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i
Open Access
OBM Integrative and Complementary
Medicine
Health Benefits of Meditation
Edited by
Sok Cheon Pak and Soo Liang Ooi
Printed Edition of the Special Issue Published in
OBM Integrative and Complementary Medicine
http://www.lidsen.com/journals/icm
ii
Health Benefits of Meditation
Special Issue Editors
Sok Cheon Pak
Soo Liang Ooi
iii
Special Issue Editors
Sok Cheon Pak
Soo Liang Ooi
Charles Sturt University
Centre for Complementary & Alternative Medicine
Australia
Singapore
Editorial Office
OBM Integrative and Complementary Medicine Editorial Office,
73 Hongkong Middle Road, Qingdao, China
Tel./Fax: +86-532-8979-9572
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This is a reprint of articles from the Special Issue published online in the open access
journal OBM Integrative and Complementary Medicine (ISSN 2573-4393) from 2018
to 2019.
Available at:
http://www.lidsen.com/journals/icm/icm-special-issues/health-benefit-meditation
For citation purposes, cite each article independently as indicated on the article
page online and as indicated below:
LastName, A.A, LastName, B.B, LastName, C.C. Article Title. Journal Name Year;
Volume(Issue):Article Number; doi.
© 2019 by the author. This is an open access article
distributed under the conditions of the Creative Commons
by Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium or format,
provided the original work is correctly cited.
iv
Contents
About the Special Issue Editors ......................................................................................................... viii
Health Benefits of Meditation ......................................................................................... ix
[Editorial]
Soo Liang Ooi, Sok Cheon Pak
The Landscape of Current Meditation Research: An Ov Health
Benefits of Meditation
Reprinted from: OBM Integrative and Complementary Medicine 2019;4(2):008;
doi:10.21926/obm.icm. 1902033 ........................................................................................................ 1
[Communication]
Russell Razzaque
Open Dialogue and the Impact of Therapist Mindfulness on the Health of Clients
Reprinted from: OBM Integrative and Complementary Medicine 2018;3(1):003;
doi:10.21926/obm.icm.1801001. ........................................................................................................ 9
Marcel Allbritton, Carrie Heeter
Meditation as an Intervention for Health: A Framework for Understanding Meditation Research
Reprinted from: OBM Integrative and Complementary Medicine 2018;3(4):012;
doi:10.21926/obm.icm.1804025 ....................................................................................................... 12
Natalia Sylvia Ramos Díaz
Proposal for a Compassionate Emotional Accompaniment Technique (CEAT) Based on Mindfulness
to Manage Disturbing Emotions
Reprinted from: OBM Integrative and Complementary Medicine 2019;4(1):013;
doi:10.21926/obm.icm. 1901017 ...................................................................................................... 24
[Case Report]
Patricia Lynn Dobkin
Living with Spondylolisthesis with (Relative) Equanimity
Reprinted from: OBM Integrative and Complementary Medicine 2018;3(2):009;
doi:10.21926/obm.icm.1803013 ....................................................................................................... 37
[Review]
Jonathan Manh Dang, Luma Bashmi, Stephen Meeneghan, Janet White, Rebecca Hedrick, Jelena
Djurovic, Brigitte Vanle, Dennis Nguyen, Jonathan Almendarez, Paula Ravets, Yasmine Gohar,
Sophia Hanna, Itai Danovitch, Waguih William IsHak
v
The Efficacy of Mindfulness-Based Interventions on Depressive Symptoms and Quality of Life: A
Systematic Review of Randomized Controlled Trials
Reprinted from: OBM Integrative and Complementary Medicine 2018;3(2):025;
doi:10.21926/obm.icm.1802011 ....................................................................................................... 46
Alexandra Koulouris, Kathleen Dorado, Christina McDonnell, Robert R. Edwards, Asimina
Lazaridou
A Review of the Efficacy of Yoga and Meditation-Based Interventions for Rheumatoid Arthritis
Reprinted from: OBM Integrative and Complementary Medicine 2018;3(4):017;
doi:10.21926/obm.icm.1803018 ....................................................................................................... 71
Marcus A. Henning, Tae Joo Park, Fiona Moir, Chris Krägeloh, Christopher Mysko, Jennifer
Hobson, Craig S. Webster
Integrating Mindfulness and Physical Exercises for Medical Students: A Systematic Review
Reprinted from: OBM Integrative and Complementary Medicine 2019;3(4):030;
doi:10.21926/obm.icm. 1804027 ...................................................................................................... 88
Nicole Thibodeaux, Matt J. Rossano
Meditation and Immune Function: The Impact of Stress Management on the Immune System
Reprinted from: OBM Integrative and Complementary Medicine 2019;3(4):016;
doi:10.21926/obm.icm. 1804032 .................................................................................................... 118
Andrew J Hede
Binary Model of the Dynamics of Active versus Passive Mindfulness in Managing Depression
Reprinted from: OBM Integrative and Complementary Medicine 2019;3(4):028;
doi:10.21926/obm.icm. 1804037 .................................................................................................... 134
Randye J. Semple, Christine Burke
State of the Research: Physical and Mental Health Benefits of Mindfulness-Based Interventions for
Children and Adolescents
Reprinted from: OBM Integrative and Complementary Medicine 2019;4(1):032;
doi:10.21926/obm.icm. 1901001 .................................................................................................... 162
Selma A. Quist Møller, Sohrab Sami, Shauna L. Shapiro
Health Benefits of (Mindful) Self-Compassion Meditation and the Potential Complementarity to
Mindfulness-Based Interventions: A Review of Randomized-Controlled Trials
Reprinted from: OBM Integrative and Complementary Medicine 2019;4(1):020;
doi:10.21926/obm.icm. 1901002 .................................................................................................... 194
Andrew Villamil, Talya Vogel, Elli Weisbaum, Daniel J. Siegel
Cultivating Well-Being through the Three Pillars of Mind Training: Understanding How Training the
Mind Improves Physiological and Psychological Well-Being
Reprinted from: OBM Integrative and Complementary Medicine 2019;4(1):016;
doi:10.21926/obm.icm. 1901003 .................................................................................................... 214
vi
Lauren E. Guerriero, Bruce F. O’Hara
Meditation, Sleep, and Performance
Reprinted from: OBM Integrative and Complementary Medicine 2019;4(2):018;
doi:10.21926/obm.icm. 1902031 .................................................................................................... 230
[Original Research]
Stephanie Bryan, Maryellen Hamilton, Elizabeth Finn
Mindfulness Meditation in College Students to Advance Health Equity
Reprinted from: OBM Integrative and Complementary Medicine 2018;3(2):012;
doi:10.21926/obm.icm.1802006 ..................................................................................................... 248
Andrew Hanna , Aileen M. Pidgeon
Leveraging Mindfulness to Build Resilience and Professional Quality of Life in Human Service
Professionals
Reprinted from: OBM Integrative and Complementary Medicine 2018;3(2):019;
doi:10.21926/obm.icm.1802007 ..................................................................................................... 260
Fraser L. E. Fisher, Aileen M. Pidgeon
The Four-Facet Model of Eudaimonic Resilience and Its Relationships with Mindfulness, Perceived
Stress and Resilience
Reprinted from: OBM Integrative and Complementary Medicine 2018;3(3):017;
doi:10.21926/obm.icm.1803015 ..................................................................................................... 279
Holly Hazlett-Stevens
Specific Somatic Symptoms Alleviated by Mindfulness Meditation Training
Reprinted from: OBM Integrative and Complementary Medicine 2018;3(4):010;
doi:10.21926/obm.icm.1804023 ..................................................................................................... 296
Paul A. Barclay, Clint A. Bowers
Feasibility of a Meditation Video Game to Reduce Anxiety in College Students
Reprinted from: OBM Integrative and Complementary Medicine 2018;3(4):012;
doi:10.21926/obm.icm.1804024 ..................................................................................................... 306
Ethan G. Lester, Amy R. Murrell, Dickson E. Dickson
A Mixed Methods Approach to Understanding Conceptions of Mindfulness Meditation
Reprinted from: OBM Integrative and Complementary Medicine 2018;3(4):015;
doi:10.21926/obm.icm.1804026 ..................................................................................................... 318
Nancy Poirier, Serge Beaulieu, Sybille Saury, Sonia Goulet
Impacts of Mindfulness-Based Cognitive Therapy (MBCT) on the Psychological and Functional
Wellbeing of Patients with Bipolar Disorders
Reprinted from: OBM Integrative and Complementary Medicine 2019;3(4):017;
doi:10.21926/obm.icm. 1804028 .................................................................................................... 333
vii
Suzie Jokic, Nicole Jacqueline Albrecht, Sue Erica Smith
Mindful Self-Compassion and Adult Learner Retention in Post-Compulsory Education
Reprinted from: OBM Integrative and Complementary Medicine 2019;4(1):028;
doi:10.21926/obm.icm. 1901004 .................................................................................................... 350
Robert Marx, Lisa Burroughes
An Evaluation of a New Programme Training Mindfulness Teachers to Deliver Non-Eight Week
Adapted Mindfulness-Based Interventions
Reprinted from: OBM Integrative and Complementary Medicine 2019;4(1):020;
doi:10.21926/obm.icm. 1901009 .................................................................................................... 378
Pei-Chen Lo, Bo-Ting Lyu, Wu Jue Miao Tian
Comparison of Respiratory Sinus Arrhythmia between Zen-meditation and Control Groups
Reprinted from: OBM Integrative and Complementary Medicine 2019;4(2):017;
doi:10.21926/obm.icm. 1902021 .................................................................................................... 398
viii
About the Special Issue Editors
Sok Cheon Pak has been teaching and researching at Charles Sturt University since 2007. His
research has been in the field of Complementary Medicine and has become recognised
internationally and nationally through ongoing external research collaborations in Korea, Hong
Kong and the USA. His area of expertise relates specifically to introducing evidence-based practice
to Complementary Medicine research and practice. This has been based on laboratory
experiments which incorporate modern medical technologies to identify and evidence the
underlying rationale of prescribing therapeutic substances for treatment.
Over the years, his principal focus has been on the experimental/clinical application of bee
venom on human diseases. The following are two examples of where his research related to bee
venom has been acknowledged: (a) Firstly, his research has been acknowledged by an invitation
from the publishing company Springer to write two chapters on 'Chemical Composition of Bee
Venom' and 'Health Benefits and Uses in Medicine of Bee Venom' for the publication of a book
entitled "Bee products - chemical and biological properties". This invitation is directly related to
his research on honeybee venom with a focus on health benefits and uses in medicine. (b) In 2015,
he was appointed as the Guest Editor of a Special Issue on "Bee and wasp venoms: biological
characteristics and therapeutic application" for the journal TOXINS (ISSN 2072-6651). A website
for this special issue was set up to seek high-quality manuscripts from around the world. A total of
15 review and research articles were published in that special issue through his role as the
Academic Editor.
Soo Liang Ooi is a nutritionist and naturopath in private practice, with clinical experience in
Australia and Singapore helping clients to harness their healing power within. He has a keen
interest in mind-body practices and research, with over 15 years of experience practising various
forms of meditation, including mindfulness, loving-kindness, Samatha & Vipassana, mantra
meditation, and yoga. He attended many long retreats in various meditation centres in Singapore,
Malaysia, India, and Australia, to sharpen his meditative insight and achieve consciousness
transformation. His research interests lie in not only in meditation, but also evidence-based
complementary medicine, nutritional medicine, naturopathy, herbal medicine, and integrative
cancer therapies.
As an avid academic writer, Soo Liang published extensively over the years in major
peer-reviewed journals of integrative and complementary medicine. He received a nomination for
lowering blood pressure: An overview of systematic reviews and meta-
Complementary Therapies in Medicine. He is currently pursuing his Doctor of Philosophy (PhD)
study in the School of Biomedical Sciences at Charles Sturt University. His thesis topic focuses on
understanding the immunomodulating properties of rice bran arabinoxylan compound and its
effects on the quality of life of cancer patients.
ix
Preface to ‘Health Benefits of Meditation’
this one way for the purification of beings, for overcoming sorrow and lamentation, for
extinguishing of stress and suffering, for attaining to higher knowledge, and for the realisation of
feelings, mind, and phenomena. Such wisdom words of an enlightened teacher uttered more than
2,500 years ago are timeless truths which modern science has just begun to uncover.
For four decades since Jon Kabat-Zinn founded the Stress Reduction Clinic at the University of
Massachusetts Medical School to introduce the structured practice of mindfulness, the interest in
mindfulness and other forms of meditation has grown exponentially. Meditation is no longer
merely a spiritual quest practised at secluded religious centres but a mainstream mind-body
therapy for health and wellbeing. Meditation classes are everywhere: hospitals, mental health
clinics, nursing homes, the military, correctional centres, sports centres, universities, schools, and
even in nurseries. Research has played a pivotal role to usher in this newfound interest in
meditation. There is growing evidence supporting the health benefits of meditation in reducing
stress, managing pain, enhancing cognition, improving resilience, cultivating positive emotions,
and much more. However, cumulative knowledge on the study of meditation from various
research disciplines including neuroscience, psychophysiology, cognitive science, mental health
and public health represent only the tip of the iceberg. There is still much to discover from these
ancient mind and body practices.
This book is a compilation of recent research in the field of meditation. It provides a snapshot
of exciting findings and developments such as the launch of a large-scale UK study to
operationalise mindfulness in the mental health system, the possibility that Zen meditation can
slow down cardiopulmonary ageing, a theoretical framework for describing meditation
interventions in health research, the potential for meditation to address health inequality, the use
of mindful self-compassion to enhance the wellbeing of adult learners, and the case study of a
clinical psychologist and meditation teacher sharing her first-hand experience of living with
spondylolisthesis in relative peace through applying mindfulness strategies. The included articles
further contribute to our understanding of the role of meditation in health, defined by the World
It is an honour to be academic editors for this Special Issue and a great pleasure to review many
insightful manuscripts first-hand. We wish to thank the publisher for this excellent opportunity to
serve the research community. We are also grateful for the hard work and support provided by
the editorial office to make this project a success. To all the authors, thank you for your
contributions. To the readers, thank you for your interest. A plethora of quality works from the
latest meditation research await in the following pages. May you gain many useful insights!
Page 1 / 414
Open Access
OBM Integrative and
Complementary Medicine
Editorial
The Landscape of Current Meditation Research: An Overview to the
Special Issue on ‘Health Benefits of Meditation’
Soo Liang Ooi, Sok Cheon Pak *
School of Biomedical Sciences, Charles Sturt University, Panorama Avenue, Bathurst, NSW 2795,
Australia; E-Mails: sooliangooi@gmail.com; spak@csu.edu.au
* Correspondence: Sok Cheon Pak; E-Mail: spak@csu.edu.au
Academic Editors: Sok Cheon Pak and Soo Liang Ooi
Special Issue: Heath Benefits of Meditation
OBM Integrative and Complementary Medicine
2019, volume 4, issue 2
doi:10.21926/obm.icm.1902033
Received: May 29, 2019
Accepted: May 29, 2019
Published: May 31, 2019
Keywords
Meditation; mindfulness; yoga; zen; depression; anxiety; stress; resilience; immune system
meditari
-day terminology, meditation is often used to refer to a broad range of
self-directed mind-body practices that typically involve complex emotional and attentional
regulation to achieve calmness of the mind and relaxation of the body. These practices include
mindfulness meditation, Transcendental meditation, Zen meditation, Vipassana, Loving-kindness
meditation, Yoga, Qigong, and Tai Chi, to name a few. Many of them originate from Eastern
philosophies and cultures. Yoga, for example, is an Indian contemplative tradition for achieving
physical, mental, emotional, and spiritual harmony that has been practised for almost 5000 years
[1]. In many cultures, meditation is also practised to promote healing forces within the mind and
body [2]. Most notable is Qigong which incorporates various exercises such as postures,
energy or Qi for self-healing [3].
The scientific study of meditation as a therapeutic means, however, is only a recent
phenomenon which began in the 1970s. The study by Benson on the potential of meditation as a
therapy for systemic hypertension [4] and the study of mindfulness meditation as a stress
OBM Integrative and Complementary Medicine 2019; 4(2), doi:10.21926/obm.icm.1902033
Page 2 / 414
reduction and relaxation technique for chronic pain patients by Kabat-Zinn [5] were among
seminal works that sparked interest in this field. The convergence of meditation research with
neuroscience since the turn of the current millennium has provided a much-needed scientific basis
for better understanding underlying mechanisms of meditation on brain function. The work of
Davidson and Lutz in early 2000 confirmed the neuroplasticity effects of meditation [6].
Meditation was subsequently found to induce growth in the cortical area of the prefrontal cortex,
a region of the brain associated with complex cognitive behaviour, personality expression,
decision-making, and moderating social behaviour. Decreased cerebral blood flow to the
prefrontal cortex can potentially lead to several neurological conditions, including schizophrenia,
bipolar disorder, and major depressive disorder. Hence, through enhancing the plasticity of the
prefrontal cortex to promote self-healing and positive health, meditation helps to achieve
emotional and neurological regulation and resilience [7].
There is a tremendous growth of interest in meditation research over the last couple of
9000 related publications since the year 2000, with over 60% of these publications published
within the last five years. With the explosive growth in research, evidence has emerged to support
a myriad of health benefits associated with the practice of meditation. The psychological benefits
of meditation include reduction in stress, anxiety, depression, as well as improved memory and
increased brain efficiency with sustained attention. Meditation is also known to induce
physiological benefits such as lowering blood pressure, heart rate, epinephrine, metabolism,
breathing pattern and increased melatonin. Pain, which has both psychological and physiological
dimensions, can also be alleviated with the practice of meditation [8]. Not surprisingly, meditation,
especially mindfulness-based programs, has enjoyed unprecedented societal interest and is
becoming increasingly mainstream [9].
It is against such a backdrop that this Special Issue on the Health Benefits of Meditation is
conceived. The aim is to collate a wide range of exemplars in contemporary research that will help
to further the understanding of meditation as a therapeutic means, its underlying mechanisms, as
well as the application of meditation in the context of individual and community health systems.
The response to the call for papers for this Special Issue was overwhelming, and we are glad to
include a total of 23 manuscripts covering a wide range of topics from seven countries/territories
(United States of America [USA], United Kingdom [UK], Spain, Canada, Australia, New Zealand and
Taiwan). This Special Issue provides a balance of different types of articles, including original
research (9), review (10), communication (3), and case report (1). Out of these 23 articles, seven
main themes were identified which are in the context of current meditation research. The
following is a brief overview of the included manuscript grouped under these seven themes.
Mindfulness in Mental Health: Currently, mindfulness-based practice is the dominant
paradigm in the clinical research of meditation. More than two-thirds of the included manuscripts
are related to mindfulness meditation, either directly or indirectly. In particular, the application of
mindfulness-based interventions (MBI) is an essential topic in mental health. Poirier et al. [10]
investigated variations in psychic and somatic anxiety during and after the completion of
Mindfulness-based Cognitive Therapy (MBCT) among 24 participants with bipolar disorder in an
uncontrolled trial. The 8-week intervention demonstrated a substantial effect on psychic anxiety
but not on somatic anxiety. Other benefits observed included improved sleep quality and quality
of life, as well as a slight reduction in manic symptoms. Hazlett-Stevens [11] observed a reduction
OBM Integrative and Complementary Medicine 2019; 4(2), doi:10.21926/obm.icm.1902033
Page 3 / 414
in somatic symptoms in mental health patients following the practice of the Mindfulness-based
Stress Reduction (MBSR) technique. Through secondary analysis of data from a sub-sample of 17
participants of an MBSR program conducted in a university-based community mental health clinic,
the authors found improvements in patient-reported outcomes of physical fatigue, sleep
disturbance, gastrointestinal symptoms, and various forms of pain. Improvements in somatic
symptoms were most pronounced in participants with a probable diagnosis of generalised anxiety
disorder.
Dang et al. [12] systematically reviewed the effectiveness of MBI on depressive symptoms and
quality of life among patients with depression comorbid medical conditions and those with major
depressive disorders. With the inclusion of 16 randomised controlled trials that utilised MBSR,
MBCT, or their variations, this review found evidence supporting the treatment efficacy for
depressive symptoms. To explain the dynamics of mindfulness in managing depression, Hede [13]
proposed a binary model centred on the two modes of mindfulness (active and passive) with a
---
selves. A combination of both cognitive decentring with active mindfulness to manage cognitive
dysfunction and existential dis-identification with passive mindfulness to manage distorted
self-identity was shown to help reduce the effects of depression. For readers unfamiliar with MBI,
Hede also presented a comprehensive review of mindfulness meditation, MBSR, and MBCT.
Beyond established MBI, Ramos Díaz [14] proposed a new technique called the Compassionate
Emotional Accompaniment Technique, as a brief mindfulness intervention to helping patients
assimilate and regulate emotions in therapeutic sessions. The technique incorporates not only
verbal affective support, but also physical contact and explores bodily sensations through the
application of mindfulness facilitated by a therapist. The objective of this technique is to
propagate a conscious reception of emotions, rather than being reactive towards them.
Meditation for Chronic Pain: Chronic pain is defined to be any painful condition that lasts more
than three months. Patients with chronic pain often turn to meditation to alleviate pain and
improve quality of life. Koulouris et al. [15] performed a systematic review to assess the suitability
and effectiveness of yoga and mindfulness meditation practices in one group of chronic pain
patients, namely those with rheumatoid arthritis. Results from thirteen clinical trials (Yoga=10,
MBI=3) showed potential beneficial effects in pain symptoms, joint inflammation, fatigue, disease
activity, and several psychological parameters. Nevertheless, research evidence based on statistics
does not mean much to an individual who is suffering from pain. The ability to handle chronic pain
with equanimity chiefly depends on individual practice. In a case report, Dobkin [16], a clinical
psychologist specialising in MBSR, shared her personal experience of living with spondylolisthesis
in relative peace by applying mindfulness guided by the Buddhist principles of the Four Noble
Truths and the Noble Eight-fold Paths.
Meditation and Human Physiology: Three studies explored the effect of meditation on human
physiology and its implication on health. Lo et al. [17] investigated the respiratory sinus
arrhythmia (RSA) behaviours of Zen meditation practitioners (n=7) compared to healthy ordinary
volunteers (n=25). Using two methods to estimate the RSA coefficient and the average RSA rate
based on electrocardiogram data, the authors demonstrated that the practitioners of Zen
meditation had a significantly higher RSA coefficient and average RSA rate than the control. The
results suggest that the practice of Zen meditation can potentially improve cardiorespiratory
[18] presented a
OBM Integrative and Complementary Medicine 2019; 4(2), doi:10.21926/obm.icm.1902033
Page 4 / 414
narrative review of the impact of meditation on sleep and performance. Meditation appears to
share several commonalities with the non-rapid eye movement sleep in physiology and may
reduce the homeostatic pressures of sleep need and positively impact sleep architecture. However,
the complicated relationship between meditation, sleep, and improved performance remains
unclear and warrants further investigation. In another review, Thibodeaux and Rossano [19]
examined the impact of meditation on immune function. Meditation appears to affect positively
on natural killer cell activity and proportions, B-lymphocyte numbers, and telomerase activity
while keeping CD8+ T-cell numbers in check during times of high stress. Hence, meditation can
also be helpful for immuno-compromised patients, such as individuals infected with Human
Immunodeficiency Virus.
Therapist Mindfulness and Professional Resilience: From patients to the healthcare system,
there is an increasing call for incorporating mindfulness training for therapists and health service
professionals. Razzaque [20] introduced Open Dialogue, which put clinician mindfulness at the
heart of a network model, as the operationalisation of mindfulness into a mental health system to
improve patient health outcomes. A multi-centre randomised controlled study is currently
underway in the UK to test the model with the results due to be released in 2022. Separately, the
trial of a new model of mindfulness training adapted from the standard MBSR/MBCT courses was
conducted by Marx and Burroughes [21] in a UK mental health and learning disabilities
organisation. The training aimed to preserve the quality and integrity of mindfulness training while
being responsive and pragmatic to the needs and capacity of therapists and health service
professionals. Mindfulness training is also being explored to alleviate burnout and compassion
fatigue in human service professionals. In a separate study by Hanna and Pidgeon [22], 46 human
service professionals were randomly allocated to undergo a mindful-awareness and resilience
skills training program or serve as controls. The study found significant improvements in
mindfulness, resilience, compassion satisfaction, and psychological well-being, as well as
significant reductions in burnout and compassion fatigue at post-intervention in the intervention
group, compared to the control group. This study provides evidence to support mindfulness-based
approaches to enhance resilience in health service professionals.
Meditation for Children, Adolescents and College Students: Empirical meditation research
with children and youth is less conducted compared to that in the adult population. Semple and
Burke [23] presented their findings on the current state of research about the health benefits of
MBI for this younger cohort. Promising evidence from 25 published studies and five systematic
reviews/meta-analyses were found to support the effectiveness of mindfulness in improving the
overall health and well-being of children and adolescents. Studies were also conducted in tertiary
education settings to investigate how meditation affects young adults. Henning et al. [24]
systematically reviewed the integration of mindfulness and physical exercises for medical students.
The combination was found to enhance mental health, reduce stress levels, assist with
interpersonal development and improve interpersonal responsivity. Fisher and Pidgeon [25]
proposed a novel four-facet model to study the development of resilience among university
students. Increased mindfulness, positive emotion, and positive reappraisal were found to be the
factors predicting increased resilience when the students were confronted by perceived academic
stress.
Besides effective stress management, high levels of mindfulness also helped to cultivate
positive health behaviours, such as exercise participation as well as fruit and vegetable intake
OBM Integrative and Complementary Medicine 2019; 4(2), doi:10.21926/obm.icm.1902033
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among university students with socio-economic disadvantages as reported by Bryan et al. [26].
Mindfulness meditation could be a viable strategy to combat health inequality according to the
authors. Nevertheless, preconceptions towards mindfulness meditation may hinder its wider
adoption. A survey by Lester et al. [27] among predominantly white, Christian, female
undergraduate students (n=479) in a south-central university in the USA found mindfulness
meditation was being regarded as a religious practice mainly for relaxation and to achieve focus,
peace, and insights. Very few equated it to a health intervention. A novel approach to encourage
the practice of mindfulness is through game-based meditation training. Barclay and Bowers [28]
conducted a brief feasibility pilot study to investigate the use of an open-source meditation video
game aimed at stimulating meditation practice among 42 undergraduate students. The results
showed significant post-training decreases in state anxiety and a high level of usability. Hence,
game-based meditation training may be a potential tool to encourage meditation practice.
Mindful Self-Compassion: Self-compassion is having an accepting, empathic, and kind attitude
toward oneself during moments of sufferings. One can develop such capacity using mindfulness as
a core element. It is a relatively new field of meditation research. Quist Møller et al. [29]
conducted a systematic review of randomised controlled trials to identify the health benefits of
self-compassion-based interventions. Although preliminary evidence did suggest that
self-compassion training may enhance improvements in MBI for highly self-critical individuals, the
authors cautioned against drawing any conclusion based on limited data. To advance knowledge
on this novel technique, Jokic et al. [30] investigated the potential use of mindful self-compassion
to enhance the wellbeing of adult learners in a qualitative study. Practising and building
self-compassion was found to support adult learners when faced with challenges within their
qualifications and in life.
Theoretical Framework for Meditation Research and Practice: Villamil et al. [31] explained
three pillars of mind training: focused attention, open awareness, and kind intention. They
incorporated all three pillars to understand and practise awareness. Nonetheless, with so many
different approaches, systems, and definitions for meditation, there is a lack of a consistent
framework for describing meditation interventions in research. Allbritton and Heeter [32] put
forth a framework with seven components: the individual, object, and experience within a
meditation session, the immediate effects of the meditation session, the approach (which
encompasses the tradition or system of knowledge) of the meditation, the intended outcomes of a
meditation intervention in research, and the required engagement (such as how often, for how
long, over what time period) of the intervention are the seven components. These components
may be applied to any form of meditation.
To conclude, this Special Issue is a compilation of high-quality research in the field. Figure 1
shows a word cloud visualisation created from the keywords associated with all included
manuscripts. The breadth and depth of the topics covered in this Special Issue truly reflect the
landscape of the current status of meditation research. The editorial team hopes that this Special
Issue will lay the foundation for the advancement of further research for many years to come.
OBM Integrative and Complementary Medicine 2019; 4(2), doi:10.21926/obm.icm.1902033
Page 6 / 414
Figure 1 Word cloud visualisation of the keywords of all manuscripts in this Special Issue.
Author Contributions
SLO substantially prepared the initial draft and SCP reviewed and revised the paper.
Competing Interests
The authors have declared that no competing interests exist.
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Open Access
OBM Integrative and
Complementary Medicine
Communication
Open Dialogue and the Impact of Therapist Mindfulness on the Health
of Clients
Russell Razzaque *
Goodmayes Hospital, North East London Foundation Trust, Barley Lane, UK; E-Mail:
Russell.Razzaque@nelft.nhs.uk
Academic Editor: Sok Cheon Pak
Special Issue: Health Benefits of Meditation
OBM Integrative and Complementary Medicine
2018, volume 3, issue 1
doi:10.21926/obm.icm.1801001
Received: January 28, 2018
Accepted: March 23, 2018
Published: March 28, 2018
1. Mindfulness for Professionals
There is an increasing body of evidence to show that mindfulness can make a real difference to
the relationships that health workers and therapists have with their clients and this, in turn,
results in improved outcomes for them. In the field of mental health this is especially marked. A
study in a large London mental health Trust in 2013 [1] showed how the degree of mindfulness a
mental health practitioner demonstrate is directly correlated to the therapeutic relationship they
possess with their clients. A further study, a couple of years later [2], exploring the benefits of a
mindfulness retreat for psychiatrists, also showed how it led to a reduction in burn out and an
increase in both self-compassion and compassion. Studies have also shown the extent to which
teaching mindfulness to psychotherapists can directly improve the outcome of therapy.
2. Open Dialogue
For many years there has been a positive drive to bring mindfulness into mental healthcare, but
this has mainly centred around interventions that clinical staff carry out on their clients. The focus
tends to be on the explicit imparting of a set of skills around mindfulness, mainly via a series of
groups. Relatively little emphasis occurred in relation to mindfulness for the clinical staff
themselves as a way of improving practice and outcomes in and of itself. Given the benefits that
this could provide, however, there has been a lot of discussion in recent years about how to
OBM Integrative and Complementary Medicine 2018; 3(1), doi:10.21926/obm.icm.1801001
Page 10 / 414
develop a form of mental health service and practice that integrates clinician mindfulness into its
fabric. In the late 1980s, an experiment in exactly this happened to be taking place in Western
Finland, and the service was known as Open Dialogue.
Open Dialogue is a model of mental health care pioneered in Finland that has since been taken
up in a number of countries around the world, including much of the rest of Scandinavia, Germany
and some US states. It involves social network approach to care, where all staff receive training in
family therapy and related psychological skills, and treatment is focused around whole
system/network meetings. It is a quite different approach to much of UK service provision where
care tends to be delivered 1:1, yet it is being discussed with interest by several Trusts around the
country. Part of the reason is the striking data from nonrandomised trials so far eg. 84% of those
with first episode psychosis treated via an Open Dialogue approach returned to work or study
within 2 yrs [3], despite significantly lower rates of medication and hospitalisation compared to
treatment as usual.
By its very nature, Open Dialogue is a profoundly mindful way of working [4]. The primary aim
of the clinician, rather than sitting with a preconceived agenda or template, is to respond to the
client in the moment and follow the dialogue in the network, being present with the experience
and emotion in the room instead of attempting to lead or guide it [5]. This actually takes a great
deal of skill and so, as a result, mindfulness has become a core part of the training in the UK.
Clinicians find that it genuinely enhances their ability to work this way, stay connected to both the
family/network in the room and the colleagues who join them [6]. In a sense, Open Dialogue is
therefore the operationalisation of mindfulness into the mental health system and it is quite likely
that this key element becomes a key mediating factor in the outcomes that it provides. There is
currently a national multi-centre cluster randomised controlled study in the UK on Open Dialogue
and it is being trialled in a several areas, providing crisis mental healthcare, across the country.
The trial launched in 2017, with the first pilot evaluations due to complete in late 2018, and the
full scale study will then launch across 5 further teams. The teams are spread across a varied
geography from rural Devon to Kent to inner city London - and the first stage was to train a local
team in Open Dialogue. The teams are now sequentially coming online and starting recruitment
into the trial. This will continue for a year and the follow up will be for a further 2-3 years. Primary
outcome data will involve time to relapse, as well as hospitalisation and several other symptom,
social and functional measures. Data is currently due to be released around 2022.
3. Summary
The value of mindfulness for clinical staff in the mental health field has been increasingly
recognised over recent years. This is now culminating in the evaluation and, potential future role
out, of whole system approaches like Open Dialogue that put clinician mindfulness at the heart of
the model. It is anticipated that this will ultimately be for the benefit of both staff and clients of
these services alike, creating improvements in the long run on many levels; personally, clinically
and systemically.
Author Contributions
Russell Razzaque drafted and revised the manuscript.
OBM Integrative and Complementary Medicine 2018; 3(1), doi:10.21926/obm.icm.1801001
Page 11 / 414
OBM Integrative and Complementary Medicine
Competing Interests
The authors have declared that no competing interests exist.
References
1. Razzaque R, Okoro E, Wood L. Mindfulness in clinician therapeutic relationships. Mindfulness.
2015; 6: 170-174.
2. Razzaque R, Wood L. Exploration of the effectiveness and acceptability of a professional
mindfulness retreat for psychiatrists. Mindfulness. 2016; 7: 1-9.
3. Seikkula J, Alakare B, Aaltonen J. The comprehensive open-dialogue approach in western
lapland: II. long-term stability of acute psychosis outcomes in advanced community care.
Psychosis. 2011; 3: 192-204.
4. Razzaque R. Mindfulness and open dialogue. 2015.
5. Razzaque R, Stockmann T. An introduction to peer-supported open dialogue in mental
healthcare. 2016; 22: 348-356.
6. Stockmann T, Wood L, Enache G, Withers F, Gavaghan L, Razzaque R. Peer-supported open
dialogue: a thematic analysis of trainee perspectives on the approach and training. J Ment
Health. 2017: 1.
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Open Access
OBM Integrative and
Complementary Medicine
Communication
Meditation as an Intervention for Health: A Framework for
Understanding Meditation Research
Marcel Allbritton 1, Carrie Heeter 2, *
1. Core Resonance Works, New Orleans, USA; E-Mail: marcel.allbritton@me.com
2. Michigan State University, East Lansing, USA; E-Mail: carrie.heeter@gmail.com
* Correspondence: Carrie Heeter; E-Mail: carrie.heeter@gmail.com
Academic Editors: Sok Cheon Pak and Soo Liang Ooi
Special Issue: Health Benefits of Meditation
OBM Integrative and Complementary Medicine
2018, volume 3, issue 4
doi:10.21926/obm.icm.1804025
Received: July 30, 2018
Accepted: October 8, 2018
Published: October 9, 2018
Abstract:
We propose a framework for understanding meditation that can support greater scientific
rigor in reporting meditation research, and selecting meditation health interventions. There
is no consistent and thorough framework for describing meditation research interventions.
This impedes rigor of meditation research design and interpretation of findings. This also
limits meaningful comparisons across research studies. The audience for this article includes
researchers, meditation experts, healthcare professionals, and those with interest in
meditation. The framework describes the key components of a meditation intervention. We
also discuss how meditation can effect individuals differently, and provide suggestions for
describing the qualifications of the expert who designed the meditations in an intervention.
The meditation framework supports (1) comparing different meditation interventions, and
(2) understanding how meditation interventions lead to outcomes. We provide examples
from a Yoga Therapy perspective of meditation (our domain of expertise), and from
published research on meditation to illustrate applications of the meditation framework. The
meditation framework provides a way of characterizing meditation interventions by
distinguishing seven essential components. The first four components describe the
meditation session (individual, object, experience, and immediate effects). Approach
describes the foundation and source of a meditation practice. The outcome component
represents both intended goals or reasons for prescribing the meditation intervention and
other longer term effects that may occur. The engagement component refers to duration,
OBM Integrative and Complementary Medicine 2018; 3(4), doi:10.21926/obm.icm.1804025
Page 13 / 414
spacing and frequency of doing the practice and quality of attention. These seven
components can be applied to any type of meditation intervention. We explain the
components of the framework and then offer examples. Our goal is to express the
importance of having a framework for describing components of meditation across systems
of knowledge and methods of application. We hope this article begins a dialogue with
experts in other forms of meditation interventions, as they apply, adapt and respond to the
proposed framework.
Keywords
Meditation; yoga; meditation intervention
1. Introduction
Meditation interventions have become increasingly popular to support health, healing, and
well-being. There are many different approaches, systems, and definitions of meditation. This
creates challenges for rigorous study of meditation. We propose a framework for describing
meditation interventions regardless of the approach or type of meditation researched. The
framework provides a vocabulary for comparing and contrasting findings relative to different types
of meditation interventions. The meditation framework can help inform research design and
interpretation of findings in meditation research. The framework also supports greater scientific
rigor in conducting meditation intervention research, and selecting meditation health
interventions. The audience for the article includes researchers, meditation experts, healthcare
professionals, and those with interest in meditation.
There are no consistent and rigorous standards for describing meditation research
interventions. This impedes rigor of meditation research design and interpretation of findings. This
also limits meaningful comparisons across research studies. Studies of meditation interventions
for health often are rigorous in sample selection, sample size, measurement scales, and statistical
analysis. And yet, the meditation intervention the experimental manipulation is inadequately
characterized and reported.
Both authors are experts on meditation and trained researchers with PhDs. Our experience and
background in meditation is from the Viniyoga perspective of Yoga and Yoga Therapy. Our goal is
to express the importance of having a broad, consistent framework for describing meditation
interventions across systems of knowledge and methods of application. Researchers can use this
framework as they plan, describe, and evaluate meditation interventions.
2. A Framework of Meditation
Research publications about meditation interventions often do not adequately describe the
intervention. More detail would help readers understand what was studied and enable
researchers to interpret and build upon prior research. The framework we propose can be applied
to any kind of meditation intervention. As stated previously, the framework can be helpful for the
design of the intervention, and the interpretation and comparisons of meditation research.
OBM Integrative and Complementary Medicine 2018; 3(4), doi:10.21926/obm.icm.1804025
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There are many different approaches, systems, and definitions of meditation. The 2012
(mantra, mindfulness, spiritual, and meditation as part of other practices) and provided 12 specific
examples (Transcendental Meditation, Relaxation Response, Clinically Standardized Meditation,
Vipassana, Zen Buddhist meditation, mindfulness-based stress reduction, mindfulness-based
cognitive therapy, centering prayer, contemplative meditation, Yoga, Tai Chi, and Qigong) [1]. This
complex diversity of meditation practices, goals, and systems of knowledge creates challenges for
rigorous study of meditation.
Taxonomies are one approach to making sense of meditation. Taxonomies have been used to
classify styles of meditation based on the object of meditation and accompanying neurological
processes during meditation. For example, Focused Attention (on a chosen meditation object)
differs from Open Monitoring (of moment to moment experience) [2] and from Automatic
Self-Transcendence (the absence of focus or effort) [3]. Another taxonomy separates
consideration of the meditation process from three types of altered state (Cognitive, Affective,
and Null) that can be achieved while meditating [4].
Our framework is not a classification taxonomy. We argue that it is essential when reporting on
a meditation intervention to fully describe the intervention along all of the components. It is
useful to apply taxonomic classifications. However, details related to the components of
meditation are essential to include so that others can understand the intervention and potentially
apply their own taxonomies.
We conceptualize meditation as attention-based practices that have an immediate effect on
the human system and lead to longer term outcomes. The framework describes the key
components of any given meditation intervention and provides a vocabulary. The meditation
framework supports (1) comparing different types of meditation interventions, and (2)
understanding how meditation interventions lead to effects.
Figure 1 Meditation framework.
Our meditation framework, Figure 1, provides a way of understanding meditation by situating
essential components. The first four (individual, object, experience, and immediate effects) are
components of a meditation session. Approach describes the source or body of knowledge
underlying a meditation practice. Longer term outcomes occur outside of the meditation session
and are usually the result of repeated practice over time. Engagement refers to quality of
attention, duration, spacing and frequency of doing the practice. These seven components can be
OBM Integrative and Complementary Medicine 2018; 3(4), doi:10.21926/obm.icm.1804025
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applied to any type of meditation. We will explain the components of the framework and then
offer examples.
3. The Meditation Session: Individual, Object, and Experience
In every meditation, a given individual is interacting with an object, in some way, and having an
experience. Meditation research is conducted on populations (such as novice meditators, veterans
with PTSD, or Buddhist monks) whose characteristics impact the process and effects of meditation.
Beyond population differences, the effects of the meditation will vary from individual to individual
and from session to session within an individual.
When describing a meditation intervention, we argue that it is important to describe the
meditation object or objects used in the meditation sessions in order to understand the
meditation intervention. We include object as a distinct component of the framework because of
its importance and utility in characterizing and defining a meditation practice. The object of
meditation refers to where the attention is placed during the meditation.
An object of meditation can be almost anything a mantra, something in nature, an idea, god,
nothingness, or self-observation. In open attention meditation, the object of meditation is less
tangible such as observing sensations and thoughts as they arise, without engaging with or
judging them [2]. Simply labeling a meditation intervention based on a meditation taxonomy (such
as focused attention or open monitoring) without detailing the meditation object limits
understanding the current study and limits future comparative analyses. It is important to describe
what a participant is directing their attention toward as part of characterizing meditation.
When reporting meditation research, it is important that the experience of the meditation be
described. The object of meditation succinctly summarizes the attentional goal of the meditation
session -- where the attention is placed. Experience refers to the what the individual does with
their body, breath, and mind during the meditation. Experience includes any actual instruction or
guidance, how the guidance is delivered, and the context of the meditation session. The
instructions may be intrinsic, where the meditator directs herself or there may be extrinsic
guidance by a meditation teacher. Guidance of a meditation experience may be delivered by a
teacher who is physically present, a recording of instructions given throughout the meditation
session, or even written instruction. Is the meditation delivered by an in-person teacher? In a
group class or one-on-one? Is technology involved, such as an online class, smartphone app or
web site? The many possible variations in how meditation is delivered may influence the
experience of meditating as well as the effects.
Context is another aspect of experience. In what context is the study participant engaging in
meditation? Are they in a research laboratory? At a meditation center for a week-long retreat? In
a group yoga class? In a classroom or MBSR program with other people? At home?
4. Immediate Effects
In a meditation session, the individual has an experience that includes directing their attention
toward an object. That experience results in an immediate effect on the human system (body,
breath, mind, and emotions). Immediate effects are changes that occur during or immediately
upon completion of a meditation session. Immediate effects include insights that arise during
meditation and enhanced mental or affective states [4].
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Some of the immediate effects -- the changes of the human system -- can easily be measured.
For example, biometric data can indicate the physiological change in breath rate, heart rate, heart
rate variability, blood pressure, cortisol levels, inflammation, interoceptive neural network
activation, and characteristic EEG brainwave patterns. Immediate effects of meditation include
physiological, psychological, and psychosocial changes. For example, health-related immediate
effects can include a sense of calm and decreased feelings of anxiety. Immediate effects are easier
to attribute to meditation than longer term effects because they occur during and/or immediately
after the meditation. The timeframe is finite and the causal link is often more direct.
Immediate effects are interesting and important, but they are not the motivation for practicing,
prescribing, or studying meditation. Lowering blood pressure during a 20 minute meditation
and the human system returns to its original state.
5. Approach
Approach is the source of the meditation. Approach refers broadly to the tradition or system of
knowledge a meditation intervention is based on. It is essential that the specific foundation of the
meditation be referenced and cited in the research. Using vague titles like Yoga or Buddhism
without mentioning specific bodies of knowledge, specific teachers, or describing specific
techniques does not reflect scientific rigor [5]. The reader should be able to look up the body of
knowledge that the meditation originated from. If the meditation did not originate from a specific
body of knowledge, then it is important to describe the methods or techniques used in the
meditation.
Many of the forms of meditation practiced in the west today have roots in ancient bodies of
knowledge such as Buddhism and Yoga [6, 7]. Endless variations exist, interpreted and adapted by
individual teachers [8, 9]. Some meditation approaches connote very specific meditation practices
(such as Transcendental Meditation [10] or Kriya Yoga [11]). Mindfulness meditation was
secularized and adapted for the West by Jon Kabat Zinn as part of Mindfulness Based Stress
Reduction (MBSR) [12] and by other students of Buddhism in other meditation interventions.
Mindfulness meditation also now has a clinical definition, as Western science studies and
appropriates the original concepts [8, 13].
If the meditations have roots in a tradition but have been adapted, it is important to identify
the tradition and characterize the adaptation. The foundation underlying the meditation should be
explicit and apparent. If the foundation is not stated explicitly and clearly, at a minimum, the
methods and techniques should be clearly described.
Programs like MBSR and apps like Headspace draw from several traditions as well as other
For example, Jon Kabat-Zinn
developed MBSR based on his training in Zen Buddhism and Yoga; however, MBSR meditations are
not presented to participants as Buddhist [14]. A study participant doing a meditation may not
care or need to know the roots of the practice. However, researchers studying a meditation
intervention should include information about the origin of the meditation methods and
techniques in publications.
As we mentioned earlier, this diversity in meditation interventions complicates research on
meditation. The practices that are coherently and consistently grounded in a system of knowledge
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can draw upon that system to develop theories and mechanisms of effect. For example, scientists
have proposed theoretical mechanisms for the effects of Yoga [15-17] and of mindfulness
meditation [18, 19]. Meditation interventions that are a combination of different approaches are
more complicated to study or interpret. But characterizing the meditation intervention using our
framework may be helpful.
6. Outcomes
Goals or intended outcomes of a meditation intervention for health should be stated clearly in
meditation research. Outcomes refer to how the meditation changes the human system so that it
functions or operates differently in some desired direction as a result of the meditation practice.
We suggest that it is helpful to think about meditation in an outcome-based way. In other words,
why is meditation being used as an intervention? What are the expected outcomes of the
meditation? The intended outcomes may be general or specific, but they should be stipulated.
Otherwise, you have no way of assessing whether or not the meditation was an effective
intervention.
The goal of meditation is to change the human system in the direction of a desired outcome. A
distinction that our meditation framework makes is that meditation interventions are not just
about the individual meditation session. It is very helpful when meditation research provides a
theoretical explanation of how the meditation session (individual, object, experience, and
immediate effects) leads to intended outcomes.
Examples of meditation outcomes for health include easing symptoms of anxiety, improved
response to stress, improved functioning of immune system, support for sleep and reduction of
insomnia, support for pain management, reduced mind wandering and dispositional mindfulness.
Meditation has also been studied for other mental health, musculoskeletal and neurological,
endocrine, and cardiorespiratory outcomes. The possibilities for meditation outcomes are vast.
Meditation interventions for health are prescribed to achieve particular or general intended
outcomes. These intended outcomes are not the only outcomes that occur from practicing
meditation. For example, the original goals for practicing Yogic, Buddhist, and other contemplative
meditation related to self-transformation, equanimity, reducing suffering, and/or deepening
spiritual connection. In other words, these practices did not originate to treat specific or
health-related goals. In addition to intended health outcomes many known and unknown ancillary
neurological, physiological and psychological changes to the human system occur as a result of
practicing meditation.
7. Engagement
Meditation can have effects in different ways. Meditating has immediate effects on the human
system at the time of the meditation session. But meditation is practiced, prescribed, and studied
not simply for immediate effects but primarily because of the potential powerful and longer
lasting changes that repeated meditation can bring about in the human system.
Meditation practices can have effects that extend beyond the practice session. Those effects
are often gradual and cumulative, as a result of engagement. In the meditation framework,
engagement refers to the duration, intensity, and spacing of meditation sessions [20] (such as how
often, for how long, over what time period). The immediate effects and the outcomes of a
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meditation are influenced by how often and for how long an individual meditates. It is important
for research to clearly describe the frequency of meditation sessions. This way, the relationship
between engagement and outcomes can be better understood.
We u
the quality of attention during a meditation session. Sitting on a meditation cushion and playing a
20 minute breath awareness meditation audio while the mind is thinking about what to say to a
co-worker or composing a grocery list impedes the effectiveness of meditation. The capacity to
direct attention during meditation increases with practice. Quality of attention contributes to the
effect and effectiveness of meditation.
Research and ancient and modern practice guidelines strongly support the proposition that
deeper, longer lasting benefits of meditation arise from repeated sustained practice over a period
of time [21]. Indications are that the benefits continue to grow the longer meditation is
practiced. It is not only that the person develops the skill of meditating. It is that effectiveness in
meditation is, to a degree, based on the action of engaging in the meditative experience
repeatedly and with regularity over time. In other words, many of the effects of meditation
emerge at least in part due to the amount of exposure the individual has to the meditation
practice.
Powerful, systemic changes in the human system occur as a result of doing the meditation
practice over time. When a yoga therapist meets with a client, as part of the session, the therapist
observes the client doing their practice. Thus, with every individual client, yoga therapists observe
the effects of meditation on an individual over time. Recognizing the importance of engagement,
clinical studies of meditation typically involve a minimum of 6 to 8 weeks of daily home practice.
While 6-8 weeks constitutes a level of engagement, this duration represents novices who have just
begun to develop a meditation practice. Different or more sustained outcomes may require
intermediate levels of engagement (3 to 12 months). Studies of long term meditators consider
years [22-24] of daily practice.
Research and practices strongly support the proposition that deeper, longer lasting benefits of
meditation arise from repeated sustained practice [21]. Indications are that the changes in how
the human system functions continue to occur the longer meditation is practiced. It is not only
that the person develops the skill of meditating. It is that effectiveness in meditation is, to a
degree, based on the action of engaging in the meditative experience repeatedly and with
regularity over time.
8. Meditation Effects Individuals Differently
We cannot assume that a meditation experience that is delivered in a consistent way will
impact every individual who does that meditation in a similar way. Meditation requires active
ongoing effort to focus attention. Each individual will have a unique experience with a meditation
intervention.
The same meditation does not work equally well for everyone. The effectiveness of meditation
depends on the predisposition and previous experiences of the individual. Meditation is a practice
and a skill. Meditation is an active process whereby the participant is engaged in the process. The
quality and extent of that engagement can have an effect on the outcomes of the meditation.
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In a meditation session, an individual follows the instructions in the meditation, focuses their
attention on an object and has an experience. The quality of the experience we have while
meditating is influenced by the effectiveness of the meditation intervention, but also by factors
such as (1) the state of our system at the time of doing the meditation (such as calm, distracted,
focused, nervous, overwhelmed, centered, etc.), and (2) the level of skill at focusing our attention
we have developed by practicing meditation over time. Other factors that determine the
effectiveness of a given meditation include appropriateness of the meditation for the individual
and appropriateness of the meditation for the symptom or condition. Also, if an individual has
more of an interest in and intrinsic motivation to do a meditation, this will have an impact on the
effect of the meditation.
9. Meditation Expertise
In meditation research, the meditation expertise of the individual or team who designed the
meditation intervention should be described. If others delivered the intervention, their expertise
should also be described. We suggest two categories to include when describing the expertise of
the designer of a meditation intervention. The categories are: 1. Meditation approach/source (the
body of knowledge the meditation originates from) and 2. Experience and practice (the meditation
-- # of years, training of the meditation expert, professional
application of meditation).
expertise.
Meditation approach/source: Yoga Therapy and Viniyoga of TKV Desikachar and classical
Yoga as presented by The Yoga Sutras of Patanjali.
Experience and practice: Marcel is a certified Yoga Therapist (C-IAYT), has completed a
1000 hour Yoga Therapy training program, and a two year clinical internship. Marcel has
been practicing Yoga Therapy as a clinical practitioner since 2010.
A challenge of studying meditation is that the researchers often do not have training or
personal experience with meditation. Researchers plan the study, then hire a meditation expert to
design and run the meditation intervention. Then the researcher analyzes the data and publishes
the findings. The researcher is often not the meditation expert and the meditation expert is not
the researcher. So we have situations where the researcher has limited understanding of
meditation and the meditation expert has limited understanding of research and limited
involvement in study design and interpretation. Involving a meditation subject matter expert as a
consultant with research from start to finish helps to address this problem.
10. Conclusions
As researchers and meditation experts, we are always seeking to better understand meditation.
Meditation is a general term that describes many different types of phenomena and interventions.
The writing of this article arose out of a need for a framework that supports better understanding
of research on meditation interventions. As researchers, we are trying to better understand the
research on meditation. As meditation experts, we are trying to better understand meditation.
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The purpose of the meditation framework we have created is to support dialogue around
meditation research and provide a common framework for making sense of meditation
intervention research across different types of meditation and different applications of
meditation.
There needs to be a way of understanding, comparing, and contrasting findings in research on
meditation interventions. This article addresses a need and starts a dialogue for more rigor in
describing and qualifying meditation intervention research. If researchers regularly apply our
framework to describe all 7 components of a meditation intervention, individuals reading the
research and future meta-analyses will be able to consider the potential influence of all of the
components that characterize the intervention.
framework and then clarifying which element or elements they are comparing. For example, some
studies have compared Mindfulness and Lovingkindness practices (two specific, common Buddhist
meditations that are also part of Mindfulness Based Stress Reduction) [25-27]. Based on our
framework, this comparison derives from both object and the experience of meditation.
[28]. Based on our framework, this is a difference in the approach of the
delivered, such as whether it is led by an in person teacher or delivered via technology [29]. Based
on our framework, this is a difference based on the delivery of the meditation. (Delivery is a
component of experience).
We are certain that further development and application of a consistent and thorough
framework like the one we propose will help researchers better understand, select, and describe
meditation interventions as they design studies, and lead to a deeper and more comprehensive
understanding of meditation as a health intervention. We also hope that the meditation
framework will inform reporting and interpretation of research findings across diverse types of
meditation and different approaches underlying meditation, and provide a strong foundation for
cross-study comparisons.
We created the framework as a beginning point for understanding what is essential to describe
about meditation interventions. This article is not a review of literature or a proposed new
taxonomy of meditation. In developing the framework we asked ourselves, what are the essential
elements to describe meditation as an intervention for health across different methods and
techniques of meditation?
We offer the framework as a first step. These recommendations were developed by two
authors whose meditation expertise is from the perspective of Viniyoga and Yoga Therapy [30-32].
It is our hope that researchers and meditation experts from different domains of meditation
expertise will proof the framework we have offered by applying it. We encourage researchers,
meditation experts, and healthcare professionals to consider the framework with their respective
method of meditation. How is it useful? What needs to be added or modified to describe essential
elements of their meditation interventions?
We hope that dialogue about and application of the meditation framework from different
perspectives and practices will lead to refinements of the framework. Ultimately, the field of
meditation intervention research would benefit from widespread use of this kind of framework as
the basis for research reporting guidelines for meditation interventions.
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Author Contributions
The authors contributed equally to conceptualizing and writing this concept paper.
Competing Interests
The authors have declared that no competing interests exist.
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ctions/Educational_Standards_2016-C.pdf.
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Open Access
OBM Integrative and
Complementary Medicine
Communication
Proposal for a Compassionate Emotional Accompaniment Technique
(CEAT) Based on Mindfulness to Manage Disturbing Emotions
Natalia Sylvia Ramos Díaz *
Universidad de Málaga, Campus de Teatinos Universidad de Malaga 29071, Spain; E-Mail:
nsramos@uma.es
* Correspondence: Natalia Sylvia Ramos Díaz; E-Mail: nsramos@uma.es
Academic Editors: Sok Cheon Pak and Soo Liang Ooi
Special Issue: Health Benefits of Meditation
OBM Integrative and Complementary Medicine
2019, volume 4, issue 1
doi:10.21926/obm.icm.1901017
Received: August 23, 2018
Accepted: March 05, 2019
Published: March 14, 2019
Abstract
One of the objectives of psychological intervention is to help patients manage their
emotions effectively by providing them with the necessary skills to accompany their own
emotional states. To this regard, there seems to be a current lack of therapeutic resources
aimed at helping patients assimilate and regulate emotions. This article proposes the
application of a new technique which incorporates mindfulness, building on the premises of
the model of psychological flexibility which defines "mindfulness" as a practice which
facilitates some of the processes necessary for adequate psychological health, particularly
those related to the open and centred styles cited in the model.
The technique herein described is termed the Compassionate Emotional Accompaniment
Technique (CEAT) and has its roots in the Mindfulness and Emotional Intelligence Program
(PINEP). CEAT can be defined as a brief mindfulness-based intervention whose aim is to
facilitate conscious emotion management in therapeutic contexts. CEAT shows encouraging
signs in the development of the processes of acceptance and contact with the present
moment cited within the Psychological Flexibility Model.
Keywords
Brief mindfulness-based interventions; emotion regulation; disturbing emotions
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1. Introduction
Different researchers converge on the idea of the functional and adaptive value of emotions.
There is general agreement on their importance in motivating cognition and action, and in being a
valuable source of information to facilitate coping, adaptation, social affiliation and well-being [1].
However, this primary functional value of emotions ceases to be as such and becomes
pathological when an emotion is of an excessively intense nature and appears to incite an
individual to carry out actions which have a negative effect on themselves and/or their
environment. In such cases, emotions are found to be disturbing. One of the characteristics of
pathological disorders is precisely their link to the presence of disturbing emotions and the
patient`s inability to regulate them.
The introduction of mindfulness within the realm of the "third generation" of cognitive and
behavioural therapeutic treatments [2] has brought both advantages and disadvantages. This can
be exacerbated by the fact that in psychology there is no unanimous definition of the concept of
"mindfulness", which has been alluded to as; a psychological process, a result, a general method,
or even as a collection of various techniques [3]. The authors of the Psychological Flexibility Model
define mindfulness in the terms of an open-ended response technique (Defusion and Acceptance)
and focussed (Flexible Attention to the Present Moment and Self-as-Context), thus providing a
viable definition of mindfulness [4]. It is beyond the scope of this article to go into great detail on
each of these component parts, but it can be underlined that this model asserts that a conscious
and flexible attention to the "here and now" enables the person to activate the skills of Defusion
and Acceptance, and when called upon engage them in value-based action [5].
The emergence of mindfulness in an academic context [6, 7] introduced an ideal framework to
experience emotions in the present moment by paying conscious attention to them and spawned
a series of individuals who did not need to judge nor over-react to their first sensations. In other
words, mindfulness implies observation without judgment and simple acceptance which in turn,
foster curiosity and compassion. As a result "mindfulness" became a valid tool to facilitate the
natural regulation of varied emotional states.
1.1 Mindfulness as a Tool to Manage Emotions
Emotional Intelligence (EI) has been defined as the ability to perceive, evaluate and express
emotions accurately, the ability to monitor and / or generate feelings that facilitate thinking; the
ability to understand emotions and discriminate among them, and the ability to regulate emotions
promoting emotional and intellectual growth [8]. The emergence of this theoretical construct
demonstrated the importance of emotions, and the need for their adequate integration as a
means of addressing everyday problems. Emotions form the basis of decision making, and how
they affect us is a fundamental determinant of both physical and psychological well-being, and
therefore by default for the prevention of psychopathology.
Gross [9] refers to emotion regulation as "those processes by which people exercise an
influence on the emotions they have, on when they have them and on how they experience and
express them" [9]. The emotion regulation model of Gross [9] distinguishes two types of
emotional strategies; the first focuses on the antecedents of emotion (exposing ourselves to
certain situations, trying to modify situations, dealing with some aspects of the situation and
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extracting some meaning from the situation), and the second focuses on the regulation of the
emotional response provoked by that experience (expression, physiological activation or
suppression).
That said, emotion dysregulation comes about due to either emotion-regulation failures; i.e.,
not engaging regulation when it would be helpful to do so, or emotion misregulation; i.e., using a
form of emotion regulation that is poorly matched to the situation [10]. One of the key elements
of the emotion regulation model is the moment in which individuals attend to the emotional
states themselves; a strategy of avoidance being very characteristic of emotional disorders leading
to individuals developing non-adaptive attentional strategies (e.g., distraction, suppression of
thought, worry and rumination). In other words, strategies that can be thought of as being active,
but which are beyond personal control, or perpetuate a state of distraction from the emotional
experience [11].
In this regard, there is a broad body of research that demonstrates that experiential avoidance
is associated with a wide variety of pathological disorders [12]. Experiential avoidance is strongly
related to depression, stress and anxiety [13]. In fact it is related to symptoms that appear
throughout different categories of classification systems, a reason why it seems to be a key
process in the transdiagnostic approach to psychopathology, being considered a functional
dimension of psychopathology, in whose extreme acceptance and openness to experience would
be found [14]. In fact, experiential avoidance is a central theme of the Psychological Flexibility
Model [5]. From a dimensional approximation to the pathological phenomenon it would be
necessary to offer therapeutic interventions whose main objective was to decrease the occurrence
of processes (such as experiential avoidance) that form the basis of the pathology [15]. Recent
psychological approaches are based precisely on exposing the patient to, or helping them to
accept those particular emotions that they are trying to suppress, as it has been empirically
verified that avoiding emotion leads precisely to their exacerbation [16].
In this sense, it seems that acceptance strategies are a positive and adaptive alternative, and in
this regard mindfulness appears to be an effective tool and could play a crucial role in the
prevention or adequate management of disturbing emotions, without disregard for other
interventions that could be very useful too. Mindfulness, as a tool recently incorporated into
therapeutic practice, emphasizes the importance of generating a space for fostering emotional
experience, and is founded on compassion and a sense of non-judgmental awareness of the
present moment. Hence, it may be understood as a means of experiencing the "here and now"
consciously, or as a way of being, or as an attitude towards life [7, 17, 18]. When it comes to
managing difficult emotions, it would require an attitude of openness toward an experience
regardless of the hedonic tone of the emotion involved, and welcoming that experience with
compassion [19]. A growing number of studies reveal the relationship between the practice of
mindfulness and the regulation of emotions. In fact, it has been associated with less negative and
more positive affect, less perceived stress and reductions in symptoms related to anxiety, guilt,
depression, emotional lability and impulsivity [20-26].
Individuals should attend to their emotional experiences within an "optimal area of
physiological activation" [27], located between two extremes; hyperactivation and hypoactivation
[28], wherein they find themselves in an optimal zone for the
integration of internal and external emotional information. In this activation zone cortical
functioning will be maintained, which is essential to integrate the information at the cognitive,
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emotional and sensorimotor levels. From the mindfulness perspective a disturbing emotion is
defined as one which moves us away from the present, regardless of its hedonic tone, and is
considered more disturbing when the reaction to it is greater [29]. One would therefore assume
that adopting a mindfulness attitude would favour the emergence of an emotion
within the "window of tolerance" defined by [28].
Dealing adequately with difficult emotions would therefore imply addressing them in the same
way they are faced during mindfulness practice. That is to say; we stop, bring a sense of awareness
and openness to the emotion, and replace any attitude of judgment or evaluation with another of
a compassionate nature [19]. Therefore, it seems that attending emotions mindfully will facilitate
the processes of emotional recovery.
1.2 The Mindfulness and Emotional Intelligence Program (PINEP)
Ramos and Salcido [30] argue that the management of emotions can be represented on a
continuum which comprises: 1) An absence of emotional strategies both at the theoretical level;
possessing only basic knowledge about emotion regulation, and at a practical level; showing an
inability to respond adequately to emotional stimuli, expressing reactivity and relying on
automatic responses. 2) An intermediate level in which the individuals know (at least theoretically)
the best way to respond to emotional stimuli, but they are still very reactive to them. 3) A level of
optimal emotion regulation in which the individual can respond consciously to different emotional
stimuli.
With the idea of facilitating the regulation of emotions through mindfulness, the Mindfulness
and Emotional Intelligence Program (PINEP) was developed. PINEP can be defined as a conscious
emotional management program whose objective is to help participants in the process of
"learning to feel ", and to provide individuals with sufficient resources to accompany their own
emotional states and those of third parties. This could result in their becoming aware of the
automatisms which inhibit the achievement of personal goals in situations of high emotional
intensity, and thus restore the adaptive value of an emotion [31]. This implies that PINEP, through
the formal and informal practice of mindfulness, helps the individual to deal with highly emotional
situations.
PINEP combines two independent training objectives; that of EI and that of Mindfulness, and
relies on the integration of both. On the one hand, the program includes exercises from other
basic mindfulness training programs [6, 7] and on the other, it employs mindfulness as a tool to
foment contact with the trainees own emotional experience (both positive and negative). It also
fosters compassion and allows an individual to gain perspective over the emotional situation to
which they are being exposed [31].
In recent years the PINEP group has been focused on demonstrating the effectiveness of
mindfulness as a technique to regulate emotions; instigating the original design of PINEP to
integrate both Mindfulness and EI, and the subsequent verification of its effectiveness through
scientific research.
To this end, Ramos et al. [25] analyzed the effectiveness of a combined Mindfulness and EI
training during 8 weekly 90-minute sessions on a non-clinical population. The results show a
decrease in negative emotions and higher scores in problem-solving, as well as a greater ability to
appreciate the positive. Moreover, there was less tendency to blame oneself and others, and
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decreased levels of anxiety. In addition, changes in the cognitive strategies of emotion regulation
were observed and these individuals were found to present a lower number of intrusions in
relation to their daily problems.
Enríquez, Ramos and Esparza [32] applied PINEP to a university population in the field of social
sciences in Ciudad Juárez, Mexico. The intervention lasted 8 weeks with sessions of two hours per
week. Significant results were observed related to; emotional repair; extroversion; mindfulness
(acting with awareness); empathy (perspective-taking); cognitive emotion regulation (planning
solutions, positive reassessment and putting into perspective). In addition, a decrease in burnout
and engagement levels was found.
Páez-Gómez, Ramos-Díaz and Hernández-Osorio [33] noted effects on biological parameters
after training with PINEP. The results in a post-test revealed a significant decrease in
immunoglobulin (IgA) concentrations in complement 3 (C3) and complement 4 (C4) fractions.
Hence it was shown that a combined 8 session training in Mindfulness and EI produces changes in
immune modulation in a general population.
Salcido, Ramos, Jiménez and Blanca [34] provide evidence on the effectiveness of PINEP in its
online version. The training consists of 12 weekly sessions of an hour and a half with additional
homework tasks. The results obtained show improvements in mindfulness skills; increased
capacity of description and an increase in non-judgement and a decreased level of reactivity.
Body, Ramos, Recondo and Pelegrina [35] presented a study on the impact of PINEP on 90
teachers carried out in two teacher training centers in Malaga, Spain. This training consisted of 9
two-and-a-half hour weekly sessions. The results show that the teachers who received the training
develop a greater capacity to identify, understand, assimilate and regulate their emotions on an
intra and interpersonal level.
Ramos, Jiménez and Lopes [36] conducted a laboratory study in which the difference between
mindfulness trait and state is demonstrated. The results indicate that a mindfulness trait was
associated with fewer intrusive thoughts 24 hours after the induction of a stressor, but with no
change in effect immediately after induction. In contrast when applied to a mindfulness state an
opposite pattern was evident; there was more of an effect immediately after the induction of the
acute stressor but this had no effect on intrusive thoughts 24 hours later. These results suggest
that people predisposed to mindfulness states may have difficulty using mindfulness effectively in
the face of an acute stressor. In addition, they suggest that the effects of brief interventions in
mindfulness may be too ephemeral to cope with acute stressors over time. Therefore, it would be
important to develop programs that involve not only the intensive practice in mindfulness, but
also include specific training which helps people to use the mindfulness tool to deal with stressors
that may appear in their daily lives.
It can be concluded that a basic requirement for accompanying people who suffer is that the
therapist masters the basic skills of emotion management which they require to deal with the
difficulties of their patients, as well as to become an effective coping model. In this sense,
therapeutic training would include the clinician's exposure to various situations that evoke
emotions of certain intensity. With this in mind, PINEP could be employed to guide therapists in
the learning of conscious emotional management [31, 37]. In tandem, the Compassionate
Emotional Accompaniment Technique (CEAT) [38, 39], which will be introduced in the next section,
and whose rudiments rely on the therapeutic value of addressing emotions with a mindfulness
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attitude, has its origin in PINEP [31]. This technique can be classified as a brief mindfulness
intervention, and will be explained in continuation [36, 40].
1.3 Proposal of Applying the Compassionate Emotional Accompaniment Technique (CEAT) as a
Brief Mindfulness Intervention
One of the characteristics of PINEP [31] is that it includes a wide range of activities to explore
emotions which prepare the individual for a broad-spectrum emotion approach in distinctive
evocative situations. When the objective is to verify the effectiveness of this type of therapeutic
approach, it becomes necessary to recreate situations of greater experimental control aimed at
understanding the mechanisms behind the interaction of mindfulness and emotion, and moreover,
if this interaction is therapeutic for an individual.
In order to exercise greater control over interventions based on mindfulness, a brief
intervention is suggested, which can take place with or without the prior training of the patient. To
this end the participants receive mindfulness instructions in a laboratory context with the aim of
verifying the benefits when faced with disturbing experiences. Under these conditions it is easier
to control the variables that can explain the results, as well as to better understand the
mechanisms of action through which the therapeutic effects are obtained.
Eifert & Heffner [41] were the first to study the effects of a brief mindfulness-based
intervention on exposure to aversive interoceptive stimuli by submitting two 10-minute periods of
air enriched with 10% carbon dioxide. The authors were able to witness how this exposure given
to participants who had received an instruction to accept the experience, generated less anxiety
than the instruction based on suppression and control of the effect. Since then, new studies have
also shown the short-term benefits obtained in interventions based on mindfulness, thus allowing
a more thorough exploration of the variables that mediate the observed effects.
A study by Campbell-Sills, Barlow, Brown and Hofmann [42], presents a similar experiment, but
in this case provoking emotions in the participants through the viewing of fragments of films of a
differing nature. The acceptance group showed less negative effect as well as a lower heart rate in
response to the film clips.
Similar results were found among a group of individuals with a high profile in emotion
regulation, with the exception that they did not manage to reduce their discomfort while being
exposed to an anguishing film, nor were differences found in the level of skin conductance [40].
These results could mean that evocative situations of greater emotional intensity require more
effective or longer lasting interventions to achieve the desired effects.
Subsequent studies that analyze the effects of brief mindfulness-based interventions have
shown a reduction in cardiovascular reactivity to stress [43], lower acute distress [44], less
suffering/distress [45], a decrease in state anxiety and negative affect in extremely dependent
persons; the mindfulness instruction being more effective than the distraction strategy [46].
When the effects of brief interventions in mindfulness are checked over time, the results reveal
that despite the immediate decrease in negative affect in the face of stress induced
experimentally with disturbing memories, 24 hours after the intervention there is no evidence of a
decrease in intrusions on memory [36]. This study also highlights how people who scored high on
mindfulness trait showed no benefit from this trait on exposure to the stressor, if they had not
received an explicit instruction to maintain a state of mindfulness during the exposure to the
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stressor. So even though mindfulness presupposes opening oneself to an experience in the
present moment, it cannot simply be inferred that people will face that experience with a mindful
attitude. When an individual faces an emotion which invokes discomfort of certain intensity, it is
quite probable that they will naturally generate a rejection of that experience, and try to control it
in a similar way to that demonstrated in the conditions of experimentally induced emotional
[28] can serve to understand how certain emotional
experiences can be outside the integration zone, complicating exposure to them. In this way a
paradox could occur, according to which some people, despite trying to bring full attention to their
emotional experience, in fact, were trying to control their internal emotional processes. Linehan
[15] argues that an important capacity to regulate emotions consists simply in the contemplation
of emotion from the moment it appears, until its return to "baseline"; a return that will inevitably
occur if we allow ourselves to sit with the emotion without reacting to it. These studies seem to be
in line with others that showed how people communicate their emotions because they
presuppose that doing so will help them overcome difficult situations and disturbing experiences.
However, emotional communication alone does not guarantee a positive integration of