LETTERS TO THE EDITOR
EEG ASYMMETRY AND
MINDFULNESS MEDITATION
Davidson and colleagues’ recent pa-
per in Psychosomatic Medicine (1) used
the extensive work on the functional
neuroanatomical substrates of emotion
to illuminate possible mechanisms of
meditation practice. Their work, origi-
nally based on EEG studies (2, 3) and
supported by current PET and fMRI re-
search (4), has associated positive and
negative affect with frontal brain activa-
tion (5, 6). Specifically, increased acti-
vation in left dorsolateral and ventral
medial prefrontal cortices, as well as in
the amygdale, has been observed during
certain forms of positive emotion and
more generally during approach-ori-
ented disposition/behavior toward re-
warding stimuli. Right prefrontal cortex
activation has been observed during cer-
tain forms of negative emotion and dur-
ing withdrawal-oriented disposition/be-
havior away from aversive stimuli.
Their recent paper reported three
findings resulting from mindfulness
meditation practice: 1) “significant in-
creases in left-sided anterior activation,
a pattern previously associated with pos-
itive affect;” 2) “significant increases in
antibody titers” (a measure of immune
functioning); and 3) that the “magnitude
of increase in left-sided activation pre-
dicted the magnitude of antibody titer
rise.”
A close examination of their paper
suggests that these conclusions are inac-
curate. First, significantly greater left-
sided activation was only observed at
central sites (C3/C4) not frontal sites
(pg. 566). C3 and C4 are over motor
cortices (7), which play little, if any, part
in emotion processing. Thus, greater
“left-sided anterior activation” was not
observed in this study. Also, the authors
never discussed why left-sided motor
cortex would be significantly activated
as a result of mindfulness meditation.
They also do not discuss why frontal
activation, which has been associated
with approach/withdrawal dispositions
and positive/negative affect, did not
Psychosomatic Medicine 66:147–152 (2004)
0033-3174/04/6601-0147
Copyright © 2004 by the American Psychosomatic Society
change as a result of mindfulness
meditation.
Second, Figures 3 and 4 are confus-
ing. The emotion research strongly sug-
gests that positive emotions lead to in-
creased left-sided activation; this is seen
in Figure 3. However, increased left-
sided activation is also seen in Figure 4,
which is in response to negative emotion
induction. This obvious contradiction
was not discussed.
Third, Figure 6 in this paper shows
the relation between changes in so-
called asymmetric “anterior” activation
(which was really C3/C4 asymmetry)
and antibody titer. Figure 6 contains a
significant outlier (first point on the
lower left-side of the figure). Correla-
tion and regression statistics are very
sensitive to outliers, which vastly inflate
correlation values (8). Visually, if the
outlier was removed, the high correla-
tion appears as though it would drop
from significance.
This research was well-designed and
investigates an important research ques-
tion—long-term effects of meditation
practice in daily life. However, the con-
clusions from this study seemed to re-
veal: 1) increased left-sided activation in
motor cortex with practice of mindful-
ness meditation, suggesting increased
motor activity in the right side; 2) im-
mune response may increase with mind-
fulness meditation, but the change in
immune function does not appear re-
lated to changes in brain functioning.
There is increasing interest by the
public, the medical community, and
funding agencies in complementary and
alternative medicine modalities in gen-
eral and particularly in meditation. Care-
ful analysis and interpretation of data
are required to ensure maximum
progress in our understanding and ap-
propriate utilization of meditation for
improving individual and collective
health. We offer these observations in
the spirit of cooperation to build a reli-
able comprehensive knowledge base to
guide mind/body research.
FREDERICK TRAVIS, PHD, AND
ALARIK ARENANDER, PHD
Maharishi University of
Management
Fairfield, Iowa
REFERENCES
1. Davidson RJ, Kabat-Zinn J, Schumacher J,
Rosenkranz M, Muller D, Santorelli SF, Ur-
banowski F, Harrington A, Bonus K, Sheridan
JF. Alterations in brain and immune function
produced by mindfulness meditation. Psycho-
som Med 2003;65:564 –70.
2. Tomarken AJ, Davidson RJ, Henriques JB.
Resting frontal brain asymmetry predicts affec-
tive responses to films. J Pers Soc Psychol
1990;59:791– 801.
3. Tomarken AJ, Davidson RJ, Wheeler RE, Doss
RC. Individual differences in anterior brain
asymmetry and fundamental dimensions of
emotion. J Pers Soc Psychol 1992;62:676 – 87.
4. Pizzagalli D, Shackman AJ, et al. Affective
Neuroscience. In: Davidson RJ, Scherer KR,
Goldsmith HH, editors. Handbook of affective
neuroscience. New York, Oxford University
Press; 2003.
5. Davidson RJ. Emotion and affective style. Psy-
chol Sci 1992;3:39 – 43.
6. Davidson RJ, Irwin W. The functional neuro-
anatomy of emotion and affective style. Trend
Cog Neurosci 1999;3:11–21.
7. Homan RW, Herman J, Purdy P. Cerebral lo-
cation of international 10 –20 electrode place-
ment. Electroencephalogr Clin Neurophysiol
1987;66:376 – 82.
8. Hair JF, Anderson RE, et al. Multivariate data
analysis. New York, Macmillan Publishing Co;
1992.
RESPONSE
We thank Travis and Arenander for
their comment because it provides us
with the opportunity to clarify a number
of issues that were clearly misunder-
stood in their reading of our article.
They raise a number of questions about
the findings we reported in the Davidson
et al. (1) study on the effects of mind-
fulness meditation on brain and immune
function.
First, the authors claim that our find-
ings of greater left-sided activation were
found only at the central sites (C3/C4).
This is simply false. As Figure 3 of the
article illustrates, the same basic effect
was also obtained at the anterior tempo-
ral sites (T3/T4). The authors then assert
that the C3/C4 electrodes are over the
motor cortices, “which play little if any
part in emotion processing.” First, the
electrodes reflect activity more broadly,
147
including the premotor frontal region
and somatosensory cortex, which
Damasio and colleagues have strongly
implicated in emotion processing. More
to the point, in other research cited in
our article, we have published findings
indicating that positive emotion is asso-
ciated with increases in left-sided acti-
vation at the C3/C4 sites. Reference 11
in our article presents these data (2).
Travis and Arenander further claimed
that we “did not discuss why frontal
activation, which has been associated
with approach/withdrawal dispositions
and positive/negative affect, did not
change as a result of mindfulness med-
itation.” Again, this claim is untrue. On
page 569 of the original article, the en-
tire second paragraph of the Discussion
section is devoted to exactly this issue!
We noted in that paragraph that the fact
that we did not find significant increases
in dispositional positive affect in the
meditation group may be related to our
failure to detect significant increases in
left prefrontal activation. We further
suggested that if the duration and/or in-
tensity of the intervention were in-
creased, we might have then been able
to detect increases in both positive affect
and left prefrontal activation.
Travis and Arenander then suggest
that Figure 4 is misleading because in it
we show that for the meditators, the
negative affect induction is associated
with left-sided activation. Figure 4 is not
a comparison of the positive vs. negative
affect induction conditions. Rather, it
depicts the changes over the course of
treatment in activation asymmetry in re-
sponse to the negative affect induction.
Most importantly, the third paragraph of
the Discussion section focuses explicitly
on this issue. We note that other work of
ours and other investigators has found
that increased left-sided activation in re-
sponse to negative affect inductions is
associated with better regulation of neg-
ative affect (3). Finally, the authors raise
a question about a possible outlier in the
scatter plot presented as Figure 6. This is
precisely why the scatter plot was in-
cluded rather than just reporting the r
value and p value of the correlation. One
of the limitations of our study that we
discuss in the Discussion section is the
148
small sample size that adversely affects
the robustness of our findings in several
different ways. It is indeed the case that
elimination of a single data point in the
scatter plot presented in Figure 6 could
alter the correlation in different direc-
tions depending on which data point was
eliminated. We could also significantly
strengthen the correlation by eliminating
a single data point (most extreme point
in the lower right quadrant). We devote
a paragraph in the Discussion section to
the various limitations of this initial
study, and the very first limitation we
discuss is the small sample size of this
study. Clearly, these findings require
replication and extension in a larger
sample.
We appreciate the opportunity to
clarify these points and share with Tra-
vis and Arenander their conclusion that
“Careful analysis and interpretation of
data are required to ensure maximum
progress in our understanding and ap-
propriate utilization of meditation for
improving individual and collective
health.”
RICHARD J. DAVIDSON, PHD
University of Wisconsin
Madison, Wisconsin
REFERENCES
1. Davidson RJ, Kabat-Zinn J, Schumacher J,
Rosenkrantz M, Muller D, Santorelli SF, Ur-
banowski F, Harrington A, Bonus K, Sheridan
JF. Alterations in brain and immune function
produced by mindfulness meditation. Psycho-
som Med 2003;65:564 –70.
2. Davidson RJ, Ekman P, Saron C, Senulis J,
Friesen WV. Approach/withdrawal and cere-
bral asymmetry: Emotional expression and
brain physiology, I. J Pers Soc Psychol 1990;
58:330 – 41.
3. Davidson RJ, Jackson DC, & Kalin NH. Emo-
tion, plasticity, context and regulation: Perspec-
tives from affective neuroscience. Psychol Bull
2000;126:890 –906
ALTERATIONS IN BRAIN AND
IMMUNE FUNCTION
PRODUCED BY MINDFULNESS
MEDITATION: THREE CAVEATS
Recent research of Davidson and his
colleagues on brain processes and mind-
fulness meditation (1) has generated
substantial media and popular attention.
In this research, participants randomly
assigned to 8 weeks of mindfulness
meditation (compared with nonmeditat-
Psychosomatic Medicine 66:148 –152 (2004)
ing controls) displayed significant in-
creases in left-sided anterior activation
(previously associated with positive af-
fect) and increases in antibody titers to
influenza vaccine. Meditators practiced
45 minutes a day, met weekly for up to
3 hours, and completed a silent 7-hour
retreat at week 6. These are exciting and
promising findings that merit comment.
Having studied and taught meditation
and relaxation for over three decades
(2–11), I note similarities between the
current burst of interest in Buddhist
techniques and interest in a Westernized
Hindu approach in the 1970s—transcen-
dental meditation (TM). For both, media
attention has been considerable, includ-
ing major articles in the New York
Times, several feature articles in the
New York Times Magazine, cover arti-
cles in Time, and significant coverage on
network television. Interestingly, for
both, heightened interest was preceded
by major articles in Psychosomatic
Medicine. Unfortunately for both, the
popular press has generally overstated
the significance of reported findings.
This in turn has provided considerable
misleading “expert recommended” ad-
vertising copy for technique advocates
and exaggerated promise of symptom
relief and psychological gain to those in
distress. Ordinarily, scholars look the
other way when the media mangles their
work. However, given that serious jour-
nalists have described current mindful-
ness studies as “milestone” (13), and
researchers, through frequent inter-
views, have done little to temper such
exuberance, it is time to take a deep
breath and bring to light three caveats.
First, most research on mindfulness has
examined Kabat-Zinn’s approach. Few, if
any, studies have cautioned that the Ka-
bat-Zinn system is not pure mindfulness,
but an amalgam of mindfulness medita-
tion, concentrative meditation, passive
breathing exercises, yoga stretching, and
even a bit of imagery, autogenic training,
and Buddhist psychology. Elsewhere I
have proposed that this system should be
viewed as a “combination approach” (10,
11, 12). The point is not minor, given the
consistent finding that the different ap-
proaches Kabat-Zinn incorporates have
different effects (8, 9, 12). Thus, it is im-
possible to determine if obtained benefits
are the result of meditation, stretching,
breathing, or a synergistic combination of
all components. Likewise, it is impossible
to identify elements that are unnecessary
or needlessly long. We risk driving clients
away with 1-hour daily meditations (most
other programs use 20 minutes or less),
3-hour weekly meditations, and 7-hour si-
lent meditation retreats every few months.
Of the six major approaches to profes-
sional relaxation (progressive muscle re-
laxation, autogenic training, yoga stretch-
ing, breathing exercises, imagery,
meditation), the Kabat-Zinn approach is
truly unique in its demands. Such de-
mands appear to be based on Buddhist
religious tradition rather than scientific
evidence.
Second, we know very little about the
biological effects of activities that con-
sistently evoke positive states. It is clear
that positive states can be evoked by
many activities, including sitting in a
Jacuzzi, listening to music, taking nature
walks, petting pets, and so on (12). Just
what are the physiological effects of,
say, basking in a Jacuzzi an hour each
day, supplemented by a 3-hour visit to
the pleasure spa every weekend, and a
7-hour marathon spa retreat after 6
weeks? I predict the lucky participants
in such research would appear quite
happy and healthy, especially if their
retreats were led by a world-famous
pleasure spa expert. Of course, it is not
my purpose to promote pleasure spas.
My point is that any consistent, pro-
longed, and enthusiastically promoted
regimen of quiet and pleasurable activ-
ity could well evoke changes in dispo-
sitional positive affect as well as brain
and immune function. This simply has
to be checked before any mindfulness
research can be described as “mile-
stone.” Until then, researchers must pro-
vide the appropriate caveat.
Third, there is the problem of happi-
ness. For over a decade (6, 7, 12), I have
argued that positive state researchers have
restricted their attention to just one or two
positive dimensions, usually happiness.
Such a focus limits what meditation re-
search can find. I predict that when brain
researchers start comparing approaches,
practitioners of different techniques will
Psychosomatic Medicine 66:148 –152 (2004)
look uninterestingly similar when happi-
ness is the only positive state examined.
Our research, as described in over 30 pub-
lished studies (7–9, 12, 14 –16), has exam-
ined several dozen types of relaxation and
meditation activities practiced by over
10,000 participants. We have found at
least 15 positive factor states associated
with the practice of relaxation, meditation,
and mindfulness. In addition to Happi-
ness, this comprehensive list includes:
Sleepiness, Disengagement, Rested/Re-
freshed, Energized, Physical Relaxation,
At Ease/Peace, Mental Quiet, Childlike
Innocence, Love/Thankfulness, Mystery,
Awe/Wonder, Prayerfulness, and Time-
less/Boundless/Infinite/At One. Further-
more, whenever we have compared tech-
niques (including mindfulness), we have
found that different approaches evoke dif-
ferent positive states, even though they
evoke the same degree of happiness. It
remains for researchers to look beyond
happiness for what may well be the true
uniqueness of mindfulness.
In sum, I sense that we may be at the
threshold of a new explosion of public
and scientific interest in mindfulness
meditation. Serious research on TM first
appeared in the scientific literature
about three decades ago, and inspired, as
listed on PsycINFO, 147 articles from
1973 to 1982 (during this time, 88 stud-
ies focused on Zen and mindfulness). In
the present decade (1993–2002), mind-
fulness research has been on the rise,
with over 140 articles to date (75 for
TM). It is my hope that a few simple
caveats may prompt or provoke medita-
tion researchers to carefully examine
their methods and avoid the exaggerated
claims uttered by TM advocates in the
1970s and 1980s. Those of us who do
meditation research should be mindful
that our findings and enthusiastic rec-
ommendations are grounded in fact, not
faith.
JONATHAN C. SMITH
Distinguished Professor of
Psychology
Roosevelt University
Chicago, Illinois
REFERENCES
1. Davidson R, Kabat-Zinn J, Schumacher J,
Rosenkranz M, Muller D, Santorelli S, Ur-
banowski F, Harrington A, Bonus K, Sheridan
J. Alterations in brain and immune function
produced by mindfulness meditation. Psycho-
som Med 2003;65:564 –70.
2. Smith J. Meditation as psychotherapy: A re-
view of the literature. Psychol Bull 1975;32:
553– 64.
3. Smith J. Psychotherapeutic effects of TM with
controls for expectation of relief and daily
sitting. Consult Clin Psychol 1976;44:630 –7.
4. Smith J. Personality correlates of continuation
and outcome in meditation and erect sitting
control treatment. J Consult Clin Psychol
1978;46:2272–9.
5. Smith J. Relaxation dynamics: Nine world
approaches to self-relaxation. Champaign, IL:
Research Press; 1985.
6. Smith J. Meditation, biofeedback, and the re-
laxation controversy: A cognitive-behavioral
perspective. Amer Psychol 1986;41:1007–9.
7. Smith J. Cognitive-behavioral relaxation
training: A new system of strategies for treat-
ment and assessment. New York: Springer;
1990.
8. Gillani N, Smith J. Zen meditation and ABC
relaxation theory: An exploration of relax-
ation states, beliefs, dispositions, and motiva-
tions. J Clin Psychol 2001;57:839 – 46.
9. Matsumato M, Smith J. Progressive muscle
relaxation, breathing exercises, and ABC re-
laxation theory. J Clin Psychol 2001;57:
1551–7.
10. Smith J. ABC relaxation theory: An evidence-
based approach. New York: Springer; 1999.
11. Smith J. ABC relaxation training: A practical
guide for health professionals. New York:
Springer; 1999.
12. Smith JC. Advances in ABC relaxation. Ap-
plications and inventories. New York:
Springer; 2001.
13. Hall S. Is Buddhism good for your health? NY
Times Mag; September 14, 2003.
14. Smith J, Wendell A, Kolotylo C, Camille J,
Lewis J, Byers K, Segin C. ABC relaxation
theory and the factor structure of relaxation
states and recalled relaxation activities, dispo-
sitions, and motivations. Psychol Rep 2000;
86:1201– 8.
15. Smith J. Steps toward a cognitive-behavioral
model of relaxation. Biofeedback Self Regul
1988;13:307–29.
16. Smith J, Amutio A, Anderson J, Aria L. Re-
laxation. Mapping an uncharted world.
Biofeedback Self Regul 1996;21:63–90
RESPONSE
We thank Professor Smith for his
useful comments and cautionary notes,
particularly regarding the response of
the media to published research on med-
itation and for the opportunity to elabo-
rate on the important issues he raises. As
a clinician who has used various forms
of meditation and relaxation for many
years, he raises three caveats about our
study that we will address in turn.
1. “Kabat-Zinn’s system is not pure
149
mindfulness, but an amalgam of mind-
fulness meditation, concentrative medi-
tation, passive breathing exercises, yoga
stretching, and even a bit of imagery,
autogenic training and Buddhist
psychology.”
Professor Smith notes that it is im-
possible in light of the complexity of the
intervention to know precisely which in-
gredient produced the effects that we
observed. He also notes that is it not
possible to know which components
may be needlessly long and unneces-
sary, and he makes the good point that
some individuals might be dissuaded
from engaging in the Mindfulness-
Based Stress Reduction (MBSR) inter-
vention because of its high-demand
characteristics.
We view all of these as important
issues, ones that we have obviously con-
sidered over the years. Our study must
be placed within its appropriate context.
While Professor Smith notes that re-
search on MBSR has been increasing,
our study was the first to examine brain
and immune function changes produced
by this intervention. Thus, in this initial
study, we simply wished to determine
whether there is any effect of the inter-
vention as it is typically administered.
Our goal was explicitly not to identify
one particular component as “the” active
ingredient, if indeed there is any. This
would require the use of several differ-
ent types of control groups, and our
goals for this initial study were consid-
erably more modest.
While we agree with Professor Smith
in his characterization of the interven-
tion as complex and multi-componen-
tial, viewed along one axis, we believe
he is overlooking another vital perspec-
tive, namely that mindfulness, defined
as moment-to-moment nonjudgmental
awareness, serves as the overarching
unifying factor across the various ele-
ments of the intervention, which, we
emphasize, do not include what he char-
acterizes as “passive breathing exer-
cises, autogenic training, and Buddhist
psychology.” Also, it should be under-
stood in this context that there is no such
thing as “pure mindfulness” meditation,
even within the Buddhist tradition; we
have emphasized the multi-modal nature
150
of its cultivation in all our characteriza-
tions of MBSR, beginning in 1982 (1).
Mindfulness as taught originally by the
Buddha is practiced formally in the sit-
ting, lying down, and standing positions,
as well as walking. There are four foun-
dations of mindfulness in the classical
formulation (Mahasatipatana sutra) (2):
body; perceptions of pleasant, unpleas-
ant, and neutral; thoughts and emotions;
and the characteristics of experience de-
scribed as dis-satisfactoriness, imperma-
nence, and emptiness of inherent self-
existence. There are 16 cultivations of
mind states in relation to awareness of
breathing alone (Anapanasati Sutra) (3).
Moreover, mindfulness is taught and
practiced classically across all activities
of daily living, and a good deal of the
curriculum in MBSR concerns itself
with this cultivation. We feel it is an
accurate first-approximation character-
ization to say that training in mindful
awareness across a number of different
practices is the salient and overarching
characteristic of MBSR.
While it is true that at this point in
time we do not know what the active
ingredient in the intervention might be
for producing the changes we observed
on measures of brain and immune func-
tion, it is a far more complex and inter-
esting question than it appears to be at
first blush, and it will require multiple
complex studies in the future to
elucidate.
In commenting on the demands made
on clients by MBSR, Professor Smith
notes that “of the six major approaches
to professional relaxation (progressive
muscle relaxation, autogenic training,
yoga stretching breathing exercises, im-
agery, and meditation), the Kabat-Zinn
approach is truly unique in its de-
mands.” If true, this is merely a reflec-
tion of the fact that MBSR is not aimed
at achieving a state of clinical relax-
ation, but more at the cultivation of in-
sight and understanding of self and self-
in-relationship via the cultivation of a
moment-to-moment, nonjudgmental but
highly discerning awareness, as de-
scribed by Kabat-Zinn (4). This orienta-
tion is likely to require a more extensive
and intensive intervention strategy than
the cultivation of relaxation in a clinical
Psychosomatic Medicine 66:148 –152 (2004)
context. Relaxation may be a byproduct
of this approach for some people under
some circumstances, but it is not the
goal of MBSR training. Indeed, Profes-
sor Smith seriously mischaracterizes
mindfulness meditation and MBSR in
suggesting that they promote quiet and
pleasurable activity, as might many
other regimens, including Jacuzzi time
and spa sessions. A good deal of the
time, the practice of mindfulness may
mean being with and observing states of
mind and body that are extremely pain-
ful or dysphoric, including fear, loneli-
ness, anger, bodily discomfort, impa-
tience, boredom, and the like. These are
to be experienced as best as one can with
the same nonjudgmental attitude as
pleasant or neutral experiences. Medita-
tion, and particularly mindfulness med-
itation, is not an isomorphic translation
for relaxation, but rather for greater
awareness, self-knowledge, equanimity,
and self-compassion. It is hardly a trip to
a luxury spa, as our patients can readily
attest. The fact that over 15,000 people
have completed MBSR training in the
UMass Stress Reduction Clinic suggests
that, whatever the demand characteris-
tics of the program and perhaps because
of them, large numbers of people are
willing to engage in such an intensive
process over 8 weeks and report signif-
icant benefits from doing so across a
wide range of medical and psychiatric
diagnoses.
Professor Smith also notes that the
demands of MBSR “appear to be based
on Buddhist religious tradition rather
than scientific evidence.” While we
agree with Professor Smith that much
more scientific evidence is required for
understanding all the potential combina-
torial possibilities for an optimal generic
MBSR intervention, we do not at all
agree that the demands are based on
Buddhist religious tradition, except in
the sense that mindfulness meditation
received its most elaborate and coherent
articulation within that tradition and
MBSR certainly makes use of lessons
learned within such contexts as appro-
priate and in the absence of defining
scientific information on the issue. As
we have stated in many different con-
texts (1, 4 – 6), MBSR is an attempt to
draw on whatever universal elements
might be present within that tradition
and others that cultivate mindfulness
(since in the final analysis, mindfulness
meditation is about the refining of atten-
tion and the cultivation of openhearted
presence, both of which have nothing
particularly Buddhist about them) and
see if they can be made accessible and
relevant to the needs of medical patients
and others suffering from those aspects
of the human condition subsumed under
the terms stress, pain, and illness.
MBSR is the outgrowth of that intention
and exploration, shaped by extensive
clinical experience delivering the inter-
vention on the part of Kabat-Zinn and
his colleagues, and drawing on their
own first-person experience with a wide
range of meditative practices. It is im-
portant in this context to clarify that the
structure and components of MBSR
have nothing to do with Buddhist reli-
gious beliefs. In fact, belief itself is a
notion that is foreign to Buddhist medi-
tative practices, which emphasize em-
piricism via direct personal experience
rather than catechism or dogma. The
MBSR curriculum is based on that kind
of empirical attitude and approach and is
entirely open to refinement on the basis
of both clinical experience of what
seems most effective and evidence from
well-designed studies. Professor Smith
is correct in pointing out that a great
many interesting questions and research
agendas can be brought to bear on the
matter of demand characteristics and
curriculum issues in mindfulness-based
interventions, and this is an area of
growing interest. It may be important to
note that MBSR ordinarily requires 6
days each week of 45 minutes of formal
guided meditation practice per day, not
1 hour, as Professor Smith states, and
this was the case in the present study.
2. “We know very little about the
biological effects of activities that con-
sistently evoke positive states. It is clear
that positive states can be evoked by
many activities. . .any consistent, pro-
longed, and enthusiastically promoted
regimen of quiet and pleasurable activ-
ity could well evoke changes in dispo-
sitional positive affect as well as brain
and immune functioning.”
Psychosomatic Medicine 66:148 –152 (2004)
Here again Professor Smith calls our
attention to a very important issue, and
that is the possibility that other forms of
leisure activity might promote changes
that may or may not be similar to those
we found produced by MBSR. Our pur-
pose in performing this study was not to
demonstrate the unique capability of
MBSR in producing these effects. This
would have required a comparison of
MBSR to many other activities and
strategies for the promotion of positive
affect. Rather, our purpose was to deter-
mine if changes in brain and immune
function could be uncovered as a conse-
quence of the intervention. If our results
were positive, as indeed they were, we
and other researchers could begin the
painstaking task of exploring the entire
question of active ingredients and their
interactions within the MBSR interven-
tion and whether any feature of the in-
tervention is truly unique or whether
similar effects could be produced by
other, very different forms of interven-
tion. As suggested in our response to
point 1 above, there may be fundamental
differences in conceptualization and de-
livery between relaxation-oriented inter-
ventions and mindfulness-based inter-
ventions that may be relevant in this
regard. These are all questions that await
future research, and it is our sincere
hope that this study and others like it
will encourage precisely this kind of re-
search and dialogue within the scientific
community.
There is one important issue with re-
spect to this point of Professor Smith
that we must not leave untouched. As
we note both in our Results and Discus-
sion sections, we failed to find any sig-
nificant increase in self-reports of Posi-
tive Affect as a consequence of our
MBSR intervention. We did find reli-
able reductions in self-reported anxiety.
This fact raises several important issues.
First, self-report measures are inade-
quate by themselves to capture positive-
affect related changes in brain function.
Second, the kind of interventions noted
by Professor Smith, such as attending a
“pleasure spa” are likely to produce
changes in self-reported positive affect
and thus appear different from the kind
of change produced by MBSR. It is very
important to note though that we made
no claims about the uniqueness of
MBSR or meditation more generally in
promoting positive affects in brain and
immune function. It is our firm intuition
that there are likely many types of ac-
tivities in which people engage that may
promote similar changes. One of the
critical questions that must be tackled in
future research is how to best “match” a
given individual to activities or inter-
ventions that will be most effective in
promoting salubrious neural and im-
mune function, if that is indeed a goal
rather than an indicator of underlying
psychological changes. We suspect that
there will considerable individual varia-
tion in the nature of the activities that are
most effective in this regard. As for its
characterization in the press as a mile-
stone, what is a milestone is the very
fact that such studies are being under-
taken at all. In our paper, we emphasized
in considerable detail the limitations of
the present study; when speaking with
the press, we take pains to make sure
that these limitations are understood.
3. “. . .there is the problem of happi-
ness. . . . I have argued that positive
state researchers have restricted their at-
tention to just one or two positive di-
mensions, usually ‘happiness.’ We have
found at least 15 positive affect factor
states associated with the practice of re-
laxation, meditation, and mindfulness.”
Professor Smith is calling our atten-
tion to an important issue in emotion
research. He argues that there are many
different forms of positive affect, other
than happiness, and that researchers who
study the impact of meditation and re-
lated interventions should examine the
diverse range of positive affective states
that might be affected. While we
strongly agree with Professor Smith that
positive affect states other than happi-
ness need to be considered, as indeed
Davidson has strongly argued in many
previous publications (7– 8), Davidson
has also provided evidence to suggest
that self-report methods by themselves
will be woefully inadequate to capture
these different forms of positive affect.
The “15 positive factor states” described
by Professor Smith are based exclu-
sively on self-report methods. While this
151
evidence is useful and important, it is
inadequate and must be complemented
by measures of brain function. One of
the central tenets of affective neuro-
science, similar to its neighboring
cousin cognitive neuroscience, is that
constituent affective processes will be
identified in the brain that are opaque to
awareness but that are consequential for
behavior.
It should also be noted that the as-
sessment of positive affect in our study
was not restricted to “happiness,” but
included many of the various adjectives
that comprise the PANAS positive af-
fect scale (9), as noted in our article.
This scale includes a number of differ-
ent facets of positive affect, including
the terms “enthusiastic,” “interested,”
and “strong.”
We wish to thank Professor Smith for
152
raising these interesting and important
issues. We strongly agree with his plea
for conducting research with the utmost
rigor and care. As noted in our article,
we have a paragraph in the Discussion
section devoted to caveats and limita-
tions of our study. We appreciate the
opportunity for elaborating on the other
issues raised by Professor Smith in his
letter.
RICHARD J. DAVIDSON
JON KABAT-ZINN
University of Wisconsin
Madison, Wisconsin
University of Massachusetts
Medical School
Amherst, Massachusetts
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