Meditation in the West: Clinical

Scientific studies of meditation can be traced back to the 1930s, with initial research focusing on the effects of meditation on autonomic function.[1] In 1935 French cardiologist Therese Brosse travelled to India to conduct systematic studies of the physiological changes that occurred as a result of yogic and meditative practices. Brosse used a portable electrocardiogram to obtain measurements from at least one yogi who claimed to be able to voluntarily stop his heart by using meditative techniques.[2] Her data showed the yogi’s heart potentials and pulse wave decreasing in magnitude to approximately zero, where they stayed for several seconds before they returned to their normal magnitude. This result was believed to support the claim that the yogi was able to voluntarily control his heart to approximate cessation of contraction.[3] Similar studies were conducted in the 1950s by Gus Wenger, a physiologist from the University of California. Wenger examined four Indian yogis who also claimed to be able to voluntarily stop their heart or pulse, and reported that while the subjects did not control the heart muscle directly, they were able to induce changes in certain circulatory variables by using muscular and respiratory control.[4]

In the 1950s there was also a growing interest in the potential use of meditation in psychotherapy. This was informed by an ongoing dialogue between Buddhism and psychoanalysis, which centred on the work of influential Neo-Freudian psychoanalysts Karen Horney (1885-1952) and Erich Fromm (1900-1980), who were both students of renowned Zen scholar Daisetz T. Suzuki (1870-1966). Influenced by their association with Suzuki, both Horney and Fromm viewed Buddhism as a culturally distinct, but comparable, form of therapy to Western psychoanalysis.[5] This view was based on perceived similarities between the two systems, most notably the idea that both Buddhism and psychoanalysis share a common aim (the alleviation of suffering and the attainment of insight) and that both use introspection as a method to achieve this goal.  Within the psychoanalytic context, meditation (in particular mindfulness, zazen and breathing techniques) was seen as a therapeutic tool that could increase an individual’s access to their unconscious mind and help to resolve psychopathology.[6]

In the 1960s and 1970s, meditation research continued to focus on both physiological and psychological effects, and researchers started to conceptualise meditation in terms of current constructs in experimental psychology such as self-regulation, addiction and stress management. Notable studies from this period include those by Japanese researchers who conducted extensive electroencephalographic (EEG) studies of Zen meditators, observing changes in brain waves and testing reactions to external stimuli. These studies suggested that zazen (a Buddhist form of seated meditation) induced a calm but alert state that could potentially improve social confidence, increase emotional stability and treat drug addiction.[7] This period also saw the birth of the humanistic and transpersonal schools of psychology. Abraham Maslow (1908-1970) and Anthony Sutich (1907-1976) founded the Journal of Humanistic Psychology (in 1961) and the American Association of Humanistic Psychology (in 1963) in an attempt to establish a “Third Force” in American psychology; that is, an approach that focused on future-oriented self-actualisation rather than past-oriented psychopathology.[8] Transpersonal psychology provided a “Fourth Force” that focused on the transpersonal and spiritual dimensions of human existence. The transpersonal movement emerged out of the encounter between Western psychology, Eastern contemplative traditions, and the psychedelic counterculture of California in the 1960s.[9] Both humanistic and transpersonal psychology acknowledged the importance of spirituality, and utilised meditative techniques such as self-awareness and mindfulness in their practices.

The 1970s also saw a significant upsurge in research on TM, with studies indicating that this form of meditation could decrease blood pressure, respiratory rate,[10] and anxiety,[11] while increasing self-actualisation[12] and other positive behavioural outcomes in a large variety of domains.[13] In particular, TM was to establish an enduring presence in Western medicine and psychology during this period via the work of cardiologist and academic Herbert Benson. Benson coined the term “relaxation response” to describe the physiological and psychological effects that occur during TM, and his work greatly influenced the modern Western conceptualisation of meditation as a scientifically-endorsed stress reduction technique.[14] As Goldberg writes:

[TM] was presented as a scientific procedure, with results as predictable as those of any medicine, and no bad side effects. This rebranding of meditation was the first step in the secularisation and medicalisation of yogic disciplines.[15]

Goldberg notes that the relaxation message impressed both the general public and the scientific community, and quickly overshadowed any more “profound” reasons for meditating.[16] Hence, by 1976 the TM movement had enough data to be able to publish a seven hundred page volume of research papers, from fifty-one institutions in thirteen countries, reinforcing meditation’s new role as a health and wellness intervention.[17]

The late 1970s was also a critical period for the scientific study of mindfulness meditation. As discussed above, mindfulness was first incorporated into medical care in the form of what is now known as MBSR, an eight-week program developed by Jon Kabat-Zinn in 1979. Initially designed to treat chronic pain, the program produced promising results, and over the next three decades mindfulness replaced TM as the most researched form of meditation. More recently, the success of MBSR has stimulated the development of other mindfulness-inspired clinical interventions including mindfulness-based cognitive therapy (MBCT),[18] acceptance and commitment therapy (ACT),[19] dialectical behaviour therapy (DBT),[20] mindfulness-based relapse prevention (MBRP),[21] mindfulness-based eating awareness training (MB-Eat),[22] and mindfulness-based therapeutic community treatment.[23] These therapies have shown efficacy in the treatment of a number of conditions including depression,[24] anxiety,[25] chronic pain,[26] substance abuse,[27] eating disorders,[28] addiction[29] and more recently psychosis.[30] Today, MBSR is an established practice in hospitals, and a large number of clinicians have undertaken training in mindfulness-based interventions.[31] Additionally, mindfulness meditation research has expanded from looking at how mindfulness can improve outcomes for a variety of illnesses, to looking at how mindfulness might improve performance enhancement in healthy populations.[32]

While the majority of meditation research is still on mindfulness, the field has also expanded to include the study of other Buddhist-derived meditation techniques, such as practices aimed at the cultivation of compassion (for example, metta, or loving-kindness meditation),[33] and other analytical styles of meditation (for example, deity visualisation practices).[34] New areas of research (for example, technological approaches to mindfulness training)[35] are emerging and discussions are taking place regarding the field of ‘contemplative science,’ and how to best define, classify and study a variety of meditation practices.[36] In recent years there has been an increased interest in the study of contemplative practices within neuroscience, psychology and the health sciences, which has resulted in the development of several new academic journals, including Mindfulness, The Journal of Compassionate Healthcare and the Journal of Contemplative Inquiry.[37]

[1] Paranjpe, “Indian Psychology,” 1-26.

[2] Brosse undertook her studies at Kaivalyadham, a yoga institute at Lonavala near Pune, India. See Paranjpe, “Indian Psychology,” 1-26.

[3] Results cited in M.A. Wenger, B.K. Bauchi and B.K. Anand, “Experiments in India on ‘Voluntary’ Control of the Heart and Pulse,” Circulation 24, no. 6 (1961): 1319-1325.

[4] Wenger conducted studies at Kaivalyadham, and at the All India Institute of Medical Sciences in Delhi. See Wenger et al., “Experiments in India,” 1319-1325.

[5] Parsons, “Psychoanalysis Meets Buddhism,” 192.

[6] A prevailing idea in psychoanalysis was that unconscious conflicts were the root cause of psychopathology. It was thought that meditation could ‘loosen’ a person’s defences and allow formerly repressed unconscious material to surface and be resolved. One popular view saw meditation as a free association technique that could be used to reveal the interior contents of the unconscious mind. For an explanation of possible processes see I. Kutz, J. Z. Borysenko and H. Benson, “Meditation and Psychotherapy: A Rationale for the Integration of Dynamic Psychotherapy, the Relaxation Response, and Mindfulness Meditation,” American Journal of Psychiatry 142, no. 1 (1985): 1-8. Also G. Bogart, “The Use of Meditation in Psychotherapy: A Review of the Literature,” American Journal of Psychotherapy 45, no. 3 (1991): 383.

[7] For a review see J.M. Kornfield, “The Psychology of Mindfulness Meditation.” Unpublished PhD Dissertation. (Saybrook Institute, 1977): 31-38.

[8] J.J. Kripal, Esalen: America and the Religion of No Religion (Chicago, IL: University of Chicago Press, 2007): 137-151.

[9] For a discussion see J.N. Ferrer, Revisioning Transpersonal Theory: A Participatory Vision of Human Spirituality (Albany, NY: State University of New York Press, 2002), 5-6.

[10] For example, R.K. Wallace and H. Benson, “The Physiology of Meditation,” Scientific American 226 (1972): 84-90.

[11] D. Ballou, “Transcendental Meditation Research: Minnesota State Prison” in The Psychobiology of Transcendental Meditation, eds. D. P. Kanellakos and P. C. Ferguson (Los Angeles, CA: MIU Press, 1973).

[12] W. Seeman, S. Nidich, and T. Banta, “Influence of Transcendental Meditation on a Measure of Self-Actualization,” Journal of Counselling Psychology 19, no. 3 (1972): 184-187. Also P.C. Ferguson and J. Gowan, “The Influence of TM on Anxiety, Depression, Aggression, Neuroticism, and Self-actualization” in The Psychobiology of Transcendental Meditation, eds. D. P. Kanellakos and P. C. Ferguson (Los Angeles, CA: MIU Press, 1973).

[13] For a review see D. H. Shapiro Jr and R. N. Walsh eds., Meditation: Classic and Contemporary Perspectives (New York, NY: Aldine Transaction, 2009).

[14] Wilson, Mindful America, 80.

[15] Goldberg, American Veda, 164.

[16] Goldberg, American Veda, 164.

[17] Goldberg, American Veda, 164.

[18] Z. V. Segal, J. M. Williams and J. D. Teasdale, Mindfulness-based Cognitive Therapy for Depression: A New Approach to Preventing Relapse (London: Guilford, 2002).

[19] S. C. Hayes, K. D. Strosahl and K. G. Wilson, Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change (New York, NY: Guilford Press, 2003).

[20] For example, M.M. Linehan, “Dialectical Behavior Therapy for the Treatment of Borderline Personality Disorder: Implications for the Treatment of Substance Abuse,” NIDA Research Monograph 137 (1993): 201-216.

[21] For example, K. Witkiewitz, G.A. Marlatt and D. Walker, “Mindfulness-based Relapse Prevention for Alcohol and Substance Use Disorders,” Journal of Cognitive Psychotherapy 19 (2005): 211-228.

[22] For example, J.L. Kristeller and R.Q. Wolever, “Mindfulness-Based Eating Awareness Training for Treating Binge Eating Disorder: The Conceptual Foundation,” Eating Disorders 19, no. 1 (2011): 49-61.

[23] For example, M.T. Marcus and A. Zgierska, “Mindfulness-based Therapies for Substance Use Disorders: Part 1,” Substance Abuse 30 (2009): 263-265.

[24] For example, S.H. Ma and J.D. Teasdale, “Mindfulness-based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects,” Journal of Consulting and Clinical Psychology 72 (2004): 31-40.

[25] For example, J. Kabat-Zinn, Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness (New York, NY: Delacorte Press, 1990).

[26] J. Kabat-Zinn, “An Outpatient Program in Behavioral Medicine for Chronic Pain Patients Based on the Practice of Mindfulness Meditation: Theoretical Considerations and Preliminary Results,” General Hospital Psychiatry 4, no. 1 (1982): 33-47. Also J. Kabat-Zinn, L. Lipworth and R. Burney, “The Clinical Use of Mindfulness Meditation for the Self-regulation of Chronic Pain,” Journal of Behavioural Medicine 8, no. 2 (1985): 163-190.

[27] For example, A. Zgierska, D. Rabago, N. Chawla et al., “Mindfulness Meditation for Substance Use Disorders: A Systematic Review,” Substance Abuse 30 (2009): 266-294.

[28] For example, J.L. Kristeller, R.A. Baer and R. Quillian-Wolever, “Mindfulness-based Approaches to Eating Disorders,” in ed. R.A. Baer, Mindfulness-Based Treatment Approaches: Conceptualization, Application, and Empirical Support (San Diego, CA: Elsevier, 2003).

[29] For example, C.A. Spears, D. Hedeker, L. Liang et al., “Mechanisms Underlying Mindfulness-based Addiction Treatment Versus Cognitive Behavioural Therapy and Usual Care for Smoking Cessation,” Journal of Consulting and Clinical Psychology 85, no. 11 (2017): 1029-1040.

[30] For example, P. Bach and S.C. Hayes, “The Use of Acceptance and Commitment Therapy to Prevent the Rehospitalisation of Psychotic Patients: A Randomised Controlled Trial,” Journal of Consulting and Clinical Psychology 70 (2002): 1129-1139. See also P. Chadwick, “Mindfulness Groups for People with Psychosis,” Behavioural Cognitive Psychotherapy 33, no. 3 (2005): 351-359.

[31] In the United Kingdom mindfulness has also been adopted by the NHS, with many primary care trusts offering and recommending the practice instead of cognitive behavioural therapy. Dawn Foster, “Is Mindfulness Making Us Ill?” The Guardian, January 23 (2016), accessed March 24, 2018: https://www.theguardian.com/lifeandstyle/2016/jan/23/is-mindfulness-making-us-ill.

[32] J. Sun, “Mindfulness in Context: A Historical Discourse Analysis,” Contemporary Buddhism 5, no. 2 (2014): 394-415.

[33] J. Kabat-Zinn, “Lovingkindness Meditation,” Mindfulness 8, no. 4 (2017): 1117-1121.

[34] M. Kozhevnikov, O. Louchakova, Z. Josipovic and M.A. Motes, “The Enhancement of Visuospatial Processing Efficiency Through Buddhist Deity Meditation,” Psychological Science 20, no. 5 (2009): 645-653.

[35] J. Sliwinski, M. Katsikitis and C.M. Jones, “A Review of Interactive Technologies as Support Tools for the Cultivation of Mindfulness,” Mindfulness 8, no. 5 (2017): 1150-1159.

[36] See D. Dorjee, “Defining Contemplative Science: The Metacognitive Self-regulatory Capacity of the Mind, Context of Meditation Practice and Modes of Existential Awareness,” Frontiers in Psychology 7 (2016): 1-15.  Also, W. B. Britton et al., “Contemplative Science: An Insider Prospectus,” New Directions for Teaching and Learning 134 (2013): 13-29.

[37] B. Ozawa-de Silva, “Contemplative Science and Secular Ethics,” Religions 7, no. 8 (2016): 5.

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