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Mindfulness-Based Therapy – Examining the Studies (Part 2)
Gareth John   Oct 7, 2015   Ethical Technology  

So is there any hard evidence that mindfulness-based therapies work? Well, the clinical evidence for mindfulness as a way to prevent depression, stress and anxiety appears at first glance to be sound. A review of the eight-week course was published in 2011 in Clinical Psychology Review by Jacob Piet and Esben Hougaard of Aarhus University, Denmark.

Part 1

After looking at six clinical trials involving 593 people, they concluded that mindfulness-based cognitive therapy reduced the risk of relapse for patients with at least three previous incidents of depression by 43% compared with people who received treatment as usual. However, there was no significant benefit for people with fewer than three major incidents.[9]

Oxford University and the Mental Health Foundation (MHF) have worked on a 10-session online course, available for £60. On its website, the foundation claims that “the effectiveness of the online course is the subject of a highly significant research paper by Oxford University published in BMJ Open.” It adds: “The reported average outcomes for completers of the course show participants enjoying reductions of 58% in anxiety, 57% in depression and 40% in stress.” That is true, but only to a point.

Firstly, the study had no control group, meaning there was nothing to compare the course with.[10]  It is also the case that Professor Mark Williams, one of the co-authors of the study, makes the point that we should be acutely aware of the dangers of overclaiming:
“A lot of people think it will cure everything. But we know there is nothing that cures everything. There is some interesting work in psychosis, bipolar disorder and schizophrenia but it’s in its early days. There’s a lot of hype around mindfulness and we need to be cautious because it doesn’t serve our science or patients well if we’re overenthusiastic. We have to make sure the science catches up with the enthusiasm.”[11]

A review of the research in Clinical Psychology Review in Jan 2014 by researchers at the University of Montreal looked at 209 studies covering 12,145 people. It concluded that mindfulness was an effective treatment for a variety of psychological problems, “and is especially effective for reducing anxiety, depression and stress.” Other studies have shown that it is effective for preventing anxiety and mood disorders and may be good for other psychiatric conditions including bipolar disorder.

The trial, published in The Lancet, a medical journal, involved a group of 424 adults from GP practices in the south-west of England, who were willing to try either the pills or the therapy. Half were randomly allotted to each. Those assigned to mindfulness had eight group sessions of more than two hours plus daily home practice and the option of four follow-up sessions over a year. The course involved mindfulness training, group discussion and cognitive behaviour exercises. The patients gradually came off their medication. Those assigned to the other group stayed on the tablets for two years.

The relapse rates in the two groups were similar, with 44% in the mindfulness group and 47% for those on the drugs. In each group there were five adverse events, including two deaths.

The researchers had thought the study might show that therapy was more effective than pills, based on their earlier work. Lead author Willem Kuyken, a professor of clinical psychology at the University of Oxford, said: “That was our hypothesis. It was based on our pilot study in 2008. There was a suggestion that MBCT might do better than medication. The reality is that it was not superior to medication.”

However, they established that mindfulness-based therapy is equally as good as drugs, which could offer a new option for those who do not want to be on medication for years. Co-author Prof Richard Byng, from the Plymouth University Peninsula Schools of Medicine and Dentistry, said: “Currently, maintenance antidepressant medication is the key treatment for preventing relapse, reducing the likelihood of relapse or recurrence by up to two-thirds when taken correctly.

“However, there are many people who, for a number of different reasons, are unable to keep on a course of medication for depression. Moreover, many people do not wish to remain on medication for indefinite periods, or cannot tolerate its side-effects.” [12]

In July of this year a mindfulness study to track the effect of meditation on 7,000 teenagers was put into action to test some of the increasingly ambitious claims about the power of mindfulness meditation to tackle illnesses such as depression and anxiety. Psychologists and neuroscientists from Oxford University and University College London announced that they planned to recruit children aged 11 to 16 from 76 secondary schools as part of a seven-year study. They said it would be the largest trial of its kind ever conducted and would look at the effect of mindfulness on obstacles to wellbeing such as exam stress and peer pressure.[13]

Thus growing amounts of research indicate that as a cognitive therapy, mindfulness works. NICE (National Institute for Clinical Excellence) backs it as a treatment for those with recurring depression and thirty per cent of British GPs now refer patients at war with their thoughts for mindfulness-based treatment.[14]

So, given the evidence that mindfulness helps with depression, some dissident psychiatrists suggest the methodology behind the positive studies hasn’t been as rigorous as it might be. “Many of the studies are small, are pilot studies and are carried on those who are not very ill,” says Professor Patricia Casey of University College Dublin. “So they would be at the mild end of the spectrum. Studies have not sufficiently frequently investigated how mindfulness compares with other therapies including pharmacological interventions. Neither have researchers paid much attention to what the active ingredient is — is it being looked after, or looking after oneself?”[15]

More critical research has been undertaken at Brown University in the US in the so-called ‘Dark Night’ project. Professor Willoughby Britton, the lead psychiatrist, has recorded problems in Buddhist practitioners such as “cognitive, perceptual and sensory aberrations, changes in their sense of self and impairment in social relationships.”  It is also clear from the research that some Buddhist meditators have been assailed by traumatic memories.[16]

Part 3 is HERE

Gareth John lives in Mid Wales; he’s an ex-Buddhist priest with a MA in Buddhist Studies at the University of Bristol, and has performed studies on non-monastic traditions of Tibetan tantric Buddhism.


Thanks for reviewing the research on mindfulness-based psychotherapy.

I’ve faciliitated 27 MBCT groups over the past 8 years, and now am co-facilitating numbers 28 and 29. The common factor for most participants is lots of negative thinking. Ive found that the biggest factor differentiating those who do well in the workshop, and those who don’t, is motivation.

I’m always trying something new. This time around I am using principles of motivation from the exercise world, based on the fact that those who exercise for health reasons exercise less than those who do it for immediate satisfaction. (Based on research and a book by Michelle Segar at U. of Michigan in the US).  I am emphasizing that the mindful activities be chosen for their ability to give immediate satisfaction. This is very different from saying “Try to do the same thing every day, to build a habit,” which is what I have been doing up till now.

I see this as qualitative research, meaning the generation of ideas for future research. But I must admit, my main motivation is the good of my patients.

I’ve just written a book that takes the principles of MBCT and applies them to individual therapy. The approach of Aware, Allow, Accept, Act is based on my clinical experience. The book has been endorsed by Dr. Zindel Segal, author of Mindfulness-Based Cognitive Therapy for Depression. It’s called Working The Present, Mindfully Based. Google and Amazon don’t yet give it much respect; best way to find it is to Google “Working the Present by Donald Fleck.”

May this be useful, Donald

Thanks for taking the time out to read the post and for your feedback. I will certainly make the time to read your book as there are lots of variables out there I’m sure I am unaware of. Always time to learn. Thanks again, Gareth

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