Mindfulness in the mainstream

What it is

The secularised form of Buddhist mindfulness practice as it now exists in hospitals, schools, prisons, armed forces and corporations — taught as a technique for stress reduction and attention training, deliberately detached from Buddhist doctrine, ethics and goals.

Its institutional forms:

• MBSR — Mindfulness-Based Stress Reduction, an eight-week structured programme
• MBCT — Mindfulness-Based Cognitive Therapy, developed for preventing depressive relapse and recommended in clinical guidelines including the UK's NICE
• Corporate programmes, of which Google's Search Inside Yourself is the best known
• Apps — Headspace, Calm and their competitors, with hundreds of millions of downloads between them
• School curricula, deployed at national scale in several countries

Where it came from

The lineage is covered under modern mindfulness; the short version is that Jon Kabat-Zinn founded the Stress Reduction Clinic at the University of Massachusetts Medical School in 1979 and built MBSR from Zen, Theravada vipassana and hatha yoga, with the Buddhist framework deliberately removed.

The removal was strategic and he has said so. His judgement was that a hospital would not accept a Buddhist practice and would accept a clinical one, and that getting the practice to suffering people mattered more than keeping its vocabulary. That judgement was vindicated commercially and institutionally beyond anything he could have expected.

How it is done

Through structured attention practice — the body scan, breath awareness, mindful movement — taught in courses or via recordings. This article does not instruct.

What we can and cannot say

We can say the clinical evidence is real and narrower than the marketing. The evidence base is examined in detail under the evidence on meditation. In summary: MBCT for preventing relapse in recurrent depression is well supported and is in clinical guidelines; mindfulness-based programmes show moderate benefits for anxiety, depression and chronic pain, generally comparable to other active treatments rather than superior to them; and effects on cognition, productivity and wellbeing in healthy populations are small and inconsistently found.

The literature has documented problems — small samples, weak control conditions, publication bias, and a 2014 JAMA meta-analysis that found the evidence considerably thinner than the enthusiasm. Later, better trials have been more mixed than the earlier wave.

We can say adverse effects exist and were under-reported for a long time. Willoughby Britton's Varieties of Contemplative Experience research documented anxiety, depersonalisation, re-experiencing of trauma, and in a minority of cases serious and prolonged difficulty. Estimates of the rate of significant adverse experience in meditators run into the low double digits in some samples. This is not an argument against the practice; it is an argument for the ordinary standard applied to any intervention — that harms are recorded, that teachers are trained to recognise them, and that people are told. Anyone experiencing distress, dissociation or worsening symptoms during intensive practice should stop and speak to a clinician; this is not medical advice.

We can state the "McMindfulness" critique fairly, because it is a serious one. Ronald Purser's argument, and Buddhist critics' more broadly, is that extracting the technique from the ethical framework changes what it is. In Buddhist practice, sati sits within the eightfold path alongside right speech, right action and right livelihood, and is aimed at insight into non-self and the end of suffering — not at stress management. Removed from that, it becomes a tool that can serve any end, including ends the tradition would reject: a technique to help employees tolerate conditions that should be changed, or to make soldiers more effective. Corporate programmes that address individual stress while leaving workload untouched are the standard example, and the objection is structural rather than sentimental.

We can say the defence is also serious. Kabat-Zinn's response is that the ethics are implicit in the practice — that sustained attention to one's own experience tends to produce the qualities the tradition names, and that a practice which reaches millions of people who would never enter a temple has done more good than a purer version reaching a few hundred. Many Buddhist teachers agree with him. The disagreement is genuine and is between people who all practise.

And we can say something about school and workplace deployment specifically. The largest trial of mindfulness in schools — the UK's MYRIAD study, published in 2022 with over eight thousand adolescents — found no benefit on the primary mental health outcomes, and some indication of worse outcomes for pupils already at risk. That is a large, well-run, negative result on a programme that had been rolled out widely before it was tested, and it is the strongest single caution in this article.

We cannot say whether the secularised practice is the same practice. What we can say is that the compromise Kabat-Zinn made was deliberate, that it achieved exactly what he intended, and that the question of what was left behind is being argued by the people best placed to know.

Further reading

• Ronald Purser, McMindfulness (2019).
• The MYRIAD trial reports (2022), on schools.
• Britton's Varieties of Contemplative Experience work, on adverse effects.