Compassion - Bridging Practice and Science - page 257

opposite. Hypervigilance, a clinical term, is associated with an exaggeration of negative
symptoms[20]. Increased attention to the pain, as just posited, should amplify the experience and
lower tolerance. Clearly something else must be involved. The mindfulness condition may hold part
of the answer.
Being Present: How Mindfulness-Based Meditation May Influence Pain
While concentrative meditation is said to stabilize the mind, an apparent insight of the Buddha was
that this was not sufficient to overcome suffering. Rather, he suggested one also needs insight;
insight into the idiosyncrasies of the mind, one’s behavior and even how one perceives (or doesn’t
perceive) the world. Enter mindfulness. Being mindful is being aware of what one is doing, while
one is doing it; being present. There is a notion of acceptance of things as they are, of simple
observation rather than elaborate judgment and reactivity. I believe this mental stance has much to
do with why meditators are less sensitive to pain.
Returning to the study I began to describe above, the second condition of interest was mindful
attention. This time control subjects reported no difference in pain from their own baseline while
meditators reported significantly reduced pain intensity and pain unpleasantness. Importantly, the
most experienced meditators had the strongest pain reductions and, as a group, the Zen
practitioners scored higher on a questionnaire measuring mindfulness. Given that during
mindfulness one places the attention on the experience itself, it is unlikely that the observed pain
reductions were due to distraction, as they may have been for the Yogi above. Rather, consistent
with descriptions of mindfulness, we suggested that Zen practitioners were better able to follow our
instructions of attending in the moment without automatic judgment. In support of our results, a
study published the following year found largely similar results in advanced Tibetan meditators[21].
However, unlike the Zen practitioners, Tibetan meditators only showed effects on the affective
dimension of pain. We move now to several brain imaging studies that have given us more insight
into these effects.
Brain imaging techniques such as functional MRI give one more power to distinguish between
competing hypotheses. In terms of meditation and pain, distraction should result in reduced pain
reports alongside brain activity reductions. Mindfulness should reduce pain and possibly increase
brain activity due to the attention allotted to the stimulus. Thus, our next study used fMRI to
measure the brain activity of our two groups during pain[15].Only two conditions were included;
baseline (pay attention normally) and Zazen (Zen meditation). Control participants were instructed
were instructed in how to do Zazen one week prior to their scan. The results were quite intriguing.
After controlling for the strength of the stimuli (stronger in meditators), we found that pain-related
areas were more strongly activated for meditators than for controls during the normal attention
condition, despite equivalent pain ratings ( Fig. 1 C, D). This finding supports the idea that the
meditators were directly focusing on the sensations and not simply distracting themselves.
Simultaneously, a whole series of brain regions had dramatically reduced activity for the meditators
during pain, but not for the controls (Fig. 1 A, B). These included the amygdala, hippocampus and
orbitofrontal, medial-prefrontal and dorsolateral-prefrontal cortices.
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