Evaluating the efficacy of psychological interventions is incredibly complicated. There is no definitive blood test in commercial use for depression or anxiety – yet. Brain scans are not sophisticated or affordable enough at this time to show us whether we are afflicted or cured. Outcomes must be determined by observation of behavior or self-report and so many variables known and unseen can affect the how things unfold.
It is also quite complicated to evaluate the quality of the research that is conducted on psychological treatment outcomes. Among the myriad challenges is the high cost in time and resources it takes to conduct good research. This is not a reason to give up – it actually makes it even more important that we do our best to investigate. However, we also must resist the urge to make snap judgments or declare ultimate truths along the way. Science is a sound method for getting us closer and closer to clear understanding.
Every day we have some news article, blog post, or Facebook status lauding or lambasting various forms of health treatments. Mindfulness based programs (MBPs) are no exception. Becoming a target is part of the price of fame. There is a strong human tendency to want to bring what has been lifted up high back down to Earth. We imagine we may be personally elevated by deflating what is lofty. In addition, the unexamined mind is especially attracted to negativity and danger warnings – it is our lizard brain’s attempt at keeping us safe.
Whether a treatment is “good” or not depends on how we define good. Outcomes for all forms of treatment will vary based on numerous conditions including the setting in which the research is conducted, the measures and criteria used, patient and provider characteristics, and a variety of extenuating circumstances. Whether laboratory outcomes translate into daily life must be examined. Finally, the systematic reviews and meta-analyses of treatment studies themselves can be flawed and of questionable quality. So, we need to investigate the quality of our reviews as well.
Tolin, et. Al in their article “Empirically Supported Treatment: Recommendations for a New Mode” in Clinical Psychology Science & Practice, advocate for considerations to be taken in the evaluation of empirically supported treatments. They describe guidelines for the various levels of efficacy for different treatment for different populations based on quality of research and strength of outcomes. The categories can include “well-established”, “probably efficacious”, etc. The CDC also has a handy guide to understanding research efficacy and effectiveness.
Another concern is the possible adverse effects of a given intervention. Yes – even something as seemingly benign as mindfulness can have untoward effects, although it is relatively rare. The authors of “Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation” cite over 1000 studies on mindfulness to date, but they found only 20 published case reports (n=1) or observational studies, over a span of several decades, of meditation-related experiences that were serious or distressing enough to warrant additional treatment or medical attention. Most of these cases occurred in the earliest days of experimentation.
So, mindfulness research suffers from many of the same challenges and limitations of other types of psychological intervention outcome research. But, it has achieved celebrity status in our culture and it is beginning to garner the same sort of gleeful, unrelenting scrutiny suffered by movie stars and sports heroes. This is why it is very important that we practice mindfulness wisely, that we ensure our teachers are well trained and embody the practices and attitudes, and that we resist the urge to water it down or use it for nefarious purposes. The current research is showing that MBPs have an effectiveness that is moderate for certain conditions (keep in mind that relatively few psychological interventions are “highly efficacious” – the HPV vaccine is considered moderately efficacious, yet we highly recommend it) with a very low adverse impact rate. To me this means we should not “throw out the baby with the bathwater” under the harsh glare of skepticism – rather we should continue to experiment with and investigate these powerful practices to better understand where they can be truly beneficial.
Its interesting to note that in an interview called “The Untold Story of America’s Mindfulness Movement: Then, Now & the Future” moderated by David Gelles of the New York Times, Dr. Richard Davidson, who pioneered now famous research on the brains of Buddhist monks, said he has never monitored the efficacy of his own mindfulness practice in his neuroimaging studies of meditators. He said he would rather trust his own “internal signals” in regards to his personal practice. I think this is a very telling statement.
Chambless, D. & Hollon, S. (1998). Defining Empirically Supported Therapies. Journal of Consulting & Clinical Psyschology. 66 (1), 7-18.
Tolin, D. et. Al. (2015). Empirically Supported Treatment: Recommendations for a New Model. Clinical Psychology: Science & Practice. 1-22.
Van Dam, T. et. Al. (2017). Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation. Perspectives on Psychological Science
Video: The Untold Story of America’s Mindfulness Movement: Then, Now & the Future
with Jon Kabat-Zinn, Daniel Goleman, and Richard Davidson moderated by David Gelles of the New York Times Recorded Tuesday, October 3, 2017, at the New York Society of Ethical Culture in NYC.