Basic Research on Effectiveness of Mindfulness Skills
When an evidence-based approach becomes popularized and clinical training standard are lowered, we may experience reports on exaggerated success of the specific intervention. The same may occur when researchers have pro/con biases. This is especially true when the provider/trainer is not a regular practitioner of the same MBIs. Now that MBIs are common in public/private school, community clinics, professional sports, and governmental organization (the Veterans Administration, etc.), both standards of care and quality of instruction must be monitored to prevent generalization drift. Generalization drift occurs when more and more people with less clinical training and experience, teach and use the MBIs. Double-sided reflection on this process would suggest a mixed picture: more and more people are 
learning to use secular MBIs to improve their lives (a good thing), but quality of training and experience of people teaching MBIs may be less than adequate for both safety and success (not a good thing). Remember that there are potential negative effects on people using MBIs. In my own 20-year experience as a MBI trainer in school, clinics and medical services programs, I have witnessed this process over and over again. In particular, when trainers/teachers used “canned” instructional programs published for profit and NOT adequately evaluated for reliability and validity, the drift and exaggerated claim may increase. When I co-led a school-based MBIs program for five years in a well-respected public school system in Vermont, we made sure the outcome research was completed by an independent and competent evaluation organization. We did this to prevent researcher-bias. Since I and other trainers were sold on the effectiveness of MBIs, it was best to have the outcome research done by others. The reason why the program was re-funded year after year was due solely to its positive effectiveness. I am happy to report that the outcomes of that specific school-based MBIs intervention were very positive and long-lasting.
In my own reasonably complete review of research I have concluded that we are better off being conservative in our claims of effectiveness. Thus I am very comfortable noting that when MBIs are provided by well-trained and experienced trainers they DO Improve conditions related to depression, anxiety, chronic pan and to a lesser degree stress reactivity and emotion self-regulation. Emotion regulation is a very important finding; this one outcome is directly related to conditions involving unresolved psychological trauma and addictions. I need say no more about the common realities of both these conditions in our American culture; we self-medicate to keep the economy going and to combat negative mood states, we have high levels of adverse childhood experiences, and we have fear and shame in seeking help for traumatic experiences and addictions. The story of positive familial attachment experiences in our country is a very sad one; we have high 
numbers of children experiences ACEs or Adverse Childhood Experiences. As far as prosocial changes related to exposure to MBIs, the research picture is less supportive. There are claims that MBIs improve compassion, empathy, connectivity with others, aggression, and prejudice in various settings. However, research support suggests that there are some improvements in compassion and empathy, but very little real evidence for improving connectivity, aggression and prejudice. In positive effects on various conditions, long-term regular meditation (with breathing retraining) practice leads the way, followed closely by long-term regular yoga and body scanning practice. “Forest Bathing,” or long-term mindful walking in nature has research support for improving general health and psychological well-being. Other MBIs/practices like qigong, tai chi, etc. do improve specific conditions but we are hard-pressed to say that they are as powerful for most people as meditation, breath training, yoga, body scanning or Forest Bathing. That said, for some people qigong and tai chi make huge differences in the quality of their lives and sense of well-being. Vigorous forms of qigong and tai chi are like mindful exercise, and according to a solid body of research regular vigorous exercise is your best path to good psychological and physical health.
See the references below to determine your own opinion.
Supports Positive Outcomes of Regular MBIs Practices:
Goyal, M., Singe, S., Sibinga, E.M.S. et al. (2014). Meditation programs for psychological stress and well-being: A systemic review and meta-analysis. Journal of The American Medical Association – Internal Medicine, 174(3), 357-368. Lang, A. et al. (2012). Theoretical and empirical basis for meditation as an intervention in PTSD. Behavior Modification, 36(6), 759-786. Van der Kolk, B. (2015). The Body Keeps the Score... New York: Penguin Books. See also various outcome studies from the Boston HRI Trauma Center on positive clinical effects of yoga and meditation. Keep in mind that there are now thousands of studies, mostly designed well enough to obtain peer review publication, showing positive effects for various MBIs with different populations. Do your own Google Scholar search to see what comes up.
Differential Outcomes of Regular MBIs Practices:
Kreplin, U., Faries, M., Brazil, I.A. (February, 2018). The limited personal effects of meditation: Systematic review and meta-analysis. Scientific Reports, 8(2403), 1-37. Borges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-Regulation. New York: W.W. Norton. Borges, S. and Buczynski, R. (2016). Polyvagal Theory. www.nicab-m.com/porges-polyvagal-theory. Retrieved Aril 26, 2016. P. Chodron’s Forward in Kongtrul, D. (2006). It’s Up To You: The Practice of Self-Regulation on the Buddhist Path. Boston: Shambhala Publications.
Possible Negative Emotional Effects of MBIs Practices:
Some people experience negative effects from MBIs. This is usually due to an underlying mental health or psychological condition and/or ineffective instruction from an inadequate, inexperienced trainer/teacher, etc. Some of the most severe negative effects occur after long-term, silent retreats – sometimes vipassana retreats. Negative effects may occur on the first major exposure to MBIs. or after repeated exposures where no negative effects existed.
Vieten, C. & Scammel, S. (2015). Spiritual and Clinical Competencies in Clinical Practice: Guidelines for Psychotherapists and Mental Health Professionals. Oakland, CA: Nerw Harbinger, pp. 99-109. Britton, W. (2011). The dark night project. www.buddhistgeeks.com. Retrieved April 26, 2016. Britton, W. (2011). The dark side of dharma. www.buddhistgeeks.com. Retrieved April 27, 2011.
Anthony R. Quintiliani, PhD., LADC
From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont and the Home of The Monkton Sangha
Author of Mindful Happiness
“experience near empathy” (Kohut), “unconditional positive regard” (Rogers), “hovering attention” (Freud), “the holding environment” in “intersubjective space” (Winnicott), and compassionate awareness to emotional distancing, separation, and dispassion is no easy task. In more in-depth clinical interactions, the process of projective identification between therapist and client may drain your emotional resources; sometimes being “as if” you were the experiencer of your client’s pain and suffering can take a serious toll on your own emotional resources. At time the therapist’s own emotional life lacks the quality of connection experienced in the therapy session. Success in setting emotional boundaries is a very important self-care skill. It may determine your success, failure, joy, or misery in the clinical work you do. It will definitely prevent most case of “burn out.”
helping skills. We suffer just like other people do. Hopefully, our training and experience have given us a bit of a positive edge here. Here are some things you may wish to consider to improve your own level of self-compassion.
meditations below are presented to expand the use of interoceptive processes in therapy practice. They are presented in very brief form, so slow down the work when using these in your therapy practice. Rather than repeating the introductory process, I will note it here. Be sure to use it in each meditation.
clients. Once a counselor has practiced these skills on a regular basis, it may be time to share such practices with clients. Live-practice therapy sessions are always more effective than simply “talk-therapy” about skills. Talk is cognitive, thereby impacting our executive brain more so than our body and limbic brain. Live mind-body practice impacts both the executive and limbic brain areas, and the body. In the same way that cognitive and psychodynamic interventions alone often fail to impact limbic system reactivity, these mind-body practices impact both mind and body – if we are lucky they may also impact the soul. A side-effect of regularly practiced skills may be increased personal happiness in life. These skills, if practiced regularly, will improve emotion self-regulation for most people. Here are the skills. This is simply an introduction, so you may have to research and learn “how to do” these skills via additional help. Be aware that if you suffer from severe physical illnesses, you may want to check with your healthcare provider before starting these practices. The same may be true if you suffer from severe psychological conditions.
interactions. When practiced regularly, it may reduce suffering from excessive stress, shame, guilt, and traumatic life experiences. One key benefit is that wise mind’s effects on emotion regulation may reduce the need to self-medicate, a core cause for all addictions. Rather than simply depending on sensory pleasures for short-term escape from pain and/or a fleeting experiences of joy/happiness, wise mind may improve radical acceptance, sensory soothing, and responding inter-personally with wisdom (kindness, respect, compassion). A valued possible outcome is increased authentic, longer-term happiness.
anxiety, the effects of trauma, addictions, and eating disorders. Various well-constructed meta-analyses have demonstrated that mindfulness practice (mainly regular meditation) produced positive effects on depression, anxiety, chronic pain and emotion regulation. It is important to note that all these conditions may become precursors for addictions, including smartphone addiction. By 2007 it was estimated that nearly ten percent of Americans (30,000,000 people) practiced meditation; add to this other mindfulness practices like yoga, qi gong, and tai chi and that number may double. By 2015 mindfulness-based practices were well-integrated into various skilled therapies: mindfulness-based stress reduction (improves depression, anxiety, chronic pain, and emotion regulation), dialectical behavior therapy (improves emotion regulation, self-soothing, and impulsivity), mindfulness-based cognitive therapy (50% eduction in relapse for repeated serious depressive episodes), mindfulness-based relapse prevention (for addictions), and acceptance and commitment therapy. The key variable was clear: if clients practiced regularly, they improved their clinical conditions, but if clients did not practice, they did not improve their clinical conditions. Therefore, two things are very important: doing regular practice in psychotherapy sessions, and the clinician being a regular mindfulness practitioner.
experienced directly. When people pay close attention to positive stories they tell themselves and/or positive emotional memories, serotonin levels may increase. Thus mindfulness practices enhance the experience of happiness. However, if people get stuck into paying attention to negative stories and negative emotional memories, the level of serotonin is reduced. Yes, being chronically stuck in the suffering of your past always makes emotional experience worse.