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.

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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

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
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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?

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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