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Basant Pradhan

Yoga and Based Cognitive Therapy

A Clinical Guide

123 and Mindfulness Based Cognitive Therapy

Basant Pradhan

Yoga and Mindfulness Based Cognitive Therapy

A Clinical Guide Basant Pradhan, MD Department of Psychiatry Cooper University Hospital, and Cooper Medical School of Rowan University Camden , NJ USA

ISBN 978-3-319-09104-4 ISBN 978-3-319-09105-1 (eBook) DOI 10.1007/978-3-319-09105-1 Springer Cham Heidelberg New York Dordrecht London

Library of Congress Control Number: 2014952228

© Springer International Publishing Switzerland 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

Printed on acid-free paper

Springer is part of Springer Science+Business Media (www.springer.com) I dedicate this book to the inspiring wisdom of the two early champions of ancient India: ( The Awakened ; circa. Sixth century BC) & (author of the Yoga - , the fi rst text book of Yoga; circa. Fourth century BC) For their profound clarity, greatness, and nobility of purpose………

Foreword

The current trend in psychotherapy has been towards more systematic approaches based on research evidence and away from practice-based experience. However, this has not meant that you need to throw the baby out with the bathwater in terms of solid conceptual models that have been proven constants withstanding the test of time. Some of these concepts and approaches come from cultural traditions that are different than the traditional Western linear-empirical model and have required translation for Western audiences. In psychotherapeutics, it is being increasingly recognized that, in order to be effective, there need to be the right balance between evidence based knowledge and the therapeutic experience: the two crucial elements of any psychotherapy essentially supplementing each other in this rich model of human interactions. One of the traditional models that have promoted this balance is that of - based psychotherapy. Meditation is the 7th step in both the Eight Limbed Yoga ( ashtanga) of the sage Patanjali (Satchidananda 1978; Feuerstein 1979) and the of the Buddha (Bodhi 2000). This is basically an ongoing cognitive-emotive-reappraisal process in the meditator in order to obtain insight and directly experience the personal truths in the meditator’s own life based on this insight. This deeply contemplative process helps the meditator own his/her experi- ences, where his/her actions are governed by ongoing knowledge obtained from the meditation rather than by reactions to the underlying impulse to act. Technically meditation involves learning to shift and focus one’s attention at will onto an object of choice, such as bodily feelings or an emotional experience, while disengaging from usual conditioned reactivity or elaborative processing. Meditation has been a part of many philosophies of human interaction and of spiritual and faith traditions for centuries, and universally seen as a healing process to calm the mind and refresh the spirit. Recent re-discovery of the value of meditation in the clinical context could be credited to many scholars including Jung (1933, 1969), Benson (1974), and Jon Kabat-Zinn (1990). Ultimately it has been mindfulness meditation, with a focus on heightened self-awareness and a key tenet of Yoga, which has captured the most attention. An example of this was Linehan’s (1993) discovery of this approach in her own emotional recovery and later her application of mindfulness meditation in her model of dialectical behavioral therapy, oriented to address the needs of some of our most complex patients.

vii viii Foreword

In this textbook by Dr. Basant Pradhan, we fi nd further integration and symptom specifi c applications of mindfulness meditation as well as other principles and skills from the broad system of Yoga for clinical intervention and treatment. However, the translation this time is conducted by a scholar who is thoroughly grounded in the Eastern tradition of Yoga but also highly conversant in Western empiricism. Dr. Pradhan received monastic training in Yoga but went on to pursue a career in the Western model of medicine as a physician-psychiatrist and empirical scholar. This means that he is truly a bi-cultural and bi-conceptual individual with a full under- standing of both domains and easily traverses from one to the other. In his model of Yoga-Mindfulness-Based Cognitive Therapy (Y-MBCT) which involves the clini- cal use of Yoga - meditation in its entirety, he not only applies mindfulness medita- tion in cognitive treatment, but also integrates other (Yogic postures) and kriyas (Yogic procedures), which allows this model to be applied across not only many different behavioral and emotional disorders and problems but also in various psychosomatic disorders. The results are evident both conceptually in this textbook as well as clinically from my own vantage point as a close colleague and collaborator. Dr. Pradhan is a rare individual in many ways. He is a true cultural bridge builder as would be expected more someone coming from an immigrant generation 1.5 background. He is truly a master of Western empirical neurosciences and cognitive sciences as well as Eastern philosophy, tradition, and wisdom, and translates across both easily. He also has deep respect for the cumulative wisdom in both traditions, which comes from his highly scholarly perspective. He is also a person of deep pas- sion and dedication to heal, which leads him to apply these concepts in such a man- ner that they are accessible both to the patient and to fellow clinicians. At the same time, as a scholar, he understands the need to apply empirical methods to the devel- opment of an objective evidence-base to match the cumulative wisdom behind many of his approaches. This textbook is refl ective of Dr. Pradhan as a person, a healer-clinician, and a scholar. Having had the pleasure of knowing him for almost 5 years, it has been evident to me that in this textbook he has applied many of the principles that he shares with us in his daily life as well as his teaching, clinical work, and scholarship. He is also true believer in the concept of collective from which arise his dedication towards healing his fellow human beings, who he ultimately sees as part of his identity. Given this genuine source of motivation behind his work, I trust that his book will become a critical resource for an innovative form of psychother- apy that is at the same time more pragmatic as well as humanistic. Bridging the existing gap, it will contribute to improved access to effective psychotherapeutic services and effective treatment for many people from East and West.

Camden , NJ , USA Andres J. Pumariega , MD Foreword ix

References

Benson H, Beary J, Carol M (1974) The relaxation response. Psychiatry: Journal for the Study of Interpersonal Processes 37(1):37–46 Bodhi B (2000) The Noble Eightfold Path: way to the end of suffering. Pariyatti Publications, Onalaska Feuerstein G (1979) The Yoga- of Patanjali. A new translation and commentary. Inner Traditions International, Rochester Jung CG (1933) Modern man in search of a . Harcourt Brace & Co., New York Jung CG (1969) Psychology and religion: west and east. Princeton University Press, Princeton Kabat-Zinn J (1990) Full catastrophe living. Delacorte Press, New York Linehan MM (1993) Skills training manual for treating borderline personality disorder. Guilford Press, New York Satchidananda S (1978) The : translations and commentary. Publications, Yogaville

About the Author

Basant Pradhan , M.D . is an academic psychiatrist for children, adolescents and adults. He was born in India and completed his medical and psychiatric education there. Upon arriving in the United States in 2006, he repeated his psychiatric train- ing at the Albert Einstein Medical Center and Thomas Jefferson University, Philadelphia. He obtained psychodynamic psychotherapy training in adults and children from the Psychoanalytic Center of Philadelphia and cognitive behavioral therapy training from the Thomas Jefferson University. Pradhan’s journey in Yoga and meditation goes back to his childhood and he has been a privileged benefi ciary of monastic training in the scriptural traditions. In his personal life, he is a humani- tarian and active practitioner of Yoga and meditation. In his professional life, he has been a student of philosophy, psychotherapy, psycho-pharmacology and researcher of psychology, psychiatry and cognitive neurosciences. Currently he serves as an Assistant Professor of Psychiatry at the Cooper University Hospital and Copper Medical School of Rowan University, Camden, New Jersey, where he also serves as the founding director of the Yoga and Mindfulness Based Cognitive Therapy (Y-MBCT, therapy models compiled by Pradhan and colleagues) and the trans- cranial magnetic stimulation (TMS) treatment programs. Pradhan is an executive member of the Group for the Advancement of Psychiatry (GAP) and the American Psychiatric Association (APA)’s Caucus on Complementary, Alternative, and Integrative Medicine and currently serves the Editorial Advisory Board of Adolescent Psychiatry , the offi cial journal of the American Society for Adolescent Psychiatry. In addition to the Y-MBCT models of therapy for psychiatric disorders, Pradhan has compiled a wellness model, the Standardized Yoga Meditation Program for Stress Reduction (SYMPro-SR), the effi cacy of which is being tested in an ongo- ing manner in mental health and illness by him and colleagues. He has widely pre- sented his scholarly work in over 50 national conferences in India and USA and has authored or co-authored over 20 peer reviewed articles, editorials and book chap- ters. In a current ongoing research project, Pradhan and colleagues are comparing the effi cacy of ketamine (a novel medication that alters the trauma memories) and Y-MBCT in treatment refractory post-traumatic stress disorder (PTSD). Pradhan has been cited by the various newspapers and has won several awards in India and USA for his clinical, academic and research work.

xi

Acknowledgments

Meditation is not an action; rather, it is a state of mind which is developed by a continuous and unfragmented stream of experience. In that sense, this book project, which has been continuously evolving in my mind from the early days of my monas- tic training until now, has been a meditation for me. I take this as an opportunity to express my profound gratitude to my mother, who was my fi rst spiritual teacher, and to my other teachers and mentors in the domains of monastic education, neuropsy- chiatry, and psychotherapy. At a virtual front, I think this book has two celebrated coauthors who have pro- foundly inspired me with their clarity of thoughts and nobility of purpose. They are none other than the Buddha (Siddhartha Gautama) and the mythical sage Patanjali (author of the Yoga - Sutras , the fi rst text book of Yoga). At a real front, fi rst and foremost, I wish to thank my mentor Dr. Salman Akhtar, Professor of Psychiatry at Thomas Jefferson Medical College and a prolifi c writer and psychoanalytic thinker, for awakening the writing spirits in me (in the traditions of Yoga, this process is called awakening of the energy ). I am immensely grateful to Dr. Andres Pumariega, Professor and Chair of Psychiatry at Cooper University Hospital, for his ongoing support as well as his wonderful collaborative efforts that have helped me immensely for integrating and applying this work to the mainstream medicine. I am grateful to all my patients, who through their direct clinical work involving Yoga and meditation have provided us clinical insight and inspiration to use these won- derful therapeutic tools. I am immensely thankful to Manna Pourrezaei, my research associate, for her tremendous help with editing many portions of this manuscript. I am deeply grateful to a number of prominent people known to me through the academic circles and through the Psychoanalytic Center of Philadelphia. Some of them have inspired me by their work in Yoga and meditation, and some others have been quite informative through their discussions and suggestions in helping me bridge across the various intersections between their domains of work and Yoga and medita- tion. Prominent among these individuals are Drs. Daniel Freeman and Dwarkananth Rao, two prominent psychoanalysts; Dr. Andrew Newberg, Professor of Radiology and Director of Research at the Myrna Brind Center of Integrative Medicine, Thomas Jefferson University Hospital; Dr. Richard Gray, a researcher in the Post-traumatic Stress Disorder (PTSD) and one of my collaborators in application of Yoga and meditation in PTSD; and Dr. Lila Massoumi, Chair of the American Psychiatric Association’s Caucus on Complementary, Alternative, and Integrative Medicine.

xiii xiv Acknowledgments

I profusely thank to the wonderful editorial staff at the Springer Publishers International Inc. including Corinna Schaefer and the editorial staff of SPi Global, Chennai, India. Lastly but not the least, I thank Dr. Madhusmita Sahoo, who is simul- taneously my wife, intellectual inspiration, and critique. Her love, support, and healthy criticism provided the nurturing matrix essential for putting this book together. Practicing Yoga with her and my daughter Aarya has defi nitely helped me develop more calmness and perseverance to stay on this task. Contents

Part I Demystifi cation

1 Yoga: Original Concepts and History ...... 3 1.1 Introduction...... 3 1.2 Yoga as a Mystery and Need for Demystifi cation ...... 4 1.2.1 Some Other Reasons for the Misconceptions ...... 5 1.3 Original Defi nitions of Yoga ...... 6 1.3.1 Yoga, Its Meanings and the Minor Conceptual Differences from the ...... 7 1.3.2 Various Forms of Yoga ...... 8 1.4 Yoga: Origins and Scriptures ...... 10 1.4.1 Origins of Yoga from the Samkhya System in Ancient India ...... 10 1.4.2 The Oral Tradition of Yoga...... 10 1.4.3 (Vedic) and (Buddhist): The Original Languages of Yogic Scriptures ...... 11 1.4.4 The Varieties of Yogic Scriptures ...... 12 1.4.5 Patanjali’s Yoga Sutras: A Brief Summary ...... 14 1.4.6 Classics on ...... 16 1.5 The Four Major Philosophical Systems of Yoga: The , , Shramana, and Tantra...... 17 1.5.1 Yoga in the Vedas (Samkhya/Rig-Vedic Philosophy) . . . . . 17 1.5.2 Yoga in the Vedanta () ...... 18 1.5.3 Summary of Yoga in the Veda (Samkhya) and Vedanta (Upanishad) ...... 19 1.6 Great Contribution of the Shramanic (Non-Hindu) Philosophies: Rise of Meditation in the System of Yoga ...... 20 1.6.1 Yoga Versus Meditation ...... 21 1.6.2 Seminal Contributions of into the Meditative System of Yoga...... 22 1.6.3 Buddha’s ...... 22

xv xvi Contents

1.7 Tantra: The Fourth and the Newest System of Yogic Philosophy ...... 23 1.8 Yogic Philosophies Bridge Across the Ideologies of All Four Schools: The Veda (Samkhya), Vedanta (Upanishads), Shramana, and Tantra...... 24 1.9 History of Yoga...... 25 1.9.1 Yoga in Ancient India ...... 26 1.9.2 Yoga in Medieval India...... 26 1.9.3 Yoga in Modern India ...... 27 1.9.4 Yoga Beyond India: Spread to the Far East ...... 28 1.9.5 Yoga Beyond India: Spread to the West ...... 29 1.10 Some Further Clarifi cations ...... 30 1.10.1 Versus Religiousness ...... 30 1.10.2 Yoga Is Not Religious ...... 31 1.11 Concluding Remarks...... 33 References ...... 33 2 Yoga, Mind, and the Psychosomatics ...... 37 2.1 Introduction...... 37 2.2 Yoga and the Mind (Consciousness, [Sans. chitta]): Some Key Terms ...... 38 2.3 Yogic Consciousness (Mind [Sans. chitta]) and Its Varieties as the Meditator Ascends in the Meditative Path ...... 40 2.4 Phenomenology of Human Experience and Role of the Mind (Consciousness) in Its Creation ...... 41 2.5 Mind (Consciousness): A Bundle of Five Things (Aggregates) ...... 42 2.6 Central Problem Inherent in the Nature of the Mind: Projection (Vikshepa) That Causes Illusion () and Ignorance (Avidya) About the ...... 43 2.6.1 Reversal of the Projections Is the Key Mechanism of Action of Yoga ...... 45 2.7 Models of the Mind (Consciousness) in the Yogic Philosophies ...... 46 2.7.1 The Monkey Metaphor: Explains the Inherently Unstable Nature of the Mind ...... 46 2.7.2 The Tripartite Model of Human Experience: The Projector Analogy ...... 47 2.7.3 The Lake Model of Consciousness (Mind): The Real Self Lies Deep Down in the Bottom ...... 49 2.7.4 Yoga Sutras Says That Our Perception of Reality Is Illusory Because of the Sensorial Mind ...... 49 Contents xvii

2.8 The Profound Psychosomatic Views Found in the Yogic Philosophies...... 50 2.8.1 Mind and Stress: Yoga as the Remedy ...... 52 2.8.2 Yogic Science as Mind–Body (Psychosomatic) Medicine: Some Mechanisms...... 53 2.8.3 Deep Connections Between Yoga and the Mental Health ...... 53 2.9 Concluding Remarks...... 54 References ...... 54 3 Brain, Mind, and Soul: Bridging the Gap ...... 57 3.1 Introduction...... 57 3.1.1 Human Experience Is Tripartite: The One Who Sees (Seer/Self), the Scene (Object/World), and the Interpreting Interface (Mind) ...... 58 3.1.2 The Trilogy in the Human Existence: Body (Brain), Mind, and Soul ...... 58 3.2 Brain: The Most Complex Organ of the Human Body...... 58 3.2.1 Facts About the Human Brain...... 58 3.2.2 The Brain as an Important Locus of All Experiences Including the Spiritual Experiences ...... 60 3.2.3 More Recent Research on the Brain: Top Brain and Bottom Brain...... 60 3.3 Concept of the Mind in Yoga ...... 61 3.3.1 Mind Is Graded: Lower to Higher...... 61 3.4 Soul: The Third Entity of Existence and Experience ...... 63 3.4.1 Soul and the Pure Awareness (Pure Experience) ...... 64 3.5 Mapping Experiences onto the Brain: The Neural Circuitry ...... 65 3.5.1 Visual Pattern Recognition: The Prototype Process in Mapping Experiences onto the Brain ...... 66 3.5.2 The Five Major Groups of Circuits in Our Brain ...... 67 3.5.3 Functions of the Prefrontal Cortical (PFC) Tri-Circuit. . . . 68 3.5.4 Close Relationship Between the OFC and Amygdala . . . . 69 3.5.5 Frontal Tri-Circuits Modulate the Thalamus (the Sensory Gate) and the Basal Ganglia ...... 70 3.5.6 A Scenario Illustrating the Functions of the Prefrontal Tri-Circuits...... 71 3.5.7 Role of Salience and Facilitated Circuits in the Neural Mapping of Experience...... 73 3.5.8 The Main Players in the Meditative Brain ...... 74 xviii Contents

3.6 Experience is Representational and Knowledge (Insight) Changes These Representations ...... 75 3.6.1 Knowledge, Direct Experience, and Reality: Three Synonyms in Yoga ...... 76 3.6.2 Knowledge (Insight [Pali Nana, Panna]) Is Graded. . . . . 77 3.6.3 Meditation as a Direct Experience: Beyond the Realm of the Intellectual Mind ...... 78 3.7 Meditative Process and Technique: as Its Prototype...... 79 3.7.1 Knowing by Fusion: The Key Technique in Samyama...... 80 3.7.2 Samyama Is a Two-Stage Process...... 81 3.8 The Meditative Experiences: A Detailed Account ...... 82 3.8.1 Meditative Phenomenology and Parameters...... 82 3.8.2 Losing the Sense of Time and Becoming One with the Experience: The Hallmarks of Yogic Absorption ...... 83 3.8.3 Meditation from the Perspective of Cognitive Neuroscience: Central Role of One’s Attention ...... 85 3.8.4 The Meditative Brain: Preliminary Understandings. . . . . 86 3.9 Yogic and Cognitive Neurosciences: Remarkable Concurrences at Many Levels ...... 87 3.9.1 Concurrence with Respect to Conceptualization of Consciousness ...... 88 3.9.2 Concurrence with Respect to the Process of Samyama (or Mindfulness): Metacognitive and Neural Paradigms of Consciousness ...... 89 3.9.3 Concurrence with Respect to Our Perception of Reality Versus Actual Reality: Map Versus Territory ...... 91 3.9.4 Concurrence with Respect to Conceptualization of Memory (Sanskrit ; Samskara) and Its Role in Construing Experience as the Perceived Reality ...... 92 3.10 Neural Models of Yoga and Meditation: Revisiting the Bottom-up or Top-Down Debate ...... 95 3.10.1 The Bottom-Up Model of Yoga and Meditation (Pradhan 1998 onwards): Neurobiologically Informed, Standardized, and Compatible with Other Contemporary Models of Therapies ...... 96 3.10.2 Experience Can Change the Brain Structure and Functions: New Insights...... 99 3.10.3 Experiences Can Change the Brain: Insights from Research on Psychotherapy ...... 100 3.10.4 Similarity Between Meditation and Psychotherapy . . . . . 101 3.10.5 The Id, Ego, and Superego from a Neural Paradigm . . . . 102 3.11 Concluding Remarks...... 103 References ...... 103 Contents xix

Part II Standardization

4 Methods in Yoga and Mindfulness ...... 111 4.1 Introduction...... 111 4.2 Some General Information on Meditation ...... 112 4.2.1 Concentration (Centering of Consciousness; FA Type) ...... 114 4.2.2 Mindfulness ( Type) ...... 114 4.2.3 The Middle Way (Pali. Majjhima Patipada; ): The Meditative Lifestyle ...... 115 4.3 Morphology of Meditation as Taught by Buddha and Patanjali ...... 116 4.3.1 Meditative Access States: The Jhanas and Samapattis of Abhidhamma ...... 116 4.3.2 The Jhanas (Contemplative Raptures) ...... 117 4.3.3 The Samapattis (Attainments) ...... 118 4.3.4 The Yogic/Meditative Consciousness and Its Various Categories in the Abhidhamma ...... 118 4.4 Description of the Key Techniques in Yoga and Meditation . . . . . 120 4.4.1 Technique of Concentrative Meditation (Focused Attention—FA [Sans. trataka])...... 120 4.4.2 Description of the Technique ...... 122 4.4.3 Visual Trataka (Sans. Dristi Trataka): Its Clinical Importance ...... 124 4.5 Techniques of Mindfulness Meditation (Pali: )...... 125 4.5.1 Two Stages of Right Mindfulness ...... 126 4.5.2 Bare Attention and Clear Comprehension: The Two Pillars of Right Mindfulness ...... 126 4.5.3 The Four Stations of Mindfulness: Body, State of Mind, Feelings, and Phenomena ...... 128 4.5.4 Actual Practice of Right Mindfulness Is Twofold (Detailed Description Can Be Found in Nyanaponika, 1965, p. 85–107) ...... 130 4.5.5 Some Bare Instructions for of the Practice of Right Mindfulness (Nyanponika 1954, p. 61–63) ...... 131 4.6 Meditative Breathing (Sans. ): The Key Tool in Meditation ...... 132 4.6.1 Standardizations in the Two Breathing and Their Symptom-Specifi c Use in the Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT©) ...... 134 4.6.2 Breathing Techniques Versus Breathing Meditations: Key Distinctions ...... 136 4.6.3 The Two Breathing Meditations in Terms of the Rate Variability (HRV) ...... 136 References ...... 137 xx Contents

5 Attempts at Standardization...... 139 5.1 Standardization of Yoga and Meditation in Ancient India: Primacy of Buddha’s Abhidhamma Pitaka and Patanjali’s Yoga Sutras...... 139 5.2 Buddha and His System of Standardization ...... 140 5.2.1 Elaboration on Buddha’s Standardization of Mental Processes/Phenomena ...... 141 5.2.2 Buddha’s Standardization in the Phenomenological Analysis of the Human Experience: The Five Aggregates ...... 142 5.2.3 Buddha’s Standardization Involved in the Categorization of Human Consciousness ...... 144 5.2.4 Buddha’s Standardization in the Analysis of Conditionality of the Human Existence ...... 145 5.2.5 Buddha’s Standardization of the Truths and the Way of Life: The and the Noble Eightfold Path...... 146 5.3 Standardization in the Yoga Sutras of Patanjali: The Eight-Limbed Yoga ()...... 148 5.4 Buddha (Sixth Century BC) and Patanjali (Fourth Century BC): Concurrence of Views Between the Two Early Champions ...... 150 5.5 The Subtle Difference Between the Meditative Methods of Buddha and Patanjali ...... 153 5.6 Tantra: Standardization of Yoga and Meditation Reaches Its Peak (Medieval and Modern India)...... 154 References ...... 157

Part III Application

6 Yoga, Mindfulness, and Mentalization: Central Role of Attention and ...... 161 6.1 Attention, Empathy, and Compassion: The Key Qualities in a Meditator ...... 161 6.1.1 Empathy and Compassion: Phenomenology and Roots in the Four Noble Truths of Buddha ...... 162 6.2 Meditation Is Part of Yoga and Mindfulness Is a Type of Meditation ...... 163 6.3 What Is Mindfulness? ...... 164 6.3.1 How Right Mindfulness (Satipatthana) Gives Rise to the Insights (Vipassana) and Subsequent Liberation (Nibbana)? ...... 165 6.4 Mentalization ...... 166 6.4.1 Dimensions of Mentalization ...... 167 6.4.2 Clarifi cation of Closely Related Terms...... 167 Contents xxi

6.5 Mapping Mindfulness and Mentalization onto Our Brain: Neural Correlates of Empathy, Self-Observation, and Mentalization ...... 169 6.5.1 Neural Components Involved in Empathy ...... 170 6.5.2 Neural Components Involved in Self-Observation and Introspection ...... 171 6.5.3 Mirror Neuron System (MNS): The Neural Correlates of Empathy and Meanings ...... 172 6.5.4 Neural Correlates of Mentalization: The Mentalizing Area of the Brain...... 174 6.6 Therapeutic Use of Mindfulness and Mentalization: The Third Wave of Cognitive Behavioral Therapies (CBT) . . . . . 174 6.6.1 Mindfulness-Based Stress Reduction (MBSR)...... 176 6.6.2 Mentalization-Based Treatments (MBT) ...... 176 6.7 Mindfulness-Based Cognitive Therapy (MBCT): Integrating Mindfulness with Cognitive Therapy...... 177 6.7.1 Differences Between CBT and MBCT...... 178 6.8 Concluding Remarks...... 179 References ...... 180 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT©): Use of Yoga in Its Entirety ...... 183 7.1 Introduction...... 183 7.1.1 Seminal Contribution of the Buddha and Sage Patanjali in Laying Out the Early Foundations for Therapeutic Use of Yoga–Meditation...... 185 7.2 Yoga as Psychotherapy ...... 186 7.2.1 Yoga and Contemplative Psychotherapies Including Psychoanalysis: A Comparison ...... 188 7.2.2 Common Grounds Between Yoga and Contemplative Psychotherapies Including Psychoanalysis...... 189 7.2.3 Other Similarities Between Yoga and Deep Psychotherapies (Psychoanalysis) ...... 190 7.2.4 Some Basic Differences Between the Yogic Philosophies and Psychoanalysis ...... 192 7.3 Psychotherapeutic Use of Yoga in Its Entirety: The Yoga–Mindfulness-Based Cognitive Therapy (Y-MBCT, Pradhan and Mishra 1998 onward) ...... 193 7.3.1 The Specifi c Cognitive Behavioral Techniques Used in the Y-MBCT ...... 195 7.3.2 More Descriptions of the Key Techniques in the Y-MBCT...... 196 7.3.3 SYMPro-SR and Y-MBCT Models: Evolution and Preliminary Data on Effi cacy...... 198 7.3.4 Preliminary Data from the Y-MBCT Clinic at Cooper University Hospital ...... 200 xxii Contents

7.3.5 Some Descriptions About the Basics of Y-MBCT Models ...... 201 7.3.6 The Staged Meditation Protocols (SMPs) and the Five- Factor Model of Human Experience as the Main Pillars of Y-MBCT ...... 203 7.3.7 Standardizations Involved in the Y-MBCT Models ...... 206 7.4 Uniqueness of the Y-MBCT as Psychotherapeutic Models ...... 207 7.5 TIMBER© (Trauma Interventions Using Mindfulness- Based Extinction and Reconsolidation; Pradhan et al. 2012 Onward): A Prototype of the Y-MBCT Protocols...... 209 References ...... 212 8 Yoga in Maintenance of Psychophysical Health ...... 217 8.1 Yoga and Meditation: Rationale and Feasibility in Health care ...... 217 8.1.1 Why Yoga–Meditation if There Is a Pill? ...... 219 8.2 Specifi c Effects of Yoga and Meditation on Brain and Body ...... 219 8.3 The Basic Dilemma of a Researcher When Testing the Effi cacy of Mind–Body Interventions ...... 220 8.3.1 Methodologically Sound Clinical Trial of Mindfulness Interventions: Essentials ...... 222 8.3.2 Effi cacy of Yoga and Meditation: Empirical Evidence ...... 223 8.4 Yoga in Maintenance of Psychophysical Health: Attention and Memory Are the Main Tools ...... 224 8.4.1 Meditation, Attention, and the Default Mode Network of the Brain...... 225 8.4.2 The Basic Mechanisms Involved in Attention ...... 226 8.4.3 Basics of Memory and Its Various Categories ...... 228 8.5 Attention and Memories in the Information Processing Model in Humans...... 231 8.5.1 Utility of Yoga–Meditation in the Various Steps in the Information Processing Model ...... 232 8.5.2 Cellular Mechanisms of Long-Term Memory and Connection with Yoga and Mindfulness ...... 234 8.6 Practice of Yoga–Meditation: General Considerations...... 236 8.6.1 Integrated Posture [Sans. ] ...... 237 8.6.2 Obstacles to the Practice of Yoga–Meditation ...... 238 8.7 Concluding Remarks...... 239 References ...... 239 Endorsements ...... 243 Introduc tion

This book is about a simple fact that calm and attentive observation of each moment of our ordinary life does bring extraordinary freshness and clarity to our experiences and makes this world a better place for us. To our relief, wonderful books are avail- able on this subject but books that truly bridge across Yoga and meditation and the many disciplines of science that deal with complexities of mind, body and their problems are really few. This is a book written by a meditator, clinician, academi- cian, and researcher which is meant not only for the aspirants of Yoga but also for patients, meditators, clinicians, academicians, and researchers. In doing so, one of my purposes has been to provide most of the information on Yoga and meditation through a single book, in a continuous stream. I am aware that despite this advan- tage, the ambitious purpose of a single book that could explain most of the things may pose some diffi culties in comprehending some of the technical aspects described in this book. For those situations, further readings given in the reference section can help. Based on ever-growing literature on this subject as well as my ongoing experiential, clinical and research knowledge on this subject, I have tried to de-mystify some of the misconceptions on Yoga-meditation, present them as theo- ries of mind from biological, psychological and cultural perspectives and how they can be used in relatively standardized and evidence based manner in both mental health and illnesses without losing their abstract essence in this standardization pro- cess. In the psychotherapeutic traditions, there has been always a need for types of psychotherapies that are not only innovative but also experiential, pragmatic as well as humanistic at the same time. The Yoga Mindfulness Based Cognitive Therapy (Y-MBCT) as described in this book is such a modality of therapy that not only combines the Western pragmatism of the Cognitive Behavioral Therapy (CBT) and Eastern wisdom of Yoga in its entirety but also delivers the therapy in an experien- tial, symptom/dysfunction specifi c, relatively standardized, culturally competent and client-centered way. The eight chapters in this book tells the reader most of the aspects of Yoga including the philosophy, techniques and practice of Yoga-meditation as they were proposed originally; how Yoga through its evolution over a few thousand years became embraced by the dominant cultures across the globe; description of the pertinent spiritual and scientifi c literature that bridges across the mind body gaps and inspires the reader to think more and fi nally, the various techniques of Yoga- meditation and their psychotherapeutic utility. In order to organize my thoughts on

xxiii xxiv Introduction these quite vast matters, I have divided this book into three sections: Fundamentals, Methods and Standardizations, and Application. The fi rst and last parts have three chapters each, while the second part has two chapters. The fi rst section (Part I),titled “Fundamentals”, opens with a chapter on historical evolution and basic concepts of yoga as proposed originally , i.e. not as religious rituals but as a science of con- sciousness describing the fundamental theories about mind and its profound role in creating the experience in us. This chapter dispels the popular myths of Yoga as a series of poses and emphasizes that Yoga is not twisting one’s body like a pretzel. The second chapter elaborates upon the intricacies of mind and Yoga as a profound psychosomatic science. This is followed by the fi nal chapter in this section which I think is the heart of this book. This chapter tries to bridge the gap between the body (brain) and the mind (Consciousness) and narrates Yoga-mindfulness from the para- digm of cognitive neurosciences. The second section (Part II) of this book, titled “Methods and Standardizations” has chapters on the key techniques in Yoga and meditation as well as attempts at standardizing these methods. The chapter-4, the fi rst chapter in this section describes the key techniques of meditation to mend the mind : S amyama (combination of dharana , dhyana and , i.e. the 6th, 7th and 8th limbs of Patanjali ’ s Eight- Limbed Yoga ) which is the prototype of meditative process; concentrative medita- tion (with trataka / visually guided concentrative meditation as the prototype), and mindfulness meditation (Pali: patthana ) as adapted and further developed by the Buddha using his background in the Vedic and the Upanishadic knowledge of medi- tation. This chapter also mentions the fi ve integrated techniques adapted by this writer integrating the key techniques of Yoga-meditation as described in the original traditions with the various principles and techniques cognitive behavioral therapy (CBT) and, how these techniques can be used in symptom specifi c manner in both illness and wellness in evidence based medicine format. These techniques are men- tioned in the various portions of Chaps. 4 and 7 under the description of the Standardized Yoga Meditation Program for Stress Reduction (SYMPro-SR)/Yoga - Mindfulness Based Cognitive Therapy (Y-MBCT) program compiled by this writer for their clinical and research use. The Chap. 5 describes the need for standardiza- tion and how it has been done over a few thousand years from the ancient times of Buddha and Patanjali till the recent times of tantra , the most modern school of Yoga. This chapter along with Chap. 7 will provide the reader with a fl avor of this author’s ongoing attempts at standardization. The last section (Part III), titled “Applications” consists of the last three chapters of the book and describes the clinical and research utility of Yoga-meditation and also things to be considered in the research methodologies involving complex inter- ventions like Yoga-meditation. In Chap. 6, I elucidate the key similarities as well as differences between three overarching concepts: Yoga , mindfulness and mentaliza- tion . In addition to describing the use of mindfulness and mentalization in the vari- ous psychotherapeutic formats, this chapter describes the key qualities in the meditators like empathy and compassion (Pali. karuna ) and the recent research on the role mirror neurons in it. The next chapter elaborates on the commonalities between Yoga and various psychotherapies starting from the healing traditions of Introduction xxv the Buddha himself, entering into a comparison with psychoanalysis and conclud- ing with description of the Yoga-Mindfulnes Based Cognitive Therapy (Y-MBCT) model compiled and used by this writer both in his clinical and research work in an ongoing manner. The concluding chapter describes not only the rationale, feasibility and utility of Yoga and meditation in healthcare, but also the dilemma of researchers and suggests some solutions. Building upon the evidence that meditation is a sci- ence of cultivating one’s attention, this chapter describes the cognitive neuroscience models of attention and memory and how the key steps in this process can be rein- forced by techniques of meditation in order to ameliorate the sufferings of the cog- nitive disorders and the likes. This chapter concludes with a brief description of the general consideration as well as obstacles one may encounter in the practice of Yoga and meditation in one’s daily life. The fundamental thrust of this book is to enhance the appreciation of Yoga and meditation as deep science of life which over the years has captured rapt attention of not only the lay people but also of the top scientists to the likes of Einstein and Oppenheimer. As mentioned before, this textbook has been a meditation for this writer and is refl ective of his personal and professional life. He hopes that the scien- tifi c rationale and the pragmatic, standardized as well as evidence based format of Yoga and meditation described in this book will be useful not only to the aspiring Yoga practitioners and patients but also will provide more impetus for furthering multi-centric research studies on utility of this ancient wisdom.

Camden, NJ, USA Basant Pradhan, MD xxvi Introduction

P a r t I

Demystification Yoga: Original Concepts and History 1

When you are inspired by some great purpose, some extraordinary project, all your thoughts break their bonds: Your mind transcends limitations, your consciousness expands in every direction, and you fi nd yourself in a new, great and wonderful world. Dormant forces, faculties and talents become alive, and you discover yourself to be a greater person by far than you ever dreamed yourself to be. —Sage Patanjali of ancient India (in the Mahabhasya)

1.1 Introduction

Yoga is not that new to the Western world. In fact, studying about the Transcendentalist Movement in the eighteenth-century West, one can see the deep infl uence of the ancient Indian Yogic scriptures (Upanishad ) on notable Western philosophers like Arthur Schopenhauer, author of the famous book, The World as Will and Representation (Payne 1958). Schopenhauer’s deep considerations that a lifestyle of negating desires, similar to the ascetic teachings of Upanishads , was the way to attain liberation and he keeping a copy of the Upanishad by his side all the time attest to the above fact. Unfortunately, despite its immense popularity, Yoga is a profoundly misunderstood subject, more so in the West. The experiential essence of Yoga is to pass beyond the world of intellectual distinctions and into the world of the unthink- able, where reality appears as undivided and undifferentiated. For most, this seems too diffi cult to grasp. Yoga is often mistaken for unclearness or un-objectiveness, mainly due to its experiential nature. Ancient Indian philosophies elude even the greatest Western thinkers. For example, in his letters to Romaine Rolland, Sigmund Freud’s mystic friend, Freud himself comments on his own diffi culty with the phi- losophy and practice of Yoga. He writes: “…let me admit once more that it is very diffi cult for me to work with these almost intangible quantities…” (Freud 1930 , p. 72). Being exclusively experiential and subjective in nature, Yogic experiences,

© Springer International Publishing Switzerland 2015 3 B. Pradhan, Yoga and Mindfulness Based Cognitive Therapy: A Clinical Guide, DOI 10.1007/978-3-319-09105-1_1 4 1 Yoga: Original Concepts and History while documented over many centuries and millennia, cannot be verifi ed using con- crete measures. Unlike scientifi c methodology, Eastern regards intellect as merely a means for clearing the path to direct mystical experience. This is called direct because it is experiential and thus bypasses the interpretive and intellectual interference of the ordinary mind. Yogic experiential knowledge is intuitive and non- conceptual and not based on a concrete sensorial experience. In essence, one must transcend taxonomies and multiplicity in order to experience a reality void of arbi- trary distinctions. Yoga’s disregard for concrete concepts, reductionism, and the mind/body dichotomy is partially responsible for the grave misunderstanding of Yoga. Here follows the fundamental diffi culty with understanding Yoga. As Suzuki (1963 , p. 11) writes: “… the scientifi c method in the study of reality is to an object from the so-called objective point of view. For example, suppose a fl ower on the table is the object of a scientifi c study. The chief characteristic in this scientifi c (or objective) approach is to put this object (fl ower) to all kinds of analyses, to talk about it, to go around it, to catch anything that attracts our sense–intellect and abstract it away from the object (fl ower) itself, and, when all is supposedly fi nished, to synthe- size these analytically formulated abstractions and take the outcome of the analysis for the object (fl ower) itself.” But the question still remains: Has the complete object really been caught ? The answer is no . These objective observations are mere descrip- tions of the object, in this case the fl ower, but in reality not the fl ower itself.

1.2 Yoga as a Mystery and Need for Demystification

It is sad to see that deviating from its original profound meanings and deep scopes, Yoga has been used as an umbrella term for all kinds of things ranging from body building, weight reduction, improving physical stamina and sexual performances, and so on. Seeing closely, one can easily realize that many of these so-called authen- tic Yogic techniques popularized in the West actually don’t have much to do with the original concepts of Yoga, as they were proposed in the Yogic scriptures of ancient India. No wonder, despite having a few thousand years of rich tradition as well as authentic literature about its philosophies as well as techniques, Yoga is still a pro- foundly misunderstood subject, more so in the Western world. This is evident from the fact that one of the most popular forms of Yoga in the West is the which involves literally heating a room to high temperatures in order to induce perspiration and may be to lose some weight. This writer’s fi rst encounter with Yoga in the USA was through Hot Yoga when shortly after his initial arrival in the USA he out of curi- osity visited a Yoga studio in a Philadelphian suburb to learn the above facts. Interestingly, despite its huge popularity in the West, this author couldn’t trace any connection of Hot Yoga to the literatures or scriptures on Yoga. This writer wondered if Hot Yoga, because of its physical focus, could have originated from the word Hatha. However, this possibility seems unlikely considering the facts that both the word Hatha in its meanings ( Ha = moon, symbolizes the parasympathetic system, tha = sun, symbolizes the sympathetic system) and Hatha Yoga as a system have entirely different origins, scopes, and signifi cance as compared to Hot Yoga . As men- tioned above, and his disciple Swami Swatmarama of 1.2 Yoga as a Mystery and Need for Demystifi cation 5

fi fteenth- century India introduced the Hatha Yoga system as a preparatory stage (rather than as a means to its ends) of physical purifi cation that is necessary for higher steps in practice of Yoga, i.e., meditation or samyama . As opposed to these original deep philosophies and practices of Hatha Yoga, unfortunately only the physical focus on Yoga became popular in the West. After the initial thrust through the transcenden- tal movements, the subsequent interest in Yoga in the Western world was created by who was not only the fi rst ever Indian monk to have visited the Western world but also translated Yogic texts from Sanskrit into English language. During his visit to the USA (Chicago) in 1893, he created a lasting impression of Yogic philosophies (Raja Yoga) in the mind of Western audience and also founded Yoga centers for training. However, it was not until the second half of the twentieth century that the Western world saw the large-scale application of Yoga, although unfortunately not in its original form but rather in the context of health and a set of mere physical . This has largely contributed to the misunderstandings that Yoga is just a set of physical exercises meant primarily for physical fi tness or losing weight.

1.2.1 Some Other Reasons for the Misconceptions

As mentioned before, understanding the ancient Indian philosophies on Yoga and meditation has been an issue even for intellectual geniuses to the likes of Sigmund Freud. Some of the mysteries about Yoga in the Western world arise from the very basic issues of mind–body dichotomy, reductionism, and primacy given to the phys- ical aspects of Yoga in the West as opposed to the holistic approach of the ancient Indian philosophies on Yoga and meditation. Experiential knowledge (as the one in Yoga) is essentially intuitive/non-conceptual, not the knowledge based on concrete sensorial experiences which are considered as mere intellectualizations rather than true experiences. One can see that these are really diffi cult concepts if one is not brought up in that culture and thus can be very often misinterpreted, based on nuances of languages and culture. In addition to the epistemological discrepancies between Eastern and Western thought, differences in culture and language are also responsible for the West’s misinterpretation of Yoga —where it has been mistaken for physical , relaxation techniques, or a form of religious practice. Sanskrit , the original language of Yogic scriptures, is a rich but diffi cult language that exhib- its complex grammar. The meanings of many Sanskrit words are culturally bound, and of those used in the Yogic scriptures many have no equivalent word in other languages. Consequentially, many Yogic techniques popularized in the West bare no ties to the philosophies proposed in the Yogic scriptures of ancient India. Furthermore, the true masters of Yoga often live reclusively (this is the Yogic tradi- tions of or the forest culture ), rarely leaving nature. Alternatively, many of the Yoga (teachers) that do engage with mainstream society do not have the proper experiential knowledge of Yoga to instruct others. Unfamiliar with classical Yogic traditions, these gurus often use Yogic concepts too concretely and/or prose- lytize misinterpretations of Yoga. Needless to say, without real practice/direct expe- rience, Yoga is just another slogan. One cannot discuss Yoga in its authentic and true 6 1 Yoga: Original Concepts and History sense without the mastery of at least some of the ancient Indian philosophies, as well as the experiential nature of its practice. As it is true for any experiential discipline and more so for Yoga and meditation, some forms of abstractness and intuitive capacity are essential for grasping the original concepts of Yoga. Thus, one can see clearly here that the Yogic experiences, although documented over many millennia, cannot be verifi ed that well by traditional experimental techniques (which are suitable for demonstrating the concrete only). The misconceptions surrounding Yoga are similar to the popular fi ve blind men and the elephant metaphor. In this when fi ve blind men in a small town are describing an elephant, each of them is narrating only part of the truth (in this case describing various body parts of the elephant as the whole elephant) but nonetheless emphatically claiming his own ver- sion as the only truth. They are all correct from their own point of view, but only partially. Finally, the wise man they consulted says each one of them is correct and each is wrong too. He further advises them that if they put their partial views together, they will get a true sense of the elephant. In other words, the holistic (rather than reductionist) view is a prerequisite for appraisal of reality. These points apply to the diffi culties in the design as well as interpretations of the Yoga and medi- tation research done in the West. Needless to say that in the best interest of mankind, to be able to use the ancient wisdom of Yoga in its true sense, a great degree of demystifi cation as well as standardization involving more integrated insights of the East as well as the West are of necessity and are long overdue.

1.3 Original Definitions of Yoga

There is no one defi nition of Yoga . The meaning of Yoga is best understood when one considers the many defi nitions together. Etymologically, Yoga derives from the Vedic Sanskrit Yuj which means to yoke, to join, to bind together, or to hold fast (Eliade 1969 , p. 4). The fi rst written usage of the term is attributed to the oldest of the ancient Indian scriptures, the Rig - Veda (circa 1200 BC). In the Rig - Veda, Yoga is described as the mental process and discipline by which an individual’s soul (Sanskrit: jivat- man) joins with the Supreme or Cosmic Soul (Sanskrit: ). Borrowing from over 2,000 years of oral tradition, Patanjali (circa 400 BC), the ancient Indian sage and teacher, defi nes Yoga as chitta nirodhah in the fi rst textbook on Yoga, the Yoga Sutras ( Vedic Sanskrit: Yoga Sutra , Section I, Verse 2; Satchidananda 1978 , p. 3–6). Literally this phrase means: Yoga is the control or stilling (Sanskrit: nirod- hah) of all the fl uctuations/transformations (Sanskrit: vritti) of mind/consciousness (Sanskrit: chitta ) at all levels. One example will help elucidate this central concept of Yoga. Imagine a lighted electric bulb suspended in a tank of clear . Here the water is like the mind ( chitta) and the bulb is like one’s Real Self or the Soul (the master of the mind). If the water is stirred too much, it will make all kinds of patterns in three dimensions ( or temporary mental states) around the bulb, and these patterns will keep on changing from moment to moment. If the agitation of water is too much, the bulb will disappear from our view (i.e., we can’t see the Real Self when the mind is too agitated, and we are caught in the endless play of chitta-vrittis . 1.3 Original Defi nitions of Yoga 7

As the three-dimensional patterns (i.e., the vrittis ) begin to subside gradually with calmness of water, the electric bulb will gradually emerge into our view (i.e., one can see/realize the True Self). This simile illustrates in a rather crude way, both the mis- identifi cation of consciousness with the modifi cations of mind and its reversion to its unmodifi ed/true state when mind comes to rest. Patanjali says that as long as the chitta-vrittis (transient mental states) are not in a state of nirodhah (control), drashta (the seer, the Self ) is not established in his svarupa (True Self); rather he misidentifi es with that particular vritti (temporary mental state) which happens to occupy the fi eld of consciousness for the moment. It is essential to still the endless fl uctuations of mind in order to experientially realize the truth of life (self-realization). Since Pantajali, others have developed their own defi nitions of Yoga . One modern defi nition claims “…the word Yoga serves, in general, to designate any ascetic tech- nique and any method of meditation” (Eliade 1969 , p. 4). Iyengar, the Yoga Master who is largely responsible for the current popularization of Hatha Yoga in the West, defi nes Yoga as: “the science to free the Soul from its constraints through the integra- tion of body, mind, and consciousness” (Iyengar 2000 , 2001a , b , 2009 ). Yoga has also been defi ned as the method of yoking, or unifying, the lower or egoistic mind to the higher mind through sublimation (Feuerstein 1990b ) and as “inner stability and balance, both of which depend upon constant concentration” (Feuerstein 1990a , 2001 ). The uses the term Yoga extensively and in a variety of ways. It claims that the root of all suffering is the agitation of the mind, the consequence of selfi sh desire. The only means of extinguishing this desire is by simultaneously still- ing the mind through Yoga and engaging oneself in higher forms of activity. This allows the practitioner (Yogi ) to embrace their essential nature or True Self (Sanskrit: svarupa) through self-realization or insight. Self-realization only occurs from within the individual and cannot be understood from the external world; the inside is the seat of all human experiences. The ultimate goal of Yoga is to liberate the Soul from its constraints using self-knowledge or insight, vipassana. This liberated state is known as samadhi or the state of sustained integrated oneness with the Ultimate Reality . In the existential sense, Yoga is the science of fi nding meaning for one’s life.

1.3.1 Yoga , Its Meanings and the Minor Conceptual Differences from the Samkhya

The term Yoga has such a large number of meanings that a Sanskrit dictionary lists three pages for just the meanings of this term (Gode and Karve 1979 ). The earliest have been traced to the third millennium BC (Worthington 1989 , p. 11). Bearing an impressive history of around 5,000 years, Yoga has become an umbrella term given to myriads of philosophies, spiritual practices, and esoteric as well as ordinary means of knowledge. The ancient Indian literature informs us that Yoga as a philosophical system is derived from the Samkhya (lit. numerist) system of philosophy which was propounded by the mythical sage and derived from the Rig-Veda (circa 1200 BC), the oldest among all the sacred scriptures of ancient India. Svetasvatara Upanishad (section VI, verse 13) defi nitely refers to the 8 1 Yoga: Original Concepts and History soteriological validity of the Samkhya philosophy with Yoga practice (Eliade 1969 , p. 389). Although, unlike Yoga, Samkhya doesn’t admit the existence of God, the profound philosophical similarities between the two systems led some authors to propose that Yoga can be said to be consisting of Samkhya with defi nite mention of God (Sanskrit: seshwara samkhya ). Vivekananda (1956 , p. 5–6) explains further the minor differences between the Samkhya and the Patanjalian system of Yoga (also called the Eight-limbed Yoga/Ashtanga / Raja Yoga ): “The two most important dif- ferences are, fi rst, that Patanjali admits the Personal God in the form of the First Teacher, while the only God that Samkhya concedes is a nearly perfected being, temporarily in charge of a cycle of creation. Second, a yogi holds the mind to be equally all- pervading as the Soul, or , and Samkhya (dualist) does not.” In his introduction to a collection of essays regarding Yoga, Jacobsen (2005 , p. 4) claims that Yoga has fi ve principal meanings according to Yogic scripture: (1) Yoga as a disciplined method for attaining a goal; (2) Yoga as techniques of controlling the body and mind; (3) Yoga as a name for one of the schools or systems of philosophy (Sanskrit: darshana ); (4) Yoga in connection with other words, such as Hatha-, -, Laya (Kundalini ) -, and Raja (Ashtanga) -Yoga, referring to traditions spe- cializing in particular techniques of its practice; and (5) Yoga as the goal of its own practice (i.e., Yoga as union with the Supreme Soul). In all Buddhist as well as some Vedantic traditions, Yoga is considered as the union of mediation/deep contempla- tion with the wisdom (Pali: nanna ; Sans: ) or insight (Pali: vipassana ).

1.3.2 Various Forms of Yoga

The Yogatattva Upanishad of the Yajur-Veda , a signifi cant ancient Indian text on Yoga, distinguishes four varieties of Yogic practice: (1) Hatha Yoga , (2) Mantra Yoga, (3) Laya Yoga, and (4) Raja (Raja = Royal) Yoga (also known as Ashtanga or Eight-limbed Yoga ). Raja Yoga (as described by Patanjali, and and Swami Vivekananda of modern India) is regarded as the highest practice (Deussen 1980 ).

Hatha Yoga (Sanskrit: Persistence or Physical Force) Hatha Yoga was systematized by yogi Gorakhnath and is detailed in (Muktibodhananda and Satyananda 2000 ), the most comprehensive text on Hatha Yoga and authored by Gorakhnath’s disciple yogi Swatmarama in the fi f- teenth century. Hatha Yoga is founded on the physical elements of Yoga: asanas (postures) and pranayama (controlled breathing). Swami Sivananda (1854–1934), a physician, Himalayan yogi, and proponent of Hatha Yoga and Kundalini tantra, describes Hatha as follows: Ha is associated with the ida . Nadis are energy channels, which are subtle and not physical, through which the vital force fl ows. The ida nadi in tantric traditions are associated with the moon. Ha also refers to the fl ow of cold air within the left nostril and activates the parasympathetic nervous system, which is responsible for the body’s relaxation response. In contrast, tha is associated with the pingala nadi, which in tantric traditions is associated with the 1.3 Original Defi nitions of Yoga 9 sun. Tha also refers to the fl ow of hot air within the right nostril and deactivates the sympathetic nervous system, responsible for the body’s fi ght or fl ight responses. Here, we see that the classical philosophy of Hatha Yoga originally emphasized the grave signifi cance of one’s breathing (Sanskrit: , from which the word pranayama or breath control derives). Breath is not only the chief link between body and mind, but it also plays a central role in the body’s energy metabolism: a profound psychosomatic insight indeed.

Mantra Yoga (Sanskrit: Man = Mind, to Think; tra = Tools or Instruments) Mantra refers to a sacred syllable, word, or phrase, usually in Sanskrit, thought to cause the practitioner’s spiritual transformation. Spiritual teachers also use mantra when initiating their disciples. The use and types of mantra s vary according to the school and philosophy. Mantra Yoga, in addition to mantra , employs yantras (Sanskrit: instrument or object serving to hold/anchor), which are auspicious geo- metrical fi gures engraved on , ground, stone, , or even skin. Yantras are used for the purpose of worship and symbolize the expressions of cosmic manifesta- tions within the objects on which they are engraved. Symbolic and representative of spiritual energy’s primordial unity, the yantra is said to transform the object upon which it is drawn or practiced. The that Carl Jung practiced upon are essentially a form of yantra (for more detail, please refer to Jung’s The Red Book , 2009 ). In Mantra Yoga, the inscribed on the yantras are essentially thought forms representing divinities or cosmic powers that exert their infl uence via sound vibrations (Feuerstein 2003 ). Both mantra and yantra are heavily used in tantra Yoga which as a system of Yoga reached its pinnacle during medieval India (circa fi fth century CE) (White 1996 ). Of note, tantra is the 4th and the newest system in the evolution of Yoga, the other three being Samkhya (Veda ), Upanishads (Vedanta ), and Shramana (non-Hindu philosophies, i.e., Buddhism and ).

Laya Yoga (Sans: Dissolution, Merger, Absorption, Yoga) It is also known as . Kunadlini (Sanskrit: kundalini = coil or spiral) is thought to be a form of life force or spiritual energy that resides at the base of the spine, where it lies dormant and coiled like a snake. The practice of Kundalini Yoga is thought to awaken one’s Kundalini , unraveling the coil and allowing it to rise and travel through the fi rst of the six primary — energy points at which the subtle or nonphysical nadis (Sans: energy channels) meet—and, ultimately, reach the last of the primary chakras , , at the crown of the head. This process is achieved through deep meditation, or dhyana . Through the practice of Laya Yog a, one may achieve union with the supreme consciousness (Avalon 1974 , p. 222).

Raja Yoga and Its Differences from the Hatha Yoga As previously mentioned, Raja Yoga , as proposed by sage Patanjali, is considered the highest form of practice (Deussen 1980 ). Raja Yoga can be better understood when comparing it to Hatha Yoga. Raja Yoga adopts Hatha yogic devices like asana and pranayama, both in principle and practice, but reduces Hatha’s multiple 10 1 Yoga: Original Concepts and History and elaborate forms that focus on physical transformation to just one form suffi cient for its immediate object of interest, the mind. Sri Aurobindo elucidates this chief difference in practice (i.e., the primacy of the body in Hatha Yoga versus that of the mind in Raja Yoga ). He describes this discrepancy as follows: “Raja Yoga takes a higher fl ight [than the Hatha Yoga]. It aims at the liberation and perfection not of the bodily, but of the mental being, the control of the emotional and sensational life, the mastery of the whole apparatus of thought and consciousness” (Aurobindo 1999 , p. 35). In Raja Yoga, the yogi fi xes the eyes on the chitta, the mental stuff of consciousness from which all activities arise. With this follows the absolute quiet- ing of the restless mind and its elevation to a higher of consciousness. Through concentration of mental force, attained via the successive stages of Raja Yoga, a superconsciousness , the utmost inner concentration or ingathered state of the con- sciousness, known as samadhi is attained (Aurobindo 1999 , p. 36).

1.4 Yoga: Origins and Scriptures

1.4.1 Origins of Yoga from the Samkhya System in Ancient India

The six astika (theistic) Hindu philosophies that recognize the authority of the Vedas are: , Vaisesika , Samkhya Yoga , Mimamsa , and Vedanta (Muller 1899 ). Nastika (atheistic) Hindu philosophies that do not recognize the authority of the Vedas include , Ajivika , Jainism , and Buddhism (Robinson et al. 2005 ). As a system of philosophies, Yoga originated from the Samkhya. Samkhya (Sanskrit. numerist) system of philosophy was propounded by the mythical sage Kapila and derived from the Rig-Veda (circa 1200 BC), the oldest among all the sacred scriptures of ancient India. Svetasvatara Upanishad (section VI, verse 13) verifi es the soteriological validity of the Samkhya philosophy with Yoga practice (Eliade 1969 , p. 389). Although, unlike Yoga, Samkhya doesn’t admit the existence of God, the profound philosophical similarities between the two systems led some authors to propose that Yoga can be said to be consisting of Samkhya with defi nite mention of God (Sanskrit: seshwara Samkhya ). Despite the ideological differences between the astika and nastika, Yoga, as a philosophy, is well accepted in both schools.

1.4.2 The Oral Tradition of Yoga

Before any textual mention of Yoga, the Yogic philosophy and practice were passed through the oral tradition. Pantajali’s Yoga Sutras (circa fourth century BC) is the very fi rst text regarding Yoga. Although the Yoga Sutra is regarded as the most important textbook on Yoga, scholars agree that Patanjali did not conceive of Yoga himself. Patanjali served merely as a great expounder of Yoga. Archeological evi- dence indicates that classical Yoga, as a system of contemplation for uniting the human spirit with the Supreme Being (Sanskrit: ), may have origins that 1.4 Yoga: Origins and Scriptures 11 reach back as far back as the Bronze Age, during the Indus Valley Civilization approximately 3000 BC till 1500 BC (Harappa and Mohenjo-Daro). Several seals excavated on Indus Valley Civilization archeological sites depict fi gures resembling the postures commonly practiced in Yoga and meditation. Furthermore, several well-known ancient Indian scriptures provide descriptions of Yoga long before Patanjali’s Yoga-Sutras (e.g., Rig-Veda , circa 1200 BC), (circa fi fth century BC), and Svetasvatara Upanishad (circa fourth century BC; Radhakrishnan 1953 ; Sarvananda 1987 ; Gambhirananda 1997 , 2003 ).

1.4.3 Sanskrit (Vedic ) and Pali (Buddhist): The Original Languages of Yogic Scriptures

Sanskrit, the oldest of the Indo-European languages (origins from the Proto-Indo- Iranian ancestral languages), and Pali , the Dravidian or Munda language (possibly the native language of the Indus Valley Civilization), are considered the original languages of most Yogic scriptures. While Sanskrit has been the written language of Vedic and Upanishadic texts (collectively called the Hindu philosophies; the word Hindu originates from the Indus Valley Civilization), Pali is the language of the canonical texts of ( ) Buddhism which was originally a spoken language with no alphabet of its own. Pali, also called prakrita (meaning natural or unrefi ned ), is actually vernaculars in contrast to Sanskrit (meaning elaborated or polished ). Historians agree (Thapar 2002 ; Robinson et al. 2005 ) that the migrated into India from the West, from what is now known as Iran, dislodging the Dravidians , the natives of the Indus Valley Civilization. Despite this dislodgement, there were great intellectual and linguistic integration between them and Sanskrit originated from this rich integration. Literature suggests that the separation of Indo- language proper from the undifferentiated Proto-Indo-Iranian ancestor group of languages probably happened somewhere between 1800 BC and 1500 BC (Mallory 1989 ; Muller 1859 ) and culminated in Vedic Sanskrit by the end of the Vedic period, around 500 BC (Witzel 1989 ). Around this time, various factors including cultural, political, and linguistic, all contributed to the end of the Vedic period, and other movements such as Jainism and (collectively called the Shramanic movement) emerged, using the popular vernacular Pali dia- lect, rather than Sanskrit for their texts. In addition to the possible integration and mutual enrichments between the Indus Valley (Vedic ) and Shramanic (non-Vedic ) philosophies, this also inspired the compositions of Yogic texts not only in Sanskrit but also in Pali: The philosophies in the Upanishads are the common origin for both Vedantic and Shramanic (Jainism and Buddhism) philosophies of ancient India (Radhakrishnan 1953 , p. 949). It is important to note that Sanskrit grammar is highly complex and many Sanskrit words lack words with equivalent meanings in other languages like English. The complexity and nuances of Sanskrit, in addition to the experiential nature of Yoga, requires careful interpretation of Yogic scrip- tures. One should be careful not to interpret Yogic scriptures rigidly according to their literal meanings alone while disregarding the context or possible symbolic 12 1 Yoga: Original Concepts and History interpretations. For the purpose of practice and to avoid a mere intellectualization, the practitioner (Yogi) should consider the truths underlying the various scriptures, rather than engaging in exegetic controversies.

1.4.4 The Varieties of Yogic Scriptures

It is important to understand the broad categories of the original scriptures on yoga. All ancient Indian sacred scriptures can be categorized under two types: shruti (or Vedas, literally means hearing or listening, oral tradition) and smriti (literally means remembered texts from oral traditions, which later were converted to written texts). Scholars believe that one possible reason the shruti or oral traditions of teaching were maintained for a long time without getting translated to the smriti traditions (the documented or scriptural forms) was because the original thinkers were aware of limitations of a written language in capturing the right meaning of the knowledge taught in the oral traditions. Shruti is traditionally believed to be a direct divine revelation of the cosmic sound (Sans: nada) of truth heard by ancient Indian sages (Sans: ) who then translated this knowledge to scriptural forms, e.g., sacred books like the Rig-Veda and the Yoga Sutra .

Approximate Time Lines for Compositions of Yogic Scriptures Rig-Veda : 1500–1100 BC; Sam-Veda : 1500–500 BC; Yajur-Veda : 1500–500 BC; Atharva-Veda : 1500–500 BC; Upanishads : 1200–500 BC; Bhagavad Gita : 500– 200 BC; Yoga Sutras of Patanjali: 400 BC–200 CE; : 400 BC–400 CE; : 400 BC–400 CE; Mimamsa Sutra: 300–200 BC; Nyaya Sutra : sec- ond century BC; Vaiseshika Sutra: second century BC; Samkhya Karika: around 200 CE; Yoga Vasistha : tenth to fourteenth century CE (Radhakrishnan 1923 , 1953 ; Radhakrishnan and Moore 1967 ; Eliade 1969 ; Thapar 2002 ; Muller 1859 , 1899 ; Jain 2007 ; Dundas 2002 ; Mohanty 2000 ) Talking about the time lines of ancient India, one notes that Gautam Buddha (founder of Buddhism) lived from 563 BC till 483 BC. Vardhamana , the famous reformer (also called the great ) of the religion Jainism , lived from 599 BC till 527 BC (Jain 2007 ). Sage Patanjali (author of the Yoga Sutra, the fi rst textbook of Yoga) is said to have lived circa 400 BC (Jacobi 1910 ; Radhakrishnan 1923), which seems to be the period after the Buddha’s demise. From the existing literature, it is not clear how much sage Patanjali’s writings were infl uenced by the teachings of the Buddha. According to some experts (Radhakrishnan 1923 , 1953 ; Radhakrishnan and Moore 1967 ), the oldest of the major Upanishads (Aitareya , Taittiriya, Chandogya, Brihadarnyaka, etc.) were composed during the pre-Buddhist era of ancient India; other Upanishads like Katha and Mandukya were composed after the fi fth century BC (in the transitional phase, after the Buddha’s life time), and the newer Upanishads (Maitri , Svetasvatara, etc.) are dated to the last few centuries BC. So understandably, the description of Yoga in the earlier Upanishads refl ected more of Samkhya (Indus Valley/Rig-Vedic ) philosophy, whereas descriptions in the later ones were more of Vedantic or probably early Buddhist philosophies. 1.4 Yoga: Origins and Scriptures 13

S hruti and smriti fall under one of the following subcategories: Veda , , and Purana .

A. The Vedas (Sanskrit: vid means to know ) The literal meaning of Veda is knowledge or wisdom . The Vedas are among the oldest sacred texts and are believed to have been compiled by the great sage of ancient India Veda (lit. person who narrated the Veda ). The Vedas have 4 divisions: (Veda proper), , Aranyaka , and Upanishads ( Vedanta ): 1 . (literally “collections”) are thought to have been composed before the twelfth century BC. They are collections of mantras (sacred syl- lables or ). The four collections are as follows: Rig-Veda Samhita (the oldest), Sam-Veda Samhita , Yajur-Veda Samhita, and Atharva-Veda Samhita. 2 . Brahmana (lit. who knows the meaning of the , the Ultimate One ) are prose texts said to have been composed around 900 BC. They outline the techniques of solemn sacrifi cial rituals and contemplate their meanings and themes. Each Brahmana is associated with a particular Samhita . Many of the Brahmana scriptures are expositions on the mystic signifi cance of the various sacrifi cial ceremonies. 3 . (lit. the forest treatise ) are the third part of the Veda and were com- posed before the Upanishads by those hermits who lived and meditated in the forest traditions (Sans: ), in total social isolation of nature. Aranyakas deal with the mystical meanings of the sacrifi cial rituals performed in seclusion in the forest life. 4 . Upanishads (Sanskrit: upa = nearby, ni = at the proper place, shad = to sit) literally means to sit at the feet of a teacher and learn the knowledge about the Supreme Spirit. These sections of the Vedas are also collectively referred to as Vedanta (Sanskrit: Vid = knowledge, anta = goal reached) and were composed between 900 and 600 BC (Radhakrishnan 1923 , 1953 ). The Vedantic/Upanishadic system of philosophy is understood as the essence of the Vedas or the purpose or goal of the Vedas. Vedanta is concerned with the end (fi nal goal) of the Vedas , both chronologically and teleologically (Humes 1966 ). The Upanishads generally mention the Vedas with respect. In the form of dialogue, the Upanishad s consider metaphysical questions (e.g., the fate of the soul) and interpretations of the Vedas. Vedantic/Upnaisadic philosophies are considered the putative end and essence of the Vedas ; hence, another name of the Upanishad is the Vedanta (Sanskrit: Vid = knowledge, anta = goal reached). Together Vedanta forms the basis for the Vedanta school of philosophy. Similar to non-Vedic Shramanic philosophies (e.g., ), Vedanta renounced all Vedic ritualism and radically reinterpreted the Vedas in purely philosophical terms. The Sutras (as in the Yoga Sutras, literally means threads , generally under- stood as aphorisms or verses ) are a category of Vedanta. Sutra language is the 14 1 Yoga: Original Concepts and History

last stratum of Vedic Sanskrit leading up to approximately 500 BC. Around 400 BC (time of the composition of the Yoga Sutras ), the sutra style of compositions reached their greatest stylistic peak. Other important texts that are considered sutras include: some Upanishads (e.g., Katha Upanishad and Maitrayaniya Upanishad ) and the Vedanta Sutra , composed around 200 BC by Indian philosopher . The Vedanta Sutra systematizes the Upanishadic philosophies into a single treatise (Radhakrishnan 1923 , 1953 ).

B. The Itihasa (Sans: events of the past or history ) , composed between 400 BC and 400 CE, are the two sacred Indian epics, the Ramayana and the Mahabharata. The Bhagavad Gita is a division of the Mahabharata and is thought to have been composed between 500 BCE and 200 BCE (Upadhyaya 1998 ).

C. The (Sanskrit: “of ancient times”) Puranas are a genre of Hindu, Jain, and Buddhist scripture that are primarily mythological narratives detailing the lives of the deities. These sacred texts may also eulogize great kings and heroes or present cosmological, philosophical, and geographical information. Sage Vyasa , the narrator of Mahabharata is tradition- ally considered the compiler of the Puranas . Scholars believe the Puranas were composed between the third century BC and sixteenth century CE, primarily under the reign of India’s Gupta Empire (third to fi fth century CE). The Purana, an important scripture that describes about Vishnu , an important God in Indian mythology, was composed approximately in 320 CE (Wilson 1840 ).

1.4.5 Patanjali’s Yoga Sutras : A Brief Summary

Despite uncertainty regarding when Patanjali lived and whether he was a single person or several using the same moniker, Indologists do agree that he most likely lived around 400 BC, during the reign of the Mauryan dynasty of ancient India (Jacobi 1910; Radhakrishnan 1923). As previously mentioned, Patanjali composed the Yoga Sutras (Sanskrit: sutra = thread, denoting continuity, perhaps tradition), based on all the existing knowledge of Yoga. The Yoga Sutras is not only the fi rst textbook on Yoga, it is the most seminal and signifi cant of all. Each sutra/apho- rism/verse in the Yoga Sutras is like the barest thread of meaning upon which a teacher might expand by adding his/her own beads of experience for the sake of instructing the student. Prior to Patanjali, Yoga was taught based on oral tradition only. The original defi nitional sutra ( Yogah chitta vritti nirodhah; Yoga Sutra , section I, verse 2) still refl ects the essence of Yoga. Yoga Sutras provides a succinct description of both the process and practice of Yoga, which it names the Eight- Limbed Method of Yoga (Sanskrit: Astanga Yoga; also known as Raja Yoga). This section of the Yoga Sutras is the most well known. 1.4 Yoga: Origins and Scriptures 15

The Yoga Sutras is written as a conversation between a Yoga Master and his disciples. The textbook itself follows the Yogic philosophy on learning—that one must not only read but, more importantly, practice Yoga in daily life in order to master it. In the Yoga Sutras, 196 brief aphorisms/verses are organized into four sections (Sanskrit. padas ). In a nutshell, the four sections or padas are as follows (Satchidananda 1978 ; Taimni 1961 ):

Section I: Samadhi Pada : On contemplation and meditation : 51 verses Section II: Pada : On practice (describes the steps in order to achieve union of jivatman, the individual soul, with the paramatman , the Supreme Soul): 55 verses Section III: Vibhuti Pada : 56 verses on accomplishments / resulting from the union of jivatman and paramatma Section IV: Kaivalya Pada : On absoluteness and liberation/freedom : 34 verses

In the Yoga Sutras, Pantajali divides the practice of Yoga into eight limbs: , , asana , pranayama , pratyahar , dharana , dhyana , and samadhi. These limbs are summarized as follows.

Limb 1 , yama , describes moral behavior that constitutes the foundation of one’s practice. They are the don’ts of one’s engagement with the external world . Specifi cally, the fi ve abstentions are nonviolence, non-lying, non-stealing, no illicit sex, and non-possessions. Limb 2, niyama , also regards moral teachings, but, unlike the yama , niyama describes what a yogi ought to do. Limb 2 details the healthy habits or the do s of one’s engagement with the inner world . The fi ve “observances” are purity, , austerities (ascetism), study of scriptures (called the self-introspection/svadhyaya ), and surrender to God. Limb 3, asana , refers to holding comfortable and steady physical postures. Limb 4, pranayama , is breath regulation and Limb 5, , is the drawing-in of senses. Limb 6, dharana , refers to concentration , centering of consciousness . Limb 7, dhyana , is meditation (Pali: jhana ; Chinese: chan ; Japanese: ). Lastly, limb 8 is samadhi (Pali: samapattis), contemplative absorption, Yogic enstasis, or union. The fi nal three steps (concentration/dharana , meditation/dhyana , and yogic enstasis/samadhi ) are collectively samyama (described further in Chap. 4 ). In Buddhism (the Noble Eightfold Path ), samyama is equivalent to the concept of satipatthana (mindfulness) where one combines the meditative jhanas and samapattis with the meditative wisdom (Pali: nanna, panna), which prepares one for liberation, the nibbana. Samyama as a deeply contemplative process remains entirely in the realm of the mind and soul and is considered the essence of Yoga–meditation. Liberation ( mukti ) or absolute freedom ( ) is the ulti- mate goal of Yoga. This is accomplished when the individual experiences peren- nial samadhi , a sustained and liberated (non-affl icted) state of mind. 16 1 Yoga: Original Concepts and History

Classical Yoga involves not only physical postures and breath work but, more importantly, a philosophy including an ethical foundation, Yogic lifestyle, inner contemplation, and a system for the practice of meditation practice. Again, we see that the common Western perception of Yoga is misunderstood as chiefl y a form of physical exercise, overemphasizing the signifi cance of asana . One should under- stand that physical postures are only preparatory steps for the yogi. Asana allows one to transcend the physical body, which is binding , so that one may achieve into higher realms of awareness. If one refers to the original literature on Yoga, as described by Patanjali as well as in other ancient Indian scriptures, Yoga is not defi ned as a mere physical exercise. This is a rather misleading and myopic view of Yoga. The Yogic philosophy including the ethical foundation, proper technique, and contemplative practices like meditation are all quintessential to the practice of Yoga. On account of its comprehensive and systematic treatment of Yoga, the Yoga Sutras still remains the most suitable book for a deep and systematic study of Yoga. It provides all essential information regarding the mastery of Yoga. Of note, Patanjali is not the inventor of Yoga; he is mostly seen by scholars as a compiler of the previ- ous knowledge of Yoga, burrowed from the pre-Patanjali oral traditions. It is impor- tant to understand that meditation ( dhyana ) and Yoga are not the same. In the eight-limbed scheme of Patanjali (Sans: Ashtanga ), Yoga is inclusive of meditation which consists of concentration (dharana ) and meditation proper (dhyana ), its 6th and 7th limbs. For more descriptions on Patanjali’s standardization of Yoga, please see Chap. 5 of this book.

1.4.6 Classics on Hatha Yoga

The most well-known form of Yoga in the West is the Hatha Yoga, popularized by Yoga teachers like B.K.S. Iyenger and Pattabhi Jois. Literature on Hatha Yoga peaked in India between the fi fteenth and seventeenth century CE. Three classical texts on Hatha Yoga were written in this period:

1 . Hatha Yoga Pradipika (lit. Light on Hatha Yoga ) was written in the fi fteenth century by Swami Svatmarama, a disciple of yogi Gorakhnatha, founder of the Hatha Yoga. This book describes 15 asanas (Yogic postures) (Muktibodhananda and Satyananda 2000 ). 2 . (lit. Expositions of Sage Gheranda): This manual of Yoga is the most encyclopedic among the three texts of Hatha Yoga and was written in the late seventeenth century by Chanda Kapali. In addition to 32 asanas , it describes seven steps of Yoga (doesn’t mention the dharana or concentration, the 6th limb of Patanjali) (Bahadur and Vasu 1914 ). 3 . Samhita (lit. Expositions of Lord Shiva): This book was written in seven- teenth century and outlines 84 asanas .

Thus, one can see that the asanas in the Hatha Yoga increased in number over the years. 1.5 The Four Major Philosophical Systems of Yoga 17

1.5 The Four Major Philosophical Systems of Yoga: The Vedas , Vedanta, Shramana , and Tantra

Yoga as a system of philosophies and techniques blends: (1) Samkhya , the philo- sophical offspring of the Rig-Veda, circa 1200 BC) with its dualism; (2) the non- dualism of Vedanta (Upanishads ); (3) Tantra’s technique-rich standardization and concepts involving homogenization and symbolism of the human body as a micro- cosm for the truth of the macrocosm; and (4) varieties of meditation (dhyana/jhana/ chan/zen ) as preserved in the Shramanic philosophies, Jainism and Buddhism . Understanding of these four original schools of Yogic philosophies, i.e., Samkhya , Vedanta , Shramana, and tantra , is essential for deeper understanding of Yoga. Over several thousand years, Yoga has served as a common matrix sewing these various philosophical traditions of India into a common matrix. Among the four systems of Yoga, Veda ( Rig-Veda ) is the oldest and tantra is the most modern one.

1.5.1 Yoga in the Vedas (Samkhya/Rig-Vedic Philosophy)

Samkhya (Sans: enumeration, numbers) is a major philosophical school of ancient India and is based on the Rig-Veda , the oldest one among the Vedas . As described by Dasgupta (1922 ), Samkhya’s metaphysical philosophy is dualist (Sans: dvaita ) and atheistic (Sans: nastika ; denies existence of God). The metaphysics of Samkhya divides the individual’s existence into two (hence it is dualist): (i) purusha (Sans: self, spirit, consciousness, soul) and (ii) prakriti (Sans: the phenomenal/ material realm that includes the body, the mind, the sense organs, etc.) (for more elaborations, please see Dasgupta 1973 , p. 1–30). Jiva (Sans: the individual) is the state in which purusha is bonded to prakriti by the force of desire (Sans: kamana ; Pali: tanha ). Liberation (moksha or mukti in the Upanishadic sense and nibbana in the Buddhist sense) of the individual is achieved when this bond is broken. This liberation can be attained by practicing Yoga. There are conceptual differences between the dualism in Samkhya and the Western forms of dualism. In the Western dualism, as proposed by the French philosopher Rene Descartes (1596–1650 CE), the dualism lies in the dichotomy of mind and body, which are both inanimate (Sans: jada ) according to Samkhya . The dualism in Samkhya , in contrast , lies between the purusha (self or Soul ) and prakriti (material principles that includes body as well as mind). Samkhya philosophy asserts that there are three possible states of the existence of purusha : (a) the liberated (Sans: mukta ) state, in which purusha has no connection with prakriti (e.g., the enlightened beings like the Buddha), (b) the bonded state without life when purusha is bonded but does not have a body (Sans: bideha , the spirits), and (c) the physical state as a living being when the individual (jiva ) gets attached to a body (e.g., we human beings in the society). Therefore, is inherent in Samkhya which considers rebirth as the process in which the Soul ( purusha) accepts another body and mind ( prakriti ). Samkhya also elaborates upon the (Sans: the intentional, conscious, and deliberate action motivated by one’s will) as the notion of responsibility for one’s 18 1 Yoga: Original Concepts and History action, where benefi cial effects are derived from past benefi cial actions and harmful effects from past harmful actions. Samkhya asserts that if the existence of karma is assumed, then proposition of God as a moral governor of the universe is unneces- sary. However, Yogic philosophies including the Yoga Sutras, despite their origin in the Samkhya (atheistic) philosophy, don’t deny the existence of God. Instead, they mention God, albeit as a passing reference. According to Dasgupta (1973 , p. 159), Isvara (God) in the Yoga system is a special type of purusha who is distinguished from all others by the fact of his being untouched by the fruits or affl ictions of karma; he is already liberated from the laws of karma .

1.5.2 Yoga in the Vedanta (Upanishads )

Within scripture the words Vedanta and Upanishad are used interchangeably. The Vedanta as a school of thought consists of multiple complex and abstract philoso- phies. Samkhya philosophy unlike the dualistic and atheistic nature of life and the universe in Samkhya philosophy, advaita (monistic) Vedantic philosophies are non- dual (hence the name advaita ) and theistic. Most prominent among the Vedantic schools is the , its major scholars being of ancient India (788–820 CE) of Medieval India and Swami Vivekananda (1863 CE-1902 CE) of Modern India. The three major concepts in advaita (non-dual) Vedanta are: (a) Brahman (the Supreme Spirit), (b) the maya (the illusory principle), and (c) mukti or moksha (liberation, deliverance). According to the philosophy of the advaita Vedanta, God, the Supreme Cosmic Spirit (Sanskrit: Brahman), is the One, the Whole, and the only Reality (Sanskrit: Paramarthika Satyam), hence the name advaita (non-dual; no second existence ). Brahman is free from any kind of differ- ences or differentiation because being non-dual there is no second Brahman. Other than Brahman , everything else, including the universe, material objects, and indi- viduals, are maya (the illusory principle of Brahman ). Unlike Brahman which is eternal (Sans: chirantana ) and absolute, maya is temporary (Sans: anitya ; Pali: anicca ) and relative to the absolute state. Maya causes the world (Sans: samsara ) to arise in one’s mind. The Vedantic philosophies disillusion us that all sensory data entering into one’s awareness via the fi ve senses are maya (illusory), and thus all our senses can be tricked. In other words, despite the real existence of the world as it is, we perceive the world in an illusory way under infl uence of maya . Being the illusory principle of Brahman , maya has two main functions, i.e., (a) to hide Brahman from ordinary human perception and (b) to present the material world in Brahman ’s place in a dynamic, ever-changing manner, which essentially creates further illusion in one’s mind/consciousness. Maya is temporary and is transcended with true knowl- edge or insight which is essentially the perception of the more fundamental reality which is able to penetrate the illusion of the maya . Vivekananda (2001 , p. 89) fur- ther explains the concept of maya : “…maya of the Vedanta, in its last developed form, is neither nor realism, nor is it a theory. It is a simple statement of facts — what we are and what we see around us. What does the statement of exis- tence of the world mean then? It means that it has no absolute existence. It exists 1.5 The Four Major Philosophical Systems of Yoga 19 only in relation to my mind, to your mind and to the mind of everyone else. We have to work in and through it….” Adi Shankara , the famous Advaita (non-dualist) Vedantin of Medieval India, summarizes the gist of Vedantic philosophies as fol- lows: Brahman is absolute reality, unborn and unchanging. Brahman is the self- existent, the absolute, and the imperishable. Brahman is indescribable. It is at best Infi nite Truth, Infi nite Consciousness, and Infi nite Bliss ( Satchidananda ). Brahman is free from any kind of differences or differentiation because being non-dual there is no second Brahman. Brahman is often described as “not this, not this” (Sanskrit: neti ) since Brahman cannot be correctly described as this or that. As Brahman is the sole reality, it cannot be said to possess any attributes whatsoever. When a person tries to know Brahman through the mind (i.e., intellectually rather than expe- rientially), due to the infl uence of maya , Brahman appears as God (Sans: Ishvara ), as a third factor separate from the world and from the individual. Vedanta asserts that in reality, there is no difference between the individual soul (called the jivatman in Samkhya) and the Cosmic Soul (called the paramatman in Samkhya ). As one can see here, advaita Vedanta considers both entities of Samkhya, i.e., jivatman (Individual Soul) and paramatman (the Supreme or Cosmic Soul) as one only ( advaita), which is essentially the Brahman, the Ultimate One. Vedanta claims that ignorance (called avidya) of this reality of Brahman is the cause of all sufferings in the world, and it happens due to tremendous infl uence of the maya , the illusory power. Liberation lies in knowing the reality of this non-difference (i.e., advaita , non-duality). Only upon true knowledge or insight (called jnana in Vedanta or Vipassana in Buddhism) of Brahman , perception of the more fundamental reality can be achieved, and thus liberation (moksha or mukti or deliverance) from the clutches of maya can be possible. Of note, Vedanta doesn’t say the world is an illu- sion. It rather says that the things of this world are real but under infl uence of maya , the illusory principle, the perception of world by an individual (under infl uence of maya ) becomes illusory; in other words, the sensorial mind plays tricks by which the individual takes the illusion as the truth and thus suffers. The individual can be liberated from this suffering by following Yoga and its methods. Thus, the path to liberation (moksha or mukti or deliverance) is fi nally only through true knowledge or jnana (Deutsch 1988 ). This is the theoretical foundation of the (lib- eration from suffering through the meditative insight or nanna ). For more descrip- tions of the philosophies of Vedanta / Upanishad, please refer to Radhakrishnan (1953 ) and Gambhirananda (1997 , 2003 ).

1.5.3 Summary of Yoga in the Veda (Samkhya ) and Vedanta (Upanishad )

Despite their ideological differences, both the Veda ( Samkhya ) and Vedanta ( Upanishad ) agree that Yoga is a method of liberation or deliverance (moksha/ mukti/ ). In both, there are multiple levels of existence of the individual, mind, and body. This is referred to as the Soul, the concept of which is founda- tional in the Eastern philosophies. A simple example will clarify the presence of 20 1 Yoga: Original Concepts and History

another entity in one’s existence, which is different from the body and mind: when one says this is my body or this is my mind , one is obviously referring to a third entity in one’s existence (the fi rst and second factors being the body and mind, respectively) in reference to one’s body and mind, which is neither the body nor the mind. This third entity is rather the owner of the body and mind because one is using the word my in reference to this third entity. Eastern philosophies refer to this third entity as the Soul. Vedanta further asserts that experience about an object in the realm of Soul is the highest level of experience or the Real or Absolute experience, whereas experiencing object at the level of ordinary or intellectual mind (Sans: ) is an incomplete or impure experience. When experience happens at the level of Soul, the experiencer (individual) and the object of experi- ence become one. In this experience, mediation of mind as the interpreting inter- face disappears, and everything becomes just pure experience. In other words, at that level of experience, the individual rather becomes the experience. No doubt why Vedanta (Upanishad ) and Buddha call this the highest level of experience: the only real experience, all other forms of experience being labeled as unreal or illusion ( maya [Sans:] in Vedanta ; avidya [Sans: Pali] in Buddhism). Despite the ideological differences in many aspects, all schools of Yoga including the Veda , Vedanta (Upanishad ), and the Shramanic (non-Hindu or Buddhist) philosophies propose Yoga and meditation as methods to make the experience happen in the realm of Soul rather than in the realm of the body or the sensorial mind. One can also note that in all these philosophies, the three words true knowledge , true expe- rience, and real experience have been used interchangeably because they all mean the same.

1.6 Great Contribution of the Shramanic (Non-Hindu) Philosophies: Rise of Meditation in the System of Yoga

Meditation as a deeply contemplative discipline developed in an elaborate way in the Shramanic traditions of ancient India. These traditions consist of two major non-Hindu religions, i.e., Jainism and Buddhism, and have provided alternatives to the Vedic traditions since ancient times, but it only became an organized tradition around the seventh century BC (Zimmer 1969 ). Shramanic traditions, employing the Pali and Prakrita languages, relied more on the ideas of Vedanta/Upanishads rather than on those of the Sanskrit Vedas (Sanskrit language). Two main thinkers in these traditions were Vardhamana Mahavira (circa 599–527 BC) of the and Buddha (Siddhartha Gautama; 563–483 BC) of Buddhism. Their contributions are responsible for the development of meditation as a distinct, elabo- rate, and deeply contemplative discipline. The major concepts in Shramanic phi- losophy are:

(a) Karma: the actions or deeds and their consequences, a concept borrowed from Samkhya (b) Samsara : the wearisome cycle of birth, aging, illness, death, and rebirth) (c) Nibbana : liberation from the cycle mentioned above 1.6 Great Contribution of the Shramanic (Non-Hindu) Philosophies 21

K arma is central to the Shramanic . From , every living being (jiva ) is in bondage to karmic residues accumulated through good and bad deeds. In the Vedic tradition, these are called samskara (Sans: engraved memories based on past deeds/ karma). The law of karma is immutable: every action eventually bears fruit accord- ing to its skillfulness. When one acts in unskillful harmful ways, unhappiness is bound to follow; if one acts skillfully, happiness will ultimately ensue. After studying the Shramanic philosophies, one can clearly see that unlike the teachings of the Vedic traditions (which has strong emphasis on metaphysics and cosmology), the Shramanic tradition emphasized much more on the individual mind and karma rather than on the metaphysical concepts. Shramanic philosophy and practice emphasize the neces- sity of self-effort (Sanskrit: sadhana ) for the individual’s (jiva ) liberation. Despite the signifi cant interaction and integration between early Buddhism and the Upanishadic ( Vedantic) schools in ancient India, diverges from meditation in other Yogic traditions. So it is important to clarify some of these.

1.6.1 Yoga Versus Meditation

Yoga and meditation are not the same. The broader rubric of Yoga includes medita- tion, as well as the metaphysical and cosmological expositions on the universe in its entirety including the mind, body, and soul. Meditation , on its own, is mostly con- cerned with the individual’s mind. Meditation is a key step in both the Eight-Limbed Yoga ( Ashtanga) and the Noble Eightfold Path of the Buddha. Meditation is essen- tially an ongoing cognitive–emotive-reappraisal process that takes place within the individual in order to obtain insight and directly experience the personal truths of their life. This deeply contemplative process regards the meditator’s own experience of life. Actions are governed by the ongoing knowledge acquired through medita- tion rather than reactions to underlying impulses. Technically, meditation involves learning to shift and focus one’s attention at will onto an object of choice , such as bodily feelings or an emotional experience, while disengaging from our condition reactions or elaborative processing. Depending upon how one’s consciousness (attention) is directed at the object of meditation, all meditations can be categorized into two types: (1) concentrative or anchoring meditation and (2) mindfulness or insight meditation. Concentrative meditation (centering of consciousness ) is the Patanjalian 6th step, i.e., dharana (which means to anchor or hold [Pali: ; sama meaning pacifi cation of dis- tracted/agitated mind]), and involves developing focused, directed, and sustained attention. Mindfulness meditation (Pali: satipatthana ) on the other hand involves a uniformly distributed attention in which the objects of meditation are held in one’s awareness and are experienced and monitored as they are in that moment. Concentrative meditation is a prerequisite for mindfulness meditation: through the concentrative meditation, the mind develops the ability of developing evenly dis- tributed attention that is characteristic of the mindfulness meditation. Thus, medita- tion is a sequential scheme, and as described in Chap. 7 of this book, this sequence provides the basis of the Staged Meditation Protocols compiled by this author for their clinical applications. 22 1 Yoga: Original Concepts and History

1.6.2 Seminal Contributions of Gautama Buddha into the Meditative System of Yoga

Meditation, conceptually as well as technically, was undoubtedly present long before the Buddha. Descriptions of meditation and Yoga are found in the Rig-Veda, ( ; Rig-Veda : X: 129; Brereton 1999 ) was composed many centuries before the Buddha. Early describe the meditative practices and medi- tative states that existed long before the Buddha. According to our knowledge of the Buddha’s biography, few of the Buddha’s teachers—particularly, the renowned masters of meditation in his early ascetic life, Alara Kalama and Uddaka Ramaputta—were trained in the Vedic (Indus Valley Civilization) system of Yoga, like that of Patanjali (Kalupahana 1994 ; Santina 1997 ). Buddha having raised in both the Shramanic and the Brahminic (Vedic and Upanishadic ) traditions inte- grated and transcended the philosophical discrepancies among these traditions and contributed in major ways to the synthesis of both traditions. This integration is at the core of Theravada, the chief Buddhist scripture. Buddha’s meditative method is popularly referred to as the mindfulness meditation (Pali: satipatthana ; vipassana ). Buddha took the philosophy, techniques, and practice of meditation and placed them in a more user-friendly and pragmatic framework of psychology. Buddhism does not require ascetic practices or for one to be born into the Yogic traditions. Buddha further developed Yoga, particularly meditation, into a means of healing (like present-day psychological therapy) and proposed their use for health and the wellness of the community. During the Indian Antiquity—the era between the rule of the Mauryan and the Gupta empires (second century BC to fi fth century CE)— Yoga became more accessible to the average man. Prior to this, Yoga was mostly pursued ascetically by select people and in social isolation like in the woods or mountains. This explains the great popularity and spread beyond India of the modi- fi ed versions of Yoga, e.g., Ashtanga Yoga, mindfulness, tantra , etc., particularly after Buddha’s era.

1.6.3 Buddha’s Middle Way

Buddha’s meditative lifestyle is popularly known as the Middle Way (Pali: Majjhima Patipada, the path of moderation; Garfi eld 1995; Dalai 2009 ; Siderits and Katsura 2013) which is a signifi cant departure from the extreme methods of Yoga described by thinkers in the pre-Buddhist era. Buddha’s Middle Way , as the name suggests, is the path of moderation, the way in between the extremes of hedonism and self- mortifi cation. Recognizing the conditioned and impermanent nature of the human existence, Buddha advised to avoid both eternalism and nihilism because both ideas are extremes. According to the Vedantic concept of eternalism, when the body dies, this Self will not die because the Self is by nature permanent and unchanging. Likewise, the concept of nihilism denies any control over the consequences of one’s destiny. Buddha believed that clinging to the extreme eternalism would bind us to the samsara , the wearisome cycle of birth and death, whereas clinging to extreme 1.7 Tantra: The Fourth and the Newest System of Yogic Philosophy 23 nihilism would only cause catastrophe and rebirth. Similarly, he rejected the ascetic lifestyle wisely considering the extremeness involved in it. Thus, Buddha’s Middle Way or the Path of Moderation is a pragmatic and realistic compromise between the extremes. In the Buddhism, the Middle Way refers to the insights that lead one to transcend the contradictions of one’s existence (Kalupahana 1992 , 2006 ; Garfi eld 1995 ).

1.7 Tantra : The Fourth and the Newest System of Yogic Philosophy

Tantra is the fourth system of Yogic philosophy, the other three being Veda / Samkhya , Vedanta , and Shramana. Tantra (Sans: Tan = human body; tra = tools or instruments, also means thread or extension of tradition or knowledge) literally means using one’s body as the tool for or freedom . Linguistically the three words man- tra , tantra, and yantra are related: Mantra denotes the /knowledge, tantra denotes the ritual actions, and yantra denotes the means by which a human is expected to lead the life. The rich interaction and integration between the major ancient Indian philosophies gave rise to tantra. Although the earliest documented use of the word tantra is in the Hindu text, the Rig-Veda (X.71.9), usually tantra is the name scholars give to a style of religious ritual and meditation popularized dur- ing medieval India (circa the fi fth century CE) and onward (Einoo 2009 , p. 45). In tantric cosmology, all the elements of the universe are wholly present within the psychophysical experience of the individual. Tantric conceptions of the body follow that the human organism, the microcosm, is homologous to the macrocosm, the universe. For example, symbolically, Mount Sumeru, the central mountain of the universe according to , is situated within the body of the prac- titioner, just as the sun and moon, the sacred rivers of India, and pilgrimage places are found within the microcosm of the body. Even further, the primary features of the transformed or purifi ed experience are symbolized in the form of the deities attributed to each . In tantra , the human body is conceptualized as, the micro- cosm, a map of the whole universe. As a result, its yogic techniques aim to establish mastery of the human body. If the human body is the microcosm that contains the macrocosm within itself, mastery of the body renders mastery of the external uni- verse. The universe we experience is the concrete manifestation of the divine energy that creates and maintains it. Tantric practice seeks to contact and channel that energy within the microcosm of the human body (Sans: tan ) by means of ritual in order to achieve freedom (Mueller-Ortega 1989 ). Tantra is the chief source of mod- ern conceptions of Yoga. While some of its seminal concepts derive from earlier, pre-tantric sources, such as the Hindu Upanishads and Yoga Sutra, they were greatly expanded upon, ritualized, and philosophically contextualized within medieval tan- tras . Heavily technique-oriented, tantra made the abstractness of Yoga more tangi- ble and, thus, more accessible to the common public. Highly ritualistic and purifi cation ceremonies are necessary prerequisites of tantric practices. Initiation is conducted by a (Tibetan: ), responsible for teaching the esoteric 24 1 Yoga: Original Concepts and History meanings of the tantric terminology and symbols to his students. Tantra is primarily a technique-based interpretation of spiritual practice, as compared to the philosoph- ical nature of Veda/ Vedanta. Still, like the Vedanta , tantra has no single coherent doctrine; rather, it developed within the context of the various religions that adopted its methodology (Wallis 2012 , p. 26, 27). Tantra became popular in the early centuries CE, developing into a fully articu- lated tradition in ancient India by the end of the Gupta period, i.e., fi fth century CE, and culminated in medieval India (White 2000 ). Tantra as a system of Yogic phi- losophy has been accepted well in (especially Kashmiri ), Buddhism (especially in , where it is called ), Jainism, (devotion) school in the medieval Hinduism, as well as in the Sufi (Islamic mysticism) traditions. Over a few thousand years, tantra has deeply infl uenced all forms of Indian religious expression to some extent. As mentioned before, through the tantra philosophy, Yoga became integrated into different religions and thus became easily available to the common mass to practice it within the belief system of their respective religions. Tantra , like Buddhism, is one vehicle through which Yoga emerged among the common mass, both in India and globally. The foremost reason for Tantra’s popularity is that its teachings are geared more toward the mar- ried , than the monastic or solitary renunciant. Ascetism is not neces- sary to its practice. As a philosophy, tantra could integrate the Vedic , Vedantic, as well as Shramanic philosophies. Especially in its non-dualistic forms, tantra rejected the renunciant values of the Vedic Yoga, instead a vision of the whole of reality as the self-expression of a single, free, and blissful Divine Consciousness that could go by Siva, , Buddha, nature, or any other name. Tantric meditations are relatively concrete, standardized, and ritualistic, while also pragmatic and unorthodox at the same time. It does not require one to understand abstract and complex philosophies, as is the case in many of the other systems of Yoga. Practice requires little prior knowledge. In fact, tantric meditation aims to deconstruct all preconceived notions of the human condition and abolish the barri- ers that limit our way of thought. Cultural and linguistic frameworks serve as bar- riers. This deconstruction and abolishment allow the individual to transcend the human condition and to experience total liberation and unity with Ultimate Truth or Reality (Timalsina 2012 , p. 112).

1.8 Yogic Philosophies Bridge Across the Ideologies of All Four Schools: The Veda (Samkhya ) , Vedanta (Upanishads), Shramana , and Tantra

Although Yoga originated in the Hindu traditions of the Indus Valley Civilizations, Buddhist philosophies further enriched the Yogic tradition. There is consensus among many Indologists that Samkhya and Yoga played a part in the philosophi- cal formation of the Buddha (Jacobi 1910; Chakravarti 1951). In particular, early 1.9 History of Yoga 25

Buddhism borrows from the Indus Valley Civilization their methods for control- the mind. According to the (lit. Acts of the Buddha ) written by Asvaghosa (circa fi rst century CE), Buddha’s fi rst teacher Arada [Pali: Alara] was a Samkhya partisan. Similarly, Indologist Hermann Jacobi (1910 , p. 1) notes that “Buddhism appears not as a copy but as a personal reinterpretation of Samkhya; the latter was not a model after which Buddhism was constructed, but rather the soil on which it grew.” Samkhya (Rig-Veda ) gave rise to the Upanishadic philosophy upon which the Vedantic and Shramaic philosophies are based, at least in part (Radhakrishnan 1953 ). The Mahayana , often likened to Shankara’s advaita Vedanta , are Madhyamaka and Yogacara , founded by and , respectively (Michaels 2004 ). Radhakrishnan (1923 , p. 439) writes: “…there are no doubt similarities between the views of Buddhism and advaita Vedanta , and this is not surprising in view of the fact that both these systems had for their background the Upanishads. ” Many others as well (Deutsch and Dalvi 2004 ) speculate that the parallels between advaita Vedanta and certain elements of Buddhism are due to the shared infl uence of the Upanishads. Some key concepts that are distinct in tantra as opposed to the other three sys- tems need mention here. Patanjali’s Eight-Limbed Yoga (Ashtanga ), being based on the Rig-Vedic (Samkhya , ancient India) philosophy, probably predates tantra , a school of thought of Medieval India, by many centuries. Ashtanga and tantra do share similarities in their technical richness and standardization, but important dif- ferences do exist. For example, Samkhya considerers the body and the world illu- sionary, while tantra does not; rather it idealizes the body as refl ected by the literal meaning of tan [Sans: body]. The body in tantra is a microcosm of the universe and, therefore, essential to one’s liberation. Metaphysically, Ashtanga and tantra diverge. Having its base in the Samkhya system, Ashtanga is dualistic and more ascetic. Also tantra rejects the renunciant values in Ashtanga and offers instead a vision of the whole of reality as self-expression of a singular, free, and blissful Divine Consciousness. In this way, tantra adheres more to the non-dualistic philosophies of Vedanta. The pragmatics and realisms of tantra attracted a following, as it allowed the average householder to achieve liberation. In summary, Yoga as a system of philosophy integrates the essence of many diverse philosophies. It lacks the philo- sophical heterogeneity and complexity, providing a means for even the common man to achieve liberation. For more detailed discussion on this, please refer to Eliade (1969 ).

1.9 History of Yoga

For India’s common mass Yoga has been a way of life for thousands of years. Unsurprisingly, its practice is profoundly and intricately intertwined with the his- tory of India itself. In fact, one might say the history of Yoga is that of India. 26 1 Yoga: Original Concepts and History

1.9.1 Yoga in Ancient India

Ancient Indian and Yogic history can be divided into four periods. These periods, which are both successive but overlapping at times, are as below:

(a) The pre-textual Vedic or Indus Valley Civilization period (circa 3000 BC to 1500 BC) during which Yoga likely originated and developed an oral tradition (e.g., the Samkhya philosophy of the Rig-Veda ). (b) The textual Vedic period (circa 1500 BC to 900 BC) during which the four Vedas were composed in Sanskrit . (c) The Upanishadic period (circa 900 BC to 200 BC), named after the Upanishads (or Vedanta) as they were written during this era. The Upanishadic period also marks the origins of the Sharmanic tradition (i.e., the philosophical traditions of ancient India which deviated from the contemporary Vedic traditions and even- tually gave rise to Jainism and Buddhism). (d) The Golden Age of ancient India (circa second century BC to fi fth century CE): around this time India was reigned by the Gupta dynasty, and during this period tantra reached its peak.

1.9.2 Yoga in Medieval India

The extensive integration of Yoga into all India’s major philosophical schools is attributed to the medieval period, spanning from the fi fth to the fi fteenth century CE. During this time, advaita Vedanta of Adi Shankara (788–820 CE), tantra , the (devotion to the personal God), Sufi sm (Islamic mysticism), and Sikhism were conceived. With the rise of advaita Vedanta, concepts of which were compiled by Adi Shankara early in the early medieval period, Buddhism declined in India. Still Yogic philosophies and techniques survived through tantra. In fact, the chief Indian religions of the early medieval period (500–1200 CE) all bear the imprints of tantra . In the late medieval period (from tenth to twelfth century CE), India saw decline of Buddhism. In 1193 CE, Turkic Islamic raiders under Muhammad Khilji burnt the University, one of the largest and most infl u- ential Buddhist University in the northeastern part of India (present-day Bihar). By twelfth century CE, Buddhism as an organized religion ceased to exist in India. Late medieval and early modern India (fourteenth to seventeenth century CE) saw integration of Yoga into all religions in various forms of religious movements cen- tered around the concept of bhakti (Sans: devotion).Yoga was integrated into Muslim culture during the fi fteenth century India when Bhakti , a division of Yoga, and Sufi sm developed. Bhakti and Sufi sm are both devotional traditions in which salvation requires only loving devotion to the God and religious rituals are not necessary (Chandra 1996 ). They had similar goals and were designed to be accessible to all, primarily using and instinctual love in the pursuit of God and self- realization. Both Bhakti and Sufi sm incorporate Yoga as a means of union with God. The Sufi s primarily interacted with the Nathpanthi , followers of yogi Goarakhnath, 1.9 History of Yoga 27 embracing Yoga themselves (Bannerji 1962). This integration of Yoga into medieval Islam was further established when the liberal Akbar, the mystic Mughal Emperor (1556–1605 CE), developed a policy that declared humanity (Persian: Din-i-Ilahi ) the one true religion. Akbar attested that yogic aims and philosophies fostered humanity (Choudhury 1971). In addition to yogi Goarakhnath’s efforts, various translations of various Yogic scriptures are also responsible for the Islamic adoption of Yoga. Al-Biruni, the revered Persian scholar of the medieval Islamic Golden Age (973–1048 CE), translated Patanjali’s Yoga Sutras into Arabic. Based on Hatha Yoga, -Kunda , literally meaning “pool of nectar,” was translated into Arabic by Qazi Rukunuddin Samarqandi (906–970 CE) and subsequently into Persian by Shaikh Muhammad Shattari (1501–1562 CE). Lastly Dara Shikoh, son of the Mughal Emperor Shah Jahan, translated 50 Upanishads into Persian in 1657 CE (Rizvi 1975 , p. 335). Yoga similarly infl uenced Sikhism ( Sikh means one who learns), a monothe- istic religion founded in the northern Punjab region of India, situated in the border between India and Pakistan. It is attributed to Nanak Dev (1469–1539 CE), the fi rst Sikh guru. Profound Yogic infl uences are clearly evident in the descriptions of Guru Granth Sahib, the religious text of Sikhism compiled in the sixteenth century CE.

1.9.3 Yoga in Modern India

Modern India encompasses the period from sixteenth century CE onward. Yoga in modern India is best understood in terms of the contributions and theories of its many prominent philosophers.

Ramakrishna Paramahamsa (1836–1886 CE): He was the proponent of the advaita Vedanta and tantra and practiced several religions, including Islam and Christianity. He emphasized that despite any differences, all religions are valid and true, as they all share the supreme goal of life, God Realization . Swami Vivekananda (1863–1902 CE): Also a follower of the advaita Vedanta and tantra, he was the chief disciple of Paramahamsa and also the fi rst Indian monk to travel to the Western world where he introduced the Vedantic philosophy. In September 1893, he represented India in the World Parliament of Religions in Chicago, where he gave his famous speech in which he introduced the major tenants and philosophies of Hinduism and the Indian tradition to the Western audience. His wisdom almost immediately earned the attention of the American press and citizens. As part of his Ramakrishna Mission that focused on providing social services, he launched a constellation of ashrams (Yoga centers) globally, spreading the teachings of Yoga beyond India and into the modern era. Swami Shivananda (1854–1934 CE): Advocate of Hatha Yoga and Kundalini tantra , Swami Shivananda, like Vivekananda, was a direct disciple of Ramakrishna Paramahamsa. Originally trained as a physician, he became the founder of the in India and authored over 25 books on Yoga. He is also known as the guru of Swami Satchidananda, the founder YogaVille, an ashram in Virginia, USA, that advocated for interfaith harmony that still operates today. 28 1 Yoga: Original Concepts and History

Sri Aurobindo (1872–1950 CE): Cambridge educated, Sri Aurobindo is the founder of Integral Yoga and was also among the fi rst freedom fi ghters of imperial India. His writings are quite integrative and accommodative of the modern concepts as well. These are particularly valuable to our understanding of transpersonal psy- chology and the sequential evolution of mind in the meditative path. Integrating Darwinian concepts of evolution with Vedantic thought, he proposed that man- kind has the capacity to evolve spiritually beyond its current limitations to a state of spiritual and supramental existence. This supramental existence is character- ized by a spiritualized and truth-consciousness-oriented humanity. Several important thinkers in transpersonal psychology have been infl uenced by Aurobindo’s work including Murphy, Wilber, and Cortright (Wilber et al. 1986 ). In his teachings, Aurobindo provides an elaborate description of the gradations of human consciousness, which he refers to as the planes of consciousness and compares to a series of steps on a staircase. He describes these planes in ascend- ing order as: the physical sub-conscient mind , vital–emotional mind , will mind , sense mind , reasoning mind , higher mind , illumined mind , intuitive mind , over- mind , and, fi nally, the supermind (Dalal 2001 ). (1888–1975 CE): He was the second president of the Republic of India and one of India’s most infl uential scholars on comparative religion and philosophy. He built a bridge between the Eastern and the Western philosophy, demonstrating how both traditions are comprehensible within the terms of the other. He is also well known for his commentaries on the three sacred scriptures of advaita Vedanta , namely, the Bhagavad Gita , the Upanishads , and the Sutra , collectively known as Prasthana Trayi . T. Krishnamacharya (1888–1989 CE): An Indian Yoga teacher, Ayurvedic healer, and scholar, he is often referred to as the father of modern Hatha Yoga . He was widely regarded as one of the most infl uential Yoga teachers of the twentieth century and is credited with the revival of Hatha Yoga, instructing future teach- ers like B.K.S. Iyenger and Pattabhi Jois.

1.9.4 Yoga Beyond India: Spread to the Far East

Patronized by the great Indian Emperor Asoka (circa third century BC), Yoga (espe- cially meditation and tantra) migrated to Sri Lanka, Burma (Myanmar), and Thailand through the expansion of Buddhism. Subsequently the fi ssion of Buddhism led to its two major divisions: Hinayana (Theravada ) and Mahayana . Although Hinayana is the parent division, Yoga expanded beyond India mainly through Mahayana Buddhism, more so in between the fi rst century CE and tenth century CE. Its practice and philosophies migrated to Southeast Asia, toward north to central Asia, , and Korea. From there its infl uence eventually reached Japan in the sixth century CE and Tibet in the seventh century. The chief varieties of Mahayana Buddhism are Chan and Zen in which meditation plays a central role. In fact, both the words Chan and Zen derive from dhyan (Sans: meditation). Buddhism shared certain similarities with , the and form of nature mysticism attributed to sage 1.9 History of Yoga 29

Lao-Tzu (fourth to third century BC). Certain differences do exist such as Buddhist emphasis on textual scholarship versus Taoist quietism and inspiration. Still, Buddhism and Taoism overlap philosophically. Buddhist meditation and the Taoist goal of living harmoniously with nature both emphasize inner stillness and actionless action (similar to the Upanishadic/Vedantic concept of niskama karma [Sans:]), referred to as -wei in the Taoist tradition. It is not surprising then that a school of developed. Chan (fi rst century CE) subsequently gave rise to (fi fth century CE; Chen 1964 ; Keown 1996). Similar to the philoso- phies of advaita Vedanta ( Jnana Yoga; Yoga through true knowledge), Chan and Zen hold that enlightenment occurs in a moment of intuitive awakening that is beyond logical comprehension . It observes that these fl ashes of insight (Japanese: ) are often triggered in the course of mundane activity when the mind is calm and relaxed, rather than when engaged in study or intellectual analysis. It is signifi cant to note that salient differences between both Chan and Zen and Indian Buddhism do exist, spe- cifi cally in that the Eastern Asian schools are more pragmatic. , the fi rst patriarch of Chan , characterizes the pragmatism of Chan and Zen teachings as fol- lows: (a) a special transmission of knowledge outside the scriptures, (b) no depen- dence upon words and letters, (c) direct pointing at the human mind, and (d) seeing into the nature to attain (Lai 1997 ). Of the two main branches of Zen, the Soto Zen School believes that calming meditation is all that is necessary, while Rinzai Zen uses other techniques as a focus of meditation, most notably (=dialogues). By fi rst century CE, Buddhism and thus Yoga and meditation were integrated into . Buddhism in China reached its highest point under the Tang dynasty (618–907 CE). Tantra in China fl ourished during the Mongol period (thirteenth and fourteenth centuries). Later, the twentieth century China saw the arrival of Communism which led to the suppression of Buddhism.

1.9.5 Yoga Beyond India: Spread to the West

Yoga’s emergence in the West began with the Transcendentalist Movement , which was heavily based upon the Vedantic or Upanishadic philosophies of ancient India. The prominent Transcendentalists, Arthur Schopenhauer (the German philosopher: 1788 –1860 CE), Ralph Waldo Emerson (1803–1882 CE), and Henry David Thoreau (1817–1862 CE), all directly acknowledged the Bhagavad Gita as intrinsic to their way of life and thought and were among the fi rst Westerners to practice Yoga and meditation. By the late nineteenth century, Yoga had caught the attention of the Western public mainly due to Swami Vivekananda and his translations of scriptures into English, as described earlier. In 1920, Swami Yogananda (1893– 1952) traveled to California and founded the Self-Realization Fellowship. He pro- posed (Sans: purifying action or Yogic procedures) and authored the well-known . Yoga later infl uenced the psychoanalytic movement as well. Rolland ( 1929) wrote extensive letters to Sigmund Freud regard- ing meditation and mystical experiences. Bion (1967 , 1970 ) characterized Yoga as the method of harnessing the mind to unharness itself of memory and desire . 30 1 Yoga: Original Concepts and History

Jung ( 1933 , 1969) took a deep interest in the Kundalini Yoga, an evolution of tantra . Other thinkers like Suzuki ( 1963 ) tried to bridge the gap between meditation (Zen) and psychoanalysis. In the 1960s, Western interest in Yoga, particularly the physical elements of the Hatha Yoga , reached its pinnacle. The second wave of Yoga followed in the 1980s and is mostly attributed to Dean Ornish, Professor of Medicine at the University of California and a disciple of Swami Satchidananda. Ornish is best known for his Lifestyle Heart Trial ( 1990 ), the results of which indicated that a lifestyle including Yoga could signifi cantly improve cardiovascular health. Yoga soon became popular as an effective system of physical exercise. The clinical applications of Hatha Yoga and Buddhist meditation (mind- fulness, Pali: satipatthana ) in mainstream medicine is also attributed to Jon Kabat- Zinn, founder of the Mindfulness-Based Stress Reduction (MBSR) program. Kabat-Zinn began teaching Yoga and meditation as part of his cognitive behavioral therapy at the Stress Reduction Clinic of Massachusetts General Hospital in 1979. Since its conception, the MBSR program has been increasingly used as a form of . Today, the scientifi c study of alternative medicine continues. The National Center for Complementary and Alternative Medicine (NCCAM), ini- tially established in 1991, is a division of the National Institutes of Health (NIH). NCCAM investigates complementary and alternative medicine (CAM) healing practices in the context of rigorous science. It also functions to train CAM research- ers and disseminate information to both health professionals and the public. Aside from Vivekananda and Yogananda, contributions of several other Indian Yoga masters have been critical to the integration of Yoga into Western mainstream culture. Iyengar, author of (2000; initial publication in 1966), founded , a division of Hatha Yoga that emphasizes precision and proper align- ment for both the practice of asana and pranayama. Swami (1925–1996 CE) was one of the fi rst Yogis to collaborate with Western scientists. The Menninger Clinic performed studies (Green and Green 1977 ) on his ability to voluntarily con- trol the non-voluntary bodily processes such as heartbeat, blood pressure, body tem- perature, etc. by Yogic techniques. Sri Ravi Sankar, founder of the Art of Living Foundation, proposed a specifi c breathing-based Yogic technique called Sudarshan Kriya Yoga (SKY). SKY has a contemporary following and has been the subject of scientifi c studies regarding mental illness (Brown and Gerbarg 2005 ). Lastly, (1918–2008 CE) and his Transcendental Meditation (TM) gained a signifi cant following in the 1960s. He conducted mass meditation session, which he believed would promote world peace and prevent violence and war.

1.10 Some Further Clarifications

1.10.1 Spirituality Versus Religiousness

Like the two terms Yoga and meditation , most commonly, the other two terms spiri- tuality and religiousness are used interchangeably. In this context, it is necessary to understand the distinction between spirituality and religiousness, which is still a 1.10 Some Further Clarifi cations 31 work in progress in the existing literature. Both terms don’t mean the same. For example, only about 20 % of American adults describe themselves as spiritual but not religious, whereas the majority of American adults (64 %) describe themselves as spiritual and religious (Marler and Hardaway 2002 ). Spirituality is derived from the Middle East English word spiritus which means breath. Spirit refers to the basic components of life: the life-giving breath of the individual. On the other hand, the word religion is generally thought to derive from both Germanic and English infl u- ences from words meaning to bind. The implication here is that religion is a way to bind people to each other and ultimately to God (possibly through an organization like church, temple, etc.). In this sense, religiosity can be seen as a subset of spiri- tuality , the broader entity. However, unlike religiosity which has an institutional origin and has a sense of binding embedded in it, spirituality appears to refer to something intrinsic within us that either is our own essence or the part of us that ultimately help us to fi nd our paths back to the God or that which is sacred and makes us liberated, i.e., free from the bindings . Spirituality is usually reserved more for the individual experience and religion more for the doctrinal concepts of an established institution. Describing the diffi culties in correctly defi ning spirituality, Nye (1999 , p. 58) writes: “Spirituality is like the win–hough it might be experi- enced, observed and described, it cannot be captured.” Spirituality is now com- monly regarded as “an individual phenomenon and identifi ed with such things as personal transcendence, supra consciousness sensitivity and meaningfulness.... Religiousness, in contrast, is now often described narrowly as formally structured and identifi ed with religious intrusions on prescribed theology and rituals” (Zinnbauer et al. 1997 , p. 551). Some theological models subsume religiousness as a category within spirituality (McDonald 2000 ). Authors like Beck (1992 ) have reconceptualized spirituality in terms of human qualities such as insight ; as an awareness of the interconnections among and between persons and other life forms ; as an experience of mystery and awe ; and as sense of compassion, generosity, and gratitude. According to Roof ( 1993, p. 64), “spirituality gives expression to the being that is in us; it has to do with feelings, with the power that comes from within, with knowing our deepest selves.” While this goes beyond the scopes of this chap- ter, it is increasingly being recognized that like the cognitive, emotional, or social development, spiritual development is another dimension of human development and at least equally signifi cant.

1.10.2 Yoga Is Not Religious

As described earlier in some detail, Yogic ideas were embraced well not only by most of the contemporary religions of India from ancient times but also by many other religions in the world including both the East and the West. Although originated in the ancient Indian philosophies, Yoga itself as a system is not religious. It is rather the science of religions, the study of which enables the practitioner to appreciate better his/her own faith. The early champions like Patanjali or Buddha had never described Yoga from a religious point of view. 32 1 Yoga: Original Concepts and History

Rather, both of them have proposed it as universally applicable philosophies about mind, its various operations, as well as innovative ways to mend the mind. Over a few thousand years, Yogic ideas were embraced well by many contemporary religions in and outside India. These attest to the fact that Yoga is irreligious despite its origin in ancient Hinduism. Here we describe some evidences to this fact.

Yoga in Ancient Greek Thoughts: As Metaphysics in the Teachings of Socrates and Plato In several dialogues, most notably the Republic, its author Socrates (father of Western philosophy and teacher of Plato, the Greek philosopher; life time: 469–399 BC) inverts the common man’s intuition about what is knowable and what is real. While most people take the objects of their senses to be real if anything is, Socrates is contemptuous of people who think that something has to be graspable in the hands to be real. According to Socrates, physical objects and physical events are shadows of their ideal or perfect forms and exist only to the extent that they instanti- ate the perfect versions of themselves. Just as shadows are temporary, inconsequen- tial epiphenomena produced by physical objects, physical objects are themselves fl eeting phenomena caused by more substantial causes, the ideals of which they are mere instances. Looking closer, one can realize the similarities between the Vedantic philosophies and the above ideas of Socrates. For more discussion, please see Saltzman (2005 , p. 363–383).

Yoga–Meditation in Certain Judeo-Christian Traditions (Kabbalah, Hesychasm)

Yogic concepts in the Jewish mysticism (Kabbalah ) Searching through the inter- net, one can fi nd readings about the Kabbalah Yoga. Kabbalah is a Jewish esoteric method, discipline, and school of thought. Similar to the Vedantic philosophies, Kabbalah seeks to defi ne the nature of the universe and the human being, the nature and purpose of existence, and various other ontological questions. It also presents methods to aid understanding of these concepts and to thereby attain spiritual real- ization. Kabbalah originally developed entirely within the realm of Jewish thought and kabbalists often use classical Jewish sources to explain and demonstrate its esoteric teachings. Inside Judaism, Kabbalah forms the foundations of mystical religious interpretation (for more discussion, please see Dan 2002 ).

Yoga in the praying methods of the Hesychastic monks The term Hesychasm is used sparingly in Christian ascetical writings emanating from Egypt from the fourth century. This term, in general, refers to a practice of marked by deep tran- quility of the spirit intent on contemplating God unceasingly by invoking the name of Jesus. Hesychastic practice involves acquiring an inner focus and blocking of the physical senses. In this, Hesychasm shows its roots in Evagrius Ponticus who was a Christian monk and ascetic with life time from 345 to 399 CE (Kallistos 1995 ) and, as described before, even in the Greek tradition of going back to Plato References 33 whose life time was from 428 to 347 BC. As a tradition, Hesychasm involves yogic methods of praying. Based on Christ’s injunction in the Gospel of Matthew (go into your closet to pray), Hesychasm in tradition has been the process of retiring inward by ceasing to register the senses (same as the Pratyahara , the 5th limb of the Eight- Limbed Yoga practice/Ashtanga as proposed by sage Patanjali around fourth cen- tury BC), in order to achieve an experiential knowledge of God. The Hesychastic monks (Eastern Christian traditions) integrate Yoga and other aspects of Eastern spirituality with prayer and meditation. This has been attributed to a desire to expe- rience God in a more complete way. For more discussion, please see Eliade (1969 ) and Horujy (2004 ) .

1.11 Concluding Remarks

Yoga is not a religion by itself. It is the science of religions, the study of which enables the practitioner to appreciate better his own faith. Swami Vivekananda, addressing to a wise audience of the West in 1907 said: “…I do not come to convert you to a new belief. I want you to keep your own belief; I want to make the Methodist a better Methodist; the Presbyterian a better Presbyterian; the Unitarian a better Unitarian…” (Virajananda 1914 , p. 420).

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….that whatever we experience – the whole (perception) of reality – depends on the conditions of our minds…. mind is the root of all sufferings, mind is root of all virtues.... The most important practice, therefore, is to discipline the mind…. ( Buddha , sixth century BC, ancient India)

2.1 Introduction

The mind has central importance in Yoga, more so in Buddhism which in general begins with the mind. The central philosophy of Yoga is the fact that the mind is the key to changing the nature of our experiences. The mind is the single most impor- tant factor in the practice of Yoga. Depending upon how one uses it, the mind can be one’s greatest enemy or greatest ally. The Yogic philosophies by and large constitute the various theories about the human mind in both structural and functional senses. Yoga is essentially the study of the mind through the instrumentality of one’s mind itself. Thus, the deep connections between Yoga and the mind cannot be overempha- sized. We use the mind as the interpreting interface between the objects of percep- tion and ourselves in order to experience those objects. Quite rightly, Buddhism focuses on the mind as the key to change the way we experience things and the way we relate to other people. In Buddha’s scheme, out of fi ve aggregates that constitute the human experience, four are mental factors. Similarly, out of the 37 factors of enlightenment, the majority are mental factors (Santina 1997 , p. 321). These illus- trate the centrality of the mind in Buddhism. Buddha out it very clearly that the mind is the source of all our experiences; all things are created by the mind. The mind is the source of all virtues, and to obtain these virtues and qualities, one must discipline the mind. In recognition of the deep connections between Yoga and the mind, arose a particular school of Buddhism, the Mind Only school [Sans. Vijnanavada (‘Chitta matra’); doctrines of knowledge), otherwise known as the Yogacara school [English the school that affi rms union of one’s achara /conduct

© Springer International Publishing Switzerland 2015 37 B. Pradhan, Yoga and Mindfulness Based Cognitive Therapy: A Clinical Guide, DOI 10.1007/978-3-319-09105-1_2 38 2 Yoga, Mind, and the Psychosomatics with the practice of Yoga ]. In the fourth century CE, this school arose as an indepen- dent and identifi able philosophical tradition in the northwest India (modern day Pakistan). Initially popularized by two famous Mahayana Buddhists, and his younger brother, Vasubandhu, this school is said to be the latest and fi nal form of Buddhism as a religion and is based on an original central fact of Buddhism that the mind is the creator of all things (Bhattacharya and Tucci 1932 ).

2.2 Yoga and the Mind (Consciousness, [Sans. chitta ]): Some Key Terms

In the vast literature on Yoga, one comes across some key terms (in either Sanskrit or Pali languages) repeatedly. Those are: mind (interchangeably used with con- sciousness ), soul (interchangeably used with self, [Sans. purusha or master of the mind]), mind stuff [Sans. chitta , the material that constitutes the mind], the various fl uctuations/transformations in the mind [Sans. vritti], tendencies/qualities of the mind [Sans. guna ], engraved memories of past deeds [Sans. samskaras , smriti ], etc. In order to understand the philosophies of Yoga and meditation as proposed origi- nally, it is necessary to understand some of these key terms. Limitations of the English language in proper explanation of these Sanskrit or Pali terms are obvious. Chitta (mind stuff or consciousness stuff): Chitta is essentially the material the mind is made of. It is the structural aspect of the mind. Chitta is conceptualized as a universal medium through which consciousness functions on all the planes of the manifest universe; it is the medium through which the individual Soul [Sans. jivatma ] mate- rializes in the individual world, lives, and evolves in this world until it has perfected and unifi ed with the Supreme Soul [Sans. Paramatma ]. The closest English word for chitta is intellect [Sans. buddhi ]. Buddha has described chittas as successive, dis- crete, evanescent, complex cognitive events which form the apparently continuous stream of consciousness; each of these complex units involves consciousness itself, as the basic awareness of an object, and a constellation of associated mental fac- tors (Pali chetasika ) exercising more specialized tasks in the act of cognition (Bodhi 2000 , p. 88). So if the mental state is the chitta , the thoughts, feelings, and percep- tions associated with that particular mental state are the chetasikas . Vritti [Sans. vrit = to exist]: Vrittis are temporary mental states (thoughts, feelings, impulses, etc.) that manifest in the medium of chitta or mind stuff. As mentioned in Chap. 1, Patanjali defi nes vrittis as the patterns or fl uctuations of chitta . If we look at the mind, we fi nd that vrittis or mental states (such as worry, happi- ness, and the like) appear and disappear every moment. They pass away and are replaced by new and different vrittis or mental states each moment. Samskaras (engraved memories) These are the deep impressions engraved in one’s memories from past experiences or past deeds [Sans. karma ]. While the abode of vrittis is in the surface aspect of chitta , that of the samskaras is deeper. In that sense, samskaras are engraved memories. Being the superfi cial aspects of the chitta , the vrittis can be destroyed relatively easily, whereas samskaras are much deeper and need long practice of meditation for their annihilation. According to the Yoga Sutras , the samskaras burden the meditator’s mind, obscure his vision, and come in 2.2 Yoga and the Mind (Consciousness, [Sans. chitta]): Some Key Terms 39

the way of obtaining a glimpse of the Reality. Hence, samskaras must be destroyed (burnt) completely, through the meditative insight [Sans. jnana ; Pali nanna ) to make the meditator’s mind (consciousness) pass into the realm of Reality. Gunas [Sans. tendencies or the innate dispositions of chitta / mind; similar to the concept of temperament ] In contrast to the chitta (which is the structural material of the mind) and the vrittis (which are the functional aspects of the mind), gunas are the qualitative aspects of the mind. Chitta takes in the forces or qualities of gunas and projects them as vrittis (thoughts, feelings, etc.). The three basic dispositions of gunas are (a) [Sans. inertia or darkness ], rajas [Sans. activity or restlessness ], and sattva [Sans. wisdom or balancing factor]. Chitta is always trying to get back to its natural, internal, and pure state (described as Soul/internal self which is the locus of one’s experience and essence of one’s existence), but the sense organs [Sans. ] constantly draw it out and thus prevent the self -realization. Guna and vrittis are the terms of Yoga Sutras (Patanjalian) and conceptually similar to the Buddhist term chetasika (associ- ated mental factors). In the Buddhist literature, chitta is considered a state of mind or the prime material that constitute one’s consciousness/mind, whereas chetasikas (like the gunas and vrittis) are the concomitants of chitta or the associated mental factors that color the chitta and give it its distinctive character (Bodhi 2000 , p. 88). Soul [Sans. Atman ] This denotes both the individual soul [Sans. jivatma , the contracted self) and the Supreme Soul [Sans. paramatma , the expanded or Universal Self]. As mentioned in Chap. 1 , Samkhya (dualistic) philosophy con- siders that the individual soul consists of two entities: the purusha [Sans. real/ true self, the Atman ] and the prakriti [Sans. matter]. Prakriti is the primordial nature, the material substratum of the creation, and consists of the three gunas mentioned above. The highest Yogic philosophy asserts that the soul is pure and perfect; it is the highest grade of the mind; it is the basic/fundamental entity in our existence. Being fundamental, the soul is not reducible further and hence called simple [Sans. maula, means which is original], whereas the body and mind are compounds [Sans. gauna, means the derivative; possibly this term has originated from guna]. As mentioned in Chap. 1 , Advaita Vedantic (non- duality) philosophy considers the soul (Universal Self or purusha ) the same as the nondual Brahman. Vedanta further asserts that (mis)taking the prakriti as the purusha is an illusion or great mistake. When the power of discrimination has been attained, the person sees that everything in this world, mental and physical, is a compound and, as such, can’t be the purusha . When the purusha (Universal Self) realizes that being the fundamental entity in existence depends on nothing in this universe, when the purusha realizes that freedom or libera- tion is its very nature and that it doesn’t need anything to attain perfection, that very moment, the purusha becomes liberated from the confl icts or illusions created by prakriti and attains the state of liberation [Sans. mukt i, kaivalya ]. Awareness versus consciousness: It is important to understand the difference between these two terms. Wheeler et al. (1997 , p. 335) clarifi es that awareness represents the general capacity that an individual possesses for particular kinds of mental repre- sentations and subjective experiences that are not directed at anything. Awareness is defi ned as the refl exive perception of the act of registering the presence of things in the environment which are actually registered in the individual’s sphere of 40 2 Yoga, Mind, and the Psychosomatics

knowledge. Awareness is not just the mere detection of things in the environment. For example, a camera or computer can detect light, movement, and objects that it is focused upon. However, the video camera is not aware of these things. Philosophers have argued that awareness requires an object to be aware of and a subject that is in fact aware. Therefore, the requirement for awareness is that there is something or someone who is actually aware. Awareness may be equivalent to the subjective experience such that there is a subject or individual who is able to have an experience of something else external to that individual. Consciousness , on the other hand, is described as our continuous stream of awareness of all the thoughts, feelings, sensa- tions, and perceptions. Consciousness is conceptualized as a constellation of attri- butes of the mind such as subjectivity, self-awareness, sentience, and the ability to perceive a relationship between oneself and one’s environment. Consciousness is related to awareness in that consciousness represents an awareness of the self as the object of awareness. Thus, awareness is more general and consciousness is subjec- tive awareness or self-awareness which is more personalized. So one can see that in consciousness (self-awareness) the individual is both the subject and the object of the experience. In Yoga, consciousness is used in a sense that is different from the consciousness in the neurological sense. While consciousness might be derived from the neurological processes, Yogic philosophies consider it as a form of energy which constitutes the primary substantive part of the universe. In these traditions, consciousness is generally referred to the various grades of the human mind and the attending mental states (Sivananda 1994 , p. 112, 131). This Yogic consciousness (Y-consciousness) includes the mind with its various grades of expression, from the lower/coarser (Sans. manasa ) to higher/fi ner (Sans. buddhi ) and to the highest/fi nest (Sans. Atman , soul) (Aurobindo 1999 ). Similarly, the various stages of are deemed the much higher levels of consciousness or mental states. These philoso- phies clarify that meditation is a process of purifi cation (in Buddhist traditions, it is rightly called the Path of Purifi cation [Pali ], in which the meditator refi nes the consciousness/mind in order to be able to realize its subtle/fi ner expres- sions). Consciousness is also described interchangeably with self- awareness which is a special type of awareness where the object in focus is the self . The act of being self-aware encompasses the potential to observe the subjective neural representations of the self and to model internally an inferred representation of what others may think about the self (Beitman and Yue 2004 ). Meditation offers the opportunity to create and function within this self-refl ective inner space that enhances one’s power of self- exploration and purifying one’s experiences with the meditative insights about the various levels of realities involved in these experiences.

2.3 Yogic Consciousness (Mind [Sans. chitta ]) and Its Varieties as the Meditator Ascends in the Meditative Path

It is important to realize that the Yogic concept of consciousness is different from the intellectual consciousness used in traditional neurological sense (which is in the sense of wakefulness). Yogic consciousness, in general, refers to the mind with its various grades or levels of fi neness or purity. Yogic consciousness is more 2.4 Phenomenology of Human Experience and Role of the Mind 41 all- encompassing and is always centered in the deep insights about Reality . In this sense, the three words that are used quite interchangeably in descriptions of the Yogic consciousness are pure awareness , true knowledge, and Reality. Sariputta , one of the foremost disciples of Buddha, applied an Abhidhammic type of analysis to the consciousness he had experienced as he progressed through the various stages of meditation. Within this objective scheme, consciousness is divided into four classes which are the various grades or qualities of consciousness (mind) as one ascends in the path of meditation (Santina 1997 , p. 333–339):

(i) The sense sphere consciousness (Pali kamavachara ) or consciousness directed toward the world of sense desire (ii) The form sphere consciousness (Pali rupavachara ) or consciousness directed toward the sphere of forms (iii) The formless sphere consciousness (Pali arupavachara ) or consciousness directed toward the formless sphere (iv) The transcendental direction of consciousness (Pali lokuttara ) or the con- sciousness directed toward nibbana

The fi rst three classes of consciousness are concerned with the world of condi- tioned things and are called worldly/mundane consciousness (Pali lokiya chitta ), whereas the fourth class, also known as supramundane consciousness (Pali alokiya chitta), refers to the transcendental direction of consciousness. As one ascends in the meditative journey, there is a progressive unifi cation and homogenization in the object of each consciousness: for example, the object of the consciousness of the sphere of sense desire is the most proliferated one; those of the formless types of consciousness are increasingly less proliferated, whereas the fourth type of con- sciousness is directed toward a transcendental (rather than concrete) type of object. See Chap. 4 for more descriptions.

2.4 Phenomenology of Human Experience and Role of the Mind (Consciousness) in Its Creation

Phenomenology is the study of the phenomena of the mind (Pali dhamma ) or description of things as they are experienced by the individual: the study of things as they are known, as they appear from the perspectives of an independent observer . Buddha renounced the metaphysical aspects of the Vedas prevalent during his time (defi ned as study of absolute or fi rst principles or otherwise called as ontology) and adopted the phenomenology instead. In meditative phenomenology (dhamma ), the meditator (independent observer) objectively and in detached manner realizes the sequence in which the various phenomena of the mind arise in the awareness, rise to their peak, interact with each other to create an experience, and fi nally dissipate in one’s fi eld of awareness. The distinctive features in the descriptions of the Abhidhamma which carries the sacred knowledge of the Buddha himself are precise defi nitions as well as elaborate concepts and systematizations about the nature of the human mind and human experiences. Studying these Abhidhammic texts, one can realize the importance of the phenomenological perspectives in the study of the 42 2 Yoga, Mind, and the Psychosomatics human mind and its experiences. The in-depth descriptions about the various expe- riences including the meditative experience in those texts never fail to amaze their readers. In the West, thinkers like Edmund Husserl (1859–1938) proposed an inves- tigative method called transcendental phenomenology and has argued for the impor- tance of the phenomenological perspective in which the mind (subjective perspective) and the brain/body (objective perspective) work together to experience the world in a more profound manner (Welton 1999 ). Emphasizing upon the key role of the mind as the creator of the experience, Buddha proposed that objects have no independent existence. Their existence is relative to causes and conditions of the object as well as the mind—most impor- tantly, the mental (subjective) causes and conditions of ignorance, attachment, aver- sion, greed, anger, jealousy, and the like. Phenomena (dhamma ), by their basic nature, are empty or neutral. It is our mind that colors these phenomena and how they affect us depends on how our minds take them and present them to us. In other words, this refers to how we relate these phenomena through our minds which in turn depends on the quality or grades of our minds. Depending on the (subjective) conditions of the mind, these empty or neutral phenomena become transformed into elaborate experiences, highly personalized narratives. The story about the experi- ence of Elder Tissa (a Buddhist monk of the Theravada tradition) will further illus- trate this point. One morning, Elder Tissa was roaming on the streets of a city in ancient India with the Buddha and the fellow monks while an extremely beautiful lady passed by. When he was asked what he saw, Elder Tissa in contrast to others replied that he saw just a heap of bones, nothing else! Of note, being motivated by Buddha’s prescriptions, Elder Tissa had cultivated a long practice of mindfulness meditation targeted specifi cally at controlling one’s sexual desires by seeing one’s body in elemental forms, i.e., fl esh and bones rather than in terms of its physical beauty (this is similar to the Buddhist cemetery contemplation, another mindfulness method in which the meditator contemplates on the perishable nature of the human body and thus realizes the truth of ). This story illustrates that the objects of our perception don’t have a stable or fi xed form of appearance. What appears as an attractive woman to somebody appears as a heap of bones to another. In this sense, it is the mind itself which causes the stress by conditioning the mind and its experiences with other (dependent) parameters which make one’s experience conditioned to something else so that one can’t experience things in a liberated way.

2.5 Mind (Consciousness ): A Bundle of Five Things (Aggregates )

The term mind refers to be constituted by the subjectively experienced functions that arise from the brain including our thoughts, feelings, perceptions, memory, and will. While there are many aspects of the mind that are created by the brain, there are mind processes that exist beyond the brain, particularly the entities in the realm of conscious- ness and awareness. In constructing an experience about an object, the fi ve fundamental things involved are thoughts, feelings, sensations and perceptions, memory, and will that create awareness or consciousness about the objects in our experience. In human experi- ence, the mere awareness of an object cannot be called as a personal experience. In daily 2.6 Central Problem Inherent in the Nature of the Mind 43 life, the various physical and mental factors work together to produce unique and per- sonal or individualized experience about things. Buddha was not satisfi ed with a vague conception of human experience; rather, he delved into a thorough analysis of each experience in terms of its basic components. Aggregates or factors (Sans. ; Pali khanda , means a bundle or pile of things ) are the basic components or factors of per- sonal experience, and quite rightly their descriptions do have a central place in the Abhidhamma , the encyclopedic texts on the analytic psychology of Buddha. The fi ve aggregates or factors that constitute our experience are: (1) aggregates of form or per- ception (Sans., Pali rupa ) or physical world (internal and external), (2) aggregates of con sciousness/ awareness / conception (includes thoughts/cognition [Sans. ]), (3) aggregates of feelings or emotions (Pali vedana ), (4) aggregates of sensations/percep- tion (sensing or perceiving an object), and (5) aggregates of volition (impulses), mental formation , and memory (Sans. samskara ). Memory (Sans. samskara , smriti ), a key com- ponent in this fi ve-component model of the mind, adds colors to our thoughts, feelings, and perceptions so that the experience is meaningfully constructed. These fi ve aggre- gates, understandings of which are a major concept in the Abhidhamma, inform us that the mind which is creator of our experiences is nothing but a bundle (Pali khanda ) of fi ve things, as depicted in Fig. 2.1 (model of the mind and the meditator). We perceive the mind or experience in terms of these fi ve contents (objects) of the mind without which we can’t perceive the mind. Being volatile in its existence, the mind always needs an anchor to hold on to; it needs certain media for it to be expressed and perceived by us. Just as we need a refl ective surface to perceive the light, similarly we depend on the contents of the mind in order to perceive the mind and the experiences created by it. In the process of meditation, the role of the mindful meditator is to observe, by mindful detachment and mindful awareness, how these fi ve aggregates of experience arise or originate in the fi eld of awareness, and cocreate the human experience by their interde- pendent actions, how these experiences change constantly, in an ongoing manner to the point of their eventual dissipation in the fi eld of awareness. It is important to realize that each of these aggregates that constitute the experience is in a state of fl ux or constant change, i.e., these are impermanent, and in reality, there is no reason to cling to them . The goal of Buddha’s analytic exercises was to gain a better idea of how these aggregates function in sequence and in relation to each other from which the human experience is constructed (by mind or consciousness) in one’s fi eld of awareness. This is the theory of interdependence (of aggregates and experiences), i.e., nothing exists in isolation. The fi ve aggregates or factors in Buddhism are the most basic factors/parameters of a personal experience which function to turn our mere aware- ness of the object into a profound personal experience. For more elaborate descrip- tions, please see Chap. 5 of this book.

2.6 Central Problem Inherent in the Nature of the Mind: Projection (Vikshepa ) That Causes Illusion (Maya ) and Ignorance (Avidya ) About the Reality

As described in the Yogic scriptures (the Upanishads which are the foundational origins of both the Hindu and Buddhist philosophies), in a single sentence, the basic problem in the human mind work can be described as its inherent tendency to run 44 2 Yoga, Mind, and the Psychosomatics

Fig. 2.1 Model of the mind and the meditator

outward, i.e., to focus on the external world rather than on one’s interior. However, fact remains that one’s interior is the center of all the myriads of human experiences including happiness, calmness, sorrows, sufferings, etc. The mind always runs outward (centrifugal), away from the locus of experience, due to its projective mechanisms (Sans. vikshepa) fuelled by the sense organs. This tendency keeps the person away from the experience. Of note, this projection is in 2.6 Central Problem Inherent in the Nature of the Mind 45 many ways different from the psychoanalytic concept of projection (a defense mechanism which plays a key role in psychosis and severe personality disorders). Objects are constantly being presented to the mind by the fi ve sense organs (carry- ing the sensations of touch, smell, taste, hearing, and vision), and the mind produces the corresponding images in one’s awareness based on the qualities/grades of one’s mind. Of note, Yoga considers the mind as another sense organ (the sixth sense). The mind being centrifugal projects these images outward. These projections are the ones that produce the impression of the world (Sans. and Pali samsara ) which are the perceived objects that lay around us in our experiences. The mind brings about the interaction of spirit and matter and, in addition, proj- ects the result of this interaction outside as a virtual image. That explains why dif- ferent people have different experiences despite seeing the same object. Thus, these projective mechanisms cause the mind to get immersed in the outer world and occu- pied all the time with the procession of images, which pass continuously in the fi eld of consciousness. Yoga asserts that under the infl uence of ignorance (Sans. avidya ) and being aided by the ongoing projection mechanisms, this elaborate image of the material world as perceived by the ordinary mind is not true or real, rather it is just like a virtual image or an illusion (Sans. maya ). Of note, maya doesn’t mean that the world is an illusion, as it is often wrongly stated such. The illusion merely lies in our point of view or perception under the infl uence of the ordinary mind (Sans. manasa , the lower mind ). This makes us to (mis)perceive the map as the territory . These projections of the mind, being focused on the exterior, don’t allow the individual (Pali and Sans. jiva ) to acquire self-knowledge about one’s internal states and thus makes one ignorant about the one’s fundamental (real ) nature (Sans. svarupa ).

2.6.1 Reversal of the Projections Is the Key Mechanism of Action of Yoga

Because the ultimate mystery of life is hidden inside of us, which is the locus of all experiences, the goals of the key techniques in Yoga and meditation are to decrease the projections of the mind and turn it inward. Essentially, this introversion (inward turning of the mind) reverses the projective mechanisms of the mind, leads to self- introspection (Sans. svadhyaya , this is a part of the niyama , the observances in Yoga) and self (or inside)-knowledge, and eventually leads to self-realization . This inside knowledge is called insight , which is quite different from the knowledge obtained from the projected mechanisms: the projections make the knowledge/experience dis- torted. Recognizing its importance in creating the illusions in the perceived experi- ences, Buddha called these distortions as delusions . As one can see in Chaps. 5 and 7 , essentially the key steps in Yoga consist of withdrawing of the consciousness (mind) from outward and turning it inward . This is called the pratyahara [Sans.], the fi fth step in the Eight-limbed Yoga. Yoga by its two main methods, i.e., concentra- tion and mindfulness , reverses the projective mechanisms of the mind. These two methods turn the mind inward, toward the key locus of all human experiences so that one can obtain insight into one’s experiences and thus able to realize the experiences in their true or direct or undistorted forms. In practice of Yoga, by the process of mental concentration, the tendency of the mind to run outward is replaced gradually 46 2 Yoga, Mind, and the Psychosomatics by a tendency to return effortlessly to its center or inside (Sans. Laya ). Therefore, this method is also known as Laya Yoga (same as Raja Yoga ). It is only under this condi- tion that the lower mind (Sans. manasa ) can be joined (Sans. Yuj , from which the word Yoga has originated), as it were, with the higher minds or higher mental states (Sans. buddhi and Atman or the soul). It is the progressive union with the higher minds by the meditative process that results in elevation of consciousness to effect the change in one’s personality style and associated functions or dysfunctions. With sincere and prolonged practice of Yoga, the strength of the soul ( Atman), the illumi- nation of intellect (buddhi ), and the meditative wisdom work together to purify/ sharpen the mind; the internal apparatus (Sans. antahkarana) which in its fi ner grades is able to perceive the subtleties of the Reality in an ever-increasing way and provide the necessary guidance and momentum for navigating the path of Yoga. This union becomes direct only in the deeper samadhis (contemplative absorption, Yogic enstasis), when consciousness leaves one vehicle after another and becomes progres- sively centered at deeper and deeper levels. So, as we see clearly here, the aim of Yoga is the reversal of the tendency of the mind to run constantly after a multitude of objects in the outer world and to develop the capacity to pursue constantly one objec- tive inside within the realm of consciousness. Samyama , which is the combination of the last three limbs (concentration, meditation, and Yogic enstasis) of Yoga in Patanjali’s Eight-limbed Yoga, is the key technique to achieve insights into Reality through the penetrative wisdom and thus get liberated from the shackles of one’s conditioned existence. Samadhi is the major means as well as the major objective of Yoga. The Yogi (practitioner of Yoga) needs to acquire the capacity to pursue the objective of Yoga with energy and perseverance and Yoga Sutras emphasizes that this objective must be within (not outside) which is the locus of experience.

2.7 Models of the Mind (Consciousness) in the Yogic Philosophies

Yogic wisdom provides us with profound insights about the nature and functions of the human mind. Yogic philosophies were proposed originally as expositions and theories about how the human mind works. This is quite clear when one throws a glance at the two seminal scriptures on Yoga and meditation, i.e., the Yoga Sutras (Patanjali, circa. 400 BC; Satchidananda 1978 ) and Visuddhimagga (Path of Purifi cation; Buddhaghosha, circa. 430 CE), respectively. The working model of the mind, as described in Yogic scriptures, is as below.

2.7.1 The Monkey Metaphor: Explains the Inherently Unstable Nature of the Mind

This metaphor elucidates the default mode of working of the mind. We know that the mind is always restless; it can run amok. This is why Yogic philosophies con- sider the mind as just another sense organ, the sixth sense. Imagine someone made 2.7 Models of the Mind (Consciousness) in the Yogic Philosophies 47 a restless monkey drink a lot of wine. Then this intoxicated monkey gets a scorpion sting. To add to the misery, the monkey then gets possessed by a demon. What lan- guage can describe the uncontrollable restlessness of this monkey?? The functional nature of our mind is like this monkey. Incessantly active by its own nature, it is inherently inebriated with the wine of desire, further increasing its turbulence. After desire has taken possession follows the sting of jealousy at the success of others. Last but not the least, the demon of pride enters the mind, making it think itself all- important. How diffi cult it is to control such a mind! Yoga is a scientifi c method to control the mind. Until you know what the mind is doing, you can’t control it. The mind is a mere instrument/interface through which one perceives and communi- cates with the external world. The real universe is like a reaction of the mind in the form of vrittis (temporary mental sates like thoughts and feelings), in response to the suggestions of our sense organs (Sans. indriyas ). This situation is similar to the situation of formation of pearl inside the oyster by irritation of the oyster shell when the parasite gets inside. As a reactionary response to this irritation, the oyster throws the enameling around the irritated nidus which leads to formation of the pearl. The layers of enamel are like the vrittis, the temporary reactionary transformations of the chitta (the mind and mind stuff); the universe of experience is our own enamel, so to speak. The ordinary man with the will never understand it because when he tries to do so, he throws out another layer of enamel (vrittis ) and sees only his own enamel.

2.7.2 The Tripartite Model of Human Experience: The Projector Analogy

Samkhya ( Rig Vedic ) philosophy and thus Yoga in its classic sense propose a tripar- tite model of experience. In this scheme, experience consists of three key things: (a) scene/seen, i.e., the world with the objects to be seen/experienced (Sans. drishya ); (b) the instrument through which one sees, i.e., the mind/the interpreting interface (Sans. manasa ); and (c) the seer/experiencer, i.e., the Soul/self (Sans. drashta , puru- sha). Here, the term seeing is meant in the experiencing sense rather than in the visual sense. As mentioned before, Yoga considers the mind as another sense organ under disposal of the seer or the soul . As an entity, soul is conceptualized as the master of the mind and is seeing everything. However, the soul is present rather in the background and unnoticeable to the individual (Sans. jiva ) because of ignorance (Sans. avidya ) and illusion (Sans. maya ). An analogy involving the projection of a movie in theater will make it easier to understand. Let’s imagine the situation of a movie being played on the screen in a theater. In this there are three things: the movie being played on the screen, the projector that projects the movie, and the person that runs the projector. In this situation, the movie scenes (seen, objects being experi- enced) are the contents of this projection. In Yogic philosophies, our life which consists of objects (both internal and external) in this world is like a movie and results from the constant interplay between the chitta and vrittis . As explained ear- lier, the chitta and vrittis mean mental faculties and mental states in their whole 48 2 Yoga, Mind, and the Psychosomatics range including thoughts, feelings, memories, psychological objects, etc. In the Yoga Sutras , Patanjali (like Buddha) says that all the mental and physical actions arise from the nature of consciousness (mind), which is to create the reality we live in by means of sensations, thought, emotions, and memory. In this way, conscious- ness (mind) creates the me , the I-factor—an elaborate fantasy played out as if on a screen, from subtle sensation to the very core of a biographically intact life lived moment to moment. What we perceive as life is nothing but our experiences associ- ated with the objects in this world, and these objects (scenes) are constantly being projected to the screen of life like a movie. The projector that is projecting the movie scenes is the mind, the instrument. The seer or the soul is the real master which is the person running the projector but always remains unnoticeable. In ordi- nary perception, under the infl uence of the ordinary mind, the three things in the tripartite model (the world, the mind and the self) are mostly confused, and thus, the self (who sees) misidentifi es with the things being seen. This leads to mistaking the representations as facts, i.e., the individual takes the map as the territory which is a profound misunderstanding. Yoga maintains that as long as we are unaware of this fact about the higher nature of the soul as opposed to the ordinary mind (as men- tioned before, the soul is also conceptualized as the mind in its purest and fi nest form), our experiences are subject to the illusions created by the (lower) sensorial mind. Being dependent on the conditions (or grades) and instrumentality of the sensorial mind, these experiences are indirect rather than true or direct experiences. The real or direct experience is where the mind as the interface disappears and everything becomes pure experience (the being or experiential mode). Here, the experience speaks for itself without the instrumentality of the interface/the mind. In this experience which can be achieved by Yoga, as its name suggests ( yuj [Sans.]: union, complete merger, dissolution), there is complete merger between the world (scene), the mind (the interface), and the self (one who experiences, the seer); all three become one, just pure experience. The goal of Yoga is to discriminate between the mind and the soul (self) and correct one’s misidentifi cations with the chitta and vrittis which are just a game created by the (lower) mind. Patanjali says that as long as the chitta–vrittis (transient mental states) are not in a state of nirodhah (control), drashta (the seer, the Self ) is not established in his svarupa (true self); rather, he misidentifi es with that particular vritti (temporary mental state) which happens to occupy the fi eld of consciousness for the moment. It is essential to still the endless fl uctuations of the mind in order to experientially realize the truth of life (self-real- ization). In doing so, the Yogi frees himself from the unreality/illusion [Sans. maya ] of the phenomenal world; realizes the timelessness of the direct experience , which is devoid of the effects of birth, death, memory, and desire; and thus transcends (or gets liberated from) the shackles of the world (Sans. and Pali samsara ). In this con- text, it is worth quoting Thoreau and Emerson, the scholars of the Transcendental Movement that spread the Indian mystical thoughts in the Western world. Thoreau advocated abandoning waste and illusion in order to discover life’s true essential needs. Emerson was strongly infl uenced by the Vedas and Vedanta (Upanishad ), and much of his writing has strong shades of nondualism (Advaita ): Within man is the Soul of the whole; …the act of seeing and the thing seen, the seer and the 2.7 Models of the Mind (Consciousness) in the Yogic Philosophies 49 spectacle, the subject and the object, are one… We see the world piece by piece, as the sun, the moon, the tree; but the whole, of which these are shining parts, is the soul (Emerson 1841 , In: The Over-Soul ).

2.7.3 The Lake Model of Consciousness (Mind): The Real Self Lies Deep Down in the Bottom

This analogy is a working model of the mind or the consciousness and has been beautifully described in Raja Yoga (Vivekananda 1956 ). The lake analogy not only explains structural make up of the mind but also elucidates the central meaning of the defi nitional sutra in the Yoga Sutras (Yogah chitta vritti nirodhah , section-I, verse-2). This defi nitional aphorism means that Yoga is control/stilling (nirodhah ) of all fl uctuations/transformations (vritti ) of the mind/consciousness (chitta ) at all levels. As Vivekananda describes:

…imagine a lake full of water in motion. If the water in the surface is agitated all the time, the bottom will not be seen. It is possible to catch a glimpse of the bottom only when the ripples have subsided and the water is calm without the waves. In this analogy, the whole lake is the mind/consciousness , water is the chitta /mind-stuff, the ripples on the surface are the vrittis or temporary mental states, which are derivatives of the chitta or mind-stuff and the bottom of the lake is the Soul/Real-Self. In an agitated state of water (chitta ), the bottom of the lake ( True- or Real-Self) can’t be clearly perceived because the surface is covered with ripples ( vrittis). Only when it is calm (like mind’s calmness with Yoga), one can see the bottom (i.e. Self-realization will be possible ).

Of note, in the broad rubric of the consciousness or mind ( chitta), the various mental states (vrittis ) are the contents or transformations of the mind. The lake model is a foundational working model of the mind in the Yogic philosophies which explains that the consciousness (mind) and experiences are multilayered, from superfi cial vrittis to deeper samskaras to the deepest entity, the true self. Looking closely one can see some similarities between this model and Freud’s topographical (layered) model of the mind (trans. Strachey, 1915).

2.7.4 Yoga Sutras Says That Our Perception of Reality Is Illusory Because of the Sensorial Mind

From the perspectives of Patanjali’s Yoga Sutras , our perception of things is main- tained by the needs of our sense organs and the sensorial (lower) mind. The senso- rial mind, because of its vast domain of engraved memories about past deeds (Sans. samskaras), is mistaken by us to represent all of Reality. These misrepresentations result in wrong notions (delusions in Buddhism) about one’s true nature or true self, i.e., taking the perceived self as the true self . The perceived self is essentially a multilayered perceived identity acquired by the individual over all years in life because of the misidentifi cations with the sensorial mind as well as from the deep 50 2 Yoga, Mind, and the Psychosomatics impressions of the samskaras . Patanjali further explains that the self (one who expe- riences, the soul, the consciousness at its fi nest level) is different from and lies behind the ordinary consciousness (mind). Our interpretation of the whole world, being based upon the use of the interpretive interface of the sensorial mind, is of illusory nature. This illusory interpretation happens because the sensorial mind pro- pels us to identify heavily with various objects (both material and psychological) which are results of the constant interplay between the outer world ([Sans. drisya ] the scene) and the sensorial mind (Sans. manasa). This profound illusory process (Sans. maya ) keeps the self (Sans. drashta , purusha ) in the dark or in the back- ground. This profound illusory process, as the name suggests, essentially makes the individual taking the thoughts, feelings, etc. (parts of the chitta–vrittis ), not just as thoughts but as facts. Thus, this illusory process keeps the individual blindfolded about its true Reality. Under its spell, the individual does not even question whether these so-called facts are true at all. Maya is the illusion of taking our mere thoughts or feelings as real, unshakable facts. One way to be free from the spell of maya is to practice Yoga and meditation in order to experience the Reality through the true knowledge, i.e., to see things as they really are (Pali tathata ) (rather than perceiving them in a distorted way based on one’s intense desire or sensorial needs). Yoga, by stilling of the mind and preventing its various fl uctuations (this is the original defi ni- tion of Yoga: Yogah chitta vritti niradha [Sans.]; Yoga-Sutras , section-I, verse-2; Satchidanada 1978 ), corrects these misidentifi cations in the individual. This rectifi - cation is essentially a complex peeling off process of the multilayered false identity acquired over the years. This peeling off is done through meditation (Sans. dhyan , Chinese chan , Japanese zen ) which results in acquisition of the true knowledge or insight (Sans. jnana , Pali nanna , vipassana, Japanese satori ) that destroys the igno- rance or illusion. This deep contemplative process, if it continues in the right man- ner for prolonged time , is said to reestablish the individual in his original true self (Sans. svarupa ) which, once achieved, makes the individual function at his funda- mental level of existence (the soul or the self or the purusha or Atman ) without the false identifi cations. This state of mind is non-affl icted and confl ictless (Sans. nirdvesa , nirdvanda ) and leads the way to freedom or liberation (Sans. moksha ; Pali nibbana ).

2.8 The Profound Psychosomatic Views Found in the Yogic Philosophies

Yoga is probably one of the most ancient and original mind–body medicine that has shed light on the intricate and complex dynamic interplay between the body and mind with clear outlines and methods about how one can achieve physical, mental, and spiritual well-being. In the all-encompassing and multidimensional aspects of Yoga, as evident in Patanjali’s Eight-limbed Yoga or Buddha’s Noble Eightfold Path, one sees the balanced harmony between the body and mind that fi nally leads to elevation of one’s consciousness to deeper meditative states ( samadhis, samapattis). 2.8 The Profound Psychosomatic Views Found in the Yogic Philosophies 51

According to the highest philosophies of Yoga, the body and mind are not separate entities but rather constitute a mind–body unit, the former being subtle and the latter being gross. These two are in a state of continuous fl ux, being gov- erned by the stimuli arising from one’s surrounding milieu, both internal and external. In maintenance of this mind–body unit, Yoga and meditation aim to restore optimal balance or equilibrium between the body and the mind. Deep meditative states like the samadhis ([Sans.] the perfect tranquility; Yogic ensta- sis) are actually these perfectly balanced states of the mind. The chronic psycho- somatic illnesses are stress-related disorders which are viewed in Yogic philosophies as faulty modes of adaptation caused by faulty processes in one’s body and mind. Because of the close interdependency between the body and mind, faulty process in one contributes to worsening the other leading to a vicious psychosomatic cycle of illness . In Yoga, particularly in tantra (Sans. tan = body, tra = tool), there are elaborate concepts of the (Sans. sukhma sharira ; Sivananda 1994 , p. 17) with its system of chakras /energy centers (Avalon 1974 , p. 222) which are different from the physical body and associated organs. Yogic philosophies go even further and propose that the physical body (Sanskrit sharira, the gross) and the external world (Sans. samsara ) are the material manifestations of the consciousness or the mind (the subtle). In these philosophies, the mind, like the fi ve physical sense organs, is considered as another sense organ: a crude part of the inner instrument (Sans. antahkarana ) which is consciousness with its various grades or fi neness ranging from lower to higher in terms of fi neness and purity. The various parts of one’s inner instrument are the lower or the sensorial mind (manasa ), the empirical ego ( ), the discriminative and intuitive faculty (buddhi ) (higher mind), and the fi nest level of consciousness (Atman, the self, or the Soul). In expression of the consciousness, the mind stuff (chitta ) is the expressive medium through which all aspects of consciousness (including the various parts of the inner instrument) man- ifest (Sivananda 1994 , p. 106, 133). In this scheme, the lower mind (manasa , also called the uncontrolled part of the mind; similar to the psychoanalytic concept of id ) lies in more proximity with the physical body and the associated fi ve sense organs, whereas the higher mind lies in more proximity with the experiential realm. Thus, one needs to refi ne the mind/consciousness in order to perceive the realities of the higher orders. Yoga asserts that the fi ne i.e. the consciousness/mind is always the cause and the gross i.e. the body and world are the effects. Psychoanalytic theo- ries have similar notions: a person’s external world is colored by the internal appa- ratus/the mind and also that subtleties of the inner world are of more importance and more meaningful than what really happened in the external world. A very pertinent and clinical example of this is the psychological effect of trauma on peo- ple: the same amount of trauma (say from a natural disaster) manifests in a quite wide range in people who got exposed to it. As one can see here, quite rightly, the rationale in Yoga is to start from one’s internal (consciousness/mind which is sub- tle and the cause), and through that, control is achieved over the whole— both internal and external (gross/effect) in the sequence of mind–body–world. This is a profound psychosomatic view indeed! 52 2 Yoga, Mind, and the Psychosomatics

2.8.1 Mind and Stress: Yoga as the Remedy

It may be a common belief that the stress response is an innate refl ex and thus can’t be changed. Actually the stress response is partly innate and partly learned in early childhood (Ron de Kloet et al. 2005 ). In the analogy of the brain and mind unit as a computer, the stress response comes already downloaded and installed on one’s early operating system , but this tendency is reinforced by one’s long experience of stress modulation by the various life situations, signifi cant others, as well as other key factors in the environment more so that in the early years of life these early experiences get wired into one’s nervous system. However, just because a habit is innate, and then reinforced, does not mean it is immune to change. From the behavioral sciences involving the conditioned learning, we know that almost any habit can be changed, or at least improved, through repeated action of a new habit. Yoga claims that experiences in the ordinary sense are just representations in the mind and brain. Representations, as the name suggests, are symbolic and dependent on the grade/quality of the mind and brain, change with change of the conditions (including the time) that invoked the representations, and thus are quite different from the reality. Needless to say that all representations can be tricked and are changeable: so no need to cling to the representations as real facts, as Buddha has advised us. As mentioned before, because of the elusive and projective properties of the sensorial mind, our perception of reality is rather a virtual reality . The origin of stress lies precisely here, in our very perceptions. Problem (stress) comes when we mistake the representations as facts (mistaking the map as territory) because of (a) our heavy (mis)identifi cations with these representations, (b) jumping to quick conclusions based on incomplete informa- tion and (c) because of our diffi culty to fl exibly update the representations in the light of new insights as they become available to us in an ongoing manner in our life. Following the above descriptions, one can see that management of the stress is actually management of self/one’s own mind through self -knowledge or insight (Pali vipassana). In that sense, Yogic philosophies are nothing but deep knowl- edge about the mind, its various modus operandi, strengths, as well as limitations and the various ways to strengthen or purify it. Yoga proposes that one effective way to perceive things as they are and thus ameliorate the incurring stress is to turn inward in order to examine things in depth rather than just being reactive and getting carried away by superfi cial understandings about things. The remedy for stress is essentially to make our actions be governed by knowledge of reality rather than by impulse. This knowledge/insight comes from the meditation which can be practiced by different methods including the methods so clearly described and prescribed by the Buddha (i.e., the Noble Eightfold Path) or Patanjali (i.e., the Eight -limbed Yoga ). 2.8 The Profound Psychosomatic Views Found in the Yogic Philosophies 53

2.8.2 Yogic Science as Mind–Body (Psychosomatic) Medicine: Some Mechanisms

Yoga works toward restoration of normalcy in all systems of the human body prob- ably through amelioration of the stress diathesis which infl uences the psycho-neuro- immuno-endocrine axis. Studies demonstrating the parasympathomimetic effects of Yoga (Streeter et al. 2007 , 2010 ) including the enhanced GABAergic activities in the central nervous system point to this direction. In addition, it has preventive role in the psychophysical health which is quite unique in the realm of healthcare. Below are just a few mechanisms that may explain how Yoga helps to attain the psychoso- matic goals:

(i) Reduction of projection by controlling the disturbing sensory input (ii) Conservation of energy, by economic use of muscular apparatus and lowered state of metabolism (iii) Reduction of the working load on the vital systems like lowered resting heart rate, resting respiratory rate, resting blood pressure, body temperature, etc. (iv) Improvement of the defense system by activation of the lymphatic system as well as by improving the effi ciency of the psycho-neuro-endocrine arms of the human system.

Despite the limitations of the conventional research methodology to capture an experiential discipline like Yoga, scientifi c research (Balasubramaniam et al. 2013 ; Streeter et al. 2007 , 2010 ) has demonstrated that interventions involving Yoga and meditation can effectively regulate and modify much the stress response in the human system.

2.8.3 Deep Connections Between Yoga and the Mental Health

The World Health Organization (WHO 1946 ) constitution states: Health is a state of complete physical , mental and social well-being and not merely the absence of or infi rmity . WHO defi nes mental health as a state of wellbeing in which individual realizes own abilities, can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her commu- nity (WHO 2009 ). In this very defi nition of mental health, emotional well-being, the capacity to live a full and creative life, and the fl exibility to deal with life’s inevita- ble challenges are key components. One major objective of Yoga is to acquire deep insights into one’s inner life which obviously includes one’s own abilities and cop- ing. Thus, one can see that the crucial role of Yoga in mental health is already inbuilt inside this very defi nition of mental health mentioned above. Traditionally, mental 54 2 Yoga, Mind, and the Psychosomatics health has been understood as absence of mental illnesses. However, in the whole spectrum with mental health (wellness) at one end and mental illnesses at the other end, there are lot of intermediary states. An important consequence of this defi nition is that mental health is described as more than the mere absence of mental disorders or disabilities. In this context, mental health is seen as a continuum, from healthier to healthy to ill, and in this continuum one can see that an individual’s mental health may have different possible aspects. In this concept, mental wellness is generally viewed as a positive attribute, such that a person can reach enhanced levels of men- tal health. This defi nition of mental health highlights emotional well-being, the capacity to live a full and creative life, and the fl exibility to deal with life’s inevita- ble challenges. From the perspective of positive psychology or holism , mental health ( mental wellness ) may include an individual’s ability to enjoy life and create a bal- ance between life activities and efforts to achieve psychological resilience. As one can see in the various parts of this book, Yoga is essentially the study of the mind through the instrumentality of one’s mind itself. Thus, Yoga being a science of the mind , it is imperative that Yoga and mental health are very closely interdependent. Integrating psychotherapy with the spiritual lives of clients carries value beyond the specifi c therapeutic benefi ts. Spirituality draws both clinician and patient into a dia- logue in which whole person meets whole person. Unlike any other topic, discus- sion of spiritual issues levels the hierarchy and power structure that usually exists between the therapist and the client which is a very important component of any strength-based psychotherapeutic intervention.

2.9 Concluding Remarks

Yogic philosophies inform us about the two fundamental things about the way the human mind operates: (a) that our inside is the seat of all human experiences, so there is need to study one’s inside which is possible by deep contemplative efforts including meditation, and (b) that the basic property of the ordinary mind is projec- tion/to run away from the seat of experience and to misidentify and cling to the objects in one’s awareness, thus getting carried away in a time travel mode rather than staying with the true experience of the moment. Yoga as a science and technol- ogy provides us the philosophy and technique about how to turn mind inward to realize our experiences as they are rather than as we want them to be. This is the basis of the stress-ameliorating effects of Yoga and meditation.

References

Aurobindo (1999) The synthesis of yoga. The complete works of Sri Aurobindo, vols 23 and 24. Sri Aurobindo Ashram Publication Department, Pondicherry Avalon A (1974) The serpent power: being the Sat-cakra-nirupana and Paduka-pancaka: two works on Laya-yoga. Courier Dover Publications, New York Balasubramaniam M, Telles S, Doraiswamy PM (2013) Yoga on our minds: a of yoga for neuropsychiatric disorders. Front Psychiatry 3(117):1–16 References 55

Beitman BD, Yue D (2004) Learning psychotherapy: a time-effi cient, research-based, outcome- measured psychotherapy training program, 4th edn. WW Norton, New York Bhattacharya V, Tucci G (eds) (1932) Madhyanta vibhaga sutrabhasyatika of Sthiramati. Being a subcommentary on Vasubandhu’s Bhasya on the Madhyantavibhagasutra of Maitreyanatha. Luzac Publishers, London Bodhi B (2000) The noble eightfold path: way to the end of suffering. Pariyatti Publications, Onalaska Buddhaghosha (originally written in Pali language, circa. 430 CE): Visuddhimagga (The path of purifi cation; English translations by Nyanamoli, 1976). Sambhala, Berkley Emerson RW (1841) The over-soul (the fi rst series of essays). In: Ziff EL (eds) (2003) Nature and selected essays. Penguin Classics, New York Ron de Kloet E, Joels M, Holsboer F (2005) Stress and the brain: from adaptation to disease. Nat Rev Neurosci 6:463–475 Santina PD (1997) The tree of enlightenment: an introduction to the major traditions of Buddhism. Buddha Dharma Education Association Inc., Chico Satchidananda S (1978) The yoga sutras of Patanjali: translations and commentary. Integral Yoga Publications, Yogaville Sivananda S (1994) Kundalini yoga, 10th edn. Divine Life Society Publication, Himalayas Streeter CC, Jensen JE, Perlmutter RM, Cabral HJ, H, Terhune DB et al (2007) Yoga asana sessions increase brain GABA levels: a pilot study. J Altern Complement Med 13:419–426 Streeter CC, Whitfi eld TH, Owen L, Rein T, Karri SK, Yakhkind A, Perlmutter R, Prescot A, Renshaw PF, Ciraulo DA, Jensen JE (2010) Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study. J Altern Complement Med 16(11):1145–1152 Vivekananda S (1956) Raja yoga. Ramakrishna Vivekananda Center, New York Welton D (1999) The essential Husserl: basic writings in transcendental phenomenology. Indiana University Press, Bloomington Wheeler MA, Stuss DT, Tulving E (1997) Toward a theory of episodic memory: the frontal lobes and autonoetic consciousness. Psychol Bull 121:331–354 World Health Organization (1946) Constitution of the World Health Organization–Basic Documents. New York: Forty-fi fth edition, Supplement (October 2006). http://www.who.int/ governance/eb/who_constitution_en.pdf World Health Organisation Australia (2009) Mental health strengthening our response, Fact sheet 220, viewed 1 February 2011; http://www.who.int/mediacentre/factsheets/fs220/en/ Brain, Mind, and Soul: Bridging the Gap 3

Every man can, if he so desires, become the sculptor of his own brain. — Santiago Ramon y Cajal (1923), neuroscientist and Nobel Prize (1906) winner

3.1 Introduction

The relationship between body (more specifi cally the brain) and mind is so intimate that it is called as a mind – body unit. The Self and It ’ s Brain (1977 ), a famous book by Popper, a philosopher, and Eccles, a neurophysiologist and Noble Prize winner, describes this beautifully. This chapter attempts to integrate neuroscience (specifi - cally, cognitive neuroscience and neuroimaging, neuropsychology), phenomenol- ogy, and the spiritual sciences and attempts to foster a multidisciplinary dialogue. Integrative dialogues of this kind are critical to the advancement of a holistic under- standing of the human system and its psychological, biological, social, and spiritual dimensions. A comprehensive understanding has the potential to transition from the dualistic Cartesian mind–body framework into a body – mind – beyond mind system. In the Vedantic ( Upanisadic) traditions, the beyond mind entity is referred to as the soul , the highest, purest form of the mind. Holistic and inclusive concepts like these impart insight into bridging the gap between ancient wisdom and modern science. Knowledge of this model is essential for understanding the spiritual sci- ences. Because of the direct relationship between experiential processes, neural phenomena, and the therapeutic power of understanding this relationship, it is essential that we study the role the brain plays in the manifestations of internal experiences— specifi cally the meditative experience. There is a need for practical concepts that connect the mind and brain. The concepts will cultivate a better understanding of how our thoughts, language, experiences, and nonverbal behav- iors can physically infl uence our brain and vice versa. Focusing on their clinical utility, these concepts aim to transcend the Cartesian mind –body dualism , which

© Springer International Publishing Switzerland 2015 57 B. Pradhan, Yoga and Mindfulness Based Cognitive Therapy: A Clinical Guide, DOI 10.1007/978-3-319-09105-1_3 58 3 Brain, Mind, and Soul: Bridging the Gap tends to isolate the experiential domains from their biological underpinnings. These following information should be viewed as an attempt at providing integra- tive insights into the individual’s mental processes in terms of the neural mecha- nisms that form our experiences, both normal and pathological.

3.1.1 Human Experience Is Tripartite: The One Who Sees (Seer/Self), the Scene (Object/World), and the Interpreting Interface (Mind)

As mentioned in Chap. 2 , Samkhya (Rig Vedic) philosophy and Yoga propose a tripar- tite model of experience. Its three elements are (1) the one who sees/seer/self/subject (the third factor or soul; Sanskrit drashta ), (2) the scene/object (Sanskrit drishya , i.e., the world , which is the external projection of the mind ), and (3) the instrument that sees the object/the “interface”/the mind (Sanskrit manasa ). It is important to note here that the word seeing is not meant in visual sense but in the sense of experiencing). The self sees everything, but it remains in the background, unnoticeable to the ordinary mind because of ignorance (Sanskrit avidya ) or lack of wisdom.

3.1.2 The Trilogy in the Human Existence: Body (Brain), Mind, and Soul

Analogous to a computer, the human operating system constructs the experience of objects and the world. There are at least two elements to this operating system: the body (specifi cally, the brain) and mind. Eastern and Western philosophers agree that there exists another element in addition to the body and mind, more popularly known as the soul . This third factor is the essence of one’s existence. The soul is the bridge between our physical self and the spiritual realm. Experientially, the soul has been regarded as the locus of the deepest levels of experience. The concept of the soul is found not only in ancient Indian scriptures. It is culturally and historically universal. For example, the ancient Chinese referred to two independent conscious- nesses, hun and po (Yu 1987 ; hun , cloud - soul , and po , white - soul ). Similarly, the ancient Egyptians believed that a human soul was made up of fi ve parts: the Ren , the Ba , the Ka , the Sheut , and the Ib (Allen 2000 ).

3.2 Brain: The Most Complex Organ of the Human Body

3.2.1 Facts About the Human Brain

The human brain is about the size of a cantaloupe, weighs about 3 lb, and has average length, width, and height of 17 cm (6.75 in.), 14 cm (5.5 in.), and 9 cm (3.5), respec- tively. The human brain has 100 billion nerve cells (called neurons ). When we add other supporting cells in the brain, this number becomes 1.1 trillion cells (1 tril- lion = 1012 ). Although the brain weighs only 2 % of the body’s weight, it consumes approximately 20 % of the body’s supply of oxygen and glucose. The largest section of the brain is the cerebrum, which constitutes 85 % of the brain’s weight. The outer 3.2 Brain: The Most Complex Organ of the Human Body 59 part of the cerebrum is the cortex. The cortex is the thinking apparatus. The inner part of the cerebrum is divided into subcortical structures, including the limbic lobe and basal ganglia, which largely govern feelings and unconscious processes. The human cerebrum is divided into two hemispheres: the left and the right. These hemispheres communicate with each other via the corpus callosum, which consists of some 250 million nerve fi bers. Nerve fi bers are the thin threadlike structures that transmit nerve signals from the nerves to receptors located in various parts of the body. Each hemi- sphere can be further divided into four lobes: the frontal (the front of the brain), parietal (the middle and top of the brain), temporal (the middle and bottom of the brain), and occipital (at the back) lobes. Some researchers (Kosslyn and Miller 2013 ) also propose a functional division of the human forebrain into the top brain and bot- tom brain. This division is demarcated largely by a groove that separates the frontal and parietal lobes from the temporal lobe below. This groove is referred to as the Sylvian fi ssure or lateral sulcus (detailed descriptions are provided later in this chap- ter). The section of the cerebrum that distinguishes humans from other primates is the frontal lobe, more specifi cally the prefrontal cortex (PFC). The PFC is the bulg- ing portion of the frontal lobe that sits behind the forehead and above the brow. The upper and outer part of the PFC (referred to as the dorsolateral PFC or DLPFC) oversees critical human faculties such as problem solving, organization, maintaining a fl exible attitude, and planning for the future. It is not surprising then that the PFC constitutes 30 % of the human’s cortical volume. The frontal lobe is the thinking center of the brain, whereas the limbic areas are the feeling centers of the brain. Hanging below the cerebrum is the brain stem , which is popularly referred to as the reptilian brain because of its involvement in various bodily refl exes. The brain stem consists of three structures: the midbrain , pons , and medulla . These three structures primarily regulate the body’s vital functions like breathing, heartbeat, and body temperature. From evolutionary perspective, the oldest part of the human brain is the brain stem and the limbic lobe ( limbus means a ring). The limbic lobe, the feeling part of the brain, lays buried deep inside the brain and surrounds the most vital centers contained in the brain stem, the breathing and heart centers. One par- ticular region within the temporal lobe is the insula . This is a portion of the cerebral cortex folded deep within the lateral sulcus that separates the temporal lobe from the parietal and frontal lobes. The insula is responsible for storing and registering the visceral emotional representations of our experiences. Functional neuroimaging studies have found that the insula is activated when the individual imagines experi- encing in response to images of painful events. The insula also plays a crucial role in interoceptive information processing. The insula links our internal experi- ence of bodily functions like heartbeat to evaluative information, thereby generating a subjective representation of one’s own body. This includes a sense of body owner- ship, as well as social emotions like empathy (Karnath et al. 2005 ). The insula and the prefrontal cortex (PFC) play a critical role in the meditative experience. The brain communicates our thoughts and feelings to other parts of the body through mediation of a system called the autonomic nervous system: this system has two parts, the sympathetic (excitatory) system and the parasympathetic (calming) sys- tem. Within the brain, nerve cells are in constant communication with each other via connections (both physically and chemically) called synapses . On average, each nerve cell has approximately 5,000 connections to other nerve cells. There are two types of synapses: (1) electrical synapses where nerve cells are in physical contact 60 3 Brain, Mind, and Soul: Bridging the Gap with each other, and (2) chemical synapses, where communication is not transmit- ted through physical contact, but by the release of chemicals, referred to as neurotransmitters , at nerve endings. A typical nerve cell fi res 5–50 times a second. When a nerve cells fi res, it sends information signals to other nerve cells communi- cating whether or not it should fi re too.

3.2.2 The Brain as an Important Locus of All Experiences Including the Spiritual Experiences

From an Eastern perspective, the connection between the mind and brain is well accepted. In fact, one of the foundational concepts among Eastern schools of thought is the integration of the mind and body. Tantra, tantric Buddhism (Vajrayana ), and propose elaborate energy systems throughout the human body. These vari- ous energy systems or fl ows are believed to support the underlying soul and human functions. These energy systems are called chakras in the Indo-Tibetan tantric sys- tem (as discussed in Chap. 1) and qu ’ and yin – yang in the Chinese qigong system (Liang et al. 1997 ). Within these systems, mind–body dynamics are represented more holistically; mind–body interactions cocreate an experience. Our brain has tremendous inductive reasoning power such as the ability to infer complete patterns when perceiving just a small fraction of the pattern. For example, we can recall a person from just a few words or a whole concept from a single phrase. Even an advanced computer cannot match the inductive reasoning power of the human brain. (Further discussion regarding the role the brain plays in our experiences is provided later in this chapter.)

3.2.3 More Recent Research on the Brain: Top Brain and Bottom Brain

Most of us are more familiar with concepts of the left versus right brain. The science indicates that these concepts are oversimplifi cations. The structures of the brain do not operate independently but as a single interactive system that function in concert. Built upon decades of cognitive neuroscientifi c research on both the brains of rhesus monkeys and those of human beings, Kosslyn and Miller (2013 ), in their recent book, Top Brain , Bottom Brain, propose four different cognitive modes on the basis of how the top and bottom portions of their brains function. This mode is supported by the anatomical division of the top and bottom parts of the brain, demarcated largely by the Sylvian fi ssure. The top brain comprises the entire parietal lobe and the upper, larger portion of the frontal lobe. The bottom brain refers to the smaller remainder of the frontal lobe and the entirety of the occipital and temporal lobes. Kosslyn and Miller describe that the top - brain system uses information on the sur- rounding environment in determining what actions to execute and goals to achieve. This determination operates in a fl exible and adaptable manner that varies with the particular needs of the circumstance. 3.3 Concept of the Mind in Yoga 61

The bottom - brain system, on the other hand, organizes signals brought to them from the sense organs and simultaneously compares these perceptions with all the information previously stored in one’s memory system. This set of comparative data is used to classify and interpret the object or event, allowing one to convey meaning to the world. While the top-brain system operates mostly on a here and now basis and in an executive or thinking-based mode, the bottom-brain system operates in a visceral, feeling, and meaning-based way. The major implication here is that the top- and bottom-brain systems always work together, albeit in varying extents that depend on the needs and personality of the individual. Kosslyn and Miller further elaborate that depending on the degree to which a person uses the top and bottom systems in various ways ( cognitive modes ), people can be categorized into four groups: movers, perceivers, stimulators, and adaptors. No one mode is better or worse than the others; rather, each mode contributes something useful. The key is how these cognitive modes interact—both among individuals and within groups of individuals that tend to favor one mode over another. If we can classify persons based on their brains , it must follow that the brain is an important locus for the experiences that shape the personalit y .

3.3 Concept of the Mind in Yoga

In Yoga, the mind is conceptualized as part of a broader entity, the consciousness . Yogic philosophies consider the mind volatile, needing an anchoring object to hold on to express itself in one’s awareness. As described in Chap. 2, just as we need a refl ective surface to experience sunlight, we require fi ve things (objects of mind ) in order to perceive the existence and functions of the mind from which our experi- ences arise. Those fi ve objects of the mind are our thoughts, feelings, sensations or perceptions, memory, and will or impulses. Memory plays a crucial role in constru- ing the experiences and symbolically codifying them in the brain. Increasingly, memories are understood as internal representations within our neural system. Memory is the mechanism in the brain and mind that—according to the philoso- phies of Abhidhamma and the Yoga Sutras —profoundly infl uences the other four objects of the mind (i.e., the thoughts, feelings, sensations/perceptions, and will/ impulse) to the perception of time in order to hold the experience across time in our minds and brains. Memory binds together the thoughts, feelings, and sensations/ perceptions. In addition, memory colors the contents of these three objects of the mind and plants the seeds of will/impulse, the fourth object of the mind , which pre- cipitates our actions.

3.3.1 Mind Is Graded: Lower to Higher

It is important to understand that consciousness in the yogic sense is different from that in the neurological sense. In the yogic sense, consciousness refers to the mind with its various grades or levels. These gradations are classifi ed as the lower level 62 3 Brain, Mind, and Soul: Bridging the Gap

(sensorial mind; Sanskrit manasa ), the higher (the intellect ; Sanskrit buddhi ,), and, fi nally, the fi nest grade (the soul or pure experiential realm; Sanskrit atma ). This understanding is essential to an understanding of the theories of the mind as described in yogic philosophies. Again we see that unlike the Cartesian perspective, Eastern traditions consider the human body in the context of a body – mind – beyond mind system. The beyond mind entity is the soul or the highest grade of the mind in its purest form. Aurobindo (1999 , 2001 ), twentieth century philosopher, meditator, and proponent of the Integral Yoga, called this as beyond – mind entity or the supra- mental state. According to yogic philosophies, one’s insight into or knowledge regarding the various levels of Reality depends upon the grade of the mind under which we experience them. The various conditions or grades of the mind and their accompanying levels of knowledge provide us various representations or various levels of expression of the Reality. As described in classical Indian texts like the Yoga Sutras and the Visuddhimagga , meditation is nothing but the incremental pro- cess of purifying one’s mind, the interactive interface, until it achieves the highest, purest form (the soul or pure awareness). In this grade of consciousness, the medita- tor can see in the most vibrant and clearest way. In the spirit of the body – mind – beyond mind conceptualization, all experience and existence lie within the spectrum of two poles. The somatic – cognitive pole , or the outer self , consists of the body and mind and includes our intellectual, concep- tual knowledge regarding ourselves and the world. The other end of the spectrum is the experiential pole, the inner self, manifests within the context of our intuitional, nonconceptual knowledge regarding ourselves and the world. Experiential nature exists in the realm of the beyond mind . Some traditions refer to the inner self as the true self and the outer self as the false self or the projected self . The outer self depends more on the outer world, relying on feedback from the others. In contrast, the inner self is self-directed and thus depends more on the inner world, relying on introspective feedback. Unlike the inner self, the outer self seeks to impress others in order to receive positive feedback. Consequentially, when functioning in the realm of the outer self, one’s happiness is at mercy of others, and thus one experi- ences more stress and constraints. In light of psychoanalytic thought, these two selves can be seen as the outer defensive structure and the inner core structure . Because the false self is a façade built on years of fearing retaliation and rejection by others, the individual is under more pressure. Maintenance of the false self requires a high cost, as it consumes all of the individual’s psychic energy. An example of this is the obsessive–compulsive person depleted of his/her psychic energy by maintaining psychological defenses against the experience of anxiety. This may explain why babies, despite their vul- nerability and helplessness, appear happy and, furthermore, increase the happiness of others. The baby has simply not lived long enough to build a false self . The true self, on the other hand, is freer because it is more natural, unconditioned, and inde- pendent of the world. When one operates as the true self , it costs less. There is no need to expend the energy needed to maintain a façade; the surplus of psychic energy is free to fuel higher deeds such as creativity, altruism, and spirituality. 3.4 Soul: The Third Entity of Existence and Experience 63

Ancient descriptions of aura surrounding a spiritual person’s head are thought to be the result of this free psychic energy. Within the spectrum of outer self to inner self, spirituality is any factor or intervention that decreases the distance between the outer self and the inner self and promotes harmony between the two. In other words, spirituality is a sort of homecoming. The individual feels settled and, therefore, does not need to fabricate the projected false self. When practicing deeply contemplative methods like meditation, one experiences a process that gradually merges the outer self (i.e., the body and the lower mind ) with the inner self ( beyond mind or the soul ) and, consequentially, the true experience. In order to understand spiritual experi- ences, we need a framework other than the one we ordinarily use to study non- spiritual experiences. In natural states like sleep or losing oneself in the vastness of nature, we can experience this merger in variable grades that depend upon the qual- ity of the experience. The relaxing effects of sleep or vacationing can explain the stress-reducing effects of these mergers.

3.4 Soul: The Third Entity of Existence and Experience

Yogic philosophies regard the mind as just another sense organ. It is an instrument or partial expression of another fi ner entity, the soul (Sanskrit Atman , purusha ). The soul lies within the experiential realm of one’s consciousness (self-awareness) rather than in the gross or physical realm. The concept of the soul is the foundation of Eastern philosophies. The following discussion provides an example of the pres- ence of another element in one’s existence, different from the body and mind. When one says this is my body , this is my mind, one must be referring to a third entity—the fi rst and second factors being the body and mind, respectively—that is neither the body nor the mind. This third entity is the owner of the body and mind, as suggested by the use of the word my in the phrases my body and my mind. Eastern philosophies assert that the experience of an object in the realm of the soul is the highest level of experience or the real or Absolute experience, while experiencing the same object at the level of the mind is just a relative or incomplete experience. Although the soul is part of the individual (Sanskrit jiva ), it can transcend and the whole universe and cosmos become an extension of the self. The soul becomes the universal self , which is limitless unlike the individual self. Belief in the soul is considered one of the universal elements of human culture (Wilson 1998 ). The term soul has been described in many different ways. In both Eastern and Western thoughts, the soul is similarly considered to be the immortal part of the human person that has infl uence over the body. Plato and Aristotle both considered the soul to be the essence of the human being. They never clarifi ed whether or not the soul could exist beyond the body, but we do know that Plato believed the soul included reason, emotions, and desires. St. Augustine, one of the early champions of Christian theology (354 CE–430 CE), described the soul as “a special substance, endowed with reason, adapted to rule the body” (Hill 1990 ). The present Catechism of the Catholic Church defi nes the soul as the innermost 64 3 Brain, Mind, and Soul: Bridging the Gap aspects of humans , that which is of greatest value in them … (1997 ). Some con- sider the soul to be related to those attributes that make human beings distinct from other animals. Despite any subtle differences, all of the above defi nitions suggest that the soul is not the brain or the mind. Still, they admit that there is a deep relationship between them. If the soul has reason, emotion, and desire and is the essence of who we are, then the brain must have some intimate connection to the soul.

3.4.1 Soul and the Pure Awareness (Pure Experience)

In both ancient and modern eras, Eastern philosophers (Buddhaghosha, 430 CE; Aurobindo 1999 , 2001 ) have described the soul as the purest form or the fi nest grade of the mind or consciousness. In yogic philosophies, the consciousness and mind are often used interchangeably. These philosophies conceptualize the mind in terms of consciousness which is different from consciousness in neurological sense. This consciousness (mind is part of it) exists in graded form: from lower to higher and from crude to fi ne, and its fi nest grade is the soul which lies in the realm of direct or pure experience rather than mere intellect. The lower mind (Sanskrit manasa) is considered another sensory apparatus (Sanskrit ), just like the other fi ve physical sense organs (touch, vision, smell, etc.). As long as one functions in the realm of the body and lower mind, one is functioning at an intellectual level that is inferior to deeper, experiential one. It is not surprising then that Yoga or meditation, as described in all the original traditions (the Vedas , the Upanishads , Shramana , and Tantra ), begins with postures and breathing patterns that involve the gross body. The individual can then transcend the body through meditation and ascend into the subtler realm of the mind. In the Patanjalian tradition, practicing the various stages of samadhi allows one to access the indescribable or the Absolute, the fi nest or subtlest level of experience. Similar concepts in Buddhist traditions are called the jhanas and sampattis . They are the various access states of the mind as one ascends from the lower mind to higher mind and then beyond the mind. As described earlier, the ancient Indian scriptural traditions (Upanishads and Visuddhimagga ) claim that pure awareness or pure experience is the highest form of consciousness . This highest form has been referred to as soul or God or the Absolute . The body, mind/internal world, and the external world are merely deriva- tives of this Ultimate One. The highest yogic philosophies claim that both the mind and the physical body are gross material and external manifestations (Sanskrit jada ) of that consciousness which is subtle and internal . The internal (i.e., the subtle consciousness or the soul) is the cause and the external (i.e., the gross body, mind, and world) is the effect . Consciousness is expanded energy (as described in Chap. 1 , in tantric traditions, this energy is called the cosmic energy or kundalini energy [Sanskrit kundal = coil, spiral]). These concepts present profound psychosomatic implications regarding the body and mind and the intricate dynamics among them. Yoga’s rationale for the deep introspection lies in the fact that by taking control of the internal (the soul ), one can also control the external. 3.5 Mapping Experiences onto the Brain: The Neural Circuitry 65

Transpersonal psychology, a subdivision of Western psychology, integrates mod- ern psychology with spiritual/meditative psychology. This school of psychology, as its name suggests, bridges (trans = across) the gap between conventional Western psychological schools and the contemplative philosophies of the East, both ancient (e.g., Buddhism) and modern (e.g., Sri Aurobindo’s Integral Yoga). Just as in modern psychology, in which the individual undergoes cognitive and emotional development that includes various stages, the prominent thinkers of the transpersonal movement (e.g., Ken Wilber, Jack Engler, D. T. Suzuki, and Mark Epstein) propose the devel- opmental progression of spiritual development. This development is a multistage model of spiritual development that begins with the physical (gross) realms, followed by the mental (subtle) realms, and ends with the fi nest stage, the soul. Integrative models like this are not only helpful when studying Eastern philosophies from the perspective of Western psychology, but they also assist in the integration of the valu- able insights of both schools. This integration allows for the understanding of a larger audience. For more descriptions, please refer to Wilber et al. (1986 ).

3.5 Mapping Experiences onto the Brain: The Neural Circuitry

The neural circuitry in our brain governs the crucial elements that constitute our expe- riences including the meditative experiences. Some of these crucial elements are atten- tion, memory, motivation, engagement, self-observation, and compassion. Experience shapes our behavior and experience is symbolically represented in our brain. Owing to cognitive neuroscience and functional neuroimaging research, we now know that neu- ral circuits can provide neurological explanations for our various behavioral patterns. Having evolved over thousands of years, the various neuronal circuits in the human brain can consider and evaluate multiple variables in a contextual manner before deciding on a course of action. These circuits include not only the ones which can detect the urge to act but also those that postpone the enactment or discharge of our urges and impulses in favor of satisfying higher demands, both from a personal and societal perspectives. These neural circuits have evolved to transcend the narrow focus of the reward system or immediacy of impulse gratifi cation and, instead, function to pursue satisfaction in a manner that is consistent with higher human values. A critical region in the brain for these higher circuits lies in the prefrontal cortex. This section of the brain facilitates the thinking faculties and allows one to tran- scend simple reward-driven behavior, typical of less evolved animals. Instead, it allows one to consider all information regarding a situation before the initiation of action. From top to bottom, the human’s prefrontal cortex consists of three critical areas, collectively referred to as the prefrontal pyramid . These regions are as fol- lows: (1) the dorsolateral (i.e., upper outer) prefrontal cortex (DLPFC), which lies on the sides of the front of the frontal lobe; (2) the anterior cingulate cortex (ACC), which lies in the middle of the frontal lobe, almost sandwiched between DLPFC and OFC; and (3) the orbitofrontal cortex (OFC), which lies at the bottom of the frontal lobe of the brain, just above the eyeballs. 66 3 Brain, Mind, and Soul: Bridging the Gap

3.5.1 Visual Pattern Recognition: The Prototype Process in Mapping Experiences onto the Brain

During information processing of the primate’s brain, one key process is pattern recognition, meaningful recognition of the different patterns of experiences across various domains of information. Pattern recognition forms a symbolic representation of an experience which maps it out on the brain. Although pattern recognition occurs in all sensory modalities, the visual pattern recognition in humans and other primates has been studied the most extensively (Haxby et al. 2001) and, thus, serves as a pro- totype. The process involves the following six steps in sequence: (1) transmission of the visual input to the occipital cortex; (2) routing the information to the lateral infe- rior occipital lobe, where a pre - pattern (an intelligent organization of the inputs) is developed; (3) the information is sent to the fusiform gyrus in the ventral temporal lobe, where it is categorized as one of two kinds—face or object; (4) from the fusi- form gyrus, the data continue to be transmitted anteriorly: at the temporal pole, the object’s identity is further clarifi ed and integrated with limbic information; (5) simul- taneously, data regarding the object are transmitted to the parietal cortex, where the object is placed within three-dimensional space; and (6) the processed information regarding the object is sent to both the entorhinal cortex, where its past signifi cance is determined, and the DLPFC, where its implications for the future are evaluated. The signifi cance of the human pattern recognition is that it processes all sources of information (i.e., visual, auditory, tactile, etc.) simultaneously . There are two types of interpretive processing: bottom -up (data driven or part-to-whole) and top - down (concept driven or whole-to-part). Information processing system in humans exhibits interaction between the data-driven and concept-driven processes. The arrival of sensory information triggers a series of automatic analyses, beginning with the sensory organs and subsequently through an extensive chain of processing stages. Simultaneously, the context in which the sensory events are embedded trig- gers expectations based upon past experience. Knowledge, in general, might be defi ned as expectations that produce concept-driven processing, top-down pro- cesses (the dorsal stream ), which eventually merge with the bottom-up processes (the ventral stream). For the proper operation of the human information processing system, both the top-down and bottom-up processes must take place simultane- ously, each assisting the other when one tries to make sense of the world. An example of this is the act of reading. Reading requires deciphering symbols (i.e., letters), consolidating them into units, and, fi nally, determining the word. Does one read by deciphering the letters and then constructing the words (bottom-up) or by interpreting the features of the entire word at once (top-down)? Reading is most likely a combination of both bottom-up and top-down processes, the balance of which is determined by what the situation demands. For example, when reading a diffi cult material, we probably use bottom-up processes. Evidence suggests that there exist multiple streams, some descending to the level of feature analysis, but reading requires quick feature analysis, giving way to a higher order of contextual recognition. This higher order follows that fi rst reading the material engages letter recognition and quickly follows with whole word and phrase recognition 3.5 Mapping Experiences onto the Brain: The Neural Circuitry 67

(Mather and Wendling 2012 ). Unfamiliar material is interpreted on the level of morphemes, the smallest grammatical units, while practiced readers tend to main- tain the holistic analysis. Reading studies have led to another remarkable discov- ery: a single printed letter is sometimes read better when it is part of a word than when it stands alone (Wheeler 1970 ). This author integrates these insights with techniques of mindfulness in his mindfulness - based trataka model (MB-t ©, Pradhan 2014 ) which he uses for the treatment of dyslexia. Trataka is a concentrative medi- tation (focused attention type) practice of which improves the visual memory (Niranjananada 1993 ).

3.5.2 The Five Major Groups of Circuits in Our Brain

Considering the complexity of human experience, any attempt to fully describe the experience in terms of neural circuitry would be an oversimplifi cation. Placing ancient wisdom of yogic and meditative philosophies within the framework of mod- ern science and evidence-based medicine could lead to a better understanding of both disciplines, more synergy, and enhancement of their therapeutic potential. With this in mind, the fi ve major neural circuits that play a critical role in the neural mapping of our experiences are as follows:

(i) Executive and evaluative circuits in the prefrontal cortex: The executive cir- cuits are centered in the dorsolateral prefrontal cortex (DLPFC) which is located above and works closely with the risk–reward evaluative circuits. These circuits enable one to function in an ongoing and adaptive manner as demanded by one’s environments, both internal and external. (ii) Risk – reward evaluation circuits : These circuits are located in the orbitofrontal cortex (OFC) and the anterior cingulate cortex (ACC) and include hubs within the amygdala (fear detector) and nucleus accumbens (reward center). These circuits work closely with the autonomic nervous system and the prefrontal executive system. This allows the thinking, feeling, and somatic functions as well as planning dimensions of the risk–reward situation to operate fl exibly and appropriately as per the needs of the situations. (iii) Visceral – self circuits (consisting of the insula, cingulated cortex, and brain stem): These circuits contain basic representations of internal states (called interoception) and the visceral self, including those representations that gener- ate discrete bodily states through autonomic and hormonal activation. (iv) Empathy and compassion circuits : These circuits include the ventromedial part of the prefrontal cortex (for mentalizing activities), the insula (for interoceptive awareness), as well as the mirror neuron system (experiential neurons) located in the lower frontal, lower parietal, and upper temporal areas of the brain. (v) Memory circuits: These circuits engage the hippocampus (explicit/conscious memory), the dorsolateral prefrontal cortex (working/problem-solving mem- ory), the basal ganglia (implicit/unconscious memory), and the amygdala and orbitofrontal cortex (secondary rewards and punishers). 68 3 Brain, Mind, and Soul: Bridging the Gap

3.5.3 Functions of the Prefrontal Cortical (PFC) Tri-Circuit

The three circuits in the PFC that modulate our complex behavior are located in three chief regions: the dorsolateral prefrontal cortex (DLPFC), the anterior cingu- late cortex (ACC), and the orbitofrontal cortex (OFC). These areas are somatotopi- cally mapped and characterized by numerous pathways or channels that run through each region (Mega and Cummings 2001 ). It is interesting to note that similar descriptions of energy channels (Sanskrit nadis ) of the human body are detailed in the ancient Indian Tantric texts (Avalon 1974 ; Sivananda 1994 ). The DLPFC is a neural workspace where information needed to evaluate situations, make decisions, solve problems, and plan for the future is gathered. DLPFC constitutes the thinking brain and tends to participate in cognitive circuits, whereas ventral prefrontal areas comprise the feeling brain, as they are signifi cantly linked to emotional circuitry. The circuit in the anterior cingulate cortex (ACC) is involved primarily in the motivation of goal-directed actions, processing of emotions and the emotion- associated movements, emotional–cognitive integration, and confl ict monitoring (Bush et al. 2000 ). Anytime we consciously exercise our will, we activate our ACC. It transmits emotional motivation to the autonomic, visceromotor, and endocrine sys- tems (Critchley et al. 2003 ). Because the ACC is central to deliberate and reasoned motivation, it is an important component of reward circuitry. The ACC is not only strategically sandwiched between but also connected by the DLPFC, associated with attention and executive functions, and the OFC, the area that elicits risk evaluation and impulse control. The ACC is closely connected with the DLPFC, which gathers information needed for problem solving, and also with the supplementary motor area of the frontal lobe, the region responsible for planning novel movements. These stra- tegic locations and connections assist the cingulate in receiving cognitive data from the DLPFC (Barbas et al. 2003 ); facilitate emotional– cognitive integration, generat- ing emotional states appropriate to cognitive contents (Critchley et al. 2003); and convey emotional information to the DLPFC for further cognitive processing. In response to cognitive information, the dorsal ACC triggers the arousal responses of autonomic centers (Critchley et al. 2003 ). The ACC is the primary overseer of our attention. It is also the chief neural region associated with the manifestation of targeted and purposeful fulfi llment of our actions. It manages our effortful control over various things. It is signifi cant that the ACC works closely with the amygdala, the center for fear learning, which is also associated with motivation. Together, the ACC and the amygdala form a joint sys- tem that elicit two forms of motivation: the ACC controls top-down, deliberate, centralized, and reasoned motivation (cool motivation), whereas the amygdala is responsible for bottom-up, reactive, distributed, passionate motivation (warm moti- vation ) (Hanson and Mendius 2009 ). The ACC and the amygdala modulate each other: in a three-step feedback loop, the amygdala excites the lower part of the ACC, which then excites the upper part of the ACC, which in turn inhibits the amygdala (Lewis and Todd 2007 ). The other inhibitor of the amygdalar activity is the ventro- medial prefrontal cortex (vmPFC). The vmPFC is the mentalizing region of the brain (further described in Chap. 6 ), and the nerve fi bers that arise from it directly 3.5 Mapping Experiences onto the Brain: The Neural Circuitry 69 inhibit the fi ring of the amygdala in situations of fear or anxiety. Given its functions, damage to the ACC may result in a lack of motivation and a general state of apathy, in which responses to internal and external stimuli are diminished. Severe damage to the ACC can result in akinetic mutism, a state characterized by little spontaneous movement or speech (Mega and Cummings 2001 ). Because of its role in reward and motivation, ACC–nucleus accumbens circuitry plays a signifi cant role in addiction. The ACC is not fully developed until 3–6 years of age (Posner and Rothbart 2000 ), which explains why young children demonstrate less self-control. Around 7 years of age, the child develops the level of cerebral, cognitive, and emotional maturation necessary for meaningful participation in attentional activities like those of meditation. The third player in the tri-circuit is the orbitofrontal cortex (OFC) which primar- ily functions to control one’s impulses and promote the pursuit of low-risk rewards that are consistent with one’s internal needs over high-risk ones. The OFC circuit modulates our pursuit of reward within the context of careful considerations of potential consequences. As a result of its connections with the ACC and the auto- nomic nervous system, the OFC induces anticipatory bodily states that encourage reward seeking, as well as aversive bodily states that reduce the likelihood of risky behavior (Mega and Cummings 2001 ). From an evolutionary perspective, the OFC modulates behaviors that have signifi cant bearings on the individual’s survival. The orbitofrontal cortex (OFC) includes distinct medial and lateral areas as well as dorsal and ventral areas (Elliott et al. 2000 ; Kringelbach 2005 ). The medial orbi- tofrontal cortex is active in monitoring associations between stimuli, responses, and outcomes under changing circumstances, whereas the lateral orbitofrontal cortex is active in inhibiting previously rewarded actions that are no longer likely to be rewarded owing to changed conditions. Exhibiting strong links to the thalamus (the sensory relay station), the ACC (the center for conscious motivation and attention), and the autonomic nervous system, which is responsible for fright–fi ght–fl ight response, the amygdala rates the emotional importance of any experience. When we reappraise a situation according to the negative and positive emotions associated with our previous memory of it, we activate corresponding punishment and reward circuits: the orbitofrontal circuits for punishment and the ACC and basal ganglia circuits for the reward.

3.5.4 Close Relationship Between the OFC and Amygdala

In the risk–reward evaluation circuits, the OFC and amygdala work together closely. The amygdala, the central alarm system, continuously monitors for oppor- tunities and threats to the individual. The orbitofrontal cortex (OFC) is reciprocally connected to the amygdala; they act in concert to generate emotional states rele- vant to the pursuit of reward and avoidance of risk (Barbas et al. 2003: experimen- tal work in nonhuman primates). Both the orbitofrontal cortex and the amygdala receive a signifi cant input from all fi ve sensory cortices, as well as from the insula, which again is associated with the visceral elements of our perceptions. The 70 3 Brain, Mind, and Soul: Bridging the Gap amygdala and OFC, by virtue of their connections to the hypothalamic autonomic centers and other particular subcortical targets, also generate emotional bodily states. Our brain integrates all of these information into comprehensive and contextual views of external and internal stimuli, making sense of our outer and inner worlds. The amygdala can exert both inhibitory and stimulatory infl uences on hypothalamic autonomic nuclei. The central nucleus of the amygdala normally inhibits the hypo- thalamic nuclei, whereas the basolateral nucleus stimulates it. The OFC can sup- press as well as activate the autonomic centers: the suppression happens through stimulation of the amygdala’s central nucleus, whereas activation happens through the intercalated cell masses of the amygdala. Stimulation of the autonomic centers occurs when the OFC stimulates the intercalated cell masses of the amygdala, thus diminishing the default inhibitory effect the central nucleus of the amygdala has on the hypothalamic nuclei (Barbas et al. 2003 ). Both the OFC and amygdala work closely with the ventromedial prefrontal cor- tex (vmPFC) which plays a critical role in the evaluation of risk and fear and the suppression of emotional responses to negative emotional stimuli (Hansel and von Kanel 2008 ). The vmPFC does so by suppressing amygdalar activity and regulating the parasympathetic system. Not surprisingly, patients with vmPFC lesions show diminished emotional responsiveness and also markedly reduced social emotions like compassion, shame, and guilt. The OFC, amygdala, and vmPFC work together to integrate sensory input into comprehensive views of both the external and inter- nal worlds. Imaging studies have shown that orbitofrontal and amygdalar circuits can be modulated through conscious cognitive processes (Ochsner et al. 2002 ). Defi cits in the orbitofrontal–amygdalar circuit can present as impulsivity, social inappropriateness, lack of empathy, lack of respect for social conventions, disregard for rules and consequences, and little response to the threat of personal risk, embar- rassment, or punishment (Mega and Cummings 2001 ).

3.5.5 Frontal Tri-Circuits Modulate the Thalamus (the Sensory Gate ) and the Basal Ganglia

The thalamus is a key midline structure of the brain that serves as a gate for all peripheral sensations, with the exception of smell, before these sensations are relayed to their fi nal destination, the sensory cortex. The thalamus also plays an important role in the modulation of sensation, sleepiness and wakefulness, and one’s overall sense of awareness. The basal ganglia, on the other hand, lie at the base of the brain that play an important role in procedural learning and implicit memory, postures and movements, motivation and reward, habitual behavior, and emotion. The basal ganglia consist of the striatum (the caudate nucleus and the putamen together), the globus pallidus, the subthalamic nucleus, the substantia nigra, and the nucleus accumbens (the reward center ). All three prefrontal circuits play a crucial role in the modulation of the thalamus via cortico-striato-thalamic projection fi bers and the basal ganglia structures. 3.5 Mapping Experiences onto the Brain: The Neural Circuitry 71

Below is the general organization of the frontal–thalamic (called cortico -striato - thalamic ) circuits:

Frontalcortex→→ Striatum Globus Pallidus / Substantia Nigra → Thalaamus

The thalamus, in turn, connects directly with the frontal cortex via the thalamocorti- cal circuits, completing the loop between the frontal cortex and the thalamus. The common functional element of all the three prefrontal circuits is the modulation of the thalamus by the globus pallidus, both its internal and external parts (Burruss et al. 2000 ; Mega and Cummings 2001 ). The thalamic circuitry is tonically inhibited by direct fi bers projecting from the internal portion of the globus pallidus (GPi ), a key structure of the basal ganglia. Other structures of the basal ganglia and the frontal cortex can reverse this default inhibition of the thalamus that is exerted by the globus pallidus. This select facilitation (reversal of inhibition) of the thalamus is transmitted through three different frontal– thalamic pathways (Feil et al. 2010 ): the direct (excit- atory), the indirect (inhibitory), and the hyper-direct (inhibitory) pathway. The direct pathway disinhibits/stimulates the thalamus via connections that run through the striatum and GPi . On the other hand, the indirect pathway inhibits the thalamus via connections that run through the striatum, the subthalamic nucleus, and the external segment of the globus pallidus (GPe ). The hyper-direct pathway is characterized by direct frontal input received by the subthalamic nucleus (bypassing the striatum), which sends excitatory output to the globus pallidus and the substantia nigra, result- ing in the inhibition of the thalamus. In this model, the excitatory projections release the neurotransmitter glutamate and the inhibitory projections release gamma-amino- butyric acid (GABA). This information processing model is an example of one of the brain’s facilitative pathways . In a similar manner, the self- excitatory loops that sus- tain representations of interest in the brain can be selectively activated or facilitated.

3.5.6 A Scenario Illustrating the Functions of the Prefrontal Tri-Circuits

Consider a real-life situation, in which someone mistakes a rope as a snake. In this circumstance, the cognitive uncertainties regarding whether it is really a rope or snake can cause autonomic arousal through the combined action of (1) the amyg- dala, which after receiving input regarding the danger from the thalamus rings the alarm that induces autonomic arousal, (2) the dorsolateral prefrontal cortex (DLPFC), which represents current cognitive contents including evaluative infor- mation concerning the dilemma (snake or rope ), and (3) the cingulate gyrus, which generates autonomic tone and body movements consistent with the emotional con- tents of the situation (Critchley et al. 2003 ). In evaluating a situation in order to determine the appropriate behavior, the brain uses the parallel information processing in which the cognitive and emotional centers pro- cess information simultaneously rather than sequentially. Because the transmission of 72 3 Brain, Mind, and Soul: Bridging the Gap

Brain cortex

Ventro-medial prefrontal cortex (Vm PFC) Slow and inhibits indirect amygdalar firing pathway

Fast and direct pathway

Thalamus Amygdala

Emotional stimulus Emotional response (Receptor arm/ (Effector arm/ Sensory data) Actions)

Human amygdala is capable of undergoing emotional learning to the various stimuli that are never experienced consciously, i.e. amygdala can totally bypass the cortical circuitry.

Fig. 3.1 Parallel information processing in the limbic and thalamo-cortical circuits in brain information from the thalamus to amygdala is quicker than transmission from the thala- mus to neocortex, emotional processing is often completed before cognitive evaluation (LeDoux 1996 ). The fast (thalamo-amygdalar) pathway activates an act fi rst, think later mode of functioning, on the basis of associative fear memories stored in the amygdala. The slow (thalamo-neocortical) pathway reacts to a stimulus only after the structural dimensions of this stimulus are analyzed. In addition, as demonstrated in Fig. 3.1 below, unconscious emotional learning may be the result of a direct pathway from the thalamus to the amygdala, which does not involve the neocortex (Morris et al. 1998 ). These mechanisms, because of their parallel presentations, may cause confl ict among the prefrontal circuits when determining behavior. This can lead to emotional 3.5 Mapping Experiences onto the Brain: The Neural Circuitry 73 states that elicit approach or withdrawal followed by cognitive assessments that dic- tate contradictory behavior. The process of restoring balance and mediating the apparent confl ict between circuitry and associated hyperarousal (caused by the thal- amus and the amygdalar circuits) requires cognitive–emotional reappraisal of the dilemma (e.g., rope or snake ) by the ACC and DLPFC. Only then can the individual determine the real situation. If reappraisal is successful, then knowledge-driven action can ensue (e.g., running away or attacking if the object is a snake or ignoring and moving on if it is a rope). While this imbalance appears greater in psychopatho- logical states like depression, anxiety disorders, and addictive and personality disor- ders, harmonious integration of cognitive and emotional input is often not possible in the average individual’s daily life. Interestingly, in the meditative brain, the act fi rst , think later functional mode is reversed, i.e., a meditative person is inclined to think fi rst , act later . This reversal is likely due to modulations of the prefrontal cor- tex, anterior cingulated cortex, orbitofrontal cortex, and thalamic activity, in addition to the dampening of limbic–amygdalar hyperarousal. The actions of a meditative individual are governed by cognitive–affective balance rather than just emotions.

3.5.7 Role of Salience and Facilitated Circuits in the Neural Mapping of Experience

In cognitive neuroscience, the term salience refers to the qualities or properties of an item that stand out relative to the neighboring items within one’s fi eld of aware- ness. Simply put, information’s salience is its pertinence or relative importance to that particular individual in that particular context within which the information was acquired. Salience plays a critical role in making our experiences unique, by means of selective attention and the activity of facilitative neural pathways involved in information processing. Salience affects how our experiences are encoded, orga- nized, and stored in our brain for future use. Salience also plays a crucial role in potentiating a memory and, thus, converting short-term memory into long-term memory (i.e., consolidation). Within the context of incentive salience and the facili- tated neural transmission of information, Berridge and Robinson (1998 ) propose an incentive salience hypothesis and elaborate on the role of dopamine, the pleasure chemical, in the reward and salience system. One signifi cant fi nding within the large body of salience research (Schultz et al. 1997 ; Schultz 1998 , 2002; Berridge and Robinson 1998 , 2003 ; McClure et al. 2003 ) demonstrates that dopamine receptor antagonism does not manipulate the appetitive value of rewards, but instead selec- tively inhibits the initiation of reward-seeking behaviors. Functional neuroimaging research points to the role of the insula and cingulate gyrus in the development of the (visceral ) representations of our experiences. The insula plays a crucial role in processing the information that integrates interocep- tion, the ability to perceive and respond to stimuli from one’s own body/organs (e.g., feeling one’s stomach rambling, timing one’s own heartbeat) with emotional salience. This integration generates a subjective representation of the body and bodily self-awareness like one’s sense of body ownership (Karnath et al. 2005 ). 74 3 Brain, Mind, and Soul: Bridging the Gap

In addition to the insula and the cingulate gyrus, the orbitofrontal and amygdala assist in determining the salience of objects within our awareness by rating their emotional signifi cance. The amygdala projects to the same sites in the orbitofrontal cortex that receive direct sensory input; this arrangement may allow the orbitofron- tal cortex to extract the emotional signifi cance of sensory events (Barbas et al. 2003 ). Both the amygdala and the orbitofrontal cortex ignore neutral sensory input, that which bears no implications of risk or reward, and function to cease response to any input lacking motivational value (Barbas et al. 2003 ). Thus, motivation plays a critical role in our experience of practice and learning like those of Yoga– meditation. When learning and practicing Yoga–meditation, the proper motivation can reinforce the experience via activity of the facilitative pathways. These pathways not only reinforce learning but also assist in maintaining representations of the experience within the brain, allowing one to own the experience.

3.5.8 The Main Players in the Meditative Brain

The cognitive and emotional processes associated with meditative practices are mediated by interactions among the neural circuitry that govern our various experi- ences. Harmonious integration of cognition and emotions often is not an easy task even in the healthiest and normal individuals, and the imbalance is even greater in psychopathological processes. With recent advances in the cognitive neurosciences, these neural circuits provide us with answers for so many questions which were unanswered before. Research has demonstrated that the key brain areas in experi- ences like the meditative experience are the prefrontal circuit triad, thalamus, amyg- dala, hippocampus, and the basal ganglia system. In the meditative process, close interactions between these key brain areas, i.e., the prefrontal pyramid, thalamus, and amygdala, need more elaboration.

The Prefrontal Pyramid and the Tri-Circuits The evolutionary signifi cance of the prefrontal tri-circuits lies in their crucial role in supporting the adaptive and non-impulsive behavior by making it possible for the individual to consider many variables before responding to a stimulus. The prefron- tal pyramid is functionally conceptualized as a top-down system of self - awareness and consists of, from top to bottom, the prefrontal cortex (PFC, mostly its dorsolat- eral, medial, and ventromedial areas), anterior cingulate cortex (ACC), and orbito- frontal cortex (OFC). Cognitive considerations are generated in the lateral prefrontal cortices. The dorsolateral prefrontal cortex (DLPFC), being on the top, potentiates execu- tive function and working memory (Wheeler et al. 1997 ; Johnson et al. 2002 ). DLPFC with the help from the right parietal cortex which provides data to defi ne the person in space and time by placing the body in the three physical dimensions (tem- poral–spatial orientation) is capable of integrating the full range of sensory, affec- tive, and memory data. In addition, DLPFC has the ability to project individuals both backward and forward in time and thus generates a coherent self with temporal 3.6 Experience is Representational and Knowledge (Insight) 75 continuity (Wheeler et al. 1997). Thus, the right parietal lobe provides the tempo- ral–spatial orientation, whereas the DLPFC allows for its presence in consciousness (by working memory, attention) and its manipulation based on the needs of the situ- ation (by problem-solving abilities). The ACC and medial PFC (mPFC) play crucial roles in the meditative process, especially in the aspects of fl exible monitoring of attention, cognitive reappraisal, and affect regulation. The ACC and mPFC make use of internal cues like emotions and incentives to regulate attention and action in changing circumstances that call for continual decision making and self-regulation. The ACC bridges emotion and attention: the ventral portions (affective region) reg- ister emotional salience of situations and regulate emotions, whereas the dorsal part (cognitive region) modulates attention and executive functions in cognitively demanding situations (Bush et al. 2000 ). The mPFC is the area of the brain that registers our gut feelings about various people, situations, or the various somatic states based on our past experiences in similar situations. It is active in ambiguous and confl ict-laden situations and not only keeps track of situations and actions that are potentially rewarding or punishing but also continually keeps updating this information on the moment-to-moment basis. Thus, in the prefrontal tri-circuits, the dorsolateral prefrontal cortex (DLPFC) plays important role in fl exible monitoring of one’s attention during the meditative process. In contrast, the medial prefrontal cortex complements the anterior cingulate in fl exibly responding to changing cir- cumstances that call for self-regulation (Frith and Frith 1999 ) and is consistently activated during self-refl ective endeavors (Johnson et al. 2002). Meditation entails such self-refl ection and introspection.

Amygdala Although a small structure in the brain, the amygdala plays important role in medi- tative experiences. The amygdala rates the emotional importance of any experience including the meditative experience, selectively directs the attention of the medita- tor to the meditation object based on its emotional salience to the meditator, and, in addition, serves as a gate to the hippocampal memory circuits for emotional experi- ences. The ventromedial prefrontal cortex (vmPFC) is a special area in the medial prefrontal cortex that also includes a portion of the anterior cingulate cortex and inhibits the fi ring of the central nucleus of the amygdala in response to emotional situations. The amygdala in conjunction with the orbitofrontal cortex plays a crucial role in motivating an individual for practice and learning, both of which are crucial in the experience of meditation as well.

3.6 Experience is Representational and Knowledge (Insight ) Changes These Representations

As previously mentioned, the mind, the creator of our experiences, is a bundle of fi ve components: thoughts, feelings, perceptions, memory, and will. From a neural perspective, a thought most likely results from the momentary pattern of stimulation that simultaneously involves much of the nervous system. Consciousness is 76 3 Brain, Mind, and Soul: Bridging the Gap described as the ongoing stream of awareness of one’s surroundings or sequential thoughts (Guyton 1987 , p. 232–233). The stimulated areas of the brain determine the general nature of the thought, as well as associate specifi c qualities to it like feelings of pleasure, pain, etc. From the pattern of stimulation involving various neural regions and specifi c localizations within the brain associated with the thoughts, discrete patterns of sensations or perceptions arise that assist in forming an experience. Sensations arise from the activity of receptors in and on the skin and other sense organs, in addition to various nerve fi bers that transmit these sensations to the appropriate neural regions. Perceptions , on the other hand, result from the operation of neural cells that lie beyond the fi rst synapse in the sensory cortex (Kolb and Whishaw 1990 ). Although sensations can be objective, the perception of expe- riences is highly subjective and personal, as it is founded on the basis of prior mem- ory of similar kinds of experiences. Sensation occurs on the bodily level and tends to be objective, whereas perceptions are essentially within the mind and are subjec- tive, representational elements of the experience. An experience has multiple dimensions. Experience is coded in the brain as rep- resentations. According to visual information processing research (Talbot 1991 , p. 163), less than 50 % of what we see actually stems from the information entering our eyes; the other 50 % is formed from our expectations and memories regarding how the world appears and operates. The meanings attributed to human experiences are largely representational and, thus, based largely on perceptions and memories and only partly on objective data provided by the sense organs. Both conscious and unconscious representations of an object will cause activation of corresponding cir- cuitry in the brain. In general, meaning is defi ned in terms of its functional signifi - cance to the individual. The meaning attributed to the physical and emotional sensations aroused when observing others (or objects) is an amalgam of actual observations and the internal transformation or representations (i.e., memories of these objects). As Wexler (2006 ), a psychiatrist and researcher from Yale University, puts it: “… we develop an internal neuropsychological representation of the world that forms the neuronal basis for all our habits, beliefs and overarching ideolo- gies…” The power to manipulate these representations lies in knowing how to access those representations and change them so that they are more comparable to Reality. Aurobindo, a twentieth century Indian philosopher and proponent of Integral Yoga, has described something similar to Wexler’s theory. Aurobindo (2001 , p. 1) states: “… it is not by ‘thinking out’ the entire Reality, but by a change of ‘consciousness’ that one can pass from the ignorance to the Knowledge—the Knowledge by which we become what we know.”

3.6.1 Knowledge, Direct Experience, and Reality: Three Synonyms in Yoga

Scriptural descriptions of yogic philosophies often use the following terms inter- changeably: true knowledge , direct experience , and Reality . The yogic philosophies claim pure knowledge or pure /direct experience provides the yogi (i.e., one who 3.6 Experience is Representational and Knowledge (Insight) 77 practices Yoga) access to the Reality of things based on the various levels of insights the yogi has obtained through meditation and from direct experience. Using a ladder analogy of insight, the yogi develops higher, more comprehensive views (insights) about the landscape (realities) when they climb atop the higher rungs of the ladder. Similarly, when one ascends the Empire State Building, their perspective of New York City becomes increasingly panoramic or holistic. The different levels of knowledge are equivalent to perceiving things from different levels of Reality. In yogic philoso- phies, pure knowledge , referred to as real knowledge or pure awareness , Truth , or wisdom , is obtained through insight that results from deeply contemplative practices like meditation. In meditative traditions, knowledge of the Reality (Sanskrit jnana ; Pali nana , panna) is referred to as insight and forms the essence of mindfulness/ insight meditation (vipassana in Buddhism or Samyama in Patanjali’s Yoga Sutras ).

3.6.2 Knowledge (Insight [Pali Nana, Panna ]) Is Graded

As described above, knowledge of Reality has various levels based on one’s insight into these realities. This very idea of graded insight into one ’s Reality is critical to a comprehensive understanding of spiritual experiences. According to yogic philoso- phies, every physical object that our sense organs perceive is really a conglomerate of several kinds of mental impressions present in our consciousness in a confused state. To a certain extent, these conglomerates of mental impressions can be sepa- rated into its fundamental elements or aggregates ( in Buddhism) through a process of mental analysis. Less knowledge regarding objects makes us more reac- tive, while with more knowledge we become less reactive and able to achieve better impulse control. Yoga and meditation emphasize directed actions based on more complete knowledge of Reality , and its practice, not surprisingly, results in more thoughtful and less impulsive actions. Yogic philosophies (as described in the major traditions including Patanjali’s Yoga Sutras , the Buddhist Visuddhimagga , Vivekananda’s Raja Yoga ) refer to three levels or grades of knowledge :

(i) Type 1 knowledge (Sanskrit ) based only on words and verbal descrip- tion. This is of the lowest level. (ii) Type 2 knowledge (Sanskrit jnana ) which is based on the ordinary or intellec- tual reasoning. (iii) Type 3 knowledge (Sanskrit ), which is the true , meaningful, or yogic knowledge. This is also referred to as intuitive or nonconceptual knowl- edge and considered as the highest grade of knowledge. In true knowledge , one transcends mere intellectualization (i.e., ordinary knowledge condi- tioned by the various grades of the ordinary mind) and obtains pure awareness — awareness that is unconditioned (i.e., independent of the oper- ations of the ordinary mind).

In Plato’s famous dialogue, The Republic , Socrates, one of the founding fathers of the Western philosophy, refers to similar concepts of knowledge and Reality. 78 3 Brain, Mind, and Soul: Bridging the Gap

Socrates claims that physical objects and physical events are mere shadows of their ideal or perfect forms and exist only to the extent that they instantiate the perfect versions of themselves. Just as shadows are temporary, inconsequential epiphenom- ena produced by physical objects are fl eeting too. Physical objects, according to Socrates, are merely impermanent imitations or instances of higher or more sub- stantial realities. According to yogic philosophies, the conventional Truth or knowl- edge (types 1 and 2 detailed above) and the ultimate Truth or knowledge (type 3) are not contradictory but rather complementary. They simply refer to two points of view: (a) the ordinary, affl icted point of view based on the intellectual mind (or conditioned mind) that is obscured by ignorance (Sanskrit avidya ) and (b) the point of view of enlightened ones or of the unconditioned mind. Within the ordinary mind, the varieties of knowledge are present in a confused/undifferentiated state. Our true knowledge of real objects is mixed-up or confused with all kinds of mental images aroused by the sensorial mind (Sanskrit manasa ). This mixed-up or confused knowledge (in contrast to the true or pure knowledge) creates confl ict (Sanskrit dvanda) and stress (Sanskrit kleshsa ) for the individual (Sanskrit jiva ). In order to realize the pure or real or internal knowledge of the object, one must tease it apart from the mixed external knowledge. It is not possible to separate the pure knowledge from the varieties of illusory mental images, using the ordinary process of mental analysis or reasoning. The yogic method for obtaining true knowledge regarding objects is called samyama . Being a combination of the last three limbs of Patanjali’s Eight - limbed Yoga (i.e., concentration, meditation, and yogic enstasis leading to liberation), samyama is a process as well as a technique and is critical for accessing the penetrative wisdom in meditation .

3.6.3 Meditation as a Direct Experience : Beyond the Realm of the Intellectual Mind

All meditative experiences in their true (higher) forms are direct experiences. This experience is called direct because the objects of experiences speak directly for themselves. This experience is not dependent upon the interpreting interface of the intellectual/ordinary/conditioned mind. There is consensus among all meditative traditions that direct experience is beyond the intellectual realm, and in order to access the direct experience, one needs to go beyond the ordinary or intellectual mind. As mentioned before, in any experience there are three things: (1) self or the subject or one who experiences, (2) the object or the scene (the world), and (3) the interface through which we experience, i.e., the mind. Direct experience results when the mind (as the interpretive interface) recedes and pure knowledge (pure awareness) surfaces. One good example of this is when we interact with a newborn baby, who has not yet developed the intellectual mind. We tend to become totally absorbed into the experience; this is one explanation for why we feel so good when interacting with a newborn. Similar examples are when we are lost amidst Mother Nature, like when atop a mountain or when carried by the natural undulations of the ocean. In these situations, we are totally lost in our experience and the mind is no longer present; everything is just pure experience. This level of experience is called 3.7 Meditative Process and Technique: Samyama as Its Prototype 79

direct experience in Yoga. In direct experience we become so absorbed into the experience to exclusion of all other things present that we actually merge with expe- rience. Because the ordinary mind is intellectual, Yoga claims that this direct experi- ence is impossible to achieve at the level of the ordinary mind. Being inherently experiential, direct experience occurs on a level beyond the intellectual. This means that in order to access the direct experience, one must journey beyond the intellec- tual mind. In many spiritual traditions, the locus of this direct experience is known as the soul . When practicing meditation in order to achieve direct experience, yogic philosophies emphasize upon one’s absorption into the experience so that time, preconceived notions, judgment, and all other things are completely excluded. Direct experience is characterized by timelessness: one’s sense of time vanishes and everything becomes pure experience. Within this Absolute experience, there is no place for any of the derivatives of the primary or pure experience, including the mind and body. In direct experience, one doesn’t do the experiencing, rather become the experience. This is the essential difference between the doing mode of the mind and the being mode of the mind (Barnard and Teasdale 1991). Learning becomes both faster and profoundly enhanced during a direct experience. In meditative tradi- tions, this profound form of learning through direct experience is known as intui- tive, nonconceptual, or experiential learning. Jon Kabat-Zinn (1990 ), a Buddhist meditator and founding director of the Center for Mindfulness at the Massachusetts Medical Center, refers to this learning as awarenessing . In order to achieve this highest level of knowledge or experience, the individual must transcend intellectu- alization—going beyond the intellectual or ordinary mind (Sanskrit manasa ). Experiential learning involves implicit memory systems, rather than explicit memory systems . Information that can be expressed in words and that may require conscious effort to remember is known as explicit memory, while information of skills and actions that is relatively automated and arises unconsciously and effortlessly is known as implicit memory. For example, recalling the date and time of a doctor’s appointment requires explicit , declarative memory. In contrast, performing daily habits like driving a car requires the implicit , non-declarative memory. Not surpris- ingly, the neural regions associated with implicit and explicit memory are distinct. In our early childhood, we learn a mass of complex information quickly and rela- tively effortlessly (e.g., taking our fi rst steps or riding a bike for the fi rst time). This is because a child tends to employ direct, experiential learning. The child’s mind (including intellect, verbal expression, etc.) has not fully developed, and so the child must rely more heavily on this instinctual mode. Operating under this instinctual mode, the experience is independent of the mind and is direct. As a result, the expe- rience is not heavily distorted and is experienced as is [Pali tathata ].

3.7 Meditative Process and Technique: Samyama as Its Prototype

Avoiding any taboos and mysteries regarding meditation, it is crucial to understand that meditation is a form of self-observation, an introspective self-analysis. This process is an open-ended exploratory process that promotes actively scanning one’s 80 3 Brain, Mind, and Soul: Bridging the Gap inner world. When observing oneself, an individual may focus attention (FA type) on the totality of one’s subjective Reality including representations of the self’s past, present, and future experiences (Wheeler et al. 1997 ). In open monitoring (OM type), observations are made mindfully —dispassionately and without criticism or evaluation (Deikman 1982 ). The refl ection of self-observation provides the indi- vidual with a sense of agency—an I that is observing, planning, deciding, executing, and evolving toward a future goal. Most meditations aim to activate the self’s self- observational capacities, with the primary intention of fi nding the real meaning of things; in other words, meditation is essentially altering faulty predictions and expectations (Pally 2005 ). Samyama is the central technique in the process of meditative absorption (Yoga - Sutras , Section-III, verse-4; Satchidananda 1978 , p. 166). This is the combination of the last three limbs of Patanjali’s Eight- limbed Yoga : (1) concentration (Sanskrit dha- rana), (2) meditation (Sanskrit dhyana ), and (3) liberation/yogic enstasis (Sanskrit samadhi). Samyama of the Yoga Sutras, considered the highest form of meditation, is conceptually similar to mindfulness meditation in Buddhism. Despite the ideologi- cal differences among the four schools of yogic philosophy (i.e., Veda, Vedanta , Shramana or Buddhism , and Tantra ), all agree upon samyama as the main technique in the practice of Yoga and the chief yogic method for changing the illusory represen- tations within mind. The Yoga Sutras mentions that samyama , imparting the indi- vidual (Sanskrit jiva ) with true knowledge , achieves the individual’s true/real nature (Sanskrit svarupa ). Furthermore, Patanjali claims that the individual is able to exist and function in a manner that is confl ictless ( nirdvanda according to Vedanta ) or unconditioned (as elaborated in Buddhist thought) and, which through the meditative process of yogic enstasis , leads ultimately to the liberated state (Sanskrit samadhi ; sam = robust/highly developed; = knowledge; Pali nibbana). Thus, samadhi is the highest mental state of the yogi: in samadhi everything is pure experience .

3.7.1 Knowing by Fusion: The Key Technique in Samyama

The Yoga Sutras claims that every physical object that we perceive through our sense organs is really a conglomerate of several kinds of mental impressions. These impressions can be detangled via meditation, as elaborated in the Yoga Sutras and Abhidhammic texts like Visuddhimagga. In order to realize the pure/real/internal knowledge regarding objects, one must isolate the means of knowing from the mixed external knowledge. In ordinary/unmindful states in which ordinary pro- cesses of mental analysis or reasoning predominate, it is not possible to separate the pure knowledge from the conglomerates of illusory mental images. According to the Yoga Sutras , as long as consciousness functions within the realm of the intellect alone, it will remain bound by the illusions. Samadhi (i.e., the state of perfect tran- quility , yogic enstasis , and the 8th and fi nal step of Patanjali’s Eight-limbed Yoga), when exercised in the realm of intellect, reveals only the lower aspects of an object’s Reality. Under the infl uence of the intellect, samadhis do not necessarily reveal the higher or the fundamental Truths of the object. Let us use a practical example: Say 3.7 Meditative Process and Technique: Samyama as Its Prototype 81 we intend to travel to a certain destination. To prepare ourselves for the journey, we acquire a road map that shows the route we must follow to reach our destination. First, we look at the map for directions, review what we have observed, and then we start the actual journey to our intended destination. The fi nal step in this process— making the actual journey—is like the actual experience (not just mere intellectual- izations) of the samadhis in the samyama for which concentration and meditation are the prerequisite preparatory steps. As mentioned before, samyama is a technique as well as a process. The Yoga Sutras describes the technique in samyama as knowing the object of meditation by fusing the mind with it (Yoga Sutra: Section-I, aphorism 42; Taimni 1961 , p. 100– 101). In this, the mind, the interpreting interface, fuses/merges with the object it is contemplating upon during the meditation. In this, yogi realizes the object by making the mind one with it (union). Upon culmination of this practice (Sanskrit sadhana ), the meditator (self/ the one who sees/ ) merges with the object (seen/scene) of meditation, the self dissolves, and the distinction between self and object, or the notion of object as nonself, disappears; everything becomes pure experience. Yoga refers to this level of experience as the highest level of experience; it is direct experi- ence or pure awareness (sometimes this pure awareness is referred to as the soul or God). Everything in this merger becomes pure knowledge or direct experience and the meditator achieves his/her real/fundamental nature (Sanskrit svarupa ).

3.7.2 Samyama Is a Two-Stage Process

Samyama is a two-stage process. In the fi rst stage, one intellectually observes, stud- ies, and examines the object of meditation. During the second stage, we meditate on what was examined and determined in the fi rst stage in order to achieve direct expe- rience. The knowledge we have gained becomes part of our living experience during this second stage. In this two-stage model, samyama should be fi rst applied to gross things as the objects of contemplation. With more practice, it can be applied to fi ner things. The two stages are detailed as follows:

(i) In the fi rst stage, the heterogeneous knowledge (mixed or confused knowledge) of the object must be separated into its different constituents. In this stage, all the constituents of knowledge, internal and external, are increasingly resolved into a state of clearly defi ned and differentiated constituents. (ii) In the second stage, the process of selective fusion takes place. The mind fuses with knowledge, which was obtained during the fi rst stage. In this process, all the other constituents of knowledge that are dependent upon memory ( sams- kara ) are automatically cleared (peeled off) from the awareness, and the mind operates according to the pure knowledge of the object and nothing else. In other words, in this stage, the object and the meditator/the one who sees (Sanskrit drashta ) become one. There is no mediation by the past memories ( samskaras ) to distort the experience of the object; instead, the experience is pure and undistorted and nothing needs modifi cation. 82 3 Brain, Mind, and Soul: Bridging the Gap

Of note, Csikszentmihalyi’s concept of fl o w is conceptually somewhat similar to the fusion in samyama . Csikszentmihalyi (1988 , p. 15–35) defi nes fl o w , a term used in positive psychology , as a mental state which involves single-minded immersion and completely focused motivation. This mental state (fl o w ) represents perhaps the ulti- mate experience in harnessing the emotions in the service of performing and learn- ing. In fl o w , the emotions or thoughts are not just contained or channeled, but positive, energized, and aligned to the task at hand. With respect to the aspects of merging with the object of meditation/the task at hand and feeling of rapture while performing in this task, the fl o w concept has some similarities to the merger in the samyama and rapture in the jhanas . It is important to note that one’s attention is critical to this whole process. Samyama is the combination of the deepest forms of meditation (i.e., concentration/dharana , meditation/dhyana , and yogic enstasis/samadhi ) in which attention allows one to ascend the rungs of the insight ladder . In both Patanjalian samyama and Buddhist jhanas and samapattis , attention reaches its highest level. It becomes so deep that it leads to the exclusion of self and culminates in the merger of self and nonself; everything becomes just pure experience or pure awareness. When the yogi (Sanskrit sadhaka , the practitioner) has mastered the technique, s amyama can be performed on anything whether it is physical or one’s mind and its contents. When the individual’s actions are governed by real knowledge, they act at the highest level, rather than just reacting to the contents of the mind (Sanskrit chitta – vrittis ). Furthermore, this action based on real knowledge liberates the per- son from the laws of karma . In this liberated state, the person no longer suffers (Sanskrit klesha ; Pali dukkha ) due to confl ict or desire. This emphasis on the need to act according to one’s wisdom rather than impulse suggests the therapeutic poten- tial of Yoga in controlling our maladaptive impulses. These clinical applications are described in Chaps. 7 and 8 of this book.

3.8 The Meditative Experiences: A Detailed Account

For over several thousand years, meditative experiences have spanned cultures and geography. Still, there is tremendous heterogeneity among the many traditions of meditation. Hence, a detailed account of the meditative experience beginning with the phenomenon, itself, is necessary for a complete understanding of the process.

3.8.1 Meditative Phenomenology and Parameters

Meditation is metacognitive (knowing about knowing , described by Koriat 2000 , p. 149), experiential, and supramental (Aurobindo 2001 ). As a phenomenon, medi- tation is essentially a cognitive–emotional process that includes learning to shift and focus the attention onto an object of choice at will (i.e., concentration ), while disen- gaging from conditioned reactivity or elaborative processing (i.e., mindfulness ). Many people, including scientists, have had mystical experiences. Interestingly, 3.8 The Meditative Experiences: A Detailed Account 83 mystical literature spans both thousands of years and widely disparate cultures yet still exhibit remarkable consistency. This consistency pertains not only to descrip- tions of particular mystical experiences but also to instructions on how to access mystical knowledge. Noting the similarities between spiritual experiences across different spiritual and meditative traditions, authors like Eliade (1969 ), Goleman ( 1988), and Newberg (2010 ) have tried to identify the elements that are common to all meditative experiences. These authors emphasize that for a full understanding of any spiritual experience, including the meditative experience, both phenomenologi- cal and physiological information are essential. Elaborating upon the phenomenology of meditative experience, d’Aquili (1986 ) emphasizes that the bottom line in understanding the phenomenology of subjective spiritual experience is to understand that every experience involves a sense of unity of Reality that is at least somewhat greater than the baseline perception of unity in day-to-day life. He goes on to further propose that the mechanism involved may be associated with altered functioning of particular brain structures believed to play a part in the construction of the self – other dichotomy. Below I provide an account summarizing the phenomena involved in meditation. Some of the basic elements in the meditative/spiritual experiences across various traditions are:

(i) A sense of being absorbed into the experience or becoming the experience (being mode) (ii) Feeling a sense of awe and an inability to describe the experience in mere words (iii) A sense of timelessness or losing one’s sense of time while having the experience (iv) Dissolution of self and going beyond self (v) A sense of going beyond the body (including out of body experiences) (vi) A sense of union and the feeling of oneness with the whole universe character- ized by the dissolution of the individual self

The above aids in the development of a higher sense of self and also provides a mechanism for decentering the self, which improves our relationship with both oth- ers and the universe, as a whole. As d’Aquili ( 1978 , 1986 ) points out, this sense of union helps in reducing one’s existential anxiety as well as in providing a sense of control over the environment.

3.8.2 Losing the Sense of Time and Becoming One with the Experience: The Hallmarks of Yogic Absorption

When the mind is divided between the objects of meditation and time, the experi- ence is too fragmented to be personalized or owned. In deep experiences like medi- tation, one loses the sense of time. Losing time means losing the temporal or spatial sense, allowing total immersion in the experience; this is called the direct or unfrag- mented experience. It is like a full movie as opposed to the individual frames or 84 3 Brain, Mind, and Soul: Bridging the Gap snapshots. This sense of timelessness in an experience emphasizes the need for one to rely on the internal clock—like the biological clock set to one’s lifestyle—rather than the arbitrary time as dictated by the external clock. Time according to the exter- nal clock is an artifact of the industrial culture used to enhance “productivity.” When one functions exclusively according to this external clock time, it makes that per- son’s mind work in a driven – doing mode or a deadline mode rather than the experi- ential or being mode . As a result, emphasis is more on productivity in the industrial sense or just getting the bulk of the work done, rather than on enjoying the work. Needless to say, this deadline mode is far from experiential and has become the root cause of the work-related stress associated with multitasking or working on numer- ous projects at one time. Elaborating upon the “culturally defi ned differences in the concept of time,” one of my mentors, Dr. Salman Akhtar (as quoted by Bonovitz 2006 ), compares the concepts of time of heart or time of love to the so-called indus- trial time. In a similar spirit, the ancient meditative traditions proposed that medita- tion could prolong one’s longevity/life span, as it untethers experience from the shackles of time. The very name of ’s classic book, Yoga : For Immortality and Freedom ( 1969), hints at the connection between the practice of Yoga and one’s longevity. Yoga has been used since ancient times for the individual to remain immortal: this is its concrete use as one sees in alchemy (for more descrip- tions, please see Eliade 1969, p. 414–419). Immortality has also been used in con- ceptual sense in order to make the experience escape the clutch of time or become immortal . In this pure experience, the person who experiences and the experience itself become one (elaborated below). According to the Yoga Sutras , when one is deeply concentrating, the idea of time will vanish. The greater the amount of time that passes unnoticed, the deeper is our concentration. When the past and the present become one, one-pointedness (Sanskrit ) of chitta is acquired. When the mind is divided between the object and time, the experience of the object is divided or conditioned to time. As a result, the experience cannot be personalized or owned in its true sense. Losing the sense of time means losing temporal Reality of events that causes a in one’s experience: in this being mode one gets totally immersed in the experience to point of exclusion of the clock time. This type of experience is very different from the other kinds when the clock time becomes the determinant of the experience. Patanjali and the Buddha have described this in the techniques of meditation (elaborated in this chap- ter and Chap. 4 of this book). According to them, meditation is more of a being and letting go than doing and clinging to process. As long as one operates within the constraints of time, being is out of reach. In the being mode of the mind (Barnard and Teasdale 1991 ), the task and the performer of the task become one and there is no other existence, not even time. The example of sword fi ghting in the Japanese samurai traditions may help demonstrate this. Samurais were the aristocratic war- riors (bushi ) in the medieval and early modern Japan who were famous for their excellent swordsmanship and austere lifestyle which is deeply infl uenced by the Zen tradition of Buddhism. One key technique used by the samurai in order to mas- ter the swordsmanship is the technique of the one - pointedness of the mind (similar to that described in this chapter under the Sect. 3.7 ). When using this technique, 3.8 The Meditative Experiences: A Detailed Account 85 which demonstrates the use of meditation in daily life, the samurai intensely medi- tates on the sword and its various movements. At the culmination of this practice, due to extreme meditative absorption, the samurai loses the sense of time and space: the practice reaches its pinnacle when the samurai and the sword become one . This process is similar to the Patanjalian concept of samyama and Buddhist concept of mindfulness (Pali sati patthana) where the state of pure awareness is achieved when the meditator or one who experiences and the object of meditation or experience become one.

3.8.3 Meditation from the Perspective of Cognitive Neuroscience: Central Role of One’s Attention

As mentioned in Chap. 1 , meditation is fundamentally a cognitive–emotional process that fi rst requires learning to shift and focus the attention at will onto any object of choice. These objects in the meditative process are otherwise called as the meditation objects (Pali kasina ). They can be bodily sensations, thoughts, feelings, will/volition, or our memories, which place the aforementioned four objects of the mind within an integrated experience. The second part of meditation is mindfulness which includes disengaging the mind from typical conditioned reactivity or elaborative processing of the above fi ve objects of the mind (please refer to Chap. 2 for more detailed descrip- tion). From the perspectives of neuropsychology and cognitive neuroscience, medita- tion can be conceptualized as a family of complex emotional and attentional regulatory practices that involve different attentional, cognitive monitoring, and awareness pro- cesses. The regulation of attention is chief commonality among the many different meditative methods (Davidson and Goleman 1977 ). Depending on how the atten- tional processes are directed and engaged, meditation practices can be classifi ed into two main categories (Cahn and Polich 2006 ; Lutz et al. 2008 ; Nyanaponika 1965 ):

1. Concentrative meditation or focused attention (FA) type (also called samatha in Buddhist traditions) 2. Mindfulness meditation or open monitoring (OM) type (satipatthana in Buddhist traditions)

In the FA style, attention is focused on an intended object in a sustained fashion. FA meditation entails monitoring the focus of attention, detecting distraction, disen- gaging attention from the source of distraction, and redirecting attention to the intended object (Lutz et al. 2008 ). In the FA style, one can use a symbol to further enhance the attentive focus. In contrast, the OM type involves nonreactive, detached, moment-to-moment monitoring of the content of experience. This monitoring pri- marily aims to determine the nature of emotional and cognitive patterns. In the OM style of meditation, one simply registers or recognizes and maintains a non-detached observation of the arising and passing away of the mental events, rather than elabo- rating upon details or clinging to the mental events. Compared to FA’s intense, selective, and focused attention on just one object of meditation, the OM type 86 3 Brain, Mind, and Soul: Bridging the Gap requires that one’s attention is evenly distributed among all the objects in one’s awareness at each moment. In Abhidhamma these objects in one’s awareness are classifi ed among the fi ve contents of the mind: thoughts, feelings, sensations/ perceptions, will/volition, and memory. In OM meditation, these mental events are simply registered and recognized, rather than elaborated upon. Because OM medi- tation requires even distribution of attention and open monitoring functions, it is not surprising that its practice stimulates neural regions that are associated with vigi- lance, monitoring, and disengagement of attention from sources of distraction in the ongoing stream of experience (Lutz et al. 2008 ). OM practices are based on a type of attention referred to as bare attention because it is pure and clear. It is also referred to as uniformly hovering attention, as OM meditation is characterized by an open presence and a nonjudgmental awareness of sensory, cognitive, and affective fi elds of experience in the present moment. Because the emphasis is on the present moment, the memory, which serves a past or future function, does not color the OM practitioner’s awareness. OM practices involve a higher order of awareness or observation of the ongoing mental processes (Cahn and Polich 2006 ). The cultivation of this refl exive aware- ness in OM meditation is associated with more vivid and conscious access to com- plex features of each experience and enhanced metacognitive and self-regulation skills (Lutz et al. 2008 ). The meditative experience of the FA type can be likened to fi lm stills or snapshots , while the OM type is like continuous fi lm clips . According to scientifi c studies on meditative experiences, OM meditation practitioners show increased distributed attentional focus (Valentine and Sweet 1999 ), enhanced con- fl ict monitoring (Tang et al. 2007 ), and reduced attentional blink or more effi cient resource allocation to serially presented targets (Slagter et al. 2007 ). Both focused attention and open monitoring attention are critical to the practice of concentrative and mindfulness meditation. Trataka , a prototype of the concentrative meditation, requires the focused attention (FA) and is a prerequisite for the mindfulness medita- tion or the open monitoring (OM) type. For more detailed accounts on trataka and vipassana , please see Chaps. 4 and 7 of this book.

3.8.4 The Meditative Brain : Preliminary Understandings

A growing body of scientifi c evidence suggests that spirituality or religiosity has biological or physiological roots (d’Aquili and Newberg 1999 ). As described before, one key feature of the spiritual experience is the dissolution of self and a new feeling of oneness with others and/or the universe. Merger of self and nonself lies at the heart of not only Eastern spiritual traditions but also Unio Mystica of Christian spiritual traditions. The cognitive–emotional aspects of this construct are largely responsible for higher human faculties like compassion and empathy. Nondistinction between the self and nonself ( me and not me) has been the cornerstone of spirituality since even before the Buddha (circa. sixth century BC), but has only recently been the topic of cognitive neuroscientifi c research. Researchers like d’Aquili (1986 ), Joseph (1996 ), and Newberg (2010 ) have described how this nondistinction between the self and nonself in spiritual persons may be related to the 3.9 Yogic and Cognitive Neurosciences: Remarkable Concurrences at Many Levels 87 altered functioning of certain neural structures. These structures are typically responsible for the construction of self – other dichotomies. These dichotomies are based on input from other sensory systems and serve an important function: they allow us to distinguish our inner and outer selves from the rest of the world. Some converging evidence indicates that the left posterior superior parietal lobe may be one of these structures. The left posterior superior parietal lobe plays a signifi cant role in differentiating graspable (concrete) objects from non-graspable (abstract) ones (Van Heertum and Tikofsky 1995 ). The meditative experience may lead to dif- ferential inhibition of input into the posterior superior parietal lobe that progres- sively diminishes the strength of the self–other dichotomy (d’Aquili and Newberg 1993 ; Newberg and Iversen 2003 ). Researchers have further hypothesized that the progressive blocking of inputs into the left posterior–superior parietal lobe creates a sense of increased unity over multiplicity. Blocking input into the right posterior superior parietal lobe, involved in orienting the individual in three-dimensional space, may result in the alterations in the sense of space and time similar to that reported in spiritual experiences. Religious rituals practiced in a group setting have synchronizing effects on the brain. In this context, Newberg (2010 ; p. 161) describes the role of rhythmic or repetitive behavior (as in praying rituals) in synchronizing the brain, mostly the limbic systems and the associated emotional/arousal responses of the group partici- pating in the rituals which in turn facilitates the necessary group action. He also provides evidence that simultaneous stimulation of the sympathetic and parasympa- thetic systems may cause the left and right hemispheres to function in , which in turn may be responsible for the synchronizing effect. He does warn that any specifi c functional relationship is far from clear. Simply stimulating the auto- nomic nervous system through recreational drugs does not typically result in cogni- tive or affective functioning. Mirror neurons , the special nerve cells that are excited both when we perform an action and when we see others performing the same action (Rizzolatti et al. 2001), may also play a role in shaping deep experiences like meditation. Mirror neurons are the experiential neurons of the human brain. For more descriptions on mirror neurons, please see Chap. 6 .

3.9 Yogic and Cognitive Neurosciences: Remarkable Concurrences at Many Levels

Neuroscientifi c data regarding the mind’s role in the phenomenology and the forma- tion of the human experience echo both the Buddha and Patanjali. Concurrences between spiritual wisdom and neuroscientifi c insights about workings of the mind (and brain) can be understood:

(a) With respect to the neuropsychology of Yoga–meditation: Yoga and meditation are attentional and psychosomatic sciences (this has already been described earlier in Chap. 2 ). (b) With respect to conceptualization of consciousness : In yogic philosophies, this term is used interchangeably with the mind with its various grades . 88 3 Brain, Mind, and Soul: Bridging the Gap

(c) With respect to descriptions of the meditative process ( samyama or mindfulness ). (d) With respect our perception of Reality and distinguishing it from actual Reality . (e) With respect to memory (Sanskrit smriti ; samskara ) and its role in construing the experience as the perceived Reality.

3.9.1 Concurrence with Respect to Conceptualization of Consciousness

The English translations of yogic concepts use the term consciousness frequently. Compared to consciousness in the ordinary sense, yogic consciousness (let’s call it Y - consciousness ) is more encompassing and is always centered in the transcendent Reality. Y - consciousness is used interchangeably with pure awareness , true knowl- edge, and Reality . Consciousness, in the strict neurological sense, refers simply to the waking state and requires only the fi ring of the reticular activating system in the brain. Y-consciousness is a complex phenomenon that is not created by the brain. Instead, the brain accesses a universal consciousness that underlies all Reality. In most Eastern spiritual traditions (elaborated by Aurobindo 2001 ), consciousness itself is described as a form of energy that permeates the whole universe. As men- tioned earlier in this chapter, Y-consciousness has been interchangeably used to mean the mind with its various grades or levels. Consciousness, in the yogic sense, is intuitive and experiential, rather than intellectual, cognitive, or sensorial. Y-consciousness concerns nonconceptual knowledge or intuitive knowledge, rather than intellectual or sensorial knowledge. It lies in the experiential realm of the soul or direct experience rather than simply the intellectual mind. It is a manifestation of the ultimate Reality. Expression of the Y-consciousness depends upon the particular grade of the mind through which it is functioning: the coarser the medium, the more limited is the expression. Y-consciousness is fundamentally immaterial but at the same time affected by matter. Its analog in modern neurology is what neurologist Antonio Damasio (1999 ) deems the extended consciousness . Consciousness, according to Damasio, is that aspect of awareness that makes you own your experi- ences and thoughts. Consciousness in this sense is analogous to wisdom in Buddhism or other yogic philosophies. It is the transformation of mere objects of intellectual knowledge into real, personal experiences or the transformation of mere book learn- ing into actual, living Truth. We speak of wisdom in terms of seeing the Truth or seeing things as they really are because the attainment of wisdom is not an intel- lectual or academic exercise: it is realizing or seeing these Truths directly . When this understanding of Reality is gained, one has attained enlightenment. This allows freedom from suffering or nibbana (Sanskrit nirvana or moksha ). Damasio claims that in addition to the primary states of wakefulness and atten- tion, there exist complex states called core consciousness and extended conscious- ness, upon which a person’s autobiographical self and social self are based. According to Damasio (1999 , p. 195–196): “…. the scope of extended conscious- ness, at its zenith, may span the entire life of an individual, from the cradle to the 3.9 Yogic and Cognitive Neurosciences: Remarkable Concurrences at Many Levels 89 future, and it can place the world beside it. On any given day, if only you let it fl y, extended consciousness can make you a character in an epic novel, and, if only you use it well, it can open wide the doors to creation.... Extended consciousness still hinges on the same core you, but that you is now connected to the lived past and anticipated future that are part of your autobiographical record. The self from which that large landscape is viewed is a robust concept in the true sense of the word. It is an autobiographical self.” Damasio’s extended consciousness is what Patanjali had described in his Yoga Sutra in the fourth century BC. From Patanjali’s perspective, all mental and physical actions arise from one’s consciousness (the yogic sense of consciousness or Damasio’s extended consciousness). We create the Reality we live in by means of our sensations, thoughts, emotions, and memory. In this way, con- sciousness creates the me or the I - consciousness . For Damasio, the study of con- sciousness falls within the realm of brain anatomy, neural functioning, the neurochemical basis of emotions, brain lesion studies, philosophy, and psychology. Based on the current advances in research on spirituality, one can hope that in the near future cognitive neuroscience will be able to advance toward an adequate the- ory of consciousness in a scientifi c format. Chitta (mind stuff), the structural con- stituents or the material medium of the mind, and vritis (to exist [Sanskrit]), the various perturbations/objects of the mind like thoughts, feelings, perceptions, mem- ory, and will, are conceptually similar to consciousness as the basis of the mind. In this sense pure consciousness is the soul. It represents awareness without a subject or object. In the highest state of liberation, there is no object or subject; everything is just one, i.e., the pure awareness or pure knowledge. The pure awareness is a timeless experience in which everything is just awareness or experience. It refers to the process of being aware without there necessarily being something that is aware. Such a concept can be found in many meditative approaches of various religious and philosophical traditions, both Eastern and Western. The principal difference that may distinguish pure awareness from pure consciousness is the notion that there is a sense of self that is associated with the latter experience such that the uni- verse has in many ways a self-refl exive consciousness. In theistic traditions, this self-refl exive awareness within the universe, or the one that pervades the universe, may be described as the God or soul.

3.9.2 Concurrence with Respect to the Process of Samyama (or Mindfulness ): Metacognitive and Neural Paradigms of Consciousness

Metacognition , also called knowing about knowing (Koriat 2000 , p. 149), is simply one’s thinking about one’s thoughts and thus focuses primarily on cognition in the self. Metacognition as a concept capitalizes on the refl exive nature of consciousness. Central to understanding metacognition in the narrow sense is the distinction between object-level and meta-level processing (Nelson 1996 ). Object-level processing focuses on the task at hand (e.g., carrying on a conversation), whereas meta- level processing entails focus on the cognitive processes involved in the task at hand (e.g., 90 3 Brain, Mind, and Soul: Bridging the Gap thinking about one’s inability to get a point across during a conversation). The object- level processing is concrete and more focused on the content and things at the moment, whereas meta-level of processing is abstract and more focused on the pro- cess as well as the continuum of the events. Following the paradigm involved in the knowing by fusing method of samayama, one can realize the metacognitive aspects involved in this. Samyama (its Buddhist equivalent is mindfulness [Pali sati pat- thana ]), the central technique in Yoga and meditation, has been universally accepted in all the four major systems of Yoga as the most effectively tool for attaining wisdom or true knowledge necessary for liberation of the individual (Sanskrit jiva ) from the shackles of birth and death cycle (Sanskrit samsara ) and consequent sufferings. Samyama consists of the last three steps of the Eight-limbed Yoga, i.e., concentra- tion, meditation, and yogic enstasis (samadhi ). In the two-stage process of samyama , otherwise called the knowing the object by fusing with it method of the Yoga Sutra, the meditator obtains the true knowledge or true experience about the objects of meditation by practicing this key technique. In Samyama , one attains true knowledge of objects by meditative absorption which culminates in the meditator and the object of meditation fi nally becoming one, i.e., everything fi nally becomes just pure experi- ence where the mind, as an intellectual interface, just disappears and only the expe- riential realm prevails. Basically, in samyama , by intense meditative absorption, the meditator (also called the one who sees or experiences [Sanskrit drashta]) and the object of meditation (also called the seen or the scene or the world [Sanskrit drishya]) reciprocally modify each other to the extent of getting fused and eventually becom- ing one object or one experience only in this process. This one - objectedness leads to the direct experience about the objects as they are (rather than as somebody who wants them to be, the distorted sense of objects based on one’s desires or confl icts about those objects). Yoga describes this direct experience as the true knowledge or Reality of these objects (otherwise called wisdom). The individual having such direct experience of the objects not only owns that experience but also acts without confl ict, in a liberated, free, unconditioned manner. Let us compare this Yoga Sutric concept of samyama with Damasio’s ideas about consciousness . According to Damasio (1999 ), consciousness is that aspect of aware- ness which makes you own your experiences and thoughts . He further explains that consciousness consists of constructing knowledge about two facts: (a) the organism is involved in relating to some object and (b) the object in relation is causing a change in the organism. The two major aspects concerning consciousness according to Damasio are (a) fi rst to learn how the brain, operating within an embodied organism that is interacting with its environment, gives rise to mental images (of objects, events, thoughts, feelings, actions) and (b) second how, in parallel with engendering mental patterns for an object, the brain also engenders a sense of self in the act of knowing. This sense of self is our sense that our experiences and ideas are ours (i.e., are “owned” by us). Damasio’s hypothesis is that your sense of self involves the feeling of what is happening to you—the feeling of how “your being is modifi ed by the acts of appre- hending something.” These neural concepts on consciousness as well as the two-stage process of owning the experience as described by Damasio sound strikingly similar to the concepts and the two-stage process (and techniques) involved in samyama . This is 3.9 Yogic and Cognitive Neurosciences: Remarkable Concurrences at Many Levels 91 similar to (or conceptually it may be a deeper level of understanding) Damasio’s sense of one owning the experience. In the practice of samyama , the meditator knows the meditation object at the highest level of knowledge by fusing with it.

3.9.3 Concurrence with Respect to Our Perception of Reality Versus Actual Reality : Map Versus Territory

Remarkable concurrence exists between the cognitive neuroscience model of Reality and the yogic model of Reality/insight theory in Yoga and meditation. The wisdom of various contemplative traditions informs us that one can have different levels of experience about the objects in one’s awareness based on the individual’s various levels of insight (knowledge). It is this insight that gives us the ability to perceive the various levels of Reality about these objects. From the highest philosophies of Yoga and meditation (as described in Chaps. 1 and 2 ), we know that actual Reality about things, i.e., the Reality which is not conditioned to the interpretative subjectivity of the mind and the Reality where the objects in one’s awareness speak for themselves, has different levels. Perception of these various levels/grades, from gross to more subtle, depends upon the levels/grades of knowledge into Reality of things ( insight ) we possess. Thus, each grade of the mind/consciousness is associated with different levels of insights; the fi ner the grade of the mind/consciousness, the sharper its recep- tion, the clearer its vision, and the higher the accompanying levels of insight. So one can see here that our perception of the Reality of things is dependent upon the level and quality of our knowledge about them. That is why in experiential sciences like Yoga, the three terms, knowledge , direct experience , and Reality , are used inter- changeably. As described before, our experiences are symbolic representations that have been encoded in our brains throughout our lifetimes, through the actions of the facilitated pathways for information processing. These facilitated pathways organize our perceptions of Reality and allow us to perform the activities of daily living. These pathways or patterns in our brains create expectations (desires ) followed by volition/ will and subsequent actions. Because of the symbolic or representational nature of experiences, expectations can be built from neutral circumstances depending upon the salience of that information, the context, and the inputs of the facilitated path- ways in co-creation of these experiences. Expectations are essentially the phenom- ena of the mind (as observed by the Buddha). There is an old saying: what mind can’ t think, eye can’ t see. We fi nd what we seek because we expect it to be there. These expectations/desires, the different patterns of feelings and behavior, etc., have been described as conditions of the mind according to Buddha or chitta– vrittis according to Patanjali. In light of the Upanisadic philosophies (views of both Buddha and Patanjali included), stress (called dukkha ) occurs when because of ignorance (Sanskrit avidya ; Pali avijja ), individuals (mis)take this virtual Reality as the Reality (like taking the map as the territory). In similar fashion, the symptoms involved in many core psychiatric disorders originate from patterns that organize perceptions and expectations in a maladaptive manner. In modern science, mostly research data in the fi elds of neuropsychology, cognitive neurosciences, neuro-linguistic 92 3 Brain, Mind, and Soul: Bridging the Gap programming (NLP, Wake et al. 2013 ), as well as functional neuroimaging concur with yogic concepts on this central point: our construction of the world or Reality is like a map, which represents the territory but is not the territory in itself, just a map. Much of what we see out there is actually co-constructed by our brain and mind through their extraordinary representational capacity. As we know and have described earlier, we experience our mind through the work of fi ve things in the mind which constitute the experience: the attending thoughts, feelings, sensations/perceptions, memory, and will/volition. This is not a new idea as we see description of these in scriptures (Upanishads ) of ancient India. Similarly in the West, David Hume (1711 CE–1776 CE), the eighteenth century philosopher who knew little of neuroscience, claimed that the mind is identical with its collections of impressions and ideas; the conviction of an external world separate from the mind is an illusion attending the relationship between different substrates of the mind.

3.9.4 Concurrence with Respect to Conceptualization of Memory (Sanskrit Smriti ; Samskara ) and Its Role in Construing Experience as the Perceived Reality

Memories are being increasingly understood as internal representations in our neural systems. As mentioned before, memory is the mechanism in the brain and mind that according to the philosophies of Abhidhamma or Yoga Sutra profoundly infl uences the other four objects of the mind (i.e., the thoughts, feelings, sensations/perceptions, and volition/will) to the perception of time in order to hold the experience across time in our minds and brains. As we know from our knowledge of cognitive neuro- sciences, memories and the experiences based on memories are representational and do not necessarily represent the actuality of things, i.e., they are maps rather than territories. The yogic (Sanskrit) terms for memory are samskara (engraved memo- ries) and smriti . The ordinary mind (Sanskrit manasa ), in the yogic sense, is just another sense organ like the other fi ve senses and all our sense organs can be tricked. According to yogic wisdom (which modern science has begun to validate), the mind plays an important role in the representational aspects of constructing an experience. Yoga informs us that perception of Reality by an ordinary, inattentive mind is rather a virtual Reality. Our memories of past experiences, e.g., the pleasures and , are stored in the brain through the work of the facilitated pathways and create the percep- tion of Reality which is rather a virtual Reality for which the yogic (Sanskrit) term is maya (illusion). About experiencing the Reality (the territory as opposed to the map), yogic philosophies give primacy to the soul or the experiential realm (this has been used in a sense similar to the fi ner/higher mind) rather than to the ordinary/sensorial/ intellectual mind. In all meditative traditions known to this author, one of the central skills is to learn how to experience things beyond the purview of the mind and more in the realm of the soul. This means that true knowledge only arises as the practitio- ner learns to transcend the mind because the mind is like a tinted glass which colors the experience and gives us the map (the symbolic representations) rather than the territory (real things). The place where we can change our perceptions about the 3.9 Yogic and Cognitive Neurosciences: Remarkable Concurrences at Many Levels 93

perceived Reality (the map) is in the internal representations that we make. By alter- ing these internal representations, we are literally reaching into our brains to change the operating system, just as in a computer. This altering process is essentially reframing the life experiences with the lights of new insights into our experiences, as if we are installing a new program or a new operating system into our perceptual apparatus. Training and practice in meditation, particularly insight meditation, involves attaining true knowledge or insight about Reality , and this process involves the tuning of brain circuitry to permit the accurate neural modeling of the observa- tions made during the process of training and the subsequent extraction of the mean- ing of the objects of meditation. When we alter these internal representations, for example, through contemplative methods directed at the mind/self, including therapy or self-analysis or having a mentoring/corrective emotional experience, we actually perceive things differently. In the highest meditative traditions, this is called seeing things as they are (rather than seeing things as we want them to be). The power to change these representations lies in knowing how to get into those representations to change them so that they are more accurate refl ections of Reality. As mentioned before, this knowledge about Reality is called insight in meditative traditions and forms the essence of mindfulness / insight meditation ( vipassana) in Buddhism. From neural sciences we know that memory of our assumptions plays a crucial role in how our assumptions might be invoked or utilized by our brain. In addition to the cognitive and memory aspects of our assumptions, another important factor in the construction of our sense of Reality is played by our emotions and the social environment. Both these elements bind our perceptions to our conscious beliefs, making whatever we are thinking about seem more real at that moment. Our emo- tional responses can modify our assumptions and thereby alter the representations in the brain. Extreme emotions, particularly anger, fear, or passion, can radically change our perception of Reality. This is very clear in a relatively common psychi- atric condition called the borderline personality disorder . People suffering from severe cases of this condition harbor extreme emotions that can result in grossly distorted perceptions of Reality in stressful conditions. These can extend to the level of transient delusions or hallucinations, prominent clinical indicators of this condi- tion. Findings from trauma research (e.g., memory dysfunctions in head trauma as well as in psychological trauma including in the post-traumatic stress disorder, dis- sociative amnesias, and borderline personality disorder) and also from the various neuropsychological models of human experience inform us that we remember who we are because we have memories (factual and nonfactual/interpretive) brought to us through our fi ve senses and stored as internal representations (memories) in the neural systems. Memories, in reciprocal way, provide the contextual matrix to our thoughts, feelings, and sensations/perceptions and help shape them. Factual memo- ries and interpretive memories are stored in different parts of the brain (Conway et al. 2003 ). The neural pathways between these areas are interfered with, as in the various physical or psychological (dissociative) traumata which interfere with the quality and accuracy of memories. Neuroimaging data suggests that the right pre- frontal cortex plays a crucial role in integrating our current perceptions and ideas with our memories through mediation of the limbic system, most importantly the 94 3 Brain, Mind, and Soul: Bridging the Gap hippocampus (Kroes and Fernandez 2012 ). Abnormalities within this integrative process can cause strange and unusual beliefs (Frith and Dolan 2000 ) including paranoia and dissociation of memory mechanisms from accompanying thoughts, feelings, perceptions, will/volitions, and actions/movements. In dissociative/ conversion disorders which are psychiatric conditions induced by trauma, we see these whole range of manifestations. Functional catatonia is another psychiatric condition (conceptualized as a disorder of will/volition) where individuals present as inability to talk or move despite possessing the full physical abilities to do so. Summarizing the accumulated research pertaining to the accuracy of our memories and beliefs, Newberg (2010 ) describes that (a) all memories, beliefs, and assumptions are subject to change and possibly distortion over time; (b) beliefs and assumptions are highly dependent on language, emotion, and social interaction; (c) the older the memory, the more diffi cult it is to ascertain its accuracy; and (d) neurological disor- ders and some medications (benzodiazepines, a class of antianxiety medications) can disrupt the brain’s ability to distinguish between true and false memories and beliefs. In this context, it is worth mentioning about reconsolidation, a relatively new concept in memory research which seems quite promising with respect to its therapeutic potentials in modulating the memories involved in psychological trauma and addic- tive disorder. Memory reconsolidation is a hypothetical process of altered state in which a previously consolidated memory item is rendered transiently malleable shortly after its reactivation/retrieval (Dudai 2006 ; Tronson and Taylor 2007 ). Of note, memory reactivation/retrieval is the process in which items in long-term memory, which are assumed to persist over time mostly in a dormant, inactive state, become active. Reconsolidation is said to be a distinct process that serves to maintain, strengthen, and modify memories that are already stored in the long-term memory. Whereas traditional teachings have hold that long-term memories once formed are stable (can’t change) across time, more recent studies on reconsolidation of memory inform us differently. These reveal that in the process of formation of long-term mem- ory, consolidation takes place over time in an ongoing manner and that each time we access our long-term memory in the stores, the memory is rendered labile and thus subject to change (LeDoux 2003 ; Alberini 2005 ; Dudai 2006; Lee 2009 ). Although quite complex, this is the basis of proposed therapeutics of reconsolidation interven- tions as the proposed means to modulate the pathological memory mechanisms in post-traumatic stress disorder (PTSD) or addictive disorders. Reconsolidation is char- acterized by increased sensitivity to amnestic (memory erasing) agents, e.g., the pro- tein synthesis inhibitors, electroconvulsive shock, or distracting sensory stimuli, that cause amnesia if applied before consolidation is completed. Post - reconsolidation amnesia is the blockade of memory performance that is observed when amnestic agents are applied during the hypothetical reconsolidation period. Ketamine, a psy- chotropic agent that modulates memory functions through its action on the glutamate system in the brain, is such an amnestic agent. This author and colleagues, in an ongo- ing research protocol involving treatment of refractory PTSD patients, are comparing effi cacy of ketamine and Yoga and mindfulness - based cognitive therapy (Y-MBCT) in ameliorating the trauma memories and the accompanying dysfunctions in this diffi - cult to treat condition (Pradhan et al. 2013 – 2014 ). 3.10 Neural Models of Yoga and Meditation 95

3.10 Neural Models of Yoga and Meditation: Revisiting the Bottom - up or Top- Down Debate

In the information processing systems in the human brain, the top - down system works from the cerebral cortex to effector organs down the stream, whereas bottom - up system works in the reverse direction. The top - down system can be understood as a from - whole - to - part or concept -/ plan - driven system and the bottom - up system as from - part - to - whole or sensory data driven. For example, in a panic situation, all of us experience unpleasant thoughts (something bad will happen , I ’ ll have a heart attack, etc.) and feelings which cause pounding heartbeat, sweating, etc., which in turn cause more panic responses. In this situation, the unpleasant thoughts and feel- ings can be called top-down symptoms, whereas the pounding heartbeat, sweating, etc., are bottom-up symptoms. In the information processing model of evaluating a situation and making decisions, the top-down system infl uences bottom-up and vice versa. Of note, a relatively greater level of abstraction is required to represent infor- mation which is independent from perceptual (external) input. The top-down con- trol infl uences how various lower-level stimulus-driven processes operate and so involves operations on information that is relatively more abstract , whereas the bottom-up system involves more concrete information. The top-down control func- tions also ensure that information fl ow proceeds along the lines of the current goal and does so by inhibiting irrelevant information processes (in this case the external perceptual stimuli like noise, smell and other distractions etc.). As neuroscientists like Damasio (1999 ) have suggested, many thoughts and feelings are interpretations of bodily and physiological processes as a more bottom - up phenomenon rather than top - down . Although there is debate, from a neural paradigm, meditation (which essentially involves self- observation and self-awareness) has been considered as a top - down process , whereas rituals as bottom - up process (Newberg 2010 ). He sug- gests that although there are fundamental differences between meditation and reli- gious rituals, there may be signifi cant similarities from a neuropsychological perspective between meditation and religious rituals in the sense that in both one basic outcome is the resolution of opposites, the reconciliation of mutually contra- dictory ideas/representations. Talking further about this, Newberg (2010 ) proposes ritual as a bottom - up process, whereas meditation is a top - down process although he agrees that such a clear distinction may be too simplistic and may not account for many of the complexities of both meditation and ritual practices. This writer exam- ines this closely from scriptural, clinical, and neurobiological standpoints and tends to propose that meditation is a bottom-up model (rather than top-down). When one closely examines scriptural models of Yoga and meditation, e.g., Patanjali’s eight- limbed scheme of Yoga (ashtanga ) and the Noble Eightfold Path of the Buddha, one can see rather a bottom - up model of meditation (more clearly so in the eight-limbed scheme). As we see in the eight-limbed scheme, the eight steps sequentially proceed from one’s body to breath to the mind and involves the following in sequence: (a) fi rst, control of the physiological processes including breathing, heart rate through lifestyle, postures, and breath control (the fi rst four limbs [Sanskrit yama , niyama , asana , and pranayama ]), followed by (b) attainment of a preparatory stage for 96 3 Brain, Mind, and Soul: Bridging the Gap meditation (indrawing of senses, the fi fth limb [Sanskrit pratyahara ]) where one gradually transitions from realm of the body to the realm of the mind, and fi nally (c) the last three steps ([Sanskrit dhyana , dharana , and samadhi ]) which are the medi- tative states collectively called samyama (similar to Buddhist’s Right Mindfulness [Pali satipatthana ]) which lie entirely in the realm of the mind. Through these last three steps, the practitioner proceeds from the lower mind (sensorial realm) to higher (intellectual realm) and fi nally to the soul (the experiential realm), the high- est/fi nest grade of the mind. Of note, compared to the concrete body (like bottom - up phenomena described above), the soul is abstract (like top - down phenomena described above). Regardless of this debate, close similarities do exist between meditation and rituals; in fact many meditative traditions employ varied combina- tions of both elements (meditative and ritualistic) for practice of meditation. From a neuropsychological standpoint, similarity between meditation and ritual may rest in the common activation of the holistic process associated with unitary experience which reconciles the opposites in attempts to resolve the contradictions in one’s mind. During intense meditative experiences (like in the meditative absorption/ samyama in the Eastern traditions or the phenomenon of Unio Mystica of the Christian traditions), the experience of the union of opposites is expanded/ generalized to the experience of the total union of self (meditator or one who sees) and other (the object of meditation or the thing that is being seen). In culmination of the meditative absorption, the self and other become one (united). In this process, the self–other dichotomy vanishes: the experiencer and the thing experienced become one and the interface, the mind through which we experience, disappears; everything becomes pure experience, pure knowledge, or real knowledge.

3.10.1 The Bottom- Up Model of Yoga and Meditation (Pradhan 1998 onwards): Neurobiologically Informed, Standardized, and Compatible with Other Contemporary Models of Therapies

Based on the reasons mentioned above, this author argues in favor of the bottom - up model of Yoga and meditation. This bottom - up model is a foundational part of the Yoga and mindfulness - based cognitive therapy (Y-MBCT) model developed by him (1998 onwards). As elaborated in Chap. 4, the Y-MBCT models have been devel- oped as standardized, symptom-specifi c, and evidence-based methods which are adapted from the three original schools of Yoga (Patanjali ’ s Eight - limbed Yoga , Buddha ’ s Mindfulness meditation, and the standardization of Tantra). Although not tested in fMRI yet, the bottom-up model of meditation is a neurobiologically com- patible model at least in its principles and clinical effects. This writer is aware that in proposing this model that bridges the abstract (mind/meditation) to the concrete (brain and body), there may be some oversimplifi cation, and nonetheless, it pro- vides a conceptual framework for integration and further testing of this model. Recent neuroimaging studies inform us about various types of changes (structural and functional) in the brain with different types of meditation which are elaborated 3.10 Neural Models of Yoga and Meditation 97 later in Chap. 8 of this book. Based on the neurobiological insights on Yoga and meditation, the whole process of Yoga–meditation can be described in neurobiologi- cal language (Hanson and Mendius 2009 , p. 25, 79–90). The bottom - up model used in the Y-MBCT program is based on the scientifi c facts that one’s thoughts and per- ceptions trigger one’s emotions which in turn trigger the conditioned autonomic hyperarousals involved in the stress response. Adapted by Pradhan from the scrip- tural traditions, the bottom - up model of meditation sequentially targets:

(i) The reactivity of the brain stem and its autonomic connections (the pontine respiratory center, medullary cardiac center, and the hypothalamic–pituitary– adrenal axis, the reactive/refl exive part of the brain, otherwise called the sur- vival brain , Ford 2009 ), (ii) The limbic area (the feeling parts of the brain) (iii) The thalamic–prefrontal cortex (the refl ective thinking and executing parts of the brain )

The rationale for this is based on the neurobiological insights that many of the psychiatric symptoms are expression of stress reactivity in the form of bodily arousal/discomfort, negative emotions, impulsivity, and affect dysregulation. This stress reactivity is refl exive rather than refl ective , i.e., set as habitual patterns through action of the lower reactive regions of the brain (the brain stem and limbic regions), the functions of which were originally meant for basic survival responses (pain, fear, hunger, etc.). Individuals with these refl exive patterns are at the mercy of these lower and reactive regions of the brain, and their actions tend not to exploit well the modulatory activities of the higher cortical regions (the prefrontal cortex and its regulatory connections with the limbic and thalamic areas). Amelioration of the stress reactivity and the affect dysregulation could involve regulation of this process in three sequential and standardized steps, from bottom (brain stem or level 1) to up (limbic–thalamic level or level 2 and frontal cortex or level 3) as elaborated below:

(a) Level 1 ( bottom level, also called the behavioral level or stimulus–response– refl ex level or brain stem level): This involves pacifi cation of the arousal responses, involves control of physiological parameters like breathing rate, heart rate, fi dgety, body temperature, etc. This can be called the control of the auto- nomic refl exes and involves the brain stem (portion of our brain called the reptil- ian or lizard brain). In the Y-MBCT model, this is done by the combination of a lifestyle of moderation (the 1st and 2nd limbs of the Eight-limbed Yoga proposed by Patanjali and the Middle Way proposed by Buddha), postures (Patanjalian 3rd limb), and the breath regulation (pranayama , Patanjalian 4th limb). (b) Level 2 (middle level or emotional regulation level or limbic–thalamic level): This involves affect/emotional regulation. Because emotions give rise to the cascade of autonomic refl exes involved in our stress response, so once the arousal refl exes (increased breathing and heart rate) are pacifi ed by the level 1 intervention, the next step should consist of controlling the emotional 98 3 Brain, Mind, and Soul: Bridging the Gap

parameters of stress response. In the Y-MBCT model, this is done by cultivation of bare attention (samatha , as said by Buddha) and the combination of indraw- ing of senses and concentrative meditation (Patanjali’s 5th and 6th limbs, respectively). This step involves the limbic lobe and the subcortical portions of our brain including the amygdala and hypothalamus (called the paleomamma- lian or squirrel brain ). (c) Level 3 (top level or cognitive level or prefrontal cortex level). This level involves cognitive restructuring and emotional reappraisal. Because our thoughts and perceptions give rise to the cascade of our emotions which in turn trigger the autonomic refl exes involved in our stress response, so once the arousal refl exes and emotions are pacifi ed by the abovementioned two steps, the next step consists of monitoring of our thoughts in detached and objective man- ner through meditation (mindfulness) and then reappraising of our thoughts, feelings, and perceptions by using the wisdom obtained from meditation. This specifi c meditation is called Buddha’s mindfulness/open-monitoring-type med- itation (similar to Patanjali’s 7th and 8th limbs). This is done by fi rst obtaining a concentrated mental state (Buddha’s bare attention, samatha or Patanjalian dharana ) and then by using bare / objective statements about the various mental states and mental contents. More detail will be described in Chap. 4 . This step involves the prefrontal cortical and thalamocortical portions of our brain (called the neomammalian or primate or monkey brain ).

Clinical Example One such example here will further clarify the concept and use of this bottom-up model in the Y-MBCT. Pradhan’s Y-MBCT model for trauma is called the mindfulness - based exposure therapy (MBET; Pradhan et al., 2013 – 2014 ), unpublished data). He and colleagues use MBET clinically for patients with refrac- tory post-traumatic stress disorder (PTSD). The MBET model (elaborated later in Chap. 7 of this book) is based on the facts that the three symptom clusters (hyper- arousal, numbing, and reliving) and attending dysfunctions in patients with PTSD are similar to the diffi culties encountered while one drives a car without brakes . MBET as a treatment model integrates the cognitive behavioral therapy (CBT, graded exposure therapy in its modifi ed client friendly forms) with Yoga and mind- fulness and specifi cally targets these clusters of symptoms using mindfulness inter- ventions at three (sequential) levels:

(a) Level 1 involves control of hyperarousal symptoms in response to trigger of traumatic memories. (b) Level 2 involves achieving the concentrated mental state and induction of detachment (please note that this is disassociation rather than dissociation which is its opposite phenomenon and involves a detached and nonjudgmental awareness and open monitoring of the trauma memories followed by its subse- quent reappraisal). (c) Level 3 involves safe processing and detached reappraisal of trauma memories with respect to accompanying perception, feelings, and thoughts using mindful detachment/disassociation, compassion, and neutrality. 3.10 Neural Models of Yoga and Meditation 99

In this MBET model of treatment for PTSD, the patients, in addition to therapist- assisted MBET training, establish a home practice module where they can handle these in graded manner without overfl ooding and loss of control and thus able to maintain the improvement in their natural surroundings. Although MBET needs to be tested in larger samples with respect to its effi cacy, the preliminary results of the pilot study so far have been promising.

3.10.2 Experience Can Change the Brain Structure and Functions: New Insights

The role of one’s mind in the way one construes a situation and adapts to it can’t be overemphasized. In recent years, we are learning more about the connection between the mind and brain, more so from the perspectives of cognitive neurosciences. The fact that experiences can change the brain both structurally and functionally is more evident from neuroimaging research in patients exposed to various traumata, physical as well as psychological as described below. As we know, a major task of the central nervous system is to organize the linkage between internal representations of sensory information and individual adaptive responses. It is interesting to note that there are some correlations between size (volume) of the brain and its style of functioning, more so in the realm of its ability to generate alternatives in response to stimuli includ- ing stressful ones. Research fi nds that larger brains have more fl exible stimulus– response connections and therefore can have a wider range of alternative responses to specifi c environmental cues (Tanaka 2003 ). On the contrary, smaller brains cope with the challenge of stress by developing infl exible bonds between sensation and action that are resistant to change (Mesulam 1998 ). This explains the rigidity/infl exibility in the behavior we see in people with smaller brain. Smaller brains represent the world at a more concrete level and also much coarser level of resolution because they have fewer cortical columns to devote to each aspect of represented Reality. Simplifi cation of the brain can result from chronic stress or illness (Teicher et al. 2002 ). We see such simplifi cation of the brain (shrinkage in volume) in patients with dementia which partly explains why they become rigid and restricted in their repertoire of actions. In similar way, hippocampal simplifi cation is seen in patients with borderline personality disorder who suffer numerous traumatic events since their early childhood. Similar hippocampal simplifi cations and reduction in hippocampal volume are found in the brains of patients suffering from post-traumatic stress disorder (PTSD), more so in the childhood onset type in which the developing brain in childhood is affected by the psychological trauma including the adverse life experiences (Hull 2002 ; Cardenas et al. 2011 ). In these conditions, specifi cally, simplifi cation of the CA3 (cornu ammo- nis, region 3) area of the hippocampus occurs; the hippocampus is a crucial brain area for memory (both temporal and spatial memories) and is intimately related to one’s ability to construe meanings and regulate emotions. In addition, damage to the dentate gyrus which is one of the very few brain areas that have the ability to regenerate (Gaze 2002 ) limits new cell production, which in turn may hinder the process of encod- ing new, differentiated memory patterns (Kemperman 2002 ). Although such 100 3 Brain, Mind, and Soul: Bridging the Gap simplifi cation of brain areas has survival values for the individual in terms of conserv- ing energy and helping the affl icted individual triage the limited brain resources avail- able, it can theoretically decrease the richness of experiences by limiting the amount of complexity that is represented. The brain constantly creates patterns from the huge array of sensory information that it processes, to make sense of the environment. As mentioned before about the way our brain is involved in processing and codifi cation (symbolization) of infor- mation throughout our lifetimes, our experiences are organized in the brain based on crucial things like salience of information and the preferential functions of the facil- itated pathways in our brains. These pathways or patterns create expectations and organize our perceptions of Reality which are not necessarily things as they are. As the yogic philosophies embark, expectations are essentially phenomena in one’s mind. A remarkable corollary of these experiential encodings is that they can induce the generation of expectations from neutral circumstances. We fi nd what we seek because we expect something to be there. Although the ancient wisdom has informed us about this long ago, insights from modern research too, especially the studies involved in the study of stress and the resulting adaptation responses in individuals, are increasingly informing us that experience (mind) can change the brain.

3.10.3 Experiences Can Change the Brain: Insights from Research on Psychotherapy

In the last decade or so, important data are beginning to accumulate more so in the research involving the domains of functional neuroimaging and cognitive neuroscience which forms the foundation of better insights into the neurobiology of psychotherapy and mechanism of response to it. This rapidly expanding knowledge is increasingly informing us that experience can change the brain. Early evidence suggests that various psychotherapeutic concepts such as cognitive restructuring, free association, and extinction can be mapped onto the brain (Viamontes and Beitman 2006 , 2011 ; Etkin et al. 2005 ; Roffman et al. 2005 ). Researchers including Roffman et al. (2005 ) have conducted a comprehensive review of neuroimaging studies in psychotherapy. As mentioned before, the vmPFC has direct inhibitory afferents to the central nucleus of the amygdale and thus decreases its fi ring rates. Extinction memories are associated with the ventromedial prefrontal cortex (vmPFC). This is more important in PTSD and also in depressive ruminations (Segal et al. 2002 , 2013). One mechanism by which meditation and mindfulness-based cognitive therapy (MBCT) may be working is that these interventions may create extinction memories as one practices meditation and in detached manner and attends to the fl ow of consciousness. Psychotherapeutic experience can change the brain as evidenced by results from the neuroimaging studies outlined below (excellent description is available in the book chapter by Viamontes and Beitman 2011 ):

1. In general, imaging studies of depressed patients have tended to show decreased activity in the dorsal prefrontal cortex (including the DLPFC) and increased activity in ventral prefrontal regions (Roffman et al. 2005 ). In depression, psychotherapy can alter the metabolic activity of the prefrontal cortex, hippocampus, and cingulate 3.10 Neural Models of Yoga and Meditation 101

gyrus (reviewed by Mayberg 2006): the specifi c patterns of alteration have been vari- able across studies. Mayberg who has extensively analyzed brain responses to a variety of treatments for depression, including psychotherapy, medication, electro- convulsive therapy, and deep brain stimulation, conceptualizes the behavioral syn- drome of depression as “a systems-level disorder affecting select cortical, subcortical, and limbic regions and their related neurotransmitter and molecular mediators” (Mayberg 2006, p. 259). Mayberg (2006 , p. 262) adds further: “The best-replicated behavioral correlate of a resting state abnormality in depression is that of an inverse relationship between (left) prefrontal activity and depression severity.” 2. In obsessive–compulsive disorder, psychotherapy has generally produced a reduction in caudate nucleus metabolism, especially on the right side (Roffman et al. 2005 ). 3. In specifi c phobia, psychotherapy has produced attenuation of metabolic activity in the amygdala, hippocampus, and periaqueductal gray. Neuroimaging work (Straube et al. 2006) suggests that during conscious identifi cation of the feared object, phobic individuals showed activation of the left and right amygdala, the left insula, the left anterior cingulate gyrus, and the left dorsomedial prefrontal cortex. All of the regions that show activation have efferent projections that allow them to modulate autonomic arousal, and they represent critical nodes in the circuitry that turn previously neutral objects into perceived threats. In addi- tion, the right amygdala is strongly activated under conditions of attentional dis- traction including in the post-traumatic stress disorder (PTSD). These new insights provide clear rationale for use of meditation (focused attention type, FA) for treating phobia and PTSD.

3.10.4 Similarity Between Meditation and Psychotherapy

Although important differences do exist (as will be described in Chap. 7), the vari- ous shared grounds between meditation and deep psychotherapies like psychoanal- ysis are as below:

(a) These are universally applicable concepts. Both Yoga and deep psychothera- peutic concepts are concepts about the human mind and its various functions. (b) Both are investigative pursuits to seek personal Truths (insight). (c) Both emphasize the centrality of the mind (as compared to the body) and pro- pose the various therapeutic ways to change the functioning of the mind not only to get rid of stress but also to improve quality of life. (d) Both rely on the existential and experiential bedrock in order to effect a change. (e) Both involve an optimal sensory deprivation which can be considered as a “pre- paratory set” before one delves deeper. (f) Attention is fundamental to both the contemplative disciplines. (g) Free association in psychoanalysis is quite similar to the process of mindfulness in Yoga. (h) Both have similar goals (although goals seem more radical in Yoga). Freedom from mental confl icts through self-analysis is a crucial goal in both. 102 3 Brain, Mind, and Soul: Bridging the Gap

Being deeply experiential, meditative processes share commonalities with the therapeutic experiences as described here. Some examples of these commonalities are well researched in studies involving therapeutic role of the Buddhist meditative experiences, e.g., in developing empathy, decreasing stress, as well as improving attention, memory, etc. Considering the similarities in the processes involved in psychotherapy and Yoga–meditation, these insights from the effect of psychother- apy on the brain can help cognitive neuroscientists in further research and integra- tion of the various disciplines involved in such an important area of study. Because experiences have their cerebral representations, with advances in neurosciences and particularly research in the disciplines of functional neuroimaging, cognitive neuro- science, and neuro-linguistic programming (NLP), it is not surprising to increas- ingly fi nd the neural correlates of deep and contemplative experiences like meditation which will pave the way for developing novel therapeutic interventions. Neurobiological research on Yoga–meditation is still at preliminary stages; how- ever, it is becoming increasingly clear that meditative processes affect the function- ing of a variety of neural circuits at both cortical and subcortical levels in measurable ways. Although the complexity of neural circuitry and the lack of uniformity among studies have made it diffi cult to draw defi nitive conclusions, nonetheless, a number of trends have emerged that provide us with insights about how meditative pro- cesses can restore the optimal functioning of neural circuits in an information pro- cessing model which can be exploited therapeutically.

3.10.5 The Id, Ego , and Superego from a Neural Paradigm

In order to explain us how the human mind works, in the Structural Theory of Mind , its proponent Sigmund Freud (1915 ), has described the concepts of id (basic impulses and drives), superego (the moral constraints the mind has against gratify- ing these impulses and drives), and ego (the entity in mind that does the balancing act between the id and ego). In the psychoanalytic literature, volumes have been written about the executive functions of the ego in the psychic apparatus, i.e., the ego has a managerial role in the human mind and it manages the confl icts resulting from the mutually contradictory properties of the id and the superego and thus brings the psychic equilibrium . From the cognitive neuroscience perspective, the dorsolateral prefrontal cortical (DLPFC) circuit modulates executive functions which include organizational abilities, problem-solving skills, working memory and memory retrieval, self-direction, the ability to address novelty, and the use of language to guide behavior (Mega and Cummings 2001 ). Individuals with damage to the DLPFC have diffi culty organizing behavior to meet internal or external demands and tend to perseverate in their thoughts and speech. Their decision making is impaired, they have signifi cant diffi culty with problem solving and are unable to address novelty. Thus, one can see that the dorsolateral prefrontal cortical circuit has many of the attributes of the ego. It facilitates executive functions such as integration of percep- tual information, problem solving, and decision making (Burruss et al. 2000 ; Mega and Cummings 2001). Imaging studies have also shown that the DLPFC, possibly References 103 in conjunction with the cingulated gyrus, plays a key role in the suppression of unwanted memories (Anderson et al. 2004 ). The DLPFC is the entry point for ver- bal psychotherapeutic interventions because it is essential for advanced reasoning and for modulating behavior through the use of words. The manifestations of the id are very much a function of the cingulate gyrus and the nucleus accumbens cir- cuitry. This circuit amplifi es signals that suggest the attainability of reward and generates body states that motivate pursuit of potential pleasures. In the presence of remembered cues, this circuit can generate overwhelming motivational pressure to engage in reward-producing behavior, as in case of the substance dependence. The functions of the superego are implemented through orbitofrontal–amygdalar cir- cuitry, which is the punitive neural circuitry . The orbitofrontal–amygdalar circuits are directly wired to autonomic centers and can produce body states conducive to disengagement and withdrawal. The actions of this circuit set limits on risk taking and can convey the visceral feelings of potential punishment or embarrassment.

3.11 Concluding Remarks

Neurobiology, including the functional neuroimaging of the meditative process, is in its infancy. Nevertheless, information is accumulating rapidly on the circuit- based changes in neural information processing that underlie meditation’s benefi cial effects. In this manner, the meditator is able to reshape his/her own internal representations and subjective meanings, leading to more adaptive behavior, better stress modulation, and higher levels of functioning. Despite the shortcomings of the currently employed methodologies in tapping the experiential domains, it is hoped that brain-informed meditation will confi rm the validity of many existing concepts and techniques in such deeply contemplative disciplines like Yoga and meditation. By knowing how the phe- nomena that underlie core meditative concepts and processes are generated in brain circuits, meditation trainers as well as trainees could become clearer about the specifi c effects of these interventions on the brain that can lead to adding more confi dence in the techniques as well as enhancing their reliability and generalizability. It will even- tually be possible to visualize the neurobiological targets for producing behavioral change through meditative interventions. The injunction to know thyself is not exactly news, but science is regularly advancing toward this ancient goal.

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Standardization Methods in Yoga and Mindfulness 4

It is wrong to blindly believe…. Just as you would take up any other science, exactly in the same manner you should take up this (Yogic) science for study. There is neither mystery nor danger in it. —Vivekananda (Raja Yoga 1956 , p. 18)

4.1 Introduction

There are two basic ways Yogic sciences are proposed in the scriptures and applied within various traditions: (i) Yoga–meditation as a psychosomatic science and (ii) Yoga and meditation as attentional sciences. The fi rst three chapters of this book provide descriptions of these two fundamental aspects. Descriptions of the key tech- niques of Yoga and meditation can be found in the following excellent source books:

(i) Patanjali’s Yoga Sutras (particularly the section on samyama; Taimni 1961, p. 98–109, 111–145) which describes the Vedic and Vedantic traditions of meditation (ii) The various literatures on the Abhidhammic (Buddhist) scriptures (particularly on the jhanas , samapattis , satipatthana : Nyanaponika 1965 , p. 85–107; Santina, 1997 , p. 333–339, 341–347; Goleman 1988 , p. 10–38) (iii) The classic description of meditative process by Eliade (1969 , p. 162–199) (iv) Descriptions of some of the meditative techniques (especially on samyama and samadhi) in the Yoga Sutras of Patanjali as elaborated by Satyananda ( 1976 , p. 68–77, 110–126) and Satchidananda (1978 , for most parts of this book) (v) Descriptions of the technique-rich methods of tantra (especially on trataka , kundalini chakras, and pranayama) as elaborated by Niranjanananda (1993 , p. 44–53, 156–198), Sivananda (1994 , p. 41–43), and Avalon ( 1974 , the whole book is on Kundalini Tantra )

© Springer International Publishing Switzerland 2015 111 B. Pradhan, Yoga and Mindfulness Based Cognitive Therapy: A Clinical Guide, DOI 10.1007/978-3-319-09105-1_4 112 4 Methods in Yoga and Mindfulness

The rich history of Yoga and meditation spans not only a few thousand years but also for many parts of the entire globe. Thus, it is impossible to describe all the techniques in detail here. The organization of this chapter will adopt the following outline:

(i) Samyama (the combination of the last three stages of the Eight-limbed Yoga , i.e., concentration, meditation and samadhi/ Yogic enstasis) as the prototype of meditation: this has been already described in the fi rst three chapters and so will not be repeated here. (ii) Attention-enhancing practices/concentrative meditation (Sanskrit: dharana ; Pali: samatha ): in this I’ll describe trataka (Sans. visually fi xative and retentive concentrative meditation) as the prototype. (iii) Mindfulness meditation (Pali: satipatthana ): This was adapted and further developed by the Buddha using his knowledge of Vedic and the Upanishadic meditation. This is the samyama equivalent of the Patanjalian tradition. (iv) The fi ve integrated techniques adapted by the author as applied in the symptom- specifi c Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT © ). These techniques combine elements of the cognitive behavioral therapy (CBT) with the chief techniques of Yoga and meditation as described in the scriptural tradi- tions, the Veda ( Samkhya ), Upanishad (Buddhist), and Tantra (the technique- rich and most modern school of Yoga).

4.2 Some General Information on Meditation

Meditation is a continuous undistorted experience. The objects of meditation speak for themselves, allowing us to see things clearly as they are. The aim of any medi- tation is to raise one’s awareness to such a state void of the restlessness of con- sciousness and energy. In its meditative state, the mind eventually becomes alert yet supple and relaxed—a rare combination. In this state, the mind becomes receptive to a broader consciousness, while the fi ve objects of the mind (i.e., thoughts, feel- ings, perceptions/sensations, memory, and will) work together harmoniously. The mediator obtains the perfect coincidence between mental phenomena; meditation unifi es the mental fl ux of these phenomena in one’s continuous stream of aware- ness by suspending every other psychic activity. The goal of meditation is to gain wisdom or direct experience concerning both the psychological and the biological life. Meditation, in the original traditions, is conceptualized as a sequential (staged) or developmental process beginning with the purifi cation of one’s lifestyle and cul- minating in direct access of the experience by means of the Right Attention of the Pure (undistorted) Mind (equivalent to the Soul of the Yoga Sutras ). The meditator becomes conscious of all those physiological functions he/she had previously per- formed automatically and unconsciously. I give the commentator’s explanation of the text: “The Yogin (practitioner) must ask himself: ‘On what are these expirations and inspirations based?’ They are based on matter, and matter is the material body, and material body is the four elements” (Warren 1896 , p. 355). This procedure is not simply a breathing exercise; it is also a meditation on the Buddhist Truths , a permanent experiencing of the unreality of matter. Fundamentally, this is the art of 4.2 Some General Information on Meditation 113 permanent attention to one’s own life, destroying the misperceptions about one’s life and gaining knowledge or wisdom. Through all the concrete actions—gate, body posture, respiration, etc.—the meditator must concretely rediscover the truths revealed by the meditative process; in other words, the meditator, through the initial preparatory steps, must turn all his/her movements, actions and thinking into pre- texts for meditation. As Eliade (1969 , p. 168) puts it: “… the purpose of this medi- tation is to assimilate the fundamental truths completely, to transform them into a continual experience, to diffuse them, as it were, through the monk’s entire being. ” As mentioned in Chap. 1, in ancient India, Buddha was the master specialist in meditation, and Patanjali was the master compiler of the whole system of Yoga and meditation. One distinct feature of Buddhism that clearly sets it apart from other contemplative traditions is that in Buddhist traditions, meditation is only the key. Alone it is not suffi cient for liberation, not until the meditative wisdom has been real- ized through personal truths in one’s life. Meditation (which is combinations of the various jhanas and samapattis [Pali]) must be combined with the wisdom (Pali. nana ) or meditative insight (Pali. vipassana) and realized in one’s daily life through practice—not as ritual, but as a way of life. Buddha always connected the knowledge with the experience in meditation. For him knowledge has little value so long as it is not realized in personal experience. In other words, according to Buddha this whole life is a meditation; this is a personal study that helps us to own our experiences . As for meditational experience, it is the Truths discovered by the Buddha that he vali- dated in meditation on life. All the truths revealed by the Buddha must be tested and experienced through the meditation and the wisdom or direct experience arising out of the meditation. Meditation involves personalizing and owning the true experience by combining the process of meditation on one’s various life events with the result- ing wisdom. One can see that meditation is like sharpening a pencil. Like we sharpen a pencil for a purpose (to write), similarly meditation is meant for sharpening the mind so that one can develop the wisdom to see things clearly. Seeing things as they are begets liberation (Pali. nibbana , Sans. moksha ), the fi nal purpose or goal of Yoga and meditation. The clear vision imparted by meditation enables one to penetrate the darkness of ignorance and see into the real nature of existence. Prior to his enlighten- ment, Buddha spent seven long years of constantly practicing meditation as a combi- nation of concentration , meditation, and wisdom . This made his mind one-pointed, supple, and directed toward a purpose—the understanding of the real nature of things as they are —and able to comprehend the Truth or Reality that begets libera- tion from the shackle of life and from the cycles of birth and death (Pali. samsara ). As mentioned before in Chaps. 1 and 3, depending upon how one’s attention is being directed during the meditative process, meditation can be classifi ed into two types (Cahn and Polich 2006 ; Lutz et al. 2008 ): (a) concentrative meditation (focused attention/FA type [Pali: samatha ]) or (b) mindfulness meditation (open monitoring/OM type [Pali: sat- tipatthana ]). In the FA type one’s attention is completely focused on an anchoring object to the exclusion of all other objects in one’s awareness. In the OM type, one’s attention is uniformly and nonjudgmentally distributed among all objects in one’s awareness at that moment. Meditation can be practiced anywhere and at any time. The beginning steps of meditation are simply cultivating a confi dent attitude of mind, developing a continuous, moment-to- moment, and attentive stream of awareness regarding the workings of one’s body and mind. Simply put, it is being aware of what we are doing at all times . 114 4 Methods in Yoga and Mindfulness

4.2.1 Concentration (Centering of Consciousness; FA Type)

This is the practice of focusing the mind single-pointedly on an object which can be either a physical or mental object. The concentration object (Pali. kasina ) can be visual (e.g., a fl ame, an image, a fl ower, a dot on the wall), auditory (e.g., a chant or word or any sound), an action (e.g., one’s breathing and the rising and falling move- ments of the belly associated with it), or one’s bodily sensations/perceptions (e.g., one’s heartbeat). The object can even be an idea in one’s mind, such as love and compassion. When complete concentration on an object is achieved, the mind becomes totally absorbed in the object for a sustained period of time to the exclu- sion of all other mental activities. This comes naturally to all of us occasionally in our daily life, for example, when listening to a piece of music or watching the deep blue ocean or the vast sky. However, by regular practice we can reproduce this con- centrated mental state at our will and apply it to our daily tasks that require sus- tained attention. One can begin with relatively short periods of concentration practice, as short as 10 or 15 min a day. One need not be a monk or live in a forest or abandon one’s daily activities. Concentrated mental state makes the mind focused and sharper. It allows the mind to see things as they really are (otherwise called direct experience ). Concentration is a prerequisite for practicing the Right mindful- ness or samyama and thus prepares the mind to attain wisdom. To turn our under- standing of the Yogic philosophies from mere book knowledge into direct experience, we have to achieve concentration or single-pointedness of the mind.

4.2.2 Mindfulness (OM Type)

Mindfulness is avoiding a distracted or cloudy state of mind. As mentioned before, the ordinary or sensorial mind is inherently outwardly driven, running away from the inner locus of all our experience. Mindfulness acts as a kind of rein upon our minds; its practice increases our effi ciency and productivity. One focuses the mind precisely on what we are doing at this very moment, whether it is interacting with people, working, studying, or cleaning the house. No matter what we are doing, we can practice mindfulness. This is why Buddha referred to mindfulness as the one way to achieve the end of suffering . Mindfulness is simply observation of our mental phenomena (the fi ve objects in our minds, i.e., our thoughts, feelings, perceptions, memory, and will or impulse) at any given moment in a particular way, i.e., in detached manner and with astute attention obtained through concentration or bare attention. In an unmindful state, these mental phenomena stir up complex processes inside us. This is referred to as the defi lement response or unwholesome response (Bodhi 2000 ). In physiological terms, it is similar to what we call the arousal response . This stirring up happens only when these mental phenomena (thoughts, feelings, etc.) escape our notice or awareness and when they are indulged or identifi ed with or clung to rather than mindfully observed. By turning these phenomena into objects of observation, mind- fulness diffuses them, avoiding the defi lement or unwholesome response. In this 4.2 Some General Information on Meditation 115 process, instead of relating to the feelings by way of habits of the sensorial mind (e.g., attachment, repulsion, or apathy), one relates by way of contemplation. Using all these phenomena mentioned above as the objects of meditations profoundly helps one to understand the nature of their origin and to realize how they rise like a wave, enter one’s awareness and eventually dissipate into the continuous stream of awareness. This experience of continuous awareness is quite different from the fragmented awareness that our sensorial mind usually operates under. It is like a movie as opposed to a snap shot. When one’s actions in daily life are governed by the knowledge obtained from this continuous awareness as applied to one’s daily life, the actions are wise actions rather than just discharge of one’s impulses. This is one fundamental wisdom in the meditative philosophies: meditation is not con- fi ned to just the prayer room; rather this whole life is meditation .

4.2.3 The Middle Way (Pali. Majjhima Patipada; Madhyamaka): The Meditative Lifestyle

It is important to realize that meditation is a process, not an act. It is a mental state. One cannot really do meditation; rather one can be meditative. To be meditative one needs some basic preparation including the cultivation of lifestyle that provides the environment in which meditative states blossom. This lifestyle is one of moderation (Buddha’s Middle Way [Pali. Majjhima Patipada ]), rather than the extreme . The Middle Way has been elaborated by Buddha in the Dhamma Cakka Pavattana Sutta (Sans. Dharma chakra pravartana sutra ; Eng. The Setting in Motion of the Wheel of Dharma ; translated by Thanissaro Bhikkhu, 1993 ) which is considered to be a record of the fi rst teaching given by him after he attained enlightenment. When the Buddha discussed the Middle Way, he was referring to the path to awakening that lies Right in the middle, between all opposite extremities. The Middle Way is essen- tially a self-awareness training that makes us aware of the extreme thoughts, feel- ings, perceptions, and actions of our daily lives. This simple awareness redirects us toward the middle, the moderate. The Middle Way as realized and exemplifi ed by Buddha in his own life gives us wisdom and can lead to inner tranquility, to direct knowledge, and to self-awakening (Lama 2009 ). Following the Middle Way in one’s journey in life is analogous to traveling in the middle lane in a road with three lanes: as we know the middle lane is the safest lane because driving in the other two (extreme) lanes has more risk of collision. While it may seem diffi cult, it is fairly easy to practice. At the author’s Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT) clinic, children as young as 8 years old are able to practice the middle way, at least in its elementary format. The Middle Way is not necessarily doing the things, rather it is being aware of one’s extreme reactivity in daily life and bringing that to the middle through this gentle self-awareness and self-redirection. This is essentially the mindful way (i.e., to be aware/observant, gentle, and compassionate toward self). This simple philosophy protects us against the dangers of the extremes. It conserves our energy and brings order to the chaos of life. This lifestyle includes basic ethics like nonviolence, non-stealing, and not lying, establishing a regular 116 4 Methods in Yoga and Mindfulness rhythm of sleep and appetite patterns, and developing a sense of compassion for others and a sense of belonging within the whole community. Once the meditator has cultivated these qualities, there comes a sense of joy (rapture) and ease.

4.3 Morphology of Meditation as Taught by Buddha and Patanjali

Both Buddha and Patanjali, the early champions of meditation and Yoga, respec- tively, have elaborated upon the morphology of meditation. As mentioned in Chaps. 1 and 3 , in both the Noble Eightfold Path of Buddha and the Eight-Limbed Yoga ( Ashtanga ) of Patanjali, meditation is the 7th step. As refl ected in the canons of Abhidhamma, Buddha has described (in oral tradition [vernacular Pali]) the various stages of meditation in terms of the various jhana and samapatti, whereas Patanjali in his Yoga Sutra has described (in text form [Vedic Sans.]) this in terms of the vari- ous stages of dhyana and samadhi . The various stages of samadhi as described in the Yoga Sutras are already elaborated to some extent in the fi rst three chapters of this book. Because of the conceptual and technical complexities and heterogeneity involved in meditation, it is crucial to learn its morphology. One cannot appreciate the various techniques in Yoga and meditation without learning these basics. In vari- ous portions of this chapter, I’ll describe the techniques of Yoga, but the primary focus will be on meditation because meditation is essentially the most important part of Yoga. All the fi ve limbs of Yoga preceding the meditation (Sans. dharana and dhyana , the 6th and 7th steps, respectively) are essentially preparatory steps.

4.3.1 Meditative Access States: The Jhanas and Samapattis of Abhidhamma

As elaborated in the Abhidhammic canons (e.g., Visuddhimagga ), Buddha has described eight sequential meditative (mental) states as one ascends the ladder of contemplative practice in search of liberation (nibbana ). In this scheme, liberation begins after one attains the ninth meditative state. All the eight meditative states are mental states of deep contemplation, among which the fi rst four states are called the jhanas (contemplative raptures) and the subsequent four more advanced states are called the samapattis (attainments). The other two terms (in the Yoga Sutra [Vedic Sans.]) that are conceptually related to these Pali terms are dhyana and samadhi , respectively, which interestingly sound similar too. The jhanas are the means of mystical experimentation, a way to directly access the realities; that is why they are referred to as meditative access states . They prepare the meditator for the super knowledge (Pali: abhijna ) of life and the fi nal goal of nibbana. Each meditative access state (Pali. jhana ) consists of fi ve factors of absorption (Pali. jhananga ): (i) initial application of mind (Pali. vitarka ), (ii) sustained applica- tion of mind (Pali. vichara ), (iii) interest/motivation/enthusiasm (Pali. piti , belongs to the aggregate of volition/will ), (iv) happiness (Pali. , belongs to the 4.3 Morphology of Meditation as Taught by Buddha and Patanjali 117 aggregate of feeling ), and (v) one-pointedness (Pali. ) (Santina 1997 ). These fi ve factors of meditative absorption, through intensifi cation of one-pointed- ness (ekaggata), lead one’s consciousness from the mundane types of super knowl- edge (Pali. or accomplishments, e.g., to read the thoughts of others and to recollect one’s former lives) toward the supramundane knowledge which eventually leads one to the supramundane sphere of consciousness (nibbana ). The samapattis (means complete absorption) are more advanced psychic states whose descriptions echo the various stages of samadhi (Yogic enstasis ) described in Patanjali’s Yoga Sutras. The six samadhis of the Yoga Sutras are savitarka samadhi (samadhi with mental reasoning/debate), nirvitarka samadhi ( samadhi without reason- ing), savichara samadhi ( samadhi with refl ection), nirvichara samadhi (samadhi with- out refl ection), ananda samadhi ( samadhi with bliss), and asmita samadhi (samadhi with complete absorption, total enstasis ). Samapattis , the advanced meditative stages, prepare the meditator for the fi nal liberation (Sans. nirvana ). It is beyond the scope of this book to provide more elaborations of samadhi here . For more detailed descrip- tions, interested readers can refer to (1976 , p. 68–77, 110–126), Taimni (1961 , p. 111–145), and Satchidananda (1978 , Section I, verses 41–51).

4.3.2 The Jhanas (Contemplative Raptures)

In Buddha’s scheme, meditation begins with experiencing the four jhanas or access states of mind. Of note, descriptions of the fi rst two jhanas (which are Buddhist traditions) closely correspond to the Yoga Sutra ’s stage of concentration (Sans. dha- rana , the 6th limb), and those of the latter two jhanas correspond to the stage of meditation (Sans. dhyana , the 7th limb). It is important to note that at the moments of entry to or exit from these jhanas , the mind’s workings are more transparent and accessible to the clear gaze of the mindful meditator. These are crucial mental states that lead to the meditative insights concerning the objects of meditation present in one’s awareness at that moment. The preferred method for cultivating mindfulness is to fi rst make the mind concentrated by practicing the jhanas. Morphology of the four jhanas as described in the Buddhist meditative traditions are as under:

(i) The fi rst jhana : This jhana starts after one has gone through the preparatory stages for meditation (Middle Way) that provide the conducive environment for meditation and its application to one’s daily life. Once the meditator has culti- vated the Middle Way, there comes a sense of joy (rapture) and ease. The fi rst jhana is the conscious awareness of this state of joy, born of the solitude, detachment, reasoning, and investigation going on in this process of self- awareness. The detachment is maintained by simply observing the continuity of the experience so far. (ii) The second jhana : This jhana is the elevated state of joy and ease, born of the serenity of concentration. In this jhana the meditator suspends all reasoning and investigation involved in the fi rst jhana and instead uses the power of con- centration or bare attention . 118 4 Methods in Yoga and Mindfulness

(iii) The third jhana : This is the stage of mindfulness in which one develops the sense of among the mental contents at that moment and distributes the attention uniformly to all fi ve objects presently in one’s awareness. The conscious awareness of the bliss or joy arising from the equanimity is the third jhana . (iv) The fourth jhana : In this stage of tranquility, the fi ve mental contents gradually dissipate until they are no longer registered by the self. In this stage, there is suspension of all relations of self with both the sensible world and with mem- ory. One obtains a placid lucidity in one’s awareness without any other content. It is the awareness of existing . Toward the end of this jhana, the meditator begins to establish a state of enstasis (the closest meaning of samadhi ). The meditator cannot receive ideas from outside and becomes established in the internal self. Thus, this state leads to the subsequent higher meditative states, i.e., samapatti/attainments ( samadhi ).

As one can see here, the four stages (jhanas ) are meant for the following:

1. Purifi cation of the mind: Isolating the mind and protecting it from the tempta- tions of the external agents to attain the autonomy of consciousness 2. Suppression of the dialectical functions of the mind (i.e., constant elaborations of the mind about its fi ve objects) by obtaining the concentration 3. Suspension of all relations of self, both with the external world and with memory 4. Reintegration to reconcile the opposites in one’s awareness so that confl ict ceases and the bliss of pure consciousness ensues

4.3.3 The Samapattis (Attainments)

As mentioned before, these are advanced meditative stages that are similar to the Patanjalian samadhi and correspond to experiences too far removed from those of normal consciousness. At the end of the four samapattis , the meditator cannot receive ideas from the outside. After this state, there begins a state of the fi nal ensta- sis where the monk has acquired that psychic state in which there is cessation of all conscious perceptions. The meditator who has acquired this has nothing more to do (Bendal 1902 , p. 48). This fi nal state of total inaction (and pure experience) of the mind is the highest level of action.

4.3.4 The Yogic/Meditative Consciousness and Its Various Categories in the Abhidhamma

According to the Abhidhammic scheme described by Sariputta (one of the foremost disciples of Buddha), as he progressed through the various stages of meditation, there are four stages of consciousness (Santina 1997 , p. 333–339, 340–347) which 4.3 Morphology of Meditation as Taught by Buddha and Patanjali 119 are the various mental states (grades of mind) as one ascends the meditative path. These are the sense sphere consciousness, the form-sphere consciousness, the formless- sphere consciousness, and, fi nally, the transcendental consciousness directed toward the nibbana . Sariputta further describes that the sense sphere con- sciousness consists of 42 meditative stages (mental states), form-sphere conscious- ness consists of fi ve stages, and the formless-sphere consciousness consists of four stages. All these states of meditative experiences (consciousness) , in their pre- nibbana forms, are characterized by impermanence, transience, and insubstantial- ity, and thus one needs to go beyond (transcend) them in order to access the nibbana. Briefl y, one proceeds by means of 40 traditional objects of meditation that include ten supporting objects or anchors (Pali. kasina ). These objects are coordinated to the temperament of the meditator, i.e., specifi c objects are prescribed for specifi c kinds of temperaments of the practitioner. Thus, the meditator traverses each sphere of consciousness by beginning with an external support; gradually that external sup- port is internalized and conceptualized, and fi nally that support is discarded and one enters the state of meditation proper . When all fi ve factors of absorption (Pali. jhan- aga: initial application of mind, sustained application of mind, motivation to prac- tice, happiness, and one-pointedness, as described above) are present, the meditator has achieved one particular level of consciousness (e.g., the fi rst form-sphere con- sciousness) and then repeats the same process to move to the next level of con- sciousness. The fi ve factors of absorption help to elevate one’s consciousness from the sense sphere to the form and formless sphere, one by one, by removing the fi ve hindrances (Pali. nivarana): initial application corrects sloth and torpor, sustained application corrects doubt, enthusiasm corrects ill will, happiness corrects restless- ness and worry, and one-pointedness corrects sensual desire. In this scheme, when one has sequentially attained the fi fth form-sphere consciousness, one experiences dissatisfaction with the limited nature of the form-sphere absorptions and then again by means of an object of meditation (one of the 10 supports or kasina ) progresses to the formless-sphere meditation. One achieves this transition by extending the sup- port until it covers the infi nity of space, then discarding the support and meditating on the infi nity of space (Sans. chidakasha ), thereby achieving the fi rst of the formless- sphere absorptions. As the meditator progresses through the form and formless spheres, gradually he/she has a unifi cation of the subject (self) and a unifi - cation of the meditation object (similar to the Patanjalian samyama/knowing by fus- ing method): by attaining the fourth formless-sphere absorption, the meditator reaches the summit of mundane experience or mundane consciousness . The mun- dane consciousness is determined, undirected, and subject to law of karma and its conditionings , whereas the supramundane consciousness is determining, directed toward a goal, and no longer subject to laws of karma and its conditionings . Supramundane consciousness is determining because of the predominance not of karma but of wisdom. There are eight basic types of supramundane consciousness, four active and four passive. The eight types of supramundane consciousness can be expanded to forty by combining each of the eight with each of the fi ve form-sphere absorptions. However, even the fourth the formless-sphere absorptions (Patanjalian nirbija samadhi) is not an end in itself; being mundane, this very high form of 120 4 Methods in Yoga and Mindfulness meditative absorption is still impermanent, and thus its power eventually wanes after which one will be reborn in a lower sphere of consciousness. So even this pin- nacle level of meditative absorption has to be combined with wisdom (Pali. panna , nanna ) obtained through the meditative process for the consciousness to become truly supramundane which would pave the way to attain liberation (Pali. nibbana ) .

4.4 Description of the Key Techniques in Yoga and Meditation

It is important to understand that regulation of attention is the common denominator among the different methods or traditions of meditation (Davidson and Goleman 1977 ). As mentioned above, meditation practices apply the following two types in succession or in various combinations: (a) fi rst, focusing attention on an idea or object that serves as the anchor (the concentrative method/FA type) and, thereafter, (b) maintaining a free-fl oating attention as the central mental mechanism that initi- ates the mindfulness process (the mindfulness method/OM type). Usually concen- trative meditation (called bare attention in Buddhist literature) is a prerequisite for practicing the mindfulness meditation. The techniques involved in both types of meditation are shown below.

4.4.1 Technique of Concentrative Meditation (Focused Attention—FA [Sans. trataka ])

The ability to concentrate is the root of all higher qualities in human beings and serves as a basic prerequisite for all types of meditations including mindfulness meditation. The word concentration means centering of one’s consciousness or making it one-pointed . Just as we need a sharp knife to cut with, the mind also must be made sharp through the practice of concentration. The ordinary mind does not function in a concentrated way; it spreads over too large an area. While we are aware of one thing, the input from other senses are constantly being received, pro- cessed, and fi ltered by the mind; so many things are happening simultaneously within our mind. There cannot be any relaxation in such a mind. Concentration not only makes one’s mind sharp or penetrative, but also it relaxes it by developing a process of mental discipline to bring order to this chaos. Concentration makes one’s awareness merge with the object of awareness and thus makes the majority of the mental faculties pinpointed at one center and work harmoniously. This results in greater relaxation and productivity because all the faculties of mind work in one direction, in harmony, and on one goal. This allows relaxation as well as productivity of the mind. As a type of meditation, concentration meditation is exemplifi ed by trataka (Sans. steady gazing), a fi xative meditative method which serves as the prototype of concentrative meditation and will be described in detail. In the classical Hatha Yoga or tantric texts, trataka is described as a key preparatory technique for practicing 4.4 Description of the Key Techniques in Yoga and Meditation 121 the higher forms of meditation. Trataka is one of the six purifi catory exercises described in the classical Hatha Yoga or tantric texts and is mainly intended for developing concentration and mental focusing. Although an ancient technique, it simply requires the steady gazing at a particular point or object without blinking. Here, the object serves as the anchor for developing sustained attention. Depending upon whether the anchoring object is external or internal, trataka can be external (Sans. bahirtrataka ) or internal (Sans. antartrataka ). When we gaze at a picture, it is external trataka, whereas when we close our eyes and mentally visualize the pic- ture, it is internal trataka. As opposed to the abstract meditations, trataka is the concentrative meditation with a form or anchor. It acts as a stepping stone or a bridge between the physically oriented Hatha Yoga and mentally oriented tech- niques of Raja Yoga. When one practices the physical (external fi xed gazing) form of trataka, it is part of the Hatha Yoga, and when one practices the mental (internal or inner visualization) form of trataka, it is part of the Raja Yoga . Sri , the famous Yogi of Arunachalam (a state in the Eastern part of India), was a devoted practitioner of this exercise. He was very calm and said to be not at all distracted by the constant talking and singing of his disciples by his side. Concentration is not a superfi cial practice. It involves three things: (1) Right method, (2) Right guidance, and (3) Right understanding. All three parts are codi- fi ed in the scriptures on Yoga and meditation. Concentration can be practiced in many ways. Almost any object can be used as the basis for concentration. In his clinical practice, this author uses a black dot on the wall as the concentration object when training young children to cultivate a steady practice of concentration (dot trataka). In Buddhist traditions, concentration is practiced on the different parts of the body (contemplation of body [Pali. kayanupasana ]) or on the various physiolog- ical processes (e.g., awareness of our breathing or heartbeats). Buddhist meditative traditions emphasize upon the primacy of breathing and the associated rising and falling movement of the abdomen during the practice of meditation and refer to it as the primary objects (Pali. mul arammana) of concentration practice (Nyanaponika 1965 , p. 94). The list of the objects of concentrations can be overwhelmingly long. A few popular ones are yantras or mandalas (tantric tools of meditation as described in Chap. 1), symbols of God, faces of people, holy objects, holy places, color, forms, natural scenes, words, or chants. The symbol or the concentration object should become so compelling that the mind is automatically drawn to it and completely integrates with it. Such a concentration object will tremendously help one to enter into concentration easily. Because the whole idea of choosing a symbol is just to anchor or focus the volatile mind, it is not necessary to select a religious symbol. Any symbol which helps to focus and steady our mind is all that is necessary. However, once the concentration object (Pali. kasina ) has been selected, one should use the same object in practice day after day until the object should come to one’s attention and inner awareness spontaneously. While practicing trataka , the concen- tration object may appear by itself in the form of a vision or a dream. During the practice of concentration, there should be minimal confrontation in the mind; con- centration should be natural and subtle. By confronting, we are creating confl ict in our mind between the endless patterns or modifi cations (Sans. vrittis ) of the mind. 122 4 Methods in Yoga and Mindfulness

One need not be upset with distractions while practicing the concentrative medita- tion; distractions are natural and bound to happen. Actually one can use the various distractions as the objects of concentration, and with steady practice eventually these distractions go away. In the Kundalini System of Yoga and also in the Vajrayna system (as part of Tantra, mentioned in Chap. 1), in addition to yantras or the man- dalas, the various chakras of the body are used as concentration objects. Chakras (means discs of psychic energy ) are considered as the focal points located in differ- ent parts of the subtle body (Sans. sukshma sarira ) and linked by channels (Sans. nadis) meant for the reception and transmission of psychic energies. Feuerstein (1990 a, p. 258) describes the chakras as “idealized version[s] of the structure of the subtle body, which are meant to guide the Yogin (practitioner)’s visualization and contemplation.”

4.4.2 Description of the Technique

Detailed elaborations on trataka can be found in authentic books including those by two masters of Yoga: Sivananda (1994 , p. 41–43) and Niranjanananda (1993 , p. 44–53, 156–198). Trataka is one of the most direct, simple, and effective tech- niques for attaining concentration of the mind. When we look at a mirror and gaze at the pupil of the eye, this is a form of trataka. Through trataka, all the attention and power of the mind are channeled into one continuous stream of psychic energy. It is a method of focusing the eyes (or other sense organs like the ears, skin, tongue, nose) and in turn the mind (which is the 6th sense organ according to Yogic philoso- phies) on an anchoring object so that consciousness becomes centered (that is why the name is concentration ). This key concentrative meditation doesn’t require any particular posture (Sans. asana ) or specifi c preparation for its practice daily. Trataka practice simply requires the practitioner to sit comfortably and steadily with spine erect and then focus in a sustained manner, with eyes open on an external object kept at a distance of one foot from the eyes and at the same level of one’s eyes. If one has defective vision, the anchoring object should be positioned in such a way that one can see clearly without use of the visual aids like glasses or contact lenses. Before starting the practice, one should decide what a suitable object is for oneself to practice. In his personal practice and clinical work, the author practices on a black dot with a half-inch diameter and fi nds it quite useful (dot trataka). As men- tioned already, once decided, one should not change the concentration object often. During practice, keeping the mind steady from all the distractions including the various thoughts, feelings, sounds, etc., one simply looks at the concentration object steadily without blinking. When distractions intrude, they are simply registered gently in one’s awareness without any elaborations or feeling upset about them. For example, if there is barking of a dog during practice, one can simply be aware of this and gently tell oneself neutral words like just a sound and then quickly redirect one’s attention to the concentration object. These neutral words, unlike the content- laden elaborative words, are able to quickly bring back one’s mind (consciousness) to the object of meditation by stopping the elaborations by the mind. Similar steps 4.4 Description of the Key Techniques in Yoga and Meditation 123 can be followed for other distractions like smell, pain, intense feelings or thoughts, etc. Use of neutral words rather than content-laden words is important during this practice so that the mind doesn’t drift away with detailed elaborations upon these distractions. If the concentration object is large, one can gaze at the different parts of the object starting from the periphery to its center. During this whole process, the goal is to have suffi cient focus and clarity of vision so as to create a clear of the concentration object rather than getting distracted with elaborations of the mind about that object. This process needs to be repeated again and again until the mind becomes steady and calms. If tears begin to fl ow, which is common in the fi rst few days of practice, one can close the eyes for a minute or so and then resume the practice. When one perceives suffi cient steadiness of mind around the concen- tration object, one can close the eyes and mentally (internally) visualize the picture in the mind’s eye. During this mental visualization with closed eyes, one can pick the midpoint between the eyebrows as an imaginary point of focus and continue with the internal visualization of the concentration object. Any distractions are dealt with the abovementioned method of using neutral words. A state of stillness or concentration of mind is achieved when the practitioner will be able to create a clear mental image of the previous external object even with closed eyes. This whole process takes about fi ve minutes per session, and after this stillness is achieved, this level of concentration usually sustains for at least half an hour which can be better used by engaging in activities that need sustained attention like mathematics, read- ing diffi cult content. When the sustained attention eventually wanes, trataka can be repeated in the abovementioned way to again reproduce the state of sustained atten- tion at one’s will. During the practice of trataka, one should not blink or move in any way. Stillness of the eyeballs and the eyelids is essential in order to attain clarity of the inner image. If the eyes feel strained, one can imagine or visualize breathing through the midpoint of the eyebrows. Simple imaginations like this helps reduce the eye strain. Trataka can be practiced on one’s breathing too; in that case it becomes a focused, slow, and deep breathing (for clinical use, this writer has stan- dardized this breathing by which one can transform this from a simple breathing to a breathing meditation: described later in this chapter). One may feel a sense of mild warmth produced in the body while or after practicing trataka. In that case one may practice a few rounds of slow and deep breathing after which this feeling goes away quickly. To start with, one can practice trataka for 2 min, twice daily, and then cau- tiously increase the duration. Gradual and steady practice with patience is required for mastering this technique. Gazing at a spot even for a few hours continuously counts for nothing, if the mind is wandering. At the end of this practice, cold water should be gently splashed into the eyes to remove the tears, if any. First of all, famil- iarity with the technique is necessary to be established by regular home practice. Then practice of trataka can be generalized to activities of daily life, e.g., when walking, reading, looking at the sky, etc. Those who cannot gaze steadily for a sec- ond in spite of several attempts need not worry much. They can close their eyes and gaze at an imaginary spot at the space between the two eyebrows (internal trataka ). Those who have very weak eyes should do trataka after closing their eyes on any imaginary spot within or outside. It is important not to over-practice. If one feels 124 4 Methods in Yoga and Mindfulness tired during this practice, one can close the eyes and still keep the mind focused on the object of trataka. There are some other natural exercises too, for generalizing the effects of trataka. Some people do trataka at the space between the two eyebrows or at the tip of the nose. When one takes a close look at the eyes of Buddha in any of his pictures, one can realize this. One can practice trataka on the pages of a book to improve the memory of the text. This writer, during his early years in medical school, has practiced trataka using the medical texts and has realized the tremen- dous benefi ts in terms of markedly improved visual memory (mostly the anatomi- cal/surgical pictures and other fi gures) and concentration. One can practice trataka on using a candle fl ame, too. One can select any of the methods that suits the best, practice this for one month regularly, and monitor the experiences and the benefi ts.

4.4.3 Visual Trataka (Sans. Dristi Trataka): Its Clinical Importance

Although trataka can be done in auditory mode too using a sound/chant (Sans. nada , ) as the anchor for focusing the mind, in its classic sense trataka is visual and there are good reasons for this. In Yoga, the eye is considered the most important sense organ (Sans. indriya ). The eyes are very sensitive to any distractions in the mind; it is the mirror of the mind . We see these distractions in the various move- ments of the eyes—saccades, nystagmus, microsaccades, etc. When one realizes that the retina is part of the brain, these fi ndings are not that surprising. In fact dur- ing the fetal life, the retina and the optic nerve are direct outgrowths of one’s brain and therefore are structurally similar to the brain. Because the brain and mind are closely related (Chap. 3 has detailed elaborations on this), any distraction of the mind can cause distractions (movements) of the eyes as well. Considering the extreme importance of one’s vision, trataka in its classic sense is visual. The move- ments of our eyes are of three different types: vergence movements , saccadic move- ments , and pursuit movements . As the name suggests, the vergence movements involve cooperation of both eyes to allow for an image to fall on the same area of both retinas so that one is able to obtain a coherent and single image rather than seeing a double. Saccadic movements, on the other hand, result when we are trying to rapidly scan a particular scene or object in the visual fi eld. The pursuit or tracking movements follow objects in motion. There has been enough research literature (readers can refer to a review article by Rommelse et al. 2008 ) that suggests neuropsychiatric disorders involving one’s attention; for example, attention defi cit and hyperactivity disorder (ADHD), dys- lexia (a form of reading disorder), childhood-onset schizophrenia, and anxiety dis- order are accompanied with more of these eye movements as compared to the normal population. This partially explains why reading diffi culties are seen more often in patients with ADHD because reading needs eyes to be focused. Pradhan (2014 ) and Pradhan et al. (2014a , b ) in their clinical work involving the use of trataka in clinical populations (patients with ADHD, dyslexia or reading disorders, anxiety and depression) note signifi cant reduction in the eye movements (fl ickers, 4.5 Techniques of Mindfulness Meditation (Pali: Satipatthana) 125 saccades, nystagmus, etc.) after 4–5 sessions of steady practice of trataka. Although not published yet, the authors believe that possible explanations for these fi ndings could be due to the effect of trataka on: (a) stabilization of the eyes and its move- ments by sustained attention and (b) the synchronicity between the various compo- nents of the mind. In this context, we ought to discuss habituation, a phenomenon in our brain as it perceives things/stimuli. Even in normal population, when the eyes are focused on an external object, the view perceived is always fl uctuating because of the spontaneous movements of the eyes. In the concentrative meditation, when the same object is constantly seen, the brain becomes habituated and soon stops registering the object. Habituation coincides with an increase of the alpha brain waves (the frequencies of which are lower than the normal awake brain waves/the beta waves). Deeper meditations produce even lower frequency brain waves (theta or delta waves; Cahn and Polich 2006 ). The alpha waves during concentrative medi- tation highlight the importance of a single unchanging stimulus (like the anchoring object of the trataka) in turning off the distracted states of the sensorial mind through the process of concentration. When awareness is restricted to one unchanging sen- sory stimulus like a fi xed point or a constant sound, the mind is turned off. Complete absorption in a single perception induces withdrawal of contact with the external world. This shutting down (to the external world) process starts with the 5th limb (indrawing of all the senses [Sans. pratyahara ]) of the Eight-limbed Yoga which precedes the concentration (trataka; Sans. dharana ), its 6th step. Needless to say that concentration (trataka) prepares one for deeper meditation in order to see (per- ceive) things clearly without any distraction or distortion . Thus, it serves as a pre- requisite for mindfulness.

4.5 Techniques of Mindfulness Meditation (Pali: Satipatthana)

Mindfulness meditation is among the most documented and clinically most researched forms of meditation. Literally satipatthana (Pali. sati = skillful, pat- thana = remaining aware of the present moment) means skillfully remaining aware of the present moment . This is otherwise called Buddha’s way of Right mindfulness which has been elaborated in the Maha (part of the Abhidhamma canon: Digha Nikaya [Pali. Digha = long; nikaya = discourse/saying]), Buddha’s original discourse on the foundations of mindfulness. Considering its crucial impor- tance, Nyanaponika (1965 ) has described mindfulness as the heart of Buddhist meditation. Simply speaking, satipatthana is the process of meditation, whereas vipassana (Burmese Pali. insight ) is the result of this process. Like the concentra- tion and meditation of the Patanjalian samyama, the samatha (Pali: sama = pacifi ca- tion or deep tranquilization of distracted/agitated mind) and vipassana are the two main strands of the satipatthana or mindfulness meditation. According to Buddha, the ultimate aim of meditation is to realize the experience in an impersonal (selfl ess) and detached manner. Before achieving satipatthana (Right mindfulness), one needs to learn ordinary mindfulness. 126 4 Methods in Yoga and Mindfulness

4.5.1 Two Stages of Right Mindfulness

Ordinary mindfulness (different from the Right mindfulness) is simply ordinary observation which is the work of the ordinary (intellectual) mind in creating an expe- rience; in this one’s mind doesn’t operate at levels of the jhana and samapatti . As one practices mindfulness more and more, at the level of the fi rst jhana (variously called as meditative access state or bare attention or concentration ), the ordinary mindful- ness stops and Right mindfulness begins. Right mindfulness involves two sequential stages: (i) the fi rst stage involves initial registration of the stimuli and their associa- tion with other parameters of experience based on memory, and (ii) the second stage involves generalization of the experience to one’s daily life in order to experience these personal truths in an impersonal and detached manner. The fi rst stage of mind- fulness, otherwise referred to as germinal mindfulness, is essentially the initial atten- tional process applied to the objects in one’s awareness or experience (in meditative traditions, thus is called as the meditation object). This initial attention results in a very general and indistinct picture of the meditation object. The subsequent process of attention involves closer attention directed toward details of the object and making associations with the various characteristics of that object, thus forming the associa- tive thinking . This step of closer attention involves not only the various detailed char- acteristics of the object (objectivity) but also its relationship to the meditator (subjectivity) based on memory without which the simple attention could furnish merely isolated facts of the objects. In this stage of associativity, adulterations of experience occur based on the incorrect associations of the ordinary mind with the objects it is experiencing. It is important to note that in these adulterations, the objects in one’s awareness are not really changing but rather they are perceived as changing based on the quality or grade of the ordinary mind. These adulterations in the stage of associative thinking can be corrected by the Right mindfulness in which Right Attention (Pali: samma sati ) is a key tool. This attention is referred to as Right because it keeps the mind free from falsifying infl uences and distortions, increasing the clarity of one’s thinking and comprehension. This Right Attention leads to the Right action. The second stage of mindfulness involves generalization of the medita- tive experience obtained in the fi rst stage to one’s daily life in order to experience the personal truths in a mindful way (i.e., in impersonal and detached manner).

4.5.2 Bare Attention and Clear Comprehension : The Two Pillars of Right Mindfulness

The practice of Right mindfulness involves two aspects :

(i) The fi rst aspect involves cultivation of bare attention or concentration and maintaining a purely receptive and detached state of awareness. (ii) The second aspect involves obtaining clear comprehension (Pali: sampajanna ). The second aspect is actually the outcome of successful application of the fi rst aspect of mindfulness. Simply said, bare attention is just registering the 4.5 Techniques of Mindfulness Meditation (Pali: Satipatthana) 127

bare event as it is and to move on to the next moment without sinking into the store house of memory and associative thinking and preventing distortion of the facts. Bare attention allows the objects to speak for themselves and thus keeps at bay the narrowing and leveling effects of the habitual judgments; it sees the objects as if for the fi rst time. Like the fi ltering processes involved in the samyama and samadhi without a seed/thought (Sanskrit: nirbija samadhi ) as described in the Yoga Sutras (Taimni 1961, p. 98–109, 111–145), bare atten- tion demands persistent practice during which attention, gradually growing in its keenness, will, as it were, use the sieves of increasingly fi ner meshes by which fi rst the grosser and then even the subtler admixture will be separated until the bare object remains devoid of any label.

Bare attention and clear comprehension are the two main pillars of Right mindful- ness (satipatthana ). They supplement each other: bare attention presents those care- fully and dispassionately shifted facts upon which clear comprehending action may safely base its decisions. As Nyanaponika (1965 , p. 55) eloquently puts it: “The high degree of alertness and self-control achieved through bare attention will make it easier to guide one’s deeds by clear comprehension instead of getting carried away by pas- sions or getting misled by deceptive appearances. On the other hand, clear comprehen- sion makes more room for bare attention by controlling and quietening infl uence it exercises upon the world of end-seeking action and restless thoughts.” The bare atten- tion and clear comprehension produce the perfect harmony of receptivity and activity in the human mind. Sequential use of both in one’s daily life results in purifi cation of the mind and clear comprehension (Buddhaghosha 430 CE ). The bare attention and clear comprehension should gradually become part of all our activities, bodily, verbal, and mental, so that meditation becomes an integral part of life. This merging of daily life with Right mindfulness (bare attention + detached and receptive awareness result- ing in clear comprehension/vipassana) is the hallmark of satipatthana. Buddhist meditative traditions often use the word bare (i.e., devoid of the subjec- tivity or falsifi cations invoked by the mind): bare attention , bare statements , bare facts , and bare truth. When cultivating Right mindfulness, the meditator methodi- cally through bare attention faces the bare facts without any subjectivity based on the various (mis-)identifi cations in one’s experience. The bare facts are the objective statements that describe the mental events of the meditator at that moment without involving the subjectivity of mind or memory, which tends to create elaborate per- sonal detail around the mental events (phenomena [Pali. dhamma ]). These subjec- tive statements with their elaborate details are products of the habitual/sensorial mind; being associative and dependent on the context and memory, the meditator time travels to the past or future rather than focusing on the present moment. This takes the meditator away from the present experience. The bare attention or bare facts bring freshness to the experience, as if one is experiencing each event for the very fi rst time. This is done by applying continuous bare attention to the fi rst phase of perception described above, when the mind is receptive rather than reac- tive/elaborative/associative. The objects in one’s awareness speak for themselves. If any further comment, prejudice, refl ection, and judgment (together called the defi le- ment responses of the sensorial mind) arise in the meditator’s mind, these are made 128 4 Methods in Yoga and Mindfulness the objects of meditation using one’s bare attention. These objects are neither pur- sued (clung to) nor averted but simply registered and then dismissed. To prevent elaboration of the mind and intellectualization of the experience, upon initial regis- tration one can use neutral words rather than content-laden words. In developing the Right mindfulness for daily life, the key goal is to have bare awareness of fl ow of mental events without any break in continuity and strain on one’s mind. In this pro- cess, the form and sequence of mental events rather than their contents or elabora- tions are more important. One-pointedness (concentration) is a crucial prerequisite for the beginners to adopt this new habit of bare perception because one’s focus can be easily overshadowed by one’s ever-wandering thoughts/feelings at any moment, and hence a critical/threshold level of mental concentration is necessary to prevent the diversion of the meditator’s awareness. As described in the Visuddhimagga (Path of Purifi cation), the Abhidhammic encyclopedia on meditation, the ordinary mind is just another sense organ, the sixth sense, like the eyes, ears, nose, skin, and tongue (Goleman 1988 , p. 20). In mindful- ness philosophy, our thoughts, feelings, perceptions, and desires are regarded as mere mental events or products of the mind rather than real facts. These mental events, like tides of the ocean, constantly arise in our stream of awareness, rise to peak, and eventually dissipate . When we operate in an unmindful way subject to the conditioning of the sensorial mind by clinging, being judgmental, or not being pres- ent in the moment, these mental events engender further reactions. Memory adds further color or elaborations to these four mental events and takes us away from the present moment and generates a cascade of reactions which is not based on the facts of the present moment. The practice of mindfulness meditation involves cultivation of bare attention, disengagement of the mind, and shifting these operations of the sensorial mind. In mindfulness meditation, our thoughts, feelings, and desire/will are observed in a detached manner as just mental phenomena arising in our aware- ness and eventually passing away. This is the doctrine of impermanence which imparts us the ability to see things as they really are (Pali: tathata). Because every- thing is perishable and nothing is permanent, there is nothing to cling to. The grad- ual development of this ability through the practice of mindfulness meditation prepares the practitioner to operate in the experiential way ( being mode) rather in the mere intellectual way (reactive or driven-doing mode). In Buddhist traditions, this is done through the Right effort, Right concentration, and Right mindfulness. This transforms our understanding of the Yogic philosophies from mere book knowledge into direct experience to be realized through the personal truths of life.

4.5.3 The Four Stations of Mindfulness: Body, State of Mind, Feelings, and Phenomena

The Right mindfulness is fourfold with respect to the objects of meditation. These objects are called the four stations (Pali. anupasana) of mindfulness. They are identi- cal in function but different in focus. Any one of these stations serves as the fi xed points (kasina ) for bare attention to be applied to the stream of consciousness. Somewhat similar to Patanjali’s (Astanga’s ) method, in which one sequentially 4.5 Techniques of Mindfulness Meditation (Pali: Satipatthana) 129 traverses from body to mind, the four stations of mindfulness span one’s whole exis- tence, from one’s body and breath to the realm of the mind and its various states. These four stations are (i) mindfulness toward body and breathing (Pali: kayanupas- sana ), (ii) mindfulness toward states of mind (Pali: chittanupassana ), (iii) mindful- ness toward present feelings and specifi c emotions (Pali: vedananupassana ), and (iv) mindfulness toward the mental contents, mind objects, or mental phenomena (Pali: dhammanupassana ). As mentioned before, the fi ve mental phenomena are one’s thoughts, feelings, perceptions/sensations, will/desire, and memory at any particular moment of awareness. The fourth station also refers to how these contents of the mind can be contemplated and realized in one’s various life situations using the concepts of the Four Noble Truths and the Noble Eightfold Path . In the fourth station, the medita- tor mindfully observes in a detached manner all the mental objects which are used as the objects of meditation. The attention is bare and sharp, distributed uniformly among all fi ve mind objects. The mind objects are seen as they are (tathata) and the meditator sees the thoughts as just thoughts and feelings as just feelings , rather than heavily identifying with them (similar concept in Buddhism is clinging to the objects). In this the meditator observes the schema and fl ow in which each event arises and eventually dissipates in one’s fi eld of awareness. Thus, in mindfulness meditation, the meditator begins to objectively witness the continuous fl ow and succession of the random units of mind stuff (Pali. chitta and chetasika ) upon which reality is built. From these obser- vations emerge a series of realizations about the nature and the contribution of the human mind in creating an experience. With these realizations, mindfulness matures into insight (Pali. vipassana ). In mindfulness meditation, one’s journey through the stations of mindfulness is based on a simple fact that the reality we perceive is in some way a mere creation of our mind and mindfulness meditation is essentially the process of attaining the insight regarding the various levels of reality or experience. With the fi rst station of mindfulness, the practitioner exhausts the material dimension of per- sonal experience, and with the three subsequent stations , he/she exhausts the mental dimension of personal experience (i.e., the aggregates of consciousness, volition, per- ception, and feeling). Practice of Right mindfulness at each station involves both bare attention (use of bare statements) and clear comprehension .

Clinical Example Let’s consider a very common clinical scenario of to see how the four stations of mindfulness can be used in symptom-specifi c manner . In designing an intervention using mindfulness meditation for insomnia, the essen- tial elements in the intervention would be contemplation on insomnia and attending dysfunctions (sufferings in Buddha’s terms) using the four station of mindfulness. With respect to the insomnia, these four contemplations will be as follows:

(i) Starting with the fi rst station, i.e., contemplation upon the bodily sensations associated with insomnia (lethargy, headache etc.); becoming aware of these and the associated autonomic activities like heart rate, breathing, etc.; and bringing these to one’s conscious awareness rather than allowing them to function automatically in uncontrolled way. Subsequently, we use mindful breathing meditation (part of mindfulness of body and breath) to ameliorate and transcend these bodily sensations and enter the realm of the mind where 130 4 Methods in Yoga and Mindfulness

the subsequent three stations can be contemplated using bare attention and bare statements. After the fi rst contemplation on the body and breath, the three contemplations on the mind are as follows: (ii) Contemplation of the state of mind : Here the bare statement would be my mind at this moment is unpleasant . (iii) Contemplation of the feelings: Here the bare statement would be my mind at this moment is fi lled with anger or frustration or anxiety . (iv) Contemplation of the contents of mind. This is done in a detached yet attentive manner. The attention is uniformly distributed among all fi ve mental contents or phenomena, and one is made aware of how all these fi ve phenomena (thoughts, feelings, etc.) related to insomnia arise and build a personal story of suffering, pushing us to lose the mindfulness state by engaging in some actions or ruminations about insomnia and the associated fantasies. The moment one is aware that these ruminations are building up and taking oneself away from the present moment, the bare statement one can use to return to the present moment could be just my thoughts. As mentioned before, in this station, one sees these are just mental objects as they are, i.e., seeing thoughts objectively as just thoughts, feelings as just feelings, and perceptions as just perceptions at that moment without identifying with them at that moment. This in itself will provide the mindful practitioner the wisdom regarding their insomnia which will guide him or her to further carry out the actions needed to alleviate this suffering (i.e., the symptom of insomnia and the attending dysfunctions).

As one can see here, the four stations of mindfulness are four specifi c appli- cations. Thorough application of mindfulness through all four stations is Buddha’s strategy for ameliorating suffering. This results in abandoning the three erroneous views on life/existence, permanence, happiness , and self. This makes the practitioner attain the insights into the three universal characteristics of life/existence, which are exactly the opposites to the former three—imperma- nence (Pali. anicca ; Sans. anitya ), suffering (Pali. dukkha ), and not-self (Pali. ; Sans. anatma ). In the philosophical texts of the Mahayana Buddhism (Mulamadhyamika Karika, composed in second century by Nagarjuna, the great Mahayana Buddhist scholar; translated by Siderits and Katsura 2013 ), the con- cept of not-self has been described as emptiness (Pali. sunyata ). These four sta- tions of mindfulness essentially comprise the meditator’s lifestyle and philosophy of life in addition to the techniques in practice of meditation (mind- fulness). A similar all-encompassing scheme, from lifestyle to body to mind, is followed in Patanjali’s Eight-limbed Yoga as well.

4.5.4 Actual Practice of Right Mindfulness Is Twofold (Detailed Description Can Be Found in Nyanaponika, 1965 , p. 85–107)

The whole evolving course of the practice of meditation begins with mindfulness, the regulating power that keeps the mind clear, cognizant, supple, and balanced. 4.5 Techniques of Mindfulness Meditation (Pali: Satipatthana) 131

There are two ways to the actual practice of Right mindfulness in the four stations/ objects of mindfulness (body, feelings, state of mind, and the mental contents), each involving a threefold method.

(a) The fi rst way is to apply all the exercises on the four stations/objects of mindful- ness in three folds: (1) to self (meditator), (2) to other (object of meditation, which may include other persons), and (3) to both the self and object, including the relations between the two. This is conceptually similar, at least in part, to the self–object–affect triad of Object Relations Theory (Greenberg and Mitchell 1983 ) . Object Relations Theory, as a school of psychoanalytic psychology, views affect as the relationship between the self–world and the object–world . For example, when the meditator is contemplating on the body as the fi rst station of mindfulness, it involves meditating on the body internally (in himself/herself), externally (in others), and then both internally and externally in immediate suc- cession. In comparing the internal and the external, the observed similarities and differences become highly instructive. In addition, attention is drawn to the inter- connections between the self (internal) and object (external) components (in this case the body). Unlike the Object Relations Theory, through the systematic med- itative development of insight/knowledge by direct experience (Pali: vipassana ), only the internal objects are observed by bare attention. This is because direct experience accesses only one’s internal objects (bodily/mental processes). The external objects (bodily and mental activities of others) present themselves either as direct sense perceptions or inferences rather than as direct experiences. Regardless, mindfulness on external objects should be practiced outside the strict meditative practice and in the various situations of one’s daily life. (b) The second way of application of all the exercises on the four stations/objects of mindfulness proceeds in another threefold rhythm: in this bare attention is paid to (1) origination of each mental object (the arising ), (2) dissolution of each mental object (the passing away), and (3) both origination and dissolution of each mental object. This direct experience of the fact and the nature of change of each mental object are the key points in the practice of Right mindfulness.

4.5.5 Some Bare Instructions for of the Practice of Right Mindfulness (Nyanponika 1965 , p. 61–63)

In an experiential process like the satipatthana , elaborate instructions are not given for two primary reasons: (a) language with which instructions will be given can’t convey the actual meanings intended and (b) the central concept that the meditator’s own experience of the process of meditation will guide them. Of course, progress is easier under the directions of an experienced meditation master. That is why the simple instructions described below can be considered bare instructions. For prac- tice of meditation, a lot of special preparations are not needed. All that is required is moderation in one’s lifestyle (Buddha’s Middle Path ) such as diet and sleeping habits, avoiding intoxicants during practice, and integrating the meditative 132 4 Methods in Yoga and Mindfulness experience into one’s daily life. The comfortable posture (Sanskrit: ) is a sitting posture and is recommended for meditation practice, but as long as both feet are placed on the ground and the spine is kept erect, even sitting on a straight chair is acceptable for practice. In the comfortable posture , both bent legs are placed on the ground evenly. The heel of the left foot rests between the legs; the toes are between the knee bend of the Right leg which provides, as it were, the outer frame of the left leg. In this posture, there is no pressure on the limbs. The actual practice of Right mindfulness involves the meditator disassociating, de-identifying, and then unclinging fi rst from the body and then the mind. T ranscending from the body and mind, one can attain pure experience. The goal in mindfulness is to have the direct experience (direct because in this experience, the object being experienced will speak for itself directly, whereas in ordinary experi- ence the mind as the interpreting interface speaks for these objects. As we know, the mind is subjective or conditioned and colors or distorts the experience with its fi ve objects/aggregates; see Chap. 2 for more discussion of aggregates). Direct experi- ence is impersonal, non-referential, and nonsubjective (i.e., devoid of self). The objects of the Right mindfulness are mankind in its entire existence and experience. To achieve mastery, the meditator should cultivate all four contemplations or objects of mindfulness: (1) contemplation of the body and breathing, (2) contemplation of feeling, (3) contemplation of the state of mind, and (4) contemplation of mental contents/phenomena (dhamma ). During the process of contemplation, bare atten- tion/concentration can be maintained by the primary object of concentration , which is the awareness of the rising and falling movements of one’s abdomen while mind- fully and meditatively breathing. When distracted, one can fl exibly and intermit- tently use other objects (the secondary objects of concentration), like the various body parts and bodily sensations or inanimate external objects like a dark spot. Eventually the meditator returns to the primary/original object of concentration. Mere registration, bare awareness, and detached observation of the form, fl ow, and the sequence of mental events in one’s awareness are more important than their elaboration, as elaboration adds to the subjectivity and thus distortions.

4.6 Meditative Breathing (Sans. Pranayama ): The Key Tool in Meditation

Pranayama (Sanskrit: prana = vital energy, ayama = expansion, extension of this energy as well as controlling, storing, and distributing it) is the Sanskrit name for the yogic–meditative breathing described in the Yoga Sutras (Section II, verse 49: Taimni 1961 , p. 231). Pranayama is the fourth limb of Yoga in the Patanjalian scheme of ashtanga. Pranayama and pratyahara and dharana (the fi fth and sixth limbs, respectively) are the key preparatory steps for the practice of any form of meditation (samyama or mindfulness ). Pranayama means control of the vital energy of the body and mind. In classical Yogic texts, prana is conceptualized as the vital life energy that is present in each individual (elaborate description of this can be found in Sivananda 1994 , p. 44–52). There is very close connection between prana 4.6 Meditative Breathing (Sans. Pranayama): The Key Tool in Meditation 133

(which is grossly manifest as one’s breath ) and the mind or soul. Interestingly, in many languages across the globe, breath is closely associated with the notion of soul. In Sanskrit, atman is closely associated with the breath and the soul; in Arabic and Hebrew the word ruh signifi es both breath and spirit/soul; in Greek, psyche means both breath and life/soul; in Latin, anima means both breath and soul; and in Romanian, the word sufl et means soul and comes from the word sufl u which means breath. Prana is not exactly the breath, although it is usually translated so. Prana is rather subtle: the difference between prana and breath is similar to the differences between physical body and the subtle body (Sans. sukshma sarira) described in tantra (Sivananda 1994 , p. 98). Meditation is the process of unconditioning our mind from its existing condition- alities so that one perceives the experience in its pure form without the interface of and interference from the sensorial mind (please see Chap. 5 for description of the conditions of mind and the fi ve aggregates ) . The two key steps in meditation are (Rhys Davids 1899 , p. 327, 328):

(a) To make one’s experience continuous by avoiding all the breaks (distractions) (b) To deliberately transform one’s automatic physiological acts like breathing into conscious acts

So meditation in scriptural sense is deliberate awareness training aimed at devel- oping a continuous stream of awareness or experience; this is a process that requires tremendous control—nothing remains automatic. This is the fundamental process in the scriptural traditions of meditation as prescribed by Buddha in his Right mindful- ness (satipatthana ) or by Patanjali in his samyama. As mentioned before, in the practice of Yoga and meditation, breathing is not only the key element in one’s stress response and metabolism, but also is the connecting link between one’s body, mind, and environment. As emphasized in both the Buddhist and Patanjalian tradi- tions, breathing is the main tool both for focusing and for ascending to meditative states. This explains why the Buddhist meditative traditions consider breathing and the associated rising and falling movement of the abdomen the primary objects (Pali. mul arammana) in the practice of concentration (Nyanaponika 1965 , p. 94). There could be many reasons for this scriptural recommendation. Breathing and the associated events in the body (e.g., movement of belly or shoulder during breathing, the faint sound when we exhale) are always available to us as anchoring objects (i.e., the concentration objects [Pali. kasina ]) during the practice of deep concentra- tion. This method does not require any other symbols or mantra chanting or their meanings (in mindfulness traditions, these are secondary objects ) which pose the dangers of serving as mere distractors during the practice. Also, the movements (rise and fall) of breathing are tangible and easily perceptible to the practitioner. Because it is neutral and generic, the mind cannot ruminate on the breath. Instead, when one uses breathing as the primary object, the mind becomes centered in the moment. In addition, breathing plays a critical role in our basic survival, metabo- lism, and modulation of arousal responses. Arousal responses, through mediation of their attending thoughts, feelings, perceptions, memories, and will (the fi ve objects 134 4 Methods in Yoga and Mindfulness of mind ), allow the mind to drift away from the present experience. In the continu- ous stream of experience, each of these lapses or drifts are like breaks or fragments imposed by the outwardly driven mind, which always runs away from the inner locus of any experience. Meditative breathing (Sans. pranayama ) not only makes us stay in the moment, but it also decreases these arousals and breaks, creating a con- tinuous experience.

4.6.1 Standardizations in the Two Breathing Meditations and Their Symptom-Specific Use in the Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT© )

According to Yogic philosophies, the most apparent external manifestation of the prana is the motion of the lungs due to breathing. As mentioned before, the Buddha’s way of meditation is to transform all automatic and habitual phenomena in the body and mind into conscious phenomena so that one can attain conscious control and, ultimately, freedom. Breathing connects our inner body with the environment or the universe. The inanimate atmospheric air becomes alive and vital (prana ) inside the living system of the body. Pranayama is more than just a deep-breathing exercise. Precision, mindfulness, and dedicated practice are essential. One’s breathing stands on the threshold between the voluntary and involuntary bodily functions and thus offers a good means of extending the scope of conscious control over the body. Recognizing this key aspect, Pradhan et al. use two specifi c types of meditative breathing in their clinical and research protocols involving Yoga and mindfulness interventions, in addition to the concentrative and mindfulness meditation. Both the Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT: psychotherapeutic ver- sion of Yoga and meditation for mental illnesses; Pradhan et al. 1998 onward) and its precursor, the Standardized Yoga Meditation Program for Stress Reduction (SYMPro-SR ©: wellness version of Yoga and meditation for mental health) use Yoga in its entirety (i.e., all eight limbs including meditation, its 7th limb) rather than in a piecemeal fashion. Both these models have been adapted from the three original traditions of Yoga and mindfulness, i.e., Buddha’s vipassana meditation (satipat- thana ), Patanjali’s Eight-Limbed Yoga ( ashtanga ), and the standardized and tech- nique-rich traditions of Tantra . As a wellness model, the SYMPro-SR was developed by Pradhan in 1992–1994 during his monastic training. Initially he piloted this in a normal and healthy population in India including himself as a means for stress reduc- tion, improvement of productivity, and improvement of quality of life. There is a signifi cant difference between the normal respiratory volume of 500 ml and the maximum capacity of respiration of up to 5 l (Martini and Nath 2008 ). In meditative breathing ( pranayama), 75 % of the air intake is caused by the contraction and a few centimeters downward movement of the diaphragm. The remaining 25 % of the air intake is caused by the rising of the side ribs by the inter- costal muscles that rise at the beginning of an inhalation (Iyengar 2009 ). The two standardized breathings described here combine both these actions, resulting in quiet, slow, and deep breathing that involves the whole lungs from the diaphragm at the bottom to the shoulders at the top, rather than just the upper portion. The 4.6 Meditative Breathing (Sans. Pranayama): The Key Tool in Meditation 135 breathing frequency is around 2–4 breaths/min as compared to 12–16/min in ordi- nary respiration. This conscious, deep, and almost noiseless breathing is different from forced breathing using the accessory muscles of respiration. These accessory muscles are not very active in these two types of meditative breathing. In the two standardized breathings described here, the main respiratory muscles are used for inhalation; exhalation is passive and is due to elastic rebound. During inhalation, the emphasis is both on the contraction of the diaphragm and vertical movement of the whole chest, which make the shoulders rise up at the height of inspiration. This increases the thoracic volume so that air can be drawn into the lungs. The two types of meditative breathings standardized by Pradhan (1998 onward) are briefl y described below:

(i) The calming heartfelt breathing: this specifi c breathing is the one initially rec- ommended in the Buddhist mindfulness traditions in which one uses one’s breathing and the associated movements as the anchors (kasina ) for meditation (Nyanaponika 1965 , p. 61–63, 94–95). This author standardized this type of breath for various age groups with respect to its rate, rhythm, and its physiolog- ical effects on the practitioners as well as the type of somatic and psychiatric symptoms. This type of breathing increases one’s parasympathetic tone, hence the name calming heartfelt breathing. This author routinely uses this type of breathing meditation to decrease the hyperarousal responses in patients suffer- ing from panic disorder and post-traumatic stress disorder (PTSD) with great success (Pradhan et al. 2014a , b ). (ii) The energizing breathing : This is Pradhan’s modifi cation of two yogic breathing procedures: and (Sivananda 1994 , p. 47–48). This type of breathing is activating, as it increases one’s sympathetic tone. Compared to calm- ing heartfelt breathing , energizing breathing incorporates a specifi c sequence of holds on breath in the various stages of respiration. These holds are one of the factors that cause activation of the sympathetic system (Telles et al. 1996 ) as evidenced by the rise in heart rate, body temperature, and energy level. The author and colleagues successfully use this type of breathing meditation in hypoarousal states to overcome the lethargy and amotivation associated with depression.

It is very important to realize that the breathing in both the calming and energiz- ing types of pranayama is through the nose only (not through the mouth), so both nostrils need to be open before one practices these (which can be achieved by sim- ply blowing the nose gentle or by practicing the nadi sodhana pranayama, a specifi c Yogic procedure, descriptions of which can be found in Sivananda 1994 ). The pranayama has been standardized by this author for clinical use and consists of three steps in 1:2:1 ratio with respect to their durations: inhalation (Sans. puraka ), reten- tion of breath (Sans. ), and exhalation (Sans. rechaka ) of the breath. Thus, in the calming heartfelt breathing, duration of inhalation, retention, and exhalation is about 5, 10, and 5 s, respectively (thus, one breathing cycle is approximately 20 s, i.e., 3 deep breaths per minute; of note, ordinary breathing rate is about 12–16/min). Compared to the calming heartfelt breathing, in the energizing pranayama, the dura- tion of breath hold (Sans. kumbhaka ) is longer (as tolerated by the practitioner) than 136 4 Methods in Yoga and Mindfulness in the former type, and this breath holding causes the sympathetic activation to energize the practitioner. In these , inhalation is felt more in the inner, lower part of the nasal sinuses and exhalation in the outer, upper part. Breathing in both these pranayama is almost soundless and through nose only, but the motion of the breath will be visible (rise and fall of shoulders during inhalation and exhalation, respectively). However, if one listens carefully to the breath during this practice, inhalation is more of a soft sss sound, exhalation more like hhh . Usually the eyes are closed, soft, and directed (internally) toward the tip of nose. Occasionally, they can be slightly opened to control the posture without disturbing the inner stillness. During this process, the middle of the forehead remains relaxed; the ears are relaxed, sensing the very mild sound of the breath.

4.6.2 Breathing Techniques Versus Breathing Meditations: Key Distinctions

As one can see from these descriptions, the two types of meditative breathing tech- niques described above complement each other physiologically, as well as metaboli- cally. When used in the Right combination, they quickly induce meditative states. These two techniques are not just breathing techniques; they are actually breathing meditations (as explained in Sect. 4.6 of this chapter). Technically speaking, they fall under the category of concentrative meditation, in which one’s breath and its associ- ated movements are used as the anchors to induce mindful states. Patanjali and Buddha emphasized that during pranayama, the mind is steadied when fi xated on some kind of focal point. During practice of these two breathing techniques, deep concentration plays a vital role. In practice of these breathings, one uses the vertical movements of one’s breathing (rising and falling of the trunk during inhalation and exhalation respectively) and the faint sounds (the soft sss sound of the gentle expira- tion as mentioned above) as the points of focus. Thus in this, one transforms the simple breathing into focused meditation by these fi xative anchorages in order to control the easily distracted mind. After the initial training using these standardized breathing meditations (i.e., concentrative meditation or focused attention type), the practitioner progresses to the mindfulness meditation (open monitoring type) by fur- ther refi nements of the practice of meditation done by using the scriptural model of the mind as described in Chap. 2 (mind as a bundle of fi ve things).

4.6.3 The Two Breathing Meditations in Terms of the Heart Rate Variability (HRV)

The two breathing meditations mentioned above play foundational roles in the staged meditation protocols (SMP) designed by Pradhan et al. in their clinical and research use of the treatment plans involving Y-MBCT interventions. As mentioned above, the calming, heartfelt breathing meditation stimulates the parasympathetic system, whereas the energizing breathing meditation stimulates the sympathetic system. These two breathing meditations are applied in a symptom-specifi c way during a particular References 137

therapeutic window period that depends upon the characteristics of the individual dis- order (see Chap. 7 for more elaborations). In hyperarousal states including anxiety- or fear-provoking situations, the effects of these two types of breathing are noticed within a few minutes of practice. These two breathing meditations and their successful appli- cations in health and illnesses support the crucial role of the autonomic nervous system (sympathetic and parasympathetic) in mediating the stress response. A good indicator of the balance between the tones of the parasympathetic and sympathetic systems in one’s body is the heart rate variability (HRV; also called instantaneous heart rate ). HRV means the alterations in the inter-beat intervals in response to stress, i.e., changes in the interval between one beat of the heart and the next (in EKG, this is measured by the alterations in the distance between successive R-waves). This range defi ned by minimum to maximum heart rate capacity is a key factor determining the level of health. As the physical condition of an individual deteriorates, this heart rate variability range (HRV range, defi ned by minimum to maximum heart rate capacity) can actually become narrowed to the point of limiting their ability to adapt to the stresses of daily life. One goal in promoting the cardiovascular health is to maintain the HRV range as wide as possible. HRV has emerged as a simple, noninvasive, and reliable method to evaluate the sympathetic and parasympathetic (vagal) balance at the sinoatrial level in the heart. Studies indicate that coherence in HRV is associated with decreased stress and improvement in cardiovascular health, immune function, and mood (Kristal- Bonech et al. 1995 ). HRV can be easily and noninvasively assessed and is a promising research parameter that bridges the gap between biology and mindfulness. HRV bio- feedback has emerged as a novel technique for training human beings to change the variability and is being applied to a variety of clinical conditions including anxiety, asthma, cardiovascular , irritable bowel syndrome, and chronic fatigue, just to name a few. However, it is diffi cult to analyze the HRV during the traditional Yogic breathings ( pranayama ) because these breathings in their non-standardized forms involve altering the breathing frequency, ratio and depth, tidal volume and minute ven- tilation infl uences, etc., which need to be fairly constant for interpretation of HRV. This author’s standardization provides a method to circumvent this particular diffi culty and could help HRV biofeedback to be applied to its true potentials, either alone or in com- bination with meditation.

References

Avalon A (1974) The serpent power: being the Sat-cakra-nirupana and Paduka-pancaka: two works on Laya-yoga. Courier Dover Publications, New York Bendal C (1902, trans) Siksasamuccaya of Santideva (Bibliotheca Buddhica). St. Petersburg Publications, St. Petersburg Bodhi B (2000) The Noble Eightfold Path: way to the end of suffering. Pariyatti Publications, Onalaska Buddhaghosha (originally written in Pali language, circa. 430 CE): Visuddhimagga (The path of purifi cation; English translations by Nyanamoli, 1976). Sambhala, Berkley Cahn BR, Polich J (2006) Meditation states and traits: EEG, ERP, and neuroimaging studies. Psychol Bull 132:180–211 Dalai Lama (2009) The Middle Way: faith grounded in reason (trans: Jinpa T). Wisdom Publications, Boston 138 4 Methods in Yoga and Mindfulness

Davidson RJ, Goleman DJ (1977) The role of attention in meditation and hypnosis: a psychobio- logical perspective on transformations of consciousness. Int J Clin Exp Hypn 25:291–308 Eliade M (1969) Yoga: for immortality and freedom, 2nd edn. Princeton University Press, Princeton Feuerstein G (1990) Yoga: the technology of ecstasy. The Aquarian Press, Wellingborough Goleman D (1988) The meditative mind: the varieties of meditative experience. G.P. Putnam and Sons, New York Greenberg J, Mitchell S (1983) Object relations in psychoanalytic theory. Harvard University Press, Cambridge, MA Iyengar BKS (2009) Light on Pranayama. Crossroad, New York Kristal-Bonech E, Raifel M, Froom P, Ribak J (1995) Heart rate variability in health and disease. Scand J Work Environ Health 21:85–95 Lutz A, Slagter HA, Dunne JD, Davidson RJ (2008) Attention regulation and monitoring in medi- tation. Trends Cogn Sci 12:163–169 Martini FH, Nath JL (2008) Fundamentals of anatomy and physiology, 8th edn. Pearson, London Niranjananada S (1993) Dharana Darshan: yogic, tantric and upanishadic practices of concentra- tion and visualization. Yoga Publications Trust, Munger Nyanaponika T (1965) The heart of Buddhist meditation. Samuel Weiser Publishers, York Beach Pradhan BK, Mishra B (1998; 18-patients: 9 patients and 9 controls, unpublished data) A pilot project on utility of Yoga and meditation in a population with alcohol and opiate addiction. Research study conducted at S.C.B. Medical College, India Pradhan BK (2014) Mindfulness based visual fi xative & retentive techniques in treatment of dys- lexia: psychobiological rationale & proposal for future clinical trials. Presented at the annual conference of the Cooper Learning Centre, Cooper University Hospital and Cooper Medical School of Rowan University, Camden Pradhan BK, Pumariega AJ, Parikh T, Goodman M (2014a) Yoga and Mindfulness Based Cognitive Therapy (Y-MBCT) for treatment of refractory depression, panic disorder and social phobia: a case series of its successful application in adolescents. Manuscript accepted for publication in Adolescent Psychiatry Pradhan BK (Chair Person and Speaker), Pumariega AJ, Sharma A, Sahoo M, Varma VK, Gupta N, Sarvet B (2014b) Yoga-mindfulness interventions in mental health and illness: moving towards symptom specifi c models. Workshop accepted for presentation at the annual conference of the American Psychiatric Association (APA), New York Rhys Davids CAF (trans.) Dialogues of the Buddha. [Pali. Digha-nikaya ] (1899), vol II. Oxford Publishers, London Rommelse NNJ, Stigchel SV, Sergeant JA (2008) A review on eye movements studies in childhood and adolescent psychiatry. Brain Cogn 68:391–414 Santina PD (1997) The tree of enlightenment: an introduction to the major traditions of Buddhism. Buddha Dharma Education Association Inc., Chico Satchidananda S (1978) The Yoga Sutras of Patanjali: translations and commentary. Integral Yoga Publications, Yogaville Satyananda S (1976) Four chapters on freedom: commentary on the Yoga Sutras of Patanjali. Yoga Publications Trust, Munger Siderits M, Katsura S (2013) Nagarjuna’s Middle Way. Mulamadhyamakakarika . Wisdom Publications, Boston Sivananda S (1994) Kundalini Yoga, 10th edn. Divine Life Society Publication, Himalayas Taimni IK (1961) The science of Yoga: the Yoga-Sutras of Patanjali in Sanskrit with transliteration in Roman (translation and commentary in English). Nesma Books, India Telles S, Nagarathna R, Nagendra HR (1996) Physiological measures of right nostril breathing. J Altern Complement Med 2:479–484 Thanissaro B (1993, trans) Dhammacakkappavattana Sutta [Pali]: setting the wheel of Dhamma in motion. Online: (Legacy Edition). http://www.accesstoinsight.org/tipitaka/ sn/sn56/sn56.011.than.html . Accessed 30 Nov 2013 Vivekananda S (1956) Raja Yoga. Ramakrishna Vivekananda Center, New York Warren HC (1896) Buddhism in translations. Cambridge Press, Boston Attempts at Standardization 5

…without meditation there is no wisdom, & without wisdom there is no meditation. But for the practitioner who puts meditation and wisdom together, the whole ocean of samsara (cycle of birth & death) can be dried up…. (Nagarjuna, second century CE Buddhist philosopher)

5.1 Standardization of Yoga and Meditation in Ancient India: Primacy of Buddha’s Abhidhamma Pitaka and Patanjali’s Yoga Sutras

Yoga is an ancient system of experiential science that has survived thousands of years. Despite the long and rich history of Yoga, for various reasons already mentioned in Chap. 1, Yoga has been used (and abused) in quite heterogeneous and non-standardized ways. Use of Yoga and meditation in piecemeal rather than in its entirety is analogous to the fragmented knowledge of the fi ve blind men about an elephant in the popular fi ve blind men and the elephant metaphor . Thus, in general, it is diffi cult to determine defi nitive effects of Yoga in healthcare as the quality of research has design limitations and lack of methodological rigor. So there is a long-standing need for standardization of techniques of Yoga and meditation, both in clinical practice and in research. Taking a look at the classics like Patanjali’s Yoga Sutras (fourth century BC) and the great Abhidhammic texts including the Visuddhimagga ([Pali] Path of Purifi cation; Buddhaghosha, circa 430 CE), one can realize the comprehensive attempts by Buddha and Patanjali to standardize the heterogeneous systems of meditation and Yoga, respectively, in ancient India about 2,500 years back. There are several schools or paths of Yoga involving some basic physical training and various mental disciplines designed for people of different types and at different spiritual levels. Among all these different schools, the Yoga Sutric Eight -limbed Yoga (Ashtanga Yoga /Raja Yoga ) and the Buddhist Noble Eightfold Path are the

© Springer International Publishing Switzerland 2015 139 B. Pradhan, Yoga and Mindfulness Based Cognitive Therapy: A Clinical Guide, DOI 10.1007/978-3-319-09105-1_5 140 5 Attempts at Standardization best documented and most elaborate methods. Patanjali’s standardization in the Ashtanga involves the entire aspects of Yoga (all the eight limbs) spanning from lifestyle and body and culminating in mediation on the mind. Buddha’s standard- ization involves more so on the psychology of Yoga and elaborates operationalization of the system of meditations and, above all, how they can be applied in psychological formats (psychotherapy) to one’s daily life. Stilling of the fl uctuations in the mind , one of the key goals of Yoga, according to both Buddha and Patanjali, is achieved by persistent practice (sadhana ) using the guid- ance of the Noble Eightfold Path or Eight -Limbed Method , respectively.

5.2 Buddha and His System of Standardization

Buddha grew up in the middle of both Shramanic (Buddhist and Jain religions) and Brahminic (Hindu Vedic and Upanishadic ) traditions. As mentioned earlier, the two early teachers of Buddha were Alara Kalama and Uddaka Ramaputta, meditators from the Indus Valley (Brahminic ) traditions. Based on this learning, Buddha further expanded upon the Yogic and meditative ideas of the Indus Valley civilization and fur- ther improvised to present it in a form of more personally usable wisdom rather than as metaphysical philosophies. He did especially so in the realm of meditation as a formal contemplative discipline to examine the human mind, its problems and the various ways or techniques to handle these problems. Because of its focus on the human mind, Buddha’s meditative method is popularly called as the mindfulness meditation . To know more about the standardization of meditation in Buddhism, one needs to have some ideas about the original Buddhist scriptures (The Theravada canon or Tripitaka [Pali Three baskets of knowledge]). The Tripitaka , recorded in Pali, was fi rst compiled by the monastic community (Pali ) in the middle of the fi rst century BC long after Buddha passed away (circa 483 BC), whereas the earliest (like the ) were written no later than the fi rst century CE (Santina 1997 , p. 157). In the Pali cannons of Theravada Buddhism, the three divisions of Tripitaka are Pitaka (basket of discipline / rules of Sangha ), Sutta Pitaka (the basket of discourses / sermons of Buddha and his close disciples), and Abhidhamma Pitaka. Literally Abhidhamma Pitaka means basket of higher doctrine (Pali Abhi = sense of preponder- ance and distinction and dhamma = teachings, phenomena, doctrine; Pitaka = basket). Abhidhamma Pitaka is a detailed psycho-philosophical analysis of the dhamma or mental phenomena (Sans. dharma ) and is quite distinct from the other two divisions because it presents the appearance of an abstract and highly technical systemization of the doctrine ( dhamma ) in seven terse books and no wonder held in the highest esteem in the Theravada tradition. Abhidhamma Pitaka is distinct not only by its analytical precision but also by its immaculately articulate and comprehensive description of the human experiences in terms of the various levels of realities or Truths. Comparing the two classic books, one can see that the Yoga Sutras of Patanjali describes all aspects of Yoga including meditation, whereas Visuddhimagga is primarily an encyclopedic guide to meditation and provides us with detailed elaborations of the standardization of meditation by the Buddha himself. Like the Yoga Sutras , the Visuddhimagga is a com- pilation rather than an original composition (Bodhi 1993 ) which concisely surveys all the methods of meditation and the accompanying mental states as the practitioner 5.2 Buddha and His System of Standardization 141 traverses through the various levels in the meditative experience. As one can fi nd in the descriptions of meditation in the Visuddhimagga , all the theoretical analysis of the mind and matter fi nally converges upon the practice of meditation, and the practice culmi- nates in the attainment of the liberation (nibbana ) of the mind, the supreme goal of Buddhism. Buddha’s standardization is evident not only in his phenomenological and analytical approach in studying the human mind but also in his categorization of the complex philosophies into clear and pragmatic ways in the form of symbolism of dis- ease and cure. For more elaborate descriptions of the standardization involved in the Abhidhamma Pitaka, interested readers can refer to many wonderful and scholarly books (classics as well as modern) (including but not limited to Buddhaghosha, 430 CE (trans. Nyanamoli, 1976 ); Nyanaponika 1965 , p. 85–107; Eliade 1969 , p. 162–199; Bodhi 1993 , 2000 ; Santina 1997 , p. 333–339, 341–347; Goleman 1988 , p. 1–38). Broadly, Buddhist standardization can be categorized in the following six areas:

(i) Standardization of the process and techniques of meditation (this aspect is already described in Chap. 4 ) (ii) Standardization of mental processes/phenomena (iii) Standardization involved in the analysis of the various human experiences as creations of the mind (iv) Standardization involved in the categorization of human consciousness (v) Standardization in the analysis of conditionality of the human existence (vi) Standardization involved in the philosophy of life (the Four Noble Truths of Life ) and the required path to obtain liberation (the Noble Eightfold Path )

5.2.1 Elaboration on Buddha’s Standardization of Mental Processes/Phenomena

Buddha literally means The Awakened . All the teachings of Buddha are compiled in the form of texts which are collectively called as Abhidhamma Pitaka. The texts of Abhidhamma are the most sacred and distinct teachings of Buddha himself, and just a glance at these canonical texts is enough to recognize the standardizations of the various mental processes inherent in these descriptions. This phenomenological psychology which carries the sacred knowledge of the Buddha himself is precise defi nitions as well as elaborate concepts and systematizations about the nature of the human mind and human experience and thus is unique in the history of human thought. Abhidhammic materials have standardized the human experiences in terms of aggregate or factors and have fi ve distinct characteristics (Santina 1997 , p. 312):

(a) Defi nition of mental factors/aggregates (Pali dhamma or phenomena ) (b) Relation of mental factors to other factors (c) Analysis of factors (d) Classifi cation of factors (e) Arrangement in numerical order

An important point to understand is that classifi cation of the factors in Abhidhamma is functional rather than ontological, i.e., the same factor has been 142 5 Attempts at Standardization used in different categories, but this is not repetition; rather this is due to differential functioning of the factor (with the same name) in each category. Abhidhammic stan- dardization is very clear and comprehensive as one can see below (Santina 1997 ): it categorizes the matter and the material experience into 28 elements and 24 modes of conditionality of the mind. Out of the 28 elements , four are primary elements (, water, fi re, and air) and fi ve are the sense organs. The 24 modes of conditionality include (a) the four roads to power (also termed predominant conditions [Pali adhipati ]), i.e., wish or desire, energy, thought, and reasoning, and (b) the fi ve con- trolling faculties (also termed as sense organs [Pali indriya]), i.e., faith, energy, mindfulness, concentration, and wisdom. In Abhidhammic scheme, the fi ve powers and the fi ve controlling faculties are considered as two aspects of the same thing. The 24 modes of conditionality of the mind mentioned above function in relation to the 12 components of interdependent origination out of which ignorance is the fi rst component. There are three unwholesome (means what tends toward undesirable results or perpetuation of suffering ) states of the mind: greed, hatred, and delusion. In addition, the eight worldly conditions (which are like two sides of the same coin) are happiness and pain, gain and loss, praise and blame, and fame and infamy. In Abhidhamma, one also can see elaborate standardizations of enlightenment too which consist of 37 factors/primary means to gain enlightenment and for obvious rea- sons deserve special mention. These 37 factors which form a fundamental part of the foundation of the Abhidhamma teaching are classifi ed under seven groups (Santina 1997 ): (1) the four stations of mindfulness (satipatthana ), (2) the four right efforts (samma padana), (3) the four roads to power ( ), (4) the fi ve controlling fac- ulties, (5) the fi ve powers (bala ), (6) the seven limbs of enlightenment ( bojjhanga ), and (7) the Noble Eightfold Path (atthangika magga ). The four principal stations of mindfulness are already elaborated in Chap. 4. The seven limbs of enlightenment are (1) mindfulness, (2) investigation, (3) energy, (4) interest/happiness (different from joy/ rapture), (5) tranquility of the mind (results from eliminating the affl ictions of igno- rance, ill will, and attachment), (6) concentration, and (7) equanimity (even-minded- ness toward all sentient beings—the absence of both attachment and aversion because both are part of clinging ). Similarly, standardization does exist in terms of the right efforts which are fourfold: (1) effort to prevent unwholesome thoughts from arising, (2) effort to reject unwholesome thoughts once they have arisen, (3) effort to cultivate wholesome thoughts, and (4) effort to maintain wholesome thoughts that have arisen. This fourth one is particularly important because it is the most crucial effort to maintain the enlightenment once it has been achieved. The objective in these four aspects of right effort is to replace the unwholesome thoughts with the wholesome thoughts in our daily life in a natural and ongoing manner, i.e., the whole life is a meditation .

5.2.2 Buddha’s Standardization in the Phenomenological Analysis of the Human Experience: The Five Aggregates

As mentioned in Chap. 2 , phenomenology is the description of things as they are experienced by the individual: the study of things as they appear to an observer from 5.2 Buddha and His System of Standardization 143 descriptive and experiential perspectives. Buddha can be called as one of the earliest phenomenologist because he was interested more in the descriptive phenomena of the mind and rejected the metaphysical and ontological aspects of the Vedas and the Vedantas (as described in Chap. 1 ) because in his realizations, unlike the analytical phenomenology, the absolute categories of metaphysics did not apply to things as they really are. Buddha in his method of analytical psychology analyzed all the experiences of the human condition with the goal of getting insight into these men- tal phenomena. In this Abhidhammic scheme, the data of human experience are divided into two components: (i) the objective component (the things we perceive around us) and (ii) the subjective component (we ourselves, the subjective perceivers). Buddha ana- lyzed the facts of experience into fi ve components or factors, both physical and mental, which are called the fi ve aggregates of experience or the fi ve factors / contents of the mind (Santina 1997 , p. 141–147). These aggregates (Sans. skandha ; Pali khanda, means a bundle or pile of things) are the most basic parameters of a person- alized human experience. In this scheme, the mere awareness of an object cannot be called as a personalized experience. Our personal experience about the various objects is rather elaborately produced through the functioning of the fi ve major aggregates or factors which are (1) aggregates of form or perception [Sans., Pali rupa] or physical world (internal and external), (2) aggregates of consciousness / aw areness / conception (includes thoughts/cognition [Sans. samjna ]), (3) aggregates of feelings or emotions [Pali vedana ], (4) aggregates of sensations/perception (sensing or perceiving an object), and (5) aggregates of volition (impulses), mental forma- tion , and memory [Sans. samskara ]. These fi ve aggregates function to turn our mere awareness of the object into a profound personal experience. The fi ve aggregates are further viewed in terms of the eighteen elements , and there is also an even more elaborate analysis in terms of the 72 factors which speak volumes about the stan- dardization involved in Abhidhamma. Aggregates of the form are self-explanatory, based on the form/physical appearance of the object; this is the only objective aggregate; the other four are subjective aggregates (i.e., based on one’s mind). Aggregates of feelings or emotions are of 3 types: pleasant, unpleasant, and indif- ferent/neutral. Aggregate of perception / sensation involves the various sensations and perceptions invoked in us by the objects in our experiences and the associated formulations like ideas or judgments about them. Aggregates of consciousness are the mere awareness of, or mere sensitivity to, an object. For example, when we see an object, fi rst the eyes and the visible object come into contact, then the conscious- ness (part of mind) joins with the material factors of experience, and after which visual consciousness arises. In this process, the ordinary consciousness (like visual consciousness in this case, consisting of the form and consciousness /mere aware- ness) becomes transformed to a profound personal experience through the function- ing of the other three major mental factors of experience, i.e., the aggregates of feeling, perception, and volition and mental formation/memory. Of note, the mental formation (memory ) and volition (will or impulse) are conceptualized as the condi- tioned response of our mind to the object of experience based upon the quality/ grade of the mind. This aggregate has two components: (1) the mental formation 144 5 Attempts at Standardization component which represents one half that comes from the past (similar to the Upanishadic concept of samskara and smriti which are related to concepts of mem- ory) and (2) the volition component which represents the other half that functions in the present, here and now, and propels us for carrying out the various actions. Mental formation and volition work together to determine our responses to the objects of experience, and these responses have moral consequences in the form of wholesome (means what tends toward desirable results or cure of suffering ), unwholesome (opposite of wholesome), and neutral effects. Volition has a moral dimension, just as perception has a conceptual dimension and feeling has an emotive dimension. Memory [Sans. samskara , smriti ], a key component in this fi ve-component model of the mind, adds colors to our thoughts, feelings, and perceptions so that the experi- ence is meaningfully constructed. Will/volition is the fi fth component which gives rise to motivation and action in an experience. One can argue that in the absence of these fi ve contents of the mind, we can’t experience the mind. About the nature of the fi ve aggregates, it is important to realize that each of them is impermanent and in a state of constant change, which concurs with the views of the modern science, i.e., experiences change in an ongoing manner.

5.2.3 Buddha’s Standardization Involved in the Categorization of Human Consciousness

Abhidhamma classifi es human consciousness into four classes (Santina 1997 , p. 333–334):

(a) The sense sphere consciousness [Pali kamavachara ]: consciousness directed toward the world of sense desires (b) Form sphere consciousness [Pali rupavachara ]: consciousness directed toward the world of forms/external shapes (c) Formless sphere consciousness [Pali arupavachara ]: consciousness directed toward beyond the form (d) Consciousness directed toward nibbana [this consciousness is called lokuttara ]

As mentioned in Chap. 3 , meditation is nothing but refi nement or purifi cation of one’s consciousness. In meditative process, as one progresses from consciousness type (a) to type (d), there is a progressive unifi cation and homogenization of the meditation object, i.e., the object at the sphere of sense desire is the most concrete, proliferated, and differentiated (there are 54 types of object consciousness in this category, Santina 1997 , p. 337), whereas those of the form and formless types of consciousness are increasingly less proliferated until the complete disappearance of these in the fourth type of consciousness which is directed toward a transcendental type of object (totally formless and abstract). Of note, the fi rst three classes of con- sciousness (“a” to “c”) are worldly/mundane consciousness [Pali lokiya chitta ] and are concerned with the world of conditioned things, whereas the fourth class, also 5.2 Buddha and His System of Standardization 145 known as supramundane consciousness [Pali lokiya chitta ], refers to the transcen- dental type of consciousness [Pali lokuttara ]. As mentioned in Chap. 4, the fi ve factors [Pali jhananga ] of meditative absorption [Pali jhana ], i.e., initial application of the mind, sustained application of the mind, interest, happiness, and one- pointedness, through intensifi cation of one-pointedness [Pali ekaggata ], lead one’s consciousness from the mundane types of super knowledge [Pali siddhis or accom- plishments, e.g., to read the thoughts of others and to recollect one’s former lives] toward the supramundane knowledge which eventually leads one to the supramun- dane sphere of consciousness [lokuttara and nibbana ].

5.2.4 Buddha’s Standardization in the Analysis of Conditionality of the Human Existence

The analysis of conditionality of the mind and existence in the Abhidhammic tradi- tion is dealt under two headings: (a) the analysis of the 24 conditions/modes of con- ditionality and (b) the analysis of 12 factors of interdependent origination. These 24 modes of conditionality are not mutually exclusive with each other, and they function in relation to the 12 components of interdependent origination. The 24 conditions are not mutually exclusive. In the cause and effect scheme of Abhidhamma, these 12 components are interpreted in 2 ways: (1) active (or causal) and (2) reactive (or resul- tant). This is the cause – effect analysis of conditionality that exists in the formula of interdependent origination . The Four Noble Truths , as one can see later in this chap- ter, also refl ects this cause–effect analysis. Honoring the format of this book, it is not possible to elaborate the 12 factors or 24 conditions, but in this cause–effect scheme, the 12 factors of interdependent origination are analyzed in the light of the 24 modes of conditionality. It is important to note that in all 12 factors, there is no self, but only processes conditioned by other processes — processes that are, in their actual nature, empty of self and substance. This is essentially the doctrine of the emptiness (Pali sunyata ) or doctrine of nonself (Pali anatta ; Sans. anatma) or illusion of self, which the monk translates into the daily life through the philosophy of non - clinging (nei- ther getting attached to nor be repulsed by objects in one’s life) and the lifestyle of the Middle Way (Pali Mula Madhyamaka; Kalupahana 2006 ; Siderits and Katsura 2013). This understanding of the emptiness of self and substance is achieved through a thorough analysis and understanding of the conditionality and how they originate in an interdependent manner. The irony of this situation is that without this under- standing, we rather misunderstand the reality of these (in this particular context, Buddhist philosophy sounds like that of Vedanta which is not surprising considering the fact that both philosophies have originated from the wisdom of the Upanishad as already described in Chap. 1 ); we (mis)identify with them as part of self, whereas in reality there is no self; in actuality these are empty or void. In a conditioned manner, as the creations of the mind (with its 5 aggregates as described before), they just arise in our fi eld of awareness as mental phenomena (Pali dhamma ); they rise to the peak and eventually dissipate like a string of bubbles. In this process of conditioned aris- ing, neither there is a persistent, permanent, and identical self nor is there an 146 5 Attempts at Standardization annihilation of the continuity of the process of cause and effect. All phenomena are just part of a continuous stream of consciousness, and meditation is the way to real- ize the continuity of these phenomena (mental events) to understand them in more complete/real way, as they are likened to the analogy of a movie rather than snapshots .

5.2.5 Buddha’s Standardization of the Truths and the Way of Life: The Four Noble Truths and the Noble Eightfold Path

The Four Noble Truths The sermons (Pali sutta ) of Buddha can be summed up into which are popularly known as the Four Noble Truths of Buddha and, as the name suggests, are the four fundamental principles of life and nature of phenomena (Pali dhamma ). As refl ected in Buddha’s sermons, they serve as his central teachings. In Buddhism, these Truths are not just read but rather realized and lived through in one’s life. The Four Noble Truths are as below:

(a) Suffering (Pali dukkha ) is inevitable and universal to the human condition. (b) Craving or desire (Pali kamana ) and clinging are the causes of suffering. (c) The cessation of suffering is possible (by practicing the Right Path). (d) The Noble Eightfold Path (Pali atthangika magga) is the Right Path of practice that leads to the cessation of suffering.

As mentioned before, there exists a cause and effect among the Four Noble Truths . One can realize that the fi rst two Truths are about suffering and its causes; the last two are the end of suffering (the effect) and the path to the end of suffering (the cause for end of suffering). In simple words, these Truths clearly convey us the following facts of life: (i) nothing happens in isolation, everything is interconnected ( theory of interdependent origination of the experiences); (ii) everything is relative to something else, nothing is absolute (basis of the Middle Way , which is the path of moderation rather than that of the extremes); and (iii) nothing is permanent, all things arise and pass away; so no need to cling to objects/ideas (theory of imperma- nence [Pali anicca ]) (Dalai Lama 1992 ). Buddha further taught that because of our ignorance (Pali avijja ; Sans. avidya ) of these Noble Truths, we remain bound to the samsara (the wearisome cycle of birth, aging, illness, death, and rebirth). Craving propels this process onward, from one moment to the next and over the course of countless lifetimes, in accordance with kamma [Sans. karma], the universal law of cause and effect.

Standardization in the Noble Eightfold Path (Pali Atthangika Magga) Happiness and freedom (from confl icts of the mind) are the two major goals of spiri- tual life. The Noble Eightfold Path of Buddha, like the Eight - limbed Yoga (Ashtanga ) of Patanjali’s Yoga Sutra, is a way to achieve both these goals. The way is through combining the meditation with the wisdom. This way or path is the Path of 5.2 Buddha and His System of Standardization 147

Purifi cation ( Visuddhimagga), i.e., refi nements of the mind by cultivating a lifestyle enriched with the combination of the meditation (Pali jhanas and samapattis ) and the resulting insight (Pali vipassana ) and wisdom (Pali nanna ; Sans. jnana ). The Noble Eightfold Path involves (Santina 1997 , p. 62–63, 389) (1) right livelihood, (2) right speech, (3) right action, (4) right effort, (5) right concentration, (6) right mind- fulness, (7) right thought, and (8) right understanding. These eight steps of the path are divided into three ways of practice as follows: (a) right livelihood, right speech, and right action belong to the way of , (b) right thought and right under- standing belong to the way of wisdom , and (c) right effort, right concentration, and right mindfulness belong to the way of mental development. Because it is necessary to purify our words and actions before we can purify our minds, we begin with morality or good conduct. Also it is noteworthy that the mental development , by strengthening the capacity of the mind and by attaining control over it, prepares the mind to achieve wisdom, which opens the door to freedom and enlightenment. The mind is the single most important factor in the practice of the Noble Eightfold Path because the mind is the key to changing the nature of experience. It is important to note that the eight folds of this path are clearly interdependent as well as founda- tional, like in the eight limbs of the Ashtanga Yoga . In this method of Buddha, one can see standardization at its pinnacle. For exam- ple, Buddha’s way to practice the Noble Eightfold Path lies in four (sequential) steps as follows: (1) to cultivate the fi ve factors of meditative absorption to reduce the infl uence of the fi ve hindrances to practice, (2) to develop the fi ve controlling faculties, (3) to connect the fi ve controlling faculties to the practice of the Noble Eightfold Path in one’s daily life, and, fi nally, (4) to develop wisdom , which is the last group of practice in the Noble Eightfold Path. Of note, the fi ve factors of medi- tative absorption are initial application of the mind , sustained application of the mind , interest , happiness , and one - pointedness, whereas the fi ve hindrances [Pali nivarana] are sloth , doubt , ill will , worry , and sensual desire. The fi ve factors of meditative absorption help elevate one’s consciousness from the sense sphere to the form and formless spheres by removing these fi ve hindrances: initial application corrects sloth; sustained application corrects doubt; enthusiasm corrects ill will; happiness corrects worry and the associated restlessness; and one-pointedness cor- rects sensual desire (Santina 1997 , p. 343). The fi ve controlling faculties (also called the fi ve powers [Pali bala]) are faith , energy , concentration , mindfulness , and wis- dom. In the meditative process when the fi ve controlling faculties become unshak- ably established in the practitioner, they transform into the fi ve powers (bala ), which elevates the consciousness to the supramundane states, i.e., to the realm of nibbana . It is important to briefl y describe the concept of wisdom here. Wisdom is the understanding of ultimate reality which is the combination of two fundamental con- cepts about the mind and its associated phenomena. Those two concepts are those of (1) nonself (anatta ) and (b) emptiness (sunyata ). In Buddhist meditation, self is analyzed in relation to the fi ve aggregates. The self is not in any way ascertainable within or without the aggregates. In the context of a personal experience, the fi ve aggregates have dependent origination , i.e., in the fi eld of our consciousness, they 148 5 Attempts at Standardization do not originate by chance or without any cause. Rather, their origin is dependent on the affl ictions of the mind (e.g., ignorance, craving, and clinging) and hence the name interdependent origination which is called the greatest treasure of the Buddha’s teaching. Understanding interdependent origination is said to be the key to get freedom from the illusive self and from the worrisome cycles of birth and death [Pali samsara]. The Buddha himself considers that he who sees interdepen- dent origination sees the dhamma and that he who sees the dhamma sees the Buddha (Santina 1997 , p. 401). Thus, one can realize that standardizations in the systems of Yoga and meditation are not new; in fact they date back to ancient India, at least to the time of Buddha himself (circa fi fth century BC). The purpose of such elaborate analysis in the Abhidhamma seems many folds but is actually one: to create the wisdom ( through meditation ) of nonself or impersonal experience, i.e., to experi- ence the world that is not constructed on and around the idea of a self. This will serve to see personal experience in terms of processes or phenomena—in de - identifi ed (ego less) ways, in terms of impersonal functions rather than in terms of a self and what affects a self. This fundamental understanding (insight or vipas- sana ) will create an attitude of equanimity, which will help us overcome both the clinging and the aversion. This will tremendously help us overcome the emotional disturbances of hope as well as of fear about the things of the world. Only then we can honor the principles of equanimity, i.e., to regard happiness and pain, praise and blame, and all the rest with even-mindedness, and thus become liberated from the duality . This is essentially the reconciliation of the contradictory opposites to create harmony by seeing things as they are rather than seeing them as we want or hope them to be.

5.3 Standardization in the Yoga Sutras of Patanjali: The Eight-Limbed Yoga (Raja Yoga)

For description of Patanjalian system of Yoga including this portion, this author has referred extensively to the writings of Radhakrishnan ( 1923 , 1953 ), Vivekananda ( 1956), Taimni (1961 ), Eliade (1969 ), Satchidananda (1978 ), Feuerstein (1979 ), and Niranjanananda (1993 ). The Yoga Sutras , the fi rst textbook of Yoga, is believed to have been compiled by sage Patanjali (circa 400 BC) in ancient India. Despite the controversies about the actual dates of its compilations, the fact remains that it still reigns supreme as the primary source and the most authoritative text even after a few thousand years. At least 50 different English translations of the Sanskrit Yoga Sutras have been completed, standing as a human testament to the profoundness of Patanjali’s wisdom. Patanjali, being a true scholar, did not limit his instructions to any particular technique or to members of any particular religion. Describing Yoga as a universally applicable science of the human mind, he standardized this hetero- geneous system into eight limbs (like Buddha) and laid out the general principles and the broad path of Yoga and the various possibilities one can choose for practice. The Yoga Sutras is the recorded expositions of a Yoga master to the students of Yoga in the true sutra exposition tradition, expounded by one who doesn’t just read but 5.3 Standardization in the Yoga Sutras of Patanjali 149 rather lives those teachings in daily life. Studying the Yoga Sutras one can see that Patanjalian standardization in the form of the Eight-limbed Yoga ( Ashtanga or Raja Yoga ) is standardization of Yoga in its entirety using one’s body as well as the mind; eight steps starting from the practitioner’s lifestyle, body (posture, breathing, etc.) and culminating in the purifi cation of the mind (samyama ) to attain liberation (mok- sha ). Primacy of the Patanjalian Ashtanga Yoga is clearly refl ected upon its very name, the Raja Yoga (Sans. Raja = Royal; the king among all the methods of Yoga). Just looking at the organization of the chapters and systematic descriptions of the methods of Yoga in the Yoga Sutras, the fi rst textbook on Yoga, one can realize the depth of the standardization by Patanjali. It succinctly describes the process as well as practice of Yoga as the Eight - Limbed Method which is the most well-known part of the Yoga Sutras . The original defi nitional description of Yoga as described in sage Patanjali’s Yoga Sutra (Sans. Yogah chitta vritti nirodhah ; Yoga Sutra , Section-I, verse-2; Satchidananda 1978 , p. 3–6) has survived the test of time and still contin- ues to be essentially the core concept of Yoga. The standardization is quite evident by the fact that Yoga Sutras is a very concise handbook of Yoga describing the phi- losophy as well as practice of Yoga in its entirety in 196 terse verses (aphorisms) organized in four sections (Sanskrit pada ). These have been already described in Chap. 1 and so will not be repeated here. Patanjalian standardization of Yoga is evident not only in operationalizing all the previous knowledge of Yoga into eight limbs but also lies in its clear elaborations upon the key meditative process, the samyama and the various deep meditative states (samadhis ). As a great scholar of Yoga, Patanjali standardized all the very heterogeneous systems of Yoga prevalent in ancient India into the operational frame work of eight limbs. This homogeniza- tion of Yoga was never done before him. The clarity and unity Patanjali brought to divergent views on Yoga prevalent till then have inspired a long line of teachers and practitioners up to the present day. The value of Patanjali’s system of Yoga lies in its standardizations as well as its capacity to subserve the needs of different types of individuals. It has all the advantages of following a defi nite technique and none of the disadvantages of being confi ned within a rigid system. The eight-limbed scheme of Patanjali is an elaborate standardization of Yoga and basically consists of the following eight steps: (1) yama (moral behavior), including the fi ve abstentions , i.e., nonviolence, non-lying, non-stealing, no illicit sex, and nonpossessions; (2) niyama (healthy habits), including the fi ve observances , i.e., purity, contentment, austerities (asceticism), self-introspection and study of scrip- tures, and surrender to God; (3) asana (comfortable and steady physical postures which will prevent any movement/distraction); (4) pranayama (breath regulation); (5) pratyahara (indrawing of senses); (6) dharana (concentration); (7) dhyana (meditation); and, fi nally, (8) samadhi (contemplative absorption/yogic enstasis/ union). In the Ashtanga scheme of Yoga , all eight steps in sequence are foundational for the right practice . As we see in the Noble Eightfold Path of Buddha, Ashtanga also emphasizes upon morality, lifestyle, mental development, etc. In Ashtanga , the fi rst two steps go hand in hand and these are about maintaining a correct lifestyle (in the form of good ethics, code of habits and conduct). One can also see that the fi rst 3 steps help in controlling the instincts and feelings and prepare the body so that it 150 5 Attempts at Standardization becomes in tune with the nature and eventually loses body consciousnesses. The 4th and 5th steps lead to conscious control over breathing and turn the focus of attention inward. The last 3 steps (collectively called samyama ) prepare the mind for deep meditation and the revelation of the ultimate self within the microcosm of one’s own self. In the practice of Ashtanga, the fi rst 5 steps are of preparatory nature and the last 3 steps are of deeper or higher nature. Samadhis are the highest levels of medita- tive states that are reached when the fi ve senses of perception, the thoughts, and the mind are all calm. Nonetheless, it is said that practice of even the preparatory stages confers great benefi ts.

5.4 Buddha (Sixth Century BC) and Patanjali (Fourth Century BC): Concurrence of Views Between the Two Early Champions

Close similarities between the methods of the Buddha and Patanjali are noticeable and have been pointed out by scholars. Contrary to the popular beliefs, Buddha did not repudiate the ascetic and contemplative traditions of the Vedas in toto; rather, he completed them. As Eliade ( 1969, p. 162) quotes Emile Senart’s writings: “It was on the terrain of Yoga that the Buddha arose; whatever innovations he was able to introduce into it, the mold of Yoga was that in which his thought was formed.” Studying both the Upanishadic origins of Buddha’s thoughts and the Vedic origin of Patanjalian thoughts, one can realize that similarities exist at many levels between the Buddhist philosophies on Yoga (described in the various Abhidhammic texts in Pali ) and the philosophies of the Yoga Sutra (described in Vedic Sanskrit ). Historical evidence does exist about the two pre-enlightenment teachers of Buddha who were trained in the Patanjalian (Samkhya / Rig Vedic system) of Yoga (Santina 1997, p. 347). It is interesting that the form sphere and formless sphere absorptions (described in Chap. 4 of this book) were known to yogis before the time of the Buddha and were practiced by the Buddha’s contemporaries. Just looking at the names of the two paths, i.e., Buddha’s Noble Eightfold Path and Patanjali’s Eight - Limbed Yoga (Ashtanga ), makes us think of the similarities. In both the paths involving eight aspects of practice, importance has been given to philosophy, tech- nique, as well as one’s lifestyle in the practice of Yoga. Both thinkers propose that insight into the reality of consciousness depends upon the grades of the mind one uses to enter each level of perception: the fi ner the grade of the mind, the sharper is its reception of the subtleties of the reality. That is why both thinkers emphasize upon the important role of mental development. Both agree that meditation is the process to obtain the insights into reality. Both propose that meditation is a graded process involving the progressive release of consciousness from the limitations/con- ditions of the mind/existence through sequential meditative states which ultimately lead to liberation (nibbana or moksha , respectively) from the human condition and from the constraints/shackles of the mind. Important differences do exist between Patanjali’s Eight - limbed Yoga and Buddha ’ s Noble Eightfold Path which are mentioned later in this chapter. 5.4 Buddha (Sixth Century BC) and Patanjali (Fourth Century BC) 151

Nevertheless, taking a look at the descriptions of the methods of Yoga and meditation in both the systems, one can unmistakably realize that although some of the termi- nologies are a bit different (probably due to the differences between the Pali ver- naculars of Buddha and Vedic Sanskrit of Patanjali), there do exist very close similarities in both. These similarities are at many levels most notable in the following:

1. Both paths involve the same number of steps (eight). 2. The ultimate goal in both paths is freedom/liberation (nibbana in Buddhism and moksha in Patanjalian system). 3. The methods of the meditative practices in both systems are to cultivate a sta- ble, bare, and directed attention (in concentrative meditation) as well as a uni- formly hovering attention (in Buddha’s mindfulness meditation or Patanjali’s meditation proper) for nonreactive, nonjudgmental, and moment-to-moment awareness of one’s internal (e.g., cognitive–affective–sensory) and external ( social– environmental) experiences. 4 . Samyama is the essence of the Patanjalian eight-limbed scheme of Yoga and consists of three key meditative steps, i.e., dharana (concentrative fi xation, the 6th step), dhyana (meditation proper, the 7th step), and samadhis (profound states of meditative absorption, the 8th step) (Yoga-Sutras: Section-III, verse-4; Satchidananda 1978 , p. 166), whereas satipatthana (mindfulness) is the essence of Buddha’s eightfold scheme. Mindfulness requires, as an essential element or preparatory step, the cultivation of stable/directed attention which serves as the anchor to redirect and contain the restless mind: this is the concentrative medita- tion of Patanjali ( dharana , meaning to hold / contain ; the 6th step in Patanjali’s eight-limbed scheme). Trataka or fi xed gazing using a visual anchor is a form of this type of meditation. The bare attention of the Buddhist meditation using the mental objects at that moment as the anchoring objects is very similar to concen- tration, the 6th step in Patanjalian scheme. The subsequent steps (jhana and samapatti ) in satipatthana / Right Mindfulness of Buddha are the 7th and 8th steps of Patanjali (i.e., dhyana and samadhi ). Here, one can notice phonetic simi- larities between these two words with Buddha’s jhana and samapatti . The Abhidhammic words vitakka (means initial application of consciousness in Abhidhammic sense and meditative reasoning in Patanjalian sense) and vichara (sustained application) have been used in Patanjalian description of samadhis ( Yoga - Sutras : Section-I, verses-17, 42; Taimni 1961 , p. 103). 5. There are many other similarities with respect to the process and the technique of Patanjalian samyama (which included the various stages of samadhis ) and Buddha’s satipatthana (mindfulness) method. Both samyama and satipatthana are the essence of Yoga in which one’s attention (bare attention in Buddhism and concentration in Patanjalian system) plays a central role in order to ascend the rungs of the insight ladder . This attention in the Patanjalian Samyama or in the Buddhist jhanas and samapattis is at the highest level, so deep that it leads to exclusion of self and culminates in the merger of self and nonself; everything becomes just pure experience or pure awareness. In the process and technique of 152 5 Attempts at Standardization

samyama , the nature of concentrative fi xation (dharana ) involves a binding of the consciousness to a particular anchoring object (physical or mental, similar to Buddha’s kasina ). Meditation proper (dhyana ) is the continued fl ow of knowl- edge (as mentioned in Chap. 3 , Patanjali describes 3 types of knowledge: shabda , aartha , and jnana ) or awareness of the meditation object. In culmination of the meditative process, all the meditative anchoring objects vanish; the self–object duality disappears and there arises in consciousness a state of identity with the known object . This profoundly absorbed deep mental state in which there is absence of the duality of the knower (self or meditator) and the known (the object of meditation) is Patanjalian samadhi . This is the knowing (the object) by fusing (with the object) method of samyama . Similar to the samyama , Buddha’s satipatthana (mindfulness) method consists of concentrative meditation ([Pali samatha] that involves cultivation of bare attention; similar to Patanjalian dha- rana ), mindfulness meditation (Pali satipatthana ) that gives rise to the medita- tive insight (vipassana ); similar to Patanjalian meditation proper), and the various samapattis (similar to Patanjalian samadhis ) until the fi nal liberation (Pali nibbana ; similar to Patanjalian moksha ). Patanjali has also elaborated upon the complex sequential stages of samadhis the equivalents of which are the samapattis described by Buddha. Samadhi is one objective of Patanjalian Yoga. When meditation (dhyana ) gives up all forms (including the external and inter- nal props/anchors [Pali kasina; Sans. bija]) and reveals only the meaning of the object of meditation, that state of mind is called samadhi . Samadhi is the process of diving into the deeper layers of one’s consciousness in order to obtain knowl- edge of the subtler and more profound aspects of the objects in this manifest universe. We can come into contact with different layers of the object or seed (Sans. bija ) by peeling it open, layer after layer. Likewise, samadhi is the process of peeling of consciousness to gain insights into the reality by practicing deep meditations. Each successive stage of samadhis reveals to our consciousness a different and deeper layer of the Reality of the object, and by continuing the process of Samyama through the successive stages, we ultimately arrive at the innermost Reality of the object. The different stages of samadhis , i.e., sampra- jnata samadhi , asamprajnata samadhi , sabija samadhi (meditation with seed/ form [Sans. pratyaya , bija ], nirbija samadhi (meditation without seed/form), savitarka samadhi , and nirvichara samadhi (for more descriptions, please see Chap. 3 of this book; also see Taimni 1961 , p. 96–98), represent the progressive release of consciousness from its limitations or constraints. In these various samadhis , there is complete merger between the self (subjective aspect) and the object of meditation: here, the relationship between the self and object (as dis- tinct things) disappears because of the disappearance of the interpreting interface (the mind) which creates this relationship. This concept is similar to the concept of interdependent originations in Buddhism. Thus, in the samadhis , all three (self, object, and the relationship between the two) fuse into one through the process of samyama. Any activity, impression, or bias that the mind has apart from the object of contemplation will stand in the way of becoming fused with it completely. It is only when the mind has annihilated itself completely and 5.5 The Subtle Difference Between the Meditative Methods of Buddha and Patanjali 153

destroyed its independent identity that it can become assimilated with the object of contemplation and shine with the pure truth enshrined in that subject. However, the highest level of samadhi is not a mere state of emptiness. In Samadhi, there is total absence of objects in consciousness, but consciousness is not in a state of vacuum—it is rather saturated with a direct and total intuition of being. In this state, the Yogi has no experience based on ordinary sensory perceptions but is endowed with a qualitatively different state described as revelation or enlightenment . 6. In the Abhidhammic descriptions, as the meditator (Pali Arahat ; Sans. Yogin ) progresses through the form and formless spheres of consciousness, gradually there is a unifi cation of the subject and a unifi cation of the object in the monk’s consciousness (one can note the similarities with the Patanjalian samyama which is knowing by fusing method). By attaining the fourth formless sphere absorp- tion, meditator reaches the summit of mundane experience . In the Yoga Sutras of Patanjali, one can fi nd meditative states identical to the form sphere and formless sphere meditative absorptions, described under sabija samadhi and nirbija samadhi , respectively (Taimni 1961 , p. 96–98). Both the form sphere meditative absorption of Buddha and the sabija samadhi of Patanjali have four stages.

In summary, both Patanjali’s samyama and Buddha’s satipatthana are meant for obtaining real knowledge or direct experience about objects by changing one’s internal representations about these objects. The Buddha operationalized it as the process of deep meditation involving the union of meditative insights and liberating wisdom , whereas Patanjali in his Yoga Sutra operationalized it as the knowing the object of meditation by fusing the mind with it.

5.5 The Subtle Difference Between the Meditative Methods of Buddha and Patanjali

As one can see in the above description, Buddha rather than discarding the Samkhya ( Rig Veda ) system of Yoga advanced it further with his innovations especially on the meditative aspects. Among all aspects of Yoga, meditation was the aspect that the Buddha operationalized to the highest level. One key innovative teaching of the Buddha was that meditative states alone are rather the beginning stages of enlight- enment rather than being the end point. What distinguishes Buddhism from the contemplative traditions of Hinduism and other religions is the fact that for Buddhism meditation is necessary but by itself is not suffi cient for liberation . For Buddha, the meditative absorption must be combined with liberating cognition or wisdom (the insights [Pali panna ] about the Four Noble Truths) which needs to be lived by the monk to attain nibbana. Buddha realized that even the fourth formless sphere absorption (Patanjalian nirbija samadhi) is not an end in itself; being mun- dane, this very high form of meditative absorption is still impermanent after which one will be reborn in a lower sphere of consciousness. Even this pinnacle level of meditative absorption has to be combined or united (one meaning of Yoga is union ) 154 5 Attempts at Standardization

with wisdom to become truly supramundane . This is a key point that distinguishes the Buddha’s method from those of the methods proposed by the thinkers in many other Indian philosophical traditions including that of Patanjali’s Yoga Sutras .

5.6 Tantra : Standardization of Yoga and Meditation Reaches Its Peak (Medieval and Modern India)

Tantra, as the newest and the fourth school of Yoga, reached its peak in the medieval India and signifi cantly contributed to the techniques as well as the standardization aspects of the heterogeneous system of Yoga. While some of these standardizations are derived from earlier, pre-Tantric sources, they were greatly expanded upon, ritu- alized, and philosophically contextualized in the medieval Tantra. Through its technique-rich styles, tantra has made the abstract concepts of Yoga and meditation more manifest, tangible, and reproducible for use of the common mass. The techni- cal improvisations as well as further standardization of Yoga through the system of Tantra transformed the practice of Yoga by a common man of the medieval India. Tantra is found in both Hindu and Buddhist thoughts. The prototype of standardized forms of Tantra in the Buddhist ( Shramanic) system is known as the Vajrayana (descriptions of these are more prominent in the Tibetan Mahayana Buddhism; readers can refer to Santina 1997 , p. 232–241) and the same in the Hindu ( Vedic and Vedantic ) system are known as the Kundalini Yoga (readers can refer to Sivananda 1994 , p. 14–34; Avalon 1974 , the whole book is on Tantra ) and the (more prominent in the trika and kaula traditions and elaborated by Abhinavagupta, 1918. Readers can also refer to White 2000 ; Timalsina 2005 , p. 213–235; Timalsina 2012 , p. 112; Mueller-Ortega 2005, p. 181–212). In the sys- tem of Tantra (both in the Buddhist Vajrayana and in Hindu versions, i.e., Kashmiri Shaivism and Kundalini Tantra) physiology, there are fi ve psychic energy centers, called chakras , found within the subtle body [Sans. sukshma sarira , lit. astral body, Sivananda 1994 , p. 17] of each individual. Most commentators concur that the chakras and the nadis are not intended as physiological depictions of the body in the contemporary Western sense but represent a subtle or mystical body. Feuerstein described them as “idealized version of the structure of the subtle body, which are meant to guide the yogin’s visualization and contemplation” (Feuerstein 1990 , p. 258). These chakras are said to be located in anatomical locations corresponding to the top of the head, midpoint between the eyebrows, throat, heart, navel, and genitals. There are a number of channels of psychic energy, called nadis , connecting these chakras (Sivananda 1994 , p. 14–34; Avalon 1974 , p. 222). Although there are a great number of these channels, three are said to be the most important: the central psychic channel (called avadhuti in Vajrayana and sushumna in Hindu tantra), which runs directly from the top of the head to the genitals and which connects the fi ve chakras, and the two psychic channels on the right and left of the central chan- nel (the rasana and lalana, respectively, in Buddhist tantra; pingala and ida in Hindu tantra). In tantric psychology, physiology, and cosmology, the practitioner standardizes, calibrates, and titrates the use of the whole philosophy and techniques of Yoga–meditation against his/her own body and mind. Here, the practitioner 5.6 Tantra: Standardization of Yoga and Meditation Reaches Its Peak 155

realizes the real meaning of the metaphoric expression that the body is a temple , that is why, the name tantra (tan = body, tra = instrument). The practice of the tantra in Buddhism is called the Vajrayana sadhana (Tibetan Mahayana Buddhism; lit. Vehicle of the Thunderbolt , elaborated by Santina 1997 , p. 232–241). In this, the body is likened to a temple that contains the celestial deities (the Buddhas in Vajrayana ), who are none other than the transformed versions of the ordinary indi- viduals (jiva ) or modes of beings in terms of the psychophysical components or aggregates. Specifi cally, the tantra supplies a special psychological and physiologi- cal scheme of the elements of experience precisely so that they can be subjected to the direct and effi cient manipulation of the mind in order to transform one’s con- sciousness so that one can directly experience the Reality/ultimate truth. This scheme employs the chakras and the nadis . In the more elaborate scheme of Tantra , the various media of the practitioner’s perceptions (called ) are described in terms of the two types of elements: gross elements (mahabhutas ) and subtle ele- ments ( ). Tantra claims that the mahabhutas are the material dimensions , whereas the tanmatras are the energy dimensions of one’s existence. The fi ve mahabhutas (earth, water, fi re, air, and ether) are the gross elements of the matter and are the basis for the material world. These fi ve elements (mahabhutas ) originate from fi ve more subtle aspects called the tanmatras which in tantra are described as the source of the creation and in which direct perception of reality can be realized . Tantra, as a system of Yogic philosophy, provides symbolic yet standardized and elaborate representations of the various components of psychophysical experience and a description of how their transformation can be achieved through the gradual purifi cation of one’s mode of being (mind) in order to culminate in liberation (mok- sha ). The special characteristic of the tantra is its use of the totality of experience to achieve direct or immediate knowledge and thus to transcend the dualities (of evil and good, of impure and pure, of self and other, of subject and object, and so on) by effecting the union of all opposites, the annihilation of all dualities, which is the goal of tantric practice. In Vajrayana sadhana, the Buddhist version of tantra prac- tice, it is important to focus fi rst on types of experience that are particularly power- ful and meaningful and thus can be used in a personalized way as the building blocks for purifying and transforming the experiences so that spiritual progress can be accelerated and can be extended to eventually encompass all experiences. In this scheme, as one progresses further in the practice, the path, the practice, and the goals of practice gradually become indistinguishable. The fi rst part of this sadhana (meditation practice) is a replica of the Buddha’s accomplishment of and knowledge, whereas the second part is a replica of the Buddha’s phenomenal and transcendental dimensions. The process of completion constitutes the dissolution of the deity ( ) and realizing Buddha’s transcendental dimension. As true to any other Buddhist tradition, in Vajrayana too one sees a union of meditation and insight or the penetrative wisdom which is essential in order to achieve the experi- ence of Buddhahood, the nibbana . In the Hindu versions of Tantra ( Kundalini Yoga and Kashmiri Shaivism), many key elements of practice include the mantras (chants), yantras (auspicious geometrical fi gures sketched on one’s body), many elements in the Eight-limbed Yoga (postures, breath regulation, concentration, meditation, etc.), and (symbolic gestures of the body). 156 5 Attempts at Standardization

Considering the importance of chakras in both the Buddhist and Hindu versions of Tantra, it needs elaborations here. Texts describing the chakras go back as far as the later Upanishads, for example, the Yoga Kundalini Upanishad. According to Kundalini (Sans. kunda, to burn; kundala , to coil or to spiral) philosophy, kundalini is the life force or spiritual energy/power located at the base of the spine in static/ dormant form in every individual. This dormant energy, the Kundalini Yogin beliefs, can be made active by practice of Kundalini Yoga or Laya Yoga. When awakened through the practice of Kundalini Tantra , it is believed that the kundalini energy rises from its coiled base, moves up through the spinal column to traverse the six chakras , and fi nally penetrates the 7th chakra or crown located in the brain, where- upon the Yogi experiences Samadhi or total absorption in the spirit. This energy is said to travel along the ida (left), pingala (right), and central/sushumna nadi —the main channels of pranic energy in the subtle body (Avalon 1974 , p. 222). The chakras are generally associated with a mantra seed-syllable (bija - mantra ), and often with a variety of colors and deities (personal gods). In addition, the number of petals in a chakra is determined by the number and position of the nadis around that chakra. In Kundalini Tantra, the body is represented as consisting of seven chakras in a series. Those are muladhara , swadhisthana , , , vishuddha , , and sahasrara . Translating from the original Sanskrit scriptures on Tantra , Avalon (1974 ) has devoted his whole classic book, The Serpent Power , to elaborate descriptions of Kundalini Yoga which includes specifi cs on chakras in p. 317–419. Descriptions of the seven chakras are also found in an excellent source book (Sivananda 1994 , p. 14–34). The seven chakras in the subtle body (Sans. sukshma sarira ), in ascending order, are as follows:

(i) Muladhara (perineal or root chakra; has four petals; physical equivalent are the perineal/pelvic plexuses and organs of reproduction; seed syllable, lam ; represents earth element) (ii) Swadhisthana (sacral chakra; has six petals; physical equivalent are the sacral and coccygeal plexuses; seed syllable, vam ; represents water element) (iii) Manipura (navel chakra; has ten petals; physical equivalent are the celiac plexuses; seed syllable, ram ; represents fi r e element) (iv) Anahata (heart chakra; has 12 petals; physical equivalent are the cardiopulmo- nary plexuses; seed syllable, yam ; represents air element) (v) Vishuddha (throat or neck chakra; has 16 petals; physical equivalent are the laryngeal/epiglottis plexus; seed syllable, ham ; represents ether element) (vi) Ajna (forehead or brow chakra; has two petals; physical equivalent are the pineal body and brain stem; seed syllable, Om ) (vii) Sahasrara (crown chakra; has 1,000 petals; physical equivalent are higher brain areas; seed syllable, AUM )

This writer has personal experience on practice of the kundalini tantra both dur- ing his monastic training (1992–1994) and in subsequent years of his practice. In his clinical work in India, he used the two chakras as the anchoring objects to train the patients in concentrative meditation which can be used either alone or as a References 157 prerequisite for subsequent mindfulness meditation. In these treatment protocols, this writer successfully used the sacral ( swadhisthana ) chakra in populations with addiction and impulse control disorders and the forehead ( ajna ) chakra for ADHD population. From the neuroanatomy, we know that meditation activates the para- sympathetic system, and the parasympathetic system is otherwise called the cranio- sacral outfl ow system (because crucial parts in this system are the 3rd, 7th, and 10th cranial nerves and also the sacral nerves 2nd, 3rd, and the 4th). So no wonder the sacral activation by meditation on sacral chakra can result in more parasympathetic/ calming activity and hence is the rationale for using it for impulse control disorders and addiction. Concentrative meditation on the forehead chakra ( ajna chakra) is a standard practice for enhancement of attention. More elaboration upon clinical work using chakras (mostly as anchoring objects for meditation) can be found in some other books as well (Jung 1933 , 1999 , 2009; Sivananda 1994 ; Judith 1996 ; and Govinda 2002 ). As one can see in this chapter, standardizations in Yoga–meditation date back to a few thousand years. These descriptions are but a few of the tenets that comprise the very elaborate system of standardization of Yoga and meditation in the system of Tantra . Moving away from the abstractness of Yoga, Tantra is focused instead on its concrete, standardized, and technique-rich aspects. Through the Tantra philoso- phy, Yoga became integrated into different religions and thus became easily avail- able to the common mass to practice it within the belief system of their respective religions. Although standardization makes Tantra as the most practicable form of Yoga–meditation, one needs to remember that standardization in excess runs the risk of concretization and thus loss of the abstractness and experiential aspects which are the essence of Yoga–meditation. It is also important not to forget the symbolism involved in Yoga and meditation in general and tantra in particular; otherwise, one runs the risk of interpreting these too concretely and ends up with use of these as mere rituals rather than as very important methods of salvation. This writer’s ongoing attempts (which have been quite challenging experiences often) in developing the various models in order to use of Yoga–meditation in healthcare have mostly been in the directions of maintaining the fi ne balance between his efforts to present Yoga and meditation in its entirety, in pragmatic, standardized, and evidence-based format but at the same time preserving the abstract essence.

References

Avalon A (1974) The serpent power: being the Sat-cakra-nirupana and Paduka-pancaka: two works on Laya-yoga. Courier Dover Publications, New York Bodhi B (1993) A comprehensive manual of abhidhamma: The abhidhammattha sangaha of Acariya (Narada, Mahathera Trans). Buddhist Publication Society, Sri Lanka Bodhi B (2000) The Noble Eightfold Path: way to the end of suffering. Pariyatti Publications, Onalaska Buddhaghosha (originally written in Pali language, circa. 430 CE): Visuddhimagga (The Path of Purifi cation); English translations by Nyanamoli (1976) Sambhala, Berkley Dalai Lama (1992) The meaning of life (trans: Hopkins J and Ed). Wisdom Publications, Boston 158 5 Attempts at Standardization

Eliade M (1969) Yoga: for immortality and freedom, 2nd edn. Princeton University Press, Princeton Feuerstein G (1979) The Yoga-Sutra of Patanjali. A new translation and commentary. Inner Traditions International, Rochester Feuerstein G (1990) Encyclopedic dictionary of Yoga. Paragon House Print, New York Goleman D (1988) The Meditative Mind: the varieties of meditative experience. G.P. Putnam and Sons, New York Govinda K (2002) A handbook of chakra healing: spiritual practice for health, harmony, and . Konecky and Konecky Publishers, Old Saybrook Judith A (1996) Eastern body, Western mind: psychology and the chakra system as a path to the self. Celestial Arts Publications, Berkeley Jung CG (1933) Modern man in search of a soul. Harcourt Brace & Co., New York Jung CG (1999) The psychology of Kundalini Yoga: Note on the seminar given in 1932. Princeton University Press, Princeton Jung CG (2009) The red book: liber novus. Shamdasani S (ed) (trans: Kyburz M, Peck J, Shamdasani S). Philemon Series & W. W. Norton & Co, London Kalupahana D (2006) Mulamadhyamakakarika of Nagarjuna. Motilal Banarsidass, Delhi Mueller-Ortega PE (2005) ‘Tarko yogangam uttamam’: on subtle knowledge and the refi nement of thought in Abhinavaguptaa’s liberative tantric method. In: Jacobsen KA (ed) Theory and prac- tice of Yoga: essays in Honor of Gerald James Larson. Leiden: Brill Academic Publications, pp 181–212 Niranjananada S (1993) Dharana Darshan: yogic, tantric and upanishadic practices of concentra- tion and visualization. Yoga Publications Trust, Munger Nyanaponika T (1965) The heart of buddhist meditation. Samuel Weiser Publishers, York Beach Radhakrishnan S (1923) Indian philosophy, vol 2. Oxford University Press, Oxford Radhakrishnan S (1953) The principal upanishads. George Allen and Unwin Publishers Ltd., Great Britain Santina PD (1997) The Tree of Enlightenment: an introduction to the major traditions of Buddhism. Buddha Dharma Education Association Inc., Chico Satchidananda S (1978) The Yoga Sutras of Patanjali: translations and commentary; Yogaville. Integral Yoga Publications, Virginia Siderits M, Katsura S (2013) Nagarjuna’s middle way. Mulamadhyamakakarika . Wisdom Publications, Boston Sivananda S (1994) Kundalini Yoga, 10th edn. Divine Life Society Publication, Himalayas Taimni IK (1961) The science of Yoga: the Yoga-Sutras of Patanjali in Sanskrit with transliteration in Roman, translation and commentary in English. Nesma Books, Bangalore Timalsina S (2005) Meditating mantras: meaning and visualization in tantric literature. In: Jacobsen KA (ed) Theory and practice of Yoga: essays in Honor of Gerald James Larson. Leiden: Brill Academic Publications, pp 213–235 Timalsina S (2012) An introduction to tantric philosophy: the Paramarthasāra of Abhinavagupta with the Commentary of Yogaraja (trans: Bansat-Boudon L, Tripathi K). Religious Studies Review 38(2) Vivekananda S (1956) Raja Yoga. Ramakrishna Vivekananda Center, New York White DG (ed) (2000) Tantra in practice. Princeton University Press, Princeton Part III

Application Yoga, Mindfulness, and Mentalization: Central Role of Attention 6 and Compassion

The faculty of voluntarily bringing back a wandering attention over and over again is the very root of judgment, character and will…..An education which should improve this faculty would be the education par excellence –William James (Principles of Psychology, 1890 ; p. 424)

6.1 Attention, Empathy, and Compassion: The Key Qualities in a Meditator

Deep philosophies of Yoga and meditation are the various theories about human mind and the various ways the mind works. Yoga , mindfulness , and mentalization are three related concepts and are often used interchangeably. Both mindfulness and mentalization are metacognitive which is defi ned simply as refl ective cognition about cognition or knowing about knowing (Koriat 2000 , p. 149). As concepts, they shed light on higher human qualities like empathy and compassion as well as on a variety of psychotherapeutic phenomena, including some aspects of transference (the thoughts and feelings aroused in the patient about his/her therapist) and coun- tertransference (the thoughts and feelings aroused in the therapist about his/her patient). It is amazing to see the progress of neural sciences exploring and explain- ing these concepts in an ongoing manner. Some of them, as discussed later in this chapter, are the concepts of mentalizing areas of brain and the mirror neurons (dis- covered by Rizzolatti et al. 1996) which can be called as the experiential neurons because they map our experiences in our brain in form of the neural impressions of the perceived actions of others as well as their meanings. One can note that attention is the key denominator in all contemplative or meta- cognitive traditions (Yoga, meditation, mindfulness, mentalizations): attentive obser- vation (of self and others) plays a key part in this. Similarly, compassion and empathy are the key qualities in a meditator. Human beings are social creatures, and empathy helps create and maintain social bonds in them by enabling people to comprehend,

© Springer International Publishing Switzerland 2015 161 B. Pradhan, Yoga and Mindfulness Based Cognitive Therapy: A Clinical Guide, DOI 10.1007/978-3-319-09105-1_6 162 6 Yoga, Mindfulness, and Mentalization: Central Role of Attention and Compassion share, and respond appropriately to others’ emotional states (Decety and Jackson 2004 ). Simply put, empathy means to put oneself in other ’ s shoes in order to under- stand other’s experience. Compassion (Pali. karuna ) is the basis of this phenomenon. Empathy involves understanding the reasons for the other’s emotions as well as men- tal state attribution in the sense of fully adopting the other’s perspective. This involves active and imaginative representations of shared experience. Because empathy is essentially a phenomenon of connection between two people based on shared emo- tional experiences, in the process of empathy, a critical task is to represent the minds of other persons within one’s own mind (otherwise called mentalization).

6.1.1 Empathy and Compassion: Phenomenology and Roots in the Four Noble Truths of Buddha

Empathizing is the drive to identify another person’s emotions and thoughts and to respond to them with an appropriate emotion. True empathy must have subject–object differentiation with respect to the emotion in question. This process involved incorpo- ration of attention by which the attended perception of the object’s emotional state automatically activates the subject’s representation of that state (Preston and de Waal 2002 , p. 4). Sympathy is a precursor of empathy but lacks the subject–object differen- tiation essential for true empathy. Multiple models of empathy point to three major components: (i) congruent affect with the target individual, (ii) perspective- taking (imaging oneself in other’s situation), and (iii) prosocial motivation to help the target individual (Zaki and Ochsner 2012 ). Because empathy is essentially a phenomenon of connection between two people based on shared emotional experiences, in the process of empathy, a critical task is to represent the minds of other persons within one’s own mind (otherwise called mentalization ). We perceive the existence of mind through our thoughts, feelings, and perceptions; without them we can’t experience the existence of the mind. These thoughts, feelings, and perceptions are essentially generated in the brain which is the organ of mind. Let’s consider a situation where person A is being empathic to person B. This process is as follows: to person A, the perception of person B’s mind is introjections of person B’s brain processes into the subjective and inter- personal space of person A. The basic interactional process between these two people awakens emotional activity, both positive and negative, within each other. When the emotions and feelings generate a connection based on shared (positive) emotional experiences, the result is positive empathy. Interpreting the actions of others requires the development of explanatory constructs that defi ne people’s behavior within the patient’s sphere of interactions. These constructs can be experiential, rational, or both. In the process of empathizing, one person understands the nature of the other person by accessing memories of similar experiences as well as by applying theoretical concepts (including philosophical concepts) about understanding people. It is interesting to note that these components including their cognitive–emotive aspects are found in the basic teachings of the Buddha, including in the Four Noble Truths. In the scheme of the Four Noble Truths, compassion is developed by the realizing of the fi rst two steps (steps a and b, as described below): (a) recognizing that suffering or pain is universal and can happen to anybody in existence, (b) other’s suffering is my suf- fering because everything is connected (this is based upon the Buddha’s doctrine of 6.2 Meditation Is Part of Yoga and Mindfulness Is a Type of Meditation 163 interdependent origination or mutual arising, which tells us that everything is dependent or conditioned on other things: nothing happens in isolation and thus there is no sepa- rately existing self in the universe), and (c) everything, including suffering, is temporary, is subject to change, and hence can be changed. At the same time pleasure is also tempo- rary and so there is no need to cling to the pleasures in life. This third step tells that because of the non-permanence of experiences, non-compassion or non-empathic experi- ences can be changed too; compassion and empathy can be developed in individuals who lack them. This gives rise to the solution for non-compassion and non-empathy and that solution itself is nothing other than the fourth and fi nal part of the Four Noble Truths . The solution (fourth Noble Truth) says that liberation [Pali: nibbana , Sanskrit: nirvana ] or release from suffering is possible by ending the clinging to the false sense of self (called the misidentifi ed self in the Upanishads) that ordinary mind usually holds. This getting rid of the clinging is otherwise called dispassion or renunciation in the Patanjalian scheme. Thus, according to Buddha and Patanjali, the solutions are embedded in the Noble Eightfold Path and in the Eight-Limbed Yoga (Sanskrit: Ashtanga ), respectively.

6.2 Meditation Is Part of Yoga and Mindfulness Is a Type of Meditation

The terms Yoga and meditation are not the same. Two Google searches done by this author in March 2013 putting the search word yoga and meditation generated 383,000,000 and 146,000,000 hits, respectively. This corroborates with the scrip- tural notions that Yoga is much broader than meditation and as a system is inclusive of meditation . Concepts in the broad rubric of Yoga include body, mind, soul, as well as the metaphysical and cosmological expositions of the universe as a whole, whereas the concept of meditation is mostly about the individual’s (Sans. jiva ) mind. In the Eight-Limbed Yoga practice (Ashtanga Yoga ) of Patanjali, meditation proper are the 6th and 7th steps. Historically, it seems that the term Yoga has been used earlier than the term meditation . Meditation is fundamentally a cognitive– emotive process that involves learning to shift and focus the attention at will onto an object of choice, such as bodily feelings or an emotional experience, while disen- gaging from usual conditioned reactivity or elaborative processing. Broadly there are two types of meditation: (a) con centrative (centering of con sciousness; Pali: samatha, Sanskrit: dharana or anchorage) type where a focused attentiveness is developed and (b) mindfulness (insight) type (Pali: satipatthana , Sanskrit: dhyana , Burmese: vipassana , Japanese: Zen ) which that focuses on present and involves holding, experiencing, and monitoring the mental objects in one’s awareness, as they are, in that moment . In an important distinction, Epstein (1990 , p. 164) sepa- rates concentration from mindfulness and further explains: “The concentration practices emphasize one-pointedness or absorption….. The mindfulness practices, on the other hand, require moment-to-moment attention to changing objects of awareness and lead to examination of the subjective sense of I . In dynamic terms, this can be expressed as investigation of the self-representations (in one’s mind)….” So, one can see clearly that meditation is a part of the broader system of Yoga and mindfulness is actually a type of meditation. Concentrative meditation , otherwise called the meditative absorption , serves as a prerequisite for mindfulness 164 6 Yoga, Mindfulness, and Mentalization: Central Role of Attention and Compassion meditation and provides the concentrative power (directed attention in the fi eld of awareness) to mind for the subsequent mindfulness meditation (uniformly distrib- uted attention in the fi eld of awareness). To practice mindfulness is to become grounded in the present moment; one’s role is simply as observer of the arising and passing away of experience. In this, one does not judge the experiences and thoughts, nor do they try to fi gure things out and draw conclusions, or change anything—the challenge during mindfulness is to simply register the mental events and observe them rather than elaborate them. As one can see here, Yoga, meditation , and mind- fulness are three overarching circles in the broad scheme of Yoga .

6.3 What Is Mindfulness?

Mindfulness is defi ned as keeping one’s consciousness alive to the present reality (Hahn 1976 ). As mentioned before, mindfulness is understood as an attentive obser- vation and is regarded as one of the two traditionally identifi ed forms of meditative practice. Kabat-Zinn (1990 ) operationally defi nes mindfulness as the intentionally focused awareness of one’s immediate experience from moment to moment, in a nonjudgmental manner, as if this is the only moment one has got in his/her life. The experience is one of a moment-by-moment attention to thoughts, emotions, physical sensations, and surroundings. Mindfulness is the process and insight is the result. So this type of meditation is also called as insight meditation (Buddhist: Vipassana ). Meditation is fundamentally a cognitive process that involves learning to shift and focus the attention at will onto an object of choice, such as bodily feelings or an emotional experience, while disengaging from usual conditioned reactivity or elab- orative processing. Mindfulness meditation is a cognitive processing, in which thoughts are observed as just thoughts rather than considering them as real experi- ences. As compared to the concentrative meditation, in mindfulness meditation, one’s attention is purposefully kept broader, utilizing a more open and fl uid focus but without engaging analytical thought or analysis. Mindfulness meditation may utilize any object of attention—whether an emotion, the breath, a physical feeling, an image, or an external object—such that there is more fl exibility in the object of awareness than there is in concentrative meditation and such that the object may shift from moment to moment. Mindfulness meditation involves the cultivation of fl exible attention as well as moment-to-moment, nonjudgmental awareness of one’s present experience, whether narrowly or more broadly focused. The goal of these practices is to cultivate a stable and nonreactive awareness of one’s internal (e.g., cognitive–affective–sensory) and external (social–environmental) experiences. Therefore, it can be argued that it is the development of stable attention and non- judgmental awareness that mediates the much wider range of effects, including physical relaxation, emotional balance, behavioral regulation, and changes in self- judgment, self-awareness, and relationship to others. Mindfulness has been conceptualized in a two-component model (Bishop et al. 2004 ): (a) the component of attention regulation and (b) the component of acceptance and openness to one’s experience. 6.3 What Is Mindfulness? 165

6.3.1 How Right Mindfulness (Satipatthana ) Gives Rise to the Insights (Vipassana ) and Subsequent Liberation ( Nibbana)?

In discussing the technicalities of meditation, it is important to understand that dur- ing the transition points from one jhana (meditative access state) to another, mind is supple and receptive rather than reactive and thus these entry and exist points between the jhanas serve as the fertile moments for meditative insight to become ripen. In the satipatthana meditation, the mindful observations of mental events by the meditator give rise to a series of realizations about the nature and workings of human mind in his/her experience. With these realizations, mindfulness matures into insight ( vipassana). The practice of insight begins at the point when mindful- ness continues when the meditating mind and the object of meditation arise together in one’s fi led of awareness in unbroken succession without any lag (similar to the process of knowing by fusing method in the Patanjalian samyama as described in Chap. 3 ). This point marked by the continuity or lack of lag in one’s experience heralds the beginning of a chain of insights about mind knowing what it is doing in a moment-to-moment manner. In the sequential process of obtaining insight, the fi rst realization is that the mental events (the phenomena ) are distinct from the mind ( creator of the phenomena) contemplating them. Of note, this knowledge is not just at the verbal or intellectual level; rather the meditator knows (in the sense of real- izing in one’s daily life) this: each ensuing realization is a direct experience ; there may not be words for this realization. Continuing to practice the vipassana , the meditator sees the whole fi eld of awareness in a continuous fl ux (rather than frag- mented snap shots). The meditator realizes that the world of reality is renewed at every moment in an endless chain and that the mental phenomena or mental events, like soap bubbles, arise and pass away at each moment. Because the inherent nature of these events (both good and bad , positive, as well as negative events) is to con- stantly change, these cannot be the basis for any lasting satisfaction and hence not worth clinging to. This is the realization of the truth of impermanence (Pali. anicca ) to develop equanimity (equal or undistorted vision to all objects in one’s awareness) which along with bare attention, mindful detachment, and phenomenological analy- sis of experience (in terms of aggregates ) leads to the realizations that one’s private reality too is devoid of self (Pali. anatta; Sans. anatma ; nonself) and is ever chang- ing which leads to states of further detachments (and de-identifi cation) from the world of experience. From these detached (mindfulness) perspectives, the imperma- nent and impersonal qualities of the meditator’s mind lead him/her to see it as a source of suffering (Pali. dukkha ) which leads to further detachments and de- identifi cations from mind, its contents, and conditionings. As succinctly elaborated by Santina (1997 ), in Buddhism, the realization of nib- bana is achieved through combining (joining) the meditation with the meditative insight or wisdom [Pali. panna , nanna ] that is the by-product of the meditative pro- cess. To develop insight, the meditator applies the two Abhidhammic methods of analysis and synthesis: (i) analytical method (based on the doctrine of impermanence ) for examination of consciousness (mind) and its object—in other words, mind and 166 6 Yoga, Mindfulness, and Mentalization: Central Role of Attention and Compassion matter—and (ii) the synthetic/relational method (based on the doctrine of interdepen- dence) by considering the causes and the conditions of our personal existence. Insight or wisdom is further developed through applying these two Abhidhammic methods by dissecting internal and external, mental, and physical phenomena and examining them in relation to their causes and conditions. Through the analytic method , one arrives at the realization that what was previously taken to be a homogeneous, unitary, and sub- stantial phenomenon is in fact composed of individual elements, all of which are impermanent and in a constant state of fl ux. On the other hand, the synthetic method , by considering the causes and the conditions of our personal existence, reveals the interdependence/interrelations between the factors that causes the existence of us as psychophysical entities and thus enlightens us that nothing happens in isolation, everything is interdependent . These analytical and relational investigations reveal three interrelated, universal characteristics of existence: (i) impermanence, (ii) suffer- ing, and (iii) nonself. Realizations of these three in one’s daily life (according to Buddha, the whole life is a meditation ) leads to the three doors of liberation : (i) the door of signlessness (results from contemplating the characteristics of impermanence and thus de-identifi cations), (ii) the door of wishlessness or freedom from desire (results from contemplating the characteristics of suffering), and (iii) the door of emptiness/sunyata (results from contemplating the characteristics of nonself). These three doors of liberation are the culmination of meditation on the three universal char- acteristics. At their highest extremes, the path of concentration [Pali. samatha , bare attention) through the jhanas and the path of insight to realization of nibbana tend to meet. A meditator who could marshal enough one-pointedness to attain the formless jhanas (equivalent to Patanjalian nirbija samadhi) might easily enter the liberated state ( nibbana or moksha) should he/she choose to turn his/her powerful concentra- tion to watching his/her own mind. Subsequently one gradually progresses through the four stages of enlightenment and eventually becomes liberated from this life, from the cycle of birth and death, and is no longer reborn.

6.4 Mentalization

Mentalization is a psychological concept and simply means holding mind in mind . It is defi ned as the ability to attend to mental states in self and others and interpreting behavior accordingly (Fonagy et al. 2002 ; Fonagy and Bateman 2007 ). We are men- talizing whenever we’re aware of what’s going on in our minds or someone else’s mind. It has been also defi ned as seeing yourself from the outside and others from the inside (Allen et al. 2008 , p. 3). Mentalizing is the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes. The theory of mentalization is rooted in Bowlby’s attachment the- ory (Fonagy et al. 2002 ). Mentalization involves unconscious, automatic, and con- scious deliberate application of one’s capacity to understand both cognitive and affective aspects of one’s own and others’ mental states. Concept of mentalization emerged in the psychoanalytic literature in the late 1960s, but diversifi ed in the early 1990s when researchers merged it with research on neurobiological defi cits that correlate with autism and schizophrenia (Baron-Cohen 1995 ). The theory of mind 6.4 Mentalization 167

(ToM; Premack and Woodruff 1978) that came from research on chimpanzees is the theoretical construct that gave rise to the construct of mentalization. ToM focuses on cognitive development and provides a conceptual framework for mentalizing. ToM is the ability to attribute mental states—beliefs, intents, desires, pretending, knowl- edge, etc.—to oneself and others and to understand that others have beliefs, desires, and intentions that are different from one’s own. In this, the individual fi rst appreci- ates the existence of different mental states in others and then accurately identifi es others’ mental states (e.g., motives, beliefs, desires, and feelings) in order to interpret their behavior. ToM is tested by the false- belief task (Wimmer and Perner 1983 ), which is an experimental paradigm in which children are told a character named Maxi puts a candy bar in a cupboard in the kitchen and then leaves the kitchen, after which his mother comes in and moves the candy bar to a drawer. The child is then asked where Maxi will look for the candy. A child who has developed theory of mind will understand that Maxi falsely believes the chocolate is in the cupboard. A majority of children master this task between 4 and 6 years of age.

6.4.1 Dimensions of Mentalization

Bateman and Fonagy (2004 ) identify three dimensions of mentalization: (i) the fi rst dimension is related to two modes of functioning (i.e., implicit and explicit), (ii) the second dimension related to two objects (i.e., self and other), and (iii) the third dimension related to two aspects (i.e., cognitive and affective) of both the content and process of mentalizing. Taking turns during a conversation is an example of implicit mentalization where without deliberate refl ection, individuals naturally and instinc- tually hold the mind of their conversation partners in mind, anticipating when the other might want to respond in turn. In contrast, the activities of a psychotherapist during psychotherapy provide an example of explicit mentalization which involves deliberately exercised and conscious imagination of the mental states of the patient. Through mentalizing two friends can come to understand a misunderstanding: this is an example of the two objects (i.e., self and other) aspects of mentalization. The third dimension of the mentalization concept relates to its cognitive and affective aspects in both the content of mentalizing activity (the intentional mental states in oneself and others) and the process of mentalizing. The integration of cognitive and affective aspects of both the process and content of understanding mental states allows indi- viduals to better know and feel the self and objects in the fi elds of mentalization.

6.4.2 Clarification of Closely Related Terms

Overlaps do exist between the concepts of mentalization and its conceptual cousins: theory of mind, mindfulness, empathy, and psychological mindedness. The basic distinction between theory of mind and mentalization is that the theory of mind is focused on the cognitive aspects in others , whereas metallization is focused on cognitive aspects as well as emotional aspects in both self and others (Allen et al. 2008 , p. 48). 168 6 Yoga, Mindfulness, and Mentalization: Central Role of Attention and Compassion

Mentalization Versus Mindfulness Mentalizing is conceptualized as mindfulness of mind (Allen et al. 2008 , p. 53). Insight is the mental content that is the product of both the mentalizing process and mindfulness (Allen et al. 2008 , p. 41). Mindfulness focuses on the present and on all aspects of one’s mind including thoughts, feelings, and perceptions. The factor analytic studies identify four skills that underpin mindfulness (Baer et al. 2004 ): (i) observing, (ii) describing, (iii) accepting without judgment, and (iv) acting with awareness. Mindfulness overlaps with mentalization within the observing and describing subscales. Both mindfulness and mentalization involve directing one’s attention to one’s own experience; both also emphasize the integration of cognitive and affective aspects of mental states in encouraging simultaneous recognition and participation in internal experience. However, distinctions are as follows: (i) mind- fulness overlaps only with one of the two modes (explicit) and one of the two objects (self) within the mentalization concept; (ii) in mindfulness, one’s own experience involves interacting with inanimate objects too rather than just other people; (iii) the practice of mindfulness is oriented to present experience, while the process of men- talization can concern the past, present, and future; and (iv) fi nally, mindfulness aims at acceptance of internal experience, whereas mentalization emphasizes the construction of representation and meaning related to these experiences.

Mentalization Versus Empathy Decety and Jackson (2004 ) describe empathy (to put oneself in other’s shoes in order to understand other’s experience) as a complex form of psychological infer- ences in which observation, memory, knowledge, and reasoning are combined to yield insights into the thoughts and feelings of others. Empathy focuses on others and emphasizes the emotional states . Conceptually, empathy has in common is three parts: (i) an affective reaction that involves sharing of another person’s emotional state, (ii) a cognitive capacity to imagine other people’s perspective (perspective-taking ), and (iii) a stable ability to maintain a self–other distinction. The concept of empathy overlaps with mentaliza- tion considerably. Both mentalization and empathy involve appreciation of mental states in others; however, empathy is more other oriented while mentalization is equally self and other oriented. Empathy can function in both implicit and explicit modes but is generally regarded in its more implicit mode. Although the process of empathy involves cognitive skill and experience of affect, its content is primarily affectively focused.

Mentalization Versus Psychological Mindedness Psychological mindedness is understood as a person’s ability to see relationships/ links among thoughts, feelings, and actions, with the goal of learning the meanings and causes of one’s own experiences and behavior (Appelbaum 1973 ) . There are several areas of overlap between psychological mindedness and mentalization, for example, in the aspects of intuition and interest in the way minds work. However, mentalization operates both implicitly and explicitly, whereas psychological mind- edness primarily concerns explicit or conscious consideration of mental states. 6.5 Mapping Mindfulness and Mentalization onto Our Brain 169

Psychological mindedness also concerns the self and one’s own mental states more so than it considers the mental states of others.

6.5 Mapping Mindfulness and Mentalization onto Our Brain: Neural Correlates of Empathy, Self-Observation, and Mentalization

With recent research on cognitive neurosciences, meditation is increasingly being conceptualized as a process of experiential remodeling. In this model, the medita- tive is understood as the combination of information processing (via attention, salience, and meaning), affect regulation (compassion, empathy), and refl ection (self-observation). So a description of neurobiology of meditative process is essen- tially a description of these key things involved in the meditative process. As described in Chap. 2 of this book, there are three parties involved in the pro- cess and experience of meditation: (a) the meditator or the experiencer (the-one- who-experiences), (b) the object of meditation (the scene or the seen or the objects in the world), and (c) the interface or medium through which we meditate (the mind or in deeper meditations, the soul). When we break down the complex process of meditation into its constituent parts, some of the key components involved in this experiential process are the following aspects in the meditator:

(i) Compassion and empathy (already mentioned and will be elaborated later) (ii) Attention (two types: selectively focused attention during the concentrative meditation and uniformly hovering attention during the mindfulness meditation) (iii) The meaning (and interpretations) of the meditation objects to the meditator (iv) The capacity for self-observation

Although there is considerable overlap in the constructs underlying these four principal components and each component deeply infl uences the others during the practice of meditation, one can broadly say that the fi rst two components, i.e., atten- tion and meaning (along with interpretation of the meaning), fall under cognitive and information processing domain, whereas the last two components, empathy and self-observation, fall under the emotive–refl ective domain. In this paradigm, the process of meditation can be conceptualized as the combination of information pro- cessing (via attention, salience, and meaning), affect regulation (compassion, empa- thy), and refl ection (self-observation) where one constantly revisits and remodels these components as one ascends the rungs in the ladder of meditation. Attention is a central concept in human experience including in the meditative experience. Attention is a general, global aspect of human cognition, intimately connected to one’s state of self-awareness, or refl exive consciousness. We see that overlearned, automated activities may require little or no conscious attention to be performed. In deep meditation, the central role of attention/concentration that cul- minates in the self–object merger (to the extent of dissolution of self as well as the 170 6 Yoga, Mindfulness, and Mentalization: Central Role of Attention and Compassion exclusion of time and space from this pure experience) has already been described in some detail under the description of the process of Samyama , the central medita- tive process in Yoga. So the bottom line is that attention is not only involved as a key process in meditation but also is the key technique in the meditative process. Meaning is an important element in all experiences including contemplative experiences like meditation or deep psychotherapy. As mentioned before, meanings in human experiences are largely representational (based on perceptions) and partly based on actual data from the sense organs. Both conscious and unconscious repre- sentations of an object will cause activation of corresponding nerve circuitry in the brain. In general, meaning in the brain is defi ned operationally and subjectively, i.e., the meaning of objects is defi ned in terms of their functional signifi cance to the individual. To encode meaning in the brain, some of the nerve circuits involved in potential use of the object in question are activated. Without going to elaborate descriptions of the cognitive neuroscience research (some of it will be elaborated in Chap. 8), it is now known that meaning is construed in terms of (i) past experience (memory of similar events and their relation to context, semantic associations), (ii) incentive salience (reward prediction errors), (iii) attentional salience, and (iv) con- ditional emotional responses in the amygdalar and other limbic areas. Meditational experiences are quite complex and abstract, and by and large these experiences involve construing the meaning of meditation objects. Knowledge of the neural cir- cuitry involved in the meditational experiences gives tangible reality to these experi- ences and their subjective meanings to the meditator. This helps a person to begin the meditative work from a concrete position that has both focus and objectivity. Self-observation is a key aspect in any meditative process. Meditation is by and large an introspective self-analysis based on one’s capacity of self-observation. As the fi eld of cognitive neuroscience keeps on expanding the knowledge about the neural circuitry that underlies self-observation, researchers will continue to acquire and integrate more information, and eventually self-observation will come to be viewed as another brain-based skill that can be developed in clients by self- contemplative methods like meditation or various psychotherapies (dialectic behav- ioral therapy/DBT; mentalization-based therapy/MBT; mindfulness-based cognitive therapy/MBCT). In all these interventions, the primary intent of self-observation is to uncover dysfunctional patterns that, if changed, will lead to relief of symptoms and improved functioning.

6.5.1 Neural Components Involved in Empathy

The neural bases of empathy have been a major topic of investigation in the past, more so in the past decade or so. Neuroimaging studies have informed us about the various neurocognitive components involved in different aspects of empathy; among which three are the most consistent components: congruent affect with the target individual, perspective-taking, and prosocial motivation to help the target individual (Zaki and Ochsner 2012 ). These are confi rmed once again in a recent study with good methodology (Morelli et al. 2014 , p. 39–47). This study examined in 32 6.5 Mapping Mindfulness and Mentalization onto Our Brain 171 participants the activation of the various brain areas in functional magnetic resonance imaging sessions while assessing the empathic responses to individuals experienc- ing painful, anxious, and happy events. The results of this important study con- fi rmed that the dorsal anterior cingulate cortex (dACC), anterior insula (AI), and ventromedial prefrontal cortex (vmPFC) are involved in affective congruence, whereas mirror neuron (intraparietal lobule and posterior inferior frontal gyrus, the mirror areas) and mentalizing systems (dorsomedial prefrontal cortex and medial prefrontal cortex, the mentalizing areas) are involved in perspective-taking and emotional sharing. In addition, this study confi rmed the important role of septal area in generating prosocial behavior by producing a caregiving state of mind. In this study, septal activity during each of these abovementioned empathic experiences was predictive of helping behavior in daily life. In addition, the results in the above study demonstrated that empathy for positive and negative emotions selectively activates different brain regions associated with positive and negative affect, respec- tively. Empathizing with emotional experiences that did not require contextual information in order to be understood (i.e., unambiguous physical pain events) engaged the mirror system, not the mentalizing system, which was more active dur- ing empathy for context-dependent events (e.g., empathy for social rejection, social suffering, sadness, anxiety, happiness, and positive and negative life events). In this study, empathy for pain relative to empathy for anxiety and happiness showed robust activation in the intraparietal lobule and posterior inferior frontal gyrus (IPL and pIFG, the mirror areas), whereas specifi cally the dorsomedial prefrontal cortex and medial prefrontal cortex (dmPFC and mPFC, the mentalizing areas) were more active during empathy for anxiety and happiness compared with empathy for pain.

6.5.2 Neural Components Involved in Self-Observation and Introspection

Self-observation and introspection have paramount importance in the meditative process and all the more so in insight meditation (mindfulness meditation). The importance of these crucial human qualities has been emphasized time and again in all the original traditions of Yoga–meditation, the Hindu, Buddhist, and Tantric tra- ditions. Recognizing its crucial importance, self-introspection (Sanskrit: svadhy- aya) has been regarded as an important niyama (observance, the second limb of Patanjalian Yoga) in the Yoga Sutras (Satchidananda 1978 : Section II, Verse-32; Radhakrishnan 1953 , p. 357). Like empathy and compassion, self-observation is a distinct process that can be distinguished from consciousness, awareness, and self- awareness. Self-observation enhances the capacity for introspection and anchors the person’s understanding of his or her relationship with the environment. Compared to the act of observing others, the act of observing oneself (self-introspection) is even a more important and key skill in the meditative process. In this key process of self-observation, one may focus attention on the totality of one’s subjective reality, which includes representations of the self’s experiences in the past, present, and future (Wheeler 1970 ). Self-observation increases the ability to distinguish inner 172 6 Yoga, Mindfulness, and Mentalization: Central Role of Attention and Compassion from outer reality and pretend from real modes of functioning and intrapersonal mental and emotional processes from interpersonal communications (Greenspan 2004 ). Introspection (looking inward) is the key technique involved in self- observation/self-analysis. As a refl ective mode, introspection can produce knowl- edge about one’s many internal states, such as intentions, expectations, feelings, thoughts, behaviors, and perceived effect on others. The ability to observe the con- tent of one’s own mind depends on the healthy functioning of many different parts of the brain. To begin the process, one must be awake, with an intact brain stem and a functioning reticular activating system. Next, the objects of self-observation, which are neural representations in the various functional circuits that drive cogni- tion, emotion, and behavior, must be accessed and integrated in working memory. The basic representation of the visceral self , along with a variety of internal states, can be obtained by accessing the insula, a key brain area in the temporal lobe; objects and space are represented in the temporal and parietal cortices; risk–reward considerations are continuously generated by the amygdala, orbitofrontal cortex, and nucleus accumbens, and episodic and semantic memories can be recalled by accessing the hippocampus and connected cortices. The ability of the autonomic nervous system (sympathetic and parasympathetic) to connect the brain and body provides the means by which deep experiences like meditative experiences can result in very visceral feelings. The autonomic nervous system, by its unique ability to transmit the neuronal activity from the brain to the rest of the body (a top-down phenomenon), serves as an important meditator of the meditative experiences.

6.5.3 Mirror Neuron System (MNS): The Neural Correlates of Empathy and Meanings

Mirror neurons are one of the newer discoveries of the modern science in its attempt to understand the role of brain in shaping our experiences. These neurons were originally discovered in the brains of macaque monkeys by Rizzolatti and cowork- ers ( 1996) at the University of Parma, Italy. They were initially discovered in the frontal and parietal lobes in the primate brain where they fi re both during the execu- tion of purposeful movements and during observation of other individuals perform- ing similar actions (Iacoboni and Dapretto 2006 ). The mirror neurons become activated when the actions and expressions of others are observed and then modeled internally (Rizzolatti et al. 2001 ). Mirror neuron activity does not depend on the action actually being observed; it responds to imitations-based learning too (Bucino et al. 2004 ). Mirror neurons provide a neurobiological explanation for some higher human qualities like empathy and compassion as well as for important psychotherapeutic phenomena, including some aspects of transference (patient’s personalized feelings toward the therapist) and countertransference (therapist’s personalized feelings toward the patient). Although the actual mechanisms by which mirror neuron sys- tems support empathy remain speculative, research seems to consistently show that one’s ability to be empathic may depend on the functioning of the mirror neurons 6.5 Mapping Mindfulness and Mentalization onto Our Brain 173

(Carr et al. 2003 ). An important component of human habitual behavior is the for- mation of internal representations of the experiences. These representations are used to organize external stimuli, determine their meaning, and respond to them accordingly. The meaning is often determined by inferences made from our obser- vations. When we meditate, essentially we observe ourselves and others in mind’s eye. The mirror neuron circuits play important role in the attribution of meaning to the actions of others and in the development of empathy. Considering the fact that these neurons allow us to experience the meaning of other people’s external actions, they can be called the experiential neurons of the human brain. According to the views of the researchers in the MNS (Rizzolatti et al. 2001 ; Carr et al. 2003 ; Iacoboni et al. 2001 ; 2006 ), an action is understood when its obser- vation causes the motor system of the observer to resonate. We understand the actions of others when we internally model with these actions, and this modeling happens by mapping the visual representation of the observed action onto our motor representation area in our brain. Before we interpret and understand the meaning of verbal messages, body movements, and emotional expressions, these observations must be modeled by the brain by critical neural processing steps which involve the mirror neuron system (MNS) as follows. MNS in the human brain consists of the following six interconnected brain regions (Carr et al. 2003 ; Iacoboni and Dapretto 2006): (i) superior temporal sulcus (STS) mirror neurons, which encode visual description of observed action by providing the initial detailed visual description to the parietal cortex of the actions to be imitated; (ii) posterior and inferior parietal mirror neurons , which add the somatosensory information to be provided to the prefrontal cortex for encoding the motoric components of the action’s movement sequence; (iii) mirror neurons in the pars opercularis (part of brain overlying the insular area) of the inferior frontal gyrus (IFG) which are within Broca’s area of the frontal lobe and defi ne the perceived goal of the observed actions; (iv) inferior fron- tal mirror neurons , which encode perceived goal of the action; (v) mirror neurons in the insula, which connect mirror neurons to limbic circuitry and which facilitate the generation of a subjective body state related to the perceived action; and (vi) mirror neurons in the limbic circuitry , including the amygdala, which can respond emotionally to the perceived goals. Of note, facial expressions are crucial part of one’s emotional expressions and contain both motor and emotional components. The premotor region of the frontal cortex (inferior frontal gyrus: IFG) and posterior parietal cortex constitutes the MNS for the motor components of facial expressions, whereas the amygdala and insula represent MNS for emotional states (van der Gaag et al. 2007 ). In the MNS, the two key temporal lobe structures are the superior temporal sulcus (STS) and the fusiform gyrus (FG). The STS not only integrates the complex visual perceptual information but also is strongly interconnected to the full range of cerebral struc- tures involved in social cognition (the social brain). In addition, STS is responsive to changeable aspects of behavior like facial expressions as well as eye and mouth movements, and thus, STS determines the intentionality in behavior . The fusiform gyrus is the key neuroanatomical area involved in facial recognition as well as iden- tifi cation of individuals. Of note, STS is activated in response to biological motion 174 6 Yoga, Mindfulness, and Mentalization: Central Role of Attention and Compassion and the active behavior of living things, whereas the FG is activated by static fi gures like animals or faces (Frith and Frith 2003). The highly social human brain is hypothesized to rely on the MNS to navigate the complex universe of social interac- tions. This hypothesis is proven in clinical situations that involve patients with autism and autism spectrum disorders (ASD) who show markedly decreased activ- ity in mirror neuron systems when viewing the emotional expressions of others (Iacoboni and Dapretto 2006 ). Effective treatment in ASD thus may focus on enhancing mirror neuron activation to the degree that this might be possible, there- fore optimizing the internal processes that lead to self-awareness and other aware- ness. This provides rationale for use of mindfulness- or mentalization-based interventions in the ASD.

6.5.4 Neural Correlates of Mentalization: The Mentalizing Area of the Brain

The orbitofrontal cortex and the ventromedial prefrontal cortex (vmPFC) are the key brain regions associated with empathy and mentalizing activity (Fonagy and Bateman 2007 ). The vmPFC is considered the mentalizing region of the brain (Frith and Frith 2003 ). The ACC (the central motivator) and vmPFC (the brain area that is stimulated when we are experiencing happiness) act in a complementary way in the process of mentalization. They make use of internal cues like emotions and incen- tives to regulate attention and action in changing circumstances that call for con- tinual decision making and self-regulation. Of note, these areas of the brain are important parts of the social brain as well.

6.6 Therapeutic Use of Mindfulness and Mentalization: The Third Wave of Cognitive Behavioral Therapies (CBT)

A story from the Buddhist literature is worth noting here. In a dialectic situation involving the pragmatics of meditation, a Buddhist monk advises his disciple, “if we had to cover the whole surface of the earth with some soft yet resilient substance to protect our feet from being hurt by sticks, thorns and stones, it would be a very dif- fi cult undertaking indeed. But merely by covering the soles of our feet with shoes, it is as if the whole surface of the earth were thus covered” (Santina 1997 , p. 75). According to the Visuddhimagga [Eng. The Path of Purifi cation ; Buddhaghosha; 430 CE], the Abhidhammic encyclopedia on meditation, all the affl ictions and condition- ing of mind are like the sticks and stones trying to harm the pure mind. Meditation is like the protective shoes that safeguard the mind against these affl ictions or condi- tioning so that the individual can have higher grades of experience through a pure and unharmed mind; enlightenment is the purifi cation of the mind in its most com- plete sense to its most pure form. Despite having a long history of their therapeutic use beginning in ancient India and South Asia, therapeutic uses of Yoga–mindfulness in the West are relatively new ventures. Psychological therapies based on the Yoga 6.6 Therapeutic Use of Mindfulness and Mentalization 175 and mindfulness philosophies have led to development of new forms of psychothera- pies that have been categorized under the third wave cognitive behavioral therapies (Kahl et al. 2012) which include the integrative models of psychotherapies like the mindfulness-based stress reduction (MBSR; Kabat- Zinn et al. 1992), mindfulness- based cognitive therapy (MBCT; Segal et al. 2002 , 2013 ), acceptance and commit- ment therapy (ACT; Hayes et al. 1999 ), dialectical behavior therapy (DBT; Linehan 1993 ), and mentalization-based therapy (MBT; Fonagy and Bateman 2007 ). A gen- eral description of these therapeutic methods including the use of mindfulness in psychotherapy can be found in an excellent book: Mindfulness and Psychotherapy (Germer et al. 2005). The fi rst wave of CBT was a focus on classical conditioning and operant learning, the second wave of CBT was classical cognitive therapy char- acterized by a focus on information processing, and the third wave is characterized by metacognitive themes that are new to behavioral psychotherapies. These themes include metacognition, cognitive fusion, emotions, acceptance, mindfulness, dialec- tics, spirituality, and therapeutic relationship. The techniques used in third wave methods are quite heterogeneous, but the commonalities lie in their emphasis on the form rather than on the content and the abandonment or cautious use of content- oriented cognitive interventions and the use of skills defi cit models to delineate the core maintaining mechanisms of the addressed disorders. Having a strong focus on the positive psychology, these therapies tend to emphasize the contextual and expe- riential change strategies with the clients in addition to the traditional didactic and behavioral components. These therapies instead of shying away from the spiritual domains of clients tend to integrate spirituality with psychotherapy. These new mod- els advocate that psychotherapists do not need to become experts in theology and religion in order to serve useful roles in their patients’ lives. They do need to learn how to apply to the spiritual domain their competencies in the therapeutic use of language and relationships. Careful listening, learning how to listen for the language of spirituality and ask existential questions, and learning how to manage negative religious countertransference are the most important contributor to psychotherapy with spiritual or religious experience. The third wave of behavioral psychotherapies is an important arena of development in modern and integrated psychotherapy and has added considerably to the spectrum of empirically supported treatments for men- tal disorders. In a recent review, authors (Kahl et al. 2012 ) conclude that the available evidence now allows all third wave treatments to be considered as empirically sup- ported. Meditation-based interventions have good effi cacy data in the randomized control trials in population suffering from psychiatric disorders including depression and anxiety disorders (Segal et al. 2002 , 2013 ; Varambally and Gangadhar 2012 ; Sanahoff-Khalsa 2004 ). Interested readers can refer to excellent review articles that describe how yoga and psychotherapy can be integrated in healthcare in order to effectively manage various neuropsychiatric disorders (Brown and Gerbarg 2005 ; Forfylow 2011; Balasubramaniam et al. 2013). The recognition that mindfulness meditation practice can heighten objective self-awareness and disengage ruminative thinking patterns has been utilized effectively in clinical trials involving the mindfulness- based stress reduction (MBSR) and the mindfulness-based cognitive therapy (MBCT). 176 6 Yoga, Mindfulness, and Mentalization: Central Role of Attention and Compassion

6.6.1 Mindfulness-Based Stress Reduction (MBSR)

The MBSR program has been developed by Jon Kabat-Zinn at the Stress Reduction Clinic of Massachusetts General Hospital in 1979. MBSR is described as a group program that focuses upon the progressive acquisition of mindful awareness (Kabat- Zinn 1990 ; Kabat-Zinn et al. 1992 ). People enrolled in a MBSR program practice various meditation techniques, including those focused on breathing and body awareness. Several recent meta-analyses (Grossman et al. 2010 ; Bohlmeijer et al. 2010 ; Fjorback et al. 2011 ) have evaluated the effi cacy of MBSR trials. Bohlmeijer et al. (2010 ) conclude that MBSR has small effects on depression, anxiety, and psychological distress in people with chronic somatic diseases. Integrating MBSR in behavioral therapy may enhance the effi cacy of mindfulness- based interventions. Meta-analysis of MBSR trials by Fjorback et al. (2011 ) found it to be a useful method for improving mental health and reducing symptoms of stress, anxiety, and depression and recommended it as means of improving the quality of life for patients managing their diseases. These authors have suggested that the experience of the MBSR practitioner had a signifi cant impact on an MBSR course’s effectiveness and noted that the course developers recommend several years of training.

6.6.2 Mentalization-Based Treatments (MBT)

Following clinical use of the theory of mind defi cits (Baron-Cohen et al. 1985 ; Baron-Cohen 1995) as explanation of the interpersonal functioning diffi culties in autism, Fonagy et al. used the same model to explain psychopathology in the borderline personality disorder. Using this theory of borderline personality dis- order as a disorder of mentalization and integrating parallel streams of thought from the fi elds of psychoanalysis, developmental psychology, and cognitive neu- roscience, mentalization-based treatment (MBT) is a psychodynamically ori- ented, manualized psychotherapy program for borderline personality disorder developed by Fonagy and Bateman (2007 ). MBT is a time-limited treatment which structures interventions that promote the further development of mental- izing. After dialectic behavioral therapy (DBT), MBT became the second psy- chotherapeutic treatment for borderline personality disorder to be empirically validated by randomized, controlled trials as more effective than non-specialized psychiatric treatment. As mentioned earlier, MBT has its roots in attachment theory which is based on the idea that people with borderline personality disor- der mainly lack the ability to mentalize, which is caused by an absence of con- tingent and marked mirroring during development. The primary goals of treatment are to improve mentalization skills, making connections between the inner experience of relationships and the actual representation and learning how to work with current emotions and how to establish real relationships. In this way they could form a more coherent sense of self and develop new (secure) attach- ment styles (Bateman and Fonagy 2004 ). 6.7 Mindfulness-Based Cognitive Therapy (MBCT) 177

6.7 Mindfulness-Based Cognitive Therapy (MBCT): Integrating Mindfulness with Cognitive Therapy

Cognitive psychotherapy is largely based on the premise that we construct (and react to) much of our reality through imposed and learned meanings . Cognitive therapy acts directly on the meanings of these experiences by directing us to substi- tute alternative content, by substituting optimistic thoughts for pessimistic thoughts, or by reframing the meaning of particular experiences. Concepts of mindfulness, both the philosophy and techniques, can be readily integrated into cognitive or behavioral treatments. The therapy resulting from this integration is called mindfulness- based cognitive therapy (MBCT). Similar to some aspects of cognitive therapy, in mindfulness one major goal is to induce detachment by disengaging the identity of the self from the contents of one’s thought. Originally MBCT as a psychological therapy was designed to aid in preventing the relapse of depression, specifi cally in individuals suffering from the major depressive disorder (Segal et al. 2002 ). The core of MBCT is derived from the Buddhist mindfulness philosophies but has been modifi ed to integrate these concepts into modern psychotherapeutic frameworks. MBCT in depression utilizes traditional cognitive behavioral therapy (CBT) methods including educating the participant about depression and adds in newer psychological strategies, like mindfulness attitude and mindfulness medita- tion. As the name suggests, the core of MBCT is derived from the Buddhist mind- fulness philosophies but has been modifi ed to integrate these concepts into modern psychotherapeutic frameworks, popularly called as the third wave of psychothera- pies. One such fusion model of mind which is employed in the MBCT is a multilevel theory of the mind called interacting cognitive subsystems (ICS), initially proposed by Barnard and Teasdale (1991 ). In this information processing model, the mind has multiple modes that are responsible for receiving and processing new information cognitively and emotionally. The two main modes of mind are (i) the doing mode and (ii) the being mode. The doing mode is quite goal oriented, based on mind’s striving for things, and is triggered when the mind develops a discrepancy between how things are versus how the mind wishes things to be. The being mode, on the other hand, is not focused on achieving specifi c goals; instead, the emphasis is on accepting and allowing what is, without any immediate pressure to change it. As described in the earlier chapters of this book, when one is operating in the doing mode of mind (e.g., the driven-doing mode/deadline mode), one is always eyeing on the goal and just getting the job done, whereas in the being mode (experiential mode), one is enjoying the process/getting absorbed in the experience. The central component of this model is the experiential aspects or the metacognitive awareness (Barnard et al. 2007 ). Metacognitive or detached awareness is the ability to experi- ence negative thoughts and feelings as mental events that pass through the mind, rather than as a part of the self. Individuals with high metacognitive awareness are able to avoid depression and negative thought patterns more easily during stressful life situations, in comparison to individuals with low metacognitive awareness (Herbert and Forman 2011 ). In the Buddhist framework, metacognitive awareness is based on the ability of the individual to perceive thoughts and feelings as both 178 6 Yoga, Mindfulness, and Mentalization: Central Role of Attention and Compassion impermanent and objective occurrences in the mind. Mindfulness attitude and mindfulness meditation focus on becoming aware of all incoming thoughts and feelings, to observe and accept them, but not getting attached (or clung) or reacting to them. In mindfulness philosophy, mind is considered one of the senses, compa- rable to the other fi ve senses (the sight, hearing, touch, taste, and smell). In mindful meditation, the contents of mind (the objects of the mind ), i.e., thoughts, feelings, perceptions, memories, and will, are allowed to arise, are registered rather than elaborated, and are then observed and responded to in detached manner rather than getting caught into them in a cascade/ruminative way. In stress response, our responses play a crucial part because they are the result of imposed meaning on the stimuli that impinge on our brains and they engender further reactions, thoughts, feelings, and behavior. The way we respond to the various stimuli in our internal and external milieu essentially defi nes our personality and the accompanying stress- adaptation response characteristic of each personality. For example, if one responds to these stimuli in a very reactive manner (based on incomplete information), that response pattern becomes impulsive and its associated stress and consequences. Mindfulness meditation practice involves disengagement of mind and shifting the operation of mind from reactive or driven - doing mode to the experiential or being mode and gears one’s stress response system toward producing better and more adaptive responses. Our mind is designed to construct meaning out of experience, and that constructed meaning is encapsulated by conscious thoughts. A central tenet of mindfulness philosophy is that our conditioned existence (conditioned existence means the interdependent way in which fi ve objects of mind create the experience ) based on attachments to objects, desires, etc., distorts our perceptions about things and creates an illusionary sense of self. This ignorance (Sans. avidya ) or incomplete knowledge of reality is the primary source of distress: this makes us reactive (rather than responsive), which creates the vicious circle of reaction and stress and so on. According to the mindfulness (vipassana ) traditions, meditation practice imparts insight ( vipassana ) into reality and thus breaks this vicious circle. Meditation affects stress response in four stages (Kristeller 2004 , p. 21–37): (i) First, it provides a way to free the mind and the senses from the distractions and make them unifi ed with one’s consciousness. (ii) Second, with somewhat more prac- tice, mindfulness meditation provides a way to observe patterns of responding or reacting, as they occur. (iii) Third, with yet more practice, conditioned reactions and responses to these sense objects gradually disengage and weaken. (iv) Finally, in the course of this uncoupling, meditation allows more integrative, insightful, wiser, or distinct levels of processing to emerge, contributing to more effective responses.

6.7.1 Differences Between CBT and MBCT

MBCT is a fusion model of therapy, and because of a strong focus on the positive psychology, these therapies tend to emphasize the contextual and experiential change strategies with the clients in addition to the traditional didactic and behav- ioral components. Unlike in CBT, in MBCT the emphasis is on the form rather than on the content: there is either abandonment or cautious use of content-oriented 6.8 Concluding Remarks 179 cognitive interventions. Also in MBCT, there is use of skills defi cit models to delineate the core maintaining mechanisms of the addressed disorders. For exam- ple, like in CBT, interventions in the MBCT are based on the theory that when individuals who have historically had depression become distressed, they return to automatic cognitive processes (e.g., the ruminations in depression) that can trigger a depressive episode. However, unlike in CBT, the MBCT interventions interrupt these negative automatic processes by teaching the participants to focus less on reacting to incoming stimuli and instead accepting and observing them without judgment (Felder et al. 2012 ). This mindfulness practice allows the participant to observe when automatic processes are occurring and also helps them reappraise these processes in the light of mindfulness attitude and philosophy. Another funda- mental difference between CBT and MBCT is that in MBCT the therapists practice meditation with their patients, i.e., MBCT emphasizes more on the experiential aspects of this therapy. Research supports the effects of MBCT in people who have been depressed three or more times and demonstrates that it reduced relapse rates by 50 % (Ma and Teasdale 2004 ).

6.8 Concluding Remarks

Meditation-based therapies can help patients become aware of their internal pat- terns and drive therapeutic change by crystallizing awareness of maladaptive stimu- lus–response connections and ways in which these might be altered (Beitman and Yue 2004). These insights mainly came from the related research in the fi elds of traumatology, attachment, and cognitive neurosciences. Studies of traumatized chil- dren (Main 1991 ) suggest that secure therapeutic relationships are associated with enhanced resiliency. To be resilient is to be able to fl exibly adapt to the new realities of life, to be able to recognize that the map is not the territory. In other words, this is the ability to realize that neural representations of the outside world, which incor- porate both external and internal contents, are not equivalent to reality. Experimental evidence suggests that secure attachment, as extrapolated from imaging studies of romantic love (Bartels and Zeki 2000 ) and mother–child affection (Bartels and Zeki 2004 ), is associated with reduction in amygdala fi ring (lessening anxiety), increases in nucleus accumbens activity (possibly related to enhanced reward representa- tions), and lessening of orbitofrontal fi ring (possibly reducing inhibitions). Within the secure attachment achieved through basic psychotherapeutic engagement tech- niques, circuits associated with negative emotions, social judgment, and mentaliz- ing (Viamontes and Beitman 2006 ) can be activated safely through verbal means, and their consequences can be explored. This controlled activation of negative con- tents within the psychotherapeutic relationship helps liberate the patient from past constraints, permitting the exploration of new interpersonal concepts. The common mechanism for such self-exploration is likely the activation of self-observation and the corresponding brain areas (Bateman and Fonagy 2004). While exciting with respect to their potential and actual utility, these interventions need to be tested and tried in an ongoing manner in the healing framework of psychotherapeutic armamentarium. 180 6 Yoga, Mindfulness, and Mentalization: Central Role of Attention and Compassion

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Yoga is nothing but practical psychology (Aurobindo, twentieth-century Indian philosopher)

7.1 Introduction

Psychotherapy (psychological therapy; popularly known as the talk therapy ) is a general term that refers to the psychological interventions executed by a trained professional to decrease distress and/or improve functioning in a client, patient, family, couple, or group. Applied psychology or psychotherapy is the study of the mind and mental states that focuses on the various mental phenomena that will facilitate or hinder one’s progress toward mental well-being. Psychotherapy in its varied paradigms and delivery models consists of an exchange of information, dia- logue, and interventions directed toward eliciting change in the clients. As men- tioned in chapter three, all experiences including psychotherapeutic experiences are representations in the brain, and achieving the psychotherapeutic goals (e.g., insight, affect modulation, decreased relational confl ict) depends on some degree of modifi - cations to these representations by causing changes into the perceptual, memory, and emotional systems that work both ambiently and enduringly within the brain. It is important to understand that memory is state dependent in the sense that there is a relationship between encoding cues and retrieval cues and that retrieval is a recon- structive process, not an actual replica of experience (Pally 1997 , 2005 ). Recent advances in our understanding of brain function associated with cognition, affect, and memory have led to new insights into the impact of experience in the individual processing of memory, emotions, motivation, and dreams (Pally 1997 , 2005 ; LeDoux 2003 ). It would not be an exaggeration to say that psychoanalysis (scientifi c study of mind) is mother to all forms of psychotherapy. Psychoanalysis, as we know it today, is largely built upon the work of Dr. Sigmund Freud, its founding father, and his followers. Like the philosophical psychology of Buddha and Patanjali in ancient India, Freud’s biggest contribution was his concepts to understand the

© Springer International Publishing Switzerland 2015 183 B. Pradhan, Yoga and Mindfulness Based Cognitive Therapy: A Clinical Guide, DOI 10.1007/978-3-319-09105-1_7 184 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT) mechanism of the human mind, particularly that of the unconscious. Freud noted that a major part of our mind is the unconscious and that what we consciously experience is only an insignifi cant part of the self. According to Freud, the more signifi cant unconscious part of the mind is the source of all confl icts between the id, ego , and superego, the three agencies of the mind. According to Freud, when a child is born, there is nothing except id or unconscious, and as he/she grows and comes in contact with the environment, the reality develops. He called this sense of reality or con- sciousness the ego . The reality is infl uenced by various taboos and constraints on the family and the society in the form of moral principles that characterize the superego . According to Freud, the unconscious contains thoughts, memories, and desires that are well below the surface of conscious awareness but, nonetheless, exert great infl u- ence on behavior. There is another part of mind he called the preconscious . The preconscious holds those mental contents the individual is usually not aware of but with conscious efforts can be made aware of. The concepts of the id , ego , and super- ego (and the associated ego defense mechanisms) describe the functions of the human mind (otherwise called Freud’s structural theory of mind), while the unconscious, preconscious, and conscious constitute Freud’s topographical model of the mind, i.e., conscious, preconscious, and unconscious are the three layers of mind, from the surface to the bottom, respectively. The genius of Freud lies in his argument that an individual’s behavior is governed by unconscious forces, which suggests that people are not masters of their own mind. The unconscious contains thoughts and memories that are well below the surface of conscious awareness but that, nonetheless, exert great infl uence on behavior. Similar to the Freudian concepts of the id , ego , and superego, the Yogic philosophers like the sage Patanjali and the Buddha elaborated upon very similar concepts of the mind, which are broadly conceptualized as the graded theory of mind, i.e., mind has various grades or levels with respect to its qual- ity. These various levels are manasa ( lower mind; cf. id ), buddhi (intellect/reasoning faculty of mind; cf. ego ), and Atman (higher mind or experiential faculty like the Soul , respectively; cf. superego ). In addition to these functional concepts of mind, there exists a similar structural theory of mind as described in the Yoga Sutras of Patanjali. As described in the lake analogy (for more descriptions, please see chapter two), one can see the similarities between Freud’s topographical theory of mind and this Yogic model of mind. The Yogic terms that are conceptually similar to the psy- choanalytic term unconscious are samskara and smriti , i.e., engraved memories of the past and the associated motives that always determine the individual’s behavior. As already elaborated in chapter four, within Yogic and mindfulness traditions, the goal of the monk in the various stages of samadhis (Pali samapattis) is achieving pure experience (i.e., unconditioning experiences from these engraved memories by eliminating the samskaras that clouds one’s experiences). This is the concept of experiencing things as they are. As we know, both the systems of Yoga and psycho- analysis agree that there is always some kind of battle (called confl ict in Freudian sense and dvanda [Sans.] in Yogic sense) waged within our mind between these forces (i.e., the id, ego , and superego in Freudian sense and the various grades of mind , from lower to higher in the Yogic sense). These confl icts infl uence all our behavior. Both systems also agree that the confl ict gives rise to suffering (Sans. duh- kha) and that insight is the cure to this suffering. Both systems attest that driven by the unconscious or samskaras , people are not masters of their own minds; however, 7.1 Introduction 185 mastery is possible with insight (called jnana or knowledge in Yoga). Despite these striking similarities between Yoga and psychoanalysis, Freud, the founding father of psychoanalysis, struggled with concepts of Yoga and Eastern spirituality: to him those concepts were intangible quantities (Freud 1930 , p. 72). In regard to oceanic feeling and Eastern mysticism, Freud claimed: “… to me mysticism is just as closed a book as music…” (Freud 1929 ). Oceanic feeling (i.e., feelings of limitlessness) is a transcendental feeling of oneness (merger) with the world. Rolland, Jung, and oth- ers, well versed in both disciplines, i.e., spiritualism and psychoanalysis, attest that this feeling is the source of all religious energy which permeates various religious systems. To Freud, however, the oceanic feeling was a primitive feeling, i.e., “a frag- ment of infantile consciousness when the infant begins to differentiate himself from his human and non- human environment.” On the contrary, the oceanic feeling, in its true sense, is the sense of wonder and awe, which leads to a humble awareness of the Truth, with some sense of the human ego’s limits as contrasted with the vastness of this whole universe. These misunderstandings about the higher meditative states have led some prominent thinkers to misinterpret these states as hallucinatory experi- ences or infantile regression. For more descriptions, please see Rolland (1929 ). For most of the twentieth century, most American and British psychotherapists kept religion and spirituality at a distance. Despite his tremendous brilliance, Freud lacked understanding of Eastern mysticism in its true sense. His antipathy toward religion and spirituality is evident in his saying that these are the black tides of occultism (McGuire and Hull 1978) which at least in part contributed to this alien- ation of spirituality from the mainstream psychotherapy. Since the 1990s, however, a rapprochement between psychotherapy and spirituality has occurred. Currently, most of the professional psychotherapy conferences in the USA, whether psychody- namic, cognitive behavioral, or family systems, commonly feature a spirituality track. In the USA today, it appears that most psychotherapists uncomfortable with spirituality are so due to a sense of incompetence in how to deal with these issues, rather than a theoretical objection to addressing these issues in psychotherapy. Some of the reasons accounting for increased positivity in the therapist’s attitude toward patient’s spirituality include the importance of acknowledging the client’s spiritual- ity in facilitating a therapeutic alliance with the therapist, spiritual resources that can help build resilience when the client is confronted with life’s adversities, and an increase in research literature regarding the effi cacy of these integrated or holistic approaches.

7.1.1 Seminal Contribution of the Buddha and Sage Patanjali in Laying Out the Early Foundations for Therapeutic Use of Yoga–Meditation

The , the ancient Indian system of healing, is based on the Yogic philoso- phies (Frawley 1999 ). The therapeutic role of meditative experiences, particularly the Buddhist meditative experiences, is well researched in various studies regarding their role in development of empathy, decreasing stress as well as improving attention, memory, and coping. As described earlier, the major innovation of Yoga in Buddhist philosophy is meditation as well as probing the structure and function of the mind in 186 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT) order to understand the conditioning and thus sufferings of the human being. According to Buddha, pain is inevitable in life, and the cause of suffering is the way one relates to one’s life and experiences. The culprit for one’s sorrows and suffering is desire. The mode of control is dispassion or detachment, and the remedy is the use of meditation (mindfulness) in one’s daily life. The goal of meditation is liberation (nib- bana) which is essentially freedom from one ’ s conditioned existence. In many ways, Yoga and meditation in Buddhism can be seen as the human wish to transcend the intolerable pain and suffering and uncertainty of human life. As mentioned before, while in Hinduism emphasis has been on the metaphysical concepts like the genesis theory, Buddhism relates more on psychology. Buddha was not interested in satisfy- ing his curiosity regarding the origin of the world or the nature of the divine. He was rather concerned exclusively with the human experience of suffering and pain. His doctrine, therefore, was not one of metaphysics, but one of psychotherapies. Building upon the traditional (Indus Valley Civilization) Yogic concepts of ancient India, Buddha determined the origin of human frustrations using dynamic and directly rel- evant psychological interpretations and described the ways to overcome these pains and sufferings. In Buddhism, Yoga is a way or a method of transcending the basic human pains and sufferings. Because of its pragmatic focus on human psychology, Buddhism contributed signifi cantly to the development of meditation as a systematic and deeply contemplative discipline (like a form of psychotherapy). Buddha’s major contribution was the development of meditation as a therapeutic system that facilitates the union of meditative insight and the liberating cognition in order to achieve libera- tion from suffering. Mindfulness and the Noble Eightfold Path were the prescriptions of the Buddha (scriptures actually describe Buddha as a physician) for curing the suf- ferings of mankind. Studying the Buddha’s own life, one realizes that based on his personal experience of severe sufferings, he experimented with the utility of mindful- ness on himself (for 7 years) and ended his own sufferings by achieving the enlighten- ment. After tremendous success in his personal use of mindfulness, he proposed it as a cure for the sufferings of all sentient beings. Mindfulness and samyama (for more descriptions, please see chapter four) are deep contemplative methods of self-analysis and self-transformation as proposed by Buddha and Patanjali and can be considered the earliest psychotherapeutic use of Yoga.

7.2 Yoga as Psychotherapy

Within the Eastern spiritual traditions including Hinduism and Buddhism, there lays signifi cant historical development of the psychological analysis of human existence, suffering, as well as psychological ways to ameliorate sufferings. These philoso- phies have extensively evaluated the human mind and psychology, focusing on human consciousness of the self (Sanskrit purusha ), the emotional attachment ( clinging according to the Buddha) to the self , and the consequent suffering (Pali dukkha) the individual (Sanskrit jiva ) experiences due to this excessive attachment. For very good reasons, the Buddha’s teachings are considered psychological, and his methods of yoga–meditation are described as forms of psychotherapy similar to 7.2 Yoga as Psychotherapy 187 cognitive therapy (because of the Buddha’s emphasis on the liberating cognition during the meditation). Symbolism of disease and healing is prominent in the teach- ings of the Buddha. The Four Noble Truths are a refl ection of the ancient scheme of disease, diagnosis, cure, and treatment used in early medical science and most likely the reason why the Buddha was called the king of physicians (Santina 1997 ). Buddha was interested in curing and not metaphysical categories. We fi nd his use of various techniques for healing throughout the discourses in the Sutta Pitaka . To summarize, we can use terms like philosophy and psychology in relation to the Buddhist tradi- tion as long as we remember that we are interested in philosophy not as it concerns essences and absolute categories but as a description of phenomena and that we are interested in psychology as it relates to psychotherapy. These qualities of the phi- losophy and psychology of the Abhidhamma are unique in the history of human thought. Nowhere else, in the ancient or modern world, in the East or the West, has such a phenomenology and psychotherapy evolved. What is unique about Buddhist phenomenology and psychotherapy is its rejection of the idea of a permanent self and its affi rmation of the possibility of liberation. In all other systems, even those of Western philosophical phenomenology and psychotherapy, we fi nd an inability to reject the idea of a permanent self—the very rejection so characteristic of the teach- ing of the Buddha and of the Abhidhamma. And nowhere within modern psychol- ogy do we fi nd that possibility of ultimate and absolute freedom so central to the teachings of Buddhism. This is one of the familiar and recognizable features that have attracted modern Western intellectuals and academics to Buddhist philosophy. Modern psychologists, too, are now deeply interested in the Buddhist analysis of the various factors of consciousness: feeling, perception, and volition. They are increas- ingly turning to the ancient teaching of the Buddha to gain greater insight into their own discipline. In the context of contemporary Western culture, scientists, psychol- ogists, and philosophers have found that Buddhism is in harmony with some of the most basic principles of the Western thoughts. Literature on Yoga–mindfulness, deep psychotherapies, functional neuroimaging studies, and cognitive neuroscience embarks upon the basic fact that because experi- ences are just representations in our brain and mind, they can be changed. Both the Yogic philosophies and contemplative therapies propose that this change in represen- tations can be effected by knowledge (insight) regarding reality. Our experiences in life are like virtual reality (likened to the map ) which can be made more real or actual (likened to the territory ) by further knowledge (likened to the programming of brain in computational model of the neurolinguistic programming, NLP; Gray and Liotta 2012; Wake et al. 2013 ). The knowledge in Yogic tradition is called the meditative insight (Sans. jnana ; Pali nanna , panna, vipassana). Buddha and Pantanjali had noted this long back and went further by proposing the two closely related paths, i.e., the Noble Eightfold Path and the Eight - Limbed Yoga, respectively. Insights from modern research including cognitive neuroscience, functional neuroimaging, and psychotherapy, particularly the studies involving stress and adaptation, provide evi- dence for this, albeit in a different language. In summary, the fact that experience can change the brain and vice versa drives the whole paradigm of self-healing and thus the psychotherapeutic potentials of Yoga and mindfulness. 188 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT)

7.2.1 Yoga and Contemplative Psychotherapies Including Psychoanalysis: A Comparison

[This author gratefully acknowledges teachings of Drs. Rao (2011 : personal com- munication) and Freeman (2010 –2012: a series of discussions) that inspired this writer about elaborating this section of this chapter. Both are prominent psychia- trists and academicians and serve as experienced training and supervising psycho- analysts in the USA.] Apart from their shared experiential and existential nature, both Yoga and psycho- therapy (including psychoanalysis) are essentially investigative pursuits into one’s per- sonal Truths. These investigative, existential, and pragmatic aspects in Yoga– meditation probably explain why such a complex philosophy like Buddhism was adopted so well by the very practical cultures (who tend to emphasize on the pragmatics of the daily life) like the Chinese or the Japanese. Possibly the fi rst explicit comparison between Yoga and psychoanalysis was made by Winter (1918 ). He contrasted psychoanalysis, as depicted in the work of Freud and Jung, with Patanjali’s Yoga Sutras . Since then, other writers have revisited this topic (Jung 1933 , 1969 , 1999 ; Bion 1967 , 1970 ; Loewald 1979 ; Wilber et al. 1986 ; Epstein 1990 ; Brickman 1998 ; Alfano 2005 ). It is important to note that like Jung, most of these writers had some kind of experiential background in Eastern spiritual philosophies. Meissner’s (2005 ) writings about this adequately summarize these concerns: “….a revision of analytic theory of mystical states is long overdue….” These writers proposed a need for developing healthy fl exi- bility within mainstream thinking of the deep contemplative therapies like psycho- analysis that will allow a new path for integration between psychotherapy and spiritualism. Below is description of some parallels between the psychoanalytic con- cepts and the Yogic concepts, keeping in mind that both Yoga and contemplative psy- chotherapies like psychoanalysis are theories of the mind and its various operations. Prominent psychoanalyst and Yoga practitioner (mostly the tantric form) Carl Jung specifi ed his psychological understanding of tantric yoga as follows (as quoted in Shamdasani 1996 , p. xxiii): “Indian philosophy is namely the interpretation given to the precise condition of the non-ego, which affects our personal psychology, however independent from us it remains. It sees the aim of human development as bringing about an approach to and connection between the specifi c nature of the non-ego and the conscious ego. Tantra yoga then gives a representation of the condition and the devel- opmental phases of this impersonality, as it itself in its own way produces the light of a higher supra-personal consciousness.” Alfano (2005 , p. 242) writes about transcenden- tal attunement and proposes that the psychoanalytic process itself can be approached as a contemplative discipline. Newman (1996 , p. 113) opines that “transference inter- pretations (in psychoanalysis) are guides to exercises in attention,” thus emphasizing the role of attention in clinical practice. Comparing the commonalities between Christian mystics (the Hesychastic monks), Buddhist meditation, and psychoanalysis with respect to the disciplines of attention, Newman (1996 , p. 6) describes further: “the participant (in each of the three disciplines) is asked to practice a careful moment-by- moment attention directed to the contents of the stream of consciousness and to do two apparently contradictory things: on the one hand, to let the thoughts go, to let the inner cinema roll, to free associate; on the other hand, to focus attention on these very same unrolling thoughts.” He goes on (p. 7): “….each of these exercises imposes on its 7.2 Yoga as Psychotherapy 189 participant a kind of systematic sensory deprivation, what I will call an asceticism of the perceptual fi eld.” He also notes that the fundamental rule of psychoanalysis is a kind of mindfulness practice and that close similarities lie between the two processes (i.e., mindfulness and transference).

7.2.2 Common Grounds Between Yoga and Contemplative Psychotherapies Including Psychoanalysis

Some themes that are common between Yoga and contemplative psychotherapies like psychoanalysis are already described in chapter three. Yoga is a process of introspective self-analysis and involves investigation of the various internal states of one’s mind using that person’s own mind as the instrument: does this not sound similar to the insight theory of psychoanalysis? Yoga proposes the use of the refl ex- ive powers of the mind in looking back into its own depths, with a hope or broader goal of transcending the sufferings of mankind through liberation from the con- straints of mind, whereas psychoanalysis uses the same power of mind to resolve the basic confl icts of mind. The most basic overlap between yoga and deep psycho- therapies is that both are contemplative disciplines and both give central importance to the mind as compared to the body. Qualitatively, like psychoanalysis, Yoga and mindfulness contemplate on the various mysteries of mind as well as revisiting to solve mystery. Both are considered universally applicable in that both are theories of the mind, albeit in different languages. The common grounds between Yoga and psychoanalysis have attracted prominent thinkers like Jung, Fromm, and Bion. Given their great experiences with both psychoanalysis and Yoga, they can be called as mystic psychoanalysts. Like Bion, Jung was deeply interested in the Yogic phi- losophy, especially those of Kundalini Yoga and the , both of which belong to the tantra , the most modern school of Yoga. According to Jung (1999 ), mandala is the tantric symbol (Sans. yantra ) that symbolically represents the total expression of the psychological self. For more descriptions, please see also Jung (1933 , 1969 ). Bion, a British psychoanalyst and one of the most prominent thinkers of the psy- choanalytic tradition, described Yoga as harnessing the mind to unharness itself of memory and desire (Bion 1967 , 1970 ). He suggested that desire and memory are enemies of psychoanalytic attention. Buddha in his various dialogues on meditation and the sage teacher Patanjali in his classic textbook the Yoga Sutras attest that the main process in deep meditative states like the samadhis ( samapattis ) involves maintaining a dispassionate attitude to make oneself free of desire (Buddha called it non - clinging attitude) and getting past one ’ s memory (to make oneself free of the engraved memories of past deeds [Sans. samskaras]). Patanjali, when describing the Eight-Limbed Yoga, goes into elaborations on the various types of samadhis (deep meditative states) and how one’s memories and desire can be diffi cult obsta- cles when one attempts to achieve these meditative states (please see Taimni 1961 , for more elaborations). In the sequential process of the samadhis , the practitioner [Sans. sadhaka] realizes the absolute truth by the process of samyama by having the pure experience which is not colored by one’s desire (Sans. kamana ) and memories (Sans. samskara ). These are also ingrained in the third and fourth Noble Truths of Buddha, i.e., desire and clinging are the main reasons for one’s sufferings in life, 190 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT) and by putting an end to these two hindrances , one can achieve freedom from the shackles of the sufferings in life. As one reads through the Yoga Sutras (Vedic) or the Abhidhammic texts (Buddhist), it is quite striking to see that Bion, who advo- cated that his patients not only to get better but also to pursue the Truth , echoes Pantanjali’s ideas as detailed in his textbook the Yoga Sutras (circa fourth century BC). In advocating for providing pure experience, to avoid any exercise of memory and to ensure the therapist’s full presence during the therapy sessions, Bion strongly recommended that his followers not take any notes. He also strongly proposed that the therapist should not harbor any desire(s) regarding the patient because such desires interfere with analytic work, erode the analyst’s power to analyze, and lead to progressive deterioration of analyst’s intuition. Although important differences do exist, the various similarities between Yoga and deep psychotherapies like psychoanalysis are manifold as detailed below:

(a) Both Yoga and deep psychotherapeutic concepts are universally applicable, apolitical, nonsectarian, and secular concepts about the human mind and its various functions. (b) Both are investigative pursuits of personal truths (insights). (c) Both emphasize the centrality of the mind, as compared to the body, and pro- pose the various therapeutic ways to change the functioning of mind so to improve quality of life. (d) Both rely on the existential and experiential bedrock in order to affect change. (e) Both involve an optimal sensory deprivation, which can be considered as a pre- paratory set before one delves deeper. (f) Attention is fundamental to both the contemplative disciplines. (g) Free association, the key technique in psychoanalysis, has many similarities with the process of mindfulness. (h) Both Yoga and psychoanalysis have similar goals, although the goals may seem more radical in Yoga. Freedom from mental confl icts through self-analysis is a crucial goal in both. (i) Yoga is a way to fi nd one’s inner analyst, a goal shared with psychoanalytic treatment.

7.2.3 Other Similarities Between Yoga and Deep Psychotherapies (Psychoanalysis)

In addition to the general and conceptual similarities described above, there are technical overlaps between the Yoga and mindfulness and contemplative psycho- therapies as described below:

(i) Technical similarities between free association and mindfulness : Freud’s free association, one key technique in psychoanalysis, is grounded in the human ability and need for mentation to be free and creative. In addition to Freud’s, work of other prominent psychoanalysts like Strachey and Bion claims that practice of the techniques, conscious control of desire, postponement of wish 7.2 Yoga as Psychotherapy 191

fulfi llment/gratifi cation, and some amount of sensory deprivation (like the couch, silence of the consulting chamber, therapist anonymity, etc.) are prereq- uisites for free association. Referring to chapters two and three in this book, one can see that the same parameters are quintessential for samyama and sati- patthana , the key techniques of Yoga and mindfulness, respectively. In free association, psychoanalysis is radical in its pursuit of the moment-to-moment experience of human beings and is consistent with similar claims by Yoga and mindfulness. The uniformly hovering attention in the mindfulness meditation is very similar to Freud’s evenly suspended attention in the free association. (ii) Conceptual similarity between the various three types of Yoga and various concepts in psychoanalysis: The three major types of Yoga are Jnana Yoga (Yoga through insight), (Yoga through devotion), and (Yoga through desire- less action). Like in psychoanalysis, the most prominent goals of Yoga are the promise of freedom from mental confl ict and certainty of knowledge. As one can see in the schemes of Buddha and Patanjali, Yoga and mindfulness are processes of learning to discriminate, through meditative wisdom , between what is real and what is not and what is eternal and what is not: this is the essence of Jnana Yoga . Similarities also exist between Bhakti Yoga and the concept of idealized transference in psychoanalysis: Bhakti ([Sans.] loving devotion) Yoga signifi es the spiritual practice of fostering loving devotion to a personal form of God (Cutler 1987 ; p. 1). Similarity also exists between Karma Yoga and the process of working through in the psychotherapy. (iii) Ov erlaps do also exist in both disciplines (psychoanalysis and Yoga) with respect to descriptions on the various models of mind, e.g., with respect to struc- tural organization of mind (id , ego , and superego , as compared with the various grades of mind, from lower to higher grades, from crude to fi ner to the fi nest) and the layered concept of mind (preconscious, conscious, and unconscious ver- sus the lake model as described earlier). The Yogic concept of lower mind (Sans. manasa ) has similarities with the concept of id , a psychoanalytic concept. (iv) Both disciplines propose that insight (psychoanalytic insight versus medita- tive wisdom) is the tool to upgrade the mind. (v) Similarities do exist in the following aspects also: (a) between psychoanalytic concepts of confl ict and Yogic concept of maya (illusory principle of mind), (b) between the concept of detachment from libido (decathexis ) in psycho- analysis and dispassion or renunciation in Yoga, and (c) between the psycho- analytic concepts of the childhood confl icts or experiences and the Yogic concept of samskara (engraved memories of past deeds). (vi) The therapeutic process of psychoanalysis involves reconstruction of the psycho- logical apparatus which is similar to purifi cation of mind / concept of mental development one comes across in the concept of cultivating the Right Mindfulness . The processes in both Yoga and psychoanalysis, like in the life cycle model of human life, are developmental and sequential. The sequential steps and develop- mental sequence of various stages of the samadhis in which one revisits and rediscovers one’s true self are like the uncovering process of attaining insight in any deeply contemplative psychotherapy including the psychoanalysis. 192 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT)

(vii) Although more elaboration on these is beyond scope of this book, conceptual similarities do exist (1) between the observing ego (Strachey 1934 ; Ormont 1995 ) and the Soul/real self, (2) between the experiencing ego (Strachey 1934 ) and the sensorial mind (manasa ), and (3) between the therapeutic dissociation (Sterba 1934 ) and the mindful awareness and detached observation during meditation.

Noting these close similarities at many different levels, in this author’s opinion, it would not be an exaggeration to say: Yoga is the psychotherapy of the East. Self- analysis is a goal of Yoga as it is for every analytically oriented therapy. For more descriptions on mindfulness (Zen Buddhism) and psychoanalysis, please refer to Suzuki (1963 ).

7.2.4 Some Basic Differences Between the Yogic Philosophies and Psychoanalysis

Despite the similarities mentioned above, there exist important differences as well. Psychoanalysis is two-person process, whereas Yoga is one-person process after one is initiated into the training during which one needs a personal teacher. Yoga begins with a guru or teacher or guide and ends with a healthy aloneness. The work of yoga is a far more individualistic, uncensored, and unsupervised act than psycho- analysis. In psychoanalysis, there is impersonal, mutual collaboration, whereas in ( Bhakti ) Yoga there is the idealized teacher–disciple (guru – chela ) relationship. Mind (consciousness) in Yoga is much more broad (see the concept of extended consciousness in chapter two) than the mind in psychoanalysis. In general, goals, objectives, and the scope of the common parameters are broader in Yoga as com- pared to those in psychoanalysis. Yoga aims at alleviating suffering through tran- scendent calming of the mind, whereas psychoanalysis aims at management of competing aims within the mind to achieve relative harmony. Prescription for health and happiness in Yoga is no longer confi ned to mind but actually is more holistic and extends to one’s lifestyle, body and breath control, as well as mind. The thera- pist’s interpretation plays a larger role and is an integral part of each session in psychoanalysis, unlike in Yoga. The difference also exists in descriptions of differ- ent levels of self in Yoga: individual self, universal self, subtle body, or subtle self. Yoga is concerned with universal self or transcendental self, whereas psychoanaly- sis is concerned with individual self only. In this sense, with respect to the concept of self, where psychoanalysis ends (individual self), Yoga begins (transcendental self). Yoga is primarily an exploratory (wonder and wonder) venture, whereas psy- choanalysis is primarily an interpretive venture. The goal of Yoga is transforming the healthy to the healthier, whereas that of psychoanalysis is to transform the unhealthy to healthy. Thus , the goals , objectives , and scopes are broader in Yoga as compared to psychoanalysis . 7.3 Psychotherapeutic Use of Yoga in Its Entirety 193

7.3 Psychotherapeutic Use of Yoga in Its Entirety: The Yoga– Mindfulness- Based Cognitive Therapy (Y-MBCT, Pradhan and Mishra 1998 onward)

Large studies involving populations with severe mental disorders like schizophrenia have proven the feasibility of Yoga and meditation (Vancampfort et al. 2012 ). Also contrary to popular beliefs that practice of Yoga and meditation takes much time, a recent study from the Mayo Clinic in the USA (Prasad et al. 2011 ) fi nds that even 15 min of practice daily has been proven useful and effective. The Y-MBCT© is the psychotherapeutic version of Pradhan’s Standardized Yoga and Meditation Program for Stress Reduction (SYMPro-SR ©, 1993, the wellness model of Yoga and meditation). As demonstrated in Figs. 7.1a, b, both the SYMPro - SR © and Y - MBCT© models use Yoga in its entirety and, thus, includes meditation, the 6th and 7th steps of Eight- Limbed Yoga. Both models are based on the three original scriptural schools of Yoga and mindfulness, i.e., the Eight-Limbed Yoga (Ashtanga ) of Patanjali (the fourth century BC), the mindfulness (satipatthana ) model of Buddha (the sixth cen- tury BC), and the standardizations of the technique-rich style of Tantra (the second century CE). These models use Yoga in its entirety from body to mind to soul (the fi nest grade of mind), and in this scheme the key meditation is the samyama (the combination of 6th, 7th, and 8th limbs of Yoga) combined with the satipatthana in the form of staged meditation protocols (SMPs) as elaborated later. Inspired by the insights provided by the original scriptural traditions as well as by the evidence- based formats of the modern medicine, both models include standardized tech- niques and incorporate the meditative lifestyle in the form of Buddha’s Middle Way [Pali majhima magga], a lifestyle of moderation and compassion . Both models combine Yogic philosophies , techniques , and practice into pragmatic and user- friendly formats. Recognizing the need and utility of complementary and alterna- tive medicine (CAM), more so for youth, this model was initially piloted on children and teens. Based on his personal and clinical experience, as well as the openness and resilience one sees in the youth, Pradhan believes that children and adolescents are the best meditators. Later on, Pradhan et al. extended these models to adult population. Both of these models are holistic models of care and can be fl exibly combined with other evidence-based treatments including medications and other behavioral interventions and psychotherapies. SYMPro-SR is a wellness model initially conceptualized by Pradhan during his monastic training (1992–1994). Initially, he piloted this in normal and healthy pop- ulation in India including on himself for stress reduction, improvement of produc- tivity, and improvement of quality of life. The SYMPro-SR, being a wellness model, is meant for use in promoting and sustaining health. For its public use as a wellness model, Pradhan uploaded the SYMPro-SR onto YouTube in August 2011 . Y-MBCT, the psychotherapeutic adaptations of the SYMPro-SR model, uses all of the facets of Yoga fl exibly and sequentially (called the staged meditation protocols : SMPs) in 194 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT)

Y-MBCT© (Pradhan et al, 1998 onwards) is the psychotherapeutic version of Pradhan’s Standardized Yoga and Meditation Program for Stress Reduction (SYMPro-SR©, 1993, the wellness model of Yoga & meditation). Both models combine Yogic philosophies, techniques and practice together and have been tested in wellness and illness by Pradhan et al. The Y-MBCT model includes five integrated, standardized & symptom specific therapy models. (a) SYMPro-SR© Model (1993 onwards): Based on the three original scriptural schools of Yoga and mindfulness: The Eight-imbed Yoga (Ashtanga) of sage Patanjali (4th century BC) integrated with that of Buddha (6th century BC) & Tantra (2nd century CE). Includes the life style of moderation (Middle Path) and compassion.

Step-8: Samadhis/Yogic enstasis begins (Various levels of Samadhis lead to the final liberation) ------SECOND PHASE OF PRACTICE Step-7: Meditation Meditative Absorption (Mindfulness meditation of Buddha) (involves transcending the body & Step-6: Con-centration observe the mind as a bundle of 5 things) (Bare attention of Buddha)

Step-5: In-drawing of Senses Transition from Body to Higher Mind ------FIRST PHASE OF PRACTICE Step-4: Breath Control Preparations for Meditation Step-3: Posture (erect spine) (involves Body, Breath & Sensorial Mind) Steps-1 &2: Yogic Life Style

(b) Y-MBCT© Model (1998 onwards): scriptural, standardized, scientific and feasible to practice.

Ultimate Goal: For use in DAILY LIFE As Needed Practice Daily: Stage-3: WHEN: Daily Practice with Log: Five Overwhelmed, Tensed, Rx Models Sad, Panicky, Too tired, 15 min. in morning (Pradhan et al, Drug craving, Not sleeping, 1998 onwards) Headaches, Body aches. 15 min. in evening Before home work too! Stage-2: Mindfulness Meditation 5 min. as needed (Samyama of Ashtanga Yoga) Symptom Specific Use Mind as a bundle of 5 things: (thoughts, feelings, perceptions, memory & will)

Stage-1: Concentrative Meditation (Trataka: Step-6 of Ashtanga Yoga) (to be one-pointed with breath, the primary anchoring object for concentration) Yogic Stage-0: Ground stage: Preparation for Meditation (Steps 1-5 of Ashtanga Yoga) Life Style (Middle Path + Learning the philosophy, technique & practice of meditation)

Highlights of Y-MBCT©: Neurobiologically informed & compatible with therapy models of West; applicable in illnesses & wellness. Proposes use of Yoga in its entirety (all limbs of Yoga including meditation, its 6th & 7th limbs)

Fig. 7.1 (a , b) Yoga & Mindfulness Based Cognitive Therapy (Y-MBCT)©: Adapted from three ancient sc riptural schools self-exploratory therapy and self-care formats that target the specifi c symptoms as well as promotes generalization of the therapeutic gains to client’s daily life. Y-MBCT integrates the ancient philosophies and techniques of Yoga and meditation with the evidence-based therapeutic techniques of the West including those of psy- chodynamic psychotherapy (object relational therapy format) and compassionate 7.3 Psychotherapeutic Use of Yoga in Its Entirety 195 cognitive behavioral therapy (CBT). Both SYMPro-SR and Y-MBCT use the origi- nal philosophies of Yoga and meditation, particularly the concept of the fi ve objects that constitute the mind (thoughts, feelings, sensations/perceptions, will/impulse, and memory that are the basic elements in any human experience, normal and path- ological; please see chapters two and four of this book) and the tripartite model of human experience (please see chapter two and three of this book). These fi ve objects in the mind serve as the anchoring points or the meditation objects (Sans. pratyaya ; Pali kasina ) for the client to bring the mind into focus during the actual practice of concentrative and mindfulness meditations. These elaborate models about nature and functions of mind that are based on the phenomenological psychology inform the practitioner more about the various experiences of the mind and body (both normal and abnormal), their origin, phenomenology, and expression in various forms. These expressions include stress and its various sequelae, psychiatric symp- toms, and the attending dysfunctions. Contemplative practices (meditation) upon these models provide powerful perspectives including nature of the human experi- ence and in addition provide a sense of detachment from the experience which paves the way for more keen observation and impulse control: all these are chief element in mindfulness that are being applied to client’s daily life, both for improv- ing wellness and ameliorating illnesses.

7.3.1 The Specific Cognitive Behavioral Techniques Used in the Y-MBCT

Traditional cognitive behavioral therapy (CBT), like any other form of therapy, has its strengths and limitations. Recognizing the strengths (e.g., symptom specifi c, measurable, can be combined with other modalities) and limitations (e.g., dropout rates, less experiential and more concrete, may have limitations with respect to per- sonality disorders or in more chronic or more complex psychiatric diagnoses) of traditional CBT in clinical settings and emphasizing the great signifi cance of the experiential nature of therapy, Pradhan and colleagues have developed fi ve specifi c therapeutic techniques (fusion interventions) that integrate elements of both medi- tation (experiential aspect) and CBT (measurable aspects) as described below:

(i) Extinction-based protocols (exposure and response prevention in its various forms) for PTSD and anxiety disorders (panic, generalized anxiety disorders, and obsessive-compulsive disorders) (ii) Reconsolidation-based protocols (for regulating the arousal response and reap- praising the trauma memories in PTSD (TIMBER© model of therapy, described in the fi nal section of this chapter); for regulating the cue-induced craving and arousal and detaching self from the conditioned memories of drugs in addictive disorders) (iii) Mindfulness-based cognitive therapy (MBCT) for depression that uses the cognitive triad model for chronic depression and specifi c MBCT techniques for sadness, hopelessness, and ruminations 196 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT)

(iv) Visually fi xative and retentive interventions (mindfulness-based trataka ) for cognitive disorders like ADHD and dyslexia (v) Specifi c Y-MBCT protocols for impulse control disorders that include chronic anger and impulsivity, trichotillomania (hair pulling), pica, skin picking, gam- bling, and various forms of behavioral addictions (vi) Specifi c Y-MBCT protocols for dissociative/conversion disorders and psycho- somatic symptoms and disorders such as chronic pain, headaches, and gastro- intestinal symptoms

Both the SYMPro-SR and Y-MBCT models use the neurobiologically informed bottom-up model of meditation (as described in chapter three) and are compatible with other Western models of therapy including cognitive behavioral therapy (CBT). The SYMPro-SR and Y-MBCT models are being tested in an ongoing manner by Pradhan and colleagues in cases of illnesses and wellness.

7.3.2 More Descriptions of the Key Techniques in the Y-MBCT

The Y-MBCT techniques have been used in symptom-specifi c manner for not only amelioration of symptoms but also for stress reduction, better coping and improve- ments in quality of life, and functioning and productivity in daily life. The Y-MBCT as psychotherapy models include a basic Y-MBCT protocol, and superimposed on it are the fi ve standardized and symptom-specifi c techniques piloted for the various groups of psychiatric disorders as detailed below:

A. The basic Y-MBCT protocol: The basic protocol is designed for the most preva- lent psychiatric disorders, i.e., depression and anxiety. The basic protocol involves the staged meditation protocol ( SMP ,© four stages of meditation: stages 0,1, 2, and 3 as described later) in combination with the standardized techniques from cognitive behavioral therapy (CBT). In this protocol, SMP is combined with (i) the cognitive spiral model for treatment of the panic disorder and gener- alized anxiety disorder and (ii) the cognitive triad model for chronic depression (extreme sadness, hopelessness, rumination). B. The fi ve symptom-specifi c techniques in Y-MBCT that are superimposed on the basic Y-MBCT protocol are as under: (i) Mindfulness - Based Kriya (MB-K; [Sans.] kriya = purifying physical proce- dure done by the Yogi): Y-MBCT program uses 2 types of MB-K—(a) © Mindfulness - Based Uddiyana ( MB-K - U ; Sivananda 1994 , p 69, Iyengar 2000 , p. 425) which is a combination of a Yogic kriya and the meditative breathing called Bhastrika (Sivananda 1994 , p. 47) adapted and used by Pradhan (1998–2014) in a symptom-specifi c manner for irritable bowel syndrome and chronic constipation (MB-K-U should be modifi ed or used with caution in people with hernia and heart conditions) and (b) © Mindfulness - Based Sukshma Kriya (MB-K-S ) for somatization symp- toms; conversion disorder; cyclic vomiting; recurrent abdominal pain; and 7.3 Psychotherapeutic Use of Yoga in Its Entirety 197

other pain syndromes in the face, head, and neck regions including chronic headaches, migraines and eye strains, etc. (ii) Trauma Interventions Using Mindfulness - Based Extinction and Reconsolidation (TIMBER© ) protocols for treatment refractory post- traumatic stress disorder (PTSD): This protocol includes mini - TIMBER and Mindfulness - Based Exposure Therapy (M-BET) modules (Pradhan et al. 2013 –2014). (iii) Mindfulness - Based Exposure and Response Prevention (MB - ERP , Pradhan et al. 2014b ): This a combination of ERP (which is the mainstay behavior therapy for obsessive-compulsive disorder/OCD) and the modifi ed staged meditation protocol—this protocol specifi cally targets OCD and phobic disorders. (iv) Mindfulness - based trataka© (MB-t, Pradhan and Khurana 2005 ; Pradhan 2014 ): trataka is a visual fi xative and retentive meditation technique and focused attention type and described in chapter four as well as by Niranjananada (1993 , p. 156–163) for dyslexia and ADHD. MB-t is the specifi c protocol for attention defi cit hyperactivity disorder (ADHD), dys- lexia, and other cognitive disorders (more specifi c for visual memory, attention, and reading performance). (v) Mindfulness-Based Inner Space Technique (M-BIST© ): For impulse control symptoms (suicidal urge; eating disorders; craving for drugs; pathological gambling and behavioral addictions; anger attacks seen in the oppositional defi ance disorder, mood disorders, and autism spectrum disorder; skin pick- ing; nail biting; and trichotillomania). M-BIST increases the time between registration of the initial urge/impulse by the client and subsequent discharge of the action and thus helps clients to delay the gratifi cation and become more aware and refl ective of the whole sequence involved from initial urge to fi nal action in any impulse control situation. In addition to the breathing meditations, in M-BIST, Pradhan et al. use fl ash cards with specifi c themes designed for individual impulse control disorders to increase awareness and to bring more effective control in self-care format in the clients. Meditation as providing an inner space has been mentioned by Goleman (1988 , p. 1–38). This concept is similar to Winnicott’s concept of the transitional space between subject and object, also called as the reality of the “in-between” (Winnicott 1971 , p. 112). Of note, D.W. Winnicott (1869–1971) was a bril- liant British pediatrician and psychoanalyst. In more recent times, Segal et al. (2002 ) have used the three - minute breathing space model in patients.

In clinical cases, these specifi c techniques can be superimposed in the various stages of the staged meditation protocols (SMPs) to deliver treatment in more effec- tive, targeted, and symptom-specifi c manner in standardized, manual-based formats, depending upon the diagnoses and their severity. For obvious reasons, these tech- niques are not suitable for patients suffering from untreated acute psychosis, acute mania, and drug intoxication, nor is it suitable for acutely suicidal patients with a suicidal plan or those with severe dementia. These select groups of patients will 198 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT) require some stabilization before they are able to participate in the Y-MBCT. However, in the past, patients with passive suicidal ideas could participate in Y-MBCT and performed well. In the Y-MBCT models, improvisations of the above techniques are now being used by Pradhan and colleagues in an ongoing manner in order to appro- priately match the techniques with the various populations. Although elaboration of each technique is not possible in this chapter, materials perhaps for another book, here one can still see that the Y-MBCT protocols consist of personalized, evidence- based, and symptom-specifi c treatment plans that are based on the combination of staged meditation protocols integrated with cognitive behavioral therapy (CBT)- based treatments to enhance attention and memory and counteract symptoms of depression, anxiety, headaches, and gastrointestinal symptoms in both adults and children. For example, in children with common comorbid psychiatric disorders like attention defi cit hyperactivity disorder (ADHD), oppositional defi ance disorder (ODD), dyslexia, and autism spectrum disorder, Y-MBCT protocols specifi cally tar- get inattention, impulsivity, symptoms of separation anxiety including school phobia and behavioral issues including anger, impulsivity, as well as enuresis. All of these psychotherapy protocols can be used alone or in combination with psychotropic medications for specifi cally targeting the individual disorders in a symptom- and dysfunction-specifi c manner. This sort of customized treatment plan is dependent not only on the scientifi c rationale but also on the needs of the specifi c populations and their attitudes and preferences toward these techniques or medications.

7.3.3 SYMPro-SR and Y-MBCT Models: Evolution and Preliminary Data on Efficacy

Since 1992–1994 during which Pradhan piloted the SYMPro-SR (wellness) model on himself for stress reduction and for improving attention, memory, and productiv- ity in his own daily life, this model has been continuously revised and adapted in terms of symptom-specifi c use of the techniques, integration with other evidence- based psychotherapies, and multiculturalism. Prior to its use in the USA, Pradhan (1994–1998) used it in India (Eastern and Northern parts) in healthy populations (medical students, software engineers, high school students) for cultivating stable attention, reduction of stress, and improving productivity. After its successful use in healthy populations in India, from 2010 onward, Pradhan has used it in the USA with healthy populations (mostly medical students, nurse practitioners). Since 2010 onward, Pradhan and colleagues have expanded the therapeutic use of this model to both healthy populations in the USA that include software engineers, medical stu- dents, and healthcare professionals. Currently, Pradhan et al. (2014a ) are in the pro- cess of applying this model to case managers to decrease their level of stress and improve their quality of life. Likewise, the Y-MBCT as a psychotherapy model was fi rst used clinically in India on a small sample (18 patients) with opiate and alcohol addiction (Pradhan and Mishra 1998 ). Compared to the control group, participants of Y-MBCT needed signifi cantly smaller doses of medications (clonidine and pain killers) for their detoxifi cation during the acute phase of recovery from opiate and 7.3 Psychotherapeutic Use of Yoga in Its Entirety 199 alcohol addiction. Y-MBCT was again used in India (Pradhan and Khurana 2005 ) in a small sample of youth (18 patients) with attention defi cit hyperactivity disorder (ADHD). Compared to the stimulant-only group, the combined stimulant and medi- tation group was signifi cantly calmer and less impulsive at school and home and earned better scores on reading and visual retention and memory tests after a 1-year follow-up. Its application to multicultural populations began in 2010 in the USA through the clinical and research work of Pradhan et al. (2010 , 2011 , 2012 , 2012 – 2013, 2013 , 2013 –2014, 2014a ; Pradhan and Gray 2013; Pradhan and Pinninti 2014 ; Pradhan 2013a , b , 2014 ). Since 2012, after Pradhan joined the Psychiatry Department at the Cooper University Hospital, Camden, New Jersey, both the Y-MBCT and SYMPro-SR models have been continuously used by him and col- leagues. In Y-MBCT-based treatment protocols, clinical populations include both adults and children (age group 7–70 years), spanning across the various populations affl icted by major psychiatric illnesses including depression, anxiety disorders (panic, generalized anxiety, PTSD, OCD), ADHD, dyslexia, autism spectrum disor- der and oppositional defi ance disorder (mostly for anger management), impulse control disorders, substance abuse disorder, eating disorders (mostly bulimia), dis- sociative/conversion disorder, and some psychosomatic disorders (mostly chronic headaches, recurrent abdominal pain, irritable bowel syndrome). For individual disorders, the symptom-specifi c Y-MBCT interventions are car- ried out in two phases: (A) acute phase treatment and (B) maintenance phase treat- ment. The acute phase of treatment consists of 6–12 individual therapy sessions (weekly, 30–45-min duration/session) involving three subphases: (i) assessment and preparatory phase (stage 0); (ii) middle phase (stage 1: focused meditation and its symptom-specifi c use and generalization to daily life), and (iii) advanced phage (stages 2 and 3: mindfulness meditation and its symptom-specifi c use and general- ization to daily life). In the Y-MBCT, patient transition to the maintenance phase of treatment after suffi cient improvements has been achieved. This phase involves booster therapy sessions and continuation of home practice as well as generalization of the improvements in a symptom-specifi c manner. The maintenance phase involves 2–3 therapist-assisted booster sessions of Y-MBCT once every 4–6 weeks followed by once every 2–3 months or as deemed necessary. From 1993 to May 2014, the SYMPro-SR model has been successfully applied to a sample of 148 normal healthy individuals including school and college stu- dents, medical students, and healthcare professionals. Likewise, from 1998 to 2014, the Y-MBCT model has been successfully applied to a sample of 152 patients. The goals for the healthy individuals were reduction of stress and anxiety in day-to-day life as well as improvement of quality and productivity in their daily life—personal as well as professional. The goals in clinical populations were amelioration of clini- cal symptoms as well as improvement in coping, functioning, and quality of life. Of note, out of these 152 patients, in only 36 patients (18 patients with opiate addiction: 9 in test group and 9 in control group; 18 patients with ADHD: 10 in the test group and 8 in the control group), the control group was involved in comparisons of the results. The use of Y-MBCT in the remaining patients (116) was prospective and longitudinal and included open trials without control groups. 200 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT)

7.3.4 Preliminary Data from the Y-MBCT Clinic at Cooper University Hospital

From September 2012 till May 2014, 80 patients (24 adults and 56 youth) were enrolled in the Y-MBCT program at the Cooper University Hospital, Camden, New Jersey. In this clinical sample of Y-MBCT, out of 80 patients, four patients (two adolescents and two adults) couldn’t complete the training sessions. Two patients (both male adolescents) out of these four who couldn’t continue the Y-MBCT had signifi cantly dysfunctional autism with poor social skills, infl exible attitude, obses- sive behavior, and perseverations (verbal) that signifi cantly interfered with their training in the meditation protocols and hence could not continue after the initial two sessions. The other two adult patients (out of four patients who couldn’t com- plete the course of Y-MBCT) relocated to different states and thus lost follow-up. As one can see here, the adherence rates in the Y-MBCT model have been very high. From these, 18 patients (7 adults and 11 youth) have been successfully discharged from the maintenance Y-MBCT sessions without the need for more booster ses- sions. Out of these 76 patients, there was no use of psychotropic medications in 18 patients. In the rest of the 58 patients, 36 patients were provided with Y-MBCT interventions in order to augment the medication that was previously reported to be ineffective. Of the rest, 22 patients (out of 58 patients) were treated with Y-MBCT interventions combined with appropriate psychotropic medications, which were either those to which patients had responded to in the past or new psychotropic medication(s) that were not previously used. It is important to note that all the above 58 patients in which Y-MBCT interventions were used to augment psychotropic medications needed considerably lower dosage of psychiatric medication compared to the patients who did not try the Y-MBCT. The average number of sessions needed for remission of acute symptoms in the various psychiatric disorders like panic dis- order, generalized anxiety disorder, depression (with somatic symptoms), and social anxiety disorder is 6–10 therapist-assisted Y-MBCT sessions (30–45-min sessions, once every week for 3 weeks, followed by once every other week) and daily home practice sessions during the course of Y-MBCT treatment. More diffi cult disorders like obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) require 8–12 sessions for achieving remission of acute symptoms (Pradhan et al. 2014a , b ). Among the 76 patients described above, within the cohort of 17 patients (12 adolescents and 5 adults) with comorbid depression, panic disorder, and social phobia, the general pattern of response to Y-MBCT was in this order: fi rst, panic symptoms improved (autonomic hyperarousal followed by avoidance followed by anticipatory anxiety) and then depression symptoms followed by social anxiety symptoms. Of note, fi ve of the twelve adolescent patients in this cohort who were home schooled due to the attending dysfunctions transitioned to regular schooling after remission of symptoms. In the depression cohort of 19 prospectively assessed patients (12 adolescents and 7 adults) with treatment-resistant depression, 8–10 sessions (weekly, 30–45-min-duration therapist-assisted sessions and home prac- tice) of Y-MBCT have induced remission of acute symptoms of depression 7.3 Psychotherapeutic Use of Yoga in Its Entirety 201

(Pradhan et al. September 2012–May 2014, unpublished data). The remission of symptoms is still maintained at this time (which is at least 4 months from the last session of the Y-MBCT during the acute phase treatment of depression) by booster sessions every 6–8 weeks. During the maintenance phase of treatment, these patients maintained the improvements both in symptoms and functioning with booster sessions, and three patients have been successfully discharged from the above cohort of 19 patients. In the above two cohorts, the Y-MBCT intervention involved educating the patients (and family members if patients preferred) on the cognitive model of panic, depression, and social anxiety; training the patient on staged meditation protocols in symptom-specifi c manner; and establishing a home practice in symptom-specifi c manner in order to generalize the therapeutic gains achieved during the therapist-assisted sessions. These preliminary evidences for the effi cacy of Y-MBCT that involve fostering of one’s spiritual elements in a cog- nitive and behavioral format for recurrent depression are similar to those described by many authors including Segal et al. (2002 , 2013) and Goyal ( 2014). As of now, patients in the maintenance treatment of Y-MBCT have been maintaining improve- ments using the above maintenance design. One patient with severe depression needed hospitalization during the course of Y-MBCT treatment. Pradhan and col- leagues ( 2013–2014) recently completed a randomized -controlled pilot study involving 10 patients suffering from refractory PTSD. This pilot study com- pared the effi cacy of the TIMBER © psychotherapy protocol with ketamine, an anesthetic agent and a glutamate antagonist that infl uences memory and mood. The effi cacy of ketamine in treating depression has been indicated by several studies (Berman et al. 2000), and a very recent study suggests that it may also have thera- peutic effects on refractory PTSD (Feder et al. 2014 ). Currently, Pradhan et al. are in the process of testing ketamine’s effi cacy for treatment of refractory PTSD in a sample of larger size.

7.3.5 Some Descriptions About the Basics of Y-MBCT Models

In the spirit of the original scriptural traditions of Buddha, Patanjali, and tantra , the Y-MBCT model incorporates all three aspects of Yoga–meditation in combination: virtue , meditation , and wisdom . The virtue includes a Yogic lifestyle which advo- cates for establishing a biorhythm in one’s basic habits including in the sleep and appetite and the cultivation of compassion and employing the philosophy of the Middle Way (Dalai Lama 2009 ) in one’s daily life which means to maintain con- scious ongoing effort not to engage in extreme behavior including violence and stealing. Meditation includes some basic preparations including posture (sukhasana , sitting posture), breath regulation, trataka, inducing meditative detachment, and practice of some Yogic procedures (kriya , bandha , ), if necessary. Meditation includes learning the philosophy as well as techniques from the scriptural traditions and establishing a non - ritualized practice of meditation where the focus is not just the limited practice in therapist’s offi ce but rather generalization into one’s daily life. This was one of the basic teachings of Buddha and Patanjali, i.e., the whole life 202 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT) is a meditation. Meditation in the Y-MBCT model is standardized by the use of the staged meditation protocols (SMPs; Fig. 7.1a ) which includes concentrative (focused attention/FA-type) and mindfulness (open monitoring/OM-type) medita- tions. In this phase, regular home practice and symptom-specifi c use of meditation within one’s daily life are encouraged. Wisdom is that aspect of our personality that motivates us to engage in insight-driven choices and actions rather than just acting on our impulses as they arise. In the Abhidhammic scheme, wisdom is a by-product of the combination of virtue and meditation. Virtue , meditation , and wisdom are basically governed by three fundamental functions of brain : regulation , attention , and selection . As Hanson and Mendius ( 2009 , p. 14) put it: “Virtue relies on the regulation, both to excite positive inclinations and to inhibit the negative ones. Mindfulness leads to new learnin–since attention shapes neural circuits and draws upon past learning to develop a steadier and more concentrated awareness. Wisdom is a matter of making choices, such as letting go of lesser pleasures for the sake of greater ones.” The three cornerstones of the Y-MBCT models are (i) the staged meditation protocols (SMPs: stages 0, 1, 2, 3), (ii) the standardized meditative breathing meth- ods (calming and energizing types as described in chapter four) and self-monitor- ing by using the standardized practice logs, and (iii) the bottom -up model of meditation which sequentially consists of control of arousal/stress response, culti- vation of focused attention (FA) and detached stance, and fi nally cultivation of mindful attitude and nonjudgmental awareness (OM). In the Y-MBCT model, the basic matrix of intervention is the SMPs upon which symptom-specifi c Yogic and meditative and cognitive behavioral techniques are added to target the client dys- functions in a symptom-specifi c manner so that treatment goals and evidence- based approaches using standardized scales and structured instruments are maintained and at the same time the abstract essence of Yoga–meditation is not lost. SMPs are the actual practice of meditation in the Y-MBCT program in a staged/progressive manner using the bottom -up model of meditation which is not only scripturally informed but also sequentially targets, from bottom up, the brain stem with its autonomic centers (reactive/refl exive part of brain, otherwise called the survival brain, Ford 2009), limbic area (feeling part of brain), and fi nally the thalamic–prefrontal cortex (refl ective thinking and executing brain) to modulate the stress reactivity in the form of bodily arousal/discomfort (refl exive or auto- matic responses via brain stem) and affect dysregulation (limbic functions). By the use of standardized means, the bottom- up model of meditation teaches clients to change their responses from refl exive or automatic somatic reactions to refl ective to less automatic and more thought - driven responses by using meditation which enhances the prefrontal cortex and its regulatory connections with thalamus and amygdalar systems (extinguishing the fi re of emotions and impulses). This forms the basis of many of the Y-MBCT models including the mindfulness-based inner space technique (M-BIST), the model that specifi cally targets impulse control disorders. 7.3 Psychotherapeutic Use of Yoga in Its Entirety 203

7.3.6 The Staged Meditation Protocols (SMPs) and the Five- Factor Model of Human Experience as the Main Pillars of Y-MBCT

The fi ve-factor model is already elaborated in chapters two and three. The SMPs are the cornerstones of the Y-MBCT models and integrate all the initial seven limbs of the Eight-limbed Yoga (including meditation, lifestyle, generalization into daily life) in a standardized manner. The SMPs (as demonstrated in Fig. 7.1b ) involve the Patanjalian Ashtanga (Eight-limbed Yoga) integrated with the Buddhist sati pathana (mindfulness/ vipassana) standardized by the technique-rich tools of the tantra into four levels: stages 0 till 3. SMP training involves four levels depending upon the treatment needs of individual patients. These four stages (stages 0, 1, 2, 3) are in sequential progression as below:

(i) Stage 0 / preparatory stage (training given in 1–2 sessions): This involves sleep hygiene, moderate lifestyle (Middle Way), education on philosophy, training in standardized energizing and calming breathing techniques (pranayama ), and establishing a home practice log. (ii) Stage 1 / focused meditation stage (training given in 1–2 sessions): This involves training in focused meditation (a prerequisite for mindfulness meditation) and transforming the standardized energizing and calming breathing techniques to breathing meditations and optimization of the home practice and generaliza- tion to daily life. (iii) Stage 2 / mindfulness meditation stage (training given over 2–3 sessions): This involves achieving further perfections on practice of breathing meditations and their ongoing symptom-specifi c use in daily life, induction of sustained atten- tion using focused meditation, and then transition to mindfulness meditation by mindful awareness and mindful detachment using the Yogic model of mind (lake model and mind as a bundle of fi ve objects ; see chapters two and four). (iv) Stage 3 (training on this is done over 3–4 sessions): This stage involves the symptom-specifi c use of meditation in the combination of experiential and cognitive behavioral format. The fi ve specifi c techniques described before (TIMBER, MB-ERP, MB-t, M-BIST, and MB-K) are integrated in this stage. In addition, in this stage, optimization of home practice and generalization to daily life are encouraged.

The sequence involved in the training and applicatory sessions of Y-MBCT is depicted in Fig. 7.2 . Training of clients in the Y-MBCT models involves individual sessions (30–45 min to begin with, shorter sessions later) in psychoeducational and experiential format dur- ing which the client practices with the therapist in a compassionate therapeutic milieu and masters the staged meditation protocols (SMPs). Once the client is trained (stage 0: takes about 2 sessions), the goal of therapy becomes establishing a home practice 204 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT)

Generating awareness in body & mind about Full blown episode symptoms in the with full range of precursor mini- symptoms episode & establishing their temporal relation with the subsequent full blown episode

Y-MBCT applicatory sessions (5-6 sessions in which Y-MBCT interventions Y-MBCT preparatory training sessions are applied during the session in therapist- (2-3 sessions using scriptural philosophy & guided formats in the window of opportunity techniques embedded in the Middle Way life style to prevent a full-blown episode. The + establishment of home practice in symptom therapeutic gains are quickly generalized to specific & personalized self-help formats) naturalistic settings by use of self-guided formats during home practice)

Fig. 7.2 Scheme of application of the disorder specifi c Y-MBCT interventions in symptom spe- cifi c manner over the next 2 sessions. The home practice involves two types of practices using stan- dardized practice logs: routine practice and as needed practice, as described below. Stage 0 is the preparatory level that involves training patients on all three key aspects of Yoga–meditation (i.e., philosophy, symptom-specifi c techniques, and customized home practice) in order to generalize improvements across their daily life. Other aspects in stage 0 are bringing order and awareness to one’s lifestyle by encouraging participants to incorporate into their daily lives the philosophies of the Middle Way (path way of moderation). This awareness is strengthened by targeted meditation practice (the shorter duration as needed form of meditation) in daily life situations and maintaining a self-introspective practice log for monitoring progress. In stage 0 which is the most crucial stage of the meditation training, misconceptions about Yoga and meditation as mere physical exercises, religious rituals, etc., are clarifi ed; also distractions like chanting (mantra, etc.) and using rituals or symbols are discouraged. Instead emphasis is placed on learning the philosophy and tech- nique of Yoga and meditation as various models to understand the workings of human mind and improve its functioning. Once mastery is achieved in stage 0, over the subsequent 2–3 sessions, clients are trained in focused meditation ( concentration / samatha: stage 1) and mindfulness (satipatthana / vipassana : stage 2) meditation. The stage 3 SMPs are the actual disorder-specifi c fusion techniques (e.g., TIMBER, M-BIST, MB-t, MB-K, etc., as described above). One key strategy in Y-MBCT (as depicted in Fig. 7.2 ) involves therapist - assisted body and mind awareness training in which clients become increasingly 7.3 Psychotherapeutic Use of Yoga in Its Entirety 205 aware of the somatic and autonomic responses of their individual stress reactivity in daily life. This is strategically explored not only to establish an individualized profi le of the stress response and affect dysregulation but also to make clients aware of the mini-arousal responses that occur a few minutes before the anxiety or panic attack or negative emotions including anger, panic, fl ashbacks, and episodes of impulse dyscontrol. This provides a specifi c window of opportunity for quickly and strategically applying the mindfulness interventions in self-help format before the mini-arousals proceed to full-blown arousal episodes. These as needed mind- fulness interventions are standardized breathing meditations (as described in chap- ter four) and the various yogic procedures ( kriyas, bandha, mudra) which are personalized and individualized for the clients through therapist-assisted in -ses- sion practice as well as daily in -home practice sessions to help clients generalize the therapeutic gains and apply them to the real-life situations. The in-home prac- tice involves relatively longer duration routine practice (10–15 min in morning and evening) and short duration as needed practice (2–3 min in the real-life situation) in the window of opportunity already established in the client so that client can apply these standardized interventions strategically before the mini-arousal epi- sodes escalate further. Throughout all of the Y-MBCT interventions, the therapist provides a compassionate and curious learning environment and strategically uses positive reinforcements to enhance more effective applications and generalizations of the Y-MBCT techniques. One can appreciate that Y-MBCT by its standardized use of the neurobiologically informed bottom-up model of meditation by both therapist-guided and home practices along with the addition of the meditative life- style of Middle Way (by self-awareness) and breathing meditations that specifi - cally ameliorate the reactivity of clients help them enhance their core abilities to engage in the refl ective self-awareness and use that awareness in standardized way to consciously regulate the emotions and process the information that provides a conceptual framework to guide a comprehensive and target-specifi c treatment plans and promotion of self-effi caciousness in a compassionate, evidence-based, and self-care format. The focus on self-help fosters less dependency on the Y-MBCT therapist; instead clients learn quickly in this experiential model of train- ing how to apply the various Y-MBCT techniques in a symptom-specifi c manner to their daily lives. In the initial phase of training, individual diffi culties encountered during the home practice or generalization into daily life are specifi cally addressed during the therapist- assisted Y-MBCT sessions in an experiential manner. In this module, the therapist practices with the client(s) during the session rather than just giving them instructions on various Y-MBCT techniques. In this model, the client’s experience of practicing itself becomes the powerful teacher that guides them in further practice. Rather than fostering dependence upon the therapist, this self-help approach enables clients to not only quickly generalize the gains but also become less dependent on the therapist for managing their symptoms or dysfunctions. This self-help attitude is central to the goals of Yoga and meditation in the original tradi- tions (i.e., to bring order to chaos and achieve control as well as freedom from suffering). This explains why remission of acute symptoms has been relatively quicker (generally in 6–8 sessions) compared to the number of sessions needed in some other models of therapies. 206 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT)

7.3.7 Standardizations Involved in the Y-MBCT Models

Pradhan and colleagues categorize the standardizations involved in the Y-MBCT models into trilogies : (a) lifestyle modifi cations and preparatory level, (b) self- exploratory therapy level (by using body–mind awareness and symptom-specifi c use of breathing meditations), and (c) formal insight/mindfulness meditation level (this is a more advanced level and uses the meditative method described in chapter four). Although the description of this sounds laborious, this is fairly easy to prac- tice if the therapist uses this model in a thoughtful manner. In the trilogies of the Y-MBCT, the actual meditation training involves three key things in sequence and in standardized manner: (i) obtaining body awareness followed by body transcen- dence, (ii) attaining the state of sustained attention by the use of concentrative meditation (the use of the various forms of trataka and the meditative breathings in symptom-specifi c manner), and (iii) attaining the meditative /mindful state (as described in the original traditions of Buddha, Patanjali, and tantra ). The mindful- ness experience involves three phases: (i) practicing the Yogic lifestyle (which is a moderate/non-extreme lifestyle with rhythmic sleep and appetite), (ii) nonvio- lence, cultivation of a sense of compassion, and (iii) the use of meditation in one’s daily life. The Y - MBCT Models Use Structured Measures : In the Y-MBCT models, clients are evaluated using a semi-structured interview format and various standardized rating scales which includes standardized rating scales specifi c for measuring psy- chopathology in individual disorders as well as for assessment of functional level and quality of life. For all the Y-MBCT interventions, Pradhan et al. use the Assessment Scale for Mindfulness Interventions (ASMI© , Pradhan 2012 , unpub- lished), an 18-item self-rated experiential scale to assess the key parameters of med- itation for its therapeutic use in health and illness, in addition to using the disorder-specifi c psychiatric rating scales. ASMI generates a quantitative score (scores range from 0 to 90: the higher the scores, the more is the level of mindful- ness in the individual) that assesses the level of mindfulness in its seven dimensions (compassion, empathy, mindful observation, level of reactivity, interoceptive aware- ness, Middle Way lifestyle, and generalization of one’s learning experiences into one’s daily life). Pradhan et al. fi nd that this scale is suitable for use in clients older than 12 years age (6th grade reading level). Scores can be used not only to assess the levels of mindfulness of the clients but also to see the progression during the mind- fulness interventions. These interventions can be therapeutically targeted to improve the scores as well as functioning in the seven dimensions of mindfulness measured by this scale. Currently, this scale is being considered for its multicultural use in the various normal and psychiatric populations in the USA. A brief description of the Mindfulness-Based Exposure Therapy (M-BET) has already been given in chapter three (in the bottom - up model of meditation section). M-BET is part of the TIMBER model (described later) which is the Y-MBCT pro- tocol specifi cally designed for the treatment of refractory PTSD. TIMBER uses a standardized rating scale called the Arousal Response during Trauma Memory Reactivation (ART-MR ©; Pradhan and Gray 2013, unpublished) scale for measuring 7.4 Uniqueness of the Y-MBCT as Psychotherapeutic Models 207 the arousal response in patients with PTSD during application of the M-BET proto- col. This semiquantitative scale is used to measure and regulate the levels of auto- nomic hyperarousal and corresponding physiological changes in the clients when they access the trauma memories. These changes include but are not limited to the heart rate, breathing rate, pupillary dilatation and ocular movements, perspiration, fi dgetiness, facial fl ush, emotional changes and the accompanying facial expres- sions, and muscular tension.

7.4 Uniqueness of the Y-MBCT as Psychotherapeutic Models

Traditional cognitive behavioral therapy (CBT) models, as the name suggests, put emphasis mostly on the thoughts, feelings, and behavior. On the other hand, the Y-MBCT models having been rooted in the phenomenological psychology of the Abhidhamma emphasize upon the whole fi ve components (aggregates; Santina 1997) of human experience, i.e., thoughts, feelings, perceptions/sensations, impulse/ will, and memory as well (see chapters two and three for descriptions). Thus, the Y-MBCT models are not only experiential which is the essence of any psychother- apy but also all-encompassing and broad based in their approach. Thus, although larger studies are needed to test their effi cacy, they have the potential at least in their concepts to be more broad spectrum with respect to their utility. Some other key differences between cognitive CBT and mindfulness-based cognitive therapy (MBCT) are already outlined in chapter six. After reading the descriptions of the various Y-MBCT models including the TIMBER© model, its prototype as described in the next section of this chapter, readers can appreciate the key similarities and differences of Y-MBCT from other models of therapy. It is important to understand that Yoga was developed in ancient India, in a time and culture completely different from that of our present world. The methods in the Yoga Sutras or the Abhidhamma can be quite diffi cult to practice by a modern man, so adaptation of some of them as applicable to modern society and their use in evidence-based and replicable manner is necessary. The use of these methods in standardized and replicable way has been challenging in both the clinical and research fi elds. From a pragmatic and evidence- based perspective, the Y-MBCT models take into account the aforementioned gaps and attempts to overcome some of the obstacles for people of modern society so that this ancient wisdom could be used by them. This psychotherapeutic model of Yoga– meditation is based on two major pragmatic concepts as described originally in the scriptural traditions:

A. Yoga as a profound psychosomatic science B. Meditation as a science of attention

Also, the Y-MBCT model advocates for the use of scriptural traditions of meditations in which one uses one’ s body, breathing, and the objects in the mind [Sans. pratyaya ; Pali kasina ] (thoughts, feelings, sensations/perceptions, will/ esire, 208 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT) and memory) as anchoring points. While many other therapy models use either only the meditational aspects or the physical aspects of Yoga in piecemeal, the Y-MBCT models advocate for the clinical use of Yoga in its entirety (all eight limbs) including the concentrative and mindfulness meditation; fl exible modifi ca- tion of lifestyle in the spirits of Buddha’s Middle Way and cultivation of compas- sion toward self and others; fl exible use of Yogic postures and procedures (Sanskrit asanas and kriya , respectively), breath regulation (pranayama ), and concentrative and mindfulness meditation; and, if deemed necessary, the use of psychotropic medications. Thus, SYMPro-SR and Y-MBCT broaden Yoga–meditation’s scope and utility to diverse and multicultural populations who have different understand- ings of Yoga and meditation. Emphasizing upon its self-help format and its direct use ( direct experience ) in daily life, the training is geared toward the basic goal of harnessing energy of the body to tame the mind . Depending upon the individual case scenario and preferences of the patient/family, Y-MBCT can be applied as the sole modality of treatment or as adjunctive treatment to augment the effects of other treatments. In the Y-MBCT and SYMPro-SR models, in the preparatory stage, clients are trained on all the three crucial elements of the yoga–meditation system (i.e., scriptural philosophy, technique, and practice of the techniques in personalized and symptom-specifi c manner). The clients experientially learn the scriptural philosophies on the workings of the human mind, they learn authentic meditative techniques integrated with the cognitive–emotive–behavioral elements in measurable formats, and during the Y-MBCT session they practice meditation with the therapist rather than just receiving instruction. After the preparatory stage (stage 0), a symptom-specifi c treatment plan is made in collaboration with the cli- ent and family to personalize the use of techniques and then apply them to daily life after honing them further by practicing at home fi rst. Emphasis is placed on naturally integrating the practice of the Y -MBCT techniques into one ’s everyday life in an ongoing way so to enjoy continued success. Clients monitor their own progress by the use of a mindfulness practice journal that includes structured logs and self-rated scales. The whole intervention is not physically demanding, does not require any specifi c equipment or elaborate preparations, and can be practiced by most of the common mass including children. The primary requirement is one’s commitment to practice the program and generalize (direct experience) to one’s daily life. The actual training involves clients practicing with therapist (often with Pradhan) during their treatment sessions (mostly individual sessions but group format of practice is also available). Considering its experiential nature, Pradhan emphasizes upon in -session practice with an experienced meditator. Thus, Y-MBCT encourages the use of all the three crucial elements in combination rather than in isolation (i.e., the philosophy of Yoga and meditation, the authentic tech- niques presented in a standardized way, and the improvement in lifestyle using the wisdom gained during practice and applied to daily life). This writer considers this last part as the key element and refl ective of the approach of Buddha himself in advocating meditation as an experiment where the object of this experiment is one ’s whole life . 7.5 TIMBER ©: A Prototype of the Y-MBCT Protocols 209

7.5 TIMBER © (Trauma Interventions Using Mindfulness- Based Extinction and Reconsolidation; Pradhan et al. 2012 Onward): A Prototype of the Y-MBCT Protocols

Pilot studies examining the effi cacy of Yoga in Vietnam veterans with PTSD found that although the physical aspects of Yoga like the postures reduced depression, they had no impact on the hyperarousal symptoms or anger outbursts associated with PTSD unless pranayama breathing and meditation were added to the practice (Brown and Gerbarg 2005). More evidence supports mindfulness meditation than other meditations like mantra reciting (Lang et al. 2012 ). As described in chapter four, the three basic tenets of mindfulness that may create change in the PTSD symptoms are (i) attention (intentional shifting of attention from directed attention/ FA to the open monitoring attention/OM), (ii) cognitive style (i.e., attention in the present moment as opposed to attention paid to the past or future, which can become pathological rumination or worry), and (iii) nonjudgmental stance to one’s experi- ences that includes thoughts, feelings, fl ashbacks, and other symptoms of PTSD. Recognizing limitations of the physical aspects of Yoga and importance of the above three tenets of mindfulness meditation, Pradhan et al. have developed a PTSD- specifi c model of therapy that uses Yoga in its entirety (which includes all 7 limbs including meditation, its 6th and 7th limbs. Of note, the 8th limb is enlightenment which is not the clinical focus although relief of suffering or symptoms can be analo- gous to the 8th limb of Yoga). The TIMBER© ( Trauma Interventions Using Mindfulness - Based Extinction and Reconsolidation ) model of psychotherapy is the PTSD version of the standardized Yoga and mindfulness-based cognitive therapy (Y-MBCT) protocol series and can be seen as the prototype of the integrative Y-MBCT models. TIMBER is evidence based and symptom specifi c and combines the learning theory and neurobiology of PTSD with the ancient scriptural traditions of Yoga and meditation in their entirety rather than in a piecemeal form like just a set of physical exercises or breathing techniques. There is increased awareness that the trauma mem- ories should be specifi cally targeted with a broader and combined approach. This is based not only on insights on the neurobiological formation of trauma memories and their perpetuation by fear-learning mechanisms (e.g., extinction and reconsolidation mechanisms involved in trauma memories: described below) but also on recent fi nd- ings on the pharmacotherapy, cognitive behavioral therapy, and mindfulness-based interventions used in the amelioration of symptoms and dysfunctions of trauma. Fear extinction is the paradigm in which a conditioned stimulus (CS) is repeatedly pre- sented in the absence of the unconditioned stimulus (US), leading to progressive reduction in the expression of fear. In the context of trauma memories, reconsolida- tion is a neurobiological process in which the existing memories are updated and integrated with the new information in the new learning environment and are consoli- dated once again (Nader et al. 2000 ). When traumatic or fearful memories are formed, they are initially labile but become increasingly consolidated into persistent memory traces via the synthesis of new proteins (Mc Gaugh 2000 ). Later retrieval of a consoli- dated fear memory engages two seemingly opposing mechanisms—reconsolidation 210 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT) and extinction—particularly when experiencing an emotionally aroused state and within a new environment (Nader et al. 2000). TIMBER is a novel and standardized psychotherapeutic protocol which is based on the neurobiological understanding of PTSD, the fear-learning mechanisms (reconsolidation and extinction; Monfi ls et al. 2009 ), as well as the therapeutic potential of mindfulness meditation in the treatment of trauma. As a treatment model, like other Y-MBCT models, TIMBER can be used alone or with psychotropic medications. It is important to recognize that the inherent limitations of extinction-only thera- pies necessitate the use of new and broader approaches that combine extinction and reconsolidation. Unfortunately, the effi cacy of extinction is strongly context depen- dent and contingent upon the spatial, sensory, and temporal contexts in which these trauma memories were acquired and subsequently perpetuated as a result of various conditioned learning mechanisms. Specifi cally, the reemergence of a previously extinguished fear is known to occur, in rodents and humans alike, under three gen- eral conditions (Monfi ls et al. 2009 ): (i) renewal, when the CS is presented outside of the extinction context; (ii) reinstatement, when the original US is given unexpect- edly; or (iii) spontaneous recovery after a substantial amount of time has passed. In clinical settings, extinction-based therapies like prolonged exposure (PE) therapy, which are generally considered the mainstay psychological intervention for treat- ment of post-traumatic stress, are effective only in some cases (Powers et al. 2004 ). Of those who do benefi t from these interventions, many show a return of fear due to spontaneous recovery, reinstatement, or renewal (Schiller et al. 2008 ; Effting and Kindt 2007 ). Also extinction, unlike reconsolidation, does not directly modify or update the existing trauma memories, and so, as noted before, the fear response often returns as a result of the three basic properties of the extinction mechanism (Schiller et al. 2010 ). Also prolonged exposure therapy can pose patient tolerability issues. The signifi cant dropout of patients is likely as the therapy’s very design pre- scribes overfl ooding the patients with memories of the trauma. This alone necessi- tates the use of combined extinction- and reconsolidation-based approaches for treatment of PTSD. As a neurobiologically informed and innovative model for the treatment of refractory PTSD, TIMBER bridges the gaps in current therapeutic interventions for PTSD. The effi cacy of TIMBER has been tested in two pilot cohorts with refractory PTSD: the fi rst cohort (Pradhan et al. 2012 –2013, unpublished data) involved the open trial of TIMBER as the sole modality in four adolescents, while the other cohort (Pradhan et al. 2013 –2014, unpublished data) involved a randomized con- trolled trial study of ten adults in which the effi cacy of combined TIMBER and ketamine was compared with that of placebo and TIMBER. The TIMBER interven- tions rely on the basic understanding that hyperarousal responses like the somatic symptoms of PTSD and fl ashbacks of trauma memories can be targeted by decon- ditioning and disassociating (mindful detachment) the patient from the memories and the psychophysical manifestations of the hyperarousal episodes, as well by sub- sequent cognitive–emotive restructuring and reappraisal of memories using cogni- tive behavioral and mindfulness-based interventions. 7.5 TIMBER ©: A Prototype of the Y-MBCT Protocols 211

The TIMBER protocol requires the spontaneous recovery of trauma narrative by the patient, thus triggering the trauma memory in therapist-assisted and therapist- controlled way. It then applies cognitive behavioral techniques integrated with mind- fulness meditation, allowing patients to self-regulate the arousal response and reappraise the trauma memories. TIMBER’s cognitive behavioral methodology is modeled after a successful study in rats (Monfi ls et al. 2009 ) and human volunteers (Kindt et al. 2009). Its combined use with the ketamine/placebo infusion in the recon- solidation window is modeled after Pradhan’s previous work involving interviews of women with PTSD and dissociative disorders using intravenous sodium Amytal (2001 –2005, unpublished data on 7 patients). Of note, Monfi l’s behavioral protocol in rats permanently attenuated the fear memory without the use of any drugs. When applying the learning mechanisms of fear/trauma memories and Y-MBCT interven- tions within the TIMBER model, the client’s reception of new (and unexpected or surprising) information in the context of accessing the trauma memories in a rela- tively aroused state makes the relatively stable trauma memories labile and thus more prone to modifi cation when in a new learning environment (Lee 2008 ; Alberini 2005 ; and Akirav and Maroun 2013 ). In this situation, two competing processes are evoked: (1) extinction mechanisms initiated by a trigger and (2) the competing learning engen- dered when the conditioned response is changed (by reconsolidation mechanism) when under an amnestic agent or due to a behavioral protocol (TIMBER in this case) that overrides the original trauma memory (Eisenhardt and Menzel 2007 ). These mechanisms involve new learning. New learning is not simply forgetting the old rep- resentations but actually updating the existing memories with the new information (Bouton 2000 , 2002 ; Duvarci and Nader 2004 ). TIMBER, in addition to its symptom- specifi c mindfulness interventions, incorporates a behavioral design in which patients suffering from PTSD reaccess or retrieve the trauma memories which then are desta- bilized and reinterpreted as safe when presenting an isolated retrieval trial before an extinction/reconsolidation session. The TIMBER protocol requires that ensuing arousals in response to the therapist-assisted trigger are measured by a semi-struc- tured scale, Arousal Response during Trauma Memory Reactivation (ART-MR, © Pradhan and Gray 2013 ). In trauma research, over the course of the past 20 years, the increased heart rate that accompanies trauma stimuli has been one of the most robust and consistent autonomic fi ndings (Orr et al. 1998 ). During the controlled reactivation of traumatic memories in the TIMBER protocol, the two key arousal responses that are targeted are patient’s heart rate and breathing rate. The interventions in TIMBER are of two types: (i) a mini-TIMBER session which consists of the breathing medita- tions adapted from a neurobiologically informed bottom-up model of meditation (as elaborated in chapter four of this book) and (ii) the elaborated TIMBER sessions, called the Mindfulness - Based Exposure Therapy (M-BET,© Pradhan et al. 2012 –2013) that combines exposure therapy (extinction mechanism) with the bottom-up model of meditation (reconsolidation mechanism) to self-regulate the arousal response and reappraise the trauma memories. As the name itself implies, the M-BET is a fusion model of treatment for PTSD that combines meditation-based (MB) techniques with those of exposure therapy (ET). The M-BET applies the bottom-up model of 212 7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT) meditation in a threefold sequential combination including fi rst the detachment from external stimuli [Sans. pratyahara ], then the concentrative meta-visualization [Sans. dharana], and, lastly, Buddhist mindfulness [Sans. dhyana ] (i.e., the 5th, 6th, and 7th limbs, respectively, of the Eight-limbed Yoga). In the context of PTSD, M-BET fi rst controls the hyperarousal response at level 1 and then achieves the concentrated men- tal state and induction of detachment at level 2. Finally, at level 3, trauma memories are safely processed and reappraised with respect to the accompanying perceptions, feelings, and thoughts using mindful detachment/disassociation, compassion, and neutrality. Level 1 of M-BET calls for standardized meditative breathing in sitting posture that controls hyperarousal symptoms and prepares one for pratyahara /detach- ment from trauma triggers. Level 2 involves standardized focused meditation that reinforces further detachment and disassociation (very different from the concept of dissociation) and prepares one for directed meta-visualization of self and trauma memories. Level 3 involves detached processing and reappraisal of trauma memories with mindful awareness and bare attention. M-BET uses therapist-guided and self- exposure formats for controlled exposure to trauma triggers, regulating and reapprais- ing the trauma response using the TIMBER interventions in structured, graded, and individualized manner. The TIMBER protocol can be combined with medications like ketamine, d -cycloserine, or propranolol that affect fear/trauma memories for more persistent reduction of learned fear, enhancing their effects. Ketamine is a glutamate antagonist that is being increasingly shown to rapidly (within a few hours) and in robust manner improve not only refractory PTSD symptoms but also those of resistant depression and suicidality (Murrough et al. 2013 ; Aan het Rot et al. 2012 ), which are major comorbidities of PTSD. Because of their ease of use and standardized method- ology, the mini- TIMBER sessions are ideally combined with medications like ket- amine during the peri-infusion period to potentiate their therapeutic effects, whereas M-BET can be used without medication for maintenance treatment of PTSD that spe- cifi cally targets the PTSD symptoms, preventing relapse. Although TIMBER/M-BET needs to be tested in larger samples with respect to their effi cacy, the preliminary results of the pilot study so far have been quite promising.

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Penetrative insight joined with calm abiding utterly eradicates affl icted states. – (1997 )

8.1 Yoga and Meditation: Rationale and Feasibility in Health care

Although heterogeneous and complex with respect to its scope and meaning, Yoga and meditation can be broadly conceptualized as self-management strategies for gaining insight into the principles of the human mind that explain the nature of its thoughts and experiences. These insights help us realize how to reaccess a natural and positive state of mind, how to experience calmness in sustained manner regard- less of the circumstances we encounter in our daily life, and how to translate these for our well-being . Yoga is based on the humanitarian philosophy that the basic ingredi- ents of happiness, though present inside everybody, remain untapped and thus inac- cessible to many. It draws upon people’s innate wisdom and proposes utilization of the healthy perspectives available to everyone. In Yoga, health is just a preliminary prepa- ration for achieving higher goals. Health is rather a very important side effect of the practice of Yoga (Iyengar 2001 ). In the all-encompassing and multidimensional aspects of Yoga, as evident in the Eight-limbed Yoga or the Noble Eightfold Path , one sees the balanced combination of the following: a healthy Yogic lifestyle (including the Middle Way, moral behavior, natural environment, and healthy diet), adequate bodywork through Yogic postures (asanas ) and procedures (Sans. bandhas , mudras , and kriyas ), breath work (pranayama ), and techniques of mental development includ- ing concentration and mindfulness that lead to elevation of one’s consciousness to deeper meditative states ( samadhis/samapattis) in the path of self-realization. Being mother to Ayurveda, the therapeutic system of ancient India (equivalent to the allo- pathic system of medicine), one can clearly see that Yoga doesn’t negate the use of medications and other methods of modern medicine (Frawley 1999 ).

© Springer International Publishing Switzerland 2015 217 B. Pradhan, Yoga and Mindfulness Based Cognitive Therapy: A Clinical Guide, DOI 10.1007/978-3-319-09105-1_8 218 8 Yoga in Maintenance of Psychophysical Health

Yoga is a technology to upgrade one’s internal infrastructure which is the source of all human experience. Therapeutic rationale of Yoga and meditation lies in the following three facts (this author calls it a trilogy ):

(i) All our experiences are created in the inside of us , but because of the projective (Sans. vikshepa ) mechanisms, the mind is constantly running away from this inner locus. (ii) Because of this projective and centrifugal mechanisms of the mind, the experi- encer (i.e., the self), the things experienced (i.e., the world with all its objects), and the medium/interface we use to experience (i.e., the mind and the associ- ated sense organs) are not able to work in a harmonious manner. This internal disharmony leads to the distortion of our experience, leading to a state of cog- nitive–emotive dissonance. Modern science calls it stress ; Yogic and medita- tive philosophies call it dvanda [Sans.] or klesha [Pali]. The stress, as we know, leads to poor health. (iii) Cogniti ve neuroscience informs us that our memories of things are the neural representation of information, which is nothing but internal representations in our brain and mind. Memory serves as a crucial parameter in shaping our experience. Memory is state dependent in the sense that there exists a rela- tionship between encoding cues and retrieval cues in this process. Retrieval is a reconstructive process, not an actual replica of experience (Pally 1997 , 2005 ). Meditative wisdom including those of Buddha and Patanjali informs us that amelioration of stress is possible by modifi cation and reappraisal of our internal representations: this is done by the meditative insight about nature of these representations. As one can see here, these models are akin to the cognitive therapy models. Actually these models are broader in approach and more extensive in their applications, as we see from utility of mindfulness models like MBCT, DBT, Y-MBCT, etc. In addition, potential utility of these lies not only in illnesses but also in health. Over the millennia, Yoga and meditation have been advocated as a way of life as well as a kind of psycho- somatic preparation for spiritual elevation. In these, one can see that Yoga refl ects the basic human goal to transcend the pain, suffering, and uncertainty of human life. As a matter of fact, health has never been the main goal of Yoga; it is rather an important side effect of the practice of Yoga (Iyengar 2001). Patanjalian Yoga and Buddhist meditation have been handed down to millions of practitioners as tools for appreciably improving the health of a person physically, mentally, and socially. As refl ected in a recent study (Prasad et al. 2011 ) conducted at the Mayo clinic, authors note that even 15 min of daily meditation practice can reduce stress and improve quality of life of the health care professionals. However, as elaborated later, the current methodol- ogy employed for the evidence- based study of Yogic interventions is not opti- mal. Yoga, a module of many do’s and don’ts, infl uences almost all aspects of our life that include but not limited to the diet, nutrition, metabolism, physical and social habits, emotional attitudes, and so on. This broad range of scope makes it rather diffi cult for researchers to experimentally determine the cause and effects of Yoga’s Do s and the Don’t s. So one important fact could be that these interventions are effective, but when we design a trial, we simply don’t have adequate methods to measure these experiential parameters. Despite 8.2 Specifi c Effects of Yoga and Meditation on Brain and Body 219

these diffi culties in measurements of the effects, Yoga–mindfulness–based interventions is feasible not only for treatment of psychotic illnesses like schizophrenia (Vancampfort et al. 2012 ) but also severe impulsivity like ADHD (Zylowska et al. 2008 ) .

8.1.1 Why Yoga–Meditation if There Is a Pill?

The straight answer to this question is simple: there is no pill that can effectively address all our healthcare concerns. There are many good reasons for using Yoga- and meditation-based psychotherapy. It can be used alone or in combination with medication and both for illness and for optimizing wellness. Used for thousands of years, studies indicate these cost-effective interventions are effective not just in amelioration of psychiatric symptoms but also greatly useful in terminal illnesses like . Another relatively untapped utility of Yoga- and meditation-based inter- ventions is their great potentials in preventive medicine. Also the effects of these tools are not just on a particular body part or system or on a particular symptom. Rather, they infl uence the person and the life as a whole. If carefully performed under supervision, there are no side effects and even people with severe psychotic illnesses like schizophrenia could tolerate these interventions (Vancampfort et al. 2012). Yoga–meditation combines humanistic models with positive psychology and self-help models of care. Thus, they promote the autonomy of the individual which could decrease the burden of care not only in the caregivers but also in the health- care providers. These therapeutic methods don’t negate the utility of appropriate pharmacological interventions, rather supplement them. These interventions could provide respite in circumventing some of the diffi culties with the health care access in this managed care era.

8.2 Specific Effects of Yoga and Meditation on Brain and Body

Meditation, being a deeply contemplative and experiential phenomenon, affects multiple regions of the brain. In addition to the key structures (frontal circuits, thala- mus, amygdala, insula, and other limbic areas) already described in Chap. 3 , its most notable effects are on the brain structures associated with parasympathetic activity. Parasympathetic activities provide recovery from stress and general resto- ration of the organism. During meditation, activity of the right parietal lobe may decrease, which can induce dissolution of the sense of self in space and time (Newberg et al. 2002 ). This is apparently contributory to reduction in the self–other dichotomy, a crucial factor in creation of empathy. As has been shown in studies (Brefczynski-Lewis et al. 2007 ), extensive training in concentrative meditation (focused attentive: FA type) improves the ability to sustain attentional focus on a particular object. The study mentioned above involved investigation of the neural correlates of FA meditation in expert meditators (in Tibetan Buddhist traditions) and novices, using f-MRI scans of brain. FA meditation in this study increased activation in multiple brain regions involved in self-monitoring (the dorsolateral 220 8 Yoga in Maintenance of Psychophysical Health prefrontal cortex, DLPFC), attentional orienting (the superior frontal sulcus and intraparietal sulcus), and engaging attention (the visual cortex). As predicted, the meditation-related activation patterns depended on the level of expertise of the practitioner. Some recent studies indicate that Yoga and meditation interventions induce not only functional changes in the brain but structural changes as well. Some of these changes are (i) increased gray matter in the insula (Lazar et al. 2005 ; Holzel et al. 2008 ), hippocampus (Holzel et al. 2008 ; Luders et al. 2009 ), and prefrontal cortex (Lazar et al. 2005 ; Luders et al. 2009 ); (ii) increased neural fi ber density in the ante- rior cingulum (Tang et al. 2010 ); (iii) reductions in the thinning of the prefrontal cortex region due to aging (Lazar et al. 2005 ); (iv) improved psychological func- tioning associated with these key brain areas including attention (Tang et al. 2007 ; Carter et al. 2005 ), compassion, and empathy (Lutz et al. 2008 ); (v) decreased stress-related cortisol (Tang et al. 2007 ); (vi) strengthened immune response (Davidson et al. 2003 ; Tang et al. 2007 ); (vii) improvement of a variety of medical conditions including , asthma, type II , and chronic pain (Walsh and Shapiro 2006 ); (viii) improvement of many psychological condi- tions including insomnia, anxiety, phobias, and eating disorders (Walsh and Shapiro 2006 ); (ix) increased thalamic GABA levels, decreased anxiety, and improvement of mood (Streeter et al. 2007 , 2010); and (x) positive effects on stress-induced changes in cognitive functions (Mohan et al. 2011 ).

8.3 The Basic Dilemma of a Researcher When Testing the Efficacy of Mind–Body Interventions

Wide-ranged applications and roles of Yoga and meditation in treatment and main- tenance of psychophysical health are being proven in increasing manner and in the rigorous ways of evidence-based research in modern medicine. The studies are too many and actually overwhelming to be mentioned in a book chapter like this. It is worth mentioning here the diffi culties inherent in conducting research in experien- tial disciplines in general and Yoga and meditation, in particular. In randomized controlled trials involving complex interventions like Yoga and meditation, the researcher is always faced with one basic dilemma of whether to design a trial with a single modality that does not refl ect the true Yoga and meditation practice accu- rately or alternatively, to undertake a multifaceted Yoga intervention trial that com- plicates interpretations from a conventional evidence-based perspective. Historically, conventional medicine follows a reductionist or linear Cartesian framework. In this approach, complex problems such as chronic diseases are typically divided into smaller, simpler, and thus tractable units. Yoga and meditation interventions are experiential and holistic, encouraging integration and gestalt (the whole) over reductionism (the parts). Yogic concepts of the complex and ever-changing mind are nonlinear and dynamic. In terms of modern science, these theories are systems (nonlinear) models or complexity models. In a system, nonlinearity or complexity is said to exist when the amount of output is not proportional to its input, i.e., the system response to a sum of inputs is not simply the sum of their separate responses. 8.3 The Basic Dilemma of a Researcher When Testing the Effi cacy of Mind 221

Because Yoga operates on a global systems level that involves human mind and its numerous complexities, research into its use should assess numerous factors at many time points and/or spatial conditions and identify patterns that refl ect global behavior rather than singular, distinguishing markers or variables. The concrete and linear reductionist approach to conventional randomized control trials cannot cap- ture experiential changes and dynamism of complex mind–body interventions like mindfulness. The reductionist approach tends to reduce the evaluated system into individual parts and thus risks missing the therapeutically active elements of Yoga and meditation. The reductionist approach can sometimes make these elements appear nonobjective . The other challenge in Yoga research is that while there is a strong need for examining utility in the evidence-based medicine format, being exclusively experi- ential and subjective in nature, transcendental experiences cannot be verifi ed well by traditional experimental techniques. One really needs to be equipped with expe- riential measures for documenting the changes that follow the researcher’s direct meditative experience. For understandable reasons, many researchers do not have an authentic experience of Yoga and meditation. Apart from the experiential abstractness and heterogeneous use of yoga, there is a paradigmatic mismatch between the fundamental principles espoused by Yogic theory and many of the ana- lytical tools and methods generally applied in . Also despite all the standardizations described earlier, there is an utter scarcity of good books describ- ing standardized protocols for conducting clinical and research work on Yoga and meditation in homogenous and standardized manner. All these issues make inter- pretation of research on the effi cacy of the interventions in Yoga and meditation very diffi cult. Similar diffi culties are inherent in the studies that examine the effi - cacy of non-behavioral psychotherapies (e.g., psychoanalysis) as well. Yoga deals mostly with the inner life, the facts of which are based upon experi- ence no less than the facts of science. However, it may not be possible or even desir- able to demonstrate them. The self-investigative spirits of Yoga to fi nd the fundamental one have attracted not only philosophers and mystics but also scientists to the likes of Albert Einstein, Julius Oppenheimer, and Fritjof Capra. One can see that despite the seemingly unrelatedness, the common ground between modern sci- ence and mystic science is the basic interest to know the roots or the origins: the fundamental unity among all the diversities of life. As Capra ( 1975 , p. 106) says: “The unity and inter-relation of all things and events is not only the very essence of the Eastern world view, but also one of the basic elements of the world view emerg- ing from modern physics. This concept of unity among diversity is the key principle which explains how the can cope with presence of so many Gods (330 mil- lion!). The basic attitude of Hinduism is that in substance, all these divinities are identical. They are all manifestations of the same divine reality, refl ecting different aspects of the infi nite, omnipresent, and the ultimately incomprehensible Brahman. ” The ultimate aim of all branches of science is discovery of the Fundamental One, the Unity, the one appearing as many out of which the manifold is manufactured. Yoga as a science has similar aims, and it proposes to start from the internal world (the subtle, the locus of experience) and, through that, to achieve control over the whole—both internal and external (the gross, the effect of the subtle). 222 8 Yoga in Maintenance of Psychophysical Health

8.3.1 Methodologically Sound Clinical Trial of Mindfulness Interventions: Essentials

A recent meta-analysis regarding the use of mindfulness interventions for insomnia (Kanen et al. 2014 ; accepted for publication) conducted by this writer and col- leagues further illustrates these points and describes what a proper (scriptural) methodology for mindfulness-based trial could entail. These points are based on the following rationale taken from the scriptures. Buddha called mindfulness as one way to achieve the end of suffering. Essentially a proper methodology for a clinical trial to test the effi cacy of mindfulness-based intervention should consist of the actual methodology of meditation as they have been described in the original scrip- tures. When designing a research trial on Yoga and meditation, some of the method- ological shortcomings could be avoided by adhering to the outstanding texts, both classical and modern, that describe these interventions in more authentic manner. These include but not limited to Buddhaghosha (430 CE) (trans. Nyanamoli, 1976 ; this whole book is devoted to description of meditation and its methodology), Nyanaponika (1965 , p. 85–107), Eliade (1969 , p. 162–199), Vivekananda (1956 ), Taimni (1961 ), Kabat-Zinn (1990 ), Santina (1997 , p. 333–339, 341–347), and Segal et al. ( 2002 , 2013). The human mind is graded with respect to its ability to perceive reality, and mindfulness is the process of cultivating one’s attention (concentration) that produces the higher grades of mind. Like we sharpen a pencil for a purpose, i.e., to write, similarly, by means of meditation we sharpen the mind for a defi nite and higher purpose—in this case, the wisdom in order to attain freedom from suffering or distress. Because meditation by itself is not enough, it must be combined with the wisdom (Pali. panna ) or meditative insight (vipassana ), the purpose being its gener- alization to daily life, to ameliorate the sufferings. In mindfulness trials, therefore, interventions should include both elements of meditation, concentration and mind- fulness, as the concentrated state of mind is a prerequisite for achieving mindful- ness. In addition, there needs to be a standardized way to implement the meditative wisdom into one’s daily life. Middle Way is such a meditative lifestyle but has not been used that much in the published Yoga–meditation effi cacy trials. In the light of above discussion, let’s examine the clinical situation insomnia and what a sound design of clinical protocol of mindfulness interventions could entail. For insomnia, clearly the target areas for interventions include the suffering or symptoms of insomnia and the attending dysfunctions. In original scriptural tradi- tions, combining concentration, meditation, and wisdom in a methodical manner for amelioration of distress is necessary. In the traditions of developing Right Mindfulness (sati patthana), the original method of meditation described by the Buddha, the cultivation of stable and focused attention (concentration/bare atten- tion) is prerequisite for the subsequent stage of mindfulness (this involves using bare statements in the four stations of mindfulness) in which uniformly hovering atten- tion provides mindful observation of present mental contents with a nonjudgmental and detached attitude. Cultivating mindfulness involves two processes: (a) develop- ment of bare attention/concentration and (b) cultivation of mindfulness, a purely receptive and detached state of awareness, while still maintaining the bare attention . 8.3 The Basic Dilemma of a Researcher When Testing the Effi cacy of Mind 223

Sequential use of both (a) and (b) in one’s daily life results in amelioration of symp- toms and sufferings. This merger of daily life with Right Mindfulness (bare atten- tion/concentration + detached and receptive awareness of mindfulness resulting in clear comprehension/vipassana) is the hallmark of sati patthana. The bare atten- tion is clear, single-minded awareness of the bare facts of perception of an object, the simple registering of the facts about that object without elaboration from subjec- tivity/self-referencing. Simply said, it is just registering the bare event as it is and moving on to the next moment without sinking into the store house of memory, preventing distortion of the facts. Bare attention about an object allows the object to speak for itself and thus keeps the narrowing and leveling effects of habitual judg- ment at bay; it sees the objects ever anew, as if for the fi rst time. The Right Mindfulness needs to be practiced with respect to its four stations: (i) mindfulness toward body and breathing, (ii) mindfulness toward state of mind, (iii) mindfulness toward feelings , and (iv) mindfulness toward mental contents (i.e., one’s thoughts, feelings, perceptions, memory, and will/desire about the object in one’s awareness at that particular moment). These four stations of mindfulness are basically the four specifi c applications of mindfulness in a symptom-specifi c manner. In the case of insomnia, the essential elements in the intervention could be meditation on insom- nia and its attending dysfunctions (sufferings in Buddha’s terms) using the four station of mindfulness. With respect to insomnia, these four contemplations are, respectively, as follows: (a) contemplating upon bodily sensations (lethargy, etc. pain) associated with insomnia, using the mindfulness breathing to ameliorate and transcend these bodily sensations. This is followed by the three contemplations on mind using the bare attention and bare statements : (b) contemplating upon the state of mind (the bare statement in this case is the mind at this moment is unpleasant ), (c) contemplating upon the feelings (the bare statement here is the mind at this moment is fi lled with anger/frustration), and (d) contemplating upon the contents of mind in a detached and uniformly attentive manner, rather than clinging to the men- tal contents, building a personal story of suffering, and losing the mindfulness state . As mentioned before, in this station, one sees the mental objects as they are , i.e., seeing thoughts objectively as just thoughts, feelings as just feelings, and percep- tions as just perceptions at that moment without identifying them. This in itself will provide the mindful practitioner the wisdom about insomnia, which will guide him/ her in carrying out the actions needed to alleviate this suffering, i.e., the symptom of insomnia and its attending dysfunctions.

8.3.2 Efficacy of Yoga and Meditation: Empirical Evidence

Despite the abovementioned diffi culties in interpreting the research on Yoga and meditation, in a recent meta-analysis (Goyal et al. 2014 ) that included 47 trials with 3,515 participants, evidence suggested that meditation programs help reduce anxi- ety, depression, and pain in some clinical populations. The author concluded that “clinicians should be prepared to talk with their patients about the role that a medi- tation program could have in addressing psychological stress. Future research in 224 8 Yoga in Maintenance of Psychophysical Health meditation would benefi t by addressing the remaining methodological and concep- tual issues.” In another recent article published by researchers from , New York (Miller et al. 2014 , p. 1–8), a 5-year longitudinal study assessed whether high-risk adults who reported high importance of religion or spiri- tuality had thicker cortices than those who reported moderate or low importance of religion or spirituality and whether this effect varied with family risk status. This prospective study, which involved 103 adults who were at familial risk for depres- sion, strongly suggests that religion and spirituality may build resilience against depression by toughening the brain . The researchers found that the brain cortices of subjects who placed a high importance on religion or spirituality were thicker than the brain cortices of those who did not. In addition, the brain cortices were espe- cially strong in those individuals who placed a high importance on religion or spiri- tuality and who had a high risk of depression. The authors of this study conclude that a thicker brain cortex associated with spirituality may confer resilience to the development of depressive illness in individuals with high familial risk for major depression, possibly by expanding a cortical reserve that counters the vulnerability that cortical thinning poses for developing familial depression. They further add: “This study points to measurable, benefi cial effects of presumably healthy spiritual- ity, especially for individuals with biological predispositions to depression, and adds to substantial and growing evidence that psychiatrists should support healthy development in that sphere of patients’ lives.” These fi ndings are consistent with the general impressions form other researchers regarding the effi cacy of Yoga- and mindfulness-based interventions (Segal et al. 2002 , 2013); Kabat-Zinn et al. 1992 ). The preliminary data from this author’s outpatient clinic at the Cooper University Hospital, Camden, New Jersey (September 2012-May 2014; unpublished), refl ect the methodology described earlier and concur with the fi ndings mentioned above with respect to the effi cacy of interventions using Yoga and meditation.

8.4 Yoga in Maintenance of Psychophysical Health: Attention and Memory Are the Main Tools

Because of shortcomings of conventional methodology in interpreting Yoga and meditation interventions and relative scarcity of access to standardized manuals on Yoga and meditation in an evidence-based format, it will not be that useful to quote the numerous research studies that examine the effi cacy of Yoga and meditation in health and illness. Instead, discussion of a conceptual paradigm on the rationale and the evidence-based ways to use Yoga and meditation in health and illness could serve the purpose better, i.e., to foster further development of standardized and inte- grated protocols for both clinical and research use of these invaluable therapeutic interventions. The three main reasons for the use of Yoga–meditation in maintenance of one’s psychophysical health are:

(a) Yoga is a profound psychosomatic science. (b) Meditation is a science of attention. 8.4 Yoga in Maintenance of Psychophysical Health 225

(c) Yoga and meditation interventions are essentially models of self-care not only for stress reduction and improvement of productivity and quality of life but also can be used in targeted and symptom-specifi c manner in illnesses.

All meditation practices involve stilling the mind (concentration) whereby all content-laden thoughts (e.g., fantasies, daydreams, plans) cease and the mind enters a state of mindfulness, i.e., open and detached awareness, formlessness, clarity, and bliss. This cultivation of stable attention (and memory) during the meditative pro- cess is a key parameter in its use for stress reduction, increasing productivity in daily life as well as for optimization and maintenance of psychophysical health. This understanding has great therapeutic potential in the treatment of disorders of attention and memory including ADHD, dyslexia, and other cognitive disorders in which use of Yoga and meditation is relatively untapped until recently. Some of these are elaborated in the previous chapters of this book. As emphasized in the Chaps. 2 , 3, and 4 , meditation (mindfulness) is the main step of Yoga ; attention (and memory) is its main tool: they deserve more discussion here. This understanding is quite pertinent in order to understand the full scope of the utility of Yoga and medi- tation in psychophysical health.

8.4.1 Meditation, Attention, and the Default Mode Network of the Brain

The various brain areas involved in meditation are already described in Chap. 3 . Meditation is the science of cultivation of attention in which a major task is to observe and regulate our internally generated thoughts . The classic defi nition of attention by James (1890 , p. 403–404) is “the taking possession by the mind, in clear and vivid form, of one out of what seem several simultaneously possible objects or trains of thought.” During meditation we close our eyes, focus on our internal train of thoughts, and try to block/uncouple the mind (internal analyzing system) from the external sensory/perceptual inputs. During periods of internally guided thought, perceptual decoupling occurs temporarily, i.e., processing of per- ceptual information (external distractions) is neglected. However, the internally and externally driven streams may compete and attention can be rapidly recoupled to perceptual events if salient external events occur. The default mode network is a network of brain regions that are active when the individual is not focused on the outside world; rather, it is involved in internal train of thoughts (day dreaming is an example of this), and the brain is at wakeful rest. The ability to generate and sustain these internal trains of thoughts (internally driven cognitions) unrelated to external reality frees one from the constraints of acting on immediate, environmentally triggered events alone. Smallwood et al. (2011 ) propose that such thoughts are produced as a result of cooperation between the default mode network and a frontal–parietal control network. The default mode network provides the autobiographical information of the individual that acts like a scaffold for the frontal–parietal network to further sustain the internal trains of thought and buffer 226 8 Yoga in Maintenance of Psychophysical Health them from the disturbances of the external world. In the process, the attention gen- erated by the frontoparietal network suppresses the irrelevant external (perceptual) information. The engagement of the internally guided trains of depends mainly upon the perceptually guided cognition and less upon external physical referents for cognition. Because access to the top-down attentional control system (from cerebral cortex downward) is generally a prerequisite of conscious experience, during peri- ods of internally guided thoughts (like in meditation), activation of top-down atten- tional control system and the default mode activity often operate simultaneously. On the other hand, the bottom up system (neural pathways from the peripheral sense organs to the cerebral cortex; see Chap. 3 ) feeds the cerebral cortex, the highest center for information processing.

8.4.2 The Basic Mechanisms Involved in Attention

Attention, memory, and intelligence are closely interdependent processes. In a con- nectionist view of how the brain processes information, O’Reilly and Munakata (2000 ) identifi ed three kinds of processing performed by neural networks of the human brain: (i) a slow learning type involving learning the overlapping and distrib- uted representations of the environment (related to semantic memory and crystal- lized intelligence) that is performed by the posterior cortex, (ii) active maintenance of limited amounts of information over short time intervals enabling the problem- solving functions of the prefrontal cortex (related to concepts like working memory, executive functions, and fl uid intelligence) , and (iii) rapid acquisition of novel infor- mation by the hippocampus (this concept is related to episodic memory). Fluid intel- ligence refers to global problem-solving profi ciency, and crystallized intelligence is characterized by collected and primarily verbal knowledge.

Attention William James, one of the fi rst modern experimental psychologists and the author of the lengthy textbook The Principles of Psychology (1890), provides a complete description of the phenomenon of attention. The immediate effects of attention allow us: (a) to perceive, (b) to conceive, (c) to distinguish, (d) to remember things more clearly, and (e) to shorten our reaction time in response to a task. From this, one can easily see the connection between one’s attention and memory. As men- tioned before, memory is closely related to intelligence. Smart individuals are of two kinds: those in the fi rst category know a lot but are not profi cient problem solv- ers, whereas people in the second category know less but are skilled at problem solving. Neuropsychologists conceptualize these two types of intelligence as: (a) crystallized intelligence, which is involved in the fi rst type of smartness, i.e., knows a lot category (this intelligence increases at least into middle age), and (b) fl uid intelligence , which is involved in the second type of smartness, i.e., the good prob- lem solver category. This intelligence reaches its zenith in late adolescence and slowly declines thereafter. Fluid intelligence is more vulnerable to brain damage and aging. 8.4 Yoga in Maintenance of Psychophysical Health 227

Dual Attentional Systems in the Human Brain Cognitive neuroscience research has found that the human brain employs dual sys- tems of attention that consists of a posterior/dorsal system and an anterior/ventral system (Fox et al. 2006 ). The posterior system orients and engages novel stimuli in order to achieve a task and consists of the superior parietal cortex, superior collicu- lus, and the pulvinar. It receives dense norepinephrine (NE) innervations from a key brain area called the locus ceruleus. NE inhibits the spontaneous activity of postsyn- aptic neurons (in this case, the parietal cortex) and thus allows us for better orienta- tion by increasing the signal-to-noise ratio of target neurons. Localized in the prefrontal cortex (PFC) and the anterior cingulate cortex (ACC), the anterior system subserves the executive functions (problem-solving abilities) and helps maintain a focus. It is modulated by ascending dopamine (DA) fi bers from the ventral tegmen- tal area (VTA). DA suppresses spontaneous activity of target neurons (in this case, the PFC) and reduces their responsiveness to new inputs thus allowing us to better focus. Any severely challenging task puts extreme pressure on both these attentional systems. Performance declines as the attention is fatigued and careless mistakes are made. Anxiety develops in response to too much arousal, further exacerbating the poor performance, and even more mistakes are made. Here, it is worth mentioning the work of Diamond et al. (2007 ) on the Yerkes–Dodson law (1908 ) that stipulates that one’s performance increases with physiological or mental arousal eventually reaching a plateau. When levels of arousal become too high, performance decreases. Graphically, this is represented as an inverted U-curve where arousal is in the x -axis and performance is in the y -axis. The upward part of the inverted U represents the energizing effect of arousal and the downward part represents the negative effects of arousal (or stress) on cognitive processes like attention, memory, and problem solving.

Selective Attention and Salience As mentioned in Chap. 3, salience is a process of selective attention that makes the important (salient) information at a particular moment and context stand out against the background of other information. Salience plays a crucial part in making our experience special and is instantiated in our brain by the facilitated pathways. Thus, salience, selective attention, and the facilitated pathways in the brain have crucial roles in potentiating the memory (consolidation). The insula and the ACC (motivat- ing center) play key roles in determining and maintaining the salience of informa- tion (Karnath et al. 2005 ). There are two types of salience systems in the human brain: (a) general salience system (salience of the selective attention ) that is concerned with environmental monitoring, response selection, and skeleto-motor body orientation and (b) emo- tional salience system (salience of the emotional arousal) within which interocep- tive information is linked with emotional salience, generating a subjective representation of the body. The right anterior insula regulates the interaction between the selective attention needed to achieve a task (the dorsal attention sys- tem) and the salience of arousal that maintains focus upon the relevant parts of the environment (ventral attention system) (Eckert et al. 2009 ; Taylor et al. 2009 ). 228 8 Yoga in Maintenance of Psychophysical Health

8.4.3 Basics of Memory and Its Various Categories

Memory is the neural representation of information. Each day we learn and remem- ber a myriad of new information. This novel information is fi rst registered and acquired (memory acquisition ) in the internal system and, if strengthened (memory consolidation ), is eventually stored in relatively stable manner in our long-term memory. Cognitive neuroscientists defi ne our experiences as internal representa- tions of things in our brain and mind. Memory, our ability to remember things/ experiences, is the retention, reactivation, and reconstruction of these internal rep- resentations and thus plays a crucial role in reproducing our experiences. Regulation of memory is now understood as having complex temporal and system determinants at signifi cant loci in the brain (Pally 2005 ; Damasio 1999 ). The operational mne- monic structure of memory includes:

(i) Iconic memory (previously referred to as immediate memory ) that operates within seconds. (ii) Working memory (WM; previously referred to as short-term memory , STM) that helps us recall events for a period of several seconds to a minute without rehearsal. (iii) Long-term memory (LTM) that allows us to recall things over indefi nite periods. (iv) Associative memory that helps us to learn and remember the relationship between unrelated items. For example, we associate a person we have just met with his or her name.

LTM is divided into implicit (i.e., outside of awareness) and explicit (i.e., declarative, in awareness) memory. Explicit memory is further divided into semantic (facts, knowledge) and episodic (spatial, temporal, sensory) memory (Vargha- Khadem et al. 1997 ). The episodic memory, i.e., capturing the what, when, and where of the specifi c events like birthday parties, weddings, etc., may be particularly signifi cant for autobiographical events. STM has limited storage capacity (typically of the order of 4–5 digits in a 10-digit telephone number; Cowan 2001 ) and is temporary and subject to disruption, whereas LTM has immeasurably large storage capacity with potentially unlimited duration (some- times a whole life span) and, once consolidated, is persistent and stable (excep- tion is reconsolidation where LTM becomes labile, as described in Chap. 7 ). Memory capacity can be increased through a process called chunking (Miller 1956). For example, in recalling a ten-digit telephone number, a person could chunk the individual digits into three groups: fi rst, the area code (such as 123), then a three-digit chunk (456), and lastly a four-digit chunk (7890). STM of writ- ten text is believed to rely mostly on an acoustic code (auditory) for storing information and to a lesser extent a visual code (Conrad 1964 ). In contrast, LTM encodes information semantically (conceptually) as well as in terms of episodic memory (Baddeley 1966 ). 8.4 Yoga in Maintenance of Psychophysical Health 229

Working Memory (WM) This is a rather new concept and helps us in the performance of everyday activities involving thought, thought processes, learning, reasoning, and problem solving. WM is a component of our executive functions: neural functions necessary for cog- nitive fl exibility as well as controlled and effortful processing of information. Simply put, one’s presence of mind is directly proportional to one’s working mem- ory. This active memory (sometimes referred to as online memory) involves tran- sient information storage and processing. It is a limited-capacity memory system that must be constantly updated as one problem solves. WM involves a process that requires inhibition, i.e., protection from the interference of associated but irrelevant information. Baddeley (2000 ) proposes a model of WM that consists of three basic stores: (a) the central executive store (attention), (b) the phonological loop store for auditory information, and (c) the visuospatial sketchpad. The central executive store essen- tially acts as attention and channels information to the other memory stores (i.e., the phonological loop and the visuospatial store) for further processing. The phonologi- cal loop stores auditory information by silently rehearsing sounds or words in a continuous articulatory process (e.g., repetition of a telephone number). The visuo- spatial sketchpad stores visual and spatial information. It is engaged when perform- ing spatial tasks like judging distances and depth and visual tasks like imagining. There is another entity called the episodic buffer which is dedicated to linking infor- mation across the various domains in order to form integrated units of visual, spa- tial, and verbal information and order information chronologically (e.g., the memory of one’s life story). The episodic buffer is also assumed to have links to long-term memory and semantics. These concepts are crucial when evaluating the role of med- itation in dyslexia and cognitive disorders.

Neuroanatomic Substrates of Memory Long-term memory (LTM) operates within the hippocampus with connections to the cortex, thalamus, and other sites in the limbic system. The hippocampus serves an index pointing function to other cortical memory sites where memories are con- solidated. The hippocampus is essential for the consolidation of information from short-term to long-term memory, and without the hippocampus, new memories can- not be stored into the LTM, although the hippocampus itself does not seem to store information itself. Although structures in the medial temporal lobe (MTL) appear to be necessary for the establishment of LTM, they may also be involved in further consolidation of information through higher-order memory . The hippocampus is the key structure involved in the explicit or declarative memory (i.e., memories that are inside our awareness). Implicit or non-declarative memory (also called proce- dural memory, i.e., memories outside our awareness) takes place below awareness and encodes information mediating motor skills, routine actions, cognitive orienta- tions, and emotional responses. The key structures involved in the implicit memory are the cerebellum, basal ganglia, and amygdala. The basal ganglia integrate proce- dural information and may play a role in habitual modes of action that form our 230 8 Yoga in Maintenance of Psychophysical Health character traits, whereas the amygdala is central in integrating and modulating emo- tional memory. The hippocampus marks memories with temporal parameters, i.e., the hippocampus gives a personalized story to our memories by adding chronologi- cal, autobiographical, and associative information to it. The hippocampus is turned online around 18 months of age. This coincides with the initial development of autonomy (separation–individuation stage) in the child’s life, as well as with an increase in the child’s narrative experiences (bedtime dialogue, stories, retelling experiences) along with active language acquisition that increases childhood explicit memory (Pally 1997 ). Recent evidence also suggests that the hippocampal forma- tion may also have a role in the attentional control of behavior. The hippocampal– orbitomedial prefrontal cortex circuit may be involved in the attentional monitoring of the internal sensorium—a type of working memory of viscero- emotional pro- cessing. The hippocampal formation is a discrepancy detector that immediately rec- onciles present cognitive–emotional data in the orbitofrontal cortex with internal data to effectively activate working emotional sets. This leads to cognitive– emotional control of behavior (Wall and Messier 2001 ). In addition to the hippocampus and its surrounding cortices (entorhinal, perirhi- nal, and parahippocampal areas) (Eichenbaum and Cohen 2001 ), cells in several other brain areas including the prefrontal cortex, frontal motor-related areas (Asaad et al. 1998), and striatum (Brasted and Wise 2004) are implicated in associative learning and memory. Working memory is largely a function of the prefrontal cortex along with the basal ganglia and anterior cingulate gyrus and allows one to generate and evaluate alternative possibilities. Thus, it allows one to fl exibly shift the cogni- tive set if necessary (Pennington 2009 , p. 21). The right frontal lobe may function to prevent/screen painful memories from gaining access (repression of memories in psychotherapeutic terms) to the left hemisphere, where over-intensive analysis may occur (LeDoux 1996 ). This may explain manic-like disinhibition in individuals with right side frontal lobe damage.

Memory Consolidation Versus Reconsolidation The process by which items are transferred from STM to LTM is called consolida- tion. Consolidation of new memories depends on a crucial phase of protein synthe- sis and presumably involves two processes at the molecular level: synaptic consolidation and system consolidation (LeDoux 2003 ). The former involves a pro- cess of protein synthesis in the medial temporal lobe (MTL), whereas the latter transforms the MTL-dependent memory into an MTL-independent memory over the duration of months to years (Ledoux 2003 ). In recent years, this traditional con- solidation dogma that LTM is stable over time and resistant to disruption has been reevaluated as a result of studies on reconsolidation, a relatively recent phenomenon in memory mechanisms. Per these new insights, reconsolidation is a putative neuro- nal process in which the retrieval of a previously consolidated memory returns to a labile state that is once again subject to stabilization. As a result, it has been pro- posed that when a memory is reactivated it must undergo additional consolidation (reconsolidation) to persist. In this process of reconsolidation, the memories that become labile when recalled require another phase of protein synthesis to be 8.5 Attention and Memories in the Information Processing Model in Humans 231 consolidated once again (Alberini 2005 ; Dudai 2006 ). These fi ndings on reconsoli- dation fi t with the behavioral evidence that retrieved memory is not a carbon copy of the initial experiences and memories are updated during retrieval. As mentioned in Chap. 7 (TIMBER model), reconsolidation research has great therapeutic poten- tials in the troubled memories of PTSD and addictive disorders.

8.5 Attention and Memories in the Information Processing Model in Humans

From an information processing perspective, there are three main stages involved in storing information in the memory system and its subsequent retrieval (Wood et al. 2011 ):

(i) Encoding or registration: receiving, processing, and combining of received information. Attention and the perceived salience of the information play a big role in this process associated with the prefrontal cortex (PFC) and the insula. (ii) Storage : the creation of permanent records of encoded information mainly associated with the hippocampal formation. (iii) Retrieval , recall , or recognition : the accessing of stored information in response to some relevant process or activity primarily attributed to the thalamus.

Pattern recognition is a prototype of the information processing system in humans. In this, the physical input passes through the sensory system and stimulus analyzing mechanisms before their representation is established in the storage sys- tems, i.e., memory systems. Simultaneously, the analysis of previously encoun- tered material coupled with the history of expectations determines the events assumed to be most pertinent at an individual moment. The material that elicits the greatest combined excitation is selected for further attention. Both the physical/ perceptual characteristics of the information (objects) and their salience (perti- nence) determine how this information will be processed further. Salience (general as well as emotional) of the information, prior memory of the information, and associated expectations modulate the facilitated pathways (nerve circuits) in the brain that guides the individual’s selection among the various sources of informa- tion engaging their sense organs at any particular time. Contextual information is of great importance in perceptual processing. Our interpretation of sensory signals depends on the whole environment in which the signals are embedded. The impor- tance of contextual information in perceptual processing is exemplifi ed by the fact that an averagely skilled reader is able to process between 300 and 600 words each minute, which means the individual is able to identify as many as 10 words or about 50 to 70 letters per second. This is far faster than the recognition process that interprets letters or words isolated from the context. This attests to the importance of contextual information in learning how to make sense of words quickly even without registering much of the content of the actual information. In other words, learning in a contextual sense is much more effi cient. This has led to propositions 232 8 Yoga in Maintenance of Psychophysical Health that most of the letters and many of the words in a text can be skipped without any loss in comprehension. Donald Broadbent ( 1958) had proposed a fi lter model that views the human brain as an analog of a limited-capacity processor, i.e., the brain is able to identify and analyze only a limited amount of the information that is presented to it by the sensory inputs. Since then signifi cant progress has been made in understanding human information processing that has shaped our current under- standing of attention and memory. Broadbent further explains that the brain con- tains a selective fi lter that can be tuned to accept the desired message and reject all others. The fi lter thus manages to block undesired inputs, reducing the processing load on the perceptual system.

8.5.1 Utility of Yoga–Meditation in the Various Steps in the Information Processing Model

Yoga–meditative practices involve stilling the mind (Sans. Yogah chitta vritti nirod- hah; Yoga Sutra, section I, verse 2). This stilling eventually leads to purity and sharpness of the mind and prevents the internal components (objects) of the mind from distorting our experience. Thus, with persistent practice, we perceive things (internal representations) in undistorted way (seeing things as they are, in Buddhist sati patthana). This will in turn decrease stress and promote improved functioning and better quality of life. Persistence/longevity of our memory is dependent upon the clarity (sharpness) and richness of information during acquisition, i.e., more vivid and stronger is the information (stimuli), better do we remember them. Within the information processing model of the human brain, the clarity and richness of information are dependent upon, fi rst, one’s mental concentration (which blocks the unnecessary information) and, then, one’s open-mindedness (mindful awareness) when acquiring the information. In other words, more mental concentration (sharp- ness) and more open-mindedness (richness) during acquisition of information not only decrease the stress that can be associated with the information (the role of stress and the negative effects of stress on memory can be a lengthy discussion for another book) but also allow for stronger representations of these in our brain, i.e., stronger memories and better experiences. These concepts of concentration as well as open-mindedness are essentially sequential steps (6th and 7th limbs) in Yoga. Despite these potentials, experimental/therapeutic applications of these aspects of Yoga and mindfulness have not been integrated into the various models of memory in order for them to be therapeutically applied in the various clinical or research protocols. Hopefully that will change in the near future. Yoga–mindfulness interventions can signifi cantly infl uence the following stages of information processing as shown below (Fig. 8.1): (a) at the level of sensory input/sense organs (to perfect one’s visual/auditory system by concentra- tive meditation/ trataka in order to decrease doubts and distractions as well as to become one with the experience, the being mode of functioning); (b) at the level of analysis (to decrease bias and distortions) internalizing the experience as it is ; (c) at the level of evaluating the information from the perspectives of contextual 8.5 Attention and Memories in the Information Processing Model in Humans 233

Sense organs Prior experience#

Attention# Registration#

has crucial role Analyzing mechanisms # (encoding)# Expectations

Storage system# (secondary memory: LTM) Belongs to the past; full of distortions /gaps; Not carbon copy of events # (modified based on salience Contextual data # of the information). Rehearsal# Storage system (pertinence/salience) It is NOT a Limited Capacity (primary memory: LTP Storage System. STM/WM) Always in the consciousness/ the more faithful

Retrieval and action and Retrieval present; record of ‘actual’ events Associative memory#

Selective # # attention and further processing of data based on pertinence/salience

Effector system (actions)#

Fig. 8.1 Mechanisms of memory and key steps where meditation can enhance it. STM short-term memory, WM working memory, LTM long-term memory, LTP long-term potentiation. #Points in this system where Yoga-mindfulness can strategically work to infl uence memory/internal representations data/salience, aiding more effective consolidation of memory by multimodal and richer experience/sensory outputs using a combination of selective attention, i.e., concentrative meditation as well as uniformly hovering attention of mindfulness meditation; and (d) at the level of retrieval. At this level, mindfulness is even more crucial because it produces less distorted memories and thus promotes easier retrieval and processing. Pradhan and colleagues are testing these interventions in ongoing manner in clinical and research protocols in disorders involving attention and memory, e.g., ADHD (Pradhan and Khurana 2005 ), dyslexia (Pradhan 2014 ), drug memories in opiate and alcohol dependence (1998 ), and trauma memories in patients suffering from PTSD (2012 –2013; 2013 –2014). Because of its great rel- evance, it is important to understand the neurobiological mechanisms involved in attention and memory. 234 8 Yoga in Maintenance of Psychophysical Health

8.5.2 Cellular Mechanisms of Long-Term Memory and Connection with Yoga and Mindfulness

Memories are represented by vastly interconnected networks of neural synapses. As mentioned before, memory is the retention, reactivation, and reconstruction of the various internal representations of an experience. The term internal representation implies that memory contains two components: (a) the expression of memory at the behavioral or conscious level and (b) the underpinning physical neural changes. The latter component is also called the memory trace , a term originally coined by Richard Sermon, a French physiologist in 1904 (Schacter et al. 1978 ). Now it is referred to as the reverberatory activity of neuronal circuits. Encoding of memory involves the spiking (a nerve impulse) of individual neurons induced by sensory input, which persists even after the sensory input disappears. It also involves persistent changes in molecular structures that alter synaptic transmission between neurons (Jensen and Lisman 2005 ). Examples of such structural changes include long-term potentiation (LTP), which is long-lasting enhancement in signal transmission between two neu- rons that results from their synchronous stimulation. LTP is a persistent increase in synaptic strength following high-frequency stimulation of a chemical synapse. Long- term potentiation, which refl ects this increase in synaptic strength or potentiation , lasts a very long time compared to other processes that affect synaptic strength (Paradiso et al. 2007 ). Increased synaptic strength is one of the factors responsible for the synaptic plasticity of neurons, the capacity for the strengthening or weakening of chemical synapses over time, in response to increases or decreases in their activity. Changes in the number of receptors located on a synapse, the quantity of neurotrans- mitters released into a synapse, or how effectively cells respond to neurotransmitters may also affect neural plasticity. One property of LTP that separates it from other factors responsible for synaptic plasticity is its persistence . It lasts from several min- utes to many months. The molecular mechanisms underlying synaptic plasticity (researched by the Nobel Prize winner Eric Kandel and colleagues, as mentioned in Martin et al. 1997 ) involve two subtypes of glutamate receptors: the NMDA and AMPA receptors. Opening of the NMDA channels, which depends on cellular depo- larization, leads to a rise in postsynaptic Ca2+ concentrations, which is linked to the LTP. Strong depolarization of the postsynaptic cell completely displaces the magne- sium ions that block NMDA ion channels and allows calcium ions to enter the cell. This strong depolarization probably causes LTP. Weaker depolarization only par- tially displaces the Mg2+ ions, resulting in less Ca2+ entering the postsynaptic neuron and lower intracellular Ca2+ concentrations, which further promotes the cascade of electrochemical events involved in memory mechanisms that store our experiences in neurons (Bear et al. 2007 ). In other words, experiences are internal representa- tions. Trauma (PTSD) therapies like the visual–kinesthetic dissociation (V/KD, a neuro-linguistic programming-based therapy; Gray et al. 2012 ; Wake et al. 2013 ) and mindfulness-based exposure therapy (M-BET; Pradhan et al. 2012 –2013) are some of the new interventions in traumatology that use interventions targeted toward changing the internal representations (memories) of trauma in patients. These 8.5 Attention and Memories in the Information Processing Model in Humans 235

treatment models mirror Buddha’s ancient wisdom that experiences are representa- tional and depend upon one’s grades of mind and these representations can be changed (in case of M-BET by graded exposure as well as by the insight gained through meditation). As memories are thought to be encoded by modifi cation of synaptic strength, LTP is widely considered as one of the chief cellular mechanisms underlying learning and memory (Bliss and Collingridge 1993 ). Synapses that have undergone LTP tend to have stronger electrical responses to stimuli than other syn- apses. NMDA (glutamate) receptor- dependent LTP in the adult’s hippocampus (CA1) is the most widely studied type of LTP. Alterations in LTP may contribute to a number of neuropsychiatric diseases, including depression, Parkinson’s disease, epilepsy, and neuropathic pain (Cooke and Bliss 2006 ). Donald Hebb (1949 ) proposed that neurons grow new connections or undergo metabolic changes that enhance their ability to communicate. His postulate is sum- marized by his famous quote: neurons that fi re together, wire together . For example, in between two nerves A and B, when nerve A is close enough to excite nerve B and repeatedly or persistently takes part in its fi ring, some growth process or metabolic change takes place in one or both nerve cells such that A becomes more effi cient at fi ring B. These lasting metabolic and/or structural changes resulting from LTP pro- vide the neurobiological basis of new learning and memory. The neuronal spikes or nerve impulses (called action potentials) across the synapses that are the basis of information transmission in the brain are generated by special types of voltage- gated ion channels embedded in a nerve cell’s membrane. A neuron that emits a spike is often said to fi re. Graded potentials (GP) are changes in the nerve mem- brane potential (the voltage of the membrane) which arise from the summation of the individual actions of ion channel proteins in the nerve membrane. Properties of the GPs, unlike those of an action potential, are that GPs are sub-threshold, vary in strength, and, depending upon the intensity of the stimulation as well as associated conditions (e.g., cooperation from other neurons), either fade over time and space till they die out. In addition, being graded, they operate cumulatively to reach the threshold potential at which the nerve will fi re with a full action potential. Postsynaptic potential (PSP) is a type of GP and is a measure of the voltage in the postsynaptic neuronal membrane, which is induced through release of chemicals (neurotransmitters) by the presynaptic neuron. Depending upon whether it stimu- lates (depolarizes) or inhibits (hyperpolarizes) the postsynaptic membrane, the PSP can be excitatory (EPSP) or inhibitory (IPSP). The function of the PSP is to initiate or inhibit action potentials. The PSPs in the relevant nerves are GPs as well and thus follow the properties of the GPs mentioned above. This could explain why persis- tence/longevity of our memory is dependent upon the clarity (sharpness) and rich- ness of information during acquisition, i.e., more vivid and stronger is the information (stimuli), better do we remember them. The clarity and richness of information in the presence of strong attention allows for stronger stimulation of the nerves, possibly generating larger postsynaptic potentials (PSP) that reach the threshold potential necessary to cause the cascade of events that result in the devel- opment of a persistent/long-term memory. 236 8 Yoga in Maintenance of Psychophysical Health

8.6 Practice of Yoga–Meditation: General Considerations

Yoga is an experimental and experiential science for self-realization. The practice of Yoga is infl uenced by individual and cultural factors. Health is not the ultimate goal of Yoga; improvement in health is just an important side effect of its practice. Yoga practice may require some changes in lifestyle to allow for planning the time necessary for practice. To go through the disciplines of Yoga and meditation requires effort, a degree of discipline, and planning. How long this takes will depend upon many factors including the practitioner’s stage of spiritual development and time one will need to master the philosophy, technique, and practice of Yoga and medita- tion. It will also depend upon the competency of the teacher [Sans. Guru ]. The process of Yoga is more of a letting go experience in which one tests oneself in the midst of pleasure and temptations—neither by yielding to temptations and indulg- ing in pleasures nor by violent struggle with them, but rather by following the phi- losophy of the Middle Way (Dalai Lama 2009 ) and by mindful observation. ( our discriminative faculty, conscience) and (renunciation/dispassion/ detached stance) are two aspects of this exercise. During early practice, it is not unusual for the practitioner to see lights and hear various sounds. These are very spurious and one need not attach special signifi cance to these transient phenomena. For successful practice of Yoga, the following are necessary:

(i) An experienced guide/teacher, at least for initial guidance (ii) Some knowledge of the philosophies and techniques of Yoga and meditation (iii) Some level of change in one’s lifestyle that promotes the moderate behavior of the Middle Way (iv) Steady and skillful practice of Yoga and meditation not only at home or the therapist’s offi ce but also throughout one’s daily life and the careful monitor- ing of progress

Below is a description of the techniques involved in scriptural practice of Yoga in its entirety (from body to mind sequentially encompassing all steps). In general, Yoga should be practiced in a quiet and pleasant place without sensory distractions. It is quite benefi cial to apply the principles of the Middle Way to one’s lifestyle which provides the right attitude and conducive environment for meditation to blossom in one’s life. Yoga–meditation should be practiced at least twice a day routinely (longer practice, 15–30 min each time) and many times as needed (short practice targeted toward the challenging situations in one’s daily life). One important thing to realize about the posture (asana ) is that it is meant to prevent all unnecessary movements while practicing, because movement produces unrest and distraction of mind. Cessation of unwanted movements during practice can be achieved by holding the body in a straight sitting posture in a chair or on the fl oor; keeping the chest, neck, and head aligned; and keeping the lips closed (to prevent any inner chatter or any movement of tongue). Then one can begin with breath regulation ( pranayama) which is deep and slow combined with a mindful awareness. In 8.6 Practice of Yoga–Meditation: General Considerations 237 this breathing meditation, the rising and falling movements of the breathing provide the initial anchor or support for the wandering mind to become more centered. This is the scriptural tradition of Buddha in which one uses breathing and the movements associated with breathing as the primary anchoring object/prop [Pali. kasina ] for concentration. Once some level of focus is realized in one’s body and mind, one can further increase the concentration and detachment from external distractions by prac- ticing the external trataka (concentrative meditation) by fi xing the gaze fi rmly on tip of nose or on an external dot put on the wall followed by practice of internal trataka in closed eyes in which one simply tries to reproduce in one’s mind the dot or anchor- ing object. These key steps serve to withdraw the sense organs and the mind from the outside world (indrawing of senses, pratyahara ). After these preparatory steps, one can follow the steps of mindfulness meditation as described in Chap. 7 . The fi rst signs of entering Yoga are lightness of body and calmness of mind (Sivananda 1994). Below are some more elaborations of some of the key steps.

8.6.1 Integrated Posture [Sans. Asana ]

Correct posture helps in the practice of Yoga–meditation. Firmness of posture doesn’t require twisting oneself like a pretzel. When we maintain a fi rm posture, we hamper the body’s natural tendency for activity and restlessness. Firm and steady posture is able to stop the movements and inner restlessness, and thus, one is able to free the mind from (transcends) the gross, physical body. This fi rmness helps one to lose all sense of the body, to move beyond, and to allow one’s access to the realm of mind and overcoming its dualities (e.g., good and bad, heat and cold, and all opposites no longer disturb us). A comfortable sitting posture (Sans. Sukhasana ) that is non-demanding is preferable for the practice of meditation. In case of any diffi culties maintaining an easy posture, modifi ed asanas exist which mostly use some forms of props. These modifi cations allow individuals of different constitutions, those with health problems and restrictions, to enjoy the same ben- efi cial effects. The practice of any asana generally begins with physical action. Gradually cognitive, mental, and refl ective actions are integrated, converting the physical posture into an integral posture . In this sense, the dedicated and attentive practice of asana contains all eight steps of Yoga practice (Yoga in its entirety, the concept of which is very different from using postures as just physical exercises). These encompass one’s lifestyle, ethical behavior in addition to other steps includ- ing meditation. They are also cultivated through attentive asana practice. In this scheme of integral asana, the physical part is just an entry point into the whole realm of Yoga and meditation. In a correctly practiced integral asana, there is no duality between body and mind, and mind and soul: the breath is synchronized with the asana, one is absorbed into this experience ( being mode rather than doing mode), and the sense perceptions and the mind are working in a calm and harmoni- ous manner. These indrawing of senses (pratyahara ) to get established in one’s inner self, getting absorbed into one’s current experience (dharana ), and cultiva- tion of mindful awareness and detached observation in the meditation proper 238 8 Yoga in Maintenance of Psychophysical Health

( dhyana ) are, respectively, the 5th, 6th, and 7th limbs of the Eight-limbed Yoga. Thus, the integral postures (asanas ) are to be performed in this continuum with complete attention and merger with the experience rather than using them as mere physical exercises. Dhyana , as a deep contemplative practice, when integrated into the asana practice, is able to create an inner space of awareness (wisdom, vipas- sana ) in which the deep awareness rather than the impulses governs one’s actions. This frees one from the impulses to act immediately and thus prevents all the unin- tended consequences of impulsivity. This is the basis of the Mindfulness-Based Inner Space Technique (M-BIST© , see Chap. 7 ), compiled by this writer for clini- cal use in the impulse control disorders.

8.6.2 Obstacles to the Practice of Yoga–Meditation

As originally described by Patanjali (Yoga Sutras, Sivananda 1994 , p. 110–111; Satchidananda 1978 ), there are nine general conditions of mind and body that cause more projection (vikshepa ) and thus serve as obstacles to the practice. This list is not complete and there may be other obstacles including the samskaras (depth memo- ries). The nine main obstacles to practice are:

(i) Doubts: Various kinds of doubts are bound to arise, particularly in early stages of practice, and constitute the greatest obstacle for practice of Yoga– meditation. An unshakeable faith (Sanskrit: Shraddha) in the effi cacy of Yoga and its methods is a sine qua non for its successful practice. (ii) Delusions: This means taking things for what they are not. This makes the practitioner’s view distorted and prevents seeing the reality of things. (iii) Disease: Disease repeatedly draws the mind to the physical body and makes it diffi cult to keep the mind directed inward. (iv) Carelessness: Carelessness is a great danger to practice of Yoga. It relaxes the mind and undermines the concentration. It prevents eminence in any line of endeavor and condemns one to a mediocre quality of life. (v) Instability: This happens when Yoga transitions from one stage to another stage of practice during which the Yogi can get a foothold on the next stage but can’t retain it for long. This is to some extent unavoidable. It is only when the instability is due to the inherent unsteadiness of mind that vikshepa can be said to be present and special treatment is called for. (vi) Languor/fatigue: This is a big obstacle for obvious reasons. (vii) Laziness: This is different from languor. Languor can be a physical/psycho- logical defect while laziness is a habit and thus is a purely psychological condition. Curing this habit requires discipline. (viii) Non-progression: This is when the Yogi becomes stuck in a particular stage of Yoga and cannot proceed further. (ix) Worldly mindedness (unwholesomeness in Buddhism): The worldly man is so immersed in the interests pertaining to his outer life that he does not have the time to even think about the real problems of life. In this way, worldly mindedness is a serious cause of projection (vikshepa ). References 239

8.7 Concluding Remarks

The following quote has been a source of inspiration for this author in his endeavors:

Yoga is a science, and not a vague dreamy drifting or imagining. It is an applied science, a systematized collection of laws applied to bring about a defi nite end. It takes up the laws of psychology, applicable to the unfolding of the whole consciousness of man on every plane, in every world, and applies those rationally in a particular case. – Annie Besant (Introduction to Yoga , 1908 , p. 15)

Happy Practicing Yoga and Meditation!

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“Dr. Pradhan’s work is very well-researched and well- referenced. This book dispels the popular misunderstanding of Yoga as a series of poses, and emphasizes how yoga can be an important mind-body treatment for mental illnesses.” Lila Massoumi , MD , ABIHM , Chair , APA Caucus on Complementary , Alternative, & Integrative Medicine , Past Chair , Behavioral Health Department , Hurley Medical Center , Medical Director , Michigan Integrative Holistic Psychiatry

“Dr. Pradhan’s book: Yoga and Mindfulness Based Cognitive Therapy provides everything you need to know about the history, philosophy, science, and practice of Yoga, and makes it accessible to anyone. This book is an essential read for anyone who practices or wants to learn about Yoga.” Andrew B. Newberg , M.D ., Professor of Emergency Medicine and Radiology , Director of Research , Myrna Brind Center of Integrative Medicine , Thomas Jefferson University and Hospital , Philadelphia

As a book, Yoga and Mindfulness Based Cognitive Therapy serves as a much needed bridge between the fundamental basis and practice of Yoga and the contemporary evidence based practice of integrative medicine. This textbook takes the reader from the historic origins of Yoga to the interrelation of the mind and body required for wellness and healing. Dr. Pradhan characterizes the essential element of Yoga as the “cultivation of attention” and not the popularized image of complicated bodily poses. As a practicing pediatric neurologist, I recognize the signifi cant and evolving role of Yoga and mindfulness in the fi elds of mental health, neurology, and pediatrics. Michael H. Goodman , MD ; Chairman of Pediatrics , Cooper University Hospital & Cooper Medical School of Rowan University , New Jersey .

“Celebrating the burgeoning confl uence of Eastern and Western thought, Yoga and Mindfulness Based Cognitive Therapy offers a rare glimpse into the powerful impact of an ancient Indian tradition on the well-being of mankind. Firmly anchored in contemporary psychodynamic thought, cognitive neurosciences, Eastern mysticism and the quintessential American pragmatism, this book sheds light on the health promoting potential of Yogic philosophies, techniques and practices. User friendly

© Springer International Publishing Switzerland 2015 243 B. Pradhan, Yoga and Mindfulness Based Cognitive Therapy: A Clinical Guide, DOI 10.1007/978-3-319-09105-1 244 Endorsements and engaging, Pradhan’s text book opens up new vistas of thought and praxis for common mass as well clinicians at all levels of experience.” — Salman Akhtar , M.D .; Professor of Psychiatry , Thomas Jefferson University , Philadelphia .