Willoughby Britton

Mindfulness and meditation need more rigorous study to identify impacts

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Dependable scientific evidence has lagged worrisomely behind the rapid and widespread adoption of mindfulness and meditation for pursuing an array of mental and physical wellness goals, wrote a group of 15 experts in a new article in Perspectives on Psychological Science, a journal of the Association for Psychological Science. The article offers a “critical evaluation and prescriptive agenda” to help the burgeoning mindfulness industry replace ambiguous hype with rigor in its research and clinical implementations.

Recent years have seen a huge surge not only in media and scientific articles about mindfulness and meditation, the authors wrote, but also in the implementation of medical interventions for everything from depression to addiction, pain and stress. The widespread adoption of therapies has put the field at a critical crossroads, the authors argued, where appropriate checks and balances must be implemented.

“Misinformation and poor methodology associated with past studies of mindfulness may lead public consumers to be harmed, misled and disappointed,” they wrote.

Co-author Willoughby Britton, an assistant professor of psychiatry and behavior at the Warren Alpert Medical School of Brown University said: “We are sometimes overselling the benefits of mindfulness to pretty much any person who has any condition, without much caution, nuance or condition-specific modifications, instructor training criteria, and basic science around mechanism of action. The possibility of unsafe or adverse effects has been largely ignored. This situation is not unique to mindfulness, but because of mindfulness’s widespread use in mental health, schools and apps, it is not ideal from a public health perspective.”

Lead author Nicholas Van Dam, a clinical psychologist and research fellow in psychological sciences at the University of Melbourne in Australia, said that the point of the article is not to disparage mindfulness and meditation practice or research, but to ensure that their applications for enhancing mental and physical health become more reflective of scientific evidence. So far, such applications have largely been unsupported, according to major reviews of available evidence in 2007 and again in 2014.

“The authors think there can be something beneficial about mindfulness and meditation,” Van Dam said. “We think these practices might help people. But the rigor that should go along with developing and applying them just isn’t there yet. Results from the few large-scale studies that have been conducted so far have proven equivocal at best.”

Added co-author David E. Meyer, a professor of psychology at the University of Michigan, “Sometimes, truly promising fields of endeavor get outstripped by efforts to harvest them before they’re really ripe; then workers there must step back, pause to take stock, and get a better plan before moving onward.”

A young, undefined field

Among the biggest problems facing the field is that mindfulness is poorly and inconsistently defined both in popular media and the scientific literature. According to the authors, there “is neither one universally accepted technical definition of ‘mindfulness’ nor any broad agreement about detailed aspects of the underlying concept to which it refers.” As a result, research papers have varied widely in what they actually examine, and often, their focus can be hard to discern.

“Any study that uses the term ‘mindfulness’ must be scrutinized carefully, ascertaining exactly what type of ‘mindfulness’ was involved, what sorts of explicit instruction were actually given to participants for directing practice,” the authors wrote. “When formal meditation was used in a study, one ought to consider whether a specifically defined type of mindfulness or other meditation was the target practice.”

“Without specific, well-defined terms to describe not only practices but also their effects, studies of interventions such as mindfulness-based stress reduction (MBSR) cannot provide valid and comparable measurements to produce reliable evidence.” As part of its proposed remedy, the new article offers a “non-exhaustive list of defining features for characterizing contemplative and medication practices.”

Greater rigor

Along with specific, precise and standardized definitions, similar improvements in research methodology must also come, the authors wrote.

“Many intervention studies lack or have inactive control groups,” Van Dam said.

The field also has struggled to achieve consistency in what it is being measured and how to measure those things perceived to be of greatest importance to mindfulness.

Van Dam said the situation is akin to earlier psychological research on intelligence. This concept proved to be too broad and too vague to measure directly. Ultimately, however, psychologists have made progress by studying the “particular cognitive capacities that, in combination, may make people functionally more or less intelligent,” he and his co-authors wrote.

Thus, the authors wrote, “We recommend that future research on mindfulness aim to produce a body of work for describing and explaining what biological, emotional, cognitive, behavioral and social, as well as other such mental and physical functions, change with mindfulness training.”

Clinical care

A wide variety of contemplative practices have been studied for an even larger variety of purposes, yet in both basic and clinical studies of mindfulness and meditation, researchers have rarely advanced to the stage where they can confidently conclude whether particular effects or specific benefits resulted directly from the practice. Measured by the National Institutes of Health’s stage model for clinical research, only 30 percent of mindfulness-based interventions (MBIs) have moved past the first stage, and only 9 percent have tested efficacy in a research clinic against an active control.

“Given the absence of scientific rigor in much clinical mindfulness research, evidence for use of MBIs in clinical contexts should be considered preliminary.,” the authors wrote.

The proposed agenda for future research is rigorous and extensive, Van Dam said.

“Replication of earlier studies with appropriately randomized designs and proper active control groups will be absolutely critical,” the authors continued. “In conducting this work, we recommend that researchers provide explicit detail of mindfulness measures, primary outcome measures, mindfulness/meditation practices and intervention protocol.”

Researchers and care providers involved with delivering MBIs have begun to become more vigilant about possible adverse effects, the authors wrote, but more needs to be done. As of 2015, fewer than 25 percent of meditation trials actively monitored for negative or challenging experiences.

Contemplating contemplative neuroscience

Van Dam said recent efforts to assess the neural correlates of mindfulness and meditation with technologies, such as magnetic resonance imaging (MRI) and magnetoencephalography, may perhaps have the potential to bring new rigor to the field. Nonetheless, he and his co-authors also express concern in the article that these technologies so far have not fulfilled this potential.

The authors note that technologies such as MRI depend on subjects remaining physically still while being tested, and image quality can be affected by subjects’ rate of breathing. Experienced meditators may be better suited to maintaining ideal physiological states for MRI studies than are inexperienced individuals or non-meditators. Due to such problematic factors, between-group differences in brain scans might have little to do with the mental state researchers are attempting to measure and much to do with head motion and/or breathing differences.

“Contemplative neuroscience has often led to overly simplistic interpretations of nuanced neurocognitive and affective phenomena,” the authors wrote. “As a result of such oversimplifications, meditative benefits may be exaggerated and undue societal urgency to undertake mindfulness practices may be encouraged.”

Ultimately that’s the authors’ shared concern: Insufficient research may mislead people to think that the vague brands of “mindfulness” and “meditation” are broad-based panaceas when in fact refined interventions may only be helpful for particular people in specific circumstances. More, and much better, scientific studies are needed to clarify these matters. Otherwise people may waste time and money, or worse, suffer needless adverse effects.

“This paper is a coordinated effort among concerned mindfulness researchers and meditation scholars to rectify this gap to maximize benefit and minimize harm from MBIs,” Britton said.

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On becoming disconnected from oneself in meditation

I often receive questions by email. Although I’ll sometimes reply directly to them, it strikes me that the best use of my time is to share my responses publicly, so that others might benefit.

Here’s the question, which came from someone who I’ll call Josh.

For a while now, I have been meditating and my body has remained tense – as I am usually quite tense – but my mind relaxes, but in a negative way; it is as if I begin to mentally and emotionally feel numbed out and lost. I would like to be able to meditate on the tension, on emotions, on really anything that’s going on within me, but I end up frustrated and confused because I feel that sense of numbed out and unable to reconnect. I wanted to ask if this is as at all common and if you had any suggestions on how to reconnect and deepen the practice regarding this issue.

Decades ago, when I was first starting to practice meditation, I’d occasionally hear warnings from my teachers about how certain approaches to practice could result in emotional “alienation.” The founder of the tradition in which I practice had come back to the UK from India, and came across (or heard about) a few individuals who had become disconnected from their own experience to the extent that they were “robotic.” One of the things they’d been doing, apparently, was “noting,” which means adding a silent mental note, describing what’s going on in one’s experience.

Noting in this way can be a valuable practice, helping us to be more mindful and clear. But in the case of these people, the mental experience of noting became a replacement for the actual physical experience that was being described. While saying “arm lifting, arm lifting” and “sipping tea, sipping tea,” the thoughts, rather than the actual physical experiences, had become the focus of attention. And having become disconnected from the body, emotional disconnection would follow. Apparently some people became hospitalized as a result of this emotional disconnection, which we now call “depersonalization.”

Despite having heard warnings about the danger of this, I never actually came across anyone who seemed to have suffered in this way. But in recent years (probably because on the internet you can find anything) I’ve heard several people say that this, or something very similar to it, has happened to them. The Brown University psychiatry researcher, Willoughby Britton, has started a project to document and study this and other troubling phenomena that may arise in meditation.

I don’t know if this depersonalization is exactly what’s happened with Josh. Most people who write to me about their meditation practice forget to mention what kind of meditation practice they’re actually doing, but probably he’s doing some form of mindfulness practice. He may not be doing “noting,” however.

But, mindfulness practice isn’t enough. The warnings I’ve referred to were in the context of emphasizing how important lovingkindness (metta), compassion, and other more emotion-based forms of meditation are. The Buddha himself taught a wide range or practices, and encouraged an all-round path of moral and emotional development.

The Triratna tradition in which I practice stresses the importance of balancing mindfulness practice with metta practice. I suggest to my students (as it was suggested to me) that practice consist of alternating metta meditation with mindfulness practice. One suggestion is to do these practices on alternate days, making sure that you don’t skip one of them because you find it more challenging. It may, however, be acceptable to focus on one practice more intensively if it’s genuinely needed. For example when you’re exceptionally distracted, you might focus more on mindfulness for a few days, or if you’re in a chronic bad mood or tend to be very critical you might want to do much more metta practice for a while—perhaps even for weeks or months.

There are other practices that are useful as well. Kalyana mitrata (spiritual friendship) is a valuable way to connect with others on an emotional as well as an intellectual level. Devotional practice can also awaken the heart. Physical exercise and the enjoyment of the arts are also ways that we can stay in touch with our emotions.

One thing to beware of is long periods of intensive practice that involve only mindfulness. Some people do fine with that, but if there’s a tendency to lose touch with the emotions, then it would be best not to be too “gung-ho” about practice, and to be gentle with oneself.

My advice to Josh would be to stop whatever practice he’s currently doing and to take up lovingkindness and compassion practice. I’d suggest focusing exclusively on those for at least six months. If possible he should connect with a sangha (a flesh and bones one rather than an online one) on a regular basis. A sangha that encourages discussion and friendship would be more valuable than one in which people merely sit together but don’t socialize or even communicate much. And the other things I’ve suggested—physical exercise and enjoyment of the arts—are something I’d also strongly encourage. Retreats focusing on lovingkindness and compassion might also be helpful.

Fortunately what Josh describes isn’t common. And I’m fairly sure that the approach I’ve described will be helpful. I’ve taught thousands of people to meditate and so far I’ve never heard of this kind of depersonalization happening to anyone I’ve known.

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Mindfulness is something worse than just a smug middle-class trend

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Separating meditation from faith is a dubious business, morally and sometimes in its effects

Melanie McDonagh, The Spectator: The chances are that by now either you or someone you know well has begun to practise ‘mindfulness’ — a form of Buddhism lite, that focuses on meditation and ‘being in the now’. In the past year or so it’s gone from being an eccentric but harmless hobby practised by contemporary hippies to a new and wildly popular pseudo–religion; a religion tailor-made for the secular West.

Think how hostile an awful lot of companies are to organised religion; to any talk of ‘faith’. Now consider that in both America and the UK, it’s probably easier to count on your fingers the number of institutions that aren’t engaging in ‘mindfulness’ than those that are; giving ‘mindfulness’ teachers special spaces to have classes and encouraging staff to take part.

The mindful include Google, Kensington and Chelsea council, the European Central Bank and the US Marines. The NHS is funding mindfulness sessions for depression as an alternative to pharmaceutical interventions. There’s an all-party mindfulness group in parliament, which Ruby Wax helped launch. Richard Layard, Britain’s ‘happiness guru’, is all for it. Madeleine Bunting has suggested in the Guardian that it should be mandatory in schools. Indeed, if you find yourself on a train with a fellow traveller gazing at you benevolently, it’s possible that they’re not insane but just radiating mindful compassion.

It’s been touted as a cure for pretty well everything, from depression, stress, anxiety and chronic pain to eczema. And for those who can’t manage the group sessions, there’s a handy app called HeadSpace which enables you to do mindfulness on the go from your smartphone and now offers a bespoke service. The app was invented by Andy Puddicombe, a fortysomething former Buddhist monk with a degree in circus arts. According to the New York Times,‘Puddicombe is doing for meditation what Jamie Oliver has done for food.’ Certainly mindfulness is doing for Puddicombe what food has done for Jamie Oliver, because he’s now worth about £25 million.

So what exactly is mindfulness? On the back of a week of sessions, I can assert with some confidence that it’s about being very much in the present moment. You’re encouraged to become aware of your breathing, your body and your surroundings. Plus you’re meant to view people and things in a compassionate, non-judgmental spirit. Think meditation, think Buddhism, and you’re there, so long as you don’t forget the breathing.

It’s ubiquitous, non-invasive and involves sitting quietly and not judging anyone. Guided, communal meditation, let’s say. Anyway, you may be thinking, what do you actually do when you’re being mindful? What actually happens? Well, normally you sit in a semi-circle in a group — anything from five or so to a couple of dozen of you, though some sessions led by the gurus of the movement can muster hundreds. It’ll be a nice quiet place, possibly with candles. Most sessions start off with an exploration of how stressed we all are. The teacher fills a chart with examples — your Tube journey? Your week at work? — and invites participants to stick up their hands if they’re stressed. Everyone does. Then there may be a bit of neurology with diagrams on the chart, showing how we’re all using the fight-or-flight bit of our brain inappropriately, as opposed to the new neurological pathways we can make by reprogramming our brains to chill out through meditation. Then there’s the conscious breathing. It may be preceded by contemplating a leaf or a glass of water before you start focusing on your breath coming in and going out. At which point, as Dorothy Parker would say, you find me and Morpheus in the corner, necking. But the routine varies. At one session, one girl, invited to imagine herself as a tree, plaintively cried: ‘Please can I not be a tree? I was dreading on the way here that I’d have to be a tree.’

Then we share our experiences. Finally we get round to compassion. In one slightly unsettling session, we were invited to pick a person to project compassion at. I selected the Turkish lady opposite; she looked a little uneasy. At another class we were invited to recite: ‘May I/you be well; be happy; be free from suffering’ — and we concluded by saying it for someone we dislike. I would have been fine, in a love-your-enemy way, if the teacher hadn’t declared that the person she really hated was Chris Grayling, the Justice Secretary. Which was a bit rich in a practice meant to teach you to go easy on judgmentalism.

That’s the format, then, and the heart of it is sitting in silence, thinking about your breath going in and out. I must say I’m not very good at this sort of thing. I’m the most judgmental person I know. My mind hops about like a flea. I dropped off during every single one of my mindful breathing sessions. But that’s fine; apparently it just shows how tired we all are. As for the distracting thoughts, they’re fine too, so long as you let them go, possibly like little clouds.

And for some people, all this is to the good. It makes them less stressed, more usefully focused on the here and now. Dr Anthony Seldon has made mindfulness part of the way of life at Wellington College, where he is headmaster. ‘Properly done,’ he observes, ‘it’s the opposite of mindlessness. It helps people to be self-aware, to collect themselves, to be thoughtful before they decide what to do.’ So obviously handy during exams, though he says the benefits go way beyond that.

The evidence seems strong that mindfulness helps with depression, although some dissident psychiatrists suggest the method-ology behind the positive studies hasn’t been as rigorous as it might be. ‘Many of the studies are small, are pilot studies and are carried on those who are not very ill,’ says Professor Patricia Casey of University College Dublin. ‘So they would be at the mild end of the spectrum. Studies have not sufficiently frequently investigated how mindfulness compares with other therapies including pharmacological interventions. Neither have researchers paid much attention to what the active ingredient is — is it being looked after, or looking after oneself?’

I would suggest also that if mindfulness helps with mental health, then let’s not forget that so does organised religion. This ‘active ingredient’ isn’t some new miracle cure: it’s the same grounding effect that Christianity has, or Judaism, or any prayerful religion. We’ve all, over the years, seen studies show that religious people are happier, and that both meditation and prayer are beneficial to the brain. Mindfulness can join the queue. Seldon’s 21st-century boys may find it beneficial to meditate, but their 20th-century counterparts may have found it just as calming to sit in the chapel for morning prayers and just as bonding to sing hymns together. Mind you, at Wellington, they do both.

One of the difficulties mindfulness will face as it sweeps across the globe is that it quite clearly in fact is a religion, however much it might shy away from the word. It’s remarkable the number of classes advertised with the caveat ‘No religious content’, which of course makes it palatable to the growing number who shy away from religion. It’s ritual for those who don’t pray; communal practice for the individualist. It’s non–doctrinal, non-prescriptive, non-demanding in terms of conduct apart from an insistence on not being judgmental. It seems to be the perfect religion for a Britain which is in full flight from its state church. Most other religion substitutes — the Sunday Assembly gatherings for atheists, for example, which Andrew Watts wrote about in this magazine back in February — are self-consciously modelled on Christian services. But mindfulness is squarely based on Buddhism. In fact, from the focus on breathing to the insistence on compassion, it really is Buddhism. At one interesting class I attended in a Buddhist temple — gold images galore — the teacher declared cheerfully that this mindfulness session was going to be a cut above the rest because it got you to the fons et origo of the thing, viz. Buddhist teaching.

Taking an established religion — Buddhism in this case — and picking bits from it piecemeal can be a more dangerous business than it might seem. However much people may dislike the idea, the major world religions have developed incrementally over time to be a comfort and support for humans in their quest for meaning. Even the seemingly eccentric bits can serve a vital purpose, hidden from non-believers. One rejects ‘the boring bits’ of an established religion at one’s peril. Mindfulness, based as it is on meditation, is not simply a path that leads nowhere in particular. It can lead you to that dangerous place, the heart of yourself. And there you may find a great, scary emptiness, or worse, your own personal demons.

Not everyone is strong enough to confront their inner self: in that case, meditation can be an affliction, not a therapy. That phenomenon is being studied at the so-called ‘Dark Night Project’ at Brown University Medical School, where Dr Willoughby Britton deals with the psychic disturbance that meditation can sometimes cause. And that’s of a piece with Buddhist as well as Christian understanding of contemplation; that you can undergo what St John of the Cross called the Dark Night of the Soul. The contemplative life, in Christianity, isn’t for everyone. It is understood that only a few, those with a vocation for it, have the strength to take it on.

There are other aspects of mindfulness which strike me as problematic, not to say unchristian. An important element of the practice is to eschew judgmentalism; to observe and accept ourselves and our surroundings with compassion. Which sounds dandy, except that there are some things about ourselves and our situation which we jolly well shouldn’t be non-judgmental about, which we should be trying to change. One of the best things about the collective culture is that we have a strong moral sense; we consider selfish behaviour unacceptable and hold others to account. Where Buddhism causes us to go within ourselves, to meditate inwardly, Christianity takes you out of yourself — to God and from there to others. Would a ‘mindful’ Britain have the same emphasis on helping others?

This brings me to what really annoys me about being mindful, which is that as far as I can gather, it’s Mostly About Me. Sitting concentrating on your breathing is a good way to chill out and de-stress, but it’s not a particularly good end in itself. Radiating compassion is fine, but it doesn’t obviously translate into action. Where’s the bit about feeding the hungry, visiting the prisoner, all the virtues that Christianity extols? Where in fact is your neighbour in this practice of self-obsession? Given a toss up between going to church, where you rub shoulders with the old, the lonely, the poor, and anyone who cares to pitch up, and a mindfulness session where, for about 25 quid a pop, you can mingle silently with congenial souls in flight from stress, I know which seems more good and human to me. Mindfulness may be the new religion — but it’s no substitute for the old one.

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The dark knight of the soul

wildmind meditation newsTomas Rocha, The Atlantic: For some, meditation has become more curse than cure. Willoughby Britton wants to know why.

Set back on quiet College Hill in Providence, Rhode Island, sits a dignified, four story, 19th-century house that belongs to Dr. Willoughby Britton. Inside, it is warm, spacious, and organized. The shelves are stocked with organic foods. A solid wood dining room table seats up to 12. Plants are ubiquitous. Comfortable pillows are never far from reach. The basement—with its own bed, living space, and private bathroom—often hosts a rotating cast of yogis and meditation teachers. Britton’s own living space and office are on the …

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Meditation study links history to science

wildmind meditation newsAshna Mukhi, Brown Daily Herald: Meditation study links history to science; Light experiences during meditation similar to visualizations caused by sensory deprivation.

Practitioners of Buddhist meditation have reported seeing globes, jewels and little stars during meditation-induced light experiences. The neurobiological explanation for these visions was the subject of a recent study led by Willoughby Britton, assistant professor of psychiatry and human behavior, and Jared Lindahl, professor of religious studies at Warren Wilson College in North Carolina.

The study, published in the journal Frontiers in Psychology Jan. 3, connects first-hand accounts of these light experiences and reports of them from Buddhist texts to scientific literature …

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The dark side of meditation

Here’s an interesting conversation between Brown University neuroscientist (and meditation teacher) Willoughby Britton and yoga and Buddhism teacher Michael Stone. Britton, as a good scientist, is interested in cataloguing the confusing, unpleasant, and sometimes harmful effects that meditators may experience, including cognitive and sensory aberrations, emotional difficulties or challenges, changes sense of self, and disturbing physiological manifestations.

My experience is that adverse effects to meditation are rare. Some manifestations in fact may not be at all harmful and may be signs of progress in meditation (e.g. changes in the perceived relative size of different parts of the body) but might be mistaken for “going crazy.” Other manifestations — such as some people who have contacted me to discuss a complete loss of emotional affect — are clearly very destructive and need to be investigated.

Britton makes the point that some approaches to meditation have ripped mindfulness from its traditional context, where it’s embedded in a framework of practice that includes intellectual understanding, ethical observance, devotion, and practices such as the brahmaviharas, and present it as a stand-alone practice. This may work for many people, but it may also lead to problems.

The fact that meditation is not enough something I’ve written about. I’ve also written about how some people, though an unbalanced approach to practice, can become disconnected from themselves.

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