Issue 141 An introduction to mindfulness

AN INTRODUCTION TO MINDFULNESS

SKILLS & LEARNING

Mindfulness has become a big buzz word over the past few years.

But what does it mean and how do we become mindful eaters?

Mindfulness is a mind-body practice which describes the human ability to be fully present and in the moment.1 Mindfulness is about paying attention but not overly reacting to automatic thoughts and behaviour patterns, and managing them more effectively through techniques such as meditation, breathing and yoga.2 Mindfulness is based on ancient Zen Buddhist meditation techniques; however, this doesn’t mean that you need to be religious or spiritual to practice mindfulness.

Over the years, various types of mindfulness interventions have emerged, with the most common types being: mindfulness-based stress reduction (MBSR), mindfulnessbased cognitive therapy (MCBT), dialectical behaviours therapy (DBT), acceptance and commitment therapy (ACT) and mindfulness-based relapse prevention (MBRP).

Without a doubt, MBSR and MBCT are the most extensively researched mindfulness interventions.3 MBSR was developed by Dr Jon Kabat-Zinn at the University of Massachusetts in the 1970s, following the success of a stress reduction programme for people with chronic illnesses. MBSR involves three main elements: the body scan (mindful body perception), gentle yoga exercises and the traditional sitting meditation.4 MBCT is based upon MBSR; however, it integrates the principles of mindfulness with cognitive therapies. It was originally developed as a relapseprevention treatment for adults with major depressive disorder, and the cognitive element focuses on better acceptance and compliance of the

present self. The goal of MBCT is to disrupt negative automatic thought processes and to not overreact to incoming stimuli, instead focusing on reflection, acceptance and observation.5 Westernised conceptualisation of mindfulness has become an innovative psychological intervention for physical and mental health conditions,2 and much of the research on mindfulness has focused on the clinical efficacy of mindfulness-based interventions.6 HEALTH BENEFITS OF MINDFULNESS

The research base for mindfulness and health and wellbeing is constantly evolving. Methodologically rigorous randomised control trials have demonstrated that mindfulness-based interventions improve outcomes in multiple domains, including chronic pain, depression relapse, stress and anxiety.2 NICE guidelines currently recommend mindfulness-based cognitive therapy for people who are currently well but have experienced three or more previous episodes of depression.

NICE recommend that MBCT should be delivered in groups of eight to 15 participants and consist of weekly twohour meetings over eight weeks.7 Whilst there is good evidence to suggest that MBCT is associated with positive outcomes in prevention of depressive relapse or recurrence, a large randomised control trial found no evidence that mindfulness-based therapies were superior to maintenance antidepressant treatment.8 This suggests that mindfulness-based therapies shouldn’t be used as standalone treatments. Furthermore, NICE does not routinely recommend mindfulness-

Harriet Smith RD Freelance Dietitian and Health Writer Harriet is Founder of Surrey Dietitian providing private dietetic consultations and consultancy services, offering evidence-based nutritional advice, backed up by the latest research on food, health and disease.

Harriet has written for national, consumer and industry media. www.surrey dietitian.co.uk @SurreyDietitian

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SKILLS & LEARNING based interventions or supportive therapy to treat social anxiety disorder.

Many of the studies investigating mindfulnessbased interventions in chronic conditions are either small or have methodological weaknesses. One small randomised trial of 33 fibromyalgia patients found that mindfulness-based interventions significantly reduced the impact of the illness and depressive symptoms after treatment.9 However, a larger randomised trial in 133 women did not support the efficacy of MBSR in fibromyalgia and concluded that further high-quality research is required.10 However, participation in a MBSR programme may help people to cope better with symptoms of chronic disease, and improve their well-being and quality of life.11 MINDFULNESS AND DIET

Much of the research on mindfulness and diet focuses on mindfulness-based interventions in disordered eating. For example, a systematic review of 14 studies found that mindfulness meditation effectively decreased binge eating and emotional eating in populations engaging with this behaviour. Interestingly, they concluded that the quality of evidence of mindfulnessbased interventions on weight isn’t as strong and warrants further research.12 However, there is very little evidence about the mechanisms of mindfulness and how this influences eating behaviours and diet. Additionally, there is very little evidence about the most effective types of mindfulness interventions, although MBCT and MBSR seem to be the most researched interventions.13 There is a lack of evidence looking at the effects of mindfulness on weight loss, with many studies concluding that randomised control studies are needed.14 A systematic review of 19 studies found that six of the eight randomised control trials reviewed reported significant weight loss in the intervention group (those who received a mindfulness-based intervention) compared with the control group. However, none of these studies reported a relationship between changes in mindfulness and weight loss. This means that we don’t know whether the weight loss seen in the mindfulness group was due to the mindfulness intervention itself or other factors, which is a methodological weakness of this study.13 32

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A literature review of 21 papers found that 86% of the reviewed studies reported targeted improvements in eating behaviours amongst obese participants (including binge eating, emotional eating and external eating) following a variety of mindfulness-based interventions.

The authors concluded that there is emerging evidence to support the use of mindfulnessbased interventions in positively changing obesity-related eating behaviours.15 More recently, a systematic review and metaanalysis reviewed 19 studies, looking at the effects of mindfulness on weight loss, eating behaviours, psychological outcomes and mindfulness. Overall, they found that mindfulness-based interventions were associated with small-to-moderate effects on weight loss, with an average loss of 7lbs at follow-up (four months post intervention). There were also some significant reductions in eating behaviours in the mindfulness group, such as a reduction in binge eating.16 There were some major limitations to this study, including small sample sizes, unrepresentative samples (mainly women), not controlling for confounders and a lack of data on long-term weight loss maintenance. Therefore, we can’t say for sure whether mindfulness helps with weight loss; however, it may be something that people want to try.

INCORPORATING MINDFULNESS INTO DAILY LIFE

Mindfulness can be practiced on your own, in a group setting, or one-to-one with a trained mindfulness coach. There is an abundance of books, websites, podcasts and apps available, which can be used for self-directed practice at home.

It can be as simple as paying attention to your breath, focusing on the speed, sensations and patterns of your breathing, or walking through nature and taking in the sights and sounds of your surroundings.

Mindful eating is about paying attention to the eating experience, being fully present and not getting caught up in any thoughts or worries at the back of your mind. It can be as simple as switching off your phone at meals and recognising the different tastes, textures and colours of foods.

Mindful eating is about paying attention to the eating experience, being fully present and not getting caught up in any thoughts or worries at the back of your mind.

Characteristics of mindful eating include: • eating more slowly, acknowledging feelings and sensations (ie, hunger) and stopping eating before you are uncomfortably full; • enjoying foods that you want to eat and savouring the eating experience; • responding to body signals and eating when your body tells you to (ie, when you feel hungry, when your stomach grumbles, or when you feel tired/dizzy); • focusing on the present moment – switch off background distractions (ie, screens/ music) – and remaining open to how things unfold rather than focusing on preconceived conceptions about how things should turn out; • being fully present – recognising the different sensations whilst eating (smells/ textures/colours of foods), enjoying the company of others whilst eating and trying to avoid eating on to go; • compassion – being gentle and kind on yourself, not judging or punishing yourself

after eating and recognising that every food can have a role in a healthy and balanced diet.

SUMMARY

Despite many uncertainties and flaws in the literature, mindfulness has been shown to have benefits for mental wellbeing, which is reflected in the NICE guidelines. As with many nutrition topics, we need more high-quality evidence before we conclude whether mindfulness is likely to benefit other aspects of our diet and eating behaviours. However, there doesn’t appear to be any harm in applying the key components of mindfulness to everyday life and eating. Many of the components of mindful eating (such as eating more slowly and savouring the eating experience) are things we should all be trying to do at mealtimes. What's more, there is some preliminary evidence to suggest that mindful eating, even in the absence of weight changes, can be beneficial in patients with disordered eating.

USEFUL RESOURCES FOR MINDFULNESS • Free apps such as Calm or Headspace, or paid-for apps such as Buddhify • Mind – free mindfulness exercises and tips from www.mind.org.uk/ • Be Mindful - part of the Mental Health Foundation charity: www.mentalhealth.org.uk/. This is a four-week online mindfulness course developed by qualified teachers: https://bemindful.co.uk. It’s listed in the NHS Digital Library at https://apps.beta.nhs.uk • Breathworks offers mindfulness courses to manage pain, stress and illness: www.breathworksmindfulness.org.uk • The book Mindfulness: A practical guide to finding peace in a frantic world by Prof Mark Williams and Dr Danny Penman • Bruce Langford Podcasts 10% Happier, The Self Help & Mindfulness Mode: http://mindfulnessmode.com

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