7 Questions About Mindfulness That Still Need An Answer

Ed Halliwell on the next frontiers in mindfulness. 

It’s been a year since I updated this blog—a combination of teaching, book-writing, and a baby have squeezed the time I’ve had available for other things. Now with a little more space, I wondered how to begin again, especially with so much note-worthy happening in the world of mindfulness in the last 12 months.

To set some intention, I wrote down a list of seven mindfulness-related questions that seem live and unresolved. Many of them are concerned with the continuing rapid expansion of interest in mindfulness, and the possible opportunities and challenges this presents. I plan to touch on each of them more fully in the coming weeks and months.

The list isn’t meant as definitive or exhaustive, and there may not (yet) be clear answers to any of the questions. I would very much welcome your additions, disagreements, or any other comments. I will do my best to reflect on and address them in future posts.

1. Mindfulness is being adopted by the mainstream very quickly. Does this help or hinder the movement?

The huge interest in mindfulness carries great potential, but urgency of pursuit caneasily leads to grasping for results, speediness, and surface-skimming. And these, of course, are the very stress-producing habits that mindfulness training is designed to address. I’ve noticed that some courses seem to be getting shorter, with less time, practice, and investment required. Is this doing participants, and mindfulness, a disservice, or can these skills really be mastered in a few weeks, days, hours or even minutes? I heard of one magazine editor recently declaring mindfulness to be ‘over’—they were already looking for the next big thing in well-being. If short attention spans and impulsivity are part of the problem, will over-simplification and impatience really be the answer?

2. How can deep, contemplative wisdom be preserved in non-religious mindfulness training?

Mindfulness is often talked of as the simple practice of ‘being in the moment.' Traditionally, meditative training is much more than this—it is embedded in ethics (how to live with wisdom and compassion), along with a pointing to the insubstantiality of our self-concepts, to which we painfully cling. These aspects are implicit (and sometimes explicit) in good mindfulness teaching, but the subtlety of their presentation means they can easily get left out, if not consciously curated. With so much science now happening in the fields of compassion, gratitude and appreciation, could these and other key evidence-based themes be integrated (or re-integrated) more explicitly into the mindfulness courses and cultures now being developed?

3. What happens when we move from the ‘I’ to the ‘We’ of mindfulness?

Until now, the modern mindfulness movement – both the science and the training - has focused on benefits to the individual. But what about the potential for changes to systems, institutions, and societies, which after all, have an impact on personal well-being (and vice versa)? If mindfulness is taught within a mindless culture, what gives? Can mindfulness start to infuse that culture with kindness, or will that culture bend mindfulness to its own ends, perhaps chipping away at its radicalism and presenting it as a palliative—a way of coping with systemic dysfunction rather than a means to change it? What might happen if the emphasis was more explicitly put on mindfulness as a social, or even political practice?

4. What are the key questions in mindfulness research?

It’s generally well-established that mindfulness courses are helpful for promoting well-being. The question to which researchers are increasingly turning towards is ‘how’? It’s been generally assumed that meditation practice is the key active ingredient in a course, but the science has been somewhat equivocal about this. Could it be that other factors are just as, if not more, important? A good mindfulness course generally provides a resonant, supportive group, and training in attitudes such as gentleness, compassion, steadfastness, appreciation, acceptance, and nurturing. How important are these to the health-producing changes that occur? What other aspects of traditional meditative training (such as ethics, exploration of self-nature, the making of commitments, the building of communities) might also be demonstrably beneficial? Are there more recent scientific discoveries (say, in the science of unconscious biases) where mindfulness training might have an impact? Early work is being carried out in these areas, and it will likely be fascinating to see the results.

5. What makes a good mindfulness teacher?

If you were looking to learn the piano, what would you look for in a teacher? Someone who loves music and can transmit their joy and passion? Someone who’s been playing themselves a long time and has a degree of proficiency? Someone who understands the pitfalls and difficulties and has the patience and skill to work with students? With no regulation of and huge demand for mindfulness courses, plus lots of enthusiasm among would-be teachers, how can we know if what’s being offered is helpful? Meditators in some traditions would be expected to train for decades before they began teaching others, and it’s often said that mindfulness is ‘caught’ as much as ‘taught,’ so will courses led by relatively inexperienced practitioners work as well? How can we help those looking for an authentic training to know what that might be, and to train those who want to deliver it?

6. What happens when a mindfulness course ends?

Many mindfulness courses are eight weeks long or less. Yet evidence and experience suggests that while remarkable changes can occur during such a short, intensive training, the possibility for deepening practice doesn’t end there—indeed, for most people, it’s only just beginning. And yet, while some teachers offer graduate courses and follow-up sessions, many people coming to the end of a mindfulness course report a sense of ‘falling off a cliff’—after a period of intensive support and learning, this ground suddenly falls away, as, frequently, does their practice, even though they are strongly motivated. In the rush to meet demand for ‘beginners’ courses, how can the yearning for connection be met, among those who’ve already started on this rewarding, challenging path?

7. Are there deeper reasons to practise than stress-reduction?

Reports in the media about the benefits of mindfulness can seem like a constant stream of good news – mental health, physical health, relationships, behavioural habits, competency, and creativity can all be improved, while stress relating to all sorts of circumstances can be reduced. This is excellent of course, but what about the aspects of being alive that are less easy to face up to? Does mindfulness have a role, for example, in working with the knowledge that we, and everyone we love, is going to die?

With all the focus on quick gains to health and happiness, there may be something deeper to these practices that our positive-results focused science and culture is missing. If so, could it be spoken of, perhaps not in the language of data, but with the language of the heart? ‘Turning towards difficulty’ is at the very core of a mindfulness course, but with our habits of avoidance, it’s also perhaps the aspect that gets talked of the least, at least in mainstream media reports. How can courage (and airspace) be found for the uncertainties, the anxieties, the suffering, the losses that can come into awareness when we pay attention, as well as the material benefits that we get so excited about? Indeed, could it be that the receiving of these benefits actually depend on our willingness to turn towards unpalatable truths? By neglecting them, might we receive a lesser version of the wellbeing we crave, and miss out on a deeper sense of meaning and value—one that can’t easily be summarized in a newspaper headline, or a scientific study abstract?

Dispatches: Mindfulness in Society Conference 2013

Ed Halliwell, Mindful's "Examined Life" blogger, explores key findings and discussions from the conference. 

A remarkable week for mindfulness in the UK. Five hundred delegates have been attending the fully-booked Mindfulness In Society conference, braving unseasonal snow to converge on the northern English city of Chester. Another packed gathering follows in London as Jon Kabat-Zinn, pioneer of Mindfulness-Based Stress Reduction (MBSR), addresses a Mindfulness in Schools conference and gives a talk for the influential Action For Happiness movement.

The demographics of this weekend’s conference were interesting. A fellow attendee told me on arrival there were ten women here for every man. Most were professionals working in the field (what’s the collective noun for mindfulness teachers? A presence? An inquiry? An invitation?) and there has been a strong sense of shared appreciation at feeling part of a growing community. Jon Kabat-Zinn once had a vision that skilled and committed meditators might make an ethical living sharing their practice for the benefit of others. Walking around the conference hotel, that vision came to life around him. Chester felt like an attentive, non-judgemental place to be the last few days.

Saturday was the start of the conference proper, and the wealth on offer—dozens of presentations on various aspects of meditation research—felt at times overwhelming. It was a challenge to stay centred in the heart with so much material that engaged the head. With the question ‘are mindfulness courses helpful?’ seemingly settled among scientists, the major focus of study seems now to be shifting to how they help—the so-called mechanisms of mindfulness.

Shauna Shapiro, associate professor of counselling psychology at Santa Clara University and one of several visitors from the US, gave a passionate keynote on the importance of intention and attitude (or, quoting Jack Kornfield, “setting the compass of your heart”). Emphasising that mindfulness is a way of shifting our relationship to experience—re-perceiving—Shapiro suggested this was an extension of developmental stages that human beings go through as children, but which continue further if we consciously practise. As youngsters we realise we are not fused with other people, and in meditation we see we are not fused with our thoughts. When this unfolds, the separate sense of self, which emerged as we grew up, falls away again, this time not into unconscious fusion but to ‘simply awareness happening’. As the sense of self drops away, so can the suffering that comes with it.

This was a theme warmed to by one of the day’s later speakers, John Teasdale, co-developer of Mindfulness-Based Cognitive Therapy (MBCT). Teasdale reflected on why zebras don’t get ulcers—unlike humans, they don’t abstract into past or future rumination, with all the stress that creates. But rather than romanticising the simple (and limited) life of a zebra, Teasdale explained that by holding our minds in kind awareness, we can move into what he called ‘post-conceptual knowing’—allowing the benefits of planning, reflecting, and learning, without the attendant distress. An enlightened zebra, perhaps?

With his complex models of modes of mind (not to mention the rest of a day jammed with ideas and data), Teasdale warned that our minds might get full, and so it was a delight to be released into a day of practice on Sunday, led by Kabat-Zinn. To the bemusement and amazement of hotel staff, their buzzing guests suddenly went silent and spent the day sitting quietly and attentively, with occasional breaks for walking and eating meditation in the foyers (cue even more bemusement and amazement). As our teacher joked from his meditation cushion at the centre of the stage: “It seems like something’s happening, and yet nothing’s happening.”

"If you're tweeting that you're meditating with Jon Kabat-Zinn, then you're not!" Kabat-Zinn warmly warned conference-goers.

Warm, funny, sharp, humble and wise, it’s difficult to convey the joy of spending a day practising with Kabat-Zinn, and he effortlessly riffed his way through zen koans, cutting-edge science, the perils of technology (“If you’re tweeting that you’re meditating with Jon Kabat-Zinn, then no, you’re not!”), stories from the early days of MBSR and the need for a new medical paradigm that nurtures what’s already right with people rather than just focusing on their ailments. Gently prodding his audience to greater insight through guided practice and keen dialogue, he reminded us it was time to live up to our species’ Latin name – homo sapiens sapiens (“Beings that know that they know”).

The day concluded with a celebratory dinner, prefaced by a stirring speech from UK Member of Parliament, Chris Ruane, who has recently tabled more than 400 mindfulness-related questions in the House of Commons. A confirmed advocate of mindfulness in politics, Ruane has rounded up an all-party group of MPs and Lords to take an eight-week mindfulness course, the final session of which Kabat-Zinn will be invited to address later this week.

Kabat-Zinn continued with a keynote yesterday morning, expanding on the need for a healthcare rather than a ‘disease-care’ system. He pointed out that meditation and medicine have the same derivation (meaning “right inward measure”), and that the Buddha’s four noble truths are actually a medical diagnosis (including favourable prognosis and treatment plan) that came from a physician who claimed to be not a God, but simply an awake person. He highlighted Norman Farb and colleagues’ 2007 study which showed that teaching people mindfulness enables them to shift their brain activity from the default, narrative network (active when we default to thinking in conceptual terms, often about ourselves) to an experiential network which comes on-line when everything—including us—is felt as more of an unfolding process. Concluding with a quote from Einstein (“The true value of a human being is determined primarily by the measure and the sense in which he has attained to liberation from the self”), it felt that we had come full circle from Shauna Shapiro’s opening talk two days earlier.

The conference continues until Tuesday, with presentations and dialogue on topics such as Mindfulness in The Workplace and the ongoing integration of mindfulness-based approaches into the UK National Health Service (MBCT has been a government-body approved treatment here since 2004), before the focus shifts south to London. We were reminded several times over the weekend that mindfulness remains “just a pimple on the elephant” in terms of its global influence, but is nevertheless becoming “a liberative meme” with the potential to relieve all manner of suffering in a stricken world. Something mindful surely seems to be happening in the UK right now, even if, in words Kabat-Zinn borrowed from our own William Shakespeare, it looks like much ado about nothing.

Mindfulness: Not Just "Brain Training"

I love that mindfulness practice is being investigated by science, and fascinated that many of the shifts reported by meditators throughout the ages are being corroborated by scientific evidence. The benefits of this are great—objective evaluations of practice can be encouraging, especially to those who might not otherwise be attracted to a "spiritual" discipline such as meditation.

Still, I often wonder if something is lost if we rely too much on scientific method and language as our way of approaching this work. I’ve written before about howscientific findings can bring expectation of future results, and that this can sometimes sabotage our mindfulness, taking us further into the stress of unfulfilled desire and out of the present moment. But I suspect there may be another risk too—that of unconsciously narrowing our experience into a conceptual frame.

Mindfulness is often spoken of these days as "brain training," especially in business settings. I do it myself sometimes, as a way of making sense of neuroscientific findings that show activity and structure in the brain can shift as a result of practice. This is fine, but traditionally, meditation has been considered more of a heart training than a brain training—a way of helping us to open our hearts to ourselves, others and the world. Indeed, the Sanskrit word sometimes translated as mind (citta) also means heart, and so mindfulness, as Jon Kabat-Zinn suggests, might just as well be called heartfulness.

Because scientific research is a matter of third-person observation, a conscious distancing in order to observe, and also a matter of logical interpretation, which happens at the level of thought and analysis, something of this heart quality can be missed when science is our only mode of engaging with things. The brain is an important organ, of course, but it’s interesting how much weight and attention is given to neuroscientific research as compared to evidence about what’s going on in the body. Brain is king, it seems.

On mindfulness courses, people often experience a realization that our supposedly logical minds, represented by the brain, are not always that logical—our thoughts are riddled with biases and preconceptions. Our thoughts are not as powerful as we make them out to be, and trying to think our way out of stresses or emotional upheavals is not usually very effective. The work of mindfulness for many of us, then, is a letting go of attachment to what’s going on in our heads, and a reacquaintance with what’s happening in our bodies—a willingness to connect with the feeling and tone of experience. This reorientation process makes us feel more balanced and whole, and often, more friendly, compassionate, and open.

Of course, thought is not bad—sometimes we just need to relate to it a little differently, realizing that it is only a part of who we are, and that our ruminations don’t have to dominate. Instead, many of us have swallowed not only "I think, therefore I am," but "what I think is who I am." When we come to mindfulness practice, part of what we’re doing is letting go of some of these apparent certainties and coming into a more fluid, more uncertain, but also richer and more rewarding way of being. As we let go of fixating on thoughts, we can feel the textures of our lives more exquisitely—we can get in touch with the heart of things. This is mindfulness as art, and it has rather a different flavor—juicy, vibrant, bubbling—than mindfulness described as "brain training," which on its own can sound rather flat and dry.

Our challenge, perhaps, is reject neither science nor art but to integrate the richness of experience with the clarity of observation. Indeed, isn’t bringing these two modes together an important aspect of what mindfulness really is?

Forget "Starve a Cold, Feed a Fever." Meditate!

Every now and then, a piece of mindfulness research turns up that I get excited about, not just because it tells us more about the potential benefits of practice, but because I know it’s going to make it easier to explain those benefits to others.

This is usually because a) the study is easy to describe b) it connects with an experience that most of us empathize with and c) it offers a clear picture of how mindfulness helps. I felt one of those waves of excitement (a springy sensation in the solar plexus) when I read Bruce Barrett’s latest study, which looks at whether there’s a relationship between starting a mindfulness practice or exercise regime and the subsequent incidence of respiratory infections. Would taking a mindfulness course or exercise have an effect on how often people caught a cold or the flu, and how sick they felt when they did fall ill?

The study ticks all three boxes. First, the study design was simple: Barrett and his colleagues at the University of Wisconsin randomly assigned 149 people (aged 50+) to either a mindfulness-based stress reduction course, an equivalent exercise program, or a control group given no particular instructions to follow. Then they tracked how often they fell prey to a cold or the flu over the following months. It ticks the empathy box because everyone knows what it’s like to get a chest infection and can see the value of succumbing less often. And the results are clear – compared to those in the control group, people who took the mindfulness course had four times fewer "sick days" (16 compared to 67), fewer bouts of infection (27 compared to 40), and were ill for just over half as long, with less severe symptoms. Given that a flu vaccine reduces incidence of infection by around 60-70 percent (and only works for some strains), this suggests that meditation practice, associated with a 40-50 percent reduction,  may be a pretty good alternative or addition – that’s box three ticked.

Including an exercise group for comparison was a bonus stroke of genius. Everybody understands that exercise is good for you, and it probably isn’t a surprise to learn that the group who worked out also got sick less often. But the discovery that mindfulness matched the exercise program in its protective impact really brings home a message – that meditation is good for you in about the same measure as  exercising, which most everyone agrees is a jolly healthy thing to do. In some aspects, mindfulness may be more effective – the fewer reported "sick days" and reduced symptom severity among the meditating group might suggest the practice helped them manage illness sensations more easily – perhaps, they were able to experience symptoms more mindfully, without being overwhelmed or struggling with them, as often happens when we get ill?

Americans suffer around 500 million colds between them each year, costing some $40 billion in lost work days, doctors’ visits and medicines. There  are currently no proven ways of protecting from a cold (apart from hand-washing and avoiding infected people) so it’s not hard to see the public health benefits of encouraging practices that might reduce incidence and severity to such a large extent.

Of course, being the first study of its kind, this research needs replicating, but as we already know that meditation reduces stress, and that stress damages the immune system, there are very plausible mechanisms to explain this rather spectacular-seeming result. It’s also worth remembering that one of the best-known trials of mindfulness-based stress reduction found increased antibody response to a flu vaccine among course completers. Bruce Barrett’s work adds further to our understanding, and could be a big step on the way to widespread recommendation of meditation, along with exercise, as a simple and effective way of looking after your well-being.

Do I need to meditate to be mindful?

This is one of the most common questions I'm asked by people wondering if mindfulness is for them. There’s often a subtext behind the inquiry: most mindfulness courses ask participants to practice for up to 45 minutes a day, the suggestion being that this will be a vital part of the learning process. Forty-five minutes a day seems a lot of work for most people, especially in a culture where sitting still and "doing nothing" for any time at all is unusual. If mindfulness just means paying attention, why can’t I do that without having to meditate? Can’t I just decide to notice things a bit more?

Well, ask yourself this—Can you just decide to be good at tennis? Or speak French? Or play the piano? While some of us might have more of an aptitude for learning skills like these, they still have to be practiced. We have to put some effort in. Evidence from the clinical and neuroscientific studies of mindfulness suggests that paying attention is an art to be cultivated in just the same way—we can develop our capacity for awareness through training. It’s also what meditators down the ages have reported.

The more we do something, the more we’re likely to continue to do it, and to do it well—this is how habits form, and skills are acquired. So it makes sense that the more we practice meditation—the art of paying attention—the more mindful we will find ourselves.

Perhaps one of the disadvantages of the gradual shift away from the use of the wordmeditation and towards the word mindfulness is that meditation conveys more of a sense of this being a practice, and not just a given attribute. "Deciding to be mindful" is something that comes from the head, a thought, whereas "practicing meditation" brings more of a sense of embodiment with it. If we want our mindfulness to be something we are, more than just a thought of something we’dlike to be, it seems we need to cultivate it through meditation.

There’s one caveat to this—the science doesn’t yet tell us clearly how important meditation practice is to mindfulness. Lots of studies suggest that engaging in periods of meditation shifts our brain, body and experience in seemingly beneficial ways. What’s less clear is the effect of meditation practice over a period of time on those changes—is it this or something else that leads to the benefits seen?

Tradition, logic, and some strong scientific indicators say the meditation practice is key, but we still can’t be quite sure. Indeed, one review of the impact of practicing meditation during a mindfulness course found much less of a link between practice time and results than received wisdom might have predicted. While there is plenty of evidence suggesting a causal link, it’s early days in the research literature, and it would be good to see some studies which compared the effect of mindfulness courses with (and without) a home practice component. For now, the jury’s out on just how important formal meditation is to cultivating mindfulness.

Today, as I meditated at lunchtime in the churchyard outside our house, I wondered at the magnificent storm clouds billowing low across the hills on the horizon, felt waves of cascading energy flow through my body as the busyness of my morning—and my mind—subsided into moments of inner quiet, letting go into a grace of appreciation at having the senses to experience such a scene. I felt content, tired, a bit wet (raindrops on the grass below) and far more present than when I’d sat down to practice. Whatever the effect of meditation on my general mindfulness and well-being, experiences like that—the sense of opening into a vivid and vibrant aliveness—feel precious enough to be worth a lot by themselves. Anything else I’ll take as a bonus.