Since the late 70s and early 80s, mindfulness meditation has been growing in popularity, and as we have recently started to become more aware and open about mental health issues, it has become the go-to tool for “self-care”.
Mindfulness was introduced to the masses in the 1970s by Jon Kabat-Zinn, dubbed “The Master of Mindfulness” by the Guardian in 2017. According to the article, he is “not a Buddhist and remarks that to insist mindfulness meditation is Buddhist is like saying gravity is English because it was identified by Sir Isaac Newton”, however he did learn about the meditative technique from Buddhism.
In 1965, while attending MIT, he attended a talk that introduced him to the concept of mindfulness, and he claims to have been meditating ever since. As he said in an interview for Alternative Therapies in Health and Medicine:
You could get an incredible education just by going to seminars at MIT and Harvard. You hardly had to be enrolled in school; you could just attend all of these different seminars. Plus, it was a time when every swami, guru, and meditation teacher was coming to Cambridge, peddling their wares, so to speak. You could get an incredible parallel education by seeing what all of these people from other cultures had to say about the power of the mind.
It’s hard to figure out what Kabat-Zinn was doing between 1971 when he completed his PhD at MIT, and 1979 when he first set up the Stress Reduction Clinic at the University of Massachusetts Medical School and started a mindfulness-based stress reduction programme. The course lasted 8 weeks, and he continued to teach it until 2000.
Mindfulness is difficult to define, but many researchers tend to agree it includes two things: to bring your mind to the present moment, and to notice those things in the present moment, without judgement.
This is where I, personally, find mindfulness really useful – as someone with chronic health issues, it’s really easy to keep pushing your body to get stuff done even when you’re in the middle of a flare up. In fact, sometimes you don’t even notice you’re having a flare up until you’ve already overdone it; you’re so busy trying to ignore the pain that you’re in, you succeed a little too well.
For me, the thing that’s helped my health conditions best is learning about my body. Taking time to check in with what my symptoms are, what pain I’m experiencing and where I can feel things in my body. Focusing on the present moment. And sometimes if I do that, it’s easy to feel frustrated that my body isn’t doing what I’ve decided it “should” be capable of doing. So, the “without judgement” part allows me to accept that my body is doing what it does and that’s ok.
This helps me to take rest when I need it, and push myself when that’s useful. For people with chronic ill health this can be a useful tool to combine with pacing techniques (the idea that you do a little more than you want to on bad days, but a little less than you can on good days so you start to find balance rather than the boom-and-bust effect you often experience with chronic illnesses). But that’s subjective and anecdotal. It worked for me. It’s not a magic cure, but it’s part of a tool kit of things I use to help me live with my condition.
So, how about the science? There are studies looking into mindfulness, and I’m sure readers will already appreciate that these are fraught with difficulties – how on earth do you control for a meditative technique? How do we measure often subjective outcomes? How do we know if it helps?
It is very hard to study, and many of the studies are pretty weak as a result. But we should still try – and many do. There are some control tools that can be used – one option is to give both groups of participants the same guided meditation talk-through, but ask one group to listen and follow the guidance, and the other group to simply count the number of verbs in the passage. Other studies offer similar education and support that you would get on a long mindfulness programme, but without the “present moment and without judgement” part.
The studies suggest that there is some weak evidence that mindfulness meditation can be helpful for people with chronic pain and depression. One systematic review concluded:
We found low-quality evidence that mindfulness meditation is associated with a small decrease in pain compared with all types of controls in 30 RCTs. Statistically significant effects were also found for depression symptoms and quality of life.
Another systematic review said that:
These preliminary findings suggest that mindfulness meditation may be effective in treating some aspects of sleep disturbance. Further research is warranted.
There are a handful of Cochrane Reviews looking into mindfulness for specific situations such as a tool for smoking cessation, for managing wellbeing in junior doctors and medical students or for managing stress in patients living with breast cancer.
Studies from Cochrane find that the quality of the evidence is usually poor, the data is likely subject to bias, and that positive effects (if any exist) are only seen immediately after the intervention people were given, but are lost in the medium-to-long term.
They conclude either that there is no evidence of benefit, or that any benefit is small and short term.
Does that mean mindfulness is a waste of time? Not necessarily. The experiences of people with chronic ill health and the observations from their doctors are important. Some people, myself included, find some of the concepts useful as part of the wider set of tools they use to manage their health conditions. We might not have concrete evidence of benefit in specific cases, but it is plausible that it can be one of many tools to be used for patients to feel like they are gaining greater understanding of their own health. The research is also still in its infancy – it is important we do more research to understand people’s experiences with mindfulness while working out better ways to control those studies and understand the mechanisms, if there are any.
However, mindfulness is based on some very shaky ground – particularly I find there are often issues with modalities that are popularised by one person who isn’t an expert in the field in which that therapy sits and who got into it through religious interest, as with Kabat-Zinn and Buddhism. There are many who overstate the value of mindfulness, and that can play into the individualism often levelled at people with ill health: that they must take control and make themselves well again, instead of getting the medical support that they so sorely need. This can lead to treatments like mindfulness being offered as a stopgap to fill the need for medical support where that support is lacking. This can be especially frustrating for people with chronic illnesses who are told to “just try mindfulness” when they’re feeling unwell and really need proper medical support that is tailored to their individual needs.
Equally, Kabat-Zinn and many other proponents of mindfulness use it in a “stress reduction” way. This is based on the premise that stress causes or exacerbates ill health, and therefore reducing stress improves ill health. Except this premise is often stated without evidence, and the research around stress and ill health is far more complicated than this over-simplification suggests. There is neither good evidence that stress is a driving force in ill health, nor good evidence that mindfulness reduces stress.
So, should you try mindfulness? If you’re curious and you want to download a free app to give it a go, I don’t see any harm, and it might be useful for you. It’s definitely not going to cure any health issues, but it might help you feel like you have a better understanding of your own body and mind, and that can be a useful thing when struggling with ill health.
