Mindfulness-Based Intervention Research

Characteristics, Approaches, and Developments

Christian U. Krägeloh, Marcus A. Henning, Oleg N. Medvedev, Xuan Joanna Feng, Fiona Moir, Rex Billington, Richard J. Siegert

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781134793822
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This book provides an outline and critical discussion of the characteristics of mindfulness-based interventions (MBIs) research. Since the first reports on the use of mindfulness practices in health interventions, a large body of research literature has emerged to document the effectiveness of MBIs for reducing psychological distress and to increase well-being. The integration of mindfulness into very diverse psychological theories makes it a unique concept in psychology that has generated a large amount of interest both in academic research but also the broader media. With this growing literature, mindfulness researchers have also recognised the need to be more critical of its developments, such as how MBIs are presented to the public or what types of research methods are used to test claims of an MBI's effectiveness. This book examines the large variety of approaches in which MBIs have been studied, including an outline of the philosophical underpinnings of MBI research, definition and measurement of mindfulness, the use of qualitative and quantitative research methods, research design, and research that addresses cultural and religious factors. The book contributes to increased awareness of the current direction of MBI research and thus seeks to contribute to further methodological refinement and sophistication of the research field. This book on the characteristics of research on MBIs is a must read for any researcher or practitioner interested in this fascinating topic.

1

The characteristics of research on mindfulness-based interventions

When reading about mindfulness in the academic literature, it is not uncommon to encounter phrases such as “exponential” (Williams & Kabat-Zinn, 2011) or “explosion of interest” (Crane, Barnhofer, Hargus, Amarasinghe, & Winder, 2017) to describe its rapid rise in popularity. A common way to emphasise this trend is to present a diagram of the number of publications per year that are more or less directly related to mindfulness such as by mentioning mindfulness in the abstract or list of article keywords (Williams & Kabat-Zinn, 2011; & Jennings, 2016; Kabat-Zinn, 2017). Of course, one needs to be aware that such diagrams will always need to be interpreted with the knowledge that publication numbers in fields such as psychology have been growing steadily overall (Krampen, von Eye, & Schui, 2011). However, mindfulness is also increasingly covered in the news media, with one estimate showing that for each scientific article about mindfulness, around 30 appeared in the media (Van Dam et al., 2018).

Another indicator of the increased interest in mindfulness research is the launch of the journal Mindfulness (Singh, 2010), which has now become the flagship journal of the area, followed later by the appearance of another journal specifically devoted to mindfulness, namely Mindfulness & Compassion (García-Campayo & Demarzo, 2016). Regular in-depth discussions of specific mindfulness topics also appear within the book series Mindfulness in Behavioral Health, which recently published work on mindful parenting (Bögels & Restifo, 2014), mindfulness interventions for children with autism spectrum disorders (Hwang & Kearney, 2015), mindfulness in education (Schonert-Reichl & Roeser, 2016), mindfulness and Zen (Masuda & O’Donohue, 2017), and the ethical foundations of mindfulness (Stanley, Purser, & Singh, 2018), to name a few examples. The increasingly large number of mindfulness-related publications also prompted the creation of a regularly updated database to which readers can subscribe (Black, 2010).

The present book focuses on research about mindfulness as taught and conceptualised within the literature emerging from so-called mindfulness-based interventions (MBIs) such as Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn, 1990) and Mindfulness-Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2013), which emphasise the practice of mindfulness-based meditation as a central component of their intervention (Crane et al., 2017). Such programmes are referred to as mindfulness-based as they share distinctive features such a systematic and sustained training in mindfulness and meditation for both course participants as well as teachers. Mindfulness is also regarded as central in theoretical models explaining the therapeutic benefits of such interventions. These approaches to mindfulness are thus in contrast with those that Crane et al. (2017) described as mindfulness-informed, such as Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 2011) or Dialectical Behavioural Therapy (DBT; Linehan, 1993) where mindfulness plays a less central role. Another way to classify these approaches is through the description of MBSR and MBCT as exemplifying neo-traditional mindfulness and ACT as well as DBT as cognitive-behavioural mindfulness (Hartelius, 2015). Additionally, the present book does not cover the research belonging to the literature of the purely socio-cognitive conceptualisation of mindfulness by Ellen Langer, which defines the concept in contrast to mindlessness, or the default mode of cognitive functioning in an automatic and inflexible manner (Khoury et al., 2017).

The present chapter outlines the literature around the increased acceptance of MBIs into mainstream psychological treatment approaches, including the discussion that this generated about mindfulness as multidisciplinary, transparadigmatic, and transdiagnostic. Increased critical discussion can also be noticed about this development, such as criticism of commercialisation of mindfulness practice and the ambiguous role of MBIs in regard to spirituality. Lastly, an overview is provided in this chapter of the various ways in which researchers and theorists have attempted to define mindfulness.

Bringing mindfulness into mainstream clinical applications

While mentioning mindfulness and meditation in academic settings may have previously conjured up stereotypes and hippie images, such connotations are no longer triggered (Bahl, 2017). Early psychological and psychophysical exploration of mindfulness practices tended to be related to transcendental meditation (e.g. Wallace, 1970) but have now shifted to more structured secular applications, which in turn has transformed how mindfulness is commonly perceived. The systematic integration of mindfulness into modern-day health interventions started with the pioneering work by Jon Kabat-Zinn. In 1979, Kabat-Zinn started MBSR at the University of Massachusetts Medical School. Unlike other Westerners who had already promoted the inclusion of Eastern philosophy into Western psychotherapy at that time, such as Carl Gustav Jung and Erich Fromm, Kabat-Zinn did not have a psychology or psychotherapy background but instead was a recent PhD graduate in molecular biology (Harrington & Dunne, 2015). He had also received extensive training in various Buddhist traditions, meaning that Kabat-Zinn can be considered a teacher of the so-called dharma – which can be translated as Buddhist teachings or even more broadly as the natural law of the world.

The first applications of mindfulness training by Kabat-Zinn at the medical school were in the form of an onsite self-care training programme for patients with a chronic pain condition, which eventually carried the name MBSR (Harrington & Dunne, 2015). This programme was particularly suited for patients with this condition as the programme taught them to develop a new attitude to their condition, shifting away from excessive self-criticism, anxiety, and catastrophising of pain to recognising their pain with acceptance and without judgment and habitual reactivity. The current model of MBSR is a structured programme that teaches meditation and mindfulness practices adapted from Buddhism but taught in a nonreligious manner. Participants are taught to develop sustained awareness of the present moment and stop worrying about the future or ruminating about the past. MBSR participants typically meet in evening groups for around two hours over a period of at least eight weeks as well as a full-day workshop around half way through the programme (Carmody & Baer, 2009). The mindfulness techniques taught during the programme include insight meditation, hatha yoga, breathing exercises, body scan exercises, mindful walking, and mindful eating. A major goal is for participants to apply these techniques to their everyday life routines, reinforced through daily home practice and the keeping of a diary.

Although it was originally intended to help patients who did not respond well to traditional medical and psychological treatments (Kabat-Zinn, 2003), MBSR has now been used to remediate a wide range of health issues (Didonna, 2009), and courses are offered in many places around the world (Cullen, 2011). Following a very similar format, MBCT (Segal et al., 2013) is more specifically focused on how participants respond to their cognitions as the programme was designed for individuals who have previously recovered from depression but who are still vulnerable to relapse. As a result of completing the course, participants will learn to process their cognitions differently, such as not getting caught up in their literal content and observing them nonjudgmentally. Apart from these two MBIs, mindfulness practice has since then been integrated into many other types of therapies and found a firm place in mainstream psychology (Shapiro, 2009; Harrington & Dunne, 2015). This position has been strengthened by the well-documented health benefits of MBIs. This includes effectiveness of mindfulness for reducing stress, anxiety, depression, chronic pain, or substance abuse (Chiesa & Serretti, 2009, 2010; Hofmann, Sawyer, Witt, & Oh, 2010; Khoury et al., 2013; Reiner, Tibi, & Lipsitz, 2013), increased coping with symptoms from chronic illness (Grossman, Niemann, Schmidt, & Walach, 2004) as well as improvement in regulation of emotions and well-being (Chambers, Gullone, & Allen, 2009; Eberth & Sedlmeir, 2012).

Further evidence for the increased acceptance of mindfulness as a mainstream therapeutic approach is the fact that it is now taught very widely. In a systematic search of website content, Barnes, Hattan, Black, and Schuman-Olivier (2018) found that, in 2014, mindfulness-related activities were present at 79% of medical schools in the United States. Universities increasingly recognise the importance of mindfulness as a tool to foster resilience in future health professionals such as medical students. There is a growing understanding that mindfulness not only fosters resilience to prevent burnout but also “improve[s] students’ capacity for nonjudgmental presence and attention, so crucial in the doctor-patient relationship” (Wong, Chen, & Chan, 2018, p.97). The importance of personal mindfulness practice is thus not only recognised by mindfulness teachers and facilitators of MBIs (Fjorback & Walach, 2012; Shonin & Van Gordon, 2015) but also by primary care physicians (Krasner et al., 2009). In general psychotherapeutic practice, personal meditation practice of the therapist has also been reported to be associated with increased empathy and other interpersonal skills (Keane, 2014).

Mindfulness as a conduit for multidisciplinary and transdiagnostic approaches

The rapid rise of mindfulness research was fuelled by repeated reports of the benefits of MBIs, which subsequently attracted the interest of researchers in many different fields. As a result, mindfulness research has become multidisciplinary, including a wide range of both clinical and nonclinical applications as well as fundamental research into psychological and physiological functioning. This multidisciplinary expansion of mindfulness research has inevitably contributed to its increased complexity and diversity, thus opening up new opportunities for research and therapeutic applications. Nevertheless, it has also resulted in unique new challenges, particularly the question to what extent studies that refer to mindfulness can be described as investigating the same concept.

In the clinical context, reports of the beneficial effects from diverse applications of mindfulness are encouraging but raise some important theoretical considerations. Apart from the early original clinical applications of mindfulness to chronic pain as well as anxiety and depression, mindfulness has since been applied to a range of other psychological conditions including borderline personality disorder, posttraumatic stress disorder, eating disorders, and psychosis (Didonna, 2009) – to such an extent that mindfulness has been regularly referred to as having transdiagnostic applicability (Hanley, Abell, Osborn, Roehrig, & Canto, 2016; , Williams, van Mawijk, Armitage, & Sheffield, 2018). While some researchers have offered some hypotheses about what might be the transdiagnostic elements in mindfulness practice – for example the practitioner’s ability to tolerate distressing qualia (Lomas, Edginton, Cartwright, & Ridge, 2015) – such transdiagnostic conceptualisations of mindfulness tend to lead to the conclusion that there will be one primary mechanism of function for mindfulness that can be proposed and studied scientifically. Although various such mechanisms have been proposed (Cebolla et al., 2018; Chiesa, Anselmi, & Serretti, 2014), the field is still far from being close to a consensus about this matter.

In addition to being transdiagnostic, arguments could be made that mindfulness is transparadigmatic as several psychological paradigms and approaches have found ways to incorporate mindfulness into their theoretical frameworks. Teasdale et al. (2000) successfully merged MBSR with principles of cognitive behavioural therapy (CBT), resulting in the popular MBCT programme. Common aspects between CBT and MBCT, for example, are techniques used to facilitate a decentred view according to which clients learn not to identify themselves with their thoughts. Even though psychodynamic therapy is very different to CBT, mindfulness is also seen to function well within this paradigm. As Martin (1997) illustrated, mindfulness resonates well with psychodynamic psychology and is considered as something that therapists see as important to develop during the ps...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of tables
• Foreword
• 1. The characteristics of research on mindfulness-based interventions
• 2. Meta-theories and qualitative methods in mindfulness research
• 3. Measuring mindfulness
• 4. Quantitative research on the effectiveness of mindfulness-based interventions
• 5. Cultural and religious factors in research on mindfulness-based interventions
• Index