佛教圖書館館刊 第六十二期 106年6月

專注力的理論與實踐

──佛教專注力訓練

廖建智 中國醫藥大學附設醫院豐原分院兼任主治醫師、康誠身心醫學科診所門診醫師


【摘要】專注力(Attention)是心智活動的過程,其具有多面向的功能表現,包括了警覺、聚焦注意、持續、定向、衝突覺察和回復。研究顯示,專注力的訓練可以透過活動與記憶,修飾神經迴路而改善。在諸多專注力訓練中,佛教正念冥想(Mindfulness Meditation)被證實能改善專注力。進一步分析佛教專注力訓練,傳統上主要有兩種方式;1. 聚焦專注冥想(Focused Attention Meditation, FAM):相當於奢摩他的方式。2. 開放覺察冥想(Open Monitoring Meditation, OMM):相當於毘婆舍那的方式。此外,亦有將慈悲觀另立為第三種。研究顯示皆能提升改善專注力整體功能,但分項上有明顯差異。推論是訓練方式不同,造成大腦塑性的差異。未來研究上,則需要對佛教專注力訓練方式進一步分析,並訂出更標準化的檢測。

關鍵詞:專注力(Attention);正念(Mindfulness);大腦可塑性(Brain Plasticity);奢摩他(Śamatha);毘婆舍那(Vipaśyanā)


一、專注力(Attention)

  「專注力(Attention)是什麼?」當你看著這個問題,心裡想著可能的內容時,那表示你正在執行你的專注力。

  其實專注力是個複雜和多面向的心智活動,目前仍存在不同面向的觀察與解釋理論。以下我們從精神、認知行為現象描述、臨床復健觀察和近代腦影像學觀點來說明專注力活動和其可被評估的特質。

  從精神(Psychiatry)和行為學來說,專注力(Attention /Concentration)是一種意識活動現象,表現出能夠聚焦(Focus)個人內外在經驗、活動並且加以辨識的能力。(註1)

  從認知行為觀察來說,專注能夠在眾多離散的訊息中,過濾不要的訊息並選擇注意的對象,不管這對象是主觀或客觀(註2)。專注力與接續的理解、記憶等相關,也可被視為是一個心智活動的過程(e.g. Gunaratana, 1993; Kapleau, 1965; Teasdale, Segal, & Williams, 1995)。

  從臨床職能復健觀察,專注力表現形態具有五個面向,包括:1. 聚焦性專注力(Focused Attention):聚焦在所要專注的目標上。2. 持續性專注力(Sustained Attention):長時間專注在某一目標上。3. 選擇性專注力(Selective Attention):過濾雜訊,專注在選取的目標上。4. 交替性專注力(Alternating Attention):將專注由一個目標轉移到另一個目標。5. 分配性專注力(Divided Attention):同時注意兩種或兩種以上目標。(註3)。

  腦神經科學從行為測驗、影像證據和神經元動力互動(Dynamic Interactions)的現象,建構了專注力的腦功能網絡模式(Attention Network Model)(註4);也就是專注力是由大腦許多功能區合作完成。如研究顯示,大腦右前額葉(Right Prefrontal Lobe)和額葉頂葉網絡(Frontoparietal Network)在專注力執行上,不管是「由上而下的調控專注」(Top-Down Attention)或「由下而上的調控專注」(Bottom-Up Attention)(註5),(註6)皆扮演過濾、發起和調控等重要角色(註7)。

  在專注力的評量方面,專注力具有三個特質可被分項評估,包括:1. 警覺(Alerting):備製或找尋將起的刺激、張力或影響的訊息或標的。2. 定向(Orienting):從眾多的感官刺激(Sensory Stimuli)中排除雜訊,找尋特別訊息。3. 衝突覺察(Conflict Monitoring):如執行專注(Executive Attention)覺察衝突和解決衝突。這三個特質可以透過專注網絡測驗(Attention Network Test, ANT)或腦影像等評估。(註8)

二、專注力的改善

  專注力與大腦功能表現息息相關(註9)。許多研究顯示,大腦是具有可塑性(Neuro-plasticity)。不管是在發育時期或成年後,行為經驗(Behavioral Experience)和神經活動(Neural Activity)都可以修飾(Modify)大腦的神經迴路(Neural Circuits)(註10)。行為、環境刺激、思考和情緒都可能透過「活動-依靠修飾」(Activity-Dependent Plasticity)(註11)模式讓腦的神經迴路發生改變(Brain Plasticity)(註12)。這也說明了透過健康的發展、學習和記憶可以治療某些腦的障礙(註13),改善專注力(註14)。

  然而專注力要如何被改善?在許多的復健和訓練專注力的方法中,東方佛教的正念冥想(Mindfulness Meditation)已經被廣泛研究,對於專注力的改善有正面的影響(註15)。

  許多研究顯示,正念冥想練習對專注力執行(Attention Performance)有正面改善(註16);也有研究顯示,能改善衝突覺察(Conflict Monitoring)(註17)。然而正念的運用來自於傳統佛教,故進一步探討和比較當代研究者對佛教專注力的研究成果,可以更加理解佛教專注力訓練的原理與方式。

三、佛教對於專注力的訓練

  關於佛教對於專注力的訓練,傳統上,其目的是為了讓修行者更清晰的體認佛陀的教導,當然這也包括認知、情緒控制和記憶等心智活動。而近代研究者的研究目標在於探討佛教專注力訓練對腦部產生的影響和變化(註18),並進一步與認知、行為、精神醫學和腦神經影像學結合,嘗試解釋人類專注力、情緒和記憶間的關聯性(註19)。兩者間目的雖有差異,但對於人類心智的探討是一致的。

  對於傳統佛教專注力訓練方式的分類,許多研究文獻使用冥想(Meditation)、正念(Mindfulness)或正念冥想(Mindfulness Meditation)語詞來概括表示。但這樣的分類是不夠精確的(註20)。實際上傳統佛教對於專注力的訓練有許多方式,《清淨道論》(巴利語Visuddhimagga)將其稱為業處(巴利語kammaṭṭhāna),並將一切業處分為奢摩他(巴利語samatha)和毘婆舍那(巴利語vipassanā)兩種方式。而漢譯(玄奘譯本)《解深密經》(梵Sandhinirmocana Sūtra)的〈分別瑜伽品〉則同樣將其分為奢摩他(梵語śamatha)和毘婆舍那(梵語vipaśyanā),再以三摩地(梵語Samādhi)概括兩者(註21)。這表示佛教的專注力訓練至少存在著兩種不同取向的方式。《解深密經》〈分別瑜伽品〉提綱解釋這兩種取向的初學差別在於有分別和無分別的專注:1. 奢摩他:是對於觀察的對象(所緣相)無分別的專注(無分別影像所緣境事);2. 毘婆舍那:是對於觀察的對象加以分別觀察(有分別影像所緣境事)(註22)。然而在實踐上,該品也進一步解釋:1. 奢摩他:是「相續作意唯思惟無間心」;2. 毘婆舍那:是「相續作意唯思惟心相」(註23)。所以,兩種取向雖然在了別注意的運用上不同,但都從一共同基礎「相續作意思惟」開啟專注。相續表達了是將心聚焦或持續專注於選擇的目標,作意思惟則如《阿毘達磨品類足論》所說的(註24):「作意云何?謂牽引心。隨順牽引,思惟牽引,作意造意,轉變心,警覺心,是名作意」。因此「作意思惟」是一個心智活動過程,包含著令心警覺(Alerting)、目標移動(Disengaging)、入位(Engaging)、執行(Executive)和脫離(Disengaging)。而這專注過程與傳統佛教建議修行須依循八正道(註25)(梵語Ārya 'ṣṭāṅga mārgaḥ;聖正的八個道支)中的正念有關,特別是在念活動上有著共通的實踐內容。

四、正念的認識與學習

  關於當代研究者對於正念(Mindfulness)的理解和概念初始多來自Kabat-Zinn的推動(註26)。Kabat-Zinn(2003)描述「正念是個覺察,這個覺察的生起(Emerge)是透過專注一個當下的目的和沒有批判地(Non-Judgmentally)讓經驗當下的開展(Unfolding of Experience)」(註27)。對於這樣的描述,有學者將其歸屬於傳統佛教業處分類中的毘婆舍那一類(註28)。

  然而"mindfulness"是衍生自巴利文(Pāli word)的"sati"一詞(註29)。若依佛教傳統典籍的字詞說明,我們對正念會有更寬廣的理解。正念一詞,巴利語是sammā-sati(梵語samyak-smṛti),意指以正確的念(sati)來修持。《分別聖諦經》(註30)載說;佛陀告訴弟子,對於其所教四聖諦(巴利語cattāri ariyasaccāni)若能「向念、念遍、念憶、復憶,心心、不忘心之所應,是名正念」。所以,正念是指對佛陀教導的內容生起念的修持,而仔細對比念的活動,則可以發現經典描述的念具有臨床觀察專注力所具有的五個向度(註31)。

  從念(sati)和奢摩他、毘婆舍那的關係來說,念在佛教心理學範疇中被歸類在心所(巴利語cetasika,梵語caitasika)。《阿毗達摩概要精解》(Ⅱ5)說明:「念(sati)……詞根意為『憶念』,然而作為心所,它是心於當下能夠清楚覺知(其目標),而不是純粹只是回憶過去。其特相是對目標念念分明而不流失;作用是不迷惑或不忘失;現起是守護或心面對目標的狀態;近因是強而有力的想(thirasanna)或四念處」。(註32)漢譯《百法明門論解》說:「念者,於曾習境令心明記不忘為性,定依為業,謂數憶持曾所受境而不忘失,能引定故。」(註33)所以,念的修行應該通於奢摩他和毘婆舍那;或者說,念的學習是奢摩他和毘婆舍那的共同基礎。

  從正念發展的奢摩他和毘婆舍那,因為訓練方式強調的重點有所不同,更促使當代研究者嘗試進一步去區分兩者的差異,並觀察對身心影響的差別。Antoine Lutz將佛教專注力訓練方式主要分為兩種(見表一):包括聚焦專注冥想(Focused Attention Meditation, FAM)和開放覺察冥想(Open Monitoring Meditation, OMM)(註34)。FAM相當於奢摩他的方式,OMM相當於毘婆舍那的方式(註35)。然而有些研究則將慈悲觀(Loving-Kindness Meditation)這種對於眾人慈愛和悲憫的冥想別列為第三種方式(註36)。

表一:佛教專注力訓練的兩種方式

 聚焦專注冥想(Focused Attention Meditation, FAM)
  --直接和持續專注在一個選擇的對象(如呼吸的感受)
  --察覺意識漂離和分心(如思考)
  --從分心移置專注力並且將專注力移回到原本選擇的對象
  --認知上重新評估分心(例如「只是個想」、「只是個分心」)

   ------------------------------------------------------------------------------------------------------------

 開放覺察冥想(Open Monitoring Meditation, OMM)

  --不明確地聚焦在對象上

  --不反應後設認知的覺察(例如新手的標示覺受)

  --不反應自動認知的警覺和感受、感官和內在的刺激上情感的詮釋

                               (Antoine Lutz, 2008)

  

五、佛教中奢摩他和毘婆舍那訓練對專注力的改善

  冥想的特色是周遭環境沒有改變,但冥想者可以透過冥想調整自己的精神狀態。這顯示佛教冥想(註37)是透過訓練,有意義地改變認知和情緒過程(註38)。這過程被認為,冥想活動促使大腦的精神網路改變並產生新的聯繫(迴路)(註39);新的聯繫則改善了大腦功能(註40)。這些聯繫和改變,不僅對大腦和心智有益,對全身也有幫助(註41)。然而部分研究也顯示,佛教冥想訓練兩種主要模式,因訓練方式不同,對腦部神經網絡改變和增進專注過程,應該也有所差別(註42)。

(一)關於FAM/奢摩他改善專注力的研究

  西方的心理學和神經學家重視專注力的功能,因為其重要性在於開啟導向目標的行為(Goal-Directed Bhavior),而FAM與這過程密切相關。西方科學者與佛教學者皆認為FAM的特質在聚焦且持續專注在一個注意目標(Intended Object)上,而且FAM強調過程除了必須要能聚焦專注,同時也必須覺察專注力在所緣目標上的持續(Sustained)、覺察脫離(Detecting Distraction)並執行再回復(Engaging)專注。這一連續專注活動與腦部的可分離系統(Dissociable System)和神經網絡有關(註43)。在較早先的FAM行為表現測驗研究中,顯示訓練能引發專注力的改變,包括持續專注力在Continuous Performance Tasks或Binocular Rivalry Tasks,和選擇專注力在如Posner Cueing Task的有意義改善(註44)。近期腦影像學,則發現FAM活化右側背外側前額葉皮層(Right Dorsolateral Prefrontal Cortex, DLPFC)(註45),因此FAM被推測與專注力活動上的三個功能相關,分別是:

1. 衝突覺察(Conflict Monitoring):目前在腦神經系統功能被認為在上部前扣帶迴皮質(Dorsal Anterior Cingulate Cortex)和DLPFC(註46)。

2. 選擇注意(Selective Attention):目前在腦神經系統功能被認為在顳頂交界(Temporo-parietal Junction)、腹外側前額葉皮層(Ventrolateral Prefrontal Cortex)、額眼區(Frontal Eye Fields)和頂內溝(Intraparietal Sulcus)(註47)。

3. 持續注意(Sustaining Attention)有關:目前在腦神經系統功能被認為在右額葉(Right Frontal)、頂葉(Parietal Areas)和下視丘(Thalamus)(註48)。

  另有推論,FAM可促成心智和腦功能的長期改變,進階的FAM被認為可以降低情緒反應(Emotional Reactivity),因為高度集中注意於一小範圍,將降低其他外在刺激的干擾(註49)。

(二)關於OMM/毘婆舍那改善專注力的研究

  不同於FAM,OMM並不啟動自主持續專注和定向回復的功能。OMM初步被認為是運用專注中的覺察、警覺和移出(Monitoring, Vigilance and Disengaging Attention);從原本的持續專注經歷中,執行轉移專注功能,而且只專注特殊標定的刺激(註50)。早期研究顯示,在對非預期的刺激反應測驗,OMM表現比FAM好,但對預期的刺激反應力則相同(註51)。

  短期訓練(6週),發現大腦背外側前額葉皮層(Dorsolateral Prefrontal Cortex; DLPFC)活化,這區域參與腦功能的執行流程(Executive Processing)(註52)。另一研究比較了接受OMM 5天訓練和接受放鬆組對照,OMM有較好的衝突覺察(Conflict Monitoring)。長期正念訓練的腦影像顯示,主要影響前扣帶迴(Anterior Cingulate Cortices, ACC)(註53),這區域與調控情緒有關。另外,OMM可以培養對處境的覺察(Cultivation of Awareness),如對情緒張力(Emotional Tone)的覺察;這過程被認為有內感受(Interoception)或是內在身體經驗的介入(Engages),在腦部應該是前腦島(Anterior Insula)、體感覺區(Somatosensory Cortex (SII))和前扣帶迴皮質等區域相關(註54)。

  更有研究推論,OMM可以透過大腦額葉的邊緣系統的調節(Prefrontal Regulation of Limbic Responses)調控情緒。傳統毘婆舍那對情緒的標定,從腦影像研究顯示,標定情緒(Labeling Affective Stimuli)可以引起右側外腹額葉(Right Ventrolateral Prefrontal Cortex)活動,並且經由外腹額葉降低杏仁核(Amygdala)活動(註55)。這被認為OMM運用的語言標記(Verbal Labeling)方式也能夠透過外腹額葉調控情緒,阻止自動化情緒反應(Automatic Affective Responses)(註56)。

六、專注力的訓練時程

  大部分研究顯示,短期(1週)的正念訓練沒有改善專注力,但長期(數月到年)則有改善(註57)。正念強調在早期練習時,必須要反覆練習(註58),才能逐漸促進足夠程度的注意力控制(Attention Control)(註59)。在FAM的訓練上,反覆的練習也是必要的;初始時,自主持續專注和定向(Orientating)訓練,扮演重要的角色。在定向部分,有研究顯示,3個月的奢摩他(Shamatha)訓練,增加了視覺目標(Visual Target)定向能力(註60)。此外,透過反覆的訓練,在更進階的FAM中,會增強練習者的清朗和元氣(Vigor),降低睡眠需求(註61)。MBT(Mindfulness Base Therapy)研究,如接受8週的正念減壓(Mindfulness-Based Stress Reduction Program)後,相對於對照組有更好的身體覺察(註62)。長期的OMM訓練,被認為也會使大腦的心智和腦功能長期改變。OMM長期培養不反應的覺察(Non-Reactive Awareness)、不對「思索初級標的」反應,這被認為可以降低對選擇目標的糾結思考(註63)。

七、結論

  專注力(Attention)是心智(Mental)活動的過程,依據認知、精神行為和腦神經活動等多面向觀察,專注力具有多層次的特殊功能表現,包括了警覺、聚焦注意、持續、定向、衝突覺察、回復和脫離。專注力的訓練可以透過內在活動與記憶,修飾神經迴路而改善不同層次的專注力。佛教冥想訓練被證實能改善專注力,目前腦科學研究顯示,長期佛教冥想訓練可以增加大腦皮質厚度(註64)、增加大腦灰質密度(註65)、增加海馬迴和額葉體積(註66)和強化白質間的聯繫(註67)。

  傳統佛教的專注力訓練主要有兩種不同的訓練方式。從專注力測驗顯示,兩者皆能提升改善專注力整體功能,也可增進認知能力和記憶,但分項上有明顯差異部分,這應該是訓練方式不同影響腦修飾的差異。FAM/奢摩他加強了專注力的聚焦持續、定向和再回復。因為FAM/奢摩他將專注集中在一小範圍,所以也能促進情緒的調整,長期的訓練可以改善意識的清朗和身體的舒適感。而OMM/毘婆舍那運用了專注力的覺察、不批判警覺和脫離。因為開放不批判的覺察自身(內在)感官和情緒狀態,對於突然的刺激和自動化情緒有更好的調控,長期的訓練對於專注覺察、認知彈性和情緒調控皆有所幫助。從兩種不同的訓練方式能多面向地改善專注力的結果顯示,與佛教典籍中建議兩種訓練方式合併或先後練習是相符的(註68)。就未來研究來說,對於兩種訓練方式,透過佛教原典更細緻和明晰的分別及制定更標準的訓練和檢測是必要的。此外,關於慈悲觀的研究,初步顯示對專注力與情緒調控皆有正面幫助,相關研究仍須持續觀察。

【附註】
註1:Benjamin James Sadock, Virginia Alcott Sadock, Pedro Ruiz, Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (11th ed), (Wolters Kluwer, 2015), p.263, 1408. Attention: Concentration; the aspect of consciousness that relates to the amount of effort exerted in focusing on certain aspects of an experience, activity, or task. Usually impaired in anxiety and depressive disorder.
註2:John R. Anderson, Cognitive Psychology and Its Implications (6th ed.), (NY, U.S.A.: Worth Publishers, 2004), p.519.
註3:McKay Moore Sohlberg, Catherine A. Mateer, "Effectiveness of an Attention-Training Program," Journal of Clinical and Experimental Neuropsychology 9:2 (March 1987), pp.117-130.
McKay Moore Sohlberg and Lyn S. Turkstra, Optimizing Cognitive Rehabilitation Effective Instructional Methods, (New York, NY: The Guilford Press, 2011), p.17.
註4:Michael I. Posner and Steven E. Petersen, "The Attention System of the Human Brain," Annual Review of Neuroscience v.13 (1990), pp.25-42.
Michael I. Posner and Mary K. Rothbart, "Research on Attention Networks as a Model for the Integration of Psychological Science," Annual Review of Psychology 58 (January 2007), pp.1-23.
Michael I. Posner, "Attentional Networks and Consciousness," Frontiers in Psychology 3 (March 2012), pp.64.
Simone Vossel, Joy J. Geng, and Gereon R. Fink, "Dorsal and Ventral Attention Systems: Distinct Neural Circuits but Collaborative Roles," The Neuroscientist 20:2 (April 2014), pp.150-159.
註5:所謂由上而下的調控專注(Top-Down of Regulation of Attention)和由下而上調控,是指大腦從感覺到辨識的過程。若刺激相同但辨識結果不同,則此辨識調控由經驗產生,是屬於由上而下的調控;若辨識由刺激產生決定,則屬於由下而上的調控。
註6:Amy F. T. Arnsten, "Stress Signalling Pathways That Impair Prefrontal Cortex Structure and Function," Nature Reviews Neuroscience 10 (2009), pp.410-422.
Fumi Katsuki, Christos Constantinidis, "Bottom-Up and Top-Down Attention: Different Processes and Overlapping Neural Systems," Neuroscientist 20:5 (October 2014), pp.509-521.
註7:Amy F. T. Arnsten, "Stress Signalling Pathways That Impair Prefrontal Cortex Structure and Function," Nature Reviews Neuroscience 10 (2009), pp.410-422.
Luiz Pessoa, Sabine Kastner, and Leslie G. Ungerleider, "Neuroimaging Studies of Attention: From Modulation of Sensory Processing to Top-Down Control," Journal of Neuroscience 23:10 (May 2003),pp. 3990-3998.
Takashi J. Ozaki, "Frontal-to-Parietal Top-Down Causal Streams Along the Dorsal Attention Network Exclusively Mediate Voluntary Orienting of Attention," PLOS ONE 6:5 (May 2011), p.e20079.
註8:Yi-Yuan Tang, Britta K. Hölzel, Michael I. Posner, "The Neuroscience of Mindfulness Meditation," Nature Reviews Neuroscience 16 (2015), pp.213-225.
註9:Kieran C. R. Fox, Savannah Nijeboer, Matthew L. Dixon, James L. Floman, Melissa Ellamil, Samuel P. Rumak, Peter Sedlmeier, Kalina Christoff, "Is Meditation Associated with Altered Brain Structure? A Systematic Review and Meta-Analysis of Morphometric Neuroimaging in Meditation Practitioners," Neuroscience & Biobehavioral Reviews 43 (June 2014), pp.48-73.
註10:Karunesh Ganguly, Mu-ming Poo, "Activity-Dependent Neural Plasticity from Bench to Bedside," Neuron 80:3 (October 2013), pp.729-741.
註11:關於腦神經具有可塑性的臨床觀察與目前證據顯示有兩種形式,第一種稱為神經修飾(Neuroplasticity):是透過外在來修飾神經,例如透過藥物或電刺激的外在方式促成腦神經的再塑,臨床上如精神相關疾病,經由藥物治療後改善精神症狀。第二種是活動-依靠修飾(Activity-Dependent Plasticity):神經修飾經由內在(Endogenous)方式進行,臨床上如中風、自閉症等,可以透過復健、早療改善運動功能和語言障礙。研究顯示大腦可以透過記憶來改變神經迴路和腦神經的基因表現(Gene Expression),所以學習、訓練等,皆可以促使神經在突觸間和非突觸間的連結改變。
註12:Elodie Bruel-Jungerman, Sabrina Davis, Serge Laroche, "Brain Plasticity Mechanisms and Memory: A Party of Four," Neuroscientist 13:5 (October 2007), pp.492-505.
註13:Alvaro Pascual-Leone, Catarina Freitas, Lindsay Oberman, Jared C. Horvath, Mark Halko, Mark Eldaief, Shahid Bashir, Marine Vernet, Mouhshin Shafi, Brandon Westover, Andrew M. Vahabzadeh-Hagh, and Alexander Rotenberg, "Characterizing Brain Cortical Plasticity and Network Dynamics Across the Age-Span in Health and Disease with TMS-EEG and TMS-fMRI," Brain Topography 24:3/4 (October 2011), pp.302-315.
Timothy A. Keller, Marcel Adam Just, "Structural and Functional Neuroplasticity in Human Learning of Spatial Routes," NeuroImage 125 (January 2016), pp.256-266.
註14:Antoine Lutz, Heleen A. Slagter, John D. Dunne, Richard J. Davidson, "Attention Regulation and Monitoring in Meditation," Trends in Cognitive Sciences 12:4 (April 2008), pp.163-169.
Heleen A Slagter, Antoine Lutz, Lawrence L Greischar, Andrew D Francis, Sander Nieuwenhuis, James M Davis, Richard J Davidson, "Mental Training Affects Distribution of Limited Brain Resources," PLOS Biology 5:6 (May 2007), p.e138.
Amishi P. Jha, Jason Krompinger, and Michael J. Baime, "Mindfulness Training Modifies Subsystems of Attention," Cognitive, Affective, & Behavioral Neuroscience 7:2 (June 2007), pp.109-119.
註15:Adam Moore, Peter Malinowski, "Meditation, Mindfulness and Cognitive Flexibility," Consciousness and Cognition 18:1 (March 2009), pp.176-186.
A. Chiesa & A. Serretti, "A Systematic Review of Neurobiological and Clinical Features of Mindfulness Meditations," Psychological Medicine 40:8 (August 2010), pp.1239-1252.
註16:Alberto Chiesa, Raffaella Calati & Alessandro Serretti, "Does Mindfulness Training Improve Cognitive Abilities? A Systematic Review of Neuropsychological Findings," Clinical Psychology Review 31:3 (April 2011), pp.449-464.
Katherine A. MacLean et al., "Intensive Meditation Training Improves Perceptual Discrimination and Sustained Attention," Psychological Science 21:6 (June 2010), pp.829-839.
註17:Bassam Khoury, Tania Lecomte, Guillaume Fortin, Marjolaine Masse, Phillip Therien, Vanessa Bouchard, Marie-Andrée Chapleau, Karine Paquin, Stefan G. Hofmann. "Mindfulness-Based Therapy: A Comprehensive Meta-Analysis," Clinical Psychology Review 33:6 (August 2013), pp.763-771.
Davina Chan & Marjorie Woollacott, "Effects of Level of Meditation Experience on Attentional Focus: Is the Efficiency of Executive or Orientation Networks Improved?," The Journal of Alternative and Complementary Medicine 13:6 (August 2007), pp.651-658.
Adam Moore, Peter Malinowski, "Meditation, Mindfulness and Cognitive Flexibility," Consciousness and Cognition 18:1 (March 2009), pp. 176-186.
Heidi Wenk-Sormaz, "Meditation Can Reduce Habitual Responding," Alternative Therapies in Health and Medicine 11:2 (March/April 2005), pp.42-58.
Heleen A Slagter, Antoine Lutz, Lawrence L Greischar, Andrew D Francis, Sander Nieuwenhuis, James M Davis, Richard J Davidson, "Mental Training Affects Distribution of Limited Brain Resources," PLOS Biology 5:6 (May 2007), p.e138.
註18:B. Rael Cahn & John Polich, "Meditation States and Traits: EEG, ERP, and Neuroimaging Studies," Psychological Bulletin 132:2 (March 2006), pp.180-211.
註19:Adam Moore, Peter Malinowski, "Meditation, Mindfulness and Cognitive Flexibility," Consciousness and Cognition 18:1 (March 2009), pp. 176-186.
Matthieu Ricard, Antoine Lutz, Richard J. Davidson, "Neuroscience Reveals the Secrets of Meditation’s Benefits," Scientific American 311:5 (November 2014), pp.38-45
註20:Antoine Lutz, Heleen A. Slagter, Nancy B. Rawlings, Andrew D. Francis, Lawrence L. Greischar, and Richard J. Davidson, "Mental Training Enhances Attentional Stability: Neural and Behavioral Evidence," Journal of Neuroscience 29:42 (October 2009), pp.13418-13427.
Yi-Yuan Tang, Britta K. Hölzel, Michael I. Posner, "The Neuroscience of Mindfulness Meditation," Nature Reviews Neuroscience 16 (2015), pp.213-225.
註21:T16n0676_003[0697c24]佛告慈氏菩薩曰:「善男子!一是奢摩他所緣境事,謂無分別影像;一是毘鉢舍那所緣境事,謂有分別影像;二是俱所緣境事,謂事邊際、所作成辦。」
[0698b17]「世尊!齊何當言菩薩奢摩他、毘鉢舍那和合俱轉?」「善男子!若正思惟心一境性。」……
[0698b22]「世尊!云何心一境性?」「善男子!謂通達三摩地所行影像,唯是其識;或通達此已,復思惟如性。」
註22:T16n0676_003[0697c18]。
註23:T16n0676_003[0698b16]、[0698b14]。
註24:T26n1542_002[0699c08]。
註25:T02n0099_028[0199a17]《雜阿含經》卷28.753經:「阿梨瑟吒比丘白佛言:『世尊!有道有跡,修習多修習,得甘露法不?』佛告比丘:『有,所謂八聖道分──謂正見乃至正定。』」。八正道包括正見、正思惟、正語、正業、正命、正精進、正念、正定。
註26:Anne Harrington, John D. Dunne, "When Mindfulness Is Therapy: Ethical Qualms, Historical Perspectives," American Psychologist 70:7 (October 2015), pp.621-631.
註27:Kabat-Zinn’s, "the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment," (Jon Kabat-Zinn "Mindfulness-Based Interventions in Context: Past, Present, and Future," Clinical Psychology: Science and Practice 10:2, June 2003, p.145).
註28:Antoine Lutz, Heleen A. Slagter, John D. Dunne, Richard J. Davidson, "Attention Regulation and Monitoring in Meditation," Trends in Cognitive Sciences 12:4 (April 2008), pp.163-169.
Yi-Yuan Tang, Britta K. Hölzel, Michael I. Posner, "The Neuroscience of Mindfulness Meditation," Nature Reviews Neuroscience 16 (2015), pp.213-225.
註29:Minoru Kiyota, Mahayana Buddhist Meditation: Theory and Practice, (Hawaii: University Press of Hawaii, 1978).
註30:T01n0026_007,0467a28《中阿含經》卷7(三一)〈中阿含舍梨子相應品分別聖諦經第十一〉。
註31:如聚焦性專注力(Focused Attention):向念。持續性專注力(Sustained Attention):念遍。選擇性專注力(Selective Attention):念憶。交替性專注力(Alternating Attention):復憶。分配性專注力(Divided Attention):心心、不忘心之所應。
註32:尋法比丘中譯,正覺學會出版,2000。
註33:T44n1836_0048a17。
註34:Antoine Lutz, Heleen A. Slagter, Nancy B. Rawlings, Andrew D. Francis, Lawrence L. Greischar, and Richard J. Davidson, "Mental Training Enhances Attentional Stability: Neural and Behavioral Evidence," Journal of Neuroscience 29:42 (October 2009), pp.13418-13427.
註35:Yi-Yuan Tang, Britta K. Hölzel, Michael I. Posner, "The Neuroscience of Mindfulness Meditation," Nature Reviews Neuroscience 16 (2015), pp.213-225.
註36:Dominique P. Lippelt, Bernhard Hommel and Lorenza S. Colzato, "Focused Attention, Open Monitoring and Loving Kindness Meditation: Effects on Attention, Conflict Monitoring, and Creativity – A Review," Frontiers in Psychology 5 (September 2014), p.1083.
David R. Vago and David A. Silbersweig, "Self-Awareness, Self-Regulation, and Self-Transcendence (S-ART): A Framework for Understanding the Neuro-biological Mechanisms of Mindfulness," Frontiers in Human Neuroscience 6 (October 2012), p.296.
Matthieu Ricard, Antoine Lutz, Richard J. Davidson, "Neuroscience Reveals the Secrets of Meditation’s Benefits," Scientific American 311:5 (November 2014), pp.38-45
註37:此處Buddhist meditation是指包括西方觀點中的正念、奢摩他和毘婆舍那等方式。
註38:Peter Sedlmeier, Juliane Eberth, Marcus Schwarz, Doreen Zimmermann, Frederik Haarig, Sonia Jaeger, and Sonja Kunze, "The Psychological Effects of Meditation: A Meta-Analysis," Psychological Bulletin 138:6 (2012), pp.1139-1171.
註39:Kieran C. R. Fox, Savannah Nijeboer, Matthew L. Dixon, James L. Floman, Melissa Ellamil, Samuel P. Rumak, Peter Sedlmeier, Kalina Christoff, "Is Meditation Associated with Altered Brain Structure? A Systematic Review and Meta-Analysis of Morphometric Neuroimaging in Meditation Practitioners," Neuroscience & Biobehavioral Reviews 43 (June 2014), pp.48-73.
註40:B. Rael Cahn & John Polich, "Meditation States and Traits: EEG, ERP, and Neuroimaging Studies," Psychological Bulletin 132:2 (March 2006), pp.180-211.
註41:Yi-Yuan Tang, Britta K. Hölzel, Michael I. Posner, "The Neuroscience of Mindfulness Meditation," Nature Reviews Neuroscience 16 (2015), pp.213-225.
註42:Antoine Lutz, Heleen A. Slagter, Nancy B. Rawlings, Andrew D. Francis, Lawrence L. Greischar, and Richard J. Davidson, "Mental Training Enhances Attentional Stability: Neural and Behavioral Evidence," Journal of Neuroscience 29:42 (October 2009), pp.13418-13427.
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Michael I. Posner and Mary K. Rothbart, "Research on Attention Networks as a Model for the Integration of Psychological Science," Annual Review of Psychology 58 (January 2007), pp.1-23.
D H Weissman, K C Roberts, K M Visscher & M G Woldorff, "The Neural Bases of Momentary Lapses in Attention," Nature Neuroscience 9:7 (July 2006), pp.971-978.[PubMed: 16767087]
註44:Roland Fischer, "A Cartography of the Ecstatic and Meditative States," Science 174:4012 (November 1971), pp.897-904.
註45:Wendy Hasenkamp, Christine D. Wilson-Mendenhall, Erica Duncan, Lawrence W. Barsalou, "Mind Wandering and Attention During Focused Meditation: A Fine-Grained Temporal Analysis of Fluctuating Cognitive States," NeuroImage 59:1 (January 2012), pp.750-760.
註46:O. L. Carter, et al., "Meditation Alters Perceptual Rivalry in Tibetan Buddhist Monks," Current Biology 15:11 (June 2005), pp.R412-R413.
K. Richard Ridderinkhof, Wery P. M. van den Wildenberg, Sidney J. Segalowitz, Cameron S. Carter, "Neurocognitive Mechanisms of Cognitive Control: The Role of Prefrontal Cortex in Action Selection, Response Inhibition, Performance Monitoring, and Reward-Based Learning," Brain and Cognition 56:2 (November 2004), pp.129-140.
註47:Maurizio Corbetta, Gordon L. Shulman, "Control of Goal-Directed and Stimulus-Driven Attention in the Brain," Nature Reviews Neuroscience 3:3 (March 2002), pp.201-215. [PubMed: 11994752]
註48:Michael I. Posner and Mary K. Rothbart, "Research on Attention Networks as a Model for the Integration of Psychological Science," Annual Review of Psychology 58 (January 2007), pp.1-23.
註49:Antoine Lutz, Heleen A. Slagter, Nancy B. Rawlings, Andrew D. Francis, Lawrence L. Greischar, and Richard J. Davidson, "Mental Training Enhances Attentional Stability: Neural and Behavioral Evidence," Journal of Neuroscience 29:42 (October 2009), pp.13418-13427.
註50:Yi-Yuan Tang, Yinghua Ma, Junhong Wang, Yaxin Fan, Shigang Feng, Qilin Lu, Qingbao Yu, Danni Sui, Mary K. Rothbart, Ming Fan, and Michael I. Posner, "Short-Term Meditation Training Improves Attention and Self-Regulation," Proceedings of the National Academy of Sciences of the United States of America 104:43 (October 2007), pp.17152-17156.
Britta K. Hölzel, Ulrich Ott, Hannes Hempel, Andrea Hack, Katharina Wolf, Rudolf Stark, Dieter Vaitl, "Differential Engagement of Anterior Cingulate and Adjacent Medial Frontal Cortex in Adept Meditators and Non-Meditators," Neuroscience Letters 421:1 (June 2007), pp.16-21.
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註52:Micah Allen, Martin Dietz, Karina S. Blair, Martijn van Beek, Geraint Rees, Peter Vestergaard-Poulsen, Antoine Lutz, and Andreas Roepstorff, "Cognitive-Affective Neural Plasticity Following Active-Controlled Mindfulness Intervention," The Journal of Neuroscience 32:44 (October 2012), pp.15601-15610.
註53:Yi-Yuan Tang and Michael I. Posner, "Training Brain Networks and States," Trends in Cognitive Sciences 18:7 (July 2014), pp.345-350.
Britta K. Hölzel, Ulrich Ott, Hannes Hempel, Andrea Hack, Katharina Wolf, Rudolf Stark, Dieter Vaitl, "Differential Engagement of Anterior Cingulate and Adjacent Medial Frontal Cortex in Adept Meditators and Non-Meditators," Neuroscience Letters 421:1 (June 2007), pp.16-21.
註54:A. D. Craig, "How Do You Feel? Interoception: the Sense of the Physiological Condition of the Body," Nature Reviews Neuroscience 3:8 (2002), pp.655-666.
Shamini Jain, Shauna L. Shapiro, Summer Swanick, Scott C. Roesch, Paul J. Mills, Iris Bell, Gary E. R. Schwartz, "A Randomized Controlled Trial of Mindfulness Meditation Versus Relaxation Training: Effects on Distress, Positive States of Mind, Rumination, and Distraction," Annals of Behavioral Medicine 33:1 (February 2007), pp.11-21.
註55:Ahmad R. Hariri, Susan Y. Bookheimer, John C. Mazziotta, "Modulating Emotional Responses: Effects of a Neocortical Network on the Limbic System," Neuroreport 11:1 (January 2000), pp.43-48.
Matthew D. Lieberman, Naomi I. Eisenberger, Molly J. Crockett, Sabrina M. Tom, Jennifer H. Pfeifer, Baldwin M. Way, "Putting Feelings into Words: Affect Labeling Disrupts Amygdala Activity in Response to Affective Stimuli," Psychological Science 18:5 (May 2007), pp.421-428.
註56:Yi-Yuan Tang, Britta K. Hölzel, Michael I. Posner, "The Neuroscience of Mindfulness Meditation," Nature Reviews Neuroscience 16 (2015), pp.213-225.
註57:Yi-Yuan Tang, Qilin Lub, Ming Fand, Yihong Yange, and Michael I. Posner, "Mechanisms of White Matter Changes Induced by Meditation," Proceedings of the National Academy of Sciences of the United States of America 109:26 (June 2012), pp.10570-10574.
Yi-Yuan Tang, Lizhu Yang, Leslie D. Leve, and Gordon T. Harold, "Improving Executive Function and Its Neurobiological Mechanisms Through a Mindfulness-Based Intervention: Advances Within the Field of Developmental Neuroscience," Child Development Perspectives 6:4 (December 2012), pp.361-366.
Amishi P. Jha, Jason Krompinger, and Michael J. Baime, "Mindfulness Training Modifies Subsystems of Attention," Cognitive, Affective, & Behavioral Neuroscience 7:2 (June 2007), pp.109-119.
Katherine A. MacLean et al., "Intensive Meditation Training Improves Perceptual Discrimination and Sustained Attention," Psychological Science 21:6 (June 2010), pp.829-839.
Giuseppe Pagnoni, Milos Cekic, "Age Effects on Gray Matter Volume and Attentional Performance in Zen Meditation," Neurobiology of Aging 28:10 (October 2007), pp.1623-1627.
註58:Antoine Lutz, Heleen A. Slagter, John D. Dunne, Richard J. Davidson, "Attention Regulation and Monitoring in Meditation," Trends in Cognitive Sciences 12:4 (April 2008), pp.163-169.
Yi-Yuan Tang, Michael I. Posner, "Attention Training and Attention State Training," Trends in Cognitive Sciences 13:5 (May 2009), pp.222-227.
註59:Britta K. Hölzel, James Carmody, Mark Vangel, Christina Congleton, Sita M. Yerramsetti, Tim Gard, Sara W. Lazar, "Mindfulness Practice Leads to Increases in Regional Brain Gray Matter Density," Psychiatry Research: Neuroimaging 191:1 (January 2011), pp.36-43.
Yi-Yuan Tang, Yinghua Ma, Junhong Wang, Yaxin Fan, Shigang Feng, Qilin Lu, Qingbao Yu, Danni Sui, Mary K. Rothbart, Ming Fan, and Michael I. Posner, "Short-Term Meditation Training Improves Attention and Self-Regulation," Proceedings of the National Academy of Sciences of the United States of America 104:43 (October 2007), pp.17152-17156.
註60:Katherine A. MacLean et al., "Intensive Meditation Training Improves Perceptual Discrimination and Sustained Attention," Psychological Science 21:6 (June 2010), pp.829-839.
註61:Antoine Lutz, Heleen A. Slagter, Nancy B. Rawlings, Andrew D. Francis, Lawrence L. Greischar, and Richard J. Davidson, "Mental Training Enhances Attentional Stability: Neural and Behavioral Evidence," Journal of Neuroscience 29:42 (October 2009), pp.13418-13427.
註62:Norman A. S. Farb, Zindel V. Segal, Helen Mayberg, Jim Bean, Deborah McKeon, Zainab Fatima, Adam K. Anderson, "Attending to the Present: Mindfulness Meditation Reveals Distinct Neural Modes of Self-Reference," Social Cognitive and Affective Neuroscience 2:4 (December 2007), pp.313-322.
註63:Antoine Lutz, Heleen A. Slagter, Nancy B. Rawlings, Andrew D. Francis, Lawrence L. Greischar, and Richard J. Davidson, "Mental Training Enhances Attentional Stability: Neural and Behavioral Evidence," Journal of Neuroscience 29:42 (October 2009), pp.13418-13427.
註64:Sara W Lazar, Catherine E Kerr, Rachel H Wasserman, Jeremy R Gray, Douglas N Greve, Michael T Treadway, Metta McGarvey, Brian T Quinn, Jeffery A Dusek, Herbert Benson, Scott L Rauch, Christopher I Moore, Bruce Fischl, "Meditation Experience Is Associated with Increased Cortical Thickness," Neuroreport 16:17 (November 2005), pp.1893-1897.
註65:Petera Vestergaard-Poulsen, Martijnc van Beek, Joshuaa Skewes, Carsten R. Bjarkam, Michaeld Stubberup, Jesd Bertelsen, Andreasa Roepstorff, "Long-Term Meditation Is Associated with Increased Gray Matter Density in the Brain Stem," Neuroreport 20:2 (January 2009), pp.170-174.
註66:Eileen Luders, Arthur W. Toga, Natasha Lepore, and Christian Gaser, "The Underlying Anatomical Correlates of Long-Term Meditation: Larger Hippocampal and Frontal Volumes of Gray Matter," NeuroImage 45:3 (April 2009), pp.672-678.
Britta K. Hölzel, James Carmody, Mark Vangel, Christina Congleton, Sita M. Yerramsetti, Tim Gard, Sara W. Lazar, "Mindfulness Practice Leads to Increases in Regional Brain Gray Matter Density," Psychiatry Research: Neuroimaging 191:1 (January 2011), pp.36-43.
註67:Yi-Yuan Tang, Qilin Lub, Ming Fand, Yihong Yange, and Michael I. Posner, "Mechanisms of White Matter Changes Induced by Meditation," Proceedings of the National Academy of Sciences of the United States of America 109:26 (June 2012), pp.10570-10574.
Yi-Yuan Tang, Lizhu Yang, Leslie D. Leve, and Gordon T. Harold, "Improving Executive Function and Its Neurobiological Mechanisms Through a Mindfulness-Based Intervention: Advances Within the Field of Developmental Neuroscience," Child Development Perspectives 6:4 (December 2012), pp.361-366.
註68:《解深密經》〈分別瑜伽品〉認為針對所緣,「事邊際所緣境事」和「所做成滿所緣境事」是奢摩他和毘婆舍那俱合的活動。

引用文獻

Coull, J. T, "Neural Correlates of Attention and Arousal: Insights from Electrophysiology, Functional Neuroimaging and Psychopharmacology," Progress in Neurobiology 55:4 (July 1998), pp.343-361.
Gunaratana, Henepola, Mindfulness in Plain English, Boston: Wisdom Publications, 1993.
Kapleau, Philip, The Three Pillars of Zen: Teaching, Practice and Enlightenment, Boston: Bacon Press, 1965.
Teasdale, John D., Segal, Zindel, & Williams, J. Mark G., "How Does Cognitive Therapy Prevent Depressive Relapse and Why Should Attentional Control (Mindfulness) Training Help?," Behaviour Research and Therapy 33:1 (January 1995), pp.25-39.




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