E12. Nicholas Van Dam – The Hype and Reality of Mindfulness

Stitcher_Listen_Badge_Color_Light_BG

US_UK_Apple_Podcasts_Listen_Badge_RGB

Today we speak with Dr. Nicolas Van Dam (@ntvandam), Senior Lecturer at the School of Psychological Sciences at the University of Melbourne and Adjunct Assistant Professor in the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai in New York.

Nicholas is a clinical psychologist and directs the Decision Making and Affective Learning in Emotional Conditions lab or DALEC lab. There he investigates the things that make us most like robots, including predictable and algorithmic processes in decision making models, and the things that make us least like robots, including interoception, self-awareness, introspection and meditation. The focus of both streams of work is to help those with high-prevalence psychiatric conditions, such as anxiety, depression and substance-use disorders.

In this conversation, we talk mindfulness. We discuss the state of mindfulness-related research and the implications for therapists and clinicians.

Show Notes

2:00 – On Nicholas’s research areas.

3:30 – How Nicholas came to study self-awareness and self-perception processes in relation to high-prevalence psychiatric conditions.

5:30 – On the state of the meditation research field at the time of the Mind the Hype paper

9:45 – Where are is mindfulness in the hype cycle

14:15 – Key points made by the Mind the Hype paper. 

22:20 – On whether the disagreements about definitions of mindfulness are fundamental or academic

28:30 – On extracting mindfulness from its Buddhist context 

47:20 – On mindfulness-based clinical interventions

53:25 – Should clinician’s be recommending mindfulness?

59:00 – The impact of the Mind the Hype paper. 

1.02:20 – What is Nicholas focusing on now?

1.05:30 – Advice to students

1.07:30 – On neurofeedback in meditation

2:00 – On Nicholas’s research areas.

Nicholas studies the things that make use most like robots and those that make us least like robots. The things that make us most like robots include predictable and algorithmic processes like decision making models. The things that make us least like robots include interoception, self-awareness, introspection and meditation. The focus of both streams of work is to help those with high-prevalence psychiatric conditions, such as anxiety, depression and substance-use disorders.

3:30 – How Nicholas came to study self-awareness and self-perception processes in relation to high-prevalence psychiatric conditions.

Nicholas did his dissertation on a mindfulness based intervention. He also became fascinated with the observation that those suffering from high-prevalence psychiatric conditions who don’t seem to respond to treatment, tend to have high levels of repetitive negative thoughts, known as rumination. Also, Nicholas had also found meditation useful in his own personal experience, particularly to deal with stress. 

5:30 – On the state of the meditation research field at the time of the Mind the Hype paper

The authors had been working on the paper for around 3.5 years before it was finally published. The authors had met at events hosted by the Mind & Life Institute. As mindfulness grew in popularity, the authors came to see the need for a corrective to the exaggerated claims in the media and in the work of some researchers. The intention of the paper was outline what we known, what we don’t know and what we should do regarding mindfulness research, with the hope of driving an improvement in the quality of research, and of communication around mindfulness. 

9:45 – Where are is mindfulness in the hype cycle

It’s hard to say, but we certainly seem to be seeing more pushback against the exaggerated claims, as seen by the greater audiences attending to those critical of modern mindfulness, such as Ron Purser. But this is a good think if it helps the field course correct, and prevent exaggerated claims that might cause people to dismiss the field altogether. Despite the recent criticism, interest continues to increase – which may be because people continue to hope in mindfulness as a panacea (which it is not) or because there is now a  commercial imperative and inertia behind it. 

14:15 – On the key points made by the Mind the Hype paper. 

There were three main areas explored by the paper; 1) On definitions and measurement, 2) Clinical implementation of mindfulness, and 3) The neuroscience of mindfulness. 

The reality is that due to the lack of active controls and variability in clinical studies, and the confounding of different intensities and duration of practice in neuroscience studies, the evidence around mindfulness is less robust than is commonly believed. 

22:20 – On whether the disagreements about definitions of mindfulness are fundamental or academic

One issue is that people use the word mindfulness to refer to a state, a trait and a practice. Another core issue is the wide variety in backgrounds that people come from in conceptualising mindfulness. This leads to problems such as measures not correlating to each other, they aren’t terribly reliable, they don’t reliably change in the expected direction with practice. 

28:30 – On extracting mindfulness from its Buddhist context 

There was a concerted effort to extract mindfulness from its religious Buddhist roots to make it more palatable to a secular audience and those from other religious traditions. Mindfulness may not be a coherent practice when extracted from its Buddhist context. However, in itself, it is not a religious practice and is compatible with secular sensitivities or other religious beliefs.

And so, when dealing with mindfulness is any way, we need to consider whether we are dealing with it as an attentional training practice, or a more traditional conception as a part of a contemplative life. Nicholas’s own research is probing this spectrum, looking at how much of each type of practice people need to see benefits. As practitioners, we need to be clear about what we are recommending and why, so that the exchange around the recommendation is informed in the way that one would expect when making a contract. 

47:20 – On mindfulness-based clinical interventions

Very few studies have compared mindfulness-based clinical interventions to an active control and against gold standard treatment. It’s not that mindfulness doesn’t promise to be part of the suite of gold-standard treatments, but much more work needs to be done to adequately evidence this. 

53:25 – Should clinician’s be recommending mindfulness?

Nicholas wouldn’t recommend mindfulness above psychotherapy of pharmacotherapy for a psychiatric condition. But if in his clinical judgment that it was a person that might benefit from mindfulness, and there reasonable evidence for their condition (for example anxiety, ruminative depression or chronic stress), he may suggest it with careful monitoring and supervision. 

Clinicians should also be cognisant of adverse events, which occur in both psychotherapy and mindfulness. Much caution should surround a recommendation of intense mindfulness practice to people with a history of trauma, vulnerabilities to psychosis or a history of bipolar disorder. In these cases, mindfulness practices can be slowly titrated. 

59:00 – On the impact of the paper. 

There has been much interest about the paper, but it’s too soon to tell whether it has driven a change in the quality of mindfulness research, or whether engagement with the paper will bog down at merely obligatory citations acknowledging it as representing a view of the limitations of the research. Early indications are that people are actually engaging with the substance of the paper. 

1.02:20 – What is Nicholas focusing on now?

Nicholas is focusing a lot on the dose-response issue. That is, how much of a given practice should people do to get an effect. He also continues to work on issues of measurement and definition and how meditation apps compare with and complement more traditional forms of instruction. Additionally he has started to look at what might be the common ingredients across different contemplative traditions. 

1.05:30 – Advice to students

Identify people that are doing what you think you want to be doing and look at how they got there. More than likely, looking at such people will show that there is more than one path there, and the path to where you want to go is not linear. 

1.07:30 – On neurofeedback in meditation

Nicholas considers the most helpful part of mindfulness apps to be the ability to nudge people towards more regular practice. He thinks neurofeedback guidance to a particular state would be less important. 

 

Episode References

Retracted PLOS One paper on Mindfulness-based Interventions.

The Mind the Hype paper which Nicholas lead.

The Mindful Elite by Jaime Kucinskas

Stephen Batchelor’s books, including Buddhism Without Beliefs