What Next After MBSR/MBCT? An Open Trial of an 8-Week Follow-on Program Exploring Mindfulness of Feeling Tone (vedana).

Objectives: The effectiveness of mindfulness-based programs (MBPs) has been established in many randomized controlled trials. However, effect sizes are often modest, and there remains ample scope to improve their effectiveness. One approach to this challenge is to offer a "follow-on" course to people who have completed an MBP and are interested in further skill development. We developed and tested a new 8-week course for this purpose based on awareness of feeling tone (vedana), an understudied aspect of mindfulness in many current MBPs, incorporating new developments in neuroscience and trauma sensitivity. We examined its effectiveness and the frequency and severity of unpleasant experience and harm. Methods: In an open trial, 83 participants, 78 of whom had previously taken part in an MBP (majority MBSR or MBCT), completed the program in nine groups. Participants completed questionnaires before and after and gave qualitative written feedback at completion. Results: Participants reported significantly reduced depression (d = 0.56), stress (d = 0.36), and anxiety (d = 0.53) and increased well-being (d = 0.54) and mindfulness (d = 0.65) with 38% meeting criteria for reliable change on anxiety and depression. As expected, about three-quarters of participants reported some unpleasant experiences associated with mindfulness practice during the course, but none reported harm. Five participants showed "reliable deterioration" (an increase) in either depression or anxiety, but four of these five also gave anonymous qualitative feedback describing benefits of the course. Conclusions: Findings support the added value of a follow-on course based on the exploration of feeling tone for participants who have a range of previous mindfulness experience. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-022-01929-0.

Universal Mindfulness Training in Schools for Adolescents: a Scoping Review and Conceptual Model of Moderators, Mediators, and Implementation Factors.

There is evidence that universal school-based mindfulness training (SBMT) can have positive effects for young people. However, it is unknown who benefits most from such training, how training exerts effects, and how implementation impacts effects. This study aimed to provide an overview of the evidence on the mediators, moderators, and implementation factors of SBMT, and propose a conceptual model that can be used both to summarize the evidence and provide a framework for future research. A scoping review was performed, and six databases and grey literature were searched. Inclusion and exclusion criteria were applied to select relevant material. Quantitative and qualitative information was extracted from eligible articles and reported in accordance with PRISMA-ScR guidelines. The search produced 5479 articles, of which 31 were eligible and included in the review. Eleven studies assessed moderators of SBMT on pupil outcomes, with mixed findings for all variables tested. Five studies examined the mediating effect of specific variables on pupil outcomes, with evidence that increases in mindfulness skills and decreases in cognitive reactivity and self-criticism post-intervention are related to better pupil outcomes at follow-up. Twenty-five studies assessed implementation factors. We discuss key methodological shortcomings of included studies and integrate our findings with existing implementation frameworks to propose a conceptual model. Widespread interest in universal SBMT has led to increased research over recent years, exploring who SBMT works for and how it might work, but the current evidence is limited. We make recommendations for future research and provide a conceptual model to guide theory-led developments.

The Questionnaire on Self-Transcendence (QUEST): A Measure of Trait Self-Transcendence Informed by Contextual Cognitive Behavioral Therapies.

Self-transcendence is thought to increase well-being and is implicitly promoted in contextual cognitive behavioral therapies (CCBTs). This study conceptualizes, develops, and validates the first comprehensive CCBT-informed self-transcendence questionnaire. Using a CCBT-informed theory, we propose four self-transcendence facets: distancing oneself from mental content, distinguishing an observer of mental experience that is separate from the content of experience, experiencing innate connectedness with other beings, and noticing the constantly changing nature of experience. We measured these facets with items from existing relevant questionnaires and novel, expert-informed items. Exploratory factor analyses and bifactor exploratory structural equation models supported the first three of these facets. Those factors evidenced convergent validity with decentering, defusion, experiential avoidance, and mindfulness, and criterion and incremental validity in predicting psychological well-being. Our findings support a CCBT-informed model of self-transcendence, introduce the first instrument to comprehensively measure the self-transcendence facets we identified, indicate links with well-being, and suggest future intervention targets.

Affective Neural Mechanisms of a Parenting-Focused Mindfulness Intervention.

OBJECTIVES: Behavioral evidence suggests that parenting-focused mindfulness interventions can improve parenting practices and enhance family wellbeing, potentially operating through altered emotional processing in parents. However, the mechanisms through which parent mindfulness interventions achieve their positive benefits have not yet been empirically tested, knowledge which is key to refine and maximize intervention effects. Thus, as part of a randomized controlled trial, the present study examined the affective mechanisms of an 8-week parenting-focused mindfulness intervention, the Parenting Mindfully (PM) intervention, versus a minimal-intervention parent education control. METHODS: Twenty highly stressed mothers of adolescents completed pre- and post-intervention behavioral and fMRI sessions, in which mothers completed a parent-adolescent conflict interaction, fMRI emotion task, and fMRI resting state scan. Mothers reported on their mindful parenting, and maternal emotional reactivity to the parent-adolescent conflict task was assessed via observed emotion expression, self-reported negative emotion, and salivary cortisol reactivity. RESULTS: Results indicated that the PM intervention increased brain responsivity in left posterior insula in response to negative affective stimuli, and altered resting state functional connectivity in regions involved in self-reference, behavioral regulation, and social-emotional processing. Changes in mothers' brain function and connectivity were associated with increased mindful parenting and decreased emotional reactivity to the parent-adolescent conflict task. CONCLUSIONS: Findings suggest that mindfulness-based changes in maternal emotional awareness at the neurobiological level are associated with decreased emotional reactivity in parenting interactions, illuminating potential neurobiological targets for future parent-focused intervention.

Frequency of Self-reported Unpleasant Events and Harm in a Mindfulness-Based Program in Two General Population Samples.

OBJECTIVES: Evidence-based mindfulness programs have well-established benefits, but the potential for harmful effects is understudied. We explored the frequency and severity of unpleasant experiences and harm in two nonclinical samples participating in an adaptation of mindfulness-based cognitive therapy (MBCT) for the general population. METHODS: Study 1 included 84 schoolteachers; study 2 included 74 university students. Both studies were uncontrolled. Participants completed self-report questionnaires about psychological symptoms before and after the 8-week mindfulness course. After the course, they responded to a survey designed for this study that included Likert ratings and free-text questions about unpleasant experiences and harm. All data were collected online. RESULTS: In both samples, about two-thirds of participants reported unpleasant experiences associated with mindfulness practice during the course. Most participants (85-92%) rated these experiences as not at all or somewhat upsetting; some indicated that difficult experiences led to important learning or were beneficial in some way. The proportion of participants reporting harm from the mindfulness course ranged from 3 to 7%. The proportion showing reliable deterioration on symptom questionnaires ranged from 2 to 7%. Those reporting harm and those showing reliable deterioration on questionnaires were largely separate subgroups; only one participant fell in both. CONCLUSIONS: Findings highlight the need for mindfulness teachers to manage expectations about benefits and difficulties that may occur in mindfulness-based programs and to work skilfully with participants experiencing difficulties. Experiences of harm may not be captured by symptom questionnaires and should be explicitly assessed in other ways. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12671-020-01547-8.

Effects of A Parenting-Focused Mindfulness Intervention on Adolescent Substance Use and Psychopathology: A Randomized Controlled Trial.

Substance use and psychopathology symptoms increase in adolescence. One key risk factor for these is high parent stress. Mindfulness interventions reduce stress in adults and may be useful to reduce parent stress and prevent substance use (SU) and psychopathology in adolescents. This study tested the feasibility and effects of a mindfulness intervention for parents on adolescent SU and psychopathology symptoms. Ninety-six mothers of 11-17 year olds were randomly assigned to a mindfulness intervention for parents (the Parenting Mindfully [PM] intervention) or a brief parent education [PE] control group. At pre-intervention, post-intervention, 6-month follow-up, and 1-year follow-up, adolescents reported on SU and mothers and adolescents reported on adolescent externalizing and internalizing symptoms. Primary intent to treat analyses found that the PM intervention prevented increases in adolescent SU over time, relative to the PE control group. The PM intervention also prevented increases in mother-reported externalizing symptoms over time relative to the PE control group. However, PM did not have a significant effect on internalizing symptoms. PM had an indirect effect on adolescent-reported externalizing symptoms through greater mother mindfulness levels at post-intervention, suggesting mother mindfulness as a potential intervention mechanism. Notably, while mothers reported high satisfaction with PM, intervention attendance was low (31% of mothers attended zero sessions). Secondary analyses with mothers who attended > = 50% of the interventions (n = 48) found significant PM effects on externalizing symptoms, but not SU. Overall, findings support mindfulness training for parents as a promising intervention and future studies should work to promote accessibility for stressed parents.Clinical Trials Identifier: NCT02038231; Date of Registration: January 13, 2014.

Latent Profile Analysis of the Five Facet Mindfulness Questionnaire in a Sample With a History of Recurrent Depression.

Extending previous research, we applied latent profile analysis in a sample of adults with a history of recurrent depression to identify subgroups with distinct response profiles on the Five Facet Mindfulness Questionnaire and understand how these relate to psychological functioning. The sample was randomly divided into two subsamples to first examine the optimal number of latent profiles (test sample; n = 343) and then validate the identified solution (validation sample; n = 340). In both test and validation samples, a four-profile solution was revealed where two profiles mapped broadly onto those previously identified in nonclinical samples: "high mindfulness" and "nonjudgmentally aware." Two additional subgroups, "moderate mindfulness" and "very low mindfulness," were observed. "High mindfulness" was associated with the most adaptive psychological functioning and "very low mindfulness" with the least adaptive. In most people with recurrent depression, mindfulness skills are expressed evenly across different domains. However, in a small minority a meaningful and replicable uneven profile indicating nonjudgmental awareness is observable. Current findings require replication and future research should examine the extent to which profiles change from periods of wellness to illness in people with recurrent depression and how profiles are influenced by exposure to mindfulness-based intervention.

Differential sensitivity of mindfulness questionnaires to change with treatment: A systematic review and meta-analysis.

[Correction Notice: An Erratum for this article was reported in Vol 31(10) of Psychological Assessment (see record 2019-58643-005). The article should have been published under the terms of the Creative Commons Attribution License (CC BY 3.0). Therefore, the article was amended to list the authors as copyright holders, and information about the terms of the CC BY 3.0 was added to the author note. In addition, the article is now open access. All versions of this article have been corrected.] In support of the construct validity of mindfulness questionnaires, meta-analytic reviews have reported that scores increase in mindfulness-based interventions (MBIs). However, several studies have also found increased mindfulness scores in interventions with no explicit mindfulness training, raising a question about differential sensitivity to change with treatment. We conducted a systematic review and meta-analysis of 37 randomized controlled trials in which mindfulness questionnaires were administered before and after an evidence-based MBI and a nonmindfulness-based active control condition. The central question was whether increases in mindfulness scores would be greater in the MBI than in the comparison group. On average, participants in MBIs showed significantly greater pre-post changes in mindfulness scores than were seen in active control conditions with no explicit mindfulness elements, with a small overall effect size. This effect was moderated by which mindfulness questionnaire was used, by the type of active control condition, and by whether the MBI and control were matched for amount of session time. When mindfulness facet scores were analyzed separately, MBIs showed significantly greater pre-post increases than active controls in observing, nonjudging, and nonreactivity but not in describing or acting with awareness. Although findings provide partial support for the differential sensitivity of mindfulness questionnaires to change with treatment, the nonsignificant difference in pre-post change when the MBI and control were matched for session time highlights the need to clarify how mindfulness skills are acquired in MBIs and in other interventions and whether revisions to mindfulness questionnaires would increase their specificity to changes in mindfulness skills. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Doing no harm in mindfulness-based programs: Conceptual issues and empirical findings.

The benefits of empirically supported mindfulness-based programs (MBPs) are well documented, but the potential for harm has not been comprehensively studied. The available literature, although too small for a systematic review, suggests that the question of harm in MBPs needs careful attention. We argue that greater conceptual clarity will facilitate more systematic research and enable interpretation of existing findings. After summarizing how mindfulness, mindfulness practices, and MBPs are defined in the evidence-based context, we examine how harm is understood and studied in related approaches to physical or psychological health and wellbeing, including psychotherapy, pharmacotherapy, and physical exercise. We also review research on harmful effects of meditation in contemplative traditions. These bodies of literature provide helpful parallels for understanding potential harm in MBPs and suggest three interrelated types of factors that may contribute to harm and require further study: program-related factors, participant-related factors, and clinician- or teacher-related factors. We discuss conceptual issues and empirical findings related to these factors and end with recommendations for future research and for protecting participants in MBPs from harm.

Assessment of mindfulness by self-report.

Assessment of mindfulness is essential to understanding its relationships with psychological functioning. Currently, mindfulness is most often assessed with self-report questionnaires. Although additional work is required, mindfulness questionnaires have reasonable psychometric properties and are making important contributions to the understanding of mindfulness and its effects on health and wellbeing. For example, measurement of mindfulness as a multidimensional construct shows that present-moment awareness can be unhelpful unless accompanied by a nonjudgmental, nonreactive stance; moreover, nonjudgment and nonreactivity may be only weakly related to present-moment awareness in people with no meditation experience. Differences between psychological and Buddhist conceptions of mindfulness, though often a source of criticism of mindfulness questionnaires, are argued here to be inevitable and not necessarily problematic.

Brief mindfulness training reduces salivary IL-6 and TNF-α in young women with depressive symptomatology.

OBJECTIVE: Pro-inflammatory cytokines have been implicated in the pathophysiology and maintenance of depression. This study investigated the effects of a brief mindfulness intervention on salivary pro-inflammatory correlates of depression (IL-6, TNF-α) and self-reported symptoms of depression in college women. METHODS: Sixty-four females with a cut score of ≥16 on the Center for Epidemiological Studies for Depression Scale (CES-D) were assigned to a 4-week mindfulness-based intervention (MBI; N = 31) or a contact-control group (N = 33). For both groups, salivary cytokines and depressive symptoms were assessed at baseline and posttreatment. For the mindfulness group only, salivary cytokines were also assessed at a 3-month follow-up. RESULTS: Both groups showed similar reductions in depression. However, MBI (vs. control) predicted greater reductions in IL-6 and TNF-α; changes in IL-6 were sustained at 3-month follow-up. Higher baseline depressive symptoms predicted greater reductions in inflammation in the mindfulness group. CONCLUSION: MBIs may reduce inflammatory immune markers commonly implicated in depression. Individuals with greater depressive symptoms may benefit more from mindfulness training. Although reductions in salivary cytokines in the mindfulness condition were not attributable to changes in depressive symptoms, future work should examine the possibility that such reductions are protective against the development of future depressive episodes. (PsycINFO Database Record

Mindfulness-Based Interventions for Older Adults: A Review of the Effects on Physical and Emotional Well-being.

This comprehensive review examined the effects of mindfulness-based interventions on the physical and emotional wellbeing of older adults, a rapidly growing segment of the general population. Search procedures yielded 15 treatment outcome studies meeting inclusion criteria. Support was found for the feasibility and acceptability of mindfulness-based interventions with older adults. Physical and emotional wellbeing outcome variables offered mixed support for the use of mindfulness-based interventions with older adults. Potential explanations of mixed findings may include methodological flaws, study limitations, and inconsistent modifications of protocols. These are discussed in detail and future avenues of research are discussed, emphasizing the need to incorporate geriatric populations into future mindfulness-based empirical research.

Assessment of mindfulness and closely related constructs: Introduction to the special issue.

This article introduces this special issue on the assessment of mindfulness and other related constructs. The need for refinements in self-report methods and the development of more objective performance-based methods for mindfulness is widely recognized. The six articles in this special issue move the field in these directions. Three of the articles expand the understanding of self-report instruments; the other three describe promising laboratory-based tasks. The articles here show that the assessment of mindfulness and related variables is an active and productive area, with interesting new findings emerging at a high rate. (PsycINFO Database Record

Anger Rumination as a Mediator of the Relationship Between Mindfulness and Aggression: The Utility of a Multidimensional Mindfulness Model.

OBJECTIVES: Mindfulness training reduces anger and aggression, but the mechanisms of these effects are unclear. Mindfulness may reduce anger expression and hostility via reductions in anger rumination, a process of thinking repetitively about angry episodes that increases anger. Previous research supports this theory but used measures of general rumination and assessed only the present-centered awareness component of mindfulness. The present study investigated associations between various aspects of mindfulness, anger rumination, and components of aggression. METHOD: The present study used self-report measures of these constructs in a cross-sectional sample of 823 students. RESULTS: Structural equation modeling revealed that anger rumination accounts for a significant component of the relationship between mindfulness and aggression, with the largest effect sizes demonstrated for the nonjudgment of inner experiences facet of mindfulness. CONCLUSION: Nonjudgment and present-centered awareness may influence aggression via reduced anger rumination. The importance of examining mindfulness as a multidimensional construct is discussed.

Self-Regulatory Deficits Associated with Unpracticed Mindfulness Strategies for Coping with Acute Pain.

Training in mindfulness is a well-supported therapeutic strategy for pain conditions, though short-term mindfulness training for acute pain is not always effective. To explore the possibility that initial attempts at mindfulness in people without previous training may drain self-regulatory resources, the current study used a student sample (N=63) to test the hypothesis that brief instruction in mindfulness would lead to reduced pain tolerance on a cold pressor task (CPT), compared to more familiar strategies for coping with acute pain. We also investigated whether high heart rate variability (HRV), a physiological indicator of self-regulatory capacity, would predict pain tolerance. Higher HRV predicted greater pain tolerance only in the control group, suggesting that applying unfamiliar mindfulness strategies while attempting to tolerate pain more rapidly sapped self-regulatory strength.

Weekly change in mindfulness and perceived stress in a mindfulness-based stress reduction program.

OBJECTIVE: The purpose of the study was to examine weekly change in self-reported mindfulness and perceived stress in participants who completed an 8-week course in mindfulness-based stress reduction (MBSR). METHOD: Participants were 87 adults with problematic levels of stress related to chronic illness, chronic pain, and other life circumstances (mean age = 49 years, 67% female) participating in MBSR in an academic medical center. They completed weekly self-report assessments of mindfulness skills and perceived stress. It was hypothesized that significant improvement in mindfulness skills would precede significant change in stress. RESULTS: Mindfulness skills and perceived stress both changed significantly from pretreatment to posttreatment. Significant increases in mindfulness occurred by the second week of the program, whereas significant improvements in perceived stress did not occur until week 4. Extent of change in mindfulness skills during the first three weeks predicted change in perceived stress over the course of the intervention. CONCLUSIONS: Evidence that changes in mindfulness precede changes in perceived stress in a standard MBSR course is consistent with previous studies suggesting that improvements in mindfulness skills may mediate the effects of mindfulness training on mental health outcomes.

The "what" and the "how" of dispositional mindfulness: using interactions among subscales of the five-facet mindfulness questionnaire to understand its relation to substance use.

Although self-report measures of dispositional mindfulness have good psychometric properties, a few studies have shown unexpected positive correlations between substance use and mindfulness scales measuring observation of present-moment experience. The current study tested the hypothesis that the relationship between present-moment observation and substance use is moderated by the tendency to be nonjudgmental and nonreactive toward the observed stimuli. Two hundred and ninety-six undergraduates completed the five-facet mindfulness questionnaire (FFMQ), a calendar measuring periods of substance use, and a measure of the five-factor model of personality. Controlling for FFMQ and personality subscales, significant interactions between the observing and nonreactivity subscales indicated that the observing subscale was negatively associated with substance use at higher levels of nonreactivity but positively associated with periods of substance use at lower levels of nonreactivity. Results support the use of statistical interactions among FFMQ subscales to test for the presence of interactive effects of different aspects of mindfulness.

Ruminative and mindful self-focused attention in borderline personality disorder.

The current study investigated the short-term effects of mindful and ruminative forms of self-focused attention on a behavioral measure of distress tolerance in individuals with borderline personality disorder (BPD) who had completed an angry mood induction. Participants included 40 individuals who met criteria for BPD and were currently involved in mental health treatment. Each completed an individual 1-hr session. Following an angry mood induction, each participant was randomly assigned to engage in ruminative or mindful self-focus for several minutes. All participants then completed the computerized Paced Auditory Serial Addition Test (PASAT-C), a behavioral measure of willingness to tolerate distress in the service of goal-directed behavior. The mindfulness group persisted significantly longer than the rumination group on the distress tolerance task and reported significantly lower levels of anger following the self-focus period. Results are consistent with previous studies in suggesting that distinct forms of self-focused attention have distinct outcomes and that, for people with BPD, mindful self-observation is an adaptive alternative to rumination when feeling angry.

Psychometric properties of the five facet mindfulness questionnaire in depressed adults and development of a short form.

In recent years, there has been a growing interest in therapies that include the learning of mindfulness skills. The 39-item Five Facet Mindfulness Questionnaire (FFMQ) has been developed as a reliable and valid comprehensive instrument for assessing different aspects of mindfulness in community and student samples. In this study, the psychometric properties of the Dutch FFMQ were assessed in a sample of 376 adults with clinically relevant symptoms of depression and anxiety. Construct validity was examined with confirmatory factor analyses and by relating the FFMQ to measures of psychological symptoms, well-being, experiential avoidance, and the personality factors neuroticism and openness to experience. In addition, a 24-item short form of the FFMQ (FFMQ-SF) was developed and assessed in the same sample and cross-validated in an independent sample of patients with fibromyalgia. Confirmatory factor analyses showed acceptable model fit for a correlated five-factor structure of the FFMQ and good model fit for the structure of the FFMQ-SF. The replicability of the five-factor structure of the FFMQ-SF was confirmed in the fibromyalgia sample. Both instruments proved highly sensitive to change. It is concluded that both the FFMQ and the FFMQ-SF are reliable and valid instruments for use in adults with clinically relevant symptoms of depression and anxiety.

Assessing mindfulness in children and adolescents: development and validation of the Child and Adolescent Mindfulness Measure (CAMM).

This article presents 4 studies (N = 1,413) describing the development and validation of the Child and Adolescent Mindfulness Measure (CAMM). In Study 1 (n = 428), the authors determined procedures for item development and examined comprehensibility of the initial 25 items. In Study 2 (n = 334), they reduced the initial item pool from 25 to 10 items through exploratory factor analysis. Study 3 (n = 332) evaluated the final 10-item measure in a cross-validation sample, and Study 4 (n = 319) determined validity coefficients for the CAMM using bivariate and partial correlations with relevant variables. Results suggest that the CAMM is a developmentally appropriate measure with adequate internal consistency. As expected, CAMM scores were positively correlated with quality of life, academic competence, and social skills and negatively correlated with somatic complaints, internalizing symptoms, and externalizing behavior problems. Correlations were reduced but generally still significant after controlling for the effects of 2 overlapping processes (thought suppression and psychological inflexibility). Overall, results suggest that the CAMM may be a useful measure of mindfulness skills for school-aged children and adolescents.