The truth about mindfulness
Transcript of the post by conducteam
https://healthselfdefense.substack.com/p/the-truth-about-mindfulness
Given that there are currently many different definitions of Mindfulness, and that not all of them align with ACT (Acceptance and Commitment Therapy) principles, we assume that Mindfulness is “a set of practices, processes, and characteristics largely defined in relation to the activity of paying full attention and accepting human suffering without moral judgment.”
The origins of Mindfulness are historically rooted in Buddhism, and it gained momentum when the Mind and Life Institute (1987) distributed dialogues between the Dalai Lama and prominent doctors and scientists, eventually becoming an extremely influential practice (2000).
The leading author, Kabat-Zinn, defines Mindfulness as “the awareness that arises from paying attention intentionally to the present moment, without judgment, as the experience unfolds moment by moment.” Unfortunately, there are also many myths and misconceptions surrounding Mindfulness, such as the myth that it is related to Positive Psychology, when in fact Positive Psychology does not prohibit “confronting negative thoughts,” but rather promotes acceptance. Its existence is accepted, just as we accept the existence of well-being.
Nor does it primarily aim to “empty the mind,” nor does it aim for “relaxation” as its ultimate goal, since the purpose of Mindfulness is to be more alert and “aware of the present,” not necessarily more relaxed.
“In Mindfulness, thoughts and emotions are not prohibited: one learns to live with them. Mindfulness is living with the awareness that we are alive.”
DOES MINDFULNESS HAVE EVIDENCE TO JUSTIFY ITS THERAPEUTIC USE?
Frankly, there are as many documents that supposedly “provide evidence” of the effectiveness of using meditation programs to treat behavioral problems as there are studies that demonstrate the opposite.
The most rigorous meta-analysis (Goyal et al., 2014) demonstrated that mindfulness has only moderate evidence for improving anxiety, depression, and physical symptoms, and weak evidence for improving stress, attention, and mood. More robust studies are undoubtedly needed to determine the positive effects of mindfulness.
“No evidence has been found that meditation programs are better than any active treatment, such as behavioral therapy or exercise.”
IS MINDFULNESS A PSEUDOSCIENTIFIC THERAPY?
To answer this question, we need to distinguish between the “representation” (the theoretical basis that attempts to justify its use) and the “practice” (its functioning in practice) of mindfulness.
On the one hand, based on its “representation,” mindfulness would be a pseudoscience. Its raison d’être relies on a single, as yet unproven, mechanism: “full attention to the present as the main way to accept and validate human suffering.” This is a mechanistic approach that possesses a large “belt of protective hypotheses” against potential criticism.
“It has not yet been demonstrated that ‘mindfulness’ (a catch-all concept) is the mechanism of change postulated by Mindfulness therapy.”
On the other hand, based on its “practice,” Mindfulness would be moderately effective and modestly helpful for some people with residual symptoms. Undoubtedly, it is necessary to discover which therapeutic components of Mindfulness it shares with other interventions.
Evidence of the use of mindfulness in clinical settings should be treated with caution until proven otherwise. The fact that something is being researched does not make it “science,” but rather makes it a subject of investigation, since mindfulness may be beneficial for some people but contraindicated for others.
“The concern about pseudoscience is not without its own interests, so our mission should not be to discredit it, but to explain why pseudoscientific practices work as well as scientific ones.
“POSITIVE” CRITICISMS OF MINDFULNESS
1. Although it is a technique that requires a lot of training to apply, we cannot deny that the technique involves useful training in discrimination and sensitization (attentional conditioning). “Focusing on the present” is learning to discriminate the variables that influence your behavior.
2. There is evidence that Mindfulness is effective for preventing and reducing relapses. Integrating it with other interventions in very advanced stages, and recommending it in a follow-up phase, could have some place if it is adapted to the patient’s preferences.
3. If we move away from religious practice, doing Mindfulness would be equivalent to doing interoceptive exposures to private responses (thoughts and emotions).
“NEGATIVE” CRITICISMS OF MINDFULNESS
1. The definition of Mindfulness does not It is not at all clear, its studies have an evident crisis in their replication and its findings can hardly be generalized to clinical practice.
2. Among the potential dangers of recommending mindfulness are some unjustified claims of benefits and the possibility that vulnerable patients with severe behavioral problems may be misled.
3. The reality behind “letting internal experiences pass by without examining their content, without prohibiting them, but learning to live with them” is a recommendation and justification for undesirable and dysfunctional avoidance behaviors.
4. Cognitive neuroscience’s attempts to theoretically justify the use of mindfulness have failed to date. They fall into too many simplistic interpretations, and neuroimaging results are subject to many methodological flaws (there are differences in the same individuals with different breathing and heart rates).
5. Its therapeutic use in the workplace adds significant political and ethical controversies. Ultimately, we are focusing the problem on the individual, when the behavioral problem is likely being perpetuated by poor working conditions, lack of workplace flexibility, insufficient sick leave, problems with wage payments, etc. Of course, the problem here wouldn’t be Mindfulness itself, but rather its application.
FINAL CONCLUSIONS ON MINDFULNESS
We find it surprising how few voices have raised a critical perspective on Mindfulness. From an experimental point of view, we are still at a very basic stage, although they are following the “gold standard” in clinical research (RCTs and meta-analyses).
Therapists should offer their clients treatments that we “know” work (empirically validated) rather than treatments that we “think” work. Furthermore, if Mindfulness involves “self-control” procedures or exposures, our opinion is that we should use them directly. First, because we know how to use them, and second, because we have a huge accumulation of evidence regarding their effectiveness.
REFERENCES
Goyal, M., et al. (2014). Meditation Programs for Psychological Stress and Well-being A Systematic Review and Meta-analysis.
Martín, O. M. (2013). ¿Por qué no soy un terapeuta Mindfulness?
Muñoz-Martínez, A. (2017). Mindfulness: ¿proceso, habilidad o estrategia? Un análisis desde el análisis del comportamiento y del contextualismo funcional.
Van Dam, T. N., et al. (2018). Mind The Hype: una evaluación crítica y una agenda prescriptiva para la investigación sobre atención plena y meditación.
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