正念[1]mindfulness),又称内观[2],是一种心理过程,通过有目的地将注意力集中于当下,不加评判地觉知一个又一个瞬间所呈现的体验的觉知力和深入观察的觉照[3][4][5][6],能以冥想和其他训练发展而成[4][7][8]。觉察同“表达当下念头、现在进行式思维之正念”。

正念源自于[9][10]、禅、观和藏传冥想技巧[11][12]。正念的定义和技巧范围很广[13],而佛教传统解释了正念的构成要素,即过去、现在、和未来的当下感觉和心智现象之生灭[9][14][15]。现代西方社会中为正念的普及做出贡献者包括释一行贺伯特·班森英语Herbert Benson乔·卡巴金理查·戴维森英语Richard Davidson[16][17][18]胡君梅

自1970年代以来,临床心理学和精神病学已经开发了许多基于正念的治疗方法,以帮助人们体验各种心理状况[18]。正念练习已被用于减轻忧郁症[19][20]、降低压力[20][21][22]焦虑[20][19][22],以及用于治疗药物成瘾[23][24][25]。而在学校、监狱、医院、退伍军人中心和其他环境中亦采用了以正念模式为基础之计划,并将之应用于诸如健康老化、体重管理、运动表现、特教需求,以及产期介入等。

临床研究已证明,在不同类别患者以及健康的成年人和儿童中,正念对身体和心理健康都有好处[5][26]。研究指出,特质正念与心理健康之间存在正相关关系[27][28]。正念练习似乎有益于治疗精神病患者[29][30][31],有研究提到,沉思和担忧会导致多种心智疾病[32][33][34],而正念则可减少沉思和担心[34][35][36],进而可预防心理健康问题的出现[37][38]

也有证据表明,进行正念冥想可能会影响身体健康。例如,反复地生活在压力想法(即沉思)中,似乎会增强生理压力源(此为交感神经系统和下丘脑-脑下垂体-肾上腺轴的持续活化之结果),这会导致身体健康相关的临床表现[39][40][41]。研究亦提到,减少沉思的正念冥想可能会改变这些生物临床路径[39][34][42]。此外,正念有利于免疫系统和减少发炎[5][43][44],特别是可减少某些慢性疾病所产生的发炎状况[45][46],有多项研究都支持这些发现[47][48][42]。再者,正念亦可对大脑内建网络模式带来较低的活化程度,进而降低罹患失智症阿兹海默症的风险[39]

然而,有人对正念的商业化和过度的健康行销提出质疑,强调需要更多的随机控制研究、方法学上的细节陈述、以及使用更多的样本[49][50][51]

练习

正念练习是涉及培养把注意力集中在当下发生的任何事情上之技能的过程[4][9][52][53][54]

观察呼吸、感受身体与其他技巧

这里有几种旨在培养正念冥想的练习方法,人们可以透过引导冥想以协助“掌握其窍门”[55][11][note 1]。作为自我观察和内感受英语Interoception的形式,这些方法增加了对身体的意识,因此它们通常对低自我意识或对自己的身体或情绪状态意识低,或对自己的身体或情绪状态认识不足的人有益处,并且会在那些非常关注自己、身体和情绪的人身上引起焦虑、苦恼、倒叙回忆、疼痛,甚至引发物质滥用[56][57]

  • 一种方法是坐在直背椅子上,或以冥想姿势英语Meditative postures(盘膝而坐)于地板或垫子上,闭上眼睛,把注意力集中在鼻孔附近的呼吸感觉,或呼吸期间的腹部运动[58][12][3][59][web 1]
    • 在这种冥想练习中,人们并不会试图控制自己的呼吸,而是试图简单地意识到自己的自然呼吸过程/节奏[4]。当进行这种练习时,人们的头脑经常会跑到其他思绪或联想上,若是如此,人们会被动地发现到自己经已走神,并且会以一种接受的、非批判的方式重新回到专注于呼吸这件事情上。
  • 人们还可以专注于当下的声音、感觉、想法、感受和动作[4][52][54]。在这方面,卡巴特-津恩于他的MBSR[锚点失效]计划中引入了一个著名的练习方法[web 5][62]——葡萄干的正念品尝[63],那就是用心(可说是利用意志、意念、心智)的作用来品尝葡萄干,当中人们需要专注地品尝和食用葡萄干[64][65][66][note 2]。透过思维上训练并重新连接内在饥饿与饱腹感,可使意念上的进食来维持健康的和有意识的进食模式[67],因此让正念饮食被认为是一种维持健康和有意识饮食模式的方式[68]

时机

建议冥想者从每天约10分钟的短暂练习开始。在人们进行持续练习后,他们会更容易把其注意力集中于呼吸上[4][69][70][web 6]。一句古老的禅宗谚语为:“你应该每天静坐冥想20分钟——除非你太忙了。然后你应该坐一个小时。”

佛教语境;道德戒律

在佛教语汇中,遵守道德戒律是正念或冥想的重要准备阶段[12][71][72]的概念还包括对无我无常现象的沉思与反思,以及对缘起和其他佛教教义的反思[73][74][75][76]

译名

正念冥想是佛教传统和实验心理学的一部分[53][77][78]

Sati 与 smṛti

佛教术语“正念”或“”源于巴利语的 sati(天城文:सति),其对应的梵语为 smṛti(天城文:स्मृति)。它常被诠释为“无遮的、纯粹的注意力”,但在佛教传统中,其意义和应用性是很广的,且这些名词的涵义都仍有讨论空间[79]

根据 Bryan Levman 的说法,在传统佛教的中,巴利语 sati 这个字有“记忆和纪念”之意,且若去掉了记忆这个元素,吾人便无法理解、应用、和实践“正念”[80]

根据 Robert Sharf 的说法,梵语 smṛti 这个字最初是指“去记得、去重拾、去记住”的神圣吠陀经语意。而在《念处经》中,巴利语 sati 则是指去记得人世间可见的现象本质:[79]。Sharf 用《弥兰王问经》来说明,“念”起可使人想起有益之法,如想起正念的四个基础(即四念住或四念处):身念住、受念住、心念住、法念住;想起五力:信力、精进力、念力、定力、慧力;和想起八正道:正见、正思维、正语、正业、正命、正精进、正念、正定[79]

根据 Rupert Gethin 的说法,

巴利语 sati 可用来觉知法、觉知事体关系、觉知相对价值。应用到四念住时,sati 可使瑜珈练习者“记得”人所感受到的事物都与万物有关,亦即感官世界的拙劣、善恶、高下、黑白等,皆为相互存在[79][81]

Sharf 进一步指出,由于四念住须对现象出现时进行适当的道德价值区分,而四念住指的即是八正道中的“正念(正向的念头。身受心法四念住,需与正见和正精进共同合作)”。因此四念住与现今对 sati 的流行诠释“无遮的、纯粹的注意力”毫无关系[79]。据此,sati 所表达的就是“许多心念的状况”,是故最合乎 mindfulness 原意的中文名词即为正念[82](或)。

Georges Dreyfus 也提到将 mindfulness 定义为“无遮的、纯粹的注意力”或“不费心、无评断、当下自我中心的觉知”似乎不够完善。佛学语意中的 mindfulness 包含“记得”之意,其功能也涵盖了讯息之保留[83]。Sharf 注意到佛教徒平日练习的目标在于正确视野或正确观念,并非仅是无遮的、纯粹的注意力[84]。Jay L. Garfield 引述寂天和其他资料,提到 mindfulness 有二个功能:提醒和谨记。从佛学范畴和现今 mindfulness 字词源流来看,Garfield 认为正念练习和道德修养有直接关系[85]

英文翻译

巴利语学者托马斯·威廉·里斯·戴维兹英语Thomas William Rhys Davids(1843–1922)于1881年首次将 sati 这个巴利语翻译为英文 mindfulness,用以表现出“正确的念”,意即正确的正念(或念)、主动的、警惕的心智(或意念)[86]

Daniel John Gogerly (1845) 首次将 sammā-sati 翻译为“正确的冥想(correct meditation)”[87],戴维兹将其解释为:

sati 字面上的意思是记忆,但人们却又不断地以“注意的和周到的 ”的意思来谈 sati。事实上,sati 所指的心智活动和心智持续存在之概念,这是好的佛教徒最常被灌输的一种责任和本分[88]

其他翻译

John D. Dunne英语John D. Dunne主张,把 mindfulness当作是 sati 和 smṛti 的英文翻译,这是很令人困惑的事。有许多佛教学者已经试图将“记忆力 (retention)”当成 mindfulness 的替代性英文翻译[89]菩提比丘英语Bhikkhu Bodhi法师也认为 sati 的意思是记忆[90]

sati/smṛti 曾经被翻译为:

  • 注意力 Attention(Jack Kornfield)
  • 觉知 Awareness
  • 聚焦注意力 Concentrated attention(Mahasi Sayadaw)
  • 检查 Inspection(Herbert V. Günther)
  • 正念性的注意力 Mindful attention
  • 正念 Mindfulness
  • 回忆正念 Recollecting mindfulness(Alexander Berzin)
  • 回忆 Recollection(Erik Pema Kunsang, Buddhadasa)
  • 沉思觉知 Reflective awareness(Buddhadasa)
  • 再次正念 Remindfulness(James H. Austin)
  • 记忆力 Retention
  • 自我回忆 Self-recollection(Jack Kornfield)

定义

心理学

A. M. Hayes 和 G. Feldman 强调正念是一种用来避免某种情绪和防止情绪介入过深的策略。正念亦是一种发展自我知识和智慧的方法。

特质、状态、和练习

根据Brown、Ryan和Creswell 的说法,正念的定义取决于个体自身和如何应用之。有人将正念当作一种心智状态,有人则当它是一组技能和技术。正念的状态和正念的特质是可以分别讨论的。

根据David S. Black,正念最初与深奥的信仰和宗教有关,是某些人才能具备的能力,科学家将这个名词变成可以量化的术语,以提供正念的操作性定义。Black提到三个可能的范畴:

  1. 特质,一种性情特征(维持相对较长时间的特质),是一个人较常进入和容易维持许多注意力的状态。
  2. 状态,一种结果(透过正念训练而产生的觉知状态),是一种觉知当下的状态。
  3. 练习(正念冥想练习)。
像特质的结构

Brown认为正念是:一种与被增强活动不同型态的意识显现。透过特质结构的自我报告方式,人们已发展出正念的测量工具:

  • 正念式的注意力觉知量表 - Mindful Attention Awareness Scale (MAAS)
  • Freiburg 正念量表 - Freiburg Mindfulness Inventory (FMI)
  • 肯塔基正念技巧量表 - Kentucky Inventory of Mindfulness Skills (KIMS)
  • 认知与情意正念量表 - Cognitive and Affective Mindfulness Scale (CAMS)
  • 正念问卷 - Mindfulness Questionnaire (MQ)
  • 认知与情意正念量表(修订版) - Revised Cognitive and Affective Mindfulness Scale (CAMS-R)
  • 费城正念量表 - Philadelphia Mindfulness Scale (PHLMS)
像状态的现象

Bishop等人认为正念是:一种不费心、无评断、当下自我中心的觉知,它会确认每一个因注意力而生起的思想、感觉、或知觉,并且就这么接受它了。

测量工具有:

  • 多伦多正念量表 - The Toronto Mindfulness Scale (TMS),此量表将正念视为一种像状态的现象,可经由一般性的练习将其唤醒或维持之。
  • 状态性正念量表 - The State Mindfulness Scale (SMS),此量表包含21题整体性的状态正念问题,它另有二个子量表(心智状态正念和身体状态正念)。

正念的练习

正念的练习,有以下几种描述方式:

  • 正念是一种起源于东方冥想练习之聚焦注意力方式。
  • 用特定方式聚焦注意力:故意地、当下地、无评断地。
  • 将全部注意力放在所经历到的每一个当下。

根据 Steven F. Hick 的说法,正念练习包括正式的与随意的冥想练习、和非冥想式的练习。正式正念(或正式冥想)是一种将注意力持续放在身体、呼吸、知觉、或当下兴起的念头;随意的正念应用在每日的正念性注意力。非冥想式的练习则是特别用在辩证行为疗法英语Dialectical behavior therapy和用在接受与承诺疗法英语Acceptance and commitment therapy

现代冥想教学所兴起的正念定义

从1970年代开始,大部分的冥想书籍都使用类似乔·卡巴金所提出的正念定义:“当下的觉知(present moment awareness)”。但近来有许多冥想教师提出不太一样的正念定义,如杨增善英语Shinzen Young认为能够同时有聚焦能力、知觉清晰、心神安宁的人,才是一个正念的人。John Yates (Culadasa) 则认为注意力和对周遭事物觉知能力是二种可以区别开来的能力,他定义正念为:“注意力和对周遭事物觉知能力之最适交互作用。”

佛教

根据美国佛教徒Bhante Vimalaramsi英语Bhante Vimalaramsi的专书《静智洞察冥想指引》(A Guide to Tranquil Wisdom Insight Meditation),他认为正念之字意常和佛教的原始涵义不同,他提供的定义是:

正念意指记得去观察心智注意力如何从一事物转到另一事物。正念的第一步是记得去观照内心、记得在心思混乱时回到冥想的主体,第二步则是观察心智注意力如何从一事物转到另一事物。

其他用法

在西方佛教徒开始使用 mindfulness 之前,此英文字早已存在。1530年首次以 myndfulness 的拼法出现,是由约翰·帕尔格雷夫英语John Palsgrave翻译法文pensée思想);1561年拼为 mindfulnesse;1817年拼为 mindfulness。就词法学的角度而言,更早的型态包括mindful(首次记载于1340年)、mindfully(1382年)及已淘汰的mindiness(约1200年)。[91]

根据《韦伯字典》,mindfulness 可意指“一种觉知的状态(a state of being aware)”,同义字为觉醒、注意、警觉、谨慎、尽职、觉知、意识和观察。

科学研究

正念练习的效果和功效

自1970年以来,正念获得了越来越多以经验为依据的关注[18][92],并且经常被研究作为压力管理的干预措施[93][24][94]。荟萃分析表明它对健康成年人[20][95][96]、青少年和儿童[97][98],以及针对不同的健康相关结果(包括体重管理[99][100][101]、精神疾病[102][103][104]、心脏病[105][106]、 睡眠障碍[107][108][109]、癌症护理[110][111][112][113]、成人自闭症治疗[114]、多发性硬化症[115][116]及其他健康相关疾病[117][118][119])的有益影响。2014年于JAMA上发表的一项经常被引用关于冥想研究的荟萃分析[120]指出没有足够的证据证明冥想计划对积极的情绪、注意力、物质使用、饮食习惯、睡眠和体重具任何影响,但发现有适度的证据表明冥想可以减少焦虑、抑郁和疼痛。然而,这项研究包括一组高度异质的冥想风格(即它并没有专门关注正念冥想),这是本研究的一个重大局限性。此外,虽然众所周知正念对诊断出患有各种类型癌症的个体具有积极的心理影响[113],关于它对患有前列腺癌的男患者疗效的证据尚不清楚[112]

尽管一些研究的方法论质量参差,然而经已进行了数以千计的冥想研究,最近的评论指出了当中的许多问题[5][27][121]。尽管如此,正念冥想是一个热门的研究课题,许多冥想对各种条件和结果都有潜在的好处。例如,正念练习也被用于改善运动表现[122][123],作为对有特殊需要儿童及其照顾者的有益干预[124][125][126],作为失眠症患者的可行治疗选择[127][128],作为健康老龄化的有效干预措施[129][130][131],作为皮肤状况管理的策略[132],并作为怀孕和围产期的干预措施[133][134][135]。最近的研究还表明,正念冥想可以利用多种独特的机制显著减轻身体疼痛[136]。冥想也可以让人调节疼痛。当人们暴露于加热引起的疼痛时,正念冥想参与者的脑部扫描(透过使用功能性磁振造影)显示他们的大脑同样注意到该疼痛,然而它不会转换为可感知的疼痛信号。因此,他们的疼痛减轻了40%至50%[137]

此外,正念冥想似乎也会导致端粒长度增加[138],考虑到短端粒可能是多种慢性健康状况发展的风险因素,这是一个重要发现[139]。研究还调查了针对不同患者群体的正念运动和正念练习[140][141]。基于正念的方法是越来越多兴趣研究的主要课题,从2003年发表了52篇论文,到2012年增加到477篇[69]。直至2014年初,经已发表了近100篇的随机对照试验[142]

神经学研究

研究性学习也集中于利用神经成像技术、生理测量和行为测试来研究正念对大脑的影响[5][94][143]。关于正念冥想如何运作的神经学观点研究表明,它在注意力调节、身体意识和情绪调节的组成部分中发挥作用[144]。在考虑到责任感、真实性、同情心、自我接纳和性格等方面时,研究表明,正念冥想有助于形成更连贯、更健康的自我意识和认同感[145][146]。神经成像技术表明,正念冥想等正念练习跟“前扣带皮层岛叶颞顶交界点英语Temporoparietal junction额叶边缘网络英语fronto-limbic network预设模式网络英语Default mode network的结构”[144][147]。此外,正念冥想可以预防或延缓轻度认知障碍阿兹海默症疾病的发作[148]。此外,正念引起的情绪和行为变化被发现是跟大脑的功能和结构变化有关[147][149]。也有建议大脑的预设模式网络可用作监测冥想治疗效果的一种潜在生物标志物[150]。最近的研究还表明,正念练习可以影响基因表达,从而降低炎症相关疾病的风险和生物标志物的有利变化[151][152]

在正念减压之后,大脑区域中负责调节情绪、自我参照处理、学习和记忆过程的灰质浓度显示出密度变化[153][150]。此外,正念减压的实践与免疫系统的改善有关[5][154],这可以解释减轻压力与提高生活质量之间的相关性[155]。这些变化的部分原因是前额叶皮层(执行功能)和海马体(学习和记忆能力)增厚的结果,杏仁核(情绪和压力反应)的萎缩,与加强脑细胞之间的联系[156][157][158]。相比于不冥想的人,长期冥想者有大量的脑回化英语Gyrification(大脑皮层的“折叠”,可能会让大脑更快地处理信息)。再者,在旋转量和冥想年数之间发现了直接相关性,这可能进一步证明了大脑的神经可塑性,或适应环境变化的能力[156]

正念与其他变体的关联

正念(作为一种特质,有别于正念“练习”)与许多结果有关。综上所述[28],铿(Keng)、斯莫斯基(Smoski)与罗宾斯(Robins)总结为:“特质正念与具有更高水平的生活满意度、宜人性、尽责心、活力、自尊、同理心、自主感、能力、乐观和愉快的情感相关联。2020年的一项研究发现了正念(正念)倾向与亲社会行为之间的联系[159]。研究还表明,正念与抑郁、神经质、心不在焉、游离、沈思、认知反应、社交焦虑、情绪调节障碍、经验性回避、述情障碍、精神病背景下的妄想体验强度与一般的心理症状之间存在着显著的负相关(引文中省略了对基础研究的参考)。

正念的效果

跟正念计划的影响相比,人们鲜有进行对增加或减少该机制的研究,因此我们对正念练习的相关组成部分所知甚少。例如,综合分析表明,跟主动控制组别相比,正念练习确实会增加正念[98][96]。这可能是因为我们不知道如何衡量正念。这也可能是正念是剂量依赖性的,并随着经验的增长而增加[160][161][162]。发现“结果为自我报告的正念与冥想练习之间的关联提供了证据,并表明正念与当前的持续实践特别相关,而不是多年积累的练习。”对其他机制的一些研究经已完成。一项从注意力竞争的角度对这种机制进行了概念化的研究[163],这可能是因为我们不知道如何衡量正念。在对该框架的测试中,发现正念与(正如预测的那样)具有被激活的保持正念意图、感觉良好、不着急与非常忙碌相关联。关于感觉良好和正念之间的关系,一项不同的研究[164]发现,因果关系可能是双向的:感觉良好会增加正念,而正念增加会让人感觉良好。

一种理论提出了一种称为“重新感知”的额外机制。重新感知是在经历了所有的意图、注意力、和态度之后,在保持正念的过程之后所产生的有益效果。人们透过重新感知,其视角发生了转变。重新感知容许从思想、情感与生理感觉分离,并允许一个人与他们共存而不是被他们定义[165]

关注与批评

学术研究

以上所引用的许多综述研究还表明有必要在该领域进行更多高质量的研究,例如使用更大的样本量进行干预研究,使用更多的随机对照研究,以及在报告的研究中提供更多方法细节的必要性[5][28]。大多数研究也把正念作为一种特质以作衡量,并且在临床实践中使用正念干预的研究中,缺乏真正的随机化对理解正念的真正有效性造成了问题。然而,使用随机样本的实验方法表明,正念作为一种状态或临时做法可以影响厌恶等感受情绪并促进抽象决策[166][167][168]。还有一些评论研究表明正念干预组与对照组之间几乎没有区别,尽管它们也确实表明他们的干预组接受的治疗时间太短,以至于研究无法得出结论[169][170]。在例如运动的某些领域中,跨研究之间缺乏内部有效性,因此无法对正念的影响作出任何强而有力的主张[123]。这些研究还列出了进行更强有力的研究调查的必要性。这还确定了与正念评估有关的几个问题,包括目前正使用的自我报告问卷[5][28][171]。潜在的偏见也存在于该领域的研究人员,他们也是该领域的从业者,可能会受到压力而发表正面或显著的结果[172]

许多学者批评了近年的西方心理学出版物中有关正念的定义或表现方式[173][174]。这些现代理解与早期佛教典籍中有关于正念/正念的描述,以及上座部佛教的权威评论与印度大乘传统大相径庭[174]:62[175]。亚当·瓦莱里奥(Adam Valerio)提出了这样的一种观点,即学术与学科之间关于正念的定义、理解和普遍呈现方式的冲突可能表明个人、机构或典范式争夺对正念(正念)的拥有权,学者、研究人员和其他作家跟宗教团体以个人的身份作出大致相同的方式投入[176]

缺点

正念作为一种“商品[177]”的普及遭到批评,被一些评论家称为“麦克正念(McMindfulness)”[web 7][web 8][178]。根据约翰·赛峰(John Safran)的说法,正念的普及是营销策略的结果[177]:“麦克正念是对构建梦想的营销;是一种理想化的生活方式;一种身份改造[177][179][180]。”心理学家汤马士·乔伊纳英语Thomas Joiner认为,现代正念冥想已被自助名人“腐蚀”以获得商业利益,并暗示它鼓励不健康的自恋与自我迷恋的心态[181][182]。根据珀泽(Purser)和洛伊(Loy)的说法,正念并没有被用作唤醒对“贪婪、恶意、妄想的不善根源”的洞察手段[web 7],但它被重新塑造成一种“平庸的、治疗性的、自助的”技术,这具有增强这些热情的反效果[web 7]。虽然正念被宣传为减轻压力的一种方式,但在佛教语境下,它是一个包罗万象的道德计划的一部分,旨在培养“明智的行为、社会和谐和同情心”[web 7]。正念私有化忽略了对社会和组织原因感到的压力与不适,而是对这些情况的传播适应[web 7]。根据菩提比丘所说,如果没有尖锐的社会批判,佛教修行很容易被用来证明和稳定现状,成为了消费资本主义的强化力量[web 7]。这个正念新品牌的流行正透过自助书籍、冥想指导课程和正念静修使冥想变得商业化。

佛教评论家批评该运动被描述为等同于佛教修行,而实际上它很可能已变质并产生不良后果,例如没有传统反思道德的基础,因此偏离了传统佛教伦理。批评建议将其道德化或重新道德化为基于临床的伦理学。这冲突通常跟导师的资历和资格有关,而不是学生的实际实践。受佛教影响的改革实践正在标准化和手册化,与佛教截然不同—这被视为一种以寺院为基础的宗教—并在现代冥想中心实践新的心理学伦理中表现为“正念/正念”[184]

风险

在媒体报导中,人们把练习正念后所增加的恐惧和焦虑、恐慌或“崩溃”归因于意想不到的效果,他们认为这可能会暴露于双相情绪障碍症或压抑的创伤后压力症症状[185]。然而,根据已发表的同行评审学术文章,冥想的这些负面影响对于正念冥想来说是罕见的[5][186][187],并且似乎是由于对真正构成正念/冥想练习的的实际理解不足而发生的[9][186]

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