Dr Ka Po CHAN
MBBS(HK) PhD(HK) FRCOG(UK) FHKAM (OBS & GYN)
Presented at The Third World Buddhist Forum, 26 April, 2012, Hong Kong
Abstract
Meditation is proving to be an excellent adjunctive treatment for many diseases and an essential element in maintaining holistic health. Psychosocial factors are important components of maternal health. Maternal health may affect foetal health. Present prenatal care is lack of elements of meditation. Present review aims to explore the importance of meditation for pregnant Chinese women in Hong Kong and the relation between meditation, maternal health and Taijiao (fetal education). The conceptual framework is based on the hypothesis that meditation can enhance maternal health which is important for foetal health and child health. A randomized control quantitative and qualitative study was carried out from September 2007 till September 2009 at Obstetric Unit, Queen Elizabeth Hospital, Hong Kong to find out the effects of an Eastern based meditative intervention (EBMI) integrating psychoeducation, cognitive intervention, mindfulness practise and Four Immeasurables meditation on meditation, maternal health and Taijiao. 64 pregnant Chinese women were recruited for intervention and 59 were for control in quantitative study. 43 pregnant Chinese women in the intervention group were recruited for qualitative research. Quantitative results showed statistically significant increase in positive appraisal (p<0.05) and difference in evening salivary cortisol during postpartum period (p<0.05) in the intervention group suggest positive effects of EBMI on maternal health. Cord blood cortisol level of babies was higher in the frequent practise group (p<0.01) and intervention group (p<0.05) indicates positive health status of the new-borns which verifies the hypothesis that maternal health can influence foetal health. Carey Infant Temperament Questionnaire showed that the infants of intervention group have better temperament (p<0.05) at sixth month reflects the importance of pregnancy health in relation to child health. Qualitative reports expand upon the quantitative findings, with the majority of participants reporting the importance of spiritual health and spiritual empowerment in pregnancy. They reported perceived benefits from all aspects of health after EBMI. This research concludes the positive effects of meditation on maternal health, foetal health and child health. Findings of positive foetal health and better temperament of infants in intervention group generate break new ground of scientific bases for Taijiao (fetal education).
BUDDHISM, PSYCHOTHERAPY AND MIND BODY MEDICINE
Mind is the forerunner of all (evil) conditions.
Mind is their chief, and they are mind-made.
If, with an impure mind, one speaks or acts,
Then suffering follows one
Even as the cart wheel follows the hoof of the ox. (Dhammapada, verse 1)
Mind is the forerunner of all (good) conditions.
Mind is their chief, and they are mind-made.
If, with a pure mind, one speaks or acts,
Then happiness follows one
Like a never-departing shadow. (Dhammapada, verse 2)
These words, which are the opening lines of the Dhammapada, were spoken by Gotama Buddha 2500 years ago. They illustrate the central theme of Buddhist teaching, the human mind. The fundamental teachings of Gotama Buddha and the core of all major branches of Buddhism, is described from a psychological perspective and interrelated with Western Psychology in general, and cognitive science, behaviour modification, psychoanalysis, and transpersonal psychology (Mikulas, 2007; Schwartz, 2011). Buddhism does not deny the reality of material existence, nor does it ignore the very great effect that the physical world has upon us. On the contrary, it refutes the mind-body dichotomy of the Brahmans and says that mind and body are interdependent (Burns, 1994). The National Institutes of Health (NIH) define Mind-Body therapies (MBTs) as “interventions that use a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms”. “Meditation” is one of the MBTs that many medical practitioners have interest (Astin, 2003; Canter, 2003) and the way of practice of Buddhism is in line with the definition of Mind-Body therapy (Bond, 2011; Chan, 2010; Mikulas, 2007). The concept of holistic health is well fit into the practice of Buddhism with its origin from India (Bonadonna, 2003; Chan, 2010; Chan et al., 2001, Ng et al., 2005), which aims at purification of mind and body, the Mind-Body intervention.
One major characteristic of Buddhism is that neither “Buddha” is equivalent to “God” nor there is any idea of God in Buddhism. There is no transcendental experience with “God”. The major idea that was discovered and put forward by Buddha is that of “Causes and Conditions” (Snelling, 1987). He experiences that everything in this world is constantly changing and nothing is permanent, they come into being, change, decay and non-existence. The important implication is that when one’s mind experiences the meaning of “impermanence”, one can manage the discomfort and pain associated with our life, both biological and psychological. Notice that the word “experience”, it doesn’t mean ONLY understanding or grasping the meaning of impermanence, it means “enlightenment” in religious term and “empowerment” in psychological term. One of the most important implications of Buddha’s teaching is that everybody can attain the state of enlightenment because we all possess “Buddha Nature” (Pine, 1992). The principle of “Causes and Conditions” is not possessed by Buddha alone or any Buddhists. Anyone can understand what “impermanence” means. Everyone can practice the “Noble Eightfold Path” if he wants to even he is not a Buddhist. Although we have to make an effort to put these teachings into practice, we all possess the innate capacity of realizing Wisdom.
In the humanistic approach of psychotherapy, Rogers also believes that man has a natural ability to actualize himself, and to move towards a state of psychological adjustment and health given an environment of unconditioned positive regard, not-judgmental attitude, and empathic understanding (Avery, 1996). The tendency to actualize oneself is defined as the inherent tendency of the organism to develop all its capacities in ways which serve to maintain or enhance the organism (Patterson, 1972). This concept of self-actualization and that of the innate capacity of Wisdom have some similarities, it appears that the latter is more encompassing and holistic than the former because it incorporates a deeper level of the psychological and spiritual aspects of an individual (Wisdom versus self). Another characteristic of Buddha teaching is that he directed most of his teachings towards two lesser goals which are empirical realities of readily demonstrable worth. These were, first, the increase, enhancement, and cultivation of positive feelings such as love, compassion, equanimity, mental purity, and the happiness found in bringing happiness to others. Secondly, he advocated the relinquishment and renunciation of greed, hatred, delusion, conceit, agitation, and other negative, unwholesome states (Burns, 1994). The cultivation of positive feelings is going in line with the development of positive psychology (Aspinwall & Tedeschi, 2010; Cope, 2010; Coyne & Tennen, 2010; Ladner, 2008; Magyar-Moe, 2009; Seligman, 2000) today and in Buddhist’s practice, there are techniques and interventions that we can follow.
In order to attain the state of enlightenment, one can practice according to the “Noble Eightfold Path” which can be viewed as a systematic model of cognitive and behavioural based intervention in terms of recent counselling psychology (Walsh & Shapiro, 2006). Williams (2000) describes the Buddhist path as the overcoming of greed, hatred and ignorance through the cultivation of their opposites, non-attachment, compassion, and wisdom. The Noble Eightfold path can be viewed as a systematic model of cognitive and behavioural based intervention in terms of recent counselling psychology. This is exactly a multidisciplinary approach of psychotherapeutic interventions according to a bio-psycho-socio-spiritual model (Mikulas, 2007).
Buddhist meditation deals exclusively with the everyday phenomena of human consciousness. In the words of the Venerable Nyanaponika Thera, a renowned Buddhist scholar and monk:
“In its spirit of self-reliance, Satipatthana does not require any elaborate technique or external devices. The daily life is its working material. It has nothing to do with any exotic cults or rites nor does it confer “initiations” or “esoteric knowledge” in any way other than by self-enlightenment. ”
Using just the conditions of life it finds, Satipatthana does not require complete seclusion or monastic life, though in some who undertake the practice, the desire and need for these may grow (Thera, 1962). Varela and associates (1991), paying tribute to the thinking of Merleau-Ponty, bring together ideas from cognitive science and Buddhist philosophy, in a work which describes our double sense of embodiment, mind in nature as described by cognitive science and mind in everyday lived experience: this later may be examined within the meditative tradition. Varela adds: ‘The possibilities for transformation of ordinary life need to be presented in a context that makes them available to science’. Buddhist meditative practice refers to achieving a positive mental state, and incorporates Right Effort, Right Mindfulness and Right Concentration in the Noble Eightfold Path. There are in Buddhism no drugs or stimulants, no secret teachings, and no mystical formulae. Buddhist meditative practice can help you train your mind in the same way exercise can train your body (Shannahoff-Khalsa, D., 2012; Wilst et al., 2009). Meditation can refine awareness, which may be a central process mediating its therapeutic benefits. Refinement of awareness is a necessary precondition for a further important meditative process: disidentification (Walsh & Shapiro, 2006). Disidentification is the process by which awareness (mindfulness) precisely observes, and therefore ceases to identify with, mental content such as thoughts, feelings, and images. Consider, as a practical example, the thought “I’m scared.” Meditators report that if they are clearly aware of such a thought, then they do not identify with it (assume it to be a valid statement about themselves). Rather, they simply observe it, recognize it as merely a thought, and are unaffected by it (Segal et al., 2002). Increased awareness can reveal depths of the psyche usually obscured by thought. Meditative practice has the power to slow, and even to stop, the unusually incessant flow of subliminal thoughts for prolonged periods, not by suppression but by deep calm (Travis & Pearson, 2000). This is said to permit easier recognition and substitution of thoughts and to facilitate disidentificaiton from them and their self-hypnotic power. Dramatic heightening and continuity of awareness are said to allow meditators to recognize and disidentify, not just from a problematic subset of thoughts, emotions, or images, but from all of them. The result is said to be the ability to observe all experiences with imperturbable calm and equanimity, in a state of mind variously described as “transcendental consciousness” (TM), “mind-body drop” (mind–body disidentification-Zen). The most encompassing explanation of meditation’s effects may be a classic higher order process one-namely, that meditation catalyzes certain developmental processes by restarting and/or accelerating them (Wilber, 2000). Extended mindfulness meditation trainings improve attention processes and the distribution of limited resources (Friese et al., 2012). Riet (2011) has provided a narrative of one person’s lived embodied experience of Vipassana meditation in Thailand. Meditation enjoys wide acceptance within the Thai culture for stress-release and as a personal health strategy for maintenance of well-being.
Buddhist meditative practices have received much attention and have stimulated lots of scientific studies (Barinaga, 2003; Hasenkamp et al., 2012; Knight, 2004; Koszycki et al., 2007; Lehmann et al., 2012; Mason et al., 1997; Pagnoni, 2008; Reibel, 2008; Sperduti et al., 2012; Takahashi et al., 2005). Moon et al. (2005) discovered changes in several growth factors/cytokines after Zen Meditation. Zen meditation also has effect on serum nitric oxide activity and oxidative stress (lipid peroxidation) which are involved in the regulation of cardiovascular functions (Kim et al., 2005). Solberg et al. (2004) found that advanced meditators have higher melatonin levels than non-meditators, suggested the effect of meditation may be via influence on neurotransmitters. Neurotransmitters and neurochemicals associated with well-being such as endorphins, dopamine, serotonin, GABA, arginine vasopressin have been found to increase, which can lead to blissful state during meditation (Wasi, 2009). Meditative practice is a mental exercise that has effect on neural plasticity (Lutz et al., 2004). Meditation traditionally requires a long-term commitment to daily practice and therefore has the potential to induce changes in neural function and structure. Initial laboratory support comes from TM practitioners who display distinctive autonomic and EEG correlates during reported episodes of thought stilling (Travis & Pearson, 2000). Internalized attention and mindfulness are two major core factors of behaviours of mind during meditation and are characterized by different combinations of psychophysiological properties (Takahashi et al., 2005). Application of brain imaging technologies, such as f MRI, PET, SPECT has revealed that meditation can change brain structures and function. Studying Buddhist monks while they meditate in MRI machines has led to startling conclusions, among them that the “monks” meditation practice, which changes their neural physiology, enables them to respond with equanimity to sources of stress. Another study of Buddhists by scientists at the University of California has also found that meditation might tame the amygdala, the part of the brain involved with fear and anger (Conlin, 2004) with decreased activity during meditation. Richard Davidson, a professor of psychology and psychiatry at the University of Wisconsin at Madison found out that “after a short time meditating, meditation had profound effects not just on how they felt but on their brains and bodies”. Meditation appears to stimulate the left prefrontal lobe (Conner, 2003), which is related to feelings of well-being and happiness. The left prefrontal cortex is remarkably active during meditation, associated with reduction of activity of the limbic system, thus decreased negative emotion. Through the thalamus gateway inhibitory firing is conveyed to the sensory parietal area, resulting in more focus attention. There is a shifting of brain activity from the self-centered area to the other-centered area, thus decreasing the sense of self. Effects on the hypothalamus connect to the autonomic nervous system with shifting toward the parasympathetic activity. This leads to slowing down, relaxation, decreased blood pressure and heart rates, and reduction of cortisol level (Wasi, 2009). Pagnoni & Cekic (2008) found that regular practice of meditation may affect the normal age-related decline of cerebral grey matter volume and attentional performance observed in healthy individual. Meditation may have neuroprotective effects and reduce the cognitive decline associated with normal aging. Jacobs, et al. (2011) found that there are changes in immune cell telomerase activity and psychological mediators in those people with intensive meditation training. Sobolewski et al. (2011) found that visual ERPs reveal altered emotional processing in meditation practitioners. At high processing levels meditatiors are less affected by adverse emotional stimuli. Conversely, processing of positive stimuli remains unchanged. Hasenkamp et al. (2012) uses new fMRI method to clarify cognitive fluctuations during focused meditation. Repeated meditation practice may lead to neural changes within relevant networks. Kozasa et al. (2012) showed that meditation training increases brain efficiency in an fMRI adapted Stroop Word-Color Task (an attention task). Luders et al. (2012) have found that corpus collosum measures were larger in meditators (DTI-based measures in combination with MRI-based measures), particularly in anterior sections. Effects were stronger locally (point-wise) than globally (segment-specific) and were more prominent for microscopic than macroscopic characteristics.
Many studies had published in order to assess the effect of meditation (Astin, 2003; Canter, 2003; Fortney & Taylor, 2010; Kristeller, 2007; Turner, 2004; Young, 2011). Effects of meditation include somatic therapeutic responses, psychotherapeutic effects and positive well-being (Walsh & Shapiro, 2006). Many studies were concerned about chronic medical illness (Bonadonna, 2003) like hypertension (Manikonda et al., 2005; Roush, 1997; Schneider et al., 1995; Schneider et al., 2005), coronary artery disease (e.g. cardiac rehabilitation) (Castillo-Richmond, 2000), headaches, chronic low back pain, arthritis, chronic asthma (Manocha et al., 2002), incontinence, insomnia, epilepsy, disease and treatment-related symptoms of cancer (Carlson et al., 2003; Meyer & Mark, 1995; Tacon, 2003), asthma and stuttering, hormonal disorders such as type 2 diabetes, primary dysmenorrheal., and premenstrual dysphoric disorder (Murphy & Donovan, 1997) and improving post-surgical outcomes (Carlson, 2003). Other studies were about depressive and anxiety disorders (Miller et al., 1995; Teasdale et al., 1995). There were also studies in the field of elderly medicine (Lindbert, 2005), longevity (Alexander et al., 1989) and psychological health (Beauchamp-Turner & Levinson, 1992; Gelderloos et al., 2001). Horrigan (2011) showed that meditation reduces Pain Scores. Srivastava et al. (2011) found that meditation training have beneficial effects on patients with adjustment disorder with anxiety and depression. Alfonso et al. (2011) discovered that combined goal management training and mindfulness meditation improve executive functions and decision-making performance in abstinent polysubstance abuser. A substantial body of evidence suggests that regular meditation has a strong relationship to positive health outcomes, self-transcendence, and overall well-being (Andresen, 2000; Schwartz, 2011). Mindfulness is probably the best understood meditation in the clinical field. There has been a growth of clinical treatment and wellness programs based on mindfulness meditation after the mindfulness-based stress reduction (MBSR) program of Jon Kabat-Zinn and colleagues (Kabat-Zinn, 2003). Mindfulness meditation is thought to be beneficial in the management of various physical and mental health conditions (Hofmann et al., 2010). It is useful in treating individuals with panic disorder (Kabat-Zinn et al., 1992), anxiety disorders (Lee et al., 2007; Liehr & Diaz, 2010) and depression (Klainin-Yobas et al., 2012; Liehr & Diaz, 2010) besides its prior application in stress reduction. It has been used as an adjunct in the treatment of conditions like psoriasis (Kabat-Zinn et al., 1998), reheumatoid arthritis (Zautra et al., 2008), cancer (Foley et al., 2010), and chronic pain (Kabat-Zinn et al., 1985). Mindfulness-based intervention is incorporated into treatment regime in clinical conditions like hypertension, menopause, and oncology (Bruce et al., 2005; Carmody et al., 2006; Eldelman et al., 2006; Fennell, 2004; Foley et al., 2010; Kabat-Zinn, 2003; Leigh et al., 2005; Lindberg et al., 2005; Ma & Teasdale, 2004; Ostafin et al., 2006; Proulx, 2003; Surway et al., 2005; Weiss et al., 2005). Young (2011) reviewed the usefulness of mindfulness on patients with rheumatoid diseases and how it can be applied to Western medical treatment plans to enhance both the medical and psychological care of patients. Mindfulness practice can improve cognitive function which is related to aging (McHugh et al., 2010). Zeller & Lamb (2011) found that mindfulness meditation can improve care quality and quality of life in long-term care settings.
PSYCHOEDUCATION, MATERNAL AND FETAL HEALTH
Stress, social support and depressive symptoms have been well documented as affecting pregnant women’s psychosocial well-being (Norbeck & Tilden, 1983). Attitudes and beliefs about the fetus, pregnancy, motherhood, and body image are significant in three psychosocial theories of pregnancy (Rubin, 1984). Also health behaviours and work status are important behavioural aspects of women’s lives in relation to pregnancy (Grason et al., 1999). Counselling is an effective tool in promoting health in various health cares’s setting (Bor et al., 1998). Pregnant women may seek counselling because pregnancy has intruded into their life and affected their view of themselves, their relationships with others and how they see themselves coping and adjusting both in the short term and in the future when they become mothers. Supportive counselling like providing support to pregnant mother with complications and has opportunity for them to air their opinion is helpful. There was study found that women receiving individualized care, led by midwives, had significantly better psychological wellbeing and a 40% reduction in risk of postpartum depression (MacArthur, 2002).
Bledose & Grote (2006) had done a meta-analysis to evaluate treatment effects for nonpsychotic major depression during pregnancy and postpartum comparing interventions by type and timing. The following interventions are included in this review based on their use in treatment trials: (1) medication in combination with cognitive behavioral therapy (CBT); (2) medications (3) group therapy with cognitive behavioral, educational, and transactional analysis components; (4) interpersonal psychotherapy (IPT); (5) CBT; (6) psychodynamic therapy; (7) counseling; and (8) educational interventions. Recently, Urizar Jr et al (2004) had done a pilot study to examine whether giving stress reduction instructions to pregnant women would be effective in regulating stress, mood, and cortisol levels during pregnancy. Duncan & Bardacke (2010) did a pilot study of (n = 27) pregnant women participating in Mindfulness-Based Childbirth and Parenting (MBCP) program during their third trimester of pregnancy. MBCP is designed to promote family health and well-being through the practice of mindfulness during pregnancy, childbirth and early parenting. Quantitative results from the increase in mindfulness and positive affect and the decrease in pregnancy anxiety, depression and negative affect. Qualitative reports, from participants expand upon the quantitative findings, reporting perceived benefits of using mindfulness practices during the perinatal period and early parenting.
Historically, the expectant mother has been advised to keep herself cheerful, listen to good music, and frequent art galleries. Indeed, it was suggested “that if a woman about to become a mother plays the piano day, her baby will be born a Victor Herbert” (Nathan & Mencken, 1921), and that a tearful mother is likely to produce a mournful (Shakespeare, Henry VI (3), Act IV, Scene iv). In Chinese, we also heard of the slogan “agitated mother will give birth to a bad temper baby（忟羗生忟仔） ”. More recently, empirical findings of fetal experience in utero have generated widespread interest and excitement. There is now general consensus that considerable sensory input impinges upon the fetus in utero, and that the mother’s behavior and physiology make significant contributions to prenatal sensory experience (Fifer & Moon, 1988; Ronca et al., 1993). The predominant causes of neurological or behavioral deficits during infant and child development are known to occur prenatally (BBC News, 2005; Larson et al, 2005; Thoresen, 2000), and disruptions in the processes occurring at any of the stages noted previously can have profound developmental consequences. There are strong pointers to the importance of the fetal adaptations invoked when the maternoplacental nutrient supply fails to match the fetal nutrient demand (Godfrey & Barker, 2000). Prenatal maternal stress has been shown to impair functioning in nonhuman primate offspring (Kaiser & Sachser, 2005). Research (O’keane and Scott, 2005; Van den Bergh et al, 2005; Wadhwa, 2005; Weinstock, 2005) proposes that maternal stress exerts a negative influence on fetal developmental outcome that is mediated by the HPA system (Wadhwa et al, 2005). Central to an understanding of how overdrive of the maternal HPA axis may alter fetal development is the knowledge that maternal-fetal communication during gestation is endocrine rather than neural, and cortisol levels in the fetus correlate with those in the maternal circulation (Gutteling et al, 2005; Thompson et al, 2001). Laplante et al (2004) suspect that high levels of prenatal stress, particularly early in pregnancy, may negatively affect the brain development of the fetus, reflected in the lower general intellectual and language abilities in the toddlers. Austin et al (2005) showed that maternal trait anxiety was predictive of ‘difficult’ infant temperament, independent of ‘concurrent’ depression and key sociodemographic and obstetric risk factors. Yehuda et al (2005) found that pregnant women who were exposed to the World Trade Center collapse during the 11th September attacks in 2001 may have passed a biological risk factor for post-traumatic stress disorder (PTSD) onto their unborn children. Both exposed mothers and their babies at less than 1 year old, had lower than average levels of the stress hormone cortisol, which has been linked to PTSD. Recent research (Yehuda et al, 2008) found that maternal, not paternal, PTSD is related to increased risk for PTSD in offspring of Holocaust survivors. Walker et al (2004) had conducted a randomized controlled study on the development of Term Low-Birth Weight Infants receiving psychosocial intervention and had positive outcome.
MEDITATION, MATERNAL HEALTH AND FETAL HEALTH
An Eastern Based Meditation Intervention (EBMI) (Chan, 2010) based on integration of psychoeducation, cognitive intervention, mindfulness practice and Four Immeasurables Meditation was developed for pregnant Chinese women in Hong Kong. The theoretical background of the developed Eastern Based Meditative Intervention (EBMI) bases on the integration of mindfulness practice, the Four Immeasurables (Chan, 2008, 2010), cognitive therapies (Abramowitz et al., 2009; Ekers et al., 2006; Raes et al., 2009) and Western psychology and psychotherapy (Chan, 2003; Mikulas, 2007; Walsh & Shapiro, 2006). Practices from certain schools of Buddhism (e.g. Zen, Tibetan Vajrayana, Pure Land) are excluded from EBMI. It aims at lightening the religious background of the practices so that the intervention is acceptable to everybody. EBMI has the capacity to increase awareness of negative thought (Fenell, 2004), bringing mental processes under greater voluntary control and directing them in beneficial ways gives people a greater sense of control (Shapiro & Walsh, 2002). When undesirable thoughts and feeling no longer overwhelming human mind (Teasdale, 1999; Teasdale et al., 2000), psychological and physical well-being is fostered by allowing for the emergence of alternative responses. Spiritual empowerment is valuable in self-regulatory behavior that is consistent with the person’s wider needs and values (Chan, 2006; Rayan et al., 1997).
The characteristic of the East ern Based Meditative Intervention (EBMI) is that through meditative practice, we can have right awareness, change our mental process, train and transform our mind. The essence of meditative practice is the tenets of philosophical systems to be practiced on the basis of a disciplined mental continuum (Dalai Lama, 1984:65-66). EBMI improves the capacity for recognizing and solving problems (McCown, 2004). As our mind changes, our daily life also changes. Recently there are researches exploring the role of meditative practice in cultivating experiences of loving kindness, compassion, empathy, and altruism (Hofmann, et al., 2011; Johnson et al., 2011; Kristeller & Johnson, 2005). Hofmann et al. (2011) reviewed the literature on loving-kindness and compassion meditation. Neuroendocrine studies suggest that compassion meditation reduces subjective distress and immune response to stress. Neuroimaging studies suggest that both meditation practices enhance activation of emotion centres of the brain. Preliminary intervention studies support the application of these strategies in clinical populations. They concluded that these techniques are effective for treating social anxiety, marital conflict, anger, and strains of long-term caregiving. The goal of EBMI is to provide positive energy for pregnant women and through maternal-foetal interaction to benefit our next generation, the aim of Taijiao.
EBMI included strategies that aimed at increasing awareness of the effect of stress, coping with stressful situation (Kristeller, 2007), increase positive thinking and pleasant activities, improving self-esteem, increasing self-care and learning skills to increase social support, and identifying and exploring unrealistic expectations about pregnancy and motherhood. EBMI for antenatal classes works in line with the theory of salutogenic theory sense of coherence (SOC) (Berg & Hallberg, 1999; Delbar & Benor, 2001; Forsgarde et al., 2000, Hillert et al., 2002) which enhances the comprehensibility, manageability and meaningfulness of life of pregnant women. EBMI focused on training participants in restructuring skills and techniques for identifying and modifying irrational thoughts that may affect their mental health in the perinatal period. Participants were asked to focus on cultivation of positive emotion and aware of their strengths to overcome negative thoughts through meditative practice. EBMI have positive effect on ratings of Maternal-foetal attachment (MFA) through meditation on the foetus. Meditation on the foetus may have beneficial effect on maternal bonding. EBMI leads to spiritual empowerment, right maternal expectations and may help the pregnant mothers to have the right view of their self-efficacy in performing parenting. The programme emphasizes on self-discipline and self-directed coping (Chan, 2010). The effects of the EBMI are consistent with Rosenbaum’s view (Rosenbaum, 1990) of the beneficial effects of learned resourcefulness on individual’s psychological well-being under stressful encounters. The training was in tone with the traditional Chinese belief that a person’s inner thoughts and perception of the situation is important in determining one’s reaction and changing their external environment (Bond, 1996; Chen, 1995).
The acceptability of EBMI based on the chance of practice on daily basis and incorporates into the daily activities of the participants (Thompson & Waltz, 2007). The content of EBMI is in line with Chinese culture and value of pregnant Chinese women in Hong Kong which are grown up under the influence of the West. EBMI is trans-cultural and suitable for individuals of diverse faiths (Beitel et al., 2007).
EFFECTS OF MEDITATION ON MATERNAL HEALTH AND TAIJIAO
A research about the effects of EBMI on maternal health and fetal health was conducted and results were published in 2011 (Chan, 2010). Seven psychoeducational classes have been conducted from September 2007 to January 2009. A randomized control quantitative and qualitative study was carried out from September 2007 till September 2009 at Obstetric Unit, Queen Elizabeth Hospital, Hong Kong. 64 pregnant Chinese women were recruited for intervention and 59 were for control in quantitative study. 43 pregnant Chinese women in the intervention group were recruited for qualitative research. Quantitative results showed statistically significant increase in positive appraisal (p<0.05) and difference in evening salivary cortisol during postpartum period (p<0.05) in the intervention group suggest positive effects of EBMI on maternal health. Cord blood cortisol level of babies was higher in the frequent practise group (p<0.01) and intervention group (p<0.05) indicates positive health status of the newborns which verifies the hypothesis that maternal health can influence foetal health. Carey Infant Temperament Questionnaire showed that the infants of intervention group have better temperament (p<0.05) at sixth month reflects the importance of pregnancy health in relation to child health. Qualitative reports expand upon the quantitative findings, with the majority of participants reporting the importance of spiritual health and spiritual empowerment in pregnancy. They reported perceived benefits from all aspects of health after EBMI.
This research concludes the positive effects of spirituality and psychoeducation on maternal health, foetal health and child health. Cord blood cortisol level, pioneered by this research, is a new indicator for foetal health. Present research illustrates the importance of positive health indicators and recommends more research in this area. Findings of positive foetal health and better temperament of infants in intervention group generate break new ground of scientific bases for foetal education (Taijiao). Present study recommends that pregnancy care providers should provide spiritual care and psychoeducation to pregnant women. EBMI, developed by present study, should be included into the prenatal care system.
禪修、妊娠健康與胎教
陳家寶醫生
發表於第三界世界佛教論壇 April 26, 2012 香港
佛教、心理治療和身心醫學
人生的活動與際遇，心為主宰，心所造成。
若依惡意去說話或做事，苦惱就會跟著，像牛車的輪，跟著牛的足跡一樣。（南傳法句經Dhammapada，詩 1）
人生的活動與際遇，心為主宰，心所造成。
若依善念去說話或做事，快樂就會跟著人，如影隨形。（南傳法句經Dhammapada，詩歌 2）
釋迦佛陀 2500年前說過這些話，是南傳法句經（Dhammapada） 的開場白。他們說明了佛教教學，以人類的心靈為中心主題。佛教的基本教義，是從心理的角度來看，和現代西方心理學、認知科學，行為治療、心理分析和超個人心理學 (Mikulas, 2007; Schwartz, 2011）有密切的關係。佛教並不否認現實的物質的存在，也不是它會忽略物理世界對我們的影響。相反，它駁斥Brahmans身心二分法的說法，並表示心靈和身體是相互依存的 (Burns,1994)。這個整個的想法完全吻合全人治療的健康模式 (Bonadonna, 2003; Chan, 2010; Chan et al., 2001, Ng et al., 2005) 。
佛教的一大特點是”佛”既不等同于”上帝”，也沒有任何宇宙創造者的想法。佛教的要旨是奠基於「因緣所生法」(Snelling, 1987)：「此有故彼有，此無故彼無；此生故彼生，此滅故彼滅」。重要的含義是當一個人的心靈體驗”無常”，就可以有能力去處理身體的不適和心理的困擾，如心經所說：『觀自在菩薩，行深般若般羅蜜多時，照見五蘊皆空，度一切苦厄』。這裏所謂的「心靈體驗”無常”」，在宗教術語是「解脫」，而在心理學術語是含有「賦權」(empowerment)的意思。佛陀的最重要是教法，就是每個人都能達到「解脫」的境界，因為我們都擁有”佛性” (Pine,1992)。「因緣所生法」並非被佛獨自或任何佛教徒所佔有。任何人都可以理解和體驗什麼是”無常”。每個人都可以通過修習”八正道”，得到解脫 (Walsh & Shapiro, 2006)。在人文心理治療的方法中，羅傑斯(Rogers)認為人有天然的能力，實現自己，邁向心理調適和健康性行為的積極方面、 不判斷的態度和移情的理解環境下的狀態 (Avery,1996)。有機體的內在傾向發展其所有的能力，有助於保持或提高機體的方式定義是實施自己的傾向 (Patterson, 1972)。這種自我實現的概念和智慧的天賦的能力，有某些相似之處，看來後者是更全面和整體比前者因為包括了深層次的心理和精神方面的個人 (智慧與自我)。佛教學的另一個特點是他針對兩個較低的目標是隨時可證明價值的實證現實發來的大部分的教誨。第一，這些是增加、 增強和培養積極向上的感覺，如仁愛、 慈悲喜捨、心理的純度和發現把幸福帶給其他人的幸福。第二，佛教主張轉化貪婪、 仇恨、 妄想、 自負、 攪拌和其他負面的情緒為正能量 (positive psychology) (Aspinwall & Tedeschi, 2010; Cope, 2010; Coyne & Tennen, 2010; Ladner, 2008; Magyar-Moe, 2009; Seligman, 2000)。”八正道”的修習，可以視為認知和行為的系統模型基於最近輔導心理學方面的干預，與生物-心理-社會-精神健康模式 (bio-psycho-socio-spiritual model) 相吻合 (Mikulas, 2007; Ng et al., 2005) ，同時符合 National Institutes of Health (NIH) 「身心醫學」的定義。”禪修” (meditation) 是很多醫生有興趣的身心療法 (Astin, 2003; Bonadonaa, 2003; Bond, 2011; Canter, 2003; Chan, 2010; Chan et al., 2001) 。
禪修專門處理人類的情緒。著名佛教學者 Nyanaponika Thera (Thera, 1962)說：
” 四念住 (Satipatthana) 不需要任何複雜的技術或外部設備，日常生活是其工作的材料，同任何外來的儀式無關，也並不需要”深奧的知識”。”
四念住與八正道的實踐，説明你可以訓練你的身心 (Shannahoff-Khalsa, D., 2012; Wilst et al., 2009) 。 相同的方式訓練你的心智，襌修可以細化意識，這可能是一個核心進程調解及其治療的好處，細化的意識是一個進一步的重要沉思進程的必要前提 (disidentification) (Segal et al., 2002; Walsh & Shapiro, 2006) 。 專注覺察訓練，可以揭示通常思想被遮蔽的心靈的深處。襌修的實踐有能力去減慢，甚至停止雜念 (Friese et al., 2012; Riet, 2011; Travis & Perarson, 2000)。
佛教襌修備受關注和刺激了大量的科學研究 (Barinaga, 2003; Hasenkamp et al., 2012; Knight, 2004; Koszycki et al., 2007; Lehmann et al., 2012; Mason et al., 1997; Pagnoni, 2008; Reibel, 2008; Sperduti et al., 2012; Takahashi et al., 2005).。Moon et al. (2005) 發現參禪打坐後幾種生長因數有所變化。參禪打坐也對血清一氧化氮活性和氧化應激 (脂質過氧化） 所涉及的心血管功能有所轉變 (Kim et al., 2005)。Solberg et al. (2004) 發現禪修者有較高的褪黑激素水準，反映禪修的影響可能通過對神經遞質的影響，如腦內啡、 多巴胺、 血清素、 氨基丁酸等 (Wasi, 2009)。襌定可影響神經可塑性(Lutz et al., 2004)。腦成像技術，例如 f MRI，PET，SPECT 証明通過打坐可以改變大腦結構和功能 (Conlin, 2004; Conner, 2003; Hasenkamp et al., 2012; Kozasa et al., 2012; Luders et al., 2012; Pagnoni & Cekic, 2008)。 靜修可以導致血壓下降、減慢心率和降低皮質醇水平 (Wasi, 2009)。 Pagnoni & Cekic (2008) 發現禪修會減慢腦灰質卷體積(cerebral grey matter volume)因年齡而衰退的速度，並減少與正常老化相關的認知能力衰退。
科學家對襌修有關身心的影響進行了很多研究 (Astin, 2003; Canter, 2003; Fortney & Taylor, 2010; Kristeller, 2007; Turner, 2004; Young, 2011).。禪修的影響包括生理的反應、 心理治療的效果和積極正面情緒的增長 (Walsh & Shapiro, 2006)。很多研究關注醫療慢性病 (Bonadonna, 2003)，像高血壓 (Manikonda et al., 2005; Roush, 1997; Schneider et al., 1995; Schneider et al., 2005)，冠狀動脈疾病 （例如心臟復康）(Castillo-Richmond, 2000)，頭痛、 慢性腰痛、 關節炎、 慢性哮喘 (Manocha et al., 2002)，尿失禁、 失眠、 癲癇、 疾病和治療相關症狀的癌症 (Carlson et al., 2003; Meyer & Mark, 1995;, Tacon, 2003)，哮喘和口吃、 荷爾蒙的障礙，比如 2 型糖尿病、 原發性痛經和前期心境惡劣障礙 (Murphy & Donovan, 1997) 和提高手術後成果 (Carlson, 2003)。其他的研究都是關於抑鬱和焦慮障礙 (Miller et al., 1995; Teasdale et al., 1995) ，也有研究老年醫學 (Lindbert, 2005) ，長壽 (Alexander et al., 1989) 與心理健康 (Beauchamp-Turner & Levinson, 1992; Gelderloos et al., 2001)。Horrigan (2011)証明襌修可以減輕痛楚指數(Pain Scores)。專注覺察訓練 (Kabat-Zinn et al., 1992) 是近年最多人研究的身心療法，對多方面的身心病如恐慌症、焦慮、抑鬱、風濕性關節炎、癌症、血壓高、妊娠健康等都有幫助 (Bruce et al., 2005;, Carmody et al., 2006; Chan, 2010; Eldelman et al., 2006, Fennell, 2004; Foley et al., 2010; Hofmann et al., 2010; Kabat-Zinn, 2003; Klainin-Yobas et al., 2012; Leigh et al., 2005; Liehr & Diaz, 2010; Lindberg et al., 2005; Ma & Teasdale, 2004; McHugh et al., 2010; Ostafin et al., 2006; Proulx, 2003; Surway et al., 2005; Weiss et al., 2005; Young, 2011; Zautra et al., 2008; Zeller & Lamb, 2011)
心理教育，孕婦和胎兒健康
妊娠即懷孕過程，即受精卵在母體發育成為胎兒的過程。妊娠全程為280天，28天為一個妊娠月，故全程為10個妊娠月或40周。雖然是短短的40個星期，但在這期間，產婦的身心郤有很大的變化。有人說：「孕婦在誕下新生命時，自己亦獲得重生（Pregnant women is preparing two births: her baby’s and her own rebirth）」，所以懷孕對於婦女的一生，有極其重大的影響，同時亦直接影響到下一代，而妊娠健康與優生，在醫學上和社 會上，都是一個重要的課題，值得我們投入資源，令產婦開心快樂，生下的小寶寶精靈活潑。
女性在妊娠期間，由於機體的適應性變化，常常引發出一些使孕婦苦惱的身體異常表現，如腸胃不適、作悶、嘔吐或消化不良等，而由於妊娠期間關節韌帶鬆弛，重心後移，脊柱過度前凸，背伸肌持續緊張，故此懷孕的婦女容易有腰背酸痛。下肢肌肉痙攣，則多見於妊娠後期，常於夜間發生。在正常情況下，於妊娠晚期，孕婦多有輕度的下肢浮腫。這些症狀，若發生在非懷孕時期，就是患病，但孕婦則不會覺得自己是病患者，因為生下了孩子後，身體就回復正常，所以雖然病徵相同，但感受有異，一般產婦都會安然接受，懷著愉快的心情，迎接新生命的誕生。
除了生理上的變化，孕婦亦容易有情緒上的波動。短暫性的妊娠期情緒失調，普遍存在於一般產婦之中，症狀通常伴隨有意志消沉、昏昏欲睡、對自己懷孕角色的焦慮感，以及記憶減退、注意力不集中等，而在各種文化背景的人士中，可能表現出的症狀亦有所不同。
婦女在懷孕後，由於社會角色的轉變，在心理上，亦需要作適當的調節。夫妻關係的轉變，孩子們在家庭中的重要性，與其他至親的關係，都要在短短十個月的期間作出適應。對於在職的孕婦，更要應付工作上所面對的壓力，所以有法定的勞工條例來保護產婦。
妊娠健康，除了要注重生理健康、心理健康和社 會健康外，還要著重精神性或靈性健康(Spiritual health)。在很多研究疾病和健康的文獻中，都指出精神性或靈性(Spirituality)與健康的重要。靈性的定義，包括關係與介入(Relationship and Involvement)。關係有人與人中間的關係以及對信神(各種宗教都算在內)的人的人與神的關係。綜合學術與宗教的解釋，靈性可理解為「個人在各種相處關係中達到平衡的最佳狀態」，而這些週遭關係包含了本身個體、自然環境、神、他人等，所以靈性並不等同宗教性(Religiosity)。有靈性的人注重在人與人的關係，這是他們自己確認對別人對社會有義務和責任。要為別人服務，不只照顧自己，他們的行為就表現出他們對自己人生的目的，自己對別人的義務的看法。妊娠婦女最能體會靈性，懷著新生命，孕育下一代，產婦與胎兒的親密接觸，最能體驗人與人之間的關係。精神性健康，可以影響生理健康、心理健康和社 會健康，十月懷胎，經歷千辛萬苦，很多媽媽還是渴望多生一個小孩，就是最好的証明了。
每一對夫婦都希望誕下健康醒目的嬰孩，但有多少人知道，在懷孕前三至六個月開始，為自己的身心作充分的準備，就可以讓準爸爸和準媽媽開懷地迎接新生命的誕生。懷孕是興奮的事情，孕婦們若對於妊娠期生理和心理的反應，有充分的認識，就能幫助自己應付新生命來臨的挑戰，令妊娠期擁有健康的身心，甚至可以培育新生兒的情緒智商。對生命充滿熱誠，可以促進懷孕期的身心健康，有助減輕和舒緩產婦所面對的壓力，而健康的情緒，則有利胎兒的身心成長，達到胎教的目的。懷孕期擁有健康的身心，會減少產後情緒的困擾，讓嬰兒能夠在健康的環境下成長。
現在互聯網資訊發達，若在互聯網上搜索 fetal education（胎教），結果絕大多數都是介紹胎教在中國的情況或者中國的網站，但中國的不少關於胎教的文章，都喜歡杜撰一些在歐美國家進行的研究成果。坊間提出的胎教，種類繁多，包括音樂胎教、語言胎教、撫摩胎教、飲食胎教、情緒胎教和優境胎教等。「胎教」一詞，最早出現在漢朝，那時胎教的基本含義是孕婦必須遵守的道德和行為規範。中國南北朝的顏之推，在《顏氏家訓•教子》中說：「在者聖王有胎之法，懷子三月，出居別宮，目不邪視，耳不妄聽，聲音滋味，以禮節之。」宋代朱熹在其《小學集注•立法》中指出：「古者婦人妊子，寢不側，坐不邊，立不蹕，不食邪味，割不正不食，席不正不坐，目不視邪色，耳不聽淫聲，…… 如此則生子形容端正，才過人矣。」廣東人有一句說話：「忟對生忟仔」。沙仕比亞的名劇則有提到，時常哭泣的母親，會誕下悲觀的嬰兒。美國有研究報告指出 (Yehuda, 2005)，受911事件影響而患上創傷後壓力疾患 (PTSD)的孕婦，所生下的嬰兒，身上的皮質醇有偏低的現象，資料顯示妊娠期創傷後壓力病可以影響新生兒患病。丹麥的研究顯示(Khashan et al., 2008)，產婦在產前十二週內若有失去至親或至親患上癌症的經歷，後代患有思覺失調的機會會增加。古往今來，不分中外，都著重產婦的情緒健康和精神性健康，相信妊娠期的情緒，會影響新生兒的情緒智商(emotional intelligent)。現代心理學家和社 會大眾，都了解情緒智力的重要，而培育下一代的情緒智力，則不是從０歲開始，因為懷胎十月，是一個重要的時刻。
禪修、 妊娠健康和胎兒健康
「產前健身健心運動」是為香港產婦設計的身心運動 (Chan, 2010)，包括一系列的心理健康教育和靜修練習，可以促進孕婦身心健康，紓緩妊娠期所面對的壓力，而健康的情緒，則有利胎兒的身心成長，達到胎教的目的。「產前健身健心運動」有別於一般的產前運動，主要的原素有專注覺察訓練、用積極語言來進行心理教育、在日常生活中培育情緒智商和利用靜修運動幫助自己加強可以帶出正能量的心念。整套運動有専注覺察咀嚼訓練、専注覺察漫步運動、専注覺察產前產後運動、每日一事、三分鐘呼吸運動、身體素描和呼吸靜修運動。
専注覺察訓練的目的是提高自己的警覺性，令自己有能力做到在行動前覺察到念頭的生起。専注覺察訓練是從覺察身體各部份開始，進而訓練自己的注意力，以達到隨時隨刻，覺察到自己情緒的起伏。専注覺察咀嚼訓練是叫自己慢慢咀嚼，覺察舌頭與口腔的活動，感受食物的味道。這個訓練可以幫助產婦減少嘔吐和有助腸胃消化食物。専注覺察漫步運動是希望產婦在漫步時保持靜觀的心態，每一刻留心自己的動作，用心的慢慢移動。専注覺察產前產後運動則是在產前產後運動中加入専注覺察訓練和身體素描的元素。
「每日一事」是利用日常的行為訓練，來轉化自己的壞習慣。「善待別人，善待自己」，對懷孕的女性來說，一定容易理解；善待自己，就等如善待自己的胎兒。方法簡單，只需每晚臨睡前想想，明天可以做些什麼令自己開心﹖如是者，每天都想想，初時只想自己，願自己快樂，慢慢延伸到你的胎兒，然後是你的親戚朋友，再之後是陌生人，而最後是一些你討厭的人。這種慈心運動，可令你從狹小的心胸跳出來，轉而對周圍的人增加了慈愛和關懷的心。對任何人都發放慈心，幫助別人就是幫助自己，沒有執著，人就變得平靜、喜悅。胎兒在開心快樂的環境中成長，自然會培育出開朗的個性。「用智化苦，轉危為機」的修習，即是逆境智商，不要想著自己失去什麼，多想自己擁有什麼。每當遇到困難時，就想著這句積極語言，幫助自己的情緒走出困境。「微笑行動」就是「每日一笑」。方法很簡單，就是每天起身梳洗時，向著鏡子對自己幑笑，因為對著自己笑，就是對著孩子笑；然後你外出，可對著看更笑，對著巴士司機笑…如此類推。心境時常保持開朗，對胎兒有很大幫助。「微笑」，就是用身體語言來培育正面情緒的好例子。「放下自在」，就是不要比較。孕婦總喜歡跟別人比較，為甚麼自己會有肚紋，為何自己的嬰兒會這麼少頭髮，什麼也拿去比，要明白，有得必有失，不要只想別人好的一面，要學習接受和包容，學懂let go，放下便得自在。
「呼吸靜修運動」包括「呼吸運動」和「全心運動」。呼吸運動是専注覺察你的呼吸，覺察空氣經過你的鼻尖，覺察腹部的起伏，也可以數你的呼氣或吸氣，由一到十，當心念分散時，重新將念頭專注到呼吸上。全心運動是借助呼吸運動的力量，來調服自己的情緒。「慈悲喜捨」心念的運動，可以轉化負面情緒為正面的力量。無量心的訓練，可以培育同理心，改善人際關係。
香港產婦精神性健康與心理教育：「產前健身健心運動」與妊娠健康及胎兒健康的研究
精神性健康(spirituality)、心理教育(psychoeducation)和妊娠健康是有相互關係的。妊娠期是促進產婦精神性健康最理想的時刻。心理教育則有助促進精神性健康。妊娠健康對孕婦、胎兒、嬰孩和家庭均有深遠的影響。目前產前檢查(prenatal care)只是爲產婦提供健康資訊，並沒有照顧妊娠婦女的精神性健康和提供心理教育。現時有關精神性健康、心理教育和妊娠健康的研究較少，所以本研究的目的就是要探究精神性健康和心理教育對懷孕的重要。鑑於目前缺乏可供選擇的有系統妊娠期心理教育模式，本研究特別為香港產婦設計了一套「產前健身健心運動（Eastern based meditative intervention, EBMI）」，並從中探討此運動對妊娠健康、胎兒健康和嬰兒健康的影響。本研究就是以精神性健康、心理教育和妊娠健康對胎兒和嬰兒健康有密切的關係作爲理論根據。EMBI是基於心理教育(psychoeducation)、認知介入治療(cognitive intervention)、專注覺察訓練(mindfulness practise) 和「四無量心」禪修(Four Immeasurables meditation)對健康有良好影響而設計的。
在研究過程中，於2007年9月至2009年1月共舉辦了7次「產前健身健心運動」訓練班。研究是隨機對照(randomized control)，探用定量(quantitative)和質性(qualitative)方法，在2007年9月至2009年9月於香港伊利沙伯醫院婦產科(Obstetric Unit, Queen Elizabeth Hospital, Hong Kong) 進行。實驗組(intervention group)有64位產婦，而控制組(control group)則有59位孕婦參與定量方法研究。實驗組中有43位參加質性研究。定量研究結果顯示，實驗組產婦對自我有正面的積極評價(positive appraisal)(p<0.05)，而且在晚間口水唾液皮質醇測試(salivary cortisol)中，比控制組有明顯的分別(p<0.05)，這表示了EBMI對妊娠健康有良好的影響。實驗組(p<0.05)和多做運動組別(frequent practise group) (p<0.01)出生嬰兒臍帶血皮質醇度數(Cord blood cortisol)比控制組為高，正好表示實驗組和多做運動組別出生嬰兒有更理想的健康狀況(positive health status)，証明妊娠健康會影響胎兒健康。凱里嬰兒氣質問卷(Carey Infant Temperament Questionnaire)結果，顯示實驗組幼兒在六個月大時比控制組幼兒有更佳的氣質(temperament)，這反映了妊娠健康對幼兒健康的重要。質性研究與定量研究得出相同的結果，証實精神性健康和EBMI對妊娠健康、胎兒健康和幼兒健康有正面的影響。質性研究顯示大部分參加者均同意研究得出的結論。
本研究得出的結論是精神性健康和心理教育可以促進妊娠健康、胎兒健康和幼兒健康。此外，臍帶血皮質醇測試對胎兒健康是一項創新的指標。本研究顯示積極健康指標(positive health indicators)的重要，這範疇宜有進一步的探究。實驗組出生嬰兒較為健康和幼兒有更好的氣質，証明了胎教(Taijiao)是有科學根據的。本研究建議孕期保健提供者(pregnancy care providers)應照顧妊娠婦女的精神性健康，並提供妊娠心理教育。EBMI可合併到產前保健系統(prenatal care system)。
REFERENCES
| Abramowitz, J.S., Moore, E.L., Braddock, A.E. & Harrington, D.L. Self-help cognitive-behavioral therapy with minimal therapist contact for social phobia: A controlled trial. Journal of Behavior Therapy & Experimental Psychiatry, 40(1), 98-105. |
| Alexander, C.N., Langer, E.J., Newman, R.I., Chandler, H.M., & Davies, J.L. (1989). Transcendental Meditation, Mindfulness and longevity: An Experimental Study with the Elderly. J Pers soc Psychol., 57(6), 950-64. |
| Andresen, J. (2000). Meditation meets behavioural medicine: The story of experimental research on meditation. In J. Andresen & R.K.C. Forman (Eds.), Cognitive models and spiritual maps: Interdisciplinary explorations of religious experience (pp. 17-73). Thorverton, UK: Imprint Academic. |
| Aspinwall, L.G., & Tedeschi, R.G. (2010). The Value of Positive Psychology for Health Psychology: Progress and Pitfalls in Examining the Relation of Positive Phenomena to Health. Ann Behav Med, 39, 4-15. |
| Astin, J.A., Shapiro, S.L., Eisenberg, D.M., & Forys, K.L. (2003). Mind-Body Medicine: State of the Science, Implications for Practice. J Am Board Fam Pract, 16(2), 131-147. |
| Austin, M.-P., Hadzi-Pavlovic, D., Leader, L., Saint, K., & Parker, G. (2005). Maternal trait anxiety, depression, and life event stress in pregnancy: relationships with infant temperament. Early human development, 81, 183-190. |
| Avery, B. (1996). Principles of psychotherapy. London: Thorsons. |
| Barinaga, M., 2003. Buddhism and neuroscience. Studying the well-trained mind. Science, 302 (5642), 44–46. |
| BBC NEWS. (2005). Autism linked to difficult births. Available at http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/4554413.stm. Published on 2005/05/17 09:13:17 GMT. |
| Beauchamp-Turner, D.L., & Levinson, D.M. (1995). Effects of meditation on stress, health, and affect. Medical-Psychother: Int J., 5, 123-31. |
| Beitel, M., Genova, M., Schuman-Olivier, Z., Arnold, R., Avants, S.K. & Margolin, A. (2007). Reflections by Inner-City Drug Users on a Buddhist-Based Spirituality-Focused Therapy: A Qualitative Study. American Journal of Orthopsychiatry, 77(1), 1-9. |
| Berg, A, & Hallberg, I.R. (1999). Effects of systematic clinical supervision on psychiatric nurses’s sense of coherence, creativity, work-related strain, job satisfaction and view of the effects from clinical supervision: a pre-post test design. Journal of Psychiatric and Mental Health Nursing, 6, 371-81. |
| Bledose, S.E., & Grote, N.K. (2006). Treating Depression During Pregnancy and the Postpartum: A Preliminary Meta-Analysis. Research on Social Work Practice, 16(2), 109-120. |
| Bonadonna, R. (2003). Meditation’s Impact on Chronic Illness. Holistic Nursing Practice, 17(6), 309-319. |
| Bond, M.H. (1996). Chinese values. In: Bond, M.H. (Ed.), The Handbook of Chinese Psychology, 208-226. Hong Kong: Oxford University press. |
| Bond, M. (2011). The real powers of meditation. The New Scientist, 209, 2794, 32-35. |
| Bor, R., Miller, R., Latz, M., & Salt, H. (1998). Counselling in health care settings. London, New York: Cassell. |
| Bruce, A., & Davies, B. (2005). Mindfulness in Hospice Care: Practicing Meditation-in-Action. Qualitative Health Research, 15(10), 1329-1344. |
| Canter P.H. (2003) .The therapeutic effects of meditation. BMJ, 326, 1049-1050. |
| Carlson, L.E., Speca, M., Patel, K.D., & Goodey, E. (2003). Quality of Life, Mood, Symptoms of Stress, and Immune Parameters in Breast and Prostate Cancer Outpatients. Psychosom Med, 65(4), 571 – 581. |
| Carmody, J., Crawford, S., & Churchill, L. (2006). A pilot study of mindfulness-based stress reduction for hot flashes. Menopause, 13(5), 1-9. |
| Chan, C.L.W., Ho, P.S.Y., & Chow, E. (2001). A body-mind-spirit model in health: An Eastern Approach. Social Work in Health Care, 34(3/4), 261-282. |
| Chan, K.P. (2003). Doctors and their faiths: Buddhism. BMJ Careers, 326, s135. |
| Chan, K.P. (2006). Spirituality and Buddhism. Present on 22 April 2006, Third biannual Sangiti Korean Conference of Buddhist Studies. Published in The Proceedings of The Korean conference on Buddhist studies 2006 (韓國佛教學結集大會論集), 3(2), 1520-154l. |
| Chan, K.P. (2008). The Four Immeasurables Meditative Intervention and Pregnancy Health. Accepted by International Buddhist Conference, the Fifth United Nations Day of Vesak 2008 Celebration, May 13th-18th, Hanoi, Vietnam. |
| Chan, K.P. (2010). The Four Immeasurables. Available at www.mind2spirit.com. Assess on 7 May 2010. |
| Chan, K.P. (2010). Spirituality and psychoeducation of pregnant Chinese women in Hong Kong: an evaluation of the effect of an Eastern based meditative intervention on maternal and foetal health status. Doctoral dissertation. University of Hong Kong, Hong Kong. |
| Chen, C.P. (1995). Counseling applications of RET in a Chinese cultural context. Journal of Rational Emotive and Cognitive Behavior Therapy, 13(2), 117-129. |
| Conlin, M. (2004). Meditation. Businessweek, 30 August 2004, 98-99. |
| Conner, S. (2003). Buddhist transcend mental reservations? Science, 22 May 2003. |
| Cope, T.A. (2010). The Inherently Integrative Approach of Positive Psychotherapy. Journal of Psychotherapy Integration, 20(2), 203-250. |
| Coyne, J.C., & Tennen, H. (2010). Positive psychology in Cancer Care: Bad Science, Exaggerated Claims, and Unproven Medicine. Annals of Behabioral Medicine, 39(1), 16-26. |
| Dali Lama. (1984). Kindness, Clarity, and Insight. New York, U.S.A.: Snow lion. |
| Delbar, V., & Benor, D.E. (2001). Impact of a nursing intervention on cancer patients’ ability to cope. Journal of Psychosocial Oncology, 19, 57-75. |
| Duncan, L.G. & Bardacke, N. (2010). Mindfulness-Based Childbirth and Parenting Education: Promoting Family Mindfulness During the Perinatal Period. J Child Fam Stud, 19, 190-202. |
| Ekers, D.M., Lovell, K., & Playle, J.F. (2006). The use of CBT based, brief, facilitated self-help interventions in primary care mental health service provision: Evaluation of a 10-day training programme. Clinical Effectiveness in Nursing, 9(1), e88-e96. |
| Eldelman, D., Oddone, E.Z., Liebowitz, R.S., Yancy, W.S., Olsen, M.K., Jeffreys, A.S., Moon, S.D., Harris, A.C., Smith, L.L., Quillian-Wolever, R.E., & Gaudet, T.W. (2006). A multidimensional integrative medicine intervention to improve cardiovascular risk. J Gen Intern Med, 21, 728-734. |
| Fenell, M.J.V. (2004). Depression, low self-esteem and mindfulness. Behaviour Research & Therapy, 42, 1053-1067. |
| Foley, E., Baillie, A., Huxter, M., Price, M., & Sinclair, E. (2010). Minfulness-Based Cognitive Therapy for Individuals Whose Lives Have Been Affected by Cancer: A Randomized Controlled Trial. Journal of Consulting and Clinical Psychology, 78(1), 72-79. |
| Forsgarde, M., Westman, B., & Nygren, L. (2000). Ethical discussion groups as an intervention to improve the climate in interprofessional work with the elderly and disabled. Journal of Interprofessional Care, 14, 351-361. |
| Fortney, L., & Taylor, M. (2010). Meditation in Medical Practice: A Review of the Evidence and Practice. Primary Care: Clinics in Office Practice, 37(1), 81-90. |
| Friese, M., Messner, C., & Schaffner, Y. (2012). Mindfulness meditation counteracts self-control depletion. Consciousness & Cognition, in press, corrected proof, available online 4 Feb 2012. |
| Gelderloos, P., Hermans, H.J.M., Ahlscrom, H.H., & Jacoby, R. (2001). Transcendence and Psychological Health Studies with long-term participants of the Transcendental Meditation and TMSidhi Program. The Journal of Psychology, 124(2), 177-197. |
| Grason, H.A., Hutchins, J.E., & Silver, G.B. (1999). Introduction: Toward a new vision of women’s health. In Grason, H.A., Hutchins, J.E., & Silver, G.B. (Eds.), Charting a course for the future of women’s and perinatal health: Vol. 2-Reviews of key issues (pp. 1-3). Baltimore, MD: Women’s and Children’s Health Policy Center, Johns Hopkins School of Public Health. |
| Gutteling, B.M., Weerth, C., & Buitelaar, J.K. (2005). Prenatal stress and children’s cortisol reaction to the first day of school. Psychoneuroendocrinology, 20, 541-549. |
| Hasenkamp, W., Wilson-Mendenhall, C.D., Duncan, E., & Barsalou, L.W. (2012). Mind wandering and attention during focused meditation: A fine-grained temporal analysis of fluctuating cognitive states. Neurolmage, 59, 1, 750-760. |
| Hillert, L., Savlin, P., & Berg, A.L. (2002). Environmental illness—effectiveness of a salutogenic group-intervention programme. Scand J Public Health, 30, 166-75. |
| Hofmann, S.G., Sawyer, A.T., Witt, A.A., & Oh, D. (2010). The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review. Journal of Consulting & Clinical Psychology, 78(2), 169-183. |
| Hofmann, S.G., Grossman, P., & Hinton, D.E. (2011). Loving-kindness and compassion meditation: Potential for psychological interventions. Clinical Psychology Review, 31, 7, 1126-1132. |
| Horrigan, B. (2011). Meditation Reduces Pain Scores. Explore: The Journal of Science and Healing, 7, 4, 215-216. |
| Jacobs, T., Epel, E., Lin, J., Blackburn, E., Wolkowitz, O., Bridwell, D., Zanesco, A., Aichele, S., Sahdra, B., MacLean, K., King, B., Shaver, P., Rosenberg, E., Ferrer, E., Wallace, A., & Saron, C. (2011). Intensive meditation training, immune cell telomerase activity, and psychological mediators. Psychoneuroendocrinology, 36, 5, 664-611. |
| Johnson, D., Penn, D., Fredrickson, B., Kring, A., Meyer, P., Catalino, L., & Brantley, M. (2011). A pilot study of loving-kindness meditation for the negative symptoms of schizophrenia. Schizophrenia Research, 129, 2-3, 137-140. |
| Kabat-Zinn, J. (2003). Mindfulness-Based Interventions in Context: Past, Present, and Future. Clinical Psychology: Science and Practice, 10(2), 144-156. |
| Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8, 163-190. |
| Kabat-Zinn, J., Massion, A.O., Kristeller, J., Peterson, L.G., Fletcher, K.E., Phert, L., Lenderking, W.R., & Santorelli, S.F. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry, 148, 936-943. |
| Kabat-Zinn, J., Wheeler, E., Light, T., Skillings, A., Scharf, M.J., Cropley, T.G., Hosmer, D., & Bernhard, J.D. (1998). Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med., 50, 625-632. |
| Kaiser, S., & Sachser, N. (2005). The effects of prenatal social stress on behaviour: mechanisms and function. Neuroscience & Biobehavioral Reviews, 29, 283-294. |
| Kim, D.H., Moon, Y.S., Kim, H.S., Jung, J.S., Park, H.M., Suh, H.W., Kim, Y.H., & Song, D.K. (2005). Effect of Zen Meditation on serum nitric oxide activity and lipid peroxidation. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 29, 327-331. |
| Klainin-Yobas, Cho, M., & Creedy, D. (2012). Efficacy of mindfulness-based interventions on depressive symptoms among people with mental disorders: A meta-analysis. International Journal of Nursing Studies, 49, 1, 109-121. |
| Knight, J. (2004). Religion and science: Buddhism on the brain. Nature, 432 (7018), 670. |
| Koszycki, D., Benger, M., Shlik, J. & Bradwejn, J. (2007). Randomized trial of a meditation-based stress reduction program and cognitive behaviour therapy in generalized social anxiety disorder. Behaviour Research & Therapy, 45, 2518-2526. |
| Kozasa, E.H., Sato, J.R., Lacerda, S.S., Barreiros, M.A.M., Radvany, J., Russell, T.A., Sanches, L.G., Mello, L., & Jr Amaro, E. (2012). Meditation training increases brain efficiency in an attention task. Neurolmage, 59, 1, 745-749. |
| Kristeller, J.L., & Johnson, T. (2005). Science Looks at Spirituality. Cultivating loving kindness: A two-stage model of the effects of meditation on empathy, compassion, and altruism. Zygon, 40(2), 391-407. |
| Kristeller, J.L. (2007). Meditation and Stress. Encyclopedia of Stress, 678-685. |
| Ladner, L. (2008). Positive Psychology & the Buddhist Path of Compassion. Available at http://www.buddhanet.net/compassion.htm. Assessed on 3 Apr 2008 HKT 22:40. |
| Laplante, D.P., Barr, R.G., Brunet, A., Fort, G.G.., Meaney, M.L., Saucier, J.F., Zelazo, P.R., & King, S. (2004). Stress during pregnancy affects general intellectual and language functioning in human toddlers. Pediatric Research, 56(3), 400-410. |
| Larson, H.J., Eaton, W.W., Madsen, K.M., Vestergaard, M., Olesen, A.V., Agerbo, E., Schendel, D., Thorsen, P., & Mortensen, P.B. (2005). Risk factors for Autism: Perinatal factors, Parental psychiatric history, and Socioeconomic status. American Journal of Epidemiology, 161, 916-25. |
| Lee, A.M., Chong, C.S.Y., Chiu, H.W., Lam, S.K., Fong, D.Y.T. (2007). Prevalance, course, and risk factors for antenatal anxiety and depression. Obstet. Gynecol., 110, 1102-1112. |
| Lehmann, D., Faber, P.L., Tei, S., Pascual-Marqui, R.D., Milz, P., & Kochi, K. (2012). Reduced functional connectivity between cortical sources in five meditation traditions detected with lagged coherence using EEG tomography. Neurolmage, 60, 2, 1574-1586. |
| Leigh, J., Bowen, S., & Marlatt, A. (2005). Spirituality, mindfulness and substance abuse. Addictive Behaviors, 30, 1335-41. |
| Liehr, P., & Diaz, N. (2010). A Pilot Study Examing the Effect of Mindfulness on Depression and Anxiety for Minority Children. Archives of Psychiatric Nursing, 24(1), 69-71. |
| Lindberg, D.A. (2005). Integrative review of research related to meditation, spirituality, and the Elderly. Geriatr Nurs, 26, 372-377. |
| Luders, E., Phillips, O., Clark, K., Kurth, F., Toga, A., & Narr, K. (2012). Bridging the hemispheres in meditation: Thicker callosal regions and enhanced fractional anisotropy (FA) in long-term practitioners. NeuroImage, in press, uncorrected proof, available online 21 February 2012. |
| Lutz, A., Greischar, L.L., Rawlings, N.B., Ricard, M., Davidson, R.J. (2004). Long-term meditators self-induce high-amplitude gamma synchrony during mental practice. Proc. Natl. Acad. Sci. U.S.A.,101 (46), 16369–16373. |
| Ma, S.H., & Teasdale, J.D. (2004). Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Journal of Consulting & Clinical Psychology, 72(1), 31-40. |
| MacArthur, C., Winter, H.R., Bick, D.E., & Knowles, H. (2002). Effects of redesigned community postnatal care on women’s health 4 months after birth: A cluster randomized controlled trial. The Lancet, 359, 3778-385. |
| Maygar-Moe, J.L. (2009). Positive Psychological Interventions. In Maygar-Moe, J.L., Therapist’s Guide to Positive Psychological Interventions, pp.73. Elsevier: USA. |
| Manikonda, P., Stoerk, S., Toegel, S., Schardt. F., Angermann, C., Gruenberger, I., Fuchs, O., Faller, H., & Voelker, W. (2005). Influence of non-pharmacological treatment (contemplative meditation & breathing technique) on stress induced hypertension – a randomized controlled study. American Journal of Hypertension, 18(5), A89-90. |
| Manocha, R., Marks, G.B., Kenchington, P., Peters, D., Salome, C.M. (2002). Sahaja yoga in the management of moderate to severe asthma: a randomized controlled trial. Thorax, 57, 110 – 115. |
| Mason, L.I., Alexander, C.N., & Travis, F.T. (1997). Electrophysiological correlates of higher states of consciousness during sleep in long-term practitioners of the Transcendental Meditation Program. Sleep, 20, 102–110. |
| McCown, D. (2004). Cognitive and Perceptual Benefits of Meditation. Seminars in Integrative medicine, 2(4), 148-151. |
| McHugh, L., Simpson, A., & Reed, P. (2010). Mindfulness as a potential intervention for stimulus over-selectivity in older adults. Research in Developmental Disabilities, 31, 178-184. |
| Meyer, T. J., & Mark, M. M. (1995). Effects of psychosocial interventions with adult cancer patients: A meta-analysis of randomized experiments. Health Psychology, 14, 101–108. |
| Mikulas, W.L. (2007). Buddhism and Western Psychology: Fundamentals of Integration. Journal of Consciousness Studies, 14(4), 4-49. |
| Miller, J.J., Fletcher, K., & Kabat-Jinn, J. (1995). Three year follow up and clinical implications of a mindfulness meditation based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry, 17(3), 192-200. |
| Moon, Y.S., Kim, D.H. & Song, D.K. (2005). Effect of Zen meditation on serum growth factors/ cytokines. European NeuroPsychopharmacology, 15(3), s621-621. |
| Murphy, M., & Donovan, S. (1997). The physical and psychological effects of meditation (2nd ed.). Petaluma, CA: Institute of Noetic Sciences. |
| Nathan, G.J., & Mencken, H.I. (1921). The American credo (pp 109). New York. Alfred A. Knopf. |
| Ng, S.M., Yau, J.K.Y., Chan, C.L.W., & Ho, D.Y.F. (2005). The Measurement of Body-Mind-Spirit Well-Being: Toward Multidimensionality and Transcultural Applicablility. Social Work in Health Care, 41(1), 33-52. |
| Norbeck, J.S., & Tilden, V.P. (1983). Life stress, social support, and emotional disequilibrium in complications of pregnancy. Journal of Health and Social Behavior, 24, 30-46. |
| O’Keane, V., & Scott, J. (2005). From obstetric complications to a maternal-foetal origin hypothesis of mood disorder. British Journal of Psychiatry, 186, 367-368. |
| Ostafin, B.D., Chawla, N., Bowen, S., Dillworth, T.M., Witkiewitz, K., & Marlatt, G.A. (2006). Intensive Mindfulness Training and the Reduction of Psychological Distress: A Preliminary Study. Cognitive and Behavioral Practice, 13, 191-197. |
| Pagnoni, G., & Cekic, M. (2008). Age effects on gray matter volume and attentional performance in Zen Meditation. Neurobiology of Aging, 28, 1623. |
| Patterson, C.H. (1972). Theories of counseling and psychotherapy. New York: Harper & Row Publishers. |
| Pine, R. (1992). The Zen teaching of Bodhidharma (Red Pine, Trans.). New York: Weatherhill, Inc. |
| Proulx, Kathryn. (2003). Integrating Mindfulness-Based Stress Reduction. Holistic Nursing Practice, 17(4), 201-208. |
| Raes, F., Dewulf, D., Heeringen, C.V., & Williams, J.M.G. (2009). Mindfulness and reduced cognitive reactivity to sad mood: Evidence from a correlational study and a non-randomized waiting list controlled study. Behaviour Research & Therapy, 47, 623-627. |
| Reibel, D.K., Greeson, J.M., Brainard, G.C., & Rosenzweig, S. (2008). Mindfulness-based stress reduction and health-related quality of life in a heterogeneous patient population. General Hospital Psychiatry, 23, 183-192. |
| Riet, P. (2011). Collegian: Journal of the Royal College of Nursing Australia, 18, 1, 36-42. |
| Ronca, A.E., Lamkin, C.A., & Alberts, J.R. (1993). Maternal contributions to sensory experience in the foetal and newborn rat (Rattus norvegicus). Journal of Comparative Psychology, 197, 61-74. |
| Rosenbaum, M. (1990). The role of learned resourcefulness in the self-control of health behavior. In: Rosenbaum, M. (Ed.), Learned Resourcefulness: On Coping Skills, Self-Control and Adaptive Behavior, 3-30. New York: Springer. |
| Roush, W. (1997). Herbert Benson: Mind–body maverick pushes the envelope. Science, 276, 357–359. |
| Rubin, R. (1984). Maternal identity and the maternal experience. New York: Springer. |
| Schneider, R. H., Alexander, C. N., Staggers, F., Orme-Johnson, D. W., Rainforth, M., Salerno, W., et al. (2005). A randomized controlled trial of stress reduction in African Americans treated for hypertension for over one year. American Journal of Hypertension, 18, 88-98. |
| Schneider, R.H, Staggers, F., Alexander, C., Sheppard, W., Rainforth, M., Kondwani, K., Smith, S., & King, C.G. (1995). A randomized controlled trial of stress reduction for hypertension in older African Americans. Hypertension, 26, 820-827. |
| Schwartz, S. (2011). Meditation-The Controlled Psychophysical Self-Regulation Process That Works. Explore: The Journal of Science and Healing, 7, 6, 348-353. |
| Segal, Z., William, J. M., & Teasdale, J. (2002). Mindfulness-based cognitive therapy for depression. New York: Guilford Press. |
| Seligman, M.E.P., & Csikszentmihalyi, M. (2000). Positive Psychology: An Introduction. American Psychologist, 55(1), 5-14. |
| Shannahoff-Khalsa, D. (2012). Meditation: The Science and the Art. Encylopedia of Human Behavior (2nd edition), 576-584. |
| Shapiro, S. & Walsh, R. (2002). An analysis of recent meditation research and suggestions for future directions. Palo Alto: VA Palo Alto Health Care System. |
| Snelling, J. (1987). The Buddhist Handbook. Sydney: Random Century Group Australia. |
| Sobolewski, A., Holt, E., Kublik, E. & Wrobel, A. (2011). Impact of meditation on emotional processing – A visual ERP study. Neuroscience Research, 71, 1, 44-48. |
| Solberg, E.E., Holen, A., Ekeberg, O., Osterud, B., Halvorsen, R., & Sandvik, L. (2004). The effects of long meditation on plasma melatonin and blood serotonin. Med Sci Monit, 10(3), CR96-101. |
| Sperduti, M., Martinelli, P., & Piolino, P. (2012). A neurocognitive model of meditation based on activation likelihood estimation (ALE) meta-analysis. Consciousness & Cognition, 21, 1, 269-276. |
| Srivastava, M., Talukdar, U., & Lahan, V. (2011). Meditation for the management of adjustment disorder anxiety and depression. Complementary Therapies in Clinical Practice, 17, 4, 241-245. |
| Surway, C., Roberts, J., & Silver, A. (2005). The effect of mindfulness training on mood and measures of fatigue, activity, and quality of life in patients with chronic fatigue syndrome on a hospital waiting list: A series of exploratory studies. Behavioral and Cognitive Psychotherapy, 33(1), 103-109. |
| Tacon, A.M. (2003). Meditation as a Complementary Therapy in Cancer. Family & Community Health, 26(1), 64-73. |
| Takahashi, T., Murata, T., Hamada, T., Omori, M., Kosaka, H., Kikuchi, M., Yoshida, H., & Wada, Y. (2005).Changes in EEG and autonomic nervous activity during meditation and their association with personality traits. Int J Psychophysiology, 55(2), 199-207. |
| Teasdale, J. (1999). Metacognition, mindfulness and the modification of mood disorders. Clin Psychol Psychother, 6, 146-55. |
| Teasdale, J.D., Segal, Z.V., Williams, J.M.G., Ridgeway, V.A., Soulsby, J.M. & Lau, M.A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol, 68(4), 615-23. |
| Teasdale, J.D., Segal, Z., & Williams, J.M.G. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behave. Res. Ther. , 33(1), 25-39. |
| Thera, N. (1962). The Heart of Buddhist Meditation. London: Rider & Co. |
| Thompson, B.L., & Waltz, J. (2007). Everyday mindfulness and minfulness meditation: Overlapping constructs or not? Personality & Individual Differences, 43, 1875-1885. |
| Thompson, C., Syddall, H., & Rodin, I. (2001). Birth weight and the risk of depressive disorder in late life. British Journal of Psychiatry, 179, 450-455. |
| Thoresen, M. (2000). Protecting the perinatal brain. Seminars in Neonatology, 5, 1-2. |
| Travis, F., Arenander, A., & DuBois, D. (2004). Psychological and physiological characteristics of a proposed object-referral/self-referral continuum of self-awareness. Consciousness and Cognition, 13, 401-420. |
| Turner, E.M. (2004). The benefits of meditation: experimental findings. The Social Science Journal, 40, 465-470. |
| Van den Bergh, B.R.H., Mulder, E.J.H., Mennes, M., & Glover, V. (2005). Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanism. A review. Neuroscience & Biobehavioral Reviews, 29, 237-258. |
| Varela F, Thompson S, Rosch E. (1991). The embodied mind: cognitive science and human experience. Cambridge, MA: MIT Press. |
| Wadhwa, P.D. (2005). Psychoneuroendocrine processes in human pregnancy influence foetal development and health. Psychoneuroendocrinology, 30, 724-743. |
| Walker, S.P., Chang, S.M., Powell, C.A. & Grantham-McGregor, S.M. (2004). Psychosocial intervention improves the Development of Term Low-Birth-Weight Infants. The Journal of Nutrition, 134(6), 1417-1423. |
| Walsh, R., & Shapiro, S.L. (2006). The Meeting of Meditative Disciplines and Western Psychology. American Psychologist, 61(3), 227-239. |
| Wasi, P. (2009). Brain and meditation. 19th World Congress of Neurology, Invited Abstracts/Journal of the Neurolgoical Sciences, 285(S1), 36. |
| Weinstock, M. (2005). The potential influence of maternal stress hormones on development and mental health of the offspring. Brain, Behavior & Immunity, 19, 296-308. |
| Weiss, M., Nordie, J.W., & Siegel, E.P. (2005). Mindfulness-Based Stress Reduction as Adjunct to Outpatient Psychotherapy. Psychother Psychosom, 74, 108-112. |
| Wilst, W.H., Sullivan, B.M., Wayment, H.A., & Warren, M. (2009). A Web-Based Survey of the Relationship Between Buddhist Religious Practices, Health, and Psychological Characteristics: Research Methods and Preliminary Results. J Relig Health, 49, 18-31. |
| Williams, P. (2000). Buddhist thought: A complete introduction to the Indian tradition. London: Rouledge. |
| Yehuda, R., Engel, S.M., Brand, S.R., Seckl, J., Marcus, S.M. & Berkowitz. (2005). Transgenerational Effects of Posttraumatic Stress Disorder in Babies of Mothers Exposed to the World Trade Center Attacks during Pregnancy. J Clin Endocrinol Metab, 90, 4115-4118. |
| Yehuda, R., Bell, A., Bierer, L.M., & Schmeidler, J. (2008). Maternal, not paternal., PTSD is related to increased risk for PTSD in offspring of Holocaust survivors. Journal of Psychiatric Research, 42(13), 1104-1111. |
| Young, L.A. (2011). Mindfulness Meditation: A Primer for Rhematologists. Rheumatic Disease Clinics of North America, 37, 1, 63-75. |
| Zautra, A.J., Davis, M.C., Reich, J.W., Nicassion, P., Tennen, H., Finan, P., Kratz, A., Parrish, B., & Irwin, M.R. (2008). Comparison of Cognitive Behaviroal and Mindfulness Meditation Interventions on Adaptation to Rheumatoid Arthritis for Patients With and Without History of Recurrent Depression. Journal of Consulting & Clinical Psychology, 76(3), 408-421. |
| Zeller, J. & Lamb, K. (2011). Mindfulness Meditation to Improve Care Quality and Quality of Life in Long-Term Care Settings. Geriatric Nursing, 32, 2, 114-118. |
Be the first to comment