Griffiths, MD

Shonin, E

Van Gordon, W

English

Nottingham Trent Institutional Repository (IRep)

ReSeArCH AnD UTIlISATIon ofBuddhist contemplative practices inclinical settings has increased signifi-cantly in recent decades. The assimilation ofBuddhist techniques by allied health caredisciplines is likely to have been influencedby factors such as: (i) increased rates oftransnational migration and the need todevelop culturally syntonic treatments forAsian Americans and Asian europeans; (ii) agrowth in research investigating the effectsof Buddhist meditation on brain neurophys-iology; and (iii) the growing popularity ofBuddhism in the West including thefounding in Western countries of Buddhistpractice centres representative of themajority of the world’s Buddhist traditions(Shonin, van Gordon & Griffiths, 2014a).Although scientific interest has predomi-nantly focussed on mindfulness meditation(see Singh et al., 2008), there is growinginterest into the clinical applications ofBuddhist insight principles such as emptinessand impermanence. This article provides abrief explication of Buddhist insight prac-tices used in clinical settings and discussescurrent directions in terms of theirpsychotherapeutic applications.Emptiness: Deconstructing the SelfBuddhist psychological and philosophicaldoctrines regarding the nature of self andreality reflect what might be seen as a para-digm shift when compared with widelysubscribed to Western psychological beliefsregarding the ego and the self. For example,Western psychological approaches totreating mental illness or improving psycho-logical well-being are invariably based on theexplicit or implicit acceptance that there isan inherently existing ‘self’ or ‘I’ entity (see Sedikides & Spencer, 2007). In otherwords, irrespective of whether a cognitive-behavioural, psychodynamic, or humanisticpsychotherapy model is employed, theseapproaches are ultimately concerned withchanging how the ‘I’ relates to its thoughts,feelings, and beliefs, and/or to its physical,social, and spiritual environment. This reflects a fundamental departurefrom the Buddhist ontological perspectivewhere it is both asserted and believed thathuman beings (and indeed all phenomena)are devoid or empty of an intrinsically existingself (Shonin et al., 2014a). This may seem tobe a somewhat abstract concept but it is – aswe shall argue – common sense, and the prin-ciple of emptiness is universal in its application.For example, Buddhism asserts that thehuman body comprises the five elements ofwater, wind (i.e. air), earth (i.e. food), sun(i.e. heat/energy), and space (i.e. in thebodily cavities and between molecules, etc.)(Shonin et al., 2014a). This means thatalthough the body exists in the relative sense,it does not exist in the absolute sense becausethe body cannot be isolated from all of itscontributing causes. Just as a wave does notexist in separation from the ocean, the bodydoes not exist in separation from all otherphenomena. According to the Buddhistteachings, when looking at the body, weshould also be able to see the trees, plants,animals, clouds, oceans, planets, and so forth(Shonin et al., 2014a). Thus, the body, andindeed the entire array of animate and inani-mate phenomena that we know of, cannot befound to exist intrinsically or independently.Issue 92 September 2014 35© The British Psychological SocietyDiscussion paper:Changing paradigms: Buddhist insight inWestern psychological treatmentsEdo Shonin, William Van Gordon & Mark D. GriffithsAn alternative method utilised inBuddhism of refuting the existence of aninherently existing self is based on deductivelogic and was widely employed by the IndianBuddhist scholar nagarjuna in the secondcentury (AD). A simplified demonstration ofthis approach is provided in Box 1 that showsa hypothetical discussion between aprofessor and their student regarding theultimate nature of existence. As the conver-sation in Box 1 demonstrates, any givenobject cannot be said to exist: (i) in isolationfrom its parts; (ii) as each part individually;or (iii) as the sum of its parts (because as acollective, the component parts do not ceaseto be component parts but are nonethelessassigned a label that by convention denotesan entirely new phenomena). Thus, consis-tent with nagarjuna’s philosophical anddidactic approach, all phenomena(including the self) are imputed constructsthat exist only as mentally-designated labels.36 PsyPAG QuarterlyEdo Shonin, William Van Gordon & Mark D. GriffithsBox 1. Hypothetical discussion between a professor and their student todemonstrate the emptiness principleProfessor: Does my fountain pen exist?Student: Well, the pen certainly writes when I put it to paper. Yes, it exists.Professor: So your criteria for existence is based on the function that an object performs?Student: Yes, of course.Professor: I see. Go ahead and take away all of the components of the pen so that you’re leftwith nothing other than the nib. Does the nib still write?Student: Yes, there is still a small amount of ink left in the nib. It still works.Professor: But the nib isn’t the pen?Student: Ah, good point. The nib is just a single pen component and cannot be all of theindividual parts that comprise the pen. One thing cannot be another thing.Professor: So does the pen exist?Student: Well, having just taken the pen apart and seen that all of its component parts arepresent, I would still argue that it exists.Professor: So you’re saying that the pen exists as the sum of its component parts?Student: Yes, that is correct.Professor: But you’ve already said that a component part can’t be two things at once. Yet nowyou seem to be saying that when the nib, cartridge, lid, and other pen components are puttogether, they stop being those components and become a new single entity?Student: No, that is illogical. The component parts still exist in the pen but the word ‘pen’ is used to designate the collection of individual components that collectively form a pen.Professor: Right, so you’re saying that the pen is just label?Student: I’m not sure – I guess so. But if the pen is just a label then it doesn’t inherently exist. Oh yes. I see now.Professor: Excellent.Adapted from Shonin & Van Gordon (2014a).The Buddhist teachings go on to assertthat suffering, including the entire spectrumof distressing emotions and psychopatho-logic states, results from adhering to a falseview about the ultimate manner in which theself (and reality more generally) exists. As ameans of operationalising this notion withinWestern psychological and clinical domains,we recently introduced the concept of ‘onto-logical addiction’. ontological addiction caneffectively be considered a new category ofaddiction (i.e. in addition to chemical addic-tion and behavioural addiction) and isdefined as ‘the unwillingness to relinquish anerroneous and deep-rooted belief in an inherentlyexisting ‘self’ or ‘I’ as well as the ‘impaired func-tionality’ that arises from such a belief’ (Shonin,van Gordon & Griffiths, 2013, p.64). Due toa firmly-embedded (yet scientifically andlogically implausible) belief that the self is aninherent and independently existing entity,Buddhism asserts that afflictive mental statesarise as a result of the imputed ‘self’ inces-santly craving after objects it considers to beattractive or harbouring aversion towardsobjects it considers to be unattractive(Shonin et al., 2014a). In Buddhist terminology, this process isknown as ‘attachment’ and it is deemed tobe an undesirable quality that leads to thereification of the ego-self. We have previouslydefined attachment as ‘the over-allocation ofcognitive and emotional resources towards aparticular object, construct, or idea to the extentthat the object is assigned an attractive qualitythat is unrealistic and that exceeds its intrinsicworth’ (Shonin et al., 2014a, p.4). Thus,attachment takes on a different meaning inBuddhism vis-à-vis its construction inWestern psychology where attachment (i.e.in the context of relationships) is generallyconsidered to exert a protective influenceover psychopathology. Based on a Buddhistconstruction of attachment, lower levels ofattachment have been shown to predictgreater levels of mindfulness, acceptance,non-reactivity, self-compassion, subjectivewell-being, and eudemonic well-being(Sahdra, Shaver & Brown, 2010). Further-more, the Buddhist attachment construct ispositively correlated with avoidance (i.e. ofintimacy), dissociation, fatalistic outlook,and alexithymia (i.e. an impaired capacity torecognise or describe feelings) (Sahdra etal., 2010).Having understood from a Buddhistperspective that attachment and harbouringan erroneous belief in an inherently existingself contraindicates adaptive psycho-spiritualfunctioning, Buddhism teaches that the nextstep towards recovery from ontologicaladdiction is to embrace emptiness and begindeconstructing our mistaken belief regard-ing the existence of an ‘I’. Based on thisBuddhist approach, a number of novelpsychotherapeutic techniques have recentlybeen developed that integrate meditativepractices aimed at cultivating an under-standing of the emptiness construct. oneexample is a six-week programme known asBuddhist Group Therapy (BGT) that hasbeen shown to be effective for treatinganxiety and depression in diabetes patients(rungreangkulkij, Wongtakee & Thongyot,2011). A further example is an eight-weeksecular psychotherapeutic approach knownas Meditation Awareness Training (MAT)that utilises phases of concentrative medita-tion to order to calm and focus the mind,immediately followed by insight meditationtechniques such as guiding participants totry and find an inherently existing self. In anumber of separate studies, MAT has beenshown to be an effective treatment for individuals with anxiety and depression,workaholism, schizophrenia, pathologicalgambling, work-related stress, and fibro-myalgia (for example, see reviews by Shoninet al., 2013, 2014a, 2014b). From a mechanistic point of view, termssuch as ‘witness consciousness’ have beenused to refer to the process of therapeuticreconnection and transformation that takesplace as client and therapist begin to widentheir view of self and work in an ‘open andempty ground state’ (Sills & lown, 2008, p.80).Greater awareness of emptiness is alsobelieved to assist in gradually uprootingIssue 92 September 2014 37Changing paradigms: Buddhist insight in Western psychological treatmentsegoistic core beliefs and, therefore, comple-ment therapeutic techniques that work atthe surface level of behaviour and cognition(Chan, 2008). Furthermore, an under-standing of emptiness can enhance thera-peutic core conditions because ‘the more thetherapist understands non-self, the less likelihoodthat the therapy will be about the selfhood of thetherapist’ (Segall, 2003, p.173).Impermanence awareness: Preparing for change Closely related to the Buddhist insight prin-ciple of emptiness is impermanence, which isreferred to in Buddhism as the first mark ofexistence. According to the Buddhist teach-ings, impermanence refers to the fact that allphenomena are transient occurrences andare subject to decay and dissolution (Shoninet al., 2014a). The Dalai lama asserts thatthe universal law of impermanence applies asmuch to psychological phenomena such asthoughts, feelings, and perceptions, as itdoes to material phenomena both animate(e.g. the birth, life, and death of sentientbeings) and inanimate. Buddhism alsoteaches that human beings have a tendencyto ignore the fact that they only live for alimited period of time, and that rather thansimply experiencing the here and now ‘as itis’, people tend to corrupt their experienceof the present moment by superimposingtheir last moment onto the next one(Shonin & van Gordon, 2014b). Cultivating an awareness of impermanence(including the certainty of death and theuncertainty of the time of death) is believedto help improve life purpose and lifeperspective (Dalai lama, 1995). TheBuddhist insight principle of impermanence isalso believed to have utility for facilitatingrecovery from trauma and grief. TraditionalWestern models of grief are based on aphasic bereavement process and normallyinvolve stages of: (i) shock; (ii) distress anddenial; (iii) mourning; and (iv) recovery(e.g. Jacobs, 1993). However, a greateracquaintance with the impermanent natureof life may exert a form of resilience effect.For instance, it has been suggested thatincreased acceptance and internalisation ofimpermanence may help to soften the grievingprocess and facilitate earlier-onset of therecovery and restorative phases (Shonin etal., 2014a; Wada & Park, 2009). Similarly,Kumar (2005) postulates that impermanenceawareness can facilitate post-traumaticgrowth due to a ‘radical acceptance’ of thefleeting nature of human existence (p.8).Conclusionsrecent decades have witnessed an increasein the research and clinical utilisation ofapproaches that derive from Buddhistcontemplative practice. As previouslyoutlined, mindfulness reflects the mostempirically researched Buddhist technique(as well as one of the fastest growing areas ofpsychological research more generally) (vanGordon et al., 2014). As scientific knowledgerelating to Buddhist meditative modalitiessuch as mindfulness advances, interest intothe applications of techniques that tradition-ally underpin and/or complement mindful-ness practice is also growing (van Gordon etal., 2013). Accordingly, although furtherempirical evaluation is clearly needed,preliminary findings indicate that tech-niques aimed at cultivating an awareness ofthe Buddhist emptiness and impermanenceconstructs may have applications in psycho-pathology treatment settings. However, giventhe variance between Buddhist and Westernpsychological standpoints regarding the egoand the merits of reinforcing a belief in anabsolute self, future research is required inorder to assess the suitability of utilisingBuddhist insight techniques for particularservice-user groups.38 PsyPAG QuarterlyEdo Shonin, William Van Gordon & Mark D. GriffithsAcknowledgementThis article is a much expanded and adaptedversion of an article originally written forPsychology Review.CorrespondenceEdo Shoninresearch Psychologist, Division of Psychology, Chaucer Building, nottingham Trent University,Burton Street, nottingham, nG1 4BU.email: meditation@ntu.ac.ukIssue 92 September 2014 39Changing paradigms: Buddhist insight in Western psychological treatmentsChan, W.S. (2008). Psychological attachment, no-selfand Chan Buddhist mind therapy. ContemporaryBuddhism, 9, 253–264.Dalai lama (1995). The path to enlightenment.new york: Snow lion.Jacobs, S. (1993). Pathological grief: Maladaption to loss.Washington, DC: American Psychiatric Press.Kumar, S.M. (2005). Grieving mindfully: A compas-sionate and spiritual guide to coping with loss.oakland, CA: new Harbinger.rungreangkulkij, S., Wongtakee, W. & Thongyot, S.(2011). Buddhist Group Therapy for diabetespatients with depressive symptoms. Archives ofPsychiatric Nursing, 25, 195–205.Sahdra, B.K., Shaver, P.r. & Brown, K.W. (2010). A scale to measure non-attachment: A Buddhistcomplement to Western research on attachmentand adaptive functioning. Journal of PersonalityAssessment, 92, 116–127.Sedikides, C. & Spencer, S.J. (eds.) (2007). The Self.new york: Psychology Press.Segall, S.r. (2003). Psychotherapy practice asBuddhist practice. In S.r. Segall (ed.), Encoun-tering Buddhism: Western psychology and Buddhistteachings (pp.165–178). new york: State Univer-sity of new york Press.Shonin, e., van Gordon W. & Griffiths, M.D. (2013).Buddhist philosophy for the treatment ofproblem gambling. Journal of Behavioural Addic-tions, 2, 63–71.Shonin, e., van Gordon W. & Griffiths, M.D. (2014a).The emerging role of Buddhism in clinicalpsychology: Towards effective integration.Psychology of Religion and Spirituality.doi: 10.1037/a0035859.Shonin, e., van Gordon W. & Griffiths, M.D.(2014b). Mindfulness as a treatment for behavioral addiction. Journal of Addiction Researchand Therapy, 5, e122.doi: 10.4172/2155–6105.1000e122.Shonin, e. & van Gordon, W. (2014a). Dream orreality? Philosophy Now. In press.Shonin, e. & van Gordon, W. (2014b). Mindfulnessof death. Mindfulness.doi: 10.1007/s12671–014–0290–6.Sills, M. & lown, J. (2008). The field of subliminalmind and the nature of being. European Journal ofPsychotherapy and Counselling, 10, 71–80.Singh, n.n., lancioni, G.e., Wahler, r.G., Winton,A.S. & Singh, J. (2008). Mindfulness approachesin cognitive behavior therapy. Behavioral andCognitive Psychotherapy, 36, 659–666.van Gordon, W., Shonin, e., Sumich, A., Sundin, e.& Griffiths, M.D. (2013). Meditation AwarenessTraining (MAT) for psychological well-being in asub-clinical sample of university students: A controlled pilot study. Mindfulness.doi: 10.1007/s12671–012–0191–5.van Gordon, W., Shonin, e., Zangeneh, M. & Griffiths, M.D. (2014). Work-related mentalhealth and job performance: Can mindfulnesshelp? International Journal of Mental Health and Addiction.doi: 10.1007/s11469–014–9484–3. Wada, K. & Park, J. (2009). Integrating Buddhistpsychology into grief counseling. Death Studies,33, 657–683.References

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Changing paradigms: Buddhist insight in Western psychological treatments

Changing paradigms: Buddhist insight in Western psychological treatments

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