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J Relig Health (2014) 53:16931705

DOI 10.1007/s10943-013-9754-6

PSYCHOLOGICAL EXPLORATION

Monitoring Emotion Through Body Sensation: A Review


of Awareness in Goenkas Vipassana

Xianglong Zeng Tian P. S. Oei Xiangping Liu

Published online: 12 July 2013


Springer Science+Business Media New York 2013

Abstract Awareness is one of the two most important abilities cultivated in Goenkas
Vipassana meditation, which refers to sensitivity to subtle bodily sensations and the
associated psychological processes. This sensitivity and its derived function of monitoring
emotion are not of notable concern in modern mindfulness-based psychotherapies. Evi-
dence supports that Vipassana meditation truly enhances sensitivity to bodily sensations,
but further study is required to assess the awareness of psychological processes. The value
of monitoring mental processing has been widely accepted in psychology, as has enhanced
sensitivity along with the potential dangers to mental health. Implications for practice and
future studies are discussed.

Keywords Goenkas Vipassana Mindfulness Awareness Embodied emotion

In recent years, several mindfulness-based therapies (MBTs) have been developed in


Western psychology, such as mindfulness-based stress reduction (MBSR; Kabat-Zinn
1982), mindfulness-based cognitive therapy (MBCT; Segal et al. 2002), dialectical
behavior therapy (DBT; Linehan 1993) and acceptance and commitment therapy (ACT;
Hayes et al. 1999). Many of the practices used in these mindfulness-based therapies are
influenced by traditional mindfulness meditations (TMMs), such as Vipassana meditation
in Theravada Buddhism and certain practices in Zen Buddhism. (Chiesa and Malinowski
2011). As study has advanced, researchers have noted that potential differences in phi-
losophy, techniques and aims still exist between MBTs and TMMs (Chiesa and
Malinowski 2011; Dreyfus 2011).

X. Zeng X. Liu (&)


School of Psychology, Beijing Normal University, No. 19, XinJieKouWai St., HaiDian District,
Beijing 100875, Peoples Republic of China
e-mail: lxp599e@163.com

T. P. S. Oei
School of Psychology, The University of Queensland, Brisbane, Australia

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As a school of the Theravada tradition that can be traced back to Buddha (S. N. Goenka
2012), Goenkas 10-day Vipassana course is a standardized course that uses TMMs to
teach mindfulness methods without requiring religious belief. This course is guided by
Goenkas tapes and has spread across more than fifty countries. It has been used in the
prison systems of several countries for prisoners general rehabilitation (Ariel and
Menahemi 1997; Chandiramani et al. 1995, 1998) and for treatment of substance abuse
(Bowen et al. 2006; Simpson et al. 2007; Chiesa 2010). This article will focus on
awareness in Goenkas Vipassana meditation (GVM) and the derived technique of mon-
itoring emotional activities through bodily sensation, which is a potentially valuable
application that is not a part of MBTs. First, this article will introduce awareness in GVM
and its application. Second, it will illustrate that awareness and its monitoring function are
not components of MBTs. Third, empirical studies on GVM and embodied emotions will
be reviewed to investigate whether the practice of GVM truly enhances the awareness of
bodily sensation and further enhances the awareness of emotion. Fourth, the benefits and
potential dangers of enhanced awareness will be discussed based on studies from the
relevant areas. Finally, directions for future research will be discussed.

The Cultivation and Application of Awareness in GVM

The 10-day Vipassana course consists of several aspects; the introduction below will focus
on meditation practices and the cultivation of awareness. A more complete introduction is
provided by Hart (1987). For the first 3 days of the 10-day course, participants focus their
attention on breathing to cultivate sustained attention and form a solid foundation for
Vipassana meditation over the next 7 days. During the Vipassana meditation, the practi-
tioner pays attention to sensations throughout the body and observes bodily sensations
piece by piece to cultivate sensitivity to sensations. This sensitivity, which is called
Awareness, is one of the two most important abilities cultivated in the course. With the
development of awareness, practitioners can not only be aware of obvious sensations (such
as heat, itching or pain) but also feel more slight sensations (such as vibration or pulsating
in the body); simultaneous observation of the symmetry of the body and fast scans of the
sensations felt throughout the whole body are encouraged as the course progresses.
The cultivation of awareness has two purposes; the first is to experience the Three
Marks of Existence from a Buddhist perspective (Rosch 2007): With enhanced awareness,
practitioners observe that the sensations (of the body) arise and subside, that is, they are
impermanent. Practitioners can thus understand that they themselves are constructed of
impermanent subtle experiences rather than of any permanent selfthat is, they in effect
consist of a nonselfand further understand that attachment to ever-changing things or
illusion of self will lead to suffering (Hart 1987). According to Theravada, the wisdom of
the Three Marks of Existence will lead to an end to greed and hatred (Rosch 2007). In
the 10-day Vipassana course, the ability to eliminate greed and hatred, called Equa-
nimity, is the other ability emphasized, and it is similar to Acceptance in modern
mindfulness-based therapies.
Another purpose for cultivating awareness is that bodily sensation is believed to be
linked to emotions (such as joy or anger) and the relevant cognitive evaluations or attitudes
(such as satisfaction or dislike): Stronger emotions such as anger are associated with
changes in breathing, and more subtle emotive activities such as satisfaction may be
associated with subtle bodily sensations such as slight vibrations throughout the body.
Thus, through the interaction of body and mind, the capacity for awareness is not only an

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awareness of bodily sensation but also an awareness of psychological status in a broad


sense. In daily life, sensitivity to bodily sensation is expected to be a monitor or reminder
of ones psychological processes, especially the emotive ones such as anger. After using
awareness to detect these emotions and their related motivational impulses, one can apply
the technique related to equanimity to overcome the influence of emotion and impulse.
Therefore, combining awareness and equanimity, people can stop automatic reactions,
enhance self-control and behave properly. (Goenka and Hart 2000) This immediate sen-
sitivity to psychological status is useful in both daily life and clinical applications, and this
function is the focus of this article.

Awareness in GVM Is Not a Component of MBTs

Concept of Awareness

When discussing mindfulness, the word awareness has different meanings, such as
observation, paying attention, regulation of attention and orientation, breadth of
consciousness and introspection (Phang and Oei 2012). Among all of these meanings,
awareness in GVM has the most similarity with awareness in reference to an introspec-
tive or observational function, which is characterized by the process of using the
observing ego to monitor ones immediate experiences (Rapgay and Bystrisky 2009,
p. 156). In this meaning, awareness is the background radar of consciousness, con-
tinually monitoring the inner and outer environment (Brown and Ryan 2003, p. 822). In
particular, internal state awareness (Cramer 2000; Trapnell and Campbell 1999), which
represents sensitivity to ongoing psychological processes, has been considered by some
researchers to be the concept most similar to mindfulness (Brown and Ryan 2003), and this
is also what awareness in GVM emphasizes.
Although sometimes nonjudgmental awareness is synonymous with mindfulness
(e.g., Luberto et al. 2012), the meanings are quite different. According to the two-
dimensional operational definition, mindfulness comprises the self-regulation of attention
so that it is maintained on immediate experience and an orientation that is characterized
by curiosity, openness and acceptance (Bishop et al. 2004, p. 232). Researchers have
noted that Bishops definition of mindfulness confused awareness with attention (Rapgay
and Bystrisky 2009): attention emphasizes being sensitive to a narrow range of experience
and ignoring other experiences (Kosslyn and Rosenberg 2001; Cardaciotto et al. 2007), in
contrast with awareness, which monitors experience in the background of consciousness.

Cultivation and Application

The emphasis on sensitivity to bodily sensation and psychological processes is not a part of
most MBTs. For example, ACT uses mindfulness to reduce experience avoidance, that
is, the maladaptive avoidance of mental events (Hayes et al. 1996). DBT uses mindfulness
to control strong emotions and to learn nonjudgmental stances (Linehan 1993). The key
points for these MBTs are how to accept inevitable distressing thoughts and emotions and
how to control ones behaviors (Herbert et al. 2009); practice aimed at sensitivity to bodily
sensation does not exist. Likewise, MBSR is designed to address the stress associated with
chronic pain and illness, and the function of mindfulness is to develop a nonjudgmental
attitude toward inevitable pain (Kabat-Zinn 1982). MBCT, as a combination of MBSR
and cognitive therapy (Beck et al. 1979), is designed to prevent relapses of depression

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(Segal et al. 2002). One important application of mindfulness in MBCT is to replace


negative rumination by focusing attention on bodily sensations with a nonjudgmental
attitude (Segal et al. 2002). Another purpose of mindfulness training is to reach a meta-
cognitive state so that patients may see symptoms as symptoms, rather than treating
negative thoughts as reality (Hargus et al. 2010). These applications of mindfulness also
emphasize acceptance. Although some MBSR and MBCT practices involve awareness,
such as being aware of anything that comes into the mind (choiceless awareness) or
summoning obvious feelings through yoga positions (Brantley 2005), these practices do
not seem to emphasize sensitivity to subtle bodily sensations or mental events as does the
practice of GVM. In addition, the intensity of training in these therapies is essentially lower
than that of the intensive meditation during the 10-day Vipassana course.
In terms of application, the monitoring function of awareness in GVM is not included in
MBTs. It is worth noting that the cultivation of sensitivity during the GVM course involves
paying attention to different parts of the body but that the application of enhanced sen-
sitivity in daily life is to detect or be aware of passing thoughts or subtle emotions. In
contrast, MBTs directly transmit the practice of mindfulness to daily life and thereby
advocate a lifestyle of paying attention to the here and now, which in practice entails an
attitude of When I do things, I get totally wrapped up in them and dont think about
anything else (Baer et al. 2004, p. 196). However, some researchers have argued that
paying more attention to the here and now rather than the past or the future is a particular
practice without much evidence or reason to support its benefit (Harrington and Pickles
2009; Baer and Sauer 2009).
Recently, the use of bodily feelings as barometers of stress or emotion, as well as
training to enhance sensitivity to the particular parts of the body that reflect stress, was
added to a book on MBCT (Williams et al. 2007). This is very similar to the applications of
awareness in GVM. The difference is that GVM emphasizes that bodily sensations should
act as a reminder (Hart 1987): that is, bodily sensations should actively remind you of your
emotions rather than you passively waiting for the emotions to occur.

Evidence that GVM Enhances Awareness

GVM Enhances Awareness of Bodily Sensation

Because awareness and its application in GVM in using bodily sensation to monitor
emotions are unique among mindfulness-based interventions and have potential value in
clinical application and in daily life, it is important to confirm empirically whether the
assertions of GVM are true. The basic question is whether GVM practice can enhance the
awareness of bodily sensations.
Recently, an MRI study demonstrated that experienced practitioners of GVM (mean
length of practice 8.6 years; 2 h daily) showed a greater gray matter concentration in the
right anterior insula than did matched nonmeditators (Holzel et al. 2008). Another study
found that experienced practitioners (mean length of practice 9.1 years; 6 h weekly) of
insight meditation involving focused attention to internal experiences (the study did not
provide further details about the meditations) had comparatively thicker right anterior
insulae and prefrontal cortexes (Lazar et al. 2005). Previous studies have indicated that
structural measurements of the gray matter volume in the right anterior insula can predict
the accuracy of both reported interoceptive activity and subjective ratings of visceral
awareness (Critchley et al. 2004). Although these neuroscientific studies did not directly

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test the awareness of bodily sensations and were cross-sectional, rather than longitudinal,
studies, they suggest that GVM and similar meditations may improve the awareness of
bodily sensations.
The existing research has seldom directly investigated whether mindfulness meditations
can improve the capacity for body awareness on a behavioral level (Holzel et al. 2011). No
report has studied GVM meditators as of yet, and previous cross-sectional studies with
other meditators found no evidence that meditators had better body awareness than did
nonmeditators in a heartbeat detection task (Khalsa et al. 2008; Nielsen and Kaszniak
2006). Holzel et al. (2011) noted that heartbeat is not emphasized in mindfulness practice
and that other tests, such as tactile acuity, should be used in the future. Furthermore, the
above studies were mainly concerned with whether certain bodily activities could be
detected; this parameter is still far from measuring improvements in sensitivity to sub-
jective bodily sensations. Overall, many factors are involved in the behavioral
measurement of awareness, and it is difficult to determine whether GVM can improve the
awareness of bodily sensations with current behavioral methods.
In addition to the psychological studies using the objective indicators mentioned above,
other evidence arising from the subjective experiences of GVM practitioners is convincing.
The practice of Vipassana changes throughout the 10-day Vipassana course: The bodily
sensations change from rough to slight, and sensitivity to bodily sensation develops. It
should be noted that these practices are guided by recordings of Goenka rather than by the
feedback of participants because the general progress through which the participants
cultivate their sensitivity to bodily sensations is common and predictable. Hence, the
enhancement of subjective sensitivity to bodily sensations during the Vipassana course is
likely, although it is unknown how long this improvement can be maintained.
More important, experiments and behavioral tests only investigate whether Vipassana
enhances the active awareness of bodily sensations or visceral activity; self-report methods
can investigate whether bodily sensations are more easily accessed in daily life, especially
when attention is not focused on the body as it is during the experiments. Zhaos study
showed that experienced GVM meditators had higher scores than did nonmeditators on all
subscales except describing (which is considered unrelated to Vipassana) on the Five
Facet Mindfulness Questionnaire (FFMQ; Baer et al. 2006) and that those with more
meditation experience had higher scores in Observing and Acting with awareness,
which are consistent with awareness in GVM (Zhao 2011). In a qualitative interview study,
some meditators whose practices called for attention to bodily sensations reported differing
levels of the spontaneous experience of bodily sensations in daily life, and some further
reported greater emotional awareness (Holzel et al. 2006).
Studies on this topic are still limited. In summary, it does appear that both short
Vipassana courses and long-term practice can result in an improved awareness of bodily
sensation. However, some concerns remain, including the extent to which this awareness
can be reached and the duration of the effects.

Enhance Awareness of Emotion Through Bodily Sensations

The cultivation of sensitivity to bodily sensation in GVM is based on the hypothesis that
bodily sensation is linked to emotion, and thus that enhanced awareness of bodily sensation
could lead to better awareness of emotions and relevant cognitive processing. To date, only
those studies based on self-report scales and interviews have implied that GVM could lead
to improved emotional awareness in daily life (Holzel et al. 2006; Zhao 2011). Such

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reports may be influenced by expectations and other factors and cannot determine whether
enhanced awareness derives from sensitivity to bodily sensations. In fact, the relationship
between bodily sensation and emotion is a popular topic in current psychology.
Current theories maintain two perspectives regarding the relationship between emotion
and the body. From emotions to the body, bodily sensations can be considered a result of
emotional stimuli. Neurovisceral integration models consider emotion to be an adaptive
function and emphasize a top-down adjustment from the central autonomic network to the
peripheric systems such as the viscera and the neuroendocrine system (Thayer and Lane
2000, 2009). For example, electromyography (EMG) can record the different muscle
activity patterns of faces while participants read sentences or words containing certain
emotional values: Anger may activate the muscles of the forehead, and happiness activates
the muscles of the eye and cheek (Niedenthal et al. 2009). In contrast, from the body to
emotions, theories considering bodily sensations as the elements of emotion date back to
Jamess study on the biological mechanisms of emotion (James 1894). In recent years, new
theories have begun to arise. The emotion circuit model emphasizes that emotional
awareness is based on information from the viscera, glands and skeletal muscles, all of
which map onto the cortexes and nuclei (such as the insulae) in the brain. In particular, the
information can come either from real activities of the body (the body loop) or from
direct activation of the corresponding brain areas without real bodily activities (the as if
body loop) (Bechara and Naqvi 2004; Bechara and Damasio 2005; Damasio 1998), which
supports the argument mentioned above that sensitivity to the real activities of the viscera
may be unnecessary for enhanced awareness of bodily sensation.
The relationship between emotions and the body is a popular topic in current psy-
chology research, and a comprehensive review is beyond the range of this paper.
Regardless of the controversy between the two perspectives, the theories and studies
discussed above prove the very close relationship between emotions and bodily sensations
and provide the possibility that emotions can be monitored with bodily sensations. How-
ever, because the details of the relationship between emotion and bodily sensation are still
not very clear, it is difficult to deduce any causal relationship between enhanced sensitivity
to bodily sensation and enhanced awareness of emotion without direct, rigorous empirical
studies.
Another question is whether focusing on body awareness is a better strategy for iden-
tifying emotion. In a recent study, researchers asked participants to make forced-choice
identifications of short-duration facial expressions (happy/angry/neutral) while EMG
recorded muscle activity. The results showed that although EMG responses were a reliable
variable in predicting expressions, the group of participants who focused on their internal
status did not show an improved identification rate or changed physiological response in
comparison with the other two groups (one focused on visual detail and the other with no
strategy). The authors explained this result by suggesting either that bodily and feeling
reactions are principally unconscious or that other training (including GVM) or instruction
are necessary to make use of them (Bornemann et al. 2011). The highlight of this study was
that it directly tested whether the additional emotive information from bodily sensations
could be accessed. This type of study is very important for investigating the effect of
bodily sensations on emotional awareness, but as far as we know, such studies are very
rare.
In summary, the close relationship between bodily sensation and emotion is reliable, but
current studies are far from answering the question of whether GVM or similar training on
sensitivity to bodily sensation can enhance the awareness of emotions or provide more
information about emotive status.

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Studies on the Benefit and Danger of Enhanced Awareness

Monitoring Psychological Process Benefit Self-Control

As mentioned above, the function of awareness is to monitor psychological status and adjust
behavior accordingly, and this function is very useful in some situations. In Buddhism, a strong
awareness of ones mentality is considered useful for protecting Bhikkhus (monks) from
breaking many types of precepts (Gilpin 2009). In clinical applications, this function is
especially useful in managing anger and hostility in comparison with other emotions or
motivations. Because anger is often aimed at the outside world, without the self-awareness of
that anger, the angry subject may act impulsively before any coping skill can be utilized. In
addition, studies have also reported that among people who tend to deny anger and other
emotions (Ketterer et al. 2004), stronger physiological signals may also help them admit to
hostility. This could be a reason that GVM has been useful for prisoners who suffer from
hostility and anger.
However, because direct empirical studies on and solid investigations of GVM and even
the enhancement of awareness are rare, the application of the relevant techniques and
related benefits has not been confirmed. As far as we know, there has only been the above-
mentioned finding that enhancing awareness of breathing helped incarcerated people who
had taken part in the 10-day Vipassana course detect their anger (e.g., Ariel and Menahemi
1997), and empirical studies do not exist.
Although the technique of monitoring emotion through bodily sensation is unique to
GVM and should be tested, self-monitoring has extensive applications and its value has
been accepted in psychology. For example, recognizing incipient anger has been consid-
ered an important ability for behavior control in children with ADHD (Hinshaw and
Melnick 1992), and some studies have demonstrated that greater self-awareness and self-
monitoring can account for success in self-control behaviors such as weight control (e.g.,
Boutelle and Kirschenbaum 1998). Overall, no matter which technique is applied, whether
maintaining equanimity as taught in GVM or using other techniques, being aware of ones
emotional status is the first step toward effective coping. The idea that awareness of inner
status provides more flexibility and control, thereby reducing automatic reactions and
increasing proper behavior, has been widely accepted (Marlatt et al. 2004; Chiesa and
Malinowski 2011); thus further elaboration is omitted here.

Enhanced Sensory and Emotional Experience Has Potential Dangers

Although enhanced self-monitoring provides potential benefits, empirical studies have also
shown that enhanced awareness of bodily sensation may have negative consequences.
Previous studies have implied that the relationship between awareness and mental health
partially depends on the nature of the perceived experience. Enhanced awareness of
positive sensation was associated with more pleasure (e.g., LeBel and Dube 2001), but
greater sensitivity to pain increased subjective distress and psychosocial disability (e.g.,
McCracken 1997). In addition, some studies showed that paying attention to the physio-
logical experiences caused by rejection was associated with increased anger and hostility
(Ayduk et al. 2002), and that panic disorder was also related to increased awareness of
internal physiological cues (e.g., Ehlers and Breuer 1992, 1996). Other studies also imply
negative consequences of increased sensitivity (Cardaciotto et al. 2007).
Addressing the potential danger of enhanced awareness, Goenka claimed that awareness
and equanimity must coexist: Equanimity without awareness only solves superficial

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problems while ignoring deeper ones, and high awareness without equanimity causes even
more suffering because it makes people more sensitive to pain (Hart 1987). This claim was
partially proved by some studies on dispositional mindfulness, the general tendency to be
mindful in daily life (Davidson 2010). For example, Baer et al. (2006) found that scores on the
Observing subscale of the FFMQ (mentioned above) can be positively correlated with
thought suppression (the opposite of acceptance) and psychological symptoms. Another
study found that smoking and binge-drinking students scored higher on the Freiburg Mind-
fulness Inventory (FMI; Buchheld et al. 2001), certain items of which reflect awareness
because of their more intense bodily sensations (Leigh et al. 2005). Researchers explained
that this association between awareness and negative outcomes might reflect a lack of
acceptance in the face of enhanced negative experiences (Baer 2011; Cardaciotto et al. 2007).
It is worth noting that all of the current studies have only calculated a direct correlation
between awareness and outcomes. According to Goenka, equanimity influences whether
people suffer when faced with emotions (as well as external reality), and awareness
influences the extent to which suffering is reduced or increased based on the adequate
presence of equanimity. That is to say, there might be a (partial or even full) moderating
effect of awareness between equanimity and outcomes. Similarly, the fact that the effect of
awareness relies on the nature of experience also implies a moderating effect of awareness.
Therefore, future studies could explore this moderating effect or the complex relationships
between awareness and other variables.

Conclusions and Implications for Practice and Further Studies

Awareness, which refers to sensitivity to bodily sensations and the related psychological
states, is one of the two important abilities cultivated in GVM. Access to slight bodily
sensations is not emphasized in MBTs; the technique of being aware of slight bodily
sensations and thereby monitoring psychological status in daily life is unique to GVM.
Some scholars have argued that acceptance is more important than the attentional aspect of
mindfulness to mental health (Kohls et al. 2009); the necessity of time-consuming medi-
tation training has also been questioned based on the idea that acceptance can be taught in a
short time without any form of meditation (Harris 2007). The cultivation and application of
awareness in GVM support the importance of intensive training in paying attention, which
is also shared by MBSR and MBCT.
Current studies on GVM are rare, but they and related studies from other areas have
provided limited empirical support for the cultivation and application of awareness in
GVM. Evidence and theories support that GVM can enhance access to bodily sensations
and that bodily sensations are genuinely associated with emotion, but it is unknown to what
extent sensitivity to bodily sensation can be cultivated and whether it enhances the
awareness of emotion. Overall, the evidence from existing studies on awareness training is
weak and does not demonstrate the effectiveness of the techniques advocated by GVM.
The ideas that awareness in monitoring emotion is valuable, especially for anger control,
and that awareness of psychological processes facilitates self-control and flexibility have
been widely accepted. Empirical studies have noted that enhanced sensory experience
could lead to negative consequences, and the combination of acceptance and awareness has
been emphasized by GVM and supported by studies. These issues imply a potential
moderator role of awareness in daily life.
With the limited empirical evidence available currently, it might be too early to
advocate that intensive training on sensitivity to bodily sensation, such as that offered in

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the 10-day Vipassana course, should be integrated into MBTs or other interventions. In
addition, the intensive training is time-consuming, and the potential benefits may not be
particularly important in targeting mental disorders. Even so, current findings on GVM still
note the potential benefits of cultivating awareness in other interventions: Observing subtle
bodily sensations could be integrated into current MBSR and MBCT practices such as
body scanning. Such modifications may enhance the awareness of emotion, and gradually
enhanced sensitivity to body sensation provides feedback and facilitates the practice of
body scanning at home. Likewise, bodily sensation as a barometer of stress and emotion
has been applied in MBCT, and detecting the biological patterns of other emotions with
subtle bodily sensations could be encouraged. Although mindfulness-based interventions
emphasize acceptance, other practices and interventions that also involve awareness of the
body may not consider acceptance a high priority, and the potential danger of enhanced
awareness of bodily sensation warrants concern.
In the future, psychologists should pay more attention to GVM and its approach to
awareness. This special technique has high potential value for a wide range of clinical
applications, and its basic mechanisms contribute to the popularity of the topic of the
relationship between emotions and the body in current psychology research. Some rec-
ommended directions for future studies are presented next.
First of all, several types of studies can be used to test the effectiveness of GVM
techniques. One, the extent to which GVM and other training on body awareness can
enhance sensitivity to bodily sensations, and further enhance awareness of emotional
status, still requires much meticulous study. Two, additional studies that vary the partic-
ipants and tasks can confirm whether focusing on bodily sensation can provide more
information in certain situations (Bornemann et al. 2011). Three, studies on the essential
relationship between bodily sensation and emotion are important in understanding the
mechanism of enhancing awareness of emotion: If bodily sensation is considered a result
of emotional reactions, a high sensitivity to bodily sensations only enhances subjective
experience and provides information about emotional status. In contrast, if bodily sensation
is an essential part of emotion, an enhanced awareness of bodily sensations may increase
overall emotional reactions or even make people more vulnerable when they are faced with
emotive stimuli. This is the concern regarding the potential danger of enhanced awareness.
A second direction to explore is the effect of awareness. Studies have more heavily
emphasized testing the effect of meditation on hypothetical mechanisms or variables in
psychotherapies in recent years (Dobson and Dozios 2009). Because several potential
mechanisms may be involved in GVM (e.g., Teasdale and Chaskalson 2011; Ronel et al.
2011), it is important to further confirm whether it is truly awareness that mediates the
positive outcomes of the 10-day Vipassana course. Considering that it is difficult to con-
firm the application and effects of emotional awareness claimed in GVM, qualitative
methods may be useful in providing more comprehensive evidence. Another method,
which was mentioned above, is to conduct a complexly designed study based on mind-
fulness scales or other instruments to explore the role of awareness in mental health, such
as its moderating effect in the relationship between Acceptance and negative symptoms as
claimed by GVM.
Third, considering the time consumption of mindfulness-based intervention, the optimal
practice is an important topic. Meta-analyses on MBSR found no significant relationship
between practice time in weekly classes and the size of the effects on outcomes, and there
is doubt regarding how long these treatments need to be (Carmody and Baer 2009; Shapiro
2009). The same question also applies to GVM, and an emphasis on awareness may also
provide new perspectives for evaluating the value of MBSR practice time. After the

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cultivation of awareness, the maintenance dose of GVM practice becomes a further


issue. The advised 2 h of practice every day after the 10-day Vipassana course is too
expensive for many people, and only a small number can maintain this schedule (Zhao
2011). As far as we know, except for the 3- or 6-month follow-up measurements in
intervention studies based on self-report scales, no rigorous study has tested the decay of
this cultivated awareness in the absence of subsequent practice. Another practical question
is which part of the body or which muscle can provide optimal sensitivity. Different
emotional stimuli activate specific patterns of muscles (Niedenthal et al. 2009), but which
muscles undergo the most intense objective reactions or most subjective sensations have
not yet been confirmed. MBCT advises reading the muscles on the back or arm because
these parts seem to be more easily observed when negative emotions occur (Williams et al.
2007). In contrast, GVM requires an awareness of bodily sensation through every portion
of the body, and this requirement might partially reflect the philosophy of Buddhism. For
clinical applications, training could be more effective if evidence could show that spe-
cialized training focused on a particular muscle was sufficient.

Acknowledgments This paper was completed when Professor Oei was a visiting Professor at Beijing
Normal University, Beijing, P.R. China.

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