Research in the News – Mindfulness for the masses?
by Agnes Hann
Over the past couple of months, mindfulness has been making headlines again. This is partly due to a new study, published in the Lancet that suggests that the practice is ‘as effective as pills for treating recurrent depression’.
It is fair to say that for some years now, there has been a lot of hype surrounding mindfulness – a type of therapy that draws on aspects of ancient Buddhist practices and is aimed at ‘increasing people’s awareness of themselves, their emotions and the environment around them, through meditation, yoga and breathing’. Perhaps predictably, there has also been a backlash – with critics urging us to ‘be mindful’ of what some have dubbed ‘McMindfulness’, often suspicious of its increasing commodification and positioning as a panacea for all ills.
But what does the existing research – and especially the Lancet study – tell us about the effectiveness of mindfulness-based interventions? The study consisted of a randomised control trial involving 424 individuals drawn from 95 general practices in the South West of England. All were receiving maintenance antidepressants at the point of being recruited to the trial, and all had had three or more previous major depressive episodes. Half of the group received a mindfulness-based cognitive therapy (MBCT) class and were supported to taper or discontinue antidepressant treatment, while the other half continued with their medications. Both groups of people were followed up over a 24 month period. The study found that ‘both treatments were associated with enduring positive outcomes in terms of relapse or recurrence, residual depressive symptoms, and quality of life’.
These findings add to a growing body of research spanning over a decade that suggests that MBCT is effective in helping people with ongoing problems with depression. This is not ‘new news’ – MBCT has been recommended by the National Institute of Clinical Excellence as a treatment for recurrent depression since 2005, and it is endorsed in the Chief Medical Officer’s report. And yet depression remains not only the most common mental illness, but also one of the most tenacious. The increased use of maintenance antidepressants as a way of preventing relapse has failed to improve longer-term outcomes for those most at risk – who often find that the medications lose their effect over time, or may be associated with unpleasant side effects. Alternative evidenced-based therapies such as MBCT are not widely available, with only a handful of CCGs offering it in their area. In this context, the Lancet study, which is the first definitive trial that compares an MBCT approach with maintenance antidepressant treatment, makes a powerful case for the overhaul of existing treatments and services for people with depression.
So far, so good. But what about mindfulness for the masses? Mindfulness for those who get stressed at work (isn’t that everyone?) Mindfulness that can ‘boost your career and help you get a job’? Mindfulness to help high-achieving young people cope with pressures at school?
What do we make of the poster for a mindfulness course on the wall of the kitchen of our serviced office space? Well – one of my colleagues is trying it out. And, as a team, we’re thinking about a mindfulness workshop for our annual ‘wellbeing day’ later this year.
A quick scan of news articles during the weeks following the publication of the study – as well as my own network of friends, acquaintances, colleagues suggests that there is far more public and professional interest in mindfulness as a wellbeing promotion mechanism than as a form of evidence-based treatment for a diagnosed mental health condition. In many ways, this is good news reflecting a shift in mental health practice and policy, which is increasingly focused on prevention and early intervention, and not just mental health treatment.
This shift towards ‘keeping people well’ is something that we have observed in the context of our evaluation of Kent County Council Public Health’s Mental Wellbeing Programme. Most of the innovative interventions we are looking at are aimed at improving the wellbeing of the general population through everyday activities, while others target particular sub-groups who are deemed as ‘high-risk’. The mechanisms through which they operate are proving to be effective at promoting wellbeing – but not as a treatment for people with more severe or long-term mental health conditions, who tend to be referred or signposted towards specialist mental health services.
These learnings parallel some of the common criticisms levelled at mindfulness – can it really be everything at once? A simple activity that anybody can integrate into their day-to-day routine to enhance their wellbeing, and also a treatment for a specific mental health condition? This is, in turn, complicated by the fact that ‘wellbeing’ is increasingly becoming a jargon term, a catch-all that can mean many different things, depending on the individual and context in question. In mindfulness’ defence, it is likely that popular and media discourses are prone to oversimplify and overlook key differences in the way in which it is delivered – including distinguishing between MBCT and mindfulness-based stress reduction (MBSR), and ‘clinical’ and ‘adapted’ versions of both.
But the question remains: how can mindfulness work to promote wellbeing and prevent mental illness at a population level? How should mindfulness-based approaches be delivered? Is it really good for everyone? Or is it more (or less) effective in certain contexts (e.g. in the workplace), or with certain groups? There is some evidence that under certain circumstances, mindfulness can have unequivocally negative outcomes, or that you can have ‘too much of a good thing’. These critics caution against the idealisation of mindfulness as ‘natural’ and therefore free of side-effects. Some of the more radical critiques of mindfulness suggest that it promotes an inward-looking, depoliticised sense of self that rejects critical engagement and social change in favour of self-improvement, thereby encouraging and enabling oppressive agendas and structures of power and inequality.
There is a clear need, then, for further research into the effectiveness of mindfulness, especially in the context of mental health and wellbeing promotion, prevention and early intervention. Future research should aim to address some of the accusations outlined above by paying close attention to the way in which these kinds of interventions influence, and are shaped by, broader discourses about mental health and the way in which mental health services are structured and funded. This is particularly important given that mindfulness, and wellbeing programmes more generally, are often framed in terms of long-term cost-effectiveness – a vision which may not match up with reality.
Agnes Hann, Senior Researcher, The McPin Foundation.