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Has the science of mindfulness lost its mind?

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Miguel Farias at Coventry University
Miguel Farias
Catherine Wikholm
Catherine Wikholm
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Abstract

The excitement about the application of mindfulness meditation in mental health settings has led to the proliferation of a literature pervaded by a lack of conceptual and methodological self-criticism. In this article we raise two major concerns. First, we consider the range of individual differences within the experience of meditation; although some people may benefit from its practice, others will not be affected in any substantive way, and a number of individuals may suffer moderate to serious adverse effects. Second, we address the insufficient or inconclusive evidence for its benefits, particularly when mindfulness-based interventions are compared with other activities or treatments. We end with suggestions on how to improve the quality of research into mindfulness interventions and outline key issues for clinicians considering referring patients for these interventions.
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‘I therefore recommend meditation, just as I recommend the
use of Jacobsen’s relaxation method or other focusing and
relaxing techniques, as a palliative, distraction method, and
advise most of my clients to use it with discretion and not take
it too seriously or view it as a general therapeutic method.’
Albert Ellis,
1
p. 673.
Something has gone wrong with the science of mindfulness.
The literature on its supposed mental and physical benefits
is conceptually and methodologically precarious and has
been divulged in a sensationalist way. Academic articles
describe weak results as ‘encouraging’ and ‘exciting’;
popular best-selling books about mindfulness, many of
which are written by researchers, are bursting with magical
promises of peace, happiness and well-being. The replace-
ment of orange-robed gurus by white-collared academics
who speak of the benefits of ‘being in the present moment’
is a powerful social phenomenon, which is probably rooted
in our culture’s desire for quick fixes and its attraction to
spiritual ideas divested of supernatural elements. There is a
misrepresentation of the place and value of meditation in
the Buddhist tradition, including its depiction as a purely
rational method of self-exploration,
2
which would feel alien
to countless past generations of Buddhists.
3
There are two major types of problems with the
attempts to study mindfulness. First, its scientific literature
is plagued by conceptual and methodological shortcomings
and the turning of a blind eye to the fact that individuals
react differently to this technique. Second, we also have
concerns about how it is being utilised by individuals with
little formal training in mental health, and its branding
(often against the alarming background of a global increase
in mental illness) as the technique of choice to develop
‘mental fitness’. Our aim is not to engage in a damning
critique of mindfulness, but simply to urge caution about its
widespread use as a therapeutic technique, including its
limitations, the lack of clear evidence about its benefits,
and its ‘assembly-line’ approach based on a reductive
understanding of the human mind.
The thorn of individual differences
When the practice of meditation exploded in the West and
was taken into the lab in the 1970s, the idea behind its
efficacy was couched in a language of altered states of
consciousness: meditating allowed an individual to enter a
particular state of consciousness,
4
which was associated
with a range of physiological alterations and mental health
benefits.
5
Although the notion of ‘altered states of
consciousness’ is no longer popular in the medical and
psychological sciences, the supposed efficacy of mindfulness
is rooted in a particular state of consciousness: a non-
judgemental awareness of the stream of our experiences.
There is an acknowledgement in the literature that
individuals will vary in their dispositional or trait levels of
mindfulness
6
-
in other words, how naturally gifted one is in
achieving this state of consciousness
-
but nevertheless the
underlying stance is a universalist one: the practice of
mindfulness is regarded as an innate human cognitive
ability which, when regularly engaged in, is beneficial to all.
Given this universalist framework, it is perhaps not
surprising that mindfulness researchers have generally
turned a blind eye to the fact that individuals react
differently to meditation techniques
-
and that these
reactions may not always be positive.
SPECIAL ARTICLES
Farias & Wikholm Has the science of mindfulness lost its mind?
BJPsych Bulletin (2016), 40,329
-
332, doi: 10.1192/pb.bp.116.053686
1
Coventry University, Coventry, UK;
2
National Health Service, UK
Correspondence to Miguel Farias
(miguel.farias@coventry.ac.uk)
First received 13 Jan 2016, final revision
22 Mar 2016, accepted 21 Apr 2016
B2016 The Authors. This is an open-
access article published by the Royal
College of Psychiatrists and distributed
under the terms of the Creative
Commons Attribution License (http://
creativecommons.org/licenses/by/
4.0), which permits unrestricted use,
distribution, and reproduction in any
medium, provided the original work
is properly cited.
Summary The excitement about the application of mindfulness meditation in
mental health settings has led to the proliferation of a literature pervaded by a lack of
conceptual and methodological self-criticism. In this article we raise two major
concerns. First, we consider the range of individual differences within the experience
of meditation; although some people may benefit from its practice, others will not be
affected in any substantive way, and a number of individuals may suffer moderate to
serious adverse effects. Second, we address the insufficient or inconclusive evidence
for its benefits, particularly when mindfulness-based interventions are compared with
other activities or treatments. We end with suggestions on how to improve the quality
of research into mindfulness interventions and outline key issues for clinicians
considering referring patients for these interventions.
Declaration of interest None.
Has the science of mindfulness lost its mind?
Miguel Farias,
1
Catherine Wikholm
2
329
Let us start by focusing on the benefits of mindfulness
as a preventive treatment for recurrent depression,
currently the only mental illness for which the National
Institute for Health and Care Excellence (NICE) recommends
the use of a mindfulness intervention. Mindfulness-based
cognitive therapy (MBCT) was developed with the intent
of treating individuals at risk for recurrent depression.
The early studies showed that, when compared with a
treatment-as-usual (TAU) group, mindfulness led to lower
relapse rates for those with three or more episodes of
depression.
7,8
However, it increased the likelihood of relapse
in individuals with two or fewer depressive episodes. But
there is more. The last two major trials found that even
patients with more than three episodes of depression react
differently to it. Those who benefit the most were shown to
be individuals with a personal history of childhood trauma
and abuse, in other words, those most psychologically
vulnerable.
9,10
It is unclear what the reasons are for
mindfulness being particularly effective within this subgroup
of individuals with a high probability of depression relapse,
but it certainly calls for a more nuanced recommendation
by NICE.
Potentially adverse effects of mindfulness
We have recently reviewed some of the evidence for what
we call the ‘dark side of meditation’, which includes
evidence of somatic, psychological and neurological
problems associated with meditation practice.
11
This is a
surprisingly under-researched area, mostly consisting of
case studies, but not exclusively. A cross-sectional study on
the effects of intensive and long-term meditation reported
that over 60% of individuals had at least one negative effect,
which varied from increased anxiety to depression and full-
blown psychosis.
12
Qualitative research on mindfulness
meditation shows that it may increase the awareness of
difficult feelings and exacerbate psychological problems.
13
One individual reported being suddenly confronted with
material relating to a forgotten childhood trauma during his
mindfulness practice:
‘I saw the depth of the pain that is buried things that have
happened to me that have not been dealt with properly. It can
be very scary to know there’s that very strong thing in there’
13
p. 853.
It can be argued that the emergence of difficult emotional
material from mindfulness practice may be a positive, rather
than an adverse circumstance. This will, of course, depend
on the context in which these feelings and memories emerge
-
if it happens in a therapeutic context, it may very well be;
but if the person is alone or doing mindfulness in a group
setting without a trained mental health clinician, a positive
outcome is more unlikely and it may simply result in
unexpected distress.
Why do some people react badly to meditation? A
possible explanation is that it amplifies inner problems; if
one has a ‘disposition’ to depression, bipolar disorder or
psychosis, meditation may heighten it. This amplification
thesis, however, is purely speculative and based on a biased
positive understanding of mindfulness. Another explanation
is that mindfulness is not only about ‘being aware’ but may
also challenge the ordinary sense of self. We call this the
ego-rattling hypothesis. Meditation techniques, including
mindfulness, were originally developed to assist with
bringing about a deep change in how individuals perceive
themselves, others and the surrounding world. It is then not
entirely surprising that a person might experience
emotional difficulties as a result. For example, it has been
found that after an 8-week mindfulness-based stress
reduction (MBSR) course, some participants experienced
increased stress and depression.
14
One experimental study,
which used the Trier Social Stress Test, found that a short
mindfulness intervention with healthy individuals led to
increased biological stress when compared with an active
control group.
15
Individual differences in mindfulness, including the
potential for adverse effects, should not be regarded as
the elephant in the room. Their study is crucial if we are
to advance our knowledge of the real therapeutic potential
of mindfulness. We must understand for whom and
under what circumstances it works and when it may be
contraindicated. The neglect of individual differences
has other obvious drawbacks: it weakens our conceptual
understanding of mindfulness and severely limits the
scientific usefulness of the plethora of studies that are
searching for its benefits.
The enthusiasm is ahead of the evidence
Contrary to popular opinion, the evidence for even the most
‘well-founded’ benefits of mindfulness is not consistent or
conclusive. A recent comprehensive meta-analysis
16
of
randomised clinical trials showed that mindfulness inter-
ventions only led to moderate improvements in depression,
anxiety and pain, and very small improvements in stress
reduction and quality of life. There was no evidence that
mindfulness had an effect on other variables, such as
positive mood, attention, sleep or substance use. Further,
when mindfulness was compared with other interventions,
such as physical exercise or relaxation, it was not more
effective. This confirms the result of an earlier meta-
analysis,
17
which found that mindfulness-based inter-
ventions did not lead to medium- or long-term (3 weeks
to 3 years post-intervention) better clinical outcomes
compared with relaxation or psychoeducation.
The enthusiasm surrounding mindfulness easily leads
to reporting the evidence in a different way. Let us again
take the case of mindfulness in the treatment of recurrent
depression. Its last major trial was published with great
media fanfare: ‘mindfulness is as effective as drugs for
treating depression’ reported the Daily Mail (21 April
2015).
18
What the media did not pick up on was that the
study had in fact failed, as its hypothesis was that MBCT
would be superior to antidepressant medication in
preventing depression relapse.
The media also completely ignored the results of the
previous major trial on MBCT for recurrent depression, a
methodologically more sophisticated study and one with
surprising results. Williams and colleagues
9
employed a
dismantling design to investigate the ‘active ingredient’ of
MBCT by comparing a typical MBCT intervention with
psychoeducation (similar in all aspects to MBCT, except it
did not involve meditation) and a TAU group. The
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Farias & Wikholm Has the science of mindfulness lost its mind?
330
psychoeducation groups met for the same amount of time
and learnt to recognise the warning signs of depression and
disengage from them, exactly as in the MBCT group. All
participants were assessed at 6, 9 and 12 months. The
results: participants in the MBCT group were as likely to
relapse as those in the psychoeducation and the TAU
groups. The only participants for whom MBCT proved more
effective were those with a higher frequency of childhood
trauma and abuse.
There are many other findings in the literature that
raise doubts about the long-term benefits of meditation.
Two meta-analyses disconfirmed the expectation that
continuous practice would lead to cumulative changes,
both in emotional
-
cognitive domains
19
and in brain
structure.
20
There are no obvious interpretations for the
finding that the expected positive changes of mindfulness
plateau after only some weeks of practice, rather than
increase with time. But the contrary is also true
-
there is no
clear rationale for why continuous mindfulness practice
would keep improving well-being or cognitive abilities. A
sort of magical rationale for the ‘power of mindfulness’
appears to be the underlying explanation. Continuous
practice is supposed to add up in a mathematical way,
making you more mindful, super aware, super controlled,
super happy and eventually liberated from the illusion of
the individual self. It is against the background of this
expectation that researchers show surprise about the lack of
a linear evolution of the benefits of mindfulness.
This grandiose expectation regarding the optimisation
of human functioning through a meditation technique may
be looked on as naive; but it is also dangerous. It is driving
an enthusiasm to show the effects of mindfulness that runs
way ahead of the modest evidence, as well as tainting our
perception of the data. It does something else that we find
worrying: it encourages a simplistic portrayal of the human
mind and of our inner lives. A number of analogies are used
to make mindfulness amenable to our modern mindset.
A particularly popular one is to think of mindfulness as a
‘mind gym’: ‘Just as brushing your teeth or going for a run
are well known ways of protecting general physical health,
mindfulness exercises develop mental fitness and resilience’.
21
It is unclear what these metaphors refer to
-
what exactly is
mental fitness and how can mindfulness promote it? Is it a
process of self-regulation mediated by improvements in
attention and awareness? Or is it a process of reappraisal of
one’s thoughts and sense of self as unimportant or illusory?
Recommendations and considerations
To improve the quality of research into mindfulness we first
need clear and comprehensive theories of how it works that
acknowledge the range of experiences people can have when
they meditate. Second, regarding methodology, studies
should involve active control groups, control for expectations,
and seek to explore individual differences in more depth.
Until we have better-designed studies and evidence
which can shed light on these areas, it is imperative that we
consider mindfulness not as the ‘go-to’ approach for
patients struggling with stress or recurrent depression, but
as one possible therapeutic approach among others. It is
important that we also speak openly about the potential for
adverse effects in order to de-stigmatise the issue; surely the
last thing we want is for a patient to feel that they ‘failed’ at
using a technique, when the reality is that it worked
differently for them than for another
-
and as yet, we do not
know why.
Currently, there is no professional or statutory
registration required to teach mindfulness-based inter-
ventions such as MBSR and MBCT, and no regulatory
body which oversees the training of mindfulness teachers.
The current popularity of mindfulness is encouraging the
rushed, unregulated formation of thousands of teachers.
Organisations offering training may set their ‘minimum
requirements’ for those wanting to train, but these vary
from organisation to organisation. Unlike other mainstream
psychological interventions available in the UK in the
National Health Service (such as cognitive
-
behavioural or
systemic family therapy), you do not need to be a therapist
or have any formal training in mental health to deliver
mindfulness courses. In other words, some mindfulness
teachers may be merely equipped to deliver a mindfulness
package, in a group setting, and may have limited
experience and expertise in identifying and managing
mental health difficulties. Yet, given that mindfulness is
promoted as a way to improve mental health, it is very likely
that for individuals attending mindfulness groups in the
community (or at school, or at work) many will be
experiencing some level of mental health difficulties. For
individuals experiencing common difficulties such as stress,
anxiety or depression and considering paying for therapy or
attending a mindfulness group, the combination of media
hype and the comparative affordability of a mindfulness
group may easily sway them to opt for this, potentially
placing their mental health in the hands of someone who
may lack adequate training and experience of working with
psychological difficulties.
Key considerations for clinicians contemplating
referring patients to mindfulness interventions include
past experiences of meditative techniques, providing
information as to the range of effects that may occur,
ensuring that the individual has support in place to help
them to manage difficult experiences should they occur, and
giving them a choice as to whether this, or some other form
of therapy, would be best suited to them.
Mindfulness has its place in therapy, as one of many
techniques available to a trained clinician. However, we
need to understand who it benefits and when, its merits and
limitations. And we need to moderate the excitement;
practise a salutary modesty that acknowledges the difficulty
of personal change and of recovery. Perhaps rethink the
metaphors of how mindfulness works — after all, picturing the
exercise of present-moment awareness as mind-pumping that
will make one more resilient to mental health bugs is
probably not the most mindful of therapeutic models.
About the authors
Miguel Farias, Reader in Cognitive and Biological Psychology, Brain, Belief &
Behaviour Group, Centre for Research in Psychology, Behaviour, and
Achievement, Coventry University, UK. Catherine Wikholm, Clinical
Psychologist, National Health Service, UK.
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Farias & Wikholm Has the science of mindfulness lost its mind?
331
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Increased psychological flexibility (PF) may underlie the lasting positive effects of psychedelic experiences on mental well-being. The associations between different components of PF, psychological inflexibility (PI), and well-being with psychedelic use are not well understood. We conducted a cross-sectional internet survey of participants (N = 629) with experience of classical psychedelics. Using network analysis, we examined how aspects of a single psychedelic experience (mystical-type features and psychological insights) and the frequency of past psychedelic use, were associated with current PF and PI components, as well as with mental well-being and ill-being. Mediation analyses explored whether PF mediated the relationship between past psychedelic use and well-being or ill-being. The network analysis linked psychological insight to the PF component Acceptance, with no association found between the frequency of past use and PF. Mediation analyses showed PF mediates the association between past psychedelic use and well-being and ill-being. These results suggest that the quality and depth of the psychedelic experience, rather than the frequency of use, are primarily linked to psychological flexibility, particularly Acceptance, and overall well-being. This underscores the importance of treating PF as a multidimensional construct to better understand the long-term mental health benefits of psychedelics.
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... In the context of business ethics education, this interdisciplinary strand of research recognises that the brain that decides how to use additive manufacturing and remote wireless tracking is the same brain that categorises sights and sounds and recalls episodic and semantic information. It is becoming evident that mindfulness approaches are not just New Age speak and that the psychological assertions in the field of mindfulness can be grounded within the context of cutting-edge neurobiological theories and findings (Farias & Wikholm 2016). With origins in early Eastern contemplative traditions, mindfulness is an innate condition of consciousness (Germer 2013). ...
Role of Mindfulness and Emotional Intelligence in Business Ethics Education
Article
  • Sep 2024
This research looks at how mindfulness can contribute to business ethics education in MBA programmes. Mediation analysis was used to measure the influence of mindfulness on the participants' performance in business ethics related courses and to quantify the influence of emotional intelligence which is a mediating variable. The effectiveness of mindfulness was evaluated using a Randomised Controlled Trial on participants of Executive MBA programmes. Half the participants were assigned to the intervention group and the other half placed on the waiting list for the next programme and used as the control group. Statistical analysis revealed that the increase in performance in business ethics related courses through mindfulness as also direct increase through emotional intelligence were significant. 40% of the enhancement of performance came through emotional intelligence while the remaining 60% came directly from mindfulness.
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How to create a mindful community of practice: Exploring the social functions of group- based mindfulness practices facilitated via Zoom during Covid-19
Article
Full-text available
  • Jan 2025
6 This exploratory qualitative study was conducted to investigate the experiences of individuals who 7 have been participating in online mindfulness sessions with an online mindfulness community since 8 the beginning of Covid-19, i.e. during a period of heightened uncertainty and social isolation. The 9 study's purpose was to better understand the social functions of regularly practicing mindfulness in 10 this online community of practice. Analyses from semi-structured interviews reveal how shared 11 mindfulness practice may foster several pillars of connection and interbeing in this community of 12 practice. These include improved mind-body awareness, coupled with a unique sense of trust and 13 connection, which may have helped cultivate collective alignment and a sense of common humanity 14 among research participants. Findings are discussed through the lens of interdependence theory, 15 resulting in several exploratory propositions on how to create a mindful community of practice. 16 The study concludes with a call for more research in this understudied research domain and invites 17 mindfulness researchers and practitioners to test these propositions further. Its overall aim is to 18 stimulate debate among individuals and groups intent on creating a mindful community in their 19 workplace, educational setting, or neighborhood. 20
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'Living in the Present' mindfulness for parents of children with skin conditions: a single group case series
Article
Full-text available
  • Sep 2024
  • BEHAV COGN PSYCHOTH
Background Parents of children with skin conditions can experience stress from the additional responsibilities of care. However, there is a lack of psychological interventions for families affected by a dermatological diagnosis. Aims To investigate (1) whether delivering the ‘Living in the Present’ mindfulness curriculum to parents of children with skin conditions reduced stress and increased both parental/child quality of life (QoL), and (2) determine intervention acceptability. Method Ten parents of children with eczema, ectodermal dysplasia, ichthyosis, and alopecia took part in a mindfulness-based intervention. Using mixed methods, a single-group experimental case design (SCED) was conducted and supplemented by thematic analysis of exit interviews. Parents completed idiographic measures of parenting stress, standardised measures of QoL, stress, mindfulness, and took part in exit interviews. Children also completed QoL measures. Results Tau-U analysis of idiographic measures revealed three parents showed some significant improvements in positive targets, and five parents showed some significant improvements in negative targets. Assessment of reliable change demonstrated that: one parent showed improvement in mindful parenting, three parents showed improvement in parenting stress, seven parents showed improvement in anxiety, three parents showed improvements in depression, six parents showed improvement in QoL, and four children showed improvement in QoL. However, two parents showed increased anxiety. Thematic analysis revealed positive changes to mood following mindfulness, although challenges were highlighted, including sustaining home practice. Conclusion Findings suggest this specific form of mindfulness intervention could be effective for parents of children with skin conditions; however, further robust studies are needed.
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Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): A randomised controlled trial
Article
Full-text available
  • Apr 2015
Background: Individuals with a history of recurrent depression have a high risk of repeated depressive relapse or recurrence. Maintenance antidepressants for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to medication. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce risk of relapse or recurrence compared with usual care, but has not yet been compared with maintenance antidepressant treatment in a definitive trial. We aimed to see whether MBCT with support to taper or discontinue antidepressant treatment (MBCT-TS) was superior to maintenance antidepressants for prevention of depressive relapse or recurrence over 24 months. Methods: In this single-blind, parallel, group randomised controlled trial (PREVENT), we recruited adult patients with three or more previous major depressive episodes and on a therapeutic dose of maintenance antidepressants, from primary care general practices in urban and rural settings in the UK. Participants were randomly assigned to either MBCT-TS or maintenance antidepressants (in a 1:1 ratio) with a computer-generated random number sequence with stratification by centre and symptomatic status. Participants were aware of treatment allocation and research assessors were masked to treatment allocation. The primary outcome was time to relapse or recurrence of depression, with patients followed up at five separate intervals during the 24-month study period. The primary analysis was based on the principle of intention to treat. The trial is registered with Current Controlled Trials, ISRCTN26666654. Findings: Between March 23, 2010, and Oct 21, 2011, we assessed 2188 participants for eligibility and recruited 424 patients from 95 general practices. 212 patients were randomly assigned to MBCT-TS and 212 to maintenance antidepressants. The time to relapse or recurrence of depression did not differ between MBCT-TS and maintenance antidepressants over 24 months (hazard ratio 0·89, 95% CI 0·67-1·18; p=0·43), nor did the number of serious adverse events. Five adverse events were reported, including two deaths, in each of the MBCT-TS and maintenance antidepressants groups. No adverse events were attributable to the interventions or the trial. Interpretation: We found no evidence that MBCT-TS is superior to maintenance antidepressant treatment for the prevention of depressive relapse in individuals at risk for depressive relapse or recurrence. Both treatments were associated with enduring positive outcomes in terms of relapse or recurrence, residual depressive symptoms, and quality of life. Funding: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme, and NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
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A Qualitative Analysis of Experiential Challenges Associated with Meditation Practice
Article
Full-text available
  • Aug 2015
  • Mindfulness
Although empirical interest in meditation has flourished in recent years, few studies have addressed possible downsides of meditation practice, particularly in community populations. In-depth interviews were conducted with 30 male meditators in London, UK, recruited using principles of maximum variation sampling, and analysed using a modified constant comparison approach. Having originally set out simply to inquire about the impact of various meditation practices (including but not limited to mindfulness) on men’s wellbeing, we uncovered psychological challenges associated with its practice. While meditation was generally reported to be conducive to wellbeing, substantial difficulties accounted for approximately one quarter of the interview data. Our paper focuses specifically on these issues in order to alert health professionals to potential challenges associated with meditation. Four main problems of increasing severity were uncovered: Meditation was a difficult skill to learn and practise; participants encountered troubling thoughts and feelings which were hard to manage; meditation reportedly exacerbated mental health issues, such as depression and anxiety; and in a few cases, meditation was associated with psychotic episodes. Our paper raises important issues around safeguarding those who practise meditation, both within therapeutic settings and in the community.
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Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners
Article
Full-text available
  • Jun 2014
Numerous studies have begun to address how the brain's grey and white matter may be shaped by meditation. This research is yet to be integrated, however, and two fundamental questions remain: Is meditation associated with altered brain structure? If so, what is the magnitude of these differences? To address these questions, we reviewed and meta-analyzed 123 brain morphology differences from 21 neuroimaging studies examining ∼300 meditation practitioners. Anatomical likelihood estimation (ALE) meta-analysis found eight brain regions consistently altered in meditators, including areas key to meta-awareness (frontopolar cortex/BA 10), exteroceptive and interoceptive body awareness (sensory cortices and insula), memory consolidation and reconsolidation (hippocampus), self and emotion regulation (anterior and mid cingulate; orbitofrontal cortex), and intra- and interhemispheric communication (superior longitudinal fasciculus; corpus callosum). Effect size meta-analysis (calculating 132 effect sizes from 16 studies) suggests a global ‘medium’ effect size (Cohen's d¯ = 0.46; r¯ = .19). Publication bias and methodological limitations are strong concerns, however; further research using rigorous methods is required to definitively link meditation practice to altered brain morphology.
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Brief Mindfulness Meditation Training alters Psychological and Neuroendocrine Responses to Social Evaluative Stress
Article
Full-text available
  • Jun 2014
Objective To test whether a brief mindfulness meditation training intervention buffers self-reported psychological and neuroendocrine responses to the Trier Social Stress Test (TSST) in young adult volunteers. A second objective evaluates whether pre-existing levels of dispositional mindfulness moderate the effects of brief mindfulness meditation training on stress reactivity. Methods Sixty-six (N = 66) participants were randomly assigned to either a brief 3-day (25-minutes per day) mindfulness meditation training or an analytic cognitive training control program. All participants completed a standardized laboratory social-evaluative stress challenge task (the TSST) following the third mindfulness meditation or cognitive training session. Measures of psychological (stress perceptions) and biological (salivary cortisol, blood pressure) stress reactivity were collected during the social evaluative stress-challenge session. Results Brief mindfulness meditation training reduced self-reported psychological stress reactivity but increased salivary cortisol reactivity to the TSST, relative to the cognitive training comparison program. Participants who were low in pre-existing levels of dispositional mindfulness and then received mindfulness meditation training had the greatest cortisol reactivity to the TSST. No significant main or interactive effects were observed for systolic or diastolic blood pressure reactivity to the TSST. Conclusions The present study provides an initial indication that brief mindfulness meditation training buffers self-reported psychological stress reactivity, but also increases cortisol reactivity to social evaluative stress. This pattern may indicate that initially brief mindfulness meditation training fosters greater active coping efforts, resulting in reduced psychological stress appraisals and greater cortisol reactivity during social evaluative stressors.
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Meditation Programs for Psychological Stress and Well-being A Systematic Review and Meta-analysis
Article
Full-text available
  • Jan 2014
Importance Many people meditate to reduce psychological stress and stress-related health problems. To counsel people appropriately, clinicians need to know what the evidence says about the health benefits of meditation. Objective To determine the efficacy of meditation programs in improving stress-related outcomes (anxiety, depression, stress/distress, positive mood, mental health–related quality of life, attention, substance use, eating habits, sleep, pain, and weight) in diverse adult clinical populations. Evidence Review We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. Findings After reviewing 18 753 citations, we included 47 trials with 3515 participants. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and pain (0.33 [0.03- 0.62]) and low evidence of improved stress/distress and mental health–related quality of life. We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. We found no evidence that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioral therapies). Conclusions and Relevance Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.
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Mindfulness-Based Cognitive Therapy for Preventing Relapse in Recurrent Depression: A Randomized Dismantling Trial
Article
Full-text available
  • Dec 2013
Objective: We compared mindfulness-based cognitive therapy (MBCT) with both cognitive psychological education (CPE) and treatment as usual (TAU) in preventing relapse to major depressive disorder (MDD) in people currently in remission following at least 3 previous episodes. Method: A randomized controlled trial in which 274 participants were allocated in the ratio 2:2:1 to MBCT plus TAU, CPE plus TAU, and TAU alone, and data were analyzed for the 255 (93%; MBCT = 99, CPE = 103, TAU = 53) retained to follow-up. MBCT was delivered in accordance with its published manual, modified to address suicidal cognitions; CPE was modeled on MBCT, but without training in meditation. Both treatments were delivered through 8 weekly classes. Results: Allocated treatment had no significant effect on risk of relapse to MDD over 12 months follow-up, hazard ratio for MBCT vs. CPE = 0.88, 95% CI [0.58, 1.35]; for MBCT vs. TAU = 0.69, 95% CI [0.42, 1.12]. However, severity of childhood trauma affected relapse, hazard ratio for increase of 1 standard deviation = 1.26 (95% CI [1.05, 1.50]), and significantly interacted with allocated treatment. Among participants above median severity, the hazard ratio was 0.61, 95% CI [0.34, 1.09], for MBCT vs. CPE, and 0.43, 95% CI [0.22, 0.87], for MBCT vs. TAU. For those below median severity, there were no such differences between treatment groups. Conclusion: MBCT provided significant protection against relapse for participants with increased vulnerability due to history of childhood trauma, but showed no significant advantage in comparison to an active control treatment and usual care over the whole group of patients with recurrent depression.
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The Psychological Effects of Meditation: A Meta-Analysis
Article
Full-text available
  • May 2012
In this meta-analysis, we give a comprehensive overview of the effects of meditation on psychological variables that can be extracted from empirical studies, concentrating on the effects of meditation on nonclinical groups of adult meditators. Mostly because of methodological problems, almost ¾ of an initially identified 595 studies had to be excluded. Most studies appear to have been conducted without sufficient theoretical background. To put the results into perspective, we briefly summarize the major theoretical approaches from both East and West. The 163 studies that allowed the calculation of effect sizes exhibited medium average effects ( = .28 for all studies and = .27 for the n = 125 studies from reviewed journals), which cannot be explained by mere relaxation or cognitive restructuring effects. In general, results were strongest (medium to large) for changes in emotionality and relationship issues, less strong (about medium) for measures of attention, and weakest (small to medium) for more cognitive measures. However, specific findings varied across different approaches to meditation (transcendental meditation, mindfulness meditation, and other meditation techniques). Surprisingly, meditation experience only partially covaried with long-term impact on the variables examined. In general, the dependent variables used cover only some of the content areas about which predictions can be made from already existing theories about meditation; still, such predictions lack precision at present. We conclude that to arrive at a comprehensive understanding of why and how meditation works, emphasis should be placed on the development of more precise theories and measurement devices. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
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For Whom May Participation in a Mindfulness-Based Stress Reduction Program be Contraindicated?
Article
  • Mar 2011
Mindfulness-Based Stress Reduction (MBSR) programs are offered worldwide. To date, there has been little discussion about for whom participation may not be appropriate. We reviewed the literature pertaining to attrition and adverse effects following participation in MBSR; relatively little was learned in this search. A few clinical trials from Mindfulness-Based Cognitive Therapy (MBCT) provide ideas concerning who may not benefit from this program and who is likely to drop out. There are some case studies of individuals who manifested various mental health issues following experiences with various forms of meditation, but often specifics are missing such that it is not known what type of meditation was practiced or if the individuals in question had previous psychiatric disorders or preexisting conditions that could predispose them to negative outcomes. While we could not provide an empirically based answer to our question, we open the discussion and offer recommendations, especially with regard to preprogram screening, to guide instructors when they form a new group for an MBSR course so that the risk of harm is reduced. We trust that this paper will prompt our colleagues to examine the issue of risk and report adverse events should they occur.
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