Epistemic Spot Check: Full Catastrophe Living (Jon Kabat-Zinn)

Link post Contents

• Overview
• Introduction
• The Model
• You Might Like This Book If… Full Catastrophe Living is a little weird, because between the first edition and the second a lot of science came out testing the thesis. For this blog post, I’m reviewing the new, scienced-up edition of FCL. However I have ordered the older edition of the book (thanks, Patreon supporters and half.com) and have dreams of reviewing that separately, with an eye towards identifying what could have predicted the experimental outcome. E.g. if the experimental outcome is positive, was there something special about the model that we could recognize in other self-help books before rigorous science comes in? I originally planned on fact checking two chapters, the scientific introduction and one of the explanatory chapters. Doing the intro was exhausting and demonstrated a consistent pattern of "basically correct, from a small sample size, finding exaggerated", so I skipped the second chapter of fact checking. I also skipped the latter two thirds of the book.

Overview

You’ve probably heard about mindfulness, but just in case: mindfulness is a meditation practice that involves being present and not holding on to thoughts, originally created within Buddhism. Mindfulness Based Stress Reduction (MBSR) is a specific class created by the author of this book, Jon Kabat-Zinn. The class has since spread across the country; he cites 720 programs in the introduction. Full Catastrophe Living contains both a playbook for teaching the class to yourself, the science of why it works (I’m guessing this is new?), a section on stress, and followup information on how to integrate meditation into your life.

Introduction

Claim: Humans are happier when they focus on what they are doing than when they let their mind wander, which is 50% of the time. Accurately cited, large effect size, possible confounding effects. (PDF). The slope of the regression between mind wandering and mind not-wandering was 8.79 out of a 100 point scale, and the difference between unpleasant mind wandering and any mind not-wandering task was ~30 points. Pleasant mind wandering was exactly as pleasant as focusing on the task at hand. Focusing accounting for 17.7% of the between-person variation in happiness, compared to 3.2% from choice of task. Some caveats:

• People’s minds are more likely to wander when they’re doing something unpleasant, and when they are having trouble coping with that unpleasantness. The study could be identifying a symptom rather than a cause.

• The study population was extremely unrepresentative, consisting of people who chose to download an iPhone app. Claim: Loss of telomeres is associated with stress and aging; meditation lengthens telomeres by reducing stress (location 404). Research slightly more theoretical than is represented, but theoretical case is strong. (Source). First, let’s talk about telomeres. Telomeres are caps on the ends of all of your chromosomes. Because of the way DNA is copied, they will shorten a bit on every division. There’s a special enzyme to re-lengthen them (telomerase), but leading thought right now is that stress inhibits it. Short telomeres are associated with the diseases of aging (heart issues, type two diabetes) independent of chronological age. This is hard to study because telomere length is a function of your entire life, not the last week, but is pretty established science at this point. Mindfulness reduces stress, so it’s not implausible that it could lengthen telomeres and thus reduce aging. The authors also present some evidence that negative mood reduces the activity of telomerase. This is a very strong theoretical case, but is not quite proven. Claim: Happiness research Dan Gilbert claims meditation is one of the keys to happiness, up there with sleep and exercise (location 461). Confirmed that Gilbert is a happiness researcher and said the quote cited, although I can’t find where he personally researched this. Claim: "Researchers at Massachusetts General Hospital and Harvard University have shown, using fMRI brain scanning technology, that eight weeks of MBSR training leads to thickening of a number of different regions of the brain associated with learning and memory, emotion regulation, the sense of self, and perspective taking. They also found that the amygdala, a region deep in the brain that is responsible for appraising and reacting to perceived threats, was thinner after MBSR, and that the degree of thinning was related to the degree of improvement on a perceived stress scale." (location 502) Accurate citation, but: small sample size (16/​26), and for the first study the effect size was quite small (1%) for regions of a priori interest, and the second had quite wide error bands (source 1) (source 2). However the book does refer to these findings as preliminary. Claim: "They also show that functions vital to our well-being and quality of life, such as perspective taking, attention regulation, learning and memory, emotion regulation, and threat appraisal, can be positively influenced by training in MBSR." (location 508). Misleading. These are really broad claims and no specific study is cited. However, source 2 above has the following quote: "The results suggest that participation in MBSR is associated with changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking." This is a very carefully phrased statement indicating that mindfulness is in the right ballpark for affecting these things, but is not the same as demonstrating actual change. Claim: "Researchers at the University of Toronto, also using fMRI, found that people who had completed an MBSR program showed increases in neuronal activity in a brain network associated with embodied present-moment experience, and decreases in another brain network associated with the self as experienced across time. […] This study also showed that MBSR could unlink these two forms of self-referencing, which usually function in tandem." (location 508). Accurate citation, small sample size (36) that they made particularly hard to find (source). I can’t decipher the true size of the effect. Claim: Relative to another health class, MBSR participants had smaller blisters in response to a lab procedure, indicating lower inflammation (location 529). True, but only because the other class raised inflammation (source). Also leaves out the fact that both groups had the same cortisol levels and self-reported stress. So this looks less like MBSR helped, and more like the control program was actively counterproductive. For the record, this is where I got frustrated. Claim: "people who were meditating while receiving ultraviolet light therapy for their psoriasis healed at four times the rate of those receiving the light treatment by itself without meditating." (location 534) Accurate citation (of his own work), small sample size (pdf). Claim: "we found that the electrical activity in certain areas of the brain known to be involved in the expression of emotions (within the prefrontal cerebral cortex) shifted in the MBSR participants in a direction (right-sided to left-sided) that suggested that the meditators were handling emotions such as anxiety and frustration more effectively. […] This study also found that when the people in the study in both groups were given a flu vaccine at the end of the eight weeks of training, the MBSR group mounted a significantly stronger antibody response in their immune system" Accurate citation (of his own work), slightly misleading, small sample size. Once again, he’s strongly implying a behavioral effect when the only evidence is that MBSR touches an area of the brain. On the other hand, the original paper gets into why they make that assumption, so either it’s correct or we just learned something cool about the brain. Claim: MBSR reduced loneliness and a particular inflammatory protein among the elderly (location 551). **Not statistically significant. **(source) More specifically; the loneliness finding was significant but uninteresting, since the treatment was "8 weeks with a regular social activity" and the control was "not." The inflammation finding had p = .075. There’s nothing magic about p < .05 and I don’t want to worship it, but it’s not a strong result. I also researched MBSR in general, and found it to have a surprisingly large effect on depression and anxiety.

The Model

To the extent Full Catastrophe Living has a model, it’s been integrated so fully into the cultural zeitgeist that I have a hard time articulating it. It could be summarized as "do these practices and some amount of good things from this list will happen to you." Which kills my hypothesis that having a good model is necessary to getting good results.

You Might Like This Book If…

I don’t know. I found it a slog and only read the first third, but the empirical evidence is very much on mindfulness’s side and I don’t know what better thing to suggest. Thanks to the internet for making it possible for me to do these kinds of investigations. Thanks to Patreon supporters for giving me money.