A Buddhist-based meditation practice for care and healing: An introduction and its application
Correspondence: Miho Iwakuma, Graduate School of Medicine, Kyoto University, Yoshida-konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan. Email: firstname.lastname@example.org
Department of Medical Communication, Yoshida-Konoecho, Sakyo-ku, Kyoto, Japan.
This paper outlines Buddhist-based meditation in terms of its spiritual, psychotherapeutic, physiological and neuroscientific perspectives. In the latter part of this paper, a pilot study is discussed, in which Japanese university students volunteered to practice meditation at home and complete questionnaires. T-tests were performed to compare with the non-meditated control group. Although only a small number in the experimental group completed the study, our analyses demonstrated that students benefited from meditation and showed significant increases in their sense of coherence, self-esteem and purpose in life. Lastly, practical implications of meditation in contemporary Japanese society are discussed.
After the Great East Japan Earthquake occurred on 11 March 2011, as a nation Japan cries for ‘healing’ more than ever. The religious circles in Japan including the Buddhists have responded in an attempt to assist those who survived but are spiritually wounded. Kawai asserts that Japanese people have lost a unifying principle, which has led to collective societal anxiety. The resulting emptiness, which is occupied by God or the Emperor, could not be filled by scientific achievements or advancements. Although Japan has made amazing technological advances and life expectancy rates are 83 (79 years for men; 86 years for women), more than 3 million Japanese people commit suicide every year (with some victims younger than 20 years of age). Unfortunately, this rate persists for more than a decade. Nowadays, the terms such as ‘spirituality’, ‘healing’ or ‘kizuna’ (bonding) have become buzzwords in Japan, especially in the post-3.11 era.
From a psychosociological perspective, meditation therapy is a psychological and emotional approach that employs the multi-faceted functions of meditation to improve psychological and physical disorders in patients, as well as develop in them a sense of humanity and spirituality. From religious and philosophical perspectives, meditation allows individuals to find meaning in their lives and spirituality, and helps them search for direction in their lives.[3, 4]
In this paper, we describe a Buddhist-based meditation practice from various perspectives (religious, psychotherapeutic, narrative, or physiological and neuroscientific) in relation to care, introduce findings gained from a preliminary study on Japanese university students and point out selected inferences of meditation practice in Japanese society today.
Understanding Spirituality, Care and Narrative
The World Health Organization (WHO) describes the introduction of spirituality into the domain of health care. These discussions question the very nature of health and wellness. Proposed revisions to the WHO's Ottawa Charter for Health Promotion regard health not only as the absence of illness or maladies but also as a psychodynamic state consisting of people's physical, mental, social and spiritual aspects. This perspective suggests that traditional psychological categories are insufficient when addressing the complex issues facing people in contemporary society. Further, it suggests that there is a need for initiatives and care that are grounded at a deep emotional level, such as upon people's existential values. The concept of spirituality can be expressed in terms that are based on a number of different perspectives such as life, spirit, soul, heart, existentialism, religion and the meaning of life.
For many people, the aspects of spirituality inherent in daily life contain religious factors; however, being spiritual is not synonymous with being religious.[4, 6-8] Some say that spirituality can be understood as consisting of those elements that comprise the totality of human life, including physical, psychological and social factors. In many cases, spirituality relates to an interest in concepts related to the meaning and goals of life. In other words, this interpretation of spirituality emphasizes the value of incorporating higher level psychogenic endeavours into aspects of care, much as respecting the perspective that religious and sacred sentiments do not equate to spirituality.
According to Taylor, the importance of both religion and spirituality in the field of care is well understood in the field of nursing. Prior to the 1970s, although spirituality was discussed in relation to ‘religion’ in nursing, today it is understood that spirituality and religion are interrelated but are required to be conceptually separated. Religion provides its believers with a frame of reference and can be a gateway leading to spirituality; however, spiritual expressions are not limited to religious rituals. Taylor also mentions frameworks in psychiatric medicine, sociology and psychology which touch upon the meaning of an individual's life and spiritual needs.
For example, sociologist A. W. Frank states that in the end-of-life care, spirituality and religion merge in storytelling, in other words, narratives. Frank offers three types of narratives (restoration, chaos and quest). The first type of narrative, restoration, is preferred by the recently ill or medical professionals with a dominant storyline of becoming ill, but restoring health (with a remedy). Conversely, chaos stories lack a sequence, as well as a ‘proper’ ending, and represent human vulnerability and the impotence of modern medicine. Quest storytelling, unlike the aforementioned two, is an attempt to utilize or gain from illness experiences.
Spiritual care refers to the acts of care providers (assistants, healthcare professionals, spiritual care workers and therapists) in providing care to clients who are experiencing inner spiritual pain (the targets of care). The providers work with these clients to determine the nature of their afflictions through an integrated domain that consists of their own pratyaya, other pratyaya and the Buddha's pratyaya, and the liberation and emancipation from suffering that this brings. In addition, it is also important to perform spiritual care assessments of care providers themselves. Similarly, aforementioned Frank comments that encouraging narrative in care encourages health professionals to pay ‘closer attention to the stories ill persons tell; ultimately, to aid listening to the ill’. The act of narration helps both the ill person to tell a story and the caregivers to bond with them through storytelling. In practice, Oshita, a Buddhist priest, utilizes meditation in palliative care units to facilitate the narratives of patients.
The dawn of Buddhist-based spiritual care in Japan, in which the ‘dependent arising’ (enishi in Japanese) is an essence, can be traced back to the 6th century.[3, 4, 13-15] Dependent arising, or pratitya-samutpada in Sanskrit, refers to ‘things that arise as a result of pratyaya’ (conditions). From this perspective, phenomenological entities arise through interdependence and are generated through a range of causes and conditions, through which they manifest. The term pratyaya also implies ‘all conditions’, and ‘dependent arising’ refers to all phenomena from mutual relationships between infinite causes (hetu) and conditions (pratyaya). Thus, they do not exist independent of each other because the absence of any of these conditions and causes would also bring about a loss of their results (phala).
On a theoretical level, pratyaya demonstrates the unlikelihood of permanent substantive entities existing in isolation; on a practical level, it explains the causal relationships between things and aims to realize liberation from the world of phenomena (the world of suffering) by eliminating causes and conditions. Thus, we should adopt the teaching of pratyaya when attempting to engage in the types of thoughts and actions that seek to understand the causes of people's suffering and ascertain and solve the root causes of these thoughts and actions.
In esoteric Buddhism, the nature of all forms of life is symbolized and embodied through mandalas. However, in seeking to explain the relationship in all forms of life, mandalas also employ the theory of the six elements (earth, water, fire, wind, space and consciousness) to explain the fundamental truth that the entire universe consists of a series of interconnections.
In the East, the foundations of human spirituality consist of an awareness of connections among the universe, nature, humans, animals, plants and minerals, with high regard given to the relationships among all of these. This is a view of life in which all conditioned phenomena are produced by a series of interdependent causal conditions.
A Psychotherapeutic Understanding of Meditation
Tetsugaku Shisō Jiten defines meditation/contemplation as the realization of a state of awareness that differs from daily awareness, one that gives practitioners a sense of conviction that they have obtained an understanding of truth and the Absolute, or as a psychosomatic act in which practitioners concentrate all their attention on a certain subject with these aims in mind. Although meditation (Latin meditatio) here refers to the rational action of concentrating all of one's attention on a certain subject, contemplation (Latin contemplatio) includes a sense of ‘partaking of sacred places’, referring to a direct spiritual conception that transcends logic, the final goal which is the pursuit of truth.
Regarding psychological and physiological responses, Shinrigaku Jiten states that ‘deep meditation brings about changes in the frequency of brainwaves and their patterns by an increase in α and θ waves, generating synchronization between the left and right cerebral hemispheres’. The goals of meditation are to promote relaxation, help alleviate stress and increase self-respect. This is achieved through a decrease in the frequency of respiration and an increase in the feelings of warmth within the body. In addition, meditation promotes concentration, develops awareness of the present and fosters self-insight. Therefore, meditation has been subjected to psychotherapeutic interpretations concerning its validity in contributing to profound insight into the meaning of a person's existence and issues surrounding the human condition, as well as improving self-awareness.
In recent years, meditation has been used as a method of aiding illness prevention and specific ailments as well as restoring health. In addition to these health benefits, because meditation can help develop awareness and promote insight such as increasing a person's feelings of self-respect. Meditation has attracted attention for its role in enhancing people's ability to contemplate what it means to be human and for the role it plays in therapy in encouraging people to seek meaning in their lives. Meditation does not only serves as a means of assisting others but also supports psychotherapists in personal and career development enabling them to improve their ability to pursue difficult clinical issues. Recently, a number of practices were posited as useful approaches to meditation from the perspectives of complementary and alternative therapies. Practices include behavioural meditation, meditation based on sitting or lying down, prayer, silent contemplation, qigong (Sendo) and meditation based on wish fulfilment.
A body of research on meditation along with other complementary and alternative medical treatments (CAM) is fast growing not only in the East but also in the Western nations.[20-43] For example, the United States (US) National Centre for Complementary and Alternative Medicine estimated that about 8% of the US population meditates for health reasons. National US surveys estimate that approximately 40% of the US population uses some form of CAM for health-care options.[22, 26, 38] CAM including meditation was used for treating people with cardiovascular diseases[26, 40, 41, 43] or patients with anxiety disorders.[28, 30] A pilot randomized controlled study demonstrated that a spiritual retreat including meditation was beneficial for the well-being of patients with post-acute coronary syndrome. In research conducted by Taylor, meditation therapy among cancer patients was useful as a form of spiritual complementary therapy in helping them develop a sense of meaning in their lives. In mental health care, a new paradigm of Integrative Mental Health (IMH) is rapidly emerging. IMH emphasizes a bio-psycho-socio-spiritual approach, spiritual narrative of patients with mental disorders and integration of conventional biomedical treatment and other treatment approaches such as acupuncture, yoga or meditation.
Astin et al. conducted a systematic review of 23 ‘distant healing’ (e.g. prayer, therapeutic touch or spiritual healing) studies involving 2774 patients with various conditions. Of these 23 studies, 13 of them (57%) showed positive treatment effects, and accordingly, the Cochrane Collaboration's review on prayer studies states the evidence thus far merits further research. Another research by Rees reviews more than 11 500 articles on meditation training towards enhancing soldier resilience. After screening articles according to 40 parameters under five domains (emotional, physical, social, family life and spiritual), Rees culls three major meditation techniques (progressive muscle relaxation, Transcendental Meditation and mindfulness). Under four criteria of acceptability, cost, efficacy and quality control, it is concluded that ‘Transcendental Meditation, mindfulness, and progressive muscle relaxation, in that order, have the most supporting data’ for improving soldier resilience programs. All evidence seems to suggest that meditation and spiritual contemplation are useful in clinical contexts.
The Physiological and Neuroscientific Understanding of Meditation
For decades, there has been extensive research in Western countries on how the practice of meditation transforms the human mind and body. In 1939, a French cardiologist measured the physiology of yoga practitioners in India and reported a decrease in the frequency of respiration and an increase in electric skin resistance as a result of meditation. In the US, in 1972, research by Wallace on the physiological effects of meditation drew much attention. This research stated the following effects of meditation:
- Deep relaxation as a result of a drastic drop in oxygen consumption and carbon dioxide emission.
- A drastic drop in breathing rate, respiratory minute volume and heart rate.
- A rapid increase in electric skin resistance, signifying a state of deep relaxation.
- The maintenance of important physiological functions, as evinced by the stability of factors such as oxygen partial pressure and carbon dioxide partial pressure in arterial blood, acid salt equilibrium and blood pressure (note: blood pressure was constantly low throughout the measurements).
- A reduction in the lactate concentration of the arterial blood.
- Changes in brainwaves in which there is an increase in α and θ waves in the forehead and parietal region, indicating a state of awakened alertness during deep relaxation.
Koenig reports positive impact of religious prayers on the quality of health, particularly on the relationship between religion and physical and mental health, role of religious piety in strengthening the immune and endocrine systems, relationship between spirituality and life and relationship between physical disabilities and spirituality.
Recent studies demonstrate the efficacy of meditation in combating illness by increasing energy levels, strengthening the immune system and preventing illness by the following means: (i) lowering the heart rate and blood pressure; (ii) increasing blood flow to the brain and heart; (iii) effecting positive changes to brainwaves, myoelectric signals and skin resistance; (iv) improving sleep and digestion; (v) reducing feelings of irritation, anxiety and depression; (vi) reducing the frequency and duration of illness; (vii) reducing instances of accidents and mistakes during work; (viii) improving human relations; and (ix) improving self-realization and emotional and spiritual indices. However, the conditions where meditation are contraindicated not suitable) include psychological illnesses, severe depression, acute derangement, extreme anxiety and dementia.
Research in recent years show that because of the action of breathing and the actions of the sympathetic nervous system, meditation is effective in stimulating brain activity through its effect on blood vessels as well as in suppressing tension and its impact on muscles, resulting in relaxed and elastic arterial walls. In addition, it promotes the smooth flow of blood to organs and tissues because of less peripheral resistance. Thus, these reports suggest that by meditation blood circulates more freely through the body's internal systems, improving a person's health. A wide range of studies mentioned previously demonstrate in various ways how meditation favourable influences physiological responses and its major impact on generating health.
Meditation Taught to Survivors
In January 2012, as the first municipality that was evacuated because of a nuclear accident, Kawauchi village, made a declaration to ‘return-to-home’. 1 The village is located in Japan's Fukushima prefecture and its northeastern border touches upon the 30-km radius from the exploded nuclear power plant. On a road to recovery and reconstruction, authors Ohshita and Iwakuma made trips to Kawauchi, where health-care professionals and municipal officials, who themselves were once evacuated and returned to care for the villagers, were under long-term stress and at risk of depression. In order to care for these people, Ohshita taught participants to practice meditation to reduce stress and anxiety, as well as to increase resilience. At the end of the sessions, participants were asked to fill out the survey. Comments written on the post-session survey include, ‘felt very refreshed without worrying about my work’, ‘have learnt to make myself at a neutral position’, ‘felt at ease, haven't felt this for a long time’ and ‘would like to find some time each day to meditate’. Although many of the participants felt changes after meditating and the qualitative data are rich and informative, a more systematic qualitative approach on meditation is required for scientific validation.
Thus, researchers designed a small-scale study in which we hoped to gain insights into how meditation impacts university students. Many were under stress and concerned about the future or existential meaning of life. The remaining of this paper describes the pilot study. The research hypothesis was as follows:
- H1: Practicing meditation results in a significant difference between a control group and an experimental group in changes for the outcome variables of (i) sense of coherence (SOC); (ii) self-esteem (SE); and (iii) purpose in life (POL).
A total of 54 Japanese university students volunteered to participate in this quasi-experimental pilot study. Confidentiality and anonymity were assured to each participant. All participants were recruited when taking the researcher's class, ‘Religion and Human Culture’. Each volunteered student chose the option of joining the non-meditating control group (group A) or the meditate-at-home for 1 month group (group B). Group A allowed researchers to distinguish the effects of meditation from other effects. Randomization was not conducted because of the field-study design. All participants completed the pretest survey, that assessed SOC, SE and POL. Following the survey, Ohshita provided instructions on meditation and written handouts to the students of group B. All participants completed a posttest 1 month later.
Sense of coherence
The Japanese version of the SOC Scale measured sense of coherence.[52, 53] The reliability of the scale was confirmed with alpha reliability scores of 0.819 at the pretest (n = 68) and 0.826 at the posttest (n = 62).
A Japanese version of Rosenberg's self-esteem scale assessed self-esteem. The scale had a pretest alpha of 0.808 (n = 68) and posttest alpha of 0.798 (n = 68).
Purpose in life
The POL Scale was used in this study to determine purpose in life. The pre- and posttest alphas were 0.891 (n = 66) and 0.887 (n = 62), respectively. These alphas are consistent with the alpha calculated for the Japanese version of the scale (0.896). The scale was based on a seven-point scoring system.
The participants were 54 Japanese university students (mean age, 20 years). Group A, the control group, consisted of 21 students (15 men and 6 women). Group B, the meditation-at-home group, consisted of 33 students (21 men and 11 women). Of the experimental group, only four students continued meditation for at least 20 days. The remaining students stopped meditating before the 5th day (11 students), 10th day (9 students), 15th day (8 students) and 20th day (1 student).
An independent samples t-test showed no significant differences between groups A and B prior to meditation (Table 1).
Table 1. Means and t-test results of pretest for control group (A) and experimental group (B)
|Sense of meaningfulness||15.57||15.09||0.44||52||NS|
|Sense of manageability||15.05||13.78||1.16||52||NS|
|Sense of comprehensibility||18.38||15.91||1.93||52||NS|
|Rosenberg's Self-Esteem scale||31.71||29.33||1.19||52||NS|
A paired t-test showed that there were no differences between the pre- and posttests for the three scales in group A, except for two items (Table 2). In contrast, significant differences were found between the pre- and posttests in group B (Table 3)—five items showed significant increases in posttest means at P < 0.05 and eight items showed significant increases in posttest means at P < 0.01.
Table 2. T-test comparisons of pretest and posttest for control group (group A)
|Sense of meaningfulness||15.57||2.80||16.24||3.40||−1.016||20||NS|
|Sense of manageability||15.05||3.22||14.48||2.42||0.917||20||NS|
|Sense of comprehensibility||18.38||3.94||17.48||3.17||1.034||20||NS|
|Rosenberg's Self-Esteem scale||31.71||5.90||31.48||5.08||0.195||20||NS|
Table 3. T-test comparisons of pretest and posttest for experimental group (group B)
|SOC scale||44.79||11.60||50.21||12.32||−3.413||32||< 0.01|
|Sense of meaningfulness||15.09||4.49||16.79||4.47||−2.489||32||< 0.05|
|Sense of manageability||13.79||4.26||15.30||4.07||−2.315||32||< 0.05|
|Sense of comprehensibility||15.91||4.94||18.12||5.48||−3.421||32||< 0.01|
|Rosenberg's Self-Esteem scale||29.33||7.87||31.97||6.96||−3.092||32||< 0.01|
|POL test||78.22||16.83||84.72||16.49||−3.863||31||< 0.01|
Overall, the posttest means for the three scales were also significantly increased in group B compared with group A (SOC: t (32) = 3.41, P < 0.01; SE: t (32) = 3.09, P < 0.01; POL: t (31) = 3.86, P < 0.01). These findings collectively support the hypothesis that meditation affects SOC, SE and POL among meditated-at-home students.
This study explored the effects of meditation on Japanese university students and demonstrated that students greatly benefit from at-home meditation. More specifically, the students who meditated at home had increased SOC, SE and POL compared with before starting meditation and the control group. Before the experiment started, t-test means showed that all volunteered students, regardless of groups, were measured the same in terms of SOC, SE and POL. However, although a paired t-test for group A showed that non-meditated students did not change much in SOC, SE and POL, group B students showed positive differences after meditation in these psychological items (SOC: t (32) = 3.41, P < 0.01; SE: t (32) = 3.09, P < 0.01; POL: t (31) = 3.86, P < 0.01). It is noteworthy that 33 students volunteered to belong to the meditation group, and many of these students dropped out prior to the 1 month of scheduled completion. Significantly, this implies that despite the fact that more than 28 students dropped out prior to meditating for half a month, they nonetheless showed increased SOC, SE and POL. This might suggest that short-term meditation can also positively influence SOC, SE and POL.
There are some limitations worth noting. First, the sample size of 53 students was small (Control group n = 21 and experimental group n = 33) and only 5 students continued meditating until the 15th day. Secondly, we have not addressed the long-term effects of meditation and whether improvements in SOC, SE or POL are maintained or change over time. A follow-up study of students in group B can address this issue. Third, caution should be exercised in generalizing the results of this study to other groups of people. Besides the follow-up of the students, descriptive qualitative data, which were a part of the survey but not included for the present study, can be a great addition to interpret the survey data.
This paper described Buddhist-based meditation in terms of its spiritual, psychotherapeutic, physiological and neuroscientific perspectives. The pilot study is highlighted in which Japanese university students volunteered to practice meditation at home for 10 min, and t-tests with the non-meditated control group's questionnaires were performed. Our analysis suggests that the experimental group students benefited from meditation and showed significant increases in SOC, SE and POL, which alludes to the efficacy of the practice of meditation.
A Buddhist priest and one of the authors of this paper, Ohshita has organized meditation workshops since 1994 at a Japanese Buddhist Temple. Participants in the past included a breadth of people, for example, pregnant mothers, elementary school students, teachers, nurses and/or family members of the deceased. In 2007, in response to an increase of spiritual care needs in Japan, the Japan Society of Spiritual Care was founded. Membership encompasses not only health-care practitioners, but also sociologists, philosophers and/or economists who were formed under the mission of training ‘spiritual care workers’ and networking with individuals interested in spiritual care. Ever since the Great East Japan Earthquake, Ohshita and Iwakuma continue involvement with the reconstruction assistance project for Kawauchi village. This project is an in situ example of Buddhist-based meditation, which makes tangible differences in the healing of the spiritually wounded, such as the earthquake victims in Fukushima. Spirituality is a matter for all walks of life, and practicing meditation is inexpensive and effective. Finally, the authors suggest that practising meditation can be utilized for prompting people to consider questions such as ‘Who am I?’ and ‘Where am I headed?’ and for improving the overall health of society.
The authors wish to thank Keiko Miyamoto who verified the statistical analysis.
The authors declare no conflict of interest.
As of October 2012, more than 1000 residents out of approximately 3000 have returned, partially or permanently, to Kawauchi. See http://www.kawauchimura.jp/kouhou/ for the latest Kawauchi.