‘Mindfulness techniques’: nonsense or medicine?

It’s tempting to debunk alternative medicines, but this is one fad that has some substance

The trouble with being sceptical about quackish health-care fads is that it’s sometimes easy to throw out the useful baby with the nonsense bathwater. If you’ve spent much time over the years wearily explaining to people that homeopathy doesn’t work, that reiki and reflexology and naturopathy and acupuncture and chiropractic are snake-oil, you become wary. Certain buzzwords act as warning signs; your ears prick up when you hear “natural remedies”, or “Chinese medicine”, or “alternative therapy”. Anything mentioning “ayurvedic” or “chakras” is right out.

All of which is a perfectly sensible labour-saving exercise to weed out obvious quackery. But every so often, an intervention that actually works can set off the alarm bells. Powdered rhino horn obviously doesn’t cure impotence, but curcumin, the active ingredient in turmeric, really does have an anti-inflammatory effect in some lab trials; they’re both available as “Chinese medicine”, but one might turn out to actually be real medicine, as well.

One such false alarm could be set off by the news that record numbers of Britons are using “mindfulness techniques” to combat mental health concerns, including depression, anxiety and post-traumatic stress disorder. It’s easy to be sceptical of a purported medical technique that claims to be based on a 2,500-year-old tradition of Buddhist meditation, especially one that leaps unexpectedly into the news, suggesting sudden fashionability. But mindfulness, the process of allowing yourself simply to experience your surroundings without judging it or thinking about the past or the future, really does, it seems, have therapeutic benefits.

There’s no disguising the fact that it has a deeply hippyish feel. Mindfulness involves “practising focused attention to sensations from the body”, according to one paper in the Canadian Journal of Psychiatry; “moment-to-moment awareness of one’s experience without judgment”, according to the American Psychological Association. The idea is that you concentrate on the here and now: the sound of the car horn that is honking behind you, the feeling of the tightness in your chest that it evokes; focusing on the sensations themselves, not what the sensations mean, is meant to reduce stress.

All of which sounds very nice, but what might be surprising is that actual, scientific evidence suggests that it can make you healthier. The National Institute for Health and Clinical Excellence (Nice) recommends that “mindfulness-based cognitive therapy” can reduce the risk of relapse in patients who have suffered depression in the past, and should be available on the NHS. A 2010 meta-analysis of 39 studies found that mindfulness is an effective treatment for anxiety and mood disorders, significantly more effective than a placebo. People with depression tend to ruminate on the past, a clinical psychologist friend of mine explains; people with anxiety disorders tend to worry about the future. Helping people who have suffered from these things to focus on the moment can help stave off future attacks, and to become aware of, and in control of, negative emotions.

Scepticism isn’t completely unwarranted. There is a bright-eyed evangelical zeal to some proponents of mindfulness, which you might expect, since the meditative techniques it promotes have their basis in religion; websites selling courses in it are all bright primary colours and exclamation marks. As we reported yesterday, some financial firms are now offering it to their staff, and some schools to pupils. Whether it has positive effects on psychologically healthy people is less clear, although my psychologist contact says it’s likely to be helpful. And, for behavioural interventions like this, it is harder to carry out top-quality experiments. While you can do randomised control trials, it’s hard to prescribe placebo meditation. Researchers can try to minimise the effects of this limitation, but it makes good evidence harder to come by.

The biggest reason for scepticism, of course, is grandiose claims that mindfulness can treat things that it can’t. This is a problem for several kinds of “alternative” medicines: chiropractic can be perfectly useful for back pain; if a chiropractor claims she can cure your bladder infection, she’s a quack. Mindfulness may be able to help you avoid a relapse of your depression, or reduce your stress levels, but any bolder claims than that should be treated with a significant pinch of salt.

But although they can come wrapped up in a certain amount of cod-eastern mysticism, mindfulness techniques are not homeopathy-style nonsense. The comedian Tim Minchin says: “You know what they call alternative medicine that’s been proved to work? Medicine.” Mindfulness, it is fair to say, is no longer “alternative”.


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