Zen and Mental health techniques

[ctpowers8]

I have two meditation groups at the clinic I intern at and I use a couple forms of meditation from a clinical stand point. I teach mindfulness meditation based on the medical model, meta meditation and also we have people try to create personal mantras that if done right can create positive self fulfilling prophesies. These all work well with people who are depressed or have ptsd and for some people with mania. My question for the Treeleaf Community is do you know of any meditative practices that might work for persons with psychotic symptoms or mania/hyperactivity?
Cheers
Chris Powers

[Jundo]

Re: Zen and Mental health techniques

I have two meditation groups at the clinic I intern at and I use a couple forms of meditation from a clinical stand point. I teach mindfulness meditation based on the medical model, meta meditation and also we have people try to create personal mantras that if done right can create positive self fulfilling prophesies. These all work well with people who are depressed or have ptsd and for some people with mania. My question for the Treeleaf Community is do you know of any meditative practices that might work for persons with psychotic symptoms or mania/hyperactivity?
Cheers
Chris Powers

Hi Chris,

Our emphasis here is on Shikantaza ... which may be said to be "being one" with what ails one, although not necessarily a cure for what ails one. HOWEVER, that "being one" with life ... can relieve much suffering in life. It is a strange thing ... we do not sit Shikantaza to be "better" or to make life "other than as it is" ...

... Yet, in the very stillness of letting life be "as is it" and embracing all of life ... and in dropping the hard borders and divisions between our "self" and the world ... this practice does thereby leave almost all people better ... and often does work an effective cure (or is one helpful part of the cure) ... from depression, stress, addiction, compulsive disorders, eating disorders, anger issues, self loathing ... you name it.

We do emphasize mindfulness of our thoughts and emotions ... but not as a form of meditation. Our Zazen is the radical non-doing of Shikantaza, and awareness of the "mind theatre" and tricks and games of the human mind is something primarily "off the cushion".

While I suspect that Shikantaza ... in its quietness, in the total stillness and acceptance ... would be something helpful with mania/hyperactivity, I have no specific evidence of that. I doubt that it would have any significant effect on psychotic symptoms, when the mind is running wild beyond the individual's control ... although I have no evidence one way or the other on that too.

Zazen is -NOT- a cure for many things ... it will not fix a bad tooth (just allow you to be present with the toothache ... you had better see a dentist, not a Zen teacher), cure cancer (although it may have some healthful effects and make one more attune to the process of chemotherapy and/or dying), etc. Zen practice will not cure your acne on your face, or fix your flat tire. All it will do is let one "be at one, and whole" ... TRULY ONE ... with one's pimples and punctured wheel, accepting and embracing of each, WHOLLY WHOLE with/as each one. There are many psychological problems or psycho/medical problems such as alcoholism that may require other therapies, although Zen can be part of a 12-Step program or such (a few Zen teachers in America with a drinking problem had to seek outside help). My feeling is that some things ... such as psychosis ... are probably best handled by psychiatric treatment, not Zen teachers.

Gassho, J

[Yugen]

Re: Zen and Mental health techniques

Chris,
I agree with Jundo completely that Zen practice is absolutely good for nothing :wink: .... and that medical and emotional conditions require the attention of medical and clinical professionals in the appropriate specialties and disciplines.

I would like to preface my remarks with the statement that I am not a medical or mental health professional, so my observations are personal and subjective.

In the case of mania (often but not exclusively associated with Bipolar and Borderline Personality Disorders) Dialectical Behavior Therapy (DBT) has been found to be of benefit. It derives from Buddhist mindfulness practices and is intended to help one "create a space" between an emotion and the associated response. . Combined with Cognitive Behavioral Therapy (CBT), DBT allows one to work with a therapist in evaluating appropriate responses which are built upon emotional regulation and improved distress tolerance. DBT's contribution is the use of mindfulness techniques to increase the time/distance between an uncontrolled emotional event and resulting action (self-injury, violence or outbursts directed towards others, other damaging behaviors in a social or individual context).

In this context, mindfulness developed during Shikantaza surely could be of potential benefit towards the development of one's awareness of one's own inner landscape. It may, repeat may, be a supplement to one's therapy program. If I recall correctly, Marsha Linnehan (sp?) of the University of Washington is one of the leading scholars of this methodology.

I recall other members of our sangha have commented upon DBT, I cannot presently recall the discussion thread. Any additional insights or experiences are welcome. I am even less qualified to offer comments regarding psychoses so I will limit my remarks.

I hope you find some useful leads in the above.

Gassho,
Yugen

[ctpowers8]

Re: Zen and Mental health techniques

Jundo and Yugen I wrote this to see if there were any clinicians in my field who have used any forms of meditation for mental health besides the ones I use in my groups. I understand Shikantaza is the core emphasis of this group but it cannot and should not be used by people with psychosis and for the most part mania (though it can work in some cases).
The problem with Shikantaza or even mindfulness is that the consumer is left to their manic thoughts or psychosis and the problems can exacerbate. I am a Cognitive Behavioral therapist and I also use Bowinian Therapy for families. There is very little on meditation and mental health problems. The few peer reviewed articles out there are based on a medical model mindfulness meditation. This is why I posted the question because maybe someone here has read a peer reviewed article or done a study using different meditation techniques in group or even individual therapy. I apologize if my post was unclear I just got off a 30+ hour shift and I may not have put forth quire in the best possible terms. I also posted on surfing which I do not remember. I think the key for today is do not post when you have been up past 24 hrs.
Cheers
Chris

[Yugen]

Re: Zen and Mental health techniques

Chris,
I understand the direction in which you are headed. If you are looking for peer reviewed literature on this topic I would start with the scholar from the University of Washington I mentioned. She has written peer reviewed scholarship and I remember follow-up work in the UK that has been performed on this topic.

Further, the issue of individuals being left alone with their racing thoughts and exacerbation thereof does not render the CBT/DBT discussion irrelevant. Some of the scholarship I have reviewed discusses these therapies in conjunction with pharmacological protocols which provide some relief while new behaviors and tools are assimilated by the individual. As a CBT practitioner yourself I would expect that you are aware of and may utilize/recommend CBT/pharmacological combined approaches. The same applies to mindfulness-based practices. I would start with a search on the work of Marsha Linehan, and also James Austen, who wrote the seminal Zen and the Brain. While this is a general readership text, the bibliography is a treasure trove of scholarly references. Austen's work more specifically addresses meditation and mental health in a Buddhist context. I will dig out Austen's work and see what might be useful.

Two starting points (one dated, and the other more recent):

Linehan, Marsha M., "Dialectical Behavior Therapy for Patients w/Borderline Personality Disorder and Drug Dependence," The American Journal on Addicitions, 1999 - while dated, this is a start.

Linehan, Marsha M., "Two Year Randomized Controlled Trial and Follow-up of DBT v Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder," Archives of General Psychiatry (American Medical Association) July 2006

Gassho,
Yugen

[ctpowers8]

Re: Zen and Mental health techniques

Chris,
I understand the direction in which you are headed. If you are looking for peer reviewed literature on this topic I would start with the scholar from the University of Washington I mentioned. She has written peer reviewed scholarship and I remember follow-up work in the UK that has been performed on this topic.

Further, the issue of individuals being left alone with their racing thoughts and exacerbation thereof does not render the CBT/DBT discussion irrelevant. Some of the scholarship I have reviewed discusses these therapies in conjunction with pharmacological protocols which provide some relief while new behaviors and tools are assimilated by the individual. As a CBT practitioner yourself I would expect that you are aware of and may utilize/recommend CBT/pharmacological combined approaches. The same applies to mindfulness-based practices. I would start with a search on the work of Marsha Linehan, and also James Austen, who wrote the seminal Zen and the Brain. While this is a general readership text, the bibliography is a treasure trove of scholarly references. Austen's work more specifically addresses meditation and mental health in a Buddhist context. I will dig out Austen's work and see what might be useful.

Two starting points (one dated, and the other more recent):

Linehan, Marsha M., "Dialectical Behavior Therapy for Patients w/Borderline Personality Disorder and Drug Dependence," The American Journal on Addicitions, 1999 - while dated, this is a start.

Linehan, Marsha M., "Two Year Randomized Controlled Trial and Follow-up of DBT v Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder," Archives of General Psychiatry (American Medical Association) July 2006

Gassho,
Yugen

Thank you Yugen for the references. Dr. Linehan is a great behaviorist and Dialectical Behavior Therapy has its merits in treatment of multiple relapse drug abusers and suicidal patients but her work with Borderline cases is suspect by some members of the APA. Her work is different for medical model mindfulness in only a few different ways but they are almost the same in principle she has multiple acronyms while medical model mindfulness has the concept of the wise mind (combining the logical mind with the emotional mind to get a balance). I am impressed by your knowledge Yugen you are well versed in psychology and though Dr. Linehans work was groundbreaking few people are familiar with it, so your knowledge is impressive.She is also one of the few people who believes Personality Disorders can be treated but cured which goes against the DSM and modern understanding of Personality Disorders. My doctoral dissertation is on how DBT and MMM can work to relieve situational stress. I am trying to get the ethics committees of my school and a few hospitals to allow me to do trials on people in ER waiting rooms or triage which are microcosms of stress, anxiety and anger. Also pre and post op patients. Since I work in a county setting we only see severe cases and so my treatment for individual therapy has to be modified and less eclectic than a therapist who works private practice. I also am a big proponent of the team approach to therapy and work together with the patient and psychiatrist so medications and therapy can be used in conjuncture to get the highest efficacy. This approach in my eyes is the best because it limits dependency and abuse potential with psychoactive drugs especially benzodiazapines. If you know of any other work out there besides DBT MMM or mindfulness therapy let me know or any knew approaches to those modes of therapy. I start this thread because I have Mindfulness Meditation group of low functioning schizophrenics and bipolar with psychotic tendencies and the techniques I have come across are not suited for these consumers. I apologize for this post taking a more medical and psychology bent then zen. Jundo, how would or have you used Shikantaza with someone with a psychosis? Did you make a distinction that the practitioner was different and may need a different approach or did you apply the same basic teaching? Just curious as to how you as clergy may have handled that situation.
Cheers and Gassho
Chris

[Jundo]

Re: Zen and Mental health techniques

I apologize for this post taking a more medical and psychology bent then zen. Jundo, how would or have you used Shikantaza with someone with a psychosis? Did you make a distinction that the practitioner was different and may need a different approach or did you apply the same basic teaching? Just curious as to how you as clergy may have handled that situation.
Cheers and Gassho
Chris

Hi Chris,

No, we discuss anything and everything around here. I am just sorry that I do not have much helpful information for you.

I am not sure of your question on using Shikantaza with someone having a psychosis, but the few times (years ago when assisting teacher at a bricks and mortar Sangha) that a person came to sit Zazen with seeming psychological issues ... hearing voices in one case, serious depression or drinking problem others ... we suggested right away that they be checked out by a qualified physician or other professional, and even required a doctor's note before allowing the person to continue. (Not to say that the "voices" might not be a kind of spiritual experience, positive for the person ... but l rather think that usually something else is going on there that may need medical attention). I have seen studies that meditation might AGGRAVATE certain conditions, especially for people of an extremely delicate mental state. Although the studies point to cases that are very isolated and anecdotal, and I have seen thousands of people meditate with only positive effects ... it is just common sense that someone's "looking within" and sitting still in a kind of "sensory deprivation" experience can be hard for some.

http://content.karger.com/produktedb/pr ... =000108125

It is not unlike the surfing you posted about in another thread, or merely going to the beach to splash on the shore. Fine, life affirming day at the beach for most people. Dangerous, perhaps, for the 300 pound man with a heart condition who can't swim.

Gassho, Jundo

[Dosho]

Re: Zen and Mental health techniques

Hi Chris,

It's late and I may not provide much detailed info, but I have an ADD diagnosis (back before they called it ADHD w/o hyperactivity...which seems a bit redundant). I have the type that is more likely to leave me distracted and having daydreams...more hyperactivity of the mind than of the body. However, soon after joining Treeleaf back in 2008 I wrote to Jundo asking if it was ok for me to sway back and forth while sitting since I was having a lot of trouble being still. He had some reservations about that, but once I assured him it was not something I saw myself doing for the rest of my life he seemed to think it would be ok. If I were to make a suggestion for any hyperactive person trying to sit shikantaza it would be to emphasize in the beginning that it does not HAVE to be absolute stillness either in body or mind. Of course there is a way to do zazen as outlined in our lineage, but to force a still position would not be shikantaza and really all of life is zazen of a sort. I think once people understand they don't HAVE to sit still, they may find it easier to do so. At least, that was my experience.

And no, I don't sway anymore and don't think I did for more than a week or so after I asked Jundo about it.

Gassho,
Dosho

[ctpowers8]

Re: Zen and Mental health techniques

Dosho I am glad that your sitting is not hindered at all by your ADHD. Oh, here is a fun fact for the day the ADHD and ADD diagnosis were changed because some people experience the distraction without the hyperactivity and both tend to be co-morbid with OCD.

[Dosho]

Re: Zen and Mental health techniques

Dosho I am glad that your sitting is not hindered at all by your ADHD. Oh, here is a fun fact for the day the ADHD and ADD diagnosis were changed because some people experience the distraction without the hyperactivity and both tend to be co-morbid with OCD.

I remember when the diagnostic criteria were changed from ADD to ADHD and at the time it just seemed strange to say, "I have Attention Deficit Hyperactivity Disorder without Hyperactivity...which you would think should be called ADD!" Also, the new name seemed to further the stereotype of boys bouncing off walls as encompassing all of the condition which didn't help girls or a minority of boys like myself with distractability get a diagnosis.

And co-morbid with OCD? Yeah, I can see that.

Gassho,
Dosho