Mindfulness – non-judgmental, purposeful awareness – is undeniably making inroads into medical practice. Many clinicians are finding success using mindfulness-based interventions (MBIs) for chronic pain and mental illness. Still, the question remains: what do we know about how mindfulness “works” and which clinical applications are effective?
In a recent special issue of Current Opinions in Psychology, over 100 scientists – writing in 57 different papers – addressed the state of mindfulness research in medically relevant areas, including sleep, epigenetics, pain, aging, general physical health and neurobiology. David Vago, Ph.D., research director of the Osher Center for Integrative Medicine at Vanderbilt University Medical Center, was an editor and contributor for the issue. He says that the future of mindfulness as a health-related intervention depends on having more empirical data to support it.
“We have solid evidence that mindfulness meditation can improve symptoms of depression, anxiety and the emotional component of pain.”
“We have solid evidence that mindfulness meditation can improve symptoms of depression, anxiety and the emotional component of pain,” Vago said. “We are coming to a level of precision in our theoretical understanding of mindfulness, but we still have a lot of science to conduct in order to say something more definitive and generalizable to the population.”
Mindfulness and Chronic Pain
Vago notes there is already strong evidence supporting MBI for some ailments, including alleviating chronic pain, a growing epidemic in the U.S. According to the CDC, 50 million U.S. adults have been in pain every day for the past six months. “That’s about 11 percent of the U.S. population. Over $600 billion is lost in medical expenses and lost work productivity every year,” Vago said.
Experts postulate that mindfulness changes an individual’s subjective experience of pain through acceptance-based strategies. As an adjunct to other forms of treatment, mindfulness can improve coping and affect the underlying mechanisms of pain perception and its regulation. Patients with chronic pain are instructed to deliberately open up to distressing sensations without reaction or judgment.
With practice, this leads to measurable changes in brain activity in sensory regions when a person anticipates or experiences pain. “Non-experienced meditators show high brain activity in anticipation of pain and perseverate about it after the stimulus ceases. In contrast, experienced meditators show almost zero brain activity in anticipation of the pain. They actually experience pain more intensely than non-experienced meditators, but they recover faster and experience less distress,” Vago said.
Strengthening the Case for MBIs
Despite 6,000 plus papers published, research on mindfulness is still in its infancy, Vago said. “Everyone agrees that we need larger, controlled studies. We need to compare mindfulness in an eight-week intervention to well-matched gold standard treatments like cognitive behavioral therapy, opiate pharmacotherapy or antidepressants.”
Further, most studies have used self-report measures of mindfulness, which have been criticized for insufficient validity. Future research should integrate multiple modalities, such as using functional MRI and EEG measurements to measure changes in brain morphology and function in response to MBIs, and subjective experiences. Vago points to phenomenological interviewing techniques that complement objective neuroimaging or behavioral performance as an example of how scientific rigor is improving.
Propelled in part by the NIH’s interest in non-pharmaceutical interventions, MBIs are being studied, refined, and deployed in the medical context, specifically as part of an integrative approach to whole-person health. Meanwhile, researchers are working hard to ensure that the underlying science both keeps pace with and informs MBI development and rollout.
Numerous authors in the special issue are driving research on MBI efficacy for conditions like anxiety, depression, psychosis and other mental illnesses. Vago believes chronic pain is the most pressing public health issue MBI can address. “Deaths from opioids are five times higher today than they were in 1999 and we need to come up with proven strategies for helping these people. Mindfulness is a non-pharmacological alternative to opioids,” Vago said.
“If we want to be able to deliver mindfulness as a health-related intervention, then we have to have the empirical data to support it.”