Ask Dr. Rick About:


What are the names of the neurotransmitters and hormones of that are secreted or boosted when being mindful?

These are very interesting questions . . . and as far as I know there are currently very limited answers to them. In equanimity, there would be low levels of neurotransmitter activity associated with stress (e.g., cortisol and other glucocorticoids), or aroused goal pursuit (e.g., dopamine). Depending on what is also present with the equanimity, there could also be increased levels of natural opioids with sukha (happiness) and increases of oxytocin activity with metta (loving-kindness). As to “behaving mindfully,” that could mean different things depending on what the behaving is. Daniel Goleman’s Altered Traits offers a good summary regarding scientific research on meditation in particular and mindfulness in general.

Where would I find the science that forms your concept about the “Leading Edge of Now?”

From a third person perspective, one can observe that there is a continuous “when something first happens” in any material process (which includes both matter and energy), such as the moment when the bat strikes a baseball, or the position of the ball in flight at any instant of time. One can also have a sense of the mathematics of calculus related to the instantaneous position and vector of the ball. And one can have some understanding of the complex neural processes underpinning any moment of consciousness. In other words, as processes occur, there is a (metaphorical) “front edge” to them, that instant when something first happens.

From a first person perspective, one can be mindful of experiences as they appear and then change, and in their changing, how they end in some sense. Here, too, there is that instant when something first appears in consciousness. There are many studies of perception related to this. More generally, this aspect of phenomenology seems inherent and obvious, that there is an ongoing “appearing” in awareness of the next perception, thought, image, desire.

So, putting the third and first person perspectives together, it seems that both objectively and subjectively, there is a “front edge of now.” Perhaps the entirety of time has already been made and our perceptions simply “slide” along it. Nonetheless, at every moment in that sliding there is always the next thing that is encountered – as something that is happening or experienced – and that next thing is in effect the front edge of the sliding.

Check out this book for some more on the physics.

Your work is based on the idea that meditation and mindfulness can change the brain. Can you expand on this?

Actually, I’d put this a little more broadly: my work – and that of many other scholars and clinicians – is grounded in the general fact of “experience-dependent neuroplasticity,” which is the capacity of mental activity to change neural structure.

For example, researchers studied cab drivers who must memorize London’s spaghetti snarl of streets, and at the end of their training their hippocampus – a part of the brain that makes visual-spatial memories – had become thicker: much like exercise, they worked a particular “muscle” in their brain, which built new connections among its neurons. Similarly, another study found that long-term mindfulness meditators had thicker cortex in parts of the brain that control attention and are able to tune into one’s body.

In the saying from the work of the Canadian psychologist, Donald Hebb: “neurons that fire together, wire together.” Fleeting thoughts and feelings leave lasting traces in neural structure. Whatever we stimulate in the brain tends to grow stronger over time.

A traditional saying is that the mind takes the shape it rests upon. The modern update would be that the brain takes its shape from whatever the mind rests upon – for better or worse. The brain is continually changing its structure. The only questions are: Who is doing the changing: oneself or other forces? And are these changes for the better?

In this larger context, my focus is on how to apply these new scientific findings: how to use the mind to change the brain to change the mind for the better – for psychological healing, personal growth, and (if it’s of interest) deepening spiritual practice. I’m especially interested in:

  • How the brain has been shaped by evolution, giving us problematic tendencies toward greed, hatred, heartache, and delusion (using traditional terms) as well as wonderful capacities for happiness, peace, love, and wisdom. For example, we have a brain that makes us very vulnerable to feeling anxious, helpless, possessive, fixated on short-term rewards, angry, and aggressive. These qualities helped our ancestors survive and pass on their genes, but today they lead to much unnecessary suffering and conflict on both personal and global scales.
  • “Neurologizing”, the deep Buddhist analysis of the mind: what is going on inside the brain when a person is caught in the craving that leads to suffering? Alternately, what is happening in the brain when a person is experiencing equanimity, lovingkindness, meditative absorption, or liberating insight?
  • Using neurologically-informed methods to help overcome our ancient inclinations to fear, dehumanize, exploit, and attack “them” so that 7 billion of us can live in peace with each other on our fragile planet.

In sum, this brain stuff can sound exotic or esoteric, but in essence the approach is simple: find the neural processes that underlie negative mental factors, and reduce them; meanwhile, find the neural processes that underlie positive mental factors, and increase them. Less bad and more good – based on neuroscience and Western psychology, and informed by contemplative wisdom.

Of course, much is not yet known about the brain, so this approach is necessarily an exploration. But if we remain modest about what we don’t know, there are still many plausible connections between the mind and the brain, and many opportunities for skillful intervention for ourselves, for our children and others we care for, and for humankind as a whole.

What are the different ways we can work with our mind?

Fundamentally, in my view, there are just three kinds of ways to engage the mind, to practice with it productively:

  1. Be with it – Observe the mind, experience the experience, feel the feelings, etc. without trying to change anything in the stream of consciousness. Hopefully one does this with an attitude of curiosity, kindness toward oneself, and a certain stepping back – “dis-identification” – from whatever one is experiencing. One could also explore more vulnerable, fundamental, or younger material “beneath” the surface of experience, such as the hurt underneath anger or the old pain from childhood that amplifies or distorts one’s reactions. Through being with one’s experience it may change, but one is not directly making efforts to change it.
  2. Decrease the negative – Here is where we make efforts in the mind to relax tension from the body, vent or otherwise release emotions like sadness or anger, challenge and let go of wrongheaded thoughts, or resist or abandon problematic desires (e.g., wanting to get hammered or to yell at the kids).
  3. Increase the positive – Here is where we make efforts in the mind to take skillful actions (e.g., sitting up straighter to be assertive, calling the doctor for an overdue check-up), to encourage feelings like gratitude and compassion, to develop useful perspectives and other thoughts, and to strengthen and commit to beneficial desires such as exercising or not interrupting one’s partner.

In effect, if the mind is like a garden we can observe it, pull weeds, and plant flowers. In a nutshell: let be, let go, and let in.

The three ways to engage the mind work together. For example, we need to make efforts to grow capacities to be with the mind, such as self-acceptance, observing-ego functions, or distress tolerance. And we be with the results of our efforts to reduce the negative and grow the positive.

Of the three, the first one (which approximates the conventional definition of “mindfulness”) is primary. You can always be with the mind, but you can’t always reduce the negative or grow the positive.

What’s the difference between mindfulness and the way you teach engaging the mind (let be, let go, let in), and which is more experiential?

There’s definitely a place for the common advice people give to just “be mindful.” Still, it is important to do more than simply observe the mind.

What happens in the mind depends on what happens in the brain, and the brain is a physical system that does not change unless it gets changed (usually by oneself, if at all). The brain does not generally erase negative patterns simply because we observe them; if anything, its evolved negativity bias makes it retain negative learning. And the brain does not generally develop determination, compassion, gratitude, forgiveness, or most any other positive qualities simply because someone is witnessing the stream of consciousness.

Even the Buddha – someone who profoundly valued mindfulness – allocated most of the elements of the Noble Eightfold Path to the second and third ways to engage the mind (i.e., the release of greed, hatred, and delusion, and the cultivation of wise view, intention, speech, action, livelihood, effort, and concentration).

When we are bothered or upset about something, there is a natural trajectory in which we start by being with our experience. Then, at some point, it feels right to start releasing it. Then, at some point, it feels right to start replacing what we’ve released with something useful and positive. The timing of this trajectory depends on the person and situation. Sometimes you realize quickly what is bugging you, and you shift into letting go of it and moving on to something happier within a minute or two. Other times, something hits you really hard – such as a shocking loss – and it could be months and even years before it feels right to shift into letting go, and then letting in.

Some people err on the side of jumping too quickly into letting go and letting in, but if you do that, those efforts don’t have much traction. Other people get stuck in letting be, in just feeling their painful feelings, and not making skillful efforts within their own mind to release the negative and replace it with something appropriately beneficial. I would like to think that my approach balances these elements in a positive way.

Mindfulness and my work on cultivation (let in – the skillful development of inner resources) are completely complementary. One needs to sustain mindfulness for effective cultivation: to turn passing mental states into lasting neural traits (the biological basis for psychological resources). And through cultivation, one develops the mental factors that support mindfulness. Additionally, mindfulness has benefits unrelated to cultivation (e.g., coming into the present moment) and cultivation has benefits unrelated to mindfulness (e.g., developing caring for others, self-respect, gratitude, positive mood, grit, hardiness).

Mindfulness and cultivation are both “experiential” in that both of these are ways of relating to our experience. Of course, our experience includes our thoughts – both verbal and non-verbal – and one can be mindful of thoughts, can have thoughts about mindfulness, and can cultivate beneficial thoughts (such as a sense of perspective on the hassles of daily life).

What are the neurophysiological correlates of the distracting (and potentially helpful) states of mind?

Your question is deep and important – and the subject of considerable research. Check out what’s being done on the default network and mind wandering. Also see Farb’s research on the brain’s medial and lateral networks; my own take-off on this work can be found in this podcast.

A person can be in the present moment while (presently) planning the future or reflecting on the past. And being lost in reverie is not necessarily involving judging or comparing or planning. I suspect that sustained present-moment awareness primarily involves a recursive loop between the anterior cingulate cortex (for executive control of attention) and the insula (for an ongoing “map” of the body and emotions).

Can you suggest some practical strategies for beginning to cultivate a “beginner’s mind” mentality around everyday experiences?

Since the brain is a big novelty detector, looking at experiences in this way, seeing what is fresh or new about them, can really help you accelerate the encoding and installation process, and thus internalize these experiences as psychological resources, also known as inner strengths.

To support this sense of freshness, you can imagine looking at the world through the eyes of child. Or adopt the attitude of “don’t know” mind – not “duh” mind – by disengaging from the internal commentary that labels and judges things, by allowing yourself not to be so sure about everything, by disengaging from your views, and by coming more into the body and less caught up in conceptualizing and abstracting. You could also engage the world and your experience in an adventuresome, playful, exploratory way . . . looking for new things, new aspects to familiar experiences. How fun!

If someone let's go of the negative thoughts in their brain and actively takes in the good, it seems that could be the same as running away from negative feelings in the mind/body, which is counter to mindfulness. Thoughts?

My take, with a bucket of salt:

  • Mindfulness is a means to an end, not an end in itself.
  • Mindfulness itself is sustained attention to something, typically with some meta-cognitive awareness of the quality of one’s attention. Mindfulness itself is morally neutral. A burglar could be very mindful. If people want, they can add other qualities to the mindfulness, such as an attitude of acceptance and friendliness toward the objects of attention, such as toward whatever may pass through the mind.
  • Mindfulness itself does not try to change the objects of attention. But mindfulness is not necessarily the only thing happening in the mind! If one likes, one could add some effort, hopefully wise, to change the objects of attention. A person could be mindful of her stress and negative thoughts for a while; then she could both be mindful and make an effort to shift what is in her mind; finally, she could be mindful of the results of her efforts.
  • As you can see, a certain set of presumptions have grown up around mindfulness in the past few decades that actually are additions to the original idea, notably the original idea promoted by the Buddha 2500 years ago. In particular, people talk as if an explicit stance against working with the contents of awareness is innate feature of mindfulness, and it is not. I recommend ready my paper, the Noble Eightfold Path for more on this.
  • Mindfulness itself is always helpful. And sometimes it is useful for a person to drop any effort to shift contents of awareness in any direction whatsoever; sometimes this kind of “choiceless awareness” alone helps negative thoughts release.
  • But often mindfulness alone is not enough. A lot of crud fills the mind, and it persists because the brain is a physical object that does not tend to change unless something changes it (in effect, Newton’s First Law). When you appreciate how embodied we are, and how much the brain is a learning organ that builds structure that it maintains unless it is actually changed, you get very interested in effective and efficient effort. Since neurons that fire together, wire together, keeping negative material in awareness can actually deepen its hold upon you.
  • In essence, there are two great elements in psychological healing, everyday well being and effectiveness, personal growth, and spiritual practice: being with and working with (in Buddhism: Right Mindfulness and Right Effort). These are the two great wings that help us fly. Each wing has strengths. And the wings work together: mindfulness improves our efforts, and it takes skillful effort to be stably mindful.
  • Then you can make a free and wise choice, moment by moment, as to what will do the most good for oneself, or one’s client: lean toward pure mindfulness, or lean toward mindful efforts. Both are beautiful, and help us fly.

How do you teach mindfulness for the first time to a general audience of adults?

If I am introducing mindfulness to a general audience, I am very matter-of-fact about it, unapologetic and undefensive, and use concrete, scientifically-tinged language. I speak of experience-dependent neuroplasticity, and therefore the critically important role of regulating attention as the first step in shaping the brain for better rather than for worse (given its negativity bias). This part takes me 2 minutes or so. Really. Simpler and faster is better.

Next I introduce the idea of sustained present moment awareness – the definition of mindfulness – as both an excellent training in attention regulation and an excellent practice in its own right.

Then we begin the practice, first seeing if they can sustain attention to the sensations of breathing – around the nose, or in the chest or belly, or in the body in general – for say 10 breaths in a row. (I always also state that other objects of attention are fine, such as a word like “peace.”) I could make a few comments about steadiness of mind, and remaining attentive to their own attention: meta-cognitive awareness of awareness. I might also gently suggest finding a posture that is comfortable and alert.

On the basis of the steadiness of mind established in this way, at some point – a few minutes in – I suggest that they remain aware of their object of attention while also staying present in this moment, and this one. Not resisting the thoughts and feelings and sounds etc. that come and go, just disengaging from them. Simply be-ing, gently relaxing, opening, softening . . . without strain or stress, opening into a growing well-being and peace . . . a kind of space or underlying quality of being that contains any pain or upset.

Usually we stay pretty quiet, though sometimes with a comment here or there by me to help draw people back into the practice.

And then we finish up. Gradually drawing people back into the room, opening their eyes if they’ve closed. Registering what the experience is like, and letting it sink in.

When talking with others I’m very focused and mindful of the topic, but not of my conversation partner’s experience. Any recommendations?

Traditionally, mindfulness is defined essentially as sustained present moment awareness of everything in the field of experience. You are present rather than absent, recollective rather than forgetful.

In this light, we can be in flow while also being mindful, but the metacognitive aspects of mindfulness – a little bit of paying attention to attention, aware of awareness, to remain mindful – do tend to pull people out of flow unless they develop the capacity to integrate flow and mindfulness.

In your case, you might explore what it is like to be really passionate and engaged, including intellectually, while also continuing to keep a bit of awareness for the overall situation, including the reactions of other people.

What happens with mindful eating?

Mindful eating would naturally down-regulate stress activation plus increase experiences of fulfillment and satiation that would reduce craving and thus suffering – of course via the various neural substrates of these mental processes.

The primary identified neural correlate of mindfulness – defined as sustained attention to something, typically with a meta-cognitive element of awareness of awareness (i.e., the Pali term for mindfulness, sati, has its root meaning in “recollectedness”) – is activation of the anterior cingulate cortex (ACC) and related PFC executive control circuits that manage the deliberate control of attention. The term mindfulness sometimes is reduced to choiceless awareness, which is a common but serious error; choiceless awareness is simply a stance toward the stream of consciousness, and one can be mindful of both that stream and the stance much as one could be mindful of one’s golf swing, the flicker of expressions on the face of one’s partner, or what happens in the mind when one eats slowly and with focused attention. When mindful attention is applied to eating, it’s very plausible that the insula would be activated, which handles interoception.

Mindful eating would plausibly affect the body by:

  • Down-regulating sympathetic nervous system and hypothalamic-pituitary-adrenal axis activation, along with their related stress hormones; get benefits of less allostatic load
  • Up-regulate parasympathetic activation; benefits of relaxation
  • Strengthen ACC and related PFC circuits; benefits of improved attentional control and executive functions
  • Strengthen insula; benefits of improved self-awareness and empathy for emotions of others (insula does both)
  • Increase signaling to hypothalamus of visceral rewards received; benefits of reducing wanting and craving

Do you think the popularization of mindfulness has had any negative consequences?

When talking about “mindfulness,” I draw on the traditional meaning of that term: sustained present-moment awareness. I believe that two unintended but significant mistakes have crept into the ways that many people think about and talk about mindfulness these days.

First, mindfulness is often taken to mean simply self-awareness. But mindfulness is sustained awareness of both the inner and outer worlds, both one’s experience and one’s environment. Driving in a busy freeway, I am mindful of both my inner anxiety as well as the big truck weaving back and forth next to my car.

Second, mindfulness is often described as simply observing, so that anything but observing is considered to be an obstruction to mindfulness. But actually, mindfulness is to be present in all three ways to engage the mind. For example, we need to be mindful of the process of cultivating the positive and of releasing or preventing the negative. And when we just be with the mind, mindfulness must be present alongside other factors such as intention or self-compassion. Making efforts in your mind is not an obstruction to mindfulness or at odds with it. In fact, we need to make efforts in the mind to grow resources for mindfulness (such as concentration).

Of course, these two mistakes about how mindfulness is frequently described and even taught these days do not mean that there is anything wrong with mindfulness itself. Mindfulness is wonderful! But these mistakes have had negative consequences that I have observed and others have described to me:

  • Encouraging a passivity with regard to one’s mind
  • Over-focusing on one’s experience, one’s inner life, and under-focusing on one’s environment and the real-world problems in it
  • Assuming that beneficial mental qualities like compassion, self-compassion, or resilience are somehow inherent in mindfulness itself so that they will grow on their own if someone just practices mindfulness
  • Assuming that negative qualities like feelings of inadequacy, anxiety, envy, or anger will just fade away if someone just practices mindfulness
  • Arguing against or otherwise resisting the idea of making skillful efforts inside one’s mind as “dualistic,” “goal-directed” (hm, what’s inherently wrong with being goal-directed?), or “egoic”

I have never really understood what is meant by mindfulness.

For me, mindfulness equals sustained present moment awareness. Period. That awareness can narrow to a tight focus or go really wide, and it can focus more on the inner world or the outer world or both at the same time. Other mental factors/contents promote mindfulness, such as attention regulation and self-compassion. Other mental factors/contents can operate beneficially alongside mindfulness, such as relationship skills while one is speaking mindfully with a friend. And mindfulness plus other mental factors can produce good learning/development, such as insight into oneself as a fruit of mindfulness.

I just read an article ``Is Mindfulness Safe?`` by Ruth Baer and Willem Kuyken from the Oxford Mindfulness Center. Is this a credible source and is mindfulnesss safe?

The article is thoughtful and thorough, and makes good points, sort of like your dentist having you sign a form acknowledging the risks of getting a cavity filled.

This said, in general, both formal and informal evidence is that for most people, the benefits of mindfulness vastly outweigh the risks, which are next to nonexistent for a typical, reasonably balanced and integrated person.

If an individual is fragile for whatever reason, or has a significant trauma history that could bubble up, or is prone to peculiar or even psychotic mental processes, then that person should be cautious about using mindfulness in everyday life to explore or “uncover” the murky depths of their psyche, and very very cautious about intensive practice in a workshop or meditation retreat. Most of the examples of mindfulness being problematic involve fragile people in intensive practice. It’s a little like having a fragile knee: maybe it’s fine to use it for a walk in the park but don’t go skiing moguls.

If spooky thoughts or other material bubble up as someone opens mindfully into themselves and it gets overwhelming, many people are readily able to “change the channel” by opening their eyes, going for a walk, eating a cookie, talking with a friend about it, etc. Of course, be reasonably cautious, etc.

Also, “mindfulness” is often equated with and reduced to only a probing inquiry into oneself, but mindfulness simply means sustained present moment awareness applied to something, which could be the whole of a person’s consciousness, the focused sensations of breath at the upper lip, the play of emotion over the face of a friend, or the big truck driving next to you on a rainy highway. Just because the use of mindfulness in a certain way (e.g., deep meditation) could have risks for a certain person doesn’t mean that person would not be benefitted by using mindfulness in other ways.

I have a hard time keeping up with a regular mindfulness practice. What would you suggest to help someone persist in practicing HEAL?

Three nice things about HEAL:

  • It’s usually quick and in the flow of everyday life, a dozen seconds here and half a minute there, a few times a day, helping good learning land and stick to your ribs.
  • It’s usually enjoyable, since – remarkably – most psychologically beneficial experiences are enjoyable. We have evolved rewarding associations to them because they actually help us survive to pass on our genes, in addition to all the benefits in terms of quality of life. These experiences feel good because they are good for us and others.
  • HEAL makes real changes in your brain, which is motivating to know.

So I find that using HEAL becomes pretty natural for people, like any good habit. If you’re a mental health professional you can do things with clients to encourage them to focus on key resource experiences between sessions, or simply put little reminders around them like doing HEAL at specific times such as at meals or just before bed or just after exercising or meditating.

As to regular mindfulness practice, you can use HEAL to internalize the experience of mindfulness so it comes more easily and you get better at it – just like internalizing the experience of any other inner strength, to grow it inside yourself. Similarly, you can use HEAL to internalize the benefits of mindfulness – or related practices such as meditation – so you get more motivated to practice as you experience its rewards.

Also, try making a commitment to meditate – which could include for a person the theistic version of contemplative practice, which is prayer – at least one minute a day.

Are there any concrete tips on how to help positive experiences sink in?

In studies, there are six well-established factors that increase learning, including for developing greater resilience, gratitude, compassion, and other inner strengths: duration (stay with it), intensity (let the experience become more powerful for you), multimodality (feel the experience in your body), novelty (look for fresh, new qualities in familiar experiences), personal relevance (see how taking in this experience could matter to you), and priming (consciously intend that the experience is really registered by you).

You have so many practices, sometimes I get overwhelmed by it all. How do you deal with that sense of overwhelm?

I definitely understand the issue of “where do I start?” Some people are more flooded than others by seeing the whole. Paradoxically, the more able one is to see everything – a beautiful gift – the more one needs to develop the executive functions to focus and act upon something.

I deal with this myself in several ways. One is literally to start at one corner of my desk and work inward from there, one piece of paper at a time. Another is to do a quick sort of papers into three piles: Action, File, and Toss – and then work my way downward on the Action pile one piece of paper at a time. Or best of all, pick the most important thing and do that one.

Overall, the key is to clock real time getting stuff done. In this frame you don’t need to pick the perfect right thing to do. Just do something and then another thing, minute after minute, hour after hour for a few hours at least in a row (take brief breaks as needed), day after day. Nothing digs ditches like shovelfuls of dirt.

And reward yourself for your efforts and progress. In this approach, you’re engaged and productive, but not pushy or self-critical with yourself.

Why is being better than doing?

I keep trying to remember (as a major do-er myself), that it is in “being” that we usually find our deepest, most reliable refuge and refueling station – including when we rest in some sense in being as we engage “doing.”

As to those who are struggling in this world that we cannot concretely help, to me it’s important to have compassion and to bear witness and to be a stand for justice: I have faith that this is worth being and doing in its own right, and faith that in ways largely unknown this will in fact be concretely helpful somehow some day.

Is gratitude beneficial as a spiritual and/or mindfulness practice in and of itself?

Gratitude supports spiritual practices – or related secular ones, such as everyday mindfulness – in a variety of ways. It draws our awareness to a sense of fullness, of having enough, and this reduces the craving and clinging that lead to suffering and harm towards oneself and others. It is a doorway to awe and wonder at the stunning fact that the universe exists at all. It helps you appreciate the extraordinary gift of being alive and of having a human life, so you want to make the most of it and don’t want to waste it. And for some, gratitude draws them toward an appreciation for God – however they experience or conceive of that.

Of course, each of these benefits also gently and gradually shapes one’s own brain in an increasingly positive direction.

How can I overcome decision fatigue?

My quick two cents is that a lot of the research about decision fatigue (or related: willpower fatigue) is first about the average of groups and does not take into account individual differences in temperament or mental training, and second the results that are found are indeed statistically significant but in practical terms are not actually very consequential.

I think too that when people surrender to their important purposes – and ideally, continue to associate rewards (e.g., “gladdening the heart” as the Buddha taught) to them – then they don’t get fatigued.

How does being-awareness relate to our underlying animal nature?

For me an underlying truth or theme is surrender, humility, and opening out into our animal nature node in a vast net of causes. One of my favorite practices is to soften, opening into the body in which the inner lizard, rat, and monkey long to feel safe, fed, and loved but are primed by mother nature to doubt and seek in order to survive and pass on genes – even though they are actually already truly safe fed and loved. This means that they need lots and lots of experiences of fullness again and again for the sweet truth to pass through Mother Nature’s well-intended veils of delusion and into their lying brain.

Is bad science driving the popularity of mindfulness meditation?

It is widely recognized in mainstream medicine that roughly half of all medical procedures (including “off-label prescriptions”) performed routinely in in-patient and out-patient settings lack a single study substantiating them. This does not mean they are bad medicine; they are considered part of the reasonable standard of care. In the well-known saying in science: “absence of evidence is not evidence of absence.”

The evidence for most healthcare interventions, including routine medical practices, is nonexistent, limited, shows mild benefits at most, or could be questioned methodologically. In this context, check out this link.

As you can see in this link, the evidence for mindfulness and related practices (e.g., meditation) for promoting mental and physical health is quite robust. If Pfizer or Merck could patent meditation, based on the research findings already, we’d regularly be seeing ads for it on primetime TV.

There is a kind of pocket industry of debunkers who make their bones trying to taking down interventions that have any kind of holistic, new age, or spiritual air about them. It is so easy to debunk things. You can debunk nearly anything. You can always find fault with academic papers. You can always call for more evidence. So let’s call for more evidence in domains with big risks instead of tiny ones.

Meditation is free or inexpensive, has rare (but occasional, as Willoughby Britton’s research has found for some vulnerable people going into intensive meditation retreats) negative side effects, and can be done in many kinds of settings by many kinds of people in many kinds of ways. Its benefits, and the evidence for its benefits, should be netted against its very low risks; the higher the risks, the higher the need for evidence for an intervention, but the lower the risks, the lower the need for evidence for an intervention. About 200,000 people die each year in America due to medical error. If you participate in medicine, there are significant risks, I don’t say this to criticize medicine – I value it highly and am grateful to my doctors – but to put this issue in context. How many people die each year due to participating in meditation? The risks are tiny.

Sure, we should be careful about over-claiming about the evidence for anything. But I rarely see that. Mostly I see people saying essentially that meditation could help you become more self-aware, lower your stress, and grow calm and other resources inside yourself, and these psychological developments couldn’t hurt your health and might even help it through the stress reduction pathway. You know, this statement is accurate when applied to the majority of people who take up meditation.

Can you suggest something to help me breathe mindfully?

Many people have difficulty using the sensations of breathing as an anchor for their attention during meditation, or even generally. Sometimes it is because body sensations in general or breathing in particular have gotten associated with painful, even traumatic, experiences. Other times there’s no trauma history but something about the breath just doesn’t work for a person.

No worries, actually: in meditation, the point is not the object/anchor of attention, the point is the quality of sustained presence of mind moment after moment – along with related helpful factors such as self-compassion, acceptance, and learning along the way from one’s experiences. So you could shift to any number of other, often common, objects of attention, such as a word or phrase (e.g., “peace,” “may we be happy,” “om”), an image (e.g., a candle, a picture of a saint, a memory of a beautiful meadow), or sensations in other parts of the body. And you could also do meditation while walking slowly.

If you still want to explore breathing, what I do is have a general awareness of my torso and whole body while breathing rather than focusing on any particular spot, and without trying to regulate breathing in any way. Move out to the body as a whole, and let the sensations of breathing come to you as it were, receiving them without effort.

Meanwhile, there is a natural relaxation, letting go, warm-heartedness, and growing sense of well-being, contentment, and peace.

I would like to have your perspective on some recent studies on the negative effects of mindfulness meditation.

There are indeed a few cautions about meditation for a few people. If someone is already really vulnerable and unstable, an intensive meditation retreat is probably not a good idea. This is why the meditation centers I am most familiar with (Spirit Rock in California and IMS in Massachusetts) try to screen out people like this. If someone is prone to manic episodes, don’t aim for intensely blissful experiences. If a person is already depressed, just sitting with themselves for many hours of silence each day is probably unwise.

As far as I know, these are the basic cautions. They apply to a tiny fraction of the people who meditate, and a tiny fraction of the settings in which they meditate. If someone is in that tiny fraction of people, be very cautious about prolonged and intensive retreats – and be careful about meditating on your own at home.

As best I can tell, the rest is media drama – essentially saying, by analogy, people with vulnerable legs shouldn’t run marathons. Wow, breaking news.

Just observe your own experience. If your way of meditating is working for you, great. If not, modify it or stop it. Use common sense.

Does mindfulness mean being submissive?

When we sustain a mindful awareness of outer events or inner experience, we are actually doing the opposite of submitting to them, in the sense you mean. We are recognizing them as facts – like them or not, they exist – perhaps with a sense of acceptance or serenity, but not letting them control us.

In fact, when we fight with them – like getting angry at having certain thoughts – they are controlling us. And, with the perspective and wisdom that come from awareness and investigation, we can be strong, forceful, even passionate in speaking truth to power – both out there, and (often more importantly) inside our own heads.

What we let go of mainly are our unhelpful, unhappy reactions to things. We don’t let go of recognizing and standing up against injustice, or let go of our legitimate interests.

The main things that take advantage of us are our fearful, angry, self-doubting reactions to things.

Check out my chapter on kindness and assertiveness in Buddha’s Brain, or the slide sets on relationships on my website, and see what you think.

How to you balance equanimity and cultivation?

To use the language of Buddhism there is a place for Right Mindfulness, but also a place for Right Effort. Mindfulness is the doorway to equanimity, which is gradually developed as virtue, concentration and wisdom deepen. Along this path, we also need to pull weeds and plant flowers in the garden of the mind: Right Effort, in other words. Cultivating wholesome states and factors of mind – by activating them, installing them through taking in the good, and then reactivating and reinstalling them again and again on life’s path, in a wonderful positive cycle – is a kindness to oneself and others.

With time, the fruits of this process of cultivation become increasingly second nature, woven into the fabric of the brain, the body, and them mind. Then conscious cultivation – Right Effort – gradually falls away and we abide without effort in spacious balanced peaceful beautiful equanimity.

How do you prevent equanimity from becoming detachment?

These are deeply important questions. We cultivate compassion along with equanimity, keeping the two in balance. Equanimity is the frame of our experiences, so we can experience anything in principle with equanimity (though calm pleasure is easier to maintain equanimity for than enraged pain!) . . . including heartbroken compassion. And as to trying to influence others wisely (as the Buddha did in many ways, including through his teachings and exhortations), that, too, can be done with equanimity . . . . and then those others do what they do, which we can also have equanimity about.

All this is a cultivation, a path, a process over time, of course.

How can meditation be used as a tool when people are suffering from basic survival issues?

This is a deep, vital question. My own take is that mindfulness itself does not, will not, solve social problems like poverty and racial injustice. We need to do other things as well (and I’ve sure got my own opinions about that, including voting).

People can also use related practices such as meditation as way to avoid dealing with real issues of all kinds.

This said, mindfulness practices can help people develop the inner stability that fosters greater resilience for dealing with whatever they’re facing. And as one’s personal well-being improves at least a little, sometimes their view can widen and see more clearly the problems around them, and feel more resourced inside to be helpful to others.

What is this awareness really? What is the sole purpose of mindfulness?

My book Neurodharma speaks to much of what you raise. In a nutshell, what’s helpful is to establish a fairly stable mindful awareness of your inner and outer world, which simply means being present much of the time, with related qualities of acceptance of your experiences and supportiveness (e.g., self-compassion) toward yourself. This is a realistic goal. It’s OK to daydream and ruminate from time to time…just not all of the time!

Awareness is the field through which experiences pass. Over time, as practice deepens, there is a growing sense of being this space in which experiences occur, while holding all experiences more and more lightly, aware of their ephemeral nature. This will come naturally. And we can deliberately practice this sense of abiding aware, allowing experiences to come and go, in specific meditations.

Then there is the classic notion of a transpersonal “cosmic” consciousness that transcends the individual awareness of people…and cats and dogs and lizards and who knows spiders as well. Teachers and writers sometimes blur and therefore confuse the distinction between individual awareness – being aware of stimuli is a biological property of animals with a nervous system, which does not mean they are self-conscious like humans – and this possible transpersonal, transcendental awareness.

Clearly there is the natural process of awareness – aware-ing? – in you and me and cats and squirrels, and there may also be a transcendental awareness/consciousness. And perhaps these two shade into each other in the depths of our being.

Meanwhile, there is always the next step to take, whatever it is. That’s worth focusing on, for all of us. Other books you might like are Diana Winston’s The Little Book of Being and Jaimal Yogis’s Saltwater Buddha.

And of course, keep going!

Dr. Ramani Durvasula is a licensed clinical psychologist, author, and expert on the impact of toxic narcissism. She is a Professor of Psychology at California State University, Los Angeles, and also a Visiting Professor at the University of Johannesburg.

The focus of Dr. Ramani’s clinical, academic, and consultative work is the etiology and impact of narcissism and high-conflict, entitled, antagonistic personality styles on human relationships, mental health, and societal expectations. She has spoken on these issues to clinicians, educators, and researchers around the world.

She is the author of Should I Stay or Should I Go: Surviving a Relationship With a Narcissist, and Don't You Know Who I Am? How to Stay Sane in an Era of Narcissism, Entitlement, and Incivility. Her work has been featured at SxSW, TEDx, and on a wide range of media platforms including Red Table Talk, the Today Show, Oxygen, Investigation Discovery, and Bravo, and she is a featured expert on the digital media mental health platform MedCircle. Dr. Durvasula’s research on personality disorders has been funded by the National Institutes of Health and she is a Consulting Editor of the scientific journal Behavioral Medicine.

Dr. Stephen Porges is a Distinguished University Scientist at Indiana University, Professor of Psychiatry at the University of North Carolina, and Professor Emeritus at both the University of Illinois at Chicago and the University of Maryland. He is a former president of the Society for Psychophysiological Research and has been president of the Federation of Behavioral, Psychological, and Cognitive Sciences, which represents approximately twenty-thousand biobehavioral scientists. He’s led a number of other organizations and received a wide variety of professional awards.

In 1994 he proposed the Polyvagal Theory, a theory that links the evolution of the mammalian autonomic nervous system to social behavior and emphasizes the importance of physiological states in the expression of behavioral problems and psychiatric disorders. The theory is leading to innovative treatments based on insights into the mechanisms mediating symptoms observed in several behavioral, psychiatric, and physical disorders, and has had a major impact on the field of psychology.

Dr. Porges has published more than 300 peer-reviewed papers across a wide array of disciplines. He’s also the author of several books including The Polyvagal Theory: Neurophysiological foundations of Emotions, Attachment, Communication, and Self-regulation.

Dr. Bruce Perry is the Principal of the Neurosequential Network, Senior Fellow of The ChildTrauma Academy, and a Professor (Adjunct) in the Departments of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine at Northwestern University in Chicago and the School of Allied Health at La Trobe University in Melbourne, Australia. From 1993 to 2001 he was the Thomas S. Trammell Research Professor of Psychiatry at Baylor College of Medicine and chief of psychiatry at Texas Children's Hospital.

He’s one of the world’s leading experts on the impact of trauma in childhood, and his work on the impact of abuse, neglect, and trauma on the developing brain has impacted clinical practice, programs, and policy across the world. His work has been instrumental in describing how traumatic events in childhood change the biology of the brain.

Dr. Perry's most recent book, What Happened to You? Conversations on Trauma, Resilience, and Healing, co-authored with Oprah Winfrey, was released earlier this year. Dr. Perry is also the author, with Maia Szalavitz, of The Boy Who Was Raised As A Dog, a bestselling book based on his work with maltreated children, and Born For Love: Why Empathy is Essential and Endangered. Additionally, he’s authored more than 300 journal articles and book chapters and has been the recipient of a variety of professional awards.

Dr. Allison Briscoe-Smith is a child clinical psychologist who specializes in trauma and issues of race. She earned her undergraduate degree from Harvard and then received her Ph.D. in clinical psychology from the University of California, Berkeley. She performed postdoctoral work at the University of California San Francisco/San Francisco General Hospital. She has combined her love of teaching and advocacy by serving as a professor and by directing mental health programs for children experiencing trauma, homelessness, or foster care.

Dr. Briscoe-Smith is also a senior fellow of Berkeley’s Greater Good Science Center and is both a professor and the Director of Diversity, Equity, and Inclusion at the Wright Institute. She provides consultation and training to nonprofits and schools on how to support trauma-informed practices and cultural accountability.

Sharon Salzberg is a world-renowned teacher and New York Times bestselling author. She is widely considered one of the most influential individuals in bringing mindfulness practices to the West, and co-founded the Insight Meditation Society in Barre, Massachusetts alongside Jack Kornfield and Joseph Goldstein. Sharon has been a student of Dipa Ma, Anagarika Munindra, and Sayadaw U Pandita alongside other masters.

Sharon has authored 10 books, and is the host of the fantastic Metta Hour podcast. She was a contributing editor of Oprah’s O Magazine, had her work featured in Time and on NPR, and contributed to panels alongside the Dalai Lama.

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