Mindfulness-Based Stress Reduction in Medicine

Mindfulness-Based Stress Reduction has been consistently documented as highly effective in teaching participants to become more responsible in the management of their own health, vitality and healing. Two decades of published research (see "References" below) indicates that the majority of people who complete the MBSR Program report lasting decreases in physical and psychological symptoms.  The studies report:

  • Dramatic reductions in pain levels and an enhanced ability to cope with pain that may not go away
  • Dramatic decreases of anxiety, depression, hostility and the tendency to somatize
  • More effective skills in managing stress
  • An increased ability to relax
  • Greater energy and enthusiasm for life
  • Improved self-esteem
  • An ability to cope more effectively with both short and long-term stressful situations

The research supporting these results is extensive and ongoing at numerous universities, medical schools and private sector research groups.  In the interest of brevity, research on Chronic Pain, Anxiety and Depression conducted at the University of Massachusetts Medical Center (UMASS) will be highlighted in addition to the Brain and Immune Functioning Studies recently published and currently being investigated.

In the pain studies, people with chronic pain such as headaches, back pain, neck pain and fibromyalgia who participated in the Mindfulness-Based Stress Reduction Clinic reported a dramatic reduction in the average level of pain during the eight-week training period and for at least four years following the treatment. 


An Outpatient Program in Behavioral Medicine for Chronic Pain Patients Based on the Practice of Mindfulness Meditation

  • Kabat-Zinn, J.
  • General Hospital Psychiatry
  • 1982
Results

Pain:
- 1/2 of patients   >>   50% decrease
- 2/3 of patients   >>   33% decrease
- significant increase in life activities
Medical symptoms (MSCL):
- 1/2 of patients   >>  33% decrease
- 1/3 of patients   >>  50% decrease
Psychological symptoms (GSI):
- 1/2 of patients   >>  33% decrease
- 1/3 of patients   >>  50% decrease              
Mood symptoms (TMD):
- 2/3 of patients   >>  50% decrease
- 3/4 of patients   >>  33% decrease

In another pain study, two groups of pain patients were compared. All 42 people in this study were being treated in the hospital’s pain clinic using standard medical protocols as well as supportive therapies such as physical therapy. But one group of 21 patients also participated in the MBSR program in addition to their pain clinic treatments, while the other group had not yet been referred to the stress clinic. Both groups were followed over a ten week period, the MBSR participants between the time they started and the time they finished the stress clinic; the other group between the time they started their pain clinic treatments and ten weeks later.


The Clinical Use of Mindfulness Meditation for the Self-Regulation of Chronic Pain

  • Kabat-Zinn, J.
  • Journal of Behavioral Medicine
  • 1985

Results

Pain:
- 3/4 of patients    >>   33% decrease in pain
- 1/2 of patients    >>   50% decrease in pain
- 44% of patients  >>   decreased analgesic use
- 28% of patients  >>   discontinued analgesics
Mood:
- 1/2 of patients    >>   33% decrease
- 1/3 of patients    >>   50% decrease
Compliance:
-  70% still meditating at follow-up
Pain Clinic comparison group:
-  no significant improvement

It was known from previous studies that they could expect MBSR participants to show large reductions in pain and psychological distress on our rating scales. The question was, "How would the MBSR participants compare with other patients in the pain clinic who were not practicing mindfulness but who were receiving powerful medical treatments for pain?"  The result was that the patients who did not have MBSR showed little change over the ten weeks that they were being treated in the pain clinic, while the MBSR participants showed the expected major improvements.


A brief review of studies investigating the value of MBSR in the treatment of anxiety, depression, fibromyalgia and quality of life:


Effectiveness of a Meditation-Based Stress Reduction Program in the Treatment of Anxiety Disorders

  • Kabat-Zinn, J.
  • American Journal of Psychiatry
  • 1992

Results:
 - 20/22 individual improvement
-
25-65 % decrease in mean Hamilton and Beck depression and anxiety scales
-
decreased frequency of panic attacks
-
decreased medical symptoms (MSCL)
- gains maintained at 3 month follow-up
- 90% still using techniques at 3 months


Prevention of Relapse/Recurrence in Major Depression by Mindfulness-Based Cognitive Therapy (MBCT)

  • Teasdale, et al
  • Journal of Consulting and Clinical Psychology
  • 2000

    Results:
    - 66 % of those who learned mindfulness remained stable
      (no relapse) over 1 year, compared with 34% in a control group


A Pilot Study of Cognitive Behavioral Therapy in Fibromyalgia

  • Singh, et al
  • Alternative Therapies
  • 1999
Results:
- decreased pain
- decreased anxiety
- decreased depression
- decreased fibromyalgia impact
- improved global assessment


Mindfulness-Based Stress Reduction and Health Related Quality of Life in a Heterogeneous Patient Population

  • Diane Reibel, Ph.D , ET AL
  • Jefferson-Myrna Brind Center of Integrative Medicine Thomas Jefferson University
  • 2000

    Results:
    -  Statistically significant changes were found on all 8 indices of the
       SF-36 Health Survey
    -  Bodily Pain scores improved by approximately 25%
    -  Role Limitations due to Physical Health by 50%
    -  Vitality improved by 40%
    -  Significant improvements on all SCL-90 subscales were also noted
        with moderate to large effect sizes
    -  Global Severity Index was reduced by 33%
    -  Anxiety, Depression and Somatization group scores dropped by 40%
    -  Improvements represent clinically or socially relevant changes


Finally, one study that employed physiologic markers to measure the influence of MBSR suggests that there may be multiple biological consequences of mindfulness training relevant to emotional and physical health.  This research has spawned a great deal of additional research currently being conducted employing physiologic markers:

Affect, Health and Meditation:
Perspectives from Affective Alterations in Brain and Immune Function Produced by
Mindfulness Meditation

  • Richard Davidson, Ph.D., Jon Kabat-Zinn, et al
  • University of Wisconsin-Madison
  • 2003

    Results:
    -  In addition to anxiety reduction, meditator’s also showed significant
       improvement in immune functioning



References

Mindfulness-Based Stress Reduction (MBSR)

Carlson, L. E., Speca, M., Patel, K. D., & Goodey, E. (2004, in press). Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology, 29(4), 448-474.

Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., Urbanowski, F., Harrington, A., Bonus, K., & Sheridan, J. F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564-570.

Frankel, D. H. (1998). Meditation and light order of the day for psoriasis. The Lancet, 352(9133), 1040

Hebert, J. R., Ebbeling, C. B., Olendzki, B. C., Hurley, T. G., Yunsheng, M., Saal, N., Ockene, J. K., & Clemow, L. (2001). Change in women's diet and body mass following intensive intervention for early-stage breast cancer. Journal of the American Dietetic Association, 101(4), 421-428, 431.

Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Illness. New York: Dell Publishing.

Kabat-Zinn, J., Lipworth, L., Sellers, W., Brew, M., & Burney, R. (date unavailable). Reproducibility and four year follow-up of a training program in mindfulness meditation for the self-regulation of chronic pain. Poster session presented at (meeting information unavailable).

Kabat-Zinn, J., & Burney, R. (date unavailable). The clinical use of awareness meditation in the self-regulation of chronic pain. Poster session presented at (meeting information unavailable).

Kabat-Zinn, J. (2002). Commentary on Majumdar et al: Mindfulness meditation for health. The Journal of Alternative and Complementary Medicine, 8(6), 731-735.

Majumdar, M., Grossman, P., Dietz-Waschkowski, B., Kersig, S., & Walach, H. (2002). Does mindfulness meditation contribute to health? Outcome evaluation of a German sample. The Journal of Alternative and Complementary Medicine, 8(6), 719-730.

Miller, J. J., Fletcher, K., & Kabat-Zin, J. (1995). Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry, 17, 192-200.

Reibel, D. K., Greeson, J. M., Brainard, G. C., & Rosenzweig, S. (2001). Mindfulness-Based Stress Reduction and health-related quality of life in a heterogeneous patient population. General Hospital Psychiatry, 23, 183-192.

Robinson, F. P., Mathews, H. L., & Witek-Janusek, L. (2003). Psycho-endocrine-immune response to Mindfulness-Based Stress Reduction in individuals infected with the human immunodeficiency virus: A quasi-experimental study. The Journal of Alternative and Complementary Medicine, 9(5), 683-694.

Shannahoff-Khalsa D. (2003). The complications of meditation trials and research: Issues raised by Robinson, Mathews, and Witek-Janusek paper – “Psycho-endocrine-immune response to Mindfulness-Based Stress Reduction in individuals infected with the Human Immunodeficiency Virus: A quasi-experimental study”. The Journal of Alternative and Complementary Medicine, 9(5), 603-605.

Shapiro, S. L., Schwartz, G. E., & Bonner, G. (1998). Effects of mindfulness-based stress reduction on medical and premedical students. Journal of Behavioral Medicine, 21(6), 581-599.

Shapiro, S. L., Bootzin, R. R., Figueredo, A. J., Lopez, A. M., & Schwartz, G. E. (2003). The efficacy of Mindfulness-Based Stress Reduction in the treatment of sleep disturbance in women with breast cancer: An exploratory study. Journal of Psychosomatic Research, 54, 85-91.

Shapiro, S. L., Figueredo, A. J., Caspi, O., Schwartz, G. E., Bootzin, R. R., Lopez, A. M., & Lake, D. (2002). Going quasi: The premature disclosure effect in a randomized clinical trial. Journal of Behavioral Medicine, 25(6), 605-621.

Speca M, Carlson LE, Goodey E, Angen M. A Randomized, Wait-List Controlled Clinical Trial: The Effect of a Mindfulness Meditation-Based Stress Reduction Program on Mood and Symptoms of Stress in Cancer Outpatients. Psychosomatic Med. 2000;62:613-622.

Weissbecker, I. Salmon, P., Studts, J. L., Floyd, A. R., Dedert, E. A., & Sephton, S. E. (2002). Mindfulness-Based Stress Reduction and sense of coherence among women with fibromyalgia. Journal of Clinical Psychology in Medical Settings, 9(4), 297-307.

Mindfulness-Based Cognitive Therapy (MBCT)

Mason, O., & Hargreaves, I. (2001). A qualitative study of Mindfulness-Based Cognitive Therapy for depression. British Journal of Medical Psychology, 74, 197-212.

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-Based Cognitive Therapy for depression: A new approach to preventing relapse. New York: The Guilford Press.

Teasdale, J. D., Segal, Z. V., Williams, J. M. G.,, Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in Major Depression by Mindfulness-Based Cognitive Therapy. Journal of Consulting and Clinical Psychology, 68(4), 615-623.

Teasdale, J. D., Segal, Z., & Williams, J. M. G. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behavioural Research and Therapy, 33(1), 25-39.

Watkins, E., & Baracaia, S. (2002). Rumination and social problem-solving in depression. Behaviour Research and Therapy, 40, 1179-1189.

Watkins, E., & Teasdale, J. D. (2004, in press). Adaptive and maladaptive self-focus in depression. Journal of Affective Disorders, 8 pp.

Williams, J. M. G., Teasdale, J. D., Segal, Z. V., & Soulsby, J. (2000). Mindfulness-Based Cognitive Therapy reduces overgeneral autobiographical memory in formerly depressed patients. Journal of Abnormal Psychology, 109(1), 150-155.

Therapies and Interventions Incorporating Mindfulness

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: The Guilford Press.

Singh, N. N., Wahler, R. G., Adkins, A. D., & Meyers, R. E. (2003). Soles of the feet: A mindfulness-based self-control intervention for aggression by an individual with mild mental retardation and mental illness. Research in Developmental Disabilities, 24, 158-169.

Zettle, R. D. (2003). Acceptance and Commitment Therapy (ACT) vs. systematic desensitization in treatment of mathematics anxiety. The Psychological Record, 53, 197-215.

Generalized Anxiety Disorder

Craske, M. G., & Hazlett-Stevens, H. (2002). Facilitating symptom reduction and behavior change in GAD: The issue of control. Clinical Psychology: Science and Practice, 9(1), 69-75.

Orsillo, S. M., Roemer, L., & Barlow, D. H. (2003). Integrating acceptance and mindfulness into existing cognitive-behavioral treatment for GAD: A case study. Cognitive and Behavioral Practice, 10, 222-230.

Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for Generalized Anxiety Disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clinical Psychology: Science and Practice, 9(1), 54-68.

Wells, A. (2002). GAD, metacognition, and mindfulness: An information processing analysis. Clinical Psychology: Science and Practice, 9(1), 95-100.

Borderline Personality Disorder, Chronic Distress (DBT)

Holmes, E. P., & Dykstra, T. (2003). A contextual behavioral approach to Dialectical Behavior Therapy. Manuscript submitted for publication.

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: The Guilford Press.

Linehan, M. M. (1993). Skills training manual for treating borderline personality disorder. New York: The Guilford Press.

Substance Abuse (Relapse Prevention)

Breslin, F. C., Zack, M., & McMain, S. (2002). An information-processing analysis of mindfulness: Implications for relapse prevention in the treatment of substance abuse. Clinical Psychology: Science and Practice, 9(3), 275-299.

Marlatt, G. A. (unavailable). The Effects of Meditation on Alcohol Use and Recidivism (NIAAA grant: 1 R21 AA13054). Unpublished manuscript.

Mindfulness Movement

Gannon, L., & Sternbach, R. A. (1971). Alpha enhancement as a treatment for pain: A case study. Journal of Behaviour Therapy & Experimental Psychiatry, 2, 209-213.

Girodo, M. (1974). Yoga meditation and flooding in the treatment of anxiety neurosis. Journal of Behavioral Therapy & Experimental Psychiatry, 5, 157-160.

Jin, P. (1992). Efficacy of Tai Chi, brisk walking, meditation, and reading in reducing mental and emotional stress. Journal of Psychosomatic Research, 36(4), 361-370.

Mills, N., & Allen, J. (2000). Mindfulness movement as a coping strategy in multiple sclerosis: A pilot study. General Hospital Psychiatry, 22, 425-431.

Mindfulness Meditation and Mindfulness Training (general)

Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125-143.

Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822-848.

Deatherage, O. G. (1996). Mindfulness meditation as psychotherapy. In Boorstein, S. (Ed.), Transpersonal psychotherapy (2nd ed., pp. 209-226). Albany: State University of New York Press.

Delmonte, M. M. (1984). Psychometric scores and meditation practice: A literature review. Personality & Individual Differences, 5(5), 559-563.

Dimidjian, S., & Linehan, M. (2003). Defining an agenda for future research on the clinical application of mindfulness practice. Clinical Psychology: Science and Practice, 10(2), 166-171.

Epstein, M. (2001). Going on being: Buddhism and the way of change. New York: Broadway Books.

Gorton, G. E. (1985). Can East and West Meet in Psychoanalysis? [Letter to the editor]. American Journal of Psychiatry, 142, p. 1227.

Hanh, T. N. (1990). Transformation & healing: Sutra on the four establishments of mindfulness. Berkely, California: Parallax Press.

Hayes, S. C. (2002). Acceptance, mindfulness, and science. Clinical Psychology: Science and Practice, 9(1), 101-106.

Hayes, S. C. (2001). Acceptance and change, Psychology of. In International Encyclopedia of the Social & Behavioral Sciences (pp. 27-30). Publisher information unavailable.

Hayes, S. C., & Wilson, K. G. (2003). Mindfulness: Method and process. Clinical Psychology: Science and Practice, 10(2), 161-165.

Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156.

Kabat-Zinn, J. (1994). Wherever you go, there you are. New York: Hyperion Press.

Kokoszka, A. (1986). Limitations of a psychobiological concept of the integration of psychotherapy and meditation [Letter to the editor]. American Journal of Psychiatry, 143, p. 1315.

Kutz, I., Borysenko, J. Z., & Benson, H. (1985). Meditation and psychotherapy: A rationale for the integration of dynamic psychotherapy, the relaxation response, and mindfulness meditation. American Journal of Psychiatry, 142, 1-8.

Roemer, L., & Orsillo, S. M. (2003). Mindfulness: A promising intervention strategy in need of further study. Clinical Psychology: Science and Practice, 10(2), 172-178.

Sugiura, Y. (2003, in press). Detached mindfulness and worry: A meta-cognitive analysis. Personality and Individual Differences.

Teasdale, J. D., Segal, Z. V., & Williams, J. M. G. (Summer 2003). Mindfulness training and problem formulation. Clinical Psychology: Science and Practice, 10(2), 157-160.

West, M. A. (1980). The psychosomatics of meditation. Journal of Psychosomatic Research, 24, 265-273.

Concentrative and Relaxation Meditations

Blanchard, E. B., Schwarz, S. P., Suls, J. M., Gerardi, M. A., Scharff, L., Greene, B., Taylor, A. E., Berreman, C., & Malamood, H. S. (1992). Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome. Behavioural Research & Therapy ??, 30(2), 175-189.

Carruthers, M. (1979). Autogenic training. Journal of Psychosomatic Research, 23, 437-440.

Delmonte, M. M. (1985). Meditation and anxiety reduction: A literature review. Clinical Psychology Review, 5, 91-102.

Derezotes, d. (2000). Evaluation of yoga and meditation trainings with adolescent sex offenders. Child and Adolescent Social Work Journal, 17(2), 97-113.

Gaughan, A. M., Gracely, R. H., & Friedman, R. (date unavailable). Pain perception following regular practice of meditation, progressive muscle relaxation and sitting. Paper presented at (meeting information unavailable).

Gordon, J. S., Staples, J. K., Blyta, A., & Bytyqi, M. (2004). Treatment of posttraumatic stress disorder in postwar Kosovo high school students using mind-body skills groups: A pilot study. Journal of Traumatic Stress, 17(2), 143-147.

Hidderley, M., & Holt, M. (2004). A pilot randomized trial assessing the effects of autogenic training in early stage cancer patients in relation to psychological status and immune system responses. European Journal of Oncology Nursing, 8, 61-65.

Keefer, L., & Blanchard, E. B. (2002). A one year follow-up of relaxation response meditation as a treatment for irritable bowel syndrome. Behaviour Research and Therapy, 40, 541-546.

Keefer, L., & Blanchard, E. G. (2001). The effects of relaxation response meditation on the symptoms of irritable bowel syndrome: Results of a controlled treatment study. Behaviour Research and Therapy, 39, 801-811.

Klajner, F., Hartman, L. M., & Sobell, M. B. (1984). Treatment of substance abuse by relaxation training: A review of its rationale, efficacy and mechanisms. Addictive Behaviors, 9, 41-55.

Larkin, M. (2000). Meditation may reduce heart attack and stroke risk. The Lancet, 355 (9206), 812.

Lehrer, P. M., Schoicket, S., Carrington, P., & Woolfolk, R. L. (1980). Psycho-physiological and cognitive responses to stressful stimuli in subjects practicing progressive relaxation and clinically standardized meditation. Behavioural Research and Therapy, 18, 293-303.

Lehrer, P. M., Woolfolk, R. L., Rooney, A. J., McCann, B., & Carrington, P. (1983). Progressive relaxation and meditation: A study of psycho-physiological and therapeutic differences between two techniques. Behavioural Research and Therapy, 21(6), 651-662.

Magarey, C. (1983). Holistic cancer therapy. Journal of Psychosomatic Research, 27(3), 181-184.

Monk-Turner, E. (2003). The benefits of meditation: Experimental findings. The Social Science Journal, 40, 465-470.

Murphy, T. J., Pagano, R. R., & Marlatt, G. A. (1986). Lifestyle modification with heavy alcohol drinkers: Effects of aerobic exercise and meditation. Addictive Behaviors, 11, 175-186.

Richter, R., & Dahme, B. (1982). Bronchial asthma in adults: There is little evidence for the effectiveness of behavioral therapy and relaxation. Journal of Psychosomatic Research, 26(5?), 533-539.

Shapiro Jr., D. H., & Walsh, R. N. (Eds.). (1984). Meditation: Classical and contemporary perspectives. New York: Aldine.

Smith, M. S., & Womack, W. M. (1987). Stress management techniques in childhood and adolescence; Relaxation training, meditation, hypnosis, and biofeedback: Appropriate clinical applications. Clinical Pediatrics, 26, 581-585.

Stamatelos, T., & Mott, D. W. (1986). Creative potential among persons labeled developmentally delayed, Part II: Meditation as a technique to release creativity. The Arts in Psychotherapy, 13, 229-234.

Targ, E. F., & Levine, E. G. (2002). The efficacy of a mind-body-spirit group for women with breast cancer: A randomized controlled trial. General Hospital Psychiatry, 24, 238-248.

West, M. A. (Ed.). (1990). The Psychology of Meditation. Oxford: Oxford Science Publications.

West, M. A. (1980). Meditation, personality and arousal. Personality and Individual Differences, 1, 135-142.

Woolfolk, R. L., Lehrer, P. M., McCann, B. S., & Rooney, A. J. (1982). Effects of progressive relaxation and meditation on cognitive and somatic manifestations of daily stress. Behavioural Research and Therapy, 20, 461-467.

Yen, L., Patrick, W. K., & Chie, W. (1996). Comparison of relaxation techniques, routine blood pressure measurements, and self-learning packages in hypertension control. Preventive Medicine, 25, 339-345.

Biological Mechanisms and Effects of Meditation

Aftanas, L. I., & Golocheikin, S. A. (2003). Changes in cortical activity in altered states of consciousness: The study of meditation by high-resolution EEG. Human Physiology, 29(2), 143-151.

Aftanas, L. I., & Golocheikine, S. A. (2002). Non-linear dynamic complexity of the human EEG during meditation. Neuroscience Letters, 330, 143-146.

Aftanas, L. I., & Golocheikine, S. A. (2001). Human anterior and frontal midline theta and lower alpha reflect emotionally positive state and internalized attention: High resolution EEG investigation of meditation . Neuroscience Letters, 310, 57-60.

Austin, J. H. (1999). Zen and the Brain. Cambridge, MA: The MIT Press.

Baerentsen, K. B., Hartvig, N. V., Stodkilde-Jorgensen, H., & Mammen, J. (2001). Onset of meditation explored with fMRI. NeuroImage, 13(6), S297.

Banquet, J. P. (1973). Spectral analysis of the EEG in meditation. Electroencephalography and Clinical Neurophysiology, 35, 143-151.

Clark, A. (1999). Where brain, body, and world collide. Journal of Cognitive Systems Research, 1, 5-17.

Credido, S. G. (1982). Comparative effectiveness of patterned biofeedback vs. meditation training on EMG and skin temperature changes. Behavioural Research & Therapy ??, 20, 233-241.

Delmonte, M. M. (1985). Biochemical indices associated with meditation practice: A literature review. Neuroscience & Biobehavioral Reviews, 9, 557-561.

Dietrich, A. (2003). Functional neuroanatomy of altered states of consciousness: The transient hypofrontality hypothesis. Consciousness and Cognition, 12, 231-256.

Dimsdale, J. E., & Mills, P. J. (2002). An unanticipated effect of meditation on cardiovascular pharmacology and physiology. The American Journal of Cardiology, 90, 908-909.

Dunn, B. R., Hartigan, J. A., & Mikulas, W. L. (1999). Concentration and mindfulness meditations: Unique forms of consciousness? Applied Psychophysiology and Biofeedback, 24(3), 147-165.

Hardt, J. V. (1994). Proficiency in Zen meditation: Correspondence with multi-channel EEG coherence spectrum [Abstract]. International Journal of Psychophysiology, 18, 112.

Harte, J. L., Eifert, G. H., & Smith, R. (1995). The effects of running and meditation on beta-endorphin, corticotropin-releasing hormone and corticotropin-releasing hormone and cortisol in plasma, and on mood. Biological Psychology, 40, 251-265.

Kawano, K., Yamamoto, M., & Kokubo, H. (2002). A study of alpha waves on the frontal area. International Congress Series, 1232, 107-112.

Kjaer, T. W., Bertelsen, C., Piccini, P., Brooks, D., Alving, J., & Lou, H. C. (2002). Increased dopamine tone during meditation-induced change of consciousness. Cognitive Brain Research, 13, 255-259.

Kubota, Y., Sato, W., Toichi, M., Murai, T., Okada, T., Hayashi, A., & Sengoku, A. (2001). Frontal midline theta rhythm is correlated with cardiac autonomic activities during the performance of an attention demanding meditation procedure. Cognitive Brain Research, 11, 281-287.

Lehmann, D., Faber, P. L., Achermann, P., Jeanmonod, D., Gianotti, L. R. R., & Pizzagalli, D. (2001). Brain sources of EEG gamma frequency during volitionally meditation-induced, altered states of consciousness, and experience of the self. Psychiatry Research: Neuroimaging, 108, 111-121.

Murata, T., Koshino, Y., Omori, M., Murata, I., Nishio, M., Sakamoto, K., Horie, T., & Isaki, K. (unavailable). Quantitative EEG study on Zen meditation (Zazen). Paper presented at (meeting information unavailable).

Newberg, A. B., & Iversen, J. (2003). The neural basis of the complex mental task of meditation: Neurotransmitter and neurochemical considerations. Medical Hypotheses, 61(2), 282-291.

Newberg, A., Alavi, a., Baime, M., Pourdehnad, M., Santanna, J., & d'Aquili, E. (2001). The measurement of regional cerebral blood flow during the complex cognitive task of meditation: A preliminary SPECT study. Psychiatry Research: Neuroimaging, 106, 113-122.

Newberg, A., Baime, M., d'Aquili, E., Duncan, D., & Alavi, A. (1995). HMPAO-SPECT imaging during intense Tibetan Buddhist meditation [Abstract]. Biological Psychiatry, 37, 619.

Peng, C. K., Mietus, J. E., Liu, Y., Khalsa, G., Douglas, P. S., Benson, H., & Goldberger, A. L. (1999). Exaggerated heart rate oscillations during two meditation techniques. International Journal of Cardiology, 70, 101-107.

Sudsuang, R., Chentanez, V., & Veluvan, K. (1991). Effect of Buddhist meditation on serum cortisol and total protein levels, blood pressure, pulse rate, lung volume and reaction time. Physiology & Behavior, 50, 543-548.

Taylor, J. G. (2002). Paying attention to consciousness. Trends in Cognitive Sciences, 6(5), 206-210.

Philosophical Issues

Goleman, D. (1996). Meditation and consciousness: An Asian approach to mental health. In Boorstein, S. (Ed.), Transpersonal psychotherapy (2nd ed., pp. 227-240). Albany: State University of New York Press.

Taylor, E. (2003). A perfect correlation between mind and brain: William James's Varieties and the contemporary field of mind/body medicine. The Journal of Speculative Philosophy, 17(1), 40-52.

Profiles of Complementary and Alternative Medicine (CAM) Users

Afari, N., Eisenberg, D. M., Herrel, R., Goldberg, J., Kleyman, E., Ashton, S., & Buchwald, D. (1999). Use of alternative treatments by chronic fatigue syndrome discordant twins. Integrative Medicine, 2(2/3), 97-103.

Balneaves, L. G., Kristjanson, L. J., & Tataryn, D. (1999). Beyond convention: Describing complementary therapy use by women living with breast cancer. Patient Education and Counseling, 38, 143-153.

Jones, H. A., Metz, J. M., Devine, P., Hahn, S. M., & Whittington, R. (2002). Rates of unconventional medical therapy use in patients with prostate cancer: Standard. Adult Urology, 59(2), 272-276.

King, M. O., & Pettigrew, A. C. . (2004). Complementary & alternative therapy use by older adults in three empirically diverse populations: A pilot study. Geriatric Nursing, 25(1), 30-37.

Mamtani, R., & Cimino, A. (2002). A primer of complementary and alternative medicine and its relevance in the treatment of mental health problems. Psychiatric Quarterly, 73(4), 367-381.

Rhee, D. J., Katz, L. J., Spaeth, G. L., & Myers, J. S. (2001). Complementary and alternative medicine for glaucoma. Survey of Ophthalmology, 46(1), 43-55.

Rhee, D. J., Spaeth, G. L., Myers, J. S., Steinmann, W. C., Augsburger, J. J., Shatz, L. J., Terebuh, A. K., Ritner, J. A., & Katz, L. J. (2002). Prevalence of the use of complementary and alternative medicine for glaucoma. Ophthalmology, 109, 438-443.

Risberg, T., Kolstad, A., Bremnes, Y., Holte, H., Wist, E. A., Mella, O., Klepp, O., Wilsgaard, T. (2004). Knowledge of and attitudes toward complementary and alternative therapies: a national multi-centre study of oncology professionals in Norway. European Journal of Cancer, 40, 529-535.

Langer’s Research and Related Articles

Burgoon, J. K., Berger, C. R., & Waldron, V. R. (2000). Mindfulness and interpersonal communication. Journal of Social Issues, 56(1), 105-127.

Demick, J. (2000). Toward a mindful psychological science: Theory and application. Journal of Social Issues, 56(1), 141-159.

Horton-Deutsch, S. L., & Horton, J. M. (2003). Mindfulness: Overcoming intractable conflict. Archives of Psychiatric Nursing, XVII(4), 186-193.

Langer, E. J. (1989). Mindfulness. Cambridge, Massachusetts: Perseus Books.

Langer, E. J. (2000). Mindful learning. Current Directions in Psychological Science, 9(6), 220-223.

Langer, E. J., & Moldoveanu, M. (2000). Mindfulness research and the future. Journal of Social Issues, 56(1), 129-139.

Langer, E. J., & Moldoveanu. (2000). The construct of mindfulness. Journal of Social Issues, 56(1), 1-9.

Napoli, M. (2004). Mindfulness training for teachers: A pilot program. Complementary Health Practice Review, 9(1), 31-42.

Reiss, S. (2000). A mindful approach to mental retardation. Journal of Social Issues, 56(1), 65-80.

Ritchhart, R., & Perkins, D. N. (2000). Life in the mindful classroom: Nurturing the disposition of mindfulness. Journal of Social Issues, 56(1), 27-47.

Sternberg, R. J. (2000). Images of mindfulness. Journal of Social Issues, 56(1), 11-26.



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