Papers by Daniel M Ingram
Mindfulness, May 17, 2024
Objectives Adoption of potentially consciousness-altering practices may be leading to a rise in e... more Objectives Adoption of potentially consciousness-altering practices may be leading to a rise in emergent phenomena (EP): sudden unusual mental or somatic experiences often interpreted as spiritual, mystical, energetic, or magical in nature. It is unclear how frequently these altered states of consciousness occur and what the clinical implications may be. Anecdotal accounts and prior literature suggest that EP may be common, under-reported, and followed by either positive or negative changes to well-being. We sought to supplement prior evidence on the prevalence and effects of EP among general populations with large-scale quantitative measurements. Method We measured the prevalence of EP, while not on mind-altering substances, through completion of online surveys by representative samples from three international communities (n = 3135). The communities sampled were UK Qualtrics online panelists, US-based MTurk workers, and the readers of a popular rationalist blog. Samples were broadly representative of underlying populations. Results Forty-five percent of participants reported experiencing non-pharmacologically induced EP at least once in their lives, including derealization (17%), unitive experiences (15%), ecstatic thrills (15%), vivid perceptions (11%), changes in perceived size (10%), bodily heat or electricity (9%), out-of-body experiences (8%), and perception of non-physical lights (5%). Respondents reported a mix of positive and negative well-being outcomes following EP, with 13% claiming moderate or greater suffering and 1.1% claiming life-threatening suffering. Of those who experienced suffering, 63% did not seek help. Conclusions EP are widespread among the studied populations with potential for both positive and negative outcomes, the latter of which do not appear to be adequately addressed through recourse to clinical practice. Keywords Altered states of consciousness • Contemplative practice • Emergent phenomena • Meditation • Mental health • Mindfulness • Mystical experience Contemplative practices such as yoga, meditation, and mindfulness-based interventions (MBIs) are gaining global popularity for their potential to enhance well-being, productivity,
Journal of Medical Toxicology, Mar 1, 2008
Introduction: Human ingestion of denture cleansers leading to gastric perforation has not previou... more Introduction: Human ingestion of denture cleansers leading to gastric perforation has not previously been described. Case Report: A 27-year-old male ingested three denture cleanser tablets in water over two days in an attempt to cause a falsenegative result on a workplace urine drug screen. Seven days later he presented to an emergency department with a perforated gastric ulcer. Discussion: A literature review of cases and the chemistry of the components of his ingestion was conducted to determine the possible relationship between these events. Ingestion of intact fragments of the tablets would be likely to result in significant gastric toxicity, but ingestion of dissolved tablets would be unlikely to have caused his illness.
Therapeutic Drug Monitoring, Apr 1, 2005
Frontiers in psychology, Jul 10, 2024
Meditation, psychedelics, and other similar practices or induction methods that can modulate cons... more Meditation, psychedelics, and other similar practices or induction methods that can modulate conscious experience, are becoming increasingly popular in clinical and non-clinical settings. The phenomenology associated with such practices or modalities is vast. Many similar effects and experiences are also reported to occur spontaneously. We argue that this experiential range is still not fully described or understood in the contemporary literature, and that there is an ethical mandate to research it more extensively, starting with comprehensive documentation and definition. We review 50 recent clinical or scientific publications to assess the range of phenomena, experiences, effects, after-effects, and impacts associated with a broad variety of psychoactive compounds, meditative practices, and other modalities or events. This results in a large inventory synthesizing the reports of over 30,000 individual subjects. We then critically discuss various terms and concepts that have been used in recent literature to designate all or parts of the range this inventory covers. We make the case that specialized terminologies are needed to ground the nascent research field that is forming around this experiential domain. As a step in this direction, we propose the notion of "emergence" and some of its derivatives, such as "emergent phenomenology," as possibly foundational candidates.
Frontiers Psychology, 2024
Meditation, psychedelics, and other similar practices or induction methods that can modulate cons... more Meditation, psychedelics, and other similar practices or induction methods that can modulate conscious experience, are becoming increasingly popular in clinical and non-clinical settings. The phenomenology associated with such practices or modalities is vast. Many similar effects and experiences are also reported to occur spontaneously. We argue that this experiential range is still not fully described or understood in the contemporary literature, and that there is an ethical mandate to research it more extensively, starting with comprehensive documentation and definition. We review 50 recent clinical or scientific publications to assess the range of phenomena, experiences, effects, after-effects, and impacts associated with a broad variety of psychoactive compounds, meditative practices, and other modalities or events. This results in a large inventory synthesizing the reports of over 30,000 individual subjects. We then critically discuss various terms and concepts that have been used in recent literature to designate all or parts of the range this inventory covers. We make the case that specialized terminologies are needed to ground the nascent research field that is forming around this experiential domain. As a step in this direction, we propose the notion of "emergence" and some of its derivatives, such as "emergent phenomenology," as possibly foundational candidates.
Neuropsychologia
Mindfulness meditation is a contemplative practice informed by Buddhism that targets the developm... more Mindfulness meditation is a contemplative practice informed by Buddhism that targets the development of present-focused awareness and non-judgment of experience. Interest in mindfulness is burgeoning, and it has been shown to be effective in improving mental and physical health in clinical and non-clinical contexts. In this report, for the first time, we used electroencephalography (EEG) combined with a neurophenomenological approach to examine the neural signature of “cessation” events, which are dramatic experiences of complete discontinuation in awareness similar to the loss of consciousness, which are reported to be experienced by very experienced meditators, and are proposed to be evidence of mastery of mindfulness meditation. We intensively sampled these cessations as experienced by a single advanced meditator (with over 23,000 h of meditation training) and analyzed 37 cessation events collected in 29 EEG sessions between November 12, 2019, and March 11, 2020. Spectral analyses of the EEG data surrounding cessations showed that these events were marked by a large-scale alpha-power decrease starting around 40 s before their onset, and that this alpha-power was lowest immediately following a cessation. Region-of-interest (ROI) based examination of this finding revealed that this alpha-suppression showed a linear decrease in the occipital and parietal regions of the brain during the pre- cessation time period. Additionally, there were modest increases in theta power for the central, parietal, and right temporal ROIs during the pre-cessation timeframe, whereas power in the Delta and Beta frequency bands were not significantly different surrounding cessations. By relating cessations to objective and intrinsic measures of brain activity (i.e., EEG power) that are related to consciousness and high-level psychological functioning, these results provide evidence for the ability of experienced meditators to voluntarily modulate their state of consciousness and lay the foundation for studying these unique states using a neuroscientific approach.
Mindfulness
Millions of people globally have learned mindfulness meditation with the goal of improving health... more Millions of people globally have learned mindfulness meditation with the goal of improving health and well-being outcomes in both clinical and non-clinical contexts. An estimated half of these practitioners follow mindfulness teachers’ recommendations to continue regular meditation after completion of initial instruction, but it is unclear whether benefits are strengthened by regular practice and whether harm can occur. Increasing evidence shows a wide range of experiences that can arise with regular mindfulness meditation, from profoundly positive to challenging and potentially harmful. Initial research suggests that complex interactions and temporal sequences may explain these experiential phenomena and their relations to health and well-being. We believe further study of the effects of mindfulness meditation is urgently needed to better understand the benefits and challenges of continued practice after initial instructions. Effects may vary systematically over time due to factors...
Journal of Medical Toxicology, Jun 1, 2008
Background: Acetaminophen (APAP) is a leading cause of fatal overdose. This study examined the pe... more Background: Acetaminophen (APAP) is a leading cause of fatal overdose. This study examined the performance characteristics of the Biosite Triage TOX Drug Screen qualitative APAP urine test (urine screen) in a clinical setting. Methods: Paired urine and serum waste samples (collected within 2 hours of one another) were quantitatively analyzed for APAP concentration and compared to the urine screen results. Results: A total of 191 paired samples met inclusion criteria. The urine screen did not report a negative result for the 21 samples with a serum APAP concentration of ≥10g/mL and had a sensitivity of 100% (95% confidence interval [CI], 85-100%). The urine screen had a sensitivity of 96% (95% CI, 91-99%) and a specificity of 90% (95% CI, 82-95%) for detecting urine APAP concentrations Ͼ5g/mL by gas chromatograph mass spectroscopy (GCMS) methods, and a sensitivity of 81% (95% CI, 73-87%) and a specificity of 95% (95% CI, 85-98%) by high-pressure liquid chromatography (HPLC) methods. Conclusions: The urine screen detected urine APAP concentrations with good accuracy and may be an effective screen to rule out acute APAP overdose in some circumstances. Its clinical utility is discussed. Funding: Partially funded by Biosite Incorporated.
Neuropsychologia, 2023
Mindfulness meditation is a contemplative practice informed by Buddhism that targets the developm... more Mindfulness meditation is a contemplative practice informed by Buddhism that targets the development of
present-focused awareness and non-judgment of experience. Interest in mindfulness is burgeoning, and it has
been shown to be effective in improving mental and physical health in clinical and non-clinical contexts. In this
report, for the first time, we used electroencephalography (EEG) combined with a neurophenomenological
approach to examine the neural signature of “cessation” events, which are dramatic experiences of complete
discontinuation in awareness similar to the loss of consciousness, which are reported to be experienced by very
experienced meditators, and are proposed to be evidence of mastery of mindfulness meditation. We intensively
sampled these cessations as experienced by a single advanced meditator (with over 23,000 h of meditation
training) and analyzed 37 cessation events collected in 29 EEG sessions between November 12, 2019, and March
11, 2020. Spectral analyses of the EEG data surrounding cessations showed that these events were marked by a
large-scale alpha-power decrease starting around 40 s before their onset, and that this alpha-power was lowest
immediately following a cessation. Region-of-interest (ROI) based examination of this finding revealed that this
alpha-suppression showed a linear decrease in the occipital and parietal regions of the brain during the pre-
cessation time period. Additionally, there were modest increases in theta power for the central, parietal, and
right temporal ROIs during the pre-cessation timeframe, whereas power in the Delta and Beta frequency bands
were not significantly different surrounding cessations. By relating cessations to objective and intrinsic measures
of brain activity (i.e., EEG power) that are related to consciousness and high-level psychological functioning,
these results provide evidence for the ability of experienced meditators to voluntarily modulate their state of
consciousness and lay the foundation for studying these unique states using a neuroscientific approach.
BackgroundAcetaminophen (APAP) is a leading cause of fatal overdose. This study examined the perf... more BackgroundAcetaminophen (APAP) is a leading cause of fatal overdose. This study examined the performance characteristics of the Biosite Triage TOX Drug Screen qualitative APAP urine test (urine screen) in a clinical setting.MethodsPaired urine and serum waste samples (collected within 2 hours of one another) were quantitatively analyzed for APAP concentration and compared to the urine screen results.ResultsA total of 191 paired samples met inclusion criteria. The urine screen did not report a negative result for the 21 samples with a serum APAP concentration of ≥10μg/mL and had a sensitivity of 100% (95% confidence interval [CI], 85–100%). The urine screen had a sensitivity of 96% (95% CI, 91–99%) and a specificity of 90% (95% CI, 82–95%) for detecting urine APAP concentrations > 5μg/mL by gas chromatograph mass spectroscopy (GCMS) methods, and a sensitivity of 81% (95% CI, 73–87%) and a specificity of 95% (95% CI, 85–98%) by high-pressure liquid chromatography (HPLC) methods.Con...
Child Abuse Neglect, Aug 31, 2001
To evaluate the relationship between the transverse hymenal orifice diameter as measured by separ... more To evaluate the relationship between the transverse hymenal orifice diameter as measured by separation technique (THODST), using a method that maximized the diameter of the hymenal orifice, and other possible markers of sexual abuse in girls from 3 through 12 years old. Over a 10-year period, clinical information was recorded on girls referred to the WakeMed Child Sexual Abuse Team in Raleigh, NC at the time of examination. The study population comprised 1975 girls of the 2058 evaluated for sexual abuse. The girls were interviewed, examined, and tested for sexually transmitted diseases. Information from referral sources, accompanying guardians, and previous recent physical examinations was recorded. The girls were assigned to three groups based upon their risk of being sexually abused. Linear regression was performed to evaluate how well the THODST distinguished between the risk groups, as well as how it was correlated with individual established markers of sexual abuse. The size of the THODST did not distinguish between the three risk groups, nor did it correlate with any potential or established markers of sexual abuse other than three potential markers of hymenal trauma: narrowing of the posterior hymenal rim, hymenal tears and lacerations, and hymenal clefts between 5 and 7 o'clock in the supine position. Thus, we found the THODST as we measured it to have no value for answering the question, "Was this child sexually abused?"
Journal of Medical Toxicology, Jun 1, 2008
Journal of Medical …, 2008
Background: Acetaminophen (APAP) is a leading cause of fatal overdose. This study examined the pe... more Background: Acetaminophen (APAP) is a leading cause of fatal overdose. This study examined the performance characteristics of the Biosite Triage TOX Drug Screen qualitative APAP urine test (urine screen) in a clinical setting. Methods: Paired urine and serum waste samples (collected within 2 hours of one another) were quantitatively analyzed for APAP concentration and compared to the urine screen results. Results: A total of 191 paired samples met inclusion criteria. The urine screen did not report a negative result for the 21 samples with a serum APAP concentration of ≥10g/mL and had a sensitivity of 100% (95% confidence interval [CI], 85-100%). The urine screen had a sensitivity of 96% (95% CI, 91-99%) and a specificity of 90% (95% CI, 82-95%) for detecting urine APAP concentrations Ͼ5g/mL by gas chromatograph mass spectroscopy (GCMS) methods, and a sensitivity of 81% (95% CI, 73-87%) and a specificity of 95% (95% CI, 85-98%) by high-pressure liquid chromatography (HPLC) methods. Conclusions: The urine screen detected urine APAP concentrations with good accuracy and may be an effective screen to rule out acute APAP overdose in some circumstances. Its clinical utility is discussed. Funding: Partially funded by Biosite Incorporated.
Journal of Medical Toxicology, 2008
Introduction: Human ingestion of denture cleansers leading to gastric perforation has not previou... more Introduction: Human ingestion of denture cleansers leading to gastric perforation has not previously been described. Case Report: A 27-year-old male ingested three denture cleanser tablets in water over two days in an attempt to cause a falsenegative result on a workplace urine drug screen. Seven days later he presented to an emergency department with a perforated gastric ulcer. Discussion: A literature review of cases and the chemistry of the components of his ingestion was conducted to determine the possible relationship between these events. Ingestion of intact fragments of the tablets would be likely to result in significant gastric toxicity, but ingestion of dissolved tablets would be unlikely to have caused his illness.
Child Abuse & Neglect, 2001
To evaluate the relationship between the transverse hymenal orifice diameter as measured by separ... more To evaluate the relationship between the transverse hymenal orifice diameter as measured by separation technique (THODST), using a method that maximized the diameter of the hymenal orifice, and other possible markers of sexual abuse in girls from 3 through 12 years old. Over a 10-year period, clinical information was recorded on girls referred to the WakeMed Child Sexual Abuse Team in Raleigh, NC at the time of examination. The study population comprised 1975 girls of the 2058 evaluated for sexual abuse. The girls were interviewed, examined, and tested for sexually transmitted diseases. Information from referral sources, accompanying guardians, and previous recent physical examinations was recorded. The girls were assigned to three groups based upon their risk of being sexually abused. Linear regression was performed to evaluate how well the THODST distinguished between the risk groups, as well as how it was correlated with individual established markers of sexual abuse. The size of the THODST did not distinguish between the three risk groups, nor did it correlate with any potential or established markers of sexual abuse other than three potential markers of hymenal trauma: narrowing of the posterior hymenal rim, hymenal tears and lacerations, and hymenal clefts between 5 and 7 o'clock in the supine position. Thus, we found the THODST as we measured it to have no value for answering the question, "Was this child sexually abused?"
Pediatrics, 2001
Objective. Testing for gonorrhea (GC) and chlamydial (Ct) infection in children who are being eva... more Objective. Testing for gonorrhea (GC) and chlamydial (Ct) infection in children who are being evaluated for sexual abuse is invasive and costly. We developed selective criteria to limit unnecessary testing for these infections. Methods. Over a 10-year period (May 1988 to May 1998), clinical information was collected in a prospectively designed database for all children ages 0 to 12 years by the WakeMed Child Sexual Abuse Team in Raleigh, North Carolina. The study population comprised 3040 (2414 girls and 626 boys) of the 3064 children evaluated for sexual abuse. Children were interviewed, examined, and tested by culture for GC and Ct orally, rectally, and genitally. Information from referral sources, accompanying guardians, and previous recent physical examinations was recorded. Bivariate analyses and logistic regression were used to develop 2 sets of screening criteria to predict children at greatest risk of infection with: 1) GC and/or Ct (GC/Ct) and 2) GC alone. Results. Fifty-eight children were identified with GC/Ct infections (37 with GC, 25 with Ct; 4 children were coinfected). The proposed algorithm for GC/Ct infections would have identified all children with these infections, while avoiding testing 56% of children without infection. Using genital cultures only, the proposed risk score for GC/Ct infections would have identified 100% of GC/Ct cases with 85% fewer cultures compared with testing all children with oral, rectal, and genital cultures. Conclusion. The use of a risk assessment algorithm for GC and Ct infections may reduce the cost and trauma of testing young children who are being evaluated for sexual abuse. Pediatrics 2001;107(5).
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Papers by Daniel M Ingram
present-focused awareness and non-judgment of experience. Interest in mindfulness is burgeoning, and it has
been shown to be effective in improving mental and physical health in clinical and non-clinical contexts. In this
report, for the first time, we used electroencephalography (EEG) combined with a neurophenomenological
approach to examine the neural signature of “cessation” events, which are dramatic experiences of complete
discontinuation in awareness similar to the loss of consciousness, which are reported to be experienced by very
experienced meditators, and are proposed to be evidence of mastery of mindfulness meditation. We intensively
sampled these cessations as experienced by a single advanced meditator (with over 23,000 h of meditation
training) and analyzed 37 cessation events collected in 29 EEG sessions between November 12, 2019, and March
11, 2020. Spectral analyses of the EEG data surrounding cessations showed that these events were marked by a
large-scale alpha-power decrease starting around 40 s before their onset, and that this alpha-power was lowest
immediately following a cessation. Region-of-interest (ROI) based examination of this finding revealed that this
alpha-suppression showed a linear decrease in the occipital and parietal regions of the brain during the pre-
cessation time period. Additionally, there were modest increases in theta power for the central, parietal, and
right temporal ROIs during the pre-cessation timeframe, whereas power in the Delta and Beta frequency bands
were not significantly different surrounding cessations. By relating cessations to objective and intrinsic measures
of brain activity (i.e., EEG power) that are related to consciousness and high-level psychological functioning,
these results provide evidence for the ability of experienced meditators to voluntarily modulate their state of
consciousness and lay the foundation for studying these unique states using a neuroscientific approach.
present-focused awareness and non-judgment of experience. Interest in mindfulness is burgeoning, and it has
been shown to be effective in improving mental and physical health in clinical and non-clinical contexts. In this
report, for the first time, we used electroencephalography (EEG) combined with a neurophenomenological
approach to examine the neural signature of “cessation” events, which are dramatic experiences of complete
discontinuation in awareness similar to the loss of consciousness, which are reported to be experienced by very
experienced meditators, and are proposed to be evidence of mastery of mindfulness meditation. We intensively
sampled these cessations as experienced by a single advanced meditator (with over 23,000 h of meditation
training) and analyzed 37 cessation events collected in 29 EEG sessions between November 12, 2019, and March
11, 2020. Spectral analyses of the EEG data surrounding cessations showed that these events were marked by a
large-scale alpha-power decrease starting around 40 s before their onset, and that this alpha-power was lowest
immediately following a cessation. Region-of-interest (ROI) based examination of this finding revealed that this
alpha-suppression showed a linear decrease in the occipital and parietal regions of the brain during the pre-
cessation time period. Additionally, there were modest increases in theta power for the central, parietal, and
right temporal ROIs during the pre-cessation timeframe, whereas power in the Delta and Beta frequency bands
were not significantly different surrounding cessations. By relating cessations to objective and intrinsic measures
of brain activity (i.e., EEG power) that are related to consciousness and high-level psychological functioning,
these results provide evidence for the ability of experienced meditators to voluntarily modulate their state of
consciousness and lay the foundation for studying these unique states using a neuroscientific approach.