What is the science of mindfulness missing?
Are the claims about the benefits of mindfulness exaggerated? Here’s what you need to know.
In a recent article entitled, Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation, a team of leading mindfulness teachers, psychologists, neuroscientists and Buddhist scholars sparked a firestorm of controversy about whether the benefits of mindfulness are fact or fiction. The authors expressed their growing concern that “misinformation and poor methodology associated with past studies of mindfulness may lead public consumers to be harmed, misled, and disappointed.”
When making claims about the scientific evidence supporting any therapy or practice, it is important distinguish between anecdotal experience and scientific evidence. Although mindfulness practitioners share a lived experience of the transformative potential of mediation, yoga, and other practices, lived experience and scientific data are neither equivalent, nor interchangeable.
A strong evidence base is derived from high quality research where the benefits of a single, well-defined intervention are measured using identical means, and are repeatedly and reliably observed across studies, and with different samples of people. Because the field of mindfulness and yoga research are relatively new, very few programs have reached this milestone. But many claim to be evidence-based. As such, the benefits or negative effects of mindfulness-based practices are often poorly understood, and subject to both positive and negative misinterpretation.
According to Mind the Hype authors, the science of mindfulness holds considerable promise for creating that evidence base, however there are two fundamental obstacles: the lack of an agreed upon definition of mindfulness, and methodological problems in the research itself.
The importance of defining mindfulness
Despite the broad coverage of the benefits of mindfulness in the media, we neither have a universal definition of it, nor a common understanding of what mindfulness practice involves.
Some use the term to refer to activities that cultivate attention, awareness, or the retention of information, whereas others identify acceptance, nonjudgment, empathy or compassion as key. Practices run the gamut from meditation, to breathing exercises, to movement, to guided relaxation.
This lack of a unified definition is reflected in nine, distinctly different published questionnaires to assess mindfulness in adults. What is measured often reflects the philosophical orientation or values of the author. This means that how mindfulness is defined in one study may be vastly different from another, making it virtually impossible to build a consistent evidence base.
The lack of agreement as to what constitutes a mindfulness practice, and the variety of types of practice that fall under the mindfulness umbrella pose a similar challenge. The problem here is not with the practices themselves, but the fact that mindfulness interventions lack a common thread necessary to make conclusions about their benefits as a whole.
To remedy this dilemma, the article’s authors recommend a move away from the blanket term of “mindfulness” toward a more explicit language that clearly defines the practices used, and the specific mental states and functions that the practice is intended to benefit. Through the more precise use of the practices and the capacities that they cultivate, we will better understand what works, and how.
Why research methods matter
The extent to which we can draw reliable conclusions about the impact of mindfulness also depends on the quality of the research methods. There are myriad factors that go into determining a study’s quality including whether or not the program was delivered consistently, whether a control group was used, and whether adverse events were monitored and reported. Many mindfulness studies lack this level of rigor, making their results speculative.
Perhaps more importantly, the credibility of research rests in its ability to be reproduced to ensure that the results did not occur by chance. The outcomes of one study do not prove that a mindfulness program is beneficial, but merely suggest its potential for impact.
The ability to reproduce results may be particularly challenging for mindfulness researchers because of the lack of an agreed upon definition of what mindfulness is, and what a practice entails. There is also considerable variability in the number of hours of training received among mindfulness programs and therapies, leaving us with little knowledge about how much meditation is enough to achieve a desired goal.
These problems are not unique to the field of mindfulness. David Vago, Research Director at the Osher Center for Integrative Medicine at Vanderbilt University and one of the authors of the article notes, “Many of the criticisms and key methodological issues the article raises are not specific to research on mindfulness – they can be made for current psychological and neuroimaging methods in general.”
It is also important to remember that there are exceptions. Thirty-five years of high quality studies examining the benefits of the “gold standard” mindfulness-based intervention, Mindfulness Based Stress Reduction (MBSR), show generally reliable evidence that 8 weeks of MBSR may lead to reductions in pain, anxiety and panic, and improved health outcomes. Nevertheless, some reviews of the data find that MBSR may not consistently result in stress reduction, or relief from depression, anxiety, or prevent relapse into depression.
There are a number of potential explanation for the lack of consistency in results, notably a lack of clarity about the definition of mindfulness, the use of many, dissimilar practices, poor quality research, and a reluctance to report negative, contradictory or neutral results.
Historically scientists in many disciplines have shied away from publishing studies that do not yield positive findings, and mindfulness studies are not immune to that problem. An analysis of 124 published trials of mindfulness as a mental-health treatment conducted by a group of Canadian researchers showed that studies reported positive findings 60% more often that is likely statistically.
What is even more troublesome, is that of the 21 mindfulness intervention studies registered with databases like ClinicalTrials.gov, 62% had no results published 30 months after the trials ended. This may leave the research community, the public, and the media with an unrealistic picture of the effects of mindfulness-based practice.
The biggest liability when “eager journalists, academic press offices, and news media outlets [over interpret] initial, tentative results as if they were established facts” is that the benefits of mindfulness may not live up to the myth, and that inconclusive data are being used to inform clinical practice and public policy.
For example, the National Institutes of Health (NIH) currently lists meditation(defined as a practice performed in a quiet location with few distractions, in a comfortable position, with a focus of attention, and an open attitude) as a potential treatment for pain, anxiety, depression, high blood pressure gastrointestinal disorders, and smoking. The NIH also recommends that people seek conventional care in addition to adopting a meditation practice.
In the realm of education, mindfulness based interventions (MBIs) have become widespread in schools across the United States, Canada, and abroad. But claims of these program’s benefits are often overstated based. A 2017 comprehensive review and analysis of mindfulness-based interventions in schools found that “there is some indication that MBIs can improve cognitive and socioemotional outcomes, but no support for improvement in behavior or academic achievement.”
Based on these findings, the authors of this review urge caution in the widespread adoption of MBIs and call for rigorous evaluation when schools choose to implement them.
This sentiment is echoed by Dr. Kimberly Schonert-Riechl, Professor at the University of British Columbia, and a leader in the field of school-based mindfulness research. She suggests that those interested in adopting mindfulness programs in schools “scrutinize and look at the evidence,” but that “there is room for experimenting and doing pilot studies.”
For researchers, she recommends that “we need to proceed cautiously, with the idea of allowing for innovation…but always operate under the idea to do no harm, and to really do rigorous research.”
Indeed, the mandate to "do no harm" is paramount. It leads us to question whether, offering practices that "reveal underlying psychological issues" or function as "exposure therapy" in school environments where psychological support is not readily available, is appropriate, particularly for students with current or past experiences of trauma.
To be sure, the intention of the research community in identifying the gaps between the scientific evidence, and the lore promoted in the press is not to disparage the research or the practice. The goal is to point out that “most of the scientific research conducted so far about the benefits and costs of cultivating ‘mindfulness’ (including neuroscientific evidence) has limitations in its interpretation and generalizability,” says Dr. Vago. “It’s best to maintain a cautious, critical attitude toward stated benefits in the popular press.”
It can often feel as though the mandate to do no harm, the financial interests of the mindfulness industry, the need for solutions to pressing social and educational problems, and what the scientific evidence tells us are in direct opposition, with researchers urging caution and the press, the general public and those who serve them demanding to know that their experience is valid.
Although this conflict is not insurmountable, the lack of funding for high quality research presents a challenge that may take years, if not decades to thoroughly resolve.
In the mean time, we may agree that, while the scientific evidence-base may not live up to anecdotal experience, each perspective is valid and necessary to furthering our understanding of why mindfulness matters, and how best to incorporate it into our lives.
Adapted from article originally published December 6 2017 at Mindful.org