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The Science of Mindfulness (part 3)

by Bruno Van de Casteele

August 11, 2013

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Donate This is my final post on the science of mindfulness. The two previous installments can be found here and here. All three posts were a follow-up on an initial post detailing a Belgian hype around the phenomenon. However, in that post I hastily remarked that there was no science to speak of. This was incorrect, and in this post I present my own personal conclusion on this topic.

I probably should have known. For several years now, Scientific American offers cruises that feature scientific lectures while at sea. In February 2014, a cruise will go around Southeast Asia, and feature as one of the speakers Ronald Siegel (Harvard) discussing mindfulness. I'm pretty sure they wouldn't feature this topic if there wasn't some decent science behind it.

And there is indeed some. In the first part, some Belgian researchers were featured. Not only did they have some interesting research, but in the explanatory notes to their training programs it was also clearly indicated for what it works and for what it shouldn't certainly be used. Significant effects have been shown for helping recovering depression patients, but it was not recommended for acute depressions. This, to me, not only showed that it was valid, but also that it wasn't a catch-all miracle cure that could solve everything (as parodied by Eric in a recent post on this blog).

In the second part, I discussed a metastudy from 2003, widely referenced as a milestone in the scientific understanding of the technique. Here too (although in an unpublished paper) was there caution against using it for "severe" disorders, but the science showed that it worked, with a significant overall effect (.5 if you know what it means). But, in reading the metastudy, I got reminded of my initial feeling, namely the preliminary state of the field. The sample size was small, and the authors had to exclude about 2/3 of selected articles because of lacking quality (no control, no objective scale used, not enough documented, ...).

Maybe that is not entirely honest, as these type of techniques typically cannot be rolled out in a full blown double-blind study featuring thousands of patients (as for medication). Indeed, a recent metastudy by Khoury et al. featured over 200 studies, with more than 12000 participants (I don't have access to the actual text, this is from the abstract). In a field like this, with a technique like mindfulness, evaluating hundreds of studies is indeed the correct way to counter the small sample size of each individual study. So, case closed, mindfulness is science?

Probably yes. But when reading the above study, something struck me. In this 2013 metastudy, mindfulness-based therapy (MBT in short) was evaluated. The 2003 study I looked at in my previous post was an evaluation of Mindfulness-Based Stress Reduction (MBSR). In my first post, I referenced an article evaluating Mindfulness-based cognitive therapy (MBCT). One commenter referred to Acceptance and Commitment Therapy (ACT), including as one of the therapeutic steps that "the client" (huh?) should "become more consistently mindful".

In an interview (I only have a paper copy) Bjrn Prins, from the ITAM institute here in Belgium, indicated that in practice, there is no real practical difference between MBSR and MBCT. That seems a little odd. But there is more. A commenter pointed me to, with a nice two-page document explaining the (scientific) concept of mindfulness. When discussing objective (and quantitative) measurements of mindfulness, I find 7 different scales that have been defined in the last ten years!

My goal is not some postmodern deconstruction of mindfulness. It is more a call to action. From an admitted outsider point of view, it seems weak when each institute has its own technique. Furthermore, remember my original post, where one "therapist" recommended the undercover journalist to "breath through his genitals", and where the technique was applied to . This does not give a good impression. So a call to action: get your research paradigms aligned, and please get the charlatans out! Because to me it is now rather clear that there are indeed serious researchers doing valid work. They also understand that it is a technique applied only to certain cases (and not to others), and that it is part of a toolbox of techniques available to a psychotherapist.

So, in conclusion, by all means, if mindfulness works for you (and it is within a proper scientific context), go for it. But if it doesn't (fully) work, please check back with your health professional. She or he knows best.

Thanks to the many commenters on the different articles, especially Shirley Rieven and mandatoryfield. Special thanks also to my friend Helmut for the initial topic and some documentation for this final part.

by Bruno Van de Casteele

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