Complementary Alternative Cardiovascular Medicine

Chapter 8 / Meditation and CVD 125
setts Medical Center is now offering professional training programs for
clinicians who are interested in using such interventions with their
patients (23,24).
When Kabat-Zinn trains his health care professionals, he cautions
them to remember that MM has in both its techniques and its objectives
a “non-doing orientation” (24, p. 768). There is no objective other than
simple awareness of the present moment, which might include pleasant
states of relaxation but may also include unpleasant feeling states. Both
are to be observed with the same attitude of acceptance and nonjudgment.
The goals and attitudes that professionals and patients might have
related to the practice and its ability to generate relaxation or relief from
suffering are intentionally observed as a part of the practice itself and are
also to be regarded with an attitude of nonattachment. Kabat-Zinn highlights
that MM in the medical setting contains a paradoxical element.
Patients are often referred for mindfulness training for specific reasons
and with hopes of achieving specific health related goals, yet, paradoxically,
patients are told early in their mindfulness training that “the best
way to get somewhere is to try not to get anywhere at all but to simply
be where they are already, with awareness” (24, p. 769). Kabat-Zinn
suggests that progress in MM is best measured by the level of acceptance
of the mindfulness process itself and in the patient’s increasing ability to
face his or her life experience (24).
RESEARCH ON MEDITATION PRACTICE
The scientific research on meditation is extensive. However, much of
the research conducted to date has methodological limitations. There are
few controlled studies, and, overall, sample sizes have been small. In
addition, there is a lack of standardization of what constitutes meditation
practice. The lack of clear operational definitions of the various types of
meditation leads to ambiguity and difficulty comparing studies. There is
often confusion between TM, MM, and relaxation. The ambiguity and
overlap of these interventions has made it difficult to isolate the mechanism
of change in these practices. Finally, there is a lack of consensus of
the training requirements for practitioners delivering the interventions.
None of the studies to date has included information about the training
of the clinicians, nor does it use clinical adherence or competence measures.
Despite these methodological weaknesses, there is mounting evidence
to support the use of meditative practice in a medical setting. What
is clear is that further, more rigorous research is required. What follows
is an overall review of the research in this area. Studies of both TM and
MM are included in this review.