Mindfulness-based therapy treatments in modern psychology: Convergence and divergence from early Buddhist thought by Ann Murphy

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Mindfulness-based therapy treatments in modern psychology: Convergence and divergence from early Buddhist thought
by
Ann Murphy
University of South Wales, Australia

Introduction

It is well-known that Buddhist philosophy and meditation have infiltrated many aspects of modern day psychotherapy and healthcare. In particular, mindfulness-based training has become increasingly popular for psychological treatment, with a burgeoning number of empirical studies demonstrating positive effects on scientific measures of psychological health and well-being. It is an interesting phenomenon that an ancient philosophy which evolved around monastics seeking enlightenment has now converged with and been adapted by psychological science and presented as an innovative form of therapy. In doing so, one might wonder if the motivation to meditate has shifted in a global sense from the lofty goal of liberation to a more modest but well-meaning intention of trying to help others to cope with the stresses of modern life and to heal from mental suffering and physical illness.

While the effects demonstrated by research have been mostly positive; there remains a polarisation in views between the general clinical community involved in psychological practice and some Buddhist practitioners and scholars. For example, some clinical psychologists maintain that meditation training, originating from a religious practice, is inappropriate and requires stricter compliance with the rigorous standards upheld by evidence-based research. On the other hand, Buddhist practitioners and scholars consider traditional Buddhist meditation practice not appropriate for psychotherapy purposes, particularly in the open arena of a secular, non-Buddhist population who resist traditional Buddhist beliefs. For some time now, Buddhists have complained that secular mindfulness has diluted and distorted the teachings of the Buddha to fit a commercialised version of meditation training; now deemed palatable to the sensibilities of a westernised non-Buddhist population who resist the suggestibility of an eastern religion.

So, given the well-cited benefits and relief that mindfulness training offers to those who are suffering, are these concerns which imply non-treatment to others a response that is remiss on compassion? Or has the secular mindfulness movement really lost its way by reneging ethics for material gain? Indeed, the booming industry of mindfulness has now infiltrated the corporate business world promising professionals more productivity and success, while disconnecting the practice completely from the underlying root causes of greed, hatred, and delusion, inherent in Buddhist philosophy. Mindfulness consultants, retreats, and courses are emerging on a global scale and as a result, critics have cynically nicknamed the mainstream introduction of secular mindfulness as ‘McMindfulness’.

Further, while mindfulness in the secular sense is essentially a tool for training the mind; there remains the question of whether it could be potentially misused in ways that might cause harm to self and others, by the dissolution of the restraints of morality, loving-kindness, and compassion, as recommended by the Buddha. For instance, Dawson and Turnbull (2006) expressed concern that a secular meditation practice in its reductionist form and disconnected from the traditional framework of Buddhist ethics could present a number of issues. For example, prior to World War Two, Zen meditation methods were adapted and used to assist the Japanese military. More recently, the effort to incorporate mindfulness training for the US military, in pre-deployment, has invoked criticism; with objections that such efforts are at a discord with the peaceful teachings of the Buddha.

Moreover, mindfulness as portrayed in the media, is represented as the cure-all for the masses and coincides with a collective rush to present research literature to promote its effectiveness. However, one might also question if there has been an accompanying reduction in critical thought by turning a blind-eye against the negatives and the less appealing aspects of this new form of treatment. Consequently, more conservative health care professionals regard the research with some degree of scepticism and question whether it is appropriate for meditation to be practiced in a clinical setting. Clearly, in terms of scientific inquiry, mindfulness-based interventions are still in its early stages of development.

Mindfulness-based therapy treatments

The most commonly accepted definition of mindfulness in the scientific literature is the definition coined by Jon Kabat-Zinn (1994); ‘paying attention in a particular way: on purpose, in the present moment, and nonjudgementally’. This definition was loosely derived from Venerable Ñāṇapoṇika Thera’s (1962) classic book on meditation, The Heart of Buddhist Meditation . Other definitions are ‘the nonjudgmental observation of the on-going stream of internal and external stimuli as they arise’ (Baer 2003), and ‘the state of being attentive to and aware of what is taking place in the present’ (Brown & Ryan 2003). Following on from this, for the purposes of empirical study, a group of colleagues developed a more comprehensive and mutually agreeable operational definition of mindfulness as: ‘a kind of nonelaborative, nonjudgmental, present-centered awareness in which each thought, feeling, or sensation that arises in the attentional field is acknowledged and accepted as it is’ (Bishop et al. 2004). Further, Germer (2005) defined mindfulness as a 3-part process: ‘1) awareness, 2) of present experience, 3) with acceptance’. Brown, Ryan, and Cresswell (2007) defined mindfulness as a clear awareness of one’s inner and external worlds that is nonconceptual and nondiscriminatory with a flexibility of awareness and attention.

In sum, while a clear operational definition of mindfulness in the scientific literature has been difficult to establish, the characteristics of awareness, attention, nonjudgment, acceptance, and being in the present moment are the collective defining features found in the modern literature. However, aspects of ethical conduct and the intentional cultivation of wholesome states of mind are not incorporated within this common understanding.

In the Pāli Canon, mindfulness is described as the ardent, clear, aware, and mindful contemplation of the body, the feelings, the mind, and the objects of the mind, with the overcoming of worry and desires for the world (DN iii 313). As an analogy, mindfulness is likened to a gatekeeper guarding a King’s fortress to protect the inhabitants and ward off outsiders (AN IV 110-111), which demonstrates the capacity for mindfulness to attend to the activities of the mind in a highly protective and discriminatory manner. Memory and recollection are also important aspects in the traditional definition of mindfulness. For example: ‘possessing supreme mindfulness and discretion, one who remembers and recollects what was done and said long ago’ (SN V 197-8; trans. Bodhi 2000).

In the Visuddhimagga, mindfulness is described as remembering, or non-forgetting, and states that its function is to guard the mind (Vsm IV 172). In the Dhammasangaṇī, mindfulness is enumerated as recollecting, calling back to mind, remembering, and bearing in mind, and characterised as the opposite of superficiality and obliviousness (Dhs 14). Similarly, in the Vibhaṅga , mindfulness is defined as constant, recollection, the act of remembering, bearing in mind, non-superficiality, and non-forgetfulness (Vibh 220). In the Paṭisambhidāmagga mindfulness is described as the dominating power in the establishment of the primary object (in meditation), and then once established, mindfulness presides in conjunction with other cognitions associated with the primary object (Paṭis I 43).

Perhaps the clearest definition in the canonical literature is in the Milindapañha. Here, the Buddhist monk Nāgasena describes mindfulness in a way that includes both the cognitive elements of recollection and astute discrimination:

‘Noting and keeping in mind. As mindfulness springs up in the mind of the recluse, he repeatedly notes the wholesome and unwholesome, blameless and blameworthy, insignificant and important, dark and light qualities and those that resemble them thinking,

‘These are the four foundations of mindfulness, these the four right efforts, these the four bases of success, these the five controlling faculties, these the five moral powers, these the seven factors of enlightenment, these are the eight factors of the noble path, this is serenity, this insight, this vision and this freedom’. Thus does he develop those qualities that are desirable and shun those that should be avoided’
(Miln; Pesala 2001, 40-41).

Therefore, mindfulness in early Buddhist thought does not only include the faculty of present-moment awareness, but additionally, contains a discriminative capacity orientated towards cultivating wholesome states of minds, along with an element of recollection that manifests together, and this recollective aspect of mindfulness involves the recollection of the dhamma.

Indeed, mindfulness is considered such a core and significant part of Buddhist teachings that mindfulness is listed eight times as part of the thirtyseven requisites of enlightenment; the bodhipakkhiyā dhammas. These are the factors said to be all presiding in unison at the moment of enlightenment. Here, mindfulness is included in the four foundations of mindfulness (satipaṭṭhāna), as one of the spiritual faculties (indriyas), one of the spiritual powers (balas), one of the factors of enlightenment (bojjhaṅgās), and as right mindfulness, the seventh factor in the Noble Eightfold Path (ariya aṭṭhaṅgika magga). Moreover, in the Abhidhamma, mindfulness is classified as one of the nineteen universal beautiful factors; a category of mind states (cetasikas) said to be present in beautiful, uplifted states of consciousness. Mindfulness arises concomitantly with other beautiful mind states including faith, non-greed, non-hatred, equanimity, and tranquillity. Here, right mindfulness is practiced with the silā aspects of right speech, action, and livelihood of the Eightfold Path, while adopting the divine attitudes of the brahma-vihāras of compassion (karuṇā), loving-kindness (mettā), sympathetic joy (muditā), and equanimity (upekkhā), all for the progressive eradication of delusion (amoha) (Bodhi 1999, 85-90). The function of discriminative analysis is considered a correct application of right view and right effort of the Eightfold Path (Bodhi 2011).

Clearly, mindfulness in early Buddhist thought is comprehensive, multi-faceted, and complex. Perhaps this might be a reason why as a term in the modern scientific literature, mindfulness has been so difficult to define and to consistently replicate in a generic manner.

Similarly, there have been difficulties in the attempt to transpose mindfulness into a measurable outcome for empirical study in the scientific literature. In this aim, a number of widely available published selfreport questionnaires have been developed (Baer 2011). For example: the 30-item Freiburg Mindfulness Inventory (FMI), the 15-item Mindful Attention Awareness Scale (MAAS), the 39-item Kentucky Inventory of Mindfulness Skills (KIMS), the 39-item Five Facet Mindfulness Questionnaire (FFMQ), the 12-item Cognitive and Affective Mindfulness Scale-Revised (CAMS-R), the 16-item Southampton Mindfulness Questionnaire (SMQ), the 20-item Philadelphia Mindfulness Scale (PHLMS), the 13-item Toronto Mindfulness Scale (TMS), the 21-item State Mindfulness Scale (SMS), the Mindfulness Process Questionnaire (MPQ), and the Meditation Attention Breath Scores (MABS).

However, like a generic definition of mindfulness, efforts to operationalise and provide an accurate and consistent measure of mindfulness have been problematic. For instance, these measures of mindfulness range in complexity from a one summarised factor (MAAS, FMI, SMQ, MABS, MPQ), to two factors (PHLMS, TMS, SMS), to four scales (KIMS, CAMS-R), and to five facets (FFMQ). Further, issues associated with self-reporting present a problem of bias and non-objectivity which may undermine authenticity in the responses. Individual differences in the subjective understanding of mindfulness affect the interpretation and therefore, the answers to the posed questions. Moreover, the variations in an understanding of mindfulness in modern psychology reflect individual specialisations in specific domains of psychological science and are at a discord with the multi-faceted, dynamic quality of an experiential understanding of mindfulness, as known by Buddhist meditation practitioners. Also, the inherent difficulties in accurately assessing a broad and diverse range of practitioners, including cultural differences, across multiple domains such as beginners in western secular mindfulness programs to long-term experienced meditators from traditional Buddhist practices, by the use of one short and succinct psychological questionnaire needs to be acknowledged.

As a short review, there are two main, commonly used mindfulness-based therapy programs: Mindfulness- Based Stress Reduction (MBSR) and Mindfulness- Based Cognitive Therapy (MBCT). Other psychotherapy interventions which include significant components of mindfulness incorporated into treatment are Dialectal Behaviour Therapy (DBT), originally developed for the treatment of borderline personality disorder, and Acceptance and Commitment Therapy (ACT). Other variations of mindfulness-based training programs are: mindfulness-based eating awareness training (MB-EAT), mindfulness-based art therapy (MBAT), mindfulness-based relapse prevention (MBRP), mindfulness-based relationship enhancement (MBRE), and mindfulness-based elder care.

The MBSR program initially began as a behaviour therapy treatment at the University of Massachusetts Medical Centre (UMMC) for clients suffering with chronic pain. The program was developed based upon an amalgamation of Buddhist meditation and yoga practices derived from Jon Kabat-Zinn’s personal experiences with Theravāda insight meditation and Mahāyāna Soto and Rinzai Zen traditions, along with yogic traditions originating from Vedanta and influences from the teachings of J. Krishnamurti and Ramana Maharshi. It was Kabat-Zinn’s original intention to develop a structured curriculum based upon underlying Buddhist principles, which was adapted in accordance with the evidence-based constraints required for mainstream medical care (Kabat-Zinn 2011). MBSR is conducted over an 8 week period consisting of group meetings for about 2.5-3.5 hours every week combined with an all-day practice session of about 7.5 hours conducted in silence during the sixth week of the program. Lovingkindness practices are included during this silent all-day session. An orientation session and a brief private interview are also recommended prior to commencing the MBSR program.

The meditation exercises in MBSR include practices that may be done both formally and informally. The formal practices are comprised of sitting meditation, the body scan exercise, walking meditation, and gentle mindful yoga postures. The informal practices are outlined in a way that meditation can be incorporated into everyday life. These are awareness of breathing, awareness of pleasant and unpleasant events, and deliberately developing awareness during routine everyday activities such as eating, driving, brushing teeth, washing the dishes, and so on.

MBCT was developed later in the 1990s by Zindel Segal, Mark Williams, and John Teasdale, with the support and help from Jon Kabat-Zinn and his colleagues at the Stress Reduction Clinic (UMMC). MBCT is based upon the MBSR program with the inclusion of cognitive therapy as a core component of the treatment. Its original purpose was for use in psychotherapy and was originally developed as a manualised methodology to specifically target relapse in depression (Segal, Williams, and Teasdale 2002). There has been further supporting research demonstrating its efficacy from a number of randomised-controlled trials. The additional cognitive therapy component incorporated into MBCT was derived from the work of Aaron Beck (Beck 1976), and was originally designed to address persistent maladaptive thought processes that predict on-going negative thought patterns and behaviour, which serve to perpetuate the reoccurrence of depressive episodes. The MBCT program is also typically delivered as an 8-week program in a group setting. However, it does not provide the one day silent retreat or the loving-kindness meditations offered in MBSR.

The dhamma as medicine?

Arguably, the underlying premise of mindfulnessbased therapy is the notion that the dhamma has not only a soteriological aim but it also promotes a healing of the mind and the body. Indeed, the nature of the dhamma could be characterised as therapeutic, in the respect that the assertion of the Four Noble Truths is to end suffering. In this context, suffering encapsulates all physical and mental suffering. The Buddha clarified human suffering as birth, ageing, death, sorrow, lamentation, pain, sadness, distress, attachment to the unloved, separation from the loved, and not getting what one wants (DN ii 306). The Vibhaṅga analysis on the multi-faceted nature of human suffering distinguishes pain in terms of either physical or mental pain (Vibh 4. 190-202). The analogy of the dhamma as medicinal is a common theme in various places throughout the Pāli Canon. For instance, in the discourse to Māgandiya, in the Māgandiya Sutta, the Buddha relates the dispensation of the dhamma as comparable to the medicinal remedies prescribed by a physician (MN i 511).

In the offering of the dhamma, the Buddha is said to portray himself as ‘an unsurpassed physician and surgeon’ (Iti 100; Ireland 1997, 226). Further, the Buddha likens the suitability of hearing the dhamma by different kinds of persons to that of a patient being prescribed a suitable medicine to recover from an illness (AN i 121).The Buddha stated that the teachings are ‘the noble purgative’ just as a physician prescribes ‘a purgative for eliminating ailments’ (AN V 218). Here it is worth considering that in many circumstances where people have experienced trauma, loss, pain, sickness, and myriad other forms of suffering in their life, that their individual form of spiritual development may require a preliminary and gradual healing of the mind and body before a dedicated effort towards liberation might even be considered.

Has contemporary scientific research collaborated the healing effects of meditative practice on physical health and well-being? To date, there is a substantial body of work on the salutogenic effects of meditation. Mindfulness-based interventions have been applied across a variety of domains in physical health, such as helping those suffering with chronic pain, fibromyalgia, rheumatoid arthritis, improving mood and well-being in cancer patients, and reducing stress and anxiety in patients with cardiovascular disease and hypertension. In particular, those physical illnesses which are exacerbated by stress or tend to promote anxiety and worry appear to be the most positively affected by mindfulness-based therapy (Carlson 2012).

In the area of psychological research, empirical studies suggest that mindfulness meditation training has a beneficial effect on psychological health and well-being (Keng, Smoski, and Robins 2011). A meta-analysis on the efficacy of mindfulness-based interventions from 39 studies revealed a reliable effect on reducing levels of anxiety and depression (Hofmann, Sawyer, Witt, and Oh 2010). A further recent meta-analysis of 209 studies concluded that mindfulness-based therapy appears to be more effective in the treatment of psychological problems compared to physical illnesses, and is most effective for specifically treating anxiety and depression (Khoury et al. 2013). Mindfulness-based interventions have been applied and demonstrated its efficacy in the treatment of a variety of mental health issues, such as for depression, generalised anxiety disorder, panic disorder, bipolar disorder, post-traumatic stress disorder, social anxiety disorder, borderline personality disorder, and for addictions.

The potential for mindfulness training to improve physical and mental health may be related to the overall capacity for meditation practice to alleviate stress-related symptoms. For example, increased levels of mindfulness and the amount of time spent in meditation practice was associated with reduced perceived stress and improved psychological wellbeing (Carmody and Baer 2008). Moreover, a recent study found that just three days of 25 minutes of mindfulness meditation practiced every day significantly reduced levels of stress (Creswell Pacilio Lindsay and Brown 2014). Reducing stress levels is beneficial because we know that the harmful effects of chronic stress suppress immune function, increase inflammation, impair memory, promote bone mineral loss and muscle wasting, and contribute towards metabolic syndrome (McEwen 2008). Again, after an 8-week MBSR program, individuals who had previously been experiencing heightened levels of stress reported significant reductions in levels of perceived stress. Another interesting fact is the correlation between the levels of perceived stress and favourable structural changes in the amygdala, an area of the brain implicated in stress and anxiety responses, was found in those participants. In previous studies, exaggerated amygdala activation has been associated with mental health conditions (Hӧlzel et al. 2010). In another study where participants received 8-weeks of meditation training, the results revealed significantly smaller inflammatory responses in the meditation group compared to a control group who participated in a health enhancement program (Rosenkranz et al. 2013). Meditation practice may also promote healing at the cellular level. For instance, greater telomerase activity was observed in participants who engaged in a 3-month long meditation retreat, when compared to controls (Jacobs et al. 2011).

Recent research in neurobiology has revealed links between meditation practice and the capacity for structures of the brain to change in response to this experience, a phenomenon termed neuroplasticity. Research indicates that meditation mindfulness training is associated with alterations in pre-frontal asymmetry, an area of the brain related to positive emotions (Davidson et al. 2003), increased cortical thickness of the brain (Lazar et al. 2005), increased brain gray matter density in brain regions related to learning, memory, emotion regulation, perspective taking, and self-referential processing (Hӧlzel Carmody et al. 2011), and is associated with positive alterations in emotional processing (Allen et al. 2012). These results suggest that prolonged meditation practice appears to alter brain function in ways that improves memory, attention, learning, and mood.

So what are the proposed underlying mechanisms of change caused by mindfulness meditation practice? Baer (2010) posits that the psychological process of change invoked by mindfulness training encompasses various cognitive and emotional faculties. These processes include higher levels of mindfulness, decentering from distressful and anxiety-producing thoughts, emotion regulation, self-compassion, and enhanced neurobiological changes in the brain, including alterations in attention and working memory capacity. In particular, decentering has been found to have a mediating effect on psychological health by observing and noting thoughts in the mind as mere transitory events, without judging or letting the thoughts influence behaviour, subsequently reducing the propensity to engage in rumination. Rumination has been demonstrated to enhance negative thinking styles which predict and maintain depressive episodes, as well as exacerbate other psychopathology such as anxiety. Mindfulness training promotes decentering by reducing negative automatic thoughts and enhancing the ability to let go of negatively-biased thoughts more easily. More recently, Hӧlzel, Lazar et al. (2011) defined distinct but interacting mechanisms from a conceptual and neural perspective. These were outlined as attention regulation (sustained and enhanced attention), body awareness (of breathing and bodily sensations), emotion regulation (including reappraisal, exposure, extinction, and reconsolidation of emotion), and changes in perspectives on self (including detachment from a fixed notion of self-identity).

Research suggests that mindfulness meditation supports emotion regulation (Chambers, Gullone, and Allen 2009), which promotes improvements in mood and helps to reduce anxiety and negative emotions. It is hypothesised that mindfulness meditation may improve emotion regulation by enhancing executive control; the prefrontal area of the brain responsible for the management and control of higher cognitive processes such as planning, problem-solving, selective attention, handling novel situations, and inhibition of habitual responses (Teper, Segal, and Inzlicht 2013). Additionally, mindfulness training has been found to improve overall cognitive function by enhancing attention, working memory capacity, and cognitive flexibility. The on-going practice of mindfulness meditation emphasises concentration by a repeated and sustained focused attention on a primary object, which supports an enhanced attentional capacity and therefore, has further positive implications for mental health (Valentine and Sweet 1999). While enhanced attention has been found to be demonstrably apparent in long-term meditators compared to short-term meditators; improvements in attention have been reported within only 5 days of meditation training and also associated with improvements in mood and lower stress levels (Tang et al. 2007). Improvements in attention are related to a better capacity for selfregulation, implying meditators are more able to skilfully select and focus attention on more beneficial mental activities with decreased rumination, leading to better psychological health (Chambers, Lo, and Allen 2008). Indeed, it has been argued that selective attention is a critical antecedent process in regulating emotions towards positivity (Wadlinger and Isaacowitz 2011). Moreover, the sustained focus on the sensations of body, as specifically instructed by the mindfulness body meditations and body scan exercise, increases interoceptive awareness or internal body awareness, theorised to play an essential role in emotional awareness, emotion regulation, empathy (Hӧlzel, Lazar et al. 2011), and diminished bodily pain (Kerr et al. 2013).

Ethics

In early Buddhist thought, mindfulness and ethical conduct were inextricably-linked practices. For laypeople, the Pāli Canon endorses adherence to the Buddhist five precepts of non-killing, non-stealing, no sexual misconduct, no wrongful speech, and non-partaking in alcohol and drugs for the purpose of training in the establishment of mindfulness. A violation of these precepts was considered a setback in the training (AN IV 457).However, given its secular motivation, the five precepts are not integrated into the MBSR/MBCT programs, with the potential implication that participants may continue to engage in unhelpful or harmful behaviours while also meditating. In particular, any adverse effects of combining alcohol or drugs in conjunction with intense meditation practice are not known.

Traditionally, in Buddhist countries, adopting the five precepts and the practice of morality would often be performed for many years before commencing a sustained meditation practice. Indeed, the Abhidhamma describes the faculty of mindfulness as accompanied by skilful (kusala), wholesome state of consciousness (citta) which contain central aspects of virtue (sīla) (Shaw 2014, p. 148). Thus, mindfulness is not an isolated activity but rather, is incorporated as part of a lifetime dedicated to perfecting the practice of the Eightfold Path. In this regard, a Buddhist practitioner attempts to maintain mindful attention to the actions of right speech, right action, and right livelihood in daily life as a sustained effort to fully integrate mindfulness practice within the Buddhist aspects of sīla.

As such, when transgressions are made, the accompanying presence of self-respect (hiri) and a genuine fear of the consequences (ottappa) are present, which include an understanding of kamma. Further, as part of the Noble Eightfold Path, wisdom (paññā) is developed by the cultivation of the two factors of right view and right intention, including the study of Buddhist philosophy (the dhamma). The other factors of right effort, right mindfulness, and right concentration comprise the unified, diligent practice of meditation (samādhi) in daily life. Hence, the practice of following the Eightfold Path encompasses the three core Buddhist principles: paññā, sīlā, and samādhi.

Therefore, right mindfulness, as the seventh factor of the Eightfold Path, includes the cultivation of wholesome, skilful mind states and the removal of less skilful mind states such as greed, hatred, and ignorance (SN 45.8). Moreover, Buddhists will also often include devotional practices such as chanting, prayers, bowing, and recollection of the Buddha to help uplift the mind in a spiritually conducive manner. Conversely, in a westernised non-Buddhist culture, the emphasis tends to be primarily focused on the meditation practice with a downplaying of the equally important role of moral behaviour and ethical conduct. Here, we see a divergence in approach between western secular mindfulness and the traditional Buddhist practice.

In its portrayal, MBSR is a hybrid of Eastern Buddhist and yoga traditions with a westernised, secular overlay and a uniquely scientific approach. For the purposes of empirical study in the scientific literature and to secure funding for research, it has been important that the mindfulness-based program remained devoid of religious connotations. MBSR offers a supportive and safe environment that gently instructs and guides newcomers to meditation in a way that is presented as non-threatening and nurturing. For non-Buddhists residing in a predominately non- Buddhist and westernised country, this provides an ideal introduction to meditation without the need to abandon their own religious beliefs and personal ideals. However, it is also worth considering whether interest in secular mindfulness has eventuated as a backlash to scandals in traditional Buddhist centres established in western countries. Moreover, difficulties for westerners in accepting the doctrine of rebirth as well as misogynistic attitudes towards women, particularly in regards to Bhikkhuni ordination, found in traditional Buddhism are the oftcited reasons for the global shift to secular Buddhism in western countries.

On the other hand, the issue of the calibre, integrity, and experience of mindfulness teachers have come under the spotlight of critique in recent times. In order to address this, the Centre for Mindfulness (the University of Massachusetts Medical School) insists upon adhering to a rigorous and structured training program in order to be certified as a MBSR teacher, which includes the pre-requisites of personally attending a number of silent meditation retreats and maintaining an on-going meditation practice. In the UK, a formal mindfulness-based interventions teacher assessment criteria (MBI: TAC) has been introduced to develop a standardised framework to ensure teacher competence in teaching both MBSR and MBCT programs. In addition, Bangor, Oxford, and Exeter Universities now offer postgraduate training in MBSR and MBCT. However, other mindfulnessinformed interventions such as ACT and DBT remain unchecked with no presiding certifying body to ensure a uniform standard and formalised qualification for teaching. Further, psychologists and other clinicians may incorporate mindfulness techniques in an adhoc fashion into their existing treatment procedures with only minor training, such as attending a short professional workshop on mindfulness as part of their on-going professional development. In these less formal cases, the health practitioners may have no personal understanding of meditation.

Therefore, while it has been generally agreed in theory that mindfulness teachers should have a well-established meditation practice of their own to inform their teaching practice, this is not always the case. This raises the question of whether it is ethical for a counsellor or mindfulness consultant to teach mindfulness when they are not a meditator themself and do not possess a personal understanding of mindfulness. For example, adverse effects of meditation have been reported, such as increased negativity, depression, anxiety-related symptoms, or activation of past traumatic experiences. Often these effects are temporary but a skilled instructor is required to deal with such issues if they arise (Melbourne Academic Mindfulness Interest Group 2006).

In traditional Buddhism, the teaching of the dhamma is not at all considered elementary and a significant number of years of personal meditation experience would typically be endorsed before a Buddhist teacher would be considered adequately qualified to teach others. Indeed, this is clearly stated in the canonical literature regarding the Buddha’s said advice to Bhikkhu Ᾱnanda on teaching the dhamma to others:

‘It isn’t easy, Ᾱnanda, to teach the Dhamma to others. One who teaches the Dhamma to others should first set up five qualities internally’
(AN III 184; Bodhi 2012, p. 773).

These five qualities in teaching the dhamma are specified as 1) giving a progressive talk that is gradual, 2) a talk that shows reason, 3) giving a talk out of sympathy for others, 4) not giving a talk that is intent on material gain, and 5) giving a talk without harming self or others (AN III 184). Here, the prerequisites of the intention to teach out of compassion for others without thought of personal material gain while seeking to do no harm is an integral aspect required in the ethics of teaching meditation to others. Moreover, in the Pāli Canon, the good friend in the dhamma or the teacher is described as:

‘He is dear, respected, and esteemed, a speaker and one who endures speech; he gives deep talks and does not enjoin one to do what is wrong’
(AN IV 32; Bodhi 2012, p. 1022).


Bhikkhu Buddhaghosa further states that the teacher, clarified here as ‘the giver of a meditation subject’, must firstly be an arahant ‘someone with cankers destroyed’. However, if no such person can be found, then Buddhaghosa suggests seeking an individual in the following succession: ‘a non-returner, a oncereturner, a stream-enterer, an ordinary man who has obtained jhāna, one who knows three Piṭakas, one who knows two Piṭakas, one who knows one Piṭaka, in descending order’. If no one can be found who knows at least one Piṭaka, then Buddhaghosa suggests seeking a person who is knowledgeable of at least one collection (of the canonical literature) and its associated commentaries and who also presents themself as a conscientious individual (Vsm III 64). Thus, a teacher of the dhamma should also be an adept and dedicated practitioner:

‘You should do yourself as you teach another; Well tamed, tame others – for self, they say, is hard to tame’
(Dhp 12.158; Roebuck 2010, p. 33).

Clearly, as represented here in the Buddhist literature, a teacher must be of high regard, possess a deep knowledge of the Buddhist teachings, and maintain good ethical conduct before they are considered adequately qualified to teach the dhamma to others.

Typically, the lay mindfulness meditation teacher has a sparse knowledge of Buddhist texts and may not be a Buddhist. A further concern regarding mindfulness-based interventions is the lack of on-going meditation support to assist the novice meditator. In actuality, participants are often left with no on-going support after the program has ended. In a traditional Buddhist setting, on-going access to the meditation teacher is typically always made available. Moreover, in contradiction to the condition of not being intent on material gain, there is in general, a high cost charged for attending mindfulness training programs. While mindfulness participants are told that there is no need for them to go to a monastery to learn meditation, it would be apropos to question if alternative information about other meditation centres could also be provided, as Buddhist centres would typically offer similar meditation training at no cost, with their funding provided solely by donation (dāna). Although, earning money from teaching the dhamma is not an intractable issue as clearly there are incurred expenses in providing training courses. Perhaps, it is the primary intention of offering the teachings out of compassion for others rather than specifically being intent on material gain that might be the grey area of interpretation here.

Further, strict adherence to ethical conduct by teachers in respect to participants in the mindfulness course has already become an issue. Most notably by the introduction of secular mindfulness training is the loss of the connection to the Triple Gem (the Buddha, the dhamma, and the saṇgha), which are the core and fundamental aspect of the Buddhist teachings. Typically, the Buddha is not referred to as part of the mindfulness course and was in fact discouraged in my personal experience while attending the MBSR teacher training program. Finally, with the mass introduction of lay meditation teachers, there would no longer be a requirement for the Saṇgha’s role in teaching the dhamma.

Conclusion

In conclusion, the enormous benefit of mindfulness practice offered by MBSR and MBCT teachers for a primarily non-Buddhist population cannot be underestimated. Empirical studies have provided a substantial body of evidence supporting improvements in both physical and psychological well-being. Further, recent research based upon uplifted states of consciousness such as compassion, self-compassion, loving-kindness practices, and equanimity derived from the Buddha’s teachings are a positive and complimentary addition to mindfulness-based therapy research which promote more wholesome and altruistic states of mind.

However, with the mindfulness movement, the connection to the Triple Gem has been lost. Here, we are reminded of the Buddha’s prediction regarding the downfall and eventual disappearance of the dhamma by the loss of reverence from the four-fold assembly (bhikkhus, bhikkhunis, male and female lay followers) towards the Buddha, the dhamma, the saṇgha, the training, and the method of concentration (SN II 224). Therefore, care must be exercised to avoid a reductionist approach towards mindfulness by its dilution into a merely intellectual mind-training tool which emphasises a heightened form of attention and reneges on ethical values. In terms of the polarisation that exists between scientists and Buddhist scholars; this may always be the case, although this natural dichotomy may protect against the imbalance of extreme views. To reiterate the Buddhist scholar Bhikkhu Bodhi (2011, pp. 35-6), as scientific work progresses on mindfulness treatments and other Buddhist-related research; an ethical responsibility is required to maintain the integrity and respect for the Buddhist meditation practices, while reminding Buddhist practitioners and scholars that the curative applications of the dhamma entails significant improvements in the lives of others and in that regard, must be disseminated openly and without a closed ‘teacher’s fist’ (DN ii 100).

Finding an amenable balance between these two perspectives is a key factor in engendering harmonious and collaborative advances in contemplative sciences in the future.


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