Jose Drost-Lopez

Research on meditation, mindfulness and related psychotherapies

In Cognitive Sciences, Religions and spirituality on November 13, 2011 at 1:59 am

Buddhism involves not just a set beliefs but also a set of practices. Two of the most important and interrelated Buddhist practices are mindfulness and meditation. Both of these concepts have many formulations in different schools of Buddhist thought, but I’d like to zero in on a simplified definition of mindfulness that has guided Western psychologists and psychiatrists. In this definition, mindfulness has two components:

(1) Purposely keeping one’s attention on the flow of experiences in the present moment

(2) An attitude of nonjudgmental curiosity, openness, and acceptance toward these present experiences.

Having defined mindfulness, we can also take an initial stab at what counts as meditation. Meditation is a procedure for mindfully exploring and transforming one’s mind. Examples of traditional meditation styles include Transcendental Meditation, which involves concentrating on a mantra, and compassion meditation, which involves projecting one’s love and kindness to all sentient beings. Though attempts to adapt meditation have a long, global history, one recent trend in the West is to strip meditation down to a secular, easy to learn process intended to promote mental and bodily health.

Having defined mindfulness and mediation, we’re almost ready to talk about the research relating to them—but first a little history. Buddhism is like most disciplines that study the mind in that it existed long before experimental psychology. But when psychology did emerge in the late 19th and early 20th centuries, one particular psychologist stood out in welcoming influences from Buddhism. His name was William James, and he’s remembered as one of the greatest American psychologists. In his 1890 work The Principles of Psychology, he popularized a concept borrowed from Buddhist texts known as stream of consciousness. James borrowed that phrase to point out that our perceptions flow together seamlessly even though they integrate many distinct elements and discrete moments. In his later writings James promoted meditation as a useful introspective and therapeutic tool. Referring to Buddhism, he proclaimed: “This is the psychology everybody will be studying twenty-five years from now.” It turns out he was basically wrong—the next big influences in psychology were the psychoanalysis of Sigmund Freud, an Austrian, and the behaviorism of B.F. Skinner, an American. Even still, plenty of psychologists and writers over the decades tried to integrate Buddhist ideas into their thought. Then in the 1970s, psychologists and neuroscientists started collecting data from Buddhist practitioners.

One of the largest lines of research on meditation has involved a technique called electroencephalography, or EEG. In EEG, electrodes are placed along the scalp to detect voltage fluctuations due to the electrical activity of the brain. EEG has some limitations—for example, it only picks up on large bursts of activity, and it gives only a very rough sense of where in the brain neurons are firing. But the biggest limitations in these studies have related to their design: often they badly controlled, unclear in their definitions and sloppy in their data collection.

So these EEG studies are a work in progress and they’re difficult to interpret, but they do generally support two points. First, meditation and mindfulness exercises cause unique patterns of brain activity. These patterns seem to represent states of awareness that at are least partially separate from related states of relaxation, drowsiness, or concentration. The second main point is that practitioners’ brain activity depends on their experience level, intensity, and style of training, which suggests that meditation and mindfulness involve somewhat different experiences in different people.

The experience of meditation, like that of many spiritual practices, involves a diminished sense of self, space and time. These subjective feelings have been validated in various brain EEG studies. The studies show decreased activity in a part of parietal lobe that monitors location in space, as well as increased activity in parts of the frontal lobe involved in attention.

Beyond EEG there have been more recent studies that look meditating brains in a different way. One study that really made a media splash back in 2005 showed an association between meditation experience and thickness in the outer layer of the brain, or the cerebral cortex. Although there is a possibility that the 20 practitioners of insight mediation in this study had thicker cortices for reasons unrelated to meditation, the most plausible interpretation of the association is that in some parts of the cortex, meditation can slow down the thinning that occurs as people age. This might mean mediation can slow down cognitive decline at certain stages.

But meditation cheerleading can be taken too far, as psychologist Mark Epstein learned  in a meditation session gone bad. The setting was a spiritual retreat led by an American teacher named Ram Dass. One of the students at this retreat, a young man, started showing signs of hallucinations and psychotic delusions. Epstein observed as this happened, and was intrigued at the opportunity to see a spiritual approach to dealing with a psychotic person. Ram Dass spent a few minutes chanting with the young man and trying to center him meditatively, but the man became agitated and violent. As the man began to lash out, Ram Dass restrained him, but in the process the man bit Ram Dass in the stomach. Soon afterward he was prescribed anti-psychotic drugs. Commenting on this episode, Epstein points out that meditation is not an all-purpose panacea, and that Western approaches including medications can be assets in promoting well-being.

The power of meditation shows itself beyond the brain. Cardiologist Herbert Benson found that experienced practitioners can decrease their blood pressure, heart rate, and oxygen consumption. Benson calls this physiological response the relaxation response. Benson helps his patients initiate this response by introducing his patients to a simple meditative relaxation exercise. This exercise is simple for you to try. It involves sitting in a comfortable position, breathing deeply, relaxing all the muscles from toe to face, closing your eyes, and focusing on a single word or phrase. Benson’s patients usually focus on a favorite prayer, which brings up an interesting point about the portability of meditation practices across religious divides. That prayer can just as easily be Christian or Muslim and make for an effective session. Picking up this thread, the psychology textbook writer David Myers points out that meditative techniques have a long history in many religious traditions, and he gives the example of Gregory of Sinai, who in the early 1300s wrote basic instructions for Christians to meditate on Jesus.

There will plenty more progress in understanding meditation in the brain, but beware of vague headlines. Here are two recent headlines from major news outlets: “Brain scans show meditation changes minds.” “Compassion meditation changes the brain.” These claims might have a ring of impressiveness at first, but they usually just echo the mundane fact that all our experiences change the brain.

Mindfulness and psychotherapy

There’s a tantalizing but sometimes inconclusive body of evidence related to mindfulness-inspired therapy programs. Two increasingly popular therapeutic practices using Buddhist mindfulness techniques are Jon Kabat-Zinn’s Mindfulness-based Stress Reduction (MBSR) and Marsha M. Linehan’s Dialectical Behavioral Therapy (DBT). Other prominent therapies that use mindfulness include Steven C. HayesAcceptance and Commitment Therapy (ACT) and, based on MBSR, Mindfulness-based Cognitive Therapy (MBCT).

Studies on these therapies show a surprising twist—there are documented adverse effects of mindfulness training, although they are almost always minor enough to be outweighed by the benefits. In part-time programs, these adverse effects include the mental discomfort and guilt that people feel when they fail to live up to some of their resolutions and expectations. In intensive retreats, some people mention vivid perceptual alterations during meditation, and a small study at one retreat even suggested that more experienced practitioners had spontaneous hallucinations and unusual perceptions more often, although they didn’t dwell much on these disturbances.

Now to the positive findings. Across the board, mindfulness-based interventions decrease people’s self-reported feelings of stress. Mindfulness exercises also lower people’s focus on financial gain, which in turn boosts their self-reported happiness. There a lot of more specific benefits attributed to mindfulness, but in assessing these claims, we have to be careful about turning a blind eye to classic problems that confront psychology experiments. Usually the experimenter can’t avoid biasing results due to their expectations and assumptions. That’s why in clinical trials the gold standard is the double-blind trial, in which neither the patient nor doctor know which treatment is being administered. Of course it’s not feasible to blind people to what type of counseling they give or receive, so we have the accept the presence of self-fulfilling expectations, especially in participants in counseling programs, who are likely to initiate a strong placebo response to that has little to do with mindfulness or meditation per se. In addition, studies of mindfulness programs often have small sample sizes, roughly meaning groups under 30 people, in which chance anomalies are easy to mistake for positive or negative results.

So let’s shift back to Mindfulness Based Stress Reduction, or MBSR. This is an eight-week part-time program developed by Jon Kabat-Zinn over a ten year period with over four thousand patients at the University of Massachusetts Medical Center. Kabat-Zinn deserves a lot of credit for initiating serious clinical studies of mindfulness techniques. But what do the studies say?

When psychologist Richard Davidson at the University of Wisconsin assigned volunteers either to a control group or two an eight-week MBSR course, the trained volunteers showed more left-hemisphere activity, which is associated with positive emotions, and improved immune functioning. These benefits may help explain a 1989 study of 73 residents of homes for the elderly that randomly assigned them to Transcendental Meditation, mindfulness training, relaxation training, or no intervention. After three years, it was clear that the meditation training group was healthiest, followed by the mindfulness group. Whereas no one in the meditation group had died, a fourth of the control group had died. Meditators also performed best on a battery of tests and ratings for associative learning; cognitive flexibility; word fluency; mental health; systolic blood pressure; behavioral flexibility and aging,

Then there was a 2004 meta-analysis in the Journal of Psychosomatic Research that reviewed 64 research reports and aggregated the results of the 20 studies that met quality criteria. They found that MBSR can help a broad range of individuals cope with clinical and nonclinical problems. Most studies showed similar statistical effect sizes of about 0.5, which means that the average MBSR participant had better mental health than 69% of people in the general population. Note that this modest effect size is comparable with the effectiveness of established Western psychotherapy techniques.

Dialectical Behavioral Therapy (DBT) is another Western-style approach to therapy that draws on Buddhism. It encourages neutral acceptance of unpleasant facts and includes mindfulness training as a core skill to enact change. DBT was designed help people with mood disorders and personality disorders, so studies of its effectiveness haved focus on these disorders. Controlled clinical studies have demonstrated DBT’s effectiveness for people with borderline personality disorder. Research indicates that DBT is also effective in treating patients who present varied symptoms and behaviors associated with spectrum mood disorders, including self-injury. Recent work suggests its effectiveness with sexual abuse survivors and chemical dependency.

Our whirlwind tour is coming to a close. You can learn much more from Chris Mace of the University of Warwick. Through the interplay of meditation and mindfulness with Western science and therapy, Buddhism has made a profound contribution to science with its mindfulness and meditation techniques and  many aspects of Buddhist beliefs complement the latest orthodoxy in neuropsychology. Science still has plenty to learn from and about Buddhism, and conversely, Buddhist teachings are still assimilating modern research findings. In the coming years it will be fun to watch that cross-pollination on a larger and larger scale.

 

This is the last in a series  on Buddhism and neuropsychology. Read more:

The origin story of Buddhism

Contrasting views of the self

Preventing depression and boosting well-being with mindfulness (videos)

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