Mindfulness study retracted: Problems with MBSR/MBCT paper

Earlier this year Plos One took the step of retracting a well known and widely cited mindfulness related study.

It's getting harder to make sense of mindfulness research
Is it getting harder to make sense of mindfulness research?

This particular study is a first for the Science of Meditation blog. Whilst we have featured a number of papers that have highlighted methodological problems in meditation and mindfulness research, this is the first time that we have drawn attention to a retraction of a peer-reviewed study.

The basis for the retraction is outlined in detail on the Plos One website, but we have paraphrased the three main points.

  • The handling Academic Editor shared an affiliation with three of the authors, although this didn’t emerge until post-publication.
  • Two of the authors hold or had held positions at an institute offering mindfulness related products and services in clinical contexts.
  • The paper has a number of errors including pooling of results which led to double counting and incorrect effect estimates in figures contained in the study.

There’s not a lot more we need to add to the identified issues, they speak for themselves. However, when considered as part of the ongoing crisis in mindfulness research they make troubling reading.

A general defence used in cognitive psychology when the findings of mindfulness studies are criticised is, the peer review system is self-regulating. That when studies are found to be below the expected standard, they are usually rejected during review. Or at the very least other experts working in the field have the opportunity to raise concerns in print. This retraction challenges this basic notion. Significant issues with both the methodology and the editorial process can endure, thus, have the ability to influence the scientific and popular understanding of mindfulness. According to Google Scholar, this Gotink et al. study has been cited over 400 times, the citing publications, in turn, used by thousands more papers. The details provided on the Plos One website indicate the study has received 50,000 views.

Rather than simply criticize this study or the journal, I would like to ask what this retraction show us about the way that meditation technologies are being treated by clinical and scientific institutions?

Authors: Gotink, R. A., Chu, P., Busschbach, J. J., Benson, H., Fricchione, G. L., & Hunink, M. M.

Year: 2015

Title: Standardised mindfulness-based interventions in healthcare: an overview of systematic reviews and meta-analyses of RCTs

Summary: This is a research paper that (at the time of writing) had been retracted by PLOS ONE.

“In light of the methodological issue and concerns about the validity of the study’s results, the PLOS ONE Editors retract this article. We regret that these issues were not fully addressed prior to the article’s publication.”

An extensive explanation of the reasons behind the retraction are published on the Plos One website which can be reached by following the link below.

Link: https://journals.plos.org

Deepening crisis in meditation research

Is contemporary mindfulness a meditation practice or something different?

pexels-photo-203553.jpeg

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?

Putting the Meditator at the Centre of the Research

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

pexels-photo.jpg

(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

No Agreement over the Meaning of the Term Mindfulness

What is the authentic meaning of mindfulness?

pexels-photo-415071.jpeg

Title: What does mindfulness really mean? A canonical perspective

Author: Bhikkhu Bodhi

Year: 2011

Summary: The mindfulness movement is inextricably linked with Buddhism, both Buddhist teachings and meditation practice. It is then of particular interest when Buddhist scholars of the Pali Cannon, such as Bhikkhu Bodhi question one of the most widely used definitions of mindfulness; ‘bare attention’. This is not simply a philological debate regarding the development and use of the term mindfulness but also a discussion of the fundamental understanding of the human behaviour of meditation. There is also the question of the appropriation and ‘translation’ of the term mindfulness into secular contexts and the implications for both Buddhism and the secular meditation schools.

Perspective: Religious studies

Link: http://www.tandfonline.com/doi/full/10.1080/14639947.2011.564813?src=recsys

 

The origins of MBSR; Zen and mindfulness

Mindfulness based stress reduction (MBSR) its origins and context.

young-game-match-kids.jpg

Title: Some reflections on the origins of MBSR, skillful means, and the trouble with maps

Author: Jon Kabat-Zinn

Year: 2011

Summary: In this frank an open exposition of Jon Kabat-Zinn’s development of the Mindfulness Based Stress Reduction (MBSR) system, readers are given an insight into the background and conditions under which the MBSR concept was transposed. I use the term ‘transposed’ because that appears to be the essence of how Kabat-Zinn positions his work in the context of his experience and knowledge of Zen Buddhism. In this paper he stresses that MBSR and other systems in the mindfulness family should be integrated and consistent with the Buddhadharma (authentic teachings of Buddhism) but not constrained by the historical, cultural and religious phenomenon that exist in the societies where the Buddhadharma has been preserved and may still flourish.

Kabat-Zinn reveals his own close connection with the Zen one thousand year view and this insight perhaps gives a clue to the current academic debate whether the understanding of mindfulness as expressed in MBSR actually reflects mindfulness in Buddhism more generally. Mindfulness in its broader meaning is given a prominent role in this paper and Kabat-Zinn shares his compassionate vision regarding the benefits of the continued growth in the ‘mindfulness’ movement.

Perspective: Health psychology, religious studies,

Link: http://www.tandfonline.com/doi/abs/10.1080/14639947.2011.564844

Reliability in the Definition of Mindfulness

Definitions of mindfulness – MBSR, MBCT

pexels-photo-156151.jpeg

Title: On Some Definitions of Mindfulness

Author: Rupert Gethin

Year: 2011

Summary: Rupert Gethin cites Rhys Davids as the first person to translate the concept of mindfulness from the Pali sati or the Sanskrit smrti, although he stresses subsequent difficulties in finding a workable definition of the term. According to Gethin, Nyanaponika’s definition appears to have been particularly influential in providing an acceptable explanation, particularly within the MBSR and MBCT approaches to meditation. However he argues that the Theravāda exposition of mindfulness may include elements not immediately explicit in either MBSR or MBCT; concerns are also raised over the use and understanding of the term ‘non-judgmental’. In conclusion Gethin suggests that westernized approaches to Buddhism may have contributed to a ‘succinct’ definition of mindfulness, and that the clinical applications of MBSR and MBCT may lead to further understanding of mindfulness and the implications for its practice.

Perspective: Cognitive psychology, religious studies, contemporary Buddhism

Link: http://www.tandfonline.com/doi/full/10.1080/14639947.2011.564843

Mindfulness Practice Leads To Increases in Regional Brain Grey Matter Density

Mindfulness increases some brain matter dentsity

pexels-photo-278791.jpeg

Authors: Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W

Year: 2011

Title: Mindfulness practice leads to increases in regional brain grey matter density

Summary: An investigation into the neural mechanisms that may be impacted by the Mindfulness Based Stress Reduction (MBSR) form of mindfulness meditation.  16 participants with no prior experience of meditation were put through an eight week MSBR training programme. Any changes to grey matter concentration within the MBSR group were investigated and compared to the control group. Analyses indicated the MBSR group experienced increased grey matter in the left hippocampus, posterior cingulate cortex, the temporo-parietal junction and the cerebellum. The findings suggest a potential relationship between the practice of MBSR and changes to concentration of grey matter in parts of the brain connected to learning and memory processes, emotion regulation, self-referential processing, and perspective taking.

Perspective: Neuroscience

Link: http://www.ncbi.nlm.nih.gov/pubmed/21071182