In the traditional Buddhist context mindfulness is considered an essential practice supporting both focused meditation and insight as the two main categories of meditation. Focused meditation practices develop attention skills and Insight (Vipassana) practices aim to cultivate experiential realization of the nature of self (in some Buddhist schools also the nature of reality). Mindfulness and metacognition skills are developed in the focused meditation training which can take on various forms – from breath-focus, through focus on sacred statues, ordinary neutral visual objects such as a pebble or recitation of mantras, to visualization of complex images. Even focused contemplations of topics such as the preciousness of human life can develop mindfulness and metacognition if they are practiced while maintaining focus on the topic and monitoring for distractions in thinking. The refined skills of mindfulness and metacognition are then applied in insight meditation together with other qualities such as virtuous intention, contemplations on impermanence and nature of suffering, emotion qualities of loving kindness, compassion, rejoicing and equanimity etc. These together with contemplative inquiry lead to the insight into the nature of self and reality, but in itself mindfulness practice cannot lead to experiential realization.
How to develop mindfulness?
As part of MBSR or MBCT courses mindfulness training involves eight weekly sessions of 2.5 hours in MBSR and 2 hours in MBCT (Segal, Williams and Teasdale, 2002) which follow a standardized progression of training. The eight sessions are typically preceded by an orientation session and/or individual interviews with those intending to take the course where participants receive detailed information about plans and practice requirements of the course. This can help manage expectations of participants and decrease dropout rates from the courses. The actual training includes practices developing mindfulness of the body (body scan), mindfulness of sounds, mindfulness of thoughts and mental habits (sitting practice) and mindful movement. Training in MBCT also emphasizes development of a decentred perspective on thoughts, sensations and emotions – perceiving them as fleeting mental events rather than solid facts. Some teachers also provide course participants with guided meditation developing acceptance and loving kindness as optional practices. All practices involve detailed verbal guidance by the teacher throughout the meditation with the amount of guidance reducing to some extent as the course progresses and participants become more familiar with the practices. Alongside mindfulness practice, MBSR and MBCT courses also contain education about stress (MBSR) and depression (MBCT), exploration of pleasant and unpleasant experiences, elements of yoga and chi-gong, sharing and inquiry into experiences arising as one progresses through the course etc. Emotional qualities such as loving kindness and compassion are not explicitly trained in MBSR and MBCT, but are considered implicitly communicated through the way the teacher relates to the students and guides practices throughout the course. Intention for engaging in the mindfulness training is also not explicitly developed as part of MBSR and MBCT courses.
Given that both MBSR and MBCT include not only mindfulness practices, but also many other elements, there is the question whether improvements in health and well-being reported from attendance of these courses can actually be attributed to the mindfulness practice as such. A recent study (Williams et al., 2014) addressed this question in a rigorous study with recurrently depressed clients. The study followed a methodologically very strong research design – a randomized controlled format which involved random assignment (to avoid biases associated with participants’ treatment preferences) of participants into three groups. The first group received MBCT training together with treatment as usual and the second group received treatment as usual together with training in Cognitive Psychological Education (CPE) – a course which followed the exact length and session format as the MBCT with the exception of mindfulness practices. The third group received only treatment as usual and was considered a control group. The treatment as usual consisted of GP visits and antidepressant prescriptions, appointments with psychiatrists or psychiatric nurses, and individual help from psychologists or psychotherapists. The three groups did not differ in their treatment as usual. Participants in the MBCT and CPE groups after the completion of the formal eight-week training also attended two follow-up classes at six weeks and six months after completion of the course.
The assessments in this study on recurrent depression were conducted before and right after the MBCT and then at 3, 6, 9 and 12 months follow-up (Williams et al., 2014). Interestingly, the findings suggested that both participation in the MBCT and in the CPE significantly decreased the likelihood of depression relapse in comparison to the control group. There were no differences between MBCT and CPE groups, which suggested that the standard format of MBCT can be effective even in the absence of mindfulness practices as such. This is an important finding, which indicates that the health and well-being outcomes of mindfulness-based courses should not be directly attributed to mindfulness practice as such. However, further analyses of participants’ characteristics in this study with recurrently depressed participants showed that those with childhood trauma did significantly benefit more from MBCT in comparison to CPE. So the mindfulness practice had distinctive effects in this particular group, which might be due to the decentring, acceptance and compassion elements of the training rather than attention-related core mindfulness skills (Williams et al., 2014). It is also possible that the increased attentional stability resulting from mindfulness training enabled participants to benefit from mindfulness non-specific meditation aspects of the MBCT course cultivating compassion and decentring.
There is limited research evidence on the efficacy of the standard MBSR and MBCT format versus the modified shorter format. Initial evidence suggests that shorter training delivery with fewer sessions and/or shorter weekly sessions can lead to the same outcomes for participants as the standard longer format (Carmody and Baer, 2009). However, attendees of MBSR and MBCT courses are also required to practice meditation for 45 minutes each day over the eight weeks of training and research findings showed a positive relationship between the amount of home practice and health-related outcomes of the courses. For example, more hours of home practice have been linked to higher increases in well-being scores after MBSR training (Carmody and Baer, 2008). Similarly, more time spent in home practice has been associated with improvements in mood and working memory capacity in military personnel during the stressful pre-deployment period (Jha et al., 2010).
In the clinical context, regular mindfulness practice three or more days a week has been linked to a nearly 50% decrease in the likelihood of depression relapse in comparison to engaging in less than this amount of weekly practice (Crane et al., 2014). Aside from formal training as part of the weekly sessions and guided (recorded) home practice, participants in MBSR and MBCT are also encouraged to engage in daily informal practice of their choice such as mindful walking, mindful eating or taking a shower mindfully. Research linking the amount of informal meditation practice to course outcomes is very limited – the above study on the amount of practice and recurrent depression also assessed possible links between outcomes and informal practice, but did not find any significant relationship.
Examination of long-term effects of MBSR and MBCT has rarely been examined beyond a few months of follow up after the initial training, but initial studies reported encouraging findings. For example, a one-year follow-up of cancer patients who participated in the eight-week MBSR course showed sustained improvements in stress symptoms and reductions in cortisol levels and systolic blood pressure (Carlson et al., 2007). In addition, a three-year follow-up of participants with anxiety disorders showed maintained reductions in anxiety and panic in most of them (Miller, Fletcher and Kabat-Zinn, 1995). Another study which included a three-year follow-up, this time with fibromyalgia patients who initially trained in MBSR, showed sustained reductions in most pain symptoms, anxiety and depression, and improvements in subscales of quality of life (Grossman et al., 2007). However, the partic
ipants assessed at follow-up in this study were nearly a half of the original sample, which may have resulted in some evaluation biases such as only those who practiced being willing to fill in the evaluations at the long-term follow-up. Overall, these initial findings are encouraging, but they also raise questions regarding how to best support participants of secular mindfulness-based courses in developing and sustaining a long-term meditation practice which need to be addressed in secular mindfulness teaching.
In the Buddhist context, mindfulness is typically developed alongside metacognition in calm abiding (focused attention or Shamatha) training (Wallace, 1999). The basic principle of the practice is simple – sustaining attention on a neutral or virtuous object for gradually more extensive periods of time while monitoring for distraction and quality of attention. As we have discussed in the previous chapter, the core qualities of attention developed through calm abiding practice are relaxation (release of tension in meditation), stability (maintaining attention on an object continuously) and clarity (vividness or attention to detail as the opposite of dullness) (Wallace, 2006). The training starts with very brief periods of practice (as short as 5 minutes) two or three times a day and the practitioner gradually builds up the ability to practice in longer sessions. In the Tibetan Buddhist tradition each meditation session follows the structure we have described in the previous section – connecting with the lineage and developing motivation/intention for the practice, followed by the practice itself and then dedication of the virtue at the end of the practice.
The development of mindfulness and metacognition through mindfulness typically follows a progression of nine stages (described in detail in Wallace, 2006). These stages are outlined in the context of visualization-based practices which are the most common form of developing mindfulness in the Tibetan Buddhist tradition. The first stage is called ‘Mental Placement’ and is characterized by the ability to hold the visualization without distraction for a couple of seconds at best. It also takes a longer time, often 10 seconds or more, for the practitioner to realize that her attention wandered away from the meditation object. The attention and metacognition skills become more stable as the practitioner progresses to the second stage, called ‘Continuous Placement’. Now the meditator is able to remain focused on the meditation object for about a minute and during that time she does not lose the meditation focus completely even though distraction arises.
The third stage, called ‘Patched Placement’, is characterized by the ability to focus on the meditation for between 30 minutes and 1 hour, but with periods of distraction, even though the meditator does not completely lose the meditation focus very often. Most of the time when distraction arises the practitioner is able to notice this quickly and readily bring attention back to the meditation object. The fourth stage is called ‘Close Placement’ and entails more stable focus for longer periods of time, mostly without major distraction. However, at this stage, when distraction due to excessive excitation is greatly decreased, the practitioner is more likely to slip into laxity, drowsiness and dullness. The practitioner may even dose off for a few seconds and then come back to the meditation object.
The fifth stage of Shamatha training is called ‘Taming’ and mostly involves training in overcoming the drowsiness and laxity in the practice. Up until this stage of mindfulness and metacognition training, the visualization of a meditation object lacks detail and is foggy. Meditation teachers warn that some practitioners may confuse the drowsy dull stability of meditation at this stage with advanced states of meditative stabilization (Wallace, 2006). The main remedy for the dullness and drowsiness is an increase in the clarity of meditation, which is the core of the practice at the Taming stage. Further refinement of attention skills leads to the sixth stage of ‘Pacification’, during which periods of major dullness and fogginess are very rare while a more subtle sense of laxity still remains. This is countered by further enhancement of clarity in the meditation practice.
‘Complete Pacification’ is the seventh stage of Shamatha. At this stage even subtle moments of dullness or distraction are noticed through further enhancement of the meta-awareness which supports increased clarity of the visualization. Interestingly, overreliance on meta-awareness can actually interfere with stability of attention at the next stage of ‘Single-Pointed Placement’. This is because the practitioner is now able to focus continuously for long periods of time and even subtle distractions or dullness arise very rarely. Hence, monitoring for distraction and quality of practice can itself become a distraction at this stage of enhanced stability and clarity of attention.
The final stage of Shamatha, called ‘Balanced Placement’, is characterized by the ability to sustain attention without distraction and with clarity continuously for hours. According to Wallace (2006) there is a particular point in the practice when Shamatha is achieved which can be associated with an experience of ecstatic joy resulting from changes in the energies of the body. This experience is transient and is not the aim of training in the Shamatha practice. After the achievement of Shamatha, the practitioner’s mind settles in a more stable and subtle state of tranquillity and joy. In the traditional teachings of Shamatha this is the point when the mind is able to fully engage in further inquiry into the nature of self and reality. Some other teachings suggest that full achievement of Shamatha is not required for effective engagement in the Vipassana practice. However, the stability and clarity of mind achieved at the fourth or fifth stage of Shamatha training seems to be the very minimum for progression into the insight practices. Without such stability and clarity the mind is too susceptive to distraction to be able to sustain attention long enough and with enough clarity to support the development of insight.
Training in Shamatha aimed at achieving the highest levels of calm abiding would be typically conducted in a retreat environment. Based on traditional writings, for most practitioners it would take about a year of training in retreat to progress through the stages of Shamatha to the highest levels of balance in mindfulness and metacognition (Wallace, 2006). Whilst this is obviously not possible for many non-monastic practitioners in the West, regular daily practice in Shamatha supported by occasional retreats could also support the development of higher levels of mental stability needed for effective engagement in Vipassana practice. Such training would require not only a commitment to the daily practice, but also adjustments of lifestyle to reduce distractions of various kinds and unhealthy habits (e.g., smoking and drinking alcohol excessively) which can be detrimental to health and well-being. Such lifestyle changes would support cultivation of mindfulness and metacognition not only in the formal daily sessions but also off the cushion in regular daily activities.
Guidance of an experienced meditation teacher who is knowledgeable about the stages of Shamatha training both in theory and own practice is indispensable if one intends to progress into advanced stages of Shamatha. Such guidance may help the practitioner to avoid common pitfalls of stagnation in the training by mistaking mediocre states of stability with advanced stages of Shamatha or even advanced insight. Similarly, the guidance is essential in case of adverse experiences which are in the traditional context considered as part of the path and need to be worked with in a skilful way. Research suggests that such experiences are more likely to arise with long-term meditation practice (Shapiro, 1992).
While in the traditional cultural context of Buddhism there are standard approaches to the training and assessment of meditation teachers, such comprehensive systems of teacher training and evaluation are for the most part not available in the West. This creates a knowledge gap in the Western culture which can easily cause confusion for Buddhist meditation practitioners in determining whether a teacher might be qualified to guide them to the more advanced stages of Shamatha and Vipassana. A simple questioning about the lineage, training and retreat experience of meditation teachers can be helpful in determining the authenticity of their teaching qualification.
For example, in the Tibetan Buddhist tr
adition it would be expected that a qualified teacher would have received teachings and extensively practiced under the guidance of an established experienced meditation master. In addition, they would have at minimum completed a cycle of preliminary practices either in a three-year meditation retreat or through regular daily practice over several years. An accomplished master would have done meditation training far beyond this initial level of training, including training in further cycles of meditation practices which can vary according to the specific Buddhist school and lineage they trained in. These can, for instance, include cycles of advanced contemplative practices in refining energies of the body such as the Six Yogas of Naropa, or practices with closer focus on Vipassana such as Mahamudra (Kagyu lineage) or Dzogchen (Nyingma lineage).
Neuroscience and Psychology of Meditation in Everyday Life Page 9