Minding the Gap: Recreating the Research Landscape for Mindfulness?

In a recent article by Van Dam, Nicholas T et al. “Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation”, authors critically reviewed the research-scape surrounding mindfulness-based interventions. They raised multiple issues with the current state of evidence on the topic, notably misinterpretation of results and subsequent claims that the practise of meditation offers users a seemingly limitless panoply of health benefits for all kinds of afflictions.

Here are some of the paper’s key points:

1. Conducting Research on a Difficult-to-Define Topic

Mindfulness is commonly described as a process that involves “moment-to-moment awareness, cultivated by paying attention in a specific way…as non-reactively, non-judgmentally, and open-heartedly as possible” (1). But being the introspective and personal process that it is, mindfulness takes on multiple different definitions according to the person, community, religion participating in it. All good research starts with a clearly-defined question, and hopes to conclude with a valid, methodological, and reproducible result; so how can a multidimensional concept be interpreted in the language of science? With that in mind, it makes sense that this problem has an important impact on studies evaluating the efficacy of mindfulness when for example a 5 minute app-based intervention is considered equivalent to a 6 week meditation retreat (2). Or, when a formal mindful exercise program is compared to a less formal process of mindful eating. It’s hard to make statements about what particular features of mindfulness are compatible with a specific result on health and wellbeing, when the intervention is actually a collection of various types of skills and mental states.

2. Statistical vs. Clinical Significance

Another shortcoming identified in this review was that of overinterpretation of results which were frequently statistically significant but had very limited implications for patient quality of life and other clinical measures of wellbeing (2). This also holds true in the area of functional neuroimaging, which at baseline does not “clearly convey the complex – often fraught – chain of biological and computational steps that lead to inferences about changes in brain structure and function” (2). Researchers’ ability to determine appropriate effect sizes with data extracted from neuroimaging is also difficult, making the interpretation of “practical significance and clinical importance…of observed changes in brain structure and neural activity associated with practicing mindfulness…elusive” (3).

3. Do no Harm?

Unlike the pharmacological research industry, studies on the impact of mindfulness are not regulated. Despite there being mixed evidence for mindfulness-based interventions, they are still being recommended by institutions with high clinical impact such as the American Psychiatric Association and the United Kingdom National Institute for Health and Clinical Excellence. In some cases, research has concluded that these interventions are in fact superior to well-established first line treatments such as psychotherapy and SSRIs (4). What’s more, some data has concluded that mindfulness based interventions are contraindicated in certain patient populations namely those with a history of “schizophrenia spectrum disorders, bipolar disorder, post-traumatic stress disorder, depression” (2), principally seeing as there is not enough clinical surveillance offered in these studies to support patients through potential adverse events such as “mania, depersonalization, anxiety, panic, traumatic-memory re-experiencing, and other forms of clinical deterioration” (2). Patients may not always know of these underlying conditions, and unlike larger scale RCTs, medical records may not be largely available or accessible. Thankfully, the MBCT Implementation Resources was drafted to describe potential adverse consequences of participation in a mindfulness intervention.  

In presenting this data as they have, the authors do not condemn mindfulness nor do they falsify all mindfulness literature out there; they simply hope to propose a more systematic, rigorous, and reproducible approach to a centuries-old practise which has played an important role in patient care for many. I don’t think there is a doubt that mindfulness has potential to help heal and recover, it’s a matter of quantifying that therapeutic potential as would be done for any other pharmacological or non-pharmacological intervention in the field of medical research.

References

(1) Kabat-Zinn J. Some reflections on the origins of MBSR, skillful means, and the trouble with maps. Contemporary Buddhism. 2011;12(1):281–306
(2) Van Dam NT, van Vugt MK, Vago DR, et al. Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation [published correction appears in Perspect Psychol Sci. 2020 Sep;15(5):1289-1290]. Perspect Psychol Sci. 2018;13(1):36-61. doi:10.1177/1745691617709589
(3) Castellanos FX, Di Martino A, Craddock RC, Mehta AD, Milham MP. Clinical applications of the functional connectome. Neuroimage. 2013;80:527–540. doi: 10.1016/j.neuroimage.2013.04.083.
(4) Crane RS, Kuyken W. The Implementation of Mindfulness-Based Cognitive Therapy: Learning From the UK Health Service Experience. Mindfulness. 2012;4(3):246–254.