Showing posts with label stress. Show all posts
Showing posts with label stress. Show all posts

Does Mindfulness Really Work? A Scientific Enquiry.


The process of paying nonjudgmental attention to the current moment has been termed as mindfulness.

The awareness of breathing is commonly employed as an attentional anchor to manage ruminative thought in the early stages of mindfulness training; however mindfulness involves much more than just noticing the breath.

It is based on Buddhist practice and has been the subject of empirical research, with over scientific publications on mindfulness released in the last decade. The evidence for its use in the treatment of depression and anxiety is the strongest.

The impact sizes of mindfulness in these two illnesses have often been reported in the moderate-strong to strong range in meta-analyses. However, because some of the studies included in these meta-analyses failed to account for the placebo effect, it's not unexpected that meta-analyses with stricter inclusion criteria yield lower results.

A recent meta-analysis of randomized controlled trials of mindfulness-based stress reduction, mindfulness-based cognitive therapy, and other mindfulness-based interventions—each with an active control—found small to moderate effect sizes in the treatment of depression or anxiety after eight weeks of mindfulness training, with a reduction in effect size after three to six months.

Although the findings are less impressive, they are equivalent to those that would be expected from antidepressant therapy in a primary care population without the side effects.

The National Institute for Health and Care Excellence and the American Psychiatric Association both recommend mindfulness-based cognitive treatment for individuals with recurrent depression, based on these findings.

Other psychiatric diseases, such as schizophrenia spectrum disorders, eating disorders, chemical and non-chemical addiction disorders, and sleep disorders, may benefit from mindfulness-based therapies, according to some data.

Despite the fact that mindfulness has recently been added to the Royal Australian and New Zealand College of Psychiatrists' practice guidelines as a non-first-line treatment for adults with binge eating disorder, there is arguably insufficient evidence from well-designed randomized trials to support its use for conditions other than depression and anxiety.

Mindfulness may potentially have a role in the treatment of somatic illnesses such as psoriasis, cancer, HIV infection, irritable bowel syndrome, heart disease, hypertension, lung disease, diabetes mellitus, and chronic pain, according to growing evidence.

Randomized trials show that mindfulness-based therapies, such as mindfulness-based stress reduction and cognitive therapy, are minimally to moderately effective in the treatment of chronic pain, with potential applications in the treatment of pain-related diseases like fibromyalgia.

However, it's unclear if mindfulness improves patients' capacity to manage with pain or lessens the frequency and severity of pain.

There is inadequate high-quality data to support mindfulness for treating somatic diseases, except for chronic pain and particular pain syndromes.

Questions that remain unanswered

As previously stated, different methodological issues restrict the overall quality of the data on mindfulness's efficacy.

A type of "popularity impact" may impact results in particular. Because mindfulness is becoming more popular, participants' perceptions of getting a "fashionable" or "proven" psychotherapy practice may affect outcomes.

Because it's very hard to blind patients from the knowledge that they're employing mindfulness techniques, this is a challenging confounding variable to control for.

We also need more clarity on whether positive outcomes last for years rather than months, whether mindfulness interventions have any negative side effects, and the validity of the traditional view among contemplative traditions that long-term improvements in health and wellbeing require daily mindfulness practice over many years, rather than just attending a retreat.

In addition, data is needed to identify whether mindfulness in general or specific interventional procedures are more useful for a particular condition.

Numerous interventions have been developed, with significant variation in factors such as total participant-facilitator contact hours, including whether one-on-one contact is provided, quantity and duration of guided mindfulness exercises, use of non-mindfulness psychotherapeutic techniques such as psychoeducation or group discussion, inclusion of a full day silent retreat, and emphasis on self-practitioner interaction.

Mindfulness is defined and operationalized differently in different interventions. Recent research, for example, has concentrated on second-generation mindfulness therapies like the eight-week Meditation Awareness Training, which are founded on the notion that mindfulness is a psycho-spiritual rather than just psychological skill.

It's challenging to extrapolate findings across the whole spectrum of treatments due to significant differences in design and pedagogic approach.

Mindfulness appears to be beneficial in improving perceptual distance from stressful psychological and physical stimuli and in causing functional neuro-plastic changes in the brain, according to emerging evidence.

However, mindfulness's "fashionable" reputation among the public and the scientific community may have obscured the need to investigate crucial methodological and practical difficulties related to its efficacy.

You may also want to read more about Mindfulness Meditation and Healing here.

Truth about Meditation as a Therapy

Listening to the breath, chanting a mantra, or detaching from the thinking process are all tools used in meditation to center the mind and bring about a state of self-awareness and inner peace. There are cultic and non-cultic varieties, the latter of which was produced for medicinal or scientific purposes. Meditation's calming and tension relief are believed to have prophylactic and preventive health effects, as a slew of scientific articles claim to demonstrate.

However, these studies have methodological flaws, that are discussed here, along with a brief review of the best evidence for meditation's medicinal efficacy in clinical populations. Meditation does not have a Cochrane review. Demonstrating that such physiological symptoms like a slower heart rate or a specific electroencephalographic pattern exist during meditation and characterize a "relaxed state" can provide insight into how meditation functions, but it does not prove its therapeutic value. Most studies looking at the long-term effects of meditation have had poor architecture.

When transcendental meditation, a common type of mantra meditation, trials was conducted, they often compared self-selected meditators with non-meditators or experienced meditators with novices. These studies did not account for methodological variations in individuals who want to learn the procedure and those who do not, as well as those who stick with it versus those who stop. In randomized trials, positively predisposed participants are often selected, resulting in assumptions of gain that vary from those of control subjects. The favorable outcome of transcendental meditation trials for cognitive benefits was limited to participants who were given passive controls such as eyes closed rest.

Trials of naïve participants and plausible controls such as pseudo meditation were found to be inconclusive. A previous meta-analysis of cognitive behavioral therapies including meditation for hypertension found a related connection.  Many co-interventions, heavy mortality, and insufficient mathematical interpretation are among the other flaws. Recent clinical trials have been somewhat more robust, but the number of participants has been reduced. Co-interventions such as cognitive rehabilitation have been used in all controlled studies of mindfulness meditation or disconnected perception of experience, but successful controls have not been used, since outcomes cannot be removed or differentiated from non-specific effects.

Few results in patients with poorly managed asthma were changed by sahaja meditation or passive witnessing of thoughts, but the differences did not last two months. People with epilepsy who practiced sahaja meditation saw a substantial decrease in quantitative stress tests and seizure frequency, but sufficient intergroup comparisons were lacking, and anxiety levels and seizure frequency were significantly different between groups at baseline.

Benson relaxation response, a non-cultic type of transcendental meditation, had no significant effect on blood lipids, weight, or blood pressure when added to a risk reduction program for elderly men with hypercholesteraemia, and while patients with irritable bowel syndrome reported a reduction in symptoms after six weeks of practicing Benson relaxation response, the only significant difference was between the two groups.

Transcendental meditation has been widely researched, but most of the research is still being done by scholars who are affiliated with the organization that offers transcendental meditation and are eager to show its special importance. The 35 trials of transcendental meditation were consistent with slightly greater effect sizes than other approaches, according to a meta-analysis of trials of calming and meditation for trait anxiety. However, it involved unregulated experiments, and there is little evidence that the result was unaffected by test design, type of supervision, or other confounders.

The significance of healthcare populations remains questionable since it omitted trials of people with mental disorders. As a result, a revised and independent meta-analysis of anxiety-related mediation research is desperately needed. The impact sizes of cognitive behavioral strategies for hypertension is particularly sensitive to the methods used for baseline measurements, according to a meta-analysis of studies.

Since then, a study using appropriate baseline tests has shown that three months of transcendental meditation activity lowered clinic-measured diastolic and systolic blood pressure compared to a group of people who were granted schooling. The impact size of progressive muscle relaxation was in the center. In the transcendental meditation community, the mean modified increases in systolic and diastolic blood pressure were 10.7 mm Hg and 6.4 mm Hg, respectively.

This study, along with many others by scholars affiliated with the transcendental meditation association, suggest that meditation has a beneficial impact on blood pressure, a claim that should be objectively verified. 

A study that found beneficial effects of transcendental meditation on exercise tolerance in men with coronary artery disease was not randomized and had significant baseline differences in exercise tolerance between groups that surpassed the effect sizes recorded.

Co-intervention with food, exercise, herbal supplements, and inadequate data collection due to attrition and lack of funds confound the observed beneficial impact of transcendental meditation on the thickness of the intima media of the carotid artery, an indicator of atherosclerosis.

A small study that found some benefit from transcendental therapy for asthma had significant issues with procedure adherence. The evidence for transcendental meditation's therapeutic efficacy in other conditions is either equally flawed or limited to small-scale studies. 

Overall, the evidence for any form of meditation's therapeutic efficacy is poor, and evidence for any impact beyond that of reliable control measures is still weaker. The only protection concern seems to be in severely depressed patients, who may have psychotic episodes because of meditation. The limited research that does exist is in areas where stress reduction can have a significant positive impact, and potential studies with better design can have more definitive positive effects in this field.