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 carefully defined. Without successful dismantling trials there can be no definitive demonstration that the outcomes of MMBI are related to MM active intervention components and are not the result of common therapeutic factors. There are several directions for future research that might clarify the active ingredients 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 ingredients 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 borderline personality disorder (Linehan 1993). The growing evidence that different techniques are associated with different outcomes (Carmody and Baer 2008; Holzel 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 culture 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 clinicians 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 concerning 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 demonstrated 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 spiritual 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, phenomenology, and cognitive and clinical science in these pursuits.

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 meditation 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 eyebrows 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 confessional 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 undergraduate studying English Literature at Oxford in the early 1990s, I encountered the anonymous 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 relationship 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 student 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 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 bhaktis 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 Center, 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 suffering 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 fortunate 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 monitoring meditation. I learned how meditation creates patterns in neural network connectivity 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 knowing" and attend kindly to this moment, this breath.

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