Stitches brew: A brief look at self-harm lip sewing

In previous blogs I have examined both self-harming behaviour (such as cutting off one’s own genitals, removing one’s own eye, removing one’s own ear, self-asphyxial risk taking in adolescence, and religious self-flagellation) and extreme body modification. One area where these two areas intersect is lip sewing. According to the Wikipedia entry on lip sewing:

“Lip sewing or mouth sewing, the operation of stitching together human lips, is a form of body modification. It may be carried out for aesthetic or religious reasons; as a play piercing practice; or as a form of protest. Sutures are often used to stitch the lips together, though sometimes piercings are made with needle blades or cannulas and monofilament is threaded through the holes. There is usually a fair amount of swelling, but permanent scarring is rare. Lip sewing may be done for aesthetic reasons, or to aid meditation by helping the mind to focus by removing the temptation to speak. BMEzine, an online magazine for body modification culture, published an article about a 23-year-old film student Inza, whose quest for body modifications was very varied. She spoke about her experiences with lip sewing as a form of play piercing”.

My reason for writing this blog was prompted by a case study published by Dr. Safak Taktak and his colleagues in the journal Health Care Current Reviews. (I ought to add that I have read a number of papers by Taktak and his colleagues as they have reported some interesting other interesting case studies including those on shoe fetishism, semen fetishism, and fetishes more generally – see ‘Further reading’ below). In this particular paper, they reported the case of a male prisoner who had continually sewed his lips together. Although they were aware of cases of sewing lips together as a form of protest, they claimed that there had never been any case reported in the medical literature.

The case report involved a male 37-year old Turkish (imprisoned) farmer, father of two children, with only basic education. After sewing his lips together, the man was brought into the hospital by the police, along with a handwritten note that read: “My jinns imposed speech ban to me and they made me sew my lips unwillingly. Otherwise, they threaten me with my children. I want to meet a psychiatrist urgently”. (Jinns I later learned are – in Arabian and Muslim mythology – intelligent spirits of lower rank than the angels, able to appear in human and animal forms and are able to possess humans). Not only were his lips sown together with black thread but he had also sewn both of his ears to the side of his head (these are also photographed in the paper and you can download the report free from here). This was actually the fourth time the man had sewed his lips together (but the first that he had sewn his ears). Each time, the doctors took out the stitches and dressed the wounds. The authors examined previous documentation about the man and reported that the man had been in prison for four years after injuring someone (no details were provided) and had been diagnosed with both anxiety disorder and anti-social personality disorder. On a prison ward comprising ten other prisoners, he had attempted suicide when trying to hang himself (in fact, you can clearly see the marks on his neck in the paper’s photographs). The authors reported that:

[The man] had blunted affect. He wasn’t able to stay in the [prison] ward because of the directive voices in his head. He declared he needed to stay in the ward alone. He heard all the words as swearing and he was punished by some people as well as some entities. He also said that some jinns in the form of animals threatened him not to speak and listen to anyone; otherwise they were going to kill his kids. He wanted to protect his children [and] he stitched his lips not to speak anyone and stitched his ears not to hear anyone. In his family history, he stated that his uncle committed suicide by hanging himself and saying ‘the birds are calling me’; his father was schizophrenia-diagnosed”.

The authors then reported:

“The patient stated that he sewed his lips with any colour of thread he could find. He had approximately fifteen pinholes on his upper and lower lips. He tended to suicide with directive auditory and visual hallucination (sic) and reference paranoid delirium. As he was imprisoned, he wasn’t able to use drugs. The patient who was thought to have a psychotic disorder was injected [with] 10 mg haloperidol intramuscularly and he was sent to a safe psychiatry hospital”.

As I have noted in my previous blogs on self-harming behaviour (and as noted in this particular paper), there are many different definitions of what constitutes self-destructive behaviour. This particular case was said to be suited to the psychotic behaviours characterised by Dr. Armando Favazza’s three self-destructive behaviours (i.e., compulsive, typical, and psychotic) outlined in his 1992 paper ‘Repetitive self-mutilation’ (published in the journal Psychiatry Annals). In their discussion of the case, the authors noted:

“The cases like sewing one’s own lips which we observe as a different type of destructing oneself in our case are mostly regarded as intercultural expression of feelings. The ones, who sew their lips in order to protest something, show their reactions by blocking the nutrition intake organ to the ones who want to continue their superiority. It can be expected in psychotic cases that the patients or his beloved ones might be harmed, damaged or affected emotionally. Thus, the patient who is furious and anxious might react by [attempting] violence as a reaction to these repetitive threats. Auditory hallucinations giving orders can cause the aggressive behaviours to start…In our psychotic case, this kind of behaviour is a way to prevent the voices coming from his inner world, not to answer them and hence making passive defending to world which he does not want to interact. By this means, he may harmonise with the secret natural powers which affect him and he may protect himself his children…[also] there can be a relief through sewing lips and ears or strangulation against the oppression created by the person not being able to adapt the prison…It should not be forgotten that the prison is a stressful environment and stressful living [increases] the disposition to psychopathologic behaviour that the living difficulties in prisons can affect the way of thinking and the capacity of coping and it may cause different psychiatric incidences”.

As noted at the start of this article, lip sewing is typically attributed to religious reasons, reasons of protest or aesthetic reasons. In this particular case, none of these reasons was apparent (and therefore notable – in the medical and psychiatric literature at the very least). The addition of sewing his ears appears to be even more rare, and thus warrants further research.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Favazza, A.R. (1992). Repetitive self-mutilation. Psychiatric Annals, 22(2), 60-63.

Taktak, S., Ersoy, S., Ünsal, A., & Yetkiner, M. (2014). The man who sewed his mouth and ears: A case report. Health Care Current Reviews, 2(121), 2.

Taktak, S., Karakus, M., & Eke, S. M. (2015). The man whose fetish object is ejaculate: A case report. Journal of Psychiatry, 18(276), 2.

Taktak, S., Karakuş, M., Kaplan, A., & Eke, S. M. (2015). Shoe fetishism and kleptomania comorbidity: A case report. European Journal of Pharmaceutical and Medical Research, 2, 14-19.

Taktak, S., Yılmaz, E., Karamustafalıoglu, O., & Ünsal, A. (2016). Characteristics of paraphilics in Turkey: A retrospective study – 20years. International Journal of Law and Psychiatry, in press.

Wikipedia (2016). Lip sewing. Located at: https://en.wikipedia.org/wiki/Lip_sewing

Meditation as self-medication: Can mindfulness be addictive?

(Please note, the following blog is an extended version of an article by my research colleagues Dr. Edo Shonin and William Van Gordon (that was first published here) and to which I have added some further text. If citing this article, we recommend: Shonin, E., Van Gordon, W. & Griffiths, M.D. (2016). Meditation as self-medication: Can mindfulness be addictive? Located at: https://drmarkgriffiths.wordpress.com/2016/10/24/meditation-as-self-medication-can-mindfulness-be-addictive/).

Mindfulness is growing in popularity and is increasingly being used by healthcare professionals for treating mental health problems. There has also been a gradual uptake of mindfulness by a range of organisations including schools, universities, large corporations, and the armed forces. However, the rate at which mindfulness has been assimilated by Western society has – in our opinion – meant that there has been a lack of research exploring the circumstances where mindfulness may actually cause a person harm. An example of a potentially harmful consequence of mindfulness that we have identified in our own research is that of a person developing an addiction to mindfulness.

In a previous blog, the issue of whether meditation more generally can be addictive was examined. In a 2010 article by Michael Sigman in the Huffington Post entitled “Meditation and Addiction: A Two-Way Street?”, Sigman recounted the story about how one of his friends spent over two hours every day engaging in meditation while sat in the lotus position. He then claimed:

“There are those few for whom meditation can become compulsive, even addictive. The irony here is that an increasing body of research shows that meditation – in particular Buddhist Vipassana meditation – is an effective tool in treating addiction. One category of meditation addiction is related to the so-called ‘spiritual bypass’. Those who experience bliss when they meditate may practice relentlessly to recreate that experience, at the expense of authentic self-awareness. A close friend who’s done Transcendental Meditation for decades feels so addicted to it, she has a hard time functioning when she hasn’t ‘transcended’”.

Obviously, this is purely anecdotal but at least raises the issue that maybe for a very small minority, meditation might be addictive. In addition, empirical studies have shown that meditation can increase pain tolerance, and that the body produces its own morphine-like substances (i.e., endorphins). Therefore, the addictive qualities of meditation may be due to increased endorphin production that creates a semi-dissociative blissful state.

Being addicted to meditation – and more specifically mindfulness – would constitute a form of behavioural addiction (i.e., as opposed to chemical addiction). Examples of better known forms of behavioural addiction are gambling disorder, internet gaming disorder, problematic internet use, sex addiction, and workaholism. According to the components model of addiction, a person would suffer from an addiction to mindfulness if they satisfied the following six criteria:

• Salience: Mindfulness has become the single most important activity in their life.
• Mood modification: Mindfulness is used in order to alleviate emotional stress (i.e., escape) or to experience euphoria (i.e., a ‘high’).
• Tolerance: Practising mindfulness for longer durations in order to derive the same mood-modifying effects.
• Withdrawal: Experiencing emotional and physical distress (e.g., painful bodily sensations) when not practising mindfulness.
• Conflict: The individual’s routine of mindfulness practice causes (i) interpersonal conflict with family members and friends, (ii) conflict with activities such as work, socialising, and exercising, and (iii) psychological and emotional conflict (also known as intra-psychic conflict).
• Relapse: Reverting to earlier patterns of excessive mindfulness practice following periods of control or abstinence.

In modern society, the word ‘addiction’ has negative connotations but it should be remembered that addictions have been described by some as both positive and negative (for instance, Dr. Bill Glasser has spent his whole career talking about ‘positive’ addictions). For example, in separate clinical case studies that we conducted with individuals suffering from pathological gambling, sex addiction, and workaholism, it was observed that the participants substituted their addiction to gambling, work, or sex with mindfulness (and maybe even developed an addiction to it, depending upon the definition of addiction). In the beginning phases of psychotherapy, this process of addiction substitution represented a move forward in terms of the individual’s therapeutic recovery. However, as the therapy progressed and the individual’s dependency on gambling, work, or sex began to weaken, their “addiction” to mindfulness was restricting their personal and spiritual growth, and was starting to cause conflict in other areas of their life. Therefore, it became necessary to help them change the way they practiced and related to mindfulness.

Mindfulness is a technique or behaviour that an individual can choose to practice. However, the idea is that the individual doesn’t separate mindfulness from the rest of their lives. If an individual sees mindfulness as a practice or something that they need to do in order to find calm and escape from their problems, there is a risk that they will become addicted to it. It is for this reason that we always exercise caution before recommending that people follow a strict daily routine of mindfulness practice. In fact, in the mindfulness intervention that we (Shonin and Van Gordon) developed called Meditation Awareness Training, we don’t encourage participants to practice at set times of day or to adhere to a rigid routine. Rather, we guide participants to follow a dynamic routine of mindfulness practice that is flexible and that can be adapted according to the demands of daily living. For example, if a baby decides to wake up earlier than usual one morning, the mother can’t tell it to wait and be quite because it’s interfering with her time for practising mindfulness meditation. Rather, she has to tend to the baby and find another time to sit in meditation. Or better still, she can tend to the baby with love and awareness, and turn the encounter with her child into a form of mindfulness practice. We live in a very uncertain world and so it is valuable if we can learn to be accommodating and work mindfully with situations as they unfold around us.

One of the components in the components model of addiction is ‘salience’ (put more simply, importance). In general, if an individual prioritises a behaviour (such as gambling) or a substance (such as cannabis) above all other aspects of their life, then it’s probably fair to say that their perspective on life is misguided and that they are in need of help and support. However, as far as mindfulness is concerned, we would argue that it’s good if it becomes the most important thing in a person’s life. Human beings don’t live very long and there can be no guarantee that a person will survive the next week, let alone the next year. Therefore, it’s our view that it is a wise move to dedicate oneself to some form of authentic spiritual practice. However, there is a big difference between understanding the importance of mindfulness and correctly assimilating it into one’s life, and becoming dependent upon it.

If a person becomes dependent upon mindfulness, it means that it has remained external to their being. It means that they don’t live and breathe mindfulness, and that they see it as a method of coping with (or even avoiding) the rest of their life. Under these circumstances, it’s easy to see how a person can develop an addiction to mindfulness, and how they can become irritable with both themselves and others when they don’t receive their normal ‘fix’ of mindfulness on a given day.

Mindfulness is a relatively simple practice but it’s also very subtle. It takes a highly skilled and experienced meditation teacher to correctly and safely instruct people in how to practise mindfulness. It’s our view that because the rate of uptake of mindfulness in the West has been relatively fast, in the future there will be more and more people who experience problems – including mental health problems such as being addicted to mindfulness – as a result of practising mindfulness. Of course, it’s not mindfulness itself that will cause their problems to arise. Rather, problems will arise because people have been taught how to practice mindfulness by instructors who are not teaching from an experiential perspective and who don’t really know what they are talking about. From personal experience, we know that mindfulness works and that it is good for a person’s physical, mental, and spiritual health. However, we also know that teaching mindfulness and meditation incorrectly can give rise to harmful consequences, including developing an addiction to mindfulness.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further Reading

Glasser, W. (1976). Positive addictions. Harper & Row, New York, NY.

Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Griffiths, M.D. (2011). Behavioural addiction: The case for a biopsychosocial approach. Trangressive Culture, 1, 7-28.

Larkin, M., Wood, R.T.A. & Griffiths, M.D. (2006). Towards addiction as relationship. Addiction Research and Theory, 14, 207-215.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioral Addictions, 2, 63-71.

Shonin, E., Van Gordon, W., & Griffiths, M.D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: The Journal of Science and Healing, 10, 193-195.

Shonin, E., Van Gordon W., & Griffiths, M.D. (2014). Mindfulness as a treatment for behavioral addiction. Journal of Addiction Research and Therapy, 5, e122. doi: 10.4172/2155- 6105.1000e122.

Shonin, E., Van Gordon W., & Griffiths, M.D. (2015). Are there risks associated with using mindfulness for the treatment of psychopathology? Clinical Practice, 11, 389-382.

Shonin, E., Van Gordon, W., & Griffiths, M.D. (2016). Mindfulness and Buddhist-derived Approaches in Mental Health and Addiction. New York: Springer.

Sigman, M. (2010). Meditation and addiction: A two-way street? Huffington Post, November 15. Located at: http://www.huffingtonpost.com/michael-sigman/meditation-and-addiction_b_783552.htm

Sussman, S., Lisha, N., Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professionals, 34, 3-56.

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2015). Mindfulness in mental health: A critical reflection. Journal of Psychology, Neuropsychiatric Disorders and Brain Stimulation, 1(1), 102.

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Meditation Awareness Training for the treatment of sex addiction: A case study. Journal of Behavioral Addiction, 5, 363-372.

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Ontological addiction: Classification, etiology, and treatment. Mindfulness, 7, 660-671.

Lust discussed: A brief overview of our recent papers on sex addiction

Following my recent blogs where I outlined some of the papers that my colleagues and I have published on mindfulness, Internet addiction, gaming addiction, youth gambling, exercise addiction, and shopping addiction, here is a round-up of recent papers that my colleagues and I have published on sex addiction.

Griffiths, M.D. & Dhuffar, M. (2014). Treatment of sexual addiction within the British National Health Service. International Journal of Mental Health and Addiction, 12, 561-571.

• At present, the prevalence of rates of sexual addiction in the UK is unknown. This study investigated what treatment services were available within British Mental Health Trusts (MHTs) that are currently provided for those who experience compulsive and/or addictive sexual behaviours within the National Health Service (NHS) system. In March and April 2013, a total of 58 letters were sent by email to all Mental Health Trusts in the UK requesting information about (i) sexual addiction services and (ii) past 5-year treatment of sexual addiction. The request for information was sent to all MHTs under the Freedom of Information Act (2001). Results showed that 53 of the 58 MHTs (91 %) did not provide any service (specialist or otherwise) for treating those with problematic sexual behaviours. Based on the responses provided, only five MHTs reported having had treated sexual addiction as a disorder that took primacy over the past 5 years. There was also some evidence to suggest that the NHS may potentially treat sexual addiction as a secondary disorder that is intrinsic and/or co-morbid to the initial referral made by the GP. In light of these findings, implications for the treatment of sex addiction in a British context are discussed.

Dhuffar, M. & Griffiths, M.D. (2014). Understanding the role of shame and its consequences in female hypersexual behaviours: A pilot study. Journal of Behavioural Addictions, 3, 231–237.

• Background and aims: Hypersexuality and sexual addiction among females is a little understudied phenomenon. Shame is thought to be intrinsic to hypersexual behaviours, especially in women. Therefore, the aim of this study was to understand both hypersexual behaviours and consequences of hypersexual behaviours and their respective contributions to shame in a British sample of females (n = 102). Methods: Data were collected online via Survey Monkey. Results: Results showed the Sexual Behaviour History (SBH) and the Hypersexual Disorder Questionnaire (HDQ) had significant positive correlation with scores on the Shame Inventory. The results indicated that hypersexual behaviours were able to predict a small percentage of the variability in shame once sexual orientation (heterosexual vs. non-heterosexual) and religious beliefs (belief vs. no belief) were controlled for. Results also showed there was no evidence that religious affiliation and/or religious beliefs had an influence on the levels of hypersexuality and consequences of sexual behaviours as predictors of shame. Conclusions: While women in the UK are rapidly shifting to a feminist way of thinking with or without technology, hypersexual disorder may often be misdiagnosed and misunderstood because of the lack of understanding and how it is conceptualised. The implications of these findings are discussed.

Dhuffar, M. & Griffiths, M.D. (2015). A systematic review of online sex addiction and clinical treatments using CONSORT evaluation. Current Addiction Reports, 2, 163-174.

• Researchers have suggested that the advances of the Internet over the past two decades have gradually eliminated traditional offline methods of obtaining sexual material. Additionally, research on cybersex and/or online sex addictions has increased alongside the development of online technology. The present study extended the findings from Griffiths’ (2012) systematic empirical review of online sex addiction by additionally investigating empirical studies that implemented and/or documented clinical treatments for online sex addiction in adults. A total of nine studies were identified and then each underwent a CONSORT evaluation. The main findings of the present review provide some evidence to suggest that some treatments (both psychological and/or pharmacological) provide positive outcomes among those experiencing difficulties with online sex addiction. Similar to Griffiths’ original review, this study recommends that further research is warranted to establish the efficacy of empirically driven treatments for online sex addiction.

Dhuffar, M. & Griffiths, M.D. (2015). Understanding conceptualisations of female sex addiction and recovery using Interpretative Phenomenological Analysis. Psychology Research, 5, 585-603.

• Relatively little research has been carried out into female sex addiction. There is even less regarding understandings of lived experiences of sex addiction among females. Consequently, the purpose of the present study was to examine the experiences of female sex addiction (from onset to recovery). This was done by investigating the experiences and conceptualisations of three women who self-reported as having had a historical problem with sex addiction. An interpretative phenomenological analysis (IPA) methodology was applied in the current research process in which three female participants shared their journey through the onset, progression, and recovery of sex addiction. The IPA produced five superordinate themes that accounted for the varying degrees of sexual addiction among a British sample of females: (1) “Focus on self as a sex addict”; (2) “Uncontrollable desire”; (3) “Undesirable feelings”; (4) “Derision”; and (5) “Self help, treatment and recovery”. The implications of these findings towards the understanding and the need for the implementation of treatment are discussed.

Dhuffar, M., Pontes, H.M. & Griffiths, M.D. (2015). The role of negative mood states and consequences of hypersexual behaviours in predicting hypersexuality among university students. Journal of Behavioural Addictions, 4, 181–188.

• The issue of whether hypersexual behaviours exist among university students is controversial because many of these individuals engage in sexual exploration during their time at university. To date, little is known about the correlates of hypersexual behaviours among university students in the UK. Therefore, the aims of this exploratory study were two-fold. Firstly, to explore and establish the correlates of hypersexual behaviours, and secondly, to investigate whether hypersexuality among university students can be predicted by variables relating to negative mood states (i.e., emotional dysregulation, loneliness, shame, and life satisfaction) and consequences of hypersexual behaviour.

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Meditation Awareness Training for the treatment of sex addiction: A case study. Journal of Behavioral Addictions, in press.

• Sex addiction is a disorder that can have serious adverse functional consequences. Treatment effectiveness research for sex addiction is currently underdeveloped, and interventions are generally based on guidelines for treating other behavioural (as well as chemical) addictions. Consequently, there is a need to clinically evaluate tailored treatments that target the specific symptoms of sex addiction. It has been proposed that second-generation mindfulness-based interventions (SG-MBIs) may be an appropriate treatment for sex addiction because in addition to helping individuals increase perceptual distance from craving for desired objects and experiences, some SG-MBIs specifically contain meditations intended to undermine attachment to sex and/or the human body. To date, no study exploring the utility of mindfulness for treating sex addiction has been conducted. This paper presents an in-depth clinical case study of a male individual suffering from sex addiction that underwent treatment utilising an SG-MBI known as Meditation Awareness Training (MAT). Following completion of MAT, the participant demonstrated clinically significant improvements regarding the addictive sexual behaviour, as well less depression and psychological distress. The MAT intervention also led to improvements in sleep quality, job satisfaction, and non-attachment to self and experiences. Salutary outcomes were maintained at six-month follow-up. The current study extends the literature exploring the applications of mindfulness for treating behavioural addiction, and findings of this case study indicate that further clinical investigation into the role of mindfulness for treating sex addiction is warranted.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D. (2000). Excessive internet use: Implications for sexual behavior. CyberPsychology and Behavior, 3, 537-552.

Griffiths, M.D. (2001). Addicted to love: The psychology of sex addiction. Psychology Review, 8, 20-23.

Griffiths, M.D. (2001). Sex on the internet: Observations and implications for sex addiction. Journal of Sex Research, 38, 333-342.

Griffiths, M.D. (2004). Sex addiction on the Internet. Janus Head: Journal of Interdisciplinary Studies in Literature, Continental Philosophy, Phenomenological Psychology and the Arts, 7(2), 188-217.

Griffiths, M.D. (2010). Addicted to sex? Psychology Review, 16(1), 27-29.

Griffiths, M.D. (2012). Internet sex addiction: A review of empirical research. Addiction Research and Theory, 20, 111-124.

Griffiths, M.D. (2012). The use of online methodologies in studying paraphilia: A review. Journal of Behavioral Addictions, 1, 143-150.

Griffiths, M.D. & Dhuffar, M. (2014). Collecting behavioural addiction treatment data using Freedom of Information requests. SAGE Research Methods Cases. Located at: DOI: http://dx.doi.org/10.4135/978144627305014533925

Tech your time: 12 top tips for a digital detox

Over the last few years there has been increasing use of the term ‘digital detox’. According to the Oxford Dictionary, digital detox is “a period of time during which a person refrains from using electronic devices such as smartphones or computers, regarded as an opportunity to reduce stress or focus on social interaction in the physical world”. I have to admit that I often find it hard to switch off from work (mainly because I love my job). Given that my job relies on technology, by implication it also means I find it hard to switch off from technology. Today’s blog is as much for me as anyone reading this and provides some tips on how to cut down on technology use, even if it’s just for the weekend or a holiday. I have compiled these tips from many different online articles as well as some of my own personal strategies. 

Digitally detox in increments: For some people, going a few minutes without checking their smartphone or emails is difficult. For many, the urge is reflexive and habitual. If you are one of those people, then ‘baby steps’ are needed. Such individuals need to learn to digitally detox in small increments (i.e., go on a ‘digital diet’). Start by proving to yourself that you can go 15 minutes without technology. Over time, increase the length of time without checking (say) Twitter, Facebook and emails (e.g., 30 minutes, 60 minutes, a couple of hours) until you get into a daily habit of being able to spend a few hours without the need to be online. Another simple trick is to only keep mobile devices partially topped up. This means users have to be sparing when checking their mobile devices.

Set aside daily periods of self-imposed non-screen time: One of the secrets to cutting down technology use to acceptable levels is to keep aside certain times of the day technology-free (meal times and bedtime are a good starting place – in fact, these rooms should be made technology-free). For instance, I rarely look at any emails between 6pm and 8pm as this is reserved for family time (e.g., cooking and eating dinner with the family). Another strategy to try is having a technology-free day at the weekends (e.g., not accessing the internet at all for 24 hours). However, watching television or using an e-reader is fine. Another simple strategy is to have technology-free meal times (at both home and work). Don’t bring your smartphone or tablet to the table.

Only respond to emails and texts at specific times of the day: Only a few individuals are ‘on call’ and have to assume that the message they receive will be an emergency. Looking at emails (say) just three times a day (9am, 1pm, 4pm) will save lots of time in the long run. Turning off email and social media, disabling push notifications, or simply turning the volume setting to silent on electronic devices will also reduce the urge to constantly check mobile devices.

Don’t use your smartphone or tablet as an alarm clock: By using a standard alarm clock to wake you in the morning, you will avoid the temptation to look at emails and texts just as you are about to go to sleep or just wake up (or in the middle of the night if you are a workaholic!).

Engage in out-of-work activities where it is impossible (or frowned upon) to use technology: Nowadays, leisure activities such as going to the pub, having a meal, or going to the cinema, don’t stop people using wireless technology. By engaging in digitally incompatible activities where it is impossible to access technology simultaneously (e.g., jogging, swimming, meditation, outdoor walks in wi-fi free areas) or go to places where technology is frowned upon (e.g., places of worship, yoga classes, etc.) and individual will automatically decrease the amount of screen time. In social situations, you can turn people’s need to check their phones into a game. For instance, in the pub, you could have a game where the first one to check their phone has to buy a round of drinks for everyone else.

Tell your work colleagues and friends you are going on a digital detox: Checking emails and texts can become an almost compulsive behaviour because of what psychologists have termed ‘FOMO’ (fear of missing out) that refers to the anxiety that an interesting or exciting event may be happening elsewhere online. By telling everyone you know that you will not be online for a few hours, they will be less likely to contact you in the first place and you will be less likely check for online messages in the first place. Alternatively, Put your ‘out-of-office’ notification on for a few hours and do something more productive with your time.

Reduce your contact lists: One way to spend less time online is to reduce the number of friends on social networking sites, stop following blogs (but not mine, of course!), delete unused apps, and unsubscribe from online groups that have few benefits. Also, delete game apps that can be time-consuming (e.g., Angry Birds, Candy Crush Saga, etc.).

Get a wristwatch: One of the most common reasons for looking at a smartphone or a tablet is to check the time. If checking the time also leads to individuals noticing they have a text, email or tweet, they will end up reading what has been sent. By using an old fashioned wristwatch (as opposed to new smart watches like the Apple Watch), the urge to reply to messages will decrease.

Think about the benefits of not constantly being online: If you are the kind of person that responds to emails, texts and tweets as they come in, you will write longer responses than if you look at them all in a block. The bottom line is that you can save loads of time to spend on other things if you didn’t spend so long constantly reacting to what is going on in the online world.

Enjoy the silence: Too many people fail to appreciate being in the moment and allowing themselves to resist the urge to log onto their laptops, mobiles and tablets. It is at these times that some people might interpret as boredom that we can contemplate and be mindful. This could be made more formal by introducing meditation into a daily routine. There are also many places that run whole weekends and short breaks where technology is forbidden and much of the time can be spent in quiet contemplation. 

Fill the void: To undergo digital detox for any length of time, an individual has to replace the activity with something that is as equally rewarding (whether it is physically, psychologically or spiritually). When I’m on holiday, I catch up on all the novels that I’ve been meaning to read. In shorter spaces of time (such as sitting in boring meetings) I doodle, write ‘to do’ lists, generate ideas to write about, or simply do nothing (and be mindful, aware of the present moment). In short, I try to productive (or unproductive) without having to resort to my technology. 

Use technology to beat technology: One thing that can shock technology users is how much time they actually spend on their mobile devices. Working out how much time is actually spent online can be the first step in wanting to cut down. (For instance, someone I once worked with was shocked to find he had spent 72 [24-hour] days in one year playing World of Warcraft). Tech users can download apps that tell them how much time spending online, (e.g., Moment). Being made aware of a problem is often the first step in enabling behavioural change.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Goodnet (2013). 7 steps to planning your next digital detox. October 22. Located at: http://www.goodnet.org/articles/7-steps-to-planning-your-next-digital-detox

Hosseini, M.D. (2013). Top 10 tips to unplug this summer with a digital detox. Advertising Week Social Club, June 28. Located at: http://www.theawsc.com/2013/06/28/top-10-tips-to-unplug-this-summer-with-a-digital-detox/

Huffington Post (2013). 10 digital detox vacation hacks to help you truly unplug. July 31. Located at: http://www.huffingtonpost.com/2013/07/31/vacation-hacks-_n_3676474.html

Levy, P. (2015). 15 tips for a total digital detox. Mind Body Green, January 15. Located at: http://www.mindbodygreen.com/0-17030/15-tips-for-a-total-digital-detox.html

Lipman, F. (2015). 12 tips for your next digital detox. March 2. Located at: http://www.drfranklipman.com/shake-it-off-12-tips-for-your-next-digital-detox/

Lipman, F. (2014). 8 ways to disconnect from technology and get more done. November 5. Located at: http://www.drfranklipman.com/8-ways-to-disconnect-from-technology-and-get-more-done/

South China Morning Post (2015). Five tips for a digital detox. Located at: http://www.scmp.com/lifestyle/technology/article/1673273/five-tips-digital-detox

Vozza, S. (2013). A realistic digital detox in 5 easy steps. Entrepreneur, November 12. Located: http://www.entrepreneur.com/article/229783

Net gains: A brief overview of our recent papers on Internet addiction

Following my recent blogs where I outlined some of the papers that I and my colleagues have published on mindfulness, I got a couple of emails asking if I could do the same thing on other areas that we have been researching into. So, here it is.

Pontes, H.M., Szabo, A. & Griffiths, M.D. (2015). The impact of Internet-based specific activities on the perceptions of Internet Addiction, Quality of Life, and excessive usage: A cross-sectional study. Addictive Behaviors Reports, 1, 19-25.

• Introduction: Recent research has examined the context in which preference for specific online activities arises, leading researchers to suggest that excessive Internet users are engaged in specific activities rather than ‘generalized’ Internet use. The present study aimed to partially replicate and expand these findings by addressing four research questions regarding (i) participants’ preferred online activities, (i) possible expected changes in online behavior in light of hypothetical scenarios, (iii) perceived quality of life when access to Internet was not possible, and (iv) how participants with self-diagnosed Internet addiction relate to intensity and frequency of Internet use. Methods: A cross-sectional design was adopted using convenience and snowball sampling to recruit participants. A total of 1057 Internet users with ages ranging from 16 to 70 years (Mean age= 30 years, SD = 10.84) were recruited online via several English-speaking online forums. Results: Most participants indicated that their preferred activities were (i) accessing general information and news, (ii) social networking, and (iii) using e-mail and/or online chatting. Participants also reported that there would be a significant decrease of their Internet use if access to their preferred activities was restricted. The study also found that 51% of the total sample perceived themselves as being addicted to the Internet, while 14.1% reported that without the Internet their life would be improved. Conclusions: The context in which the Internet is used appears to determine the intensity and the lengths that individuals will go to use this tool. The implications of these findings are further discussed.

Pontes, H.M., Kuss, D.J. & Griffiths, M.D. (2015). The clinical psychology of Internet addiction: A review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23.

• Research into Internet addiction (IA) has grown rapidly over the last decade. The topic has generated a great deal of debate, particularly in relation to how IA can be defined conceptually as well as the many methodological limitations. The present review aims to further elaborate and clarify issues that are relevant to IA research in a number of areas including: definition and characterization, incidence and prevalence rates, associated neuronal processes, and implications for treatment, prevention, and patient-specific considerations. It is concluded that there is no consensual definition for IA. Prevalence rates among nationally representative samples across several countries vary greatly (from 1% to 18.7%), most likely reflecting the lack of methodological consistency and conceptual rigor of the studies. The overlaps between IA and other more traditional substance-based addictions and the possible neural substrates implicated in IA are also highlighted. In terms of treatment and prevention, both psychological and pharmacological treatments are examined in light of existing evidence alongside particular aspects inherent to the patient perspective. Based on the evidence analyzed, it is concluded that IA may pose a serious health hazard to a minority of people.

Lai, C-L., Mak, K-K., Cheng, C., Watanabe, H., Nomachi, S., Bahar, N., Young, K.S., Ko, H-C., Kim, D. & Griffiths, M.D. (2015). Measurement invariance of Internet Addiction Test among Hong Kong, Japanese, and Malaysian adolescents: An item response analysis. Cyberpsychology, Behavior and Social Networking, 18, 609-617.

• There has been increased research examining the psychometric properties on the Internet Addiction Test (IAT) in different populations. This population-based study examined the psychometric properties and measurement invariance of the IAT in adolescents from three Asian countries. In the Asian Adolescent Risk Behavior Survey (AARBS), 2,535 secondary school students (55.9% girls) aged 12-18 years from Hong Kong (n=844), Japan (n=744), and Malaysia (n=947) completed a survey in 2012-2013 school year. A nested hierarchy of hypotheses concerning the IAT cross-country invariance was tested using multigroup confirmatory factor analyses. Replicating past findings in Hong Kong adolescents, the construct of the IAT is best represented by a second-order three-factor structure in Malaysian and Japanese adolescents. Configural, metric, scalar, and partial strict factorial invariance was established across the three samples. No cross-country differences on Internet addiction were detected at the latent mean level. This study provided empirical support for the IAT as a reliable and factorially stable instrument, and valid to be used across Asian adolescent populations.

Griffiths, M.D., Kuss, D.J., Billieux J. & Pontes, H.M. (2016). The evolution of internet addiction: A global perspective. Addictive Behaviors, 53, 193–195.

• Kimberly Young’s initial work on Internet addiction (IA) was pioneering and her early writings on the topic in- spired many others to carry out research in the area. Young’s (2015) recent paper on the ‘evolution of Internet addiction’ featured very little European research, and did not consider the main international evidence that has contributed to our current knowledge about the conceptualization, epidemiology, etiology, and course of Internet-related disorders. This short commentary paper elaborates on important literature omitted by Young that the present authors believe may be of use to researchers. We also address statements made in Young’s (2015) commentary that are incorrect (and therefore misleading) and not systematically substantiated by empirical evidence.

Stavropoulos, V., Kuss, D.K., Griffiths, M.D. & Motti-Stafanidi, F. (2016). A longitudinal study of adolescent internet addiction: The role of conscientiousness and classroom hostility. Journal of Adolescent Research, in press.

• Over the last decade, research on Internet addiction (IA) has increased. However, almost all studies in the area are cross-sectional and do not examine the context in which Internet use takes place. Therefore, a longitudinal study examined the role of conscientiousness (as a personality trait) and classroom hostility (as a contextual factor) in the development of IA. The participants comprised 648 adolescents and were assessed over a 2-year period (while aged 16-18 years). A three-level hierarchical linear model was carried out on the data collected. Findings revealed that (a) lower conscientiousness was associated with IA and this did not change over time and (b) although being in a more hostile classroom did not initially have a significant effect, it increased girls’ IA vulnerability over time and functioned protectively for boys. Results indicated that the contribution of individual and contextual IA factors may differ across genders and over time. More specifically, although the protective effect of conscientiousness appeared to hold, the over-time effect of classroom hostility increased the risk of IA for girls. These findings are discussed in relation to the psychological literature. The study’s limitations and implications are also discussed.

Ostovar, S., Allahyar, N., Aminpoor, H. Moafian, F., Nor, M. & Griffiths, M.D. (2016). Internet addiction and its psychosocial risks (depression, anxiety, stress and loneliness) among Iranian adolescents and young adults: A structural equation model in a cross-sectional study. International Journal of Mental Health and Addiction, in press.

• Internet addiction has become an increasingly researched area in many Westernized countries. However, there has been little research in developing countries such as Iran, and when research has been conducted, it has typically utilized small samples. This study investigated the relationship of Internet addiction with stress, depression, anxiety, and loneliness in 1052 Iranian adolescents and young adults. The participants were randomly selected to complete a battery of psychometrically validated instruments including the Internet Addiction Test, Depression Anxiety Stress Scale, and the Loneliness Scale. Structural equation modeling and Pearson correlation coefficients were used to determine the relationship between Internet addiction and psychological impairments (depression, anxiety, stress and loneliness). Pearson correlation, path analysis, multivariate analysis of variance (MANOVA), and t-tests were used to analyze the data. Results showed that Internet addiction is a predictor of stress, depression, anxiety, and loneliness. Findings further indicated that addictive Internet use is gender sensitive and that the risk of Internet addiction is higher in males than in females. The results showed that male Internet addicts differed significantly from females in terms of depression, anxiety, stress, and loneliness. The implications of these results are discussed.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Billieux, J., Deleuze, J., Griffiths, M.D., & Kuss, D.J. (2015). Internet addiction: The case of massively multiplayer online role playing games. In N. El-Guebaly, M. Galanter, & G. Carra (Eds.), The Textbook of Addiction Treatment: International Perspectives (pp.1516-1525). New York: Springer.

Griffiths, M.D. (2010). Internet abuse and internet addiction in the workplace. Journal of Workplace Learning, 7, 463-472.

Griffiths, M.D. & Pontes, H.M. (2014). Internet addiction disorder and internet gaming disorder are not the same. Journal of Addiction Research and Therapy, 5: e124. doi:10.4172/2155-6105.1000e124.

King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2011). Assessing clinical trials of Internet addiction treatment: A systematic review and CONSORT evaluation. Clinical Psychology Review, 31, 1110-1116.

King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2012). Cognitive-behavioural approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology, 68, 1185-1195.

Kuss, D.J. & Griffiths, M.D. (2015). Internet Addiction in Psychotherapy. Basingstoke: Palgrave Macmillan.

Kuss, D.J., Griffiths, M.D. & Binder, J. (2013). Internet addiction in students: Prevalence and risk factors. Computers in Human Behavior, 29, 959-966.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2014). Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20, 4026-4052.

Kuss, D.J., Shorter, G.W., van Rooij, A.J., Griffiths, M.D., & Schoenmakers, T.M. (2014). Assessing Internet addiction using the parsimonious Internet addiction components model – A preliminary study. International Journal of Mental Health and Addiction, 12, 351-366.

Kuss, D.J., van Rooij, A.J., Shorter, G.W., Griffiths, M.D. & van de Mheen, D. (2013). Internet addiction in adolescents: Prevalence and risk factors. Computers in Human Behavior, 29, 1987-1996.

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: Does it really exist? (Revisited). In J. Gackenbach (Ed.), Psychology and the Internet: Intrapersonal, Interpersonal and Transpersonal Applications (2^nd Edition), (pp.141-163). New York: Academic Press.

Widyanto, L. & Griffiths, M.D. (2011). Unravelling the Web: Adolescents and Internet Addiction. In Virtual Communities: Concepts, Methodologies, Tools and Applications (pp. 2433-2453). Hershey, Pennsylvania: Idea Publishing.

Occult figure: David Bowie and living life at the extremes

Since David Bowie’s death earlier this year, I’ve already written two articles on the psychology of Bowie (which you can read here and here) but this article takes a look at the more extreme aspects of Bowie’s life (excluding his various addictions which I briefly examined in my previous pieces). As a long-time David Bowie fan I’ve been meaning to write this particular blog for a long time but just never got around to it. I had made lots of notes taken from various Bowie biographies (see ‘Further reading’ below) but Dr. Dean Ballinger (University of Waikato) recently beat me to the punch by publishing a similar article to the one I had planned in the March 2016 issue of the Fortean Times.

During Bowie’s five decades in music he has been interviewed on almost every conceivable topic but it’s always the interviews about his most extreme and esoteric subjects that have caught my eye whether it concerned his religious and spiritual beliefs, his political views, or his moral philosophy. I’ve always looked for hidden meanings in his lyrics and taken the view that his lyrics provide an insight into his personality as much as anything else that I have seen or read about him in the print and broadcast media. Like most other hardcore Bowie fans, I have been poring over the lyrics of his final studio album Blackstar now knowing that he wrote and recorded it while suffering from an aggressive form of cancer. The album is arguably his most cryptic and mysterious since the classics of the mid- to late-1970s (Station To Station, Low and “Heroes”) – although I also love 1.Outside and Heathen both lyrically and musically.

Looking back, it was probably the Station To Station title track that really made me wonder what was going on in Bowie’s head. Although Bowie says he was “out of his gourd” on cocaine at the time (and has little recollection of recording the album), the lyrics (as a teenager) made no sense to me at all (“Here are we/One magical movement/From Kether to Malkuth/There are you/You drive like a demon/From station to station”). I had no idea that Kether (“the crown” – divine will or pure light) and Malkuth (“the kingship” – the nurturing receptacle of the light) originated from Kabbalah (an esoteric school of thought rooted in Judaism) representing two of 10 sephirots (sometimes spelled ‘sefirots’ and meaning ’emanations’ or ‘attributes’) in the Tree of Life.

During his cocaine-fuelled days, Bowie rarely slept and filled his time reading books. Not only books about Kabbalah but also books on the occult (a number of books by Aleister Crowley; Louis Pauwels and Jacques Bergier’s The Morning of the Magicians; Israel Regardie’s books on the Hermetic Order of the Golden Dawn), on the symbolic obsessions of Nazism (most notably Trevor Ravenscroft’s The Spear of Destiny), and defensive magic and tarot cards (Dion Fortune’s Psychic Self-Defense) as well as more general books on the secret history of Christianity, UFOs, political conspiracies, and numerology. It’s also worth noting that Bowie’s 1976 persona (‘The thin white duke’ in his ‘Station To Station’ lyric) is almost certainly taken from Crowley’s erotic poetry (“The return of the thin white duke making sure white stains” from the 1898 book White Stains).

It’s been claimed by Chris O’Leary (author of the excellent Rebel Rebel and founder of the Pushing Ahead of The Dame website) that “Bowie’s immersion in Kabbalah was part of an overarching spiritual quest that took him from Tibetan Buddhism (he almost joined a monastery in the late 1960s, until his teacher told him that he’d make a better musician than monk) to Christian mysticism, occult worship and a flirtation with neo-Nazi imagery that nearly derailed his career when it was discovered that he collected Nazi memorabilia”. I hadn’t realised that Bowie had made reference to the occult in earlier songs such as ‘Quicksand’ (The Order of the Golden Dawn – a late 19th/early 20th century organisation devoted to the practice of occult, metaphysical, and paranormal phenomena, and the root of more traditional modern day occult practices such as Thelema and Wicca) as well as Tibetan Buddhism (more specifically his use of the word ‘Bardo’ in the song – the state of existence intermediate between two lives on earth).

Bowie’s interest in Buddhism and Tibet dates back to the 1960s as evidenced by songs such as ‘Silly Boy Blue’ (first demoed in 1965). In an interview by Bowie with the Melody Maker (24 February, 1966) notes:

“I want to go to Tibet. It’s a fascinating place, y’know. I’d like to take a holiday and have a look inside the monasteries. The Tibetan monks, Lamas, bury themselves inside mountains for weeks, and only eat every three days. They’re ridiculous—and it’s said they live for centuries…As far as I’m concerned the whole idea of Western life – that’s the life we live now – is wrong. These are hard convictions to put into songs, though”.

Chris O’Leary also noted that:

“Bowie’s interest in Tibetan Buddhism wasn’t a sudden trendy affectation—he had begun exploring the religion when he was in his mid-teens, first inspired by reading Heinrich Harrer’s 1952 book Seven Years in Tibet, and he eventually met and befriended the Tibetan lama Chimi Youngdong Rimpoche, who was exiled in London. Bowie even fantasized about becoming a Buddhist monk – cropping his hair and dyeing it black, wearing saffron robes and even changing his skin color (he’d have to settle for becoming Ziggy). Buddhism was an early influence in his songs: he had meant for the backing chorus of his single ‘Baby Loves That Way’ to sound like chanting monks.”

Bowie didn’t appear to have strong religious beliefs. In an interview in 1997 he noted that there was an “abiding need in me to vacillate between atheism or a kind of Gnosticism…what I need is to find a balance, spiritually, with 
the way I live and my demise” but in relation to thoughts on his own mortality he said “I believe in a continuation, kind of a dream-state without the dreams. Oh, I don’t know. I’ll come back and tell you”. In addition to his spiritual leanings, Dr. Ballinger in his 2016 Fortean Times article goes as far to say that occult and paranormal themes constituted an “integral dimension” of Bowie’s career. Bowie clearly had an interest in aliens, science fiction, and the paranormal as reflected in many of his singles dating back to ‘Space Oddity’ (1969) through to ‘Loving The Alien’ (1985) and ‘Hallo Spaceboy’ (1996) (as well as many album tracks and his acting breakthrough as an alien in Nic Roeg’s film The Man Who Fell To Earth). Dr. Ballinger also argued that:

“Bowie was also reading upon esoteric subjects and alternative ideas in a relatively in-depth way beyond fashionable name dropping is made clear by the songs 
on his fourth album, Hunky Dory (1971).
 The jaunty pop of ‘Oh You Pretty Things!’ is belied by lyrics that evoke a rather sinister picture of spiritual evolution, in which the listener is asked to ‘make way’ for ‘the coming race’ of ‘homo superior’ Nietszchean super children…The ‘coming race’ is also a probable nod to the Bulwer-Lytton novel of the same name that became a staple of the ‘Vril’ mythos associated with occult-minded Nazis, a subject that would have a rather negative influence on Bowie in the near future. More overt is the ballad ‘Quicksand’, in which Bowie expounds a New Age manifesto – ‘I’m not a prophet or a Stone Age man/Just a mortal with potential of a superman’ – with reference to the Western magical tradition (‘I’m closer to the Golden Dawn/Immersed in Crowley’s uniform/of imagery), [and] The Tibetan Book of the Dead (‘You can tell me all about it on the next Bardo’)”.

Bowie wasn’t the first musician to use The Tibetan Book of the Dead as inspiration for lyrics. More famously, John Lennon used it for The Beatles classic ‘Tomorrow Never Knows’, the final track on the 1966 Revolver album (something I forgot to mention in my previous article on Bowie and The Beatles). However, John Lennon based his lyrics after reading The Psychedelic Experience: A Manual Based on The Tibetan Book of the Dead written by Timothy Leary, Ralph Metzner and Richard Alpert. (And while I’m going off on tangents, I just wanted to mention that Alpert’s most well known book Be Here Now just happens to be the title of (Beatle-loving) Oasis’ third album).

Dr. Ballinger also makes the argument that in Bowie’s 1972 breakthrough LP The Rise and Fall of Ziggy Stardust and the Spiders From Mars there were “evident resonances between occultism and his musical career” and that he drew inspiration from a wide range of esoteric cultural influences to source “stimulating ideas and imagery to explore in lyrics, costumes and videos”. Ballinger also claims that Bowie’s work at this point of his career had a more integral relationship with the theory and practice of magic and occultism:

“Parsing Crowley’s legacy, one of the key aspects of magic is the transformation of the self (and, possibly, the wider social reality) through acts that focus the imagination/will towards such change, such acts including sex, drug consumption, meditation, and creative performance (i.e., rituals). In this vein Bowie can be considered a distinctly magical musician whose whole career revolved around the transformation of the self and the wider culture through the ‘ritual performances’
of rock music, such as concerts, recordings, and videos. In his most influential period
 of the 1970s, Bowie created personae (such 
as Ziggy, Aladdin Sane, and the Thin White Duke) and undertook musical experiments (the ‘plastic soul’ of Young Americans and the avant-garde/krautrock/funk synthesis of the ‘Berlin trilogy’) that in turn transformed rock culture by inspiring scores of other artists. The gender-bending that was a notable aspect of Bowie’s personae in this period (for example, the androgynous cover photo for The Man Who Sold The World (1970) or the 1979 video for ‘Boys Keep Swinging’), and the cultivation of bisexual overtones in his lyrics and performance (‘John, I’m Only Dancing’ as an account of bisexual angst), are also interesting to consider in relation to Crowley’s emphasis on sexuality as a core component of magical transformation”.

Like some of the best music by The Beatles, some of the best music made by Bowie was while he was using drugs excessively (often described by his biographers as a ‘cocaine-induced psychosis’). Bowie himself claims that in 1975 he was in poor mental and physical health but ironically he was producing some of the best music (and acting) of his career. However, Bowie’s cocaine addiction has also been used as an excuse for his behaviour during the 1976 period where he flirted with Nazi occultism and made the claim that the UK would benefit from a fascist leader (“I think I might have been a bloody good Hitler. I’d be an excellent dictator. Very eccentric and quite mad”). Many musicians have said they are interested in Nazi imagery and fashion (e.g., Bryan Ferry) and others have collected Nazi memorabilia (e.g., Lemmy) but these interests do not mean such people are Nazi-loving or fascists.

Bowie’s esoteric and occultist interests appear to subside as his career progressed and it wasn’t until his final album that Bowie appeared to be using music (and the accompanying promo videos) in a symbolic way for people to re-interpret his music as a cryptic death note to all his hardcore acolytes (of which I would include myself). Unless Bowie left any explanation for his final seven songs, we can only speculate. However, I’ll leave you with the thoughts of Dr. Ballinger who has done a better job than I could ever do:

“The Blackstar album has seen Bowie go out with a distinctly occult bang…As every prior Bowie album cover has featured a portrait, the five-pointed ‘black star’ of 
this one is presumably meant to represent Bowie too – perhaps in his ultimate persona as spirit (the five-pointed star being a classic Hermetic/Gnostic symbol of ‘man as microcosm’, with the contradictory image of a ‘black star’ also evoking a koan or the alchemical union of opposites). The creepy atmosphere conjured up by the lyrics of the title track – “In the villa of Ormen/Stands a solitary candle/On the day of execution/Only women stand and smile” – is successfully evoked in the video for the song. Bowie 
is depicted as preacher of some dark 21st century faith, brandishing a Blackstar bible among acolytes whose spasmodic ‘dancing’ suggests a state of possession. A reading of the imagery here as analogous to Crowley and his Book of the Law is perhaps apt; director Johan Renck, who designed the videos with Bowie, has mentioned Crowley as a reference point. Some kind of Hermetic/Gnostic subtext about eternity, spirit and the flesh is further implied in the imagery of the video’s other ‘storyline’, in which the shade of a dead astronaut – Bowie himself, in his formative Major Tom persona? – floats up into a ‘black star’ of eternity, before, in a possibly Orphic reference, leaving behind his bejewelled skull for ritual veneration by a sect of mutant women. Where the esoteric overtones of the ‘Blackstar’ video are eerie, those of the video for ‘Lazarus’ are poignant. Bowie plays himself as a patient in a hospital bed, whose closet is a portal from which appears a double who is seemingly meant to signify his essential spirit. This figure is not garbed as Ziggy, the Thin White Duke
 or any of Bowie’s most famous personae, but in the striped black jumpsuit in which he undertook the famous occult photo shoot for Station to Station, in which he is depicted drawing Kabbalistic symbols on the wall. That Bowie chose this costume for his valedictory performance suggests he was giving a subtle nod to the deep, lasting metaphysical significance that this period had upon the rest of his life”.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Ballinger, D. (2016). The mage who sold the world. Fortean Times, 338, 28-33.

Buckley, D. (2005). Strange Fascination: David Bowie – The Definitive Story. London: Virgin Books.

Cann, K. (2010). Any Day Now: David Bowie The London Years (1947-1974). Adelita.

Doggett, P. (2012). The Man Who Sold The World: David Bowie and the 1970s. London: Vintage.

Goddard, S. (2015). Ziggyology. London: Ebury Press.

Hewitt, P. (2013). David Bowie Album By Album. London: Carlton Books Ltd.

Leigh, W. (2014). Bowie: The Biography. London: Gallery.

O’Leary, C. (2016). Rebel Rebel. Alresford: Zero Books.

Pegg, N. (2011). The Complete David Bowie. London: Titan Books.

Rogovoy, S. (2013). The secret Jewish history of David Bowie. Forward.com, April 16. Located at: http://forward.com/culture/174551/the-secret-jewish-history-of-david-bowie/

Seabrook, T.J. (2008). Bowie In Berlin: A New Career In A New Town. London: Jawbone.

Spitz, M. (2009). Bowie: A Biography. Crown Archetype.

Trynka, P. (2011). Starman: David Bowie – The Definitive Biography. London: Little Brown & Company.

Stick in the Buddhism: Mindfulness in the treatment of addiction and improved psychological wellbeing (Part 2)

Following on from my previous blog, here are some of my more recent papers with Dr. Edo Shonin and William Van Gordon on mindfulness that have been appearing on my Research Gate and Academia.edu webpages. We are happy for anyone interested in these papers to contact us at the email addresses below.

Griffiths, M.D., Shonin, E.S., & Van Gordon, W. (2015). Mindfulness as a treatment for gambling disorder. Journal of Gambling and Commercial Gaming Research, 1, 1-6.

• Mindfulness is a form of meditation that derives from Buddhist practice and is one of the fastest growing areas of psychological research. Studies investigating the role of mindfulness in the treatment of behavioural addictions have – to date – primarily focused on gambling disorder. Recent pilot studies and clinical case studies have demonstrated that weekly mindfulness therapy sessions can lead to clinically significant change among individuals with gambling problems. This purpose of this paper is to appraise current directions in gambling disorder research as it relates to mindfulness approaches, and discuss issues that are likely to hinder the wider acceptance of mindfulness as a treatment for gambling disorder. It is concluded that although preliminary findings indicate that there are applications for mindfulness approaches in the treatment of gambling disorder, further empirical and clinical research utilizing larger-sample controlled study designs is clearly needed.

Shonin, E., Van Gordon W., Compare, A., Zangeneh, M. & Griffiths M.D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161–1180.

• Although clinical interest has predominantly focused on mindfulness meditation, interest into the clinical utility of Buddhist-derived loving-kindness meditation (LKM) and compassion meditation (CM) is also growing. This paper follows the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines and provides an evaluative systematic review of LKM and CM intervention studies. Five electronic academic databases were systematically searched to identify all intervention studies assessing changes in the symptom severity of Diagnostic and Statistical Manual of Mental Disorders (text revision fourth edition) Axis I disorders in clinical samples and/or known concomitants thereof in sub-clinical/healthy samples. The comprehensive database search yielded 342 papers and 20 studies (comprising a total of 1,312 participants) were eligible for inclusion. The Quality Assessment Tool for Quantitative Studies was then used to assess study quality. Participants demonstrated significant improvements across five psychopathology-relevant outcome domains: (i) positive and negative affect, (ii) psychological distress, (iii) positive thinking, (iv) interpersonal relations, and (v) empathic accuracy. It is concluded that LKM and CM interventions may have utility for treating a variety of psychopathologies. However, to overcome obstacles to clinical integration, a lessons-learned approach is recommended whereby issues encountered during the (ongoing) operationalization of mindfulness interventions are duly considered. In particular, there is a need to establish accurate working definitions for LKM and CM.

Shonin, E., Van Gordon W., & Griffiths M.D. (2014). The emerging role of Buddhism in clinical psychology: Towards effective integration. Psychology of Religion and Spirituality, 6, 123-137.

• Research into the clinical utility of Buddhist-derived interventions (BDIs) has increased greatly over the last decade. Although clinical interest has predominantly focused on mindfulness meditation, there also has been an increase in the scientific investigation of interventions that integrate other Buddhist principles such as compassion, loving kindness, and “non-self.” However, due to the rapidity at which Buddhism has been assimilated into the mental health setting, issues relating to the misapplication of Buddhist terms and practices have sometimes arisen. Indeed, hitherto, there has been no unified system for the effective clinical operationalization of Buddhist principles. Therefore, this paper aims to establish robust foundations for the ongoing clinical implementation of Buddhist principles by providing: (i) succinct and accurate interpretations of Buddhist terms and principles that have become embedded into the clinical practice literature, (ii) an overview of current directions in the clinical operationalization of BDIs, and (iii) an assessment of BDI clinical integration issues. It is concluded that BDIs may be effective treatments for a variety of psychopathologies including mood-spectrum disorders, substance-use disorders, and schizophrenia. However, further research and clinical evaluation is required to strengthen the evidence-base for existent interventions and for establishing new treatment applications. More important, there is a need for greater dialogue between Buddhist teachers and mental health clinicians and researchers to safeguard the ethical values, efficacy, and credibility of BDIs.

Van Gordon W., Shonin, E., Griffiths M.D. & Singh, N. (2015). There is only one mindfulness: Why science and Buddhism need to work together. Mindfulness, 6, 49-56.

• This commentary provides an alternative perspective to some of the key arguments and observations outlined by Monteiro and colleagues (2015) concerning the relative deficiency of authenticity in secular mindfulness-based approaches compared with mainstream Buddhist practice traditions. Furthermore, this is achieved by critically examining the underlying assumption that if secular mindfulness-based approaches represent a more ‘superficial’ construction of mindfulness, then the ‘superior’ approach embodied by present-day Buddhist teachers and traditions should be easily identifiable. More specifically, a means of understanding mindfulness (and related Buddhist meditative principles) is presented that attempts to communicate the versatility and underlying unity of the Buddha’s teachings, and the fact that the scriptural, empirical, and logical grounds for asserting that secular mindfulness-based approaches offer a less authentic practice mode than mainstream Buddhist modalities are not as robust as contemporary general opinion might suggest.

Shonin, E., Van Gordon, W. & Griffiths, M.D. (2015). Does mindfulness work? Reasonably convincing evidence in depression and anxiety. British Medical Journal, 351, h6919 doi: 10.1136/bmj.h6919.

• In 2014, over 700 scientific papers on mindfulness were published, which is more than double the amount of mindfulness papers published in 2010. Approximately 80% of adults and 70% of General Practitioners in the UK believe that practising mindfulness can lead to health benefits. The most convincing evidence exists for the use of mindfulness-based interventions (MBIs) in the treatment of depression and anxiety. Meta-analytic studies assessing the efficacy of mindfulness as a treatment for these two disorders have typically reported effect sizes in the moderate-strong to strong range. There is increasing evidence suggesting that mindfulness is an effective means of increasing perceptual distance from distressing psychological and somatic stimuli, and that it leads to functional neuroplastic changes in the brain. However, the aforementioned ‘fashionable’ status of mindfulness amongst both the general public and scientific community has likely overshadowed the need to address a number of key methodological and operational issues concerning its treatment efficacy.

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D., Shonin, E.S., & Van Gordon, W. (2015). Mindfulness as a treatment for gambling disorder. Journal of Gambling and Commercial Gaming Research, 1, 1-6.

Shonin, E., Van Gordon W., Compare, A., Zangeneh, M. & Griffiths M.D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161–1180.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2015). Mindfulness in psychology: A breath of fresh air? The Psychologist: Bulletin of the British Psychological Society, 28, 28-31.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2015). Teaching ethics in mindfulness-based interventions. Mindfulness, 6, 1491–1493.

Shonin, E., Van Gordon, W. & Griffiths, M.D. (2015). Does mindfulness work? Reasonably convincing evidence in depression and anxiety. British Medical Journal, 351, h6919 doi: 10.1136/bmj.h6919.

Shonin, E., Van Gordon, W., & Griffiths, M.D. (2016). Mindfulness and Buddhist-derived treatment techniques in mental health and addiction settings. In Shonin, E., Van Gordon, W., & Griffiths, M.D. (Eds.), Mindfulness and Buddhist-derived Approached in Mental Health and Addiction (pp. 1-6). New York: Springer.

Van Gordon, W., Shonin, E., Griffiths, M.D., & Singh. N.N. (2015). Mindfulness and the Four Noble Truths. In: Shonin, E., Van Gordon, W., & Singh, N. N. (Eds). Buddhist Foundations of Mindfulness. (pp. 9-27). New York: Springer.

Van Gordon W., Shonin, E., Griffiths M.D. & Singh, N. (2015). There is only one mindfulness: Why science and Buddhism need to work together. Mindfulness, 6, 49-56.

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2015). Can second generation of mindfulness-based interventions be helpful in treating psychiatric disorders? Australian and New Zealand Journal of Psychiatry, 49, 591-592.

Shonin, E., Van Gordon, W., & Griffiths, M.D. (2016), Mindfulness and Buddhist-derived Approaches in Mental Health and Addiction. New York: Springer.

Van Gordon, W., Shonin, E., Singh. N.N. & Griffiths, M.D. (2015). The mindfulness of emptiness and the emptiness of mindfulness. In: Shonin, E., Van Gordon, W., & Singh, N. N. (Eds). Buddhist Foundations of Mindfulness (pp. 159-179). New York: Springer.

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2015). Mindfulness in mental health: A critical reflection. Journal of Psychology, Neuropsychiatric Disorders and Brain Stimulation, 1(1), 102.

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Are contemporary mindfulness-based interventions unethical? British Journal of General Practice, 66, 94-95.

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Meditation Awareness Training for individuals with fibromyalgia syndrome: An interpretative phenomenological analysis of participants’ experience. Mindfulness, in press.

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Buddhist emptiness theory: Implications for the self and psychology. Psychology of Religion and Spirituality, in press.

Van Gordon, W., Shonin, E., Cavalli, G. & Griffiths, M.D. (2016). Ontological addiction: Classification, aetiology and treatment. Mindfulness, in press.

Stick in the Buddhism: Mindfulness in the treatment of addiction and improved psychological wellbeing (Part 1)

Over the last year I’ve been receiving a lot of emails (well, about nine or ten to be honest but it seems like a lot) expressing surprise at the increasing numbers of papers on mindfulness that have been appearing on my Research Gate and Academia.edu webpages. This research program is actually being led by my friends and Nottingham Trent University research colleagues, Dr. Edo Shonin and Willliam Van Gordon. Given this increasing level of interest, I thought I would use my next two blogs to briefly overview some of these publications. My research colleagues and I are happy for anyone interested in these papers to contact us at the email addresses below. We also have a new book on the topic too (Mindfulness and Buddhist-derived Approaches in Mental Health and Addiction).

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 806–823.

• There is a paucity of interventional approaches that are sensitive to the complex needs of individuals with co-occurring schizophrenia and pathological gambling. Utilizing a single-participant design, this study conducted the first clinical evaluation of a novel and integrated non-pharmacological treatment for a participant with dual-diagnosis schizophrenia and pathological gambling. The participant underwent a 20-week treatment course comprising: (i) an initial phase of second-wave cognitive behavioral therapy (CBT), and (ii) a subsequent phase employing a meditation-based recovery model (involving the administering of an intervention known as Meditation Awareness Training). The primary outcome was diagnostic change (based on DSM-IV-TR criteria) for schizophrenia and pathological gambling. Secondary outcomes were: (i) psychiatric symptom severity, (ii) pathological gambling symptom severity, (iii) psychosocial functioning, and (iv) dispositional mindfulness. Findings demonstrated that the participant was successfully treated for both schizophrenia and pathological gambling. Significant improvements were also observed across all other outcome variables and positive outcomes were maintained at three-month follow-up. An initial phase of CBT to improve social coping skills and environmental mastery, followed by a phase of meditation-based therapy to increase perceptual distance from mental urges and intrusive thoughts, may be a diagnostically-syntonic treatment for co-occurring schizophrenia and pathological gambling.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: Journal of Science and Healing, 10, 193-195.

• Recent decades have witnessed a marked increase in research investigating the etiology, typology, symptoms, prevalence, and correlates of workaholism. However, despite increasing prevalence rates for workaholism, there is a paucity of workaholism treatment studies. Indeed, guidelines for the treatment of workaholism tend to be based on either theoretical proposals or anecdotal reports elicited during clinical practice. Thus, there is a need to establish dedicated and effective treatments for workaholism. A novel broad-application interventional approach receiving increasing attention by occupational and healthcare stakeholders is that of third-wave cognitive behavioral therapies (CBTs). Third-wave CBTs integrate aspects of Eastern philosophy and typically employ a meditation-based recovery model. A primary treatment mechanism of these techniques involves the regulation of psychological and autonomic arousal by increasing perceptual distance from faulty thoughts and mental urges. A ‘meditative anchor’, such as observing the breath, is typically used to aid concentration and to help maintain an open-awareness of present moment sensory and cognitive-affective experience. The purpose of this case study was to conduct the first evaluation of a treatment employing a meditation-based recovery model for a workaholic.

Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioral Addictions, 2, 63-71.

• In the last five years, scientific interest into the potential applications of Buddhist-derived interventions (BDIs) for the treatment of problem gambling has been growing. This paper reviews current directions, proposes conceptual applications, and discusses integration issues relating to the utilisation of BDIs as problem gambling treatments. A literature search and evaluation of the empirical literature for BDIs as problem gambling treatments was undertaken. To date, research has been limited to cross-sectional studies and clinical case studies and findings indicate that Buddhist-derived mindfulness practices have the potential to play an important role in ameliorating problem gambling symptomatology. As an adjunct to mindfulness, other Buddhist-derived practices are also of interest including: (i) insight meditation techniques (e.g., meditation on ‘emptiness’) to overcome avoidance and dissociation strategies, (ii) ‘antidotes’ (e.g., patience, impermanence, etc.) to attenuate impulsivity and salience-related issues, (iii) loving-kindness and compassion meditation to foster positive thinking and reduce conflict, and (iv) ‘middle-way’ principles and ‘bliss-substitution’ to reduce relapse and temper withdrawal symptoms. In addition to an absence of controlled treatment studies, the successful operationalisation of BDIs as effective treatments for problem gambling may be impeded by issues such as a deficiency of suitably experienced BDI clinicians, and the poor provision by service providers of both BDIs and dedicated gambling interventions. Preliminary findings for BDIs as problem gambling treatments are promising, however, further research is required.

Shonin, E.S., van Gordon, W., Slade, K. & Griffiths, M.D. (2013). Mindfulness and other Buddhist-derived interventions in correctional settings: A systematic review. Aggression and Violent Behavior, 18, 365-372.

• Throughout the last decade, there has been a growth of interest into the rehabilitative utility of Buddhist-derived interventions (BDIs) for incarcerated populations. The purpose of this study was to systematically review the evidence for BDIs in correctional settings. MEDLINE, Science Direct, ISI Web of Knowledge, PsychInfo, and Google Scholar electronic databases were systematically searched. Reference lists of retrieved articles and review papers were also examined for any further studies. Controlled intervention studies of BDIs that utilised incarcerated samples were included. Jaded scoring was used to evaluate methodological quality. PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines were followed. The initial comprehensive literature search yielded 85 papers but only eight studies met all the inclusion criteria. The eight eligible studies comprised two mindfulness studies, four vipassana meditation studies, and two studies utilizing other BDIs. Intervention participants demonstrated significant improvements across five key criminogenic variables: (i) negative affective, (ii) substance use (and related attitudes), (iii) anger and hostility, (iv) relaxation capacity, and (v) self-esteem and optimism. There were a number of major quality issues. It is concluded that BDIs may be feasible and effective rehabilitative interventions for incarcerated populations. However, if the potential suitability and efficacy of BDIs for prisoner populations is to be evaluated in earnest, it is essential that methodological rigour is substantially improved. Studies that can overcome the ethical issues relating to randomisation in correctional settings and employ robust randomised controlled trial designs are favoured.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Mindfulness meditation in American correctional facilities: A ‘what-works’ approach to reducing reoffending. Corrections Today: Journal of the American Correctional Association, March/April, 48-51.

• Throughout the last decade, there has been a growth of interest into the rehabilitative utility of Buddhist-derived interventions (BDIs) for incarcerated populations. The purpose of this study was to systematically review the evidence for BDIs in correctional settings. MEDLINE, Science Direct, ISI Web of Knowledge, PsychInfo, and Google Scholar electronic databases were systematically searched. Reference lists of retrieved articles and review papers were also examined for any further studies. Controlled intervention studies of BDIs that utilised incarcerated samples were included. Jaded scoring was used to evaluate methodological quality. PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines were followed. The initial comprehensive literature search yielded 85 papers and but only eight studies met all the inclusion criteria. The eight eligible studies comprised two mindfulness studies, four vipassana meditation studies, and two studies utilizing other BDIs. Intervention participants demonstrated significant improvements across five key criminogenic variables: (i) negative affective, (ii) substance use (and related attitudes), (iii) anger and hostility, (iv) relaxation capacity, and (v) self-esteem and optimism. There were a number of major quality issues. It is concluded that BDIs may be feasible and effective rehabilitative interventions for incarcerated populations. However, if the potential suitability and efficacy of BDIs for prisoner populations is to be evaluated in earnest, it is essential that methodological rigour is substantially improved. Studies that can overcome the ethical issues relating to randomisation in correctional settings and employ robust randomised controlled trial designs are favoured.

Contact details

e.shonin@awaketowisdom.co.uk; william@awaketowisdom.co.uk; mark.griffiths@ntu.ac.uk

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Additional input by Edo Shonin and William Van Gordon

Further reading

Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2012). The health benefits of mindfulness-based interventions for children and adolescents, Education and Health, 30, 94-97.

Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2013). Mindfulness-based interventions: Towards mindful clinical integration. Frontiers in Psychology, 4, 194, doi: 10.3389/fpsyg.2013.00194.

Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioral Addictions, 2, 63-71.

Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 617, 654-654.

Shonin, E., Van Gordon, W. & Griffiths, M.D. (2013). Mindfulness and addiction: Sending out an SOS. Addiction Today, March, 18-19.

Shonin, E., Van Gordon, W. & Griffiths, M.D. (2013). Mindfulness-based therapy: A tool for spiritual growth? Thresholds, Summer, 14-18.

Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2014). Practical tips for using mindfulness in general practice. British Journal of General Practice, 624 368-369.

Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2014). Meditation Based Awareness Training (MBAT) for psychological wellbeing: A qualitative examination of participant experiences. Journal of Religion and Health, 53, 849–863.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Mindfulness meditation in American correctional facilities: A ‘what-works’ approach to reducing reoffending. Corrections Today: Journal of the American Correctional Association, March/April, 48-51.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Does mindfulness meditation have a role in the treatment of psychosis? Australian and New Zealand Journal of Psychiatry, 48, 124-127.

Shonin, E., Van Gordon W., & Griffiths M.D. (2014). The emerging role of Buddhism in clinical psychology: Towards effective integration. Psychology of Religion and Spirituality, 6, 123-137.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: Journal of Science and Healing, 10, 193-195.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2014). Mindfulness and the Social Media, Mass Communication and Journalism, 4: 194. doi: 10.4172/2165-7912.1000194.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 181-196.

Shonin, E., Van Gordon, W., & Griffiths, M.D. (2016), Mindfulness and Buddhist-derived Approaches in Mental Health and Addiction. New York: Springer.

Shonin, E.S., van Gordon, W., Slade, K. & Griffiths, M.D. (2013). Mindfulness and other Buddhist-derived interventions in correctional settings: A systematic review. Aggression and Violent Behavior, 18, 365-372.

Shonin, E., Van Gordon W., & Griffiths, M.D. (2014). Are there risks associated with using mindfulness for the treatment of psychopathology? Clinical Practice, 11, 389-392.

Van Gordon, W. Shonin, E.S., Skelton, K. & Griffiths, M.D. (2014). Working mindfully: Can mindfulness improve work-related wellbeing and work? Counselling at Work, 87, 14-19.

Van Gordon, W., Shonin, E., Sumich, A., Sundin, E., & Griffiths, M.D. (2014). Meditation Awareness Training (MAT) for psychological wellbeing in a sub-clinical sample of university students: A controlled pilot study. Mindfulness, 12, 806–823.