While proselytizers talk up “the science of mindfulness,” it barely exists in the form they imply. Their public presentations have more to do with rhetoric than scientific rigor, subordinating proof to what sounds “science-y.” Like the “truthiness” of Stephen Colbert, who satirized “alternative facts” long before the Trump era, what matters is not what’s true but how things feel, and mindfulness feels very “science-y.”
Mind the Hype
The entangling of scientists and advocates generates hype. One example of the risks when the two coexist in a single head is a study of mindfulness-based interventions by Bassam Khoury at McGill University. Khoury practices mindfulness and is an avid proponent — he calls himself a “mindful psychologist” and promotes his own workbook of mindfulness exercises. In his meta-analytic review (a statistical approach that combines results from numerous studies), Khoury and his colleagues concluded that mindfulness-based therapy “is an effective treatment for a variety of psychological problems, and is especially effective for reducing anxiety, depression, and stress.”7
However, an independent review of Khoury’s study by researchers at the University of York — under the auspices of the Centre for Reviews and Dissemination — was less convinced. “The authors’ conclusions may be overstated given the poor quality and wide variation between studies,” it found.“ Quality was generally low for controlled studies; it was better for before-and-after studies, but this design is open to several sources of bias. Many studies were uncontrolled, which prevents definitive conclusions.”8
There is convincing evidence that mindfulness studies suffer from positive reporting bias, suggesting therapies are more effective than they really are. Stephanie Coronado-Montoya and her team in the Department of Psychiatry at McGill University recently found that authors of mindfulness studies tended to downplay negative findings. Given the small sample size and weak statistical power of the pool of mindfulness studies examined, McGill researchers were concerned by the skewed results.9
The late Catherine Kerr, who trained at Harvard Medical School and was Director of the Contemplative Neuro-science program at Brown, feared the tendency to overstate mindfulness research could backfire. “If this wave of hype continues,” Kerr warned, “the backlash will be too strong.” Her concern was simple: if findings don’t pan out, “people will lose faith and revert to the other side: mindfulness has no value.”10
We are now witnessing what Joel Best describes in Flavor of the Month: Why Smart People Fall for Fads. Best calls this problem “the illusion of diffusion,” a mistaken belief that the extent of enthusiasm for mindfulness is evidence of its effectiveness and durability.11 In many respects, branding mindfulness with scientific jargon is not all that dissimilar to the way a new fitness craze or low-fat diet is promoted. Boosters of exercise and dieting are notorious for cherry-picking studies and appealing to the authority of science to bolster their claims that we can shed extra pounds and improve our lives in just a few weeks. Very few of these miracle solutions are anything more than short-lived fads.
The mindfulness movement enjoys much greater credibility, yet this rests in part on the sheer momentum of its methods. Self-congratulatory studies, media hype, books and courses all feed off each other. The main problem of skewed research stems from the academic mindfulness industry, in which millions of dollars of grant money are at stake. Research support is most readily available for “evidence-based” studies that work with randomized-controlled trials (RCTs) — in theory, the gold standard of science.
However, the problems with studies on mindfulness are not new. Before they started to receive grant funding in the last decade, there was a similar enthusiasm from government funding agencies for Transcendental Meditation (TM). Between 1992 and 2010, the US National Institutes of Health (NIH) awarded nearly $23 million to Maharishi University, the site for the majority of research on TM. However, by 2010 TM had fallen out of favor, and has since received no grant money. As former TM insider Aryeh Siegel points out in his book Transcendental Deception, TM’s fall from grace in the research world could be traced to such factors as “poorly designed studies that rarely include a randomized active control group,” “a history of exaggerated findings,” and biased researchers who were themselves TM practitioners.12
It is worth noting that TM’s efficacy was also explained in biomedical terms, like MBSR’s. Early support came from Herbert Benson, professor of Mind/Body Medicine at Harvard Medical School, and author of the best-selling book The Relaxation Response.13 As Benson described it: “The Relaxation Response is a universal human capacity, and even though it has been evoked in the religions of both East and West for most of recorded history, you don’t have to engage in any rites or esoteric practices to bring it forth.”14
His method dispensed with TM’s secret mantras, initiations, attempts at levitation, and Hindu influences. People repeated a simple word, phrase, or activity to keep the mind from wandering, along with maintaining a passive and receptive attitude.
Like Kabat-Zinn, Benson used universalizing discourse to distance his work from religious traditions, while making science the means of validation and legitimation. Jeff Wilson argues in Mindful America that this jettisoning of religious elements accounts for the popularity of MBSR and its acceptance in medicine, while the demise of TM is due in part to racism. As Wilson observes of TM’s guru: “The Maharishi was a brown-skinned Indian man with a big beard and long, somewhat unkempt hair worn forward of the shoulders, who typically appeared in yoga robes with Hindu prayer beads.” In contrast: “Jon Kabat-Zinn, the face of MBSR, is a clean-shaven white American doctor with short hair and rimless glasses, who delivers his teachings in business attire.”15
When TM research dropped off government funding registers, mindfulness-based interventions filled the void. The NIH has so far spent over $100 million on mindfulness research, four times as much as it gave TM in half the time. In 2017 alone, the University of Wisconsin-Madison’s Center for Healthy Minds — run by contemplative neuro-scientist Richard Davidson — was awarded a whopping $7,637,000.16
The Myth of Efficacy
Scientific claims by mindfulness researchers are now being examined with greater scrutiny. In another meta-analytic study published in the Journal of the American Medical Association (JAMA), Internal Medicine, Dr Madhav Goyal and his colleagues from John Hopkins University searched databases using a set of key meditation terms.17 They found 18,753 citations, of which forty-seven matched their inclusion criteria, such as the use of randomized controlled trials. They found that mindfulness was moderately effective in treating a variety of conditions, but not more effective than other active treatments, such as drugs or exercise. Moreover, the fact that only 0.25% of the studies were deemed of high enough quality should give one pause. Hype is the unsurprising outcome of such low standards of methodological rigor, despite the lukewarm findings they conceal.
The US Agency for Healthcare Research and Quality also commissioned meta-analytic studies on the efficacy of mindfulness-based interventions (MBIs), first in 2007 and again in 2014. Both studies were critical of the lack of rigorous standards, noting that the majority of studies did not utilize randomized control groups. The more recent 2014 meta-analysis found that MBIs had lackluster efficacy, ranging from moderate to none whatsoever.18 What is especially noteworthy was the low reported efficacy of MBIs for reducing stress and improving people’s quality of life.
One of the claims made by mindfulness advocates is that the practice in and of itself leads to pro-social conduct, enhancing compassion, altruism and empathy, while reducing aggression and prejudice. This is one of the movement’s central tenets, used to justify the absence of any overt discussion of ethics. It is the basis of the utopian promise that a mindful revolution will usher in a more humane society and even world peace.
A recent meta-analytic study on the effects of meditation on pro-social behaviors casts serious doubts on these grandiose claims. A paper published in Scientif
ic Reports in 2018 found that moderate increases in compassion occurred only in studies that had the meditation teacher as a co-author, and only when the study used a passive (rather than active) control group.19 Furthermore, 61% of the studies were methodologically weak. Experimenter allegiance and bias (that is, when the teacher of the meditation intervention also authored the study) accounted for the moderate increase in compassion. Take that condition away, and the results disappeared. In addition, their study found no evidence that meditation had any significant effect on the reduction of aggression and prejudice.
The widespread belief that there is compelling clinical proof that “mindfulness works” is simply not supported by the scientific evidence. Another recent meta-analysis found MBSR was not effective for people suffering from depression.20 Even using the more specific Mindfulness-Based Cognitive Therapy (MBCT), which is sanctioned for treating depression by the UK’s National Institute for Health and Clinical Excellence, the efficacy is only modestly helpful for reducing the likelihood of depression relapse.
Blobology
Colorful pictures of brains are often featured in media reports touting evidence that science has verified the efficacy of mindfulness. They come from neuroscientific studies using functional magnetic resonance imaging (fMRI) of meditators’ brain states. Their “before and after” shots are seen as an official stamp of legitimacy, incontrovertible proof of functional and structural changes in the brain — even if the neuroscientists who produce them are more circumspect about the actual significance of increasing the size of grey matter, shrinking the amygdala, or quieting the default mode network. As Richard Henson at the University of Cambridge wryly comments, “the pictures of blobs on brains seduce one into thinking that we can now directly observe psychological processes.”21 A study has shown the dangers of this thinking. Under the title “The Seductive Allure of Neuroscience Explanations,” Deena Weisberg and her colleagues found that even bogus and bad explanations for psychological phenomena are seen as more satisfying by most people when couched in the language and dazzling visual imagery of neuroscience.22
There is also the flawed assumption that neural correlates of brain states — shown on colorful fMRI scans — can explain first-person experiences. This rests on the premise that mindfulness is a form of inner observation of a private mental realm inside the brain — resembling a “theatre of the mind.” But that imagines an Enlightenment ideal of a truly objective inner observer, while reducing mindfulness to the purely biological, ignoring the influence of contextual factors — social, cultural, economic, and cosmological — on meditative experience. Such a reductionist view perpetuates the ill-conceived notion, as the scholar of Buddhism David McMahan puts it, that “meditation can be isolated from the rest of life for the sake of scientific study.”23
By suggesting that we can see inside the brain in an unmediated way, fMRI scans impose what Michel Foucault called a “regime of truth.” They appear to show clear signs of something significant, but there is actually always activity across the whole brain, even at times of so-called rest. The brighter parts of fMRI images show the most metabolically active regions, which may be only a few percent more active than regions colored gray. The images are actually statistical patterns of brain-wide metabolic activity — and, contrary to what much of the public is led to believe, they don’t show actual engagement of specific regions as if they were mental organs in any meaningful sense. Nor are they snapshots of cognitive activity actually taking place in the brain; that occurs at the microscopic level. The use of specific regions is just a way to make analysis tractable.
Brain scans are complex composites of statistical mapping and averaging of multiple data points and subjects. Brain imaging is about indirect measurements of cell activity in huge (by brain standards) aggregates rather than at the cellular level, which is where the brain actually performs its electro-chemical processing. As my colleague David Lewis points out, fMRI images only resolve down to cubes of tissue measuring 1-3mm a side, each with upwards of a million neurons.24 Lewis provides a useful metaphor for brain-imaging studies, comparing them to trying to deduce the economic and social structure of New York City by observing movements of vehicles and people from an airplane. One can see that Lower Manhattan is active from 8am to 5pm, with a spike in foot traffic around noon, and parts of midtown are buzzing around 8pm and again at 11pm. On that basis one might gain a crude idea what is going on, but any assertions about how the financial and theater industries work would be unreliable guesses.
In effect, fMRI images of brain activity amount to a simulation, which in itself is not problematic. Computer simulations are frequently used for earthquake prediction, or computer modeling that tracks hurricane developments — based on quantitative data that can also be reproduced in dynamic imagery. The problem here with fMRI simulations is that their pictorial representations create a powerful illusion of accurate and direct images of phenomenological mental states, what Nikolas Rose and Joelle Abi-Rached refer to as a “visual imaginary.” This is a little like that of phrenologists of the nineteenth century, who mapped and measured the contours of the human skull as a means of assessing character, emotional dispositions and mental states.25
There are other conceptual and technological issues that make neuroimaging look deceptive. Evan Thompson, a philosopher at the University of British Columbia, has been an outspoken and lucid critic of contemplative neuroscientists who claim to have mapped the neural correlates of mindfulness. Thompson argues that it is empirically unwar-ranted to map cognitive functions involved in meditative practice onto localized brain areas or networks. Analysis of large databases of neuroimaging data “demonstrates that there is no one-to-one correspondence between particular brain regions and particular cognitive functions; rather any given region is activated across a wide array of tasks,” Thompson says.26 Even the latest attempts to understand brain regions in terms of networks still fail to show any sort of one-to-one connection. This multiplicity has turned out to be true of every brain region involved in cognition and emotion. Worse, even trying to understand and structure the various precursors for each region has not led to scientific consensus on mental function in terms of regions or sub-regions, though they are clearly different from one another. Theories are hotly debated for each region, but experiments turn up new observations that entail reconsideration, and there is no trend toward convergence.
Cognitive functions are not just in the head, but are embodied, involving an array of affective and bodily skills that are situated in a social environment. To illustrate his point, Thompson uses the analogy of good parenting to understand that we cannot simply deduce what good parenting is by mapping brain regions. As he explains:
Being a good parent consists in a host of emotional and cognitive skills and putting those skills into play in action. The skills and behaviors based on them clearly depend on the brain — and improving them changes the brain — but they are not private mental states and do not exist inside the brain… Parenting simply is not visible at the level of the brain.”27
The same is true for mindfulness. Decontextualizing it promotes the myth that it is a private mental state detached from social and cultural contexts. Viewed this way, it can be promoted as a way to “train your brain,” and scientific careers can be bankrolled with millions of dollars in government funding for brain-mapping studies.
Measuring Mindfulness?
Another weak link in research on mindfulness is the reliance on dubious methods of self-reporting by practitioners. To date, there are at least nine different psychometric question- naires, all of which define and measure mindfulness differently. In addition to numerous problems of reliability, construct validity and self-reporting biases, there is a basic underlying assumption that discrete psychological characteristics, which can be measured and quantified, are equivalent to mindfulness. However, the wide variety of definitions can allow for very different conceptions of practice and objectives, with no necessary connection to
the teachings that inspired Kabat-Zinn to create MBSR.
There are other problems too. Western psychological interpretations conceive of mindfulness as both a single and multifaceted trait. For example, Brown and Ryan’s Mindfulness Attention Awareness Scale (MAAS), perhaps the most widely used tool for measuring mindfulness, assumes that it is single-faceted and based on “present-centered attention.” The MAAS relies on the notion that mindfulness can be measured by how individuals think they experience lapses of attention — what researchers call “mind-wandering.” In contrast, the Five-Facet Mindfulness Questionnaire (FFMQ) views mindfulness as multifaceted. It includes such sub-scales as “describing” measuring the extent to which people believe they can express themselves in words. Non-meditators tend to score similarly to meditators, except on one factor — close observation of experience.
Self-reporting measures also are prone to simplistic language, failing to capture some aspects of mindfulness while also allowing for incompatible interpretations. This has resulted in a number of absurd and questionable findings. One classic example is a study comparing binge-drinking students to experienced meditators after an intensive retreat. Based on results from the Freiburg Mindfulness Inventory (FMI), binge-drinkers scored significantly higher on mindfulness than experienced meditators (normal college students were in the middle).28
In another twist, these scales do not assume that training in mindfulness is needed, since such self-reports are usually based on ordinary states of awareness without any expectation of engaging in deliberate acts of attention.
Many previous studies, also relying on highly subjective self-report measures, have claimed that mindfulness improves the quality of sleep. However, using a different technique — the more sophisticated and objective polysomnographic (PSG) — Willoughby Britton and her colleagues at Brown University found just the opposite. Subjects in their sleep lab study woke up more often in the night and data showed their sleep was much lighter, yet the same subjects had self-reported sleeping better. According to Britton’s write-up in Psychosomatic Medicine: “Contrary to predictions that [mindfulness] would improve or deepen objectively measured sleep, several findings from this study suggest that mindfulness training had an arousing effect on PSG sleep profiles.”29
McMindfulness Page 10