What is mindfulness? Nobody really knows, and that's a problem

You've probably heard of mindfulness. These days, it's everywhere, like many ideas and practices drawn from Buddhist texts that have become part of mainstream Western culture.

15 oct 2017--But a review published today in the journal Perspectives on Psychological Science shows the hype is ahead of the evidence. Some reviews of studies on mindfulness suggest it may help with psychological problems such as anxiety, depression, and stress. But it's not clear what type of mindfulness or meditation we need and for what specific problem.
The study, involving a large group of researchers, clinicians and meditators, found a clear-cut definition of mindfulness doesn't exist. This has potentially serious implications. If vastly different treatments and practices are considered the same, then research evidence for one may be wrongly taken as support for another.
At the same time, if we move the goalposts too far or in the wrong direction, we might lose the potential benefits of mindfulness altogether.

So, what is mindfulness?

Mindfulness receives a bewildering assortment of definitions. Psychologists measure the concept in differing combinations of acceptance, attentiveness, awareness, body focus, curiosity, nonjudgmental attitude, focus on the present, and others.
It's equally ill-defined as a set of practices. A brief exercise in self-reflection prompted by a smart-phone app on your daily commute may be considered the same as a months-long meditation retreat. Mindfulness can both refer to what Buddhist monks do and what your yoga instructor does for five minutes at the start and end of a class.
To be clear, mindfulness and meditation are not the same thing. There are types of meditation that are mindful, but not all mindfulness involves meditation and not all meditation is mindfulness-based.
Mindfulness mainly refers to the idea of focusing on the present moment, but it's not quite that simple. It also refers to several forms of meditation practices that aim to develop skills of awareness of the world around you and of your behavioral patterns and habits. In truth, many disagree about its actual purpose and what is and isn't mindfulness.

What's it for?

Mindfulness has been applied to just about any problem you can think up - from relationship issues, problems with alcohol or drugs, to enhancing leadership skills. It's being used by sportsmen to find "clarity" on and off the field and mindfulness programs are being offered at school. You can find it in workplaces, medical clinics, and old age homes.
More than a few popular books have been written touting the benefits of mindfulness and meditation. For example, in a supposedly critical review Altered Traits: Science Reveals How Meditation Changes your Mind, Brain and Body, Daniel Goleman argues one of the four benefits of mindfulness is improved working memory. Yet, a recent review of about 18 studies exploring the effect of mindfulness-based therapies on attention and memory calls into question these ideas.
Another common claim is that mindfulness reduces stress, for which there is limited evidence. Other promises, such as improved mood and attention, better eating habits, improved sleep, and better weight control are not fully supported by the science either.
And while benefits have limited evidence, mindfulness and meditation can sometimes be harmful and can lead to psychosis, mania, loss of personal identity, anxiety, panic, and re-experiencing traumatic memories. Experts have suggested mindfulness is not for everyone, especially those suffering from several serious mental health problems such as schizophrenia or bipolar disorder.

Research on mindfulness

Another problem with mindfulness literature is that it often suffers from poor research methodology. Ways of measuring mindfulness are highly variable, assessing quite different phenomena while using the same label. This lack of equivalence among measures and individuals makes it challenging to generalise from one study to another.
Mindfulness researchers rely too much on questionnaires, which require people to introspect and report on mental states that may be slippery and fleeting. These reports are notoriously vulnerable to biases. For example, people who aspire to mindfulness may report being mindful because they see it as desirable, not because they have actually achieved it.
Only a tiny minority of attempts to examine whether these treatments work compare them against another treatment that is known to work – which is the primary means by which clinical science can show added value of new treatments. And a minority of these studies are conducted in regular clinical practices rather than in specialist research contexts.
A recent review of studies, commissioned by the US Agency for Healthcare Research and Quality, found many studies were too poorly conducted to include in the review and that mindfulness treatments were moderately effective, at best, for anxiety, depression, and pain. There was no evidence of efficacy for attention problems, positive mood, substance abuse, eating habits, sleep or weight control.

What should be done?

Mindfulness is definitely a useful concept and a promising set of practices. It may help prevent psychological problems and could be useful as an addition to existing treatments. It may also be helpful for general mental functioning and well-being. But the promise will not be realised if problems are not addressed.
The mindfulness community must agree to key features that are essential to mindfulness and researchers should be clear how their measures and practices include these. Media reports should be equally specific about what states of mind and practices mindfulness includes, rather than using it as a broad term.
Mindfulness might be assessed, not through self-reporting, but in part using more objective neurobiological and behavioural measures, such as breath counting. This is where random tones could be used to "ask" participants if they are focused on the breath (press left button) or if their mind had wandered (press right button).
Researchers studying the efficacy of mindfulness treatments should compare them to credible alternative treatments, whenever possible. Development of new mindfulness approaches should be avoided until we know more about the ones we already have. Scientists and clinicians should use rigorous randomised control trials and work with researchers from outside the mindfulness tradition.
And lastly, mindfulness researchers and practitioners should acknowledge the reality of occasional negative effects. Just as medications must declare potential side effects, so should mindfulness treatments. Researchers should systematically assess potential side effects when studying mindfulness treatments. Practitioners should be alert to them and not recommend mindfulness treatments as a first approach if safer ones with stronger evidence of efficacy are available.

The benefits of 'being in the present'

When you have a full schedule, multitasking might seem like the best way to finish your endless to-do list. But the brain actually benefits from focusing on one activity at a time.
When you commit to training your attention and exerting control over your mind, you're practicing mindfulness. 

10 oct 2017--While it has become a popular psychotherapy technique, mindfulness originated in Buddhism over 2,000 years ago.
The idea of mindfulness is that life should be lived in the present moment. In addition to improving your focus, the practice can bring stress and insomnia relief, and pain reduction.
How?
One explanation comes from a study published in the journal Psychiatry Research. The study found that mindfulness can change the concentration of gray matter in areas of the brain involved in learning, memory, regulating emotion and more.
Yoga and tai chi are two mind-body practices that help increase mindfulness along with their physical and relaxation benefits.
There's also mindfulness meditation, a very focused approach developed by Jon Kabat-Zinn. He is creator of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical School.

However, you don't need a formal program to incorporate mindfulness into your day. Here are some ideas:

• When you start a task, imagine you're doing it for the first time. Be curious. Feel sensations like you've never experienced them before.
• Focus on your breathing. Take notice as you breathe in and as you breathe out. Follow your breath. It's a reminder that you're alive.
• When you're overcome with emotion, take a step back and trace the emotion's origin and duration. Mindfulness teaches recognition that emotions are fleeting, which helps to reduce fear and anxiety.
• Embrace imperfection. Once you understand that the world is filled with it, it becomes less upsetting.
• Always try to immerse yourself in your surroundings; this helps you be present and connect with the world around you.

More information: The U.S. National Center for Complementary and Integrative Health has more on the positive brain changes from mindfulness and on meditation itself.

A neural basis for benefits of meditation

Magnetoencephalographic studies show that people who have been trained in mindfulness have quicker and larger changes in alpha wave amplitude when they shift focus. 

Why does training in mindfulness meditation help patients manage chronic pain and depression? In a newly published neurophysiological review, Brown University scientists propose that mindfulness practitioners gain enhanced control over sensory cortical alpha rhythms that help regulate how the brain processes and filters sensations, including pain, and memories such as depressive cognitions.

14 feb 2013--The proposal, based on published experimental results and a validated computer simulation of neural networks, derives its mechanistic framework from the intimate connection in mindfulness between mind and body, since standardized mindfulness meditation training begins with a highly localized focus on body and breath sensations. This repeated localized sensory focus, the scientists write, enhances control over localized alpha rhythms in the primary somatosensory cortex where sensations from different body are "mapped" by the brain.

In effect, what the researchers propose in their paper in Frontiers in Human Neuroscience, is that by learning to control their focus on the present somatic moment, mindfulness meditators develop a more sensitive "volume knob" for controlling spatially specific, localized sensory cortical alpha rhythms. Efficient modulation of cortical alpha rhythms in turn enables optimal filtering of sensory information. Meditators learn not only to control what specific body sensations they pay attention to, but also how to regulate attention so that it does not become biased toward negative physical sensations such as chronic pain. The localized attentional control of somatosensory alpha rhythms becomes generalized to better regulate bias toward internally focused negative thoughts, as in depression.

"We think we're the first group to propose an underlying neurophysiological mechanism that directly links the actual practice of mindful awareness of breath and body sensations to the kinds of cognitive and emotional benefits that mindfulness confers," said lead author Catherine Kerr, assistant professor (research) of family medicine at the Alpert Medical School and director of translational neuroscience for the Contemplative Studies Initiative at Brown.

Experimental evidence

In experiments that Kerr and neuroscientist co-authors Stephanie Jones and Christopher Moore have published over the last few years, the team has used a brain imaging technology called magnetoencephalography (MEG) to show that alpha rhythms in the cortex correlate with sensory attention and that the ability to regulate localized alpha brainwaves on a millisecond scale is more distinct in people who have had standardized mindfulness training than in those who have not. The trio led these experiments at the Massachusetts Institute of Technology, Harvard, and Massachusettes General Hospital before they all came to Brown in 2011.

In one experiment published in the Journal of Neuroscience in 2010, they observed that when people focused their attention on sensations in the left hand, the corresponding "map" for the hand in the cortex showed a marked drop in alpha wave amplitude (as if to reduce filtering there). When the subjects' attention shifted away from that body part, the alpha rhythm amplitude in the corresponding brain map went back up (as if restoring the alpha filter). Other research groups have shown this to be the case for other kinds of attention-related tasks including focusing spatial attention and working memory.

Then in 2011 in Brain Research Bulletin, the team published another paper. They randomized subjects to eight weeks of mindfulness training versus a control group. In MEG, they asked members of each group to focus attention on sensations in their hand and then to switch their attention to their foot. The people trained in mindfulness displayed quicker and larger changes in alpha wave amplitude in their brain's hand map when they made the attentional shift than the six people who did not have mindfulness training.

Mindful computational model

In addition to the emerging experimental evidence, the research framework is also informed by a computer model that Jones has developed to simulate the alpha brainwaves through reciprocal interactions between the cortex, which processes information and thoughts, and the thalamus, which is like a switchboard that mediates information flow from the rest of the brain to the cortex. The model is well validated in that it produces alpha rhythms that closely match those observed in live MEG scans of real subjects.

Jones, assistant professor (research) of neuroscience, did not originally develop the model to aid meditation research.

"We were investigating what are the brain mechanisms that can create this prominent alpha rhythm and mediate its impact on sensory processing," Jones said. "The model simulates the electrical activity of neural networks and makes very specific predictions about how this rhythm is generated. Once we understand the brain processes regulating alpha rhythm expression, we can better understand how it can be modulated with mindfulness practice and why this is beneficial."

Among the most important predictions is one that could explain how gaining control of alpha rhythms not only enhances sensory focus on a particular area of the body, but also helps people overcome persistent competing stimuli, such as depressive thoughts or chronic pain signals.

To accomplish this, the model predicts, meditators must achieve proper control over the relative timing and strength of alpha rhythms generated from two separate regions of the thalamus, called thalamic nuclei, that talk to different parts of the cortex. One alpha generator would govern the local "tuning in," for instance of sensations in a hand, while the other would govern the broader "tuning out" of other sensory or cognitive information in the cortex.

It's a bit like focusing a telescope by precisely aligning the position of two different lenses. The authors' framework hypothesizes that experienced meditators gain the ability to turn that proverbial focus knob to align those different rhythms.

Working with the framework

In the new paper the authors propose that training chronic pain patients in the standardized mindfulness techniques of focusing on and then focusing away from pain, should result in MEG-measurable, testable improvements in alpha rhythm control.

"By this process of repeatedly engaging and disengaging alpha dynamics across the body map, according to our alpha theory, subjects are re-learning the process of directly modulating localized alpha rhythms," they wrote. "We hypothesize that chronic pain patients trained in mindfulness will show increased ability to modulate alpha in an anticipatory tactile attention paradigm similar to that used in [the 2011 study]."

Many such experiments are yet to be done, Kerr acknowledges, and her group can only do so many.

"There are a number of hypotheses in this framework that can be tested," Kerr said. "That's one of the reasons we wanted to put this out as a framework. It is beyond our ability to test all of these ideas. We wanted to make this available to the scientific field and present this unified view."

Provided by Brown University

Mindfulness meditation training changes brain structure in 8 weeks

31 jan 2011-- Participating in an 8-week mindfulness meditation program appears to make measurable changes in brain regions associated with memory, sense of self, empathy and stress. In a study that will appear in the January 30 issue of Psychiatry Research: Neuroimaging, a team led by Massachusetts General Hospital (MGH) researchers report the results of their study, the first to document meditation-produced changes over time in the brain's grey matter.

"Although the practice of meditation is associated with a sense of peacefulness and physical relaxation, practitioners have long claimed that meditation also provides cognitive and psychological benefits that persist throughout the day," says Sara Lazar, PhD, of the MGH Psychiatric Neuroimaging Research Program, the study's senior author. "This study demonstrates that changes in brain structure may underlie some of these reported improvements and that people are not just feeling better because they are spending time relaxing."

Previous studies from Lazar's group and others found structural differences between the brains of experienced mediation practitioners and individuals with no history of meditation, observing thickening of the cerebral cortex in areas associated with attention and emotional integration. But those investigations could not document that those differences were actually produced by meditation.

For the current study, MR images were take of the brain structure of 16 study participants two weeks before and after they took part in the 8-week Mindfulness-Based Stress Reduction (MBSR) Program at the University of Massachusetts Center for Mindfulness. In addition to weekly meetings that included practice of mindfulness meditation – which focuses on nonjudgmental awareness of sensations, feelings and state of mind – participants received audio recordings for guided meditation practice and were asked to keep track of how much time they practiced each day. A set of MR brain images were also taken of a control group of non-meditators over a similar time interval.

Meditation group participants reported spending an average of 27 minutes each day practicing mindfulness exercises, and their responses to a mindfulness questionnaire indicated significant improvements compared with pre-participation responses. The analysis of MR images, which focused on areas where meditation-associated differences were seen in earlier studies, found increased grey-matter density in the hippocampus, known to be important for learning and memory, and in structures associated with self-awareness, compassion and introspection. Participant-reported reductions in stress also were correlated with decreased grey-matter density in the amygdala, which is known to play an important role in anxiety and stress. Although no change was seen in a self-awareness-associated structure called the insula, which had been identified in earlier studies, the authors suggest that longer-term meditation practice might be needed to produce changes in that area. None of these changes were seen in the control group, indicating that they had not resulted merely from the passage of time.

"It is fascinating to see the brain's plasticity and that, by practicing meditation, we can play an active role in changing the brain and can increase our well-being and quality of life." says Britta Hölzel, PhD, first author of the paper and a research fellow at MGH and Giessen University in Germany. "Other studies in different patient populations have shown that meditation can make significant improvements in a variety of symptoms, and we are now investigating the underlying mechanisms in the brain that facilitate this change."

Amishi Jha, PhD, a University of Miami neuroscientist who investigates mindfulness-training's effects on individuals in high-stress situations, says, "These results shed light on the mechanisms of action of mindfulness-based training. They demonstrate that the first-person experience of stress can not only be reduced with an 8-week mindfulness training program but that this experiential change corresponds with structural changes in the amydala, a finding that opens doors to many possibilities for further research on MBSR's potential to protect against stress-related disorders, such as post-traumatic stress disorder." Jha was not one of the study investigators.

More information: Psychiatry Research: Neuroimaging

Provided by Massachusetts General Hospital