eMindful

By BENEDICT CAREY
Published: May 27, 2008
The New York Times

The patient sat with his eyes closed, submerged in the rhythm of his own breathing, and after a while noticed that he was thinking about his troubled relationship with his father.

“I was able to be there, present for the pain,” he said, when the meditation session ended. “To just let it be what it was, without thinking it through.”

The therapist nodded.

“Acceptance is what it was,” he continued. “Just letting it be. Not trying to change anything.”

“That’s it,” the therapist said. “That’s it, and that’s big.”

This exercise in focused awareness and mental catch-and-release of emotions has become perhaps the most popular new psychotherapy technique of the past decade. Mindfulness meditation, as it is called, is rooted in the teachings of a fifth-century B.C. Indian prince, Siddhartha Gautama, later known as the Buddha. It is catching the attention of talk therapists of all stripes, including academic researchers, Freudian analysts in private practice and skeptics who see all the hallmarks of another fad.

For years, psychotherapists have worked to relieve suffering by reframing the content of patients’ thoughts, directly altering behavior or helping people gain insight into the subconscious sources of their despair and anxiety. The promise of mindfulness meditation is that it can help patients endure flash floods of emotion during the therapeutic process — and ultimately alter reactions to daily experience at a level that words cannot reach. “The interest in this has just taken off,” said Zindel Segal, a psychologist at the Center of Addiction and Mental Health in Toronto, where the above group therapy session was taped. “And I think a big part of it is that more and more therapists are practicing some form of contemplation themselves and want to bring that into therapy.”

At workshops and conferences across the country, students, counselors and psychologists in private practice throng lectures on mindfulness. The National Institutes of Health is financing more than 50 studies testing mindfulness techniques, up from 3 in 2000, to help relieve stress, soothe addictive cravings, improve attention, lift despair and reduce hot flashes.

Some proponents say Buddha’s arrival in psychotherapy signals a broader opening in the culture at large — a way to access deeper healing, a hidden path revealed.

Yet so far, the evidence that mindfulness meditation helps relieve psychiatric symptoms is thin, and in some cases, it may make people worse, some studies suggest. Many researchers now worry that the enthusiasm for Buddhist practice will run so far ahead of the science that this promising psychological tool could turn into another fad.

“I’m very open to the possibility that this approach could be effective, and it certainly should be studied,” said Scott Lilienfeld, a psychology professor at Emory. “What concerns me is the hype, the talk about changing the world, this allure of the guru that the field of psychotherapy has a tendency to cultivate.”

Buddhist meditation came to psychotherapy from mainstream academic medicine. In the 1970s, a graduate student in molecular biology, Jon Kabat-Zinn, intrigued by Buddhist ideas, adapted a version of its meditative practice that could be easily learned and studied. It was by design a secular version, extracted like a gemstone from the many-layered foundation of Buddhist teaching, which has sprouted a wide variety of sects and spiritual practices and attracted 350 million adherents worldwide.

In transcendental meditation and other types of meditation, practitioners seek to transcend or “lose” themselves. The goal of mindfulness meditation was different, to foster an awareness of every sensation as it unfolds in the moment.

Dr. Kabat-Zinn taught the practice to people suffering from chronic pain at the University of Massachusetts medical school. In the 1980s he published a series of studies demonstrating that two-hour courses, given once a week for eight weeks, reduced chronic pain more effectively than treatment as usual.

Word spread, discreetly at first. “I think that back then, other researchers had to be very careful when they talked about this, because they didn’t want to be seen as New Age weirdos,” Dr. Kabat-Zinn, now a professor emeritus of medicine at the University of Massachusetts, said in an interview. “So they didn’t call it mindfulness or meditation. “After a while, we put enough studies out there that people became more comfortable with it.”

One person who noticed early on was Marsha Linehan, a psychologist at the University of Washington who was trying to treat deeply troubled patients with histories of suicidal behavior. “Trying to treat these patients with some change-based behavior therapy just made them worse, not better,” Dr. Linehan said in an interview. “With the really hard stuff, you need something else, something that allows people to tolerate these very strong emotions.”

In the 1990s, Dr. Linehan published a series of studies finding that a therapy that incorporated Zen Buddhist mindfulness, “radical acceptance,” practiced by therapist and patient significantly cut the risk of hospitalization and suicide attempts in the high-risk patients.

Finally, in 2000, a group of researchers including Dr. Segal in Toronto, J. Mark G. Williams at the University of Wales and John D. Teasdale at the Medical Research Council in England published a study that found that eight weekly sessions of mindfulness halved the rate of relapse in people with three or more episodes of depression.

With Dr. Kabat-Zinn, they wrote a popular book, “The Mindful Way Through Depression.” Psychotherapists’ curiosity about mindfulness, once tentative, turned into “this feeding frenzy, of sorts, that we have going on now,” Dr. Kabat-Zinn said.

Mindfulness meditation is easy to describe. Sit in a comfortable position, eyes closed, preferably with the back upright and unsupported. Relax and take note of body sensations, sounds and moods. Notice them without judgment. Let the mind settle into the rhythm of breathing. If it wanders (and it will), gently redirect attention to the breath. Stay with it for at least 10 minutes.

After mastering control of attention, some therapists say, a person can turn, mentally, to face a threatening or troubling thought — about, say, a strained relationship with a parent — and learn simply to endure the anger or sadness and let it pass, without lapsing into rumination or trying to change the feeling, a move that often backfires.

One woman, a doctor who had been in therapy for years to manage bouts of disabling anxiety, recently began seeing Gaea Logan, a therapist in Austin, Tex., who incorporates mindfulness meditation into her practice. This patient had plenty to worry about, including a mentally ill child, a divorce and what she described as a “harsh internal voice,” Ms. Logan said.

After practicing mindfulness meditation, she continued to feel anxious at times but told Ms. Logan, “I can stop and observe my feelings and thoughts and have compassion for myself.”

Steven Hayes, a psychologist at the University of Nevada at Reno, has developed a talk therapy called Acceptance Commitment Therapy, or ACT, based on a similar, Buddha-like effort to move beyond language to change fundamental psychological processes.

“It’s a shift from having our mental health defined by the content of our thoughts,” Dr. Hayes said, “to having it defined by our relationship to that content — and changing that relationship by sitting with, noticing and becoming disentangled from our definition of ourselves.”

For all these hopeful signs, the science behind mindfulness is in its infancy. The Agency for Healthcare Research and Quality, which researches health practices, last year published a comprehensive review of meditation studies, including T.M., Zen and mindfulness practice, for a wide variety of physical and mental problems. The study found that over all, the research was too sketchy to draw conclusions.

A recent review by Canadian researchers, focusing specifically on mindfulness meditation, concluded that it did “not have a reliable effect on depression and anxiety.”

Therapists who incorporate mindfulness practices do not agree when the meditation is most useful, either. Some say Buddhist meditation is most useful for patients with moderate emotional problems. Others, like Dr. Linehan, insist that patients in severe mental distress are the best candidates for mindfulness.

A case in point is mindfulness-based therapy to prevent a relapse into depression. The treatment significantly reduced the risk of relapse in people who have had three or more episodes of depression. But it may have had the opposite effect on people who had one or two previous episodes, two studies suggest.

The mindfulness treatment “may be contraindicated for this group of patients,” S. Helen Ma and Dr. Teasdale of the Medical Research Council concluded in a 2004 study of the therapy.

Since mindfulness meditation may have different effects on different mental struggles, the challenge for its proponents will be to specify where it is most effective — and soon, given how popular the practice is becoming.

The question, said Linda Barnes, an associate professor of family medicine and pediatrics at the Boston University School of Medicine, is not whether mindfulness meditation will become a sophisticated therapeutic technique or lapse into self-help cliché.

“The answer to that question is yes to both,” Dr. Barnes said.

The real issue, most researchers agree, is whether the science will keep pace and help people distinguish the mindful variety from the mindless.

A variety of meditative practices have been studied by Western researchers for their effects on mental and physical health.

Tai Chi

An active exercise, sometimes called moving meditation, involving extremely slow, continuous movement and extreme concentration. The movements are to balance the vital energy of the body but have no religious significance.

Studies are mixed, some finding it can reduce blood pressure in patients, and others finding no effect. There is some evidence that it can help elderly people improve balance.

Transcendental Meditation

Meditators sit comfortably, eyes closed, and breathe naturally. They repeat and concentrate on the mantra, a word or sound chosen by the instructor to achieve state of deep, transcendent absorption. Practitioners “lose” themselves, untouched by day-to-day concerns. Studies suggest it can reduce blood pressure in some patients.

Mindfulness Meditation

Practitioners find a comfortable position, close the eyes and focus first on breathing, passively observing it. If a stray thought or emotion enters the mind, they allow it to pass and return attention to the breath. The aim is to achieve focused awareness on what is happening moment to moment.

Studies find that it can help manage chronic pain. The findings are mixed on substance abuse. Two trials suggest that it can cut the rate of relapse in people who have had three or more bouts of depression.

Yoga

Enhanced awareness through breathing techniques and specific postures. Schools vary widely, aiming to achieve total absorption in the present and a release from ordinary thoughts. Studies are mixed, but evidence shows it can reduce stress.

By Melinda Beck
May 13, 2008; Page D1
Durham, N.C.

First, ask yourself how hungry you are, on a scale of 1 (ravenous) to 7 (stuffed).

Next, take time to appreciate the food on your plate. Notice the colors and textures.

Take a bite. Slowly experience the tastes on your tongue. Put down your fork and savor.

“Most people don’t think about what they’re eating — they’re focusing on the next bite,” says Sasha Loring, a psychotherapist at Duke Integrative Medicine, part of Duke University Health System here. “I’ve worked with lots of obese people — you’d think they’d enjoy food. But a lot of them say they haven’t really tasted what they’ve been shoveling down for years.”

Over lunch, Ms. Loring is teaching me how to eat mindfully — paying attention to what you eat and stopping just before you’re full, ideally about 5½ on that 7-point scale. Many past diet plans have stressed not overeating. What’s different about mindful eating is the paradoxical concept that eating just a few mouthfuls, and savoring the experience, can be far more satisfying than eating an entire cake mindlessly.

It sounds so simple, but it takes discipline and practice. It’s a far cry from the mindless way many of us eat while walking, working or watching TV, stopping only when the plate is clean or the show is over.

It’s also a mind-blowing experience: I’m full and completely satisfied after three mindful bites.

The approach, which has roots in Buddhism, is being studied at several academic medical centers and the National Institutes of Health as a way to combat eating disorders. In a randomized controlled trial at Duke and Indiana State University, binge eaters who participated in a nine-week mindful-eating program went from binging an average of four times a week to once, and reduced their levels of insulin resistance, a precursor to diabetes. More NIH-funded trials are under way to study whether mindful eating is effective for weight loss, and for helping people who have lost weight keep it off.

One key aspect is to approach food nonjudgmentally. Many people bring a host of negative emotions to the table — from guilt about blowing a diet to childhood fears of deprivation or wastefulness. “I joke with my clients that if I could put a microphone in their heads and broadcast what they’re saying to themselves when they eat, the FCC would have to bleep it out,” says Megrette Fletcher, executive director of the Center for Mindful Eating, a Web-based forum for health-care professionals.

Using food as a reward or as solace also interferes with eating mindfully; if you’re eating to satisfy emotional hunger, it’s hard to ever feel full. “Ask yourself, what do you really need and what else can you do it fulfill it?” says Ms. Loring.

Chronic dieters in particular have trouble recognizing their internal cues, says Jean Kristeller, a psychologist at Indiana State, who pioneered mindful eating in the 1990s. “Diets set up rules around food and disconnect people even further from their own experiences of hunger and satiety and fullness,” she says.

Mindful eaters learn to assess taste satiety. A hunger for something sweet or sour or salty can often be satisfied with a small morsel. In one exercise, Ms. Kristeller has clients mindfully eat a single raisin — noticing their thoughts and emotions, as well as the taste and texture. “It sounds somewhat silly,” she explains, “but it can also be very profound.”

Mindful eating also means learning to ignore urges to snack that aren’t connected to hunger. And it’s critical to leave food on your plate once you are full; pack it to go, if possible.

In contrast to other diet programs, the researchers involved with mindful eating avoid making weight-loss claims; that’s still being investigated. But some practitioners say it’s life-changing.

“I don’t think about food anymore. It’s totally out of my mind,” says Mary Ann Power, age 50, of Pittsboro, N.C., a lifelong dieter who thinks she’s lost eight or 10 pounds in two weeks since learning the practice at Duke. “I think you could put a piece of chocolate cake in front of my nose right now, and it wouldn’t tempt me. Before, I could eat three pieces.”

One mindful meal at Duke made a big impression on me — I was satisfied with minimal meals for days afterward. But it’s hard to sustain. I find myself eating mindlessly again in front of the TV, or at the computer.

“Try to eat one meal or one snack mindfully every day,” advises Jeffrey Greeson, a psychologist with the Duke program. “Even eating just the first few bites mindfully can help break the cycle of wolfing it down without paying any attention.”

by Celina Ottaway
May 2008
WholeLiving.com

For effective and lasting weight loss, ditch the scale and grab a pencil and paper instead.

So you’re ready to try again. You’ve got the books, the healthy snacks in the fridge, and, yes, you even threw away that secret stash of Oreos in the back of the pantry. Ah, the familiar rush of a new weight-loss plan: a heady mix of hope, promise, and fantasy shopping. But how can you make this time different, and finally step off the diet merry-go-round?

Grab a pen. Writing — everything from keeping a food log to free-association journaling — is a powerful tool when it comes to healthy eating and shedding pounds. Putting pen to paper helps break the momentum during a rush to the pretzel jar, and studies show that writing down what you eat can help you lose weight and keep it off. “Two of the most important factors in weight loss are intention and monitoring,” says Sasha Loring, a psychotherapist with Duke Integrative Medicine at Duke University. “Writing can help with both.”

Take intention. Often, people approach weight loss with a fuzzy notion that they’d like to drop a few pounds or look good in a bathing suit, says Loring. “But just saying you want to lose weight won’t work,” she says. Journal writing, however, can help you move away from vague ideas and focus on concrete steps. The more detailed and practical your writing, the better. You might, for example, brainstorm a list of strategies to sidestep your problem areas — outlining a route to work that steers clear of your favorite drive-through doughnut shop, for instance, or shopping on Sundays to make sure you have healthy snacks and lunches for the upcoming week.

Of course, even the best-laid eating plans are no good if you make a beeline for the potato chips every time you get an e-mail from your ex. Here, too, putting pen to paper can help. A regular writing practice, one that allows you to offload your feelings, can shift your emotions from the fridge to the page, says creativity maven Julia Cameron, author of “The Writing Diet.” Sometime during her 25 years of teaching people to unlock their creativity in “The Artist’s Way” seminars and books, Cameron started noticing something: Her students were doing more than getting in touch with their inner artiste; they were shedding pounds, too. “I would see people start to transform, physically,” she says. “It took me a long time to see this as a weight-loss tool, but it was showing up all along as people looking more fit.”

At the heart of Cameron’s classes is a technique called “morning pages,” in which you rise early and write three longhand pages of absolutely anything — no thinking, no worrying, no editing. Although Cameron instructs her students to write freely, she says people often use morning pages as an emotional outlet, one they were accustomed to finding in food. “You take a look at your fear, anxiety, and nervousness directly instead of eating something to squelch it, she says. “You don’t need to focus on it; it will just come up. Morning pages are remarkable in how they get to the underside of what’s bothering you.”

And the more you give voice to your emotions, the less you’ll need food to keep your real feelings quiet. “When you do morning pages,” says Cameron, “you start to take your likes and dislikes a little more seriously. It helps with speaking your mind.”

Keeping Track of Eating

If journal writing is an intimate form of writing for weight loss, food logs are a basic one — which doesn’t mean they’re less effective. A simple list of when and what you eat (scratched on­to a napkin if necessary), food logs act as monitoring tools that keep you aware of what you’re taking in. In one study, people lost far more weight in the two weeks they used food logs most consistently compared with the two weeks they were least consistent. In another study, the only participants to lose weight during the diet-treacherous holiday season were those diligent with their food logs. “They help you be clear about what you are actually doing versus what you think you are doing,” says Loring. “We are very good at fooling ourselves. Writing it down is sort of a truth monitor.

“Food logs prove especially effective when you write down how you feel (both emotionally and physically) when you eat. It doesn’t have to be a long or elaborate entry, just a few words — perhaps “angry and tired” or “anxious about work” scrawled next to your less-than-ideal snack of a bag of Cheez-Its and leftover tuna casserole. “You start to see patterns,” says Loring. “Anything that makes you more aware of what you’re doing helps.”

And awareness is the first step. In making the connections between your emotions and behavior, writing of any sort can lead you to your own strength and wisdom, says Cameron, and even deepen your sense of spiritual connection: “You start to see solutions, and your intuition sharpens,” she says, which in turn can lead to “a heightened level of synchronicity” that helps support healthy changes. Indeed, Cameron insists that there’s often a direct connection between our spiritual lives — or lack thereof — and our eating habits. “Sometimes,” she says, “what we’re trying to fill with food is actually something that you might call a God-shaped hole.”