This piece was written by one of our contributors; graduate of an MSc in Health Psychology – Joe O’Brien.
We’ve all read the headlines that grab our attention regarding the positive success of mindfulness, with smartphone apps becoming wildly more popular – for example in 2018 Headspace surpassed a whopping 1 million subscribers. We’ve also seen popular public figures endorsing mindfulness and meditation include the likes of Oprah Winfrey and Bill Gates. Even the use of the term mindfulness has almost quadrupled in the last thirty years, according to Google’s Ngram viewer. It’s pretty evident that mindfulness is gaining some serious popularity!
But what’s all the hype about and is it just another fad?
So far, the research supporting mindfulness for promoting mental health has been promising. In terms of managing stress specifically, mindfulness practice seems to have a positive impact[1]. However, it is difficult to address what exactly “mindfulness” is, as there are multiple strands of mindfulness in the research and many research papers interchangeably use mindfulness and meditation, which makes it difficult.
What seems to be the most comprehensive in terms of the evidence base for stress management is MBSR (Mindfulness Based Stress Reduction). This is a specific 8-week programme that has been shown to be effective for stress reduction, but also have lesser effects on anxiety and depression symptoms[2]. Despite what seems like largely positive reviews no matter where you look, there are some people that don’t gain any benefit from it. In fact, some people may have difficult or negative thoughts that arise during mindfulness practice.
It’s important to realise that the research supporting the efficacy of mindfulness generally promote skills that contribute to positive mental health, and not so much as a sole solution or replacement for traditional treatment for mental health issues – rather an extra tool. Judging by the headlines of “Mindfulness requires your brain” you would be forgiven for assuming it is all powerful, however the evidence behind the rewired brain concept is even more blurry.
Firstly, there is an issue with publication bias in the research, meaning that studies with significant findings may be more likely to be published. Secondly, there is also an issue with the quality of the research. There are many studies which show differences in brain structure between meditators and non-meditators, however much of that data is cross-sectional meaning they don’t measure the changes of beginner meditators over time[3]. This means that a lot of the data is correlational, not causational. The reason it’s hard to assume causality is down to a few things.
The quality of the research, for many reasons, is quite poor, but because we haven’t got good research tracking brain changes over time we don’t know that people who practice mindfulness may be more likely to engage in other health promoting behaviours which might explain the differences in the structure of the brain. Of the data that is longitudinal, there are some suggestions that mindfulness could change areas of the brain. While not concrete- it’s certainly promising [4].
With that being said, the cross-sectional data is quite impressive. For example, one meta-analysis found differences in up to eight brain regions in expert meditators compared to naïve meditator, including brain regions related to self-awareness and emotional regulation, which would be considered important factors for promoting mental health. As well as that, areas associated with memory and communication were also associated with meditators. The fact that these findings seem to be consistent is encouraging for the area, however the researchers themselves state that “Evidence for meditation practice as the causative factor in structural brain change remains tenuous”[5]. This doesn’t mean mindfulness doesn’t work, it almost certainly has some really positive benefits – it just means we can’t say for certain that mindfulness practice definitely causes these brain changes.
I think it’s fair to say, based on the evidence and regardless of structural brain changes, there are certainly benefits from practicing mindfulness in terms of stress management and mood. What the research has found is that mindfulness can be helpful in promoting mental health in both clinical and non-clinical populations, so I’ll answer the question you’re all wondering.
Do the mindfulness apps work?
In a 2016 publication of online guided mindfulness interventions, the researchers found that practicing mindfulness through online interventions was successful [6] and that mindfulness-based interventions had a medium effect on stress, and had a small effect on scores of depression, anxiety and wellbeing. Despite these results being quite substantial, the researchers admittedly were analysing poor quality research, so until more concrete, good quality research is imposed it’s hard to say for sure how effective these interventions are, but there is certainly promise behind them.
To conclude on what is a messy area, what the evidence suggests is that mindfulness certainly can contribute to promoting positive mental health. As of yet, we don’t know to what extent, or whether they’re a viable adjunctive treatment for mental health issues.
I think it’s important to note from a clinical responsibility perspective, that mindfulness should not be thought of as a replacement for traditional mental health treatment or clinical contact with a professional. However, it might be useful as an extra tool. As my own manager pointed out, “You wouldn’t ask a surgeon to complete all his surgeries with a scalpel. They would need more tools.” Mindfulness is a good tool, but it is one of a number of tools that are necessary to promote positive mental health.
“Nature never rushes, but everything is on time”
References
(1) Khoury B, Sharma M, Rush SE, Fournier C. Mindfulness-based stress reduction for healthy individuals: A meta-analysis. J Psychosom Res. 2015 Jun;78(6):519–28.
(2) Baer RA. Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review. Clinical Psychology: Science and Practice. 2006 May 11;10(2):125–43.
(3) Tang Y-Y, Hölzel BK, Posner MI. The neuroscience of mindfulness meditation. Nature Reviews Neuroscience. 2015 Apr;16(4):213–25.
(4) Hölzel BK, Carmody J, Vangel M, Congleton C, Yerramsetti SM, Gard T, et al. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Res. 2011 Jan 30;191(1):36–43.
(5) Fox KCR, Nijeboer S, Dixon ML, Floman JL, Ellamil M, Rumak SP, et al. Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners. Neuroscience & Biobehavioral Reviews. 2014 Jun 1;43:48–73.
(6) Spijkerman MPJ, Pots WTM, Bohlmeijer ET. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review. 2016 Apr 1;45:102–14.
