Mindfulness: is the evidence exaggerated?

Mindfulness-based techniques are now mainstream in psychotherapy.

A recent review and look at the evidence, published by Nicholas Van Dam et al. (Perspectives on Psychological Science, October 10, 2017, doi 10.1177/1745691617709589) is worth reading.   This article is discussed by Bret Stetka in Scientific American Mental Health today.

I believe there are very important points to consider:

1) Mindfulness itself could mean different things to different people.
2) People are earning a lot of money from mindfulness education, groups, books, etc.

We come to a theme that I have often found, in so many other areas of life, and specifically in psychiatry:  "dogma."

In a therapeutic encounter, or in a long-term course of therapy, the patient or client may feel better.   In the process of this therapy, the client or patient may adopt new ideas, habits, or beliefs, based on the subject matter of therapy.  We see this in CBT, in psychodynamic therapy, and in meditation-based therapies.  In other areas of life, such as in religion, in exercise training, in education, and in nutritional change, we also see people adopt new ideas, habits, or beliefs.  The benefits of these experiences are often attributed to the specific changes in ideas, habits, or beliefs.

But I believe that in many cases, the specific ideas, habits, or beliefs are less important (sometimes totally unimportant, or at worst even harmful) than the process.

In meditation, people adopt a quiet behavioural habit, which is then practiced diligently.  Time and effort is committed to learning the skill, perhaps paying money take lessons, and to meet others who share the same practice.

The process here is of diligent commitment, daily behavioural practice which differs from the status quo, and often different social affiliation.

The actual theory or literal practice of the meditation might sometimes not be important at all.  These details are part of the dogma of the practice, and may not be required for the practice to be helpful.  Yet, we humans can become more committed to a practice if we believe there is some strong theoretical foundation behind it.

I see this phenomenon in other therapeutic styles.   CBT has a strong theoretical foundation, yet I have to wonder if much of the benefits from CBT occur irrespective of the theory, but rather simply because of the diligent practice of exercises.  Psychodynamic theory features many dogmatic beliefs (such as about the impact of certain childhood events), but yet the process of the therapy (of warmth, communicative freedom, invitation to reflect) is probably the key factor in its benefits, irrespective of the theoretical dogma.

In this post, I am not meaning at all to be critical of meditation-based techniques.  I actually think that meditation could be quite a wonderful and transformative practice.  But I do encourage people to question the theoretical dogma.  Your own personal version of meditation may be equally effective or better than some other formally prescribed method, provided you are engaging with it in a way which feels comfortable, meaningful, useful, and enjoyable.

Another implication is that positive disciplined activity can be very therapeutic, but perhaps we can be free to choose the specifics according to our interests and proclivities.  So it may be that a Tango class or art lessons or nature photography or horseback riding could be more therapeutically "meditative" than an actual mindfulness or yoga class.  But others might prefer the mindfulness class.  I encourage us to be open-minded.  I also encourage us to have a little bit of healthy skepticism about therapeutic trends, especially when there is a lot of money and salesmanship involved.