Mindfulness Research
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Thomas Marra, Ph.D. Excerpts from the text "Dialectical Behavior Therapy In Practice: A Practical and Comprehensive Guide" (Oakland: New Harbinger Press, 2005) |
| Acceptance –based therapy procedures, unlike traditional behavior therapy that attempts to solve problems and engage in behavior and affect change, invite patients to experience their situation without struggle or expectation of change (Kabat-Zinn, 1994). Mindfulness is the most widely accepted technique used to accomplish acceptance-based decreases in agony (Goleman, 2003; Kabat-Zinn, Lipworth, Burney, & Sellers, 1986; Kabat-Zinn, Massion, Kristeller, & al, 1992; Kabat-Zinn et al., 1998; Miller, Fletcher, & Kabat-Zinn, 1995; Segal, Williams, & Teasdale, 2002; Teasdale et al., 2000; Wegner, 1994). The pioneering research work with mindfulness (to be reviewed below) was originally conducted on chronic pain patients (Kabat-Zinn, Lipworth, & Burney, 1985), but was adopted as a “core” strategy of DBT in use with borderline personality patients (Linehan, 1987, 1993). |
| Chronic pain patients offer an unusual challenge to traditional behavior therapy. Behavior therapy offers patients the hope of change of the status quo, while chronic pain patients by definition have little hope of substantially changing their physical pain. Chronic pain patients typically have had multiple evaluations by physicians, physical therapists, pain specialists, occupational medicine specialists, as well as mental health specialists. It is unusual for the chronic pain patient to not also be depressed because of the chronicity and intensity of their discomfort. Dr. Kabat-Zinn is the acknowledged leader in using mindfulness-based interventions to treat pain patients. |
| Dr. Kabat-Zinn (1985) taught mindfulness meditation in a 10 week stress education and relaxation program to train 51 chronic pain patients in self-regulation. Detached observation of their pain is taught, specifically having the patients attend to their pain rather than avoid or escape experience of their pain. He couched, at the time, his intervention as increasing patient’s knowledge of their own proprioception. His research showed a reduction of 33% in the mean total of a pain rating index at the conclusion of the 10 week program. Large and significant reductions in mood disturbance and psychiatric symptomatology accompanied these changes and were relatively stable up to 1.5 years later. The next year the same experimenter (Kabat-Zinn et al., 1985) conducted another study on 90 chronic pain patients. These pain patients were also trained in mindfulness meditation in a 10-week stress reduction and relaxation program. Self-report indices, including the McGill Pain Questionnaire, the Profile of Mood States, and the Hopkins Symptom Checklist, were administered to the experimental subjects to assess aspects of pain and certain pain-related behaviors. Results show statistically significant reductions in measures of present-moment pain. This is significant in that patients were not taught how to reduce pain experience per se, but how to attend to their physical pain in a detached and nonjudgmental manner. In addition to the reduction of perceived pain, these experimental subjects showed scores indicative of reductions in negative body image, inhibition of activity by pain, pain symptoms, mood disturbance, and psychological symptomatology, including anxiety and depression. Reduction in perceived pain, and increases in psychological health, were thus observed through group mindfulness meditation practice. More objective measures such as pain-related drug utilization decreased, and activity levels and feelings of self-esteem increased. Dr. Kabat-Zinn concluded that improvement appeared to be independent of gender, source of referral, and type of pain. A comparison group of 21 pain patients did not show significant improvement on these measures after traditional treatment protocols. At follow-up, the improvements observed during the meditation training were maintained up to 15 months postmeditation training for all measures except present-moment pain (suggesting the importance of continued practice of the meditation techniques with an experienced therapist, in spite of the fact that the majority of subjects reported continued high compliance with the meditation practice as part of their daily lives). |
| In addition to the robust effectiveness of mindfulness-based treatment effects with chronic pain patients, the experimenters (Kabat-Zinn et al., 1986) demonstrates that these effects are long-lasting and that patients continue to use the mindfulness-based procedures up to four years after the initial 10-week intervention. Few short-term interventions have shown the staying power and effectiveness that mindfulness-based procedures have shown. Although mindfulness meditation was originally developed in the Buddhist religious tradition, it has been adopted as a nonreligious strategy to decrease emotional suffering by Western psychology. Hayes and Wilson (Hayes & Wilson, 2003) provide an elegant description of “experiential avoidance” that mindfulness is designed to treat: Experiential avoidance is the phenomenon that occurs when a person is unwilling to remain in contact with particular private experiences (e.g., bodily sensations, emotions, thoughts, memories, behavioral predispositions) and takes steps to alter the form or frequency of these events and the contexts that occasion them, even when doing so creates life harm. (p. 162) |
| In addition to the robust effectiveness of mindfulness-based treatment effects with chronic pain patients, the experimenters (Kabat-Zinn et al., 1986) demonstrates that these effects are long-lasting and that patients continue to use the mindfulness-based procedures up to four years after the initial 10-week intervention. Few short-term interventions have shown the staying power and effectiveness that mindfulness-based procedures have shown. Although mindfulness meditation was originally developed in the Buddhist religious tradition, it has been adopted as a nonreligious strategy to decrease emotional suffering by Western psychology. Hayes and Wilson (Hayes & Wilson, 2003) provide an elegant description of “experiential avoidance” that mindfulness is designed to treat: Experiential avoidance is the phenomenon that occurs when a person is unwilling to remain in contact with particular private experiences (e.g., bodily sensations, emotions, thoughts, memories, behavioral predispositions) and takes steps to alter the form or frequency of these events and the contexts that occasion them, even when doing so creates life harm. (p. 162) |
| They note the substantial body of evidence that such experiential avoidance is harmful in a variety of psychopathological areas (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). And they provide a poetic discrimination of acceptance-based psychological treatment strategies from traditional cognitive-behavioral approaches: These new methods…seek to increase the range and flexibility of functions that occur in contexts that previously had only literal, avoidant, or evaluative functions. They carry the same message as old-fashioned, functionally oriented behavior therapy, but in a new package that validates and dignifies the importance of human thoughts and feelings and their role in human suffering….Mindfulness, acceptance, and defusion are not just a different way of treating traditionally conceptualized problems of depression or anxiety. They imply a redefinition of the problem, the solution, and how both should be measured. The problem is not the presence of particular thoughts, emotions, sensations, or urges: It is the constriction of a human life. The solution is not removal of difficult private events: It is living a valued life. (pages 164-165) The review of mindfulness research here presented is categorized as acceptance-based research because mindfulness training is proposed to have several components, only one of which is the actual practice of the meditative process. First, mindfulness is an intentional act. It requires that the meditator be aware of his own attentional and observational process. It thus predicts that there are various kinds of attention and consciousness, and “ordinary” or automatic consciousness is only one among many ways of experiencing the world. Second, mindfulness encourages nonevaluative contact with events in the moment. Such attention to the functions of evaluative language itself serves to change one’s historical and immediate experience. It thus separates analytical thought from experience per se (discriminating observation itself from thoughts about observation). Rather than informing the meditator that their thoughts are distorted (that the patient is wrong), as some cognitive-behavioral theories presumes, mindfulness invites the meditator to simply notice the evaluations and let them go when possible. Third, mindfulness invites acceptance of private events that previously may have been ignored or avoided. It increases contact with what is occurring in the meditator’s private world. Fourth, mindfulness promotes a principle that experience is valuable. By inviting participation with one’s experience (noticing what is going on in the meditator’s private world), there is implicit understanding that there is existential meaning to be found by training the mind to observe better and more fully. |
| (Goleman, 1978) notes that there are two distinct processes involved in meditation: concentration and mindfulness. (Davidson & Goleman, 1977) note in an early review of the literature that meditative attention appears to enhance cortical specificity, but a simple concentration technique does not. Their early conclusion has been more recently confirmed by Dunn (Dunn, Hartigan, & Mikulas, 1999) who used electroencephalographic recordings from 10 subjects (including 19 scalp recording sites) in meditation, concentration, mindfulness, and a normal relaxation control condition. The subjects were assessed both after initial training and after prolonged training. During each recording session, all subjects performed 3 tasks: an eyes-closed relaxed baseline, a concentration mediation, and a mindfulness mediation. Analysis of all standard frequency bandwidth data showed strong mean amplitude frequency differences between the two meditation conditions and relaxation over numerous cortical sites. Significant differences were obtained between concentration and mindfulness states at all bandwidths, showing the superiority of mindfulness. Results suggest that concentration and mindfulness "meditations" may be unique forms of consciousness and are not merely degrees of a state of relaxation. |
| Valentine (Valentine & Sweet, 1999) studied the performance of 19 concentrative and mindfulness meditators (aged 24-43 years) on a test of sustained attention, and compared the results with that of 34 controls. Both groups of meditators demonstrated superior performance on the test of sustained attention in comparison with controls. Long-term meditators were superior to short-term meditators, suggesting the progressive gain that can occur with increased practice. How can the simple group-based intervention of having patients attend to their experience, one thing at a time, nonjudgmentally, and without attempt to alter the course or intensity of their experience, result in such subjective and objective treatment effects? Brown (Brown, Forte, & Dysart, 1984a) might argue that mindfulness meditators increase their observational powers per se. He conducted an experiment with more limited and objective experimental variables, testing visual sensitivity differences, using tachistoscopic presentation of light flashes, in 39 practitioners (in 3 groups) of Buddhist mindfulness meditation and 10 nonmeditator controls. Results showed that meditation practitioners were able to detect light flashes of shorter duration than the nonmeditators. There were no differences among practitioner and control groups in ability to discriminate between closely spaced successive light flashes. Brown suggests that lower detection threshold for single light flashes reflects an enduring increase in sensitivity, the long-term effects of the practice of meditation on certain perceptual habit patterns. The lack of differences in the discrimination of successive light flashes, Brown suggests, reflects the resistance of other perceptual habit patterns to modification. He reports that his results support the statements found in Buddhist texts on meditation concerning the changes in perception encountered during the practice of mindfulness. |
| In another study with a similar design (Brown, Forte, & Dysart, 1984b), he tested visual sensitivity before and immediately after a 3-month retreat employing intensive Buddhist meditation for 21 retreatants at the Insight Meditation Society (IMS) and 11 IMS staff members (controls). Retreatants practiced mindfulness meditation for 16 hours per day, while staff meditated about 2 hours per day in addition to their work at the IMS. Visual sensitivity was defined by a detection threshold, presented tachistoscopically and of fixed luminance, based on the duration of simple light flashes and a discrimination threshold based on the interval between successive simple light flashes. Results show that after the retreat, practitioners could detect short single-light flashes and required a shorter interval to differentiate between successive flashes correctly. The control group did not change on either measure. While this study thus examines the effect of intensive mindfulness meditation on experienced practitioners of the technique, it clearly suggests that mindfulness enabled practitioners to become aware of some of the pre-attentive processes involved in visual detection. Mindfulness-based strategies appear to change the scope and accuracy of attention. |
| While there is no reason to believe that a shorter and extremely less intensive intervention, such as those that are being conducted in the US (Baer, 2003; Bishop, 2002; Davidson et al., 2003; Kabat-Zinn, 1984; Kabat-Zinn et al., 1985; Kabat-Zinn et al., 1986; Kabat-Zinn et al., 1992; Kabat-Zinn et al., 1998; Kaplan, Goldenberg, & Galvin-Nadeau, 1993; Reibel, Greeson, Brainard, & Rosenzweig, 2001; Segal et al., 2002; Speca, Carlson, Goodey, & Angen, 2000; Williams, Kolar, Reger, & Pearson, 2001; Wiser & Telch, 1999), would produce similarly dramatic changes in the ability to attend to simple visual stimuli, the fact that both experienced mindfulness meditators (when measuring simple objective criteria) and patients (when measuring global psychological criteria) experience changes is powerful experimental evidence for the effectiveness of mindfulness-based procedures. But the evidence, and the number of experimenters producing the data, is much larger than those yet reviewed. Twenty-two patients with generalized anxiety and panic disorder were administered the same mindfulness-based group meditative practice as used with chronic pain patients (Kabat-Zinn et al., 1992), and significant improvements in several measures of anxiety and depression were found at posttreatment as well as at 3-month follow up. A three-year follow up of the same participants showed that the treatment gains had been maintained (Miller et al., 1995). Kaplan (Kaplan et al., 1993) assessed the effectiveness of a 10-week mindfulness meditation-based stress reduction program in the treatment of 77 patients with fibromyalgia. Although the mean scores of all subjects completing the program showed improvement, only the 51% who showed at least 25% improvement in 50% of the outcome measures were counted as treatment responders, again showing the clinical utility of the intervention. |
| Kabat-Zinn (Kabat-Zinn et al., 1998) studied 37 psoriasis patients treated with mindfulness meditation in combination with phototherapy or photochemotherapy treatment. The patients scheduled for medical treatment were randomly assigned to one of two conditions: a mindfulness-based stress reduction intervention guided by audiotaped instructions during light treatments, or a control condition consisting of the light treatments alone with no taped instructions. Psoriasis status was assessed by direct unblinded inspection by clinic nurses, direct inspection by blinded physicians (tape or no-tape), and blinded physician evaluation of photographs of psoriasis lesions. Four sequential indicators of skin status were monitored during the study, with the mindfulness-treated group showing significantly more rapid response to treatment than those in the no-tape condition, for both medical treatments. The authors conclude that a brief mindfulness-based stress reduction intervention delivered by audiotape during ultraviolet light therapy can increase the rate of resolution of psoriatic lesions. |
| There is even evidence that meditative techniques, including mindfulness, can extend longevity of life and increase psychological well-being (Alexander, Langer, Newman, Chandler, & Davis, 1989). Alexander took 73 residents of 8 homes for the elderly (mean age = 81 years) and randomly assigned them among no treatment and 3 treatments highly similar in external structure and expectations: the Transcendental Meditation (TM) program, mindfulness training (MF), or a relaxation (low mindfulness) program. A planned comparison indicated that the "restful alert" TM group improved most, followed by MF, in contrast to relaxation and no-treatment groups, on two measures of cognitive flexibility, on mental health measures, and on physical measure (systolic blood pressure). The MF group improved most, followed by TM, on perceived control. After 3 years, survival rate was 100% for TM and 87.5% for MF in contrast to lower rates for other groups. |
| There is even evidence that meditative techniques, including mindfulness, can extend longevity of life and increase psychological well-being (Alexander, Langer, Newman, Chandler, & Davis, 1989). Alexander took 73 residents of 8 homes for the elderly (mean age = 81 years) and randomly assigned them among no treatment and 3 treatments highly similar in external structure and expectations: the Transcendental Meditation (TM) program, mindfulness training (MF), or a relaxation (low mindfulness) program. A planned comparison indicated that the "restful alert" TM group improved most, followed by MF, in contrast to relaxation and no-treatment groups, on two measures of cognitive flexibility, on mental health measures, and on physical measure (systolic blood pressure). The MF group improved most, followed by TM, on perceived control. After 3 years, survival rate was 100% for TM and 87.5% for MF in contrast to lower rates for other groups. |
| Kutz (Kutz, Borysenko, & Benson, 1985) early noted the beneficial effects of adding meditative practices to traditional psychotherapy techniques. He studied the effect of a 10-week meditation program on 20 patients (mean age 38 years) undergoing long-term individual dynamic-explorative psychotherapy. The length of the patient-subject psychotherapy ranged from 1 to 10 years. Their diagnoses varied from severe narcissistic and borderline personality disorders to anxiety and obsessive neuroses, thus showing great variability in their symptom picture. While the patients continued their weekly individual psychotherapy sessions, they also met weekly as a group to meditate and discuss meditation, and meditated for 45 minutes daily at home. Home meditation consisted of meditation through attention to breathing, body awareness meditation, and mindfulness meditation. The patient’s improvement was rated by themselves and their individual psychotherapists. Both the therapists as well as the patients identified similar areas of improvement on measures of anxiety and depression. Therapists reported marked improvement in the development of insight. Kutz (Kutz et al., 1985) concludes that meditation can be an important adjunct to even dynamically-oriented psychotherapy in that it reduces arousal and thus improves insight. He sees these benefits as complimentary rather than competing therapeutic technologies. |
| Mindfulness has been shown beneficial in nonpathological samples (pre-med and medical students) as well (Shapiro, Schwartz, & Bonner, 1998). The experimenters examined the short-term effects of an 8-week meditation-based stress reduction intervention on 73 students using a wait-list control group as a comparison group. The Empathy Construct Rating Scale, the Hopkins Symptom Checklist 90 (Revised), the State-Trait Anxiety Inventory (Form Y), and the Index of Core Spiritual Experiences were used as pre-post measures. Findings indicated that participation in the intervention effectively reduced self-reported state and trait anxiety, reduced reports of overall psychological distress (including depression), increased scores on overall empathy levels, and increased scores on a measure of spiritual experiences assessed at the termination of the intervention. These results were replicated in the wait-list control group later, as well as held across different experiments. (Astin, 1997) conducted a similar study over an 8-week period with 28 undergraduate students and found similar results. Mindfulness has thus been shown effective with “normal” populations. Results such as these have been interpreted in light of control theory or self awareness (Barbieri, 1996). The frequency of mindfulness research has increased recently as the effect sizes and variety of patient populations on whom they are found effective has increased. A great deal of research has been published just in the last three to four years. Carlson and her colleagues (Carlson, Speca, Patel, & Goodey, 2003) investigated the relationships between an 8-week mindfulness-based stress reduction meditation program for 49 early stage breast and 10 prostate cancer patients and quality of life, mood states, stress symptoms, lymphocyte counts, and cytokine production. Significant improvements were seen in overall quality of life, symptoms of stress, and sleep quality. T cell production of IL-4 increased and IFN-gamma decreased, whereas NK cell production of IL-10 decreased. The authors conclude that their results are consistent with a shift in immune profile from one associated with depressive symptoms to a more normal profile, although there were no significant changes in the overall number of lympocytes or cell subsets other than those noted above. |
| Cancer patients were studied by Speca (Speca et al., 2000). They assessed the effects of mindfulness on mood disturbance and symptoms of stress in 90 cancer outpatients (aged 27-75 years). The study is significant not only in decreased symptoms, but that the symptom relief was consistent across gender, age, type, and stage of illness. Subjects completed the Profile of Mood States and the Symptoms of Stress Inventory both before and after the intervention. The intervention consisted of a weekly meditation group lasting 1.5 hrs for 7 weeks plus home meditation practice. After the intervention, patients in the treatment group had significantly lower scores on Total Mood Disturbance and subscales of Depression, Anxiety, Anger, and Confusion and more Vigor than control subjects. The treatment group had fewer overall Symptoms of Stress, fewer Cardiopulmonary and Gastrointestinal symptoms, less Emotional Irritability, Depression, and Cognitive Disorganization, and fewer Habitual Patterns of stress. Overall reduction in Total Mood Disturbance was 65%, with a 31% reduction in Symptoms of Stress. Sleep-related complaints were investigated by Shapiro and colleagues (Shapiro, Bootzin, Figueredo, Lopez, & Schwartz, 2003) following treatment with mindfulness-based stress reduction. Sixty-three 38-77 year-old women diagnosed with Stage II breast cancer were administered questionnaires before, during, and postintervention. Subjects who reported greater mindfulness practice improved significantly more on the sleep quality measure most strongly associated with distress. Binge eating disorder has been experimentally tested with mindfulness (Kristeller & Hallett, 1999). These experimenters use an even shorter intervention period (6 weeks rather than the 8 weeks used by most researchers), but use eating-specific mindfulness meditation exercises as well as standard mindfulness instructions developed by Kabat-Zinn. A single-group extended baseline design assessed all variables at 3 weeks pre and post-intervention, and followed up at 1, 3, and 6 weeks. Binges decreased in frequency, from 4.02/week to 1.57/week, and in severity. Scores on the Binge Eating Scale (BES) and on the Beck Depression and Anxiety Inventories decreased significantly, while sense of control increased. Time using eating-related meditations predicted decreases on the BES. |
| Demonstrating the robust effectiveness of mindfulness-based interventions, Riebel and colleagues (Reibel et al., 2001) examined an admitted heterogeneous 136 patients on health-related quality of life, physical, and psychological symptomatology after an 8-week intervention. The patients were aged 23-76 years old, and were required to practice 20 minutes of meditation daily in addition to participation in the structured treatment intervention. Pre- and postintervention data included the Short-Form Health Survey (SF-36), Medical Symptom Checklist (MSCL), and Symptom Checklist-90 Revised (SCL-90-R). Health-related quality of life increased as demonstrated by improvement on all indices of the SF-36, including vitality, bodily pain, role limitations caused by physical health, and social functioning. Physical symptoms were reduced as shown by a 28% reduction on the MSCL. Decreased psychological distress was indicated on the SCL-90-R by a 38% reduction on the Global Severity Index, a 44% reduction on the anxiety subscale, and a 34% reduction on the depression subscale. One-year follow-up revealed maintenance of improvements. |
| Some of the most powerful research showing, in neuroanatomical terms, the power of a simple 8-week mindfulness-based stress reduction program was recently conducted by Davidson, Kabat-Zinn and colleagues (Davidson et al., 2003). A randomized and controlled study on the effects on brain and immune function were applied in a work environment with healthy employees. They measured brain electrical activity before and immediately after, and then 4 months after the 8-week training program in mindfulness meditation. Twenty-five subjects were tested in the meditation group, while 16 subjects in the wait-list control group were tested at the same points in time as the meditators. At the end of training, subjects in both groups were vaccinated with an influenza vaccine. They report significant increases in left-sided anterior activation, a pattern previously associated with positive affect, in the meditators compared with the nonmeditators. They also found significant increases in antibody titers to influenza vaccine among subjects in the meditation compared with those in the wait-list control group. Meditation thus shows changes in neurobiology, affecting the immune system directly. It can lead to brain changes consistent with more effective handling of negative emotion under stress (Kabat-Zinn, 2003). |
| Teasdale (Teasdale, Segal, & Williams, 1995) present one of the most interesting applications of mindfulness. They attempt to use mindfulness as a prevention strategy with recurrent depression. Experimental subjects had to have several prior episodes of depression, but not be currently depressed in order to participate in this multisite study. In patients with three or more episodes of depression (77% of the total sample of 145), what they term mindfulness-based cognitive therapy (MBCT) significantly reduced relapse compared to treatment as usual; in patients with only two prior episodes of depression (23% of the total sample), there was no difference in relapse rates between patients receiving MBCT and treatment as usual. More episodes of depression predicted greater effect from the MBCT program. The treatment-as-usual control group patients showed a 66% relapse rate over the total 60-week study period, whereas those who received MBCT showed a relapse rate of 37%. Adding MBCT to treatment as usual had the effect of reducing risk of relapse almost by half for those patients who had more than two prior episodes of depressive disorder. What is interesting in this study is that very little of the intervention is designed around known aspects of depression (loss of interest in pleasurable activities, disputing depressing thoughts, increasing hope and behavioral activity level, increasing reinforcer effectiveness, etc.). Instead, the authors use psychoeducation (cognitive therapy) to encourage mindfulness practice both during group treatment interventions as well as daily (45 minutes) in between each treatment session. In a treatment manual subsequently published (Segal et al., 2002), the authors present one of the most comprehensible explanations of how to lead mindfulness-based interventions. The authors emphasize that the stance of the mindfulness approach is one of welcoming and allowing. It is invitational. It encourages "opening" to the difficult and adopting an attitude of gentleness to all experience, rather than engaging in problem solving that reinforces rumination. Nonreactivity, kindly awareness, gentleness, curiosity, adventure, and a willingness to observe are noted as essential characteristics of mindfulness.“...wherever your mind may be, you can always start again the next moment. The essence of mindfulness is the willingness to begin over and over and over again." (p. 134) The aim is not to prevent mind wandering "but to become more intimate with how one's mind behaves...If your mind wanders a hundred times, then simply bring it back a hundred times." (p. 168) Staying present and being nonreactive, or nonstriving, to what you observe is noted. Notice the change during the practice from focusing attention (gathering) in the early stage to expanding attention in the later stage." (p. 197) Note the similarity to Linehan's notions of primary and secondary feelings: "...people find themselves preoccupied with avoiding harm or achieving reward in unhelpful ways that add to the negativity of the unwanted object or event, or to the frustration of not having the object of desire or affection." (p. 201) Attachment and aversion are noted to be antithetical to mindfulness. "Note, again, that the aim of the practice is not relaxation or even happiness. Rather, it is freedom from the tendency to get drawn into automatic reactions to pleasant and unpleasant thoughts, feelings, and events." (p. 193) Linehan (Dimidjian & Linehan, 2003) goes even further and states that “mindfulness is conceptualized as attitudes and behaviors that the therapist emits, as opposed to behaviors that the therapist teaches the client to do” (page 169). Segal, Williams, and Teasdale (2002) specifically note the role of negative thoughts in mindfulness-based approaches: Unlike cognitive-behavior therapy, mindfulness invites us not to gather evidence for or against our thoughts, to dispute them as if they are the enemy, but rather to bring a different quality of awareness to our thoughts such that we relate to them in different and new ways. |
| Baer (2003) reviews the literature on mindfulness and finds 20 studies that meet her criteria for experimental soundness. She interprets mindfulness as involving exposure, cognitive change, self-management, relaxation, and acceptance. Of the 20 studies, she notes that 9 studies used pre-post designs with no control group. Nine used treatment as usual or waiting-list control groups. A meta-analysis of the 20 studies found effect sizes that ranged from 0.15 to 1.65, which she interprets as medium-sized effects “with some effect sizes falling within the large range” (p. 135). She concludes that “mindfulness training, on average, may bring participants with mild to moderate psychological distress into or close to the normal range” (p. 137). However, it should be noted that the studies she reviews primarily use the mindfulness-based stress reduction program developed by Kabat-Zinn regardless of the patient population or disorder being treated. The mindfulness exercises are not combined with disorder-specific interventions. A standardized 8 to 10 week mindfulness practice program is provided no matter what the diagnosis or patient population. In spite of this nonspecific intervention, the noted statistically significant effects were shown. The Segal study (Segal et al., 2002), as mentioned, relies substantially upon mindfulness-based stress reduction program developed by Kabat-Zinn. It has been suggested that the powerful nonspecific effects of this program may be due to deep breathing, that may increase parasympathetic activity and vagal tone, thus facilitating attention and affect regulation (Thayer, Friedman, Borkovec, Johnsen, & Molina, 2000). These powerful effects, however, might be substantially increased if mindfulness-based meditative strategies were combined with disorder-specific psychotherapeutic interventions (as suggested in the forthcoming book, from which this section was taken, Dialectical Behavior Therapy in Private Practice, scheduled for publication by New Harbinger Press in 2006). |
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