The benefits of mindfulness receive a lot of press (e.g., see the Huffington Post ). Mindfulness boosters frequently cite scientific studies to support the case for mindfulness as a kind of cure-all for the ills of the modern age. Given that mindfulness meditation involves the near-constant control of attentional processes and ongoing mental distancing through “observing” thoughts, labeling mental activity as “just thoughts” and gently redirecting attention away from thoughts, it makes a lot of sense that certain neuropsychological tendencies and profiles would be found in meditators. Given a worldview that values loving kindness and calm nonreactivity, it makes sense that mindfulness practitioners would report less stress and show fewer biomarkers for stress. It makes sense that mindfulness would be associated with greater well-being and happiness. Given hundreds or thousands hours of practice directing and redirecting attention, it makes sense that neural efficiency and connectivity patterns would be altered. The brain, body and personality all change with experience. If you spend hours and hours regulating cognitive, emotional and physiological processes in specific ways, your brain, body and personality will change in specific ways.
Questions remain regarding the mechanisms of change and how large and consistent these effects are. In books, blogs and the popular press one often sees statements that “researchers have found” or “studies show” without information on the quality or size of the studies involved or the robustness of the findings. When I check out the actual research, more often than not the researchers acknowledge the tentativeness of their conclusions and the need for replication. More often than not, the study design was not a randomized controlled trial and if even there was a control group, there was not a suitable comparison treatment condition. More often than not, the researchers did not appear to control for the placebo effect or factors common to most interventions (“common factors”) An example:
Take the study Prevention of Relapse/Recurrence in Major Depression by Mindfulness-Based Cognitive Therapy by Teasdale, Segal, Williams and others. This study has been frequently cited in academic papers and used by mindfulness advocates as strong evidence of the benefits of mindfulness. For instance, here’s how Jon Kabat-Zinn summarizes the study: “…people with a prior history of three of more episodes of major depression taking the MBCT [Mindfulness-Based Cognitive Therapy] program relapsed at half the rate of the control group, which only received routine health care from their doctor…This was a staggering result…” (Full Catastrophe Living, Kindle p. 7322)
Now for some context. This particular study had no active comparison therapy. The control group received “treatment as usual” (aka routine health care). The MBCT group actually had a higher rate of relapse for participants who had two-or-fewer prior depressive episodes, not quite statistically significant but trending that way (p=>.10). The benefit for MBCT (for participants with 3+ prior episodes) was seen with a few as 4 treatment sessions (out of 8 possible) but the authors do not let us know if additional sessions (up to 8) increased benefit. We also have no idea what the actual ingredients of change are. Without an active comparison group that matches MBCT in factors common to all efficacious treatments, we don’t know if anything specific to MBCT made a difference in participant outcomes.
(Quick word about “common factors”: these include things like therapeutic alliance, empathy, goal consensus/collaboration, “buy-in”, positive regard/affirmation, and congruence/genuineness. Common factors are thought to exert much more influence over therapy outcomes than factors specific to individual therapies – for more on common factors, see Laska, Gurman and Wampold 2014.)
Other types of therapies have also been associated with reduced relapse in chronic depressives such as Maintenance Cognitive-Behavioral Therapy and Behavioral Activation Therapy. So when we are told the results of the MBCT study are “staggering”, I’m thinking: promising, yes – staggering, hardly. Mindfulness-based cognitive therapy clearly has some value; for one thing, it provides practical tools to help reduce stress and regulate unruly thoughts and emotions. It probably does help with unproductive rumination. But are mindfulness meditation and mindfulness-based therapies that much better than what’s already out there? Hard to say – since the quality of the research often leaves much to be desired.
To be continued...
References
Kabat-Zinn, Jon Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness, Kindle Version, Revised Edition 2013; Bantam Books, New York
Laska, K. M., Gurman, A. S., & Wampold, B. E. (2014). Expanding the lens of evidence-based practice in psychotherapy: A common factors perspective. Psychotherapy;51:467–481. http://dx.doi.org/10.1037/a0034332
Teasdale, J.D., Segal, Z., Williams, J.M.G., Ridgeway, J.A., Sousby, J.M., & Lau, M.A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615–623.