In this article, I aim to introduce you to the unsettled meaning of mindfulness and why this is problematic in conducting high-quality research.
Estimated reading time: 13 minutes
Mindfulness has become a “sexy” intervention, as mindfulness reporting has saturated news cycles. However, mainstream media has failed to interpret scientific research about mindfulness accurately.
In this article, I aim to introduce you to the unsettled meaning of mindfulness and why this is problematic in conducting high-quality research. Subsequently, you may recognize “hyped” media claims, and thus you are in a better position to make “evidence-based” decisions.
In this Article:
Table of contents
- The Unsettled Meaning of “Mindfulness”
- Multiple Definitions of “Mindfulness”
- Implications for Research Because of Differences in Meaning of “Mindfulness”
- Consequences of Semantic Vagueness for Empirical Studies of “Mindfulness”
- Consequences of Semantic Vagueness for Theoretical Models of “Mindfulness”
- Integrative Evaluation of Scholars in Contemplative Science
- What are Mindfulness Researchers to do?
- Next Steps for Would Be Practitioners
- The Center for Mind-Body Medicine
- Mindfulness-Based Stress Reduction (MBSR)
- The Mindfulness Awareness Research Center (MARC)
- UCSD Center for Mindfulness Mindfulness-Based Professional Training Institute
- Center for Healthy Minds University of Wisconsin-Madison
- The Mindsight Institute
- Mindfulness Skill Training in Medicine (MSTM)
- The Bottom Line: “Do Mind the Hype” When it Comes to Mindfulness Practice in Healthcare!
Together, Kristi Artz, MD, dipABLM, CCMS, and I co-created the Mindfulness Skill Training for Medicine (MSTM). At the same time, we set out to have the evidence make our case for a program we predominately aimed at healthcare professionals.
For this reason, it only seems fitting that the first article we invite our participants to read is “Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation”(Van Dam et al., 2018).
We believe Van Dam et al. (2018) should be mandatory reading for any healthcare professional and researcher wanting to dabble in mindfulness.
Often overlooked, mainstream media serves up mindfulness as a panacea for all that ails us in contemporary society. Proponents of the practice publicize it for corporate wellbeing and education from K-12 to higher education. The military adopts it to create more resilient soldiers. On occasion, we find suggestions to replace psychotherapy with mindfulness (Van Dam et al., 2018).
In contrast, Van Dam and colleagues (2018) highlight critical areas where mindfulness research has not kept pace with the claims made in mainstream media (Van Dam et al., 2018).
There are many unknowns when we talk about adopting mindfulness in healthcare. Van Dam et al. (2018) highlight that misinformation from poorly designed studies could potentially lead to consumers being harmed and misled.
Essentially, the authors focus on two main topics in their paper.
- The Problematic Meaning of “Mindfulness” and
- Methodological Issues in Mindfulness Meditation Research
In this article, we are honing in on the problem of defining mindfulness. In a follow-up article, we will focus on mindfulness research’s methodological issues of investigating mindfulness practice.
Essentially, empirical research does not entirely support popular media’s claims about mindfulness. Hopefully, after reading this article, you are in a better position to recognize the hype behind media claims for contemplative interventions.
The Unsettled Meaning of “Mindfulness”
Van Dam et al. (2018) explain that there are many reasons their paper came into existence. First, they take issue that there is quite a bit of confusion from lumping mindfulness and meditation into one basket.
They claim a lack of differentiation of mindfulness and meditation when interpreting scientific research on particular states and practices. For this reason, the authors argue that there cannot be any ambiguity about which mindfulness practice was used (Van Dam et al., 2018).
They cite two examples:
- Because people use the terms mindfulness and meditation interchangeably, there is no differentiation in nomenclature. As long researchers use the terms interchangeably, there is no distinction between a five-minute meditation exercise from a popular phone application and the same in a 3-month meditation retreat” (Van Dam et al., 2018, p. 38).
- It’s important to realize when we label both the same, a self-report questionnaire could essentially equate the characteristics of someone devoting half a lifetime to a particular type of meditation (Van Dam et al., 2018).
Multiple Definitions of “Mindfulness”
Researchers currently cannot agree on a technical definition. Markedly, researchers have no consensus on the detailed aspects of the underlying concepts to which mindfulness refers (Van Dam et al., 2018).
We could look to Davidson & Kaszniak (2015) and Goldberg et al. (2016) for examples of this. Van Dam and colleagues (2018) cited their papers when they acquaint readers that mindfulness, a mental faculty, has underlying concepts related to attention, awareness, retention, memory, and potentially discernment. At present, research practice rarely represents those underlying concepts of mindfulness.
Considerable Differences About the Meaning of “Mindfulness” Exist
While the debates continue to ensue across complementary disciplines that deal with research and practice, interpreting the definitions of “mindfulness” continues in conflicting ways. For example, Jon Kabat-Zinn (2009)described that mindfulness means “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” in 1994. In 2011, Kabat-Zinn wrote that his definition might include concepts and practices that his initial description may have omitted (Kabat-Zinn, 2011).
Implications for Research Because of Differences in Meaning of “Mindfulness”
When looking at published research, readers need to center on statements that explicitly explain the type of mindfulness practiced. Researchers need to inform consumers of the precise instructions given to research participants. A reader needs to understand what mindfulness practice or what type of meditation was the study’s focus. In other words, did the researchers have the participants practice the kind of practice that they described in their methodology section (Van Dam et al., 2018).
Consequences of Semantic Vagueness for Empirical Studies of “Mindfulness”
By far, Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR) has been the most investigated model of mindfulness instruction. However, even within the original MBSR model, different versions have varied time commitments and duration. Generally speaking, time commitment speaks to hours of practice per day. Practice duration speaks to the program’s length (4 weeks, 6 weeks, eight weeks, etc.).
Instructional methods to teach those skills can vary as well. This is very important. Suppose peer-reviewed journals and mainstream media brush those differences aside when reporting a study’s results.
In that case, unseemly comparisons are drawn “…between what might be fundamentally different states, experiences, skills, and practices.”(Van Dam et al., 2018, p. 40).
Varying Definitions of Expertise and Skills
Then there is the dilemma of including participants with varied skills. Some researchers consider a novice of mindfulness to have absolutely no experience with the practice whatsoever. However, other investigators are more lenient and allow up to a few hundred hours of mindfulness practice for novice practitioners. Prior mediation experiences are, of course, a critical factor when conducting research. Then, researchers sometimes do not require research participants to have any instructions in mindfulness at all. Some researchers do not require participants to achieve or maintain a present-moment awareness or commitment to maintain a compassionate experiential state (Van Dam et al., 2018).
Consequences of Semantic Vagueness for Theoretical Models of “Mindfulness”
Van Dam and colleagues (2018) cite research that, in theory, entails mental activities and brain processes that support insight and personal transformation. For instance, Van Dam et al. (2018) provide psychological distancing/reperceiving, decentering and inhibitory control, nonconceptual discriminatory awareness, acceptance, reintegration, focused attention, decentering, and meta-awareness as examples.
We further learn from the authors that some of the outcomes about insight and personal transformation could occur on the path of long-term, regular practice. At the same time, other effects of mindfulness practice may only become evident in experienced long-term practitioners (Van Dam et al., 2018).
It is essential to highlight that the meaning of mindfulness that investigators invoked when setting out to collect data will confirm or disconfirm a specific model. Van Dam et al. (2018) cite an example of decentering.
“It is nearly impossible to test whether decentering has occurred if one has not obtained a measure of it.”(Van Dam et al., 2018, p. 40)
Essentially, no “magic bullet” theoretical model exists that can wrestle with all of the different facets of “mindfulness,” so researchers need to create integrative models and document which data support which models (Van Dam et al., 2018).
Integrative Evaluation of Scholars in Contemplative Science
There seems to be a consensus about the semantic ambiguity of “mindfulness” and that it does not resembles one particular construct. Often it includes aspects of the definition laid out by Kabat-Zinn (1990). Kabat-Zinn’s definition entails paying attention in a specific way, present moment awareness, nonreactivity, and nonjudgment. Besides, Buddhist philosophers suggest it often involves attention, awareness, memory and retention, and discernment (Van Dam et al., 2018).
Scholars in the field agree that mindfulness entails attention and awareness with some crucial qualifiers about those faculties’ nature. Also, mindfulness falls into a more expansive combination of goals and attitudes (Van Dam et al., 2018).
From a traditional Buddhist perspective, the characteristics fitting attention and awareness are a requirement of a higher pursuit, such as enlightenment, including recognition/awareness, tranquility, concentration, equanimity, energy, joy, and discrimination (Van Dam et al., 2018).
Definitions of mindfulness rooted in Buddhist contemplative practice probably do not matter to definitions implemented in contemporary practice. However, traditional definitions can contribute powerful context and insight into mindfulness practice’s essence and likely mechanisms (Van Dam et al., 2018).
There are probably significant differences in mindfulness that research measures and Western mindfulness and meditation training attempts to nurture. Mindfulness developed by long-term meditators in diverse contemplative traditions relative to one another is perhaps quite different as well (Van Dam et al., 2018).
What are Mindfulness Researchers to do?
Van Dam and colleagues (2018) recommend that scientists, practitioners, instructors, and mainstream news media shift from focusing on the generalized, omnipresent usage of “mindfulness.” The authors argue for the need for more precise, differentiated representations of precisely what mental states, processes, and functions were being guided, practiced, and studied.
In their paper, Van Dam et al. (2018) provide a list of determining characteristics of contemplative practices. The authors divide the list into primary and secondary defining features for the characterization of meditation practice. Van Dam et al. (2018) argue that using the list would allow researchers in contemplative science to move past the considerable imprecision of the definition of mindfulness.
Van Dam et al. (2018) point toward additional examples of lists for mindfulness-related practices from a scientific neurocognitive perspective (Lutz et al., 2015) and a contemplative aspect (Analayo, 2003). In future articles, I will take a closer look at Antoine Lutz and colleagues’ (2015), as well as the Bhikkhu Anālayo’s (2003) list. I think it is also worthwhile investigating a third list. That list is by Nash & Newberg (2013) to determine the characteristics of contemplative practices.
As far as self-report measures are concerned, Van Dam et al. (2018) prompt users to list the exact measurements and discuss the aspects of “mindfulness” they utilized measure characterizes. For example, the Five Facet Mindfulness Questionnaire (FFMQ) aims to assess 1) Nonreactivity, 2) Observing, 3) Awareness, 4) Describing, and 5) Nonjudging.
So far, we have only addressed the ambiguity regarding mindfulness terminology. Researchers and practitioners will also need to deal with factors about the meaning of mindfulness in the encompassing practice.
Researchers will need to be very clear in their reporting of the data and inform the readers about the instructor’s training, the regularity of meetings, group vs. individual practice, home practice type, and amount (Van Dam et al., 2018).
In a subsequent post, we will explore how Van Dam et al. (2018) propose to solve research-related issues in contemplative neuroscience, mindfulness, and meditation.
Next Steps for Would Be Practitioners
There are many highly reliable mindfulness programs for you to study. Most of those programs are off-shoots of the programs mentioned below. Ideally, the facilitators of those training programs will have undergone rigorous training to be qualified to teach the content.
The Center for Mind-Body Medicine
Dr. Jim Gordon, a Harvard-educated psychiatrist, is the founder of the Center for Mind-Body Medicine in Washington, D.C. Dr. Gordon is an internationally recognized expert for self-awareness, self-care, and group support to heal population-wide psychological trauma. He is a clinical professor at Georgetown Medical School and served as chairman (under Presidents Clinton and GW Bush) of the White House Commission on Complementary and Alternative Medicine Policy (https://cmbm.org).
On a side note: I underwent rigorous training with Dr. Jim not only at the CMBM, but Dr. Jim was also the Dean of Saybrook University’s School of Mind-Body Medicine, where I received my Ph.D. in Mind-body Medicine.
Mindfulness-Based Stress Reduction (MBSR)
The founder of the MBSR program is Jon Kabat-Zinn. MBSR uses mindfulness meditation, body awareness, yoga, and exploration of behavior, thinking, feeling, and action patterns (https://mbsrtraining.com).
The Mindfulness Awareness Research Center (MARC)
Located at UCLA, the Mindful Awareness Research Center partners with the Norman Cousins Center for Psychoneuroimmunology, within the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA (https://www.uclahealth.org/marc/about-marc).
UCSD Center for Mindfulness Mindfulness-Based Professional Training Institute
The UC San Diego Center for Mindfulness (UCSD CFM) is a multi-faceted clinical care program, education, research, and outreach. UCSD CFM intends to integrate mindfulness into individuals’ lives throughout the healthcare and educational system, including patients, students, teachers, and business persons (https://mbpti.org).
Center for Healthy Minds University of Wisconsin-Madison
Dr. Richard J. Davidson, a world-renowned neuroscientist, is the founder of the Center for Healthy Minds. The Center for Healthy Minds envisions a kinder, wiser, more compassionate world. Their mission is to cultivate wellbeing and relieve suffering through a scientific understanding of the mind (https://centerhealthyminds.org).
The Mindsight Institute
Dr. Dan Siegel, MD, is the Mindsight Institute’s founder to provide a scientifically grounded, integrated view of human development to promote healthy minds’ growth in the exciting field of interpersonal neurobiology. https://www.mindsightinstitute.com
Mindfulness Skill Training in Medicine (MSTM)
Dr. Kristi Artz, MD, dipABLM, CCMS, and I developed the Mindfulness Skill Training in Medicine (MSTM) program. We based the MSTM program on Tania Singer’s “ReSource Model of Compassion” (Singer, & Bolz, 2013) and evidence derived from the field of contemplative neuroscience. Dr. Singer is a researcher at the Max Planck Institute at the Department for Human Cognitive and Brain Science in Leipzig, Germany (https://mindbodymed.net).
The Mindfulness Skill Training in Medicine (MSTM) program currently includes four Live Interactive Webinars Facilitated Online by Dr. Kristi and myself. We also created a 100% Online, Self-Paced, Home Study Course. Click here for more information about our programming.
You can also watch our very brief promo video below.
The Bottom Line: “Do Mind the Hype” When it Comes to Mindfulness Practice in Healthcare!
Researchers still need to do much work to improve the rigor of methods for mindfulness research. Be cautious of the accuracy of news media reporting of mindfulness research.
If you are on the cusp of committing time, money, and energy into mindfulness training, only train with the best practitioners. Do your due diligence and find a program and practitioners that can demonstrate subject matter expertise. That includes practitioners who have a clinical and practical working knowledge of published mindfulness research. Those practitioners also need to have a documented track record of a commitment to continuous professional practice and personal, immersive, contemplative practice.
You’ll find that all of the programs mentioned here, including our Mindfulness Skill Training in Medicine (MSTM) program, are based on sound science and a commitment to excellence.
Davidson, R. J., & Kaszniak, A. W. (2015). Conceptual and methodological issues in research on mindfulness and meditation. American Psychologist, 70(7), 581–592. https://doi.org/10.1037/a0039512
Goldberg, S. B., Wielgosz, J., Dahl, C., Schuyler, B., MacCoon, D. S., Rosenkranz, M., Lutz, A., Sebranek, C. A., & Davidson, R. J. (2016). Does the Five Facet Mindfulness Questionnaire measure what we think it does? Construct validity evidence from an active-controlled randomized clinical trial. Psychological Assessment, 28(8), 1009–1014. https://doi.org/10.1037/pas0000233
Kabat-Zinn, J. (2009). Wherever you go, there you are: Mindfulness meditation in everyday life. Hyperion e-book. https://www.overdrive.com/search?q=12C84FA5-47C8-425E-B105-F6A92F559F3B
Kabat-Zinn, J. (2011). Some reflections on the origins of MBSR, skillful means, and the trouble with maps. Contemporary Buddhism, 12(1), 281–306. https://doi.org/10.1080/14639947.2011.564844
Nash, J. D., & Newberg, A. (2013). Toward a unifying taxonomy and definition for meditation. Frontiers in Psychology, 4. https://doi.org/10.3389/fpsyg.2013.00806
Singer, T., & Bolz, M. (Eds.). (2013). Compassion: Bridging practice and science. Max-Planck-Institut für Kognitions- und Neurowissenschaften. http://nbn-resolving.de/urn:nbn:de:101:1-2014012819982
Van Dam, N. T., van Vugt, M. K., Vago, D. R., Schmalzl, L., Saron, C. D., Olendzki, A., Meissner, T., Lazar, S. W., Kerr, C. E., Gorchov, J., Fox, K. C. R., Field, B. A., Britton, W. B., Brefczynski-Lewis, J. A., & Meyer, D. E. (2018). Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation. Perspectives on Psychological Science, 13(1), 36–61. https://doi.org/10.1177/1745691617709589