The "Mindfulness" Fad

Fads come and go, and one that is lately taking a lot of money from one group of people and transferring it to another group of people is "mindfulness":

Mindfulness involves a conscious focus on and awareness of your present state of mind and surroundings, without judgment or reaction. Mindfulness is rooted in Buddhism and was developed in the 1970’s as a therapeutic intervention for stress in adults by Jon Kabat-Zinn, who founded the Mindfulness-Based Stress Reduction Clinic at the University of Massachusetts Medical School. Over the past several decades, the practice of mindfulness has evolved into a booming billion dollar industry, with growing claims that mindfulness is a panacea for host of maladies including stress, depression, failures of attention, eating disorders, substance abuse, weight gain, and pain.

Separating people from their money is a time-honored practice; in fact, in our language we have several phrases related to doing so, including "shark oil salesman".  When the supposed treatment lives up to the Hippocratic Oath of doing no harm, "caveat emptor" is the rule of the day.  I'm not saying it's ok to defraud people, I'm saying that at least no physical harm is done. 

But what if physical harm is done?

In an effort to address these limitations, Catherine Johnson, Christine Burke, Sally Brickman, and Tracey Wade conducted a large-scale study including a randomized control group to assess the benefits of mindfulness training in teens.

They evaluated the efficacy of mindfulness training in 308 middle and high school students (average age 13.6 yrs) from diverse socio-economic backgrounds. The students were enrolled in 17 different classes across 5 different schools. Students opted in to the study, and were randomly assigned to the control group or the mindfulness training group. Students in the control group received no mindfulness training but instead participated in community projects or received lessons in pastoral care. Students in the mindfulness group completed 8 weeks of training in the .b (“Dot be”) Mindfulness in Schools curriculum, which is based on the “gold standard” Mindfulness Based Stress Reduction (MBSR) intervention for adults. The training sessions varied in length from 35 to 60 min and were administered once a week. All mindfulness training was conducted by the same certified instructor. Beyond the weekly training sessions, teens in the mindfulness group were encouraged to practice mindfulness techniques at home and were given manuals to assist in this practice.

All participants were assessed at three different time points: a baseline taken one week before the intervention, a post-test measure taken a week after the sessions were over, and a follow-up assessment administered about 3 months later. The study included measures of anxiety and depression, weight and shape concerns, well-being, emotional dysregulation, self-compassion, and mindfulness. Participants were also asked to report their compliance with home practice, and to provide an evaluation of the intervention. Attrition rates were low (just 16 percent at follow up) and comparable for both groups.

Despite the numerous outcome measures employed in the study, there was no evidence of any benefit for the mindfulness group at either the immediate post-test or the follow up. In fact, anxiety was higher at the follow up for males in the mindfulness group relative to males in the control group. The same was true for participants with low baseline depression and low baseline weight concerns; mindfulness training led to an increase in anxiety in these individuals over time.

The careful design and implementation of this study addressed a number of shortcomings from previous studies, as the authors used a large and diverse multi-site sample, a randomized control group, an age-appropriate mindfulness curriculum, a certified trainer, and a plethora of outcome measures. The fact that this carefully-controlled investigation showed no benefits of mindfulness for any measure, and furthermore indicated an adverse effect for some participants, indicates that mindfulness training is not a universal solution for addressing anxiety or depression in teens, nor does it qualify as a replacement for more traditional psychotherapy or psychopharmacology, at least not as implemented in this school-based paradigm.

I know it's shocking to consider that I might be getting cynical in my old age,  but I don't think "mindfulness" is going away any time soon.  It's got too much going for it--a Far Eastern origin, a lack of "Big Pharma", cures for all the big issues of the day, and it just "makes sense".  The problem is that those who support mindfulness practice in teenagers forget the axiom attributed to Sherlock Holmes, "When the facts contradict your expectations, believe the facts."  Mindfulness belongs in schools about as much as EST does.