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The Downside of the Here-and-Now

29 October 2019 - Dr Jan Orman

We have been talking about mindfulness in mental health for some time. It’s sometimes hyped as the universal panacea for all things anxious and depressed. Easy, cheap and with no side effects!

How did we get so wrapped up in mindfulness?

Jon Kabat Zinn started the trend - his own Buddhist practice led him to teach mindfulness to help people cope with stress, anxiety, pain, and illness. This led to the development of a whole new therapy model – mindfulness-based stress reduction (MBSR). You can get a good taste of MBSR on the THISWAYUP website where the free Introduction to Mindfulness course might lead you to the $60 Mindfulness Based CBT course if you’ve a mind to go there.

Marsha Linehan helped consolidate mindfulness into therapy by including mindfulness training as a major strand of Dialectic Behaviour Therapy.

Segal, Williams and Teasdale were the first to show that regular mindfulness practice could be helpful in preventing depression relapse.

But does it work for everyone?

I’m sure you too have had the experience of meeting someone for whom mindfulness not only did not have any benefit but for whom it seemed to be a counterproductive activity. There is actually evidence in the research that mindfulness is not for everybody.

In 2016 in an Australian study 132 adolescents were provided with 8 weekly sessions of in-school mindfulness training. The study showed no significant improvement in anxiety, depression, weight and shape concerns and general well-being immediately after the intervention and again at 3-month follow up. In fact, the boys were more anxious than their unmindful peers in the control group, and more anxious than before the training.

There’s lots to be said about this study. Is in-school a good place to deliver mindfulness training? How seriously will adolescents taught mindfulness in a group setting with their peers take the whole process? Is this study really an assessment of the effectiveness of mindfulness training on the individual or a comment on the way mindfulness can be effectively taught and to whom? 

What else is there to fall back on?

I have met people who get more anxious when they try mindfulness. Many of these people simply refuse to keep trying. Many say that attempting mindfulness exercises simply draws their attention to their thoughts and makes their rumination worse.

Many of those people feel a failure if they cannot practice mindfulness. Their feeling of failure is often exacerbated by practitioners who insist that mindfulness helps everyone and all they need to do is keep practicing. 

Those people may do better with distraction techniques including progressive muscle relaxation, breath based relaxation, repetition of mantra, puzzles, creative activities such as writing or crafting or practices involving physical activity such as tapping or drumming.

People need to be reassured that if they can’t stay in the here-and-now they are not alone. They simply need to find the self-soothing and relaxing practice that is right for them. If they never get to mindfulness then that’s OK but some day they may find they are able to benefit from mindfulness as well – just not here and now.






Dr Jan Orman
Dr Jan Orman

Jan is Sydney GP, private psychological medicine practitioner in Sydney’s inner west and a GP educator for Black Dog Institute.

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