Volume 32, Number 3 Fall, 2004

Meditation: Elevating Consciousness, Improving Health

Biofeedback FROM THE EDITOR Volume 32, No 3 From the Editor: Donald Moss, PhD 4 Fall 2004

Biofeedback is published four times per year PROFESSIONAL ISSUES and distributed by the Association for Applied Psychophysiology and Biofeedback. Circulation 1600. ISSN 1081-5937. Ethical Issues in Meditation 5 Sebastian “Seb” Striefel, PhD Editor: Donald Moss PhD Associate Editor: Theodore J. LaVaque, PhD sEMG Division Editor: Randy Neblett, MA SPECIAL TOPICS: CASE STUDIES EEG Division Editors: Lynda Kirk and Dale Walters, PhD Overview of Meditation, Consciousness, and Health Today 9 Copyright © 2004 by AAPB Sat Bir Khalsa, PhD

Editorial Statement Meditation Styles: Common Features and 13 Items for inclusion in Biofeedback should be for- warded to the AAPB office. Material must be in pub- Distinguishing Characteristics lishable form upon submission. Adam Burke, PhD Deadlines for receipt of material are as follows: ¥ November 1 for Spring issue, Demystifying Meditation 16 published March 31. Ramesh J. Bijlani, MD ¥ April 1 for Summer issue, published June 30. ¥ May 15 for Fall issue, Meditation and Limbic Processes 22 published September 30. Tobias Esch, MD, Massimo Guarna, PhD, Enrica Bianchi, PhD, ¥ September 1 for Winter issue, and George B. Stefano, PhD published December 31. Articles should be of general interest to the AAPB membership, informative and, where possi- Brain Mechanisms of Meditation 29 ble, factually based. The editor reserves the right to K. K. Deepak, MD, PhD accept or reject any material and to make editorial and copy changes as deemed necessary. Relationship between Meditation Practice and Transcendent 33 Feature articles should not exceed 2,500 words; States of Consciousness department articles, 700 words; and letters to the Frederick Travis, Ph.D editor, 250 words. Manuscripts should be submitted on disk, preferably Microsoft Word or WordPerfect, for Macintosh or Windows, together with hard copy Transformation: The Role of Reperceiving 37 of the manuscript indicating any special text for- Shauna Shapiro, PhD, and John Astin matting. Also submit a biosketch (30 words) and photo of the author. All artwork accompanying man- uscripts must be camera-ready. Graphics and pho- Mindfulness-Based Stress Reduction: 42 tos may be embedded in Word files to indicate Overview and Applications in Cancer position only. Please include the original, high-res- Linda E. Carlson, PhD olution graphic files with your submission – at least 266dpi at final print size. TIFF or EPS preferred. AAPB is not responsible for the loss or return of unsolicited articles. AAPB NEWS AND EVENTS Biofeedback accepts paid display and classified advertising from individuals and organizations pro- From the President 1A viding products and services for those concerned with the practice of applied psychophysiology and Biofeedback. Inquiries about advertising rates and From the Executive Director 2A discounts should be addressed to Denise Townsend [email protected]. From the President-Elect 3A Changes of address, notification of materials not received, inquiries about membership and other matters should be directed to the AAPB Office: About the Authors 46 Association for Applied Psychophysiology and Biofeedback 10200 West 44th Ave., No. 304 Wheat Ridge, CO 80033-2840 Tel 303-422-8436 Fax 303-422-8894 E-mail: [email protected] The articles in this issue reflect the opinions of the authors, and do not Website: http://www.aapb.org reflect the policies or official guidelines of AAPB, unless stated otherwise.

Fall 2004 Biofeedback 3 FROM THE EDITOR

Special Issue: Fall 2004 Meditation: Elevating Consciousness, Improving Health Donald Moss, PhD Donald Moss, PhD

The cover of this Fall 2004 issue of Biofeedback Magazine shows enhancing health. an ancient seal of a yogi seated in meditation, from the Mohenjo- A multi-national team led by Tobias Esch of Berlin has con- Daro region of India, ca. 2,500 B.C.Ei. Our cover introduces this tributed an article exploring the neural mechanisms affected by special issue of the Biofeedback magazine: “Meditation: Elevating meditation, especially brain structures in the limbic system. K. K. Consciousness, Improving Health.” Yogic practices, including Deepak of the All India Institute of Medical Sciences in New meditation, date back approximately 4500-5000 years, represent- Delhi examines both physiological processes and neural mecha- ing an original system of mind-body theories and practices, origi- nisms affected in meditation practice, and develops a functional nating as spiritual practices within a complex cultural and model of meditation identifying four “functional units” correspon- spiritual tradition. ding to specific brain structures. Yogic and meditation practices are gaining increasing acceptance Frederick Travis contributes an article examining the subjective with practical applications, for spiritual, fitness, and health purpos- experience of transcendence, its contents, and physiological pat- es. One of the hottest topics in health care today involves the terns corresponding to the subjective elements. He also examines effort to identify specific spiritual practices, such as meditation, the clinical benefits of transcendental experiences. Shauna Shapiro refine their efficacy, and measure their clinical benefits for psycho- and John Astin examine the currently popular psychological con- logical disorders, psychophysiological conditions, and medical struct of “mindfulness,” which has historical roots in Buddhist illness. meditation. They develop a model of mindfulness, emphasizing Our guest editor, Sat Bir S. Khalsa, PhD, brings a background specific cognitive processes, and introduce the concept of “reper- in the neurosciences, chronobiology, and the yoga lifestyle. His ceiving” which designates a specific shift in perspective. The final current research focus is on the health effects of yoga and medita- article in this special series, by Linda Carlson, examines mindful- tion. Dr. Khalsa’s introductory article reviews both the historical ness-based stress reduction, a specific clinical model for interven- roots of yoga and meditation, and their current applications to tion, based on the mindfulness approach. health care. In addition, Dr. Khalsa has recruited articles which We are grateful to Sat Bir Khalsa and the authors contributing apply the perspectives of psychophysiology and neurophysiology to to this special issue, for the time and energy dedicated to this time- explore the brains and bodies of the meditators. Our guest authors ly topic. examine some of the following questions: What neural and physio- AAPB News and Events Section logical mechanisms are affected by meditative practice? What are some of the measurable health effects of meditation? How can we AAPB President Steve Baskin, President-Elect Richard Sherman, understand the often wondrous experiences of meditators both and Executive Director Francine Butler offer their current perspec- psychologically and neurophysiologically? tives on events shaping professional research and practice today. In addition, we include a preliminary overview of AAPB’s 36th Articles in the Special Issue annual meeting in Austin, Texas, April 1-3, 2005. Sebastian Striefel provides an article on the ethical issues inher- Proposals and Abstracts are now invited for future special issues ent in the clinical application of meditation and spiritual practices. of Biofeedback: Hypnosis and Biofeedback for Spring 2005, Pediatric Adam Burke provides a simple overview of the various forms of Applications of Hypnosis for Summer 2005, Teaching Children and meditation, highlighting both their common elements and areas in Youth to Self-Regulate for Fall 2005, and Integrating Life Style which they diverge. Ramesh Bijlani of the All India Institute of Change into Applied Psychophysiological Therapies for Spring 2006. Medical Sciences in New Delhi provides an introduction to one The editor also welcomes proposals for future special issues of the well-known yogic approach, the Raja yoga of Patanjali, and Biofeedback Magazine. explores the experiential “peak” state called Samadhi, which most Hindu meditation approaches seek. He also examines the practical iThis yogic seal is copyrighted, and utilized with the permission of J.M. Kenoyer, courtesy of the Department of Archaeology and Museums, Govt. of application of meditation in coping with life problems and Pakistan.

4 Biofeedback Fall 2004 PROFESSIONAL ISSUES

Ethical Issues in Meditation Sebastian “Seb” Striefel, PhD, Logan, Utah

Abstract: Meditation has been used for in the practice (Spence, 2004). When medi- listens. When I meditate, God talks and I thousands of years for achieving many differ- tation is used in Western Cultures for clini- listen.” (Spence, 2004, p. 2). Such informa- ent goals. For any contemplative/relaxation cal purposes, it is generally devoid of tion when used during the informed con- procedure to survive that long there must be religious connections. sent process would also help the some positive outcomes achieved or it would Contextual Issues practitioner establish good rapport with a have disappeared because of non use. client. Whereas, proposing a non-religious Meditation was traditionally used as part of It is important for applied psychophysiol- form of meditation without discussing why various religions, but can be used clinically ogy and biofeedback practitioners to recog- that form of meditation is being proposed, without religious connotations. Meditation nize that every form of meditation has an and without also discussing why the form can be used ethically in treatment if a reason- origin and a context that influence the pur- of meditation commonly practiced in the able rationale exists, provided the appropriate pose for which it is practiced, when it is client’s religion is not appropriate, could be informed consent is obtained. Meditation is used, what is done, why, and by whom. A detrimental to both rapport and motiva- one way of reflecting on one’s own values and competent clinician will be familiar with tion. A client could well believe that the gaining a better perspective about ethical and consider such contextual factors in practitioner really does not understand him behavior and discipline. It can also be useful deciding whether to use meditation, and or her or his or her religion and that could in treating a wide variety of problems. A what form of meditation might be appro- also lead to doubt about a practitioner’s number of considerations for ethically using priate for helping a specific client achieve competence. meditation clinically are discussed. his or her treatment goals. For example, someone who practices a specific religion in Sophisticated Knowledge Introduction which a specific form of meditation is prac- and Competence Meditation is a term used to label reli- ticed might find that form of meditation There is a difference between having gious study in numerous Eastern Religions. more comfortable and desirable than an basic knowledge and/or competence about a It serves a purpose analogous to prayer and unfamiliar form of meditation that has no form of treatment (e.g., meditation) and devotion in the Judeo-Christian system religious context. Practitioners, of course, having sophisticated knowledge and/or (Lichstein, 1988). Meditation in one form must ensure that the specific form of medi- competence about the same form of treat- or another has been practiced for thousands tation is appropriate for helping the client ment. With continuing education in the of years and has survived because its propo- achieve his or her treatment goals. The less form of classes and workshops, self-study, nents have found it useful for helping to published support that exists in supporting clinical practice, supervision, and consulta- achieve a variety of different goals. The ori- the use of a particular form of meditation tion, practitioners knowledge and compe- gin of most forms of meditation was within with a client the more important it is to be tence move from a basic level to a more a religion. Meditation is a component of all thorough in obtaining and documenting sophisticated level of knowledge and compe- religions, but many religions do not use the the informed consent process. The combin- tence. When a practitioner has a sophisti- word meditation (Spence, 2004). Words ing of religion and meditation could well cated level of knowledge and/or like prayer or contemplation are often used help motivate the client to practice medita- competence, she or he is more likely to be in place of the word meditation. For exam- tion regularly. Lehrer and Carrington effective in dealing with daily life (Dalai ple, one form of prayer for Catholics is the (2003) pointed out that whether a client Lama and Cutler, 1998), or for example, in rosary. The rosary is a form of meditation likes practicing a specific relaxation or med- dealing with practice issues like ethical in which specific prayers are repeated much itation approach is important because she dilemmas, client motivation, the risks and like the use of a mantra in other forms of or he is unlikely to practice an approach benefits of different forms of meditation or meditation. Theresa of Avila’s that she or he does not like. relaxation, etc. Before considering using any Contemplative Meditation was strongly Chinmoy, a Hindu spiritual, teacher said form of meditation for helping clients it is tied to religion, but meditation can be that the difference between meditation and important for the practitioner to be compe- practiced without any religious elements prayer is that “when I pray, I talk and God tent in the use of that form of meditation.

Fall 2004 Biofeedback 5 Increasing Competence number of factors. Cognitive behavior therapy seems to target After conducting the appropriate intake, the content of thoughts. Mantras and auto- Via Meditation history, and assessments to correctly identify genic statements seem to block verbal Meditation may well be an effective and diagnose the client’s problem(s), it is thought. The critical factor for a practition- method for a practitioner to become more important to work cooperatively with the er in all this is having a rationale for select- competent both as a practitioner in general client in developing appropriate treatment ing a specific form of relaxation training for and as a practitioner who has acquired a goals and objectives (outcomes). Why is helping a client, e.g., selecting a form of higher level of self and ethical control. meditation being considered? Is it a treatment meditation rather than one of the other Meditation can be defined as a way of tak- of choice? Does the research literature support forms of relaxation training. ing control of the mind so that it becomes its use in helping this client? B. A practitioner should also be able to more peaceful and focused and the medita- Meditation is generally used to achieve inform the client about the risks and bene- tor becomes more aware (Spence, 2004). one or more of three primary goals fits of the proposed intervention approach Chinmoy said that effective meditation is (Lichstein, 1998): a) contemplation and (e.g., meditation) and those for other major, listening attentively in silence. When such a wisdom, b) an altered state of conscious- appropriate treatment approaches during state of silence is achieved, not only is the ness, and c) relaxation. In clinical treatment the informed consent process. So the risks body calm and tranquil, but the mind is settings in Western Culture, relaxation is and benefits of a specific form of medita- also quiet and free from external stimuli most likely to be the treatment considera- tion versus those for progressive muscle and thought. In such a state a practitioner tion. relaxation, autogenic training, and/or can just be, and can without effort contem- If relaxation training for stress reduction, biofeedback might need to be explained. plate and reflect on various virtues and their pain control, or other purposes seems The client should also be informed about meaning, e.g., compassion, kindness, or appropriate, a practitioner must select an any religious connotations of the treatment ethically right and wrong behaviors. Since appropriate relaxation approach. Various approaches discussed. If one is using medi- our beliefs, values, and attitudes influence forms of biofeedback, relaxation approaches tation for treatment of a clinical problem, our thoughts and our thoughts influence (e.g., progressive relaxation, autogenic train- the content of the informed consent process our behavior it seems important to learn to ing), and meditation can all be used to would be somewhat different than if one discipline and control our mind. By con- achieve a relaxed state. A practitioner must were teaching meditation to a community trolling our thoughts we have a higher thus have a rationale for selecting a particu- group (non-patients) as a general form of probability of engaging in ethically appro- lar relaxation approach. relaxation or stress control. The overlap in priate behavior. The Dalai Lama believes A. One such factor is: What does the pub- producing similar outcomes using different that bringing about discipline within one’s lished literature support as being effective and relaxation approaches is striking for those mind is a feature of ethical behavior that efficient, or even as the treatment of choice for who master an approach (Lehrer and can lead to greater happiness (Dalai Lama treating the client’s current problem(s)? For Carrington, 2003). What published research and Cutler, 1998). The more sophisticated example, EMG and skin temperature support exists for different meditation and a practitioner’s level of education and biofeedback or progressive muscle relaxation other relaxation approaches for treating the knowledge about what leads to appropriate might well be appropriate for certain types problems of the clients you see? Have I provid- ethical behavior, the more effective he or of headaches, whereas autogenic training ed accurate and complete information to the she should be at engaging in ethical behav- might be most appropriate for treating cer- client and obtained a valid informed consent? ior. Contemplative meditation is believed to tain kinds of autonomic nervous system Did I carefully document the process and con- help individuals learn to take control of his problems. Lehrer and Carrington (2003) tent of the informed consent? This is espe- or her thoughts. Thich Nhat Hahn (2000) said that mantra meditations seem to have cially important for interventions that lack combines meditation and ethics as a means the most effect on cognitive functions. My published support. of transforming the mind. He believes that own experience is that autogenic training is C. Am I competent to use the proposed when the mind is quiet one can gain very effective in producing cognitive effects. intervention? Do I need supervision or con- insights that lead to inner transformations. As clients learn that their mind (repeating sultation? Should I refer this client elsewhere? Carrington (1998) has pointed out that autogenic statements) can produce physio- In deciding which form of meditation to meditation seems to target the act of think- logical changes (e.g., warm hands), they use a practitioner would generally use clini- ing rather than the content. Learning to readily believe that they can change both cally oriented forms of meditation such as think differently about things could have their way of thinking and the content of Benson’s Relaxation Response, Carrington’s many positive outcomes. their thoughts. Autogenics seems to be a Standardized Meditation (a modified form Selecting a Treatment natural entry for conducting cognitive of transcendental meditation) (Schwartz Approach behavior therapy. Meditation seems to tar- and Olson, 2003), or the Mindfulness- get the act of thinking about something Meditation approach pioneered by Jon In selecting a treatment approach (e.g., a rather than the content of thoughts Kabat-Zinn (Baer, 2003; Kabat-Zinn, et al, form of meditation) for use with a specific (Carrington, 1993), but it can impact both. 1992; Teasdale, et al, 2000), versus other client it is ethically important to consider a

6 Biofeedback Fall 2004 forms of meditation which have not been References Nhat Hahn, T. (2000). The mind of transforma- tion: Combining ethics and meditation. Gardena, standardized (Lehrer and Carrington, Baer, R. A. (2003). Mindfulness as a clinical CA: Parallex Press. 2003). However, McGrady (2003) pointed intervention: A conceptual and empirical review. Schwartz, M. S., and Olson, R. P. (2003). A his- out that physicians should question clients Clinical Psychology: Science and Practice, 10, 125- 143. torical perspective on the field of biofeedback and about spiritual factors as they relate to treat- applied psychophysiology. In M. S. Schwartz and F. Carrington, P. (1993). The clinical use of medi- Andrasik (Eds.), Biofeedback: A practitioner’s hand- ment and Striefel (2001) pointed out the tation. In P. M. Lehrer and R. L. Woolfolk (Eds.), book (3rd ed., pp. 3-19). New York, NY: Guilford ethical importance of considering spirituali- Principles and practices of stress management (2nd Press. ed., pp. 139-168). New York, NY: Guilford Press. ty and religion in all health care services. Spence, A. (May 24, 2004). Reflections on medi- Dalai Lama and Cutler, H. C. (1998). The art of Since spirituality has again become an tation. www.bbc.co.uk/religion. happiness. New York, NY: Riverhead Books. important part of health care services it may Striefel, S. (2001). Ethical issues when spirituali- Kabat-Zinn, J., Massion, A. O., Kristeller, J., ty or religion and health care meet. Biofeedback, well be important to consider non-clinically Peterson, L. G., Fletcher, K. E., Pbert, L., 23(3), 8-10. standardized forms of meditation for some Lenderking, W. R., and Santorelli, S. F. (1992). limited number of clients who are much Effectiveness of a meditation-based stress reduction Teasdale, J. D., Williams, J. M., Soulsby, J. M., Segal, Z. V., Ridgeway, V. A., and Lau, M. A. more receptive to practicing a tradition that program in the treatment of anxiety disorders. The American Journal of Psychiatry, 149 (7), 936-943. (2000). Prevention of relapse/recurrence in major they are familiar with, provided of course, depression by mindfulness-based cognitive therapy. Lehrer, P., and Carrington, P. (2003). Progressive Journal of Consulting and Clinical Psychology, 68, that there is a rationale for using such an relaxation, autogenic training, and meditation. In 615-623. approach for treating the client’s specific D. Moss, A. McGrady, T. C. Davies, and I. problem. Wickramasekera (Eds.), Handbook of mind-body medicine in primary care (pp. 139-149). Thousand Oaks, CA: Sage Publications. Lichstein, K. L. (1988). Clinical relaxation strate- gies. New York, NY: John Wiley and Sons.

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Meditation: Elevating Consciousness, Improving Health Sat Bir S. Khalsa, PhD

“Who is that in you that controls the mind? spontaneously for some in moments during the cross-legged lotus yoga/meditation pos- It is called the will of the being. It is also part the course of ordinary events when one is ture, with the heels inverted into the per- of the mind. Mind is like an onion. It has so completely absorbed in something for an ineum, a well-known yoga meditation many layers. If you peel the onion, you will all-to-brief, fleeting moment - a so-called technique. Other artifacts from this civiliza- find nothing.” peak experience. tion show sculptures and figurines which The practice of meditation has been have been interpreted to depict the medita- “What is meditation? When you empty yourself and let the universe come in you.” shown to have discreet psychological and tive practice of focusing the gaze upon the (Yogi Bhajan, 1977, pp. 92, 175) physiological effects. Benson has coined the tip of the nose, the distention of the term “relaxation response”, which refers to abdomen characteristic of the full yogic Abstract: Meditation is an ancient but sim- the coordinated psychophysiological abdominal breathing technique (Rowland, ple cognitive technique that historically pre- response that is generated by meditation 1953), and the adoption of postures sugges- dates modern religions. The practice of and a variety of other similar mind-body tive of hatha yoga techniques (www.harrap- meditation is associated with discrete changes practices (Wallace, Benson, and Wilson, pa.com). in both psychophysiology and state of con- 1971; Benson, Beary, and Carol, 1974). The earliest clear textual description of sciousness. This has lead to its use as both a The relaxation response is associated with meditative practice, and the associated spiritual technique in many religious tradi- an elevation of mood and well-being, a transformation in consciousness associated tions as well as a therapeutic intervention. decrease in cognitive and emotional arousal with it, appears in ancient Indian texts Widespread adoption of meditation may ulti- and a reduction of physiological arousal in which predate the advent of modern reli- mately contribute significantly to improvement both the autonomic nervous system and the gions. In the Upanishads we find: As a fire without fuel becomes quiet in its in the quality of life in Western society. hypothalamic pituitary axis (Benson, 1983). place, thus do the thoughts, when all activi- Meditation is most simply defined as the Such psychophysiological changes are also consistent with the use of meditation as a ty ceases, become quiet in their sustained control of mental attention in a place…When a man, having freed his mind relaxed and passive manner. The focus of spiritual practice to generate transformative, transcendent and unitive states of con- from sloth, distraction, and vacillation, attention may be on a single target such as becomes as it were delivered from his mind, sciousness described so eloquently by saints the breath, a mantra or a visual point as in that is the highest point…That happiness the case of so-called “concentrative” medita- and holy men and which underlie the which belongs to a mind which by deep tion, or it may be on the flow of sensation philosophical discipline of mysticism. meditation has been washed clean from all or thought in the present moment as in the The first known archaeological evidence impurity and has entered within the Self, case of mindfulness meditation. In either of the practice of meditation dates back to cannot be described here by words; it can be case, meditation is the antithesis of the typi- the Indus Valley civilization which ended felt by the inward power only…Mind alone is the cause of bondage and liberty for men; cal ceaseless mental stream of ruminative no later than 1,500 B.C.E., and flourished for millennia before that time, in what is if attached to the world, it becomes bound; thought. In this broad definition, medita- if free from the world, that is liberty. tion can also apply to any behavior in now Pakistan. Artifacts from the ancient cities of Harappa and Mohenjo Daro reveal (Maitrayana Brahmana Upanishad, transla- which the mind is so absorbed into/with tion by Muller, 1884, pp. 332-334) something, that only the pure experience of images of postures synonymous with the practice of yoga and meditation (see In another passage, a direct analogy with the present moment exists. This state can be the control of mental attention in medita- manifested in a deliberate and prescribed www.harappa.com). The most famous of these, depicted on the cover of this issue, is tion is made to the act of steering a horse- manner such as the formal practice of medi- driven chariot in which the horses are the tation and yoga. However, it can also come a seal depicting a human figure seated in

Fall 2004 Biofeedback 9 thoughts/senses, the body is the chariot, Mahesh Yogi inspired practice, teaching and practiced in homes, schools and workplaces. and the rider is the intellect controlling the research of the Transcendental Meditation , Such a widespread application of medita- horses through the reins which represent technique, and more recently the Dalai tion practice may function as a simple but the mind. Lama has done the same for Buddhist effective preventive medicine that could He who is without discrimination and Vipassana or mindfulness meditation, and substantially reduce the incidence of stress- both groups have promoted meditation whose mind is always uncontrolled, his sens- related disorders and psychopathology and research (www.tm.org/research/home.html) es are unmanageable, like the vicious horses improve our overall quality of life. of a driver. But he who is full of discrimina- (Barinaga, 2003). Currently, both yoga and tion and whose mind is always controlled, meditation practices have become very pop- References his senses are manageable, like the good ular amongst the general public both for Baer, R. A. (2003). Mindfulness training as a horses of a driver. He who does not possess wellness and as therapeutic interventions clinical intervention: A conceptual and empirical discrimination, whose mind is uncontrolled (Saper, Eisenberg, Davis, Culpepper, and review. Clinical Psychology: Science and Practice, 10, 125-143. and always impure, he does not reach that Phillips, 2004; Barnes, Powell-Griner, Barinaga, M. (2003). Buddhism and neuro- goal, but falls again into Samsara (realm of McFann, and Nahin, 2004). They have also become the focus of strong media attention, science. Studying the well-trained mind. Science, birth and death). But he who possesses right 302, 44-46. discrimination, whose mind is under control including cover stories in Time magazine on the science of yoga (4/23/01), meditation Barnes, P. M., Powell-Griner, E., McFann, K., and always pure, he reaches that goal, from and Nahin, R. L. (2004). Complementary and alter- which he is not born again. The man who (8/4/03) and the mind-body connection native medicine use among adults: United States, has a discriminative intellect for the driver, (1/20/03). 2002 (Rep. No. 343). Hyattsville, Maryland: and a controlled mind for the reins, reaches Although historically a spiritual practice, National Center for Health Statistics. the end of the journey, the highest place of the physiological effects of meditation are Barnes, V. A., Bauza, L. B., and Treiber, F. A. Vishnu (the All–pervading and ideally suited as a countermeasure for stress- (2003). Impact of stress reduction on negative school behavior in adolescents. Health Qual Life Unchangeable One). (Katha Upanishad induced arousal and for stress-related physi- Outcomes, 1, 10-16. translation by Paramananda, 2002) cal and psychological disorders. Not Benson, H., Beary, J. F., and Carol, M. P. In ancient Tantric texts, which may well surprisingly, over the past three decades (1974). The relaxation response. Psychiatry, 37, 37- predate the Vedas and Upanishads, there are meditation has been widely utilized as a 46. similar and very deliberate prescriptions for, therapeutic intervention, and a significant Benson, H., Kornhaber, A., Kornhaber, C., and descriptions of, meditation and the body of research has validated its clinical LeChanu, M. N., Zuttermeister, P. C., Myers, P. et al. (1994). Increases in positive psychological char- resulting transformation in consciousness. effectiveness in a wide variety of conditions acteristics with a new relaxation-response curricu- One can be aware of [divine consciousness] (Baer, 2003; Proulx, 2003; Perez-de-Albeniz lum in high school students. Journal of Research and only when one is completely free of all and Holmes, 2000; Murphy and Donovan, Development in Education, 27, 226-231. thought-constructs. 1999; Jacobs, 2001). Benson, H., Wilcher, M., Greenberg, B., [The highest state of divine consciousness] is Huggins, E., Ennis, M., Zuttermeister, P. et al. It is remarkable that despite the enor- free of all notions pertaining to direction, (2000). Academic performance among middle- time, ... space or designation. In verity that mous advances in the physical sciences and school students after exposure to a relaxation response curriculum. Journal of Research and can neither be indicated nor described in technology in the West, a rudimentary cog- Development in Education, 33, 156-165. words. nitive technique with such apparent benefits should have taken so many centuries to Benson, H. (1983). The relaxation response: Its The aspirant should neither maintain the subjective and objective historical precedents and attitude of aversion nor of attachment have been noticed and adopted. Aside from physiology. Trends in Neurosciences, 6, 281-284. towards any one. Since he is freed of both its therapeutic benefits, perhaps the most Bhajan, Yogi (1977). In Harbhajan Singh Khalsa, aversion and attachment, there develops ... valuable contribution to Western society Yogiji, The teachings of Yogi Bhajan. New York: the nature of the divine consciousness will be the incorporation of basic medita- Hawthorn Books. (which is also the nature of the essential Self) tion as a commonplace lifestyle practice. Carrington, P., Collings, G. H., Jr., Benson, H., Robinson, H., Wood, L. W., Lehrer, P. M. et al. in his heart. (Vijnana-bhairava Tantra, trans- The ubiquitous practice of dental hygiene lation by Singh, 1991, pp. 14, 113) (1980). The use of meditation—relaxation tech- (i.e. the toothbrush, dental floss) has The early practices of meditation have been niques for the management of stress in a working population. J. Occup.Med, 22, 221-231. most purely maintained throughout history become a fact of ordinary life, whose adop- Davidson, R. J., Kabat-Zinn, J., Schumacher, J., in the practice of yoga, but they have also tion as a daily practice has reduced the inci- dence of dental and oral disease in our Rosenkranz, M., Muller, D., Santorelli, S. F. et al. become embedded practices in oriental reli- (2003). Alterations in brain and immune function gious disciplines such as Buddhist and society. Since meditation research has produced by mindfulness meditation. Psychosomatic Hindu meditation practices. Meditation already shown measurable health effects in Medicine, 65, 564-570. practices do not appear in the Western school and workplace settings (Benson et Deckro, G. R., Ballinger, K. M., Hoyt, M., Judeo-Christian traditions to the same al., 1994; Benson et al., 2000; Deckro et Wilcher, M., Dusek, J., Myers, P. et al. (2002). The degree, and it has only been over the past al., 2002; Barnes, Bauza, and Treiber, 2003; evaluation of a mind/body intervention to reduce half-century that a significant influence of psychological distress and perceived stress in college Carrington et al., 1980; Peters, Benson, and students. Journal of American College Health, 50, meditation practice has appeared in the Porter, 1977; Davidson et al., 2003), it is 281-287. West, especially in the late 1960’s with the easily conceivable that meditation may also arrival of a number of yoga and meditation teachers from the East. Notably, Maharishi become a regular daily “mental hygiene” Continued on page 45

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Meditation Styles: Common Features and Distinguishing Characteristics Adam Burke, PhD, MPH, LAc, San Francisco, CA

Abstract: Meditation is a time honored started arriving on American shores. The have been numerous forms of practice over process used in the pursuit of healing and self- Theosophical Society, founded in 1875 in the centuries, often quite philosophically transformation. During the past several New York City, endorsed many Eastern and ritualistically different from each other. decades the practice of meditation has been ideas as central to world transformation. These include the schools of Tendai, growing in popularity in the US. As a result Swami Vivekananda addressed the 1893 Shingon, Jodo, Nichiren, Rinzai Zen and we find a plethora of methods that may con- World Parliament of Religions in Chicago Soto Zen. Despite the real differences fuse the novice seeking to begin a practice. discussing the benefits of meditation and between these schools, there may also be Fortunately, despite the apparent differences Eastern thought to an exuberant audience. similarities in the sitting posture, the use of one observes on the surface there are actually Transcendentalist authors, such as Emerson an object of meditation and proper attitude, quite a few commonalities to the diverse body and Thoreau, incorporated Eastern concepts and the engagement in regular practice. The of methods. This article presents some of those of life into their writings. This interest in same can be said for all systems of medita- common themes (including thoughts on pos- meditation and yoga continued unabated, tion practice: Differences exist as do many ture, object of focus, attitude and breath), and and has experienced dramatic growth dur- commonalities in the core elements of prac- highlights a key distinction between major ing the last 50 years. As a result, a signifi- tice. That being the case the best style for schools, the quality of attention. cant body of scientific literature has been an individual is often ultimately a matter of generated on the topic. A search of biomed- availability or of personal preference among No sky ical literature produces over 1,000 studies forms. Regarding the elements common to No earth – yet still with the keyword ‘meditation’. A great deal practice and some important distinguishing The snowflakes fall of this research has focused on characteristics, they include the following: — Haiku poem by Kajiwara Hashin Transcendental Meditation in the 1970’s, The Method followed later by the Relaxation Response, A Brief History and more recently by studies of Meditation, as a tool of a specific school of thought, such as Zen Buddhist medita- Meditation is a self-regulatory, mind- Mindfulness Meditation. Much of this tion, takes a specific form, the unique medi- body process used to narrow attention and work has repeatedly substantiated the bene- tation method employed by that school. In to produce a state of inner quiescence. It is fits of meditation for physical and mental general one can speak of two major meth- ideally practiced daily over an extended health and well-being. ods of meditation practice—dynamic and period of time, with the goal of stabilizing As a consequence of our interest in sitting. Dynamic forms involve some type and maintaining these changes. The intend- Eastern spirituality and related practices, we of movement characteristic of the practice, ed benefits of the practice include improved now find many forms of meditation avail- such as the Indonesian practice of Latihan, physical and mental health, greater tran- able in the US to choose from. Although or the Chaotic Meditation of Rajneesh, or quility, deeper insight into the nature of this diversity is advantageous on one level it Kinhin (Zen walking meditation). The sec- existence, and transcendence or spiritual also presents the consumer or the advising ond, and more characteristic form of medi- liberation. Meditation as a self-transforma- professional with a potential dilemma. tation, is the sitting practice. tive process has been used for millennia, as What is the best form for any one person to evidenced by extensive treatises on the sub- follow? Fortunately, although there are Posture ject found in India, China, Tibet and other many forms we do find within this diversity Sitting meditation generally involves an major cultural centers. In the US popular- a good deal of similarity in essential aspects upright symmetrical posture. The spine is ization began around the beginning of the of practice. In Japan, for example, within erect, head facing forward, eyes closed or 20th century when ideas from the East the Buddhist meditation tradition, there partially closed looking down slightly. The

Fall 2004 Biofeedback 13 hands rest on the lap or legs. They may be held in a specific pos- schools, to cultivate a deepening of focus and greater opportunity ture, known as a mudra, in order to facilitate retention of focus or for stabilization of behavioral and psychophysiological changes. as a way to move energy in a beneficial fashion. The specific sitting Focus of Attention postures help to reduce sensory input, and to promote stillness and alertness, or relaxation with attention. One of the final aspects of meditation, and a major distinguish- ing characteristic between forms, is the issue of focus of attention. Object of Focus Meditation involves focusing the attention for the purpose of quiet- Typically in meditation there is some object of meditation, some- ing the mind and body. There are two major schools of thought thing to focus one’s attention on. This is important as meditation regarding this question of where to focus. They can be described as involves narrowing the field of attention as a means to reduce senso- Closed Focus and Open Focus. The Closed Focus style is some- ry input and extraneous thought. The object can include things such times referred to as concentration meditation. It is more common in as the breath, a mantra (specific sound repeated mentally, like OM), Yogic meditation practices. In this style the attention is focused on an internal visual image, or the position of the hands or body. a single object of meditation, such as an internally generated Proper Attitude mantra or visual image, to the exclusion of all other input. Transcendental Meditation would be more in keeping with this Schools of meditation typically encourage a non-critical attitude type of practice. The ultimate goal of this form of meditation is to in practice. They advise the practitioner to effortlessly return to the become so deeply focused on the object that one’s consciousness object of meditation once the loss of focus is recognized. This fos- merges with the object thereby eliminating awareness of space, time ters the habit of direct return to the object, rather than a delayed and self. The practitioner in this case is said to have entered a state return resulting from self-critical analysis of one’s practice. Such of Samadhi, a state of deep absorption, a state of oneness with a self-criticism could also be psychophysiologically arousing. A sec- universal essence. ond key is effortless striving. One holds the intention to meditate, By contrast, the Open Focus style is a form in which the practi- but does not strive effortfully for success. Finally, a commitment to tioner seeks to maintain a continual conscious awareness of chang- do the practice consistently and as effectively as possible, to be the ing phenomena, not being fixated on any one thing, but seeking to best meditator one can be, is useful. This is all to be done with an maintain an awareness of one’s endlessly changing experience. This egolessness, which is often accomplished through the process of is often referred to as insight or mindfulness meditation, and is more offering the practice of meditation as a gift for the greater good. common in Buddhist forms. The objective of this path is to Proper Environment become silently present in the midst of ever changing reality, with It is advised that the meditation be done in a suitable environ- no attachment to experience. In this latter form one does not seek ment. The ideal environment is free of distractions, quiet, and to transcend momentary awareness, but to remain continually and healthy. Historically in India, China and Tibet practitioners would quietly vigilant in the moment. An example of this would be the often spend time in caves—dark, quiet and isolated—to do their Zen practice of Shikantaza ‘just sitting’. practices. Although these two schools of thought use fundamentally differ- ent attentional styles – fixed and open – they both seek to move the Breath practitioner to a state where the true nature of existence can be more Some practices work with breath directly, either as a vehicle for fully apprehended, where attachment and suffering can be tran- passive observation, or through self-regulation of the breathing cycle. scended. They both seek to cultivate within the practitioner a deep- Otherwise breath is to be natural, typically through the nostrils. ening and sustained experience of equanimity, health and happiness. Time and Length of Practice Conclusion Practice is ideally done on a daily basis, at a consistent time, for There is considerable unity within the diversity of meditation 20 minutes or more. Some schools advise 1-2 hours per seated forms, at least to a degree. The wing of a bird, the fin of a whale, practice. Occasional extended retreats are also encouraged in some and the hand of a human look quite different on the surface, yet underneath there is a dramatic similarity in skeletal form. It is not surprising that meditation, an expression of our human nature, dis- plays some of this same surface difference and deep similarity. Even such fundamentally distinct aspects of meditation as difference in attentional focus share a similarity in the intended benefits and out- comes of practice. Ultimately, when considering a meditation prac- tice it is important to recognize that many paths lead to the same mountain. In the end it is not so much the path we choose, but what we do along the way.

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Demystifying Meditation Ramesh L. Bijlani, MD, New Delhi, India

Abstract: Meditative techniques possibly mon, and what is still more interesting, the first two limbs are preparatory steps of evolved in the course of resolving basic existen- product of meditation is remarkably inde- moral purification, which underscore the tial questions. While the validity of the uni- pendent of the technique used. The product point that meditation is not a technique to versal consciousness or the Spirit discovered by of meditation is an experience which be practiced in isolation: it should be part the mystics may be controversial, the peace and belongs to a plane of consciousness quite of an overall process of self-improvement. tranquility generated by meditation have been different from the ordinary. The experience The technique of meditation begins with exploited by modern medicine to alleviate mis- has two main components. First, the clear the third limb, which is asana (physical pos- ery. This article also touches on the apparent boundary which ordinarily separates an ture). The asana is meant to put the body similarities and significant differences between individual from the rest of the universe gets in a steady and comfortable position. This meditative experiences and hallucinations gen- blurred. The second component of the step reduces the proprioceptive input to the erated by sensorimotor deprivation or psyche- experience is the glimpse of a reality which minimum. Further, during the asana the delic drugs. seems immutable, imperishable, ineffable, eyes are generally closed, which eliminates Meditative techniques possibly evolved in universal and all-pervasive. In short, it has visual inputs. The body is also generally the course of resolving some fundamental the characteristics of the Absolute Reality, kept motionless so that motor output is at questions such as “Who am I?”, “What is in contrast with the ever-changing, its minimum. the purpose of life?”, and “Is there an ephemeral and fragile character of the The next step in meditation is pranayama Absolute Reality?” These extremely difficult superficial reality which we experience with (control of the life force). The most visible questions have engaged mankind since the help of our sense organs while living in manifestation of the life force is breathing. times immemorial but we still have no ordinary consciousness. One reason why we Therefore, during pranayama the person definitive answers. Further, these questions are not ordinarily aware of the Absolute takes slow, regular and deep breaths, and are not amenable to scientific exploration Reality is possibly that it is masked by the observes closely the process of breathing. the way physical phenomena are. There are ordinary reality. Thus the principle of most broadly two methods appropriate for meditative techniques is to create condi- Eight Limbs of Raja Yoga addressing such questions: introspective tions in which sensory inputs are mini- reflection and rational analysis. One who mized and ordinary activities of the mind 1. Yama (Restraints) a. Non-violence chooses the method of introspective reflec- are suspended. To use an analogy, as the b. Truth tion would have a natural tendency to seek turbulence on the surface of the ocean set- c. Non-stealing a quiet corner where he/she can seek his/her tles down, one can get a better view of the d. Continence answers in silence. If the exercise is repeated depths. e. Non-hoarding often enough, one is likely to discover some The Technique 2. Niyama (Do’s) finer points which make the process more a. Cleanliness One of the oldest techniques of medita- efficient in exploring the deeper recesses of b. Contentment the mind. Thus the process of sitting silent- tion is based on the eight limbs of Raja c. Austerity ly would itself become more and more elab- yoga as enunciated by Patanjali d. Study orate till it acquires a ritualistic character. (Vivekananda, 1995). Raja yoga (literally, e. Surrender to God Since several sages have carried out this the royal path of yoga) is the school of yoga 3. Asana (Physical postures) 4. Pranayama (Breath control) exercise independently over millennia in that emphasizes mental perfection. It aims at achieving absence of the ordinary activi- 5. Pratyahara (Sensory withdrawal) different parts of the world, the details of 6. Dharana (Concentration) the technique they have arrived at differ ties of the mind. The ordinary activities have to be suspended in order to enable 7. Dhyana (Meditation) (Anon., 2001). However all meditative 8. Samadhi (Superconsciousness) techniques have some basic features in com- higher planes of consciousness to work. The

16 Biofeedback Fall 2004 Thus breathing, which we are normally concentration during dharana is synchro- recitation has a catalytic effect on the effi- quite unaware of, becomes a conscious nized with the breath so that the two form ciency with which peace is achieved. And, process. Sitting comfortably in a quiet place one unit. A common practice is to concen- the peaceful feeling is highly favorable for with the eyes closed and breathing slowly, trate on a humming sound, which is recited the consciousness to shift to a higher plane. deeply and consciously is in itself quite silently during each expiration. Although After dharana, the next step is dhyana, or enough to relax the mind considerably. The Patanjali did not specify what to concen- meditation proper. Dhyana consists of con- normally chaotic thought process of the trate on, the sound selected for recitation is templation on the theme of concentration. mind is suspended, and at least for a few commonly a meaningful sound (i.e. not a Contemplation is a natural sequel to con- breaths the person may be aware of only the neutral sound), symbolizing something centration. Frequent sessions of repetition process of breathing. In fact, some tech- sacred to the individual. However, in the of the same thing would naturally generate niques of meditation consist primarily of transcendental meditation (TM) technique, some thoughts about it. Thoughts related to disciplined breathing. But the mind, by its the meaning of the mantra is not disclosed the subject of dharana (concentration) con- very nature, is so restless that it soon breaks in the beginning. It is believed that till the stitute dhyana (meditation). These thoughts through the restful state achieved by con- process of meditation has been rightly further strengthen the bond between the sciously regulated breathing. If one can established, the meaning might distract the seeker and his sacred support. That, in turn, keep all thoughts (other than awareness of mind (Mahesh Yogi, 1967). Dharana has a makes the peace deeper and more durable breathing) suspended for even twenty two-fold implication in the process of medi- because now the seeker starts perceiving breaths at a stretch, it is a remarkable tation. First, as mentioned earlier, it is diffi- that the tremendous power of Divine grace achievement. cult for the mind to stay devoid of thoughts has been added to his feeble efforts. The It is possibly for this reason that in for any length of time. However, if the process of meditation ends with dhyana. Patanjali’s scheme, meditation has three mind is made busy with an activity such as The eighth and last limb of Patanjali’s yoga, more steps. The next step after pranayama is repetition of a word, the possibility of samadhi, is the product of meditation. pratyahara, which means sensory withdraw- avoiding other thoughts improves. If the Samadhi is the peak experience during al. After the visual and proprioceptive mind gets a job to do, it does not drift as which the seeker is immersed in a transcen- inputs have been taken care of, the princi- readily as an idle mind would. However, the dent, unitive state of consciousness. pal source of sensory stimulation is sound. mechanical repetition of the word does not There are several techniques of medita- Sounds abound even in a quiet environ- require analytic attention. Therefore it does tion, which differ widely in their details. In ment. After the other sensory inputs have not mask the vision of the Absolute Reality a brilliant analysis, Sri Aurobindo divided been curtailed, background noises which the way an endless train of assorted the conditions conducive to meditation into were earlier escaping attention get thoughts would. Secondly, if the word or two external and two internal conditions unmasked. Even the rustling of leaves or the phrase chosen for repetition is sacred to the (Aurobindo, 1993, p. 147). Nearer our chirping of birds may acquire a disturbing person, its regular repetition eventually times, Herbert Benson has independently character. Pratyahara involves a gentle with- leads to the development of a bond with deduced four basic elements that are com- drawal of attention from these sounds in an the sacred entity which the expression sym- mon to all forms of meditation (Benson, attempt to cultivate a studied indifference bolizes. The result is that, with time, the 1975). Physiologically, meditation generally to the source and significance of these sounds. In addition to thoughts triggered Table 1 by sensory stimuli, is the spontaneous flow The Basic Elements of Meditation of thoughts often manifesting as rumina- tion. The person learns to ignore these Sri Aurobindo’s Benson’s Limbs of Physiological thoughts as well during pratyahara. conditions elements Raja yoga correlates External However, instability is such an inherent characteristic of the mind that left to itself, Solitude and it cannot remain blank for any respectable seclusion Quiet environment Assumed Sensory attenuation length of time, and unless that happens, there can be no room for experiences origi- Stillness of the nating in higher planes of consciousness. body Comfortable posture Asana Sensory and Therefore in Patanjali’s scheme, from motorattenuation pratyahara the person moves on to the next Internal step, dharana (concentration). During dha- rana, the person concentrates on an object Concentration of or a sound or an idea, in addition to the the will Mental device Dharana Non-analytic attention breath on which he started concentrating Purity and calm of the during pranayama. The mental focus of inner consciousness Passive attitude Dhyana Non-targeted thinking

Fall 2004 Biofeedback 17 involves sensory and motor attenuation, whereas straining implies anxiety and agita- aware of a deeper reality within, of which non-analytic attention and non-targeted tion (Sri Aurobindo, 1993, p. 156). The the body and the mind are surface manifes- thinking (Deepak, 2002). It is customary to aim of all meditative techniques is to tations. The second component of the expe- divide the techniques of meditation into restrain the ordinary activities of the mind rience is the perception of the very same those which involve concentration, and while staying not just awake but also alert. reality within, behind and above everything those which do not. The difference between Concentration, contemplation and self- in the universe: everything animate and these two types is one of emphasis, rather observation are the usual, but not an inanimate. The plurality and multiplicity of than in the underlying principles. Sri exhaustive list of mental devices used for the universe are seen as superficial and tem- Aurobindo talks of three closely related achieving this combination. A few tech- porary manifestations of a deeper imperish- processes. The first is concentration of the niques of meditation require loud chanting, able reality. To give an analogy, the waves of mind on a single train of ideas. It is relative- walking, singing and even dancing instead an ocean have a variety of appearances and ly easy, but the narrowest in its results. The of sitting quietly. The key seems to be total a brief existence, but the deeper reality second is contemplation on a single object absorption in an activity which does not behind all the waves is water. Perception of or idea so that knowledge about the object require analytic attention or targeted think- the individual as part of a vast interrelated or idea may arise naturally in the mind. ing. In neurophysiological terms, it trans- universe provides infinite width to the expe- Contemplation is more difficult than con- lates into marked reduction in neuronal rience. Samadhi is a peak spiritual experi- centration but leads to greater results. The activity, especially in the left parietal lobe. ence. But in fact there is a spectrum of third is standing back from one’s own The question arises as to what is it that different levels of spiritual experiences thoughts and engaging in self-observation. steps in to fill the vacuum created by a con- (Aurobindo, 1970, pp. 939-955, Austin, Self-observation is the most difficult, but certed effort at reduction in neural traffic: Is 1998, pp. 298-305, 579-584). The earliest the widest and greatest in its fruits. Self- it consciousness of a deeper reality waiting experiences that occur after beginning a reg- observation leads to “emptying of all to reveal itself, or is it a set of mental aber- ular meditative practice may be just brief thoughts out of the mind so as to leave it a rations or hallucinations? From the scientif- periods of peace, tranquility and joy. sort of pure vigilant blank on which the ic point of view, this remains an open Between these and the peak experience are divine knowledge may come and imprint question. To keep our minds open to the several planes of consciousness bringing in itself” (Aurobindo, 1993, pp. 146-147). possibility of perception through a route their wake progressively higher degrees of Since it is a basic principle of learning to other than the sense organs is, however, less enlightenment. proceed from the easy to the difficult, med- unscientific than believing that no such Introspective reflection in a state of itative techniques pass through concentra- route can exist. intense concentration and purification has tion and contemplation before arriving at The Experience Called been used for exploring the mystery of exis- self-observation. Using Herbert Benson’s tence by sages across millennia all over the terminology, concentration, contemplation Samadhi world irrespective of caste or creed. Their and self-observation are ‘mental devices’ of Samadhi is an experiential state, and an experiences as well as their interpretations of increasing complexity for achieving a vigi- experience defies description. For example the experiences show remarkable similarities. lant blank, or attentive relaxation. In differ- no description can truly convey the sweet- Independent replication of experiences by so ent techniques of meditation, the emphasis ness of sugar the way tasting sugar can. If many separated so much in time and space is on one or the other of these mental commonplace experiences cannot be is probably the strongest argument in favor devices. In techniques emphasizing concen- described adequately, it is understandable of the validity of these experiences. tration, the focus of concentration may be that the limitation would be all the more However, being subjective, the only person neutral or sacred, external or internal. For true for an experience as rare as samadhi. who can attest the veracity of these experi- example, concentration may be on the Therefore it has been said that if samadhi ences is the person who has experienced breath, a part of the body, or on a bright has been experienced, no description is nec- them. Therefore, an objective proof of the spot of light. When the focus of concentra- essary; and if it has not been experienced, validity of spiritual experiences remains an tion is external, the eyes may be kept open no description is adequate. impossibility. What is more important is to during meditation. In techniques emphasiz- However, this fundamental limitation has examine the practical implications of these ing self-observation (or mindfulness), con- not prevented many of those who have experiences. If these experiences end as an centration is usually confined to the initial experienced samadhi from making attempts individual achievement, they are not of attention to breathing. The reason why to describe it. Although these descriptions much value to humanity at large. The deep- concentration is downplayed in several differ from one another as might be reason- er and wider consciousness experienced techniques is not only because its results are ably expected, they have some striking basic through meditation has extremely positive narrow, but also because it is likely to be similarities. The first and foremost compo- implications for a basic change in human confused with straining, which would make nent of the experience is a radical change in nature itself. It integrates our physical, emo- meditation unpleasant and counter-produc- the person’s way of looking at oneself. tional and intellectual energies with a deeper tive. Concentration is quiet and steady, Instead of identifying oneself entirely with and higher power, thereby banishing igno- the body and mind, the person becomes

18 Biofeedback Fall 2004 rance, evil and misery. Further, the question mechanisms by which meditation might act. preservation and restoration of health can- arises whether a radical change in the nature Meditation is a relaxing experience, and has not be considered abusing, or even misus- of a few can in any way make a difference to therefore been used primarily for the disor- ing, the technique; it is just an instance of the world. It has been observed that in ders to which mental stress makes a signifi- under-using. On the positive side, every- towns where at least one percent of the pop- cant contribution. These disorders include body falls ill sometime or the other, but not ulation was practicing transcendental medi- hypertension, coronary artery disease, many are interested in spiritual growth. tation (TM), the crime rate came down insomnia, incontinence, headache, chronic Using meditation for restoration of health significantly (Borland & Landrith, 1976). It pain, especially low back pain, stress-related may provide the first opportunity to the seems that when more than a critical mass of symptoms in cancer, anxiety disorders and patient to get interested in spiritual growth people raise their consciousness, it has a rip- premenstrual syndrome (Barrows and as a worthwhile goal. In fact, the experience ple effect on their fellow beings (Keyes, Jacobs, 2002; Astin, et al., 2003). of human life down the ages has been that 1982). David Hawkins, a pioneer in quan- The efficacy of meditative techniques in in an overwhelming majority of spiritual tification of consciousness and its collective such a wide variety of disorders is not sur- seekers, the spiritual turn was triggered by influence, has argued on mathematical prising in view of mounting evidence in some turbulent, traumatic or tragic episode grounds that even a few loving thoughts favor of the mind-body relationship. in life. That being so, ill-health is as good during the course of the day more than Physical and mental relaxation, as achieved an event as any for initiating the process. counterbalance all of our negative thoughts. during meditation, has reproducible physio- While working on a cure for the illness, the Thus, even a brief and modest elevation of logical effects such as an increase in EEG person also discovers a technique for spiri- consciousness during meditation has a alpha activity and skin resistance, and a tual growth. What begins as a treatment remarkable spillover effect on an individual’s reduction in respiratory rate, oxygen con- ends up being a treat. life. Further, Hawkins has suggested that sumption, arterial lactate levels, and sympa- Many Roads to Rome? just a few individuals at a highly elevated thetic activity (Anand et al., 1961; Wallace level of consciousness can exert a significant and Benson, 1972; Vempati and Telles, The ecstatic, unitive and transcendent influence on society as a whole (Hawkins, 2002). It has been reported that those who experience is not restricted to meditation. 1995, p. 237). have been meditating for more than 5 years Similar experiences, dispassionately described as alternative states of conscious- Applications of are, on an average, biologically 12 years younger than people their age in the general ness, may be generated by nitrous oxide, Meditation population (Wallace et al., 1982). The indi- lysergic acid (LSD), or sensorimotor depri- Using meditation successfully for rising cators of aging used in this study were acu- vation (SMD) (Austin, 1998, pp. 407-436). to a higher plane of consciousness is not ity of hearing, near point of vision (roughly, This raises two questions: first, if drugs or common. But several watered-down ver- the minimum distance from which a book SMD produce hallucinations, are medita- sions of meditation are used instinctively or may be read) and systolic blood pressure. tive experiences also hallucinations, and under guidance for very ordinary ends. Thus a 60-year old who has been meditat- second, if meditative experiences are spiritu- Dealing with Problems. When faced with ing for more than 5 years matches a 48-year al, are drugs and SMD short-cuts to a vexing problem, an instinctive response is old non-meditator so far as these indicators enlightenment. to retire to a quiet corner and concentrate are concerned. At cellular level, slower aging Regarding the first question, those who on the problem. This corresponds to the may be due to reduced oxidative stress as consider all such experiences to be halluci- stage of dharana. If this goes on long suggested by lower lipid peroxide levels in nations are in distinguished company; the enough, and frequently enough, an analysis meditators (Schneider et al., 1998). Nobel Prize-winning physicist, Richard of the problem starts running through the However, by far the most impressive evi- Feynman, also thinks so (Feynman, 1992). mind. This corresponds to dhyana. With dence in favor of the mind-body relation- Feynman considers these ‘hallucinations’ to luck, a solution to the problem may present ship, which meditation exploits for securing be the product of sensory deprivation. The itself in a sudden flash, leading to an health-related benefits, has come from fact that many people have had the experi- intensely peaceful feeling. This may corre- psychoneuroimmunology (Kiecolt-Glaser ence, and that their descriptions of the spond to a brief sampling of the samadhi et al., 2002). experience resemble one another, does not experience. prove that the experiences are rooted in Preserving and Promoting Health. Meditation as Medication: reality. It could be simply the result of all of Spiritual seekers have generally enjoyed good Right or Wrong? them starting with similar expectations; the health and longevity. To these seekers, Medicine has borrowed meditative tech- interpretation of the experience possibly health-related gains are a fringe benefit, not niques from spiritual disciplines. When depends on what one is expecting to ‘see’. the primary goal. However, these gains have meditation is used for spiritual growth, Some recent brain imaging studies on medi- become the primary goal of meditation in health is a fringe benefit. Purists are prone tating Buddhist monks and Christian nuns modern medicine. Several empirical studies to question making the fringe benefit itself have been construed as ‘evidence’ for the suggest that the technique actually works, the goal of the technique. Speaking dispas- existence of a supraphysical reality. The and we also have evidence for plausible sionately, using meditation for promotion, authors of these studies have made no such

Fall 2004 Biofeedback 19 claims. In fact, one of the best known pp. 579-584). These behavioral changes are Aurobindo, Sri. (1993). The integral yoga: Sri investigators in this area, Andrew Newberg, singularly missing in one who has gone Aurobindo’s teaching and method of practice. Selected letters of Sri Aurobindo. Pondicherry: Sri Aurobindo has merely said “… the possibility of such a through apparently similar drug-induced Ashram. reality is not inconsistent with science” experiences. This all-important difference Austin, J.H. (1998). Zen and the brain: Toward (Rause, 2002). What Andrew Newberg and holds in spite of similar brain areas being an understanding of meditation and consciousness. Eugene d’Aquili have observed is that the activated or inactivated, and similar neuro- Cambridge: The MIT Press. peak of spiritual experiences coincides with transmitters being released in both cases. Barrows, K.A., and Jacobs, B.P. (2002). Mind- body medicine. An introduction and review of the dramatic reduction in the activity of the Thus there is no short-cut to enlighten- literature. Medical Clinical of North America, 86, brain’s left parietal lobe. This is the part of ment. Bliss may have an associated neuro- 11-31. the brain which processes sensory informa- chemistry but bliss does not reside in Benson, H. (1975). The relaxation response. New tion, and helps define the boundary chemical molecules. York: Avon Books, pp. 159-161. between the individual and the rest of the Meditation is based on the simple princi- Borland, C., and Landrith, G III. (1976). universe. Silence of this area at the peak of ple that clearing a clutter is enough for clar- Improved quality of city life through the transcen- dental meditation program: Decreased crime rate. meditation is not surprising because reduc- ity to surface spontaneously. But in practice, In D. W. Orme-Johnson and J. T. Farrow (Editors), ing and ignoring sensory inputs is an the inherent restlessness of the mind makes Scientific research on the Transcendental Meditation important component of meditation. meditation extremely difficult. Several tech- program: Collected papers, Volume I (pp. 639-648). Further, since this is the area which enables niques are available to make the process less Seelisberg, Switzerland: Maharishi European Research University Press. the individual to identify himself as separate difficult, but they are nothing more than Deepak, K.K. (2002). Neurophysiological mech- from the rest of the universe, inactivity of guidelines. With practice, each meditator anisms of induction of meditation: a hypothetico- this area is likely to erase this boundary. A works out his own style, so that in the final deductive approach. Indian Journal of Physiology feeling of unity with the universe, a feeling analysis, there are as many ways to meditate and Pharmacology, 46, 136-158. of being a drop in an ocean, is the core of as the number of people who meditate. Feynman, R.P. (1992). “Surely you’re joking Mr. Feynman!” Adventures of a curious character. spiritual experiences. Newberg and d’Aquili Further, while meditation as a deliberate London: Vintage, pp. 330-337. have hypothesized that the brain is so wired exercise may be difficult, getting totally Hawkins, D.R. (1995). Power vs. force: An anato- that the vacuum created by inactivity of the absorbed in an enjoyable activity is easy, my of consciousness. Sedona AZ: Veritas Publishing. area which thrives on ‘normal’ sensory expe- and is also a type of meditation. That is Keyes, K. Jr. (1982). The hundredth monkey. riences is filled in by the transcendent expe- why artists, poets, scientists and even ath- Coos Bay, Oregon: Vision Books. rience. The experience is indeed real; the letes have experienced transcendence when Kiecolt-Glaser, J.K., McGuire, L., Robles, T.F., and Glaser, R. (2002). Emotions, morbidity and question that has not been, and probably deeply immersed in activity. But all the mortality: new perspectives from psychoneuroim- cannot be answered is whether the experi- same, meditation as a deliberate exercise is munology. Annual Review of Psychology, 53, 83-107. ence corresponds to a reality that really also of value for peace, longevity, and with Mahesh Yogi, Maharishi. (1967). Meditation exists. Since science is incapable of proving perseverance, for a direct experience of the (with questions and answers). Rishikesh: a negative, it is unreasonable to expect from universal consciousness. Humanity today is International SRM Publications, p. 106. science proof for the nonexistence of a sup- obsessed with a long and ever-growing list Rause, V. ( 2002, January). Searching for the divine. Reader’s Digest (India), pp. 124-129. raphysical reality. of external goals, and is in a terrible hurry Schneider, R.H., Nidich, S.I., Salerno, J.W., Regarding the second question, the to reach them. Meditation is not a panacea Sharma, H.M., Robinson, C.E., Nidich, R.J., and resemblance between meditation and for all the problems of the modern world, Alexander, C.N. (1998). Lower lipid peroxide levels drug/SMD-induced experiences, when it but is a tempting tool for slowing down, in practitioners of transcendental meditation. Psychosomatic Medicine, 60, 38-41. does exist, is superficial. Two important dif- looking within, and reaching beyond the Vempati, R.P., and Telles, S. (2002). Yoga-based ferences exist between these contrasting sit- obvious. guided relaxation reduces sympathetic activity uations. First, drug/SMD-induced judged from baseline levels. Psychological Reports, References 90, 487-494. experiences are temporary. They last only as Anon. (2001). Paths of meditation: A collection of long the person is under the influence of essays on different techniques of meditation according Vivekananda, Swami (1995). Raja yoga: the hallucinogenic agent. On the other to different faiths. Madras: Sri Ramakrishna Math. Conquering the internal nature, 22nd impression. Calcutta: Advaita Ashrama. Anand, B.K., Chhina, G.S., and Singh, B. hand, the meditative experiences have a ten- Wallace, R.K., and Benson, H. (1972). The dency to gradually outlast the meditative (1961). Some aspects of electroencephalographic studies in yogis. Electroencephalography and Clinical physiology of meditation. Scientific American, practice. Secondly, and more importantly, Neurophysiology, 13, 452-456. 226(2 ), 85-90. the core of the spiritual experience is the Astin, J.A., Shapiro, S.L., Eisenberg, D.M., and Wallace, R.K., Dillbeck, M., Jacobe, E., and transforming influence it has on the indi- Forys, K.L. (2003). Mind-body medicine: state of Harrington, B. (1982). The effects of the transcen- dental meditation and TM-Siddhi program on the vidual. A person whose consciousness is ele- the science, implications for practice. Journal of American Board of Family Practice, 16, 131-147. aging process. International Journal of Neuroscience, vated by meditation shows a progressive loss 16, 53-58. Aurobindo, Sri. (1970). The life divine,5th edi- of vanity, desires, cravings and aversions, tion. Pondicherry: Sri Aurobindo Ashram. and a remarkable growth in compassion (Aurobindo, 1993, p. 153; Austin, 1998,

20 Biofeedback Fall 2004

SPECIAL TOPICS: MEDITATION, CHANGES IN CONSCIOUSNESS, AND HEALTH

Meditation and Limbic Processes Tobias Esch, MD, Berlin, Germany; Massimo Guarna, PhD, Siena, Italy; Enrica Bianchi, PhD, Siena, Italy; and George B. Stefano, PhD, Old Westbury, New Yorki

Tobias Esch, MD George B. Stefano, PhD

Abstract: Currently, complementary and interest. ‘somatic markers’ (bodily sensations that alternative medicine (CAM) are experiencing The common idea that the limbic system may escort an emotion), sets the ‘feeling growing popularity. However, most of the is solely concerned with emotion is at best a tone’, i.e., it strongly influences what ‘feels underlying physiological and molecular mech- half-truth, but there certainly is a connec- right’ to a person (Stefano et al., 2001). anisms as well as participating biological tion, which is probably relevant to CAM Furthermore, emotion may reinforce a structures are still speculative. Meditation was (Campbell, 1999). The limbic lobe sur- belief and trigger positive physiological examined with regard to the central nervous rounds the corpus callosum and consists of reactions even ‘against’ rationality (Stefano system activity pattern involved. Frontal/pre- the cingulate gyrus and the parahippocam- & Fricchione, 1995b). Thus, belief in frontal and limbic brain structures play a role pal gyrus. The hippocampus, which is in regard to a doctor or a therapy (e.g., CAM) in CAM, including meditation. Particularly, the floor of the temporal horn of the lateral may stimulate naturally occurring ‘healthy’ left-anterior regions of the brain and reward ventricle, is also included in the limbic lobe. processes (Stefano et al., 2001). These sub- or motivation circuitry constituents are Additional structures incorporated in the jective processes may particularly involve involved, indicating positive affect and emo- limbic system, i.e., the limbic concept, are limbic structures, i.e., ‘remembered well- tion-related memory processing. Thus, trust the dentate gyrus, amygdala, hypothalamus ness’ (Stefano et al., 2001). We recently and belief in a therapist or positive therapy (especially the mammillary bodies), septal reviewed the literature on acupuncture, expectations seem to be important. In this area (in the basal forebrain), and thalamus music therapy, meditation and massage regard, endogenous morphine is emerging as a (anterior and some other nuclei). therapy, regarding their limbic commonali- chemical messenger involved in limbic process- Functionally, the ‘hippocampal formation’ ties (Esch et al., 2004) and found that belief es. consists of the hippocampus, the dentate and expectation are crucial components of Introduction gyrus, and most of the parahippocampal acupuncture, massage, meditation and gyrus (Campbell, 1999). music therapy treatment (Esch et al., 2004). Despite the popularity of complementary With regard to CAM, the limbic system When patients actively participate in their and alternative medicine (CAM), little is is strongly associated with memory (emo- treatment, i.e., positively anticipate clinical known about the physiological pathways tional memory), i.e., positive or negative effects, the chosen therapy presumably is and biological structures involved. Besides emotions, and the CNS-located reward cir- more effective (Esch, et al., 2004). specific effects that CAM therapists claim cuitry: Belief has an emotional component Meditation as an for themselves and for each single approach, in that the brain motivation and reward cir- trust, belief, and other subjective or more cuitry – linked to the limbic system – will Example general factors may play a role in CAM be reinforced with a positive emotional Recently, we have surmised that there is a (Slingsby & Stefano, 2000; Slingsby & valence attached to the believed in person, connection between constitutive nitric Stefano, 2001; Esch, Guarna, Bianchi, Zhu, idea, or thing (Stefano, Fricchione, Slingsby, oxide (NO) (and its release via constitutive & Stefano, 2004). Thus, the role of belief, & Benson, 2001). This emotionalized nitric oxide synthase [cNOS]) and the ele- emotions, and limbic activation will be of memory, potentially accompanied by mental physiological phenomenon called

22 Biofeedback Fall 2004 the ‘relaxation response’ (RR) (Stefano et al., 2001), an innate (Esch et al., 2003; Elias & Wilson, 1995). Here, anxiolytic effects physiological response that is the opposite of the stress response. of the RR may occur by promotion of an inhibitory (GABAergic) NO release is involved in this phenomenon, and it may be substan- tone in specific areas of the brain (Elias et al., 1995). tially responsible for some of the RR-related physiological changes Meditation has been shown to increase left-sided anterior activa- (Stefano et al., 2001). The RR has the potential to be elicited tion of the brain, a pattern that is associated with positive affect actively, i.e., consciously (in humans), not only automatically, but (Davidson, et al., 2003). Again, positive emotion-related brain by the use of various techniques such as repetitive imagination or activity is a substantial part of the CNS reward circuitry, and the verbalization of a word, prayer, phrase, or even repetitive muscular frontal regions of the brain not only are involved in RR pathways, activity, progressive muscle relaxation, meditation, yoga and other but also exhibit a specialisation for certain forms of positive and methods (Benson, 1975). Herbert Benson first described the RR negative emotion (Davidson & Irwin, 1999). Interestingly, reliable (and the technique of eliciting it) more than 30 years ago (Benson, increases in left-sided activation are observable with meditation Beary, & Carol, 1974). The RR results in decreased metabolism, training in response to both the positive and negative affect induc- heart rate, blood pressure and rate of breathing, as well as a decrease tion (Davidson et al., 2003). Davidson et al. suggested recently that in brain activity (Wallace, Benson, & Wilson, 1971), although a left-sided anterior activation is associated with more adaptive recent study using functional magnetic resonance imaging (fMRI) responding to negative and/or stressful events (Davidson et al., for brain mapping of the RR and meditation has shown that, even 2003; Davidson, 2000). Specifically, individuals with greater left- though overall brain activity is decreased, there are regions that are sided anterior activation have been found to show faster recovery activated in meditation, respectively elicitation of the RR, especially after a negative provocation (Davidson, 2000). those areas and neural structures involved in attention and control Deep CNS structures are crucial components of the neural RR of the autonomic nervous system (Lazar et al., 2000; Newberg et pathways. These components primarily consist of limbic structures, al., 2001). Using the RR in a therapeutic medical approach is but not solely. Hence, increases in regional cerebral blood flow (i.e., becoming more popular today because of its low-cost support of brain activity) following or coming along with meditation have health and self-care. Research has documented that regular elicita- been detected, for example, in the dorsolateral prefrontal cortex, tion of the RR results in alleviation of many stress-related medical inferior or orbital frontal cortices/anterior regions, inferior parietal disorders: It is effective in the treatment of hypertension (Stuart et lobes, pre- and postcentral gyri, temporal lobes, cingulate gyrus, al., 1987), cardiac arrhythmias (Benson, Alexander, & Feldman, hippocampus and parahippocampus, amygdala, globus 1975), chronic pain (Caudill, Schnable, Zuttermeister, Benson, & pallidus/striatum, thalamus, and the cerebellar vermis (Lazar et al., Friedman, 1991), insomnia (Jacobs, Benson, & Friedman, 1996), 2000; Newberg et al., 2001; Davidson et al., 2003; Newberg, anxiety and mild/moderate depression (Benson et al., 1978), pre- Pourdehnad, Alavi, & d’Aquili, 2003; Critchley, Melmed, menstrual syndrome (Goodale, Domar, & Benson, 1990), and Featherstone, Mathias, & Dolan, 2001) (Figure 1). However, infertility (Goodale et al., 1990). Some of these studies, as well as inconsistent results have been reported with regard to the parietal additional reports, used a combination of RR-based approaches and cortices: Some studies demonstrated an inverse correlation between nutritional, exercise, and stress management/behavioral interven- tions. With regard to the CNS, the RR activates areas in the brain responsible for emotion, attention, motivation, and memory (e.g., anterior cingulate, hippocampal formation, amygdala) and may also serve the control of the autonomic nervous system (Stefano et al., 2003; Lazar et al., 2000; Newberg et al., 2001). This specific pat- tern of activation may exert protective effects on the brain, although this is still a speculative prospect (Esch, Fricchione, & Stefano, 2003). However, such a protective mechanism could be related, for example, to a generally decreased production of metab- olism-derived harmful by-products, i.e., oxidative stress. Also, the RR seems to be effectively capable of improving concentration and cognitive function, e.g., memory (Esch et al., 2003; Travis, Tecce, & Guttman, 2000). This may be due to hippocampal/limbic acti- vation (see above), including reward or motivation circuitry involvement (Stefano et al., 2001). We now also know that stress may reduce neurogenesis in the adult hippocampus, possibly facili- Figure 1. Representative connections among the limbic–hypothalamic pituitary tating memory impairment (Esch, Stefano, Fricchione, & Benson, adrenal axis, demonstrating that these centers are linked to vital functions, 2002b). Thus, the RR – and the reduction of stress with it – may which appear to be modified by complementary medical therapies. This figure be clinically relevant in dementia syndromes (Esch et al., 2002b; specifically depicts vascular tone regulation. This pathway suggests how belief, Esch et al., 2003). In addition, RR techniques have also been trust and emotion may exert a level of top-down control on vasomotor activity. described to be helpful in the treatment of anxiety and depression The illustration is not meant to be all-inclusive. Taken from Esch, et al., 2004.

Fall 2004 Biofeedback 23 the dorsolateral prefrontal and the ipsilater- therapy (Lund et al., 2002; Piotrowski et cared for and participates in his/her health al superior parietal lobe blood flow change: al., 2003). These molecules that possess a care as a self and respected being, believing This correlation may reflect an altered sense strong CNS affinity may also be involved in in a remedy or ‘resonating’ with a method of space experienced during meditation the placebo response (besides dopamine and and its unique sociocultural background, (Newberg et al., 2001; Newberg et al., serotonin) (Fuente-Fernandez, Schulzer, & feeling in control and giving up resistance – 2003). Clearly, meditation is a complex Stoessl, 2002; Fuente-Fernandez & Stoessl, clearly, CAM addresses individual, i.e., sub- phenomenon that involves several coordi- 2002; Sher, 2003) and facilitate positive jective, beneficial mind/body physiological nated cognitive processes and autonomic CAM effects or subjective feelings of well- pathways. Thus, personal history and for- nervous system alterations. RR techniques being and relaxation. Moreover, they own a mer experiences (e.g., ‘remembered well- modulate CNS activity patterns with partic- stress-antagonizing capacity – like CAM ness’) as well as therapy expectations may ular focus on structures associated with (Esch, et al., 2003; Stefano, et al., 2003; play a role, although CAM is based on spe- attention, emotion, and memory. Benson, 1984; de la Torre & Stefano, 2000; cific and non-specific components together, Knowing details on the brain activity pat- Esch, 2003c; Esch, 2003b; Salamon, et al., obviously. Every approach may make use of terns or CNS involvement in the RR, e.g., 2003; Spintge, 1985; Steelman, 1990; these two components that correspond with through neuroimaging techniques, doesn’t Knight & Rickard PhD, 2001; Fricchione, each other. This ‘holistic’ interpretation of necessarily help us with the interpretation Mendoza, & Stefano, 1994; Moyer, CAM with a particular focus upon shared of these results. However, we do know now Rounds, & Hannum, 2004; Diego, Field, CNS functions and common brain-located that limbic system activation is an integral Sanders, & Hernandez-Reif, 2004; Walach, innate healing capacities still has to be part of the brain physiology involved in the Guthlin, & Konig, 2003; Lund, et al., investigated further and may be critically RR. Hence, the very same structures that 2002; Piotrowski et al., 2003; Woods & questioned (Esch, et al., 2004). revealed increased activity in the RR, as Dimond, 2002; Wikstrom, Gunnarsson, & Recent information suggests that endoge- described, are well-known components of Nordin, 2003; Yun, et al., 2002; Lim, Ryu, nous morphinergic signaling should be part the brain reward and motivation circuitry: Kim, Hong, & Park, 2003). The relief of of this hypothesis as well (Stefano, et al., Prefrontal and orbitofrontal cortex, cingu- stress or detrimental effects related to stress, 2000; Esch, et al., 2004; Stefano, Zhu, late gyrus, amygdala, hippocampus, and i.e., stress-associated diseases, may be due to Cadet, Salamon, & Mantione, 2004). nucleus accumbens (Stefano, et al., 2001). the CAM-connected reduction of norepi- Endogenous morphine, both biochemically Thus, RR and reward circuitry seem to be nephrine reactivity/turnover or a decreased and immunocytochemically, has been found physiologically interconnected. Memories of autonomic nervous system hyperresponsive- in various neural tissues as well as in limbic the pleasure of wellness, i.e., ‘remembered ness (e.g., see (Esch, et al., 2003; Esch, structures (Cardinale, et al., 1987; wellness’, are accessible to this circuitry 2003b; Woods, et al., 2002; Yun, et al., Donnerer, Oka, Brossi, Rice, & Spector, through hippocampal mechanisms. Further, 2002)). This ability has been demonstrated 1986; Donnerer et al., 1987; Gintzler, Levy, belief affects mesocortical-mesolimbic for various CAM therapies (Esch et al., & Spector, 1976; Kodaira & Spector, 1988; appraisal of an experience, leaving one, for 2003; Hoffman et al., 1982). However, Kodaira, Listek, Jardine, Arimura, & example, well and relaxed. Yet, trust or many of the CAM effects occur almost Spector, 1989; Bianchi, Alessandrini, belief in a therapy/therapist may facilitate instantaneously. Hence, constitutive nitric Guarna, & Tagliamonte, 1993; Bianchi, positive affect, sense of well-being, and oxide, endocannabinoid and morphinergic Guarna, & Tagliamonte, 1994; Guarna, motivation, thereby involving limbic/reward auto regulation represent rather fast acting Neri, Petrioli, & Bianchi, 1998; Stefano, et circuitry activation, possibly leading to signaling pathways ideally suited for this al., 2000; Zhu, et al., 2003; Spector, relaxation (i.e., elicitation of the RR) or ini- role (Stefano, et al., 2003; Esch, Stefano, Munjal, & Schmidt, 2001) (Figure 2). tiating a beneficial placebo response Fricchione, & Benson, 2002a). Additionally, reports demonstrate the pres- (Stefano, et al., 2001). Subjective and objective mechanisms may ence of morphine precursors in various Molecular Signaling be associated with various CAM approach- mammalian tissues, including brain, sug- es. For example, a recent study on acupunc- gesting that this chemical messenger can be On the molecular level, nitric oxide, ture working with anesthetized volunteers, made by animals (see (Zhu, et al., 2003). endocannabinoids, and endorphin/ thereby avoiding subjective conscious cogni- Furthermore, an opiate receptor subtype, enkephalin autoregulatory signaling have tion and interaction, showed a specific anal- designated mu3, has been cloned, which is been demonstrated or discussed in associa- gesic effect (Meissne et al., 2004). However, opiate alkaloid selective and opioid peptide tion with acupuncture (Ma, 2003; trust and belief in a therapy/therapist may insensitive (Cadet, Mantione, & Stefano, Kaptchuk, 2002; Jang, Shin, Kim, Kim, & activate naturally occurring self-healing 2003), strongly supporting the hypothesis Kim, 2003; Yang, Huang, & Cheng, 2000; capacities (self-care), especially when posi- of an endogenous morphinergic signaling Meissner et al., 2004), meditation tech- tive qualities like pleasurable sensations, system. The psychiatric implications of this niques (Stefano et al., 2001; Esch et al., touch, and attention, and feelings of well- system have been examined as well, includ- 2003; Stefano et al., 2003), music (Esch, being or protection are involved. These sub- ing brain reward circuitry (Fricchione, et 2003b; Esch, 2003a; Salamon, Kim, jective qualities may be utilized by CAM al., 1994). Thus, morphine, given its Beaulieu, & Stefano, 2003), and massage therapies. The mind/body that wants to be reported effects and those exerted via con-

24 Biofeedback Fall 2004 stitutive nitric oxide stimulated nitric oxide release, may form the which contains high concentrations of opiate neurons involved in foundation of this common signaling among these complementary the descending pain inhibitory pathway. Neurons immunoreactive medical methodologies (Stefano, et al., 2000). Furthermore, mor- for morphine are largely present all along the extension of PAG and phine exerts immune, vascular, and neural down-regulating activi- in brainstem raphe nuclei (Esch, et al., 2004), implicating mor- ties in the periphery, i.e., lowering blood pressure via nitric oxide phinergic neural pathways in the placebo response. Importantly, (Stefano & Scharrer, 1994; Stefano et al., 1996). Opiate com- this process also may be active in altering the experience of pain. pounds are part of the reward system. Indeed, morphine may addi- The presence of endogenous morphine has been confirmed by gas tionally represent signaling that allows one to make rational short chromatography coupled to mass spectrometry in the brainstem cuts, since being rational may be too time consuming, i.e., emo- and cortex (Donnerer, et al., 1987). Moreover, the prefrontal cortex tional motivation (Stefano & Fricchione, 1995a). Taken together, possesses close neural connections to limbic components such as endogenous morphinergic signaling would appear to be an impor- the hippocampal formation and cingulate cortex where morphine tant missing component in the literature linking the factors that immunoreactivity is largely present in neurons and fibers (Esch, et make complementary medical therapies important. al., 2004; Spector, et al., 2001). These limbic areas play a major In particular, multiple component expectation-induced placebo role in memory processes and also mediate motivational, affective effects may involve morphinergic signaling, since a reduction of and autonomic responses often accompanying pain. Additionally, placebo effects by the opioid selective antagonist naloxone has been endogenous morphine appears to modulate memory processes play- demonstrated (Wager, et al., 2004; Levine, Gordon, & Fields, ing a role in weakening the memory of a nociceptive experience 1978). In placebo experiments (Wager, et al., 2004) increased brain (Guarna, et al., 2004). Limbic areas also are connected to the pre- activity was found. This was determined by fMRI (functional mag- frontal cortex, which integrates emotion, memory, belief, expecta- netic resonance imaging) during the anticipation of pain relief in tion, motivation and reward processing, i.e., affective and the midbrain in the vicinity of periaqueductal gray (PAG) matter, motivational responses (Stefano, et al., 2001; MacDonald, III, Cohen, Stenger, and Carter, 2000). Also, prefrontal mechanisms may trigger opiate release in the midbrain (Wager, et al., 2004). Taken together, prefrontal cortex activation in placebo as well as CAM treatments may reflect a form of – mainly – externally elicit- ed top-down CNS control, possibly involving morphinergic auto regulatory pathways. Conclusions Common brain structures like frontal and limbic regions get acti- vated in various CAM approaches, indicating a crucial role of affect and belief. Meditation therapies also possess a stress-reducing capac- ity that may be addressed in self-care-oriented medical procedures, some of them accepted for their low-cost (although effective) way of acting in the healing process given their down regulating proper- ties. While medical knowledge and technical abilities are expand- ing, they still have to be affordable. CAM may help to solve this problem. However, knowledge about mechanisms involved in CAM, including meditation, is often fragmentary. This deficit has to be reduced before CAM becomes part of the regular and scientif- ic medicine. Thus, the existence of subjective CNS phenomena and commonalities in CAM may emphasize the significance of naturally occurring health processes and general self-care capabilities. Trust and belief may increasingly become part of future therapeutic strategies and regular medicine (Slingsby, et al., 2001).

Figure 2. Immunohistochemistry localization of morphine-like References immunoreactivity in rodent brainstem, hippocampal formation and c Benson, H. (1975). The relaxation response. New York: William Morrow. ingulated cortex- Immunoreactive neurons are visible in rostral PAG (1), linear Benson, H. (1984). Beyond the relaxation response. New York: Times Books. raphe (2), dorsal hippocampus (3) and cingulated cortex (4,5). The images in Benson, H., Alexander, S., and Feldman, C. L. (1975). Decreased premature 1, 3 and 5 were obtained from coronal paraffin sections and immunostained ventricular contractions through use of the relaxation response in patients with stable ischemic heart-disease. Lancet, 2, 380-382. with an alkaline phosphatase immunoenzymatic method. Peroxidase-anti- Benson, H., Beary, J. F., and Carol, M. P. (1974). The relaxation response. peroxidase method was used in coronal vibratome sections for images 2 and 4. Psychiatry, 37, 37-45. An affinity purified anti-morphine IgG which exhibited minimal cross- Benson, H., Frankel, F. H., Apfel, R., Daniels, M. D., Schniewind, H. E., reactivity with codeine and other peptides, was used in this study. Nemiah, J. C. et al. (1978). Treatment of anxiety: A comparison of the useful- Taken from Esch, et al., 2004. ness of self-hypnosis and a meditational relaxation technique. Psychotherapy and Psychosomatics, 30, 229-242.

Fall 2004 Biofeedback 25 Bianchi, E., Alessandrini, C., Guarna, M., and Esch, T. (2003a). Musical healing in mental dis- Jang, M. H., Shin, M. C., Kim, Y. P., Kim, E. Tagliamonte, A. (1993). Endogenous codeine and orders. In G.B.Stefano, S. R. Bernstein, and M. H., and Kim, C. J. (2003). Effect of acupuncture morphine are stored in specific brain neurons. Kim (Eds.), Musical healing. Warsaw: Medical on nitric oxide synthase expression in cerebral cor- Brain Research, 627, 210-215. Science International. tex of streptozotocin-induced diabetic rats. Bianchi, E., Guarna, M., and Tagliamonte, A. Esch, T. (2003b). [Music medicine: Music in Acupuncture and Electrotherapeutics Research, 28, 1- (1994). Immunocytochemical localization of association with harm and healing]. 10. endogenous codeine and morphine. Advances in Musikphysiologie Musikermedizin, 10, 213-224. Kaptchuk, T. J. (2002). Acupuncture: Theory, Neuroimmunology, 4, 83-92. Esch, T. (2003c). 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26 Biofeedback Fall 2004 Newberg, A., Pourdehnad, M., Alavi, A., and Spintge, R. (1985). Some neuroendocrinological Stefano, G. B., Scharrer, B., Smith, E. M., d’Aquili, E. G. (2003). Cerebral blood flow during effects of socalled anxiolytic music. International Hughes, T. K., Magazine, H. I., Bilfinger, T. V. et meditative prayer: Preliminary findings and Journal of Neurology, 19-20, 186-196. al. (1996). Opioid and opiate immunoregulatory methodological issues. Perceptual and Motor Skills, Steelman, V. M. (1990). Intraoperative music processes. Critical Reviews in Immunology, 16, 109- 97, 625-630. therapy. Effects on anxiety, blood pressure. AORN 144. Piotrowski, M. M., Paterson, C., Mitchinson, A., Journal, 52, 1026-1034. Stefano, G. B., Zhu, W., Cadet, P., Salamon, E., Kim, H. M., Kirsh, M., and Hinshaw, D. B. Stefano, G. B., Esch, T., Cadet, P., Zhu, W., and Mantione, K. J. (2004). Music alters constitu- (2003). Massage as adjuvant therapy in the man- Mantione, K., and Benson, H. (2003). tively expressed opiate and cytokine processes in lis- agement of acute postoperative pain: A preliminary Endocannabinoids as autoregulatory signaling mol- teners. Medical Science Monitor, 10, MS18-MS27. study in men. Journal of the American College of ecules: coupling to nitric oxide and a possible asso- Stuart, E., Caudill, M., Leserman, J., Surgeons, 197, 1037-1046. ciation with the relaxation response. Medical Science Dorrington, C., Friedman, R., and Benson, H. Salamon, E., Kim, M., Beaulieu, J., and Stefano, Monitor, 9, RA63-RA75. (1987). Nonpharmacologic treatment of hyperten- G. B. (2003). Sound therapy induced relaxation: Stefano, G. B. and Fricchione, G. L. (1995a). sion: A multiple-risk-factor approach. Journal of Down regulating stress processes and pathologies. The biology of deception: Emotion and morphine. Cardiovascular Nursing, 1, 1-14. Medical Science Monitor, 9, RA96-RA101. Medical Hypotheses, 49, 51-54. Travis, F., Tecce, J. J., and Guttman, J. (2000). Sher, L. (2003). The placebo effect on mood and Stefano, G. B. and Fricchione, G. L. (1995b). Cortical plasticity, contingent negative variation, behavior: possible role of opioid and dopamine The biology of deception: The evolution of cogni- and transcendent experiences during practice of the modulation of the hypothalamic-pituitary-adrenal tive coping as a denial-like process. Medical Transcendental Meditation technique. Biological system. Forschende Komplementarmedizin und klas- Hypotheses, 44, 311-314. Psychology, 55, 41-55. sische Naturheilkunde, 10, 61-68. Stefano, G. B., Fricchione, G. L., Slingsby, B. T., Wager, T. D., Rilling, J. K., Smith, E. E., Slingsby, B. T. and Stefano, G. B. (2000). and Benson, H. (2001). The placebo effect and Sokolik, A., Casey, K. L., Davidson, R. J. et al. Placebo: Harnessing the power within. Modern relaxation response: Neural processes and their cou- (2004). Placebo-induced changes in FMRI in the Aspects of Immunobiology, 1, 144-146. pling to constitutive nitric oxide. Brain Research: anticipation and experience of pain. Science, 303, Slingsby, B. T. and Stefano, G. B. (2001). The Brain Research Reviews, 35, 1-19. 1162-1167. active ingredients in the sugar pill: Trust and belief. Stefano, G. B., Goumon, Y., Casares, F., Cadet, Walach, H., Guthlin, C., and Konig, M. (2003). Placebo, 2, 33-38. P., Fricchione, G. L., Rialas, C. et al. (2000). Efficacy of massage therapy in chronic pain: a prag- Spector, S., Munjal, I., and Schmidt, D. E. Endogenous morphine. Trends in Neurosciences, 9, matic randomized trial. Journal of Alternative and (2001). Endogenous morphine and codeine. 436-442. Complementary Medicine, 9, 837-846. Possible role as endogenous anticonvulsants. Brain Stefano, G. B. and Scharrer, B. (1994). Research, 915, 155-160. Endogenous morphine and related opiates, a new class of chemical messengers. Advances in Continued on page 32 Neuroimmunology, 4, 57-68.

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Fall 2004 Biofeedback 27 Remote training for EEG Biofeedback overcomes concerns from clinicians THE CASE FOR EEG BIOFEEDBACK REMOTE TRAINING

major barrier to the spread of EEG Bio- EEG Biofeedback should be an feedback beyond the clinic has been the agent for change; not an end in itself. AAlack of confidence that clinicians felt when sending equipment remotely with a COACHING CLIENTS REMOTELY client to their home, school, office, or other Remote training allows the clinician to setting. Concerns regarding compliance, the continue to coach clients while they are away proper use of the equipment, and the abil- from the clinic setting. It also ity to monitor and report results have stood allows a single clinician to in the way of the growth of the field of re- coach multiple patients at any download the results of his/her clients’ remote mote biofeedback training. one time by using multiple training sessions for that day, analyze and record Because of financial difficulty, geographic modules (such as the the data, respond to their progress, and then or other limitations, certain clients find them- BrainMastertm) and the Internet. bill those clients for their services. selves unable to continue office-based training. Clients begin their relationship with the To further reach clients disenfranchised by Denying neurofeedback to these clients on those clinician in the standard one-on-one sessions. finances, travel, or scheduling problems, some bases is unethical. It is the industry’s responsi- By the time a client may be impacted by the clinicians are creating walk-in clinics that can bility to seek other avenues to ensure the cre- demands of travel or the diminishing resources reach and help dozens of clients per day. The ation of a new model in which remote of money and time, the clinician will have BrainMaster 2.0 Remote Systems insure clini- neurofeedback is as effective and well supervised worked with the client long enough to know cian-selected protocol for easy, safe, and effec- remotely as it is in the clinic. that they are now able to handle sessions on the tive relaxation training. In remote training, the clinician remains BrainMaster system without constant, direct su- For clinicians seeking alternative profit the focal point of responsibility for the deploy- pervision. Clients who meet those requirements centers for their practice and who find insurance ment, use, and supervision of neurofeedback are ready for Remote Training. to be challenging — remote training may be equipment as he/she is in the clinic. The sys- Each of these evaluated clients will be sup- the answer. When brainwave training is ordered tems in effect must embody the spirit and in- plied by the clinician with a BrainMaster mod- for home, school or office, clients should feel tent of applicable laws and regulations, while ule to connect to their computer at home. The peace of mind with the personal assurance of a providing cost-effective, simple, and efficacious module comes with software and a protocol that private personal coach directing and motivating feedback to a wide range of clients. the clinician designs specifically for each client. them towards achievement session by session. Effective, clinician-based remote Per the clinician’s instructions, each client works This distinct change in training neurofeedback training does not consist of with the BrainMaster in the manner they did environment insists on direct payment from the merely sending home a clinical instrument, ex- when they were coached one-on-one at the clinic. client offering an income alternative for pecting the client — or member of the family When a client has completed a remote ses- clinicians in insurance challenged regions yet — to become a ‘mini-clinician.’ Rather, there sion, they may initiate a module (like the Session affordability for clients in need of such service. should be continuity of supervision and train- Librariantm ) which sends, safely and securely via To ensure that all who could benefit from ing. Systems should make it easy to define and the Internet, the results of that session (includ- EEG Biofeedback get the opportunity to experi- deliver protocols, provide reporting and moni- ing the raw EEG, if desired) to the clinician for ence that benefit, it is incumbent on clinicians to toring functions that use the Internet (where observation, analysis, and recommendation at a employ new models to reach those ends. applicable) and leverage the clinician’s time to time convenient to the clinician’s daily schedule. Remote Training is such a model, empow- the fullest extent of the client base. As the remote training branch of a ering both clients and clinicians to achieve their The proliferation of EEG Biofeedback clinician’s practice matures, patients will con- mutual goals in the most ethical and efficacious should be broad-based, yet maintain the high- tinue to be supervised one-on-one at the clinic, manner possible. est possible standards of quality, safety, and ad- with the clinician observing results and analyz- ______herence to applicable laws and regulations. ing progress in real time. BrainMaster’s 2.0 EEG Biofeedback should be served by a Clinical Pro Software makes it easy for a clini- For more information, please broad base of education, training, and supervi- cian to set up, apply, and review Remote Train- contact us at: sion that empowers and protects clinicians and ing sessions and client data. BrainMaster Technologies, Inc. trainees alike. And, at day’s end, the clinician will also 24490 Broadway Avenue Oakwood Village, OH 44146 440.232.6000 www.brainmaster.com [email protected] SPECIAL TOPICS: MEDITATION, CHANGES IN CONSCIOUSNESS, AND HEALTH

Brain Mechanisms of Meditation K. K. Deepak, MD, PhD, New Delhi, India1

Abstract: The human brain is naturally instructor. However, only motivated and excessive sweating, depressed immune equipped with certain mechanisms, which are desirous aspirants of this highly skilled defense mechanisms etc. This is essentially a capable of inducing meditation. A meditative knowledge were successful in mastering this hyper-sympathetic response. Meditation can effect appears due to reduction in brain out- mental discipline. The essential process of induce the so-called ‘relaxation response’ as put, decrement in sensory input and modifica- meditation involves modifying the atten- suggested by Herbert Benson (1975), who tion in the attentional behavior. tional process with the aim of achieving the proposed that the human body has the Non-analytical attending appears to be a highest possible degree of focused attention innate capacity to induce relaxation. major brain mechanism in induction and sus- in a non-analytical manner. Meditation induces an overall decrement in tenance of meditation. In this article three With the increasing complexities of mod- sympathetic response. In other words it mechanisms have been put together to generate ern times, meditation — which previously reduces arousal. Various research studies a functional model of meditation vis-à-vis was a tool used only to attend to spiritual support that it also reduces oxygen demand, brain structures’ involvement in the functional health — has evolved as a tool for the relax- blood pressure, heart rate, respiration, per- components. ation of body and mind. It is a particularly spiration and improves the body’s immune In its earliest form in human history, effective way to minimize the stress and defense mechanisms. Thus, a variety of psy- meditation evolved as a religious process for tension that comes with living in a highly chophysiological responses accompany the the upliftment of self and attainment of a competitive society. This has provided med- process of meditation. Therefore, medita- higher state of consciousness. For thousands itation an excellent opportunity for clinical tion serves as an antidote to stress related of years it has been transferred from genera- application with almost all stress related dis- disorders like headaches, hypertension, dia- tion to generation (and from teacher to the orders. In turn, this has led to the extensive betes, gastrointestinal disorders, certain psy- pupil) in various forms among many reli- research on quantifying the physiological chological disorders and immunological gious sects. In ancient times in the East, responses to meditation and comparing it compromises. education was intimately associated with with related interventions for inducing The mechanisms of meditation, especially religion. Basically, this religious education relaxation, such as biofeedback. with reference to its induction and subse- was for the attainment of the ultimate truth The Physiological quent effects have always intrigued scientists and its knowledge was rendered to the dis- and clinicians. There have been several ciples in various Ashrams or Gurukuls (spe- Response and Clinical attempts to explore these mechanisms of cial schools situated away from the Applications of meditation and allied states of mind. The populace) where not only the children of Meditation first point one should recognize is that there the common masses but also of the royal are clear differences between meditation families used to be educated and trained. Human beings have a natural capacity to and simple relaxation in terms of induction The first and foremost aim was to address achieve a certain level of bodily relaxation. methods, brain activity, autonomic respons- physical, mental and spiritual well-being for This innate capacity can be induced both es, psychic experiences and the end-stage of the overall development of the individual. passively and actively. This can be induced the process (Warenburg, et al., 1980; Meditation happened to be one of the most by oneself or otherwise. In the human brain Deepak, 2002). The second point is that important methods to modulate the mental there are certain neurons, which control several other similar states and variants of faculty. human response to stress and fear. This meditation may induce different psycho- Meditation is not only a body of knowl- manifests in terms of certain involuntary physiological responses, qualitatively and edge but a refined psychomotor skill which responses called autonomic responses. quantitatively, and that the induction meth- can be learned through practice and experi- Under stress the body reacts with excessive ods employed by various related interven- ence. The best way to transfer this skill to arousal leading to heightened autonomic tions may be different. Although it is not an inexperienced and novice disciple was by responses, namely, increased heart rate, possible to cover the mechanisms of all direct instruction from an experienced raised blood pressure, increased respiration, types of meditations in this article, the

Fall 2004 Biofeedback 29 physiological mechanisms of induction and human mind by nature is hyperactive and attending to inner or external stimuli. This a holistic model incorporating the relevant the distraction of the surroundings adds is a minimally provocative process and a brain structures involved in the induction further instability. However, after practice powerful tool to induce the relaxation of meditation and its subsequent effects will and expertise one can ultimately learn to response. The differences between medita- be presented. Meditation may involve single meditate in any given surroundings, even tive concentration, mindful meditation or multiple methods of inducing the medi- with eyes open, suggesting that active sup- (intake of thoughts with detached observa- tative state including a reduction in move- pression of incoming stimuli has been tions) and selective attention have been ments and thoughts (efferent attenuation; achieved. Sensory attenuation, whether described elsewhere (Deepak, 2002). efferent from the Latin root meaning ‘to active or passive, remains one of the impor- The involvement of cognitive restructur- bring out’), reduction of all incoming tant mechanisms of induction of medita- ing is further supported by its use in achiev- impulses namely light and sounds (sensory tion. The various types of meditation use ing the meditative state by practitioners of attenuation), and modification of thought various strategies to attain attenuation of ‘Tai Chi Chuan’ (the moving meditation). processes and rearranging thought patterns sensory inputs like specialized postures In this form of meditation the subject med- and knowledge (cognitive restructuring). (lotus posture etc.) and focusing vision on itates while continuously performing soft, The following account describes the physio- featureless stimuli (illuminated point by smooth, effortless and natural movements. logical effects of these three mechanisms. Sahaj yoga meditators, rock gardens by Zen Of these three mechanisms that are The Mechanisms of meditators). In some cases masking effects involved in induction of meditation, the on environmental the noise can be achieved last one (cognitive structuring) appears to Induction of Meditation through the use of word repetition or pro- be the major mechanism in the induction The first mechanism of induction is duction of certain prolonged sounds. These of meditation. Put simply, this means that ‘efferent attenuation’ referring to the reduc- mechanisms work to inhibit the stimulatory meditation is basically a form of attention tion of all types of outgoing brain activity. effects of sensory input on the brain and as that is voluntary, non-analytical and the Through maintenance of a calm, motionless is the case for efferent attenuation, may attention follows logical and linear posture both physically and mentally, one individually result in elicitation of the relax- approach that avoids any attempts to ana- may pass into a relaxation state which is a ation response. lyze and interpret. prelude to meditation. During motionless The third mechanism of meditation Brain Model of posture the brain manifests typical brain induction is based on active mental process wave activity in the 12-16 Hz frequency without involvement of peripheral inputs or Meditation band as has been by reported by an eminent outputs. Most oriental meditative practices Several physiological studies (Anand, et American scientist Sterman (1977). heavily depend on manipulation of thought al., 1961; Wallace & Benson, 1972: However, meditation is more than simple processes (cognitive restructuring). Deepak, et al., 1994; Newberg et al., 2001) motionless posture (simple relaxation) as it Normally a single thought (depending upon and several brain imaging studies (Lazer, et involves active relaxation through learned degree of reward/punishment attached to it) al., 2000; Lou et al., 1999) have provided autosuggestion and relaxation of smooth is capable of inducing a chain of thought sufficient literature to put forth a functional musculature, thus, reducing autonomic activity associated with feelings of sensation, model to explain the phenomenon of medi- effects to a greater degree (Warenburg, et overt/covert feelings, emotional elaboration, tation. The model essentially presents four al., 1980). Efferent attenuation operates on muscle tension and a series of autonomic functional units, each associated with spe- the output side of the control system, and it responses. It has been observed that even a cific brain circuitry as depicted in Figure 1. reduces activity and stress on the muscular non-provoking stimulus can lead to certain The number of structural units exceeds the system (skeleto-motor system). This mecha- degree of generalized muscle tensing. All number of functional units (Figure 2). In nism is purely voluntary. It is noteworthy these effects can be effectively controlled by other words the structures present some here that there are many changes in the calming down the thought process. The overlap in their functioning. brain which follow generalized muscle need of cognitive restructuring as a third According to this model the prefrontal relaxation. Such reduction unloads the cen- mechanism of induction of meditation is cortex (the foremost and most advanced tral brain structures and consequently pro- explained by two facts. First, the combined part of the higher brain) initiates a desire to duces the significant beneficial effects of effect of the first two mechanisms efferent start meditation. The prefrontal cortex fur- relaxation and thereby can act as an anti- attenuation and sensory attenuation is mul- ther controls the process of attention and dote to any kind of stress-induced disease. tiplicative. That is, the total effect is more modifies it into a non-analytical one (func- The second mechanism of induction of than the sum of the two (Warenburg, et al., tional unit 1, Figure 1). This structure is meditation involves sensory attenuation, or 1980). Secondly, the types of verbal instruc- driven by the lower structures namely thala- the cutting-off of all the possible incoming tion given to/followed by the subject under- mus, pons and hippocampus that provide stimuli. Meditation practice usually requires going meditation practice emphasize the input from internal and external stimuli. the reduction of background stimulation of modification of attention. The mental Another large structure of the higher brain senses through the selection of a calm and process adopted consists of non-analytical (posterior parietal cortices) helps in arrest- quiet place for performing meditation. The ing the intruding thoughts. Thus, it pro-

30 Biofeedback Fall 2004 vides an opportunity for the brain to be active within. The activity keeps on shifting from one area to another. Since the parietal cortex deals with body perception, this may result in altered awareness of body and heaviness in limbs (functional unit 2, Figure 1). Another pair of bilateral brain structures (superior temporal cortices) helps in the execution of functional unit 3 (Figure 1). This unit helps in the scanning of internal memory traces that are continuously pre- sented to it in the face of a continuously decreasing barrage of external stimuli. This unit also helps in the genesis of a unique feel- ing of void and space and also in the perception of various sounds that have been reported in the literature. Since the temporal cor- tices are a storehouse for memories for emotions, there is a possibil- ity that this is involved in autonomic elaboration of emotions that are seen sometimes in long-term meditators during meditation (functional unit 3, Figure 1). All the above-mentioned functional units require rhythm generators. The necessity of rhythm is impor- tant to allow these functional units to execute their functions in a waxing and waning manner. Indeed, the induction of meditation is rhythmic in nature. The two structures of the lower brain (thala- mus and pons) have a capacity to generate driving rhythms. These rhythms drive the aforesaid higher brain structures (Figure 2). Fortunately, these two structures also have the capacity to control the incoming external stimuli. Figure 2 provides a description of incoming stimuli, the functional relationship of central brain struc- tures and the characteristics of the output of these structures involved in the process of meditation Conclusion Figure. 2. Characteristics of input and output, and neural structures involved in processing them during initial and sustained stage of meditation. The thin Clearly, meditation has a neural basis and through a component arrows represent the input / output pathways along which the activity is analysis we have dissected what is a holistic experience into its func- minimized. The dashed lined boxes are involved in initiation of meditation. tional units. These functional units do have neural substrates. The The thick lined boxes contain core structures involved in maintaining sustained brain model of meditation described here is simple and comprehen- meditative state. The thick lined arrows indicate the pathways along which sive. Although based on a reductionistic analysis, it is capable of idling rhythm is generated during sustained meditation. There are several other structures involved during initial phase (pre-meditation or inductive phase) and others, which are spontaneously active during sustained stage. Compare this model with functional units given in Fig 1. (Courtesy : editor, Indian Journal Physiology and Pharmacology, Dept of Physiology, All India Institute of Medical Sciences, New Delhi 110029, India).

accounting for the holistic experience of meditation and its effects. The model is not only useful for explaining the brain mechanisms underlying the basic psychophysiology of meditation, but may also be useful for the understanding for various brain disorders and drug-induced meditation-like experiences. References Anand, B.K., Chhina, G.S., and Singh, B. (1961). Some aspects of elec- troencephalographic studies in yogis. Electroencephalography and Clinical Neurophysiology, 13, 452-456. Benson, H. (1975). The relaxation response. New York: Avon Books, pp. 159- 161. Deepak, K.K. (2002). Neurophysiological mechanism of induction of medi- tation: a hypothetico-deductive approach. Indian Journal of Physiology and Pharmacology, 46, 136-158.

Figure 1. The functional model of brain functioning in the induction and sustenance of meditation. For details please refer to the text. Continued on page 36

Fall 2004 Biofeedback 31 Meditation and Limbic Processes Continued from page 27

Wallace, R. K., Benson, H., and Wilson, A. F. (1971). A wakeful hypometa- bolic physiologic state. American Journal of Physiology, 221, 795-799. Wikstrom, S., Gunnarsson, T., and Nordin, C. (2003). Tactile stimulus and neurohormonal response: a pilot study. The International Journal of Neuroscience, 113, 787-793. Woods, D. L., and Dimond, M. (2002). The effect of therapeutic touch on agitated behavior and cortisol in persons with Alzheimer’s disease. Biological Research in Nursing, 4, 104-114. Yang, R., Huang, Z. N., and Cheng, J. S. (2000). Anticonvulsion effect of acupuncture might be related to the decrease of neuronal and inducible nitric oxide synthases. Acupuncture and Electrotherapeutics Research, 25, 137-143. Yun, S. J., Park, H. J., Yeom, M. J., Hahm, D. H., Lee, H. J., and Lee, E. H. (2002). Effect of electroacupuncture on the stress-induced changes in brain- derived neurotrophic factor expression in rat hippocampus. Neuroscience Letters, 318, 85-88. Zhu, W., Ma, Y., Cadet, P., Yu, D., Bilfinger, T. V., Bianchi, E. et al. (2003). Presence of reticuline in rat brain: A pathway for morphine biosynthesis. Brain Research: Molecular Brain Research, 117, 83-90. Note i Corresponding author: George B. Stefano, PhD, Neuroscience Research Institute, State University of New York College at Old Westbury, P.O. Box 210, Old Westbury, New York, 11568, USA. Phone: 516-876-2732; Fax: 516-876-2727; E-mail: gstefano@sun- ynri.org

32 Biofeedback Fall 2004 SPECIAL TOPICS: MEDITATION, CHANGES IN CONSCIOUSNESS, AND HEALTH

Relationship between Meditation Practice and Transcendent States of Consciousness Frederick Travis, PhD, Fairfield, IA

Abstract: Research demonstrates that tran- how we deliberately control behavior. on anything else. (Prabhavananda, et al., scendental experiences during meditation prac- The “hard” questions are: What is the 2002) tice are characterized by distinct subjective nature of inner experience? The hard ques- This article explores the subjective and and objective patterns. Subjectively, the frame- tions cannot be investigated in the same objective correlates of this ‘fourth condition work for understanding waking experience— way that we investigate objects in the world of consciousness.’ It ends with a considera- time, space, and body sense— is absent during or observable behavior. tion of the practical benefits of contact with transcendental experiences. Physiologically, The objective western research tradition ‘the fourth.’ breath patterns, autonomic patterns, EEG has yielded a highly developed understand- Distinction between patterns, and patterns of cerebral metabolic ing of matter. It has penetrated to the non- rate distinguish transcendental experiences material quantum mechanical basis of Meditation and Simple from eyes-closed rest. Transcendental experi- matter and its interactions (Davies, 2001). Eyes-Closed Relaxation ences give a broader perspective of life. They Yet, our Western scientific tradition is still Modern science is beginning to investi- foster the development of an inner anchor of in its infancy in researching inner subjectiv- gate the reality of inner meditation experi- self-awareness that allows anyone to better ity. It still asks superficial questions about ences, and particularly transcendental deal with high stress and demanding situa- cortical and cognitive mechanisms of expe- experiences during meditation practice. The tions. Developing one’s sense of self is the basis rience rather than probing deep into the distinction between eyes-closed rest and for recovery from mental instability, substance nature of consciousness underlying cortical meditation practice is the subject of debate. abuse, addictions and criminal behavior. and cognitive processing. For instance, in 1984 Holmes reviewed the ...our normal waking consciousness, rational In contrast, the subjective traditions of meditation literature and reported no differ- consciousness as we call it, is but one special the East—the Vedic tradition of India ences in heart rate (16 studies), respiration type of consciousness, whilst all about it, (Maharishi, 1969), and the Buddhist tradi- rate (8 studies), electrodermal activity (13 parted from it by the flimsiest of screens, tions of China (Chung-Yuan, 1969) and studies), or blood pressure levels (4 studies) there lie potential forms of consciousness Japan (Reps, 1955)—include systematic entirely different. We may go through life during simple eyes-closed rest compared to meditation techniques predicted to lead to without suspecting their existence....No meditation practice (Holmes, 1984). account of the universe in its totality can be the state of “consciousness itself” without Holmes, however, looked at many sys- final that leaves these other forms of con- particular content in consciousness. For tems of meditation. Research is emerging sciousness quite disregarded. (James, 1962) instance, the Maitri Upanishad 6:19 states: suggesting that all meditation techniques pg. 305) When a wise man has withdrawn his mind are not the same (Orme-Johnson, et al., What are these ‘potential forms of con- from all things without, and when his spirit 1998). Different meditation practices have sciousness’ that are entirely different than of life has peacefully left inner sensations, let different steps of practice and different him rest in peace, free from the movements normal waking consciousness? Chalmers effects (Jin, 1992; Kabat-Zinn, et al., 1992; of will and desire.... Let the spirit of life has helped answer this question by catego- surrender itself into what is called turya, the Travis, et al., 2004). For instance, Qigong rizing questions about consciousness into fourth condition of consciousness. For it has involves moving “Qi” to different parts of easy and hard questions (Chalmers, 1995). been said: There is something beyond our the body by attending to an area of the The “easy” questions ask how we discrimi- mind that abides in silence within our mind. physiology while controlling inhalation and nate, categorize, and react to environmental It is the supreme mystery beyond thought. exhalation (Lim, et al., 1993); Vipassana or stimuli, how we report mental states, and Let one’s mind…rest upon that and not rest mindfulness-meditation involves attention

Fall 2004 Biofeedback 33 on the breath during eyes-closed medita- throughout the session. In the first minute Individuals’ descriptions gave insight into tion, and on the dispassionate, non-manip- of Transcendental Meditation practice, the nature of transcendental experiences ulative observation of ongoing perceptual, breath rate was lower, skin conductance lev- (cited from Travis, et al., 2000): bodily and/or mental states during eyes els —a marker of sympathetic tone—was During meditation, my thoughts become open tasks (Buchheld, et al., 2001); Yoga lower, high frequency heart rate variabili- less and less concrete, less and less absorbing, Nidra meditation involves visualization of ty—a marker of parasympathetic tone—was and often my mind becomes completely free various mental and bodily states (Lou, et higher, and frontal alpha EEG coherence of the grip of thinking and planning—then al., 1999; Lazar, et al., 2000); and the was higher. In addition, the levels of these I am. It is not an experience; there is nothing I can report about this state. I am complete- Transcendental Meditation technique four physiological measures in the first ly full, vibrant, and alive; but I am com- involves transcending—an effortless process minute of Transcendental Meditation prac- pletely still. It’s absolute silence. of experiencing more subtle levels of per- tice did not significantly differ from those A second individual echoes the difficulty ception, thoughts and feelings (Travis, measured at 5 or 10 minutes. of describing this inner experience with 2001), which culminates in the experience These studies lend strong support to the concepts used to describe ordinary waking of pure, self-referral consciousness; aware- assertion that Transcendental Meditation experiences: ness without mental content, referred to as practice differs from eyes-closed rest. Since Actually, it’s not that I experience ‘Oh, “pure consciousness” (Maharishi, 1969). all meditations are not the same in practice how great this is!’, but it’s an inner peace Since meditation practices are different, or results, similar comparative studies need that is very, very nourishing. It’s a feel- mixing together results of studies using dif- to be conducted with other meditation prac- ing of freedom, of no restraints. In this ferent meditations together in one analysis, tices as well. For example, differences state boundaries do not exist. Time has as Holmes did, would mix different subjec- between meditation practice and eyes-closed no meaning. Space has no meaning. I tive and physiological effects and so con- rest are also reported in neuroimaging stud- feel right at home. It is normal func- found valid comparisons between ies. One example is Newberg’s work demon- tioning. Everything seems right. eyes-closed rest and meditation practice. strating that Tibetan Buddhism (Newberg, Physiological Patterns A meta-analysis by Dillbeck and Orme- et al., 2001) and Christian prayer (Newberg, during Transcendental Johnson (Dillbeck, et al., 1987) focused on et al., 2003) differ from eyes-closed rest by studies solely comparing Transcendental higher frontal and lower parietal cerebral Experiences Meditation practice to eyes-closed rest. In metabolic rate during the practice. Various physiological markers have been addition, they transformed group differ- Content Analysis of reported during transcendental experiences ences into “effect sizes” (Cohen, 1988), and in subjects practicing different meditation conducted statistics on these effect sizes Transcendental techniques. For instance, during practice of (Glass, et al., 1981). This quantitative Experiences Tibetan Buddhism, experiences character- meta-analytic approach is a more rigorous, To identify common themes of transcen- ized by the “loss of the usual sense of space reliable method of drawing conclusions dental experiences, individuals’ descriptions and time” were associated with increased from many studies than is the qualitative of that experience can be analyzed. A con- frontal regional cerebral blood flow, and sig- “roll-call” system of meta-analysis used by tent analysis of 64 descriptions of transcen- nificant correlation between left dorsolateral Holmes (Hunter, et al., 1990). dental experiences during Transcendental frontal blood flow increases and left parietal Dillbeck and Orme-Johnson found that Meditation practice yielded three common blood flow decreases (Newberg, et al., Transcendental Meditation sessions were themes: “unboundedness,” “silence,” and 2001). During practice of Diamond Way distinguished from eyes-closed rest by sig- “the absence of time, space and body sense” Buddhism, experiences of the “dissolution nificantly lower breath rates (22 studies), (Travis, et al., 2000). Sense of time, space, of the self into a boundless emptiness” were plasma lactate levels (9 studies), and skin and body sense are characteristics that con- associated with right fronto-temporal 40- conductance levels (20 studies) (Dillbeck, et tribute to the framework for understanding Hz amplitude increases (Lehmann, et al., al., 1987). waking experience and specific qualities 2001). During Transcendental Meditation The distinction between eyes-closed rest (color, shape, size, movement, etc.) are its practice, experiences of “unboundedness” and Transcendental Meditation practice has content. During transcendental experiences, and the “loss of time, space and body sense” also recently been tested with a random- both the fundamental framework and the were associated with (1) spontaneous breath assignment within-subjects design that content of waking experience are reported quiescence (breath periods from 10-40 sec) allows for strong cause-effect inferences to to be absent. (Farrow, et al., 1982; Badawi, et al., 1984; be made (Travis, et al., 1999). This study These findings suggest that transcenden- Travis, et al., 1997), (2) autonomic orient- supported the assertion that Transcendental tal experiences are not “altered” states of ing at the onset of breath changes (Travis, et Meditation practice differs from eyes-closed waking. Rather, they reflect a state funda- al., 1997), (3) increase in frequency of peak rest. It also revealed a new finding. mentally different from waking — all the power in the alpha band (Badawi, et al., Differences between eyes-closed rest and customary qualities and characteristics of 1984; Travis, et al., 1997), and (4) contin- Transcendental Meditation practice were waking experience are not part of transcen- ued high EEG coherence, which rose to seen in the first minute, and continued dental experiences. high levels in the first minute of meditation

34 Biofeedback Fall 2004 practice (Travis, et al., 1997; Travis, et al., in (1) greater reductions in anxiety (Eppley, basis for recovery from addiction and men- 1999). et al., 1989) (144 studies), (2) greater tal instability (O’Connell, et al., 1994). There is a great design-challenge inherent reductions in hypertension (Eisenberg, et Conclusion in this research: How can one reliably mark al., 1993) (26 studies), (3) greater reduc- the onset of transcendental experiences? tions in the use of alcohol and tobacco Distinct subjective and objective markers Some researchers have used subject-initiated (Alexander, et al., 1994) (N=198 studies), characterize transcendental experiences. signals — the meditator pulls a string (4) greater increases in self-concept (Orme- Subjectively the framework for understand- (Newberg, et al., 2001), or presses a button Johnson, et al., 1998) (51 studies), and (5) ing waking experience— time, space, and (Farrow, et al., 1982) to mark the occur- greater increases in self-actualization body sense— is absent during transcenden- rence of transcendental experiences during (Alexander, et al., 1991) (42 studies). In tal states. Physiologically, breath patterns, meditation. Other researchers have used addition, the Transcendental Meditation autonomic patterns, EEG patterns, and pat- experimenter-initiated signals, such as a bell technique has been used successfully in terns of cerebral metabolic rate distinguish ring after key physiological markers are seen prison settings, resulting in a 40% decrease transcendental experiences from eyes-closed (e.g. spontaneous breath quiescence). After in recidivism (Rainforth, et al., in press). rest. Meditative experiences offer a new the meditation practice, subjects were asked The clinical benefits of transcendental angle to help clinical populations. Working to classify different bell rings (maximum of experiences can be understood in terms of a from the “inside” one gains a broader per- three) into different experience-categories. movie-metaphor. When watching a movie, spective on life and thus is better able to One of the bell-rings was after a transcen- most individuals are “lost” in the movie. deal with high stress and demanding situa- dental experience (Travis, et al., 1997). The movie is real. Your emotions and tions more effectively. This growth of sense- The design-challenge here is obvious. thoughts are dictated by the ever-changing of-self through meditative practice may be When a meditator can signal, he/she would sequence of the film. Your sense of well- the mechanism for its effectiveness in no longer be having an experience that is being is constantly shadowed by traffic jams addressing a wide range of clinical prob- beyond time and space. To signal, you must on the freeway, angry outbursts from a lems. be in time and space. Despite these major friend or family, insensitive remarks by co- References design problems, repeatable patterns in workers, and inadvertent mistakes that you Alexander, C., P., R., & Rainforth, M. (1994). breath, autonomic markers and EEG coher- or others make. This leads to high mental Treating and preventing alcohol, nicotine, and drug abuse through Transcendental Meditation: A review ence are reported during transcendental and physical stress levels resulting in high and statistical meta-Analysis. Alcohol Treatment experiences. anxiety, depression, low self-esteem, and Quarterly, 11, 13-87. Clinical Benefits of stress-related diseases. Although you try to Alexander, C., Rainforth, M., & Gelderloos, P. deal with your feelings, which are real, there (1991). Transcendental Meditation, self-actualiza- Transcendental is a tendency to misattribute the source of tion, and psychological health: A conceptual overview and statistical meta-analysis. Journal of Experiences these feelings solely to the external circum- Social Behavior and Personality, 5, 189-247. The clinical benefits of transcendental stances while being relatively unaware of the Badawi, K., Wallace, R.K., Orme-Johnson, D., experiences arise from the psychological fact role of your subjective perception and inter- & Rouzere, A.M. (1984). Electrophysiologic char- pretation of these circumstances. acteristics of respiratory suspension periods occur- that we do not respond to events them- ring during the practice of the Transcendental selves, but to our perception of those events Repeated transcendental experiences alter Meditation Program. Psychosomatic medicine, 46(3), (James, 1962; Biederman, 1985). Regular this common “movie-going experience”. 267-76. transcendental experiences change our per- Subjectively, you begin to “wake up” to Biederman, L. (1985). Human image under- ception of who we are, and so naturally give your inner status. Although continuing to standing: Recent research and a theory. Computer Vision, Graphics, and Image Processing, 32, 29-73. a different perspective to all experiences enjoy the movie, you gradually become aware that you exist independent from the Buchheld, N., Grossman, P., & Walach, H. (Travis, et al., 2004). This has led to meas- (2001). Measuring mindfulness in insight urable benefits of Transcendental movie. You experience a value of ‘witness- Meditation (Vipassana) and Meditation-Based Meditation practice for a variety of clinical ing’ the activity around you (Travis, et al., Psychotherapy. Journal for Meditation and populations. O’Connell and Alexander in 2004). Then, the ever-changing movie- Meditation Research, 1(1), 10-33. Chalmers, D.J. (1995). The puzzle of conscious their book Self-Recovery report successful frames are a secondary part of experience because those frames are always changing. experience. Scientific American, 107, 80-86. application of the Transcendental Chung-Yuan, C. (1969). Original teachings of Meditation technique to improve the condi- The most salient part of every experience is Ch’an Buddhism. New York: Vintage Books. tion of alcoholics, smokers, substance your inner expanded self-awareness. What is Cohen, J. (1988). Statistical power analysis for the abusers, addicts, dysfunctional families, and ‘real’ shifts from the movie to your self, behavioral sciences. Hillsdale, New Jersey: Hove and high-security prisoners (O’Connell, et al., from outer to inner. As your sense-of-self London. 1994). Meta-analyses, which pool results changes, so your perspective on the prob- Davies, P.C. (2001). Quantum vacuum noise in lems and challenges you face change. You physics and cosmology. Chaos, 11(3), 539-547. from many studies, report that Dillbeck, M.C., & Orme-Johnson, D.W. (1987). Transcendental Meditation practice com- see them as temporary challenges rather Physiological differences between Transcendental pared to other meditation practices results than overwhelming odds. This shift in per- Meditation and rest. American Psychologist, 42, 879- spective from outer to inner could be a new 881.

Fall 2004 Biofeedback 35 Eisenberg, D.M., Delbanco, T.L. and Berkey, C.S. (1993). Cognitive behav- Orme-Johnson, D.W., & Walton, K.G. (1998). All approaches to preventing ioral techniques for hypertension: Are they effective? Annual Journal of Internal or reversing effects of stress are not the same. American Journal of Health Medicine, 118, 964-972. Promotion, 12(5), 297-9. Eppley, K.R., Abrams, A.I. and Shear, J. (1989). Differential effects of relax- Prabhavananda, S., & Manchester, F., Eds. (2002). The Upanishads: Breath of ation techniques on trait anxiety: A meta-analysis. Journal of Clinical Psychology, the eternal. New York: Signet. 45(6), 957-974. Rainforth, M., Bleick, C., & Alexander, C.N. (in press). A 13-year follow-up Farrow, J.T., & Hebert, J.R. (1982). Breath suspension during the transcen- on recidivism rates of Folsom prison inmates who practiced the Transcendental dental meditation technique. Psychosomatic medicine, 44(2), 133-53. Meditation program. 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Jin, P., & Department of Psychology, L.T.U.B.V.A. (1992). Efficacy of Tai Travis, F., & Pearson, C. (2000). Pure consciousness: distinct phenomeno- Chi, brisk walking, meditation, and reading in reducing mental and emotional logical and physiological correlates of “consciousness itself”. The International stress. Journal of Psychosomatic Research, 36(4), 361-70. Journal of Neuroscience, 100, 77-89. Kabat-Zinn, J., Massion, A.O., Kristeller, J., Peterson, L.G., Fletcher, K.E., Travis, F., & Wallace, R.K. (1997). Autonomic patterns during respiratory Pbert, L., Lenderking, W.R., & Santorelli, S.F. (1992). Effectiveness of a medi- suspensions: possible markers of Transcendental Consciousness. Psychophysiology, tation-based stress reduction program in the treatment of anxiety disorders. The 34(1), 39-46. American Journal of Psychiatry, 149(7), 936-43. Travis, F. and Wallace, R.K. (1999). Autonomic and EEG patterns during Lazar, S.W., Bush, G., Gollub, R.L., Fricchione, G.L., Khalsa, G., & eyes-closed rest and transcendental meditation (TM) practice: the basis for a Benson, H. (2000). Functional brain mapping of the relaxation response and neural model of TM practice. Consciousness and Cognition, 8(3), 302-18. meditation. Neuroreport, 11(7), 1581-5. Lehmann, D., Faber, P.L., Achermann, P., Jeanmonod, D., Gianotti, L.R., & Note Pizzagalli, D. (2001). Brain sources of EEG gamma frequency during volition- Corresponding author: [email protected] ally meditation-induced, altered states of consciousness, and experience of the Phone 641-472-7000 x. 3309, self. Psychiatry Research, 108(2), 111-21. Fax: 641-472-1123 Lim, Y.A., Boone, T., Flarity, J. and Thompson, W. (1993). Effects of Qigong on Cardiorespiratory Changes. The American Journal of Chinese Medicine, 21, 1-6. Lou, H.C., Kjaer, T.W., Friberg, L., Wildschiodtz, G., Holm, S. and Nowak, Brain Mechanisms of Meditation M. (1999). A 15O-H2O PET study of meditation and the resting state of nor- Continued from page 31 mal consciousness. Human Brain Mapping, 7(2), 98-105. Maharishi (1969). Maharishi Mahesh Yogi on the Bhagavad Gita. New York: Penguin. Deepak, K.K., Manchanda, S.K., and Maheshwari, M.C. (1994). Newberg, A., Alavi, A., Baime, M., Pourdehnad, M., Santanna, J., & Meditation improves clinicoencephalographic measures in drug-resistant d’Aquili, E. (2001). The measurement of regional cerebral blood flow during epileptics. Biofeedback and Self Regulation, 19(1), 25-40. the complex cognitive task of meditation: a preliminary SPECT study. Lazar, S.W., Bush, G., Gollub, R.L., Frichhione, G.L., Khalsa G., and Psychiatry Research. 106(2), 113-22. Benson, H. (2000). Functional brain mapping of relaxation response and med- Newberg, A., & Iversen, J. (2003). The neural basis of the complex mental itation. Neuroreport, 11(7), 1581-1585. task of meditation: Neurotransmittor and neurochemical considerations. Lou, H.C., Kjaer, T.W., Friberg, L., Wildschiodtz, G., Holm, S., and Medical Hypotheses, 61, 282-291. Nowak, M. (1999). A 150-H20 PET study of mediatation and resting state O’Connell, D., & Alexander, C.N. (1994). Self recovery. Binghamton, N.Y.: of normal consciousness. Human Brain Mapping, 7(2), 98-105. Harrington Park Press. Newberg, A., Alavi, A., Baime, M., Pourdehnad, M., Santanna, J., and d’Aquili, E.G. (2001). The measurement of regional cerebral blood flow during the complex cognitive task of meditation: a preliminary SPECT study. Psychiatry Research, 106(2), 113-122. Sterman, M.B. (1977). Sensorimotor EEG operant conditioning: experi- mental and clinical effects. Pavlovian Journal Biological Sciences, 12, 63-92. Travis, F., and Wallace, R.K. (1999). Autonomic and EEG patterns during eye-closed rest and transcendental meditation practice: The basis for a neural Free BioGraph InfinitiTM Workshops model of TM practice. Consciousness and Cognition, 4, 159-162. Wallace, R.K. and Benson, H. (1972). The physiology of meditation. We are offering FREE one day workshops on “How to Scientific American, 226(2), 85-90. get the most out of your BioGraph Infiniti Software.” Warenburg, S., Oagano, R.R., Woods, M., and Hlastala M. (1980). A com- We will be holding these workshops across North parison of somatic relaxation and EEG activity in classical progressive relax- America periodically. ation and transcendental meditation. Journal of Behavioral Medicine, 3(1), 73-93. Thought Technology Ltd. Please visit our website Tel: (800) 361-3651 • 514-489-8251 Note 1 for more information. Fax: 514-489-8255 Address all correspondence to K. K. Deepak, MD, PhD, New http://www/thoughttechnology.com Delhi, India at e-mail address: [email protected]

36 Biofeedback Fall 2004 SPECIAL TOPICS: MEDITATION, CHANGES IN CONSCIOUSNESS, AND HEALTH

Meditation and Transformation: The Role of Reperceivingi Shauna L. Shapiro, PhDii, Santa Clara, CA, and John Astin,iii San Francisco, CA

Abstract: The intention of this paper is to studies to evaluate the Shauna L. Shapiro, PhD John Astin explore the questions: “What exactly is mind- efficacy of mindfulness- fulness? And, how does it work?” In attempt to based interventions such define mindfulness, we suggest three essential as the Mindfulness components (axioms): (1) Intention, (2) Based Stress Reduction Attention, and (3) Attitude (IAA). In attempt (MBSR) program. This line of research pri- the recent development of two valid and to explore how mindfulness works, a meta- marily addressed the first order question “Is reliable measures of mindfulness (see Brown mechanism of action, “reperceiving” is intro- mindfulness effective?” The studies led to and Ryan, 2003, Bishop, 2002). A testable duced. Reperceiving is a shift in perspective promising data suggesting that mindfulness theory of the mechanisms involved in the (making what was subject, object) which is an effective intervention for treatment of process of mindfulness itself is needed to allows increasing capacity for objectivity about both psychological and physical symptoms explicate how mindfulness effects change one’s own internal experience. We suggest this (see Baer, 2003; Bishop, 2002). Clearly this and transformation The aim of this paper is shift in perspective underlies the transforma- line of research is fundamental to validating to propose a first draft of such a theory, tional effects of mindfulness. mindfulness as an efficacious psychological focusing on mindfulness itself, as opposed Recently, the psychological construct intervention, and controlled clinical trials to the whole package of MBSR and other mindfulness has received a great deal of across diverse populations should continue. mindfulness-based interventions. attention. Mindfulness has its roots in However, an equally important direction We would like to emphasize that this is a Eastern contemplative traditions and is for future research is to address the second beginning, a first attempt at understanding most often associated with the formal prac- order question “How do mindfulness-based the mysterious and complex process of tice of mindfulness meditation. In fact, interventions actually work?” Investigating mindfulness. Further, it is “a” theory, not mindfulness has been called “the heart” of questions concerning the mechanisms of “the” theory – it is a search for common Buddhist meditation (Kabat-Zinn, 2003; action underlying mindfulness-based inter- ground on which to build a more precise Thera, 1962). Mindfulness, however, is ventions will require two different but com- understanding of the primary mechanisms more than meditation, it is “inherently a plementary lines of exploration. The first of action involved in mindfulness practices state of consciousness” which involves con- approach involves dismantling studies to that have made their way into contempo- sciously attending to one’s moment to separate and compare the various active rary psychology and behavioral medicine. moment experience (Brown and Ryan, ingredients in mindfulness-based interven- Our intention is to open a dialogue. 2003). The meditation practice is simply a tions such as social support, relaxation, and How does mindfulness work? We posit means to develop the state, or skill, of cognitive behavioral elements. The second three components (axioms) of mindfulness: mindfulness. The intention of this paper is approach involves examination of the cen- (1) Intention, (2) Attention, and (3) to refine the exploration of this particular tral construct of mindfulness itself, to deter- Attitude (IAA). We then introduce a meta- state of mindfulness and to explore the mine if the development of “mindfulness” is mechanism of action, “reperceiving” and questions: “What exactly is mindfulness? what actually leads to the positive changes discuss the significance of this shift in per- And, how does it work?” that have been observed, rather than other spective in terms of the transformational Over the past 20 years the majority of common characteristics of mindfulness pro- effects of mindfulness. research has focused on clinical intervention grams. This step can be facilitated through

Fall 2004 Biofeedback 37 A Model of Mindfulness (32). He continues, “I used to think that However, the quality of this attention, the The Axioms. In an attempt to break meditation practice was so powerful …that attitudes we infuse it with define the atten- mindfulness down into a simple, compre- as long as you did it at all, you would see tion itself. Attention can have a cold, criti- hensible construct, we reflected on the core growth and change. But time has taught me cal quality, or it can include an “an components of the practice, the essential that some kind of personal vision is also affectionate, compassionate quality…a sense building blocks of mindfulness. An often necessary” (1990, p.46). The inclusion of of openhearted, friendly presence and inter- cited definition of mindfulness — “paying intention (i.e., why one is practicing) as a est” (Kabat-Zinn, 2003, p. 145). It is help- attention in a particular way: on purpose, in central component of mindfulness is crucial ful to note that the Japanese characters of the present moment, and nonjudgmentally” to understanding the process as a whole. mindfulness are composed of two interac- (Kabat-Zinn, 1994, p. 4) — embodies the Axiom II. Attention. A second funda- tive figures: one mind, and the other heart three axioms of mindfulness: mental component of mindfulness is atten- (Santorelli 1999). Therefore, perhaps a 1. “On purpose” = Intention, tion. In the context of mindfulness practice, more accurate translation from the Japanese 2. “Paying attention” = Attention, paying attention involves observing the is heart-mindfulness (Shapiro and Schwartz, 3. “In a particular way” = Attitude operations of one’s moment-to-moment in preparation), which underlines the (mindfulness qualities) internal and external experience. This is importance of including “heart” qualities in Axioms are fundamental building blocks what Husserl refers to as a “return to things the attentional practice of mindfulness (see out of which other things emerge. We sug- themselves”. That is, suspending all the Shapiro and Schwartz, 2000 for review). gest that Intention, Attention and Attitude ways of interpreting experience and attend- We posit that persons can learn to attend are the fundamental components of mind- ing to experience itself, as it presents itself to their own internal and external experi- fulness. From an understanding of IAA we in the here and now. In this way one learns ences, without evaluation or interpretation, can deduce how mindfulness might work. to attend to the contents of consciousness, and practice acceptance, kindness and Intention, Attention, and Attitude are not moment by moment. Attention has been openness even when what is occurring in separate processes or stages—they are inter- suggested in the field of psychology as criti- the field of experience is contrary to deeply woven aspects of a single cyclic process and cal to the healing process. For example, held wishes or expectations. With training, occur simultaneously (see Figure 1). Gestalt therapy emphasizes present moment one becomes increasingly able to take inter- Mindfulness is this moment to moment awareness, and its founder, Fritz Perls est in each experience as it arises and also process. claimed that, “attention in and of itself is allow what is being experienced to pass Axiom I. Intention. When Western psy- curative.” The importance of attention can away (i.e., not be held on to). Through chology attempted to extract the essence of also be seen in cognitive-behavior therapy, intentionally bringing the attitudes of mindfulness practice from its original reli- which is based on the capacity to attend to patience, compassion and non-striving to gious/cultural roots, we lost, to some extent, (i.e., observe) internal and external behav- the attentional practice, one develops the the aspect of Intention, which for iors. At the core of mindfulness, is this capacity not to seek out pleasant experi- Buddhism was enlightenment and compas- practice of paying attention. ences, or to push aversive experiences away. sion for all beings. It seems valuable to Attention is distinct from awareness. In fact, attending without bringing the explicitly bring this aspect back into our Awareness can be thought of as “knowing” heart qualities into the practice may result model. As Kabat-Zinn writes, “Your inten- whereas attention is what directs and/or in practice that is condemning or judgmen- tions set the stage for what is possible. They focuses our awareness. Mindfulness is a tal of inner experience. Such an approach remind you from moment to moment of form of awareness, a particular kind of may well have consequences contrary to the why you are practicing in the first place” knowing which allows the ontological status intentions of the practice such as cultivating of the object to be recognized, as one is able the patterns of judgment and striving to see things as they are. As Brown and instead of equanimity and acceptance. Ryan eloquently put it, “awareness and Proposing “a” Theory. We suggest that attention are intertwined, such that atten- the 3 axioms, IAA, are the fundamental tion continually pulls “figures” out of the components (or internal behaviors from a “ground” of awareness…” (2003, p.822). Behaviorist perspective) of mindfulness. We Axiom III. Attitude. However, how we posit that they account directly or indirectly attend is also essential. The qualities one for a large amount of the variance in the brings to attention have been referred to as transformations that are observed in mind- the attitudinal foundations of mindfulness fulness practice. Building on these behav- (Kabat-Zinn, 1990, Shapiro and Schwartz, iors, we propose a meta-mechanism of 1999, 2000). This axiom asserts that the mindfulness, which suggests that intention- attitude one brings to the attention is essen- ally attending with openness and nonjudg- tial. Often, mindfulness is associated with mentalness leads to a significant shift in bare awareness, and the quality of this perspective, which we term reperceiving. Figure 1 awareness is not explicitly addressed.

38 Biofeedback Fall 2004 Reperceiving as Meta Mechanism. However, as he develops, a shift in perspec- which he had previously been embedded. Reperceiving involves a fundamental shift in tive occurs such that there is an ever- However, in this case, the dis-identification perspective, which allows what was previous- increasing capacity to take the perspective is from the content of one’s mind (e.g., ly subject, to become object. Reperceiving is of another (e.g., “my mother’s needs are dif- thoughts, feelings, self-concepts, memories) akin to the western psychological concepts ferent from mine”), precisely because what rather than one’s physical environment. of decentering (Safran and Segal, 1990), was previously subject (identification with Through reperceiving brought about by the deautomatization (Deikman, 1982; Safran the mother) has now become an object cultivation of mindfulness, the stories that and Segal, 1990) and detachment (Bohart, which he subsequently realizes he is now were previously identified with so strongly 1983). For example, Safran and Segal define separate from (no longer fused with). This become simply “stories.” In this way, there decentering as the ability to “step outside of is the dawning of empathy, the awareness of is a profound shift in one’s relationship to one’s immediate experience, thereby chang- his mother as a separate person with her thoughts and emotions, the result being ing the very nature of that experience.” own needs and desires. The example greater clarity, perspective, objectivity, and (117) Deikman describes dautomatizaition demonstrates that as individuals are able to ultimately equanimity. This process is simi- as “an undoing of the automatic processes shift their perspective away from the narrow lar to Hayes and colleagues’ (1999) concept that control perception and cognition.” (p. and limiting confines of their own personal of cognitive diffusion, in which the empha- 137). And according to Bohart (1983), points of reference, development occurs. sis is on changing the context of one’s rela- detachment “encompasses the interrelated Mindfulness Practice Continues tionship to mental activity rather than the processes of gaining ‘distance,’ ‘adopting a Developmental Process. If we view reper- specific content of the mental activity itself. phenomenological attitude,’…and the ceiving as a naturally occurring develop- Disidentification with Sense of “self.” The expansion of ‘attentional space’.” (see mental process, we can see meditation as a next step in the developmental process can Martin, 1997 for review). All of these con- means of continuing or accelerating the be a shift in perspective as applied to self- cepts share at their core a fundamental shift multi-step process of development. The concept. As one strengthens the capacity for in perspective. This shift, we believe, is facili- next step in this process, is an increasing self-witnessing/inner observation, there is tated through mindfulness – the process of capacity for objectivity in relationship to often a corresponding shift in self-sense. intentionally attending moment by one’s internal/external experience. As The “self” starts to be seen through or moment with openness and non-judgmen- Goleman suggests, “The first realization in deconstructed, and is realized to be a psy- talness (IAA). ‘meditation’ is that the phenomena contem- chological construction, an ever-changing Reperceiving and Development. plated are distinct from the mind contem- system of concepts, images, sensations and Reperceiving can be described as a rotation plating them” (1980, p. 146). beliefs. These aggregates, or constructs that in consciousness in which what was previ- Disidentification with Contents of were once thought to comprise the stable ously “subject” becomes “object.” This shift Consciousness. Through the process of self, are eventually seen to be impermanent in perspective (making what was subject, intentionally focusing nonjudgmental atten- and fleeting. Through reperceiving not only object) has been heralded by developmental tion on the contents of consciousness, the do we learn to stand back from and observe psychologists as key to development and mindfulness practitioner begins to strength- our “story” or inner commentary about life growth across the lifespan (see Kegan, en what Deikman refers to as “the observ- and the experiences encountered, we also Wilber, Piaget). Therefore, if reperceiving is ing self”. To the extent we are able to begin to stand back from (witness) our in fact a meta-mechanism underlying mind- observe the contents of consciousness, we “story” about who and what we ultimately fulness, then the practice of mindfulness is are no longer completely embedded in or are. Through this shift in perspective, iden- simply a continuation of the naturally fused with such content. For example, if we tity begins to change from the contents of occurring human developmental process are able to see it, than we are no longer consciousness to awareness itself. It is this whereby one gains an increasing capacity merely it; i.e., we must be more than it. figure/ground shift that may be responsible for objectivity about one’s own internal Whether the it is pain, depression, or fear, for the transformations facilitated through experience. reperceiving allows one to dis-identify from mindfulness practice. This natural developmental process is thoughts, emotions, body sensations as they Connection with Larger “Self.” As illustrated in the classic example of a moth- arise, and simply be with them instead of noted, reperceiving involves the develop- er’s birthday, in which her 8-year son gives being defined (i.e., controlled, conditioned, ment of a meta-cognition, a witnessing her flowers, while her 3-year old gives her determined) by them. Through reperceiving awareness that can stand back and observe his favorite toy. Although developmentally we realize, “this pain is not me,” “this the workings of the mind. As we discussed, appropriate, the 3-year old is basically depression is not me,” “these thoughts are the capacity to observe our ever-changing caught in the limits of his own self-centered not me,” as a result of being able to observe inner experience –thoughts, feelings, con- (i.e., narcissistic) perspective. For him, the them from a meta-perspective. cepts, memories, perceptions, sensations – world is still largely “subjective,” that is, an The shift in perspective is analogous to facilitates dis-identification from such men- extension of his self (preconscious fusion). our earlier example of the young toddler tal-emotional content, which in turns fos- And as a result, he cannot clearly differenti- who over time is eventually able to see him- ters greater cognitive-behavioral flexibility ate his own desires from those of another. self as separate from the objective world in and less automatic reactivity. As one

Fall 2004 Biofeedback 39 strengthens the capacity for self- Bohart, A. (1983). Detachment: a variable com- Safran, J.D., and Segal, Z.V. (1990). witnessing/inner observation, there is often mon to many psychotherapies? Paper presented at the Interpersonal process in cognitive therapy. New York: 63rd Annual Convention of the Western Basic Books. a corresponding shift in self-sense. This Psychological Association, San Francisco, CA. Santorelli, S. (1999). Heal thy self: lessons on shift in identity may then give space for the Borkovec, T.D. (2002). Life in the future versus mindfulness in medicine. New York: Random arising of a larger sense of “Self” which life in the present. Clinical Psychology: Science and House. transcends and includes all experience. This Practice, 9, 76-80. Segal, Z.V., Williams, J.M.G., and Teasdale, J.D. “Self” contains both “other” and small Brown, K.W., Ryan, R.M. (2003). The benefits (2002). Mindfulness-based cognitive therapy for of being present: mindfulness and its role in psy- depression: a new approach to preventing relapse. New “self” and recognizes there is no distinction chological well-being. Journal of Personality and York: Guilford Press. between the two. This larger “Self” has Social Psychology, 84(4), 822-848. Shapiro (1992). been referred to as “true nature”, “Buddha Deikman, A.J. (1982). The observing self. Boston: Shapiro, S.L., and Schwartz, G.E.R. (1999). nature”, “witness”, “awareness”, and “pure Beacon Press. Intentional systemic mindfulness: an integrative consciousness”. Goleman, D. (1980). A map for inner space. In model for self-regulation and health. Advances in R.N. Walsh and F. Vaughan (Eds.), Beyond ego (pp. Mind-Body Medicine, 15, 128-134. Summary 141-150). Los Angeles: J.P. Tarcher. Shapiro SL and Schwartz GE. (2000). The role In summary, we posit that the state of Hayes, S.C., Strosahl, K., and Wilson, K.G. of intention in self-regulation: Toward intentional mindfulness is composed of three axioms, (1999). Acceptance and commitment therapy: an systemic mindfulness. In Monique Boekaerts, Paul experiential approach to behavior change. New York: R. Pintrich, Moshe Zeidner (Eds.) Handbook of Intention, Attention and Attitude (IAA). Guilford. Self-Regulation, 253-273. Academic Press, NY. When IAA are simultaneously cultivated, Hayes, S. (2002). Acceptance, mindfulness and Teasdale, J.D., Segal, Z.V., and Williams, J.M.G. the state of mindfulness arises. Through this science. Clinical Psychology: Science and Practice, 9, (2003). Mindfulness training and problem formula- process, reperceiving occurs, facilitating a 101-106. tion. Clinical Psychology: Science and Practice, 10, 157-160. dramatic shift in perspective. This shift, we Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, Thera, N. (1962). The heart of Buddhist medita- suggest, is at the heart of the change and pain and illness. New York: Delacorte. tion. New York: Weiser. transformation affected by mindfulness Kabat-Zinn, J. (1994). Wherever you go, there you practice. Further, this shift is simply a con- are: mindfulness meditation in everyday life. New Notes tinuation (or acceleration) of the naturally York: Hyperion. iThe authors would like to acknowledge occurring developmental process. Kabat-Zinn, J. (2003). Mindfulness-based inter- the Center for Mindfulness and Health ventions in context: past, present, and future. The developmental process can be rough- Clinical Psychology: Science and Practice, 10, 144- Care, which invited the talk on ly summarized as following 5 steps: (1) 156. Mechanisms of Mindfulness, March 2004, preconscious fusion . (2)) Through reper- Martin, J.R. (1997, April). Limbering across from which this paper is based. We also ceiving we are able to experience a separa- cognitive-behavioral, psychodynamic and systems acknowledge Linda Carlson for her contri- tion of self from other. (3)As we continue orientations. In J.R. Martin (Chair), Retooling for bution. Dr. Shapiro also acknowledges her integration: perspectives on the training of post-licensed to develop the capacity to reperceive, we are psychotherapists. Symposium presented at the 13th parents, Johanna and Deane Shapiro, and able to separate self from the contents of annual conference of the Society for the in particular, her grandfather, Benedict consciousness. (4) This shift in relationship Exploration of Psychotherapy Integration, Toronto, Freedman, who significantly contributed to to experience often corresponds a decon- Canada. developing the ideas for this paper. struction of sense of “self.”(5)As awareness Nolen-Hoeksema, S., and Morrow, J. (1991). A prospective study of depression and posttraumatic ii continues to be refined and expanded a stress symptoms after a natural disaster: The 1989 Correspondence directed to Shauna L. state of consciousness ensues which includes Loma Prieta earthquake. Journal of Personality and Shapiro, PhD Counseling Psychology both other and “self” and recognizes there Social Psychology, 61, 115-121. Department. Santa Clara University. is not distinction between the two. This Ryan, R.M., and Deci, E.L. (2000). Self-deter- 500 El Camino Real. Santa Clara, CA. mination theory and the facilitation of intrinsic developmental process is best captured motivation, social development, and well-being. 95053-0201. [email protected] through the Hindu saying American Psychologist, 55, 68-78. ii1California Pacific Medical Center, San When I forget who I am I serve you. Ryan, R.M., Kuhl, J., and Deci, E.L. (1997). Francisco, CA. Through serving I remember who I am, Nature and autonomy: an organizational view of And know that I am you” social and neurobiological aspects of self-regulation in behavior and development. Development and References Psychopathology, 9, 701-728. Baer, R.A. (2003). Mindfulness training as a clinical intervention: a conceptual and empirical review. Clinical Psychology: Science and Practice, 10, EEG/QEEG Data Base Receives FDA Approval 125-143. The NeuroGuide EEG and QEEG software has received FDA 510k approval for the Barlow, D.H., and Craske, M.G. (2000). Mastery sale of the normative database and discriminant function software as a medical device. of your anxiety and panic (3rd ed.). New York: The FDA approval number is K041263. FDA registration promotes high standards and Psychological Corporation. general acceptance of quantitative EEG. Go to www.appliedneuroscience.com to read Bishop, S.R. (2002). What do we really know about mindfulness-based stress reduction? more. (This brings to two the number of QEEG software analysis systems that have Psychosomatic Medicine, 64, 71-83. gained FDA approval, including NX Link and NeuroGuide).

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Bio-Medical Instruments Inc. bio-medical.com 2387 E. 8 Mile Road, Warren, MI 48091 SPECIAL TOPICS: MEDITATION, CHANGES IN CONSCIOUSNESS, AND HEALTH Mindfulness-Based Stress Reduction: Overview and Applications in Canceri Linda E. Carlson, PhD, Calgary, Alberta, Canada

Abstract: The origin and format of courses. So what is this magic bullet that’s Clinical Applications of Mindfulness-Based Stress Reduction (MBSR) taking the health care system by storm? is introduced, followed by a brief summary of In fact, MBSR has its roots in 2,500 MBSR the clinical research into its effectiveness in years of contemplative spiritual traditions, MBSR has been clinically utilized with various medical populations. A more compre- in which the practice of focusing attention success in treating the symptoms of disor- hensive overview of our and others’ research on and awareness upon the moment-by- ders such as chronic pain (Kabat-Zinn, MBSR in cancer patients follows, detailing moment experience of being, in an open Lipworth, and Burney, 1985; Kabat-Zinn, studies that have shown improvements in and non-judgmental manner, is actively cul- Lipworth, Burney, and Sellers, 1987), anxi- mood, stress symptoms and quality of life, as tivated. This new twist on the ancient prac- ety disorders (Kabat-Zinn, Massion, well as shifts in immune and hormonal tice of mindfulness seems to be just what Kristeller, Peterson, Fletcher et al.; Miller, parameters. A theory of biological dysregula- the Western world has been clamoring for, Fletcher, and Kabat-Zinn, 1995) (Roemer tion in disease and some evidence based on as it strips the practice of its ritualistic and and Orsillo, 2002), fibromyalgia (Kaplan, studies of relationships between sleep, stress, religious overtones and packages it in a way Goldenberg, and Galvin-Nadeau, 1993; immune function and disease are presented that has proven accessible to many, but still Sephton, Lynch, Weissbecker, Ho, and and discussed. manages to retain the essence of the prac- Salmon, 2001), and epilepsy (Deepak, Manchanda, and Maheshwari, 1994), and What is MBSR? tice. Kabat-Zinn describes MBSR as, “A well-defined and systematic patient-centered in general medical populations (Reibel, When Jon Kabat-Zinn first developed the educational approach which uses relatively Greeson, Brainard, and Rosenzweig, 2001). Stress Reduction and Relaxation program at intensive training in mindfulness medita- Components of MBSR have been used in the University of Massachusetts Medical tion as the core of a program to teach peo- an individual format to help hasten the rate Centre in the late 1970s, it’s unlikely he ple how to take better care of themselves of skin clearing in psoriasis sufferers (Kabat- ever imagined it would come to this. and live healthier and more adaptive lives.” Zinn, Wheeler, Light, Skillings, Scharf et Currently, in 2004, there are several hun- (Kabat-Zinn, 1990). Key components of al.), and improve movement and symptom dreds of programs of what is now called the program include theoretical material management in multiple sclerosis patients Mindfulness-Based Stress Reduction related to relaxation, meditation, and the (Mills and Allen, 2000). Aspects of MBSR (MBSR) in locations around the world as body-mind connection and the experiential have been incorporated into mindfulness- distant as South Africa, Australia, Germany practice of meditation during group meet- based cognitive therapy (MBCT; Segal, and Argentina. Training programs are flour- ings and daily home based practice. Diverse Williams, and Teasdale, 2002) which has ishing and MBSR is being applied to condi- but related practices utilize body and breath successfully reduced relapse rates in treat- tions as diverse as heart disease, pain, awareness, attention regulation, and include ment of major depression (Teasdale et al., anxiety, fibromyalgia and eating disorders, sitting meditation, walking meditation, and 2000). Mindfulness techniques have also as well as to childbirth training and prob- gentle hatha yoga. Group process focused been incorporated into Dialectal Behavior lems in prisons and school settings. on problem-solving related to impediments Therapy (Dimidjian and Linehan, 2003; The popularity of the program is reflect- to effective practice, practical day to day Linehan, 1987), an approach to the treat- ed in cover stories in Time Magazine, the applications of mindfulness, and supportive ment of patients with difficult personality New York Times Magazine and in national interaction between group members are a disorders, and the recently popular news coverage. An internet search of meaningful part of the regular group meet- Acceptance and Commitment Therapy “Mindfulness-Based Stress Reduction” ings. (Blackledge and Hayes, 2001). yields 5,470 hits. Most seem to be touting A recent study of MBSR for healthy the virtues of the approach and offering workers published by Davidson, Kabat-

42 Biofeedback Fall 2004 Zinn et al. (Davidson, Kabat-Zinn, Participants in the intervention group of are particles of the immune system that can Schumacher, Rosenkranz, Muller et al., this RCT had less overall mood distur- have antitumor as well as pro- or anti- 2003) has caused quite a stir in the popular bance, less tension, depression, anger, con- inflammatory activity, so depending on the media. Brain electrical activity was meas- centration problems, and more vigor than subtype of cytokine, either increases or ured before and immediately after, and then control subjects following the intervention. decreases in production are desirable. We 4 months after an 8-week MBSR training They also reported fewer symptoms of found results that were consistent with a program for healthy subjects in the work- stress, including peripheral manifestations shift in immune profile from one associated force. Twenty-five subjects were tested in of stress, cardiopulmonary symptoms of with depressive symptoms (and cancer) to a the meditation group and 16 in a wait-list arousal, central neurological symptoms, gas- more normal healthy profile. Significantly, control group. At the end of the 8-week trointestinal symptoms, habitual stress interleukin-4, one of the cytokines studied, period, subjects in both groups were vacci- behavioral patterns, anxiety/fear, and emo- has been identified as possibly having anti- nated with influenza vaccine. Significant tional instability compared to those still tumor activity in breast cancer and levels of increases in left-sided anterior cortical acti- waiting for the program. We then analyzed this cytokine increased more than three-fold vation, a pattern previously associated with the result of the six-month follow-up, post-intervention. If physiologically mean- positive affect, were found in the meditators which indicated a maintenance of these ingful increases in this or other anti-cancer compared with the non-meditators. gains over the follow-up period (Carlson, cytokines can reliably be produced through Amazingly, there were also significant Ursuliak, Goodey, Angen, and Speca, meditation it may point to potentially ben- increases in antibody titers to influenza vac- 2001). eficial effects on disease outcome. Of cine among subjects in the MBSR group We next received a grant in July 2000 course, studies to definitely demonstrate compared with those in the wait-list control from the Canadian Breast Cancer Research this are still a long way off. group. Finally, the magnitude of increase in Initiative for a study entitled “The Effects The patterns of secretion of the stress left-sided activation predicted the magni- of a Mindfulness Meditation Intervention hormone cortisol were also of special inter- tude of antibody titer rise to the vaccine. on Psychological Parameters, Quality of Life est to us, as previous research had demon- This studied nicely demonstrated that a and Autonomic, Endocrine and Immune strated that abnormal profiles were short training program in mindfulness med- Functioning in Breast and Prostate Cancer associated with shorter survival time in itation could have profound effects on both Patients.” Two papers have been published breast cancer patients (Sephton, Sapolsky, brain function and immunity. thus far from the study; one looking at the Kraemer, and Spiegel, 2000). That is, MBSR in Cancer Patients pre-post effects on immune function patients who didn’t display the usual (Carlson, Speca, Patel, and Goodey, 2003) healthy pattern of higher cortisol in the Our focus has been on offering MBSR and one looking at hormone levels morning, declining throughout the day, training to groups of cancer patients. The (Carlson, Speca, Patel, and Goodey, 2004). were more likely to die of their illness. Prior issues endemic in cancer diagnosis and A third on blood pressure is currently under to intervention, we found that about 40% treatment such as increased levels of stress review. The one-year follow-up data has yet of our sample evidenced similar types of and distress, fear of death and dying, loss of to be submitted for publication. abnormal daily secretion patterns to those control, loss of independence and feelings Briefly summarized, fifty-nine and forty- seen in the previous study. However, after of isolation are just those that MBSR is the- two patients were assessed pre- and post- MBSR there were fewer troubling evening oretically well suited to address (Mackenzie, intervention, respectively. The 59 patients cortisol elevations and more patients evi- Carlson, and Speca, 2004; Brennan and attended a median of eight of a possible denced the healthy pattern of decreases Stevens, 1998). Beginning in 1995, the nine sessions over eight weeks (range 1-9). throughout the day. This also points to a Department of Psychosocial Resources at They also practiced at home as instructed, potential regulating effect of MBSR on pat- the Tom Baker Cancer Centre offered reporting an average of 24 minutes/day of terns of stress hormone secretion, similar to patients the opportunity to participate in meditation and 13 minutes/day of yoga what was seen with the immune results. the MBSR program. In October 1997 we over the course of the eight weeks. This was The theory we are now postulating is that began a randomized wait-list controlled similar to what we had seen in the previous meditation, and MBSR in particular, may clinical trial, evaluating the effect of the study, and heartening, since there was some affect diurnal systems such as cortisol, MBSR program on mood and symptoms of concern that these patients may not have immune function, autonomic function and stress in cancer outpatients, which was the been well enough to comply with the other daily rhythms such as sleep. MBSR first published controlled trial to investigate homework demands. Significant improve- may counteract dysregulation in these sys- mindfulness meditation in cancer patients ments were seen in overall quality of life, tems by having a modulating, or normaliz- (Speca, Carlson, Goodey, and Angen, symptoms of stress and sleep quality. In ing effect on these natural cycles, which are 2000). Participants were a heterogeneous terms of the immune outcomes, although often dysregulated in patients with disease. group. Indeed, the final sample of 89 there were no significant changes in the These positive regulating effects may result patients consisted almost equally of patients overall number of lymphocytes or cell sub- in better disease outcomes for these from stage I-IV disease with all types of sets, there were changes in the secretion of patients. As mentioned above, however, cancers and in various phases of treatment. cytokines upon cell stimulation. Cytokines tests of this putative association between

Fall 2004 Biofeedback 43 MBSR, changes in biologic rhythmicity and tion, sharing, support, collective medita- experimental and experimental designs to disease outcome have yet to be conducted. tion). These rich themes point to a number have promise in the treatment of many This theory is supported, however, by of avenues through which MBSR has affect- medical disorders, including cancer. What recent work in our lab looking more closely ed the lives of participants in profound the field needs now, I would offer, in addi- at sleep parameters in cancer patients who ways, and suggest many potential research tion to implementing rigorous randomized participate in MBSR and their association directions. controlled clinical trials, is to further eluci- with stress levels. Sleep rhythm, of course, A recent review of MBSR concluded that date potential mind-body mechanisms of has very important biological functions that “although the efficacy of MBSR to self- action, such as dysregulation of immune, affect many aspects of functioning when manage stress and mood symptoms associ- endocrine, autonomic and sleep systems. In dysregulated, and is associated with other ated with cancer seems particularly parallel to this, more phenomenological systems we have been studying. People with promising, it would be difficult based on a inquiry into the lived experience of MBSR sleep deprivation or sleep disorders (includ- single randomized controlled trial (the Tom participation is needed to fully understand ing shift workers with dysregulated sleep Baker study) to strongly recommend it at the human terms of this journey. As we patterns) have alterations in various meas- this time. This study is significant however look back on the explosion of interest and ures of immune function (Bovbjerg, 2003), as it represents the first rigorous test of the research on MBSR over the last decade, it’s and are also at higher risk for cancer (Davis, efficacy of this approach to foster adapta- quite likely that Jon Kabat-Zinn may be Mirick, and Stevens, 2001; Schernhammer, tion to a medical illness. Replication is most surprised of us all. Laden, Speizer, Willett, Hunter, et al.) and clearly needed to firmly establish its efficacy References have higher mortality rates (Savard and in this population” (Bishop, 2002, p.76). Bishop, S. R. (2002). What do we really know Morin, 2001). Indeed, other researchers have also been about mindfulness-based stress reduction? Similar to what others have reported, we investigating MBSR in cancer patients. A Psychosomatic Medicine, 64, 71-83. found a very high proportion of our cancer study by Shapiro, Bootzin, Figueredo, Blackledge, J. T. and Hayes, S. C. (2001). patients with disordered sleep (approx. Lopez, and Schwartz (2003) examined the Emotion regulation in acceptance and commitment therapy. Journal of Clinical Psychology, 57, 243-255. 85%). In these patients, sleep disturbance relationship between participation in an Bovbjerg, D. H. (2003). Circadian disruption was closely associated with levels of self- MBSR program and sleep quality and effi- and cancer: sleep and immune regulation. Brain, reported stress and mood disturbance, and ciency, but did not find statistically signifi- Behavior and Immunity, 17 Suppl 1, S48-S50. when stress symptoms declined over the cant relationships between participation in Brennan, C. and Stevens, J. (1998). A grounded course of the MBSR program, sleep also an MBSR group and sleep quality. They theory approach towards understanding the self perceived effects of meditation on people being improved (Carlson, Speca, Goodey, and did, however, find that those who practiced treated for cancer. The Australian Journal of Holistic Garland, 2004). Whether decreases in stress more informal mindfulness reported feeling Nursing, 5, 20-26. led to improvements in sleep, or vice versa, more rested. This is contradictory to our Carlson, L. E., Speca, M., Goodey, E., and and via which neuroimmune or neuroen- preliminary sleep findings summarized Garland, S. (2004). Improvements in sleep quality docrine pathways, is as yet unknown. It above, but could be explained by the differ- in cancer outpatients participating in mindfulness- based stress reduction. Psychosomatic Medicine, 66, may well be that all these systemic dysregu- ing methods used to measure sleep parame- A-80. lations are related to one another, and as a ters, or slight differences in program Carlson, L. E., Speca, M., Patel, K. D., and whole, contribute to negative disease out- content. Goodey, E. (2003). Mindfulness-based stress reduc- comes. These associations present exciting An innovative study by Kabat-Zinn’s tion in relations to quality of life, mood, symptoms and fruitful avenues for future research. group looked at the effects of combining a and stress and immune parameters in breast and prostate cancer outpatients. Psychosomatic Medicine, Another fascinating avenue of inquiry has dietary intervention with MBSR on 65, 571-581. been to delve further into the self-perceived prostate specific antigen (PSA) levels, an Carlson, L. E., Speca, M., Patel, K. D., and benefits of MBSR in cancer patients using indicator of the level of activity of the Goodey, E. (2004). Mindfulness-based stress reduc- qualitative methods of inquiry, as up to this prostate cancer, in men with prostate cancer tion in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehy- point much of the research has been quanti- and found the combined program resulted droepiandrostrone-Sulftate (DHEAS) and mela- tative. To that end we’ve recently conduc- in a slowing of the rate of PSA increase tonin in breast and prostate cancer outpatients. tive a grounded theory interview study (Saxe, Hebert, Carmody, Kabat-Zinn, Psychoneuroendocrinology, 29, 448-474. investigating patients’ self-perceived effects Rosenzweig, et al.., 2001). This is another Carlson, L. E., Ursuliak, Z., Goodey, E., Angen, of participating in ongoing MBSR after interesting finding that links MBSR with M., and Speca, M. (2001). The effects of a mind- fulness meditation based stress reduction program cancer diagnosis and treatment. Themes the body’s biological regulatory systems. on mood and symptoms of stress in cancer outpa- that have consistently emerged include: Conclusions tients: Six month follow-up. Supportive Care in Self-Regulation (internal control, empower- Cancer, 9, 112-123. (correct) ment, less reactivity); Transformation In summary, MBSR seems to appeal to Davidson, R. J., Kabat-Zinn, J., Schumacher, J., the yearning of both those with disease and Rosenkranz, M., Muller, D., Santorelli, S. F. et al. (change in perspective, acceptance, creation (2003). Alterations in brain and immune function of new path); Collective Learning (validat- those without for a more genuine way of living, and slowing down our fast pace of produced by mindfulness meditation. ing one’s experience, process of discovery), Psychosom.Med., 65, 564-570. and; Group Dynamics (friendship, motiva- life. It has been shown in several quasi-

44 Biofeedback Fall 2004 Davis, S., Mirick, D. K., and Stevens, R. G. Mackenzie, M. J., Carlson, L. E., and Speca, M. Sephton, S. E., Sapolsky, R. M., Kraemer, H. C., (2001). Night shift work, light at night, and risk of (2004). Mindfulness-based stress reduction and Spiegel, D. (2000). Diurnal cortisol rhythm as breast cancer. J.Natl.Cancer Inst., 93, 1557-1562. (MBSR) in oncology: rationale and review. a predictor of breast cancer survival. Journal of the Deepak, K. K., Manchanda, S. K., and Unpublished manuscript (Under review) National Cancer Institute, 92, 944-1000. Maheshwari, M. C. (1994). Meditation improves Psychotherapy and Psychosomatics. Shapiro, S. L., Bootzin, R. R., Figueredo, A. J., clinicoelectroencephalographic measures in drug- Miller, J. J., Fletcher, K., and Kabat-Zinn, J. Lopez, A. M., and Schwartz, G. E. (2003). The resistant epileptics. Biofeedback and Self- Regulation, (1995). Three-year follow-up and clinical implica- efficacy of mindfulness-based stress reduction in the 19, 25-40. tions of a mindfulness meditation-based stress treatment of sleep disturbance in women with Dimidjian, S. and Linehan, M. (2003). Defining reduction intervention in the treatment of anxiety breast cancer: an exploratory study. Journal of an agenda for future research on the clinical appli- disorders. General Hospital Psychiatry, 17, 192-200. PsychosomaticResearch, 54, 85-91. cation of mindfulness practice. Clinical Psychology: Mills, N. and Allen, J. (2000). Mindfulness of Speca, M., Carlson, L. E., Goodey, E., and Science and Practice, 10, 166-171. movement as a coping strategy in multiple sclerosis. Angen, M. (2000). A randomized, wait-list con- Kabat-Zinn, J. (1990). Full catastrophe living: A pilot study. General Hospital Psychiatry, 22, 425- trolled clinical trial: the effect of a mindfulness Using the wisdom of your body and mind to face 431. meditation-based stress reduction program on stress, pain and illness. New York: Delacourt. Reibel, D. K., Greeson, J. M., Brainard, G. C., mood and symptoms of stress in cancer outpatients Kabat-Zinn, J., Lipworth, L., and Burney, R. and Rosenzweig, S. (2001). Mindfulness-based [In Process Citation]. PsychosomaticMedicine, 62, (1985). The clinical use of mindfulness meditation stress reduction and health-related quality of life in 613-622. for the self-regulation of chronic pain. Journal of a heterogeneous patient population. General Teasdale, J. D., Segal, Z. V., Williams, J. M., BehavioralMedicine, 8, 163-190. Hospital Psychiatry, 23, 183-192. Ridgeway, V. A., Soulsby, J. M., and Lau, M. A. Kabat-Zinn, J., Lipworth, L., Burney, R., and Roemer, L. and Orsillo, s. M. (2002). Expanding (2000). Prevention of relapse/recurrence in major Sellers, W. (1987). Four-year follow-up of a medita- our conceptualization of and treatment for general- depression by mindfulness-based cognitive therapy. tion based program for the self-regulation of chron- ized anxiety disorder: Integrating Journal of Consulting and Clinical Psychology, 68, ic pain: Treatment outcomes and compliance. The mindfulness/acceptance-based approaches with 615-623. Clinical Journal of Pain, 2, 159-173. existing cogntive-behavioral models. Clinical Note Kabat-Zinn, J., Massion, A. O., Kristeller, J., Psychology: Science and Practice, 9, 54-68. Peterson, L. G., Fletcher, D. E., Pbert, O. et al. Saxe, G. A., Hebert, J. R., Carmody, J. F., iDirect Correspondence to: (1992). Effectivenes of a meditation-based stress Kabat-Zinn, J., Rosenzweig, P. H., Jarzobski, D. et Dr. Linda E. Carlson, al. (2001). Can diet in conjunction with stress reduction program in the treatment of anxiety dis- Assistant Professor, University of Calgary orders. American Journal of Psychiatry, 149, 943- reduction affect the rate of increase in prostate spe- 963. cific antigen after biochemical recurrence of Division of Psychosocial Resources Kabat-Zinn, J., Wheeler, E., Light, T., Skillings, prostate cancer? Journal of Urology, 166, 2202- Alberta Cancer Board – Holy Cross Site A., Scharf, M. J., Croplwy, T. G. et al. (1998). 2207. 2202 2nd St. S.W. Influence of a mindfulness meditation-based stress Schernhammer, E. S., Laden, F., Speizer, F. E., Calgary, Alberta, Canada T2S 3C1 Willett, W. C., Hunter, D. J., Kawachi, I. et al. reduction intervention on rates of skin clearing in Phone: (403) 355-3209, patients with moderate to sever psoriasis undergo- (2001). Rotating night shifts and risk of breast can- ing phototherapy (UVB) and photochemotherapy cer in women participating in the nurses’ health Fax: (403) 355-3206 (PUVA). Psychosomatic Medicine, 60, 625-632. study. Journal of the National Cancer Institute, 93, E-Mail: [email protected] Kaplan, K. H., Goldenberg, D. L., and Galvin- 1563-1568. Nadeau, M. (1993). The impact of a meditation- Segal, Z. V., Williams, M. G., and Teasdale, J. based stress reduction program on fibromyalgia. D. (2002). Mindfulness-based cognitive therapy for General Hospital Psychiatry, 15, 284-289. depression. New York: Guilford Press. Linehan, M. M. (1987). Dialectical behavior Sephton, S. E., Lynch, G., Weissbecker, I., Ho, therapy for borderline personality disorder. Theory I., and Salmon, R. (2001). Effects of a meditation and method. Bulletin of the Menninger Clinic, 51, program on symptoms of illness and neuroen- 261-276. docrine responses in women with fibromyalgia. Psychosomatic Medicine, 63, 91.

Meditation: Elevating Consciousness, Improving Health Continued from page 10 Jacobs, G. D. (2001). Clinical applications of the Paramananda, S. (2002). Katha Upanishad, Part Proulx, K. (2003). Integrating mindfulness- relaxation response and mind-body interventions. 3. In S. Paramananda (transl.), Project Gutenberg, based stress reduction. Holistic Nursing Practice, 17, Journal of Alternative and Complementary Medicine, The Upanishads. Retrieved July 9, 2004, from 201-208. 7 Suppl 1, S93-101. website http://onlinebooks.library.upenn.edu/webbin/ Rowland, B. (1953). The art and architecture of Muller, M. (1884). Maitrayana Brahmana gutbook/lookup?num=3283 India. Baltimore, Maryland: Penguin Books. Upanishad, 6th Prapathaka: 34. In M. Mueller Perez-de-Albeniz, A. and Holmes, J. (2000). Saper, R. B., Eisenberg, D. M., Davis, R. B., (Transl. and Ed.), The sacred books of the east, Meditation: Concepts, effects and uses in therapy. Culpepper, L., and Phillips, R. S. (2004). volume 15. Oxford: Clarendon Press, 1879-1910. International Journal of Psychotherapy, 5, 49-58. Prevalence and patterns of adult yoga use in the Murphy, M. and Donovan, S. (1999). The physi- Peters, R. K., Benson, H., and Porter, D. (1977). United States: Results of a national survey. cal and psychological effects of meditation A review of Daily relaxation response breaks in a working popu- Alternative Therapies in Health and Medicine, 10, contemporary research with a comprehensive bibliogra- lation: I. Effects on self-reported measures of 44-49. phy 1931-1996. (2nd ed.) Sausalito, CA: The health, performance, and well-being. American Wallace, R. K., Benson, H., and Wilson, A. F. Institute of Noetic Sciences. Journal of Public Health, 67, 946-953. (1971). A wakeful hypometabolic physiologic state. American Journal of Physiology, 221, 795-799.

Fall 2004 Biofeedback 45 ABOUT THE AUTHORS

John A. Astin, PhD, received his doctor- (AIIMS) nearly 50 years ago. He is an Yoga, Meditation, Biofeedback and ate in Health Psychology from the ardent student of religious and spiritual tra- Hypnosis for the past two decades and his University of California, Irvine. From ditions and has studied in depth the works work on Meditation as intervention strategy 1997-1999, he was a research fellow in the of Sri Aurobindo, one of the most powerful has been widely acclaimed. Recently his Complementary and Alternative Medicine exponents of Indian wisdom in recent group has compared the effect of yogic Program at the Stanford University School times. About 5 years ago, Dr. Bijlani initiat- intervention with biofeedback for irritable of Medicine. From January 2000-June ed at AIIMS a facility which uses medita- bowel syndrome. He currently directs the 2002, he was the director of mind-body tion and other elements of yoga as tools for Clinical Autonomic Function Laboratory at research at the Complementary Medicine influencing the mind positively in order to the All India Institute of Medical Sciences. Program, University of Maryland School of promote self-healing. The work of Dr K.K. Deepak has special- Medicine. In July of 2002, he took a posi- Adam Burke, PhD, MPH, Lac, is a ized in applying a reductionistic approach tion as Research Scientist at the California research psychologist, acupuncturist, and towards the in-depth analysis of physiologi- Pacific Medical Center in San Francisco. educator. He received advanced degrees in cal signals. His scientific approach is based His research and clinical work has focused public health and psychology from the on non-invasive assessment of physiological on several related areas: 1) the use of mind- University of California. He has also stud- signals and it attempts to extract informa- body therapies, particularly mindfulness ied traditional Chinese medicine in San tion on brain mechanisms from peripheral meditation, to treat various health-related Francisco and in Sichuan, China. He is cur- signals. problems; 2) psychosocial factors associated rently assistant professor/associate director, Tobias Esch, MD, studied medicine at with use of complementary and alternative Department of Health Education/Institute the University of Goettingen (Germany). medical therapies; 3) the psychological con- for Holistic Healing Studies, at San He was a resident in neurology (University struct of control and its relationship to Francisco State University. Dr. Burke is of Witten/Herdecke, Germany), followed mental and physical health; and, 4) the role actively engaged in mind-body healing by internal medicine, surgery and family of spirituality in healthcare. His research research and policy work. He is also the medicine – where he became specialized in has appeared in such journals as Archives of author of the recently released book, Self 2004.Mr. Esch wrote his thesis on stress Internal Medicine, JAMA, and the Annals of Hypnosis, published by Crossing Press. and mutation research and received his doc- Internal Medicine. He is the co-author (with Linda E Carlson, PhD, completed her toral degree (MD) in 2000. Since then he Deane Shapiro) of the book: “Control ther- doctorate in Clinical Psychology at McGill has published a variety of reports on stress. apy: An integrated approach to psychother- University in Montreal. She then held a Dr. Esch was appointed research fellow at apy, health, and healing.” Along with his Terry Fox Postdoctoral Research Fellowship Harvard Medical School (U.S.A.) in 2001. scholarly pursuits, Dr. Astin is also an funded by the National Cancer Institute of He is clinically trained in complementary, accomplished singer, songwriter and record- Canada at the Tom Baker Cancer Centre in integrative and mind/body medicine. ing artist having produced 5 albums of Calgary, Canada. Currently she is an Currently, Dr. Esch is a fellow at the original music that are distributed world- Assistant Professor in the Department of Charité, University Medicine Berlin wide. Oncology in the Faculty of Medicine at the (Germany). Enrica Bianchi, PhD, is currently con- University of Calgary, and an adjunct pro- Massimo Guarna, PhD, is currently con- ducting research in the Department of fessor in the Department of Psychology. She ducting research in the Department of Neuroscience at the University of Siena in is currently funded by a Canadian Institutes Anatomical and Biomedical Sciences at the Italy. Her research interests have been gen- of Health Research New Investigator University of Siena in Italy. His research erally in the field of molecular and anatomi- Award. Her research interests lie in the field interests are in the molecular physiology of cal neuropharmacology. Her recent of psychoneuroimmunology, mind-body endogenous opioids such as endogenous published research has studied mu-opioid medicine, exercise interventions, meditation morphine and codeine. His recently pub- receptor binding characteristics and the and yoga, smoking cessation and quality of lished research has evaluated mu-opioid neuroanatomical localization of endogenous life research in cancer patients. Dr. Carlson receptor binding characteristics, the role of morphine in the brain. She is also interest- works out of the Department of endogenous morphine in nociception and ed in the involvement of endogenous opi- Psychosocial Resources of the Tom Baker the neurophysiology of endogenous mor- oid activity in complementary and Cancer Centre, as a psychologist and a phine secretion/release. He is also interest- alternative therapies. researcher. ed in the involvement of endogenous Ramesh L. Bijlani, MD, is a product of K. K. Deepak, MD, PhD, an additional opioid activity in complementary and alter- the B. K. Anand school of physiology professor of Physiology in AIIMS is an native therapies. which pioneered classical studies on yoga at expert on the Autonomic Nervous System. Sat Bir S. Khalsa, PhD, has conducted All India Institute of Medical Sciences He has been working on various aspects of research in neuroscience, chronobiology and

46 Biofeedback Fall 2004 sleep and is currently on the faculty of Harvard Medical School as an Instructor in Medicine. He has also practiced a yoga lifestyle for over 30 years and is a certified Kundalini Yoga instructor. His current research interests are in the effects of yoga and meditation Does AAPB have practices. He is currently conducting a clinical trial at Brigham and Women’s Hospital evaluating a yoga treatment for insomnia funded your e-mail address? by the National Center for Complementary and Alternative Medicine. He also teaches a course in mind body medicine for • e-mail communications enable Harvard medical students. AAPB to communicate better with Shauna L. Shapiro, PhD, is an assistant professor at Santa Clara University. She received her doctorate in clinical psychology at the members. University of Arizona and is adjunct faculty for Andrew Weil’s Program of Integrative Medicine. Her research has focused primari- • E-mail communications also save ly in examining the effects of MBSR across a wide range of popula- AAPB money, and enable the tions including breast cancer, insomnia, substance abuse, and health care professionals. Dr. Shapiro has published over two dozen arti- Association to use your dues cles and book chapters in the area of meditation and has presented money for other critical activities. her research findings nationally and internationally. George B. Stefano, PhD, received his Ph. D. from Fordham Please send your e-mail address University and was awarded a Distinguished Teaching Professorship at SUNY where he is the Director of the Neuroscience Research today to the following address: Institute. He has published over 300 reports and edited 7 books. [email protected] He has grants from the National Institute of Mental health, National Institute on Drug Abuse, National Science Foundation, Fogarty International Center, Cell Dynamics and International Lifewaves. His research deals with the demonstration of morphine as a endogenous signaling molecule and mind/body interactions potentially involving opiate signaling. Sebastian “Seb” Striefel, PhD, became a Professor Emeritus in the Department of Psychology at Utah State University in September 2000. For twenty six years he taught graduate level courses in ethics and professional conduct, clinical applications of biofeedback, clinical applications of relaxation training and behav- ior therapy. He was also the Director of the Division of Services at the Center for Persons with Disabilities at Utah State University. In that role he managed a variety of programs, including an outpatient clinic, a biofeedback lab and an early intervention program. He is a past president of the Association of Applied Psychophysiology and Biofeedback (AAPB), past president of the Neurofeedback Division of AAPB, current vice-president of and past secretary/treasurer of the International Section of AAPB, and regularly writes an ongoing ethics column and conducts workshops on ethics, standards, and professional conduct. Frederick Travis, PhD, received his Masters in Psychology 1986 and his PhD in Psychology in 1988 from Maharishi University of Management. After a two-year post-doctoral position in EEG sleep research at University of California Davis, he returned to Maharishi University of Management to direct the EEG, Consciousness and Cognition Lab. Over the last 14 years he has authored and co- authored 39 papers that have investigated subjective and physiolog- ical markers of meditation practice and of growth of human consciousness through meditation practice.

Fall 2004 Biofeedback 47 Association for Applied Psychophysiology and Biofeedback Canadian 10200 W 44th Ave Suite 304, Publication Agreement Wheat Ridge CO 80033-2840 #1583581

Address Service Requested News aapb & Events

FROM THE PRESIDENT

Creating the Next Step: Honoring Tradition and Embracing Science Steve Baskin, PhD

It is my belief that AAPB is a truly Dr. Benson is the founding President of the massed practice, use of the arm more affect- unique professional group with members Mind-Body Medical Institute and Associate ed by the stroke. A number of neuroimag- from numerous disciplines and diverse Professor of Medicine at Harvard Medical ing studies have shown that the backgrounds. We need to keep our shared School. He is the author of over 170 scien- concentrated repetitive-practice of CI thera- values paramount and continually meet the tific papers and ten books including the py produces a cortical reorganization that demands of an increasingly segmented groundbreaking work, The Relaxation increases the area of cortex involved in the membership. In a sense, unity and diversity Response in 1975. Dr. Benson is a pioneer in innervation of movement of the more come through our science. Peter Madill, the behavioral and mind/body medicine as well affected limb. Dr. Taub’s work has emerged program chair for the 2005 meeting, is a as bringing spirituality and healing into from his basic behavioral neuroscience primary care physician who takes a unique medicine. He has recently hypothesized that research with monkeys. He has done work perspective on our field. His views are a eliciting the relaxation response liberates with upper limb deficits with stroke and hybrid, as Peter says in his native New constituent nitric oxide that counteracts the other neurological conditions, lower limb Zealand twang (we’re meeting in Texas), effects of major stress hormones. Peter and I deficits in individuals with neurologic and between “brain science” and mind-body are thrilled that Dr. Benson has accepted orthopedic conditions and recently in chil- medicine. Our meeting theme is “Creating our invitation. This will be a fantastic event. dren with partial paralysis from cerebral the Next Step: Honoring Tradition and Ed Taub, PhD, has been a major figure palsy. This intensive rehab therapy has Embracing Science.” It will be an exciting in behavioral neuroscience for many years. helped brains “rewire” themselves. Ed will provocative meeting. We are emphasizing He has graciously accepted our invitation to receive the 2004 Distinguished Scientific our core science and values while attempt- give a keynote address. Dr. Taub is a Past- Award for the applications of psychology by ing to increase our visibility by reaching out President of AAPB, Professor of Psychology the American Psychological Association. His to students and other professional groups. at the University of Alabama-Birmingham, work is remarkable. Ed is a long-term Here’s a sampler. Senior Scientist for the Center for Aging at AAPB member, one of our most noted sci- Our annual meeting is in Austin, Texas; a UAB and Director of the Taub Therapy entists, and a great friend to our communi- wonderfully unique and diverse city (sound Clinic. He is the developer of the innova- ty. familiar?) with great music venues, out- tive Constraint-Induced (CI) Movement One of the more innovative clinicians standing restaurants, and Texas friendliness. Therapy — a new family of rehabilitation and researchers in the chronic pain world is The Renaissance Hotel is a well-priced lux- techniques. This exciting therapy is shown Robert Gatchel, PhD, Chair of Psychology urious property with both class and great to be effective in producing large improve- at the University of Texas-Arlington. Dr. meeting space. Our meeting will begin on ments in limb use in the real-world envi- Gatchel has investigated the complex and Thursday evening, March 31 with one of ronment in patients post-stroke. His initial dynamic interaction among physiologic, the pioneers and thought leaders in our therapy constrained movement of the less Continued on page 4A field, the noted Herbert Benson, MD. affected arm while intensively training, with

Fall 2004 Biofeedback 1A FROM THE EXECUTIVE DIRECTOR’S DESK

Hellooo Out There Francine Butler, PhD

Have you ever been in a group in a con- tion with the hope that if physicians under- by 11.6% and progressive relaxation by 3%. versation where the topic happened to be stand how important behavior is, they can And biofeedback – are you ready for this – one you were very familiar with – in fact, change how health care functions. The arti- 0.1%. the topic was one about which you consider cle concludes it is possible that “physicians Given that the number for use of pro- yourself something of an expert? But who back behavioral interventions might gressive relaxation is 3%, one wonders why nobody knew you were there! Several also persuade more insurers to pay for our usage data is so low. recently published articles have made me proven interventions.” AAPB members are the most knowledge- feel that way about biofeedback and AAPB. While these two reports extol the virtues able group of professionals in the world The first article appears in the APA and the need to study CAM therapies, the who understand the benefits of biofeed- Monitor (June 2004, pages 42-44), and is third report by Barnes et al (2002) tells us back. We should be seen as THE SOURCE entitled “Alternative Health Care Gains who uses CAM and breaks the data into of knowledge in this area – for APA, for Steam.” The author notes that “nearly half numerous categories. I urge all of you to other professionals, and for health statistics. of all Americans have used some type of read this article because it presents a per- Why then, is it, that our voice is not alternative or complementary medicine” spective of biofeedback within the larger heard. Hellooooo out there! Can you and she cites meditation and relaxation scheme of CAM in the context of all CAM hear me? therapy as examples of mind-body applica- usage. From the abstract: It has been esti- The report is available at tions. The article quotes Margaret Chesney, mated that the U.S. public spent between http://www.nccam.nih.gov/news/camsurvey deputy director of the National Center for $36 billion and $47 billion on CAM thera- Reference Complementary and Alternative Medicine pies in 1997. Of this amount, between Barnes, P.M, Powell-Griser, E., McFann, K., & (NCCAM) as saying that the public is turn- $12.2 billion and $19.6 billion was paid Nahin, R.L. (2004). Complementary and alterna- ing to these forms of medicine but that out of pocket for the services of professional tive medicine use among adults: United States, there is little to no evidence that many of CAM health providers, such as chiroprac- 2002. Advance Data from the Vital and Health Statistics; No. 343 (May 27, 2004). Hyattsville, these therapies are safe and effective. She tors, acupuncturists, and massage therapists. MD: National Center for Health Statistics. goes on to describe NCCAM’s efforts to The next commonly used CAM therapies support research to study efficacy. Examples during the past 12 months were use of of funded studies include the effects of prayer, specifically for one’s own health meditation on hypertension, acupuncture (45%). Deep breathing exercises were used on brain activity, yoga on HIV and dia- betes, self-hypnosis in surgery, massage for cancer-related fatigue, and B-vitamins on stress. The article concludes with a call for psychologists to make a contribution to We Encourage Submissions CAM research. Send chapter meeting announcements, section and division The second article titled “Expanding meeting reports, and any non-commercial information regarding Medical Training” in the APA Monitor meetings, presentations or publications which may be of interest (June 2004, pages 46-48) reports there is a to AAPB members. Articles should generally not exceed 750 need for “increased integration of behav- words. Remember to send information on dated events well in ioral and social sciences into medical school advance. curricula.” The report emphasized the need to focus on behavior’s role in health, physi- Send Word (.doc) or text files to: Ted LaVaque, PhD, cian-patient communication and social [email protected] and they will be considered for posting influences on the health care system. The on the AAPB website. strategy is to affect medical school educa-

2A Biofeedback Fall 2004 FROM THE PRESIDENT-ELECT

Quality Clinical Presentations Richard Sherman, PhD

No field can progress without new ideas. the problem’s intensity, and long enough effectiveness for a specific disorder. This is especially true of developing fields baselines to encompass expected variability No attempt is made to sort out which such as applied psychophysiology and of the problem. For example, baselines for parts of the intervention are producing the bio/neurofeedback. A great place to share studying typical migraines without aura effect as the idea at this point is to show ideas is at meetings where they can get need to be about a month long. The inter- that there is, indeed, a clinically important exposure and discussion. Last year’s annual vention includes every potentially effective effect. If the effect isn’t clinically important meeting was chock full of presentations of part of the treatment and is given for long or if the technique takes longer or is more new ideas and early testing of ones which enough and with sufficient intensity to expensive than current interventions, there have been around for a while. maximize the odds of success – to “give it is no need to progress to complex, expen- Most of the posters were really exciting everything it’s got”. sive studies. There is certainly no need at not only for their ideas but for the high There is no use worrying about what this stage to try to demonstrate whether the quality of the studies. They tended to be makes a technique work until it is proven to theory underlying the intervention is cor- reports of meticulous delineations of psy- have a clinically important effect in the first rect or not. chophysiological responses to interventions place. Thus, these designs aren’t intended to The best aspect of these designs is that or tests of measurement techniques. What provide evidence of why changes take place they are absolutely free to perform. Other made the posters reporting trials of clinical by sorting out the contributions of non-spe- than the time needed for the pre-treatment interventions so valuable was their clean cific factors such as the placebo effect, but baseline, they don’t require clinicians to do methodology and good writing. Readers they do show that the changes are real and anything they wouldn’t do when perform- could usually tell just what was done and consistent. Finding out how much of the ing high quality interventions. Pre-treat- why each step was taken. The populations effect is due to changes with time and the ment baselines are usually done between the tested were identified, the objective meas- placebo effect (up to 50% in behavioral time a patient is identified and the first or ures used to determine severity of the prob- interventions) can wait until the technique’s second week of treatment as there is usually lem were shown, pre and post intervention overall impact can be estimated. sufficient lag time between the initial con- baselines showing extent of the problems Single subject designs are for testing a tact and when the treatment really gets before and after the interventions were brand-new idea. Each subject can be treated rolling. reported, the interventions were clearly very differently as the technique is altered Most new clinical ideas die of their own explained, and – of great importance, in to be successively more effective and sub- obvious failure as the clinicians who try many cases, the post-intervention baselines jects can differ from each other as the types them realize that not much is happening. were long enough to tell whether the inter- of subjects appearing to be most responsive Unfortunately, people frequently don’t real- ventions actually had effects once the to the technique are identified through trial ize that their ideas aren’t working because patients returned to their normal lives. and error. Single group designs are the next they don’t follow-up their patients long These are the characteristics of good clin- step. They use the matured technique so enough to see if the treatment has main- ical presentations. They are based on the each participant gets a similar treatment tained its effectiveness. For example, when I principles of single case and single group and the participants are as similar as possi- surveyed hundreds of people treating phan- designs which have proven to be highly ble in variables which would be expected to tom limb pain, all thought their treatments effective for demonstrating whether or not a affect the treatment (e.g., age, in a wound were effective (over sixty unrelated treat- new idea has an effect on the people it is healing study) diagnostic characteristics of ments were identified). When patients’ tried on. Both designs follow the general the disorder. Single group designs need to records were evaluated, it turned out that format of pre-treatment baseline – interven- have sufficient subjects so amount of symp- only one of the treatments was having any tion – post-treatment baseline/follow-up. tom change due to the intervention can be effect at all. The patients simply were going This is abbreviated as an A-B-A design. differentiated from random variability on to other therapists rather than returning These designs require good diagnosis of the between subjects and over time. This per- to the original therapist so the mass of ther- problem, objective tracking of changes in mits an estimation of the intervention’s apists thought their interventions worked.

Fall 2004 Biofeedback 3A Many clinicians waste major parts of stringent nightmares of today. All the FDA intervention accepted because he says it their careers providing useless treatments asked for was a few decent clinical studies. works are rapidly dying within the surgical because the treatments have never been test- Surgical and behavioral interventions arena. Hopefully, behavioral medicine will ed using the simple A-B-A designs discussed aren’t governed by the FDA unless they continue joining the trend as well. above. There is simply no need for this. involve the use of devices. Surgical societies The basic principles for doing good clini- When the US Food and Drug and journals have now generally adopted cal presentations are summarized in the fol- Administration began to require that sup- the requirement that at least single group of lowing table. When these commonly pliers of devices and medications actually studies with follow-ups of clinically signifi- applied precepts are followed, everybody provide evidence that they were effective, cant duration be performed before a tech- benefits. nearly every medication and device on the nique is accepted in wide clinical trial market disappeared. The levels of evidence practice. The days when the “big man on Continued on page 6A required in those early days weren’t the campus” gets his (it always used to be “his”)

Creating the Next Step: Honoring Tradition and Embracing Science continued from page 1A psychological, and social factors that may easily and effectively. Also for our students known nutritionist and a group of experts perpetuate or worsen a clinical pain condi- and new members, we will have an “Ask the exploring the research and clinical guide- tion. His significant contributions have Experts” symposium where some of our lines on reducing cardiac risk factors. We helped explain the diversity of pain or ill- most noted senior researchers and clinicians are also planning an invited woman’s health ness expression and led to numerous clinical will give a “snapshot” of their work and symposium. As the year proceeds, I will be interventions including much work with answer questions about our field. We are sending you e-mail updates letting you biofeedback. His work has stressed the also please to announce that our Board know the progress of the meeting. The pro- importance of early intervention and pre- Member Susan Antelis, MPS, will also give gram committee, Peter and I promise you a vention. We are very fortunate to have him a free workshop on how to begin and mar- diverse exciting program, exploring the sharing with us in Austin his exciting clini- ket a private practice or join a group prac- waterfront of applied psychophysiology, cal research. tice. This will be a true “how-to” experience neurofeedback, biofeedback, and mind- The early operant conditioning work in geared for our student members and indi- body medicine. So please plan to come and epilepsy by Barry Sterman PhD (our 2004 viduals new to the field. We are making a bring your friends and colleagues. distinguished scientist) has a wonderful commitment to reduce the gray in our soci- place in our scientific history. This year we ety. Talk to you soon, are fortunate to have Jon Walker, MD, We are also working on getting a well- Steve Baskin share with us his exciting research combin- ing coherence and power training to reme- diate epilepsy. Dr. Walker is a Dallas based Printed AAPB Membership Directory Available board certified neurologist and electroen- A number of requests have been received for printed copies of the Directory. You may order a printed copy list- cephalographer who is making a major neu- ing the name, address, city, state, zip code, phone number, and email address. If you would like a copy, please complete and return the order form below. rofeedback contribution. The program Please send ______(quantity) copy(ies) of the AAPB printed Directory at a cost of $23 each, including committee is putting together a morning or postage and handling. afternoon epilepsy session, with a few sur- Name: ______prise presenters, to further explore this important area of research and therapy. Address: ______We have planned a unique introduction City, State, and Zip Code: ______to AAPB for new members and student members. Frank Andrasik PhD, our journal Phone: ______Email: ______editor and Past-President has agreed to put Payment: ❐ check ❐ Visa ❐ MasterCard ❐ American Express together a free, that is correct, no cost intro to research methods workshop. Frank gives Card Number: ______a wonderful, invigorating and very under- Expiration Date: ______standable overview of methodology issues. This will help the early professional become Name on Card: ______a good consumer of the research literature Cardholder signature: ______as well as to design studies and gather data Mai this form to AAPB, 10200 W. 44th Ave. #304, Wheat Ridge CO 80033 or fax to 303 422-8894

4A Biofeedback Fall 2004 AAPB’s 36th Annual Meeting

ome join AAPB in Austin where the leaders of our indus- try will be gathering to share cutting-edge research and Cinsight. Plans are in the works for a memorable event. We guarantee you the best in applied psychophysiology, neuro- feedback, biofeedback, and mind-body medicine. Here are just a few of the confirmed highlights you can expect:

• The meeting will begin Thursday night, March 31, with a very special opening reception presentation by the noted Herbert Benson, MD. Dr. Benson is a pio- neer in behavioral and mind-body medicine and the founding President of the Mind-Body Medical Institute and Associate March 31 – Professor of Medicine at Harvard Medical School. April 3 • AAPB’s Past President, Ed Taub, PhD, will be giving a keynote lec- 2005 ture highlighting his award-win- ning research on Constraint-Induced Movement Therapy. This intensive rehab therapy has helped brains “rewire” themselves post-stroke, in other neurological conditions and recently in The children with partial paralysis secondary to cerebral palsy.

• Naomi Eisenberger, from UCLA, will join us this year. Her Renaissance work explores the neurocognitive mechanisms underlying both physical and Hotel social pain (pain following rejection). Her research has appeared in Science and she is one of the brilliant young voices in cognitive neuroscience whose work is very relevant to future clinical applications.

Austin, • Jon Walker MD, a neurologist, will present his exciting work with neurofeedback in patients with epilepsy. Dr. Walker is a Texas wonderful clinician and electroencephalographer who will edu- cate us with his most recent clinical findings.

• Bob Gatchel, PhD, has investigated the complexities in physio- logic, psychological, and social aspects in the presentation of numerous chronic pain conditions. He has done extensive biofeedback work and is a leading clinician and researcher in the chronic pain field.

Visit the AAPB Website at www.aapb.org for details as they become available and watch for your program coming soon.

Fall 2004 Biofeedback 5A Quality Clinical Presentations continued from page 4A Cardinal Rules* for Establishing Credibility When You: Prepare a Clinical Listen to/Read a Clinical Presentation/Article Presentation/Article Be certain to: Is/are there: 1. Title your presentation/article appropriately so it doesn’t promise more than it can 1. Adequate diagnosis and assessment deliver or ascribe changes to one aspect of a multifaceted intervention. of the subjects? 2. Begin with a brief summary of what you did/found. 2. Adequate pre treatment baseline to 3. Describe the general characteristics of the group you worked with and define your establish symptom variability? inclusion and exclusion criteria. 3. Objective outcome measures relevant 4. Present how your patients were diagnosed. Don’t fall into the trap of trusting diag- to the disorder? Were they used cor- noses by others if such diagnoses are known to be frequently incorrect. Use recog- rectly? nized criteria so your audience will understand that your patients had the disorder 4. Intensity of the intervention suffi- you claim to be treating. cient to produce an effect? 5. Use correct assessment techniques for the disorder (e.g., the MMPI is not valid for 5. Way to check whether the interven- establishing the psychological components of low back pain). tion was successful (drug taken prop- 6. Define your assessment so you establish the basis for saying that people learned the erly, behavioral technique tasks you were teaching during your treatment, e.g., if you are teaching people to successfully learned and then used). change their muscle tension, show the baseline status then show that those people 6. Sufficient patient-subjects so result is who improved changed in the desired direction. This establishes the relationship credible? between the intervention and changes in symptoms. 7. Appropriate design for the question 7. Use the correct outcome measures and use them correctly. Review the literature so (e.g. single group, controls, believ- you are up to date. For example, 0 – 10 analog pain scales must define 10 to have an able placebo, etc.? objective limit such as “would faint if had to bear the pain for one more second” 8. Sufficient descriptive statistics so rather than “most pain can imagine”. results are clear? 8. Establish pre and post treatment baselines of sufficient duration to establish symp- 9. Long enough follow-up so duration tom variability, e.g., headache baselines need to be between two weeks and a month. of results can be established? This is how you demonstrate effectiveness. 10. In a multifaceted intervention, were 9. Use the correct design for the level of work done on the intervention already, e.g., a any changes in symptoms ascribed to new idea needs only a baseline – intervention – baseline design while a test of an one element of the intervention idea which has been shown to produce changes needs to incorporate a control group when there is no way to differentiate to show that changes are not due to non-specific effects. the effects of each part? 10. Include sufficient subjects so your results are likely to be due to the intervention rather than chance variability. 11. Clearly explain what your intervention was and have some way to know that there was sufficient intensity to have a chance of causing a change, e.g., one relaxation ses- sion isn’t likely to cure anything. 12. Present your results clearly with graphics rather than just tables. Show sufficient descriptive statistics so people decide what happened. 13. Never ascribe symptom changes to one aspect of a multifaceted intervention when you have no way to tease out the effect of that aspect, e.g., if you gave relaxation training and biofeedback, don’t say that the changes were due to biofeedback only. 14. Do not worry about the need to prove an underlying mechanism for the technique you used. All you need to do in a clinical presentation is demonstrate that a change did take place. Other types of research demonstrate how and why.

*From the inside front cover of: Sherman, R. (2003). Clinical research: Skills clinicians need to maintain effective practices. Suquamish, WA: Behavioral Medicine Research & Training Foundation.

6A Biofeedback Fall 2004

Book Order Form Send this form to AAPB 10200 W. 44th Ave. Suite 304, Wheat Ridge, CO 80033 or log onto the website at www.aapb.org and click on the AAPB Bookstore New and Popular AAPB Publications!

BC-80: Pain: Assessment and Intervention BC-81: Practice Guidelines and Standards from a Psychophysiological Perspective - for Providers of Biofeedback and Applied By Richard Sherman, PhD Psychophysiological Services, 2004 - By Information about our current knowledge of Sebastian Striefel, PhD pain disorders in a straightforward, and easy-to- Information to providers and others that will understand format. Provides practical assess- help them develop reasonable expectations ment and treatment strategies, which are about legal and ethical practice issues and supported by clinical research. Comes with a practice guidelines and standards of CD-Rom client/patient care and treatment.

Member Price: $69.95 Non-Member Price: $89.95 Member Price: $20.00 Non-Member Price: $35.00

BC-79: Evidence-Based Practice in BC-76: The Neurofeedback Book - By Biofeedback and Neurofeedback - By Lynda Thompson, PhD, and Michael Christopher Gilbert, PhD, and Carolyn Thompson, PhD Yucha, PhD An understandable explanation of the science A summary of the research findings, mostly behind biofeedback and neurofeedback. over the past 20 years, examining the efficacy Material specifically written to prepare for certi- of biofeedback for approximately 38 various fication, including a special section correspon- disorders. ding to the BCIA blueprint areas for EEG biofeedback.

Member Price: $35.00 Non-Member Price: $55.00 Member Price: $79.00 Non-Member Price: $99.00

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