Meditation and Mindfulness to receive medical rebates?

Who will be the first health insurer in Australia to provide medical rebates for the therapeutic application of meditation and mindfulness? Currently, very few providers in the USA or elsewhere provide reimbursement for these widely used treatments. 

Recent research has added to compelling, existing evidence that reinforce the fact it may well be time; mindfulness-based stress reduction has been found to be as effective as a commonly used antidepressant drug for treating anxiety disorders. 

"Our study provides evidence for clinicians, insurers, and healthcare systems to recommend, include and provide reimbursement for mindfulness-based stress reduction as an effective treatment for anxiety disorders,” says Elizabeth Hoge, MD, the lead author. 

So this week we look at this new evidence, and what it means for individuals and the medical system – including medical rebates and Allevi8, but first

  

   Thought for the day

           Wisdom without compassion 

           Feels no pain

                    Gary Snyder

Significant recent research published this year in JAMA Psychiatry demonstrated guided mindfulness-based stress reduction program was as effective as use of the gold-standard drug - the antidepressant drug escitalopram - for patients with anxiety disorders. 

Researchers at Georgetown University Medical Center have found mindfulness-based stress reduction is as effective as a common antidepressant drug for treating anxiety disorders.

Anxiety disorders can be highly distressing; they include generalized anxiety, social anxiety, panic disorder and fear of certain places or situations, including crowds and public transportation, all of which can lead to an increased risk for suicide, disability and distress and therefore are commonly treated in psychiatric clinics. 

Drugs that are currently prescribed for the disorders can be very effective, but many patients either have difficulty getting them, do not respond to them, or find the side effects (e.g., nausea, sexual dysfunction and drowsiness) a barrier to consistent treatment. 

Standardized mindfulness-based interventions, such as mindfulness-based stress reduction (MBSR), can decrease anxiety, but prior to this study, the interventions had not been studied in comparison to effective anti-anxiety drugs. 

Of note, approximately 15% of the U.S. population tried some form of meditation in 2017.

"A big advantage of mindfulness meditation is that it doesn't require a clinical degree to train someone to become a mindfulness facilitator. Additionally, sessions can be done outside of a medical setting, such as at a school or community center."

For this study, MBSR was offered weekly for eight weeks via two and a half-hour in-person classes, a day-long retreat weekend class during the 5th or 6th week, and 45-minute daily home practice exercises. 

Patients' anxiety symptoms were assessed upon enrollment and again at completion of the intervention at 8 weeks, along with post-treatment assessments at 12 and 24 weeks after enrollment. 

The patients were relatively young, with a mean age of 33 and included 156 women, which comprised 75% of the enrollees, mirroring the disease prevalence in the U.S.

Both the MBSR and the drug treatment groups saw a statistically equivalent reduction in their anxiety symptoms. 

The drop in the severity of their anxiety was significant – around 30%.

The researchers added, "It is important to note that although mindfulness meditation works, not everyone is willing to invest the time and effort to successfully complete all of the necessary sessions and do regular home practice which enhances the effect," 

"Also, virtual delivery via videoconference is likely to be effective, so long as the 'live' components are retained, such as question-and-answer periods and group discussion."

Hoge points out many phone apps do offer guided meditation, but researchers are yet to assess how apps compare with the full in-person, weekly group class experience. However, the researchers did conduct a second phase of the study during the pandemic that involved moving the treatments to an online, videoconference which will be the focus of future analyses. The researchers also hope to explore the effects of MBSR on sleep and depression.

RELEVANCE

1. This study adds to the evidence base in support of the Allevi8 app being used in therapeutic settings for anxiety disorders. Our app includes live components - direct interaction is available with experienced meditation teachers.

2. The evidence supporting health funds reimbursing meditation and mindfulness programs is now compelling. My guess is it will not be long before companies are adding these rebates as an edge to attract and retain new members. In the process, they are likely to make significant cost savings…

 

Mindfulness and sleep – more research

Also this year, research been published by Gao and colleagues exploring the benefits mindfulness might offer to those with sleep disorders. 

This study demonstrated a mechanistic link between mindfulness practice and increased emotional nonreactivity, decreased worry, and a reduction in reported sleep disturbances, suggesting that app-based mindfulness training may be a viable option to help individuals who report worry interferes with their sleep.

NOTE The Allevi8 app also features a sleep section

REFERENCES

1. Hoge AE et al. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults with Anxiety Disorders. JAMA Psychiatry, 2023;80(1):13–21. DOI: 10.1001/jamapsychiatry.2022.3679

2. Gao M et al. Targeting Anxiety to Improve Sleep Disturbance: A Randomized Clinical Trial of App-Based Mindfulness Training. Psychosomatic Medicine 84(5):p 632-642, June 2022. 

In praise of fast cars

What can we learn from a very fast old car?

Plenty really. I drive a Subaru WRX. Fabulous car. I was fortunate and happened to buy the 1998 model, the best looking WRX of all time. Sleek, elegant, relatively cheap, and bloody fast!

My car has just celebrated its 25th birthday, having completed over 330,00Kms. Yes 330,000Kms! And it still goes very fast!

And yes, I know that these days it is about as politically correct to admit to loving driving fast as it is to being a smoker, but it is a fact. I love speed. Always have. Never smoked :)

So this week, let’s go “Out on a Limb” once again and discover what we can learn from a very fast old car. But first, I love being still as well, so

      Thought for the day

      Profound and tranquil, free from complexity

      Uncompounded luminous clarity

      Beyond the mind of conceptual ideas

      This is the depth of the mind of the victorious ones.

      In this there is not a thing to be removed

      Nor anything that needs to be added.

      It is merely the immaculate

      Looking naturally at itself

                      Nyoshul Khen Rinpoche 

The metaphor is simple but very strong. As a fast car, to get to be 25 years old and to continue to look as good as you did in the early days, to continue to go as fast as you did in the early days; it all takes some work. Good care, regular servicing, a few running repairs, and maybe a facelift!

My WRX came with all the raw ingredients. The car looks terrific to my eye; it has beautiful lines, is compact and elegant. In many ways it looks like a modest hatchback.

But then there is this incredible turbo-charged Boxer motor that is hooked up to everything that matches. The outcome? A racing billycart. Sure the ride is a little rough, but it moves fast, handles extraordinarily well and has been incredibly reliable. I love driving this car.

But then, the truth is the car is serviced regularly by the best Subaru people I could find using only genuine parts. It has never had an accident, despite being driven very hard in its early days; more sedately of late. 

It did blow up a transmission at 30K, but Subaru recognised an in-built fault and replaced it free of charge. Being automatic, the transmission did need replacing again recently.

The only other difficulty was when the failure of a minor part led to a major engine problem at around 200K and the bottom half of the engine needed replacing. And I did have it resprayed a year or so ago.

So the simple metaphor. Compare the car to the body. My body is 73 years old. Still goes quite well despite being short of one leg, one lung and most likely one kidney. But this body of mine, like the WRX, gets very well looked after. 

Fuel

I am quite particular about what goes into it this body of mine. 

The WRX would probably run on basic unleaded; splutter along at least; but it goes best on Premium and that is also better for its engine. 

My body, like the WRX, is a combustion engine. 

You put things into it, it burns them up and it goes. 

The WRX has a relatively simple combustion engine and I am very particular about what I put in its petrol tank. 

My body has an exquisitely complex combustion engine. 

It makes logical sense to be even more attentive to what goes into my own tank.

Why not use the best? Why not eat the best?

Regular servicing

For me, regular meditation is like servicing. Worth doing daily. Going on retreat is a more deliberate form of servicing, as is having a regular massage, taking time out in the garden or going for a walk. Regeneration time. When I need to, which is often, I want to know that everything has been done, everything is ready, so that I can be at my best. 

Why not be at your best?

Respraying

This seems to be unknown or overlooked by many, but in my view, good food, really good food, is way more effective then a facelift. Eat consistently well and skin tone is good, wrinkles smooth out and an inner glow emerges. 

Why not look at your best?

Actually, I treat my body better than the WRX. 

I like to think I treat it like a Formula One racing car, where everything is taken seriously, but there is a lot of fun involved. 

That attitude certainly helped me to recover from a very difficult cancer. 

And these days, while I am not fixated, I am fairly diligent, and this attitude helps me to make the most of the bits that I do have, to live and enjoy life to the full, and to make the most of what it is that I have to offer to others.

And finally, along with the WRX’s milestone 25th birthday next month, I have no demerit driving points against my name. Not sure as the years advance if I am becoming more politically correct or just more careful?

Love that car!

RELATED BLOG

What food goes into your tank?

Bottom line comfort

I am often asked where to obtain a good meditation cushion.

Here is a link to where you can order great Zafus (buckwheat filled, round cushions) and other meditation gear...

They also have buckwheat refills for well used, flattened Zafus that need replenishing. 

https://onanea.com/

 

 

Relationship – a crucial point in learning and deepening your meditation

In the Western world, relationships with teachers can be really mixed up. Because of the power differential between students and teachers, because of the dependency, the desperation that sometimes can be involved, students worry about giving their power away, of being taken advantage of or being abused.

However, the relationship we have with our meditation teacher can be crucial; it can add great depth and ease to learning and progressing along the path.

So this week, we look at something that may well be provocative, and that is not so often spoken about: the meditation teacher/student relationship, and we will look at it from both sides; but first

     Thought for the day

          The absolute truth cannot be realized 

          Within the domain of the ordinary mind. 

          And the path beyond the ordinary mind, 

          All the great wisdom traditions have told us, 

          Is through the heart. 

          This path of the heart is devotion.

                             Sogyal Rinpoche

Meditation and the student/teacher relationship

Evidence would say there can be risks involved, but in holding back, in taking a defensive stance, students may well miss out on fully developing one of the biggest supports for meditation. And in this day of heightened sensitivities, teachers may well hold back, they may well limit themselves in what they offer.

If you had gone to Dr Ainslie Meares to learn to meditate, it may not have been what you expected. He would request you read his meditation books before attending. Then at the first and subsequent meetings, he spoke little and deflected questions. It was all about how he could share his experience with you. 

Being an accomplished meditator himself, Dr Meares' understanding of the teacher’s role was to impart his experience in the most direct and effective way he could. 

As he was interested in the essence of meditation, the stillness, in his view, talking about meditation only stirred up the thinking mind and created a barrier to going beyond that and into the stillness.

So his approach involved using words to lead into meditation that were abstract, that did not invite rational analysis, that were softly and slowly spoken with plenty of gaps to allow for the silences and stillness to become more apparent.

He used his presence to convey his experience.

This was back in the 1960s to 1980s. 

In those days he also used physical touch; lightly touching his students in a way that these days where the risk of being misunderstood is high is just too risky for practitioners to do. 

Having learnt from and been mentored by Dr Meares, you may well notice a similar use of words and voice when I or people I have trained introduce meditation. In the early days of this work, we used physical touch as well; always having a male and female teacher in the room and touching people lightly on the head and shoulders. 

Sadly – as in my opinion it lessened the experience for our students – as time moved on, this part of the work just seemed too easy to be misconstrued and we stopped doing it around 2015.

Dr Meares was a deeply spiritual man, but not aligned to any specific spiritual tradition. His approach was secular. On the other hand, my even more significant teacher, Sogyal Rinpoche, grew up in and was highly trained in Tibetan Buddhism. His quote above reflects his deep connection with, his reliance upon, and his devotion to his own teachers and their unbroken lineage right back to the Buddha himself.

But maybe it is the word “devotion” that encompasses the key issue for Westerners. 

We have been so inculcated in the notion of being independent, or finding “ourselves”, of standing on our own two feet, and so on. 

And there are quite a few stories where devoted people have been taken advantage of, and have suffered as a consequence.


There is not much in this world that does not carry some risk…

But read Rinpoche’s quote again. It does have compelling logic. How do we get past this thinking mind with all its attendant emotions, and connect more directly to our still, inner essence? The path of the heart is regarded as actually being the easiest and most reliable path, and the path of the heart is devotion.

So again, that word that seems to strike fear in some – devotion.

Speaking personally, when I first became interested in Tibetan Buddhism, I really struggled with devotion. What did it mean? What would I need to give up? What would I need to commit to? Would becoming devoted to a teacher diminish me or put me at risk? Why was I holding back? What to do???
Happily, I was able to discuss this with Sogyal Rinpoche and he taught on it extensively during retreats. My own conclusion is each one of us who considers making a conscious commitment to devotion needs to listen, read, discuss and especially contemplate this deeply. It nay takes years to reach clarity.

For myself, I was really helped by coming to understand devotion is a logical conclusion. It is actually a profound commitment to the teachings, based upon an understanding of how powerfully they work, and a gratitude for being able to listen to them, to learn and to practice them. 

A good teacher embodies what they are teaching. If they do this authentically, then devotion to them is devotion to the teachings. 

The more fully we can see the teacher as a pure vessel for authentic teaching, the more fully they will fulfill their role for us.

From the teacher’s perspective, the more they can put their own ego aside (at the very least while teaching), the more effective they will be in sharing their teachings in an authentic and effective manner. 

That is why good teachers start each session with a commitment along these lines. This may well go unspoken, but it does reflect this deep inner wish to present the teachings free of impediments.

Now just to be clear, it is true one can gain a lot from a good meditation teacher while keeping a distance. But there is a greater depth on offer when one makes more of a commitment and engages more fully.

A comparison may be to experience the use of a meditation app where the connection with the person leading the practice is quite superficial. The app and the practices may well be helpful, but it is no surprise within a month of downloading a basic meditation app, only 5% of people are still using it.

This is why with Allevi8 we offer direct online contact with our trained teachers; and the difference in connection and regularity of practice is hugely different.

And it is why wherever possible, the ideal is to go to meditation teachers in person…

So maybe reflect some more on the nature of your own connection to the teacher(s) you have…

Happy meditating 

Is meditation bad for your (mental) health?

You may have read or heard recent concerns mindfulness apps may be bad for your mental health?

Is this so? And if so, is there a risk in using the Allevi8 mindfulness and meditation app I have helped develop specifically to help people with their mental health, and with managing significant illness?

Also, pardon the long gap between post; there has been a lot going on that maybe warrants another post at another time, but first

          Thought for the Day

If you ask me what sort of self-control you need 

To do the work of contemplation, 

My answer is, ‘None at all!’ 

In everything else you do, 

You should practise moderation. 

Avoid extremes when eating, drinking or sleeping. 

Also, protect your body from severe cold or heat, 

Do not pray or read too long 

And do not spend too much time 

Conversing with your friends. 

In all of these things, it is important 

That you do neither too much nor too little. 

But in contemplation, 

You may throw caution to the wind. 

Indulge. 

I hope you will never stop doing this loving work 

As long as you live.

         The Cloud of Unknowing – wonderful 14th Century Christian mystical text 


Following the recent Choice investigation of mindfulness apps, Nicholas Van Dam, Director of the Contemplative Studies Centre, and Jeannie Paterson, Co-Director of the Centre for Artificial Intelligence and Digital Ethics, recently spoke with Life Matters on ABC Radio National about the potential for harm that apps may pose to users, particularly (but not limited to) those with existing trauma or mental health issues.`

Allevi8’s experience in this domain goes way back to the 1980’s when I was learning from and being mentored by Dr Ainslie Meares. 

Dr Meares was a world-renowned psychiatrist and the earliest driving force behind the use of meditation in a therapeutic context. 

I had recently recovered (unexpectedly by most) from a very difficult cancer using meditation as a mainstay. 

Following some press and many enquiries, I was just beginning to help others affected by cancer, stress, anxiety and other conditions.

I had the good fortune to meet regularly with Dr Meares. 

We spoke often about potential risks, potential adverse side-effects and how to avoid them. The was not much research back in those pioneering days, but Dr Meares drew on his extensive psychiatric background, and we were both working with many people dealing with a wide range of conditions.

Maybe Allevi8 can present a full webinar or conference on this subject one day, but for now, maybe it is enough to point out:


1. The techniques used on the Allevi8 app have been clinically tested on literally thousands of people by Dr Meares, myself and the large number of staff I had the privilege to work with over nearly 40 years. These people had a very wide range of physical and mental health conditions. 

Dr Meares said the only concerns he had were for people with bi-polar disorder. So in my own work, we did screen people. However, as the years moved on, a number of people reported they had not disclosed their bi-polar condition, had learnt and practices meditation and had either felt much better, actually improved or in a couple of cases, remained symptom free over long periods of time.

2. The techniques used on the Allevi8 app have been developed with safety in mind. 

A big part of what we could describe as inbuilt safety, is the initial focus on relaxing the body. 

In our experience, techniques that only include the mind can lead to dis-association, whereas an initial bodily focus is very grounding and stabilising.

3. While not formally researched, the techniques on Allevi8 have strong similarities to techniques that have been researched and have been found to have both good efficacy and low risk profiles. 

A summary of the evidence base is on the Allevi8.net website. 

4. In all the nearly 40 years using these techniques and with over 100,000 people having used them in residential and non-residential programs with a good deal of interaction with staff, there have been no reported major setbacks or side-effects reported by these people, and most problems have been simply around difficulty with application – learning the techniques and practicing regularly.

5. At Allevi8 we take the concerns for adverse effects very seriously. This is another reason why we developed our online mentoring system and engaged senior, well trained, and experienced teachers to fill these mentoring roles. We know that personal connection with a teacher/mentor provides a strong safeguard.

6. We do encourage anyone who may experience problems to do the obvious thing and tell us about it via the website Allevi8.net. 

So in conclusion, while aware of small potential for risk, based upon our extensive experience, we have confidence in the techniques on the Allevi8 app and commend it for your consideration and use.

Street compassion

What do you do when you pass by the homeless in the city? Or a car window-washer at a street intersection? What do you do at the checkout in a supermarket? Or as you pass anyone in the street?

A friend has just introduced me to a beautiful term – “street compassion”. It refers to how we engage with people in the street, and it is a wonderful practice to take up consciously.

So this week, street compassion – what it is and how to practice it, but first

   Thought for the day

       When your fear touches someone’s pain 

       It becomes pity.

      When your love touches someone’s pain, 

       It becomes compassion.

            Stephen Levine

So, we are all busy and have limited resources. 

But then there are the homeless, and the person at the checkout, and the one who gets into a lift at the same time as you. What to do?
Retreat into one’s self and maintain the status quo of ignore and isolate? Or find some way to interact? And if we do chose to interact, how to do that without descending into pity, condescension, guilt or even arrogance?

My friend tells me about her own 'street compassion' practice.  How in the everyday, she connects with people in the street from her own inner wisdom essence to reach out to them and be 'there' for them just as they are in that moment.  A kind word of appreciation, a hug of acknowledgement and to bear

witness to a story of difficulty and pain.  

She says this is always spontaneous and comes from within, from her own connection to her inner 'wisdom light'. She fearlessly reaches out to engage with all sorts of people. But she says this does not come from any preconceived intent; it is spontaneous, in the moment.

For me it has been a bit more pre-meditated. 

For years I have enjoyed attempting to engage with people I meet casually. 

I was inspired by Dr Patch Adams who I brought to Australia for those wonderful Mind, Immunity and Health conferences of the ‘90s. 

Patch told me how whenever he had time, he would ring random telephone numbers – in the days when we had home lines – and try to engage people in spontaneous conversations. 

He recounted how often these chats went to remarkable depths and often went on for an hour or so.

Often people would say no one had ever listened to them in such a way. And how delightful that was – for him and for them.

So my approach has been to attempt to engage with people whenever possible. Over the years, 2 approaches seem most reliable – flattery and a simple question.

Flattery is simple. 

Find something that stands out about the person and compliment them on that aspect of their being. 

Hair colour is easy, and even though those bright streaks are becoming more common, nearly everyone responds well. 

If you have gone to that much trouble to colour your hair, to have someone acknowledge it, seems always appreciated, and often opens to more of a conversation. 

Of course, with flattery and with being PC, one really has to check the motive, be genuinely interested in engaging openly with the other person, and be coming from a good place. 

The second approach, the simple question, is maybe less fraught. 

The most effective and reliable question I have found so far is simply “How is your day going?” 

Asked this of a teller in a service station just a couple of days ago. He seemed to be deeply troubled and yet he replied “fine” in a manner we both knew meant far more. However, this simple exchange felt like it was enough at even this basic level to acknowledge whatever deep distress he was feeling; and without needing to go into detail. 

Others will open remarkably to this simple question…

And then the special case of homeless beggars...

There are 2 types of compassion – relative and absolute. Relative compassion requires an object. 

You see something or someone who arouses your compassion. 

This type of compassion has an intellectual aspect to it and fluctuates according to what provokes it. 

It is often accompanied by an inner debate.

Absolute compassion comes from the stillness of our inner essence. It is a ground state and exists independently of any particular object. It is there for everyone and everything. A bit like unconditional love or agape, this is unconditional compassion. With absolute compassion there is no inner debate; one just acts or does nothing as the circumstances dictate.

So beggars and the homerless. How conditional or unconditional are we? Do we give effortlessly, or do we enter into a frantic inner debate? Are we encouraging them by giving money? Are we feeling superior as we part with a few dollars? Are we paying for a drug habit? Are we providing refuge for the night? Is their need genuine?

I love watching my mind when approaching someone in need on the street. Definitely an advanced practice – to act spontaneously, do what is appropriate and then, whether having parted with some cash - or not, not spend the next 5 minutes in internal debate around whether it was in fact the right thing to do - or not.

By the way, Ruth is a master practitioner with this and gives naturally, freely and often :)

So here is the challenge – what form does your street compassion take?