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Potentially Adverse Effects of Contemplative Practice

12/7/2016

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An examination of pertinent and under researched issues related to the growing use of mindfulness meditation (MM) and other contemplative practices in health care starts with discussions of the common understanding of mindfulness developed by John Kabat-Zinn’s (1994) who famously defined it as – “paying attention in a particular way, on purpose, in the present moment, non-judgmentally” (p.4).  Changing understandings of mindfulness, now impacting how it is taught and practiced, start with the differentiation of MM and Mindfulness Based Interventions (MBI).  MM practices are generally grouped into two primary types: focused attention and open monitoring (Vago & Silbersweig, 2012). MBIs, although often incorporating MM practices, generally do so within a larger collection of therapeutic techniques.  The most common MBIs are Mindfulness Based Stress Reduction (MBSR) (Kabat-Zinn, 1990), Mindfulness Based Cognitive Therapy (MBCT) (Segal, Williams, & Teasdale, 2002), Dialectical Behavioral Therapy (DBT) (Linehan, 1993), and Acceptance and Commitment Therapy (ACT) (Hayes, Strosahl, & Wilson, 1999).  This under researched issue introduces a number that are currently arising, which challenge the rapid adoption of contemplative practices such as MM.
 
In particular, while there are significant benefits to practicing mindfulness meditation and other contemplative practices interest is now turning to the potential harms associated with these practices.  Hanley et al. (2016) introduce their research into what they term the ‘other side of mindfulness’ by highlighting the attrition rates in MM and MBI courses.  They suggest that this aspect of these interventions is frequently ignored in the literature, but they have found, for example, that participants with a history of suicidal depression, depressive rumination, and younger participants who inconsistently take antidepressants were less likely to finish MBCT programs.  From this and other findings they construe that participant completion rates in both MBSR and MBCT are consistently aligned with participant motivation.  This confirms the often unspoken but compulsory aspect of engaging these programs, which is that they require significant effort, and while not a serious harm, failure to complete may exacerbate the depression experienced by those who drop out of these programs.
 
According to Hanley et al., (2016) it is only one of a wide range of adverse effects that can potentially arise from mindfulness and other contemplative practices.  While little theoretical attention has been paid to this aspect of meditation Hanley and his colleagues found a number of theorists working in this area.  Interestingly, this began in the 1970’s with seminal work done by theorists such as Roger Walsh and Lorin Roche and their 1979 “Precipitation of acute psychotic episodes by intensive meditation in individuals with a history of schizophrenia”.  More recently, as the use of meditation interventions has increased in a range of settings, theorists have returned to the issue of harms result from meditation.  Deane Shapiro (1992) found in his work with 27 experienced meditators on a 10 day silent Vipassana meditation retreat that despite an 80% positive response to the retreat, a significant proportion of retreatants reported negative effects.  These effects were divided into three major domains: Intrapersonal – increased negativity, disorientation, addiction to meditation, boredom and pain; Interpersonal – family conflicts as the retreatants became more judgmental; Societal effects – increased alienation, discomfort with the ‘real world’ (Shapiro in Hanley et al., 2016, p. 108).  It is important to note that these adverse effects appeared to transform over time and six months after the retreats participants reported that many of the issues were resolved.  Castillo (1990) describes similar adverse effects in his case-study, including depersonalization and associated anxiety and panic.  Relevant here is that depersonalization can be a function of the “nature of the ideational construction of the experience in the mind of the individual” (Castillo, 1990, p. 167), thus context and participant expectation is a determinate of the psychological distress associated with MM.  A form of meditation-induced psychosis is reported by Kuijpers et al. (2007) who provide the case study of a young man suffering acute but transient psychotic symptoms after a silent meditation retreat.  However, it is important to note that the young man had a history of mental illness and there were stressors including sudden weight loss resulting from recent marathon training. 
 
Kuijpers et al’s (2007) article provides an overview of 10 similar case studys of meditation-induced psychosis with more than half of those cases being with individuals who had psychiatric histories.  Fasting and sleep deprivation were implicated in a number of these situations and all but one of the individuals recovered in a time period of between a few days to 5 months after the incident.  Reporting on the phenomenon of meditation-induced psychosis Manocha (2000) advises that “meditation is contraindicated in those [individuals] suffering from psychosis and should only be applied with great caution in those with severe psychological problems” (pp. 1137-1138).  Kuijpers et al., (2007) arrive at a similar conclusion as they also highlight issues related to sleep deprivation, fasting and physical exhaustion.  Arias et al., (2006) caution that it is difficult to interpret the relationship between meditation and psychosis given the frequency of accompanying sleep and food deprivation in many of the reports. Accompanying, research on psychosis and meditation is a growing literature on the benefits of using mindfulness-based therapies in the treatment of psychosis.  Shonin et al. (2014) acknowledge that meditation may induce psychotic episodes though counter this by outlined that most of the evidence of this stems from case studies with low participant numbers who have engaged in intensive meditation retreats.  Shonin et al (2013) caution against intensive retreats where participants can meditate for up to 18 hours at a time often while fasting or with reduced food intake, as the extreme stress associated practice can in rare cases result in psychotic episodes.  Shonin et al. (2014) also differentiate between a wide range of contemplative practices such as Transcendental Meditation (TM) and Qigong and what they term ‘analytical meditative methods’ associated with Vipassana meditation and MM, suggesting that MM is a more ‘passive’ method particularly suited for those with mental ill health.  According to Shonin and his colleagues (2014) MM provides an attentional strategy (nonjudgmental open awareness anchored by breath-observance) that has been shown to “increase perceptual distance from cognitive and affective processes, which can be beneficial for those suffering from psychosis” (p. 126).  They conclude that MM used in clinical settings appears to be beneficial in the treatment of psychosis.
 
In addition to particular forms of contemplative practices playing a dual role in psychosis, there are specific adverse effects linked to certain practices.  In his research on the Chinese movement meditation practice of Qigong, Ng (1990) claims that it has been found to produce three types of ‘disturbances’: sensory, motor, and psychic.  Sensory disorders range from difficulty breathing, and nervousness to disturbed sleep and numbness or aching; motor disturbances that have been reported are: twitching, tremors or involuntary movements of the head and torso, which confirms Lustyk et al.’s (2009) proposition that meditation can increase epileptogenesis.  Psychic disturbances include alterations in consciousness such as confusion and disorientation, ‘spirit possession’ or feelings of bodily possession, distracting thoughts and delusions (Ng 1999).  In addition to these serious outcomes of contemplative practice there are ‘low level’ negative results that Lomas and his colleagues (2015) discovered in their research with 30 male contemplative practitioners in London, England.  They include the difficulty of acquiring particular skills needed to meditate, the struggle of integrating meditation into busy lives, the boredom of practice, and problems with tiredness or ambivalence (p. 10).  Lomas et al., (2015) also highlight gender specific problems with meditation, where they identified what they believe to be a problem with meditation, specific to men, related to their proposed restricted emotionality.  In their discussion of these issues Lomas etc al. (2015) acknowledge the more serious problems that can arise from meditation, which they found in their research with a quarter of their participants reporting substantial difficulties with meditation.
 
Each of the above mentioned studies introduces relevant points, apart from those already mentioned, which are important to understand when engaging the issue of harms associated with meditation. Starting with the need to acknowledge that there are vulnerable communities (Kuijpers, et al., 2006), the understanding that different practices can produce different outcomes (positive and negative), there are relevant cultural and gender issues (Ng 1990, Lomas, 2015) and the necessity for empathetic and qualified instructors (Hanley et al., 2016).  To conclude, Lustyk et al. (2009) systematize potential adverse effects of meditation by dividing them into three main categories: mental, physical and spiritual, while emphasizing that adverse mental effects are the most common.  These are: psychosis including schizophrenia, dissociative states, and affective and anxiety disorders such as bipolar disorders, manic states, and depression and anxiety.  Lustyk and his colleagues (2009) don’t detail negative physical and spiritual outcomes though the claim they are less common than the adverse mental effects of meditation, they also propose that the latter are rare.  It appears that serious adverse effects of meditation are uncommon while low level discomfort either resolves or is accepted because of the far greater benefits.  Lustyk et al. (2009) also ask why meditation can produce harm, suggesting there is little research in this area, while hypothesizing that it may simply be that meditation reveals existing mental, emotional and physical discomfort generally suppressed by daily activity.

References:
Arias, A., Steinberg, K., Banga, A., & Trestman, R. (2006). Systematic review of the efficacy of meditation techniques as treatments for medical illness. Journal of Alternative and Complementary Medicine, 12, 817-832.

Castillo, R. (1990). Depersonalization and meditation. Psychiatry: Interpersonal and Biological Processes, 53, 211-237.

Hanley, A., Abell, N., Osborn, D., Roehrig, A., & Canto, A. (2016). Mind the gaps: Are conclusions about mindfulness entirely conclusive? Journal of Counseling & Development, 94, 103-113.

Hayes, S., Luoma, J., Bond, F., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behavior Research and Therapy, 44, 1-25.

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York, NY: Delta.

Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York, NY: Hyperion.

Kuijpers, H., Van der Heijden, F., S., T., & Verhoeven, W. (2007). Meditation-induced psychosis. Psychopathology, 40, 461-474. doi:doi:10.1159/000108125

Lindhan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.

Manocha, R. (2000). Why meditation? Australian Family Physician, 29, 1135-1138.

Ng, B. (1999). Qigong-induced mental disorders: A review. Australian and New Zealand Journal of Psychiatry, 33, 197-206. doi:doi:10.1046/j.1440-1614.1999.00536.x

Segal, Z., Williams, J., & Teasdale, J. (2002). Mindfulness-based cognitive therapy for depression. New York, NY: Guilford Press.

Shapiro, D. (1992). Adverse effects of meditation: A preliminary investigation of long-term meditators. International Journal of Psychosomatics, 39, 62-67.

Shonin, E., Van Gordon, W., & Griffiths, M. (2013). Buddhist Philosophy for the treatment of problem gambling. Journal of Behavioral Addictions, 2, 63-71.

Shonin, E., Van Gordon, W., & Griffiths, M. (2014). Do mindfulness-based therapies have a role in the treatment of psychosis? Australian and New Zealand Journal of Psychiatry, 48(2), 124-127.

Vago, D., & Silbersweig, D. (2012). Self-awareness, self-regulation, and self-transcendence (S-Art): A framework for understanding the neurobiological mechanisms of mindfulness. Frontiers in Human Neuroscience, 6, 1-30. doi:doi:10.3389/fnhum.2012.00296

Walsh, R., & Roche, L. (1979). Precipitation of acute psychotic episodes by intensive meditation in individuals with a history of schizophrenia. American Journal of Psychiatry, 136, 1085-1086.


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Frontline Yoga: Contemplative Approaches to PTSD

12/7/2016

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I was recently introduced to this organization, Frontline Yoga, which is helping veterans and front-line support people such as the Police and nurses and doctors in emergency wards - who are suffering trauma because of their work. It looked like a great initiative to me: http://www.yogaforthefrontline.com/
And this is their Facebook site, there are some inspiring stories on it: https://www.facebook.com/FrontlineYogaFoundation/?fref=nf
From their website:

"Frontline Yoga Inc. delivers Trauma Aware Yoga to members at the Frontline. Police, Paramedics, Firefighters, Defence, Healthcare Workers, SES/RFS and Surf Life Savers are able to access free weekly Yoga.  Our aim is to foster community and support, develop mental and physical strength, build resilience, a sense of peace and tools for self-regulation in order to optimise the processing of occupational stressors. 



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Andrew Olendzki on a Buddhist Approach to Contemplative Art

11/7/2016

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Andrew Olendzki: "Consciousness, Non-Self and Contemplative Art: Buddhist Influences on a New Art Movement."  Video of a presentation given at Smith College in Northampton, MA on August 5, 2015.  There are a number of interesting video presentations on different aspects of Buddhism presented by the Buddhist scholar Andrew Olendzki, scroll down to the bottom of the page to see the one on Contemplative Art through a Buddhist lens:
http://www.andrewolendzki.org/video.html



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Trauma Informed Approaches in Contemplative Education

11/7/2016

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I have recently been introduced to the idea of a trauma informed approach to contemplative practice not only in Contemplative Education but in all uses of contemplative practice.  This is link to a short video on trauma informed yoga: https://www.youtube.com/watch?v=f_mBp5p6h2M
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Second Generation Mindfulness-Based Stress Reduction Interventions

20/5/2016

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I was recently introduced to this idea of: Second Generation Mindfulness-Based Stress Reduction Interventions, I'm not sure if it quite does what is outlined in this quote from Shonin and Van Gordon but its a great start to remediating the issues related to stripping Buddhism out of some of the foundational practices in MBSR.
 
Shonin, E., & Van Gordon, W. (2015). Managers' experiences of meditation awareness training. Mindfulness, 6, 899-909.
 
“Due to the suggestion that some individuals may prefer to be trained in a version of mindfulness that more closely resembles a traditional Buddhist approach, recent years have witnessed the development and early stage evaluation of several Second Generation Mindfulness-Based Interventions (SG-MBIs; Singh et al. 2014). Although SG-MBIs still follow a secular format that is suitable for delivery within Western applied settings, they are overtly spiritual in aspect and teach mindfulness within a practice infrastructure that integrates what would traditionally be deemed as prerequisites for effective spiritual and meditative development. At the most basic (but by no means the least profound) level, such prerequisites include each element of the Noble Eightfold Path. The Noble Eightfold Path comprises each of the three quintessential Buddhist teaching and practice principles of (1) wisdom (i.e. right view, right intention), (2) ethical conduct (i.e. right speech, right action, right livelihood) and (3) meditation (i.e. right effort, right mindfulness, right concentration). Each of these three fundamental elements (Sanskrit: trishiksha—the three trainings) must be present in any path of practice that claims to expound or be grounded in authentic Buddhadharma, and they apply to (and form the basis of) the Fundamental or Theravada vehicle just as much as they do the Mahayana and Vajrayana Buddhist vehicles. Thus, for mindfulness practice to be effective, it must be taught as part of a rounded spiritual path, and it must be taught by a spiritual guide that can transmit the teachings in an authentic manner (Shonin et al. 2014; Shonin and Van Gordon 2014)." (Shonin and Van Gordon, 2015, p. 900 )
 
References:
Singh, N. N., Lancioni, G. E.,Winton, A. S.W., Karazsia, B. T.,& Singh, J. (2014a).
Mindfulness-based positive behavior support (MBPBS) for mothers of adolescents with
autism spectrum disorders: Effects on adolescents’ behavior and parental stress. Mindfulness. doi:10.1007/s12671-014-0321-3.
Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014a). The emerging role of Buddhism in
clinical psychology: Towards effective integration. Psychology of Religion and Spirituality, 6, 123–137.
Shonin, E., & Van Gordon, W. (2014a). The lineage of mindfulness. Mindfulness.
doi:10.1007/s12671-014-0327-x.


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Developments in Contemplative Education at Atma Jaya Yogyakarta University, Yogyakarta, Indonesia

29/4/2016

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I have a wonderful friend and colleague Prasasto Satwiko a professor of Architecture in the Faculty of Engineering at Atma Jaya Yogyakarta University (AJYU), Yogyakarta, who since 2010, has supported the integration of yoga into classes in his faculty.  This started with the use of yoga and meditation in an Art History class. 
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He and his colleagues were gratified to see that these students were enthusiast about the yoga classes and from 2012-14, 80 students and 8 assistants have successfully taken part in the classes.  Because of the success of these courses yoga has now became an integral part of their design studies.  This started formally in semester 2, 2015 and they now have yoga integrated into Design Studio 1-6 with 10 parallel classes.
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The increasing interest in contemplative practice at AJYU links with the university's declaration to be a ‘green and healthy campus’.  As a part of this initiative AJYU now has the vegan restaurant Veganissimo on campus.

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A New Contemplative Law Publication

27/4/2016

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I am pleased to announce the publication of “Contemplative practice in the law school: Breaking barriers to learning and resilience” and my co-authored chapter with Professor Vines: Contemplative practice in the law school: breaking barriers to learning and resilience:
 
The Abstract
In this chapter we argue that the increasing use of contemplative practices in law schools is significant not just in relation to enhancing resilience and diminishing stress and depression, but that they also have major benefits in the development of traditional legal roles.  However, there is an attitudinal barrier that needs to be overcome as law students and legal academics have commonly been resistant to the use of these practices.  It is interesting and somewhat ironic, therefore, that just as we are developing some level of openness to practices that seem alien in legal study and practice we also find evidence that they indeed enhance capacities for legal and educational practice such as level of focus, ability to prioritize, the optimization of objectivity, higher order thinking and so on.  Further, the management of ethical issues of professional practice, which are frequently triggers for depression, may also be improved by contemplative practices as they enhance students’ and lawyers’ ability to articulate their personal and professional ethics.  In turn, this knowledge can be used to help break down remaining barriers to the use of contemplative practices within the legal academy. To reiterate, until recently the supposition was that the remedial benefits of contemplative practices ameliorated negative aspects of legal education and practice.  However, now it appears that the enhancement may also be linked to a direct correspondence between contemplation and the law.
 
For more information please see: For more information please see: https://books.google.com.au/books?id=jzz7CwAAQBAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q=Patricia%20Morgan&f=false
 


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Two Great Australian Initiatives

9/4/2016

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I was recently sent information about two great educational initiatives in Australia:
The first from Tony McKenzie, which has two parts first his:
Blog about learning and teaching in the twenty-first century titled:
One giant learning curve for humanity
(http://tonymckenzie.wix.com/learning-curve).
And the other is a project called ‘i witness’ being mounted by local community group, Orange CultureHub; see http://orangeculturehub.wix.com/joinus#!i-witness/wu6nx.

And John Turner's Quiet Kit, he says:

I recently launched QuietKit ( http://quietkit.com/ ), which helps people get started with mindfulness and meditation, as well as helps them build a meditation habit, all for free.
 
It's already helped a number of people deal with stress, and I'm hoping to reach many more. John Turner
Founder, QuietKit http://quietkit.com/ ( http://quietkit.com/ )

The Quiet Kit helps individuals Learn to increase focus, reduce stress, and increase mindfulness with simple guided meditation for beginners.

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Contemplative Education in the UK

25/2/2016

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The  Contemplative Pedagogy Network, UK, has a blog page listing a number of interesting posts the most recent being one on 'Exploring Labyrinths' and the preceding post which reflects on the question: 'Is telling students to be compassionate enough?'  To read these posts go to: http://contemplativepedagogynetwork.com/

If you're going to be in Scotland in April their events page is currently listing the
Growing Contemplative Practices in Higher Education?Queen Margaret University, Edinburgh, EH21 6UU, Scotland, Friday 22nd April 2016, 9am-4.30pm, See: http://contemplativepedagogynetwork.com/events/





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Hilma Klint - Visionary Contemplative Artist

24/2/2016

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This article in the Guardian engages with Hilma Klint's Visionary Art, starting with this question: "Was Hilma af Klint Europe’s first abstract artist – before even Kandinsky and Mondrian? As an exhibition of her extraordinary, occult-inspired works opens at the Serpentine Gallery, London, we travel to Sweden to find out"
http://www.theguardian.com/artanddesign/2016/feb/21/hilma-af-klint-occult-spiritualism-abstract-serpentine-gallery

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    Author: Dr Patricia Morgan

    I am a teacher, contemplative practitioner, researcher, community developer and artist, currently working in the area of Contemplative Education, which I believe is one of the most important movements in education today.

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