The Nondual Awareness Dimensional Assessment (NADA): New tools to assess nondual traits and states of consciousness occurring within and beyond the context of meditation

Cultivating Self-Transcendence Through Meditation Practice: A Test of the Role of Meta-Awareness, (Dis)identification and Non-Reactivity

In this paper, we present a study comprising two distinct stages to examine the extent to which metacognitive processes of decentering facilitate the emergence of self-transcendence experiences in everyday life (i.e., the frequency of self-transcendent emotions, flow proneness, and adopting an interconnected identity). In the course of conducting this research, the first stage (N = 374) focused on assessing the structure and validity of the French version of the Metacognitive Processes of Decentering Scale (MPoD-t). Building on this, the second stage (N = 294) examined the potential relationship between meditative practices and psychological decentering processes (i.e., meta-awareness, (dis)identification with internal experiences, and (non)reactivity to thought content) and explored whether these mechanisms explain the association between meditative practices and the experience of self-transcendent states. Overall, the results demonstrated satisfactory psychometric properties of the French version of the MPoD and provided enhanced insights into the distinct mediating roles played by various decentering components in the manifestation of self-transcendence experiences in daily life. Indeed, the findings revealed that the relationship between practice and the occurrence of self-transcendent emotions or flow was mediated by the meta-awareness component, while the association between practice and the development of an interconnected identity was explained by the (dis)identification with internal experiences component. The implications of these findings are discussed.

Enhancing Chronic Non-Cancer Pain Management: A Systematic Review of Mindfulness Therapies and Guided Imagery Interventions

Background and Objectives: There has been an increasing interest in the use of non-pharmacological approaches for the multidimensional treatment of chronic pain. The aim of this systematic review was to assess the effectiveness of mindfulness-based therapies and Guided Imagery (GI) interventions in managing chronic non-cancer pain and related outcomes. Materials and Methods: Searching three electronic databases (Web of Science, PubMed, and Scopus) and following the PRISMA guidelines, a systematic review was performed on Randomized Controlled Trials (RCTs) and pilot RCTs investigating mindfulness or GI interventions in adult patients with chronic non-cancer pain. The Cochrane Risk of Bias Tool was utilized to assess the quality of the evidence, with outcomes encompassing pain intensity, opioid consumption, and non-sensorial dimensions of pain. Results: Twenty-six trials met the inclusion criteria, with most of them exhibiting a moderate to high risk of bias. A wide diversity of chronic pain types were under analysis. Amongst the mindfulness interventions, and besides the classical programs, Mindfulness-Oriented Recovery Enhancement (MORE) emerges as an approach that improves interoception. Six trials demonstrated that mindfulness techniques resulted in a significant reduction in pain intensity, and three trials also reported significant outcomes with GI. Evidence supports a significant improvement in non-sensory dimensions of pain in ten trials using mindfulness and in two trials involving GI. Significant effects on opioid consumption were reported in four mindfulness-based trials, whereas one study involving GI found a small effect with that variable. Conclusions: This study supports the evidence of benefits of both mindfulness techniques and GI interventions in the management of chronic non-cancer pain. Regarding the various mindfulness interventions, a specific emphasis on the positive results of MORE should be highlighted. Future studies should focus on specific pain types, explore different durations of the mindfulness and GI interventions, and evaluate emotion-related outcomes.

A Single-Session, 2-Hour Version of Mindfulness-Oriented Recovery Enhancement (One MORE) Improves Chronic Pain Patients' Pain-Related Outcomes Through 3-Month Follow-Up in a Randomized Controlled Trial

Introduction: Traditional, 8-week, mindfulness-based interventions can effectively treat chronic pain, but require a time and resource investment too burdensome for many patients and providers. The solution to this logistical challenge may be to distill the core, therapeutic elements of an efficacious 8-week, mindfulness-based intervention, Mindfulness-Oriented Recovery Enhancement (MORE), into a 2-h, single-session intervention. Methods: In this study, the authors conducted a waitlist-controlled, randomized clinical trial to assess the impact of a 2-h, single-session adaptation of MORE (i.e., One MORE) on chronic pain patients' (N = 40) pain-related outcomes through 3-month follow-up. Results: Results indicated that One MORE significantly improved chronic pain patients' pain catastrophizing (i.e., primary outcome; F = 9.97, p = 0.002), pain intensity (F = 26.58, p < 0.001), pain interference (F = 39.43, p < 0.001), physical function (F = 16.29, p < 0.001), sleep (F = 16.66, p < 0.001), anxiety (F = 12.54, p < 0.001), and depression (F = 17.48, p < 0.001). One MORE also significantly increased theoretically indicated therapeutic mechanisms through the 3-month follow-up: mindfulness, positive reappraisal, savoring, self-transcendence. Discussion: Study results are promising, and if replicated, would suggest that One MORE is a highly scalable, low-cost (e.g., sustainable), nonpharmacologic treatment for chronic pain. Clinical Trial Registration: NCT05194241.

Mindfulness-induced self-transcendence promotes universal love with consequent effects on opioid misuse

In addition to its health benefits, mindfulness has been theorized in classical contemplative frameworks to elicit self-transcendent experiences as a means of promoting universal love and compassion. Increasing feelings of love may be especially clinically relevant for the treatment of opioid misuse, in that addictive use of opioids dysregulates neurobiological processes implicated in the experience of love. Here we tested these hypotheses in a secondary analysis (n = 187) of data from a randomized clinical trial of Mindfulness-Oriented Recovery Enhancement (MORE) versus supportive psychotherapy for comorbid opioid misuse and chronic pain. At pre- and post-treatment, participants completed a measure of state self-transcendence immediately following a laboratory-based mindfulness task. Through 9-month follow-up, we assessed changes in universal love and opioid misuse. Participants also completed ecological momentary assessments of opioid craving during the 8-week study interventions and for the following month. Compared to supportive psychotherapy, participants in MORE reported significantly greater increases in mindfulness-induced self-transcendence, which mediated the effect of MORE on increased feelings of universal love. In turn, increases in universal love significantly predicted decreased opioid craving and lower odds opioid misuse through 1- and 9-month follow-ups, respectively. Findings suggest mindfulness-induced self-transcendence may promote feelings of universal love, with possible downstream benefits on reducing addictive behavior.

Clarifying and measuring the characteristics of experiences that involve a loss of self or a dissolution of its boundaries

Mystical experience, non-dual awareness, selflessness, self-transcendent experience, and ego-dissolution have become increasingly prominent constructs in meditation and psychedelic research. However, these constructs and their measures tend to be highly overlapping, imprecise, and poorly integrated with similar pathological experiences. The present study seeks to clarify the common factors involved in the characteristics of these experiences using precise distinctions across an array of experience contexts (including meditation, psychedelics, and psychopathology). Participants (N = 386) completed an online survey about an experience that involved either a dissolution of self-boundaries or a loss of selfhood. Confirmatory factor analyses resulted in 16 experience characteristics, including multiple types of changes in sense of self, co-occurring phenomenology, and cognitive and affective responses. Qualitative thematic analysis provided rich descriptions of experience characteristics. Taken together, results lead to a more specific measurement model and descriptive account of experiences involving a loss of self or self-boundary.

Effectiveness of four deconstructive meditative practices on well-being and self-deconstruction: study protocol for an exploratory randomized controlled trial

INTRODUCTION

The efficacy of interventions based on mindfulness and compassion has been demonstrated in both clinical and general population, and in different social contexts. These interventions include so-called attentional and constructive meditation practices, respectively. However, there is a third group, known as deconstructive meditation practices, which has not been scientifically studied. Deconstructive practices aim to undo maladaptive cognitive patterns and generate knowledge about internal models of oneself, others and the world. Although there are theoretical and philosophical studies on the origin of addiction to the self or on the mechanisms of action associated with the deconstruction of the self, there are no randomized controlled trials evaluating these techniques in either a healthy population or clinical samples. This study aims to evaluate the effect of three deconstructive techniques by comparing them to mindfulness in the general population.

METHODS AND ANALYSIS

A randomized controlled clinical trial will be conducted with about 240 participants allocated to four groups: (a) mindful breathing, (b) prostrations, according to Tibetan Buddhist tradition; (c) the Koan Mu, according to Zen Buddhist tradition; and (d) the mirror exercise, according to Toltec tradition. The primary outcome will be the qualities of the non-dual experience and spiritual awakening, measured by the Nondual Embodiment Thematic Inventory, assessed at pre- and post-treatment and at 3- and 6-month follow-ups. Other outcomes will be mindfulness, happiness, compassion, affectivity and altered state of consciousness. Quantitative data will be compared using mixed-effects linear regression models, and qualitative data will be analysed through thematic analysis and using the constant comparative method from grounded theory.

ETHICS AND DISSEMINATION

Approval was obtained from the Research Ethics Committee of Aragon, Spain. The results will be submitted to peer-reviewed specialized journals, and brief reports will be sent to participants on request.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05317754. Registered on August 2,2022.

A neurophenomenological approach to non-ordinary states of consciousness: hypnosis, meditation, and psychedelics

No contemporary unifying framework has been provided for the study of non-ordinary states of consciousness (NSCs) despite increased interest in hypnosis, meditation, and psychedelics. NSCs induce shifts in experiential contents (what appears to the experiencer) and/or structure (how it appears). This can allow the investigation of the plastic and dynamic nature of experience from a multiscale perspective that includes mind, brain, body, and context. We propose a neurophenomenological (NP) approach to the study of NSCs which highlights their role as catalysts of transformation in clinical practice by refining our understanding of the relationships between experiential (subjective) and neural dynamics. We outline the ethical implications of the NP approach for standard conceptions of health and pathology as well as the crucial role of experience-based know-how in NSC-related research and application.

Mindfulness-induced endogenous theta stimulation occasions self-transcendence and inhibits addictive behavior

Self-regulation is instantiated by theta oscillations (4 to 8 Hz) in neurons of frontal midline brain regions. Frontal midline theta (FMΘ) is inversely associated with default mode network (DMN) activation, which subserves self-referential processing. Addiction involves impaired self-regulation and DMN dysfunction. Mindfulness is an efficacious self-regulatory practice for treating addiction, but little is known about the mechanisms by which mindfulness reduces addictive behavior. In this mechanistic study of long-term opioid users (N = 165), we assessed meditation-induced FMΘ as a mediator of changes in opioid misuse. Relative to a supportive psychotherapy control, participants treated with Mindfulness-Oriented Recovery Enhancement (MORE) exhibited increased FMΘ during a laboratory-based meditation session. FMΘ during meditation was associated with self-transcendent experiences characterized by ego dissolution, nondual awareness, and bliss. MORE's effects on decreasing opioid misuse were mediated by increased FMΘ. Given the role of aberrant self-referential processing in addiction, mindfulness-induced endogenous theta stimulation might "reset" DMN dysfunction to inhibit addictive behavior.

Beyond the veil of duality-topographic reorganization model of meditation

Meditation can exert a profound impact on our mental life, with proficient practitioners often reporting an experience free of boundaries between a separate self and the environment, suggesting an explicit experience of "nondual awareness." What are the neural correlates of such experiences and how do they relate to the idea of nondual awareness itself? In order to unravel the effects that meditation has on the brain's spatial topography, we review functional magnetic resonance imaging brain findings from studies specific to an array of meditation types and meditator experience levels. We also review findings from studies that directly probe the interaction between meditation and the experience of the self. The main results are (i) decreased posterior default mode network (DMN) activity, (ii) increased central executive network (CEN) activity, (iii) decreased connectivity within posterior DMN as well as between posterior and anterior DMN, (iv) increased connectivity within the anterior DMN and CEN, and (v) significantly impacted connectivity between the DMN and CEN (likely a nonlinear phenomenon). Together, these suggest a profound organizational shift of the brain's spatial topography in advanced meditators-we therefore propose a topographic reorganization model of meditation (TRoM). One core component of the TRoM is that the topographic reorganization of DMN and CEN is related to a decrease in the mental-self-processing along with a synchronization with the more nondual layers of self-processing, notably interoceptive and exteroceptive-self-processing. This reorganization of the functionality of both brain and self-processing can result in the explicit experience of nondual awareness. In conclusion, this review provides insight into the profound neural effects of advanced meditation and proposes a result-driven unifying model (TRoM) aimed at identifying the inextricably tied objective (neural) and subjective (experiential) effects of meditation.

Mindfulness-Oriented Recovery Enhancement for Addictive Behavior, Psychiatric Distress, and Chronic Pain: A Multilevel Meta-Analysis of Randomized Controlled Trials

Objectives

Methods

Results

Conclusions

Meta-analysis Pre-registration: PROSPERO #CRD42022319006

Supplementary Information

Pharmacological, neural, and psychological mechanisms underlying psychedelics: A critical review

This paper provides a critical review of several possible mechanisms at different levels of analysis underlying the effects and therapeutic potential of psychedelics. At the (1) biochemical level, psychedelics primarily affect the 5-HT_2A receptor, increase neuroplasticity, offer a critical period for social reward learning, and have anti-inflammatory properties. At the (2) neural level, psychedelics have been associated with reduced efficacy of thalamo-cortical filtering, the loosening of top-down predictive signaling and an increased sensitivity to bottom-up prediction errors, and activation of the claustro-cortical-circuit. At the (3) psychological level, psychedelics have been shown to induce altered and affective states, they affect cognition, induce belief change, exert social effects, and can result in lasting changes in behavior. We outline the potential for a unifying account of the mechanisms underlying psychedelics and contrast this with a model of pluralistic causation. Ultimately, a better understanding of the specific mechanisms underlying the effects of psychedelics could allow for a more targeted therapeutic approach. We highlight current challenges for psychedelic research and provide a research agenda to foster insight in the causal-mechanistic pathways underlying the efficacy of psychedelic research and therapy.

The Distinctive Mindfulness of Dzogchen: Jigme Lingpa’s Advice on Meta-Awareness and Nondual Meditation

For Indian Buddhists and their Tibetan successors, the faculty of “mindfulness” (Skt. smṛti, Tib. dran pa) has been interpreted as the foundation of the threefold development of wisdom (study, reflection, cultivation). Such a model was, in Tibet, the hallmark of the gradual approach to awakening, whereas in the simultaneous approach, the state beyond ordinary mindfulness was emphasized. The complementarity of both approaches has been an essential issue, especially for the Nyingma tradition, which holds the direct teaching of Dzogchen to be the penultimate. To elucidate the operations of mindfulness in this context, this paper analyzes two guidance texts on mindfulness by Rigdzin Jigme Lingpa (1730–1798), Ocean of Qualities: Advice on Mindfulness and Cudgel to Discern the Real: Advice that Shines from Mindfulness and Meta-Awareness, the latter translated into English for the first time in this paper. As this study shows, Jigme Lingpa articulates a twofold typology of mindfulness, first a mindfulness that is effortful and conditioned, and secondarily the distinctive mindfulness of Dzogchen that is inseparable from pure awareness or rigpa (rig pa). Jigme Lingpa thus applies mindfulness to integrate Buddhist teachings and make sense of alternative modes of practice along the Dzogchen path.

Psychedelic Microdosing, Mindfulness, and Anxiety: A Cross-Sectional Mediation Study

While anecdotal reports claim that psychedelic microdosing reduces anxiety and mood symptoms, evidence supporting these claims is scarce. This cross-sectional study investigated the association between microdosing and trait anxiety. Furthermore, it was investigated if trait mindfulness mediated this association. Participants completed anonymous online questionnaires and were divided into three groups: current microdosers (n = 186), former microdosers (n = 77) and microdosing-naïve controls (n = 234). Trait anxiety and trait mindfulness were measured using the State-Trait Anxiety Inventory - Trait subscale (STAI-T) and the 15-item Five-Facet Mindfulness Questionnaire (FFMQ-15) respectively. Current and former microdosers reported lower STAI-T scores compared to microdosing-naïve controls. Furthermore, associations of current and former microdosing with trait anxiety were mediated by trait mindfulness, with small effects of FFMQ-15 Total, Non-judging and Non-reactivity scores. However, in an exploratory analysis, all associations between microdosing and STAI-T scores became non-significant when participants with previous macrodose experience (n = 386) were excluded. Our findings suggest that RCT<apos;>s are warranted to test causal hypotheses concerning the effects of microdosing and the role of trait mindfulness in the effects of microdosing, while controlling for previous macrodose experience.

Examining the Relation Between Practicing Meditation and Having Peak Experiences and Lucid Dreams. A Cross-Sectional Study

The aim of this study was to compare meditators and non-meditators in terms of their tendency to have peak experiences and their dream lucidity, while examining the associations between these outcomes and some related variables such as non-dual awareness, mindfulness facets and absorption. In this cross-sectional study, 237 participants from general Spanish population completed an online survey that included ad hoc questions related to the study aim, along with the Five Facet Mindfulness Questionnaire (FFMQ), the Non-dual Embodiment Thematic Inventory (NETI), the Tellegen Absorption Scale (TAS) and the Lucidity and Consciousness in Dreams Scale (LUCID). Of the total, 110 participants were identified as meditators and 127 as non-meditators. More than half of the sample (58.2%) reported having experienced at least one peak experience in their life; these showed no differences in the number, intensity, or self-inducing ability of these experiences between both groups but were significantly more common among meditators (71.8% vs. 46.8%; p < 0.001), who also presented higher scores in most of the questionnaires, except for some LUCID subscales. Regression models demonstrated that being a meditator was a significant predictor of having had a peak experience, but not of LUCID scores. These results, which need to be interpreted considering the study limitations, support the potential of meditation to facilitate having peak experiences, while its impact on lucid dreams remains unclear.

Potential processes of change in MDMA-Assisted therapy for social anxiety disorder: Enhanced memory reconsolidation, self-transcendence, and therapeutic relationships

OBJECTIVE

Researchers have suggested that psychotherapy may be enhanced by the addition of 3,4-methylenedioxymethamphetamine (MDMA), particularly in the treatment of disorders wherein interpersonal dysfunction is central, such as social anxiety disorder. We review literature pertaining to three potential processes of change that may be instigated during sessions involving MDMA administration in the treatment of social anxiety disorder.

DESIGN

This is a narrative review that integrates research on the etiology and maintenance of social anxiety disorder and mechanisms of action of MDMA to examine how MDMA may enhance psychotherapy outcomes.

RESULTS

We first outline how MDMA may enhance memory reconsolidation in social anxiety disorder. We then discuss how MDMA may induce experiences of self-transcendence and self-transcendent emotions such as compassion, love, and awe; and how these experiences may be therapeutic in the context of social anxiety disorder. We subsequently discuss the possibility that MDMA may enhance the strength and effectiveness of the therapeutic relationship which is a robust predictor of outcomes across many disorders as well as a potential key ingredient in treating disorders where shame and social disconnection are central factors.

CONCLUSION

We discuss how processes of change may extend beyond the MDMA dosing sessions themselves.

Complex Moral Injury: Shattered Moral Assumptions

An infographic model of moral injury (MI) is introduced in this conceptual paper that distinguishes the development of a worldview discrepancy-induced genus of MI, called complex moral injury (C-MI), from a standard expression of moral injury (S-MI), clearly delineated as perpetration-focused and a violation of moral belief in the contemporary view. It builds upon a previous essay that examined the potential of paradoxical circumstance (e.g., clashes of value, competing moral expectations, and moral paradox) to inflict MI among military personnel during wartime (Fleming in J Relig Health 60(5):3012-3033, 2021). Accordingly, it heeds Litz et al.'s recommendation to expand the research of MI beyond the effects of perpetration and investigate the impact of morally injurious events that shake one's core moral beliefs about the world and self (Litz et al. in Clin Psychol Rev 29(8):695-706, 2009). A review of definitional, scale, and qualitative studies shows evidence of a nuanced and complex form of MI that presents as moral disorientation and is a response to a disruption and subsequent failure of foundational moral beliefs to adequately appraise ethical problems and inform moral identity. Interrelations between MI, assumptive world, and meaning theories suggest the mechanism of C-MI and potential therapies. Case studies from a Veterans Administration hospital in the United States and a walk through the diagram will help illustrate the model. Clinical implications of a definition that includes morally injurious events that shatter fundamental moral assumptions are discussed. The role of chaplains in facilitating acceptance and meaning-making processes is recommended for C-MI recovery. Acknowledging the model's need for empirical support, a plausible scale is discussed for future research.

Virtual Reality as a Moderator of Psychedelic-Assisted Psychotherapy

Psychotherapy with the use of psychedelic substances, including psilocybin, lysergic acid diethylamide (LSD), ketamine, and 3,4-methylenedioxymethamphetamine (MDMA), has demonstrated promise in treatment of post-traumatic stress disorder (PTSD), anxiety, addiction, and treatment-resistant depression. Psychedelic-assisted psychotherapy (PP) represents a unique psychopharmacological model that leverages the profound effects of the psychedelic experience. That experience is characterized by strong dependency on two key factors: participant mindset and the therapeutic environment. As such, therapeutic models that utilize psychedelics reflect the need for careful design that promotes an open, flexible, trusting mindset and a supportive setting. To meet this need, the PP model is increasingly supplemented by auxiliary methods, including meditation, relaxation, visualization or spiritual practices. We suggest virtual reality (VR) as a full-spectrum tool able to capitalize on and catalyze the innately therapeutic aspects of the psychedelic experience, such as detachment from familiar reality, alteration of self-experience, augmentation of sensory perception and induction of mystical-type experiences. This is facilitated by VR’s evidenced capacity to: aid relaxation and reduce anxiety; buffer from external stimuli; promote a mindful presence; train the mind to achieve altered states of consciousness (ASC); evoke mystical states; enhance therapeutic alliance and encourage self-efficacy. While these unique VR features appear promising, VR’s potential role in PP remains speculative due to lack of empirical evidence on the combined use of VR and PP. Given the increased commercial interest in this synergy there is an urgent need to evaluate this approach. We suggest specific VR models and their role within PP protocols to inspire future direction in scientific research, and provide a list of potential disadvantages, side effects and limitations that need to be carefully considered. These include sensory overstimulation, cyber-sickness, triggering memories of past traumatic events as well as distracting from the inner experience or strongly influencing its contents. A balanced, evidence-based approach may provide continuity across all phases of treatment, support transition into and out of an ASC, deepen acute ASC experiences including mystical states and enrich the psychotherapeutic process of integration. We conclude that the potential application of VR in modulating psychedelic-assisted psychotherapy demands further exploration and an evidence-based approach to both design and implementation.

Validation of the Psychological Insight Scale: A new scale to assess psychological insight following a psychedelic experience

INTRODUCTION

As their name suggests, 'psychedelic' (mind-revealing) compounds are thought to catalyse processes of psychological insight; however, few satisfactory scales exist to sample this. This study sought to develop a new scale to measure psychological insight after a psychedelic experience: the Psychological Insight Scale (PIS).

METHODS

The PIS is a six- to seven-item questionnaire that enquires about psychological insight after a psychedelic experience (PIS-6) and accompanied behavioural changes (PIS item 7). In total, 886 participants took part in a study in which the PIS and other questionnaires were completed in a prospective fashion in relation to a planned psychedelic experience. For validation purposes, data from 279 participants were analysed from a non-specific 'global psychedelic survey' study.

RESULTS

Principal components analysis of PIS scores revealed a principal component explaining 73.57% of the variance, which displayed high internal consistency at multiple timepoints throughout the study (average Cronbach's α = 0.94). Criterion validity was confirmed using the global psychedelic survey study, and convergent validity was confirmed via the Therapeutic-Realizations Scale. Furthermore, PIS scores significantly mediated the relationship between emotional breakthrough and long-term well-being.

CONCLUSION

The PIS is complementary to current subjective measures used in psychedelic studies, most of which are completed in relation to the acute experience. Insight - as measured by the PIS - was found to be a key mediator of long-term psychological outcomes following a psychedelic experience. Future research may investigate how insight varies throughout a psychedelic process, its underlying neurobiology and how it impacts behaviour and mental health.

Psychedelics alter metaphysical beliefs

Can the use of psychedelic drugs induce lasting changes in metaphysical beliefs? While it is popularly believed that they can, this question has never been formally tested. Here we exploited a large sample derived from prospective online surveying to determine whether and how beliefs concerning the nature of reality, consciousness, and free-will, change after psychedelic use. Results revealed significant shifts away from 'physicalist' or 'materialist' views, and towards panpsychism and fatalism, post use. With the exception of fatalism, these changes endured for at least 6 months, and were positively correlated with the extent of past psychedelic-use and improved mental-health outcomes. Path modelling suggested that the belief-shifts were moderated by impressionability at baseline and mediated by perceived emotional synchrony with others during the psychedelic experience. The observed belief-shifts post-psychedelic-use were consolidated by data from an independent controlled clinical trial. Together, these findings imply that psychedelic-use may causally influence metaphysical beliefs-shifting them away from 'hard materialism'. We discuss whether these apparent effects are contextually independent.

The Paths to Connectedness: A Review of the Antecedents of Connectedness to Nature

Although many philosophers and environmental psychologists agree that progress toward a more ecologically conscious society depends upon individuals developing a sense of connectedness to nature, such agreement is of limited use if we do not understand how connectedness forms. The purpose of this review is to delineate the state of the psychological literature concerning the antecedents of connectedness to nature. The literature review is organized into three main sections: (1) situational contexts that influence connectedness; (2) individual difference predictors, such as demographic group membership, personality, or beliefs; and (3) internal psychological states that may explain psychological processes that result in connectedness. Major critiques of the extant literature and future directions are presented in a discussion following the body of the review. The primary implications highlighted by the review are a greater need for theories delineating the formation of connectedness, a greater focus on process, and increased differentiation between similar antecedents of connectedness.

From Self-Esteem to Selflessness: An Evidence (Gap) Map of Self-Related Processes as Mechanisms of Mindfulness-Based Interventions

Self-related processes (SRPs) have been theorized as key mechanisms of mindfulness-based interventions (MBIs), but the evidence supporting these theories is currently unclear. This evidence map introduces a comprehensive framework for different types of SRPs, and how they are theorized to function as mechanisms of MBIs (target identification). The evidence map then assesses SRP target engagement by mindfulness training and the relationship between target engagement and outcomes (target validation). Discussion of the measurement of SRPs is also included. The most common SRPs measured and engaged by standard MBIs represented valenced evaluations of self-concept, including rumination, self-compassion, self-efficacy, and self-esteem. Rumination showed the strongest evidence as a mechanism for depression, with other physical and mental health outcomes also supported. Self-compassion showed consistent target engagement but was inconsistently related to improved outcomes. Decentering and interoception are emerging potential mechanisms, but their construct validity and different subcomponents are still in development. While some embodied self-specifying processes are being measured in cross-sectional and meditation induction studies, very few have been assessed in MBIs. The SRPs with the strongest mechanistic support represent positive and negative evaluations of self-concept. In sum, few SRPs have been measured in MBIs, and additional research using well-validated measures is needed to clarify their role as mechanisms.

Implicit-explicit gradient of nondual awareness or consciousness as such

Consciousness is multi-dimensional but is most often portrayed with a two-dimensional (2D) map that has global levels or states on one axis and phenomenal contents on the other. On this map, awareness is conflated either with general alertness or with phenomenal content. This contributes to ongoing difficulties in the scientific understanding of consciousness. Previously, I have proposed that consciousness as such or nondual awareness-a basic non-conceptual, non-propositional awareness in itself free of subject-object fragmentation-is a unique kind that cannot be adequately specified by this 2D map of states and contents. Here, I propose an implicit-explicit gradient of nondual awareness to be added as the z-axis to the existing 2D map of consciousness. This gradient informs about the degree to which nondual awareness is manifest in any experience, independent of the specifics of global state or local content. Alternatively, within the multi-dimensional state space model of consciousness, nondual awareness can be specified by several vectors, each representing one of its properties. In the first part, I outline nondual awareness or consciousness as such in terms of its phenomenal description, its function and its neural correlates. In the second part, I explore the implicit-explicit gradient of nondual awareness and how including it as an additional axis clarifies certain features of everyday dualistic experiences and is especially relevant for understanding the unitary and nondual experiences accessed via different contemplative methods, mind-altering substances or spontaneously.

Moral Injury and the Absurd: The suffering of moral paradox

Drawing upon qualitative and construct validity evidence within MI research and the oral histories of combat-exposed Veterans, this paper explores the role of moral paradox (MP) as a precondition of moral injury (MI). Research is recommended to clearly delineate MP as a causative factor leading to more intractable cases of MI in the definitional literature, beyond the recognized impact of perpetration and betrayal-based conditions. Veteran stories collected during the normal course of providing spiritual care to combat-exposed Veterans and used by permission will provide insight into the theoretical concepts and interrelations of MP; proposed here as: circumstances in which moral obligations and/or ethical values come into conflict, forcing a choice between sides, none of which can be honored without violating the other. Acquainted with religious traditions that elucidate the perplexity and liberating effects of paradox, the work of Chaplains will also be recommended to address the problem of MP in wartime situations, highlighting the efficacy of acceptance-based spiritual interventions and therapeutic programs. Psychological and spiritual interventions that facilitate self-transcendence and non-dual awareness through experiential acceptance and a subscale measuring paradox-induced injury will be recommended for future research as well.

Modeling the mindfulness-to-meaning theory's mindful reappraisal hypothesis: Replication with longitudinal data from a randomized controlled study

The Mindfulness to Meaning Theory provides a detailed process model of the mechanisms by which mindfulness may promote well-being. Central to the Mindfulness to Meaning Theory is the mindful reappraisal hypothesis (MRH), which suggests mindfulness training promotes well-being by facilitating positive reappraisal. Emerging evidence from interconnected domains of research supports the MRH. However, it remains unclear whether mindful reappraisal continues to develop after a mindfulness training course and whether this continued development encourages well-being over time. As such, this randomized controlled study compared participants receiving a mindfulness-based stress reduction (MBSR) course with participants receiving no mindfulness training on positive reappraisal use and well-being over the course of 6 years. Latent growth curve modeling revealed that mindfulness training increased well-being by significantly increasing the trajectory of positive reappraisal over time. The MRH was then unpacked by examining whether MBSR also stimulated decentering and broadened awareness, core components of the MRH. Multivariate path analysis revealed that mindfulness training increased decentering, which in turn broadened awareness, which was then associated with positive reappraisal, ultimately promoting well-being. Taken together, these findings suggest that MBSR cultivates a downstream cascade of adaptive psychological processes that continue to promote quality of life 6-years after mindfulness training.

3-Doors Compassion Project: Examining the longitudinal effects of a nine-month Tibetan mind-body meditation program

Abundant research supports the benefits of participating in mindfulness meditation training programs including Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy. However, these well researched programs include a narrow range of meditation practices and research to date has minimally examined how home practice associates with favorable outcomes. The present study evaluated the 3 Doors Compassion Project (3DCP), a structured 9-months meditation program that teaches Tibetan Mind-Body practices and examined how frequency and duration of home practice associated with favorable outcomes. Twenty-seven medical and mental healthcare professionals completed assessments prior to, during, and following participation in the 3DCP program and recorded daily meditation practices. Study aims were to test general effectiveness of the 3DCP program and to test the hypotheses that frequency and duration of meditation home-practice would associate with improvements on mindfulness, stress, and depression. General linear mixed modeling demonstrated significant improvements throughout the duration of the 3DCP program for mindfulness, depression (p < .001) and stress (p < .05), with each variable evidencing incremental monthly improvements. Frequency of meditation (i.e., days practiced per month), but not time (i.e., minutes per month) was significantly associated with improvements throughout the 3DCP program. Results provide support for the benefits of the 3DCP while offering clinically useful information that can inform current guidelines for meditation home practice. As predicted, the 3DCP was associated with significant improvements on all outcomes. Favorable outcomes were linked to frequency, but not total time of meditation practice, which suggests that consistent meditation may be more helpful than extended meditation.

The Minimal Phenomenal Experience questionnaire (MPE-92M): Towards a phenomenological profile of "pure awareness" experiences in meditators

Objective

To develop a fine-grained phenomenological analysis of “pure awareness” experiences in meditators.

Methods

An online survey in five language versions (German, English, French, Spanish, Italian) collected data from January to March 2020. A total of 92 questionnaire items on a visual analogue scale were submitted to exploratory and confirmatory factor analysis.

Results

Out of 3627 submitted responses, 1403 were usable. Participants had a median age of 52 years (range: 17–88) and were evenly split between men and women (48.5% vs 50.0%). The majority of meditators practiced regularly (77.3%), were free of diagnosed mental disorders (92.4%) and did not regularly use any psychoactive substances (84.0%). Vipassana (43.9%) followed by Zen (34.9%) were the most frequently practiced meditation techniques. German (63.4%) and English (31.4%) were by far the most frequent questionnaire languages. A solution with 12 factors explaining 44% of the total variance was deemed optimal under joint conceptual and statistical considerations. The factors were named “Time, Effort and Desire,” “Peace, Bliss and Silence,” “Self-Knowledge, Autonomous Cognizance and Insight,” “Wakeful Presence,” “Pure Awareness in Dream and Sleep,” “Luminosity,” “Thoughts and Feelings,” “Emptiness and Non-egoic Self-awareness,” “Sensory Perception in Body and Space,” “Touching World and Self,” “Mental Agency,” and “Witness Consciousness.” This factor structure fit the data moderately well.

Conclusions

We have previously posited a phenomenological prototype for the experience of “pure awareness” as it occurs in the context of meditation practice. Here we offer a tentative 12-factor model to describe its phenomenal character in a fine-grained way. The current findings are in line with an earlier study extracting semantic constraints for a working definition of minimal phenomenal experience.

The Mindfulness-Oriented Recovery Enhancement Fidelity Measure (MORE-FM): Development and Validation of a New Tool to Assess Therapist Adherence and Competence

OBJECTIVE

Mindfulness-Oriented Recovery Enhancement (MORE) is a mind-body therapy that unites complementary aspects of mindfulness training, third-wave cognitive behavioral therapy (CBT), and principles from positive psychology into an integrative treatment for addiction and its comorbidities. As interest in MORE has grown among researchers and clinicians, there is an increasing need to provide quality assurance measures to ensure treatment integrity during implementation of MORE. Here, we describe the development and validation of the Mindfulness-Oriented Recovery Enhancement Fidelity Measure (MORE-FM).

METHOD

We developed a 17-item scale assessing therapist competence and adherence to the MORE treatment manual, which was then used for fidelity monitoring of 40 MORE treatment sessions across two Stage 2 and two Stage 1 RCT for addictive behaviors (e.g., opioid misuse, obesity) involving a total N = 295.

RESULTS

Internal consistency for the Adherence (α =.89) and Competence subscales (α =.92) was high, and interrater reliability was adequate (Adherence subscale ICC =.77; Competence subscale ICC =.51), with therapists exhibiting good-to-excellent levels of fidelity across all trials. Importantly, linear mixed modeling indicated that higher levels of overall fidelity were associated with greater reductions in opioid misuse across two Stage 2 RCTs (F_1,48.00 = 7.38, p=.009), indicating that the MORE-FM is a valid measure of treatment fidelity that can predict clinical outcomes.

CONCLUSIONS

Findings from this study yielded insights for future iterations of the MORE-FM. In sum, the MORE-FM is a valuable tool for assessing and enhancing the integrity of MORE in future research trials and clinical applications.

Endogenous theta stimulation during meditation predicts reduced opioid dosing following treatment with Mindfulness-Oriented Recovery Enhancement

Veterans experience chronic pain at greater rates than the rest of society and are more likely to receive long-term opioid therapy (LTOT), which, at high doses, is theorized to induce maladaptive neuroplastic changes that attenuate self-regulatory capacity and exacerbate opioid dose escalation. Mindfulness meditation has been shown to modulate frontal midline theta (FMT) and alpha oscillations that are linked with marked alterations in self-referential processing. These adaptive neural oscillatory changes may promote reduced opioid use and remediate the neural dysfunction occasioned by LTOT. In this study, we used electroencephalography (EEG) to assess the effects of a mindfulness-based, cognitive training intervention for opioid misuse, Mindfulness-Oriented Recovery Enhancement (MORE), on alpha and theta power and FMT coherence during meditation. We then examined whether these neural effects were associated with reduced opioid dosing and changes in self-referential processing. Before and after 8 weeks of MORE or a supportive psychotherapy control, veterans receiving LTOT (N = 62) practiced mindfulness meditation while EEG was recorded. Participants treated with MORE demonstrated significantly increased alpha and theta power (with larger theta power effect sizes) as well as increased FMT coherence relative to those in the control condition-neural changes that were associated with altered self-referential processing. Crucially, MORE significantly reduced opioid dose over time, and this dose reduction was partially statistically mediated by changes in frontal theta power. Study results suggest that mindfulness meditation practice may produce endogenous theta stimulation in the prefrontal cortex, thereby enhancing inhibitory control over opioid dose escalation behaviors.

The Questionnaire on Self-Transcendence (QUEST): A Measure of Trait Self-Transcendence Informed by Contextual Cognitive Behavioral Therapies

Self-transcendence is thought to increase well-being and is implicitly promoted in contextual cognitive behavioral therapies (CCBTs). This study conceptualizes, develops, and validates the first comprehensive CCBT-informed self-transcendence questionnaire. Using a CCBT-informed theory, we propose four self-transcendence facets: distancing oneself from mental content, distinguishing an observer of mental experience that is separate from the content of experience, experiencing innate connectedness with other beings, and noticing the constantly changing nature of experience. We measured these facets with items from existing relevant questionnaires and novel, expert-informed items. Exploratory factor analyses and bifactor exploratory structural equation models supported the first three of these facets. Those factors evidenced convergent validity with decentering, defusion, experiential avoidance, and mindfulness, and criterion and incremental validity in predicting psychological well-being. Our findings support a CCBT-informed model of self-transcendence, introduce the first instrument to comprehensively measure the self-transcendence facets we identified, indicate links with well-being, and suggest future intervention targets.

A Review on Research and Evaluation Methods for Investigating Self-Transcendence

Self-transcendence has been characterized as a decrease in self-saliency (ego disillusionment) and increased connection, and has been growing in research interest in the past decade. Several measures have been developed and published with some degree of psychometric validity and reliability. However, to date, there has been no review systematically describing, contrasting, and evaluating the different methodological approaches toward measuring self-transcendence including questionnaires, neurological and physiological measures, and qualitative methods. To address this gap, we conducted a review to describe existing methods of measuring self-transcendence, evaluate the strengths and weaknesses of these methods, and discuss research avenues to advance assessment of self-transcendence, including recommendations for suitability of methods given research contexts.

Understanding the Nature of Oneness Experience in Meditators Using Collective Intelligence Methods

Research on meditation and mindfulness practice has flourished in recent years. While much of this research has focused on well-being outcomes associated with mindfulness practice, less research has focused on how perception of self may change as a result of mindfulness practice, or whether these changes in self-perception may be mechanisms of mindfulness in action. This is somewhat surprising given that mindfulness derives from traditions often described as guiding people to realize and experience the non-separation of self from the world or its "oneness" with the whole of reality. The current study used a collective intelligence methodology, Interactive Management (IM), to explore the nature of oneness experiences. Five IM sessions were conducted with five separate groups of experienced meditators. Participants generated, clarified, and selected oneness self-perceptions they believed most characterized their experience both during meditation and in their everyday experience in the world. Each group also developed structural models describing how highly ranked aspects of oneness self-perceptions are interrelated in a system. Consistent themes and categories of oneness experience appeared across the five IM sessions, with changes in the sense of space (unboundedness), time, identity, wholeness, and flow highlighted as most influential. Results are discussed in light of emerging theory and research on oneness self-perception and non-dual awareness.

The Metacognitive Processes of Decentering Scale: Development and initial validation of trait and state versions

The ability to decenter from internal experiences is important for mental health. Consequently, improving decentering is a common therapeutic target, particularly for mindfulness-based interventions. However, extant decentering measures are limited as they fail to directly assess all 3 metacognitive processes recently theorized to subserve decentering. We thus conducted 4 studies to develop and test the Metacognitive Processes of Decentering-Trait (MPoD-t) and State (MPoD-s) scales. Consistent with the metacognitive processes model, exploratory factor analysis (N = 355) and then bifactor exploratory structural equation modeling (N = 275) indicated the MPoD-t was composed of three independent yet interrelated lower-order factors, metaawareness, (dis)identification with internal experience, and (non)reactivity to internal experience, which subserved an emergent, higher-order, decentering factor. We next found evidence of the MPoD-t's convergent validity; as well as known-groups criterion validity, wherein mindfulness practitioners reported higher MPoD-t scores than nonpractitioners. Item response theory analyses were then used to identify a subset of 3 MPoD-t items for the MPoD-s. Finally, we found evidence that the MPoD-s was sensitive to changes in state decentering following a brief mindfulness induction relative to an active control condition; and that MPoD-s changes mediated the effect of mindfulness on levels of pain and related outcomes among a sample of preoperative surgery patients (N = 82). These studies indicate the trait and state versions of the MPoD may prove useful for the study of decentering and its constituent metacognitive processes. As such, the MPoD may help advance our understanding of how the metacognitive processes of decentering support mental health and well-being. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Nondual Awareness and the Whole Person

Integrative Health aims to treat the whole person and to do so within the context of whole systems and practices. We raise questions as to what constitutes the whole person and what must be taken into account to support the creation of optimal well-being. We propose that in order to fully account for the whole person, the transcendent aspects of human awareness, the development of which is the goal of many meditative traditions, must be taken into account. “Nondual awareness” is a term increasingly used in the literature to describe a state of awareness that is characterized by the experience of nonseparation, compassion, and love. Well-being in this state does not depend on anything being experienced per se, but it is rather an innate attribute of living in nonduality. For these reasons, nondual awareness can be considered foundational to the realization of the whole person and achieving the state of optimal well-being.

Proof of Concept of an Eclectic, Integrative Therapeutic Approach to Mental Health and Well-Being Through Virtual Reality Technology

Across three studies, we provide a proof-of-concept evaluation of an integrative psychotherapeutic application of virtual reality (VR) technology. Study 1 (n = 36) evaluated an unguided “safe-place” imagery task, where participants were instructed “to create a safe space… [such as] a scene, item, design, or any visual representation that makes you feel safe” using either the Google Tilt Brush application (VR condition), the standard Microsoft Paint application (2-D condition), or via eyes-closed mental imagery alone (IMG condition). Study 2 (n = 48) evaluated a narrative episodic recall task, where participants viewed their childhood and adult homes and places of schooling either using either the Google Earth VR application (VR condition) or the standard Google Earth application (2-D condition) or recalled these places with their eyes closed via mental imagery alone (IMG condition). Finally, Study 3 (n = 48) evaluated a guided wilderness imagery task, during which different scripts were narrated, specifically, a trail walk in autumn, a spring meadow, and a hillside walk in snowy winter, while either these same scenes were visually presented using the Nature Treks VR application (VR condition), the scenes were presented using the same software but shown on standard computer monitor (2-D condition), or participants’ eyes were closed (IMG condition). Order of intervention format was randomized across participants. Across all three studies, quantitative survey ratings showed that the VR format of intervention delivery produced greater positive affect and satisfaction and perceived credibility ratings as an intervention for trauma- and stressor-related disorders and psychological well-being as rated by university students who varied in traumatic and stressful life event history and symptoms of posttraumatic stress disorder, whereas qualitative findings revealed additional themes of experiential response including increased experience of presence and vividness in the VR condition. Future research directions and clinical applications are discussed.

Effects of Mindfulness Meditation on Self-Transcendent States: Perceived Body Boundaries and Spatial Frames of Reference

Objectives

Mindfulness training is believed to encourage self-transcendent states, but little research has examined this hypothesis. This study examined the effects of mindfulness training on two phenomenological features of self-transcendence: 1) perceived body boundary dissolution, and 2) more allocentric spatial frames of reference.

Methods

A sample of healthy, young adults (n=45) were randomized to five sessions of mindfulness training or an active listening control condition.

Results

Results indicated mindfulness training decreased perceived body boundaries (F _4,172=6.010, p<.001, η ²=.12) and encouraged more allocentric frames of reference (F _4,168=2.586, p=.039, η ²=.06). The expected inverse relationship was observed between perceived body boundaries and allocentric frames of reference ((β=-.58, p=.001)), and path analysis revealed the effect of mindfulness training on allocentric frames of reference was mediated by decreased perceived body boundaries (β=.24, se=.17, CI: 0.11 to 0.78).

Conclusions

Taken together, study results suggest that mindfulness training alters practitioners' experience of self, relaxing the boundaries of the self and extending the spatial frame of reference further beyond the physical body. Future studies are needed to explore the psychophysiological changes that co-occur with phenomenological reports of self-transcendence and the behavioral consequences following self-transcendent experiences.

Mystical and Other Alterations in Sense of Self: An Expanded Framework for Studying Nonordinary Experiences

Although many researchers in psychology, religious studies, and psychiatry recognize that there is overlap in the experiences their subjects recount, disciplinary silos and challenges involved in comparing reported experiences have left us with little understanding of the mechanisms, whether biological, psychological, and/or sociocultural, through which these experiences are represented and differentiated. So-called mystical experiences, which some psychologists view as potentially sui generis, provide a test case for assessing whether we can develop an expanded framework for studying unusual experiences across disciplines and cultures. Evidence for the special nature of "mystical experience" rests on the operationalization of a metaphysically untestable construct in two widely used self-report scales: the Mysticism Scale and the Mystical Experiences Questionnaire. Consideration of the construct in light of research on alterations in sense of self induced by psychoactive drugs and meditation practices suggests that "positive experiences of undifferentiated unity" are not sui generis, but rather a type of "ego dissolution." To better understand the nature and effects of unusual experiences, such as alterations in the sense of self, we need self-report measures that distinguish between generically worded experiences and the way they are appraised in terms of valence, significance, cause, and long-term effects in different contexts.

The Role of Heart Rate Variability in Mindfulness-Based Pain Relief

Mindfulness meditation is a self-regulatory practice premised on sustaining nonreactive awareness of arising sensory events that reliably reduces pain. Yet, the specific analgesic mechanisms supporting mindfulness have not been comprehensively disentangled from the potential nonspecific factors supporting this technique. Increased parasympathetic nervous system (PNS) activity is associated with pain relief corresponding to a number of cognitive manipulations. However, the relationship between the PNS and mindfulness-based pain attenuation remains unknown. The primary objective of the present study was to determine the role of high-frequency heart rate variability (HF HRV), a marker of PNS activity, during mindfulness-based pain relief as compared to a validated, sham-mindfulness meditation technique that served as a breathing-based control. Sixty-two healthy volunteers (31 females; 31 males) were randomized to a 4-session (25 min/session) mindfulness or sham-mindfulness training regimen. Before and after each group's respective training, participants were administered noxious (49°C) and innocuous (35°C) heat to the right calf. HF HRV and respiration rate were recorded during thermal stimulation and pain intensity and unpleasantness ratings were collected after each stimulation series. The primary analysis revealed that during mindfulness meditation, higher HF HRV was more strongly associated with lower pain unpleasantness ratings when compared to sham-mindfulness meditation (B = -.82, P = .04). This finding is in line with the prediction that mindfulness-based meditation engages distinct mechanisms from sham-mindfulness meditation to reduce pain. However, the same prediction was not confirmed for pain intensity ratings (B = -.41). Secondary analyses determined that mindfulness and sham-mindfulness meditation similarly reduced pain ratings, decreased respiration rate, and increased HF HRV (between group ps < .05). More mechanistic work is needed to reliably determine the role of parasympathetic activation in mindfulness-based pain relief as compared to other meditative techniques. Perspective: Mindfulness has been shown to engage multiple mechanisms to reduce pain. The present study extends on this work to show that higher HRV is associated with mindfulness-induced reductions in pain unpleasantness, but not pain intensity ratings, when compared to sham-mindfulness meditation. These findings warrant further investigation into the mechanisms engaged by mindfulness as compared to placebo.

Positive psychological states in the arc from mindfulness to self-transcendence: extensions of the Mindfulness-to-Meaning Theory and applications to addiction and chronic pain treatment

The Mindfulness-to-Meaning Theory (MMT) is a temporally dynamic process model of mindful positive emotion regulation that elucidates downstream cognitive-affective mechanisms by which mindfulness promotes health and resilience. Here we review and extend the MMT to explicate how mindfulness fosters self-transcendence by evoking upward spirals of decentering, attentional broadening, reappraisal, and savoring. Savoring is highlighted as a key, potential means of inducing absorptive experiences of oneness between subject and object, amplifying the salience of the object while imbuing the sensory-perceptual field with affective meaning. Finally, this article provides new evidence that inducing self-transcendent positive emotions and nondual states of awareness through mindfulness-based interventions may restructure reward processing and thereby produce therapeutic effects on addictive behavior (e.g. opioid misuse) and chronic pain syndromes.

Employing pain and mindfulness to understand consciousness: a symbiotic relationship

Consciousness, defined here as the quality of awareness of self and the corresponding sensory environment, is considered to be one of most enigmatic and contentious areas of scholarly dissection and investigation. The subjective experience of pain is constructed and modulated by a myriad of sensory, cognitive and affective dimensions. Thus, the study of pain can provide many inroads to a concept like consciousness that the traditional sense modalities do not. Mindfulness defined here as non-reactive awareness of the present moment, can uniquely control and/or modulate particular substrates of conscious experience. Thus, in combination with brain imaging methodologies, we propose that the interactions between pain and mindfulness could serve as a more comprehensive platform to disentangle the biological and psychological substrates of conscious experience. The present review provides a brief synopsis on how combining the study of pain and mindfulness can inform the study of consciousness, delineates the multiple, unique brain mechanisms supporting mindfulness-based pain relief, and describes how mindfulness uniquely improves the affective dimension of pain, an important consideration for the treatment of chronic pain.