I wrote a blog post yesterday just before heading out to what was billed as an international conference on "Mindfulness, health and wellbeing" with Jon Kabat-Zinn.  I described the structure of the day - with a variety of interesting speakers billed - and sounded a note of caution about possible tensions between "gurus" and "scientists".  Now it's the morning after and I'm feeling a bit sad, confused and a little anxious.  But before I talk more about this, I would just like to start by honouring Jon Kabat-Zinn and the people who put the conference together.

In the four hours or so that he spoke, Jon gave some detail about the pretty extraordinary journey that he - and mindfulness - have taken over the last thirty to forty years.  And it is an extraordinary journey from well out in left field to the limelight and the mainstream.  I and, I'm sure, very many others would want to deeply honour what has happened.  The hard work, dedication, integrity, goodwill, persistence - so much that has been contributed - and arguably Jon is the central figure in this flowering of health professional & public interest in the possible ways that mindfulness can contribute to easing suffering in our world.  Fantastic.  Impressive.  Very good reasons for gratitude and respect.  And linked with this are the multitude of other good-hearted, intelligent people who are contributing to this exploration  - not least those who helped put together this interesting and helpful Glasgow conference.

So why am I feeling a bit sad, confused and a little anxious this morning?  Well I think the anxiety is that I sense myself as being out of step with the majority of the 300 or so other people in yesterday's conference audience, and I guess many people who might be reading this blog.  I wasn't impressed by Jon's four hour contribution yesterday and again, some of the anxiety is looking at myself and querying "Why not?  Why weren't you more impressed when this fine man has clearly impressed & inspired thousands & thousands of others all around the world?  Am I somehow unbearably awkward not to have been more moved & informed by all that he said?"  And I think part of the problem was organizational.  Jon is 68 years old.  He was probably quite jet-lagged.  He appears to give conference after conference.  And his morning presentation was a straight three hours long with no break.  Wow, that's a very big ask ... both for him and for the audience's attention & bladder capacities.  It didn't work for me and I would have much preferred a mid-presentation stretch & pee break.

I also think the talk was misdescribed.  Jon is Emeritus Professor of Medicine at the University of Massachusetts Medical School.  His presentation was entitled "Mindfulness: theory, practice, teaching and research".  It was programmed to come in two parts - a three hour morning session and an hour & a half's afternoon session (this latter subsequently got reduced to just an hour or so).  The title led me to hope that some of what we would hear would be a clear, critical, insightful overview of mindfulness's evolving status as an increasingly well-evidenced health intervention.  There has been a fascinating dialogue between traditional models of how mindfulness works and developing research-based exploration of key change mechanisms.  I think this is so important because it has significant implications for how to teach mindfulness most helpfully.  Currently the only UK guideline-based recommendation is for "mindfulness-based cognitive therapy for people who are currently well but have experienced three or more previous episodes of depression."  This is a somewhat limited group of people.  Although there is a huge flowering of mindfulness research, most of the studies involve just small numbers of people and are often of fairly poor quality.  There is however a developing sense that mindfulness training may have something important to offer people who are suffering from chronic ongoing depression.  There is also a growing research base suggesting mindfulness interventions may have a good deal to offer people with anxiety.  How good is this evidence?  Are some anxiety disorders more responsive than others to mindfulness treatments?  Is mindfulness any use in the treatment of acute depression?  Is it contra-indicated?  In fact what are the potential adverse effects of mindfulness training?  How does it actually stack up against other active, well-supported interventions?  What are the other conditions that are looking as though they might also benefit from mindfulness approaches?  Do interventions need to be adapted for different conditions or are there evidence-based reasons for keeping people in general mindfulness groups?  Is the current eight week plus a full day mindfulness training optimal?  Do some people need more?  Would a significant proportion of participants do as well with less?  So many important questions.  I wasn't left much wiser after listening to Jon's four hours of presentation.  I feel sad about this.  What I personally got from his talk was an intriguing, sometimes rambling, often charming, peppered with occasional research references, description of a journey he has taken over the last thirty plus years.  Fine.  Good.  I think it should have been entitled something like "A thirty five year journey with mindfulness".  And some people may say that I'm missing the point, that mindfulness is a way of being much more than just a limited health intervention, that it's so much more profound than is being realised or assessed in current health research.  And that may well be true, but this conference wasn't a meditation retreat.  It was co-hosted by the University of Glasgow, advertised on their website under "General practice and primary care", and the audience was very much a gathering of health professionals.  

There was also other good input during the day.  Fascinatingly and for me completely unexpectedly, I found the most inspiring talk was the 15 minute opening address given by Sir Harry Burns, chief medical officer for Scotland.  Gosh.  So enlightening, passionate and intelligent in it's quick take on Scotland's dreadful health record and what is probably needed to begin to turn the situation round.  Great that some people in positions of influence have such good brains and good hearts.  Also well worth hearing was Maura Kenny on her work on mindfulness in Australia.  Helpful stuff ... exploring mindfulness treatment of chronic depression, looking at how well gains are maintained, sifting through what types of symptom/disorder seem to respond best, discussing potential adverse effects, looking at economic implications ... all so much what I was hoping for in more global terms from Jon.  It was well worthwhile for me also to hear the input from Stewart Mercer, Alistair Wilson & Neil Rothwell on the current provision and plans for mindfulness teaching in the Scottish Health Service.  Useful to get these updates.

So a rich day.  Honour, confusion, sadness & interest ...