Wednesday, October 15, 2014

Compass of the Heart & Measuring a Dose of Mindfulness

Researchers studying new medicines must often come to grips with "patient compliance" issues--assuring that participants actually take each dose of an experimental treatment. But the patient compliance difficulty factor goes up orders of magnitude when it comes to studying the effects of mindfulness.

I'm currently taking an EdX class (with 100,000 other people!) on The Science of Happiness from the University of California, Berkeley's Greater Good Science Center. The subject for this week is mindfulness. One of this week's guest presenters--Shauna Shapiro from UCal Santa Clara--is a leading light in the academic field of mindfulness.

In her definitions, Dr. Shapiro highlights three core elements of mindfulness: Intention, Attention, and Attitude. It was her discussion of the role of Intention that has given me new appreciation for one of the most serious challenges of conducting mindfulness research. Shapiro sees Intention as "knowing why you are practicing" mindfulness or "setting the compass of your heart."

To drive this home, Shapiro quotes a confession from the father of mindfulness, Jon Kabat-Zinn:
"Your intentions set the stage for what is possible. They remind you from moment to moment of why you are practicing . . .  I used to think that meditation practice was so powerful...that as long as you did it at all, you would see growth and change. But time has taught me that some kind of personal vision is also necessary."
Personal intentions of participants in mindfulness studies are essentially the equivalent of "patient compliance" in studies of medical treatments. Each person's intention in pursuing mindfulness is a key determinant of the "dosage" of mindfulness that reaches his or her brain.

Miranda Bevis, my mindfulness teacher, framed intention with a light touch in one of the first classes.  She had us form small groups and invited us to say why we'd signed up for the class and what we hoped to get out of it. And, when telling us we needed to do our meditation homework assignments, she said learning mindfulness was like learning a foreign language. It doesn't do much good just to come to class once a week, she said -- you need to practice, practice, practice.

The drill of home practice no doubt is one necessary manifestation of intention to develop mindfulness. But it's probably not sufficient. I learned this from a close friend who studied mindfulness (but not with Dr. Bevis) and who had a very different experience from mine.

My friend signed up for the class on the recommendation of friends and colleagues. He had studied and practiced psychology and thought studying mindfulness would familiarize him with a new aspect of the field that had come along since he was at school. His intention was to learn about mindfulness techniques in order to help others. He was irritated to get a "pre-test" for various psychological problems in the first class, followed by instruction that seemed to be oriented toward resolving psychological challenges of class members.

My friend did do his home practice during the course, but it's fair to say he did not set the compass of his heart on becoming mindful himself. He found the voice on his practice tape irritating; the practices took too long; they didn't do much for him. He was especially irritated to get a "post-test" version of the psychological assessment again at the end of the 8-week class. Easily fudged and he saw it as more for subsequent promotion of the course than for the students' benefit. He hasn't practiced mindfulness since he finished the class.

My friend is case-in-point for why mindfulness studies are hugely difficult. A typical research paper would say that my friend and I both got the same "dose" of Mindfulness-based Stress Reduction -- we both had an 8-week class with a trained Mindfulness teacher and did our home mindfulness practices. But clearly the difference in our respective intentions meant that we got very different doses.

Currently, the closest mindfulness studies come to measuring (and controlling for) participant compliance is data on class attendance and self-reports of home-practice. The degree to which these data approximate participants' actual intentions and efforts to cultivate mindfulness determines --and currently limits-- the reliability and strength of the studies' conclusions. Someday researchers may do better. Maybe cheap, easy, painless, convenient, home-use brain scanning? Or perhaps they can do a massive data crunch and find better correlates of actual mindfulness dose.  Controlling more precisely for heart-compass readings will make for sounder science.

Beyond this, finding better correlates of intention also could help improve the way mindfulness teachers advertise Mindfulness courses, the claims they make, and how and what they teach. It might change class composition, the way teachers relate to class participants -- or even help identify people who are wasting their time and money studying mindfulness.

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