How far can we trust meditation research?

Strategic reviews are challenging the popular perception of the beneficial effects of mindfulness

How far can we trust meditation research?
Looking for answers from meditation?

How far can we trust meditation research?

No matter how I tried to write the headline it came out as provocative. My intention wasn’t to be controversial, rather I wanted to articulate concerns that have been rumbling around the science of meditation and mindfulness for decades. At the heart of this story are two important yet unresolved issues. Firstly how does psychology and neuroscience understand meditation and what do the results of meditation research really mean?

The limited prosocial effects of meditation is a recent systematic review of research undertaken by Ute Kreplin, Miguel Farias and Inti Brazil. The study has been discussed in the meditation community at some length so I’m not going to review it here. But to summarize, the positive effects of meditation on prosocial behaviours (compassion, empathy, aggression, connectedness and prejudice) in healthy adults were only observed in compassion and empathy scores. However increases to compassion were just seen when the meditation teacher was one of the co-authors of the research paper or when the study used a ‘passive’ control group (this means the control group were on a waiting list). These findings are suggestive of flaws and possibly ‘bias’ in some of those studies  that demonstrated significant results. In an interview with Ute Kreplin published in the international Buddhist journal Tricycle, a number of broader issues have been highlighted, it’s those that I’d like to push around a little now. Leaving to one side the methodological flaws which are the main focus of the Tricycle interview, let me draw attention to the potential causes of the ongoing limitations in our attempts to evidence the effects of meditation.

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It should be stressed that the Kreplin, Farias and Brazil paper is one of a number of reviews that came to similar conclusions, that many (possibly most) of the published studies reporting significant effects in non clinical populations had methodological and/or theoretical flaws. And as Kreplin hinted, published research tends only to be the tip of the iceberg, studies that fail to show measurable changes in meditators rarely see the light of day. So the examples analyzed in strategic reviews are not the full picture of meditation research, they offer a very selective (positive) account of the scientific landscape. And yet the common perception grows that meditation is a panacea able to deliver a range of desirable outcomes to almost anyone willing to practice a method.

“At this moment in time the science generally isn’t helping us to understand the benefits of meditation…”

Stephen Gene Morris

By way of transparency I should make it clear that I’m an experienced meditator and confident of the great benefits of the practice. My interest in contemplative science comes from the perspectives of both a trained cognitive psychologist and a practicing Buddhist. From my experience of teaching traditional meditation systems, it is unrealistic to claim that a few weeks of meditation practice automatically leads to ‘significant’ change. Some practitioners do progress rapidly, embracing the transformative potential of meditation, but others fall away after only a few weeks, sometimes disillusioned and unfulfilled. This is a difficult subject to address coming from a traditional meditation perspective, because judging or criticizing the progress of another practitioner is something of a taboo. But to enhance the wider understanding of meditation this point needs to be stressed. There is no reason to assume that the meditation method alone leads to change, the method is an integral part of a firmly established theoretical framework. The effects of meditation tend to be meditated by several factors such as, individual capacity, participant motivation and qualitative differences between the teacher or teaching systems.

The contemporary scientific investigation of meditation typically takes the reductionist approach, stripping out components that might confound the results of an experiment, such as variability in the method or differences in the environment. But isolating the cause (meditation method) and the effect (empirical change in the participant) is difficult, and in complex aspects of human behaviour such as empathy or compassion it may be beyond the scope of many experiments. Consider that large numbers of the participants in meditation studies are likely to be undergraduates ‘pressed’ into research projects, obliged to participate in return for course credits. If meditation doesn’t always work for the people who choose to attend classes in the wider community why should things be any different in an experimental setting?

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The ‘expectation’ that a meditation method in itself leads to change is not supported by the human history. This idea may eventually be confirmed by science but the data gathered so far is inconclusive. We know that a number of meditation scientists are committed practitioners, so perhaps they have first hand experience of the benefits of meditation or mindfulness. Is this as Kreplin suggests, part of the problem? Could the experiential knowledge of the results of meditating introduce subconscious bias into research methodology? I’m a meditator I know about the benefits of regular practice but I can see dangers to the credibility of meditation systems if claims based on poor science are over-hyped. The lack of long term studies for secular forms of meditation should also be a serious concern.

The failure to establish robust findings in meditation research begs a further question, without reliable replicated science how does the delivery of meditation technologies continue to grow in society? If scientists are raising questions about the claims made in individual studies why isn’t this filtering down more into health care, public policy and the media? If meditation and mindfulness interventions cannot be shown to work, or deliver predictable results, confidence in meditation generally may decline. It might also lead to an erosion in the status of experimental psychology as a provider of independent and reliable data.

These few paragraphs are simply an introduction to the subject, the start of a very long road. It can be argued that the contemporary western scientific investigation of meditation began in the 1970s, since when perhaps as many as 10,000 studies have been published. But based on the findings from recent strategic reviews our scientific understanding of meditation is at a surprisingly preliminary stage.

Notes

The Kreplin, Farias and Brazil study can be found here.

Spiritual based meditation may help preserve cognitive function

Whilst intensive meditation practice may improve cognitive function, sustained daily practice may help maintain it.

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Authors: Anthony P. Zanesco, Brandon G. King, Katherine A. MacLean, Clifford D. Saron

Year: 2018

Title: Cognitive Ageing and Long-Term Maintenance of Attentional Improvements Following Meditation Training

Summary: Can meditation lead to improvements in cognitive abilities such as attention? Meditation research generally suffers from a shortage of longitudinal studies, therefore this seven-year project should be applauded. Building on their earlier work which examined the effects of a three-month meditation retreat on cognition. This investigation assessed the benefits of sustained practice in the following years. The findings appeared to demonstrate that age-related decline in reaction time was negatively correlated with the continuation of meditation practice (regular practice leading to slower decline), following the intensive three-month retreat. The research broadly concludes that the cognitive benefits achieved through periods of intensive activity may receive protection against age-related decline from regular meditation practice.

In the original retreat at least two forms of meditation were undertaken, a basic mind training and a compassion/empathy based practice, both embedded in a spiritual tradition. Inevitably it is problematic to evaluate the benefits of each of the practices or their interaction effect. As an experienced meditator I should underline that by their very nature, participants willing and able to undertake retreats of three months and sustain meditation practice over several years are probably unrepresentative of meditators generally, let alone the wider population. Limitations of ecological validity are discussed in the study. There was also insufficient information provided regarding the meditation history of participants, their levels of accomplishment, the degree of their theoretical training and information regarding secondary or special practices undertaken since the retreat.

Link: https://link.springer.com

Deepening crisis in meditation research

Is contemporary mindfulness a meditation practice or something different?

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Two leading researchers from contemplative science respond to a critical study of meditation and mindfulness research.

Authors: Richard J. Davidson and Cortland J. Dahl

Year: 2018

Title: Outstanding Challenges in Scientific Research on Mindfulness and Meditation

Summary: The article begins by applauding the critique of Van Dam et al. This is only to be expected, published meditation and mindfulness research often falls short of the methodological standards normally required of journal articles in cognitive psychology and neuroscience. The authors address the five points raised by the original paper in a very linear fashion, not appearing to engage with the underlying issues. The same issues that have dogged meditation research since the launch of MBSR. However to summarize the five rebuttals contained in the paper:

1 – The criticisms of meditation research reflect weakness in psychological research more generally.

2 – Contemplative practices are varied and scientific enquiry is only able to understand a few limited forms.

3 – Mindfulness and contemplative practices were not originally therapeutic in nature

4 – Research has failed to understand meditation in a relevant context.

5 – Mobile technology may be able to resolve some of the methodological issues.

Link: http://journals.sagepub.com

Author’s Critique: It is important to note that Davidson and Dahl are leaders in this field, but if they permit I offer some observation as an experienced meditator and trained neuroscientist and cognitive psychologist.

Psychology does not appear to understand meditation in the broadest sense, the (mis)appropriation of the term mindfulness has led contemporary meditation research into a limited field of investigation without clear definitions. For example, the reduction of meditation (or mindfulness) to method alone, existing in isolation to wider cognitive processes is hard to understand in the context of traditional meditation. And it must be acknowledged that the MBSR/MBI movement uses methods ‘congruent’ with traditional meditation.

If we strip the motivation of the meditator from the meditation rationale we change the entire cognitive setting. To use a rough analogy, I can train people to kick a football but if participant A is training just for a course credit and participant B is training to play in the World Cup final we can expect the effect of the training to be different. This doesn’t just mean that comparing traditional and contemporary meditation practices is fraught with difficulty but that the current understanding of how we research meditation needs to be refined. Traditional meditation literature spanning hundreds of years indicates that two people undertaking the same practice may not experience the same effects. Their individual motivation, their capacity to meditate, external conditions such as the availability of a reliable teacher and methods can all play a part. Psychology has the instruments to consider and account for many of the factors presumed to impact on the effect of meditation, but generally, the method alone dominates the thinking of meditation scientists.

Don’t misunderstand me, the study of MBSR and related families of mindfulness are legitimate objects of clinical enquiry and experimental study. They have however unconfirmed connections with mindfulness in its many forms as practised in spiritual traditions. Buddhism is not one unified tradition, there are different approaches to what one might call mindfulness, these extend from ‘bare attention’ through to ‘shine’ as practised in Tibetan traditions. Often shine is only engaged with after many years of stable foundational practice and if approached from the Vajrayana perspective would be embedded in a context of a nondual appreciation of human consciousness.

The ability of the meditation teacher and the degree of challenge to dualistic thinking are just two factors able to meditate the impact of a meditation method. But these and other components are generally ignored by scientific studies, even strategic reviews and meta-studies. In a traditional context, a meditation master may undertake decades of practice and study to understand meditation on theoretical and experiential levels. Therefore the capacity of the meditation teacher is an established factor in the progress of traditional meditation students but this is rarely discussed in the scientific literature. The point is that the assumption that the teaching of the meditation method is not a potential variable in any experiment is probably unscientific. The Van Dam et al. study is one of the first to suggest the role of the teacher can influence the effect of meditation training on participants.

Leaving aside traditional mindfulness methods, the reliability of the term mindfulness in relation to MBSR and other contemporary practices needs some further work. Several recent studies have highlighted a lack of consistency in the way mindfulness is understood and thus operationalised. Perhaps this is the single biggest challenge meditation research faces today. If there is a weakness in the reliability over what mindfulness is, how it is understood, applied and taught, it makes experimental replication difficult. Without methodologically sound replication the building blocks to advance meditation research can’t be put in place. This I think is the main message from the Van Dam et al. review. Consider that the scientific investigation of meditation in the west is at least 45 years old, an estimated 15,000 meditation studies have been published in that time and yet experimental work is still often described as ‘preliminary’. What is the strategy to elevate meditation research to a more reliable footing?

Compassion and palliative care

Compassionate, loving kindness and mindfulness interventions in a palliative care setting.

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Authors: Claudia Orellana-Rios, Lukas Radbruch, Martina Kern, Yesche Regel, Andreas Anton, Shane Sinclair and Stefan Schmidt

Year: 2017

Title: Mindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams: a mixed-method evaluation of an “on the job“ program

Summary: Notwithstanding the extensive body of work exploring meditation and mindfulness, there is a shortage of studies that address the potential of compassion based interventions in the workplace. A national survey of palliative care practitioners had established that for 42% of respondents, frequent patient deaths was a challenging aspect of their work. Although many people report beneficial effects from delivering compassionate care, extensive exposure to suffering can be a problem for workers. This investigation recruited participants from a palliative care centre in Bonn, Germany.  Ten weeks of training in meditation combining a number of elements including, mindfulness, loving kindness and tong-len was provided. A range of mixed measures was used to establish the benefits of the practice including, a battery of self-reporting questionnaires, semi-structured interviews and a physiological measure. In conclusion, no evidence that participants experienced an increase in compassion was observed. However, improvements were reported by participants in areas including self-care and emotional regulation. The was no significant change to the cortisol levels taken as part of the trial.

Given the complex nature of introducing compassion into this particular work environment, the mixed method approach should be commended. Where compassion, loving-kindness and mindfulness are brought together as an ‘omnibus’ approach, a degree of epistemological plurality is likely to be required to gain a full understanding of the results. Reliably evaluating the effects of one approach (such as compassion) in such a trial can be a challenge in itself. However to integrate three approaches (mindfulness, compassion and loving-kindness) into a working environment, then to understand their effect individually and collectively, is making great demands of the self-reporting instruments.

It should be noted that in a recent meta-study investigating the pro-social effects of meditation, the teaching of the meditation practice by a co-author of the research was seen to be an influential factor. The precise nature of the meditation taught in this case is unclear and may, to some extent, be related to the individual approach of the teacher. The assumption that different kinds of meditation, such as compassion (tong-len), all fit within an easily replicated framework is perhaps the result of the theoretical uncertainty withing psychology towards contemplative science. There is still a shortage of data exploring how interrelated constructs such as loving-kindness and compassion might influence behaviour in the workplace. In this regard, the study provides useful information that may help the understanding of these constructs in particular working environments.

Link: https://bmcpalliatcare.biomedcentral.com

Measuring loving kindness-compassion

To what extent can loving kindness and compassion be reliably measured?

Title: The development and validation of the Loving kindness-Compassion Scale (LCS)

Authors: Hyunju Cho, Seunghye Noh, Sunghyun Park, Seokjin Ryu, Ven Misan and Jong-Sun Lee 

Year: 2017 (online), 2018 (print)

Summary: The thorny issue of effective trait and state scales for both loving-kindness and compassion is far from resolved in psychology. In fact if anything it is less clear now than it was a decade ago. One of the problems can be attributed to attempts to merge or unify concepts with subtle differences and specific cultural weighing factors. This paper explains some of the express differences between compassion and loving-kindness from a classical perspective. And the justification for drawing them together is found in the ‘boundless state of mind’. However, it is reasonable to ask in what way can the unlimited nature of mind be evaluated using limited psychometric measures? To what extent the LCS can align two distinct concepts in one scale will emerge over time.

The three reported highlights of the paper were

  • The LCS reflects the Buddhist concept of lovingkindness-compassion.
  • The LCS consists of three-factor with fifteen items.
  • The reliability and validity of LCS were adequate within our study.

This study was based on the definitions of compassion within a branch(es) of the Theravada tradition. So it should be stated at the outset the precise meanings established as a starting point may not reflect the whole family of Buddhism. This is not to say that other Buddhist schools (Zen, Mahayana or Vajrayana) might not wholly or partially share the definitions used. Simply that the definitions may not be representative of the wider Buddhist community. It should also be noted that the measures, therefore, may not reflect the explicit, not dual and absolute compassionate approaches found elsewhere in the Buddha Dharma.

Nevertheless, this paper established fifteen items within three factors through the use of exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The results suggest that LCS was significantly correlated with self-compassion, compassionate love, social connectedness, empathy and satisfaction with life. This study used 469 university students as participants and the data supports the reliability and validity of the LCS to measure lovingkindness-compassion.

An extremely useful investigation into compassion and loving-kindness raises several important questions.

Link: https://www.sciencedirect.com/science/article/pii/S019188691730733X

Putting the Meditator at the Centre of the Research

Meditators know the most about meditation, if science ignores them they miss a trick.

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(The research is now complete, thanks to all who participated)

Do you meditate or practice mindfulness?

I am currently undertaking an academic survey into meditation and wellbeing. I would like to ask meditators over the age of 18 to complete a short anonymous questionnaire about their practice (it should take around ten minutes). The research has been ethically approved and conforms to all the usual academic norms.

This important research seeks to capture the meditation and mindfulness experience of practitioners of different levels of experience and backgrounds. Based on meditators self reported insights, this projects follows recent signposts in contemplative science putting greater emphasis on the experiential nature of mindfulness and meditation.

Regards

SGM

Is Mindfulness Buddhist and Does its Social Context Matter?

Can mindfulness be regarded as a Buddhist practice?

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Title: Is mindfulness Buddhist? (and why it matters)

Author: Robert H. Sharf

Year: 2015

Summary: Modern mindfulness meditation is often associated with the state of ‘bare attention’, paying attention in the moment, non judgementally but deliberately. This particular state is not without established precedent in different schools of Buddhism and Robert H. Sharf outlines examples from Burmese reformed Buddhism, the Chinese Chan and Tibetan Dzogchen traditions. This paper also highlights issues associated with the theoretical framework for mindfulness in Buddhism and the relationship between the transformative potential of meditation and the wider context within which meditation is undertaken.

Perspective: Religious studies, psychiatry, health psychology

Link: http://buddhiststudies.berkeley.edu/people/faculty/sharf/documents/Sharf%20Is%20Mindfulness%20Buddhist.pdf