April 25, 2014
How convincing is the science driving the popularity of mindfulness meditation? A Brown University researcher has some surprising answers.
Given the widespread belief that meditation practice is scientifically certified to be good for just about everything, the results of a recent major analysis of the research might come as some surprise. Conducted by the Association for Health and Research Quality (AHRQ)—a government organization that oversees standards of research—the meta-study found only moderate evidence for the alleviation of anxiety, depression, and pain, and low to insufficient evidence to suggest that meditation relieved stress, improved mood, attention, or mental-health-related quality of life, or had a substantial impact on substance use, eating habits, sleep, or weight. It looks like the scientific evidence for the benefits of meditation aren’t as solid as many might claim.
If it is indeed proven that meditation works for some purposes but not for others, in what sense does scientific proof translate into proof of its liberative efficacy? Does any of this scientific research prove that what we do as Buddhists works? And as Buddhists, why should we care about the science?
For an insider’s perspective on these questions, Tricycle turned to clinical psychologist, neuroscience researcher, and Buddhist practitioner Willoughby Britton. Assistant Professor of Psychiatry and Human Behavior at Brown University Medical School, Britton specializes in research on meditation in education and as treatment for depression and sleep disorders. Britton has long focused on sorting out confusion about meditation within the realm of science. Responding to the first AHRQ meta-study of meditation (2007), which observed the imprecision of scientists’ understandings of words like “mindfulness” in interpreting and correlating study results, Britton won National Institutes of Health backing to create standards for consistent terminology in research. She is currently studying the underlying neurobiology of how and why particular practices seem to work better (or worse) for particular kinds of people.
Britton is also one of first researchers to explore possible adverse effects of meditation. In a groundbreaking study known as “The Varieties of Contemplative Experience” project, she is interviewing dozens of advanced meditation practitioners, teachers, and Buddhist scholars regarding what she calls “difficult or challenging mind (or body) states” that can occur as a result of intensive meditation practice. Her observations have been cautionary, highlighting the need to develop a more nuanced and informed view of (and also more respect for) the power of meditation.
As a scientist and as a Buddhist, what do you make of the AHRQ report? The report sounds pretty fair. This review—and pretty much every one before it—has found that meditation isn’t any better than any other kind of therapy.
The important thing to understand about the report is that they were looking for active control groups, and they found that only 47 out of over 18,000 studies had them, which is pretty telling: it suggests that there are fewer than 50 high-quality studies on meditation.
What are active control groups and why are studies based on them of higher quality? There are different levels of scientific research, different levels of rigor. I think this is a place where the public could use a lot of education. Because they don’t know how to interpret science, they assume much higher levels of evidence.
The first level is a “pre-post” study, which looks something like this: We go learn to meditate for eight weeks and at the end of it we feel better. We took a stress and anxiety scale before and after, and our stress or anxiety improved. So we say, “Meditation helped me!” That is actually not a valid conclusion. The conclusion you can make in science is that something helped. We didn’t control for the idea that just deciding to do something is going to help. Just that factor—intentionally deciding to make a commitment to your health and well-being—can make a big difference.
One problem is that just filling out the questionnaire changes you. In my recent sleep study, I had people fill out a questionnaire and keep a sleep diary. That is all they did for eight weeks. They didn’t meditate. And their sleep improved a lot. So, you have to control for the effect of taking the questionnaires.
You also have to control for the passage of time. Sometimes people just feel better after two months compared with when they started. So you can’t actually conclude that meditation had anything to do with it. A lot of the studies on meditation are pre-post studies like this. They shouldn’t count at all as evidence.
The next level of rigor is “wait-list controls.” Half the participants begin meditating immediately while the other half acts as a control group, and only later participate in the actual meditation. Those in the control group might be thinking, “I’m in the study. I’m going to learn to meditate!” They’re psyched. Their depression is already getting better because they’ve decided to do something about it. These are effects of expectation; they aren’t doing meditation.
But even at this level the study is not considered in any way conclusive. If I have an inspiring teacher, for example, it can be a helpful factor that is not meditation. Even to know that somebody felt depressed and anxious at one point and then got better is helpful. There’s the normalization of my symptoms. There’s the social support. I meet other people who have my problem. I thought I was the only person in the world who had anxiety, and now there are all these other people who have anxiety and we’re all talking about it. And I really get along with them. So I’m making friends. I’m less lonely. That’s not meditation either. There are all these things that are not meditation that could be helping me feel better.
If we really want to be able to say that meditation was the active ingredient, the control group has to do everything the other group is doing except meditation, and they can’t know that they are in the control group. This level of scientific study is called “active control groups.” But that largely isn’t what is happening in meditation research, although it’s starting to.
Why do people conduct pre-post studies if they don’t count as evidence? A lot of times they are not really doing research. They are running a clinic and they want to see if the clinic is having any beneficial effects. For example, the Center for Mindfulness gives people some questionnaires when they sign up for the mindfulness-based stress reduction (MBSR) program, and the participants fill them out on the last day and hand them in. It is better than nothing, but it’s not the same thing as having participants randomly assigned to either MBSR or a control group.
It is not that these sorts of studies are worthless. They are valuable at different stages of the game. When you are first starting out and wondering if something works, you measure pre-post. At early stages, that level of rigor is appropriate. But it is not appropriate for as much hype as “we should give this to children” or “we should give this to everyone.” You need a much higher level of evidence for that.
Public enthusiasm is outpacing scientific evidence. The public perception of where the research is is way higher than the actual level.
Have the claims for the scientific evidence supporting the efficacy of meditation been overstated by proponents of meditation? Definitely. Because they take all those studies that I was just describing (like pre-post studies) as evidence. You really shouldn’t cite those as evidence.
Are meditation researchers perhaps a bit biased? When we first started research on meditation, there was this principle that the scientists should be meditators because they understood it. But we are all also incredibly biased! Meditation is not just a practice we do like, “I like to run.” It is an entire worldview and religion. I worry about this kind of bias in meditation research.
There are many people doing studies who are making money off of some kind of meditation-based program, and that is technically considered a conflict of interest. They have something to gain by finding a positive effect, and therefore are not one hundred percent objective. When an experimenter is also the person who created the therapy, there is a factor called “experimenter allegiance.” This factor can count for a larger effect than the treatment itself. That is something we haven’t looked at in our field.
In the Buddhist community, there are a lot of people who are excited about the scientific findings that support the efficacy of meditation because it seems to be confirming what we already knew. But that is not the purpose of science—to confirm the dharma. And if that is what people are doing as scientists, they need to seriously step back and look at the ethics of that. To use science to prove your religion or worldview—there is something really wrong with that.
Do you see that happening in the world of science? I’ll talk about myself so I don’t point fingers. My first ten years of practice, when I was also a researcher, I was in that bright-faith phase of “Meditation can fix everything! Everybody should do it!” I wrote a mega-article, the precursor to my dissertation, on all of the neurological and biological concomitants to stress and depression. And then I cited all of the studies that suggested meditation could reverse those processes. And I submitted that mega-article to three different journals and it got rejected three times. It finally dawned on me that I was cherry-picking the data. I wasn’t actually being a scientist or doing a scientific review; I was writing a persuasive essay. I think that is much more common. Our natural bias to confirm our own worldview is very much at work. People are finding support for what they believe rather than what the data is actually saying. Ironically, we need a lot of mindfulness to “see clearly” the science of mindfulness.
This is why these meta-analyses are important. They reviewed over 18,000 articles. They were not cherry-picking.
Is the data better for some applications of meditation than others? I have done very careful reviews of the efficacy of meditation in two areas in which there are high levels of popular misconception about how much data we have: sleep and education. The data for sleep, for example, is really not that strong. And the AHRQ article concurs: it judges the level of evidence for meditation’s ability to improve sleep as “insufficient.”
What I found from my study was that meditation made people’s brains more awake. From a very basic brain point of view, what happens in your brain when you fall asleep? The frontal cortex deactivates. Nobody agrees what meditation does to the brain, but across the board, one of the most common findings is that meditation increases blood flow and activity in the prefrontal cortex. So how is that going to improve sleep? It doesn’t make any sense. It is completely incompatible with sleeping if you are doing it right. And we know that people stop sleeping when they go on retreats. That is never reported in scientific publications, even though it is well known among practitioners.
This is a very interesting example of the confusion that arises in the confluence between modern secular and traditional Buddhist contexts. In the buddhadharma, meditation is never used to promote sleep. It is for waking up. Sleep is a hindrance. Often in the modern use of meditation for everything—and especially here in the case of sleep—we’re using meditation in ways basically the opposite of what Buddhists were using it for. People aren’t trying to dismantle themselves: they want a stronger sense of self; they want more self-esteem; they want more sensuality.
In a study I’m doing on the “Varieties of Contemplative Experience,” people are having all kinds of unexpected meditation effects, and it’s scaring the hell out of them. Many of the meditators in my studies in clinical settings are reporting classic meditation side effects like depersonalization. De-repression of traumatic memories is another really common one. People have all this energy running through them; they are having spasms and involuntary movements; they are seeing lights. They check themselves into psychiatric hospitals. Some of the people I’ve seen in my study come from a health and medicine framework and are not Buddhist, and yet they are reporting meditation effects that are well documented in Buddhist texts. But these are not well documented in the scientific literature because nobody is asking about them. That’s the chasm I am trying to bridge.
Not all effects are so adverse. The fact that somebody’s sense of self disappears for a second is not necessarily a problem for that person. They might think, “Oh, that was weird.” Effects can be transient and mild. But a lot of people have charged emotional material or memories coming up. No MBSR teacher is going to be surprised by that. If you sit down on a cushion and count your breath for two months, all sorts of things— wounds, memories, traumas—are going to come up. It is a very common experience. But there is only a single paper on that, written three decades ago. Catharsis of that sort (what Buddhists call “purification”) is just not part of the model. The model is: meditation is going to calm you down.
What are other aspects of the model? I think the term “insight,” instead of being insight into the three characteristics [suffering, impermanence, and non-self], is now insight into “my own personal patterns of neurosis.” So I think there is maybe a little of the idea that you are facing your demons and getting insight into your patterns, but here “insight” is being used in a very personal way. We could all use that kind of insight, but it’s not really Buddhist insight in the traditional sense.
The fact that adopting meditation may be very disruptive to your life, that you might require supplemental therapy, or that you might be a little less functional and lower performing while stuff gets kicked up and you are working through it…that is not really in the current marketing scheme.
I think there are a lot of people who think meditation will have a Buddhist effect, even if it is not done in a Buddhist context. What do you think of that? I’m seeing people who came to meditation through MBSR or who are not Buddhist but are meditating “to be happy.” They are following their breath or doing a mantra. And then they eradicate their sense of self. They freak out. That is a pretty common experience in my study.
If “getting happy” is the context in which you have adopted meditation, will meditation in fact lead to that end? It might, but the next questions are: What’s in the middle? At what price? I think the people who have stuck with meditation for a long time, and who have cultivated some kind of wisdom or enduring change, have paid for it dearly with a lot of pain. It is very hard to extract some sort of enduring positive gain from dharma practice without taking a really thorough look at your own mind. The first step is a very close look at the nature of suffering: seeing what suffering is and getting to know our own suffering. It is through that deep intimacy with our own suffering that there is liberation. It’s not like, “Let’s take that and put it under the rug and be happy and connected with everyone!” Wisdom and enduring change are born out of really looking at every little piece of your own suffering and how it is generated and held together and maintained. How can it not be painful to do that?
What would you say is the way forward for scientific research on meditation? What would you like to see happen? As my research is showing, along with this mass enthusiasm for meditation has come an epidemic of casualties. That needs to be part of the picture going forward. No more denial. Let’s just admit that this is happening and have a mature support system for it. There needs to be more dialogue and collaboration between Buddhists and dharma teachers and the medical community—clinicians, people with training in all psychiatric problems, but particularly in trauma, which is something not really addressed in traditional Buddhist frameworks.
One of the statistics that blows my mind is that the main delivery system for Buddhist meditation in the modern West isn’t Buddhism; it is science, medicine, and schools. There is a tidal wave behind this movement. MBSR practitioners already account for the majority of new meditators and soon they are going to be the vast majority. If Buddhists want to have any say, they better stop criticizing and start collaborating, working with instead of just against. Otherwise, they might get left in the dust of the “McMindfulness” movement.
Where would you say we are now in the scientific investigation of meditation? With any new discovery, there is usually some initial craze before it gets too popular, and then there is a backlash. A lot of things that were overhyped get torn down. And whatever is really legitimately true is left standing in the end. So I think we are at the peak of this first phase. There have already been a couple rounds of criticism.
What kinds of criticism? The biggest criticism is coming from the more traditional Buddhists who think these new applications of mindfulness are a denaturing of the dharma.
A related criticism is: “What is mindfulness?” People still aren’t clear about that. What are these different practices? And which practices are best or worst suited to which types of people? When is it skillful to stop meditating and do something else? I think that this is the most logical direction to follow because nothing is good for everything. Mindfulness is not going to be an exception to that. A lot of people would probably have a strong reaction to that statement, which tells you something right there. If we think anything is going to fix everything, we should probably take a moment and meditate on that.
Linda Heuman, a Tricycle contributing editor, is a freelance journalist based in Providence, Rhode Island. Follow her on Twitter: @lindaheuman
With support from the John Templeton Foundation, Tricycle’s Buddhism and Modernity project is initiating a conversation between Buddhists and leading thinkers across the humanities and social sciences. Tricycle is exploring how perspectives drawn from research on the nature of religion, culture, science, and secularism can shed light on unexamined assumptions shaping the transmission of Buddhism to modernity. This project offers Western Buddhists new ways of thinking about their spiritual experiences by demonstrating how reason can be used as a tool to open up—rather than shut down—access to traditional faith.