You can’t open a newspaper or browse a health website these days without seeing the latest glowing testimonial to the benefits of meditation training. Yet only a small subset of psychiatrists actually practice meditation, and fewer still incorporate awareness training into their tool kit in treating their patients. It’s not as if there has been an absence of attention to meditation in the mental health community. The works of Drs Jon Kabat-Zinn,1 Mark Epstein,2 Marsha Linehan,3 and others4-7 as well as more recent research8 have reinforced meditation’s ameliorative effect on most chronic medical and psychological conditions.
Nevertheless, many psychiatrists have not caught on. Some mistrust the validity of a practice that entrains observation of a subjective, hard-to-assess interior experience. Others may misunderstand it as uncomfortably associated with religiosity. There is also the practical obstacle of squeezing even basic meditation skills training into the psychiatrist’s already over-subscribed treatment visits. Regardless of our possible reasons for stiff-arming it, meditation training remains a valuable, thoroughly secular tool for psychiatrists to incorporate into our patient practices—and our own personal self-care routines.
Meditation: what is it?
Meditation is a purposeful practice in the observation of experience. It entrains the skill of attention with the goal of optimizing our observing and “holding” experiences of daily life in mind. It can be thought of as the “lesson plan” in developing mindfulness, defined by Kabat-Zinn9 as “non-judgmental, moment-to-moment awareness.” That task may sound easy enough to perform until one recognizes that the human mind is an endless fountain of narrative content and editorial judgments on one’s ongoing experience. Modern minds, deeply invested in our intellectual analytic skills, tend to overvalue our trails of cortical production.
A simpler witnessing of the phenomena present in any moment, without running off in additional mental production, cannot and should not replace our prodigious cortical capabilities. But it does add an important tool in basic adaptation to experience, a developing ability to “sit with” painful but usually temporary states of interior suffering such as physical pain, anxiety, anger, sadness, and uncertainty. There is also benefit in discovering one’s own conditioning, the linking of specific patterns of thought, feeling, and sensation and even the loss or reduction in attention itself as a defensive maneuver of the mind.
While a survey of the totality of writings on meditation over millennia reveals thousands of variations on practice and technique, most texts break them into 3 main types.
1. Concentration practice involves entraining attention via intense observation of a single object in the mind’s eye. Breath meditation, a very common starting point for any beginner, is a concentration practice. Meditating on the heartbeat, a mantra, or a visual object such as a candle flame also represents types of concentration practice.
2. Insight practice entrains the bare awareness of all phenomena in the field of mind as they come and go. For many, this is a more advanced practice that can have a more spiritual connotation, as it is associated in Buddhism with experiencing an ultimate sense of oneness and cosmic connection. This practice can also have a great diagnostic utility in psychotherapy, entraining observation of patterns of thought and feeling that co-occur in response to the triggers in day-to-day life.
3. Compassion practice uses globally familiar phenomena of positive human feelings—equanimity toward others, compassion, kindness, and joy—as an “object of mind” to hold and observe one’s reactions to.
A model of mind
I’ve found in my teaching of these techniques to my own patients—and in teaching medical residents about how to convey them to theirs—that a “landscape” model is effective. The metaphor involves observing one’s experience in any one moment like a walk outdoors, witnessing the field of mind as an observer/photographer. When working with a patient, I describe basic components of that field:
• Physical: including “interior” experiences of the breath, heartbeat, and bodily sensations, such as pain and muscle tension; and “exterior” sensory inputs such as sight, hearing, smell, taste, and touch
• Emotional: usefully compared with the “weather in the field,” these include anger, anxiety, joy, and sadness
• Thought: most ardently pulling our attention in mind, these include concepts, memory, new creative synthesis, speculation, and analysis
Dr Sazima is a psychiatrist in private practice in Roseville, CA, and is Senior Behavioral Faculty at the San Jose/O’Connor Family Medicine Residency Program, San Jose, CA (affiliate, Stanford University School of Medicine). He has also developed and taught mindfulness training programs for adults and children for 12 years.
1. Kabat-Zinn J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. NY: Delta Trade Paperbacks; 1991.
2. Epstein M. Thoughts Without a Thinker: Psychotherapy From a Buddhist Perspective. NY: Basic Books; 1995.
3. Linehan M. Cognitive-Behavioral Treatment for Borderline Personality Disorder. NY: Guilford Press; 1993.
4. Thich NH. The Miracle of Mindfulness. Boston: Beacon Press; 1975.
5. Benson H. The Relaxation Response. NY: Harper Collins; 1971.
6. Boorstein S. Don’t Just Do Something, Sit There. San Francisco: Harper; 1996.
7. Dalai Lama, Cutler H. The Art of Happiness. New South Wales, Australia: Riverbed Books; 1998.
8. Goyal M, Singh S, Sibinga EMS, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174:357-368.
9. Kabat-Zinn J. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. NY: Hyperion Books; 1994.
10. McGee M. Meditation and psychiatry. Psychiatry (Edgmont). 2008;5:28-4