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Four aspects of helpful inner focus: 1.) reducing negative states

I started meditating regularly while I was still at university in the early 1970's.  I then went on a number of meditation retreats and visited a whole series of monasteries and ashrams.  By the late 70's I had a good deal of experience of a fruit salad of methods including vipassana, zen, yoga relaxation, pranayama, dynamic meditation, hypnosis, chanting, and several other approaches.  I began running "Introduction to Meditation" days where I would introduce people to maybe six or seven different methods.  I puzzled then and still puzzle now over what the similarities and differences are between these various ways of producing "altered states of consciousness".  Maybe more importantly I puzzle too over what might make them helpful, in what ways, and for what conditions.  See the simple model "Four aspects of helpful inner focus" that I've been using for a while to make some sense of this diversity - either as a Powerpoint slide or as a Word document.  The diagram doesn't, by any means, cover all that's important about therapeutic aspects of altered states of consciousness.  It does however highlight four overlapping and well-researched mechanisms - reducing negative mind-body states, increasing positive mind-body states, encouraging mindfulness, and exploring & processing emotions.  In the rest of this post, I'll look a little more at reducing negative mind-body states (and in later posts I intend to talk more about the other three mechanisms).

When I'm teaching forms of relaxation, meditation or self-hypnosis, I often start by talking about the value of reducing negative mind-body states.  I say that the methods I'm showing them produce benefits in a number of ways (see the Four aspects diagram) of which a key one is to ease muscle tension, settle autonomic nervous system over-activation, reduce stress hormone levels, and calm thinking.  Herbert Benson's 1970's book "The Relaxation Response" was a standard bearer for this reduction of negative overactivated states approach.  It can be very helpful to highlight the impressive reductions in metabolic rate achievable in just a few minutes of experienced elicitation of a relaxation response by showing the trainee an appropriate diagram (see Relaxation response & metabolic rate below).  Carlson's meta-analysis (Carlson and Hoyle 1993) demonstrated the broad benefits achievable with these methods, the importance of extended training, the value of using training tapes/CD's, and the encouraging way benefits persist at follow-up.  Ost's applied relaxation studies extended these ideas further (Ost 1987; Ost and Breitholtz 2000) by teaching the techniques as methods one can use actively during daily life as well as at formal practice times.  The handout "What progress can you expect?" emphasises this skills learning orientation (see below).  Biofeedback training too is often conceptualized as targeting ‘negative states' such as excessive muscle tension (Nestoriuc, Rief et al. 2008). 

When working with groups, I tend to teach an adapted form of Autogenic Training.  This is largely because I find Autogenics works very well in a group teaching format and, when I started running classes many years ago, Autogenics seemed to side-step the then oddball reputation of meditation, the occasional notoriety of hypnosis, and the potentially too-mundane-to-help-me view of relaxation. My suspicion is that it may not matter very much whether one uses Autogenics, Progressive Muscular Relaxation, Mindfulness Based Cognitive Therapy, or some other well-organized training.  I think how the method is presented, the thoroughness of the home practice, the duration of the course, and the confidence with which the participants come to view the technique may all be over-arching and important common components.  Although Autogenics has encouraging research to support its use (Stetter and Kupper 2002) including - fascinatingly when one considers the furore over mindfulness training - in the reduction of depressive relapse (Krampen 1999), I find that adding ideas from other approaches like Applied Relaxation and Mindfulness Training seems to boost its effectiveness.  It is encouraging to see the recent meta-analysis (Manzoni, Pagnini et al. 2008) highlighting the medium to large effect sizes achievable using relaxation for anxiety disorders and the value of using an efficient group training format.  Years ago, I and a consultant psychiatrist colleague approached all relevant local hospitals and clinics asking whether they taught relaxation training for patients.  Most said yes, and we then contacted whoever was named as the appropriate "expert".  We convened a meeting of all these experts to discuss what approaches were used and how they were applied.  It was quite shocking to hear the mishmash of half-heartedly applied teaching that was being provided.  I doubt the situation has much improved.  I strongly feel these group skills-training approaches are often under-appreciated, poorly taught, and not widely enough available.

Benson, H. (2000)  "The relaxation response".  (Revised edition)  Avon Books  [AbeBooks]  [Amazon UK]
Carlson, C. R. and R. H. Hoyle (1993). "Efficacy of abbreviated progressive muscle relaxation training: a quantitative review of behavioral medicine research." J Consult Clin Psychol 61(6): 1059-67.  [PubMed] and 2 slide summary [Free Full Text]
Hawkins, J.  "Four aspects of helpful inner focus".  Powerpoint slide handout.  [Free Full Text] and Word document [Free Full Text]
Hawkins, J.  Other handouts relevant to relaxation & mindfulness training.  [Free Full Text]
Hawkins, J.  "Relaxation response & metabolic rate"  Powerpoint slide handout [Free Full Text]
Hawkins, J.  "What progress can you expect?"  Word document handout.  [Free Full Text]
Krampen, G. (1999). "Long-term evaluation of the effectiveness of additional Autogenic Training in the psychotherapy of depressive disorders " European Psychologist 4(1): 11-18.  [Abstract/Full Text]
Manzoni, G. M., F. Pagnini, et al. (2008). "Relaxation training for anxiety: a ten-years systematic review with meta-analysis." BMC Psychiatry 8: 41.  [Free Full Text]
Nestoriuc, Y., W. Rief, et al. (2008). "Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators." J Consult Clin Psychol 76(3): 379-96.  [PubMed]
Ost, L. G. (1987). "Applied relaxation: description of a coping technique and review of controlled studies." Behav Res Ther 25(5): 397-409.  [PubMed]
Ost, L. G. and E. Breitholtz (2000). "Applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder." Behav Res Ther 38(8): 777-90.  [PubMed]
Stetter, F. and S. Kupper (2002). "Autogenic training: a meta-analysis of clinical outcome studies." Appl Psychophysiol Biofeedback 27(1): 45-98.  [PubMed]

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