To focus on the outcome is misinformed – mindfulness (MF) is about the path, and not the destination. In understanding oneself, control over emotive reactions is gained but slowly. Introductory courses deliver little more insight than the clinical trials control groups who are doing either relaxation classes, or else education on the mind/body connection as affecting health. MF is so much more, and changing your brain takes committed effort rather than mere tuition of a technique. There are many studies published accessibly, demonstrating evidence of the therapy’s efficacy. ‘Mindfulness‘ by Springer is just one of many academic journals making a sample of reports publicly available (21 as of Feb ’16). The other subscriber-only 467 articles offer preview with an Abstract, which usually suffices anyway. © Clinical Journal of Pain Neural imaging by Oxford Uni of participants on a Breathworks course isn’t much benefit unless the role of the sensorimotor cortex and Event Related Potential in anticipation of a painful stimuli is understood.
The reason an excerpt of journal articles is presented in Links on this page is to examine where MF was unexpectedly inadequate in studies, so as to benefit our understanding.
David Gelles’ in his excellent book ‘Mindful Work’ surmises that “… not even mindfulness can prevent school from being a truly nerve-racking experience” on the basis of MF-Based Wellness Education offered as a student elective. A statistical aberration in comparing group results aside (the trial was non-randomised, hence baselines showed the more-stressed students opted in… but their distress indeed improved, and other’s worsened), the Study 2 protocol shows that students were given a CD and told to practice for an hour and a half each week. On top of their teacher training workload. This is a clear explanation for only a moderate effect size in results. Lack of cushion time.
Clinician’s evidence base Cochrane provides structured frameworks for aggregating trial results so as to convey confidence in an overall effect, regardless of study biases. CD001980 Theadom_et_al-2015-The_Cochrane_library.pdf reviewing Mind and Body Therapy for Fibromyalgia is easily googled, but excerpted here since it runs 221 pages. The condition is archetypal for chronic pain and fatigue symptoms. Interventions of psychotherapy, biofeedback, relaxation, movement therapy (eg yoga, qi-gong), and mindfulness were compared for subjective symptom relief. The benefit of MF was reported as not being statistically significant, but again a mismatched patient assignment resulted in the MF group suffering worse symptoms at baseline. If the change in
Quality of Life score is considered instead, the benefit is apparent but on a scale of 100 is arguably inadequate. The poorest result pictured has been excerpted: Treating fibromyalgia with mindfulness-based stress reduction_Schmidt; Pain 2011(© Elsevier). The disappointed authors reflected on their shortcomings in MBSR course delivery, since their earlier pilot had proven so successful. It was speculated that the extent of physical monitoring was burdensome, and the emotional perceptiveness of instructors was uncertain. The setting of a formal, uninvolved research context may have failed to support participants whilst they examined deep, emotional responses.
This makes sense. Treating patients like they’re subjects of a study won’t alleviate stress. An empathetic, supportive group should be sought out. Which leads to the major criticism of formulaic McMindfulness. High dropout rates over the course of a study, indicating that anxious feelings have been uncovered. For busy obsessives, work distractions may be holding together their semblance of order. Author of ‘The Buddha Pill‘, psychologist Miguel Farias rails against the fact that * “…mindfulness keeps its priority status for the treatment of recurrent depression by the National Institute for Health and Care Excellence“. The study cited is a comparison of MF Based Cognitive Therapy (MBCT) against Cognitive Education, in avoiding relapse after treatment for Major Depressive Disorder. MBCT appeared to be more effective, but a difference that was only statistically significant for those whose illness is associated with more severe childhood trauma. The very group for whom MF is cautioned against, for fear of exacerbating PTSD recall.
Nonetheless, moves are afoot to regulate MF teaching, and the burgeoning field of Positive Psychology is poised to provide a framework assuring practitioner expertise.
* British Medical Jnl letter: BMJ 2015;350:h144