Chiesa (2013) argued that there has been minimal effort to formulate a consensus on operational definitions of mindfulness within the context of the Western society. Chiesa advocated that current attempts at operationalizing mindfulness have been unsuccessful at creating an unambiguous definition that respects its origins in Eastern philosophy. In the context of traditional Buddhism, acquisition of Sati, or awareness, is not viewed as the end in the process but this is how it is viewed in MBCT or MBSR (Chiesa, 2013). Sati is further deemed as being valuable in its ability to separate individuals from a false, individual ego and to create emotional stability (Chiesa, 2013). This state does not need to depend on modification of external conditions and instead involves changing one’s individual cognitive state and state of emotionality (Chiesa, 2013). Chiesa advocated that many mindfulness-based interventions fall under the term “mindfulness,” and yet a global definition has not yet been devised. As well, attempts to establish a common denominator for this definition have created reductionism in which divergence from original Buddhist context has occurred (Gause & Coholic, 2010). Rosch (2007) also argued that attempts at defining mindfulness have ignored the spiritual components of mindfulness including mystery, synergy, and interdependence that occur in the practice (as cited in Gause & Coholic, 2010). Traditionally, mindfulness possesses a contextual worldview which entails perceiving the world as interconnected in activity, change as continual, and personality as being single moments that combine to form a whole (Germer, 2013). Gause and Coholic (2010) advocated that if one ignores spiritual dimensions of mindfulness practice in definitions, then holistic narratives will not be able to be constructed. Kang and Whittingham (2010) also concluded that mindfulness with roots in Buddhism is more substantive as compared to its application in psychology.
Gause and Coholic (2010) also asserted that mindfulness approaches in cognitive-based treatment have diverged from roots in Buddhism. Separating mindfulness from its holistic roots can create an inaccurate perception of mindfulness that its practice means it must be separate from daily life (Gause & Coholic, 2010). For instance, individuals may come to misinterpret being mindful as meaning that they must be so immersed in the present moment that they lack awareness of their surroundings (Gause & Coholic, 2010). Overall, Kornfield (2009) advocated that Western psychology differs from Buddhist psychology in that Western psychology is ego based and involves forming a healthy sense of self that can be immersed into society (as cited in Gause & Coholic, 2010). However, from a Buddhist point of view, psychological treatment should involve providing a pathway for the individual to discover his or her selflessness (Gause & Coholic, 2010). Confusingly, modern definitions of mindfulness also stem from multidimensional Buddhist roots, which means that Buddhist psychology does not necessarily agree on the meaning of mindfulness (Germer, 2013). However, Bodhi (2013) stated that nontraditional mindfulness approaches are acceptable since they can be used to alleviate suffering in humans. However, he also advised that individuals should not assume a reductionist approach when examining mindfulness, and he also urged individuals to respect the religious context that the tradition is derived from (Bodhi, 2013).
Hutchinson and Dobkin (2009) described that there are also difficulties that exist in relation to defining mindfulness in that it is described as being an idea as opposed to a concept. Ideas require one to experience them in order to fully experience the effect of the ideas. However, concepts are merely comprised of correct words to be communicated effectively. Hutchinson and Dobkin therefore argued that if mindfulness is only discussed on the level of a concept as opposed to being practiced through experience, then this will become the teaching method. An additional criticism of mindfulness practice is that it must be practiced on a regular basis for effectiveness to be derived from it. Therefore, it may be a difficult practice for individuals to incorporate from professional vocations, such as those in the medical profession, who possess demanding schedules (Hutchinson & Dobkin, 2009).
Studies have also indicated that mindfulness has shown negligible effects at treating certain psychopathologies. Anderson, Lau, Segal, and Bishop (2007) studied healthy individuals before and after an 8-week MBSR course, with the control group being comprised of wait list participants. The participants completed tests to measure ability to sustain attention and Stroop task performance in interference measures. Anderson et al. concluded that participating in MBSR improved emotional well-being and increased ability to detect objects. However, the results of this study did not indicate improvements in attentional control of the MBSR group as compared to the control group (Anderson et al., 2007). A criticism of this study is that healthy subjects were used, which differs from other studies which primarily had subjects who had experienced past episodes of depression. Therefore, studies including depressed subjects may yield different results about the ability of mindfulness to influence attention, since depressed patients tend to experience altered attention.
Toneatto and Nguyen (2007) also conducted a meta-analysis to determine the impact of MBSR on individuals experiencing anxiety and depression. Toneatto and Nguyen examined 15 studies for variables of clinical outcome after the MBSR program, compliance with instructions of MBSR, type of clinical populace studied, and the length of the follow-up. The results of this study indicated that there were equivalent beneficial effects affiliated with MBSR for individuals with anxiety and depression (Toneatto & Nguyen, 2007). However, when active control groups were used, MBSR programs did not have an effect on levels of depression and anxiety (Toneatto & Nguyen, 2007). Overall, Toneatto and Nguyen deduced from their study that MBSR does not have an effect of reliable quality on anxiety and depression. Bishop (2002) paralleled this research finding from the review of research that was engaged in in his study. Bishop stated that despite the growing integration of MBSR into the field of medicine for purpose of managing emotions, there is a relatively small amount of information pertaining to the efficacy of this approach. Furthermore, Bishop argued that the evidence available does not support that it should be used in clinical treatment simply because it is a popular research topic. However, it is important for one to note that this study was conducted in 2002 and there have been developments in research since this time on MBSR applications to regulating emotions as noted in the review of studies engaged in for this research project.
Another study conducted by Manicavasgar, Parker, and Perich (2011) furthered the sentiment that mindfulness has a lack of effectiveness in treatment of psychopathology. Particularly in this study, the efficacy of 8-week programs of MBCT or CBT as treatment methods was compared for individuals experiencing melancholic depression. Participants were assigned to MBCT-based or CBT-based conditions and were assessed before treatment, 8 weeks after the program occurred, and 6 to 12 months after the program occurred. There were improvements in scores of anxiety and depression between the two groups, and no significant differences were observed between the groups. However, Manicavasgar et al. observed that when the participants were further subdivided on the basis of quantity of depressive episodes, participants in the CBT group who experienced four or more previous episodes of depression showed more improvement in relation to depression than those who had less than four episodes of depression. Manicavasgar et al. did not observe these differences in the MBCT condition, which contradicts other research that was found which stated that more depressive episodes induce more efficacy in relation to MBCT treatment. Hence, overall the results of this study indicated that CBT had more efficacy as a treatment methodology for those who had experienced four or more depressive episodes (Manicavasgar et al., 2011). This counters previous assertions, by Segal et al. (2013), that mindfulness is useful in treating individuals who have experienced more episodes of depression. However, a limitation of this study that one can observe is that of a small sample size for each treatment condition with 26 individuals in the CBT group and 19 individuals in the MBCT group. The small sample sizes used for this study limit generalizability.
In working with individuals with depression, mindfulness may also experience limits in relation to its application to certain populations. Particularly, Deatherage (1975) noted that this technique may not be beneficial for individuals experiencing depression with active psychotic symptoms. Namely, this is because for mindfulness to be beneficial, there must be an intact rational component of the mind as well a motivation to engage in metacognition (Deatherage, 1975). Deatherage stated that if these are not present, then this mitigates against the utility of the practice. However, more recent research conducted by Chadwick (2014) discovered that mindfulness applied to individuals experiencing psychosis can be therapeutic and beneficial if used in an adapted format. Chadwick, Hughes, Russell, Russell, and Dagnan (2009) noted in another study that for individuals experiencing active distressing psychotic experiences, mindfulness was helpful for coping with the thoughts and images that these individuals were experiencing but exhibited negligible effects in relation to altering the experience of voices. Overall improvement in relation to clinical functioning was noted for both the experimental group and the control group, both of which were experiencing psychotic experiences of a distressing nature (Chadwick et al., 2009). The groups were divided into experimental versus control group on the basis of whether they received training in mindfulness or if they were placed on a wait list for therapy (Chadwick et al., 2009).
As well, as mentioned previously in this research project, MBCT is more effective in individuals who have experienced three or more prior depressive episodes as compared to those who have experienced only two previous depressive episodes (Segal et al., 2013). This contingent effectiveness may present as problematic in clinical practice since therapists tend to be presented with clients who have experienced two or fewer bouts of depressive episodes. Hence, MBCT may not be as effective in working with these clients; if therapists are not well versed in the literature on these findings, they may attempt to apply it to their clientele even when it will not be effective for them.
Another criticism of mindfulness approaches can be observed in the phenomenon of the relaxation response elicited from the activity. Dr. Benson from the Harvard School of Medicine conducted a study on individuals in the 1970s about the effects of transcendental meditation (Kabat-Zinn, 2013). It was discovered that individuals who engaged in this form of meditation exhibited profound changes on a physiological level, which he termed the “relaxation response” (Kabat-Zinn, 2013). Such changes include a reduction in blood pressure, reduced consumption of oxygen, and a decrease in arousal (Kabat-Zinn, 2013). Dr. Benson further articulated that the relaxation is physiologically opposite in nature to the hyperarousal state that one experiences when threatened or stressed (Kabat-Zinn, 2013). Therefore, one can observe that a potential criticism of mindfulness-based techniques is that they may merely be inducing a relaxation effect as opposed to actually assisting in altering the relationship that a person has to his or her thoughts.
Another criticism of mindfulness practice is that its effects may not be similar to those from other forms of meditative practice. Tomasino, Chiesa, and Fabbro (2014) described that mindfulness is a Buddhist meditation that involves focusing one’s attention on one’s body, breathing, and being aware of the content of one’s thoughts. Mindfulness also has an end goal of an individual reaching a state of nothingness. Conversely, Hindu meditative practices involve a focus on duality, which is termed Samadhi. Within this study, fMRI was utilized in order to determine if different points of activation occurred in the brain. Tomasino et al. observed that individuals who engaged in Buddhist meditation exhibited activation in the frontal lobe structures, which are affiliated with executive attention. Conversely, Hindu-based meditations triggered a network of brain areas that included the postcentral gyrus, the superior parietal lobe, the hippocampal region, and the right middle cingulate cortex (Tomasino et al., 2014). Hence, Tomasino et al. demonstrated that different meditation styles activate different brain regions. However, a limitation of this study is that there was a large difference between the number of subjects used in each of these groups. In the Buddhist meditation group there were 263 subjects, whereas in the Hindu meditation group there were 66 subjects.
Overall, this review involved an extensive critical analysis of literature on mindfulness-based interventions to depression. Research was primarily quantitative based, but qualitative research involving case studies were also used. Hence, this review is categorically a developmental study in that it contains a review of relevant research followed by a proposal of an ideal study based on gaps in the current literature.
