MEDITATION AND STRESS REDUCTIONPSYC347 ASSESSMENT AND INTERVENTION

TAN MENG CHUAN, UOW ID: 4886628

Before We Begin• Experiential laboratory• Multiple stimuli• Notice where your attention is placed• Notice how fast your attention moves• End of session: What’s your experience?

Getting present•While you were waiting…How stressed are you?

•Quick exercise: Take 20 seconds and think of nothing. How far did you get before you had a thought?

Contents• Getting Present• Stress

• Definitions• Classes

• Meditation• Definitions• Types• Mechanisms and Rationale• Important Procedural Guidelines• Applications• Efficacy• Side Effects & Contraindications

Stress: Definitions

• The non-specific response of the body to any demand for change (Selye, 1936)

• State of psychological and/or physiological imbalance when the perceived demands are greater than the perceived resources to meet those demands (McGonigal, 2015)

Stress: Classes

Acute Episodic Chronic

Positive or negative, short term

Stress as a way of life Never-ending, inescapable stressDangerous, unhealthy

Irritation, headache

Type A personality Difficulties sleeping, frequent fatigue

Stress: InterventionsPsychological Behavioural Lifestyle Alternatives

ReframingPositive thinking

AssertivenessGet organisedVentilationHumourDiversion and distraction

DietCease smoking and alcoholExerciseSleepLeisureRelaxation(Retail therapy)

Conventional medicineCounselling and psychotherapyRelaxationMeditationYogaAcupunctureAromatherapyHerbalismBiofeedbackHypnotherapyMassageReflexology

Meditation: Definitions

• The act or process of spending time in quiet thought (Merriam-Webster)

• A practice where an individual trains the mind or induces a mode of consciousness, either to realise some benefit or for the mind to simply acknowledge its content without becoming identified with that content, or as an end in itself (Wikipedia)

• The intentional self-regulation of attention, in the service of self-inquiry, in the here and now (Albeniz, 2000)

Meditation: Definitions• Methods and States definitions

• Methods: Meditation as a family of mental training techniques• States: Meditation by reference to the enhanced experiential states or altered states

of consciousness which arise from the uses of these methods

• Functional model: Meditation should encompass (Cardoso et al, 2004):

• The use of a specific (clearly defined) technique• Muscle relaxation in some moment of the process• Logic relaxation• It must necessarily be a self-induced state • The use of “self-focus” skill

Meditation: Definitions

• Process model (Nash and Newberg, 2013):

• Meditation is an engagement of the process intended to be inclusive of several different possibilities, with the intention of attaining an enhanced mental state.

Meditation: types  Insight-Oriented ConcentrativeKey Characteristics

Can be done anywhereStay present in the momentMaintain alertness, awareness in a non-judgemental way. Just observe.Expand awareness from single-pointed to encompass external stimuli which ariseSometimes using breath as tools to return to a mindful state of attention

Sit comfortably in silenceCenter attention by focusing mental awareness on a preselected object or process, always coming back to anchorNarrow awareness to a single-pointed consciousnessDisengage usual mental processesAvoiding cognitive analysis or fantasy

Analogy Searchlight Laser light beam

Intended Effects Greater awareness of and insight into the personal conditioning of our minds and an understanding of the nature of mind itself

Stability, calmness, unruffled mindDetached from emotional and interpersonal involvementHeightened awareness

Mindfulness - the self-regulation of attention, providing a continuous moment-to-moment awareness of subjective experience, in a non-judgemental and accepting way (Zabat-Zinn, 1994)Slows down the speed and control the amount of thoughts that go through the mind

  Mindfulness-Based Stress Reduction (MBSR)

Transcendental Meditation (TM)

Historical roots Buddhist tradition Vedic tradition

Main personalities John Kabat-Zinn, 1970s Maharashi Mahesh Yogi, mid 1950

About Insight-oriented, Mindfulness Passive attention, open monitoring

Concentrative: MantraAutomatic self-transcendenceEffortless, settling the mind naturally

EEG signals Theta brain waves – readiness to process incoming signals

Alpha brain waves – relaxation

Goals To have thought be on the present moment Transcending thought to experience a state of “pure awareness”, without an object of thought

Practices Mindfulness meditation, Body scanning, Simple yoga postures

Mantra meditation15-20 minutes twice a day, eyes closed

Program 8-week course taught by certified instructors with group meetings, homework, retreat

One-on-one instructionVariety of programs: Transcendental Meditation Technique, TM-Sidhi program

Meditation: types• More than 100 types and variations• Virtually all involve a combination of approaches• Fundamentally:

• Focused attention• Concept of self-observation• In the here and now• Acceptance of process rather than content• Enhanced mental state (mindfulness, awareness, calmness, transcendence.

etc.)

Meditation: Mechanisms and RationalePhysiological • Efficient functioning of the natural compensatory responses within the

autonomic nervous system• Meditation intentionally activates calming responses of the Parasympathetic

Nervous System

• Increased cortical thickness (sensory, emotional) • Improved processing of emotionally salient material and adaptive decision making

• Improved immune functions• Stronger physiological resilience

• Reduced physiological arousal during stressful times

Meditation: Mechanisms and Rationale

Psychological• Hozel et al (2011)

• Enhanced self-regulation• Attention regulation• Body awareness• Emotion regulation• Change in perspective on the self

• Gu et al (2015)• Greater mindfulness• Reduction in repetitive negative thinking (worry and rumination)

• Rumination: tendency to dwell on negative thoughts related to one’s condition• Reduction in cognitive and emotional reactivity

• Extent to which a mild state of stress coupled with stress reactivates negative thinking and emotional patterns

Meditation: Applications

• With different populations• Non-clinical• Clinical

• In clinical settings• As adjunct to psychotherapies

• In everyday settings• In personal lives• In corporate settings• In school settings

Meditation: Efficacy [Psychological measure]

• Hoseman (2015)• Compared two types of meditators against non-meditators, non-clinical population• Australian public, n=695• Freiburg Mindfulness Inventory and Perceived Stress Test

Group n M Mindfulness (SD) M Stress (SD)

Insight-Oriented 158 44.20 (6.19) 16.99 (5.95)

Concentrative 158 42.84 (6.19) 17.67 (7.27)

Non-meditators 158 35.29 (6.74) 25.62 (7.95)

Meditation: Efficacy [Psychological measure]• Paul, Elam & Verhulst (2007)• Deep Breathing Meditation on academic stresses• Medical students, n=64• Survey on perceptions on stress

Survey Questions Pretest M (SD) Posttest M (SD) Follow Up 8-months M (SD)

Experience test anxiety 6.3 (2.25) 4.92 (2.09) 3.97 (2.27)

Become nervous during exams 5.98 (2.31) 4.67 (2.0) 3.83 (2.22)

Have self-doubt during exams 6.16 (2.29) 5.19 (2.32) 4.16 (2.23)

Meditation: Efficacy [Physiological Measure]• Turakitwanakan, Mekseepralard & Busarakumtragul (2013)• Mindfulness meditation on cortisol levels

• Stress hormone• Chemical mediator to stress response

• Second year medical students, n=30• Significantly lower levels• This suggests that mindfulness meditation can lower stress, and

decrease risk of diseases arising from stress• Recommends use in combination with standard treatment

Meditation: Efficacy [Physiological, Psychological Measures]• Nidich et al (2009)• Transcendental Meditation vs wait-list

control on psychological distress, coping and blood pressure

• University students, n=298• Randomized Controlled Trial• Decrease in blood pressure associated

with decreased psychological distress and increased coping

Meditation: Efficacy [Meta-Analyses]• Khoury, Sharma, Rush & Fournier, 2015

• 29 studies, n=2668, healthy non-clinical population• Mindfulness-based Stress Reduction had a large reduction in

stress, moderate effects on clinical measures of depression and anxiety

• Mindfulness a central component of treatment effectiveness• Clinicians can recommend standard MBSR programs to reduce

stress, distress, anxiety and depression and to increase quality of life regardless whether patients meet diagnostic criteria for a mental disorder.

Meditation: Efficacy [Meta-Analyses]• Goyal et al, 2014

• 47 studies, n=3515, clinical populations• Meditation programs can reduce negative dimensions of psychological stress• Mindfulness meditation programs show small improvements in anxiety,

depression, and pain with moderate evidence and small improvements in stress/distress

• Mantra meditation programs did not improve any of the outcomes, but the strength of this evidence varied from low to insufficient

• No evidence of harm of meditation programs

Meditation: Efficacy • The bigger picture: Strong but yet to be conclusive

• Issues with many studies:• Small population → Lack strong statistical power• Heterogeneity in populations, application, variables and

assessments• Long-term nature of meditation practices

Meditation: Side Effects & Contraindications

• Relaxation-induced anxiety and panic• Paradoxical increases in tension• Less motivation in life• Boredom• Pain• Impaired reality testing• Confusion and disorientation• Feeling spaced out• Depression• Increased negativity• Being more judgmental• Feeling addicted to meditation• Feelings of defencelessness• Avoidance of real issues

• Unpleasant affective experiences: fear, anger, apprehension, despair

• Sobbing and hidden memories and themes from the past

• Uncomfortable kinaesthetic sensation• Mild dissociation• Feelings of guilt• Via anxiety-provoking phenomena

• psychosis-like symptoms• grandiosity• elation• destructive behaviour• suicidal feelings

Meditation: Side Effects & Contraindications

• Shapiro, 1994• Psychosis• Schizoid and schizotypal personality• Dissociative states• Hypochondrial and somatization disorders

Meditation: Important Procedural Guidelines

• Importance of apprising clients of side-effects and destabilisation

• Design client-oriented meditative exercises

• Encourage prolonged periods of practice

• Increase client motivation

Meditation: Important Procedural Guidelines

• Monitor and support ego strength or emotional resilience

• Distinguish between temporary discomfort and fragmentation of sense

• Consider meditation as an adjunct to psychotherapy

• Therapist credentials

Conclusion• Strong evidence for effectiveness • Heterogeneity • Generally safe, but risks • Long-term nature • Increasing applications• Stand alone or adjunct

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