正念學 四念住的當代理解與運用 溫宗堃/ 法鼓佛教學院專任助理教授 tzungkuen@ddbc.edu.tw 1

兩種知識論的交匯 禪修的智慧 法 科學 經驗依據的知識

Aug.4, 2003 http://www.time.com/time/covers/0,16641,20030804,00.html http://www.time.com/time/magazine/article/0,9171,1005349,00.html 美國《時代》(TIME)雜誌(Aug.4, 2003)的封面標題是"The Science of Meditation"，並引起了許多報紙如《華爾街日報》等的後續報導。根據該報導， 全美約有1000萬個成年人宣稱自己定期練習靜坐，約佔美國總人口的5%，是過 去十年（1990年代）習禪人數的兩倍。 The Benefits of Meditation: Research Findings and Data “Not only do studies show that meditation is boosting their immune system, but brain scans suggest that it may be rewiring their brains to reduce stress… Ten million American adults now say they practice some form of meditation regularly.” Stein, J. (2003) The Science of Meditation, TIME magazine (cover story), August 4: 48-56. 

September 27, 2004 September 27, 2004 http://www.health.harvard.edu/newsweek/Welcome_Newsweek_readers.htm

Jan. 20, 2003 http://www.time.com/time/covers/0,16641,20030120,00.html Print Email Reprints share inShare If you close your eyes and think about it for a while, as philosophers have done for centuries, the world of the mind seems very different from the one inhabited by our bodies. The psychic space inside our heads is infinite and ethereal; it seems obvious that it must be made of different stuff than all the other organs. Cut into the body, and blood pours forth. But slice into the brain, and thoughts and emotions don't spill out onto the operating table. Love and anger can't be collected in a test tube to be weighed and measured. Rene Descartes, the great 17th century French mathematician and philosopher, enshrined this metaphysical divide in what came to be known in Western philosophy as mind-body dualism. Many Eastern mystical traditions, contemplating the same inner space, have come to the opposite conclusion. They teach that the mind and body belong to an indivisible continuum. In the past, doctors and scientists have tended to dismiss that view as bunk, but the more they learn about the inner workings of the mind, the more they realize that in this regard at least, the mystics are right and Descartes was dead wrong. Mind and body, psychologists and neurologists now agree, aren't that different. The brain is just another organ, albeit more intricate than the rest. The thoughts and emotions that seem to color our reality are the result of complex electrochemical interactions within and between nerve cells. The disembodied voices of schizophrenia and the feelings of worthlessness and self-hatred that accompany depression, although they seem to be based on reality, are no more than distortions in brain electrochemistry. Researchers are learning how these distortions arise, how to lessen their severity and, in some cases, how to correct them. Scientists are also learning something else. Not only is the mind like the rest of the body, but the well-being of one is intimately intertwined with that of the other. This makes sense because they share the same systems--nervous, circulatory, endocrine and immune. What happens in the pancreas or liver can directly affect brain function. Disorders of the brain, conversely, can send out biochemical shock waves that disturb the rest of the body. The pages that follow, our annual special report on health, take you to the cutting edge of mind-body research, where scientists, having left Descartes's great mistake far behind, are exploring how the brain works, how it malfunctions, and what can be done when it goes awry. --By Michael D. Lemonick Read more: http://www.time.com/time/magazine/article/0,9171,1004082,00.html#ixzz1xbXe6dam

此圖為2011年2月5日在ISI Web of Knowledge資料庫，以mindfulness搜尋摘要 和關鍵詞的結果。此研究僅限於以英語發表者為限。此表格由南加州大學的 David S. Black製作

什麼是正念

佛教(禪修)的心要 四念住/四念處

運用注意力的方法

正念的操作型定義

「刻意的、不加評判的、針對當下 的注意力」（Kabat-Zinn, 1994)

「對當下事件和經驗的一種接受性 的注意和覺察。」（Brown, Ryan, & Creswell, 2007）

正念的練習不是 邏輯思考 正向思惟 觀想影相 為了專注於一點 為了停止念頭

失去正念的情況？

忘了東西放哪裡 走路時心不在焉 開車時錯過交流道、路口 食不知味 與人對話，有耳無心 身在洗澡，心在開會 後悔說過的話、做過的動作

人在這裡，心在他方 這意味著 我們可能活著，但卻未真正地活 過。 人們問：死後是否還有另期生命的延續 更大的問題是：人們可能未曾真正活過。混混噩噩，不清不楚地過一生

我到這森林，因為我希望從容地生活， 僅僅面對生命中最基本的事實，看看我 是否能掌握生命的教導，而不會在臨死 時才發現自己未曾活過。 ~梭羅

正念的研究與應用

從不同的角度了解正念： 1.醫學 2.心理學 3.神經科學 4.教育學 5.其他運用

醫學的正念 參考http://www.umassmed.edu/cfm/index.aspx。 參考http://cme.ucsd.edu/mindfulness/。 22

依據美國國家健康研究院 （National Institute of Health）所 屬的「國立輔助與另類醫學中心」 的網頁，該中心於2011年度亦撥 付1008萬美金，資助36項相關的 研究專案 （National Center for Complementary and Alternative Medicine） （http://nccam.nih.gov/research/ extramural/awards/），

申請的單位包括：威斯康新、布朗、加州、史丹佛、杜克、華盛頓、羅徹斯特、 約翰霍普金斯等大學，以及麻州總醫院等醫療機構。

「正念減壓」(MBSR) 身心醫學、參與醫學、行為醫學的一個 臨床範例 設計良好，參與性的課程

於1979年，由「美國麻省大 學醫學中心」附屬「減壓 門診」的Jon Kabat-zinn博 士所創立。 MBSR的創立 於1979年，由「美國麻省大 學醫學中心」附屬「減壓 門診」的Jon Kabat-zinn博 士所創立。 門診於1995年擴大為「正念 中心」(Center for Mindfulness in Medicine, Health Care, and Society，簡 稱CFM) 27

多重硬化症（multiple sclerosis） 纖維肌痛症（fibromyalgia） 運用在下列疾病患者身上： 慢性疼痛（chronic pain） 牛皮癬（psoriasis） 多重硬化症（multiple sclerosis） 纖維肌痛症（fibromyalgia） 心血管疾病（cardiovascular disease） 高血壓（hypertension） 最新的正念研究與資源，參考http://www.mindfulexperience.org/。 29

大腸急躁症（irritable bowel syndrome） 癌症（cancer） 後天免疫不全症候群（AIDS） 熱潮紅（hot flash） 偏頭病（migraine） 糖尿病（ diabetes） 類風溼性關節炎(Rheumatoid arthritis )

相關的利益： 免疫力的提升 血壓降低 疼痛適應 症狀的減輕 幸福感的提升 滅低疾病引起的壓力與焦慮 更好的生活品質

ClinicalTrials.gov offers up-to-date information for locating federally and privately supported clinical trials for a wide range of diseases and conditions. A clinical trial (also clinical research) is a research study in human volunteers to answer specific health questions. Interventional trials determine whether experimental treatments or new ways of using known therapies are safe and effective under controlled environments. Observational trials address health issues in large groups of people or populations in natural settings. ClinicalTrials.gov currently contains 127,372 trials sponsored by the National Institutes of Health, other federal agencies, and private industry. Studies listed in the database are conducted in all 50 States and in 178 countries ClinicalTrials.gov receives over 50 million page views per month 65,000 visitors daily. The U.S. National Institutes of Health (NIH), through its National Library of Medicine (NLM), has developed this site in collaboration with the Food and Drug Administration (FDA), as a result of the FDA Modernization Act, which was passed into law in November 1997. See the FDA document - Guidance for Industry: Information Program on Clinical Trials for Serious or Life- Threatening Diseases and Conditions (March 2002).

在1998年的一項研究，Kabat- Zinn博士及其同僚指出，於接受 光線療法(UVB)或光化療法 (PUVA)治療之同時練習正念修行 的病患，其治癒牛皮癬的速度比 純粹接受光線療法的病患要快上 四倍。 Kabat-Zinn j. et al., (1998) ‘Influence of a Mindfulness-Based Stress Reduction Intervention on Rates of Skin Clearing in Patients with Moderate to Severe Psoriasis Undergoing Phototherapy (UVB) and Photochemotherapy (PUVA)’, Psychosomatic Medicine. 60(5): 625-632. 改變牛皮癬治癒速度 Kabat-Zinn j. et al., (1998) ‘Influence of a Mindfulness-Based Stress Reduction Intervention on Rates of Skin Clearing in Patients with Moderate to Severe Psoriasis Undergoing Phototherapy (UVB) and Photochemotherapy (PUVA)’, Psychosomatic Medicine. 60(5): 625-632. 33

改變大腦活動與免疫功能 象徵「正面積極情緒」的大腦左前 額葉(left prefrontal cortex)的活動，相較 於未參加訓練的對照組員工，有相 當顯著的活躍現象； 參加正念訓練的員工因應流感疫苗 所產生的抗體(antibody)也明顯較未受 訓的員工來得多。 Davidson R.J., Kabat-Zinn J., et al., (2003) ‘Alterations in Brain and Immune Function Produced by Mindfulness Meditation’, Psychosomatic Medicine. 66: 564-570. 論文：Davidson R.J., Kabat-Zinn J., et al., (2003) ‘Alterations in Brain and Immune Function Produced by Mindfulness Meditation’, Psychosomatic Medicine. 66: 564-570. 象徵「正面積極情緒」的大腦左前額葉(left prefrontal cortex)的活動，相較於未參加訓練的對照組員工，有相當顯著 的活躍現象； 參加正念訓練的員工因應流感疫苗所產生的抗體(antibody)也明顯較未受訓的員工來得多。 這個研究指出，「正念減壓療程」能夠藉由心的訓練促進正面的大腦活動，並強化人體的免疫功能。 詳細的經過 It is the hope of Davidson and his sometime collaborator Jon Kabat-Zinn that the power of meditation can be harnessed to promote not only emotional well-being but also physical health. Since founding the Stress Reduction Clinic at the University of Massachusetts Medical School in 1979, Kabat-Zinn and colleagues have treated 16,000 patients and taught more than 2,000 health professionals the techniques of ''mindfulness meditation,'' which instructs a Buddhist-inspired ''nonjudgmental,'' total awareness of the present moment as a way of reducing stress. Along the way, Kabat-Zinn has published small but intriguing studies showing that people undergoing treatment for psoriasis heal four times as fast if they meditate; that cancer patients practicing meditation had significantly better emotional outlooks than a control group; and not only that meditation relieved symptoms in patients with anxiety and chronic pain but also that the benefits persisted up to four years after training. Kabat-Zinn is conducting a study for Cigna HealthCare to see if meditation reduces the costs of treating patients with chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome. For the time being, meditation science is still stuck in a cultural no-man's land between being an oxymoron and something more substantive. ''We're very early in the research,'' said Davidson, who admitted that ''the vast majority of meditation research is schlock.'' But a well-designed study published in July by Davidson, Kabat-Zinn and their colleagues provides further evidence that the topic is legitimate. In July 1997, Davidson recruited human subjects at a small biotech company outside Madison called Promega to study the effects of Buddhist-style meditation on the neural and immunological activity of ordinary American office workers. The employees' brains were wired and measured before they began a course in meditation training taught by Kabat-Zinn. It was a controlled, randomized study, and after eight weeks, the researchers would test brain and immune markers to assess the effects of meditation. There was reluctance among some employees to volunteer, but eventually, about four dozen employees participated in the study. Once a week for eight weeks, Kabat-Zinn would show up at Promega with his boom box, his red and purple meditation tape cassettes and his Tibetan chimes, and the assembled Promega employees -- scientists, marketing people, lab techs and even some managers -- would sit on the floor of a conference room and practice mindfulness for three hours. In July, the results of the experiment at Promega were published in the journal Psychosomatic Medicine, and they suggest that meditation may indeed leave a discernible and lasting imprint on the minds and bodies of its practitioners. Among the Promega employees who practiced meditation for two months, the Wisconsin researchers detected significant increases in activity in several areas of the left prefrontal cortex -- heightened activity that persisted for at least four months after the experiment, when the subjects were tested again. Moreover, the meditators who showed the greatest increase in prefrontal activity after training showed a correspondingly more robust ability to churn out antibodies in response to receiving a flu vaccine. The findings, Kabat-Zinn suggested, demonstrated qualitative shifts in brain activity after only two months of meditation that mirror preliminary results seen in expert meditators like monks. 36

MBSR課程內容—自己的實驗 室

連續八週至十週的團體訓練課程 最多20-35人 每週一次長達2.5至3小時的課程，學習以及實 際練習培育正念的方法，並共同討論如何以 正念面對、處理生活中的壓力與自身疾病 家庭作業：每週六天，每天至少45分鐘練習 含一天(通常在第六週)約7至8小時的禁語密集 正念訓練。 38

正式練習

身體掃描 正念靜坐 正念伸展、瑜伽 正念步行 慈心培育 Body scan, sitting meditation, mindful yoga, walking meditation, mindfulness in daily life, loving-kindness meditation 40

非正式練習

在日常生活中覺察身體、心念、 呼吸、外在環境。 一切的日常活動：入睡前、醒時、 起床、 刷牙、 沐浴 覺察與父母、同事、小孩之間的 關係 注意壓力來源與壓力反應

MBSR家庭作業 MBSR療程家庭作業 43

課程費用 學費：600美金，含講義費。課程的支出全賴學員 的學費。我們依家庭總收入來收費。家庭年收入： 50,000美元或更多者：學費600美元 (若報名時全繳， 收540元) 40,000 – 49,000美元：學費525美元 39,000及以下者：學費450美元 學費可報名時繳清，或分六個月繳 (信用卡)。因為 我們想讓會受益者參加，不在意付費的能力，所 以也可以考慮另外的付費方案。 The tuition cost is $600 and includes all materials. The Program is entirely supported through tuition. We offer a sliding scale based on household income. HOUSEHOLD INCOME TUITION $50,000 or greater $600 ($540, if paid in full at time of registration) $40,000 – $49,000 $525 $39,000 and under $450 Tuition may be paid in full at time of registration or in six monthly payments (charged to Visa, MasterCard, or Discover). Because our goal is to make the Program available to those who could benefit without regard to ability to pay, alternative payment options may be considered. 44

http://www.osher.ucsf.edu/classes-and-lectures/meditation-and- mindfulness/mindfulness-based-childbirth-parenting/

以MBSR為基礎發展出的其他課程， 如「正念分娩與育兒課程」（MBCP） http://cme.ucsd.edu/mindfulness/mbcp_011313_home.html

心理學的正念

如「正念滅壓」被運用於如社交 焦慮障礙（social anxiety disorder） 等焦慮症、注意力不足過動症 （attention deficiency hyperactivity disorder, ADHD）、創傷後壓力症 候群（posttraumatic stress disorder, PTSD）、失眠（insomnia）、恐 慌(panic)與強迫症(obsessive compulsive)等。

「正念認知療法」（mindfulness- based cognitive therapy, MBCT） 主要用於預防憂鬱症（depression） 的復發，亦能作為躁鬱症 （bipolar disorder）的輔助治療與 自殺傾向的預防。 參考http://www.mbct.com/Index.htm。 56

1992年三位心理學者：至麻州 醫學院學習「正念減壓」。他 們結合「正念減壓」與「認知 行為療法」，於1995年發展出 「正念認知療法」。其標準化 的治療手冊業已於2002年出版。 「正念認知療法」所針對的病患，是曾患過一次以上的抑鬱症，但接受藥物治 療後已經康復的患者。一個療程可接受12位至30位病患。其療程結構，和正念 減壓療程類似，是歷時八週、每週一次2小時課程的團體治療。課程教導病患與 正念減壓療程相同的正念修行方法，即包含「身體掃描」、「坐禪」、「正念 瑜伽」、「行禪」及「日常生活中的正念」。八週課程中，病患須一週六日、 每日45分鐘練習正念修行。但此療法不包含「一日的密集訓練」。正念認知療 法與正念減壓療程的主要差異在於，前者增加一部分「認知行為療法」(CBT)對 抑鬱症病患的訓練內容。[1] [1] Segal et al. (2002) pp. 99-307。 57

正念認知療法 Zindel Segal Mark Williams John Teasdale University of Toronto University of Oxford John Teasdale Medical Research Council Cognition and Brain Sciences Unit, Cambridge Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness- based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press. 58

145位曾患「抑鬱症」但已康復三個 月的病患參與實驗，其中23%的病 患於參與實驗之前曾有兩次病發的 紀錄，77%則有三次或以上發病的 紀錄。 在60週的研究期間內，對照組中， 曾患有三次及以上「抑鬱症」的病 患，其「抑鬱症」復發的比率高達 66%；然而，參與療程，且曾患有 三次「抑鬱症」及以上的病患，其 復發的比率卻僅37%。 59

「正念復發預防」 （mindfulness-based relapse prevention, MBRP）用於防止藥 物濫用及其他上癮行為的復發。 參考http://www.mindfulrp.com/。 63

「正念飲食覺察訓練」 （mindfulness-based eating awareness training）用於幫助暴 食症（binge eating disorder）、 貪食症（bulimia）、厭食症 （anorexia nervosa）等與飲食相 關的心理疾病之患者。 參考http://www.tcme.org/。 66

神經科學的正念 參考丹尼爾．席格（2011）、理查．韓森（2011）。 68

69

有研究指出，八週「正念減壓」的 課程能夠活化負責積極正向的左腦 前額葉的活動（Davidson et al., 2003）。 以正念覺照當下身心的正念禪修所 產生的神經迴路（直驗迴路direct experience circuitry）如何不同於平常 「思惟過去、未來」時的神經迴路 （敘事迴路narrative circuitry）（Farb et al., 2007）。

八週的「正念減壓」能改變大腦 的結構，增加了與記憶、學習相 關的海馬迴的灰質，和其他與自 覺、悲憫、內省相關的結構，同 時與壓力、焦慮相關的杏仁核灰 質也變得減少（Hölzel et al., 2011）。 Britta K. Hölzel, James Carmody, Mark Vangel, Christina Congleton, Sita M. Yerramsetti, Tim Gard, Sara W. Lazar. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, 2011; 191 (1): 36 DOI: 10.1016/j.pscychresns.2010.08.006

研究顯示，正念禪修的「標記」 技巧能夠啟動右腦內側前額葉 皮質，同時降低與情緒相關的 杏仁核的活動（Creswell et al

Holzel, Lazar, Gard, et al 2011

教育學的正念

http://www.mindfuled.org/ 77

例如，「正念減壓課程」運用於 醫師、諮商師、心理治療師、護 理師、律師、社會工作者的養成 教育。 http://mindfulnessinlaw.com/； http://www.themindfullawstudent.com/Home.html。 78

Effects of mindfulness-based stress reduction on medical and premedical students. Shapiro SL, Schwartz GE, Bonner G. Source Department of Psychology, University of Arizona, Tucson 85719, USA. Abstract The inability to cope successfully with the enormous stress of medical education may lead to a cascade of consequences at both a personal and professional level. The present study examined the short-term effects of an 8-week meditation-based stress reduction intervention on premedical and medical students using a well-controlled statistical design. Findings indicate that participation in the intervention can effectively (1) reduce self-reported state and trait anxiety, (2) reduce reports of overall psychological distress including depression, (3) increase scores on overall empathy levels, and (4) increase scores on a measure of spiritual experiences assessed at termination of intervention. These results (5) replicated in the wait-list control group, (6) held across different experiments, and (7) were observed during the exam period. Future research should address potential long-term effects of mindfulness training for medical and premedical students.

http://www.themindfullawstudent.com/Home.html 81

紐約州立大學石溪分校

佛羅里達大學

課程結合了認知神經科學、教室 教學法、正念教育、社會與情緒 學習原則，和正向心理學。 由美國Hawn Foundation開發的 「心昇課程」（mindup program），運用於三個學齡層： 幼稚園學齡前至二年級、三年級 至五年級、六年級至八年級。 課程結合了認知神經科學、教室 教學法、正念教育、社會與情緒 學習原則，和正向心理學。 參考 http://www.thehawnfoundation.org/。 88

The SEL framework guiding MindUP™ was developed by the Collaborative for Academic, Social, and Emotional Learning (CASEL), a research-focused organization whose mission is to "establish social and emotional learning as an essential part of education." MindUP™ features lessons to improve behavior and learning for children. The lessons fit easily into any schedule and can be implemented with minimal preparation. Classroom management tips and content-based activities are also provided to assist educators in using MindUP™ throughout their classrooms. Our program provides children with emotional and cognitive tools to help them manage emotions and behaviors, reduce stress, sharpen concentration, and increase empathy and optimism. 89

「正念的學校」（mindful schools program）提供一套課 程教導學校的教師、學童培養 正念，課程分「全校」的課程 和以「班級」為單位的課程。 參考http://www.mindfulschools.org/。 90

「正念的學校」（Mindful Schools）位於美國加州Oakland，是一非營利組織， 始於2007年，正式成立於2010年。提供一套兩階段的課程，Mindfulness Fundamentals Courses和Curriculum Training Courses教導學校的教職員、父 母如何教導學童培養正念；近來已提供線上模式的課程。「正念的學校」也提 供「全校教導」（In-school Instruction）的課程，至今在加州灣區（Bay Area） 已有53所小學、650位赴師和14000兒童參與過其課程。但關於其課程的研究， 目前尚未發表。相關訊息可參見其網頁（http://www.mindfulschools.org/）。

英國「正念在學校」 （mindfulness in schools project） 提供共八堂課用於中學的正念 教育課程（●b）和師資培育課 程（MiSP Tearcher Training）。 參考http://www.mindfulnessinschools.org/ 92

英國的「正念在學校」（Mindfulness in Schools Project），由Richard Burneet、 Chris Cullen等成立，為非營利組織，致力於鼓勵、支持、研究學校的正念教育。 該組織提供共八堂用於中學的正念教育課程（●b）和師資培育課程（MiSP Tearcher Training）。也和Oxford Mindfulness Centre合作，並曾於2010年舉辦 英國第一屆「學校中的正念全國會議」（National Mindfulness in Schools Conference）。課程曾獲得BBC的報導。相關訊息參見其網頁 （http://mindfulnessinschools.org/）。

想像一下

此外，許多大學的「學生服務中 心」也為學生和教職員提供「正 念禪修」的課程。除了一般教育 外，在美國、印度的監獄、矯正 機構也為收容人提供正念禪修或 「內觀」（vipassana）的課程。

Bush（2011）探討一些在美國高等教育課程裡融入正念練習的情況。論文討論 的課程都是由「社會觀照心中心」（Center for Contemplative Mind in Society） 的計畫：「觀照實踐研究員」（Contemplative Practice Fellows）所教。有些 課程由佛教學者所教，有些是教導其他科目但有過禪修經驗的學者。討論的學 校包括州立大學（如State University of New York, Universty of Arizona, University of Washington)、文理學院（如Amherst College, Mount Holyoke College, Bryn Mawr College）、常春藤盟校（如Brown University）、傳統黑 人學院；融入正念的學科包羅萬象，包括宗教、心理學、社會工作、文學、藝 術、建築、詩學、化學、經濟和法律。 位於麻州的「社會觀照心中心」（Center for Contemplative Mind in Society）， 透過「觀照實踐研究員」（Contemplative Practice Fellows）贊助將觀照的元 素融入高等教育的教學、課程。如前述Bush（2011）所述，許多大學、學院的 學者曾加入此研究員計畫。該中心亦為學校的教育者設立禪修營（retreat for educators）提供禪修練習的機會，同時也有暑期課程幫助大學教師深入了解觀 照實踐和如何融入觀照實踐於課程中。相關訊息可參見其網頁 （http://www.contemplativemind. org）

其他運用

Mindfulness-Based Elder Care

一種心的運動

情意神經科學家理查．大衛森 （Richard Davidson）在去年 （2012）曾說： 「我們正見證我認為是『心運動』 的發展。從現在起二十年後，人 們將以我們現在視『身運動』為 理所當然的方式做著『心運 動』。」 “We’re witnessing the growth of what I think of as mental exercises. Twenty years from now the way we now take for granted physical exercise, people will do mental exercises.”　“And it will be done in a completely secular way, people won’t know the origin of these practices was in traditional Buddhism.””Michelle Boorstein, ‘Is meditation a religion?’ 網址 http://www.washingtonpost.com/blogs/under-god/post/is-meditation-a- religion/2011/07/14/gIQA5cksEI_blog.html (2011/08/28). 103

「人們將會以完全非宗教的方式 來做，他們不會知道這些練習 的源頭來自傳統的佛教。 」

自修書籍

自修書籍

謝謝 tzungkuen@ddbc.edu.tw 118