Mindfulness and mental health: myth or medicine?

''Mindfulness means paying attention in a particular way; on purpose, in the present moment, and

nonjudgmentally." - Jon Kabat Zim

''Goddamn hippies' - Eric Cartman

What is mindfulness?

Mindfulness is a form of meditation that encourages judgment-free focus on the present moment. Practice relies on a variety of exercises based around a central theme of exploring current feelings, whether physical or emotional. The practice is said to better connect the meditator to the universe as a whole; essentially to be more at one with all things. It is said to calm anxiety, depression and reduce pain.

Exercises may include sitting or lying quietly and focussing on the sensation, sounds or feelings felt in the present. Thoughts are treated as transient entities of little importance. Bodily feelings are playfully experienced, but not seen as good nor bad. Practice may help the meditator apply this approach to day- to-day life, where the inconveniences of the hustle and bustle are no longer seen as black and white entities, but a transient change of little emotional significance. It is suggested that this thought process may help arrest thought cycles leading to mental health problems.

Meditation itself has been around for millennia and is practised in a number of groups, both religious and non-religious. Different types include mindfulness, mantra and yoga. Mindfulness has been suggested as a possible treatment for some mental health problems and adopted widely into healthcare. A wealth of studies has suggested benefits, but few of these hold up to scientific scrutiny. Let us meditate on mindfulness, and see what we feel. Orange robes are optional.

What is the evidence?

Evidence for alternative therapies is characteristically woolly. All scientific studies must stand up to scrutiny, and good science requires specific findings within a controlled environment. Results must be measureable, plausible and replicable. Usually multiple instances of results together may begin to suggest a relationship between variables. One way of evaluating the evidence for a treatment is to compare findings across a field. This is precisely what a metanalysis and systematic review did in 2014.

Goyal et al evaluated the efficacy of mindfulness meditative practices compared with placebo and current medical treatments in depression, anxiety, post-traumatic stress disorder (PTSD), pain, and addictive behaviour. Studies were only included if they fit strict criteria, so dramatic studies making overly optimistic claims on spurious evidence were quickly ruled out. Scientific light was shone on an ancient practice.

The team found that for mild to moderate depression and anxiety, as well as pain, mindfulness meditation improved outcomes significantly against a placebo (fake treatment). They also found that in these same problems, mindfulness was as effective as drugs. There was no evidence for mindfulness meditation in post-traumatic stress or addiction. They concluded that mindfulness may be a useful treatment in the conditions above, but more research was needed.

Multiple anecdotal cases and studies have suggested that mindfulness may carry risk. These reports suggest that those with PTSD are at risk of experiencing severely traumatic reactions, whilst there are isolated incidences of severe delusional states as a result of treatment. It has been suggested that this practice may 'unlock' distressing memories and may be of risk in certain patient groups.

Furthermore, there is no national standard or registry that sets a curriculum or qualification to teach mindfulness. There is likely significant variation in the quality of practitioners. Without a set standard, it is hard to judge efficacy. A simple analogy is to ask a population how good cola is, but changing the brand each time. Despite this variation, patients feel that it works. Whether this is truly working, or simply a belief that it is, it is hard to argue against the outcomes.

Conclusion

Meditation is an ancient art that has exploded in popularity. Widespread adoption into healthcare services is supported by rigorously analysed research. It is cheap, easy to practice and encourages a patient-led plan. Side effects are absent, and benefits are clear quickly. The risk of adverse reaction is anecdotal at best, and clear evidence suggests which problems are unsuitable for treatment.

The adoption of this treatment into NHS care saves money and provides a unique opportunity. However, like any treatment, it must be used wisely. It may be better to treat mindfulness as a tool, to be used in situations where necessary, rather than a one-size-fits-all cure. Further study is needed to explain how it works, but from where I'm sitting, it feels right.

Any opinions above are the author's alone. Guidance is based the best available evidence at the time of writing. Online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice. There are no conflicts of interest.
 
Ben is a young NHS doctor in the Southwest. His interests include neurology, health communication, and medical ethics. He is also an avid advocate of compassionate care and quality improvement, running a project in the Southwest around medical humanities. Please follow and support: Dr Janaway on Facebook Dr Janaway on Twitter

Sources:

1) http://www.scientificamerican.com/article/is-meditation-overrated/ (first accessed 4/7/16)

2) https://www.theguardian.com/lifeandstyle/2016/jan/23/is-mindfulness-making-us-ill (first accessed 4/7/16)

3) http://www.health.harvard.edu/blog/mindfulness-meditation-may-ease-anxiety-mental-stress-201401086967 (first accessed 4/7/16)

4) Goyal M et al (2014) 'Meditation Programs for Psychological Stress and Well-being. A systematic review and meta-analysis' JAMA Internal Med 174:3

5) http://www.wildmind.org/applied/daily-life/what-is-mindfulness (first accessed 6/7/16)

6) http://www.chopra.com/ccl/5-types-of-meditation-decoded (first accessed 6/7/16)

7) Williams, M. Penman, D (2011) 'Mindfulness; finding peace in a frantic world' Hatchett, London