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As somebody with clinical anxiety, I have been prescribed CBT and Mindfulness on the NHS, I think this piece misses several key points. For one thing, NICE (th

As somebody with clinical anxiety, I have been prescribed CBT and Mindfulness on the NHS, I think this piece misses several key points. For one thing, NICE (the UK NGO responsible for analysing evidence and making recommendations on the efficacy of treatments and their cost effectiveness) and an all-party Parliamentary group found signifcant evidence to recommend Mindfulness as a treatment for anxiety and mild depression along with traditional cognitive-behavioural therapy and SSRIs. Secondly, mindfulness feels, to me, closely related to CBT, a tried and true therapy. It appears to be very closely related to CBT in what it helps to control: intrusive thoughts. The increased focus on meditation is why it's more effective for anxiety and mild depression. It's most certainly NOT recommended for serious cases of clinical depression. As often, selected application of evidence and over-generalisation is the problem here. Mindfulness can help with a range of relatively-minor mental health issues, and it can also help prevent relapses in those that have recovered. For those of us who have been helped that's really not something to diminish. It's not that there's no evidence for its effectiveness at all. There is. (Disclosure: Mindfulness helped my anxiety a lot. I believe it to be more than placebo, but then I would, wouldn't I?)

mettamage 9y ago
> Secondly, mindfulness feels, to me, like an offshoot of CBT. It appears to be very closely related to CBT in both its approach and what it helps control. Really? When I meditate I need to turn my thoughts off. With CBT you reframe your thoughts by a process of what I'd like to call creative thinking and empiricism. So for me, it's not an offshoot of CBT, since mindfulness is not concerned with thoughts but with being mindful on whatever your object of mindfulness is (in 95% of the cases it's your body). Also, mindfulness was ripped out of Buddhism. Mindfulness was "Buddha's" invention on top of Hinduism -- as I understand it. Hinduistic meditation focuses on concentration (note: I stand corrected if I'm wrong), whereas Buddhistic meditation shifts (eventually) towards mindfulness and depending on the tradition you have like 4+ different forms of mindfulness. What psychologists/neuroscientists did was take these techniques out of their contexts to see if they were helpful for therapy. And apparently -- according to their studies -- they were. I just know from personal experience how mindfulness damages me, I also know how it can heal me. I prefer to use it for healing purposes. For me, when I need to be more connected to my body and to other people I use mindfulness and loving kindness meditation (metta) as a practice. Metta makes me more connected to people and mindfulness acts as a multiplier towards that connection (since I am more aware of all my feelings). Whenever I need to code, focus and analyze more I tend to be less interested in meditation practices. I'm noticing it's not a hoax. I've meditated 500+ hours and my baseline level of being aware of my feelings is slightly but noticeably higher. Even if I don't meditate for months.
- grabcocque 9y ago
  Well, CBT is about recognising and stopping intrusive thoughts before they become too harmful. Mindfulness extends this idea to using meditation to create an environment in which it's hard for intrusive thoughts to occur. The focus on meditation as a treatment for anxiety and depression is relatively new, the focus on reducing or eliminating intrusive thoughts isn't.
- rippeltippel 9y ago
  > When I meditate I need to turn my thoughts off Good luck with that! From my experience and the teachings I received, meditation is not about turning thoughts off (which is practically impossible) but becoming aware of them in a way that you don't get lost into them, the goal being to understand hands-on how the mind works. > Mindfulness was "Buddha's" invention on top of Hinduism That's completely wrong AFAICT, although I concede that the term "mindfulness" can be perceived as a lay version of "meditation", without religious or philosophical connotation.
  - vidarh 9y ago
    Mindfulness meditation indeed is not about turning thoughts off. Concentration meditation on the other hand can involve turning thoughts off. Mindfulness meditation involve a certain degree of concentration practice (e.g. the use of breath meditation - anapanasati) to maintain focus, but too much concentration is directly detrimental to mindfulness meditation.
  - red75prime 9y ago
    > is not about turning thoughts off (which is practically impossible) It depends on the person probably. I can easily shut the "loud" thoughts down, what remains is muted "flashes" of concepts in the back of the mind which almost lack vocalization. I can shut down those too, then only awareness of sensory experiences remains. I was never able to feel pure awareness of existence of self though. Maybe it's just one thing.
- vidarh 9y ago
  > When I meditate I need to turn my thoughts off. Mindfulness meditation is very explicitly not about turning thoughts off, but about letting thoughts arise and fall away without getting caught up in it. Concentration meditation practices do involve turning thoughts off. That said, I also find the comparison to CBT curious. > (in 95% of the cases it's your body). In mindfulness meditation, while it can be your body, it is not generally nearly as dominant a focus unless you want it to be. The "baseline" tends to be mindfulness of breath (anapanasati) because it is a convenient basis for a necessary level of concentration, and while it may involve the body peripherally as where you will notice the breath, is not about the body (indeed, while mindfulness of breath is simple as a starting point, people have written 500+ pages of books just on that one subject, and that involves e.g. the selection of other meditation objects to use while practising mindfulness of breath to achieve specific effects, such as dulling distractions, and a lot of that seems to be down to draw attention away from your body, because your body is a rife source of distracting sensations). Mindfulness of the body is a separate aspect which tends to explicitly involve letting the sensations of part of the body fill your mind and diffuse outwards until it feels like that part of your body is all there is. When you do it with sufficient concentration it produces very curious sensations. It can also be a useful practice to reduce physical pain (I've had success with it but to very varying degree) - I see that as a trick of the mind where you basically seek to "spread the pain around" mentally so that it feels like it dissolves; sharp pains feel like dull aches. Nevertheless when successful it is a very useful trick of the mind (as a skeptic it feels to me as intentionally seeking out a placebo effect, but if it works it works). Mindfulness of mind and and mindfulness of emotion are other separate aspects, and purely disassociated from the body, though you will tend to use mindfulness of breath to bring the concentration needed for it. Most beginners mindfulness practice tends to focus first on mindfulness of breath to attain base levels of concentration and then mindfulness of mind. If you focus only on the body as the object of meditation, you miss out on many aspects.
DanBC 9y ago
I agree. But one of the problems NICE finds is the variable quality of what "mindfulness" actually is. Can an app deliver mindfulness? Can an MP3? Can it be self-delivered? Is there a difference between group work and solo work? If a mental health professional gives a patient a link to HeadSpace has that MH professional delivered a mindfulness treatment? And NICE are sometimes giving DO NOT recommendations for mindfulness, eg here: https://www.nice.org.uk/guidance/cg159/chapter/1-Recommendations https://www.nice.org.uk/guidance/cg159/chapter/1-Recommendat... > Do not routinely offer mindfulness-based interventions[3] or supportive therapy to treat social anxiety disorder. The supporting evidence for that is here: https://www.nice.org.uk/guidance/cg159/evidence/full-guideline-pdf-189895069 https://www.nice.org.uk/guidance/cg159/evidence/full-guideli...
- vidarh 9y ago
  I'm not surprised they recommend against it for social anxiety. I've dealt with (relatively low levels of) social anxiety myself, and I also do mindfulness meditation, and while I thing mindfulness can be useful in understanding the mental impulses ("why did I not say hi to that person even though I badly wanted to?") and have made me a lot more acutely aware of the impulses driving how I act in social situations, it alone has done nothing to alter that behavior or the anxieties around it. In my case my anxieties were limited enough that while I won't say I've completely gotten rid of it, I got over most it by applying my own gradual exposure - I spent months setting myself challenges of e.g. getting eye contact with and saying hi, or "how are you?" in "low stress" situations like to cashiers or other "captive" audiences. It not only reduced my anxieties but was a big eye opener in terms of social interactions in general (peoples responses changed dramatically). [note: I don't recommend people do this if they face severe anxiety - see a therapist; it worked for me, but probably largely because my anxiety was mild] I'd think mindfulness might be useful for someone with social anxiety after they have the actual anxiety under control, though, as a way to further improve social skills, just like for people without anxiety. But I'm not surprised it's not a good choice as a replacement for other therapy or drugs to get the anxiety itself under control. [EDIT: As an example of the awareness it brought to me, one thing I hate is making phone calls, and mindfulness has not stopped that, but one thing mindfulness has done was making me aware of avoidance behaviors, such as letting me more easily "catch myself out" when I use silly excuses for going to pointless lengths to e.g. seek out information online instead of making a two minute phone call; it didn't make me feel less anxious about the call but may have had a limited effect in making it more easily apparent to me which things I are worth addressing using other methods]
girzel 9y ago
> (Disclosure: Mindfulness helped my anxiety a lot. I believe it to be more than placebo, but then I would, wouldn't I?) I don't see why this would need to be dismissed as a placebo. A placebo is something that works by tricking the mind into have an effect on the body, right? The key being that there really is an effect. So couldn't mindfulness be seen as purposefully harnessing the placebo effect?
viraptor 9y ago
> Mindfulness helped my anxiety a lot. I believe it to be more than placebo, but then I would, wouldn't I? Even if it improved your quality of life just because you think it did, so what? A reliable way to placebo yourself with actual results would be amazing.
mercer 9y ago
I'm quite excited about CBT, but I think it's kind of a half-way-there step towards meditation/mindfulness, and in my personal case it actually was counter-productive in a way that meditation hasn't been. The core difference, I'd say, is that with CBT there is still too much emphasis on your thoughts. You're taught to use your own thinking to counter those thoughts, which is a bit like pulling yourself up by your own bootstraps. In my case, that made an anxious mind more anxious, because the anxiety itself is usually irrational and caused by thoughts. Again, I'm quite excited by CBT because I do think it can be very effective. But I'm even more excited about some of the 'newer' approaches under the CBT umbrella that don't suffer from the flaw of still relying on your irrational mind to solve irrational problems.
- visarga 9y ago
  > But I'm even more excited about some of the 'newer' approaches under the CBT umbrella Can you give examples?
  - mercer 9y ago
    It's a while back that I did my research, but I think it was https://en.wikipedia.org/wiki/Dialectical_behavior_therapy https://en.wikipedia.org/wiki/Dialectical_behavior_therapy that struck me as a kind of progression toward even more of the mindfulness/observational approach, and away from using your thinking to solve your thinking. I also find https://en.wikipedia.org/wiki/Acceptance_and_commitment_therapy https://en.wikipedia.org/wiki/Acceptance_and_commitment_ther... an interesting approach. Either way I wouldn't argue that those approaches are better in all cases, but rather that they appear to draw even more from (Zen?) Buddhism than CBT does, and that for an atypical, anxious mind like mine they seem to work in a way that CBT doesn't. In fact, I've found that my anxiety was often worse when I actively applied CBT when I was in therapy.
p-funk 9y ago
There are some modified versions of CBT that some people use with more of a focus on mindfulness. There's one called DBT, dialectical behavior therapy. For me, this was like all the benefits of CBT but with a much easier way to get to there. Although, I'm not sure what the research evidence is like for DBT. But I definitely agree that CBT feels extremely similar to mindfulness. Mindfulness is just sort of another approach to the same end result, and certainly might not be the right approach for everyone.

mettamage 9y ago

> Secondly, mindfulness feels, to me, like an offshoot of CBT. It appears to be very closely related to CBT in both its approach and what it helps control. Really? When I meditate I need to turn my thoughts off. With CBT you reframe your thoughts by a process of what I'd like to call creative thinking and empiricism. So for me, it's not an offshoot of CBT, since mindfulness is not concerned with thoughts but with being mindful on whatever your object of mindfulness is (in 95% of the cases it's your body). Also, mindfulness was ripped out of Buddhism. Mindfulness was "Buddha's" invention on top of Hinduism -- as I understand it. Hinduistic meditation focuses on concentration (note: I stand corrected if I'm wrong), whereas Buddhistic meditation shifts (eventually) towards mindfulness and depending on the tradition you have like 4+ different forms of mindfulness. What psychologists/neuroscientists did was take these techniques out of their contexts to see if they were helpful for therapy. And apparently -- according to their studies -- they were. I just know from personal experience how mindfulness damages me, I also know how it can heal me. I prefer to use it for healing purposes. For me, when I need to be more connected to my body and to other people I use mindfulness and loving kindness meditation (metta) as a practice. Metta makes me more connected to people and mindfulness acts as a multiplier towards that connection (since I am more aware of all my feelings). Whenever I need to code, focus and analyze more I tend to be less interested in meditation practices. I'm noticing it's not a hoax. I've meditated 500+ hours and my baseline level of being aware of my feelings is slightly but noticeably higher. Even if I don't meditate for months.

grabcocque 9y ago
Well, CBT is about recognising and stopping intrusive thoughts before they become too harmful. Mindfulness extends this idea to using meditation to create an environment in which it's hard for intrusive thoughts to occur. The focus on meditation as a treatment for anxiety and depression is relatively new, the focus on reducing or eliminating intrusive thoughts isn't.
rippeltippel 9y ago
> When I meditate I need to turn my thoughts off Good luck with that! From my experience and the teachings I received, meditation is not about turning thoughts off (which is practically impossible) but becoming aware of them in a way that you don't get lost into them, the goal being to understand hands-on how the mind works. > Mindfulness was "Buddha's" invention on top of Hinduism That's completely wrong AFAICT, although I concede that the term "mindfulness" can be perceived as a lay version of "meditation", without religious or philosophical connotation.
- vidarh 9y ago
  Mindfulness meditation indeed is not about turning thoughts off. Concentration meditation on the other hand can involve turning thoughts off. Mindfulness meditation involve a certain degree of concentration practice (e.g. the use of breath meditation - anapanasati) to maintain focus, but too much concentration is directly detrimental to mindfulness meditation.
- red75prime 9y ago
  > is not about turning thoughts off (which is practically impossible) It depends on the person probably. I can easily shut the "loud" thoughts down, what remains is muted "flashes" of concepts in the back of the mind which almost lack vocalization. I can shut down those too, then only awareness of sensory experiences remains. I was never able to feel pure awareness of existence of self though. Maybe it's just one thing.
vidarh 9y ago
> When I meditate I need to turn my thoughts off. Mindfulness meditation is very explicitly not about turning thoughts off, but about letting thoughts arise and fall away without getting caught up in it. Concentration meditation practices do involve turning thoughts off. That said, I also find the comparison to CBT curious. > (in 95% of the cases it's your body). In mindfulness meditation, while it can be your body, it is not generally nearly as dominant a focus unless you want it to be. The "baseline" tends to be mindfulness of breath (anapanasati) because it is a convenient basis for a necessary level of concentration, and while it may involve the body peripherally as where you will notice the breath, is not about the body (indeed, while mindfulness of breath is simple as a starting point, people have written 500+ pages of books just on that one subject, and that involves e.g. the selection of other meditation objects to use while practising mindfulness of breath to achieve specific effects, such as dulling distractions, and a lot of that seems to be down to draw attention away from your body, because your body is a rife source of distracting sensations). Mindfulness of the body is a separate aspect which tends to explicitly involve letting the sensations of part of the body fill your mind and diffuse outwards until it feels like that part of your body is all there is. When you do it with sufficient concentration it produces very curious sensations. It can also be a useful practice to reduce physical pain (I've had success with it but to very varying degree) - I see that as a trick of the mind where you basically seek to "spread the pain around" mentally so that it feels like it dissolves; sharp pains feel like dull aches. Nevertheless when successful it is a very useful trick of the mind (as a skeptic it feels to me as intentionally seeking out a placebo effect, but if it works it works). Mindfulness of mind and and mindfulness of emotion are other separate aspects, and purely disassociated from the body, though you will tend to use mindfulness of breath to bring the concentration needed for it. Most beginners mindfulness practice tends to focus first on mindfulness of breath to attain base levels of concentration and then mindfulness of mind. If you focus only on the body as the object of meditation, you miss out on many aspects.

DanBC 9y ago

I agree. But one of the problems NICE finds is the variable quality of what "mindfulness" actually is. Can an app deliver mindfulness? Can an MP3? Can it be self-delivered? Is there a difference between group work and solo work? If a mental health professional gives a patient a link to HeadSpace has that MH professional delivered a mindfulness treatment? And NICE are sometimes giving DO NOT recommendations for mindfulness, eg here: https://www.nice.org.uk/guidance/cg159/chapter/1-Recommendations https://www.nice.org.uk/guidance/cg159/chapter/1-Recommendat... > Do not routinely offer mindfulness-based interventions[3] or supportive therapy to treat social anxiety disorder. The supporting evidence for that is here: https://www.nice.org.uk/guidance/cg159/evidence/full-guideline-pdf-189895069 https://www.nice.org.uk/guidance/cg159/evidence/full-guideli...

vidarh 9y ago
I'm not surprised they recommend against it for social anxiety. I've dealt with (relatively low levels of) social anxiety myself, and I also do mindfulness meditation, and while I thing mindfulness can be useful in understanding the mental impulses ("why did I not say hi to that person even though I badly wanted to?") and have made me a lot more acutely aware of the impulses driving how I act in social situations, it alone has done nothing to alter that behavior or the anxieties around it. In my case my anxieties were limited enough that while I won't say I've completely gotten rid of it, I got over most it by applying my own gradual exposure - I spent months setting myself challenges of e.g. getting eye contact with and saying hi, or "how are you?" in "low stress" situations like to cashiers or other "captive" audiences. It not only reduced my anxieties but was a big eye opener in terms of social interactions in general (peoples responses changed dramatically). [note: I don't recommend people do this if they face severe anxiety - see a therapist; it worked for me, but probably largely because my anxiety was mild] I'd think mindfulness might be useful for someone with social anxiety after they have the actual anxiety under control, though, as a way to further improve social skills, just like for people without anxiety. But I'm not surprised it's not a good choice as a replacement for other therapy or drugs to get the anxiety itself under control. [EDIT: As an example of the awareness it brought to me, one thing I hate is making phone calls, and mindfulness has not stopped that, but one thing mindfulness has done was making me aware of avoidance behaviors, such as letting me more easily "catch myself out" when I use silly excuses for going to pointless lengths to e.g. seek out information online instead of making a two minute phone call; it didn't make me feel less anxious about the call but may have had a limited effect in making it more easily apparent to me which things I are worth addressing using other methods]

girzel 9y ago

> (Disclosure: Mindfulness helped my anxiety a lot. I believe it to be more than placebo, but then I would, wouldn't I?) I don't see why this would need to be dismissed as a placebo. A placebo is something that works by tricking the mind into have an effect on the body, right? The key being that there really is an effect. So couldn't mindfulness be seen as purposefully harnessing the placebo effect?

viraptor 9y ago

> Mindfulness helped my anxiety a lot. I believe it to be more than placebo, but then I would, wouldn't I? Even if it improved your quality of life just because you think it did, so what? A reliable way to placebo yourself with actual results would be amazing.

mercer 9y ago

I'm quite excited about CBT, but I think it's kind of a half-way-there step towards meditation/mindfulness, and in my personal case it actually was counter-productive in a way that meditation hasn't been. The core difference, I'd say, is that with CBT there is still too much emphasis on your thoughts. You're taught to use your own thinking to counter those thoughts, which is a bit like pulling yourself up by your own bootstraps. In my case, that made an anxious mind more anxious, because the anxiety itself is usually irrational and caused by thoughts. Again, I'm quite excited by CBT because I do think it can be very effective. But I'm even more excited about some of the 'newer' approaches under the CBT umbrella that don't suffer from the flaw of still relying on your irrational mind to solve irrational problems.

visarga 9y ago
> But I'm even more excited about some of the 'newer' approaches under the CBT umbrella Can you give examples?
- mercer 9y ago
  It's a while back that I did my research, but I think it was https://en.wikipedia.org/wiki/Dialectical_behavior_therapy https://en.wikipedia.org/wiki/Dialectical_behavior_therapy that struck me as a kind of progression toward even more of the mindfulness/observational approach, and away from using your thinking to solve your thinking. I also find https://en.wikipedia.org/wiki/Acceptance_and_commitment_therapy https://en.wikipedia.org/wiki/Acceptance_and_commitment_ther... an interesting approach. Either way I wouldn't argue that those approaches are better in all cases, but rather that they appear to draw even more from (Zen?) Buddhism than CBT does, and that for an atypical, anxious mind like mine they seem to work in a way that CBT doesn't. In fact, I've found that my anxiety was often worse when I actively applied CBT when I was in therapy.

p-funk 9y ago

There are some modified versions of CBT that some people use with more of a focus on mindfulness. There's one called DBT, dialectical behavior therapy. For me, this was like all the benefits of CBT but with a much easier way to get to there. Although, I'm not sure what the research evidence is like for DBT. But I definitely agree that CBT feels extremely similar to mindfulness. Mindfulness is just sort of another approach to the same end result, and certainly might not be the right approach for everyone.