Unless you’ve been living in a cave, you have surely noticed the proliferation of mindfulness-based products flooding the retail market. Self-help guides, smartphone apps and, of course, colouring-in books. So many colouring-in books.
Mindfulness is adapted from Eastern philosophy, most famously Buddhism. A simple explanation of the concept, and it is actually a relatively simple concept, is that mindfulness is a form of non-judgmental, moment-to-moment, self-awareness. In a world where we always seem to be looking forward and worrying about what is to come, or looking back and dwelling on past mistakes, the appeal of mindfulness is obvious. And, in line with the edict of medical and mental health professionals to first do no harm, mindfulness appears to be a cheap, easy and non-invasive solution to a multitude of problems. Indeed, there is a growing body of research showing that mindfulness practices may reduce anxiety and depressive symptoms, improve sleep, enhance cognitive function, and even reduce chronic pain. However, while the rest of the world has been contentedly colouring their way to enlightenment, a group of researchers from Canada have been looking more closely at the body of research supporting mindfulness. Noting a lack of published mindfulness research reporting non-significant results, the authors investigated whether the magnitude of positive findings exceeded that which could be reasonably expected, and to determine whether publication bias might be preventing the publication of non-significant results. Side note: ‘significance’ in the context of research findings means that the results of the study are statistically unlikely to have occurred as a result of chance. This kind of significance does not necessarily imply that the results are meaningful. For example, a study could show that a sleeping tablet increases sleep duration from nine hours to nine hours and five minutes. While this increase might be statistically significant, in practice it is not likely to make a meaningful difference to the individual. Anyway – back to it. These Canadian contrarians collected recently published mental health research comparing the effects of a mindfulness intervention to usual care, placebo, or an inactive control condition. The authors determined whether these trials were ‘positive’, that is – whether they reported that mindfulness resulted in a significant improvement in some aspect of mental health. They then compared the number of positive trials to the number that would be expected if mindfulness were assumed to be as effective as other empirically validated psychological therapies. There were 1.6 times as many positive trials than could be reasonably expected. Further, of the 124 trials reviewed, only three presented unequivocally negative findings. Curious. Next, the research team investigated the potential for papers to be submitted or selected for publication only if they were able to report significant, ‘positive’ results. When you conduct a clinical trial it is best practice to register that trial on a public website. The entry includes all the details of your scientific method, as well as the dates that the trial begins and concludes. By examining the number of registered mindfulness trials and comparing that to the number of publications presenting trial results, the authors estimated that only 17 percent of mindfulness trials were registered prior to data collection. Of the registered trials, 62 percent had yet to be published. The authors propose that the therapeutic potential of mindfulness may have been somewhat overblown, with contradictory findings either not submitted or accepted for publication. They also suggest that failure to register clinical trials with a clear outcome variable means that research groups are able to dredge their data for a significant finding, ‘cherry-picking’ a positive result, if you will. The result, of course, is that the published literature presents mindfulness as a remarkably effective therapeutic intervention. And it may well be, but that is potentially only half of the story. This isn’t the first time that publication bias has called the integrity of the psychological publishing process into question. In August, 2015, a paper was published in Science detailing the largest effort yet to replicate psychology studies. Only 39 percent of the studies included could be replicated. The author reporting on the study commented on how the tendency to only publish positive results can skew our understanding of important issues, and actually inhibit progress and improvement. Indeed, as psychologist Joshua Correll from the University of Colorado states, “How else will we converge on the truth?” So, perhaps we don’t have the full story on the efficacy and utility of mindfulness just yet. Perhaps the truth is even bigger and better than what we know. Perhaps it doesn’t even matter? Mindfulness practices seem to bringing some people some relief. After all, the placebo effect is the closest thing to a natural remedy in which I can make myself believe. Dr Jessica L. Paterson, Senior Research Fellow CQUniversity, Appleton Institute @drjesspaterson