Interest in applications of mindfulness-based approaches with adults has grown rapidly in recent times, and there is an expanding research base that suggests these are efficacious approaches to promoting psychological health and well-being. Interest has spread to applications of mindfulness-based approaches with children and adolescents, yet the research is still in its infancy. I aim to provide a preliminary review of the current research base of mindfulness-based approaches with children and adolescents, focusing on MBSR/MBCT models, which place the regular practice of mindfulness meditation at the core of the intervention. Overall, the current research base provides support for the feasibility of mindfulness-based interventions with children and adolescents, however there is no generalized empirical evidence of the efficacy of these interventions. For the field to advance, I suggest that research needs to shift away from feasibility studies towards large, well-designed studies with robust methodologies, and adopt standardized formats for interventions, allowing for replication and comparison studies, to develop a firm research evidence base.
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- Contemplation by Applied Subject,
- Psychiatry and Contemplation,
- Mindfulness-Based Stress Reduction / Cognitive Therapy,
- Parenting & Childcare and Contemplation,
- Psychotherapy and Contemplation,
- Preschool, Child Care, and Contemplation,
- K-12 Education and Contemplation,
- Health Care and Contemplation,
- Education and Contemplation,
- Psychology and Contemplation,
- Science and Contemplation
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<p>This book presents an innovative eight-session program designed to prevent relapse in clients who have recovered from depression.</p>
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<p>Recovered recurrently depressed patients were randomized to treatment as usual (TAU) or TAU plus mindfulness-based cognitive therapy (MBCT). Replicating previous findings, MBCT reduced relapse from 78% to 36% in 55 patients with 3 or more previous episodes; but in 18 patients with only 2 (recent) episodes corresponding figures were 20% and 50%. MBCT was most effective in preventing relapses not preceded by life events. Relapses were more often associated with significant life events in the 2-episode group. This group also reported less childhood adversity and later first depression onset than the 3-or-more-episode group, suggesting that these groups represented distinct populations. MBCT is an effective and efficient way to prevent relapse/recurrence in recovered depressed patients with 3 or more previous episodes.</p>
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The high likelihood of recurrence in depression is linked to a progressive increase in emotional reactivity to stress (stress sensitization). Mindfulness-based therapies teach mindfulness skills designed to decrease emotional reactivity in the face of negative affect-producing stressors. The primary aim of the current study was to assess whether Mindfulness-Based Cognitive Therapy (MBCT) is efficacious in reducing emotional reactivity to social evaluative threat in a clinical sample with recurrent depression. A secondary aim was to assess whether improvement in emotional reactivity mediates improvements in depressive symptoms. Fifty-two individuals with partially remitted depression were randomized into an 8-week MBCT course or a waitlist control condition. All participants underwent the Trier Social Stress Test (TSST) before and after the 8-week trial period. Emotional reactivity to stress was assessed with the Spielberger State Anxiety Inventory at several time points before, during, and after the stressor. MBCT was associated with decreased emotional reactivity to social stress, specifically during the recovery (post-stressor) phase of the TSST. Waitlist controls showed an increase in anticipatory (pre-stressor) anxiety that was absent in the MBCT group. Improvements in emotional reactivity partially mediated improvements in depressive symptoms. Limitations include small sample size, lack of objective or treatment adherence measures, and non-generalizability to more severely depressed populations. Given that emotional reactivity to stress is an important psychopathological process underlying the chronic and recurrent nature of depression, these findings suggest that mindfulness skills are important in adaptive emotion regulation when coping with stress.
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BACKGROUND: Many antidepressant medications (ADM) are associated with disruptions in sleep continuity that can compromise medication adherence and impede successful treatment. The present study investigated whether mindfulness meditation (MM) training could improve self-reported and objectively measured polysomnographic (PSG) sleep profiles in depressed individuals who had achieved at least partial remission with ADM, but still had residual sleep complaints.
METHODS: Twenty-three ADM users with sleep complaints were randomized into an 8-week Mindfulness-Based Cognitive Therapy (MBCT) course or a waitlist control condition. Pre-post measurements included PSG sleep studies and subjectively reported sleep, residual depression symptoms.
RESULTS: Compared to controls, the MBCT participants improved on both PSG and subjective measures of sleep. They showed a pattern of decreased wake time and increased sleep efficiency. Sleep depth, as measured by stage 1 and slow-wave sleep, did not change as a result of mindfulness training.
CONCLUSIONS: MM is associated with increases in both objectively and subjectively measured sleep continuity in ADM users. MM training may serve as more desirable and cost-effective alternative to discontinuation or supplementation with hypnotics, and may contribute to a more sustainable recovery from depression.
<p>BACKGROUND: Many antidepressant medications (ADM) are associated with disruptions in sleep continuity that can compromise medication adherence and impede successful treatment. The present study investigated whether mindfulness meditation (MM) training could improve self-reported and objectively measured polysomnographic (PSG) sleep profiles in depressed individuals who had achieved at least partial remission with ADM, but still had residual sleep complaints. METHODS: Twenty-three ADM users with sleep complaints were randomized into an 8-week Mindfulness-Based Cognitive Therapy (MBCT) course or a waitlist control condition. Pre-post measurements included PSG sleep studies and subjectively reported sleep, residual depression symptoms. RESULTS: Compared to controls, the MBCT participants improved on both PSG and subjective measures of sleep. They showed a pattern of decreased wake time and increased sleep efficiency. Sleep depth, as measured by stage 1 and slow-wave sleep, did not change as a result of mindfulness training. CONCLUSIONS: MM is associated with increases in both objectively and subjectively measured sleep continuity in ADM users. MM training may serve as more desirable and cost-effective alternative to discontinuation or supplementation with hypnotics, and may contribute to a more sustainable recovery from depression.</p>
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Mindfulness-based cognitive therapy (MBCT), a meditation-based maintenance therapy, reduces the relapse risk in individuals suffering from major depressive disorder (MDD). However, only a few studies investigated the psychophysiological mechanisms underlying this protective effect. We examined effects of MBCT on trait rumination and mindfulness, as indicators of global cognitive style, as well as on residual depressive symptoms in a group of recurrently depressed patients (n = 78) in remission. Additionally, alpha asymmetry in resting-state electroencephalogram (EEG) was assessed. Alpha asymmetry has been found to be predictive of affective style and a pattern indicative of stronger relative right-hemispheric anterior cortical activity may represent a trait marker for the vulnerability to develop MDD. In line with previous findings, residual depressive symptoms and trait rumination decreased, whereas trait mindfulness increased following MBCT, while no such changes took place in a wait-list control group. Mean values of alpha asymmetry, on the other hand, remained unaffected by training, and shifted systematically toward a pattern indicative of stronger relative right-hemispheric anterior cortical activity in the whole sample. These findings provide further support for the protective effect of MBCT. In the examined patients who were at an extremely high risk for relapse, however, this effect did not manifest itself on a neurophysiological level in terms of alpha asymmetry, where a shift, putatively indicative of increased vulnerability, was observed.
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<p>Baer's review (2003; this issue) suggests that mindf ulness-based interventions are clinically efficacious, but that better designed studies are now needed to substantiate the field and place it on a firm foundation for future growth. Her review, coupled with other lines of evidence, suggests that interest in incorporating mindfulness into clinical interventions in medicine and psychology is growing. It is thus important that professionals coming to this field understand some of the unique factors associated with the delivery of mindfulness-based interventions and the potential conceptual and practical pitfalls of not recognizing the features of this broadly unfamiliar landscape. This commentary highlights and contextualizes (1) what exactly mindfulness is, (2) where it came from, (3) how it came to be introduced into medicine and health care, (4) issues of cross-cultural sensitivity and understanding in the study of meditative practices stemming from other cultures and in applications of them in novel settings, (5) why it is important for people who are teaching mind-fulness to practice themselves, (6) results from 3 recent studies from the Center for Mindfulness in Medicine, Health Care, and Society not reviewed by Baer but which raise a number of key questions about clinical applicability, study design, and mechanism of action, and (7) current opportunities for professional training and development in mindfulness and its clinical applications.</p>
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<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 & 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>
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- Classical Buddhist Contemplation Practices,
- Buddhist Contemplation by Applied Subject,
- Contemplation by Tradition,
- Four Foundations of Mindfulness (Satipatthana),
- Sutras,
- Psychology and Buddhist Contemplation,
- Science and Buddhist Contemplation,
- Literature of Buddhist Contemplation,
- Practices of Buddhist Contemplation,
- Buddhist Contemplation
<p>"Everyday life is so frantic and full of troubles that we have largely forgotten how to live a joyful existence. We try so hard to be happy that we often end up missing the most important parts of our lives. In Mindfulness, Oxford professor Mark Williams and award-winning journalist Danny Penman reveal the secrets to living a happier and less anxious, stressful, and exhausting life. Based on the techniques of Mindfulness-Based Cognitive Therapy, the unique program developed by Williams and his colleagues, the book offers simple and straightforward forms of mindfulness meditation that can be done by anyone--and it can take just 10 to 20 minutes a day for the full benefits to be revealed"-- "From one of the leading thinkers on Mindfulness-Based Cognitive Therapy, a pioneering set of simple practices to dissolve anxiety, stress, exhaustion, and unhappiness. Everyday life is so frantic and full of troubles that we have largely forgotten how to live a joyful existence. We try so hard to be happy that we often end up missing the most important parts of our lives. In Mindfulness, Oxford professor Mark Williams and award-winning journalist Danny Penman reveal the secrets to living a happier and less anxious, stressful, and exhausting life. Based on the techniques of Mindfulness-Based Cognitive Therapy, the unique program developed by Williams and his colleagues, the book offers simple and straightforward forms of mindfulness meditation that can be done by anyone--and it can take just 10 to 20 minutes a day for the full benefits to be revealed. "--</p>
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Twenty-seven adult survivors of childhood sexual abuse participated in a pilot study comprising an 8-week mindfulness meditation-based stress reduction (MBSR) program and daily home practice of mindfulness skills. Three refresher classes were provided through final follow-up at 24 weeks. Assessments of depressive symptoms, post-traumatic stress disorder (PTSD), anxiety, and mindfulness, were conducted at baseline, 4, 8, and 24 weeks. At 8 weeks, depressive symptoms were reduced by 65%. Statistically significant improvements were observed in all outcomes post-MBSR, with effect sizes above 1.0. Improvements were largely sustained until 24 weeks. Of three PTSD symptom criteria, symptoms of avoidance/numbing were most greatly reduced. Compliance to class attendance and home practice was high, with the intervention proving safe and acceptable to participants. These results warrant further investigation of the MBSR approach in a randomized, controlled trial in this patient population. © 2009 Wiley Periodicals, Inc. J Clin Psychol 66: 1–18, 2010.
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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.
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Mindfulness is defined as paying attention in the present moment. We investigate the hypothesis that mindfulness training may alter or enhance specific aspects of attention. We examined three functionally and neuroanatomically distinct but overlapping attentional subsystems: alerting, orienting, and conflict monitoring. Functioning of each subsystem was indexed by performance on the Attention Network Test (ANT; Fan, McCandliss, Sommer, Raz, & Posner, 2002). Two types of mindfulness training (MT) programs were examined, and behavioral testing was conducted on participants before (Time 1) and after (Time 2) training. One training group consisted of individuals naive to mindfulness techniques who participated in an 8-week mindfulness-based stress reduction (MBSR) course that emphasized the development of concentrative meditation skills. The other training group consisted of individuals experienced in concentrative meditation techniques who participated in a 1-month intensive mindfulness retreat. Performance of these groups was compared with that of control participants who were meditation naive and received no MT. At Time 1, the participants in the retreat group demonstrated improved conflict monitoring performance relative to those in the MBSR and control groups. At Time 2, the participants in the MBSR course demonstrated significantly improved orienting in comparison with the control and retreat participants. In contrast, the participants in the retreat group demonstrated altered performance on the alerting component, with improvements in exogenous stimulus detection in comparison with the control and MBSR participants. The groups did not differ in conflict monitoring performance at Time 2. These results suggest that mindfulness training may improve attention-related behavioral responses by enhancing functioning of specific subcomponents of attention. Whereas participation in the MBSR course improved the ability to endogenously orient attention, retreat participation appeared to allow for the development and emergence of receptive attentional skills, which improved exogenous alerting-related process.
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Studies have suggested that the default mode network is active during mind wandering, which is often experienced intermittently during sustained attention tasks. Conversely, an anticorrelated task-positive network is thought to subserve various forms of attentional processing. Understanding how these two systems work together is central for understanding many forms of optimal and sub-optimal task performance. Here we present a basic model of naturalistic cognitive fluctuations between mind wandering and attentional states derived from the practice of focused attention meditation. This model proposes four intervals in a cognitive cycle: mind wandering, awareness of mind wandering, shifting of attention, and sustained attention. People who train in this style of meditation cultivate their abilities to monitor cognitive processes related to attention and distraction, making them well suited to report on these mental events. Fourteen meditation practitioners performed breath-focused meditation while undergoing fMRI scanning. When participants realized their mind had wandered, they pressed a button and returned their focus to the breath. The four intervals above were then constructed around these button presses. We hypothesized that periods of mind wandering would be associated with default mode activity, whereas cognitive processes engaged during awareness of mind wandering, shifting of attention and sustained attention would engage attentional subnetworks. Analyses revealed activity in brain regions associated with the default mode during mind wandering, and in salience network regions during awareness of mind wandering. Elements of the executive network were active during shifting and sustained attention. Furthermore, activations during these cognitive phases were modulated by lifetime meditation experience. These findings support and extend theories about cognitive correlates of distributed brain networks.
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In light of a growing interest in contemplative practices such as meditation, the emerging field of contemplative science has been challenged to describe and objectively measure how these practices affect health and well-being. While “mindfulness” itself has been proposed as a measurable outcome of contemplative practices, this concept encompasses multiple components, some of which, as we review here, may be better characterized as equanimity. Equanimity can be defined as an even-minded mental state or dispositional tendency toward all experiences or objects, regardless of their origin or their affective valence (pleasant, unpleasant, or neutral). In this article, we propose that equanimity be used as an outcome measure in contemplative research. We first define and discuss the inter-relationship between mindfulness and equanimity from the perspectives of both classical Buddhism and modern psychology and present existing meditation techniques for cultivating equanimity. We then review psychological, physiological, and neuroimaging methods that have been used to assess equanimity either directly or indirectly. In conclusion, we propose that equanimity captures potentially the most important psychological element in the improvement of well-being, and therefore should be a focus in future research studies.
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A review of behavioral and neurobiological data on mood and mood regulation as they pertain to an understanding of mood disorders is presented. Four approaches are considered: 1) behavioral and cognitive; 2) neurobiological; 3) computational; and 4) developmental. Within each of these four sections, we summarize the current status of the field and present our vision for the future, including particular challenges and opportunities. We conclude with a series of specific recommendations for National Institute of Mental Health priorities. Recommendations are presented for the behavioral domain, the neural domain, the domain of behavioral-neural interaction, for training, and for dissemination. It is in the domain of behavioral-neural interaction, in particular, that new research is required that brings together traditions that have developed relatively independently. Training interdisciplinary clinical scientists who meaningfully draw upon both behavioral and neuroscientific literatures and methods is critically required for the realization of these goals.
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Meditation refers to a family of complex emotional and attentional regulatory practices, which can be classified into two main styles – focused attention (FA) and open monitoring (OM) – involving different attentional, cognitive monitoring and awareness processes. In a functional magnetic resonance study we originally characterized and contrasted FA and OM meditation forms within the same experiment, by an integrated FA–OM design. Theravada Buddhist monks, expert in both FA and OM meditation forms, and lay novices with 10 days of meditation practice, participated in the experiment. Our evidence suggests that expert meditators control cognitive engagement in conscious processing of sensory-related, thought and emotion contents, by massive self-regulation of fronto-parietal and insular areas in the left hemisphere, in a meditation state-dependent fashion. We also found that anterior cingulate and dorsolateral prefrontal cortices play antagonist roles in the executive control of the attention setting in meditation tasks. Our findings resolve the controversy between the hypothesis that meditative states are associated to transient hypofrontality or deactivation of executive brain areas, and evidence about the activation of executive brain areas in meditation. Finally, our study suggests that a functional reorganization of brain activity patterns for focused attention and cognitive monitoring takes place with mental practice, and that meditation-related neuroplasticity is crucially associated to a functional reorganization of activity patterns in prefrontal cortex and in the insula.
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The scientific interest in meditation and mindfulness practice has recently seen an unprecedented surge. After an initial phase of presenting beneficial effects of mindfulness practice in various domains, research is now seeking to unravel the underlying psychological and neurophysiological mechanisms. Advances in understanding these processes are required for improving and fine-tuning mindfulness-based interventions that target specific conditions such as eating disorders or attention deficit hyperactivity disorders. This review presents a theoretical framework that emphasizes the central role of attentional control mechanisms in the development of mindfulness skills. It discusses the phenomenological level of experience during meditation, the different attentional functions that are involved, and relates these to the brain networks that subserve these functions. On the basis of currently available empirical evidence specific processes as to how attention exerts its positive influence are considered and it is concluded that meditation practice appears to positively impact attentional functions by improving resource allocation processes. As a result, attentional resources are allocated more fully during early processing phases which subsequently enhance further processing. Neural changes resulting from a pure form of mindfulness practice that is central to most mindfulness programs are considered from the perspective that they constitute a useful reference point for future research. Furthermore, possible interrelations between the improvement of attentional control and emotion regulation skills are discussed.
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OBJECTIVE: Positron emission tomography was used to investigate the neural substrates of normal human emotional and their dependence on the types of emotional stimulus.
METHOD: Twelve healthy female subjects underwent 12 measurements of regional brain activity following the intravenous bolus administration of [15O]H2O as they alternated between emotion-generating and control film and recall tasks. Automated image analysis techniques were used to characterize and compare the increases in regional brain activity associated with the emotional response to complex visual (film) and cognitive (recall) stimuli.
RESULTS: Film- and recall-generated emotion were each associated with significantly increased activity in the vicinity of the medial prefrontal cortex and thalamus, suggesting that these regions participate in aspects of emotion that do not depend on the nature of the emotional stimulus. Film-generated emotion was associated with significantly greater increases in activity bilaterally in the occipitotemporparietal cortex, lateral cerebellum, hypothalamus, and a region that includes the anterior temporal cortex, amygdala, and hippocampal formation, suggesting that these regions participate in the emotional response to certain exteroceptive sensory stimuli. Recall-generated sadness was associated with significantly greater increases in activity in the vicinity of the anterior insular cortex, suggesting that this region participates in the emotional response to potentially distressing cognitive or interoceptive sensory stimuli.
CONCLUSIONS: While this study should be considered preliminary, it identified brain regions that participate in externally and internally generated human emotion.
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Davidson and Schwartz (1) have proposed a psychobiological analysis of anxiety that emphasizes the patterning of multiple processes in the generation and self-regulation of this state. The present article specifically reviews recent research on cognitive and somatic components of anxiety. A dual component scale which separately assesses cognitive and somatic trait anxiety is described and applied to the study of the differential effects of a somatic (physical exercise) and a cognitive (meditation) relaxation procedure. A total of 77 subjects was employed; 44 regularly practiced physical exercise and 33 regularly practiced meditation for comparable periods of time. As predicted, subjects practicing physical exercise reported relatively less somatic and more cognitive anxiety than meditators. These data suggest that specific subcomponents of anxiety may be differentially associated with relaxation techniques engaging primarily cognitive versus somatic subsystems. It is proposed that relaxation consists of (1) a generalized reduction to multiple physiological systems (termed the relaxation response by Benson) and (2) a more specific pattern of changes superimposed upon this general reduction, which is elicited by the particular techniques employed. The data from this retrospective study need to be followed up by prospective studies to establish the precise mechanisms for these effects.
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