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 experience 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).
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 disease, 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 addiction 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 programs of interventions such as acceptance and commitment therapy (ACT) and mindfulness-based stress reduction (MBSR) programs. It is difficult to disentangle 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 component in all of these elements, it is difficult to determine which elements (including 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 psychotherapy. 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 mindfulness 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.