Major Types of Meditation

Dr Ruwan M Jayatunge 

Meditation refers to a family of practices that may share many similarities, but can have differences in underlying methods and goals (Olex et al., 2013). Meditation practice is difficult to access because of its countless forms of appearances originating from the complexity of cultures it has to serve (Fell et al., 2010). There are different types of meditations that can be practiced in many different ways. 

Vipassana Meditation

The concept of mindfulness is based on Vipassana, a Buddhist meditation technique (Delgado-Pastor et al., 2013) from Theravadan tradition.Vipassana meditation belongs to the pole of mindfulness (Chiesa, 2010) and it helps to cultivate mindfulness qualities (Thatcher, 2006).

The Pali word 'Vipassana' is derived from two words: ‘Vi’ which means 'in various ways' and 'passana' which means 'seeing'. Thus Vipassana means 'seeing in various ways' Vipassana can be translated as “Insight,” a clear awareness of exactly what is happening as it happens.  Vipassana refers to insight into the true nature of reality (Amihai & Kozhevnikov, 2015). Vipassana meditation is also known as mindfulness meditation because this type of meditation was taught by the Buddha in the Satipatthana Sutta or the Four Foundations of Mindfulness.

Vipassana seeks self transformation through self observation (Al-Hussaini  et al., 2001).Vipassana can be cultivated by the practice that includes contemplation and introspection through primarily awareness and observation of bodily sensations (Wikipedia).  This method provides visceral awareness.  Some view Vipassana as a process of self-purification by self-observation. According to S.N. Goenka, - Burmese-Indian meditation Guru the Vipassana meditator observes the changing nature of body and mind, and experiences the universal truths of impermanence, suffering and egolessness. 

Vipassana meditative practice involves the adoption of a mindful and receptive mental awareness, with attentional absorption on present-moment body sensations and meta-cognitive reframing of ongoing experience as impersonal phenomena to be observed without reacting (Hart, 1987; Gunaratana, 2002; Lutz et al., 2007; Cahn et al., 2013). Vipassana, stresses avoiding discursive thought through nonjudgmental concentration on the content of one's momentary mental activity (Gunaratana, 2002).

The main practice of Vipassana consists in mentally scanning one by one each body part and feeling the sensations in each of these body parts. Practitioners are instructed to move their attention down from the top of the head to the tips of the toes and then in the opposite direction in a repetitive pattern, paying attention to somatic sensations (Braboszcz et al., 2017).Vipassana meditation leads to a state of altered attentional engagement with the sensory surround marked by enhanced stimulus encoding to both standard and distracter stimuli (Cahn et al., 2013).

Vipassana meditation assists individuals to perceive the transitory nature of the self (Emavardhana et al, 1997). Vipassana’s observation-based journey to the common root of mind and body is expected to reduce the tendency of the mind to dwell on the past (thereby reducing regrets) or to delve into the future (thus lowering expectations and anxieties), helping the participant to remain in the ‘here and now’ and achieve relative mental tranquility (Al-Hussaini et al., 2001). Vipassana emphasizes acceptance, rather than suppression of unwanted thoughts (Bowen et al., 2007).

Vipassana meditation improves capacity for executive control and attentional stability (Zanesco et al., 2013). Long term Vipassana meditation contributes to increased occipital gamma power related to long-term meditational expertise and enhanced sensory awareness (Cahn et al., 2010).

Vipassana meditation increases the activity in prefrontal areas (Lazar et al., 2003). A study using fMRI demonstrated that experienced Vipassana meditators during meditation evinced higher levels of hemodynamic activity in rostral anterior cingulate cortex and medial prefrontal cortex relative to novice meditators (Holzel et al., 2007; Cahna & polichb, 2009). Lazar and group (2005) indicate that Vipassana meditators have cortical thickness in regions related to auditory, visual, somatosensory, and interoceptive processing.  Nagendra and colleagues   (2012) report that Vipassana meditation was endowed with enhanced states of  slow wave sleep  and REM sleep compared to that of non-meditating control group.

Vipassana meditation has an immense therapeutic value. Vipassana meditation is a rational method for purifying the mind of the mental factors that cause distress and pain (Thatcher, 2006). Decreased emotional reactivity and increased well-being can be seen among the Vipassana practitioners (Goleman, 1996). Bowen and colleagues (2006) observed Vipassana meditation participants showed decreases in alcohol-related problems and psychiatric symptoms as well as increases in positive psychosocial outcomes. Simpson and colleagues (2007) state that Vipassana meditation is worthy of further study for those with comorbid PTSD and substance use problems.

Mindfulness Meditation

The term “mindfulness” has been used to refer to a psychological state of awareness, a practice that promotes this awareness, a mode of processing information, and a characterological trait (Brown et al., 2007; Davis &Hayes, 2011).  According to Bodhi (2000) the word mindfulness originally comes from the Pali word sati, which means having awareness, attention, and remembering   (Davis &Hayes, 2011). Mindfulness is a psychological construct and as a form of clinical intervention.

Mindfulness' is the working principle behind the effect of all meditations (Panta, 2017). Jon Kabat-Zinn describes mindfulness as paying attention in a particular way: on purpose, in the present moment, and non-judgmentally. (Kabat-Zinn, 1995). Mindfulness is the dispassionate, moment-by-moment awareness of sensations, emotions and thoughts (Marchand, 2014).  Bishop (2004) specifies that mindfulness is an umbrella term that can be understood to refer to the self-regulation of attention to one's experiences in the present moment with curiosity, openness and acceptance.  The aim of mindfulness is to cultivate consistent and non-reactive present moment awareness or directed attention (Appel & Appel, 2009).

Being mindfulness means paying attention to current experience instead of focusing on the past or the future. It’s living here and now, being intentionally present.  It is accepting the moment without judging it. Mindfulness meditation encourages individuals to focus on their internal experiences such as bodily sensations, thoughts, and emotions (Melloni et al., 2013). It is the   non-judgmental observation of the ongoing stream of internal experiences as they arise (Hölzel et al., 2008). It is being alert and awake about the every present moment (Patil, 2009). Mindfulness understanding is a decreased attachment to the self, higher self-compassion and lower emotional reactivity to inner experience.

Mindfulness meditation is an effective cognitive technique for the development of self-awareness (Kutz et al., 1985) and has the capacity to adopt an “observing self (Birnbaum, 2005). According to Shyam, (1994) mindfulness meditation promotes self awareness. The goal of mindfulness is to maintain awareness moment by moment, disengaging oneself from strong attachment to beliefs, thoughts, or emotions, thereby developing a greater sense of emotional balance and well-being (Ludwig & Kabat-Zinn, 2008). Mindfulness transforms suffering through changes in what the mind is processing, changes in how the mind is processing it, and changes in the view of what is being processed (Teasdale & Chaskalson, 2011).     Mindfulness meditation typically focuses on several domains, including bodily sensations, states of mind, and interactions between one’s behavior and the universe (Harvey, 1990).

Mindfulness meditation is regarded as a mind-body therapy or integrative body–mind training. It has beneficial effects on brain and body(Krygier et al., 2013). This is an attention-based, regulatory and self-inquiry training regime which is described as more of an open monitoring style of practice (Lutz et al., 2008). Over the past 35 years, mindfulness meditation practices have increasingly been integrated into Western medical settings (Wilson et al., 2017). Kabat-Zinn and colleagues found that mindfulness based meditation program had sustained positive effects in reduction in pain, psychological and overall health measures (Patil, 2009). 

The scientific interest on mindfulness meditation has significantly increased in the last two decades probably because of the positive health effects (Crescentini &Viviana Capurso, 2015). Mindfulness may promote a more participatory medicine by engaging and strengthening an individual’s internal resources for optimizing health in both prevention of and recovery from illness (Ludwig & Kabat-Zinn, 2008).

The beneficial clinical effects of mindfulness practices are receiving increasing support from empirical studies (Chiesa et al., 2013). Mindfulness-based approaches are increasingly employed as interventions for treating a variety of psychological, psychiatric and physical problems (Chiesa & Malinowski, 2011). Long-term practice of mindfulness leads to emotional stability by promoting acceptance of emotional states and enhanced present-moment awareness (Taylor et al., 2011). Mindfulness has been shown to reduce stress, promote health, and well-being, as well as to increase compassionate behavior toward others (Laneri et al., 2017). Ivanovski and Malhi (2007) state that Mindfulness-based therapeutic interventions appear to be effective in the treatment of depression, anxiety, psychosis, borderline personality disorder and suicidal / self-harm behaviour. Mindfulness is associated with high levels of self-esteem and satisfaction with life (Brown & Ryan, 2003). 

Vedananupassana Mediation

 Vedananupassana meditation (Contemplation on Feelings) is one of the four types of Vipassana meditations. Vedananupassana consists of minutely observing feelings such as aversion and desire as well as pleasant and unpleasant ones (especially pain). As described by Nyanaponika, (1962) when there are painful impulses the person dwells practicing feeling-contemplation on feelings internally, or externally, or both internally and externally.

Although pain is essential or survival pain is an ‘unpleasant sensory and emotional experience.  Pain signals often drive the individual into a behavioral response. The very attempt that the patient makes to detach and banish pain keeps pain more adhered. A growing body of research supports the notion that pain-related fear may contribute to the development of chronic pain and pain-related disability (Zale et al., 2014). In this meditation painful impulses become the focus.

The strength and unpleasantness of pain is neither simply nor directly related to the nature and extent of tissue damage (McGrath, 1994). Psychological factors are closely associated with pain. Situational and emotional factors intensely affect pain perceptions. By concentrating and accepting painful impulses the patient learns to manage his painful symptoms more effectively. Vedananupassana mediation enables the meditatior to radically accept his somatic pain. The experience in Vedananupassana mediation is associated with less anticipation and negative appraisal of pain (Brown & Jones, 2010).

Vedananupassana mediation helps to transform pain by contemplating painful sensations. It edifies patients to be mindful of painful feelings and become tolerable to them. Acceptance of the painful impulses helps to reduce pain and it boosts psychological flexibility. A study done by Viane and colleagues (2004) found that acceptance was related to less attention to pain. As reported by McCracken and Velleman (2010) psychological flexibility may reduce the impact of chronic pain in patients with low to moderately complex problems outside of specialty care. In addition McCracken & -O’Brien (2010) suggest that, when people with chronic pain are willing to have undesirable psychological experiences without attempting to control them, they may function better and suffer less.

Mindfulness of the body and mindfulness of the pain help to see the true nature of pain and pain related suffering. While concentrating on pain the person realizes that the sensation of pain is created by the mind. Being mindfulness of the painful sensations it helps to see different elements of pain and soothes the mind’s perception of pain. Therefore Vedananupassana mediation is associated with greater pain tolerance. Revealing personal experiences Frezza (2008) narrates that focusing on chronic pain helped to manage painfully sensations more effectively. Accodring toZeidan and team (2011) reductions in pain unpleasantness is associated with orbitofrontal cortex activation and thalamic deactivation.

Body Scan Meditation

Body scanning is a type of mindfulness practice that gives greater awareness of the physical body. It uses physical sensations and visualization as an anchor to root the mind in the physical body and in the present moment. The aim in body scan meditation is to become aware of different areas of the body and tune into how each body part feels, with curiosity and non-judgment. The body scan meditation dissolutes the perceived body boundaries.

In the body scan meditation interoception is an essential element. Interoception is defined as the sense of the internal state of the body (Khalsa et al., 2016). Interoception describes the processing and awareness of bodily signals arising from visceral organs (Palmer & Tsakiris, 2018). It is the conscious detection and perception of sensory signals in the body.

Body awareness is an attentional focus on and awareness of internal body sensations (Cramer et al., 2018). Body awareness has been proposed as one of the major mechanisms of mindfulness interventions de (Jong et al., 2016). Interoceptive body awareness is crucial for psychological well-being and plays an important role in many contemplative traditions (Bornemann et al., 2015).

Chronic pain and depression are associated with decreased levels of body awareness (de Jong et al., 2016). Body scan meditation increases body awareness. Body scan explore the relationship between mind and body.

Body scan meditation is indicated in chronic somatic pain. The meditator brings nonjudgmental, compassionate present moment awareness to every part of the body, one at a time. This meditation gives a reflective awareness of body-mind sensations and mind body connection. Hence the meditator gets an insight into the nature of his pain and true nature of suffering.  

A study done by  Dambrun (2016) found that participants in the body-scan meditation condition reported greater happiness and less anxiety than participants in the control condition. Kok and Singer (2017) repot that body scan led to the greatest state increase in interoceptive awareness and the greatest decrease in thought content.

Samatha Meditation (Tranquility Meditation)

Samatha is all about calmness or peaceful abiding. Samatha (Serenity) is a form of concentration meditation that is geared to remove the mental clutter and purify the mind. It is also called as the Tranquility meditation.  Samatha meditation emphasizes avoiding discursive thought by letting the practitioner concentrate on an object of meditation (Amihai & Kozhevnikov, 2015). Samatha meditation helps to stabilize and strengthen the mind.

Some experts describe Samatha meditation as returning the mind to its natural, joyful state. It is connected with calm and purification maintaining inner peace. Samatha meditation purifies the mind from defilements - greed, hatred and delusion that distort the perception. It helps to develop clarity of the mind and achieve Samadhi- ultimate stage of meditation. Samadhi- is seeing things as they are. According to the Venerable Ajahn Brahmavamso Samadhi can only come from the basis of happiness.

Samatha involves focusing on a specific object for an extended period of time. It is geared to attain deep concentration of the mind on a single object. This is mainly done through mindfulness of breathing. According to Adeline Van Waning – Psychiatrist and a Samatha meditation researcher, Samatha training cultivates relaxation, attentional stability, and vividness of perception. Samatha meditation aims to develop attention and concentration to high levels (Dennison, 2014). Samatha meditation increases concentration, reduce ruminations, increases inner peace, develop inner strength, reduces stress and increases calmness of the mind.

Anapanasati Meditation

Anapanasati meditation is also known as respiration meditation or mindfulness of breathing or focused-attention meditation (awareness of one's own respiration). This is an early Buddhist meditation which derives form of Samatha meditation. Anapanasati is most commonly practiced with attention centered on the breath (mindfulness of inhalation and exhalation) without any effort to change the breathing (Wikipedia).  

Breathing is an exquisite tool for exploring subtle awareness of mind and life itself (Deo et al., 2015). In this meditation, one focuses one's attention on bodily sensations caused by incoming and outgoing breath and it provides cumulative health-related improvement (Deo et al., 2016).Anapanasati meditation facilitates deep internal relaxation.  

Being in the present the meditator is watching the breath without controlling it. This is known as mindfulness of inhalation and exhalation. The attention is focused on to the natural breathing process. The meditator breathes in mindfully, breathes out mindfully. The meditator follows the physical sensations of the breath as it flows in and out of the body. He allows the breath to flow naturally and simply aware of it.  There is no control over the breath. The breath becomes a kind of anchor that helps to stay in awareness (Bodhipaksa, 2003). Gradually the meditator develops mental concentration.

Anapanasati meditation helps to build mindfulness. It is a meditation in which one obtains mastery over one's unruly mind through objective observation of one's own natural and normal breath (Deo et al., 2016).

There are a number of health benefits in Anapanasati meditation. In Anapanasati meditation cerebral oxygenation is increased. This technique leads to a deeper level of physical relaxation. During the meditation stress hormones such as cortisol and epinephrine levels are decreasing. Therefore Anapanasati meditation is an antidote for stress and anxiety.

Breathing-Based Meditation improves psychological states such as anger, confusion, depression, fatigue, strain, and vigor (Iwakuma et al., 2017). Anapanasati meditation stimulates   parasympathetic nervous system slowing down heart rate, lowering blood pressure, and calming body and mind. 

Loving-Kindness Meditation (Metta Meditation)  

Loving-kindness meditation (LKM) has been used for centuries in the Buddhist tradition to develop love and transform anger into compassion (Carson et al., 2005).  Loving-kindness meditation is a practice designed to enhance feelings of kindness and compassion for self and others. LKM involves repetition of phrases of positive intention for self and others (Kearney et al., 2013). It is directed well-wishing, typically supported by the silent repetition of phrases such as "may all beings be happy," to foster a feeling of selfless love (Garrison et al., 2014). According to Gunaratana (2002) Loving-kindness meditation promotes a state of acceptance and compassion for the self and others.  

Kindness-based meditation is a rubric covering meditation techniques developed to elicit kindness in a conscious way (Galante et al., 2014). The literature suggests that Loving-kindness meditation associated with an increase in positive affect and a decrease in negative affect (Hofmann et al., 2011). Neuroimaging studies suggest that Loving-kindness meditation may enhance activation of brain areas that are involved in emotional processing and empathy (Hofmann et al., 2011). LKM may influence brain structures associated with affective regulation (Leung et al., 2013).

LKM is a present-centered, selfless focus.  Loving-kindness meditation may be efficacious in alleviating self-criticism, increasing self-compassion and improving depressive symptoms among self-critical individuals (Shahar et al., 2015). Loving-kindness meditation leads to an increase in compassionate behavior (Bankard, 2015) and   effective in enhancing positive emotions (Zeng et al., 2015) and potential for reducing anhedonia and avolition (Johnson et al., 2009). Furthermore loving-kindness meditation increases social connectedness (Hutcherson et al., 2008) and healthy social interaction (Galanteet al., 2014).

Hofmann , Grossman and  Hinton (2011) state that LKM   provide potentially useful strategies for targeting a variety of different psychological problems that involve interpersonal processes, such as depression, social anxiety, marital conflict, anger, and coping with the strains of long-term caregiving. LKM meditation reduces PTSD symptoms and depression by enhance self-compassion (Kearney et al., 2013).

  

Meditation on Death (Marananusmathi Meditation)

Buddhist Marananussati meditation practice or reflection on one’s mortality described in the Visuddhimagga commentary (Burke et al., 2017). Contemplation and meditation on death provide profound understanding of life. Meditation on death is a means of purifying the mind in order to gain a crucial revelation of the meaning and significance of life (Kapleau, 1997).

Death is inevitable and death is a reality of life. Death is definite and time of death is indefinite. Death is a universal phenomenon. Dying is a part of nature.  The American novelist Ernest Hemingwayonce said "Every man's life ends the same way. It is only the detail of how he lived and how he died that distinguishes one man from another"

Terror management theory posits that people tend to respond defensively to reminders of death, including worldview defense, self-esteem striving, and suppression of death thoughts (Niemiec et al., 2010). The terror management theory describes mortality salience which is the awareness by an individual that his or her death is inevitable. Many people have worldview defense and suppression of death-related thoughts. Marananussati meditation (meditation on mortality) can eliminate fear and anxiety associated with mortality salience.

Meditation on death helps to grasp impermanence.  The meditator who becomes mindful of death eliminates fear of death and dying.  A meditation on death enhances spiritual potential of the meditator. The American Buddhist monk Venerable Thanissaro states: “when dying, meditation is the one thing that won’t abandon you”

Transcendental Meditation  

Transcendental Meditation or TM is a form of silent mantra meditation. Transcendental meditation is derived from the ancient yoga teaching (Lansky & St. Louis, 2006).   TM was developed by Maharishi Mahesh Yogi in the second half of the twentieth century (Marciniak et al., 2014). As described by Forem   (2012) attention is paid on inner psychological processes with the aim of overcoming even the mildest forms of thinking and to discover the source of thoughts, which is felt as a moment of pure consciousness, absolutely free of any content.

According to Benson and colleagues (2001) TM is one of the most widely practiced and researched meditation techniques.  It is a purely mental technique that falls within the category of ‘automatic self-transcending’ because the practice allows the mind to effortlessly settle inward, beyond thought, to experience the source of thought, pure awareness (Rees 2011; Travis and Shear 2010).

Mahone and colleagues (2018) found during Transcendental Meditation practice, blood flow patterns were significantly higher in executive and attention areas (anterior cingulate and dorsolateral prefrontal cortices) and significantly lower in arousal areas (pons and cerebellum). Chhatre and team (2013) have described transcendental meditation as a behavioral stress reduction program that incorporates mind-body approach, and demonstrated its effectiveness in improving outcomes through stress reduction.

Leffler (2018, Personal Communication) states that  TM is very effective at re-setting the mind and body towards normal functioning and indicated in Post-traumatic stress disorder, depression, anxiety, and even hypertension.

Zen Meditation

Zen Buddhist meditative practices emphasize the long-term, mindful training of attention and awareness during one's ordinary daily-life activities, the shedding of egocentric behaviors, and the skillful application of one's innate compassionate resources of insight-wisdom toward others and oneself (Austin, 2013).  According to Zen, meditation is to heal and transform (Goldstein & Kornfield, 1987). Zen meditation centered on attentional and postural self-regulation (Pagnoni & Cekic, 2007).  

Zen is a religion, or a philosophy, or a way of life, or a mental and physical discipline (Buksbazen, 2002). Zen is a practice of transforming mental processes by honouring the present. Zen meditation is often classified as a meditational technique based on fundamentals of mindfulness (Marciniak et al., 2014).

Zen meditation is often referred to as the study of the self. Zen is based on the recognition of two incompatible types of thought: rational and intuitive. The truth of Zen has always resided in individual experience rather than in theoretical writings and Zen insights can arise only from individual experience. (Hoover, 1980).

Zen is one of several mental or spiritual disciplines that have become the object of recent scientific interest and theory (Shimano & Douglas, 1975). Chiesa (2009) states that Zen meditation practice could protect from cognitive decline usually associated with age and enhance antioxidant activity. Marchand (2012) indicates that Zen meditation has a role in pain management.

Meditation on Emptiness (Shuniya Meditation)

Sunyata is a Sanskrit word that means emptiness. Emptiness is the true nature of reality. It is the actual nature of all phenomena. Emptiness as a meditative state is said to be reached when "not attending to any themes or themeless concentration of awareness. This is not nihilism. There is no judgment, expectation, desire, opinion or wish. It is bare attention - awareness without thought). 

In this meditation the meditator brings his mind to a state of awareness in which the mind is brought to complete stillness. He experiences inner calmness.  It is a state of emptiness, where no positive or negative is assigned to things. The meditation is practiced through emptiness of thoughts with silence and stillness. It is a neutral state without attachments. Hinterberger and group (2014) found decreased electrophysiological activity represents the conscious state of emptiness in meditation.

According to J .Krishnamurti meditation really is a complete emptying of the mind. He further states that the meditative mind has no horizon. The mind cannot go from the limited to the immense, nor can it transform the limited into the limitless.

Meditation Combined with Bilateral Eye Movements 

Some experts believe that bilateral eye movements influence brain activity. Eye movements may enhance anterior posterior interactions (Parker & Dagnall, 2007). Performing a sequence of fast saccadic horizontal eye movements has been shown to facilitate performance on a range of cognitive tasks, including the retrieval of episodic memories (Parker et al., 2013).  

Human brain has two hemispheres. Some believe that through eye movements these two brain hemispheres can be stimulated and it allows the unprocessed negative information (traumatic memories, triggers, cravings etc) to process and convert in to processed memories. According to Herkt and colleagues (2014) bilateral alternating stimulation increase in limbic processing along with decreased frontal activation. Saccadic bilateral eye movements bring about increased hemispheric interaction (Parker et al., 2013). 

Dr. Francine Shapiro –the creator of EMDR developed the adaptive information processing (AIP) model. Information processing is impacted by pathogenic memories and these dysfunctional pathogenic memories are considered to form basis of a variety of mental disorders (Hase et al., 2017). With pathogenic memories information processing becomes incomplete. These neuro-physiologically stored memories ought to be processed for recovery. Through the therapeutic process pathogenic memories become more adaptive neural networks of memory.

Pathogenic memories can create erroneous schemas or maladaptive cognitive schemas. Schema is an active organization of past reactions, or of past experiences, which must always be supposed to be operating in any well-adapted organic response (Bartlett, 1932). Schemas or schemata represent knowledge about concepts: objects and the relationships they have with other objects, situations, events, sequences of events, actions, and sequences of actions. Psycho trauma related erroneous schemas can cause vivid pathological symptoms.

Aaron T. Beck describes habitual patterns of schemas (ie, organized patterns of thought or behavior) as vital elements of emotional and behavioral experience, whereas biased processing of information accompanies psychopathological states (Singh et al., 2014). Cognitive theories of depression posit that early maladaptive schemas are key vulnerability factors for psychological disorders (Davood et al., 2018). In the recovery process these maladaptive cognitive schemas must be transformed to healthy schemas. Meditation and bilateral eye movements can transform maladaptive schemas to healthy schemas.

Series of horizontal saccadic eye movements are known to improve episodic memory retrieval in healthy adults and to facilitate the processing of traumatic memories in eye movement desensitization and reprocessing (EMDR) therapy (Samara et al., 2011).  Meditation (such as Anapanasathi meditation / Kasina meditation) combined with bilateral eye movements can be used to treat psycho- trauma, chronic pain and addiction disorders. Meditation produces greater wakefulness as a result of neuroplastic changes and more efficient processing (Britton et al., 2014).

Meditation helps to combat stress, anxiety, pain and depression. But when trauma related memories (pathogenic memories) come to the surface people frequently relapse. Series of rapid and rhythmic eye-movements with meditation can ameliorate the symptoms associated with trauma and addictions.   Meditation combined with bilateral eye movements helps to process negative memories and heals the morphological changes caused by trauma and addiction.

Kasina Meditation

The Buddhist text “Visuddhi Magga” describes various forms of Kasina meditations.  Kasiṇa means entirely or whole (Pesala, 2015). In this meditation visual objects and colours are used to focus the mind. Kasiṇa meditation is associated with the Theravāda tradition.

Kasiṇa meditation is a concentration meditation geared to settle the mind and helps to process negative memories and emotions. In Kasina meditation a physical element (Kasina disk) is used as an object of meditation and it helps in bilateral brain hemispheric stimulation. These kasinas are the concepts of earth, water, fire, wind, the colors blue, red, yellow and white, and the ideas of enclosed space and bright light or consciousness (Gerrard, 2013).

In Kasina meditation elements such as earth (pathavī kasiṇa),  water ( āpo kasiṇa) Fire( tejo kasiṇa) , Wind ( vāyo kasiṇa) Light ( aloka kasiṇa) Red ( lohita kasiṇa) Blue ( nīla kasiṇa)  Yellow ( pīta kasiṇa) White ( odāta kasiṇa,)  Space ( ākāsa kasiṇa ) are used as an object of samatha meditation. The purpose of the kasina is to develop the use of the visual sense without grasping at visual "objects (Brooks, 2004). Colour-kasina meditation may prove to be very useful for some meditators who have found limited success using the breath or other subjects of meditation (Thitapunno, 2009).

According to Thitapunno (2009) the kasina device should be placed between 1.5 and 3 meters away from the eyes. One then stares at the center of the colored image without considering the border or the remaining white area. One may blink one’s eyes to relieve them of tension or fatigue. Focusing on the color one may initially repeat to oneself (mantra-like) the corresponding name of the color (e.g., “blue, blue…”) for a short while until the initial focus on the object has been established and one is increasingly less distracted. The main drawback of kasina meditation is that it may place excessive strain on the eyes in some individuals, giving rise to eye irritation or fatigue (Thitapunno, 2009).

Walking Meditation

Walking meditation also known as Sakman Bhavana uses the experience of walking as focus (walking postur).  In this meditation the meditatorobserves the movement of the left and right foot and motion. Walking meditation produces a multitude of favorable effects (Gainey et al., 2016). It is effective in reducing depression, improving functional fitness and vascular reactivity, and appears to confer greater overall improvements than the traditional walking program (Prakhinkit et al., 2014). 

According to the meditation Guru Sayadaw Silananda walking meditation is as powerful as mindfulness of breathing. This practice leads to concentration, insight and wisdom through the physical activity.  In addition this technique helps to overcome drowsiness and dullness. It facilitates to develop strength and clarity of mind, helps to cultivate presence during exercise.

Walking meditation helps to cultivate mindfulness as well as physical fitness. Walking meditation is effective in   improving functional fitness and vascular reactivity (Prakhinkit et al., 2014). Walking improves physical fitness, body composition, and glycemic control (Karstoft et al., 2013).

Repulsive Meditation

Repulsive meditation (Contemplation of the disgusting) or Pilikul Bhavana aka Ashubha Bhavana are reflections on repulsiveness. In this meditation thirty-one parts of the body are contemplated in a variety of ways through mindfulness. This type of meditation in indicated in sex addiction and it helps to overcome desire and lust and eventually reduce craving and attachment for the body and bodily pleasure. While practicing repulsive meditation the meditator realizes the impermanence, decay and suffering associated with the body.   

Spiritual Meditation

Human beings have spiritual and existential issues.  They seek spiritual connectedness. Spirituality, a related but different concept, has been less well studied, especially empirically, but shows promise as a mechanism for coping with deleterious social and health circumstances (Dill, 2017).There are four dimensions of spirituality eg; Meaning, Transcendence, Values, and Psychosocial Identity. Spirituality is characterized by faith, a search for meaning and purpose in life, a sense of connection with others, and a transcendence of self, resulting in a sense of inner peace and well-being (Delgado, 2005). Spiritual life can be defined as the search for personal contact with the transcendent (Miccinesi et al., 2012). Spiritual dimension is important in holistic care. 

Nonreligious spirituality relates to an inner experience, transcendent states of consciousness, meaningfulness, responsibility, sympathy, ethics, humanisation, faith (Irmiš, 2015). Spiritual well-being is one of the most important aspects of health promotion (Ranabhat et al., 2018).

Meditation is an ancient spiritual practice (Baerentsen et al., 2010). It has been been used for spiritual   healing (Birnbaum, 2005; Cebolla et al., 2017). Meditation promotes spirituality. Meditation has much wider philosophical and existential implications, aiming for a radical liberation from all illusions, attachments, suffering and pain (Facco, 2017).

The empirical study on religion and spirituality in relation to mental health has rapidly expanded over the past decade (McClintock et al., 2016). Spirituality is an essential element of person-centered care (Puchalski, 2012).The spiritual dimension is important in the process of coping with stress and anxiety. Research in neurobiology supports use of spiritual techniques as a beneficial treatment for anxiety (Mayo, 2009). Numerous studies show that personal spirituality developed through prayer positively influences mental health (Larrivee &Echarte, 2018).

Spiritual distress may have a negative influence on health outcomes (Monod et al., 2010). Studies have demonstrated a positive connection between a patient's spirituality and health outcomes, including quality of life, depression and anxiety, hopefulness, and the ability to cope with illness (Puchalski et al., 2018). 

The inner experience of spiritual and religious feelings is an integral part of the everyday lives of many individuals (Colucci &Martin, 2008). A growing body of empirical studies documents largely positive effects of religious involvement on health (Moss, 2002).  There are a number of spiritual meditation methods. Christian contemplative prayer, Sufi dhikr, and Jewish kabbalistic practices come under spiritual meditation. Accodrding to Dijoseph & Cavendish (2005) prayer is the most frequently used spiritual practice. Prayer appears to offer subjective benefit to those who pray (Harmon &Myers, 1999).

The Sacramental meditation is a popular form of spiritual meditation. The Sacramental meditation relies on sacred objects and spontaneous imagination to prepare its participants for spiritual experience and the meditation object is likened to an icon (Bradford, 2013).

Spiritual meditation focuses on developing a deeper understanding of spiritual/religious meaning and connection with a higher power (Burke et al., 2017). It helps in spiritual transformation and spiritual ways of making meaning. Travis, (2001) has reported predominant parasympathetic activity during spiritual practices which includes decreased heart rate and blood pressure, decreased respiratory rate, and decreased oxygen metabolism.