Mindfulness Meditation Research: Issues of Participant Scree

What is the mind? What is the mind of a human? What is the mind of the one who investigates the human? Can the human mind understand itself? Can a human mind understand the mind of an other? This is psychology.

Re: Mindfulness Meditation Research: Issues of Participant S

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Single Case Study: Transcendental Meditation, Altered Reality Testing, and Behavioral Change: A Case Report
by Alfred P. French, M.D.1, Albert C. Schmid, Ph.D.2, and Elizabeth Ingalls, MLS3
The Journal of Nervous and Mental Disease, Vol. 161. No.1
Copyright © 1975 by The Williams & Wilkins Co.

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This paper presents the case of a 39-year-old woman who, several weeks following initiation into transcendental meditation (TM), experienced altered reality testing and behavior. We discuss the course of this episode, present evidence for a causal relationship between her practice of TM and altered behavior, and discuss the appropriate treatment of such phenomena.

The past decade has seen an increasing awareness of the value of each individual's subjective experiences, including an interest in "altered states of consciousness," induced by various means. Of these, the most prominent meditation form to be represented in this movement is transcendental meditation (TM) in which 200,000 people have been trained in this country (6). TM consists of the correct utilization of a mantra, or "sacred sound," to facilitate a state of consciousness characterized by physiological and psychological quiescence (4, 5).

The objectives of this paper are to present a case of psychosis-like behavior, which occurred in direct conjunction with the use of TM,
and to discuss the theoretical and therapeutic implications of this case.

CASE REPORT

Mrs. M., a 38-year-old woman who had never previously experienced any behavioral or thought disorder of any kind, experienced a radical "expansion" of her state of consciousness within days after beginning TM according to approved methodology. This state was initially characterized by sustained optimism, moderate euphoria, and a strong sense of the inherent goodness and value of her experience. In a letter to her teacher, written after 1 month of TM, she described "mental and creative energy at a peak .... Soaking up creative energy like earth drinking rain. Beautiful people everywhere. Life is so rich I have to keep expanding to hold my portion." She later explained, "I was in a state of openness and readiness for new growth; I felt that there were unreached areas in my mind and that there must be more to life. When, through meditation, I began reaching new areas of myself, I was delighted."

Two weeks after beginning meditation, but not during meditation itself, she began to experience compelling fantasies, which were euphoric in quality. These led to unusual behavior which would have been described clinically as psychotic. Soon she actively sought these experiences. Later, she described them as "waking dreams in which I created and experienced fantastic cosmic and inner adventures. I was able through them to fulfill my meta-need to help relieve the world's tensions by astrologically correcting a planetary gravitational imbalance that was deeply troubling the human race."
(It should be noted that, although there was continuity between the initial euphoric response to TM and the quality of the first of the compelling "waking dreams," this sustained exploration of an affective state. and its associated content. are not part of TM.)

We interviewed Mrs. M. at the end of the 3-month period during which she had experienced euphoria. She was an attractive, neatly dressed and young looking woman who was immediately congenial upon our arrival. She displayed substantial use of intellectual processes, particularly abstractions and analogies, and seemed clearly above average in intellectual functioning. She was oriented in all spheres, and her discourse was coherent but at times circumstantial. She spoke freely about herself and her unusual experiences. She seemed to be experiencing a fixed level of moderate euphoria reflected in frequent laughter, a virtually constant smile, and an attitude of cheerful optimism toward all events, including her recent experiences. The unusual finding was the lack of variation in her affect and general manner over the 3 hours we interviewed her. She later explained, "I was not totally there. I was operating also on other levels and couldn't completely return to the here and now that you were experiencing."

Image
Fig. 1. lMMPI profiles 4 months after beginning TM [x] and 10 months later [x].

Psychological test results at this point indicate a moderate thought disorder. The Minnesota Multiphasic Personality Inventory (MMPI) profile (Figure 1) indicates excessive pressure from unconscious material, resulting in anxiety, social and emotional alienation and withdrawal, and ruminative and obsessive qualities. The Rorschach performance was characterized by tension, depressive content, concern about death, and obsessive attempts to integrate percepts of the blots. With respect to the latter, Mrs. M. was only partially successful at perceptual integration and at times displayed moderately loosened associations. Her performance also reflected rather primitive sexual content. The initial Adjective Check List (ACL) profile (Figure 2) (1) is that of a somewhat inhibited individual who was both anxious and actively seeking help from others, while at the same time seeking independence and new experience.

During the 2 months following our interview, there was a dramatic shift in the nature of Mrs. M.'s experience. The affect became dysphoric, and the intensity increased until it was "unbearable." Simultaneously, there was a loss of control. "The process took me over. I was on such a precarious balance, that it would have been dangerous to change direction or stop." She experimented occasionally with shorter meditation times, and with eliminating meditation altogether, with no perceptible decrease in the rush or intensity of the experience. "I was afraid to stop altogether lest I lose the link that kept my feet on the ground." During this interval, only inexperienced TM teachers were available. Although clearly aware that Mrs. M. was in severe distress, they could offer no advice except the standard "meditate your allotted time and come in for checking." She sought a psychiatric evaluation to ascertain "whether I was in my right mind." The young Szaszian psychiatrist described her experiences as "unusual," but not indicative of mental illness. He suggested further counseling, which was a financial impossibility, and recommended medication.

"I turned to psychological and religious literature when new experiences began to occur to ascertain that I was going through a positive and natural process and to answer my questions about what was happening. Rossi's theories of psychosynthesis and growth, Maslow's metamotivation, metaneed, peak experience, and self-actualization concepts, Jung's symbols and archetypes, Lilly's rules for observing inner experiences, Ellenberger's "creative illness," and Maharishi's discussions of evolution and levels of consciousness became incorporated into my experience." The entire episode finally ended when, "in a state of complete physical and emotional exhaustion, I knew I had reached my limit." The rush gradually subsided, and "I began to sleep again. I had to sleep or die."

Image
Fig. 2. Adjective Check List (2) profiles 4 months [x] after beginning TM and 10 months later [x]

The MMPI and ACL were repeated 10 months after the initial testing and our interview. The second MMPI profile (Figure 1) indicates no evidence of thought disorder, in contrast to the initial profile. The validity scales indicate a defensive posture, and reflect a response set of "faking good" (F-K = 14). The shift in the ACL profile (Figure 2) over the 10-month period is toward less self-confidence, increased impulsiveness, and a marked decrease in the subjective sense of discomfort and need for outside assistance, while autonomy and active interest in new experience remain high. This might be summarized as a shift toward being both more "loose" and more comfortable.

DISCUSSION

The challenge of any process designed to catalyze adaptive change may be to facilitate access to repressed material without excessive hazard, while simultaneously facilitating the integration of emerging material into the personality structure. Derepression, by itself, is readily obtained by a wide variety of methods but cannot by itself lead to adaptive change. Some meditation forms appear to decrease repression, while providing various means for reintegration of material. TM involves experiencing "a thought at 'subtler' or more abstract levels of thinking, in an easy and natural manner" (4, p. 8). This occurs because "the nature of the mind is such that allowing the mind to remain lively, in a non-directed manner, spontaneously minimizes mental and physiological activity."4 We hypothesize that this shift in mental function is often accompanied by derepression.

TM, now widely popularized, is generally considered to be a remarkably simple and benign meditation method. While the method is not commonly described as potentially dangerous, precautions include limitation of meditation to 20 minutes, twice a day, and follow-up with trained teachers. In contrast, numerous reports abound of the hazards of Zazen, the meditation form used in Zen Buddhism, which may lead to terrifying experiences and which must be handled carefully. These "makyo" are "a mixture of the real and the unreal, not unlike ordinary dreams. [The student must] never be tempted into thinking that these phenomena are real or that the visions themselves have any meaning ... above all, do not allow yourself to be enticed by visions of the Buddha or of gods blessing you or communicating a divine message. This is to squander your energies in the foolish pursuit of the inconsequential" (2, pp. 40-41). The similarity of TM and Zazen is supported by EEG studies (4).

While proposing a causal relationship between TM and the psychosis-like episodes, we cannot rigorously exclude the possibility that a disorder of thought or mood might have occurred without TM. In any case, the continued presence of an altered state of consciousness within days after beginning TM, and the occurrence of the "waking fantasies" shortly thereafter, leave little doubt of some causal relationship between the use of TM and the subsequent psychosis-like experience. In fact, we would expect the occurrence of powerfully compelling fantasies in some portion of normal individuals utilizing derepressive procedures of any form.

Despite enjoying the euphoria of her initial "waking dreams," Mrs. M. was capable of effectively grieving the loss of her expanded world-view. It is in this area, rather than in the area of the occurrence of such phenomena, that the issues of risk, and the appropriate response by TM teachers and psychiatrists, are significant. Anyone may experience a makyo, just as we all experience powerful dreams. Our hypothesis that TM has the potential of markedly decreasing repression carries several immediate therapeutic implications. First, interaction with an experienced "guide" is in general to be preferred to indiscriminate use of medication; second, such "trips," while often clinically psychosis-like, are distinct clinical entities from functional psychoses. Our scientific-medical prejudice leads us to label any unusual behavior as "sick." Tart (3) has outlined the basis for an alternate view. Mrs. M. states, "my faith in my own system's ability to guide and safeguard, my sense of identity, and my mind/body system are greatly strengthened. Life has a depth it didn't have before. I am operating at new levels of knowledge and understanding, and I have not yet discovered the boundaries of my mind."

In retrospect, it appears that appropriate management of the present case would have included decrease in or cessation of meditation time; frequent contact with an experienced teacher, whose function would be process rather than content oriented; contact with a mental health professional to assist in the grief work and suicidal ideation involved in the process of giving up the fantasy world; and use of medication to facilitate sleep and, if necessary, repression. While all these elements were present in Mrs. M.'s case, earlier recognition of the type of process involved might have decreased Mrs. M.'s suffering and risk over a period of several months. The usefulness of TM, like any process which seeks to facilitate adaptive change through decreased repression, appears to be not altogether without potential risk. The very nature of the mind and of this form of meditation carries the risk of psychosis-like and potentially dangerous regression. Appropriate recognition of inappropriate response to meditation should lead to intervention which protects without over-repression.

_______________

Notes:

1 Department of Psychiatry. University of California. Davis-Sacramento Medical Center. 4430 "V" Street. Sacramento. California 98517.

2 Department of Mental Health. Sacramento County Health Agency; and Division of Mental Health. School of Medicine. University of California. Davis.

3 Medical Learning Resources, University of California. Davis.

4 Kersey, R. Teacher of Transcendental Meditation. Personal communication.

REFERENCES

1. Gough, H., and Heilbrun, A. Adjective Check List. Consulting Psychologists Press. Palo Alto, California, 1965.

2. Kapleau, P. The Three Pillars of Zen. Beacon Press. Boston. 1965.

3. Tart, C. States of consciousness and state-specific sciences. Science. 176: 1203-1210. 1972.

4. Wallace, R. The Physiological Effects of Transcendental Meditation. Students' International Meditation Society. Los Angeles. 1970.

5. Wallace, R. The physiology of meditation. Sci. Am., 226: 84-90, 1972.

6. Whitman, A. The art of meditation. Reader's Digest, September: 130-134. 1973.
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Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Fri Feb 22, 2019 4:14 am

Meditation may predispose to epilepsy: an insight into the alteration in brain environment induced by meditation
by Harinder Jaseja*
Physiology Department, G.R. Medical College, 8, 10-C-Block, Near Paliwal Health Club, Harishanker-puram, Lashkar, Gwalior 474009, MP, India
Received 31 August 2004; accepted 13 September 2004
c 2004 Elsevier Ltd. All rights reserved.

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Summary

Stress-induced diseases in modern life are on an alarming rise not only in developed countries but also in developing ones. To alleviate stress, one practice that is being commonly and increasingly adapted to is meditation. Limited studies on meditation have reported occurrence of mental calmness along with apparently favorable changes in certain autonomic functional parameters like heart rate, blood pressure, respiration and skin resistance. Recently, meditation is also being practiced and advised for alleviation of epilepsy; however, very little work is available to comprehend effect and utility of meditation on epilepsy. Neuro-imaging and in-depth studies during the course and attainment of meditational state have revealed alteration in neuro-chemistry and neuro-physiology of brain environment that could favor epileptogenesis. The rise in brain glutamate and serotonin along with development of ‘hypersynchrony’ of EEG activity (which occur during the course and attainment of meditational state) are well documented to form the underlying basis of epilepsy. Each of the above-mentioned factors is individually capable of inducing susceptibility and decreasing threshold to epilepsy. Based on these changes in brain, this paper raises a grave possibility and risk of meditation in developing epilepsy or increasing the severity and frequency of attacks in an already epileptic state, contrary to the popular belief of its remedial role in alleviating epilepsy.

Introduction

There is global increase in stress and strain of today’s life, both at home front and job place. The global competitiveness and challenges of modern life are taking a great toll on physical and mental health that is being reflected by an alarming rise in stress induced diseases.

Counseling and/or drug therapy have not been much effective in relieving stress in most of the cases. In addition, these methods cannot be applicable in many situations. Also, in those cases where they have been able to produce significant relief, the effect has been short lived.

An increasing tendency towards adapting practice of meditation for relief of stress is being observed universally as it is devoid of side effects of drugs and great compromise with life style that one is used to. Meditation is a complex process, during the course and attainment of which, multiple changes in mental, neuro-hormonal and autonomic functions occur. These changes vary from being subtle to sometimes being easily perceptible by the meditator. Due to the complexity, mystique and fascination of the mental processes and changes associated with meditation, it still remains a phenomenon of great interest to researchers and shall continue to do so for several years to come.

The biological autonomic effects on heart rate, blood pressure, respiration and skin resistance have been studied to a significant extent. However, with the advent of neuro-imaging techniques like EEG, fMRI, PET and SPECT [1–5], the cerebral and mental processes associated with meditation have attracted much interest to researchers. Undoubtedly, it is these processes that form the underlying basis of the composite effect of meditation on body and mind.

Effects of meditation on brain

EEG changes


A number of investigators have studied EEG changes in normal meditators. The effects have mainly been on alpha rhythm as observed by Bagchi & Wenger [28] and Kasamatsu & Hirai [29]. In 1961, Anand et al. [30] observed increasing amplitude and slowing frequency of alpha rhythm, which gradually spread from its normal predominant locality i.e., occipital to frontal regions. Banquet [6] also found high amplitude alpha rhythm during meditation and coined the term ‘hypersynchrony’ [6,7]. It needs to be reminded that epileptic discharges are more appropriately known as ‘hypersynchronous’ discharges, which are due to an abnormally high synchronized firing of a neuronal aggregate. Banquet also noted development of theta frequencies during meditation. These low frequency, high amplitude EEG rhythms are generally present during meditation.

Effect on prefrontal and cingulate cortex

Neuro-imaging techniques have demonstrated increased activity in prefrontal (PFC) (mainly right side) and cingulate cortex (CC) [8–11] during meditation. This leads to production of the excitatory neurotransmitter, Glutamate in the brain. This hormone is used by PFC neurons to communicate among themselves and other brain structures [12]. There is continued increase in Glutamate with continued activity in PFC during the course of meditation process.

Effect on serotonin

It has been observed that Serotonin (5-HT) increases during meditation. Secretion is increased by stimulation of lateral hypothalamus and PFC [13] that invariably occurs during meditation. Several studies have demonstrated increased urinary excretion of Serotonin metabolites after meditation [14].

Effect on inter-hemispheric coherence

Kiloh et al. [15] observed increase in inter-hemispheric coherence, symmetry and synchronization of alpha rhythm during meditation.

Thus, the neuro-effects of meditation may be summarized to produce:

1. Increase in synchrony of EEG activity (hypersynchrony).

2. Increase in inter-hemispheric coherence of EEG activity.

3. Increase in brain Glutamate.

4. Increase in brain Serotonin.


There is overwhelming evidence of hypersynchrony predisposing to epilepsy. Hyperventilation causes synchrony and precipitates epilepsy [16]. It is a provocative technique during EEG recording. Sleep also is a provocative technique, a significant number of epileptics reveal inter-ictal epileptiform activity in their EEG only during sleep [17,18]. Hypersynchrony of sleep facilitates both initiation and propagation of partial seizures [17]. It is well known that NREM sleep causes increased susceptibility to epilepsy. Spiky epileptic discharge means more synchronisation of unit cell populations and Spike is caused by synchronisation of population group 1 neurons [19]. Spikes depict interictal epileptiform activity and their correlation with intracellular recordings shows that the former are associated with firing of action potentials [20].

Increase in inter-hemispheric coherence of EEG activity may contribute in its own way towards propagation and generalization of epileptic discharges. A focal discharge restricted to a localized region can tend to become widespread precariously. Corpus callostomy is a surgical procedure performed for control of un-controllable generalized seizures, the objective being to block inter-hemispheric transmission of epileptic potentials.

Glutamate is neuro-excitatory transmitter and widely implicated in epilepsy. The epileptic focus has been shown to contain more Glutamate than in normal state [21] and potassium-stimulated Glutamate release is more in cortical slices removed from epileptic patients than normal tissue [21].

Neurons in epileptic region exhibit paroxysmal depolarization shift (PDS) that is associated with a burst of action potentials [22]; interestingly, effect of Glutamate on NMDA receptors also produces a response similar to PDS [22] and a search for Glutamate antagonists as anti-epileptics is being promoted.

Serotonin also has been implicated in epileptogenesis and anti-serotonin are found to possess anti-convulsant properties [23,24]. 5-HT 2A receptor activation causes slow depolarisations and enhancement of excitatory signals such as Glutamate [25] and Cyproheptadine, which is 5-HT 2A blocker, has anti-convulsant activity [26].

Conclusion

Thus, each of the above-cited effects, which invariably occur at sometime during the course of meditation can present a potential risk for epileptogenesis and/or precipitating attack(s) in an epileptic patient. Needless to say, the concurrent presence of two or more of these effects can contribute tremendously to epileptogenesis, even to the extent of rendering a normal person epilepsy-prone.

Meditation is known to produce relaxation and epilepsy after relaxation is a well-known entity [27]. Meditation is presently being advised and resorted to for alleviating epilepsy; this paper clearly outlines the risk of enhancing the epileptic state during the course and attainment of meditation state.

However, further insight into the neuro-physiological and neuro-chemical avenues associated with meditation is definitely required. The epileptic proneness and incidence of epilepsy in regular meditators needs to be elucidated. Presently, however, caution may be exercised over the practice of meditation in patients prone to epilepsy. At least, epileptic patients seeking alleviation of their attacks through practice of meditation may be warned of the potential hazard outlined in the paper.
_______________

Notes:

* Tel.: +91 751 233 1147. E-mail address: dr_jaseja@yahoo.com.

0306-9877/$ - see front matter c 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.mehy.2004.09.012

References

[1] Herzog H, Lele VR, Kuwert T, et al. Changed pattern of regional glucose metabolism during Yoga meditative relaxation. Neuropsychobiology 1990-1991;23:182–7.

[2] Lou HC, Kjaer TW, Friberg L,. et al. A 15O-H2O PET study of meditation and the resting state of normal consciousness. Human Brain Map 1999;7:98–105.

[3] Kjaer, Bertelsen, Piccini, Brooks, Alving, Lou, 2002.

[4] Newberg AB, Alavi A, Baime M,. et al. The measurement of regional blood flow during the complex cognitive task of meditation: a preliminary SPECT study. Psychiatr Res Neuroimaging 2001;106:113–22.

[5] Lazar SW, Bush G, Gollub RL,. et al. Functional brain mapping of the relaxation response and meditation. Neuroreport 2000;11:1581–5.

[6] Banquet JP. Spectral analysis of EEG in meditation. Electroencephal Clin Neurophysiol 1973;35:143–51.

[7] Banquet JP. EEG and meditation. Electroencephalography Clin Neurophysiol 1972;33:449.

[8] Ingvar DH. The will of the brain: cerebral correlates of willful acts. J Theor Biol 1994;171:7–12.

[9] Frith CD, Friston K, Liddle PF,. et al. Willed action and the prefrontal cortex in man. A study with PET. Proc R Soc Lond 1991;244:241–6.

[10] Posner MI, Peterson SE. The attention system of the human brain. Ann Rev Neurosci 1990;13:25–42.

[11] Pardo JV, Fox PT, Raichle ME. Localization of a human system for sustained attention by positron emission tomography. Nature 1991;349:61–4.

[12] Cheramy A, Romo R, Glowinski. Role of corticostriatal glutamatergic neurons in the presynaptic control of dopamine release. In: Sandler M, Feuerstein C, Scatton B et al, editors. Neurotransmitter interactions in the basal ganglia. New York: Raven Press; 1987.

[13] Olds ME, Forbes JL. The central basis of motivation, intracranial self-stimulation studies. Ann Rev Psychol 1981;32:523–74.

[14] Walton KG, Pugh ND, Gelderloos P, Macrae P. Stress reduction and preventing hypertension: preliminary support for a psychoneuroendocrine mechanism. J Altern Complement Med 1995;1:263–83.

[15] Kiloh LG, Osselton JW. Clinical electroencephalography. 4th ed. London: Butterworth; 1981.

[16] Handbook of electro-encephalography and clinical neurophysiology. vol. 13, part A. Amsterdam: Elsevier Scientific Publishing Company; 1975. p. 48–9.

[17] Herman ST, Walczak TS, Bazil CW. Neurology 2001;56:1453–9.

[18] Handbook of electro-encephalography and clinical neurophysiology. vol. 13, part A. Amsterdam: Elsevier Scientific Publishing Company; 1975. p. 31, 38.

[19] Fenwick P. The relationship between mind, brain and seizures. Arch Indian Psychiat 1994;1(1):3–6.

[20] Goodman and Gilman’s The pharmacological basis of therapeutics. 9th ed., International edn.; 1996. p. 465.

[21] Rang HP, Dale MM, Ritter JM. Pharmacology. 3rd ed. 1995. p. 599.

[22] Rang HP, Dale MM, Ritter JM. Pharmacology. 3rd ed. 1995. p. 598.

[23] Vimal Chandra. Ind J Pharmacol 1972;4(3):174–7.

[24] Bapat SK, Vimal Chandra. Ind J Pharmacol 1969;1(4):32–6.

[25] Goodman and Gilman’s. The pharmacological basis of therapeutics. 9th ed. International edn. 1996. p. 256.

[26] Satoskar, Kale, Bhandarkar’s. Pharmacology and pharmacotherapeutics. 16th ed. 1999, p. 318.

[27] Epilepsy News, Sleep and Epilepsy, Mohammed I. Zahoor produced by Sleep Research Laboratory, Wallace Mendelson, Director, The University of Chicago Hospitals.

[28] Bagchi BK, Wenger MA. Simultaneous EEG and other recordings during some yogic practices. Electroencephalogr Clin Neurophysiol 1958;10:193.

[29] Kasamatsu A, Hirai T. An electroencephalographic study on the zen medication. In: Tart, editor. Altered states of consciousness; 1969. p. 501–14.

[30] Anand BK, Chhina GS, Singh B. Some aspects of electroencephalographic studies in yogis. Electroencephalogr Clin Neurophysiol 1961;13:452–6.
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Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Fri Feb 22, 2019 4:46 am

Psychiatric Problems Precipitated by Transcendental Meditation
by Arnold A. Lazarus
Graduate School of Applied & Professional Psychology, Rutgers University
Psychological Reports, 1976, 39, 601-602.© Psychological Reports 1976
Accepted August 11, 1976.

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Summary.

Like many procedures, Transcendental Meditation (TM) proves extremely effective when applied to properly selected cases by informed practitioners. It is not a panacea. In fact, when used indiscriminately, there are clinical indications that the procedure can precipitate serious psychiatric problems such as depression, agitation, and even schizophrenic decompensation.

Scientific psychology has emphasized the significance of individual differences. Folklore is equally aware that "one man's meat is another man's poison." Yet popular systems and movements from psychoanalysis to Transcendental Meditation (TM) generalize and universalize, present their views and findings in absolutistic rather than probabilistic terms, and depart from established scientific pathways in several other respects. Their procrustean deftness at fitting everyone to their system damages the integrity and individuality of persons who are temperamentally and otherwise unsuited to their procedures.

Need one belabor the fact that individual differences make it essential to list indications, contraindications, and possible side-effects for everything from strawberries to penicillin, from sit-ups to saunas, or from skydiving to meditating? Research in psychotherapy has yielded the "specificity factor" -- specific techniques produce specific changes in specific patients under specific conditions.
Meditation, when shorn of its mystical connotations, is essentially a specific series of techniques much like relaxation training (cf. Benson, 1975). But as underscored several years ago (Lazarus, 1971), relaxation training is not for everyone; when properly applied to selected cases by informed practitioners, it can overcome many facets of stress, tension and anxiety.

The first "meditation casualty" I encountered was a 34-yr.-old woman who made a serious suicidal attempt following a weekend training course in Transcendental Meditation (TM). Since then I have come across several people who allege that such meditation exacerbated their depressive affect. Similarly, several agitated, restive individuals have reported that the basic procedure of repeating a mantra tended to heighten their ongoing tension and restlessness. P. Carrington in a book to be published this year [1] described three patients who "suffered a complete mental breakdown for which they had to be hospitalized, within a matter of weeks after commencing the practice of meditation." She notes that some people seem to be "abnormally 'sensitive' to meditation, and unable to take it, even in average doses." R. L. Woolfolk (personal communication, 1976) has also reported the case of a 24-yr.-old woman in whom an experience of severe depersonalization seemed to have been precipitated by Transcendental Meditation. Otis (1973, 1974) emphasized that Transcendental Meditation can be harmful. He cites data on the reoccurrence of a bleeding ulcer which was under control during the previous 5 yr., as well as the precipitation of depression and extreme agitation.

Apart from the specific casualties alluded to above, there are more subtle negative influences that probably afflict large numbers of dropouts from meditation. For example, a rather insecure young man found that the benefits he had been promised from Transcendental Meditation simply did not emerge, and instead of questioning the veracity of the exaggerated claims, he developed a strong sense of failure, futility, and ineptitude.

My clinical observations have led me to hypothesize that methods like Transcendental Meditation are most effective with certain "obsessive-compulsive" individuals whose levels of anxiety and tension are moderate rather than severe. In psychiatric nomenclature, Transcendental Meditation does not seem as effective with persons who demonstrate "hysterical tendencies" or strong "depressive reactions." And, I would hazard a guess that some "schizophrenic" individuals might experience an increase in "depersonalization" and self-preoccupation.
However, seriously disturbed psychiatric patients may learn to meditate successfully, provided adequate attention is given to various problems that tend to arise during the first weeks of practice (Glueck & Stroebel, 1975).

Transcendental Meditation and other systems of meditation and relaxation can undoubtedly prove extremely beneficial to a large number of individuals. But, like most things, there are those for whom it is contraindicated, those for whom it will be of marginal benefit, moderate benefit, etc. While the pundits of Transcendental Meditation do not make the necessary discriminations, researchers need to know (a) the precise benefits that may accrue from such procedures and (b) the drawbacks, limitations, shortcomings, risks and dangers that may exist. On the whole, we need far less proselytism and much more data.

_______________

Notes:

1 Cited with permission from the manuscript of the book.

REFERENCES

BENSON H. The relaxation response. New York Morrow, 1975.

GLUECK B. C., & STROEBEL. C. F. Biofeedback and meditation in the treatment of psychiatric illnesses. Comprehensive Psychiatry, 1975, 16, 303-321.

LAZARUS A. A. Behavior therapy and beyond. New York: McGraw-Hill, 1971.

OTIS, L. S. Transcendental Meditation. Paper presented at the American Psychological Association Convention in Montreal, 1973.

OTIS, L. S. The facts on Transcendental Meditation. Part 3. If well-integrated but anxious, try TM. Psychology Today, 1974, 7 (4), 45-46.
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Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Fri Feb 22, 2019 5:24 am

Striking EEG Profiles From Single Episodes of Glossolalia and Transcendental Meditation
by Michael A. Persinger, Laurentian University1
Accepted December 6, 1983.
Perceptual and Motor Skills, 1984, 58, 127-133. © Perceptual and Motor Skills 1984

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Summary

Transient, focal, epileptic-like electrical changes in the temporal lobe, without convulsions, have been hypothesized to be primary correlates of religious experiences. Given these properties, direct measurement of these phenomena within the laboratory should be rare. However, two illustrated instances have been recorded. The first case involved the occurrence of a delta-wave-dominant electrical seizure for about 10 sec. from the temporal lobe only of a Transcendental Meditation teacher during a peak experience within a routine TM episode. The second case involved the occurrence of spikes within the temporal lobe only during protracted intermittent episodes of glossolalia by a member of a pentecostal sect. Neither subject had any psychiatric history. These observations are commensurate with the hypothesis that religious experiences are natural correlates of temporal lobe transients that can be detected by routine EEG measures.

Religious experiences have been hypothesized to be associated with temporal lobe transients (Persinger, 1983). These phenomena are defined as brief (a few seconds), focal (deep within the temporal lobe) electrophysiological changes that reflect the conditions associated with the experience. Trigger stimuli, events that can precipitate temporal lobe transients (TLTs), include the chemistry of personal crisis (corticosteroid elevations), fatigue, hypoxia, hypoglycemia and psychotropic drugs that preferentially affect temporal lobe structures. Predisposing factors influence the potency of the trigger variable. Although most TLTs should occur as deep microseizures, some of them should be expressed occasionally in surface (electroencephalographic) measures.

Because of the focal nature of TLTs, religious experiences should be dominated by the functions associated with this part of the brain. Intense meaningfulness, focus upon the "sense of self" with respect to the limits of space and time and sudden revelations through "knowing" are dominant symptoms. Coherence at lower frequencies among temporal lobe structures (especially the hippocampus and amygdala) that have not been correlated since early childhood could allow access to and retrieval of older ontogenetic functions. These transient operations could also recruit infantile body images and reinforcement patterns, such as the expectations of parental surrogates, into the experience.

TLTs could become associated with discriminative stimuli which could control the occurrences. This is not unusual for subcortical temporal lobe structures. Learned controlled electrophysiological changes are typical of kindling phenomena in general (Gloor, 1972; MacLean, 1970; Pay, 1982). There are several anecdotal cases (Efron, 1957) of electrical seizures that were influenced (apparently) by volitional cues. The most likely discriminative stimulus would be language, specifically, a particular sequence of words with unique associations (Persinger, Carrey, & Suess, 1980). Nonsense phrases, such as mantras or infantile gibberish, are classic candidates.

The present study reports two cases of TLTs occurring during routine EEG recordings of populations of people claiming to engage in various forms of mystical experiences. Although the existence of transient and focal changes within EEG profiles in normal human beings is well documented, interpretation of these changes is difficult since behavioral correlates are either not measured or are ignored.

METHODS AND RESULTS

The first case involved a 32-yr.-old Caucasian, brunette female who had been practicing Transcendental Meditation (TM) for about 10 yr. and had been teaching the technique for an unspecified period; there was no history of psychiatric disorders. Bipolar E4S silver-plated disk electrode arrangements (Kiloh, et al., 1972) along the same horizontal plane over the temporal lobe (approximately T3-T4), occipital lobe (01-02) and frontal lobe (Fpl-Fp2) were secured by EC2 electrode cream and maintained by an adjustable headband. Continuous recordings during the latter 5 min. of standardization and throughout the 30 min. of meditation and postmeditation were completed with a three-channel Model 79 EEG (Grass Instrument; Quincy, MA). The subject sat quietly in a comfortable chair during the entire recording period. Ambient fluorescent illumination ranged between 10 and 50 lux.

Image
FIG. 1. Electroencephalographic (EEG) recordings from temporal (T), occipital (O) and frontal (F) bipolar electrodes for a Transcendental Meditation (TM) teacher just before the onset of the electrical seizure. Maximum vertical displacements of the records are equivalent to about 50 uV. Increments on the bottom line indicate 1-second intervals.

As can be seen in Fig. 1, typical alpha frequency bursts were generated from all three leads (eyes closed) during the first portion of the experiment. However, after about 19 min. of meditation, clear delta frequencies with an aberrant spike and slow-wave-like profile emerged for about 15 to 20 sec. on the temporal lobe leads only (Fig. 2). No obvious changes occurred in the other leads. The TLT, whose amplitude was about 3X the pre- and postoccurrence activity, was followed by a silent period of a similar duration and then a return to normal amplitude and frequency.

Image
FIG. 2. Topography of the electrical seizure within the temporal lobe (T) of the TM teacher noted in Fig. 1 after about 19 minutes of meditation. No changes were evident in the occipital and frontal lobe channels.

After the subject had completed the meditation sequence, the occipital EEG was dominated by the typical "beta buzz" (associated with higher than normal amplitude beta frequencies) for about 30 sec. When asked about the quality of the episode, she reported that this particular experience was especially meaningful and that she had felt being very close to "the cosmic whole." There had been no evidence of any facial movements (jerks or muscle twitches) or general body alterations during the TLT period. From a total of 10 TM practitioners monitored during mantra repetition in this laboratory, this subject was the only one to display a TLT during a meditational episode. None of the other nine reported a "peak experience, although relaxation reports were frequent.

The second subject was a 20-yr.-old blond, Caucasian female who claimed she could speak in tongues (SIT). She was one of only two volunteers who responded to a request to test people who could "speak in the spirit," from local pentecostal groups. The other volunteer, a 23-yr.-old brunette Caucasian female, did not demonstrate any unusual EEG phenomena. Both volunteers were university students.

Image
FIG. 3. EEG profiles from a member of a pentecostal group during sequences of "voluntary" initiation of glossolalia (SIT). S refers to the spike events.

The subject was an A student who had been argumentative in several classes about religious topics and had proselytized frequently within the university. Although there was no psychiatric history, she had sought pastoral counseling. Unlike the 23-yr.-old volunteer who had "learned speaking" by watching others in a protestant pentecostal sect, the subject "had suddenly begun to speak by herself" one day as a young girl. She was Roman Catholic by early training and had recently been attracted, presumably in view of her glossolalia, to a pentecostal group.

During a 2-hr. test period, the subject sat comfortably and was requested to speak in tongues with both free and forced paradigms. Each "speaking" episode lasted about 5 to 10 min. and was followed by a 1- to 5-min. rest period. Since these episodes were reported to have both an "overt" and "covert" component, that is, vocal or non-vocal, these operations in conjunction with eyes-open and eyes-closed instructions were instituted as well. Bipolar electrode arrangements were attached to the same basic areas in the temporal, occipital, and frontal regions as reported for the TM subject, although different channels were used to measure the temporal and frontal leads. The entire session was tape recorded.

Image
FIG. 4. Magnification of spike-like events recorded from the temporal lobe of the subject during glossolalia

Figs. 3 and 4 are representative of the phenomenon noted. Spike events began to occur from the temporal lobe electrodes within 20 min. of the recording session following about 10 min. of overt glossolalia Initially, the spike numbers were reduced when the speaking episode was terminated. However, as the session progressed, the spikes began to persist during non-SIT intervals. Neither removal and replacement of electrodes nor alteration of channel leads eliminated the phenomenon which was only recorded from the temporal lobe input. Heart rate artifacts were not evident. The subject reported that the "closest contact with the Spirit" occurred during the latter periods of the session. These periods were followed by conspicuous increases in the amount of enhanced beta activity ("beta buzz"), for 10 to 15 sec., from the temporal lobe. The effect was enhanced by simultaneously terminating the speaking episode and opening the eyes.

Close attention by a second experimenter indicated that the subject did not display any obvious facial transients or stereotyped body movements with the exception of subtle alterations in the right foot during the "covert" periods of glossolalia. This movement was regular, synchronous and similar to "foottapping" associated with musical stimuli. Inspection of the tape by two independent witnesses identified three to four distinguishable sounds that comprised the bulk of the glossolalic material. There was no apparent change in the distribution of these sounds over the session.

Image
FIG. 5. Occurrence of spikes within the temporal lobe during non-SIT episodes for the latter portion of the 2-hr. test period. Primary changes in EEG profiles reflect typical eyes open or eyes closed consequences. However, occasional spikes were noted in the temporal lobe. Note "beta buzz" in first frame of the temporal lobe channel. The changes in frontal lobe leads coincided with vocal instructions by the experimenter for the next operation.

DISCUSSION

The delta wave and spike burst associated with the TM episode and the spike-like activity associated with glossolalia can be considered candidate TLTs. They were very brief displays that were not transcencephalic. Since the electrode arrangement involved bipolar, bilateral comparisons, there is a strong possibility that these events were localized within only one hemisphere. Both cases are commensurate with the hypothesis that TLTs, without motoric concomitants, are a portion of the electroencephalic continuum that are correlates of religious experiences.

The validity of religious experiences, if TLTs are clearly demonstrated to be persistent correlates, may involve different methodologies. From a neuropsychological perspective, these events may be considered self-limiting and perhaps even learned microseizures within the reward centers of the human brain. There is no doubt, based upon both facial expression and verbal reports, that the two episodes reported here were paired with significant and meaningful personal experiences. They were explained with religious significance.

Over the last 10 years, about 50 people, with no detectable epileptic or psychiatric history, claiming various forms of mystical states (from out-of-body experiences to "spiritual communion") have been measured in this laboratory. These two cases are the most specific TLT displays from only four possible candidates. Most "altered states," within the limits of our recordings, have been associated with enhanced bouts of alpha activity or normal alpha trains or spindles (even with the eyes open). According to the hypothesis (Persinger, 1983), most of the TLTs that are associated with religious experiences should remain within deep subcortical structures. Occasionally, a few, especially those that have been leaned or have been brought under cortical control, should be evident even with surface (electroencephalographic) measures.

_______________

Notes:

1 Neuroscience Laboratory, Department of Psychology, Laurentian University, Sudbuq, Ontario, Canada P3E 2C6.

REFERENCES

EFRON, R. The conditioned inhibition of uncinate fits. Brain, 1957, 80, 251-257.

GLOOR, P. Temporal lobe epilepsy: its possible contribution to the understanding of the functional significance of the amygdala and of its interaction with neocortical-temporal mechanisms. In B. E. Eleftheriou (Ed.), The neurobiology of the amygdala. New York: Plenum, 1972. Pp. 423-457.

KILOH, L. G., MCCOMAS, A. J., & OSSELTON J. W. Clinical electroencephalography. (3rd ed.) London: Butterworths, 1972.

MACLEAN, P. D. The limbic brain in relation to the psychoses. In P. Black (Ed.), Physiological correlates of emotion. New York: Academic Press, 1970. Pp. 129-146.

PAY, R. G. Behavioral steering in dual and social states of conation by the amygdala, hypothalamus, ventrial striatum and thalamus. International Journal of Neuroscience, 1982, 16, 1-40.

PERSINGER M. A. Religious and mystical experiences as artifacts of temporal lobe function: a general hypothesis. Perceptual and Motor Skills, 1983, 57, 1255- 1262.

PERSINGER M. A., CARREY, N., & SUESS, L. TM and cultmania. Boston, MA: Christopher, 1980.
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Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Sun Feb 24, 2019 12:22 am

Transcendental Meditation [TM] and General Meditation Are Associated With Enhanced Complex Partial Epileptic-Like Signs: Evidence For "Cognitive" Kindling?1
by M.A. Persinger
Laurentian University
Accepted November 27, 1992
Perceptual and Motor Skills, 1993, 76, 80-82. © Perceptual and Motor Skills 1993  

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Summary

The Personal Philosophy Inventories of 221 university students who had learned to meditate (about 65% to 70% Transcendental Meditation[TM]) were compared to 860 nonmeditators. Meditators displayed a significantly wider range of complex partial epileptic-like signs. Experiences of vibrations, hearing one's name called, paranormal phenomena, profound meaning from reading poetry/prose, and religious phenomenology were particularly frequent among meditators. Numbers of years of TM practice were significantly correlated with the incidence of complex partial signs and sensed presences but not with control, olfactory, or perseverative experiences. The results support the hypothesis that procedures which promote cognitive kindling enhance complex partial epileptic-like signs.

Intermittent, stereotyped stimuli that are presented at optimal interstimulus intervals are known to evoke responses whose quantitative and qualitative properties increase within susceptible media as a function of the number of stimulus presentations. Positive feedback subsequent to the resonance interaction between electromagnetic fields or mechanical vibrations and the natural frequency of the target medium is a common operation that is evident across all levels of scientific discourse. Repeated, brief presentations of electrical or chemical stimuli (Cain, 1989) to Limbic (pyriform) cortices and subcortical structures evoke successive increases in both the spatial distribution of paroxysmal (integrated) electrical discharges and the range in the characteristics of behavioral seizures.

One would expect "cognitive kindling" to occur as a function of the appropriate repetition of linguistic or ideational patterns. The subsequent changes would reflect the neural pathways by which the cognitive stimulus was mediated. Whereas negatively affective ideation concerning death to the self could ultimately recruit collateral neuropathways that mediate heightened vigilance (e.g., panic attacks), repetition of "novel" or unusual words could access other pathways that mediate positive affect. Although experimental kindling of limbic seizures in human beings would be unethical, there are multiple anecdotal cases where repeated meditation was associated with increased indicators of complex partial seizures (Persinger, 1984). For example, Young (1984) reported more frequent and intense incidences of lights and movements in the upper left visual field (indicative of right temporal lobe stimulation through Meyer's loop) as a function of meditation trials.

Because meditation, and Transcendental Meditation in particular, are operationally a cognitive kindling process (specific stimuli for 20 minutes once per day), one would expect meditators to display an increase in the range of complex partial epileptic-like signs (Persinger, Carrey, & Suess, 1980). To test this hypothesis, the Personal Philosophy Inventories (Persinger & Makarec, 1987) of 1,081 university students (ages 18 to 60 years), collected over 11 consecutive years (1981 to 1992), were evaluated. All analyses involved SPSS[x] software on a VAX 4000 computer. Two hundred twenty-one subjects indicated that they had learned to meditate; specific questioning during two of the years indicated that approximately 65 to 70% had taken Transcendental Meditation. Those who had learned meditation were significantly (F[1,1060] = 64.16, p< .001; eta = .25; there were no age data for 16 subjects) older (M = 28.6, SD = 10.3 yr.) than those who had not (M = 23.8, SD = 6.9 yr. old) learned. There was no disconcordance between the numbers of men and women who had learned to meditate (X[2]<2.98, p> .05).

Two-way analyses (sex, meditation) of variance (all dfs = 1,1077) and covariance (for age: dfs = 1,1076) for the dusters of control (for yes-responding and mundane phenomenology) items and complex epileptic items (Persinger & Makarec, 1987; Makarec & Persinger, 1990) showed that people who had learned to meditate displayed significantly (F=39.27, p<.001; eta = .19) more complex partial epileptic-like signs (M = 35%, SD = 21%) than those who had not (M = 27%, SD = 17%). There were neither sex differences (F = .007, p> .05) nor an interaction of sex by meditation (F = .66, p > .05). Covariance for age (F = 19.31, p< ,001) enhanced the difference (F = 54.77, eta = .23) between meditators and nonmeditators. There were no statistically significant differences between meditators and nonmeditators on the control clusters (F = 1.23); women endorsed more of these items (F = 18.47, 14.82) than did the men [grand M = 78 (10%)]. Covariance for age did not diminish the sex differences.

To discern which subclusters of complex partial epileptic-like signs were specifically elevated in the meditators, one-way analyses of variance (all dfs = 1,1079) were completed for each of 13 clusters of items that were derived from the major scale; these items infer temporal lobe phenomenology (Persinger & Makarec, 1990). Meditators endorsed significantly (p < .001; eta in parentheses) more experiences of paranormal phenomena (.16), automatic behaviors (.11), writing (keeping notes about personal thoughts .13), profound experiences from reading/reciting poetry/prose (.21), religious experiences (.21), visual anomalies (.15), auditory (hearing inner voice). vestibular (vibrational) experiences (.19), and sensations of "cosmic consciousness" (.21). There were no differences (F<2.00, p> .01) between meditators and nonmeditators with respect to olfactory, depersonalization, widened affect, limbic motor, or perseverative experiences. Discriminant analyses indicated that the three most important variables were religious, auditory-vestibular, and paranormal experiences.

To discern "duration dependency" of the effect, the 56 subjects (a subset of the 221 meditators in the previous analysis) who reported they had taken Transcendental Meditation specifically (most of these questionnaires were collected between 1981 and 1984) were compared to age-matched nonmeditators (n = 27) from this period. The former claimants were classified according to the duration of practice: 1 year, 2 years, 3-5 years, and more than 5 years; the consistency of practice was not assessed. One-way analyses of variance between people who had learned Transcendental Meditation specifically and the reference group (n = 27) indicated the former showed significant (F[1,181] = 50.25, p< .001) elevations in complex partial epileptic-like signs [44 (19)%, 15 (13)%], but not Ln (F< 1.50) control experiences [79 (13) %, 76 (13)%].

The strongest (p<.001) correlations (Spearman rho) between the duration of reported meditation experience and the phenomenological clusters were for: complex partial epileptic-like signs (.60) and sensed presence (.39) while the weakest correlations (p> .05) were for olfactory (.11), widened affect (.19), and control (.10) responses. These results support the hypothesis that meditation techniques encourage complex partial epileptic-like signs.

The positive association between the self-reported duration of meditation (an inference of repeated trials) and the frequency of complex partial epileptic-like signs (but not control experiences) suggests a specific "dose-dependence" relationship. Obviously a third factor, that enhanced the symptoms and encouraged continuation of meditation, could have been present. However, a causal relationship could explain the development of frank epileptic displays over the temporal lobe (Persinger, 1984) in subgroups of prolonged meditators as well as the myoclonic and limbic motor disorders that have been claimed by some experienced TM teachers who subsequently withdrew from the organization (e.g., TM-Ex Newsletter, PO Box 7565, Arlington, VA 22207).

If the general hypothesis is valid, then the elevation of complex partial epileptic signs among patients who display the phobic anxiety depersonalization syndrome (Harper & Roth, 1962), general anxiety, or the posttraumatic stress disorder may reflect variants of cognitive kindling that access different neuropathways which subserve these adverse experiences. Although meditation may enhance complex partial epileptic-like phenomenology and anxiety (Persinger & Makarec, 1987), one must emphasize that moderate elevation of these indicators in the normal population is also associated with creativity and suggestibility. These characteristics can sometimes facilitate adaptation.

_______________

Notes:

1 Please send reprint requests to Dr. M. A. Persinger, Behavioral Neuroscience Laboratory, Laurentian University, Sudbury, Ontario P3E 2C6, Canada.

REFERENCES

CAIN, D. P. Excitatory neurotransmitter in kindling: excitatory amino acid, cholinergic, and opiate mechanisms. Neuroscience and Biobehauioral Reviews, 1989, 13, 269-276.

HARPER, M., & Roth, M. Temporal lobe epilepsy and the phobic anxiety-depersonalization syndrome: Part I. A comparative study. Comprehensive Psychiatry, 1962, 3(3), 129-151.

MAKARECK, K, & PERSINGER, M.A. EEG validation of a temporal lobe signs inventory in a normal population. Journal of Research in Personality, 1990, 24, 323-337.

PERSINGER, M.A. Striking EEG profiles from single episodes of glossolalia and Transcendental Meditation. Perceptual and Motor Skills, 1984, 58, 127-133.

PERSINGER, M.A., CARREY, N., & SUESS, L. TM and cultmania. Boston, MA: Christopher Publ., 1980.

PERSINGER M.A., & MAKAREC K. Temporal lobe signs and correlative behaviors displayed by normal populations. Journal of General Psychology, 1987, 114, 179-195.

YOUNG, M.L. Agartha: a journey to the stars. Stillpoint, N H : Walpole, 1984.

Accepted November 27, 1992.
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Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Sun Feb 24, 2019 1:26 am

Relationship of meditation and psychosis: case studies
by Sujata Sethi, Subhash C. Bhargava
Department of Psychiatry, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
Aust N Z J Psychiatry. 2003;37(3):382.

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The word meditation is much used these days, covering a wide range of practices with an ultimate aim of controlling the mind and enhancing psychological health. Altered perceptions, and surfacing of repressed memories and conflicts have been reported during meditation [1]. There have been few reports of precipitation of psychosis in vulnerable individuals [1,2]. We discuss the possible factors operative in the precipitation of psychosis in two meditators.

Case 1 Mr A, a 20-year-old male, presented with a one-month history of aggressive behaviour, inappropriate laughter and suspiciousness. Examination revealed delusions of persecution and of reference, and auditory hallucinations. Prior to the onset of illness he had been practicing intensive meditation for 4 days without communication of any kind with outer world; he had also been fasting, and sleep had been reduced. There was no previous personal or family history of psychiatric illness. A diagnosis of schizophrenia was made. Treatment with olanzapine was started with good response. The patient discontinued treatment after 3 months and again became symptomatic. Treatment was reinstituted and he responded rapidly.

Case 2 Mr D, a 30-year-old married male, was brought home by his colleagues from a meditation retreat centre as he started to exhibit bizarre behaviour on the sixth day of the retreat. At the time of examination, he appeared to be perplexed and exhibited bizarre religious delusions. His sleep was markedly disturbed. He was hospitalized and treated with risperidone. The final diagnosis was schizophrenia. Reportedly, he had had two previous psychotic episodes, each one after attending the annual religious retreat, and with complete interepisode recovery.


These cases raise the issue of whether meditation can induce psychosis. Fischer [3] described perception– hallucination–meditation on a continuum; creative, psychotic and ecstatic experiences on one end and hypoarousal states of Zazen and Samadhi on the other. Normal persons may travel freely between states [3]. Vulnerable individuals may get stranded at this stage and eventually have a psychotic breakdown, especially under stress. People with a previous history of psychosis have been recognized as more vulnerable to have a psychotic breakdown during intensive meditation [1]. Also, it is arguably not the meditation alone that is causal; the associated fasting, and sleep and sensory deprivation could be other factors contributing towards the precipitation of psychosis. On the other hand, there are data to suggest that meditation in moderation can be helpful in treating a range of psychopathology [4]. Review of the history from the two reported patients, as well as from the their families, did not suggest that these patients were psychologically unwell prior to attending the meditation courses.

Attending meditation retreats is a common and regular practice in northern India. When carried out under proper guidance and in moderation, meditation can enhance psychological wellbeing [1].

_______________

References

1. Walsh R, Roche L. Precipitation of acute psychotic episodes by intensive meditation in individuals with a history of schizophrenia. American Journal of Psychiatry 1979; 136:1085–1086.

2. Chan-ob T, Boonyanaruthee V. Meditation in association with psychosis. Journal of Medical Association of Thailand 1999; 82:925–929.

3. Fischer R. Cartography of the ecstatic and meditative states. Science 1971; 174:897–903.

4. Shafii M. Adaptive and therapeutic aspects of meditation. International Journal of Psychoanalysis and Psychotherapy 1973; 2:367–382.
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Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Mon Feb 25, 2019 5:44 am

Buddhist Teachers' Experience With Extreme Mental States in Western Meditators
by Lois VanderKooi
The Journal of Transpersonal Psychology, 1997, Vol. 29, No. 131
Copyright © 1997Transpersonal Institute

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Boulder, Colorado

In the past thirty-five years, Buddhism and its sophisticated meditation practices have attracted a large number of Western students, especially those in search of a psychologically oriented spirituality. Based on descriptive and qualitative research, this paper focuses on extreme mental states that can occur in emotionally fragile Western students undergoing intensive meditation and the adaptations that teachers have made to deal with these difficulties. Implications for the clinical use of meditation will also be addressed.

BUDDHIST BASICS

Goals and Methods of Practice


Freud approached Eastern practices with misgiving, equating mystical states with "oceanic feelings" and a search for "restoration of limitless narcissism" and the "resurrection of infantile helplessness" (Freud, 1961, p. 72). As Epstein (1986, 1988, 1995) points out, Freud was unaware of Buddhist methods and goals which involve the dismantling of narcissism and the notion of inherent selfhood. The process of reaching nirvana or the "Absolute" (italicized terms are defined in the glossary) is far from blissful, and nirvana is far from narcissistic grandiosity and self-absorption.

Buddhist training involves moral discipline (shila) to increase wholesome states of mind, training in concentration and mindfulness (samadhi), and training in wisdom or insight into the true nature of phenomena (prajna) (Brown, 1986; Goleman, 1988). The ultimate fruit of training is to end suffering by realizing the Four Noble Truths: that life is basically unsatisfying, that suffering is caused by attachment arising from ignorance about the nature of reality, that suffering can cease with release from clinging, and that freedom is realized by living the Noble Eightfold Path: right understanding, intention, speech, action, livelihood, effort, mindfulness, and concentration. The three major defilements conditioning worldly existence, namely attachment (lust, desire, greed), aversion (hatred, anger, and aggression), and ignorance are overcome with realization of shunyata. Shunyata or "emptiness" is difficult to describe and explain, and there are doctrinal differences as to its meaning (Hopkins, 1983). It involves the "middle way" in that both inherent or independent existence and total non-existence are refuted. Through insight into the components of experience, one realizes that there is no "inherently existing I" and appreciates the representational and relative nature of reality (Epstein, 1989, 1990). One adopts neither an absolutistic stance involving belief in an eternal principle (godhead, self, eternal beyond) nor a nihilistic stance involving belief in voidness. One realizes that phenomena are interdependent and mutually condition each other. Realizing shunyata and interdependence, one lives with equanimity, wisdom, and compassion, fearless and awake to each moment of life. "In its true state, mind is naked, immaculate ... not realizable as a separate thing, but as the unity of all things, yet not composed of them; of one taste, and transcendent over differentiation" (Evans-Wentz, 1969, p. 211). It should be noted that there are degrees of enlightenment, and full enlightenment is more an ideal than an attainable reality. Brown and Engler (1986) found it extremely difficult to find people who had attained the last two paths of enlightenment (Nonreturner and Arhat) as outlined in early (Theravadan) traditional literature.

Buddhist meditation can be divided into two major branches, samatha, which stabilizes the mind, and vipassana, which is uniquely Buddhist and the basis of insight (Goleman, 1972a, 1972b; Gunaratana, 1985/1992; Lodro, 1992; Sole-Leris, 1986). Samatha practices involve concentrating on a prescribed object to attain tranquility and absorption. The mind gradually withdraws from all physical and mental stimuli except the object, and the usual conceptual mode of thinking is suspended. Mindfulness is used to guard against active senses and thoughts, which, on the one hand, scatter the mind, and, on the other hand, lend to a passive dullness which prevents clarity and focus. Body and mind become pliable as one progresses, and, in the end, one experiences samadhi or dwelling effortlessly, mind unified with object. In the Theravadan tradition, once adequate mindfulness and concentration are achieved, vipassana meditation begins. This involves paying "bare attention" to the rising and passing away of phenomena. One fully and precisely examines sensory and mental processes, moment by moment, to realize the nature of phenomena -- impermanent (anicca), unsatisfactory (dukkha), and lacking inherent essence or self (anatta). It is said that one of these marks of existence can serve as the gateway to nirvana and liberation from suffering.

As outlined by the Yisuddhimagga (a fifth-century work that supposedly collects the Buddha's teachings on meditative states), the process of realizing nirvana is fraught with troubling and sometimes excruciating states (Brown & Engler, 1986; Namto, 1989; Nyanamoli, 1976). Initially, confusion, hallucinations, disturbing feelings, and involuntary movements can occur as one gains knowledge of mental and physical states through increasing concentration and mindfulness. As samadhi is achieved, "pseudo-nirvana" experiences of rapture, tranquility, and bliss can be accompanied by frightening images, uncomfortable body sensations such as itching, heat, and stiffness, and gastrointestinal problems of nausea, vomiting, and diarrhea. Then, sadness, irritability, extreme fear, and a deep sense of the insipid nature of life may manifest as one becomes more and more aware of the arising and passing away of phenomena. A desire for deliverance can emerge, and one may wish to discontinue practice. For example, the body may itch as though being bitten by ants. Later, when deciding to practice to completion, one may feel odd sensations such as being slashed by a knife. Finally, as equanimity is achieved and mindfulness and concentration become balanced and natural, practice becomes smooth and one may be able to meditate for hours.

There are many types of meditative practices, and even within the major divisions of Theravada (Southeast Asia), Zen (China and Japan), and Tibetan (Himalaya region) traditions, practices vary. Theravada practices (see e.g., Goldstein, 1987; Goldstein & Kornfield, 1987; Kornfield, 1977; Namto, 1989; Nhat Hanh, 1987) usually involve detailed mindfulness of the aggregates which constitute personality, namely those of form (body senses, postures, and movement) and mind (feelings of pleasantness, unpleasantness, or neutrality, perception, mental states and contents, and consciousness itself). Initial practice involves developing concentration and mindfulness by alternating periods of sitting and walking meditation. The meditator focuses on the breath, then other sensations while sitting, and on the components of movement while walking slowly. When the mind wanders, mental noting is used to return to mindfulness. For example, when distracted by sound, the meditator notes "hearing" versus becoming lost in thoughts about the sound. Gradually, as skill develops, other objects are the focus, and the meditator develops "bare attention" or an awareness of phenomena without the usual self-consciousness and conceptual-perceptual elaborations. For example, in seeing or hearing something, one may see only color or hear vibrations.

Zen practices tend to focus more on concentration than detailed mindfulness, at least initially. Meditators are usually instructed to focus on the breath, first counting it and later just being aware of it without letting the mind wander. In the Rinzai tradition, once sufficient concentration is achieved, a koan, or question impervious to solution by logic, may be assigned. Some well-known initial koans are Chao-Chou's dog (Mu), the sound of one hand clapping, and your original face before your parents were born. The meditator becomes absorbed in the koan and eventually experiences kensho or breakthrough to an intuitive, nonconceptual experience. After that, other koans are assigned to deepen and extend the enlightenment experience (Loori, 1992). Shikantaza or "just sitting" is an alternative route and involves mindfulness as well as concentration by simply watching thoughts and sensations come and go (Goleman, 1972b). Rather than striving for kensho, proper posture and breathing are stressed, both to unify body-mind and to cut through attachment to the thinking mind. In both koan and shikantaza practices, attachment to thoughts lessens and then stops, and then the thinker too may disappear. Eventually, after years of practice, shunyata may be realized, and this realization penetrates daily life.

Tibetans utilize initial practices similar to those of Theravada and Zen except that they do not use koans (Gen Lamrimpa, 1992; Gyatso, 1991; Lodro, 1992; McDonald, 1984; Wangchen, 1987). Some schools emphasize philosophical analysis and study of texts, considering these as meditation because they help create wholesome states of mind and lay a foundation for later realization. Mandalas, visualizations, mantras, poly tone chanting, and complicated rituals are also used, which in conjunction with Tibetan cosmology and understanding of mind, can make practice complex indeed (Goleman, I972h). At advanced stages, more esoteric Tantric practices may he undertaken. Involving primal energy and emotion, these supposedly are quick paths to enlightenment ( i.e., they take only one lifetime) and provoke a wakefulness that is sharp in its ability to cut through habitual mind and pride. Because they can be dangerous and involve psychotic-like experiences, these practices require the guidance of a qualified teacher, and adequate ego strength and foundation in philosophy and meditation on the part of the practitioner.

STUDY RESULTS

Western psychology has usually focused on the short-term physiological and psychological benefits of meditation outside of a Buddhist context (see e.g., Carrington, 1977; Shapiro, 1982; West, 1987). As mentioned above, this study focuses on the experience of Buddhist teachers in dealing with problematic states that occur in some students during intensive meditation, some examples of which are described. Traditionally, although dealing with nonordinary states of consciousness (NSC) that occur during meditation, Buddhists did not deal much with extreme mental states, such as psychosis, because very troubled people were restricted from entering practice. With a focus on how prana or energy moves through channels in the body, Tibetan teachers probably have the most complex understanding of how extreme mental states can occur during meditation which is improperly done or excessive (Epstein & Rapgay, 1989). Buddhists also have not traditionally focused on dealing with students' personal history, emotions, and relationship problems. These have become more pertinent in the practice of Western students who often turn to meditation for psychological relief and help with problems in these areas. Brown and Engler (1986) note that unlike people in the East, many Westerners practice a form of self-exploratory therapy while meditating and consequently fail to develop the concentration and mindfulness which is necessary for formal meditation.

Descriptive and phenomenological research methods were used in this study because of 1) the historical and cognitive-subjective nature of the data, 2) difficulties in measuring such data "objectively" and in using a rigorous research design, and 3) the study's exploratory nature (Polkinghorne, 1989). Semi-structured interviews were conducted with a total of twelve experienced and sanctioned teachers, four each from Theravada, Zen, and Tibetan traditions, and four college-educated meditators who had major difficulties with meditation and volunteered to talk about their experience. Subjects were recruited through therapist and Buddhist contacts in Colorado. The teachers were asked about their meditation techniques and process and their experience with handling both vulnerable meditators and extreme mental states. The meditators were asked about their spiritual and psychological history and about the difficulties they encountered. Besides interviewing these subjects, the author attended nine meditation retreats led by various Theravada, Zen, and Tibetan teachers to gain personal experience with the meditation retreat milieu.

Three vignettes are presented to illustrate the range of motivations, personality structure, and experiences that meditators may have, and then teacher experiences are summarized to illustrate how they have adapted meditation practices to deal with meditator difficulties. Identifying information has been changed to protect confidentiality.

Meditator Experience (Three Vignettes)

Cracking the shell: Quest of unraveling.


Sara comes from an upperclass, ambitious family, which has no history of major mental illness. Her father, a successful businessman, wanted Sara to follow in his steps. She accordingly began work on a MBA, which was antithetical to her true desire to be an artist. In college, she generally felt depressed, saw a therapist a few times, and frequently turned to alcohol. She had an experience, however, while writing a paper about Blake, that everything was in her mind. This was freeing, and she felt that she had glimpsed a higher state of consciousness. After a year of misery in graduate school, she dropped out and turned to Zen, which was attractive because its simplicity and meditation practice promised freedom of mind despite life circumstances. Also, the Zen meditators seemed to constitute a more like-minded, understanding family than her family of origin.

Sara began working odd jobs and participating in all the activities of her Zen center. She attended morning, evening, and all-night sittings and seven-day retreats. The center was large, and she was "just a beginner," which meant that she did not have a position or duties. The center had a hierarchy of students with senior students playing major roles. Those who had "broken through" wore a special cloth, setting them apart. An "all or nothing" attitude pervaded the atmosphere, and people were encouraged to go to the extreme of practice. It was believed that the harder one worked, the longer and more one-pointedly one focused in meditation, the more likely one would experience kensho. The teacher, an American trained in Japan, was generally distant and formal. Sara admired him from afar, and they did not know each other well. She only talked with him during retreat interviews in which the teacher guides and tests each student's progress in meditation.

Sara does not remember whether students were screened in terms of their ability to handle meditation (this was in the mid-1970s). She said that one "had to be a good and devoted sitter" to attend a retreat. She never felt at risk in sitting strenuously and sat at least two hours a day when not in retreat. She had no problems until the retreat that preceded her psychotic break. That retreat occurred after she had seriously meditated for a year and a half. It was a seven-day retreat following another seven-day retreat that had ended a week before.

The retreat was intense. Sara meditated day and night with breaks for meals, chanting, work, and rest during the day and breaks for juice at night. She said that, fiercely intent on going deeper, she was able to sit full-lotus and did not experience pain. She had intense makyo (nonordinary sensations, perceptions, and emotions) but did not fear going crazy. The makyo involved mostly positive imagery except near the end, when there were demon-like faces. She also experienced going down a shaft, opening doors to different realities. At the end, she experienced an overwhelming sense of holiness and felt she had tapped into universal mind. She was able to let the makyo go and was sure she had broken through, as she could answer most of the teacher's questions, and he hugged her and seemed to appreciate her experience.

Following the retreat, Sara told others that she had broken through. Word got back to her teacher, and he told her otherwise. She thought that he just wanted her to go deeper, so meditated more. She experienced being like a bird in an egg, tapping to get out, and suddenly she heard tapping from the other side. She felt that God was revealing Himself and tapping to free her, and she was ready to "throw herself into the fire of consciousness to break through to His love." That was when she consciously decided to let her mind go. After that, everything seemed symbolic and had cosmological dimensions. She found her mind racing as she tried to figure everything out. She thought and thought and wandered around looking for her teacher, who she believed was God. Finally, she was hospitalized and received antipsychotic medication.


In the next few years, Sara went on and off medication and required further hospitalization. She returned to the Zen Center, but did not heed advice to take her medication, and eventually was not allowed to be there. She thought that she was going through an enlightening experience and did not understand people's concern. She felt hurt that they pushed her away.

Sara's experience in the mental health system was taxing. Few understood her experience and most were condescending. She felt that her mind was "unraveling," with all the major fears, desires, and "skeletons from the past" emerging into consciousness. She was helped most by a Buddhist psychiatrist who acknowledged the value and spiritual dimension of her experience and helped her remain grounded with medication and questions about mundane things.

Sara received a diagnosis of schizophrenia.
In trying to understand her experience, she assumes that she has some genetic, biochemical proclivity for psychosis and that her lack of control over the unraveling resembled schizophrenia. At the same time, the spiritual quest and her sense of release from past karma seemed different. Once the "unraveling" was complete, she felt more stable and peaceful than ever before and was able to discontinue medication.

Currently Sara meditates an hour a day. She follows her breath, thinks about things (though not in the prior searching way), and listens to her inner life. She lives alone and tries to live according to her ideas of simplicity and mindfulness. She believes that more intense meditation would be harmful. She also feels her spirituality is closer to Christianity at this point, in part because of her experience of God tapping at her shell.
She says that she does not often share her unique, personal, and somewhat mystical spiritual beliefs with others.

Terror alone: Snapping and song yet unsung.

Ada grew up in a "workaholic" home with parents too busy and striving to pay attention to a little girl. Sweets were soothers, and "happy and good" were the ways to be. As an infant, she was left to cry for hours, and she remembers three times of terror as a young child when she did not know where she was while in a familiar place. As a teenager, she experienced ecstasy while intensely writing poetry, which she felt was an avenue to a different type of consciousness.

Ada's involvement in meditation began in 1967 with TM (Transcendental Meditation), which helped calm her after a breakup with the "love of her life," Paul. Nine months later she entered a year-and-a-half practice of Vedanta, a form of Hindu mysticism, which involved meditating on a spiritual passage. Ada "upped the ante" after reading books by Watts (1957) and Kapleau (1965/1989) which describe Zen enlightenment experiences. She began practicing in earnest after meeting a Japanese Zen master in 1970 who was "dear and warm." Paul, also excited about Zen, came back into her life, and they sat and studied regularly with a group. It was a "high" time.

Ada was attracted to the "intensity, high drama, and do or die effort" of Rinzai Zen. It felt good to "bust her butt" and survive the pain of extended sitting. She does not remember which practice her teacher taught, but knows that she pushed herself to the limit. She took his words "just sit" to heart after seeking his help regarding a career in opera and a failed relationship with Paul. Thinking that her problems would be solved if she became enlightened, she meditated as much as possible. She attended at least one extended retreat a month with various teachers. When not in retreat, she sat for at least four hours a day and otherwise tried to remain in the moment. She felt peaceful and loving, more like herself than ever before. Veils fell from her eyes, and she experienced "everything just as it is." Yet, she still was unsure about her career. Conversations with others seemed trivial, and she cut off relationships and discontinued therapy. In retrospect, she thinks that her practice was an evasion of painful feelings, which would make themselves known at some point.

After six months of such practice, Ada attended a ten-day Theravada retreat involving concentration and mindfulness practices done alone in one's room. The teacher checked on each person daily and gave group talks. Ada had intense makyo during the retreat: crackling electricity traveled up and down her spine, and she felt profoundly relaxed as she recalled early memories of sounds and sights. Near the end of the retreat, she woke to an "absolute state" that she believed was kensho. First came cosmic pulsation with things flowing towards a single point and erupting back through it. Then appeared a sheet-like image with elements of reality floating. As she looked at them, she realized that they were her and that there was nothing in the universe except her. Rather than joy, she felt extreme fear and loneliness. The next morning, when she yearned for affirmation and advice, her teacher responded, "Now you know that you're afraid of being alone."

After the retreat and during the month prior to her "breakdown," Ada had another unbearable experience of loneliness. She also took LSD for the third time in her life and had a "terrifying trip" that involved disintegrating into bones. She willed herself out of that by refusing to accept it. She also was deeply "grabbed" (influenced) by Janov's "Primal Scream," and thought that if she reached and released her primal energy, she would be free. Then something "snapped," and she felt tremendous grief, then rage and terror. Only months later did she connect this experience to her grief about losing Paul.

The next few years were like "heavy labor with no rest" and "being in a tunnel without light." Ada could not talk about her pain and felt that people would lock her up if she did. She reentered therapy and tried other things as well: encounter and therapy groups, energy and body work, and Arica training, which involves meditation, yoga, body work, and psychological processing. The therapies never quite enabled her to reach and release her core problem. She also meditated and attended retreats, but found that her energies were too high to feel safe with meditation. She did not know how to transition back into the world of ordinary experience. She met with a Zen teacher who was also a psychoanalyst, but was not able to heed her advice because she (Ada) was too "freaked out" and emotionally disconnected. This teacher affirmed her kensho and "ripe" concentration practice, but advised that she needed more balance-work, singing, and a light meditation practice. Throughout this difficult period, she experienced one sign of hope: a dream of herself holding a tennis racket that resembled an Ankh, Egyptian sign of life.

Twenty years later and after even more therapy, Ada still struggles.
She believes that she has a borderline personality disorder and agrees with Engler's (1986) idea that you cannot go beyond yourself until you have a self. She does not meditate much for fear of what might come up but has worked with a Theravada-Zen teacher who meditated with her, demystified "enlightenment," and gave her feedback about her meditation. The technique of noticing what is prominent in the body and being with it helped her with pain a few times and offers hope. Ada says that when she first practiced, teachers were not psychologically sophisticated enough to ask about students' lives or to process emotional issues. She believes that she could have benefited from a moderate, gentle practice and advice to work, sing, and learn to relate better. I needed someone to investigate my big hurry and terrible race toward enlightenment, and to say that I was running from something."

Lost in thought: Twenty-four-hour practice.

Rose's family history involves mental illness: two siblings suffered psychosis or suicidal impulses, and her father, a physician and researcher, is riddled with phobias and compulsions. Rose's first psychotic episode occurred when she was nineteen and her second a year later. They were triggered by relationship stresses involving family and two gestalt therapists who she experienced as using her to work on their marital problems. The third occurred at age thirty-seven and the fourth at age thirty-nine. These related to not knowing her limits and becoming overextended and "lost" without realizing it. The last involved meditation, a "twenty-four-hour practice" as Rose calls it.

Rose first read a Buddhist book in her mid-twenties. She likes philosophy, thinking about mind and spirituality, and is interested in other cultures, and found Buddhism intellectually stimulating. Also, she felt frustrated with her psychosis and disliked the "deadening" effects of medication. She saw that TM helped a friend become less flighty and more able to be alone, and she hoped that meditation would help her gain control of her mind and be more content with herself. She did not begin meditating until her mid-thirties, however. At that time, stress over having a boyfriend in prison and exposure to Trungpa Rinpoche's (1969) Meditation in Action prompted her to seek instruction. She was told to follow her breath while sitting comfortably and to label any thoughts that arose as "thinking" and return to her breath.

Rose had two consecutive meditation instructors; she did not feel comfortable with either. She thought one was too strict and pushy about a particular type of training. She felt too intensely about the other and also worried that she was insensitive to him. Generally, she feels hemmed in and controlled by others' instructions. She ended up meditating on her own with little instruction and no supervision. She practiced at most three hours a week and generally did not meditate daily or at the same time every day.

Five years later, Rose met a Tibetan teacher who seemed to her to know what he was doing. He was not pushy about the practice, was careful about the effect of his words, and would stop if someone said he was going too far. He also tolerated doubt and skepticism and wanted people to think for themselves. She went to a weekend retreat that he led and was interviewed. Her only strange experience came before the interview. She felt driven to get up enough nerve to even have the interview and then experienced seeing a series of faces as she looked in a mirror. She had an "ordinary, down-to-earth conversation" with the teacher but did not mention the faces.

Rose did not tell her teachers about her prior psychotic episodes. They may have known about them through her therapist, but, if so, did not mention them to her. Her goal to overcome psychosis through meditation was never clarified.

The Tibetan teacher emphasized a "twenty-four-hour" practice of mindfulness as well as sitting meditation. This appealed to Rose and she began sitting for hours, letting her mind wander while half noticing her breath and other things. She discontinued her antipsychotic medication on her own a few months after the retreat. She also was working less, so she had less structure and contact with people. Moreover, the Los Angeles riots occurring after the Rodney King verdict of 1994 upset her greatly. Due to a foot injury, she then lost her usual way of stabilizing her mind, which was running. Running relaxed her and slowed her mind so that thoughts came more gradually and were more to the point. Around the same time, she saw another face in the mirror and began having intense fantasies involving reincarnation and Christian symbols. These experiences became more important than details of her everyday life, and she lacked her usual awareness and her usual fear that she was going too far. Her psychotic break occurred six months after the retreat.

Rose was hospitalized and she resumed medication. Her diagnosis has been paranoid schizophrenia. She finds the diagnosis hurtful and limiting, a label of being different and "all washed up." It also pressures her to become well and "enlightened." "Psychosis does not mean you're better or worse than others; it's just what has happened to a person in her life."

For her practice Rose now uses a Yoga tape that helps induce sleep through relaxation of different parts of the body. She thinks about seeing the Tibetan teacher again but does not feel ready to face questions about why she wants to meditate and see him. Her spirituality is private. She is trying to regain a sense of wonder and to accept her life, freed from the compulsion to be like everyone else.

Teacher Experience. Understanding of nonordinary states of consciousness (NSC).

The Buddhist teachers interviewed in this study (four Zen, four Theravadan, four Tibetan, all teaching in the U.S.) understand NSC as phenomena that often emerge as practice progresses. Similar to the "unstressing" cited in TM literature (Carrington, 1977; Goleman, 1971), NSC common in early phases of Buddhist meditation include disturbing emotions and fantasies, perceptual aberrations and hallucinations, memories, and proprioceptive sensations and movements (see also, Epstein & Lieff, 1986; Komfield, 1979). A Zen teacher noted that NSC at a later "preawakening" phase are different from earlier NSC. They tend to be either very alluring, often involving religious symbols and blissful feelings, or very frightening and evocative of doubt. Two Tibetan teachers noted that in advanced Tantric practices, visions of deified aspects of mind (yidams) can resemble psychosis in that they are both real and imaginary, external and internal.

The teachers defined psychosis as a problem of overidentifying with NSC and being unable to disidentify and let go. Also, several teachers said that psychosis involves an inability to function and respond in normal ways. Some Zen teachers noted that samadhi and kensho can involve a loss of functioning that can last from minutes to hours, however.

The teachers posited various reasons for NSC, some related to meditation and others not. All correlated NSC with deepening concentration, which seems to settle the usual discursive mind and allow other layers of mind to emerge, layers seen as tainted by the defilements of existence. The Theravadans especially emphasized that NSC emerge and become problematic when concentration is not balanced with adequate mindfulness, which can cleanse the mind of these defilements. Zen teachers suggested that incorrect posture and breathing also contribute. Tibetan teachers spoke of how an improper use of certain advanced meditation practices leads to an incorrect flow of energy in the body. All of the teachers noted that excessive effort and striving creates problems with NSC; the Asian teachers said that perhaps this was a bigger problem for meditators in the East because they have been culturally conditioned to seek enlightenment. Factors not related to meditation include health imbalances arising from lack of sleep, poor diet, and stress.

Dealing with NSC.

NSC are relatively common during intensive, prolonged meditation, and teachers are accustomed to dealing with them. Some Theravadans estimated that during a three-month retreat, about half of the students experience NSC. In dealing with these, teachers generally assure students that such phenomena occur with deepening practice but will pass. They try to help the student just observe the experience without denying, rejecting, or indulging it. They may supportively listen, such as when memories of trauma emerge, or on the other hand, they may make light of NSC that the student mistakes for enlightenment. Theravadans tend to focus on "mindfulness in the present moment" and may have the student "mentally note" the experience without getting caught up in its content. Zen teachers may correct the student's posture and breathing. A Tibetan teacher noted that he circumvents problems with NSC by checking for health imbalances that cause difficulties and has students start with a short practice and gradually increase time meditating as they gain insight.

When NSC is more extreme, a student may become paralyzed and unable to follow meditation instruction. At this point, most teachers advocate decreasing concentration on the meditative object, such as a koan or the breath; instead they ask the student to develop a more panoramic mindfulness of internal and external stimuli. This can mean "lightening up" and just watching the mind without judgment and effort to practice. Theravadans may have the student focus mindfully on the body or what is happening presently in the mind. Zen teachers may switch a student from a more concentrative koan practice, which tends to suppress unconscious material, to shikantaza or breath practice, which allows material to emerge more naturally and slowly. Teachers may also have more frequent interviews with the student, decrease the student's sitting time, and involve the student in "grounding" physical activities. A Tibetan and Theravadan commented that they sometimes confront a student's NSC as being "crazy." Some Theravadans have found that acupuncture treatment and heavier meals of meat and pasta can be helpful as well.

The teachers identified a number of signs that these extreme NSC could foreshadow a psychotic break. These include obsession with the NSC, more negative, fearful, and bizarre NSC, fear of going crazy, aberrant behavior, and emotionally disconnected "schizoid" states. One teacher thought that people prone to psychosis have more rage and self-pity and fewer moments of sadness and clarity than those who are not prone. Another teacher said that lack of humility is a sign of difficulty. These warning signs generally signal a need to discontinue or lighten up in practice.

The teachers found that psychosis, estimated to occur in far less that one percent of meditators, can develop at either initial or advanced stages of practice. During initial stages, it can rather easily occur in people with a history of psychosis; it relates to the student's inability to use meditation practices to stabilize the mind as defenses are relaxed. A Zen teacher said that he knows of a few cases where psychosis occurred after a retreat. He finds that stripped of their usual defenses, students can become depressed and overstimulated when they reenter ordinary life. In more advanced stages, psychosis is very rare because meditators have developed more equanimity or ability to observe and let go of mental content. Psychosis at advanced states usually relates to excess concentration and overexertion. The Tibetans called this a "sokrlung" disorder, which involves energy moving improperly in the body. Several teachers noted that Western meditators tend to give up meditation when they encounter difficulty. Few reach advanced stages of practice where meditation-related psychosis can occur.

If psychosis occurs in initial phases of practice, the student is asked to discontinue meditation and may be asked to leave the retreat or be hospitalized if they cannot return to ordinary functioning. A Theravadan said that, for more advanced meditators who develop true meditation-related psychosis, he may ask the student to focus on the state of mind as an object of mindfulness. If that fails, he may try to get at the deeper meaning of the problem or change the object of mindfulness. A Tibetan advised that advanced meditators need a qualified teacher to help with the practice used and to differentiate between psychotic states and true spiritual visions. Another Tibetan noted that advanced practices are meant to provoke confusion and extreme states. He tries to help people find balance between withstanding discomfort and knowing their limits so that they do not damage themselves.

Adapting to Western students.

The teachers reported that they have learned more about psychology in working with Western students, some with major mental illness and many with motivation to deal with psychological problems. Several teachers noted that they consult with mental health professionals regarding severe psychological problems in their students. Teachers who were demanding of students twenty years ago have become more moderate and gentle. They now believe that vigorous approaches help some students, but that in general, pushing students to "break through" does not facilitate integration of enlightenment experience and can damage students who are psychologically fragile. They emphasized knowing students so that practice can be tailor-made for each student's temperament and needs. Teachers with students who have a major mental illness said that they advocate moderation, teach initial mindfulness-breath practices, and increase their monitoring of the student's practice. Two said that metta or loving-kindness meditation can help as well, because such students often suffer from poor self-esteem. Many also encourage utilization of Western medication and therapy and restrict such students from attending retreats that last more than two days. Teachers also have instituted screening questionnaires and interviews to assess students' ability to handle meditation, asking about things such as prior history of psychosis and health status. Such screening has virtually eliminated problems with students becoming psychotic during initial practice, even though some students lied about their history. Teachers still have difficulty assessing students who do not have a history of psychosis. One noted that he knows of several high-functioning, articulate, and humorous people who had brief psychotic episodes during advanced Tibetan practices. Generally, teachers reported that too much effort and too much or too little anxiety can signal difficulties and that high-strung, emotionally volatile people have more intense and frequent NSC. The teachers tend to deal with these people by supportively listening and guiding, paying more attention than before to psychological issues. The Zen teacher who noted students' vulnerability after retreats has also started checking on fragile students a few days after a retreat.

DISCUSSION

It is apparent that Buddhist teachers have become more psychologically sophisticated in working with Western students over the past thirty-five years and have adapted traditional meditation practices to deal with extreme mental states that may arise during intensive meditation. The meditator vignettes illustrate some of the difficulties that can occur when a student's life, motivations, and vulnerabilities are not well understood, and when a student leaves the monitored and protected retreat milieu. The experiences of Sara and Ada suggest that narcissistic issues around grandiosity and borderline issues around abandonment can be activated in more advanced stages of meditation. They also illustrate how extreme effort to attain enlightenment can itself be a symptom and can create harmful imbalance in the mind and daily life. With such students, teachers may need to emphasize other aspects of Buddhist training besides meditation, e.g., relationships in the community (sangha) and moral precepts (shila). Rose's experience suggests that it may be difficult for students with a major mental illness to openly discuss their concerns with a teacher. Teachers may need to be more active with such students in discussing mental illness and being clear and supportive in their suggestions for practice. They can also foster community understanding and support.

Implications for the Clinical Use of Meditation

Meditation can enhance self-awareness and self-regulation, goals of most psychotherapies in working with a broad range of patients. Similar to expressive psychotherapies that aim at uncovering the unconscious, meditation has "derepressive" and destabilizing effects (Wilber, 1986). In both meditation and psychotherapy, one must deal with issues of personality structure, motivation, resistance, and relationship as the mind opens up to itself and becomes more integrated and stable.

This study has a number of implications for therapists who "prescribe" meditation or work with patients who meditate as a spiritual practice: 1) Most people will not have difficulties with meditation unless they meditate intensively. This is consistent with Glueck and Stroebel's (1975) findings that psychiatric patients benefited from TM at prescribed twenty-minute periods twice a day, but were prone to psychosis when meditating more. 2) Some meditative practices are more appropriate than others, depending on a patient's needs. Initial concentrative practices that focus on the breath can help patients calm themselves but, if engaged in over an extensive period of time, may result in NSC that are experienced as troublesome. Initial mindfulness practices involving breathing, mental noting, and awareness of body sensations may help patients become more grounded in the present. Metta meditation (Salzberg, 1995) can help develop a sense of kindness towards oneself and others. Any physical activity, including martial arts and yoga, can be an antidote for overwhelming thoughts and emotions. 3) Most meditators will discontinue meditation when frustrated or remain beginners because of the dedication, perseverance, and time it takes to develop meditation skills. As Allen (1995) points out, meditation and other self-regulation techniques are simple but require motivation and practice. Because of self-hatred, patients often fail to do things to care for themselves. Thus, resistance to self-care must be explored and encouragement to begin and maintain practice must be given. 4) Although Westerners tend to focus on Buddhist meditation, other aspects of Buddhist training, such as being a member of a community and practicing moral precepts, may be equally or more helpful for psychological and spiritual development.

In sum, Buddhist practices, as being adapted by teachers in the West, seem to offer a promising avenue of psychological and spiritual development. Possibilities for further study of the interface between Buddhist practice and Western psychology abound. For example, one could focus on the nature and use of transference in student-teacher relationships. A teacher in this study noted that he treats students differently at different stages of their practice: he is a parent in initial phases, a guide as the student becomes more independent, a spiritual friend who can also learn from the student, and finally not a teacher at all. Sexual relationships and the power differential between teachers and students have been topics of animated discussion and could be studied as well.

GLOSSARY

kensho-Zen expression for the experience of awakening or breaking through normal consciousness to realize one's true nature and the nonduality of the "Absolute" (nirvana) and "Relative" (samsara).

jhana (Pali) (dhyana. Skt.)-a degree of absorption on a continuum (eight jhanas altogether), beginning with a full break with normal consciousness that is characterized by absorption in the meditative object to the exclusion of other thoughts and sensory awareness.

koan-Zen teaching phrase or story that presents a paradox unsolvable through logic or reason. In concentrating on a koan and attempting to solve it, one is forced to transcend discursive thinking and realize a world beyond dualism. It is used to promote initial kensho and subsequently, to deepen realization.

makyo--Zen term for the deceptive, illusory sensations and feelings that arise in meditation.

nirvana (nibbana, Pali)-the "absolute" or unconditioned, uncreated, unformed realm beyond and underlying consensual. phenomenal reality (samsara), Awakening to nirvana and realizing it in samsara is the goal of meditation.

prajna (panna, Pali)-"insight wisdom." The definitive moment of prajna is insight into emptiness [shunyata], which is the true nature of reality.

prana-life force. "wind," or energy that in Eastern thought circulates through channels in the body and supports life processes.

Rinzai-one of the two major schools of Japanese Zen. Koans are an integral part of its practices.

samadhi-nondualistic state of consciousness reached when the mind becomes absorbed in an object through focus on the object and calming the mind.

samatha (Pali) (shamatha, Skt.)-"calm abiding" or "dwelling in tranquility." One of the two major branches of meditative practices in Buddhism. Samatha calms the mind and culminates in samadhi and jhana levels of absorption.

samsara-the "relative" or conventional, phenomenal reality conditioned by the three "unwholesome" roots (attachment, aversion, ignorance) that tie beings to worldly existence, which involves birth, sickness, old age, and death.

shikantaza- "just sitting," A form of Zen practice that involves a neutral, mindful observation of thoughts and sensations as they come and go.

shila (sila, Pali)-precepts or ethical guidelines for those on the Buddhist path. More broadly speaking, it refers to morality based on insight-wisdom.

shunyata (sunnata;Pali)-"emptiness." Central notion of Buddhism that phenomena, including "self," have no inherent or independent existence.

vipassana (PaU) (vipashyana, Skt.)-"special insight" or "clear seeing." One of the two major branches of Buddhist meditation practices. Vipassana develops prajna or insight-wisdom. It is sometimes used to describe Theravada meditation practices, which involve careful cultivation of mindfulness in early stages of practice. Technically, true vipassana does not begin until mindfulness and concentration are well-developed and balanced.

yidam-"deity" that practitioners visualize in advanced Vajrayana practices. Yidams involve primal energy and emotions.

REFERENCES

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BROWN D. P. & Engler, J. (1986).The stages of mindfulness meditation: A validation study. In K. Wilber, J, Engler & D. P. Brown (Eds.), Transformations of consciousness: Conventional and contemplative perspectives on development (pp. 161-217).Boston: Shambhala.

CARRINGTON P., (1977). Freedom in meditation. Garden City, NY: Anchor Press.

ENGLER J., (1986). Therapeutic aims in psychotherapy and meditation: Developmental stages in the representation of self. In K. Wilber, J. Engler & D.P. Brown (Eds.), Transformations of consciousness: Conventional and contemplative perspectives on development (pp, 1751). Boston: Shambhala.

EPSTEIN M., (1986). Meditative transformations of narcissism. Journal of Transpersonal Psychology, 18(2), 143-158.

EPSTEIN, M., (1988). The deconstruction of the self: Ego and "egolessness" in Buddhist insight meditation. Journal of Transpersonal Psychology, 20(1), 61-69.

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EPSTEIN, M. & LIEFF, J. (1986). Psychiatric complications of meditation practice, In K. Wilber, J. Engler & D.P. Brown (Eds.], Transformations of consciousness: Conventional and contemplative perspectives on development (pp. 53-63). Boston: Shambhala.

EPSTEIN, M. & RAPGAYL. (1989). Mind, disease, and health in Tibetan medicine. In A.A. Sheikh& K.S. Sheikh (Eds.), Eastern and Western approaches to healing: Ancient wisdom and modern knowledge. New York: Wiley.

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Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Mon Feb 25, 2019 7:47 am

Mania precipitated by meditation: A case report and literature review
by Graeme A. Yorston
St. Andrew's Hospital, Northampton, UK
Mental Health Religion & Culture, November 2001

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ABSTRACT

Meditation is a popular method of relaxation and dealing with everyday stress. Meditative techniques have been used in the management of a number of psychiatric and physical illnesses. The risk of serious mental illness being precipitated by meditation is less well recognized however. This paper reports a case in which two separate manic episodes arose after meditation using techniques from two different traditions (yoga and zen). Other cases of psychotic illness precipitated by meditation and mystical speculation reported in the literature are discussed.

Introduction

Meditation as a method of relaxation and dealing with everyday stress is becoming increasingly popular in the West with an estimated six million practitioners in the USA alone (Graham, 1986). A variety of techniques are in use but most owe their origins to oriental practices. Meditation has also been used as a therapeutic tool in psychiatry for behaviour modification (de Silva, 1984), as part of a holistic programme for chronic schizophrenia (Lukoff et al., 1986) and as an adjunct to dynamic psychotherapy (Kutz, 1985). A number of recent studies have examined the effects of meditation on physical illness (Kabat-Zinn et al., 1998;Wenneberg et al., 1997)

Meditation is generally considered safe with beneficial effects on mental health rather than as a potential trigger for psychiatric illness but there are reports in the literature of the hazards of meditation: Walsh and Roche (1979) described three cases of psychotic illness precipitated by meditation in subjects already diagnosed as suffering from schizophrenia who had discontinued medication. Garcia-Trujillo et al. (1992) described a further two cases of acute psychosis precipitated by oriental meditation in subjects previously diagnosed as schizotypal personality disorder. Chan-Ob and Boonyanaruthee (1999) report a further three patients who presented with psychotic symptoms after practicing meditation. French et al. (1975) reported a single case of ‘altered reality testing’ after transcendental meditation. The precipitation of psychotic illness by Jewish mystical speculation has also been reported (Greenberg et al., 1992). Krieger and Zussman (1981) reported a case of a brief reactive psychosis in a Thai immigrant to the USA which occurred after confronting a family Buddhist mortuary ritual.

A review of the literature failed to reveal any cases of affective disorder being precipitated by meditative techniques. This paper reports a case in which two separate manic episodes were precipitated by periods of intense meditation using techniques from two different traditions (yoga and zen).

Case report

Miss X, a 25-year old self-employed, university graduate presented with a two week history of increased talkativeness, sleeplessness, over-activity and disinhibited behaviour. The onset followed a weekend yoga course that encouraged psychological release. She telephoned her instructor frequently, often in the middle of the night, offering undying love. She also pushed her hand through a window and sustained minor lacerations. There was no past psychiatric history but she had experienced brief periods of low mood 10 and six years previously which had resolved without psychiatric intervention. There was a family history of depression in her father who had received electro-convulsive therapy, and of late life depression in her paternal grandmother. Her birth and milestones were normal. There was no history of illicit drug use.

She was admitted informally to hospital but was detained when she became irritable and aggressive and insisted on leaving. At interview she shouted and tried to embrace some members of staff, but struck out at others. There was pressure of speech, thought disorder with flight of ideas, her mood was elevated and there were grandiose delusions including the belief that she had some special mission for the world: she had to offer ‘undying, unconditional’ love to everyone. She had no insight. A diagnosis of manic episode was made and she was treated with haloperidol 10mg daily and lorazepam up to 4mg daily and her symptoms were gradually controlled over the next six weeks. She refused mood-stabilizing medication.

At outpatient follow up she was noted to be mildly hypomanic on two occasions (the second after a sesshin or intensive Zen meditation weekend) but these episodes responded to chlorpromazine without admission to hospital. She agreed to a trial of carbamazepine 800mg daily which she took for two years. She also underwent twice weekly psychodynamic psychotherapy for over two years.

Two months after entering a Zen Buddhist retreat that she had been associated with for two years, she re-presented with a five-day history of sleeplessness, decreased appetite and labile affect. At interview she laughed inappropriately and had outbursts of activity – lying on her bed one moment, jumping off the next. She made stereotypical praying movements, was sexually disinhibited, restless, distractible and irritable. She was thought disordered with pressure of speech. Though admitted informally she soon insisted on leaving and attacked a member of staff. She was detained and transferred to an intensive psychiatric care unit for three days where treatment with haloperidol 6mg and lorazepam 3mg was commenced. Her mental state settled over the next eight weeks. She continued to refuse mood stabilizing treatment and re-entered the Buddhist retreat.

Discussion

The precipitation of mania by meditation has not been described before yet descriptions of the altered state of consciousness (ASC) associated with contemplative practice abound in the mystic literature of different religions (Buckley, 1981). Zen is a Japanese school of Buddhism – the word itself derives from Sanskrit dhyana or meditation and it is meditation or mindfulness that forms the essence of the Zen philosophy of life. A euphoric state of enlightenment called satori is sometimes achieved by experienced monks (Humphreys, 1962). Thapa and Murtha (1985) compared the subjective accounts of ASCs in subjects with complex partial seizures, schizophrenia and meditators from ashrams and other religious organizations in India. They found the core experiential characteristics of perceptual distortion were common to all three ASCs but important differences existed such as only the meditative ASC being accompanied by a positive emotional effect. The authors did not include manic patients in their study so were unable to make direct comparisons with the experiences in mania. Lukoff (1988) however reported in a single case study that seven of the eight dimensions of mystical experience described by Stace (1960) were experienced by a manic patient.

There is evidence that mystical experiences have a neuro-biological basis possibly in the right temporal lobe (Fenwick, 1996) and contemplative meditation which can lead to such experiences can be studied in experimental conditions (Deikman, 1963, 1964). Lou et al. (1999) have shown a differential cerebral blood flow distribution in meditative states and normal consciousness.

Students practise Zen to develop concentration without thinking (Watts, 1962) but this can be difficult and novices are often bombarded by distracting stimuli – both external and intrapsychic which can continue after the meditation session leading to insomnia. There is evidence to suggest sleep deprivation may act as a final common pathway in the onset of mania (Kasper & Wehr, 1992; Wehr, 1991; Wright, 1993) and it is possible that it was the pressure of thought stirred up by meditation that disrupted the patient’s sleep and precipitated the manic episode in this case and in two of the cases reported by Chan-Ob and Boonyanaruthee (1999). Interestingly the patient herself likened both episodes of mania to a release of tension and blocked energy from years of not dealing with emotions in a helpful way.

Other evidence for psychological precipitants for mania comes from life events (Sclare & Creed, 1990) and expressed emotion (Miklowitz et al., 1986) research. These factors appear to be most important in the first episode of illness, the effects lessening with each subsequent episode. These observations have been suggested as evidence in support of the kindling hypothesis (Silverstone & Romans-Clarkson, 1989). The move to the retreat and adoption of a different lifestyle in this case must have been a significant stressor. Indeed, religious change in itself can be associated with psychiatric illness: Witztum et al. (1990) showed high rates of serious mental illness in converts to ultra-orthodox Judaism in Jerusalem and speculated that, for some, the conversion may have been an attempt to control emerging signs of psychiatric illness.

Other more established risk factors for mania in this case are the positive family history of affective disorder and the discontinuation of carbamazepine (Scull & Trimble, 1995).

The orthodox psychiatric diagnosis in this case was bipolar affective disorder. Grof and Grof (1986) have argued however that traditional psychiatric thinking fails to recognize the difference between mystical and psychotic experiences, tending to underestimate the potential for a healing and positive transformation of what the authors term a transpersonal crisis. It is important to remember that other cultures have and do classify what we now call psychoses in different ways and that, as Carey (1997) has advocated, knowledge drawn from different approaches should be respected and allowed to contribute to the scientific study of mental illness. The absence of previous reports of mania precipitated by meditation despite its apparent potency at inducing euphoric states of consciousness suggests that adequate practice and supervision may enable the subject to learn to control the emergence of intrapsychic material. If this is so, then it could have implications for reducing the risk of relapse in this patient and potentially in others. Thus, although our understanding of the psychology and neurobiology of meditation is growing (see West, 1987) for a comprehensive review) it deserves more study.

_______________

References

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FENWICK, P. (1996) The neurophysiology of religious experience. In D. BHUGRA (Ed.) Psychiatry and Religion (pp. 167–177). London: Routledge.

FRENCH, A.P., SCHMID, A.C. & INGALLS, E. (1975). Transcendental meditation, altered reality testing and behavioral change. Journal of Nervous and Mental Disease, 161, 55–58.

GARCIA-TRUJILLO, R., MONTERREY, A.L. & GONZALEZ DE RIVIERA, J.L. (1992). Meditacion y psicosis. Psiquis Revista de Psiquiatria Psicologia y Psicosomatica, 13(2), 39–43.

GRAHAM, H. (1986) The human face of psychology: humanistic psychology in its social and cultural context. Milton Keynes: Open University Press.

GREENBERG, D., WITZTUM, E. & BUCHBINDER, J (1992). Mysticism and psychosis: the fate of Ben Zoma. British Journal of Medical Psychology, 65(3), 223–235.

GROF, C. & GROF, S. (1986). Spiritual emergency: The understanding and treatment of transpersonal crises. Special Issue: The psychotic experience: disease or evolutionary crisis? ReVision, 8(2), 7–20.

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KRIEGER, M.J. & ZUSSMAN, M. (1981). The importance of cultural factors in a brief reactive psychosis. Journal of Clinical Psychiatry, 42(6), 248–249.

KUTZ, I. (1985) Meditation as an adjunct to psychotherapy: an outcome study. Psychotherapy and Psychosomatics, 43(4), 209–218.

LOU, H.C., KJAER, T.W., FRIBERG, L., WILDSCHIODTZ, G., HOLM, S. & NOWAK, M. (1999). A 150-H2O PET study of meditation and the resting state of normal consciousness. Human Brain Mapping, 7(2), 98–105.

LUKOFF, D. (1988). Transpersonal perspectives on manic psychosis: creative, visionary and mystical states. Journal of Transpersonal Psychology, 20, 111–140.

LUKOFF, D., WALLACE, C.J., LIBERMAN, R.P., & BURKE, K. (1986) A holistic program for chronic schizophrenic patients. Schizophrenia Bulletin, 12, 274–282.

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SILVERSTONE, T. & ROMANS-CLARKSON, S. (1989). Bipolar affective disorder: Causes and prevention of relapse. British Journal of Psychiatry, 154, 321–335.

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WALSH, R. & ROCHE, L. (1979) Precipitation of acute psychotic episodes by intensive meditation in individuals with a history of schizophrenia. American Journal of Psychiatry, 136 (8), 1085–1086.

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Re: Mindfulness Meditation Research: Issues of Participant S

Postby admin » Mon Feb 25, 2019 8:30 am

Schizotypy and mindfulness: Magical thinking without suspiciousness characterizes mindfulness meditators
by Elena Antonova a, Kavitha Amaratunga a, Bernice Wright a, Ulrich Ettinger b, Veena Kumari a,c,*
© 2016 The Authors.

NOTICE: THIS WORK MAY BE PROTECTED BY COPYRIGHT

YOU ARE REQUIRED TO READ THE COPYRIGHT NOTICE AT THIS LINK BEFORE YOU READ THE FOLLOWING WORK, THAT IS AVAILABLE SOLELY FOR PRIVATE STUDY, SCHOLARSHIP OR RESEARCH PURSUANT TO 17 U.S.C. SECTION 107 AND 108. IN THE EVENT THAT THE LIBRARY DETERMINES THAT UNLAWFUL COPYING OF THIS WORK HAS OCCURRED, THE LIBRARY HAS THE RIGHT TO BLOCK THE I.P. ADDRESS AT WHICH THE UNLAWFUL COPYING APPEARED TO HAVE OCCURRED. THANK YOU FOR RESPECTING THE RIGHTS OF COPYRIGHT OWNERS.


a King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Department of Psychology, London, UK b University of Bonn, Department of Psychology, Bonn, Germany c NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK

ABSTRACT

Despite growing evidence for demonstrated efficacy of mindfulness in various disorders, there is a continuous concern about the relationship between mindfulness practice and psychosis. As schizotypy is part of the psychosis spectrum, we examined the relationship between long-term mindfulness practice and schizotypy in two independent studies. Study 1 included 24 experienced mindfulness practitioners (19 males) from the Buddhist tradition (meditators) and 24 meditation-naïve individuals (all males). Study 2 consisted of 28 meditators and 28 meditation-naïve individuals (all males). All participants completed the Schizotypal Personality Questionnaire (Raine, 1991), a self-report scale containing 9 subscales (ideas of reference, excessive social anxiety, magical thinking, unusual perceptual experiences, odd/eccentric behavior, no close friends, odd speech, constricted affect, suspiciousness). Participants of study 2 also completed the Five-Facet Mindfulness Questionnaire which assesses observing (Observe), describing (Describe), acting with awareness (Awareness), non-judging of (Non-judgment) and non-reactivity to inner experience (Non-reactivity) facets of trait mindfulness. In both studies, meditators scored significantly lower on suspiciousness and higher on magical thinking compared to meditation-naïve individuals and showed a trend towards lower scores on excessive social anxiety. Excessive social anxiety correlated negatively with Awareness and Non-judgment; and suspiciousness with Awareness, Non-judgment and Nonreactivity facets across both groups. The two groups did not differ in their total schizotypy score. We conclude that mindfulness practice is not associated with an overall increase in schizotypal traits. Instead, the pattern suggests that mindfulness meditation, particularly with an emphasis on the Awareness, Nonjudgment and Non-reactivity aspects, may help to reduce suspiciousness and excessive social anxiety.

1. Introduction

Mindfulness is a translation of the Pali term sati that in meditation context refers to remembering to keep awareness of one's practice. Mindfulness practice normally proceeds in stages, starting from the mindfulness of bodily sensations to awareness of feelings and thoughts, ultimately aimed at developing a present-centered awareness without an explicit focus. These stages are apparent in most schools of Buddhism, as well as in Mindfulness-Based Interventions (MBIs) such as Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn, 1990) and Mindfulness-Based Cognitive Therapy (MBCT; Segal et al., 2002). Mindfulness practice as incorporated in MBIs is often contrasted with more effortful concentration-based practices such as those taught in Theravada Buddhism (Bishop et al., 2004). The traditions of Buddhism most closely aligned with mindfulness as taught in MBSR and MBCT are Dzogchen and Mahamudra, which take a gentle approach to practice by letting go of any striving to achieve a particular mental state, and simply resting in a present-centered awareness free of emotional reactivity and conceptual elaboration (Dunne, 2011; Kabat-Zinn, 2011).

MBSR has been shown to reduce stress, depression, and anxiety, and to improve general well-being in a number of physical and psychological conditions (meta-analysis, Hofmann et al., 2010; Zainal et al., 2013), as well as in healthy populations (meta-analysis, Khoury et al., 2015). MBCT has been reported to prevent depression relapse (Teasdale, 2000), and to be at least as effective as anti-depressants (Kuyken et al., 2015). Mindfulness as a trait also inversely correlates with anxiety and depression in healthy individuals (Baer et al., 2004). Despite this transdiagnostic efficacy of MBIs, the relationship between mindfulness and psychosis is currently unclear.

There are persistent concerns that mindfulness might induce psychosis in vulnerable individuals and even in people with no previous history or known vulnerability to psychosis based on a number of single-case studies that appear to suggest that meditation can induce acute psychotic episodes in individuals with a history of schizophrenia (Walsh and Roche, 1979), as well as in people without a history of psychiatric illness (Sethi and Subhash, 2003; Yorston, 2001). However, as discussed in more detail by Shonin et al. (2014), in all these cases the individuals were involved in intensive meditation retreats, and it is unclear to what extent the meditation practices that the described cases were engaged with are in line with the approach employed in MBIs. A number of MBIs for psychosis conducted to date, although mostly preliminary, suggest that mindfulness practice of short duration can actually alleviate the distress associated with psychotic symptoms, such as hearing voices, and reduce depression and anxiety (Abba et al., 2008; Chadwick et al., 2008, 2009; Escudero-Perez et al., 2015; Moritz et al., 2015; Randal et al., 2015; Strauss et al., 2015; Tong et al., 2015; Ubeda-Gomez et al., 2015).

With a clinical prevalence of about 7 per 1000 in the adult population, psychosis is more common among the general population than previously assumed (Johns et al., 2004) and is expressed along a continuum (Verdoux and Van Os, 2002). Schizotypy is a psychological construct, encompassing a range of personality traits and cognitions that are similar to psychosis but less severe in nature (Ettinger et al., 2014). According to Raine et al. (1995), schizotypy is characterized by nine dimensions: ideas of reference, excessive social anxiety, magical thinking, unusual perceptual experiences, eccentric behavior or appearance, no close friends or confidants, odd speech, constricted affect and suspiciousness. Schizotypy clearly encompasses both psychosis-like symptoms and symptoms related to anxiety and depression.

The main aim of the present study therefore was to examine the relationship between regular long-term (N2 years) practice of mindfulness and the dimensions of schizotypy (Raine, 1991) in two independent studies. Based on the reviewed evidence for the positive effects of mindfulness on anxiety and depression, it was hypothesized that experienced meditators will score lower on the excessive social anxiety and constricted affect compared to meditation-naïve individuals. Given the lack of any direct data on this topic, no specific predictions were made in relation to other schizotypy dimensions. It was, however, anticipated that any associations present in both studies, even if with a small effect size,would represent true effects. Study 2, in addition to aiming to replicate the findings of Study 1, explored the relationship between the dimensions of schizotypy and the facets of trait mindfulness indexed by the Five Facets Mindfulness questionnaire (FFMQ) (Baer et al., 2006).

2. Methods

2.1. Participants and design


This investigation included two independent studies. Study 1 included 24 experienced lay meditators (19 males) and 24 meditation-naïve individuals (all males). The meditators were recruited from Buddhist centers across the UK via posters and advertisements. Meditators had to have been consistent in their practice for over 2 years, practicing at least 6 days a week for a minimum of 45 min a day, and were drawn from Dzogchen and Mahamudra traditions of Tibetan Buddhism. Meditation-naïve individuals had to have no experience of mindfulness-related practices including meditation, yoga, tai chi, chi gong, or martial arts and were recruited from a database of healthy volunteers as well as emails and circulars sent to the students and staff of King's College London. Study 2 included 28 experienced male meditators mainly from Zen, Theravada, Vajrayana and Triratna traditions of Buddhism, and 28 meditation-naïve male individuals, recruited in the same way as Study 1 using the same criteria.

Additional inclusion criteria for both studies included IQ N 80 as assessed by Wechsler Abbreviated Scale of Intelligence (Wechsler, 1999), age between 18 and 60 years, non-smoking and not drinking more than 28 units of alcohol per week. Participants with diagnosis of neuropsychiatric disorders, current or past, substance abuse and/ or regular prescription medication as assessed by the screening interview were excluded.

The study procedures were approved by King's College London research ethics committee. Participants provided written informed consent to their participation and were compensated for their time.

2.2. Assessment of schizotypal personality traits and mindfulness

All participants completed the Schizotypal Personality Questionnaire (SPQ) (Raine, 1991) which contains 9 subscales: ideas of reference, excessive social anxiety, magical thinking, unusual perceptual experiences, odd/eccentric behavior, no close friends, odd speech, constricted affect and suspiciousness. This 74-item assessment of DSM-III-R schizotypal personality disorder provides an overall score of individual differences in schizotypal personality in addition to the scores of the above-mentioned subscales. With high internal reliability (0.90), test–retest reliability (0.82), convergent validity (0.59) and discriminant and criterion validity (0.63, 0.68), it is considered a well-validated measure of schizotypy.

All participants of Study 2 also completed the FFMQ (Baer et al., 2006) to investigate the relationship between trait mindfullness and schizotypy. FFMQ has been derived from factor analysis performed on five of the most commonly used mindfulness measures. The five facets are observing (Observe), describing (Describe), acting with awareness (Awareness), non-judging of inner experience (Nonjudgment), and non-reactivity to inner experience (Non-reactivity) as assessed using Likert scale with 39 items. FFMQ has high internal consistency, ranging from 0.75 (Non-reactivity) to 0.91 (Describe).

2.3. Data analysis

Group differences in age, IQ, FFMQ and SPQ scores were examined using independent sample t-tests, run separately for the two studies. Given the significant difference in age and IQ between the meditator and meditation-naïve groups in Study 1 (Table 1), we examined the relationship of SPQ scores with age and IQ, and then re-evaluated the group difference in one of the SPQ subscales (no close friends) that showed a positive association with IQ (in Study 1), using analysis of covariance (ANCOVA) co-varying for IQ.

In Study 2, we examined the correlations between trait mindfulness (FFMQ) and SPQ (total and subscale) scores across both samples, and then separately in the meditator and meditation-naïve groups. Given the limited range of scores on some SPQ subscales, we report Spearman correlations (the same pattern of associations was observed with Pearson's r).

All data analysis was conducted using IBM Statistical Package for Social Sciences (version 22). The alpha level of significance (two-tailed) was set at p=0.05 in all analyses unless specified otherwise.

3. Results

Demographic characteristics of the meditator and meditation naïve groups, along with the descriptive statistics and group differences in SPQ and FFMQ scores, are presented in Table 1.

Table 1: Demographic characteristics, trait mindfulness and schizotypal scores of the meditator and meditation-naive groups.

[x]

3.1. Study 1

Meditators were older and had higher IQ than meditation-naïve individuals (Table 1). Meditators scored significantly higher on ‘magical thinking’ and significantly lower on the ‘suspiciousness’, ‘constricted affect’ and ‘no close friends’ subscales of the SPQ relative to meditation-naïve individuals. The two groups did not differ in total schizotypy scores (Table 1). Unexpectedly, there was a significant negative correlation between IQ and ‘no close friends’ subscale scores (across all participants, r=−0.324, p=0.04) and the significant difference between the meditator and meditation-naïve groups in ‘no close friends’ scores was abolished when we controlled for IQ (p N 0.20). IQ and age were not correlated with ‘excessive social anxiety’, ‘magical thinking’ or ‘suspiciousness’ (or with any other SPQ subscale) scores.

3.2. Study 2

The meditator and meditation-naïve groups were comparable on age and IQ (Table 1). Replicating the observations of Study 1, meditators scored significantly higher on ‘magical thinking’ and lower on ‘suspiciousness’ relative to meditation-naïve individuals. They also scored lower, at trend-level, on ‘excessive social anxiety’ (a weak trend also present in Study 1). As in Study 1, total SPQ profile did not significantly differ between the two groups (Table 1). Age and IQ did not correlate with SPQ (total or subscale) scores.

Meditators scored significantly higher on the Observe, Nonjudgment and Non-reactivity mindfulness facets of FFMQ compared to meditation-naïve individuals (Table 1). Across all participants (n = 56), there were negative correlations of ‘excessive social anxiety’ with Awareness and Non-judgment; ‘odd speech’ with Describe and Awareness; ‘constricted affect’ with Awareness and Nonjudgment; and ‘suspiciousness’ with Awareness, Non-judgment and Non-reactivity (Table 2). Both the meditator and meditation-naïve groups contributed to all these relationships, except for the negative correlation between suspiciousness and Non-reactivity, which was present mainly in the meditator group (Table 2).

4. Discussion

In line with our a priori hypothesis, meditators, compared to the meditation-naïve individuals, scored significantly lower on ‘constricted affect’ in Study 1, and showed a trend level for lower scores on ‘excessive social anxiety’ in both studies. In addition, meditators scored significantly higher on ‘magical thinking’, and significantly lower on ‘suspiciousness’ in both studies. In relation to the association between (FFMQ) trait mindfulness and (SPQ) schizotypy dimensions (Study 2), lower ‘excessive social anxiety’ and ‘constricted affect’ scores were associated with higher Awareness and Nonjudgment; lower ‘odd speech’ with higher Awareness and Describe; and lower ‘suspiciousness’ with higher Awareness, Non-judgment and Non-reactivity scores.

‘Constricted affect’ relating to a form of emotional blunting (Raine, 1991) appears to be positively affected only by the mindfulness practice styles of Dzogchen and Mahamudra (Study 1) which are most similar to the MBSR/MBCT approach, as this schizotypy dimension did not significantly differentiate the long-term meditators drawn from Zen, Vipassana, Theravada, Vajrayana and Triratna traditions of Buddhism from the meditation-naïve participants in Study 2. The ‘excessive social anxiety’ subscale relates to overt physiological changes along with a high degree of nervousness and anxiety (Raine, 1991). The finding of lower scores in meditators on this subscale, albeit non-significant, is in line with the notion that mindfulness training reduces anxiety (e.g., Khoury et al., 2015). Significant inverse correlations of lower ‘excessive social anxiety’ and ‘constricted affect’ scores with higher Awareness and Non-judgment scores suggest that mindfulness trait alleviates the so called negative symptoms of schizotypy via non-judgemental present-centered awareness, and this effect could be strengthened by mindfulness practice as suggested by significantly higher scores on the Non-judgment facet in long-term meditators, compared to meditation-naïve individuals. This is in line with preliminary evidence showing ameliorating effects of mindfulness training on symptoms of anxiety and depression in people with psychosis by reducing self-critical attitudes and developing non-judgmental present-centered awareness, as well as self-acceptance and self-compassion (review, Shonin et al., 2014).

Table 2: Spearman rank order correlations between mindfulness facets (FFMQ) and schizotypy (SPQ) dimensions in Study 2.

[x]

One of our novel findings is that meditators scored significantly lower on ‘suspiciousness’ in both samples. Although not specifically hypothesized, this finding is highly relevant to the clinical applications of mindfulness for the prevention and treatment of psychosis. From the time of Kraepelin, suspiciousness and paranoia have been considered to be among the main symptoms of psychosis (Kendler et al., 1996). These symptoms may stem from the avoidance of personal exposure and negative self-image, distorting reality in the process so as to strengthen impaired self-esteem (Bentall et al., 2008; Oxman et al., 1982). This avoidant nature is in contrast to mindfulness, which promotes direct engagement with reality and attention to all aspects of the present-moment experience non-judgmentally and non-reactively. Similarly, the distorted view of one-self and the characteristics of suspiciousness and paranoia are in contrast to greater empathy, compassion, and prosocial behavior associated with mindfulness (Condon et al., 2013). Given that a) paranoid schizophrenia is the most common type of psychosis experienced (Lieberman et al., 2012), b) suspiciousness/paranoia carries a high predictive power for conversion to psychosis in high risk individuals, alongside genetic risk and unusual thought content (Cannon et al., 2008), and c) we found inverse correlation between ‘suspiciousness’ and Non-judgement in meditators only, MBIs might hold promise in preventing psychosis in high-risk individuals.

Another novel finding of our investigation is higher score on ‘magical thinking’ in meditators in both studies. Given that ‘magical thinking’ was not associated with any of the FFMQ facets that were significantly higher in meditators compared to meditation-naïve individuals in study 2 and, as such, does not appear to develop due to mindfulness practice per se, the most likely explanation for this finding is that our mindfulness meditators were mainly practicing within Buddhist tradition. The ‘magical thinking’ subscale measures beliefs into such supernatural experiences as telepathy, clairvoyance, astrology, and sixth sense, which are incorporated into Buddhist psychology and metaphysics, particularly in the Tibetan Buddhist tradition. The higher scores on ‘magical thinking’ in the face of low scores on other schizotypy dimensions are in line with research showing that having a context for unusual experiences and/or beliefs makes a difference in terms of whether they lead to diagnosable mental health difficulties or whether they become integrated into one's life without causing a functional disruption (Brett et al., 2014; Heriot-Maitland et al., 2012; Peters et al., 2016). It is also possible that people attracted to meditation practice within the context of Buddhist beliefs and metaphysics are higher on magical thinking to begin with, or that higher score on ‘magical thinking’ simply reflects greater openness to experience in meditators, rather than actual beliefs in these ‘supernatural’ constructs. The latter possibility is more likely given that trait mindfulness has been shown to be associated with greater openness to experience (Baer et al., 2004; van den Hurk et al., 2011), and there is an association between schizotypy and openness to experience (DeYoung et al., 2011). Mindfulness meditators thus may simply have greater open-mindedness towards what constitutes ‘magical thinking’ in the SPQ than the average population. Whether higher ‘magical thinking’ is an ‘artifact’ of Buddhist belief system or whether it indexes greater open-mindedness of mindfulness practitioners could be addressed by further research by recruiting long-term meditators that practice mindfulness within a secular setting.

Particularly relevant to psychosis is our finding that higher ‘magical thinking’ in meditators was not accompanied with higher ‘ideas of reference’. The ‘ideas of reference’ subscale measures the tendency to self-reference the experience, i.e. over-subscribe personal relevance and meaning to inner experiences and external events. Mindfulness practice, on the other hand, attenuates self-referential tendencies and associated brain dynamics (Brewer et al., 2011; Farb et al., 2007); the same brain networks are found to be hyperactive in people with schizophrenia (Whitfield-Gabrieli et al., 2009). The combination of high magical thinking and low ideas of reference is in alignment with the frameworks of psychosis that suggest that it is not unusual beliefs and/or experiences per se that constitute a risk for psychosis, it is rather their interpretation and hyper self-referencing (Peters et al., 2012). Given that unusual beliefs and thought content constitute risk for psychosis conversion (Cannon et al., 2008), the reduction of self-referencing might be another rationale for mindfulness-based psychosis prevention.

The observed pattern of inverse associations between the dimensions of schizotypy (‘excessive social anxiety’, ‘odd speech’, ‘constricted affect’ and ‘suspiciousness’) and the Awareness, Non-judgment and Nonreactivity facets of mindfulness suggests that trait mindfulness reduces negative dimensions of schizotypy, whereas mindfulness practice might have further ameliorating effects on ‘excessive social anxiety’ and ‘suspiciousness’ as these were lower in meditators compared to meditation-naïve participants. These findings may have important therapeutic implications, suggesting that a) future MBIs with a strong emphasis on the Awareness, Non-judgment and Non-reactivity aspects of mindfulness may be particularly effective in reducing anxiety-related symptoms, depression, and suspiciousness in psychosis; and b)mindfulness could be used as a therapeutic tool for psychosis prevention by addressing suspiciousness and paranoia in high risk populations.

Our investigation has a number of limitations. First, it examined the relationship between schizotypy dimensions and mindfulness in a cross-sectional correlational design, without any knowledge of the meditators' schizotypy scores prior to them starting mindfulness practice. Future research could examine the effects of shorter duration MBIs on the relationship between these traits. Second, this investigation was opportunistic, using two existing data sets (from two independent psychophysiology projects, Antonova et al., 2015; Kumari et al., 2015), consisting of mostly (Study 1) or only men (Study 2). Our findings thus cannot be generalized to women. Third, both schizotypy and mindfulness were assessed using self-report methods. While self-reports have their strengths, such as in depth, detailed data gathered directly from the participant, whilst limiting experimenters' bias, they also have limitations, such as socially desired responses resulting in underestimation or overestimation of actual traits. Given that people's perceptions of themselves are known to be poor predictors of their behavior (Baumeister et al., 2007), future studies, wherever possible, should incorporate experimental analogues of relevant phenomena (e.g. Atherton et al., 2016).

In conclusion, to our knowledge, this is the first investigation to have focused on the schizotypy profiles of experienced mindfulness practitioners. The findings demonstrated lower (trend-level) 'excessive social anxiety', as well as significantly lower 'suspiciousness' and higher 'magical thinking' in meditators relative to meditation-naïve individuals. These differences, taken together with the pattern of correlational observations (i.e. inverse associations between 'excessive social anxiety' and Awareness and Non-judgment; and between 'suspiciousness' and Awareness, Non-judgment and Non-reactivity), suggest that mindfulness training with emphasis on developing the facets of Awareness, Non-judgment and Non-reactivity may help to reduce social anxiety and suspiciousness in psychosis and related populations.

Role of funding source

The sponsors had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Contributors

Elena Antonova and Veena Kumari conceptualized the study. Elena Antonova and Bernice Wright assisted with participant recruitment and data collection. Veena Kumari and Elena Antonova undertook the statistical analysis and prepared the first draft. All authors contributed to the final version.

Conflict of interest

The authors report no biomedical financial interests or potential conflicts of interest.

Acknowledgement

The research was funded by the Bial Foundation (282/14) and the John Templeton Foundation, the Positive Psychology Center of the University of Pennsylvania (13759). VK is supported by the Biomedical Research Centre for Mental Health at the Institute of Psychiatry, King's College London, and the South London and Maudsley NHS Foundation Trust for some of her time.

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* Corresponding author at: Department of Psychology (P077), Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK.

E-mail address: veena.kumari@kcl.ac.uk (V. Kumari).
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Re: Mindfulness Meditation Research: Issues of Participant S

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Adverse Effects of Meditation: A Preliminary Investigation of Long-Term Meditators
by Deane H. Shapiro, Jr., Ph.D.
International Journal of Psychosomatics, Vol. 39 (Nos. 1-4), 1992 63
Manuscript submitted June 30, 1991 and accepted May 1 1992.

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Adverse effects of meditation were assessed in twenty-seven long term meditators (average 4.21 years) both retrospectively (time one) and prospectively at one month (time two) and six months (time three) following a meditation retreat. At both time one and time three subjects reported significantly more positive effects than negative effects from meditation. However, of the twenty-seven subjects, seventeen (62.9%) reported at least one adverse effect, and two (7.4%) suffered profound adverse effects. When subjects at time one were divided into three groups based on length of practice (16.1 months; 41.1 months; 105 months) there were no significant differences in adverse effects. How the data should be interpreted, and their implications both for the clinical and psychotherapeutic use of meditation as a relaxation/self control strategy, and as a technique for facilitating personal and spiritual growth, are discussed. Limitations of the study and suggestions for future research are also offered.

INTRODUCTION

Although the clinical use of relaxation strategies have shown positive effects in arousal reduction, there is a small but growing literature pointing out some of the potential adverse effects of these strategies. For example, Lazarus and Mayne (1) (p. 261) cited such negative effects for progressive, deep muscle relaxation as "relaxation induced anxiety and panic, paradoxical increases in tension, and parasympathetic rebound." There have been similar reports of negative effects for meditation (2-5). These reports indicate that meditation may be contraindicated for those with certain types of psychiatric illness (2); that too much daily meditation may precipitate psychiatric illness and impaired reality testing (4).

Most of these case reports were with short term meditators. However, in a reanalysis of his data, Otis (5) reported that negative effects of meditation (Transcendental Meditation) were stronger in 18 month meditators than in 3-6 month meditators. Further, even teacher trainees of TM with an average of 46.7 months practice, continued to report the same adverse effects. Otis concluded his study by noting that although 52-64% of his subjects did not list a single adverse effect, that the number of those reporting adverse effects was sufficiently high to warrant further investigation.

The current study can be seen as both a replication (with a different population) and an extension of the Otis study in two ways. First, adverse effects were assessed both retrospectively (as did Otis) as well as prospectively. Secondly, the longest term meditation group in Otis's study was 46.7 months, whereas in this study the middle group is 47.1 months, and the longest group is 105 months.

METHODOLOGY

Subjects and Setting


Subjects were 27 individuals, 17 men and 10 women, with a mean age of 35.6 years (sd 13.2), who had signed up for an intensive Vipassana meditation retreat in Barre, Mass, and agreed to participate in the research study. This number who agreed to participate represented 25% of those who were attending the retreat. All subjects had meditated previously, with the average length of meditation experience 4.27 years (sd 3.32). Seventy percent meditated regularly, more than an hour a day. Two thirds had previously practiced Vipassana; and the remaining 33.3% practiced different types of concentrative or opening-up types of meditation (eg., mantra; silent; mindfulness; Soto Zen; breathing concentration; yoga; visualization). A little less than 1/4 of the group were married; over 70% had completed college; over 1/3 were atheist/agnostic; and over 50% were in professional careers.

Grouping by Length of Practice

For some of the analyses, the meditators were divided into three groupings based on length of practice. Group one (n= 10) had practiced two years or less. Test Time One average was 16.7 months practice, approximately 45 minutes a day, 80% regular meditators. Group 2 had practiced from over two years to less than seven years. Test Time One average was 47.1 months, approximately 45 minutes a day, 88.8% regular meditators. Group three (N=8) had practiced seven years or more. Test Time One average was 105 months, 75% were regular meditators, over an hour a day.

Nature of Vipassana Meditation

The meditative technique practiced at the retreat was Vipassana, part of the Theravadan Buddhist tradition. Vipassana meditation is a mindfulness type of meditation practice, a quieting technique designed to observe the mind and develop concentration. The individual is instructed to develop a "bare awareness," observing "whatever comes into awareness" without judging or evaluating (6). Individuals filling out the questionnaire had chosen either to attend a two week or three month meditation retreat. In the retreat, the day is structured into 45 minute to one and one-quarter hour segments beginning at 5:30 a.m. until 10 p.m. Formal meditation, both sitting and walking, occurs a minimum often hours per day. Further, the explicit demand characteristics of the retreat are that mindfulness meditation should be practiced at all times during the day, from when the eyes first open in the morning, to when they close at night. Silence at meals and all other times throughout the retreat is observed by the meditators except for sessions with teachers, which occur once every few days.

Method of Assessment

General effects of meditation were assessed via a paper and pencil questionnaire as part of two larger questionnaires on 1) Adherence, Expectation, Motivation; and 2) Mode of Control. The questions on Meditation Effects followed three prior questions asking 1) Why had the individual started meditation; 2) What did they perceive to be the qualities of a gifted meditator; and 3) What specifically did they hope to get from the current retreat. These questions were designed to assess "expectation effects." Subjects were then provided space to list (in an open ended format) the effects of meditation on their life under three categories 1) Positive influences 2) Adverse influences; and 3) General influences.

Data Collection and Analysis

A questionnaire was filled out before the meditators entered the retreat (retrospective-time one) and information was then gathered prospectively at one month (time two) and six months (time three) after the end of each retreat. Each individual who did not respond to the one month or six month follow-up within two weeks was sent a second form requesting compliance.

Three types of data analysis were performed: to compare responders to non-responders; to compare frequency of adverse effects to positive effects; and general descriptive statistics to examine the nature of the adverse effects. Regarding non-responders, of the 27 individuals assessed at time one, 16 (59.3%) ruled out the questionnaire at time two; and 13 (48.1 %) at time three. To assess whether there were differences in those who responded versus those who did not, a Fisher exact chi-square (7) analysis was used to compare differences between those who completed follow-up questionnaires and those who did not. Two four celled chi-square were performed. The first, comparing time one and time two, examined those who reported adverse effects and those who did not at time one in terms of those who took the assessment at time two and those who did not. The second chi-square made a similar comparison for time one and time three. There were no significant differences in either case.

To compare the frequency of adverse and positive effects, a non-parametric sign test (7) was used to compare the reporting of at least one adverse and/or positive influence. On the questionnaire an individual was free to report one or more adverse effects (or none) and/or one or more positive effects (or none). For this analysis, regardless of frequency or intensity, a person was given either a 1 or 0 depending upon whether there was at least one positive effect, and a 1 or 0 depending upon if there was at least one negative effect. The sign test was used to determine whether there were more of one type of effect than another.

RESULTS

Frequency of Adverse and Positive Effects Compared


Subjects reported significantly more positive than negative effects from meditation at time one (2 tailed p=.002); and at time three (p=.0215).

Adverse Effects

Of the twenty-seven subjects, seventeen (62.9%) reported at least one adverse effect at one of the three time periods. The frequency of adverse effects was not affected by length of practice (chi-square=3.68; df=2; p=.16). Yet the trend is in the opposite direction from what one might expect: the fewest individuals reporting adverse effects were in group one (40%), which had practiced less than two years; and the highest frequency of subjects reporting adverse effects was from group three (75%), which had practiced the longest, over 8.5 years. These results were similar both retrospectively (time one) as well as prospectively (time two, time three).

Two (7.4%) of the twenty-seven individuals suffered profound adverse effects of such intensity that they stopped meditating. Both subjects were male, but one was in group one (shortest length of practice) who had taken the two week retreat; and the other was in group three (longest length of practice) and had taken the three month retreat. The group one individual wrote at one month follow-up that the retreat left him totally disoriented: "confused, spaced out, quit meditation since retreat."

The group three individual noted at the six month follow-up:

My experience of returning from the retreat was a difficult one. The mind set values that the retreat cultivated felt out of synch with the world I came back to and I've been slowly digesting the transformative changes that the retreat generated. Lots of depression, confusion, struggle during the last six months....experienced some severe shaking and energy releasing; eventually injured my back and stopped doing Vipassana practice.


Of those reporting adverse effects, intrapersonal were mentioned by 13 (76.4%); interpersonal by three (17.6%); and societal by three (17.6%) (More than one could be listed by an individual).

Intrapersonal adverse effects could be divided, heuristically, into four groupings. The first was increased negativity, which included statements such as increased awareness of negative qualities and emotions within myself (e.g., more judgmental, increased negative emotions, more emotional pain; increased fears and anxiety; more high strung. The second was increased disorientation, which included statements such as "confused about who I am; "loss of orientation; "loss of self'; "becoming aware of how low my self image is, how often I get down on myself;" "a feeling of incompleteness, that I need something else"; decreased attentional clarity: more spaced out, confused mind, ego strain; less motivated in life. The third was addicted to meditation, including such statements as "attached to quiet and withdrawal"; feel I am missing something between meditation retreats. And finally, boredom and pain.

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Table 1. Adverse and positive influences from meditation: Number of Subjects Reporting at Least One Adverse and/or Positive Influence.

Examples of worsened interpersonal relationships included "my family objects; I meditate as alternative to people; increased awareness of negative qualities of others, more judgmental of others, feel "false" superiority; increased discomfort with current friends; realize how bad my home situation is." Finally, examples of societal adverse effects included feelings of increased alienation from society; more uncomfortable in real world; hypersensitive to city environment; hard to adjust to the world.

Positive effects.

As noted in Table 1, eighty-eight per-cent (24 of 27) individuals listed positive effects at time one; 13 of 16 (81.3%) individuals at time two; and 12 of 13 (92.3%) at time three. These positive influences included greater happiness and joy; more positive thinking, more self-confidence; better ability to get things done (more effective); better problem solving; more accepting, compassionate, tolerant to self, and to others; more relaxed, less stressed, more resilient; better able to control feelings.

DISCUSSION

This preliminary investigation of long term meditators showed adverse effects occurring in 38% to 55.5% of the individuals reporting at different time periods. These figures, based on Vipassana meditation developed within the Buddhist tradition, is comparable to the 36% to 48% adverse effects reported in the Otis (5) study (with Transcendental Meditation developed within the Hindu/Vedic tradition). Further, rather than adverse effects decreasing based on length of practice, there is an increase in the percentage of those who report adverse effects based on the length of practice. This finding also replicates Otis's earlier finding that the adverse-effects of meditation (Transcendental Meditation) were stronger in 18 month meditators than in 3-6 month meditators, and even teacher trainees of TM with an average of 46.7 months practice, continued to report the same adverse effects. In this study, 75% of subjects with 105 months meditation experience reported adverse effects, compared to 40% of those with 16.7 months experience.

At first glance these data appear perplexing. With this high a percentage of self-reported adverse influences, why do these subjects continue to meditate, and even attend an intensive meditation retreat? Certainly one possibility is that the individuals must feel that, at some level, the positive benefits of meditation outweigh the negative. As noted, the data indicate that nearly 90% of the individuals at pretest cited positive influences of meditation; and expectation effects for the individuals regarding meditation at time one were 100% positive.

Second, individuals that listed an adverse influence often noted that there was a positive aspect to it, either currently, or within a philosophical context. One person noted; "-my family objects to my participation in the Buddhist way, but they enjoy being around me more". Another noted (time two) "brief but powerful experience of egolessness which brought deep terror and insecurity caused by reflex of mind. This is temporary; the fear will pass." At time three, this person said there were no adverse effects, noting that in meditation he is able to see that life is really "a roller coaster of powerfully pleasant and unpleasant experiences. Over time I learned the patience and forbearance and equilibrium to treat pleasant and unpleasant alike, with the same unattached awareness. This leads to a wonderful sense of strength and a lessening of fear." Thus, for some individuals, the adverse effects seem to be transformed over time, and are seen not as problems, but as something from which a person can learn.

One especially thoughtful and insightful explanation and description of this issue based on personal experience was given by another participant. His notes were quite instructive, and are therefore cited here in some detail.

As background, he noted that for two years he was disabled with active suicidal depression, including two hospitalizations and many forms of treatment, including psychotherapy, bioenergetic therapy, drug treatments of many kinds and electroconvulsive therapy. He stated that:

For me meditation is by far the most effective form of therapy... it is not a palliative; rather it eliminates the cause of mental suffering at its very roots. However, I have found in my own experience that I needed a certain degree of mental health and stability before I could undertake intensive meditation. Most psychotherapy seems to me a way of strengthening the ego. Meditation is a way of tearing it down.

The paradox is that one seems to need a relatively strong ego in order to endure its removal... Three months of intensive uninterrupted meditation seemed to me very much like a controlled breakdown, paralleling in many marked ways my own breakdown four years ago.

In order to reach a deeper stability, one becomes fundamentally destabilized. To undergo this, one needs considerable preliminary strength and faith. If that strength and faith do not exist, intensive meditation can be dangerous. One of my colleagues during the three month retreat was asked to leave early because he was becoming seriously unstable and delusive. Degeneration continued at home for a month and a half. Eventually he attempted suicide because he had "failed" to become enlightened. He is now hospitalized and is seriously mentally ill.


The above account suggest that for one individual, the adverse effects were part of positive personal transformation, but for his friend, they were not. Similarly, in this study, there were those for whom positive effects outweighed the adverse effects; but there were also two for whom the adverse effects forced the individual to stop meditating. And one individual noted that she realized that what she needed was psychological insight, not "bare awareness" of meditation.

Clinicians and health care professionals may use meditation as a relaxation technique (8) and as an adjunct in psychotherapy (9-11), and therefore should be aware of these possible adverse effects. Further, individuals may practice meditation for a variety of reasons, ranging from relaxation to personal and spiritual development (12,13). Some of these individuals may develop emotional, physical, and/or psychosomatic adverse effects, as this study indicates. Again, it is important that the clinician be sensitive to these adverse effects, the potential developmental issues, and the philosophical context in which meditation is being practiced. For example, the technique of meditation can occur within a context in which going beyond individual ego, learning surrender, and ultimate trust of the universe are positively valued. Meditation may be compelling for many individuals on different levels. Self-regulation goals can include mental peace and equanimity; and greater emotional discipline and concentration. Self-liberation goals can involve going beyond personal ego to an experiential belief about the sacred nature of the universe, a deepening of compassion; and an increased sensitivity and efforts to help end suffering in oneself and others. Depending upon the health care provider's orientation, these may or not be seen as signs of psychological well being or goals of positive health (14-17). Often a therapist may inappropriately pathologize that which does not fit neatly into his/her orientation.

On the other hand, the attainment of positive psychological and/or spiritual well being can be exceptionally difficult (16). At the risk of mixing nontheistic Buddhist and theistic Jewish metaphors, the sages of old reported in the Talmud nearly two thousand years ago the story of four Rabbis who entered Pardes to seek enlightenment. One dies, one becomes an apostate, one goes crazy; and only one returns with wisdom. These findings from this study cannot be easily dismissed, and suggest the critical importance of being sensitive to the adverse influences in short, as well as long term meditators. These potential negative effects may be true not only for meditation as relaxation, but also for meditation as a spiritual path.

PROBLEMS WITH THE STUDY AND FUTURE DIRECTIONS

Although collecting research data always presents some problems, collecting data from meditators presents special problems. For example, one commented "I found myself tense, angry, spaced out taking (the questionnaire) the second time (right after the retreat). I also found it painful and did not like doing it at all." Another noted "I am sorry to foul up your study, but I no longer feel able to make accurate generalizations about myself... one no longer knows 'what' one 'is' except in the moment -- which makes filling out this form nigh impossible."

Problems of the size of the sample, the low return rate, and the nature of questionnaire data in general, make it necessary to be cautious in generalizing from this study. Future research should attempt to determine whether it is possible to be more precisely predict, using psychological measures of defensiveness, ego strength, tolerance of ambiguity, attentional absorption, whether there is a certain subset of individuals who have more serious adverse effects. In addition, this study clearly highlights the importance of obtaining prospective, in addition to retrospective data. However, because this study so closely replicates the previous study of Otis, using a different meditation population, it does add one more piece to our understanding of adverse effects.

This article suggests a middle road, between uncritical hosannahs of meditation's effectiveness, and equally uncritical dismissal of that which does not neatly conform to the biases of rationalistic science. On the one hand, we as scientists and therapists may need to be open to exploring ultimate issues and world views which do not neatly fit within our preexisting paradigm. On the other hand, we also need to be careful that we not allow our belief systems to keep us from blindly seeing growth where there may in fact be harm occurring.

_______________

REFERENCES

1. Lazarus, AA. and Mayne, TM Relaxation: Some limitations, side effects, and proposed solutions. Psychotherapy 27,2,261266, (1990).

2. Walsh, R. and Rauche, L. The precipitation of acute psychoses by intensive meditation in individuals with a history of schizophrenia. American Journal of Psychiatry 138(8), 185-186, (1979).

3. Lazarus, AA (Psychiatric problems precipitated by transcendental meditation. Psychological Reports 10,39-74, 1975).

4. French, AP, Smid, AC, and Ingalls, E. Transcendental meditation, altered reality testing and behavioral change: A case report. Journal of Nervous and Mental Disease 161, 55-58, (1975).

5. Otis, LS. Adverse effects of transcendental meditation. In DH Shapiro and RN Walsh (Eds). Meditation: Classic and Contemporary Perspectives. New York: Aldine. 201-208, (1984).

6. Goldstein, J. The experience of insight, Santa Cruz, Ca: Unity Press, (1976).

7. Siegel, S.. Nonparametric statistics for the behavioral sciences. New York: McGraw Hill, (1956)

8. Benson, H., The Relaxation Response New York: Morrow, (1975).

9. Shapiro, DH and Giber, D Z Medication and psychotherapeutic effects. Archives of General Psychiatry, 35,294-302,.(1978).

10. Kutz, I; Borysenko, JZ, and Benson, H Meditation and Psychotherapy. American Journal of Psychiatry 142:1,1-8, (1985).

11. Shapiro, D. H. Comparison of meditation with other self-control strategies: biofeedback, hypnosis, progressive relaxation: A review of the clinical and physiological literature. American Journal of Psychiatry, 139(3),267-274, 1982.

12. Shapiro, D. H. Meditation: Self Regulation Strategy and Altered States of Consciousness, New York: Aldine, (1980).

13. Shapiro, D.H. and Walsh, R.N, (Eds,) Meditation: Classic and Contemporary Perspectives. New York: Aldine, (1984)

14. Shapiro, DH. Meditation, self-control, and control by a benevolent other: Issues of content and context. In Psychotherapy, Medication, and Health M. Kwee (Ed,) London: East-West, pp. 65-123, (1990).

15. Walsh, RN., The consciousness disciplines and the behavioral sciences. American Journal of Psychiatry, 137, (6), 663-673, (1980).

16. Walsh, RN and D. H. Shapiro (Eds) Beyond Health and Normality. Toward a vision of exceptional Psychological health New York: Van Nostrand Reinhold, 371-387.

17. Grof, S; and Grof, C. (Eds) Spiritual Emergencies: When Personal Transformation becomes a crisis. Los Angeles: Tarcher, (1989).

18. Shapiro, DH. The Role of Control and Self-Control in Psychotherapy and Health Care. New York: John Wiley, (in press).

19. Shapiro, DH. The Human Quest for Control. Los Angeles: Tarcher, (in press).

20. Shapiro, DH. The Shapiro Control Inventory (SCl): Measuring Personal, Interpersonal and Spiritual Sense of Control. Palo Alto: Behaviordyne, (1992).

Index Terms

Negative effects, Vipassana meditation, relaxation

Requests for Reprints:

Deane H. Shapiro, Jr., Ph.D.
1009 Canyon View Drive
Laguna Beach, CA 92651

Deane H. Shapiro, Jr., Ph.D. is an Associate Professor in Residence, Department of Psychiatry and Human Behavior, California College of Medicine, University of California, Irvine. Portions of this article have been presented at the International Association for Applied Psychology (Kyoto, Japan, 1990); First International Conference on Psychotherapy, Meditation, and Health (Amsterdam, Holland, 1990); and the Institute of Noetic Sciences Third Annual Meditation Research Seminar (Esalen, Big Sur, California, 1991).
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