Welcome…

This blog focuses on culturally and ethically sensitive
applications of spirituality in mental health.

There has been a big shift in the mental health field over the past 10 years or so in recognizing the importance of spirituality in therapy and healthcare in general. Unfortunately the legacy from Freud, BF Skinner and Albert Ellis has been one of pathologizing or ignoring spirituality. Yet research has firmly established that spirituality is associated with positive mental health outcomes, and that for many clients, spirituality is a valuable coping resource. Spiritual beliefs and practices influence a client’s approach to health, illness and treatment. Now spirituality has been recognized as a part of culturally competent practice by the American Psychological Association, NASW and other professional organizations as well as by the leading accreditation organization—the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). In my own clinical work I have observed this importance, and in a series of published case studies have documented the significant role that spirituality plays in recovery for many clients.

However surveys also show that most mental health professionals have not been trained in how to work with clients’ spiritual issues that frequently arise in therapy, and do not conduct adequate assessments of the spiritual beliefs and practices of their clients, even though these can greatly impact their health care.

On the associated Spiritual Competency Resource Center web site, you will find articles of mine as well as guides to online resources and continuing education courses for psychologists, social workers, MFTs, and nurses (which are free to preview in their entirely). This blog devoted to innovative applications of spirituality that are available online.

The Internet is a phenomenal resource both for mental health professionals and for consumers. In this blog, I will present a wide range of web sites and search strategies that you can use to stay informed about developments in the field. I will use screencasting to document the available resources. So visit the associated videoblog.

Topics that I will cover in upcoming blogs include innovative and evidence-based spiritual interventions such as meditation and forgiveness, assessment of spirituality, and ethical issues. In the next blog, I will discuss an exciting project I am involved with involving a spiritually sensitive approach to recovery from mental problems: The California Mental Health & Spirituality Initiative.

Who Am I?

I am a licensed psychologist (California PSY 8707) and Professor of Psychology at the Institute of Transpersonal Psychology. For the past 30 years  I have worked with patients with serious mental disorders, at Camarillo State Hospital, then at UCLA Neuropsychiatric Institute where I served on the faculty, and then for 14 years starting in 1986 at the San Francisco VA Day Treatment Center. I have worked with people with schizophrenia, bipolar disorder, substance abuse, chronic illness and pain, end of life issues, and PTSD, and have found spirituality to be an essential component of recovery for many. Most of my 70 articles and chapters address spiritual issues in clinical practice.

My clinical approach is informed by my own personal experience of having had a psychotic episode that lasted 2 months, and the important role that spirituality played in my own recovery. In a video of my recent lecture and in an article I describe that period in my life when I believed myself to be a reincarnation of Buddha and of Christ who had a messianic mission to write a new “holy book” that would unite all the peoples of the world (seemed like a good idea). During the past 30 years, I have often found myself face-to-face with hospitalized individuals with the same beliefs. By giving me a rare opportunity to go through the complete cycle and phenomenology of a naturally-resolving psychotic episode, this was a valuable clinical experience as well as my spiritual awakening! I spent many years in therapy and also reading books by C.G. Jung, Joseph Campbell and others to understand and integrate this experience. It led to my first working at a psychiatric hospital and then going to graduate school to become a clinical psychologist.

In 1990 I joined together with 2 psychiatrists—Francis Lu and Robert Turner who were on the faculty at UCSF Department of Psychiatry-to propose a new diagnostic category to the Task Force preparing the 4th edition of the DSM which was due to be published in 1994. We viewed such an addition to the diagnostic nomenclature as the most effective way to increase the sensitivity of mental health professionals to spiritual issues in therapy. The initial impetus for this proposal came from the Spiritual Emergence Network which was concerned with the mental health system’s pathologizing approach to intense spiritual crises. In 1994 the category we proposed was accepted into the DSM-IV. (more detailed history)

My current work is centered on increasing the spiritual competency of mental health professionals to enhance their skills in addressing spiritual problems and utilizing spirituality sensitively and yet effectively in their clinical work.

Posted in General | Comments Off

Self-Compassion Lesson IV: Cultivating Self-Compassion in Your Own Life and Using Self-Compassion Interventions with Clients

[take this course online for CE credit]

 

This lesson offers you the opportunity to directly explore the cultivation of self-compassion for yourself through the use of assessments, guided meditations, and written exercises developed by the experts in the field. These are the same exercises you could use as interventions with your clients. At the end of the lesson, further resources are provided for clinicians, including training opportunities and online materials to further your knowledge and expertise in the application of self-compassion interventions in a clinical context.

The Self Compassion Test

Begin with the informal self-assessment, provided by Neff on her website, entitled Exercise 1.

Once you have completed this exercise, try a more formal self-assessment tool. Kristin Neff has also developed the Self-Compassion Scale for use by researchers in the field. This 26-item measurement tool is available online for self-use in a version which scores itself. Assess your own level of self-compassion taking the Self-Compassion Scale yourself. How do your results with these two approaches compare? Which one was more useful for you as a self-assessment exercise? Which might be more useful for your clients?

Why Self-Compassion is Important

Kelly McGonigal is a senior teacher for the Stanford University Center for Compassion and Altruism Research and Education (CCARE). In this video, McGonigal covers topics such as the impact of self-compassion on depression and happiness, relationship between self-compassion and compassion for others, the effects of self-compassion on the brain, forms of resistance to self-compassion, and the usefulness of self-compassion for changing difficult behaviors. Watch McGonigal’s Youtube video “Why Self-Compassion Matters, and How to Develop It” (13 mins.)

 

 

Then view the following video including Kristin Neff’s perspective on why self-compassion is important. (1 min.)

 

 

In the next video, listen to Duke University Professor of Psychology and Neuroscience Mark Leary discussing self-compassion vs. self-esteem. Topics include the downside of self-esteem, and the effects of self-compassion on self-indulgence and accountability.  (3 min.)

 

 

Guided Meditations

Christopher Germer’s website has written meditation instructions and audio guided meditations designed to help with the cultivation of self-compassion and related skills. Many are adaptations of traditional Buddhist meditations that are also used in secular contexts, like Mindfulness-Based Stress Reduction (MBSR) or Mindfulness-Based Cognitive Therapy (MBCT) (See our lessons on MBSR and MBCT), but phrased to invite the cultivation of self-compassion within the context of a mindfulness exercise.

Germer makes available a variety of downloadable audios for guided self-compassion meditations . See especially Compassionate Body Scan, Compassionate Breathing, Self-Compassion Meditation, and Mindful Self-Compassion Meditation. (These exercises are listed with their file size in megs. The length in minutes is a bit more than the file size in mgs. For example, a 10 meg file takes about 12 minutes to play.) The authors have found it useful to refer clients to guided meditations such as these for practice between therapy sessions.

Self-Compassion Exercises from Neff, Germer, and Gilbert

Handouts for self-compassion activities included in “Mindful Self-Compassion,” the eight-week group intervention Neff and Germer are developing, can be found on Germer’s website. Titles of the activities include: “Compassionate Letter to Myself,” “The Self-Compassion Break,” and “Developing Your Own Self-Compassion Mantra.”

Self-compassion activities developed by Paul Gilbert can be found in his online handbook, An Introduction to the Theory & Practice of Compassion Focused Therapy and Compassionate, pages 56-97. Exercises include “Imaging the Self Critical Part of Self,” “Developing Qualities of Inner Compassion,” and ”Compassion-Focused Imagery Work.”

Look through these experiential exercises and pick several to try for yourself. These exercises may also be adapted for use in the context of individual or group therapy.

Training in Self-Compassion

Both Germer and Neff offer trainings for their eight-week intervention, “Mindful Self-Compassion,” sometimes together. See their websites (Germer and  Neff) for their current teaching schedules.

In England, Paul Gilbert’s organization, The Compassionate Mind Foundation, offers workshops on the clinical applications of compassion. Gilbert has also made his clinical intervention handbook, An Introduction to the Theory and Practice of Compassion Focused Therapy and Compassionate Mind Training for Shame Based Difficulties, available for free online (see above) as well as the accompanying materials for participants.  For those interested in more information about how this material is implemented in a clinical intervention, Gilbert provides a detailed downloadable description of the use of his Compassion-Focused Group Therapy as taught by himself in the context of a Dialectical Behavior Therapy (DBT) program. 

In addition, Stanford’s Center for Compassion and Altruism Research and Education (CCARE) offers what they call “Compassion Cultivation Training” which they describe as follows:

“Compassion Cultivation Training (CCT) is a nine-week program designed to develop the qualities of compassion, empathy, and kindness for oneself and for others. CCT integrates traditional contemplative practices with contemporary psychology and scientific research on compassion. The program was developed at Stanford University by a team of contemplative scholars, clinical psychologists, and researchers.”

Details can be found on the CCARE website

Tara Brach has developed a nine-session training program for clinicians on integrating mindfulness, including self-compassion, into psychotherapy practice available through Sounds True. Brach’s own website also has many useful resources for those cultivating self-compassion, including talks on self-forgiveness and radical acceptance.

Gilbert is careful to caution that clinicians employing his material should be adequately trained to do so, especially noting that CFT and CMT are grounded in Cognitive Behavioral Therapy (CBT), as well as mindfulness. For CBT, he directs those interested to  Tony Roth’s website for developing core competencies for the various psychotherapies. As with any mindfulness-based intervention, a clinician using such interventions should themselves have a personal mindfulness practice.

[take this course online for CE credit]

Further Resources for Clinicians

Online self-compassion bibliography .

 The Self Compassion Diet: A Step-by-Step Plan to Lose Weight With Lovingkindness by Jean Fain. To view Harvard Medical School psychotherapist Fain describing her approach to dieting, watch the following video.

 

Posted in Self-Compassion | Tagged , , , | Comments Off

Self-Compassion III: The Research

[take this course online for CE credit]

The Creation and Evolution of Self-Compassion as a Field of Psychological Study and Clinical Practice

The creation of a new field of psychological study tends to follow a particular progression. Initially the identification of a previously unresearched psychological construct includes efforts to define the construct and develop reliable instruments to measure it. In the case of self-compassion, this first stage was largely the work of a single professional, Kristin Neff (See Self-Compassion Lesson II). What is perhaps somewhat remarkable with Neff’s work on self-compassion is the degree to which her setting of the stage has almost single-handedly shaped the field. For example, in contrast to research efforts on forgiveness and self-forgiveness, characterized by a variety of definitions and a multiplicity of measurement tools, Neff’s initial definition has so far stood the test of time as the standard definition in nearly all research on the topic while her measurement tool, the Self-Compassion Scale, is the primary instrument used to measure this psychological construct (See Self-Compassion Lesson II). Neff’s seminal field-creating article,  Self-compassion: An alternative conceptualization of a healthy attitude towards oneself (2003), includes her three-part definition of self-compassion. Those interested in Neff’s work on creating and validating her Self-Compassion Scale can find it described in another article entitled  The development and validation of a scale to measure self-compassion (2003). 

With a clear standard definition and widely accepted measurement tool in place, research on self-compassion then followed a familiar pattern. The earliest research assessed self-compassion as a personality trait and explored what other traits and kinds of experience were associated with its strength or weakness in an individual’s psychological makeup. This approach has documented some of the benefits of self-compassion. The second category of research included studies measuring the presence or absence of this construct in individuals with specific clinical diagnoses or symptoms.

When the first two types of research began to show strong associations between self-compassion and positive aspects of human well-being, the study of efforts to strengthen this quality through various kinds of interventions emerged in the research literature. Lastly, researchers have begun to use self-compassion training techniques with populations suffering from mental health problems to test its efficacy as a treatment intervention. In addition, some researchers have explored cross-cultural aspects of self-compassion, while others have considered the benefits of self-compassion as a practice for clinicians themselves.

Characteristics of the Self-Compassionate Personality.

Not surprisingly, the earliest research in the U.S. was done by Neff and her colleagues. In 2006, Neff, Rude, and Kirkpatrick published their findings of their research exploring the relationship of self-compassion to various personality traits among 177 undergraduates. They found positive correlations between self-compassion and “happiness, optimism, positive affect, wisdom, personal initiative, curiosity and exploration, agreeableness, extroversion, and conscientiousness” while self-compassion was negatively associated with “negative affect and neuroticism.” (Neff (2006) An examination of self-compassion in relation to positive psychological functioning and personality traits)

In a second 2006 study, Neff, Kirkpatrick, and Rude showed that self-compassion offers some protection against anxiety in ego-threatening situations and evidence that increases in self-compassion were accompanied by greater psychological well-being. In a part of their study where participants were asked to describe their own weaknesses in writing, analysis of subjects’ writing styles demonstrated that those who showed stronger self-compassion used language reflecting “a more interconnected and less separate view of the self, even when considering personal weaknesses.” The authors go on to note that other studies have associated similar language usage patterns with lower levels of depression and better relationships. (These researchers also measured self-esteem but found no correlation between self-esteem and connective language patterns.) (Neff, K., Kirkpatrick, K., and Rude, S. (2006) Self-compassion and adaptive psychological functioning)

In 2009, Neff and Vonk compared self-compassion, as defined by Neff, to self-esteem in two studies. They found that both constructs were equally strong in predicting happiness, optimism, and positive affect. However self-compassion was more strongly associated with “stable feelings of self-worth” while self-esteem was more clearly associated with “social comparison, public self-consciousness, self-rumination, anger and the need for cognitive closure.” Perhaps especially noteworthy was the clear association between self-esteem and narcissism, something not found with self-compassion. (Neff, K. and Vonk, R. (2009)  Self-compassion versus global self-esteem: Two different ways of relating to oneself) Neff and Vonk’s conclusion’s supported the results of earlier research by Leary, et al (2007). They conducted five studies to explore the effects of self-compassion on negative self-relevant events such as distressing social incidents or receiving ambivalent feedback. Comparing their results with earlier research on self-esteem, Leary et al. concluded that “self-compassion attenuates people’s reactions to negative events in ways that are distinct from and, in some cases, more beneficial than, self-esteem.” (Leary, M., et al. (2007) Self-compassion and reactions to unpleasant self-relevant events: The implications of treating oneself kindly)

In a study with somewhat mixed results, Allen, Goldwasser, and Leary examined the relationship between self-compassion and well-being among elderly adults ranging in age from their 60’s to 90’s. In their 2011 research project, self-compassion was not associated with higher well-being scores for those who were physically healthy. But among those in poor health, subjects who demonstrated stronger self-compassion capacities also scored higher on the well-being scale. Results also showed that those with higher self-compassion scores were “less bothered by the use of assistance,” although they were not necessarily more likely to use assistive devices. (Allen, A., Goldwasser, E., and Leary, R. (2011) Self-compassion and well-being among older adults)

Self-compassion also plays a positive role in the lives of those going through a divorce. In 2011, Sbarra, Smith, and Mehl engaged over 100 divorcing adults in 4-minute stream-of-consciousness reflections about the experience of separation. Four evaluators then listened to tapes of the reflections, scoring them for each of the three components of Neff’s definition of self-compassion. There was high interrater reliability among the judges’ assessments. Subjects were later evaluated for “divorce-related emotional intrusion over a period of nine months. Having self-compassion was predictive of less “divorce-related intrusive emotions,” a result that lasted the full nine months of the study. (Sbarra, D., Smith, H., and Meh, M.l (2011) When leaving your ex, love yourself: Observational ratings of self-compassion predict the course of emotional recovery following marital separation)

Additional studies of self-compassion as a personality trait have shown that it is positively related to lower levels of loneliness (Akin, A.  (2010) Self-compassion and loneliness), use of emotionally-focused strategies, as opposed to avoidance, in the face of negative news about grades among college students (Neff, K., Hsieh, Y., and Djitterat, K. (2005) Self-compassion, achievement goals, and coping with academic failure), and improved goal management skills leading to enhanced well-being (Neely, M., et al., 2009, Self-kindness when facing stress: The role of self-compassion, goal regulation, and support in college students’ well-being.)

Self-compassion and Specific Clinical Issues

Evidence supporting the benefits of self-compassion as a personality trait is growing. But what about its benefits for those experiencing clinically significant mental health challenges? In their 2008 study of self-compassion and post-traumatic stress disorder, Thompson and Waltz gathered data from over 200 university students, nearly half of whom reported having experienced a significant trauma. Analysis of the results from that subgroup suggested that trauma victims with more self-compassion were less likely to engage in avoidance behaviors, a common post-trauma symptom. The authors suggest that “Individuals high in self-compassion may engage in less avoidance strategies following trauma exposure, allowing for a natural exposure process.” (Thompson, B., and Waltz, J. (2008) Self-compassion and PTSD symptom severity) In a related study in 2011 by Vettesse et al., the authors concluded that transition-aged youth who had a history of childhood maltreatment may benefit from self-compassion interventions. The authors’ data showed that among their subjects, those who scored higher for trait self-compassion also had fewer problems with emotional dysregulation. (Vettesse, L., et al. (2011)  Does self-compassion mitigate the association between childhood maltreatment and later emotion regulation difficulties? A preliminary investigation)

In 2011, Werner et al. compared self-compassion scores on Neff’s scale for patients diagnosed with social anxiety disorder (SAD) with those for healthy controls (HC). As they predicted, patients with SAD showed less self-compassion. While self-compassion scores did not correlate with severity of SAD, within the SAD group, those with lower self-compassion scores showed higher fear levels for both negative and positive evaluation. When the researchers analyzed their results relative to their subjects’ age, patients with SAD scored lower for self-compassion as their age increased while the opposite was true for the HC group. They concluded that “self-compassion may be a particularly important target for assessment and treatment in persons with SAD.” (Werner, K., et al.(2011) Self-compassion and social anxiety disorder)

Three studies that focused on subclinical levels of potentially clinically significant issues also pointed to the possible usefulness of self-compassion in the treatment of these issues. First, in 2009, Raes researched the relationship between self-compassion, depression and anxiety among nearly 300 nonclinical undergraduates. He specifically targeted the connection between self-compassion and the tendency to ruminate and worry. Findings showed that self-compassion reduced depression by negatively affecting the tendency for brooding rumination. Self-compassion also predicted lower anxiety by reducing the tendency both to worry and to brood. (Raes, F. (2009) Rumination and worry as mediators of the relationship between self-compassion and depression and anxiety) A later study in 2011 by Van Dam et al. compared mindfulness and self-compassion in relation to “anxiety, depression, worry, and quality of life” in a population of 500 people who had sought self-help for anxiety. Like Renden, they found that self-compassion was a significantly stronger predictor for psychological health than was mindfulness. (Van Dam, N., et al. (2010) Self-compassion is a better predictor than mindfulness of symptom severity and quality of life in mixed anxiety and depression)

Lastly, self-compassion may also be useful in the prevention and treatment of alcohol abuse. In 2006, using a series of online questionnaires, Rendon studied 300 college students for correlations between alcohol use and mindfulness, self-compassion, self-esteem, and psychological symptoms. Rendon found that those students with the highest self-esteem and the highest self-compassion were least likely to use alcohol. Specifically analyzing the role of self-compassion, the author concludes that “It appears that self-compassion first reduces depression, anxiety, painful affective states, stress, and tension, which in turn reduce drinking.” (p. 79) Like Van Dam, et al., Rendon also reported that self-compassion proved to be more strongly associated with psychological health than was mindfulness. (Rendon, 2006) Understanding alcohol use in college students: A study of mindfulness, self-compassion, and psychological symptoms)

Self-Compassion Interventions with Clinical Populations

While there is growing evidence to suggest the potential efficacy of self-compassion interventions for various clinical issues, actual intervention research on self-compassion with clinical populations is still in its infancy. In a 2006 pilot study, Gilbert and Proctor used Gilbert’s Compassionate Mind Training (CMT) intervention (12 two-hour sessions) with a small group of patients at a cognitive-behavioral-based day treatment center for those with chronic mental health problems. Their results, based on the six patients who completed the full 12 sessions, indicated “significant reductions in depression, anxiety, self-criticism, shame, inferiority, and submissive behavior (and) … a significant increase in the participants’ ability to be self-soothing and focus on feelings of warmth and reassurance for the self.” (Gilbert, P., and Proctor, S. (2006) Compassionate mind training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach)

Two years later Mayhew and Gilbert conducted a study using CMT adapted for individual therapy with patients diagnosed with schizophrenia who also experienced hearing malevolent auditory hallucinations. Initially seven subjects were recruited, though for various reasons four dropped out before completing the 12 individual CMT sessions. Nonetheless the results for the 3 who completed the intervention were impressive. In the words of the authors, there were “decreases for all participants in depression, psychoticism, anxiety, paranoia, Obsessive Compulsive Disorder, and interpersonal sensitivity. All three participants’ auditory hallucinations also became less malevolent, less persecuting, and more reassuring.” (Mayhew, S. and Gilbert, P.  (2008) Compassionate mind training with people who hear malevolent voices: A case series report)

These studies suggest that some of the qualities of self-compassion can be increased through self-compassion interventions with clinical populations. However in both cases the number of subjects was very small. To date (2011) larger studies of CMT and similar interventions, such as Neff and Germer’s Mindful Self-Compassion (See Self Compassion Lesson II), have not yet been undertaken.

Other Interventions or Psychological Skills that Enhance Self-Compassion

In the absence of strong research on the efficacy of self-compassion interventions, there is, nonetheless, a growing body of evidence showing that self-compassion can be increased in various other ways. Over the past six years a number of studies have demonstrated that several different interventions that don’t specifically target increasing self-compassion nonetheless do have that result. These interventions include: a 4-session loving-kindness meditation intervention (Weibel, D. (2007) A loving-kindness intervention: Boosting compassion for self and others), a Gestalt two-chair intervention for intrapsychic conflict (Kirkpatrick, K. (2005), Enhancing self-compassion using a gestalt two-chair intervention), process group psychotherapy (Jannazzo, E. (2009) An examination of self-compassion in relation to process group psychotherapy), and Mindfulness-Based Stress Reduction (MBSR) (Birnie,K., Speca, S., and Carlson,C. (2010), Exploring self-compassion and empathy in the context of Mindfulness-based Stress Reduction (MBSR)). All of the researchers in these studies assessed self-compassion using Neff’s Self-Comapssion Scale. As such, it seems fair to conclude that self-compassion is a trait that can be strengthened in various ways. However further research is needed to determine the best approaches to enhance self-compassion, both for the general population and for specific clinical populations.

Contraindications for Self-Compassion Interventions

So far, the evidence in favor of self-compassion is quite strong. But are there clinical situations where a self-compassion intervention would not be advisable? Baker and McNulty wondered if self-compassion might adversely effect motivation to “correct interpersonal mistakes” in the context of relationships. Their 2011 article reported conflicting gender-related results. For men, self-compassion increased motivation to atone for transgressions, but only among those with high conscientiousness (defined as being “determined, scrupulous, and reliable”). In contrast, for men scoring low on conscientiousness, self-compassion actually reduced corrective behavior and increased both marital dissatisfaction and inter-partner problems. (For similar results concerning self-forgiveness in the context of marriage see Forgiveness Lesson V.)  Among women, however, self-compassion seemed to have no negative effects. The authors theorize that this may be due to women being “inherently more motivated than men to preserve their relationships for cultural and/or biological reasons.” To date, this study is the only one found by the authors offering any suggestion of contraindication for self-compassion. (Baker, L. and McNulty, J. (2011)  Self-compassion and relationship maintenance: The moderating roles of conscientiousness and gender)

Cross-Cultural Considerations

Clinicians who work with a multiplicity of ethnic groups might wonder if there are differences between cultures when it comes to self-compassion. In a 2008 study, Neff, together with Pisitsungkagarn in Thailand and Hsieh in Taiwan, examined self-compassion across three cultures. While they found that those with strong self-compassion also reported higher well-being in all three cultures, the level of self-compassion in the general population varied from one culture to another. Surprisingly, given that self-compassion is strongly associated with Buddhism, an Eastern religion prevalent in Thailand and Taiwan, only Thailand, of the two Asian cultures studied, showed higher self-compassion scores than did the United States. Neff et al.’s research also suggested that while in Thailand self-compassion was highly associated with interdependence, in both the United States and Taiwan it was associated with independence. (Neff, K., Pisitsungankarn, K., and Hsieh, Y. (2008) Self-compassion and self-construal in the United States, Thailand, and Taiwan) These results suggest that clinicians should be sensitive to potential culture-specific responses to self-compassion interventions.

Self-Compassion for Clinicians

Some researchers have looked at the value of self-compassion for therapists and other healthcare workers. A 2005 pilot study by Shapiro et al. looked at the ability of Mindfulness-Based Stress Reduction (MBSR) to cultivate self-compassion among health care professionals. They found that the eight-week MBSR intervention shows promise to both reduce stress and increase self-compassion for this group.  (Shapiro, S. et al. (2005 Mindfulness-Based Stress Reduction for health care professionals: Results from a randomized trial) (For more on MBSR see our lesson on this topic.)

In a 2009 study of 164 professional counselors, Ringenbach showed those who practice some form of meditation demonstrated stronger self-compassion and less burnout than those who are not meditators. (Ringenbach, R. (2009) A comparison between counselors who practice meditation and those who do not on compassion fatigue, compassion satisfaction, burnout and self-compassion) Kanne used a grounded theory approach with eight seasoned clinicians who had practiced both mindfulness and self-compassion to study the effect of these qualities in the context of psychotherapy sessions. (For an overview of the grounded theory approach, see Borgatti’s internet article Introduction to Grounded theory.) In this 2009 dissertation research, after analyzing in-depth interview data, Kanne concluded that both mindfulness and self-compassion help clinicians in two ways. They not only enhance clinical skills but also contribute to “clinician resilience and well-being.” (Kanne, A. (2009) A grounded theory study of mindfulness and self-compassion as they relate to clinical efficacy and clinician self-care.)

 [take this course online for CE credit]

Additional Resources

Watch the following video to hear Kristin Neff lecture on the science of self-compassion.

 

Posted in Self-Compassion | Tagged , | Comments Off

Mindfulness with Children in Clinical Contexts

[take this course online for CE credit]

Background: Mindfulness and Its Uses with Adults

Since Jon Kabat-Zinn first began teaching Mindfulness-Based Stress Reduction (MBSR) (LESSON LINK) in a basement at the University of Massachusetts Medical School in 1979, there has been a boom of both clinical interest in and research on the applications of this simple practice adapted from the Buddhist tradition. According to a recent article by Margaret Cullen in the journal Mindfulness (2011, Mindfulness-Based Interventions: An Emerging Phenomenon), Kabat-Zinn’s secularized approach to the teaching of mindfulness has been the subject of literally hundreds of clinical studies that have demonstrated its clinical effectiveness in the treatment of a wide range of physical and mental health issues including the following:

• Depression, including relapse prevention

• Anxiety

• Substance abuse

• Eating disorders

• Insomnia

• Chronic pain

• Psoriasis

• Rheumatoid arthritis

• Cancer

• Heart disease

In addition mindfulness has been shown to improve immune function. (Davidson, R. et al. (2003) Alterations in brain and immune function produced by mindfulness meditation)

In fact, it turns out that mindfulness training is also good for those who are basically healthy. Chiesa and Serretti report in their review of the literature on healthy adults that mindfulness reduces stress, ruminative thinking, and trait anxiety in those of us who are basically healthy. In addition, mindfulness increases empathy and self-compassion in people with no current clinically significant physical or mental health issues. (For a review of the research, see  Chiesa, A. and Serretti, A. (2009) Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis)

Interest in Mindfulness for Children

With this strong base of evidence for adults, the past five years have seen attention begin to shift toward applications with children and adolescents as well. In this lesson we will explore mental health applications of mindfulness with children. In the next lesson, the intimately related topic is mindfulness for children in education.

There is some significant overlap of these two areas in several ways. Much of the research on mindfulness with children in education focuses on executive function. Differences or deficits in executive function are important in childhood mental health concerns as well, so the educational research has strong relevance for mental health uses of mindfulness with children. (For more on executive function and mindfulness in education with children see the lesson “School-Based Mindfulness for Children.”) In addition, many of the mindfulness interventions being developed for use with children in the classroom can also be effectively adapted for clinical groups or individual therapy with this age range. In fact, some therapeutic uses may actually take place in the school setting under the purview of school counselors and school psychologists.

Lastly, mindfulness with children in the classroom is an example of Positive Psychology  Mindfulness interventions in educational contexts are typically given to all students in a class or even to a whole school. Yet most school children don’t have clinically significant mental health issues. However the use of mindfulness to enhance their executive function by improving such skills as attention, impulse control, meta-cognition, and cognitive flexibility has the potential to strengthen cognitive and emotional well-being in addition to educational benefits. Mindfulness in the classroom thus naturally falls within the arena of psychological interventions that enhance human flourishing. In addition, improved executive function during childhood may serve to prevent the development of mental health issues as adults. Clinicians are therefore encouraged to explore the lesson on School-Based Mindfulness Interventions for Children.

Issues Involved in the Application of Mindfulness Interventions with Children

Therapeutic mindfulness interventions with children represent a further extension of third-wave Cognitive Behavioral Therapy (CBT) into the domain of childhood mental health issues. (See our full listing of courses on mindfulness in mental health.) As with third-wave CBT with adults, the emphasis in mindfulness interventions with children is on processes that happen within the child rather than changing the content of the child’s experience (e.g., challenging a thought to change or reduce it thereby changing the frequency of an emotion). With mindfulness-based therapies we help the client learn to turn towards their challenging emotions with equanimity rather than helping them replace an unpleasant emotion with a pleasant one. In mindfulness-based CBT, its OK to be vulnerable. It’s not helpful to hide from or avoid painful feelings. And we work to remember that we are not alone in our suffering.

This orientation in the therapeutic alliance involves the potential for conflict between openness to emotions taught through mindfulness practice versus emotional suppression often modeled and taught by other adults in a child’s life. All of these points suggest that third-wave CBT, whether with children or adults, involves a re-emphasis on the importance of the therapeutic relationship. And within this reemphasis, it is especially important that the clinician using mindfulness-based interventions is practicing a mindful approach in their own lives.

There are other challenges for mindfulness-based interventions with children as well. Perhaps the most obvious is that of the various developmental levels of childhood. New methods of training mindfulness to include child-friendly teaching strategies such as imagery, story telling, songs, play, art, and games are being developed and tested for different childhood age groups.

In addition, much mindfulness research relies on self-report of various kinds. Mindfulness research with adults thus already struggles with the challenge of using subjective data to measure the very private experience of being mindful. How much more difficult will it be doing mindfulness research on children, where self-report may need to come from a child who cannot speak, let alone read and write, at an adult level of sophistication when reporting their inner experience.

Lastly, the more we learn about mindfulness as a treatment for issues like childhood anxiety, impulsivity, inattentiveness, etc., the more our attention will turn to the potential preventive capacity of mindfulness interventions as well as their expression as an element of Positive Psychology by which we make the lives of mentally healthy children even happier and more fulfilling. Can then visions of societal and cultural change be far behind?

Research on Clinical Interventions with Children

While we are just in the early stages of studying mindfulness in educational settings with elementary school students, there has been even less research on clinical populations of children. In fact much of the research with children that has a clinical focus has been conducted in the context of educational institutions. In the earliest such study (Semple, R., Reid, E., and Miller, M. (2005 ) Treating anxiety with mindfulness: An open trial of mindfulness training with anxious children), the authors worked with five students identified by their teachers as demonstrating anxiety symptoms. These five students were given a 6 week group mindfulness intervention after which each child showed “improvement in at least one area – academic functioning, internalizing problems, or externalizing problems.” However the researchers did not report on anxiety issues since the students in the study did not show clinically significant levels of anxiety when evaluated as part of the initial assessment process for this study. The researchers concluded that mindfulness interventions were both feasible and promising for children.

Semple and Lee (2011) then went on to develop a manualized protocol called Mindfulness-Based Cognitive Therapy – Children (MBCT-C) that was adapted developmentally for children in conjunction with Williams, Teasdale, and Segal, the creators of MBCT for adults. (This manual has been published as Mindfulness-Based Cognitive Therapy for Anxious Children: A Manual for Treating Childhood Anxiety.) Semple and Lee along with Miller and Rosa used this protocol to conduct a randomized trial with boys and girls aged 9-13. Their intention in this study was to increase social-emotional resiliency, which they defined as reduced problems in the areas of attention and behavior as well as reduced symptoms of anxiety. Those who completed the program did show reduced attention problems, a shift that was maintained for three months post intervention. For behavior problems and anxiety symptoms no overall shift was seen, though it is of note that both these areas improved significantly for those students who showed clinical levels of anxiety pre-intervention. (Semple,, R. (2010) A randomized trial of mindfulness-based cognitive therapy for children: promoting mindful attention to enhance social-emotional resiliency in children)

A second study conducted in an educational setting also shows potentially clinically relevant results. In 2005, Napoli, Creach and Holley published the results of their study on the effects of a mindfulness intervention called the Attention Academy with 1st to 3rd graders. The subjects demonstrated better selective attention (the ability to pick and choose what to pay attention to), but were not different from controls on sustained attention (the ability to stay with a particular chosen focus of attention over a sustained time period). Those receiving the mindfulness intervention also showed less test anxiety and their teachers reported fewer ADHD type symptoms. (An ADHD behaviors measurement was used to track behaviors even though the test subjects themselves were a randomly chosen 1st to 3rd graders, and thus not a group chosen for clinical ADHD symptoms.) (Napoli, M., Creach, P., and Holley, L. (2005) Mindfulness training for elementary school students: The attention academy)

In another pilot study that blends clinical and educational contexts, Desmond studied the effects of mindfulness on six students in a special support classroom for those with learning and emotional disabilities. They concluded that their results “strongly support the positive effects of mindful awareness teaching on student cognitive, physical, and social behaviors for both learning support and emotional support students..” (Desmond, C. (2009) The effects of mindful awareness teaching practices in the “Wellness Works in Schools” program on the cognitive, physical and social works in schools program on the cognitive, physical and social behaviors of students with learning and emotional disabilities in an urban, low income middle school, p. 11)

Liehr and Diaz recruited 18 children from a summer camp for minority children for a study of the effects of mindfulness on depression and anxiety. Half were given a mindfulness intervention while the others attended classes in health education. Results showed that mindfulness reduced depression symptoms, but not anxiety symptoms, in the mindfulness group relative to the health education group. (Liehr, P. and Diaz, N. (2010) A pilot study examining the effect of mindfulness on depression and anxiety for minority children)

An Australian study by Joyce et al. involving a school-based mindfulness program for 10-12 year olds focused on mental health issues. The researchers found that after mindfulness training, students scored lower on psychological assessment tools designed to identify those with mental health issues at clinical levels. One test was a general assessment tool used to screen for a variety of diagnostic categories while the other was designed to detect depression. There was an overall 35% drop in students who tested within the borderline or clinical range for mental health issues while the drop was 16% when depression alone was the focus of the assessment. (Joyce,  A., et al. (2010) Exploring a mindfulness meditation program on the mental health of upper primary children: A pilot study

Coholic, Eys, and Lougheed in Canada have designed a program integrating mindfulness with visual arts. In their preliminary qualitative research using this protocol with 8-14 year old children in the foster care system or referred to them by child protective agencies, they examined reports both from the participants and their parents/guardians. They found that the children experienced a decrease in emotional reactivity while the reports also depicted them as happier, more confident and more willing to talk about their emotions. The authors of this study, which was essentially a feasibility study, found that the program was both acceptable to and suitable for participants while showing promise as an effective intervention. (Coholic, D., Eys, M., and Lougheed, S. (2012) Investigating the effectiveness of an arts-based and mindfulness-based group program for the improvement of resilience in children in need)

By contrast, a study by White of a once-a-week, hour-long, 8-week intervention of mindful yoga for 4th and 5th grade girls recruited from a local school yielded ambiguous results. Both control and yoga groups demonstrated increased self-esteem and self-regulation while the yoga group reported higher levels of stress but also better ability to deal with stress. The authors suggest that this may be because their subjects were more aware of stress and therefore, while they tended to report more stress, they were better able to cope with it as well. (White, L. (2012) Reducing stress in school-age girls through mindful yoga)

Self-Esteem vs. Mindfulness-based Self-Compassion

This last study raises the issue of self esteem in childhood. Self-esteem is another area that has both clinical and educational significance. Self-esteem was important in education from the 60s through the 90s, when it began to come under some question. The practice of mindfulness-based self-compassion has been developed and studied by Kristin Neff at the U. of Texas as an alternative to self-esteem. Mindfulness-based self-compassion involves the cultivation of three elements: mindfulness, kindness towards oneself, and what Neff calls common humanity, the recognition that others also experience similar difficulties and challenges to the ones we ourselves experience. In 2009, Neff and Vonk compared self-compassion to self-esteem in two studies with adults. They found that both constructs were equally strong in predicting happiness, optimism, and positive affect. However self-compassion was more strongly associated with “stable feelings of self-worth” while self-esteem was more clearly associated with “social comparison, public self-consciousness, self-rumination, anger, and the need for cognitive closure.” Perhaps especially noteworthy was the clear association between self-esteem and narcissism, something not found with self-compassion. Although this research was done with adults, given that mindfulness research on executive function with children tends to follow results with adults, there is reason to believe that self-compassion work, grounded so strongly, as it is, in mindfulness practice, would also have similar results in children. (Neff, K. and Vonk, R. (2009) Self-compassion versus global self-esteem: Two different ways of relating to oneself). (For an article which offers exercises for children in the development of self-compassion, see Persinger, J. (2011) An alternative to self-esteem: Fostering self-compassion in youth p. 4ff) 

[take this course online for CE credit]

Web-based Resources

Website for Diane Coholic, developer of an art-based approach to teaching mindfulness.

Diane Coholic’s work described in an article can be found at Tollinsky, N. (2009) Arts-based work groups help children.

An overview of executive function from the perspective of academic skills can be found on the Great Schools website.

Books

Susan Kaiser Greeneland, The Mindful Child, Free Press, 2010.

Thich Nhat Hanh, Chan Chau Nghiem, and Wietzke Vriezen, Planting Seeds: Practicing Mindfulness with Children , Parallax Press, 2011.

Thich Nhat Hanh and Wietzke Vriezen, Mindful Movements: Ten Exercises for Well-Being, Parallax Press, 2008.

Sarah Wood Vallely, Sensational Meditation for Children: Child-Friendly Meditation Techniques Base on the Five Senses, Satya International, Inc., 2008.

Christoper Willard, Child’s Mind: Mindfulness Practices to Help Our Children Be More Focused, Calm, and Relaxed , Parallax Press, 2010.

Diane Coholic, Art Activities for Children in Need, Jessica Kingsley Publishers, 2010

Posted in Mindfulness with Children in Clinical Contexts | Tagged , , , | Comments Off

School-Based Mindfulness Interventions for Children

[take this course online for CE credit]

Mindfulness in a New Context: The Classroom

Since the turn of the millennium, there has been a significant increase in the teaching of mindfulness to children in educational settings. This has involved the development of curricula targeted at the elementary and secondary school levels and has generated the beginnings of empirical study of these interventions as well. Among the pioneers in this field is Susan Kaiser Greeneland.

clip_image002

Trained as a corporate lawyer, Greeneland found her own way to mindfulness meditation during a family crisis. She attributes her weathering of that crisis to the practice of mindful breathing. As her own children grew older, she wondered if mindfulness might also help them deal with their own stressors. She experimented with adapting her own mindfulness practice for children, and she began practicing together with her children. Soon she was also teaching other children, which eventually led to her second career as a teacher and advocate for mindfulness with children and in education. Together with her husband she founded the InnerKids Foundation, and began teaching mindfulness in public schools in Southern California since 2000. Today she travels widely speaking about the value of introducing mindfulness to children.

To hear Greeneland talk about mindfulness in education, see. “The New ABCs of Learning: Attention, Balance, Compassion.”

The next video shows her Inner Kids program in action.

 

The Following video shows children talking about their own experience of of the InnerKids program.

For more videos featuring Greeneland and her innovative teaching techniques, see the Youtube VDO section below. For additional resources on other mindfulness programs in education, see the websites for Mindful Schools, Marin Mindfulness Cooperative, and The Hawn Foundation.

Mindfulness in Education: Issues to Consider

The issues regarding mindfulness with children are largely the same as those listed in the course “Mindfulness with Children in Clinical Contexts.” One of the main differences is the impact of developmental stages of childhood. The techniques for teaching mindfulness to children differ somewhat from the techniques used for adults. In addition, the approach to teaching mindfulness in an early childhood setting or a kindergarten classroom differs from the approach that will work with sixth graders. Curricula for teaching mindfulness in the educational context vary according to the age group being taught. (For information regarding training on a leveled mindfulness curricula for elementary school children contact Mindful Schools.)

A second issue specifically for the public school setting is that of separation of church and state. Mindfulness is most often associated with Buddhism, although similar practices can be found in all the major religions of the world. But because public schools receive funding from the state, mindfulness taught in schools needs to be completely secularized. As such, it’s Jon Kabat-Zinn’s secularized approach to mindfulness, epitomized in his “Mindfulness Based Stress-Reduction (MBSR) protocol (See course on  MBSR.), that has been the model for school-based mindfulness curricula. Vocabulary used also needs to be tailored in a secular manner. For example, in the Mindful Schools curriculum, practices that are secularized versions of such Buddhist practices as lovingkindness are referred to as heartfulness to avoid any confusion with religious tradition. These practices, which include compassion, empathy, generosity, and gratitude, are, of course, widely accepted as societal values independent of any religious context. Even the term ‘meditation,’ which for many people has a religious or spiritual connotation, is not used in the public school setting. For example, Greeneland, when asked if students are meditating, replies that she doesn’t know, and that it’s not relevant to her because she’s not teaching meditation, but rather mindfulness.

Executive Function

Research on mindfulness in education is still in its infancy. One of the main lenses through which mindfulness in education is currently being studied is that of executive function (EF). Executive function is a set of cognitive abilities that together play a central, though often under-addressed, role in the school setting. As the name suggests, EF serves to help us direct our efforts towards the completion of a task or achieve a goal. As such, metaphors that are sometimes used to describe EF are that of a corporate CEO, the conductor of a symphony orchestra, or a principal of a school. In the context of teaching mindfulness in the classroom I sometimes use EF as a concept to describe how mindfulness works with higher grade levels. In this context I usually mention that the teacher is responsible for the EF in a classroom or the principal is for the whole school.

A common list of the components of EF includes the following:

  • Sustained attention
      • The ability to stay focused on the task at hand.in the face of alternatives or distractions.
  • Working memory
      • Holding information in mind so that it can be used for later activities, e.g., remembering multi-step instructions to complete a task.
  • Organizational skills
      • Arrange elements into a functioning whole.
      • Keep track of commitments and responsibilities such as chores and homework.
  • Planning and prioritizing
      • Thinking ahead.
      • Recognizing logical sequencing.
      • Recognizing the hierarchy of importance.
  • Setting goals and persistence in their pursuit
      • Persistence towards completion of a goal
  • Time management
      • Follow a schedule
      • Estimate time to complete a task and allot that time.
  • Task initiation
      • Initiate a task w/o procrastination
  • Metacognition
      • Self-monitoring, self-assessment
  • Cognitive Flexibility
      • The ability to adapt to changing circumstances
  • Emotional control/impulse control/ response inhibition
      • Sustain effort in the face of frustration
      • Ability to stop or delay an impulse
      • Express rather than act out in response to strong emotion
  • Social Thinking
      • Label and describe one’s own feelings and their causes
      • Understand the needs and perspectives of others
      • Understand and use nonverbal cues and social conventions
      • Show care and concern for others

The working together of these separate functions helps us to get where we want to go, to complete what needs to be completed, and to maintain relationships. (For details concerning these categories of EF, see Krapes-McKinnon, S. (2011) How your children learn: Executive functions: The new intelligence.)

Neuroimaging research has shown that these functions are generally associated with the pre-frontal portion of the cerebral cortex and serve to manage the activities of other parts of the brain. fMRI studies show that the pre-frontal cortex is one of the main areas of the brain that becomes more active during mindfulness practice. Anatomical research also supports the theory of neuroplasticity which states that the parts of the brain that get used in mindfulness increase in thickness and connectivity. In fact in adults, simply learning and practicing mindfulness for the duration of a two-month MBSR course was found to be “associated with changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking.” (Hozel, B. (2011) Mindfulness practice leads to increases in regional brain gray matter density, from abstract.)

In another study, the simple labeling of affect, taught as a tool employed in the cultivation of mindfulness, resulted in “enhanced prefrontal cortical regulation of affect” leading to “reduced bilateral amygdala activity.” The amygdala is a part of the middle brain associated with emotions. (Creswell, D., et al. (2007) Neural correlates of dispositional mindfulness during affect labeling.)

Given their clear relationship to the brain and in light of the past decade’s focus on the plasticity of the brain, one can easily see how the various components of EF might be strengthened through mindfulness training. In fact, research on adults offers much evidence in support of this view. For example, in one study by Valentine and Sweet, mindfulness training was found to increase sustained attention. (Valentine, E. and Sweet, P. (1999)  Meditation and attention: A comparison of the effects of concentrative and mindfulness meditation on sustained attention)

In their overview of the benefits of mindfulness in the context of psychotherapy, Davis and Hayes (Davis, D. and Hayes, J. (2011) What are the benefits of mindfulness? A practice review of psychotherapy-related research) list other empirically supported benefits of mindfulness in adults that match the EF list above including:

  • Metacognition
  • Working memory
  • Emotional regulation
      • Mindfulness leads to emotional control, impulse control, and response inhibition
  • Social Thinking
      • Mindfulness practice leads to increased empathy/compassion
  • Cognitive flexibility
      • Decreased automatic responses leading to greater flexibility

Studies of Mindfulness in Children

In light of these research findings, it is not surprising that attention has been focused on mindfulness training as one way to develop these critical capacities in children. In fact, several research studies on this topic have already been completed with elementary school students.

In 2010, Flook et al. followed 64 seven to nine year olds before and after their participation in a program of mindful awareness practices developed by InnerKids, a southern California non-profit devoted to teaching mindfulness to children. The InnerKids curriculum consists of 16 eight-hour lessons taught over an eight week period. (A detailed description of the curriculum can be found in an appendix to the research article.) Data that was collected came from questionnaires filled out by both teachers and parents. Results showed that participants demonstrated significant gains specifically in the areas of behavioral regulation, meta-cognition and overall global executive function. Of particular note is the fact that those students who started with the lowest executive function scores made the greatest gains, a also pattern mentioned in other similar studies. In addition, since reports of both teachers and parents showed similar effects, the gains in EF by these students seem to be generalizable to all life contexts. (Flook, L., et al. (2010) Effects of mindful awareness practices on executive functions in elementary school children)

In a similar study the same year by Desmond and Hanich of 40 sixth graders from an urban low-income middle school in Pennsylvania, a different mindfulness curriculum, Wellness Works in Schools, adapted from the Mindfulness-Based Stress Reduction (MBSR) curriculum developed by Jon Kabat-Zinn at the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical School in Worcester. (See course on  MBSR.) The intervention consisted of weekly lessons for a period of 10 weeks. (See the website for more details concerning this mindfulness-in-education curriculum.) The researchers measured a number of executive function variables: 1) inhibiting, 2) shifting, 3) emotional controlling, 4) initiating, 5) working memory, 6) planning & organizing, 7) organizing of materials, and 8) monitoring. These areas were assessed utilizing three general measurements: a) behavioral regulation, b) metacognition, and c) global executive function, a composite of the previous two. Results showed that students receiving the curriculum in this study demonstrated a significant increase in the subscale area of shifting/flexibility and were trending towards increases in the general areas of metacognition and global executive function. At first glance this might not seem too impressive but as it turns out the results for the control group showed declines on all three indices. (Desmond, C. and Hanich, L. (2010) The effects of mindful awareness teaching practices on the executive functions of  students in an urban, low income middle school)

In a 2010 article published in the journal Mindfulness, Schonert-Reichl and Lawlor report on their study of the use of a mindfulness-based social emotional learning curriculum called MindUP with students in grades 4-7. The MindUP curriculum takes a Positive Psychology approach, teaching students basic mindfulness skills integrated with social and emotional learning. The authors’ research revealed that, compared to a control group, students receiving the MindUP curriculum showed both increased optimism and positive affect, as well as decreased externalizing behaviors. For students in younger grades, self-concept also was significantly improved, although in this area the result was less robust for pre-adolescent 6th and 7th graders. (Schonert-Reichl, K. and Lawlor, M. (2010) The effects of a mindfulness-based education program on pre- and early adolescents’ well-being and social and emotional competence) For more information about the MindUP curriculum used in this study, see The Hawn Foundation.

In 2005, Napoli, Krech and Holley published the results of their study on the effects of a mindfulness intervention called the Attention Academy with 1st to 3rd graders. The subjects demonstrated better selective attention (the ability to pick and choose what to pay attention to), but were not different from controls on sustained attention (the ability to stay with a particular chosen focus of attention over a sustained time period). Those receiving the mindfulness intervention also showed less test anxiety and their teachers reported fewer ADHD type symptoms. (An ADHD behaviors measurement was used to track behaviors even though the test subjects themselves were randomly chosen 1st to 3rd graders, and thus not a group chosen for clinical ADHD symptoms.) (Napoli, M., Krech, P., and Holley, L. (2005) Mindfulness training for elementary school students: The attention academy

In a 2011 literature review on programs designed to improve EF, Diamond and Lee list mindfulness programs among those that demonstrated increased EF. The authors identified the public school setting as the most viable context in which to impact EF since schools can reach the most children early in their lives. The authors concluded that focusing narrowly on the specific skill that make up EF is not the best way to develop it. Rather programs that emphasize social and emotional development along with physical exercise are the most promising strategies. In addition, when designing curricula they recommend an approach that emphasizes exercises designed to improve EF throughout the day rather than focused in discrete modules. As they note “repeated practice produces the benefits” (p.964). (Diamond, A. and Lee, K. (2011) Interventions shown to aid executive function development in children 4–12 years old)

Importance of Mindfulness in Public Education

To summarize, the early research has shown that school based-interventions have the potential to positively impact the mental health of students in many ways, including improvement in certain aspects of executive function, such as metacognition, impulse control, cognitive flexibility, sustained attention, and social thinking, deficits of which contribute to numerous childhood mental health diagnoses. As such, teaching mindfulness in schools, especially public education, represents a huge potential for a large-scale approach to addressing childhood mental health issues. In addition, teaching mindfulness, a skill that has been clearly shown to have many benefits for the mental health of adults (See course entitled Mindfulness as a Complementary and Alternative Medicine), to the next generation early in their lives could have positive implications for the future of adult mental health, as well. As such, mindfulness in education is an area where mental health clinicians and researchers should take an active role.

 

[take this course online for CE credit]

Resources

Mindful Schools is a mindfulness program for children and teachers in school settings. Mindful Schools works primarily with inner city schools in the Oakland, CA area and both teach mindfulness in public and private schools as well as train teachers to school teach mindfulness. In 2012, Mindful Schools expanded their training to include teaching secondary school teachers and began offering teacher training online. (Mindful Schools teacher training)

Founded by Lesley Grant, a Waldorf-trained early childhood educator and mindfulness teacher, Marin Mindfulness Cooperative is an innovative program that includes three components: Early childhood education for children 3-5, after-school mindfulness classes for elementary school students, and mindfulness training for parents, all in a way that supports the integration of mindfulness in the life of families.

Actress Goldie Hawn has taken a very active role in the promotion of mindfulness in education. Her organization, The Hawn Foundation, has developed curriculum and trains teachers to bring mindfulness into education.

Youtube Videos

Mindfulness expert Jon Kabat-Zinn: “The Role of Mindfulness in Education.”.

Inner Kids’ Susan Kaiser Greeneland: “Mindfulness Is Not a Crystal Ball But Clarity Can Be Magical”; “Past, Present and Future All in One Apple.”

The Santa Monica Ferris Wheel: A Visual Metaphor for Both Sides of Our Minds 

InnerKids classroom sending Friendly Wishes

InnerKids mirroring activity/mindful movement

Mindful Schools program video: Includes interview with a parent.

Mindful Schools testimonial  by a counselor from an East Oakland school.

The “Changing Channels” mindfulness technique.

“Sounds Right mindful listening game” from Yoga In My Schools.

Other Web-based Resources

An overview of executive function from the perspective of academic skills.

Posted in Mindfulenss in Education | Tagged , , , , | Comments Off

Self-Compassion Lesson I: Spiritual and Psychological Roots

[take this course online for CE credit]

 

“If you want others to be happy, practice compassion.
If you want to be happy, practice compassion.”
–– His Holiness the Dalai Lama ––

Introduction

Over the past decade, the practice of self-compassion has emerged as one of the fastest growing and most promising areas of Positive Psychology research. In psychological terms, self-compassion is most commonly defined in three parts as follows:

“Self-compassion entails being kind and understanding toward oneself in instances of pain or failure rather than being harshly self-critical; perceiving one’s experiences as part of the larger human experience rather than seeing them as isolating; and holding painful thoughts and feelings in mindful awareness rather than over-identifying with them.” Neff K (2003). Self-Compassion: An alternative Conceptualization of a Healthy Attitude Toward Oneself. 

Researchers have developed instruments for measuring this important human capacity, explored its relationship to a variety of other psychological constructs as well as mental health issues, and begun to develop interventions that bring it into the clinical setting.

The Buddhist Background of Self-Compassion

As you will see in Lesson II, the two American pioneers in this field, psychologists Kristin Neff and Christopher Germer, both came to their personal interest and practice of self-compassion through their connection with the Buddhist Insight Meditation tradition. The roots of each of the three parts of Neff’s definition can be traced to Buddhist practice and philosophy.

At the core of the Buddha’s teachings is his approach to suffering as expressed in The Four Noble Truths. The First Noble Truth is simply an acknowledgement of suffering as the single most cogent common denominator of the experience of all human beings. The Buddha’s traditional definition of suffering includes forms of suffering commonly addressed in Western psychotherapy: “sorrow, pain, lamentation, grief and despair” (Bhikkhu Ñanamoli and Bhikkhu Bodhi (trans.) (1995). The Middle Length Discourses of the Buddha: A Translation of the Majjhima Nikāya.) The First Noble Truth is thus a parallel to the second aspect of Neff’s definition. As human beings, we are united in our encountering of suffering. None of us are left out. We’re all in it together.

Mindfulness, the third factor in the definition above, is the central Buddhist practice of insight meditation, or vipassana. Mindfulness is traditionally defined as a key element in the Fourth Noble Truth where it is viewed as the antidote to the dis-ease of suffering, In the Buddhist scriptures mindfulness is defined in terms of contemplation or attentiveness to four aspects of human experience: the body, the pleasant, neutral or unpleasant feeling tones of our subjective experience, the mind, and the experiences of mind (The Middle Length Discourses of the Buddha, p. 1100) Mindfulness involves intentionally and non-judgmentally paying attention to one’s present moment experience. It is this process of stepping back, so to speak, to be the witness of the flow of one’s own conscious experience, including one’s thoughts and emotions, that protects against over-identification. The cultivation of this non-judgmental approach undermines our tendency to be self-critical. (For more on mindfulness see our courses on this topic under the course category “Mindfulness.” 

Other Buddhist practices such as Metta, which translates to Lovingkindness, increase compassion including self-compassion. The third quality in Neff’s definition of self-compassion is roughly equivalent to the capacities of lovingkindness which starts with compassion directed towards oneself and one’s own suffering. For example, to develop compassion, the practitioner begins with a focus on someone they know who is experiencing great physical or mental pain. The instructions involve visualizing that person as best as you can then mentally reciting a simple phrase, such as “may you be free of pain and sorrow,” while directing the feeling expressed by that phrase towards the visualized person. (Salzberg S. (1995). Lovingkindness: The Revolutionary Art of Happiness.  p. 116.) Next the practitioner shifts to direct compassion towards the following recipients: “self, benefactor, friend, neutral person, difficult person, all living beings, all females, all males, all beings in the ten directions” (Lovingkindness p. 116). With these latter focal points, the practice moves into what could be called the boundless stage where compassion is directed towards particular classes of beings without number and infinitely in all directions (to the north, the northwest, above, below, etc.)

These then are self-compassion’s three Buddhist roots: 1) That suffering is a universal human experience, 2) Our common experience of suffering connects us with others, and 3) Coping with our own suffering with both mindful attention and a kind and compassionate attitude reduces suffering. According to Buddhist Insight Meditation teacher, Sharon Salzberg,

What we are doing in compassion meditation is purifying and transforming our relationship to suffering, whether it is our own or that of others. Being able to acknowledge suffering, to open to it, and respond to it with a tenderness of heart allows us to join with all beings, and to realize that we are never alone. (Lovingkindness, p. 117)

In a passage that presages Neff’s contrasting of self-compassion with self-esteem (See Self-Compassion II), Salzberg  writes “If you are filled with judgment or condemnation of yourself or of others, can you revise your perceptions to see the world in terms of suffering and the end of suffering, instead of good and bad?” (Lovingkindness, p. 117)

Similarly, Neff sees such judgments as an inherent problem with self-esteem. (Neff K (2003). Self-Compassion: An alternative Conceptualization of a Healthy Attitude Toward Oneself.) Along these lines it is also interesting to consider the Buddhist notion of māna. Māna, is often translated as conceit. However this single English word is highly inadequate since māna includes three possibilities: the views that one is either superior, equal, or inferior to another. It really connotes that psychological structure by which we measure our self-worth against our perceptions of others. In Buddhist psychology, māna is viewed as a detrimental construct yet one that is highly resistant to change, only falling away at the highest level of spiritual attainment. (Nyānatiloka. (1980). Buddhist Dictionary: Manual of Buddhist Terms and Doctrines, p. 114.)

Guided Buddhist Meditations

For a Buddhist lovingkindness meditation, guided by Tara Brach, PhD, psychologist and founding teacher of the Insight Meditation Community of Washington, DC (IMCW), go to Brach’s online Guided Meditations webpage, then scroll down to the “Guided Meditation – Metta Practice,” dated 4/20/2011. (31 minutes)

Watch the following video for an example of a compassion meditation, called Tonglen, from the Tibetan Buddhist tradition, led by Tulku Tsori Rinpoche.

 

 

Psychological Roots

Self-compassion also has roots in Western Psychology, particularly in the Humanistic Psychology movement. Abraham Maslow, who in many ways presaged the Positive Psychology movement (See the lesson “Introduction to Positive Psychology”), proposed something like self-compassion in his classic Toward a Psychology of Being. (Maslow AH (1968). Toward a Psychology of Being.) Maslow lamented our human tendency to fearfully defend against our own psychological pain and shortcomings in the service of self-esteem. As an alternative, he proposed what he called “B-perception,” a way of relating to oneself characterized by a forgiving, nonjudgmental, loving acceptance. Carl Rogers offered a similar approach with his “unconditional positive regard” applied both towards clients and oneself. (Rogers CR (1961). On Becoming a Person. )

Other humanistic psychologists have chimed in with further variations. Among these are Albert Ellis and Maryhelen Snyder. Ellis’  preferred term was “unconditional self-acceptance,” characterized by a self-forgiving acknowledgment of one’s own faults and grounded in the belief that human existence has inherent worth. (Ellis A (1973). Humanistic Psychotherapy: The Rational-Emotive Approach.) Snyder’s notion of an ”internal empathizer” that explored one’s own experience with “curiosity and compassion” also touches on two parts of Neff’s definition. (Snyder M (1994). The development of social intelligence in psychotherapy: Empathic and dialogic processes. )

Later Judith Jordan, writing in the feminist tradition, offered “self-empathy” as an important psychological construct. She defined self-empathy as a way of relating to ourselves in which the parts of ourselves towards which we have been critical are now “accepted and responded to in a caring, affectively present and re-connected manner.” (Jordan JV (1991). Empathy, mutuality and therapeutic change: Clinical implications of a relational model. In Jordan JV, et al. (Eds.), Women’s Growth in Connection: Writings from the Stone Center (pp. 283-290).

Self-compassion also bears some resemblance to strategies for emotional regulation. As such, self-compassion can be seen as a form of emotional intelligence, popularized in the mid 1990s by Daniel Goleman’s book, Emotional Intelligence: Why It Can Matter More Than IQ. (New York: Bantam Dell, 2004) Emotional intelligence is generally described as the ability to attend to one’s own affective states leading to the skillful use of information and emotional energy in life activities (Salovey P, Mayer, JD (1990). Emotional intelligence. In the following video, Goleman introduces the concept of emotional intelligence.

 

 

Another important precursor for self-compassion in psychology is the the study of self-esteem. In crafting this relatively new niche, Neff compares and contrasts self-compassion to the preceding decades’ work on the topic of self-esteem. This theme is addressed in Self-Compassion II.

[take this course online for CE credit]

Resources

For a perspective that bridges Buddhism and psychology, listen to these two talks buy Tara Brach, PhD, psychotherapist and Buddhist teacher:

“The Healing Power of Self-compassion, Part I.” (54 min.)

“The Healing Power of Self-compassion, Part 2.” (54 min.) (54 min.)

A deep theme in Brach’s teaching is the importance of radical self-acceptance. For Brach’s article on this topic in relation to healing trauma in psychotherapy, read “The power of radical acceptance: Healing trauma though the Integration of Buddhist meditation and psychotherapy.” 

For a more detailed description of emotional intelligence as described by Daniel Goleman, and its role in the work force watch this video.

 

 

Posted in Self-Compassion | Tagged , , , , , | Comments Off

Self-Compassion II: The Pioneers

[take this course online for CE credit]

 

The current psychological interest in self-compassion can be traced to the work of three pioneers in the field, two Americans and one from England. In the United States, Kristin Neff, PhD, has been instrumental in creating and researching the new clinical niche of self-compassion. She has been aided in this endeavor, especially in the cultivation of therapeutic interventions by Christopher Germer, PhD. In Europe,the lead has been taken by Paul Gilbert, PhD, both in research and clinical applications.

 

Kristin Neff, PhD

clip_image002

The field of the psychology of self-compassion in America is largely the brainchild of Kristin Neff.

Associate Professor of Human Development and Culture, Educational Psychology Department, University of Texas. Neff graduated with her PhD in Psychology from the University of California, Berkeley in 1997. She then traveled to the Far East where she spent time in India studying the ethical thought process of children. Upon returning to the US, her initial professional interests were the experience of authenticity and issues of self-concept. She spent several post-doc years at the University of Denver with self-esteem expert, Dr. Susan Harter. In 1999, she moved to her current post in Austin.

Neff first encountered the notion of self-compassion during the early years of her interest in Buddhism and mindfulness practice. She describes how, during her last year of work on her dissertation, one night at a Buddhist mindfulness class the teacher talked about the possibility of being compassionate towards oneself. Neff, who was going through a painful divorce at the time, had an epiphany of sorts. It had never occurred to her that she could apply the way she had been taught to be compassionate towards the suffering of others also to herself.

It was in her early years at the University of Texas that Neff decided to focus her professional efforts on the study of the psychological construct of self-compassion. In 2003 Neff published a seminal article on self-compassion, describing it in psychological terms. (Neff, K. (2003) Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself) In this article Neff offered her three-part definition of self-compassion (see Self-Compassion Lesson I) which has become the standard in the research literature. In addition, she compared and contrasted self-compassion to the self-empathy work of Judith Jordan, the efforts of earlier proponents of Humanistic Psychology, and dynamics of emotional regulation. ( see Self-Compassion Lesson I) But perhaps most importantly, she gives a thorough analysis of the differences between self-compassion and self-esteem, a psychological construct first described by American psychologist William James in the late 1800s. Self-esteem emerged as a popular psychological theme during the late 60s through the early 90s, when research began to question it as a construct. Neff offers self-compassion as a viable new direction that addresses many of the same goals as self-esteem but, she would suggest, without the pitfalls. In the following video, Neff discusses the advantages of the construct of self-compassion over self-esteem.

 

 

Neff emphasizes that research is needed to determine the validity and efficacy of self-compassion. In order to further that cause, Neff developed and validated the Self-Compassion Scale, which has become the standard in self-compassion research. Her own subsequent research has included studies of self-compassion as it relates to academic goals and academic failure, psychological functioning, personality traits, and resiliency among teens and young adults. See Self-Compassion Lesson III for details.

Neff considers herself first and foremost a person who has benefited tremendously in her own life from self-compassion. She sees her research as a way to document what she knows to be true from personal experience for the benefit of the larger community. In the following video, Neff tells the story of her own discovery of the possibility of self-compassion and how it has served her personally, particularly in her role of being the mother of an autistic child.

 

 

In 2011, Neff published a book for the general public, Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind. Neff also writes a blog for Huffington Post.

 

Christopher Germer, PhD

clip_image003

More recently, Neff has teamed with another psychologist, Christopher Germer, a clinical instructor at the Department of Psychology, Harvard Medical School, and faculty member of the Boston-based Institute for Meditation and Psychotherapy. Together the two have been developing a group-based intervention, “Mindful Self-Compassion (MSC),” and are field-testing it both on the East Coast and in Texas. (See their websites for particulars.)

Germer began his career in Psychology with a bachelor’s degree from Colby College. Like many of his generation, he then set off to travel the world, especially Asia. It was while living in India, studying indigenous mental health practices that he first became interested in meditation. He eventually returned to the US and enrolled in Psychology graduate school at Temple University where, in 1984, he received his doctorate. From there he moved north to the Boston area. In addition to his teaching and supervision activities, he began a private practice.

Living in New England, he soon found his way to the Insight Meditation Society in Barre, MA, where he learned Buddhist mindfulness practices (vipassana) and has been a committed practitioner ever since. He became a member of a monthly Buddhist psychology study group which later gave birth to the Institute for Meditation and Psychotherapy. Adding writing to his other professional activities, he is the co-editor of  Mindfulness and Psychotherapy (2005) and author of the recently published The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions. Dr. Germer is also the co-director of Harvard Medical School’s annual “Meditation and Psychotherapy Conference.” He brings a passion for the use of mindfulness in psychotherapy to his work with Neff on self-compassion interventions.

In the following brief interview of Dr. Germer by Dr. Ruth Buczynski, psychologist and a co-founder and president of the National Institute for Clinical Applications of Behavioral Medicine, Germer discusses the relationship between mindfulness, self-compassion, suffering and healing.  

 

 

Below is from a description of the Mindful Self-Compassion course that Neff and Germer taught at Esalen Institute in February of 2011:

“This workshop provides simple tools for responding in a kind, compassionate way whenever you suffer, fail, or feel inadequate. These tools are essential steps toward living a happier, more fulfilling life. You’ll be taught how to:

• Stop being so hard on yourself
• Handle difficult emotions with greater ease
• Motivate yourself with kindness rather than criticism
• Transform your relationships, both old and new
• Practice mindfulness and self-compassion exercises for everyday life
• Be your own best teacher

 

Paul Gilbert

clip_image004

On the other side of the Atlantic, another self-compassion pioneer has been working in parallel with Neff and Germer. Paul Gilbert, head of the Mental Health Research Unit as well as Professor of Clinical Psychology at the University of Derby in England. He is a past president of both the International Society for Evolutionary Approaches to Psychopathology (1992) and of the British Association for Cognitive and Behavioural Psychotherapy (2003). Gilbert is a prolific author with over 20 published books and more than 100 academic articles. His books include:

The Compassionate Mind: A New Approach to Life’s Challenges (2009),

Compassion Focused Therapy: Distinctive Features (2010), and

The Compassionate Mind-Guide to End Overeating: Using Compassion Focused Therapy to Overcome Bingeing and Disordered Eating (2011),

Gilbert’s early career focus led him to become an expert on depression and the treatment of shame. A convergence of two interests, evolutionary neurophysiology, on the one hand, and Buddhist philosophy and practice, on the other, carried him further to his current professional concentration, exploring the neurophysiology and therapeutic effectiveness of what he calls Compassion Focused Therapy (CFT).

Gilbert defines compassion as “the sensitivity to the suffering of self and others with a motivation to alleviate it.” According to Gilbert, one underlying cause of human suffering is the different functionality of the reptilian and mammalian aspects of our brain. This inherited neurophysiology often results in inner conflicts between our emotions and our intellect. Gilbert emphasizes that an important point for clients to understand is that while it may be our individual responsibility to do what we can to regulate this conflict, the conflict itself isn’t our fault. We simply were born with it. For Gilbert, the good news is that there is help for this self-regulation challenge. Gilbert has found that when clients can really take in this truth, it significantly undermines their tendency towards shame and increases their openness to self-compassion. He further notes that according to Buddhism “training the mind … can liberate us from this brain that we inherit.” From Gilbert’s perspective, one that he says is increasingly supported by empirical science, training in self-compassion is especially important towards this end. With this in mind, he has developed what he calls Compassion Focused Therapy (CFT) and Compassionate Mind Training (CMT) In his training manual, available for free online at http://www.compassionatemind.co.uk/resources/Workbook.doc Gilbert describes CFT and CMT as follows:

“(CFT is an) approach (which) guides therapeutic interventions especially for the development of self-soothing and self-compassion. The interventions themselves are derived from many other therapies and include the importance of: the therapeutic relationship, guided discovery, Socratic dialogues, inference chains, function analysis, chain analysis, maturation awareness, behavioural experiments, exposure and toleration, mindfulness, guided imagery, expressive writing, and independent practice. CMT refers to the specific training and use of guided exercises to develop compassionate attributes of compassionate motivation, sensitivity, sympathy, distress tolerance, empathy, non-judging and non-condemning. CMT utilizes a range of exercises that focus on developing compassionate attention and imagery, reasoning and thinking, behaviour, and feeling. CMT refers to the specific ways/techniques we can use to help us experience compassion, and to develop the various aspects of compassion for self and others.” (p. 7)

Gilbert has been involved in several research projects exploring the efficacy of self-compassion interventions, including working with people with chronic mental health issues and those with eating disorders. See Self-Compassion Lesson III for examples of his research.

In July of 2011, Claudia Hammond, host of BBC’s radio talk show, “All in the Mind,” interviewed Gilbert and “Joe,” also a professional psychologist, who is a compassion focused therapy client of Dr. Gilbert’s, about self-compassion. To listen to the interview, especially, the first 11 minutes, click on this link.

Tara Brach

clip_image006

It seems important to mention one additional pioneer in the self-compassion movement. Though her work does not take place in an academic setting, nonetheless Tara Brach, PhD, has had a strong influence on the field of self-compassion. Neff and Germer list her book,  Radical Acceptance: Embracing Your Life With the Heart of a Buddha (2003), along with their own volumes, as one of a few recommended readings for those who take their “Mindful Self-Compassion” courses. Brach is a practicing psychotherapist but is perhaps best known as the founding teacher of the Insight Meditation Community of Washington, D.C.

After completing a double undergraduate major in psychology and political science, Brach felt drawn in a spiritual direction. She began practicing yoga and moved into an ashram where she lived for 10 years. But it wasn’t until leaving the ashram and attending an Insight Meditation retreat that she felt she’d found her true spiritual home. Brach eventually entered a 5-year teacher training program with Jack Kornfield,PhD, leading to her starting the D.C. sangha in 1998.

Along the way, Brach also went back to school for her doctorate in psychology at the Fielding Institute. Her dissertation research explored the use of meditation in the treatment of addiction. Brach’s dual interests in mindfulness and psychotherapy have led to her remarkable ability to synthesize the two and to communicate about their integration to Dharma students, therapy clients, and clinicians alike. She defines her trademark of that synthesis, “radical acceptance,” as “recognizing what we are feeling in the present moment and regarding that experience with compassion.” Brach’s article “The Power of Radical Acceptance: Healing Trauma Through the Integration of Buddhist Meditation and Psychotherapy” (2012) describes her use of radical acceptance to treat trauma. Click on this link to listen to a Sounds True interview with Tara Brach on Radical Acceptance. To read an interview of Tara Brach by mindfulness expert Elisha Goldstein, including the theme of Brach’s latest book, True Refuge: Three Gateways to a Fearless Heart (scheduled for publication February of 2013) click on this link. Also see Self-Compassion Lesson I for links to two talks by Tara Brach on self-compassion.

[take this course online for CE credit]

Resources for Clinicians

Neff, Germer, and Gilbert, have all generously made available a wealth of resources for clinicians for free on their websites.

Kristin Neff’s website.

Christopher Germer’s website.

The website for Paul Gilbert’s The Compassionate Mind Foundation.

Tara Brach’s website also includes many free resources.

Website for Stanford’s Center for Compassion and Altruism Research and Education.

An extensive self-compassion bibliography is available at this link.

Posted in Self-Compassion | Tagged , , , , , , | Comments Off

Mindfulness for Parents and Families

[take this course online for CE credit]

 

Introduction

Perhaps it is not surprising that the pioneer in the field of mindful parenting is the one and the same Jon Kabat-Zinn who developed Mindfulness-Based Stress Reduction (MBSR). In 1997, Kabat-Zinn, together with his wife Myla, a childbirth educator, who are themselves the parents of three children, published Everyday Blessings: The Inner Work of Mindful Parenting, (Hyperion Books, 1998). Their book, about which Daniel Goleman, author of Emotional Intelligence, exclaimed “At last an emotionally intelligent guide for parents,” set the stage for the interest in the uses of mindfulness in the context of families. Since that time, the applications of mindfulness in family life have gradually grown, with programs being developed in various contexts. Today there is the beginning of a body of research literature focused on family-related mindfulness interventions, as well.

Boegels,  Lehtonen, and  Restifo look at the growing use of mindfulness in parenting programs as an effective strategy for both the treatment and prevention of childhood mental disorders. Noting the current shortage of good research on how mindful parenting might actually work. They propose six possible mechanisms as follows:

(1) reducing parental stress and resulting parental reactivity;

(2) reducing parental preoccupation resulting from parental and/or child psychopathology;

(3) improving parental executive functioning in impulsive parents;

(4) breaking the cycle of intergenerational transmission of dysfunctional parenting schemas and habits;

(5) increasing self-nourishing attention; improving marital functioning and co-parenting. 

(Boegels, S., Lehtonen, A., and Restifo, K. (2010) Mindful Parenting in Mental Health Care.)

Reviewing the available literature, the authors conclude that it is still too early to draw conclusions regarding how mindfulness positively affects parenting and call for more and larger studies. However their preliminary analysis seems to suggest that there is already some support for mechanisms 1, 2, and 6 above.

Below we will look at the research on how mindfulness interventions can be impactful within families in several ways. These include the special relationship during pregnancy and following birth between mother and child, the effects of mindfulness on parenting, improved relationships between parents, and the role of mindfulness as a shared experience including all members of the family.

Prenatal Mindfulness

Several studies have been recently conducted where mindfulness was taught to expecting mothers or mother/father pairs. In the first such study Vieten and Astin found that the 31 mothers trained in mindfulness experienced 20–25% less anxiety during their final months of pregnancy than those in the control group. (Vieten, C. and Astin, J. (2008) Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood: the results of a pilot study.) In the second 2010 study, Duncan and Bardacke followed 27 expectant mother/father pairs who participated in a program called Mindfulness-Based Childbirth and Parenting. Again the quantitative results revealed statistically significant reductions in pre-birth anxiety and increases in both mindfulness and positive affect. Qualitative reports from the subjects showed benefits during the early period of parenthood as well. Such results suggest that mindfulness training for expectant mothers could possibly improve attachment outcomes for their children. (Duncan, L. and Bardacke, N. (2010) Mindfulness-based childbirth and parenting education: promoting family mindfulness during the perinatal period.)

Mindfulness and Attachment Theory

In fact, recently attention has turned to the relationship between mindfulness and attachment theory. In their 2012 article “Attachment Theory and Mindfulness,” Snyder, Shapiro, and Treleaven explore this topic. Attachment theory has shown that our early life experiences, especially with our most intimate caregiver, shape our expectations of relationships in the future. We learn how to relate to the world through our relationship with our primary caregiver. The style of relationship we learn depends largely on the ability of our caregiver to attune to us. If attunement is strong, a child will develop a secure way of being in the world. However if the caregiver is not so capable of attunement, various insecure attachment styles may be the result. The attachment, or relationship, style we develop in infancy stays with us and influences our ongoing life experience. Research suggests that while secure attachment results in cheerful, socially well-adjusted children, those with insecure styles are more likely to be unhappy, socially alienated, and have difficulty responding to adversity. The attachment style a child acquires in their early years from their own caregivers tends then to be the style they themselves employ later as parents and thus pass on to their own children. Attachment styles thus tend to be handed down from generation to generation. Snyder, R., Shapiro,S., and Treleaven, D. (2012) Attachment and mindfulness.)

Yet the good news is that it is possible later in life to reverse an insecure attachment style. According to Daniel Siegel, an expert on the neurobiology of mindfulness, one factor that promotes this shift is self-understanding, something that is a central benefit of mindfulness practice. Through the cultivation of mindful introspection, it is possible to develop increased self knowledge, compassion for oneself and deepened self-acceptance, a process that could be called self-attunement or “earned security,” leading to a healing of a parent’s own attachment wounds and a more secure attachment style going forward, one that she/he is then able to impart to her/his own children. (Siegel, D. (2007) The Mindful Brain,  p. 204ff.)

In fact, as Siegel notes, the neurophysiological effects of mindfulness practice are similar to that of secure attachment. (Siegel, D, The Mindful Brain, p. 132.) Because becoming a parent is a challenging time when a new parent’s own attachment styles become particularly obvious, it is also a time when mindful awareness can heighten self-knowledge leading towards the transformation of attachment style. A more self-attuned parent is more likely to effectively attune to a young child leading to a more secure attachment style for the child as well.

Mindful Parenting

This theoretical perspective on mindfulness and attachment theory is implicit in the model of mindful parenting offered by Duncan, Coatsworth, and Greenberg. Detailed in an article published in 2009, their model for mindful parenting takes a prevention-oriented, family-focused, mental health approach to parenting grounded in mindfulness training. They describe mindful parenting across five dimensions of the relationship between parent and child as follows: “(a) listening with full attention, (b) nonjudgmental acceptance of self and child, (c) emotional awareness of self and child, (d) self-regulation in the parenting relationship, and (e) compassion for self and child.” They especially emphasize the value of this approach parents during their children’s transition between childhood and adolescence. For their full article see Duncan L., Coatsworth, J., and Greenberg, M. (2009) A model of parenting:Implications for parent-child relationships and preventive research.)

However to date, few studies have been conducted on mindful parenting interventions. Those that have been had somewhat mixed results. Singh et al. have conducted a series of small pilot studies involving teaching mindfulness to mothers of children with various challenging mental health issues. In their first such study, published in 2006, three mothers of autistic children were given mindfulness training. According to the authors, “Results showed that the mothers’ mindful parenting decreased their children’s aggression, noncompliance, and self-injury and increased the mothers’ satisfaction with their parenting skills and interactions with their children.” Singh, N., et al. (2006) Mindful parenting decreases aggression, noncompliance, and self-injury in children with autism.)

These same researchers published a second study a year later with four parents of children with developmental disabilities who were also aggressive and lacked social skills. The results were similar to those of the previous study, yet with one additional positive result: an increase in positive interactions between the developmentally disabled children and their siblings. Singh, N., et al. (2007) Mindful parenting decreases aggression and increases social behavior in children with developmental disabilities.)

Lastly, in a 2010 article, these researchers describe their work with mothers of children diagnosed with ADHD. They found that when they gave mindfulness training to two such mothers, the compliance of their children to their parents’ instructions and requests. Then, when similar training was given to the children, an even greater improvement was found. Improvement persisted through their follow-up evaluations. It should be noted that in all these studies no attempt was made to teach the parents new parenting strategies or to influence the children’s behavior in any way (apart from the mindfulness training the children with ADHD were given.) The changes can thus be attributed simply to the mindfulness skills gained by the parents (and by the ADHD children). Singh, N., et al. (2010). Mindfulness training for parents and their children with ADHD increases the children’s compliance. )

In another study of families with children diagnosed with ADHD, this one conducted in The Netherlands, van der Oord, Bogels, and Peijnenburg trained both parents and children in mindfulness. They compared teacher and parent ratings of child behavior before and after the intervention. Parents’ ratings showed significant improvement in both their children’s ADHD behavior as well as in their own. However, while the teachers did note statistically significant increases in classroom attention, they reported no appreciable change in the students’ classroom ADHD behaviors. (van der Oord, S., Bogels, S., and Peijnenburg, D. (2012) The effectiveness of mindfulness training for children with ADHD and mindful parenting for their parents.)

Published in 2006, a study by Blackledge and Hayes used a 14-hour experiential group workshop format to introduce Acceptance and Commitment Therapy (ACT), which incorporates mindfulness to 20 parents (15 mothers, 5 fathers) of children diagnosed with autism. The found modest improvements in parental levels of depression, psychiatric symptoms and psychological distress when compared tothe participants’ scores on measures for these factors taken three weeks before the workshop and then 3 months after. And as seems often to be the case where mindfulness-based interventions such as ACT are used, the benefits were greatest for those parents whose pre-workshop scores were near or above the clinically significant level. (Blackledge, J. and Hayes, S. (2006). Using acceptance and commitment training in support of parents of children diagnosed with autism.)

However not all mindfulness research involving parents trained in mindfulness have shown positive results. In 2005 Raelynn Maloney published her study of a 12-week intervention called Mindful Parenting Program given to 12 recently divorced parents with preschool-aged children. While the parents all showed increased levels of mindfulness after the program when compared with their starting levels, improvements in their relationships with their children were not observed. Nonetheless the program was well-received by parents who reported it to be quite valuable. (Maloney, R. (2005) Cultivating mindful parenting during marital transition: An initial evaluation of Mindful Parenting Program.)

Mindfulness and Marriage

Another context in which mindfulness can have an effect on families is its use with couples. Barnes et al. in a 2007 study showed that naturally higher levels of mindfulness, called trait mindfulness, predicted for greater ability to handle stress in romantic relationships. On the other hand, state mindfulness, or mindfulness in the moment, was associated with better relationship communication skills. (Barnes, S., et al. (2007) The role of mindfulness in romantic relationship satisfaction and responses to relationship stress.)

Wachs and Cordova studied 30 married couples to examine the relationship between mindfulness and various aspects of the experience of being married. They found strong relationships between mindfulness and “relationship health and stability … increases in satisfaction and affectionate behavior, …(and) greater inter-partner harmony” (p. 478). According to research results these positive benefits seemed related to the heightened skill in relational emotional repertoires, which the authors hypothesize is due to the ability of mindful individuals to “closely watch their feeling states and potentially become newly tolerant as even negative feelings, such as anger, are observed to come and go of their own accord when they are not elaborated upon by suppression or rumination.” In addition, those stronger in mindfulness had stronger “empathy, improved ability to identify and communicate emotions, and (better) handling of anger” (p. 478-9). (Wachs, K. and Cordova, J. (2010) Mindful relating exploring mindfulness and emotion repertoires in intimate relationships

Carson, J., Carson, K., Gil K., and Baucom, D., have developed a mindfulness intervention for couples which they call Mindfulness-Based Relationship Enhancement (MBRE). They tested their intervention on a group of 44 couples, none of whom were experiencing significant marital distress at the time of the intervention (i.e., a non-clinical sample). 22 couples were given the intervention while the others served as a control group. The MBRE intervention they used was a manualized adaptation of Jon Kabat-Zinn’s MBSR. The authors describe their adaptations as follows:

(a) greater emphasis on loving-kindness meditations, with a particular focus on one’s partner;

(b) incorporation of partner versions of yoga exercises, …

(c) mindful touch exercises … ,

(d) a dyadic eye-gazing exercise …,

(e) application of mindfulness to both emotion-focused and problem-focused approaches to relationship difficulties; and

(f ) the context for practicing various mindfulness skills, both in-session and at home, was tailored to bring couples’ relationships into focus.

(Carson, J.,et al., (2004)  Mindfulness-based relationship enhancement, p.479.) Group discussions also had a couple-focused orientation. According to the authors the intervention was efficacious in (a) favorably impacting couples’ levels of relationship satisfaction, autonomy, relatedness, closeness, acceptance of one another, and relationship distress; (b) beneficially affecting individuals’ optimism, spirituality, relaxation, and psychological distress; and (c) maintaining benefits at 3-month follow-up (p. 471). As is often the case with mindfulness studies, those participants with the most frequent mindfulness practice showed greater positive effect. In fact, the researchers also reported that “analyses of diary measures showed greater mindfulness practice on a given day was associated on several consecutive days with improved levels of relationship happiness, relationship stress, stress coping efficacy, and overall stress.” (p.471)

A qualitative research study conducted by Pruitt and McCollum involved asking seven advanced meditators how meditation had affected their intimate relationships.  The meditators identified four qualities that they attributed to their mindfulness practice that were beneficial to their intimate relationships:

1. greater awareness of body and emotions,

2. ability to disidentify from emotions and thoughts,

3. greater self-acceptance and acceptance of others, and

4. more compassion and lovingkindness both towards oneself and towards others.

Here again we see evidence of self-attunement or Siegel’s notion of “earned security,” a shift in attachment style that can have a positive effect on parenting. (Pruitt,I. and McCollum, E. (2010) Voices of experienced meditators: The Impact of meditation practice on intimate relationships.)

Mindfulness with Families

At The Still Quiet Place, a Menlo Park, CA non-profit, Amy Saltzman and Philippe Goldin have developed a mindfulness curriculum for groups of parents and their children. They describe their program and report on their preliminary research results in a chapter entitled “Mindfulness-Based Stress Reduction for School-age Children” in Greco, L. and Hayes, S. (2008) Acceptance and Mindfulness Treatments for Children and Adolescents. The program is an adaptation of MBSR For specific program details, see Saltzman and Goldin’s chapter above.

The authors conducted research on their program with a total of 32 “self-referred, non-clinical” families, 24 of whom received the mindfulness training program and 8 of whom were waitlisted to provide a control group. Saltzman and Goldin measured five areas: attention, emotional reactivity and regulation, anxiety, depression, and metacognitive functioning. Compared with the waitlist group, both parents and children showed improvement in their ability to “direct their attention in the face of distractions that usually induce conflict” (p. 155). Parents showed mood improvements in both depression and anxiety while children did not. Both age groups showed increased metacognitive capacity, especially in the areas of self-judgment and self-compassion. While both parents and children showed decreased emotional reactivity the change was stronger for the parents than for the children. The intervention taught mindfulness in both formal practices, such as mindfulness of breathing, and in informal everyday activities, such as brushing one’s teeth. Analysis of the impact of these two distinct aspects of mindfulness practice revealed that formal practice was the strongest factor in improving attention while informal practice was more critical when it came to reducing depressive symptoms.

Mindfulness in the Context of Family Therapy

So far there is little literature on the uses of mindfulness in the context of family therapy. The one resource available currently is a book chapter by Quintilliani that consists of a case study of mindfulness-based family therapy with a family dealing with a combination of stress, anxiety and chronic pain. He describes his integration of such mindfulness practices as mindful breathing, the body scan etc., into family therapy sessions, and reports a reduction in overall family stress, clearer roles, better boundaries, increased family harmony and more effective family rituals. There were also reductions in symptoms for individual family members with, overeating issues, chronic pain, and ADD. (Quintillani, A. “A family case study on mindfulness-based family therapy for chronic co-occurring disorders: Chronic stress, chronic anxiety, chronic pain,” in Atwood, J. and Gallo, C. (eds.) (2009) Family Therapy and Chronic Illness )

Where We Stand

While the research to date is promising, there is the need for extensive additional research into the potential of family-based mindfulness interventions to heal family dysfunction as well as to improve the lives of healthy families.

Programs

Spirit Rock Meditation Center in Woodacre, CA, a Buddhist meditation center offers a Family Program which incorporates the teaching of mindfulness in a Buddhist context to children, adolescents, and their parents, Their program involves classes, daylongs, and, each summer, their annual Family Retreat.

Lesley Grant, a pioneering Waldorf-inspired educator in San Anselmo, CA, has developed a community-based family mindfulness program, Marin Mindfulness Cooperative, that incorporates early childhood education together with mindfulness classes for parents and their older children. To learn more about Grant’s program visit her website at

Resources for Mindful Parenting

The Mindful Parent website.

The Garrison Institute report “Mindful Parenting: Conceptualization and Measurement” on the current status of mindful parenting. The Garrison Institute describes itself as follows: “Founded in 2003, the Garrison Institute is a non-profit, non-sectarian organization exploring the intersection of contemplation and engaged action in the world.” They focus on both social and environmental issues.

Myla and Jon Kabat-Zinn’s “12 Ecercises for Mindful Parenting.”

Psychology Today blog by Jonathan Kaplan, PhD: “Urban Mindfulness- Letting Go of Expectations: A Lesson in Mindful Parenting”

Julia Kantor, MFT, describes her own experience of being in a mindful parenting group and its impact on her family culture.

Books

Parenting Your Anxious Child with Mindfulness and Acceptance, by Christopher McCurry, PhD.

Parenting Your Stressed Child: 10 Mindfulness-Based Stress Reduction Practices, by Michelle Bailey, MD

Mindful Parenting: Meditations, Verses, and Visualizations for a More Joyful Life, by Scott Rogers.

[take this course online for CE credit]

Posted in mindfulness for parents and families | Tagged , , , , , , | Comments Off

Mystical Experience

[take this course online for CE credit]

Descriptions


Mystical experiences represent a fundamental dimension of human existence. These experiences are commonly reported across all cultures. A mystical experience subjectively is characterized by encountering the divine in a way that disrupts the normal sense of self. The definitions of mystical experience used in research and clinical publications vary considerably, ranging from “upheaval of the total personality” (Neumann, E., in Campbell, J. (ed.) (1989) The Mystic Vision) to definitions such as “everyday mysticism” (Scharfstein, B. (1974) Mystical Experience).

William James believed the mystical experience was at the core of religion, and believed that such experiences led to the founding of the world’s religions. Many of the personal religious experiences uncovered in Gallup polls (reviewed later) have their roots in mystical states of consciousness.

In Varieties of Religious Experience, James (1902) described mystical experiences as having:

· Ineffability: defying description

· Noetic quality: accessing special kinds of knowledge

· Temporal transiency

· Passivity, where the participant feels “as if he were grasped and held by a superior power”

‘Neurotheology’ is a new field of research that seeks to understand the relationship between the brain, the mind and religion ( Newberg, A. (2010) excerpt from Principles of Neurotheology). Research by Newberg (here, in a 2009 interview) has been strongly focused on the relationship between neurobiology and mystical experience. Many studies have found EEG changes indicating a marked shift in neural processing during mystical states. For example, a study of Carmelite nuns found

“that mystical experiences are mediated by marked changes in EEG power and coherence. These changes implicate several cortical areas of the brain in both hemispheres.” (Beauregard, M., Paquette, V. (2008) EEG activity in Carmelite nuns during a mystical experience)

For additional definitions and descriptions of mystical experiences, see Common Threads in Mysticism, an interview with Robert Frager, PhD, one of the founders of transpersonal psychology. See also Several Definitions of Mysticism.

Mystical Experiences and Psychopathology

Surveys assessing the occurrence of mystical experience in the general population indicate that they are quite common and the incidence has been rising. For 40 years, the Gallup Poll has posed the question: “Have you ever been aware of, or influenced by, a presence or a power—whether you call it God or not—which is different from your everyday self?”

· 1973: 27%

· 1986: 42%

· 1990: 54%

· 2001: 70%

(Gallup, 2011)

A 2002 Gallup poll found 41% reported that “I have had a profound religious experience or awakening that changed the direction of my life.”

Rupert Sheldrake discussed the prevalence of mystical experiences in this video.

 

Surveys show that most clinicians do not currently view mystical experiences as pathological (Allman, L., et al. (1992) Psychotherapists’ attitudes towards clients reporting mystical experiences.)

To some degree this reflects a change, partly attributable to Abraham Maslow, Ph.D., who was a founder of humanistic psychology in the 1960s, and then went on to found transpersonal psychology. He described the mystical experience as an aspect of everyday psychological functioning:

It is very likely, indeed almost certain, that these older reports [of mystical experiences], phrased in terms of supernatural revelation, were, in fact, perfectly natural, human peak experiences of the kind that can easily be examined today. (Maslow, A. (1964) Religion, Values, and Peak Experiences)

This healthy view of mystical experience was corroborated in research that found people reporting mystical experiences scored lower on psychopathology scales and higher on measures of psychological well-being than control subjects (Wulff D (2002), Mystical Experience, in Cardena, E., Lynn, S., Krippner, S. in The Varieties of Anomalous Experience: Examining the Scientific Evidence.)

Yet historically, mental health theory and diagnostic classification systems have tended to either ignore or pathologize such intense religious and spiritual experiences. Some clinical literature has described the mystical experience as symptomatic of

· ego regression

· borderline psychosis

· a psychotic episode

· temporal lobe dysfunction

(Lukoff, D., Lu, F. (1992). Toward a more cultrually sensitive DSM-IV: psychoreligious and psychospiritual problems)

The personality is unable to rightly assimilate the inflow of light and energy. This happens, for instance, when the intellect is not well coordinated and developed when the emotions and the imagination are uncontrolled when the nervous system is too sensitive, or when the inrush of spiritual energy is overwhelming in its suddenness and intensity. (Assagioli, R., in Grof, S. and Grof, C. (1989) Spiritual Emergency: When Personal Transformation Becomes a Crisis, p. 34-5)

One of the main risks observed following ecstatic mystical experiences is ego inflation, in which an individual develops highly grandiose beliefs or even delusions about their own spiritual stature and attainment. Many theorists have seen this as an “occupational risk” associated with seeking spiritually transformative experience. The very experience often contains elements of grandiose inflation — or as it is called in Zen, “the stink of enlightenment.” (Rosenthal, G. in Anthony, D., Ecker, B., and Wilber, K. (1986) Spiritual Choices: The Problems of Recognizing Authentic Paths to Inner Transformation.)

Jung also observed inflation as a risk of spiritual practices:

The state we are discussing involves an extension of the personality beyond individual limits, in other words a state of being puffed up…The inflation has nothing to do with the kind of knowledge, but simply and solely with the fact that any new knowledge can so seize hold of a weak head that he no longer sees and hears anything else. He is hypnotized by it and instantly believes he has solved the riddle of the universe.
(Jung, C. (1992) Relationships between ego and unconscious, in Two Essays on Analytical Psychology, p. 156)

I (the author) certainly experienced this inflation in a spiritual crisis in my early twenties, believing for a while that I was a reincarnation of Buddha and Christ. (see my published case history)

Lecture at Santa Rosa Junior College where I described this experience:

 

Another risk is isolation after such intense experiences convinced no one can understand. This was observed by Zen Master Jakusho Kwong Roshi, that powerful spiritual awakenings can sometimes lead to isolation:

Anybody with a body and mind can experience realization. Often they don’t tell anybody because they think it is strange. They either keep it quiet, go crazy, or their search leads them to a teacher who can explain their situation.

Differential Diagnosis Between a Mystical Experience and Psychotic Symptoms

There is evidence for a type of brief psychotic episode that is related to a religious or spiritual problem. During this time, components of a person’s personality are undergoing rapid change: “There is every indication that this process emerges as the psyche’s own way of dissolving old states of being and of creatively…forming visions of a renewed self and of a new design of life with revivified meanings in one’s world” (Perry, J. (1974) The Far Side of Madness, p. 38).

Criteria for making the differential diagnosis between psychopathology and authentic spiritual experiences have been proposed by several authors. (Agosin in Halligan, F., Shea, J. (eds.) (1992) The Fires of Desire: Erotic Energies and the Spiritual Quest; Grof, S. and Grof, C. (1989) Spiritual Emergency: When Personal Transformation Becomes a Crisis; and Lukoff, D. (see following))

The diagnostic criteria listed below were originally published in the Journal of Transpersonal Psychology (Lukoff, D. (1985). The diagnosis of mystical experiences with psychotic features.) The use of operational criteria is intended to identify cases of any kind of spiritual problems with a high degree of accuracy (validity) and consistency across different diagnosticians (reliability). These criteria have been developed based on literature reviews and 30 years of clinical experience but have not been subjected to any prospective studies to determine their validity.

1) Phenomenological overlap with a mystical experience

2) Prognostic signs indicative of a positive outcome

3) No significant risk for homicidal or suicidal behavior

1. Phenomenological overlap with mystical experience

Here are five criteria by which phenomenological overlap with a mystical experience can be identified:

· ecstatic mood- The most consistent feature of the mystical experience is elevation of mood. Laski, in 1968, (Ecstasy: The Study of Some Secular and Religious Experiences) describes it as a state with “feelings of a new life, another world, joy, salvation, perfection, satisfaction, glory” (cited in Perry, J. (1974) The Far Side of Madness, p. 84). Bucke, examined the experiences of well-known mystics, leaders, and artists, as well as his own mystical experience, and noted they all shared “a sense of exultation, of immense joyousness.” (Bucke, R. (1969) Cosmic Consciousness, p. 9). James also points to the “mystical feeling of enlargement, union and emancipation” (James, W. (1902) The Varieties of Religious Experience, p. 334), and claims that “mystical states are more like states of feeling than like states of intellect.” (p. 300).

· sense of newly-gained knowledge- Feelings of enhanced intellectual understanding and the belief that the mysteries of life have been revealed are commonly reported in mystical experiences (Leuba, P. (1925) The Psychology Of Religious Mysticism). James describes this phenomenon of newly-gained knowledge (“gnoesis”) as states of insight into the depths of truth unplumbed by the discursive intellect. They are illuminations, revelations, full of significance and importance (James, W. (1902) The Varieties of Religious Experience, p. 33). Jacob Boehme, a seventeenth-century shoemaker whose mystical experience ushered in a new vocation as a nature philosopher, reported: “In one-quarter of an hour, l saw and knew more than if I had been many years together at a university. For I saw and knew the being of all things” (cited in Perry, J. (1974) The Far Side of Madness, p. 92).

· perceptual alterations- Mystical experiences often involve perceptual alterations ranging from heightened sensations to auditory and visual hallucinations. Boehme felt himself surrounded by light during his mystical experience. Visual and auditory hallucinations with religious content are also common, e.g., Saint Therese saw angels and Saint Paul heard the voice of Jesus Christ saying “Paul, Paul, why persecutest thou me?’ (Acts: 3-4).

· absence of conceptual disorganization- Some psychotic patients have cognitive deficits which cause them difficulty with their basic thought processes. For example, a person with schizophrenia complained, “I get lost in the spaces between words in sentences. I can’t concentrate, or I get off onto thinking about something else” (Estroff, S. (1981) Making It Crazy, p. 223). Systematic comparisons of first person accounts of mystical experiences and schizophrenia have found that “Thought blocking and other disturbances in language and speech do not appear to accompany the mystical experience” (Buckley, P. (1981) Mystical experience and schizophrenia, p. 521). Therefore, the presence of conceptual disorganization, as evidenced by disruption in thought, incoherence and blocking, would indicate the person is experiencing something other than a spiritual emergency.

· delusions with specific themes related to mythology- James and Neumann have both commented on the diversity of content in mystical experiences across time and cultures. The mystical experience does not have specific intellectual content of its own. It is capable of forming matrimonial alliances with material furnished by the most diverse philosophies and theologies. (James, W. (1902) The Varieties of Religious Experience, p. 333 and Neumann, E. (1989) in Campbell, J. (ed.) The Mystic Vision.)

John Perry, MD, points out that below the surface level of specific identities and beliefs are thematic similarities in the accounts of patients whose psychotic episodes have good outcomes:

There appears to be one kind of episode which can be characterized by its content, by its imagery, enough to merit its recognition as a syndrome. In it there is a clustering of symbolic contents into a number of major themes strangely alike from one case to another. (Perry, J. (1974) The Far Side of Madness, p.9)

Based on Perry’s research and other accounts of patients with positive outcomes, the following eight themes were identified as occurring commonly in what he called visionary crises which are similar to mystical experiences:

1. Death: being dead, meeting the dead or meeting Death

2. Rebirth: new identity, new name, resurrection, apotheosis to god, king or messiah

3. Journey: Sense of being on a journey or mission

4. Encounters with Spirits: demonic forces and/or helping spirits

5. Cosmic conflict: good/evil, communists/Americans, light/dark, male/female

6. Magical powers: telepathy, clairvoyance, ability to read minds, move objects

7. New society: radical change in society, religion, New Age, utopia, world peace

8. Divine union: God as father, mother, child; Marriage to God, Christ, Virgin Mary, Radha or Krishna

In contrast, not all delusions have content related to the eight mythic themes described above. The following statements from schizophrenic patients with whom I have worked illustrate different themes:

· My brain has been removed.

· A transmitter has been implanted into my brain and broadcasts all my thoughts to others.

· My parents drain my blood every night.

· The Mafia is poisoning my food and trying to kill me.

· My thoughts are being stolen and it interferes with my ability to think clearly.

· The person claiming to be my wife is only impersonating her; she’s not my wife.

Despite many similarities, there are differences observed in studies as well. Hallucinations in mystical experiences are more often visual than auditory although both auditory and visual hallucinations occur with other sensory involvement as well. (Buckley, P. (1981) Mystical experience and schizophrenia)

A computerized content analysis comparing written passages describing schizophrenia, hallucinogenic drug experiences, and mystical experiences and also autobiographical accounts as controls also provides guidance for differential diagnosis:

· Schizophrenic subjects emphasize illness/deviance themes

· Hallucinogenic accounts emphasize altered sensory experience

· Mystical accounts focus on religious/spiritual issues

· Normal control subjects emphasize adaptive and interpersonal themes
(Oxman, T., et. al. (1988) The language of altered states.)

Thus the content can at times be used as a guide in differential diagnosis. Familiarity with the range and variation of content in myth, religion and psychosis is essential for determining which delusions have mythic themes. The following five-part video graphically and creatively illustrates the overlap between psychotic and mystical experiences which the author, Sean Blackwell, calls “bipolar awakening.” (The video featured is Part 2, the most relevant to our topic. However at the beginning and the end of Part 2 there are links to the other parts of the series for those interested.)

 

 

Differential diagnosis between a substance-induced experience and a psychotic break is also important, as there are both similarities and differences.

Here is a video of Rick Strassman talking about his research on psilocybin and mystical experience.

 

2. Prognostic signs are indicative of a positive outcome

Research-validated prognostic indicators help predict positive long term outcome. The features listed below are based on a survey of the outcome literature from this review (Lukoff, D. (1985) The diagnosis of mystical experiences with psychotic features) supported by some newer research.

Good prognostic indicators include:

· good pre-episode functioning

· acute onset of symptoms during a period of 3 months or less

· stressful precipitant to the psychotic episode

· a positive exploratory attitude toward the experience.

3. The person is not a significant risk for homicidal or suicidal behavior

Psychotic disorders can be the basis for homicidal and suicidal behaviors. Both John Lennon and President Reagan were shot by persons with previously diagnosed psychotic disorders. Arieti & Schreiber have described the case of a multiple murderer whose auditory hallucinations from God and delusions of being on a religious mission fueled his bizarre and bloody killings. (Arieti, S. and Schreiber, F. (1981) Multiple murders of a schizophrenic patient: A psychodynamic interpretation.)

Assessment of dangerousness and suicidality following standard of care protocols are legal responsibilities of licensed mental health professionals. This exclusionary criterion should be implemented when danger seems imminent. Behavior which appears bizarre, but presents no risk to self or others, does not preclude meeting this criterion.

Treatment

There are numerous accounts of individuals in the midst of intense mystical experiences who have been hospitalized and medicated when less restrictive and more therapeutic interventions could have been utilized. Some individuals can handle such experiences on an outpatient basis with social support and professional help. However some have not got the resources for therapy and need residential treatment.

Innovative treatment programs such as Diabysis and Soteria treated first-onset patients with minimal use of medication and a supportive psychosocial milieu to foster a natural recovery. A study of Soteria found that most of the patients recovered in 6–8 weeks without medication (Bola, J. and Mosher, L. (2003) Treatment of acute psychosis without neuroleptics)

A recent meta-analysis of data from two carefully controlled studies of Soteria found better 2-year outcomes for the randomly assigned Soteria patients in the domains of psychopathology, work, and social functioning than for the patients with newly diagnosed schizophrenia spectrum psychoses who were treated in a psychiatric hospital. Only 58% of Soteria subjects received antipsychotic medications during the follow-up period, and only 19% were continuously maintained on antipsychotic medications. (Bola, J. and Mosher L. (2003) Treatment of acute psychosis without neuroleptics)

Some have suggested that the presence of a mystical experience is a contraindication for medication:

The phenomenological overlap in some aspects of the acute mystical experience and acute schizophrenia . . . suggests that the presence of similar subjective phenomena in some acute schizophrenics might be a possible marker of patients who should not receive medication. (Buckley, P. (1981) Mystical experience and schizophrenia, p. 430)

Research conducted by randomly assigning first episode patients to a medication or non medication oriented treatment program suggests that 10 to 40 percent of people with symptoms of psychosis can self heal without medication. (Bola, J. and Mosher, L. (2003), Treatment of acute psychosis without neuroleptics)

Sometimes the process is so intense that the person is overwhelmed and becomes very anxious. At times, he or she could benefit from slowing down the process. Bruce Victor, MD, a psychiatrist and psychopharmacologist, describes his use of low doses of tranquilizing or antipsychotic medication to alleviate some of the most distressing feelings and allow the person to better assimilate the experience in outpatient therapy:

The resolution of this seeming contradiction lies in the assessment of whether the presence of the debilitating state serves the function of psychological growth. Although the experience of pain, whether psychological or physical, can be a powerful motivator for personal change, its persistence beyond a certain point can retard it… It becomes a challenge to determine whether the person can actively work with the pain therapeutically toward further psychological growth…One important role of pharmacotherapy is to titrate the level of symptoms, whether they be pain, depression, anxiety, or psychotic states, so that they can be integrated by the person in the service of growth. (Scotten, B., Chinen. A., and Battista, J (eds.) Textbook of Transpersonal Psychiatry and Psychology)

Case Examples

Canadian psychiatrist Richard Bucke describes his personal mystical experience as recounted in his influential book in the field of psychology of religion.

An Eloquent description of a mystical experience by John Franklin, the secretary of the Alister Hardy Society, which studies the spiritual and religious experience.

Artist Alex Grey describes a mystical experience.

Myths in Mental Illness by David Lukoff,PhD
Case of Howard, hospitalized while on a Mystical Experience with Psychotic Features.

Here are some more definitions of mysticism from some of the psychologists and researchers most associated with the topic. Also, see the PubMed results on a search for “mystical experience.”

Alan Watts describes this ineffable quality of mystical experiences from a Zen perspective.

Arthur Deikman’s views on two types of mystical experience.

[take this course online for CE credit]

Posted in mystical experience | Tagged , , , , , | Comments Off

Integrative Restoration (iRest) – Yoga Nidra

[take this course online for CE credit]

Background and Description

Integrative Restoration – iRest, also known as Yoga Nidra, is a multifaceted intervention with a strong mindfulness component developed by psychologist Richard Miller. A longtime yoga and meditation practitioner and teacher, Miller saw the potential for the application of Yoga Nidra in clinical, in addition to, spiritual contexts. He has adapted the ancient traditional Yoga Tantric practice of Yoga Nidra, a meditation rather than Hatha Yoga practice that integrates Eastern and Western aspects of psychology and psychotherapy. This adapted form, in its secular application, is called iRest. Beginning in March 2005, iRest has been used in a wide variety of clinical applications. Most notably, iRest has been the focus of pilot studies at the Deployment Health Clinical Center at Walter Reed Army Medical Hospital, Brooke Army Medical Center, and the Miami and Chicago VA Centers researching the impact of iRest with active duty and veterans returning from Iraq and Afghanistan warfronts suffering from Post Traumatic Stress Disorder (PTSD). See below for a listing of iRest research to treat a long list of other psychiatric and medical conditions.

Dr. Miller himself first encountered Yoga Nidra in 1970. He began teaching this practice several years later. In the 80s and 90s his teaching of Yoga Nidra gradually took the shape that is now being taught by the many practitioners he has trained. Today instruction in Yoga Nidra is offered at many spiritual centers and, as iRest, in many clinical settings throughout North America. For more about Dr. Miller and a description of his own initial experiences of Yoga Nidra that started him on his path, watch the following video.

 

Overview of iRest

iRest is grounded in the skill of paying close attention to present moment experience, or mindfulness. Inherent in this process is the cultivation of an attitude of acceptance, even welcoming, towards the experience of the moment, whatever it may be. See the following video for Dr. Miller’s own expression of this most fundamental spirit of iRest practice.

 

iRest is comprised of ten stages including: setting conscious intentions, creative visualization, mindfulness of a variety of human experiential domains such as body, breath, energy, emotions, cognitions and joy, and the resourceful strategy of shifting the focus of attention between opposites, then holding both opposites in mindful attention simultaneously. Lastly iRest introduces a practice that is perhaps unique in its use in the clinical context, that of turning to inquire into the nature of our own mind’s capacity to know, Awareness itself. The richly multifaceted iRest protocol can be taught both in a group context and in the course of individual psychotherapy.

Details of the iRest Therapeutic Protocol: Preliminary Steps

Whether taught to a group or individually, iRest is presented as a series of meditative skills and inquiries that are gradually developed through hands-on practice. Unlike other forms of mindfulness practice, iRest is often practiced while lying down, a posture that facilitates the deep relaxation that is the hallmark of this practice. As with other mindfulness practices, however, other postures can also be used. It is the cultivation of attention to, and inquiry into, present moment experience that is the central point.

The iRest protocol is taught in ten stages with three preliminary steps. The first preliminary step involves establishment of intention. Here the intention is set to fully engage in the practice during the current day’s iRest session. Any particular goals specific to the present session are also noted. The next step in an iRest session is referred to as the Heartfelt Desire. In this phase the practitioner opens to the deepest personal reasons that motivate him or her in life. These could include desires for healing or relief from suffering for oneself and/or others, yearning for understanding or wisdom, the cultivation of compassion, etc. The iRest approach to expressing one’s Heartfelt Desire is present-centered and sensually based. As the practitioner becomes aware of their own deepest yearnings emerging in the moment, they are phrased in thought in the present, as opposed to future, tense and imagined through one or more of the five physical senses as if happening in the present moment.

The third preliminary of the iRest protocol is the cultivation of an Inner Resource or safe place. Sometimes when exploring our direct experience, we open into challenging emotions, memories, or other kinds of difficult experiences. To assist at those times, the third phase of iRest practice is the cultivation of an individual inner resource of safety, security, well-being, and peace. The practitioner is guided to visualize a place, either from memory or using imagination that feels completely secure and safe to them. They are encouraged to expand their experience beyond just the visual sense to include sounds, aromas, or physical sensations that are present for them in their experience of their special place. Ultimately, this Inner Resource is located within one’s body as a felt-sense or inner experience of well-being that can be accessed at any time, no matter the circumstance one may be experiencing. This inner resource is revisited briefly at the beginning of each iRest session and is available as a refuge should difficult experiences become overwhelming or unmanageable, either during the formal iRest practice session or in daily life situations.

Stages One Through Four

Once intentions, Heartfelt Desires, and the remembrance of the Inner Resource of well-being have been established, the main body of an iRest practice session shifts to focused mindful inquiry into one of several domains of present moment experience. These domains, the first through fourth stages of iRest practice listed below, are taught in succession over a period of weeks.

1. Bodily sensations

2. Breath and subtle energetic sensations

3. Feelings and emotions

4. Thoughts, beliefs, imagery, and memory

Guided iRest sessions with each of these domains as the focus are taught in successive weekly sessions. Practice between sessions is assigned as homework, usually with a CD or Mp3 of a guided session as a support.

Particularly with bodily sensations, emotions, and beliefs, an additional strategy is taught to assist in dealing with challenging kinds of experiences that may arise. This strategy involves working with opposites. Using emotion as an example, the practitioner is asked to identify a particularly challenging emotion, one that causes them difficulty in their lives. If, for example, the practitioner chooses anger, they are then asked to determine for themselves what the opposite of anger would be. The answer may differ from one practitioner to another. For one person, the opposite of anger might be calmness, for another, acceptance, for a third, happiness. The practitioner is then instructed to begin their practice with intention for this period of practice, perhaps including their hopes relative to the target emotion, their Heartfelt Desire, and an experiential recollection of their Inner Resource. Next they are asked to bring to mind their target emotion, to allow it to emerge into their present moment experience. Further instruction is given to notice if the emotion is associated with any body sensations. After allowing anger to be present, attending mindfully to the experience in both mind and body, for some minutes, the instruction is given to let go of the anger and allow its opposite to be present. The opposite emotion is then experienced mindfully in the same manner for several minutes. Instruction is then given to return to the experience of anger. Instructions then alternate for some time between mindfulness of the target emotion and mindfulness of its opposite. Finally the instruction is given to hold both target and opposite in the mind at the same time.

Stages Five through Ten

The fifth phase involves connecting with our capacity for joy and, in particular, a deep layer of joy that rests within us always. In practice, this is accomplished by inviting the meditators to remember an especially joyful moment in their lives. As the memory comes into present moment experience, practitioners are guided to enhancement the experience by tuning into all sensory aspects of the event being remembered. Once the memory is strongly established along with its joyful emotional dimension, the memory is dropped leaving only the joy itself. This experience of pure joy is then allowed to expand throughout the body and into the space beyond bodily boundaries. Further instructions explore the relationship between joy and the one who is experiencing the joy, the location of joy, and finally the identity between joy and the underlying awareness itself.

The sixth stage involves connecting with the foundational feeling of being (as opposed to ‘doing’ or even ‘well-being’). This stage lays the foundation for further and more subtle developments as the mind, or witness, that which knows, is directed to look more pointedly at its own role in experience. The stages that ensue involve opening to the mind’s underlying spacious nature and an awareness of knowing pervading that space, the recognition of the insubstantiality and formlessness of mind and all that it experiences, and the recognition and letting go of the subtle thought that creates the sense of self-as-knower. Finally at the tenth stage, there dawns a way of being in the world in which these insights remain active in the background even while the ordinary world of distinctions, of apparent separation, of apparent solidity, of apparent self, unfolds.

For Dr. Miller’s own more detailed description of his protocol as applied in the context of PTSD treatment with soldiers returning from combat, watch the following video.

 

Research on iRest

Integrative Restoration is currently in the early stages of clinical research. Preliminary results suggest its usefulness in the treatment of PTSD and other forms of stress, as well as with a number of other psychiatric and medical situations. At present five completed studies have been completed, two of which have been published (see below). Completed or ongoing research studies (as of Summer, 2011) include testing iRest for the treatment of PTSD, insomnia, anxiety, stress (in colleges students and that experienced by patients suffering from multiple sclerosis and cancer), and chemical dependency relapse prevention. (See below for links to studies.) Research in the planning stages includes studies of iRest in the treatment of depression, chronic pain, traumatic brain injury, wellness and resiliency. A summary of the research with links to articles or preliminary reports can be found on the Integrative Restoration Institute’s website.

[take this course online for CE credit]

Further Information

Additional information about iRest/Yoga Nidra, including practice and training opportunities, as well as a list of qualified practitioners by region, can be found at Dr. Miller’s website, Integrative Restoration Institute.

For a detailed print introduction to Yoga Nidra, including a CD with guided Yoga Nidra sessions, see Richard Miller’s book, Yoga Nidra: The Meditative Heart of Yoga,  Boulder Co: Sounds True, 2005.

Popular Media Articles

PAUL DAVID LAMPE AND ROSE RAYMOND Lampe, PD and Raymond R (2008) Columbia residents learn to relax through yoga nidra. Missourian May 7, 2005. 

Research Results

Peer-Reviewed

Pritchard M, Elison-Bowers P, Birdsall B (2010). Impact of integrative restoration (iRest) meditation on perceived stress levels in multiple sclerosis and cancer outpatients. Stress and Health 26(3): 233–237.

Published Independently

For a preliminary report showing iRest’s effectiveness as a stategy for coping with stress among college students, see Eastman-Mueller H, Wilson T, Raynes D. (undated). The impact of iRest (Yoga Nidra) on college students. Columbia, MO: University of Missouri Student Health Center.

For the results of a feasibility study using iRest at Walter Reed Army Medical Center with war veterans suffering from PTSD, read Engel C, et al. (undated). Yoga Nidra as an Adjunctive Therapy for Post-Traumatic Stress Disorder: A Feasibility Study. San Rafael, CA: Integrative Restoration Institute.

For a summary of preliminary findings for a research study using iRest with homeless adults living in a homeless shelter see Vieten C.  (undated). Report on results of iRest/Yoga Nidra to reduce stress in homeless shelter residents with a history of trauma. Institute of Noetice Science and Committe on the Shelterless, Petaluma, CA

Posted in General | Comments Off

Forgiveness Part I: Spiritual Perspectives on Forgiveness

[take this course online for CE credit]

Introduction

According to the Oxford Dictionary forgiveness is defined as “to grant free pardon and to give up all claim on account of an offense or debt.” Given this straightforward explanation of the concept, forgiveness might seem like a fairly simple topic. Yet psychologically it holds a multiplicity of clinically significant dimensions and raises many questions. How does forgiveness differ from condoning, excusing, or forgetting? Does forgiveness imply a reconciliatory action between victim and the one doing the harm? Does forgiveness need to be unconditional, as the Oxford Dictionary definition implies, or is a conditional forgiveness possible? Can forgiveness truly be given without a request to be forgiven, a gesture of apology, or feelings of remorse from the offender? Are there offenses for which forgiveness is either impossible or inappropriate? What about the relationship between self-forgiveness and being forgiven by the one you’ve offended? Can forgiveness be learned? What, if any, are the clinically significant mental and physical health benefits of forgiveness? Does forgiveness have any downsides? What are the cross-cultural dimensions of forgiveness?

In this and following lesson, some light will be shed on all these topics. However the last one serves as a useful starting point for this exploration. Long before the advent of the modern Western discipline of Psychology, with its empirical approach to knowledge and clinical applications, forgiveness has been a potent theme in the world’s religious traditions. The well-known adage “To err is human, to forgive is divine,” attributed to the English poet and critic Alexander Pope, suggests the strong connection we feel in Western culture between forgiveness and spirituality. Today the clinical applications of forgiveness, as studied by contemporary psychologists, are grounded to a significant extent in the perspectives on forgiveness and forgiveness practices of the world’s religions.

Taking a look at the beliefs and attitudes towards forgiveness found in various religious traditions provides valuable insights into the complexity of this topic. At the same time, knowledge about different spiritual approaches to forgiveness is important background information for clinicians regarding the religious/spiritual perspectives their clients bring to the clinical process of forgiveness.

Judaism

Different religious and spiritual traditions have characteristic beliefs about, and ways of approaching, forgiveness. Take for example the religious traditions whose roots lie in the Middle East: Judaism, Christianity and Islam. In Judaism, forgiveness comes only from the one offended. As such, while offenses against God can only be forgiven by God, likewise an offense against a fellow human can only be forgiven by the offended person, though one may pray to God for His help in obtaining forgiveness from fellow humans. God’s assistance can also be requested for help with a guilty conscience, that is forgiveness of oneself.

Judaism also emphasizes the importance of having a forgiving attitude towards the wrongs others have done towards us. In fact, if someone has wronged us and then asked for forgiveness, withholding forgiveness shifts the moral burden to us for our unwillingness to forgive. Being forgiven is only possible if you, yourself, have forgiven others for their offenses against you.

Forgiveness is such a central theme in Judaism that one of its principal annual religious observances, Yom Kippur, or Day of Atonement, is devoted to this practice. Prior to the day of Yom Kippur, it is the custom to ask for forgiveness from those persons you have harmed during the past year. This asking for human forgiveness is required in order to be eligible for forgiveness, or atonement, from God, for one’s offenses against Him, which is requested and received on Yom Kippur itself.

For more on Yom Kippur and forgiveness, watch the following video (7 mins.)

 

For a brief description of the three layers of forgiveness from a Jewish perspective read “Elul: A time to reflect.”.

Christianity

In the Christian tradition Jesus offers a similar perspective. He said, “Forgive and you will be forgiven” (Luke 6:37, NIV) and “… if you hold anything against anyone, forgive him, that your Father in heaven may forgive you your sins” (Mark 12:25 NIV).

Such verses suggest the requirement of our having an attitude or habit of forgiving others before receiving God’s mercy in return. Jesus’s death on the cross is widely held to be the sacrifice which makes Divine atonement for all human sins a potent reality.

Regardless of the requirements for God’s forgiveness, humans forgiving humans was strongly emphasized by Jesus in his teachings. When asked by his disciple Peter if we should forgive repeated offenses against us by the same person up to seven times, Jesus replied, “I do not say to you up to seven times but up to seventy-seven times.” Another well-known example of Jesus’s teachings on forgiveness is his Parable of the Prodigal Son. And of course Jesus set the bar quite high himself when, while dying on the cross, he asked God to forgive those who were responsible for his own crucifixion, even in the absence of their remorse for their actions.

For a Christian view of the unconditional nature of forgiveness, the role of apology, and the purpose of forgiveness by a Protestant theologian see Miroslav Volf below (7 mins.).

For a Catholic perspective on the accountability of the perpetrator in relation to forgiveness watch Johann Vento below (4 mins.)

 

Islam

In Islam, among the epithets for God are Al-Ghaffar, “The All Forgiving,” Al Tawab, “The Acceptor of Repentance,” Al Rahim, “The Most Merciful and Compassionate” emphasizing God’s deeply forgiving nature. As such, like Christianity and Judaism, Islam places a great emphasis on asking forgiveness from God, who has the choice either to forgive or to punish. And yet in Islam it is understood that God’s mercy prevails over his wrath.

Forgiveness between humans is also important. Here Islam makes a distinction between forgiveness when we have no recourse for vengeance or retribution, and forgiveness when retribution is within our power, the latter being the more highly valued form of forgiveness. And just as God’s mercy is described as prevailing over his wrath, so in Islam, human to human forgiveness is associated with the control of one’s anger. In fact, one of the characteristics of the Islamic Believer is that “…when they are angry they forgive.” (al-Shura 42:37) Muslims are encouraged to reflect on their own need, as imperfect beings, for God’s forgiveness, as a reason to offer forgiveness in turn to their fellow humans. Forgiveness among humans is given a high societal value for its ability to heal wounds and promote reconciliation.

For a brief historical perspective on the societal role of forgiveness in Islam see th following video featuring Imam Sajid (1 min.).

 

In the video below Muhammad Nur Abdullah offers a Muslim perspective on counseling for forgiveness (5 min.).

 

Buddhism

While the Buddhist tradition also places a strong value on forgiveness, it approaches this topic from a different non-theistic angle. In Buddhism, forgiveness is seen as a skillful means of promoting internal harmony free from regret and inner conflict. Personal harmony allows for the cultivation of an inner collectedness and quietude of mind that in turn foster deep insight. Inner peace and the insights it makes possible are both required for liberation from the endless rounds of rebirth into the suffering of existence. According to Ajahn Passano of Abhayagiri Monastery, “If we haven’t forgiven, we keep creating an identity around our pain, and that is what is reborn.”

And yet the ability to forgive is also related to deep insight. The absences of forgiveness is characterized by thoughts of resentment, ill will, and even revenge grounded in challenging emotions like hatred. The Buddhist approach is to look deeply into the nature of these thoughts and emotions to discover their inherent impermanence and the emptiness of self making these judgments. It is this depth of insight that allows for the letting go of these mental afflictions and the unforgiving attitude they perpetuate. As the Buddha said in the Dhammapada:

‘He abused me, he struck me, he overcame me, he robbed me’ — in those who harbor such thoughts hatred will never cease. ‘He abused me, he struck me, he overcame me, he robbed me’ — in those who do not harbor such thoughts hatred will cease. Dhammapada 1.3-4.

With its emphasis on the Law of Karma, a parallel Buddhist perspective is that it is the transgressor, not the victim, who is most at risk. This viewpoint is used to encourage compassion and for those who have wronged us.

In the following video Vietnamese Zen Master Thich Nhat Hanh offers a Buddhist perspective on forgiveness (4 mins.)

 

Te hear the Dalai Lama’s Buddhist views on the different levels of forgiveness see (8 mins.)

 

Hinduism

The Hindu tradition offers a variety of views on the topic of forgiveness. From the theistic perspective we find in the Hindu scriptures a description of forgiveness as “the one supreme peace” (Mahabarata, Udyoga Parva Section XXXIII). In the Bhagavad Gita Krishnu, an avatar, or human incarnation, of the god Vishnu, lists forgiveness as a Divine characteristic when embodied by a human being. In the more philosophical Hindu traditions, a transcendental view is taken. When someone is wronged, the reflection arises that this, too, is the will of God. We don’t need to focus on the one who has wronged us because they were just acting as the instrument of the Divine. Rather we can reflect on what lesson we can learn.

A less theistic Hindu might evoke the Law of Karma, of cause and effect. Yet being unable to discover all the causes leading up to the unfortunate effect, it is difficult to assign blame and therefore to engage in forgiveness. In fact f rom the Karmic perspective, everything that happens to us is the result of our own past actions in this or some previous life. As such, it is more skillful to acknowledge the impermanence of the transgression and let go. Letting it go prevents it from causing continued suffering in the present. Even the thought of forgiveness keeps the event alive in memory. As for justice, the Law of Karma itself will hold the perpetrator accountable.

For  brief, more mystical description of the role of forgiveness in relation to the Infinite in Hinduism from the nondual or Advaita perspective see the following videos featuring Anantanand RAmbachand (2 mins. and 4 mins.).

 

For a Hindu Advaita or nondual view on forgiveness see

 

Denominational and Cultural Perspectives

While the above information gives clinicians a general sense of each major tradition’s orientation towards forgiveness, it is important to also point out that there may be significant denominational variations within each major religion. For example, the forgiveness attitudes and practices of Christian clients may vary significantly depending on whether they are Catholic, Protestant, or Evangelical. A Mahayana Buddhist may take a different approach than a Theravadan Buddhist. Particularly with Eastern religions, perspectives may vary within a denomination depending on whether the practitioner is Asian, for example a Thai who grew up in a Theravadan Buddhist culture, or a white Anglo-Saxon American who learned and converted to Theravadan Buddhism in the West.

[take this course online for CE credit]

Further Resources

To read the parable of the prodigal son and a similar one from Mahayana Buddhism, go to “The Parable of the Prodigal Son in Christianity and Buddhism.”

A common theme regarding forgiveness across traditions seems to be the usefulness of distinguishing between the transgression and the transgressor. For more on this topic, see (3 mins.)

 

For a survey of some of the practices that are used in various religious traditions that promote forgiveness, watch Fetzer Institute’s “Consider Forgeiveness”. (9 mins.)

For a comparison of Jewish and Protestant Christian attitudes towards forgiveness, see Cohen R, Malka A, Rozin P, Cherfas L (2006). Religion and Unforgivable Offenses. J of Personality 74(1): 85–118.

For a Buddhist perspective on the role of forgiveness of self and others in the face of impending death, see Preparing for DeathThe Final Days of Death Row Inmate Jaturun “Jay” Siripongs.

Posted in forgiveness | Tagged , , , , | Comments Off