Mindful of the hype

IT’S the flavour of the month at the moment, with promises it can fix everything from stress to chronic pain.

The US Army is even using the psychological technique to prepare soldiers for the stress and dangers of battle, believing it can equip them with a sort of “mental armour”.

But should we perhaps be a bit more mindful about the vaunted benefits of mindfulness?

The idea that we can make our lives better, improve our wellbeing and our health, simply by shifting the way we think about things is immensely seductive.

Recent studies, though, raise questions about whether the benefits are as impressive as has sometimes been claimed.

A 2014 review, for example, revealed mixed results.

The researchers did find moderate evidence for small improvements in anxiety, depression and pain. Although small, the improvements in anxiety and depression were actually similar in magnitude to those achieved with antidepressants, but that’s another story.

There was little or no evidence of benefit, however, for the other conditions studied, which included stress, mental health-related quality of life, mood, attention, substance use, eating habits, sleep and weight.

The researchers, from Johns Hopkins University in the US, ended up giving qualified support for clinical use of mindfulness-based techniques in some patients, while cautioning that the scarcity of properly conducted trials made it difficult to draw definite conclusions.

From the more than 18 000 citations they identified, only 47 trials met their quality criteria for inclusion (ie, randomised controlled trials with adequate controls for placebo effects).

• Related: MJA -- Mindfulness training: an adjunctive role in the management of chronic illness?
• Related: MJA -- Mindfulness-based cognitive therapy: an efficacious community-based group intervention for depression and anxiety in a sample of cancer patients

Previous reviews had been more enthusiastic about the benefits of mindfulness meditation, but the reason could be that they had also been more willing to include poorer quality studies.

Another study, published this month, raises further questions about the quality of the evidence.

Canadian researchers examined 124 published trials of mindfulness-based therapy and found a suspiciously high rate of statistically significant benefits being reported.

Based on the small size of most trials, the researchers calculated that just over 50% of them might have been expected to report a statistically significant finding.

In fact, 88% concluded mindfulness-based therapy was effective.

“A concern … is that the overwhelmingly statistically significant results in favour of [mindfulness-based therapy] interventions that can be seen in the published literature, despite very low power in many studies, may be influenced by reporting biases,” the researchers wrote.

Reporting bias is, of course, a concern across most fields of science. It’s not really surprising that researchers and journals are more motivated to publish studies with significant findings of benefit than those with equivocal results.

But a serious overestimation of benefits has consequences, even when you’re dealing with something as apparently innocuous as mindfulness.

It may be unlikely anybody will suffer toxic side effects from an overdose of meditation, as they might with an overhyped drug therapy.

But there’s always the risk a seriously ill person will neglect evidence-based treatment if they have somehow become convinced that an alternative approach is the panacea for all their problems.

A recent article by Princeton philosopher Dr Andreas Schmidt makes a case for “cautious optimism” about the usefulness of mindfulness-based interventions, while also discussing potential ethical concerns.

Could mindfulness programs be used, for example, by corporations (or presumably the US military) to make individual employees responsible for the stress they experience at work, rather than adopting organisational strategies to mitigate it?

“This is indeed a good argument not to overstate the role and effectiveness of mindfulness,” Dr Schmidt writes.

We must not allow the current hype about the technique to “crowd out discussion of organisational and social determinants of stress, lowered well-being, and mental illness and the collective measures necessary to address them”, he writes.

Because, in the end, no matter how much we might want one, there’s no such thing as a panacea.

Jane McCredie is a Sydney-based science and medical writer.