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A front-back inhibition also occurs. The “rational” pre-
frontal cortex inhibits the “emotional” limbic system deep in
the brain. The orbitofrontal cortex (the region above the eyes)
is highly active when we focus and use language, and the
“naming” function in meditation enhances this effect. Scans
using fMRI technology show that naming unpleasant emo-
tional states results in a down-regulation of the amygdala.
This means that even a few seconds of mindfulness (“Stop,
look, and evaluate”) can speed up a return to emotional base-
line after an overreaction. Over time and with training, this
return to baseline can become an automatic response, requir-
ing little cognitive intervention.
So far, I haven’t presented any substantial proof that
meditation works. I’ve just presented some of the theories by
which it could work. Let’s now look at what the researchers, as
opposed to the popular writers, are saying.
HOW GOOD IS THE SCIENCE?
There is a “widespread belief that meditation practice is sci-
entifically certified to be good for just about everything,”
according to Linda Heuman in her recent 2014 article in the
Buddhist magazine Tricycle.1 Mindfulness has gained respect-
ability from the simple fact that so much research is being
done on it, but how good is the science? Has journalistic and
researcher exaggeration and hype inflated the public percep-
tion of mindfulness?
Many scientists think so. An eleven-author team writ-
ing in the journal Clinical Psychology: Science and Practice
quotes the researcher Scott Bishop, who argued that the pop-
ularity of mindfulness-based stress reduction has grown “in
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the absence of rigorous evaluation.”2 Willoughby Britton is a clinical psychologist and neurologist in the field. When
interviewed by Heuman for Tricycle, she said, “The public
perception of where the research is at is way higher than the
actual level.”
Most mindfulness research shares some common prob-
lems: the small size of studies; the lack of replication or peer
review; the lack of double blinding; the selection criteria; the
questions of dosage, durability, and size of effect; the exclu-
sion of confounding effects (such as relaxation); overreliance
on self-reporting questionnaires; poor monitoring of partici-
pant adherence to practice protocols; the confirmation bias
tendencies of researchers; and, finally, the lack of compari-
sons with other treatments. An enthusiastic new report in the
media about the promise of mindfulness could have ignored
or trivialized all of the issues in this paragraph.
Fortunately, we can trust some scientists to evaluate the
science itself. We can’t ever take the results from a single
paper at face value, but the meta-analyses that summarize
the conclusions from hundreds or thousands of papers are
far more reliable. One of these meta-analyses reviewed nearly
twenty thousand research papers. Published in a 2014 issue of
JAMA Internal Medicine, the study (Goyal et al.) has given us
the best positive evidence yet for mindfulness.
The study’s fifteen authors concluded, “Mindfulness med-
itation programs had moderate evidence of improved anxi-
ety . . . depression . . . and pain” but “low evidence of improved
stress/distress and mental health-related quality of life.”3 The
results are hardly resounding, but they do seem to be reliable,
and they suggest that mindfulness is promising as a mental
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health treatment for perhaps 10 to 20 percent of the population. They also match my experience as a teacher. I find
that mindfulness works well for anxiety, depression, pain,
and insomnia. I also tell people with medical problems that
mindfulness will be most useful in reducing the anxiety that
accompanies health issues, but that a cure is unlikely.
My experience also suggests that mindfulness can have
superb results for people who are temperamentally suited
to it but only mediocre or nil results for those who are not.
This is why the discretion of a doctor or a psychologist in
recommending mindfulness to a patient is so important.
Mindfulness training could be next to worthless if it is given
indiscriminately to a particular population. In fact, the
averaging-out effect of studies probably gives a misleading
impression of the usefulness of mindfulness training: Some
participants could have spectacular results, while those who
are ill suited to the practice could drag the statistics down.
In 2007 the University of Alberta’s Evidence-Based Prac-
tice Center in Canada published a meta-analysis of the best
813 studies available at that time. It concluded that none of
them achieved the standard of good research, but it did iden-
tify two issues that explained why. It argued that two issues
would have to be clarified if mindfulness is ever to deserve
scientific respect: (1) There are no generally accepted defini-
tions of meditation. (2) There are no good hypotheses about
how it works.
The abstract to another meta-analysis, by Peter Sedlmeier
et al. (a seven-person team at the Chemnitz University of
Technology in Germany) put it this way: “We conclude that
to arrive at a comprehensive understanding of why and how
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meditation works, emphasis should be placed on the development of more precise theories and measurement devices.”4
If mindfulness is to gain credibility, it will need to trim itself
down to a workable definition and a hypothesis capable of
being tested. Above all, it needs good technical terms free
of ambiguities and contradictions. At some point, I think
researchers will also need to differentiate between mindful-
ness as a cognitive function (attention) and mindfulness as an
ideal state of mind (nonjudgmental acceptance). These two
interpretations are not compatible with one another. They
are not even two poles of a sliding scale. One is a measur-
able, down-to-earth, cognitive function. The other is a poorly
defined psychological or spiritual ideal.
In practice, the question finally comes down to what
degree of proof we personally find acceptable. Do we have a
high standard for proof or a low one? For reasons of profes-
sional integrity, I demand a high standard of proof. I admit
that I am more difficult to please than most. Despite being a
mindfulness teacher, I do not want to be seen as another New
Age enthusiast who will believe anything!
Whenever I find scientific claims in popular
books or the
media, I try to trace them back to their original sources in the
research literature. I usually find that the claims are based on
single trials that use far more nuanced expressions such as
“a small but statistically significant increase.” I’ve now read
hundreds of the scientific papers. As a nonprofessional, I still
find it hard to objectively evaluate any of the claims beyond
the abstract on the first page.
I have my own rough standards for interpreting scientific
claims about mindfulness. First, don’t believe anything that
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comes from a single study. There is no possible way that all design faults could be eliminated—that only comes from multiple trials. Second, don’t trust any claim that does not refer
to a traceable study. Third, don’t trust grapevine generaliza-
tions such as, “Researchers now believe that . . .” Far too many
researchers are willing to give credence to poor-quality stud-
ies.
Finally, don’t trust claims based on popular opinion or
even widespread usage. Science is about proof, not popular-
ity or placebo. The histories of medicine and psychology are
full of fads. The resounding popularity of bloodletting over
millennia was never a proof of its efficacy. If Google, Mon-
santo, and the US military have big mindfulness programs,
this doesn’t prove anything in a scientific sense.
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24
The Story of
Modern Mindfulness
What I refer to as Modern Mindfulness has been around
for decades now, and tens of thousands of people are
working in the field. Popular interest in mindfulness dates
from 1979 when the American biologist Jon Kabat-Zinn devel-
oped his mindfulness-based stress reduction program. This
program started life as a treatment for relief of chronic pain,
and uptake into the wider culture was modest until psycholo-
gists started to experiment with it.
MBSR has now been adapted for anxiety, depression, and
many other psychological disorders. Two other therapies that
use mindfulness as components in their broader approaches
developed about the same time: dialectical behavior therapy
and acceptance and commitment therapy. Most mindfulness
research, however, has been done on the MBSR model. As a
one-technique therapy, it is the industry standard.
Until MBSR appeared, meditation had remained firmly
within the grip of Buddhist, yogic, Christian, and New Age
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groups. I had been peripherally involved in some of these groups for years and became increasingly disgusted by their
childish level of thought, lack of imagination, and reliance on
authority. With such poor advocates it was hardly surprising
that meditation had failed to thrive in the secular West.
Out of this unpromising background, Kabat-Zinn and
his colleagues managed a minor miracle. They have firmly
established a place for standard meditation practice in main-
stream psychology and spearheaded its general acceptance
in Western culture. This wasn’t at all easy to do. The Tran-
scendental Meditation (TM) movement had tried to become
similarly established for decades and had largely failed. We
talked briefly about Kabat-Zinn’s own sources in the intro-
duction to this book, but now let me explain the background
to MBSR in a bit more detail.
For twenty-five hundred years, Buddhist meditation was
largely an in-house doctrine. It was only taught by monks
to monks. Laypeople were generally regarded as incapable
of either practicing or teaching meditation because their
impure lives precluded it. In reality very few monks practiced
meditation, either. Traditional Buddhist monks mostly train
in chanting, ceremonial, and magical skills, and they have
surprisingly little interest in what we would call meditation.
Early in the twentieth century, however, a back-to-the-
roots revival of Buddhist meditation emerged in Burma
(today’s Myanmar) based on the Satipatthana Sutta. Ledi
Sayadaw, U Narada, and Mahasi Sayadaw were the most
prominent monks, but laypeople were also involved to an
unprecedented degree. U Ba Khin, a charismatic bureaucrat
and politician, led retreats for laypeople and founded the
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International Meditation Centre in Rangoon in 1952. This established the formula of ten-day Vipassana retreats that
went on to sweep the world.
These retreats retained many Buddhist values, but they
were commonly described as “pure meditation, not Bud-
dhism.” And in fact, U Ba Khin authorized several Burmese
and Western laypeople to teach them. This was the spark that
ignited a wildfire. For the first time in its twenty-five-hun-
dred-year history, Buddhist meditation was being taught on
a large scale by laymen, and even women, to other laypeople,
many of whom had no Buddhist allegiances at all.
Thousands of backpackers, hippies, and other seekers
attended Vipassana retreats in the 1960s and 1970s, and hun-
dreds became monks or nuns for a while. Within a decade,
dozens of Westerners including myself were teaching ten-
day retreats far removed from the original Buddhist goals. I
taught about forty retreats of three to ten days’ duration until
I stopped over duty-of-care concerns.
In 1975 a group of young Western teachers acquired a
large property in Massachusetts where they established the
Insight Meditation Society (IMS). Most Western Buddhist
groups are overseen by an Asian monk of a particular lin-
eage, but IMS didn’t take that path. Almost by default this
enabled it to become the umbrella group for a wide range of
nonmonastic Western teachers throughout the world. IMS is
very much the spiritual anchor for modern Western Vipas-
sana. Many if not most of its founding teachers and writers
will have practiced and taught there.
Jon Kabat-Zinn was not originally involved in Vipassana,
but he had been heavily interested in Zen for many years.
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When he attended IMS he saw the potential for a different kind of meditation. With understandable caution he adapted
the standard ten-day Vipassana retreat format of breath and
body scan meditations into an eight-week program for pain
relief.
Mindfulness-based stress reduction requires partici-
pants to dedicate a total time of about sixty to seventy hours
to this program. This involves participation in a class as well
as daily home practice usin
g guided meditation CDs. Sev-
enty hours is close to the amount of time a ten-day retreat-
ant would spend in formal meditation, and the usual session
is forty minutes long. MBSR is thus a faithful adaptation of
a formal retreat into a household setting. These demands
of time and commitment mean that MBSR is certainly not
a quick-fix, pop-psychology technique. It places the same
high value on inactivity and withdrawal from the world that
Buddhism itself does.
Because the MBSR training is so demanding, it is com-
monly abbreviated to fit the requirements of time-poor
people. The eight-week program becomes six weeks or four
weeks. The standard one-day workshop is omitted. The yoga
sessions are dropped. The forty-minute meditations become
twenty minutes and so on. I’m sure that many of these modi-
fications improve the program. I have taught thirty thousand
people since 1987, and I find the law of diminishing returns
usually sets in after twenty to twenty-five minutes of medi-
tation. However, MBSR is surprisingly accommodating in
another respect.
Ten-day Vipassana retreats emphasize strong self-
discipline and attentional training. The retreats come with
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many variants, but they typically involve seven to ten hours a day of sitting on the floor, with no talking and no reading
for the whole ten days. It is understandable that Kabat-Zinn
wanted MBSR to have a more accommodating approach for
his target group of people in chronic pain. So he took the
word “mindfulness” and gave it an entirely new meaning.
For the Buddha, to be mindful ( sati) means to pay
attention, or to consciously perceive and evaluate something,
such as a body sensation, emotion, state of mind, thought,
or action. Similarly, Rhys Davids, the Satipatthana Sutta’s
nineteenth-century translator, probably chose the archaic
word “mindfulness” as a translation of sati because of
its strong moral tone. It implies a sense of careful self-
observation and judgment.
In the century between Rhys Davids and Kabat-Zinn, the
word “mindfulness” was almost exclusively used as a descrip-
tion of Vipassana meditation practice. It is hard to imagine
this now, but “mindfulness” as a noun did not enter common