Alan Cassels is a drug policy researcher and regular contributor to the blog. He is also the author, most recently, of The Cochrane Collaboration: Medicine’s Best-Kept Secret. He tweets as @akecassels.
Is it possible to use our minds to create a better sense of physical well-being? Can we use meditative breathing, non-judgmental “mindfulness” techniques and so on to reduce anxiety and depression, hone social skills, and improve learning? The short answer is “probably,” but when you look at the body of scientific study and reporting of mindfulness research, you can’t help but feel pushed toward a more conclusive frame of mind.
There are undoubtedly many health-related claims attributed to mindfulness, plugged as the cure for pain, chronic fatigue, mental distress and other afflictions. And the media has been quick to report on those claims. This NPR report covers research claiming mindfulness works better than opioids for lower back pain. The New York Times said the practice might cause beneficial changes in the brain.
It can’t be that flaky because even the business world is catching the mindfulness vibe. Business.com asserts that CEOs must learn to embrace mindfulness if they want to improve their performance and well-being. This Forbes column says that mindfulness can help businesses dealing with anxious, stressed out and unengaged employees. The Huffington Post adds that adopting mindfulness is a good way to deal with difficult people. US News and World Report says it can even help prevent overspending and reduce consumer debt.
Is mindfulness, then, the new blockbuster Super Drug that we should all be taking?
Mindfulness as marketing tool
That’s hard to say, but if you haven’t absorbed this yet, let me plant one undeniable seed: mindfulness has an influence that is BIG and growing. This New York Times piece reveals there are incredible efforts to commercialize it, to make it grow even bigger and more mainstream than yoga. You can flip through Mindful Magazine, pick up a copy of one of an estimated 8,000 mindfulness books on the market, or peruse the growing list of peer-reviewed journal publications on the topic. Hungry? Why not spread a dollop of Mindfulness Mayo on your BLT, have a Mindful burger in a chain of Chicago burger joints, drink mindful tea, or go on a mindful diet, according to the Washington Post?
Promoters of mindfulness-based approaches claim that there’s plenty of solid research showing that the practice improves attention, emotional regulation, compassion, and sense of calmness. But how do those claims square up against a dispassionate review of the evidence?
Researchers at Montreal’s McGill University just released a publication in PLOS One looking closely at how randomized controlled trials of mindfulness-based mental health interventions are reported. One of the authors of this report, McGill psychiatry professor Dr. Brett Thombs told me that there is a “massive push to support and propagate it [the mindfulness message],” adding that “it isn’t dissimilar to [the drug industry] pushing cures that don’t work like they say they do.”
Thombs believes that people certainly have some ability to control their bodies with their minds, but he and his team wanted to find some “real evidence” to support the health claims. He said: “While I’d agree that those selling wares carry out all sorts of shenanigans to promote their work, could this be happening with mindfulness?”
Systematic review finds biased reporting of benefits
His team looked at 124 published trials of mindfulness, finding that 87% of them reported at least one positive outcome in the abstract, and 88% that said mindfulness-based therapy was effective. Based on the effect size they found, the number of positive trials was much larger than they would have expected. Of the trials reviewed, only 21 had been registered (as required by the International Committee of Medical Journal Editors), and most of those — 13 (62%) — remained unpublished 30 months after the trial was completed. (Note to reader: This is what we call publication bias.)
Thomb’s team also found that of all of the 36 systematic reviews and meta-analyses of mindfulness they looked at, none gave sufficient attention to important caveats and limitations as you’d expect with any meta-analysis. In other words, by failing to acknowledge reporting biases, those reviews are likely overestimating the effects of mindfulness.
What’s one to conclude from all of this? That researchers in mindfulness, like almost anywhere, are capable of cherry-picking studies, some of which may make outrageous claims, including real nose-stretchers that mindfulness can “change the brain” in a short period of time.
Bear in mind: It’s unlikely to do harm
So, what’s the take-away, Alan?
As Thombs says: “I don’t believe that mindfulness training is completely ineffective or is harmful. I do believe–and I am supported by the evidence that we are publishing–that we don’t have a very good idea of how effective it is.”
Mindfulness is about being open and receptive, focusing on breathing and being intentionally nonjudgmental. Certainly anything that can reduce stress, bring peace and help focus our attention can’t be that bad, can it? We are surrounded by so many demands on our attention, and it seems to me that the resulting chaos, stress and potentially harmful impact to our psyche demands some sort of effective antidote. Does it matter that vested interests may be exaggerating the evidence base underlying mindfulness? Sure, but it’s surely not worth tossing the baby out with the bathwater.
I would conclude here — and I consider myself, as I write this, to be as “in the moment” as one can be while staring at a computer screen — that probably the truest thing that you can say about mindfulness or meditation is that it is unlikely to ever be harmful–a sentiment you could apply to almost no health care intervention in the modern world. If it’s a Super Drug, it’s probably beneficial in small doses and very unlikely to lead to a harmful overdose.
And that might be something worth meditating on.