Mindfulness: The Great Paradox

7th Regional Medical Humanities Seminar on the 13th of October

Stephen Gene Morris @ 7th Regional Medical Humanities Seminar on the 13th of October

Happy to have shared exciting mindfulness research at the 7th Regional Medical Humanities Seminar on the 13th of October in Maidstone. Thanks for all the great questions, feedback, and follow-up invitation.

Explored from a historical perspective, the scientific study of meditation reveals some great opportunities and significant limitations. Not least is the mindfulness paradox; despite a billion-dollar research investment, science and medicine remain divided over the reliability of mindfulness research and, thus, its clinical potential.

Evaluating the billion-dollar mindfulness experiment: promising but not proven

A new study may have discovered why, despite a huge scientific investment, mindfulness research has been problematic for decades.

Photo by Alex Azabache on Pexels.com

With the aim of bridging these two epistemologies of science and dharma, I felt impelled to point out in the early years of MBSR the obvious etymological linkage of the words medicine and meditation and articulate for medical audiences their root meanings.

Jon Kabat-Zinn1

The version of mindfulness founded by Jon Kabat-Zinn in 1979 has always been problematic to validate scientifically. Over the last forty years, scientists, clinicians and other academics have been trying to understand what mindfulness is and how it works.2 My recently published study argues that attention to Kabat-Zinn’s claims about the origins of mindfulness hold an explanation for the current research crisis.3

There is (and always has been) a paradox in the scientific understanding of mindfulness. Thousands of preliminary clinical studies claim health benefits linked to its use. At the same time, strategic scientific reviews have illustrated that many of these studies cannot be regarded as scientifically reliable. And as the research interest has grown, the mindfulness paradox has become more problematic. We may have also reached the stage where mindfulness may be considered by health and social policy as too big to fail’. Mindfulness is now a global phenomenon; there are over 30,000 published papers in academic databases. And many scientists and institutions have continued to promote the use of mindfulness despite the presence of scientific uncertainty. In financial terms, the cost of meditation and mindfulness research is estimated at over $1.6 bn. The vast majority of this investment has been made since 2012.

In financial terms, the cost of meditation and mindfulness research is estimated at over $1.6 bn. The vast majority of this investment made since 2012.

Stephen Gene Morris

Based on a three-year study of the scientific literature, I contend mindfulness can only be fully understood by looking at its origins. The paradigm established by Jon Kabat-Zinn is rooted in the medicalised meditation movement founded in 1970. And in one sense follows the trajectory of the Religion of Science, a popular philosophy in the first decade of the twentieth century. Mindfulness has been built on a belief that an ontological congruence exists between religion and science. Unpacking this claim is key to resolving the costly mindfulness paradox and charting a more scientifically reliable future.

Notes:

1. Kabat-Zinn, Jon, ‘Some Reflections on the Origins of MBSR, Skillful Means, and the Trouble with Maps’, Contemporary Buddhism, 12.1 (2011), 281–306. https://doi.org/10.1080/14639947.2011.564844

2. For an overview of the current issues, see: Van Dam, Nicholas T., Marieke K. Van Vugt, David R. Vago, Laura Schmalzl, Clifford D. Saron, Andrew Olendzki, Ted Meissner et al. “Mind the hype: A critical evaluation and prescriptive agenda for research on mindfulness and meditation.” Perspectives on psychological science 13, no. 1 (2018): 36-61. https://journals.sagepub.com/doi/abs/10.1177/1745691617709589

3. Morris, Stephen,””The Rise of Medicalised Mindfulness During the 1970s and 1980s: The Attempted Convergence of Religion and Science.” Brief Encounters 6, no. 1 (2022). http://www.briefencounters-journal.co.uk/BE/article/view/296

The mindfulness concept can be saved, but a major revision is needed

The latest study of mindfulness in schools found that it ‘does not improve mental health’ and is contraindicated for some students.

Everything might have an ‘effect’, but how do we evaluate it?

On Tuesday 12th of July, the Guardian published details of a scientific study that raised important questions about the use of mindfulness in secondary schools. This article discussed a My Resilience in Adolescence (Myriad) trial of the benefits of School-based mindfulness training (SBMT), a major research effort involving 8,376 students in the 11–13 age range across different sites. The study had robust clinical methodologies, and it’s perhaps the most reliable SBMT investigation published to date. However, the Guardian headline claimed that ‘SBMT does not improve mental health’. But the original paper offers even more challenging findings:

SBMT as delivered in this trial is not indicated as a universal intervention. Moreover, it may be contraindicated for students with existing/emerging mental health symptoms.

Clinical implications:

Universal SBMT is not recommended in this format in early adolescence. Future research should explore social−emotional learning programmes adapted to the unique needs of young people.1

This is not the first scientific study of SBMT; the Guardian describes earlier research as ‘mixed’. Taken together, the earlier and current findings for the benefits of SBMT reflect an established pattern in the science of mindfulness that is frequently ignored, a tension between tentative early-stage studies and more robust scientific evidence. Demonstrating positive preliminary effects has never been a problem in the scientific engagement with meditation. In the first twenty years of mindfulness research, spectacular claims were frequently made about the benefits of meditating, but few of those preliminary findings were confirmed by large-scale randomised controlled trials (RCTs).

Since the 1980s, scientists have warned that preliminary uncontrolled, unrandomised, unreplicated mindfulness studies must be treated cautiously. And strategic reviews of mindfulness research frequently found initial claims to be unreliable on both theoretical and methodological grounds. But these evidence-based problems have had little effect on the scientific and social policy enthusiasm for mindfulness. This binary of positive preliminary studies challenged by more scientifically reliable evidence continues to this day. And traces of it can be seen in other forms of medicalised meditation. The problem illustrated by this Myriad trial of SBMT is simply the latest example of the paradoxical nature of mindfulness, an intervention frequently more promising than proven. 

The rationales underpinning many mindfulness clinical studies have provoked concerns. One of the harshest from Nicholas Van Dam and 14 co-authors who, in 2018, claimed that methodological weaknesses and unreliable reporting of initial claims might lead mindfulness consumers to be harmed.2 As a meditator and meditation scientist, nobody wants to see the success of medicalised meditation methods more that I. But there is evidence that we are in an epistemological crisis in meditation research. A state confirmed by my current project to write a scientific history of mindfulness. However, rather than a simple description, my work has identified the causes of the crisis and, thus, the possible solutions. But given the current trajectory of mindfulness research, there is little hope of significant change until the mindfulness community confronts the systemic research problem in this field present since the 1980s.

Notes

  1. Montero-Marin, Jesus, Matthew Allwood, Susan Ball, Catherine Crane, Katherine De Wilde, Verena Hinze, Benjamin Jones et al. “School-based mindfulness training in early adolescence: what works, for whom and how in the MYRIAD trial?.” Evidence-Based Mental Health (2022).
  2. Van Dam, N.T., Van Vugt, M.K., Vago, D.R., Schmalzl, L., Saron, C.D., Olendzki, A., Meissner, T., Lazar, S.W., Kerr, C.E., Gorchov, J. and Fox, K.C., 2018. Mind the hype: A critical evaluation and prescriptive agenda for research on mindfulness and meditation. Perspectives on psychological science, 13(1), pp.36-61

Do we need more balance when reporting mindfulness research?

As mindfulness heads towards another incarnation, unresolved issues linked to its scientific reliability remain unresolved.

https://www.theguardian.com/world/2022/may/04/eu-bureaucrats-being-trained-meditate-help-fight-climate-crisis

On the 4th of May, the Guardian published an article describing the benefits of ‘applied mindfulness’ courses. However, many of the tropes observed in earlier mindfulness discussions were still prominent. Below is my reply to the Editor.

“I enjoyed the feature on EU officials learning to meditate published in The Guardian on the  4th of May. It’s hard to argue against any attempt to use the ‘potential of meditation to encourage lower-carbon lifestyles.’ But as a researcher documenting the scientific history of mindfulness, it would be remiss of me not to draw your attention to some problems with this article. So, if you permit, I’ll signpost some evidence that offers a more complete perspective of mindfulness than that normally seen in the UK media.

I’m a trained meditation neuroscientist, but my research changed direction in 2018  when I read a new scientific study called Mind the Hype.[1] Fifteen of the leading meditation scientists and clinicians reviewed the evidence supporting claims made for mindfulness. They found that: ‘Misinformation and poor methodology associated with past studies of mindfulness may lead public consumers to be harmed, misled, and disappointed.’ These claims appeared to run counter to much of the reported evidence and many of the media accounts I’d seen; I decided to take a closer look.

The published evidence (rather than the media hype) revealed that scientists such as Michael West had been warning against methodological problems in the research of medicalised meditation (of which mindfulness is part) since 1970.[2]  These warnings consistently appear in strategic reviews of meditation research. In the 1980s, Marguerite Malone and Michael Strube confirmed the presence of ‘spectacular’ claims based on limited experimental approaches.[3] The robust application of the scientific method to mindfulness experiments has continued to challenge promising but frequently unproven claims. The characterisation of criticisms of mindfulness using the trope of ‘McMindfulness’, ignores dozens, perhaps over a hundred systematic studies by credible mainstream scientists and academics.

Your article repeated claims about mindfulness-based cognitive therapy’s (MBCT) benefits. And while MBCT is based on a more reliable methodology, there are important and often undiscussed issues here. MBCT combines cognitive behavioural therapy (CBT) with mindfulness. Research has indicated that the clinical benefits of MBCT are comparable with CBT, leading critics to argue that removing mindfulness from MBCT does not alter its clinical effectiveness. As you mention, there is cross-party political support for mindfulness through the Mindfulness All-Party Parliamentary Group (MAPPG) at Westminster. Therefore, it is unfortunate that the 2015 MAPPG report failed to discuss many of the evidenced limitations in the science supporting mindfulness. Further many of the protagonists in this field appear unaware of the social policy agenda linking mindfulness to economic objectives through the concept of ‘mental capital’.

To describe mindfulness as ‘Buddhist inspired’ is problematic in my opinion. Jon Kabat-Zinn, the founder of mindfulness-based stress reduction (MBSR) described it as a ‘bridge’ between belief (Buddhism) and science, an improbable fusion of world views.[4] And while mindfulness is now a fragmented technology with over 30,000 studies in the academic databases, the scientific paradigm developed by Kabat-Zinn in the 1980s is present in much contemporary research.

I appreciate this is a complex area, and I have had the advantage of researching this field for many years. But New Scientist began to ask critical questions about the ‘hype’ behind mindfulness last year. So I’m sure many of your readers would be interested in a more balanced perspective on mindfulness research and practice.

Regards

Stephen Gene Morris”


[1] Nicholas T. Van Dam and others, ‘Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation’, Perspectives on Psychological Science, 13.1 (2018), 36–61 <https://doi.org/10.1177/1745691617709589&gt;.

[2] Michael West, ‘Meditation.’, The British Journal of Psychiatry : The Journal of Mental Science, 135.5 (1979), 457–67 <https://doi.org/10.1192/bjp.135.5.457&gt;.

[3] Marguerite D. Malone and Michael J. Strube, ‘Meta-Analysis of Non-Medical Treatments for Chronic Pain’, Pain, 34.3 (1988), 231–44 <https://doi.org/10.1016/0304-3959(88)90118-2&gt;.

[4] Jon Kabat-Zinn, ‘Some Reflections on the Origins of MBSR, Skillful Means, and the Trouble with Maps’, Contemporary Buddhism, 12.1 (2011), 281–306 <https://doi.org/10.1080/14639947.2011.564844&gt;.

Does science understand compassion meditation?

Compassion may be the most beneficial of all meditation techniques, but scientists have to work harder to understand it

Compassion meditation.
Compassion? – Photo by bin Ziegler on Pexels.com

In preparation for some upcoming blog articles, including looking at the Luberto et al. meta-review of compassion meditation research, I wanted to talk about terminology and concepts in this field.1 While science is a powerful system for measuring and predicting nature, it has problems in understanding and thus evaluating complex human behaviours such as compassion. But these challenges are made harder by imprecision and generalisations. For example, scientific reviews frequently combine or aggregate the findings from compassion, empathy, and loving-kindness studies. Cognitively speaking, these practices draw on related but different processes. Empathy, identifying with the experiences of others, is quite different from compassion, seeking to alleviate the suffering of others. If scientists compare the effects of belief-based versions of these practices, it becomes even more problematic. Even within Buddhism, the major schools have distinct ontological perspectives, which makes the operational deployment of their meditation methods quite different.

While the psychological sciences can observe almost any human behaviour, including meditation, the problems arise when attempting to understand what takes place, particularly in methods, like Buddhist meditation, developed in non-positivist environments. So while it’s relatively simple for scientists to measure the before and after effects of one form of meditation, understanding what the meditators are doing is more challenging. And aggregating the impact of different forms of compassion meditation seems likely to deliver unreliable data. These problems become even greater when empathy, metta, loving-kindness and self-compassion practices are thrown into the mix.

Understanding the concept of compassion as an object of scientific inquiry is preliminary; we don’t yet have comprehensive knowledge of trait and state compassion or how to measure them reliably. Added to this challenge, concepts of compassion are culturally embedded and can be incredibly complex to unravel. Simply moving a compassionate activity from a church or temple into a laboratory may change the psychological impact of the practice. As described in the scholarly literature, removing mindfulness from its religio-cultural contexts changed its nature.2 This doesn’t mean that medicalised mindfulness is not a useful intervention, simply that it does not reliably reflect the mental training present in the dozen or so known spiritual mindfulness practices.

Let’s look at the complexity of understanding compassion meditation in Buddhist traditions. First, we have to consider there are three main Buddhist schools or vehicles, Theravada, Mahayana and Vajrayana, each has a different world view. These particular world views lead to operational differences in how the concept of compassion is integrated into meditation methods. Furthermore, multiple schools exist within the three ‘vehicles’, each of which may have a degree of uniqueness in their compassion practices. At this stage, it’s probably better not to discuss the role of non-dual compassion as there is almost nothing replicated in the scientific literature about this element of human consciousness (although we all access it every day).

So the take-home message here is how well we define compassion will inevitably be linked to our ability to harness meditation practices’ health and well-being benefits.

Notes:

  1. Luberto, Christina M., Nina Shinday, Rhayun Song, Lisa L. Philpotts, Elyse R. Park, Gregory L. Fricchione, and Gloria Y. Yeh. “A systematic review and meta-analysis of the effects of meditation on empathy, compassion, and prosocial behaviors.” Mindfulness 9, no. 3 (2018): 708-724.
  2. King, Richard. “‘Paying attention’in a digital economy: reflections on the role of analysis and judgement within contemporary discourses of mindfulness and comparisons with classical Buddhist accounts of sati.” In Handbook of Mindfulness, pp. 27-45. Springer, Cham, 2016.

Can Mindfulness Meditation Boost Immunity

There are many preliminary scientific studies that indicate meditation improves self-reported measures of disease symptomatology. But what do we know about the link between mindfulness and inflammation?

Does Mindfulness Meditation Boost Immunity
Mindfulness and immunity. (Photo by Anna Shvets on Pexels.com)

Authors: Black, D.S. and Slavich, G.M

Year: 2016

Title: Mindfulness meditation and the immune system: a systematic review of randomized controlled trials.1

Summary: The role of inflammation in health and wellbeing is becoming increasingly important in our understanding of illness and perhaps more important to establish greater resilience to ill health. For example, we now know that an unhealthy gut can lead to inflammation in many different organs. It’s not that inflammation should be seen as the problem per se; it is a function of the immune system, our body’s essential response to harmful stimuli. However, too much or too little inflammation can lead to major and minor health problems. Therefore if meditation can regulate excessive inflammation and its causes before they can damage the body, it will improve health and wellbeing.

Mindfulness meditation and immune system biomarkers. This systematic review of 20 randomized controlled trials, comprising more than 1600 participants, revealed replicated, yet tentative, evidence that mindfulness mediation is associated with changes in select immune system processes involved in inflammation, immunity, and biological aging.1

This scientific review was a meta-study; the authors looked across several different published papers to establish the overall state of research in this field. When analyzed together, these individual papers indicated that: ‘mindfulness meditation modulates some select immune parameters in a manner that suggests a more salutogenic immune profile.’ Simply that practising mindfulness can reduce pro-inflammatory reactions and an increase in the biological mechanisms linked to cell ageing. The study’s authors stress that despite the scope of the paper, the reviewed literature contained some methodological limitations, so the findings of individual studies and the meta-review should be treated with caution. 

What does this study mean for meditation and mindfulness practitioners?

Since the development of medicalised meditation (the relocation of belief based practices into medico-scientific domains) in 1970, the science of meditation has had an increasing tendency to pragmatism rather than empiricism. This means that the effects of meditation and not underlying causal mechanisms tend to be the object of most research projects. This paper represents a movement towards a more rigorous positivist approach, but no definite conclusions were established. My personal view is that the evidence supports much of what we already know about regular meditation practices; it can improve overall health and wellbeing. This paper was published in 2016 but it remains one of the few reviews of the relationship between mindfulness and the immune system.    

Notes:

  1. Black, D.S. and Slavich, G.M., 2016. Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Annals of the New York Academy of Sciences, 1373(1).

Link: www.ncbi.nlm.nih.gov

The crisis in mindfulness research: have we been asking the wrong questions?

A review of mindfulness research in New Scientist highlighted long standing scientific problems; is it time for a new approach?

The crisis in mindfulness research: have we been asking the wrong questions?

How does science understand meditation
xvideTheo.com

Writing in New Scientist on June 5th Jo Marchant summarised the state of mindfulness research and practice. The investigation added some much-needed balance to the overview of medicalised mindfulness. The article confirmed the enduring presence of uncertainties in theoretical understandings and systemic methodological weaknesses. A discussion of the potentially harmful effects of meditation was especially welcome; most experienced meditation teachers know that practices can lead to beneficial or detrimental outcomes in practitioners.

However, the absence of greater historical insights left us with a snapshot rather than an overview of the current state of our scientific knowledge. For example, scientists have been criticising meditation experiments since the 1970s, but the weaknesses identified over 40 years ago can still be seen in contemporary research. The scientific study of meditation can be traced back at least 80 years; the first decades were relatively free of scientific uncertainty. By identifying the beginning of hesitancy in meditation research, we can better understand the current crisis in the science of mindfulness. Since 1975, an estimated 7,000 scientific papers investigating meditation have been published. The vast majority of this work has focussed on mindfulness, so should we be worried that we still don’t have a reliable scientific definition of it?

The evidence suggests that we (meditation scientists) have been trying to establish mindfulness’s psychological and clinical potential ahead of a stable understanding of what it is. We know from several strategic reviews that multiple ways of understanding mindfulness exist in the scientific literature. While each mindfulness experiment can offer us some new insights, findings are rarely confirmed through replication? When taking the long view of meditation research, medicalised mindfulness manifests within visible patterns of scientific progress. In its origins, medicalised meditation reflects a confluence between positivist and belief based knowledge systems. The current theoretical uncertainty in mindfulness research can be traced back to this convergence. If mindfulness has been developed as a bridge between spiritual and scientific understandings, do we have adequate ways of making sense of meditation as a human experience? The lack of stable definitions and replication suggests there are still significant gaps in our knowledge. The most pressing unanswered questions remain the most important, what is medicalised mindfulness, and how can we understand it?

Can meditation slow cognitive decline?

Might mindfulness meditation be used to slow brain ageing by regulating connectivity between brain networks?

The relationship between brain networks can be enhanced with meditation

As we get older, we experience an inevitable decline in physical and mental functions. However, the rate of this reduction is dependent on several factors, both genetic and environmental.  It has long been contended that there is a relationship between how we use our brains and mental capacity loss. Mind-training, particularly in the form of meditation, has the potential to mediate how we age. There is a great deal of anecdotal evidence that long term meditators retain good mental function throughout their lives; I have even researched the possible link between meditation and resilience to neurodegeneration (dementia). However, progress in this area is limited by two main problems; poor understanding of the mental processes underpinning meditation and the presence of confounding variables.

Despite over eighty years of meditation research, we know relatively little about how long term meditation changes our brain. This problem is compounded because most long-term meditators are found in spiritual traditions; their lifestyles tend to be atypical. For example, committed Buddhists generally eat healthier diets, take less alcohol and are less likely to be found in stressful occupations than the general population; all factors likely to influence health. Despite these problems, some preliminary research suggests that meditation might slow ‘mental ageing’ (age-related mental decline).

One of the more convincing hypotheses is that meditation plays a role in regulating the brain’s intrinsic and extrinsic networks (I-ENs). The scientific understanding of the I-ENs is still pretty basic. But neuroscience has illustrated that two main brain networks are responsible for our internal perspectives (intrinsic) and external task-based capacities (extrinsic). These are overarching structures connected to anatomically separate parts of the brain. The default mode network (DMN) is a significant component of the intrinsic network. It includes all of those ‘default’ functions that are more active when we’re not undertaking demanding tasks, for example, daydreaming about the past or thinking about our values. The extrinsic network encompasses the task-positive network (TPN). As the name implies, it includes task-oriented and performance systems that allow us to coordinate and carry out attention-demanding activities. But the point I want to make here is that these networks are negatively correlated. Significant activity in the intrinsic network may lead to less activity in the extrinsic, and vice versa. Thus these networks are heavily interdependent; what happens in one is linked to the other.

We can be reasonably confident that abnormally low levels of activity in either the intrinsic or the extrinsic networks leads to problems with our mental functioning and mental health. Meditation research often focuses on attenuating or augmenting function or structure in one of these networks, but typically fails to take into account any relational effect in the other network. For example, meditation and mindfulness experiments have illustrated improvement in cognitive tasks linked to meditation practice. But the increased TPN functionality may also be reducing activity in the DFN; unfortunately, this is an underresearched area.

“While more clinical and basic research is needed to establish the modulation of the DMN and TPN through meditation, and to understand the impact of modulation on ageing and mental disease, the data indicate that meditation may influence different cognitive processes, thus increasing attentional focus and cognitive flexibility.”

Ricardo Ramírez-Barrantes et al.1

Ricardo Ramírez-Barrantes and colleagues published a paper in 2019 that drew attention to the relationship between mental training and meta-awareness.1 Meta-awareness, also known as metaconsciousness or metacognitive awareness, can mediate activity across the I-ENs. That by using meditation to integrate functions in these networks, the rate of cognitive decline in middle and old age might be reduced.

Because of the limitations in meditation and mindfulness research, claims about the regulation of I-ENs through mind-training are still speculative. However, there is a good deal of data,  some presented in this paper, that suggests meditation may have an essential role in maintaining brain function and structure through the lifecycle.

Notes

1 Ramírez-Barrantes, R., Arancibia, M., Stojanova, J., Aspé-Sánchez, M., Córdova, C., & Henríquez-Ch, R. A. (2019). Default mode network, meditation, and age-associated brain changes: what can we learn from the impact of mental training on well-being as a psychotherapeutic approach?. Neural plasticity.

Meditation, poverty and mental health; psychology and nonduality

We know that poverty can make poor mental health more likely. But therapeutic interventions rarely consider the root causes of mental illness. Could nondual treatments be a solution?

Poverty is a factor in poor mental health

The BPS’s project to support people move from poverty to flourishing has highlighted several important issues; among the most challenging is the notion that mental health is not a ‘DIY project’.1 The challenge arises because, in psychology, there are technical and conceptual barriers to considering social factors such as community and institutional engagement in clinical intervention. However, the social networks that mediate mental wellbeing are becoming even more critical in the COVID and post-COVID worlds.2 Positive social interaction is foundational to health and wellbeing, but many clinical interventions fail to integrate biopsychosocial models into diagnosis and treatment. And the reductive nature of experimental psychology places barriers to considering the individual and the social concurrently. Understanding the personal cost of poverty requires a wide lens; mental suffering doesn’t exist in isolation to family, community or institutions.3 Integrating and tackling mental health’s inner and outer determinants is central to countering the psychological damage caused by enduring poverty. This article will discuss how compassion mind training (meditation) can address mental suffering while encouraging supportive social networks. I’m also going to argue that to access the full potential of compassion mind training, new psychological approaches to meditation are required.

Although there are challenges to defining compassion, the wish and/or the action to alleviate suffering is an acceptable description for many working in the field. Therefore, it is not controversial to argue that a more compassionate society would reduce suffering. There is also evidence that more compassionate individuals suffer less. Although an oversimplification, it’s worth pausing on the notion that compassion interventions can support individual psychological wellbeing and the social factors able to mediate mental health. The consideration of clinical interventions linked to broader social settings is unusual for many psychologists, certainly those working in experimental settings. But understanding how poverty affects a person within their environment is a priority. Without attention to the root causes of mental suffering, psychological interventions will only have a modest impact. I’m not talking about social policy here (in any direct sense); instead, I’m suggesting that more attention needs to be given to curative approaches that address both the internal (mental) and external (social) causes of suffering. Over the last two decades, the growth in compassion research has emerged from the project to medicalise spiritual meditation. But few of the 7,000 meditation studies published over the previous eight decades address the biopsychosocial potential of meditation. Ironically, this holistic and now neglected aspect of traditional meditation was critical to the initial academic and scientific interest.

The reasons for reluctance to consider social factors, alongside mental health treatment, are typically linked to preserving the integrity of the experimental method. Controlling potential confounding variables has always been a central goal of experimental psychology. But compassion mind training highlights that mental states are influenced by cognitive processes based on our inner and outer worlds. Medicalised meditation is one area of research and practice where therapy considers both the psychological and the social. Over the last twenty years, compassion mind training has been shown to improve, physical and mental health as well as social relationships. In their 2017 meta-review of published compassion studies, James Kirby, Cassandra Tellegen and Stanley Steindl concluded that compassion interventions held ‘promising’ potential to reduce suffering from depression, anxiety, and psychological distress.4 Two of the leading advocates for the use of compassion training are Paul Gilbert and James Doty. Paul Gilbert OBE is the founder of Compassionate Mind Training (CMT) and  Compassion Focussed Therapy (CFT), Dr Doty has been the driving force behind Stanford’s Center for Compassion and Altruism Research and Education (CCARE). Between them, Doty and Gilbert have highlighted how compassion mind training can support individual and collective mental health. Gilbert’s 2019 exploration into the nature and function of compassion sets out current research and practice.5 Particularly relevant here is the notion of compassion as a ‘social mentality’. In this context, social mentality refers to the creation of relationships. Although this concept falls far short of the use of compassion in spiritual meditation, it signposts new opportunities for scientific understanding.

A multi-directional view of compassion allows a relationship of mutual support between the psychologist and the patient to develop. In this scenario, peers come together to solve problems; hierarchical limitations are less pronounced. Gilbert uses the primary caregiver-child relationship as an example of this reciprocity, but this illustration is most useful as a heuristic to think about compassion in new ways. Rather than the passive recipient of therapy, the patient also becomes a catalyst for compassionate thoughts towards others. Mind training in compassion can be, as Gilbert describes, a dynamic process between patient and clinician, but it is not necessarily limited to that. Compassion can support the mental health of the patient while also developing their compassionate insights towards society more generally, and thus stimulating increased social engagement. The research agenda of CCARE includes investigation of ‘methods for cultivating compassion and promoting altruism within individuals and society-wide’.6 These are the nondual insights that highlight the potential of mind training to support mutually dependent relationships between community and self.

Despite pioneers such as Gilbert and Doty, compassion research appears to be developing the same limitations as other forms of medicalised meditation. Construct validity is still uncertain, and reliable psychometric instruments are a work in progress. And if you follow the literature, you will find frequent overlaps between compassion and concepts such as empathy, altruism and loving-kindness. Attempts to reduce the idea of compassion by establishing the binary constructs of self-compassion and other-compassion have also run into difficulty; in 2017 Christian Kandler and his colleagues demonstrated that self-compassion is a facet of neuroticism.7 From a historical perspective, several common problems are visible in the relocation of meditation to psychology. For example, similar methodological and theoretical limitations exist in the research of mindfulness, compassion and related pro-social behaviours.8 While it might be premature to suggest the scientific study of meditation in its current form (and therefore compassion mind training) has reached an impasse; clearly, there are obstacles to making further progress. The scientific study of meditation technologies is rich with intersections between traditional spiritual practice and psychology. For example, Doty and Gilbert both draw heavily on Tibetan Buddhist influences in their work. But while psychology can safely observe the effects of traditional meditation from a scientific perspective, integrating practices from spiritual traditions with psychology is a risky undertaking. Risky on several levels, but primarily because of the conflict between the world views of Western science and Eastern knowledge systems.

The migration of traditional meditation from the temple to the laboratory followed a long and complicated path. Many of the problems and opportunities for meditation-based mind training come into sharper focus when we consider meditation’s scientific history. From the early engagements, western scholars and scientists have been working on two broad trajectories to medicalise Eastern mind training methods. The paths of integration and appropriation. The integration path can be traced back through the medical counter-culture, Zen psychotherapy and Buddhist reform movements of the late 19th century. Experimental work with electroencephalographic (EEG) technologies from the 1930s laid the foundations of the path of appropriation. The rise of scientist-practitioners since the 1970s, people such as Robert Wallace and Jon Kabat-Zinn, accelerated spiritual and psychological convergence. In both interconnected strands, foundational cognitive elements of traditional meditation, such as ethical judgement and compassion, were uncoupled from modern medicalised methods. These ‘human’ factors give spiritual meditation holistic curative potential through the interconnectivity between self and others. Richard King and Steven Stanley are just two of the academics that highlight the loss of these elements during meditation’s relocation. In scientific investigations of mind training’s operational features, I have found no comparative studies that evaluate traditional meditation methods with reference to their ontological frameworks. This inevitably means that we have uncoupled compassionate mind training practices, by accident or design, from their original conceptual contexts. This same point applies to mindfulness meditation.

There is no question of normativity here or comparative judgement of the psychological methods over spiritual practices (or vice-versa). The issue under discussion is, how can compassion mind training be best used to support people from poverty to flourishing? Despite a lack of replication, the cumulative evidence for the benefits of compassion methods is significant. However, in common with mindfulness, compassion meditation remains a ‘promising’ rather than an effective mental health intervention. We should not underestimate the impressive progress made in this field, particularly since the 1970s. But the challenges presented by increasing levels of poverty require more reliable and flexible meditation-based interventions. In order to harness the full potential of compassion mind training, two questions need to be addressed; what happens to traditional meditation methods translated to psychological interventions, and what is lost or gained in the process?

Even a preliminary investigation of Buddhist (Mahayana) ‘science and philosophy’ reveals foundational concepts underpinning meditation methods such as ‘relative compassion’, ‘nonduality’ and ’emptiness’. But acknowledgement of these elements in traditional meditation is almost totally absent from the psychological literature. It is problematic to relocate human technologies to new knowledge systems without understanding the original cognitive components. This is an approach that risks creating interpretive forms that lack essential elements. The uncoupling of meditation from its full potential during the migratory process probably explains the perennial ‘promising’ tag that has followed the clinical use of meditation for fifty years. New translated forms of mind training could develop into effective Westernised psychological interventions in their own right. But taking the historical perspective, I’d ask how long will it take and how useful will they be? The pressing challenge of tackling the suffering linked to poverty requires new approaches to develop our current knowledge.

Perhaps the most significant limitation in the project to medicalise meditation is the failure to find a common language for psychology to engage with the traditional forms of meditation. There is a need for a lingua franca, a conceptual rosetta stone that will allow psychologists to access the curative potential of compassion long observed in Buddhist meditation. Doty, Gilbert and others frequently hint at this potential but generally retreat into positivist terminology to investigate and describe it. The role of meditation in supporting mental health and social networks remains largely theoretical or anecdotal to psychology. The shortfall between what medicalised meditation is and what it could become appears to be brought about by inflexible approaches to non-Western knowledge systems; a tendency to translate human technologies ahead of the full documentation of psychological benefits. The scientific history of meditation indicates that psychology requires more sophisticated ways of understanding the world if it wishes to unlock mind training’s full potential. While positivism is a powerful investigative tool, its current form appears unable to penetrate aspects of traditional (non-positivist/nondual) knowledge systems. Given the growing role of meditation technologies in society, the creation of a new discipline to access traditional knowledge is long overdue. The development of nondual psychology would create an approach able to consider the curative potential of traditional compassion meditation (and its operational cognitive components) free of the distortions of cultural and ontological translation.

Notes


1 ‘From Poverty to Flourishing: Towards 2021 | The Psychologist’ https://thepsychologist.bps.org.uk/volume-33/october-2020/poverty-flourishing-towards-2021.

2 Ichiro Kawachi and Lisa F Berkman, Social Ties and Mental Health, Journal of Urban Health: Bulletin of the New York Academy of Medicine, 2001, lxxviii.

3 ‘WHO | Social Determinants of Mental Health’, WHO, 2019 http://www.who.int/mental_health/publications/gulbenkian_paper_social_determinants_of_mental_health/en/ [accessed 4 January 2021].

4 James N Kirby, Cassandra L Tellegen, and Stanley R Steindl, A Meta-Analysis of Compassion-Based Interventions: Current State of Knowledge and Future Directions, 2017 <www.elsevier.com/locate/bt>.

5 Paul Gilbert, ‘Explorations into the Nature and Function of Compassion’, Current Opinion in Psychology (Elsevier B.V., 2019), 108–14 https://doi.org/10.1016/j.copsyc.2018.12.002.

6 Mission & Vision – The Center for Compassion and Altruism Research and Education’ http://ccare.stanford.edu/about/mission-vision [accessed 4 January 2021].

7 Christian Kandler and others, ‘Old Wine in New Bottles? The Case of Self–Compassion and Neuroticism’, European Journal of Personality, 31.2 (2017), 160–69 https://doi.org/10.1002/per.2097.

[8] Nicholas T. Van Dam and others, ‘Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation’, Perspectives on Psychological Science, 13.1 (2018), 36–61 https://doi.org/10.1177/1745691617709589.

What does the replication crisis mean for the science of meditation and mindfulness?

The scientific study of meditation has been limited by a replication crisis and a mindfulness crisis. What does this mean and what is the way forward for contemplative science?

Replication, an important element of the scientific method

For at least the last 20 years psychological science has been facing a replication crisis.1 For those who don’t know, the replication crisis reflects a deep-seated problem in how psychology carries out scientific investigations. In essence, it means that many psychological studies from the past may not be as reliable as we thought they were. This uncertainty has implications for the way psychology is conducted, and it may accelerate the declining public confidence in science more generally.

The replication crisis is visible in social sciences and medicine, but not all disciplines have been affected to the same extent. Although social psychology is regarded as having the most significant replication problem, the phenomenon is present in other areas such as the science of meditation. For an experimental study to be scientifically reliable, it generally has to be repeated, repeated by other scientists in alternative locations. If the results are the same, or at least very similar on each of these occasions, the scientific findings are much more likely to be reliable. However, if scientific claims cannot be replicated, it raises questions about how they were initially established, and the extent to which they can be generalised across populations. So if one scientific study found that regular meditation reduced the effects of hay fever, we’d expect to see the same results in other studies carried out in the same way. If not it could mean that there was an unusual characteristic in the first study or some problem in the method. It is for these reasons meditation scientists, teachers and practitioners are reevaluating what they know about the health benefits of meditation.

A failure to replicate doesn’t necessarily prove that scientific findings in the original study were not reliable, but it raises questions over the extent to which the claims are robust. So any isolated evidence for the health and wellbeing benefits of meditation has to be seen as a pilot study, preliminary in nature. In most cases, without replication, we cannot assume that findings from any individual study could apply to the general population.

For those of us working with meditation, the replication crisis is compounded because we are also facing a ‘mindfulness crisis’. The mindfulness crisis describes systemic problems in meditation research that go back 50 years. At least half a dozen studies published since 2015 have identified and described the meditation and mindfulness research crisis. Its main characteristics are conflicting theoretical understandings of meditation and methodological limitations which include low levels of replication. Although many, perhaps most scientific studies of meditation have been impacted by problems linked to the replication and mindfulness crises. The scientific enthusiasm for meditation technologies since the 1970s has been so great that one-off unreplicated claims for the benefits of meditation have not always been critically evaluated by the scientific community. As Van Dam and colleagues have demonstrated, this has led to the ‘hyping’ of preliminary evidence as robust scientific findings.2

Measures are being taken to address the replication crisis within psychology more generally. These initiatives have had a limited effect so far, and their impact will have to be evaluated over the longer term. To overcome the problems being experienced in Contemplative Science, there are three issues that need to be considered by the scientific and practice communities. Firstly the development of a system where unreplicated, preliminary findings are not treated in the same way as robust, replicated work. Secondly, address the pressing need to understand and resolve the known theoretical and methodological limitations. And finally, to review the procession of the scientific understanding of meditation since the 1930s to make sense of the current crisis and diagnose its underlying causes.

Notes

1 Maxwell, S. E., Lau, M. Y., & Howard, G. S. (2015). Is psychology suffering from a replication crisis? What does “failure to replicate” really mean?. American Psychologist, 70(6), 487.

2 Van Dam, N. T., van Vugt, M. K., Vago, D. R., Schmalzl, L., Saron, C. D., Olendzki, A., … & Meyer, D. E. (2018). Mind the hype: A critical evaluation and prescriptive agenda for research on mindfulness and meditation. Perspectives on psychological science, 13(1), 36-61.

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