Mauri Tau me te Māramatanga: Weaving world views together in Aotearoa

Among all, there is a deep, pervasive mamae (pain) representing the legacy of colonisation

The piercing karanga offered by kaiwhakahaere Valerie Teraitua weaves a spiritual rope of safe passage for manuhiri (guests) as they are welcomed onto the Papatūānuki Kōkiri Marae in Māngere, south Auckland.

Referred through their local doctors and the marae networks, they are here to engage in Mauri Tau me te Māramatanga (MTM), a six-week, 2.5 hours per week, te ao Māori enriched, transdiagnostic and trauma-informed, mindfulness meditation (MM)-based programme adapted from the gold standard, evidence-based, mindfulness-based stress reduction (MBSR) programme (see panels below). ies and scientific methods.

Mauri tau – mindfulness

Mauri tau is mindfulness – a life force energy that is calm, relaxed, focused and deliberate. It is way of paying attention to our moment-to-moment experience and remembering what we value the most.

Māramatanga – awareness

Through the practice of MM, awareness grows. With greater mindfulness and awareness of self, others and our relationship to the whole of life, we are more able to respond wisely to circumstances, rather than react impulsively. As mauri tau deepens, so does māramatanga, the capacity for enlightened insight.

The scientific dimension

MM contributes to wellbeing through transforming four main neural pathways:²

• those for stress and our recovery from it
• the circuitry for attention, retraining our habits of focus
• those for empathy and compassion
• our sense of self (an emphasis of contemplative traditions).

The dimension of wairua

Across time and global wisdom traditions, mauri tau me te māramatanga (mindfulness and awareness) practices have cultivated wairuatanga (the spiritual dimension). Many people have shared that the universal nature of MM is in harmony with their beliefs and has enriched their wairua. We acknowledge the spiritual origins of these practices and the place of wairua in care that is whai tikanga (meaningful) to Māori.

More than 50 years of research suggests salient benefits of MM for mental and physical wellbeing. MBSR research is most influential. How do MMbased interventions (MMBIs) measure up against gold standard, evidence-based therapies (EBTs)? A parsimonious review of the field suggests:^₃

Depression – MMBIs have been rated as equivalent to cognitive behavioural therapy (CBT) and antidepressant medications. In MM, progressive training in returning attention to the present moment targets cognitive processes perpetuating depression. MM decreases negative rumination and increases capacity for meta-cognition (ie, this thought is not a fact, and I don’t have to believe it). MM targets the default mode network, decreasing its activation, increasing connectivity with the prefrontal cortex, and increasing top-down attentional control.

Anxiety – MMBIs afford similar results to EBTs, including exposure therapy. A study of 89 participants assigned to either MBSR or a psychoeducation group, found greater reductions in stress reactivity, self-reported anxiety and global severity in the MBSR group. Exposure during MM leads to reduced reactivity to physiological and cognitive symptoms of anxiety. An MTM participant described “having a chuckle” at the thoughts perpetuating her phobia of driving. MM brings about change in the mind’s default to self-related processing and reduces negative self-related beliefs.

Post-traumatic stress (emerging) – informed by trauma-sensitive guidelines, MM can lower emotional reactivity to negative affect, and facilitate gradual exposure and, thus, tolerance to unpleasant stimuli. Neuroimaging of military veterans participating in mindfulness-based exposure therapy suggests MM supports increased activation of the medial prefrontal cortex and decreased activation of the amygdala when viewing angry faces. Negative, repetitive thoughts were also ameliorated through MM.

Pain – pain syndromes have been a long-term research target. MM suggests significant quality of life benefits, decreased pain-related distress and moderate evidence for pain reduction. MM influences appraisal circuitry, reducing perceptions of pain intensity and unpleasantness. In experienced meditators, there is reduced activity in the amygdala and salience networks related to cue and onset of painful stimuli.

Substance use – an exemplar trial of 208 participants participating in either mindfulness-based relapse prevention, CBT-based relapse prevention or a 12-step programme showed the mindfulness-based participants had fewer days of substance use at 12-month follow-up. MMBIs have been rated superior to other treatments for smoking cessation. MM cultivates response inhibition and extinction. For smoking cessation, MM has been linked to lower amygdala and insula activation.

Other – attention disorders, eating disorders and serious mental illness (eg, bipolar disorder, psychosis) are nascent, emerging targets for MMBIs.

MTM is the outcome of an 18-month-long, marae-based co-design funded by Counties Manukau Health, Tāmaki Health and Total Healthcare PHO. In addition to the adult programme, rangatahi ora from the Te Rau Ora NGO and the community have contributed to a one-hour, term-length, college-level curriculum. A six-week, two-hour course is available as a wellbeing programme for medical and mental health professionals.

MTM is whai tikanga (meaningful) for Māori, and educative for all New Zealanders on the journey towards greater understanding of te ao Māori. According to Tanya Turuwhenua, mental health and addictions portfolio manager at Counties Manukau Health, MTM is a “koha to the community that can be offered throughout primary and secondary health and mental healthcare in a variety of settings.” The presence of a Māori facilitator or cultural support worker will preserve the cultural integrity of the programme.

Developed slowly on a foundation of trust and reciprocity, the MTM co-design process reflects Tā Mason Durie’s guidelines for working at the interface of indigenous wisdom and scientific knowledge:¹

Mutual respect – recognition of the validity of each system of knowledge. Shared benefits – indigenous communities share benefits of teaching and research, including intellectual property and commercialisation.

Human dignity – cultural and spiritual beliefs and practices are reinforced in teaching and research. Indigenous world views are not compromised.

Discovery – innovation and exploration using indigenous methodologies and scientific methods.

Kaimātai hinengaro (clinical psychologist) Sharon Rickard is a member of the MTM enrichment rōpu who has worked with Māori for several decades in south Auckland.

She reflects, “My client base is 99 per cent Māori. I work with tamariki (children), rangatahi (adolescents) and wāhine Māori. Phrases such as ‘resistant and hard to work with’, ‘difficult to treat’, ‘reluctant to engage’, ‘unreliable’, and/or ‘unmotivated’ are common judgement-laden descriptions included in referral information.

“Perhaps the referral is for anger management, but if you scratch the surface, there is anxiety and/or depression, post-traumatic stress disorder, and underneath that is a trauma history inflicted by others who have their own trauma histories. Among all, there is a deep, pervasive mamae (pain) representing the legacy of colonisation.

“Western treatments, intervention models, brief behavioural modification programmes, medication, hospitalisation, incarceration, institutionalised care, talking therapies, etc, have not always been empowering, useful or effective in the long term.

“Common in everyone I work with is the inability to whakatau wairua – to settle the spirit or self-regulate – the inability to notice and just be with the mamae. There is an inability to slow or clear the pīwaiwaka (fantail) mind, and there is a lack of aroha for self and others. Overall, clients are in a state of pōraruraru (confusion), they are troubled, with few strategies to manage their emotional turmoil.

“Mindfulness integrated with mātauranga and tikanga Māori offers strategies and a way of being that can be learnt, practised and used. For the people I have worked with, the mindfulness skills, such as ‘the centring breath’, sitting, walking and body scan meditations, and mindful movement combined with Māori knowledge, has been a ‘freeing’ experience. For some, it can be the beginning of a healing journey, including self-awareness and self-control, and an appreciation and compassionate understanding of self and others.”

Rebecca, a 50-year-old wāhine Māori, is such a person. Referred to the mindfulness course by her GP, she lives with asthma, chronic back pain, obesity and depression (not otherwise specified). She graduated a first focus group of MTM, attended once again, and became a regular visitor to the marae. Rebecca enjoys practising MM outdoors, meditating on the sounds of the tui that frequent her garden.

Her recent mental outlook assessment indicates that, one year later, her mood is good. She says, “I joined the mindfulness course, thinking it would be like all the other courses, with textbooks and homework. Instead, I got an MP3 of meditations. This helped me with my chronic back pain, depression…and the stress with my family.

“This course has opened up the ‘relaxed me’ and given me calmness. It is based on the marae in Māngere, and it’s good for my own people – Māori people – because a lot of them are going through the same thing. So, thank you for helping me to find my mind.”

Carlos, a 28-year-old Māori male, attended MTM following the death of his beloved cousin, by suicide. He feared his grief could lead him down a “dark path.” His mother suggested that the mindfulness course could be helpful to him.

He explains, “I went in with an open mind, not really knowing what to expect. The programme provided me with key strategies to release personal pain and to deal with conflict better. My favourite practice was the body scan.

“I believe the programme will make a difference for our young Māori and Pasifika men, as it helped transform the way I see, respond and act towards life’s situations.” Carlos is now a member of the group of rangatahi training to share MTM with other young people.

Within Māori culture, there is great diversity of knowledge and understanding. Deep and complete, te ao Māori needs no modification or addition, and it cannot be adequately shared or known through English language and culture.

However, some elements of te ao Māori have been integrated into healthcare, and we have utilised a number of these approaches in the timely co-design of MTM. In doing so, the MTM rōpu joins others integrating mindfulness practices into a Māori framework.

A six-day marae-based MTM teacher training will take place in November 2021. Would you like to learn more about, experience, or train to teach MTM? Contact Lila O’Farrell at lila.o@tamakihealth.co.nz

Lila O’Farrell (Ngāti Kereti, Tangata Tiriti) is a senior therapist and MTM/Aotearoa Mindfulness and Awareness clinical lead at Tāmaki Health, director of deeplyawareyou.com, and a member of the MTM enrichment rōpu; Sharon Rickard (Ngāti Te Ata, Ngāti Tipa) is a clinical psychologist and director at Te Aho Tapu Trust and Ngamako Limited, and a member of the MTM enrichment rōpu

*Client consent was obtained to share these case studies, and some details have been changed to protect confidentiality

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