Mental Ailments and Covid Pandemic: New Targets for Mindfulness Interventions ?

The Covid epidemic is heavily hitting, adding social and mental afflictions to the direct medical consequences of the viral infection. Psychological difficulties create additional needs requiring intervention, and mindfulness interventions have been proposed and begin to be employed. Mindfulness was devised in the late ‘70s in United States by Jon Kabat-Zinn as a new approach for treating the negative consequences caused by stressful life events. The method proposed offered “the wisdom at the heart of Buddhist meditation without the Buddhism”, defining mindfulness as the “awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally” [1].


Opinion
The Covid epidemic is heavily hitting, adding social and mental afflictions to the direct medical consequences of the viral infection. Psychological difficulties create additional needs requiring intervention, and mindfulness interventions have been proposed and begin to be employed. Mindfulness was devised in the late '70s in United States by Jon Kabat-Zinn as a new approach for treating the negative consequences caused by stressful life events. The method proposed offered "the wisdom at the heart of Buddhist meditation without the Buddhism", defining mindfulness as the "awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally" [1].
The aim of Buddhism, originated 2,500 years ago in Northern India, is the relief of the sufferings of life. Kabat-Zinn decided to choose meditation, isolated from the complexity of Buddhist teachings, and to employ it his program to use what he called mindfulness to alleviate the mental ailments of the present Western society. The subsequent diffusion of mindfulness and use for treating a variety of mental and psychosomatic conditions is astonishing; depression, particularly the cases of relapses and limited antidepressant drug responsiveness, is a main target. It is noteworthy that these developments occurred prevalently in biological psychiatry and basic and cognitive neurosciences, following the methods of evidence based medicine. The involvement of meditation of the mindfulness approaches was progressively minimalized and diluted into cognitive psychotherapies, and the original spiritual roots and the humanistic interpersonal psychodynamic perspectives were left aside. The relevant literature is amazingly wide: "Mindfulness, Psychotherapy and Buddhist" analyses the complex relationships of these interconnected fields [2]. At the same time, critiques appear and are eloquent in the title of their publications. An article in The BJ Psychology Bulletin asks whether "Has science of mindfulness lost its mind" [3], and Perspective on Psychological Science publishes "Mind the hype: A critical evaluation and prescriptive agenda for research on mindfulness and meditation" [4]. Ronald Purser is concerned about "Mcmindfulness: How Mindfulness Became the New Capitalist Spirituality", and the book by Thomas Joiner adds his concern: "The Corruption of Mindfulness in a Culture of Narcissism" [6]. The majority of the reports use the terms mindfulness, meditation and mindfulness meditation interchangeably. The same term of mindfulness probably owes its popularity to its current literal meaning, rather than its original significance. Mindfulness is the English translation of the Pali term "sati" of the ancient Buddhist scriptures, which in its new life it lost the original meaning of "to call to the mind, to memorize, not to forget", as meant also by its Sanskrit declination "smrti" [7].
The choice to pick up just meditation from the immense complexity and richness of Buddhist teachings, and to rename it "sati", appears surprising. The attention now given to meditation in the West is a peculiar feature, since in the countries where Buddhism is an established religion, meditation is practiced almost exclusively by the monks residing in monasteries [8]. The fundamental characteristic of ethics and moral values which deeply pervade Buddhism vanished [9], and amazing applications such as the "Mindfulness-Based Mind Fitness Training" (MMFT) program are employed by the US Army to promote resilience and provide a "mental armor" to their warriors [10]. UK offers
a unique example of initiatives in mental health and society. The NICE guidelines, and the IAPT program, avoid the prescription of antidepressants as the first response the mild cases of depression, and encourages the use of psychological support and psychotherapy: Mindfulness Based Cognitive Therapy (MBCT) is one of the choices available. When the results obtained are analysed, positive and substantially similar results are obtained, in spite of the variety of psychotherapies employed ranging from cognitive and third wave cognitive therapies to psychodynamic and interpersonal psychotherapies [11]. Additionally, the "Mindfulness Initiative" aims to make the whole Great Britain a Mindful Nation [12].
The available evidence indicates that mindfulness based applications can cause positive effects, also when combined with cognitive psychotherapies or psycho-social interventions. At the same time, the protocols employed so far do not show the superiority of the interventions including mindfulness over those without it, and in general lack a comparison with a placebo and the "blinding" of therapists, patients and evaluators in relation to the treatment received. When a similar analysis was applied to the different psychotherapies commonly used, all were shown to provide largely overlapping results, in a way independent form the nature of the therapy provided. The question "Are all psychotherapy created equal" was made, and the term of "Dodo effect" was coined for referring to the similarity of effectiveness in spite of the different nature of the approaches considered [13]. The specific "ingredient" of each approach evades identification, and a similarity with the current enthusiasm for mindfulness and its combination with cognitive psychotherapies is apparent.
The ailments of globalized Western life, worsened by the Covid pandemic, constitute new unmet needs which are receiving medical attention and various types of psychological support, more often based on biological psychiatry and cognitive behavioural techniques. A variety of mindfulness interventions also integrated into cognitive behavioural therapies are proposed. These approaches, deprived of their Buddhist roots, appear to be devoid of humanistic existential and interpersonal dimension. It will be interesting to observe the results of these interventions when more rigorous experimental protocols will be followed, and humanistic and existential values will receive the greater attention they likely deserve.