Category: Research

Do You Really Know Yourself?

Do You Really Know Yourself?

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The words ‘know thyself’ appear frequently in the work of the Greek philosopher Plato and have been used by writers and philosophers for thousands of years. But what does it mean to know oneself, why is it important, and how can a person acquire such knowledge?

We suspect that some people would be uncomfortable, or even offended, by the suggestion that they don’t know themselves. We spend 24 hours a day in our own company and while it can sometimes be difficult to interpret other people’s thoughts, emotions, and behaviours, we can’t use this excuse when it comes to ourselves. We have direct access to our inner psychological world and in theory, we are in an ideal position to cultivate an in-depth understanding of who we are.

However, the truth is that many people are not aware of the events unfolding in their mind. At any one moment, a vast number of psychological processes are happening inside them, but at best, they are only partially aware of a small number of these. Consequently, their behaviours are the automated product of a complex – and sometimes competing – assortment of impulses, thoughts, emotions, perceptions, and memories. Rather than consciously allowing these psychological processes to influence their choices, they are effectively ‘processed’ by them. Instead of collaborating with the mind and using it as a tool, they find themselves ‘lived’ by the mind.

Changing this habit is easier said than done but there are some remits of human endeavour that may be able to assist us. In particular, we can look to modern science in order to gain insight into how we can develop a better understanding of ourselves. In order to acquire knowledge about a given phenomenon, scientists engage in the process of observation. This observation takes on many forms. It can involve observing phenomena in their natural state or it can involve observing how phenomena behave under a given set of experimental conditions. However, either way, careful observation is a crucial part of scientific enquiry and if we adopt the same principle in order to gain insight into ourselves, it is likely that our journey of ‘inner scientific enquiry’ will bear fruit.

By stepping back and observing our inner psychological world, a number of ‘truths’ about ourselves become apparent. Firstly, given that it is possible – particularly when using meditation – to observe our thoughts, feelings, and impulses, we must conclude that we are something more than these psychological processes. Secondly, we must also conclude that there exists a part of us that can ‘consciously observe’ our own mind. As we continue to engage in the process of inner observation, this ‘conscious observer’ part of us steadily grows, such that it becomes easier to maintain concentration and observe ourselves for longer periods of time.

A third truth that we may come to understand about ourselves is that the closer we observe, the harder it becomes to establish exactly who and what we are. The reason for this is that we don’t exist as standalone or isolated entities. We exist in reliance upon all other phenomena in the universe. We breathe in the out-breath of every other living being. When we drink a glass of water, we are effectively drinking rivers, clouds, and oceans. Our visit to the bathroom produces food for the plants and trees. Being embraced by a loved one can change a bad day into a good one, and a single heartfelt smile can completely change another person’s life.

In order to truly know ourselves, we have to fundamentally change our ideas of who we think we are and of how we think we exist. In effect, in order to find ourselves, we have to let go of ourselves.  When we stop thinking in terms of ‘me’, ‘mine’, and ‘I’, we start to see the world differently. We start to experience that the boundaries between ourselves and other phenomena become blurred. It becomes difficult to determine where the ‘self’ ends and ‘other’ begins. We adopt a much looser definition of ‘self’ yet somewhat paradoxically, we start to understand more about who and what we are.

Letting go of self really means that we are embracing the universe. The universe has existed for billions of years and it contains lots of knowledge. It contains the knowledge of creation, existence, and dissolution. We are an indispensable part of the universe and it relies upon us just as much as we rely upon it. By exploring the inner universe of our mind, we can weaken – or even remove completely – the boundary that we think exists between our inner psychological world and the external physical world. In other words, our practice of inner scientific enquiry and observation can, in time, cause our inner and outer worlds to collide. When this happens, we find ourselves flooded with the knowledge of the universe and the universe becomes flooded with the knowledge of our mind.

Ven Dr Edo Shonin & Ven William Van Gordon

The Four Types of Psychologist: Ineffective, Satisfactory, Gifted and Gone Beyond

Note: The following post was written with Professor Mark Griffiths and has recently been published on PsychCentral. The full reference is: Van Gordon, W., Shonin., E., & Griffiths, MD. The Four Types of Psychologist: Ineffective, Satisfactory, Gifted, and Gone Beyond. Psych Central. Available at: http://pro.psychcentral.com/the-four-types-of-psychologist-ineffective-satisfactory-gifted-and-gone-beyond/0016491.html 

The Four Types of Psychologist: Ineffective, Satisfactory, Gifted and Gone Beyond

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Most introductory books on psychology inform readers that there are many different types of psychologist such as clinical psychologists, forensic psychologists, developmental psychologists, social psychologists, cognitive psychologist, health psychologists, occupational psychologists, sports psychologists, counselling psychologists, neuropsychologists and research psychologists. Clearly there are many other types of psychologist in addition to the list above, and there are also numerous sub-types of psychologist that specialise in a specific area within one of the aforementioned domains.

In this article, we deviate from the traditional model of categorising psychologists according to work setting and/or study perspective, and suggest a new schema that focusses on the underlying qualities and competencies of the psychologist. Our approach is not intended to supplant the aforementioned traditional categorisations. Rather, it is solely intended as ‘food for thought’ by suggesting a method of categorisation that emphasises the core skills and values that are common to the job description of all psychologists (i.e., irrespective of whether they work in clinical, occupational, or developmental settings, or adhere to a specific psychological perspective, etc.). Consequently, we have based our schema on the assumption that regardless of the particular setting or perspective in which a psychologist specialises, there is an expectation that all psychologists – at least to a small degree –  have an understanding of the scientific workings of the human mind and behaviour that exceeds that of the average lay person. Our method of categorisation is also founded on the assumption that, based on this greater degree of insight into the mind, all psychologists have a duty to guide others toward a better understanding of their own minds and behaviour, and where appropriate, toward improved levels of psychological wellbeing. Our ‘food for thought’ model comprises four categories of psychologist.

1. Ineffective Psychologists: The first class of psychologist are those that actually do more harm than good. There are various reasons why a psychologist might fall into this category, but in general it is due to shortfalls in either their attitude and/or ability. Therefore, it is possible that a psychologist in this category may sincerely wish to help a person, but they happen to be ineffective in this respect (i.e., they have the right attitude but lack the ability). Alternatively, a psychologist belonging to this category might be capable of treating people in a manner that helps them to grow as human beings, but they are uninterested in doing so (i.e., they have the necessary ability but the wrong attitude). One explanation of why a psychologist might have the required ability but inappropriate attitude is because the primary purpose for them performing their role is to accrue wealth or reputation.

2. Satisfactory Psychologists: Unlike the first class of psychologist, the second class of psychologist do more good than harm. However, although they create and spread more positivity than negativity, they are not what one might call ‘natural’ in the manner in which they embody and perform the role of a psychologist. In general, when this category of psychologist takes it upon themselves to better the psychological wellbeing of another human being, they are relying heavily on the various theories, models and practice guidelines that they have studied and trained in. These theories and practice techniques are normally evidence-based, and as such, they are generally of assistance to the other person. However, the fact that this second type of psychologist is heavily reliant upon processes and theories, means that there will always be a degree of disconnect between them and the individual they are interacting with. To a certain extent, this disconnect can be useful because it forms a protective barrier that the psychologist can work behind. However, it can also create an obstacle that prevents the ‘core’ of the psychologist’s being connecting and communicating with the ‘core’ of the other person’s being.

Put simply, it is rare for this type of psychologist that a meaningful ‘human-to-human’ interaction takes place, and as such, the person they are attempting to help invariably feels that they are the subject of a process or service. Consequently, an individual in the hands of this category of psychologist is unlikely to feel truly nourished or renewed. In summary, satisfactory psychologists do not embody and live the practice of psychology, and they are invariably unskilled at drawing upon and integrating their life experience into their work.

3. Gifted Psychologists: Individuals belonging to the third class of psychologist are much more natural at performing their role compared with those in the satisfactory category. In fact, one could probably go as far as to say that an individual belonging to this category of psychologist is ‘gifted’. They have an in-depth knowledge of all of the relevant psychological theories and techniques, but they understand that these models and processes are only tools. In fact, more often than not, this category of psychologist develops their own models and psychological techniques and they use these in their work and interactions with others. However, when they interact with other people, it is not entirely accurate to state that they are applying a theory or model. Rather, they are directly connecting with the individual on the ‘human-to-human’ level and they allow their intuition and instinct to guide how the dialogue and relationship evolves. The way in which they do this is still aligned with proven methods and practices, but they are not constrained by these methods and are spontaneous in the manner in which they help others.

Gifted psychologists have an in-depth understanding of their own mind, and as such, they understand well the mind and behaviours of others. When a patient, client, or another individual meets with a psychologist of this category, they immediately feel reassured due to knowing that they are in capable hands. This type of psychologist is confident, positive and energetic, and they inspire and invigorate people. They take the responsibility of being a psychologist and human being seriously and they are, by all accounts, impressive members of society.

4. Psychologists that have Gone Beyond: The fourth type of psychologist is an individual that has transcended all conventional criteria for evaluating the competency of a psychologist. Consequently, accurately determining whether a psychologist falls into this category requires skill, and it is easy to misinterpret their behaviour as evidence of them meeting the inclusion criteria for one of the three aforementioned outlined classifications. The rules that govern the decisions and strategies employed by ineffective, satisfactory, and gifted psychologists no longer apply here. Psychologists that have Gone Beyond are individuals that have studied and investigated their own mind and behaviour to such an extent, they are no longer limited by it. They understand fully that, much like a spider’s web that spreads out in multiple directions, they are deeply connected to all other life forms and phenomena in the universe. Their insight and wide-ranging perspective means that they have a much more expansive selection of tools, techniques, and materials at their disposition. Psychologists that have Gone Beyond know and make full use of the fact that each of their thoughts, words and actions will reverberate throughout space and time, and will eventually come to touch all other beings. In this manner, they understand that they are a sculptor, and they use the world and its inhabitants as their raw material.

Psychologists that have Gone Beyond are truly remarkable beings – everyone they meet becomes their ‘client’, but in the majority of instances, individuals are unaware of the fact they are being helped. Irrespective of who a psychologist of this category meets or interacts with (e.g., a supermarket cashier, neighbour, work colleague, partner, or even a person wishing them harm), they provide the individual with exactly what they need in order to help them evolve as a human being. Except for a small number of individuals that also want to become Psychologists that have Gone Beyond (and who are searching for a suitable mentor), the work of psychologists belonging to this category often goes unnoticed. However, they are not in any way demotivated by this and in the majority of instances, maintaining a low profile allows them to perform their role more effectively.

Ven Dr Edo Shonin and Ven William Van Gordon

When Does Mindfulness Become Addictive?

When Does Mindfulness Become Addictive?

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Mindfulness is growing in popularity and is increasingly being used by healthcare professionals for treating mental health problems. There has also been a gradual uptake of mindfulness by a range of organisations including schools, universities, large corporations, and the armed forces. However, the rate at which mindfulness has been assimilated by Western society has – in our opinion – meant that there has been a lack of research exploring the circumstances where mindfulness may actually cause a person harm. An example of a potentially harmful consequence of mindfulness that we have identified in our own research is that of a person developing an addiction to mindfulness.

Being addicted to mindfulness would constitute a form of behavioural addiction (i.e., as opposed to chemical addiction). Examples of better known forms of behavioural addiction are gambling disorder, internet gaming disorder, problematic internet use, sex addiction, and workaholism. According to a model of addiction formulated by our research colleague Dr Mark Griffiths (a Professor of behavioural addiction), a person suffers from a behavioural addiction when in respect of the behaviour in question, they satisfy the following six criteria:

  1. Salience: Mindfulness has become the single most important activity in their life.
  2. Mood Modification: Practising mindfulness in order to alleviate emotional stress or to engender euphoric or high states.
  3. Tolerance: Practising mindfulness for longer durations in order to derive the same mood-modifying effects.
  4. Withdrawal: Experiencing emotional and physical distress (e.g., painful bodily sensations) when not practising mindfulness.
  5. Conflict: The individual’s routine of mindfulness practice causes (i) interpersonal conflict with family members and friends, (ii) conflict with activities such as work, socialising, and exercising, and (iii) psychological and emotional conflict (also known as intra-psychic conflict).
  6. Relapse: Reverting to earlier patterns of excessive mindfulness practice following periods of control.

In modern society, the word ‘addiction’ has negative connotations but it should be remembered that an addiction can be both positive and negative. For example, in separate clinical case studies that we conducted with individuals suffering from pathological gambling, sex addiction, and workaholism, it was observed that the participants substituted their addiction to gambling, work, or sex for an addiction to mindfulness. In the beginning phases of psychotherapy, this process of addiction substitution represented a move forward in terms of the individual’s therapeutic recovery. However, as the therapy progressed and the individual’s dependency on gambling, work, or sex began to weaken, their addiction to mindfulness was restricting their personal and spiritual growth, and was starting to cause conflict in other areas of their life. Therefore, it became necessary to help them change the way they practiced and related to mindfulness.

Mindfulness is a technique or behaviour that an individual can choose to practice. However, the idea is that the individual doesn’t separate mindfulness from the rest of their lives. If an individual sees mindfulness as a practice or something that they need to do in order to find calm and escape from their problems, there is a risk that they will become addicted to it. It is for this reason that we always exercise caution before recommending that people follow a strict daily routine of mindfulness practice. In fact, in the mindfulness intervention that we developed called Meditation Awareness Training, we don’t encourage participants to practice at set times of day or to adhere to a rigid routine. Rather, we guide participants to follow a dynamic routine of mindfulness practice that is flexible and that can be adapted according to the demands of daily living. For example, if a baby decides to wake up earlier than usual one morning, the mother can’t tell it to wait and be quiet because it’s interfering with her time for practising mindfulness meditation. Rather, she has to tend to the baby and find another time to sit in meditation. Or better still, she can tend to the baby with love and awareness, and turn the encounter with her child into a form of mindfulness practice. We live in a very uncertain world and so it is valuable if we can learn to be accommodating and work mindfully with situations as they unfold around us.

One of the components of Professor Griffiths’ model of addiction is ‘salience’ or importance. In general, if an individual prioritises a behaviour (such as gambling) or substance (such as cannabis) above all other aspects of their life, then it’s probably fair to say that their perspective on life is misguided and that they are in need of help and support. However, as far as mindfulness is concerned, we would argue that it’s good if it becomes the most important thing in a person’s life. Human beings don’t live very long and there can be no guarantee that a person will survive the next week, let alone the next year. Therefore, it’s our view that it is a wise move to dedicate oneself to some form of authentic spiritual practice. However, there is a big difference between understanding the importance of mindfulness and correctly assimilating it into one’s life, and becoming dependent on it.

If a person becomes dependent on mindfulness, it means that it has remained external to their being. It means that they don’t live and breathe mindfulness, and that they see it as a method of coping with (or even avoiding) the rest of their life. Under these circumstances, it’s easy to see how a person can develop an addiction to mindfulness, and how they can become irritable with both themselves and others when they don’t receive their normal fix of mindfulness on a given day.

Mindfulness is a relatively simple practice but it’s also very subtle. It takes a highly skilled and experienced meditation teacher to correctly and safely instruct people in how to practise mindfulness. It’s our view that because the rate of uptake of mindfulness in the West has been rather fast, in the future there will be more and more people who experience problems – including mental health problems such as being addicted to mindfulness – as a result of practising mindfulness. Of course, it’s not mindfulness itself that will cause their problems to arise. Rather, problems will arise because people have been taught how to practice mindfulness by instructors who are not teaching from an experiential perspective and who don’t really know what they are talking about. From personal experience, we know that mindfulness works and that it is good for a person’s physical, mental, and spiritual health. However, we also know that teaching mindfulness and meditation incorrectly can give rise to harmful consequences, including developing an addiction to mindfulness.

Ven Dr Edo Shonin and Ven William Van Gordon

Further Reading

Griffiths, M. D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

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

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: The Journal of Science and Healing, 10, 193-195.

Shonin, E., Van Gordon W., & Griffiths, M. D. (2014). Mindfulness as a treatment for behavioral addiction. Journal of Addiction Research and Therapy, 5, e122. doi: 10.4172/2155-6105.1000e122.

Shonin, E., Van Gordon W., & Griffiths, M. D. (2015). Are there risks associated with using mindfulness for the treatment of psychopathology? Clinical Practice, 11, 389-382.

Sussman, S., Lisha, N., Griffiths, M. D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professionals, 34, 3-56.

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2015). Mindfulness in mental health: A critical reflection. Journal of Psychology, Neuropsychiatric Disorders and Brain Stimulation, 1(1), 102.

Van Gordon, W., Shonin, E., & Griffiths, M. D. (2016). Meditation Awareness Training for the treatment of sex addiction: A case study. Journal of Behavioral Addiction, 5, 363-372.

Van Gordon, W., Shonin, E., & Griffiths, M. D. (2016). Ontological addiction: Classification, etiology, and treatment. Mindfulness, 7, 660-671.

Behind the Times: Viewing the Present from the Past

Behind the Times: Viewing the Present from the Past

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When astronomers estimate the distance between earth and another astronomical entity, they often talk in terms of light years. For example, the Alpha Centauri star (that actually comprises three separate stars) is the closest star to earth other than the sun and is estimated to be 4.37 light-years away. This means that if we were to view Alpha Centauri from earth, we would be looking at the star as it was some 4.37 years ago. In others words, it could be said that our view of Alpha Centauri is 4.37 years out of date.

On a much smaller scale, the exact same principle applies when we perceive objects that are much closer to us. We see an object because light from the sun (or another light source) is reflected by the object before travelling to the light-sensitive retina at the back of our eyes. As discussed in our recent post on ‘The World Through the Eyes of the Central Nervous System’, when sight receptors are stimulated, electrochemical impulses travel via a process of saltatory conduction and once received by the central nervous system, they are transformed into a coherent image that can be acted upon.

The speed of light is 299,792 kilometres per second but for the purposes of this post, we have rounded it up to 300,000 km/s. This means that if we look from the top of a mountain at a lake that is 30 kilometres away, it takes 0.00001 seconds for light from the lake to reach us. Therefore, our view of the lake is ever so slightly out of date. Likewise, if we look at a person standing just three meters in front of us, it takes approximately 0.000000001 seconds for the reflected light to reach us. In fact, it actually takes slightly longer than this because light travels slower through the earth’s atmosphere than it does through space, and it also takes a brief moment for electrochemical impulses to travel from the eyes and be processed by the brain.

In terms of how the average person goes about their daily business, we suspect that there are few (if any) implications of this observation. However, the fact of the matter is that when a person says that they are living in the present moment, this is not entirely true. They might be perceiving in the present, but what they are perceiving is the past. From this point of view, perhaps one could say that individuals following the fashionable trend of mindfulness are actually (slightly) behind the times!

 Ven Dr Edo Shonin and Ven William Van Gordon

 Further Reading

Mendelson, K. S. (2006). “The story of c”. American Journal of Physics, 74, 995-997.

Penrose, R. (2004). The Road to Reality: A Complete Guide to the Laws of the Universe. Vintage Books.

Schaefer, B. E. (1999). Severe limits on variations of the speed of light with frequency. Physical Review Letters, 82, 4964-4964.

Shonin, E., & Van Gordon, W. (2014). Dream or reality? Philosophy Now, 104, 54.

Shonin, E., & Van Gordon, W. (2013). Searching for the present moment, Mindfulness, 5, 105-107.

Torres, C. A. O., Quast, G. R., da Silva, L., de la Reza, R., Melo, C. H. F., & Sterzik, M. (2006). Search for associations containing young stars (SACY). Astronomy and Astrophysics 460(3): 695–708

Van Gordon, W., Shonin, E., & Griffiths, M. D. (2016). Buddhist emptiness theory: Implications for psychology. Psychology of Religion and Spirituality, DOI: 10.1037/rel0000079.

Wiegert, P. A., & Holman, M. J. (1997). The stability of planets in the Alpha Centauri system. The Astronomical Journal, 113, 1445-1450.

The World Through the Eyes of the Central Nervous System

The World Through the Eyes of the Central Nervous System

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An important principle of psychology is that of saltatory conduction through the nervous system. Saltatory conduction is not particularly difficult to understand and in the United Kingdom it is probably taught as part of the A-level or even GCSE curriculum. The basic idea is that when sense receptors are stimulated, electrochemical impulses travel via the peripheral nervous system to the central nervous system (CNS). The central nervous system, which comprises the brain and spinal cord, receives these electrochemical messages and transforms them into coherent information that can be acted upon.

Recently, we (along with our friend and co-author Professor Mark Griffiths) had a paper accepted for publication in the American Psychological Association Division 36 journal Psychology of Religion and Spirituality (see further reading list below) where we used saltatory conduction as one form (amongst many others) of evidence to support our claim that reality exists in a fundamentally different manner than contemporary psychological and scientific opinion might lead us to believe. The paper is entitled ‘Buddhist Emptiness Theory: Implications for Psychology’ and it should be published in the next week or so. In our paper, we state that “without exception, an individual’s sense of movement, touch, taste, pain, pleasure, sight, sound, and so forth is based upon a mental impression formulated by the CNS. In other words, the CNS transforms electrochemical information into a ‘working’ three-dimensional image or movie.” We then went on to explain that although there is the impression of living in and moving through a physical world, in truth, there is never any movement and life is experienced solely as the mental projection of the CNS.

If we accept that the principle of saltatory conduction is valid (we should accept it because it can be scientifically observed and proven), then we also have to accept that in actual fact, we have never truly touched an object, smelt a smell, seen a sight, heard a sound, or tasted a flavour. When we look at a tree, what we see is the brain’s interpretation of electrochemical signals that were transmitted by sensory receptors in the eyes. We don’t ‘directly see’ the tree and if we tried to touch it, then once again all that we would feel is the brain’s interpretation – based on input from electrochemical signals – of what it believes the tree feels like.

The implications of what we are saying here and of what we asserted in our abovementioned peer-reviewed paper are potentially far-reaching. If the evidence and logical reasoning we presented is robust, then it means that human beings experience and interact with the world exclusively at the level of the mind. In other words, we exist at the centre of the universe and both we and the universe make part of our mental projection. In fact, the notion of ‘centre’ and ‘periphery’ become null and void because if it is accepted that existence unfolds exclusively at the level of the mind, then how can we talk about near and far, centre or periphery, large or small, etc.?

Consider the analogy of a dream in which the dreamer can be under the impression that they are coming or going, experiencing pleasure or pain, are safe or are in danger. However, in truth, the dreamer doesn’t go anywhere because the dream is unfolding within the expanse of the mind. The dreamer has the impression of movement and this can be very convincing – so much so that individuals can wake up screaming if, for example, they were dreaming of falling off a cliff. But just because something is convincing doesn’t mean that our understanding of it is correct. For example, at one time scientists (and the church) were convinced that the sun revolves around the earth. However, it subsequently transpired that, as had been proposed by (the much persecuted) Galileo all along, the earth revolves around the sun.

We also discussed (this time in a more light-hearted manner) the notion of reality existing at the level of mind and in a manner similar to a dream in a paper entitled ‘Dream or Reality?’ that was published in Philosophy Now (see further reading list below). The paper features a discussion between a professor and a student who are trying to establish whether they are awake or dreaming. The key point of the paper is that there are no logical grounds for asserting that there exists a difference between the manner in which waking reality and dream reality function.

We think it is marvellous that in some basic psychological and biological processes such as saltatory conduction, there exists evidence that could help to fundamentally change scientific thought concerning the fundamental properties of the mind, matter and universe. Maybe in the future scientists will use terms such as ‘mind particles’ or ‘mind-like properties’ when referring to certain qualities of the universe or to the true mode in which everything exists.

Ven Dr Edo Shonin and Ven William Van Gordon

Further Reading

Chan, W. S. (2008). Psychological attachment, no-self and Chan Buddhist mind therapy. Contemporary Buddhism, 9, 253-264. doi: 10.1080/14639940802556586

Shonin, E., & Van Gordon, W. (2014). Dream or reality? Philosophy Now, 104, 54

Soeng, M. (1995). Heart Sutra: Ancient Buddhist Wisdom in the Light of Quantum Reality. Cumberland: Primary Point Press.

Vogel, H. (2009). Nervous System: Cambridge Illustrated Surgical Pathology. New York: Cambridge University Press.

Van Gordon, W., Shonin, E., & Griffiths, M. D. (2016). Buddhist emptiness theory: Implications for psychology. Psychology of Religion and Spirituality, DOI: 10.1037/rel0000079.

Shonin, E., & Van Gordon, W. (2015). The lineage of mindfulness. Mindfulness, 6, 141-145.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 63, 654.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591

Shonin, E., Van Gordon, W., Compare, A., Zangeneh, M., & Griffiths, M. D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161-1180.

Shonin, E., & Van Gordon, W. (2013). Searching for the present moment, Mindfulness, 5, 105-107.

Mindfulness for Treating Addiction: A Clinician’s Guide

Mindfulness for Treating Addiction: A Clinician’s Guide

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An aspect of our scientific work relating to mindfulness involves investigating its applications for treating addiction. In this respect, we have a longstanding collaboration with Dr. Mark Griffiths who is Professor of Behavioural Addiction at Nottingham Trent University (UK) and is internationally recognised for his work in this field of study. Today’s post draws upon findings from our research using Meditation Awareness Training and provides ten recommendations on the psychotherapeutic use of mindfulness in addiction treatment contexts. These recommendations are primarily intended for mental health professionals, but individuals with addiction problems may also find them of interest. Although we have principally based our recommendations on insights gained from using mindfulness and meditation for treating behavioural addictions (e.g., gambling disorder, workaholism, sex addiction), we have also consulted the literature concerning the use of mindfulness for treating chemical addictions (e.g., substance- and alcohol-use disorders). Therefore, whilst we acknowledge that there are important differences between behavioural and chemical addictions (e.g., the physical signs of drug addiction are typically absent in behavioural addiction), we envisage that the following recommendations will be applicable to both addiction categories.

  1. Undertake a Thorough Assessment: Careful evaluation of the client’s history (e.g., clinical history, social history, education history, religious history, employment history, etc.) and presenting problems will come high on the list of any competent mental health clinician. However, we have chosen to include ‘thorough assessment’ as one of our specific recommendations because there appears to be a belief amongst a minority of mental health professionals that mindfulness is a one-stop cure for all mental health issues. As discussed in one of our peer-reviewed papers that was recently published in the British Medical Journal, the only psychopathologies for which the empirical evidence is robust enough to support the wide scale utilisation of mindfulness are specific forms of depression and anxiety. In other words, mindfulness is not a suitable treatment for every individual presenting for treatment. For example, we recommend that clinicians exercise additional caution (including taking into account their own experience with using mindfulness) before introducing mindfulness to clients whose addiction problem occurs in conjunction with psychotic features.
  2. Build Strong Meditative Foundations: Mindfulness is a practice to develop throughout one’s lifetime. It is a marathon and not a sprint. If an individual is to derive lasting benefit from mindfulness, it is essential that they establish strong meditative foundations. If we want to become aware of the subtle aspects of mind, we first need to become aware of the gross aspects of mind. And before we can do that, we need a method of calming, collecting and focussing the mind. This is why breath awareness is a vital feature of meditative development. Using the breath as a concentration anchor provides the client with a reference point – a place of safety to which they can return whenever their mind starts to run away with itself. The mental cravings that underlie addiction can be powerful and consuming, and without strong meditative foundations, it is unlikely that the client will be able to regulate these cravings as well as the withdrawal symptoms that they are likely to encounter during later treatment phases. Another important foundation of mindfulness is awareness of the body. At the early stages of treatment, clients should be taught how to sit with awareness, eat with awareness, walk with awareness and talk with awareness. Clients should be encouraged to adopt mindfulness as a way of life and not just a technique to apply when they are feeling low or susceptible to addiction-related urges.
  3. Make use of Psycho-education: In addiction treatment contexts, we suggest that psycho-education should be utilised at the early stages of treatment and should focus on two key areas: (i) educating clients in the science concerning the aetiology and symptom course of their particular addiction, and (ii) explaining the principles of mindfulness and a meditation-based recovery model. For a comprehensive and insightful academic resource that clinicians can draw upon in this respect, we recommend the chapter on mindfulness and addiction by Dr. Sean Dae Houlihan and Dr. Judson Brewer that features in our recent edited Springer volume on ‘Mindfulness and Buddhist-Derived Approaches in Mental Health and Addiction’ (see further reading list below).
  4. Teach ‘Urge Surfing’: The term ‘urge surfing’ has been used in the scientific literature to refer to the process of mindfully observing the mental urges associated with addiction. The idea is that the client, having established themselves in awareness of breathing, takes craving as the object of meditation. They follow their breath and observe how craving dominates their cognitive-affective processes. The process of observing mental craving helps to objectify it and creates ‘mental space’ whereby instead of feeding the craving (i.e., by emotionally and conceptually adding to it), craving is allowed to exist ‘as it is’. It may appear as though urge surfing is concerned with controlling craving, but that’s not the case. Rather, the technique involves allowing craving to come and go such that it can progress through its natural cycle of birth, life and dissolution. When we teach this technique, we inform clients that if craving is manifest in the mind, that’s OK. We also inform them that if craving is not manifest, that’s OK too.
  5. Make use of Bliss Substitution: Substitution techniques are sometimes used in the treatment of both behavioural and chemical addictions. For example, studies have shown that some individuals with gambling disorder respond well to gradually substituting their gambling activity for recreational activities such as singing, learning computer skills, communication workshops, dance and music. Our own studies have shown that the substitution principle can also work well in the case of addiction treatments following a meditation-based recovery model. One of the key drivers of addiction is the mood modification (e.g., ‘feeling high’) that results from engaging with a particular substance or behaviour. Meditation may be particularly suitable as an addiction substitution technique because specific forms of meditation can induce blissful feelings. Effectively, the client learns to replace the ‘buzz’ or ‘high’ associated with a ‘negative addiction’ with the bliss and peace of meditation (i.e., a positive form of addiction). Eventually, clients should be encouraged to relinquish any dependency on meditation, but in the early stages of treating addiction, it can be a useful therapeutic technique.
  6. Employ Meditation Exposure Therapy: Exposure therapy is a method employed by various modalities of psychotherapy, and it can also be used as part of mindfulness therapy for individuals suffering from addiction. It is all very well teaching the client how to practise mindfulness from the safety of the psychotherapist’s consulting room, but at some point it is probable that they will encounter the stimuli that have previously caused strong mental urges to arise. Consequently, we encourage the psychotherapist to accompany (i.e., where it is safe and realistic to do so) the client in ‘real-world settings’ that are likely to induce relapse. For example, if the client is addicted to off-line gambling, consider accompanying them to a casino in order to demonstrate that it is possible for them to remain meditatively composed whilst surrounded by the object of their addiction. Meditation exposure therapy isn’t suitable for every client (or indeed for every mental health clinician), but where applicable, we generally recommend that it is used towards the end of the treatment course.
  7. Undermine the Value of the Addictive Object: This technique involves guiding the client to think about the ‘true nature’ of the object of their addiction. More specifically, it involves introducing the client – albeit at an elementary level – to the concepts of impermanence, interconnectedness and emptiness. Again, the clinician will have to assess on a case-by-case basis whether this technique is appropriate, but we have personally found it to be effective in addiction treatment contexts. By fostering meditative awareness of impermanence and the empty nature of all phenomena, the client can gradually begin to question and then undermine the intrinsic value that they have assigned to the object of their addition. For example, an individual suffering from sex addiction can use specific meditative techniques in order to better understand that (i) the individual components that comprise the human body are not particularly desirable in and of themselves (e.g., nails, hair, mucus, faeces, urine, pus, vomit, blood, sinew, skin, bone, teeth, flesh, sweat, etc.), (ii) the inevitable destiny of the body is that of ageing, illness and decay, and (iii) the body exists as a composite entity but does not exist intrinsically. If the client looks deeply using meditation, they can learn to see that in beauty and life, there is foulness and decay (and vice-versa). They can also learn to see that there is ‘other’ in ‘self’ and ‘self’ in ‘other’, and that when they practice kindness and respect towards themselves, they practise kindness and respect towards the entire world.
  8. Schedule Follow-up Sessions: Most of the available treatments that use mindfulness generally adhere to an eight-week treatment course. However, in the traditional Buddhist setting, a person would normally be required to engage in day-to-day mindfulness practice over a period of many years before being deemed to have gained a reasonable grounding in the practice. Consequently, it is important to schedule booster sessions and to meet with the client at regular (e.g., monthly) intervals following the initial programme of treatment. Ideally, clients should also be encouraged to make contact with mindfulness groups that are facilitated by competent teachers.
  9. Lead by Example: As discussed in a previous post where we offered guidelines on the general use of mindfulness in psychotherapy (i.e., not specific to treating addiction), it is important that the mental health clinician emanates a presence of meditative calm and awareness. This has to be natural and as indicated above, it can only arise after consistent daily practice over a period of many years. If the clinician merely ‘acts’ at being mindful, the client is likely (whether consciously or subconsciously) to pick up on this and it will inevitably act as an obstacle to recovery.
  10. Be Inspired: Mindfulness has been practised by spiritual traditions for thousands of years. When a clinician engages with the practice in a sincere manner, and when they wholeheartedly wish to help the client overcome their suffering, that clinician is bestowed with the blessings and wisdom of this ancient spiritual lineage. They become what is known in Buddhism as a Bodhisattva – a rare and beautiful being that conduct acts of kindness in order to alleviate the suffering of others. Skilled mental health professionals perform an invaluable role to society. They are inspired individuals who in turn help to inspire the clients they work with.

Ven Dr Edo Shonin and Ven William Van Gordon

 

Further Reading

Alavi, S. S., Ferdosi, M., Jannatifard, F., et al. (2012). Behavioral addiction versus substance addiction: Correspondence of psychiatric and psychological views. International Journal of Preventative Medicine, 3, 290-294.

Appel, J., & Kim-Appel, D. (2009). Mindfulness: Implications for substance abuse and addiction. International Journal of Mental Health Addiction, 7, 506-512.

Griffiths, M. D., (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Griffiths, M. D., Shonin, E., & Van Gordon, W. (2015). Mindfulness as a treatment for gambling disorder. Journal of Gambling and Commercial Gaming Research, 1, 1-6.

Houlihan, S. D., & Brewer, J. A. (2015). The emerging science of mindfulness as a treatment for addiction. In: E. Y. Shonin, W. Van Gordon and M. D. Griffiths (eds.), Mindfulness and other Buddhist-derived approaches in mental health and addiction (pp. 191-210). New York: Springer.

Iskender, M., & Akin, A. (2011). Compassion and internet addiction. Turkish Online Journal of Educational Technology, 10, 215-221.

Jackson, A. C., Francis, K. L., Byrne, G., et al. (2013). Leisure substitution and problem gambling: report of a proof of concept group intervention. International Journal of Mental Health and Addiction, 11, 64–74.

Rosenberg, K. P., Carnes, P. J., & O’Connor, S. (2014). Evaluation and treatment of sex addiction. Journal of Sex and Marital Therapy, 40, 77-91.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014). The treatment of workaholism with Meditation Awareness Training: A Case Study. Explore: The Journal of Science and Healing, 10, 193-195.

Shonn, E., Van Gordon, W., & Griffiths, M. D. (2014). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 181-196.

Shonin, E., Van Gordon W., & Griffiths, M. D. (2014). Mindfulness as a treatment for behavioral addiction. Journal of Addiction Research and Therapy, 5, e122. DOI: 10.4172/2155-6105.1000e122.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014). Mindfulness and the social media. Journal of Mass Communication and Journalism, 2014, 4: 5, DOI: 10.4172/2165-7912.1000194.

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

Shonin, E., Van Gordon W., & Griffiths, M. D. (2013). Meditation for the treatment of addictive behaviours: Sending out an SOS. Addiction Today, March, 18-19.

Shonin, E., Van Gordon, W. & Griffiths, M. D. (2013). Mindfulness-based interventions for the treatment of problem gambling. Journal of the National Council on Problem Gambling, 16, 17-18

Sussman, S., Lisha, N. & Griffiths, M. D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

Witkiewitz, K, Marlatt, G. A., & Walker, D. (2005). Mindfulness-based relapse prevention for alcohol and substance use disorders. Journal of Cognitive Psychotherapy, 19, 211-228.

Shonin, E., & Van Gordon, W. (2013). Searching for the present moment, Mindfulness, 5, 105-107.

Shonin, E., Van Gordon, W., Compare, A., Zangeneh, M., & Griffiths, M. D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161-1180.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 63, 654.

Shonin, E., & Van Gordon, W. (2015). The lineage of mindfulness. Mindfulness, 6, 141-145.

What are the Active Ingredients of Mindfulness-based Interventions?

What are the Active Ingredients of Mindfulness-based Interventions?

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Mindfulness-based interventions typically comprise numerous elements, including some or all of the following: guided mindfulness exercises, guided loving-kindness and compassion meditation exercises, group discussion, psycho-education (sometimes in the style of a university lecture), yoga, one-to-one discussion with the programme facilitator, a CD of guided meditations to encourage at-home practice, and a full or half-day silent group retreat. Given that each of the above techniques arguably have therapeutic utility in their own right, ascertaining why MBIs are effective is problematic because they have numerous ‘active ingredients’.

Not controlling for other active ingredients is a common limitation of MBI intervention studies. Indeed, although scientific evidence demonstrates that certain MBIs are equally or more effective than other treatments for improving specific health conditions, it is currently unclear whether it is mindfulness, or mindfulness in combination with other therapeutic techniques, that results in health benefits. One way to overcome this methodological limitation is to employ a purpose-designed ‘active’ control condition. This is a control intervention that mirrors the main intervention in terms of its design, but does not include any mindfulness techniques. By conducting a randomised controlled trial that compares the effectiveness of an MBI against a suitably formulated active control intervention, we can determine that superior outcomes in the MBI versus control group are caused by mindfulness.

It could be argued that it doesn’t matter whether it is specifically mindfulness or other intervention components that make MBIs effective. If we are only interested in treatment outcomes and adhere to a ‘what works’ approach to alleviating illness symptoms, then establishing which intervention components are most effective becomes less important. However, from the point of view of advancing scientific understanding of how the human mind reacts to given psychotherapeutic techniques, it is useful to establish which ingredients are most active within a given intervention. Such knowledge can also help to inform the development of more effective and ‘therapeutically streamlined’ MBIs.

When designing an active control intervention for MBI efficacy studies, in addition to matching the design of the target and control interventions (i.e., minus the inclusion of mindfulness techniques), it is also important to match the ‘competency’ of the instructor or instructors delivering the two interventions. For example, a number of meditation intervention studies employing an active control condition have used an experienced clinician and meditation teacher to deliver the MBI, whilst leaving a relatively inexperienced student to administer the control intervention. Clearly, such an approach can introduce bias and weaken the strength of the evidence from MBI studies.

In order to overcome the above methodological limitation, in a recent randomised controlled trial that we conducted, the study was designed such that the same instructor delivered the MBI and comparison intervention. To control for potential bias on the part of the instructor, participants in each intervention condition were asked to rate the instructor’s levels of enthusiasm and preparation. Statistical tests were then performed to determine if there were significant differences between how participants from the intervention and control group rated the instructor’s performance.

We decided to control for an ‘instructor effect’ because in our opinion, the mindfulness instructor is one of the most active ingredients in MBIs. Part of our research has involved the development and empirical investigation of a ‘second-generation’ of MBI. Second-generation MBIs (such as Meditation Awareness Training) are designed slightly differently compared to ‘first-generation’ MBIs (such as Mindfulness-based Stress Reduction or Mindfulness-based Cognitive Therapy). More specifically, second generation MBIs are overtly spiritual in nature and teach a greater range of meditative techniques. Given that second-generation MBIs comprise different design elements compared to first-generation MBIs, it is reasonable to assume that these two types of MBIs will result in different outcomes. However, despite the design differences between first- and second-generation MBIs, it is our view that if a mindfulness teacher with authentic spiritual realisation was to administer a first-generation MBI, the outcomes would be very similar to them administering a second-generation MBI.

In other words, if the mindfulness teacher is genuinely rooted in the present moment, the specific design of the MBI becomes less important. As we discussed in our post on The Four Types of Psychologist, we would argue that the same principle applies to the majority of psychological therapies. If the clinician knows their own mind, has genuine compassion for the client, and is skilled in helping the client understand their problems, then the choice of therapy becomes less important.

Although preliminary findings (including from some of our own clinical case studies and qualitative studies) support the notion that the mindfulness teacher is one of the (if not the) most important ingredients of MBIs, there is clearly a need for further research investigating how the instructor influences outcomes. However, in the absence of extensive empirical investigation into this subject, we hypothesise that what participants of MBIs need most (and therefore respond best to), is the unconditional love and spiritual wisdom of a teacher who is without a personal agenda, and whose mind is saturated with meditative awareness.

 

Ven. Edo Shonin and Ven. William Van Gordon

Further Reading

Baer, R., Smith, G., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27-45.

Chiesa, A. (2013). The difficulty of defining mindfulness: Current thought and critical issues. Mindfulness, 4, 255-268.

Chiesa, A., & Malinowski, P. (2011). Mindfulness-based approaches: Are they all the same? Journal of Clinical Psychology, 67, 404-424.

MacCoon, D., Imel, Z., Rosenkranz, M., Sheftel, J., Weng, H., Sullivan, J., . . . Lutz, A. (2012). The validation of an active control intervention for Mindfulness Based Stress Reduction (MBSR). Behavior Research and Therapy, 50, 3-12.

Shonin, E., Van Gordon, W., Dunn, T., Singh, N. N., & Griffiths, M. D. (2014). Meditation Awareness Training for work-related wellbeing and job performance: A randomised controlled trial. International Journal of Mental Health and Addiction, 12, 806-823.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015a). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.

Shonin, E., & Van Gordon, W. (2015). The lineage of mindfulness. Mindfulness, 6, 141-145.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 63, 654.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.

Shonin, E., Van Gordon, W., Compare, A., Zangeneh, M., & Griffiths, M. D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161-1180.

Shonin, E., & Van Gordon, W. (2013). Searching for the present moment, Mindfulness, 5, 105-107.

Does Mindfulness Have a Role in the Treatment of Fibromyalgia Syndrome?

Does Mindfulness Have a Role in the Treatment of Fibromyalgia Syndrome?

Fibro 1

Fibromyalgia syndrome is a poorly understood chronic pain disorder. An estimated 3% of adults are reported to suffer from fibromyalgia, with higher levels of occurrence in females compared to males. The main symptoms of fibromyalgia syndrome are all-over body pain, tiredness, difficulty in sleeping, and cognitive dysfunction such as memory impairment. There is also a high level of association between fibromyalgia syndrome and poor quality of life, mental health issues such as depression and anxiety, irritable bowel syndrome, and unemployment.

Some of the reasons why fibromyalgia syndrome is believed to be a controversial illness are as follows:

  1. Individuals with fibromyalgia are reported to exert a higher burden upon healthcare resources when compared with individuals diagnosed with other chronic illnesses.
  1. Research has shown that individuals with fibromyalgia often experience difficulty in having their illness diagnosed, and often feel that their needs and symptoms are poorly understood by the medical profession.
  1. A diagnosis of fibromyalgia is primarily based upon the exclusion of other illnesses, the patient’s medical history, and their reaction to pressure being gently applied to ‘tender points’. In other words, there isn’t a reliable laboratory test for fibromyalgia syndrome (e.g., blood test, x-ray) and this means that it is difficult to be 100% certain that a given individual is genuinely suffering from the illness.

The current treatment-of-choice for fibromyalgia syndrome is the use of psychopharmacology (principally antidepressants) coupled with non-pharmacological approaches such as physical exercise, cognitive-behavioural therapy, self-help, and/or psycho-education. However, pharmacological treatments for fibromyalgia have shown only a limited degree of effectiveness, and many patients withdraw from treatment due to the side-effects of antidepressants as well as low levels of symptom reduction.

The lack of convincing treatment efficacy outcomes for existing pharmacological and non-pharmacological fibromyalgia interventions has led to the empirical evaluation of alternative treatment approaches. Since there exists evidence (which varies in quality and quantity) supporting the use of mindfulness in treating each of the individual symptoms of fibromyalgia syndrome (e.g., chronic pain, sleep disturbance, fatigue, depression, anxiety, and cognitive dysfunction), mindfulness-based interventions have been an obvious candidate in terms of investigating their effectiveness for treating the illness.

A systematic review and meta-analysis comprising six randomised and non-randomised controlled trials of mindfulness-based stress reduction (MBSR) for individuals with fibromyalgia (674 participants in total) found that individuals receiving MBSR experienced significant short-term improvements in quality of life and pain compared to individuals in the non-meditating control groups. A further systematic review (incorporating a range of intervention study designs) examined the findings from ten studies of mindfulness meditation (702 participants in total). The review concluded that mindfulness led to significant improvements in both physical symptoms (e.g., pain, sleep quality, functionality) and psychological symptoms (e.g. depression, anxiety, perceived helplessness).

In terms of the possible mechanisms by which mindfulness helps to alleviate the symptoms of fibromyalgia syndrome, the most widely proposed explanation is that mindfulness helps to increase perceptual distance from somatic pain and distressing psychological stimuli. By mindfully observing painful bodily sensations, it appears that individuals suffering from fibromyalgia (and other pain disorders) can begin to objectify and almost distance themselves from their pain. The same applies to feelings of psychological distress and fatigue that are often associated with musculoskeletal pain. Mindfully observing feelings of distress, frustration and low mood appears to weaken the intensity of such feelings, and to help create the ‘psychological space’ necessary for other – more psychologically adaptive – feelings and thought processes to arise.

Based on findings from a randomised controlled trial of an online mindfulness-based intervention, it has been suggested that stronger treatment outcomes can actually be achieved by using mindfulness not just as a means of improving patient’s ability to cope with pain and psychological distress, but as a means of helping improve patients’ ability to engage in effective social and interpersonal interactions. In other words, given the complexity of fibromyalgia syndrome, it appears that in order to maximise treatment effectiveness, mindfulness interventions targeting fibromyalgia should be purpose-designed and encourage participants to draw on both psychological and social resources.

In terms of other potential mechanisms of action, there is evidence to suggest that mindfulness leads to changes in neurological pain pathways, reduced levels of ruminative thinking and self-preoccupation, and improvements in spirituality. This latter potential mechanism is important because cross-sectional studies involving individuals with fibromyalgia have specifically identified a positive correlation between spirituality and positive affect (i.e., as levels of spirituality increase so do positive mood states), and a negative association between spirituality and symptoms of depression and anxiety (i.e., as levels of spirituality increase in individuals with fibromyalgia, their levels of depression and anxiety decrease).

Findings indicate that purpose-designed mindfulness-based interventions may have a role to play in the treatment of fibromyalgia syndrome. However, at present the overall quality of the evidence is weak and there is a need to replicate and consolidate findings using methodologically robust randomised controlled trials.

Ven Edo Shonin and Ven William Van Gordon

 

Further Reading

Branco, J. C., Bannwarth, B., Failde, I., Abello Carbonell, J., Blotman, F., Spaeth, M., … Matucci-Cerinic, M. (2010). Prevalence of fibromyalgia: a survey in five European countries. Seminars in Arthritis and Rheumatism, 39, 448-55.

Cramer, H., Haller, H., Lauche, R., & Dobos, G. (2012). Mindfulness-based stress reduction for low back pain. A systematic review. BMC Complementary and Alternative Medicine, 12, 162.

Davis, M. C., & Zautra, A. J. (2013). An online mindfulness intervention targeting socioemotional regulation in fibromyalgia: results of a randomized controlled trial. Annals of Behavioural Medicine, 46, 273-284.

Dennis, N. L., Larkin, M., & Derbyshire, S. W. G. (2013). ‘A giant mess’ – making sense of complexity in the accounts of people with fibromyalgia. British Journal of Health Psychology, 18, 763-781.

Häuser, W., Wolfe, F., Tölle, T., Üçeyler, N., & Sommer, C. (2012). The role of antidepressants in the management of fibromyalgia syndrome: a systematic review and meta-analysis. CNS Drugs, 26, 297-307.

Henke, M., & Chur-Hansen, A. (2014). The effectiveness of mindfulness-based programs on physical symptoms and psychological distress in patients with fibromyalgia: a systematic review. International Journal of Wellbeing, 4, 28-45.

Hickie, I., Pols, R. G., Koschera, A., & Davenport, T. (2004). Why are Somatoform Disorders so Poorly Recognized and Treated? In: G. Andrews & Henderson S. (Eds). Unmet Need in Psychiatry: Problems, Resources, Responses (pp. 309-323). Cambridge: Cambridge University Press.

Hughes, G., Martinez, C., Myon, E., Taïeb, C., & Wessely, S. (2005). The impact of a diagnosis of fibromyalgia on health care resource use by primary care patients in the UK: an observational study based on clinical practice. Arthritis and Rheumatism, 54, 177-183.

Jones, K. D., Sherman, C. A., Mist, S. D., Carson, J. W., Bennett, R. M., & Li, F. (2012). A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients. Clinical Rheumatology, 31, 1205-1214.

Langhorst, J., Klose, P., Dobos, G. J., Bernardy, K, & Häuser, W. (2013). Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials. Rheumatology International, 33, 193-207.

Lauche, R., Cramer, H., Dobos, G., Langhorst, J., & Schmidt, S. (2013). A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome. Journal of Psychosomatic Research, 75, 500-510.

Moreira-Almeida, A., & Koenig, H. G. (2008). Religiousness and spirituality in fibromyalgia and chronic pain patients. Current Pain and Headache Reports, 12, 327-332.

Nüesch, E., Häuser, W., Bernardy, K., Barth, J., & Jüni, P. (2013). Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: network meta-analysis. Annals of the Rheumatic Diseases, 72, 955-962.

Peterson, E. L. (2007). Fibromyalgia – Management of a misunderstood disorder. Journal of the American Academy of Nurse Practitioners. 19, 341-348.

Rimes, K. A., & Wingrove, J. (2013). Mindfulness-based cognitive therapy for people with chronic fatigue syndrome still experiencing excessive fatigue after cognitive behaviour therapy: a pilot randomized study. Clinical Psychology and Psychotherapy, 20, 107-117.

Scott, M., & Jones, K. (2014). Mindfulness in a fibromyalgia population. The Journal of Alternative and Complementary Medicine, 20, A94-A95.

Sicras-Mainar, A., Rejas, J., Navarro, R., Blanca, M., Morcillo, A., Larios, R., … Villarroya, C. (2009). Treating patients with fibromyalgia in primary care settings under routine medical practice: a claim database cost and burden of illness study. Arthritis Research & Therapy, 11, R54. DOI:10.1186/ar2673.

Wolfe, F., Brähler, E., Hinz, A., & Häuser, W. (2013). Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: results from a survey of the general population. Arthritis Care and Research, 65, 777-785.

Wolfe, F. (2009). Fibromyalgia wars. Journal of Rheumatology, 36, 671-678.

Wolfe, F., Anderson, J., Harkness, D., Bennett, R. M., Caro, X. J., Goldenberg, D. L., … Yunus, M. B. (1997a). A prospective, longitudinal, multicenter study of service utilization and costs in fibromyalgia. Arthritis and Rheumatology, 40, 1560-1570.

Wolfe, F., Anderson, J., Harkness, D., Bennett, R. M., Caro, X. J., Goldenberg, D. L., … Yunus, M. B. (1997b). Work and disability status of persons with fibromyalgia. The Journal of Rheumatology, 24, 1171-1178.

Shonin, E., & Van Gordon, W. (2013). Searching for the present moment, Mindfulness, 5, 105-107.

Shonin, E., Van Gordon, W., Compare, A., Zangeneh, M., & Griffiths, M. D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161-1180.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 63, 654.

Shonin, E., & Van Gordon, W. (2015). The lineage of mindfulness. Mindfulness, 6, 141-145.

Mindfulness in Mental Health: A Critical Reflection

Mindfulness in Mental Health: A Critical Reflection

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We were recently invited to write a paper for the inaugural issue of the Journal of Psychology, Neuropsychiatric Disorders and Brain Stimulation. Our contribution (which was co-authored with our friend and colleague Professor Mark Griffiths) was entitled ‘Mindfulness in Mental Health: A Critical Reflection’. In light of the substantial growth of scientific and public interest into the health-related applications of mindfulness, our paper discussed whether the scientific evidence for mindfulness-based interventions actually merits their growing popularity amongst mental health practitioners, scientists, and the public more generally. We concluded that mindfulness-based interventions have the potential to play an important role in mental health treatment settings. However, due to the rapidity at which mindfulness has been taken out of its traditional Buddhist setting, and what is possibly evidence of media and/or scientific hype concerning the effectiveness of mindfulness, we recommended that future research should seek to:

  1. Establish whether the benefits of participating in mindfulness-based interventions are maintained over periods of years rather than just months.
  2. Examine whether there are any risks or unwanted consequences associated with participating in mindfulness-based interventions.
  3. Make sure that research findings are not influenced by what is perhaps best described as a form of ‘intervention effect’. Rather than behavioural and psychological changes arising from actually practising mindful awareness, it is possible that some of the positive outcomes observed by researchers actually reflect a belief amongst participants that they are receiving a very popular and ‘proven’ therapeutic or ‘spiritual’ technique. In other words, rather than mindfulness practice per se leading to health improvements, one of the reasons that mindfulness-based interventions are effective might be due to participants’ expectations, and their belief that mindfulness works.
  4. Investigate the Buddhist position that sustainable improvements to mental and spiritual health typically require consistent daily mindfulness practice over a period of many years (i.e., they do not arise after attendance at just eight two-hour classes with some self-practice in between).

The full reference for the article is shown below, and the article can be downloaded (free of charge) from here: Mindfulness_A critical reflection 2015

Article Reference: Van Gordon, W., Shonin, E., & Griffiths, M. D. (2015). Mindfulness in Mental Health: A Critical Reflection. Journal of Psychology, Neuropsychiatric Disorders and Brain Stimulation, 1(1), 102.

Ven Edo Shonin & Ven William Van Gordon