by Niki Akbarian

Graphic design by Anne Catalina McGrath

Mindfulness practices, such as mindful meditation, breathing practices, and yoga, have garnered considerable popularity in recent years as they are often promoted as the accessible go–to tools to reduce stress and increase well–being.¹ But what exactly is mindfulness, and what do mindfulness practices encompass? 

At its core, mindfulness is the translation of the Buddhist and Hindu concept of Sati. Sati is the first of the seven elements of enlightenment; a journey towards liberation from the mental struggles that often oppress us, and a way to achieve profound peace, presence, and wholeness in our lives.²

Sati, and by extension, mindfulness, revolves around the awareness of one’s present state. It is the art of fully immersing oneself in the moment, embracing the here and now, as well as observing thoughts, emotions, and bodily sensations with a non-reactive and non-judgmental perspective.² It is a practice that invites us to let go of the burdens of the past and cease anticipating the uncertain future. Consequently, mindfulness-based practices offer structured activities that provide individuals with the time and space to focus their attention, enhance their awareness, and develop an accepting stance toward their experiences. These exercises are designed to help individuals tap into the potential benefits of mindfulness to optimize their well-being.³

Over the past few years, there has been a significant increase in the use of mindfulness practices as therapeutic tools to address mental health conditions such as anxiety, depression, obsessive compulsive disorder, and eating disorders.  Nevertheless, there is an ongoing inquiry into whether scientific evidence also supports the effectiveness of these practices for enhancing mental health, both among healthy individuals and within clinical populations.

To comprehensively evaluate the efficiency of mindfulness practices as therapeutic tools, it is essential to delve into the potential psychological and biological mechanisms that underlie the capacity of these practices to influence mental health outcomes. One significant psychological effect associated with mindfulness is a perceptual shift in how individuals react to and relate to their thoughts, emotions, and sensory experiences. This shift involves the ability to observe these mental and emotional phenomena with greater detachment and impartiality, reducing psychological distress. In addition, mindfulness practices facilitate a heightened level of self-awareness, which enhances one’s ability to identify and accurately label negative emotions and thought patterns. Recognizing and naming these mental states, in turn, can foster a more nuanced understanding of our inner world, enabling us to utilize more effective coping strategies.⁴

From a biological perspective, there is evidence to suggest that mindfulness practices can lead to neuroplastic changes in various regions of the brain, including the default mode network structures, left hippocampus, and fronto-limbic network. These structural changes are associated with enhanced learning and memory abilities, improved self-regulatory capabilities, and better interoceptive awareness. In addition, mindfulness practices have been found to increase the output of the vagus nerve, a cranial nerve responsible for regulating heart rate and breathing. When the vagus nerve is stimulated, it can lead to reduced autonomic arousal and is associated with an increased relaxation response. This response can have both physiological and psychological positive effects by contributing to a sense of calm and well-being.⁴

Yet, another question to consider is whether the psychological and biological changes associated with mindfulness translate into noticeable improvements in the tangible symptoms and overall outcomes of mental health in non-clinical and clinical populations.

In non-clinical settings, results from a recent meta-analysis suggest that mindfulness-based practices yield improvements in mental health outcomes compared to taking no action. Among these outcomes, psychological distress exhibits the most noticeable improvement with mindfulness practices. While improvements in depressive and anxiety symptoms are also often observed, overall well-being shows low to no enhancement in response to mindfulness practices. Moreover, in comparison to other interventions aimed at improving mental health, there is no clear evidence to suggest that mindfulness practices are either superior or inferior.⁵

Interestingly, the effects of mindfulness practices on mental health outcomes, specifically depression and anxiety outcomes, in nonclinical populations seem to be moderated by individual-level differences. That is, individuals at higher risk or those with subclinical symptoms of mental disorders appear to obtain more substantial benefits from mindfulness practices,⁵ perhaps because they are more motivated and have more room for improvement. Therefore, in nonclinical settings, mindfulness practices seem to be effective in reducing psychological distress, with the extent of their effects being contingent on individual characteristics.

On the other hand, the effectiveness of mindfulness practices as treatments for psychiatric disorders in clinical settings has generated mixed findings. One meta-analysis has indicated that, when compared to no treatment or non-specific active controls (such as placebo treatments), mindfulness-based interventions may improve clinical symptoms, particularly for depression. Furthermore, mindfulness practices have demonstrated comparable performance to evidence-based psychological treatments.⁶ However, another meta-analysis found that while mindfulness practices are superior to no treatment, there is no evidence to support that they produce treatment effects equal to or better than evidence-based psychological interventions, such as Cognitive Behavioral Therapy, for psychiatric disorders.⁷ In essence, mindfulness practices can be considered experimental treatments for psychiatric disorders due to the lack of research support. 

To summarize, mindfulness seems to offer well-established benefits for individuals without clinical diagnoses, notably in alleviating psychological distress and subclinical symptoms of depression and anxiety. However, using mindfulness practices as the primary treatment for clinically diagnosed psychiatric disorders lacks scientific backing. In my view, even if mindfulness practices do not produce scientifically substantial effects, they can still be valuable in helping us pause, tune into our emotions and experiences, and reduce unnecessary worry. However, when dealing with more severe mental health issues, it is vital not to depend solely on mindfulness practices as treatments. It is important to seek guidance and explore evidence-based treatment options in such circumstances.

References

1. Kabat-Zinn J. Foreword: Seeds of a necessary global renaissance in the making: The refining of psychology’s understanding of the nature of mind, self, and embodiment through the lens of mindfulness and its origins at a key inflection point for the species. Current Opinion in Psychology. 2019;28:xi–xvii. doi:10.1016/j.copsyc.2019.02.005 
2. Bazzano M. After mindfulness: New perspectives on psychology and meditation. Basingstoke: Palgrave Macmillan; 2014. 
3. Mindfulness exercises [Internet]. Mayo Foundation for Medical Education and Research; 2022 [cited 2023 Oct 6]. Available from: https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/mindfulness-exercises/art-20046356
4. Shonin E, Van Gordon W. The mechanisms of mindfulness in the treatment of mental illness and addiction. International Journal of Mental Health and Addiction. 2016;14(5):844–9. doi:10.1007/s11469-016-9653-7 
5. Galante J, Friedrich C, Dawson A, Modrego-Alarcón M, Gebbing P, Suárez I, et al. OP62 mindfulness-based programmes for mental health promotion in adults in non-clinical settings: A systematic review and meta-analysis of Randomised Controlled Trials. Oral Presentations. 2020; doi:10.1136/jech-2020-ssmabstracts.61 
6. Goldberg SB, Tucker RP, Greene PA, Davidson RJ, Wampold BE, Kearney DJ, et al. Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clinical Psychology Review. 2018;59:52–60. doi:10.1016/j.cpr.2017.10.011 
7. Hedman-Lagerlöf M, Hedman-Lagerlöf E, Öst L-G. The empirical support for mindfulness-based interventions for common psychiatric disorders: A systematic review and meta-analysis. Psychological Medicine. 2018;48(13):2116–29. doi:10.1017/s0033291718000259