depression

Saying adios to doubt

In traditional Buddhist teaching, doubt is a hindrance to progress. Now the English word doubt can also mean something positive. It can refer to the kind of skeptical inquiry upon which rational thought, science, and even true spiritual practice are based. But the hindrance of doubt is not a helpful thing. While healthy skepticism is an essential part of a search for truth, the hindrance of doubt (vicikiccha) is an avoidance or even denial of the truth.

Doubt is a form of storytelling. It’s the lies we tell ourselves. So when we hit an obstacle and tell ourselves “I can’t do this” or “this is a stupid task anyway,” that’s doubt. When we tell ourselves “this always happens,” that’s doubt. When we’re feeling depressed and hopeless and think that things will never change, that’s doubt.

The root of the word vicikiccha is cikicchati, a verb meaning “reflecting, thinking over.” That sounds like a good thing, right? But then we add the prefix “vi-“ and we go from “thinking” to something more like “over-thinking,” or ruminating. That’s not so helpful. Doubt is a kind of cognitive distortion: an inability to see what’s really going on, and an inability to recognize our own potential.

Also see:

When we’re in a state of doubt, we profoundly limit ourselves. We believe the stories we tell ourselves, and so we end up stuck. We lose touch with our memories and experience of change and growth and competence.

If we’re hit by doubt while writing, we say “I can’t write,” and forget about all the times that our writing has come fluently. (Writer’s block is a classic form of doubt).

When doubt hits us and we tell ourselves “nobody likes me, I’m always alone,” we don’t recognize or value the connections we have with others. We forget about all the friendships we’ve had in the past, or currently have.

We can become so invested in the doubt that we’ll concoct all kinds of stories to explain away evidence that contradicts our narrative of hopelessness. If someone says “Yes, but I love you and care for you” we might tell ourselves “they’re only saying that to make me feel better” or think that if they like us their friendship can’t be worth much. Isn’t it crazy?

So how can we deal with doubt? Here are a few tips:

1. Link unhappiness and inner enquiry

First we have to recognize that what we’re experiencing is doubt. And that’s not easy. We live inside a web of stories, and rarely question our interpretation of reality, assuming that our interpretation is reality. So here’s a suggestion: when you’re not feeling happy, take a look at what your mind is doing to cause your unhappiness. We feel down, and we check to see what thought-patterns and emotional habits are making us miserable. This healthy skepticism becomes a habit. Once this habit becomes established, it’s harder to stay in a state of doubt.

2. Don’t believe everything you think

We need then to question the thought patterns that are presenting themselves to us, and look for more creative responses. So if we find ourselves saying “This isn’t fair — life sucks” we can remind ourselves that life has ups and downs, and that just as the ups are impermanent, so are the downs. If we’re telling ourselves that we can’t write, and that everything that comes from our pen is trite, we can remind ourselves that that’s what editing’s for, or remind ourselves of past successes.

3. But don’t judge your doubt

It’s tempting to say “Oh, heck, I’m experiencing doubt. How stupid of me. I’m always doing that. I’m a terrible person.” Hey, wait a minute. Isn’t that just more doubt? Yup, unfortunately doubt has a way of hijacking the mind, so that recognizing doubt is just another excuse to experience more doubt.

So we also have to train ourselves to be nonjudgmental about our doubt. Doubt is just one of these things that happens. It’s no big deal. Just note the thoughts and let them go.

4. Give your doubt a name

Jack Kornfield suggeste that we give our inner critic a name. We can then listen to our doubts and then say, “OK, Betty. I’ll get back to you on that.”

It’s a great idea.

5. Align your spine

When we feel low, we actually physically get low, by slumping. When we slump we can’t breathe properly, and the brain runs at low efficiency, keeping us in a state of doubt.

So sit up! Upen your chest. And as we say in Britain, “Keep your pecker up.” (That always gets a smile from my American friends. Honestly, it means the same as “keep your chin up.”)

6. Connect with Awakening

Sometimes we can reach out to, and surrender to, our own potential Buddhahood. I often find the phrase, “All beings are, from the very beginning, Buddhas,” going through my head. It’s a way of reminding myself of my potential. Another way of doing the same thing is to call to mind a Buddha or Bodhisattava, like Tara or Avalokiteshvara. Surrendering ourselves to these figures (who are simply embodiments of our potential) is a way of embracing change — and change, fundamentally, is what doubt tries to deny. Doubt and an awareness of change cannot long coexist, and so calling our potential to mind is a way of saying “adios” to doubt.

7. Reflect

The traditional way to dispel doubt is to reflect on the Dharma (the path and teachings that help us reach enlightenment). I’ve always thought “Oh, yeah, right!” when it comes to the effectiveness of this kind of reflection. But a few weeks ago I was sleep-deprived and feeling low, and I found myself reflecting that all things arise from conditions (the traditional teaching of pratitya-samutpada, or conditioned co-arising) and found that within seconds, almost, my doubt was gone.

So the tips above constitute a kind of toolbox for dealing with doubt. They’ve worked for me, and I hope they work for you.

Do you have any tips of your own that you’d like to share? If so, take a moment to comment below.

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Mindfully navigating out of depression

I have a long history of depression. And though it’s thankfully not a constant companion anymore, it still drops by for a visit now and then. This past week was one of them. Being in it again gave me another opportunity for practice. But it also showed me how far I’ve come. I have the confidence that there’s a way out.

When these moods come lately, they go up and down, and usually pass away after a week or two. (Thank goodness! It didn’t used to be that way.) And all the things that seem so hopeless and overwhelming when I’m down suddenly turn manageable when the mood passes. Interesting, isn’t it? It’s not like my situation changes. The only thing that changes is the state of my body and mind. When the heaviness lifts, my world is completely different.

This stark contrast has shown me – very directly – how distorted my views can get when I’m down. And how unreal all those thoughts are. I feel fortunate to have been given this gift. It’s a really helpful perspective into the workings of my mind.

Because of this, I’ve now come to treat my depressive episodes as physiological events, not emotional ones. You know how when we get sick, we feel really crappy and miserable? And how we feel a strong pull toward thinking and behaving accordingly – i.e. badly? Well, I now see my depression as the same sort of thing. It’s the same as having a bad cold.

And when I’m like that, I try not to take my thoughts too seriously. And I don’t let them string me along. If I start thinking I’m hopeless and nobody cares about me, well … I can remind myself it’s my depression talking, not the real me. These moods are like thick masks that are temporarily covering my face and eyes. Even though everything I see looks bleak, I know the “me” underlying it is just fine.

See also:

The thing that’s been most helpful to me is learning how to separate out what’s happening physically vs. emotionally. When I very mindfully note how I’m feeling physically, there’s the heaviness, the fogginess in my head, the sleepiness. I don’t try to run away from them. There’s no way to escape from them anyway. It’s far more helpful to face them directly, get closer to them. When I really get to know them well, I can use that knowledge to make better choices in the moment.

But my emotions and thoughts are a different matter entirely. I don’t need to buy into those. It’s much better to investigate and question them. Am I really so tired that I can’t exercise today? Or is it because of my mood? Can I pick myself up and just do it? Or would I feel better by being kind to myself and giving myself a break?

And whatever I decide, there’s no second-guessing. There’s no going back and wondering if I made the right choice. I just make a choice, and move on. Deal with whatever happens as it comes. I stay mindfully with myself every step along the way.

And above all, I always make sure to be completely kind to myself. Feeling bad is never an excuse to beat myself up. Never ever.

I really, really hate being depressed. It’s a terrible, painful place to be. But you know what? I’ve found out how much better it is to stop fighting against it, and just relax into it. When I stop the struggle, I find a gentle, nurturing place inside all the mess that keeps me sane. And I can stay there and ride out the storm with equanimity.

As I’ve practice like this over the years, those terrible thoughts have slowly loosened their grip on me. Some have gone away completely. And as for the ones that are still hanging around – over time they seem to have less and less power over me.

For those of you out there who suffer from depression, I offer my experience as a bit of hope. There is a way out. It doesn’t have to involve drugs. I’m finding my way out, and have the faith that you can too.

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Becoming doubtful of doubt

Some recent and ongoing research sheds light on how the experience of depression arises, and also squares with the Buddhist teaching on the hindrance of doubt (vicikicchā).

Buddhist meditation traditions speak of five hindrances to meditation. No, this isn’t things like throbbing knees or the neighbor playing his stereo too loud. The hindrances are five mental states or activities that “hijack” the mind and make it hard, if not impossible, for us to stay focused in meditation. The central one of these hindrances is doubt.

In English we use the word doubt to mean many things. We can talk about doubt in terms of a willingness to question, and a desire to seek the truth without taking ideas on board too quickly. You might be skeptical, for example, that there are in fact five hindrances to meditation, and want to know more about them. You might want to test out in your experience whether this model is valid and useful. And those are very useful responses. That’s part of the meaning of the English word doubt, but in Pali, the word vicikicchā is much more specific. It refers to a lack of confidence and clarity.

Doubt as a hindrance involves, on an emotional level, a collapse in trust. We lack confidence in ourselves, or we lack confidence in the practice we’re doing, or we lack confidence in others and in whether they have anything to offer us. At its mildest doubt can simply be a form of disgruntlement, disengagement, or confusion, but at its most severe it can be a crushing burden of depression.

Doubt has a more cognitive aspect as well. Accompanying the confused, critical, and sometimes depressed emotions are various kinds of disordered thinking. For example, we may be having a hard time with a task we’re working on — whether it’s meditation or something at work — and we generalize this into statements about ourselves (“I can’t do this … I’m not getting anywhere”) or about the task (“Meditation is stupid … this is pointless”) or about the world generally (“This isn’t fair … life sucks”).

Part of the cognitive distortion is that we’re temporarily unable to remember any counter-examples — times that we succeeded and when the task went well, and times when we experienced obstacles and difficulties and overcame them. We think of ourselves as trapped, and stuck, and can’t imagine any creative way out of our situation. The hindrance of doubt hijacks the mind — both our emotions and our thoughts — and leaves us feeling trapped.

The other day I was talking to a meditation student who is writing a novel, and he talked about the difficulty of actually finishing his writing. Being on the verge of completing a project, or being on the verge of a breakthrough, can often trigger doubt. Say the book isn’t popular; how are we going to deal with that? Say it is popular; we’re then faced with the problem of adjusting to a new self-view, and the dread of having other people’s expectations of future success to live up to. Sometimes it seems best just to delay completion.

The research I mentioned earlier, which is described in a New York Times article, illuminates the connection between the emotional aspect of doubt (at its most extreme, depression) and the cognitive.

People were given words, like “rejection” or “loved” and were asked to come up with one specific memory connected with the word. The word specific here meant an event that lasted less than one day.

For “rejected,” one participant answered, “A few weeks ago, I had a meeting with my boss, and my ideas were rejected.” Another said, “My brothers are always talking about going on holiday without me.”

The second answer was wrong — it is not specific, and it refers to something that took place on several occasions.

You can see how the second response is a generalization. It’s highly unlikely that the brothers in question were literally “always” talking about going on holiday without the participant who wrote that comment. Sometimes people will take one or two examples that happened on specific occasions, and generalize them into an “always.” Sometimes counter-examples will be ignored: the time the writer was invited to go on vacation with his or her brothers but wasn’t able to go, or chose not to go for some reason. Sometimes the generalization in these cases is built on a misunderstanding: the intent wasn’t to exclude, perhaps, but the joint holiday was based on an activity that the brothers shared (like rock-climbing) and that the writer didn’t. With doubt, all the nuance gets squeezed out of the experience, and we’re left with a tight, hard statement of hopelessness expressing doubt in the brothers (“they don’t care about me”) and oneself (“I’m not likable enough to be invited”) and even the world (“Nobody likes me”).

These over-general memories seem to be connected with the arising of depression and related conditions:

Scientists at the University of New South Wales in Sydney, Australia, assessed 46 firefighters during their initial training and again four years later, when all had experienced traumatic events like seeing comrades injured or killed. Those who could not recall the past in specific detail during the first assessment were much likelier to have developed the disorder by the later one.

Interestingly, Dr. Mark Williams, who is well-known for his research into how meditation can help with depression, has

induced an overgeneral style in subjects by coaching them to recall types of events (“when I drive to work”) rather than specific occasions (“when I drove to work last Saturday”). He found they were suddenly less able to solve problems, suggesting that overgeneral memory is capable of producing one symptom of depression.

Doubt is treatable. My advice to students when doubt arises in meditation is first to deal with their posture. When we’re feeling depressed the body usually slumps and the head drops, and this posture reinforces the feelings of depression. When we straighten up the body it’s harder to feel depressed. Remembering how the body feels when we’re full of confidence can help us change our posture and empower us by bringing confidence into our present-moment experience.

The next thing I advise is to cultivate a healthy distrust of our own stories. Just because we think something doesn’t mean it’s true. If we recognize the signs of vicikicchā — in the form of over-generalized thoughts and stories that disempower us — we can step back from them and not take them so seriously. Jack Kornfield has suggested giving this inner doubter a name. When you hear the nagging voice of doubt you can say something like “Thanks for your input, Betty. I’ll get back to you on that.”

I also suggest seeking a more balanced perspective by seeking the truth. “My brothers are always planning to go on vacation without me.” Really? How often? Twice? Three times? Is that really “always.” Is it a bad thing if they don’t invite me on a climbing trip given that I don’t climb? Have I ever invited them to go away with me? We need to be doubtful of our doubt.

“Meditation just doesn’t work?” Wait, is that true? Are there counter-examples? Well, I guess there are actually lots of times I’ve been on retreat and felt amazing afterward…

I’d expect that this research on depression and over-generalizing will end up by recognizing that depression is just the extreme end of a spectrum of doubt that starts with a mild lack of confidence, and that patterns of over-general thinking are the mechanism that get us from feeling just a bit “down” to a full-blown depressive attitude.

There’s good news in the article regarding how to circumvent this slide:

Williams has found that specificity can be increased with training in mindfulness, a form of meditation increasingly popular in combating some types of depression. Subjects are taught to focus on moment-to-moment experiences and to accept their negative thoughts rather than trying to avoid them. It may help by making people more tolerant of negative memories and short-circuit the impulse to escape them, which can lead to overgenerality.

We’re also told that:

Spanish researchers have reported that aging patients showed fewer symptoms of depression and hopelessness after they practiced techniques for retrieving detailed memories.

This is good news for depression sufferers, but it also shows other people how to maintain robust mental health: be specific in your recollections so that you don’t “talk yourself” into a depressed state of mind.

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Brains of Buddhist monks scanned in meditation study

Matt Danzico: In a laboratory tucked away off a noisy New York City street, a soft-spoken neuroscientist has been placing Tibetan Buddhist monks into a car-sized brain scanner to better understand the ancient practice of meditation.

But could this unusual research not only unravel the secrets of leading a harmonious life but also shed light on some of the world’s more mysterious diseases?

Zoran Josipovic, a research scientist and adjunct professor at New York University, says he has been peering into the brains of monks while they meditate in an attempt to understand how their brains reorganise themselves during the exercise.

Since 2008, the researcher has been placing the minds and bodies of prominent Buddhist figures into a five-tonne (5,000kg) functional magnetic resonance imaging (fMRI) machine.

The scanner tracks blood flow within the monks’ heads as they meditate inside its clunky walls, which echoes a musical rhythm when the machine is operating.

Dr Josipovic, who also moonlights as a Buddhist monk, says he is hoping to find how some meditators achieve a state of “nonduality” or “oneness” with the world, a unifying consciousness between a person and their environment.

“One thing that meditation does for those who practise it a lot is that it cultivates attentional skills,” Dr Josipovic says, adding that those harnessed skills can help lead to a more tranquil and happier way of being.

“Meditation research, particularly in the last 10 years or so, has shown to be very promising Read the rest of this article…

because it points to an ability of the brain to change and optimise in a way we didn’t know previously was possible.”

When one relaxes into a state of oneness, the neural networks in experienced practitioners change as they lower the psychological wall between themselves and their environments, Dr Josipovic says.

And this reorganisation in the brain may lead to what some meditators claim to be a deep harmony between themselves and their surroundings.
Shifting attention

Dr Josipovic’s research is part of a larger effort better to understand what scientists have dubbed the default network in the brain.

He says the brain appears to be organised into two networks: the extrinsic network and the intrinsic, or default, network.

The extrinsic portion of the brain becomes active when individuals are focused on external tasks, like playing sports or pouring a cup of coffee.

The default network churns when people reflect on matters that involve themselves and their emotions.

But the networks are rarely fully active at the same time. And like a seesaw, when one rises, the other one dips down.

This neural set-up allows individuals to concentrate more easily on one task at any given time, without being consumed by distractions like daydreaming.

“What we’re trying to do is basically track the changes in the networks in the brain as the person shifts between these modes of attention,” Dr Josipovic says.

Dr Josipovic has found that some Buddhist monks and other experienced meditators have the ability to keep both neural networks active at the same time during meditation – that is to say, they have found a way to lift both sides of the seesaw simultaneously.

And Dr Josipovic believes this ability to churn both the internal and external networks in the brain concurrently may lead the monks to experience a harmonious feeling of oneness with their environment.
Self-reflection

Scientists previously believed the self-reflective, default network in the brain was simply one that was active when a person had no task on which to focus their attention.

But researchers have found in the past decade that this section of the brain swells with activity when the subject thinks about the self.

The default network came to light in 2001 when Dr Marcus Raichle, a neurologist at the Washington University School of Medicine in the US state of Missouri, began scanning the brains of individuals who were not given tasks to perform.

The patients quickly became bored, and Dr Raichle noticed a second network, that had previously gone unnoticed, danced with activity. But the researcher was unclear why this activity was occurring.

Other scientists were quick to suggest that Dr Raichle’s subjects could have actually been thinking about themselves.

Soon other neuroscientists, who conducted studies using movies to stimulate the brain, found that when there was a lull of activity in a film, the default network began to flash – signalling that research subjects may have begun to think about themselves out of boredom.

But Dr Raichle says the default network is important for more than just thinking about what one had for dinner last night.

“Researchers have wrestled with this idea of how we know we are who we are. The default mode network says something about how that might have come to be,” he says.

And Dr Raichle adds that those studying the default network may also help in uncovering the secrets surrounding some psychological disorders, like depression, autism and even Alzheimer’s disease.

“If you look at Alzheimer’s Disease, and you look at whether it attacks a particular part of the brain, what’s amazing is that it actually attacks the default mode network,” says Dr Raichle, adding that intrinsic network research, like Dr Josipovic’s, could assist in explaining why that is.

Cindy Lustig, associate professor of psychology and neuroscience at the University of Michigan, agrees.

“It’s a major and understudied network in the brain that seems to be very involved in a lot of neurological disorders, including autism and Alzheimer’s, and understanding how that network interacts with the task-oriented [extrinsic] network is important,” she says. “It is sort of the other piece of the puzzle that’s been ignored for too long.”

Dr Josipovic has scanned the brains of more than 20 experienced meditators, both monks and nuns who primarily study the Tibetan Buddhist style of meditation, to better understand this mysterious network.

He says his research, which will soon be published, will for the moment continue to concentrate on explaining the neurological implications of oneness and tranquillity – though improving understanding of autism or Alzheimer’s along the way would certainly be quite a bonus.

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Researchers teaching subjects to control brains with MRI scans

Tiffany Crawford: For centuries, yogis have imparted the secrets of healing through meditation and self-awareness.

Now researchers at the University of British Columbia say they’ve found a way to eventually help people combat depression or obsessive-compulsive disorders through similar methods using MRI technology.

In this first-of-its-kind study, published in the April edition of NeuroImage, researchers say participants were able to control their thoughts better when they watched their brain activity on a functional magnetic resonance imaging (fMRI) screen.

The research suggests that awareness of negative or detrimental thoughts — made possible by seeing them on a screen — allows research subjects to control those thoughts.

Many patients who suffer from depression, anxiety or obsessive-compulsive behaviour are not aware of negative thoughts, said co-author Kalina Christoff, a psychology professor at UBC. The technology could be used in the future as a tool to help them become more aware.

Participants in the study watched feedback on the fMRI from their rostrolateral prefrontal cortex, the area of the brain responsible for self-reflection.

They were asked to alternate their thoughts, in 30-second intervals over four six-minute sessions, between their external surroundings — their bodies, current events — and introspective thoughts.

The fMRI would only pick up the introspective thoughts that were being actively contemplated by the participant. Researchers were not told what the participants were thinking about.

Then by watching levels go up or down Read the rest of this article…

on a thermometer-like bar on the fMRI screen, the participant was able to see whether there was an awareness of thoughts. The technique does not differentiate between particular self-reflective thoughts so there is no way to tell whether the participant was fretting over an exam or obsessing about being overweight, for example.

“If the bar is low that means you are not aware of your thoughts,” said Christoff. “You might be having thoughts you are not aware of. But if the bar is increasing it means you are successfully paying attention to your thoughts.”

People who are coping with anxiety, trauma or depression often have negative thoughts of which they are not aware — until they become angry or grumpy and snap at people, she said.

“We think this helps train you to become more self-reflective.”

Christoff said in followup training sessions, all the participants had higher scores of self-reflection and were much more able to observe their thoughts after the training than before.

By using the technology to target the areas of the brain responsible for self-reflection, Christoff said, people who battle depressive thoughts might be able to modify them as they become more aware of them.

“If a depressed person thinks, ‘The world is horrible and everybody is against me,’ and they don’t notice, it will bring their mood down and they’ll feel more depressed,” she said. “And because they feel that, they’ll have even more horrible thoughts.

“The way to break the cycle is to look at that thought and turn your attention and to say, ‘Well this is just a thought — it doesn’t necessarily reflect reality.’ And often that improves the mood.”

The idea then would be to use the MRI technology in conjunction with cognitive behavioural therapy, a type of psychotherapy that aims to help people struggling with depression learn to recognize that their thinking can contribute to the sad moods and despair.

“We’d like to see if we can speed up this process or enhance it by having additional MRI training sessions that can tell them whether or not they are becoming aware,” said Christoff.

The study could also have implications for treating people with post-traumatic stress disorder. Soldiers who come back from Afghanistan, for example, often have obsessive thoughts. And so with the MRI training psychologists could help them “catch” repetitive thoughts before they do too much damage.

Christoff admitted the process was very similar to meditation, a practice that is included in many disciplines of yoga.

“By training your thoughts anyone can benefit. You don’t have to have a clinical condition. This is very similar to meditation. And in that similarity these training methods could have the same benefits that meditation can have. You are training yourself to be more aware.” © Copyright (c) The Vancouver Sun

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Meditation improves endothelial function in metabolic syndrome

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(From a press release) Meditation may help improve endothelial function in patients with metabolic syndrome, potentially reducing cardiovascular risk, new research suggests.

Presented here at the American Psychosomatic Society 69th Annual Scientific Meeting, a randomized trial in a group of African American patients with metabolic syndrome showed significant improvement in endothelial function in those randomly assigned to a year-long meditation program compared with their counterparts who underwent a program of health education alone.

“We found there was a significant difference between the consciously resting meditation group and the health education group in the flow-mediated dilation, which measures endothelial function,” principal investigator Kofi Kondwani, PhD, National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia, told Medscape Medical News.

A risk factor for coronary heart disease, the clinical manifestations of metabolic syndrome include hypertension, hyperglycemia, high triglycerides, reduced high-density lipoprotein, and abdominal obesity. A diagnosis of metabolic syndrome is contingent on an individual having three or more of these risk factors.

According to the investigators, the etiology of metabolic syndrome is complex, but psychological stress appears to play a role, possibly through overactivation of stress hormones. They also note that endothelial dysfunction, which is also influenced by stress, is a major consequence of metabolic syndrome.

In addition, metabolic syndrome is a major health concern in the African American population — particularly among African American women — and is increasing in prevalence, paralleling the US obesity epidemic.

Particular Problem for African Americans

According to Dr. Kondwani, it has been shown that meditation can be effective in reducing psychological stress and improving some cardiovascular risk factors. However, he added, whether it can improve endothelial function in the setting of metabolic syndrome is unknown.

He noted that although metabolic syndrome and cardiovascular disease are important health issues in general, the major health disparities that exist in the African American population make it a particular concern in this population.

“If we could find some simple, easy, cost-effective approach to reduce some of these risk factors — whether it is blood pressure or endothelial function — that could be adopted in the community on a large scale we may be able to have a positive impact on the health of African Americans,” he said.

A joint initiative between Morehouse Medical School and Emory University, the study randomly assigned 65 African American patients age 30 to 65 to undergo consciously resting meditation (CRM) (n = 32), a 12-month meditation program developed by Dr. Kondwani, or a 12-month health education program (n = 33). At study outset there were no significant differences in demographic characteristics or cardiovascular risk factors between the 2 groups.

The CRM group received three 90-minute sessions of initial instructor-led training. They returned once a week for the following 3 weeks, then once every 2 weeks for 2 months, and finally once per month for the remainder of the study. In the interim they were assigned “home rest” assignments that involved meditating for 15 to 20 minutes twice a day.

Improvements in Blood Pressure, Weight, Triglycerides

The study’s primary outcome measure was endothelial function assessed by brachial artery flow-mediated dilation (FMD) at baseline and 6 and 12 months. A secondary outcome was arterial stiffness, measured by pulse-wave velocity.

Trend tests were performed to assess changes in outcome measures and metabolic syndrome factors across the 3 study time points. The investigators found that FMD significantly improved from baseline in the CRM group (2.10 ± 0.79; P = .009) but that improvement was smaller in the health education group (1.36 ± 0.80; P = .09). Dr. Kondwani said there was no difference in arterial stiffness in the groups.

The researchers also found favorable and statistically significant trends in 3 metabolic syndrome risk factors in the CRM group but not in the health education group: diastolic blood pressure (change, -6.24 ± 2.75 mm Hg; P = .03), weight (-2.52 ± 1.16 kg; P = .03), and triglyceride levels (-32 ± 15 mg/dL; P = .04).

Dr. Kondwani also pointed out that certain psychological factors, including some measures of depression, significantly improved in both study groups. This indicates that “that just because an intervention has an impact on patients’ psychological well-being doesn’t necessarily mean it is going to change their physiology.”

These findings, he added, suggest that physicians should not hesitate to encourage their patients to learn meditation. “It will not hurt and invariably it will help. They also shouldn’t get hung up on the type of meditation. It’s highly likely that even if patients weren’t trained in meditative practice but just sat quietly for 20 minutes twice a day there would be benefit,” said Dr. Kondwani.

Dr. Kondwani said that his group hopes to replicate the study’s findings in a larger trial with 150 participants in each arm.

“Wonderful” Form of Stress Management

Commenting on the study for Medscape Medical News, Lorenzo Cohen, PhD, a professor in the Department of Behavioral Science and director of the Integrative Medicine Program at M.D. Anderson Cancer Center in Houston, Texas, said it is well known that psychological stress has a profound effect on many biological functions.

“In our work we know that stress can directly impact certain cancer-related biological systems. We believe it is very important to provide different forms of stress management to patients to help relieve the psychological stress they experience due to life-threatening illness and that one wonderful form of stress management is meditation,” Dr. Cohen said in an interview.

He added that it was not surprising to him that meditation had a positive effect on endothelial function or other measures of metabolic syndrome.

“We know that metabolic syndrome is related to inflammatory processes and we know that stress can increase inflammatory processes. We also know of course that meditation decreases these processes so it would make sense that it has the potential to be a useful adjunct to the treatment of this syndrome,” said Dr. Cohen.

Dr. Cohen noted that in recent years meditation has gained a great deal of acceptance by the medical community and patients alike and is widely accessible.

Ideally, he said, it is useful to have an instructor teach patients how to meditate in order to optimize practice. However, he added, the tools of the information age, including Web-based programs and audio materials, can also be “quite useful.”

He said in his experience there has been some resistance among patients because of a belief that meditation is associated with religion. However, he added, once they are informed that it is taught in a secular manner, this concern is assuaged.

Dr. Kondwani reports he is the founder of Consciously Resting Meditation.

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of metabolic syndrome is complex, but psychological stress appears to play a role, possibly through overactivation of stress hormones. They also note that endothelial dysfunction, which is also influenced by stress, is a major consequence of metabolic syndrome.

In addition, metabolic syndrome is a major health concern in the African American population — particularly among African American women — and is increasing in prevalence, paralleling the US obesity epidemic.

Particular Problem for African Americans

According to Dr. Kondwani, it has been shown that meditation can be effective in reducing psychological stress and improving some cardiovascular risk factors. However, he added, whether it can improve endothelial function in the setting of metabolic syndrome is unknown.

He noted that although metabolic syndrome and cardiovascular disease are important health issues in general, the major health disparities that exist in the African American population make it a particular concern in this population.

“If we could find some simple, easy, cost-effective approach to reduce some of these risk factors — whether it is blood pressure or endothelial function — that could be adopted in the community on a large scale we may be able to have a positive impact on the health of African Americans,” he said.

A joint initiative between Morehouse Medical School and Emory University, the study randomly assigned 65 African American patients age 30 to 65 to undergo consciously resting meditation (CRM) (n = 32), a 12-month meditation program developed by Dr. Kondwani, or a 12-month health education program (n = 33). At study outset there were no significant differences in demographic characteristics or cardiovascular risk factors between the 2 groups.

The CRM group received three 90-minute sessions of initial instructor-led training. They returned once a week for the following 3 weeks, then once every 2 weeks for 2 months, and finally once per month for the remainder of the study. In the interim they were assigned “home rest” assignments that involved meditating for 15 to 20 minutes twice a day.

Improvements in Blood Pressure, Weight, Triglycerides

The study’s primary outcome measure was endothelial function assessed by brachial artery flow-mediated dilation (FMD) at baseline and 6 and 12 months. A secondary outcome was arterial stiffness, measured by pulse-wave velocity.

Trend tests were performed to assess changes in outcome measures and metabolic syndrome factors across the 3 study time points. The investigators found that FMD significantly improved from baseline in the CRM group (2.10 ± 0.79; P = .009) but that improvement was smaller in the health education group (1.36 ± 0.80; P = .09). Dr. Kondwani said there was no difference in arterial stiffness in the groups.

The researchers also found favorable and statistically significant trends in 3 metabolic syndrome risk factors in the CRM group but not in the health education group: diastolic blood pressure (change, -6.24 ± 2.75 mm Hg; P = .03), weight (-2.52 ± 1.16 kg; P = .03), and triglyceride levels (-32 ± 15 mg/dL; P = .04).

Dr. Kondwani also pointed out that certain psychological factors, including some measures of depression, significantly improved in both study groups. This indicates that “that just because an intervention has an impact on patients’ psychological well-being doesn’t necessarily mean it is going to change their physiology.”

These findings, he added, suggest that physicians should not hesitate to encourage their patients to learn meditation. “It will not hurt and invariably it will help. They also shouldn’t get hung up on the type of meditation. It’s highly likely that even if patients weren’t trained in meditative practice but just sat quietly for 20 minutes twice a day there would be benefit, “said Dr. Kondwani.

Dr. Kondwani said that his group hopes to replicate the study’s findings in a larger trial with 150 participants in each arm.

“Wonderful” Form of Stress Management

Commenting on the study for Medscape Medical News, Lorenzo Cohen, PhD, a professor in the Department of Behavioral Science and director of the Integrative Medicine Program at M.D. Anderson Cancer Center in Houston, Texas, said it is well known that psychological stress has a profound effect on many biological functions.

“In our work we know that stress can directly impact certain cancer-related biological systems. We believe it is very important to provide different forms of stress management to patients to help relieve the psychological stress they experience due to life-threatening illness and that one wonderful form of stress management is meditation,” Dr. Cohen said in an interview.

He added that it was not surprising to him that meditation had a positive effect on endothelial function or other measures of metabolic syndrome.

“We know that metabolic syndrome is related to inflammatory processes and we know that stress can increase inflammatory processes. We also know of course that meditation decreases these processes so it would make sense that it has the potential to be a useful adjunct to the treatment of this syndrome,” said Dr. Cohen.

Dr. Cohen noted that in recent years meditation has gained a great deal of acceptance by the medical community and patients alike and is widely accessible.

Ideally, he said, it is useful to have an instructor teach patients how to meditate in order to optimize practice. However, he added, the tools of the information age, including Web-based programs and audio materials, can also be “quite useful.”

He said in his experience there has been some resistance among patients because of a belief that meditation is associated with religion. However, he added, once they are informed that it is taught in a secular manner, this concern is assuaged.

Dr. Kondwani has disclosed no relevant financial relationships.

American Psychosomatic Society (APS) 69th Annual Scientific Meeting: Abstract 1639. Presented March 10, 2011.

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Mindfulness meditation improves well-being, researchers report

Sit down. Close your eyes. Focus on your breath. Observe your thoughts objectively as if you were a scientist.

There, you’ve achieved it: mindfulness, a heightened awareness and acceptance of the present moment without judgment.

As simple as it seems, mindfulness, with its origins in the 2,500-year-old Buddhist practices of meditation and yoga, has become the latest buzzword in wellness, as study after study confirms its power to relieve anxiety and improve mood when combined with Western therapies.

Last month University of Toronto researchers reported in the Archives of General Psychiatry that mindfulness-based cognitive therapy, which mixes mindfulness meditation with cognitive behavioral therapy, is as effective as antidepressants for preventing relapses in depression.

Dr. Zindel Segal, head of the Cognitive Behaviour Therapy Clinic at the University of Toronto, and his colleagues gathered 84 participants who had all recuperated from at least two spells of depression.

Participants were then divided into three groups. One group underwent weekly group therapy. Another received an antidepressant. The third took a placebo.

Over the span of one and a half years, 70 percent of the participants who had taken the placebo had one or more relapses of depression. Only 30 percent of those who received the therapy or the antidepressant suffered from another relapse.

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Segal believes the therapy is so effective because it teaches patients how to observe and correct the destructive ways of thinking that typically lead to depression.

“People may get criticized at work or face rejection, but this therapy teaches skills,” he said. “They can watch those negative thoughts and feelings come and go in their mind without having to engage in them. Patients can then decide to take some action which is more adaptive.”

In Chicago hospitals and private practices, mindfulness-based therapies often cater to specific conditions. Integrative Health Partners in the Loop, for example, offers mindfulness classes for those suffering specifically from anxiety, depression, physical pain and compulsive overeating.

These therapies are offered not only in one-on-one sessions, but also in couples therapy and group classes.

Chicago writer Betsy Storm completed a mindfulness-based stress reduction class last summer at Rush University Medical Center. She has continued to meditate ever since because it improved her chronic sleep problems.

“I told somebody that it was one of the best things that happened to me in 2010—adding meditation in my life,” Storm said. “I feel more alert. I’m able to relax more.”

NorthShore Evanston Hospital and the Rehabilitation Institute of Chicago offer mindfulness programming as well. Researchers are conducting studies at various universities in the area including Rush, Loyola and Northwestern.

Dr. David Victorson, assistant professor in Northwestern’s the department of medical social sciences, studies the effects that mindfulness meditation has on patients in the early stages of prostate cancer. He also runs a nonprofit called True North Treks to bring young cancer survivors together on mindfulness wilderness trips.

Many of the area’s mindfulness professionals meet monthly for networking opportunities, and annually for a teacher’s retreat. The group, called The Chicago Area Mindfulness-Based Stress Reduction Teacher’s Sangha, has about 30 members, according to founder Holly Nelson-Johnson.

She said several of the group’s members were the first to bring mindfulness-based stress reduction therapy to Chicago in the mid-90s after training with the therapy’s founder Jon Kabat-Zinn. The group later opened the first mindfulness-based stress reduction clinic in Illinois at Cook County Hospital in 1996.

Today, the group helps Chicagoans suffering from sleep deprivation, stress and anxiety. The Amsterdam-based Philips Center for Health and Well-Being recently found that Americans could use the help. In a global survey, the center found that about 49 percent of Americans reported they were too worried or stressed out to sleep.

For some, this figure may indicate that cultural values are responsible for the anxiety and stress that mindfulness-based therapies help to reduce.

“My two-year-old knows his alphabet, numbers and colors, all because of a computer,” said Vered Hankin, a mindfulness-based stress reduction therapist in Chicago. “That’s great, but you’ll learn all that eventually. But will you learn to tap into your intuition and creativity? Not if your TV or phone is always on. That’s important to remember in our society. After running around and information gathering, do we really know how to come back to the self?”

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Stressed out? Try mindfulness meditation (Toronto Globe & Mail)

Zindel Segal was in a Toronto bookstore a few weeks ago, when a title caught his eye. The book, The Mindful Investor, caused him a moment of shock and panic.

“I turned to someone and said, ‘This is the beginning of the end,’ ” recalls Dr. Segal, who heads the cognitive behaviour therapy clinic at Toronto’s Centre for Addiction and Mental Health.

The book, which purports to explain how a calm mind can help a person achieve financial security, is a sign that the concept of mindfulness is making a leap into mass popularity. But that doesn’t mean people actually understand it, he says.

Mindfulness is a technique for slowing down and examining one’s thought processes, and learning to be in the moment. Based on Buddhist principles, it became popular in the United States in the 1970s, and was taken up by celebs such as Meg Ryan and Goldie Hawn. Today, researchers are studying its benefits for everything from depression to stress.

In a multi-year study, whose results were published last month in the Archives of General Psychiatry, Dr. Segal and a group of colleagues found that mindfulness meditation – the term they use is “mindfulness-based cognitive therapy” – was just as effective as antidepressants when it came to preventing depression relapse.

Dr. Segal, who was one of the developers of the therapy, teaches it at CAMH in group treatment sessions with patients who have…

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recovered from depression and are “trying to stay well.”

“We’re seeing a demand as people feel that it’s more and more legitimate,” Dr. Segal says. He defines mindfulness meditation as “a way of training yourself to pay attention in the present moment without judgment [as] to what your experience is.”

Thanks to a similar U.K. study, which found the technique reduces the risk of depression relapse by 50 per cent, Britain’s National Institute for Clinical Excellence recommends mindfulness meditation in cases of chronic depression. The Mental Health Foundation, a U.K.-based charity, has recentlylaunched a campaign called Be Mindful, and offers an online program intended to make mindfulness more widely available.

“It’s growing exponentially almost, in terms of there now being an evidence base,” says Ed Halliwell, a British mindfulness teacher and co-author of The Mindfulness Manifesto: How Doing Less and Noticing More Can help Us Thrive in a Stressed-out World. While the field is still relatively new, some 300 to 400 studies are published each year, Mr. Halliwell estimates.

The studies show benefits for many conditions, including anxiety and stress. A study published last year in the journal Neurology found that mindfulness could be used to help people with multiple sclerosis.

And just as it is becoming more popular among researchers, it is also increasingly being sought out by busy professionals.

“Life these days is these days so full of stress … so I think this offers some way of simplifying our life,” says Marian Smith, founder of Mindful Living, a Vancouver-based clinic. Many clients, says Ms. Smith, are dealing with “the challenge of juggling full-time work, having a family, trying to make life meaningful to themselves and to be grounded.”

Doug MacLean, a mindfulness meditation instructor and owner of Practical Wellbeing in Calgary, says there has been an “explosion” in interest, in large part because of the research being published on the topic.

But some experts worry that some people may think all they need to do to solve their problems is close their eyes and pay attention to what’s going on in their heads.

“That can be a real danger, because people can go, ‘All I need to do is be mindful.’ And then perhaps they try meditation and discover it’s not easy – it’s simple, but it’s not easy – and then that can create another level of beating yourself up,” Mr. Halliwell says.

Dr. Segal says that people need to understand that mindfulness is much different than the popular idea of meditation.

“You think of the Beatles, you think of TM [transcendental meditation], you think of people achieving some kind of bliss state. And it’s really different from what people who are going through mindfulness-based cognitive therapy get,” he says. “If anything, what the meditation does is provide them with a way of staying grounded in the midst of very difficult emotions.”

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Mindfulness therapy is no fad, experts say (LA Times)

There is solid evidence that mindfulness therapy, which combines elements of Buddhism and yoga, can relieve anxiety and improve mood.

Of all fields of medicine, psychology seems especially prone to fads. Freudian dream analysis, recovered memory therapy, eye movement desensitization for trauma — lots of once-hot psychological theories and treatments eventually fizzled.

Now along comes mindfulness therapy, a meditation-based treatment with foundations in Buddhism and yoga that’s taking off in private practices and university psychology departments across the country.

“Mindfulness has become a buzzword, especially with younger therapists,” said Stefan Hofmann, a professor of psychology at Boston University’s Center for Anxiety and Related Disorders.

Mindfulness therapy encourages patients to focus on their breathing and their body, to notice but not judge their thoughts and to generally…

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live in the moment. It may sound a bit squishy and New Agey to some, but Hofmann and other experts say mindfulness has something that discredited theories of the past never had: solid evidence that it can help.

“I was skeptical at first.” Hofmann said. “I wondered, ‘Why on Earth should this work?’ But it seems to work quite well.”

Hofmann and colleagues burnished the scientific credentials of mindfulness therapy with a review article in the April issue of the Journal of Consulting and Clinical Psychology. After combining results of 39 previous studies involving 1,140 patients, the researchers concluded that mindfulness therapy was effective for relieving anxiety and improving mood.

The treatment seemed to help ease the mental stress of people recovering from cancer and other serious illnesses, but it had the strongest benefits for people diagnosed with mood disorders, including generalized anxiety disorder and recurring depression.

Jordan Elliott, a 26-year-old marketer for a New York publishing company, said mindfulness training had helped pushed his once-disabling anxiety — about work, the weather, the meaning of life — into the background. “The anxiety is still there, but it’s not as bad as it was,” he said.

Elliott started getting one-on-one therapy four years ago at the American Institute for Cognitive Therapy in New York. It was hard at first, partly because he was skeptical of the technique and partly because he didn’t feel particularly mindful. “I was such a nervous wreck I could hardly sit still for three minutes,” he said.

Now he starts every day with a 10-minute meditation. He sits cross-legged in his apartment, TV and music off, and thinks about his breathing.

“When a negative thought pops off in my head, I say to myself, ‘There’s a thought. And feelings aren’t facts.’ ”

Elliott said he was taking Prozac before he started mindfulness therapy, but he no longer needed medication to keep his anxiety under control.

“It’s pretty clear that people can improve their health if they can encourage this practice in their lives,” said David Fresco, an associate professor of psychology at Kent State University in Ohio. “But we have to be careful not to move beyond the data too quickly.”

Fresco warns that mindfulness treatment is unlikely to help someone suffering from severe and ongoing depression. Those patients, he said, need a more active approach to recovery, perhaps including antidepressants and cognitive behavioral therapy, a type of counseling that encourages patients to question the validity of their negative thoughts.

Once recovery from depression begins, however, mindfulness therapy could provide a valuable defense against future episodes, said Zindel Segal, a professor of psychiatry at the University of Toronto who was one of the pioneers behind mindfulness-based cognitive therapy, or MBCT, a treatment that combines mindfulness with cognitive behavioral therapy.

In December, Segal and colleagues published a study in the Archives of General Psychiatry suggesting that the treatment was as effective as antidepressants for preventing relapses of depression.

The study involved 84 patients who had recovered from at least two bouts of major depression. The patients were broken up into three groups: One had eight weekly group sessions of the therapy, one took an antidepressant and one took a placebo. Over 18 months, about 70% of patients taking a placebo suffered at least one more episode of depression. By comparison, only about 30% of patients receiving therapy or taking an antidepressant had a setback.

Segal said mindfulness therapy could help patients avoid rumination, the process of endlessly chewing on incidents from the past. Rumination is a driving force behind depression, he said, and it just doesn’t mesh with mindful thinking. He also believes that by encouraging patients to focus on their current thoughts, mindfulness can discourage anxiety and worry — up to a point.

“If you’re having panic attacks in the mall, mindfulness therapy on its own isn’t going to be enough,” he said.

Segal adds that mindfulness treatment changes the relationship people have with their emotions, so much so that shifts in brain activity even show up in magnetic resonance imaging tests.

“When your mind has a thought, such as, ‘My colleague just insulted me at the office,’ you can explore the consequences of that thought,” he said. “Thoughts have a less intense grip because you are an observer.”

Hofmann said most patients could pick up mindfulness fairly easily, but it’s not for everyone.

“It takes quite a bit of intelligence,” he said. “It’s good for people who like intellectual stimulation.”

In addition, children, older people (who tend to be more set in their ways) and rigid thinkers may have trouble understanding or embracing the treatment, he said.

Hofmann hopes that the ongoing flood of mindfulness studies will help clarify the benefits and limitations of the approach and ultimately shape the way that the therapy is offered in the real world.

“Some therapists embrace these new and sexy treatments without a lot of critical thinking because they sound cool,” he said.

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Conquering self-doubt with mindfulness-based therapies

The boss loves your work. Your spouse thinks you’re sexy. The kids—and even the cat—shower you with affection. But then there’s the Voice, the nagging presence in your head that tells you you’re a homely, heartless slacker.

Even people who appear supremely fit, highly successful and hyper-organized are sometimes riddled with debilitating doubts, fears and self-criticisms.

“Most people are struggling with difficult thoughts and feelings. But the show we put on for others says ‘I’ve got it handled,'” says Steven C. Hayes, a professor of psychology at University of Nevada-Reno. In reality, however, “there’s a big difference between what’s on the outside and what’s on the inside.”

Cognitive-behavioral therapy aims to help patients conquer their self doubts in two ways: Either by changing the behaviors that go along with it (I’m so fat—I need to get to the gym!) or by challenging the underlying thoughts, which are often distorted. (I’m 45-years old and I’m comparing myself to anorexic models. Get serious!)

Now, a third-wave of cognitive-behavioral therapy is catching on…

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in psychology and self-help circles. It holds that simply observing your critical thoughts without judging them is a more effective way to tame them than pressuring yourself to change or denying their validity.

” ‘Tame’ is an interesting word,” says Dr. Hayes, who pioneered one approach, called Acceptance and Commitment Therapy. “How would you go about taming a wild horse? You wouldn’t whip it back into a corner. You’d pat it on the nose and give it some carrots and eventually try to ride it.”

This new psychology movement centers on mindfulness—the increasing popular emphasis on paying attention to the present moment. One of its key tenets is that urging people to stop thinking negative thoughts only tightens their grip—”like struggling with quicksand,” Dr. Hayes says. But simply observing them like passing clouds can diffuse their emotional power, proponents say, and open up more options. (“Here’s that old fat feeling again. You know, this happens every time I look at fashion magazines. I am sure judging myself harshly. Do I want to go to the gym? Or I could go to a movie. Or I could stop reading magazines.”)

“Part of what mindfulness does is get to you to recognize that these critical thoughts are really stories you have created about yourself. They are not necessarily true, but they can have self-fulfilling consequences,” says Zindel V. Segal, a professor of psychiatry at the University of Toronto who devised Mindfulness-Based Cognitive Therapy to help depressed patients. “If you can get some distance from them, you can see that there are choices about how to respond.”

Mindfulness also involves paying attention to your breathing and other physical sensations while observing your thoughts so you have a tapestry of information to consider, says Dr. Segal. In fact, neuro-imaging studies have shown that when people consider problems mindfully, they use additional brain circuits beyond those that simply involve problem-solving.

Although some critics initially dismissed mindfulness-based therapies as vacuous and New Age-y, dozens of randomized-controlled trials in the past decade have shown that they can be effective in managing depression, panic disorders, social phobias, sleep problems and even borderline personality disorder.

A study of 160 patients with major depression, led by Dr. Segal and published in the Archives of General Psychiatry last month, found that mindfulness-based cognitive therapy was just as good at as antidepressants at warding off relapses of depression.

The National Institutes of Health is funding more than 50 research studies involving mindfulness treatments for psychological problems.

A growing number of therapists are also using mindfulness-based acceptance in their practices. Katherine Muller, associate director of the Center for Integrative Psychotherapy in Allentown, Pa., says she sometimes brings out a little plastic gnome to represent a patient’s negative feelings. “The idea is, ‘These feelings are going to come. What are you going to do about them?’ ” she says. “You don’t have to react to them at all. Just allowing them to exist takes away their power.”

She also finds that practicing mindfulness is more effective at easing her own fear of flying than being reminded about the safety statistics.

On one flight, she says, “all my cognitive skills were going right out the window.” Then another psychologist suggested focusing on the tray table rather than fighting her fears. “It helped me center my head and get a grip,” she says. “It gave me a chance to watch the movie and talk to the person next to me, rather than focus on how the plane might go down in a fiery ball.”

Psychologist Dennis Tirch, director of the New York Center for Mindfulness, Acceptance and Compassion-Focused Therapies, uses this formula to help even people with profound developmental disabilities take control of their emotions: “Feel your soles of your feet. Feel yourself breathe. Label your emotions and make space for your thoughts.”

Extending some compassion for yourself is also an important part of the new mindfulness therapies, Dr. Tirch says. “I can’t tell you how many clients I have who are just beating themselves up about things” says Dr. Tirch. “Give yourself a break—not so you can curl up in bed and stay home, but so you can interact better with the world.”

Kindness and accepting your thoughts nonjudgmentally doesn’t mean having to settle for the status quo, proponents say. Rather than be paralyzed by negative thoughts, you can opt to change your situation—get to the gym or work harder—but with a clearer set of options based on what really matters.

Some critics note that such advice doesn’t sound so different from standard cognitive-behavioral therapy or being kind to the “inner child” of earlier psychotherapy approaches. And some experts say that still more scientific data are needed to evaluate its effectiveness, particularly now that it’s being applied to such a wide array of disorders.

It’s also not clear yet who might benefit most from mindfully accepting their thoughts rather than reasoning with them. For example, Dr. Tirch thinks that it’s still important to convince someone with severe agoraphobia that a piano won’t fall on their head if they leave the house.

Yet Marsha Linehan, a professor of psychology at the University of Washington, found that the acceptance therapy she developed in the 1990s enabled suicidal patients and those with borderline personality disorder to accept their feelings and get help while trying to challenge them would only have created more bad feelings.

“It’s the nonjudgmental part that trips most people up,” says Dr. Linehan. “Most of us think that if we are judgmental enough, things will change. But judgment makes it harder to change.” She adds: “What happens in mindfulness over the long haul is that you finally accept that you’ve seen this soap opera before and you can turn off the TV.”

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