Yoga and Mindfulness Based Cognitive Therapy

Basant Pradhan

Yoga and Mindfulness Based Cognitive Therapy

A Clinical Guide

Basant Pradhan, MD Department of Psychiatry Cooper University Hospital, and Cooper Medical School of Rowan University Camden , NJ USA

ISBN 978-3-319-09104-4 ISBN 978-3-319-09105-1 (eBook) DOI 10.1007/978-3-319-09105-1 Springer Cham Heidelberg New York Dordrecht London

Library of Congress Control Number: 2014952228

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I dedicate this book to the inspiring wisdom of the two early champions of ancient India: Buddha ( The Awakened ; circa. Sixth century BC) & Patanjali (author of the Yoga - Sutras , the fi rst text book of Yoga; circa. Fourth century BC) For their profound clarity, greatness, and nobility of purpose………

vii

Foreword

The current trend in psychotherapy has been towards more systematic approaches based on research evidence and away from practice-based experience. However, this has not meant that you need to throw the baby out with the bathwater in terms of solid conceptual models that have been proven constants withstanding the test of time. Some of these concepts and approaches come from cultural traditions that are different than the traditional Western linear-empirical model and have required translation for Western audiences. In psychotherapeutics, it is being increasingly recognized that, in order to be effective, there need to be the right balance between evidence based knowledge and the therapeutic experience: the two crucial elements of any psychotherapy essentially supplementing each other in this rich model of human interactions.

One of the traditional models that have promoted this balance is that of meditation- based psychotherapy. Meditation is the 7th step in both the Eight Limbed Yoga ( ashtanga ) of the sage Patanjali (Satchidananda 1978 ; Feuerstein 1979) and the Noble Eightfold Path of the Buddha (Bodhi 2000). This is basically an ongoing cognitive-emotive-reappraisal process in the meditator in order to obtain insight and directly experience the personal truths in the meditator’s own life based on this insight. This deeply contemplative process helps the meditator own his/her experi-ences, where his/her actions are governed by ongoing knowledge obtained from the meditation rather than by reactions to the underlying impulse to act. Technically meditation involves learning to shift and focus one’s attention at will onto an object of choice, such as bodily feelings or an emotional experience, while disengaging from usual conditioned reactivity or elaborative processing. Meditation has been a part of many philosophies of human interaction and of spiritual and faith traditions for centuries, and universally seen as a healing process to calm the mind and refresh the spirit. Recent re-discovery of the value of meditation in the clinical context could be credited to many scholars including Jung (1933, 1969), Benson (1974), and Jon Kabat-Zinn (1990). Ultimately it has been mindfulness meditation, with a focus on heightened self-awareness and a key tenet of Yoga, which has captured the most attention. An example of this was Linehan’s (1993) discovery of this approach in her own emotional recovery and later her application of mindfulness meditation in her model of dialectical behavioral therapy, oriented to address the needs of some of our most complex patients.

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In this textbook by Dr. Basant Pradhan, we fi nd further integration and symptom specifi c applications of mindfulness meditation as well as other principles and skills from the broad system of Yoga for clinical intervention and treatment. However, the translation this time is conducted by a scholar who is thoroughly grounded in the Eastern tradition of Yoga but also highly conversant in Western empiricism. Dr. Pradhan received monastic training in Yoga but went on to pursue a career in the Western model of medicine as a physician-psychiatrist and empirical scholar. This means that he is truly a bi-cultural and bi-conceptual individual with a full under-standing of both domains and easily traverses from one to the other. In his model of Yoga-Mindfulness-Based Cognitive Therapy (Y-MBCT) which involves the clini-cal use of Yoga - meditation in its entirety , he not only applies mindfulness medita-tion in cognitive treatment, but also integrates other asanas (Yogic postures) and kriyas (Yogic procedures), which allows this model to be applied across not only many different behavioral and emotional disorders and problems but also in various psychosomatic disorders. The results are evident both conceptually in this textbook as well as clinically from my own vantage point as a close colleague and collaborator.

Dr. Pradhan is a rare individual in many ways. He is a true cultural bridge builder as would be expected more someone coming from an immigrant generation 1.5 background. He is truly a master of Western empirical neurosciences and cognitive sciences as well as Eastern philosophy, tradition, and wisdom, and translates across both easily. He also has deep respect for the cumulative wisdom in both traditions, which comes from his highly scholarly perspective. He is also a person of deep pas-sion and dedication to heal, which leads him to apply these concepts in such a man-ner that they are accessible both to the patient and to fellow clinicians. At the same time, as a scholar, he understands the need to apply empirical methods to the devel-opment of an objective evidence-base to match the cumulative wisdom behind many of his approaches.

This textbook is refl ective of Dr. Pradhan as a person, a healer-clinician, and a scholar. Having had the pleasure of knowing him for almost 5 years, it has been evident to me that in this textbook he has applied many of the principles that he shares with us in his daily life as well as his teaching, clinical work, and scholarship. He is also true believer in the concept of collective consciousness from which arise his dedication towards healing his fellow human beings, who he ultimately sees as part of his identity. Given this genuine source of motivation behind his work, I trust that his book will become a critical resource for an innovative form of psychother-apy that is at the same time more pragmatic as well as humanistic. Bridging the existing gap, it will contribute to improved access to effective psychotherapeutic services and effective treatment for many people from East and West.

Camden , NJ , USA Andres J. Pumariega , MD

Foreword

ix

References

Benson H, Beary J, Carol M (1974) The relaxation response. Psychiatry: Journal for the Study of Interpersonal Processes 37(1):37–46

Bodhi B (2000) The Noble Eightfold Path: way to the end of suffering. Pariyatti Publications, Onalaska

Feuerstein G (1979) The Yoga-Sutra of Patanjali. A new translation and commentary. Inner Traditions International, Rochester

Jung CG (1933) Modern man in search of a soul. Harcourt Brace & Co., New York Jung CG (1969) Psychology and religion: west and east. Princeton University Press, Princeton Kabat-Zinn J (1990) Full catastrophe living. Delacorte Press, New York Linehan MM (1993) Skills training manual for treating borderline personality disorder. Guilford

Press, New York Satchidananda S (1978) The Yoga Sutras of Patanjali: translations and commentary. Integral Yoga

Publications, Yogaville

Foreword

xi

About th e Author

Basant Pradhan , M.D . is an academic psychiatrist for children, adolescents and adults. He was born in India and completed his medical and psychiatric education there. Upon arriving in the United States in 2006, he repeated his psychiatric train-ing at the Albert Einstein Medical Center and Thomas Jefferson University, Philadelphia. He obtained psychodynamic psychotherapy training in adults and children from the Psychoanalytic Center of Philadelphia and cognitive behavioral therapy training from the Thomas Jefferson University. Pradhan’s journey in Yoga and meditation goes back to his childhood and he has been a privileged benefi ciary of monastic training in the scriptural traditions. In his personal life, he is a humani-tarian and active practitioner of Yoga and meditation. In his professional life, he has been a student of philosophy, psychotherapy, psycho-pharmacology and researcher of psychology, psychiatry and cognitive neurosciences. Currently he serves as an Assistant Professor of Psychiatry at the Cooper University Hospital and Copper Medical School of Rowan University, Camden, New Jersey, where he also serves as the founding director of the Yoga and Mindfulness Based Cognitive Therapy (Y-MBCT, therapy models compiled by Pradhan and colleagues) and the trans- cranial magnetic stimulation (TMS) treatment programs. Pradhan is an executive member of the Group for the Advancement of Psychiatry (GAP) and the American Psychiatric Association (APA)’s Caucus on Complementary, Alternative, and Integrative Medicine and currently serves the Editorial Advisory Board of Adolescent Psychiatry , the offi cial journal of the American Society for Adolescent Psychiatry. In addition to the Y-MBCT models of therapy for psychiatric disorders, Pradhan has compiled a wellness model, the Standardized Yoga Meditation Program for Stress Reduction (SYMPro-SR), the effi cacy of which is being tested in an ongo-ing manner in mental health and illness by him and colleagues. He has widely pre-sented his scholarly work in over 50 national conferences in India and USA and has authored or co-authored over 20 peer reviewed articles, editorials and book chap-ters. In a current ongoing research project, Pradhan and colleagues are comparing the effi cacy of ketamine (a novel medication that alters the trauma memories) and Y-MBCT in treatment refractory post-traumatic stress disorder (PTSD). Pradhan has been cited by the various newspapers and has won several awards in India and USA for his clinical, academic and research work.

xiii

Acknowledgments

Meditation is not an action; rather, it is a state of mind which is developed by a continuous and unfragmented stream of experience. In that sense, this book project, which has been continuously evolving in my mind from the early days of my monas-tic training until now, has been a meditation for me. I take this as an opportunity to express my profound gratitude to my mother, who was my fi rst spiritual teacher, and to my other teachers and mentors in the domains of monastic education, neuropsy-chiatry, and psychotherapy.

At a virtual front, I think this book has two celebrated coauthors who have pro-foundly inspired me with their clarity of thoughts and nobility of purpose. They are none other than the Buddha ( Siddhartha Gautama ) and the mythical sage Patanjali (author of the Yoga - Sutras , the fi rst text book of Yoga). At a real front, fi rst and foremost, I wish to thank my mentor Dr. Salman Akhtar, Professor of Psychiatry at Thomas Jefferson Medical College and a prolifi c writer and psychoanalytic thinker, for awakening the writing spirits in me (in the Tantra traditions of Yoga, this process is called awakening of the Kundalini energy ). I am immensely grateful to Dr. Andres Pumariega, Professor and Chair of Psychiatry at Cooper University Hospital, for his ongoing support as well as his wonderful collaborative efforts that have helped me immensely for integrating and applying this work to the mainstream medicine. I am grateful to all my patients, who through their direct clinical work involving Yoga and meditation have provided us clinical insight and inspiration to use these won-derful therapeutic tools. I am immensely thankful to Manna Pourrezaei, my research associate, for her tremendous help with editing many portions of this manuscript.

I am deeply grateful to a number of prominent people known to me through the academic circles and through the Psychoanalytic Center of Philadelphia. Some of them have inspired me by their work in Yoga and meditation, and some others have been quite informative through their discussions and suggestions in helping me bridge across the various intersections between their domains of work and Yoga and medita-tion. Prominent among these individuals are Drs. Daniel Freeman and Dwarkananth Rao, two prominent psychoanalysts; Dr. Andrew Newberg, Professor of Radiology and Director of Research at the Myrna Brind Center of Integrative Medicine, Thomas Jefferson University Hospital; Dr. Richard Gray, a researcher in the Post-traumatic Stress Disorder (PTSD) and one of my collaborators in application of Yoga and meditation in PTSD; and Dr. Lila Massoumi, Chair of the American Psychiatric Association’s Caucus on Complementary, Alternative, and Integrative Medicine.

xiv

I profusely thank to the wonderful editorial staff at the Springer Publishers International Inc. including Corinna Schaefer and the editorial staff of SPi Global, Chennai, India. Lastly but not the least, I thank Dr. Madhusmita Sahoo, who is simul-taneously my wife, intellectual inspiration, and critique. Her love, support, and healthy criticism provided the nurturing matrix essential for putting this book together. Practicing Yoga with her and my daughter Aarya has defi nitely helped me develop more calmness and perseverance to stay on this task.

Acknowledgments

xv

Contents

Part I Demystifi cation

1 Yoga: Original Concepts and History . . . . . . . . . . . . . . . . . . . . . . . . . 31.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.2 Yoga as a Mystery and Need for Demystifi cation . . . . . . . . . . . . . 4

1.2.1 Some Other Reasons for the Misconceptions . . . . . . . . . . . 51.3 Original Defi nitions of Yoga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

1.3.1 Yoga, Its Meanings and the Minor Conceptual Differences from the Samkhya . . . . . . . . . . . . . . . . . . . . . . 7

1.3.2 Various Forms of Yoga . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.4 Yoga: Origins and Scriptures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

1.4.1 Origins of Yoga from the Samkhya System in Ancient India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

1.4.2 The Oral Tradition of Yoga. . . . . . . . . . . . . . . . . . . . . . . . . 101.4.3 Sanskrit (Vedic) and Pali (Buddhist):

The Original Languages of Yogic Scriptures . . . . . . . . . . . 111.4.4 The Varieties of Yogic Scriptures . . . . . . . . . . . . . . . . . . . . 121.4.5 Patanjali’s Yoga Sutras: A Brief Summary . . . . . . . . . . . . . 141.4.6 Classics on Hatha Yoga . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

1.5 The Four Major Philosophical Systems of Yoga: The Vedas, Vedanta, Shramana, and Tantra . . . . . . . . . . . . . . . . . . 171.5.1 Yoga in the Vedas (Samkhya/Rig-Vedic Philosophy) . . . . . 171.5.2 Yoga in the Vedanta (Upanishads) . . . . . . . . . . . . . . . . . . . 181.5.3 Summary of Yoga in the Veda (Samkhya)

and Vedanta (Upanishad) . . . . . . . . . . . . . . . . . . . . . . . . . . 191.6 Great Contribution of the Shramanic (Non-Hindu)

Philosophies: Rise of Meditation in the System of Yoga . . . . . . . . 201.6.1 Yoga Versus Meditation . . . . . . . . . . . . . . . . . . . . . . . . . . . 211.6.2 Seminal Contributions of Gautama Buddha into

the Meditative System of Yoga. . . . . . . . . . . . . . . . . . . . . . 221.6.3 Buddha’s Middle Way . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

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1.7 Tantra: The Fourth and the Newest System of Yogic Philosophy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

1.8 Yogic Philosophies Bridge Across the Ideologies of All Four Schools: The Veda (Samkhya), Vedanta (Upanishads), Shramana, and Tantra. . . . . . . . . . . . . . . . . . . . . . . 24

1.9 History of Yoga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251.9.1 Yoga in Ancient India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261.9.2 Yoga in Medieval India . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261.9.3 Yoga in Modern India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271.9.4 Yoga Beyond India: Spread to the Far East . . . . . . . . . . . . 281.9.5 Yoga Beyond India: Spread to the West . . . . . . . . . . . . . . . 29

1.10 Some Further Clarifi cations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301.10.1 Spirituality Versus Religiousness . . . . . . . . . . . . . . . . . . . . 301.10.2 Yoga Is Not Religious . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

1.11 Concluding Remarks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

2 Yoga, Mind, and the Psychosomatics . . . . . . . . . . . . . . . . . . . . . . . . . . 372.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372.2 Yoga and the Mind (Consciousness, [Sans. chitta]):

Some Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382.3 Yogic Consciousness (Mind [Sans. chitta]) and Its

Varieties as the Meditator Ascends in the Meditative Path . . . . . . 402.4 Phenomenology of Human Experience and Role

of the Mind (Consciousness) in Its Creation . . . . . . . . . . . . . . . . . 412.5 Mind (Consciousness): A Bundle of Five

Things (Aggregates) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422.6 Central Problem Inherent in the Nature of the Mind:

Projection (Vikshepa) That Causes Illusion (Maya) and Ignorance (Avidya) About the Reality . . . . . . . . . . . . . . . . . . . 432.6.1 Reversal of the Projections Is the Key Mechanism

of Action of Yoga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 452.7 Models of the Mind (Consciousness) in the Yogic

Philosophies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462.7.1 The Monkey Metaphor: Explains the Inherently

Unstable Nature of the Mind . . . . . . . . . . . . . . . . . . . . . . . 462.7.2 The Tripartite Model of Human Experience:

The Projector Analogy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472.7.3 The Lake Model of Consciousness (Mind):

The Real Self Lies Deep Down in the Bottom . . . . . . . . . . 492.7.4 Yoga Sutras Says That Our Perception of Reality

Is Illusory Because of the Sensorial Mind . . . . . . . . . . . . . 49

Contents

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2.8 The Profound Psychosomatic Views Found in the Yogic Philosophies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 502.8.1 Mind and Stress: Yoga as the Remedy . . . . . . . . . . . . . . . . 522.8.2 Yogic Science as Mind–Body (Psychosomatic)

Medicine: Some Mechanisms. . . . . . . . . . . . . . . . . . . . . . . 532.8.3 Deep Connections Between Yoga and

the Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 532.9 Concluding Remarks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

3 Brain, Mind, and Soul: Bridging the Gap . . . . . . . . . . . . . . . . . . . . . . 573.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

3.1.1 Human Experience Is Tripartite: The One Who Sees (Seer/Self), the Scene (Object/World), and the Interpreting Interface (Mind) . . . . . . . . . . . . . . . . . . . . . . . 58

3.1.2 The Trilogy in the Human Existence: Body (Brain), Mind, and Soul . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

3.2 Brain: The Most Complex Organ of the Human Body. . . . . . . . . . 583.2.1 Facts About the Human Brain. . . . . . . . . . . . . . . . . . . . . . . 583.2.2 The Brain as an Important Locus of All

Experiences Including the Spiritual Experiences . . . . . . . . 603.2.3 More Recent Research on the Brain:

Top Brain and Bottom Brain. . . . . . . . . . . . . . . . . . . . . . . . 603.3 Concept of the Mind in Yoga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

3.3.1 Mind Is Graded: Lower to Higher. . . . . . . . . . . . . . . . . . . . 613.4 Soul: The Third Entity of Existence and Experience . . . . . . . . . . . 63

3.4.1 Soul and the Pure Awareness (Pure Experience) . . . . . . . . 643.5 Mapping Experiences onto the Brain:

The Neural Circuitry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 653.5.1 Visual Pattern Recognition: The Prototype

Process in Mapping Experiences onto the Brain . . . . . . . . 663.5.2 The Five Major Groups of Circuits in Our Brain . . . . . . . . 673.5.3 Functions of the Prefrontal Cortical (PFC) Tri-Circuit. . . . 683.5.4 Close Relationship Between the OFC and Amygdala . . . . 693.5.5 Frontal Tri-Circuits Modulate the Thalamus

(the Sensory Gate) and the Basal Ganglia . . . . . . . . . . . . . 703.5.6 A Scenario Illustrating the Functions of the

Prefrontal Tri-Circuits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 713.5.7 Role of Salience and Facilitated Circuits in the

Neural Mapping of Experience. . . . . . . . . . . . . . . . . . . . . . 733.5.8 The Main Players in the Meditative Brain . . . . . . . . . . . . . 74

Contents

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3.6 Experience is Representational and Knowledge (Insight) Changes These Representations . . . . . . . . . . . . . . . . . . . 753.6.1 Knowledge, Direct Experience, and Reality:

Three Synonyms in Yoga . . . . . . . . . . . . . . . . . . . . . . . . . 763.6.2 Knowledge (Insight [Pali Nana, Panna]) Is Graded. . . . . 773.6.3 Meditation as a Direct Experience: Beyond

the Realm of the Intellectual Mind . . . . . . . . . . . . . . . . . . 783.7 Meditative Process and Technique: Samyama

as Its Prototype. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 793.7.1 Knowing by Fusion: The Key Technique

in Samyama. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 803.7.2 Samyama Is a Two-Stage Process. . . . . . . . . . . . . . . . . . . 81

3.8 The Meditative Experiences: A Detailed Account . . . . . . . . . . . . . 823.8.1 Meditative Phenomenology and Parameters. . . . . . . . . . . 823.8.2 Losing the Sense of Time and Becoming

One with the Experience: The Hallmarks of Yogic Absorption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

3.8.3 Meditation from the Perspective of Cognitive Neuroscience: Central Role of One’s Attention . . . . . . . . 85

3.8.4 The Meditative Brain: Preliminary Understandings. . . . . 863.9 Yogic and Cognitive Neurosciences: Remarkable

Concurrences at Many Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873.9.1 Concurrence with Respect to Conceptualization

of Consciousness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 883.9.2 Concurrence with Respect to the Process of

Samyama (or Mindfulness): Metacognitive and Neural Paradigms of Consciousness . . . . . . . . . . . . . 89

3.9.3 Concurrence with Respect to Our Perception of Reality Versus Actual Reality: Map Versus Territory . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

3.9.4 Concurrence with Respect to Conceptualization of Memory (Sanskrit Smriti; Samskara) and Its Role in Construing Experience as the Perceived Reality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

3.10 Neural Models of Yoga and Meditation: Revisiting the Bottom-up or Top-Down Debate . . . . . . . . . . . . . . . . . . . . . . . 953.10.1 The Bottom-Up Model of Yoga and Meditation

(Pradhan 1998 onwards): Neurobiologically Informed, Standardized, and Compatible with Other Contemporary Models of Therapies . . . . . . . . . . . . . . . . . 96

3.10.2 Experience Can Change the Brain Structure and Functions: New Insights. . . . . . . . . . . . . . . . . . . . . . . 99

3.10.3 Experiences Can Change the Brain: Insights from Research on Psychotherapy . . . . . . . . . . . . . . . . . . . 100

3.10.4 Similarity Between Meditation and Psychotherapy . . . . . 1013.10.5 The Id, Ego, and Superego from a Neural Paradigm . . . . 102

3.11 Concluding Remarks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Contents

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Part II Standardization

4 Methods in Yoga and Mindfulness . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1114.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1114.2 Some General Information on Meditation . . . . . . . . . . . . . . . . . . . 112

4.2.1 Concentration (Centering of Consciousness; FA Type) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

4.2.2 Mindfulness (OM Type) . . . . . . . . . . . . . . . . . . . . . . . . . . . 1144.2.3 The Middle Way (Pali. Majjhima Patipada;

Madhyamaka): The Meditative Lifestyle . . . . . . . . . . . . . . 1154.3 Morphology of Meditation as Taught by Buddha

and Patanjali . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1164.3.1 Meditative Access States: The Jhanas

and Samapattis of Abhidhamma . . . . . . . . . . . . . . . . . . . . . 1164.3.2 The Jhanas (Contemplative Raptures) . . . . . . . . . . . . . . . . 1174.3.3 The Samapattis (Attainments) . . . . . . . . . . . . . . . . . . . . . . 1184.3.4 The Yogic/Meditative Consciousness and Its

Various Categories in the Abhidhamma . . . . . . . . . . . . . . . 1184.4 Description of the Key Techniques in Yoga and Meditation . . . . . 120

4.4.1 Technique of Concentrative Meditation (Focused Attention—FA [Sans. trataka]). . . . . . . . . . . . . . 120

4.4.2 Description of the Technique . . . . . . . . . . . . . . . . . . . . . . . 1224.4.3 Visual Trataka (Sans. Dristi Trataka):

Its Clinical Importance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1244.5 Techniques of Mindfulness Meditation

(Pali: Satipatthana). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1254.5.1 Two Stages of Right Mindfulness . . . . . . . . . . . . . . . . . . . . 1264.5.2 Bare Attention and Clear Comprehension:

The Two Pillars of Right Mindfulness . . . . . . . . . . . . . . . . 1264.5.3 The Four Stations of Mindfulness: Body,

State of Mind, Feelings, and Phenomena . . . . . . . . . . . . . . 1284.5.4 Actual Practice of Right Mindfulness Is Twofold

(Detailed Description Can Be Found in Nyanaponika, 1965, p. 85–107) . . . . . . . . . . . . . . . . . . . . . 130

4.5.5 Some Bare Instructions for of the Practice of Right Mindfulness (Nyanponika 1954, p. 61–63) . . . . . . . 131

4.6 Meditative Breathing (Sans. Pranayama): The Key Tool in Meditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1324.6.1 Standardizations in the Two Breathing

Meditations and Their Symptom-Specifi c Use in the Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT©) . . . . . . . . . . . . . . . . . . . . . 134

4.6.2 Breathing Techniques Versus Breathing Meditations: Key Distinctions . . . . . . . . . . . . . . . . . . . . . . 136

4.6.3 The Two Breathing Meditations in Terms of the Heart Rate Variability (HRV) . . . . . . . . . . . . . . . . . . . . 136

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

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5 Attempts at Standardization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1395.1 Standardization of Yoga and Meditation in Ancient

India: Primacy of Buddha’s Abhidhamma Pitaka and Patanjali’s Yoga Sutras. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

5.2 Buddha and His System of Standardization . . . . . . . . . . . . . . . . . . 1405.2.1 Elaboration on Buddha’s Standardization

of Mental Processes/Phenomena . . . . . . . . . . . . . . . . . . . . 1415.2.2 Buddha’s Standardization in the Phenomenological

Analysis of the Human Experience: The Five Aggregates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142

5.2.3 Buddha’s Standardization Involved in the Categorization of Human Consciousness . . . . . . . . . . . . . . 144

5.2.4 Buddha’s Standardization in the Analysis of Conditionality of the Human Existence . . . . . . . . . . . . . . . 145

5.2.5 Buddha’s Standardization of the Truths and the Way of Life: The Four Noble Truths and the Noble Eightfold Path. . . . . . . . . . . . . . . . . . . . . . . . . . . 146

5.3 Standardization in the Yoga Sutras of Patanjali: The Eight-Limbed Yoga (Raja Yoga) . . . . . . . . . . . . . . . . . . . . . . . 148

5.4 Buddha (Sixth Century BC) and Patanjali (Fourth Century BC): Concurrence of Views Between the Two Early Champions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150

5.5 The Subtle Difference Between the Meditative Methods of Buddha and Patanjali . . . . . . . . . . . . . . . . . . . . . . . . . 153

5.6 Tantra: Standardization of Yoga and Meditation Reaches Its Peak (Medieval and Modern India). . . . . . . . . . . . . . . 154

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

Part III Application

6 Yoga, Mindfulness, and Mentalization: Central Role of Attention and Compassion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1616.1 Attention, Empathy, and Compassion: The Key

Qualities in a Meditator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1616.1.1 Empathy and Compassion: Phenomenology

and Roots in the Four Noble Truths of Buddha . . . . . . . . . 1626.2 Meditation Is Part of Yoga and Mindfulness Is a

Type of Meditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1636.3 What Is Mindfulness? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

6.3.1 How Right Mindfulness (Satipatthana) Gives Rise to the Insights (Vipassana) and Subsequent Liberation (Nibbana)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165

6.4 Mentalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1666.4.1 Dimensions of Mentalization . . . . . . . . . . . . . . . . . . . . . . . 1676.4.2 Clarifi cation of Closely Related Terms. . . . . . . . . . . . . . . . 167

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6.5 Mapping Mindfulness and Mentalization onto Our Brain: Neural Correlates of Empathy, Self-Observation, and Mentalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1696.5.1 Neural Components Involved in Empathy . . . . . . . . . . . . . 1706.5.2 Neural Components Involved in Self-Observation

and Introspection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1716.5.3 Mirror Neuron System (MNS): The Neural Correlates

of Empathy and Meanings . . . . . . . . . . . . . . . . . . . . . . . . . 1726.5.4 Neural Correlates of Mentalization: The Mentalizing

Area of the Brain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1746.6 Therapeutic Use of Mindfulness and Mentalization:

The Third Wave of Cognitive Behavioral Therapies (CBT) . . . . . 1746.6.1 Mindfulness-Based Stress Reduction (MBSR). . . . . . . . . . 1766.6.2 Mentalization-Based Treatments (MBT) . . . . . . . . . . . . . . 176

6.7 Mindfulness-Based Cognitive Therapy (MBCT): Integrating Mindfulness with Cognitive Therapy. . . . . . . . . . . . . . . . . . . . . . . 1776.7.1 Differences Between CBT and MBCT . . . . . . . . . . . . . . . . 178

6.8 Concluding Remarks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180

7 Yoga and Mindfulness-Based Cognitive Therapy (Y-MBCT©): Use of Yoga in Its Entirety . . . . . . . . . . . . . . . . . . . . . . . 1837.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183

7.1.1 Seminal Contribution of the Buddha and Sage Patanjali in Laying Out the Early Foundations for Therapeutic Use of Yoga–Meditation. . . . . . . . . . . . . . . . . 185

7.2 Yoga as Psychotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1867.2.1 Yoga and Contemplative Psychotherapies

Including Psychoanalysis: A Comparison . . . . . . . . . . . . . 1887.2.2 Common Grounds Between Yoga and Contemplative

Psychotherapies Including Psychoanalysis. . . . . . . . . . . . . 1897.2.3 Other Similarities Between Yoga and Deep

Psychotherapies (Psychoanalysis) . . . . . . . . . . . . . . . . . . . 1907.2.4 Some Basic Differences Between the Yogic

Philosophies and Psychoanalysis . . . . . . . . . . . . . . . . . . . . 1927.3 Psychotherapeutic Use of Yoga in Its Entirety:

The Yoga–Mindfulness-Based Cognitive Therapy (Y-MBCT, Pradhan and Mishra 1998 onward) . . . . . . . . . . . . . . . 1937.3.1 The Specifi c Cognitive Behavioral Techniques

Used in the Y-MBCT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1957.3.2 More Descriptions of the Key Techniques

in the Y-MBCT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1967.3.3 SYMPro-SR and Y-MBCT Models: Evolution

and Preliminary Data on Effi cacy. . . . . . . . . . . . . . . . . . . . 1987.3.4 Preliminary Data from the Y-MBCT Clinic at

Cooper University Hospital . . . . . . . . . . . . . . . . . . . . . . . . 200

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7.3.5 Some Descriptions About the Basics of Y-MBCT Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201

7.3.6 The Staged Meditation Protocols (SMPs) and the Five- Factor Model of Human Experience as the Main Pillars of Y-MBCT . . . . . . . . . . . . . . . . . . . . . . . 203

7.3.7 Standardizations Involved in the Y-MBCT Models . . . . . . 2067.4 Uniqueness of the Y-MBCT as Psychotherapeutic Models . . . . . . 2077.5 TIMBER© (Trauma Interventions Using

Mindfulness- Based Extinction and Reconsolidation; Pradhan et al. 2012 Onward): A Prototype of the Y-MBCT Protocols. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212

8 Yoga in Maintenance of Psychophysical Health . . . . . . . . . . . . . . . . . 2178.1 Yoga and Meditation: Rationale and Feasibility

in Health care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2178.1.1 Why Yoga–Meditation if There Is a Pill? . . . . . . . . . . . . . . 219

8.2 Specifi c Effects of Yoga and Meditation on Brain and Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219

8.3 The Basic Dilemma of a Researcher When Testing the Effi cacy of Mind–Body Interventions . . . . . . . . . . . . . . . . . . . 2208.3.1 Methodologically Sound Clinical Trial

of Mindfulness Interventions: Essentials . . . . . . . . . . . . . . 2228.3.2 Effi cacy of Yoga and Meditation: Empirical

Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2238.4 Yoga in Maintenance of Psychophysical Health:

Attention and Memory Are the Main Tools . . . . . . . . . . . . . . . . . . 2248.4.1 Meditation, Attention, and the Default Mode

Network of the Brain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2258.4.2 The Basic Mechanisms Involved in Attention . . . . . . . . . . 2268.4.3 Basics of Memory and Its Various Categories . . . . . . . . . . 228

8.5 Attention and Memories in the Information Processing Model in Humans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2318.5.1 Utility of Yoga–Meditation in the Various Steps

in the Information Processing Model . . . . . . . . . . . . . . . . . 2328.5.2 Cellular Mechanisms of Long-Term Memory

and Connection with Yoga and Mindfulness . . . . . . . . . . . 2348.6 Practice of Yoga–Meditation: General Considerations. . . . . . . . . . 236

8.6.1 Integrated Posture [Sans. Asana] . . . . . . . . . . . . . . . . . . . . 2378.6.2 Obstacles to the Practice of Yoga–Meditation . . . . . . . . . . 238

8.7 Concluding Remarks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

Endorsements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243

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Introduc tion

This book is about a simple fact that calm and attentive observation of each moment of our ordinary life does bring extraordinary freshness and clarity to our experiences and makes this world a better place for us. To our relief, wonderful books are avail-able on this subject but books that truly bridge across Yoga and meditation and the many disciplines of science that deal with complexities of mind, body and their problems are really few. This is a book written by a meditator, clinician, academi-cian, and researcher which is meant not only for the aspirants of Yoga but also for patients, meditators, clinicians, academicians, and researchers. In doing so, one of my purposes has been to provide most of the information on Yoga and meditation through a single book, in a continuous stream. I am aware that despite this advan-tage, the ambitious purpose of a single book that could explain most of the things may pose some diffi culties in comprehending some of the technical aspects described in this book. For those situations, further readings given in the reference section can help. Based on ever-growing literature on this subject as well as my ongoing experiential, clinical and research knowledge on this subject, I have tried to de-mystify some of the misconceptions on Yoga-meditation, present them as theo-ries of mind from biological, psychological and cultural perspectives and how they can be used in relatively standardized and evidence based manner in both mental health and illnesses without losing their abstract essence in this standardization pro-cess. In the psychotherapeutic traditions, there has been always a need for types of psychotherapies that are not only innovative but also experiential, pragmatic as well as humanistic at the same time. The Yoga Mindfulness Based Cognitive Therapy (Y-MBCT) as described in this book is such a modality of therapy that not only combines the Western pragmatism of the Cognitive Behavioral Therapy (CBT) and Eastern wisdom of Yoga in its entirety but also delivers the therapy in an experien-tial, symptom/dysfunction specifi c, relatively standardized, culturally competent and client-centered way.

The eight chapters in this book tells the reader most of the aspects of Yoga including the philosophy, techniques and practice of Yoga-meditation as they were proposed originally; how Yoga through its evolution over a few thousand years became embraced by the dominant cultures across the globe; description of the pertinent spiritual and scientifi c literature that bridges across the mind body gaps and inspires the reader to think more and fi nally, the various techniques of Yoga-meditation and their psychotherapeutic utility. In order to organize my thoughts on

xxiv

these quite vast matters, I have divided this book into three sections: Fundamentals, Methods and Standardizations, and Application. The fi rst and last parts have three chapters each, while the second part has two chapters. The fi rst section (Part I),titled “Fundamentals”, opens with a chapter on historical evolution and basic concepts of yoga as proposed originally , i.e. not as religious rituals but as a science of con-sciousness describing the fundamental theories about mind and its profound role in creating the experience in us. This chapter dispels the popular myths of Yoga as a series of poses and emphasizes that Yoga is not twisting one’s body like a pretzel. The second chapter elaborates upon the intricacies of mind and Yoga as a profound psychosomatic science. This is followed by the fi nal chapter in this section which I think is the heart of this book. This chapter tries to bridge the gap between the body (brain) and the mind (Consciousness) and narrates Yoga-mindfulness from the para-digm of cognitive neurosciences.

The second section (Part II) of this book, titled “Methods and Standardizations” has chapters on the key techniques in Yoga and meditation as well as attempts at standardizing these methods. The chapter-4, the fi rst chapter in this section describes the key techniques of meditation to mend the mind : S amyama (combination of dharana , dhyana and samadhi , i.e. the 6th, 7th and 8th limbs of Patanjali ’ s Eight - Limbed Yoga ) which is the prototype of meditative process; concentrative medita-tion (with trataka / visually guided concentrative meditation as the prototype), and mindfulness meditation (Pali: sati patthana ) as adapted and further developed by the Buddha using his background in the Vedic and the Upanishadic knowledge of medi-tation. This chapter also mentions the fi ve integrated techniques adapted by this writer integrating the key techniques of Yoga-meditation as described in the original traditions with the various principles and techniques cognitive behavioral therapy (CBT) and, how these techniques can be used in symptom specifi c manner in both illness and wellness in evidence based medicine format. These techniques are men-tioned in the various portions of Chaps. 4 and 7 under the description of the Standardized Yoga Meditation Program for Stress Reduction (SYMPro-SR)/ Yoga - Mindfulness Based Cognitive Therapy (Y-MBCT) program compiled by this writer for their clinical and research use. The Chap. 5 describes the need for standardiza-tion and how it has been done over a few thousand years from the ancient times of Buddha and Patanjali till the recent times of tantra , the most modern school of Yoga. This chapter along with Chap. 7 will provide the reader with a fl avor of this author’s ongoing attempts at standardization.

The last section (Part III), titled “Applications” consists of the last three chapters of the book and describes the clinical and research utility of Yoga-meditation and also things to be considered in the research methodologies involving complex inter-ventions like Yoga-meditation. In Chap. 6 , I elucidate the key similarities as well as differences between three overarching concepts: Yoga , mindfulness and mentaliza-tion . In addition to describing the use of mindfulness and mentalization in the vari-ous psychotherapeutic formats, this chapter describes the key qualities in the meditators like empathy and compassion (Pali. karuna ) and the recent research on the role mirror neurons in it. The next chapter elaborates on the commonalities between Yoga and various psychotherapies starting from the healing traditions of

Introduction

xxv

the Buddha himself, entering into a comparison with psychoanalysis and conclud-ing with description of the Yoga-Mindfulnes Based Cognitive Therapy (Y-MBCT) model compiled and used by this writer both in his clinical and research work in an ongoing manner. The concluding chapter describes not only the rationale, feasibility and utility of Yoga and meditation in healthcare, but also the dilemma of researchers and suggests some solutions. Building upon the evidence that meditation is a sci-ence of cultivating one’s attention, this chapter describes the cognitive neuroscience models of attention and memory and how the key steps in this process can be rein-forced by techniques of meditation in order to ameliorate the sufferings of the cog-nitive disorders and the likes. This chapter concludes with a brief description of the general consideration as well as obstacles one may encounter in the practice of Yoga and meditation in one’s daily life.

The fundamental thrust of this book is to enhance the appreciation of Yoga and meditation as deep science of life which over the years has captured rapt attention of not only the lay people but also of the top scientists to the likes of Einstein and Oppenheimer. As mentioned before, this textbook has been a meditation for this writer and is refl ective of his personal and professional life. He hopes that the scien-tifi c rationale and the pragmatic, standardized as well as evidence based format of Yoga and meditation described in this book will be useful not only to the aspiring Yoga practitioners and patients but also will provide more impetus for furthering multi-centric research studies on utility of this ancient wisdom.

Camden, NJ, USA Basant Pradhan, MD

Introduction

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Introduction