Scientific Research About the Benefits of Mindfulness

The Science of Mindfulness
by Susan L Smalley, Ph.D.
September, 2019
We are often asked, is there scientific support for mindfulness? Will practicing it help my health?
Will it make me feel better? What are the benefits and what are the risks? Lastly, how do I do
it? With the MAPs class we have begun to answer the last question first but this document is an
update on the first set of questions.

What is Mindfulness?
Before embarking on any scientific study of mindfulness, we have to have a means of defining it
and then measuring it. Over the last two decades there have been a host of articles describing
studies designed to define and measure mindfulness. A working definition of mindfulness is
‘moment to moment attention to experience with a stance of open curiosity’. While there
are other definitions they all include an element of attention (paying attention to present moment
experiences) and an element of openness or curiosity (as opposed to a stance of criticism).
Using this definition, many instruments to measure mindfulness have been created – all of them
currently are self-report questionnaires – and most are designed for use with adults although
there is a growing body of research on assessing mindfulness in childhood and adolescence.
What these questionnaires have allowed scientists to do is to study mindfulness and examine
how it relates to health and wellbeing, as well as what factors may change it.
As mindfulness becomes more widespread and scientific research on it increases, its definition
may undergo change. Alan Wallace, a Buddhist scholar, suggests that the definition should
incorporate an additional element of an increasing ability to maintain attention toward
wholesome or beneficial states (Wallace, 2008). While this has not been included in most
working definitions used in research, the essence of this additional piece is that mindfulness, and
mindfulness practice, will aid the practitioner in discerning helpful from harmful thoughts and
feelings and to lean toward actions that are beneficial. Whether this needs to be part of its
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definition or one of the many outcomes of practice remains equivocal but there is increasing
interest in the role mindfulness practice may have as a tool for promoting empathy, compassion,
and beneficial acts (reviewed in a later section.)
Mindfulness has both state and trait qualities. By that we mean that it is both a trait –
something that varies in the population – like eye color – and may be influenced by genetic and
environmental effects and is part of an individual’s inherent orientation of consciousness. At the
same time, mindfulness is also a state of consciousness that can be changed with practice, much
like putting colored contact lenses in your eyes can change the “state” of eye color. As we are
beginning to understand mindfulness from a scientific lens, we don’t know how ‘fixed’ or
‘changeable’ it really is. For some people who score low on the trait of mindfulness (this is often
referred to as dispositional mindfulness) practice may increase it quite substantially and even stay
at this changed level over time or fall back to their baseline state if they stop practicing. We
don’t know enough about the long-term effects of varying degrees of mindfulness practices (or
what types of practices and to whom they are most beneficial) so it remains unclear to what extent
‘dispositional’ mindfulness can be altered to become more permanent or trait-like with time. We
do know that in the short term with practice, people change in many ways – including their o w n
r e p o r t s o f t h e i r mindfulness. And we know that people who have practiced mindfulness for
years and years (e.g. like monks or nuns or long-time meditators) have brain and body states look
different from non-meditators. Some of the differences – short-term and long term- involve
changes in gene expression, immune function, brain function, brain structure, attention,
mood, happiness and how we interact with others. In the following sections we review the
‘state of the science’ around mindfulness.
The Science of Mindfulness is in the Early Stages
Although scientific research around mindfulness is increasing the body of research is still
relatively small. As an example, in Pubmed (a major resource for scientific papers), when you
search for the term “mindfulness and health”, 3,860 articles are identified compared to 149,060
articles for “exercise and health”. While we all agree that exercise is a good thing to do for
health, look at the quantity of research available. Mindfulness – as we will see – has support in
science for being a ‘good thing to do’ yet the body of research around it is still relatively small.
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Dispositional Mindfulness
Many studies show that when people fill out questionnaires measuring mindfulness, there are
those who score ‘very mindful’ and those who score at the other end of the distribution and then
most people score in the middle (they fall along a ‘bell shaped’ curve from low to high). Those
who fall in the upper end of the distribution (the more mindful of us), report themselves as
happier than those who score at the other end of the mindfulness distribution. There is a positive
correlation of scales of ‘happiness’ or ‘well-being’ with scales of mindfulness suggesting that the
more mindful we are, the happier we are.
There is also a relationship of dispositional mindfulness and how the brain responds to emotion.
David Creswell – a psychologist who did this work while at UCLA – found that the brains of
very mindful people responded differently to visual images of emotions (anger, happy, sad)
than non- mindful people when their brains were studied using fMRI (functional Magnetic
Resonance Imaging). Specifically, the parts of the brain involved in emotional regulation
responded differently in people who reported high dispositional mindfulness versus low. In
general, when people see a facial emotion like fear or anger, the amygdala fires in the brain (the
amygdala is an ‘almond-shaped’ part of the brain involved in emotion). When you ‘label or name’
the emotion, the front part of the brain gets active and it ‘quiets down’ the firing of the amygdala
(that’s why it can help to name a feeling to calm down). Creswell’s work showed that the frontal
activation and calming of the amydala was stronger in the more mindful than less mindful group.
The study supports the idea that dispositional mindfulness reflects biological differences among
us, particularly how we cope with emotions. Several other studies examining dispositional
mindfulness support the idea that it is connected to health.
This may partially explain why people who score high on mindfulness questionnaires tend to be
less anxious, less depressed, and happier in general. They even report going to the doctor less
often than those who score low on mindfulness. In a meta-analysis by Tomlinson et al. (2017),
93 studies were evaluated. Overall higher scores on mindfulness were related to better emotional
processing and regulation, less symptoms of depression, anxiety and adaptive cognitive
processing (i.e. less rumination and pain catastrophizing). It was positively associated with well-
being in 13 studies that measured it. Interestingly two aspects of mindfulness – acting in
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awareness and non-judgemental – were most correlated with wellbeing. What genetic and
environmental factors contribute to dispositional mindfulness are not yet known, however, self-
report questionnaires that measure mindfulness are found on questionnaires measuring attention
(i.e. ‘acting in awareness’ is an example) suggesting there may be shared influences of attention
and mindfulness (Smalley et al. 2009).
Changing Mindfulness States
Most research around mindfulness is about what happens when people practice some kind of
mindfulness meditation. The kinds of mindfulness practice differ from study to study but a large
number of studies use Mindfulness Based Stress Reduction (MBSR) or Mindfulness Based
Cognitive Therapy (MBCT), programs that share features with our MAPs course, specifically
practicing mindfulness with different objects of attention including breath, body sensation,
thoughts, and feelings. There are studies that look at different meditation practices as well, such
as Transcendental Meditation, Yoga, Tai Chi and a range of loving-kindness, gratitude, and self-
compassion practices. Studies may group all of the above under meditation or specifically select
one type of practice to examine the effects of mindfulness practice. It is not clear which practices
are best and for whom, but those types of questions are currently being investigated. What we do
know is that mindfulness meditation can stand alone as a practice or be integrated into traditional
psychotherapeutic models (such as cognitive therapy) or woven in with educational or treatment
programs (substance abuse, eating behavior). Teasing apart what elements are most effective
and for whom are topics of great interest today.
Mood
Mindfulness Based Cognitive Therapy (MBCT) was developed to help people who suffer from
depression (Segal, Williams and Teasdale, 2002). While Cognitive Therapy (CT) and Cognitive
Behavioral Therapy (CBT) are widely used and effective tools for treating and working with
depression, integrating mindfulness with these therapeutic approaches is even more effective.
When MBCT was compared to CT for people who suffered from depression but were currently
not in a depressive episode, the rates of relapse into another depressive episode were
significantly different. Of those patients given CT, 2 out of 3 slipped back into another
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depressive episode while only 1 out of 3 of the patients given MBCT did so. That study has now
been replicated and it is clear that MBCT is a superior treatment over CT of CBT for preventing
depression relapse, and it is as effective as medication maintenance (Rand.org. 2015). However,
for people suffering from depression or a mood disorder like bipolar illness mindfulness practice
is best when done in conjunction with traditional treatments and with the knowledge of a mental
health professional.
Mindfulness and Anxiety
Mindfulness Based Stress Reduction (MBSR) was developed by Jon Kabat-Zinn initially to help
people with pain problems, and it has been used widely for people with a variety of health
conditions as well as individuals suffering from the day to day stresses of life. Overall the
studies support that mindfulness reduces anxiety and stress, and that even biological
markers of stress – like cortisol – may change. This finding is very clear among people in the
normal range of anxiety – but also helpful for those at the more severe end of the spectrum of
anxiety who meet criteria for an anxiety disorder.
It may be that Mindfulness interventions are more helpful in treating anxiety disorders when they
are adjunctive to traditional treatment or integrated into a psychological intervention like MBCT.
Mindfulness increases ‘meta-cognitive awareness’ the ability to step out of one’s thoughts or
feelings and to observe them from a neutral observer stance. It is the increased ‘space’ between
the self and a thought or feeling that may make ‘changing the narrative’ easier to do (cognitive
therapy helps the patient identify and change the stories they may tell themselves). We know that
a ‘narrative’ self and ‘experiential’ self are different ways (with accompanying brain processes)
for self-referencing. The narrative self is the story we tell about who we are while the
experiential self is the experience we have ‘in the present moment’. Mindfulness increases
activation of brain regions that correspond to the experiential self and decreases activation of
brain regions that correspond to the narrative self. It may be why it can be helpful in reducing
anxiety or improving mood because distorted or negative views along with rumination and
catastrophizing often accompany anxiety and/or depression. CT and CBT work by helping the
patient create a new story while mindfulness works to create a space or distance – a change in
relationship – of self to the story. Mindfulness increases meta-cognition and that may enable the
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patient to see a story as ‘just a story’ (one of many) and have greater capacity to change it. In this
way, mindfulness changes the relationship of our “self” to our “self”.
Mindfulness and Pain
Chronic pain is a major problem in the United States. 1/3 people suffer from chronic pain such as
migraines, low back pain, etc. Mindfulness was first brought into a hospital setting (by JKZ) to
treat chronic pain sufferers who had been told to ‘go home’ and live with their pain. Kabat-Zinn
used MBSR to treat chronic pain sufferers and the results spoke for themselves. People endorsed
feeling less pain with mindfulness. Although researchers don’t know ‘how’ pain is reduced, one
hypothesis is that mindfulness affects a part of the brain that is important in feeling pain, the
Insula Cortex, a sort of ‘thermostat’ for notifying you when your body is out of homeostasis (its
normal state, not under stress). When you burn your hand or hit your elbow your insula takes the
incoming signals (from your hand or elbow) and integrates those signals so you know you feel
pain and take action to reduce it. In studies of long-time meditators, this part of the brain is
structurally different (i.e. thicker than) from non-meditators. In a meta-analysis of mindfulness
and its impact on pain, researchers found a significant (yet small) reduction in pain, as well as a
reduction in depressive symptoms and improvements in quality of life (Hilton et al., 2017).
Mindfulness and the Immune Response
Several studies support that mindfulness training boosts the immune response. Some areas that
have been implicated are resistance to influenza, immune response signals among cancer patients
and HIV patients, and healing rates in cases of psoriasis. This is an exciting area of research
because it suggests that with mindfulness practice we can boost our body’s ability to fight
disease. It is well known that stress can reap havoc on the immune system and increase the
inflammatory response. It seems that mindfulness practice has the opposite effect. In a meta-
analysis of randomized controlled trials, Black and Slavich (2016) found support for an impact
on inflammatory systems, cell mediated immunity and biological aging but studies were so
varied (in size, markers measured, etc.) that results remain tenuous and more rigorous
investigation are needed. Still, mindfulness meditation looks to impact gene regulation in
systems related to inflammatory and immunity. Buric and colleagues (2017) looked at 18 studies
across a wide range of forms of meditation and sample sizes and found positive support. One of
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the challenges of interpreting studies in mindfulness and biological changes are the large number
of different types of practices, varying sample sizes and characteristics, and the biological
measurements taken.
Mindfulness and the Cognition (thoughts, attention, memory)
A growing number of studies are looking at the effects of meditation – including mindfulness –
on the brain and cognitive functioning. In terms of cognition, attention appears to be easily
affected by mindfulness practice. There are at least three kinds of attention: alerting (getting
ready to pay attention), orienting (where you place your attention) and conflict attention
(ignoring intruding information and focusing attention). Mindfulness may affect all three but the
strongest evidence for its effects are on conflict attention. Conflict attention is an important
component of executive function – the ability to set goals and carry them out.
Conflict attention is a helpful kind of attention in getting things done because it is important for
setting goals and follow-through. It is the kind of attention we need to ignore distracting
information and stay focused on the task at hand. Even in a short 5-day training period of less
than 30 minutes a day of mindfulness practice, undergraduate students showed improvements in
conflict attention compared to controls. It is the kind of attention that is impacted by
mindfulness quite readily, even among people with difficulties in this sort of attention, like those
with Attention Deficit Hyperactivity Disorder (ADHD). (Zylowska, et al., 2008)
Mindfulness and the Brain
Not only does mindfulness affect attention but it may alter brain function and even structure.
There are several studies of mindfulness practice (or meditation) where brain changes in activity
are monitored – through electrical signals picked up by EEG or through activation changes
monitored by fMRI. Based on EEG studies, meditation leads to a consistent change in brain
waves, with slower brain waves (signs of relaxation) increasing particularly in the frontal part of
the brain and greater ‘synchronicity’ (syncing of wave states in different regions of brain)
occurring. It may be that meditation brings the brain into a more relaxed brain state; however, at
the same time there is some evidence that superfast brain waves (gamma waves) may also arise
and sync in different brain regions and that may be a measure of ‘insight’ or ‘creativity’.
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What is perhaps most striking from brain studies of long-time meditators versus non- meditators
is that there emerge brain differences in structure. Specifically, there are regions of the brain
that show greater grey matter thickening in meditators than non-meditators. One region where
the differences are most pronounced is the Insula Cortex (discussed previously), a region
important in pain and mapping changes in body states. Some researchers think this is a major
site for ‘self-awareness’ as well. There is a meta-analysis of brain studies and the finding is
fairly consistent, meditation can change the brain; yet, different regions are identified across
studies. Perhaps most hopeful for those of us who are adding meditation to our daily lives is the
evidence that mediation may prevent the typical thinning of grey matter in the brain with age. In
one study by Sarah Lazar at Harvard, long-time meditators do not show the dramatic thinning of
grey matter (in some brain regions) across ages 25-55 that the non-meditators show. It needs
further replication and especially longitudinal studies, but it is an intriguing hypothesis that
mindfulness may protect the brain from the normal effects of aging.
Mindfulness and Genetics
We are born with some 25,000 genes encoded in our DNA. DNA is wound tightly into bodies
called chromosomes (remember you inherit 23 chromosomes from your mom and 23 from your
dad) to create the full complement of 46 chromosomes. On the end of the chromosomes are
regions called telomeres and the shortening of the telomeres has been associated with aging and
stress. The telomeres are to chromosomes what plastic tips are to the ends of shoestrings. When
they are new they are easy to lace through a shoe, when they are old they are often frayed and
difficult to thread. Like the shoelace, when the tips are worn, the chromosomes (and DNA) do
not replicate and divide well in cell division so things die or fail to function. Mindfulness
practice has been associated with healthier telomeres (longer length) and its possible that it may
help prevent the hazards to cell health that come with aging.
Additionally, while every cell of the body contains the same DNA information, genes are turned
up and down in terms of expression in different types of cells, at different times in development,
and in response to different external and internal changes. Understanding what turns genes up or
down in expression is the area of epigenetics. It is epigenetics that explains why a liver cell and a
heart cell have very different functions in terms of proteins produced from genes. Scientists are
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looking at the impact of environmental factors on gene expression and stress is one factor that
seems to have a pretty strong impact. Steven Cole and his colleagues at UCLA have shown that a
set of genes involved in the immune system and fighting viruses and bacteria turn up and down
as a function of stress. They are also showing that practices like meditation and social connection
(specifically ‘helping behavior’) can turn this same set of genes on in a healthy way. Their
research shows that wellbeing itself – a felt sense of purpose, embracing change, resilience in the
face of hardship – has an epigenetic profile that is healthier than those who are not experiencing
such wellbeing. It is an area of increasing focus because we are seeing how social experiences
(e.g. loneliness, chronic stress) can impact gene expression, and how practices like meditation
may do so as well but in an opposite direction (Fredrickson et al., 2013; Cole, 2013)
Mindfulness across the Lifespan
Research shows that the benefits of mindfulness increase with increasing practice. Like any other
skill, those with greater lengths of practice seem to show greater change. Many researchers,
teachers and parents have asked – can mindfulness be taught in childhood and what might happen
over time. At UCLA, Lisa Flook and colleagues implemented mindfulness meditation in pre-K
students and second graders and found that they enjoyed it and that it showed positive benefits.
(Flook et al., 2010). Later Lisa worked on implementing a kindness curriculum that included
mindfulness to Pre-K students and data showed positive benefits in prosocial behavior. (Flook et
al., 2015) Young children can learn mindfulness meditation practices, but they need to be
delivered in age-appropriate ways. There are a host of well-developed age appropriate practices
now available on line and in books to use with children. Several school programs are exploring
the delivery of mindfulness in schools including MindUp and Mindful Schools as well as apps
that deliver mindfulness to kids and that can be used in the classroom (e.g. Stop, Breathe and
Think Kids). The research is small but growing on how mindfulness practices may be beneficial
in the classroom for helping students reduce stress and build social-emotional skills.
Mindfulness and our Relationships to others
The effects of mindfulness on ‘prosocial’ behavior (a term to define helping, sharing and kind
action toward another) have been of interest lately in the research community. A group at
Northeastern University (Condon et al., 2013; Lim et al., 2015) showed that a mindfulness course
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increases prosocial behavior. In their research they were looking at a simple action of giving up
one’s chair for another to sit down in a controlled research setting. Mindfulness increased
‘sharing’ rate by almost 3-fold whether it was delivered by a live class session or via an App. Just
a simple act of learning mindfulness increased positive social relationships – i.e. kindness. Sonja
Lyubomirsky’s work at the University of California, (Riverside) supports helping behavior as a
means of boosting wellbeing and positive relationships. Her work has suggested that attention to
helpful acts is one of the best things you can do to feel good (Lyubomirsky, 2008; 2013).
Interestingly, when people practice mindfulness there appears to be a natural increase of attention
to thoughts, feelings, and actions that are beneficial (remember that discussion previously). In its
secularized delivery, there is often no specific discussion of conduct as part of initiating a practice
while it may be worth further study to see how focusing on beneficial actions might complement a
mindfulness practice.
What are the practices of mindfulness and how best to learn them?
There are many kinds of mindfulness practices available today, such as MAPs, MBSR, MBCT,
and other movement and meditation-based exercises that can increase mindfulness (yoga, tai chi,
other types of meditation) and lots of ways to learn them – in a class, online, via apps, and from
books to name a few. Some related sorts of practices to mindfulness include Gratitude practices
and studies of ‘helping’ behavior. Some of the outcomes of gratitude practices and helping actions
are similar to those found in mindfulness – like increased well-being and reduced stress. Quite
possibly, a range of behaviors can increase ‘mindfulness’ as a state of mind and impact health and
well-being. However, the practice of mindfulness – such as that found in MAPs, MBSR or MBCT
– provide a foundation for attending to present experience with curiosity no matter what the topic
of attention might be (i.e. a gratitude wish, a helpful action, a job loss, an illness). In this way, the
practice of mindfulness meditation may yield a greater awareness of action and wishes toward
others. When practicing mindfulness, there develops an improved ability to discern or
discriminate ideas, thoughts, feelings and actions that are beneficial to others from those that are
not (or are harmful). With practice, one can lean more toward the beneficial. Gratitude and
increased helping actions are often the outcomes of mindfulness practices. Practicing them in lieu
of mindfulness may engage a similar mindset over time, but science is only beginning to study the
impact and their relationship with mindfulness.
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Is digital delivery of mindfulness as good as mindfulness taught in a live setting?
There is a big interest in the digital delivery of mindfulness today. Thousands of meditation apps
are available today (including our UCLA Mindful app) and others like Calm, Head Space, Insight
Timer, Stop, Breathe and Think, along with podcasts. Meditation is big business with an
estimated market cap of some 1.2 billion dollars in 2017. There are a handful of studies that
suggest learning mindfulness via a digital platform is similar in outcomes as taking a class in
person. Most of the studies compare the improvements seen in health and wellbeing for an app vs.
some sort of digital but non-meditation practice. In a study of an app, Stop, Breathe and Think, a
significant improvement in reported mood and feelings of stress among users that used the app at
least 10 times or more, even if the practices were on average only 5 minute a day (Athanas et al.,
2019). Head Space was compared with Luminosity (a cognitive training app) as a control in a
study of mindfulness on “prosocial” behavior (Lim et al., 2015). As shown in a previous study by
the same group comparing mindfulness delivered live with an educational program (as a control),
there was a significant improvement of helping behavior with mindfulness, but the results were
the same whether mindfulness delivered live or digitally. More studies are underway today and
results are promising: practicing mindfulness– however it is most feasible for you to do so – is
what really matters to yield the benefits on health, wellbeing, and positive social interactions.
What kind of practice is best for me?
Studies are beginning to look at the different sorts of practices, delivery of practices, and our
individual differences in personality, biology, etc. to see if there are any differences in what sort
of practice works best for whom. For example, in one study of college students, women showed
greater increases in mindfulness and self-compassion than did men with a 12-week course in
meditation training. Men improved in their ability to describe emotions and that was related to
less negative emotions but there was no relationship of mindfulness changes to their changes in
negative emotions (in contrast to the positive relationship seen among women) (Rojani et al.,
2017). There may be personality, cognitive or demographic factors, like gender, ethnicity, or age
that impact which practice is best and for whom and such research is in its early stages. For
example, a recent study of the MAPs classes delivered in Spanish showed outcomes around
mood that were similar to those found in English speaking groups (Lopez-Maya et al., 2019).
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One of the most important aspects of any practice is its continuation. The best guide for which
practice to do is your own experience and whether you stick with it. The effects of mindfulness on
health and wellbeing seem to accumulate with practice – the more you do the better the effects, in
general. Of course, there are always obstacles that can get in the way of a practice and that’s why
a teacher, a group, or helpful friends, can be beneficial. It’s also a good idea to try different
practices– like walking, mindful listening, sitting, etc. and even try different sorts of meditation
practices (tai chi, yoga, etc.) to find what works best for you.