Being mindful of mindfulness

Over the past decade there has been a surge of interest in mindfulness approaches in the general community as well as in the psychology profession, to the extent that it is often aligned with cognitive-behavioural approaches. Based on Buddhist principles of focused breathing and meditation, mindfulness emerged in the late 1970s in the form of a treatment known as mindfulness-based stress reduction and has been used for a range of physical and mental health problems including chronic pain, anxiety, depression, addiction, eating disorders, the list goes on. It has been adopted as a strategy for stress reduction and offered by clinicians and health and wellness centres, as well as being adopted in organisations such as schools and workplaces. However, a recent review of the literature undertaken by 15 researchers from prestigious universities calls into question our understanding of the concept of mindfulness and its utility.

The review paper (Van Dam et al., 2018) investigated conceptual, methodological and clinical implications of mindfulness research published between 1970 and 2015. Conclusions drawn indicate that mindfulness research is fraught with methodological problems and in particular, there is a lack of standardisation in how mindfulness is defined, measured and applied.

What is mindfulness?

Research examining the efficacy of mindfulness often describes it as a level of consciousness or awareness that arises through the use of purposeful attention that is focused on the present moment in a non-judgemental and accepting way (Gu, Strauss, Bond & Cavanagh, 2015) and while mindfulness is said to be cultivated through meditation, yoga, tai chi and related techniques, it is seen to be distinct from these. The research revealed that there are diverse definitions and characteristics of mindfulness in research and practice, and that is of concern to Van Dam and his colleagues. Indeed, studies varied in the extent to which they highlighted particular features of mindfulness with some concentrating on physical techniques such as breathing to direct the person to a mindful state and others drawing on cognitive aspects such as exercising awareness and attention, and again others introducing an attitudinal component such as being non-judgemental and accepting.

Operationalising and measuring mindfulness

In applying mindfulness in training and practice it was noted that the methods for teaching mindfulness varied with programs highlighting different components (e.g., different states, skills and practices) as well as differences in duration and time commitment.

The difficulties in operationalising and measuring mindfulness are acknowledged by the authors, but they raise considerable concern about current practices. The way that mindfulness has been investigated in many studies has been through the use of self-report measures where there is no comparison to equivalent measures and where there is a lack of clarity in what is being measured. As a result, the authors argue these data are largely unreliable. Few studies compared mindfulness to an active control group and even fewer studies have been undertaken outside of the research context. There is also concern about the interpretation of data from the field of neuroscience on the brain mechanisms underlying mindfulness.

Where to from here?

While the researchers formed the view that mindfulness-based interventions have potential utility, they argue that more rigorous research is needed and made a number of recommendations including that:

• scientists and practitioners move away from a broad definition of mindfulness to more explicit and specific terminology with a view to developing a consistent and accepted definition and greater uniformity in research practice
• caution is applied in making claims about the effectiveness of mindfulness given the inconclusive results and lack of clarity regarding generalisability (due largely to the difficulty in defining components of mindfulness)
• there is consideration of potential adverse events; for studies looking more broadly at medication, these include symptoms of psychosis, mania, depersonalisation, anxiety, panic, traumatic memory re-experiencing, general clinical deterioration
• consideration is given to certain disorders being excluded from mindfulness treatment as there is no research to conclude efficacy, and there is a potential risk of doing harm (i.e. psychotic disorders and those at risk for psychosis, bipolar disorder, PTSD) as indicated in broader medication research
• there be a focus on creating objective measures of mindfulness, suggesting the most promising of these may stem from the fields of neurological and behavioural science
• researchers report both the positive and negative outcomes of research studies relating to mindfulness, along with the limitations of techniques utilised.