Adobe Flash Player is required to view this feature. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. Original Article Results of a Home-Based Environmental Intervention among Urban Children with Asthma Wayne J. Morgan, M.D., C.M., Ellen F. Crain, M.D., Ph.D., Rebecca S. Gruchalla, M.D., Ph.D., George T. O'Connor, M.D., Meyer Kattan, M.D., C.M., Richard Evans, III, M.D., M.P.H., James Stout, M.D., M.P.H., George Malindzak, Ph.D., Ernestine Smartt, R.N., Marshall Plaut, M.D., Michelle Walter, M.S., Benjamin Vaughn, M.S., and Herman Mitchell, Ph.D., for the Inner-City Asthma Study Group N Engl J Med 2004; 351:1068-1080 DOI: 10.1056/NEJMoa032097.

Results For every 2-week period, the intervention group had fewer days with symptoms than did the control group both during the intervention year (3.39 vs. 4.20 days, P.

Inner-city children with asthma are commonly exposed to multiple indoor allergens and environmental tobacco smoke, exposures that may contribute to the increased asthma-related complications in this population. Asthma-management guidelines have stressed the need for environmental control measures, but there is limited evidence of their efficacy. Previous studies of environmental interventions for patients with asthma have focused on a single allergen, such as dust mites, or environmental tobacco smoke, rather than on the multiple exposures encountered by many urban children with asthma. Measures to avoid exposure to dust mites, including bedding encasement, have reduced the levels of exposure to these allergens, but their clinical effectiveness remains a matter of controversy.

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Exposure to cockroach allergens may aggravate asthma among sensitized urban children, but reducing allergen levels in inner-city homes has proven difficult and has had no apparent clinical benefit. Efforts to use educational approaches to reduce exposure to environmental tobacco smoke in the home have also been disappointing; however, the use of interventions including air filtration has not been reported in this population. One potential limitation of all these intervention strategies is their focus on decreasing exposure to a single allergen, rather than improving the indoor environment as a whole. The Inner-City Asthma Study evaluated the effectiveness of a multifaceted, home-based, environmental intervention for inner-city children with asthma.

The objective of the study was to determine whether an intervention tailored to each child's sensitization and environmental risk profile could improve the symptoms of asthma and decrease the use of health care services. Methods We enrolled children 5 through 11 years of age in whom asthma had been diagnosed by a physician at research centers in the Bronx, New York; Boston; Chicago; Dallas; New York City; the Seattle and Tacoma, Washington, area; and Tucson, Arizona. Eligibility was limited to residents of census tracts in which at least 20 percent of households had incomes below the federal poverty level. Other eligibility criteria included at least one asthma-related hospitalization or two unscheduled, asthma-related visits to the clinic or emergency department during the previous six months and a positive skin test in response to at least 1 of 11 indoor allergens. Children were not enrolled within three weeks after an asthma-related hospitalization or visit to the emergency department and could not have any other serious chronic illness. All appropriate institutional review boards approved this study. Written informed consent was obtained from each participant's parent or legal guardian, and children gave assent.

A two-by-two factorial design was used to evaluate environmental and physician-feedback interventions in the same study population. The physician-feedback intervention included bimonthly reports of the children's asthma symptoms and use of health care services to their primary care physicians. There was no interaction between the two interventions, so their effects are considered separately; this article describes the results of the environmental intervention. A baseline clinical evaluation included questionnaires on complications related to asthma and the home environment.

Skin testing was performed with the use of the percutaneous MultiTest method (MultiTest II, Lincoln Diagnostics), involving extracts of German and American cockroach (Bayer) and of the dust mites Dermatophagoides farinae and D. Pteronyssinus, rat, mouse, the fungi Alternaria alternata, Cladosporium herbarum, aspergillus mix, and Penicillium chrysogenum, cat, and dog (all from Greer Laboratories). A response was considered positive if the diameter of the resulting wheal exceeded that caused by the saline control by 2 mm or more. Approximately three weeks after the baseline clinical examination, a baseline home evaluation was performed that involved both direct visual inspection and dust collection from the child's bedroom.

Using a standardized protocol, the home-evaluation team collected separate, vacuumed dust samples from the child's bedroom floor and bed. Dust samples were stored at –20°C and then analyzed in batches for allergens of D. Pteronyssinus (Der p1) and D. Farinae (Der f1), cockroach allergen (Bla g1), cat allergen (Fel d1), and dog allergen (Can f1) by means of an enzyme-linked immunosorbent assay. Environmental Intervention Children were randomly assigned to either the control group or the intervention group by blocked randomization within a site.

Families in the control group received visits only for evaluation at six-month intervals throughout the study. Neither the study staff nor the children were masked as to group assignment once the intervention had begun.

The goal of the intervention was to provide the child's caretaker with the knowledge, skills, motivation, equipment, and supplies necessary to perform comprehensive environmental remediation. We used an approach that was based on social learning theory.

This theory emphasizes the importance of a person's attitudes and expectations and modeled behavior in evoking behavioral change. For each component of the intervention, we attempted to educate the family regarding the importance of the mitigation behavior and its effectiveness, while at the same time modeling the targeted behavior. The caretakers were then asked to perform the mitigation behavior while the environmental counselors provided feedback and encouragement. The intervention was organized into six modules that focused on remediation of exposure to dust mites, passive smoking, cockroaches, pets, rodents, and mold. Intervention activities were tailored to each child's skin-test–sensitization profile and environmental exposures on the basis of the caretaker's report and the study staff's observations during the baseline home evaluation. During the 12-month intervention, two research assistants conducted five mandatory and two optional home visits.

All visits were followed by a telephone call to address any barriers to implementing the remediation plan. Overall, a median of 4 modules was delivered per child in the intervention group (range, 0 to 6) during a median of 5 visits (range, 0 to 7). During the first visit, the intervention teams taught the caretaker about the role of allergens and irritants in the child's asthma and introduced the environmental intervention plan, including the creation of an environmentally safe sleeping zone.

Allergen-impermeable covers (Allergy Control Products) were placed on the mattress, box spring, and pillows of the child's bed at this visit. Families were given a vacuum cleaner equipped with a high-efficiency particulate air (HEPA) filter and either a power brush (model S434-I, Miele) if the child's bedroom or family room was carpeted or a bare-floor brush (model S312-I, Miele) and instructed in its use. A HEPA air purifier (model 293, Holmes Products) was set up in the child's bedroom if the child was exposed to passive smoking, sensitized and exposed to cat or dog allergens, or sensitized to mold. For children sensitized and exposed to cockroach allergen, professional pest control (Terminix) was provided. The study received volume discounts in purchasing products and services from Allergy Control, Greer, Holmes, Miele, MultiTest, and Terminix.

None of the vendors were involved in the design of the study or the interpretation of the results. Follow-up Home Evaluations Follow-up surveys of the home environment and collection of dust allergens were repeated at 6, 12, 18, and 24 months according to the same protocol described above in order to assess changes in the home environment. The teams conducting the home-environment evaluations differed from the environmental-intervention teams.

However, it is unlikely that the evaluation teams were masked to the study group because of the presence of study materials such as HEPA vacuum cleaners in the homes of the intervention-group families. Outcome Measures Interviewers masked to the children's study-group assignment conducted standardized telephone interviews with each child's primary caretaker every two months during both the year of intervention and the year after the intervention. These interviewers collected data on asthma symptoms, medication use, and health care use. The primary outcome was the maximal number of days with symptoms in the two weeks before the telephone interview, defined as the largest value among the following three variables: number of days with wheezing, tightness in the chest, or cough; number of nights with disturbed sleep as a result of asthma; and number of days on which the child had to slow down or discontinue play activities because of asthma.

Spirometry was performed at baseline and 12 months after randomization with a Renaissance II spirometer (Nellcor Puritan Bennett), according to the guidelines of the American Thoracic Society. The peak expiratory flow rate was measured (in liters per minute) twice daily for a period of two weeks at baseline and every six months thereafter with the use of a digitally recording peak flowmeter (AirWatch, ENACT Health Management Systems, or Simplicity, Nellcor Puritan Bennett), which was modified to mask the results.

Statistical Analysis All analyses were performed according to the intention to treat, regardless of the number of intervention visits conducted. Participants were required to have had at least one follow-up assessment for symptoms and health care use related to asthma and one follow-up assessment of allergens.

The difference in asthma-related outcomes between groups was modeled with the use of a linear mixed model with fixed effects for treatment group and visit, with adjustment for baseline symptoms and study site. Differences in the one-year risk of hospitalization were evaluated with the use of a two-sided Cochran–Mantel–Haenszel analysis, stratified according to whether the child had been hospitalized at any time in the two months before baseline. Differences in pulmonary function between the groups were analyzed with the use of analysis of variance, with adjustment for baseline measurement and site. Children had to have data for at least 3 days within a given 14-day period of measurement to be included in analyses of peak expiratory flow rate. Log-transformed allergen levels were modeled with the use of a linear mixed model, and between-group differences in the change from baseline to the average of the post-baseline levels were then calculated. We used a linear mixed model to assess whether reductions in the levels of allergens were associated with decreased asthma-related morbidity. Each allergen was considered separately because the changes in allergen levels were highly collinear, limiting the value of including multiple allergens in a single analysis.

All statistical analyses were performed with the use of SAS software (version 8.02, SAS Institute). Study Population A total of 1059 inner-city children with moderate-to-severe asthma were screened for possible enrollment ( Figure 1 Enrollment, Randomization, and Retention.

) between August 1998 and July 1999. Of these, only 65 (6.1 percent) had no skin-test reactions to any indoor allergens and were thus ineligible for enrollment. Another 57 children (5.4 percent) were excluded because their caretakers did not complete the baseline home evaluation.

A total of 937 children with a mean age of 7. Drivers Asus Ranger 200 Driver. 7 years (range, 5 to 11) were therefore enrolled. There were no significant differences in baseline demographic characteristics between the intervention group and the control group ( Table 1 Baseline Characteristics of the 937 Children.

The sample had a small predominance of boys, and the majority of children were black or of Hispanic descent (race or ethnic background was reported by each child's caretaker). A majority had annual household incomes below $15,000.

Over 87 percent of the children completed the two-year study, with 869 having at least one follow-up assessment for asthma-related symptoms and health care use and at least one bedroom-dust sample obtained in the first year, and 821 doing so in the second year. Baseline Sensitivity to Allergens and Environmental Exposure There were no significant differences in baseline allergen sensitivity and environmental exposures between the groups ( ). The children in both groups had a high prevalence of allergic sensitization to cockroach and dust-mite allergens, and exposure to tobacco smoke and aeroallergens was common. Detectable levels of cockroach allergen (Bla g1) were found in 68.4 percent of bedrooms; 20.8 percent of children had a cockroach-allergen level above 2 U per gram in their beds or on their bedroom floors. Dust-mite allergen (Der p1 or Der f1) was found in 84.1 percent of bedrooms, and 27.6 percent had a dust-mite–allergen level of more than 2 μg per gram in their beds or on their bedroom floors. In addition, 76.8 percent of children sensitive to cockroach and 86.7 percent of those sensitive to dust-mite allergen had detectable levels of these allergens in their bedrooms.

Levels of cockroach allergen were higher on the bedroom floor than in the bed (P. Effect of Intervention on Asthma Symptoms, Health Care Use, and Lung Function The intervention group reported significantly fewer symptoms of asthma during both the intervention year and the follow-up year ( Table 2 Effect of Intervention on Symptoms of Asthma and Health Care Use. The maximal number of days with symptoms was lower in the intervention group by 0.82 day per 2-week period in the first year (P.

Effect of Intervention on the Home Environment Levels of cockroach allergen (Bla g1) and dust-mite allergens (Der f1 and Der p1) in the bedroom decreased in both groups over the course of the study; however, greater reductions occurred in the intervention group ( Table 3 Effect of Intervention on Allergen Levels. In the first year, the intervention group had significantly greater declines than the control group in Der f1 (P. Reduction in Allergens and Asthma-Related Morbidity Within the intervention group there was a significant relationship between the reduction in the levels of dust aeroallergens and improvements in reported asthma-associated morbidity ( Table 4 Relationship between Reductions in Allergens and Changes in Asthma-Related Morbidity among Children in the Intervention Group.

Similar relationships were seen in the control group between reductions in allergen levels and improvements in asthma-related symptoms (data not shown). Reductions in bedroom-floor levels of cockroach (Bla g1) and dust-mite (Der f1) allergens in the intervention group were associated with decreases in the maximal number of days with symptoms, the number of hospitalizations, and the number of unscheduled visits for asthma in both years of the study. The estimated effects of a 50 percent reduction in allergen levels from baseline on these outcomes are presented in. This level of reduction was found in 52.1 percent of all children with detectable Bla g1 on their bedroom floor and 48.9 percent of all participants with detectable Der f1 in their bed. The correlation between reduction in levels of cockroach allergen on the bedroom floor and reduction in asthma-related morbidity was particularly strong. Discussion We found that a home-based intervention focused on reducing exposure to multiple indoor allergens and environmental tobacco smoke decreased reported symptoms among inner-city children with atopic asthma. The observed reduction in symptoms translates into 34 fewer days with reported wheeze during the 2 years of the study among children in the intervention group as compared with those in the control group.

This effect is similar to that described in placebo-controlled studies of inhaled corticosteroids. Unscheduled visits for asthma were also reduced slightly during the intervention year. The risk of hospitalization was not significantly changed; however, this study was not powered to detect a reduction in this infrequent outcome. Changes in lung function over the intervention year did not differ significantly between groups. However, clinical trials of inhaled corticosteroids in children and adolescents have demonstrated subtle improvements in lung function before a bronchodilator is given, in contrast to the marked improvements seen in symptoms, exacerbation rates, and health care use. Although children with asthma are commonly sensitized to multiple indoor allergens, most previous clinical trials of remediation interventions have targeted only one allergen or have not dealt with environmental tobacco smoke. In contrast, our intervention was multifaceted, mirroring current guidelines for environmental remediation.

As suggested in response to the recent failures of approaches involving reductions in exposure to a single allergen, clinically successful allergen avoidance is likely to require “the definition of what patients are allergic to, additional measures beyond the use of mattress covers, and education.” One reason that we were able to demonstrate a sustained reduction in allergens may have been that our intervention was based on established models of behavioral change, particularly those based on social cognitive theory. Staff members modeled the target remediation behavior, had the caretaker rehearse the behavior, and verified that the caretaker had mastered the behavior. They also reinforced the caretakers' expectations of successful outcomes and their ability to achieve them. Our findings demonstrate that allergen levels can be successfully reduced in the homes of inner-city children with allergic asthma and that this reduction is associated with a decrease in asthma-related morbidity. The reduction in cockroach allergen is especially notable since it plays such an important role in asthma-related morbidity among children who reside in the inner city.

Previous efforts to decrease the levels of cockroach allergen in this setting have not been particularly successful. The Institute of Medicine concluded that insufficient evidence was available to determine whether reducing the levels of cockroach allergen in home environments reduces asthma-related morbidity in persons allergic to cockroaches. We found not only a reduction in the levels of cockroach allergen in the bedroom, but also a significant correlation between a reduction in cockroach allergen and a decrease in asthma-related morbidity. Reductions in the levels of dust-mite allergens in the children's bedrooms were also correlated with reductions in the symptoms of asthma and health care use. Inspection and interview data obtained during the home evaluations did not reveal significant differences in the observable home environment between the groups over the course of the study. Nonetheless, the greater reductions in the levels of cockroach and dust-mite allergen in the bedroom in the intervention group than in the control group indicate an improvement in the bedroom environment resulting from the intervention's focus on the child's sleeping area, including the use of mattress and pillow covers and a HEPA vacuum cleaner.

Owing to the lack of data on allergen levels in other rooms, the relative effects of cockroach extermination and bedroom cleaning cannot be determined. Furthermore, most homes received a HEPA air filter, and a recent meta-analysis has suggested that air filtration is associated with an improvement in asthma-related symptoms. No direct measures of the child's exposure to environmental tobacco smoke were made, so the effect of changes in allergen exposure cannot be separated from the potential benefits of reduced levels of exposure to environmental tobacco smoke. One limitation of our study is that there were no sham intervention visits for the control group, and thus, although both groups received the same number of telephone interviews, intervention homes were visited more frequently. This frequency of contact could have contributed to the reduction in asthma-related symptoms by increasing caretakers' attention to asthma care or by decreasing their willingness to report symptoms.

However, the intervention teams were not clinically trained and were prohibited from discussing the medical management of asthma with the families. Furthermore, reductions in key allergen levels in the bedroom were significantly correlated with the improvement in symptoms in the intervention group. This dose–response relationship suggests that environmental change was central to the improvement in the asthma-related outcomes.

We estimate the cost of the intervention to be in the range of $1,500 to $2,000 per child, or approximately $750 to $1,000 for each year of the study. These costs include personnel and equipment. This is similar to the Drug Topics Red Book cost of mid-range inhaled corticosteroid and albuterol for a child with moderately severe asthma.

The benefit of the intervention was apparent during both the treatment year and the year thereafter. If the duration of benefit is assumed to be even longer, the cost per year of benefit would be even lower.

The intervention resulted in 2.1 (13.6 percent) fewer unscheduled visits per year, 21.3 (19.5 percent) fewer days with symptoms per year, and 4.4 (20.7 percent) fewer missed school days per year. Although the direct health care savings from the intervention may not offset its cost, the overall improvements in terms of societal benefits and the quality of life of children with asthma and their families need to be considered in evaluating the intervention. Atopic children with asthma who live in the inner city have numerous adverse indoor environmental exposures.

We have shown that remediation strategies can be implemented that result in both sustained reductions in indoor allergen levels and sustained improvements in reported asthma-associated morbidity in this high-risk population. Although it is difficult to generalize our results to all children with asthma, it seems likely that children who are exposed to environmental allergens and irritants similar to those present in the homes of our inner-city study participants may derive a similar benefit from this intervention. Supported by grants (AI-39769, AI-39900, AI-39902, AI-39789, AI-39901, AI-39761, AI-39785, and AI-39776) from the National Institute of Allergy and Infectious Diseases and the National Institute of Environmental Health Sciences, National Institutes of Health, and by a grant (M01 RR00533) from the National Center for Research Resources, National Institutes of Health. Morgan reports having received consulting fees and grant support from Genentech and lecture fees from GlaxoSmithKline, AstraZeneca, and Merck; Dr. Gruchalla reports having served as a paid consultant to GlaxoSmithKline and having received grant support from Exxon Mobil; Dr. O'Connor reports having chaired a data and safety monitoring board for GlaxoSmithKline; Dr.

Kattan reports having received consulting and lecture fees from AstraZeneca; Dr. Evans reports having served as a consultant to Schering-Plough and AstraZeneca; and Dr. Stout reports having lectured at an event sponsored by Schering-Plough and having received unrestricted grant support from GlaxoSmithKline. Source Information From the University of Arizona College of Medicine, Tucson (W.J.M.); the Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, N.Y.

(E.F.C.); the University of Texas Southwestern Medical Center at Dallas, Dallas (R.S.G.); Boston University School of Medicine, Boston (G.T.O.); Mount Sinai School of Medicine, New York (M.K.); Children's Memorial Hospital, Chicago (R.E.); the University of Washington School of Medicine and Public Health, Seattle (J.S.); the National Institute of Environmental Health Sciences, Research Triangle Park, N.C. (G.M.); the National Institute of Allergy and Infectious Diseases, Bethesda, Md. (E.S., M.P.); and Rho, Chapel Hill, N.C. (M.W., B.V., H.M.). Address reprint requests to Dr. Morgan at the Arizona Respiratory Center, University of Arizona, 1501 N.

Campbell Ave., Tucson, AZ 85724. Appendix The Inner-City Asthma Study was a collaboration of the following institutions and investigators (principal investigators are indicated by asterisks): Boston University School of Medicine, Boston — G.

O'Connor,* S. Steinbach, A. Casagrande; L. Schneider (Children's Hospital, Boston); Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, N.Y. Rosenstreich; Children's Memorial Hospital, Chicago — R. Evans III,* J.

Pongracic, A. Koridek; University of Texas Southwestern Medical Center at Dallas — R.S. Gruchalla,* V. Gorham; Mount Sinai School of Medicine, New York — M. Xanthos; University of Washington School of Medicine and Public Health, Seattle — J.

Powell; University of Arizona College of Medicine, Tucson — W. Garcia; El Rio Health Center, Tucson — A. Martinez; Data Coordinating Center, Rho, Chapel Hill, N.C. Mitchell,* M.

Nuebler; the Department of Environmental Health Laboratory, Harvard School of Public Health, Boston — H. Muilenberg, D. Gold; the Johns Hopkins Dermatology, Allergy, and Clinical Immunology Reference Laboratory, Johns Hopkins University School of Medicine, Baltimore — R. Hamilton; National Institute of Allergy and Infectious Diseases, Bethesda, Md. Adams; National Institute of Environmental Health Sciences, Research Triangle Park, N.C. Malindzak, P.

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• • • includes an analysis of human psychology,,, and along with practices. A unique feature of Buddhist psychology is that it is embedded within the greater and, and its psychological terminology is colored by ethical overtones. Buddhist psychology has two therapeutic goals: the healthy and virtuous life of a ( samacariya, 'harmonious living') and the ultimate goal of, the total cessation of dissatisfaction and suffering (). And the modern discipline of have multiple parallels and points of overlap. This includes a descriptive of mental states, emotions and behaviors, as well as theories of and mental factors. Psychotherapists such as have found in Buddhist experiences (e.g.

) the potential for transformation, healing and finding existential meaning. Some contemporary mental-health practitioners such as increasingly find ancient Buddhist practices (such as the development of ) of empirically proven therapeutic value, while Buddhist teachers such as see Western Psychology as providing complementary practices for Buddhists. Main article: According to Padmal de Silva 'Buddhist strategies represent a therapeutic model which treats the person as his/her agent of change, rather than as the recipient of externally imposed interventions.'

Silva argues that the Buddha saw each person responsible for their own personal development and considers this as being similar to the approach to psychology. Humanistic psychotherapy places much emphasis on helping the client achieve self-actualization and personal growth (e.g. Since Buddhist practice also encompasses practical wisdom, spiritual virtues and morality, it cannot be said to be just another form of psychotherapy.

It is more accurate to see it as a way of life or a way of being (). In Buddhism is based upon the noble which integrates, wisdom or understanding () and psychological practices such as (, cultivation, development). In traditional Buddhism is based on the ideas of and.

The highest state a human can achieve (an or a Buddha) is seen as being completely free from any kind of dissatisfaction or suffering, all negative mental tendencies, roots and influxes have been eliminated and there are only positive emotions like and present. Buddhist meditation of two main types, is meant to calm and relax the mind, as well as develop focus and concentration by training on a single object. Is a means to gain insight or understanding into the nature of the mental processes and their through the application of continuous and stable and comprehension ().

Though the ultimate goal of these practices are, the Buddha stated that they also bring mundane benefits such as relaxation, good sleep and pain reduction. Buddhist texts also contain mental strategies of thought modification which are similar to techniques. A comparison of these systems of cognitive behavioral modification has been discussed by professor William Mikulas and Padmal de Silva. Main article: The third part (or pitaka, literally 'basket') of the Tripitaka is known as the (Pali; Skt. The Abhidhamma works are historically later than the two other collections of the Tipitaka (3rd century BCE and later) and focus on. The Buddhist Abhidhamma works analyze the mind into elementary factors of experience called dharmas (Pali: dhammas).

Dhammas are phenomenal factors or 'psycho-physical events' whose interrelations and connections make up all streams of human experience. There are four categories of dharmas in the Theravada Abhidhamma: ( awareness), ( mental factors), ( physical occurrences, material form) and ( cessation). Abhidhamma texts are then an attempt to list all possible factors of experience and all possible relationships between them.

Among the achievements of the Abhidhamma psychologists was the outlining of a theory of, a theory of, and a. Ven., president of the, has synopsized the Abhidhamma as follows: 'The system that the Abhidhamma Pitaka articulates is simultaneously a philosophy, a psychology, and an ethics, all integrated into the framework of a program for liberation. The Abhidhamma's attempt to comprehend the nature of reality, contrary to that of classical science in the West, does not proceed from the standpoint of a neutral observer looking outwards towards the external world. The primary concern of the Abhidhamma is to understand the nature of experience, and thus the reality on which it focuses is conscious reality. For this reason the philosophical enterprise of the Abhidhamma shades off into a phenomenological psychology.

To facilitate the understanding of experienced reality, the Abhidhamma embarks upon an elaborate analysis of the mind as it presents itself to introspective meditation. It classifies consciousness into a variety of types, specifies the factors and functions of each type, correlates them with their objects and physiological bases, and shows how the different types of consciousness link up with each other and with material phenomena to constitute the ongoing process of experience.'

Buddhism and Psychology [ ] Buddhism and psychology overlap in theory and in practice. Since the beginning of the 20th century, four strands of interplay have evolved: • descriptive phenomenology: scholars have found in Buddhist teachings a detailed introspective psychology (particularly in the which outlines various traits, emotions and ). • psychotherapeutic meaning: psychotherapists have found in Buddhism's approach and experiences (such as in Zen ) the potential for transformation, healing and finding existential meaning. This connection was explained by a modification of introducing the process of initiation. • clinical utility: some contemporary mental-health practitioners increasingly find ancient Buddhist practices (such as the development of ) of empirically proven therapeutic value. • popular psychology and spirituality: psychology has been popularized, and has become blended with in some forms of. Buddhist notions form an important ingredient of this modern mix.

Psychology [ ]. Was one of the first modern Psychologist to conceptualize canonical Buddhist writings in terms of psychology. The contact between Buddhism and Psychology began with the work of the scholars, whose main work was translating the Buddhist. In 1900, Indologist published through the a translation of the 's first book, the, and entitled the translation, 'Buddhist Manual of Psychological Ethics'. In the introduction to this seminal work, Rhys Davids praised the sophistication of the Buddhist psychological system based on 'a complex continuum of subjective phenomena' ( dhammas) and the relationships and laws of causation that bound them (Rhys Davids, 1900, pp.

Buddhism's psychological orientation is a theme Rhys Davids pursued for decades as evidenced by her further publications, Buddhist Psychology: An Inquiry into the Analysis and Theory of Mind in Pali Literature (1914) and The Birth of Indian Psychology and its Development in Buddhism (1936). An important event in the interchange of East and West occurred when American psychologist invited the Sri Lankan Buddhist to lecture in his classes at in December 1903.

After Dharmapala lectured on Buddhism, James remarked, “This is the psychology everybody will be studying 25 years from now.” Later scholars such as (The principles of Buddhist psychology, 1987), Padmal de Silva (Buddhism and behaviour modification, 1984), Edwina Pio (Buddhist Psychology: A Modern Perspective, 1988) and (Zen and the Psychology of Transformation, 1990) wrote about and compared Buddhism and Psychology directly. Writers in the field of (which deals with, and similar topics) such as also integrated Buddhist thought and practice into their work. The 1960s and '70s saw the, especially in the United States. In the 1970s, psychotherapeutic techniques using “mindfulness” were developed such as therapy by (1934–2011), possibly the first mindfulness based therapy. 's Mindfulness-Based Stress Reduction (MBSR) was a very influential development, introducing the term into Western Cognitive behavioral therapy practice. Kabat-Zinn's students Zindel V.

Williams and John D. Teasdale later developed (MBCT) in 1987. Research by Sarah Lazar et al (2005) found brain areas that are thicker in practitioners of Insight meditation than control subjects who do not meditate. More recent work has focused on clinical research of particular practices derived from Buddhism such as mindfulness meditation and compassion development (ex. The work of, ) and on psycho-therapeutic practices which integrate meditative practices derived from Buddhism. From the perspective of Buddhism, various modern Buddhist teachers such as and have academic degrees in.

Applying the tools of modern (EEG, fMRI) to study is also an area of integration. One of the first figures in this area was neurologist, who wrote (1998). Others who have studied and written about this type of research include,, Rick Hanson (Buddha's Brain, 2009) and Zoran Josipovic. A recent review of the literature on the concludes that the practice 'exerts beneficial effects on physical and mental health, and cognitive performance' but that 'the underlying neural mechanisms remain unclear.' Japanese Psychology [ ].

Shoma Morita (1874-1938) In, a different strand of comparative thought developed, beginning with the publication, 'Psychology of Zen Sect' (1893) and 'Buddhist psychology' (1897), by (1858–1919). In 1920, Tomosada Iritani (1887–1957) administered a questionnaire to 43 persons dealing with Zen practice, in what was probably the first empirical psychological study of Zen. In the field of psychotherapy, was developed by (1874-1938) who was influenced. Koji Sato (1905–1971) began the publication of the journal, Psychologia: An International Journal of Psychology in the Orient in 1957 with the aim of providing a comparative psychological dialogue between East and West (with contributions from Bruner, Fromm, and Jung). In the 1960s, Kasamatsu and Hirai used to monitor the brains of Zen meditators. This led to the promotion of various studies covering psychiatry, physiology, and psychology of Zen by the which were carried out in various laboratories. Another important researcher in this field, Prof.

Yoshiharu Akishige, promoted Zen Psychology, the idea that the insights of Zen should not just be studied but that they should inform psychological practice. Research in this field continues with the work of Japanese psychologists such as Akira Onda and Osamu Ando. In Japan, a popular psychotherapy based on Buddhism is therapy, developed from Buddhist introspection by Ishin Yoshimoto (1916–1988). Naikan therapy is used in correctional institutions, education, to treat alcohol dependence as well as by individuals seeking self development. Buddhism and Psychoanalysis [ ] Buddhism has some views which are comparable to. These include a view of the and unconscious thought processes, the view that unwholesome unconscious forces cause much of human suffering and the idea that one may gain insight into these thought processes through various practices, including what Freud called 'evenly suspended attention.'

A variety of teachers, clinicians and writers such as,,,,, and have attempted to bridge and integrate psycho-analysis and Buddhism. British barrister has referred to mid-twentieth century collaborations between psychoanalysts and Buddhist scholars as a meeting between: 'Two of the most powerful forces operating in the Western mind today.' Suzuki's influence [ ]. (1870-1966) was instrumental in spreading to the World. One of the most important influences on the spread of Buddhism in the west was scholar. He collaborated with psycho-analysts, and. Wrote the foreword to Suzuki's Introduction to Zen Buddhism, first published together in 1948.

In his foreword, Jung highlights the enlightenment experience of as the 'unsurpassed transformation to wholeness' for Zen practitioners. And while acknowledging the inadequacy of Psychologist attempts to comprehend through the lens of intellectualism, Jung nonetheless contends that due to their shared goal of self transformation: 'The only movement within our culture which partly has, and partly should have, some understanding of these aspirations [for such enlightenment] is psychotherapy.' Referencing Jung and Suzuki's collaboration as well as the efforts of others, and noted that: 'There is an unmistakable and increasing interest in Zen Buddhism among psychoanalysts'. One influential psychoanalyst who explored Zen was, who traveled to Japan in 1952 to meet with Suzuki and who advised her colleagues to listen to their clients with a 'Zen-like concentration and non attachment'. Suzuki, Fromm and other psychoanalysts collaborated at a 1957 workshop on 'Zen Buddhism and Psychoanalysis' in Cuernavaca, Mexico. Fromm contends that, at the turn of the twentieth century, most psychotherapeutic patients sought treatment due to medical-like symptoms that hindered their social functioning.

However, by mid-century, the majority of psychoanalytic patients lacked overt symptoms and functioned well but instead suffered from an 'inner deadness' and an 'alienation from oneself'. Paraphrasing Suzuki broadly, Fromm continues: Zen is the art of seeing into the nature of one's being; it is a way from bondage to freedom; it liberates our natural energies.

And it impels us to express our faculty for happiness and love. [.] [W]hat can be said with more certainty is that the knowledge of Zen, and a concern with it, can have a most fertile and clarifying influence on the theory and technique of psychoanalysis. Zen, different as it is in its method from psychoanalysis, can sharpen the focus, throw new light on the nature of insight, and heighten the sense of what it is to see, what it is to be creative, what it is to overcome the affective contaminations and false intellectualizations which are the necessary results of experience based on the subject-object split' Buddhist psychoanalytic dialogue and integration [ ] The dialogue between Buddhism and psychoanalysis has continued with the work of psychiatrists such as,, Jack Engler, Axel Hoffer, Jeremy D.

Safran, David Brazier, and Jeffrey B. (1927-1997) was the Director of the London Clinic of Psychoanalysis, a and a. She theorized that there are distinct similarities in the transformation of the self that occurs in both and. She believed that the practice of Buddhism and Psychoanalysis where 'mutually reinforcing and clarifying' (Coltart, The practice of psychoanalysis and Buddhism).

Is an American psychiatrist who practiced Buddhism in Thailand under and has since written several books on psychoanalysis and Buddhism ( Thoughts Without a Thinker 1995, Psychotherapy Without the Self, 2008). Epstein relates the Buddhist Four Noble Truths to primary as described by in his theory on the. The first truth highlights the inevitability of humiliation in our lives of our narcissistic self-esteem. The second truth speaks of the primal thirst that makes such humiliation inevitable. The third truth promises release by developing a realistic self-image, and the fourth truth spells out the means of accomplishing that. Rubin has also written on the integration of these two practices in Psychotherapy and Buddhism, Toward an Integration (1996).

In this text, he criticizes the Buddhist idea of enlightenment as a total purification of mind: 'From the psychoanalytic perspective, a static, conflict-free sphere-a psychological 'safehouse' -beyond the vicissitudes of conflict and conditioning where mind is immune to various aspects of affective life such as self-interest, egocentricity, fear, lust, greed, and suffering is quixotic. Since conflict and suffering seem to be inevitable aspects of human life, the ideal of Enlightenment may be asymptotic, that is, an unreachable ideal.' He points to as examples. Rubin also outlines a case study of the psychoanalytic treatment of a Buddhist meditator and notes that meditation has been largely ignored and devalued by psychoanalysts.

He argues that Buddhist meditation can provide an important contribution to the practice of psychoanalytic listening by improving an analyst's capacity for attention and recommends meditation for psychoanalysts. Axel Hoffer has contributed to this area as editor of 'Freud and the Buddha', which collects several essays by psychoanalysts and a Buddhist scholar, Andrew Olendzki. Olendzki outlines an important problematic between the two systems, the Freudian practice of, which from the Buddhist perspective is based on: “The reflexive tendency of the mind to incessantly make a narrative of everything that arises in experience is itself the cause of much of our suffering, and meditation offers a refreshing refuge from mapping every datum of sensory input to the macro-construction of a meaningful self.” Olendzki also argues that for the Buddhist, the psychoanalytic focus on linguistic narrativity distracts us from immediate experience. David Brazier [ ].

See also: David Brazier is a psychotherapist who combines psychotherapy and Buddhism (Zen therapy, 1995). Brazier points to various possible translations of the Pali terms of the, which give a new insight into these truths.

The traditional translations of samudhaya and nirodha are 'origin' and 'cessation'. Coupled with the translation of dukkha as 'suffering', this gives rise to a causal explanation of suffering, and the impression that suffering can be totally terminated.

The translation given by gives a different interpretation to the Four Noble Truths. • Dukkha: existence is imperfect, it's like a wheel that's not straight into the axis; • Samudhaya: simultaneously with the experience of dukkha there arises, thirst: the dissatisfaction with what is and the yearning that life should be different from what it is. We keep imprisoned in this yearning when we don't see reality as it is, namely imperfect and ever-changing; • Nirodha: we can confine this yearning (that reality is different from what it is), and perceive reality as it is, whereby our suffering from the imperfectness becomes confined; • Marga: this confinement is possible by following the. In this translation, samudhaya means that the uneasiness that's inherent to life the craving that life's event would be different. The translation of nirodha as confinement means that this craving is a natural reaction, which cannot be totally escaped or ceased, but can be limited, which gives us freedom.

Gestalt therapy [ ], an approach created by, was based on phenomenology, existentialism and also and Taoism. Perls spent some time in Japanese Zen monasteries and his therapeutic techniques include mindfulness practices and focusing on the present moment. Practices outlined by Perls himself in Ego, hunger and aggression (1969), such as “concentration on eating” (“we have to be fully aware of the fact that we are eating”) and “awareness continuum” are strikingly similar to Buddhist mindfulness training. Other authors in Gestalt Therapy who were influenced by Buddhism are and (who developed by including ).

According to Crocker, an important Buddhist element of Gestalt is that a “person is simply allowing what-is in the present moment to reveal itself to him and out of that receptivity is responding with ‘’”. More recently, has written about the practice of Gestalt and Tibetan Buddhism. Existential and Humanistic psychology [ ] Both and models of human psychology stress the importance of personal responsibility and freedom of choice, ideas which are central to and psychology. Humanistic psychology's focus on developing the ‘fully functioning person’ (Carl Rogers) and (Maslow) is similar to the Buddhist attitude of self development as an ultimate human end. The idea of can also be compared to the Buddhist view that the individual is ultimately responsible for their own development, that a Buddhist teacher is just a guide and that the patient can be “a light unto themselves”. 's idea of 'unconditional positive regard' and his stress on the importance of has been compared to Buddhist conceptions of compassion ().

Meditation has been seen as a way to aid the practice of person centered psychotherapy. Person centered therapist Manu Buzzano has written that 'It seemed clear that regular meditation practice did help me in offering congruence, empathy and unconditional positive regard.' He subsequently interviewed other person centered therapists who practiced meditation and found that it enhanced their empathy, nonjudgmental openess and quality of the relationship with their clients. A comparison has also been made between 's and ideals of, both in theory and in manifesting Buddhist ideals in practice. Padmasiri de Silva sees the focus of existential psychology on the 'tragic sense of life' just a different expression of the Buddhist concept of. The existential concept of anxiety or angst as a response to the human condition also resonates with the Buddhist analysis of fear and despair.

The Buddhist monk in the preface to his 'Notes on Dhamma' wrote that the work of the existential philosophers offered a way to approach the Buddhist texts, as they ask the type of questions about feelings of anxiety and the nature of existence with which the Buddha begins his analysis. Nanavira also states that those who have understood the Buddha's message have gone beyond the existentialists and no longer see their questions as valid. Likewise sees the parallel between the Buddhists and Existentialists only preliminary: 'In terms of the Four Truths, the existentialists have only the first, which teaches that everything is ill. Of the second, which assigns the origin of ill to craving, they have only a very imperfect grasp. As for the third and fourth, they are quite unheard of.Knowing no way out, they are manufacturers of their own woes.' Positive Psychology [ ] The growing field of shares with Buddhism a focus on developing a positive emotions and personal with the goal of improving human.

Positive psychology also describes the futility of the ', the chasing of ephemeral pleasures and gains in search of lasting happiness. Buddhism holds that this very same striving is at the very root of human unhappiness. The Buddhist concept and practice of mindfulness meditation has been adopted by psychologists such as Rick Hanson ( Buddha's brain, 2009), T.B.

Ciarrochi ( Mindfulness, acceptance, and positive psychology, 2013) and Itai Ivtzan ( Mindfulness in Positive Psychology, 2016). Brown and Richard M. Ryan of the have developed a 15-item 'Mindful attention awareness scale' to measure dispositional mindfulness. The concept of studied by has been compared to Buddhist meditative states such as and mindfulness. Ronald Siegel describes flow as “mindfulness while accomplishing something.” Nobo Komagata and Sachiko Komagata, however, are critical of characterizing the notion of “flow” as a special case of mindfulness, noting that the connection is more complicated. Zen Buddhism has a concept called (無心, no mind) which is also similar to flow.

Christopher K. Germer, clinical instructor in psychology at and a founding member of the Institute for Meditation and Psychotherapy, has stated: 'Positive psychology, which focuses on human flourishing rather than mental illness, is also learning a lot from Buddhism, particularly how mindfulness and compassion can enhance wellbeing.

This has been the domain of Buddhism for the past two millennia and we’re just adding a scientific perspective.' And Buddhist monk have pointed out that the framework of Positive psychology is ethically neutral, and hence within that framework, you could argue that 'a serial killer leads a pleasant life, a skilled Mafia hit man leads a good life, and a fanatical terrorist leads a meaningful life.'

Thanissaro argues that Positive psychology should also look into the ethical dimensions of the good life. Regarding the example of flow states he writes: 'A common assumption is that what you do to induce a sense of flow is purely a personal issue, and ultimately what you do doesn’t really matter. What matters is the fact of psychological flow. You’re most likely to experience flow wherever you have the skill, and you're most likely to develop skill wherever you have the aptitude, whether it’s in music, sport, hunting, meditating, etc. From the Buddha’s point of view, however, it really does matter what you do to gain gratification, for some skills are more conducive to stable, long-term happiness than others, due to their long-term consequences' The skills that Thanissaro argues are more conductive to happiness include Buddhist virtues like harmlessness, generosity, moral restraint, and the development of good will as well as mindfulness, concentration, discernment. Naropa University [ ].

'Buddhism will come to the West as a psychology.' - Chogyam Trungpa, 1974 In his introduction to his 1975 book, Glimpses of the Abhidharma, Rinpoche wrote: Many modern psychologists have found that the discoveries and explanations of the coincide with their own recent discoveries and new ideas; as though the Abhidharma, which was taught 2,500 years ago, had been redeveloped in the modern idiom.'

Trungpa Rinpoche's book goes on to describe the nanosecond phenomenological sequence by which a sensation becomes conscious using the Buddhist concepts of the '.' In 1974, Trungpa Rinpoche founded the Naropa Institute, now called. Since 1975, this accredited university has offered degrees in 'contemplative psychology.' Mind and life institute [ ]. With the, and Richard Davidson at XXVI conference. Every two years, since 1987, the has convened gatherings of Buddhists and scientists. Reflecting on one Mind and Life session in March 2000, psychologist notes: Since the time of in the fifth century BC, an analysis of the mind and its workings has been central to the practices of his followers.

This analysis was codified during the first millennium after his death within the system called, in the Pali language of Buddha's day, (or Abhidharma in Sanskrit), which means 'ultimate doctrine'. Every branch of Buddhism today has a version of these basic psychological teachings on the mind, as well as its own refinements' Buddhist techniques in clinical settings [ ] For over a millennium, throughout the world, Buddhist practices have been used for non-Buddhist ends. More recently, clinical psychologists, theorists and researchers have incorporated Buddhist practices in widespread formalized psychotherapies.

Buddhist practices have been explicitly incorporated into a variety of psychological treatments. More tangentially, psychotherapies dealing with share core principles with ancient Buddhist antidotes to personal suffering.

Mindfulness practices [ ] Fromm distinguishes between two types of meditative techniques that have been used in psychotherapy: • used to induce relaxation; • meditation 'to achieve a higher degree of non-attachment, of non-greed, and of non-illusion; briefly, those that serve to reach a higher level of being' (p. 50). Fromm attributes techniques associated with the latter to Buddhist mindfulness practices.

Two increasingly popular therapeutic practices using Buddhist mindfulness techniques are 's (MBSR) and 's (DBT). Other prominent therapies that use mindfulness include ' (ACT), founded in 1978 by the British psychiatrist and Zen Buddhist and, based on MBSR, (MBCT) (Segal et al., 2002). Clinical researchers have found Buddhist mindfulness practices to help alleviate anxiety, depression and certain personality disorders. Mindfulness Based Stress Reduction (MBSR) [ ] Kabat-Zinn developed the eight-week program over a ten-year period with over four thousand patients at the University of Massachusetts Medical Center. Describing the MBSR program, Kabat-Zinn writes: This 'work' involves above all the regular, disciplined practice of moment-to-moment awareness or mindfulness, the complete 'owning' of each moment of your experience, good, bad, or ugly. This is the essence of full catastrophe living. Kabat-Zinn, a one-time practitioner, Although at this time mindfulness meditation is most commonly taught and practiced within the context of Buddhism, its essence is universal.

Yet it is no accident that mindfulness comes out of Buddhism, which has as its overriding concerns the relief of suffering and the dispelling of illusions. In terms of clinical diagnoses, MBSR has proven beneficial for people with depression and anxiety disorders; however, the program is meant to serve anyone experiencing significant stress. It would be based on relatively intensive training in Buddhist meditation without the Buddhism (as I liked to put it), and yoga. Dialectical Behavioral Therapy (DBT) [ ] In writing about DBT, Zen practitioner Linehan states: As its name suggests, its overriding characteristic is an emphasis on 'dialectics' – that is, the reconciliation of opposites in a continual process of synthesis. This emphasis on acceptance as a balance to change flows directly from the integration of a perspective drawn from Eastern (Zen) practice with Western psychological practice.' Similarly, Linehan writes: Mindfulness skills are central to DBT. They are the first skills taught and are [reviewed].

The skills are psychological and behavioral versions of meditation practices from Eastern spiritual training. I have drawn most heavily from the practice of Zen Controlled clinical studies have demonstrated DBT's effectiveness for people with. Acceptance and Commitment Therapy (ACT) [ ] did not explicitly emerge from Buddhism, but its concepts often parallel ideas from Buddhist and mystical traditions.

ACT has been defined by its originators as a method that 'uses acceptance and mindfulness processes, and commitment and behavioral activation processes to produce psychological flexibility.' • Buddhist doctrine was first articulated by (traditionally ca. 563 BCE to ca. 483 BCE; historically probably ca. 480 BCE to ca. Bechert, 2004]). The establishment of a self-conscious field of psychology as the empirical assessment of human mental activities and behavior is often identified with the work of (August 16, 1832 – August 31, 1920).

• The notion that consciousness is a sequence of states, like cells in a film strip, while not explicitly contrary to notions of consciousness found in the, is found explicitly in the Pali (see Bodhi, 2000, p. • Fromm et al., (1960), back cover. Explicitly, in regards to the book associated with the 1957 Cuernavaca, Mexico conference mentioned below, Humphries wrote: 'This is the first major attempt to bring together two of the most powerful forces operating in the Western mind today.' • Both Fromm (1960) and Ellis (1962) cite this text as influential. • In particular, Jung quotes 's stating, 'Zen is neither psychology nor philosophy' (Suzuki & Jung, 1948, p. • To support this statement, Fromm (1960, p. 1) refers to Jung's foreword to Suzuki (1949), Benoit (1955), and Sato (1958).

78) also refers to who 'was intensely interested in Zen Buddhism during the last years of her life.' • Fromm et al. Selected presentations from this conference are included in Fromm et al. Fromm's interest in Buddhism extended to multiple as evidenced by his writing the foreword for Nyanaponika et al.

• Cited in Goleman, 2004, p. Goleman, who was teaching psychology at Harvard University at the time, goes on to write: 'The very idea that Buddhism had anything to do with psychology was at the time for most of us in the field patently absurd. But that attitude reflected more our own naivete than anything to do with Buddhism. It was news that Buddhism — like many of the world's great spiritual traditions — harbored a theory of mind and its workings' (p. • Naropa University has also been a training ground and meeting place for many of today's most prolific popularizers of a Buddhism-informed psychology such as and a psychologically savvy Buddhism such as • Books that have documented these meetings include Begley (2007), Davidson & Harrington (2002), Goleman (1997), Goleman (2004), Harrington & Zajonc (2006), Haywood & Varela (2001), Houshmand et al.

(1999), Varela (1997), and Zajonc & Houshmand (2004). • For instance, ninth-century Chinese Patriarch referred to non-Buddhist uses of Buddhist meditation practices as bonpu meditation. For more information, see • For an authoritative source regarding Buddhist mindfulness meditation, Fromm (2002) references Nyanaponika (1996). Fromm (2002, pp. 52-53) goes on to write: [T]here are two core doctrines acceptable to many who, like myself, are not Buddhists, yet are deeply impressed by the core of Buddhist teaching. I refer first of all to the doctrine that the goal of life is to overcome greed, hate, and ignorance. In this respect Buddhism does not basically differ from Jewish and Christian ethical norms.

More important, and different from the Jewish and Christian tradition, is another element of Buddhist thinking: the demand for optimal awareness of the processes inside and outside oneself. For an overview of Buddhist mindfulness practices, see and. • In Kabat-Zinn (2005, p. 26), for instance, he writes: Because I practice and teach mindfulness, I have the recurring experience that people frequently make the assumption that I am a Buddhist. When asked, I usually respond that I am not a Buddhist (although there was a period in my life when I did think of myself in that way, and trained and continue to train in and have huge respect and love for different Buddhist traditions and practices), but I am a student of Buddhist meditation, and a devoted one, not because I am devoted to Buddhism per se, but because I have found its teachings and its practices to be so profound and so universally applicable, revealing and healing.' He goes on to write: • According to Kabat-Zinn (2005, p. 431): 'Marsha [Linehan] herself is a long-time practitioner of Zen, and DBT incorporates the spirit and principles of mindfulness and whatever degree of formal practice is possible.'

• The parenthetical '(Zen)' is included in Linehan's actual text. • Regarding DBT's empirical effectiveness, Linehan (1993b, p. 1) cites Linehan et al. (1991), Linehan & Heard (1993), and Linehan et al.

Clinical experience has shown DBT to be effective for people with borderline personality disorder as well as other Axis II. • Elsewhere in Ellis (1991, pp. Piya Dekho Na Kaavish Mp3 Download.

336-37), in response to concerns voiced by Watts (1960) regarding overly rationalistic psychotherapy, Dr. Ellis expresses a caveat specifically regarding Zen-like spiritual pursuits. Ellis notes that 'perhaps the main goal' of a patient of rational-emotive therapy 'is that of commitment, risk-taking, joy of being; and sensory experiencing, as long as it does not merely consist of short-range self-defeating hedonism of a childish variety.' Ellis then adds: Even some of the Zen Buddhist strivings after extreme sensation, or, would not be thoroughly incompatible with some of the goals a devotee of rational-emotive living might seek for himself — as long as he did not seek this mode of sensing as an escape from facing some of his fundamental anxieties or hostilities • In the example cited from Ellis (1997), a person attempts to replace their hostile feelings with pleasant feelings associated with the same individual. In general, with Buddhist metta practice, one elicits feelings of loving kindness by contemplating on a benefactor and one then uses these self-elicited warm feelings to then permeate the experiencing of a perceived 'enemy.'

Moreover, Buddhist metta practice directs loving kindness towards all beings, near or far, kind or brutal, human or non-human. References [ ].