Recently, there has been a flurry of research interest in mindfulness – one could almost call it hype! Not that this is reflected in loads of rigorous trials, rather it manifests itself by an unprecedented amount of systematic reviews on mindfulness being published.
I conducted a Medline search on 8/2/2022 for meta-analyses of mindfulness. It resulted in no less than 9 such papers. Here are their conclusions:
- This meta-analysis suggests that SOF is a moderately effective evidence-based practice for reducing disruptive behavior.
- In conclusion, both mindfulness interventions showed robust evidence on anxiety symptoms in pretest-posttest periods compared to control groups. Few studies and lack of evidence of follow-up periods were the main limitations found.
- Memory specificity did not significantly differ from baseline to post-treatment for either MBCT and Control interventions.
- Although this review was limited by search strategies and most of the included studies were of low quality, it still provided some tentative support for PSIs for the treatment of TOPFA women.
- Meta-regression results showed that some heterogeneity in effect size could be accounted for by intervention dosage, study population, and study design. Our findings quantify MBIs’ potential for improving immune function and thus impacting somatic disorders.
- Mindfulness interventions somewhat improved depression in emerging adults. Because primary researchers did not report the adverse effects, mindfulness interventions should be used with caution. Future researchers might study the adverse effects of mindfulness interventions as well as the long-term effects.
- The effect of MBIs on pain in cancer patients was demonstrated in our analysis, albeit with small effect sizes. High-quality RCTs are needed to verify the efficacy of MBIs on cancer patients or survivors with pain complaints. Future trials should take into account the specific pain outcome measures (pain intensity or pain interference), the approach of intervention provision (clinic-based or remote MBI, group or individual practice), the duration and frequency of interventions and the comparators (passive or active control arms).
- This meta-analysis found that MBIs had beneficial effects on mental health such as psychological distress and wellbeing in nurses.
- Because MBIs show promise across some PICOS, future RCTs and meta-analyses should build on identified strengths and limitations of this literature.
This amounts to about two systematic reviews/meta-analyses per week!
And what do these papers tell us?
If you are an advocate of mindfulness, you probably conclude that your pet therapy is supported by reasonably sound evidence. If, however, you think a little more critically, you would probably see that the evidence is far from strong. The effect size is usually small and of doubtful clinical relevance. This is, I think, important because clinical trials of mindfulness cannot easily control for placebo effects (there is no adequate placebo that would allow patients to be blinded). Therefore, the small effects that do emerge in systematic reviews/meta-analyses are most likely the result of a placebo response and not due to mindfulness per se.
My conclusion is therefore not nearly as positive as that of fans of mindfulness: the collective evidence suggests to me that the success of mindfulness relies mostly or even entirely on the placebo effect. And this means that even dozens of further systematic reviews are not going to advance our knowledge significantly. What is needed, I think, is a few truly rigorous studies aimed at determining whether the effects of mindfulness are specific or non-specific in nature. My prediction is that, once we have this evidence, the current hype around mindfulness will calm down.
21 Responses to Mindfulness: not nearly as effective as it is currently made out to be
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When it comes to meta analysis and systematic reviews the underlying studies are critical. Always remember that a stack of cow pies, no matter how high, will not get you a cream pie.
Cow Pies once dried by the sun can become deadly discs when thrown. ; )
There are almost as many different practices of “Mindfulness” as there are practitioners. It is meaningless to try to make a general conclusion about it. This is the second blog post where EE (and I assume the researchers he quotes) tries to do just that..
thanks for demonstrating that you also do not understand meta-analyses.
But this is part of the problem, isn’t it? No-one is clear what “mindfulness” actually means. Steve Novella discussed this in 2017; when my former employer, back in around 2008, started offering “mindfulness” as part of staff health no-one could adequately and consistently explain to me what it was and how it works, and that was a large NHS mental health trust…
I feel that “mindfulness” is an over-used sentiment bandied around almost every sector of my life. it’s almost a knee-jerk reaction so if you are to say you are stressed, someone always pipes up with “you should practice mindfulness.” Thank you for pointing out the not-so-obvious, as I hadn’t realized until I read this.
How could we conduct this sort of rigorous studies? Since it’s so difficult to establish a real control…
this problem comes up with many therapies; the very least researchers should to is to run an ‘attention control group’, i.e. a control group that receives the same time of attention and care without the actual therapy.
So the ‘attention control group’ should be something similar to mindfulness without being mindfulness?
yes
So wouldn’t that be mindlessness? Would homeopathy fit the bill?
to come as near as possible to a placebo/sham it is best to imitate the verum as closely as possible.
Thank you for this! The college where I work is very woo-woo susceptible, and our HR Department advocates and offers all manner of “Mindfulness and Meditation” events each year.
Of course, I am always the asshole who speaks out against their effectiveness, and pays the price by being thought a curmudgeon.
But this, too, shall pass and another nonsensical, ineffective fad, will eventually take its place. And most of the advocates will silently move on to that one, and conveniently forget that they ever took part in Mindfulness, or believed in it at all.
Hi Prof. Ernst,
I just listened to the most recent episode of the “Mindscape Podcast” of Prof. Sean Carroll.
Usually I very much like his podcast interviews, but this time was a bit odd.
The topic was “Mindfulness and the Body” and his interview partner was Prof. Ellen Langer from Harvard University.
Amongst other claims, she said that according to a recent study of her, wound healing is dependent on the psychological experience of time (i.e. wounds heal faster if a person believes that more time has passed than it actually has).
I am quite skeptical that this could be true, so I wonder if you have heard of her work and have an opinion on it.
This is the wound healing paper that she referred to:
https://www.nature.com/articles/s41598-023-50009-3
The podcast episode can be found here:
https://www.preposterousuniverse.com/podcast/2024/06/17/279-ellen-langer-on-mindfulness-and-the-body/
this is outside my area of expertise;
my IMPRESSION is that it’s odd too.
I would want at least one independent replication before I accept the findings
Agreed, especially since in this study, only 33 participants were enrolled.
The way Prof. Langer talked about Mindfulness reminded me of a person talking about the good old panacea. On the other hand, she is a Harvard professor… so what do I know.
From reading this, Langer seems a bit a of loon:
https://sciencebasedmedicine.org/eminent-harvard-psychologist-mother-of-positive-psychology-new-age-quack/
This “healing” experiment seems another in a long of line of attempts to show that manipulating the perception of time can reverse diabetes, aging and cancer. Presumably these didn’t work out, so they are trying a very simple form of “healing”.
@zebra,
You’ve explained much more succinctly what I was in the process of writing, so I’ll just add the following…
This is my impression of her mind–body unity conjecture and experiment(s):
1. use cupping to cause injury
2. use mindfulness verum (to confirm the conjecture)
3. verum group heals faster than control group
4. therefore mind–body unity confirmed
Occam’s razor reminds us to choose the option that requires the fewest assumptions.
Instead of touting mind–body unity, with its many assumptions, it seems to me that the chemical differences (including glucocorticoids, vassopressin and other hormones) — between those who were stressed and those who were relaxed — was sufficient cause for the time differences in healing.
That is easy to test by substituting the verum treatment with other well-known treatments.
According to my understanding of epistemology and ontology, those who claim that thoughts can control physical objects, healing, cancer, etc., are suffering ontological confusion. As do those who believe in such things as telepathy and psychokinesis.
My main objection to New Age positive psychology is that many of its adherents eventually become bored with it, then get drawn to the lucrative realm of insidious toxic positivity. This realm encompasses such things as the law of attraction, victim blaming, and the just-world hypothesis.
https://en.m.wikipedia.org/wiki/Toxic_positivity
https://en.m.wikipedia.org/wiki/Law_of_attraction_(New_Thought)
https://en.m.wikipedia.org/wiki/Victim_blaming
https://en.m.wikipedia.org/wiki/Just-world_hypothesis
Interesting, thanks!
As Steve Novella pointed out several years ago – https://sciencebasedmedicine.org/is-mindfulness-meditation-science-based/ – a huge problem around “mindfulness” is the lack of a unified, agreed definition, meaning it tends to disappear off into Humpty Dumpty Land very quickly.
A huge problem around mindfulness, chiropractic, homeopathy,… — indeed, with most branches of the SCAM tree — is their lack of a unified, agreed definition, meaning they tend to disappear off into Humpty Dumpty Land very quickly.