Growing utilization of mindfulness and meditation
The expanding implementations of MM parallel growing consumer demand. National surveys have consistently noted that meditation and related practices are among the most commonly used complementary and alternative medicine (CAM) modalities in the United States to address health and mental health issues. The 2007 National Health Interview Survey (NHIS) found that 38.4% of adults in the United States had used some type of CAM in the past 12 months, with deep breathing exercises, meditation, and yoga being among the most common, used by 12.7%, 9.4%, and 6.1%, respectively, and showing increases from the rates of usage in the 2002 survey (Barnes et al. 2008). An in-depth analysis of the 2007 NHIS CAM data reported that a quarter of the 16.3% who used meditation and relaxation practices did so to treat a specific medical condition. In addition, those with greater psychological distress were more likely to use meditation and relaxation (Lee and Yeo 2013), so clearly there is a growing consumer perception that MM practices can be therapeutic.
Clinicians likewise increasingly embrace MM as therapeutic. Some work suggests that mindfulness is considered a theoretical orientation by many therapists. In a survey of more than 2000 North American practicing psychotherapists, mindfulness was the third most frequently endorsed theoretical orientation, utilized by 41%. It followed cognitive behavioral therapy (CBT; 79%) and family systems (49%) in popularity. More than a fifth of therapists taught skills such as meditation to at least half of their clients (Cook et al. 2010). MM has also been incorporated into regular clinical care on a broad scale. A survey of veterans’ hospitals in the United States found that 72% offer meditation to their patients (VA Office of Research and Development 2011). Despite the fact that MM research for post-traumatic stress disorder (PTSD) is still an emerging area, MM appears to be in widespread usage among trauma therapists. A survey of expert clinicians about best practices in the treatment of complex PTSD identified MM as an appropriate second-line intervention, used in place of standard trauma therapy because of patient preference or treatment non-response (Cloitre et al. 2011). A recent trauma therapist survey found that the majority use MM in some form in psychotherapy with traumatized patients, typically integrated into standard psychotherapy sessions rather than being offered in standardized forms such as MBSR or MBCT as an adjunct or stand-alone treatment (Waelde et al. in press). As reviewed below, existing research has primarily addressed the effects of standardized protocols, so these indications of widespread acceptability and individualized applications suggest that, for the moment at least, the practice has exceeded the evidence base.