The mental health of teenagers is not improved by it, new research is found. But is that because of how it was taught, asks Helen Rumbelow.

The Times

Gerry Gajadharsingh:

I have never been a fan of the term mindfulness, simply because it means different things to different people, however in this soundbite society that we live in, people think it’s clever to condense complex concepts into short words or phrases because apparently most people are short of time or lose interest, if they think they don’t get something in 30 seconds.

 Meditation for me is a more tangible concept, although there are also numerous forms of meditation, the main aim is to reach a more relaxed place in your brain compared to the constant bombardment of thoughts that most of us seem to suffer from. The challenge is that many patients, who could probably benefit from meditation, find it incredibly difficult to do, simply because their brains are so bus and, they are unable to use meditative techniques to calm them down and focus.

 This is the reason why I tend to focus on relaxed breathing. Once patients actually know what to do, the vast majority can follow instructions which lead to a more relaxed breathing pattern. In my opinion this is much easier for the majority of patients rather than trying to focus on meditation or so-called mindfulness. Relaxed breathing has multiple health benefits and can be an excellent prelude to be able to move to the more relaxed parts of the brain when meditation might then be more successful. I use capnometry to assess breathing behaviour and heart rate variability monitoring, which measures the balance in our autonomic nervous system, as a way of working out whether or not what the patient is doing is actually calming their nervous system down.

 The article below focuses on research that was carried out on secondary school children where their teachers were trained in so-called “mindfulness” but unfortunately the children found it boring and so actually didn’t carry out their “mindfulness” practice.  I’m not sure that that’s a surprise. I don’t know exactly what these teachers were taught in their training, but the article focuses on comparisons of so-called mindfulness experts, one pro and one against and it’s interesting to read their opposing opinions.

 One of my lovely patients Amy Dickson who is a Grammy award winning saxophonist, has taken what I have taught her on breathing bahaviour and adapted it to a program called the Elephant breath, from her Take a breath program, aimed at primary school children and the feedback has been amazing.

 It just goes to show that if someone knows what they’re actually talking about, it can actually be effective. This requires time and commitment to actually understand something and so before the government throws the baby out with the bath water, they should really try to understand why this particular research has not come up with the expected results.

 The first part of the article deals with the benefits of exercise, in this case tango dancing and how the effects we are more pronounced on the reduction of psychological stress compared to mindfulness meditation. Exercise of all kinds will usually improve breathing behaviou,r so again to me this is probably not a surprise and again we have no idea what the detail of the mindfulness meditation actually was.

 The downside again, focusing on the word breathing, is that means different things to different people and the media is full of articles on breathing, with the latest breathing Guru to expand their thoughts and many people take this as gospel, despite a profound lack of understanding of respiratory behaviour in the so-called Guru.

 Modern life has much to answer”

In 2014 researchers randomised a group of nearly 100 adults to take part in a course either of mindful meditation or of Argentine tango with expert teachers (and another group were stuck on a waiting list as a control).

In the end the results were a little surprising. Both courses improved mood, but only tango reduced psychological stress. Those in the tango group reported a greater increase in “mindfulness” — nearly double — than those in the actual mindfulness group, and when offered a voucher for more lessons in either activity, 97 per cent chose tango.

So why aren’t we teaching all children tango in schools?

The question isn’t facetious. It goes to the heart of the mindfulness phenomenon that is sweeping through 21st-century life — from apps such as Headspace, co-founded by two Britons, Andy Puddicombe and Richard Pierson (their parent company was recently valued at $3 billion), to books (70,000 titles on Amazon use the word “mindful”, from dogs to menopause) — and has lately swept through the expanses of Prince Harry’s mind.

There seem to be few problems in the world to which the answer is not “more mindfulness”. The founder of modern mindfulness, the American Jon Kabat-Zinn, was one of the first to divorce the practice from its more altruistic and community-based Buddhist roots in the 1990s and instead make unhappiness an individual responsibility.

In other words, it’s not your lack of friends or childcare or time to take a walk in the woods that’s the problem, as Kabat-Zinn put it, “happiness is an inside job”. If capitalism makes us sad, it’s up to you to buy the app for £49.99 (the price I paid for my annual Headspace subscription; also the pro-rata cost of each meditation I conducted that year).

It wasn’t long before this idea spread to children, the canaries in our mental health mine. Mindfulness was heading towards being taught as standard in schools before scientists found the funding for an expensive, rigorous trial. The results published this week changed that for good. It adds weight to the growing body of work suggesting some drawbacks, if not dangers, of the mindfulness movement.

This seven-year study, called “Myriad” and published in BMJ: Evidence-Based Mental Health, took teachers from 100 British secondary schools and sent them on a standard part-time mindfulness programme over eight weeks. They also had a four-day intensive mindfulness-teaching course — in short, as good a training course as you could realistically get. But the children who were assigned their subsequent mindfulness teaching over ten weeks did not emerge armoured against the modern mental health malaise.

Teaching mindfulness in schools didn’t help. Kids found it boring. For those children already at risk of mental health problems, mindfulness training actually resulted in worse scores on risk of depression and wellbeing, which persisted at the one-year follow-up, although researchers noted “differences were small and not clinically relevant”.

“The first arguably adequately-powered trial” into mindfulness in teenagers, the researchers concluded, “found no main effects”.

In the UK the godfather of the mindfulness movement is Mark Williams, emeritus professor of clinical psychology at Oxford University, and co-founder of a style of widespread treatment called mindfulness-based cognitive therapy or MBCT, which has been shown in trials to reduce depressive symptoms in adults. As well as spearheading a practice that has become something of a secular religion, he is an ordained priest in the Church of England.

If you want to look at the other side of the mindfulness debate you need go no further than Miguel Farias, a man who was once a researcher in experimental psychology just across Oxford who went on to write the Oxford Handbook of Meditation and is co-author of The Buddha Pill, both sceptical scientific histories of the practice. I spoke to both in the wake of the Myriad trial.

“Most of the kids here surprised us by saying, ‘Oh, this is boring,’ ” Williams says. “A good teacher would be able to take that and go, ‘What does boring feel like?’ ”

In other words, the problem was — I’m paraphrasing here — the kids being taught meditation by a hapless geography teacher. It was the messenger not the message, according to Williams: “Engagement of the kids seems to be a marker of whether it’s going to be effective.”

In smaller trials with vocational meditation teachers, results in teenagers were better, he argued. With a poor teacher, going inward may lead to “brooding”, Williams speculated. Would it be just as effective, I ask, for the kids to get outside in the fresh air and play or exercise?

“When you run, it’s a really good way of clearing your mind. But when you stop running, things can come roaring back,” Williams says. Mindfulness, he believes, can be a “unique tool” to help those any time problems. That’s why he backed this trial at its outset, with good intentions. The data for effectiveness of mindfulness programmes on depression in adults “was holding up well”, he said.

“That was the rationale for saying, ‘Could you give the same sort of protection right at the very start?’ Fifty per cent of people who are ever going to get depressed will have been depressed by the age of 18, so the patterns are laid down fairly young. Our question was, ‘Can you get in early before the first depression and do something which might help?’ Well, not with this top-down roll-out, I think is the answer.”

Then I called Farias. He knows Williams continues to keep the faith for mindfulness for teenagers. “I would be surprised if Mark would have said otherwise, he’s one of the major figures of mindfulness.”

Farias also knows it’s hard to go against the zeitgeist: after his chapter on the adverse effects of meditation in The Buddha Pill, “I actually lost some friends” in the research community. Some became “very angry”.

According to Farias, in the historic Eastern tradition meditation is strictly for adults: ancient literature catalogues how the discipline can have a negative impact on vulnerable minds. In the recent trial, older teenagers, those 15 and up, seemed to respond better to mindfulness.

A Cochrane review, published last year, found that antidepressants only had a very small or no effect on depression for children and teenagers compared with adults. Their brains are just wired differently. Maybe it is similar for meditation — science does not yet have these answers.

In the foreword to The Buddha Pill, Farias and his co-author, the clinical psychologist Catherine Wikholm, said they have heard first-hand from teenagers who were taught mindfulness in schools “ranging from those who have found it helpful, to others who describe it as uncomfortable, anxiety-provoking or even ‘terrifying’.

“Meditation allows people, children potentially more than adults, to get in touch with difficult emotions or even traumatic experiences,” Farias says.

In the book the pair cite the 1930s doctor Edmund Jacobson, whose book You Must Relax recommended practical methods to counteract the stresses of “modern living”. “If written today, the book would have been renamed ‘You Must Meditate’.”

“The whole excitement about mindfulness was quasi-religious in a secular garb,” Farias says. “That has been a problem with quite a lot of the claims, they have been very naive in investing in this glamour and hope that this would be wonderful for everyone.”

Initially it was estimated that only 1 per cent of people felt worse after meditation or mindfulness, Farias says. “Seven years after our book we have a growing body of research showing that these adverse events are much more common than we had ever thought. It’s more likely that they’re between 8 and 15 per cent.”

The research literature also reinforces this recent study, Farias says, that it is those with pre-existing mental health problems that need to exercise most caution when meditating.

“You might think this is intuitive. But on the other hand, given that these mindfulness interventions are developed exactly for people with mental health problems, it’s not that intuitive actually.”

Farias writes in the book that mindfulness is also politically insidious, in that it lays the responsibility for children feeling unhappy at their own feet. If only they were better at sitting quietly in a classroom, instead of fidgeting!

What about if adult society got better at laying off the exam stress, at giving children more nature, art, sport and drama? A bit of mindfulness doesn’t do much to change the fact that a 16-year-old will do 20-plus different external exams at GCSE, just two years before they are re-examined even more stringently. Farias says his own teenagers are stressed, and he completely sees why.

“I’m from Portugal, and I’ve been here 21 years but only realised too late this idea of GCSEs is a horrendous torturous system. We are distracted from the real questions which are not being asked. The kids are getting anxious: why?”

He uses mindfulness sometimes, to get into the flow when driving. Would he teach it to his children? “I’ve found relaxation techniques, using gentle exercise and breathing, are more helpful.”

In 2015 I interviewed André Spicer, dean and professor of organisational behaviour at Bayes Business School, University of London. An all-party parliamentary group on mindfulness had just been set up to apply the meditative practice to a “range of policy areas”.

Spicer co-wrote The Wellness Syndrome, a book pointing up the absurdity of asking individuals to self-help their way out of structural problems. I catch up with him now.

“I think we’re realising mindfulness isn’t this cure for every malady that modern life throws at us,” Spicer says. “It’s useful in a limited range of contexts, which is generally fairly healthy people who just want to be able to focus and calm down a bit.

“We are attracted to it because it’s an easy solution you can put on an app. But real interventions to deal with problems with our children go far beyond that.”

Our children live in far more “closed worlds” than their grandparents, Spicer says. My children dream of being able to roam a beach or climb trees for hours. Maybe if they close their eyes tightly enough, they can.