MEDITATION

Presented by Dr Pavan Kumar Kadiyala Chaired by Dr V K Bhat

INTRODUCTION

Definition

• The word ―meditation‖ derived from Latin ‗meditari’, which means “to engage in contemplation or reflection.” • Synonyms • meditate - think - ponder - consider - reflect - muse – contemplate • The word meditation comes from the same Greek and Latin root as the word medicine.

• Manocha (2000) described meditation as a • discrete and well-defined experience of a state of ―thoughtless awareness‖ or • mental silence, in which the activity of the mind is minimized without reducing the level of alertness.

1989). .• Walsh and Shapiro (2006) defined meditation from cognitive and psychological perspective. • as a family of self-regulation practices that .through focusing attention and awareness. and maintenance of self-observing attitude (Craven.aim to bring mental processes under voluntary control . • A voluntary and alert hypometabolic state of parasympathetic dominance with suspension of logical thought processes.

. and • (5) the use of a self-focus skill or ―anchor‖ for attention. (2004) .• difficult to capture the essence of meditation in one definition. • Meditation (1)utilizes a specific & clearly defined technique. • Cardoso et al.operational definition encompassing both traditional and clinical parameters. not ―to intend‖ to analyze possible psychophysical effects. to judge the possible results. • (2) involves muscle relaxation somewhere during the process • (3) involves logic relaxation i..e. to create any expectation regarding the process • (4) a self induced state.

• Behaviours of mind connotes whether the meditation is based on concentration or mindfulness.• Mikulas (1990) classified meditative practice into 4 components. . • Object refers to object of one‘s attention during the meditation. • Form refers to the setting of meditation and the activity of body during the meditation. • Attitude is the mental set with which one approaches meditation.

7th of 8 steps prescribed to reach an ultimate stage of spiritual emancipation. an ancient science of India. such as physical postures (asanas). • Meditation . meditation & lectures on philosophical aspects of yoga. (Patanjali.HISTORY • Meditation has been prevailing throughout the human history among diverse cultures • Yoga. instructed relaxation and interoception. regulated breathing (pranayama). • Yoga includes diverse practices. with components of physical activity. circa 900 BC) .

regarded • suffering as an essential part of existence.• The Buddha approached spiritual awakening from a more empirical perspective. meditation and philosophy as a means by which to transcend suffering and attain enlightenment. in brief. • The Buddha. conduct. and introduced a system of ethics. . thought. and understanding. attributed suffering to improper behavior. • this approach is encapsulated in his Four Noble Truths and Eightfold Path.

HISTORY IN MODERN WORLD • introduction to the western world by Indian spiritualist Paramahansa Yogananda in 1920 • 1960s .scientific studies started focusing on the clinical effects of meditation on health by behavioural scientists • academic curiosity within psychology came in 1977 when APA stated ―meditation may facilitate the psychotherapeutic process.‖ .

• distinguished by their focus of attention and • organized by attentional style along a continuum. .Types of meditation • Meditation techniques practiced presently can be grouped into 2 basic approaches• Concentrative / Focused attention (FA) meditations and • Mindfulness / Insight / Diffuse / Open monitoring (OM) meditations. with • concentrative techniques on one end & diffuse techniques on the other.

• TM allows a practitioner to access ―the original source of thought. • TM is generally done by focusing the mind on some mantra (sound) to achieve transcendental state of consciousness. image or sensation to still the mind and achieve greater awareness. to test experimentally. • Most popular form is ―transcendental meditation‖(TM) developed by Maharshi Mahesh Yogi in1958.‖ a claim that is difficult. . if not impossible.Concentration meditation • aims at single pointed focus on some sound.

attention is directed solely to a mental stimulus .Concentrative techniques • • • • Clinically standardized meditation (CSM) – a noncultic meditation technique devised by Patricia Carrington mental repetition of a sound selected from a list of sounds (or self-created) allowed to proceed at its own pace • is not systematically linked with the breath. • During CSM.

• During ROM.• Respiratory one method (ROM) • Noncultic meditation technique devised by Herbert Benson • mental repetition of the word "one" (or another preferred word or phrase) is systematically linked with each outbreath. . attention is directed both to mental and physiological stimuli.

• developing non-reactive state of mind.Mindfulness meditation • involves opening up or becoming more alert to the continuous passing stream of thoughts. images. • what was previously ―subject‖ (thoughts and feelings that make up a sense of self) now becomes the ―object‖ of awareness. triggering a shift in perspective. emotions and sensations without identifying oneself with them. .

• Vipassana and Zen meditations belong to this category. • His or her focus is on the process. rather than on the content itself. . or flow of psychic content.• Instead of narrowing the focus (concentration) practitioner becomes alert to the entire field of consciousness.

• These insights facilitate a stance whereby even very difficult thoughts and feelings come to be calmly noticed. and emotions are transient. with the participant maintaining his or her attention on the present moment. and ultimately neutral. thoughts. contemplated. fluctuating. .Philosophical component • Buddhist meditations are not merely diffuse or concentrative. they are also profoundly philosophical. • with the therapist encouraging the participant to develop a detached view of phenomena (―I am not my thoughts‖) • to realize that most sensations. and • then allowed to pass on.

Modern meditations • modern group-based standardized meditations.a formalized psychoeducational intervention that helps individuals self-manage and reframe worrisome and intrusive thoughts • MBCT incorporates cognitive strategies. . • MBSR uses training in mindfulness meditation as the core of the program. • MBSR. such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).

. • DBT has helped legitimize meditation as a credible component of psychiatric treatment.Dilectical behavioral therapy • (DBT) (Marsha Linehan). • The central dialectic of DBT is between acceptance and change. is an ex of the successful integration of mindfulness meditation with psychotherapy • for the treatment of character pathology. addictions. depression. and eating disorders. accepting oneself as one is and yet working toward change at the same time.

or a desire to change them. • As in DBT. and to change their behaviors in constructive ways to improve their lives. . • to experience and accept emerging thoughts and emotions without judgment. ACT • teaches skills that are consistent with mindfulness training. evaluation. to simultaneously accept their thoughts and feelings as they are.Acceptance and Commitment Therapy. • Participants are encouraged to develop detachment from internal and external phenomena. • and to develop a neutral observational capacity.

• the participant comes to realize that urges will always pass and that new urges may always come. • In the exercise of ―urge surfing.‖ participants learn to experience urges as waves that grow gradually until they crest and subside. when they arrive. . are accepted nonjudgmentally and are dealt with in adaptive ways.Relapse prevention therapy • RPT is not a mindfulness-based treatment. but it uses mindfulness training as a strategy to cope with cravings. • These new urges.

Autogenic training. Tai chi. Hatha yoga. Lectio divina. Qigong. Raja yoga. Transcendental Meditation technique (TM). Clinically standardized meditation. Unilateral forced nostril breathing. Tae eul ju. Yogic breathing. Dialectical behavior therapy. Progressive muscle relaxation (PMR). Mantra. Kinemantra meditation (KM). Hesychasm. Sudarshan kriya yoga. Guided imagery. Pratyahara. Dhyana. Kapalabhati.Naam. Visual imagery. Yoga (any). Mindfulness-based cognitive therapy (MBCT). Relaxation response (RR). Mindfulness-based stress reduction (MBSR). Mindfulness meditation (MM). • • • • • • • • • • • • Pranayama. Centering prayer. Sound chanting. Anapana sati. Sufic practices • . Guided visualization. Silva method.List of all existing meditations • • • • • • • • • • • • • Vipassana. Creative visualization. Zen Budhhist meditation (Zazen). Kundalini yoga. Samadhi. Dharana.

• In a study comparing Kundalini (mantra-based and concentrative) or Vipassana (insight-oriented and diffuse) meditation.• The variations in style. Lazar and colleagues found that each style was associated with a different pattern of brain activity by functional MRI (fMRI) during active meditation.and longterm effects on the brain. • different practices may lead to distinct short. as well as to specific benefits. . may have significant clinical consequences.

between these two states realize the possible abilities of the mind. calm it. • a technique of 'moving meditation'. • • • • CM states: 'In a state of mental inactivity awaken the mind. when agitated. Nagendra). .Other meditations • Cyclic meditation (CM) (H. combines the practice of yoga postures with guided meditation • has its' origin in ancient Indian text. Mandukya Upanishad.R.

. the mental state is routinely somewhere between the extremes of being 'inactive' or of being 'agitated' and hence • to reach a balanced/relaxed state the most suitable technique would be one which combines 'awakening' and 'calming' practices. • The underlying idea is that.• If the mind has reached states of perfect equilibrium do not disturb it again'. for most persons.

• In CM. . • while periods of supine rest comprise 'calming practices'. • the period of practicing yoga postures constitutes the 'awakening' practices. • Combination of stimulating and calming techniques may • reduce psycho physiological arousal more than resting in a supine posture for the same duration.

Effects of Meditation: Physiological • meditation though a mental activity. 1975) . had effects on human physiology • Heart rate: slows down during quite meditation and quickens in the moments of ecstasy during meditation (Tamini.

1982. • studies indicate that the benefit disappears once practice is discontinued (Patel. 1980..• Blood pressure and hypertension: • lowers BP for the people who are normal or moderate hypertensive (Sears & Raeburn. Wallace et al. . 1983). 1976). Swami Karmananda Saraswati.

carbon dioxide elimination is reduced (sometime up to 50%) and respiration rate is lessened • Skin resistance • Low skin resistance (measured in terms of galvanic skin response) is a good indicator of stress. • high skin resistance has been documented by many researchers especially among TM practitioners .• Metabolism and respiration • Oxygen consumption is reduced (sometime up to 50%).

CORTICAL ACTIVITY: EEG • alpha activity (8-12Hz) increases significantly • Indicating deep relaxed state of mind • Long term meditation practitioners also exhibit theta brain wave activity (5-7Hz) during which • they report peaceful and pleasant experience with intact self awareness • During QiGong (a Chinese meditation exercise) predominant EEG activity was witnessed in the anterior half of the brain while it silently occurred in the posterior half (considered the cerebral ying and yang) • .

• Studies show theta. alpha. and gamma activation • along with increased EEG coherence involving • predominantly the anterior cingulate and frontal lobes in experienced meditators .

Lou et al. brain stem and cerebellum. . also anterior cingulate. striatum.(1999) found a decreased flow in the executive system of the brain.e. thalamus. using H2O-PET. dorsolateral prefrontal. orbital frontal cortices. • During yoga nidra.Neural activity • Neural activity (inc fMRI signal) evolve during meditation and is dynamic. i..

• which then shifts towards the right hemisphere.HEMISPHERIC PREDOMINENCE • Research also indicates that during meditation right brain activity increases (Pagano & Frumkin. • Delmonte (1984b) reported that • meditation practice may begin with left-hemisphere activity. 1977). • while in advanced meditation both left.and righthemisphere activity are largely inhibited or suspended. .

HIGHER CORTICAL FUNCTIONS
• Schwartz & Goleman (1975,76) pointed that • meditation lead to • heightened cortical arousability and simultaneous • decreased limbic arousability, which lead to • heightened perception and • reduction of emotional activity.

• With long-term, consistent meditation, these changes are no longer circumscribed to the active meditative state and generalize to normal activity • Research performed on the monks of Dharamsala, proved that their prefrontal lobes (responsible for positive emotions) is lit even when not meditating (Davidson et al., 2003).

NEURAL PLASTICITY
• Young and colleagues have hypothesized that • the hypometabolic state, consciously induced during TMstyle meditation, • serves an hibernation-like role that allows for successful adaptation and plasticity in the midst of environmental change and stress. • Long-term practitioners of insight meditation had significantly greater cortical thickness in areas associated with interoception, attention, and sensory processing, including the PFC and right anterior insula

BLOOD FLOW
• TM has also been found to be associated with increased cerebral perfusion to the frontal and occipital regions during active meditation

NEUROTRANSMITTERS
• The dopaminergic system seems to play an important role in the suppression of executive system during relaxation meditation. • found GABA levels in the brain increase significantly after a 60-minute yoga session. • Potential increase in GABA - possible mechanism explaining the benefit that TM and yoga on certain disorders associated with low GABA, such as depression, anxiety, and epilepsy

• potentially enhancing brain-derived neurotrophic factor (BDNF) function .NEUROENDOCRINE RESPONSE • Long-term (duration of four months or greater) TM has been shown to result in decreased cortisol levels. • as well as a heightened cortisol response to acute stress—which has been interpreted to suggest that TM can protect against the impact of chronic stress.

• While a relative excitement is continuously present in the brains of non-enlightened subjects. integration and coherence in enlightened people. even while engaged in dynamic outer activity . • This exactly matches with their subjectively felt and narrated experience of persistent immovable inner calmness. • the enlightened people maintain a low level of excitation until s/he confronts the very moment when it is appropriate to make a decision.FINAL OUTCOME • Unique style of brain functioning with increased orderliness.

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structuring one‘s life around a disciplined practice. there are also the • acts of sitting still (or abstaining from movement). • and allying oneself with a social system that provides the meaning and values • that the practitioner uses to conceptualize his or her experience .Effects of meditation: Psychological • Apart from the act of attending to the present moment.

1983).Heightened perceptual receptivity • normal to paranormal perceptual and cognitive abilities • • • • • • • • Perceptual ability significant improvement in visual sensitivity (Brown 1984) increased auditory acuity (McEvoy et al. 1978). increased reaction time (Robertson. 1973). 1983). reduction of perceptual noise (Walsh.1980) increased visual imagery abilities (Heil. and enhanced perceptual motor speed (Jedrczak 1986) . enhanced attentive ability (Linden.

in which the observing self comes to experience its true nature devoid of the contents of awareness • This action is called disidentification. because the empty self is disidentified with the contents of awareness .The act of attending • The act of attending to this moment in meditation separates the observer from the contents of awareness • results in 2 fundamental primary consequences • an increased perceptual receptivity and the segregation of awareness from the contents of awareness • induces a therapeutic split in the ego.

• The act of attending prevents habituation and increases cognitive flexibility • experience of seeing things differently than before • a type of regression to a pre-verbal state of consciousness in which primary-process cognition predominates • ―regression in the service of ego.‖.stimulated by the psychoanalytic process .

• regardless of how distasteful the contents of awareness. • it should be acceptant and caring.• The quality of attention given to one‘s experience is crucial. patients provide a therapeutic service to themselves . • In this way.

• meditators do notice that attending to experience stimulates observing ego functions of thinking about our experience.‖ • This is the level of thinking at which psychological insight takes place. . • This is called ―meta-cognition.

• Enhanced awareness of feelings includes awareness of pain. rage. which were previously hidden from awareness. this process promotes healing by enabling mourning. abreaction. emptiness. . and coping. • But to do so is to replace neurotic suffering with legitimate suffering as the practitioner encounters feelings of fear. • Although painful. Here the act of focusing attention on suffering is counter-reflexive and requires conscious effort.

• Prolonged practice of meditation when one can sit and observe the world without any thinking for an extended period of time. • This state of consciousness can be called ―pure awareness‖ or ―empty mind.Empty awareness.‖ because it has no cognitive content. .

and • is filled with content namely the secondary reactions to. our immediate sensory/affective/ cognitive experience. . • therapeutic split of awareness from ego. which is that complex of functions constituting metacognition or reflexive awareness. is to be distinguished from the • observing ego of traditional psychoanalytic thought. • contribute to psychological healing & • promote a restructuring of the superego.• The observing self. and elaborations of. which is content-less.

• As the ability to concentrate improves. • Concentration allows the person in pain to continue to attend to that pain and thus nurture a developing ability to bear what is painful.Enhanced concentration • Meditation is a practice of concentration. especially when fatigued or in pain. patients may become more productive at tasks that require concentration. .

or herself from responding to any impulse for the period of meditation unless there is a risk of physical damage.The act of abstinence. • Sitting still. or the delinking of action from impulse. can actually be thought of as a behavioral technique. has profound implications for healing. or abstaining from movement. . • The meditator inhibits him. • Response prevention.

• When sitting motionless is associated with anxiety. delinking maintains an in-vivo exposure and enables desensitization so that relaxation can occur. tension. • The association of quiescence with discomfort causes autonomic desensitization and blunting of the sympathetic response to stress . or restlessness.

• This may nurture compassion for both self and others because of an enhanced ability to attend to both one‘s own as well as others‘ suffering. with suffering patients when little else can be done . • As psychiatrists. this capacity to attend allows us to just sit. with presence and compassion.

• practicing abstinence enhances appropriate spontaneity • spontaneity is distinguishable from impulsivity by the quality of attentive awareness with which it is endowed .

and increased commitment to one‘s own self care. regularization of one‘s lifestyle.The act of routine practice • Practicing meditation routinely has three immediate consequences: • increased discipline. • Meditation is a practice of psychological weightlifting .

intelligence. school grades. learning ability. 1991).. short and long term memory (Cranson et al.Memory and intelligence • higher performance on nonverbal intelligence test • improvements in cognitive abilities. .

• Self actualization is thought to be the major goal of dedicated meditation practitioner. and resilient sense of self. • effect size of TM on self actualization is approximately three times larger than other forms of meditation and relaxation practices . • Measured through affective maturity. integrative perspective on the self and world.Creativity and self actualization • Mixed results have been reported regarding creativity and meditation.

Mechanisms for the therapeutic effects of Meditation • Helminiak (1981) described six possible mechanisms through which meditation works. .

include-decrease in the BMR.(1) Relaxation: • induce a pleasant and deep relaxed state of body & mind • Herbert Benson (1976) developed a therapeutic technique called ―relaxation response‖ a form of meditation to reduce stress & HTN by inducing a state of deep relaxation. slow and rhythmic breathing. muscle relaxation. . • He measured series of physiological parameters in response to relaxation response. decrease in HR. decrease in BP. • All this effects help in balancing physiological abnormalities and promotes healing. and so on.

instrumental in reducing anxiety. in a deep relaxed state client confronts (either by imagination or by presentation of actual stimuli) each of the anxiety producing stimuli progressing in hierarchy. Client is thought to induce deep state of muscle relaxation. Finally.(2) Systematic desensitization • • • • • Joseph Wolpe‘s BT . • This therapy is based on the principle of reciprocal inhibition. the stimuli loose their anxiety provoking quality. Hierarchical list of stimuli inducing anxiety is prepared . Since anxiety and relaxation are incompatible to each other. . This therapy involves 3 steps.

. • When one confronts them in a deeply relaxed state. thoughts. • As a result. the practitioner first enters in deep relaxation and suspends conscious thoughts by either detached observation or concentration. these factors loose their power to induce anxiety and finally get eliminated. and feelings arise in the mind. • Every meditation involves induction of a relaxed state. many anxiety provoking repressed memories.• In meditation also a practitioner undergoes similar steps. • In meditation.

the practitioner remains under low arousal and sensory deprivation for a long time and under such condition repressed feelings and thoughts arises (Benson. • This could be initially disturbing. but with constant practice unconscious mind gets cleaned of such memories and healthy mind is achieved. 1976).(3) Release of repressed psychic material: • With regular practice of meditation. • This is very similar to the release of unconscious phenomenon during free association in psychoanalysis. release of repressed unconscious thoughts. and images. emotions. • During meditation. .

weeping. jerking. tics. • This could be involuntary muscular-skeletal movements such as repeated twitches. spasms. internal pressures.(4) Unstressing • Parallel to release of repressed memories. shaking. gasps. pains. headaches. . tingling. swaying. • Goleman (1971) interprets this phenomenon on the basis of psycho-physiological principle contemplating that all psychic and emotional phenomena have parallel physiological processes. aches. TM practitioner calls this as “unstressing”. many practitioner reports many physical reactions during intense meditation. and laughter. • The experience covers the range from extreme pleasure to acute distress .

• With detached observation. feeling. • Most of the unhealthy habitual patterns are due to our identification with emotions that we are not able to control and regulate. . • Many of these patterns are unhealthy and cause neurotic and psychotic problems.(5) Dissolution of habitual patterns of perception • Human beings are mostly governed by rigid and fixed patterns of thinking. emotions and thoughts loose their power and practitioner is able to identify the unhealthy patterns of behavior and replace them with healthy ones. and reactions.

• As a result. . and moksha. • highest goal achieved by meditation in esoteric traditions where a person transcends his personal ego. a tremendous sense of love and compassion arises in him and highest state a human can achieve. • Many terms represent cosmic consciousness .(6) Cosmic consciousness • Attainment of cosmic consciousness is a mystical concept and not available for scientific investigation. satori.samadhi. • In the state of cosmic consciousness a person realizes that he/ she is one with the whole cosmos and is not separate from others. nirvana.

Meditation and health • meditation have been used as health-enhancing techniques for centuries. allopathic medical approaches . • Their use has been investigated more recently in the context of more conventional.

promoting abstinence from drugs of Abuse. and promoting cardiovascular health. • Long-term meditation may have a role. too. managing the stress of chronic illness. . and • reducing the self-injurious behaviors of personality disordered patients. improving anxiety. in slowing and perhaps stopping cortical atrophy and cognitive decline .• The medical benefits of meditation include improving hypertension. • meditation‘s possible benefits may include • ameliorating depression.

angina pectoris • Decreased stress and hypertension have been related to decreased autonomic arousal or reactivity .Cardiovascular health • decreased blood pressure in both pharmacologically treated and untreated hypertensive patients and reduction in premature ventricular contractions in patients with stable ischaemic heart disease. • It has been used in the treatment of coronary artery disease.

psoriasis. . diabetes. fibromyalgia …etc are other conditions with mixed results.• Dyslipidemia.

. and substance abuse. and/or tertiary prevention strategy • Meditation has been studied in populations with fibromyalgia. cardiovascular diseases. chronic pain. hypertension. cancer.MEDITATION AND CHRONIC ILLNESS • Meditation practice can positively influence the experience of chronic illness and can serve as a primary. secondary. and psoriasis • evidence regarding the efficacy and effectiveness of meditation practices for the three most studied conditions in the scientific literature: hypertension.

in some cases. or access to the deep regions of the personal unconscious. and effective in.Meditation and psychiatry • Meditation may. promoting the aims of psychotherapy— • for example. • A framework for the integration of meditation and psychotherapy is presented through a consideration of the psychobiological nature of meditation (the relaxation response) and • discussion of a traditional meditation practice (mindfulness meditation) as an effective cognitive technique for the development of self-awareness. be compatible with. cognitive and behavioral change. .

by which meditation may preserve cognition and reduce age-related allostatic stress and neuronal loss.• • • • • • positive emotions. plasticity. and learning. and enhanced immune functioning. thereby promoting brain longevity. . reduced oxidative damage.

enhancing their interactions with patients .• MBCT has been found effective in reducing relapse in patients with major depression • MBCT may be an acceptable and potentially effective treatment for reducing anxiety and mood symptoms and increasing awareness of everyday experiences in patients with GAD • MBSR is also therapeutic for healthcare providers.

.Meditation and sleep • sleep can be improved by mindfulness-based stress reduction (MBSR). • Meditation also provide a longer term reduction in sleep need • roughly equal to the time spent in meditation.

• Engler notes that people with narcissistic or borderline character structures • may attempt to use meditation to make themselves ―pure‖ or • to recast feelings of emptiness and fragmentation as the ―voidness‖ or ―selflessness‖ of enlightenment. .

Shapiro et al. depression.. burnout. in turn. • Self-compassion. 2005.• Metta practices have been shown to increase selfcompassion (Shapiro et al.. 2007). and anxiety as well as increases in life satisfaction . • including reductions in perceived stress. has been associated with a variety of desirable endpoints.

• In addition to MBSR. developed specifically for substance abusing populations. Dialectical Behavior Therapy (DBT).Based Relapse Prevention (MBRP) and Mindfulness-Based Therapeutic Community (MBTC) treatment .Meditation and addiction • MBSR is now used as an adjunctive treatment in the treatment of addiction. • Recent modifications of these approaches. . include Mindfulness. used in a context of addictive disorders. mindfulness-based interventions. include • Mindfulness-Based Cognitive Therapy (MBCT). Acceptance and Commitment Therapy (ACT).

is encouraged in the highly spiritual. 12-step programs.• Informal. • the eleventh step involves engaging in prayer or meditation regularly. . nonspecific meditation. for example.

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• (i) a rajasic – active (personality) mind would be restless all through the session and • (ii) a tamasic – a mind with inertia could fall asleep • Can be overcome by CM .Hinders during starting meditation • novïce attempts to meditate directly. there could be two responses based on the quality of the mind viz..

and self-destructive behaviors . Western psychotherapists are culturally unfamiliar with the various meditative traditions. • But useful for patients with neuroses and mild to moderately severe character disorders who are plagued by defensiveness. lack of self awareness. it was a technique not for the neurotic. or character-disordered person. • As such.Limitatons for meditation practice • First. which have been uprooted from their ancient Asian culture. psychotic. vulnerability to intense and painful affects.

• meditation is a safe and well-tolerated practice . • meditation can cause depersonalization and derealization • Like a drug. it can precipitate psychosis or release a debilitating flood of painful affect in some seriously disturbed individuals.• meditation can actually be harmful. meditation must be prescribed with careful attention to the psychological status of the patient. • it can exacerbate obsessive and schizoid traits.

Prescription • To whom. in what form. in what dose. and for how long? • sufficient motivation to resolve their difficulties and work through their ambivalence about changing to practice meditation. for what symptom. . • The therapist‘s experience and understanding are important here. • The therapist must be able to present meditation with clear instructions and with a sensible explanation of the effects.

• Complications or difficulties have to be noted and corrected. impatience. and • doubt or frustration at not being able to ―do it right .Monitoring • Part of the intelligent use of meditation as a psychotherapeutic tool is the monitoring of its effects on the patient. such as • dealing with negative feelings about the practice or • restlessness during practice.

with 49 percent being RCTs or NRCTs.Research in meditation • The majority of studies on meditation practices identified in this review have been conducted in Western countries and published as journal articles within the past 15 years. . • The majority of research in meditation practices has been conducted as intervention studies (67 percent).

detection bias. and attrition bias. • systematic error such as selection bias.Limitations in research • methodological quality of meditation research to be poor. • Intervention studies that used designs with pre-post treatment comparisons within the same group (or uncontrolled trials) are not as rigorous as designs that use between-group comparisons because they do not allow investigators to determine whether the results are due to the meditation practice or to other factors. • Observational studies -33 percent of all the studies. .

found the quality of reporting to be poor . however.• Studies with stronger designs such as RCTs and NRCTs allow a greater sense of confidence in study results.

Future work • More sophisticated studies are needed • to define sample populations more thoroughly. and • then use appropriate control groups. • adequately isolate the independent variable (the act of meditating) for scrutiny. .

character change.SUMMARY • as a practice that self-regulates the mind and body by engaging a certain attentional set. • wakeful hypometabolic state of parasympathetic dominance and sympathetic attenuation • meditation may promote the diminishment of psychiatric illness. . and the resolution of neurosis when used adjunctively with psychotherapy • Investigators have yet to fully identify. the benefits that are attributable specifically to the act of meditating. with controlled studies.

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