By Dr. Phang Cheng Kar (M.D.) & Dr. Song Beng Kah (Ph.D.).
8. Mindfulness practice is stress-free and relaxing.
No, the practice is not always stress-free and relaxing; it sometimes involves experiencing more stress for a meaningful purpose.
The mindfulness-based approach is one of the useful ways for relaxing the mind and body. However, the process of mindfulness training may not always be relaxing. At times, practicing mindfulness can bring up old painful memories that create a lot of stress, that some may not be well prepared to confront alone. It is not uncommon for people to have the wrong attitude in mindfulness practice, like the unrealistic expectation (using mindfulness) to be totally free from stress or compulsively trying to control things in life. The unhelpful attitude naturally generates more stress. That is why, it is often emphasized in mindfulness training, “Mindfulness is not a technique to get rid of stress; it’s an approach to help us to understand and make peace with stress.” In fact, in certain situations, like exposure therapy to manage social anxiety, one needs to experience more stress (supported by mindfulness-based approach) for a long-term happiness. That is stressful, right? But it is a good stress; the type of stress that eventually leads to less stress. For people with severe mental health disorders (schizophrenia, bipolar disorders, depression with psychosis), using mindfulness as self-help is usually not helpful; it often generates more stress and confusion. A better option is to seek help from mental health professionals (e.g. psychiatrist) to stabilize the disorder. Once emotionally stabilized, guided mindfulness practice (preferably by a psychotherapist trained in mindfulness-based therapies) is a useful option.
9. Mindfulness is the best treatment for clinical depression.
No, it is not the best treatment for clinical depression; it is one of the treatment options for recurrent depression.
As mindfulness becomes popular, we often see such headlines in the media: “Mindfulness can control depression as well as drugs, study shows,” “Mindfulness holds promise for treating depression,” “Curing depression with mindfulness meditation.” These headlines are often misinterpreted to mean that mindfulness is the best treatment for depression. That is a fact, right? Well, not really. It is true that mindfulness-based therapy in the form of Mindfulness-Based Cognitive Therapy (MBCT) is being professionally recommended as one of the treatment options for people with three or more episodes of recurrent depression (Kuyken et al., 2016). However, it does not mean that MBCT is the best treatment for people with clinical depression. The best treatment of depression depends on many factors, e.g. types and severity of depression, patients’ preference for treatment options, and experience of the therapists. Proper psychological assessment is necessary before we can decide on the best-individualized treatment plan. Medications supported by psychotherapy may be necessary for certain types of severe depression. Even if one is keen and suitable to use mindfulness to complement depression treatment, it is better to be guided by someone who understands depression well and is trained in both mindfulness and psychotherapy. For example, a professional counselor or clinical psychologist who has received training in MBCT, instead of a corporate mindfulness trainer or mindfulness meditation teacher without understanding on clinical depression.
Even if one is keen and suitable to use mindfulness to complement depression treatment, it is better to be guided by someone who understands depression well and is trained in both mindfulness and psychotherapy.
10. Mindfulness is suitable and safe for everyone.
No, it may not be suitable and safe for everyone; it can have negative effects.
Despite its effectiveness, mindfulness practice (especially intensive mindfulness meditation) may not be suitable for everyone. In an online survey of 342 meditation practitioners (Cebolla et al., 2017) in European countries and North America, 87 (25.4%) reported negative effects of meditation. The negative effects include boredom; more fear, anxiety, and depression; heighten awareness of their negative traits; greater self-criticism; the feeling of being alienated from society; and lack of life orientation. In another interview of 60 Western Buddhist meditation practitioners (sixty percent were meditation teachers), the similar distressing experience was reported (Lindahl et al., 2017). Although relatively rare, mindfulness practice can have negative side effects and are usually more common among people with who are emotionally vulnerable. Due to the intense emotional suffering, that is exactly the group of people who are attracted to mindfulness practice; high-risk group. In view of that, we strongly recommend that for people with mental illness, if they wish to learn mindfulness for better mental health, it should be guided by someone who understands mindfulness and mental illness well.
So, what else should we be mindful of in mindfulness for mental health?
The huge investment in mindfulness-based therapies will only see its worth when the general public adopts a correct mindset and right understanding of mindfulness. We welcome an open discussion with stakeholders, including patients with their family and healthcare providers on these emerging issues related to “mindfulness industry.” Keeping in mind that research and media publications might be biased and sensationalized, the discussion should be based on credible sources. It should be supported by robust scientific studies, clinical and teaching experience, and not in a way of picking up bits and pieces from the internet or social media. This can be achieved with the support of public education.
Dr. Phang Cheng Kar (M.D.) is a consultant psychiatrist and mindfulness-based therapist. He is the creator of the MINDFULGym program and president of the Malaysia Association for Mindfulness Practice & Research.
Dr. Song Beng Kah (Ph.D.) is a molecular geneticist by training. He is interested in mindfulness practice ever since his first meditation retreat during undergraduate years. With scientific skepticism and a belief that every problem has a solution, he tries to explore and learn more about ''mindfulness'' through writing. Images credit: https://pixabay.com
References:
1. Khoury, B., T. Lecomte, G. Fortin, M. Masse, P. Therien, V. Bouchard, M. A. Chapleau, K. Paquin, and S. G. Hofmann. "Mindfulness-Based Therapy: A Comprehensive Meta-Analysis." Clinical Psychology Review. 2013; 33(6): 763-71. 2. Kuyken W, Warren FC, Taylor RS, Whalley B, Crane C, Bondolfi G, Hayes R, Huijbers M, Ma H, Schweizer S, Segal Z, Speckens A, Teasdale JD, Van Heeringen K, Williams M, Byford S, Byng R, Dalgleish T. Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-analysis From Randomized Trials. JAMA Psychiatry. 2016; 73(6):565-74. 3. Lindahl JR, Fisher NE, Cooper DJ, Rosen RK, Britton WB. The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists. PLoS One. 2017 May 24;12(5):e0176239. 4. Cebolla A, Demarzo M, Martins P, Soler J, Garcia-Campayo J. Unwanted effects: Is there a negative side of meditation? A multicentre survey. PLoS One. 2017 Sep 5;12(9):e0183137.
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