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Psychosomatic Medicine:
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Alterations in Brain and Immune Function Produced By Mindfulness Meditation: Three Caveats

Smith, Jonathan C.

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Distinguished Professor of Psychology

Roosevelt University

Chicago, Illinois

Recent research of Davidson and his colleagues on brain processes and mindfulness meditation (1) has generated substantial media and popular attention. In this research, participants randomly assigned to 8 weeks of mindfulness meditation (compared with nonmeditating controls) displayed significant increases in left-sided anterior activation (previously associated with positive affect) and increases in antibody titers to influenza vaccine. Meditators practiced 45 minutes a day, met weekly for up to 3 hours, and completed a silent 7-hour retreat at week 6. These are exciting and promising findings that merit comment.

Having studied and taught meditation and relaxation for over three decades (2–11), I note similarities between the current burst of interest in Buddhist techniques and interest in a Westernized Hindu approach in the 1970s—transcendental meditation (TM). For both, media attention has been considerable, including major articles in the New York Times, several feature articles in the New York Times Magazine, cover articles in Time, and significant coverage on network television. Interestingly, for both, heightened interest was preceded by major articles in Psychosomatic Medicine. Unfortunately for both, the popular press has generally overstated the significance of reported findings. This in turn has provided considerable misleading “expert recommended” advertising copy for technique advocates and exaggerated promise of symptom relief and psychological gain to those in distress. Ordinarily, scholars look the other way when the media mangles their work. However, given that serious journalists have described current mindfulness studies as “milestone”(13), and researchers, through frequent interviews, have done little to temper such exuberance, it is time to take a deep breath and bring to light three caveats.

First, most research on mindfulness has examined Kabat-Zinn’s approach. Few, if any, studies have cautioned that the Kabat-Zinn system is not pure mindfulness, but an amalgam of mindfulness meditation, concentrative meditation, passive breathing exercises, yoga stretching, and even a bit of imagery, autogenic training, and Buddhist psychology. Elsewhere I have proposed that this system should be viewed as a “combination approach”(10, 11, 12). The point is not minor, given the consistent finding that the different approaches Kabat-Zinn incorporates have different effects (8, 9, 12). Thus, it is impossible to determine if obtained benefits are the result of meditation, stretching, breathing, or a synergistic combination of all components. Likewise, it is impossible to identify elements that are unnecessary or needlessly long. We risk driving clients away with 1-hour daily meditations (most other programs use 20 minutes or less), 3-hour weekly meditations, and 7-hour silent meditation retreats every few months. Of the six major approaches to professional relaxation (progressive muscle relaxation, autogenic training, yoga stretching, breathing exercises, imagery, meditation), the Kabat-Zinn approach is truly unique in its demands. Such demands appear to be based on Buddhist religious tradition rather than scientific evidence.

Second, we know very little about the biological effects of activities that consistently evoke positive states. It is clear that positive states can be evoked by many activities, including sitting in a Jacuzzi, listening to music, taking nature walks, petting pets, and so on (12). Just what are the physiological effects of, say, basking in a Jacuzzi an hour each day, supplemented by a 3-hour visit to the pleasure spa every weekend, and a 7-hour marathon spa retreat after 6 weeks? I predict the lucky participants in such research would appear quite happy and healthy, especially if their retreats were led by a world-famous pleasure spa expert. Of course, it is not my purpose to promote pleasure spas. My point is that any consistent, prolonged, and enthusiastically promoted regimen of quiet and pleasurable activity could well evoke changes in dispositional positive affect as well as brain and immune function. This simply has to be checked before any mindfulness research can be described as “milestone.” Until then, researchers must provide the appropriate caveat.

Third, there is the problem of happiness. For over a decade (6, 7, 12), I have argued that positive state researchers have restricted their attention to just one or two positive dimensions, usually happiness. Such a focus limits what meditation research can find. I predict that when brain researchers start comparing approaches, practitioners of different techniques will look uninterestingly similar when happiness is the only positive state examined. Our research, as described in over 30 published studies (7–9, 12, 14–16), has examined several dozen types of relaxation and meditation activities practiced by over 10,000 participants. We have found at least 15 positive factor states associated with the practice of relaxation, meditation, and mindfulness. In addition to Happiness, this comprehensive list includes: Sleepiness, Disengagement, Rested/Refreshed, Energized, Physical Relaxation, At Ease/Peace, Mental Quiet, Childlike Innocence, Love/Thankfulness, Mystery, Awe/Wonder, Prayerfulness, and Timeless/Boundless/Infinite/At One. Furthermore, whenever we have compared techniques (including mindfulness), we have found that different approaches evoke different positive states, even though they evoke the same degree of happiness. It remains for researchers to look beyond happiness for what may well be the true uniqueness of mindfulness.

In sum, I sense that we may be at the threshold of a new explosion of public and scientific interest in mindfulness meditation. Serious research on TM first appeared in the scientific literature about three decades ago, and inspired, as listed on PsycINFO, 147 articles from 1973 to 1982 (during this time, 88 studies focused on Zen and mindfulness). In the present decade (1993–2002), mindfulness research has been on the rise, with over 140 articles to date (75 for TM). It is my hope that a few simple caveats may prompt or provoke meditation researchers to carefully examine their methods and avoid the exaggerated claims uttered by TM advocates in the 1970s and 1980s. Those of us who do meditation research should be mindful that our findings and enthusiastic recommendations are grounded in fact, not faith.

Jonathan C. Smith

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REFERENCES

1. Davidson R, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli S, Urbanowski F, Harrington A, Bonus K, Sheridan J. Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med 2003; 65: 564–70.

2. Smith J. Meditation as psychotherapy: A review of the literature. Psychol Bull 1975; 32: 553–64.

3. Smith J. Psychotherapeutic effects of TM with controls for expectation of relief and daily sitting. Consult Clin Psychol 1976; 44: 630–7.

4. Smith J. Personality correlates of continuation and outcome in meditation and erect sitting control treatment. J Consult Clin Psychol 1978; 46: 2272–9.

5. Smith J. Relaxation dynamics: Nine world approaches to self-relaxation. Champaign, IL: Research Press; 1985.

6. Smith J. Meditation, biofeedback, and the relaxation controversy: A cognitive-behavioral perspective. Amer Psychol 1986; 41: 1007–9.

7. Smith J. Cognitive-behavioral relaxation training: A new system of strategies for treatment and assessment. New York: Springer; 1990.

8. Gillani N, Smith J. Zen meditation and ABC relaxation theory: An exploration of relaxation states, beliefs, dispositions, and motivations. J Clin Psychol 2001; 57: 839–46.

9. Matsumato M, Smith J. Progressive muscle relaxation, breathing exercises, and ABC relaxation theory. J Clin Psychol 2001; 57: 1551–7.

10. Smith J. ABC relaxation theory: An evidence-based approach. New York: Springer; 1999.

11. Smith J. ABC relaxation training: A practical guide for health professionals. New York: Springer; 1999.

12. Smith JC. Advances in ABC relaxation. Applications and inventories. New York: Springer; 2001.

13. Hall S. Is Buddhism good for your health? NY Times Mag; September 14, 2003.

14. Smith J, Wendell A, Kolotylo C, Camille J, Lewis J, Byers K, Segin C. ABC relaxation theory and the factor structure of relaxation states and recalled relaxation activities, dispositions, and motivations. Psychol Rep 2000; 86: 1201–8.

15. Smith J. Steps toward a cognitive-behavioral model of relaxation. Biofeedback Self Regul 1988; 13: 307–29.

16. Smith J, Amutio A, Anderson J, Aria L. Relaxation. Mapping an uncharted world. Biofeedback Self Regul 1996; 21: 63–90

Copyright © 2004 by American Psychosomatic Society

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