BUDDHISM A N D PSYCHIATRY (pathological) anxiety-response, whilst allowing the ('normal') intrusive cognitions to continue. This is exactly what is achieved in mindfulness — a training of the mind which adapts only the emotional response to thoughts, and not the thoughts themselves. BUDDHIST PSYCHOLOGY that of an auditory stimulus - the input is A N D ANXIETY DISORDERS distorted by an array of perceptions and memories (beautiful, calming, powerful etc). Similarly, when a thought enters the mind, The American Psychiatric Association's that thought is subject to an equal number Diagnostic and Statistical Manual (APA, 1994) of distortions and interpretations. defines obsessions (of OCD) as 'recurrent Mindfulness meditation trains the mind to and persistent thoughts, impulses, or images that Similar claims can be made with regard strip away these distortions, allowing are experienced as intrusive and inappropriate antdo the role of mindfulness in other anxiety cognitions to be objectified as they pass that cause marked anxiety or distress". Resistance disorders. Evidence suggests that the through consciousness, with no emotional to these intrusive thoughts is another perception of threat arising from the response generated towards them. important (almost defining) property of content/occurrence of intrusive cognitions OCD. That is to say that the sufferer is also important in the psychopathology of Mindfulness precipitates particular insight attempts to ignore or suppress intrusions generalised anxiety disorder (GAD) (Beck et into the Buddhist principle of impermanence with some other thought or action (the al 1995, Freeston et al 1994)'. A comparable (annicd). This notion suggests that all things compulsion). model of panic disorder is proposed by - be they objects, people, sensations, or Clark (1985), who suggests that panic attacks beliefs - are transient; nothing eternal; Anxiety (the metacognition) in OCD nothing everlasting. This makes Buddhism arises from two sources - from the content occur in response to the catastrophic quite unique amongst the great faiths in of the obsession ("I must clean the kitchen interpretation of bodily sensations such as that, when applied to the self, the notion ten times or I will die"), but also from the palpitations and breathlessness (as opposed of impermanence postulates that there is no perceived threat of a repetitive cyclical to the pathological interpretation of cognitions everlasting soul. This is the Buddhist thought that refuses to disappear from in OCD and GAD). Similarly, Barlow principle of anatta, or no-self. Anatta is consciousness. Mindfulness meditation could (1986) proposes a model of psychosexual realised though meditation — in the moment- potentially train the mind to objectify the dysfunction based on the notion of 'negative to-moment bare attention of mindfulness, obsession as it passes through consciousness, automatic thoughts'. In this model, sexual the Buddhist ceases to identify with without generating the pathological anxiety- dysfunction is maintained by cognitive sensations and feelings as his/her 'self. As response. Furthermore, a realisation of interference from intrusive thoughts concentration intensifies the sense of self annica (impermanence) can promote a sense occurring during sex. An important dissipates, and is replaced instead by the commonality of all these models is the notion of anatta. This principle is succinctly that the cyclical thoughts will eventually notion of a pathological reaction to intrusive described by Morris (1993): "There is no cease, since all things are transient. This thoughts or bodily sensations. The detached provides a reassuring sense of order and immutable core of being, no eternal soul, either observation of mindfulness may therefore within the individual person or in the world. control over a chaotic thought process provide relief from all of these pathologies. previously viewed as threatening. Existence is, for the Buddha, impermanent, Only a limited amount of research is conditioned, and essentially transient and in flux". Currendy, the aim of cognitive behavioural available to empirically verify the efficacy of therapy in OCD is to modify the anxiety- mindfulness in the treatment of mental The principles of dukkha, anicca and response by direct exposure to feared disorder. Kabat-Zinn et al (1992) studied anatta (suffering, impermanence and no-self) cognitions (e.g. to show that cleaning the the effectiveness of a mindfulness are termed the three pillars of Buddhism. kitchen only once does not result in death), meditation-based stress reduction program An important point to note with regard and through systematic deconstruction and for the treatment of GAD and panic to mindfulness is that each thought is rationalisation of false beliefs. These two disorder. They observed significant regarded as distinct from the emotional approaches reduce anxiety by directly reductions in subjective and objective response to it. attacking the obsession itself. That is they measures of anxiety following eight weeks try to prevent the undesired metacognition This is not dissimilar to the metacognitive (anxiety) by obliterating the intrusive of meditation training. 9 1 % of subjects framework used in the West to model obsession. Interestingly, however, it has showed significant reductions in Hamilton anxiety states. A metacognition is a belief been shown that intrusive thoughts and Beck Anxiety (and depression) scores or attitude towards one's own cognitions, or indistinguishable in content from clinical post intervention and at three month follow- 'a reflective process directed at ones own cognitive up. Significant reductions were also observed obsessions occur in nearly 90% of the activity' (Allen & Armour-Thomas, 1991). general population (Rachman and de Silva, in the severity and frequency qf panic This framework is a useful platform from 1978; Salkovskis and Harrison, 1984). This attacks. which to cast light on some of the similarities suggests that it is the response to the obsession between the Buddhist and the cognitive which is pathological in OCD, not the therapist's views of the mind. We shall obsession itself. It could be argued, begin by considering Western metacognitive therefore, that the ideal intervention for modelling of obsessive compulsive disorder OCD would seek only to modify the (OCD). (143) A 3-year follow-up study of the same cohort (Miller et al, 1995) showed that meditation practice was maintained in at least 77% of subjects (although some were untraceable), and that all therapeutic benefits