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To better understand the neurobiological mechanisms by which mindfulness-based practices function in a psychotherapeutic context, this article details the definition, techniques, and purposes ascribed to mindfulness training as described by its Buddhist tradition of origin and by contemporary neurocognitive models. Included is theory of how maladaptive mental processes become habitual and automatic, both from the Buddhist and Western psychological perspective. Specific noting and labeling techniques in open monitoring meditation, described in the Theravada and Western contemporary traditions, are highlighted as providing unique access to multiple modalities of awareness. Potential explicit and implicit mechanisms are discussed by which such techniques can contribute to transforming maladaptive habits of mind and perceptual and cognitive biases, improving efficiency, facilitating integration, and providing the flexibility to switch between systems of self-processing. Finally, a model is provided to describe the timing by which noting and labeling practices have the potential to influence different stages of low- and high-level neural processing. Hypotheses are proposed concerning both levels of processing in relation to the extent of practice. Implications for the nature of subjective experience and self-processing as it relates to one's habits of mind, behavior, and relation to the external world, are also described.
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Patients in the placebo arms of randomized controlled trials (RCT) often experience positive changes from baseline. While multiple theories concerning such “placebo effects” exist, peculiarly, none has been informed by actual interviews of patients undergoing placebo treatment. Here, we report on a qualitative study (n = 27) embedded within a RCT (n = 262) in patients with irritable bowel syndrome. Besides identical placebo acupuncture treatment in the RCT, the qualitative study patients also received an additional set of interviews at the beginning, midpoint, and end of the trial. Interviews of the 12 qualitative subjects who underwent and completed placebo treatment were transcribed. We found that patients (1) were persistently concerned with whether they were receiving placebo or genuine treatment; (2) almost never endorsed “expectation” of improvement but spoke of “hope” instead and frequently reported despair; (3) almost all reported improvement ranging from dramatic psychosocial changes to unambiguous, progressive symptom improvement to tentative impressions of benefit; and (4) often worried whether their improvement was due to normal fluctuations or placebo effects. The placebo treatment was a problematic perturbation that provided an opportunity to reconstruct the experiences of the fluctuations of their illness and how it disrupted their everyday life. Immersion in this RCT was a co-mingling of enactment, embodiment and interpretation involving ritual performance and evocative symbols, shifts in bodily sensations, symptoms, mood, daily life behaviors, and social interactions, all accompanied by self-scrutiny and re-appraisal. The placebo effect involved a spectrum of factors and any single theory of placebo—e.g. expectancy, hope, conditioning, anxiety reduction, report bias, symbolic work, narrative and embodiment—provides an inadequate model to explain its salubrious benefits.
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<p>Patients in the placebo arms of randomized controlled trials (RCT) often experience positive changes from baseline. While multiple theories concerning such “placebo effects” exist, peculiarly, none has been informed by actual interviews of patients undergoing placebo treatment. Here, we report on a qualitative study (n = 27) embedded within a RCT (n = 262) in patients with irritable bowel syndrome. Besides identical placebo acupuncture treatment in the RCT, the qualitative study patients also received an additional set of interviews at the beginning, midpoint, and end of the trial. Interviews of the 12 qualitative subjects who underwent and completed placebo treatment were transcribed. We found that patients (1) were persistently concerned with whether they were receiving placebo or genuine treatment; (2) almost never endorsed “expectation” of improvement but spoke of “hope” instead and frequently reported despair; (3) almost all reported improvement ranging from dramatic psychosocial changes to unambiguous, progressive symptom improvement to tentative impressions of benefit; and (4) often worried whether their improvement was due to normal fluctuations or placebo effects. The placebo treatment was a problematic perturbation that provided an opportunity to reconstruct the experiences of the fluctuations of their illness and how it disrupted their everyday life. Immersion in this RCT was a co-mingling of enactment, embodiment and interpretation involving ritual performance and evocative symbols, shifts in bodily sensations, symptoms, mood, daily life behaviors, and social interactions, all accompanied by self-scrutiny and re-appraisal. The placebo effect involved a spectrum of factors and any single theory of placebo – e.g. expectancy, hope, conditioning, anxiety reduction, report bias, symbolic work, narrative and embodiment – provides an inadequate model to explain its salubrious benefits.</p>
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<p>Abstract The performance of concentrative and mindfulness meditators on a test of sustained attention (Wilkins' counting test) was compared with controls. Both groups of meditators demonstrated superior performance on the test of sustained attention in comparison with controls, and long-term meditators were superior to short-term meditators. Mindfulness meditators showed superior performance in comparison with concentrative meditators when the stimulus was unexpected but there was no difference between the two types of meditators when the stimulus was expected. The results are discussed in relation to the attentional mechanisms involved in the two types of meditation and implications drawn for mental health.</p>

The aim of mindfulness meditation is to develop present-focused, non-judgmental, attention. Therefore, experience in meditation should be associated with less anticipation and negative appraisal of pain. In this study we compared a group of individuals with meditation experience to a control group to test whether any differences in the affective appraisal of pain could be explained by lower anticipatory neural processing. Anticipatory and pain-evoked ERPs and reported pain unpleasantness were recorded in response to laser stimuli of matched subjective intensity between the two groups. ERP data were analysed after source estimation with LORETA. No group effects were found on the laser energies used to induce pain. More experienced meditators perceived the pain as less unpleasant relative to controls, with meditation experience correlating inversely with unpleasantness ratings. ERP source data for anticipation showed that in meditators, lower activity in midcingulate cortex relative to controls was related to the lower unpleasantness ratings, and was predicted by lifetime meditation experience. Meditators also reversed the normal positive correlation between medial prefrontal cortical activity and pain unpleasantness during anticipation. Meditation was also associated with lower activity in S2 and insula during the pain-evoked response, although the experiment could not disambiguate this activity from the preceding anticipation response. Our data is consistent with the hypothesis that meditation reduces the anticipation and negative appraisal of pain, but effects on pain-evoked activity are less clear and may originate from preceding anticipatory activity. Further work is required to directly test the causal relationship between meditation, pain anticipation, and pain experience.

Those with high baseline stress levels are more likely to develop mild cognitive impairment (MCI) and Alzheimer's Disease (AD). While meditation may reduce stress and alter the hippocampus and default mode network (DMN), little is known about its impact in these populations. Our objective was to conduct a "proof of concept" trial to determine whether Mindfulness Based Stress Reduction (MBSR) would improve DMN connectivity and reduce hippocampal atrophy among adults with MCI. 14 adults with MCI were randomized to MBSR vs. usual care and underwent resting state fMRI at baseline and follow-up. Seed based functional connectivity was applied using posterior cingulate cortex as seed. Brain morphometry analyses were performed using FreeSurfer. The results showed that after the intervention, MBSR participants had increased functional connectivity between the posterior cingulate cortex and bilateral medial prefrontal cortex and left hippocampus compared to controls. In addition, MBSR participants had trends of less bilateral hippocampal volume atrophy than control participants. These preliminary results indicate that in adults with MCI, MBSR may have a positive impact on the regions of the brain most related to MCI and AD. Further research with larger sample sizes and longer-follow-up are needed to further investigate the results from this pilot study.

This study investigated the link between meditation, self-reported mindfulness and cognitive flexibility as well as other attentional functions. It compared a group of meditators experienced in mindfulness meditation with a meditation-naïve control group on measures of Stroop interference and the “d2-concentration and endurance test”. Overall the results suggest that attentional performance and cognitive flexibility are positively related to meditation practice and levels of mindfulness. Meditators performed significantly better than non-meditators on all measures of attention. Furthermore, self-reported mindfulness was higher in meditators than non-meditators and correlations with all attention measures were of moderate to high strength. This pattern of results suggests that mindfulness is intimately linked to improvements of attentional functions and cognitive flexibility. The relevance of these findings for mental balance and well-being are discussed.

Meditation is a mental training, which involves attention and the ability to maintain focus on a particular object. In this study we have applied a specific attentional task to simply measure the performance of the participants with different levels of meditation experience, rather than evaluating meditation practice per se or task performance during meditation. Our objective was to evaluate the performance of regular meditators and non-meditators during an fMRI adapted Stroop Word-Colour Task (SWCT), which requires attention and impulse control, using a block design paradigm. We selected 20 right-handed regular meditators and 19 non-meditators matched for age, years of education and gender. Participants had to choose the colour (red, blue or green) of single words presented visually in three conditions: congruent, neutral and incongruent. Non-meditators showed greater activity than meditators in the right medial frontal, middle temporal, precentral and postcentral gyri and the lentiform nucleus during the incongruent conditions. No regions were more activated in meditators relative to non-meditators in the same comparison. Non-meditators showed an increased pattern of brain activation relative to regular meditators under the same behavioural performance level. This suggests that meditation training improves efficiency, possibly via improved sustained attention and impulse control.

In order to gain a deeper understanding of the mindfulness construct and the mental health benefits associated with mindfulness-based programmes, the relation between mindfulness and its proposed core component attention was studied. Buddhist and Western mindfulness meditators were compared with non-meditators on tasks of sustained (SART) and executive (the Stroop Task) attention. Relations between self-reported mindfulness (FFMQ) and sustained and executive attention were also analysed. No significant differences were found between meditators and non-meditators either in sustained or executive attention. High scores on the FFMQ total scale and on Describe were related to fewer SART errors. High scores on Describe were also related to low Stroop interference. Mindfulness meditators may have an increased awareness of internal processes and the ability to quickly attend to them but this type of refined attentional ability does not seem to be related to performance on attention tests requiring responses to external targets.

<p>Meditation is now one of the most enduring, widespread, and researched of all psychotherapeutic methods. However, to date the meeting of the meditative disciplines and Western psychology has been marred by significant misunderstandings and by an assimilative integration in which much of the richness and uniqueness of meditation and its psychologies and philosophies have been overlooked. Also overlooked have been their major implications for an understanding of such central psychological issues as cognition and attention, mental training and development, health and pathology, and psychological capacities and potentials. Investigating meditative traditions with greater cultural and conceptual sensitivity opens the possibility of a mutual enrichment of both the meditative traditions and Western psychology, with far-reaching benefits for both.</p>

The capacity to stabilize the content of attention over time varies among individuals, and its impairment is a hallmark of several mental illnesses. Impairments in sustained attention in patients with attention disorders have been associated with increased trial-to-trial variability in reaction time and event-related potential deficits during attention tasks. At present, it is unclear whether the ability to sustain attention and its underlying brain circuitry are transformable through training. Here, we show, with dichotic listening task performance and electroencephalography, that training attention, as cultivated by meditation, can improve the ability to sustain attention. Three months of intensive meditation training reduced variability in attentional processing of target tones, as indicated by both enhanced theta-band phase consistency of oscillatory neural responses over anterior brain areas and reduced reaction time variability. Furthermore, those individuals who showed the greatest increase in neural response consistency showed the largest decrease in behavioral response variability. Notably, we also observed reduced variability in neural processing, in particular in low-frequency bands, regardless of whether the deviant tone was attended or unattended. Focused attention meditation may thus affect both distracter and target processing, perhaps by enhancing entrainment of neuronal oscillations to sensory input rhythms, a mechanism important for controlling the content of attention. These novel findings highlight the mechanisms underlying focused attention meditation and support the notion that mental training can significantly affect attention and brain function.

The capacity to stabilize the content of attention over time varies among individuals, and its impairment is a hallmark of several mental illnesses. Impairments in sustained attention in patients with attention disorders have been associated with increased trial-to-trial variability in reaction time and event-related potential deficits during attention tasks. At present, it is unclear whether the ability to sustain attention and its underlying brain circuitry are transformable through training. Here, we show, with dichotic listening task performance and electroencephalography, that training attention, as cultivated by meditation, can improve the ability to sustain attention. Three months of intensive meditation training reduced variability in attentional processing of target tones, as indicated by both enhanced theta-band phase consistency of oscillatory neural responses over anterior brain areas and reduced reaction time variability. Furthermore, those individuals who showed the greatest increase in neural response consistency showed the largest decrease in behavioral response variability. Notably, we also observed reduced variability in neural processing, in particular in low-frequency bands, regardless of whether the deviant tone was attended or unattended. Focused attention meditation may thus affect both distracter and target processing, perhaps by enhancing entrainment of neuronal oscillations to sensory input rhythms, a mechanism important for controlling the content of attention. These novel findings highlight the mechanisms underlying focused attention meditation and support the notion that mental training can significantly affect attention and brain function.
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This study examined the relationship between the executive control process of inhibition and self-reported dispositional mindfulness, controlling for gender, grade, and cortisol levels in 99 (43% female) fourth- and fifth-graders ( = 10.23 years, SD = 0.53). Students completed a measure of mindful attention awareness and a computerized executive function (EF) task assessing inhibitory control. Morning cortisol levels also were collected and were used as an indicator of neuroendocrine regulation. Hierarchical regression analyses revealed that, after controlling for gender, grade, and cortisol levels, higher scores on the mindfulness attention awareness measure significantly predicted greater accuracy (% correct responses) on the inhibitory control task. This research contributes to understanding the predictors of EF skills in early adolescents’ cognitive development. Specifically, it identifies mindfulness—a skill that can be fostered and trained in intervention programs to promote health and well-being—as significantly related to inhibitory processes in early adolescence.
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<p>A number of books have explored the ways psychotherapy clients can benefit from learning and practicing mindfulness. This is the first volume to focus specifically on how mindfulness can deepen the therapeutic relationship. Grounded in research, chapters demonstrate how therapists' own mindfulness practice can help them to listen more attentively and be more fully present. Leading proponents of different treatment approaches—including behavioral, psychodynamic, and family systems perspectives—illustrate a variety of ways that mindfulness principles can complement standard techniques and improve outcomes by strengthening the connection between therapist and client. Also presented are practical strategies for integrating mindfulness into clinical training.</p>

<p>This study was designed to test the hypothesis that mindfulness involves sustained attention, attention switching, inhibition of elaborative processing and non-directed attention. Healthy adults were tested before and after random assignment to an 8-week Mindfulness-Based Stress Reduction (MBSR) course (n = 39) or a wait-list control (n = 33). Testing included measures of sustained attention, attention switching, Stroop interference (as a measure of inhibition of elaborative processing), detection of objects in consistent or inconsistent scenes (as a measure of non-directed attention), as well as self-report measures of emotional well-being and mindfulness. Participation in the MBSR course was associated with significantly greater improvements in emotional well-being and mindfulness, but no improvements in attentional control relative to the control group. However, improvements in mindfulness after MBSR were correlated with improvements in object detection. We discuss the implications of these results as they relate to the role of attention in mindfulness. Copyright © 2007 John Wiley &amp; Sons, Ltd.</p>

<p>Objective This study compared changes in bodily pain, health-related quality of life (HRQoL), and psychological symptoms during an 8-week mindfulness-based stress reduction (MBSR) program among groups of participants with different chronic pain conditions. Methods From 1997-2003, a longitudinal investigation of chronic pain patients ( n=133) was nested within a larger prospective cohort study of heterogeneous patients participating in MBSR at a university-based Integrative Medicine center. Measures included the Short-Form 36 Health Survey and Symptom Checklist-90-Revised. Paired t tests were used to compare pre–post changes on outcome measures. Differences in treatment effect sizes were compared as a function of chronic pain condition. Correlations were examined between outcome parameters and home meditation practice. Results Outcomes differed in significance and magnitude across common chronic pain conditions. Diagnostic subgroups of patients with arthritis, back/neck pain, or two or more comorbid pain conditions demonstrated a significant change in pain intensity and functional limitations due to pain following MBSR. Participants with arthritis showed the largest treatment effects for HRQoL and psychological distress. Patients with chronic headache/migraine experienced the smallest improvement in pain and HRQoL. Patients with fibromyalgia had the smallest improvement in psychological distress. Greater home meditation practice was associated with improvement on several outcome measures, including overall psychological distress, somatization symptoms, and self-rated health, but not pain and other quality of life scales. Conclusion MBSR treatment effects on pain, HRQoL and psychological well-being vary as a function of chronic pain condition and compliance with home meditation practice.</p>
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<p>Mindfulness-based approaches are among the most innovative and interesting new approaches to mental health treatment. Mindfulness refers to patients developing an "awareness of present experience with acceptance." Interest in them is widespread, with presentations and workshops drawing large audiences all over the US and many other countries. This book provides a comprehensive introduction to the best-researched mindfulness-based treatments. It emphasizes detailed clinical illustration providing a close-up view of how these treatments are conducted, the skills required of therapists, and how they work. The book also has a solid foundation in theory and research and shows clearly how these treatments can be understood using accepted psychological principles and concepts. The evidence base for these treatments is concisely reviewed.* Comprehensive introduction to the best-researched mindfulness-based treatments* Covers wide range of problems &amp; disorders (anxiety, depression, eating, psychosis, personality disorders, stress, pain, relationship problems, etc)* Discusses a wide range of populations (children, adolescents, older adults, couples)* Includes wide range of settings (outpatient, inpatient, medical, mental health, workplace)* Clinically rich, illustrative case study in every chapter* International perspectives represented (authors from US, Canada, Britain, Sweden)</p>

Objective There is a growing scientific interest in mindfulness meditation (MM), yet its underlying neurophysiological mechanism is still uncertain. We investigated whether MM affects self-referential processing, associated with default mode network (DMN), either as short (state) – or long-term (trait) effects. Methods Three levels of MM expertise were compared with controls (n = 12 each) by electroencephalography (EEG). Results DMN deactivation was identified during the transition from resting state to a time production task, as lower gamma (25–45 Hz) power over frontal and midline regions. MM practitioners exhibited a trait lower frontal gamma activity, related to narrative self-reference and DMN activity, as well as producing longer durations, these being negatively correlated with frontal gamma activity. Additionally, we found state increases in posterior gamma power, suggesting increased attention and sensory awareness. MM proficiency did not affect the results. Conclusions Gamma power over frontal midline areas reflects DMN activity. MM practitioners exhibit lower trait frontal gamma activity, as well as a state and trait increases in posterior gamma power, irrespective of practice proficiency. Significance First, the DMN can be studied non-invasively by EEG. Second, MM induces from the early stages of practice neuroplasticity in self-referential and attentional networks.

In theory, mindfulness has a role to play in resolving intercultural conflicts. This suggestion rests upon the relatively untested presumption that mindfulness operates similarly across cultures. In a test of this presumption, university students from two countries that are often in conflict at the governmental level, Iran (N=723) and the United States (N=900), responded to the Mindful Attention Awareness Scale (Brown and Ryan Journal of Personality and Social Psychology 84(4):822-848, 2003), along with an array of other psychological measures. This Mindfulness Scale displayed structural complexities in both societies, but a measurement invariant subscale was nevertheless identified. Similar cross-cultural evidence of concurrent validity was obtained in relationships with wide-ranging measures of adjustment. Nonsignificant linkages with Public Self-Consciousness and Self-Monitoring demonstrated discriminant validity in both societies. These data identified mindfulness as a cross-culturally similar psychological process that could plausibly have a role in resolving intercultural conflicts.
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This article presents a conceptual model for the mindfulness-based psychotherapeutic treatment of chronic pain. It describes the process of mindfulness meditation and places it in the context of a practical model for conceptualizing pain. It presents case vignettes on the phenomenology and treatment of chronic pain. Resources for mindfulness are presented.

Although research has found that long-term mindfulness meditation practice promotes executive functioning and the ability to sustain attention, the effects of brief mindfulness meditation training have not been fully explored. We examined whether brief meditation training affects cognition and mood when compared to an active control group. After four sessions of either meditation training or listening to a recorded book, participants with no prior meditation experience were assessed with measures of mood, verbal fluency, visual coding, and working memory. Both interventions were effective at improving mood but only brief meditation training reduced fatigue, anxiety, and increased mindfulness. Moreover, brief mindfulness training significantly improved visuo-spatial processing, working memory, and executive functioning. Our findings suggest that 4 days of meditation training can enhance the ability to sustain attention; benefits that have previously been reported with long-term meditators.

Objective: ADHD is a childhood-onset psychiatric condition that often continues into adulthood. Stimulant medications are the mainstay of treatment; however, additional approaches are frequently desired. In recent years, mindfulness meditation has been proposed to improve attention, reduce stress, and improve mood. This study tests the feasibility of an 8-week mindfulness training program for adults and adolescents with ADHD. Method: Twenty-four adults and eight adolescents with ADHD enrolled in a feasibility study of an 8-week mindfulness training program. Results: The majority of participants completed the training and reported high satisfaction with the training. Pre—post improvements in self-reported ADHD symptoms and test performance on tasks measuring attention and cognitive inhibition were noted. Improvements in anxiety and depressive symptoms were also observed. Conclusion: Mindfulness training is a feasible intervention in a subset of ADHD adults and adolescents and may improve behavioral and neurocognitive impairments. A controlled clinical study is warranted. (J. of Att. Dis. 2008; 11(6) 737-746)

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