By: Christos Ioannidis (Bugle Team)
In recent years, the clinical realm has witnessed the rise of a new type of intervention revolving around the concept of “mindfulness”. Although still very young, the field of mindfulness is growing rapidly, with expert enthusiasm over the potential of mindfulness-based therapies being discernible.However, if left unchecked, this excitement could overshadow important issues concerning such interventions. Here, I touch on the concept of mindfulness and the related therapies, before outlining some concerns that should be minded before clinical science can fully put its trust in mindfulness-based psychotherapy.
Mindfulness is not a modern concept; it stems from the Buddhist tradition and counts with more than two millennia of history. Its introduction to western clinical science began in the 1960s, yet the concept did not appear in therapeutic contexts until the late 1970s. Expectedly, the westernized conceptualisation of mindfulness differs remarkably from its oriental precursor. Despite an ongoing discord regarding the definition of the westernized construct, there is general consensus that mindfulness involves two main elements: attentional management and non-judgemental reception of experience. More specifically, the former refers to “the ability to anchor one’s attention on what is occurring, and […] intentionally switch attention from one aspect of experience to another” (Keng, Smoski & Robins, 2011,pp. 1042). The latter, in turn, involves “an attitude of curiosity, openness, and acceptance” (Keng, et al., 2011, pp.1042) towards ongoing experience.
Work on the therapeutic applications of mindfulness has advanced significantly, with numerous mindfulness-based therapies having been developed to date. Though these interventions differ considerably in their utilization of mindfulness-derived principles, their aim is common: To help the patient generate an open, non-judgmental attitude towards ongoing experiences and internal states, in hopes of alleviating psychological distress. Some interventions rely directly on mindfulness mediation training (Mindfulness-Based Stress Reduction; MBSR), while others have maintained the focus on mindfulness-derived teachings without the element of meditation (Acceptance and Commitment Therapy; ACT). Finally, some techniques have evolved through a combination of principles from extant therapies, such as cognitive behavioural therapy, with mindfulness-based doctrines (Mindfulness Based Cognitive Therapy; MBCT; Dialectical Behaviour Therapy; DBT). Though research on the effectiveness of these interventions is still limited, numerous randomized controlled trials investigating the more prominent mindfulness-based therapies mentioned above have been reported, with initial evidence being in support of their efficacy.
At first sight, one would conclude that mindfulness-based psychotherapy constitutes a promising avenue for clinical intervention. Though this attitude does not fall far from my own, a few considerations prevent me from sharing in the excitement of professionals in this field. Initially, there is considerable controversy over the definition and conceptualization of mindfulness. For example, there is widespread disagreement over whether it is a unidimensional concept, or if it comprises of various facets – the number of which also remains controversial. This issue became clear to me while working on a project involving mindfulness questionnaires at the UCL Psychometrics Laboratory. There, I learned there is no single accepted measure of mindfulness standardly used in research. In contrast, ten different measures providing alternative conceptualizations of the construct are currently available, with dissimilarities being at times striking. Moreover, current mindfulness therapies diverge phenomenally from how mindfulness is taught and practiced in the Buddhist tradition (Keng, et al., 2011). Buddhism involves a network of practices ranging from mediation to living an ethical way of life, thus constituting a lifestyle rather than an ideology. While demanding, this lifestyle is combined with contemplation over Buddha’s teachings, such as impermanence and the self, and is conceptualised as the path towards “liberation” from suffering. Consequently, it is the meaning that these practices gain which promotes their significance. In sharp contrast, relevant interventions do not involve guidance over lifestyle habits or pondering over larger questions, nor are they associated with any specific philosophy.
All of the above, I believe, illustrate the problem that mindfulness-based treatments currently lack a true theoretical identity. In essence, experts have picked out and merged techniques meant to enhance cognitive function into a therapeutic method, completely isolating them from the spiritual “habitat” which made these practices meaningful and endowed them with their properties over psychological health. As a result, it seems unlikely that western mindfulness-based treatments will have the same positive effects on well-being as seen in individuals who have mastered Buddhism. Obviously, the currently limited research on the efficacy of these interventions prevents any conclusions. I would, however, urge the reader to direct his or her attention to criteria such as life satisfaction, particularly in the depth of time, to judge the effectiveness of these therapies.
On a final note, it is perhaps my deepest worry that this lack of consideration over the concept of “mindfulness” suggests that mindfulness-based treatments are about to join a long line of mechanized, dispassionate therapies. Therapies that focus excessively on applying a manual and sticking to a fixed number of sessions, and believe change can come about by implementing techniques meant to “correct” the patient, instead of generating a meaningful therapeutic relationship with him or her. As a neuroscientist in a recent conference I attended explained, “All interventions should be relationship-based, because relationships can change the structure of the brain”, and therein lies the rub.
All of the above information and research references, unless otherwise indicated, can be found in:
Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review, 31, 1041–1056.