I can’t recall how often I’ve mentioned mindfulness to people and get that eye roll and ‘It doesn’t work!’ response. Let’s dig into this a bit more, and touch on one of the groups of people who quite often think mindfulness is not for them (pssst! I’m talking to you, ADHDers!).
The first question that comes to mind for me is what people mean when they say ‘it doesn’t work’. I mean, what are people expecting from mindfulness? How are they measuring whether it’s ‘worked’ or not? And I do not mean this in any negative way at all, this is a genuinely curiousity-driven question for me because I wonder about how mindfulness is introduced to people.
What is mindfulness ‘sold’ as?
I used Google to find out what the first few entries about mindfulness say:
Wow! It’s a miracle! Why isn’t everyone doing it?!! Mindfulness can do anything!
What are the effects?
There is little doubt in my mind that research demonstrates some positive effects on people – the ability to stop, be willing to notice rather than act, to take as non-judgemental an attitude as possible, to give room to being rather than doing. All good things. And yet mindfulness is not an instant fix. It can be HARD to stop wanting an outcome. Hard to enter mindfulness with curiosity – because often we’re introduced to mindfulness as a means to an end, and often at a time when we’re seeking something different from where we’re at.
I suppose the point of mindfulness is not to achieve a thing, or any specific thing. That’s not easy because almost everything else we do IS intended to achieve something, even looking at a sunset is usually done to ‘appreciate the sunset.’
This excerpt from Shapiro, Siegel & Neff (2018) really sums it up to me:
So the first reason someone might say that it doesn’t work is because they’re hoping for a particular result, and if this isn’t achieved the practice is deemed a failure.
I really do like the Shapiro ‘model’ of mindfulness – that mindfulness consists of intention, attention, and attitude. Intention being about knowing why we want to do mindfulness – oh hey, is that a contradiction? Didn’t I say it’s not to achieve anything specific thing just above? Well yes – and here’s another of the weird contradictions of mindfulness: it’s not about outcome-based goals, it’s about the direction or the ‘compass of the heart’ as Shapiro, Siegel & Neff (2018) put it. I think of intention as being willing to experience what is present, as it is. To be open. To allow my heart to be with what shows up. Attention is pretty obvious because, as I’ve said above, it is about bringing your mind back to where you want it. Again, I love the way Shapiro and colleagues put it: “a dynamic process of learning how to cultivate attention that is discerning and non-reactive, sustained, and concentrated, so that we can see clearly what is arising in the present moment.” And attitude, attitude is about the quality of our attention (again, from Shapiro et al., 2018). Kabat-Zinn is quoted in this paper saaying “mindfulness is understood as an affectionate attention.” They go on to say quote him again saying attitude is an attempt to relate to whatever is in a certain way.
But it still doesn’t work!!
How might this influence ‘but it doesn’t work’? Again, from Shapiro, Siegel & Neff (2018), who point out that people seek mindfulness usually because they’re suffering, so they want things to change – and what mindfulness does is hit this desire head on. Accepting things as they are is the first step to change. This is weird! And this next sentence quoted from Shapiro et al, really hammers that one home: “acceptance doesn’t mean we want things to be the way they are, it simply reflects that things are the way they are, so we might as well accept them instead of resisting what is.” It’s only from this position of willing non-resistance that we can see our position and choose our next best step. We can’t do that when we’re fighting hard against what is (or trying to pretend it isn’t).
In a sense, when someone says ‘it doesn’t work’ I see this moment as a fantastic opportunity to help them notice what it is they’re noticing. What IS present in this moment? Often it’s a moment of frustration – let’s give that frustration a moment to be. What does it feel like? What do you feel in your body at that moment? What does your mind tell you right then? Can you sit with it and be curious about it? Not for long – but long enough to let it be there without being judged as a bad thing.
ADHDers and mindfulness
I said I’d mention ADHDers. There’s no doubt that ADHD means, by definition, that regulating attention is hard (unless it’s a hyperfocus, and that’s a completely different ballgame!). But coming back to ADHD and attention: a common problem I’ve heard is that ADHDers can’t do mindfulness. Well, actually we can. Now when I say this I am not thinking of using mindfulness to treat ADHD. No, this conversation is confined to mindfulness for people with pain – but there is a higher rate of chronic pain amongst my kin! Below you’ll find a wee list of references in no specific order, just random ones I’ve collected, and it’s evident that ADHD is a risk factor for chronic pain.
I take the position that ADHD and other neurodivergence exist as fairly stable traits in the population, and that efforts to fundamentally change these traits are unlikely to work. And besides, I love my quirky brain! However, living with chronic pain is no fun, neither is un-treated and un-recognised ADHD, and this is a series on mindfulness, and today’s post is about ‘it doesn’t work’ – and ADHDers often believe they can’t do mindfulness. TLDR: we can. It’s just not easy.
When I looked for papers about mindfulness and ADHD, I had trouble locating any dedicated to mindfulness and pain and ADHD, so I’ve drawn on this meta-analysis by Cairncross & Miller (2020) where they found 10 studies on mindfulness for inattention with an effect size of d=-.66; and nine studies on hyperactivity/impulsivity with an effect size of d=-.53. Pretty cool numbers. According to these authors, the effect size for adults with ADHD were larger than in children. There were loads of caveats for these findings, mainly because studies didn’t measure mindfulness pre and post, they didn’t describe their mindfulness interventions well, and we don’t know much about adherence to mindfulness. So my conclusion is that yes, ADHDers can ‘do’ mindfulness AND there appear to be good effects on attention and impulsivity, but we don’t know how well this translates to influences on pain.
A second paper published in 2021 by Oliva, et al also found that mindfulness-based interventions are effective, and arrived at similar conclusions to Cairncross & Miller (2020) – better quality research needs to be carried out, but they add that in studies where an active control was used (ie experiment = mindfulness, control = something active), the effect sizes were tiny.
What this leads me to conclude is that mindfulness is something ADHDers can do, it will be hard because, you know, ADHD, but it can be done. And the strategies I described last week of dipping in to mindfulness seem to be one of the best ways for us to begin. Things like:
“Can I notice my breath right now?”
“What is the texture of my steering wheel under my fingers while I wait at this traffic light?”
“What does my coffee smell like?”
“What does it feel like to have all my weight through my feet?”
To summarise, if we set out to achieve a Thing with mindfulness, it’s like to be pretty frustrating and fail, because mindfulness is about a way of being in the world, a heart towards being open and allowing what is present to be there without fighting it. It’s about training not just attention, but our intention to be like water, to be with what is. It’s also about attention and training our minds to go where we want them to go – and training takes time and commitment. Frequent dips into being present, gradually extended as we get better at it. And it’s about an attitude of ‘affectionate’ attention. Kindness towards our mind wandering off like a toddler in the garden. Kindness in the way we bring our mind back to sit with us. Kindness because we all need that affection in our lives, especially from ourselves towards ourselves. Especially if we’ve had trouble with attention, and if we have pain.
Cairncross, M., & Miller, C. J. (2020). The Effectiveness of Mindfulness-Based Therapies for ADHD: A Meta-Analytic Review. J Atten Disord, 24(5), 627-643. https://doi.org/10.1177/1087054715625301
Leca, S., & Tavares, I. (2022). Research in Mindfulness Interventions for Patients With Fibromyalgia: A Critical Review. Front Integr Neurosci, 16, 920271. https://doi.org/10.3389/fnint.2022.920271
Oliva, F., Malandrone, F., di Girolamo, G., Mirabella, S., Colombi, N., Carletto, S., & Ostacoli, L. (2021). The efficacy of mindfulness-based interventions in attention-deficit/hyperactivity disorder beyond core symptoms: A systematic review, meta-analysis, and meta-regression. J Affect Disord, 292, 475-486. https://doi.org/10.1016/j.jad.2021.05.068
Shapiro, S., Siegel, R., & Neff, K. D. (2018). Paradoxes of Mindfulness. Mindfulness, 9(6), 1693-1701. https://doi.org/10.1007/s12671-018-0957-5
References re ADHD and pain prevalence
Fuller-Thomson, E., Lewis, D. A., & Agbeyaka, S. K. (2016). Attention-deficit/hyperactivity disorder casts a long shadow: findings from a population-based study of adult women with self-reported ADHD. Child Care Health Dev, 42(6), 918-927. https://doi.org/10.1111/cch.12380
van Rensburg, R., Meyer, H. P., Hitchcock, S. A., & Schuler, C. E. (2018). Screening for Adult ADHD in Patients with Fibromyalgia Syndrome. Pain Med, 19(9), 1825-1831. https://doi.org/10.1093/pm/pnx275
Kasahara, S., Niwa, S. I., Matsudaira, K., Sato, N., Oka, H., Fujii, T., Konno, S. I., Kikuchi, S. I., & Yamada, Y. (2021). High Attention-Deficit/Hyperactivity Disorder Scale Scores Among Patients with Persistent Chronic Nonspecific Low Back Pain. Pain Physician, 24(3), E299-E307.
Kasahara, S., Takahashi, K., Matsudaira, K., Sato, N., Fukuda, K. I., Toyofuku, A., Yoshikawa, T., Kato, Y., Niwa, S. I., & Uchida, K. (2023). Diagnosis and treatment of intractable idiopathic orofacial pain with attention-deficit/hyperactivity disorder. Scientific Reports, 13(1), 1678.