Meditation As a Tool for Rehabilitation of Prison Inmates

Prisoners of Our Own Mind: The Powerful Effects of Meditation as a Tool for Rehabilitation


The inability to cope efficiently with anxiety and negative emotions may lead to various physical and psychological problems. The primary purpose of this paper was to examine the effects of Vipassana Meditation (VM) and X Meditation (TM) on the psychological health and rehabilitation of inmates. The most common physiological and psychological effects of meditation are: lower heart rate, reduced blood pressure, decreased breathing, decreased metabolism, increased mental alertness, improved cognitive and affective performance, enhanced well-being, reduced pain and stress, reduced anxiety, reduced depression, and modification of EEG patterns. Some of the previous findings have highlighted the plasticity of the brain and its adaptive capacity to stressful situations. With the attainment of heightened awareness and better coping capabilities through meditation, inmates possess a self-empowering tool to maintain good mental health. Furthermore, with the regular practice of meditation, inmates are better able to cope with their anger and frustrations, and violence rates as well as recidivism can be lowered.

Positive psychology, a new trend in the field of psychology, was pioneered by Martin Seligman in 1998. The purpose was to challenge the focus of current forms of therapy on negative aspects of the human condition, and rethink the positive characteristics of human nature that promote greater well-being. Positive psychology claims that people possess a wide range of psychological strengths and qualities which are essential for dealing with the challenges encountered in life. According to Seligman, prior to WWI, psychology had three goals: cure mental illness, make life productive and more fulfilling, and identify and nurture high talent (Seligman, 2005). The latter two of these goals were apparently forgotten as psychology shifted to focus on curing the mental illnesses of veterans and traumatized citizens. Today, the field is shifting back to focus on the prevention of mental illness and the promotion of better quality of life.

The primary goal of positive psychology is to help patients, and in this specific case, inmates, develop their strengths in order to lead more fulfilling lives and better cope with stress and aggression. Specific coping approaches are particular coping mechanisms designed to help people better deal and overcome the hardships of life. Of these coping mechanisms, there has been an increased interest in the application of the Asian techniques of meditation as a way of rehabilitation for the prison population.

The aim of meditation is to understand our true nature and be freed from the illusion that causes our suffering. From a psychological growth perspective, it is essential for individuals to be able to free themselves from the imaginary boundaries that limit their worldviews and consciousnesses. By realizing the true fleeting nature of emotions and sensations, one learns not to feel attached to physical or psychological pain, and to let go. The regular practice of meditation teaches one about the impermanence of mental and physical states, helping the person not to react emotionally and to experience more detachment. As a result, meditation induces a state of deep relaxation, inner harmony and heightened consciousness. Diverse techniques can be used during meditation, but all of them imply concentration on a particular object or activity and the elimination of all forms of internal or external distractions.

The first type of meditation presented in this paper is Vipassana Meditation (VM). The origins of mindfulness go back to the teachings of Siddharta Gautama (563 BCE – 483 BCE), the Buddha. The Buddha emphasized the notion of mindfulness of speech, thought and action in order to attain relief from suffering and ignorance. Being mindful means being fully aware of the present moment. The teaching of mindfulness or “insight” meditation focuses on a deep, penetrative nonconceptual seeing into the nature of the mind and the world and continuity of awareness in all daily activities. Vipassana Meditation is referred to as an opening up meditation, where one is to attend to all internal and external stimuli non-judgmentally. This type of meditation requires an ability to focus and to be open. By analyzing one’s thoughts or cognitions, VM focuses on a greater understanding through the systematic cultivation of inquiry and insight. Like cognitive behavioral therapy, VM involves the use of introspection or insight, where cognitions can be observed non-judgmentally and better understood. Hence, the path to better physical and psychological health comprises a better understanding of one’s reactions to all emotions. The main cause of human suffering stems from the way we interpret the world surrounding us. By understanding and changing our cognitions, we can lead more fulfilling lives and experience an increase in well-being.

Relaxation is a bi-product of this type of meditation, but it is not an objective of the process. Vipassana Meditation is taught during intensive 10-day retreats, where one is to remain silent for the duration of the retreat and meditate all day. The schedule is very strict and meditators must begin their daily sittings before sunrise, not eat after midday, refrain from any intoxicants, from killing, from sexual activity, from lying, singing, dancing and talking. Furthermore, in order to turn one’s full attention inward; eye contact with other participants is to be avoided, as well as reading, watching television, listening to the radio, and engaging in strenuous exercise.

The second type of meditation to be studied is X Meditation (TM). TM has its foundation in the Indian Vedanta philosophy and is practiced for at least 20 minutes twice daily while sitting with the eyes closed. The technique comprises the silent mental repetition of a mantra, which is a word or phrase used as a focus for the attention. The goal of this meditation is to attain pure consciousness: Samadhi. This technique became very popular in the early 1970s and scientists soon began to research the therapeutic effects of meditation.

In the United States, although sentencing is severe, recidivism rates are alarmingly high and many offenders fail to be rehabilitated into society. In order to improve a failing system, some facilities have considered rehabilitation as a viable alternative to punishment and opened their doors to promising, but non-conventional interventions such as meditation.

Beginning in 1997, Vipassana Meditation courses have been held in North American correctional facilities and researchers have demonstrated that such a technique has beneficial effects on lowering recidivism rates and improving inmate behavior and coping skills. Because of its very nature, the practice of Vipassana leads to a systematic process of self-observation that increases awareness, self-control, and inner balance, thus helping inmates make wiser decisions.

According the North American Vipassana Prison Project, to this day, only three research studies have been conducted on the effects of Vipassana Meditation (VM) courses on inmates in North America.

In 2002, a study conducted at the North Rehabilitation Facility (NRF) in Seattle, Washington, demonstrated that inmates participating in VM courses were 20% less likely to return to jail than the general inmate population who did not complete a course. Furthermore, Parks and Marlatt (2006) evaluated the effects of VM courses on substance use, recidivism, and psychological outcomes in an incarcerated population. According to the authors, previous findings in India suggested that VM courses are correlated to lowered levels of recidivism, depression, anxiety, hostility, and increased cooperation with prison authorities. The first Vipassana courses offered in a North American correctional facility were conducted at the North Rehabilitation Facility (NRF), a minimum-security adult jail in Seattle, Washington, with male and female inmates. Five men’s courses and four women’s courses were evaluated during a 15-month period. Study participants completed baseline measures 1 week prior to the start of the course, and a post-course assessment within 1 week of the end of the course. Follow-up assessments were administered 3 and 6 months after release from NRF. The total number of participants who volunteered for the Vipassana course was 79.2% men and 20.8% women, ranging in age from 19 to 58 years. Results indicated a significant relationship between participation in the VM course and post incarceration substance use, as well as improved psychosocial functioning. Thus, participants reported lower levels of psychiatric symptoms, more internal alcohol-related locus of control, and higher levels of optimism.

Unfortunately, very little research has been conducted on the effects of VM courses in prisons. The preliminary results are very encouraging, but not many facilities are open to trying alternative treatments for rehabilitation. Furthermore, unlike X Meditation (TM), VM courses are very demanding and require strong commitment. Sitting for 10 days in absolute silence and meditating 10 or more hours each day is very challenging. Also, one of the possible reasons for the lack of research is probably a lack of funding. Vipassana courses, as taught by S.N. Goenka, are entirely free. Participants are encouraged to make a donation only if they complete the course and no donations are accepted by people who have not completed a retreat. Also, unlike TM teachers, Vipassana teachers worldwide work as volunteers and are not remunerated. Thus, the money that is donated helps maintain or open new retreat centers, but does not fund research.

Unlike VM, X Meditation (TM) has generated an extensive amount of research in many different areas. TM has become famous in the 1960s when the Beatles introduced the Maharishi Mahesh Yogi to the West. Since then, many paying courses have been held worldwide and a university has been created. Thus, the majority of the research on TM has been conducted and sponsored by the Maharishi University.

The rationale behind the use of TM as a means for rehabilitation of prison inmates is the notion that people at different stages of self-development are at greater or lesser risk for committing crimes. Alexander, Walton, and Goodman (2003) have simplified Loevinger’s stages of ego development into three major levels: Preconventional, Conventional, and Postconventional. Each level contains several other stages of development, which vary along dimensions of impulse control, conscious concerns, and interpersonal and cognitive styles. Thus, people at lower levels of development are more likely to engage in basic coping mechanisms such as being impulsive or egocentric. Furthermore, people demonstrating a needs-gratification frame of reference tend to experience strenuous interpersonal relations and have little awareness of inner states. Therefore, such people might be unaware or have difficulty conforming to the conventions, rules, or laws of society and may engage in criminal behaviors. The next level is the Conventional level, in which the person can be described as conformist, self-aware, and conscientious. This level is typically attained by late adolescence. Finally, the last level is the Postconventional level, which is the most mature type of functioning in Loevinger’s framework. People at this level have a capacity for self-actualization, are autonomous, experience inner fulfillment, strong moral values and respect for others, and demonstrate flexibility in adapting to demands and coping with external or internal conflicts. Proponents of the TM method cite previous studies indicating that TM programs enhance self-development and self-actualization, thus suggesting that continued practice of this type of meditation facilitates advancement through the stages of self-development in adulthood. Therefore, by introducing TM programs as a means for rehabilitation, self-development can be accelerated in inmates, thus providing them with a technique that promotes a greater ability to function in a manner acceptable to society.

In their study, Alexander, Walton, and Goodman (2003) discuss the use of TM as a means for rehabilitation of repeat offenders. According to their research, the practice of TM reduces multiple factors such as anxiety, aggression, addictions, and other psychological as well as physiological factors linked to the likelihood of committing a crime. Therefore, they propose that the systematic practice of this type of meditation promotes the experience of transcendental consciousness, which in turn alleviates stress-induced imbalances including hypertension, psychopathology, as well as addictive behaviors. The purpose of their study was to demonstrate that the practice of TM by prison inmates would lead to more rapid self-development, increased experiences of major states of consciousness said to be higher than walking, sleeping, and dreaming, and the reduction of psychopathological conditions. The researchers hypothesized that, compared to control groups, inmates practicing the TM program would show decreased psychopathology, as indicated by questionnaire measures of psychoticism, hostility, aggression, depression, and psychopathic deviation; they would show enhanced personality development, particularly as indicated by measures of ego- or self-development, moral reasoning, and cognitive development; and finally, they would show increased reports of higher states of consciousness, as indicated by scores on the State of Consciousness Inventory. The subjects were 160 adult male inmates from the Massachusetts Correctional Institute (MCI), Walpole: a maximum-security institution. Results indicated that inmates who had practiced the TM program for a duration of 20 months had improved scores compared to the control group. Highly significant differences were found in development, consciousness, and psychopathology scores. Thus, the results confirmed the stated hypothesis that inmates practicing TM would demonstrate reduced levels of psychopathology, increased self-development, and increased experiences of higher states of consciousness.

In the second part of the Walpole Study, Alexander and Orme-Johnson (2003) studied longitudinal changes in self-development and psychopathology over a 15.7 month period in 271 maximum-security prisoners. For this study, four groups were compared: prisoners participating in the TM program, counseling, drug rehabilitation, or Muslim or Christian groups. The results indicated that only regular participants in the TM program changed significantly, moving from Loevinger’s Conformist level, which is characterized by an exploitative orientation, to the Self Aware level, which is characterized by a greater awareness of norms and goals. Furthermore, TM participants demonstrated significant reductions in aggression, schizophrenic symptoms, decreased trait-anxiety, and increased frequency of post-conceptual experience of higher states of consciousness. Thus, the results of the longitudinal follow-up corroborated the cross-sectional findings, showing that TM practice increases self-development.

In the third part of the Walpole Study, Alexander, Rainforth, Frank, Grant, Von Stade, and Walton (2003) conducted a retrospective investigation of recidivism among 286 inmates released from Walpole prison, by following them for 59 months. Results indicated that only 32% of inmates who practiced the TM technique returned to prison for a stay of 30 days or more, compared to 48% of inmates who participated in other prison programs. Therefore, the practice of TM correlated with a statistically significant reduction in recidivism of 33%. Again, those findings were consistent with the assumption that regular practice of TM would result in reduced psychopathology, accelerated psychological development, and reduced criminal behavior.

In another study, Rainforth, Alexander, and Cavanaugh (2003) examined recidivism rates over a 15-year period among inmates trained in the TM method who had been released from a maximum security prison in California. From 1975 to 1982, a total of 153 inmates at Folsom Prison participated in the TM program. By 1982, all of them had been paroled. The researchers matched each TM participant to a non-meditating control subject from the Folsom Prison records, controlling for variables such as parole year, race, offence, prior commitment record, age, history of drug abuse, ethnicity, marital status, educational attainment, IQ, employment history, military service, age at first arrest and first commitment, age at parole, months served, and rule violations prior to entry into the study. Results were statistically significant and indicated that the TM group had a 46.7% recidivism rate during follow-up period compared to 66.7% for the controls. Furthermore, the results also indicated that the TM program demonstrated lasting rehabilitation effects.

In their pilot study, Orme-Johnson and Moore (2003) investigated the physiological and psychological effects of TM on 17 prison inmates who practiced the method for two months. Participants were male inmates of La Tuna Federal Penitentiary near El Paso, Texas, who had been incarcerated for narcotic-related crimes. Results indicated increased stability of the autonomic nervous system, as indicated by fewer spontaneous skin resistance responses (SSRR). Furthermore, reductions in rigidity, obsessive thoughts, and compulsive behaviors were observed on the Minnesota Multiphasic Personality Inventory (MMPI): decreased Psychastenia and Social Introversion. Also, it was noted that regularity of practice correlated significantly with the percentage decrease in SSRR, which in turn correlated with decreased Psychasthenia. As noted by the authors, previous studies have indicated electrodermal hyporeactivity of subjects with antisocial behavior. Thus, psychopathic, delinquent, hyperactive, and aggressive individuals show lower tonic levels of skin conductance, smaller amplitude autonomic responses to stimulation, slower recovery of the skin resistance response, and fewer SSRR. In light of such physiological responses, the authors discuss previous studies showing that antisocial individuals suffer from an unresponsive autonomic nervous system, and therefore exhibit little to no anxiety or criminal inhibition. Whereas psychopathic inmates demonstrate slow electrodermal recovery from stimulation or lack of electrodermal and heart rate responses, TM subjects demonstrated more rapid recovery and larger amplitude of electrodermal and heart rate responses. Therefore, Orme-Johnson and Moore (2003) propose that this type of meditation increases reactivity of feelings, spontaneity, capacity for warm interpersonal relations, affective maturity, integrated perspective on self and the world, and resilient sense of self. Such personality changes are associated with positive behavioral changes, including decrease recidivism and better rehabilitation of the inmate population.

Based on his review of the literature on TM, Hawkins (2003) also notes that incarcerated offenders show rapid positive changes in risk factors associated with criminal behavior. Hence, with the regular practice of TM, factors such as anxiety, aggression, hostility, moral judgment, in-prison rule infractions, and substance abuse are greatly improved. Furthermore, it is noted that the TM program significantly helps reduce substance use as well as the underlying factors that trigger substance dependence, such as anxiety, depression, neuroticism, and other forms of psychological distress. As a holistic approach, TM addresses psychological as well as physical issues. Thus, psychological health as well as autonomic functioning and neuroendocrine balance can be achieved. As a result, the practice of TM not only improves the current status of inmates, but also provides long-term outcomes such as lower recidivism rates for parolee practitioners and lower relapse rates for addicts.

In review of the above studies on the effects of X Meditation and Vipassana Meditation on prison inmates, it appears that similar results can be obtained with the practice of either form of meditation.

In contrast to the TM program which relies on the repetition of a given mantra, the VM program shares some similarities with cognitive therapy. Cognitive therapy involves recognizing unhelpful patterns of thinking and modifying or replacing these patterns with more realistic or helpful ones. However, with Vipassana Meditation, the emphasis is on acknowledging thoughts and their impermanence, and learning to let go without identifying with them.

Perhaps, the Vipassana program has generated less research in the area of forensic psychology because of the strenuous conditions necessitated in order to complete a course. Thus, unless they are extremely motivated, inmates might demonstrate greater difficulty participating in such a program than they would with the TM program, which only requires two short 20-minute sessions per day.

Finally, based on the current research conducted at several maximum-security prisons, including Folsom and San Quentin in California, and Walpole in Massachusetts, Magill (2003) reports that up to 56% fewer inmates are convicted of new crimes after completing the TM program. Such results emphasize how beneficial the introduction of meditation programs in correctional facilities are. Thus, not only does meditation improve physical and psychological behaviors of inmates and reduces recidivism, it is also a cost-effective way to address rehabilitation.

References Alexander, C., & Orme-Johnson, D. (2003). Walpole study of the X Meditation program in maximum security prisoners II: longitudinal study of development and psychopathology. X Meditation in Criminal Rehabilitation and Crime Prevention, 127-160.

Alexander, C., Rainforth, M., Frank, P., Grant, J., Von Stade, C., & Walton, K. (2003). Walpole study of the X Meditation program in maximum security prisoners III: reduced recidivism. X Meditation in Criminal Rehabilitation and Crime Prevention, 161-180.

Alexander, C., Walton, K., & Goodman, R. (2003). Walpole study of the X Meditation program in maximum security prisoners I: cross-sectional differences in development and psychopathology. X Meditation in Criminal Rehabilitation and Crime Prevention, 97-125.

Hawkins, M. (2003). Section I: theory and review. Effectiveness of the X Meditation Program in criminal rehabilitation and substance abuse recovery: a review of the research. X Meditation in Criminal Rehabilitation and Crime Prevention, 47-65.

Magill, D. (2003). Cost savings from teaching the X Meditation program in prisons. X Meditation in Criminal Rehabilitation and Crime Prevention, 319-331.

Orme-Johnson, D., & Moore, R. (2003). Section II: original research on rehabilitation. First prison study using the X Meditation program: La Tuna Federal Penitentiary, 1971. X Meditation in Criminal Rehabilitation and Crime Prevention, 89-95.

Parks, G., & Marlatt, A. (2006). Mindfulness meditation and substance use in an incarcerated population. Psychology of Addictive Behaviors, 20, 343-347.

Rainforth, M., Alexander, C., & Cavanaugh, K. (2003). Effects of the X Meditation program on recidivism among former inmates of Folsom prison: survival analysis of 15-year follow-up date. X Meditation in Criminal Rehabilitation and Crime Prevention, 181-203.

Snyder, C. R., & Lopez, S. J. (2005). Handbook of positive psychology. Oxford, NY: Oxford University Press.

How to Spot a Dangerous E-Therapist And Find a Great One!

Our nation is only getting more internet-centered. You can change your driver’s license address online. You can transfer money online. You can order fast food online.

It’s not a surprise that internet therapy is another thing in high demand right now. It’s more convenient than driving to an office, and more private. People can access it from anywhere! At some point very soon, I predict that therapists who are not practicing at least partially online will be in the minority.

However, right now, E-Therapy is still barely a toddler in terms of the overall age of psychotherapy. At this stage, the practice is still working out the kinks. There’s not a good overall screening system for ethical online therapists.

That puts you, the potential client, in danger.

This is a business that requires a huge amount of trust. Unfortunately, some clients get hurt when they put that trust in unethical, abusive therapists. That’s why I want to share some simple “red flags” that indicate a potentially unethical online therapist and some “green flags” that mean this person is probably legit. Use these guidelines to help keep yourself safe when searching for a therapist online.

Red Flag #1 The first way you can tell something might be wrong is that you cannot find information about the therapist’s license anywhere. Each therapist should proudly list the state license they worked so hard for, and you should be able to verify their name and license with your state’s licensing board. You can find the web address of your state’s licensing bureau at the American Association of State Counseling Boards website.

Red Flag #2 The therapist disregards state licensing laws. Did you know that it’s unethical to practice outside of what’s called the “scope” of your license? Counseling outside of your state of licensure is considered beyond the scope of your license. It’s such a no-no that the counselor’s liability coverage will not protect them in the event they are sued for practicing outside of their state. If your counselor doesn’t restrict practice to those in their state, be aware they may take liberties with other ethical guidelines as well.

Red Flag #3 The therapist offers you manipulative free session offers in which the boundaries are undefined. Manipulative free session offers might be “unlimited” minutes or sessions until you decide you’re ready to pay. How much will they hold back in the time you are getting for free?

Red Flag #4 The therapist cannot explain how he or she will protect your privacy online. Did you know that just like medical doctors, licensed counselors have to protect your information in a HIPPA-compliant manner? So, you might ask them, how will they store your files? Will they collect your credit card information? If the counselor cannot answer this readily, that’s a red flag.

Red Flag #5 The therapist doesn’t require paperwork or informed consent from you as a client. Why does this matter? Because it’s against the law! A first “session” can legitimately work around this under the umbrella of being a first consultation. But before you get into a committed relationship with your therapist, (i.e. they begin collecting money from you) they should require a signature on an informed consent document showing that you understand the risks and limitations of online therapy.

These are some things not to do. But there are some ethical, responsible E-Therapists out there, and here’s how you can find them.

Green Flag #1 The therapist identifies their license and state, and can provide the date their licenses expires on demand. This means they have been through rigorous standards to get to this point, and they know what they will have to do to keep it up.

Green Flag #2 Your counselor states that they practice only in the state in which they are licensed. is the pioneer service for authenticating counselor licenses and restricting client contact to those licensed in their state. If you’re looking for an online therapist, I would start there.

Green Flag #3 Your therapist clearly defines “free” offers, such as a single free session, discounted first 10 minutes, free e-book, or free initial email consult. These are a legitimate tool for a therapist to demonstrate their effectiveness. It’s when the boundaries are unclear that it might be a ploy to manipulate you.

Green Flag #4 Your therapist tells you how they collect credit card information and if they store it, as well as what service they will use to conduct therapy. Video, chat and email therapy need to be encrypted to HIPAA standards. The therapist should have a private line to talk to you that no one else can use to “pick up the extension.”

Green Flag #5 You are given a full informed consent document to sign, as well as an intake form to fill out. E-signatures are fine. The therapist should let you know of potential risks of therapy in general and online therapy in particular, when he or she would have to break confidentiality, and where you can complain if he or she behaves in an unethical manner. They also need to know your real name and emergency contact information, so they can get you help if you become suicidal.

I predict more and more e-therapists will arise in the future, as people realize the benefit to be had from private, in-home therapy sessions. But while it is still emerging, clients like you must be aware that there are some scammers out there. You deserve the best care possible, so arm yourself! If you have any further questions, I’m always here to help. Drop me a line anytime!

Does the VeRO Program Mean I Should Stay Away From eBay?

The eBay VeRO program has been developed to protect the rights of the owners of an intellectual property and to minimize the risk of fraudulent usage of items that infringe on the copyright acts. VeRO is the acronym for “Verified Rights Owner Program” and has been put in place to put a stop to selling illegal items and handle copyright related issues more effectively. eBay was one of the pioneers to adopt the online process that aims to protect the rightful owner of a product, and also to develop a system that would allow the owner to report any kind of infringement noted on the Website.

eBay is a platform that allows anyone to sell anything online. Such a popular online market place is prone to the guiles and greed of unscrupulous sellers who may want to violate copyright and ownership rights to ensure that they are able to sell products that they do not own any rights over. If one has to open a store in the real world, he/she has to follow rules and go through processes to ensure that there is no infringement on the rights of the owners of an intellectual property.

The virtual world, on the other hand, during its inception, provided a relatively easy way for sellers to sell any product that they could lay their hands on. As eBay grew in popularity as one of the premier Websites handling diverse product offerings, it became extremely important for eBay to ensure that owners’ rights were not violated and that there were systems to validate verified rights.

The Benefits Of The Verified Rights Owner Program:

The VeRO program has been devised specifically to provide the rights’ owners with the following benefits:

  • eBay employs trained and dedicated professionals to help rights owners get the maximum benefit out of the program
  • eBay responds quickly and effectively to terminate the listings reported by the rights owners
  • eBay maintains dedicated email queues for reporting rights infringements that get the top-most priority
  • The rights owners can easily get all the relevant information pertaining to the identification of eBay users
  • All the rights and privileges are clearly mentioned in the eBay user agreement for the benefit of the rights’ owners
  • The rights’ owners are entitled to receive automatic updates regarding the eBay VeRO program

The Process Of Participation And Creation Of About Me Page

The process of participating in the program is simple and fast. All that a rights’ owner has to do is to download the Notice of Claimed Infringement (NOCI) form and fax it to eBay. After eBay processes the first complaint, eBay emails a soft copy of the form, along with instructions on how to submit the form electronically in the future. A rights’ owner can create an About Me page on eBay to specify the products that he owns and the intellectual property rights owned by him so that the channel of communication with the other eBay sellers is open, clear and transparent. After posting the About Me page, an email to eBay will ensure that it is included in the list of VeRO Participant About Me pages. All this is free and for the benefit of the rights owner.

Tips For Sellers Regarding The eBay Vero Program

If a seller finds himself delisted from eBay, he may follow the following steps:

  • Try and contact the rights owner directly through email as the rights’ owner is in the correct position to understand the products and the intellectual property rights associated with them. The email ID of the rights’ owner is supplied in the email notification from eBay that informs him of the delisting. If the rights’ owner agrees that there has been an error on his part and sends an email to this effect to eBay, then eBay would delist the item immediately.
  • Rights verification is a complex issue and, therefore, to avoid future hassled due to delisting a seller would do well to go through the VeRO Program Participation About Me pages. Participants create these pages to inform sellers about the reasons behind the delisting of an item.
  • A rights owner must be registered with eBay through the VeRO program before requesting to delist an item. Rights’ owners are required to sign a legally binding contract with eBay to ensure that everyone gets a fair deal.
  • A seller must read the privacy policy of eBay which explicitly states: “We can (and you authorize us to) disclose your user ID, name, street address, city, state, pin code, country, phone number, email, and company name to eBay VeRO Program participants as we in our sole discretion believe necessary or appropriate in connection with an investigation of fraud, intellectual property infringement, piracy, or other unlawful activity.” So, if you, as a seller, understand all the terms and conditions agree with the right owner’s position and have gone through the policy of eBay and still believe that you have been unjustly delisted from eBay, you may email eBay.

Is The eBay Vero Program Scaring Away Sellers?

There is a lot of miscommunication pertaining to the eBay VeRO program. The program has been devised to protect the rights’ owners and, at the same time, create a fair and transparent platform for the buyers and sellers to interact. However, small-time and some of the bigger sellers on eBay believe that VeRO is against them, since all it takes is a simple form from the rights’ owners to get them delisted without any prior warning. Moreover, the emails that are sent out informing them about the delisting are generic emails with no particular information regarding the details of the delisting. Most of the sellers think that the issues of verified rights and information infringement are used against them at the whims of the rights’ owners without giving them an opportunity to defend their case prior to delisting.

Sellers also believe that there is a process of random or selective targeting by rights owners as many other similar sellers are untouched and they are allowed to carry on with their business. Sellers are unhappy with the option given by eBay in such situations because of the explanations and the options as mentioned below:

  • The delisted seller is mostly told that the others with similar kind of listings are actually not similar as they appear to be. They have differences in the manner in which the items are portrayed, which does not effectively infringe any rights of ownership.
  • The others may be listed by the owners themselves.
  • May be the delisted seller in question was the one that was found out and therefore reported against.
  • eBay offers the delisted seller the right to lodge complaints against other similar offenders.
  • The rights’ owner felt the need to report that particular user and not others for reasons that are best known to him as he has the ultimate right to decide who is the offender and who is not. However, if the delisted user feels strongly about anything he is free to email the rights owner and take up the issue with him directly.

All of these points seem to be heavily loaded against sellers, and they believe that eBay stays away by pitting the rights’ owner and the alleged offender against one another. As a service provider, sellers think eBay should take more proactive steps to ensure that the interests of the sellers are also protected. Sellers stipulate that since the general perception amongst online buyers is that eBay is a platform to purchase discounted materials, the brand owners are adverse to the display of their items on eBay, as it directly pits their mainstream product line with the ones sold via eBay. Therefore, delisted sellers think the rights’ owners deliberately use the eBay VeRO program to counter cannibalization of their product.

The sellers on eBay think that it becomes extremely difficult for them to sell anything at all since they are not the rights’ owners and anything used by them to advertise their product-be it an image or any logo will come under the purview of infringement of intellectual property. Therefore most of the sellers are bound to not use any brand names and instead have to rely on scanned invoices to prove the realness of their items on display. Many DVD sellers are often caught by the eBay VeRO program, as most of the sellers list the items prior to the commercial release dates as the products reach the customer way after the release happens. Many buyers also like to keep the original cartons or packages of products manufactured by premium brands. But the sellers who offer the original packaging are often caught off-guard by the stringent intellectual property infringement laws and are therefore promptly delisted.

Is The eBay Vero Program Beneficial For Everybody?

The simple answer is “No.” The sellers must understand that the emphasis is on transparency and making the selling process on eBay legal. However, if they follow the policies and abide by clauses mention on the About Me pages maintained by the rights of owners, selling products within the laws should not be difficult. A large number of people are running profitable businesses through eBay by following the rules and one must appreciate the fact that weeding out spurious sellers and sellers of counterfeit products is for the benefit of everyone. If a customer gets a good product without any hassles, he is bound to use eBay again for shopping. But in case the shopping experience is bad, he will turn away and visit other similar e-commerce based websites to buy the products of his choice. That would be bad news for the rights’ owners, the sellers and also for eBay.

However, like every process, the eBay VeRO program is not free from errors and a seller may even be delisted by mistake. In such a case, the seller must take up the issue with the rights’ owner and also with eBay, create a trail of communication and try to make the other person see their side. If your line of logic is proper and well defined, then there is every reason for you to believe that your concerns would be addressed and you would be relisted back on eBay.

The bottom line is that in today’s era of Internet-based transactions, the number of illegitimate traders has shot up exponentially. Premier sites such as eBay must ensure that their services are being used by genuine sellers who are not scam artists out to dupe customers and in the process tarnish the brand image of eBay. eBay is a seller friendly and a customer-friendly site that offers a platform for everyone to do business. If a seller is genuine and respects the rights of the owners, he should have no problems in carrying out his business. Even if he faces unjust persecution, proper systems are in place for him to have his grievances addressed. The onus lies on eBay to ensure that the sellers do not get unduly harassed, as sellers are the backbone of eBay. eBay would do well to mention the specific reasons behind a delisting, as well as employ internal and external auditors to review a delisting, so that there is more clarity and transparency in the entire process.

Treatment of Recurrent Varicose Veins by Sclerosant Foam

“. . . we suggest that ultrasound guided foam sclerotherapy should be the first-line treatment.”

M Perrin and JL Gillet.

Varicose veins recur frequently after primary surgery. The acknowledged rate of recurrence is at least 25%, simply because no mechanical means of varicose vein treatment changes heredity or the propensity for varicose veins to follow the Mendelian laws of inheritance.

Recurrent varicose veins are more prevalent after great saphenous ligation (35%) than after stripping (18%). A review of publications on the subject of variceal recurrence from 1954 to 1988 found rates of return of varices following surgery of varicose veins to range from 14% to 80%, with the majority of the papers reporting 30-70% recurrent varices.

Among patients who have had surgery, the most commonly cited cause is incorrect surgery. Erik Lofgren, the respected and pioneering phlebologic surgeon of the Mayo Clinic, said in 1977: “Early recurrence of varicosities within 2-3 years of the vein stripping operation is interpreted as being caused by incomplete surgery and recurrence beyond 3 years is interpreted as being caused by breakdown of other veins that were clinically normal at the operation.” With the broad use of diagnostic ultrasound, that conclusion has been challenged. Allegra, for example, stated, “Varicose veins recurred despite technically correct surgery confirmed on post-operative duplex ultrasonography.”

Twenty percent of recurrent varicose veins are believed to be due to neovascularization, and a scattered few are due to abnormal anatomy. Fischer reported three main patterns of neovascularization among patients who had late recurrent saphenofemoral junction reflux after ligation and stripping. charts these as single-channel (29%), multichannel (41%) and circumjunctional (29%).

Personal experience

Patients were received over 48 months in referral at a single-site private practice office. A history detailing previous treatments and complications was recorded. A focused physical examination was supplemented by a standardized duplex ultrasound examination. A venous map was created for each lower extremity considered for treatment.

Patients with recurrent varices, whether of primary or post-thrombotic etiology, in the great or small saphenous vein distribution were included in this study. These were limbs with protuberant, saccular varicose veins and a history of previous intervention by surgery, laser or radiofrequency closure. Exclusions were limbs treated by sclerotherapy without surgery, isolated telangiectasias, limbs that were a part of the Klippel-Trenaunay syndrome, limbs with congenital or acquired arteriovenous malformations, and limbs with venous malformations. Not excluded were legs with venous ulceration, a history of ulceration and/or lipodermatosclerosis (CEAP classification C4, C5 and C6).

Patients and methods

A total of 75 lower extremities from 62 patients had recurrent varicose veins following either great saphenous stripping (35 lower extremities), ligation and phlebectomy (38 lower extremities), or VNUS Closure” (2 lower extremities). There were 49 women (mean age: 52.7 years) and 13 men (mean age: 59.6 years) who had 68 limbs that were symptomatic by CEAP classification C2, five were C4, 1 was C3 and 1 was C6.

Sclerosant foam was made by the two-syringe Tessari technique with a 1/4 sclerosant-to-air mixture. The sclerosant was polidocanol administered through one or more varices, directed by massage into previously marked varicose veins using ultrasound guidance. For the most part, the great saphenous vein was absent or obliterated, so this was not regularly a target for therapy.

After instillation of foam, the treated limb was held in a 45° elevated position for 10 minutes to fix the foam distally and to allow foam to revert to its liquid state. This was done to avoid adverse events and was successful. The dosage of sclerosant foam ranged from 5 to 17 mL per limb (1% polidocanol in 2 limbs, 3% in 18 limbs and 2% in the remaining 55 limbs). The number of treatments ranged from 1 to 4 (average: 2.1). Class II or III thigh-high support stockings with added focal pressure over large varices were applied immediately after treatment and left in place for 48-72 hours. Afterwards, the stockings were worn only during the day for 2 weeks or for comfort according to patients’ wishes. Deep venous thrombosis (DVT) surveillance was done at 7 and 21 days.


Immediately after treatment, all patients returned to normal activity. None were instructed to forced ambulation. Absence of sedation, analgesia and anesthesia allowed unaccompanied patients to drive themselves from the office. No adverse events such as dry cough, ocular signs, chest pain or panic attacks developed. Unlike surgical interventions, no treatment hematomas or wound infections developed. After treatment, one ulcer remained unhealed. Three limbs remained C4, but the inflammatory component of lipodermatosclerosis slowly disappeared following direct ultrasound-guided perforating vein injections. The remaining 71 became either C0 or C1. (The CEAP score was not designed to provide an evaluation of clinical results in general, but in this study did show elimination of recurrent varicose veins.) Clinical and an associated duplex examination led to supplemental treatment with foam injection in all but three limbs. These three received only one treatment. In 60 of 75 limbs, the second treatment was the last required. Thus, 84% of limbs with recurrent varicose veins received satisfactory treatment with one or two sessions. The unhealed ulcer in a diabetic patient remained unhealed despite subsequent placement of an iliac venous stent, performance of a femorotibial arterial bypass and six treatments with foam injections. The ulcer eventually responded to biological dressings. The unimproved C4 limbs responded to direct perforator vein foam injections, as mentioned above. No paresthesias were encountered after foam injections. Foot and ankle swelling immediately after treatment was encountered, but this was usually caused by the compression dressings. Narcotics were not required for pain management, but analgesics were taken whenever the compression dressing interfered with sleep. Endresults, as assessed by the patients and by the treating physician, were satisfactory for most of the cases. There was elimination of varicose veins and sources of venous reflux in every case. No DVTs or treatment ulcerations were detected.


The idea of enhancing the action of liquid sclerosant by mixing it with air was introduced by German clinicians. Flückiger, the most prominent of these, recognized the futility of injecting a liquid sclerosing agent in an orthograde fashion toward the heart, where the agent would flow into vessels of progressively larger diameter and tributaries would not be sclerosed. He then described the essential elements of present-day techniques of foam sclerotherapy: peripherally directed injection, steep leg elevation and manual guidance of the sclerosant. In the absence of ultrasound imaging, he guided the foam by noting subcutaneous crepitus.

Interventions for recurrent varicose veins actually follow the same pattern as primary treatment. That is, sources of reflux such as neovascularization are diagnosed with a venogram. These reservoirs of varicose veins that receive such reflux need to be closed, and this can be achieved surgically with a single operation. But such procedures are tedious at best, and dangerous and incomplete at worst. The stump of saphenous vein remaining in the groin must be approached through scar, and great difficulty is encountered when the femoral vessels are encased in scar and neovascularization is present. In such situations, a lateral approach to the femoral vessels is advocated.

Figure 18.3 Venogram illustrating neovascularization feeding a previously ligated, and still refluxing, great saphenous vein.

Actually, there are many patterns of varicose recurrence. Van Rij found neovascular reconnection and persistent abnormal venous function as the major contributors to disease recurrence. The Freiberg group found no junctional recurrence in 68% of their limbs with recurrent varices, and Rutherford et al from the Royal Surrey County Hospital in the United Kingdom focused on perforating veins as a cause of recurrent varices.

Clearly, a technique designed to deal with these several patterns of recurrence must have broad applicability to all patterns of recurrent varices. Foam sclerotherapy does this: the foam can be manipulated into each of the areas of recurrence with little effort.

Finally, the best treatment of recurrent varicose veins should minimize post-treatment discomfort and disability and have a reliably successful outcome. Our experience in treating recurrent varices demonstrates that success has been achieved with no need for sedation, analgesia or anesthesia.

Our experience is almost identical to that reported from the Ealing Hospital in London, where 38 patients with recurrent varicose veins were treated by the same techniques used in the present study. Their report was that in 87% of all legs, complete elimination of varicose veins and all reflux points was achieved. Also, they did not encounter DVT or systemic complications.

The absence of complications in our experience and from the Ealing Hospital are in contrast to reports of surgical treatment of recurrent varicose veins. For example, in a report from Milan, 61 lower extremities were treated surgically. The immediate complications included hemorrhage (1.6%), wound infections (4.9%) and one case of lymphorrhagia. Similarly, from Naples comes a report in which 98 limbs in 82 patients were treated for recurrent varicose veins. There were five wound infections and four lymphorrheas, but no thrombotic or phlebitic complications.

It must be acknowledged that conventional treatment of recurrent varicose veins is no more successful than primary treatment. Eklof reviewed published reports of results of surgical treatment of recurrent varicose veins4 and found that the long-term results revealed a recurrence rate of approximately 35% for the “re-do” surgery. Thus, it must be concluded that neither standard primary surgical treatment of varicose veins nor secondary surgical treatment of recurrent varicose veins gives acceptable results with minimal complications. Foam sclerotherapy holds promise as being a better treatment for both primary and recurrent varicose veins.


This experience in treating 62 patients having 75 lower extremities with recurrent varicose veins showed that foam sclerotherapy of recurrent varicose veins is successful and causes little morbidity. Treatment with foam sclerotherapy is quick and efficient: no operating room time, no local or general anesthesia, and no time off work or away from normal activities make the technique attractive to the patient and to the physician.