I participate in a biweekly meditation and discussion group. It is my turn to select a reading to start the conversation, and I have selected an excerpt from an excellent conversation which happened on Sam Harris’ Waking Up Podcast. The episode is a much larger conversation than just this topic, and the entire episode is super interesting. In this episode, three of the world’s leading academic experts on meditation and mindfulness discuss the evidence and research that exists for benefits from meditation and mindfulness. You can read more about their expertise and credentials here.

The section I want to share is a discussion of studies they have conducted on people suffering from depression, anxiety, and chronic pain, and the evidence suggesting mindfulness based cognitive therapy is actually more effective than medication for dealing with these problems.

The Three Main Points

• Mindfulness means knowing that you’re knowing. It means recognizing that a thought is just a thought, a feeling is just a feeling. The default mode is letting those things define who you are, but mindfulness means learning to understand that those things are separate from who you are. This is also sometimes called meta-cognition or meta-awareness.

• Cognitive behavior therapy (commonly just called therapy) means you don’t have to believe your thoughts and feelings. You can decide to change them. You can decide how you want to think and feel. Thoughts and feelings come from what your brain is used to, so if you choose to proactively think or feel differently, your natural thoughts and feelings will change over time.

• The evidence suggests that combining mindfulness and cognitive behavior therapy is more effective than medicines at treating depression, anxiety, and chronic pain disorders.
  • Suffering, depression, anxiety, and chronic pain are often anticipatory emotions which are experienced in anticipation of pain which may or may not even happen. Recognizing that fact and choosing how to feel can mitigate symptoms of suffering more effectively than medicine.

These main points together can help us define goals for our meditation practices; something solid to try to do which is based on evidence. These are the things that the data show are effective at changing behaviors and improving outcomes.

Diving Deeper (Optional)

Here is the actual conversation and the definitions given in depth. Our main group conversation will be about the points listed above, but here is the rest of the interview for background.

The Experts Define The Terms

Towards the beginning of the conversation, they define mindfulness and cognitive behavior therapy as it applies to the conversation. (You can click here to listen to that section or read below 34:12)

Davidson: “Meta-awareness is simply knowing that you’re knowing. Recognizing that a thought is a thought rather than being swept away in its content.”

Goleman: “One of the main principles of cognitive therapy is that you don’t have to believe your thoughts. That’s a very revolutionary idea for most of us.”

Harris: “We should probably define mindfulness at this point…. for those who are new to the topic, … how would you define mindfulness?”

Goleman: “I think mindfulness as it’s taught in the classic traditions encourages us to take an equanimeous position amongst the comings and goings of our own thoughts, and to see them as feelings and thoughts rather than, ‘that’s me’. And to just note them without judgment or without reactivity, and let them come and let them go. That’s a very radical stance internally.”

Harris: “And so is there any distinction between what you’re calling meta-awareness and mindfulness as you just used it?”

Davidson: “…In the classical traditions, mindfulness often has some additional components in addition to the ones [Goleman] described. It includes remembering to bring a certain view to every encounter. And what does that mean? Well in part it means recognizing that every human being shares the same wish to be happy and to be free of suffering.And also a view that has an altruistic intent. The disposition to help relieve the suffering of others whenever it’s encountered. And remembering to bring that conviction, that stance to every encounter is also part of mindfulness.”

The Reading

This conversation starts at 49:53 and continues to 54:30. You can listen to it here or read it below;

https://www.youtube.com/watch?v=I1YKcOSClGU&t=3002

Harris: “Let’s talk about a few categories of human suffering and you can tell me the state of the literature on the utility of mindfulness in particular as a remedy. What do we know about depression and mindfulness at this point?”

Goleman:”Well there, it’s  mindfulness in tandem with cognitive therapy, mindfulness-based cognitive therapy. Which meta-analyses suggest can be as effective for mild and ordinary depression as are medications. Also for anxiety disorders, it seems to have the same amount of efficacy [as medications].”

Davidson: “I think that most of the work with depression has in fact been focused on mindfulness based cognitive therapy. And where it’s particularly effective is in reducing the likelihood of depressive relapse. That’s where the best data are. So if you take an individual who has had a history of depression — and one of the things we know about depression is that it’s a recurring illness — teaching a person mindfulness based cognitive therapy when they are admitted has a dramatic impact on the likelihood of relapse. In fact, it’s the one case where mindfulness based intervention is actually more effective than medication.”

Harris: “So this is in preventing or reducing the likelihood of relapse.”

Davidson: “Correct. And this is for depression and not bipolar disorder.”

Harris: “So what about pain perception and the problem of chronic pain which obviously links unhelpfully with the problem of opioid abuse which is so in the news now.”

Davidson: “I think we need to make an important distinction between pain and suffering. The neuroscience literature has helped us to understand  the different parts of neural circuitry involved in pain processing that are related to pain more explicitly itself, versus the suffering that often occurs as a consequence of the initial pain. With regard to the impact of meditation, the data show that the circuitry involved in the more emotional components of pain, the suffering component can be modulated much more strongly than the sensory features of the pain itself. Here is where I think mindfulness and related practices can make an important difference.”

Harris: “So this distinction between pain and suffering, lets say a little bit more about that because it’s highly counter-intuitive to people. What are your findings there, or what are the findings of meditators in general there?”

Davidson: “Well there are two kinds of findings. One is that during the anticipation of pain, we see the activation of parts of the neural circuitry associated with pain. We can see in the laboratory that when a person is told that they are going to be receiving a painful stimulus in the future, the circuitry involved in pain processing is activated in response to the innocuous queue that simply informs them that a painful stimulus will be occuring. In situations of chronic pain, we often encounter something quite similar where a person is anticipating for example that when they start walking, they will start feeling pain. And that activates aspects of the pain matrix itself even though they may not have begun to walk the actual triggers might not have been activated. The parts of the pain matrix that are activated during those anticipatory periods are parts that are associated with suffering; more the emotional components of pain rather than the sensory components of pain.”