Should be more mindful of Mindfulness?
Published 03/11/2015 | 02:30
Mindfulness is the psycho-buzzword of the moment. Books, workshops, retreats are advertising its power to transform lives. In Britain, it has even been suggested that it be included in the school curriculum. Multinational companies such as Google use it to reduce stress and there are books on mindfulness eating and mindfulness anger management.
It is recommended as a treatment for all manner of mental health conditions from stress to anxiety and depression. But is it really the panacea that it's being portrayed as?
Many of my patients are hooking up with it and most psychologists now include a mindfulness component in their therapy, whether it be cognitive, interpersonal or some other kind. Most patients tell me that they find it very beneficial. Surely that should be enough for it to be prescribed?
Yet, there are questions as to how something so simple and accessible could help such a range of conditions?
Mindfulness is a form of meditation derived from the Buddhist tradition. It's history in the Western world can be traced to Jon Kabat-Zinn, professor emeritus at the Stress Reduction Clinic and Centre for Mindfulness in Medicine, at the University of Massachusetts Medical School, who developed "mindfulness-based stress reduction" in the late 1970s. It is only in the past five years that it has come to universal prominence. Prior to that, the catch-all therapy was cognitive behavioural in type (CBT) and there is little doubting its benefits, although these were not as universally hailed and widely acclaimed as those of mindfulness.
Perhaps mindfulness was a natural successor to CBT, with its structured style and requirements for exercise completion. These CBT exercises consisted of written responses that challenged assumptions the person made, which were believed to drive the symptoms, whether they were of anxiety or depression or low self-esteem. In practice, many found the demands of these exercises excessive and failed to complete the sessions.
More recently, studies of the outcomes with CBT have shown that, over time, the benefits have diminished. The most likely reason is that, increasingly, therapists are not practising it as taught by its founder in 1964, Aaron Beck. Indeed, what is called cognitive therapy is often a pale derivation from the original. Mindfulness, on the other hand, is gentler and does not require the psychological work demanded by CBT.
Mindfulness-based cognitive therapy is a hybrid of both mindfulness and CBT. This focuses on accepting the here and now rather than forecasting the future or dwelling on the past. It also applies problem-solving techniques to dealing with current stressors.
Bolstering its universal popularity are a number of studies that have shown it to be helpful in preventing relapse in recurrent depressive disorder, in reducing anxiety and in potentially helping those diagnosed with cancer.
The National institute for Clinical Excellence (NICE) has recommended it as an adjunct to antidepressants for those with recurrent depressive disorder. But some headlines reporting a recent study published in the Lancet, one of the most prestigious peer-reviewed journals in 2015, have been misleading, such as: "Meditation is as effective as drugs for treating depression".
The truth is, the study may have been too small to detect differences between the two interventions, was not double blind, the authors were co-directors of the Mindfulness Network Community Interest Company, and the participants may not have been representative of the generality of those with depression, since only those willing to try a psychological treatment and to try reducing their antidepressant dose were included.
Similar problems have been identified in other mindfulness studies also.
I have referred patients for mindfulness, so not only am I concerned about whether it is beneficial or not, but whether it can do harm. So far, there is little evidence of this, but a book published in May 2015, The Buddha Pill by Drs Miguel Farias and Catherine Wikholm, both psychologists, hints otherwise.
For example, mindfulness meditation has been shown to increase levels of cortisol, the stress hormone, in the body and the authors report an increase in emotional distress in some. In others, the failure to engage with mindfulness may induce a sense of despondency and pessimism in light of the overwhelming public approval.
Yet, just as I need more evidence to make me hail this form of meditation as the be-all of therapy, I also need to be more convinced that it does harm.
Like all interventions in medicine and psychiatry, there are benefits and side effects. For the moment, the zeitgeist is somewhat in the direction of benefits from mindfulness while being suggestive of little harm. However, that may change when better-designed studies are available.
Let's be honest, there is no magic bullet when it comes to illness, physical or mental - and to think that mindfulness is it, is bordering on the delusional.
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