The psychology of mindfulness, digested

Right now, mindfulness is a hot topic in psychology and beyond. In 2012, 40 new papers on mindfulness were published every month, a number that has probably risen since. Last September, the Guardian journalist Barney Ronay noted that a staggering 37 new books had been released on the topic that very week. There are numerous conferences devoted to mindfulness around the world, multiple organisations and even dedicated science journals and magazines. And yet, a dissenting voice in this chorus of enthusiasm, a new book out last month – The Buddha Pill: Can Meditation Change You? – warned that mindfulness is not harmless. To bring you up to speed in a jiffy, here we digest the psychology of mindfulness:

What is mindfulness?

With its roots in various philosophical and religious traditions, especially Buddhism, mindfulness is usually defined as paying attention in a non-judgmental way to one's experience of the here and now. Some psychologists' and practitioners' definitions are broader and speak of compassion for and curiosity about the world. The Oxford Mindfulness Centre, affiliated with the University of Oxford, states: "Mindfulness is the awareness that emerges through paying attention on purpose, in the present moment, with compassion, and open-hearted curiosity." A mindful mindset can be adopted deliberately as part of a meditative exercise, but mindfulness is also considered a trait. As a trait, mindfulness is measured by agreement with questionnaire items such as "I intentionally stay aware of my feelings" and disagreement with questionnaire items like "I tend to make judgments about how worthwhile or worthless my experiences are". One popular measure, The Five-Facets Mindfulness Questionnaire measures a person's non-reactivity, their acting with awareness, tendency to be non-judgmental, to be observant, and to describe experiences.

Is mindfulness-based meditation beneficial?

Lots of research certainly suggests it can be, but there are question marks over the rigour of some studies. Case in point: a 2013 study reported that a brief mindfulness intervention increased healthy people's sense of inner peace compared with a control group. But the control group did nothing, so as the researchers acknowledge, " We cannot exactly say whether the significant positive effects in the present study were caused by the mindfulness practice or just by the non-specific support provided by a weekly group."

That said, a review from 2011 of 23 relevant studies reported that mindfulness training could have benefits for people's attentional control and working memory (although the authors warned the quality of the evidence was often poor). Another review, published the same year, of dozens of studies reported that mindfulness has a range of psychological benefits, including reduced anxiety and greater feelings of life having meaning.

A systematic review from 2013 of 8 papers found that mindfulness meditation and similar practices could be beneficial to prison inmates (for example by reducing their anger and hostility), but the authors again warned about the need for higher quality research. Increasingly, aspects of mindfulness meditation are being incorporated into forms of therapy. For instance, a meta-analysis and review from 2012 of controlled trials found that mindfulness-based cognitive therapy successfully helps prevent depression relapse. 

What about trait mindfulness?

There's evidence that people who are inclined to be mindful tend to have advantages over others who are not. For instance, students who are more mindful have higher self-esteem. And a study from the noughties reported that people who score higher in trait mindfulness tend be more satisfied with their romantic relationships, and respond better to relationship stress. Another paper claimed that managers who are more mindful tend to have higher-performing staff, who are more satisfied with their jobs. There is even evidence that people who are more mindful are less susceptible to the harmful effects of discrimination.

How does mindfulness exert its apparent beneficial effects?

Research into this question is ongoing, but a review published in 2011 proposed four key ways: by helping people have more control over their minds, such as the ability to ignore distractions; through increased awareness of one's own body; through improved control over one's own emotions and the ability to cope with unpleasant emotions; and finally, through a changed perspective on the self. Regarding the last component, Britta Hölzel and her colleagues write that: "In place of the identification with the static self, there emerges a tendency to identify with the phenomenon of 'experiencing' itself". This fits the Buddhist teaching that there is no such thing as a permanent unchanging self. The authors go on to say that these four components are highly interrelated and are associated with various neural changes, such as enhanced grey matter in frontal brain areas involved in mental control. 

Mindfulness sounds amazing, is there any reason not to do it?

There's some evidence that mindfulness meditation can be unhelpful or even harmful for some people. A study from the early 90s reported that following a mindfulness-based meditation retreat most meditators described positive benefits, but 17 said they'd had at least one adverse effect, and two described experiencing "profound" adverse effects, such as panic attacks and loss of motivation.

A paper published in 2009 summarises instances of adverse effects documented in 12 published case studies and reviews of mindfulness meditation. The authors place these adverse effects in three categories: mental health (e.g. anxiety, depersonalisation and hallucinations), physical health (e.g. seizures, double vision); and spiritual health (e.g. religious delusions). 

So who could be at risk from these potential adverse effects? Another paper from 2012 warns that little research has been conducted into this question. The authors led by Patricia Dobkin explain why mindfulness might be risky for some vulnerable people: "Meditation, when practiced intently, leads one into deep exploration of 'inner space.' Long-held grief, body tension, and critical or judgmental thoughts may be met perhaps for the first time with full attention."

Writing in The Guardian, co-author of The Budha Pill Catherine Wikholm reminds us: "the fact that meditation [including mindfulness-based versions] was primarily designed not to make us happier, but to destroy our sense of individual self – who we feel and think we are most of the time – is often overlooked in the science and media stories about it, which focus almost exclusively on the benefits practitioners can expect."

This is not intended to be a comprehensive literature review. The views expressed here belong to the writer or to those quoted, they do not represent the position of the British Psychological Society.