Advances in Contemplative Psychotherapy

Accelerating Healing and Transformation

Joseph Loizzo, Emily J. Wolf, Miles Neale, Joe Loizzo, Miles Neale, Emily J. Wolf

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317245841
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

Advances in Contemplative Psychotherapy offers mental health professionals of all disciplines and orientations the most comprehensive and rigorous introduction to the state of the art and science in integrating mindfulness, compassion, and embodiment techniques. It brings together clinicians and thinkers of unprecedented caliber, featuring some of the most eminent pioneers in a rapidly growing field. The array of contributors represents the full spectrum of disciplines whose converging advances are driving today's promising confluence of psychotherapy with contemplative science. This historic volume expands the dialogue and integration among neuroscience, contemplative psychology, and psychotherapy to include the first full treatment of second- and third-generation contemplative therapies, based on advanced meditation techniques of compassion training and role-modeled embodiment. Advances in Contemplative Psychotherapy offers the most profound and synoptic overview to date of one of the most intriguing and promising fields in psychotherapy today.

Part One
Mindfulness and Personal Healing

P1.1 The Historical Buddha, Shakyamuni (Robert Beer, used with permission)

Chapter 1
Buddhist Origins of Mindfulness Meditation

Miles Neale

Mindfulness and mindfulness meditation have become household words. This is due to an explosion of scientific research over the last four decades, sparked by interest in the health benefits and clinical applications of mindfulness. While the efficacy of mindfulness-based interventions across a number of health indices has been well documented, the traditional Buddhist psychology underpinning the practice of mindfulness has been largely neglected. This chapter outlines the Buddhist origins of mindfulness meditation, its role in self-healing and liberation, and the psychological mechanisms of change that contribute to its clinical benefits.

Mindfulness Defined

The word ‘mindfulness’ refers to a psychological trait or quality of consciousness, while ‘mindful’ refers to a psychological state or process of being aware. Mindfulness as a type of meditation originated in Buddhist India around 500 BCE. The term is a translation of the Pali word sati and the Sanskrit word smrti, which means ‘to remember’. In this and following chapters, original Buddhist terms are cited—without diacriticals—in Sanskrit, unless otherwise indicated. Mindfulness involves a voluntary, sustained, present-centered attention, which resists automatic habits of thought, emotion, and action, facilitating discernment and transformative insight. Popular and scientific definitions of mindfulness neglect its traditional aim of insight, focusing instead on simple mindfulness understood as: “clear and single-minded awareness of what actually happens to us and in us at the successive moments of percep-tion” (Nyanaponika Thera, 1972, p. 5); “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment to moment” (Kabat-Zinn, 2003, p. 5); and “awareness of present experience with acceptance” (Germer et al., 2005, p. 7).

Mindfulness training can be voluntarily applied—to breath, sensations, emotions, thoughts, and images. When distracted by tangential thoughts or stimuli, meditators practice re-collecting their attention and returning to the chosen focus. According to tradition, present-centered awareness trained repeatedly over time through mindfulness practice produces several distinct mental qualities: relaxation, concentration, balanced sensitivity, mental clarity, and pliancy. In addition, mindfulness affords two key skills—recognition and choice. These skills are not well documented, but are traditionally seen as the active ingredients in self-healing and liberation, allowing one to leverage consciousness and override default habit-patterns. This provides an opportunity for more constructive choices about how one relates to external or internal stimuli in the moment. As the Buddha described in his theory of karma, with every intentionally driven thought, word, and action in the present, our minds shape our experience in the future.

Buddhist Origins and Contemplative Science

While Buddhism is clearly a world religion, it is also a practical philosophy, an ethical way of life, and one of humanity’s first coherent psychologies. For this reason, some researchers now refer to a subset of Buddhist thought and practice as a contemplative science, because the Buddha based his teaching on a causal theory of mind and well-being (Wallace, 2007). On awakening to reality, Shakyamuni framed his initial teaching by applying a medical model to the human condition. His Four Noble Truths framework identifies the symptoms, etiology, prognosis, and treatment for the alleviation of human suffering. While foundational to Buddhist psychology and all future developments within Buddhist culture, the Four Truths are not a set of dogmas, but an invitation to actively engage one’s experience, as the Buddha did, so that the nature of suffering is understood, its origin abandoned, its cessation realized, and the path to liberation cultivated. The Four Truths can be summarized as follows:

1. All life is prone to various forms of distress and suffering, one’s conditioned reactions to which leave the mind and body poisoned by stress instincts and traumatic habits.
2. Suffering is self-perpetuated through an unconscious chain of twelve causally linked neuropsychological processes known as dependent origination (pratityasamutpada), comprising four stages:
   1. Reification and misperception of self and reality, that elicits …
   2. … afflictive reactions such as fear-based clinging and defensive hostility, which compel a narrow range of …
   3. … maladaptive and compulsive actions that eventually hardwire themselves into one’s neurobiology, causing an …
   4. … adaptation to a compulsive life that conditions future moments of perception, affect, and behavior.
3. Because suffering is self-created in this causal cycle of stress (not random, innate, or predetermined), people have the ability to consciously intervene, break the links, and fully extinguish future causes of suffering. This cessation of suffering is known as liberation or nirvana, and is considered the peak personal achievement of a human being.
4. There is a comprehensive method or path for achieving self-healing, sustainable well-being and eventual liberation. It involves the holistic transformation of eight domains of living—known in the Buddhist canon as the Eightfold Path:
   1. Realistic view
   2. Wholesome intention
   3. Harmonious lifestyle
   4. Truthful speech
   5. Ethical action
   6. Joyous effort
   7. Sustained mindfulness
   8. Precise concentration.

These eight domains can be further subdivided into three categories of training, sometimes referred to as three higher educations (adhishiksha), each designed to counteract the major components of the conditioned stress cycle outlined in the Second Truth:

1. Wisdom training applies a realistic worldview of reality and wholesome intentions to clarify and counteract distorted or erroneous misperceptions—particularly the self-reifying habit (atmagraha) at the root of all mental afflictions.
2. Meditation training involves joyous effort, accurate mindfulness, and precise concentration that stabilize and refine awareness as well as counteracting afflictive emotional reactions.
3. Ethical training involves harmonious lifestyle, truthful speech, and ethical action, paving the way for a more wholesome engagement with self, others, and the world, counteracting compulsive behaviors and ensuring constructive development.

Wisdom, meditation, and ethical training each work synergistically (rather than linearly) to support one another. Harmonious lifestyle reduces fluctuations of mind and facilitates deepening insight, while insight into the nature of reality fosters tranquility and enables a responsible, caring engagement with life. Like the three-pronged cycle of self-imposed stress (misperception, afflictive reaction, and compulsive action), the three-pronged cycle of self-correction and freedom (accurate perception, balanced emotion, and harmonious lifestyle) eventually rewires one’s neurobiology and coalesces positive states into wholesome traits, generating a new optimal mode of being.

So meditation is only a third of the Buddhist approach to healing. It needs to be combined with wisdom and harmonious lifestyle to achieve the deeper transformation Buddhist contemplative science asserts is possible for all. Elsewhere (Neale, 2011, 2012), I have coined the term ‘McMindfulness’ for the recent trend in the Western mainstream, overemphasizing mindfulness meditation to the exclusion of the other disciplines, diluting the potency of Buddha’s psychology. My critique is based on two observations. First, extracted from the curricula of wisdom and ethics, mindfulness has been reduced to a mere stress-reduction technique. Second, diluted mindfulness is being mass-marketed as a panacea, often by those who lack knowledge of traditional Buddhist science and methodology. This dilution in the service of greater distribution risks throwing the baby out with the bathwater. While there is little doubt about the many benefits of secular or clinically applied mindfulness (Davis and Hayes, 2011), the active ingredients for liberation employed within the tradition are in danger of being jettisoned. The contemplative science of Buddhism offers humanity one of the deepest, most universal systems of personal healing and social transformation in history. It would be shortsighted and naive to reduce this comprehensive path of liberation to merely a method for relaxation or symptom reduction.

Four Foundations of Mindfulness

The Four Noble Truth framework of Buddhist science is complemented by a practical framework called the Four Foundations of Mindfulness. The aim of this meditative pedagogy is to systematically strengthen one’s attention by applying it to four discrete domains of experience in order to refine the mind’s natural capacities for insight (wisdom) and behavior change (ethics). The four foundations or foci of mindfulness taught within this pedagogy are: 1) the body, 2) sensations, 3) mind, and 4) realities. The specific way these foundations are taught differs widely in different traditions. What follows is one adaptation for clinicians developed by Joseph Loizzo and taught in the Nalanda Institute Certificate Program in Contemplative Psychotherapy (CPCP) and Nalanda Contemplative Life Training (NCLT).

The First Foundation: Body

In the first foundation of breath and body, one begins meditative training by restricting the focus of attention to the smallest input or stimulus, similar to narrowing the focus of the aperture on a telephoto lens to magnify something small or remote. This is applied to the coarsest layer or scope of experience, such as the effect of posture, movement, the changing elements within the body, or simply the breath as it is experienced at the nostrils, chest, or abdomen while it flows in and out. Focusing attention narrowly and repeatedly while consciously self-redirecting one’s awareness develops concentration and eventually elicits a sense of relaxation and fundamental safety, which some have equated with the so-called “safe base” of secure attachment (Epstein 2001; Siegel 2012).

The Second Foundation: Sensation

As concentration develops, one proceeds to the second foundation of physical sensations, opening the attentional lens to allow more input, while containing it to the field of sensation arising in the body at the present moment. Awareness of physical sensations involves an attunement to one’s sensory feeling tone, specifically noting if the experience is pleasant, unpleasant, or neutral. By coupling an attitude of inquisitiveness, patience, and acceptance with this mindful observing of whatever is encountered, one learns to override habitual reactive tendencies of clinging to the pleasant, avoiding the unpleasant and becoming disinterested in the neutral. Whereas the first foundation helps to cultivate focused calm, the second cultivates balanced sensitivity, which the tradition describes as equanimity, since one is able to remain present to the full range of internal sensations without impulsive reactions. Equanimity does not attempt to flatten experience or foster a numb detachment. On the contrary, in mindfulness of sensations one fully attends to the raw experiences of pain, pleasure, and the midrange between, but deconditions the reactive response to each state. Mindfulness actually allows for an even deeper, more intimate experience of feeling tone unobstructed by conditioned reactions.

The Third Foundation: Mind

The third foundation attunes one to the nature of mind itself, opening the lens of awareness to include awareness itself, while maintaining unbiased objectivity. Here one observes mental states as they emerge, for example noticing whether one is overstimulated or focused, afflicted or free. One learns to observe the states and qualities of awareness without being compelled by them on the one hand, or needing to suppress them on the other. In the same way that one learns to override habitual reactions of clinging and avoiding physical sensations in the second foundation, in the third foundation one learns to decondition automatic reactions by applying antidotes that counterbalance the so-called five hindrances to mental pliancy:

1. Restlessness, excitation
2. Mental dullness, lethargy
3. Sensory fixation, greed
4. Sensory repulsion, hostility
5. Doubt.

As one strategically counteracts these hindrances, awareness is freed and harnessed towards deepening investigation and insight. Since this observing of mental states includes the prior foundations of body and sensation, it avoids the pitfalls of disembodied abstraction and numbing detachment. So mindfulness of mind protects one from the escapism or disassociation characteristic of spiritual bypassing, by engaging mind/body events fully, clearly, and courageously without reactive tendencies (Welwood, 2000).

Through this mindfulness of mind, one learns to identify less with states of mind and more with the so-called nature of mind itself, traditionally described as naturally clear and cognizant (Lati, 1981). Mind in the West is commonly equated with thoughts themselves, but in Buddhist contemplative science it is that spacious awareness in which thoughts arise, capable of reflecting on itself (meta-cognitive awareness) and recognizing the true nature of things (meta-cognitive insight). In this practice, mind is metaphorically likened to a sky that includes all weather patterns, or a polished mirror reflecting all that comes before it. Training to rest without reactions in the so-called natural state of clarity or unobscured awareness (vidhya, in Tibetan, rigpa) is considered an advanced practice in the great perfection (mahasandhi, in Tibetan, dzogchen) and great seal (mahamudra) traditions, which aim at insight into the interdependent nature of phenomenon. When the mind is made pliable by overcoming the five hindrances, then one cultivates seven important mental faculties known as awakening factors (bodhyanga):

1. Mindfulness, unwavering awareness
2. Analytic investigation
3. Energy, determined effort
4. Joy, sustained well-being
5. Concentration, sustained focal attention
6. Tranquility, deep relaxation
7. Equanimity, non-reactivity.

These seven factors facilitate discernment leading to insight of the three primary characteristics that define the nature of all phenomenon: impermanence, insubstantiality, and dissatisfactoriness. In other words, self-healing and sustainable well-being are direct outcomes of perceptual clarity, and lead to an intuitive understanding of how subjects and objects exist beyond appearances. As one deepens insight to the profound level of transcendent wisdom, one naturally adjusts one’s view, speech, and actions towards self and others to live in accordance with the principles of interdependence and universal compassion.

The Fourth Foundation: Realities

In the final foundation, mindfulness of realities (dharmas), two procedures are combined. The first is a process of memorizing and internalizing an extensive list of psychological phenomena, elements, or realities, and the second is observing these realities as they naturally arise in meditation. This internalization and analytic investigation then carries over into one’s daily activities, as an ability to discern between wholesome and unwholesome mental factors, and to consciously direct karmic responses. So based on these four foundations, mindfulness works to decondition mental hindrances, cultivate positive factors of awakening, and to generate experiential insight into the facts of life that facilitates optimal development towards liberation from self-imposed suffering.

The final frontier beyond the fourth application of mindfulness includes the domains of body, sensations, and mind, but opens the lens of awareness to embrace all experience arising in the present moment. One is free to adopt any physical posture (lie, sit, stand, walk) and attend to breath, body, sensations, emotions, thoughts, external stimuli, and all mental qualities, combining focused calm, balanced sensitivity, and discerning insight. This invokes the practice of natural wakefulness in daily life, sometimes referred to as choiceless awareness or even non-meditation. Here mindfulness is not cultivated for its own sake, but to continually yoke intuitive discernment with harmonious activity in the service of conscious evolution.

Clinical Applications and Mechanism of Change

As awareness is trained, it is more accessible for self-redirection and conscious self-healing. Over the past forty years research in mindfulness-based interventions (MBIs) have demonstrated reductions in a wide variety of clinical issues and syndromes including chronic pain, anxiety, obsessive compulsive disorder, depression, self-injurious behavior, and addictions. Additionally, immune function, concentration, empathy, and general quality of life have been enhanced. One review (Baer, 2003) of the clinical research on mindfulness identified five major mechanisms underlying positive change: relaxation, acceptance, affect tolerance, behavior change, and meta-cognitive awareness/insight. A more recent wave of neuroscientific research correlates these psychological effects with specific brain changes (Lutz et al., 2007). Taken together, a compelling body of research exists that demystifies meditation and illuminates the mechanisms behind its clinical efficacy.

Relaxation

All meditative traditions share some techniques of concentration, applying sustained focal awareness to objects from breath and sound to image and prayer. When a client trains in mindfulness of breath, or any similar concentrative technique, s/he will usually experience decreased arousal and a sense of calm and relaxation. This is because single-pointed attention temporarily restricts external stimuli, inhibiting internal reactivity that would ordinarily lead to distraction or overwhelm. Focused attention and diaphragmatic breathing help elicit the body’s natural relaxation response through activating the parasympathetic nervous system. The link between stress and medical conditions is universally accepted. Cardiac patients have been found to reduce their mortality by 41 percent during the first two years of meditation training, along with a 46 percent reduction in recurrence rates of coronary artery disease (Linden et al., 1996). Eighty percent of hypertensive patients have lowered blood pressure and decreased medications, while 16 percent were able to discontinue use of all medications for at least three years (Dusek et al., 2008). Most patients with medical and psychological syndromes would benefit from developing the capacity to relax. It serves as an optimal state of mind for learning and insight in therapy, and along with physical exercise has been correlated to increased neural plasticity (Seigel, 2010b).

Acceptance

Buddhist mindfulness practice distinguishes itself from purely concentrative techniques by expanding its scope beyond an exclusive focus on a single object. Mindfulness training emphasizes an attitu...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• List of Illustrations
• About the Editors
• List of Contributors
• Foreword
• Preface
• Introduction
• Part One: Mindfulness and Personal Healing
• Part Two: Compassion and Social Healing
• Part Three: Embodiment and Natural Healing
• References
• Index