67

Us i n g Mi n d f u l n e s s Me di t a t i o n t o Pr o mo t e Hol i s t i c Heal t h i n
I ndi vi dual s Wi t h HIV/ AIDS
Sus an Logs don- Conr a ds e n, B e r r y Col l ege
There is clearly a need f o r effective stress management programs f o r i ndi vi dual s wi t h HI V / A I DS gi ven their increased susceptibility
to illness a n d disease progression as a result o f the i mmunosuppressi ve effect o f stress. Mi ndf ul ne s s medi t at i on is a relatively new ho-
listic approach to health promot i on a n d is associated wi t h improved stress management al ong wi t h reductions i n negat i ve affect a n d
i mprovement s i n well-being. Surprisingly, empi ri cal st udi es or theoretical discussions o f the usef ul ness o f mi ndf ul nes s medi t at i on
wi t h HI V- posi t i ve i ndi vi dual s are limited. Af t e r briefly revi ewi ng exi st i ng data, a rat i onal e f o r i ncorporat i ng mi ndf ul nes s medita-
t i on i nt o t reat ment programs f o r i ndi vi dual s wi t h HI V / A I DS is presented.
T
HE INTEGRATION of Eastern meditative practices with
t radi t i onal West ern heal t h care is a bl ossomi ng field
as pract i t i oners become more focused on holistic health.
Al t hough medi t at i on i n some form exists in the majority
of spiritual t radi t i ons as a met hod of devel opi ng aware-
ness, medi t at i on is not antithetical to Western religious
beliefs and can be used regardless of one' s religious be-
liefs (Marlatt & Kristeller, 1999). Despite its l ong exis-
tence, medi t at i on onl y recent l y became a subject of em-
pirical investigation.
Al t hough t here are many di fferent types of medita-
tion, they general l y fall under the categories of concen-
t rat i on medi t at i on and mi ndful ness medi t at i on. In con-
cent rat i on medi t at i on (e.g., Transcendent al Meditation,
Raj Yogi), the person focuses awareness on a single stim-
ulus such as a word (or mant ra) or the br eat hi ng process.
When her or his at t ent i on drifts, the person bri ngs their
awareness back to the stimulus. In mi ndful ness medita-
t i on (e.g., Vipassana, zazen), awareness is not focused on
a single stimulus. Instead, at t ent i on is focused on the full
range of stimuli within one' s i mmedi at e awareness. Thus,
mi ndful ness medi t at i on promot es clearness and scope of
consciousness while concent r at i on medi t at i on fosters
cont rol l i ng the focus of one' s at t ent i on ( Dunn, Hart i gan,
& Mikulas, 1999).
Medi t at i on has oft en been i naccurat el y descri bed as a
type of relaxation. In fact, EEG pat t erns have shown t hat
mi ndful ness medi t at i on and concent r at i on medi t at i on
are physiologically di fferent from relaxation. Further-
more, the two kinds of medi t at i on result i n di fferent
EEGs, with mi ndful ness medi t at i on resul t i ng i n more
delta, alpha, theta, and bet a 1 waves ( Dunn et al., 1999).
These results, demonst r at i ng that bot h slow and fast wave
Cogni t i ve and Behavioral Practice 9, 6 7 - 7 2 , 2002
1077-7229/02/67-7251.00/0
Copyright 2002 by Association for Advancement of Behavior
Therapy. All rights of reproduction in any form reserved.
activity occur dur i ng mi ndful ness medi t at i on, suppor t
the hypothesis that dur i ng mi ndful ness medi t at i on the
mi nd is bot h rel axed and alertly observant of stimuli.
In this article, I briefly review the efficacy of mi ndful -
ness medi t at i on and the l i mi t ed research on medi t at i on
with persons with HIV/AIDS. I will t hen provide the ra-
tionale for i ncor por at i ng mi ndful ness medi t at i on i nt o
comprehensi ve t r eat ment pl ans for individuals with
H1V/AIDS. Drawing on clinical experi ence, I will discuss
how mi ndful ness medi t at i on is uni quel y suited to this
popul at i on.
Mi n d f u l n e s s Me d i t a t i o n
Jon Kabat -Zi nn and his colleagues at the University of
Massachusetts Medical Cent er devel oped a stress reduc-
t i on and rel axat i on pr ogr am based on mi ndful ness med-
itation t hat is frequent l y used i n empi ri cal investigations.
Kabat -Zi nn (1982) also describes mi ndful ness medi t at i on
i n detail, and the following summary is primarily based
on his description. Mi ndful ness medi t at i on is the process
of bei ng fully aware of one' s present experi ence. It in-
volves observi ng and at t endi ng to a changi ng field of ob-
jects as they occur, moment to moment , i n a det ached
and nonj udgment al manner. The task of det ached self-
observat i on involves payi ng at t ent i on to the present mo-
ment and, when the mi nd inevitably wanders, experi enc-
i ng the cur r ent t hought or event as it arises wi t hout j udg-
ment , and t hen re-anchori ng the at t ent i on i n the pr esent
moment . Thus, i n mi ndful ness medi t at i on all t hought s
or events are consi dered objects of observation, not dis-
tractions. Furt hermore, all ment al events are consi dered
equal i n value or i mport ance; no t hought is bet t er or
more accurate t han anot her t hought . Importantly, the
dispassionate self-observation that occurs as the result of
this focused at t ent i on to i nner states enabl es one to act
more reflectively versus reflexively.
The efficacy of mi ndful ness medi t at i on i n t reat i ng dif-
68 Logs don- Conr ads en
f er ent condi t i ons (e.g., cancer, anxi et y di sorders, and fi-
bromyal gi a) has been established in t he last decade (Kabat-
Zi nn et al., 1992; Kapl an, Gol denber g, & Gal vi n-Nadeau,
1993; Speca, Carl son, Goodey, & Angen, 2000). Mi ndful -
ness medi t at i on is associ at ed with si gni fi cant i mpr ove-
ment s i n physical, psychol ogi cal , and cogni t i ve f unct i on-
ing. For i nst ance, dat a i ndi cat e mi ndf ul ness medi t at i on
pr ovi des l ong-l ast i ng r educt i ons in t he severity and fre-
que nc y of chr oni c pai n (Kabat-Zinn, 1982; Kabat-Zinn,
Li pwor t h, & Burney, 1985; Kabat -Zi nn, Li pwor t h, Burney,
& Sellers, 1986). Reduct i ons in gast roi nt est i nal , cardi o-
puhnonar y, and stress s ympt oms have also been docu-
me n t e d ( Speca et al., 2000). Ot h e r benefi ci al physical
effects of mi ndf ul ness medi t at i on i ncl ude a faster rat e o f
heal i ng in i ndi vi dual s with psoriasis ( Ber nhar d, lgd-is-
teller, & Kabat -Zi nn, 1988; Kabat -Zi nn et al., 1998) and
i ncr eased levels of mel at oni n, bel i eved t o pl ay an i mpor -
t ant rol e in heal t h ma i nt e na nc e and pr event i on o f dis-
ease (Massion, Teas, Heber t , Wer t hei mer , & Kabat-Zinn,
1995).
Resear cher s have f o u n d mi ndf ul ness medi t at i on t o be
consi st ent l y l i nked t o r educt i ons in addi ct i ve behavi ors,
as well as negat i ve mo o d states, such as depr essi on, anxi-
ety, anger, and emot i onal irritability (Astin, 1997; Kabat-
Zi nn et al., 1985; Kabat -Zi nn et al., 1986; Kabat -Zi nn et
al., 1999; Kristeller & Hal l et t , 1999; Marlatt, 1994; Miller,
Fl et cher, & Kabat -Zi nn, 1995; Shapi r o, Schwartz, & Bon-
net , 1998; Speca et al., 2000). For exampl e, cancer pa-
tients r e por t e d t hei r overall mo o d di s t ur bance decr eased
by 65% and s ympt oms of stress decr eas ed by 31% (Speca
et al.). The l ast i ng effect of t hese i mpr ove me nt s in nega-
tive mo o d states has be e n d o c u me n t e d up t o 3 years aft er
t r eat ment (Miller et al., 1995).
Whi l e si mul t aneousl y r e duc i ng negat i ve sympt oms,
mi ndf ul ness medi t at i on has also e n h a n c e d gener al per-
cept i on of well-being. Mi ndf ul ness medi t at or s r e por t an
e n h a n c e d ability t o cope with stressful si t uat i ons and live
life mor e fully i n t he pr es ent mo me n t (Kabat-Zinn, 1982;
Kristeller & Hal l et t , 1999). Dat a also i ndi cat e t hat mi nd-
ful ness medi t at i on is associ at ed with i ncreases in adapt i ve
modes o f cont r ol , sel f-regul at i on, positive spi ri t ual expe-
ri ences, insight, and e mpa t hy (Astin, 1997; I~-isteller &
Hal l et t ; Shapi r o et al., 1998). These positive at t ri but es
likely st em f r om t he at t ai nment o f a nonj udgme nt a l atti-
t ude t owar d ones el f t hat appear s t o resul t f r om pract i c-
i ng mi ndf ul ness medi t at i on (Kristeller & Hal l et t ). Fi-
nally, n u me r o u s per s onal account s have descr i bed how
medi t at i on he l pe d i ndi vi dual s t o fi nd me a ni ng and
achi eve t ranqui l i t y (Marl at t & Kristeller, 1999).
I mpr ove me nt s i n cogni t i ve s ympt oms are also associ-
at ed with mi ndt ul ness medi t at i on t r eat ment s. Dat a f r om
cancer pat i ent s i ndi cat e l ower levels o f conf us i on and
cogni t i ve di sor gani zat i on fol l owi ng t r eat ment ut i l i zi ng
mi ndf ul ness medi t at i on ( Speca et al., 2000). Anot he r re-
cent st udy (Val ent i ne & Sweet, 1999) f o u n d t hat bot h
c onc e nt r a t i on and mi ndf ul ness medi t at i on r esul t ed in
s uper i or ability t o sustain at t ent i on and i gnor e distrac-
tions. However, mi ndf ul ness pr act i t i oner s si gni fi cant l y
o u t p e r f o r me d pr act i t i oner s o f c onc e nt r a t i on medi t at i on
in t hei r ability t o pay at t ent i on when pr es ent ed with un-
expect ed stimuli. The aut hor s c onc l ude d t hat mi ndf ul -
ness medi t at or s had l ear ned t hat all stimuli ar e equal l y sa-
l i ent and were less likely t o be c ome abs or bed i n any one
stimulus. Ther ef or e, mi ndf ul ness medi t at i on was mor e
effective in medi at i ng t he addi t i onal de ma nds on at t en-
t i on due t o une xpe c t e d stimuli.
The r e is evi dence t hat t he benefi t s o f mi ndf ul nes s
medi t at i on i ncr ease with r egul ar pract i ce. A r ecent nat u-
ralistic st udy by East erl i n and Car def i a (1998) f o u n d t hat
advanced pr act i t i oner s r e por t e d hi gher levels o f positive
mood, sel f-accept ance, and self-awareness. I n addi t i on,
advanced pr act i t i oner s o f mi ndf ul ness medi t at i on were
less af f ect ed by stress, whi ch s uppor t s t he pr opos i t i on
t hat mi ndf ul ness medi t at i on pr omot e s "gr eat er equani m-
ity in t he face of adversity" (Easterlin & Cardefi a, p. 77).
Similarly, i ndi vi dual s who e nga ge d i n mor e h o me prac-
tice and a t t e nde d gr oup pr act i ce r egul ar l y r e por t e d
gr eat er r educt i ons in stress level and i mpr ovement s i n
overall mo o d (Speca et al., 2000). Likewise, l ong- t er m
medi t at or s have bet t er at t ent i onal skills t han shor t - t er m
medi t at or s (Val ent i ne & Sweet, 1999).
I n concl usi on, t he benefi ci al results o f mi ndf ul ness
medi t at i on i ncl ude r educt i ons in chr oni c pai n, anxiety,
depr essi on, psychol ogi cal distress, and negat i ve mood. I n
addi t i on, mi ndf ul ness medi t at i on is associ at ed with sig-
ni f i cant i ncreases in at t ent i on, positive mood, c opi ng
ability, resi st ance t o stress, feel i ngs o f cont r ol , empat hy,
spiritual exper i ences, and living life mor e fully. Thus, t he
positive effects of mi ndf ul ness medi t at i on are cl earl y sup-
por t e d by empi r i cal data.
Medi tati on and HIV/AIDS
As evi dent f r om t he dat a discussed, one of t he positive
effects o f mi ndf ul ness medi t at i on is i mpr ove me nt i n
stress ma na ge me nt . Effective stress ma n a g e me n t t ech-
ni ques are part i cul arl y i mpor t a nt i n HI V/ AI DS si nce t he
i mmunos uppr es s i ve effect of stress is mor e p r o n o u n c e d
(Taylor, 1995). Nume r ous st udi es s uppor t t he l i nk be-
t ween stress and i ncr eased mor bi di t y and disease pr o-
gressi on in i ndMdual s with H1V/ AI DS (Kessler, J os eph,
Ostrow, Phail, & Chmi el , 1989; Kiecolt-Glaser, 1988,
1991; LaPer r i er e et al., 1991; Sol omon & Temoshok,
1987; Taylor, 1995; Wor kma n & La Via, 1991). I mpor -
tantly, stress ma n a g e me n t t echni ques may i mpr ove t he
f unc t i oni ng o f t he i mmu n e system (Halley, 1991; Kiecolt-
Gl aser & Glaser, 1992; Schul z & Schulz, 1992; Van Rood,
Bogaards, Goul my, & van Houwel i ngen, 1993). Several
Us i ng Mi ndf ul ne s s Me di t a t i o n 6 9
st udi es o f stress ma n a g e me n t t r eat ment s wi t h HIM-in-
f ect ed i ndi vi dual s have yi el ded benefi ci al effects t hat in-
cl ude r e duc t i on i n psychol ogi cal distress (Fawzy, Nami r,
& Wol cut t , 1989; McCai n, Zeller, Cella, Urbanski , & No-
vak, 1996; Mul der et al., 1994; Perry, Fi shman, Jacobs-
ber g, Young, & Frances, 1991) and i ncr eased i mmu n e
r es pons e ( Ant oni et al., 1991; Est erl i ng et al., 1992; La-
Per r i er e, Schnei der man, Ant oni , & Fl et cher, 1990).
Al t hough it is cl ear t hat stress ma n a g e me n t is i mpor -
t ant with HiM-positive individuals, a nd t hat mi ndf ul ness
medi t at i on is an effective stress ma n a g e me n t t echni que,
a review o f t he l i t er at ur e r eveal ed no publ i s hed empi r i cal
st udi es o f mi ndf ul ness medi t at i on with this popul at i on.
I n fact, r esear ch on medi t at i on o f any ki nd as an inter-
vent i on with HIM-infected i ndi vi dual s is surpri si ngl y
scarce.
Kelly (1989) pr es ent ed a pr el i mi nar y st udy at t he In-
t er nat i onal Conf e r e nc e on AIDS i nvest i gat i ng whe t he r a
stress ma n a g e me n t pr ogr a m, consi st i ng o f mi ndf ul nes s
medi t at i on a nd self-hypnosis, coul d si gni fi cant l y r e duc e
HIM-related psychol ogi cal distress. I n this study, homo-
sexual me n wi t h HIM par t i ci pat ed i n a pr ogr a m consist-
i ng o f a bdomi na l br eat hi ng, mi ndf ul ness medi t at i on,
self-hypnosis, and st r et chi ng exercises. Results suggest ed
t hat t he t r e a t me nt was effective i n r e duc i ng psychol ogi cal
distress, e n h a n c i n g e nj oyme nt in life, and p r o mo t i n g an
i ncr eased sense of cont r ol . Al t hough t he dat a are prel i m-
inary, a nd t he sampl e size was small ( N = 4), t he results
ar e si mi l ar t o st udi es wi t h ot he r pat i ent popul at i ons a nd
s uppor t t he effi cacy o f a t r e a t me nt t hat ut i l i zed mi ndf ul -
ness medi t at i on as a c o mp o n e n t .
An o t h e r st udy (Taylor, 1995) ut i l i zed a mul t i compo-
ne nt s t r es s - management pr ogr a m, consi st i ng o f con-
cent r at i on medi t at i on, progressi ve muscl e r el axat i on,
e l e c t r omyogr a ph bi of eedback, a nd hypnosi s with asymp-
t omat i c HIV-positive men. Part i ci pant s in t he t r e a t me nt
condi t i on evi denced si gni fi cant i ncreases i n overall
mood, self-esteem, and T-cell count , as well as si gni fi cant
decr eases i n state and trait anxiety. Tr eat ment gai ns were
ma i nt a i ne d at t he 1- mont h follow-up.
Fur t her s uppor t f or t he pot ent i al efficacy o f medi t a-
t i on f or i ndi vi dual s with HI M/ AI DS is f o u n d i n anecdot al
r epor t s. A per s onal a c c ount pr e s e nt e d at t he I nt er na-
t i onal Conf e r e nc e on AIDS r e por t e d t he benefi ci al influ-
ences of pr act i ci ng t r ans cendent al medi t at i on i n c opi ng
with HIM-related pr obl ems (Kinara, 1996).
Kabat -Zi nn (1990) di scussed a pat i ent wi t h AIDS and a
pat i ent with HIM who c ompl e t e d his mi ndf ul nes s medi t a-
t i on pr ogr a m. Th e pat i ent with AIDS r e por t e d t hat t he
medi t at i on pr act i ce assisted hi m i n c opi ng with emo-
t i onal and physi cal c ons e que nc e s o f t he disease, i ncl ud-
i ng chr oni c fat i gue, a nd i mpr ove d his mood. The pat i ent
wi t h HIM, who also had hi gh bl ood pr essur e, r e por t e d a
positive out l ook on life, nor mal bl ood pressure, i mpr oved
i nt er per s onal rel at i onshi ps, a nd i ncr eas ed cont r ol o f his
anger f ol l owi ng t he t r eat ment .
M i n d f u l n e s s M e d i t a t i o n a s a n I n t e r v e n t i o n
f o r H I V / A I D S
Mi ndf ul ness medi t at i on woul d be an i deal compl e-
me n t t o t r adi t i onal t r e a t me nt pr ogr a ms f or HI V/ AI DS.
Indi vi dual s with HI V/ AI DS ar e subj ect t o a br oa d r ange
of stress fact ors across physical, psychol ogi cal , social, cul-
tural, and e c onomi c domai ns. Medi cal compl i cat i ons,
chr oni c pai n, compl i cat ed t r e a t me nt r egi mens, decl i ni ng
heal t h, r e t ur ni ng heal t h, social i sol at i on, st i gma, loss o f
social s uppor t , di scr i mi nat i on, depr essi on, anxiety, pov-
erty, fami l y confl i ct s, une mpl oyme nt , physi cal and emo-
t i onal disabilities, subst ance abuse, het er osexi sm, physi-
cal sympt oms, fears o f t he f ut ur e, a nd de me nt i a ar e j us t
s ome of t he pot ent i al stressors i ndi vi dual s with H1V/
AIDS face. I n fact, t he r ecent advances in ant i r et r ovi r al
medi cat i ons, whi ch p r o l o n g life f or ma ny i ndi vi dual s wi t h
HIM, cr eat e ot he r l ong- t er m stressors, i ncl udi ng c opi ng
with t he side effects o f medi cat i on, di scl osi ng di agnosi s,
changes i n social rel at i onshi ps, survi vor guilt, r e- ent er i ng
t he wor k f or ce, heal t h i nsur ance, fi nanci al responsi bi l i -
ties, a nd mor e. It is a ppa r e nt t hat t he di agnosi s o f HI M/
AIDS involves a myr i ad o f social, psychol ogi cal , and phys-
ical f act or s. Thi s c ompl e xi t y i n t ur n s uppor t s t he bene-
fit o f mi ndf ul nes s medi t at i on c o mp l e me n t i n g o n g o i n g
medi cal a n d / o r psychol ogi cal t r e a t me nt f or n u me r o u s
reasons.
First, mi ndf ul nes s medi t at i on is an effective stress
ma n a g e me n t pr ogr a m t hat has t he pot ent i al t o facilitate
c opi ng wi t h n u me r o u s pot ent i al stressors. I n addi t i on,
t he ability t o cope effectively wi t h stress is associ at ed with
i mpr ove d i mmu n e f unct i oni ng. HIM is a virus t hat at t acks
t he i mmu n e system, ma ki ng t he i ndi vi dual mo r e vul ner a-
bl e t o oppor t uni s t i c i nfect i ons. Tr eat ment s t hat e n h a n c e
t he i mmu n e system ar e ext r emel y i mpor t a nt because
t hey hel p decr ease t he f r equency/ s ever i t y o f oppor t uni s -
tic i nfect i ons. Effective c opi ng me c ha ni s ms f or stress
woul d al so mi t i gat e t he negat i ve effects of stress on pr eex-
isting illnesses (e.g., lessen out br eaks of her pes or shi n-
gles). Fur t he r mor e , t he specific i nt er vent i on o f mi ndf ul -
ness medi t at i on has b e e n associ at ed with an i ncr eas ed
r at e of heal i ng (Kabat -Zi nn et al., 1998).
Second, mi ndf ul nes s medi t at i on has be e n shown t o be
effective i n r e duc i ng pai n, physi cal compl ai nt s, addi ct i ve
be ha vi or / s ubs t a nc e abuse, anxiety, a nd depr essi on, all o f
whi ch ar e c o mmo n oc c ur r e nc e s wi t hi n t he HI M/ AI DS
popul at i on. I ns t ead o f t r eat i ng each psychol ogi cal pr ob-
l em separately, mi ndf ul nes s medi t at i on coul d pot ent i al l y
alleviate ma ny o f t hese s ympt oms si mul t aneousl y. I n fact,
ma ny o f t he st udi es di scussed r e por t e d c onc omi t a nt im-
pr ovement s i n vari ous physi cal a nd psychol ogi cal symp-
7'0 Logsdon-Conradsen
t oms. As s t at ed by Eas t er l i n a n d Ca r de f i a (1998), t he abi l -
ity t o e x a mi n e o n e ' s me n t a l pr oces s es n o n j u d g me n t a l l y
a n d gai n an awar enes s o f ha bi t ua l r es pons es f aci l i t at es
t he abi l i t y t o i n t e r r u p t t he cycle, a n d l eads t o a r e d u c t i o n
i n r u mi n a t i o n . Thi s r e d u c t i o n will i n t ur n l e a d t o i m-
p r o v e d me n t a l h e a l t h a n d h i g h e r qual i t y of life.
Fur t he r , ef f ect i ve n o n p h a r ma c o l o g i c a l t r e a t me nt s f or
t hes e s ympt oms a r e pa r t i c ul a r l y i mp o r t a n t wi t h t hi s pop-
ul a t i on f or var i ous r easons. I ndi vi dual s wi t h HI V/ AI DS
ar e of t e n on c o mp l e x a n d t i me- i nt ens i ve me d i c a t i o n r eg-
i me ns f or t he vi r us al one. Fur t her , t hey may t ake o t h e r
me d i c a t i o n s t o ma n a g e t he si de effect s of t he ant i r et r ovi -
ral me di c a t i ons . AS mo r e me d i c a t i o n s ar e a d d e d (e. g. , f or
pa i n or d e p r e s s i o n ) , t he r i sk of d r u g i nt er act i ons , adver s e
si de effect s, a n d n o n a d h e r e n c e t o t he me d i c a t i o n r egi -
me n i ncr eases. Ad h e r e n c e t o a nt i r e t r ovi r a l me d i c a t i o n
s c he dul e s is pa r t i c ul a r l y i mp o r t a n t be c a us e t he vi r us has
t he pot e nt i a l t o b e c o me r es i s t ant t o t hes e me d i c a t i o n s i f
t hey a r e n o t t a ke n as pr e s c r i be d. Thus, any i nt e r ve nt i on
t hat f aci l i t at es c o p i n g wi t h t he si de ef f ect s o f t hes e medi -
cat i ons a n d c ons e que nt l y i mpr ove s a d h e r e n c e is hi ghl y
des i r abl e. Mor eover , ma ny pa t i e nt s wi t h H1V/ AI DS do
not wi sh t o i nc r e a s e t he n u mb e r o f me di c a t i ons t hey ar e
t aki ng a n d may r esi st a d d i n g ps yc hot r opi c me di c a t i ons t o
al l evi at e ps ychi at r i c s ympt oms .
Th i r d , mi ndf ul ne s s me d i t a t i o n is al so as s oci at ed wi t h a
var i et y o f posi t i ve effect s, such as e n h a n c e d over al l wel l -
bei ng, t hat have t he pot e nt i a l t o i nc r e a s e qual i t y of life.
Th e two ma i n pr oces s es t hat oc c ur d u r i n g mi ndf ul ne s s
me d i t a t i o n , d e s c r i b e d by Mar l at t a n d Kr i s t el l er (1999),
of f er u n i q u e benef i t s . Th e fi rst pr oces s i nvol ves exper i -
e n c i n g t he c h a n g i n g n a t u r e of me n t a l l i fe as one be-
c ome s mi n d f u l o f hi s or h e r mo me n t - t o - mo me n t awar e-
ness. Th e r eal i zat i on t hat one ' s me n t a l l i fe is always
c h a n g i n g l eads t o t he r eal i zat i on t hat "t hi s t oo will pass. "
Th e s e c o n d pr oces s , b e c o mi n g a d e t a c h e d obs e r ve r of
one ' s t hought s , f eel i ngs, a n d s ens at i ons , e na bl e s t he per -
son t o see t he t hought s , f eel i ngs, a nd s ens at i ons as t hey
ar e (i. e. , me r e l y a t h o u g h t or a f eel i ng, n o t a t r ut h p e r
se) . By obs e r vi ng one ' s t hought s obj ect i vel y, t he powe r of
t hought s to c o n t r o l s u b s e q u e n t behavi or s is di mi ni s he d.
Thi s r e d u c e d i de nt i f i c a t i on wi t h one ' s i mp e r ma n e n t
t h o u g h t p a t t e r n p r o mo t e s gr e a t e r f r e e d o m a n d l eads t he
p e r s o n t o achi eve pe r s ona l ba l a nc e i n h e r or hi s lif,e
( Mar l at t & Kr i st el l er ) . I n a ddi t i on, di s pa s s i ona t e awar e-
ness r emoves t he e mo t i o n a l i nt ens i t y a n d e na bl e s i ndi vi d-
ual s t o r e s p o n d t o t he i r t hought s i n a g r e a t e r var i et y of
ways. For i ns t ance, i ndi vi dual s wi t h HI - V/ AI DS of t en re-
p o r t t h i n k i n g t hat t hey ar e " da ma ge d" or "t ai nt ed. " By
r e c ogni z i ng t hat t hi s t h o u g h t is j u s t a t h o u g h t a nd has no
mo r e me a ni ng, accuracy, or i mp o r t a n c e t han t he t hought ,
"I n e e d t o r e me mb e r t o cal l Bill," t he pe r s on can c hoos e
t o l et t hat t h o u g h t go a n d p r e v e n t t he pr evi ous p a t t e r n of
b e c o mi n g ups e t at t hi s t hought .
Si mi l arl y, mi ndf ul ne s s me d i t a t i o n is t a ught as "a way o f
bei ng, as a way of l i vi ng o n e ' s l i fe" a n d i ndi vi dual s ar e en-
c o u r a g e d t o r e a c t mi ndf ul l y t o s i t uat i ons i ns t e a d of re-
s p o n d i n g r eact i vel y ( Kabat - Zi nn et al. , 1992, p. 942) . Th e
at t i t udi nal f bunda t i ons o f mi n d f u l n e s s - - n o n j u d g i n g ( ob-
ser vi ng wi t hout j u d g me n t ) , pa t i e nc e ( al l owi ng t hi ngs t o
unf ol d at t he i r own pa c e ) , a d o p t i n g a b e g i n n e r ' s mi n d
( s eei ng t hi ngs as i f f or t he fi rst t i me) , t r ust (i n your s e l f
a nd your f eel i ngs) , nons t r i vi ng ( be i ng ful l y p r e s e n t ver sus
doi ng) , a c c e pt a nc e ( s eei ng t hi ngs as t hey ar e r i ght now) ,
a n d l et t i ng go ( obs er vi ng t hi ngs wi t hout a t t a c h me n t ) -
ar e t a u g h t i n t he pr a c t i c e of mi ndf ul ne s s me d i t a t i o n
( Kabat - Zi nn, 1990). Thus, i ndi vi dual s can a ppl y what t hey
have l e a r n e d fl-om mi ndf ul ne s s me d i t a t i o n t o live t he i r
lives mo r e fully. Li kewi se, da t a i ndi c a t e mi ndf ul ne s s me d-
i t at i on can al so l ead to i nsi ght , t r anqui l i t y, a n d g r e a t e r
spi r i t ual i t y. Thus mi ndf ul ne s s - ba s e d me d i t a t i o n pr ovi de s
t he o p p o r t u n i t y f or d e e p e r levels of ps ychol ogi cal gr owt h.
Four t h, HI V- r el at ed cogni t i ve i mp a i r me n t is ex-
t r e me l y c o mmo n ( Boccel l ar i & Dilley, 1992). Ne ur ol ogi -
cal c o mp l i c a t i o n s such as conf us i on, a t t e nt i on def i ci t s,
a n d me mo r y p r o b l e ms a r e f r e que nt l y obs e r ve d i n var yi ng
de gr e e s o f severity. As di scussed, mi ndf ul ne s s me d i t a t i o n ,
as s oci at ed wi t h i mp r o v e d a t t e nt i on skills a n d r e d u c e d
me n t a l conf us i on, c oul d be usef ul i n c o mb a t i n g cogni -
tive dys f unct i on. Mor eover , mi ndf ul ne s s me d i t a t i o n has a
s t r o n g e r ef f ect on i nc r e a s i ng c o n c e n t r a t i o n whe n f a c e d
wi t h u n e x p e c t e d st i mul i ( Val ent i ne & Sweet, 1999)i As one
woul d expect , muc h of t he st i mul i of l i fe is une xpe c t e d.
Fi ft h, as Kabat - Zi nn et al. (1985) p o i n t out , mi ndf ul -
ness me di t a t i on emphas i zes sel f - obser vat i on a n d self-
r esponsi bi l i t y. Thi s f ocus on t he sel f can assist t he p e r s o n
i n i dent i f yi ng i l l n e s s / h e a l t h behavi or s as wel l as f os t er i ng
f eel i ngs o f sel f-wort h a nd cont r ol . I n fact, a gr owi ng f i el d
wi t hi n ps ychol ogy is t he c o mb i n a t i o n of mi ndf ul ne s s
me di t a t i on wi t h ps yc hot he r a py ( Epst ei n, 1995; Kutz,
Bor ysenko, & Benson, 1985; Teasdal e, Segal , & Wi l l i ams,
1995). I nc r e a s i ng one ' s sense o f c ont r ol when f aced wi t h a
l i f e- t hr eat eni ng i l l ness is always i mpor t a nt . Wi t h H1V/
AIDS, pat i ent s of t en f eel out of c ont r ol i n sever al ar eas o f
t hei r lives. For i nst ance, t hey may f eel f or c e d t o t ake me d-
i cat i ons, or hel pl es s t hat t hey c a n' t ke e p t he i r j o b due t o
n u me r o u s sick days, or r e j e c t e d by soci et y f or s o me t h i n g
b e y o n d t he i r cont r ol . I t is al so i mp o r t a n t t o f ost er i nvol ve-
me n t wi t h t hei r t r e a t me n t r e gi me n, a n d pa r t i c i pa t i ng i n
me di t a t i on r egul ar l y allows t he pa t i e nt t o be an act i ve par-
t i ci pant i n he a l t h p r o mo t i o n . Fur t her , e n h a n c e d self-
obs er vat i on of me nt a l a nd physi cal s ympt oms can h e l p
i dent i f y pot e nt i a l p r o b l e ms mo r e qui ckl y a nd accurat el y.
Fi nal l y, mi ndf l f l nes s me d i t a t i o n is r e ma r k a b l y easy t o
i mp l e me n t a n d cost -effect i ve. Ot h e r t h a n . a r el at i vel y
qui e t r o o m ( even oc c a s i ona l noi s e is gr i st f or t he awar e-
ness mi l l ) , no o t h e r p r o p s o r t e c hni c a l e q u i p me n t a r e
n e e d e d . , Mt hough t he i ns t r uc t or mus t be wel l ver s ed a n d
Us i n g Mi n d f u l n e s s Me d i t a t i o n 71
p r a c t i c e d i n mi n d f u l n e s s me d i t a t i o n , o t h e r s p e c i a l t r a i n -
i n g o r a d v a n c e d d e g r e e s a r e n o t n e c e s s a r y . F u r t h e r , i t i s
p r o v i d e d i n a g r o u p f o r ma t ( u p t o 30 p a r t i c i p a n t s a t a
t i me ) a n d t h e i n i t i a l i n s t r u c t i o n i s t i me - l i mi t e d , g e n e r a l l y
o c c u r r i n g o n a we e k l y b a s i s f o r 8 we e k s . Du e t o t h e n u -
me r o u s b e n e f i t s o f r e g u l a r p r a c t i c e , t r e a t me n t p r o g r a ms
s h o u l d i n c l u d e a n o n g o i n g me d i t a t i o n g r o u p f o r i n d i v i d -
u a l s t o p a r t i c i p a t e i n a f t e r t h e i r i n i t i a l i n s t r u c t i o n .
C o n c l u s i o n
Mi n d f u l n e s s me d i t a t i o n wo u l d b e a n i n v a l u a b l e a d d i -
t i o n t o t r e a t me n t r e g i me n s f o r i n d i v i d u a l s wi t h H 1 V /
AI DS . E mp i r i c a l r e s e a r c h h a s s u p p o r t e d t h e n u me r o u s
p h y s i c a l a n d p s y c h o l o g i c a l b e n e f i t s o f mi n d f u l n e s s me d i -
t a t i o n f o r a v a r i e t y o f i n d i v i d u a l s wi t h me d i c a l a n d p s y c h i -
a t r i c i l l n e s s e s . T h e s e d a t a , c o mb i n e d wi t h c l i n i c a l e x p e r i -
e n c e , s u g g e s t ma n y a d v a n t a g e s t o u t i l i z i n g mi n d f u l n e s s
me d i t a t i o n i n t h e t r e a t me n t o f p a t i e n t s wi t h HI V/ AI DS ;
i t i s c r u c i a l t h a t r e s e a r c h b e c o n d u c t e d t o v a l i d a t e t h e s e
c l a i ms .
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Address correspondence to Susan Logsdon-Conradsen, Berry College,
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Received: January 10, 2000
Acc@ted: February 20, 2001

A Metacognitive Therapy for Anxiety Disorders:
Buddhist Psychology Appl i ed
Tony Tone a t t o, Uni versi t y o f Toront o
Buddhist psychology and philosophy have the potential of contributing to the cognitive behavioral conceptualization and treatment
of psychopathology. I n this article, the relevance of Buddhism to the treatment of clinical anxiety is presented. Metacognition is
viewed as a concept that can bridge Buddhist and cognitive behavioral psychology. I n addition to delineating Buddhist conceptions
of cognition and cognitive functioning, practical applications, in the form of mindful attention, are outlined.
Give up all negat i ve act i ons;
Always act per f ect l y i n vi rt ue;
Devel op c ompl e t e mas t er y of your own mi nd;
Thi s is t he t eachi ng of t he Buddha.
- - Buddha Shakyamuni
O
NE OF THE ENDURING s t r engt hs of cogni t i ve- behav-
i oral t her apy is its i nhe r e nt adapt i veness. No t ech-
ni que or st r at egy is e xc l ude d as a cogni t i ve- behavi or al
t e c hni que if empi r i cal evi dence is suppor t i ve. As a resul t ,
C o g n i t i v e a n d B e h a v i o r a l P r a c t i c e 9 , 7 2 - 7 8 , 2 0 0 2
107%7229/ 02/ 72-7851. 00/ 0
Copyright 2002 by Association for Advancement of Behavior
Therapy. All rights of reproduct i on in any form reserved.
cogni t i ve- behavi or al t her apy c ont i nue s t o devel op a wi de
r ange of i nt er vent i on t ool s sui t abl e t o an ever - i ncr easi ng
r ange of cl i ni cal phe nome na a nd popul at i ons . Its adher -
e nc e to a sci ent i fi c mode l of de ve l opme nt ens ur es t hat
such pr ol i f er at i on does not l ead t o a ha pha z a r d r el i ance
on uns ubs t ant i at ed cl i ni cal tools. Des pi t e its yout h as a
sci ence, it has ma de r emar kabl e advances i n effect i vel y
r el i evi ng huma n suf f er i ng. It is not s ur pr i s i ng t hat t her e
is an ope nne s s by r es ear cher s a nd cl i ni ci ans wor ki ng
wi t hi n a cogni t i ve- behavi or al f r a me wor k to t he i nsi ght s of
t he Buddha, whi ch dat e back over 2 mi l l enni a. The Bud-
dha also e mpl oye d a st ri ct empi r i cal a ppr oa c h t o devel -
opi ng hi s i nsi ght s on t he nat ur e of huma n s uf f er i ng a nd
its al l evi at i on. He di s cour aged hi s f ol l ower s f r om accept -