All About Mindfulness

Fads are ubiquitous; they always have been, and always will be. They tend to come and go. Some fads are goofy and some are great, and sometimes the great ones leave the realm of fad and become mainstream. It's only been a few years since the meditation method called mindfulness grew into a fad of New York Times bestseller proportions, so we're still waiting to see if it finds a permanent place there. Today we're going to look at the research and find out what we know — or at least what we know so far — about mindfulness. Is it any different from other types of meditation, and by extension, is meditation really any different from other types of relaxation? We know that simple relaxation unequivocally brings a number of measurable health benefits. Do those health benefits truly increase when a billion-dollar industry springs up around a branded version, now being sold at a bookstore near you as mindfulness?

Typically in a Skeptoid episode, this second paragraph is where I'll start with a good definition of mindfulness and perhaps its history, to establish what it is we're talking about. Not so today. The biggest problem with discussing mindfulness from the perspective of scientific skepticism is that it's not a defined term. The practice itself is only vaguely defined as a type of meditation with certain characteristics, objectives, and outcomes, but those always vary depending on what author you read; and what every author gives you is generalized and vague as well. A 2017 article in Perspectives on Psychological Science by Van Dam et. al. which attempted to prescribe a framework for scientific study into mindfulness, offered this description:

The term mindfulness has a plethora of meanings; a reflection of its incredible popularity alongside some preliminary support, considerable misinformation and misunderstanding, as well as a general lack of methodologically rigorous research.

Dr. Steve Novella, writing in the Science-Based Medicine blog, pointed out:

Mindfulness research... is plagued by a lack of a consistent definition, or one that can be operationalized for research. What is/are the critical component(s) of mindfulness? Is it relaxation, introspection, being in the moment, directing one's attention, avoiding mind-wandering, or something else?

Based on my own survey of a large number of sources, the definition of mindfulness that I arrived at — and that I think is the most defensible definition — is a combination of Eastern-derived practices rebranded with the Western-sounding word "mindfulness" to strip away any stigma for those disinterested in Eastern mysticism, and make it more palatable to the mainstream psychological profession. It's still not a single well-defined practice though, but rather an umbrella term that can include any combination of various meditation, relaxation, and yoga practices, with a built-in hook allowing them to be combined with conventional cognitive therapy, thus making it part of a prescribable treatment.

Mindfulness — the idea of focusing on the here and now — had always been a concept in Zen Buddhism and traditions of meditation, but it was around 1970 that a student at MIT, Jon Kabat-Zinn, became obsessed with these Eastern philosophies. By 1979 he was a professor at the University of Massachusetts, and codified a practice he called Mindfulness-Based Stress Reduction (MBSR). It was conventional Zen Buddhist meditation, but what he did that was new was to describe it using purely secular and scientific terminology, with no references to its religious roots. Its objective was to help a person get through a particularly painful or traumatic period using meditation. Other researchers extrapolated from MBSR and created MBCT (Mindfulness-Based Cognitive Therapy) intended to treat specific major depressive disorders.

Fundamentally, the concept is perfectly sound, but only insofar as stress reduction is enormously helpful psychologically in dealing with trauma or depression; and meditation is generally acknowledged as a valid method of stress reduction, among many others.

Around 2005, mindfulness became a "thing" in pop culture, with books being published on the subject and classes starting to appear everywhere. By 2010 the term's popularity in search engines and in both academic and popular press was skyrocketing. Think of it in the same way the organic food fad suddenly appeared and became stunningly popular among Westerners seeking some form of esoterically enlightened meaning in an ordinary act like eating. Today we can find some 40,000 annual mentions of mindfulness in the popular press. Mindfulness, one could say, has arrived.

Today Kabat-Zinn's MBSR is practiced widely, most noticeably in complementary and alternative medicine centers for cancer patients. But many of its proponents are hoping to see MBSR, MBCT, and other mindfulness developments expand beyond the fringe of alternative medicine and into the legitimate mainstream. In pursuit of this, many claims are being made for it, claims that are said (by proponents) to be science based.

2015 was a banner year for publication of amazing claims of benefits from mindfulness. One article in Forbes was a great example of this. Claims included that mindfulness meditation is an equally good treatment for depression and anxiety as psychotherapy or medication; it improves concentration and attention; it increases attendance and test scores for students; and most notably, that it produces measurable physical changes in the brain.

This "changes in the brain" claim has been central to mindfulness marketing for some time now. A number of research teams used fMRI studies — a type of brain scan that shows areas of increased blood flow in the brain, which is associated with neuron activity — to show that MBCT had better results than conventional therapies at treating depression. Such work has been roundly criticized, however, as brain scans are not relevant to psychiatric diagnoses and are not the way we gauge a patient's depression level, or determine whether a treatment has been successful. The brain scans are, however, interesting; just not in the way they've been reported as miraculous therapeutic results.

And it's all of this pop mass-market reporting that has been a huge problem for legitimate research into mindfulness as a therapy. Worldwide headlines were generated by a few studies' findings that the brain's gray matter is found to be thicker in mindfulness practitioners, which is reported as if it's an assumed given that this is a useful, desirable, or helpful trait. A number of such claims have been published in the academic literature, and magnified with a megaphone (in greatly exaggerated terms) in the mass media.

While meta-analyses of many of these studies do indicate that modest changes in brain structure are likely associated with mindfulness, there are two points that the hyped-up mass-media articles always fail to mention. First is that these types of brain changes — like thicker gray matter — are commonly associated with a lot of different activities, even sports training and other things that have nothing to do with meditation. Van Dam et. al. continued:

Caution must be exerted in interpreting these findings; similar changes have been observed following other forms of mental and physical skill acquisition, such as learning to play musical instruments and learning to reason, suggesting that they may not be unique to mindfulness or other popular types of meditation practice.

But simply by mentioning these brain changes, promoters of mindfulness hope that you will wrongly assume that mindfulness is the way to achieve them. Which brings us to the second point omitted from the hype articles, which is that there's no reason to think these brain changes (real as they may be) are beneficial, or otherwise something you should be pursuing.

Brain changes aside, can mindfulness produce measurable benefits? The answer is yes, it can, but it's also clear that these benefits can be achieved in many ways. Another 2018 publication in Nature's Scientific Reports discussed the well-known physical benefits of relaxation: reduced stress, lower blood pressure, better sleep, improved emotional state, etc., and then sought to look at the entire existing body of research into mindfulness to see if it produced anything. The results were very interesting. Five areas of emotional improvement were identified: compassion, empathy, aggression, connectedness and prejudice. The analysis did show an improvement, but in only two of the five measures: compassion and empathy. Further, it turned out that even these two benefits were only produced when the teacher in the meditation intervention was a co-author in the study(!!), and when the study was of low methodological quality; i.e., it did not employ a control group. The article concluded:

Compared to doing no new emotionally engaging activity, [meditation] might make one feel moderately more compassionate or empathic, but our findings suggest that these effects may be, at least in part, the result of methodological frailties, such as biases introduced by the meditation teacher, the type of control group used and the beliefs and expectations of participants about the power of meditation.

In other words, mindfulness may well work great for people who are already inclined toward belief in mindfulness, transcendental meditation, or other Eastern-influenced meditation techniques. If Eastern mysticism isn't your thing, you're likely to get similar benefits from crashing on the couch and putting on your favorite nature documentary. In short, whatever you find relaxing will relax you. For me, it's putting on one of my favorite movies and solving the 9x9x9 Rubik's Cube. For you, maybe it's mindfulness meditation.

The bottom line, from all that we currently know, is that mindfulness appears to offer no benefits over any other type of relaxation. Those benefits are real, but they are just as easily obtained by reading in a hammock, crocheting, or even binge-watching Bob Ross videos. For most of us, that time we're able to turn off everything else and just engage in our favorite relaxation, whether that's meditation or anything else, is usually our favorite part of the day. For you that might be practicing mindfulness, and if so, that's great. The takeaway from today is that any specific benefits you might have been looking for were already available from any number of other activities that you already enjoyed and knew how to do without buying books and seminars. For me, this episode is the opportunity to wrap up a subject with something I've always wanted to say, and which could arguably be the ultimate summation of the entire body of 650-something Skeptoid episodes: just relax.

By Brian Dunning
Follow @BrianDunning