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Cultivating Compassion and Connectedness
Abstract
This chapter guides the mental health therapists in delivering Stage 4, “empathic stage”, the last skillset of Mindfulness‐integrated Cognitive Behavior Therapy (MiCBT). It introduces three central elements, starting with the next and most advanced body‐scanning method, “sweeping in depth”. The purpose of sweeping in depth is becoming more aware of emotional experience and related schemas that operate more deeply and less consciously. The second element is the combining of advanced mindfulness skills with empathy training through the daily practice of loving‐kindness meditation. The third element is to apply mindfulness skills to enhance ethical behavior and increase a sense of worth in ourselves and of others, and an overall sense of connectedness. The therapists are able to accurately describe the main purpose of dedicating a whole MiCBT stage to the development of compassion, grounded in loving‐kindness meditation and ethical living: the prevention of relapse, resulting from the cultivation of compassion, meaning, equanimity and well‐being.
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Interoception refers to the process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a moment-by-moment mapping of the body’s internal landscape across conscious and unconscious levels. Interoceptive signaling has been considered a component process of reflexes, urges, feelings, drives, adaptive responses, cognitive and emotional experiences, highlighting its contributions to the maintenance of homeostatic functioning, body regulation, and survival. Dysfunction of interoception is increasingly recognized as an important component of different mental health conditions including anxiety disorders, mood disorders, eating disorders, addictive disorders, somatic symptom disorders, and others. However, a number of conceptual and methodological challenges have made it difficult for interoceptive constructs to be broadly applied in mental health research and treatment settings. In November 2016, the Laureate Institute for Brain Research organized the first Interoception Summit, a gathering of interoception experts from around the world, with the goal of accelerating progress in understanding the role of interoception in mental health. The discussions at the meeting were organized around four themes: interoceptive assessment, interoceptive integration, interoceptive psychopathology, and the generation of a roadmap that could serve as a guide for future endeavors. This article presents an overview of the emerging consensus generated by the meeting.
Recent imaging research shows that approximately 80% of people who transit from acute to chronic pain produce neuroplasticity linking pain pathways to learning areas of the brain, thus showing physiological evidence that chronic pain is largely learned. Mindfulness meditation programs have been used successfully to teach people a way of decreasing pain-related distress and unlearning their unhelpful relationship to pain. However, not all chronic pain patients are amenable to undergo a full mindfulness program and then maintain daily practice. Accordingly, we conducted a pilot study of a task extracted from a second-generation MBI, Mindfulness-integrated Cognitive Behavior Therapy, which consisted of a self-guided 30-s mindfulness-based interoceptive exposure task (MIET) to pain sensations in 15 medically diagnosed chronic pain patients. Participants using the MIET repeatedly over 15 days learned not to identify with pain and focused on four subcomponents of interoception (mass, motion, temperature, and cohesiveness) while remaining equanimous. This led to significant reduction in pain anxiety (p = .001; d = 0.96), pain duration (p = .01; d = 0.86), and pain intensity after each 30-s exposure (p < .001; d = 1.37). These effects were maintained, and some further improved, at 2-month follow-up. Marked decrease in depression, anxiety and stress were also observed (p < .001; d = 0.81). While participants rated the task as highly acceptable and some reduced their use of analgesic medication; no other change in medical or psychological treatment was required. These early results show the potential for the MIET to be use as an adjunct to traditional treatments of chronic pain, although controlled studies are needed to establish the validity of our results. Brain-imaging studies are also needed to assess the possible unlearning effect of the MIET on corticolimbic regions, a process that may be termed “central desensitization.”
Mindfulness training has been shown to have a beneficial impact on emotions and perceptions. We examined whether it would reduce negative emotions and perceptions and lead to increased support for compromise in the context of prolonged intergroup conflict. We also examined the effect of an intervention that combines mindfulness with cognitive reappraisal, a method that enhances emotion regulation. Israeli students participated in a mindfulness course that either began in the winter semester (mindfulness group) or in the spring semester (control group). After the termination of the mindfulness course, all participants were invited to a laboratory session in which they were randomly assigned to either receive or not a short cognitive reappraisal training. The results showed that after being presented with anger-inducing information related to the Israeli-Palestinian conflict, participants in the mindfulness condition only, the reappraisal condition only or the combined group (mindfulness and reappraisal), were more supportive of conciliatory policies compared to participants that received no mindfulness nor reappraisal training. The increased support for conciliatory policies was mediated by a decrease in negative emotions in all groups, while in the mindfulness group, it was also mediated by reduction in negative perceptions. The combined impact of mindfulness and reappraisal did not reveal any additional effect.
Background: Previous studies have shown the effectiveness of cognitive behavior therapy in improvement of psychological symptoms such as depression, anxiety, and stress. Recent studies suggest that mindfulness-based interventions (MBI) are effective in reducing these psychological symptoms in chronic diseases. The present study was the first study to examine the effects of mindfulness-integrated cognitive behavior therapy (MiCBT) on common comorbid psychological symptoms in patients with multiple sclerosis (MS). Objectives: The present study aimed at examining the effect of mindfulness-integrated cognitive behavior therapy on depression, anxiety, and stress in females with multiple sclerosis. Methods: This research was a quasi-experimental study conducted on female patients with MS who referred to Fars MS Society, Shiraz, Iran, in 2015. A total of 56 patients with MS were selected by convenience sampling method and randomly assigned into intervention and control groups. The intervention group received eight 2-hour sessions of MiCBT, while the control group was only given the usual treatment (TAU). The patients in both groups filled out a demographic questionnaire along with depression, anxiety and stress scales (DASS-21) in pre-and posttest. Results: In the current study, no statistically significant differences were found between the study groups in demographic variables (P > 0.05). Analysis of covariance revealed significant differences between the study groups in all the 3 variables in posttest compared to the pretest. The mean scores of depression, anxiety, and stress in the MiCBT group were significantly lower than the control group (P < 0.001). The mean score of depression was 16.69 ± 7.1 in the experimental group before the intervention, which decreased to 6.17 ± 5.7 after the intervention (P < 0.001). In addition, the mean score of anxiety was 13.2 ± 7.25 in pre-intervention, which significantly reduced to 6.09 ± 5.2 in post-intervention (P < 0.001). The mean score of stress also decreased from 22.09 ± 6.07 to 10.87 ± 6.3 compared to the pretest (P < 0.001). Conclusions: The results of the present study suggested that mindfulness-integrated cognitive behavior therapy is an effective and affordable treatment in reducing depression, anxiety, and stress for patients with MS.
Background
Cognitive behavior therapy (CBT) involving exposure and response prevention is the gold standard psychotherapeutic intervention for obsessive-compulsive disorder (OCD). However, applying traditional CBT techniques to treat patients with predominant obsessions (POs) without covert compulsions is fraught with problems because of inaccessibility of mental compulsions. In this context, we examined the efficacy of mindfulness-integrated CBT (MICBT) in patients with POs without prominent overt compulsions.
Materials and Methods
Twenty-seven patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of OCD were recruited from the specialty OCD clinic and the behavior therapy services of a tertiary care psychiatric hospital over 14 months. Patients had few or no overt compulsions and were free of medication or on a stable medication regimen for at least 2 months prior to baseline assessment. All patients received 12–16 sessions of MICBT on an outpatient basis. An independent rater (psychiatrist) administered the Yale–Brown Obsessive-Compulsive Scale (YBOCS) and the Clinical Global Impression Scale at baseline, mid- and post-treatment, and at 3-month follow-up.
Results
Of the 27 patients, 18 (67%) achieved remission (55% reduction in the YBOCS severity score) at 3-month follow-up. The average mean percentage reduction of obsessive severity at postintervention and 3-month follow-up was 56 (standard deviation [SD] = 23) and 63 (SD = 21), respectively.
Conclusions
Our study demonstrates that MICBT is efficacious in treating patients with POs without prominent overt compulsions. The results of this open-label study are encouraging and suggest that a larger randomized controlled trial examining the effects of MICBT may now be warranted.
There is expanding interest in mindfulness-based programs (MBPs) within the mainstream. While there are research gaps, there is empirical evidence for these developments. Implementing new evidence into practice is always complex and difficult. Particular complexities and tensions arise when implementing MBPs in the mainstream. MBPs are emerging out of the confluence of different epistemologies—contemplative teaching and practice, and contemporary Western empiricism and culture. In the process of navigating implementation and integrity, and developing a professional practice context for this emerging field, the diverse influences within this confluence need careful attention and thought. Both contemplative practices, and mainstream institutions and professional practice have well-developed ethical understandings and integrity. MBPs aim to balance fidelity to both. This includes the need to further develop skillful expressions of the underpinning theoretical and philosophical framework for MBPs; to sensitively work with the boundary between mainstream and religious mindfulness; to develop organizational structures which support governance and collaboration; to investigate teacher training, supervision models, and teaching competence; to develop consensus on the ethical frameworks on which mainstream MBPs rests; and to build understanding and work skillfully with barriers to access to MBPs. It is equally important to attend to how these developments are conducted. This includes the need to align with values integral to mindfulness, and to hold longer-term intentions and directions, while taking small, deliberate steps in each moment. The MBP field needs to establish itself as a new professional field and stand on its own integrity.
Introduction: Pregnancy can be associated with different psychological problems such as depression and anxiety. These problems are often neglected and left untreated. This study aimed to examine the effect of mindfulness-integrated cognitive behavior therapy on depression and anxiety among pregnant women.
Methods: A convenient sample of 80 pregnant women were selected. Participants were randomly allocated to either the experimental or the control groups. Participants in the experimental group received mindfulness-integrated cognitive behavior therapy while women in the control group only received routine prenatal care services. A demographic questionnaire, the Edinburgh Postnatal Depression Scale, and the Beck Anxiety Inventory were used for data collection. Descriptive statistics measures such as frequency, mean, and standard deviation as well as the repeated-measures analysis of variance test were used for data analysis.
Results: After the study intervention, the mean scores of anxiety and depression in the experimental group were significantly lower than the control group.
Conclusion: Mindfulness-integrated cognitive behavior therapy can significantly alleviate pregnant women’s depression and anxiety. So implementation of this method alongside with other prenatal care services is recommended.
Mindfulness has been suggested to impact emotional learning, but research on these processes is scarce. The classical fear conditioning/extinction/extinction retention paradigm is a well-known method for assessing emotional learning. The present study tested the impact of mindfulness training on fear conditioning and extinction memory and further investigated whether changes in white matter fiber tracts might support such changes. The uncinate fasciculus was of particular interest in the context of emotional learning. In this pilot study, 46 healthy participants were quasi-randomized to a Mindfulness-Based Stress Reduction (MBSR, N=23) or waitlist control (N=23) group and underwent a two-day fear conditioning, extinction learning, and extinction memory protocol before and after the course or control period. Skin conductance response data served to measure the physiological response during conditioning and extinction memory phases. Diffusion tensor imaging data were analyzed with probabilistic tractography and analyzed for changes of fractional anisotropy in the uncinate fasciculus. During conditioning, participants were able to maintain a differential response to conditioned vs not conditioned stimuli following the MBSR course (i.e., higher sensitivity to the conditioned stimuli), while controls dropped the response. Extinction memory results were not interpretable due to baseline differences. MBSR participants showed a significant increase in fractional anisotropy in the uncinate fasciculus, while controls did not (group by time interaction missed significance). Pre-post changes in uncinate fasciculus were correlated with changes in the response to the conditioned stimuli. The findings suggest effects of mindfulness practice on the maintenance of sensitivity of emotional responses and suggest underlying neural plasticity. (ClinicalTrials.gov, Identifier NCT01320969, https://clinicaltrials.gov/ct2/show/NCT01320969).
This paper comments on an article by Monteiro, Musten, and Compson (Mindfulness 6: 1-13, 2015) and a series of replies that explored the issue of ethics training for participants in contemporary mindfulness-based interventions (MBIs). The perceived need for explicit ethical training stems from concerns about potentially harmful or misguided applications of secular MBIs, particularly in settings whose activities may be inconsistent with the ethics of the Buddhist traditions from which mindfulness training originates. Much of the discussion in the target article and replies focused on whether ethical foundations of mindfulness in MBIs should remain implicit or should be taught from a Buddhist perspective. The present commentary argues that psychological science provides well developed alternatives for researchers and clinicians interested in secular approaches to ethics-related issues in MBIs. The experimental psychology literature provides a strong foundation for working with personally meaningful, prosocial values in MBIs. Positive psychology provides a complementary perspective on moral virtues and character strengths that have been widely recognized across cultures. Organizational psychology and related disciplines provide empirically based perspectives on the ethical implications of mindfulness training in the workplace. An approach to ethical issues in MBIs that is firmly grounded in psychological science and suitable for secular settings is recommended.
We read with interest the recent commentary paper by Baer (2015). Although Baer used different terminology, her paper essentially discussed the different approaches adopted by what have been termed first-generation mindfulness-based interventions (FG-MBIs) and second-generation mindfulness- based interventions (SG-MBIs) in terms of how they conceptualise and teach ethics. The key difference between these two approaches is that compared to FG-MBIs (such as mindfulness-based stress reduction and mindfulness-based cognitive therapy), SG-MBIs (such as meditation awareness training [MAT]) tend to explicitly teach a greater range of meditative and/or spiritual practices (i.e., in addition to mindfulness) and tend to be more overtly spiritual in nature (Van Gordon et al. 2015a). Although Baer admittedly made a number of valid and interesting points concerning the most appropriate means of teaching ethics in MBIs, her lack of support for the SG-MBI approach was based on a number of oversights and factual inaccuracies that we would like to challenge
and correct
Interoception can be broadly defined as the sense of signals originating within the body. As such, interoception is critical for our sense of embodiment, motivation and well-being. And yet, despite its importance, interoception remains poorly understood within modern science. This paper reviews interdisciplinary perspectives on interoception, with the goal of presenting a unified perspective from diverse fields such as neuroscience, clinical practice, and contemplative studies. It is hoped that this integrative effort will advance our understanding of how interoception determines well-being, and identify the central challenges to such understanding. To this end, we introduce an expanded taxonomy of interoceptive processes, arguing that many of these processes can be understood through an emerging predictive coding model for mind-body integration. The model, which describes the tension between expected and felt body sensation, parallels contemplative theories, and implicates interoception in a variety of affective and psychosomatic disorders. We conclude that maladaptive construal of bodily sensations may lie at the heart of many contemporary maladies, and that contemplative practices may attenuate these interpretative biases, restoring a person’s sense of presence and agency in the world.
Contemporary mindfulness has grown through innumerable secular and clinical programs. This rapid growth has raised two main concerns from the Buddhist community: the accuracy of the teachings and the impact of not explicitly including ethics as part of the teachings. Specific concerns include a potential weakening of the concept of Right Mindfulness and, as a corollary, misunderstanding the intent mindfulness as being a technique for symptomatic relief. With respect to the absence of explicit ethics in the teachings, concerns are expressed that this omission risks misappropriating mindfulness practices so that they do more harm than good. This article explores the main criticisms expressed by Traditional Mindfulness community and assesses the validity of these criticisms. The dialogue between traditional and contemporary mindfulness practitioners is an opportunity to examine the conceptual integrity of mindfulness-based interventions (MBIs) with respect to what comprises Right Mindfulness, assess whether MBIs include the factors that can extend them beyond symptomatic relief, and reflect on the issues related to teaching ethics as part of an MBI program. Because ethics is viewed in Traditional Mindfulness as a foundation for a meditative practice, it is explored in detail for its potential contribution to MBIs.
IntroductionWithin just the last decade, the word mindfulness has gained enormous popularity and traction in Western society, commerce and science. Long in vernacular English usage to define “the quality or state of being conscious or aware of something (Oxford Online Dictionary [http://www.oxforddictionaries.com]),” or “the state or quality of being mindful; attention; memory (obs.); intention, purpose (obs.)” from 1530 A.D. (from the Oxford English Dictionary [www.oed.com]), a specialized meaning of the word was, perhaps, first offered to academic psychology about 35 years ago as (1) “the ability to view both objects and situation from multiple perspectives and (2) the ability to shift perspectives depending upon context” (Langer and Newman, 1979).The current broad enthusiasm for mindfulness, nevertheless, seems mainly to derive from a philosophical, psychological, and religious, semantic amalgam, recently flown onto Western mainstream shores and adapted from a far continent of Buddh ...
Functional magnetic resonance imaging studies have shown that the insular cortex has a significant role in pain identification and information integration, while the default mode network is associated with cognitive and memory-related aspects of pain perception. However, changes in the functional connectivity between the default mode network and insula during pain remain unclear. This study used 3.0 T functional magnetic resonance imaging scans in 12 healthy subjects aged 24.8 ± 3.3 years to compare the differences in the functional activity and connectivity of the insula and default mode network between the baseline and pain condition induced by intramuscular injection of hypertonic saline. Compared with the baseline, the insula was more functionally connected with the medial prefrontal and lateral temporal cortices, whereas there was lower connectivity with the posterior cingulate cortex, precuneus and inferior parietal lobule in the pain condition. In addition, compared with baseline, the anterior cingulate cortex exhibited greater connectivity with the posterior insula, but lower connectivity with the anterior insula, during the pain condition. These data indicate that experimental low back pain led to dysfunction in the connectivity between the insula and default mode network resulting from an impairment of the regions of the brain related to cognition and emotion, suggesting the importance of the interaction between these regions in pain processing.
Loving kindness is a form of meditation involving directed well-wishing, typically supported by the silent repetition of phrases such as “may all beings be happy,” to foster a feeling of selfless love. Here we used functional magnetic resonance imaging to assess the neural substrate of loving kindness meditation in experienced meditators and novices. We first assessed group differences in blood oxygen level-dependent (BOLD) signal during loving kindness meditation. We next used a relatively novel approach, the intrinsic connectivity distribution of functional connectivity, to identify regions that differ in intrinsic connectivity between groups, and then used a data-driven approach to seed-based connectivity analysis to identify which connections differ between groups. Our findings suggest group differences in brain regions involved in self-related processing and mind wandering, emotional processing, inner speech, and memory. Meditators showed overall reduced BOLD signal and intrinsic connectivity during loving kindness as compared to novices, more specifically in the posterior cingulate cortex/precuneus (PCC/PCu), a finding that is consistent with our prior work and other recent neuroimaging studies of meditation. Furthermore, meditators showed greater functional connectivity during loving kindness between the PCC/PCu and the left inferior frontal gyrus, whereas novices showed greater functional connectivity during loving kindness between the PCC/PCu and other cortical midline regions of the default mode network, the bilateral posterior insula lobe, and the bilateral parahippocampus/hippocampus. These novel findings suggest that loving kindness meditation involves a present-centered, selfless focus for meditators as compared to novices.
Mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) are particularly effective treatment approaches in terms of alleviating depressive symptoms and preventing relapse once remission has been achieved. Although engaging in mindfulness practice is an essential element of both treatments; it is unclear whether informal or formal practices differentially impact on symptom alleviation. The current study utilizes a correlational design to examine data provided by thirty-two previously depressed, remitted outpatients who received either MBCT or MBSR treatment. Outpatients in the MBCT group received treatment as part of a previously published randomized efficacy trial (Segal et al. in Arch Gen Psychiatry 67:1256–1264, 2010), while those in the MBSR group received treatment as part of a separate, unpublished randomized clinical trial. Throughout treatment, clients reported on their use of formal and informal mindfulness practices. Results indicate that engaging in formal (but not informal) mindfulness practice was associated with decreased rumination, which was associated with symptom alleviation.
In light of a growing interest in contemplative practices such as meditation, the emerging field of contemplative science has been challenged to describe and objectively measure how these practices affect health and well-being. While “mindfulness” itself has been proposed as a measurable outcome of contemplative practices, this concept encompasses multiple components, some of which, as we review here, may be better characterized as equanimity. Equanimity can be defined as an even-minded mental state or dispositional tendency toward all experiences or objects, regardless of their origin or their affective valence (pleasant, unpleasant, or neutral). In this article we propose that equanimity be used as an outcome measure in contemplative research. We first define and discuss the inter-relationship between mindfulness and equanimity from the perspectives of both classical Buddhism and modern psychology and present existing meditation techniques for cultivating equanimity. We then review psychological, physiological, and neuroimaging methods that have been used to assess equanimity, either directly or indirectly. In conclusion, we propose that equanimity captures potentially the most important psychological element in the improvement of well-being, and therefore should be a focus in future research studies.
Two prominent emotions in borderline personality disorder (BPD) are shame and anger. Rumination has been demonstrated to occur in response to shame and to escalate anger, and rumination, particularly anger rumination, has been shown to predict BPD symptoms. The present study tested a structural equation model in which shame leads to the features of BPD via increased anger and anger rumination. A sample of 823 undergraduates completed self-report measures of shame, trait-level anger, anger rumination, and BPD features. The hypothesized model of shame to anger and anger rumination to BPD features was largely supported. Bootstrapping was used to establish significant indirect effects from both situational and global forms of shame via anger rumination to BPD features, and from global shame via anger to most BPD features. The alternative hypothesis that anger and anger rumination contribute to BPD features via increased shame was also examined, with no significant indirect effects found. Recognizing this function of anger and anger rumination may be important in understanding the relationship between shame-proneness and BPD features and may have implications for treatment. Further research into determining other ways individuals maladaptively respond to shame, and understanding the functions of anger and anger rumination, is recommended. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Events evoke seamlessly integrated stimulus evaluation and response preparation processing streams, guided by regulative functions that change behavior flexibly in accord with the internal goals and contextual demands. The neural basis of the effects of alcohol intoxication on these processing streams is poorly understood, despite the evidence of alcohol's deleterious effects on both attention and motor control. In an attempt to separate and examine relative susceptibility of these two dimensions, we employed a color version of the Eriksen flanker task that manipulated compatibility at the stimulus- and response-processing levels. Functional magnetic resonance imaging (fMRI) was performed in healthy social drinkers as they participated in both alcohol (0.6 g/kg ethanol for men, 0.55 g/kg for women) and placebo conditions in a counterbalanced design. Alcohol increased reaction times to response-level incongruity and decreased accuracy overall. Relative to the no-conflict condition, the observed brain activity was predominantly evoked by response-related conflict in medial prefrontal and lateral prefrontal cortices under placebo, in agreement with extensive evidence of their role in conflict processing. Activity evoked by response incongruity in the medial frontal cortex and insula was insignificant under alcohol, indicating its interference with response inhibition and preparation. Conversely, activity in ventrolateral prefrontal and premotor areas was relatively greater under alcohol than placebo, suggesting their compensatory engagement. This finding is consistent with the compensatory prefrontal activity increase found in studies with chronic alcoholic individuals, indicating functional reorganization with a goal of optimizing response strategy. These results delineate functional differences and selective susceptibility of a prefrontal network subserving response-level conflict processing. Our findings are incompatible with notions that moderate alcohol primarily affects attentional or stimulus-related processing and argue instead that its primary influence is on response inhibition, selection, and execution, with ramifications for the models of behavioral self-control and the inability to refrain from drinking.
Based on theoretical considerations and recent observations, we argue that continued suffering of chronic pain is critically dependent on the state of motivational and emotional mesolimbic-prefrontal circuitry of the brain. The plastic changes that occur within this circuitry in relation to nociceptive inputs dictate the transition to chronic pain, rendering the pain less somatic and more affective in nature. This theoretical construct is a strong departure from the traditional scientific view of pain, which has focused on encoding and representation of nociceptive signals. We argue that the definition of chronic pain can be recast, within the associative learning and valuation concept, as an inability to extinguish the associated memory trace, implying that supraspinal/cortical manipulations may be a more fruitful venue for adequately modulating suffering and related behavior for chronic pain. We briefly review the evidence generated to date for the proposed model and emphasize that the details of underlying mechanisms remain to be expounded.
Previous studies associated psychopathy in adults with deficits in empathy but these studies did not directly compare cognitive and emotional facets of empathy. The present study sought to establish whether psychopathy is associated with impairments in emotional empathy among adult offenders. Participants were 90 male offenders scoring low (n = 29), medium (n = 33) or high (n = 28) on the Psychopathy Checklist-Revised (PCL-R) and n = 28 male noncriminal controls. Empathy functioning was assessed through self-report and computerized decision tasks, differentiating between perspective-taking (cognitive empathy) and compassion (emotional empathy). Against expectations, level of psychopathy among the offenders was not associated with either emotional or cognitive empathy. Offenders however had lower scores for both cognitive and emotional components of empathy functioning than controls. Both facets of empathy showed small but significant positive correlations with education level and social desirability. The methods employed to assess differences in empathy functioning may not be sensitive enough to assess differences in forensic samples.
Psychosocial interventions often aim to alleviate negative emotional states. However, there is growing interest in cultivating positive emotional states and qualities. One particular target is compassion, but it is not yet clear whether compassion can be trained. A community sample of 100 adults were randomly assigned to a 9-week compassion cultivation training (CCT) program (n = 60) or a waitlist control condition (n = 40). Before and after this 9-week period, participants completed self-report inventories that measured compassion for others, receiving compassion from others, and self-compassion. Compared to the waitlist control condition, CCT resulted in significant improvements in all three domains of compassion—compassion for others, receiving compassion from others, and self-compassion. The amount of formal meditation practiced during CCT was associated with increased compassion for others. Specific domains of compassion can be intentionally cultivated in a training program. These findings may have important implications for mental health and well-being.
The mechanism of brain reorganization in pain chronification is unknown. In a longitudinal brain imaging study, subacute back pain (SBP) patients were followed over the course of 1 year. When pain persisted (SBPp, in contrast to recovering SBP and healthy controls), brain gray matter density decreased. Initially greater functional connectivity of nucleus accumbens with prefrontal cortex predicted pain persistence, implying that corticostriatal circuitry is causally involved in the transition from acute to chronic pain.
Two studies are presented to examine the relation of self-compassion to psychological health. Self-compassion entails being kind and understanding toward oneself in instances of pain or failure rather than being harshly self-critical; perceiving one’s experiences as part of the larger human experience rather than seeing them as isolating; and holding painful thoughts and feelings in mindful awareness rather than over-identifying with them. Study 1 found that self-compassion (unlike self-esteem) helps buffer against anxiety when faced with an ego-threat in a laboratory setting. Self-compassion was also linked to connected versus separate language use when writing about weaknesses. Study 2 found that increases in self-compassion occurring over a one-month interval were associated with increased psychological well-being, and that therapist ratings of self-compassion were significantly correlated with self-reports of self-compassion. Self-compassion is a potentially important, measurable quality that offers a conceptual alternative to Western, more egocentric concepts of self-related processes and feelings.
How exteroceptive attention (EA) alters neural representations of the external world is well characterized, yet little is known about how interoceptive attention (IA) alters neural representations of the body's internal state. We contrasted visual EA against IA toward respiration. Visual EA modulated striate and extrastriate cortices and a lateral frontoparietal "executive" network. By contrast, respiratory IA modulated a posterior insula region sensitive to respiratory frequency, consistent with primary interoceptive cortex, and a posterior limbic and medial parietal network, including the hippocampus, precuneus, and midcingulate cortex. Further distinguishing between EA and IA networks, attention-dependent connectivity analyses revealed that EA enhanced visual cortex connectivity with the inferior parietal lobule and pulvinar of the thalamus, while IA enhanced insula connectivity with the posterior ventromedial thalamus, a relay of the laminar I spinothalamocortical pathway supporting interoceptive afference. Despite strong connectivity between the posterior and the anterior insula, anatomical parcellation of the insula revealed a gradient of IA to EA recruitment along its posterior-anterior axis. These results suggest that distinct networks may support EA and IA. Furthermore, the anterior insula is not an area of pure body awareness but may link representations of the outside world with the body's internal state-a potential basis for emotional experience.
Pain can be modulated by several cognitive techniques, typically involving increased cognitive control and decreased sensory
processing. Recently, it has been demonstrated that pain can also be attenuated by mindfulness. Here, we investigate the underlying
brain mechanisms by which the state of mindfulness reduces pain. Mindfulness practitioners and controls received unpleasant
electric stimuli in the functional magnetic resonance imaging scanner during a mindfulness and a control condition. Mindfulness
practitioners, but not controls, were able to reduce pain unpleasantness by 22% and anticipatory anxiety by 29% during a mindful
state. In the brain, this reduction was associated with decreased activation in the lateral prefrontal cortex and increased
activation in the right posterior insula during stimulation and increased rostral anterior cingulate cortex activation during
the anticipation of pain. These findings reveal a unique mechanism of pain modulation, comprising increased sensory processing
and decreased cognitive control, and are in sharp contrast to established pain modulation mechanisms.
Many philosophical and contemplative traditions teach that "living in the moment" increases happiness. However, the default mode of humans appears to be that of mind-wandering, which correlates with unhappiness, and with activation in a network of brain areas associated with self-referential processing. We investigated brain activity in experienced meditators and matched meditation-naive controls as they performed several different meditations (Concentration, Loving-Kindness, Choiceless Awareness). We found that the main nodes of the default-mode network (medial prefrontal and posterior cingulate cortices) were relatively deactivated in experienced meditators across all meditation types. Furthermore, functional connectivity analysis revealed stronger coupling in experienced meditators between the posterior cingulate, dorsal anterior cingulate, and dorsolateral prefrontal cortices (regions previously implicated in self-monitoring and cognitive control), both at baseline and during meditation. Our findings demonstrate differences in the default-mode network that are consistent with decreased mind-wandering. As such, these provide a unique understanding of possible neural mechanisms of meditation.
Human decision-making is often conceptualized as a competition between cognitive and emotional processes in the brain. Deviations from rational processes are believed to derive from inclusion of emotional factors in decision-making. Here, we investigate whether experienced Buddhist meditators are better equipped to regulate emotional processes compared with controls during economic decision-making in the Ultimatum Game. We show that meditators accept unfair offers on more than half of the trials, whereas controls only accept unfair offers on one-quarter of the trials. By applying fMRI we show that controls recruit the anterior insula during unfair offers. Such responses are powerful predictors of rejecting offers in social interaction. By contrast, meditators display attenuated activity in high-level emotional representations of the anterior insula and increased activity in the low-level interoceptive representations of the posterior insula. In addition we show that a subset of control participants who play rationally (i.e., accepts >85% unfair offers) recruits the dorsolateral prefrontal cortex presumably reflecting increased cognitive demands, whereas rational meditators by contrast display elevated activity in the somatosensory cortex and posterior superior temporal cortex. In summary, when assessing unfairness in the Ultimatum Game, meditators activate a different network of brain areas compared with controls enabling them to uncouple negative emotional reactions from their behavior. These findings highlight the clinically and socially important possibility that sustained training in mindfulness meditation may impact distinct domains of human decision-making.
The inclusion of ethics in mindfulness-based interventions (MBIs) has become a hot topic in recent years, contributing to a differentiation between what has recently been called first- and second-generation MBIs. This chapter first discusses the origins and purpose of ethics in Theravada Buddhism and the traditional understanding that developing mindfulness also aids in monitoring and preventing harmful intentions and actions, while cultivating beneficial ones, to decrease suffering. It will then describe the role and benefits of cultivating ethics in Mindfulness-integrated Cognitive Behavior Therapy (MiCBT), a four-stage transdiagnostic approach that combines Burmese Vipassana meditation and core principles of traditional CBT. There are three principal reasons for which MiCBT dedicates a whole therapeutic stage to the development of empathy grounded in loving-kindness meditation and ethical living: (1) the cultivation of compassion, (2) the prevention of relapse into common mental health disorders, and (3) the cultivation of joy and well-being. The chapter also offers some insight into the reasons for which more advanced mindfulness states inevitably lead to the observation that ethics and compassion are interdependent, and reflects on some of the implications that this may have for MBI programs.
This study examined the role of degree of adherence in a mindfulness-based intervention on mindfulness, flow, sport anxiety, and sport-related pessimistic attributions in athletes. Twelve athletes participated in an 8-week mindfulness intervention which incorporated a mindfulness focus on movement training component. Participants completed baseline and posttest measures of mindfulness, flow, sport anxiety, and sport-related pessimistic attributions, and they filled out daily mindfulness-training logbooks documenting their frequency and duration of mindfulness practice. Participants were identified as either high adherence or low adherence with mindfulness-training based on a composite score of logbook practice records and workshop attendance. Athletes high in adherence, operationalized as following recommended practice of mindfulness exercises, showed significantly greater increases in mindfulness and aspects of flow, and significantly greater decreases in pessimism and anxiety than low adherence athletes. Greater increases in mindfulness from baseline to posttest were associated with greater increases in flow and greater decreases in pessimism. Increases in flow were associated with decreases in somatic anxiety and pessimism.
Awareness of the body (i.e., interoceptive awareness) and self-referential thought represent two distinct, yet habitually integrated aspects of self. A recent neuroanatomical and processing model for depression and anxiety incorporates the connections between increased but low fidelity afferent interoceptive input with self-referential and belief-based states. A deeper understanding of how self-referential processes are integrated with interoceptive processes may ultimately aid in our understanding of altered, maladaptive views of the self – a shared experience of individuals with mood and anxiety disorders. Thus, the purpose of the current study was to examine how negative self-referential processing (i.e., brooding rumination) relates to interoception in the context of affective psychopathology. Undergraduate students (N = 82) completed an interoception task (heartbeat counting) in addition to self-reported measures of rumination and depression and anxiety symptoms. Results indicated an interaction effect of brooding rumination and interoceptive awareness on depression and anxiety-related distress. Specifically, high levels of brooding rumination coupled with low levels of interoceptive awareness were associated with the highest levels of depression and anxiety-related distress, whereas low levels of brooding rumination coupled with high levels of interoceptive awareness were associated with lower levels of depression and anxiety-related distress. The findings provide further support for the conceptualization of anxiety and depression as conditions involving the integration of interoceptive processes and negative self-referential processes.
Pain is a multidimensional experience that involves interacting sensory, cognitive, and affective factors, rendering the treatment of chronic pain challenging and financially burdensome. Further, the widespread use of opioids to treat chronic pain has led to an opioid epidemic characterized by exponential growth in opioid misuse and addiction. The staggering statistics related to opioid use highlight the importance of developing, testing, and validating fast-acting nonpharmacological approaches to treat pain. Mindfulness meditation is a technique that has been found to significantly reduce pain in experimental and clinical settings. The present review delineates findings from recent studies demonstrating that mindfulness meditation significantly attenuates pain through multiple, unique mechanisms-an important consideration for the millions of chronic pain patients seeking narcotic-free, self-facilitated pain therapy.
Mindfulness-integrated CBT: Principles and Practice represents the first set of general principles and practical guidelines for the integration of mindfulness meditation with well-documented and newly developed CBT techniques to address a broad range of psychological dysfunctions. • The first book to provide a strong rationale and general guidelines for the implementation of mindfulness meditation integrated with CBT for a wide range of psychological difficulties • Incorporates ancient Buddhist concepts of how the mind works, while remaining firmly grounded in well-documented cognitive and behavioural principles • Provides new insights into established understanding of conditioning principles • Includes a comprehensive list of frequently asked questions, week-by-week instructions for professionals to facilitate application of the therapy, along with case examples and the inspiring stories of former clients.
Some scholars of Chinese Chan Buddhism maintain that the innovations associated with early (eighth-century) Chan were largely in the area of doctrine and mythology. In other words, early Chan meditation and ritual practices would have been indistinguishable from non-Chan forms until the emergence, in the Song, of distinctive new methods such as kanhua meditation. This article argues that at least some of the early Chan patriarchs did indeed experiment with a new method (or methods), and that this method foreshadowed, at least superficially, techniques developed in twentieth-century Burmese Theravāda that we now associate with the satipaṭṭhāna movement (i.e., “mindfulness,” understood as “bare attention”); similar innovations, possibly influenced by early Chan, can be found in Tibetan Dzogchen. There is evidence that in eighth-century China, as in twentieth-century Burma, these new techniques emerged in order to make Buddhist practice more accessible to the laity, who were not in a position to engage in more traditional forms of meditation. And in China, as in Burma, the innovations sparked controversy: opponents held that the cultivation of a non-judgmental, non-discursive meditative state was ethically dubious and at odds with orthodox Buddhist teachings.
This collaborative inquiry reports the impact of mindfulness meditation practice in a hospital's palliative care setting. Designed as action research, the collaborative program invited participants to investigate and deepen the benefits of the practice for themselves with others over the course of 12 weeks. Participants expressed surprise by how liberating it was to learn to notice and drop their self-centered thinking. Theorizing these findings by bringing perspectives from pragmatism and psychological perspectives on Buddhism, an experience-near understanding of the self also emerged. The article includes reflection on how the combination of action research and mindfulness is practical and useful to participants in the context of caregiving as it reports many benefits to participants. The article ends with a definition of self as encompassing all that which can be responded to, which also contributes a practical and useful direction for reconceptualizing the self as a more collaborative self.
In the current resurgence of interest in the biological basis of animal behavior and social organization, the ideas and questions pursued by Charles Darwin remain fresh and insightful. This is especially true of The Descent of Man and Selection in Relation to Sex, Darwin's second most important work. This edition is a facsimile reprint of the first printing of the first edition (1871), not previously available in paperback. The work is divided into two parts. Part One marshals behavioral and morphological evidence to argue that humans evolved from other animals. Darwin shoes that human mental and emotional capacities, far from making human beings unique, are evidence of an animal origin and evolutionary development. Part Two is an extended discussion of the differences between the sexes of many species and how they arose as a result of selection. Here Darwin lays the foundation for much contemporary research by arguing that many characteristics of animals have evolved not in response to the selective pressures exerted by their physical and biological environment, but rather to confer an advantage in sexual competition. These two themes are drawn together in two final chapters on the role of sexual selection in humans. In their Introduction, Professors Bonner and May discuss the place of The Descent in its own time and relation to current work in biology and other disciplines.
This essay critiques the standard characterization of mindfulness as present-centred non-judgmental awareness, arguing that this account misses some of the central features of mindfulness as described by classical Buddhist accounts, which present mindfulness as being relevant to the past as well as to the present. I show that for these sources the central feature of mindfulness is not its present focus but its capacity to hold its object and thus allow for sustained attention, regardless of whether the object is present or not. I further show that for these sources mindfulness can be explicitly evaluative, thus demonstrating the degree to which classical Buddhist accounts differ from the modern description of mindfulness as non-judgmental. I conclude that although this modern description may be useful as an operational definition intended for practical instruction, it does not provide an adequate basis for a theoretical analysis of mindfulness, for it fails to emphasize its retentive nature to privilege its alleged nonconceptuality.
Alcohol use in humans is associated with aggression and other socially inappropriate behaviors. These adverse effects have been attributed to an acute impairment of behavioral control, and research findings indicate that inhibitory aspects of behavioral control might be particularly vulnerable to the effects of alcohol. The present study tested the degree to which alcohol-induced impairment of behavioral control is due to a specific impairment of inhibitory mechanisms or due to a general information processing deficit.
Forty subjects (29 men) performed a cued reaction time task before and after receiving 0.65 g/kg alcohol or a placebo. Subjects performed the task under conditions that differed in the type of response needed to maintain behavioral control: response-suppression and response-alteration.
Alcohol impairment was observed when behavioral controlwas dependent on response-suppression, but no impairment was observed when control relied on response-alteration.
The findings point to the susceptibility of inhibitory processes by showing that alcohol can be particularly detrimental to behavioral control in situations where prepotent responses must be completely suppressed. Evidence for alcohol-induced impairment of inhibitory functions could provide important clues about basic behavioral mechanisms by which alcohol disrupts such higher order cognitive processes as working memory, learning and decision making.
