopes that hatha yoga would be easy for me! On my first visit,
the teacher asked if I had ever taken yoga and I announced proudly that I had practiced
yoga and meditation for the past eight years. I still remember her unsmilingly raised eye-
brows when I told her that I had taught myself from books. It was a searingly painful
realization (physically and otherwise) that I actually knew nothing at all about yoga and
meditation and was in fact at quite a disadvantage because I thought I knew much.
I didn’t meet my meditation teacher, Sri Shambhavananda, until I was starting graduate
school. In my guru I met a person who lives what he teaches; who established ashrams
as places of practice and learning that are beautiful and provide the opportunity to do
the hard work of developing spiritually. I am very fortunate to have the benefit of 25
years of his instruction. The meditation practice forms an inner discipline and structure
that helps me weather all kinds of momentary and lasting difficulties. Because of my
teacher, I have missed out on so much self-imposed suffering over the years, which has
left room for so much happiness. The opportunity to share what I have gained in service
to others is an ongoing creative process that gives my life tremendous meaning.
Jason M. Thompson
January 2015
Until I was ten years old, I believed in the God of Roman Catholicism. Every night, I
knelt beside my bed and prayed. Sometimes I imagined what God would likely say in
response to me. Then one night, I had an epiphany that the interlocutor of my confes-
sional dialogues was not in fact God, but another part of me. The dissolution of my
childhood faith felt like a loss of innocence, though, raising far more questions than it
answered. For some time, book learning became my religion. Then, as an undergradu-
ate studying English Literature at Oxford in the early 1990s, I encountered the anonym-
ous fourteenth-century Christian mystic text The Cloud of Unknowing. “All rational
beings, human and angelic, possess two faculties: The power of knowing and the
power of loving,” states the text’s author. “To the first, to the intellect, God who made
them is forever unknowable; but to the second, to love, God is completely knowable.”
I found this mystical conception of reality intriguing yet remote, especially when I left
university and found myself 24 years old, single after my first long-term romantic rela-
tionship ended in a painful break-up, my parents divorced after years of emotional
chaos.
I soon discovered that when trail running, mountaineering, or surfing, I experienced a
flow state in which I felt a sense of unity with nature; the more intense my exertion, the
more unity. In my late twenties, after moving to San Francisco, I became a regular stu-
dent of a yoga teacher who taught a practice that combined physical intensity with an
explicit message that the true purpose of yoga is bhakti (spiritual devotion). Lying on the
floor in savasana at the end of class, I felt a sense of relaxation extend throughout my
PERSONAL MEDITATION JOURNEYS 145
body and mind. After class, I felt more interested in socializing with other students and
more grateful to my teacher, and wondered if this was a novice glimpse of bhakti. I was
eager to know how to maintain these warm feelings outside yoga class, but for several
years I could only feel calm when I was pushing myself hard physically; often, the
moment I left the yoga mat, my mind was busy again with worry or sadness or anger. I
sought out harder asanas and bigger waves, erroneously perceiving athletic intensity as
bhakti’s necessary condition. One day, I broke my board in 15-feet surf a quarter of a
mile from shore, and barely made the swim back to the beach through a maelstrom of
whitewater; my path of upping the athletic ante to achieve emotional balance had
revealed its outer limit.
From finding calm in the outer chaos of ocean waves, in my mid-thirties, following
the birth of my first child, I began to look for a more sustainable means of calming
the turbulence of consciousness. I took a meditation class at San Francisco Zen Cen-
ter, developed a daily zazen practice, participated in several one-day sittings, studied
Zen’s ethical precepts through weekly dialogues with a Zen priest, and pursued a
Buddhist Studies course. I soon noticed how the waves of my awareness began to
settle much more easily, even in difficult circumstances. I came to understand that
self-care was coterminous with a compassionate commitment to alleviating the suf-
fering of others: Zen’s non-theistic version of the Christian idea of God’s knowability
through love alone. I then became fascinated with the emerging dialogue between
the meditative traditions and modern science. I embarked on a Ph.D. in clinical
psychology at Palo Alto University (PAU) in the hope that I could both deepen my
theoretical enquiry and integrate my personal insights as a meditation practitioner
with clinical skills grounded in scientific psychology. Given those aims, I was fortu-
nate indeed to find a faculty advisor, Lynn Waelde, whose expertise so closely
matched my interests. At PAU, I trained to apply Dr. Waelde’s meditation intervention,
Inner Resources, to a range of clinical and community needs. I then served as a
research assistant on an NIH-funded fMRI meditation and hypnosis investigation of
which Dr. Waelde is a co-investigator, data from which I analyzed in my dissertation,
a neurophenomenological study of decentering in focused attention and open moni-
toring meditation. I learned how meditation creates patterns in neural network con-
nectivity that support a more stable sense of selfhood, interdependent with other
selves.
From Catholic prayer to zazen, perhaps I have come full circle from my boyhood self who
prayed and wondered about the reality of his internal dialogue; I still notice my thoughts
and ask if they are real. But that act of introspection is informed now by years of practice
that has shown me the inner calm that emerges when I suspend the “power of know-
ing” and attend kindly to this moment, this breath.
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Chapter 7
Meditation and the management

of pain
Vidyamala Burch
Introduction
Nobody likes to suffer. When we experience pain, we don’t like it. When we
haven’t cultivated skills in mental and emotional training, we automatically add
mental, emotional, and physical reactions of “not wanting” onto the sensations
of pain, creating an experience of resistance. We then have painful sensations +
resistance = increased suffering. Our reactions to the unpleasant experience of
pain mean that our overall suffering intensifies.
Meditation—both mindfulness and compassion approaches—is the training
ground for the mind and heart. Awareness has a crucial role to play in reducing
this automatic reaction. The basic sensations of pain may be unavoidable for
individuals living with health problems that cause physical pain, but the reac-
tion is optional. It is possible to train the mind with meditation so that pain is
experienced on the level of unpleasant physical sensation alone, free from add-
itional mental and emotional suffering.
I know this from first-hand experience. My whole adult life has been engaged
with the mystery of living with chronic pain after spinal injuries in my teens.
Alongside this has been a deep longing for inner peace based on intuitions that
it is possible to experience the human condition in ways that transcend strug-
gle. It has been a grueling and intense life journey that has taken me to great
depths and heights of experience. It has also been profoundly satisfying, even if
it is not a life journey I would ever have chosen.
In this chapter I will explore the underlying physiology of physical pain and the
different ways it manifests; the immense burden pain places on both individuals
and society; and how meditation and mind/heart training can help to manage
reactions to pain and thus transform quality of life; and I will offer an overview of
the research into meditation for pain. Finally I will introduce the specific approach
I have developed at Breathworks with mindfulness-based pain management
(MBPM) and the Buddhist roots that underlie the Breathworks Program.
154 Meditation and the management of pain
What is pain?
Until fairly recently, the prevailing view was that pain is a result of damage to
the body. In the seventeenth century the French philosopher René Descartes
developed a “rope-pull” model of pain. Just as pulling a rope in a church tower
rings the bell, Descartes thought that tissue damage in the body is a tug that
causes the sensation of pain in the brain. Following Descartes, for centuries
Western doctors regarded pain as a sensation that could be explained by neu-
rology. The intensity of the pain was thought to be directly proportional to the
degree of damage to the body, which would mean that if different people had
the same injury they would experience the same pain. If no obvious physical
cause could be found, often the patient would be accused of malingering.
However, in the last half-century views of pain have changed dramatically as
scientists discovered the extent to which it involves the whole person—the
mind as well as the body—and research using modern neuroimaging methods
showed how complex pain is. The leading professional body of pain specialists,
the International Association for the Study of Pain (IASP), defines pain as: “an
unpleasant sensory and emotional experience associated with actual or poten-
tial tissue damage, or which is described in terms of such damage.” They add
that “pain is always subjective” (International Association for the Study of Pain
1994, p. 210). The key point is that pain is an experience and emotions, beliefs,
and attitudes, as well as past experiences, all play a role in how the experience
we label “pain” is perceived (Bond and Simpson 2006, p. 4).
Why do we experience pain?

Acute pain is part of our evolutionary heritage. It is an essential part of our sur-
vival apparatus. It is the pain experienced in the short term following an injury. If
you stub a toe or touch something hot, you feel an acute pain that is a direct con-
sequence of a pain signal sent to the brain from the injured muscles, bones, liga-
ments, or skin. This pain is part of the body’s inbuilt alarm system, signaling that
it is under attack and that there is a need to take care of the injured area to allow
it to heal. Inflammation will probably be evident, such as a bruise, swelling, or
blister, and pain will be felt at the site of the injury. Following an injury, chemical
and physical responses in the affected cells and tissues begin healing the damage.
Most healing is completed within six weeks and acute pain usually reduces over
this period, while nearly all injured tissues are fully healed within six months.
Acute pain also arises without obvious injury, as with a stomachache after over-
eating, or the headache that comes with a hangover. People who do not experi-
ence pain to warn them of damage—a condition called “congenital insensitivity
to pain”—suffer repeated injuries and, very often, reduced life expectancy.
Why do we experience pain? 155
Chronic pain, also called persistent or long-term pain, is pain that has lasted
for three months or more (Cole et al. 2005, p. 37)—sometimes it can continue
for decades. Chronic pain can develop after an injury and persist, often inexpli-
cably, after tissue healing has taken place. Or it may start for no obvious or spe-
cific reason. If the pain remains even when there is no continuing physical
damage, the experience of pain becomes a medical problem in its own right and
is often referred to as “chronic pain syndrome.”
Chronic pain is complex and multi-faceted, involving physical, emotional,
and mental reactions (see Wall 1999). Some pain is caused by obvious tissue
damage that persists over time—for example, in the case of arthritis and cancer.
This pain is caused by continuing physical processes at the area of disease or
joint degeneration and there is a clear cause of the aversive sensations.
Neuropathic pain occurs in the nervous system rather than being prompted
by tissue damage and can be confusing—often medical investigations reveal no
obvious cause. Some neuropathic pain is caused by damage or injury to the
nerves, the spinal cord, or the brain, but sometimes pain is felt even when there
is no damage, or healing has finished at the site of the injury. The latest research
suggests that the nervous system responds to the experience of pain by increas-
ing its capacity to process pain signals, rather as a computer devotes extra cir-
cuits and memory to an important task. The central nervous system can then
become over-sensitized so that a little pain feels far worse. The nervous system
can act as an amplifier of pain sensations, such that when one develops chronic
pain it is as if the amplifier has been turned up.
Neuropathic pain can also take the form of unusual sensations, such as elec-
tric shocks, the sensation of water or burning on the skin, or distorted percep-
tions of the body. Another example of neuropathic pain is phantom limb pain,
when pain persists in a limb after it has been amputated. In each case, the sen-
sation of pain is produced by nerves that have been damaged or whose signals
have become confused in some way, so that neuropathic pain is an electrical
rather than a mechanical fault.
Chronic and neuropathic pain offer no evolutionary advantage and arise
through dysfunction of the nervous system. Such pain can be compared to use-
less “white noise” that is constantly present in the background; like being
trapped in a room with a radio that is tuned off the station and produces con-
stant hissing, crackling, and humming.
Recent studies show how the experience of pain is very complex and individ-
ual. We might assume, for example, that if a person has back pain then detailed
MRI scans would allow us to see the cause of the problem. In fact, in a study
where a number of people without back pain were scanned, 64% had disc abnor-
malities in the spine (Jensen 1994) while in another study of people with back
pain, 85% had no obvious damage (Fordyce et al. 1984; Gamsa 1994). Research
also shows huge individual variation in pain perception. Two individuals given
the same pain stimulus while being monitored in the scanner can show vastly
different brain activity (Wall 1999, p. 78).
One well-established view of pain is the “gate control theory” developed in
the 1960s by Patrick Wall—a neuroscientist who specialized in studying p ain—
and his collaborator Ronald Melzack (Wall and Melzack 1982, p. 98). They sug-
gested that there are “gates” in the nerve junctions, spinal cord, and the brain’s
pain centers. For pain to be experienced, these gates need to be opened and this
is what happens when a healthy person is injured. Pain messages are a signal to
protect that part of the body that helps it to heal. The gates can also close, which
means pain is reduced or stopped. Again, this is what happens in the case of a
healthy person when healing is complete.
Opening and closing these gates is a complex process that is affected by emo-
tional states, mental activity, and where attention is focused. Whether the brain
expects pain or is primed to detect any damage or strain also has an impact.
Then the pain pathways (or gates) open so the brain doesn’t miss a nything—
and the pain experience is amplified. People with chronic pain commonly
report that they manage some pain effectively, but a sudden, unexpected
increase in pain feels much worse because of the fear that it is caused by new
damage. The anxiety causes the gates to open or to stay open longer.
Researchers are searching for ways to close the gates in people living with
chronic pain so that their nervous systems can return to normal functioning.
Mindfulness training and meditation may be one way to do this because it
calms mental, physical, emotional, and nervous systems, allowing them to
return to a state of balance. The view of pain emerging from this research
includes the mind, the body, and the environment. As Wall (1999, p. 31) writes:
Pure pain is never detected as an isolated sensation. Pain is always accompanied by
emotion and meaning so that each pain is unique to the individual. The word “pain” is
used to group together a class of combined sensory-emotional events. The class con-
tains many different types of pain, each of which is a personal, unique experience for
the person who suffers.
This growing awareness of the complexity of pain shows that treating it involves the
whole of a person’s experience. The bio-psychosocial model of pain, widely used in
chronic pain management, suggests that the biological, psychological, and social
aspects of an individual’s life all influence the way that person deals with pain. This
has led to the development of multi-faceted pain management programs—
intensive courses, often run in hospitals, which offer in-depth help in managing
the many ways in which pain has affected a person’s life, drawing on psychology,
occupational therapy, and physiotherapy, as well as advice from doctors.
Why does a deeper understanding of pain matter? A modern epidemic 157
Mindfulness-based pain management (MBPM), as developed at Breathworks

(www.breathworks-mindfulness.org.uk) in the UK, is one such program. It
combines a scientific view of pain with an understanding of the nature of
experience that comes from the practice of meditation and mindfulness. These
practices have ancient roots in the Buddhist tradition and they augment scien-
tific understanding in practical ways by offering methods of learning to respond
constructively to pain.
Why does a deeper understanding of pain matter?

A modern epidemic
Advances in acute medical care are obviously welcome. However, many dis-
eases that used to be fatal are now treatable, leaving people with long-term
health conditions and pain to contend with. Consequently, chronic pain is
increasingly common and can have a major impact on individuals and their
families; it also exerts a major burden on health care services and on society as
a whole.
On average, around one in five people in the developed world now suffers
from chronic pain and a recent survey in the UK reported that 31% of men and
37% of women experience chronic pain (Health Survey for England 2011). This
equates to around 20 million people in the UK, with 7.8 million of them suffer-
ing moderate to severe pain that has lasted for more than six months. The
prevalence of chronic pain also increases with age, from 14% of men and 18%
of women aged 16–34, to 53% of men and 59% of women aged 75 and over. In
2004, primary care management of patients with chronic pain in the UK was
estimated to account for 4.6 million appointments per year; this is equivalent to
793 whole-time GPs at a cost of approximately £69 million (Belsey 2002). Fig-
ures are similar in the USA with some 116 million people suffering chronic
pain, causing estimated costs of $635 billion a year, which is more than the
yearly costs for cancer, heart disease, and diabetes (Gaskin and Richard 2012).
People with chronic pain not only suffer with physical pain itself but fre-
quently have co-morbidities to manage, such as depression, anxiety, physical
dysfunction, and social isolation, which can make pain management even more
complex (Royal College of General Practitioners 2013). A recent meta-
ethnography investigating patients’ experiences of chronic pain revealed a
number of key themes:
◆ 16% of sufferers feel their chronic pain is so bad that they sometimes want to
die (Donaldson 2008, p. 37).
◆ 49% of patients with chronic pain experience depression (Donaldson 2008,
p. 34).
◆ The overall quality of life for people with chronic pain is very poor; the aver-
age life score was 0.4, where 1 is perfect health (National Pain Audit 2010–
2012, quoted in Royal College of General Practitioners 2013, p. 6).
◆ The average mental well-being score for men and women with severely
limiting chronic pain was at a similar level to that of the lowest-scoring 10%
of people who were pain free (Health Survey for England 2011).
◆ Sufferers were more likely to be anxious or depressed; 69% of people with
severe pain reported one of these compared with 17% (anxious) and 22%
(depressed) respectively among those with no chronic pain (Health Survey
for England 2011).
◆ 25% of pain sufferers lose their jobs (Donaldson 2008, p. 34).
With obesity and sedentary lifestyles becoming more prevalent, the problem of
chronic pain will only increase as a result of the associated physical strains and
dysfunctions. Add in an ageing population and it is no surprise that chronic
pain is sometimes referred to as a silent epidemic.
In the UK, in recognition of the burden of pain to the NHS, it was announced
in Parliament on February 1, 2012, that chronic pain should be viewed as a
long-term condition (LTC). Historically, pain was viewed only as a symptom of
other diseases, rather than as a condition in its own right, so defining pain as a
LTC constitutes a major shift in how chronic pain is managed by the NHS.
How meditation can help

Meditation as a means of training the mind and heart away from reactivity and
toward peace and equanimity can play a major role in responding to this epi-
demic. It is low cost to the health care provider and enables the individual to self-
manage their condition, using other health care interventions as required. For
these reasons researchers and policy makers are beginning to discuss meditation
and mindfulness as key public health initiatives in the management of pain.
In order for a new paradigm to make its way into the Western scientific mind-
set, there is a need for a robust evidence base. Over the last 40 years this evidence
base has been slowly developing, with an explosion of interest in mindfulness
over the last decade. In 2014, the Mindfulness All Party Parliamentary Group
(MAPPG) in the UK reviewed the evidence base in preparation for writing the
Mindful Nation UK report for publication in 2015 (Mindfulness All Party Par-
liamentary Group 2015). The first draft recommends:
Mindfulness training is a valuable complement to conventional medical care. It is a
form of “participatory medicine” by which the patient is enabled to develop their own
understanding of their condition and draw upon their own resources for healing and
Review of research into meditation for pain management 159
care, often within peer-to-peer groups. This is a new model of healthcare which it is
widely believed will be increasingly significant in the future, as healthcare needs con-
tinue to grow. There is good evidence that MBIs [Mindfulness Based Intervention] can
help reduce symptoms of depression and anxiety for people living with long-term con-
ditions such as vascular disorders, chronic pain and cancer, and promising evidence is
emerging for the helpfulness of MBIs for other long-term physical health conditions.
Review of research into meditation for pain

management
Some of the first quantitative papers published on the medical benefits of mind-
fulness concerned a cohort of 51 chronic pain patients who enrolled in a ten-
week mindfulness meditation training program (Kabat-Zinn 1982). The
dominant pain categories were lower back, neck and shoulder, and headache
pain. These were patients who had not improved with traditional medical care.
At ten weeks, 65% of the patients showed a reduction of greater than or equal to
33% in the mean total Pain Rating Index, and 50% showed a reduction of greater
than or equal to 50%. Similar decreases were recorded on other pain indices
and in the number of medical symptoms reported. Large and significant reduc-
tions in mood disturbance and psychiatric symptomatology accompanied
these changes and were relatively stable on follow-up. Two years later a similar
study was published (Kabat-Zinn et al. 1985), which showed statistically signifi-
cant reductions in measures of present-moment pain, negative body image,
inhibition of activity by pain, symptoms, mood disturbance, and psychological
symptomatology, including anxiety and depression. Pain-related drug utiliza-
tion decreased and activity levels and feelings of self-esteem increased. At
follow-up, the improvements observed during the meditation training were
maintained up to 15 months post-meditation training for all measures except
present-moment pain. The majority of subjects reported continued high com-
pliance with the meditation practice as part of their daily lives. However, these
were not randomized clinical trials, but rather observational studies, and we
therefore do not know how much of the improvement was part of the natural
course of illness and wellness.
These early studies looking into the role meditation can play in pain manage-
ment provided tantalizing evidence that benefit could be gained. Since then
there has been an explosion of interest in mindfulness research generally,
including studies related to chronic pain. However, there is a need for more
high-quality research in this emerging field.
In 2010, Arthritis Research UK conducted a literature review looking specifically
at meditation for chronic pain. The report reviewed 91 pieces of evidence, including
evidence summaries, systematic reviews, and primary research. The paper con-
cluded that: “this report identifies the lack of high quality clinical trial evidence . . .
in establishing the effectiveness and underlying psychological processes of
mindfulness-based interventions in the context of chronic musculoskeletal pain”
(Arthritis Research UK 2010). The report also identified a lack of consensus regard-
ing definitions, components, and processes of mindfulness meditation and the need
for future research to include systematic reviews of meditation for chronic pain.
In 2013 a major systematic review and meta-analysis was conducted into
meditation programs for psychological stress and well-being, which included
reviewing the effectiveness of meditation for pain (Goyal et al. 2014). Medita-
tion techniques were defined as those emphasizing mindfulness, concentra-
tion, and automatic self-transcendence. After reviewing 18,753 citations, the
researchers found 47 trials to match their research criteria of randomized clin-
ical trials with active controls for placebo effects through November 2012 from
MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the
Cochrane Library, and hand searches. The review reported that “The strength
of evidence is moderate that mindfulness meditation programs have a small
improvement in pain severity among a variety of populations when compared
with a nonspecific active control” (Goyal et al. 2014, p. 119). Other findings in
this review included moderate evidence of improved anxiety (effect size, 0.38
[95% CI, 0.12–0.64] at 8 weeks and 0.22 [0.02–0.43] at 3–6 months) and depres-
sion (0.30 [0.00–0.59] at 8 weeks and 0.23 [0.05–0.42] at 3–6 months).
As research into meditation for chronic pain develops, researchers are
attempting to tease apart the many variables and gain a clearer understanding
of how meditation can provide relief to pain sufferers. This includes gaining a
deeper understanding of the role that different meditation practices have to
play. In general there are two main types of meditation, drawn from Buddhism,
that are utilized within meditation programs for pain. These are described as:
1 Attention control (Sedlmeier et al. 2012)—In the scientific literature this is
most commonly described as focused awareness (FA) (also known as shama-
tha in the Buddhist tradition, concentration, and attentional balance (Wal-
lace and Shapiro 2006)). These skills have been identified as basic attentional
processes and, along with training the stability and flexibility of one’s atten-
tion, the FA practitioner likely engages in cognitive reappraisal by repeatedly
reinterpreting distracting events as fleeting or momentary, and doing so with
acceptance (Zeidan et al. 2012).
2 A shift in perspective—Applied when meditation is used to help people shift
the perspective from which they view their subjective experience. This is
described as open monitoring (OM) (also referred to as vipashyana in the
Review of research into meditation for pain management 161
Buddhist tradition, or decentering (Safran and Segal 1990), cognitive diffu-

sion (Hayes et al. 1999), deautomization (Deikman 1966), and cognitive bal-
ance (Wallace and Shapiro 2006)). Some people also use the word
mindfulness itself as a term to specifically describe OM approaches to aware-
ness training. As Sedlmeier and colleagues point out in Chapter 13 of this
volume, there is a need to establish consistent nomenclature across the field
in order to reduce confusion. While practicing OM, the practitioner experi-
ences the current sensory or cognitive “event” without evaluation, interpre-
tation, or preference. This is sometimes referred to as “non-judgmental”
awareness. Zen meditation is considered to be one form of OM practice
(Austin 1999, p. 844).
Zeidan et al. (2012) examined a range of studies into mindfulness for pain
and concluded that the OM style of meditation is more effective at reducing
pain after extensive meditation training, as compared to FA. Support for this
can be found in Grant and Rainville (2009), which reports that the analgesic
effect in advanced meditators, performing an OM-style of attention, did not
arise until around 2000 hours of practice. On the other hand, approaches com-
bining elements of both FA and OM are effective at reducing behavioral and
neural mechanisms of pain after brief mental training (Zeidan et al. 2010, 2011).
These findings suggest that cognitive practices employing attentional stability
(focused attention) in conjunction with non-evaluative awareness of sensory
events (open monitoring) can reduce pain, even after brief mental training.
In addition to examining the different meditation types that lead to pain
reduction, researchers are increasingly using neuroimaging in order to attempt
to understand the different neural mechanisms involved. These studies comple-
ment the traditional use of self-report questionnaires that the early mindfulness
studies relied on. Although the field is very much in its infancy and many ques-
tions remain unanswered, some studies assessing the anticipation and experi-
ence of acute experimental pain converge to show reduced pain anticipation in
meditators associated with increased activation of brain regions implicated in
cognitive/emotional control (rostral anterior cingulate cortex (rACC) and
ventromedial-prefrontal cortex (vmPFC) (Brown and Jones 2010; Gard

et al. 2011)). Brown and Jones (2010) postulated that cultivating an attitude of
acceptance toward impending stimuli produces this increased cognitive and
emotional control through increased cognitive flexibility. The anticipation or
expectation reductions were postulated to be some of the active mechanisms of
meditation-related pain relief (Gard et al. 2011).
Gard et al. (2011) also reported that pain can be modulated by mindfulness.
A group of mindfulness practitioners and control participants underwent an
MRI scan during which they received unpleasant electrical stimuli during a
mindfulness and a control condition. The researchers found that mindfulness
practitioners, but not controls, were able to reduce pain unpleasantness by 22%
and anticipatory anxiety by 29% during a mindful state. In the brain, this reduc-
tion was associated with decreased activation in the lateral prefrontal cortex
and increased activation in the right posterior insula during stimulation and
increased rACC activation during the anticipation of pain. The rACC is associ-
ated with the cognitive modulation of pain, cognitive control, and the regula-
tion of emotions (Ochsner and Gross 2005; Vogt 2005).
Brown and Jones (2013) conducted EEG studies, along with self-report ques-
tionnaires, in participants on the Breathworks Mindfulness-Based Pain Man-
agement (MBPM) Program, again looking at the effect of mindfulness on pain
anticipation using experimentally induced pain stimuli. Twenty-eight patients
with chronic pain were assessed and randomized into an intervention group
(who attended an eight-week MBPM) or a control group (treatment-as-usual),
before being reassessed after eight weeks. Outcome measures included clinical
pain, perceived control over pain, mental and physical health, and mindfulness.
Neural activity was measured during the anticipation and experience of acute
experimental pain, using electroencephalography with source reconstruction.
Improvements were found in the MBPM group relative to the control group in
mental health, which related to greater perceived control of pain, but not to
reductions in clinical or experimental pain ratings. Anticipatory and pain-
evoked event-related potentials to acute experimental pain were decreased, but
sources of these event-related potentials were estimated to be in regions that
modulate emotional responses rather than pain intensity. This study raises
interesting questions about the role that emotions can play in the suffering asso-
ciated with pain, given the participants experienced improved mental health
and greater perceived control over pain, even though the actual pain intensity
did not reduce to a significant degree. This study is also interesting in that the
individuals participating in the study were those who lived with chronic pain,
rather than healthy volunteers. The researchers concluded:
The study supports the hypothesis that mindfulness training provides a cognitive strat-
egy for improving pain management, which has positive consequences for mental
health. Our results show that this is related to maintaining activity in central executive
regions responsible for emotional regulation (DLPFC) during anticipation of pain,
whereas reductions in processing during pain experience were modest and restricted to
regions that are known to mediate emotional responses to pain including the amygdala
and anterior insula (Brown and Jones 2013, p. 243).
Although research into mindfulness for chronic pain is commanding increas-

ing interest, Zeidan et al.’s (2012) review looking at unique brain mechanisms
The Breathworks Program (MBPM) 163
observes that some of the studies appear to contradict each other, showing the
need to emphasize the importance of acknowledging differences in dependent
measures (fMRI vs. EEG), meditation traditions, meditator experience level,
and experimental directives. Clearly, more work is necessary to understand
these discrepancies (Zeidan et al. 2012, p. 168). Overall, Zeidan et al. (2012,
p. 170) concluded:
In this review we have surveyed the rapidly emerging field of meditation-related pain
reduction. The data indicate that, like other cognitive factors that modulate pain, pre-
frontal and cingulate cortices are intimately involved in the modulation of pain by
mindfulness meditation. Mindfulness meditation, like other cognitive manipulations,
alters the contextual evaluation of pain but is likely to do so dynamically over time and
experience, such that beginners reappraise events and the most advanced practitioners
may refrain from elaboration/appraisal entirely. Admittedly, many of these interpret-
ations are based on reverse inference and assumptions derived from traditional claims
and require more scrutiny in future research. Nonetheless, mindfulness-related pain
reduction promises to be an important tool for understanding how our awareness of
sensory events occurs as well as a potentially important adjunct to current treatment
options for acute and chronic pain.
For more on the evidence base of MBIs for chronic pain, see Carlson in Chap-
ter 9 of this volume.
The Breathworks Program (MBPM)

When I first decided to design a program to help others living with chronic pain
and long-term health conditions, I turned to mindfulness-based stress reduc-
tion (MBSR) for inspiration before making adaptations drawn from my own
experience and meditation training, as well as the field of pain management.
Central to the program is the understanding that human beings have the cap-
acity to be objective about mental, emotional, and physical experiences. This
allows a perceptual shift from over-identification with passing experience to
having perspective on what is happening. With a realistic appraisal of thoughts,
emotions, and bodily sensations as they are perceived in the present moment, a
move from a passive, reactive mode of behavior to one that is infused with ini-
tiative and choice can be made. The research noted in the previous section bears
out the value of such a shift with evidence of greater emotional regulation in
response to pain.
The key components of Breathworks MBPM are:
1 Meditation. Over the course of eight weeks, six different meditations are
taught. These are all based on the core Buddhist practices of the Mindfulness
of Breathing and Metta Bhavana (the development of loving kindness). The
six practices are:
a. Body Scan—a meditation that involves progressively resting awareness

on physical sensations in the body as a way of reducing conceptual
elaborations.
b. Breathing Anchor—a meditation that trains awareness on the physical
sensations and movements of breathing—again to reduce conceptual
elaborations as well as focus the mind.
c. Compassionate Acceptance—a meditation where one opens awareness
to include unpleasant sensations with an attitude of self-compassion,
tenderness, and care. This helps to soften habits of resistance and
aversion.
d. Treasure of Pleasure—a meditation that focuses on “seeking out” pleasant
aspects of moment-by-moment experience. This helps to strengthen the
neural pathways of positive emotion.
e. Open Heart—a meditation that cultivates broad, warm, receptive, non-
reactive awareness.
f. Connection—a meditation where one broadens awareness to include
others. This builds empathy and compassion.
The Body Scan and Breathing Anchor cultivate FA (focused awareness/
shamatha). The Compassionate Acceptance, Treasure of Pleasure, Open
Heart, and Connection are an adaptation of the Metta Bhavana and help
with the development of kindness and compassion. OM (open monitoring/
vipashyana) is particularly cultivated in the Open Heart practice.
Taken together, all the meditations help to cultivate precise awareness of
physical, mental, and emotional experience (FA), an ability to rest within the
flow of life and to cultivate non-reactive equanimity (OM), and a quality of
warmth and compassion toward both self and others. As Zeidan et al. (2010)
describe, meditative approaches that combine different approaches to medi-
tation have been shown to be effective in reducing pain even after relatively
brief training.
2 Mindfulness in daily life. This includes a detailed activity management
module using diary-based approaches to pacing. This weakens “boom and
bust” patterns of over-activity on good days followed by periods of exhaus-
tion and inactivity—patterns that are so prevalent amongst individuals
living with chronic pain (or indeed any chronic health condition). “Three-
minute breathing spaces,” originally developed for use in mindfulness-
based cognitive therapy (MBCT), are also taught. These are an effective
way to insert pauses into daily life and reconnect with self-awareness and
choice.
The Buddhist roots to MBPM 165
3 Mindful movement. This is based on very gentle yoga and pilates. Essen-
tially what is being taught is a moving meditation with the emphasis on the
quality of awareness as you move, rather than how far you can move or
stretch. This training can then be applied to all the movements of daily life
such as opening doors, lifting household objects, etc.
4 Working with thoughts and emotions. Central to MBPM is the notion that
by becoming aware of one’s mental and emotional tendencies, one no longer
needs to be a victim of them. Emphasis is placed upon the concept that
“thoughts are not facts, even those that say they are!” (Segal et al. 2002,
p. 244). Participants are also taught how to look “at” thoughts rather than
“from” them (Smith and Hayes 2005, p. 66), seeing thoughts as transitory
mental events, in order to overcome habits of being over-identified with the
content of passing thoughts.
5 Habit releasers. These are simple activities to bring into daily life to provide
an opportunity to cultivate mindfulness, rather than being caught up in
unhelpful habits. Examples include: Watching the sky for a few moments
and seeing thoughts and emotions as passing weather events rather than
mistaking them for substantial and enduring entities; spending some time in
nature; waiting for the kettle to click off when it has boiled rather than rush-
ing to make the tea or coffee; and committing random acts of kindness.
Taken as a whole, all the different elements of the program allow for a thorough
transformation in the individual’s response to pain and difficulty. Formal medi-
tation practice is only one element. Emphasis is also placed on bringing aware-
ness and kindness to the activities of daily life and to a gradual positive
re-orientation of behavior and attitudes.
The Buddhist roots to MBPM

Underlying all the different elements of the program are core Buddhist teach-
ings. Two Pali Canon texts in particular stand out as being especially relevant to
pain management, the Sallatha Sutta and Satipatthana Sutta, and we also draw
on key compassion approaches. Language has been adapted to be suitable for a
health care intervention but the underlying principles have been developed
over the 2500-year history of Buddhist practice.
Salattha Sutta
In this Sutta the Buddha is asked to describe the difference between the response
of a wise person and that of an ordinary person to pain. He goes on to use an
analogy for physical pain as like being pierced by an arrow. Any human being
will experience this, at least from time to time, as unpleasant sensations come
with the territory of being human. He goes on to say an “ordinary” (unwise)

person reacts with resistance and resentment and this is akin to being pierced
by a second arrow. So, they then have the pain of two arrows:
When an ordinary person experiences a painful bodily feeling they worry, agonise and
feel distraught. Then they feel two types of pain, one physical and one mental. It’s as if
this person was pierced by an arrow, and then immediately afterwards by a second
arrow, and they experience the pain of two arrows . . .
Having been touched by that painful feeling, they resist and resent it. They harbour
aversion to it, and this underlying tendency of resistance and resentment towards that
painful feeling comes to obsess the mind . . .
Being overwhelmed and dominated by pain, the ordinary person is joined with suf-
fering and stress (Burch 2008, pp. 41, 43).
According to the Buddha, there is an alternative response to painful bodily feel-

ings, which is that of a wise person:
When a wise person experiences a painful bodily feeling, they don’t worry, agonise and
feel distraught, and they feel physical pain but not mental pain. It’s as if this person was
pierced by an arrow, but a second arrow didn’t follow this, so they only experience the
pain of a single arrow . . .
The wise person is not joined with suffering and stress. This is the difference between
the wise person and the ordinary person (Burch 2008, p. 47).
At Breathworks this Sutta forms the core theoretical basis for the program. We
call the first arrow Primary Suffering and the second arrow(s) Secondary Suf-
fering, and suggest that MBPM can help us accept the Primary Suffering and
reduce or overcome Secondary Suffering.
As the Buddha says, Primary Suffering/first arrow is a “given” in the moment
it is experienced and the mindful response is an attitude of kindly acceptance.
Secondary Suffering comes from reacting to the Primary Suffering with resist-
ance and aversion—all the ways we act out “I don’t want this to be happening.”
This Secondary Suffering causes the majority of distress, and usually manifests
within two extremes of avoidance (blocking) and overwhelm (drowning).
Blocking includes behaviors such as addictions, restlessness, an inability to
stop, and “headiness.” Drowning includes behaviors such as depression, being
overwhelmed and taking to bed, self-pity, and a tendency to catastrophize and
lose perspective. People with chronic pain often cycle between these poles, run-
ning away from unpleasant experience until they become exhausted, and then
falling into an overwhelming loss of perspective and low mood.
As the Buddha says in the Sallatha Sutta, we can move toward acceptance of
Primary Suffering and avoid Secondary Suffering by being like the wise person
who “discerns and understands” his or her feelings “as they are actually pres-
ent.” In other words, pay attention to experience as it really is, without trying to
block it out or feeling overwhelmed. By coming back to present moment body

awareness, primary sensations can be accepted with an attitude of kindness and
care, and Secondary Suffering can dissolve away. Central to this perception is
also the direct seeing into the nature of pain—that it is a flow of changing sen-
sations rather than an unchanging “enemy.” This leads to the overall experience
of suffering being lessened, often dramatically.
Satipatthana Sutta
Another key Buddhist text that underlies the Breathworks program (MBPM) is
the Satipatthana Sutta, widely considered one of the central texts on mindful-
ness in the Buddhist tradition. This Sutta clearly lays out the process of percep-
tion for human beings and, like the Sallatha Sutta, it divides experience into
aspects that are a “given” in each moment (Primary) and aspects that are active—
either reactive/destructive or creative/responsive (Secondary).
Primary experience consists of bodily awareness as well as the first glimmer-
ings of perception that arise through the senses, called “vedana” in Pali, the
language of the early Buddhist texts. This is generally translated as “sensations”
or “feelings” and refers to “feeling” in the specific sense of whether sense impres-
sions are pleasant, painful, or neutral when they first come into awareness. In
the case of pain, these sense impressions will enter awareness as painful or
unpleasant vedana. The Buddha stated that in any present moment these two
aspects of perception—body and sensations—will be present for everyone,
whether we are wise or not, simply because all human beings have a body with
sensing apparatus.
The Buddha made it clear in this Sutta that the task of the mindful person is
to cultivate awareness of these first impressions before automatic reactions take
hold. For individuals living with pain, the task is thus to detect the first glim-
merings of unpleasant sensations as they arise in the body, moment by moment.
This then creates a “choice point” or “gap” to choose how one wishes to respond,
as opposed to automatically experiencing the kneejerk or auto-pilot negative
emotions that so quickly arise in the unaware person and are the cause of Sec-
ondary Suffering.
With mindfulness one can experience the unpleasant sensations of pain with-
out automatically reacting, and see directly into their nature—that they are
impermanent and transitory, like everything else in the phenomenal world.
One adept in mindfulness will be able to let the painful sensations arise and fall
moment by moment, rather like watching clouds pass across the sky. Crucially,
when one relates to the sensations of pain in this way, one is free of reactivity
and thereby reduces additional suffering.
With the mindfulness skills of mental and emotional agility, one can also
learn to pay attention to aspects of awareness that are pleasant, rather than
being solely fixated on the unpleasant. Using the principle of “what we dwell on
we become,” paying attention to those pleasant sensations that have a quality of
openness and non-clinging within them—such as those that arise listening to
music or being in nature—gives rise to open, expansive, concentrated states of
mind and heart that will in turn lead to freedom. The Canadian neuropsycholo-
gist Donald Hebb described this as “neurons that fire together wire together”
(Hebb 1949). For example, by choosing to place awareness on sensations that
contain the first glimmerings of positive emotion, we create neurological path-
ways whereby these expansive states become more the norm rather than the
previously habitual reactive states. By learning to do this again and again, one
becomes increasingly adept at choosing positive rather than reactive responses.
Thus, transformation is possible. Kabat-Zinn (2004, p. 264) coined the phrase
“learning to respond rather than react,” which is a helpful, simple description of
this approach.
Along with detailed descriptions as to how the perceptual process unfolds,
the Satipatthana Sutta also has some important verses that outline key attitudes
to bring to the cultivation of mindfulness (known as the definition verses). One
can see these as a “call to action” at the start of the text to encourage motivation
and engagement. The attitudes identified as important are:
◆ appropriate effort or diligence (atapi)
◆ intelligence and clarity in regard to what is coming into awareness through
the senses, i.e. clearly knowing experience (sampajanna)
◆ knowing what is happening right now, in each moment, i.e. being
mindful (sati)
◆ letting go of being a slave to likes and dislikes, or more literally, being free from
desires and discontent in regard to the world (vineyya abhijjhadomanassa).
Throughout the Sutta there is also a “refrain” that echoes between each section
of the text like a drum-beat or chorus. This provides dramatic intensity and
points out ways to use contemplation of the different aspects of experience to
gain insight and liberation. These are:
◆ reflecting on how body, vedana, mood, and mental events are present in
both oneself and other people
◆ seeing into the impermanent and insubstantial nature of passing experience
◆ cultivating mindfulness for the purposes of gaining freedom, i.e. not getting
caught up in experience
◆ using mindfulness to gain liberation from any kind of clinging.
Anālayo, a leading scholar of the Satipatthana Sutta, sums up the whole text
with these four words: Keep calmly knowing change (Anālayo 2004). Taken in its
depth and profundity, this approach will free the individual living with pain
from all reactive suffering.
Loving kindness, compassion, and the Brahma Viharas

Alongside these core mindfulness texts, the Breathworks MBPM program also
draws on key loving-kindness and compassion teachings from the Buddhist
tradition. This is in keeping with the Buddhist path as a whole, where equal
stress is placed on meditations that cultivate positive emotions and those that
cultivate awareness. Positive emotion is the precursor to compassion, and
awareness is the precursor to wisdom. Taken together, compassion and wisdom
are traditionally seen as the two wings of enlightenment—providing a balanced
and integrated approach to freeing the heart and the mind from ignorance,
craving, and hatred, considered the three root poisons in Buddhist psychology.
The meditations that cultivate positive emotion in Buddhism are presented as
a set of four, collectively known as the Brahma Viharas, or Divine Abodes. The
first Brahma Vihara/divine abiding is the fundamental quality of metta, most
commonly translated as loving kindness. This is an emotional attitude of
warmth, love, and kindly concern both for oneself and for others. The other
divine abidings are emotional qualities that arise when metta encounters par-
ticular aspects of experience:
◆ Karuna (compassion) arises when metta comes into contact with suffering,
either one’s own or that of others.
◆ Mudita (sympathetic joy) arises when metta comes into contact with the
good fortune of another. It is a benevolent feeling of good will and rejoicing
as opposed to the opposite of mudita, which is envy or jealousy.
◆ Upekkha (equanimity) is the pinnacle of the divine abodes and expresses an
ability to maintain an even, stable quality of mind under all circumstances.
It is an unshakeable freedom of mind and heart and a state of inner equi-
poise that is not disturbed by the inevitable ups and downs of life.
Studies show that those who are low in scores of mindfulness, and who find it
difficult to treat themselves with compassion and kindness, suffer pain of
greater intensity (Costa and Pinto-Gouveia 2011). Their overall physical and
mental health tends to be poorer too. Research carried out at Duke University
Medical Center in the USA found that cultivating “loving kindness” through
meditation could substantially reduce pain (Carson et al. 2005). Another
study, carried out at Emory University, USA, found that it can reduce inflam-
mation (particularly important for diseases such as arthritis) and boost the
immune system (Pace et al. 2009; see also Halifax 2011). Simply treating your-
self with a little more kindness and compassion can also yield significant ben-
efits. Eighty-eight obese individuals who suffered from persistent pain
completed a self-report assessment measure before or after their appointment
with their anesthesiologist. Hierarchical linear regression analyses demon-
strated that even after controlling for important demographic variables, self-
compassion was a significant predictor of negative affect (b ¼ 0.48, P < 0.001),
positive affect (b ¼ 0.29, P ¼ 0.01), pain catastrophizing (b ¼ 0.32, P ¼ 0.003),
and pain disability (b ¼ 0.24, P < 0.05) (Wren et al. 2012).
In the traditional structure of Brahma Vihara meditations from the Buddhist
tradition, the practitioner follows several stages. Only the first stage is devoted
toward oneself and the other stages are structured around cultivating loving kind-
ness toward others, and ultimately all of sentient existence. It is obvious from this
structure that loving kindness toward others is seen as tremendously important in
traditional Buddhist approaches to meditation. Seen more deeply, it is through this
kind of meditation that we come to see into the interconnected and fluid nature of
experience. The boundaries between self and other begin to break down, including
the illusion of a fixed and unchanging essence in both oneself and others.
When dealing with pain, this shift in perspective from being dominated by
self toward “taking one’s place in humanity” offers the opportunity for a pro-
found shift in perspective in terms of the meaning one brings to the experience
of pain. When contracting against pain and dominated by resistance, pain can
be perceived as a cause of isolation from others. One can feel alone in a world
where everyone else’s experience seems preferable to one’s own. However, when
engaging in loving kindness meditation, there is a particular focus on using
imagination to empathize with others and identify with their experience. Seen
from this perspective it becomes apparent that everybody suffers in one way or
another, at least from time to time, and nobody likes this experience of suffer-
ing. One’s personal experience of pain then becomes an opportunity for
empathy with the suffering of others. Because you know what it is like to feel
pain, by inference you know what it is like for others to feel pain, and so you can
feel sympathy with their experience. That is a radically different perspective.
Rather than pain leading to emotions of isolation, pain leads to emotions of
empathy and connection. This reduces Secondary Suffering greatly.
A participant on a MBPM course summed up this shift in perspective very well:
I think the biggest thing for me being on the course was recognising that my pain didn’t
isolate me, in fact it was my pain that made me human . . . and I was able to accept
that . . . everybody experienced pain to some degree and some level . . . and that it wasn’t
unique to me and instead of feeling isolated and apart I could use it as a way of engaging
with other people.
PERSONAL MEDITATION JOURNEY 171
Conclusion
The Personal Meditation Journey below describes my own journey. It described
how spinal injuries in my teens made the investigation of meditation for pain
management an intensely personal matter. This chapter began with a discussion
of what we mean by pain and the different ways that pain manifests: acute,
chronic, and neuropathic. I suggested that the pervasive nature of chronic pain
in our culture (affecting about one in five people) means we have a silent epi-
demic on our hands. This places an immense burden on both the individual and
on health and social care services. I went on to look at how meditation can ease
the suffering associated with chronic pain and reviewed the evidence base,
before introducing mindfulness-based pain management (MBPM), the pro-
gram I developed, in more detail. The chapter concluded with a review of the
Buddhist roots of MBPM, which includes the Sallatha and Satipatthana Suttas
from the Pali Canon, as well as the Brahma Vihara approaches to cultivating
kindness and compassion toward oneself and empathy and compassion toward
others. Taken as a whole, this chapter offers a thorough overview of the promise
and opportunities meditation offers to the field of pain management.
I experienced my first spontaneous meditative state when I was a fit and healthy
13-year-old, tramping the Routeburn Track in the Southern Alps of New Zealand. One
day, as I gazed at the towering peak of Mt Tutoko, I seemed to merge with the mountain
and time stood still. It was as if I had become one with something much vaster than my
limited self. I was overwhelmed by beauty in what I can only describe as some kind of
ecstasy. I have never forgotten that experience and it sowed the seeds for how my life
has unfolded.
When I was 16 I suddenly went from being this fit and active girl, to a girl dealing with
major physical injury after I fractured a vertebra in my lower spine in a lifting accident.
Almost overnight my life changed. Treatment ranged from physiotherapy, traction, and
having my torso in plaster for weeks, to eventually requiring major surgery. Complica-
tions required further major surgery six months later and the beginning of a life of chronic
pain and physical disability. This ended my dreams of living in the mountains as a wildlife
officer and drove my awareness inwards as I sought ways to deal with the pain.
Five years later I fractured the middle of my spine in a car accident. Although I recovered
adequately, the culmination of injuries was too much for my body to bear. Further com-
plications led me to being hospitalized in an intensive care ward when I was just 25.
The message being delivered was bleak: There were no further medical interventions
possible for my spine and I just needed to learn to live with it. In an attempt to help me
accept this situation, the hospital chaplain came to see me. This kind man held my hand
and took me through a guided visualization meditation practice. He asked me to direct
my mind to a time and a place when I’d been happy. Of course I went back to the South-
ern Alps and found that I was able to recapture some of the awe and wonder I had felt
as a teenager. When he guided me back to the present I was stunned to discover how
different I felt, simply through what I did with my mind. I was the same girl lying in the
same hospital bed, but the ten minutes or so of visualization had dramatically changed
my subjective experience. Although my body was broken to some extent, I discovered
that my mind could be a tool for healing and well-being, and this was an astonishing
and unexpected discovery.
This awoke a hunger in me and when I left hospital I devoured books and cassette tapes
of meditations during the many months I was largely confined to my bed. Although this
was a grim period in many respects, it did give me the gift of time. I was able to spend
many hours each day turning my awareness inward and investigating my mind and
heart. Although my dreams of becoming a mountaineer had been shattered, I dis-
covered that, through meditation, I could become a mountaineer of the inner world.
After a couple of years of this “do it yourself” approach to meditation, a friend invited
me to accompany him on a yoga weekend at a rural ashram. We rose at 6am each day
to do an extensive yoga and meditation session before breakfast. Never one to admit to
my limits, I wholeheartedly threw myself in and endured extraordinary pain as I tried to
bend my body into shapes that were incompatible with a girl who had been largely
bedbound for two years! After breakfast we had to do some gardening and I remember
lying behind the cabbages sobbing. But I persevered. To my amazement, by the end of
the weekend I felt more flexible than I had for years and felt certain that this was a path
I would follow. I started going to yoga at the city center three days a week for a 6am
class of yoga and meditation and I also attended many weekend events. Gradually I
discovered more about the Hindu philosophy and found it fascinating. But I was less
enamored by the humiliations the head teacher regularly heaped upon hapless stu-
dents, presumably in an attempt to break their egos, and became increasingly suspi-
cious of this approach.
A couple of years later the same friend invited me to go on a Buddhist weekend retreat.
Off I went, again not knowing what to expect, and this time I discovered warmth and
lightness of being and met people who were in their own individual ways “extraordinar-
ily ordinary.” I had never before come across people who exuded such comfort in their
own skins and I found them magnetic role models. I intuited that this suited me much
better than the yoga and Hindu approach and started attending Buddhism and medita-
tion classes in Auckland with the Friends of the Western Buddhist Order (FWBO), now
renamed the Triratna Buddhist Community. I quickly became committed and when I was
30 I moved from New Zealand to the UK to live at Taraloka, a rural residential Buddhist
retreat center for women. I stayed there for five years, attending dozens of retreats, and
was ordained into the Triratna Buddhist Order at the end of that time, when I received
the name Vidyamala.
When I look back on my early years of meditation I can see how my primary motivation
was to escape from my body. I hated the fact that I was disabled and lived with pain and
I used meditation to try to cultivate a kind of parallel universe that was pain-free. I man-
aged to keep this up for many years and fooled myself that I was making progress.
However, eventually I realized that my whole approach needed to change. I had another
severe deterioration in my spinal condition when I was 37, leading to partial paraplegia
and requiring me to start using a wheelchair. This took me to a dark place within myself.
At this point I had been meditating intensively for over ten years—both mindfulness
and metta (loving kindness) practices—and yet I felt that my approach was out of bal-
ance: Too much striving and not enough acceptance. So began a time of reckoning. I
read widely about pain management and meditation. This was in 1997, when the secu-
lar mindfulness movement was still very much in its infancy. However, I stumbled across
the work of Jon Kabat-Zinn and Stephen Levine, both of whom wrote lucidly about the
need to turn toward the difficult, rather than try to escape it. I realized that this was the
very thing I’d never done through all my meditation experience. I also read widely about
how to bring balance into the activities of daily life. In the pain management world this
is known as “pacing” or “activity management.” I began to bring this very consciously
into my own behavior and found it transformative. For example, when writing this chap-
ter, I work for 20 minutes at the computer and then lie down for 15 minutes. This is a far
cry from my previous behavior of working until I was in agony and then being wrecked
for the rest of the day. The idea of taking a break before I needed it was completely revo-
lutionary, but it was the missing piece of the jigsaw.
Gradually I managed to rehabilitate myself again, but this time with a profoundly differ-
ent attitude. Now I was using meditation to turn toward my experience in its fullness
and to bring some compassion and kindness to the pain I was experiencing, before
broadening my awareness to rest in a deeper sense of wholeness within the flow of life.
I became more integrated and peaceful. Paradoxically, I began to experience life in the
very way I had been trying to willfully cultivate in my escapist days.
In 2001 I started running mindfulness-based courses and this formed the basis for
mindfulness-based pain management (MBPM) as offered by Breathworks, the social
enterprise I co-founded in 2003. I now teach and write extensively about this approach
and there are Breathworks teachers in over 25 countries.
In terms of my own journey, I continue to meditate daily—mindfulness, compassion,
and insight practices—and also benefit tremendously from my working life being
oriented around kindly present-moment awareness. My back has settled down a lot
over the past few years, which seems nothing short of a miracle. I used to think that
miracles happened through one blinding flash, but the quiet miracle of my own improve-
ment is a result of a steady application of gentle effort across a very broad front. There
is a great lesson in this. Huge change can come about through lots of smaller changes
woven into the fabric of ordinary everyday life. In my case these are: Meditation; regular
exercise; good diet; going to the Antipodes every English winter, as my condition is
much better in the warmth; pacing my activities; wearing a spinal brace; regular oste-
opathy and acupuncture; and hormonal changes with the menopause. None of these
alone would bring about significant change, but taken together they have resulted in a
remarkable improvement in my condition. I know it is unlikely that this will last, as I
have a lot of metalwork in my spine that will inevitably wear out, but for now I have a
life I never imagined would be possible, and for that I am deeply grateful. Meditation
has indeed been the key to freedom. Meditation has helped me to change my mind to
transform my life and my behavior.
Acknowledgment
This section is adapted from Burch 2008, pp. 33–38.
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Chapter 8
Addictive disorders
Sarah Bowen, Matthew Enkema, Corey
Roos, Haley Douglas, Erin Harrop, Tatyana
Kholodkov, and Katie Witkiewitz
Introduction
At the center of Buddhist teachings are the Four Noble Truths. The first of these
truths states that, as sentient beings, we experience suffering. The second truth
explains that experiences of craving (wanting what we do not have) or aversion
(not wanting what we do have) are at the root of our suffering. Nowhere do we
see a clearer and more painful illustration of these truths than in the cyclical
trappings and anguish caused by addictive behaviors. Whether we understand
the seemingly intractable addictive cycles through traditional Buddhist teach-
ings on craving, or through behavioral principles of conditioning and rein-
forcement, the challenging and destructive nature of addiction is painfully
clear.
The third of these noble truths, however, describes a way out of suffering, and
the fourth lays out a path to this end. Recently, treatments for addictive dis-
orders have begun systematically incorporating teachings and practices from
this tradition into Western cognitive behavioral treatment approaches to
inform integrated secular mindfulness-based programs for treatment of addict-
ive behaviors.
The nature of addiction

Whether or not we struggle with addiction as traditionally defined in Western
cultures, the processes that underlie the addictive cycles are common to us all.
We all experience craving for something that we do not have, believing it will
bring us happiness or relief. Conversely, when we experience discomfort caused
by something we do have, such as sadness or physical discomfort, we naturally
look for a means of alleviation. This is our nature; we are hardwired to avoid
uneasiness. However, without insight into these processes and their potential
costs, we often react on “automatic pilot,” reaching for what we think is missing
178 Addictive disorders
or will most immediately alleviate our distress. For individuals with histories of
substance abuse, the desire for alleviation can manifest as craving for a mind-
altering substance, often leading to subsequent alcohol or drug use. In the short
run, this may indeed bring relief. In the long run, however, it only perpetuates
and exacerbates suffering.
Before we can change such deeply ingrained behavioral patterns, we must be
awake to them. It is common for clients to report a lack of awareness as to what
preceded or caused a relapse or high-risk situation (“All of a sudden, I was in the
parking lot of the liquor store”). Bringing greater awareness to day-to-day
moments and actions can help raise awareness in such situations. If the client in
the liquor store parking lot, for example, was aware of the preceding cognitive,
affective, and behavioral processes, he may have been able to make different
decisions along the way. Even if he still made the decision to go to the liquor
store, being aware of the processes at play may have helped him to reduce the
pull of thoughts and emotions, and to be aware that even at this “point of no
return,” there are still choices.
If reflection on and self-observation of the human tendencies toward craving
and aversion can be helpful for stepping out of the addictive cycle, how do we
practice this? Through mindfulness meditation, we can train our awareness and
undo some of the over-learned behaviors and cognitive patterns. Through prac-
ticing non-judgmental observation of the nature of our mind, we begin to see
for ourselves how the seemingly automatic progression of triggers, craving, and
relapse behaviors functions. In seeing this more clearly, we introduce the possi-
bility of alternative, intentional, and skillful responses.
The roles of habit and “autopilot” in addiction are often accompanied by
shame and guilt, also powerful factors in the development and maintenance of
addictive behaviors. Feelings of shame and guilt-laden thoughts may predict
the transition from a lapse (single instance of the behavior) to a full-blown
relapse (return to baseline levels of the behaviors). For example, after a lapse,
such as a drink or a cigarette following a period of abstinence, an individual
often feels defeated and ashamed, and has thoughts such as, “I failed,” or “I
knew I couldn’t do this.” Such a constellation of emotion and thought has been
termed the “abstinence violation effect” (Marlatt and Gordon 1985), and can
put an individual at greater risk of spiraling further into the addictive cycle.
Mindfulness training, or practicing awareness of the constituent parts of such
processes while bringing a non-judgmental attitude to an experience, can help
break the cycles of shame and self-hatred that are often both causes and results
of addiction. Through recognition of the mind’s tendencies, not only is there
more possibility of choice, but there may also be a recognition of the inherent
humanness, versus personal pathology, of these experiences.
Mindfulness and concentration practices 179
Mindfulness and addiction treatment

Over the last four decades, research on applications of meditation and
mindfulness-based approaches for an array of psychological problems has
grown exponentially. As part of this growth, meditation has begun to receive
attention as a potentially useful treatment for individuals seeking help with
addiction, and various meditation practices have been evaluated for their
effectiveness (Marlatt 2003). Some of the earliest investigations of meditation
as a treatment for addiction were Marlatt’s preliminary investigations in the
early 1970s, evaluating transcendental meditation (TM) as a preventive inter-
vention for high-risk drinkers (Marlatt and Marques 1977). After some prom-
ising findings, a subsequent randomized trial of TM-based meditation, in
comparison with several other methods of relaxation, provided further evi-
dence of salutary effects of meditation for heavily substance-using individ-
uals. Results indicated that TM was associated with a strong and consistent
reduction in substance use, and led to the inclusion of meditation in the
Relapse Prevention Model as a potential alternative to substance use and a
significant step toward a more balanced way of living (Marlatt 2003; Marlatt
and Gordon 1985).
Mindfulness and concentration practices

Within the Eastern-based meditation practices used in contemporary health
care, there is a distinction between concentration practices and those intended
to develop mindfulness or insight (Baer 2003). During concentrative practice,
the meditator’s intention is to focus awareness on a particular object (e.g., a
mantra, an image, the breath) and thereby limit attention and allow a deep con-
centration to develop (Zgierska et al. 2008). The intention in mindfulness medi-
tation is for the practitioner to allow awareness to be present-focused and
non-judgmental, and in doing so develop insight (vipassana) into the causes
and conditions of suffering. While earlier studies focused on TM, a concentra-
tive practice, recent research in addictions has shifted to a primary focus on
mindfulness-based practices.
It has been proposed that mindfulness meditation might provide additional,
specific benefit for individuals experiencing the craving and compulsive behav-
ior characteristic of addiction (Groves and Farmer 1994). Indeed, results from
an early trial of an intensive meditation course in an incarcerated population
showed evidence of a significant relationship between participation in an inten-
sive ten-day Buddhist “vipassana” meditation retreat and substance use, as well
as psychosocial outcomes, when compared to participants in the “treatment as
usual” condition (Bowen et al. 2006).
For many seeking treatment, however, a ten-day Buddhist meditation retreat

may not be appropriate or feasible. As a result, several programs integrating
cognitive behavioral approaches with mindfulness practice for alcohol and sub-
stance use disorder have been proposed (e.g., Bowen et al. 2009; Garland
et al. 2014; Witkiewitz et al. 2005), providing practices to help clients step out of
“automatic pilot” or destructive habit patterns into fuller awareness and flexibil-
ity. For example, mindfulness-based relapse prevention (Bowen et al. 2009;
Witkiewitz et al. 2005) integrates cognitive behavioral relapse prevention treat-
ment (Marlatt and Gordon 1985) with secularized mindfulness practices in an
outpatient, eight-week program, designed to be accessible to a broad array of
clients and settings. The intention is to offer the best of both Eastern and West-
ern approaches in a format that can be implemented in medical and community
treatment settings, and to avoid trappings or limitations of religion-based
approaches.
Integration of mindfulness meditation into Western psychology appears to
be taking two primary forms, with one fundamental factor that differentiates
between the two approaches. In one school of “third wave” behavior therapies,
mindfulness practices are integrated into a platform of CBT-based approaches
as a supplementary practice, and are thus one of several components of the
treatment. For example, dialectical behavior therapy (DBT) and acceptance and
commitment therapy (ACT) come from behavioral traditions but contain ele-
ments, components, or “modules” integrating mindfulness practice. In con-
trast, the other emerging group of therapies, recently termed mindfulness-based
interventions or MBIs, have at their foundation, and thus part of every session,
formal mindfulness meditation practices. These treatments ask their clients,
beginning in the very first week, to adopt a daily formal meditation practice
into their lives. Thus, third wave behavior therapies and MBIs differ mainly in
the degree of focus on formal meditation practice; as one component (in DBT
or ACT) versus the core focus of the treatment (in MBIs). The third wave behav-
ior therapies and MBIs have fundamental similarities as well, including using
mindfulness practices to help clients increase their focus on present-moment
awareness, and learning to discern between what is actually happening in the
present moment versus what stories or judgments the mind may be adding.
Both have shown promise in the treatment of addictive behaviors.
Among the third wave of cognitive behavioral treatments, acceptance and
commitment therapy (ACT) has emerged as a promising field of study (Hayes
et al. 2006). Within this approach, the intention is not to change psychological
processes, as in the case of more traditional cognitive behavioral therapies;
rather, it is to change the individual’s relationship to such processes through the
development of acceptance and mindfulness skills. According to an ACT model
Mindfulness and concentration practices 181
of psychopathology, addictive behaviors are the result of factors such as experi-

ential avoidance, impulsivity, weak self-knowledge, and a lack of clarity of val-
ues (Hayes et al. 2006). Similarly, relief from these pathologies is believed to be
achieved through increased psychological flexibility, which is developed
through six core skills: (1) acceptance; (2) being present; (3) values; (4) commit-
ted action; (5) self as context; and (6) cognitive diffusion (Hayes et al. 2006; see
also Bond et al. in Chapter 11 of this volume). The mindfulness skill of “being
present” is defined as maintaining consistent, non-judgmental awareness of
internal and external experiences. It is thus suggested that this awareness pro-
motes a more direct experience of the world that enhances the individual’s abil-
ity to act in accordance with his or her value system (Hayes et al. 2006).
Several studies have shown promising results of ACT as a treatment for
addictive behaviors. In a preliminary trial, ACT was shown to reduce illicit
drug use among methadone-maintained opiate addicts, compared to intensive
12-Step Facilitation (see the next section on “The 12-Step tradition”) (Hayes
et al. 2004). In another study assessing male and female inpatients at a residen-
tial treatment facility, participants receiving six hours of ACT had better treat-
ment outcomes compared to those receiving treatment as usual (Luoma
et al. 2012). Finally, in an outpatient setting for tobacco smoking cessation, par-
ticipants receiving ACT reported better smoking outcomes at one year com-
pared to those receiving nicotine replacement therapy (Gifford et al. 2004).
A related third wave approach is Spiritual Self-Schema therapy (3-S; Marcotte
et al. 2003), a protocolled intervention that integrates a cognitive model of self
within a Buddhist psychology framework, appropriate for people of all faiths. It
was designed to help individuals struggling with addiction to develop a “self-
schema” for compassion that supports abstinence from alcohol and other drugs,
and HIV preventive behavior. To date, there have been no randomized con-
trolled trials examining 3-S as a treatment for addiction. One small uncon-
trolled trial did find that 3-S was effective in changing several outcomes that are
relevant to addiction, most notably impulsivity and motivation for change
(Amaro et al. 2010). Another small trial found that participants in 3-S, in com-
bination with methadone maintenance, showed greater reductions in impulsiv-
ity and drug use than a non-randomized standard care group that included
methadone maintenance without 3-S (Margolin et al. 2007).
Dialectical behavior therapy (DBT; Linehan 1993) is a skills-based therapy
originally developed for the treatment of suicidal individuals and those with
borderline personality disorder. DBT includes the addition of principles from
Zen practices. The core mindfulness techniques encompass practicing observa-
tion of life experience, including one’s emotions and behaviors. The aim is for
one’s emotional mind and reasonable mind to become balanced and joined into
“wise mind,” which is capable of intuitive knowledge. The skills of observing,

describing, and participating with one’s experiences are termed the “what”
skills. The “how” skills involve taking a non-judgmental stance, focusing on one
thing in the moment, and being effective. Through these techniques, clients not
only develop better self-awareness but are able to participate wholly in activities
with less judgment and worry. Ultimately, these mindfulness skills are import-
ant within all of the other DBT modules (emotion regulation, distress tolerance,
and interpersonal effectiveness).
Several studies have been conducted assessing DBT for the treatment of
addictions. A randomized clinical trial compared the efficacy of DBT to treat-
ment as usual among women with borderline personality disorder drug
dependence. Those in the DBT condition had significantly more days of abstin-
ence from drugs and alcohol, corroborated by urinalysis results (Linehan
et al. 1999). When DBT was compared to comprehensive validation therapy
plus 12-Step (CVT + 12S) in treating opioid dependence in women with bor-
derline personality disorder, both conditions reported reductions in opiate use.
However, those in the CVT + 12S condition significantly increased opiate use
during the final four months of treatment (Linehan et al. 2002). A recent review
by Bankoff et al. (2012) indicated that DBT is also effective in reducing eating-
disordered behaviors.
The 12-Step tradition

While there has been a recent surge in integration of meditation into treatment
for addictions, we can trace the roots of this application back many decades,
across several treatment traditions, orientations, and programs. For example, in
traditional Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)
groups, participants are encouraged to work the “12 Steps,” a set of instructions
aimed at integrating recovery principles into their lives. In the eleventh step of
this program, participants are encouraged to deepen their individual spiritual
practices by incorporating “prayer and meditation” into their recovery routines.
Traditional AA and NA groups are characterized by a distinctly Judeo Christian
slant, but effort in recent years has been made to incorporate a wider range of
religious preferences (Gorski 1989). The perspective and approach to medita-
tion in this tradition, however, may differ from meditation in other traditions;
it may be more oriented toward prayer and reflection rather than observation of
moment-to-moment experience.
Recently, there has been an attempt to bring more mindfulness-based medi-
tation into 12-Step practices. For example, Kevin Griffin is a Buddhist medita-
tion teacher and long-time 12-Step practitioner who advocates the integration
Review of the research 183
of 12-Step principles with mindfulness meditation. In his book, One Breath at

a Time: Buddhism and the Twelve Steps, Griffin (2004) endeavors to character-
ize the relationship between the 12-Steps and Buddhism. Similarly, Noah Lev-
ine, a Buddhist teacher, counselor, and writer, explores his own journey to
sobriety through the help of meditation practices such as awareness of the
breath (Levine 2004).
Buddhist Recovery Network

The Buddhist Recovery Network (BRN), founded by Griffin, Levine, and oth-
ers, is an organization with international chapters that offers help to individuals
with addictive behaviors through the use of Buddhist teachings, principles, and
practices. All Buddhist traditions are welcome and one does not need to iden-
tify themselves as a Buddhist to be involved. A strong parallel is drawn between
the eleventh step of 12-Step programs and the BRN’s recovery support through
the use of mindfulness and meditation. The program is aimed at strengthening
one’s recovery through the practice of meditation, a sense of community, and
ethical principles (e.g., non-harming) drawn from Buddhism.
Tao of recovery/sobriety
Several self-help books are viewed as classics within the field of mindfulness
and addiction. The Tao of Recovery—A Quiet Path to Wellness by Jim McGregor
(1997) applies the principles of Taoism to recovery, and is a resource for those
suffering from addiction and for the family and friends of those impacted by
addiction. The book consists of four sections: Being, Awakening, Recovering,
and Living. Its structure of 81 short verses parallels the classic Chinese text of
Lao Tzu’s Tao Te Ching (Tzu 1974) and connects teachings to the recovery pro-
cess, incorporating the author’s experience with recovery. Gregson and Efran’s
The Tao of Sobriety: Helping You Recover from Alcohol and Drug Addiction
(2002) also applies the Eastern philosophy of Taoism to recovery. The book
contains a variety of exercises, including meditations and content for contem-
plation and affirmations. The book is based on Taoist precepts (guidelines for
living) to offer a gentle way for the reader to let go of suffering, particularly by
learning how to be free of guilt that may maintain addiction.
Review of the research

Several studies have examined the feasibility and efficacy of integrated, secular-
ized, mindfulness-based treatment for alcohol and other substance use dis-
orders (SUDs), as well as cigarette smoking and eating disorders. Several of these
studies have found mindfulness-based approaches to be more effective than no

treatment/wait-list/standard care control groups (Bowen et al. 2009; Brewer
et al. 2011) and in some studies, more effective than existing evidence-based
treatments (Bowen et al. 2014; Witkiewitz et al. 2014). In a review of 24 studies,
Chiesa and Serretti (2014) concluded that mindfulness-based interventions can
significantly decrease the consumption of alcohol and illicit drugs. Discussed
here are a sample of the programs and studies of these interventions.
Findings from one pilot study by Zgierska and colleagues (2008) indicated
that mindfulness-based outpatient intervention was feasible, well received by
participants, and associated with significant improvements in stress, depression,
and anxiety. Additionally, participants reported reduction in drinking behaviors
that were maintained four months after the end of the course (Zgierska
et al. 2008). A subsequent pilot study, conducted by Brewer et al. (2009), assessed
a similar mindfulness-based approach, comparing the effect of mindfulness
training to cognitive behavioral therapy for treatment of alcohol and/or cocaine
use disorder. Results indicated that both treatments were acceptable, and there
was no difference in alcohol or drug use between the groups. However, labora-
tory tests indicated a greater reduction in psychological and physiological stress
during a protocol designed to elicit a stress reaction for participants in the mind-
fulness training condition compared to participants in the CBT group.
Mindfulness-oriented recovery enhancement (MORE) is a program devel-
oped by Garland and colleagues (2014) that provides individuals with oppor-
tunities to practice and develop awareness and acceptance of moment-to-moment
experience. Uniquely, this model of mindfulness training targets mechanisms
believed to drive chronic pain and problematic opioid use. In a study evaluating
the efficacy of MORE, investigators found significant improvements in prob-
lematic pain symptoms post-treatment, but changes were not significant at a
three-month follow-up (Garland et al. 2014).
While there have been a sizable number of preliminary investigations evalu-
ating the feasibility, acceptability, and efficacy of mindfulness-based treatments
for addiction, until recently few studies had investigated the relative effective-
ness of mindfulness-based approaches compared to more conventional cogni-
tive behavior therapy and traditional 12-Step treatment. Two recent randomized
clinical trials by our research team (Bowen et al. 2014; Witkiewitz et al. 2014)
provide evidence for the efficacy of mindfulness-based relapse prevention
(MBRP) in treating SUDs. Bowen and colleagues (2014) examined the relative
efficacy of group-based MBRP, cognitive behavioral RP, and treatment as usual
(TAU; which consisted of 12-Step and psychoeducational components) among
individuals (N = 286) who completed intensive outpatient or inpatient treat-
ment for SUDs. At six-month follow-up, individuals randomly assigned to
Review of the research 185
either RP or MBRP had significantly better outcomes (defined as fewer days of

drug use and heavy drinking) than those assigned to TAU. However, at the
12-month follow-up MBRP participants had fewer drug use days and an
increased rate of abstaining from heavy drinking than both RP and TAU.
Subsequently, Witkiewitz and colleagues (2014) examined the efficacy of
group-based MBRP compared to RP within the context of residential treatment
for female criminal offenders. Individuals (N = 105) were randomized to receive
eight weeks of MBRP or RP during the course of a six-month residential addic-
tion treatment program, and were later followed for 15 weeks post-release from
the program. Individuals randomly assigned to MBRP had significantly lower
rates of drug use, fewer drug-related consequences, and lower addiction sever-
ity at follow-up, compared to those assigned to RP.
In addition to reductions in substance use, studies indicate that mindfulness-
based interventions are associated with other benefits. These include decreased
craving (Bowen et al. 2009; Vieten et al. 2010), an attenuation of the association
between depressive symptoms and craving (Witkiewitz and Bowen 2010),
decreased cue reactivity (Brewer et al. 2010; Garland et al. 2010), and reduced
shame (Luoma et al. 2012).
Recent evidence suggests that mindfulness-based and related interventions
may also be effective for smoking cessation (Chiesa and Serretti 2014). Brewer
and colleagues (2011) demonstrated that eight sessions of group-based mind-
fulness training was associated with significant reductions in cigarette use, as
compared to the American Lung Association’s Freedom from Smoking Treat-
ment. Moreover, in this study self-reported mindfulness meditation practice
outside of treatment sessions was correlated with less cigarette use. Studies indi-
cate that ACT may also be effective in treating nicotine dependence. For exam-
ple, Hernández-López and colleagues (2009) found long-term benefits of ACT
over CBT in reducing smoking, and Gifford and colleagues (2004) showed that
participants who had received ACT had higher quit rates at one-year follow-up
compared to those who had received only nicotine replacement therapy.
There is also preliminary, yet promising, empirical support for mindfulness-
based and related interventions in the treatment of eating disorders and in the
promotion of weight loss among obese or overweight individuals. These inter-
ventions similarly combine mindfulness practices, targeting awareness and tol-
erance of discomfort, with more traditional cognitive and behavioral approaches.
Two small, wait-list controlled trials (Safer et al. 2001; Telch et al. 2001) and one
sizeable randomized controlled trial (RCT; Safer et al. 2010) provided evidence
for the efficacy of DBT in treating binge eating disorder (BED). Mindfulness-
Based Eating Awareness Training (MB-EAT; Kristeller and Wolever 2011) also
holds promise as a treatment for BED. In an RCT of 150 overweight and obese
individuals with BED, both MB-EAT and a psychoeducational/cognitive behav-

ioral intervention produced significant reductions in binge eating and depres-
sion over a wait-list control group (Kristeller et al. 2013).
Compared to BED, there has been considerably less research on MBIs for
anorexia nervosa (AN) and bulimia nervosa (BN). Preliminary evidence sug-
gests that a mindful eating group (Hepworth 2011) and ACT (Juarascio
et al. 2013) may be effective adjunctive treatments for individuals with AN
and BN. Moreover, Juarascio et al. (2010) found that ACT reduced disordered
eating in a subclinical population to a greater extent than cognitive therapy,
suggesting that ACT may be an effective treatment for subclinical eating
pathology.
In relation to mindfulness-related interventions as weight loss interventions,
several studies suggest that ACT may be effective. In a sizeable RCT, Forman
and colleagues (2013) demonstrated that ACT produced significantly greater
weight loss compared to a standard behavioral treatment when the interven-
tionist was a weight control expert. Additionally, two open trials (Forman
et al. 2009; Niemeier et al. 2012) and two smaller controlled trials of ACT for
weight loss (Tapper et al. 2009; Weineland et al. 2012) provide evidence for ACT
as a weight loss intervention.
Limitations of current findings and future directions

Despite the positive findings from initial studies on mindfulness-based and
mindfulness-related interventions for substance use disorders, smoking,
eating disorders, and obesity, many of the extant studies included small
sample sizes, lacked randomization to treatment, and did not employ well-
established treatments (i.e., cognitive behavioral therapy) as comparison
groups. Additionally, there is a wide variety of mindfulness involvement in
interventions, with some interventions emphasizing formal meditation
(i.e., MBRP) more than others (i.e., DBT, ACT). Thus, it is still unclear
whether practicing formal meditation is a mechanism of action in mindful-
ness interventions. Finally, while mindfulness-based interventions appear
effective as aftercare treatments or additive components to existing inter-
ventions, there is still limited evidence to suggest that mindfulness-based
interventions can be effective as primary stand-alone treatments. Alto-
gether, although current evidence indicates that MBIs and other third wave
therapies are promising treatments for substance use disorders, eating dis-
orders, and obesity, there is still a need for more rigorous research on the
efficacy and mechanisms of action of mindfulness-based interventions
compared to other well-established treatments.
Conclusions 187
Conclusions
Limitations of the approach and new directions
for research and treatment
There are numerous limitations to the current research on mindfulness-based
treatments. One of the primary issues is the lack of consensus on an operational
definition of mindfulness that adequately captures changes in mindfulness
(present moment awareness, non-judgment, non-reactivity) often targeted in
treatment. Also lacking are objective or behavioral measures of mindfulness
practice that would allow assessment of mindful awareness, non-judgment, and
non-reactivity without relying on self-report. Additional limitations include
the diversity of treatments that individuals are receiving as part of mindfulness-
based treatments, with some including components of CBT, DBT, or other
alternative treatments. Dismantling studies that refine the active ingredients of
mindfulness treatment are necessary to improve our understanding of what
works in treatment.
The field of mindfulness-based treatment is relatively young and is both rich
with promise and fraught with unanswered questions. New directions for
research include developing behavioral/objective measures of mindfulness
practice, gaining a better understanding of the neurobiological and psycho-
physiological correlates of successful outcomes following mindfulness-based
treatment, and developing methods for dissemination and implementation of
mindfulness-based treatments in community settings. There are also many
questions related to the treatment of addiction using mindfulness-based
approaches. For example, many studies have been conducted in group formats,
but therapists in the community often use an individual form of the group
interventions. As noted above, the importance of the personal mindfulness
practice of the treatment provider (and possibly the treatment agency staff)
needs to be examined.
Overall, despite these limitations, mindfulness-based treatments appear to
hold promise as an alternative or supplement to traditional 12-Step, CBT, and
relapse prevention approaches in the treatment of addictive behaviors. We are at
the beginning; there are many questions remaining to be explored, but prelimin-
ary evidence from increasingly large randomized controlled trials suggests that
these questions are worth pursuing. Research designed to better understand and
improve the processes underlying mindfulness-based treatments, and efforts to
increase the dissemination and implementation of these effective interventions, is
now needed. While there are now several research trials, there has been relatively
little work on dissemination of these programs. We have yet to study training and
supervision models for therapists, for example, and the implementation of these
treatments in varied settings and diverse different populations. Future studies

should also include the longer-term trajectories of participants in these groups.
Effective treatment of addictive behaviors remains a challenge for clinicians
and researchers, and is ever more important for modern societies. Drawing
upon age-old wisdoms and practices offers promise, and while we are at the
beginning, it is an exciting and intriguing exploration.
It has been a rich journey as we, authors of this chapter, have explored and deepened
our own practice while, in sometimes elegant and sometimes messy parallels, examin-
ing data and integrating questions and theories back at the lab. This multidirectional
flow between lab, clinic, and retreat practice has offered a rich, ever-growing experi-
ence, filled with questions, curiosity, and vitality. Mostly, this integration has nurtured
the questioning and curiosity that is at the heart of both our meditation practice and the
science with which we study it.
Although authors of this chapter have since moved along to other institutions and posi-
tions, several of us were fortunate to study under the tutelage of Dr. Alan Marlatt. As
human as any of us, and more courageous and visionary than most, he dedicated his
personal and professional efforts to meditation practice and the study of addiction, and
allowed his students and junior colleagues the space and encouragement to do the same.
Many of us, while working in the lab, would take a week or ten days off of work to go sit
a retreat. This was fully supported, regardless of the time it took away from his lab.
It is a beautiful and unique model, especially for those of us in academia, to be able to explore
our own experiences and invite first-person observational learning into our science, and to sit
squarely in the middle of human experience rather than endlessly theorizing from a safe
distance. We were invited to allow our own humanity, rich with struggle and questioning, to
inform and enrich our research and clinical work. We are grateful for this; it laid a foundation
for this way of working, and it will remain at the center of our work from here forward.
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Chapter 9
Meditation and physical health

Linda E. Carlson
Introduction
There are many styles of meditation practice honed through millennia by prac-
titioners from many countries and regions, as discussed in earlier chapters.
These have traditionally been used for purposes of self transcendence, liber-
ation, and being of service to others, rather than specifically for treating symp-
toms of physical diseases, or even achieving optimal physical health. However,
in Western applications of meditation, since the 1960s when Eastern practices
were first introduced to the West en masse, one of the key applications has been
not only mental health and stability, but also achieving optimal physical health.
The two best examples of this are the creation of the mindfulness-based stress
reduction (MBSR) program by Jon Kabat-Zinn and colleagues at the Massa-
chusetts Medical Centre in 1979 (Kabat-Zinn 1990), followed by various adap-
tations collectively known as mindfulness-based interventions (MBIs) and the
application of transcendental meditation (TM), specifically for the treatment of
high blood pressure (Schneider et al. 2005).
This chapter will focus on the mindfulness-based interventions, largely
because the bulk of the work has been conducted in this area. The idea of mind-
fulness stems from traditional Buddhist conceptions, and is typically defined in
the West as non-judgmental present-moment awareness (Kabat-Zinn 1990).
Shapiro and Carlson (2009) developed the “IAA” model of mindfulness, speci-
fying three components of Intention, Attention, and Attitude. The intention can
vary but is typically one of intending to be in the present moment. Attention is
the quality and focus of awareness, which is typically on the moment-to-
moment fluctuation of the breath, bodily sensation, sound, or thought. Attitude
emphasizes the need for the attention to be kind, open, non-judging, curious,
and accepting, rather than harsh or critical. Mindfulness is thought of as both a
way of being in the world, and a specific practice (mindfulness meditation) that
promotes and supports this way of being.
There are several compelling reasons that meditation practices, particu-
larly mindfulness, might be useful in helping people cope with physical
194 Meditation and physical health
illness and pain. One is simply because mindfulness turns out to be a good
antidote to stress, which is known to be associated with a range of illnesses
and symptoms. Specific psychological characteristics of the illness experi-
ence itself also respond well to a mindfulness approach, such as loss of con-
trol, uncertainty about the future, existential worries and life threat, unwanted
changes in plans and priorities, and coping with specific treatments and
symptoms. In this chapter I will first discuss the rationale for applying mind-
fulness techniques in the treatment of physical diseases and symptoms in
general, and then review the literature on the application of mindfulness-
based approaches for specific conditions, ending with suggestions for future
research priorities.
The illness experience

To understand the potential benefits of mindfulness in physical medical con-
ditions it may be helpful to think about the illness experience itself. Take the
case of cancer, which for almost everyone challenges their world view and self
concept, often requiring debilitating and sometimes mutilating treatments,
with an uncertain future. On an existential level people are forced to confront
their own mortality in a real way, often for the first time. The possibility of one’s
death becomes real and potentially imminent, and substantial and perhaps
permanent changes in functional abilities, appearance, and lifestyle may fol-
low, as well as having to face the possibility of ongoing pain and dysfunction.
Life plans are necessarily altered, and the future is premised on whether or not
the illness comes back or gets worse. On a psychological level, illness and treat-
ment often produce a sense of unpredictability, loss of control, and feelings of
anxiety and fear. After treatment, no matter how successful, for most people
there is a lingering fear of recurrence or progression, which turns every ache
and pain into a potential life threat. Escalating anxiety can then set up a nega-
tive spiral, which results in worsening of the suspicious symptoms due to mus-
cle tension and hypervigilance, followed by greater fear and certainty of
recurrence. Mindfulness practices allow a short-circuiting of this process to
prevent such escalation.
In general, most people function well because they assume more control over
the course of their lives than they really have; diagnosis with a chronic or
life-threatening illness throws this inaccurate conception into sharp relief. In
response, many people try harder to control some aspects of their lives, but
within the framework of diagnosis, treatment, and an uncertain future, this is
often a losing battle. The best response is actually to embrace uncertainty, but
for many people this is a tall order.
Mindfulness-based interventions 195
Why mindfulness?
This fundamental inability to control or change the course of illness progres-
sion (and ultimately death) is why acceptance-based approaches, such as MBIs,
can be especially helpful. The core training in MBIs is the development of stable
and kind mindful attention, through repetitive and consistent application of
awareness of present-moment experience, with a kind, curious, and
non-judgmental attitude. This typically begins with training in focused atten-
tion on the breath or bodily sensation through body scanning, sitting medita-
tion, and mindful movement. Once stability of attention has been established
through ongoing practice, a broadening of attention (“bare awareness”) is
applied, which allows people to directly experience the nature of mind for what
it is: Transient, impersonal, and constantly changing. Through observation par-
ticipants can also directly experience how grasping at certain outcomes or states
of being causes suffering, and through that insight learn to let go of clinging and
personalization of experience. Repetitive practice of alternative responses to
difficult emotions or thoughts during meditation helps retrain the brain to
respond in ways that are supportive of more positive emotions.
A mindfulness approach is eminently adaptable to a wide array of circum-
stances. Simply absorbing the general understanding that the only certainty in
life is change, and that sometimes the best thing to do to solve a problem is
accept it, can be extremely relieving and even liberating to people who are des-
perately and often frantically trying to fix things. Realizing that in fact they can
slow down and see things as they are, without blinders, and learn ways to hold
the strong emotions and sensations that arise can be transformative. The fur-
ther realization that although specific symptoms may be unpleasant, they are
tolerable and are also constantly in flux, can provide further liberation from
suffering. Stepping back and seeing the racing thoughts, worries, and self-blame
as just thoughts, and not necessarily the truth, provides further relief. Hence,
change occurs not only by training the mind through formal mindfulness prac-
tice, but via a shift in attitude and perspective that allows people to see their
illness in a new light, without allowing fear to consume them and to drive
behavior.
Mindfulness-based interventions
MBSR emerged in the late 1970s through the combination of popular stress
management techniques such as relaxation and deep breathing, with more
novel practices and concepts from Eastern meditation traditions (Kabat-Zinn
1990). Jon Kabat-Zinn, the founder of MBSR, himself studied Zen meditation
and vipassana and distilled some of the key concepts around mindfulness and
the idea of present-moment awareness into a secular program palatable to the

Western medical system. The MBSR program is an eight-week group course
that includes a six-hour silent retreat near the end of the program. Gentle hatha
yoga is incorporated into each class, as are a range of key meditation practices
including body scan, sitting meditation, walking meditation, loving kindness
(metta) practice, and a smattering of other practices such as Mountain or Lake
meditations meant to highlight “mountainlike” or “lakelike” qualities in people,
which meditation enhances. These may include majesty, stillness, equanimity,
rootedness, depth, reflection, etc.
Key also to the MBSR program is reflection on the practices, skilled inquiry
by the facilitator, and dialogue around personal practice meant to enhance
insight and personal growth. Didactic materials specific to topics such as the
stress response, balance in the nervous system, mindful communication, mind-
ful attitudes, and other topics are also often included. The groups are offered in
sizes ranging from 8 to as many as 35 in some cases. The basic MBSR model has
been adapted and modified to suit the needs of different clinical and non-clini-
cal populations, and to reflect this, different names are often used (such as
mindfulness-based cancer recovery (MBCR), our adaptation for people living
with cancer). The most well known of these is mindfulness-based cognitive
therapy (MBCT), originally developed to prevent depression relapse (Segal
et al. 2002), since shown to be effective in many studies (Piet and Hougaard
2011), and now applied to a range of different mental and physical health condi-
tions. As a collective, we refer to these as MBIs.
Summary of the literature

The strategy employed in reviewing research on MBI effects on physical health
outcomes is to add to other comprehensive reviews (Carlson 2012; Piet and
Hougaard 2011) by highlighting more recent, well-designed studies that may
inform further understanding of efficacy and mechanisms of action. The focus
is on quantitative studies and primarily randomized controlled trials (RCTs).
While there is also an interesting and growing body of qualitative work on MBIs
in many disease conditions (Mackenzie et al. 2007), space limitations make it
impossible to cover that work here. The review is organized by disease type,
rather than type of intervention or outcome studies, with diseases with a greater
bulk of research summarized first.
Cancer
Cancer is a leading cause of morbidity and mortality worldwide, with 13 mil-
lion new cases and 7.6 million deaths recorded in 2008 alone (Boyle and Levin
Summary of the literature 197
2008). Due to improvements in treatments and increasing incidence rates,

growing numbers of people are living longer after having been treated for can-
cer. In the USA, an estimated 13.7 million Americans with a history of cancer
were alive on January 1, 2012 (American Cancer Society 2012). Cancer treat-
ments and disease processes often leave survivors with symptoms and side
effects such as lingering fatigue, sleep difficulties, pain, anxiety, depression, and
worries about cancer recurrence (Carlson et al. 2004a). Hence, there is a signifi-
cant need for psychosocial interventions to help people cope with the difficul-
ties of cancer diagnosis and treatment.
As a response to this need, clinicians and researchers have been interested in
applying MBIs to the vagaries of the cancer experience, and there is now a large
body of work investigating their efficacy for patients with various types of can-
cer. This literature has been reviewed on several occasions since 2006 (Lamanque
and Daneault 2006; Ledesma and Kumano 2009; Matchim and Armer 2007;
Matchim et al. 2011; Musial et al. 2011; Shennan et al. 2011), with four reviews
and meta-analyses just in 2012 and 2013 (Carlson 2012; Cramer et al. 2012; Piet
et al. 2012; Zainal et al. 2013). A 2011 meta-analysis of 19 studies reported
medium effect sizes on mood (d = 0.42) and distress (d = 0.48) (Musial
et al. 2011) outcomes, consistent with earlier reviews. Two other meta-analyses
focused only on breast cancer patients, reporting large effect sizes on stress (d =
0.71) and anxiety (d = 0.73) across nine studies with various designs (Zainal
et al. 2013) and medium effects on depression and anxiety in three RCTs
(Cramer et al. 2012). Piet et al. examined 22 randomized and non-randomized
studies of cancer patients and reported moderate effect sizes on anxiety and
depression in non-randomized studies (0.6 and 0.42, respectively), and slightly
smaller effects for RCTs (Piet et al. 2012). Finally, Carlson reviewed all cancer-
related studies applying levels of evidence criteria and concluded that there is
Level 1 (highest) evidence for the efficacy of mindfulness-based interventions
in oncology (Carlson 2012).
The first MBI study in a cancer population was published by our group in
2000, on the MBCR program. It was an RCT that assigned 89 patients with a
variety of cancer diagnoses to either MBCR or a wait-list control (Speca
et al. 2000). Patients in the program improved significantly more on mood
states including anxiety, anger, and depression and on symptoms of stress such
as physical tension, cardiopulmonary, gastrointestinal (GI), and cognitive
symptoms than controls, with large improvements of approximately 65% on
mood and 35% on stress symptoms. In a six-month follow-up, these improve-
ments were maintained (Carlson et al. 2001). More home practice was associ-
ated with greater decreases in overall mood disturbance and the greatest
improvements were seen on anxiety, depression, and irritability. Since that time
many pre/post observational studies without comparison groups, and RCTs

with usual care or wait-list control groups, have been published, citing improve-
ments in a range of outcomes including quality of life (QL) domains such as
emotional, social, role, and physical functioning, and psychological improve-
ments on measures including stress symptoms, anxiety, depression, fear, and
avoidance (for reviews see Ledesma and Kumano 2009; Matchim et al. 2011;
Musial et al. 2011; Shennan et al. 2011).
While a substantial number of RCTs compare MBIs to wait-list or usual care
controls, some with quite large sample sizes (Branstrom et al. 2012; Foley
et al. 2010; Hoffman et al. 2012; Lengacher et al. 2009), still few studies have
included randomization to active comparison groups. One exception is a three-
armed trial in which Henderson et al. (2012) randomized 172 early-stage breast
cancer patients into MBSR, a nutrition education program matched on contact
time, or a usual care control condition. They also included follow-up assess-
ments post-program (four months) and one and two years later. The MBSR
group improved more than the other two conditions on a wide range of meas-
ures at the four-month post-program assessment, including quality of life,
active behavioral and cognitive coping, avoidance, and spirituality, as well as
depression, hostility, anxiety, unhappiness, meaningfulness, and several meas-
ures of emotional control. These group differences eroded somewhat over time,
however, as participants in the other two groups continued to improve more
slowly, so that by 24 months the only group differences apparent were on meas-
ures of anxiety, unhappiness, and emotional control, still favoring MBSR over
usual care, but not the other active intervention. From this study it appears that
MBSR participation may help speed up the natural course of cancer recovery
across many domains, and also add a shift in perspective and skills in emotion
regulation that are lasting.
More recently, we conducted two comparative effectiveness RCTs of the MBCR
program: MINDSET and I-CAN Sleep. The MINDSET study directly compared
MBCR to another active group intervention for cancer support, supportive
expressive therapy (SET; Classen et al. 2008), in 271 distressed breast cancer
patients and a minimal intervention control condition (a one-day stress manage-
ment seminar) (Carlson et al. 2013). Similarities between interventions are the
group format, size, structure, and contact hours. However, the two treatment
modalities are quite distinct in their content, focus, and theoretical underpin-
nings, with the focus of SET on group support and emotional expression. We also
included only distressed breast cancer survivors, in order to avoid floor or ceiling
effects on outcomes, and included both psychological and biological outcomes.
Participants in the control group were re-randomized to one of the active inter-
ventions, then everyone was followed after either MBSR or SET for a full year
post-program to determine long-term outcomes. The study was also powered for
moderator analyses to determine if outcomes differed across groups for people
with different baseline characteristics, personalities, and preferences.
Pre-to-post program, women in MBCR improved more on stress symptoms
compared with women in both the SET and control groups, on quality of life
compared with the control group, and in social support compared with the SET
group (Carlson et al. 2013), but cortisol slopes (a marker of stress responding)
in both active intervention groups were maintained over time relative to the
control group, whose cortisol slopes became flatter, where steeper slopes are
generally considered to be healthier. The two intervention groups also main-
tained their telomere length, a potentially important marker of cell ageing, over
time compared to controls (Carlson et al. 2014a). Over the longer-term follow-
up of one year, the MBCR participants maintained all the benefits received in
the group, while the SET participants still had higher levels of stress and mood
disturbance and lower quality of life (Carlson et al. 2015, under review). This
suggests that the MBCR group provided longer-term protection from distress
for these women compared to those who did not participate.
The most preferred treatment (by over half of participants) was MBCR, and
those who got their preferred treatment (regardless of what it was) improved
more on quality of life and spirituality over time (Carlson et al. 2014b). Prefer-
ence seemed to be a more powerful predictor of outcome than individual per-
sonality traits. This begins to tell us something beyond what can be learned
from classic RCT designs: Preference matters. Treatment credibility and expect-
ancy for benefit are likely important components in harnessing the power of the
individual to produce meaningful change.
In another head-to-head comparative effectiveness trial, we also tried some-
thing novel for behavioral interventions by blinding participants to treatment.
We did this by advertising the study simply as “I-CAN Sleep: Non-drug treat-
ments for insomnia in cancer survivors,” and didn’t tell participants what the
treatments were until they were already enrolled. Even then they only knew
about the treatment they received, and didn’t know what the other treatment
was (S. N. Garland et al. 2011). They were randomly assigned to either MBCR
or cognitive behavioral therapy for insomnia (CBT-I), the gold-standard treat-
ment for insomnia. This is a very tough test of efficacy for MBCR, and was
designed as a non-inferiority trial to test whether the novel treatment for sleep
(MBCR) was as good as the gold-standard.
In total, 111 patients with a variety of cancer types were randomly assigned to
CBT-I (n = 47) or MBCR (n = 64) (S. N. Garland et al. 2014). Immediately post-
program, MBCR was inferior to CBT-I for improving the primary outcome of
insomnia severity, but MBCR was non-inferior three months later. The time
taken to fall asleep was reduced by 22 minutes in the CBT-I group and by 14
minutes in the MBCR group at follow-up. Similar reductions in wake time after
sleep onset were observed for both groups. Total sleep time increased by 0.60
hours for CBT-I and 0.75 hours for MBCR. CBT-I improved sleep quality and
dysfunctional sleep beliefs, and both groups resulted in reduced stress and
mood disturbance. This indicated that while MBCR was slower to take effect, it
could be as effective as the gold-standard treatment for insomnia in cancer sur-
vivors over time, and is a viable option for patients preferring that type of
approach.
In another application, Monti et al. (2013) conducted a large RCT of a novel
MBI called mindfulness-based art therapy (MBAT), also in distressed women
with breast cancer. A total of 191 women were randomized to either an eight-
week MBAT intervention or a breast cancer educational support program. Both
groups improved on psychosocial stress and quality of life, but women with
high stress levels at baseline improved only in the MBAT group. This shows that
this type of intervention can be superior to other active interventions for those
with higher need.
One final example of stretching the boundaries of traditional service delivery
is a study we conducted of an online adaptation of MBCR for people living in
rural and remote areas who didn’t have access to face-to-face MBCR groups
(Zernicke et al. 2013). We conducted a wait-list RCT comparing those in the
online program to a group randomly assigned to wait for the next online pro-
gram. Our primary interest was in whether people would sign up, and if they
would complete the program and get any benefit. The participants attended
each week at a set time like an in-person group, and could see and interact with
the instructor and the other participants in the online classroom using web-
cams and headsets. We enrolled 62 people and 83% of those completed the
program (similar to in-person programs). All participants said the program
either met (40%) or exceeded (60%) their expectations and all said they would
recommend the program to other cancer patients. There were significant
improvements and medium effect sizes in the online MBCR group relative to
controls on total mood disturbance, stress symptoms, and spirituality (Zer-
nicke et al. 2014).
In summary, evidence has accumulated through a number of high quality
RCTs comparing MBIs to other active interventions showing superiority across
a range of outcomes, in large sample sizes over substantial follow-up periods,
but still mostly in breast cancer survivors. More work is needed for other types
of cancer, late stage patients, and patients undergoing active treatments.
So far I have reviewed the clinical trials looking at psychological outcomes of
MBIs in cancer patients, but a number of studies have also assessed their
impact on biomarkers such as salivary cortisol and measures of immune func-

tioning relevant to stress and cancer progression. For example, Carlson et al.
(2003, 2004, 2007) measured immune and endocrine function pre/post MBSR
in 59 breast and prostate cancer survivors, showing increased T cell produc-
tion of IL-4 (an anti-inflammatory cytokine) and decreased interferon gamma
(IFN-λ) and NK cell production of IL-10. Patterns of change in cytokines over
one year of follow-up also supported a continued reduction in pro-inflamma-
tory cytokines (Carlson et al. 2007). In that group of patients, salivary cortisol
profiles also shifted pre- to post-intervention, with fewer evening cortisol ele-
vations found post-MBCR, and some normalization of abnormal diurnal sali-
vary cortisol profiles (Carlson et al. 2004b). Over a year of follow-up, continuing
decreases in overall cortisol levels were seen, mostly due to further decreases
in evening cortisol (Carlson et al. 2007), recently replicated in a large RCT
comparing MBCR to SET and control (Carlson et al. 2013). This is significant
as higher cortisol levels, particularly in the evening, are considered to be a
potential marker of dysregulated Hypothalamic-Pituitary-Adrenal axis func-
tioning and poorer clinical outcomes, such as shorter survival times in meta-
static breast cancer patients (Sephton et al. 2000).
Another group also showed decreased late-afternoon cortisol in combination
with re-establishment of NK cell activity and cytokine production toward nor-
mal levels post-MBSR compared to controls (Witek-Janusek et al. 2006, 2008).
Lengacher and colleagues (2011) reported increased response of T cells to anti-
gen stimulation and an improved ratio of Th1/Th2 cytokines in early-stage
breast cancer patients after a six-week MBSR program, and also found decreases
in both cortisol and IL-6 pre-to-post session, and decreases in baseline levels
across sessions in patients with advanced cancer and their caregivers (Len-
gacher et al. 2012). The interpretation of these results is complex, but in general
an anti-inflammatory environment is thought to be more favorable to cancer
outcomes than one with elevated Th2 (pro-inflammatory) cytokines (Armaiz-
Pena et al. 2009).
Measures of autonomic system function have also been conducted, since can-
cer survivors are at high risk for cardiovascular disease due to the toxicity of
many cancer treatments. In a group of 72 women with various forms of cancer,
weekly home blood pressure (BP) monitoring showed significant decreases in
systolic blood pressure over the course of the program for women with higher
premorbid BP in MBSR, compared to those in a comparable naturalistic wait-
list group (Campbell et al. 2012).
In summary, the literature on cancer and MBIs is substantial and continues to
grow, with improving quality of research design through the application of active
control groups, larger samples, more diverse patient groups, longer follow-up
periods, and a wide range of outcomes. Outcomes consistently favor MBSR over
usual care and other active interventions immediately post-program across a
range of psychological and QL outcomes. Its superiority over other active inter-
ventions over a longer period of time has yet to be definitively shown, though
some specificity of effect is emerging. Its value in improving cancer-related bio-
markers also still requires further investigation.
Pain (chronic pain and low back pain)

Chronic pain affects approximately 13% of the population, and is defined as an
unpleasant sensory and emotional experience associated with actual or poten-
tial tissue damage that persists beyond the expected time frame for healing, or
that occurs in disease processes in which healing may never occur (Ospina and
Harstall 2002). The earliest reported application of MBSR was for patients with
chronic pain (Kabat-Zinn 1982). Other more specific pain conditions have also
been studied, including low back pain, fibromyalgia, rheumatoid arthritis, and
migraine. The pain literature has been reviewed in depth on several recent occa-
sions (Chiesa and Serretti 2011; Elabd 2011; Jensen et al. 2014; McCracken and
Thompson 2011; Patil 2009; Veehof et al. 2011). Chiesa and Serretti (2011) sys-
tematically reviewed all controlled studies (n = 10) and concluded that MBIs
could have non-specific effects on mood, coping, and pain symptoms in chronic
pain patients, but studies often suffered from small sample sizes, lack of ran-
domization, and the use of non-specific control groups. In a meta-analysis of
both controlled and uncontrolled studies (n = 22), Veehof et al. (2011) found
small effect sizes of 0.37 for pain improvements and 0.32 for depression, and
suggested that while MBSR and acceptance-based interventions for chronic
pain can be viable alternatives to standard CBT for pain, they have not been
shown to be superior to it.
While many early studies of MBIs and chronic pain utilized pre/post designs or
comparisons to usual care, only three studies have employed randomization to
active comparison groups. One study (Plews-Ogan et al. 2005) evaluated MBSR for
the management of chronic musculoskeletal pain in 30 pain patients randomly
assigned to either MBSR, massage, or a no-intervention control condition. Immedi-
ately post-intervention, the massage group had more pain reduction and improved
mental health status compared to usual care, while the MBSR group showed greater
improvements one month later in mental health outcomes compared to usual care
and the massage condition. In this case, MBSR was more effective for enhancing
mood in the long term, but massage provided more immediate pain relief.
Wong et al. (2011) compared two active interventions—MBSR versus a multidis-
ciplinary pain intervention, composed of primarily psychoeducation with sessions
on physiotherapy for pain and nutrition—for 99 chronic pain patients in Hong
Kong. Patients who completed the interventions improved similarly in both groups
on measures of pain intensity and pain-related distress over time. Without a usual
care or no-treatment control, it is difficult to conclude if these improvements are
due to the interventions themselves or natural fluctuations in symptomatology due
to healing over time, historical trends, regression toward average pain and distress,
or expectancy effects. However, the non-specificity of treatments is notable.
Finally, in the largest study to date, E. L. Garland et al. (2014) applied an MBI
called mindfulness-oriented recovery enhancement (MORE), which was
designed to target both chronic pain and opioid misuse in chronic pain suf-
ferers. In 115 patients assigned to either MORE or a support group, reductions
in pain severity and pain interference favored MORE and were maintained
three months after the program. MORE participants also had greater reduc-
tions in stress arousal and desire for opioids and were less likely to meet diag-
nostic criteria for an opioid misuse disorder post-program compared to the
support group, but these benefits were not maintained.
Although the number of RCTs in this area is small, support for MBIs as help-
ful interventions for improving coping with pain symptoms and overall adjust-
ment in chronic pain patients continues to mount. However, superiority to
standard CBT or support groups for pain has not been definitively established.
Fibromyalgia
Fibromyalgia (FM) is a pain-related condition associated with overall bodily
stiffness and soreness, pain trigger points located throughout the body, fatigue,
and sleep disturbance, where symptoms seem to be exacerbated by stress
(Grossman et al. 2007). Earlier pre/post studies and some wait-list or usual care
MBI RCTs (Goldenberg et al. 1994; Grossman et al. 2007; Weissbecker
et al. 2002) have shown improved pain, sleep, FM impact, global severity of psy-
chological symptoms, coping, quality of life, anxiety, depression, somatic com-
plaints, and sense of coherence. A recent meta-analysis reviewed six trials of
MBSR for FM and cautiously concluded that evidence existed for short-term
improvements in quality of life compared to usual care, and for both quality of
life and pain symptoms compared to active control conditions, but effect sizes
were small to medium and effects were not considered robust against bias
(Lauche et al. 2013). For example, a recent RCT compared MBSR to usual care
in 99 patients and found no group differences on pain, quality of life, physical
function, or depression post-program or a year later, but the mindfulness group
did improve somewhat faster (Fjorback et al. 2013).
In the largest and most rigorous study reviewed (Schmidt et al. 2011), 177
female patients were randomized to MBSR, an active control condition, or wait-
list. The active control was matched to MBSR on format, instructors, contact
time, and homework, with the focus on progressive muscle relaxation and
stretching, rather than mindfulness practices. There were no significant differ-
ences between groups on the primary outcome of health-related QL two months
post-treatment, but all patients improved over time. Only MBSR resulted in
significant pre-to-post-intervention within-group improvements in QL, and on
six of eight secondary outcome variables, compared to improvements on three
measures for the active control group, and on two in the wait-list condition.
Hence, MBSR seems to be a potentially effective intervention for alleviating
symptoms common in FM such as pain, depression, and a range of psycho-
logical outcomes, although as with chronic pain, it has not proven superior to
other active control conditions consistently across studies. MBIs have also not
yet been tested against proven efficacious treatments such as CBT, which would
provide a more rigorous test of overall efficacy.
Cardiovascular disorders
Cardiovascular disorders are the most common group of diseases in North
America and include a range of conditions such as hypertension (high blood
pressure), coronary artery disease, heart failure, and angina. The effect of MBIs
on cardiovascular disease outcomes and clinical markers has been reviewed
elsewhere (Ospina et al. 2007), so here the focus will be on recent applications
of MBIs in participants diagnosed with either hypertension or heart disease.
In addition to pre/post studies showing improvements on a range of psycho-
logical outcomes in people with heart disease (Chang et al. 2010; Delaney
et al. 2011; Olivo et al. 2009), two very small RCTs comparing MBSR to wait-list
control groups reported benefits in anxiety and emotion regulation and less use
of reactive coping styles in MBSR participants (Robert McComb et al. 2004;
Tacon et al. 2003).
Sullivan and colleagues conducted a novel prospective cohort study in which
they geographically assigned 208 patients with chronic heart failure to either an
MBI consisting of mindfulness meditation practice, coping skills, and group
discussion for those who lived close enough to attend, or a usual care control
condition for those living further away from the medical center (Sullivan
et al. 2009). Patients in the MBI group had greater decreases in anxiety, depres-
sion, and cardiac symptoms post-intervention and at three and six months.
However, after one year of follow-up, group differences were no longer appar-
ent, as all participants showed increased symptoms. This pattern is similar to
that seen in studies of other conditions, where MBSR provides an initial benefit
that erodes somewhat over time. Again, home practice over the follow-up was
not reported, but one speculation is that continued practice may be important
in order to maintain psychological and physical benefits.
A recent RCT assigned 101 people with high BP to either MBSR or wait-list,
and found no effect of the intervention on ambulatory BP (Blom et al. 2014). The
only effect found in post-hoc analyses was a decrease in BP pre-to-post in female
MBSR participants. Another RCT compared MBSR to progressive muscle relax-
ation (PMR) in 56 patients with prehypertension (Hughes et al. 2013). Patients
randomized to MBSR had a 4.8 mmHg reduction in clinic systolic BP, compared
to a 0.7 mmHg reduction in the PMR group, and a decrease in diastolic BP of 1.9
compared to 1.2 mmHg, but again no group difference in ambulatory BP values.
This leaves the question of beneficial effects of MBIs on blood pressure equivo-
cal. It may be the case that learning mindfulness helps in the clinic, but does not
transfer to everyday life. For the moment, the question remains unresolved.
Diabetes
Diabetes impacts about 7% of the North American population, and is due to the
body’s inability to sufficiently produce and/or properly use insulin. It is charac-
terized by symptoms of fatigue, lack of energy, frequent infections, easy bruis-
ing, tingling and pain in extremities, and weight changes (Public Health Agency
of Canada 2012). A number of studies have been reported recently, many of
which have monitored biomarkers as well as psychological functioning. Two
earlier studies compared MBIs to educational control conditions in RCTs (Teix-
eira 2010) and reported greater improvements in QL related to pain and symp-
toms, adaptive coping, and better self-care behaviors in the MBI condition, as
well as glycosylated hemoglobin (Hb) A1c values (a marker of blood glucose
control) in the target range.
In a large ongoing study (Hartmann et al. 2012), 110 patients with type II dia-
betes were assigned to either MBSR or a usual care control condition. The
MBSR participants improved more on overall health status, depression, and
stress symptoms relative to controls after one year. Participants will be followed
for a full five years post-treatment. Another large study compared MBCT to
usual care in 139 diabetes patients (van Son et al. 2013) and found the interven-
tion superior to control for decreasing stress, depressive symptoms, anxiety,
and improving quality of life, but not on HbA1c.
A recent RCT evaluated a three-month mindful eating intervention com-
pared to diabetes self-management in 52 patients (Miller et al. 2014), a much
tougher test of differential efficacy against an active intervention group. Both
groups improved over the course of six months on measures of depression,
nutrition and eating-related self-efficacy, and cognitive control of eating, but
the self-management group improved more on specific nutrition knowledge
and self-efficacy, as well as fruit and vegetable consumption. The mindfulness
group showed greater improvement on measures of mindfulness.
Thus, there is initial evidence that MBIs can be beneficial for improving psy-
chological functioning and possibly improving glycemic control and helping
with the neuropathy associated with type II diabetes. However, MBIs have only
been shown to be superior to usual care or education control at this point, with
the one study comparing an MBI to self-management showing few differential
effects. Studies are still few in number and much more work needs to be done in
this area.
HIV/AIDS
In 2010, 34 million people worldwide were reported to be living with HIV infec-
tions, which typically cause flu-like symptoms and put a person at risk of oppor-
tunistic infections (World Health Organization 2012). Untreated, HIV progresses
to full-blown AIDS, characterized by symptoms such as fatigue, shortness of
breath, fever, chronic cough, weight loss, and eventual death (World Health
Organization 2012). MBSR research in this area has increased substantially in
the last several years. For example, a 2012 RCT assessed the potential for MBSR
to help patients cope with common side effects of antiretroviral medication,
including gastrointestinal problems such as diarrhea, nausea, and vomiting,
neuropathic pain, and dermatological problems including rashes (Duncan
et al. 2012). Seventy-six people with HIV assigned to MBSR had fewer symptoms
related to antiretroviral therapies at both post-program and six-month follow-
up, as well as less symptom-related distress compared to wait-list control.
Some studies have also investigated the impact of MBSR on immune meas-
ures in HIV-positive participants. Two uncontrolled studies showed increases
in CD4 T-cell lymphocyte numbers (Jam et al. 2010), and an increase in NK cell
activity and quantity (Robinson et al. 2003), compared to patients who chose
not to participate in MBSR.
Three RCTs have also been reported. Creswell and colleagues (2009) assigned
48 HIV-infected adults to either an eight-week MBSR class or a one-day stress
reduction education seminar control condition. Peripheral counts of CD4 + T
lymphocytes decreased substantially in the control group, but remained stable
in the MBSR group. Those who attended more classes showed more stability in
their CD4 lymphocytes, accounting for up to two-thirds of the effect on T-cell
counts. In 40 HIV patients on long-term antiretroviral therapy assigned to
either MBCT or usual care, large improvements in the MBCT group were seen
on quality of life, stress, depression, anxiety, and CD4 + lymphocyte counts
compared to control (Gonzalez-Garcia et al. 2014).
In the largest study, 173 Iranian HIV-positive patients not yet receiving
antiretroviral therapy were randomized into either MBSR or a brief two-hour
education support group (SeyedAlinaghi et al. 2012). In the MBSR condition,
the mean CD4 + lymphocyte count increased up to nine months post-treat-

ment, then returned to baseline levels at 12 months. Control group counts
remained relatively stable over the full year. Medical and psychiatric symptom-
atology improved in MBSR participants post-program, but only medical symp-
toms remained lower than controls over follow-up.
In sum, MBSR in HIV-infected patients may help to improve psychological
well-being and symptom control, as well as improve measures of immune sys-
tem functioning that are important predictors of disease progression compared
to usual care. However, research has not used evidence-based active control
groups matched on intervention duration or with CBT content, which might
potentially have the same benefits.
Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a functional disorder of the lower gastrointes-
tinal tract defined by the presence of chronic or recurring symptoms that
include abdominal pain, flatulence, bloating, and altered bowel habits (Dross-
man 1994). Prior to 2010 there were no reports in the literature on the applica-
tion of MBIs for people with IBS, but since that time several research groups
have reported large, well-designed RCTs. The first treatment results were pub-
lished by Ljotsson and colleagues (2011a) in Sweden, who evaluated a ten-
session group focusing on three themes: Cognitive awareness and education
around stress and coping; mindfulness training; and exposure to noxious IBS
symptoms. They conducted an RCT of an online adapted version of their
acceptance and mindfulness-based intervention with 61 patients, compared to
wait-list control. The intervention was conducted online largely by patients on
their own at home, following a structured program of education and practice,
and included weekly internet contact with therapists via e-mail. There was also
a closed discussion forum for patients to share questions or progress with one
another (Ljotsson et al. 2011a). Compared to those on the wait-list, participants
improved more over time on IBS symptom severity, quality of life, and IBS-
related fear and avoidance behaviors, and these improvements were maintained
over 12 months.
This group continued investigating the online MBI against active controls,
randomly assigning 86 patients to either the online acceptance and mindful-
ness intervention or an online discussion forum wait-list (Ljotsson et al. 2010).
In this case, participants in the treatment condition reported a 42% decrease
(compared to a 12% increase in the control group) in primary IBS symptoms,
and they improved on GI-specific anxiety, depression, and general functioning
with large effect sizes. These participants were followed-up 16 months later after
they had all completed the intervention (Ljotsson et al. 2011c). Treatment gains
were maintained on all outcome measures, including IBS symptoms, quality of

life, and anxiety related to gastrointestinal symptoms, again with large effect
sizes (most d > 1.0).
Finally, in a large and well-designed RCT, this group investigated their
online mindfulness intervention compared to online stress management
matched in time and format with 195 patients, and also measured credibility
of the treatments, expectancy for improvement, and therapeutic alliance
(Ljotsson et al. 2011b). At post-treatment and six-month follow-up, the MBI
group improved more than stress management controls on IBS symptom
severity, IBS quality of life, visceral sensitivity, and the cognitive scale for func-
tional bowel disorders. Both groups improved similarly on the perceived stress
scale and hospital anxiety and depression scale subscales. There were also no
group differences on the treatment credibility scale or the working alliance
inventory. This impressive series of studies provides strong support for the effi-
cacy of the online MBI for improving both physical symptoms and QL in IBS
patients, but showed that other active interventions can also successfully treat
stress, anxiety, and depression.
Two North American groups have also evaluated in-person traditional
MBSR. In an RCT of MBSR versus wait-list for 90 IBS patients, Zernicke et al.
(2012) showed that while both groups exhibited a decrease in IBS symptom
severity scores over time, the improvement in the MBSR group was greater than
the controls and was clinically meaningful, with symptom severity decreasing
from constantly to occasionally present, which was maintained in the MBSR
group six months later.
In an active comparison trial, 75 women with IBS were randomized to MBSR
or a support group matched for time and other non-specific factors (Gaylord
et al. 2011). Women in MBSR, compared to the support group, showed greater
reductions in IBS symptom severity post-training (26.4% vs. 6.2% reduction)
and at three-month follow-up (38.2% vs. 11.8%). Changes in quality of life, psy-
chological distress, and visceral anxiety favoring MBSR emerged only at the
three-month follow-up. Path analysis suggested that MBSR worked by promot-
ing non-reactivity to gut-focused anxiety and less catastrophic appraisals of the
significance of abdominal sensations, as well as refocusing attention onto
interoceptive data without the high levels of emotional reactivity often charac-
teristic of the disorder (E. L. Garland et al. 2011).
Considered together, this body of well-designed and executed studies pro-
vides consistent evidence for the efficacy of both in-person and online versions
of MBIs for IBS sufferers, showing greater improvements specifically in IBS
symptoms over other credible treatments, including stress management and
social support.
Rheumatoid arthritis
There are two RCTs in this area, investigating the effect of MBSR on rheumatoid
arthritis (RA), a painful autoimmune condition caused by swelling of the joints.
In one (Pradhan et al. 2007), 63 participants were randomized to MBSR or a
wait-list control. After two months, there were no differences between the
groups on measures of depressive symptoms, psychological distress, well-being,
mindfulness, and RA disease activity as evaluated by a physician masked to
treatment status. However, at six months there were significant improvements
across self-reported outcomes in the MBSR group.
The second study employed multimodal outcome measures and compared
144 participants randomly assigned to one of three conditions: CBT for pain;
mindfulness meditation and emotion regulation therapy; or education-only
(Zautra et al. 2008). The greatest improvements in pain control and reductions
in inflammatory cytokines were observed in participants in the CBT pain
group, but both the CBT and mindfulness groups improved more in coping
efficacy than the education control group. Patients with a positive history of
depression benefited more from mindfulness on outcomes of both negative and
positive affect and physicians’ ratings of joint tenderness, suggesting that MBSR
might be preferable to CBT for treating individuals who struggle with depres-
sion; however, overall it did not prove to be a superior intervention.
In summary, the literature in this area is thin, but in controlled trials with
active comparison groups, only with secondary analyses did outcomes emerge
consistently favoring MBSR. For pain control itself, it may be the case that
standard CBT is still the most effective treatment, whereas acceptance-based
interventions may be more effective in increasing the ability to tolerate ongoing
pain, and for people who struggle with depression in addition to pain.
Organ transplant
A series of well-designed studies was conducted by Gross and colleagues for
patients who were recipients of organ transplants, who are often coping with a
host of medical symptoms, side effects of anti-rejection drugs, and symptoms
associated with recovery from complicated surgeries (Gross et al. 2004, 2010;
Kreitzer et al. 2005). Pilot work with 19 kidney, lung, or pancreas transplant
recipients showed improvement from baseline after MBSR on measures of
depression and sleep, with the sleep effects maintained at three-month follow-
up, when improvements in anxiety also became significant (Gross et al. 2004).
At six months post-MBSR, continued improvements in sleep quality and dura-
tion as well as decreases in anxiety and depression were reported (Kreitzer
et al. 2005). In a larger RCT, 138 recipients of kidney, kidney/pancreas, liver,
heart, or lung transplants were randomized to either MBSR or a health educa-

tion control group (Gross et al. 2010). MBSR participants had greater reduc-
tions in anxiety and sleep symptoms compared to the controls, with
medium-sized effects up to one-year follow-up. Within the MBSR group, anxi-
ety, depression, and sleep symptoms decreased and QL improved by eight
weeks; these benefits were maintained at one year. Hence, this evidence sug-
gests that MBSR is a specifically effective treatment for psychological symp-
toms in organ transplant recipients.
Summary and future directions

This chapter began with a brief description of the experience of suffering
chronic or acute illness, and how MBIs might help people in these circum-
stances. This was followed by a review of quantitative research in the specific
conditions with the most empirical evidence to support their efficacy, with an
emphasis on newer RCTs. Generally, MBIs seem effective for short-term relief
of many symptoms across conditions and for enhancing overall quality of life,
but the longer-term effects are not yet well-studied, and there are suggestions
that benefits erode over time without ongoing practice. However, some studies
also found that benefits took time to accrue, not realizing the full value for
symptom reduction until several months post-program. The timing, duration,
and specificity of program effects have rarely been studied. Comparisons with
active interventions, particularly CBT-based modalities, suggest that they may
be comparable in some ways for outcomes such as pain control or insomnia
treatment. More comparison trials with other active interventions would help
to determine specificity of outcomes. Overall, the total number of studies is still
small in many areas, with much more work to be done.
In terms of recommendations for research directions, continued compari-
sons to gold-standard active interventions constitute more rigorous tests of the
specificity of MBIs, and more of these are still needed. As seen in some pain
studies in particular, and for treating insomnia in cancer, MBIs may not prove
superior to other cognitive behavioral approaches. Non-specific factors such as
group support, the therapeutic alliance, expectancy for improvement, psychoe-
ducation, self-monitoring, and self-empowerment are likely also important
drivers of change, as may be the specific targets of CBT: Altering dysfunctional
thoughts and behaviors directly relating to the presenting problem.
In terms of understanding processes and mechanisms of change, we know
that enhancing emotion regulation strategies such as decreasing worry and
rumination, and the development of certain facets of mindfulness including
non-judging and present-moment awareness, are important precursors to
Summary and future directions 211
improving symptomatology in medical patients. Further dismantling research

evaluating other postulated mechanisms of change, processes of change, tim-
ing, and mediating factors would help improve our understanding of active
ingredients within these complex multidimensional interventions.
Additionally, investigating the impact of patient preferences and treatment
credibility on outcomes in RCTs would approximate more real-world scenarios
wherein patients choose interventions of their liking that they think will work.
Evidence suggests that increasing credibility of interventions may be important
to harness expectancy effects. Utilizing pragmatic or preference-based trial
designs, in which patients with a preference are assigned to their preferred
intervention while those with no preference are randomized to one of two treat-
ments, is an interesting way to investigate these influences.
Further pursuing this idea of individualizing or tailoring therapy, programs
could also be tailored by determining goodness-of-fit or treatment matching, as
not everyone benefits from mindfulness-based approaches, but we don’t know
what the specific predictors of benefit are. For example, some patients may benefit
from CBT training first, followed by a mindfulness approach for maintenance of
effects; others may do better with either CBT or mindfulness alone, but we don’t
know for whom to recommend which approach. Focus on tailoring interventions
to individuals would also be helpful for potentially improving program retention
and maximizing outcomes. Given that there is always attrition in MBIs, better
understanding the motivations for taking programs, reasons for dropping out, and
barriers to developing and maintaining home practice would be helpful—then
identified barriers could potentially be addressed either programmatically or on a
case-by-case basis. Further adapting MBIs to single-person interventions, home-
study programs, internet-based programs, and shorter programs would also be
beneficial to reach a larger number of underserved patients in rural and remote
locations. Indeed, alternative formats and lengths have scarcely been investigated.
Finally, the principles of training facilitators who are grounded in mindful-
ness practice themselves and receive adequate training and supervision is
widely considered to be essential, but little research has been conducted in this
area. Studies should compare more to less experienced facilitators to empiric-
ally investigate this longstanding and deeply-held belief. If, as most clinicians
believe, training and personal practice is essential in order to facilitate MBIs,
this element is likely to be of increased importance as various MBI adaptations
in form and delivery continue to evolve.
In summary, MBIs and other forms of meditation training hold great promise
for helping people struggling with a wide range of physical health conditions.
They have potential for not only alleviating suffering and managing difficult
symptoms, but also for enhancing personal growth and helping people find
more meaning and purpose in life, despite the significant challenges posed by
chronic and acute disease.
I was first introduced to meditation as an actual practice (rather than just an idea I read
about in books) during my first year of graduate school in clinical psychology at McGill
University in Montreal, Canada, in the early 1990s. The great serendipity of that time
was that one of my eight classmates was a “mature” student who had just returned
from seven years sequestered as a monk in the Thai Forest Tradition of Theravadan Bud-
dhism. He was so different from the rest of us—slow, quiet, thoughtful, and calm—and
very interested and willing to teach anyone who wanted to learn. His teacher was the
venerable Ajahn Chah, who directly taught my friend in the last years of his life. So he
invited me and a few other interested students to sit with him on a weekly basis, a trad-
ition we carried on throughout graduate school. At the same time, I was taking classes
in Iyengar yoga twice a week from an experienced teacher and learning much about
myself and the philosophy behind the various practices. I began attending vipassana
retreats locally and around the country when possible. I’m sure this practice is what
sustained me through the difficult years of completing a Ph.D., which was in the area of
psychoneuroendocrinology (how hormones affect behavior and vice versa).
When it was time to complete my final year clinical internship, I returned to my home
town of Calgary, Canada. One of the internship rotations was at the Tom Baker Cancer
Centre, where my colleagues had just begun to put together a meditation and yoga
program for the people we serve who are living with cancer. I was overjoyed to be able
to apply what had become a central and very important part of my personal life to my
professional work. We adapted the program over time and called it mindfulness-based
cancer recovery. I focused my research career on evaluating this program, writing grants
and research papers. In the last 15 years we’ve taught close to 2000 patients and sup-
port people in the eight-week group program and shown benefit across a wide range
of outcomes.
In parallel, I was receiving training in the mindfulness-based stress reduction model
from Jon Kabat-Zinn and Saki Santorelli at the University of Massachusetts Center for
Mindfulness, and attending retreats and workshops through Spirit Rock Meditation
Center and the Insight Meditation Society, among other more local offerings. I travelled
to India to study yoga in an ashram, and to Burma to study with a vipassana nun.
Throughout the first ten years of my career as a research scientist my practice was regu-
lar and strong; I felt it grew and deepened and enriched my life in many ways.
REFERENCES 213
Then I had children. This has been the most challenging time in my practice (and in my
life) as regular routines and patterns were suddenly obliterated and schedules revolved
around the needs of my children. It took some time to re-establish a regular practice,
and this continues to be a challenge with full-time work and raising two preschoolers.
Fatigue is constant and getting up early in the morning to meditate no longer works. I
had to move my practice to the evening after the kids are sleeping, and haven’t attended
a long retreat for over five years now. I still teach MBCR classes and this helps to keep
me grounded in the practice and emphasizes its continued importance in my life and
that of others. I know once my family grows up I will get back to attending longer
retreats and more regular practice, but for now my challenge is mindful parenting. I try
every day to be in the moment, with love and acceptance for my children, balancing this
with necessary limits and boundaries. I feel this practice will stretch me in directions I
need to grow in order to be there for my kids and the people I work with in a more
accepting and compassionate manner.
Acknowledgments
Dr. Linda E. Carlson holds the Enbridge Research Chair in Psychosocial Oncol-
ogy, co-funded by the Alberta Cancer Foundation and the Canadian Cancer
Society Alberta/NWT Division. She is also an Alberta Innovates-Health Solu-
tions Health Scholar.
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Chapter 10
The cognitive and affective

neurosciences of meditation
Antonino Raffone
Introduction
Meditation can be conceptualized as a family of practices regulating cognition
and emotion, in which mental and related somatic events are influenced by a
specific directing of attention and awareness. As promulgated in several con-
templative traditions, mental training based on meditation leads to enhanced
cognitive and emotional regulation, and to mental states characterized by
reduced negative emotions and motives, and enhanced positive features and
attitudes such as serenity, joy, acceptance, and compassion.
More recently many scientific and clinical studies have provided evidence of
the beneficial effects of meditation on cognition, emotion, and health. Such
studies have developed considerably over recent years as a result of several fac-
tors, including the availability of new research techniques, such as neuroimag-
ing. The involvement in meditation research of leading laboratories in cognitive
and affective neuroscience, such as the Laboratory for Affective Neuroscience
led by Richard Davidson in Wisconsin, has also played an important role. Also,
the interest of His Holiness the Dalai Lama in science and its dialogue with
Buddhism has stimulated research on meditation and related aspects of con-
templative practice. Other influential authors, such as Daniel Goleman, who
has co-authored books with the Dalai Lama on negative (Goleman and Dalai
Lama 2003) and wholesome emotions, have contributed to the diffusion of
interest in meditation and contemplative practices in the West. The
mindfulness-based protocols resulting from the mindfulness-based stress

reduction (MBSR) program developed by Jon Kabat-Zinn (e.g., Kabat-Zinn
1990, 2003) have led to a number of clinical, psychological, and neuroscientific
studies on meditation practices in the context of such protocols.
The training of attention is a central feature of different meditation methods
(Davidson and Goleman 1977). Indeed, several studies have reported the devel-
opment of more efficient attentional processes with meditation practice,
222 The cognitive and affective neurosciences of meditation
including increased attentional control and sustained attention (e.g., Slagter

et al. 2007; van den Hurk et al. 2010 for a review see Lutz et al. 2008a). More
generally, a number of recent behavioral, electroencephalographic (EEG), and
neuroimaging studies have revealed the importance of investigating states and
traits related to meditation to achieve an increased understanding of cognitive
and affective plasticity (and related neuroplasticity), attention, and awareness
(Cahn and Polich 2006; Lutz et al. 2008a; Raffone and Srinivasan 2010). Clinical
applications are also increasingly recognized (Cahn and Polich 2006; Hofmann
et al. 2010; van Aalderen et al. 2012).
In this chapter I will provide an overview of the neural correlates of meditation,
and will then focus on neuroplasticity as related to meditation-based mental train-
ing. Attention will be given to the two main facets of meditation, focused attention
(related to “concentration”) and open monitoring (related to “mindfulness”),
which are highlighted in scientific research, with related neuroscientific findings.
An overview of the neural correlates of meditation

A key question in relation to the neural correlates of meditation is whether
there is a single area or only a few areas of the brain crucially involved in medi-
tation experiences, associated with attention, awareness, and compassion
(localistic view), or whether there is a large-scale brain activity pattern (holistic
view) involved in meditation. Several findings about the neural correlates of
meditation (Lutz et al. 2007, 2008b; Manna et al. 2010; Raffone and Srinivasan
2010) suggest a “middle way” as the most plausible response to such a question,
which goes beyond the dichotomy of localistic and holistic views. Indeed, it
seems plausible that meditation leads to changes in activity and structure of
specific sets of interacting brain areas, in terms of networks or functional sys-
tems, rather than of a single key area or a large, undifferentiated set of brain
regions. In particular, it seems that meditation influences brain networks
involved in cognitive control and conscious access (e.g., Raffone and Srinivasan
2009), feeling and emotional awareness (e.g., Craig 2009; Lutz et al. 2008b), and
processing related to the self (e.g., Pagnoni et al. 2008).
Another question is whether such neural activities and structures involve
more “archaic” brain regions, such as those of the limbic system connected to
emotions and body regulation, or whether more cognitive and “refined” areas
acquired more recently in evolution, such as the prefrontal cortex, are involved.
The latter, more than any other brain regions, differentiate Homo sapiens from
other species, and can be related to fluid intelligence, planning, and cognitive
control. Furthermore, one may wonder whether meditation affects “deep”
regions of the brain, for more basal functions, such as thalamic nuclei or brain
An overview of the neural correlates of meditation 223
stem structures involved in regulating vigilance and the sleep-wake cycle, and
whether there is a larger involvement of the right brain hemisphere or of the left
hemisphere in meditation. There might also be interest in which brain rhythms
(electroencephalographic or EEG) are mainly involved in meditation, such as
the alpha or theta rhythms. Finally, one may wonder whether there are universal
neural correlates for all types of meditation, or whether there are specific correl-
ates of each type or form of meditation. Below I will attempt to provide tentative
answers to such challenging questions based on neuroscientific findings.
A panoramic overview of neuroscientific studies of meditation suggests that
attention (“concentration”) and awareness (mindfulness) during meditation are
associated with a set of areas at different functional levels in the brain, at both
cortical and subcortical levels. These include sensory areas such as the somato-
sensory cortex and posterior insula, which are involved in processing different
types of body inputs, such as those related to touch, pain, and the so-called
interoception, that is sensory inputs from the inside of the body such as visceral
inputs (e.g., Craig 2009). Areas implicated in rapid emotional responses, such as
the amygdala, can also be associated with meditation states and meditation-based
mental training (Hoelzel et al. 2011; Lutz et al. 2008b). The amygdala is an area
of the so-called limbic system for emotional coloring of perceptual and memory
inputs linked to the survival of the organism, and is over-activated in stress and
anxiety, and altered in mood disorders. Remarkably it has been found that
meditation (mindfulness) based training does not only change the function
(activity) of the amygdala, but also its structure (Hoelzel et al. 2011).
Meditation-based mental training also influences areas linked to episodic
memory, such as the hippocampus, and thus not only responses to perceptual
inputs. In particular it reduces the occurrence of over-general memories in
autobiographical retrieval. This influence therefore increases the specificity and
vividness of autobiographical memory, such as in depression, which is often
characterized by over-general memories (e.g., Williams et al. 2000).
Areas linked to the control of attention and cognitive processing, such as the
anterior cingulate cortex and dorsolateral prefrontal cortex, are also markedly
associated to meditation states and traits (Cahn and Polich 2006; Raffone and
Srinivasan 2009). These areas are involved in several aspects of cognitive func-
tioning, including the control of attention and conscious access to perceptual
information, as well as in so-called cognitive flexibility, i.e. the ability to respond
to stimuli in flexible ways depending on the current task context and demand
(Moore and Malinowski 2009). Meditation-related brain regions also include
those associated with monitoring and stimulus-independent thinking, such as
the anterior prefrontal cortex, the brain region that more than any other differ-
entiates Homo sapiens from other animals (including primates), and other areas
linked to body (interoceptive) awareness, feelings, and mental states, such as

the anterior insula (in particular in the right hemisphere) (see Hoelzel
et al. 2011; Lazar et al. 2005; Lutz et al. 2008b; Manna et al. 2010; Siegel 2007).
Moreover, several studies suggest that meditation and mindfulness modulate
the brain network involved in self-representation and self-referential processing,
the so-called “default mode network” (Raichle et al. 2001). In other words, medita-
tion affects those areas of the brain that are responsible for shaping our experience
of “self ” and our thinking about this “self.” This network also appears to be involved
in mind wandering during resting and task performance, in self-projectionin the
past and in the future, and in several types of identifications linked to one’s own
mental processes and representations of the mental states of others. It is not by
chance that mindfulness meditation makes the operation of such a network more
flexible and regulated, and reduces the conditioning of mind wandering on cogni-
tion, mood, and mental states, as well as the identification with mental processes
and aspects of the flow of experience (Dor-Ziderman et al. 2013; Pagnoni
et al. 2008). Therefore, meditation appears to change not only brain responses to
stimuli, but also the intrinsic or spontaneous activity of the brain during wakeful-
ness. More research needs to be conducted to explore whether spontaneous men-
tation and brain activity during dreams is also affected by meditation training.
In sum, neuroscientific findings suggest that meditation enhances the abilities
of cognitive and affective regulation, strengthening the ability to regulate dys-
functional mental states and conditioning such as stress, anxiety, and negative
mood. And, in more subtle ways, meditation regulates processes of identifica-
tion and attachment. Such neuroscientific outcomes are consistent with results
from several studies into the clinical effectiveness of mindfulness-based pro-
grams for stress and anxiety reduction, for preventing relapse into depression
(through mindfulness-based cognitive therapy—MBCT—Segal et al. 2002),
and in focused applications such as for treatment of eating disorders, addic-
tions, and post-traumatic stress disorder (see Keng et al. 2011).
It is also remarkable that meditative practices appear to be linked to brain
areas that are involved in the different functions of cognitive, affective, and
body state regulation. Such areas can be regarded as interfaces between emo-
tion and cognition, and between the regulation of mental and body states. In
particular, such areas include the anterior cingulate cortex and the anterior
insula, both regions that were acquired remotely in evolution, but with import-
ant re-adaptations in humans. For example, in humans such areas incorporate
the so-called von Economo neurons, which are capable of establishing long-
range connections in the brain and can thus mediate influences of emotions,
motives, and mental states over long distances in the brain, such as related to
consciousness and decision making.
An overview of the neural correlates of meditation 225
According to the perspectives of influential researchers (Allman et al. 2001;

Craig 2009), such neurons play a key role in mediating the influences of mental
states on thoughts and actions: for example, the influence of negative and
unwholesome mental states such as anger. In other words, meditation and
mindfulness might be expected to influence the ability to reduce the impact of
anger by regulating the “broadcasting” of anger-related signals in the brain. In
combination with reducing the influence of negative mental states on con-
sciousness, positive mental states generated with meditation, such as serenity
and joy, may spontaneously broadcast in the brain and thus reduce mind wan-
dering and support sustained attention, receptive awareness, and meditative
insight. Interestingly, such neurons appear altered in autistic people (Allman
et al. 2005), who often have heightened anxiety, and can also be found, though
in less refined patterns, in other species that display refined social interactions,
such as other superior primates, dolphins, and elephants (e.g., Butti et al. 2009;
Hakeem et al. 2009; Nimchinsky et al. 1999). In this respect, it is noteworthy
that such species are capable of mirror self-recognition, suggesting some
enhanced self-awareness in comparison with other species.
Thus, it seems that such key areas, which provide interfaces between mind
and body, and emotion and cognition, and mediate the influence of mental
states on thinking, consciousness, and action, are modified by meditation. For
example, a recent study (Hasenkamp et al. 2012) has shown that such areas are
activated when there is awareness of distraction during meditation, while other
areas, such as the dorsolateral prefrontal cortex, are activated in the process of
refocusing and sustaining attention on the intended meditation object.
Moreover, both the anterior insula and anterior cingulate cortex are involved
in pain experience, particularly in the subjective or secondary aspect of pain
experience (Baliki et al. 2009; Vogt and Sikes 2000). Other regions, such as the
somatosensory cortex and posterior insula, are involved in the direct (primary)
sensory experience of pain, and others, such as the amygdala, in the unpleasant
feeling of the pain experience. In a recent study (Zeidan et al. 2011) it was found
that a meditative exercise focused on breathing (for 20 minutes per day for four
days) led to modified activities of the anterior insula and the anterior cingulate
cortex, as related to subjective reports of the pain experience. However, the
responses of brain areas associated with the sensory experience of pain were not
modified. This is consistent with the accounts of meditators managing pain
described by Vidyamala Burch in Chapter 7 of this volume.
These findings help to counteract a common and inappropriate stereotype
about meditation: that it is a means for withdrawal, isolation, abstraction, or
anesthesia from the surrounding world. Rather, the neuroscientific evidence
suggests that meditation changes the interpretation of sensory inputs, which
are, however, openly received in the field of perceptual awareness, rather

than being gated (except for visual inputs when meditating with closed
eyes). In the same vein, it has been found that compassion meditation does
not lead to a suppression of sensory inputs related to the pain of another
person, but rather intensifies them, while activating higher-level areas
related to empathy and emotion sharing (which is different from emotional
contagion) (Lutz et al. 2008b). Remarkably, such areas include the anterior
insula, which also appears to be a key brain area linked to mindfulness (see
also Lazar et al. 2005).
This research suggests that brain areas that are plausible substrates of mind-
fulness are also implicated in empathy and compassion. Such evidence is con-
sistent with the suggestion that the ability to connect and understand our own
emotions and mental states, which is developed through mindfulness (insight)
meditation, is related to the ability to empathize with others. Psychotherapy
research suggests that therapist difficulty in seeing and recognizing their own
emotions and experiences makes it difficult for them to recognize the same
emotions and experiences in others (e.g., patients) (Stedmon and Dallos 2009).
Now we turn to the question of whether meditation practice is associated
with hemispheric lateralization of brain activity patterns. Even though the
function of sustained attention in meditation appears linked to the right brain
hemisphere, neuroscientific findings show the involvement of both hemi-
spheres in meditation, although not necessarily with a bilateral involvement of
the different regions. Such involvement also depends on the specific task, sub-
jects, and type of meditation (e.g., see Cahn and Polich 2006; Lutz et al. 2008a).
Finally, regarding the brain rhythms related to meditation, taking together
different studies it seems that multiple rhythms can be related to meditation
states and traits, including the so-called “slow” delta, alpha, and theta rhythms
and the “fast” beta and gamma rhythms. Again, this depends on the tasks, sub-
jects (their expertise), forms of meditation, and observed brain regions (see, for
example, Cahn and Polich 2006).
Meditation and neuroplasticity

The Buddha’s teachings emphasized that the mind can be modified in a positive
way via meditation practice, and current research has also described meditation
as mental training. Such training might be expected to lead to long-term changes
in brain structure and function. Indeed, researchers have suggested that
neuroplasticity—structural and functional changes at different levels in the
brain—is an outcome of meditative states and meditation practice (e.g., Lutz
et al. 2007, 2008a).
Meditation and neuroplasticity 227
One key research question is how much meditation practice it takes to observe
changes in brain activities and structures. A number of neuroscience studies sug-
gest that functional and structural changes in the brain linked to meditation can
take place on several time-scales. Indeed, one study showed meditation-related
changes in brain activity after just four days of meditation practice (with 20 min-
utes of practice per day) (Zeidan et al. 2011). Another study found that just five
days of meditation practice (20 minutes per day) led to enhancements of atten-
tional control and immune responses, and a reduction in stress responses (Tang
et al. 2007). Other studies (e.g., Farb et al. 2007; Moore and Malinowski 2009;
Segal 2002) show pronounced changes in cognitive and emotion regulation pro-
cesses and related brain activity patterns after eight weeks of meditation training
using mindfulness protocols (e.g., MBSR and MBCT). Another study also found
that after eight weeks of meditation training there were structural changes in the
meditators’ brains, as well as changes in brain activity patterns (Hoelzel
et al. 2011). On a longer time-scale, Slagter et al. (2007) found pronounced
changes in attentional and conscious access processes and related neural activ-
ities among a sample of meditators participating in a retreat lasting three months,
with meditation practice for eight hours per day on average (Slagter et al. 2007).
There are also studies showing pronounced differences in brain activity pat-
terns when meditation practitioners with an average of about 16,000 hours of
meditation practice are compared with practitioners with an average of about
44,000 hours of meditation practice (Brefczynski-Lewis et al. 2007). Moreover,
multiple studies highlight differences in cognitive processes (e.g., attentional
networks) between people who undertook eight weeks of mindfulness-based
training and people who were long-term insight (vipassana) Buddhist medita-
tors (Jha et al. 2007; van den Hurk et al. 2010).
Studies such as that carried out by Lutz et al. (2004) have shown that brain
activity patterns, such as brain rhythms in key areas of the cerebral cortex,
appear to change as a function of both meditation expertise (traits) and specific
meditation states. These studies confirm that meditation practice leads to stable
changes in certain brain activities (e.g., brain rhythms) related to awareness and
compassion, outside meditation practice (“off the cushion”) (e.g., Lutz
et al. 2004). Such experimental findings suggest that beneficial changes related
to meditation, such as calmness, awareness, acceptance, and compassion, are
not limited to the periods of meditation practice (e.g., sitting meditation) but
are extended into daily life. Reciprocally, in terms of the same neural processes,
it is plausible to assume that positive mental states developed in daily life,
through the process of developing (informal) awareness, wisdom, and compas-
sion (loving kindness) practice, reverberate positively in formal meditation
practice.
Meditation practice appears also to counteract brain ageing processes. For

example, a study by Lazar et al. (2005) found a reduced loss of cortical thickness
(which depends on the number of neurons and their harborizations in the cor-
tical layers) with ageing in long-term vipassana (insight) meditators in several
brain areas involved in cognitive control and emotion regulation, such as the
anterior prefrontal cortex and the anterior insula. Such findings suggest that
meditation alleviates the effects of cognitive and brain ageing by plausibly
enhancing the functioning of cortical circuits and reducing the loss of neurons
and synapses with ageing. Following such findings, it also appears important to
assess to what extent meditation and mindfulness practices can be protective in
respect to dementias in ageing.
Therefore, meditation training appears to influence several important aspects
of mind, brain, and behavior, with differential effects depending on meditation
expertise. The next section will characterize meditation states and traits in
terms of two main categories suitable for psychological and neuroscientific
research.
The two facets of meditation in neuroscientific studies:

focused attention and open monitoring
The term meditation refers to a relatively large family of practices linked to dif-
ferent traditions and contexts. For the purposes of research, which demands a
precise reference to the objects of investigation, meditation practices can be
classified into two main styles—focused attention (FA) and open monitoring
(OM)—depending on how the attentional processes are directed (Cahn and
Polich 2006; Lutz et al. 2008a; but see Travis and Shear 2010 for a different per-
spective). In the FA (“concentrative”) style, attention is focused on a given
object in a sustained manner. The second style, OM meditation, involves the
non-reactive monitoring of the contents of ongoing experience, primarily as a
means to become reflectively aware of the nature of emotional and cognitive
patterns. Given their importance in current research on meditation, in this sec-
tion we first describe FA meditation, and then OM meditation, and then discuss
how focused attention and open monitoring can also be practiced in the same
meditation context and understood in a unitary manner.
Focused attention meditation

In FA meditation practice, high attentional stability and vividness (acuity) are
achieved in a mental state of concentrated calm or serene attention, denoted by
the word samatha (with the literal meaning of quiescence) in the Buddhist con-
templative tradition (Wallace 1999). By using a telescope analogy, Wallace
The two facets of meditation in neuroscientific studies 229
(1999) observed that in FA or samatha meditation, the development of atten-

tional stability may be likened to mounting a telescope on a firm platform,
while the development of attentional vividness is like polishing the lenses and
bringing the telescope into clear focus.
Apart from sustaining attentional focus on an intended object, FA meditation
also involves the regulative skills of monitoring the focus of attention, detecting
distraction, disengaging attention from the source of distraction, and refocus-
ing on the object (Lutz et al. 2008a). FA meditation techniques involve observ-
ing the experiential field by allowing thoughts and sensations to arise and pass
without clinging to them, and maintaining attention on an object or bringing it
back to the specific object of focused attention, in order to develop an internal
“witnessing observer” (Cahn and Polich 2006). The attentional and monitoring
functions of FA meditation have been related to different systems in the brain
involved in attentional control and in selective and sustained attention (Lutz
et al. 2008a; see also Weissman et al. 2006). The neural correlates of such differ-
ent FA meditation functions have recently been described by a functional mag-
netic resonance imaging (fMRI) study conducted by Hasenkamp et al. (2012).
This study elegantly identified different brain regions involved in mind wander-
ing (distraction), awareness of distraction, shifting back to the meditation
object, and then sustaining focus on it.
Srinivasan and Baijal (2007) reported changes in automatic sensory process-
ing at early stages (before the intervention of attention) due to concentration
(FA) meditation. Frequent and infrequent auditory tones were presented to
meditators before meditation and while exiting meditation, and to a control
group who practiced relaxation. The results showed increases in brain waves
(“mismatch negativity” amplitudes) immediately after and before meditation,
indicating enhanced sensitivity of the perceptual system of the meditators at
early sensory processing stages, even before attention could be allocated for a
cognitive task. Changes in perceptual processes have also been shown in a study
of expert meditators (Tibetan Buddhist monks) who could sustain a perceptual
state (motion-induced blindness) for a significantly longer period in an FA
meditation state (Carter et al. 2005). The study also reported longer durations
with a binocular rivalry task, in which conflicting inputs are presented to the
two eyes (with uncontrolled switches between the two in perceptual awareness
in general participants), indicating possible changes in the brain mechanisms
responsible for perceptual awareness, as a state effect of FA meditation based on
(trait) meditation expertise (Carter et al. 2005).
In addition to enhancement of perceptual processing, meditation practice is
associated with changes in attentional processes dependent on the nature of the
meditation practice (Baijal et al. 2011). A study with children who practiced
transcendental meditation showed that not all attentional processes benefited

from increased practice and expertise (Baijal et al. 2011). More specifically, they
investigated alerting (the ability to enhance attention by an external trigger),
orienting (the ability to direct attention to a cued location), and conflict moni-
toring (the ability to prevent interference from a distracter flanker) using the
Attention Network Test (ANT). While conflict monitoring and alerting per-
formance was different between meditators and controls, there was no diffe-
rence in orienting. The results also showed that those practicing transcendental
meditation were better able to handle conflict trials that were followed by non-
conflict trials, indicating a benefit in reactive control mechanisms.
An fMRI study with practitioners of FA meditation showed lower activation
in regions related to distraction and task-unrelated thoughts compared to con-
trols during a task that required the observers to ignore auditory stimuli
(Brefczynski-Lewis et al. 2007). Practice of FA meditation appeared to result in
enhanced ability to focus attention, thereby reducing the effects of irrelevant
stimuli. During FA meditation compared to rest, there was activation in mul-
tiple regions associated with monitoring and engagement of attention (such as
dorsolateral prefrontal cortex, visual cortex, and superior frontal and intrapari-
etal sulci). Interestingly, the strength of activity in these regions showed an
inverted u-shaped curve with meditation. Meditators with moderate experi-
ence showed stronger activation but very experienced meditators showed less
activation. The u-shaped pattern of brain activity suggests that, with very exten-
sive mental training such as the practice of FA meditation, minimal effort might
be necessary to sustain the focus of attention.
We will now focus on OM meditation, which unlike FA meditation does not
involve focusing on a specific meditation object, such as breath sensations
linked to an area of the body. OM meditation just involves a receptive awareness
of the fields of experience in the present moment, without an explicit focus or
sustaining attention onto any perceptual, feeling, or thought content.
Open monitoring meditation

Lutz et al. (2008a) suggest that OM meditation can strengthen regulatory influ-
ences on emotional processes, through prefrontal regulation of limbic
responses. Indeed, neuroimaging studies have shown that simple verbal label-
ing of affective stimuli leads to the activation of the (right) ventrolateral pre-
frontal cortex, and to reduced responses of the amygdala through ventromedial
prefrontal cortex activity (Hariri et al. 2000; Lieberman et al. 2007). This strat-
egy of labeling aspects of experience (e.g., “this is unpleasant”) is used in vipas-
sana (or insight) meditation, for example, and nurtures a more detached
awareness of affective content in moment-to-moment experience.
The two facets of meditation in neuroscientific studies 231
In OM meditation, monitoring is reflected in the capacity to notice arising sen-

sory, feeling, and thought events in the present moment within an unrestricted
receptive awareness. In the transition from an FA to an OM meditative state,
which may for example take place after some minutes in a meditation sitting, the
object as the primary focus is gradually replaced by a sustaining of an open
awareness (Lutz et al. 2008a). Behavioral studies of OM meditators have shown a
more distributed attentional focus (Valentine and Sweet 1999), enhanced con-
flict monitoring (Tang et al. 2007), and reduced attentional blink or more effi-
cient resource allocation to serially-presented targets (Slagter et al. 2007).
Lutz et al. (2004) found a high-amplitude pattern of synchrony in the gamma
oscillatory band in expert meditators during an emotional version of OM medi-
tation (non-referential compassion or loving kindness meditation). In that
study, compared with a group of novices, the practitioners (with a mental train-
ing of 10,000 to 50,000 hours over time periods ranging from 15 to 40 years)
self-induced higher-amplitude sustained gamma band oscillations and long-
range phase synchrony, especially over lateral frontoparietal electrodes, during
meditation. This pattern of gamma band oscillations and synchrony was also
significantly more pronounced in the baseline state of the long-term practi-
tioners compared with the novices, thus suggesting a neuroplasticity-based
transformation in the default brain mode of the practitioners.
Therefore, mental training based on both FA and OM meditation leads to
changes of brain activity that can be observed both as trait-related (off the cush-
ion) and as related to meditation states (during or immediately after medita-
tion), though with remarkable differences in brain activity patterns for FA and
OM meditation. We will now focus on the possible complementarity of FA and
OM meditation within a unitary meditation practice, i.e. by regarding FA
and OM facets of meditation as two aspects that can be expressed in alternation
within the same meditation sitting.
Focused attention and open monitoring in a unitary

view of meditation
Attentional stability and vividness (acuity), as developed in FA meditation, are
regarded as necessary for deep and reliable introspection to take place in medi-
tation, as in the practice of vipassana (insight) meditation. Tsongkhapa (1357–
1419), an eminent Tibetan Buddhist contemplative and philosopher, uses an
analogy to highlight the importance of attentional stability and vividness for the
cultivation of contemplative insight (see Wallace 1999). If an oil-lamp that is
both radiant and unflickering is used at night to light a hanging tapestry, the
depicted forms can be vividly observed. By contrast, if the oil-lamp is dim, or
even if it is bright but then flickers due to the wind, the depicted images cannot
be seen. Thus, both stability of attentional focusing and the temporal resolution
(acuity) of attention and consciousness linked to such focus play a crucial role
in meditation.
It has to be noted that the witnessing observer or meta-awareness function
plays a key role in both FA and OM meditation forms. Such a function is also
related to the well-known notion of mindfulness, generally defined as focusing
one’s attention in a non-judgmental or accepting way on the experience occur-
ring in the present moment (e.g., Brown et al. 2007; Kabat-Zinn 1990). Indeed,
it is possible to be mindfully aware of all that is currently salient and, simultane-
ously, to be mindful of something in particular by focusing attention toward a
stimulus or phenomenon (Kornfield 1993). For example, we can focus attention
on a given object (the breath) and be reflectively mindful of such focus and any
distracting phenomena (sounds, thoughts, physical sensations).
Thus, in several meditation practices, FA and OM styles can be seen as sim-
ply two sides of the same coin, as in Buddhist insight meditation (e.g., Khanti-
palo 1984). Chiesa (2012) notes “. . . concentrative and mindfulness meditation
practices are no longer described as opposed processes. Instead, several authors
recognize that they usually share a common background of focused attention
(concentration), which can take different directions depending on the specific
meditation form . . . While the former primarily concerns the stability of the
meditative state, the latter concerns the specific phenomenological ‘angle’ from
which the receptive field can be observed” (p. 3). However, other meditation
practices, such as non-referential open presence meditation, do not involve
focused attention on an object (see Lutz et al. 2007 for a review on different
forms of Buddhist meditation). These observations thus pose constraints for a
rigid distinction between FA and OM meditation in psychological and neuro-
scientific research. Meditation training that emphasizes focused attention has
been found to improve attentional orienting (Jha et al. 2007; van der Hurk
et al. 2009), as well as conflict monitoring (Tang et al. 2007; van der Hurk
et al. 2009). In contrast, meditation training that emphasizes open monitoring
improves the alerting network as measured using the Attention Network Test
(see Jha et al. 2007).
A study of vipassana (insight) meditation entailing FA and OM facets inves-
tigated the phenomenon of attentional blink (AB); that is, poor identification of
the second of two targets (T1 and T2) amongst a stream of stimuli presented
rapidly one after another. Vipassana meditators showed a reduced AB, indicat-
ing efficient distribution of their limited attentional resources (Slagter
et al. 2007). The vipassana meditators may have gained better control over the
allocation of attention by reducing the resources devoted to processing the first
(T1) target (also suggested by a reduced amplitude of a specific brain wave
Conclusions and research directions 233
linked to T1, the P3b amplitude), such that the subsequent target was more
often detected (or reduced AB).
In a related study (Slagter et al. 2009) with the same participants, EEG spec-
tral analyses showed that intensive mental training in the form of vipassana
meditation was associated with decreased cross-trial variability in the phase of
oscillatory theta activity after successfully detected T2s, in particular for those
individuals who showed the greatest reduction in brain resource allocation to
T1. This finding suggests theta phase locking in conscious target perception,
which in turn suggests that after meditation-based mental training, the cogni-
tive system is more rapidly available to process new target information.
In another investigation, Lutz et al. (2009) found a reduced variability in
attentional processing of target tones after intensive FA/OM meditation train-
ing, as shown by both enhanced theta-band phase consistency of oscillatory
neural responses over anterior brain areas and reduced reaction-time variabil-
ity. Moreover, those participants who showed the greatest increase in neural
response consistency showed the largest decrease in behavioral response vari-
ability. Taken together, these findings suggest that linked to neuroplasticity,
key brain activity (oscillatory) patterns become more coherent with intensive
meditation and may thus enable a more efficient transmission of signals over
long distances in the brain, such as for access of perceptual information to
consciousness.
Conclusions and research directions

As discussed in this chapter, an increasing number of neuroscientific, psycho-
logical, and clinical findings show the effectiveness of meditation practice in
supporting mental and physical health, as well as for improving a set of atten-
tional processes, cognitive flexibility, cognitive monitoring, and emotion
regulation, and enhancing mental states of empathy and compassion. Research
has also shown that meditation-based mental training leads to changes in the
function and structure of several brain areas and systems at different levels,
and that different aspects of meditation are plausibly related to different com-
ponents of brain structure and processes, as also related to meditation
expertise.
However, several neurocognitive and neuroaffective processes need to be
clarified in further investigations. For example, the neural correlates of dif-
ferent facets of consciousness need to be clarified in meditation settings. In
particular, there might be involvement of highly-trained meditators (“virtu-
osos”) capable of switching between different attentional and awareness
modes, with attention to (awareness of) external sensory fields or internal
(thought- and feeling-related) fields of experience, by using the neurophe-

nomenology approach (Lutz and Thompson 2003; Varela 1996). In the neu-
rophenomenological approach, quantitative measures of neural activity are
combined with first-person data about the subject’s inner experience. Parti-
cipants’ reports can thus be useful in identifying variability in brain activity
from moment to moment; this unique information might guide the detection
and interpretation of neural processes correlated to different aspects of con-
scious experience. Novel techniques for EEG analysis might be fruitfully
applied in that framework (Fingelkurts and Fingelkurts 2006; Thompson and
Varela 2001).
In further studies it would be insightful to compare brain activity patterns in
OM meditation conditions with differential awareness of fields of experience,
such as body sensory fields, external sensory fields, and “internal” thoughts
and feelings. Moreover, it appears useful to design an experiment comparing
brain activity patterns in FA meditation with a focus on breathing-related sen-
sations and on an external visual point. Indeed, somewhat different brain activ-
ity patterns have been observed in expert FA meditators with the focus on an
external visual point (Brefczynski-Lewis et al. 2007) and on breathing sensa-
tions (Manna et al. 2010).
Also, an increased scientific understanding of compassion (loving kindness)
meditation and related brain circuitries is important in light of relevant rela-
tionships with empathy and theory of mind (Lutz et al. 2008b) and clinical
implications of compassion-based mental training (Gilbert 2009). It also
appears relevant to integrate such an understanding with knowledge about the
mechanisms of focused attention, monitoring, and awareness investigated in
other forms of meditation. Moreover, it appears interesting to investigate
whether and how meditation traits influence sleep and dreaming, and how
these measures relate to mindfulness, mental states, and relevant psychological
dispositions.
Large-scale computational models with biological and cognitive constraints
can shed further light on the neural mechanisms of attention and conscious-
ness implicated in meditation. In particular, earlier neurocomputational
models of conscious processing (e.g., Dehaene et al. 2003; Raffone and Pan-
tani 2010) might be usefully adapted to simulate plausible neural mechanisms
for focused attention and cognitive monitoring in meditation, including
meditation expertise-related effects, and could possibly lead to novel testable
predictions. Finally, further neuroscientific studies may shed more light on
whether or not different forms of meditation involve the same brain struc-
tures, processes, mechanisms, and expertise-related structural and functional
changes.
REFERENCES 235
I started meditation practice in 2004 in England under the guidance of Prof. Peter Har-
vey, with a samatha Buddhist meditation style. Such practice, in combination with
Dhamma teachings, was deeply transformative in my life, bringing a deeper meaning of
existence and leading to the enhancement of awareness, wholesome mental states and
attitudes, and important insights about conditioning of the mind. It also had positive
reverberations in my relationships with others, such as in terms of more mindful, patient,
kind, and compassionate dispositions in the family and at work.
From the end of 2005 I started practice in the Arco Soto Zen Center in Rome, under the
guidance of Ven. Dario Doshin Girolami, and received a lay ordination (Bodhisattva
vows) in this context in 2009. I also assist Prof. Henk Barendregt in vipassana (insight)
meditation retreats taking place every year near Rome, with a duration up to 15 days. I
practice meditation daily (with a 40-minute Zazen meditation sitting in the early morn-
ing), with an intensive practice every Sunday (up to seven 40-minute sittings), and
promote the practice of meditation and related research in several contexts, including
university (such as in the form of weekly seminars led by qualified meditation teachers)
and prison (in collaboration with Ven. Dario Doshin Girolami) contexts.
I have recently founded (with others) the “Consciousness, Mindfulness, Compassion—
CMC—International Association,” of which I am currently Chair, promoting interdiscip-
linary research on consciousness, mindfulness, and empathy, as well as practice of
meditation, mindfulness, and compassion in several clinical and societal contexts. I have
also recently founded and currently direct the Master’s in “Mindfulness: Practice, clinical
applications and neuroscience” at the Sapienza University of Rome.
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Part 3
Meditation in
workplaces and schools
Chapter 11
Mindfulness and meditation in

the workplace: An acceptance
and commitment therapy
approach
Frank W. Bond, Paul E. Flaxman,
and Joda Lloyd
Introduction
There is a wide-ranging and growing body of evidence that mental health and
behavioral effectiveness are influenced more by how people interact with their
thoughts and feelings than by their form (e.g., how negative they are) or fre-
quency. Research has demonstrated this key finding in a wide range of areas.
For example, in chronic pain, psychosocial disability is predicted more by the
experiential avoidance of pain than by the degree of pain (McCracken 1998). A
number of therapeutic approaches have been developed that share this key
insight: Distress tolerance (e.g., Brown et al. 2002; Schmidt et al. 2007), thought
suppression (e.g., Wenzlaff and Wegner 2000), and mindfulness (Baer 2003). It
is also central to a number of the newer contextual cognitive behavior therapy
(CBT) approaches to treatment, such as mindfulness-based cognitive therapy
(MBCT; Segal et al. 2002), dialectical behavior therapy (DBT; Linehan 1993),
metacognitive therapy (Wells 2011), and acceptance and commitment therapy
(ACT; Hayes et al. 1999).
The purpose of this chapter is to describe how ACT conceptualizes mindful-
ness and tries to enhance it in the pursuit of promoting mental health and
behavioral effectiveness (e.g., productivity at work). To this end, we discuss
ACT’s key construct of psychological flexibility, which involves mindfulness,
and how it has led to a somewhat different approach not only to conceptualizing
mindfulness, but also to how we try to enhance it in the workplace. In so doing,
we hope to show that whilst formal meditation practice is valued in ACT, it is
only one strategy that is used to promote mindfulness, as well as psychological
flexibility more generally.
242 Mindfulness and meditation in the workplace
ACT hypothesizes that psychological flexibility1 is a primary determinant of

mental health and behavioral effectiveness. It refers to the ability to fully contact
the present moment and the thoughts, feelings, memories, and physiological
sensations it contains without needless defense or avoidance and, depending
upon what the situation affords, persisting or changing behavior in the pursuit
of goals and values (Hayes et al. 2006).
A key implication of this concept—and hence its name—is that, in any given
situation, people need to be flexible as to the extent to which they base their
actions on their internal events (e.g., thoughts, feelings, memories, and physio-
logical sensations) or the contingencies of reinforcement (or punishment) that
are present in that situation. ACT maintains, and research suggests, that people
are more psychologically healthy and perform more effectively when they base
their actions on their own values and goals (Bond et al. 2011). Thus, if a person
values being a caring friend, she may broach a difficult topic, even if doing so is
anxiety provoking; in another situation, however, she might refrain from men-
tioning something, even if she strongly feels like doing so, in order to pursue her
personally meaningful goal of being a caring friend. In short, when people are
psychologically flexible, they base their behavior, in any given situation, more
on their values and goals and less on their ever-changeable internal events or
current situational contingencies (Bond et al. 2011).
An implication of acting flexibly is that people will experience, at times,
unwanted psychological events (e.g., anxiety) whilst pursuing their values-
based goals. Thus, a great deal of ACT theory and practice emphasizes the
use of mindfulness strategies for experiencing these events, so that they have
less of a negative impact on individuals’ psychological health and their abil-
ity to pursue their values-based goals. When people are mindful of their
psychological events, they deliberately observe them on a moment-to-
moment basis, in a non-elaborative, open, curious, and non-judgmental
manner (Brown and Ryan 2003; Kabat-Zinn 1990; Linehan 1993; Marlatt
and Kristeller 1999). Thus, psychological flexibility emphasizes both com-
mitted action toward meaningful goals and mindfulness. It is this combin-
ation of mutually enhancing processes that is likely to account for the many
mental health and performance benefits associated with this individual
characteristic (see Bond et al. 2011, 2013; in prep.; and Hayes et al. 2006 for
reviews).
1
For historical reasons, psychological flexibility has also been referred to as psychological
acceptance, and psychological inflexibility has been referred to as experiential avoidance.
Bond et al. (2011) discuss these reasons.
Psychological flexibility and ACT at work 243
Psychological flexibility and ACT at work

Psychological flexibility, and its promotion through ACT, has been primarily
discussed in terms of mental health (see Hayes and Strosahl 2004; Hayes
et al. 2006); however, the implication that flexibility may help people to be sen-
sitive to, and contact, contingencies of reinforcement that bear on chosen val-
ues makes its usefulness to the work setting clear. If people value doing well at
work (even if it is just to get paid), greater psychological flexibility increases
their sensitivity to performance-related contingencies of reinforcement in their
work environment (Bond et al. 2006). This is because people who are more flex-
ible are more mindful and, as a result, are not expending their limited atten-
tional resources in trying to change, control, or otherwise avoid their internal
events; as a result, they are better able to notice and respond effectively to those
performance-related contingencies that exist in their current environment. Put
more succinctly, this context sensitivity hypothesis states that, in the context of
work, flexibility allows people to learn how to do their job more successfully
and to have better mental health (in particular, through greater and more
mindful contact with values-centered contingencies of positive reinforcement)
(Bond et al. 2006).
In the workplace, research has shown that higher levels of psychological flexi-
bility correlate with, and longitudinally predict, multiple work-related out-
comes, including better mental health, better job performance, and an increased
capacity to learn skills at work (Bond and Bunce 2003; Bond and Flaxman 2006;
Bond et al. in prep.; Hayes et al. 2006). In some instances, these effects have been
found even after controlling for other widely researched, work-relevant, indi-
vidual characteristics, such as negative affectivity and locus of control (Bond
and Bunce 2003), emotional intelligence (Donaldson-Feilder and Bond 2004),
and the Big Five personality traits (Bond et al. 2013).
Research has also indicated that people with greater levels of psychological
flexibility better utilize beneficial resources within their work environments.
Bond et al. (2008) found, using mediated moderation analyses, that higher levels
of psychological flexibility enhanced the beneficial impact of a work reorganiza-
tion intervention designed to improve job control. Specifically, people with
higher levels of flexibility perceived that they had greater levels of job control as
a result of the intervention, and this perception of higher levels of control allowed
these people to experience greater improvements in mental health and absence
levels (as recorded by the company’s Human Resources department). Consistent
with the goal-related context-sensitivity hypothesis, the authors suggested that
psychological flexibility helped people in the intervention group to better notice
where, when, and the degree to which they had increased levels of control; they
also maintained that it helped participants to better recognize goal-related

opportunities for putting that control to effective use (Bond et al. 2008).
Importantly, research shows that psychological flexibility not only predicts a
wide range of outcomes, it also demonstrates that interventions can enhance it
to promote emotional health and productivity in the work environment. As
noted, psychological flexibility is at the core of ACT’s model of mental health
and behavioral effectiveness (Hayes et al. 1999). ACT hypothesizes that an
increase in psychological flexibility constitutes the mechanism, or mediator, by
which this intervention enhances mental health and performance (Hayes
et al. 1999). Results from randomized controlled intervention trials have sup-
ported this mediation hypothesis in relation to ACT’s ability to improve
employee mental health (Bond and Bunce 2000; Flaxman and Bond 2010; Lloyd
et al. 2013), enhance employees’ ability to be innovative (Bond and Bunce
2000), reduce emotional burnout, and increase helpful attitudes toward client
groups (Hayes et al. 2004; Lloyd et al. 2013). In sum, research shows that psy-
chological flexibility is an important variable for predicting people’s mental
health and behavioral effectiveness in the workplace; furthermore, ACT train-
ing can enhance this characteristic and, as a result, produce emotional and
behavioral benefits to workers and their organizations.
The hexagon: the six characteristics that promote

psychological flexibility
ACT postulates six core processes that, together, promote psychological flexi-
bility; as we discuss later, ACT, including when used in the workplace, attempts
to enhance these processes. The hexagon (colloquially referred to as the hexaf-
lex; see Figure 11.1) is a graphic representation of the six core psychological
processes that constitute psychological flexibility (and we can influence those
processes through various ACT techniques) (Hayes et al. 2006). The processes
on the left of the hexaflex (acceptance and defusion) constitute the mindfulness
processes, whilst those on the right (values and committed action) promote
commitment to values-based action processes. The two at the center of the hex-
aflex (present moment and self as context) facilitate both types of processes. As
we will discuss, though, and as the connecting lines amongst the processes sug-
gest, this distinction between the mindfulness and values-based action pro-
cesses is not so clear-cut, and one set can help to facilitate the other.
Values
For individuals, values refer to a direction of travel that people choose to take in
their lives, and that give their lives meaning. People need to work constantly
The hexagon: the six characteristics that promote psychological flexibility 245
Present Moment
Acceptance Values
Psychological
Flexibility
Defusion Committed
Action
Self as
Context
Fig. 11.1 ACT’s psychological flexibility model.
Source: Reprinted from Behaviour Research and Therapy, 44 (1), Steven C. Hayes, Jason B.
Luoma, Frank W. Bond, Akihiko Masuda, and Jason Lillis, Acceptance and Commitment Therapy:
Model, processes and outcomes, pp. 1–25, doi:10.1016/j.brat.2005.06.006 Copyright 2006,
Elsevier. With permission from Elsevier.
toward their values, as they can never be forever (if ever) achieved, or sustained
(Hayes et al. 2012). For example, a person has to work constantly on being a
loving partner; it cannot be achieved in perpetuity without consistently taking
action. Indeed, values drive people’s goals and day-to-day actions.
Committed action
Committed action involves the specification of actions or goals that individuals
pledge to take, in order to move toward their values (Hayes et al. 2012). Taking
committed action will likely involve creating an (albeit perhaps informal)
action plan that specifies the goal, how it will be achieved, psychological and
external barriers that may get in the way of achieving the goal, and perhaps even
a time frame in which sub-goals and the goal itself will be met (Bond et al. 2006).
Importantly, the concept of committed action implies strongly that problems
are an inevitable part of working toward goals, and they should be expected and
addressed (Hayes et al. 2011). Psychological “problems” such as anxiety, and
other unwanted internal events, are considered “normal” and not something
that needs to be changed or gotten rid of in order to achieve one’s goals; people
need only approach them from a mindful perspective.
Self as context
Self as context (SAC) is a complex process that has a wide range of psychological
implications, for matters ranging from mental health and autistic spectrum dis-
order to cognitive ability (Hayes et al. 2012). One key function of SAC is that it
creates a psychological space from which people can mindfully observe their
self-conceptualizations (e.g., “I am a shy person,” “I am a good partner”), with-
out having such conceptualizations overly determine their actions (Hayes
et al. 2012). Instead, from a perspective of SAC, and the mindfulness it pro-
motes, people are better able to take actions, in a given context, that are more
consistent with their values (e.g., intimacy) than their thoughts as to who they
are (e.g., an unlovable person) and who they are not (e.g., confident). As we dis-
cuss later, SAC also constitutes a more stable perspective from where people can
observe their internal events as part of themselves but not wholly themselves;
they are more than the constantly fluctuating private experiences that they
experience. As research shows, when people view their thoughts, feelings, and
memories from the perspective of SAC, then these internal events tend to exert
a less problematic or emotional impact (Foody et al. 2013).
Defusion
Mindfulness is further promoted through the process of cognitive defusion.
When defused, people notice their internal events—thoughts, feelings, physio-
logical sensations, memories—as they occur, in the moment. Their focus is on
the events themselves (e.g., “I am having a thought”), rather than on the mean-
ing or content of those events (e.g., “I am a hopeless person”). In this way, peo-
ple do not get entangled in their internal events and are better able to let them
come and go. From an ACT perspective, defusion alters the undesirable func-
tions of internal events (especially thoughts) without changing their form, fre-
quency, or situational sensitivity (Hayes et al. 2012). Put another way, defusion
involves changing the way that people interact with their private experiences,
so, whilst they still may be present, they no longer have detrimental psycho-
logical/behavioral effects on them.
Acceptance
Defusion, SAC, and hence mindfulness are facilitated when people are willing to
experience, be open to, or accept unwanted or difficult internal events. If, instead,
people attempt to avoid those unwanted experiences, such avoidance diverts
their responding away from the present moment and toward getting rid of, chan-
ging, or minimizing those unwanted internal events. Such inflexible responding
to these types of experiences is unlikely to promote people’s values, because they
ACT and mindfulness 247
are guided by trying to avoid unwanted internal states, rather than by seeing how
they can best work toward their values and goals in the present situation.
Present moment
SAC, defusion, and acceptance are the tools that allow people to be in the pres-
ent moment and be aware of, and open to, the (even difficult) internal and exter-
nal events that they are currently experiencing. In so doing, people can better
attend to broad or narrow ranges of the current moment, as the context
demands. At times, it will be beneficial for people to attend to a broad range of
the present moment (e.g., when driving a car through a busy intersection); at
other times, it is more useful for people to focus on a narrow range of a particu-
lar situation (e.g., when having an uncomfortable conversation with one’s part-
ner). Being in the present moment helps people to establish which degree of
focus is most advantageous to them (in relation to their values and goals) in a
given situation; the other three mindfulness processes—SAC, defusion, and
acceptance—give them the ability to realize that advantage (e.g., by listening to
criticism from one’s partner in order to promote intimacy), despite any emo-
tional difficulties experienced in that situation.
As may be seen, ACT largely conceptualizes mindfulness as a means to an
end: Living a valued, or meaningful, life. It is the tool that allows people to over-
come the internal events that can prevent one from doing so. As noted earlier,
the connecting lines inside the hexagon in Figure 11.1 indicate that mindful-
ness not only promotes valued living, but identifying one’s values and commit-
ting to values-based goals gives people the impetus to engage in the (at times
effortful) processes that, for ACT, constitute mindfulness. Thus, the mindful-
ness and values-based action skills come together in ACT to produce a mutu-
ally beneficial and virtuous cycle that can promote a meaningful life.
ACT and mindfulness

As mindfulness is a core aspect of psychological flexibility, it is understandable
that ACT interventions include many techniques that attempt to enhance
mindfulness. Interestingly, though, ACT tends to use mindfulness techniques
that are shorter, less formal, and more varied than those used by other psycho-
logical approaches to mindfulness. For example, mindfulness-based stress
reduction (MBSR; Kabat-Zinn 1990) advocates meditating for 45 minutes per
day, with people directing their attention to the ever-changing physiological
and psychological processes occurring in their bodies. In contrast, ACT tends
to use mindfulness techniques that are rarely more than 15–20 minutes long
and are more often done during the normal course of a person’s day (e.g., taking
a shower or walking to work mindfully, or through mindful engagement in

value-guided actions). When we apply ACT to the workplace (Bond and Hayes
2002; Flaxman et al. 2013), we use many mindfulness meditation exercises that
can be shorter still, approximately 10 minutes. In so doing, we are attempting to
teach workers with very busy days both formal and informal (i.e., non-sitting)
meditation techniques that they may actually use on a regular basis.
More substantively, though, ACT uses shorter mindfulness meditation tech-
niques because, as noted, the goal of ACT is to get people to take actions that will
help them to construct more meaningful lives; mindfulness is viewed primarily
as a strategy that will help them to take that action in the presence of difficult or
challenging internal events. This is in contrast to some other psychology-focused
uses of mindfulness, such as MBSR, whose primary therapeutic goal is largely to
promote mindfulness, in-and-of-itself. That said, ACT does recognize, and
advocates, the psychological and physiological benefits of mindfulness, in-and-
of-themselves (Creswell et al. 2012). For example, research indicates that even
one 15–20-minute meditation session can have beneficial physiological effects,
including on temporal gene expression that is associated with a range of physio-
logical functioning, including inflammatory responses, insulin secretion, and
even telomere maintenance. These beneficial changes were seen for novice
meditators and even more strongly for long-term practitioners (Bhasin
et al. 2013). Briefly discussing these benefits in training sessions can often serve
to enhance the face validity of a skill that some workers may see as less important
than ones surrounding, for example, cardiovascular types of exercise.
ACT techniques for promoting mindfulness

in the workplace
In order to see more clearly the way that we foster mindfulness using ACT in
the workplace, we will describe a number of brief and varied techniques that we
use in our empirically validated training program (Flaxman et al. 2013). Each
one is normally more closely associated with one process on the hexagon shown
in Figure 11.1 and described earlier. It may be useful to note several points
when we describe these techniques or skills:
1 Each one, alone, is useful for encouraging mindfulness, even if it does not
resemble formal meditation.
2 Consistent with the psychological flexibility model, each process on the
hexagon, and its associated technique or skill, helps to develop skills associ-
ated with all of the other processes on the hexagon; thus, many different
types of skills (e.g., clarifying one’s values) can work together to promote
mindfulness, not just those that “look like” meditation or mindfulness.
ACT techniques for promoting mindfulness in the workplace 249
3 None takes more than approximately 15–20 minutes to complete during

one’s day and so are useful to busy workers.
In short, the hexagon and its associated skills help to show, from an ACT per-
spective, the different processes from which mindfulness emerges, is encour-
aged, and is maintained in the service of a meaningful life.
Present moment
The following extract is from our empirically validated ACT at work training
manual. It is, perhaps, the ACT at work exercise that is closest to a formal, sit-
ting meditation; it is also significantly shorter than formal meditation exercises
advocated by other interventions (e.g., Segal et al. 2002).
First, we encourage participants to adopt an upright posture, with the back straight and
dignified but not too rigid, and spine infused with energy. We say that by doing this we
are “doing what the meditators do.” We invite participants either to close their eyes or
allow the gaze to become unfocused and directed downward.
We then invite participants to pay mindful attention to current sensations in their
feet and toes, perhaps noticing any tingling or throbbing in their feet or toes; noticing
whether different parts of the feet feel warmer or colder than other parts; noticing the
sensations of their feet encased within their shoes; and exploring any areas of pressure
in the soles of the feet where they contact the floor. After a few moments, we invite par-
ticipants to shift the “spotlight of their attention” to current sensations in the hands and
fingers—just noticing, without judgment, whatever sensations are there in this moment
to be noticed; exploring with gentle curiosity and interest any tingling or throbbing in
the hands and fingers; noticing the position and temperature of their hands and fingers.
While focusing on hands and fingers, we encourage participants to notice how easy it is
to drift away into thoughts and lose awareness of current physical sensations. Each time
participants notice they have drifted away into thought, they are asked to return atten-
tion once again to sensations in the body. We then invite participants to shift their
attention to the abdomen for a minute or so, noticing the sensations and movement in
the tummy with each breath. Finally, we end this brief exercise by inviting participants
to expand their awareness from the abdomen to notice sensations throughout the
entire body—to gradually develop a “strong sense of the entire body” sitting here in this
chair, in the here and now. We then ask participants to open their eyes and return to the
room (Flaxman et al. 2013, pp. 82–83).
This exercise helps people to develop the flexibility to attend both to narrow and
broader aspects of the present moment (e.g., the abdomen and the entire body,
respectively, in this present moment exercise). This skill, in itself, is useful in the
work environment, as it helps people to concentrate on a particular task; in
addition, it can help people to notice quickly, because they are in the present
moment, when they might react avoidantly to an internal event (e.g., anxiety).
It can thus function as an early warning indicator that it would be useful for
them to accept such an internal event, instead of avoiding it.
Acceptance
The more that people can be in the present moment, the better they will be able
to notice and respond flexibly to their internal and external events. Such present
moment attention can be very painful for people, unless they are willing to
experience or accept internal events that they do not like (Hayes et al. 2001). To
develop people’s ability to respond with acceptance, we normally use a “physic-
alizing” exercise (Hayes et al. 1999) that can help people to be willing to experi-
ence their difficult internal events.
In this exercise, we ask participants to think of a current or recent situation (or
person) that they have found difficult. This does not have to be a major life issue,
just an experience that they have found moderately uncomfortable. As partici-
pants think about the situation or person, we ask them to notice any sensations
or feelings that arise, and we ask them to note whereabouts in the body it is the
strongest (e.g., the chest or stomach). We ask various questions that draw mind-
ful attention to the underlying physical sensations—such as whether a noticed
feeling or sensation that arises feels sharp or dull, warm or cold, static or pulsat-
ing, and whether the feeling is on the surface of the body or deep down inside
(or both). In the next part of this practice, we ask our participants to imagine
that the feeling or sensation is a physical object so that they can reach into their
body, pull it out, and sit it down next to them. We then get them to really experi-
ence the “object,” by asking them a series of questions about it, such as “What is
the shape of the object? What color is the object? What is its texture like?” We
also ask about its size, weight, density, and any other physical attributes.
The aim here is to cultivate some healthy psychological distance between the
feeler (i.e., the person) and the feeling, and also to provide a way of practicing
simply “being with” what may be a somewhat difficult feeling or somatic sensa-
tion. At the end of this exercise, participants are asked to welcome the object
back inside the skin, from where they first removed it, and they are asked to
notice whether or not it has changed. We emphasize that the goal of the exercise
is not to reduce or change unpleasant feelings or sensations, but to take a psy-
chological step back and to observe the feeling or sensation for what it actually
is and not what it may represent or imply. The ultimate aim is to reduce the
unhelpful influence that (typically undesirable) emotions can exert over our
ability to pursue personally valued actions and goals.
Defusion
In our ACT at work protocol (see Flaxman et al. 2013), one of the well-known
ACT defusion techniques we have used is the Milk, Milk, Milk exercise, originally
devised by Titchener in 1916 (as described by Hayes et al. 1999, pp. 154–156). In
it, participants are first asked for any thoughts that come to their minds in rela-
tion to the word “milk,” and they tend to come up with ones such as “it’s white
and tastes disgusting”; “cows”; “feeding my baby”; “it goes in my tea.” Participants
and the trainer then continually repeat the word “milk” for approximately 45
seconds. During this time, the trainer occasionally encourages participants to
speed up, slow down, say the word louder, and to really experience the word. At
the end of the 45 seconds, the trainer asks whether the participants noticed any-
thing while performing this rather strange exercise. More often than not, partici-
pants notice that the meaning of the word (e.g., white stuff, cows, feeding babies,
etc.) disappears as they begin to experience the word “milk” simply as a word or
sound.
Immediately following the exercise, we write the word “milk” on a flip chart
or whiteboard, alongside some words that summarize various negative self-
conceptualizations (e.g., “I’m weak,” or “I’m stupid”). We then offer the follow-
ing observation: At the level of literal meaning, “milk” and “stupid” are very
different; however, on another level, the level of word and sound, “milk” and
“stupid” are not fundamentally different—they are, after all, both just words or
sounds. We go on to discuss that it is not necessary to suspend literal meaning
in this way for very long. Rather, the Milk exercise is simply designed to provide
a glimpse of the “illusion” that is naturally woven by taking thoughts and lan-
guage as if they were the actual event that they represented. Nonetheless, an
occasional glimpse of this process is often all it takes to reduce thought believ-
ability and undermine the context of cognitive fusion (cf. Masuda et al. 2004).
Another defusion strategy that is facilitated by, and facilitates, present
moment awareness and acceptance involves how we label our experience of
internal events; in particular, it involves, for example, substituting the label “I
am anxious” or “I am stressed” for the more accurate and more defused state-
ment “I am having the feeling of anxiety” or “I am having the thought that I’m
stressed” (Hayes et al. 1999). Participants often instantly recognize how such
labeling offers a more defused and descriptive (i.e., less evaluative) way of relat-
ing to private events. This technique has additional benefits: For example, it can
help participants to practice labeling internal events as they unfold in present
moment awareness (e.g., now I’m having this thought; now I’m having this
memory; now I’m having this feeling; now I’m having this bodily sensation). It
also highlights the fundamental (yet often overlooked) distinction that exists
between difficult private events and the person who is having those experiences
(Hayes et al. 2004); this is a distinction that experiments show reduces emo-
tional distress (e.g., Foody et al. 2013).
As can be seen, people can use these two defusion techniques—and especially
the second one—in order to promote mindfulness quickly, in any situation, and
even when experiencing difficult or unwanted internal events. No formal medi-

tation is required in order to use them effectively. As the hexagon implies, pres-
ent moment awareness and acceptance can facilitate the efficacy of these two
techniques, just as defusion can promote people’s willingness to be present with
and experience difficult private experiences; these are all mutually beneficial
processes and skills.
Self as context
One of the core aims of ACT is to help people contact a stable sense of self
that is distinct from (and therefore not threatened by) negative thoughts,
memories, emotions, sensations, and other internal events. In ACT, this
somewhat transcendent sense of self is often referred to as SAC, or the
“observing self ”; it is accessed through various defusion and mindfulness
exercises, such as the mindfulness meditation described earlier, as well as the
physicalizing exercise (also see Hayes et al. 2012). Furthermore, we use meta-
phors in order to make the observation that there are essentially two pro-
cesses operating during mindfulness practice—first there is “The Mind,”
constantly doing what minds are designed to do (i.e., chattering, predicting,
imagining, planning, worrying, comparing, judging, criticizing, and so on);
and then there is “The Observer” (or Awareness), which is the SAC perspec-
tive; the unchanging part of us that has always observed ourselves—our
beliefs, thinking, emotions, and memories. It is the part of us that knows we
have changed, in physical appearance, beliefs, and feelings, because it has
always been there, observing these changes. To emphasize this point, we use
a cloud and sky metaphor (from Hayes et al. 1999, p. 187), in which clouds
and weather are the “verbal chatter” of the mind, behind which lies blue sky.
We do not have to remove the clouds to know that there is blue sky; whenever
we look we will see that it is there.
We would typically guide participants through a brief observer experiential
exercise to encourage experiential contact with SAC (see Harris 2008, pp. 176–
177). The exercise asks us to notice thoughts, emotions, and sensations as they
unfold in the here and now, and become aware that part of us is able to stand
back and to observe these internal events. Participants are encouraged to
experience their thoughts, feelings, and sensations as constantly changing,
while the observing self is a constant—always there, noticing these changes.
As can be seen, when using more formal mindfulness meditation to promote
SAC, ACT tweaks the practice so that it is more guided in nature, helping
people to see their experiences from their observing self. As with the other
mindfulness processes discussed earlier, SAC facilitates, and is facilitated by,
the others.
Clarifying values
One of the primary reasons for promoting mindfulness skills in ACT is that
they can help to ensure that people do not aimlessly go about their life, failing to
pursue a direction that is meaningful to them. As noted earlier, in ACT, a value
is a chosen life direction that is never achieved, or at least achieved indefinitely;
for example, one must work constantly at being a caring partner: Even if one is
caring today, further caring actions need to be undertaken tomorrow in order
to remain caring. In contrast, goals are specific and have discrete outcomes that
constitute observable steps in the direction of one’s values; actively listening to
one’s partner instead of watching the television could be a goal that is in the
service of the value of being a caring partner.
Mindfulness is useful in clarifying values in at least two ways. First, it facili-
tates the “accuracy” of a values assessment exercise that we use in our workplace
ACT training program. In this exercise, participants are presented with ten core
areas of life (e.g., family relations, work/career, recreation/leisure, physical
health, and so on) (adapted from Hayes et al. 1999, pp. 224–225). Participants
are asked to write down their “chosen life directions” (i.e., values) in each area
of life that they rate as personally important. To facilitate this process, the
trainer introduces various questions, such as “Imagine you are now 80 years old
and looking back. What footprints would you like to see behind you in this area
of your life?” and “What do you want to be about in this area of your life?” and
“If you have goals in this area of your life, in which direction are they taking
you?” These questions can themselves help to increase mindfulness by promot-
ing defusion and the perspective-taking that can enhance SAC. According to
ACT theory, though, people who approach this exercise from a mindful per-
spective to start with are more likely to contact the values that are truly mean-
ingful to them, rather than what is meaningful to others or what they feel is
expected of them.
Mindfulness is further helpful in values clarification in that it helps people to
identify honestly “internal barriers” (e.g., difficult or unhelpful thoughts, mem-
ories, moods, or emotions) that have the potential to interfere with clarifying
and pursuing their valued directions (e.g., fear of rejection). These barriers
often provide the richest material around which to practice and develop mind-
fulness and acceptance skills, as they are the internal events that can most
effectively block people from living a life that is meaningful to them.
Finally, mindfulness can help people to distinguish between internal barriers
to living a valued life (e.g., anxiety) and external barriers (e.g., lack of relevant
skills). It is not unusual for these two types of barriers to interact, so that people
fail to address an external barrier because they do not recognize or acknowledge
the internal one. Thus, the reason given for not pursuing one’s values is the
external barrier when, in fact, it could be overcome if only a person were willing
to address the internal one.
Unsurprisingly, reflecting on one’s values in a considered and methodical
manner can be powerful, and participants occasionally become upset while
completing such exercises, especially if they realize that they have been mind-
lessly pursuing life directions that they would not ultimately choose for them-
selves. Here, mindfulness skills help people to make room for that upset so that
they are freer to identify, accept, and move in directions that are meaningful to
them. Finally, and reflected in the hexagon, clarifying values and identifying
internal barriers to pursuing them can serve as an impetus to practice the mind-
fulness exercises that will help them to create their meaningful life; a point that
we often make in our training sessions.
Increasing commitment to values-based goals and actions

In our ACT at work protocol (Flaxman et al. 2013), we use a number of strat-
egies that encourage participants to generate concrete goals and action plans
that are based upon the values that they have identified. For example, after every
session in our ACT training, participants are invited to choose three relatively
small value-guided actions that they would be willing to perform over the next
week. Our participants are encouraged to engage in these actions mindfully—

that is, by noticing what happens before, during, and after the action, and also
by noticing any thoughts and feelings that arise and have the potential to func-
tion as “internal barriers” to the pursuit of these actions. We also ask if they will
commit to achieving four values-consistent goals between the second and third
sessions, and we distribute diaries and rating forms that are designed to encour-
age participants to self-monitor their progress toward achieving those goals.
These materials also help participants more generally to monitor their values-
based behavior on a weekly basis. Such goal-identification, commitment mak-
ing, and careful monitoring in themselves can promote the defusion, perspective
taking, and acceptance that encourage mindfulness. We also clearly show how
the mindfulness techniques that they are learning will serve them well in mov-
ing through the difficult psychological content that they will experience when
taking action to achieve their life-enhancing goals.
ACT: a multi-method approach to mindfulness

As can be seen, our workplace ACT protocol, like most other ACT guides, does
not focus heavily on formal meditation practice (Hayes et al. 2012), but it does
include guided experiential exercises, metaphors, and other interventions that
promote mindfulness. From a training and therapeutic perspective, we believe

that this diverse range of mindfulness exercises is a strength; if one type does
not work for a person, perhaps another one will. From a theoretical perspective,
it is reassuring that, despite the eclectic range of ACT techniques, as contrasted
to formal meditation only, research is very consistent in showing that these
various techniques appear to work by impacting the same psychological mech-
anism: Psychological flexibility (Hayes et al. 2006; Bond et al. in prep.). Know-
ing this is not just a theoretical nicety; it also allows people to expand and
develop ACT to include additional, and perhaps more effective, mindfulness
interventions that can target this mechanism and thus help people to lead vital
and meaningful lives. The increasing acceptance of, and research literature sup-
porting, contextual CBTs augurs well for this expansion, and we look forward
to seeing how it develops.

Frank W. Bond
I do not think that I really understand the distinctions and overlaps between meditation
and mindfulness. I have examined the relevant literature to try to identify established
and agreed-upon definitions for both terms, but I have not been able to do so for “medi-
tation,” although I have found agreed-upon definitions for “mindfulness.” Perhaps this
should not be surprising, as operational definitions are crucial in science but are less
important in the realm of religion, from which meditation originally emerges. Psychology
has largely adopted the term mindfulness, so it is not surprising that there are agreed-
upon definitions for this word. Further complicating the definitional quandary is that
“mindfulness meditation” is used freely in the literature, which could imply that this is
different from mere “meditation” or “mindfulness.” I mention this definitional issue only
because I do not know whether what I personally practice is meditation or mindfulness,
but here is my personal account of my experience with what I shall term mindfulness.
As an undergraduate, I would lie on my floor with headphones on and really concentrate
on listening to modern composers, particularly Luciano Berio. I found trying to pick out the
different instruments, and the different ranges and tempos at which they played, incred-
ibly enjoyable. It was effortful to do this, but I found that I got more accustomed to doing
it over time. It was many years later that I heard the term mindfulness, and its definition of
deliberately observing one’s psychological and physiological events on a moment-to-
moment basis, in a non-elaborative, open, curious, and non-judgmental manner. I then
realized that I had been doing this, with regard to music, for many years and so I decided
to try to extend mindfulness to other areas of my life, from walking to work to speaking
with a friend. I found this very satisfying and meaningful; engaging in the here-and-now
was far more calming and enjoyable than being wrapped up in my own thoughts.
When I discovered ACT, with its emphasis on mindfulness and its roots in science, I knew
that I had found a psychological theory of human cognition and behavior that reson-
ated with me, both as a scientist and as a person. As we note in this chapter, ACT uses
brief and/or guided mindfulness techniques that are largely integrated into one’s daily
life (e.g., listening to music or talking with a friend). This is how I had been using mind-
fulness for many years, and ACT showed me how I could extend this practice into my life
in a way that could make it more vital and meaningful.
About ten years after stumbling upon ACT, I signed up for the traditional eight-week
MBSR training, in which we were asked to practice what I consider to be “formal” medi-
tation for approximately 45 minutes every day. This largely involved paying non-
judgmental attention to your body, breath, and thoughts on a moment-to-moment
basis. I was a good student and practiced my mindfulness meditation almost every day.
I found it very revealing in that I was able to sit with my thoughts, boredom, and dis-
comfort for quite some time, and that it got easier to do so the more that I practiced.
After the course ended, I soon stopped “sitting,” but the “boot camp” experience of the
MBSR training did increase my use of, and facility with, the going-mindfully-about-your-
day techniques that ACT teaches. Occasionally, when I cannot sleep, I will do a medita-
tion exercise that I learned in MBSR classes, so I am very glad that I had that training;
however, I find trying to go mindfully about my daily life, choosing actions to take that
are consistent with my values, is very useful to me in creating a meaningful life. (This is
not to say, however, that formal meditation does not serve the same function for many
people.) Thus, with my psychotherapy and coaching clients, I try a range of mindfulness
techniques, including formal meditation, hoping that they will respond favorably to one
of them. This, I think, from my own experience, is the key point: The technique (e.g.,
meditation) is not the issue; it is living mindfully, however one gets there. So, in my own
mind and life, I think that I have addressed the quandary that I posed at the beginning
of this piece: Meditation and mindfulness are distinct, with the former one being a
means of achieving the latter.
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Chapter 12
Mindfulness in education
Katherine Weare
Introduction
The term mindfulness refers to the ability to direct the attention to experience
as it unfolds, moment by moment, with open-minded curiosity and kindness
(Kabat-Zinn 1996). Mindfulness is partly an ability that can be developed, and
practices that encourage mindfulness are designed to train the attention and
ability to “be with” present experience in an interested rather than judgmental
way. This process is intended to help loosen the grip of habitual, mindless
activity, including negative ruminations and worries, and produce less reactiv-
ity and impulsiveness, and a greater ability to examine thoughts and feelings
more rationally and thus respond more skillfully to life’s challenges (Hölzel
et al. 2011a).
The process of applying non-judgmental curiosity to experience often of itself
induces a greater sense of kindness and compassion toward the self and others,
and some approaches to mindfulness include specific work to train these
empathic abilities. Over time, shifts can take place in unwanted repetitive men-
tal and behavioral patterns that otherwise create and maintain negative mental
states, such as stress, anxiety, depression, and hostility (Ma and Teasdale 2004).
Mindfulness practice can also cultivate positive mind states such as mental sta-
bility and calm, giving rise to greater happiness, more effectiveness in everyday
life, and a stronger sense of well-being and satisfaction with life (Williams and
Penman 2011).
The growth of secular mindfulness

Mindfulness is said to derive from Buddhist philosophy and meditation practice,
set in motion by the Buddha over 2500 years ago, although the urge to contem-
plation is probably as old as the human race and most religions include contem-
plation of some kind. However, mindfulness in the modern secular sense can be
traced to the work of Jon Kabat-Zinn in the mid-1970s, himself a Buddhist medi-
tator, working at the Medical Center at the University of Massachusetts. He was
interested to discover whether the essence of the practices he found useful could
260 Mindfulness in education
be turned into secular, brief, skills-based exercises anyone could learn. He devel-
oped an eight-week “mindfulness-based stress reduction” (MBSR) program,
which taught some simple core practices in two-hour sessions once a week, sup-
ported by short home practices. He taught this program to a variety of patients
who were not responding to conventional medical treatment and had intractable
problems. At the time his course had a clear and relatively rapid impact on the
psychological and physical health of the people who took part (Kabat-Zinn
1996). The basic formula of the eight-week course has stood the test of time, and
is still the way many Western adults initially encounter secular mindfulness,
including its adaptations such as mindfulness-based cognitive therapy (MBCT)
for recurrent depression.
Mindfulness practices
Secular mindfulness is learned through mind-training practices—some of
which might be termed ‘meditations’—in which the learner is encouraged to
pay bare attention to their changing experience, for example to the sensation of
the breath, to passing sound, and to the inner stream of thoughts, feelings, and
bodily sensations. These practices are usually undertaken in a state of stillness.
Other practices are more active and include paying attention to usually taken-
for-granted activities—examples are mindful eating, mindful walking, and
mindful movement. Learners are encouraged to pay open-minded and curious
attention—as if for the first time—to some daily activities they usually do on
“automatic pilot,” such as showering and washing dishes. Other practices
include learning to be more mindful of communications with others, and of
one’s reactions to experiences, both pleasant and unpleasant. Ultimately mind-
fulness can include paying close attention to any and all aspects of experience.
The evidence base for adult mindfulness

The emerging evidence base, derived from an exponentially increasing number
of studies, suggests that mindfulness has a wide range of potential applications
for mental and physical health. Well-conducted randomized controlled trials
(RCTs) have shown moderate impacts (statistically speaking) of relatively short
interventions for adults on depression, anxiety, and stress, and on physical
health problems, such as pain, blood pressure, and the immune function (Baer
2006; Goyal et al. 2014).
Mindfulness training is popular with funding bodies as it is relatively cheap
to provide and carries the promise of some fairly rapid and sustained benefits.
In the UK, the MBCT course is now recommended for recurrent depression by
the National Institute for Health and Care Excellence (NICE 2009), having
The growth of mindfulness programs for children and young people 261
proved to be twice as effective as “treatment as usual.” The time spent learning

mindfulness does not have to be extensive, although it is generally agreed that
more is better, provided practice is gradually increased. Pre/post analysis
showed that five days of 20-minute mindfulness meditations in adults reduced
anxiety, depression, anger, and fatigue, improved immune-reactivity, and
decreased cortisol (a stress hormone), and four days of mindfulness training
was sufficient to improve mindfulness, visual-spatial memory, working mem-
ory, and sustained attention (Hölzel et al. 2011a). Eight weeks of mindfulness
practice have been shown to start to reshape the neural pathways in the brain,
increasing the areas associated with kindness, compassion, and rationality and
decreasing those involved in anxiety, worry, and impulsiveness (Davidson and
Lutz 2008).
What mindfulness adds to existing approaches

Rather than using mindfulness meditation as a stand-alone panacea or magic
bullet, recent initiatives for both adults and young people see mindfulness as
being a “value added” intervention, augmenting other evidence-based
approaches. Relatively small amounts of mindfulness can usefully be added to
enhance other efforts such as CBT in health contexts and social and emotional
learning (SEL) in school contexts, to help people manage their thoughts, feel-
ings, and behavior. Mindfulness brings to more cerebral and words-based
approaches, the ability to ground both therapy and learning in immediate felt
and embodied experience. Mindfulness also provides a balance to the tendency
of therapy and education to want people to change, to “fix things” and help
people immediately think more “positively”—the value-laden judgments of
which can sometimes get in the way of helping people get in touch with and
understand what is happening to them, actually making them feel worse. Mind-
fulness can bring a greater recognition of the value of first simply accepting how
things are, and the paradox that it is only when people accept who they are that
they are actually able to change. We explore further the ways in which mindful-
ness brings this ‘value added’ to existing work in schools on ‘resilience’, life
skills, and social and emotional learning later in this chapter.
The growth of mindfulness programs for children

and young people
Mindfulness in schools is not totally new. Some “alternative” schools such as
Montessori and Steiner have routinely included a focus on mindfulness in
the sense of concentrated attention to sensory experience (Lillard 2011),
and there have been sporadic attempts to interest those in education in
mindfulness for at least two decades (e.g., Langer 1993). Now mindfulness
is developing fairly rapidly in mainstream schools, although it is far from
being widespread.
Mindfulness programs by definition share a focus on the core intention of
developing the ability to pay bare attention and to being present with experi-
ence with open-minded curiosity. Beyond that they range widely in aims and
scope; those with the most sound evidence base will be outlined as illustra-
tions in this chapter. The bulk of school-based programs come from the US,
but work is developing elsewhere, including in Europe, Australasia, and in the
East—where mindfulness could be said to have originated and have its nat-
ural roots.
Teaching approaches for mindfulness

with young people
The basic intentions and approaches to mindfulness for the young are the
same as for adult mindfulness, as described at the beginning of this chapter.
Young people do not, however, enter the classroom as keen trainee contempla-
tives and the idea of sitting quietly focusing the mind may seem many miles
from their current habits and mindsets in their multi-tasking, distracted
worlds. Unlike adults, for whom mindfulness is a voluntary activity, many
young people will encounter mindfulness as “conscripts,” i.e. as part of their
compulsory curriculum, not as something in which they have expressed a
particular interest. Programs therefore need to capture their imagination, and
developers are experimenting with approaches that demonstrate rich diver-
sity and considerable innovation (Kaiser-Greenland 2009; Meiklejohn
et al. 2012). Some programs, such as the Stressed Teens program (Beigal 2009;
see Case Study 1), working with older students, use the format of the eight-
week MBSR course. Others, such as the UK’s Mindfulness in Schools Project
(Mindfulness in Schools 2014; see Case Study 2 later), have at their core the
familiar basic practices of mindfulness but they also use fun activities, tan-
gible objects, vivid images, media, and resources, and a pacey and edgy style
that appeals to more active learning styles and higher energy levels. Some
programs work directly with the active and lively nature of youth to include
yoga, tai chi, relaxation, music, the arts, and contact with nature (e.g., Holistic
Life Foundation 2014). In comparison with adult mindfulness courses, ses-
sions and practices for the young tend to be briefer, the length of a conven-
tional lesson—or less in the case of younger children—and more structured,
with more repetition and with more overt explanations about the purpose of
the activity for often skeptical youth.
The evidence base with children and young people 263
The evidence base with children and young people

The evidence base for work on mindfulness and youth can be described as
“promising.” There are to date eight reviews of the quantitative studies of
mindfulness and the young, the most recent of which are two meta-analyses
by Zoogman et al. (2015) and Zenner et al. (2014). Both concluded that mind-
fulness had an overall effect size in the small to moderate range and found no
examples of adverse (harmful) effects. There is also a growing literature of
qualitative work, on mindfulness for the young in health contexts, on mind-
fulness for the adults who work with youth, on the theories behind mindful-
ness, and on the neuroscience of mindfulness. Interventions amenable for
robust evaluation tend to be relatively short, with six to eight sessions being
common, although many are part of wider and more diffuse programs and
frameworks. They are diverse but tend to be in schools rather than health set-
tings, and more with adolescents than with younger students. Twice as many
are targeted as universal programs, and a growing number in teacher educa-
tion and in the community.
All reviews comment on the methodological weaknesses of existing studies
(e.g., Greenberg and Harris 2012), as would be expected in a young field. Stud-
ies are generally underpowered, being mostly small pilots and exploratory stud-
ies. There are few RCTs. There are a number of studies that show some element
of control (mostly wait-list), but many are before and after studies with no con-
trols. Few studies have adequate follow-up. Measurement is underdeveloped,
with few measures designed specifically for young people, no standardization
or even much overlap in the use of measures, and a good deal of emphasis on
self-report rather than more “objective” measures. Studies cover a diverse range
of age groups, contexts, problems, and conditions, with little replication, which
undermines claims for generalizability. There is frequent use of the same teams
to design, deliver, and evaluate programs with the consequent problem of bias.
Calls for better quality and more robust research are being heeded and many
teams are currently addressing the methodological concerns in newer research;
meanwhile, there is reason to believe that all of this activity is proving to be
worthwhile. The hard evidence that has emerged so far is positive and promis-
ing. Interventions tend to be highly “acceptable,” that is popular with staff and
students, with no reported adverse effects. The outcomes, which will be dis-
cussed later, are very much in line with the outcomes that have emerged in
research with adults. The same broad processes and mechanisms are at work for
children and adults, although some teams are now examining the developmen-
tal aspects of mindfulness; for example, how mindfulness skills and the nature
of appropriate interventions may change across the age range.
Impact of mindfulness on mental health

in children and young people
Mindfulness would appear to be helpful in addressing youth mental health dif-
ficulties, echoing its demonstrable success with adults (Baer 2006; Ma and Teas-
dale 2004). Although the impacts of any particular intervention are not
guaranteed, both targeted and universal interventions have generally had at
least a modest impact on mental health problems in the young. Indeed, mind-
fulness interventions appear to have had the most impact in both adults and
young people in addressing such problems. The recent meta-analysis by Zoog-
man et al. (2015) of 20 studies concluded that both targeted and universal inter-
ventions had twice the effect on “psychological symptoms” compared to other
outcomes measured by studies of mindfulness interventions for youth, such as
well-being or learning.
This impact on mental health is welcome, as the level of problems is alarming
and increasing, running currently at about 25% of young people with an iden-
tifiable disorder and 10% needing specialist treatment (UK estimate by the
Mental Health Foundation 2014). Such figures probably represent the tip of the
iceberg, as most young people with mental health problems remain untreated.
In the wider population, problems such as anxiety, depression, low self-esteem,
self-harm, bullying, and stress are widespread, with serious impacts on well-
being and quality of life. Even low-level mental health problems can disrupt
thinking, undermine enjoyment of life, hinder learning, and diminish school
performance (Barnes et al. 2003), a state that has been termed ‘languishing’
(Keyes 2002).
The case for a targeted/universal balance

One way to approach mental health problems is through targeting those people
with problems. Children and young people targeted by mindfulness interven-
tions so far represent a wide range of problematic conditions, particularly
depression, anxiety, behavior problems/attention deficit hyperactivity disorder
(ADHD), substance abuse, sleep problems, and learning difficulties. Targeted
approaches in mindfulness have generally been shown to have significantly
greater impacts than universal ones, in line with the well-documented ten-
dency for mental health interventions to have the largest impact on those with
most need (Shucksmith et al. 2007; Weare and Nind 2011). In their meta-
analysis, Zoogman et al. (2015) found twice as much impact on children and
young people drawn from clinical samples (i.e., with a defined problem) com-
pared to non-clinical samples, for example in special schools.
The case for a targeted/universal balance 265
Case Study 1: The impact of targeted mindfulness on children

and young people with mental health problems
Biegel et al. (2009) studied the effects of the Stressed Teen program for children and young
people who were receiving clinical help for a wide range of psychiatric problems. It followed
the adult MBSR course pattern of eight weekly classes of two hours per week and used the
same practices of attention to the breath, body scan, sitting meditation letting thoughts come
and go, mindful movement/yoga, and walking meditation. However, as participants were
young, practices were shorter, on average 20 rather than 40 minutes, and discussion in class
focused on issues relevant to these young people, including self-image, life transitions, self-
harming behaviors, and relationships. For homework students were asked to pay mindful
attention to selected routine, day-to-day activities. All received a workbook to reinforce the
instruction and a CD with sitting and body scan meditations for at-home practice.
One hundred and four children and young people were eligible to take part and were ran-
domly allocated to control and experimental groups, with 74 of them completing all three
phases of the assessment. When compared with the control group (who received the interven-
tion later), those who received the course reported reduced symptoms of anxiety, depression,
and somatic distress (i.e., physical symptoms thought to be caused by psychological prob-
lems), an overall sense of well-being, increased self-esteem, and better sleep.
However, although targeted inputs have the most impact in absolute terms, the
case is clear for a balance that also includes universal mental health interven-
tions that attempt to push the whole population toward a state of optimal men-
tal health, or “flourishing” (Huppert 2014). The mental health promotion
paradigm has shifted in recent years away from a focus on pathology alone to
include the positive, with a surge of energy under various banners, including
positive psychology, flourishing, well-being, resilience, strengths, and capaci-
ties. There is growing interest in interventions and policies that put subjective
well-being at the center and have the potential to increase the level of well-being
across the population. Newer approaches such as mindfulness are very much a
part of this shift in offering a helpful intervention for all across the mental
health spectrum (Huppert 2014; Keyes 2002).
The evidence is that universal approaches appear to help people who are
“doing well” to experience even better mental health and at the same time have
their greatest impact on those at the sharp end of difficulty (Adi et al. 2007;
Huppert 2014; Weare and Nind 2011). Many children and their carers never
seek clinical interventions for emotional disorders (Farrell and Barrett 2007)
and so providing universal programs is a vital way to reach a needy and under-
served population. Providing a universal entitlement helps avoid the perni-
cious problem of stigma almost invariably associated with targeting, which
makes those most in need of help reluctant to attend or to cooperate. Universal
entitlement also creates a humane and respectful culture and ethos that helps
everyone, including those “without problems,” to support young people “with
problems.” In such a context, the needs of the more vulnerable can be better
understood, and the overall environment is therapeutic rather than toxic,
avoiding recreating the conditions under which people’s problems return or
increase.
We turn now to look in more detail at the outcomes of mindfulness practice
for children and young people, beginning by examining the impact on mental
health problems.
Specific mental health outcomes

Depression
A positive impact on depression is one of the most common outcomes of
mindfulness for adults (NICE 2009) and a growing number of studies report a
reliable impact on child and adolescent depression from a wide range of differ-
ent interventions (e.g., Biegel et al. 2009; see Case Study 1). As with adults, this
impact appears to be connected to the role of mindfulness in reducing worry
by allowing people to gain a sense of space and objectivity around their
thoughts and “unhook” from the automatic pilot of circular negative rumin-
ation (Hölzel et al. 2011b; Ma and Teasdale 2004). Case Study 2 illustrates the
content and evaluation of a program from the UK that is having clear impacts
on depression.
Case Study 2: The impact of a universal approach to mindfulness

on depression in teenagers
The Mindfulness in Schools curriculum (Mindfulness in Schools 2014) from the UK is
aimed at teens and is a nine-week course of one session a week. It takes place in normal lesson
time and is supported by home practice. The overall content is based loosely on the MBSR
course and includes the basic practices of mindfulness of breath and of body, the passing
nature of thoughts, mindful eating, mindful walking, and dealing with stress. It is supported
by a manual, an indicative script for teachers, and a student booklet. The course designers,
who are classroom teachers, focused particularly on making the program attractive to teens,
with interactive, experiential, and lively teaching methods and high quality resources, includ-
ing film clips, and challenging and often edgy activities, such as the mindful eating of hot
chilli and a ‘shockball’ game.
The program was evaluated in a non-randomized controlled study of a sample of 522
young people aged 12 to 16 in 12 secondary schools (Kuyken et al. 2013). Young people in
the intervention group reported significantly fewer depressive symptoms post-treatment
and at three-month follow-up, and lower stress and greater well-being at follow-up.
Although young people benefitted whether or not they practiced, greater home practice was
significantly associated with better outcomes such as greater well-being and less stress at
follow-up.
On well-being and “flourishing,” including emotional regulation 267
Anxiety
Anxiety is the most reported mental health problem among children, often co-
occurring with depression. The pressurized, multi-tasking nature of modern
life appears to be making anxiety a chronic problem for many young people. It
often persists into adulthood, and causes impairment in many areas of life. Sev-
eral mindfulness interventions have shown an impact on anxiety in the young
(e.g., Beauchemin et al. 2008; Semple et al. 2005).
Mindfulness appears to impact on anxiety by improving attentional focus
(Semple et al. 2005) and the ability to relax (Woodruff et al. 2014). As with
depression, it offers a way of “catching” recurrent worrying thought processes
and helps the individual to recognize that they are passing mental phenomena
rather than facts (Ma and Teasdale 2004). The ability to reduce anxiety may help
to explain the fairly reliable impact on sleep and eating problems in both adults
and the young (e.g., Biegel et al. 2009; see Case Study 1 earlier.)
Case study 3: Mindfulness impacts on anxiety

in young children
The Attention Academy Program (AAP) from the US was longer than average, and consisted
of 12 sessions of 45 minutes of mindfulness and relaxation over 24 weeks. It employed the
familiar exercises including breath work, body scan, movement, and sensorimotor awareness
activities, and was taught to children aged between five and eight with high anxiety. Napoli
et al. (2005) evaluated it with a methodologically strong study, using an RCT design, a large
sample of 228 participants, and objective measures of attention. There was a significant
improvement in self-rated test anxiety, teacher-rated attention, social skills, and selective
(visual) attention post-treatment, with effect sizes ranging from small to medium.
On well-being and “flourishing,” including

emotional regulation
A number of studies indicate that mindfulness as a trait is associated with better
health and well-being in adults and young people, and that children and teens
who are more mindful generally experience more positive emotion, greater
well-being, and less negative emotion and anxiety (Ciarrochi et al. 2010). The
development of “emotional regulation” is a key foundation for well-being, help-
ing people avoid or overcome mental health problems, serving as a protective
factor against the emergence of psychosomatic symptoms, and underpinning
successful performance and adjustment of all kinds throughout life (Goleman
1996). Emotional regulation includes the ability to control impulses, delay grat-
ification, monitor attention, and make wiser choices as a result. Mindfulness
appears to strengthen this vital skill in both adults and young people (e.g.,
Beauchemin et al. 2008; Zylowska et al. 2007).
Mindfulness in adults impacts on the ability to feel calm and in control of

emotions, to accept experience, to manage difficult feelings, and to be resilient,
motivated, persistent, and optimistic (e.g., Mendelson et al. 2010). Varied short
mindfulness interventions have had a small but measurable impact on young
people’s well-being and emotional regulation. Some of the areas of impact are
on levels of happiness, calmness, self-acceptance, relaxation (e.g., Biegel
et al. 2009; Sibinga and Stewart 2008), and the resilience to manage stress (e.g.
Kuyken et al. 2013), optimism (Schonert-Reichl and Lawlor 2010), and ability
to set goals more effectively (Bogels et al. 2008). A case study of one such pro-
gram is provided in Case Study 4.
Case Study 4: Mindfulness enhances well-being and emotional

regulation in teenagers
The “Learning to BREATHE” curriculum (Learning to Breathe 2014) is an MBSR-based
program adapted for young people. The six lessons or themes are 45 minutes long but designed
to be delivered flexibly. Each follows a predictable format, which includes a short introduc-
tion to the topic, several activities for group participation and discussion to engage students
in the lesson, followed by an opportunity for in-class mindfulness practice. The core practices
as usual include body scan, mindfulness of thoughts, mindfulness of emotions, and mindful
movement, plus the less frequently included loving kindness practice (where students are
invited to bring someone to mind, including themselves, and wish them well). Student work-
books and individual practice CDs for home mindfulness practice are provided to students.
The program was evaluated by Metz et al. (2013). Participants included 216 high school stu-
dents with complete data at pre-test and post-test who participated in the program or teaching as
usual as a comparison group. Students who participated in the program reported statistically
lower levels of perceived stress and psychosomatic complaints, higher emotional regulation
including emotional awareness, access to emotional regulation strategies, and emotional clarity.
On behavior
At least partly through its impact on emotional regulation, mindfulness appears
to help initiate control of difficult behavior. There is a small but rapidly growing
body of work on the measured impact of mindfulness on behavior in the young,
with demonstrable impacts shown so far on ADHD, impulsiveness, aggression,
and oppositional behavior (e.g., Bogels et al. 2008). Mindfulness appears to
increase the capacity to “be with” experience rather than reacting, increasing the
time lapse in brain pathways between the impulse to respond to a stimulus or
thought and the response (Hölzel et al. 2011b), allowing more time for con-
sidered choices to be made. Mindfulness also triggers the relaxation response
and induces a sense of inner calm, and this may also contribute to improvements
in behavior control. This can be helpful for schools, parents, and, of course, for
Impact on academic performance 269
young people themselves, who often have no real understanding of why they get
into difficulties, let alone sufficient ability to control the process.
On relationships with the self and others

Several interventions have shown impacts on social and emotional capacities,
such as self-awareness, self-esteem, and self-acceptance (e.g., Biegel et al. 2009;
Haydicky et al. 2012), on sociability and relationships (e.g., Kerrigan et al. 2010;
Mendelson 2010), and on attunement, including of teachers to their students
(Albrecht et al. 2012). Many mindfulness programs have seen a growth in com-
passion and kindness as a “side effect” of practicing the core attitude of curiosity
and kindness, and some (e.g., the Mindfulness in Schools Project; see Case
Study 2) have added more specific sessions on kindness and compassion as they
have developed. There is currently a growth in school programs (e.g., Mind
with Heart 2014) that combine mindfulness with work to develop attitudes of
empathy and compassion. These contain substantial specific and explicit prac-
tices that focus on a sense of kindness and wishing well to self and others and,
in some cases, on developing ethical actions toward others, social responsibil-
ity, and global awareness (Mind and Life 2014; Wake Up Schools 2014).
Case Study 5: Mindfulness impacts on self-concept and sociability

in young children
Schonert-Reichl and Lawlor (2010) investigated the effects of the Mindful Education program,
a universal intervention delivered by teachers, involving ten lessons, and supported by a teach-
ing manual. The course included the usual MBSR practices of quieting the mind, in this case
listening to a resonating instrument (chime), focusing on the breath, and paying mindful atten-
tion to bodily sensations, thoughts, and feelings. More unusual components included man-
aging negative emotions and negative thinking, positive affirmations and visualizations that
aimed to foster optimism and positive affect, ways to acknowledge the self and others, and work
on making friends. In addition to the mindfulness class, children also practiced mindfulness
meditation three times a day in normal classes for a few minutes at a time. There was a signifi-
cant increase in scores on self-report measures of optimism, positive self-concept, and positive
emotions. Teacher reports showed an improvement in social and emotional competence for
children in the intervention group, and a decrease in aggression and oppositional behavior.
Impact on academic performance

Academic learning is seen by most schools as their core task, with well-being
and mental health often being seen as of lower priority and as supports for
learning, especially in secondary schools. Schools are often reluctant to take on
what they see as “someone else’s business,” and if mindfulness is to increase in
mainstream schools, the case has to be made for why efforts put into the promo-
tion of well-being support academic learning.
Fortunately, making this case is becoming easier, for social and emotional
learning in general and for mindfulness in particular. The evidence on the links
between programs to support emotional and social well-being and school
achievement is clear and definitive (Durlak et al. 2011; Zins et al. 2004). There
is a growing body of neuroscience evidence about how the brain/mind/body
works, which turns out to be as one interconnected organism in which emotion
and cognition interact constantly, and where both acute and chronic stress
inhibit healthy brain development and the ability of the higher parts of the
brain to function effectively (LeDoux 1998). Brains need healthy social attach-
ments in order to develop normally (National Research Council and Institute of
Medicine 2000) and perform best when optimally stimulated but not over-
stressed (Csikszentmihalyi 1990).
There is also growing evidence that mindfulness can impact directly on cogni-
tive processes and school achievement. Schools are likely to be particularly
attracted to this, and the underlying sense that mindfulness is about helping
students focus and “pay attention,” abilities central to all learning and often
increasingly lacking in today’s distracted, multi-tasking youngsters. Indeed,
Goleman (2013) argues that the ability to “focus” is for everyone a critical skill
underlying emotional intelligence. The evidence is that mindfulness appears to
enhance awareness and clarity (e.g., Zylowska et al. 2007) and develop metacog-
nition (the ability to stand back from the thought stream and to appraise thoughts
in a reflective manner) (Flook et al. 2010; Schonert-Reichl and Lawlor 2010).
Several programs in schools (e.g., Beauchemin et al. 2008; Franco et al. 2011)
have been associated directly with improvements in academic learning, aca-
demic performance, and school achievement. An example is given in Case
Study 6.
Case Study 6: Mindfulness improves academic

learning in teenagers
A program called Meditación Fluir was taught to first-year high school students in three
schools randomly chosen in a province of southern Spain. It was evaluated in a robust ran-
domized controlled study by Franco et al. (2011). Sixty-one students were allocated at ran-
dom to experimental and control groups; the control group were offered the same program
later. Students were taught a 1½ hour session once a week for ten weeks and were expected to
practice daily for 30 minutes. The course used the familiar MBSR practices of letting thoughts
come and go, observing the breath, and body scan. Class discussion included exploring tales
from the Zen tradition. Significant improvements were found in academic performance of
the participants in Spanish language and literature, foreign languages, and philosophy (the
three subjects examined). Students also improved their self-concept and had reduced anxiety.
Some current developments 271
The authors hypothesized that the academic improvements were causally related to students
feeling better about themselves and having less anxiety when studying.
Mindfulness research increasingly includes measures of cognitive performance

in the assessed potential outcomes, and school programs are increasingly look-
ing to evaluate their results on academic achievements. Such results, if sus-
tained, will be likely to make mindfulness a good deal more attractive to all
mainstream schools, including secondary schools.
Some current developments

We will now explore two key areas in which mindfulness in schools is currently
developing, namely linking with social and emotional learning and with staff
development.
The “missing key” for SEL

Many in education are suggesting that schools need to do more to educate the
heart and character, as well as the intellect. The last few decades have seen schools
increasingly focusing on the mental, social, and emotional health and well-being
of their students, as well as their academic learning. There is a cluster of social and
emotional interventions going under a plethora of names, such as “resilience,”
“life skills,” “character education,” mental health, well-being, and, more recently,
“flourishing,” which attempt to develop this “non-cognitive” side of education.
SEL has been defined as “the processes through which children and adults acquire
and effectively apply the knowledge, attitudes and skills necessary to understand
and manage emotions, set and achieve positive goals, feel and show empathy for
others, establish and maintain positive relationships, and make responsible deci-
sions” (CASEL 2014) and is becoming globally widespread.
The evidence base for the broad thrust of SEL programs’ work is sound and
the best of the interventions, when well implemented, have been shown to be
effective in promoting positive well-being, reducing emotional, behavior, and
social problems, teaching social and emotional skills, and enhancing academic
learning (Zins et al. 2004). A landmark meta-analysis by Durlak et al. (2011)
calculated that the effect sizes from the 207 SEL interventions they reviewed
averaged to an 11% improvement in achievement tests overall. There was also a
25% improvement in social and emotional skills and a 10% decrease in class-
room misbehavior, anxiety, and depression. The effects tended to be maintained
for at least six months after the intervention.
Mindfulness appears to be valuable to add to SEL since it shares many of the
goals of SEL, for example self-awareness, emotional regulation, and empathy. As
Shucksmith et al. (2007) concluded in their review of the field, if we look beneath
the “branding,” effective SEL-type interventions offer a very similar mix of CBT
and social skills training for children in self-regulation, and for parents and
teachers in appropriate relationship building, classroom management, and bet-
ter methods of discipline. Mindfulness can be termed the “missing piece” that
has the potential to work alongside these worthy but generally cognitive, verbal,
and teacher-driven approaches and make them more effective. It can help other-
wise rather cerebral approaches take on the new depth that comes from the
grounded work of quiet exploration of mind and body; the objectivity that
comes with relaxed and acceptant awareness of passing thoughts, feelings, and
sensations; and the empowerment that comes from developing the inner
self-management techniques required to take charge of one’s own growth and
development (Lantieri and Nambiar 2012). In return, basing mindfulness
within SEL is helpful for the development of mindfulness, ensuring the skills
and attitudes that mindfulness meditation is attempting to cultivate are sup-
ported by a wider curriculum, which explores cognitive and real-world implica-
tions in more “normal” classroom and school activities and methodologies.
Starting with school staff

When developing mindfulness in schools, it is generally accepted that it is
important to include (or indeed to begin with) staff, rather than focusing only
on young people (Crane et al. 2010). “Staff ” in this context includes most obvi-
ously teachers, but potentially also others such as support workers, administra-
tive staff, psychologists, therapists, social workers, and youth workers.
Work on the impact of mindfulness on school staff is developing; a recent
search resulted in 27 papers on mindfulness and staff, mainly teachers, of which
16 are interventions, with some evaluated examples of success. An example of the
CARE program that has shown a range of impacts can be found in Case Study 7.
Staff generally experience direct benefits for their own well-being in line with
the well demonstrated impacts of mindfulness on adult mental health prob-
lems, such as reduced depression, anxiety, and stress, and an increased sense of
happiness, calm, and clear-thinking mindfulness. They are in particular need of
this. Working in schools is a particularly tough job, mental health problems are
endemic, and the human and financial costs in terms of staff stress, absentee-
ism, and attrition are high (Brouwers and Tomic 2000). Several well-conducted
studies with teachers have shown a reduction in burnout and stress (e.g., Albre-
cht et al. 2012).
Interestingly, mindfulness also appears to have the attractive benefit of enab-
ling those who work with the young to be more effective in their everyday rou-
tine work. It can improve staff core “people skills,” such as managing emotion,
Conclusions and recommendations for future actions 273
staying calm and in control, attuning more empathically to others with greater
“presence,” managing behavior more effectively, being more flexible and respon-
sive, making better decisions, and staying on track with intentions (Albrecht
et al. 2012; Meiklejohn et al. 2012).
Case Study 7: Mindfulness impacts on teacher well-being,

stress, and effectiveness in the classroom
The Cultivating Awareness and Resilience in Education (CARE) program at the US Gar-
rison Institute (2015) aims to help teachers reduce stress through greater calm and bring
greater awareness into the classroom to enhance their relationships with their students, their
classroom management, and their curricular implementation. It does this through attempt-
ing to promote awareness, presence, compassion, and reflection. The program introduces
mindful awareness activities, such as mindful listening, and silent reflection, and includes
activities that explore how to bring mindfulness to the challenging situations teachers often
encounter.
The CARE program has been subject to an RCT of 50 teachers (Jennings et al. 2013), which
showed that participation resulted in significant improvements in teacher well-being, effi-
cacy, burnout/time-related stress, and mindfulness compared with controls. Qualitative data
showed that teachers felt CARE reduced stress and improved their own performance, and
they reported that their students spent more time on task and showed improvements in aca-
demic performance.
On the strength of this growing evidence, interventions for teachers and others
who work with the young are developing apace. An all-party parliamentary
committee in the UK (New Economics Foundation 2014) has recommended
that mindfulness be incorporated into basic training of the teaching profession.
Conclusions and recommendations for future actions

For those already engaged in mindfulness in schools
There is a strong need for better quality research. Priorities are larger studies
with more power, using an RCT design and longer follow-up, better and more
consistent and standardized measures, and a greater use of real-world measures
such as tests of performance rather than just self-report. Enhancing the research
base will bring toughness and clarity, increase comprehensibility by the public,
and improve acceptability to commissioning and funding agencies that favor
‘evidence-based’ approaches (Shadish et al. 2001).
However, there is a balance to be struck. The view of mindfulness as simply a
set of separate controlled interventions comes from the world of medicine, an
approach that is known to have major limitations when applied to complex
social organizations such as schools (Vogt et al. 2011). It is not a particularly use-
ful guide for how mindfulness is actually likely to have most benefit in schools
and in the lives of the young in the long run, which is integrated into the fabric
of school life. We must take care that the research tail does not wag the dog.
There is clear evidence that teaching of emotional and social skills has
greater and longer-term impact when skills are integrated into the general
classroom curriculum and staff development as a whole, and reinforced in all
interactions across the school (Adi et al. 2007; Berkowitz and Bier 2007). Cur-
rent developments in promoting well-being favor taking a “whole school
approach,” a multi-component view of school that takes in and uses the total-
ity of the school experience to promote well-being. Research over many dec-
ades has shown that multi-component approaches are more effective in
promoting social and emotional well-being than those that focus on only one
or two parts of school life.
In an authentic “whole school approach,” well-being and mental health are
“everyone’s business,” with genuine involvement of all parts of the school,
including all staff, pupils, governors, parents, the community, and outside agen-
cies. The fact that such approaches have proved hard to evaluate, due to their
complexity and multi-causal nature, does not make them any less worthwhile.
There is considerable good quality research that has identified the key
evidence-based elements of an effective whole school approach across a range of
empirical studies and reviews (e.g., Adi et al. 2007; Berkowitz and Bier 2007;
Shucksmith et al. 2007; Weare and Nind 2011). Effective whole school approaches
are founded on a sound, warm, and positive school climate and ethos, under-
pinned by strong human values, played out through humane and consistent
school relationships, policies, and procedures, supported by effective skills-
based work in the classroom and in teacher education, and with the genuine and
coordinated engagement of parents, the community, and supportive agencies
(Durlak et al. 2011). Mindfulness, with its holistic approach to human experi-
ence, its emphasis on hearts as well as minds, and its focus on the development
of practical human skills, has an integral part to play in achieving this vision.
For those new to mindfulness

Those new to mindfulness, including head teachers and policy makers, might
like to look into the now fairly convincing evidence from practice and research
studies and consider its potential to impact not only on the mental health and
well-being of their students and staff, but also on their core business of improv-
ing the quality of students’ learning and staff teaching. When a well-designed
program is well taught, the consensus is clear that schools find mindfulness
attractive, acceptable, easy to integrate into a range of contexts, cost-effective,
and a relatively quick way to help students and staff face the many challenges
and choices the modern world throws at them.
Conclusions and recommendations for future actions 275
However, mindfulness, although good value for the time and money invested
in it, has to be of sufficient quality, and “any old” mindfulness will not do—it is
not a rock-bottom, cheap and easy option to be delivered by anyone with the
help of a script or CD that then brings overnight miracles. The evidence for
mindfulness comes from high-quality programs, taught by educated trainers
with a regular personal practice, and there is no evidence that more random or
dilute interventions are effective. Programs need to be selected with care, good
quality trainers employed, time allowed for it to take effect, and there should be
realistic expectations of modest gains.
Those in schools who would teach mindfulness need to learn it themselves, so
they understand its somewhat paradoxical and non-traditional processes from
within and model the core attitudes of open-minded non-judgmentalism in an
authentic and convincing way (Albrecht et al. 2012; Crane et al. 2010). The ana-
logy is often made with swimming: You would not expect to learn to swim from
someone who had never encountered the physicality of water or the bodily and
emotional experience of swimming in it. Heads and policy makers might at
least have a go at studying mindfulness themselves, to explore its personal value
and appreciate the need for courses to be taught by those with sufficient training
and commitment to understand it from within.
Those who take to mindfulness, and this particular route is not for everyone,
will almost certainly find it helps them to experience, model, and embody the
particular qualities that mindfulness develops, such as flexibility, attention,
open-minded curiosity, kindliness, empathy, compassion, acceptance, and
patience, in their everyday interactions with colleagues and children. These are
not “odd,” left-field qualities, they are the skills and attitudes to which most edu-
cators aspire but that few of us have naturally, and underlie all effective engage-
ment with young people.
Through mindfulness, and the stilling and calming practices it engenders,
schools are starting to help staff and students look inwards as well as outwards,
and manage their minds in a quiet but effective manner that offers new hope to
schools and young people. It is well worth the consideration of anyone involved
in the education of the citizens of tomorrow.
We end with two specific but fairly typical quotations from those who have
experienced a mindfulness course:
I tend to use Mindfulness to create pauses in my day. The sessions I hold for students are
part of my own formal practice, but I do a lot of mindful eating, showering, as well as
more ‘heavy meditation’—20–30 mins sitting session—but not as often as I should. Mind-
fulness practice definitely makes me less reactive and more responsive and also proactive
(instead of moaning). It also has a calming effect around me—students and colleagues.
A-Level Mathematics teacher (Weare 2015)
I’ve been unsuccessfully trying to think of some witty comment that would encourage
other students to practice it, but all I can say is that it gives me the chance to reach my
full potential in all situations in life. With mindfulness I have an option out of the crip-
pling fear, shakes and anxiety that set me back and the chance to believe that I could
achieve my potential . . . The time I’ve invested in mindfulness has proven to be one of
the best choices that I’ve made.
Student on a performing arts course (Mindfulness for Students 2015)
I had practiced yoga regularly for most of my adult life off and on, starting with the
weird line diagrams from Teach Yourself Yoga at a time when no-one I knew was at all
interested. I have no idea why it attracted me but I approached it as a form of physical
exercise, and the striving and competitive way I tackled it is about as far from mindful-
ness as it is possible to get. I was totally impatient with the breathing and relaxation,
just wanting to get to headstands. However, despite myself, I found the classes had
calming and somewhat “other worldly” effects. At one point I wandered into a Buddhist
meditation class and spent an hour doing metta practice (I now realize), which led to an
extraordinary, blissful—and, it transpired, sadly one-off—transcendental experience of
feeling at one with all beings for much of the following day. I thus had meditation on
my bucket list, aware that my driven, perfectionist, and somewhat overbearing person-
ality would benefit from some kind of antidote, but one day, not yet.
In 2002, in the middle of a successful academic career and a thriving social and personal
life, I hit the buffers—as so many people do. My husband and I had adopted a family of
three children who were eight, seven, and three—blithely imagining our competent
personas would enable us to rise above the gloomy prognostications and produce a
happy, balanced family of (possibly grateful!) children. Laughable in retrospect, and the
stress of the reality of dealing with early trauma and the sequelae of attachment dis-
order and mental health problems (in all five of us) was almost certainly what led to the
development of a mysterious and barely understood autoimmune condition. This condi-
tion, complex regional pain syndrome (CRPS), is pretty well impervious to any treatment
or even painkillers, prevented me from walking, was constantly and excruciatingly pain-
ful, and was spreading. In the depths of suicidal despair, in the face of a problem no-one
could “fix,” I was directed to mindfulness by a pain specialist, who himself had no
experience of it but had heard it was helpful. I tracked down a local and wonderful calm,
patient teacher, Mark Bowden, and began the journey into mindfulness—starting with
one-to-one sessions—which saved my life, and did so much else.
My day one discovery was the extraordinary ball of physical tension that constituted my
body, followed by the dawning realization that I had been driving myself and the rest of
my family into the ground with unsurfaced neuroses from my Catholic childhood and
deep-rooted mind-states of shame, guilt, self-dislike, and striving. In the face of gentle
mindfulness practice, the pain and the CRPS condition started subsiding fairly quickly to
become manageable, and have diminished steadily since so that now they are hardly
present. I experienced the “eight-week course” several times over, and resigned from
my post at the university to focus on my personal life, as all this was far more compelling
than becoming Dean of the Faculty. I enrolled in the University of Exeter’s postgraduate
diploma in Mindfulness-based Approaches to train as a mindfulness teacher.
Since then I have taught and practiced mindfulness “as best I can” in a wide variety of
settings. My professional life has revived but now with mindfulness integrated into it
(my specialty is child well-being and social and emotional learning, so the links are
pretty obvious). Trained at the University of Exeter, I am working to develop teaching
and research on mindfulness in schools in various contexts and to move it into public
consciousness. In the course of this work I have been fortunate to work alongside some
extraordinary people, in academia, in schools, and in the contemplative world. They
include my fellow Exeter students, now colleagues, and particularly the redoubtable
Willem Kuyken, Professor at the University of Oxford and role model of the mindful
approach to a huge workload and the longed-for ability to write cryptic e-mails. Also the
phenomenal minds and authentic presence behind the UK mindfulness in schools pro-
gram, Chris Cullen and Richard Burnett. Thich Nhat Hanh’s Plum Village monastics, who
are the sanest people I have met. The quiet wisdom of the staff from Mind and Life, such
as Arthur Zajonc, and the talented people their meetings attract, such as the brilliantly
gritty Guy Claxton. I sit with the effort to find them all inspirational, but noting my
“imposter complex” arising constantly.
It is not all nirvana. I struggle with deep aspects of my own shame and guilt, which
come to greet me on the cushion, especially during lengthy retreats, my impulsiveness,
and my ingrained tendency to turn everything into smart-ass words. I try to use mind-
fulness myself, to help my children and arrive in a state of calmness. And mostly I man-
age it, in the face of some extraordinary difficulties, although sometimes the attunement
and openness of mindfulness goes the other way and I find myself being drawn into
their trauma, self-dislike, and brain fog, with which my mind can easily resonate. I
remind myself that writing about and talking about mindfulness do not in themselves
constitute mindfulness, and you do actually have to do the daily practice if you are to be
able to live it. I remind myself that mindfulness is not the universal panacea, that it will
not in itself make you thinner, fitter, and on top of your workload; that it can alienate
friends if it turns to smugness; and that it works best if part of a balanced life. The best
single piece of advice I have is from the calligraphy from Thich Nhat Hanh on the wall
over my bed—smile and breathe—and if I do nothing else in the day that is at least the
way it starts.
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Part 4
Conclusions
Chapter 13
Meditation: Future theory

and research
Peter Sedlmeier, Juliane Eberth,
and Maika Puta
Introduction
Meditating improves relationships, reduces anxiety and negative emotions, and
strengthens positive aspects of personality; it helps people stay more concen-
trated and boosts learning and memory. These are just some effects found in a
comprehensive meta-analysis that summarized the psychological effects of
meditation for healthy adults found in 163 studies (Sedlmeier et al. 2012).
Another recent meta-analysis that examined the effects of meditation (mostly
mindfulness meditation) on stress-related outcomes (e.g., anxiety, depression,
stress, distress, well-being, positive mood, quality of life, and stress-related
pain) also found moderate effects in diverse adult clinical populations when
compared to nonspecific active controls (Goyal et al. 2014). Why does medita-
tion have these beneficial consequences? The sobering answer to this question
is that we do not know, despite the fact that there have been many studies on the
effects of meditation. These studies differ widely in focus and methods but
almost all contain little or no theoretical background. This lack of theory and,
consequently, of precise hypotheses has led researchers to look at how medita-
tion changes a wide range of both physiological and psychological measures.
Although the psychological (beneficial) effects can be regarded as established,
results in brain research are not clear-cut. There is some indication that medita-
tion affects brain processes and even brain structure (e.g., Cahn and Polich
2006; Clausen et al. 2014; Fox et al. 2014) but as yet there is no satisfactory the-
oretical account for these changes.
There have been attempts to explain how meditation works but these explan-
ations have not been precise enough to allow for stringent empirical tests and
have, for the most part, been ignored by researchers examining the effects of
meditation. Advancing the theory of meditation, we suggest, is the most
important task in meditation research. More trial-and-error research will not
286 Meditation: Future theory and research
yield a better understanding of the processes and effects of meditation. It can,

however, offer hints for where to look. For instance, our recent meta-analysis
(Sedlmeier et al. 2012) found diverging effect sizes for different variables. Large
effects, according to Cohen’s (1988) standards, were found for improvement of
relationships (d = 0.89), reduction of anxiety (d = 0.80), and decrease of nega-
tive emotions (d = 0.73). Medium-sized effects were found for measures of
mindfulness, perception, and attention (all three d = 0.58). And somewhat
smaller, though still substantial, effects were found for improvements in learn-
ing and memory (d = 0.43), decreases in negative personality traits (d = 0.37),
and emotion regulation (d = 0.35). Why these differences? It might be that
meditation has its strongest effects on reducing negative emotions and thereby
also affects other areas, such as relationships and cognitive functioning. How-
ever, the size of effects does not necessarily have to be an indicator for the causal
strength; it could also be that even moderate effects on attention may yield
changes in many other areas, because meditators could become more aware of
their emotions and more focused on their tasks. Again, we do not know yet.
The meta-analysis also identified another important source of variation:
The type of meditation practiced. Because only a few studies were conducted
for each of the meditation techniques, categorization of meditation types was
coarse and yielded only three categories: Transcendental Meditation (TM);
mindfulness meditation; and a third category, into which all remaining tech-
niques were placed. Although these three categories did not differ in their
overall effects, pronounced differences showed up if effects for specific vari-
ables were compared. TM exhibited comparatively large effects for the reduc-
tion of negative emotions, anxiety, and for learning and memory; mindfulness
meditation techniques yielded higher effects than the other two categories
for the reduction of negative personality traits, stress reduction, and the
improvement of attention and mindfulness; and the “other” category had a
comparatively strong effect on measures of cognitive ability. There are even
pronounced differences in effects within specific categories of meditation,
such as mindfulness meditation. For instance, Eberth and Sedlmeier (2012)
found in their meta-analysis on mindfulness meditation that “pure” mindful-
ness meditation yielded larger effects on variables associated with the con-
cept of mindfulness than techniques that also included some bodily
components (MBSR), but that practitioners of the latter attained higher psy-
chological well-being.
These results suggest that theories of meditation might need to be technique
specific: Different meditation techniques might achieve effects through differ-
ent mechanisms. This lack of commonality might also hold for people: Differ-
ent meditators might profit differentially from a given approach. A useful
Toward better theories 287
theory of meditation would specify precise hypotheses about what effects to

expect for different kinds of approaches and different kinds of people.
Another problem of meditation research is deficient research methods. In
our meta-analysis (Sedlmeier et al. 2012) we found 595 studies that satisfied a
first screening (adult meditators from non-clinical populations, with only or
mainly psychological effects reported) but the number of studies that could be
used in the meta-analysis was reduced to 163, largely because of methodo-
logical problems (e.g., no control group, no effect sizes calculable due to miss-
ing information). A similar selection process had to be performed by Goyal
et al. (2014). This indicates a general need for improving methodological skills
in meditation research. There is also a need to develop better techniques of
measurement, including qualitative methods, to capture facets of the processes
involved in meditation for which no questionnaires or established methods of
measurement so far exist (Sedlmeier 2006; 2014). Apart from problems of
measurement, the usual group-comparison designs in meditation research also
have their limits and can cause problems, such as too few individuals to serve as
participants for a specific research question or difficulty in finding a suitable
control group. This calls for some rethinking about useful research designs.
In this chapter, we deal with all three problems of current meditation research
outlined earlier: Deficient theorizing; unsatisfactory measurement; and sub-
optimal research designs (see also Goyal et al. 2014; Ospina et al. 2007). We
begin with suggestions for how theorizing in the field can be improved. Then we
propose better ways to measure effects, and finally we discuss the issue of
research design in meditation research. It will become evident that these three
issues are closely interconnected.
Toward better theories

There are at least three possible starting points for the development of a com-
prehensive theory of meditation. First, it would be useful to summarize and
seek a synthesis of Western approaches to explaining the effects of meditation.
Second, it seems worthwhile to examine the ancient (mostly Indian) philosoph-
ical theories in which meditation is embedded. And third, valuable insights
might be gained from questioning experienced practitioners of meditation.
Western explanations
An early Western explanation of how meditation works was that it was simply a
relaxation technique that yields a “relaxation response” (Benson et al. 1974).
Although it seems plausible to assume that meditation techniques have relaxing
effects (among others), empirical evidence shows that the effects of meditation
on basically all psychological variables exceed the effects of standard relaxation

techniques (Sedlmeier et al. 2012). Moreover, recent findings indicate that at
least some meditation techniques might not yield relaxation effects at all (Ami-
hai and Kozhevnikov 2014; Lumma et al. 2015). So, the “mere relaxation”
explanation can be refuted on empirical grounds.
Most Western theoretical approaches to meditation center on attentional pro-
cesses and their effects. For instance, Lutz et al. (2008) suggested different effects for
meditation techniques that focus attention on a process (e.g., the breath) or object
(e.g., a mantra) and those that cultivate open awareness (i.e., staying mindful to all
sensations and cognitions that come up without becoming attached to them). They
proposed that focused meditation benefits the monitoring faculty that notices
potential distractions, alleviates disengagement from a distracting object without
further involvement, and increases the ability to redirect the focus of attention to
the chosen object. On the other hand, meditation techniques that emphasize open
monitoring increase vigilance and the ability to be attentive moment by moment to
anything that occurs in experience without focusing on any explicit object.
Shapiro et al. (2006) argued that mindfulness meditation improves sustained
attention, deliberate switching between objects or mental contents, and cogni-
tive inhibition of undesirable thoughts, emotions, and sensations. Similarly,
Hölzel et al. (2011) postulated improvement in attention regulation, body
awareness, emotion regulation, and a change in perspective on the self. Improve-
ment of one’s awareness and attention helps in quickly coming back to the pres-
ent moment (Brown et al. 2007). Focusing attention on experience in the
present moment, it is suggested, eventually leads to a less biased reappraisal of
experiences and better emotion regulation, and to a “meta-cognitive aware-
ness.” This meta-cognitive awareness allows meditators to disidentify from
thoughts and emotions and to come to see them not as aspects of the self but
simply as mental events (Baer 2009; Coffey et al. 2010; Garland et al. 2009; Teas-
dale et al. 2002; Teper et al. 2013). There have also been attempts to connect
these and similar postulated results to neurobiological mechanisms (Vago and
Silbersweig 2012). These attempts to explain the effects of meditation within the
context of cognitive psychology are promising, but as yet they have dealt mainly
with one kind of meditative practice (mindfulness meditation), have mostly
centered on a limited selection of potentially relevant processes, and have usu-
ally not been well connected to or embedded in theories and research in cogni-
tion (see Claxton’s Chapter 3 in this volume for a notable exception).
Eastern explanations
Meditation as practiced today is almost always embedded in a spiritual context
that, in most cases, can be traced back to an ancient Indian origin. Therefore,
Toward better theories 289
the literature deriving from that spiritual context also contains theories of
meditation. Of course, such theories are not purely psychological because they
have religious and philosophical content that Western scholars struggle with.
Another problem is that they were mostly developed more than 1000 years ago
and are often written in an “awkward” style and in languages such as Sanskrit
and Pali that produce ambiguities when translated into contemporary Western
languages. Nonetheless, the basis for most of these theories is as empirical as
can be, as they can be assumed to be based on the experiences of what one now-
adays would probably call “very experienced meditators” (e.g., Olendzki 2010;
see also Batchelor’s Chapter 2 in this volume).
There have been some attempts to describe these theories for Western medi-
tation researchers. For instance, Lutz et al. (2007) described in detail three
kinds of practice recommended in a particular strand of Tibetan Buddhism and
explicated hypotheses about what can be expected from each. In another
attempt to make Eastern theories available to Western researchers, Grabovac
et al. (2011) “translated” theoretical aspects contained in a Burmese version of
Theravada Buddhism into a cognitive model. A more comprehensive approach
was used by Sedlmeier and Srinivas (2015). They extracted the psychological
theories of cognition from two ancient Indian thought systems: (early) Bud-
dhism; and Sankhya-Yoga. These theories not only deal with meditation but are
cognitive theories that embed meditation in a broader theoretical context.
Interestingly, these theories also contain hypotheses that go beyond current
Western mainstream psychology, especially concerning questions of conscious-
ness (e.g., the assumption of “pure consciousness” that is non-intentional) and
the mind–brain relationship (mind works independently of the brain).
We recommend not disregarding these Eastern explanations that stem from
empirically grounded insights gathered over millennia. Instead, an attempt
should be made to derive from them and to make these hypotheses (e.g., that
mind is not merely an epiphenomenon of the brain but instead uses it as a tool) as
precise as possible (see Sedlmeier 2014 for more examples of such hypotheses).
Self-reports of experienced meditators

Most meditation techniques can be seen as practice in introspection. Therefore,
one should expect experienced meditators to have very high introspective
accuracy because of their improved attentional capacity and cognitive control
(e.g., Cornelissen 2011; Lutz et al. 2008), an expectation that is backed by some
empirical evidence. For instance, Fox et al. (2012) examined meditation practi-
tioners with a range of 1–15,000 hours of meditation experience and found that
overall meditation experience was a good predictor for individual introspective
accuracy. The results of introspection by very experienced meditators were the
main source for the theories of meditation contained in Indian texts. So, it
seems reasonable that contemporary experienced meditators would also be a
profitable source for the development of a theory of meditation. There is already
an abundance of such accounts in the books written by spiritual teachers, but
there are several pitfalls if introspection is done without some outside control.
It might, for instance, be difficult to separate one’s own experiences from infor-
mation and insights taken from other sources (books, conversations with teach-
ers and fellow meditators, interpretations of experiences, etc.). To access
theory-relevant knowledge of experienced meditators successfully, researchers
probably need at least some basic meditation experience and special (learnable)
skills in guiding unbiased introspection (Vermersch 1999; Wallace 1999).
First attempts to extract a theory of meditation in this way indicate that medi-
tators’ introspections are largely consistent with Indian theoretical approaches
but go well beyond book knowledge (Eberth et al. 2015a). In general, this
method seems to be a good complement to both the theories extracted from
ancient Indian thought systems and Western approaches to explaining medita-
tion. Obviously, such an approach is restricted to mental processes we have
access to, but this access is potentially far better than usually assumed. For
instance, Petitmengin-Peugeot (1999) demonstrated that people can be guided
to become aware of the process of intuitive experiences, and Petitmengin et al.
(2013) showed that expert guidance greatly facilitated the detection of decision
processes that people are usually unaware of.
How can we proceed?

We have proposed three ways to arrive at better theories of meditation. One
could begin with trying to find a unifying framework for the Western approaches
by asking if attentional processes are at the core of the mechanisms involved in
meditation (as we interpret the existing literature) or if there are several (par-
tially independent) basic mechanisms, such as direct effects of meditation on
emotional or cognitive processes that interact with each other. The different
Eastern approaches to explaining the effects of meditation should be made
more precise and an effort should be made to connect them to the Western the-
oretical approaches, complemented by the self-reports of contemporary experi-
enced meditators.
As almost all major forms of meditation are embedded in a spiritual context,
future theories of meditation should include assumptions about the role of such
a context (Sedlmeier et al. 2014). Possible functions of the spiritual context could
be help and motivation in overcoming times of doubt or difficulties meditators
experience in their practice. It could also serve as a framework that allows for
meaningful interpretations of meditation experiences and it might, especially if
Toward better measurement 291
a personal good is involved in the framework, provide solace in times of crisis. It

seems that different spiritual contexts fit different people and, therefore, future
theories should also take personality factors into account, as well as social and
environmental factors, so that it might eventually be possible to make recom-
mendations as to which meditation technique fits a given person best.
Toward better measurement

In the earlier studies on the effects of meditation, many different measure-
ments have been used, often indiscriminately. A theory-guided use of specific
measurements and methods is promising for furthering our understanding of
meditation along with innovation in research. Conventional measurements
such as questionnaires reach their limits in meditation research, especially if
one wants to measure hitherto neglected effects among experienced medita-
tors that are expected to arise with increasing practice. Here, one needs
custom-tailored kinds of measurement that will often be of a qualitative nature.
However, there are already several questionnaires that have been developed
from a Buddhist or Hindu theoretical background and might prove to be use-
ful in meditation research. We give a short overview of these instruments and
then turn to some suggestions for how measurement could be custom-tailored
to meditation research.
Conventional measurement
Most meditation techniques come from a Hindu or Buddhist context and at
least some of the theoretical concepts can be made measurable. In particular,
there have been several attempts to develop questionnaires that measure aspects
of personality described in Hindu thought systems, the three gunas. There have
also been several measures of a central concept in Buddhist practice: Mindful-
ness. In addition, Buddhism also suggests a “personality theory” that can be
operationalized using conventional questionnaire techniques.
Guna questionnaires
According to the ancient Indian thought system of Sankhya, people are com-
posed of three “qualities,” (three gunas)—sattva (purity), rajas (energy), and
tamas (inertia)—which, in their specific mixture, are the basis of a person’s per-
sonality (Dasgupta 1930; Jha 2008). According to Sankhya, people with a high
level of sattva are balanced and mindful, frequently experience positive emo-
tions, and are satisfied with their lives. They are enthusiastic and persevering.
People with a high level of rajas frequently feel stressed and sorrowful; they are
often restless and dissatisfied, pursue money and status, and tend to be selfish in
social relationships. Finally, people with a high level of tamas lack enthusiasm
and energy. They are pessimistic and postpone tasks and problem solving; they
frequently experience negative emotions and are dissatisfied with their lives.
However, the mixture of the three qualities is not seen as stable and the aim
should be to increase the level of sattva: Only if sattva is dominant will a person
be able to achieve well-being and higher spiritual aims.
Empirical evidence, mostly collected by Indian psychologists, indicates some
connections between the concept of the three gunas on the one side and issues
of illness, psychological well-being, and spirituality on the other. The results of
this research are broadly supportive of the Hindu assumptions (for an overview,
see Puta and Sedlmeier 2014). For example, sattva correlated positively with
experiencing positive emotions and self-discipline (Hopkins 2003), short-term
memory and concentration (Sitamma 2005), personal effectiveness and self-
actualizing behavior (Kaur and Sinha 1992), and daily spiritual experiences
(Stempel et al. 2006), and negatively with impulsiveness, neuroticism, and a
vulnerability to stress (Hopkins 2003), attention and thought problems, aggres-
sive behavior (Archana Das and Venu Gopal 2009), phobic anxiety, and feelings
of personal inferiority and inadequacy (Stempel et al. 2006).
Studies have also demonstrated the negative effect of dominant rajas and/or
tamas on health. Both rajas and tamas correlate positively with attention and
thought problems (Archana Das and Venu Gopal 2009), a vulnerability to
stress, neuroticism, angry hostility, and impulsiveness (Hopkins 2003), and
anxiety (Stempel et al. 2006), and negatively with the frequent experience of
positive emotions and self-discipline (Hopkins 2003) and daily spiritual experi-
ences (Stempel et al. 2006). Furthermore, studies show that tamas correlates
positively with occupational stress (Daftuar and Anjuli 1997), psychoticism,
depression, and phobic anxiety (Stempel et al. 2006), aggressive behavior, and
somatic problems (Archana Das and Venu Gopal 2009), and negatively with
short-term memory and concentration (Sitamma 2005). In a recent study, Puta
and Sedlmeier (2015) found further evidence of the relatedness of the gunas to
well-being: Sattva correlated positively and rajas and tamas negatively with life-
satisfaction, positive emotions, physical well-being, work engagement, and
calmness, whereas sattva correlated negatively and rajas and tamas positively
with depressiveness, stress, anger, and tumultuousness.
Several questionnaires have been developed to measure the concept of the
gunas but their quality is poor. All the questionnaires (with one exception:
Shilpa and Murthy 2012) have operationalized only part of the theoretical
model. Furthermore, only two attempts have been made to examine the factor
structure of the questionnaires, one pointing at the need for further research
(Wolf 1998) and the other yielding an extremely short 13-item scale with three
factors that can each be attributed to a respective guna (Bhal and Debnath
2006). Puta and Sedlmeier (2015) attempted to overcome these limitations by

constructing a questionnaire based on a complete theoretical model and by
verifying its factor structure. They found that it was impossible to measure the
gunas across different levels of human experience (like cognition, volition,
social behavior, etc.) in one single scale composed of three factors. The differ-
ences and similarities of items of different behavioral categories seemed
stronger than the differences and similarities of the three guna categories, thus
distorting the factor structure. So, they developed nine separate scales for items
grouped according to different aspects of behavior and experience (cognition,
style of working, emotions, motives, activity level, volition, spiritual orienta-
tion, social behavior, and health). The three guna factors could be found in all
nine scales.
Guna questionnaires could prove especially useful in examining the effects of
meditation and other yoga practices, because the gunas play a dominant role in
the theoretical basis for the Yoga Sutras. These, in turn, are an important basis
of all Hindu approaches to meditation and can be meaningfully connected to
Buddhism (see Sedlmeier and Srinivas 2015; Whiteman 1993).
Mindfulness questionnaires
The concept of mindfulness has attracted much attention recently and is some-
times even used as a synonym for meditation. Interest in the topic has also pro-
duced a number of mindfulness questionnaires. However, one problem in
constructing mindfulness questionnaires is lack of consensus about the concept
(Eberth et al. 2015b), and there might be the additional problem that people
with and without mindfulness training might understand test items differently
(Belzer et al. 2013).
The “original” meaning of mindfulness, as found in the Theravada insight
meditation (vipassana) literature, is a kind of “awareness behavior”: The mind
simply observes the “four foundations of mindfulness”—the body and its pro-
cesses, the feeling tone (positive, negative, and neutral), the mind itself, and the
“Dhammas,” which can be roughly translated as “objects of mind” (see Anālayo
2003 for a comprehensive treatment). The “original” hypothesis is that the cul-
tivation of mindfulness, understood in this way, leads to the experience of intui-
tive wisdom (prajna). However, mindfulness in the “mindfulness literature” can
mean many things: Apart from its original (Buddhist) usage, the term is used to
denote an intervention, a (transient) state, and, most often, a (relatively stable)
trait (Davidson 2010).
Most questionnaires measure trait mindfulness (for an overview see Sauer
et al. 2013). The factor structures of these questionnaires differ widely, ranging
from one factor (e.g., Brown and Ryan 2003) to up to five factors. For instance,
the FFMQ, developed by Baer et al. (2006) assumes the following five factors:
(1) non-reactivity to inner experience; (2) observing/noticing/attending to sen-
sations/perceptions/thoughts/feelings; (3) acting with awareness/automatic
pilot/concentration/non-distraction; (4) describing/labeling with words; and
(5) non-judging of experience. The most important difference between the
existing mindfulness questionnaires seems to be whether they focus on only
present-moment attention or, in addition, include some emotional compo-
nents, such as acceptance of what is happening in the present moment (Sauer
et al. 2013). Unfortunately, there is not yet consensus on what mindfulness
means (Chiesa and Malinowski 2011; Dunne 2011; Grossman 2008). Therefore,
it may be fruitful to either disentangle different definitions and specify what
exactly is meant by mindfulness in order to eventually arrive at a consensus, or
to develop different terms for different elements of mindfulness. The basis for a
specific definition should be a precise theory of meditation. Only then can the
operationalization of the respective concepts of mindfulness into a question-
naire with non-ambiguous items be expected to yield valid results.
Buddhist “temperaments”
One of the central tenets in Buddhism is that there is no enduring self, which
also means that the Western conception of self as a part of one’s personality that
persists over time and situations (e.g., Feist and Feist 2009; Phares and Chaplin
1997) is not fully consistent with the Buddhist view. However, even the Buddha
occasionally used the common ways of describing personality for pragmatic
purposes and his discourses about a “personality theory” were elaborated in a
famous ancient commentary called Visuddhimagga, or “Path of Purification”
(Buddhagosa 2010; see also Kornfield 2009 for a recent rendering). This per-
sonality theory was used to find the most suitable kind of meditation practice
for a given individual. The theory describes six types of personalities, consisting
of three pairs—a negative temperament is always paired with respective posi-
tive tendencies. The greed/faith type is characterized by craving and optimism,
the aversive/discerning type by criticism and clarity, and the deluded/speculative
type by doubt and equanimity (see also Ekman et al. 2005; Schmidt 2009).
Correct practice of meditation is expected to change the “personalities” more
into the respective positive dimension. For instance, greedy types should con-
template old age, sickness, and death to recognize the inherent transience of all
objects and experiences; to develop faith and optimism, aversive types should
learn to relax or notice joy (and not only suffering) to redirect their critical abil-
ities into analytical ones; and deluded types should increase their awareness by
labeling experiences and practicing single-pointed concentration, such as sim-
ple breath meditation. This theory of personality could be used to predict
people’s success in practicing a given kind of meditation or to give advice to

those who are interested in taking up a meditation practice but do not know
which one to choose.
Custom-tailored measurement
Nothing speaks against using conventional methods in meditation research,
such as the questionnaires described in the last section, as long as this is pos-
sible and makes sense. A huge advantage of such methods consists in their easy
use and interpretation. However, some central questions in meditation research
are hard to tackle with conventional quantitative methodological approaches,
for reasons of both content and applicability. For instance, Indian theoretical
approaches to meditation predict changes in cognition (e.g., the experience of
“pure consciousness” or of “emptiness”) that are not (yet) part of Western the-
orizing (Sedlmeier 2014; Sedlmeier and Srinivas 2015). Thus, there would be no
existing theoretical basis for constructing a questionnaire and, in addition, it
might not make much sense even if there was such a theoretical basis: How
would one go about measuring “liberation,” “enlightenment,” or access to “pure
consciousness” with a questionnaire? As long as there is no comprehensive the-
ory of what happens when one meditates in the short and long term, a question-
naire would inevitably miss potentially important issues and it would limit the
kinds of answers that could be given by meditators. Therefore, there seems to be
no way to make progress in meditation research other than to ask meditators in
a suitable way; that is, to apply qualitative methods.
Partly due to Nisbett and Wilson’s (1977) highly influential paper on the
inaccuracy of verbal reports in studies that examined social judgment tasks,
there is still widespread doubt in the scientific community about whether intro-
spection is a reliable source of knowledge. A later review of the evidence (White
1988) showed that Nisbett and Wilson’s analysis was methodologically flawed
and came to a much more positive conclusion about the accessibility of mem-
ory contents. Both analyses were concerned with inexperienced “introspec-
tionists,” whereas meditators can be expected to be highly sensitive and accurate
about their experiences (Fox et al. 2012). But still, even with experienced intro-
spectionists, there are two potential problems with traditional introspectionist
practice. The first problem concerns the disentangling of experiences (the
desired outcome) and interpretations (not desirable at this stage); even experi-
enced meditators might occasionally have problems with this. Using a second
person, trained to detect meditators’ switches to interpretations and able to lead
them back to their experiences, would be the solution (for respective tech-
niques, see Petitmengin 2006; Petitmengin-Peugeot 1999). Whereas this first
problem can be considered a technical one, the second concerns the contents of
meditators’ accounts. These contents might only be understandable by a know-

ledgeable second person, that is, a researcher who is also a meditator or at least
has a basic knowledge of theories of meditation. The “second person” of such an
approach (Varela and Shear 1999) would also be more able to guide meditators’
introspections so they would not miss important aspects of their experience
(see also the section on “Meditators as expert collaborators”).
How can we proceed?

There will, of course, still be many research questions that can be dealt with by
using conventional methods of measurement, especially in evaluation studies
that address changes in beginning meditators (e.g., the effectiveness of mindful-
ness programs in schools or work organizations). Such studies can benefit from
developing theory-guided conventional instruments such as the guna or mind-
fulness questionnaires discussed earlier. Theories of meditation make and will
go on making predictions about processes and changes over time, so it would be
advantageous both for theory development and testing to increasingly use lon-
gitudinal (e.g., daily or weekly) measurement. Last but not least, qualitative
methods will often be the only way to test theories in meditation research
because of the lack of (and difficulty of constructing) suitable conventional
methods of measurement. This holds especially if the researchers’ aim is to find
out more about special effects to be expected with experienced practitioners of
a specific kind of meditation, or if theories of consciousness are to be tested.
Toward better research designs

Meditation research has usually relied on cross-sectional group comparisons
(meditators vs. non-meditators) with either pre/post measurements (often with
randomized control groups) or single measurements (with matched control
groups). This is a feasible approach for relatively simple research questions (e.g., “Is
the meditation group better/superior than the control group in variable X?”).
However, group comparisons involving experienced meditators as participants
can be expected to often suffer from high heterogeneity because these participants
differ in many ways and it might then be difficult to find a control group that
matches the experimental group in all important respects. In other words: Control
of “nuisance variables,” that is variables other than meditation that might also have
an impact on the outcome, is hard to achieve. The ensuing variation in results that
can be expected in such cases makes it difficult to detect even pronounced effects.
Moreover, there might not be so many experienced meditators who are available
for examining a specific research question, thus yielding low sample sizes with low
chances of finding an effect. Connected to the first two points, a third drawback
Toward better research designs 297
with the usual group comparisons is that a single cross-sectional measurement (or
even two such measurements) cannot really capture more detailed and specific
changes over time that might be postulated by more precise theories of medita-
tion. And fourth, more specific, custom-tailored measurements, as postulated
earlier, considering meditators’ personalities and experiences, are hard to make in
a group setting. Therefore, we suggest that designs in meditation research at least
in part move toward the individual and to repeated measurements. Two ways
seem especially appropriate: Single-case experimental designs and designs that
make the role of researcher and meditator in principle exchangeable.
Single-case experimental designs

The central aim of science is causal explanation. In meditation research, we
want, for instance, to find out about causal relationships such as “If I meditate,
my worries diminish,” or “If I practice mindfulness meditation, my mindfulness
will grow.” The basic procedure for arriving at causal explanations in science is
to perform “true” experiments, in which one or more independent variables are
manipulated (e.g., meditation training: Yes or no) and all other potential causal
factors (such as gender, age, education, motivation, etc.) are controlled for. In
true experiments this control is achieved by dividing participants randomly
between the experimental group(s) (e.g., meditators) and a control group (e.g.,
non-meditators). This randomization procedure guarantees that all variables
that also might have an impact on the dependent variable(s) on average have the
same or similar effects in both the experimental and the control group and so
cannot systematically influence the difference in outcomes for the two groups.
If, then, a difference between groups (e.g., meditators and non-meditators) is
found, it can be concluded with high confidence (the height of this confidence
depends on how well all parts of the study were operationalized) that it must be
due to the manipulation of the independent variable (e.g., some people medi-
tated and others did not). Randomization works well with large samples, less
well with small samples, and not at all well with individuals.
The difference between any single-case design and single-case experimental
designs consists in some kind of randomization that is a central ingredient in
the latter (for a good introduction and overview see Barlow et al. 2009). This
randomization obviously cannot be done over people. Instead it is done over
time for a given person. The basic idea in single-case experimental designs is
that the treatment(s) or intervention(s) are administered at randomly chosen
points or intervals in time and then compared to baseline intervals or intervals
of other treatments. Similar to randomization over people in group designs,
randomization over time in single-case experimental designs controls for
causal influences other than the independent variable(s) in question.
Probably the best known kinds of single-case designs are A–B–A designs or
variations thereof (e.g., A–B–A–B, etc.) that begin with a baseline (A), intro-
duce a treatment (B), and then withdraw the treatment again (A). Such designs
are appropriate for examining whether a treatment is effective in principle but
they target treatments that are not assumed to have lasting effects, as would be
expected for meditation practice. However, a variation of this kind of design
might be of some value in meditation research and will be briefly discussed
later. More appropriate for examining the effects of meditation are multiple-
baseline designs and, for special kinds of research questions, alternating-
treatment designs.
Multiple-baseline designs
If meditation has an effect on some variable, one cannot expect this effect to
vanish more or less completely once practitioners temporarily quit their medi-
tation practice. Therefore, the usual A–B–A designs would not be a good choice.
However, if meditation works in a specific way, one should see the effect in
question irrespective of when meditators begin their practice. So, if it would be
possible to demonstrate that there is a strong contingency between practicing a
given meditation technique and a certain effect, irrespective of when the prac-
tice starts, this would be a strong argument for the causal role of this meditation
practice. If meditators are randomly assigned a starting point in time, factors
that change over time are controlled for, and if there is then a systematic pattern
in the dependent variable that is similar for all participants, the results can be
generalized if the selection of participants is representative.
Figure 13.1 illustrates the outcome of a hypothetical study on the effects of
meditation in a multiple-baseline design with three male and three female par-
ticipants who began their meditation at randomly chosen points in time, after
two, three, or four weeks of baseline measurement. The hypothetical results in
Figure 13.1 show a clear picture. After the onset of meditation practice, there is
a pronounced effect; this, however, decreases again for the male but not the
female participants.
Multiple-baseline designs of this type have been used in studies that looked
at the effects of some specific meditation techniques. For instance, Singh et al.
(2011a) examined the effects of a mindfulness-based procedure they called
“Meditation on the Soles of the Feet” to control physical aggression of children
with Asperger syndrome; and Singh et al. (2011b) studied the impact of a com-
bination of this procedure and another one they called “Mindful Observation
of Thoughts” on the behavior of adult sexual offenders with intellectual disa-
bility. In both studies, results indicated that the meditation procedures were
effective.
Baseline Training Baseline Training
20 20
15 15
10 10
5 5
Ana Jörg
0 0
Mean Score / Week

Mean Score / Week
20 20
15 15
10 10
5 5
Jessie Oscar
0 0
20 20
Toward better research designs

15 15
10 10
5 5
Paula Rafael
0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Week Week
Fig. 13.1 Illustration of a multiple-baseline design.
299
Usually, when examining meditators, the length of the baseline measure-

ments will be varied across different participants. But sometimes, it might also
make sense to examine multiple baselines for different interventions for the
same meditator. For instance, one might be interested in examining the effects
of combining two meditation techniques and in the order effect in so doing. So,
each meditator would, at a randomly chosen point in time, begin with one tech-
nique (e.g., some kind of focused meditation) and later, at another randomly
chosen point in time, add a second technique (e.g., some kind of open aware-
ness practice), with order of techniques again chosen randomly over medita-
tors. If systematic patterns emerge for meditators in a given condition,
irrespective of the random timing, this could be regarded as good evidence for
some causal (and potentially differential) effects of the respective techniques
and combinations thereof. But also apparently unsystematic results could be
very informative, if differences in patterns could be related to the specifics (e.g.,
personality, social context, health condition, demographic variables, etc.) of
different meditators.
If more than a few meditators take part in a study that uses a multiple-baseline
design, nothing speaks against the usual group comparisons. Actually, a con-
ventional waiting-group design could also be set up as a dual-baseline design
with, say, a baseline of one week for the members of one group and a baseline of
five weeks for the members of the other group (with random assignment to
groups). The group comparison could, for instance, take place just before the
second group begins their practice. In addition to a group comparison, one
would have several kinds of additional information. One would know about the
variation of effects over time, both within and across all participants, and one
would have information about any systematic influences over time other than
the effects of meditation (by analyzing the baseline data of the second group).
Alternating-treatment designs
If the main aim of a study was to discover if techniques differ in their effects
(e.g., their effectiveness) concerning changes in some dependent variable,
another single-case experimental design might be more appropriate: The
alternating-treatment design. In this design, periods of different treatments are
administered at randomly chosen intervals for each individual. Figure 13.2
gives a hypothetical example. Two meditation techniques (Treatment A and
Treatment B) are administered for one week each in a randomly chosen order
for a given participant. If the number of measurement points is not very large
(such as the eight weeks depicted in Figure 13.2), one might want to restrict
the random process by, for instance, not allowing more than two weeks in suc-
cession for a given meditation technique.
Toward better research designs 301
70
PERCENT IMPROVEMENT
60
50
40 TREATMENT A
30
TREATMENT B
20
10
0
A B B A B A A B TREATMENT
1 2 3 4 5 6 7 8 WEEK
Fig. 13.2 Illustration of an alternating-treatment design.
A great advantage of alternating-treatment designs is that they automatically

control for potential causal effects other than the independent variable (e.g.,
meditation technique A versus meditation technique B, or meditation versus
no meditation). For instance, Figure 13.2 shows a general upward trend that is
common for both Treatment A and Treatment B. This trend might be due to
some mechanism shared by the two treatments or to other unknown processes.
The important point is that such common or additional causal factors are auto-
matically controlled for in alternating-treatment designs. The effect in question
is the difference between the two (or more) treatments. And this effect will
always be seen by looking at the difference in the lines that connect the meas-
urements for the different types of treatments. In Figure 13.2, the two lines are
more or less parallel, indicating a general superiority of Treatment A, but
another angle of the lines might lead to other conclusions that could be seen
immediately (e.g., initial difference but eventual convergence of effects).
Other designs
Even the classic A–B–A design (and extensions thereof, such as A–B–A–B, etc.)
might be useful in meditation research if one is interested in the stability of
meditation effects. What happens if, after having practiced a meditation tech-
nique for a month or any other randomly chosen time interval, people cease to
meditate? What happens when they begin again? One might also be interested
in a dose effect. What happens if meditators change the amount of time they
spend on their daily meditation? Would, for instance, a meditation retreat with
continually increasing meditation times per day (e.g., A–B2 h–B3 h–B4 h–B5 h–
B6 h–A) be more effective than one with an identical overall time but constant
daily meditation times (e.g., A–B4 h–B4 h–B4 h–B4 h–B4 h–A)?
In sum, single-case experimental designs are a promising alternative to con-

ventional group designs. But far from being only a substitute for group designs,
single-case experimental designs offer much higher flexibility and allow the
examination of hypotheses and questions (especially about changes over time)
that are not feasible in group designs.
Meditators as expert collaborators

In the section on custom-tailored measurement, we argued that meditation
research would profit from a “second-person” approach, in which a researcher
who is both knowledgeable in qualitative methods and in meditation research
collaborates with an experienced meditator. Such a collaborative research effort
can of course be done in many ways and using many kinds of designs, including
single-case experimental designs as described in the earlier section. Especially for
examining cognitive processes of very advanced meditators, the most promising
design might, however, be a researcher–meditator dyad that is based on true equal-
ity (and possibly interchangeability) in the roles of researchers and meditators.
Such a collaboration between experienced meditators and researchers (who
are also meditators) might be the only way to explore very specific questions,
especially those that deal with the ultimate aim of meditation according to the
original Indian approaches, termed enlightenment, liberation, nirvana, or
moksa, among other names. But irrespective of the research question pursued,
the collaborative endeavor would have several advantages compared to the
traditional researcher–participant set-up. First, research on advanced topics of
meditation needs a trusting relationship between researcher and meditator,
which might be fostered by shared experiential background. Second, such a
common background would enable the researcher to understand the collabora-
tor’s utterances more easily than experimenters with no respective experiences.
And third, as meditation practice is usually expected to go along with an
increasingly less biased perception of one’s inner processes, “measurements”
can also be expected to be more precise on the meditator’s side and to be inter-
preted with less bias by the researcher. In the ideal case, meditation research
would be conducted by experienced meditators and experienced researchers
who could interchange their roles at any time.
However, this kind of research, of course, also faces challenges such as collusions
between researchers and meditators, or shared delusions. It can only be expected
to work if researchers’ and meditators’ experiences and findings are made available
in an unfiltered way and are replicated by independent dyads. These potential
problems notwithstanding, it seems that there is no other way to get a satisfactory
and systematic access to the experiences of highly advanced meditators.
Conclusion 303
How can we proceed?

While conventional research designs still have their merits, meditation
research would profit from designs that take into account the meditators’ per-
sonality characteristics and specific experiences, and the peculiarities of the
respective meditation techniques they practice. This can be better done in
single-case designs, and single-case experimental designs seem to be most
appropriate because they allow for causal conclusions due to the random
selection of time intervals, which distinguishes these kinds of designs from
“normal” single-case designs. In general, it seems beneficial, if not necessary,
at least in some cases, that researchers also have some meditation practice
themselves, especially if long-term effects are the topic of research. A good
way to start single-case research in this way might be to consider having a
closer look at selected individuals, even when attempting to do conventional
group research.
Conclusion
Although the effects of meditation have been examined now for several dec-
ades, it seems that systematic meditation research is still at the stage psycho-
therapy research was at about 40 years ago, when predictions about, as well as
evaluations of, different forms of psychotherapy were rather undifferentiated
(see Barlow 2010). The most urgent current task in meditation research is to
make existing theories more precise and comprehensive. In this chapter we
have made suggestions about how researchers might arrive at better theories.
Better theories will lead to better and more specific methods of measurement
being done in research designs that are more appropriate for meditation
research than the ubiquitous group designs.
In this chapter we have mainly dealt with meditation research as if it was a
monolithic endeavor. In fact, there are at least three strands of meditation
research. The oldest deals with therapeutic aspects of meditation (e.g., Wal-
lace and Shapiro 2006; Walsh and Shapiro 2006). A second strand deals with
the psychophysical effects of meditation and is currently receiving much
attention. The third strand deals with psychological effects for non-clinical
practitioners. This is the approach that is closest to the original use of medita-
tion as part of a path (yoga) to liberation from the limitations of life (Feuer-
stein 2001). The arguments for improving theories, measurements, and
designs in meditation research advanced in this chapter are equally relevant
for all three strands, and it is certainly worthwhile to put our collected efforts
into that improvement.

Peter Sedlmeier
I was already drawn to meditation and yoga in my youth and tried several techniques I
learned from books. Eventually I received an introduction to Transcendental Meditation,
which I then practiced for about a year. This period of my life culminated in a half-year jour-
ney to India and Nepal, where I had some personal encounters with yoga teachers and
people practicing Aurobindo’s Integral Yoga. Then, after having begun to study psychology, I
abandoned meditation and yoga. Only about 13 years ago, shortly after I got my professor-
ship, I noticed that something was missing in my life and I resumed my meditation practice:
This time Zen meditation (a mixture of Rinzai and Soto), under the guidance of an Indian Zen
master. This is what feels good for me and what I have been continually practicing since
then, notwithstanding an excursion into the Theravada world (a month-long retreat in a Thai
monastery in the tradition of Mahasi Sayadaw). My daily practice consists of a short yoga
routine and one daily sitting, interspersed with regular periods of more intense meditation
practice, including week-long silent retreats (Sesshins) in Germany and India.
In the winter of 2004, during a sabbatical in India, I began to combine my practice with
an interest in the theoretical foundations of meditation and first met with Indian philo-
sophers at Pondicherry University and members of a loose nationwide Indian organiza-
tion consisting of psychologists, philosophers, linguists, and others who propagate
Indian psychology in the sense of “psychology that goes back to the Vedas.” Since then,
together with my Indian colleagues, I have tried to find out what the psychological the-
ories contained in ancient Indian texts have to contribute to a theory of meditation. This
sabbatical was also the starting point for including issues of meditation in the areas I
am exploring in my research, and since then I have also supervised students who are
interested in working on topics that have to do with meditation.
Meanwhile, especially after completing a meta-analysis on the psychological effects of
meditation, but also by watching myself and companion meditators, I have become
convinced that meditation works. However, it seems that the more I learn about medi-
tation, the more new questions come up. I find it especially interesting and important to
also have a systematic look at advanced effects of meditation as postulated by basically
all Indian theoretical approaches. This is not an easy enterprise. My Indian colleagues
tend to argue that science does not provide the right means to look at meditation and
spirituality, while many of my Western colleagues think that the topic is not worthy of
scientific examination because the Indian theoretical background, especially, is esoteric,
cannot be disentangled from religion, and is full of unfounded beliefs—in one word:
Unscientific. I don’t agree with either opinion but I think that such views can only be
overcome if meditation research is done open-mindedly and if we are willing to use all
available resources that the scientific method can supply. The value of meditation
should not be a matter of belief and ideology but of empirical evidence.

Juliane Eberth
When I was 14, in school we talked about the principles of Buddhism. I became inter-
ested in Buddhism and increasingly incorporated Buddhist ideas into my way of thinking.
Later, I began studying psychology and was very interested in happiness research. When
studying the literature on happiness and well-being, I came across many ideas that con-
curred with Buddhist thought. I began reading books by Buddhist monks. They strongly
recommended trying meditation instead of engaging only cognitively in Buddhist
thought. Lacking a meditation center or teacher in the vicinity, I attended a mindfulness-
based stress reduction program where people are taught various meditation practices
(observing breath, mindfulness meditation, loving kindness meditation, and others).
Afterward, I kept on meditating, sometimes with a newly founded meditation group.
While doing research on the effects of meditation, I stopped practicing. I was increas-
ingly satisfied with the cognitive engagement. Nevertheless, with informal practice, I’ve
been trying to be constantly aware of the impermanence of everything and to behave
accordingly. During my pregnancy, I attended a hatha yoga program and re-established
my meditation practice. Still, the Buddhist ideas continue to stir my interest. I deem it
essential to my life to endeavor to keep the Buddhist mindset every single day; for me,
formal practice is important for achieving this goal.

Maika Puta
I meditated for the first time in 2003 while visiting a program at a bhakti yoga center. I
was accompanying a friend and didn’t really know what to expect. Part of the program
included a mantra meditation on the Hare Krishna mantra, in the form of singing the
mantra together. The mantra and music touched me, but I also remember wondering
how the others managed to be so absorbed in the meditation for a whole hour without
getting bored or distracted. I don’t know what I would have thought if I had known that
this is actually one of the easiest kinds of meditation due to the support of the music
and congregation. I was intrigued by the thought of shaping my inner life with regular
practice and first started experimenting with meditation by singing the mantra ran-
domly during the day. In the following months my interest in bhakti yoga bloomed and
at some point I reserved a place for focused silent mantra meditation in my daily life—a
place that remains.
In the bhakti yoga philosophy, mantras are compared to touchstones. Reflecting on the
effects mantra meditation has had on my life, I cannot think of a more fitting comparison.
Meditation has been a touchstone for my mind and heart. Most importantly it has intro-
duced me to unprecedented and profound peace of mind, happiness, and love. Over the
years the practice has finely woven itself into the fabric of my life. On the one hand, it dir-
ectly strengthens and influences me and on the other hand I have molded my life so that it
supports the meditation. I have found that the depth of my meditation is not an isolated
experience, but that it reflects my life and firmly rests on the way I act and, most import-
antly, think outside of the practice. In this way, meditation has grown from an experiment
to a practice and way of life. Meditation—during and outside of the practice itself—
continues to be my greatest adventure and I look forward to the experiences that await me.
Acknowledgment
We thank Guadalupe Peralta-Ramos for her precious help in preparing the
figures.
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Chapter 14
How meditation changes lives:

Practice, research, and personal
journeys
Michael A. West
The start of the day. Getting up, showered and to the

garden to sit on a cushion in the gazebo by the pond.
Drifting from here and now presence into thoughts of
the talk I gave in London earlier in the week. And back
again. A bumble bee floating by. Thoughts about the
meetings coming up today. And back to presence.
Settling back each time into an open and contented
orientation to nowness. Moments, periods of clear
awareness. And thoughts about the way we humans
manage our collective affairs—imprisonment for
transgressors in most societies. The futility of so much
in our political systems. And is the exploration of our
consciousness via meditation a solution? And back
again to awareness of the present moment. Presence.
The peace and clarity and unbounded, quiet import of
presence—being present. What is this practice?
Concentration and enquiry

A number of themes have appeared and reappeared across the chapters of this
book. One powerful theme is the exploration of the processes or mechanisms of
meditation. Martine Batchelor’s chapter draws on her long experience as a practi-
tioner and teacher of meditation in a variety of contexts (Korea, England, and
France) and her profound understanding of Buddhist teachings. The chapter sug-
gests that there are two core elements of meditation: Concentration and enquiry.
312 How meditation changes lives: Practice, research, and personal journeys
The necessary first component is concentration. During meditation, the practi-

tioner narrows attention to a single focus such as the breath, a mantra, or to aware-
ness of the present moment. Regardless of whether the meditation involves
focused awareness or opening up to all in the present moment, the practice
involves concentration (with more or less intensity) on one aspect of experience—
such as the experience of here and now, the experience of the self, a candle flame,
or the intent to cultivate compassion toward others. Meditation is a training of
attention; the development of attentional discipline. How this is achieved can vary
from a permissive, gentle coaxing of attention when it wanders through to a more
deliberate and “muscular” determination to discipline the wayward mind.
The second element describes the exploration of experience, whether through
sensation, awareness, or intellectual engagement with what arises both during
and outside of meditation. By not only being aware of experience, but also
engaging with it, we become more informed and curious about the conse-
quences of the concentration processes of meditation. As negative thoughts
arise or fantasies about our success bubble up in our minds, we can observe and
explore them through a process of enquiry. Our curiosity enables us to interro-
gate our experience and derive a deeper appreciation if not understanding, but
only if we accept rather than avoid, suppress, or seek out these thoughts and
sensations. Martine Batchelor argues that the combination of enquiry with con-
centration ensures we are not simply increasing our awareness of the contents
of consciousness but nurturing the conditions for a more creative awareness.
Through meditation practice we develop a less filtered, stereotypic, and habit-
ually categorical orientation to our experience, enabling us to taste the moments
of our experience rather than responding with pre-scripted appreciation or
with habituated neutrality. In this sense, she suggests, our awareness is more
creative both during and as a result of meditation practice. The value of this
enquiry element of meditation practice to our recognition of our conditioning
is emphasized by other contributors throughout the book.
The “microgenesis” of experience

Guy Claxton (in Chapter 3) adopts an embodied cognition perspective to
explore how the “microgenesis” of moment-to-moment experience is revealed
through regular meditation practice. Using metaphors, he describes how we are
generally unaware of the subtle processes by which cognitions and feelings
manifest. Cognitions, for example, may unfurl from subtle cues in our environ-
ment, so subtle that we are unaware of them. Feelings too may “well up,” build-
ing to a point where we become aware of them (e.g., as a lump in the throat
during the narration of a tragic story). But through the process of repeatedly
Loosening the bonds of social conditioning 313
paying attention (through concentration and enquiry) via meditation practice,

over time we become gradually more aware of these subtle processes as they
become conscious, rising to the surface like bubbles. With practice, we catch
them earlier in their upward drift and understand more of their genesis. My
vague feeling of discomfort is associated with the sound of a distant voice that
seemed tinged with anger, which I had barely noticed. And, as a result, my cur-
rent actions are somehow unfolding in a defensive and anxious way. Guy Clax-
ton suggests that our crude binary distinction between what is conscious and
unconscious is revealed by meditation practice to be masking what is in reality
a gradual slope that we can explore. The practice of meditation changes our
awareness by retraining our sensitivity so we break the hypnotic spell that allows
us only to see the bubbles when they break noisily on the surface of the water.
Loosening the bonds of social conditioning

Another theme is the recognition of and, thereby, increasing freedom from
social conditioning. Our experiences are shaped by society, by language, by the
myriad consensus constructions of our social worlds. We are trapped in cages
of perception shaped by our cultures and by the bombardment from social
media, television, conversations, advertisements, indeed all the information
intensity of modern society. Such stimulus intensity leaves us struggling to
appreciate this moment; to engage with our moment-to-moment being in this
vast, mysterious universe. Instead, our moments are dominated by transient
and superficial concerns with status, power, money, and reputation. Our need
to manage impressions has us anxiously checking and rechecking our appear-
ance both physically and behaviorally to ensure we garner good will and respect,
and avoid at all costs (including the cost of simply being) negative judgments of
others. We spend much of our lives lost in thought, ruminating about the past
and planning for the future. And the richness of the present moment passes us
by; it is lost to us, except for rare moments when the clouds seem to part and we
experience the blue sky of this moment.
Our construction of our lives is as passive recipients of scripts handed to us
through socialization and social interaction; and we are so caught in the cage of
these human constructions that we find it difficult to fly free in the infinite
potential of the present moment. By catching our experience in the process of
unfurling we become aware of these constructions and cages; little by little at
first but with increasing stability as we practice meditation. And by slowing
down the process of unfurling, we develop an increasingly powerful awareness
of both the thought and emotional processes we are enslaved by and thereby
develop the ability to loosen the bonds. We come to realize that we don’t have to
live the scripts we have been handed. As Guy Claxton points out, by stabilizing
attention though meditation practice we can hold it steadily at different points
in the unfurling process and see what is going on. We become more aware of
body and cognitive processes, more vigilant to the emerging sensations at earl-
ier stages in their genesis, and we see the extent to which our moment-to-
moment experiences are masked in the social constructions we are programmed
by. We become aware of the matrix we are embedded in. Through meditation
practice, we hear the sound of preconditioned bodily and cognitive processes
earlier and earlier in their genesis, allowing us to exercise choice about the man-
ner of their arrival as full-blown experiences. And crucially, we can connect
more authentically and deeply with those around us.
The desire to find certainty or structure that frees us can also lead to the
reproduction of our entanglements in the very liberating groups and move-
ments we seek. There is the potential for us inadvertently to reconstruct the
cages of our conditioning through membership of spiritual or philosophical
movements that engage our impulsion to conformity—be they Buddhist,
Hindu, Christian, mindfulness groups, TM, or whatever. I attended a retreat in
the 1980s led by a revered Tibetan Buddhist lama, who happened to have a cold
that he was sensibly treating by dousing his handkerchief in eucalyptus oil.
Remarkably, many of those attending the retreat began using the remedy
throughout the day, though few had colds. Joining groups that tell us what to
think and perceive and how to behave, or that we seek to conform with, albeit
in the name of liberation, can simply cloud our vision in new ways. Ironically,
membership of the group may be a current pulling in a direction quite opposite
to the process of increasing awareness of the unfurling process.
Tolerance of uncertainty
Much in human society is constructed to reduce uncertainty and insecurity (a
consequence, as James Carmody argues, of our evolved attentional vigilance).
Another theme in this book is that meditation practice can strengthen our tol-
erance of uncertainty, since we are less likely to passively categorize, label, or
trap the birds of our experience in pre-defined cages. By becoming aware of the
shenanigans of the mind and by seeing the undefined nature of experience
more frequently in our meditation practice, we can accept uncertainty (and the
associated insecurity of uncertainty) more comfortably (see the discussion of
this by Watts 2011). By maintaining an attitude of openness and acceptance
during meditation practice, uncertainty, ambiguity, and insecurity become
more the comfortable norm than the threat-arousing exception. Perhaps we are
then more able to be at peace with the broader uncertainty, ambiguity, and
Becoming less threatened and more vigilant 315
insecurity of our existence as a consequence. And because of that greater peace,

we can more readily embrace the reality of the present moment without it
threatening to tip us into existential anxiety or terror.
James Carmody’s evolutionary perspective highlights our evolved vigilance-
related attending—vigilance to opportunity (food, mates, safe places to sleep)
and more powerfully to threats (predators, hostile others, approaching storms).
This vigilance creates an almost perpetual state of at least vague unease or dis-
satisfaction as we strive to avoid danger or increase opportunity. Much of our
experience is consequently distorted—we cannot savor the food we are eating
in this moment if we are anxious about future events or lost in ruminations
about past hurts or shames. And so we seek solutions to our unease by looking
through the lenses of vigilance for further opportunity or threat, when the
problem is those very lenses.
Becoming less threatened and more vigilant

We add to this threat vigilance an internal monologue that overlays our experi-
ence (“I said the wrong thing”; “I wasn’t sufficiently entertaining to be with”; “he
put me down in front of others”), and our affective world is a boulder we must
roll continually uphill. But meditation helps us to be aware of these default men-
tal processes. As Carmody says, meditation will not eradicate this vigilance sys-
tem but can enable us “to work with it more skillfully.” By being more sympathetic
and compassionate toward our experience, we can begin to exercise more choice;
to be less passively susceptible to the threat vigilance processes that filter our
moment-to-moment experience. We can let go of threat and just be more vigilant
to our moment-to-moment experience. We can more skillfully appreciate the
moment without necessarily being carried away by a current of anxiety, instead
choosing to observe the inner monologue and noting it compassionately.
In the process, we find we have more choice about what and how we experi-
ence our moments by learning to be in a more spacious and choiceful way.
Meditation practice is thus a process of learning to engage directly with the
present moment in an open, more contented and accepting rather than threat-
ened (or needful) way. We learn to be aware of sensations, thoughts, and feeling
tones and develop the ability to observe, understand, and accept them in a less
incendiary way than when they are simply unconscious processes that cause us
pain. This can enable us to see our world, material objects, our feelings, our
thoughts, other people, and our wider existence with freshness and curiosity. By
interrupting stressful or painful thoughts through observing them compas-
sionately, we can choose to have the more positive experience of being in the
present moment.
Sense of self and presence

Exploration of the self is a theme across the contributors’ chapters and is an
abiding theme in all traditions that employ meditation practice, since it focuses
us directly on the experience of self. Sitting in meditation is frequently accom-
panied by unfiltered encounters with our self. Here I am sitting in meditation;
there is little other stimulation; there is the experience of a “me”; it is fleeting
and sometimes unsettling; it shifts and changes; sometimes the self seems to
evaporate altogether in the breadth of the present moment as thought dies away
and awareness of nowness fills consciousness. And this undermines the illusion
of a stable, constant self-concept—our experience of our self as a clear and con-
stant presence behind moment-to-moment experience. Meditation is a means
of investigating self, “I-ness,” existence, and being. By paying attention repeat-
edly to the present moment and our subjective experience of it, we become
infused with awareness of the present (we develop “presence”) such that it is
more and more the flavor of our moments. This living awareness of nowness
then becomes a way of being, changing our experience of self—our practice (in
the second sense of practice that Carmody describes as a calling). Our practice
is no longer confined to a cushion but is deliberately strengthened with the con-
sequent gradual changes in the hue of our moment-to-moment experience.
Thus, our meditation practice is both an investigation into the experience of
being (in the present moment) but also enables direct experience of I-ness via
new and sustained awakenings.
What these practices produce over time, according to many practitioners and
researchers, is greater peace, a sense of more profound meaning, more and
deeper joy, and a sense of gratitude and privilege in life (see the discussion in
Chapter 1 for references to this literature). Freed from the narratives of rumina-
tive preoccupation, they suggest, we experience more immediately and directly
the moments of our existence and have the available capacity to see the trees, to
be with those we love, to appreciate the benevolence life has conferred on us,
and to marvel at the fact of our universe, our planet, and the riches of loving
relationships.
Developing compassion
Some meditation practices, such as compassion-focused meditation, are aimed
at equipping us with the ability to cultivate new fields of thought. Rather than
simply observing unfolding thought processes, we can cultivate new mind-
body, thought-feeling fields of activity. I may wish to be a more compassionate
person, paying attention to others (listening with fascination), having empathic
responses, and taking intelligent action to help—the components of compassion
Finding connection 317
(Atkins and Parker 2012). By rehearsing compassion toward myself, toward my

loved ones, toward those I have difficulty with, and all humankind, I begin to
tread into existence new paths of thought and feeling that have neurophysio-
logical reality too (Neff and Germer 2013; Salzberg 2011). The brain develops
new ways of working as a result of these practices and the person becomes more
compassionate (see Gilbert 2013 for an extensive treatment of this perspective).
Several contributors refer to the extent to which meditation may bring us
closer to others. Guy Claxton talks about how, through meditation practice,
altruism can emerge because self-protection and enhancement are no longer so
powerful in separating us from others. The natural motivations we have to altru-
ism and to building strong, close relationships, normally inhibited by self-
protection and self-enhancement (the vigilance processes Carmody describes),
are free to be expressed. The choice that stable attention to the unfurling of those
processes provides the space for altruism and reaching out. The practice of lov-
ing kindness meditation (or compassion meditation) is intended to directly
promote stronger connection and altruism in interactions with others.
Finding connection
A second kind of connection is sought by many meditators or it may emerge as
a natural consequence of long-term practice. Many who practice meditation do
so to achieve some spiritual benefit. They seek a closer union to an absolute,
however labeled, and transcendence—a rising above myopic human affairs to an
understanding and connection with the profound. Loriliai Biernacki describes
how Eastern religions (with the exception of Buddhism) have emphasized a con-
cept of self that encompasses all beings, all materiality, or all existence. Individu-
als are a part of that all-encompassing self but are typically suffering under the
illusion of being separate from it. This duality, Claxton suggests, develops
through our use of language that posits continually and pervasively from infancy
that we embody a separate agent or self, and the metaphor becomes an unob-
served, taken-for-granted reality. We are divided from the rest of existence and,
having experienced the mystery of birth, are condemned to consciously face the
terror of death—of our non-existence and complete separation from all we love
and all that gives us meaning. The alternative perspective argues that all is inte-
gral and connected and that the illusion of our separateness is the problem. If we
experience our indivisibility from and integral connection with all existence,
our terrors, urgencies, anxieties, and illusions fall away. Rather than seeing our-
selves as separate, we recognize that in essence we are of the same stuff as trees,
rocks, planets, etc. We are of existence and manifestations of that universal self
or Self. Rather than “Self ” we could use the notion of interconnectedness.
From Eastern religion too comes the notion of a game of hide and seek that
the Self, that is all existence, plays with itself. And as manifestations of that Self,
we occasionally catch glimpses during the game but fail to complete the game
by seeing that we are one with that Self—we are part of the Indra’s Net of all
existence—a net made up of an infinite number of multifaceted jewels that
reflect all the other jewels. There are different accounts from different religions
of this proposition, each with its own historical coding, but the concept is
largely the same. Through practicing meditation religiously (in both senses),
these traditions propose, we begin to see the illusion of notions of separation
and of an imagined duality of the self and the rest of existence. Instead, we begin
to develop awareness of the omnipresence of this Self that is all existence and
our indivisibility from it. As an intriguing extension, Biernacki describes the
idea from Kashmiri Tantra of our sharing an all-encompassing consciousness
that is continually evolving. This is in contrast to other Eastern conceptions that
see the universal, cosmic Self as unchanging.
Whatever, the idea is that meditation practice can help to free us from the
imprisoning matrix of our self-concept in order to experience our indivisibility
from and reassuring connection with all that is. Wonder arises, according to
many practitioners and writers, when one accesses the sense of self in all its full-
ness through enlightenment experiences or the practice of meditation; then we
understand not just intellectually but experientially our connection with all,
and thereby our indivisibility from all.
These speculations, interpretations, philosophical explorations, and theoret-
ical formulations outstrip the research evidence on the effects and processes of
meditation and stray into the metaphysical. Now we pull the reader smartly
back to the psychological by exploring the extent to which these themes are rep-
licated in neuroscience research.
Neurophysiological research evidence

The fascination with brain studies of meditation that was evident in early
research (Fenwick 1987) continues today. Antonino Raffone (Chapter 10) offers
a clear review of the available evidence on the neuroscience of mindfulness
meditation. A close reading of the relevant research is both intriguing and
instructive. In another recent review of this work, Tang et al. (2015) point out
the many research challenges in this area (not least the enthusiasm with which
the media and practitioners respond to neuroscience findings relating to mind-
fulness and meditation). There is some evidence of changes in brain structure
associated with meditation practice (Fox et al. 2014). Eight brain regions seem
to be consistently affected: The front polar cortex, which might be related to
Neurophysiological research evidence 319
enhanced meta-awareness; the sensory cortices and insula, related to body

awareness; the hippocampus, associated with memory processes; the anterior
cingulate cortex, mid cingulate cortex, and orbitofrontal cortex, which are all
areas related to self and emotion regulation; and the superior longitudinal fas-
ciculus and corpus callosum, areas responsible for intra and inter-hemispheric
communication (Fox et al. 2014). What these changes in brain structure mean
is dependent upon how (and if) they relate to improvements in affective, cogni-
tive, and social function.
Meditation is an attentional exercise and much research in the last ten years
has focused on attentional control and neurophysiological correlates of such
control. Several studies have shown that meditation practices are associated
with improved conflict monitoring—the ability to resist the effects of distract-
ing stimuli, to sustain attention on a specific focus, and to direct attention to
relevant stimuli amongst a range of stimuli. Studies suggest that experienced
meditators have enhanced activation of the anterior cingulate cortex, associated
with executive attention and control (Tang et al. 2015). There is also evidence of
diminished age-related decline in grey matter volume and associated dimin-
ished age-related decline in sustained attention performance (Pagnoni and
Cekic 2007). Although these studies are encouraging, there is a need to deter-
mine whether the neurophysiological changes are related to improved atten-
tional performance.
There is much research evidence for the effects of meditation on emotion
regulation (Brown et al. 2007; Sedlmeier et al. 2012) and some evidence from
neurophysiological studies of associated neural mechanisms. However, the
research suggests the mechanisms may differ between novice and experienced
meditators, with the prefrontal cortex more involved among the former (Tang
et al. 2015). The findings are consistent with the descriptions earlier in this
chapter that novice meditators begin by actively regulating cognitions in order
to overcome habitual ways of reacting to thoughts and emotions, whereas
expert meditators no longer use this form of control because they have devel-
oped an accepting approach toward their experience. There is accumulating
evidence of structural changes in areas of the brain associated with emotion
regulation following meditation practice but we still need to demonstrate
whether these changes are linked to the positive effects of meditation on emo-
tion regulation.
In relation to our discussions of self-awareness earlier, there is some evidence
of structural changes following training in meditation in the default mode net-
work of the brain, which is associated with self-referential processing. This
research suggests diminished activity, consistent with the idea that meditation
enables a detachment from concerns with self enhancement and the need to
identify with the self as a static entity (Brewer et al. 2011; Hasenkamp and
Barselou 2012). There is also some evidence that core regions of the brain asso-
ciated with awareness of present moment experience are affected by meditation
practice. Studies suggest changes in the prefrontal cortex consistent with a more
detached and objective awareness of physical, cognitive, and emotional sensa-
tions and imply the possibility of a state in which awareness itself becomes the
subject of awareness (Farb et al. 2007; Josipovic 2014). The neuroscience of
meditation suggests shifts in self-awareness such that the narrative, evaluative
default option of experiencing self is replaced by both a greater detachment and
awareness of the self and the present moment.
In summary, the best conducted studies of the neuroscience of meditation
offer consistent evidence of changes in the anterior cingulate cortex, prefrontal
cortex, posterior cingulate cortex, insula, striatum, and amygdala—key areas
associated with self-regulation of attention, emotion, and awareness. Fascinat-
ing though all of this is, we are still scraping at the edges of this field of research
and there is a need for many more rigorous and sophisticated studies to help us
in our understanding.
A second theme in this volume is the clear distinction between meditation
practice as a way of living or being and meditation practice as therapy for psy-
chological, physical, or social disorders. What then of the therapeutic applica-
tion of meditation and mindfulness practices?
Therapeutic applications
Vidyamala Burch’s chapter (Chapter 7) provides a poignant and powerful
insight into the reality of dealing with chronic pain, along with suggestions for
how meditation may help in that process. The practice of meditation involves
acceptance of whatever arises, from the minor discomfort associated with a stiff
knee while sitting through to the fear of a sudden confrontation with the experi-
ence of the self and existence. Pain management involves the anticipation and
acceptance of pain and learning to recognize that (like the self) it is changing
rather than constant, temporary rather than permanent, and, to an extent,
amorphous. As with our experience of the self, the more we seek to control,
avoid, or diminish subjective experience, the more difficult and magnified it
seems to become. And the theme of connection emerges in the consideration of
pain with the notion that by learning to have compassion in relation to my own
pain (paying attention to myself, having an empathic response, and taking
intelligent action), I learn to be more compassionate to others in pain—paying
attention to them, having an empathic response, and taking intelligent action to
help (Gilbert 2013; Gilbert and Choden 2013).
Therapeutic applications 321
Linda Carlson, in Chapter 9, echoes these themes. Physical illness often

involves an associated loss of control, stress, feelings of uncertainty about the
future, and profound existential worries, including fear of death. It involves
coping with symptoms and often with noxious, painful treatments. Dealing
with physical illness includes acceptance of change and uncertainty rather
than resistance. And the research on physical illness that Linda Carlson reviews
suggests some benefits of meditation practice, though the mechanisms by
which these benefits occur are, for the most part, unclear. In the treatment of
cancer, the use of mindfulness and meditation practices is associated with
improvements in quality of life, emotional well-being, physical functioning,
stress, anxiety, depression, fear, and avoidance. Meditation is not necessarily
superior to cognitive behavioral therapy (CBT) or support groups but it offers
an important alternative or complement to existing approaches. The evidence
is on balance positive in relation to cancer care and irritable bowel syndrome
(for example) but more questionable in relation to the treatment of heart dis-
ease, diabetes, and HIV. This chapter offers a valuable balance to the literature
and popular writings that portray mindfulness as a miracle intervention,
instead suggesting its value but cautioning about the need for more careful
research.
Similarly, the chapter by Sarah Bowen and colleagues (Chapter 8) on addic-
tion suggests some benefits of meditation practice for addictive disorders. The
theme of developing awareness and nurturing a non-judgmental (accepting)
orientation is echoed here in the sense that such processes help people to see the
triggers for their addictive behaviors before they respond. The unfurling of the
behavior is spotted earlier in the process, to use Guy Claxton’s metaphor. And
the evidence suggests that meditation and mindfulness practices are associated
with reductions in the use of alcohol and illicit drugs, and may have positive
effects for those with eating disorders. However, the research is at an early stage
and meditation and mindfulness are often single components of complex pro-
grams of interventions such as acceptance and commitment therapy (ACT) and
mindfulness-based stress reduction (MBSR) programs. It is difficult to disen-
tangle the effects of mindfulness/meditation practice from the effects of the
other elements of these interventions. For example, ACT has six core elements:
Acceptance of experience; being present in the moment; living in accordance
with one’s values; committed action by setting goals and working to achieve
them; self as context—being able to disengage from crippling self-conceptions;
and cognitive defusion—learning to observe and dilute the effects of our
ruminative preoccupations. Although mindfulness is important as a compo-
nent in all of these elements, it is difficult to determine which elements (includ-
ing mindfulness/meditation) are most potent in helping those with addiction.
And this observation applies to other areas within which meditation is used as
a therapeutic intervention.
Lynn Waelde and Jason Thompson in Chapter 6 illustrate these points very
clearly in their review of meditation and mindfulness as interventions in psy-
chotherapy. Their review also provides a useful counterbalance to the cure-
all claims associated with mindfulness and meditation in the popular press.
The meta-analyses they report suggest that meditation and mindfulness,
when applied in therapeutic contexts, do have small pre/post effects on
depression, anxiety, and pain (Goyal et al. 2014). Mindfulness-based therapy
is generally not significantly more effective than relaxation or cognitive
behavioral therapy at follow-up, although the evidence suggests that mind-
fulness does have consistently positive effects (Khoury et al. 2013; Strauss
et al. 2014). Their chapter echoes the themes we have heard in other chapters
in this volume that mindfulness and meditation may produce its effects via
attention regulation, enhanced body awareness, emotion regulation, and
changes in the sense of self.
Meditation in applied settings

In the two chapters exploring the application of meditation and mindfulness in
work and school settings, there is encouragement for practitioners and
researchers to extend research. It is important to know, regardless of the more
basic scientific questions about the precise mechanisms of efficacy, whether
meditation and mindfulness can help create cultures in schools and workplaces
that are more conducive to human well-being. Katherine Weare’s chapter sug-
gests the value of multi-component interventions in schools to create such cul-
tures (in environments that often suppress learning, motivation, and growth)
and argues for a growth in interventions and research. Frank Bond and col-
leagues in Chapter 11 describe their applications of acceptance and commit-
ment therapy, with strong components of mindfulness, in the workplace. They
have delivered such interventions to over 2000 employees across 50 organiza-
tions and trained hundreds of psychologists to use their interventions for peo-
ple at work. And there is supporting evidence for the powerful effects of such
interventions in the workplace. Fredrickson and colleagues (2008) conducted a
study with 139 working adults, training them in loving kindness meditation
and finding beneficial effects over time on positive emotions, mindfulness, pur-
pose in life, social support, illness symptoms, life satisfaction, and depressive
symptoms.
Both chapters provide impressive evidence of attempts to apply mindfulness
and meditation practices in challenging environments where knowledge about
Personal meditation journeys 323
how to create conditions that enhance human well-being and flourishing is

much needed. Schools and workplaces are often characterized by noise, frenetic
activity, overwork, stress, anger, conflict, and abuse. Finding effective ways to
create conditions that enhance well-being and growth and development is a
core challenge for the discipline of psychology.
Personal meditation journeys

The themes identified across the chapters are replicated too in the contributors’
accounts of their encounters and experiences with meditation practices and
traditions over the years. These accounts vary enormously from initial encoun-
ters with transcendental meditation to reciting the “Ode on Melancholy” for
weeks on end or practicing Zen meditation in South Korea. One contributor
describes her nine-year-old self searching for adult library books on meditation
and yoga and hoping the librarian would not confiscate them. This sense of call-
ing to explore meditative traditions, try out meditation, or respond to the allure
of the esoteric mirrors the theme of meditation as a component of spirituality,
philosophy, or religion.
This is reflected too in the extraordinary dedication to their practice shown
by the contributors. One travelled to Korea to become a nun and practiced
meditation ten hours a day for six months a year for ten years. A number went
to India—several times each (“so once again, I headed off to India”). Others
sought out ashrams that offered yoga training and most dedicated thousands of
hours of practice over the subsequent years. None were dilettantes—this experi-
ence became, in most cases, the grounding for a way of life: “It was the start of a
decades-long immersion in Buddhist practice that included long periods of
solitary retreat.” They describe how, over time, they observed a consistent
change in daily awareness, which became clearer and more powerful over time.
It has become, for many, a core to their way of living, a key component of their
days, and a core element in their philosophy of life. They describe the profound
consequences for their life experience: “Meditation has been a touchstone for
my mind and heart. Most importantly, it has introduced me to unprecedented
and profound peace of mind, happiness, and love . . . the practice has woven
itself into the fabric of my life.” Another contributor described finding many
benefits: “. . . deeper meaning of existence and . . . enhancement of awareness,
wholesome mental states and attitudes, insights about conditioning of the
mind . . . positive reverberations in relationships with others, such as in terms of
more mindful, kind, and compassionate dispositions in the family and at work.”
Why have they pursued meditation? Meditation for most has been an experi-
ential/existential enquiry rather than merely a palliative or a therapy. They
describe learning the value of turning toward the difficult rather than trying to
escape it, in sharp contrast to the idea of using meditation as a means for escap-
ing from neurotic patterns or developing a “superimposed equanimity”: “My
mind could be a tool for healing and well-being and this was an astounding and
unexpected discovery.” As psychologists, most have sought synergy between
their private meditation practice and their work, describing complementarities
such as the “questioning and curiosity that is at the heart of both our meditation
practice and the science with which we study it.” And relishing the opportunity
“to sit smack in the middle of human experience rather than endlessly theoriz-
ing from a safe distance.” For others, there was also the opportunity to share
their own learning about meditation and its benefits with others: “I was over-
joyed to be able to apply what had become a central and very important part of
my personal life . . .”; “The opportunity to share what I have gained in service to
others is an ongoing creative process that gives my life tremendous meaning.”
Another described meditation as like becoming “a mountaineer of the inner
world.”
Such exploration has also been demanding: “It is not all nirvana. I struggle
with deep aspects of my own shame and guilt, which come to greet me on the
cushion.” But there is wisdom too: “. . . the act of introspection is informed now
by years of practice that has shown me the inner calm that emerges when I sus-
pend the ‘power of knowing’ and attend kindly to this moment, this breath.”
And the discovery of powerful touchstones: “The best single advice I have is . . .
smile and breathe . . . And if I do nothing else in the day, that is at least the way
it starts.”
The outcomes of their practices vary; some describe wisdom or a sense of
“presence”; the experience of inner peace even during turbulent times; and
of balance in the activities of daily life: “The meditation practices form an
inner discipline and structure that help me weather all kinds of momentary
and lasting difficulties”; “Infused into daily living, it has all seeped into my
bones and given me a richer register of ways of being an ordinary human
being.” This slow infusion of awareness extended to the management of
acute pain also: “The quiet miracle of my own improvement is the result of
a steady application of gentle effort across a very broad front.” Other out-
comes relate to the simple yet important challenges of daily living: “My chal-
lenge is mindful parenting. I try every day to be in the moment with love
and acceptance for my children, balancing this with necessary limits and
boundaries.” Another reflects that “I find I go mindfully about my daily life.
Choosing what actions to take that are consistent with my values is very use-
ful to me in creating a meaningful life.” Particularly striking in all these
accounts is how many of the contributors describe a sense of privilege,
Conclusions: Meditation research and practice 325
gratitude, and joy—discovering, as one says: “Joy, the inner throb at the
heart of everything, even sadness.”
Conclusions: Meditation research and practice

In the preceding chapter, Peter Sedlmeier and colleagues summarized the chal-
lenges for a psychology of meditation, asking for methodologically better
research. They seek research and research designs and methods that have the
rigor and robustness to advance knowledge rather than only raise more ques-
tions (though looking back to the 1987 precursor to this volume, there has been
huge progress). They also argue for better use of theory and new theory devel-
opment, suggesting particularly the value of translating both ancient and mod-
ern Eastern theory into modern psychology. Using existing psychological
theory to underpin research is vital if we are to avoid the trap of lapsing into the
research question “Does it work?” And they suggest the value of co-designing
and conducting research with experienced meditation practitioners in order
that the gap between research and practice can be reduced.
The contributors to this book are all psychologists who conduct research into
meditation and they are also practitioners of meditation. And it is striking how
their dedication to both pursuits has invested an intensity into their work that
is revealed in their writing. It is also striking that the research questions and
methods they have adopted are (to an extent) divergent from the themes they
describe in their personal journeys. There is a sense in which the perspectives
of contemporary psychology constrain the questions that can be asked and the
research designs that can be used in research in this area. The research they
describe is generally of high quality and is helpful in advancing understanding,
but there is something of a gap between their accounts of personal practice and
experience, and the research approaches employed. This reflects the broader
psychological research literature on meditation.
In another 25 to 30 years, perhaps we will see research that closes the gap
between advances in understanding that arise from research and the percep-
tions of change in self, experience, and relationship with the world that medi-
tation practitioners describe. Such research should help us to understand how
the varieties of meditation practices across cultures and time, described in
Chapter 1, affect our behavior and experience beyond a recognition that they
are perceived as somehow important and experientially powerful. Are they at
minimum simply a way of dealing with distress and unease? Or are they at
most a means of learning to be present in this great mystery so we connect with
each other, our planet, our universe, and our existence more effectively and
compassionately?
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Name index
A Baliki, M. N. 235
Ackerman, D. L. 281 Bambling, M. 146
Adame, D. D. 176 Bankoff, S. M. 188
Adi, Y. 278 Barlow, D. H. 306
Āgāśe, K. S. 115 Barnes, P. M. 146
Aggs, C. 146 Barnes, V. A. 150, 278
Agras, W. S. 191 Barnes-Holmes, D. 257, 258
Aitken, J. A. 71 Barnes-Holmes, Y. 257
Albrecht, N. J. 278 Barnhofer, T. 152
Albrecht, P. M. 278 Barrere, C. 214
Albuquerque, K. 219 Barrett, P. 279
Alexander, C.N. 218 Barrs, B. J. 69
Allman, J. M. 235, 237 Barsalou, L. W. 236, 326
Amaro, H. 188 Barta, M.K. 216
American Cancer Society 213 Baumgarten, M. 218
Amihai, I. 306 Bauza, L. 278
Anālayo, B. 33, 36, 38, 46, 174, 306 Beary, J. F. 22, 306
Anderson, A. K. 147 Beattie, T.L. 214
Andersson, E. 216, 217 Beauchemin, J. 278
Andersson, G. 216 Beck, A. T. 146
Angen, M. 214, 218 Beitel, M. 190
Anjuli 307 Bekkers, M.-J. 148
Antle, M.C. 215 Belsey, J. 174
Apkarian, A. V. 235 Belzer, F. 306
Arch, J. J. 146 Benson, H. 22, 214, 306
Archana Das, G. M. 306 Berkovich-Ohana, A. 236
Archer, T. 149 Berkowitz, M. W. 278
Arendt, M. 215 Bhal, K. T. 306
Armaiz-Pena, G.N. 213 Bhasin, M. K. 256
Armer, J.M. 217 Biegel, G. M. 278
Arnkoff, D. B. 25, 281 Bier, M. C. 278
Arthritis Research UK 159, 174 Biernacki, L. 115
Arvidsson, D. 191 Bishop, S. R. 22, 135, 146
Astin, J. A. 191, 309 Biyanova, T. 147
Atkins, P. 326 Black, D. S. 146
Aubert, A. E. 151 Blackmore, S. 51, 69
Austin, J. H. 174 Blasey, C. 214
Avants, K. 190 Blom, K. 213
Bloom, B. 146
B Blustein, P.K. 219
Babuscio, T. A. 189 Bodduluru, L. N. 149
Bacon, S.L. 213 Bodhi, B. 29, 36, 39, 40, 46, 146
Badali, P. 279 Boettiger, C. A. 189
Baddeley, A. D. 69 Bogels, S. 278
Baer, R. A. 135, 146, 147, 188, 256, 257, 278, Bohlmeijer, E.T. 219
306 Bonar, C. J. 236
Baijal, S. 229, 235, 238 Bond, F. W. 190, 257, 258
Baillie, A. 215 Bond, K. 150, 308
Baime, M. J. 236 Bond, M. 174
Baker, B. 213 Bond, T.K. 217
Baker, P. 281 Bookheimer, S. Y. 236
328 NAME INDEX
Booth, S. 219 Carson, J. W. 175

Bormann, J. E. 146 Carter, O. L. 236
Borntrager, C. F. 146 Carter-Thomas, S. 309
Borras, X. 215 Carus, C. 175
Bowen, S. 22, 146, 189, 191 CASEL 278
Boyle, P. 213 Casey, A. 214
Braboszcz, C. 146 Caspar, F. 150
Branstrom, R. 213 Cavanagh, K. 150, 326
Brefczynski-Lewis, J. A. 146, 149, 235, 237 Cekic, M. 237, 326
Brewer, G. A. 189 Chan, C. C. H. 149
Brewer, J. A. 23, 39, 47, 189, 326 Chan, F.W. 219
Bricker, J. B. 190 Chang, B. H. 214, 256
Brotto, L. A. 23 Changeux, J. P. 236
Brouwers, A. 278 Chaplin, W. F. 309
Brown, C. A. 152, 161, 162, 174, 176 Chaskalson, M. 67, 70
Brown, D. P. 23, 66, 69 Chawla, N. 146, 189
Brown, J. 69 Chemero, A. 70
Brown, K. W. 236, 257, 278, 307, 326 Chen, J. A. 23, 189
Brown, P. M. 69 Cheston, S. E. 310
Brown, R. A. 257 Chiesa, A. 147, 184, 189, 214, 236, 307
Brown, R. F. 150 Chinul 44, 47
Brownell, C. A. 70 Choden 326
Bruner, J. S. 69 Chorpita, B. F. 146
Bucci, W. 69 Chroniak, K.R. 219
Buckner, J. D. 258 Ciarrochi, J. 278
Buddhagosa, B. 307 Clark, A. 70
Buis, T. 148 Classen, C. C. 214
Bunce, D. 257 Clausen, S. S. 307
Burch, V. 166, 175 Claxton, G. L. 70
Burgmer, P. 148 Clemow, L. 216
Burklund, L. J. 257 Clifasefi, S. L. 189
Burney, R. 23, 175 Cloitre, M. 147
Buscemi, R. 191 Coffey, K. A. 307, 326
Bussing, A. 217 Cohen, J. 286, 307
Butler, C. 23 Cohen, M. 278
Butler, L. D. 146 Cohn, M. A. 326
Butryn, M. L. 189 Cole, F. 175
Butti, C. 236 Cole, S.W. 213, 214
Bynum, C. W. 115 Coleman, F. E. 23
Collins, S. E. 189
C Cook, J. M. 147
Cahn, B. R. 147, 236, 307 Cook, T. D. 281
Cahour, B. 309 Cornelissen, M. 307
Caldera, Y. 218 Corrigan, M. W. 69
Callahan, J. L. 147 Costa, J. 175
Callistemon, C. 236 Courtois, C. A. 147
Calsyn, D. A. 175 Craig, A. D. 236
Campbell, D. T. 281 Cramer, H. 214
Campbell, T.S. 213, 219 Cramer, H. 216
Cangas, J. A. 279 Crane, C. 152
Carapezza, R. 147 Crane, R. S. 278
Carlson, L. E. 193, 197, 201, 213, 214, 215, Craske, M. G. 146
217, 218, 309 Crawford, C. C. 307
Carmichael 58 Creswell, J. D. 206, 214, 236, 257, 307, 326
Carmichael, L. 69 Crick, F. 70
Carmody, J. 147, 236, 279 Critchley, H. D. 147
Carol, M. P. 22, 306 Crockett, M. J. 237
NAME INDEX 329
Cromer, K. R. 258 Eisenlohr-Moul, T. A. 150

Crum, A. 23 Ekman, P. 307
Csikszentmihalyi, M. 278 Elabd, S. 215
Cullum, J. 214 Elhai, J. 147
Currier, E. 149 Elwafi, H. M. 47
Engler, J. 23, 66, 69
D Epel, E. 24
Daftuar, C. N. 307 Ersser, S.J. 216
Dahl, J. 191 Erwin, J. M. 235
Dalai Lama 221, 236 Evans, K. C. 236
Dallos, R. 238
Damasio, A. R. 70, 147 F
Daneault, S. 216 Falk, L. 216
Dariotis, J. K. 280 Fan, M. 151
Dasgupta, S. 307 Farb, N. A. S. 147, 236, 326
Dass, B. H. 147 Faris, P. 214
David, Z., 149 Farmer, R. 190
Davidson, R. J. 149, 221, 236, 237, 278, Farrell, L. 279
307, 308 Feist, G. J. 307
Davis, J. H. 47, 142, 147 Feist, J. 307
Davis, M. C. 219 Fenlon, D. 218
Day, M. A. 216 Fenwick, P. 326
Debnath, N. 306 Ferrer, M.J. 215
Dehaene, S. 236 Feuerstein, G. 307
Deikman, A. J. 175 Fingelkurts, A. A. 236
Delaney, C. 214 Fjorback, L.O. 215
Delorme, A. 146 Flaxman, P. E. 249, 257, 258
Desbordes, G. 147 Fletcher, K. 150
Diffenbaugh, D. 147 Fletcher, L. 190
Dillworth, T. M. 22, 189 Flood, G. 148
Dimeff, L. A. 190 Flook, L. 279
Dixon, M. L. 308, 326 Foley, E. 215
Dobos, G. 214, 216 Foody, M. 257
Dodson-Lavelle, B. 217 Forbes, H. E. 188
Doll, R. 214 Fordyce, W. E. 175
Donaldson, L. 175 Forman, E. M. 189, 190
Donaldson-Feilder, E. J. 257 Foroughi, M. 216, 218
Donders, A. R. 238 Forstmann, M. 148
Dor-Ziderman, Y. 236 Fortin, G. 149, 326
Doucleff, M. 70 Fox, K. C. R. 308, 326
Dreyfus, G. 36, 47 Franco, C. 279
Drossman, D.A. 214 Frank, J. L. 279, 280
Duncan, E. 236 Fredrickson, B. L. 307, 326
Duncan, L.G. 215 Freedman, B. 309
Dunn, R. 147 Freedman, M. L. 280
Dunne, J. D. 147, 237, 307, 308 French, R. 23
Durkalski, V. L. 148 Fresco, D. M. 148, 216
Durlak, J. A. 271, 278 Freuchen, P. 23
Dusek, J. A. 214, 256 Friedman, T. L. 70
Dymnicki, A. B. 278 Froeliger, B. 189, 215
Frueh, B. C. 148
E Fulton, P. R. 23, 148
Eberth, J. 147, 150, 176, 286, 307, 309, 326
Eccles, J., 147 G
Edelman, G. 60, 70 Gabram, S. 219
Efran, J. S. 183, 189 Galante, I. 148
Eisenberger, N. I. 237 Galante, J. 148
330 NAME INDEX
Gallacher, J. 148 Guenole, N. 257

Gallagher-Thompson, D. 151 Guleria, A. 149
Gallego, J. 279 Guo, Y. 237
Galloway, G. P. 191 Gur, R. M. 149
Gamsa, A. 175
Gard, T. 147, 148, 161, 175, 279, 308 H
Gardner, D. 281 Haeffele, L. 281
Garfinkel, S. N. 147 Hahusseau, S. 146
Garland, E. L. 184, 189, 203, 215, 308 Hakeem, A. J. 235, 236
Garland, S.N. 215 Halevi, Z’ev Ben Shimon 23
Gaskin, D. J. 175 Halifax, J. 175
Gaylord, S. A. 189, 215, 308 Hamilton, V. 70
Gaylord-King, C. 151 Hariri, A. R. 236
Geha, P. Y. 235 Harris, A. R. 279
Gendlin, E. 55, 65, 70 Harstall, C. 217
Germer, C. K. 23, 148, 326 Hartman, M. 307
Gielen, S. C. 238 Hartmann, M. 215
Giese-Davis, J. 214 Hasenkamp, W. 229, 236, 326
Gifford, E. V. 189, 190 Hastings, R. P. 278
Gilbert, P. 236, 326 Hastings, T. A. 146
Gilissen, E. 237 Haug, M. 116
Gillespie, C. K. 310 Haydicky, J. 279
Giommi, F. 238 Hayes, S. C. 135, 148, 175, 176, 189, 190, 257, 258
Glasenapp, H. Von 115 Hayhurst, H. 310
Glass, C. R. 25, 281 Headings, A. 217
Glicksohn, J. 236 Hebb, D. O. 168, 175
Goldberg, S. 281 Hechanova, M. R. M. 148
Goldenberg, D.L. 215 Hedman, E. 217
Goldin, P. R. 148 Helming, M. 214
Goldstein, A. 236 Henderson, V.P. 216
Goleman, D. 12, 23, 61, 70, 221, 236, Hepworth, N. S. 190
270, 279 Herbert, J. D. 189, 190
Gollwitzer, P. M. 47 Hernández-Lopez, M. 185, 190
Gonzalez-Garcia, M. 215 Herrnleben-Kurz, S. 281
Goodey, E. 214, 218 Hersen, M. 306
Goodman, M. 217 Heusser, P. 217
Goolkasian, P. 152, 176 Hewitt, J. 23
Gordon, J. R. 191 Higa-McMillan, C. 146
Gordon, N. S. 152, 176 Higgins-D-Alessandro, A. 69
Gorski, T. T. 189 Hildebrandt, M. 258
Gou 47 Hindman, R. K. 25, 281
Goyal, M. 138, 148, 175, 279, 308, 326 Hoelzel, B. K. 236
Grabovac, A. D. 289, 308 Hoffman, C.J. 216
Grant, J. A. 152, 175, 176 Hoffman, K. L. 189
Gray, J. R. 326 Hofmann, S. G. 236
Greenberg, M. T. 279, 280 Hogan, H. P. 69
Greene, C. J. 148 Hogan, M. 23
Greer, J. M. 310 Hoge, E. A. 147
Gregson, D. 183, 189 Holistic Life Foundation 279
Greischar, L. L. 237, 238 Holley, L. C. 280
Grepmair, L. 148 Hölzel, B. K. 148, 175, 279, 288, 308, 326
Griffin, K. 183, 189 Hoogstaf, B. 278
Griffith, R. T. H. 116 Hopkins, J. A. 306, 308
Griffiths, M. D., 151 Hopkinson, J.B. 216
Gross, C.R. 215, 216 Hougaard, E. 217
Gross, J. J. 176 How, M. 213
Grossman, P. 148, 215, 218, 308 Howard, M. O. 189
Groves, P. 190 Howden-Leach, H. 175
NAME INDEX 331
Hughes, J.W. 216 Kaur, P. 308

Huppert, F. A. 219, 279 Keats, J. 65, 70, 114
Hutchins, T. L. 278 Keefe, F. J. 175
Huxter, M. 215 Keng, S. L. 237
Hyeguk 47 Kennedy, S. 148
Kerr, C. E. 237
I Kerrigan, D. 279
Ie, A. 23 Kesper, U. 215
Ilsley, J. 191 Keyes, C. L. M. 279
Imani, A.H. 216 Khantipalo, B. 237
Inzlicht, M. 310 Khoury, B. 138, 149, 326
Irwin, M. R. 214, 257 Killoran, A. 278
Isayeva, N. 116 Kilpatrick, L. A. 149
Ivanovski, B. 148 Kinsbourne, M. 70
Ives, J. A. 307 Kip, K.E. 216
Iwanicki, S. 151 Kircher, C. 215
Kitil, M. J. 279
J Kiyonaga, A. 235
Jagaddhar, Z. 116 Knight, J. B. 189
Jakobsen, J. C. 147 Kohlenberg, B. S. 189, 190
Jam, S. 216, 218 Kok, B. E. 308
Janmohamed, K. 278 Kopf, S. 215
Jazaieri, H. 148 Kornfield, J. 237, 308
Jennings, P. A. 279 Kozhevnikov, M. 306
Jensen, M. C. 175 Kraemer, H.C. 214, 218
Jensen, M. P. 216 Kraft, R. A. 176, 238
Jha, A. 235 Krech, P. R. 280
Jha, A. K. 308 Kreitzer, M.J. 215, 216
Jha, A. P. 236 Kremen, I. 38, 47
Jo, B. 191 Krishnamurti, J. 14, 24
Jo, H. J. 149 Kristeller, J. L. 23, 24, 149, 190, 217, 258
Johnson, K. 279 Krompinger, J. 236
Johnson, S. K. 70, 149, 152 Kumano, H. 216
Johnson-Mallard, V. 216 Kumar, U. 149
Johnstone, T. 149, 237 Kunkel, E.J. 217
Jones, A. K. 174 Kupper, Z. 150
Jones, S. 161, 162, 281 Kuyken, W. 278, 280
Josefsson, T. 149 Kvillemo, P. 213
Josipovic, Z. 149, 326
Juarascio, A. S. 189, 190 L
Jung, W. H. 149 Labelle, L.E. 213
Lamanque, P. 216
K Lancioni, G. E. 309
Kabat-Zinn, J. 15, 23, 125, 135, 149, 150, 168, Langenberg, P. 218
175, 193, 195, 216, 221, 237, 258, 259, 279 Langer, E. J. 23, 280
Kadloubovsky, E. 24 Lansky, D. 175
Kahler, C. W. 257 Lantieri, L. 280
Kaiser-Greenland, S. 279 Lau, M. A., 22, 146, 308
Kakoulidis, T. P. 191 Lauche, R. 214, 216
Kalupahana, D. 70 Lawlor, M. S. 269, 281
Kang, D. H. 149 Lazar, S. W. 148, 228, 237, 279, 308
Kaplin, K.H. 215 Lazarides, C. 307
Karkhaneh, M. 150, 217, 308 Leahey, T. 191
Karpel, M. G. 188 Learning to Breathe 280
Kasala, E. R. 149 Lecomte, T. 149, 326
Kash, K.M. 217 Ledesma, D. 216
Kashdan, T. B. 278 LeDoux, J. 280
Katz, R. 24 Lee, E. O. 149
332 NAME INDEX
Leeson, P. 278 Massion, A. O. 23, 216

Lejuez, C. W. 257 Masuda, A. 258
Lengacher, C.A. 216 Matchim, Y. 217
Leung, M. K. 149 Mathews, H.L. 218, 219
Levin, B. 213 Mayberg, H. 147, 236, 326
Levin, M. 258 Mazziotta, J. C. 236
Levine, N. 183, 190 McComb, J. 218
Libet, B. 70 McCracken, L. M. 24, 217,258
Lieberman, M. D. 237 McFarlin, D. R. 150
Lillard, A.S. 280 McGregor, J. 183, 191
Lindahl, J. R. 149 Mckinley, P. 150
Lindfors, P. 217 McNeill, D. 53, 70
Lindwall, M., 149 Meiklejohn, J. 280
Linehan, M. M. 149, 190, 191, 258 Melendez, M. 188
Lipworth, L. 23, 175 Melzack, R. 156, 176
Livheim, F. 257 Mendelson, T. 280
Ljotsson, B. 207, 216, 217 Mental Health Foundation 280
Lloyd, J. 257, 258 Merchant, J., 176
Loew, T. 148 Merton, T. 24
Lu, Q. 151 Metz, S. 268, 280
Luciano, C. 257 Miller, C.K. 217
Luciano, M. C. 190 Miller, J. J. 150
Lucius-Hoene, G. 306 Miller, L. 281
Lumma, A. L. 308 Mind and Life 280
Luoma, J. B. 190, 258 Mind with Heart 280
Luoma, J. C. 190 Mindfulness All Party Parliamentary
Lutgendorf, S.K. 213 Group 158, 176
Lutz, A. 146, 149, 150, 227, 230, 231, 233, 235, Mindfulness for Students 280
237, 238, 278, 308 Mindfulness in Schools 280
Lyddy, C. 23 Miro, J. 216
Lykins, E. L. B. 146, 147, 150 Mitterlehner, F. 148
Lynch, T. R. 175 Monti, D. A. 200, 217
Moore, A. 237
M Moore, R. G. 310
Ma, S. 280 Morland, L. A. 148
Ma, Y. 238 Moskowitz, J. T. 213, 215
Maas, P. 116 Munoz, M. 217
Macdonald, H. 175 Murthy, C. G. V. 309
Mackenzie, M.J. 217 Musial, F. 217
MacLeod, A. M. 238 Muyeo 47
Magno-Gatmaytan, C. 188 Myers, H.F. 214
Malhi, G. S. 148 Myerscough, R. 216
Malinowski, P. 237, 307
Mallik, S. 189 N
Manas, L. 279 Nadeau, M.G. 215
Maneti, Y., 149 Nagaraja, H. 217
Manna, A. 237 Nahin, R. L. 146
Manusov, E. G. 189, 215 Nambiar, M. 280
Marcotte, D. S. 190 Nanamoli, B. 46
Margolin, A. 190 Napoli, M. 280
Marlatt, G. A. 146, 191, 258 Naranjo, C. 9, 12, 14, 24
Marques, J. K. 191 Nash, J. D. 150
Marquett, R. 151 National Research Council Institute of
Marro, J., 70 Medicine 280
Marsh, R. L. 189 Neff, K. D. 326
Martindale, C. 70 Negi, L. T. 176
Martucci, K. T. 176, 238 Neilands, T.B. 215
NAME INDEX 333
New Economics Foundation 280 Phillips, C., 280

Newberg, A. 150 Phillips, D. 24
Ngnoumen, C. T. 23 Piet, J. 217
NICE 260, 281 Pinniger, R. 150
Nichols, S. R., 70 Pinto-Gouveia, J. 175
Nicholson, R. A. 24 Plews-Ogan, M. 217
Niemeier, H. M. 191 Polich, J. 147, 236, 307
Nijeboer, S. 308, 326 Pollak, S. M. 150
Nimchinsky, E. A. 237 Pop, V.J. 219
Nind, M. 281 Posner, M. I. 326
Nisbett, R. E. 295, 308 Post-White, J. 216
Nock, M. K. 306 Pradhan, E.K. 218
Nordlie, J. W., 151 Presti, D. E. 236
Nyklicek, I. 219 Progoff, I. 24
Public Health Agency of Canada 218
O Purser, R. E. 150
Ochsner, K. N. 176 Puta, M. 309
Oh, D. 236
Olendzki, A. 308 R
Olendzki, N. 147 Rabago, D. 191
Olivelle, P. 116 Raffone, A. 237, 238
Oliver, A. 150, 326 Rahula, W. 24
Olivo, E. L. 217 Raichle, M. E. 238
Orme-Johnson, D. W. 150 Rainville, P. 175
Ornbol, E. 215 Ramos, P. A. P. 148
Ornstein, R. E. 13, 14, 24 Ramseyer, F. 150
Oskam, M.J. 219 Randolph, P. 218
Ospina, M. B. 150, 217, 308 Rawlings, N. B. 237
Osuna, Fray F. de 24 Raysz, A. 215
Owens, J.E. 217 Reed, K. 191
Reibel, D. 280
P Reich, J.W. 219
Pace, W. W. T. 176 Reid, E. F. 281
Pagnini, F. 24 Remillieux, A. 309
Pagnoni, G. 237, 326 Reynolds, S. K. 190
Palmer, G. E. H. 24 Rhys Davids 35
Palsson, O. S. 215 Ricard, M. 307
Panksepp, J. 150 Richard, P. 175
Pantalone, D. W. 188 Richey, J. A. 258
Pantani, M. 237 Rikhye, K. 149
Parfit, D. 70 Robert McComb, J. J. 218
Park, J. 308 Roberts, K. C. 238
Parker, S. 326 Robins, C. J. 237
Patel, K.D. 214 Robinson, A. H. 151, 191
Patil, S.G. 217 Robinson, F.P. 218
Patterson, F. 278 Roche, B. 258
Paul, A., 214 Ross, N. W. 14, 24
Payne, S. 218 Rubenstein, M-J. 116
Pearson, C. 151 Russas, V. 215
Pedulla, T. 150 Ryan, R. M. 236, 257, 307, 326
Penman, D. 281 Rychlak, J. 70
Perlman, D. M. 150
Perrucci, M. G. 237 S
Petitmengin, C. 308, 309 Sack, A. T. 175
Petitmengin-Peugeot, C. 290, 309 Sackett, C. F. 258
Pettman, D. 150, 326 Safer, D. L. 191
Phares, E. J. 309 Safran, J. D. 176
334 NAME INDEX
Salmon, P. 219 Sinha, R. 23, 189

Salzberg, S. 326 Sitamma, M. 309
Sanderson, A. 116 Slagter, H. A. 237, 238, 308
Sapolsky, R.M. 218 Smalley, S. L. 279
Sauer, S. 309 Smith, G. T. 146, 306
Sauer-Zavala, S. E. 150 Smith, K. B. 23
Sawyer, A. T. 236 Smith, S. R. 149, 176
Schaefer, H. S. 146, 235 Smoski, M. J. 237
Schäfer, T. 307 Snowberg, K. E. 279
Schmidt, A. 309 Snyder, A. Z. 238
Schmidt, H. III 190 Somers, T. 176
Schmidt, N. B. 258 Son, Y. D. 150
Schmidt, S. 218, 306, 309 Sood, A.K. 213
Schneider, R. H. 150, 218 Soulsby, J. 238
Schonert-Reichl, K. A. 269, 281 Speca, M. 214, 217, 218, 219
Schreurs, K.M. 219 Spiegel, D. 218
Schubert, C. M. 278 Spurgeon, C. 24
Schuman-Olivier, Z. 190 Sri, S. 149
Schwarz, M. 150, 176, 309, 326 Srinivas, K. 309
Schwarzer, B. 218 Srinivasan, N. 229, 237, 238
Sedlmeier, P. 147, 150, 161, 176, 286, 307, Staggers, F. 218
309, 326 Stedmon, J. 238
Segal, Z. V. 71, 147, 148, 150, 176, 218, 236, Stempel, H. S. 310
238, 258, 310, 326 Stephen, J. 214
Semple, R. J. 281 Stephens, A. J. 215
Sephton, S.E. 218 Stewart, B. R. 217
Sergent, C. 236 Stewart, M. 279, 281
Serretti, A. 147, 184, 189, 214 Stewart-Brown, S. 278
SeyedAlinaghi, S. 218 Strauss, C. 150, 326
Shadish, W. R. 281 Strong, D. R. 257
Shanon, B. 51, 70 Strosahl, K. D. 148, 175, 258
Shapiro, D. H. 24 Studts, J.L. 219
Shapiro, S. L. 13, 22, 146, 151, 176, 193, 218, Su, J. C. 150
278, 288, 309, 310 Sullivan, M. J. 204, 218
Shaw, C. 191 Sully, B. 191
Shaw, J. 190 Summerbell, C. 281
Shear, J. 151, 238, 310 Suyenobu, B. Y. 149
Sheeran, P. 47 Svetlova, M. 70
Sheets, V. 190 Sweet, P. L. G. 238
Shennan, C. 218 Swift, J. K. 147
Sherwood, C. C. 236
Shilpa, S. 309 T
Shonin, E. 151 Tacon, A.M. 218
Shucksmith, J. 281 Tamagawa, R. 214
Sibinga, E. M. S. 148, 175, 279, 281, 308, 326 Tang, Y.-Y. 151, 238, 326
Siegel, D. J. 238 Tanner, M. A. 151
Siegel, E. P. 151 Tapper, K. 191
Siegel, R. D. 23, 150 Teasdale, J. D. 67, 70, 71, 150, 176, 218, 238,
Sikes, R. W. 238 238, 258, 280, 310
Silbersweig, D. A. 310 Teixeira, E. 218
Simon, B. 281 Telch, C. F. 191
Simpson, K. 174 Teper, R. 310
Singer, T. 308 Terry, J. 218
Singh, A. D. A. 309 Tetreault, N. A. 235
Singh, N. N. 151, 298, 309 Thipparaboina, R. 149
Singh, S. 148, 175, 279, 308, 326 Thomas, R. 62, 71
Sinha, A. K. 308 Thomas, W. 215
NAME INDEX 335
Thompson, E. 71, 237, 238 Wallace, B. A. S. L. 176, 228, 307, 310

Thompson, J. M. 151 Walsh, E. C. 150
Thompson, L. 151 Walsh, R. 151, 310
Thompson, M. 217 Walshe, M. 151
Thorp, S. R. 146 Walter, A. A. 69
Thorsteinsson, E. B. 150 Wang, J. 238
Tiefenthaler-Gilmer, U. 215 Wang, M. C. 281
Tomic, W. 278 Warner, K. 191
Tononi, G. 60, 70 Warren, J. 31, 47
Torres, J. J. 70 Wasserman, R. H. 237
Travis, F. 151, 238 Watson, K. K. 235
Treiber, F. 278 Watts, A. W. 13, 24, 71, 326
Trevarthen, C. 71 Weare, K. 280, 281
Trimble, M. 71 Wegner, D. M. 258
Tsai, H.-T. 150 Wei, M. 150
Twohig, M. P. 258 Weineland, S. 191
Tzu, L. 183, 191 Weiss, M. 151
Weissbecker, I. 219
U Weissberg, R. P. 278, 281
Uddo, M. 151 Weissman, D. H. 238
Ukoumunne, O. 280 Weisz, J. R. 146
Unsworth, N. 189 Wells, A. 71, 258
Ursuliak, Z. 214 Welwood, J. 24
Wenzlaff, R. M. 258
V Werner, H. 52, 71
Vago, D. R. 142, 147, 310 Werner, K. 148
Valentine, E. R. 238 West, M. A. 10, 24, 25
van Aalderen, J. R. 238 Wetherell, J. L. 146
Van Dam, N. T. 148 White, F. 25
van den Hurk, P. A. M. 222, 238 White, P. A. 310
Van Diest, I. 151 Whiteman, J. H. M. 310
Van Dun, L. 278 Whittaker, V. 281
Van Gordon, W. 126, 151 Wiener, J. 279
van Son, J. 219 Willett, B. R. 308
Vangel, M. 279 Williams, J. M. G. 150, 152, 238, 258
Varela, F. J. 238, 310 Williams, M.G. 71, 176, 218, 281
Veehof, M.M. 219 Williams, P. 152
Venu Gopal, D. V. 306 Wilson, K. G. 175, 190, 258
Vermersch, P. 310 Wilson, T. D. 295, 308
Verstappen, K. 151 Wilson-Mendenhall, C. D. 236
Vesterlund, A.W. 216 Winton, A. S. W. 309
Vieten, C. 191 Witek-Janusek, L. 218, 219
Villatte, M. 258 Witkiewitz, K. 22, 185, 189, 191
Vingerhoets, A. 71 Witt, A. A. 236
Visscher, K. M. 238 Woldorff, M. G. 238
Vogt, B. A. 176, 238 Wolever, R. Q. 190
Vogt, W. 281 Wolf, D. B. 310
Wong, R.L. 219
W Wong, S. Y. 202, 219
Waelde, L. C. 146, 148, 151 Woo, J. 116
Wahbeh, H. 24 Wood, L. 218
Wake Up Schools 281 Woodruff, S. C. 25, 281
Walach, H. 281, 309 Worhunsky, P. D. 326
Walberg, H. 281 World Health Organization 219
Walker, D. 191 Wren, A. 176, 217
Wall, P. 156, 176 Wright, M. 176
Wallace, A. 238 Wurtzen, H. 217
336 NAME INDEX
Y Zautra, A.J. 219

Yang, M. H. 281 Zeidan, F. 152, 161, 162, 163, 164, 176, 238
Ye, X. 216 Zenner, C. 281
Yeo, Y. 149 Zernicke, K. A. 208, 219
Yin, J. 149 Zgierska, A. 184, 191
Zilcha-Mano, S 25
Z Zins, J. E. 281
Zachariae, R. 217 Zoogman, S. 264, 281
Zainal, N. Z. 219 Zuelsdorff, M. 191
Zakarauskas, P. 308 Zylowska, L. 281
Subject index
12-Step Facilitation (12S) 181, 182–3 anxiety

chronic pain 158
A muscular signals 61
acceptance 246–7, 250 arousal 50
acceptance and commitment therapy low 58
(ACT) 134, 180–1 Asperger syndrome 298
binge eating disorder (BED) 185–6 ātman 98
self-perspective, changes in 137 attachment 66–7
substance use disorders (SUDs) 185–6 attention 30
acceptance and commitment therapy (ACT) in conscious redirection 81
the workplace 241–2 neural correlates 223
acceptance 246–7, 250 wandering 78
as a multi-method approach to Attention Academy Program (AAP) 267
mindfulness 254–5 attention control in pain management 160
clarifying values 253–4 attention deficit hyperactivity disorder
committed action 245 (ADHD) 264, 268
defusion 246, 250–2 attention habits 56–9
increasing commitment to goals and attention regulation 135–6
actions 254 Attention Network Test (ANT) 230
mindfulness 247–8 attentional blink (AB) 232
mindfulness promotion 248–54 automatic self-transcending meditation 124
present moment 247, 249 automatism 31, 32
psychological flexibility 243–4 autopilot actions/habits 177–8
self as context (SAC) 246, 252 aversion 66–7
six core characteristics 244–7 awareness
values 244–5 creative 35–7
addictive disorders 177 of the body 3, 16
12-Step tradition 182–3 qualities of presence 85–6
Buddhist Recovery Network (BRN) 183
future directions 186–8 B
limitations of current fundings 186–8 back pain 202–3
mindfulness 179 basis of meditation 27–9
mindfulness and concentration becoming less threatened 315
practices 179–82 Bhakti 105–6
nature of addiction 177–8 binge eating disorder (BED) 185–6
research review 183–6 bio-psychosocial model of pain 156
Tao of recovery/sobriety 183 body awareness 136–7
Advaita Vedānta 104–5 Body Scan 164
affective neuroscience 221–2 Brahma Viharas 170
affective sensation 42 brain rhythms 223, 227, 232–3
agnistoma 96 brain structure 223
Alcoholics Anonymous (AA) 182 breath, paying attention to 31, 32
analytic meditation 28 Breathing Anchor 164
anchoring 31–3 Breathworks Program 153, 157, 162, 163–5
angst, source of 74–5 Brahma Viharas 170
not ordinarily apparent 82–3 Buddhist roots 165–70
threat-based schemes 77–8 compassion 169–70
anorexia nervosa (AN) 186 loving kindness 169
antaryāmin 98 Salattha Sutta 165–7
anterior cingulate cortex (ACC) 223 Satipatthana Sutta 167–9
338 SUBJECT INDEX
Buddhism 102–4 espaliered experience 55–6

foundations of consciousness 29–31 meditation, how it helps 62–7
Four Noble Truths 103, 177 mind, metaphors of 49–52
Buddhist Recovery Network (BRN) 183 welling up of gesture and thought
Buddhist temperaments 294–5 53–5
bulimia nervosa (BN) 186 consciousness 3
Buddhist perspective 29–31
C emergence of 59–62
cancer 196–202 contact 30
cardiovascular disorders 204–5 contentedness 4–5
central executive 50, 54 core self 60
chamber of consciousness 50 creative awareness 35–7
checking 60 creative awareness tools 37
children and mindfulness 261–2 listening 37–8
academic performance 269–71 mindfulness of feeling tones 38–43
anxiety 267 creative engagement 40
behavior 268–9 Cultivating Awareness and Resilience in
current developments 271–3 Education (CARE) program 273
depression 266
emotional regulation 267–8 D
evidence base 263 declarative memory 50
flourishing 267–8 default mode network 224
future directions 273–6 defence mechanisms 61
impact on mental health 264 defusion 246, 250–2
relationships with self and others 269 depression
school staff 272–3 anxiety 267
social and emotional learning (SEL) 271–2 children and young people 266
specific mental health outcomes 266–7 chronic pain 157, 158
targeted/universal balance 264–6 Dhammas 293
well-being 267–8 diabetes 205–6
choiceless awareness 14 dialectical behavior therapy (DBT) 134, 180,
Christian practices 7–8, 11 181–2
chronic pain 155, 157, 202–3 Dionysian Way 12
meditation 159–63 distress tolerance 241
cognition 84 dorsolateral prefrontal cortex 223
Cognitive Behavioral Therapy (CBT) 64 dukkha 67
cognitive neuroscience 221–2
cognitive unconscious 50 E
committed action 245 Eastern explanations of meditation 288–9
compassion 169–70 education and mindfulness 259, 322–3
developing 316–17 effortless effort 33
Compassion Acceptance 164 emotion regulation 136
comprehensive validation therapy (CVT) 182 children and young people 267–8
concentration 27–9, 311–12 enquiry 27–9, 311–12
anchoring 31–3 espaliered experience 55–6
focusing 31–3 evidence for adult mindfulness 260–1
neural correlates 223 evidence for children and young people
concentrative meditations 13 mindfulness 263
addiction disorders 179–82 evolution 75
compared with mindfulness everyday attending 76
meditation 122–3 existence 3
congenital insensitivity to pain 154 experience
connection 164 microgenesis of 312–13
finding 317–18 through practice 84
conscious awareness 50 experiential avoidance 242
conscious experience 49, 67 experiential enquiry 33–5, 43
attention habits 56–9 Expressive Way 12–13
emergence of consciousness 59–62 exteroceptive perceptual systems 58–9
SUBJECT INDEX 339
F Intention, Attention, Attitude (IAA)

feeling 30 model 193
feel less threatened 315 internal barriers 253, 254
feeling tones 38–43 interoceptive body states 58
feeling-sensation 42 irritable bowel syndrome (IBS) 207–8
fibromyalgia (FM) 203–4 Islamic practices 8, 11
focused attention (FA) 123–4, 131–2
neurological effects 228–30 J
pain management 160 Jainism 100–2
unitary view of meditation 231–3 Jewish practices 8, 11
focusing 31–3, 65 jyotistoma 96
body sensations 64
form 29 K
Four Noble Truths 103, 177 Kabbalah 11
functional fixedness 58 kaivalya 100, 101, 108
future theory 285–7, 303 karuna 169
alternating-treatment designs 300–1 kesin 97
conventional measurement 291–5 kindness-based meditation (KBM) 134, 138
custom-tailored measurement 295–6
Eastern explanations 288–9 L
meditators as expert collaborators 302 Learning to BREATHE curriculum 268
multiple-baseline designs 298–300 levels of thinking 31–2
self-reports of experienced meditators listening meditation 37–8
289–90 London Underground meditation 63
single-case experimental designs 297–8 long-term pain 155, 158
towards better measurement 291–6 lotus posture 107
towards better research designs 296–303 loving kindness 169
towards better theories 287–91 low arousal 58
ways forward 290–1, 296, 303 low back pain 202–3
Western explanations 287–8 low ego-control 58
G M
gate control theory of pain 156 mantra 5
generalization, tendency to 34 mantram repetition program (MRP) 134–5
germ of an idea 51 Māyā 110
gesture 53–5 meanings 170
guna questionnaires 291–3 meditation
guru 6 as practice 79–82
compared with mindfulness 16–17
H definition 78–9
habit releasers 165 effects on the brain 222–6
habits of attention 56–9 neuroplasticity 226–8
Hindu practices 10–11 meditation as a process of recognition 73–4
Hinduism 104–5 affective downside of default attending
hippocampus 223 processes 76–7
historical meditation practice 6–10 angst, source of 74–5
HIV/AIDS 206–7 angst-inducing patterns 82–3
cultivating mindfulness 78
I evolutionary pressures in everyday
I attending 76
experience of 50, 85, 316 expertise 84–5
linguistic use of 55–6 individual purposes and interests 83–4
sense of 74 principles of practice 90–1
I-CAN Sleep study 199–200 qualities of presence 85–6
illness experience 194 recognizing threat-based schemes in
inner resources (IR) for stress 134 everyday angst 77–8
intensity 59 social and political landscape 88–90
intention 30 yin and yang 87–8
340 SUBJECT INDEX
meditation examples mindfulness-based intervention (MMBI),

London Underground 63 theoretical rationale 135–7
sitting on the brink of the unconscious 63 mindfulness-based intervention (MMBI),
Meditation on the Soles of the Feet 298 treatment component studies 139–41
meditation practice 27, 44–5 nondual awareness (NDA) 124–5, 131–2
basis of meditation 27–9 open monitoring (OM) 123–4, 131–2
concentration 31–3 secular classification 121–2
creative awareness 35–7 spectrum of usage intensity 132–3
creative awareness tools 37–44 traditional versus secular 125–8
experiential enquiry 33–5 mindfulness in daily life 164
listening 37–8 Mindfulness in Schools curriculum 266
mindfulness of feeling tones 38–43 mindfulness practice 28
questioning 43–4 mindfulness questionnaires 293–4
meditators as expert collaborators 302 mindfulness-based art therapy
metta 83, 87 (MBAT) 200
microgenesis 52 mindfulness-based cancer recovery
microgenesis of experience 312–13 (MBCR) 196, 197–202
Milk, Milk, Milk exercise 250–1 mindfulness-based cognitive therapy
mind metaphors 49–52 (MBCT) 119, 133–4, 138, 196
Mindful Education program 269 treatment component studies 141
mindful movement 165 mindfulness-based eating awareness training
Mindful Observation of Thought 298 (MB-EAT) 185–6
mindfulness 4, 6, 15–17 mindfulness-based intervention (MBI) 119,
addiction disorders 179–82 133–5
adding to existing approaches 261 attention regulation 135–6
as psychological training 59 body awareness 136–7
attention 63 cancer 197
children and young people 261–2 diabetes 205–6
compared with meditation 16–17 emotion regulation 136
creative awareness 35–7 future directions 141–2
creative awareness tools 37–44 irritable bowel syndrome (IBS) 207–8
cultivating 78 physical health 195–6
evidence for adults 260–1 reappraisal 135–6
evidence for children and young self-perspective, changes in 137
people 263 theoretical rationale 135–7
feeling tones 38–43 treatment component studies 139–41
impact on mental health of children and mindfulness-based pain management
young people 264 (MBPM) 153, 157, 162, 163–5, 171
listening 37–8 Brahma Viharas 170
practice of 260 Buddhist roots 165–70
secular 259–60 compassion 169–70
separation of awareness from judgment 59 habit releasers 165
targeted/universal balance 264–6 loving kindness 169
teaching to young people 262–3 meditation 163–4
mindfulness and meditation (MM), mindful movement 165
psychotherapeutic applications 119–20, 132 mindfulness in daily life 164
Buddhist tradition 128–30 Salattha Sutta 165–7
concentrative versus mindfulness Satipatthana Sutta 167–9
meditation 122–3 working with thoughts and emotions 165
focused attention (FA) 123–4, 131–2 mindfulness-based relapse prevention
future directions 141–2 (MBRP) 133–4
growing utilization 120–1 substance use disorders (SUDs) 184–5
Hindu tradition 130–1 mindfulness-based stress reduction
historical origins 128–32 (MBSR) 119, 123, 133, 138
mindfulness-based intervention cardiovascular disorders 204–5
(MMBI) 133–5 diabetes 205–6
mindfulness-based intervention (MMBI), HIV/AIDS 206–7
meta-analysis 137–9 irritable bowel syndrome (IBS) 208
SUBJECT INDEX 341
organ transplant 209–10 Buddhism 102–4

pain management 202–3 Hinduism 104–5
physical health 195–6 Jainism 100–2
rheumatoid arthritis (RA) 209 overview 95–6
mindfulness-oriented recovery enhancement Tantra 108–11
(MORE) 184, 203 Vedānta 97–100
MINDSET study 198–9 Vedic period 96–7
mudita 41, 169 wonder 111–14
yoga 106–8
N physical health 193–4
namarupa 29 cancer 196–202
name 29, 30 cardiovascular disorders 204–5
Narcotics Anonymous (NA) 182 diabetes 205–6
negative capacity 65 fibromyalgia (FM) 203–4
Negative Way 12, 13 future directions 210–12
neural correlates of meditation 222–6 HIV/AIDS 206–7
future directions 233–4 illness experience 194
neuropathic pain 155 irritable bowel syndrome (IBS) 207–8
neurophysical evidence 318–20 literature summary 196–210
neuroplasticity 226–8 mindfulness 195
nirvana 14 mindfulness-based interventions 195–6
nondual awareness (NDA) 124–5, 131–2 organ transplant 209–10
non-judgemental acceptance 16 pain 202–3
rheumatoid arthritis (RA) 209
O plasticity of the brain 226–8
observing self 252 practice
Open Heart 164 as meditation 79–82
open monitoring (OM) 123–4, 131–2 definition 78–9
neurological effects 228, 230–1 practice of meditation 3–4, 325
pain management 160–1 across cultures and through history
unitary view of meditation 231–3 6–10
opening-up meditations 13 mindfulness revolution 15–17
openness 4–5 openness and contentedness 4–5
organ transplant 209–10 reason for meditation 10–12
typologies 12–15
P varieties 5–6
pain management 153, 171, 202–3 practice of mindfulness 260
Breathworks Program 163–5 prajna 293
definition of pain 154 presence, qualities of 85–6
experience of pain 154–7 presence, sense of 316
importance of understanding pain 157–8 present moment 247, 249
meditation 158–9 present moment focus 16
mindfulness-based pain management Primary Suffering 166
(MBPM) 163–5 procedural memory 50
research into meditation 159–63 progressive muscle relaxation (PMR) in
Pain Rating Index 159 cardiovascular disorders 205
perception 30–1 pseudonirvana 14
permanentize, tendency to 34 psychological acceptance 242
persistence 59–60 psychological flexibility 242
persistent pain 155 acceptance 246–7
personal meditation journey 21–2 at work 243–4
personal meditation journeys 45–6, 67–9, committed action 245
91–2, 114–15, 143–5, 171–4, 188, 212–13, defusion 246
255–6, 276–8, 304–6, 323–5 present moment 247
phenomenology 93–4 self as context (SAC) 246
philosophical perspectives 93–5 six core characteristics 244–7
Advaita Vedānta 104–5 values 244–5
Bhakti 105–6 psychological inflexibility 242
342 SUBJECT INDEX
psychotherapeutic applications of mindfulness school staff 272–3

and meditation (MM) 119–20, 132 Secondary Suffering 166–7
Buddhist tradition 128–30 secular mindfulness 259–60
concentrative versus mindfulness self 224
meditation 122–3 core self 60
focused attention (FA) 123–4, 131–2 sense of 316
future directions 141–2 self as context (SAC) 246, 252
growing utilization 120–1 self-awareness 3
Hindu tradition 130–1 self-compassion 170
historical origins 128–32 self-perspective, changes in 137
mindfulness-based intervention self-regulation 81
(MMBI) 133–5 shikantaza 6, 13
mindfulness-based intervention (MMBI), siddhis 95
meta-analysis 137–9 significance 60
mindfulness-based intervention (MMBI), sky gazing 29
theoretical rationale 135–7 social and emotional learning (SEL) 261
mindfulness-based intervention (MMBI), current developments 271–2
treatment component studies 139–41 social conditioning, loosening the bonds
nondual awareness (NDA) 124–5, 131–2 of 313
open monitoring (OM) 123–4, 131–2 soma 96
secular classification 121–2 spiritual bypass 87
spectrum of usage intensity 132–3 Spiritual Self-Schema (3-S) therapy 181
traditional versus secular 125–8 stickiness 31, 32
stream of consciousness 58
Q substance use disorders (SUDs) 183–4
quality of life (QoL) 198 acceptance and commitment therapy
questioning meditation 28, 43–4 (ACT) 185–6
mindfulness-based relapse prevention
R (MBRP) 184–5
rajas 291–3 suffering 75
reappraisal 135–6 reduction of 4
reasons for meditation 10–12 supportive expressive therapy (SET) 198–9,
research 285–7, 303, 325 201
alternating-treatment designs 300–1 sustained attention 16
conventional measurement 291–5
custom-tailored measurement 295–6 T
Eastern explanations 288–9 tamas 291–3
meditators as expert collaborators 302 Tantra 108–11
multiple-baseline designs 298–300 Tao of recovery/sobriety 183
self-reports of experienced meditators temperaments 294–5
289–90 therapeutic applications 320–2
single-case experimental designs 297–8 Thinking at the Edge (TAE) 65
towards better measurement 291–6 thinking, levels of 31–2
towards better research designs 296–303 thought 53–5
towards better theories 287–91 thought suppression 241
ways forward 290–1, 296, 303 Tibetan Buddhism 34
Western explanations 287–8 tolerance of uncertainty 314–15
reverberation 60 Trancendental Meditation (TM) 11–12, 14,
Rg Veda 95 119–20, 134
rheumatoid arthritis (RA) 209 addiction intervention 179
Rorschach images 66 Treasure of Pleasure 164
rostral anterior cingulate cortex (rACC) typologies of meditation 12–15
161–2
U
S uncertainty 314–15
samatha 28, 123, 228–9 unfurling 51–2
sati 35–7, 128 Upanisads 95
sattva 291–3 upekkha 169
SUBJECT INDEX 343
V committed action 245

values 244–5 defusion 246, 250–2
varieties of meditation practice 5–6 increasing commitment to goals and
vedana 38 actions 254
Vedānta 97–100 present moment 247, 249
Vedic period 96–7 psychological flexibility 243–4
ventromedial-prefrontal cortex (vmPFC) 161 self as context (SAC) 246, 252
verbal chatter on the mind 252 six core characteristics 244–7
vigilance 315 values 244–5
vigilance function 80, 83 worldwide meditation practice 6–10
vinnana 29
vipassana 13, 14, 28, 33–4, 38, 123, 232–3 Y
visualising meditation 28 yoga 106–8
Visuddhimagga 294 young people and mindfulness 261–2
von Economo neurons 224 academic performance 269–71
anxiety 267
W behavior 268–9
Way of Forms 12 current developments 271–3
well-being of children and young people depression 266
267–8 emotional regulation 267–8
welling up 51–2 evidence base 263
gesture and thought 53–5 flourishing 267–8
Western explanations of meditation 287–8 future directions 273–6
whole school approach to well-being 274 impact on mental health 264
wonder 111–14 relationships with self and others 269
working with thoughts and emotions 165 school staff 272–3
workplace mindfulness and meditation 241–2, social and emotional learning (SEL) 271–2
322–3 specific mental health outcomes 266–7
acceptance 246–7, 250 targeted/universal balance 264–6
acceptance and commitment therapy teaching mindfulness 262–3
(ACT) 247–8 well-being 267–8
acceptance and commitment therapy (ACT),
promotion through 248–54 Z
ACT as a multi-method approach 254–5 Zen Buddhism 6, 9, 13, 34
clarifying values 253–4 zoom-lens attention 14

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The Psychology

In 1987 Oxford University Press published a book entitled The Psychology of

Part 1 Meditation perspectives

Part 2 Therapeutic and clinical applications

Part 3 Meditation in workplaces and schools

Name index 327

biological imperatives, and describes the psychological mechanisms by

Juliane Eberth studied psychology at Technische Universität Chemnitz from

Dominion University. She is currently a clinical psychology intern at the

Channel 4 in London. Following emigration to the United States in 1999, he

Substance Abuse, and Addictions. The underlying theme of her research is

The practice of meditation

with all experience, whether positive, negative, or neutral, in a (relatively) unfil-

Box 1.1 Openness and contentment in meditation

Box 1.1 Openness and contentment in meditation (continued)

Continue the meditation in this way for a quarter of an hour, remembering

Varieties of meditation practices

Meditation across cultures and through history

Another example of Christian meditation comes from an anonymously writ-

Fray Francisco de Osuna, a tenth-century monk, writing in The Third Spirit-

In the Judaic religion, it is common to repeat a simple prayer accompanied by

And even the motion of our human blood

Tennyson would mentally repeat his name continually to encourage experi-

No doubt many experience something of such states, perhaps sitting on a

Why do we practice meditation?

To what extent is there a consensus of objectives amongst the many tradi-

In the Sufi tradition of Islam, meditation is a central practice in the attempt to

is usually content-oriented . . . He is one who has attained communication with

Ornstein (1972) describes two major types of meditation—concentrative and

Shapiro (1982) describes three major attentional strategies—a focus on a

Zoom-lens attention is what both Ornstein and Naranjo call concentrative

The “mindfulness” revolution

Mindfulness as a concept is not new, as the quotation from Rahula reveals.

compassion, or whatever). Mindfulness practiced in clinical settings is secular

in a way that is demystifying, offering conceptual coherence rather than mys-

addictive behaviors. They review the use of mindfulness-based relapse preven-

people and explores ways in which mindfulness is developing in interventions

Personal Meditation Journey

When a friend talked of learning meditation in my first year at university, my reaction

The basis of meditation: concentration and enquiry

Definition of the foundations of consciousness

“Name” is constituted by five elements—contact, feeling, perception, inten-

Concentration: focusing and anchoring

some new organizational process, we can but not in an obsessive manner. We

existence is penetrative awareness of its impermanence and therewith conditioned

The early usage of the term implied a quality to be developed. Concentration

Creative awareness as meditative mindfulness

“present-centered and non-judgmental” awareness. However, the Buddhist

Mindfulness therefore serves different functions. It is at the same time some-

us to be aware of what is happening in this moment. This in turn enables us to

Tools of creative awareness

Mindfulness of feeling tones (Pali: vedana)

smell, a taste, a sight, a physical sensation, a sound, or a thought, is the experi-

When the uninstructed worldling is being contacted by a painful feeling, he sorrows,

Mindfulness of unpleasant feeling tones helps us to be with the experience

rest is interpreted as neutral or unpleasant. If instead we perceive that the base-

In this type of practice, concentration resides in repeating the sentences and

Meditation involves a balance between concentration and enquiry. It is import-

essential elements, meditation becomes relevant to a scientific, psychological

Personal Meditation Journey

I became interested in meditation in 1971 aged 18 and in 1975 I decided to travel to

How conscious experience

Metaphors of mind, old and new