Mindfulness

In the 1980s, psychology started its own meditation movement. Jon Kabat-Zinn, who was introduced to meditation by Zen advocate Philip Kapleau, starting using mindfulness meditation as a therapy for chronic pain patients.

The term "mindfulness" is one of several translations of the Buddhist concept of sati. In Buddhism this meant monitoring memories and experience to prevent worldly concerns such as desire and craving.

In 1989, Susan Langer of Harvard wrote a book called Mindfulness, introducing more psychologists to the topic. In 1994, Kabat-Zinn's second book, Wherever You Go, There You Are became a national bestseller in the U.S., and interest in mindfulness accelerated.

Google's ngram service, which provides objective data about how often a word or phrase occurs in books scanned by Google, showed what happened to the word "mindfulness."

Graph shows references to mindfulness rapidly accelerating
Google ngram data shows how frequently the word "mindfulness" was used in literature

As you can see, the word was used a few times in the 1950s and 1960s. But then the concept of mindfulness really took off around 1980 and climbed in usage ever since.

As mindfulness meditation was made the subject of thousands of psychological studies, the concept strayed from its Buddhist origins. As of 2017, a search online to answer the question, "What is mindfulness?" produced answers like this:

First of all, mindfulness involves paying attention "on purpose". Mindfulness involves a conscious direction of our awareness. [wildmind.org]
Mindfulness is the basic human ability to be fully present, aware of where we are and what we're doing, and not overly reactive or overwhelmed by what's going on around us. [mindful.org]
Mindfulness...involves acceptance, meaning that we pay attention to our thoughts and feelings without judging them–without believing, for instance, that there's a "right" or "wrong" way to think or feel in a given moment. [greatergood.berkeley.edu]
Mindfulness is a state of active, open attention on the present. When you're mindful, you observe your thoughts and feelings from a distance, without judging them good or bad. Instead of letting your life pass you by, mindfulness means living in the moment and awakening to experience. [psychologytoday.com]
...completely engaged in the present moment experience–the here and now. [mrsmindfulness.com]
...a special way of paying attention that can help with how you cope with everyday life or deal with tough times [au.reachout.com]
...the psychological process of bringing one's attention to the internal and external experiences occurring in the present moment [en.wikipedia.org]
...paying attention in a particular way: on purpose, in the present moment, and non-judgmentally [takingcharge.cash.umn.edu]
...having both present-time awareness and mental calmness [mindfulschools.org]
...simply paying attention to the present moment in everyday experiences [healthypsych.com
...paying attention here and now with kindness and curiosity [mindfuleducation.org]
...moment-to-moment, non-judgmental awareness, cultivated by paying attention in a specific way, that is, in the present moment, and as non-reactively, as non-judgmentally, and openheartedly as possible [Kabat-Zinn (2005) in Coming to Our Senses]

That last definition comes from Kabat-Zinn, who introduced the term to psychologists. In his 2005 book, Kabat-Zinn explained that part of his inspiration came from taking care of his father, an eminent immunologist, who died of Alzheimer's Disease.

Kabat-Zinn watched his father lose all sense of who he was and what was happening to him. It re-emphasized the importance of giving full appreciation to the present moment and making the best use of awareness while we have it.

In 1982, Kabat-Zinn published an article reporting on an outpatient program for chronic pain based on mindfulness meditation. While only preliminary results were reported, they were encouraging.

In 1985, Kabat-Zinn, Lipworth, and Burney (1985) presented more complete results. They had trained 90 chronic pain patients in mindfulness meditation during a 10-week Stress Reduction and Relaxation Program.

What did Kabat-Zinn report?

Afterwards the clients showed many improvements. These included "statistically significant reductions...in measures of present-moment pain, negative body image, inhibition of activity by pain, symptoms, mood disturbance, and psychological symptomatology, including anxiety and depression."

That was the beginning of three decades of research using mindfulness as an independent variable. The list of benefits reads like an infomercial. Published studies showed that mindfulness could...

counter normal age-related decline in cognitive functioning (link)
decrease posttraumatic stress disorder symptoms in U.S. military veterans (link)
cut in half the hazard of relapse to depression (link)
remediate sleep problems among older adults (link)
reduce body dissatisfaction and body shame in women (link)
reduce stress in younger breast cancer survivors (link)
attenuate anxiety by improving regulation of self-referential thought (link)
reduce psychological distress among young women with breast cancer (link)
improve self-regulation in chronic pain patients (link)
improve anxiety and panic disorders (link)
reduce anxiety and depression (link)
increase emotionally positive 'blissful' experience (link)
decrease binge eating in obese women (link)
improve visuo-spatial processing, working memory, and executive functioning (link)
increase compassionate responses to suffering (link)
reduce chronic insomnia (link)
alleviate fibromyalgia symptoms in women (link)
decrease binge eating (link)
improve well-being, social competence and academic achievement in schools (link)

Scattered in with the overwhelmingly positive results were a few negative reports. For example, mindfulness failed to help with smoking cessation.

Many of the positive changes listed above were measured using questionnaires administered after mindfulness training. That form of measurement could easily be influenced by positive expectations.

A medication claiming benefits like those above would meet with requests for well-controlled double-blind studies. That is difficult with mindfulness.

How do you do a double-blind test of mindfulness? A convincing placebo therapy would have to be devised, and the person administering it would have to be convinced of its efficacy just as a typical mindfulness instructor would be about mindfulness. This could be done, but not easily.

Meta-analysis of Mindfulness Effects

Recognizing many methodological problems in mindfulness research (which they summarized) Goyal et al. (2013) decided on a critical, systematic review and meta-analysis of all mindfulness research they could locate. The group consisted of 16 researchers, all from Johns Hopkins University.

Goyal et al. surveyed 18,753 published studies of mindfulness, looking for randomized clinical trials with active controls. 47 studies met their criterion. That is a quarter of 1% of the total. The other 99.75% of mindfulness studies were not well controlled.

After restricting their attention to the well-controlled studies of mindfulness, the research team summarized their findings this way:

Mindfulness meditation programs had moderate evidence of improved anxiety... depression... and pain... and low evidence of improved stress/distress and mental health-related quality of life.

We found...no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight.

We found no evidence that meditation programs were better than any active treatment (i.e., drugs, exercise, and other behavioral therapies). (Goyal et al., 2013)

Is there something special about the particular approach Americans developed toward mindfulness meditation? Probably not. Different forms of meditation, not labeled as mindfulness and often associated with particular religious or philosophical traditions, claim very similar benefits:

Kirtan Kriya yogic meditation lowered levels of depressive symptoms and improved mental health and cognitive functioning
Tai Chi moving meditation dropped stress and improved mood
Lovingkindness meditation reduces self-criticism and depressive symptoms (link)
Mind Subtraction meditation lowered social anxiety, aggression, and stress in elementary school students in South Korea (link)
Christian meditation and biofeedback reduced the levels of stress, anxiety, and depression in seminary students (link)
Dhammakaya Buddhist meditation lowered stress and blood pressure plus reduced reaction times by 22% (link)

As mindfulness research entered its fourth decade, attention shifted from demonstrating significant effects to exploring mechanisms. Researchers looked for neural mechanisms of attentional control that might be influenced by meditation.

Cognitive scientists say attention requires alerting, orienting, and executive control. Circuits performing those actions must be quieted during meditation. That might involve widespread areas of the brain.

Alerting, orienting, and executive control, taken together, require brain areas in the front (prefrontal cortex), sides (temporal lobes), middle (posterior cingulate cortex and parietal lobes), the back of the brain (cerebellum), plus areas deep into the brainstem used for orienting and arousal. Brefczynski-Lewis, Lutz, Schaefer, Levinson, and Davidson (2007) showed that expert meditators quieted this "network of brain regions typically involved in sustained attention."

In addition to avoiding sustained attention, meditators must quiet more introspective processes such as daydreaming or wondering about other people's mental states. Those activities are associated with the Default Mode Network (DMN) of the brain.

As expected, mindfulness meditation was found to be associated with reduced activity in the DMN (Taylor et al., 2013). Those researchers suggested that reduced Default Mode Network activity was consistent with "strengthened present-moment awareness."

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References:

Brefczynski-Lewis, J. A., Lutz, A., Schaefer, H. S., Levinson, D. B., & Davidson, R. J. (2007) Neural correlates of attentional expertise in long-term meditation practitioners. Proceedings of the National Academy of Sciences of the United States of America (PNAS), 104, 11483-11488. doi:10.1073/pnas.0606552104

Goyal, M. et al. [15 more authors] Meditation programs for psychological stress and well-being: A systematic review and meta-analysis. JAMA Internal Medicine, 174, 357-368. doi:10.1001/jamainternmed.2013.13018

Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. General Hospital Psychiatry, 4, 33-47.

Kabat-Zinn, J. (1994). Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life (10th anniversary ed.). New York: Hyperion.

Kabat-Zinn, J. (2005). Coming to Our Senses: Healing Ourselves and the World through Mindfulness. New York: Hyperion.

Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8, 163-190.

Langer, E. J. (1989). Mindfulness. Reading, MA: Addison Wesley.

Malinowski, P. (2013, February 04) Neural mechanisms of attentional control in mindfulness meditation. Frontiers in Neuroscience. Retrieved from: https://journal.frontiersin.org/article/10.3389/fnins.2013.00008/full https://doi.org/10.3389/fnins.2013.00008

Taylor, V. A., Daneault, V., Grant, J., Scavone, G., Breton, E. Roffe-Vidal, S., Courtemanche, J., Lavarenne, A.S., Marrelec, G., Benali, H., & Beauregard, M. (2013) Impact of meditation training on the default mode network during a restful state. Social Cognition and Affective Neuroscience, 8, 4-14. doi:10.1093/scan/nsr087

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