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Meditation and the clinical applications of mindfulness

‘The benefits of meditation are two-fold,’ says Ajahn Brahmali, a Buddhist monk of over 11 years standing, a resident of the Bodhinyana Buddhist Monastery in Western Australia. ‘The “ordinary” benefit of meditation, like getting rid of depression, anxiety and stress [allows you to] feel more peaceful, more relaxed, more at ease,’ he says, ‘because you feel more peaceful, more relaxed, you become more efficient in your work and you become a more pleasant person to be around. So, you become more socially adept. All of these things go together.’

‘Apart from the worldly side, there is [also] the spiritual side of meditation, [which can be] divided into two parts. One is the feeling of meditation, when you experience joy, peace, happiness and tranquillity, and the other aspect is the insight aspect, where you come to understand the mind and the body. You understand what you’re truly like; you understand the world around you, basically,’ says Ajahn Brahmali. ‘[Hence,] you become wiser and you have less suffering.  That’s what wisdom is all about. You have less suffering and you can help other people.’

Regarding the “ordinary” benefit of meditation, since Kabat-Zinn demonstrated clinical psychological benefits of meditation in 1982, meditation has been widely incorporated in clinical treatment within psychiatry and psychology, to treat conditions such as anxiety and depression.

Calm therapy – dialogue with a psychiatrist

Dr Christopher Walsh, a consultant psychiatrist for Turning Point Alcohol and Drug Centre in Victoria, Australia, prescribes meditation as part of treatment for his patients. ‘I was doing it [meditation] for a long, long time before I decide to formally introduce it to patients. Firstly, I felt it was very helpful in my own life: it helped me to be more flexible, to cope with stress, to remain compassionate and not be reactive to things in a bad way. So I could stay calm and help people through crisis. So, I found that the first application of meditation to my work was actually just to create a healing space for patients by me meditating, not by teaching them to meditate. That’s probably the most important application,’ he says, ‘You’d find that when you’re creating a meditation space, even without saying anything about it, you’d find your patients becoming a bit more flexible and more capable of responding in a good way to the challenges around them. I think we’ve all had our experiences too, when we’re in the presence of meditation masters, that our minds become open. So we can all create that opening, that meditation space.’

Dr Christopher Walsh also has a private practice in North Carlton, Victoria. He explains how he came to use meditation in practice: ‘When I went into private practice I wasn’t dealing with people who were quite so sick. [But] when I was in public sector psychiatry I was dealing with people who were psychotic and they weren’t really up to doing the kind of meditation practices that I had learned. And in fact, that could in some ways make them worse. So I didn’t teach them that,’ he says. ‘But when I went into private practice I was dealing with a different population of people who were suffering from depression and anxiety. And I started to experiment with it.’

From www.providencezen.org.
From amitabhaseacoast.com.
Tranquility and applied practice is embodied in the smile of the Buddha image. www.tomswope.com.
Dr Walsh says that most people start to notice some benefits after a couple of weeks, if they are meditating every day, for about 20 minutes or more. From www.manchesterbuddhistcentre.org.uk.
Ven. Zhi Sheng, a columnist for Buddhistdoor International, being filmed for a guided meditation. From Buddhistdoor YouTube.

‘And then a number of years later a lot of researches start to appear showing the value of mindfulness meditation, and so I started to be more formally teaching it, at that point, once I had the confidence of having the research and the professional support, rather than being something that was a bit on the outside.’ Dr Christopher Walsh has researched and published papers on mindfulness meditation in psychotherapy.

Dr Walsh says he suspects some psychiatrists had been incorporating meditation into psychotherapy very quietly for decades, but only in the last decade it has become more and more overt. He thinks meditation can be adapted to benefit a wide range of mental conditions, besides depression. ‘There is certainly good proof for it [meditation] being helpful in preventing relapse in people with chronic relapses in depression. There’s good research for that. But I think it’s applicable in a whole lot of range of conditions, but it needs to be approached in different ways,’ he says. ‘People who have problems with personality disorders or drug addictions or serious psychotic illnesses like schizophrenia – first you need to get them reasonably stable and then you can teach them meditation techniques, but often in an adapted way.’

‘Say, you might start with what we might call “Meditation In Action” – merely bringing mindfulness to day to day activities like brushing your teeth, washing the dishes, or driving the car. In that way it doesn’t bring up too many difficult feelings. Normal meditation can bring up a lot of problems like agitation, boredom, grief, and that can overwhelm some people,’ he explains. ‘What I’m saying is that you can use to it most population but you just have to tailor it, tailor how you introduce people to it.’

Dr Walsh takes a step-by-step approach in introducing meditation to his patients and encourages them to apply it in everyday situations: ‘Generally I’d do some exercises in the therapy room. Explain to them what the technique is and actually do the meditation with them for a little while and ask them about their experience afterwards, and clarify any simple misunderstandings. And then to encourage them to experiment with it in their lives, and then gradually introduce [to] them Mindfulness in Action practices and see which they go with: whether they go with Mindfulness in Action or sitting meditation or both.  Sometimes, that experience is enough for them to realise that they are more than their thoughts, which is a good start,’ he says. ‘Sometimes, people just find they get so much agitation that I would send them along to yoga classes or some kind of movement work, which can be very helpful as well, and also it may get them ready for meditation practice further down the track.’

Dr Walsh admits it was hard to establish ‘a success rate’ because meditation was part of the general therapy, so it was not easy to work out what was causing the success. However, he notices that people who had developed a regular sitting practice had progressed quite a bit faster in their therapy than those who hadn’t. ‘I have seen people plodding along and not doing very well and then starting to meditate and going ahead much faster once they started to meditate, so that I guess is pretty good evidence [of the beneficial effects of meditation],’ he adds.

Dr Walsh says that most people start to notice some benefits after a couple of weeks, if they are meditating every day, for about 20 minutes or more. ‘Then they start to notice some things: for a start, they notice they are not identifying with their thoughts so much, and they often find that they are a bit calmer during the day. Later on, they start to notice some more significant things, like they become more flexible and dealing with more difficult situations.’

Apart from clinical use, more and more people are recognising the benefits of meditation and are learning to incorporated it into their everyday routine.

A novice’s perspective

Ken Liu, a Technical Buyer for a British engineering company, took up meditation about five months ago, after experiencing a lot of stress at work. ‘I became very snappy and bad tempered. I didn’t like the person I was becoming,’ says Ken. ‘I first tried sports, which worked well to relief stress temporarily, but after that, I was back to square one. So, I thought I’d try meditation to see if I can calm myself down.’

Ken practices the breath meditation which he learned from friends and reading. Though he only has time to meditate in the weekends. He finds meditation in the morning, when he feels more refreshed, is a good way to start the day. ‘After about a week or two I found myself getting calmer and calmer,’ he reports, ‘for example, if a supplier forgot to ring me to say that they can’t deliver the goods, I’d normally have a go at them straight away. But now, if I find there is a problem I’d sit back and think “Ok, there is a problem, how do I solve it?” instead of getting snappy and angry, which doesn’t help at all’

Ken finds meditation has benefitted both work and family life, allowing him to feel much calmer, more relaxed and at ease, as well as being more productive.

Starting out small

Knowing that meditation can enrich our lives is one thing, but doing it is another. And, as with everything else, making a start can often be the most difficult part. ‘The first thing is when they can do it. The best time to meditate is when you can,’ Dr Walsh advises. ‘And I try to encourage people to set up a routine, because if it was in the morning one day and in the afternoon the next day they’d often miss it. Whereas, if they have a regular time and they do it as part of getting up in the morning, which is a favourite time, then it becomes more regular, more quickly.’

As well as getting down to it, meditation can only be enjoyable if it is approached in the right way. ‘There is no hard and fast rule how much or how long you meditate. Just make sure you enjoy it,’ is Ajahn Brahmali’s advice for beginners. ‘One of the most important things about meditation is to be able to relax, because if you can relax you can have a good time in meditation. Don’t use too much will power. Just sit back and relax, just enjoy being peaceful with yourself. That is the way to start off.’

Attending a local meditation class is a good starting point. ‘As well as learning good stuff it can help motivate people to establish a practice, because often it can be quite difficult to establish a practice and also people often report, and this happened to me when I first started meditating, that they feel they have a better quality meditation when they meditate in a group,’ says Dr Walsh.

‘Going to meditation class is very useful,’ says Ajahn Brahmali. ‘You get very basic advice what to do, how to practice. Sometimes in the class, as you meditate problems come up, because you have teachers there you can ask them straight away, that’s often the best way of getting feedback. Because, if you just have pure theory you can’t really relate to any real experience.’

However, both Ajahn Brahmali and Dr Walsh were quick to point out that people with serious mental illness, such as schizophrenia or psychosis, should avoid meditation because they can often get worse. ‘Firstly, if they’re suffering from psychotic illness that their psychotic symptoms are pretty much under control, and they have insight: they know when they’re getting unwell,’ Dr Walsh explains. ‘The second thing is I think people who suffered from psychotic illnesses should stay away from meditation that uses visualisation. Because they can become very psychotic if they do visualisations’

Learning to meditate is easy. However, for a beginner, it is best to learn from an experienced teacher. Also, attending a meditation group is fun and it offers better support for the practice, especially at the beginning.

With sincere thanks to my interviewees

Dr. Chris Walsh, a psychiatrist working in private practice in North Carlton (Melbourne, Australia). http://www.mindfulness.org.au/

Mr Ken Liu, a technical buyer,

UK.?

Ajahn Brahmali, a resident monk at the Bodhinyana Monastery, Perth, WA.

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