Mindfulness under the microscope

Mindfulness under the microscope - it doesn't work for everyone

While sitting alone with one's thoughts seems pretty innocuous, for men facing advanced cancer it may allow realisations ...While sitting alone with one's thoughts seems pretty innocuous, for men facing advanced cancer it may allow realizations to rise to the surface that they may not be equipped to deal with.

Mindfulness, a practice that initially centred on enhancing the human condition and easing suffering, has become a billion-dollar business churning through schools, universities, the military, corporations and clinics.

This contemplative practice has been commodified and is now being delivered to the market as a "natural" drug. But like vitamins, the hype is running way ahead of the science.

The practice is unregulated and the common view that if it does no good, at least it will do no harm, may not be accurate. There are anecdotal reports of harm.

Mindfulness, derived from Buddhism, enables people to focus their attention on the present moment.

It's marketed as a natural way of dealing with stress, anxiety or depression and such is the enthusiasm for it, that some even claim it can alter the course of disease.

But now a well-designed Australian study has put mindfulness under the microscope.

The study involved almost 200 men living with advanced cancer. They had prostate cancer which, when advanced, can present plenty of physical and psychological challenges.

The study, by Griffith University and Cancer Council Queensland, showed mindfulness didn't help them. Its authors also speculate it may have the potential for harm.

Being openly aware

Mindfulness involves being openly aware of what you are experiencing while observing how you react to it. The aim is to make you less reactive and non-judgmental so you can reach a state of equanimity in relation to these experiences.

But while sitting alone with one's thoughts and experience may seem innocuous, for men facing advanced cancer, realisations may rise to the surface that they are not ready to deal with.

The Queensland study is published in the high ranking Journal of Clinical Oncology and underscores the dangers of naive realism in clinical practice.

The authors say it is now increasingly directed by commercial interests and naive realism, with clinicians using intuition rather than evidence to assess its effectiveness.

"It's almost as if we've focussed on mindfulness as the answer to all ills and are using it, with great fervour and with limited evidence," says lead author, Suzanne Chambers, professor and director of Menzies Health Institute QLD at Griffith.

When it comes to psychological distress, she says a "one size fits all approach" does not work.

While mindfulness has been shown to be helpful for recurrent depression and for women with breast cancer, "greater caution and rigorous evaluation are needed before it is recommended across the board".

'Overwhelming' experience

"If you are going to become aware of what's happening within you, you are opening yourself up to the situation you are in. Focusing on this for some time could be overwhelming.

"We know that being non-judgmental about one's inner experience can have a psychological benefit for men with advanced prostate cancer, however paradoxically observing their experience seems to not be helpful. Being mindful may not be helpful in all situations."

In the study men were randomly divided into two groups. One group received usual care with self-help materials and information about accessing free support services.

The other group received eight group therapy sessions delivered weekly via telehealth, with peer support, workbooks and daily home practice of mindfulness meditation.

The men were followed for nine months and there was no difference in benefit between the two groups.

"A concern is that mindfulness has been turned into a commodity to meet consumer demand', says Jeff Dunn, secretary of International Psycho-Oncology Society and professor of social science at the University of Southern, Queensland.

He says it has been sliced off a broadly based philosophy of life and commodified to suit market trends.

It is now being delivered in multiple ways to multiple parts of society with limited evidence that it works. "What's the correct dose for each situation and what quality control do we have? asks Dunn.

Pleas for careful approach

While it is one thing for business executives to pursue mindfulness retreats to enhance their performance, Dunn says it is quite another when mindfulness is delivered to vulnerable people with life threatening diseases.

"We need to be careful about whether it can contribute to their wellbeing."

There is always "a hopefulness" when vulnerable people enter a new therapeutic process. If it doesn't actually help, it can leave them dispirited. Mindfulness is time intensive and they could possibly have better used their time and resources doing something with proven benefits.

There is also the question of whether what began as a practice for the whole of life can be turned into a commodity that is delivered in several hours as a "cure all".

In their book The Buddha Pill, psychologists Miguel Farias and Catherine Wikholm examine the science of meditation and the delusions of personal change.

After looking over 45 years of scientific literature, they realised with astonishment that it's not known how meditation works, who benefits the most or the least and how long the effects last.

Last year, a group of leaders in the field of mindfulness-based therapy described it as "nascent and highly promising".

In an editorial in the journal, Psychological Medicine, published by Cambridge University Press, they said there had been an explosion of interest in it over the last two decades and although evidence had built in some areas, in many others the landscape could best be characterised as promising or as yet unexplored.

Jill Margo is an adjunct associate professor at the University of NSW.

Read more: http://www.afr.com/business/health/mindfulness-under-the-microscope--it-doesnt-work-for-everyone-20170305-gurdct#ixzz4b1WacBcK 
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