Mindfulness
In psychology, mindfulness means keeping attention on what is happening now, in the body, the surroundings or the mind, with an open and non-judging stance toward it. Researchers use the word in three ways: for a trait some people lean toward, for a state anyone can be in for a moment, and for a skill trained in programs that often run about eight weeks.
Halfway through washing the dishes, Dana sees that her mind has been on tomorrow's meeting for several minutes. She notices the thought without arguing with it, feels the warm water on her hands for a moment and keeps washing.
It isn't harmless for everyone. In one study of an eight-week program, most participants reported at least one side effect, and a smaller group reported effects that lasted. The study is described below. Anyone who is struggling with a practice may find it useful to talk it over with a doctor, a therapist or the program's teacher.
How it shows
At work
Noticing mid-email that attention has gone to a worry, and coming back to the sentence. Feeling irritation rise at a message and seeing it before typing a reply. Hearing a question through to the end.
In close relationships
Hearing a partner out while noticing the pull to prepare a defense. Noticing a tight chest at the start of an argument. Seeing the wish to fix something before it is asked for.
In ourselves
Catching the mind in a replay of yesterday and naming it as a replay. Meeting the catch with a neutral remark rather than a scolding one. Noticing a feeling in the body as it rises.
How it differs from similar ideas
Decentering
Decentering is seeing a thought as a passing event in the mind and not a fact about us. It is one way of relating to thoughts. Mindfulness is the wider term, which also covers attention to the body, sounds and surroundings.
Flow
Flow is deep absorption in a task that stretches us, and self-awareness fades while it lasts. Mindfulness keeps a light awareness of what is going on, including that attention has drifted, and it can go with a dull task as well as a gripping one.
Experiential avoidance
Experiential avoidance is the effort to escape or control unpleasant thoughts, feelings and sensations. A mindful stance stays in contact with them. The two describe opposite responses to the same unpleasant feeling.
Rumination and worry
Rumination is going around the same negative thoughts, absorbed in them. Mindful attention notices a thought as it happens, and that includes noticing a ruminative one.
What it doesn’t mean
It doesn't mean emptying the mind. The definitions researchers use describe awareness of what is happening, and thoughts count as part of what is happening. A mind that wanders and then returns is the ordinary case, and the return is part of what is trained.
It doesn't mean relaxing. Relaxation training aims to lower tension. Mindfulness asks for attention to whatever is present, calm or not. A 2014 review treated relaxation training such as progressive muscle relaxation as a separate active treatment to compare mindfulness against, and researchers have documented anxiety brought on by relaxation exercises themselves.
It doesn't mean the same as meditation. Mindfulness can refer to a mental state or a personality trait, and meditation to many practices. A 2018 review noted that a five-minute app exercise and a three-month retreat both get called meditation, and that a questionnaire score and decades of practice both get called mindfulness.
It doesn't mean a cure for everything. A 2018 review said much news coverage has presented it as a cure-all. In the trials below, the programs gave small gains on some measures and no clear gain on others, and they were not shown to beat other treatments.
An example: Dana, a sink, and eight weeks of practice
Dana is 41 and works in accounting. After a year of poor sleep and a crowded job she joins an eight-week group program in mindfulness. She sits with attention on her breathing for about fifteen minutes on most days.
- Week 1 By the third breath she is writing an email in her head. In ten minutes she loses count of how often it happens, and she decides she is bad at this.
- Week 4 The group spends a session on how ordinary the drifting is. Dana drifts as often as before. What has shifted is the next second: a short "there it goes" and a return, with less scolding.
- Week 6 One evening the sitting leaves her jittery, with a racing heart. She tells the group, and the leader talks it over with her afterward. Two days later the practice feels ordinary again.
- Three months on Her sleep is about what it was. She says the part she would keep is catching "I'm rehearsing again" before an evening is gone.
In the story, the drifting never stops. What changes is how Dana meets it. Her sleep stays about the same, and one session goes badly before it settles.
Several things in the story match how the research describes the idea. The definition is about attention and attitude, so a wandering mind is the material of the practice and a sign nothing has gone wrong. The change that Dana reports is in her stance toward her own thoughts, which fits the stated aim of MBCT, to help people disengage from gloomy thinking. And her sleep is a fair match for the review below, which found too little evidence to say that meditation programs change sleep.
The story can't say why she feels better, if she does. Eight weeks of group attention, a regular routine and the expectation of benefit would all be present with or without the breathing. Her bad evening is also on the research record: in the trial described below, many people had passing unpleasant experiences, and a smaller group had lasting ones.
What the research shows
Most of the research asks one of two questions: do programs built on mindfulness help with specific problems, and how far do the claims reach. The studies below cover a review of trials with active comparison groups, a pooled analysis for relapse in depression, a critical review by researchers in the field and a study of side effects.
Across trials with active comparison groups, mindfulness programs gave small gains for anxiety, depression and pain. Pooled trials of MBCT found fewer relapses in recurrent depression over 60 weeks. No study here showed an edge over other treatments. A critical review argued the claims outrun the evidence, and a side-effects study found passing unpleasant experiences were common and lasting ones were reported by a minority.
In 47 trials with active comparison groups, mindfulness programs gave small gains for anxiety, depression and pain, with no evidence they beat other treatments
In 2014, Madhav Goyal and colleagues pooled randomized trials of meditation programs for adults, published through November 2012. They kept only trials that compared a program with an active comparison group, such as an education class or another treatment, rather than a waiting list. They included 47 trials.
For mindfulness programs, they rated the evidence as moderate for anxiety (effect size 0.38 at 8 weeks and 0.22 at 3 to 6 months), depression (0.30 and 0.23) and pain (0.33), and low for stress and for mental-health-related quality of life. An effect size near 0.3 is small: about a third of the usual spread in people's scores. For positive mood, attention, substance use, eating habits, sleep and weight, the evidence was either low for no effect or too thin to say. The authors found no evidence that meditation programs were better than drugs, exercise or other behavioral therapies.
Doesn’t show Many of the trials were run before modern standards, and most were not registered or did not say in advance what their main outcome was. The effects are reported at 8 weeks and at 3 to 6 months, so they say little about the longer run. No evidence of an advantage over other treatments means none was shown. It does not say the two are equal.
Pooling nine trials, mindfulness-based cognitive therapy went with fewer relapses of depression over about a year
In 2016, Willem Kuyken and colleagues combined the individual patient records from nine randomized trials. The 1,258 adults had recurrent depression and were in full or partial remission when they joined. The average age was 47, and 75 percent were women. People who got MBCT were compared with people who got usual care or another treatment, including antidepressants.
Over the 60-week follow-up, the MBCT groups had a lower risk of relapse than the groups with no MBCT (hazard ratio 0.69, where a ratio of 1 would mean no difference). Against the active treatments alone, the ratio was 0.79. Age, sex, education, relationship status, age at first depression and number of earlier episodes made no statistically significant difference to the effect. Compared with other treatments, people with more severe leftover symptoms before treatment seemed to gain more.
Doesn’t show The follow-up was 60 weeks, and the people studied were between episodes, so the result says nothing about treating a depression that is under way. The searches ran to November 2014. The authors include the program's developers, and an earlier 2000 trial found a benefit only for people with three or more earlier episodes. A 2018 critical review also noted that the match with antidepressants had so far been shown only tentatively.
Fifteen researchers argued that claims for mindfulness have run ahead of the evidence
In a 2018 article, Nicholas Van Dam and 14 co-authors, researchers in the field, reviewed what is and isn't known about mindfulness. They wrote that there is neither one universally accepted technical definition of mindfulness nor broad agreement on details of the idea. They noted that the word is used for a mental state, a personality trait and a trained practice, and that much research measures it with self-report questionnaires.
Citing an estimate by Dimidjian and Segal, they reported that only about 30 percent of research on mindfulness-based programs had moved past the first stage of building a program. Only 9 percent of all the research had compared a program with an active comparison group. They also described many small studies, and wrote that the belief that meditation has few adverse effects rests largely on a lack of research and has little solid evidence behind it.
Doesn’t show This is a review and a set of recommendations. It adds no new trial data, and its percentages come from earlier counts by other researchers. The authors' aim was better research and plainer claims for the public, and the paper does not conclude that mindfulness fails.
In an eight-week program, most people reported at least one side effect, and some reported lasting bad effects
In 2021, Willoughby Britton and colleagues followed 96 adults who took one of three versions of an eight-week program of mindfulness-based cognitive therapy. The average age was about 40 and 73 percent were women. Most had symptoms of depression or anxiety. At a follow-up three months later, an independent interviewer asked about 44 kinds of experience. For each one, the interviewer asked whether it happened, whether it was linked to practice, how long it lasted, how it felt and whether it affected daily functioning.
Eighty-three percent reported at least one side effect, though some of these were neutral or positive. Fifty-eight percent reported at least one that felt unpleasant at the time. Lasting bad effects, meaning effects that harmed daily functioning for a stretch of time, were reported by 6 to 14 percent, depending on how long the stretch was. Those effects went with signs of dysregulated arousal, meaning a revved-up state of alertness and a sense of being cut off from oneself or the world, which the library describes as dissociation. The authors concluded that the rates of passing distress and negative impact were similar to those of other psychological treatments.
Doesn’t show There was no group that did not meditate, so the study can't say how many of these experiences the practice caused. Participants judged for themselves whether an experience was linked to practice. The sample was mostly white and well educated, and people with bipolar or psychotic disorders, active suicidal thoughts and some other conditions were excluded, so it says nothing about them. The authors describe it as an early step toward measuring harms. Only people who finished the program were interviewed, and the authors note that at least one person left because symptoms got worse. The comparison with other treatments draws on other studies, since this one had no such group.
Try it: a stretch of ordinary attention
Think of a ten-minute stretch from earlier today when you were doing something simple, such as washing up, walking or waiting. Write three short notes.
- What I was doing, and where my attention was for most of it
- The moment I noticed it had moved, if I did, and what I noticed it on
- The words I used for myself when I noticed, if any, and how they sounded
The first note shows how the stretch went. The second shows whether the noticing happened at all, which is the part the research calls awareness. The third shows the tone, the other part of the definition. A stretch with no noticing, or a harsh tone, says nothing wrong with the person. It is the ordinary case.
What is mindfulness in psychology?
Keeping attention on what is happening in the present moment with an open, non-judging stance. Psychologists use the word for a trait that varies between people, a state anyone can be in for a moment, and a skill trained in programs. A 2018 review found no single accepted definition, so the meaning in any one study depends on how that study measured it.
What is the difference between mindfulness and meditation?
Mindfulness usually names a mental state, a trait or a way of paying attention. Meditation names many practices, and some of them aim at mindfulness. A 2018 review argued that blurring the two terms has helped cause confusion and hype, since a short app exercise and a long retreat both get called meditation.
Does mindfulness work?
For some problems, to a small degree. A 2014 review of 47 trials with active comparison groups found moderate evidence of small gains for anxiety, depression and pain, and no evidence of benefit over other treatments. Pooled trials of mindfulness-based cognitive therapy found fewer relapses in recurrent depression over 60 weeks. Evidence for sleep, attention and weight was low or too thin to say.
Can mindfulness be harmful?
Some people report unpleasant effects. In a 2021 study of 96 adults in an eight-week program, 83 percent reported at least one side effect, 58 percent at least one that felt unpleasant at the time, and 6 to 14 percent lasting bad effects. There was no non-meditating group, so the study can't say how many were caused by the practice. A person in distress may find it useful to talk with a doctor, a therapist or the teacher.
Where does mindfulness come from?
The English word is used for sati, from early Buddhist teaching. The research version began in medicine. Jon Kabat-Zinn started a Stress Reduction Clinic at the University of Massachusetts in 1979, which became MBSR. Teasdale, Segal and Williams developed mindfulness-based cognitive therapy, tested in a 2000 trial for preventing a return of depression.
Is mindfulness a trait or a skill?
Researchers use it in both ways, and as a momentary state. As a trait, it is measured by questionnaire as how much a person tends to be mindful in daily life. As a skill, it is trained in programs of about eight weeks. A 2018 review warned that a questionnaire score and the effects of years of practice are different things that share a name.
Where the idea comes from
The English word is used for sati, a term from early Buddhist teaching, and the research use of it began in medicine. Jon Kabat-Zinn started a Stress Reduction Clinic at the University of Massachusetts Medical Center in 1979, and the program he built there became Mindfulness-Based Stress Reduction, or MBSR. A 1982 report on its first results described a 10-week program for 51 chronic pain patients who had not improved with usual care. It had no comparison group.
In 2000, John Teasdale, Zindel Segal, Mark Williams and colleagues tested a group program built on this work for people who had recovered from repeated depression, with the aim of helping them step out of the gloomy thinking that may feed a relapse. They called it mindfulness-based cognitive therapy, or MBCT. In their trial of 145 people, it lowered relapse for those with three or more earlier episodes of depression and did not for those with two. Segal, Williams and Teasdale published the program as a manual in 2002.
Psychologists have never fully agreed on what the word covers. In 2004, Scott Bishop and colleagues, after meetings aimed at consensus, proposed an operational definition with two components. A review by 15 researchers in 2018 still found no single accepted definition and no broad agreement on details of the idea behind it.
The question it adds
When a mind has been busy for a while, this idea asks where the attention actually went, and how we spoke to ourselves once we saw it.
Where was my attention a minute ago, and what did I say to myself when I noticed?
Buddhist sati. Jon Kabat-Zinn, Stress Reduction Clinic and MBSR, 1979. John Teasdale, Zindel Segal and Mark Williams, MBCT (trial 2000, manual 2002). Scott Bishop and colleagues, a proposed operational definition, 2004
Questions to carry
- Where did my attention go for most of the last hour, and what did I say to myself when I noticed?
- What is one feeling in my body right now, and what happens to it as I describe it in plain words?
Related
being present, present moment, paying attention on purpose, living in the moment, mindful, meditation, meditating, does meditation work, mbsr, mbct, on autopilot, noticing without judging, stay in the now, awareness of the present
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