Compassion and palliative care

Compassionate, loving kindness and mindfulness interventions in a palliative care setting.

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Authors: Claudia Orellana-Rios, Lukas Radbruch, Martina Kern, Yesche Regel, Andreas Anton, Shane Sinclair and Stefan Schmidt

Year: 2017

Title: Mindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams: a mixed-method evaluation of an “on the job“ program

Summary: Notwithstanding the extensive body of work exploring meditation and mindfulness, there is a shortage of studies that address the potential of compassion based interventions in the workplace. A national survey of palliative care practitioners had established that for 42% of respondents, frequent patient deaths was a challenging aspect of their work. Although many people report beneficial effects from delivering compassionate care, extensive exposure to suffering can be a problem for workers. This investigation recruited participants from a palliative care centre in Bonn, Germany.  Ten weeks of training in meditation combining a number of elements including, mindfulness, loving kindness and tong-len was provided. A range of mixed measures was used to establish the benefits of the practice including, a battery of self-reporting questionnaires, semi-structured interviews and a physiological measure. In conclusion, no evidence that participants experienced an increase in compassion was observed. However, improvements were reported by participants in areas including self-care and emotional regulation. The was no significant change to the cortisol levels taken as part of the trial.

Given the complex nature of introducing compassion into this particular work environment, the mixed method approach should be commended. Where compassion, loving-kindness and mindfulness are brought together as an ‘omnibus’ approach, a degree of epistemological plurality is likely to be required to gain a full understanding of the results. Reliably evaluating the effects of one approach (such as compassion) in such a trial can be a challenge in itself. However to integrate three approaches (mindfulness, compassion and loving-kindness) into a working environment, then to understand their effect individually and collectively, is making great demands of the self-reporting instruments.

It should be noted that in a recent meta-study investigating the pro-social effects of meditation, the teaching of the meditation practice by a co-author of the research was seen to be an influential factor. The precise nature of the meditation taught in this case is unclear and may, to some extent, be related to the individual approach of the teacher. The assumption that different kinds of meditation, such as compassion (tong-len), all fit within an easily replicated framework is perhaps the result of the theoretical uncertainty withing psychology towards contemplative science. There is still a shortage of data exploring how interrelated constructs such as loving-kindness and compassion might influence behaviour in the workplace. In this regard, the study provides useful information that may help the understanding of these constructs in particular working environments.

Link: https://bmcpalliatcare.biomedcentral.com

Methodological problems in mindfulness research

Problems in how meditation is researched are highlighted in this meta study. But the paper stops short of explaining why its lost in a ‘theoretical mist’.

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Authors: Ute Kreplin, Miguel Farias & Inti A. Brazil

Year: 2017 (print), 2018 (online)

Title: The limited prosocial effects of meditation: A systematic review and meta-analysis

Summary: This systematic meta-review explored the effects of meditation and mindfulness on five types of pro-social behaviour (compassion, empathy, aggression, connectedness and prejudice). The study contended that although there was evidence that compassion and empathy were mediated by meditation, the other three factors were not. Further, that compassion levels were found only to increase when a co-author of the study was the meditation teacher or when the control group was a passive (not active) waiting list. The study highlighted a number of key problems in the ongoing study of meditation, particularly the consistent application of appropriate methodologies.

However, weaknesses in the scientific investigation of meditation tend to be linked to the absence of robust theoretical frameworks. For example inconsistent definitions of mindfulness and meditation. Meta-studies in this field can reflect wider patterns but risk drawing together forms of meditation that may in effect, be quite different. The authors are correct to highlight the ‘theoretical mist’ surrounding meditation research and the failure of science to treat meditation as either a secular or spiritual practice. But despite citing architects and theorists of contemporary meditation, the authors fall short of explaining how the pseudo-spirituality of contemporary secular meditation arose or is being sustained.

Link: https://www.nature.com/articles/s41598-018-20299-z

How much does science know about meditation?

Scientific understanding of meditation and mindfulness

Science and meditation
Science and meditation

Blogging about a related issue at Meditation for Health prompted me to think about how much does science really know about meditation and mindfulness. Leading scientists in the field state that empirical meditation research is at a relatively early stage. But relative to what? Surely not the efforts of the scientific community, thousands of scientific studies have already been published that explored meditation and/or its presumed operationalised components. It should also be considered that there is a vast body of traditional texts available, documenting many aspects of contemplative sciences over the last two thousand years. Contemporary research should also have benefited from the millions of current practitioners, including meditation masters with great experience of practice and underlying theoretical frameworks. It is hard to imagine more auspicious conditions for the study of meditation, so why is the research struggling to make significant progress?

After I had been meditating for five years I asked a traditional meditation teacher what the goal of my particular practice was. She stripped away the esoteric imagery in which the practice was framed and explained the likely result of my efforts. In particular, she emphasized the importance of my motivation. The idea that the method alone is not the practice is central to many forms of meditation and contemplation. In fact, traditional literature from Tibetan Buddhism makes it clear that progress in a particular method may require the application of significant levels of compassion or non-attachment. It is not my suggestion that a western scientific approach cannot fully understand the processes engaged in different forms of meditation. But rather it might be time to start to think about the phenomena underpinning meditation in a more complete way, even within cognitive psychology or neuropsychology. In some traditional schools, meditators are discouraged from evaluating the progress of others. But when you meditate cheek by jowl in a community of meditators for years, you may inevitably observe differences in the effects of the same meditation practice on different people.

Whilst the capacity of practitioners (individual differences) is a known factor in the experience of meditation. An individual’s motivation is also central to the benefits of a practice. This is a paradigm for all meditators and mindful practitioners in all settings. Unless a scientist can integrate the enthusiasm, scepticism and goals of the meditator into the input part of the equation, great uncertainty regarding the output is inevitable.  In a survey of meditators and mindfulness practitioners (Morris, 2017) that included both types of practice and reasons for commencement. The motivation of practitioners was very varied. Among the cited reasons for beginning meditation or mindfulness were:        

Motive %
To improve my health 12
To improve my general well-being 43
For spiritual/religious reasons 22
As a lifestyle choice 6
Because of the influence of others 3
Any other reasons 14

There are reasons to suppose that the motivation of a meditator is a significant influencer on the results of a practice. The empirical approach has a great deal to offer the investigation of meditation, it can help to construct reductionist models able to identify the elements contemplative practice. But we are perhaps at a point when a fuller understanding of meditation and meditators needs to evolve.

 

References

Morris, S. (2017), An exploration of the relationship between wellbeing and meditation experience amongst meditators and mindfulness practitioners. The Open University, Milton Keynes. Unpublished

Putting the Meditator at the Centre of the Research

Meditators know the most about meditation, if science ignores them they miss a trick.

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(The research is now complete, thanks to all who participated)

Do you meditate or practice mindfulness?

I am currently undertaking an academic survey into meditation and wellbeing. I would like to ask meditators over the age of 18 to complete a short anonymous questionnaire about their practice (it should take around ten minutes). The research has been ethically approved and conforms to all the usual academic norms.

This important research seeks to capture the meditation and mindfulness experience of practitioners of different levels of experience and backgrounds. Based on meditators self reported insights, this projects follows recent signposts in contemplative science putting greater emphasis on the experiential nature of mindfulness and meditation.

Regards

SGM

Is Mindfulness Buddhist and Does its Social Context Matter?

Can mindfulness be regarded as a Buddhist practice?

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Title: Is mindfulness Buddhist? (and why it matters)

Author: Robert H. Sharf

Year: 2015

Summary: Modern mindfulness meditation is often associated with the state of ‘bare attention’, paying attention in the moment, non judgementally but deliberately. This particular state is not without established precedent in different schools of Buddhism and Robert H. Sharf outlines examples from Burmese reformed Buddhism, the Chinese Chan and Tibetan Dzogchen traditions. This paper also highlights issues associated with the theoretical framework for mindfulness in Buddhism and the relationship between the transformative potential of meditation and the wider context within which meditation is undertaken.

Perspective: Religious studies, psychiatry, health psychology

Link: http://buddhiststudies.berkeley.edu/people/faculty/sharf/documents/Sharf%20Is%20Mindfulness%20Buddhist.pdf

No Agreement over the Meaning of the Term Mindfulness

What is the authentic meaning of mindfulness?

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Title: What does mindfulness really mean? A canonical perspective

Author: Bhikkhu Bodhi

Year: 2011

Summary: The mindfulness movement is inextricably linked with Buddhism, both Buddhist teachings and meditation practice. It is then of particular interest when Buddhist scholars of the Pali Cannon, such as Bhikkhu Bodhi question one of the most widely used definitions of mindfulness; ‘bare attention’. This is not simply a philological debate regarding the development and use of the term mindfulness but also a discussion of the fundamental understanding of the human behaviour of meditation. There is also the question of the appropriation and ‘translation’ of the term mindfulness into secular contexts and the implications for both Buddhism and the secular meditation schools.

Perspective: Religious studies

Link: http://www.tandfonline.com/doi/full/10.1080/14639947.2011.564813?src=recsys

 

The origins of MBSR; Zen and mindfulness

Mindfulness based stress reduction (MBSR) its origins and context.

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Title: Some reflections on the origins of MBSR, skillful means, and the trouble with maps

Author: Jon Kabat-Zinn

Year: 2011

Summary: In this frank an open exposition of Jon Kabat-Zinn’s development of the Mindfulness Based Stress Reduction (MBSR) system, readers are given an insight into the background and conditions under which the MBSR concept was transposed. I use the term ‘transposed’ because that appears to be the essence of how Kabat-Zinn positions his work in the context of his experience and knowledge of Zen Buddhism. In this paper he stresses that MBSR and other systems in the mindfulness family should be integrated and consistent with the Buddhadharma (authentic teachings of Buddhism) but not constrained by the historical, cultural and religious phenomenon that exist in the societies where the Buddhadharma has been preserved and may still flourish.

Kabat-Zinn reveals his own close connection with the Zen one thousand year view and this insight perhaps gives a clue to the current academic debate whether the understanding of mindfulness as expressed in MBSR actually reflects mindfulness in Buddhism more generally. Mindfulness in its broader meaning is given a prominent role in this paper and Kabat-Zinn shares his compassionate vision regarding the benefits of the continued growth in the ‘mindfulness’ movement.

Perspective: Health psychology, religious studies,

Link: http://www.tandfonline.com/doi/abs/10.1080/14639947.2011.564844