Mindfulness has become part of many people’s lives because of its clinical applications. In part 6 of our blog series on the science of mindfulness, we dive into current knowledge on mindfulness-based interventions (MBIs).
This blog series breaks down the special mindfulness issue of Current Opinion in Psychology, a large project of more than 100 leading mindfulness scholars. Learn about the background of this immense collaboration to present where the science of mindfulness is at. We also recommend reading Part 2, Part 3, Part 4 and Part 5 of the blog series.
Find the bibliography at the end of this article.
Mindfulness & Behavioral Therapy
David M. Fresco and Douglas S. Mennin look at the commonalities between Cognitive Behavioral Therapy, or CBT, and MBIs and offer a principled approach to combine the two. With a focus on distress disorders, such as depression, post-traumatic stress disorder, and generalized anxiety disorder, Fresco and Mennin suppose that CBT and MBI could be more effective when combined. They discuss how to best implement this combination through structured sequencing and dosing of the two behavioral therapies.
Melissa A. Rosenkranz, John D Dunne and Richard J Davidson review the lack of specificity in measuring mindfulness versus other types of interventions. Mindfulness-Based Stress Reduction, MBSR, is effective, but is it more effective than other cognitive-behavioral therapies? The evidence doesn’t yet show that it is.
The authors offer recommendations to improve the design and measures of future studies in order to better delineate when MBSR is preferable to other therapeutic interventions.
Mindfulness & Accessibility
Alissa J. Mrazek and her fellow co-authors review the unique advantages of digitally based MBIs as well as the challenges they present. The authors outline best practices to avoid challenges associated with digital learning. Suggestions include
- defining and understanding your audience,
- selecting learning objectives and targeting outcomes,
- addressing audience diversity,
- maintaining engagement,
- to structure lessons, graphics and materials for effective learning, and
- anticipate challenges and provide forums for both technical support and community building.
Accessibility is a focus in the paper submitted by Zindel Segal, Sona Dimidjian, Rachel Vanderkruik and Joseph Levy. Segal, a founder of Mindfulness-Based Cognitive Therapy, first reminds us that MBCT is effective in depressive relapse prevention. Yet despite the robust evidence base for MBCT, its penetration at the population health level and in routine clinical settings has been limited.
Addressing the gap between the science of MBCT and public access requires grappling with two questions: What is the role of home practice of mindfulness skills in realizing the benefits of MBCT? And what role do digital platforms play in the delivery of mindfulness programs?
To stay relevant in the arena of mood disorders, the authors suggest addressing the critical issue of accessibility. Online MBCT solutions can be instrumental in heightening user engagement through personal practice, experiential learning and group learning.
While Segal and his team discuss the challenges of measuring one’s home practice, Brandon King and his fellow co-authors look at a different type of practice, the residential retreat. Brandon King et al seek to bridge the gap between the multitude of studies involving meditation novices who receive only brief introductions to mindfulness with the study of intensive meditation practice by those who have developed a proficiency and expertise.
The authors distinguish residential retreats from other MBIs and highlight their utility in better understanding meditation, cognition, and well-being. ing says,
“Residential retreats are an important training component of many people’s ongoing meditation practice and, accordingly, they offer an ecologically valid research strategy for bridging empirical gaps between non-intensive interventions in novices and cross-sectional studies of expert practitioners.”
In his conclusion, King recognizes that mobile mindfulness apps and digital meditation programs have been widely studied due to their popularity in popular discourse, yet by replying only on scalable, modular, manualized and accessible training programs, researchers may be foregoing valuable insight into the benefits of a more personalized and “full range” contemplative practice.
Mindfulness & Special Populations
In his paper, Judson Brewer looks at the use of MBIs to treat addiction. He reviews the role of award based learning and the physiology of the orbitofrontal cortex where relative reward value is stored. Brewer connects the Buddhist concept of dependent origination to that of reward-based learning and supposes that through mindfulness the same cyclical system that leads to addiction could lead one out of it.
Thorsten Barnhofer, among the editors of this mindfulness edition of Current Opinion in Psychology, explores the use of mindfulness training to counter progressive depression.
Depression often takes a recurrent and progressive course. Recurring episodes can lead to biological changes that keep the disorder in place. Mindfulness training seems like it would be particularly beneficial in reversing this maladaptive plasticity, however, research in this area is lacking.
In an effort to encourage more research on the biological mechanisms of mindfulness training, Barnhofer outlines psychobiological mechanisms underlying persistent depression, discusses why mindfulness training may be particularly suited to address these mechanisms, and reviews current evidence supporting the potential for reversibility.
His conclusion emphasizes the need for more studies investigating sustained training in mindfulness and the effect of neuroplasticity within otherwise persistent trajectories.
Paul Chadwick briefly reviews the history of using mindfulness interventions to treat psychosis, or rather not. Although it was once considered taboo to discuss symptoms with a psychotic patient, there is now a growing research base that demonstrates adapted mindfulness is indeed safe and therapeutic for patients experiencing distressing psychosis.
Chadwick explores the why, arguing that the humanizing process at the core of mindfulness allows individuals to discover that they are more than the psychosis, and that the self is balanced (both positive and negative) and changing. He recommends more research be done to increase scientific knowledge and therapeutic effectiveness of adapted mindfulness. In addition to randomized controlled trials, it is important to research the intra-personal and inter-personal therapeutic processes that lie at the heart of mindfulness for psychosis.
Relational Functioning Of Mindfulness
Susan Maria Bögels and Lisa-Marie Emerson’s paper on the mindful family explores the role of MBIs that target family systems, as opposed to just the individual with a health condition, and focuses on families dealing with chronic somatic or mental health issues.
The role of MBIs in regulating stress appears to be an important underlying mechanism that leads to more positive outcomes for the health of the individual grappling with illness, and for the health and wellbeing of their loved ones. The authors discuss relational mindfulness and the impact of mindfulness on relational functioning. Bögels and Emerson suggest that MBIs that target a whole system, and not just a single individual, deserve a place in health care.
Is Mindfulness For Everyone?
On the other hand, Willoughby Britton wonders if mindfulness can be “too much of a good thing” and if it is the right thing for everyone. Her paper points out that few psychological or physiological processes are universally beneficial and discusses mindfulness-related processes that could have negative effects under certain conditions.
Britton reminds us that even positive phenomena follow a non-monotonic course. Something that once gave us only beneficial results can turn. Under certain conditions, for certain people, or at certain levels, even the effects of increased mindfulness can flip from positive to negative.
Britton seeks to define an optimal level of mindfulness, which would benefit not only the end-users, but also researchers, program developers, and providers. She suggests a personalized approach to MBIs. Britton quotes Baljinder Sahdra:
“Mindfulness cannot be fully understood as ‘more is better, less is worse.’…Rather, it’s how the different mindfulness skills combine in a person that may be most important for his or her mental health.”
With a staggering number of people worldwide dealing with mental illness, substance use disorders, chronic stress and anxiety, Mindfulness-Based Intervention is a pertinent topic. It’s being addressed by the authors represented here and many others.
