Let me share a few thoughts regarding the state of mindfulness research and also reflecting on mindfulness-based applications that, at least partially, justify their use by referring to scientific evidence of their effectiveness.
A recently published analysis of the available research regarding the effectiveness of meditation programmes for psychological stress and wellbeing inspired me to jot down some of the thoughts I have been carrying around for a while. This review concludes that the observed small improvements in negative affect resulting from mindfulness meditation “are comparable with what would be expected from the use of an antidepressant in a primary care population but without the associated toxicities”. With other words, the effects of mindfulness-based interventions are not worse than those of standard antidepressants for treating anxiety, depression and stress, but do not have the side effects that can result from taking antidepressants.
However, the review also highlights that the evidence for the effectiveness of meditation-based approaches for other conditions than anxiety, depression and stress is less clear and that overall the whole field still suffers from a lack of high quality research.
Considering this ‘verdict’ it may seem surprising how frequently mindfulness courses are offered with reference to the scientifically confirmed benefits often citing the fact that the UK’s National Institute for Health and Care Excellence (NICE) includes mindfulness in their guidelines for depression [download pdf here]. However, what tends to be omitted is that these guidelines are very specific; it is not mindfulness per se but Mindfulness-based Cognitive Therapy (MBCT) that is recommended by NICE! And more than that, also MBCT is not recommended as panacea but rather as treatment for one specific situation, namely when an individual is “at significant risk of relapse” into depression. In such cases “mindfulness-based cognitive therapy for people who are currently well but have experienced three or more previous episodes of depression” is the recommended treatment. To put it clearly, MBCT is not the recommended treatment for most cases of depression, but merely in the specific case of three or more episodes of depression and at a time when people are feeling well. This, of course, does not necessarily mean that mindfulness-based interventions do not work in other cases. It merely means that the evidence is not yet convincing enough to be considered by NICE and not as strong as some would make us believe. The consequence certainly is that current NICE guidelines should not be used for justifying anything else than relapse prevention for depression in the way stipulated above.
There are several other considerations that ask us to be careful.
For instance, the huge public presence of the mindfulness topic has fuelled a rapid increase in demand and one may wonder to what extent this demand can be met by sufficiently qualified mindfulness teachers or trainers. Furthermore, often the media are not very clear in showing that the evidence they are presenting actually relates to very specific programmes such as MBSR or MBCT, that are – I hope – carried out by practitioners fully qualified in offering mindfulness training and counselling, therapy or what else the context requires. As a result of this, people appear at the doorsteps of meditation centres hoping to get help with their depression, anxiety or OCD having decided to discontinue their medication without informing their doctors. With probably only few exceptions meditation centres will not have staff/volunteers/helpers with the appropriate level of professional training to deal in the required way with the different mental health issues visitors are presenting with – a situation that may significantly aggravate the mental health issues. The media also tend to neglect the fact that it is not meditation per se and on its own that is considered beneficial in these cases, but mindfulness meditation embedded within a complete and coherent therapeutic concept – something most meditation centres will not be qualified to offer.
We can observe further varieties of misunderstanding regarding mindfulness that can go to the core of the concept itself. Together with several other colleagues I was recently interviewed by a journalist who wrote a piece about the effects of mindfulness practice. The resulting article with the title “Breathing In vs. Spacing Out” appeared in January this year in the New York Times. I think it is an excellent example how mindfulness can be misinterpreted as the opposite of mind wandering. In a comment on this article I have argued that this is actually incorrect:
“It seems he partially misunderstood what mindfulness meditation is about; thinking it merely is a practice of focusing the mind, the opposite of mind wandering. I would rather say that mindfulness practice leads to more relaxed mind wandering and the psychological flexibility to either engage with the wandering thoughts or just let them play around. It’s a bit like the noise of playing kids: We just know that they are there, but only engage or jump in if something dramatic is about to happen. The article shows how difficult it is to grasp the actual experience of the practice without practising it.”
If you browse the comment section to the NYT article you will find that many share this concern.
So, what to do about it? Well, the simple answer is that more high quality research is desperately needed and that until evidence is strong one would be well-advised to be modest and careful with our claims. In addition to conducting more high quality studies that evaluate the effectiveness of existing mindfulness programmes there are a host of other questions that will need to be answered. Here are just a few of those questions, some of which are crucial for offering mindfulness programmes in an appropriate way and making sure that there will be a lasting legacy:
- How much personal experience with mindfulness/meditation practice is required before somebody can be considered to be qualified to guide others through the process?
- Are there ways of evaluating whether somebody is a good and reliable meditation/mindfulness guide?
- Is mindfulness an approach that can benefit anybody or do certain personal prerequisites need to be there?
- The dosage: How much practice is needed to get the expected results?
- What happens once a mindfulness course has ended? Does participation in one 8-week course suffice or is a minimum dosage of practice required to maintain what has been achieved?
- Related to the previous question: Where to turn once the course is over? From where to get further guidance if somebody wants to continue with their mindfulness practice?
And now back to work.
© 2014, Peter Malinowski. All rights reserved. You may republish this post in unaltered form – On republishing it you must provide the link to this original post.