Healthcare in Pali Buddhism

This article addresses an apparent paradox found in Pali Buddhist literature: while the "uncompounded" (asaṅkhata) is valued over and above what is "compounded" (saṅkhata), the texts also encourage careful attention to relative (or, physical) health. The mind is the laboratory and the object of a thorough work meant to lead to final liberation from mental affliction and from the cycle of existence, whereas the body is perceived as impure, limited, and intrinsically unsatisfactory. Nonetheless, a disciple of the Buddha is supposed to take care of his/her own and others' physical wellbeing, and monastic equipment includes a set of medicines. "Ultimate health" is the final goal, but conventional healthcare supports the path to nibbāna and represents a value per se. The present article will explore the intricate connection between these two dimensions.

Ethnic disparity in breast cancer survival in southern Thai women

BACKGROUND

Breast cancer has the highest incidence in women of all cancers and its burden is expected to continue to increase worldwide, especially in middle-income countries such as Thailand. The southern region of Thailand is unique in that it is comprised of 30% Muslims, whereas the rest of Thailand is 95% Buddhist. Breast cancer incidence and survival differ between these religious groups, but the association between clinical subtype of breast cancer and survival has not yet been assessed.

METHODS

Here we characterized differences in breast cancer survival with consideration to clinical subtype by religious group (Muslim Thai and Buddhist Thai women). We compared distributions of age, stage and clinical subtype and assessed overall survival by religion.

RESULTS

Our findings show that Muslim Thai women with breast cancer are diagnosed at a younger age, at later stages and have shorter overall survival times compared to Buddhist Thai women with breast cancer. We also observe a higher proportion of triple negative tumors characterized in Muslim Thai women.

CONCLUSIONS

Our findings confirm previous studies that have shown lower survival rates in Muslim Thai women compared to Buddhist women with breast cancer and offer novel information on subtype distribution. To date, this is the first study assessing clinical subtypes in southern Thailand by religious status.

IMPACT

Our findings are critical in providing information on the role of clinical subtype in cancer disparities and provide evidence from the Southeast Asian region for global studies on breast cancer survival.

Karma or Immortality: Can Religion Influence Space-Time Mappings?

People implicitly associate the "past" and "future" with "front" and "back" in their minds according to their cultural attitudes toward time. As the temporal focus hypothesis (TFH) proposes, future-oriented people tend to think about time according to the future-in-front mapping, whereas past-oriented people tend to think about time according to the past-in-front mapping (de la Fuente, Santiago, Román, Dumitrache, & Casasanto, 2014). Whereas previous studies have demonstrated that culture exerts an important influence on people's implicit spatializations of time, we focus specifically on religion, a prominent layer of culture, as potential additional influence on space-time mappings. In Experiment 1 and 2, we observed a difference between the two religious groups, with Buddhists being more past-focused and more frequently conceptualizing the past as ahead of them and the future as behind them, and Taoists more future-focused and exhibiting the opposite space-time mapping. In Experiment 3, we administered a religion prime, in which Buddhists were randomly assigned to visualize the picture of the Buddhas of the Past (Buddha Dipamkara) or the Future (Buddha Maitreya). Results showed that the pictorial icon of Dipamkara increased participants' tendency to conceptualize the past as in front of them. In contrast, the pictorial icon of Maitreya caused a dramatic increase in the rate of future-in-front responses. In Experiment 4, the causal effect of religion on implicit space-time mappings was replicated in atheists. Taken together, these findings provide converging evidence for the hypothesized causal role of religion for temporal focus in determining space-time mappings.

The Impact of Self-directed Voice of Love Messages on Anger: A Pilot Study

Context • Buddhist texts direct practitioners to generate a feeling of love to stop the affliction of anger. Modern self-help practices and clinical psychology have demonstrated that generating emotions of love can reduce anger. More studies are needed, however, to identify the active components of interventions and their applicability in clinical populations. Objective • The study investigated the hypothesis that enhancing self-love through frequent listening to recorded self-loving messages can reduce anger. Design • The pilot study was designed to measure changes in anger level between baseline and postintervention in the course of 12 wk. Setting • The study occurred at Moa Oasis, Israel. Participants • Participants were adults enrolled in a program of study on advanced Tibetan Buddhism. Intervention • Participants were directed to record statements expressing love and appreciation of themselves in their own voices, inserting their names as the recipients of the messages. Participants listened to their recording for 2 min every morning, for 12 wk. Outcome Measures • At baseline and postintervention, the participants completed a self-reported questionnaire, the clinical anger score (CAS). Every 2 wk, they completed the short dimensions of anger reactions (DAR-5) scale to assess temporal changes in anger. Results • Eighty-six participants, 69 women and 17 men with a median age of 45 y and a range from 20 to 70 y, enrolled in the study. Fifty-six completed all designated tests. The mean CAS score decreased significantly, from 10.4 to 6.7 (P < .001). The analysis of variance demonstrated a time-X-practice effect, with 6 wk of practice being necessary to achieve a significant reduction in the DAR-5 score. Conclusions • The present study provided encouraging preliminary evidence on the effectiveness of a daily regimen of listening to a short recording of self-love and appreciation in reducing anger. The findings indicate that the technique merits replication in larger controlled studies. If supported, it could be applied in conflict resolution.

Using Surplus Embryos and Research Embryos in Stem Cell Research: Ethical Viewpoints of Buddhist, Hindu and Catholic Leaders in Malaysia on the Permissibility of Research

The sources of embryos for Embryonic Stem Cell Research (ESCR) include surplus embryos from infertility treatments, and research embryos which are created solely for an ESCR purpose. The latter raises more ethical concerns. In a multi-religious country like Malaysia, ethical discussions on the permissibility of ESCR with regard to the use surplus and research embryos are diversified. Malaysia has formulated guidelines influenced by the national fatwa ruling which allows the use of surplus embryos in ESCR. Input from other main religions is yet to be documented. In light of this, this study addresses (i) the ethical viewpoints of Buddhist, Hindu and Catholic leaders on the permissibility of using surplus and research embryos; and (ii) the moral standpoints of religious leaders towards attaining a consensus on the practice of ESCR in Malaysia. Responses from the religious leaders were obtained via semi-structured, face-to-face interviews. The findings show that generally the Buddhist and Hindu leaders approve the use of surplus embryos. Their responses on the creation of research embryos for ESCR are varied. Meanwhile, the Catholic leaders distinctively objected to ESCR regardless of the embryo sources, referring to it as the destruction of life. Taking into account the diverse views, this study explores the response of the religious leaders for a general consensus wherever possible. The ethical discourse surrounding ESCR in a multi-religious setting offers new perspective, which needs to be explored in a broader global community.

Sex-related illness perception and self-management of a Thai type 2 diabetes population: a cross-sectional descriptive design

BACKGROUND

Increased knowledge concerning the differences in the illness perception and self-management among sexes is needed for planning proper support programs for patients with diabetes. The aim of this study was to investigate the illness perception and self-management among Thai women and Thai men with type 2 diabetes and to investigate the psychometric properties of the translated instruments used.

METHODS

In a suburban province of Thailand, 220 women and men with type 2 diabetes participated in a cross-sectional descriptive study. The participants were selected using a multistage sampling method. Data were collected through structured interviews and were analyzed using group comparisons, and psychometric properties were tested.

RESULTS

Women and men with type 2 diabetes demonstrated very similar experiences regarding their illness perception and no differences in self-management. Women perceived more negative consequences of the disease and more fluctuation in the symptoms than men, whereas men felt more confident about the treatment effectiveness than women. Furthermore, the translated instruments used in this study showed acceptable validity and reliability.

CONCLUSIONS

The Thai sociocultural context may influence people's perceptions and affect the self-care activities of Thai individuals, both women and men, with type 2 diabetes, causing differences from those found in the Western environment. Intervention programs that aim to improve the effectiveness of the self-management of Thai people with diabetes might consider a holistic and sex-related approach as well as incorporating Buddhist beliefs.

The Foot-Reading Cult of Japan

Ho-no-Hana-Sanpogyo was a Japanese new religious movement referred to as the "foot-reading cult" in the media. Its founder, Fukunaga Hogen, claimed to have divine authority and the ability to diagnose physical illness by studying the soles of an individual's feet. The purpose of this paper is to provide an overview of the history of Ho-no-Hana-Sanpogyo and Fukunaga's practice of foot reading.

The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists

Buddhist-derived meditation practices are currently being employed as a popular form of health promotion. While meditation programs draw inspiration from Buddhist textual sources for the benefits of meditation, these sources also acknowledge a wide range of other effects beyond health-related outcomes. The Varieties of Contemplative Experience study investigates meditation-related experiences that are typically underreported, particularly experiences that are described as challenging, difficult, distressing, functionally impairing, and/or requiring additional support. A mixed-methods approach featured qualitative interviews with Western Buddhist meditation practitioners and experts in Theravāda, Zen, and Tibetan traditions. Interview questions probed meditation experiences and influencing factors, including interpretations and management strategies. A follow-up survey provided quantitative assessments of causality, impairment and other demographic and practice-related variables. The content-driven thematic analysis of interviews yielded a taxonomy of 59 meditation-related experiences across 7 domains: cognitive, perceptual, affective, somatic, conative, sense of self, and social. Even in cases where the phenomenology was similar across participants, interpretations of and responses to the experiences differed considerably. The associated valence ranged from very positive to very negative, and the associated level of distress and functional impairment ranged from minimal and transient to severe and enduring. In order to determine what factors may influence the valence, impact, and response to any given experience, the study also identified 26 categories of influencing factors across 4 domains: practitioner-level factors, practice-level factors, relationships, and health behaviors. By identifying a broader range of experiences associated with meditation, along with the factors that contribute to the presence and management of experiences reported as challenging, difficult, distressing or functionally impairing, this study aims to increase our understanding of the effects of contemplative practices and to provide resources for mediators, clinicians, meditation researchers, and meditation teachers.

[The image of the ancient Indian pharmacists in the Chinese Buddhist scriptures]

In the Chinese Buddhist Scriptures, there are many stories or topics about the ancient Indian pharmacist, however, they are not the Medicine Buddha as people knows, but real doctors. In the Chinese Buddhist Scriptures, the doctors gave the medical service to the monks and the laymen. Some of them are respected as the "miracle doctor" or the "king of doctor" , influencing the medicine of ancient East Asian.

Religious Scholars' Attitudes and Views on Ethical Issues Pertaining to Pre-Implantation Genetic Diagnosis (PGD) in Malaysia

Pre-Implantation Genetic Diagnosis (PGD) represents the first fusion of genomics and assisted reproduction and the first reproductive technology that allows prospective parents to screen and select the genetic characteristics of their potential offspring. However, for some, the idea that we can intervene in the mechanisms of human existence at such a fundamental level can be, at a minimum, worrying and, at most, repugnant. Religious doctrines particularly are likely to collide with the rapidly advancing capability for science to make such interventions. This paper focuses on opinions and arguments of selected religious scholars regarding ethical issues pertaining to PGD. In-depth interviews were conducted with religious scholars from three different religious organizations in the Klang Valley, Malaysia. Findings showed that Christian scholars are very sceptical of the long-term use of PGD because of its possible effect on the value of humanity and the parent-children relationship. This differs from Islamic scholars, who view PGD as God-given knowledge in medical science to further help humans understand medical genetics. For Buddhist scholars, PGD is considered to be new medical technology that can be used to save lives, avoid suffering, and bring happiness to those who need it. Our results suggest that it is important to include the opinions and views of religious scholars when it comes to new medical technologies such as PGD, as their opinions will have a significant impact on people from various faiths, particularly in a multi-religious country like Malaysia where society places high value on marital relationships and on the traditional concepts of family.

A week of Danjiki (Buddhist fasting ritual) on cardiometabolic health: a case report

Danjiki is an ascetic traditional fasting ritual in the Japanese Buddhism training. Here we present a case of a 48-year-old man who underwent a 1-week-long Danjiki fasting ritual in a remote Buddhist temple. The daily ritual consisted of waking up at 3:30 am, hiking strenuously in the steep mountains followed by meditations on the rocks, focused calligraphy of religious drawings and documents, recital of Buddhist prayer chanting, and standing under waterfalls while reciting prayers. He was allowed to drink water ad libitum and a cup of carrot juice a day. After a week of the Danjiki ritual, his body weight decreased by 5 kg. Resting metabolic rate did not change. Fasting blood glucose did not change but plasma triglyceride decreased 35 %. There were no changes in blood pressure. Arterial stiffness increased 15-25 % and endothelium-dependent vasodilation decreased 5 %. These results indicate that the Danjiki ritual produced significant weight loss but unexpectedly reduced vascular functions.

Pain Perception in Buddhism Perspective

Dhamma, which Lord Buddha has presented to people after his enlightenment, analyzes every phenomenon and objects into their ultimate elements. The explanation of sensory system is also found in a part of Dhamma named Abhidhammapitaka, the Book of the Higher Doctrine in Buddhism. To find out the relationship between explanation of pain in the present neuroscience and the explanation of pain in Abhidhamma, the study was carried out by the use of a comprehensive review. The comparisons were in terms of peripheral stimulation, signal transmission, modulation, perception, suffering, determination and decision making for the responding to pain. We found that details of the explanation on pain mechanism and perception in Abhidhamma could associate well with our present scientific knowledge. Furthermore, more refinement information about the process and its function in particular aspects of pain perception were provided in Abhidhammapitaka.

Religion and Subjective Well-Being: Western and Eastern Religious Groups Achieved Subjective Well-Being in Different Ways

Culture can moderate which variables most influence subjective well-being (SWB). Because religion can be conceptualized as culture, religious differences can be considered cultural differences. However, there have been few studies comparing how different religious groups evaluate SWB at any given time. This study is among the first to investigate this issue. The present study compared Buddhists, Taoists, Christians, and atheists. In addition to demographic items, 451 Chinese adults completed Chinese version of the Socially Oriented Cultural Conception of SWB Scale. Religious belief was distributed as follows: 10 % Christian, 20 % Buddhist, 25 % Taoist, and 43 % atheists. As predicted, the socially oriented cultural conception of SWB was found to be highest among Buddhists, followed in order by Taoists, atheists, and Christians. It was concluded that the various religious groups achieved SWB in different ways.

Individuals with Mental Illness Can Control their Aggressive Behavior Through Mindfulness Training

Verbal and physical aggression are risk factors for community placement of individuals with serious and persistent mental illness. Depending on the motivations involved, treatment typically consists of psychotropic medications and psychosocial interventions, including contingency management procedures and anger management training. Effects of a mindfulness procedure, Meditation on the Soles of the Feet , were tested as a cognitive behavioral intervention for verbal and physical aggression in 3 individuals who had frequently been readmitted to an inpatient psychiatric hospital owing to their anger management problems. In a multiple baseline across subjects design, they were taught a simple meditation technique, requiring them to shift their attention and awareness from the anger-producing situation to the soles of their feet, a neutral point on their body. Their verbal and physical aggression decreased with mindfulness training; no physical aggression and very low rates of verbal aggression occurred during 4 years of follow-up in the community.

Exploring Oral Health Beliefs and Behaviour Among Tibetan Immigrants of Bylakkupe

PURPOSE

To explore the oral health beliefs and behaviour among Tibetan immigrants of Bylakkupe village.

MATERIALS AND METHODS

A stratified random sampling technique involving 366 Tibetan monks in Bylakkupe monasteries was used in this study. The oral health beliefs were measured using a pre-tested questionnaire.

RESULTS

The results showed that seriousness was higher compared to other domains in the health belief model. Further, as the duration of the stay increased, the perceived importance was also higher among the population studied.

CONCLUSION

The results show that in general, although the seriousness of oral health was high among the participants, the perceived benefit of dental treatment was relatively low.

Human Embryonic Stem Cell Research: Ethical Views of Buddhist, Hindu and Catholic Leaders in Malaysia

Embryonic Stem Cell Research (ESCR) raises ethical issues. In the process of research, embryos may be destroyed and, to some, such an act entails the 'killing of human life'. Past studies have sought the views of scientists and the general public on the ethics of ESCR. This study, however, explores multi-faith ethical viewpoints, in particular, those of Buddhists, Hindus and Catholics in Malaysia, on ESCR. Responses were gathered via semi-structured, face-to-face interviews. Three main ethical quandaries emerged from the data: (1) sanctity of life, (2) do no harm, and (3) 'intention' of the research. Concerns regarding the sanctity of life are directed at particular research protocols which interfere with religious notions of human ensoulment and early consciousness. The principle of 'do no harm' which is closely related to ahimsa prohibits all acts of violence. Responses obtained indicate that respondents either discourage research that inflicts harm on living entities or allow ESCR with reservations. 'Intention' of the research seems to be an interesting and viable rationale that would permit ESCR for the Buddhists and Hindus. Research that is intended for the purpose of alleviating human suffering is seen as being ethical. This study also notes that Catholics oppose ESCR on the basis of the inviolability of human life.

The Associations Between the Religious Background, Social Supports, and Do-Not-Resuscitate Orders in Taiwan: An Observational Study

Prior studies have demonstrated important implications related to religiosity and a do-not-resuscitate (DNR) decision. However, the association between patients' religious background and DNR decisions is vague. In particular, the association between the religious background of Buddhism/Daoism and DNR decisions has never been examined. The objective of this study was to examine the association between patients' religious background and their DNR decisions, with a particular focus on Buddhism/Daoism.The medical records of the patients who were admitted to the 3 surgical intensive care units (SICU) in a university-affiliated medical center located at Northern Taiwan from June 1, 2011 to December 31, 2013 were retrospectively collected. We compared the clinical/demographic variables of DNR patients with those of non-DNR patients using the Student t test or χ test depending on the scale of the variables. We used multivariate logistic regression analysis to examine the association between the religious backgrounds and DNR decisions.A sample of 1909 patients was collected: 122 patients had a DNR order; and 1787 patients did not have a DNR order. Old age (P = 0.02), unemployment (P = 0.02), admission diagnosis of "nonoperative, cardiac failure/insufficiency" (P = 0.03), and severe acute illness at SICU admission (P < 0.01) were significantly associated with signing of DNR orders. Patients' religious background of Buddhism/Daoism (P = 0.04), married marital status (P = 0.02), and admission diagnosis of "postoperative, major surgery" (P = 0.02) were less likely to have a DNR order written during their SICU stay. Furthermore, patients with poor social support, as indicated by marital and working status, were more likely to consent to a DNR order during SICU stay.This study showed that the religious background of Buddhism/Daoism was significantly associated with a lower likelihood of consenting to a DNR, and poor social support was significantly associated with a higher likelihood of having a DNR order written during SICU stay.

[How Jungian Psychology Has Been Developed in Japan]

Jungian Psychology was introduced to Japan in 1931 by Kokyo Nakamura for the first time in Sekai Daishiso Zenshu ("The Complete Works of Thoughts in the World") vol. 33. (Shunjusha Publishing Company). Yoshitaka Takahashi and others made Jungian Psychology more accessible to the Japanese public in the mid-1950s although they did not succeed in full repre- sentation of the fundamental ideas of C. G. Jung. It was Hayao Kawai who truly understood those ideas and initiated the Jungian movements in Japan in 1967. In my opinion, however, there are hardly any Jungian Analysts who develop Jung's ideas further enough to reach a new awareness of the human psyche except a very few people such as Neumann, E., and Gug- genbtihl-Craig, A., Kalff, D. M., Spiegelman, M., Meier, C. A. and Hillman, J., Giegerich, W, in the West and H. Kawai and me in Japan. Kawai develops and deepens Jungian thoughts to a cer- tain extent in his book, The Buddhist Priest Myoe : A Life of Dreams (Shohakusha Publishing Company), while his understanding of Buddhism does not exceed what D. T. Suzuki describes in his work, An Introduction to Zen Buddhism. That is to say the ideas of both Zen and Shin Buddhism are abstracted and assimilated in general Buddhism in his work, resulting in losing their unique features which could have been pursued further. Moreover, although Kawai translates Jung's idea of SynchronizitAt to "kyoji-sei" (synchronicity), I claim that "engi-ritsu" (the pratitya-samutpada principle) would be a more appropriate term to reflect the original concept as it would imply the opposite principle to"inga-ritsu" (the causal principle). It should be noted that the pratitya-samutpada principle is different from the Buddhist concept of pratitya- samutpada which includes causality. In addition I transcribed the Avatamsaka sutra, which originated in India and was developed in China. I also attended to the 2"d international confer- ence featuring the Avatamsaka sutra at Belesbat on the outskirts of Paris. Eventually I have reached an idea that when combined with the concept of the pratitya-samutpada principle, the Avatamsaka sutra could be considered as a-product of Eastern wisdom which would provide an insight beyond Jung. What was originally comprehended by Gautama Buddha was crystallised in abstract images of Amitabha and Vairocana in China during the second and fourth centuries. Amitabha is a celestial buddha that Shinran, the founder of Shin Buddhism, established his own understanding of in his school whereas Vairocana is a celestial buddha that appears in the Avatamsaka sutra. Vairocana could be taken as an image of the"rising sun", the creator of all things, while Amitabha as the "sinking sun", the saviour of all creatures. This picture of psychological cosmology gives a new perspective on the human psyche that would succeed Jungian Psychology. I believe this unique conception is equivalent to the findings in modern physical cosmology, such as Einstein's theories and the Alpha-Beta-Gamow paper, which provided a new understanding of the universe.

[A Buddhist view of health and care]

Buddhism has an original anthropology without dolorism or sacrifice, based on which a care ethic is deployed. The Buddhist way leads to freeing the spirit of the illusions that lead it astray and considers the body as a precious material support for the spirit. Pain and illness are treated while paying great attention to the person's suffering, whether conscious or not.

Breast cancer diagnosis: biographical disruption, emotional experiences and strategic management in Thai women with breast cancer

In this article we draw on Bury's theory of biographical disruption to discuss the meanings of, and emotional experiences related to, being diagnosed with breast cancer among southern Thai women. Qualitative methods, including in-depth interviewing and drawing methods, were used to collect data from 20 women with breast cancer. The women perceived breast cancer to be a rhok raai; an evil or dread disease. They believed that breast cancer would lead to death. The disruption in their biography occurred when they detected abnormalities indicating breast cancer. The women's narratives revealed their chaotic lives upon this diagnosis and the news precipitated in them shock, fear, anxiety and loss of hope. Although they experienced chaos and disruption, the women cultivated strategies that helped them cope with their experiences by accepting their fate and adhering to Buddhist beliefs and practices. Through their narratives of biographical disruption, the women in our study offer healthcare providers knowledge that could lead to an appreciation of their needs and concerns. This knowledge is crucial for health professionals who wish to provide emotional support to women who have been diagnosed with breast cancer in Thailand and elsewhere.

Explaining attitudes about homosexuality in Confucian and non-Confucian nations: is there a 'cultural' influence?

The majority of research on attitudes about homosexuality has concentrated on the global North and on Christian and Muslim majority nations. Little research attention has been given to the factors that shape tolerance in societies with a Confucian heritage. Residents of Confucian counties are less tolerant than Europeans and Americans. One reason given for this difference is the emphasis on Confucian values in many Asian societies. Using data from the World Values Survey, we examine whether values that could be described as Confucian influence attitudes in Confucian and non-Confucian nations. We find a unique Confucian cultural effect, which can partially be explained with concerns about keeping the family intact. Conversely, in Confucian societies values related to obedience, conformity, and filial piety are unrelated to attitudes. There is also a small Buddhist contextual effect, resulting in more tolerant attitudes, and the Confucian influence cannot be reduced to an Asian regional effect.

A critical analysis of the concepts and measurement of awareness and equanimity in Goenka's Vipassana meditation

Goenka's Vipassana meditation (GVM), a widely applied mindfulness training system rooted in Buddhism, is currently widely used. Although the two abilities cultivated in GVM, awareness and equanimity, exhibit certain similarities with the mindfulness cultivated in mindfulness-based psychotherapies (MBTs), they are not major concerns in MBTs. While many mindfulness scales have been created to measure different aspects of mindfulness constructs and certain scales and items can indeed reflect the basic abilities of awareness and equanimity, none of them can adequately capture the way in which those abilities and related ideas are applied in GVM. This paper presents a critical examination of the problems associated with the concepts and measurement of awareness and equanimity and presents potential solutions for achieving better measurement of these concepts in the future.

Assessing a Buddhist treatment for bereavement and loss: the mustard seed project

From a Buddhist perspective, grief becomes complicated because mourners have trouble accommodating the reality of impermanence in the face of deep and unwelcome change, as they struggle to make sense of the "event story" of their loss and to revise their life story and identity accordingly. Joining this perspective with a constructivist emphasis on grieving as meaning reconstruction, we developed a distinctive group intervention to help people reflect on the natural conditions of impermanence and limitation in a compassionate environment in which they were encouraged to cultivate a new self-narrative in the wake of loss. Integrating meditative interludes, dyadic sharing, dharma lessons, and informal didactics on the human quest for meaning, we used expressive arts exercises to engage the existential dilemmas of loss from a self-distancing perspective. Evidence from an open trial on 41 participants in 2 groups documents that the intervention is both feasible and acceptable to clients, and that they display significant decreases in grief related suffering, and corresponding increases in meaning making and personal growth, across the brief course of the workshop experience.

Multiscale factors affecting human attitudes toward snow leopards and wolves

The threat posed by large carnivores to livestock and humans makes peaceful coexistence between them difficult. Effective implementation of conservation laws and policies depends on the attitudes of local residents toward the target species. There are many known correlates of human attitudes toward carnivores, but they have only been assessed at the scale of the individual. Because human societies are organized hierarchically, attitudes are presumably influenced by different factors at different scales of social organization, but this scale dependence has not been examined. We used structured interview surveys to quantitatively assess the attitudes of a Buddhist pastoral community toward snow leopards (Panthera uncia) and wolves (Canis lupus). We interviewed 381 individuals from 24 villages within 6 study sites across the high-elevation Spiti Valley in the Indian Trans-Himalaya. We gathered information on key explanatory variables that together captured variation in individual and village-level socioeconomic factors. We used hierarchical linear models to examine how the effect of these factors on human attitudes changed with the scale of analysis from the individual to the community. Factors significant at the individual level were gender, education, and age of the respondent (for wolves and snow leopards), number of income sources in the family (wolves), agricultural production, and large-bodied livestock holdings (snow leopards). At the community level, the significant factors included the number of smaller-bodied herded livestock killed by wolves and mean agricultural production (wolves) and village size and large livestock holdings (snow leopards). Our results show that scaling up from the individual to higher levels of social organization can highlight important factors that influence attitudes of people toward wildlife and toward formal conservation efforts in general. Such scale-specific information can help managers apply conservation measures at appropriate scales. Our results reiterate the need for conflict management programs to be multipronged.

Babies born dying: just bad karma? A discussion paper

The paper examines the notion of being born dying and karma. Karma is a belief upheld by Buddhists and non-Buddhists: That is, karma follows people from their previous lives into their current lives. This raises a difficult question: Does karma mean that a baby's death is its own fault? While great peace can be found from a belief in karma, the notion of a baby's karma returning in some sort of retributive, universal justice can be de-emphasized and is considered "un-Buddhist." Having an understanding of karma is intrinsic to the spiritual care for the dying baby, not only from the perspective of parents and families who have these beliefs, but also for reconciling one's own beliefs as a healthcare practitioner.

Through a spiritual lens: early childhood inclusive education in Hong Kong

The main purpose of this research was to explore early childhood education teachers', principals', and parents' perceptions of the role of spirituality in the lives of children with special needs, and how educators and schools can support the spiritual development of these children. Three preschools, the Buddhist, Christian, and Waldorf schools, were purposefully selected on the basis that each of them reflects a philosophy that includes the spiritual. Three themes emerged from the data analysis: (a) the influence of the schools' religion and/or spiritual orientations on inclusion; (b) support provided for the spiritual development of children with special needs; and (c) the role of spirituality in the lives of children with special needs. By drawing attention to and offering a preliminary study on early childhood inclusion and spirituality, I hope to encourage more scholars and educators to engage with research and debate on this important yet under-studied dimension of early childhood education.

Religious perspectives on the use of psychopharmaceuticals as an enhancement technology

The use of psychopharmaceuticals as an enhancement technology has been the focus of attention in the bioethics literature. However, there has been little examination of the challenges that this practice creates for religious traditions that place importance on questions of being, authenticity, and identity. We asked expert commentators from six major world religions to consider the issues raised by psychopharmaceuticals as an enhancement technology. These commentaries reveal that in assessing the appropriate place of medical therapies, religious traditions, like secular perspectives, rely upon ideas about health and disease and about normal human behavior. But unlike secular perspectives, faith traditions explicitly concern themselves with ways in which medicine should or should not be used to live a "good life".

THE ADOPTION OF BUDDHISM'S PRINCIPLES AS A MEANS OF IMPROVING PHYSICIANS' WORK WITH TERMINALLY ILL PATIENTS

The medical approach as summarized by Leibowitz--"We must treat the person, not just the disease"--highlights the importance of treating the sick person and not only the illness' pathology. This approach calls for healing not only the physical side, but also--and mainly--the mental aspect of the patient. One of the goals of this article is to turn physicians' attention towards the compassion necessary in treating a person with a severe or chronic illness, or a person who is dying--precisely because sometimes there is no medical cure for the physical state of such a patient. Therefore, physicians' attention does need to be directed to providing emotional assistance to such a patient. Sometimes, the emotional strength the patient draws from the medical team that is treating him can change his view of, and approach to, the illness, and can enable his body to muster the emotional strength necessary to deal with his situation. Buddhism's approach enables the sick patient to experience his illness in a different way, by making peace with one's situation and, sometimes, even viewing the situation differently--viewing the illness as a type of renewal. Buddhism, therefore, enables a sick person to choose a different point of view when his energy is exhausted and he loses hope, providing quality of life to patients. In such a situation, a sick person finds emotional strength in the knowledge that the end of his life is actually a renewal somewhere else. The limited life expectancy of the terminally ill patient demands that he be able to spend his time with minimal concerns and worries, and does not leave much time for treating the emotional side--the patient's fear. In light of this fact, the patient's ability to look ahead and grasp at hope is the most important issue. As much as possible, this is accomplished in an atmosphere of acceptance and with the absence, or reduction, of fear. The freedom to decide for oneself how to behave, according to one's own approach, is what makes it possible for the sick individual to feel empowered, and is liable to encourage the patient to adopt a different point of view. The Buddhist approach recommends replacing the helplessness that usually accompanies the predicament of terminally ill patients with acceptance of responsibility for their behavior in any given situation; this is Buddhism's main contribution to both physicians and patients alike.

Arousal vs. relaxation: a comparison of the neurophysiological and cognitive correlates of Vajrayana and Theravada meditative practices

Based on evidence of parasympathetic activation, early studies defined meditation as a relaxation response. Later research attempted to categorize meditation as either involving focused or distributed attentional systems. Neither of these hypotheses received strong empirical support, and most of the studies investigated Theravada style meditative practices. In this study, we compared neurophysiological (EEG, EKG) and cognitive correlates of meditative practices that are thought to utilize either focused or distributed attention, from both Theravada and Vajrayana traditions. The results of Study 1 show that both focused (Shamatha) and distributed (Vipassana) attention meditations of the Theravada tradition produced enhanced parasympathetic activation indicative of a relaxation response. In contrast, both focused (Deity) and distributed (Rig-pa) meditations of the Vajrayana tradition produced sympathetic activation, indicative of arousal. Additionally, the results of Study 2 demonstrated an immediate dramatic increase in performance on cognitive tasks following only Vajrayana styles of meditation, indicating enhanced phasic alertness due to arousal. Furthermore, our EEG results showed qualitatively different patterns of activation between Theravada and Vajrayana meditations, albeit highly similar activity between meditations within the same tradition. In conclusion, consistent with Tibetan scriptures that described Shamatha and Vipassana techniques as those that calm and relax the mind, and Vajrayana techniques as those that require 'an awake quality' of the mind, we show that Theravada and Vajrayana meditations are based on different neurophysiological mechanisms, which give rise to either a relaxation or arousal response. Hence, it may be more appropriate to categorize meditations in terms of relaxation vs. arousal, whereas classification methods that rely on the focused vs. distributed attention dichotomy may need to be reexamined.

A Buddhist perspective on industrial engineering and the design of work

The modern way of life is highly dependent upon the production of goods by industrial organizations that are in turn dependent upon their workers for their ongoing operations. Even though more than a century has passed since the dawn of the industrial revolution, many dangerous aspects of work, both physical and mental, remain in the workplace today. Using Buddhist philosophical principles, this paper suggests that although many sources of the problem reside within the larger society, the industrial engineer is still a key factor in bettering work and providing a workplace suitable for their fellow workers. Drawing on these insights, we present a number of work design guidelines that industrial engineers who abide by Buddhist principles could practice to help overcome some of the many sufferings produced by modern work.

A survey of opinions regarding wishes toward the end-of-life among Thai elderly

BACKGROUND

Knowledge of wishes toward the end-of-life is crucial for carrying out high quality palliative care. However, advance directive is not commonly available among Thais, particularly for non-cancerous older patients.

OBJECTIVE

The present study aimed to explore Thai older person's wishes toward cares needed at the end-of-life.

MATERIAL AND METHOD

A convenience sample of 100 older patients, who attended geriatric clinic at a university hospital in Thailand, was recruited. A 3-page questionnaire developed to suit Thai culture was utilized to elicit opinions concerning circumstances around end-of-life period.

RESULTS

All participants were Buddhists with mean age of 75.9 (8.2). Toward the end-of-life, the majority wanted to know the truth about their illnesses and to be free from uncomfortable symptoms. Seventy-five percent did not want "prolong-life" treatments when chance of surviving is slim. Age less than 70 and having education of no more than 6 years were factors associated with being unwilling to prolong suffering with OR of 9.88 (1.20-81.57, p = 0.03) and 3.15 (1.11-8.95, p = 0.03), respectively. Interestingly, fifty-six percent of elderly did not want to die at home. Age less than 70 was the only factor significantly associated with being unwilling to die at home with OR of 2.80 (95% CI = 1.05-7.47, p = 0.04).

CONCLUSION

The present study illustrated older persons' opinions in relation to cares at the end-of-life from a Thai perspective, which showed some similarities and differences when compared to western countries. These opinions should be crucial for carrying out optimal and qualitative end-of-life care for older people when advanced care planning is not in place for the individual.

Taiwanese vegetarians and omnivores: dietary composition, prevalence of diabetes and IFG

Introduction

Vegetarian diets have been shown to improve glucose metabolism and reduce risk for diabetes in Westerners but whether Chinese vegetarian diets have the same benefits is unknown.

Methods

We evaluated the association between diet and diabetes/impaired fasting glucose (IFG) among 4384 Taiwanese Buddhist volunteers and identified diabetes/IFG cases from a comprehensive review of medical history and fasting plasma glucose.

Results

Vegetarians had higher intakes of carbohydrates, fiber, calcium, magnesium, total and non-heme iron, folate, vitamin A, and lower intakes of saturated fat, cholesterol, and vitamin B12. Besides avoiding meat and fish, vegetarians had higher intakes of soy products, vegetables, whole grains, but similar intakes of dairy and fruits, compared with omnivores. The crude prevalence of diabetes in vegetarians versus omnivores is 0.6% versus 2.3% in pre-menopausal women, 2.8% versus 10% in menopausal women, and 4.3% versus 8.1% in men. Polytomous logistic regression adjusting for age, body mass index, family history of diabetes, education, leisure time physical activity, smoking and alcohol, showed that this vegetarian diet was negatively associated with diabetes and IFG in men (OR for diabetes: 0.49, 95% CI: 0.28–0.89; OR for IFG: 0.66, 95% CI: 0.46–0.95); in pre-menopausal women (OR for diabetes: 0.26, 95% CI: 0.06–1.21; OR for IFG: 0.60, 95% CI: 0.35–1.04); and in menopausal women (OR for diabetes: 0.25, 95% CI: 0.15–0.42; OR for IFG: 0.73, 95% CI: 0.56–0.95).

Conclusion

We found a strong protective association between Taiwanese vegetarian diet and diabetes/IFG, after controlling for various potential confounders and risk factors.

The perspective of psychosomatic medicine on the effect of religion on the mind-body relationship in Japan

Shintoism, Buddhism, and Qi, which advocate the unity of mind and body, have contributed to the Japanese philosophy of life. The practice of psychosomatic medicine emphasizes the connection between mind and body and combines the psychotherapies (directed at the mind) and relaxation techniques (directed at the body), to achieve stress management. Participation in religious activities such as preaching, praying, meditating, and practicing Zen can also elicit relaxation responses. Thus, it is time for traditional religions to play an active role in helping those seeking psychological stability after the Great East Japan Earthquake and the ongoing crisis related to the nuclear accident in Fukushima, Japan, to maintain a healthy mind-body relationship.

Role of Tibetan Buddhist monasteries in snow leopard conservation

The snow leopard (Panthera uncia) inhabits the rugged mountains in 12 countries of Central Asia, including the Tibetan Plateau. Due to poaching, decreased abundance of prey, and habitat degradation, it was listed as endangered by the International Union for Conservation of Nature in 1972. Current conservation strategies, including nature reserves and incentive programs, have limited capacities to protect snow leopards. We investigated the role of Tibetan Buddhist monasteries in snow leopard conservation in the Sanjiangyuan region in China's Qinghai Province on the Tibetan Plateau. From 2009 to 2011, we systematically surveyed snow leopards in the Sanjiangyuan region. We used the MaxEnt model to determine the relation of their presence to environmental variables (e.g., elevation, ruggedness) and to predict snow leopard distribution. Model results showed 89,602 km(2) of snow leopard habitat in the Sanjiangyuan region, of which 7674 km(2) lay within Sanjiangyuan Nature Reserve's core zones. We analyzed the spatial relation between snow leopard habitat and Buddhist monasteries and found that 46% of monasteries were located in snow leopard habitat and 90% were within 5 km of snow leopard habitat. The 336 monasteries in the Sanjiangyuan region could protect more snow leopard habitat (8342 km(2) ) through social norms and active patrols than the nature reserve's core zones. We conducted 144 household interviews to identify local herders' attitudes and behavior toward snow leopards and other wildlife. Most local herders claimed that they did not kill wildlife, and 42% said they did not kill wildlife because it was a sin in Buddhism. Our results indicate monasteries play an important role in snow leopard conservation. Monastery-based snow leopard conservation could be extended to other Tibetan Buddhist regions that in total would encompass about 80% of the global range of snow leopards.

Seeds used for Bodhi beads in China

BACKGROUND

Bodhi beads are a Buddhist prayer item made from seeds. Bodhi beads have a large and emerging market in China, and demand for the beads has particularly increased in Buddhism regions, especially Tibet. Many people have started to focus on and collect Bodhi beads and to develop a Bodhi bead culture. But no research has examined the source plants of Bodhi beads. Therefore, ethnobotanical surveys were conducted in six provinces of China to investigate and document Bodhi bead plants. Reasons for the development of Bodhi bead culture were also discussed.

METHODS

Six provinces of China were selected for market surveys. Information was collected using semi-structured interviews, key informant interviews, and participatory observation with traders, tourists, and local residents. Barkhor Street in Lhasa was focused on during market surveys because it is one of the most popular streets in China.

RESULTS

Forty-seven species (including 2 varieties) in 19 families and 39 genera represented 52 types of Bodhi beads that were collected. The most popular Bodhi bead plants have a long history and religious significance. Most Bodhi bead plants can be used as medicine or food, and their seeds or fruits are the main elements in these uses. 'Bodhi seeds' have been historically used in other countries for making ornaments, especially seeds of the legume family. Many factors helped form Bodhi bead culture in China, but its foundation was in Indian Buddhist culture.

CONCLUSIONS

As one of the earliest adornment materials, seeds played an important role for human production and life. Complex sources of Bodhi beads have different cultural and historical significance. People bought and collected Bodhi beads to reflect their love and admiration for the plants. Thus, the documentation of Bodhi bead plants can serve as a basis for future investigation of Bodhi bead culture and modern Buddhist culture.

The influence of religious affiliation on heavy drinking, heavy smoking and heavy betel nut chewing

The results of a national survey of determinants of drinking, smoking and betel-nut chewing behaviors are analyzed. The purpose of this paper is to empirically investigate whether drinking, smoking and betel-nut chewing are influenced by a variety of religions based on Taiwan data. Our results suggest that Buddhism, Taoism and practitioners of Chinese folk region are positively associated with heavy betel nut chewing while the religion effects on heavy smoking and drinking are statistically insignificant. Our findings on religion effects in Taiwan can be a valuable reference for comparison in Christian and western countries.

For mothers and sisters: care of the reproductive female body in the medico-ritual world of early and medieval Japan

While married female members of the Japanese aristocracy followed the ideal of bearing children, female Buddhist novices and ordained women, often belonging to the aristocracy themselves, had to abstain from sexual activity and reproduction in accordance with the ordination rules. Infertility was considered with disdain by the first group, whereas not bearing children was the utmost expression of leading a virtuous life for the second group. However, both groups were concerned with keeping their physical bodies healthy: some to become mothers, the others to live as nuns or religious sisters. Focusing on the early medieval period, this paper examines various sources to illuminate the ways in which women were cared for and the kind of views and ideas that informed this care. Instead of looking at the ancient methods of treatment through a modern "scientific" lens and sorting them into "proto-scientific" and "superstitious" categories, medico-ritual and religious views on the female body are explored as facets of the worldview prevalent in the period under consideration. Special attention is paid to relevant chapters of the first medical work produced in Japan, the Ishinpō, compiled by a court physician, Tanba no Yasuyori, in the late 10th century CE. The investigation of other sources, such as Buddhist legends and doctrinal texts, suggests that women were recommended to seek to overcome their femaleness altogether by transforming their female bodies into male bodies in order to reach ultimate "healing" in terms of salvation. In lay circles, however, the Buddhist divinities and other powerful deities were worshipped to ensure this-worldly "healing" in terms of successful procreation and continuation of the family line.

[Contributions of Catholicism, Protestantism, and Buddhism to medicine--taking into account the future of palliative medicine in Japan]

It is worth recalling that Catholicism and Protestantism have each played an important role in the development of modern medicine. Before modern medicine become widely accepted, palliative care was addressed by Catholic abbes in Western Europe, as well as by Buddhist monks in Japan. Palliative medicine exceeds the capability of contemporary medicine in general, insofar as spirituality is an important dimension when doctors are caring for patients who may be facing death. Being aware of this problem, the author tries to elucidate the contributions of religion to medicine, with the intention of considering the future of palliative medicine in Japan.

Meditation research, past, present, and future: perspectives from the Nalanda contemplative science tradition

This article offers an overview of meditation research: its history, recent developments, and future directions. As the number and scope of studies grow, the field has converged with cognitive and affective neuroscience, and spawned many clinical applications. Recent work has shed light on the mechanisms and effects of diverse practices, and is entering a new phase where consensus and coherent paradigms are within reach. This article suggests an unusual path for future advancement: complementing conventional research with rigorous dialogue with the contemplative traditions that train expert meditators and best know the techniques. It explores the Nalanda tradition developed in India and preserved in Tibet, because its cumulative approach to contemplative methods produced a comprehensive framework that may help interpret data and guide research, and because its naturalistic theories and empirical methods may help bridge the gulf between science and other contemplative traditions. Examining recent findings and models in light of this framework, the article introduces the Indic map of the central nervous system and presents three testable predictions based on it. Finally, it reviews two studies that suggest that the multimodal Nalanda approach to contemplative learning is as well received as more familiar approaches, while showing promise of being more effective.

Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness

Buddhist meditation practices have become a topic of widespread interest in both science and medicine. Traditional Buddhist formulations describe meditation as a state of relaxed alertness that must guard against both excessive hyperarousal (restlessness) and excessive hypoarousal (drowsiness, sleep). Modern applications of meditation have emphasized the hypoarousing and relaxing effects without as much emphasis on the arousing or alertness-promoting effects. In an attempt to counterbalance the plethora of data demonstrating the relaxing and hypoarousing effects of Buddhist meditation, this interdisciplinary review aims to provide evidence of meditation's arousing or wake-promoting effects by drawing both from Buddhist textual sources and from scientific studies, including subjective, behavioral, and neuroimaging studies during wakefulness, meditation, and sleep. Factors that may influence whether meditation increases or decreases arousal are discussed, with particular emphasis on dose, expertise, and contemplative trajectory. The course of meditative progress suggests a nonlinear multiphasic trajectory, such that early phases that are more effortful may produce more fatigue and sleep propensity, while later stages produce greater wakefulness as a result of neuroplastic changes and more efficient processing.

Faith-based perspectives on the use of chimeric organisms for medical research

Efforts to advance our understanding of neurodegenerative diseases involve the creation chimeric organisms from human neural stem cells and primate embryos--known as prenatal chimeras. The existence of potential mentally complex beings with human and non-human neural apparatus raises fundamental questions as to the ethical permissibility of chimeric research and the moral status of the creatures it creates. Even as bioethicists find fewer reasons to be troubled by most types of chimeric organisms, social attitudes towards the non-human world are often influenced by religious beliefs. In this paper scholars representing eight major religious traditions provide a brief commentary on a hypothetical case concerning the development and use of prenatal human-animal chimeric primates in medical research. These commentaries reflect the plurality and complexity within and between religious discourses of our relationships with other species. Views on the moral status and permissibility of research on neural human animal chimeras vary. The authors provide an introduction to those who seek a better understanding of how faith-based perspectives might enter into biomedical ethics and public discourse towards forms of biomedical research that involves chimeric organisms.

Prevalence of coronary artery disease in different ethnic groups at a tertiary care hospital

OBJECTIVE

To compare the prevalence of coronary artery disease (CAD) between Thai Muslim and Thai Buddhist patients.

MATERIAL AND METHOD

A hospital based retrospective study was carried out to investigate the prevalence of CAD and cardiovascular risk factors of these two ethnic and religious groups at Nopparat Rajathanee Hospital between June 2012 and December 2012. All Thai Muslim patients aged > or = 35 years who visited the internal medicine outpatient department (OPD) were studied. The compared population was randomly selected and matched by age and sex from the Thai Buddhist patients in the same period

RESULTS

Five hundred seventy nine patients with median age of 62 years (interquartile range = 24) were studied. There were 289 Thai Muslims and 290 Thai Buddhists. The prevalence of definite CAD in Muslims (14.20%) was significantly higher than the prevalence in Buddhists (6.2%) (p = 0.002). The prevalence of diabetes mellitus, hypertension, high total cholesterol (> or = 240 mg/dl), and high triglyceride in Muslims were significantly higher For high-density lipoprotein cholesterol (HDL-C), only Muslim females showed significantly higher prevalence of low HDL-C than that of Buddhist females.

CONCLUSION

Thai Muslims showed significantly higher prevalence of definite CAD than that of Thai Buddhists. The greater prevalence of certain risk factors may contribute to higher prevalence of CAD in Thai Muslim patients.

Influences of stigma and HIV transmission knowledge on member support for faith-placed HIV initiatives in Chinese immigrant Buddhist and protestant religious institutions in New York City

Ethnic religious institutions in the United States are uniquely positioned to influence HIV programming within Asian immigrant communities at large. This article examines how knowledge of HIV transmission and stigma potentially influenced attendees' support for their institutions' involvement in HIV programs. Quantitative questionnaires were individually administered to 400 Chinese attendees of Protestant churches and 402 attendees of Buddhist temples in New York City. Mediational analyses indicated that HIV stigma significantly mediated the direct effects of HIV transmission knowledge on attendees' support of their institution's involvement in HIV education (bias corrected and accelerated [BCa] 95% confidence interval [CI], 0.004 to 0.051), HIV care (BCa 95% CI, 0.019 to 0.078), and stigma reduction initiatives (BCa 95% CI, 0.013 to 0.070), while controlling for religious affiliation, age, gender, and education. To mobilize Chinese churches and temples to engage in HIV programming, it remains important to support educational programs on HIV transmission that specifically help to mitigate stigma toward persons living with HIV.

Measurement of acoustic characteristics of Japanese Buddhist temples in relation to sound source location and direction

Although temples are important buildings in the Buddhist community, the acoustic quality has not been examined in detail. Buddhist monks change the location and direction according to the ceremony, and associated acoustical changes have not yet been examined scientifically. To discuss the desired acoustics of temples, it is necessary to know the acoustic characteristics appropriate for each phase of a ceremony. In this study, acoustic measurements were taken at various source locations and directions in Japanese temples. A directional loudspeaker was used as the source to provide vocal acoustic fields, and impulse responses were measured and analyzed. The speech transmission index was higher and the interaural cross-correlation coefficient was lower for the sound source directed toward the side wall than that directed toward the altar. This suggests that the change in direction improves speech intelligibility, and the asymmetric property of direct sound and complex reflections from the altar and side wall increases the apparent source width. The large and coupled-like structure of the altar of a Buddhist temple may have reinforced the reverberation components and the table in the altar, which is called the "syumidan," may have decreased binaural coherence.

The use of mindfulness practice in the treatment of a case of obsessive compulsive disorder in Sri Lanka

For over 20 centuries, Buddhism has been the spiritual practice of the majority of Sri Lankans. Though Buddhist practices have been increasingly influencing psychotherapy in the West, the use of such practices in psychotherapy in Sri Lanka is not common. This paper attempts to bridge this gap by presenting a case study where Buddhist mindfulness practice was used successfully in the treatment of a case of obsessive compulsive disorder. This paper also presents an outline of the association between Buddhist mindfulness practice and mindfulness practices used in modern-day psychotherapy and discusses issues in the use of mindfulness practice in psychotherapy.